ER s14e01 Episode Script
The War Comes Home
Thank you.
How's that done? Is that a staff meeting? That was fun.
Yeah, can't wait for the next one.
Don't know what this guy's up to.
It ain't gonna fly.
- Not sure there's anything we can do.
- Get Kovac to come back ASAP? Luka's not the chief anymore.
Moretti's the man now.
Well, someone should talk to Anspaugh.
- Me? Why me? - Come on, girl.
- I've seen that old Abby charm.
- Old? Anspaugh's not gonna give a damn that we don't like the new guy.
He's gonna say we haven't given him a chance.
Why? Because he's only been working here 13 hours? Hey, let's go grab a drink while we plan the revolution.
- I could use something to eat.
- You're buying.
Me? No, no, no, I'm not buying, and I'm not going.
Oh, come on.
Where's that old Pratt charm? Oh, maybe just one.
Hi.
Are you the charge nurse? Sent me down from the dean's office, I'm a new intern.
Interns don't start for another month, so you're early.
Actually, I'm late.
Like, almost a year.
Had some trouble last spring with the law.
But it's all good now, you can see here.
That's just me.
Kind of skyjewkuss, if you know what I mean.
- I don't.
- Ah.
Oh, it kind of means off-kilter, in case you were wondering.
I wasn't.
Hey, leave her alone now.
He's who you wanna talk to.
Are you Grady? Hi, I'm Kevin Moretti.
So you're my clod of unmolded clay.
My tabula rasa.
Aren't you new too? I heard you just took over, like, today.
Lesson number one, take no lessons from anybody here.
That's a paradox.
If I take no lessons from anyone here - " I" can't take lessons from you - Except from me, Grady.
Copy that, Rescue 49.
Blanket orders for C-spine, IVs, O2.
Multi-victim incident, some crowd trampling.
- Ten minutes out.
- Who's on? You got an R3, a junior, and your lump of Play-Doh there.
We'll take two patients.
I already accepted four majors and 10 minors.
That's standard protocol.
Good thing I showed up.
- Aah! - Sats are coming up.
You're doing better, Aaron.
You're okay.
We'll drop you off, then get back.
There's 50 more victims.
- Who picked up Neela? - I don't know.
- Could have been Dumar.
Check on it? - Sure, after we drop him off.
- Check on it now! - Aah! Hey, driver, mellow out up there.
It's okay, buddy.
Sorry.
Give me two of MS and a couple of rolls to stabilize.
Yeah, Bardelli in 93 is trying to locate a victim from the park.
- No problem.
- This will help so it won't move around.
- They sound busy.
- Are you gonna stick that in me again? No, it's just gonna go right in your Iv.
It's pain medication.
It won't hurt at all.
Yeah, a female doc, works at County.
- How old is she? - Twenty-nine.
Twenty-nine years old.
Name, Neela Rasgotra.
- What we need is a unified approach.
- Like what? Like a secret signal to each other " if" we don't agree with what Moretti's saying.
- What are we, like 8 years old? - No, I like it.
It's good.
Say we think an intubation is called for and Moretti disagrees I can look at Morris across the gurney and go like this: Heh.
Abby, don't encourage him, okay? Heh.
Oh, that can't be good.
Maybe we should get out of here before Moretti decides to Ah I knew I should have gone home.
Check, please.
Daniel Harrison, 58, chest pain.
ST elevation in leads two and three, shocked him for V-fib.
- Injuries? - I was running to get away.
- Heart.
He's - Aspirin, beta blockers, cath lab.
- We got a protocol.
- Grady, did you ever handle a STEMI? - I think so.
MORETTl: Stick with the nurse.
I want door-to-balloon time in under 60 minutes.
Candice Morgan, 16, bad crush injury to the chest.
Tachy to 120, pulse ox, 90, BP, 100/60.
- I can't breathe.
Multiple rib fractures.
Flail chest.
She got trampled? Public-address speaker fell on her.
Must weigh 200 pounds.
- Where do you want her? - Trauma 2.
Get her labs cooking.
I'll be right in.
- We heard there was a riot or something.
- Yes, you're back on.
Aaron Gonzalez, chest trauma, crushing to the pelvis.
- Gates, what you doing? - I was there, I saw him get hurt.
- Get it out, pull it out.
- You gotta see more doctors first.
- What is that? Piece of a protest sign.
- Doris, you see Neela? You with her? - Not me.
Hey, Bards, who took Neela? Who transported Neela? - Never heard.
- Neela got hurt? I tried to get to her but that kid was critical.
I had to stay.
- Maybe she didn't need an ambulance.
- Probably helping.
Guys, come on! We got another 10 victims coming in.
Gates, come on, let's go.
Pulse ox, 92 on 5 liters.
- Let's put her on a non-rebreather.
- Where are we? Paradoxical movement in the flail segment.
- X-ray's cooking.
- Don't place a chest tube Unless there's a definite hemothorax.
We know.
It hurts a lot.
Another four of morphine.
- No, you'll decrease her respiratory drive.
- What? She's in pain.
She'll need a good tidal volume.
Let's try an epidural.
Look, we can't wait for anesthesia to come down.
You don't have to.
I'm credentialed in the procedure.
- Call Central for a tray, please.
- My granddad, is he coming? - I'll be right back.
Does he know I'm here? "Patient ID?" - Rasgotra, Neela Rasgotra.
Patients are ID'd by run number, not name.
She's a doctor.
The drivers know her.
- A minute.
I'll run it.
MORETTl: How is he doing? Second intercostal space, midclavicular line.
- Another 500 of MS and fresh dressing.
Where's my mom? She's coming soon, buddy.
I resuscitated the kid in the field, told his mom I'd stay with him.
Where did they take all the other patients? - I need another two of Kerlix.
- Damn it, where is it? - Check the cart.
- Do your secondary survey.
Casualties were transported to multiple hospitals.
- Yeah, which ones? - Mercy, St.
Rafe's, Northwestern - Hey! - This kid needs your undivided attention.
Give it to him.
How's the pain, sir? - Still a nine.
Another nitro spray.
- When can the cath lab take him? - Five minutes.
- He's had a heparin bolus? - Oh, yeah.
MORETTl: Two B3A receptor blocker? - Sam? - Uh - Like abciximab? - Yeah.
- Eptifibatide? - Yeah.
Oh.
They give that to them sometimes down in the cath lab, but not here.
Well, they should.
If you believe The Journal of Cardiology that stuff can reduce in-hospital mortality by 50 percent.
- Very good.
Excuse me.
- Should bring that up with Dr.
Kayson.
- I will, don't worry.
- Dr.
Moretti.
- Mm-hm.
- This guy on a backboard is miserable.
- Pressure's down.
MORETTl: Titrate dopamine.
- Can you clear his neck? - No.
Give him a limited C-spine series.
Okay.
Lady in 3, dislocated hip.
- No, let one of the residents take her.
- They're all busy.
- Sam, start another IV.
- Doing it right now.
All right, a little prick here.
Four of morphine, tell her we'll get to her.
- How long? - Are you the attending? - Yeah.
Tell her we're busy.
- Foreign body to the eye, 10 pain.
Two drops of Alcaine.
- Where do you keep that? - You're asking me? I got floated from Surgery.
I don't know the ER.
- Channel 4's outside with a video crew.
- No, no.
Also, I got an elderly man with a bad nosebleed on Coumadin.
Just keep pressure on it for now.
Yes, this is County General ER, we're looking for a Neela Rasgotra.
I'm familiar with HIPAA, but she's one of our doctors.
Lab from Trauma 1.
You try calling Lutheran and Rush? Frank, no.
Try Ophthalmology, Cardiology and General Surgery.
Let's focus on the patients who are actually here and need our help.
You ready to do the epidural? I'll be right there.
- Chest film's back.
- Does it hurt, "mi hijo?" - I'm okay.
Morphine's on board.
- Lung's partially collapsed.
- Put a tube in to help it expand.
- Whatever it takes.
- You can step outside if you prefer.
No, I'll stay.
It's crazy.
I never worry about Aaron, just his brother.
Eddie is in the Army, in Iraq.
We went to the rally to support the troops.
To support Eddie.
All they hear are people saying we shouldn't be over there.
- How's the x-ray look? - Mom's consented to the chest tube.
Let's let Dr.
Lockhart do that procedure.
You're not on if I remember correctly.
- I'm happy to supervise.
- Dr.
Lockhart is a senior doctor.
It would be better for your son if she places the tube.
- Lf that's what you think.
- It is.
Excuse me.
- I don't think that guy likes you.
- Mm.
Bilateral hemothoraces.
- A little less than 200 cc's on each side.
- The grandfather is here.
- Jared Morgan.
MORETTl: Dr.
Moretti.
Did they explain the epidural to you? Yeah.
Will it hurt? You'll have a little burning with the local.
Okay, here it comes.
- Didn't you call Mom and Dad? - I couldn't get through.
Her parents are on an Alaskan cruise.
Spinal needle.
Okay, how do we find the epidural space? Feel for a pop in the ligamentum flavum.
MORETTl: Yeah.
And then we make sure that we're not through the dura.
- Then inject air.
MORETTl: All right.
How many ribs did she break? Five on each side.
And, bingo.
- Okay? - It was a peaceful demonstration.
MORETTl: Okay, relief is on its way.
Catheter.
I wanted to show her the power of people raising their voices in a democracy, and those Grandpa was teargassed at the '68 Democratic Convention.
- Heh-heh.
Right on.
- Yeah, yeah.
But then I worked on defending the Chicago Eight.
- Oh, an old peacenik, huh? - No justice, no peace.
Did I ever tell you how I was sitting right next to Bobby Seale the day the bailiffs chained him to his chair and gagged him? Only about 10 times.
And what did you learn from that? Okay, tape it.
- And we're done.
- It feels better.
Nice job.
Excellent.
Doctors Morris and Pratt, let's review the chest film.
Why do I smell ETOH on your breath? - Oh, we were off shift.
- Shh.
Yeah, we had less than half a beer.
- All right, you're done for the day.
- Are you serious? - Yeah, I can't have you working.
- Have you looked around? - Shh.
- We're getting slammed.
- It's too much of a liability.
- You were smart for calling us back in.
You really wanna act stupid now? Paramedics en route with a young woman, late 20s, in full arrest.
They're ready to call it.
Just FYI, Doctors Morris and Pratt will no longer be working today.
- Why? - It's just you and me.
Fifteen minutes of asystole.
She's done, not gonna make it.
- How long since the last epi? Three minutes.
- Two of atropine.
- Get her to Grady.
MORETTl: What have we got? - It's Neela.
Extensive crush injuries to the chest, abdomen, all four extremities.
Pressure's only 90/60.
- Hey, how you doing? I've been better.
MORETTl: Okay, well, the pupils are equal and reactive.
- What year is it, hon? - Oh-seven.
- Okay, good, let's go to Trauma 1.
- Oh, God, not the yellow room.
Let start with a lateral C-spine.
A waste of time if you're gonna pan scan her in CT.
Yeah, we're starting with the lateral, okay? - Four units of O-neg, set up central line.
MORETTl: Okay.
Ladies and gentlemen, evening rounds are on hold.
- Until when? - Until we get out from this.
- We're getting the bulk of the victims.
- Got an O.
R.
Open.
See it on the news? We need more.
I want three rooms, prepped, ready.
- I've got an elective gall bladder - Cancel case.
It's the ER, again.
- Herniorrhaphy? - Tomorrow at 7.
- Dr.
Dubenko - A minute.
Page both anesthesiologists.
- ER called.
- About to head down.
Make sure Ortho and Neurosurg are ready.
- They want you.
- On my way.
- Do you have nurses to staff the rooms? - Yes.
Get a perfusionist on standby, in case.
They have a major trauma victim downstairs.
It's Neela.
How much pain on a scale of 1 to 10? One.
- Give him your cell phone, Mommy.
What for? A picture.
The kids at school won't believe it.
All right, you ready? Here we go.
- A hundred cc's out so far.
- Good, he's not losing too much blood.
When's he going to surgery? - Soon, I hope.
- Can you call them again, please? - Yeah, yeah.
- Where are you going? - I need to talk to the surgeons.
One, two, three.
Trauma panel and catheterize urine.
- I'm sorry, we gotta.
- Bollocks.
Sats, 91 on 5 liters.
MORETTl: Get a capnograph on her.
- We don't have those.
- I brought one from ICU.
On the counter.
- Hey, I've been looking for you.
- Guess you found me.
- You're here for what reason? - I was waiting for Dubenko.
I need a consult on my chest impalement.
Well, he's not here.
- All right, well, maybe I can help.
- No, I don't think so.
- HemoCue, 9.
4 after fluids.
- All right, two units of O-neg.
I'm bleeding internally? - It's okay.
- You're in good hands.
Quick and concise, how is she? Hypotensive, anemic with abdominal pain.
Extensive crush injuries.
- Neela? - Thirsty, some water.
- Sats dropping.
MORETTl: CO2, 60.
Bag her, she's retaining.
- Etomidate, sux and an intubation tray.
- Maybe I can do a femoral, huh? Dr.
Gates, Aaron dropped his BP.
- Give him saline.
I'll be right in.
- No, go now.
Etomidate's in.
Neela, you're going to sleep.
- See you when you wake up, okay? MORETTl: Okay, here we go.
- How's it going here? Sixty over 40.
What's happening? Well, his pressure's low, and he's not bleeding in his chest.
I don't feel so good.
Is he bleeding somewhere else? What's happening? - More Compazine? - Give me that SonoSite.
- I'm suturing an arm lac.
That can wait.
- Gates, O.
R.
Can take him in 30 minutes.
- It needs to be sooner than that.
- How's Neela doing? - They seem to have it under control.
- You wanna help here? - I can't.
The idiot benched me.
- Hey, is that for Candice? - She's not doing good.
Hey, Chuny, wait up.
What are the sats? - Eighty-five on 100 percent.
- All right, start at 10 over five.
- Okay, the doctors are here.
Your lungs are bruised.
What we gotta do is give this pressure boost to help get more oxygen to your air sacs.
- Okay.
- The mask will go over your nose.
- It'll feel a little weird, okay? - Pratt, what are you doing? BiPAP for hypoxia, Morris.
- Well, Moretti is right next door.
- Yeah, I know.
- How's that? Better.
- Pulse ox is up to 94.
- Thank you.
Dr.
Pratt, I need a consult in sutures.
Excuse us a moment.
Come on, Morris, will you stop grabbing me? - Know what we should do? Be there with Neela.
Since we can't, we gonna fix as many patients as we can.
We need to draw blood-alcohol levels on each other.
You better get real.
We gotta prove to Moretti we're good to go.
You wanna get back in the game, you gotta pass the test.
- First two units are in.
- Systolic's up to 100.
PVCs, wide QRS.
- We got blood in Morrison's pouch.
- Liver laceration? Most likely.
We're going to the O.
R.
- Her heart's too irritable.
- Because she's bleeding.
- Can't screw around.
- She has to get to Surgery.
- She will.
What's her potassium? Not back.
- Get it back.
- Dr.
Dubenko, can you help me? - No, I can't.
- It's rhabdo, that's what it is.
Rhabdo.
Her potassium is sky high because of the crushed muscle.
- Amp of calcium now.
My kid has persistent hypotension.
Repeat a crit and chest film.
- Lf she has hyper K Gates, please.
- What is wrong with that guy? - He and Neela used to date.
Let's go.
We can manage electrolytes in the O.
R.
No, she will crash in the elevator.
Doctor, dislocated-hip lady's losing a foot pulse.
- Okay.
Kevin? JARvlK: I've got neck films.
- I've got - Okay, I got it, I got it, I got it.
- Abby, I need you out there.
Go.
- Type specifics up, units three and four.
Get her on a portable monitor.
We're out of here in two minutes.
That's it.
Okay, let's rush these to the lab, please.
- Greg, I need you in here.
- All right, okay.
What's happening? Well, sometimes the BiPAP isn't enough.
Intubation tray.
- We need to put her on a ventilator.
- Then she'll be okay? - Grandpa.
Induction meds are ready.
Seven-point-five tube.
Listen, when you wake up there's gonna be a tube in your throat to help you breathe, okay? Okay, hip's back in.
Check a post-reduction film and admit to Ortho.
Okay.
- Who's next? Nosebleed in the hall.
- Hi, I'm Dr.
Lockhart.
- Can you stop this? Let me see.
Okay, I'm gonna try.
All right, here we go.
Now, this is gonna feel a little bit slimy.
Did they find out who set off the bomb? I don't know.
I was walking by the park, like I do every day next thing I know, I'm on the ground.
Are you an intern? Need tube gauze for an avulsed toenail.
Okay, hang in there.
I'll be back to check you, all right? I'm not an intern.
I'm a third-year resident and the tube gauze is in Exam 2, center cabinet.
Heh.
Thanks.
Thanks a lot.
- Yeah.
Exam 2 is that way.
- Right.
- Second-degree bilateral forearm.
- How'd this happen? They were burning the flag.
I was trying to put it out.
Okay, Silvadene dressing and 10 of MS.
And nothing circumferential.
You're not gonna need surgery.
- Thank God for that.
- Here you go.
You'll be feeling better soon.
All right, my man, you might feel a little pressure here.
Is that a suprapubic catheter? Yeah, he must have torn his urethra.
His bladder's the size of a basketball.
- So he's not bleeding? - No, his bladder is distended " and" that's what's making his pressure drop.
Okay.
I'll tell Dubenko.
- Hey, how's Neela? - I don't know, been out here for a while.
You'll let me know? - Yup.
All right.
- Am I peeing? - Sort of.
Mom, quick, take another picture.
Get out of the way.
MORETTl: No.
- We're going.
- Bad idea.
- I'll call security.
MORETTl: I don't care.
- V-tach.
- This happens when you screw around.
- Three hundred charge.
- Clear.
- No change.
Resuming compressions.
MORETTl: Charge to 300.
All right, 100 of lido.
All right, clear.
- Sinus rhythm.
With a pulse.
- All right, clear the way, let's go.
- Nope, no.
- Potassium's 8.
1.
- Oh, my God.
CK's 9200.
- It is rhabdo.
Bicarb, insulin, glucose and Kayexalate.
Right away.
Keep urine output over 300 an hour or she'll renal failure.
Yours in a minute, Lucien.
Abby, on the floor.
I was just out there.
Well, then you go! - Excuse me? - I'm not leaving her.
I'm not leaving.
- Hang another liter of saline.
Blood? - Fourth unit's going in.
Send FFP upstairs, call O.
R.
, tell them we're on our way up.
Neela, you're intubated, and you're going for an ex-lap.
And I'm gonna stay with you, okay? You're doing great, Neela.
Hang in there.
Just hang in there.
Hang in there.
Did that impaled boy make it up okay? - Stable in O.
R.
2.
- Good, thank you.
Dr.
Moretti, can I present some patients? - Of course.
- Foreign body to the eye.
Now has total vision loss on the right.
- Complete loss? - A little light perception.
- For how long? - About 15 minutes.
- Why didn't you come and get me? - You were busy.
Hi, I'm Dr.
Moretti.
Can you close your good eye for me, please? Okay, how many fingers am I holding up? - I couldn't tell you.
- All right, give me that.
- Oh.
Irregular pupil.
- That's new.
It was reactive.
No, no, it's not a foreign body, it's a ruptured globe.
I tripped and some jerk stomped on my face.
Something penetrated your eyeball.
It's bleeding inside.
- Am I gonna be blind? - Not if surgery can correct it.
And the sooner the better.
All right, head of bed to 45 degrees.
Metal eye shield, gram of Ancef and stat page Ophtho.
- 4-0 Vicryl.
MORETTl: Gentlemen.
Hand service has been paged.
I did a Bier block, so he's feeling no pain.
- Great, I got it from here.
- No, we can do it, really.
In my pocket, labs on two of your favorite attendings.
Blood alcohol is less than 0.
01.
- They let airline pilots fly at that level.
- Shh.
Keep your voice down.
Another Vicryl, Dr.
Gates.
Sure.
Okay.
- How'd this happen? - I was cutting the lawn.
I was having problems with the mower.
I was running out of gas so I tried to refill the tank without shutting the engine off.
I don't really remember what happened.
I blacked out.
There's a reason it's called an internal combustion engine.
You managed to make it an external.
You gonna be able to sew my fingers back on? Do you have them? Good luck.
- She's bleeding inside her lungs.
- Oh, my God, How do you stop that? You just have to wait for it to heal.
This low-pressure vent will help.
All set.
- Dr.
Pratt.
Hey, don't even start, man.
I'm serious, okay? I'm working on my patient.
- She needs constant attention - Relax, I talked to Dr.
Morris.
- I saw the blood tests.
Relax.
- All right, good.
We got severe pulmonary contusions, hypoxia with PEEP.
- And we switched to an oscillator.
- You can be better utilized outside.
Have you taken a look at the x-ray? Patient is critical.
So are 10 other patients who have a chance.
You're wasting time and resources trying to save a dead girl.
- Excuse me.
What does that mean? - I'm sorry, I didn't know you were there.
- Okay.
- Okay.
With the extent of her hemorrhaging, her chances of survival are almost nil.
- So, what? You just give up on her? - We're not giving up.
- We're giving her the best care.
- Leave.
I don't want you in here.
He's doing fine.
- Please, continue.
- I will.
- She's bradying down.
Lost her pulse.
- All right, PEA.
- She was fine until you came in here.
Sir, please get out of the way.
- This is your fault.
- All right, get out of the way.
Amp of atropine.
Kocher clamps.
Buzz here.
How about the cell saver? Ready to go.
Metz.
Couple of Richardsons.
Let's go.
Into the peritoneum.
Oh, my God.
We're on it.
- Suction, Dusty.
Got it.
Another suction line.
Keep packs coming.
Yankauer's not gonna do it.
Pool sucker.
Systolic's down to 60.
Clots in left upper quadrant.
Pack off the spleen.
No, she had impact on the right.
Pack the liver first.
- And that's your call.
- Yeah, damn right it is.
Yeah, okay.
Please have somebody call down if you hear anything.
Is she out of surgery? Yo, Taggart.
Got a live one for you.
Found him in the street, directing traffic.
Well, I was just trying to calm the masses.
There was so much negative energy that nobody could feel the universal connection that we all have.
- Right, what are you on, buddy? - Oh, no.
You know, when I touch you like this we are exchanging matter on a subatomic particle level.
I don't know where your atoms have been.
Keep them to yourself.
- What's this? - I'm thinking acid trip.
Oh, you would be wrong.
LSD is a man-made chemical and psilocybin is a gift from God.
- Oh-ho.
The magic of mushrooms.
- Yes, that is corr Look at this.
Your shirt is breathing.
All right, you're freaking him out.
Ho.
No.
- How's your doctor friend doing? - It's too soon to tell.
- We're all thinking about her.
- Thanks.
Ho-ho.
Oh, this is so good.
No, don't stop.
Excuse me.
Do you have any medical problems? No.
My skin becomes transparent, occasionally.
I can see my organs, but I'll going to get a urine tox screen and find him a comfy bed.
- Dive, dive! - Don't touch that.
You'd better hold my hand if you don't want me to just float away.
- I'll hold your hand, sir.
- Oh.
I can feel the love you have for your friend.
- It's beautiful.
- Any other victims? - No, I think we got most of them.
- No shrapnel or blast injuries? - It wasn't a bomb.
- There was an explosion.
I heard it.
- People saw smoke.
It was on the news.
- Bomb squad figures it was some guy setting off fireworks or something.
Well, it had to be at least an M-80.
Whatever it was, it wasn't the terrorists.
Not today.
Complex, stellate liver laceration.
It's a bear-claw injury.
You'll never repair that.
What? Why? What do you mean? Bovie.
Bleeding too briskly.
Bovie can't even coagulate.
- Well, what else can you do? - Get me the argon-beam coagulator.
The thing to do is pack up the liver, put in a Bogota bag, close her up.
We'll come back in two days for repair.
- Two days? - No.
I don't want biliary leaks or abscess formation.
Lap pads.
- Can't screw around while she bleeds.
- You can't try to repair the liver? We would have to clamp the artery less than an hour before the liver died.
- Can you do it in an hour? - No.
Yes, yes, we can try.
Where's my argon? - Ready in a minute.
Stop.
- You're not helping.
- That makes two of us.
- I don't know what you're getting at.
- Doctor.
Perhaps you should just shut up, both of you.
Lucien, can the repair be done? - Yeah, yes, it can.
- Okay.
Dr.
Crenshaw's gonna do it.
What? - You're too close to this.
You know I'm right so let him operate you'll assist and I'll keep time, okay? Okay, you.
- How's it going here? - Hand service can take him in an hour.
Good.
- Can I get something to drink? Chuny, why don't you get him some ice chips.
All right.
So whose? Whose lawn were you cutting? - Mine.
- Yours.
All right.
Says here you live on Halstead.
Not a lot of lawns out there on Halstead, right? There's some grass around the building, on the side.
Right.
So, what are you, the super? No, but sometimes I help out.
So you help out the super cut the lawns on the side of the? - He's old.
I feel sorry for him.
- Yeah.
You know, there are a lot of hospitals between Halstead and County.
- That's my stuff.
- Right.
I stopped by a friend's house around here.
She told me I needed to go to the hospital.
- What are you doing? - Doesn't smell like gasoline, does it? - Smell that.
That smell like gasoline? - No.
I didn't spill it.
- Does it smell like gas? - No! Smells like black powder, doesn't it? What's this? A lighter.
Your chart says you don't smoke, but what's that? What was it? M-80? Cherry bomb? What? - Where you going? - You're crazy.
- Get back in bed.
- No.
What are you doing? - Where the docs don't sniff your - Oh, yeah? - What's your problem? - You know what my problem is, ass? All these people are here because of you.
Look at this girl.
Look at that girl.
You see that? This is your fault.
Look at him.
Look at him, huh? That's because of you.
Tony! - What are you doing? This guy, you see him? - Tony, calm down.
Use your brain.
You killed people.
Do you understand? Look over there.
Look at that little girl.
You killed that girl.
All right? You killed people.
You understand that? Are you supposed to be a tough guy? Where'd you hear that? - Oh, I don't know.
Word on the street.
- Mm.
Seems you have a history of violence whenever your vocabulary is overtaxed.
That happens with alarming frequency.
Look around.
Every bed has a patient because of that jackass.
- Not to mention Dr.
Rasgotra.
- Yeah.
Not to mention.
You think a dalliance with a coworker mitigates the situation? - Is that what you think? - I don't know.
- You don't know.
It doesn't.
- Hmm.
You attacked a patient.
Who caused a riot that messed up a lot of people.
That has been established.
For what? For nothing.
Because he thought it was fun.
I don't care! I don't care! I don't care if he attacked your crippled, blind mother.
You are not gonna get away with this stuff anymore.
- You understand me? - Yeah.
- Do you? - Yes, sir, I do.
I will check myself next time this happens.
- You can check yourself in the ICU.
- What? There are lots of lessons for a guy like you up there.
Trust me.
- You're kidding? - No, I'm not kidding you.
The ICU forces one especially an ex-paramedic, ER doc like yourself to slow down and to think.
People are dying up there, often in excruciatingly slow ways " so" you won't really have much choice.
We're at 52 minutes.
Okay, release the Pringle.
Let's see if the dam holds.
- How's the liver look? Not bad.
Not bad at all.
Minimal oozing.
Systolic's holding at 110.
- It was a sound approach, Lucien.
- Well, you executed it well.
Let's hope that her brain was sufficiently perfused.
We'll see how she wakes up.
Dr.
Crenshaw, brachial artery repair is ready for you in 2.
- Care to finish? - Yes, I would.
A few big liver sutures and simple closure.
I'll be in O.
R.
2 if you need me.
And I have to get back downstairs.
So I'll "just " I'll check on her later.
Okay.
I'll let you know when she's in Recovery.
What's the word on Neela? She took 10 units of blood.
Yeah, they're still working on her.
Take a deep breath and let it out.
Another deep breath.
Let it out.
Now you're gonna feel some discomfort " but" it's not going to bother you, because you're in your safe place.
Hey, you old stoner, what are you doing? Well, it's a Colles' fracture, I've reduced and casted.
What? You what? This is embarrassing.
I've neglected to introduce myself properly.
I am James Broderick.
I'm the chair of Orthopedics at St.
Raphael's Hospital.
You're a doctor? One of the leading orthopods in the country, yes.
- And you are doctor? - Morris.
- Morris, yes.
- Why don't we get you back to a bed.
And maybe it's best if you don't touch anyone else.
I don't mean to brag, but I am here now.
And there are those who feel I have a certain gift.
Well, save it for Christmas.
We're good at this ourselves.
You're not licensed to practice in this hospital.
Will you show this gentleman back to his bed, please? - This way, sir.
- Sure.
But I am internationally renowned.
Don't let him drift away.
He's on a beach.
- Look at that cast.
It's perfect.
- Looks nice.
- I didn't do it.
- Who did? - A patient.
- Fast learner.
Hey, I heard Moretti reassigned you.
I'm sorry.
- It's only temporary.
- I'm sure.
So, what's happening in surgery? She's had a hard time maintaining her BP.
- They said she's in renal failure.
- I'm calling.
No, you're not.
They're in the middle of surgery.
Let them do their thing.
- Who's there with her? - Crenshaw and Dubenko.
- She's in good hands.
- Abby's there too.
Not anymore.
Is she all right? Yeah.
She in Recovery? They just They repaired the liver.
Her vitals are stable, and Dubenko was closing up.
- She awake? - Not yet.
With the arrest and hypotension, probably be a while.
Yeah, that's what they said.
- Well, that's great.
- Yeah.
All right, where's Mussolini? He said he needed me down here.
He gave me these to give you.
You're not to see "him " until they are all disposed.
- Okay.
Thank you.
Mm.
All right, watch your step.
Easy now.
Melman? Melman.
Where the hell did we put Melman? You're not lost, are you? - Lf you need directions, you know - No, no.
You know why we're here? Because of war.
Without it, you would be a pediatrician or an oncologist " and" I'd probably still be losing my mind in the ICU.
- War, huh? - Mm-hm.
Emergency medicine is actually the result of centuries of warfare.
It's a field that was defined by doctors and nurses in bombed-out buildings trying to take care of patients on dirty canvas stretchers.
And performing procedures in tent hospitals that were literally hundreds of feet away from where the battles raged.
And these people, our predecessors they had a simple primary focus.
Survival.
And down in the bunkers, they dug in deep " to" try to save their patient's lives, and to try to save their own lives.
And they ended up giving life to this whole new art form this great collaborative enterprise that we still carry on today.
That's why we're here.
You don't get out much, do you? If you can't take the bunker, get out of the trauma room.
Ha.
I hope, I hope you're not talking about me.
Heh.
No.
If I can't manage this floor during a mass-cas then what good am I? Every day is not the bunker.
Most days aren't, in fact.
Thank God.
I guess every war teaches us something, right? I wonder what we'll learn from this one.
Hey, stop it.
- Somebody call Security.
Stop that.
You son of a bitch.
- Get off of him.
You killed her.
MORETTl: Hey, come on, come on.
You killed her.
- You son of a bitch.
MORETTl: Come here.
- You MORETTl: Hey, hey.
Hey, hey, hey.
You killed her.
MORETTl: Come here.
You stupid You killed her.
- Stop.
- You Let me go.
Sir.
Sir? Not responsive.
No pulse.
- He's not breathing.
She's ready for an ABG on 5 liters.
No problem.
- Hey, how's she doing? - Pressure's up, hematocrit's 32.
- Hi, Mayday.
- That's good.
She'll be sleeping for a while.
It's probably best if you wait out here.
I have several pages of postop orders to write.
Be an hour before she's ready for visitors.
I'll just I'll wait out here, okay? - Check a repeat HemoCue in 15 minutes.
- Got it.
You gonna write those postop orders now? No, I already did.
It's all on the chart.
No, call PR.
That's extension 456.
County, hello? Extension 456.
Hello? Didn't I just talk to you and tell you we already have digital television? Criminy.
Telemarketers.
Hey, Frank.
Heard Neela's in recovery.
Yeah.
I have confirmation on that.
Is she awake? - Negative.
- Look, it's irrelevant, right? - Yeah, it doesn't mean anything.
I mean, it'd be weird if she was awake this soon.
- Absolutely.
- Sam was about to go up there.
She wondered if anybody wanted to go with her.
Any news? Vitals are stable, crits are okay.
- She hasn't woken up yet.
- How much longer is it gonna be? Oh, waking up takes awhile after all that anesthesia.
- Hey.
- Hey.
- Has anybody seen her? - I saw her on her way to Recovery.
- She looked okay.
- Can we go in? Not yet.
Dubenko said he'll let us know.
So I guess we wait.
I'm calling for pizza.
Who's in? - Cool.
Pratt, you buying? - No, no, I'm not.
- Sure, you are.
- You got cash, right? Morris
How's that done? Is that a staff meeting? That was fun.
Yeah, can't wait for the next one.
Don't know what this guy's up to.
It ain't gonna fly.
- Not sure there's anything we can do.
- Get Kovac to come back ASAP? Luka's not the chief anymore.
Moretti's the man now.
Well, someone should talk to Anspaugh.
- Me? Why me? - Come on, girl.
- I've seen that old Abby charm.
- Old? Anspaugh's not gonna give a damn that we don't like the new guy.
He's gonna say we haven't given him a chance.
Why? Because he's only been working here 13 hours? Hey, let's go grab a drink while we plan the revolution.
- I could use something to eat.
- You're buying.
Me? No, no, no, I'm not buying, and I'm not going.
Oh, come on.
Where's that old Pratt charm? Oh, maybe just one.
Hi.
Are you the charge nurse? Sent me down from the dean's office, I'm a new intern.
Interns don't start for another month, so you're early.
Actually, I'm late.
Like, almost a year.
Had some trouble last spring with the law.
But it's all good now, you can see here.
That's just me.
Kind of skyjewkuss, if you know what I mean.
- I don't.
- Ah.
Oh, it kind of means off-kilter, in case you were wondering.
I wasn't.
Hey, leave her alone now.
He's who you wanna talk to.
Are you Grady? Hi, I'm Kevin Moretti.
So you're my clod of unmolded clay.
My tabula rasa.
Aren't you new too? I heard you just took over, like, today.
Lesson number one, take no lessons from anybody here.
That's a paradox.
If I take no lessons from anyone here - " I" can't take lessons from you - Except from me, Grady.
Copy that, Rescue 49.
Blanket orders for C-spine, IVs, O2.
Multi-victim incident, some crowd trampling.
- Ten minutes out.
- Who's on? You got an R3, a junior, and your lump of Play-Doh there.
We'll take two patients.
I already accepted four majors and 10 minors.
That's standard protocol.
Good thing I showed up.
- Aah! - Sats are coming up.
You're doing better, Aaron.
You're okay.
We'll drop you off, then get back.
There's 50 more victims.
- Who picked up Neela? - I don't know.
- Could have been Dumar.
Check on it? - Sure, after we drop him off.
- Check on it now! - Aah! Hey, driver, mellow out up there.
It's okay, buddy.
Sorry.
Give me two of MS and a couple of rolls to stabilize.
Yeah, Bardelli in 93 is trying to locate a victim from the park.
- No problem.
- This will help so it won't move around.
- They sound busy.
- Are you gonna stick that in me again? No, it's just gonna go right in your Iv.
It's pain medication.
It won't hurt at all.
Yeah, a female doc, works at County.
- How old is she? - Twenty-nine.
Twenty-nine years old.
Name, Neela Rasgotra.
- What we need is a unified approach.
- Like what? Like a secret signal to each other " if" we don't agree with what Moretti's saying.
- What are we, like 8 years old? - No, I like it.
It's good.
Say we think an intubation is called for and Moretti disagrees I can look at Morris across the gurney and go like this: Heh.
Abby, don't encourage him, okay? Heh.
Oh, that can't be good.
Maybe we should get out of here before Moretti decides to Ah I knew I should have gone home.
Check, please.
Daniel Harrison, 58, chest pain.
ST elevation in leads two and three, shocked him for V-fib.
- Injuries? - I was running to get away.
- Heart.
He's - Aspirin, beta blockers, cath lab.
- We got a protocol.
- Grady, did you ever handle a STEMI? - I think so.
MORETTl: Stick with the nurse.
I want door-to-balloon time in under 60 minutes.
Candice Morgan, 16, bad crush injury to the chest.
Tachy to 120, pulse ox, 90, BP, 100/60.
- I can't breathe.
Multiple rib fractures.
Flail chest.
She got trampled? Public-address speaker fell on her.
Must weigh 200 pounds.
- Where do you want her? - Trauma 2.
Get her labs cooking.
I'll be right in.
- We heard there was a riot or something.
- Yes, you're back on.
Aaron Gonzalez, chest trauma, crushing to the pelvis.
- Gates, what you doing? - I was there, I saw him get hurt.
- Get it out, pull it out.
- You gotta see more doctors first.
- What is that? Piece of a protest sign.
- Doris, you see Neela? You with her? - Not me.
Hey, Bards, who took Neela? Who transported Neela? - Never heard.
- Neela got hurt? I tried to get to her but that kid was critical.
I had to stay.
- Maybe she didn't need an ambulance.
- Probably helping.
Guys, come on! We got another 10 victims coming in.
Gates, come on, let's go.
Pulse ox, 92 on 5 liters.
- Let's put her on a non-rebreather.
- Where are we? Paradoxical movement in the flail segment.
- X-ray's cooking.
- Don't place a chest tube Unless there's a definite hemothorax.
We know.
It hurts a lot.
Another four of morphine.
- No, you'll decrease her respiratory drive.
- What? She's in pain.
She'll need a good tidal volume.
Let's try an epidural.
Look, we can't wait for anesthesia to come down.
You don't have to.
I'm credentialed in the procedure.
- Call Central for a tray, please.
- My granddad, is he coming? - I'll be right back.
Does he know I'm here? "Patient ID?" - Rasgotra, Neela Rasgotra.
Patients are ID'd by run number, not name.
She's a doctor.
The drivers know her.
- A minute.
I'll run it.
MORETTl: How is he doing? Second intercostal space, midclavicular line.
- Another 500 of MS and fresh dressing.
Where's my mom? She's coming soon, buddy.
I resuscitated the kid in the field, told his mom I'd stay with him.
Where did they take all the other patients? - I need another two of Kerlix.
- Damn it, where is it? - Check the cart.
- Do your secondary survey.
Casualties were transported to multiple hospitals.
- Yeah, which ones? - Mercy, St.
Rafe's, Northwestern - Hey! - This kid needs your undivided attention.
Give it to him.
How's the pain, sir? - Still a nine.
Another nitro spray.
- When can the cath lab take him? - Five minutes.
- He's had a heparin bolus? - Oh, yeah.
MORETTl: Two B3A receptor blocker? - Sam? - Uh - Like abciximab? - Yeah.
- Eptifibatide? - Yeah.
Oh.
They give that to them sometimes down in the cath lab, but not here.
Well, they should.
If you believe The Journal of Cardiology that stuff can reduce in-hospital mortality by 50 percent.
- Very good.
Excuse me.
- Should bring that up with Dr.
Kayson.
- I will, don't worry.
- Dr.
Moretti.
- Mm-hm.
- This guy on a backboard is miserable.
- Pressure's down.
MORETTl: Titrate dopamine.
- Can you clear his neck? - No.
Give him a limited C-spine series.
Okay.
Lady in 3, dislocated hip.
- No, let one of the residents take her.
- They're all busy.
- Sam, start another IV.
- Doing it right now.
All right, a little prick here.
Four of morphine, tell her we'll get to her.
- How long? - Are you the attending? - Yeah.
Tell her we're busy.
- Foreign body to the eye, 10 pain.
Two drops of Alcaine.
- Where do you keep that? - You're asking me? I got floated from Surgery.
I don't know the ER.
- Channel 4's outside with a video crew.
- No, no.
Also, I got an elderly man with a bad nosebleed on Coumadin.
Just keep pressure on it for now.
Yes, this is County General ER, we're looking for a Neela Rasgotra.
I'm familiar with HIPAA, but she's one of our doctors.
Lab from Trauma 1.
You try calling Lutheran and Rush? Frank, no.
Try Ophthalmology, Cardiology and General Surgery.
Let's focus on the patients who are actually here and need our help.
You ready to do the epidural? I'll be right there.
- Chest film's back.
- Does it hurt, "mi hijo?" - I'm okay.
Morphine's on board.
- Lung's partially collapsed.
- Put a tube in to help it expand.
- Whatever it takes.
- You can step outside if you prefer.
No, I'll stay.
It's crazy.
I never worry about Aaron, just his brother.
Eddie is in the Army, in Iraq.
We went to the rally to support the troops.
To support Eddie.
All they hear are people saying we shouldn't be over there.
- How's the x-ray look? - Mom's consented to the chest tube.
Let's let Dr.
Lockhart do that procedure.
You're not on if I remember correctly.
- I'm happy to supervise.
- Dr.
Lockhart is a senior doctor.
It would be better for your son if she places the tube.
- Lf that's what you think.
- It is.
Excuse me.
- I don't think that guy likes you.
- Mm.
Bilateral hemothoraces.
- A little less than 200 cc's on each side.
- The grandfather is here.
- Jared Morgan.
MORETTl: Dr.
Moretti.
Did they explain the epidural to you? Yeah.
Will it hurt? You'll have a little burning with the local.
Okay, here it comes.
- Didn't you call Mom and Dad? - I couldn't get through.
Her parents are on an Alaskan cruise.
Spinal needle.
Okay, how do we find the epidural space? Feel for a pop in the ligamentum flavum.
MORETTl: Yeah.
And then we make sure that we're not through the dura.
- Then inject air.
MORETTl: All right.
How many ribs did she break? Five on each side.
And, bingo.
- Okay? - It was a peaceful demonstration.
MORETTl: Okay, relief is on its way.
Catheter.
I wanted to show her the power of people raising their voices in a democracy, and those Grandpa was teargassed at the '68 Democratic Convention.
- Heh-heh.
Right on.
- Yeah, yeah.
But then I worked on defending the Chicago Eight.
- Oh, an old peacenik, huh? - No justice, no peace.
Did I ever tell you how I was sitting right next to Bobby Seale the day the bailiffs chained him to his chair and gagged him? Only about 10 times.
And what did you learn from that? Okay, tape it.
- And we're done.
- It feels better.
Nice job.
Excellent.
Doctors Morris and Pratt, let's review the chest film.
Why do I smell ETOH on your breath? - Oh, we were off shift.
- Shh.
Yeah, we had less than half a beer.
- All right, you're done for the day.
- Are you serious? - Yeah, I can't have you working.
- Have you looked around? - Shh.
- We're getting slammed.
- It's too much of a liability.
- You were smart for calling us back in.
You really wanna act stupid now? Paramedics en route with a young woman, late 20s, in full arrest.
They're ready to call it.
Just FYI, Doctors Morris and Pratt will no longer be working today.
- Why? - It's just you and me.
Fifteen minutes of asystole.
She's done, not gonna make it.
- How long since the last epi? Three minutes.
- Two of atropine.
- Get her to Grady.
MORETTl: What have we got? - It's Neela.
Extensive crush injuries to the chest, abdomen, all four extremities.
Pressure's only 90/60.
- Hey, how you doing? I've been better.
MORETTl: Okay, well, the pupils are equal and reactive.
- What year is it, hon? - Oh-seven.
- Okay, good, let's go to Trauma 1.
- Oh, God, not the yellow room.
Let start with a lateral C-spine.
A waste of time if you're gonna pan scan her in CT.
Yeah, we're starting with the lateral, okay? - Four units of O-neg, set up central line.
MORETTl: Okay.
Ladies and gentlemen, evening rounds are on hold.
- Until when? - Until we get out from this.
- We're getting the bulk of the victims.
- Got an O.
R.
Open.
See it on the news? We need more.
I want three rooms, prepped, ready.
- I've got an elective gall bladder - Cancel case.
It's the ER, again.
- Herniorrhaphy? - Tomorrow at 7.
- Dr.
Dubenko - A minute.
Page both anesthesiologists.
- ER called.
- About to head down.
Make sure Ortho and Neurosurg are ready.
- They want you.
- On my way.
- Do you have nurses to staff the rooms? - Yes.
Get a perfusionist on standby, in case.
They have a major trauma victim downstairs.
It's Neela.
How much pain on a scale of 1 to 10? One.
- Give him your cell phone, Mommy.
What for? A picture.
The kids at school won't believe it.
All right, you ready? Here we go.
- A hundred cc's out so far.
- Good, he's not losing too much blood.
When's he going to surgery? - Soon, I hope.
- Can you call them again, please? - Yeah, yeah.
- Where are you going? - I need to talk to the surgeons.
One, two, three.
Trauma panel and catheterize urine.
- I'm sorry, we gotta.
- Bollocks.
Sats, 91 on 5 liters.
MORETTl: Get a capnograph on her.
- We don't have those.
- I brought one from ICU.
On the counter.
- Hey, I've been looking for you.
- Guess you found me.
- You're here for what reason? - I was waiting for Dubenko.
I need a consult on my chest impalement.
Well, he's not here.
- All right, well, maybe I can help.
- No, I don't think so.
- HemoCue, 9.
4 after fluids.
- All right, two units of O-neg.
I'm bleeding internally? - It's okay.
- You're in good hands.
Quick and concise, how is she? Hypotensive, anemic with abdominal pain.
Extensive crush injuries.
- Neela? - Thirsty, some water.
- Sats dropping.
MORETTl: CO2, 60.
Bag her, she's retaining.
- Etomidate, sux and an intubation tray.
- Maybe I can do a femoral, huh? Dr.
Gates, Aaron dropped his BP.
- Give him saline.
I'll be right in.
- No, go now.
Etomidate's in.
Neela, you're going to sleep.
- See you when you wake up, okay? MORETTl: Okay, here we go.
- How's it going here? Sixty over 40.
What's happening? Well, his pressure's low, and he's not bleeding in his chest.
I don't feel so good.
Is he bleeding somewhere else? What's happening? - More Compazine? - Give me that SonoSite.
- I'm suturing an arm lac.
That can wait.
- Gates, O.
R.
Can take him in 30 minutes.
- It needs to be sooner than that.
- How's Neela doing? - They seem to have it under control.
- You wanna help here? - I can't.
The idiot benched me.
- Hey, is that for Candice? - She's not doing good.
Hey, Chuny, wait up.
What are the sats? - Eighty-five on 100 percent.
- All right, start at 10 over five.
- Okay, the doctors are here.
Your lungs are bruised.
What we gotta do is give this pressure boost to help get more oxygen to your air sacs.
- Okay.
- The mask will go over your nose.
- It'll feel a little weird, okay? - Pratt, what are you doing? BiPAP for hypoxia, Morris.
- Well, Moretti is right next door.
- Yeah, I know.
- How's that? Better.
- Pulse ox is up to 94.
- Thank you.
Dr.
Pratt, I need a consult in sutures.
Excuse us a moment.
Come on, Morris, will you stop grabbing me? - Know what we should do? Be there with Neela.
Since we can't, we gonna fix as many patients as we can.
We need to draw blood-alcohol levels on each other.
You better get real.
We gotta prove to Moretti we're good to go.
You wanna get back in the game, you gotta pass the test.
- First two units are in.
- Systolic's up to 100.
PVCs, wide QRS.
- We got blood in Morrison's pouch.
- Liver laceration? Most likely.
We're going to the O.
R.
- Her heart's too irritable.
- Because she's bleeding.
- Can't screw around.
- She has to get to Surgery.
- She will.
What's her potassium? Not back.
- Get it back.
- Dr.
Dubenko, can you help me? - No, I can't.
- It's rhabdo, that's what it is.
Rhabdo.
Her potassium is sky high because of the crushed muscle.
- Amp of calcium now.
My kid has persistent hypotension.
Repeat a crit and chest film.
- Lf she has hyper K Gates, please.
- What is wrong with that guy? - He and Neela used to date.
Let's go.
We can manage electrolytes in the O.
R.
No, she will crash in the elevator.
Doctor, dislocated-hip lady's losing a foot pulse.
- Okay.
Kevin? JARvlK: I've got neck films.
- I've got - Okay, I got it, I got it, I got it.
- Abby, I need you out there.
Go.
- Type specifics up, units three and four.
Get her on a portable monitor.
We're out of here in two minutes.
That's it.
Okay, let's rush these to the lab, please.
- Greg, I need you in here.
- All right, okay.
What's happening? Well, sometimes the BiPAP isn't enough.
Intubation tray.
- We need to put her on a ventilator.
- Then she'll be okay? - Grandpa.
Induction meds are ready.
Seven-point-five tube.
Listen, when you wake up there's gonna be a tube in your throat to help you breathe, okay? Okay, hip's back in.
Check a post-reduction film and admit to Ortho.
Okay.
- Who's next? Nosebleed in the hall.
- Hi, I'm Dr.
Lockhart.
- Can you stop this? Let me see.
Okay, I'm gonna try.
All right, here we go.
Now, this is gonna feel a little bit slimy.
Did they find out who set off the bomb? I don't know.
I was walking by the park, like I do every day next thing I know, I'm on the ground.
Are you an intern? Need tube gauze for an avulsed toenail.
Okay, hang in there.
I'll be back to check you, all right? I'm not an intern.
I'm a third-year resident and the tube gauze is in Exam 2, center cabinet.
Heh.
Thanks.
Thanks a lot.
- Yeah.
Exam 2 is that way.
- Right.
- Second-degree bilateral forearm.
- How'd this happen? They were burning the flag.
I was trying to put it out.
Okay, Silvadene dressing and 10 of MS.
And nothing circumferential.
You're not gonna need surgery.
- Thank God for that.
- Here you go.
You'll be feeling better soon.
All right, my man, you might feel a little pressure here.
Is that a suprapubic catheter? Yeah, he must have torn his urethra.
His bladder's the size of a basketball.
- So he's not bleeding? - No, his bladder is distended " and" that's what's making his pressure drop.
Okay.
I'll tell Dubenko.
- Hey, how's Neela? - I don't know, been out here for a while.
You'll let me know? - Yup.
All right.
- Am I peeing? - Sort of.
Mom, quick, take another picture.
Get out of the way.
MORETTl: No.
- We're going.
- Bad idea.
- I'll call security.
MORETTl: I don't care.
- V-tach.
- This happens when you screw around.
- Three hundred charge.
- Clear.
- No change.
Resuming compressions.
MORETTl: Charge to 300.
All right, 100 of lido.
All right, clear.
- Sinus rhythm.
With a pulse.
- All right, clear the way, let's go.
- Nope, no.
- Potassium's 8.
1.
- Oh, my God.
CK's 9200.
- It is rhabdo.
Bicarb, insulin, glucose and Kayexalate.
Right away.
Keep urine output over 300 an hour or she'll renal failure.
Yours in a minute, Lucien.
Abby, on the floor.
I was just out there.
Well, then you go! - Excuse me? - I'm not leaving her.
I'm not leaving.
- Hang another liter of saline.
Blood? - Fourth unit's going in.
Send FFP upstairs, call O.
R.
, tell them we're on our way up.
Neela, you're intubated, and you're going for an ex-lap.
And I'm gonna stay with you, okay? You're doing great, Neela.
Hang in there.
Just hang in there.
Hang in there.
Did that impaled boy make it up okay? - Stable in O.
R.
2.
- Good, thank you.
Dr.
Moretti, can I present some patients? - Of course.
- Foreign body to the eye.
Now has total vision loss on the right.
- Complete loss? - A little light perception.
- For how long? - About 15 minutes.
- Why didn't you come and get me? - You were busy.
Hi, I'm Dr.
Moretti.
Can you close your good eye for me, please? Okay, how many fingers am I holding up? - I couldn't tell you.
- All right, give me that.
- Oh.
Irregular pupil.
- That's new.
It was reactive.
No, no, it's not a foreign body, it's a ruptured globe.
I tripped and some jerk stomped on my face.
Something penetrated your eyeball.
It's bleeding inside.
- Am I gonna be blind? - Not if surgery can correct it.
And the sooner the better.
All right, head of bed to 45 degrees.
Metal eye shield, gram of Ancef and stat page Ophtho.
- 4-0 Vicryl.
MORETTl: Gentlemen.
Hand service has been paged.
I did a Bier block, so he's feeling no pain.
- Great, I got it from here.
- No, we can do it, really.
In my pocket, labs on two of your favorite attendings.
Blood alcohol is less than 0.
01.
- They let airline pilots fly at that level.
- Shh.
Keep your voice down.
Another Vicryl, Dr.
Gates.
Sure.
Okay.
- How'd this happen? - I was cutting the lawn.
I was having problems with the mower.
I was running out of gas so I tried to refill the tank without shutting the engine off.
I don't really remember what happened.
I blacked out.
There's a reason it's called an internal combustion engine.
You managed to make it an external.
You gonna be able to sew my fingers back on? Do you have them? Good luck.
- She's bleeding inside her lungs.
- Oh, my God, How do you stop that? You just have to wait for it to heal.
This low-pressure vent will help.
All set.
- Dr.
Pratt.
Hey, don't even start, man.
I'm serious, okay? I'm working on my patient.
- She needs constant attention - Relax, I talked to Dr.
Morris.
- I saw the blood tests.
Relax.
- All right, good.
We got severe pulmonary contusions, hypoxia with PEEP.
- And we switched to an oscillator.
- You can be better utilized outside.
Have you taken a look at the x-ray? Patient is critical.
So are 10 other patients who have a chance.
You're wasting time and resources trying to save a dead girl.
- Excuse me.
What does that mean? - I'm sorry, I didn't know you were there.
- Okay.
- Okay.
With the extent of her hemorrhaging, her chances of survival are almost nil.
- So, what? You just give up on her? - We're not giving up.
- We're giving her the best care.
- Leave.
I don't want you in here.
He's doing fine.
- Please, continue.
- I will.
- She's bradying down.
Lost her pulse.
- All right, PEA.
- She was fine until you came in here.
Sir, please get out of the way.
- This is your fault.
- All right, get out of the way.
Amp of atropine.
Kocher clamps.
Buzz here.
How about the cell saver? Ready to go.
Metz.
Couple of Richardsons.
Let's go.
Into the peritoneum.
Oh, my God.
We're on it.
- Suction, Dusty.
Got it.
Another suction line.
Keep packs coming.
Yankauer's not gonna do it.
Pool sucker.
Systolic's down to 60.
Clots in left upper quadrant.
Pack off the spleen.
No, she had impact on the right.
Pack the liver first.
- And that's your call.
- Yeah, damn right it is.
Yeah, okay.
Please have somebody call down if you hear anything.
Is she out of surgery? Yo, Taggart.
Got a live one for you.
Found him in the street, directing traffic.
Well, I was just trying to calm the masses.
There was so much negative energy that nobody could feel the universal connection that we all have.
- Right, what are you on, buddy? - Oh, no.
You know, when I touch you like this we are exchanging matter on a subatomic particle level.
I don't know where your atoms have been.
Keep them to yourself.
- What's this? - I'm thinking acid trip.
Oh, you would be wrong.
LSD is a man-made chemical and psilocybin is a gift from God.
- Oh-ho.
The magic of mushrooms.
- Yes, that is corr Look at this.
Your shirt is breathing.
All right, you're freaking him out.
Ho.
No.
- How's your doctor friend doing? - It's too soon to tell.
- We're all thinking about her.
- Thanks.
Ho-ho.
Oh, this is so good.
No, don't stop.
Excuse me.
Do you have any medical problems? No.
My skin becomes transparent, occasionally.
I can see my organs, but I'll going to get a urine tox screen and find him a comfy bed.
- Dive, dive! - Don't touch that.
You'd better hold my hand if you don't want me to just float away.
- I'll hold your hand, sir.
- Oh.
I can feel the love you have for your friend.
- It's beautiful.
- Any other victims? - No, I think we got most of them.
- No shrapnel or blast injuries? - It wasn't a bomb.
- There was an explosion.
I heard it.
- People saw smoke.
It was on the news.
- Bomb squad figures it was some guy setting off fireworks or something.
Well, it had to be at least an M-80.
Whatever it was, it wasn't the terrorists.
Not today.
Complex, stellate liver laceration.
It's a bear-claw injury.
You'll never repair that.
What? Why? What do you mean? Bovie.
Bleeding too briskly.
Bovie can't even coagulate.
- Well, what else can you do? - Get me the argon-beam coagulator.
The thing to do is pack up the liver, put in a Bogota bag, close her up.
We'll come back in two days for repair.
- Two days? - No.
I don't want biliary leaks or abscess formation.
Lap pads.
- Can't screw around while she bleeds.
- You can't try to repair the liver? We would have to clamp the artery less than an hour before the liver died.
- Can you do it in an hour? - No.
Yes, yes, we can try.
Where's my argon? - Ready in a minute.
Stop.
- You're not helping.
- That makes two of us.
- I don't know what you're getting at.
- Doctor.
Perhaps you should just shut up, both of you.
Lucien, can the repair be done? - Yeah, yes, it can.
- Okay.
Dr.
Crenshaw's gonna do it.
What? - You're too close to this.
You know I'm right so let him operate you'll assist and I'll keep time, okay? Okay, you.
- How's it going here? - Hand service can take him in an hour.
Good.
- Can I get something to drink? Chuny, why don't you get him some ice chips.
All right.
So whose? Whose lawn were you cutting? - Mine.
- Yours.
All right.
Says here you live on Halstead.
Not a lot of lawns out there on Halstead, right? There's some grass around the building, on the side.
Right.
So, what are you, the super? No, but sometimes I help out.
So you help out the super cut the lawns on the side of the? - He's old.
I feel sorry for him.
- Yeah.
You know, there are a lot of hospitals between Halstead and County.
- That's my stuff.
- Right.
I stopped by a friend's house around here.
She told me I needed to go to the hospital.
- What are you doing? - Doesn't smell like gasoline, does it? - Smell that.
That smell like gasoline? - No.
I didn't spill it.
- Does it smell like gas? - No! Smells like black powder, doesn't it? What's this? A lighter.
Your chart says you don't smoke, but what's that? What was it? M-80? Cherry bomb? What? - Where you going? - You're crazy.
- Get back in bed.
- No.
What are you doing? - Where the docs don't sniff your - Oh, yeah? - What's your problem? - You know what my problem is, ass? All these people are here because of you.
Look at this girl.
Look at that girl.
You see that? This is your fault.
Look at him.
Look at him, huh? That's because of you.
Tony! - What are you doing? This guy, you see him? - Tony, calm down.
Use your brain.
You killed people.
Do you understand? Look over there.
Look at that little girl.
You killed that girl.
All right? You killed people.
You understand that? Are you supposed to be a tough guy? Where'd you hear that? - Oh, I don't know.
Word on the street.
- Mm.
Seems you have a history of violence whenever your vocabulary is overtaxed.
That happens with alarming frequency.
Look around.
Every bed has a patient because of that jackass.
- Not to mention Dr.
Rasgotra.
- Yeah.
Not to mention.
You think a dalliance with a coworker mitigates the situation? - Is that what you think? - I don't know.
- You don't know.
It doesn't.
- Hmm.
You attacked a patient.
Who caused a riot that messed up a lot of people.
That has been established.
For what? For nothing.
Because he thought it was fun.
I don't care! I don't care! I don't care if he attacked your crippled, blind mother.
You are not gonna get away with this stuff anymore.
- You understand me? - Yeah.
- Do you? - Yes, sir, I do.
I will check myself next time this happens.
- You can check yourself in the ICU.
- What? There are lots of lessons for a guy like you up there.
Trust me.
- You're kidding? - No, I'm not kidding you.
The ICU forces one especially an ex-paramedic, ER doc like yourself to slow down and to think.
People are dying up there, often in excruciatingly slow ways " so" you won't really have much choice.
We're at 52 minutes.
Okay, release the Pringle.
Let's see if the dam holds.
- How's the liver look? Not bad.
Not bad at all.
Minimal oozing.
Systolic's holding at 110.
- It was a sound approach, Lucien.
- Well, you executed it well.
Let's hope that her brain was sufficiently perfused.
We'll see how she wakes up.
Dr.
Crenshaw, brachial artery repair is ready for you in 2.
- Care to finish? - Yes, I would.
A few big liver sutures and simple closure.
I'll be in O.
R.
2 if you need me.
And I have to get back downstairs.
So I'll "just " I'll check on her later.
Okay.
I'll let you know when she's in Recovery.
What's the word on Neela? She took 10 units of blood.
Yeah, they're still working on her.
Take a deep breath and let it out.
Another deep breath.
Let it out.
Now you're gonna feel some discomfort " but" it's not going to bother you, because you're in your safe place.
Hey, you old stoner, what are you doing? Well, it's a Colles' fracture, I've reduced and casted.
What? You what? This is embarrassing.
I've neglected to introduce myself properly.
I am James Broderick.
I'm the chair of Orthopedics at St.
Raphael's Hospital.
You're a doctor? One of the leading orthopods in the country, yes.
- And you are doctor? - Morris.
- Morris, yes.
- Why don't we get you back to a bed.
And maybe it's best if you don't touch anyone else.
I don't mean to brag, but I am here now.
And there are those who feel I have a certain gift.
Well, save it for Christmas.
We're good at this ourselves.
You're not licensed to practice in this hospital.
Will you show this gentleman back to his bed, please? - This way, sir.
- Sure.
But I am internationally renowned.
Don't let him drift away.
He's on a beach.
- Look at that cast.
It's perfect.
- Looks nice.
- I didn't do it.
- Who did? - A patient.
- Fast learner.
Hey, I heard Moretti reassigned you.
I'm sorry.
- It's only temporary.
- I'm sure.
So, what's happening in surgery? She's had a hard time maintaining her BP.
- They said she's in renal failure.
- I'm calling.
No, you're not.
They're in the middle of surgery.
Let them do their thing.
- Who's there with her? - Crenshaw and Dubenko.
- She's in good hands.
- Abby's there too.
Not anymore.
Is she all right? Yeah.
She in Recovery? They just They repaired the liver.
Her vitals are stable, and Dubenko was closing up.
- She awake? - Not yet.
With the arrest and hypotension, probably be a while.
Yeah, that's what they said.
- Well, that's great.
- Yeah.
All right, where's Mussolini? He said he needed me down here.
He gave me these to give you.
You're not to see "him " until they are all disposed.
- Okay.
Thank you.
Mm.
All right, watch your step.
Easy now.
Melman? Melman.
Where the hell did we put Melman? You're not lost, are you? - Lf you need directions, you know - No, no.
You know why we're here? Because of war.
Without it, you would be a pediatrician or an oncologist " and" I'd probably still be losing my mind in the ICU.
- War, huh? - Mm-hm.
Emergency medicine is actually the result of centuries of warfare.
It's a field that was defined by doctors and nurses in bombed-out buildings trying to take care of patients on dirty canvas stretchers.
And performing procedures in tent hospitals that were literally hundreds of feet away from where the battles raged.
And these people, our predecessors they had a simple primary focus.
Survival.
And down in the bunkers, they dug in deep " to" try to save their patient's lives, and to try to save their own lives.
And they ended up giving life to this whole new art form this great collaborative enterprise that we still carry on today.
That's why we're here.
You don't get out much, do you? If you can't take the bunker, get out of the trauma room.
Ha.
I hope, I hope you're not talking about me.
Heh.
No.
If I can't manage this floor during a mass-cas then what good am I? Every day is not the bunker.
Most days aren't, in fact.
Thank God.
I guess every war teaches us something, right? I wonder what we'll learn from this one.
Hey, stop it.
- Somebody call Security.
Stop that.
You son of a bitch.
- Get off of him.
You killed her.
MORETTl: Hey, come on, come on.
You killed her.
- You son of a bitch.
MORETTl: Come here.
- You MORETTl: Hey, hey.
Hey, hey, hey.
You killed her.
MORETTl: Come here.
You stupid You killed her.
- Stop.
- You Let me go.
Sir.
Sir? Not responsive.
No pulse.
- He's not breathing.
She's ready for an ABG on 5 liters.
No problem.
- Hey, how's she doing? - Pressure's up, hematocrit's 32.
- Hi, Mayday.
- That's good.
She'll be sleeping for a while.
It's probably best if you wait out here.
I have several pages of postop orders to write.
Be an hour before she's ready for visitors.
I'll just I'll wait out here, okay? - Check a repeat HemoCue in 15 minutes.
- Got it.
You gonna write those postop orders now? No, I already did.
It's all on the chart.
No, call PR.
That's extension 456.
County, hello? Extension 456.
Hello? Didn't I just talk to you and tell you we already have digital television? Criminy.
Telemarketers.
Hey, Frank.
Heard Neela's in recovery.
Yeah.
I have confirmation on that.
Is she awake? - Negative.
- Look, it's irrelevant, right? - Yeah, it doesn't mean anything.
I mean, it'd be weird if she was awake this soon.
- Absolutely.
- Sam was about to go up there.
She wondered if anybody wanted to go with her.
Any news? Vitals are stable, crits are okay.
- She hasn't woken up yet.
- How much longer is it gonna be? Oh, waking up takes awhile after all that anesthesia.
- Hey.
- Hey.
- Has anybody seen her? - I saw her on her way to Recovery.
- She looked okay.
- Can we go in? Not yet.
Dubenko said he'll let us know.
So I guess we wait.
I'm calling for pizza.
Who's in? - Cool.
Pratt, you buying? - No, no, I'm not.
- Sure, you are.
- You got cash, right? Morris