ER s05e04 Episode Script
Vanishing Act
Previously on ER: So four candidates, including me.
Actually, you make it five.
This hearing aid is expensive.
My insurance won't cover it.
I said that we share everything.
I meant it.
I practice IVs on a mannequin.
That's good.
But know when to ask for help.
I want you to toast the new Pedes ER Attending.
Me.
I have heard of foreign doctors who were willing to start over as interns.
If they amputate, is it certain I'll live? It looks like it's stopped two blocks.
- Should we hoof it? - I don't know.
- Aren't you supposed to set policy? - I'm here for the ride-along.
- I hate one-way streets.
- This is nothing.
I once responded to a call from a Metallica concert.
Try getting an anaphylactic headbanger past "ten thousand maniacs.
" The guy dropped some acid.
Started him "counting crows.
" I have to live with this.
You got any pull with crew assignments? Can you get us assigned to the med team at the Bears game? I don't do the scheduling, guys.
You were almost my new best friend.
Make way! Paramedics coming through! Hey, stand back! Stand back! Give us some room! Looks like a single Whoa! Whoa! Jeez! - It's Cujo! - He's protecting his owner.
- Okay, you open the door.
- Sir, can you hear me? - Is he breathing? - His chest is moving.
- You got any ideas? - You're asking me? - Unit 57 to OCD, over.
- A little puppy Valium? We need Animal Control to 4th.
A dog is barring access to an MVA victim.
Over.
That'll take too long.
Look.
- He's right.
We gotta get in.
- What do you suggest? - I've got a gun.
- I'll keep him busy.
- You're kidding.
- We gotta assess him now.
You're the boss.
Hey, boy! Ready? One, two three! Hey! - Got a pulse.
- Good breath sounds.
Get a backboard.
- You okay? - Yeah, I just can't let go.
- When was your last tetanus shot? - 1992.
- One booster coming right up.
- That's okay, I'll pass.
- It could be worse, like rabies.
- I wouldn't rule it out.
Think we'd notice the difference? - So how many interviews today? - Two.
You and one other.
You know, I'm still interested but I've decided just not to push so hard.
If I get it, I get it.
- Good idea.
- What do you mean? I mean it's not a good idea to get worked up over these things.
- What happened? - Long story.
- Rachel's sleepover? - Good guess.
Thanks, Kerry.
- What's going on? - Graffiti guys went crazy last night.
- You're on? - I'm getting set up for tomorrow.
Color-coordinated charts? Well, whoever said Doug Ross isn't organized? - I did.
- Take it easy.
Hey, Mark, don't Attendings pay for Nurse's Night? Yeah.
Now Doug can contribute.
No, that's the ER.
I'm the Pedes ER.
Well, Pedes needs nurses, right? So I'm billing.
Hey, get this, 19-year-old, third pregnancy says she doesn't know how to use a condom.
- So did you teach her? - We're way past that.
- I'm talking her into a Norplant.
- Are you sure? I'd tie her tubes myself if I could.
If the drawbridge is up, you can't storm the castle.
- Excuse me? - Try a diaphragm.
They work.
Oh, yeah? I wouldn't be too sure.
I'm three days late.
What? What? These came from upstairs.
Letters of rec for chief.
- Thank you.
- Okay, lift your sleeve.
When did someone get tetanus from a dog? Don't be a baby.
- Nice suit, Dr.
Weaver.
- Thank you.
- I didn't know you read Cosmo.
- Excuse me? Last month's article on the power suit.
I guess I missed that one.
Are you sure? I mean, you nailed it, down to the accessories.
- So how long have you been on? - Oh, just now.
- Who's your Resident? - I suppose I'll find out in a minute.
Why? Did you vie for me? You're too much for me to handle.
Hopefully, whoever I get feels the same way.
No, I suspect I'll be sidelined as a consultant more than anything.
Hey, do me a favor.
Reach in his bag and hand me his hearing aid.
It's in the black case.
- Is he having trouble with these? - No.
- So why are you putting them on now? - I was running late.
- Peter, have you not told everyone? - Told who? I don't have time for a whole bunch of repetitive questions and sympathy.
Are you sure that's it? - My son is deaf.
I know that, okay? - Okay.
Okay.
Wish me luck.
Jeff Whitcher, 38-year-old magician, inhaled flash powder.
What happened? Trap door didn't open? More complicated.
Short of breath and tachypneic, respiratory rate is 28.
No previous history of respiratory illness or inhalation of toxic substances.
- What's in flash powder? - Sorry.
Trade secret.
Lycopodium with potassium nitrate.
I looked it up on the Internet.
Pulse ox is borderline, 91.
No cyanosis.
- Are you a smoker? - Occasional.
Occupational hazard.
- You can't smoke that here! - I wasn't planning to.
- What do you want to do? - Get a blood gas and check a PO2.
You get to learn a new procedure.
I happen to have a blood gas kit here.
- Hey, pretty good, doc.
- Trade secret.
- Can you get a cup of ice, please? - Sure.
- We're out of gloves.
- Try your pocket.
How did you do that? It's not what they see, it's what they think they see.
- You didn't even move.
- Lucy.
The blood gas.
This one you watch.
Next one you do.
Don't panic.
It's a couple of days.
- You said three days.
- Two, three, whatever.
You said you were regular as a Swiss watch.
Yeah.
I'm regular, not a machine.
You gonna do a pregnancy test? - You're really sweating this.
- Aren't you? A little? - I don't feel pregnant.
- Have you been pregnant before? I shouldn't have said anything.
- What's up? - Syncope.
Fourth episode.
- Seizure? - I don't think so.
You want to use the Pedes room? No waiting.
Here we go.
Okay.
Hey, what's this? Hey! Could be Carter's.
- Carter! Is this your body in here? - Yeah, sorry.
- Transport's slow.
Need the room? - Yeah.
Give me a hand.
- I thought the Pedes ER was closed.
- Don't leave your stiffs in here.
Take him to the morgue.
We've been waiting on a transfer for hours.
- This "the" Prince Albert? - Who? His ding-dong's pierced.
He has a diamond.
A diamond in his penis? Haleh said it was tricky getting in the Foley.
- Want to peek? - I've seen one.
- I bet.
- Hey, watch it.
It's your lucky day.
It seems I'm your intern.
- You missed rounds.
- It's the first day.
I wasn't sure how this would work.
You need to be here at 5 a.
m.
Sharp.
I hope you don't expect special treatment.
I don't know what you've been told.
This is more of a formality.
Maybe for you.
You're the only intern I have.
Finish pre-rounding before 6.
I need all the vitals.
T-max, mental status, I's and O's.
After rounds, check the labs and run down all x-rays.
Go over the x-rays yourself.
Don't trust the radiologist.
Buff the electrolytes as needed.
You take all floor calls.
If we have clinic that day, you do H and P's.
And, of course, all pre-op orders: CBC, lytes, UA, EKG, PT.
I know how to pre-op a patient, thank you.
Good.
If surgery's canceled because you miss a lab, it's your ass.
We'll start with Mr.
Anderson.
I reduced his O2.
Redraw an ABG in 30 minutes.
Monitor urine output Q one hour.
Advance drains on beds three and five.
One, two and six need wet-to-dry dressing changes.
You're serious? This is how it works.
As third-year, I'm busy operating.
This stuff is not my job.
But the scut has to be done, by an intern.
I have three cases today.
If you finish, you can scrub in for one.
Oh, and this is for you.
Interns wear short coats.
Hold the elevator! Hold it! - Are you all right? - I said, hold the elevator! Where are we? We got multiple stab wounds to the extremities.
One in the forearm and chest.
BP's 120/75.
Pulse ox 99.
- Did the guy have friends? - Lungs are clear.
Four plus right radial and ulnar pulses.
- What's your name? - Bo.
Bo, we'll take care of you.
You're very lucky.
The chest wound is superficial.
Bo, do this with your hand.
How about a car, Bo? Spread your fingers.
Don't let me close them.
I'm tired of this game.
Tell me who it was.
- Does he have to be here? - Can you wait outside? You were stabbed in daylight.
You didn't see anything? You know what? Wait outside.
Okay, let's roll him.
- He'll try to settle this on his own.
- Now we have to treat him.
You know what? Forget it.
Have it your way.
You could've pressed that hold button.
Damn, these elevators are slow.
I'm gonna catch that lunch traffic.
I know it! - Do you drive? - Do I? My son used to have one of those.
Gave him a heart attack.
Nothing but stress.
Come on, come on.
No, I didn't watch the whole thing.
The part I saw looked benign.
It was my fault.
Sorry.
- Well, you did.
Thanks.
- Problem? Did you know that Romeo and Juliet is PG-13? - I wasn't aware of it.
- It is.
I showed it at Rachel's slumber party.
Now all the mothers are calling me.
Elizabeth.
Elizabeth! Can you come take a look at a pulseless foot? I've been waiting 40 minutes for a surgical consult.
Normally, I would.
But I'm only an intern.
I can't believe it.
I don't want to believe it.
I already have five admissions.
Lab turnaround time is pathetic.
And Radiology already lost three of my films.
Dale has me sitting for a bleeding time on your Ewing's sarcoma amputation.
Waste of time.
- Dana Ellis? - She doesn't have a clotting problem.
- Is that today? - Yes, surgery's at 4 p.
m.
Five minutes.
54-year-old male, peripheral vascular disease calf pain at rest.
I'm thinking arterial thrombosis.
- Did you get a Doppler pulse? - Yeah.
Mr.
Darcy, this is Dr.
Corday, our Surgical Resident.
How long will this keep me down? I choreograph a video next week.
Let me examine you, and I'll have a clearer idea.
- Are you a smoker? - What's that got to do with my leg? - Is this the Vascular consult? - I asked Dr.
Corday to examine.
I'll take over.
Did you get the labs on the perfed diverticulum? They're not ready yet.
Better sit on them.
You know Romano.
Gotta start on time.
Of course.
Come on.
- Lucy? - What?! - Is something wrong? - No.
Can you work up this guy with vertigo for me? You know how to check for cerebellar function? Find me when you're done.
We'll discuss the differential.
Got it.
- What's the extension for the morgue? - 5001.
See this guy? He's looking for Dr.
Carter.
- Can I help you? - Yeah.
My brother died last night.
They gave me his valuables.
But something's missing.
- I need to get some jewelry off him.
- Oh, right! Right! - Your brother's down in the morgue.
- Last name Naughton? Definitely down in the morgue.
- Can you tell me how to get there? - Yeah.
No.
They don't allow family down there.
It's They make you wait.
It takes forever.
It's chilly.
You know what I'm gonna do? I'm gonna go down there and get it.
Your brother.
And bring your brother up here.
- Great.
That'd be great.
Thank you.
- Don't mention it.
- What are you doing here? - Checking in on you.
How you feeling? Well, they're chopping my leg off.
- Your decision? - You could call it that.
I wouldn't have had a say at all if it wasn't for you.
You gotta go with the odds, right? You scared? I thought, "Okay, I'll just get used to it.
" But In pain? A little.
I'll tell them to increase the dosage.
That's okay.
I sort of like to feel it.
It'll be gone in a few hours.
- Hello, Mr.
Ellis.
- What's going on? I came to check in on Dana.
She's being taken care of.
Thank you.
I wanted to talk to you about her pain.
Dana's having surgery in a few hours.
If you don't mind, Dr.
Romano is gonna handle everything from here.
Okay.
Excuse me.
Are you in charge of transport? Depends who's asking.
I know this sounds weird.
I was wondering if you by any chance found a body? Transport! Yeah, what floor? Okay.
I don't know.
Half-hour.
Damn! - What did you want? - I lost a body.
- Did you try to move it yourself? - You guys were taking so long.
- What was I supposed to do? - It's our fault? No, it's not your fault.
I just want to find the body.
I'll call the morgue.
- I checked.
He's not there.
- Yo, Gerald! Yo, it's Tony.
Have any unclaimed bodies? Yeah, she's here now.
Hold on, I'll ask.
Would this body fit down the incinerator chute? The incinerator?! Yeah, that got her.
Yo, thanks, G.
Okay, I'll be right down.
You're in luck.
Someone stuffed some fat stiff in the closet of the ICU.
Why? Why do you have to go? I just gotta.
Well, what's the hurry? The doctor said it's okay.
Well, it will be okay.
He has to stitch it up first.
Besides, I like having you around.
There's not very many interesting people here today.
So maybe I'll come back.
You've gotta help me out.
You'll get me in trouble.
I'll write you a note.
Besides, you do not want to get that infected.
Just a few minutes.
I'll get a doctor.
We'll take care of it.
- All right.
- Good.
- Lynette? - Yeah? - Could you get his mother for me? - He's 18.
He got stabbed.
I'm afraid he'll bolt to settle the score.
- Mark! - Yeah.
Hold on a minute.
- You admitting that thrombosis? - He's got a high-grade lesion.
- You taking him up? - I need to present him to Romano.
Then we'll bring the team.
- When? - As soon as I can.
Can you stitch Bo? He's antsy.
I'll be right there.
Can you clear this neck for me? He looks okay.
I ordered a trauma panel.
- Sure.
You got it.
- Thank you.
- How are we doing? - Vitals are normal.
I'm fine.
- Did you lose consciousness? - No.
This really isn't necessary.
- Any chest or abdominal pain? - Can I go home? We need to get an x-ray of your neck first.
- Have you ever had hepatitis? - I don't think so.
Why? Your eyes are a little yellow.
On any medication? - Prednisone, cyclosporine, Imuran.
- Those are transplant meds.
Well, I had a new liver two years ago.
Okay.
Let's get a ProTime, LFTs and a cyclosporine level.
- Something's wrong? - Doctor! Doctor! One minute.
You're jaundiced.
- I can go see my doctor.
- We need to do those tests now.
I'll be back.
- Here you go, Jeanie.
- Thanks.
- This is her card.
- Rosa Munoz.
That's social security card.
She said her name was Carmen.
- And your name? - Luisa.
- Her sister? - Cousins.
I understand you're concerned.
This would be fraud.
It doesn't matter if he's illegal.
No, that's her number.
- This is your card.
- No.
She say that he need a special doctor? There could be a problem with Angel's heart.
Please take this number.
Other hospital no take him We're a county hospital.
We treat all emergencies.
- True? - True.
When we're short on beds, we stick the bodies in the storage room.
- Why didn't you call us? - We did.
- Guys, I gotta get back.
- You want to take him back? - He's black.
- Is that a problem? Dana Ellis.
What about her? - I'm worried about phantom limb pain.
- Don't be.
She's on morphine.
That won't do it.
I want her on a preemptive analgesia to rewire the motor nerves.
She's still your patient? Dr.
Greene's on line 3, waiting on a consult for an ischemic leg.
- Does he have a pulse by Doppler? - I'll check.
It's a simple lumbar epidural.
It'll put the surgery off a few days.
One night course does not a pain management specialist make.
The patient has a Doppler pulse.
Dr.
Greene wants an ETA.
- When I get there! - There's no reason not to try.
I don't know that she's psychologically ready.
Three days won't make much difference.
- How's that new intern working out? - She'll get the hang of it.
Let her scrub in.
- I'm gonna talk to the family.
- No, you're not! That girl has a cancer that could spread very rapidly.
I won't sit idly by and watch you experiment with a technique you read! - Dr.
Romano? - What?! You should talk to Greene.
He wants something definitive.
If the guy has calf pain, tell him to do an ultrasound.
Don't go! Rule out DVT.
That'll shut him up.
Leave it alone! I have to go upstairs to this interview.
Will you page me when Romano graces us with his presence? Don't hold your breath.
You'll tear your stitches! Let me out! I gotta go! So you can get the guy that did this? - What's going on? - Bo here wants to retaliate.
You said the doc would stitch me up and I could go.
- We want you to be safe, Bo.
- Save it, lady.
Look, thanks for fixing me! I'm going.
If you want me to sign, I'll sign.
You'll rip your vein open.
I don't want you bleeding.
- Then take it out.
- You want to leave that bad, fine.
Let me get the right instrument.
You can go about your business.
Please, wait here.
Wait one minute.
I'll be right back.
- What's going on? - He can't leave.
- When's the mother getting here? - I haven't reached her.
- I'm calling Psych.
- He'll be gone by then.
- What is that? - Versed.
I have to sedate him until the mother gets here.
That might be an option if it wasn't unethical.
- Not with someone's life at stake.
- You can't restrain him with drugs.
He was agitated.
To finish the treatment, we had to sedate him.
Security can keep him down here until Psych puts him on a hold.
They'll have to prove that he's a danger to others.
- He knows the system.
He'll lie.
- Maybe we'll find his mother.
- I'm gonna make sure.
- Not with that.
- You have a better idea? - I'll handle it.
You know what he'll do if you don't.
I understand your motive.
I know I asked for your help.
Why don't you stick with the clinic patients? Leave the ER ones to me.
Good luck.
It don't matter what I do.
It's my business.
I don't want you here again, maybe dead.
If it goes down like that, it does.
Wouldn't be the first time.
You don't mean that.
Yo, what's the rent-a-cop doing here? So you can talk to somebody.
- I trusted you! - I'm trying to help you.
Save it! I ain't talking to nobody.
We'll wait until your mom gets here.
- My mom? You called my mom? - I'll be right back.
Don't let him leave.
Pay attention, Dale.
Peter's one of our fastest colon dissectors now that Lizzie's gun's in the holster.
We've got an open abdomen, people.
Let's turn up the heat, please.
Elizabeth, would you retract the descending colon? My pleasure.
Actually, Dale, why don't you retract and bovie and give Lizzie the sucker? Right.
Lizzie, suck out this oozing area, would you? If you don't mind, I don't care for being called Lizzie.
Really? Dr.
Romano calls you that.
- Dale, what structure am I dissecting? - Ilioinguinal nerve.
Elizabeth, would you help him out? Owing to the slight peristalsis, it's obviously the left ureter.
Better get faster with that suction, Lizzie.
I freed the sigmoid.
Elizabeth, ligate the proximal side while I clamp the vessels.
- Certainly.
- Dale, move over and start irrigating.
I prefer Dale do any ligating.
Just as soon as we finish the mesenteric vessels.
Sorry to bother you, Dr.
Romano.
Dr.
Greene is calling again.
Lizzie, I think you just contaminated yourself.
- I did not.
- Better be safe.
Change gowns.
- I didn't contaminate myself.
- I saw it.
She's clean.
- Thank you.
- So don't pick on her.
Lizzie, scrub out and go pacify Greene, would you? - You're still here? - Yeah.
You're putting a lot of effort into this Pedes ER.
I'll give you that.
- I'll take it.
- Hey, guys.
This is our new Pedes ER Attending and full-time delivery boy, Doug Ross.
- What do you got for us? - You're cut off.
This is Claudia Olson.
She's a candidate for the new Chief of Emergency Medicine.
- A masochist? - Yeah.
- Good luck.
- Thanks.
- Kerry Weaver.
- The Interim Chief? Yeah.
It's nice to meet you.
You're interviewing today as well? How did you guess? Well, at least I got to go first.
It was nice to meet you.
You too.
It could be hepatitis.
But our major concern is that you're rejecting the liver.
Well, I feel fine.
A little tired.
Do you ever forget to take your meds? No.
I set my watch daily.
My cyclosporine level's therapeutic, isn't it? We should arrange for a liver biopsy.
If it's all the same to you, I would rather see my own doctor.
I understand.
He hasn't said anything about your abnormal LFTs? I got busy, missed a couple of checkups.
You know how important follow-ups are after organ transplantation.
I think part of me always suspected but didn't want to know for sure.
Now I do.
You can put yourself on the UNOS list again.
I don't think so.
It's the second time around.
You qualified the first time.
You could get lucky again.
- Do you have the Munoz kid? - I do, yes.
Excuse me one more time.
Excuse me.
- Is it cardiomyopathy? - He needs a full EP workup.
Did he have an ectopy? The echo ruled out an outlet obstruction.
The cause of his fainting? - It's probably arrhythmia.
- Arrhythmia.
I'm going to try to induce it in a cath lab.
If so, he'll need an internal cardioverter defibrillator.
- I'm glad we caught it.
- I'll call the surgeon.
- Can you get consent? - Sure.
Thank you.
Don't thank me.
The kid needs it.
- It's about time.
Where's Romano? - Just me, I'm afraid.
So can you admit him? Based on my responsibilities, I'd say no.
- So you're here to stall me.
- Something like that.
I'll pass him through Radiology.
He needs an angiogram.
But tell Romano you only bought him 20 minutes.
Don't leave him long.
Radiologists have a way of snatching the procedures if the surgeons are slow on the uptake.
Noted.
Thank you.
Jeanie.
- Here's the BA on your MVA.
- On who? - Lipson, Trauma 2.
- I didn't order a BA.
I did.
It's part of the trauma panel.
Randi put it in my box.
- Something wrong? - Blood alcohol's.
04.
- That's below the limit.
- It means he drinks.
I finished my write-up on the vertigo.
- And I got you coffee.
- You don't need to do that.
I was in the cafeteria looking for something.
All right, thanks.
Why don't you start the IV on the Be careful, she's dehydrated.
- Could be tricky.
- Right.
- Thanks a lot.
I feel so much better.
- Glad to hear it.
Call me if you'd like some free tickets to my show.
- Are you okay? - How'd that get there? There you go.
I didn't want things disappearing on you.
Hey, you haven't by any chance seen a body Carol, could you help me start an IV? She's dehydrated.
I don't want to hurt her.
- Have you tried? - Not yet.
- So you haven't even started an IV? - Honestly, no.
This is ridiculous.
Everyone thinks you can.
- I'll talk to Dr.
Carter today.
- Lf you don't, I will.
Hey! Hey! - What happened? - He took off.
- You were supposed to stop him.
- There was no talking him down.
You weren't supposed to negotiate, just stop him.
- I can't keep him without the hold.
- He didn't know that! - Sorry.
- Oh, God! Hold still.
I'm gonna secure this catheter.
You're doing great.
- How much longer? - A little bit.
Just a second here.
Roll back over on your back, okay? Nice and easy.
There you go.
- How long does it take to work? - 20 minutes for the full effect.
You'll start feeling things soon.
I'm gonna put you on a six-day cycle.
That's three days before the surgery.
And three days after for the drug.
- Dr.
Romano.
- Dr.
Ross.
Hey, Dana.
- I decided I wanted the epidural.
- You did? You were in surgery, so I explained the protocol.
- The parents? - They're onboard.
- Terrific.
You got a second? - Sure.
Be right back.
You did great.
Congratulations.
You postponed the surgery.
You didn't leave me any options.
Pedes Attending barely happened.
I thought, "The guy's a maverick.
Good to shake things up.
" If you want to play John Wayne, do it in the ER, not with my patients.
This girl is in a very vulnerable place.
This is not about being right.
Hell, we all think we're right.
Doesn't make you special.
Fine.
Did you give the kid the cheeseburger before or after the parents agreed? Thought I might need 24 hours to talk them into it.
- Do you know what you're doing? - Hold on.
Let me get a smaller gauge.
- Oh, hey! You.
- Hi.
I have been looking for you.
You forget about me? Well, no, I didn't forget about you.
- I've been waiting for three hours.
- Okay, I went to the morgue.
- Me too.
He's not there anymore.
- No, he isn't.
- So where did you put him? - I don't know how to How to what? How to tell you how sorry I am about your loss.
Thank you.
But where did you put him? - Where did I put him? - You don't remember.
Of course I remember.
I couldn't find you.
I got very busy here.
So I put your brother Where did I put him? Radiology.
I put him in Radiology.
But he was kind of in the way there so I left him here in the hall.
I'm sorry.
No problem.
I can't believe I didn't see him there.
He's easy to miss.
- What's wrong? - There aren't any pregnancy tests.
- How could we be out of them? - I don't do inventory.
It wasn't an accusation.
- What is that all about? - What? The scarf.
Where'd you get it? I got it at the gift shop.
You don't think it works? - What about your jacket? - I wanted something different.
Lose the earrings.
It throws the whole thing off.
- Carol.
Carol.
- No, no.
I can get it.
I can't have students starting IVs on kids.
- Can you do it for me? - Sure.
- Is there a problem? - No.
I just want experienced staff starting IVs on kids.
- This is a teaching hospital.
- Not when pain's inflicted on kids.
- Lucy's great.
- It's not about Lucy.
- It's a policy I'm setting.
- You're setting a policy.
Well, first time for everything.
I'd be in a hurry to get out of here too.
What? We found out why your liver's failing.
You've been drinking.
You're not gonna believe me.
One time.
I don't believe you.
I checked with UNOS.
You've been on the list for another transplant for two months.
- Did you tell them? - Did I tell them what? That you drank through the first one and you want another? It wasn't like that.
It was today.
My son passed his bar examination.
I knew I was rejecting, so I figured what could it hurt? We had champagne at brunch.
That's it.
You've been lying ever since you came in here.
Please.
You can't tell UNOS.
I don't have a choice.
You're doing this to me over one glass of champagne? There are people on that list who haven't had any champagne.
If I lose my place, I won't last six months.
You report me, I'm dead.
I'm begging you.
Sorry I'm late.
There was traffic.
You take the EI.
- Who's on? - Weaver.
She's interviewing for Chief of Emergency Medicine.
- I thought she was Chief.
- Where have you been? - Dr.
Greene? - He's upstairs interviewing her.
- So we have no Attendings.
- Watch it, Jerry.
Sorry, Dr.
Ross.
Is he an Attending? Normally I wouldn't say anything.
But don't you think that attire is a little inappropriate? It's business.
I was helping out Dr.
Weaver.
Great job, Kerry.
We'd be lucky to have you.
It was a formality.
Thanks for coming.
I appreciate the opportunity.
Your presentation was everything we expected.
- Thank you.
- I'll walk you down.
It went great, Kerry.
- The pie charts weren't too much? - Charts are good.
- Did anybody else use them? - You were the first.
- Lf I came across as too eager - No, it went terrific.
Thank you, Mark.
I never know how to answer that question about my weaknesses.
I could've helped you out there.
That's a nice leather jacket.
I said I wanted to run some tests.
But I can't without Medicaid.
What's wrong? - This patient is illegal.
- Yes, but it doesn't matter.
Oh, yes, it matters.
The state won't pay for thousands of dollars worth of tests.
- You won't treat him? - I'll give him beta blockers.
He could have a cardiac arrest.
- He's had no arrhythmias.
- That's why we need the EP studies.
His father died from this.
- Did you document an arrhythmia? - No.
All right.
Then there is nothing else that I can do.
- Dr.
Kayson! - What? This boy could drop dead.
Well, so could a lot of people.
He's not emergent.
I'm sorry.
You said he was stable.
Single GSW to the arm.
- He was.
- He's intubated and hypotensive.
- Things change.
- What's the problem? Botched gang shooting.
They were ready for him.
- Is this the guy from this morning? - Yeah.
His name's Bo.
We thought it was his arm.
He crashed in the rig.
- Carter, we need your help.
- Come on.
Welcome back, Bo.
Okay, everybody, on my count.
One, two, three.
- Why didn't you recontact? - Things got pretty crazy.
Carol, put him on the monitor.
- What do we got? - GSW, mid-tricep area.
- Where's the probe? - Run it, Carter.
Decreased breath sounds on the right.
Tracheal shift to the left.
- Tension pneumo.
- BP's down to 70.
Pulse ox 89.
Damn it! And then I'm gonna need a 36 French.
I want to decompress into the second intercostal space, mid-clavicular line.
Okay.
Pulse is getting stronger.
- Lucy, get a blood gas.
- I'll do it.
It's okay.
I showed her how.
- Ten blade.
- Get the pressure back on the line.
Entrance wound, right mid-axillary line.
Bullet went through the arm into the chest.
- Why couldn't you undress him? - We had to run.
Where's that chest tube? - You didn't see this chest wound? - Not now, Carol.
- I can't get the blood gas.
- Move over.
I'll do it.
Chest tube is in.
That's okay, Lucy.
Those can be tough.
- Help me with the second line.
- Okay.
50 cc's out.
I need four by fours.
I need elastoplast.
I'm gonna call X-ray, get a portable chest.
I got the blood gas.
BP's up to 100/70.
- How's that second line? - I can't.
- Move the drape for more room.
- I can't do it.
- Focus.
We need the second line.
- I really can't do it.
- It's like any other IV.
- I haven't started an IV.
Never.
I'm sorry.
- Whoa! He's bradying down! - Okay! His chest tube is pouring blood! Let's get two units of O-neg in and call the O.
R.
- You cost me a procedure.
- Am I supposed to ask how? You should've babysat that pulseless foot.
Greene let the radiologist set him.
I didn't realize that was part of my job description.
Well, you're still learning.
- How was your first day? - As expected.
You are either a masochist or the stubbornest woman I've met.
But I admire your fortitude.
I couldn't handle taking orders from a weasel like Dale.
- Is that supposed to be a compliment? - Sounded like one to me.
And you can wear the long coat.
It looks better on you.
- 700 cc's out the chest tube.
- Take him up, Carter.
- Do they know he needs a thoracotomy? - Yeah.
O.
R.
3.
Have the blood bank send up four units, type-specific.
We weren't prepared for a trauma.
You should've called.
Sorry.
We were busy protecting his airway.
- You guys should've called ahead.
- There was no way And we have to be prepared for anything.
- I would've been prepared - Nobody's to blame.
We treated the patient.
Let's move on.
Do you want to review the run tape? - No.
- No.
Doggy.
Yeah! You want to pet the doggy? Oh, that is good.
You want him to respond in some way.
To point or to make some kind of sound.
Kitty says Do you want to pet the kitty? - Don't like the kitty? - It's okay, man.
That's okay.
One quick hug.
Then back to work.
- What? - He's gotta learn to focus.
Give him a break.
He's only a year old.
You can't give him a break.
He's not like other 1 -year-olds.
He needs constant verbal stimuli.
You try.
All right, man.
Here we go.
Doggy.
Doggy.
Hey, doggy.
I can't do this.
You're gonna have to learn.
Coming here twice a week isn't gonna do it.
I might've been able to keep that kid here this afternoon.
But he would've gone out and done the same thing tomorrow.
His mom's in Chairs.
You want me to go talk to her? No.
No, I'll do it.
- Did you get a number? - No.
You still here? Yeah.
I got sidetracked.
- You could use some help.
- Okay, take rashes.
- No, something more permanent.
- Allergies? Actually, I meant being your full-time P.
A.
I'd like to work with kids for a while.
I'm good at it.
Somehow it seems more worthwhile.
Well, I don't know about that.
At least you know whose side you're on.
You know, I'd love to.
I think I've used up all my chips with Anspaugh.
I've got some pull.
I could work it out.
- Great.
I'd love that.
- Excellent.
Yeah, hi.
May I have the transplant coordinator for UNOS, please? - I paged you twice.
- I don't want to talk yet.
That's too bad because I deserve an explanation.
If you want me to feel bad, I do.
I'm really disappointed in myself.
You should be.
That's not an explanation.
I don't know how it started.
You thought I could do it.
I wanted to impress you.
It spun out of control.
I'm sorry.
What did you think you were going to accomplish? I don't know.
- I thought I could learn on my own.
- You can learn on your own.
You don't need to be here, then.
You endangered patients.
You don't need to make me feel bad! I feel horrible! That would work if this was about you.
But down there it's never about you.
Go home.
Don't come back unless you're serious about learning.
If you ever lie to me again, you can look for another rotation.
What are you doing back here? Waiting for the grill to heat up.
I thought it was fend-for-yourself night.
No.
I'm sick of fend-for-yourself.
I got us some steaks.
Sounds good.
You got another one of those for me? What's in the bag? It's a pregnancy test.
Just to be sure.
No need.
I started my period.
Well, I guess I wasted $17.
50.
Save it for next time.
I'm kidding.
That was a joke.
We dodged a bullet there, didn't we? - That's good, right? - Yeah.
Yeah.
Although all day, I kept thinking, "Wow, a kid.
" You know, that would really change my life.
- Our life.
It would change ours.
- Okay.
Our lives.
That would be bad, right? I changed my mind.
I don't want to joke about it.
Maybe I'm not joking.
Actually, you make it five.
This hearing aid is expensive.
My insurance won't cover it.
I said that we share everything.
I meant it.
I practice IVs on a mannequin.
That's good.
But know when to ask for help.
I want you to toast the new Pedes ER Attending.
Me.
I have heard of foreign doctors who were willing to start over as interns.
If they amputate, is it certain I'll live? It looks like it's stopped two blocks.
- Should we hoof it? - I don't know.
- Aren't you supposed to set policy? - I'm here for the ride-along.
- I hate one-way streets.
- This is nothing.
I once responded to a call from a Metallica concert.
Try getting an anaphylactic headbanger past "ten thousand maniacs.
" The guy dropped some acid.
Started him "counting crows.
" I have to live with this.
You got any pull with crew assignments? Can you get us assigned to the med team at the Bears game? I don't do the scheduling, guys.
You were almost my new best friend.
Make way! Paramedics coming through! Hey, stand back! Stand back! Give us some room! Looks like a single Whoa! Whoa! Jeez! - It's Cujo! - He's protecting his owner.
- Okay, you open the door.
- Sir, can you hear me? - Is he breathing? - His chest is moving.
- You got any ideas? - You're asking me? - Unit 57 to OCD, over.
- A little puppy Valium? We need Animal Control to 4th.
A dog is barring access to an MVA victim.
Over.
That'll take too long.
Look.
- He's right.
We gotta get in.
- What do you suggest? - I've got a gun.
- I'll keep him busy.
- You're kidding.
- We gotta assess him now.
You're the boss.
Hey, boy! Ready? One, two three! Hey! - Got a pulse.
- Good breath sounds.
Get a backboard.
- You okay? - Yeah, I just can't let go.
- When was your last tetanus shot? - 1992.
- One booster coming right up.
- That's okay, I'll pass.
- It could be worse, like rabies.
- I wouldn't rule it out.
Think we'd notice the difference? - So how many interviews today? - Two.
You and one other.
You know, I'm still interested but I've decided just not to push so hard.
If I get it, I get it.
- Good idea.
- What do you mean? I mean it's not a good idea to get worked up over these things.
- What happened? - Long story.
- Rachel's sleepover? - Good guess.
Thanks, Kerry.
- What's going on? - Graffiti guys went crazy last night.
- You're on? - I'm getting set up for tomorrow.
Color-coordinated charts? Well, whoever said Doug Ross isn't organized? - I did.
- Take it easy.
Hey, Mark, don't Attendings pay for Nurse's Night? Yeah.
Now Doug can contribute.
No, that's the ER.
I'm the Pedes ER.
Well, Pedes needs nurses, right? So I'm billing.
Hey, get this, 19-year-old, third pregnancy says she doesn't know how to use a condom.
- So did you teach her? - We're way past that.
- I'm talking her into a Norplant.
- Are you sure? I'd tie her tubes myself if I could.
If the drawbridge is up, you can't storm the castle.
- Excuse me? - Try a diaphragm.
They work.
Oh, yeah? I wouldn't be too sure.
I'm three days late.
What? What? These came from upstairs.
Letters of rec for chief.
- Thank you.
- Okay, lift your sleeve.
When did someone get tetanus from a dog? Don't be a baby.
- Nice suit, Dr.
Weaver.
- Thank you.
- I didn't know you read Cosmo.
- Excuse me? Last month's article on the power suit.
I guess I missed that one.
Are you sure? I mean, you nailed it, down to the accessories.
- So how long have you been on? - Oh, just now.
- Who's your Resident? - I suppose I'll find out in a minute.
Why? Did you vie for me? You're too much for me to handle.
Hopefully, whoever I get feels the same way.
No, I suspect I'll be sidelined as a consultant more than anything.
Hey, do me a favor.
Reach in his bag and hand me his hearing aid.
It's in the black case.
- Is he having trouble with these? - No.
- So why are you putting them on now? - I was running late.
- Peter, have you not told everyone? - Told who? I don't have time for a whole bunch of repetitive questions and sympathy.
Are you sure that's it? - My son is deaf.
I know that, okay? - Okay.
Okay.
Wish me luck.
Jeff Whitcher, 38-year-old magician, inhaled flash powder.
What happened? Trap door didn't open? More complicated.
Short of breath and tachypneic, respiratory rate is 28.
No previous history of respiratory illness or inhalation of toxic substances.
- What's in flash powder? - Sorry.
Trade secret.
Lycopodium with potassium nitrate.
I looked it up on the Internet.
Pulse ox is borderline, 91.
No cyanosis.
- Are you a smoker? - Occasional.
Occupational hazard.
- You can't smoke that here! - I wasn't planning to.
- What do you want to do? - Get a blood gas and check a PO2.
You get to learn a new procedure.
I happen to have a blood gas kit here.
- Hey, pretty good, doc.
- Trade secret.
- Can you get a cup of ice, please? - Sure.
- We're out of gloves.
- Try your pocket.
How did you do that? It's not what they see, it's what they think they see.
- You didn't even move.
- Lucy.
The blood gas.
This one you watch.
Next one you do.
Don't panic.
It's a couple of days.
- You said three days.
- Two, three, whatever.
You said you were regular as a Swiss watch.
Yeah.
I'm regular, not a machine.
You gonna do a pregnancy test? - You're really sweating this.
- Aren't you? A little? - I don't feel pregnant.
- Have you been pregnant before? I shouldn't have said anything.
- What's up? - Syncope.
Fourth episode.
- Seizure? - I don't think so.
You want to use the Pedes room? No waiting.
Here we go.
Okay.
Hey, what's this? Hey! Could be Carter's.
- Carter! Is this your body in here? - Yeah, sorry.
- Transport's slow.
Need the room? - Yeah.
Give me a hand.
- I thought the Pedes ER was closed.
- Don't leave your stiffs in here.
Take him to the morgue.
We've been waiting on a transfer for hours.
- This "the" Prince Albert? - Who? His ding-dong's pierced.
He has a diamond.
A diamond in his penis? Haleh said it was tricky getting in the Foley.
- Want to peek? - I've seen one.
- I bet.
- Hey, watch it.
It's your lucky day.
It seems I'm your intern.
- You missed rounds.
- It's the first day.
I wasn't sure how this would work.
You need to be here at 5 a.
m.
Sharp.
I hope you don't expect special treatment.
I don't know what you've been told.
This is more of a formality.
Maybe for you.
You're the only intern I have.
Finish pre-rounding before 6.
I need all the vitals.
T-max, mental status, I's and O's.
After rounds, check the labs and run down all x-rays.
Go over the x-rays yourself.
Don't trust the radiologist.
Buff the electrolytes as needed.
You take all floor calls.
If we have clinic that day, you do H and P's.
And, of course, all pre-op orders: CBC, lytes, UA, EKG, PT.
I know how to pre-op a patient, thank you.
Good.
If surgery's canceled because you miss a lab, it's your ass.
We'll start with Mr.
Anderson.
I reduced his O2.
Redraw an ABG in 30 minutes.
Monitor urine output Q one hour.
Advance drains on beds three and five.
One, two and six need wet-to-dry dressing changes.
You're serious? This is how it works.
As third-year, I'm busy operating.
This stuff is not my job.
But the scut has to be done, by an intern.
I have three cases today.
If you finish, you can scrub in for one.
Oh, and this is for you.
Interns wear short coats.
Hold the elevator! Hold it! - Are you all right? - I said, hold the elevator! Where are we? We got multiple stab wounds to the extremities.
One in the forearm and chest.
BP's 120/75.
Pulse ox 99.
- Did the guy have friends? - Lungs are clear.
Four plus right radial and ulnar pulses.
- What's your name? - Bo.
Bo, we'll take care of you.
You're very lucky.
The chest wound is superficial.
Bo, do this with your hand.
How about a car, Bo? Spread your fingers.
Don't let me close them.
I'm tired of this game.
Tell me who it was.
- Does he have to be here? - Can you wait outside? You were stabbed in daylight.
You didn't see anything? You know what? Wait outside.
Okay, let's roll him.
- He'll try to settle this on his own.
- Now we have to treat him.
You know what? Forget it.
Have it your way.
You could've pressed that hold button.
Damn, these elevators are slow.
I'm gonna catch that lunch traffic.
I know it! - Do you drive? - Do I? My son used to have one of those.
Gave him a heart attack.
Nothing but stress.
Come on, come on.
No, I didn't watch the whole thing.
The part I saw looked benign.
It was my fault.
Sorry.
- Well, you did.
Thanks.
- Problem? Did you know that Romeo and Juliet is PG-13? - I wasn't aware of it.
- It is.
I showed it at Rachel's slumber party.
Now all the mothers are calling me.
Elizabeth.
Elizabeth! Can you come take a look at a pulseless foot? I've been waiting 40 minutes for a surgical consult.
Normally, I would.
But I'm only an intern.
I can't believe it.
I don't want to believe it.
I already have five admissions.
Lab turnaround time is pathetic.
And Radiology already lost three of my films.
Dale has me sitting for a bleeding time on your Ewing's sarcoma amputation.
Waste of time.
- Dana Ellis? - She doesn't have a clotting problem.
- Is that today? - Yes, surgery's at 4 p.
m.
Five minutes.
54-year-old male, peripheral vascular disease calf pain at rest.
I'm thinking arterial thrombosis.
- Did you get a Doppler pulse? - Yeah.
Mr.
Darcy, this is Dr.
Corday, our Surgical Resident.
How long will this keep me down? I choreograph a video next week.
Let me examine you, and I'll have a clearer idea.
- Are you a smoker? - What's that got to do with my leg? - Is this the Vascular consult? - I asked Dr.
Corday to examine.
I'll take over.
Did you get the labs on the perfed diverticulum? They're not ready yet.
Better sit on them.
You know Romano.
Gotta start on time.
Of course.
Come on.
- Lucy? - What?! - Is something wrong? - No.
Can you work up this guy with vertigo for me? You know how to check for cerebellar function? Find me when you're done.
We'll discuss the differential.
Got it.
- What's the extension for the morgue? - 5001.
See this guy? He's looking for Dr.
Carter.
- Can I help you? - Yeah.
My brother died last night.
They gave me his valuables.
But something's missing.
- I need to get some jewelry off him.
- Oh, right! Right! - Your brother's down in the morgue.
- Last name Naughton? Definitely down in the morgue.
- Can you tell me how to get there? - Yeah.
No.
They don't allow family down there.
It's They make you wait.
It takes forever.
It's chilly.
You know what I'm gonna do? I'm gonna go down there and get it.
Your brother.
And bring your brother up here.
- Great.
That'd be great.
Thank you.
- Don't mention it.
- What are you doing here? - Checking in on you.
How you feeling? Well, they're chopping my leg off.
- Your decision? - You could call it that.
I wouldn't have had a say at all if it wasn't for you.
You gotta go with the odds, right? You scared? I thought, "Okay, I'll just get used to it.
" But In pain? A little.
I'll tell them to increase the dosage.
That's okay.
I sort of like to feel it.
It'll be gone in a few hours.
- Hello, Mr.
Ellis.
- What's going on? I came to check in on Dana.
She's being taken care of.
Thank you.
I wanted to talk to you about her pain.
Dana's having surgery in a few hours.
If you don't mind, Dr.
Romano is gonna handle everything from here.
Okay.
Excuse me.
Are you in charge of transport? Depends who's asking.
I know this sounds weird.
I was wondering if you by any chance found a body? Transport! Yeah, what floor? Okay.
I don't know.
Half-hour.
Damn! - What did you want? - I lost a body.
- Did you try to move it yourself? - You guys were taking so long.
- What was I supposed to do? - It's our fault? No, it's not your fault.
I just want to find the body.
I'll call the morgue.
- I checked.
He's not there.
- Yo, Gerald! Yo, it's Tony.
Have any unclaimed bodies? Yeah, she's here now.
Hold on, I'll ask.
Would this body fit down the incinerator chute? The incinerator?! Yeah, that got her.
Yo, thanks, G.
Okay, I'll be right down.
You're in luck.
Someone stuffed some fat stiff in the closet of the ICU.
Why? Why do you have to go? I just gotta.
Well, what's the hurry? The doctor said it's okay.
Well, it will be okay.
He has to stitch it up first.
Besides, I like having you around.
There's not very many interesting people here today.
So maybe I'll come back.
You've gotta help me out.
You'll get me in trouble.
I'll write you a note.
Besides, you do not want to get that infected.
Just a few minutes.
I'll get a doctor.
We'll take care of it.
- All right.
- Good.
- Lynette? - Yeah? - Could you get his mother for me? - He's 18.
He got stabbed.
I'm afraid he'll bolt to settle the score.
- Mark! - Yeah.
Hold on a minute.
- You admitting that thrombosis? - He's got a high-grade lesion.
- You taking him up? - I need to present him to Romano.
Then we'll bring the team.
- When? - As soon as I can.
Can you stitch Bo? He's antsy.
I'll be right there.
Can you clear this neck for me? He looks okay.
I ordered a trauma panel.
- Sure.
You got it.
- Thank you.
- How are we doing? - Vitals are normal.
I'm fine.
- Did you lose consciousness? - No.
This really isn't necessary.
- Any chest or abdominal pain? - Can I go home? We need to get an x-ray of your neck first.
- Have you ever had hepatitis? - I don't think so.
Why? Your eyes are a little yellow.
On any medication? - Prednisone, cyclosporine, Imuran.
- Those are transplant meds.
Well, I had a new liver two years ago.
Okay.
Let's get a ProTime, LFTs and a cyclosporine level.
- Something's wrong? - Doctor! Doctor! One minute.
You're jaundiced.
- I can go see my doctor.
- We need to do those tests now.
I'll be back.
- Here you go, Jeanie.
- Thanks.
- This is her card.
- Rosa Munoz.
That's social security card.
She said her name was Carmen.
- And your name? - Luisa.
- Her sister? - Cousins.
I understand you're concerned.
This would be fraud.
It doesn't matter if he's illegal.
No, that's her number.
- This is your card.
- No.
She say that he need a special doctor? There could be a problem with Angel's heart.
Please take this number.
Other hospital no take him We're a county hospital.
We treat all emergencies.
- True? - True.
When we're short on beds, we stick the bodies in the storage room.
- Why didn't you call us? - We did.
- Guys, I gotta get back.
- You want to take him back? - He's black.
- Is that a problem? Dana Ellis.
What about her? - I'm worried about phantom limb pain.
- Don't be.
She's on morphine.
That won't do it.
I want her on a preemptive analgesia to rewire the motor nerves.
She's still your patient? Dr.
Greene's on line 3, waiting on a consult for an ischemic leg.
- Does he have a pulse by Doppler? - I'll check.
It's a simple lumbar epidural.
It'll put the surgery off a few days.
One night course does not a pain management specialist make.
The patient has a Doppler pulse.
Dr.
Greene wants an ETA.
- When I get there! - There's no reason not to try.
I don't know that she's psychologically ready.
Three days won't make much difference.
- How's that new intern working out? - She'll get the hang of it.
Let her scrub in.
- I'm gonna talk to the family.
- No, you're not! That girl has a cancer that could spread very rapidly.
I won't sit idly by and watch you experiment with a technique you read! - Dr.
Romano? - What?! You should talk to Greene.
He wants something definitive.
If the guy has calf pain, tell him to do an ultrasound.
Don't go! Rule out DVT.
That'll shut him up.
Leave it alone! I have to go upstairs to this interview.
Will you page me when Romano graces us with his presence? Don't hold your breath.
You'll tear your stitches! Let me out! I gotta go! So you can get the guy that did this? - What's going on? - Bo here wants to retaliate.
You said the doc would stitch me up and I could go.
- We want you to be safe, Bo.
- Save it, lady.
Look, thanks for fixing me! I'm going.
If you want me to sign, I'll sign.
You'll rip your vein open.
I don't want you bleeding.
- Then take it out.
- You want to leave that bad, fine.
Let me get the right instrument.
You can go about your business.
Please, wait here.
Wait one minute.
I'll be right back.
- What's going on? - He can't leave.
- When's the mother getting here? - I haven't reached her.
- I'm calling Psych.
- He'll be gone by then.
- What is that? - Versed.
I have to sedate him until the mother gets here.
That might be an option if it wasn't unethical.
- Not with someone's life at stake.
- You can't restrain him with drugs.
He was agitated.
To finish the treatment, we had to sedate him.
Security can keep him down here until Psych puts him on a hold.
They'll have to prove that he's a danger to others.
- He knows the system.
He'll lie.
- Maybe we'll find his mother.
- I'm gonna make sure.
- Not with that.
- You have a better idea? - I'll handle it.
You know what he'll do if you don't.
I understand your motive.
I know I asked for your help.
Why don't you stick with the clinic patients? Leave the ER ones to me.
Good luck.
It don't matter what I do.
It's my business.
I don't want you here again, maybe dead.
If it goes down like that, it does.
Wouldn't be the first time.
You don't mean that.
Yo, what's the rent-a-cop doing here? So you can talk to somebody.
- I trusted you! - I'm trying to help you.
Save it! I ain't talking to nobody.
We'll wait until your mom gets here.
- My mom? You called my mom? - I'll be right back.
Don't let him leave.
Pay attention, Dale.
Peter's one of our fastest colon dissectors now that Lizzie's gun's in the holster.
We've got an open abdomen, people.
Let's turn up the heat, please.
Elizabeth, would you retract the descending colon? My pleasure.
Actually, Dale, why don't you retract and bovie and give Lizzie the sucker? Right.
Lizzie, suck out this oozing area, would you? If you don't mind, I don't care for being called Lizzie.
Really? Dr.
Romano calls you that.
- Dale, what structure am I dissecting? - Ilioinguinal nerve.
Elizabeth, would you help him out? Owing to the slight peristalsis, it's obviously the left ureter.
Better get faster with that suction, Lizzie.
I freed the sigmoid.
Elizabeth, ligate the proximal side while I clamp the vessels.
- Certainly.
- Dale, move over and start irrigating.
I prefer Dale do any ligating.
Just as soon as we finish the mesenteric vessels.
Sorry to bother you, Dr.
Romano.
Dr.
Greene is calling again.
Lizzie, I think you just contaminated yourself.
- I did not.
- Better be safe.
Change gowns.
- I didn't contaminate myself.
- I saw it.
She's clean.
- Thank you.
- So don't pick on her.
Lizzie, scrub out and go pacify Greene, would you? - You're still here? - Yeah.
You're putting a lot of effort into this Pedes ER.
I'll give you that.
- I'll take it.
- Hey, guys.
This is our new Pedes ER Attending and full-time delivery boy, Doug Ross.
- What do you got for us? - You're cut off.
This is Claudia Olson.
She's a candidate for the new Chief of Emergency Medicine.
- A masochist? - Yeah.
- Good luck.
- Thanks.
- Kerry Weaver.
- The Interim Chief? Yeah.
It's nice to meet you.
You're interviewing today as well? How did you guess? Well, at least I got to go first.
It was nice to meet you.
You too.
It could be hepatitis.
But our major concern is that you're rejecting the liver.
Well, I feel fine.
A little tired.
Do you ever forget to take your meds? No.
I set my watch daily.
My cyclosporine level's therapeutic, isn't it? We should arrange for a liver biopsy.
If it's all the same to you, I would rather see my own doctor.
I understand.
He hasn't said anything about your abnormal LFTs? I got busy, missed a couple of checkups.
You know how important follow-ups are after organ transplantation.
I think part of me always suspected but didn't want to know for sure.
Now I do.
You can put yourself on the UNOS list again.
I don't think so.
It's the second time around.
You qualified the first time.
You could get lucky again.
- Do you have the Munoz kid? - I do, yes.
Excuse me one more time.
Excuse me.
- Is it cardiomyopathy? - He needs a full EP workup.
Did he have an ectopy? The echo ruled out an outlet obstruction.
The cause of his fainting? - It's probably arrhythmia.
- Arrhythmia.
I'm going to try to induce it in a cath lab.
If so, he'll need an internal cardioverter defibrillator.
- I'm glad we caught it.
- I'll call the surgeon.
- Can you get consent? - Sure.
Thank you.
Don't thank me.
The kid needs it.
- It's about time.
Where's Romano? - Just me, I'm afraid.
So can you admit him? Based on my responsibilities, I'd say no.
- So you're here to stall me.
- Something like that.
I'll pass him through Radiology.
He needs an angiogram.
But tell Romano you only bought him 20 minutes.
Don't leave him long.
Radiologists have a way of snatching the procedures if the surgeons are slow on the uptake.
Noted.
Thank you.
Jeanie.
- Here's the BA on your MVA.
- On who? - Lipson, Trauma 2.
- I didn't order a BA.
I did.
It's part of the trauma panel.
Randi put it in my box.
- Something wrong? - Blood alcohol's.
04.
- That's below the limit.
- It means he drinks.
I finished my write-up on the vertigo.
- And I got you coffee.
- You don't need to do that.
I was in the cafeteria looking for something.
All right, thanks.
Why don't you start the IV on the Be careful, she's dehydrated.
- Could be tricky.
- Right.
- Thanks a lot.
I feel so much better.
- Glad to hear it.
Call me if you'd like some free tickets to my show.
- Are you okay? - How'd that get there? There you go.
I didn't want things disappearing on you.
Hey, you haven't by any chance seen a body Carol, could you help me start an IV? She's dehydrated.
I don't want to hurt her.
- Have you tried? - Not yet.
- So you haven't even started an IV? - Honestly, no.
This is ridiculous.
Everyone thinks you can.
- I'll talk to Dr.
Carter today.
- Lf you don't, I will.
Hey! Hey! - What happened? - He took off.
- You were supposed to stop him.
- There was no talking him down.
You weren't supposed to negotiate, just stop him.
- I can't keep him without the hold.
- He didn't know that! - Sorry.
- Oh, God! Hold still.
I'm gonna secure this catheter.
You're doing great.
- How much longer? - A little bit.
Just a second here.
Roll back over on your back, okay? Nice and easy.
There you go.
- How long does it take to work? - 20 minutes for the full effect.
You'll start feeling things soon.
I'm gonna put you on a six-day cycle.
That's three days before the surgery.
And three days after for the drug.
- Dr.
Romano.
- Dr.
Ross.
Hey, Dana.
- I decided I wanted the epidural.
- You did? You were in surgery, so I explained the protocol.
- The parents? - They're onboard.
- Terrific.
You got a second? - Sure.
Be right back.
You did great.
Congratulations.
You postponed the surgery.
You didn't leave me any options.
Pedes Attending barely happened.
I thought, "The guy's a maverick.
Good to shake things up.
" If you want to play John Wayne, do it in the ER, not with my patients.
This girl is in a very vulnerable place.
This is not about being right.
Hell, we all think we're right.
Doesn't make you special.
Fine.
Did you give the kid the cheeseburger before or after the parents agreed? Thought I might need 24 hours to talk them into it.
- Do you know what you're doing? - Hold on.
Let me get a smaller gauge.
- Oh, hey! You.
- Hi.
I have been looking for you.
You forget about me? Well, no, I didn't forget about you.
- I've been waiting for three hours.
- Okay, I went to the morgue.
- Me too.
He's not there anymore.
- No, he isn't.
- So where did you put him? - I don't know how to How to what? How to tell you how sorry I am about your loss.
Thank you.
But where did you put him? - Where did I put him? - You don't remember.
Of course I remember.
I couldn't find you.
I got very busy here.
So I put your brother Where did I put him? Radiology.
I put him in Radiology.
But he was kind of in the way there so I left him here in the hall.
I'm sorry.
No problem.
I can't believe I didn't see him there.
He's easy to miss.
- What's wrong? - There aren't any pregnancy tests.
- How could we be out of them? - I don't do inventory.
It wasn't an accusation.
- What is that all about? - What? The scarf.
Where'd you get it? I got it at the gift shop.
You don't think it works? - What about your jacket? - I wanted something different.
Lose the earrings.
It throws the whole thing off.
- Carol.
Carol.
- No, no.
I can get it.
I can't have students starting IVs on kids.
- Can you do it for me? - Sure.
- Is there a problem? - No.
I just want experienced staff starting IVs on kids.
- This is a teaching hospital.
- Not when pain's inflicted on kids.
- Lucy's great.
- It's not about Lucy.
- It's a policy I'm setting.
- You're setting a policy.
Well, first time for everything.
I'd be in a hurry to get out of here too.
What? We found out why your liver's failing.
You've been drinking.
You're not gonna believe me.
One time.
I don't believe you.
I checked with UNOS.
You've been on the list for another transplant for two months.
- Did you tell them? - Did I tell them what? That you drank through the first one and you want another? It wasn't like that.
It was today.
My son passed his bar examination.
I knew I was rejecting, so I figured what could it hurt? We had champagne at brunch.
That's it.
You've been lying ever since you came in here.
Please.
You can't tell UNOS.
I don't have a choice.
You're doing this to me over one glass of champagne? There are people on that list who haven't had any champagne.
If I lose my place, I won't last six months.
You report me, I'm dead.
I'm begging you.
Sorry I'm late.
There was traffic.
You take the EI.
- Who's on? - Weaver.
She's interviewing for Chief of Emergency Medicine.
- I thought she was Chief.
- Where have you been? - Dr.
Greene? - He's upstairs interviewing her.
- So we have no Attendings.
- Watch it, Jerry.
Sorry, Dr.
Ross.
Is he an Attending? Normally I wouldn't say anything.
But don't you think that attire is a little inappropriate? It's business.
I was helping out Dr.
Weaver.
Great job, Kerry.
We'd be lucky to have you.
It was a formality.
Thanks for coming.
I appreciate the opportunity.
Your presentation was everything we expected.
- Thank you.
- I'll walk you down.
It went great, Kerry.
- The pie charts weren't too much? - Charts are good.
- Did anybody else use them? - You were the first.
- Lf I came across as too eager - No, it went terrific.
Thank you, Mark.
I never know how to answer that question about my weaknesses.
I could've helped you out there.
That's a nice leather jacket.
I said I wanted to run some tests.
But I can't without Medicaid.
What's wrong? - This patient is illegal.
- Yes, but it doesn't matter.
Oh, yes, it matters.
The state won't pay for thousands of dollars worth of tests.
- You won't treat him? - I'll give him beta blockers.
He could have a cardiac arrest.
- He's had no arrhythmias.
- That's why we need the EP studies.
His father died from this.
- Did you document an arrhythmia? - No.
All right.
Then there is nothing else that I can do.
- Dr.
Kayson! - What? This boy could drop dead.
Well, so could a lot of people.
He's not emergent.
I'm sorry.
You said he was stable.
Single GSW to the arm.
- He was.
- He's intubated and hypotensive.
- Things change.
- What's the problem? Botched gang shooting.
They were ready for him.
- Is this the guy from this morning? - Yeah.
His name's Bo.
We thought it was his arm.
He crashed in the rig.
- Carter, we need your help.
- Come on.
Welcome back, Bo.
Okay, everybody, on my count.
One, two, three.
- Why didn't you recontact? - Things got pretty crazy.
Carol, put him on the monitor.
- What do we got? - GSW, mid-tricep area.
- Where's the probe? - Run it, Carter.
Decreased breath sounds on the right.
Tracheal shift to the left.
- Tension pneumo.
- BP's down to 70.
Pulse ox 89.
Damn it! And then I'm gonna need a 36 French.
I want to decompress into the second intercostal space, mid-clavicular line.
Okay.
Pulse is getting stronger.
- Lucy, get a blood gas.
- I'll do it.
It's okay.
I showed her how.
- Ten blade.
- Get the pressure back on the line.
Entrance wound, right mid-axillary line.
Bullet went through the arm into the chest.
- Why couldn't you undress him? - We had to run.
Where's that chest tube? - You didn't see this chest wound? - Not now, Carol.
- I can't get the blood gas.
- Move over.
I'll do it.
Chest tube is in.
That's okay, Lucy.
Those can be tough.
- Help me with the second line.
- Okay.
50 cc's out.
I need four by fours.
I need elastoplast.
I'm gonna call X-ray, get a portable chest.
I got the blood gas.
BP's up to 100/70.
- How's that second line? - I can't.
- Move the drape for more room.
- I can't do it.
- Focus.
We need the second line.
- I really can't do it.
- It's like any other IV.
- I haven't started an IV.
Never.
I'm sorry.
- Whoa! He's bradying down! - Okay! His chest tube is pouring blood! Let's get two units of O-neg in and call the O.
R.
- You cost me a procedure.
- Am I supposed to ask how? You should've babysat that pulseless foot.
Greene let the radiologist set him.
I didn't realize that was part of my job description.
Well, you're still learning.
- How was your first day? - As expected.
You are either a masochist or the stubbornest woman I've met.
But I admire your fortitude.
I couldn't handle taking orders from a weasel like Dale.
- Is that supposed to be a compliment? - Sounded like one to me.
And you can wear the long coat.
It looks better on you.
- 700 cc's out the chest tube.
- Take him up, Carter.
- Do they know he needs a thoracotomy? - Yeah.
O.
R.
3.
Have the blood bank send up four units, type-specific.
We weren't prepared for a trauma.
You should've called.
Sorry.
We were busy protecting his airway.
- You guys should've called ahead.
- There was no way And we have to be prepared for anything.
- I would've been prepared - Nobody's to blame.
We treated the patient.
Let's move on.
Do you want to review the run tape? - No.
- No.
Doggy.
Yeah! You want to pet the doggy? Oh, that is good.
You want him to respond in some way.
To point or to make some kind of sound.
Kitty says Do you want to pet the kitty? - Don't like the kitty? - It's okay, man.
That's okay.
One quick hug.
Then back to work.
- What? - He's gotta learn to focus.
Give him a break.
He's only a year old.
You can't give him a break.
He's not like other 1 -year-olds.
He needs constant verbal stimuli.
You try.
All right, man.
Here we go.
Doggy.
Doggy.
Hey, doggy.
I can't do this.
You're gonna have to learn.
Coming here twice a week isn't gonna do it.
I might've been able to keep that kid here this afternoon.
But he would've gone out and done the same thing tomorrow.
His mom's in Chairs.
You want me to go talk to her? No.
No, I'll do it.
- Did you get a number? - No.
You still here? Yeah.
I got sidetracked.
- You could use some help.
- Okay, take rashes.
- No, something more permanent.
- Allergies? Actually, I meant being your full-time P.
A.
I'd like to work with kids for a while.
I'm good at it.
Somehow it seems more worthwhile.
Well, I don't know about that.
At least you know whose side you're on.
You know, I'd love to.
I think I've used up all my chips with Anspaugh.
I've got some pull.
I could work it out.
- Great.
I'd love that.
- Excellent.
Yeah, hi.
May I have the transplant coordinator for UNOS, please? - I paged you twice.
- I don't want to talk yet.
That's too bad because I deserve an explanation.
If you want me to feel bad, I do.
I'm really disappointed in myself.
You should be.
That's not an explanation.
I don't know how it started.
You thought I could do it.
I wanted to impress you.
It spun out of control.
I'm sorry.
What did you think you were going to accomplish? I don't know.
- I thought I could learn on my own.
- You can learn on your own.
You don't need to be here, then.
You endangered patients.
You don't need to make me feel bad! I feel horrible! That would work if this was about you.
But down there it's never about you.
Go home.
Don't come back unless you're serious about learning.
If you ever lie to me again, you can look for another rotation.
What are you doing back here? Waiting for the grill to heat up.
I thought it was fend-for-yourself night.
No.
I'm sick of fend-for-yourself.
I got us some steaks.
Sounds good.
You got another one of those for me? What's in the bag? It's a pregnancy test.
Just to be sure.
No need.
I started my period.
Well, I guess I wasted $17.
50.
Save it for next time.
I'm kidding.
That was a joke.
We dodged a bullet there, didn't we? - That's good, right? - Yeah.
Yeah.
Although all day, I kept thinking, "Wow, a kid.
" You know, that would really change my life.
- Our life.
It would change ours.
- Okay.
Our lives.
That would be bad, right? I changed my mind.
I don't want to joke about it.
Maybe I'm not joking.