ER s13e16 Episode Script
Crisis of Conscience
Previously on E.
R.
Our goal is to enroll 200 donor-recipient pairs.
By mixing and matching, we'd find kidneys for almost 50% of them.
Ask me again.
Ask me to marry you.
I don't know what happened If it is what I think, it scares the hell out of me.
She's yours,Tony.
Is it possible? Crisis of conscience Oh,crap! What time is it? I don't want to stay over.
-It's okay.
-No,it's not okay.
We agreed that it was too soon for Sarah to deal with this.
Sleep in for another hour.
She won't even know you're here.
Well,when are you going to tell her? Tell her what? Come on.
I don't even know if it's true.
Well,you will be if you do the test.
What am I supposed to do? "Hey,can I have some of your DNA? I want to find out if I'm your father"? What if I'm not?I don't want to mess with the kid's head.
-Why,are you afraid to find out? -No.
Maybe.
I don't know.
Maybe the actual biology doesn't matter anyway,huh? Of course it does.
You want something to eat before you go? No,I'm fine.
-Some juice? -We don't have any.
I'm sorry.
Did we wake you? No,I couldn't sleep.
I'm just leaving.
You don't have to sneak out.
She's not sneaking out.
She's going to work.
And I'm late.
-I'll page you later? -Okay.
I made coffee.
Since when do you drink coffee? Since we ran out of juice.
Oh.
Give me some.
Sorry,I meant to go to the store.
I just You know,if you want me to, I can do all the cooking and the shopping and cleaning.
If you did that, when would you do your homework and talk to boys on the phone and text? It's called multitasking.
Since it is plainly ludicrous to page a surgeon at 6:15 in the morning for something as silly as Tylenol, the only conceivable explanation I have for your call is that you have a crush on me.
I'm flattered.
Thank you.
Good-bye.
Who was that? This new ICU nurse.
She's useless.
Someone needs to show her the ropes.
Did you say "ropes"? Jane,come on.
I have to round soon.
FYI? This is my last night in the call room.
The prosthetics lab could be fun.
No,we're through with hospital kink.
We're staying at your place next time.
Whoa,whoa,whoa.
No,we can't.
I I know,I know,you have no bed,you sleep on the couch,your sink is clogged, this pathetic "I work all the time, so my place is a rat hole" thing is not going to fly anymore.
What? Yeah,you're going to clean up your apartment and buy a proper bed today.
Jane,just because you want to stay at my place Hey,it's been three months,okay? Upgrade the sleeping arrangements -or you will be punished.
-Ooh.
-Do you understand? -Yeah.
It's tradition, a symbol.
Yeah,a symbol of the wedding industrial complex.
No,I'll wear a ring.
I want to wear a ring, you just have to abide by my ring policy.
Your ring policy? Yeah,if one of us loses our wedding ring, we replace the ring immediately and give the new ring full status.
You're going to lose it? Well,I don't know,if something happens to the ring, and everybody freaks out like the marriage is doomed.
But a simple gold band would be very nice.
Now we're getting somewhere.
So do you think we should make an announcement or just tell people individually and let it trickle out? Uh,is it all right if we wait a while? Really? Why? When-when you tell people you're getting married, they start asking a million questions about a wedding, and marriage is not about wedding.
Like it's not about ring.
Let's just enjoy this for a while, the two of us,okay? That's fine.
A secret engagement will be fun.
All right,Jane, you take the boob rash and,Ray,you get the bounty hunter with the gout.
Dr.
Kovac returns.
Nice seeing you again,man.
-You,too.
-Welcome back.
It was weird here without you.
What's that? A rat died in the air vent.
There's a cleaning crew up there.
Hey,did you really squash your own hand in a vise? I mean,'cause, wow,that's Need a doc here.
Jane,why don't we take this? seizures.
You,take the bus.
Something bad's going to happen on the El today.
I upped my meds,but-but-but the seizures won't stop.
Well,you're not seizing now.
No,yes,yes,I am.
I-I two milligrams of Ativan should take care of it.
Sir,you're sitting up and you're talking to me.
-You're not having a seizure.
-Can we not stop here? We're about to transfer you.
Yeah,but can you just move me back at all here? Just be patient.
-Move me now,please?! -All right,all right.
ER Season 13 Episode 16 Lily's sick, Marquez is out on vacation, and the rest of us are doing doubles trying to cover all their shifts.
This is why nurses quit and burn out.
Shortage just keeps getting worse.
What about your boy ***? Uh,he was lured to a hospital in Minneapolis.
New cars for nurses willing to stay six months.
Cool with that? What,I got left for a Camry? Nah,it's a good gig.
I can't blame him.
Anna Hayes,39,vomiting and altered mental status.
Tachy to 120, sats 92 on room air.
This your mom? Yeah.
I could barely wake her up this morning.
Ms.
Hayes, I'm Dr.
Gates.
Can you open your eyes for me,please? Please,just take me home.
No,you need oxygen and fluids.
Wait,is she going to be all right? Honey,I'm fine.
Ma'am,you're not fine, you're severely dehydrated, but we're going to help you with that.
Access? blew.
Sam? Trauma One's open.
I'll be right in.
Hey,Jeff,what's up? I think we have something that belongs to you.
Alex,what happened? Okay,Mr.
Brewer, let's get you hooked up.
Yeah,okay.
You're not going to need that.
You're not going to need that? No? No,these are temporal lobe seizures,okay? I never have any cardiac or respiratory symptoms.
Okay,well,we'll just hook you up to be safe.
If you haven't noticed, my-my,uh,seizures are unusual.
I get hunches,premonitions, that sort of thing.
Nothing ever shows up on the heart monitor.
-I see.
-Yeah.
Oh,here comes another one.
I'm sensing bacon and eggs.
There you go,okay? So can you just give me the Ativan and I'll be out of your hair? I'm sorry,but I just think anybody could have made that prediction,Mr.
Brewer.
Look,I know that,uh,it looks like I'm making this stuff up just so I can get drugs but that's not what's going on,okay? Can you call my neurologist? He'll back me up.
Did you get what you want,Alex? Huh? A couple bags of quarters? You know what? You can be in jail right now.
It's not anything like they're saying,okay? Officer Greenberg is going to take you home.
I'm going to call you every half hour.
You don't answer that phone, we got a problem.
-Mom,it's not my fault.
-Of course,it's not,it never is.
Mom,please, just listen to me.
I have to go back to work.
I'll talk to you tonight.
-Thank you very much,Jeff.
-Yeah.
Hey.
What's up with Alex? He knocked off a Laundromat near his school.
Ah I'll get better faster at home,really.
Mom,you're sick,okay? We're not leaving.
-She hates hospitals.
-Oh,but this is County.
This is nice here.
You get organic food and room massage.
We have ice sculptures.
You're going to love it here.
All right,she needs coags.
She's oozing around the needle.
Pulse up to 125.
You know,when you were four years old, our neighbor fell off that ladder and they brought him here.
Mr.
Madsen? Oh,he was such a grouch.
He was always yelling at you and your brother for playing too loud.
But when you found out he was sick, you wanted to visit him.
Systolic's only 84.
She needs access,Gates.
I'm trying,Sam.
She's clamping down.
One more try and I'll go central.
You stood up on your chair and you stuck your favorite toy turtle in bed with him,and you said anybody who was sick, needed a toy turtle.
She's making this up.
No,no,I made a lot of mistakes,son, but you were the one thing I got right.
All right,I'm in,Sam.
Let's get the fluids up.
You okay? Yeah.
Morning,Neela.
Ready to round? Uh,sorry.
Shoot, I need five more minutes.
I overslept.
I never oversleep.
Is that a yoga mat? Yeah,there's an Ashtanga class in the anesthesia conference room.
You should check it out.
Nurses station,five minutes.
I'll see you there.
Uh,hello,good morning.
I'm Dr.
Manish? Hi.
Uh,this is the doctor I was telling you about.
I'm Emily.
I've heard a lot about you.
What are you doing here? -Uh,well,I was -Saving my life.
I was giving a talk about the paired exchange program at a dialysis center in Evanston He was really impressive.
He gave us all hope.
And there were all these people there,and they were just waiting and suffering and it inspired me.
To donate your kidney? You ran screaming from a blood drive.
Well,I was moved by their stories.
We've worked together every day for the past month.
How come you never said anything? 'Cause I thought that I'd chicken out.
I've been on dialysis for six years, on the UNOS list for five.
I'd just about given up when,boom, Manish walks into my life.
Got tested,turns out I'm a good match.
Wow.
Amazing,right? It's like right out of a movie or something.
What's your differential? Infectious hepatitis is at the top of my list.
Sent viral titers.
Good.
What else? Hepato-renal syndrome, vascular disorder, autoimmune, alcoholic hepatitis.
But my mom doesn't drink.
Oh,we're just running through the possibilities.
Here,Luka,Jane's tibia fractures got compartment syndrome-- ortho's MIA.
What about toxic ingestions? Acetaminophen,poison mushrooms? Tox screen's negative, acetaminophen's zero.
Okay,get a CT and notify nephrology and GI.
Sam,come with me.
Is there,uh,is there anyone else you want to be here? My other son's at work.
Don't bother him.
Oh,I think he should be here.
Is it close? He's a repair guy over at Begley's Appliances.
My mom works there,too.
It's just the stomach flu.
Don't bother Nick.
It's a little more serious.
Why don't you go out to the front desk.
The clerk will help you call your brother.
It's all right,honey.
Go.
It's out there to the left.
Thanks.
You're scaring him.
You're in acute liver failure,ma'am.
This-this is a little scary.
Did you hear what I said? This is serious.
You could die.
I heard you.
Do you have any questions? No.
Manish nearly fainted the other day when I was drawing blood.
Now he's giving his kidney to someone he barely just met.
Isn't that a little strange? No,everyone goes through some kind of a mini-life crisis in their 20s.
He's far from family,he's unattached, he's unsure about career, he's drifting, he's looking for purpose.
Some people donate kidneys, others end up working at the Jumbo Mart.
Who are we to judge? Neela,what are you doing? I came down to see the volvulus case.
But you're supposed to be covering the post-op floor.
You done with all those dressing changes? Well,not all of them,no.
Okay,I'm going to leave you kids to work this out.
I'll be in Curtain Three.
-You,upstairs,shoo.
-Well What is this? A consult note.
-I said black ink today.
Only black.
-Oh -What color is this? -Eh,blue.
Oops.
Hey,Mayday.
How's it going? Well,my attending thinks I'm a complete idiot, and Crenshaw's back to being a little bitch.
Hey,most hepatic toxins take a few days to destroy the liver,right? Yeah.
So,theoretically, you could trash your liver, but by the time you become symptomatic, the toxin couldn't be detected in the blood.
I suppose.
Hmm.
I'll page you later.
Ms.
Hayes? Anna.
Anna What's a young,healthy woman with no medical history doing with fulminant liver failure? Aren't you the doctor? You got a family, 40 good years ahead of you.
Yet when I told you,you might die,you hardly reacted.
Yeah.
I guess we all have our own way of dealing with bad news.
Huh.
You know,I used to be a paramedic for ten years before I became a doctor.
Young healthy patients,no matter how religious,mellow,Zen they were they don't want to die.
Something kicks in-- instinct.
Maybe I've just been too tired to cry.
You seem depressed.
Let's say someone wanted to kill themselves without anyone knowing it was suicide.
You know,there's a whole class of chemicals that can damage the liver just days after they're ingested.
Please.
I just want to go to sleep now.
Fuels and solvents found in refrigerators, dryers,cleaning products.
Stuff you'd have access to every day at your job.
Come on,Anna,tell me what you took so I can help you.
Your sons deserve to have you around.
-They're all grown up now.
-I know I'm right about this.
Propane? Kerosene?Carbon tetrachloride? What? Tell me.
I hear if you mix it with juice, it's got quite a kick.
Everything okay? Anna?!Anna?!! Everything's back to normal with you and Luka? Uh,I don't know if I'd say normal, but they're good.
-How's things with you and Katey? -Uh,she's great.
Really great.
But? But nothing.
She's awesome.
Our friend's hurt.
Help! Don't move so fast.
Come on,you're tough.
Please don't make me walk.
You can do it.
Come on,guys, give her a break.
-I got her.
-Get a gurney over here please.
-Are you a doctor? -We both are.
Okay,what happened? They were doing a formation called layer cake.
Most schools do three layers and we do five.
Tasha fell all the way from the top.
Wow,four layer fall,huh? I need this kiddo back in action for the Great Lakes Regionals.
Okay,Tasha,let's go.
Clear.
Still V tach.
No pulse.
-Gates,I got poison control on the line.
-All right,put them on speakerphone.
-Wh What's this about? -Okay,she's on.
Possible carbon tetrachloride overdose.
Fulminant liver and kidney failure.
Why the hell didn't you say anything about this before? It was just a hunch.
When did the exposure occur? Unclear.
Transaminases in 2,000 range.
It's too late.
Nothing to offer other than supportive measures.
Nothing to offer? No.
If it's carbon tet,the damage to the liver has already been done.
I'm afraid that's right.
Cell death is irreversible at this point.
All right,thanks.
Epi's in,fourth dose.
Another hundred of lido and recheck the K.
Wh why were you withholding patient history? I wasn't sure.
She didn't fully admit it.
Charging to 360.
Where'd her son go? He's out at the front desk trying to bet ahold of his brother.
Well,he better find him fast.
All right,clear.
I don't think I could do something like this for a stranger.
So,maybe it bothers me that you can.
Look,Emily's parents are too old to be donors.
She's getting sicker every day.
You would have done the same thing.
I don't think so.
You're a better person.
I'm not a better person,Neela.
I'd be too worried about time lost from work,complications.
I don't mean to be negative, but you have to at least consider the possibility of bleeding,infection I've considered it.
We've all considered it.
-It's covered.
-Covered? Manish Look,it wasn't my intent, it wasn't why I agreed, but they offered, they insisted actually.
-Manish,no.
-Just listen,okay? First I refused.
But then I started thinking what $50,000 could do for my family.
Stop.
I don't want to hear any more.
Look,when I was 14,my parents sent me here to live with a distant cousin.
I went to school, I learned English,I played baseball, while my sisters sewed shirts for two dollars a day in Mumbai.
-I understand you feel guilty.
-Yeah,well,with $50,000, I could hire an immigration lawyer.
I can get my whole family over here.
My parents could get proper health care.
My sisters could get a proper education.
Emily's family is wealthy.
It's no hardship for them.
So why not? Because people don't sell their body parts in this country,period.
Not to mention the fact that you could put our whole transplant program in jeopardy.
-Nobody needs to know.
-But I know,Manish.
I don't understand why you told me, but if you were looking to clear your conscience, I can't help you there.
Of all people,I would think that you would understand.
Well,I don't understand.
I don't.
And I kind of resent the assumption that I should.
You can't do this, Manish,I'm sorry.
No deformities, no step-offs.
We have this one cheer, it's so cool.
It's called paper dolls.
Yeah,it's our signature formation.
It's like a college level routine.
Pulse is in the 120s, and the hemacue is dropping.
That would be because she's bleeding into her belly.
I have fluid here.
We've got the All-Cheer Regionals coming up next week.
I've been driving them too hard.
The outer flyers have their outside hand in the half "Y," and the other hand grabs hold of the middle flyer.
That's me.
-And the ending is really cute.
-Sounds great.
Liter of warm salinewide open, and call for O-neg.
Make sure surgery knows to get down here.
Oh,my God,surgery? If we don't have a middle flyer for the competition, -we are so screwed.
-Watch it,girls.
Why don't we worry less about the competition and more about your friend,okay? I'll get the infuser.
-Do you guys have any warm saline? -There's LR in the oven.
K is 7.
2.
Amp of D-50 and ten units of insulin.
Her nose is bleeding.
Her coags are through the roof.
Oh,my God,she wasn't like this when I left.
Her condition changed quickly.
Without a functioning liver, toxins start to accumulate in the blood.
She's in an abnormal heart rhythm.
She isn't getting enough blood to her brain and body.
We're doing CPR, and giving her medications, but she's just not responding.
But can't you just do something to fix her liver? Once the cells have died, there's little we can do,Evan.
So is this it, or what? We're breathing and compressing her heart for her, but your mother's body is shutting down.
Anything you guys want to say? No,Mom,okay? This isn't happening.
This can't be happening.
Please don't go.
-One more round for the kids? -Don't let her die.
Sam.
All right,clear.
Whoa,wait a minute.
She's got a pulse.
Sinus rhythm.
I don't understand, is she dying or not? Her heart is beating, but her brain was deprived of oxygen for a long time.
It's very likely that she suffered serious brain injury.
Wow.
She can't even die right.
Pressure's stabilized after two liters, but her crit's still dropping, and did I mention I hate cheerleaders? I hate clowns.
-I heard Gates was afraid of folksingers.
-Really? Two plus guarding with rebound on the left.
Could be a splenic rupture.
Neela,you writing this down? Yes,Dr.
Crenshaw, I am.
-How do you stand this? -I don't know.
I'm like a battered child.
I just keep coming back for more.
All right,let's bring her up to whatever OR is open.
Dr.
Dubenko will meet you there.
Okay,girls,Tasha's going to surgery now.
Everyone say good-bye and wish her luck.
I'm really sorry you need surgery and everything,Tash.
But you should know that we'll have to replace you for All-Cheer.
Where's my mom? Hey,she sacrificed her spleen for you guys.
Show some respect.
It's going to be okay.
I'll explain everything as we go.
-Am I going to have a big scar? -Not if we can help it.
-Let me tell you something about Mom -Don't talk like that,okay? She's not going to die.
This is the best idea she's had in a long time.
You don't mean that.
This is your mother we're talking about.
You don't know the first thing about my mother.
I know that she's barely alive, and I know you guys should be in there instead of out here fighting in the hall.
-Sorry,I just don't care.
-Why do you hate her so much? Ever since Dad died,all she does is try to make us happy.
Happy,right.
By gambling on the Internet all day? -It helps her relax.
-Shut up! She started out with a few dollars on poker.
And by the end of the year, she'd lost everything.
The crummy cars,the savings from our dad.
She has a problem.
When they stopped giving her credit, she took out more cards in our name and racked up more debt.
$80,000,Evan.
We got to live with that now.
-She was trying to get help.
-Stop making excuses for her! The house is in foreclosure, Evan.
Next week,you're going to be homeless.
All right,she may be screwed up, but she's your mother.
That's not good enough.
It's not.
-Can I get your advice on something? -Yeah,of course.
Well,let's say I knew a really nice person about to do a pretty bad thing.
But this bad thing had really good consequences for a bunch of people.
-You don't need my advice.
-Yes,I do.
No,no,'cause you have like this ethical alarm system hardwired into your brain.
Makes you a self-righteous pain in the ass, but it's one of the best things about you.
But if I tell what I know, it's going to mess things up for a whole bunch of people.
They'll get over it.
It will be a major betrayal.
Uh,do the right thing,Neela.
That's all I'm saying.
Is this where I'm having my operation? Yep.
The ORs are straight ahead.
I'm scared.
I know.
But we're going to take good care of you.
My stomach Hey,we'll get you more pain medication when we get to pre-op.
No.
That's not it.
Is it your mom? We won't start until she gets here.
I didn't fall from the top of the formation.
You didn't? The other girlsthey did this.
They didi this to me.
New cheerleaders are forced to submit to ten minutes in an equipment closet in their gym.
The newbie just takes it while her teammates do whatever they want.
Tasha got kicked in the stomach till she started coughing up blood.
I trust the authorities have been notified.
-Ray's on it.
-Good.
Lucien,there's something else I need to talk to you about.
Sure.
Go ahead.
-Can it wait? -Not really.
Well,it's going to have to.
Our cases are completely backed up.
Let's go.
Oh,Dr.
Kovac, you really must see this.
This is,uh Fred and Brenda.
Neurovascular symptoms after a Handfasting Ceremony.
-A what? -It's a Wiccan wedding.
The guests bound our wrists with cords.
It's where the expression "tie the knot" comes from.
These are really strong.
Braided to be tough, like our marriage bond.
Regular scissors didn't work, and the knots were too tight to undo.
-I can't feel my fingers.
-And I can't move my thumb.
Is a Wiccan ceremony recognized by the state? No.
We have to get married at the courthouse so I can put Fred on my insurance.
They don't recognize us because we don't believe in mating for life.
Oh,you don't? We are betrothed for one year and one day.
To be reevaluated at the end of that period.
Yeah,well,it does seem like "till death" is kind of extreme.
Yeah.
Just Judeo-Christian bullcrap.
I don't think so.
We're getting married,and all those things are on our minds.
Sorry.
Just slipped out.
Uh okay.
That's all right.
Um,all right,um I'll be right back,okay? What,the first people we tell are strangers? Wiccans? I just felt like saying it.
Hey,Abby,have you seen the cheerleading coach? She's outside practicing with the girls.
Oops.
When tissues are deprived of oxygen for a long time, they produce acids,so we're giving her medicine for that.
How long can she live like this? Weeks.
Months.
It's hard to tell.
But it's just a matter of time,right? I mean,if you want to help us,don't prolong this.
She's not suffering.
Evan and I are going to have to be responsible for her.
We're the only close family she has.
We're alone.
It's too much.
I understand.
Social worker will call you.
We have programs.
There's a support group.
Please.
We've been through enoug She's been having runs of V tach.
Forget the lido drip.
What,you want amiodarone? No.
Why prolong the inevitable? That's not your call to make.
Oh,come on,Sam,we both know how this ends.
Why put her boys through it? She's a full code.
We don't know the extent of her injuries.
We gave her CPR for 40 minutes.
Her brain is fried.
Another run of ten.
Sam,your little raver is having a dystonic reaction to Haldol.
It's cool.
Go.
The lido is hanging and the infuser is set.
If she has another run, start the drip,okay? Page Dr.
Kovac and tell him his patient in Trauma One is coding.
Thanks.
You heard what happened last year.
My girls are not staying in the same motel as the football team.
I need to talk to you about Tasha.
-How's she doing? -Get off the phone.
I'll call you back.
Tasha's injuries were not caused by a fall.
What do you mean? I saw her hit the ground.
She was forced into a closet, and then she was beaten by the other girls.
What? My girls would never Come on! Don't do this! She knows you know.
It's not what you think.
Tasha's sensitive.
Never really fit in with the others.
What she's referring to is just a little team-building exercise we do.
They ripped open her spleen.
That's not little.
And I definitely wouldn't consider that team-building.
My girls are regional champions.
They're under a lot of pressure.
Why don't you save the excuses for these guys,all right? Mom,I don't care what happened.
I don't care about the money.
Just please don't go.
-Another mig of epi.
-Charged to 360.
Clear.
Resume compressions.
What were you thinking? Why didn't you talk to me? Lido isn't going to change the outcome.
I thought you'd agree.
Yeah,well, we work together here,Gates.
Clear! I'll be right back.
Gates,you can't leave in the middle of a code.
The kid should be in here.
Gates! Hey! What do you want? Look,I know you're angry, and I know you got screwed.
You don't know anything.
I know your dad died, and your mom messed up.
It ain't fair.
No,it isn't.
But your mom is dying.
And I know you care.
Because,if you didn't,you wouldn't be out here sulking in the hall.
You go in there and you forgive your mother right now.
I can't.
Nick,you have one shot at being with your mother while she's dying.
Hold compressions.
That's enough.
Save a cheerleader, save the world.
Lucien,I still need to talk to you about that thing.
Well,make it quick.
Manish is on the table, everyone's waiting.
Well,that's what it's about.
Emily paid Manish for his kidney.
-That's ridiculous.
He knows better.
-Well,it's true.
He told me.
He was screened by psych.
They would have picked this up.
-Well,they didn't.
-Come on.
It's wrong,and could jeopardize the whole transplant program.
All right.
All right,Neela.
All right,well,look.
Just as an exercise, consider this.
There are over 65,000 people on the UNOS list waiting for kidneys.
Can we really rely on voluntary altruism to solve this problem? -What are you saying? -What am I saying? Well,when somebody donates a kidney, the recipient obviously benefits,right? Hospitals make money.
The surgeons get paid.
The donor who gives up a kidney gets flowers and a handshake.
Am I right? Are you kidding? So many sick people, so few organs.
Why not let market forces sort out the imbalance? Because people aren't commodities.
We don't live in a world where it's all right for rich people to buy body parts from those less fortunate.
Hey,it's legal to rent out your uterus, or to harvest your eggs for money.
You can get paid to donate sperm.
How is this different? All I know is thata dying girl is going to get a new kidney today.
Then what happens to the 65,000 others who can't afford to buy one? Ancef will be ready to run soon.
Quick question.
Why are you doing this? Excuse me? Why are you giving this girl your kidney? I guess I've been inspired by the work that we do here.
Mm-hmm.
And you would never dream of jeopardizing everything by doing something stupid and illegal,would you? What are you talking about? You know exactly what he's talking about.
Okay,Emily wanted to give me money, but I turned her down after talking to Neela.
Money was never part of the reason why I wanted to do any of this.
Lucien,he's just saying what he knows you need to hear.
She's obviously made up her mind about me.
I don't know what else to say.
All right.
That's enough.
Neela,let's go scrub.
No.
I won't be a part of this.
Fine.
Shirley,have Crenshaw get me a surgeon who actually wants to operate.
You get out of here Nella,now.
The tornado was hard to see against the background, so I painted it black.
I was going to put some lights in the bottom, but I ran out of time.
Wow,that should look really,really cool.
Sam.
Yeah,and I fell down the stairs at school and it broke.
That's not the only thing you broke.
I know-- I broke my tibia and my fibula.
Can you fix it fast? -I can fix you up in about an hour.
-An hour?! I'll never have time to finish my tornado before the end of the science fair.
Hey,did you know that casts give off heat when they're hardening? -No.
-Mm-hmm.
It's called an exothermic reaction.
It could make a pretty cool science project.
Can you help me make it?! Uh,sure.
I'll get the stuff.
-Sam,can you dispose of the rest of that Ativan,please? -Sure.
-Hi.
-Hi.
-So,I talked to your neurologist, -Uh-huh.
and I got quite an eful about temporal lobe epilepsy.
Yeah.
Interesting stuff.
-Well,I told you I was the real deal.
-Mmmm.
Well,do you have any last words of psychic wisdom before I medicate you and sever your ties to the paranormal? Oh,sure.
Um,well,I see great things for you in the year to come, although you will struggle to balance home and career.
-That's it? -Yeah.
That's the most generic fortune I've ever heard.
And you should really invite your dad to the wedding.
I'm just saying.
-Gates.
-Hm? -Can you explain this,please? -Explain what? Why did you write "idiopathic liver failure" on her death certificate worksheet? It should be "carbon tetrachloride ingestion.
" Well,she never admitted it straight-out.
We don't know what really happened.
You can't withhold information whenever it suits you.
What she told you needs to be part of the medical record.
If we document suicidality, then life insurance won't pay.
We say it was a natural death-- what's the harm? The harm is that it's unethical, and it's insurance fraud.
Oh,come on,insurance companies screw people over any chance they get.
And why should those kids be punished for the rest of their life because of something their mother did? Gates,I'm worried about you.
Don't worry abou4 me.
I'm all right.
No,I'm worried about your ability to do this job.
And it's too bad because you're good, but you-you you lie and you think nothing of it.
It's not lying if we don't know for sure.
Now,come on,let their mother do this one last thing for them.
I'm not going to let you lie for them,Gates.
-Hey,Gates,can you sign this discharge? -Later.
Jane,you seen Neela? Uh,Dubenko sent her home early.
Oh.
I just had to wheel an appy up from the ER, in case you're wondering.
-Wondering what? -Why I'm here.
Good night,Jane.
King-sized,wrought iron frame.
The rest is up to you.
Hey,you guys, have you seen Tony around? -Not in a while.
-Okay,have a good night.
-Do you think I chased away my father too fast? -No.
Maybe I should've at least listened to what he had to say.
-Why? You can call him.
-I tried.
He checked out of his hotel--the number he gave me in Texas is disconnected.
Um,Abby,uhSorry,I just need a minute to check something,okay? Hey,Malik,do we still have the chart on Anna Hayes? You think I memorize the name of every patient who comes through here? The woman that died of liver failure.
I forgot to do some paperwork for the death certificate.
-Here you go.
-Thanks.
Hey,first day back.
How'd it go? Just like riding a bike.
Luka,I told Miranda we'd be home by Coming.
CAUSE OF liver failure of unknown et iology -Good night.
-See ya.
-Hey.
-Hey.
How'd it go with your little secret? Oh,terrible,actually.
Worse than expected.
But our cheerleader did well,though.
The police are interviewing the whole squad as well as the coach,so -Oh,good.
-Getting off soon? -Uh,yeah,thank God.
-Yeah,me,too.
Want to grab a beer? Sounds good,but,um I've got some dictations to do.
Okay.
Another time.
-Dr.
Gates.
-You're still here.
Yeah.
Our uncle drove in from Ann Arbor.
He wanted to see her.
I'm sorry for your loss.
You know,I never got to thank you for everything you did.
It's my job.
You really helped us.
Yeah.
Good night,Nick.
You know,she knew it was the only way out.
Had to look natural so we could get the insurance money.
I found some old solvent at the store.
You helped her? I left out a bottle.
At least she finally got something right.
Good night,Doc.
Leave me alone.
No,you can't break and steal things,Alex--you know that.
You do that,you're going to end up on the wrong track Mom,you're not in my head,okay? You-you don't know what happened! Alex,come on.
Alex! Open this door! You hear me? Right now! -Open the door! -Go away! I can't go away-- I'm your mom! Come on,Alex, don't do this to me.
Hey,do you remember that time that,uh, we made that science project for your school,that volcano? And I couldn't get the mix of,uh, of baking soda and vinegar right? And it erupted all over the living room.
What were you,what, five or six? I know I didn't give you the most stable childhood,okay? I know you've seen a lot of crazy stuff, that is mostly my fault.
But the only thing I ever wanted was for you to be happy,Alex.
Okay? And I don't know how to give that to you.
So,please tell me what to do.
I know you're listening in there,Alex,okay? I love you.
You know that,right? Hi.
-Hi.
-You look tired.
-Want a beer? -Yeah,thanks.
I made chili,salad and corn bread from scratch.
I know what your next question is.
My homework's already done.
All right.
No more fast food around here.
Wow,Sarah, this looks great.
Yeah.
Leaving so soon? Guess not.
R.
Our goal is to enroll 200 donor-recipient pairs.
By mixing and matching, we'd find kidneys for almost 50% of them.
Ask me again.
Ask me to marry you.
I don't know what happened If it is what I think, it scares the hell out of me.
She's yours,Tony.
Is it possible? Crisis of conscience Oh,crap! What time is it? I don't want to stay over.
-It's okay.
-No,it's not okay.
We agreed that it was too soon for Sarah to deal with this.
Sleep in for another hour.
She won't even know you're here.
Well,when are you going to tell her? Tell her what? Come on.
I don't even know if it's true.
Well,you will be if you do the test.
What am I supposed to do? "Hey,can I have some of your DNA? I want to find out if I'm your father"? What if I'm not?I don't want to mess with the kid's head.
-Why,are you afraid to find out? -No.
Maybe.
I don't know.
Maybe the actual biology doesn't matter anyway,huh? Of course it does.
You want something to eat before you go? No,I'm fine.
-Some juice? -We don't have any.
I'm sorry.
Did we wake you? No,I couldn't sleep.
I'm just leaving.
You don't have to sneak out.
She's not sneaking out.
She's going to work.
And I'm late.
-I'll page you later? -Okay.
I made coffee.
Since when do you drink coffee? Since we ran out of juice.
Oh.
Give me some.
Sorry,I meant to go to the store.
I just You know,if you want me to, I can do all the cooking and the shopping and cleaning.
If you did that, when would you do your homework and talk to boys on the phone and text? It's called multitasking.
Since it is plainly ludicrous to page a surgeon at 6:15 in the morning for something as silly as Tylenol, the only conceivable explanation I have for your call is that you have a crush on me.
I'm flattered.
Thank you.
Good-bye.
Who was that? This new ICU nurse.
She's useless.
Someone needs to show her the ropes.
Did you say "ropes"? Jane,come on.
I have to round soon.
FYI? This is my last night in the call room.
The prosthetics lab could be fun.
No,we're through with hospital kink.
We're staying at your place next time.
Whoa,whoa,whoa.
No,we can't.
I I know,I know,you have no bed,you sleep on the couch,your sink is clogged, this pathetic "I work all the time, so my place is a rat hole" thing is not going to fly anymore.
What? Yeah,you're going to clean up your apartment and buy a proper bed today.
Jane,just because you want to stay at my place Hey,it's been three months,okay? Upgrade the sleeping arrangements -or you will be punished.
-Ooh.
-Do you understand? -Yeah.
It's tradition, a symbol.
Yeah,a symbol of the wedding industrial complex.
No,I'll wear a ring.
I want to wear a ring, you just have to abide by my ring policy.
Your ring policy? Yeah,if one of us loses our wedding ring, we replace the ring immediately and give the new ring full status.
You're going to lose it? Well,I don't know,if something happens to the ring, and everybody freaks out like the marriage is doomed.
But a simple gold band would be very nice.
Now we're getting somewhere.
So do you think we should make an announcement or just tell people individually and let it trickle out? Uh,is it all right if we wait a while? Really? Why? When-when you tell people you're getting married, they start asking a million questions about a wedding, and marriage is not about wedding.
Like it's not about ring.
Let's just enjoy this for a while, the two of us,okay? That's fine.
A secret engagement will be fun.
All right,Jane, you take the boob rash and,Ray,you get the bounty hunter with the gout.
Dr.
Kovac returns.
Nice seeing you again,man.
-You,too.
-Welcome back.
It was weird here without you.
What's that? A rat died in the air vent.
There's a cleaning crew up there.
Hey,did you really squash your own hand in a vise? I mean,'cause, wow,that's Need a doc here.
Jane,why don't we take this? seizures.
You,take the bus.
Something bad's going to happen on the El today.
I upped my meds,but-but-but the seizures won't stop.
Well,you're not seizing now.
No,yes,yes,I am.
I-I two milligrams of Ativan should take care of it.
Sir,you're sitting up and you're talking to me.
-You're not having a seizure.
-Can we not stop here? We're about to transfer you.
Yeah,but can you just move me back at all here? Just be patient.
-Move me now,please?! -All right,all right.
ER Season 13 Episode 16 Lily's sick, Marquez is out on vacation, and the rest of us are doing doubles trying to cover all their shifts.
This is why nurses quit and burn out.
Shortage just keeps getting worse.
What about your boy ***? Uh,he was lured to a hospital in Minneapolis.
New cars for nurses willing to stay six months.
Cool with that? What,I got left for a Camry? Nah,it's a good gig.
I can't blame him.
Anna Hayes,39,vomiting and altered mental status.
Tachy to 120, sats 92 on room air.
This your mom? Yeah.
I could barely wake her up this morning.
Ms.
Hayes, I'm Dr.
Gates.
Can you open your eyes for me,please? Please,just take me home.
No,you need oxygen and fluids.
Wait,is she going to be all right? Honey,I'm fine.
Ma'am,you're not fine, you're severely dehydrated, but we're going to help you with that.
Access? blew.
Sam? Trauma One's open.
I'll be right in.
Hey,Jeff,what's up? I think we have something that belongs to you.
Alex,what happened? Okay,Mr.
Brewer, let's get you hooked up.
Yeah,okay.
You're not going to need that.
You're not going to need that? No? No,these are temporal lobe seizures,okay? I never have any cardiac or respiratory symptoms.
Okay,well,we'll just hook you up to be safe.
If you haven't noticed, my-my,uh,seizures are unusual.
I get hunches,premonitions, that sort of thing.
Nothing ever shows up on the heart monitor.
-I see.
-Yeah.
Oh,here comes another one.
I'm sensing bacon and eggs.
There you go,okay? So can you just give me the Ativan and I'll be out of your hair? I'm sorry,but I just think anybody could have made that prediction,Mr.
Brewer.
Look,I know that,uh,it looks like I'm making this stuff up just so I can get drugs but that's not what's going on,okay? Can you call my neurologist? He'll back me up.
Did you get what you want,Alex? Huh? A couple bags of quarters? You know what? You can be in jail right now.
It's not anything like they're saying,okay? Officer Greenberg is going to take you home.
I'm going to call you every half hour.
You don't answer that phone, we got a problem.
-Mom,it's not my fault.
-Of course,it's not,it never is.
Mom,please, just listen to me.
I have to go back to work.
I'll talk to you tonight.
-Thank you very much,Jeff.
-Yeah.
Hey.
What's up with Alex? He knocked off a Laundromat near his school.
Ah I'll get better faster at home,really.
Mom,you're sick,okay? We're not leaving.
-She hates hospitals.
-Oh,but this is County.
This is nice here.
You get organic food and room massage.
We have ice sculptures.
You're going to love it here.
All right,she needs coags.
She's oozing around the needle.
Pulse up to 125.
You know,when you were four years old, our neighbor fell off that ladder and they brought him here.
Mr.
Madsen? Oh,he was such a grouch.
He was always yelling at you and your brother for playing too loud.
But when you found out he was sick, you wanted to visit him.
Systolic's only 84.
She needs access,Gates.
I'm trying,Sam.
She's clamping down.
One more try and I'll go central.
You stood up on your chair and you stuck your favorite toy turtle in bed with him,and you said anybody who was sick, needed a toy turtle.
She's making this up.
No,no,I made a lot of mistakes,son, but you were the one thing I got right.
All right,I'm in,Sam.
Let's get the fluids up.
You okay? Yeah.
Morning,Neela.
Ready to round? Uh,sorry.
Shoot, I need five more minutes.
I overslept.
I never oversleep.
Is that a yoga mat? Yeah,there's an Ashtanga class in the anesthesia conference room.
You should check it out.
Nurses station,five minutes.
I'll see you there.
Uh,hello,good morning.
I'm Dr.
Manish? Hi.
Uh,this is the doctor I was telling you about.
I'm Emily.
I've heard a lot about you.
What are you doing here? -Uh,well,I was -Saving my life.
I was giving a talk about the paired exchange program at a dialysis center in Evanston He was really impressive.
He gave us all hope.
And there were all these people there,and they were just waiting and suffering and it inspired me.
To donate your kidney? You ran screaming from a blood drive.
Well,I was moved by their stories.
We've worked together every day for the past month.
How come you never said anything? 'Cause I thought that I'd chicken out.
I've been on dialysis for six years, on the UNOS list for five.
I'd just about given up when,boom, Manish walks into my life.
Got tested,turns out I'm a good match.
Wow.
Amazing,right? It's like right out of a movie or something.
What's your differential? Infectious hepatitis is at the top of my list.
Sent viral titers.
Good.
What else? Hepato-renal syndrome, vascular disorder, autoimmune, alcoholic hepatitis.
But my mom doesn't drink.
Oh,we're just running through the possibilities.
Here,Luka,Jane's tibia fractures got compartment syndrome-- ortho's MIA.
What about toxic ingestions? Acetaminophen,poison mushrooms? Tox screen's negative, acetaminophen's zero.
Okay,get a CT and notify nephrology and GI.
Sam,come with me.
Is there,uh,is there anyone else you want to be here? My other son's at work.
Don't bother him.
Oh,I think he should be here.
Is it close? He's a repair guy over at Begley's Appliances.
My mom works there,too.
It's just the stomach flu.
Don't bother Nick.
It's a little more serious.
Why don't you go out to the front desk.
The clerk will help you call your brother.
It's all right,honey.
Go.
It's out there to the left.
Thanks.
You're scaring him.
You're in acute liver failure,ma'am.
This-this is a little scary.
Did you hear what I said? This is serious.
You could die.
I heard you.
Do you have any questions? No.
Manish nearly fainted the other day when I was drawing blood.
Now he's giving his kidney to someone he barely just met.
Isn't that a little strange? No,everyone goes through some kind of a mini-life crisis in their 20s.
He's far from family,he's unattached, he's unsure about career, he's drifting, he's looking for purpose.
Some people donate kidneys, others end up working at the Jumbo Mart.
Who are we to judge? Neela,what are you doing? I came down to see the volvulus case.
But you're supposed to be covering the post-op floor.
You done with all those dressing changes? Well,not all of them,no.
Okay,I'm going to leave you kids to work this out.
I'll be in Curtain Three.
-You,upstairs,shoo.
-Well What is this? A consult note.
-I said black ink today.
Only black.
-Oh -What color is this? -Eh,blue.
Oops.
Hey,Mayday.
How's it going? Well,my attending thinks I'm a complete idiot, and Crenshaw's back to being a little bitch.
Hey,most hepatic toxins take a few days to destroy the liver,right? Yeah.
So,theoretically, you could trash your liver, but by the time you become symptomatic, the toxin couldn't be detected in the blood.
I suppose.
Hmm.
I'll page you later.
Ms.
Hayes? Anna.
Anna What's a young,healthy woman with no medical history doing with fulminant liver failure? Aren't you the doctor? You got a family, 40 good years ahead of you.
Yet when I told you,you might die,you hardly reacted.
Yeah.
I guess we all have our own way of dealing with bad news.
Huh.
You know,I used to be a paramedic for ten years before I became a doctor.
Young healthy patients,no matter how religious,mellow,Zen they were they don't want to die.
Something kicks in-- instinct.
Maybe I've just been too tired to cry.
You seem depressed.
Let's say someone wanted to kill themselves without anyone knowing it was suicide.
You know,there's a whole class of chemicals that can damage the liver just days after they're ingested.
Please.
I just want to go to sleep now.
Fuels and solvents found in refrigerators, dryers,cleaning products.
Stuff you'd have access to every day at your job.
Come on,Anna,tell me what you took so I can help you.
Your sons deserve to have you around.
-They're all grown up now.
-I know I'm right about this.
Propane? Kerosene?Carbon tetrachloride? What? Tell me.
I hear if you mix it with juice, it's got quite a kick.
Everything okay? Anna?!Anna?!! Everything's back to normal with you and Luka? Uh,I don't know if I'd say normal, but they're good.
-How's things with you and Katey? -Uh,she's great.
Really great.
But? But nothing.
She's awesome.
Our friend's hurt.
Help! Don't move so fast.
Come on,you're tough.
Please don't make me walk.
You can do it.
Come on,guys, give her a break.
-I got her.
-Get a gurney over here please.
-Are you a doctor? -We both are.
Okay,what happened? They were doing a formation called layer cake.
Most schools do three layers and we do five.
Tasha fell all the way from the top.
Wow,four layer fall,huh? I need this kiddo back in action for the Great Lakes Regionals.
Okay,Tasha,let's go.
Clear.
Still V tach.
No pulse.
-Gates,I got poison control on the line.
-All right,put them on speakerphone.
-Wh What's this about? -Okay,she's on.
Possible carbon tetrachloride overdose.
Fulminant liver and kidney failure.
Why the hell didn't you say anything about this before? It was just a hunch.
When did the exposure occur? Unclear.
Transaminases in 2,000 range.
It's too late.
Nothing to offer other than supportive measures.
Nothing to offer? No.
If it's carbon tet,the damage to the liver has already been done.
I'm afraid that's right.
Cell death is irreversible at this point.
All right,thanks.
Epi's in,fourth dose.
Another hundred of lido and recheck the K.
Wh why were you withholding patient history? I wasn't sure.
She didn't fully admit it.
Charging to 360.
Where'd her son go? He's out at the front desk trying to bet ahold of his brother.
Well,he better find him fast.
All right,clear.
I don't think I could do something like this for a stranger.
So,maybe it bothers me that you can.
Look,Emily's parents are too old to be donors.
She's getting sicker every day.
You would have done the same thing.
I don't think so.
You're a better person.
I'm not a better person,Neela.
I'd be too worried about time lost from work,complications.
I don't mean to be negative, but you have to at least consider the possibility of bleeding,infection I've considered it.
We've all considered it.
-It's covered.
-Covered? Manish Look,it wasn't my intent, it wasn't why I agreed, but they offered, they insisted actually.
-Manish,no.
-Just listen,okay? First I refused.
But then I started thinking what $50,000 could do for my family.
Stop.
I don't want to hear any more.
Look,when I was 14,my parents sent me here to live with a distant cousin.
I went to school, I learned English,I played baseball, while my sisters sewed shirts for two dollars a day in Mumbai.
-I understand you feel guilty.
-Yeah,well,with $50,000, I could hire an immigration lawyer.
I can get my whole family over here.
My parents could get proper health care.
My sisters could get a proper education.
Emily's family is wealthy.
It's no hardship for them.
So why not? Because people don't sell their body parts in this country,period.
Not to mention the fact that you could put our whole transplant program in jeopardy.
-Nobody needs to know.
-But I know,Manish.
I don't understand why you told me, but if you were looking to clear your conscience, I can't help you there.
Of all people,I would think that you would understand.
Well,I don't understand.
I don't.
And I kind of resent the assumption that I should.
You can't do this, Manish,I'm sorry.
No deformities, no step-offs.
We have this one cheer, it's so cool.
It's called paper dolls.
Yeah,it's our signature formation.
It's like a college level routine.
Pulse is in the 120s, and the hemacue is dropping.
That would be because she's bleeding into her belly.
I have fluid here.
We've got the All-Cheer Regionals coming up next week.
I've been driving them too hard.
The outer flyers have their outside hand in the half "Y," and the other hand grabs hold of the middle flyer.
That's me.
-And the ending is really cute.
-Sounds great.
Liter of warm salinewide open, and call for O-neg.
Make sure surgery knows to get down here.
Oh,my God,surgery? If we don't have a middle flyer for the competition, -we are so screwed.
-Watch it,girls.
Why don't we worry less about the competition and more about your friend,okay? I'll get the infuser.
-Do you guys have any warm saline? -There's LR in the oven.
K is 7.
2.
Amp of D-50 and ten units of insulin.
Her nose is bleeding.
Her coags are through the roof.
Oh,my God,she wasn't like this when I left.
Her condition changed quickly.
Without a functioning liver, toxins start to accumulate in the blood.
She's in an abnormal heart rhythm.
She isn't getting enough blood to her brain and body.
We're doing CPR, and giving her medications, but she's just not responding.
But can't you just do something to fix her liver? Once the cells have died, there's little we can do,Evan.
So is this it, or what? We're breathing and compressing her heart for her, but your mother's body is shutting down.
Anything you guys want to say? No,Mom,okay? This isn't happening.
This can't be happening.
Please don't go.
-One more round for the kids? -Don't let her die.
Sam.
All right,clear.
Whoa,wait a minute.
She's got a pulse.
Sinus rhythm.
I don't understand, is she dying or not? Her heart is beating, but her brain was deprived of oxygen for a long time.
It's very likely that she suffered serious brain injury.
Wow.
She can't even die right.
Pressure's stabilized after two liters, but her crit's still dropping, and did I mention I hate cheerleaders? I hate clowns.
-I heard Gates was afraid of folksingers.
-Really? Two plus guarding with rebound on the left.
Could be a splenic rupture.
Neela,you writing this down? Yes,Dr.
Crenshaw, I am.
-How do you stand this? -I don't know.
I'm like a battered child.
I just keep coming back for more.
All right,let's bring her up to whatever OR is open.
Dr.
Dubenko will meet you there.
Okay,girls,Tasha's going to surgery now.
Everyone say good-bye and wish her luck.
I'm really sorry you need surgery and everything,Tash.
But you should know that we'll have to replace you for All-Cheer.
Where's my mom? Hey,she sacrificed her spleen for you guys.
Show some respect.
It's going to be okay.
I'll explain everything as we go.
-Am I going to have a big scar? -Not if we can help it.
-Let me tell you something about Mom -Don't talk like that,okay? She's not going to die.
This is the best idea she's had in a long time.
You don't mean that.
This is your mother we're talking about.
You don't know the first thing about my mother.
I know that she's barely alive, and I know you guys should be in there instead of out here fighting in the hall.
-Sorry,I just don't care.
-Why do you hate her so much? Ever since Dad died,all she does is try to make us happy.
Happy,right.
By gambling on the Internet all day? -It helps her relax.
-Shut up! She started out with a few dollars on poker.
And by the end of the year, she'd lost everything.
The crummy cars,the savings from our dad.
She has a problem.
When they stopped giving her credit, she took out more cards in our name and racked up more debt.
$80,000,Evan.
We got to live with that now.
-She was trying to get help.
-Stop making excuses for her! The house is in foreclosure, Evan.
Next week,you're going to be homeless.
All right,she may be screwed up, but she's your mother.
That's not good enough.
It's not.
-Can I get your advice on something? -Yeah,of course.
Well,let's say I knew a really nice person about to do a pretty bad thing.
But this bad thing had really good consequences for a bunch of people.
-You don't need my advice.
-Yes,I do.
No,no,'cause you have like this ethical alarm system hardwired into your brain.
Makes you a self-righteous pain in the ass, but it's one of the best things about you.
But if I tell what I know, it's going to mess things up for a whole bunch of people.
They'll get over it.
It will be a major betrayal.
Uh,do the right thing,Neela.
That's all I'm saying.
Is this where I'm having my operation? Yep.
The ORs are straight ahead.
I'm scared.
I know.
But we're going to take good care of you.
My stomach Hey,we'll get you more pain medication when we get to pre-op.
No.
That's not it.
Is it your mom? We won't start until she gets here.
I didn't fall from the top of the formation.
You didn't? The other girlsthey did this.
They didi this to me.
New cheerleaders are forced to submit to ten minutes in an equipment closet in their gym.
The newbie just takes it while her teammates do whatever they want.
Tasha got kicked in the stomach till she started coughing up blood.
I trust the authorities have been notified.
-Ray's on it.
-Good.
Lucien,there's something else I need to talk to you about.
Sure.
Go ahead.
-Can it wait? -Not really.
Well,it's going to have to.
Our cases are completely backed up.
Let's go.
Oh,Dr.
Kovac, you really must see this.
This is,uh Fred and Brenda.
Neurovascular symptoms after a Handfasting Ceremony.
-A what? -It's a Wiccan wedding.
The guests bound our wrists with cords.
It's where the expression "tie the knot" comes from.
These are really strong.
Braided to be tough, like our marriage bond.
Regular scissors didn't work, and the knots were too tight to undo.
-I can't feel my fingers.
-And I can't move my thumb.
Is a Wiccan ceremony recognized by the state? No.
We have to get married at the courthouse so I can put Fred on my insurance.
They don't recognize us because we don't believe in mating for life.
Oh,you don't? We are betrothed for one year and one day.
To be reevaluated at the end of that period.
Yeah,well,it does seem like "till death" is kind of extreme.
Yeah.
Just Judeo-Christian bullcrap.
I don't think so.
We're getting married,and all those things are on our minds.
Sorry.
Just slipped out.
Uh okay.
That's all right.
Um,all right,um I'll be right back,okay? What,the first people we tell are strangers? Wiccans? I just felt like saying it.
Hey,Abby,have you seen the cheerleading coach? She's outside practicing with the girls.
Oops.
When tissues are deprived of oxygen for a long time, they produce acids,so we're giving her medicine for that.
How long can she live like this? Weeks.
Months.
It's hard to tell.
But it's just a matter of time,right? I mean,if you want to help us,don't prolong this.
She's not suffering.
Evan and I are going to have to be responsible for her.
We're the only close family she has.
We're alone.
It's too much.
I understand.
Social worker will call you.
We have programs.
There's a support group.
Please.
We've been through enoug She's been having runs of V tach.
Forget the lido drip.
What,you want amiodarone? No.
Why prolong the inevitable? That's not your call to make.
Oh,come on,Sam,we both know how this ends.
Why put her boys through it? She's a full code.
We don't know the extent of her injuries.
We gave her CPR for 40 minutes.
Her brain is fried.
Another run of ten.
Sam,your little raver is having a dystonic reaction to Haldol.
It's cool.
Go.
The lido is hanging and the infuser is set.
If she has another run, start the drip,okay? Page Dr.
Kovac and tell him his patient in Trauma One is coding.
Thanks.
You heard what happened last year.
My girls are not staying in the same motel as the football team.
I need to talk to you about Tasha.
-How's she doing? -Get off the phone.
I'll call you back.
Tasha's injuries were not caused by a fall.
What do you mean? I saw her hit the ground.
She was forced into a closet, and then she was beaten by the other girls.
What? My girls would never Come on! Don't do this! She knows you know.
It's not what you think.
Tasha's sensitive.
Never really fit in with the others.
What she's referring to is just a little team-building exercise we do.
They ripped open her spleen.
That's not little.
And I definitely wouldn't consider that team-building.
My girls are regional champions.
They're under a lot of pressure.
Why don't you save the excuses for these guys,all right? Mom,I don't care what happened.
I don't care about the money.
Just please don't go.
-Another mig of epi.
-Charged to 360.
Clear.
Resume compressions.
What were you thinking? Why didn't you talk to me? Lido isn't going to change the outcome.
I thought you'd agree.
Yeah,well, we work together here,Gates.
Clear! I'll be right back.
Gates,you can't leave in the middle of a code.
The kid should be in here.
Gates! Hey! What do you want? Look,I know you're angry, and I know you got screwed.
You don't know anything.
I know your dad died, and your mom messed up.
It ain't fair.
No,it isn't.
But your mom is dying.
And I know you care.
Because,if you didn't,you wouldn't be out here sulking in the hall.
You go in there and you forgive your mother right now.
I can't.
Nick,you have one shot at being with your mother while she's dying.
Hold compressions.
That's enough.
Save a cheerleader, save the world.
Lucien,I still need to talk to you about that thing.
Well,make it quick.
Manish is on the table, everyone's waiting.
Well,that's what it's about.
Emily paid Manish for his kidney.
-That's ridiculous.
He knows better.
-Well,it's true.
He told me.
He was screened by psych.
They would have picked this up.
-Well,they didn't.
-Come on.
It's wrong,and could jeopardize the whole transplant program.
All right.
All right,Neela.
All right,well,look.
Just as an exercise, consider this.
There are over 65,000 people on the UNOS list waiting for kidneys.
Can we really rely on voluntary altruism to solve this problem? -What are you saying? -What am I saying? Well,when somebody donates a kidney, the recipient obviously benefits,right? Hospitals make money.
The surgeons get paid.
The donor who gives up a kidney gets flowers and a handshake.
Am I right? Are you kidding? So many sick people, so few organs.
Why not let market forces sort out the imbalance? Because people aren't commodities.
We don't live in a world where it's all right for rich people to buy body parts from those less fortunate.
Hey,it's legal to rent out your uterus, or to harvest your eggs for money.
You can get paid to donate sperm.
How is this different? All I know is thata dying girl is going to get a new kidney today.
Then what happens to the 65,000 others who can't afford to buy one? Ancef will be ready to run soon.
Quick question.
Why are you doing this? Excuse me? Why are you giving this girl your kidney? I guess I've been inspired by the work that we do here.
Mm-hmm.
And you would never dream of jeopardizing everything by doing something stupid and illegal,would you? What are you talking about? You know exactly what he's talking about.
Okay,Emily wanted to give me money, but I turned her down after talking to Neela.
Money was never part of the reason why I wanted to do any of this.
Lucien,he's just saying what he knows you need to hear.
She's obviously made up her mind about me.
I don't know what else to say.
All right.
That's enough.
Neela,let's go scrub.
No.
I won't be a part of this.
Fine.
Shirley,have Crenshaw get me a surgeon who actually wants to operate.
You get out of here Nella,now.
The tornado was hard to see against the background, so I painted it black.
I was going to put some lights in the bottom, but I ran out of time.
Wow,that should look really,really cool.
Sam.
Yeah,and I fell down the stairs at school and it broke.
That's not the only thing you broke.
I know-- I broke my tibia and my fibula.
Can you fix it fast? -I can fix you up in about an hour.
-An hour?! I'll never have time to finish my tornado before the end of the science fair.
Hey,did you know that casts give off heat when they're hardening? -No.
-Mm-hmm.
It's called an exothermic reaction.
It could make a pretty cool science project.
Can you help me make it?! Uh,sure.
I'll get the stuff.
-Sam,can you dispose of the rest of that Ativan,please? -Sure.
-Hi.
-Hi.
-So,I talked to your neurologist, -Uh-huh.
and I got quite an eful about temporal lobe epilepsy.
Yeah.
Interesting stuff.
-Well,I told you I was the real deal.
-Mmmm.
Well,do you have any last words of psychic wisdom before I medicate you and sever your ties to the paranormal? Oh,sure.
Um,well,I see great things for you in the year to come, although you will struggle to balance home and career.
-That's it? -Yeah.
That's the most generic fortune I've ever heard.
And you should really invite your dad to the wedding.
I'm just saying.
-Gates.
-Hm? -Can you explain this,please? -Explain what? Why did you write "idiopathic liver failure" on her death certificate worksheet? It should be "carbon tetrachloride ingestion.
" Well,she never admitted it straight-out.
We don't know what really happened.
You can't withhold information whenever it suits you.
What she told you needs to be part of the medical record.
If we document suicidality, then life insurance won't pay.
We say it was a natural death-- what's the harm? The harm is that it's unethical, and it's insurance fraud.
Oh,come on,insurance companies screw people over any chance they get.
And why should those kids be punished for the rest of their life because of something their mother did? Gates,I'm worried about you.
Don't worry abou4 me.
I'm all right.
No,I'm worried about your ability to do this job.
And it's too bad because you're good, but you-you you lie and you think nothing of it.
It's not lying if we don't know for sure.
Now,come on,let their mother do this one last thing for them.
I'm not going to let you lie for them,Gates.
-Hey,Gates,can you sign this discharge? -Later.
Jane,you seen Neela? Uh,Dubenko sent her home early.
Oh.
I just had to wheel an appy up from the ER, in case you're wondering.
-Wondering what? -Why I'm here.
Good night,Jane.
King-sized,wrought iron frame.
The rest is up to you.
Hey,you guys, have you seen Tony around? -Not in a while.
-Okay,have a good night.
-Do you think I chased away my father too fast? -No.
Maybe I should've at least listened to what he had to say.
-Why? You can call him.
-I tried.
He checked out of his hotel--the number he gave me in Texas is disconnected.
Um,Abby,uhSorry,I just need a minute to check something,okay? Hey,Malik,do we still have the chart on Anna Hayes? You think I memorize the name of every patient who comes through here? The woman that died of liver failure.
I forgot to do some paperwork for the death certificate.
-Here you go.
-Thanks.
Hey,first day back.
How'd it go? Just like riding a bike.
Luka,I told Miranda we'd be home by Coming.
CAUSE OF liver failure of unknown et iology -Good night.
-See ya.
-Hey.
-Hey.
How'd it go with your little secret? Oh,terrible,actually.
Worse than expected.
But our cheerleader did well,though.
The police are interviewing the whole squad as well as the coach,so -Oh,good.
-Getting off soon? -Uh,yeah,thank God.
-Yeah,me,too.
Want to grab a beer? Sounds good,but,um I've got some dictations to do.
Okay.
Another time.
-Dr.
Gates.
-You're still here.
Yeah.
Our uncle drove in from Ann Arbor.
He wanted to see her.
I'm sorry for your loss.
You know,I never got to thank you for everything you did.
It's my job.
You really helped us.
Yeah.
Good night,Nick.
You know,she knew it was the only way out.
Had to look natural so we could get the insurance money.
I found some old solvent at the store.
You helped her? I left out a bottle.
At least she finally got something right.
Good night,Doc.
Leave me alone.
No,you can't break and steal things,Alex--you know that.
You do that,you're going to end up on the wrong track Mom,you're not in my head,okay? You-you don't know what happened! Alex,come on.
Alex! Open this door! You hear me? Right now! -Open the door! -Go away! I can't go away-- I'm your mom! Come on,Alex, don't do this to me.
Hey,do you remember that time that,uh, we made that science project for your school,that volcano? And I couldn't get the mix of,uh, of baking soda and vinegar right? And it erupted all over the living room.
What were you,what, five or six? I know I didn't give you the most stable childhood,okay? I know you've seen a lot of crazy stuff, that is mostly my fault.
But the only thing I ever wanted was for you to be happy,Alex.
Okay? And I don't know how to give that to you.
So,please tell me what to do.
I know you're listening in there,Alex,okay? I love you.
You know that,right? Hi.
-Hi.
-You look tired.
-Want a beer? -Yeah,thanks.
I made chili,salad and corn bread from scratch.
I know what your next question is.
My homework's already done.
All right.
No more fast food around here.
Wow,Sarah, this looks great.
Yeah.
Leaving so soon? Guess not.