ER s13e20 Episode Script
Lights Out
Previously on ER It'd help if you could write a letter or something.
- All right.
What kind of work? - An E.
M.
T.
I'll help your brother out, no worries.
- I just don't know how I fit in.
- Oh, I understand that.
Well, you won't have to wait long.
- So, we're still waiting? - Oh, it's only been a week.
- Well, I sent you a few e-mails.
- Never got any of them.
Where are the groceries, Mike? I gave you $100.
- How much you got left? - I don't know.
Come on ! Smile for the camera, birthday girl.
Ovarian cancer.
First time around.
- First? - But they say the third time's a charm.
- Happy Birthday.
- I'm going to send Alex away.
I just can't help but feel like I'm giving up on him.
And we both know that's not true.
It was so smoky, I could barely see.
The flames were eating the walls like maggots on dead meat.
So, where was the little boy? Well, I looked everywhere for him, and when they radioed me to get out, something told me to check again.
- Was he there? - Yeah.
He was behind the dresser.
He could barely breathe.
- can I call you back in five minutes? - And just about the time I went to get him-- boom! The second floor caved in.
- Tony, have you heard this? - It's time for you to go to school.
Well, it's teacher conferences today, and me and Mike are having a cartoon marathon.
Oh, really? Well, Mike needs to go find a job, and you need to go to Heather's.
Heather's sick, and I start at Home Depot tomorrow.
- Isn't that great? - Yeah, great.
We should recheck the K on your diabetic in two.
I did.
It was 3.
6.
- Still ketotic? - Yeah, but only one plus now.
event with transient LOC at a travel agency.
Oh, damn.
A & O times three, pulse 88, resps 26, sat 96.
- Well, listen to you.
- He hasn't hurt you, has he? I'm fine.
I just got dizzy.
All right, I'm Dr.
Pratt.
We're going to take a look at you, okay? I didn't eat breakfast.
I-I just got dizzy.
I want to go home.
We'll try to make it quick, all right? Just put her in curtain two, okay? I'll roll her in.
Newbie, you finish up the run sheet.
No problem.
- Not bad, man.
- Tight, huh? Very tight.
- So, this your first day? - Two MIs, an MVC on a Dan Ryan - and the shift's not even half over.
- How's Dumar treating you? - He's cool, man.
Real cool.
- He's not giving you a hard time? He made me stock the rig and get the coffee.
But it's not like I had to shine the rims or anything.
Just make sure it doesn't get in the way of your school work.
It won't.
Hey, Pratt, you see this? Kovac is having a mandatory department dinner next week.
Now, why would I want to hang out with you losers on my free time? Hey, it's better than the time, uh, Weaver took us to the Olive Plantation.
- Yeah, I was hugging the toilet for days.
- Okay, too much information.
Hey, you guys met my brother? It's his first day on the job.
- Congratulations.
- Hey, buddy.
- Heard you started today.
- Thanks for everything.
You got it.
Hey, be careful.
The ladies love the uniform.
- We'll see.
- Look.
Here.
- Department dinner.
- Sounds like fun.
Obviously, you haven't been.
- Yeah, beats work.
- All right, all right, speaking of which-- Marquez, staple gun lady in three, Sam, liter of NS and get an EKG for the new one in two.
What's this, uh, dinner all about? Well, after County's lousy Joint Commission survey, Kovac probably just wants to boost morale.
What about emergency power for all the rooms? We're getting to that.
And the bathrooms still aren't ADA compliant.
First I need to upgrade the nurse call systems and get automatic fire doors.
Well, you'll have plenty of time to do that when we close.
- Just-Just give me another week, okay? - I gave you a month.
We're too busy.
- We're busy every day.
- Soccer player has a positive culture.
Start vancomycin.
Look, I haven't even prepared the staff.
Well, you have the rest of your shift to do so.
What about the patients? We've increased capacity at the urgent care clinic.
- You promised shuttles to other facilities.
- We don't have enough money for that.
You have no idea what it's like to be down here.
I covered trauma in this E.
R.
for 20 years.
We're trying to improve the way it works.
- How long are you going to shut us down? - For as long as it takes.
So we can comply with trivial rules? Without accreditation, we can't run this hospital.
- Come on, Donald - In 12 hours, we close the E.
R.
End of story.
You heard what he just said.
We're closing down.
- It's only temporary.
- How do you know? Old boys running around here checking for cracks in the ceiling, - and now we're having some dinner.
- Oh, we have the dinner every few years.
Just drinks and dancing.
Usually you can't bring a date.
- Maybe I'll bring Wilson.
- The cop? They say white men can't jump, but he sure can - Who you bringing? - I I don't know.
You know, Sam, it's obvious you got some stuff going on.
You don't need to keep it all in.
Nurses stick together.
No, I Honestly, I don't know who I'd bring.
It's the first time in my life I've really been alone.
You're kidding me.
No, and now that Alex is out of the house, I got to find something to do with myself.
Girl, it's called the rabbit.
It costs a grip, but it's worth every dime.
Oh, God.
You'll be saying more than that, trust me.
Excuse me.
Hold on.
Oh get that look off your face.
- How are you? - Mets to the liver, lungs, bones.
Not a K Kodak moment.
- I'm sorry.
Are you getting chemotherapy? - No, I'm done.
Keep him on the monitor, and call for an ICU bed! Hi.
Uh, this is Diana Moore.
She's, uh, here for syncope.
- History of ovarian cancer.
- I'm Dr.
Kovac.
It's not history, Sam.
It's right now.
Metastatic.
End stage.
- Doctors need to know that.
- You two know each other? - She's been here before.
- Not as a patient.
Diana's a photographer.
She's, uh, doing a project on hospice patients.
Oh, that's right, yeah.
I re I remember you.
Wow, you've got pretty bad ascites here.
Your abdominal cavity is accumulating fluid.
I know what ascites is.
I took a picture of it.
It looks like I'm pregnant.
- BP's 92/58.
- She's depleted intravascularly.
- Okay, run in a liter of NS.
- No, no IVs.
I told the paramedics, I'm D DNR.
- It's just an IV for rehydration.
- No.
I know how I know, okay? I know I know how this starts, and-and then you You get sucked into the-the hospital vortex, and it and it never ends up well.
- The fluids will make you feel better.
- No.
Listen to me.
No.
No IVs, no blood tests, no no-no monitors, no-no medicines.
- I'm going to Costa Rica.
- What's in Costa Rica? The beach.
Sam, give her a liter of oral rehydration solution.
Just stay long enough to show us you can hold that down, okay? Okay.
Hey, shouldn't we at least drain some of the fluid? We can't do a paracentesis.
Why? It'll help her breathe easier, it'll make her more comfortable.
You heard her-- no blood tests.
It's a needle in the belly.
It'll take you five minutes.
Come on, Luka.
Ray's right.
We can't tap the fluid without checking labs.
She could be dangerously anemic, coagulopathic-- not a good idea.
She doesn't want any treatment, Sam, so let's respect that, all right? Luka, your favorite skin popper won't let me I & D her abscess.
- Sign her out AMA and get her out of here.
- Yeah, but she knows you.
- Maybe if you could talk to her - No.
We can't keep convincing people to stay if they don't want to be here.
We can't even take care of the ones we already have.
Okay, listen up.
We got reassignments for all of you during the E.
R.
closing.
How are they just going to tell us this today? I thought I could prevent this, but Anspaugh's not budging.
- How long are we shutting down for? - I'm not sure.
Great.
I'm sure I'll wind up giving enemas in Geriatrics.
No, you're going to ICU.
Malik, Geriatrics.
Pratt, Family Medicine.
Abby, you're going to the NICU.
I'm not going to the NICU.
Right.
I'll, uh, fix that.
Uh, Gates goes to Anesthesia.
- What about me? - You're going to the cafeteria.
Cafa-what? Oh, why don't they just give me a jockey suit and sit me out on the lawn? - Well, do we get to keep the same shifts? - Will we still get our choice of schedule? Uh, you'll have to talk to your supervisors about shift scheduling.
Well, give it to us straight.
Are they going to shut down the residency? These are just alternate rotations until the E.
R.
opens again.
Yeah, that's what they told the residents at MLK in Los Angeles.
And now they're scrambling for spots in other programs.
No.
Our didactic programs for the residents will continue, and for our attendings, there'll be some administrative duties to help correct the JC deficiencies, and we'll also be assigned clinical shifts in the urgent care center, okay? - Great.
Med refills, URIs and back pain.
- Yeah.
I bet we're closing for good.
I'm with you.
Something stinks, and it's not the diarrhea in four.
Uh, who has Johnson? Oh, I did.
No pneumonia, but are you aware he has multiple rib fractures? - Yeah, the kid plays rugby.
- So, uh, guess who's, uh - Guess who's going to Family Medicine? - I don't know.
Who? Yours truly.
No nights, no weekends.
Now maybe you can come over for some dinner.
We can crack open a bottle.
- You know? - Yeah, maybe.
Hey, Betina, I saw your abstract on neuroimaging and autism.
Pretty cool stuff.
Paper's coming out in Neuroscience next month.
Wow.
Very impressive.
But not surprising, considering you managed to enroll such a big cohort of autistic children.
And the way you correlated the MRI findings with the tissue specimens I mean, no one's ever done that on this scale before.
- You actually read it? - I sure did, and if you ever have time to talk about it more, I'd love to chat.
I'm looking for some areas to focus clinical research in the E.
R.
I'd be interested in collaborating with your department.
- Are you free for lunch tomorrow? - Sounds great.
Okay, great.
What just happened? Blunt trauma to the head and arms.
Assaulted with a baseball bat.
- Alert times three.
- Got it.
- Okay, put him in trauma one.
- What happened? I was at a sci-fi convention, and some Romulan started beating me! Get a C-collar.
He accused us Intergalactic Rebel Warriors of being inferior.
He was just being uppity, 'cause Romulans are biological cousins to Vulcans.
- Of course.
- Where is your pain? Mostly in my shoulder.
My arm hurts, too.
Okay, let's get a line in, get him some morphine.
And a C-spine film to his right shoulder and left forearm.
It hurts.
Well, you dislocated your shoulder anteriorly.
- Am I going to die? - Not today.
- Have you seen that patient? - She stumbled off, so did my doctor.
- Can you find him? - Yeah, I'll send someone over.
Today? Next year? During Cinco de Mayo? When? - Have you seen Diana? - Who the hell is that? The photographer lady, she was in curtain two.
- Sam, where are the glucometers? - They're all packed up.
They were supposed to leave one in the trauma room.
- And the test strips? - Uh, you're on your own.
I get that Klingons used to be enemies of the Federation, - but we have nothing to do with that.
- Okay, move your toes.
- Good.
Can you feel me touching your foot? - Yes.
I never heard of Intergalactic Rebel Warriors.
- What show were you on? - We're still in the conceptual stage, - but we're about to land a deal.
- Looks like you're right.
- Anterior shoulder dislocation.
- C-spine is clear.
And he's got a nightstick fracture of the left ulna.
- Okay, let's get a sugar tong splint.
- Let's give him, uh, 100 of Propofol - for his shoulder reduction.
- Propofol? Yeah, I just got credentialed to use it.
Why don't we try, uh, scapular manipulation, you know? Put it in without having to knock him out.
No, n-no, reductions are much easier, if you have good sedation.
Sedation has risks.
Morris, I need you to dispose some patients out here.
We got a full waiting area, and the clock is ticking.
Come on.
Okay, uh let's get set up for the Propofol, and we'll do the reduction when I get back.
All right, let's get him prone, and we'll try the scapular manipulation.
W-- He-- Morris said he wants to use sedation.
- He's a kid with a new toy.
- Well, the kid's the attending, so even if you're right, you have to talk to him about it.
If it goes in easy, great.
If not, then we'll try the Propofol.
Let me roll you over.
Hey I've been looking all over for you.
I got to get an airline ticket before the price goes up.
Come here.
Come on, sit down, please.
I had malaria once.
I didn't feel as bad as this.
Look, the fluid in your belly is compressing your lungs.
If you let us take some of it off, it'll make it easier for you to breathe.
I just want to get o-on the plane.
I understand that okay? But you are breathless and you're pale, and flight crews are trained to spot people just like you.
I'll wear blush.
The paracentesis will only take a few minutes.
Sam I have friends i-in Costa Rica And they're waiting for me.
And it's all planned out.
This is your only chance to get there.
Come on, trust me on this.
- ICU has beds for our intubated patients.
- Well, there are only three stepdown beds, but these others can go to telemetry.
Yeah, we have 11 patients going to medicine.
They can use the GYN floor for overflow.
- Uh, what about the waiting room? - Send them to urgent care.
The E.
R.
is closing at 8:00.
How do you say "This is going to hurt" in Intergalactic Rebel Warrior? - What the hell are you doing? - He did it.
- What?! - Gates thought he'd try it this way.
Yeah, and it worked.
No need for Propofol.
- Well, who made that call? - I did.
His shoulder's back in.
That's not the point; I gave you an order.
So do what a boss does.
Take credit for my resourcefulness.
I'm writing you up.
Why, because my approach was better than the attending? Go home; you're done.
You can't send me home.
You should have thought about that before, cowboy.
- I helped the guy without sedation.
- You went against my orders.
- Oh, come on, Morris.
- You're supposed to be a soldier.
- I am a soldier.
A real one.
- Could have fooled me.
Y-You're acting like I killed the guy.
I am sick and tired of you not taking orders.
In the time that you got here, you have placed a subclavian line without supervision, you tapped a VP shunt without even calling neurosurgery, you overrode an attending to give Digibind to a guy that was already brain dead - What, you keeping score? - You transpose numbers, - you falsify charts.
- You sound like - you're slow as hell with documentation - like my high school girlfriend.
And still you act like you're God's gift to medicine, like, like you're too good to seek advice or need help.
You're arrogant and dangerous, and I've had enough.
- We all have.
Go home.
- Where's Kovac? - This is my call, not his.
- Okay.
- What was that about? - I sent him home.
I tried that once.
Yeah, well, this time he's getting a letter in his file.
So how did you cut your leg? I was trying to get the chip out.
What kind of chip? A neurogenic biomatrix nanosilicate chip.
The aliens put it there.
And, uh, did the aliens do anything else to you? Not that I didn't consent to.
Look They want me to go back and report my findings.
Really? I'm willing to give them a report, but I don't want them tracking me! Hey, Sam, can you page Psych for a consult, please? - Katey's already down here.
- Katey? We're gonna move you to exam three to do the procedure, and you're all set.
One ticket to Costa Rica.
Tomorrow evening, 7:55.
Seat 13B.
- You ever been to Costa Rica? - Only on the Discovery Channel.
That's where my dad bought me my first camera.
My family lived there when I was 15 for six months.
It was very magical.
Very beautiful.
The sunsets, the beaches.
Sounds romantic.
Yeah.
It's where I met Paul.
He was a journalist for the BBC.
The only guy who ever got me.
Is he going to meet you there? No.
He died in Baghdad.
He was embedded with a Marine unit, and they drove over an IED.
I'm so sorry.
Sorry yeah I never had his kid.
- What do you think? - Please hide me.
We should, uh, put her on a 72-hour hold.
She cut her leg open.
She's a danger to herself.
- She's a crazy bird.
- Aren't we all? My best friend thinks I'm nuts sitting around waiting for you to call.
- Okay, look, I'm sorry.
- No, I'm sorry.
The moment I jump in the pool, you get out.
Katey, that's not-- Hey, this is Katey Alvaro, fourth year on Psych.
Do we have any beds? You know, I pulled out my best for you.
Hey, don't get me wrong.
The sex was great.
I'm not talking about the sex.
No, that's great.
I-I'll bring her right up.
- I should have called you.
- You should have call? - You dropped off the face of the Earth.
- Okay, it was wrong.
No, it was, it was more than wrong.
It was wussy, immature, tenth-gradish.
You're right.
What happened? You start dating Neela or something? Okay, can we talk about this? What's there to talk about? You're stupid, and I'm done.
Did Morris tell you not to do the procedure? Well, yes, but b-but scapular manipulation doesn't pose any real risk.
That's not the point.
- I saved the guy from being sedated.
- Doesn't matter.
You were out of line, and now you're going over his head to me.
My way was better, and it doesn't merit being written up.
Actually, it does.
When an attending tells you to do something, you do it or discuss it.
Now you're gonna go home and think about that, okay? - Am I, am I in trouble? - Morris that's one of the best moves you ever made.
See? I knew it! He can't go against me.
He shouldn't even be able to go against residents.
- There was a resident in the room? - Uh, let's leave me out of it.
- You should have stopped him.
- Oh, please, like he's going to listen to me.
- He doesn't even listen to you.
- Well, maybe I should send you home, too.
Okay.
Well well, not today.
But I'll do it, Abby.
Don't test me.
- It wasn't life threatening.
- Doesn't matter.
Morris is the attending.
It's his decision.
Got my Coltrane, my Margaret Bourke-White books, new timer for my camera.
- You seem at peace.
- Yeah.
Why stress this? My friend's gonna cook, drink wine on the beach.
That necessary? Uh, it's a precaution for the invasive procedure.
I-I said no blood.
It's just platelets; your count's a little low.
- I'm still gonna get out of here.
- I promise you.
- Platelets running, belly's prepped.
- Lido's drawn up and ready.
Got to get my film to my publisher.
And my camera to Yolonda.
Who's Yolonda? She's a girl I mentor in a photography program.
Okay, a little sting, so you won't feel the big needle.
- Vitals? - A little tachy, but BP's good.
Okay.
You're gonna feel some pressure here.
That's it.
If the bottle fills up, clamp the tubing before you switch to an empty one.
Yeah, got it.
I need to see if I have enough miles to upgrade.
- Why skimp on your last plane ride? - She refused the morphine.
Okay, the painful part is over, anyway.
- Eh, fluid's bloody.
- Just a little; shouldn't be a problem.
Oh, I don't know.
I don't know.
I feel weird.
Diana? Diana, come on.
Systolic's only 84.
Get the crash cart.
- Come on, Diana.
- Sam, she's DNR.
No, no, no.
We talked her into this, we at least got to get her back to where she was when she walked in here.
Please? No crash cart, no CPR.
Give her a liter of NS and lower the head of the bed.
BP's 88 over 45.
Damn it.
Urticaria.
Another liter of NS and DC the platelets, now.
Crackles at the bases.
on the non-rebreather.
- Diana.
- What happened? You had a bad reaction to some of the blood products.
Okay, I'll start another line.
Oh, no, I don't want that.
I don't want any of this.
You dropped your pressure; you have no choice.
Yes, I do.
Stop.
- We need a way to get her fluids, fast.
- No, no.
Listen to me.
This is very serious.
Platelet allergy can be life threatening.
- Especially in your condition.
- Great.
What is it about hospitals? It's a toxic environment.
Everybody gets worse here.
It's gonna be okay, Diana.
Really? I don't think I'm gonna be okay.
- Want me to start a subclavian? - She's coagulopathic.
Let's give the meds a chance to kick in and then reassess.
Hang in there, Diana.
We'll come and check on you soon.
Sam shouldn't have pushed that.
That was Diana's only chance to get on that plane.
Dr.
Kovac, people are asking about this dinner thing.
Morris, just tell Marquez to officially close us to trauma.
No problem.
So how are we affording such a fancy place? - It's not Ladokern, is it? - Don't worry about it.
You didn't get in bed with a pharmaceutical company? Guys, come on, we have a lot of work to do.
Say it isn't so.
They're Satan.
Trust me, I know.
Hey, I got a 14-year-old with altered mental status and respiratory distress.
We were walking home from rehearsal; he said his back hurt.
Then he just sat down and stopped making sense.
Please All right, Ray, can I get a hand over here? Come on, let's go.
- What's your friend's name? - Demitri.
Does your friend have any medical problems? I don't know.
Demitri.
Hey, man.
Wake up, Demitri.
Wake up.
One, two, three.
- Sat's only 76.
- You sure it's picking up? - Yeah, we got a good wave form.
- All right.
We got shallow resps, decreased at the bases.
Throw me the bag.
- Does he take any medicine? - We're in orchestra together.
We're not really friends.
- Anybody call his parents? - Yeah, Timmy's on it.
Pulse is thready, tacky at 125.
- You guys take any drugs? - We don't mess with that.
Okay, did he fall? Did you guys get in a fight? He just passed out.
Okay, all right, we're gonna need to tube him-- seven-oh and a Mac two.
I got access; what do you want? CBC, trauma panel, tox screen, type and cross.
Call for a portable chest and let surgery know that they need to come down and do a trauma eval.
It's not my fault, I swear.
Let's get an ABG.
- Didn't call me back this morning.
- What? - You didn't call me back this morning.
- Morris is such a little bitch.
- What happened? - He's sending me home.
- What did you do? - I reduced a shoulder, that's what I did.
I don't get it.
I was trying to do what was safest for the patient, right? And then he shows up a-and he pulls this big power trip.
- So you went against him? - That's not the point.
- Well, it kind of is.
- Well, no, it kind of isn't.
It the point You know what? I don't even want to talk about it, forget it.
Why don't you just tell Morris you're sorry? - I'm not sorry.
- So what? - So what? I'm not a kiss ass.
- So you want to get written up? He doesn't have the balls to write me up.
- Neela.
- What? Since you've been ignoring Dr.
Crenshaw's pages, he asked me to read this to you.
"Get your ass into the trauma room, now.
" - I got to go.
- Where you going? - W-What'd you have to say to me? - Nothing.
I'll call you later.
Just go apologize to Morris.
- Suction! - All right, I'm in! - Bag him up.
- Sat's are in the 70s, Pratt.
- Blood gas is ugly.
PH only 7.
02.
- What's happening? He may have taken something that's making him acidotic.
There's no gap, but Hey, you know what? Listen, Todd.
It's very important you tell us the truth.
Did you guys take any pills? I told you, we were at orchestra practice all day.
- I can't bag him above 80.
- That's because of this.
Yikes.
What is that, pneumonia? Seems unlikely without a fever, but we got to cover it.
It hurts me when you ignore my pages, truly.
It wounds me to the core.
- You rang? - Yeah, we got a 14-year-old - with severe hypoxia and this film.
- Pneumonia? H and H is back.
Hemoglobin's 6.
2.
- Pulmonary hemorrhage.
- That's what I'm thinking.
- Any history of trauma? - We still don't know, - and his buddy's not being too helpful.
- I told you, I don't know anything.
Look, Todd, if you know something, you got to tell us right now.
- Hey, hey, Todd! Get back here! - All right, sonosite, please.
And a chest tube tray, sterile sixes and a ten blade.
What did you do to him? What did you do to him? - Nothing, I swear.
- Yeah? Then why are you running? You know, your friend could die? - He could? - Yes! Did you do something to him? I wanted the solo.
What did you do? I kept praying he'd get sick, but when that didn't work We did this experiment in chemistry where we used sulfur, and I saw what happens when you heated it up, so I figured eating it couldn't be good.
You You put it in his food? Listen, our school orchestra goes to Milwaukee tomorrow, and I wanted to play the solo.
I didn't mean for all of this to happen.
I'm sorry.
I'm sorry this didn't go the way we wanted.
Why don't you, uh just sign me out.
I have a plane to catch.
Diana, you can leave, but nothing's changed.
They're not gonna let you on that plane.
Well, why? We can send you home.
Hospice can bring you pain medications.
- No, but I'm not in pain.
- Not right now, but sometimes when people die this way, they get they get really uncomfortable.
Well, what can you do? Another para paracentesis? We can't we can't risk you bleeding.
Why can't Why can't I just fall asleep and not wake up? You've seen this.
It doesn't always work that way.
The fluid in your body is gonna continue to build up, and as it does, it'll compress your lungs and make it harder for you to breathe.
I'll feel like I'm drowning.
We're not gonna be able to get to everyone before the E.
R.
closes.
But what about my headache? - It could be a brain tumor.
- I can't wait till next week.
I've got the mother of all yeast infections.
I'm sorry to hear that, but you'll have to go find a doctor somewhere else.
- We've got a list of local clinics here.
- How long will the E.
R.
be closed? - We don't know.
- We need a room! - We're closed.
You guys know that.
- You got to take this.
No, we can't.
Turn around and go to Good Shepherd.
- No, listen, it's Dr.
Pratt's brother.
- Chaz? - He kind of overdid it.
- Somebody, I'm not feeling too good.
- What happened? - Happy hour overload.
- Hey, we need a gurney over here! - Trauma Two's open.
Sam, we got this.
Go give the nursing report on Diana.
- We got a bed for her upstairs.
- My appendix is bursting! - She's going home.
- No, she wants to be admitted.
What? To the hospital? - No.
She is not dying here.
- Sam, just make the call, okay? Hey, Sam, I got these kids doing fence plowing.
What the hell is that? A bunch of knuckleheads run full-speed into a fence and try to break it.
Do we have time to treat them? Hurry up; they have to be out of here in an hour.
- Hey, Pratt - Yep? You got to get to Trauma Two.
- Your brother's here.
- Yeah, I know, he's working.
- No, he's drunk.
- What? Demitri's parents just called.
He's got sickle cell.
- You're kidding.
- At least makes sense.
Yeah, means the white out is acute chest syndrome.
What's that? Um, Dr.
Barnett will explain everything.
Ray, take them upstairs, okay? - Where you going? - It's my brother.
All right, let's go.
I just spoke to Dr.
Kovac.
- It's okay.
- No, it isn't.
It's fine, Sam.
No, this isn't what you want.
It's the hospital vortex.
You said it yourself.
Come on, let me take you home.
We'll tell your friends to meet you there instead.
It's okay.
It's okay.
Don't say that.
Come on.
Sam, look, actually, there is no one, okay? I-I-I just I did my thing my whole life.
And I I didn't develop any real relationships, and I don't have any kids.
So Okay.
But you are still not doing this here.
Not like this.
Sam, I can't.
Look at me.
I can't do this alone.
Pulse ox is dropping.
- Breath sounds equal.
- Chaz, wake up.
- Breathe for us, buddy.
Come on.
- I have one beer.
Hell, I have four beers.
But 15 shots of tequila?! - It's a paramedic tradition.
- Yeah, tradition my ass! What the hell were you guys thinking?! - Sat's only 89.
He needs a tube.
- No! 15 liters oh-two by mask.
That's not gonna work if he's hypoventilating.
What are you, frat boys? You guys see people die from alcohol poisoning all the time.
- Yep, he's still got a gag.
- Barely.
Chaz, come on, man.
Chaz, hey! Pratt, his GCS is trending down and so are his sat's.
- We need to tube him.
- Not yet; he's arousable.
- See, look at that, he's talking.
- Mac two and an eight-oh.
I said no.
You're not putting a tube in my brother.
Once he aspirates, it's gonna be a mess.
- It's easy to extubate him later.
- I'm not putting him on a vent! Marquez, place an NG.
We'll evacuate his stomach so he can't aspirate.
- That's gonna make him vomit.
- Chaz, come on, wake up, man.
He better wake up or I'll kill you guys, I swear, I'll kill you.
Hey, come on.
Hey, hey.
Hey.
- I'm sorry.
- Sat's up to 92.
Good.
That's good.
- Let's put him on a non-rebreather.
- I'll call for a med-surge bed.
This is nice.
It's very chic.
Thank you.
Here.
Did you do all these? Uh yeah, mostly.
Some are friends.
I thought you had no friends.
Well, uh, kind of friends that you bunk with in Kabul, or let you sleep on their floor in Marrakech.
I haven't told them.
Diana? They'll read about it in the obit.
I bet you underestimate them.
That's Paul.
A week before the bomb went off.
I'm sorry.
Oh, here, let me help you.
Yeah, got you.
Sit down.
You know Sam? You don't have to You don't have to stay.
I'm sure you have a family to go home to.
Actually, uh, my son is away at school, so He's been, you know, having problems.
A picture? - What's that? - Picture? Yeah.
Yeah, I do.
Here.
There's Alex.
It's an old one, but he looks pretty much the same.
- Well, he's beautiful.
- Thanks.
I used to think you had to chose between family and career.
By the time I figured out you could have both, it was too late, 'cause I was I was already sick.
Yeah, well, I got pregnant at 14, so by the time I realized you could have a career, my kid was in preschool.
So, nursing isn't what you wanted? Uh, I actually never thought about what I wanted.
Feeding Alex was the reality.
It's never too late to choose.
You have time.
The room is ready for Mrs.
Sherman on Four South, and the surgical step down says they will make room for our pertussis kid.
Do you think it's a good idea to put a coughing toddler in a room with a bunch of surgical post-op patients? - No, but it's the only option.
- Dr.
Kovac - You can't send me out, Doc.
- can you sign this discharge? Look, we'll give you a taxi voucher to get to a shelter, okay? - Oh, you know what them shelters like.
- I'm afraid that's all we can offer.
You don't need to stay in the hospital.
Dr.
Barnett, I finished packing up Trauma One, and I found this.
Oh, it's a violin.
My patient must have left it.
- I'll take care of it, thanks.
- All right.
- Hey, how's he doing? - We're going to monitor him overnight.
Hey, you know if you get admitted, you can't be a paramedic? - Is he for real? - I'm afraid so.
- Oh, hell, no.
- It's a joke.
Sit your ass down.
Oh! What-What happened? His first day as an EMT.
Got initiated.
Damn traditions.
Um, I'll be up in a sec.
Hey, Betina, Betina? About earlier I'm sorry about how I came off.
"How you doing, girl?" "Maybe we could have dinner.
" - "Crack open a bottle of wine"? - Yes, yes, yes, but I do want to hear about your research.
Then you're going to have to read up like your buddy, Morris.
I'll do that, but I still want to take you out.
There's this E.
R.
department dinner next week, Thursday night.
An E.
R.
dinner? - You're kidding me.
- And I thought maybe afterwards, we could get a drink in a bar in a public spot.
Sounds better.
Come on, what do you say? Call me.
Hey, you forgot this.
Thanks.
Demitri's still not awake? Well, he's got a tough road ahead of him, but the disease did this to him, not you.
You sure? Yeah, I'm positive.
Sulfur doesn't make you sick, not like this.
- You know you got lucky.
- I know.
Look, when the time is right, you'll get the solo, okay? Have you ever felt, like, jealous? Wanted something someone else had? Sure.
Hey, but in the end, I believe people get what they deserve.
And if you're patient, and you're committed, then you can get what you want-- whatever you want-- whether that means a violin solo, or a better grade, or even a girl.
Sarah?! Sarah! - I didn't like Happy Feet.
- What? What kind of a kid are you? - Everybody likes Happy Feet.
- Well, I'm not everybody.
- Hey, you're home? - Yeah, I got off early.
- Where you guys been? - The video store.
We ran out of movies.
You know, if you want, you can join us.
We got a bunch of Jackie Chan movies.
- Charlie Chan.
- Okay, Charlie Chan.
Sarah, can you, uh, give Mike and I a second to talk? Sure.
- What's up? - What's in the thermos, Mike? - I haven't been drinking.
- So, what's in the thermos? I felt like having a little bit of orange juice.
- Yeah.
Prove it.
- What-- what's your problem? I don't have to prove a damn thing.
You need to relax.
I need to relax? You've been drinking while driving with Sarah? - I was not.
- Let's see.
- Let go of that.
- Give me that.
Let go.
That's it! I'm done with you! Tony! Come on, Tony.
It was only a little.
- You're out, you're moving out.
- We just went around the corner! - I should have never let you in.
- What are you doing? - I fall for this crap every time.
- Please, Tony, listen to me.
I'm done listening, too.
You're drunk.
- You'll always be a drunk.
- Come on, Tony.
Get out of my way.
Look, I'll change, okay? That's what you want.
- Yeah, how many times have I heard that? - Tony, what are you doing? - Stay here.
- Tony? I got a job.
Yeah, and the day the rent's due, you're going to go blow it at a bar.
- That's not true.
- It's true.
It's always true.
And you know what else? You weren't a fire chief.
You were a second-rate captain who got demoted because none of the other guys wanted to go into the fire with you.
- Son of a bitch.
- Face facts, old man-- you killed that rookie, didn't you? You left him.
You left him burning in that building, 'cause you were too out of it to go save him.
- Why don't you just face it? - You can't talk to me like that! You killed him.
You killed your career.
And the only way Mom could escape you was to die herself.
You did it, Dr.
Kovac.
I don't like this.
Hey, it's not all Mercedes and racquetball.
I know that, but I'm beginning to feel like the politics aren't worth the paycheck.
First you make me fire Weaver.
Then I spend half my time in BS meetings.
- I'm flooded with paperwork, and now this.
- Well, welcome to management, Luka.
This isn't me.
I'm resigning as Chief.
Luka, part of being the boss is being the bad guy.
I'll leave that to someone else.
I just want to be a doctor.
Have a good night.
- All right.
What kind of work? - An E.
M.
T.
I'll help your brother out, no worries.
- I just don't know how I fit in.
- Oh, I understand that.
Well, you won't have to wait long.
- So, we're still waiting? - Oh, it's only been a week.
- Well, I sent you a few e-mails.
- Never got any of them.
Where are the groceries, Mike? I gave you $100.
- How much you got left? - I don't know.
Come on ! Smile for the camera, birthday girl.
Ovarian cancer.
First time around.
- First? - But they say the third time's a charm.
- Happy Birthday.
- I'm going to send Alex away.
I just can't help but feel like I'm giving up on him.
And we both know that's not true.
It was so smoky, I could barely see.
The flames were eating the walls like maggots on dead meat.
So, where was the little boy? Well, I looked everywhere for him, and when they radioed me to get out, something told me to check again.
- Was he there? - Yeah.
He was behind the dresser.
He could barely breathe.
- can I call you back in five minutes? - And just about the time I went to get him-- boom! The second floor caved in.
- Tony, have you heard this? - It's time for you to go to school.
Well, it's teacher conferences today, and me and Mike are having a cartoon marathon.
Oh, really? Well, Mike needs to go find a job, and you need to go to Heather's.
Heather's sick, and I start at Home Depot tomorrow.
- Isn't that great? - Yeah, great.
We should recheck the K on your diabetic in two.
I did.
It was 3.
6.
- Still ketotic? - Yeah, but only one plus now.
event with transient LOC at a travel agency.
Oh, damn.
A & O times three, pulse 88, resps 26, sat 96.
- Well, listen to you.
- He hasn't hurt you, has he? I'm fine.
I just got dizzy.
All right, I'm Dr.
Pratt.
We're going to take a look at you, okay? I didn't eat breakfast.
I-I just got dizzy.
I want to go home.
We'll try to make it quick, all right? Just put her in curtain two, okay? I'll roll her in.
Newbie, you finish up the run sheet.
No problem.
- Not bad, man.
- Tight, huh? Very tight.
- So, this your first day? - Two MIs, an MVC on a Dan Ryan - and the shift's not even half over.
- How's Dumar treating you? - He's cool, man.
Real cool.
- He's not giving you a hard time? He made me stock the rig and get the coffee.
But it's not like I had to shine the rims or anything.
Just make sure it doesn't get in the way of your school work.
It won't.
Hey, Pratt, you see this? Kovac is having a mandatory department dinner next week.
Now, why would I want to hang out with you losers on my free time? Hey, it's better than the time, uh, Weaver took us to the Olive Plantation.
- Yeah, I was hugging the toilet for days.
- Okay, too much information.
Hey, you guys met my brother? It's his first day on the job.
- Congratulations.
- Hey, buddy.
- Heard you started today.
- Thanks for everything.
You got it.
Hey, be careful.
The ladies love the uniform.
- We'll see.
- Look.
Here.
- Department dinner.
- Sounds like fun.
Obviously, you haven't been.
- Yeah, beats work.
- All right, all right, speaking of which-- Marquez, staple gun lady in three, Sam, liter of NS and get an EKG for the new one in two.
What's this, uh, dinner all about? Well, after County's lousy Joint Commission survey, Kovac probably just wants to boost morale.
What about emergency power for all the rooms? We're getting to that.
And the bathrooms still aren't ADA compliant.
First I need to upgrade the nurse call systems and get automatic fire doors.
Well, you'll have plenty of time to do that when we close.
- Just-Just give me another week, okay? - I gave you a month.
We're too busy.
- We're busy every day.
- Soccer player has a positive culture.
Start vancomycin.
Look, I haven't even prepared the staff.
Well, you have the rest of your shift to do so.
What about the patients? We've increased capacity at the urgent care clinic.
- You promised shuttles to other facilities.
- We don't have enough money for that.
You have no idea what it's like to be down here.
I covered trauma in this E.
R.
for 20 years.
We're trying to improve the way it works.
- How long are you going to shut us down? - For as long as it takes.
So we can comply with trivial rules? Without accreditation, we can't run this hospital.
- Come on, Donald - In 12 hours, we close the E.
R.
End of story.
You heard what he just said.
We're closing down.
- It's only temporary.
- How do you know? Old boys running around here checking for cracks in the ceiling, - and now we're having some dinner.
- Oh, we have the dinner every few years.
Just drinks and dancing.
Usually you can't bring a date.
- Maybe I'll bring Wilson.
- The cop? They say white men can't jump, but he sure can - Who you bringing? - I I don't know.
You know, Sam, it's obvious you got some stuff going on.
You don't need to keep it all in.
Nurses stick together.
No, I Honestly, I don't know who I'd bring.
It's the first time in my life I've really been alone.
You're kidding me.
No, and now that Alex is out of the house, I got to find something to do with myself.
Girl, it's called the rabbit.
It costs a grip, but it's worth every dime.
Oh, God.
You'll be saying more than that, trust me.
Excuse me.
Hold on.
Oh get that look off your face.
- How are you? - Mets to the liver, lungs, bones.
Not a K Kodak moment.
- I'm sorry.
Are you getting chemotherapy? - No, I'm done.
Keep him on the monitor, and call for an ICU bed! Hi.
Uh, this is Diana Moore.
She's, uh, here for syncope.
- History of ovarian cancer.
- I'm Dr.
Kovac.
It's not history, Sam.
It's right now.
Metastatic.
End stage.
- Doctors need to know that.
- You two know each other? - She's been here before.
- Not as a patient.
Diana's a photographer.
She's, uh, doing a project on hospice patients.
Oh, that's right, yeah.
I re I remember you.
Wow, you've got pretty bad ascites here.
Your abdominal cavity is accumulating fluid.
I know what ascites is.
I took a picture of it.
It looks like I'm pregnant.
- BP's 92/58.
- She's depleted intravascularly.
- Okay, run in a liter of NS.
- No, no IVs.
I told the paramedics, I'm D DNR.
- It's just an IV for rehydration.
- No.
I know how I know, okay? I know I know how this starts, and-and then you You get sucked into the-the hospital vortex, and it and it never ends up well.
- The fluids will make you feel better.
- No.
Listen to me.
No.
No IVs, no blood tests, no no-no monitors, no-no medicines.
- I'm going to Costa Rica.
- What's in Costa Rica? The beach.
Sam, give her a liter of oral rehydration solution.
Just stay long enough to show us you can hold that down, okay? Okay.
Hey, shouldn't we at least drain some of the fluid? We can't do a paracentesis.
Why? It'll help her breathe easier, it'll make her more comfortable.
You heard her-- no blood tests.
It's a needle in the belly.
It'll take you five minutes.
Come on, Luka.
Ray's right.
We can't tap the fluid without checking labs.
She could be dangerously anemic, coagulopathic-- not a good idea.
She doesn't want any treatment, Sam, so let's respect that, all right? Luka, your favorite skin popper won't let me I & D her abscess.
- Sign her out AMA and get her out of here.
- Yeah, but she knows you.
- Maybe if you could talk to her - No.
We can't keep convincing people to stay if they don't want to be here.
We can't even take care of the ones we already have.
Okay, listen up.
We got reassignments for all of you during the E.
R.
closing.
How are they just going to tell us this today? I thought I could prevent this, but Anspaugh's not budging.
- How long are we shutting down for? - I'm not sure.
Great.
I'm sure I'll wind up giving enemas in Geriatrics.
No, you're going to ICU.
Malik, Geriatrics.
Pratt, Family Medicine.
Abby, you're going to the NICU.
I'm not going to the NICU.
Right.
I'll, uh, fix that.
Uh, Gates goes to Anesthesia.
- What about me? - You're going to the cafeteria.
Cafa-what? Oh, why don't they just give me a jockey suit and sit me out on the lawn? - Well, do we get to keep the same shifts? - Will we still get our choice of schedule? Uh, you'll have to talk to your supervisors about shift scheduling.
Well, give it to us straight.
Are they going to shut down the residency? These are just alternate rotations until the E.
R.
opens again.
Yeah, that's what they told the residents at MLK in Los Angeles.
And now they're scrambling for spots in other programs.
No.
Our didactic programs for the residents will continue, and for our attendings, there'll be some administrative duties to help correct the JC deficiencies, and we'll also be assigned clinical shifts in the urgent care center, okay? - Great.
Med refills, URIs and back pain.
- Yeah.
I bet we're closing for good.
I'm with you.
Something stinks, and it's not the diarrhea in four.
Uh, who has Johnson? Oh, I did.
No pneumonia, but are you aware he has multiple rib fractures? - Yeah, the kid plays rugby.
- So, uh, guess who's, uh - Guess who's going to Family Medicine? - I don't know.
Who? Yours truly.
No nights, no weekends.
Now maybe you can come over for some dinner.
We can crack open a bottle.
- You know? - Yeah, maybe.
Hey, Betina, I saw your abstract on neuroimaging and autism.
Pretty cool stuff.
Paper's coming out in Neuroscience next month.
Wow.
Very impressive.
But not surprising, considering you managed to enroll such a big cohort of autistic children.
And the way you correlated the MRI findings with the tissue specimens I mean, no one's ever done that on this scale before.
- You actually read it? - I sure did, and if you ever have time to talk about it more, I'd love to chat.
I'm looking for some areas to focus clinical research in the E.
R.
I'd be interested in collaborating with your department.
- Are you free for lunch tomorrow? - Sounds great.
Okay, great.
What just happened? Blunt trauma to the head and arms.
Assaulted with a baseball bat.
- Alert times three.
- Got it.
- Okay, put him in trauma one.
- What happened? I was at a sci-fi convention, and some Romulan started beating me! Get a C-collar.
He accused us Intergalactic Rebel Warriors of being inferior.
He was just being uppity, 'cause Romulans are biological cousins to Vulcans.
- Of course.
- Where is your pain? Mostly in my shoulder.
My arm hurts, too.
Okay, let's get a line in, get him some morphine.
And a C-spine film to his right shoulder and left forearm.
It hurts.
Well, you dislocated your shoulder anteriorly.
- Am I going to die? - Not today.
- Have you seen that patient? - She stumbled off, so did my doctor.
- Can you find him? - Yeah, I'll send someone over.
Today? Next year? During Cinco de Mayo? When? - Have you seen Diana? - Who the hell is that? The photographer lady, she was in curtain two.
- Sam, where are the glucometers? - They're all packed up.
They were supposed to leave one in the trauma room.
- And the test strips? - Uh, you're on your own.
I get that Klingons used to be enemies of the Federation, - but we have nothing to do with that.
- Okay, move your toes.
- Good.
Can you feel me touching your foot? - Yes.
I never heard of Intergalactic Rebel Warriors.
- What show were you on? - We're still in the conceptual stage, - but we're about to land a deal.
- Looks like you're right.
- Anterior shoulder dislocation.
- C-spine is clear.
And he's got a nightstick fracture of the left ulna.
- Okay, let's get a sugar tong splint.
- Let's give him, uh, 100 of Propofol - for his shoulder reduction.
- Propofol? Yeah, I just got credentialed to use it.
Why don't we try, uh, scapular manipulation, you know? Put it in without having to knock him out.
No, n-no, reductions are much easier, if you have good sedation.
Sedation has risks.
Morris, I need you to dispose some patients out here.
We got a full waiting area, and the clock is ticking.
Come on.
Okay, uh let's get set up for the Propofol, and we'll do the reduction when I get back.
All right, let's get him prone, and we'll try the scapular manipulation.
W-- He-- Morris said he wants to use sedation.
- He's a kid with a new toy.
- Well, the kid's the attending, so even if you're right, you have to talk to him about it.
If it goes in easy, great.
If not, then we'll try the Propofol.
Let me roll you over.
Hey I've been looking all over for you.
I got to get an airline ticket before the price goes up.
Come here.
Come on, sit down, please.
I had malaria once.
I didn't feel as bad as this.
Look, the fluid in your belly is compressing your lungs.
If you let us take some of it off, it'll make it easier for you to breathe.
I just want to get o-on the plane.
I understand that okay? But you are breathless and you're pale, and flight crews are trained to spot people just like you.
I'll wear blush.
The paracentesis will only take a few minutes.
Sam I have friends i-in Costa Rica And they're waiting for me.
And it's all planned out.
This is your only chance to get there.
Come on, trust me on this.
- ICU has beds for our intubated patients.
- Well, there are only three stepdown beds, but these others can go to telemetry.
Yeah, we have 11 patients going to medicine.
They can use the GYN floor for overflow.
- Uh, what about the waiting room? - Send them to urgent care.
The E.
R.
is closing at 8:00.
How do you say "This is going to hurt" in Intergalactic Rebel Warrior? - What the hell are you doing? - He did it.
- What?! - Gates thought he'd try it this way.
Yeah, and it worked.
No need for Propofol.
- Well, who made that call? - I did.
His shoulder's back in.
That's not the point; I gave you an order.
So do what a boss does.
Take credit for my resourcefulness.
I'm writing you up.
Why, because my approach was better than the attending? Go home; you're done.
You can't send me home.
You should have thought about that before, cowboy.
- I helped the guy without sedation.
- You went against my orders.
- Oh, come on, Morris.
- You're supposed to be a soldier.
- I am a soldier.
A real one.
- Could have fooled me.
Y-You're acting like I killed the guy.
I am sick and tired of you not taking orders.
In the time that you got here, you have placed a subclavian line without supervision, you tapped a VP shunt without even calling neurosurgery, you overrode an attending to give Digibind to a guy that was already brain dead - What, you keeping score? - You transpose numbers, - you falsify charts.
- You sound like - you're slow as hell with documentation - like my high school girlfriend.
And still you act like you're God's gift to medicine, like, like you're too good to seek advice or need help.
You're arrogant and dangerous, and I've had enough.
- We all have.
Go home.
- Where's Kovac? - This is my call, not his.
- Okay.
- What was that about? - I sent him home.
I tried that once.
Yeah, well, this time he's getting a letter in his file.
So how did you cut your leg? I was trying to get the chip out.
What kind of chip? A neurogenic biomatrix nanosilicate chip.
The aliens put it there.
And, uh, did the aliens do anything else to you? Not that I didn't consent to.
Look They want me to go back and report my findings.
Really? I'm willing to give them a report, but I don't want them tracking me! Hey, Sam, can you page Psych for a consult, please? - Katey's already down here.
- Katey? We're gonna move you to exam three to do the procedure, and you're all set.
One ticket to Costa Rica.
Tomorrow evening, 7:55.
Seat 13B.
- You ever been to Costa Rica? - Only on the Discovery Channel.
That's where my dad bought me my first camera.
My family lived there when I was 15 for six months.
It was very magical.
Very beautiful.
The sunsets, the beaches.
Sounds romantic.
Yeah.
It's where I met Paul.
He was a journalist for the BBC.
The only guy who ever got me.
Is he going to meet you there? No.
He died in Baghdad.
He was embedded with a Marine unit, and they drove over an IED.
I'm so sorry.
Sorry yeah I never had his kid.
- What do you think? - Please hide me.
We should, uh, put her on a 72-hour hold.
She cut her leg open.
She's a danger to herself.
- She's a crazy bird.
- Aren't we all? My best friend thinks I'm nuts sitting around waiting for you to call.
- Okay, look, I'm sorry.
- No, I'm sorry.
The moment I jump in the pool, you get out.
Katey, that's not-- Hey, this is Katey Alvaro, fourth year on Psych.
Do we have any beds? You know, I pulled out my best for you.
Hey, don't get me wrong.
The sex was great.
I'm not talking about the sex.
No, that's great.
I-I'll bring her right up.
- I should have called you.
- You should have call? - You dropped off the face of the Earth.
- Okay, it was wrong.
No, it was, it was more than wrong.
It was wussy, immature, tenth-gradish.
You're right.
What happened? You start dating Neela or something? Okay, can we talk about this? What's there to talk about? You're stupid, and I'm done.
Did Morris tell you not to do the procedure? Well, yes, but b-but scapular manipulation doesn't pose any real risk.
That's not the point.
- I saved the guy from being sedated.
- Doesn't matter.
You were out of line, and now you're going over his head to me.
My way was better, and it doesn't merit being written up.
Actually, it does.
When an attending tells you to do something, you do it or discuss it.
Now you're gonna go home and think about that, okay? - Am I, am I in trouble? - Morris that's one of the best moves you ever made.
See? I knew it! He can't go against me.
He shouldn't even be able to go against residents.
- There was a resident in the room? - Uh, let's leave me out of it.
- You should have stopped him.
- Oh, please, like he's going to listen to me.
- He doesn't even listen to you.
- Well, maybe I should send you home, too.
Okay.
Well well, not today.
But I'll do it, Abby.
Don't test me.
- It wasn't life threatening.
- Doesn't matter.
Morris is the attending.
It's his decision.
Got my Coltrane, my Margaret Bourke-White books, new timer for my camera.
- You seem at peace.
- Yeah.
Why stress this? My friend's gonna cook, drink wine on the beach.
That necessary? Uh, it's a precaution for the invasive procedure.
I-I said no blood.
It's just platelets; your count's a little low.
- I'm still gonna get out of here.
- I promise you.
- Platelets running, belly's prepped.
- Lido's drawn up and ready.
Got to get my film to my publisher.
And my camera to Yolonda.
Who's Yolonda? She's a girl I mentor in a photography program.
Okay, a little sting, so you won't feel the big needle.
- Vitals? - A little tachy, but BP's good.
Okay.
You're gonna feel some pressure here.
That's it.
If the bottle fills up, clamp the tubing before you switch to an empty one.
Yeah, got it.
I need to see if I have enough miles to upgrade.
- Why skimp on your last plane ride? - She refused the morphine.
Okay, the painful part is over, anyway.
- Eh, fluid's bloody.
- Just a little; shouldn't be a problem.
Oh, I don't know.
I don't know.
I feel weird.
Diana? Diana, come on.
Systolic's only 84.
Get the crash cart.
- Come on, Diana.
- Sam, she's DNR.
No, no, no.
We talked her into this, we at least got to get her back to where she was when she walked in here.
Please? No crash cart, no CPR.
Give her a liter of NS and lower the head of the bed.
BP's 88 over 45.
Damn it.
Urticaria.
Another liter of NS and DC the platelets, now.
Crackles at the bases.
on the non-rebreather.
- Diana.
- What happened? You had a bad reaction to some of the blood products.
Okay, I'll start another line.
Oh, no, I don't want that.
I don't want any of this.
You dropped your pressure; you have no choice.
Yes, I do.
Stop.
- We need a way to get her fluids, fast.
- No, no.
Listen to me.
This is very serious.
Platelet allergy can be life threatening.
- Especially in your condition.
- Great.
What is it about hospitals? It's a toxic environment.
Everybody gets worse here.
It's gonna be okay, Diana.
Really? I don't think I'm gonna be okay.
- Want me to start a subclavian? - She's coagulopathic.
Let's give the meds a chance to kick in and then reassess.
Hang in there, Diana.
We'll come and check on you soon.
Sam shouldn't have pushed that.
That was Diana's only chance to get on that plane.
Dr.
Kovac, people are asking about this dinner thing.
Morris, just tell Marquez to officially close us to trauma.
No problem.
So how are we affording such a fancy place? - It's not Ladokern, is it? - Don't worry about it.
You didn't get in bed with a pharmaceutical company? Guys, come on, we have a lot of work to do.
Say it isn't so.
They're Satan.
Trust me, I know.
Hey, I got a 14-year-old with altered mental status and respiratory distress.
We were walking home from rehearsal; he said his back hurt.
Then he just sat down and stopped making sense.
Please All right, Ray, can I get a hand over here? Come on, let's go.
- What's your friend's name? - Demitri.
Does your friend have any medical problems? I don't know.
Demitri.
Hey, man.
Wake up, Demitri.
Wake up.
One, two, three.
- Sat's only 76.
- You sure it's picking up? - Yeah, we got a good wave form.
- All right.
We got shallow resps, decreased at the bases.
Throw me the bag.
- Does he take any medicine? - We're in orchestra together.
We're not really friends.
- Anybody call his parents? - Yeah, Timmy's on it.
Pulse is thready, tacky at 125.
- You guys take any drugs? - We don't mess with that.
Okay, did he fall? Did you guys get in a fight? He just passed out.
Okay, all right, we're gonna need to tube him-- seven-oh and a Mac two.
I got access; what do you want? CBC, trauma panel, tox screen, type and cross.
Call for a portable chest and let surgery know that they need to come down and do a trauma eval.
It's not my fault, I swear.
Let's get an ABG.
- Didn't call me back this morning.
- What? - You didn't call me back this morning.
- Morris is such a little bitch.
- What happened? - He's sending me home.
- What did you do? - I reduced a shoulder, that's what I did.
I don't get it.
I was trying to do what was safest for the patient, right? And then he shows up a-and he pulls this big power trip.
- So you went against him? - That's not the point.
- Well, it kind of is.
- Well, no, it kind of isn't.
It the point You know what? I don't even want to talk about it, forget it.
Why don't you just tell Morris you're sorry? - I'm not sorry.
- So what? - So what? I'm not a kiss ass.
- So you want to get written up? He doesn't have the balls to write me up.
- Neela.
- What? Since you've been ignoring Dr.
Crenshaw's pages, he asked me to read this to you.
"Get your ass into the trauma room, now.
" - I got to go.
- Where you going? - W-What'd you have to say to me? - Nothing.
I'll call you later.
Just go apologize to Morris.
- Suction! - All right, I'm in! - Bag him up.
- Sat's are in the 70s, Pratt.
- Blood gas is ugly.
PH only 7.
02.
- What's happening? He may have taken something that's making him acidotic.
There's no gap, but Hey, you know what? Listen, Todd.
It's very important you tell us the truth.
Did you guys take any pills? I told you, we were at orchestra practice all day.
- I can't bag him above 80.
- That's because of this.
Yikes.
What is that, pneumonia? Seems unlikely without a fever, but we got to cover it.
It hurts me when you ignore my pages, truly.
It wounds me to the core.
- You rang? - Yeah, we got a 14-year-old - with severe hypoxia and this film.
- Pneumonia? H and H is back.
Hemoglobin's 6.
2.
- Pulmonary hemorrhage.
- That's what I'm thinking.
- Any history of trauma? - We still don't know, - and his buddy's not being too helpful.
- I told you, I don't know anything.
Look, Todd, if you know something, you got to tell us right now.
- Hey, hey, Todd! Get back here! - All right, sonosite, please.
And a chest tube tray, sterile sixes and a ten blade.
What did you do to him? What did you do to him? - Nothing, I swear.
- Yeah? Then why are you running? You know, your friend could die? - He could? - Yes! Did you do something to him? I wanted the solo.
What did you do? I kept praying he'd get sick, but when that didn't work We did this experiment in chemistry where we used sulfur, and I saw what happens when you heated it up, so I figured eating it couldn't be good.
You You put it in his food? Listen, our school orchestra goes to Milwaukee tomorrow, and I wanted to play the solo.
I didn't mean for all of this to happen.
I'm sorry.
I'm sorry this didn't go the way we wanted.
Why don't you, uh just sign me out.
I have a plane to catch.
Diana, you can leave, but nothing's changed.
They're not gonna let you on that plane.
Well, why? We can send you home.
Hospice can bring you pain medications.
- No, but I'm not in pain.
- Not right now, but sometimes when people die this way, they get they get really uncomfortable.
Well, what can you do? Another para paracentesis? We can't we can't risk you bleeding.
Why can't Why can't I just fall asleep and not wake up? You've seen this.
It doesn't always work that way.
The fluid in your body is gonna continue to build up, and as it does, it'll compress your lungs and make it harder for you to breathe.
I'll feel like I'm drowning.
We're not gonna be able to get to everyone before the E.
R.
closes.
But what about my headache? - It could be a brain tumor.
- I can't wait till next week.
I've got the mother of all yeast infections.
I'm sorry to hear that, but you'll have to go find a doctor somewhere else.
- We've got a list of local clinics here.
- How long will the E.
R.
be closed? - We don't know.
- We need a room! - We're closed.
You guys know that.
- You got to take this.
No, we can't.
Turn around and go to Good Shepherd.
- No, listen, it's Dr.
Pratt's brother.
- Chaz? - He kind of overdid it.
- Somebody, I'm not feeling too good.
- What happened? - Happy hour overload.
- Hey, we need a gurney over here! - Trauma Two's open.
Sam, we got this.
Go give the nursing report on Diana.
- We got a bed for her upstairs.
- My appendix is bursting! - She's going home.
- No, she wants to be admitted.
What? To the hospital? - No.
She is not dying here.
- Sam, just make the call, okay? Hey, Sam, I got these kids doing fence plowing.
What the hell is that? A bunch of knuckleheads run full-speed into a fence and try to break it.
Do we have time to treat them? Hurry up; they have to be out of here in an hour.
- Hey, Pratt - Yep? You got to get to Trauma Two.
- Your brother's here.
- Yeah, I know, he's working.
- No, he's drunk.
- What? Demitri's parents just called.
He's got sickle cell.
- You're kidding.
- At least makes sense.
Yeah, means the white out is acute chest syndrome.
What's that? Um, Dr.
Barnett will explain everything.
Ray, take them upstairs, okay? - Where you going? - It's my brother.
All right, let's go.
I just spoke to Dr.
Kovac.
- It's okay.
- No, it isn't.
It's fine, Sam.
No, this isn't what you want.
It's the hospital vortex.
You said it yourself.
Come on, let me take you home.
We'll tell your friends to meet you there instead.
It's okay.
It's okay.
Don't say that.
Come on.
Sam, look, actually, there is no one, okay? I-I-I just I did my thing my whole life.
And I I didn't develop any real relationships, and I don't have any kids.
So Okay.
But you are still not doing this here.
Not like this.
Sam, I can't.
Look at me.
I can't do this alone.
Pulse ox is dropping.
- Breath sounds equal.
- Chaz, wake up.
- Breathe for us, buddy.
Come on.
- I have one beer.
Hell, I have four beers.
But 15 shots of tequila?! - It's a paramedic tradition.
- Yeah, tradition my ass! What the hell were you guys thinking?! - Sat's only 89.
He needs a tube.
- No! 15 liters oh-two by mask.
That's not gonna work if he's hypoventilating.
What are you, frat boys? You guys see people die from alcohol poisoning all the time.
- Yep, he's still got a gag.
- Barely.
Chaz, come on, man.
Chaz, hey! Pratt, his GCS is trending down and so are his sat's.
- We need to tube him.
- Not yet; he's arousable.
- See, look at that, he's talking.
- Mac two and an eight-oh.
I said no.
You're not putting a tube in my brother.
Once he aspirates, it's gonna be a mess.
- It's easy to extubate him later.
- I'm not putting him on a vent! Marquez, place an NG.
We'll evacuate his stomach so he can't aspirate.
- That's gonna make him vomit.
- Chaz, come on, wake up, man.
He better wake up or I'll kill you guys, I swear, I'll kill you.
Hey, come on.
Hey, hey.
Hey.
- I'm sorry.
- Sat's up to 92.
Good.
That's good.
- Let's put him on a non-rebreather.
- I'll call for a med-surge bed.
This is nice.
It's very chic.
Thank you.
Here.
Did you do all these? Uh yeah, mostly.
Some are friends.
I thought you had no friends.
Well, uh, kind of friends that you bunk with in Kabul, or let you sleep on their floor in Marrakech.
I haven't told them.
Diana? They'll read about it in the obit.
I bet you underestimate them.
That's Paul.
A week before the bomb went off.
I'm sorry.
Oh, here, let me help you.
Yeah, got you.
Sit down.
You know Sam? You don't have to You don't have to stay.
I'm sure you have a family to go home to.
Actually, uh, my son is away at school, so He's been, you know, having problems.
A picture? - What's that? - Picture? Yeah.
Yeah, I do.
Here.
There's Alex.
It's an old one, but he looks pretty much the same.
- Well, he's beautiful.
- Thanks.
I used to think you had to chose between family and career.
By the time I figured out you could have both, it was too late, 'cause I was I was already sick.
Yeah, well, I got pregnant at 14, so by the time I realized you could have a career, my kid was in preschool.
So, nursing isn't what you wanted? Uh, I actually never thought about what I wanted.
Feeding Alex was the reality.
It's never too late to choose.
You have time.
The room is ready for Mrs.
Sherman on Four South, and the surgical step down says they will make room for our pertussis kid.
Do you think it's a good idea to put a coughing toddler in a room with a bunch of surgical post-op patients? - No, but it's the only option.
- Dr.
Kovac - You can't send me out, Doc.
- can you sign this discharge? Look, we'll give you a taxi voucher to get to a shelter, okay? - Oh, you know what them shelters like.
- I'm afraid that's all we can offer.
You don't need to stay in the hospital.
Dr.
Barnett, I finished packing up Trauma One, and I found this.
Oh, it's a violin.
My patient must have left it.
- I'll take care of it, thanks.
- All right.
- Hey, how's he doing? - We're going to monitor him overnight.
Hey, you know if you get admitted, you can't be a paramedic? - Is he for real? - I'm afraid so.
- Oh, hell, no.
- It's a joke.
Sit your ass down.
Oh! What-What happened? His first day as an EMT.
Got initiated.
Damn traditions.
Um, I'll be up in a sec.
Hey, Betina, Betina? About earlier I'm sorry about how I came off.
"How you doing, girl?" "Maybe we could have dinner.
" - "Crack open a bottle of wine"? - Yes, yes, yes, but I do want to hear about your research.
Then you're going to have to read up like your buddy, Morris.
I'll do that, but I still want to take you out.
There's this E.
R.
department dinner next week, Thursday night.
An E.
R.
dinner? - You're kidding me.
- And I thought maybe afterwards, we could get a drink in a bar in a public spot.
Sounds better.
Come on, what do you say? Call me.
Hey, you forgot this.
Thanks.
Demitri's still not awake? Well, he's got a tough road ahead of him, but the disease did this to him, not you.
You sure? Yeah, I'm positive.
Sulfur doesn't make you sick, not like this.
- You know you got lucky.
- I know.
Look, when the time is right, you'll get the solo, okay? Have you ever felt, like, jealous? Wanted something someone else had? Sure.
Hey, but in the end, I believe people get what they deserve.
And if you're patient, and you're committed, then you can get what you want-- whatever you want-- whether that means a violin solo, or a better grade, or even a girl.
Sarah?! Sarah! - I didn't like Happy Feet.
- What? What kind of a kid are you? - Everybody likes Happy Feet.
- Well, I'm not everybody.
- Hey, you're home? - Yeah, I got off early.
- Where you guys been? - The video store.
We ran out of movies.
You know, if you want, you can join us.
We got a bunch of Jackie Chan movies.
- Charlie Chan.
- Okay, Charlie Chan.
Sarah, can you, uh, give Mike and I a second to talk? Sure.
- What's up? - What's in the thermos, Mike? - I haven't been drinking.
- So, what's in the thermos? I felt like having a little bit of orange juice.
- Yeah.
Prove it.
- What-- what's your problem? I don't have to prove a damn thing.
You need to relax.
I need to relax? You've been drinking while driving with Sarah? - I was not.
- Let's see.
- Let go of that.
- Give me that.
Let go.
That's it! I'm done with you! Tony! Come on, Tony.
It was only a little.
- You're out, you're moving out.
- We just went around the corner! - I should have never let you in.
- What are you doing? - I fall for this crap every time.
- Please, Tony, listen to me.
I'm done listening, too.
You're drunk.
- You'll always be a drunk.
- Come on, Tony.
Get out of my way.
Look, I'll change, okay? That's what you want.
- Yeah, how many times have I heard that? - Tony, what are you doing? - Stay here.
- Tony? I got a job.
Yeah, and the day the rent's due, you're going to go blow it at a bar.
- That's not true.
- It's true.
It's always true.
And you know what else? You weren't a fire chief.
You were a second-rate captain who got demoted because none of the other guys wanted to go into the fire with you.
- Son of a bitch.
- Face facts, old man-- you killed that rookie, didn't you? You left him.
You left him burning in that building, 'cause you were too out of it to go save him.
- Why don't you just face it? - You can't talk to me like that! You killed him.
You killed your career.
And the only way Mom could escape you was to die herself.
You did it, Dr.
Kovac.
I don't like this.
Hey, it's not all Mercedes and racquetball.
I know that, but I'm beginning to feel like the politics aren't worth the paycheck.
First you make me fire Weaver.
Then I spend half my time in BS meetings.
- I'm flooded with paperwork, and now this.
- Well, welcome to management, Luka.
This isn't me.
I'm resigning as Chief.
Luka, part of being the boss is being the bad guy.
I'll leave that to someone else.
I just want to be a doctor.
Have a good night.