ER s06e14 Episode Script

All in the Family

E.
R.
Previously on E.
R.
- Paul Sobriki? - Yeah.
- Hold him! - ¬°What are you doing to me! - ¬°Carter! - No now, Lucy.
Paul Sobriki? He doesn't have a CNS infection.
I think he might be schizophrenic.
Somebody! Lucy! E.
R.
6x14 "ALL IN THE FAMILY" Dr Weaver you better hurry up! You're gonna miss the party! What? - Dr.
Weaver.
- Cleo! You're off? Dr.
Kovac gave me 15 to grab my dry-cleaning before closes.
- We're slow, I take it? - We are now.
What's that music? - Looks like nail polish.
- It's buffed! You got a manicure, Malik? The ladies check out your hands first.
I check out the butt, myself.
- That's a myth.
I tested it.
- Tested what? It's so not worth explaining.
- Kerry, happy Valentine's Day.
- It's a little loud! Sorry! What are you doing? Oh.
Hi, chief.
You on? Someone went overboard with the hearts.
What's wrong with them? - Want some pizza? - No.
Isn't Mark still on? He left at 8.
Double date.
I'm on till 9.
Mighty fine.
We slowed down.
No one's waiting to be seen.
I took over the board.
Okay.
Another five minutes and then back to work, all right? I'm sorry, Mrs.
Minear, it was a mistake.
It won't- I was expecting some money, and it- I was expecting a check to clear, and it didn't.
I promise- I promise I'll get it to you.
Thanks.
Teach me to check my messages.
- Everything okay? - No.
- But it'll work out.
- I'm beat.
You're leaving? I've been here since 7.
I just want to go home and hug my girls.
- Lose a patient today? - Yeah.
Nice to have someone at home.
- Alex and I broke up.
- I thought he was The Man.
- Yeah, so did my neighbor.
- Ouch.
- Luka, do have anyone to hand off? - If you want.
Ankle films are back on Cupid.
A Singing Telegram slipped.
I need a doc in Radiology for a patient named Rodriguez.
- That's Carter's.
- Find Carter.
- Can I have a bath? - Let me look at your foot.
- Pablo, you're alive? - Yeah, I'm alive.
- We haven't seen you.
- They put me on a bus.
- What kind of a bus? - A green one.
- Where did it take you? - I need a bath.
I think Pablo got deported.
- How'd he get back? - That part's fuzzy.
- It took a long time.
- Welcome back.
Yeah, welcome back.
Kerry, happy Valentine's Day- Or night, I guess.
Yeah, you too.
- You know where Sobriki is? - Who? - I got called down for a consult.
- I just got on.
Check the board.
- You must be Mr.
Morris.
- How'd you guess? Is that my x-ray? Yep.
Let's take a look.
- Is the bone broken? - Hold on.
Gotta find another board.
I'll be right back.
Could you talk to Toxicology? What's the problem? "Bare Butt Booty Oil"? Kid drank it, isn't symptomatic so they won't test it.
- No ingredient list.
- "Bare Butt Booty Oil.
" - Okay, I'll talk to them.
- Thanks.
- Is it just me, or are they dreadful? - No, it's not just you.
Surgery's on its way! - Spin a crit right away! - Watch it on the right! No, I can't stay on the line! This guy could still be here! Get them here! John, can you hear me? - Airway looks clear.
- John, open your eyes.
No response to command.
Glasgow coma-scale 7.
- How long were they there? - Long enough.
- I can't believe no one noticed.
- Later.
One, two, three.
Push Etomidate and sux now.
Stab wounds to neck and chest.
Two more to the belly.
Number 8 ET tube.
What's her BP? - Pulse ox is low.
82.
- Get me a blood pressure! - Chest tube tray.
- No, start a central line.
BP is 90/50.
Four units of O-neg, hang two on the rapid infuser.
You okay? - I got it.
Start the central line now.
- Betadine and a sterile drape.
People are having parties while they're bleeding to death.
Two stab wounds to left flank.
First one is at L-2, Second one is in the mid-scapular line.
- He hit the spinal cord? - Depends on the angle.
- BP's 70/50.
Pulse, 120.
- Set me up for a subclavian.
Good breath sounds bilaterally.
Pulse ox, 93.
- Should we intubate? - No.
Ten liters by mask.
Send a trauma panel, type and cross for 4.
Get X-ray for a chest.
And one shot IVP.
I was just talking to him.
Right here.
The patient's gone.
What's his name? - Paul Sobriki.
- Who are you? Carl DeRaad, chief of psychiatry.
- What's he look like? - I hadn't seen him.
- I'll get his chart.
- I will.
This is a crime scene.
It's okay.
He's a doctor.
- First crit is 31.
- Is he conscious? - Is he conscious?! - No, but he is responding.
It was a psych patient.
Got Lucy too.
Roll him, let me see.
Oh, man! Pressure's up to 90.
Why wasn't he in restraints? - Where's the Foley? - That's next.
- Pulse ox is 83.
- Give it a minute.
The police are sealing off Curtain 3.
They need someone who took care of the patient.
Look at this! Look at this! - Tracheal laceration.
- She needs a crike.
No, a trach.
Get Benton in here.
Prep the neck, open a Melker kit.
- Dr.
Benton! - Hold on.
No spinal injury.
Hang the next two units on the infuser.
- It's not set up.
- Get it set up! Probably got the descending colon.
Peter, Dr.
Weaver needs you now.
She has to trach Lucy.
- Book an O.
R.
Where's the Foley? - I'm working on it.
Clear the field of blood.
Hemostat! - Where's the infuser kit? - It should be there.
- They're not here! - Well, try the top shelf.
- What is it? - A knife.
Don't touch it.
We got a weapon.
- Any blood? - Some.
We were gonna use it to cut the cake.
I have to go find some tubing.
- Are you working on a victim? - Yeah.
- Will he make it? - I don't know.
- Is he awake? - Got it! Second unit's in.
- Pressure's up to 100.
- Give a gram of cefotetan.
Right pupil is 5 mm and reactive.
Left is- John? John! - Deb? - Do you know where you are? My back.
You were stabbed.
Your pressure's up.
Lucy? Did you see the man who-? - Not now! - It's better if I- You'll have to wait! - What? - Nothing.
He missed your spinal cord.
BP's 80 palp.
- Is that Lucy? - Yes.
She's alive.
- Dr.
Kovac.
- What? What? What is it? Get Benton.
He needs to go up! Dr.
Benton, we need you! Hook up the Thora-Seal! Dr.
Benton, Carter's got a bad renal lac.
Foley output is bright red.
Got another surgeon coming? We're outside! I'll be right there! Dad, wait for us inside.
- Register in front.
- I'm a surgeon! - We don't have time for this! - You must move your vehicle.
- There! - Okay, go ahead.
Dad, I need you to move the van.
- Where do I park it? - You're asking me? You stay awake until you get up there.
- FFP? - Two units.
Carter, stay with me! - How is he? - We're red-lining him to the O.
R.
- A patient did this? - Yeah.
- What's his pressure? - Kerry needs you.
Carter! Look at me, right in the eye.
Stay with me, man.
- Xeroform and Elastoplast.
- Probably intra-abdominal bleed.
- Why wasn't this guy sedated? - I don't know.
- Was there a sitter with him? - I never saw him! - Where are we? - Stab wounds to neck, chest, abdomen.
- We had to trach her.
- And blood loss? before we found her.
Looks deep.
How long was the blade? - Pressure's 60.
- She needs volume now.
- It could be tamponade.
- No, wait! Check the CVP.
- Lost her pulse! - We're in P.
E.
A.
Starting compressions.
- We need to crack her.
Prep her chest.
- Amp of epi.
Sterile gloves.
Stab wound is near the midline.
- Sternal saw.
Now, Lily.
- Go! Go! Go! - Ultrasound is ready.
- In a minute.
Ten blade.
Stand back.
Sats are down to 85.
- Almost got it.
Okay.
- Rib spreader.
Suction.
- V-fib! - Start internal compressions.
There's an effusion.
Metz.
Prep the internal paddles.
- We've got a major hemorrhage.
- Looks like the proximal aorta.
I need a 4.
0 prolene on a n RB-1 needle now.
Belly's full of blood.
- Clamp the aorta.
- First things first.
Autotransfuse from the cell saver.
- Charge the paddles to 15.
- Cut! Cut! Clear! We're still in V-Fib.
Another amp of EPI.
Clear.
- Sinus tach.
- Check pressure! We're moving her to the O.
R.
now.
Pulse ox is up to 92.
- Pressure's 90.
- Let's go! - Pulse ox cable! - Is she making urine? - Only 50 cc's.
- That's better than nothing.
Tell O.
R.
we have an open chest wound.
- We're waiting on the type-specific.
- Have it sent up.
- Are you putting her on bypass? - Have a perfusionist.
Don't bag so fast.
We don't want her alkalotic.
- Need anyone else? - I hope not.
Don't forget the drug box.
Go! I can't believe this.
You think we got it in time? - She has a good chance.
- Kerry? You're the one who found them? We got a problem with the Medevac chopper.
- Try to divert.
- I did but- Whatever.
Peter! I just heard.
What happened? This is O-neg.
I asked for type-specific.
He is O-negative.
I'll scrub in.
Hang in there, Dr.
Carter! - How many units is that? - Five, but you shouldn't be counting.
It's bad, isn't it? Well, we're having problems keeping your crit up.
That's from the renal lac.
I'm giving you Versed to relax you before I intubate.
- It could be the aorta.
- Or mesenteric vessels.
Oh, God.
Don't worry.
I'll explore the abdomen and check out everything, okay? I'm glad it's you.
I'm getting you through this, man.
You hear me? Okay, ready to intubate.
- I want to cut in 2 minutes.
I mean it.
- You got it.
- Lac to the proximal aorta.
- What happened? - We had to crack her.
- I got this.
- Who's on anesthesia? - I got her.
Put her on the table supine.
Keep her chest covered.
You need a six-inch butcher knife to cut a cake? They just told me that's what we use.
- We just leave it out? - I didn't.
- Was it in the lounge? - I don't know.
I couldn't find it.
Go get Security to open up the personnel office.
I need contact numbers for Carter and Lucy.
I want you to bring the files down.
- He presented with a headache.
- Who? Paul Sobriki.
Please tell me that you saw him.
Yeah.
Lucy worked him up, Carter supervised.
- Who supervised him? - The LP came back negative.
You could have rounded before leaving.
- I ran the board with Dr.
Kovac.
- For 30 seconds? - He was up to speed.
- You didn't say he was psychotic.
I didn't know.
Did he present to you? - We wait on psych consults.
- Unless his status changes! - I was managing the whole board.
- You were having a party! We thought that Lucy and Carter had it covered.
- Well, they didn't.
- Excuse me.
We use the Residents to keep us informed.
- You're blaming Carter? - I'm not blaming anyone.
I have Samantha Sobriki here.
She's looking for her husband.
I got a message from Lucy Knight.
She said to come down.
She didn't say what was wrong.
You'd better come with me.
That chopper's landing right now.
The Medevac from Whiting.
Kerry, go and change.
I'll take it.
What happened? The air squad's here.
- Was there a bomb scare? - I wish.
- It's not true.
I want to see him.
- He's not here.
Paul couldn't hurt anyone.
- He needs help.
- There's been a mistake.
We believe he may have schizophrenia.
What? The first psychotic break can happen in your 20s.
You're wrong, okay? You're wrong.
- The kidney won't tamponade.
- You couldn't get an IVP? I didn't want to chance it.
The colon's lacerated, all right.
There's blood welling in the hilum.
Isolate the renal artery.
Get a clamp on it.
- He's hypotensive.
- We gotta get this kidney out! Let me finish suturing before we do something drastic.
- I'll dissect out the arteries.
Move! - I said wait! He's lost too much blood.
His hilum's trashed.
He's getting shocky.
Pressure's 78 palp.
- We have time.
- We don't! Peter, calm down and listen to me! Let's check the source of the bleeding once more.
- Too many vessels are injured.
- Let's be sure.
I can't identify the source of the bleeding.
- I'll pack off the liver.
- BP's 105/70.
- Angled Potts now.
- What're you doing? Pringle maneuver.
Have to cut this blood loss.
- The spleen's still bleeding.
- Okay.
- BP's falling, 80/60.
- Run another unit.
- She loses it as fast as we give it.
- Then quickly! A and O times 4.
BP, 132/82.
Pulse 110.
You sure there wasn't a projectile? Just oil.
Must've been a loose fitting.
A small stream at that pressure will cut through you like a.
22.
- Hey, Dad.
- What's going on? Get a trauma panel.
Type and cross for 4, I'll be there in a minute.
- A couple of our staff were hurt.
- I heard.
Who's that? I'm covering.
Things are off-balance.
- Where's Elizabeth? - She's up in Surgery.
An MVA's coming, auto vs.
pedestrian, in five minutes.
Grab Chen and Malucci.
Weaver should be around.
- What do I do with her mother? - I'll drive you home in a half-hour.
- Will they be okay? - Who? - Your friends.
- I don't know, Dad.
You're acting like you know he did it.
You don't.
You're right.
But we still need to find him.
He's not at home.
Nobody's seen him at the diner.
Is there any other place he would feel safe? He was depressed.
It doesn't make him crazy.
Maybe.
But we have to assume he could be a danger to himself or others.
If he was dangerous, why did they leave him alone? I understand.
This doesn't make sense to any of us.
But if Paul is in trouble, he needs help.
And it's better if we can find him now.
Sometimes he goes to the roof to be alone.
- The roof? - Of our apartment building.
He didn't do this.
Bleeding's under control.
Pean clamp.
- Watch the pancreas.
- Hold on.
I'll enlarge the incision in the peritoneum.
Watch for splenic flexure.
- Got it.
I'll clamp, you cut.
- Metz.
Bastard sliced the hell out of it.
It's senseless to cut up this poor girl.
It's better than the alternative.
Let the renal artery flush retrograde before closing the defect.
There.
Think we got it? There's one way to know.
Release the clamp, let the kidney perfuse.
Okay.
Go ahead.
No bleeding.
Hilum's intact.
And the kidney is pinking up.
All right, we did it.
You were right.
Thanks.
He could've lived without a kidney.
Pressure's still down, 80/62.
- We caught up on volume? - Almost.
Why is he still hypotensive? There's swelling in the periaortic area.
A hematoma's forming.
- From the lumbar artery? - I hope.
- It could paralyze him! - It's better than his aorta.
Dissect down to the artery.
- Some kind of life.
- I hope this isn't normal.
No, I don't think so.
You've got quite a girl there in Elizabeth.
I can't take the credit.
The boarding school raised her.
I was teasing.
- Her father passed on? - He was alive, the last I heard.
- I'm sorry.
- Don't be.
It wasn't your fault.
- Have you heard anything? - They're in the O.
R.
- Think we should go up? - They'll call when everything's okay.
- What have you got? - John Doe hit by a van.
- No head trauma, repeated questions.
- I called a cab! - I think we got a looney-toon.
- Why? He was running around naked in the freezing cold.
You can't do this! - Are you sure? - Yeah, it's him! Trauma panel, C-spine, chest and pelvis.
- Is he combative? - I'm not taking any chances.
- Get the police detective in here! - Get X-ray.
- Abdomen is soft, non-tender.
- I won't talk! I made promises! Pupils equal and reactive.
- Paul, do you know where you are? - Who told you my name?! - Paul, do you remember what happened? - You can't trick me! - No deformity.
- I'm not deformed! Temperature's 95- Get off of me! Leave me alone.
Don't stick me.
You want some Haldol? Dr.
Weaver, do you want some Haldol? Two liters of saline and five of Haldol.
Where are you going? - Can you take this patient? - You okay? He's the guy.
He's the psych patient.
He got hit by a car.
Can you just take him? - Okay.
- Thank you.
BP 120/82 after a liter.
Probably venous oozing.
Can you take him? - Who's our surgeon? - Whoever's free.
He has a chest tube and head CT.
I don't want you to touch me! Stop sticking me! - Let me go! - Keep that mask on him! Don't cut me! Don't cut me! No! Hell of a Valentine's Day.
She's satting at 98 on 30% oxygen.
Can't ask for better than that.
Good work.
How's Carter? Took a while to control the bleeding.
They saved his kidney and are doing a colostomy.
Unbelievable.
County supervisor's on the phone.
He heard what happened.
- Tell him I'm in surgery.
- I told him you got out.
Thank you.
Appreciate that.
I'll be right back.
Dr.
Corday, she's waking up.
Lucy Lucy, can you hear me? Do you know what happened? There's several stab wounds.
One lacerated your proximal aorta.
We performed a thoracotomy after you arrested.
They gave you a trach to maintain your airway.
Your liver was damaged, but we were able to repair it.
However, we removed your spleen.
I'm sorry.
You can't speak.
You can whisper if I plug the trach.
Want to try? Remember, only whisper.
Thank you.
Bring the proximal colon to skin surface.
- Hanging in there? You look ragged.
- I'm fine.
Metz.
I think young Dr.
Carter is very fortunate.
Depends on how you see it.
- We need a surgeon in O.
R.
3.
- What is it? Penetrating trauma.
Something about oil.
- Where's Corday? - Should I page her? - We're busy.
- Take a look.
I can finish.
I've come this far.
Is the patient stable? - Who's with the patient? - Dr.
Finch.
Have her stay until Corday shows.
They need me in the O.
R.
I'll be back.
Hold on.
Her sat's down to 82.
What is it? Chest pain? Sudden onset.
Put her at 100%.
We must do a spiral CT now.
PE is a possibility.
- What is it? - Sudden chest pain.
Dropped her sats.
We'll scan for a PE.
Bolus 5000 heparin.
Start a drip, 1000 an hour.
Hold on.
Keep going.
Come here.
Don't thin her blood if we don't have to.
I think she threw a massive clot.
We don't want her to bleed out.
If it's PE and we don't thin her blood, she'll throw another clot.
We won't heparinize for more than two hours.
- I won't need that long.
- Let's go.
Were you working on my husband? He was hit by a car.
Collapsed lung, but we fixed it.
No head trauma.
- He's with the psychiatrist now.
- Can I see him? You should wait a minute.
We gave him a drug to calm him down.
I really need to see him.
Right pulmonary artery.
Get her into angiography.
I'll meet you there.
Get the room ready.
Chest and abdominal dressings soaked through.
Watch her BP.
Send her for a hematocrit.
There's some oozing from the incision.
Happens with heparin.
Blood pressure's fine.
No major hemorrhage.
CT shows a pulmonary embolism.
We'll take you to Angiography and put in a filter.
We'll reverse the heparin.
You may need another transfusion.
Lucy, are you with me? I'll get you through this.
All right? All right.
- Want anything? - Coffee.
Two coffees, please.
- You didn't want to go home either? - Yeah.
Sit down.
We thought it was better than waiting upstairs.
- Pretty scary, huh? - Pretty scary.
I was complaining about my day.
BP's 112/78.
Pulse 102.
AC 14, tidal volume 600, Another two of Versed.
To relax you a bit during procedure.
Want to stay awake? I'll numb the inguinal area and put a catheter in the femoral vein.
- I'll prep.
- Spun crit's 32.
- Good.
Go.
- I'll be right back, Lucy.
We put too much time and energy into your training to lose you.
Filters are a snap.
I've done 100 of them.
I'll talk you through it.
BP's down to 60.
Pulse ox 72.
- No carotid pulse.
- She threw a clot.
Start chest compressions.
Bag her! Lizzie, I need you! Get me a staple remover! Throw some betadine on the chest.
- You're opening her? - She won't make it to O.
R.
We need two more nurses.
- What happened? - She's in PEA.
Get wire cutters.
- Wire cutters? - We wired the breastbone.
- Corday's tied up.
- Why? - She's in CT.
- Can you take it? - I'm suturing.
- I gotta run the bowel.
He needs an exp-lap.
Go.
I'll page you if anything changes.
- Vitals? - BP's 125/85.
Pulse 92.
- Crit? -42.
Prep for an exp-lap.
Stay here until the surgeon comes.
- You can't stay? - I'm operating on Carter.
Start internal compressions.
- Right ventricle's dilated.
- Side clamp.
- Want a fogarty? - No, just a yankauer.
Scalpel.
- We'll suck out what we can.
- Suction.
- Right side.
- We've got a few clots.
Maybe she'll get some oxygen.
- Pressure's dropping.
- He can't wait.
Where are they? Probably tore a mesenteric artery.
Lost the pulse.
Starting compressions.
Betadine! - What are you doing? - Thoracotomy tray.
- He only needs a laparotomy.
- I don't know how to do that.
You can't operate here.
Wait for the surgeon.
He can take over.
Get me a scalpel! Get Benton! - Pulse ox? -68 on 100%.
- We're not oxygenating.
- Removing side clamp.
- V-fib! Resuming compressions.
- Internal paddles.
Charge to 15.
Clear! Still in v-fib.
- Charge to 30.
- Push an amp of epi.
Clear.
- Nothing.
- Again.
Clear.
- Sat down to 62.
- Charge again.
100 of lidocaine.
Clear.
Again.
Clear.
- What are you doing? - Saving his life.
- He needed a laparotomy.
- You should've been here.
- Should've called me.
- Aorta's cross-clamped.
This was unnecessary.
What were you thinking? - There was no pressure.
Now there is.
- I've got it.
- He was about to arrest.
- Step the hell back now! - Pulse is down to 90.
- Move, people.
- I'm sorry Carter's hurt- - Irrigate the chest with warm saline.
Clear! - Asystole.
- Amp of atropine.
- When was the last epi? - Four minutes ago.
Push another 7 mg now! Clear! We've done everything we can.
Holding compressions.
Damn it.
Son of a bitch! Give a minute for the last epi to circulate.
Charge.
- Lizzie, let's go! - Robert Call it.
Time of death 2:56.
When can I go home? I don't know.
I want to go home.
I need to feed my dog.
Paul, we have someone here to see you.
- Paul.
- Sam.
I want to go home.
- What happened? - They took my clothes.
My shoes.
- Who took your clothes? - Them.
Who's them? They had a blue cake.
- Is that where you got the knife? - They were gonna open me.
- The knife? - They were gonna take my organs.
- What organs? - My internal organs! Don't you understand? I had to protect them! Don't try to tell me I don't know.
I know.
They tried to take them.
I had to stop them! Is he ready? Yeah.
- Do you want to take him upstairs? - Can I please go home now? I'll meet you in recovery.
Is Carter out of the O.
R.
? He's extubated in recovery.
Vitals are stable.
- Peter- - You were right.
I put you in a tough position.
What's wrong? There was a complication with Lucy.
- Not "Vanessa" Vanessa! - The one and only.
You know her? I saw her in medical school.
She had abdominal pain.
Carter orders a pelvic.
Tells Lucy the patient's more comfortable with a woman.
- Oh, man! - Who's Vanessa? Lucy's official, polite.
She gets her tray puts on her gloves, pulls back the curtain- - Carter's outside waiting.
- For what? - The scream.
- I don't get it.
Carter sent her in to do a pelvic on a drag queen.
He did not! - Terrible.
- She didn't know? Hand it to Vanessa, he's got a better figure than I do.
What is it? Lucy.
Tell me when the vibration stops.
- What about the pancreas? - Intact.
He got the colon.
- How long will I have the colostomy? - A month.
We'll do a take-down.
Now.
Good.
Sensation's intact.
- You were lucky.
- I know.
Thank you.
You're welcome.
I'll test your motor strength.
Lift your leg.
- How's Lucy doing? - Come on.
Lift.
- That hurts.
- I know.
Don't let me push it down.
Hold it.
Hold it.
Good, good.
- My back is killing me.
- I know.
Hematoma on lumbar plexus.
I'll give you morphine.
I want you walking in 12 hours.
Lucy's dead, isn't she? Oh, you're home.
Everything all right? No.
- Do you want to tell me about it? - Not particularly.
I'll make breakfast.
We need a pressure transducer for Trauma.
Get two units of O-neg.
- We're out of Ancef.
- Call the pharmacy.
I just heard.
How did this happen? - Can we talk about it later? - Sure.
- Something coming in? - Multi-victim trauma.
Assembly-line accident.
We'll take 2 major, 6 minors.
- ETA? - Now, but we're short a doc.
- Abby, you on? - No.
- We're short.
Can you cover? - Sure.
We need someone to cover triage.
Crush injury, right arm.
Gave him morphine and two liters.
Shocky, 90/60.
Neuro-circ intact? Couldn't get a pulse.
Multiple fractures.
Call Ortho and Vascular.
Type and cross for four.
Trauma 2.
I had to close her chest.
Thank you.
- The nurses can do that.
- I know.