ER s10e18 Episode Script
Where There's Smoke
E.
R.
Previously on E.
R.
- You did it.
- We have a baby.
Will you be home late again tonight? - Med list.
- Why didn't you have it? Phenelzine? She'll be a star in internal medicine or research You have to be more decisive.
Shall we try the high-dose epi? I assessed it, I ordered it, I pushed it.
- I gave her the order.
- You falsified the chart.
That's a felony.
Nothing I did on this shift can convince me or anyone else that I belong here.
She's not an ER doc.
E.
R.
10x18 "WHERE THERE'S SMOKE" We need more wipes.
Where's your mom? She's late.
- Hey, 9 ounces.
- Nice.
Can't say I don't produce.
Better put on your shirt.
She already thinks we're pervs.
Come on, baby.
You gonna be good for your grandma? Yeah, you're always a good boy, aren't you? That's my baby.
That's my baby.
I'm sorry.
My battery was dead.
- I had to get a jump.
- That's all right.
- Hi, baby.
- Hands.
Wait, hands, hands.
- Hi, Ma.
- Hi, hija.
Carlos is going to buy me a new battery.
Really? What you need is a new car, Mom.
- Yeah? - Preferably with an air bag.
Yes, well, you going to buy it for me? Yeah, right.
My brother's a saint because he's getting a battery but I gotta pick up the tab for a whole new car.
He didn't sleep well last night so you might wanna put him down early for his morning nap.
Oh, okay.
Poor lindo.
Just like your mother, only don't be so stubborn, okay? - You ready to go, babe? - Yeah.
- Say goodbye to Mama.
- Goodbye, baby.
- And Mommy too.
- Say goodbye.
- Come on, baby.
- Okay.
It's all right, papa.
Don't worry.
We'll be back.
- Your son has a set of pipes on him, huh? - Yeah.
- He gets that from your side of the family.
- Oh, yeah? What are you trying to say? I got a big mouth? You want a turkey or peanut butter sandwich? Both.
You want turkey with peanut butter? - You used to make it for me, remember? - No, I didn't.
Well, somebody did.
Hey, what are sodomy laws? I'll get it.
- What are you doing here? - Just got off work.
- Thought I'd stop by, say hello.
- Hey.
Guess he misses us or something.
I have to be at work in, like, 40 minutes, and he has to be at school, like, now.
- You know, if he wants, I could stay.
- Nice try.
Gina got a ticket for double-parking last time.
Go.
When are you gonna stop working night shifts? Soon.
- And what are sodomy laws? - Out! You know I have a couple of minutes before I have to leave.
Really? A lot can happen in a few minutes.
I'm sorry.
It doesn't have to be anything fancy.
I'm really tired.
How tired? Not that tired.
How did you score? - On your boards? - Don't know.
I can't bring myself to look.
- Any luck, I failed.
- Now, that's a positive attitude.
Part of me is afraid I'll be given a license to practice medicine one day.
- Isn't that the point? - If I was good at it, yeah.
Between annoying Attendings, butting heads with nurses and being responsible for a patient's death because I tried to be aggressive writing's on the wall for me, wouldn't you say? You're not good until you've killed someone.
Spoken like someone who hasn't.
So how you doing? Fine.
And I don't have much of a poker face, do I? Abby, pilonidal cyst in Four.
Gallant, shingles in Two.
Neela, vaginal bleeding in One.
Get to work.
Sorry, I'm late.
Had a meeting with Risk Management.
Oh, my God.
Are you okay? My feet are swollen, my back is killing me and apparently, my waddle's too slow for people.
Got a long day.
The sooner we start, the better.
All right.
We're doing interviews on the phenelzine death.
- I'll need some time off the floor.
- Are we being sued? Not yet.
Need to clarify the hospital's defense.
All right, Gallant, you're up last at 11:30.
The Attending's up last since he's the one who will be named in the suit.
God knows Carter's got assets.
That why he left the country? All right, we'll start at the bottom and work our way up.
Neela, that's you.
The guy's records fell through the cracks.
It's not like anyone did anything wrong.
What's the matter with you? This chick is hot.
- A little overweight, but in a good way.
- Not interested.
- Mike, she's your type.
- I'm busy.
- Lieutenant James on line one.
- Tell him I'll call him back.
Busy doing what? Playing soldier? You need a life.
Dr.
Gallant, you treat the immersion burn in Exam Four? - Problem? - I tell you You did excellent with the débridement.
Magna cum laude.
- Ever thought of switching to surgery? - I'm pretty well committed.
- If you change your mind - She has legs up to here: - Pratt.
- You're playing games.
Susan's with Risk Management, so present to me.
- Yeah, okay.
You all right? - Yeah.
Why? - How's your dad doing? - Oh, he's much better, thanks.
Okay.
We have a homeless John Doe, approximately 70 years old found in a makeshift tent in Lincoln Park, cold and altered.
His sugar's at 435, so I gave him 8 units of insulin sub-Q.
- How long has he been outside? - Rectal temp's 92.
3.
Overnight? Diabetic ulcerations on the feet.
Also has high blood pressure: 180/95.
And evidence of a prior MI on the EKG.
- Pretty bad cataracts too.
- You sure he's homeless? - Well, he fits the bill, right? - Nails are groomed.
Check Missing Persons.
Maybe he's a wanderer.
Sir.
Sir.
Oh, great.
- Here.
- Seems like he's incontinent too.
Kerry.
My department's in utter chaos.
Since Robert, there's been no leadership.
Scheduling's a nightmare.
And nobody's representing us at the bargaining table.
- Our salaries have been cut back.
- I know.
- Well, what will you do? - Have the new department head assess the situation and get back to me about it.
- You selected a chairman? - Dr.
Weaver, Sandy on two.
Chairwoman.
Can you find out if it's urgent? Unless you prefer to be gender non-specific and simply referred to as chair.
Only dinner.
Call her back.
I'm late for a medical executive committee meeting.
I don't understand.
When was this decided? Two months ago.
Still need final approval, but that shouldn't be an issue.
Fine, but it would have been nice to have been asked.
Three months.
I don't know.
Something like that.
You don't want it? Maybe.
I don't know.
It would have been nice to be given a choice in the matter.
How long has your back been hurting, Mr.
Halpern? A couple of days now.
Did you fall or strain yourself? I slipped on the stairs about a week ago.
Might have triggered something.
I had a slipped disk a few years back.
- You have surgery for it? - No, no.
I couldn't afford it.
It just flares up once in a while.
I usually just take Vicodin.
Let me guess.
You're allergic to Tylenol and ibuprofen and Vicodin is the only thing that works.
Yeah, I don't really like the stuff, but what am I gonna do, you know? - Abby? - Tand L spine and get some urine? Yep.
We'll be right back.
Then run a tox screen.
Check his records.
Make sure he's not drug-seeking.
You read my mind.
So you think you'll match at County? I don't know.
So you basically let a desk clerk get in the way of your getting a medical history? I suppose I did.
Did you inform Dr.
Gallant that you didn't have Mr.
Sanchez's med list? - Yes.
- And yet he gave the order for Demerol? Yes.
- Do you have anything else? - No, I'm good.
Okay.
Thanks, Neela.
I have a friend who's doing a study on neuroprotective agents in stroke.
They're looking for students to work in the lab.
Research? Just check it out.
This is crazy.
If Susan knew she was in inquisition, she should have scheduled another Attending.
Abby: chest pain, scalp lac, itchy groin rash.
- Already got eight.
- I've got 12.
What's your point? Dr.
Chen, old frozen guy is waking up.
- He asked for some water.
- Oh, hey, Kovac called.
He said next time he's gonna have a triple latte.
- That make sense? - Yeah.
- Aren't you two living together now? - No.
For what it's worth, I think Luka's a good guy.
- Oh, wait.
You didn't-? - Sleep with him? No.
I went in a completely different direction.
Hi, I'm Dr.
Chen.
Can you tell me your name, sir? Jones.
First name is Bob.
Is there any family we can contact, Bob? No.
I'm homeless.
Mr.
Jones, your hemoglobin A1 C suggests that your diabetes was under control until recently.
What happened? No missing-persons report that fits.
Well, we'll just have to call Social Services get him placed somewhere.
Yes.
I need somewhere to live.
All right, re-check d-stick, urine ketone- You know what, why am I doing this? He's Pratt's patient.
So the Klonopin's working? Okay.
No, that's good.
Just give me a call if he gets agitated again.
All right.
What are you doing? Talking to your father's nurse.
She tried to call, but you were busy.
He tried to fry a steak while she was stripping his bed.
- What? - Yeah.
Set off all the smoke alarms scared himself, but he's okay now.
Oh, my God.
I gave her verbal orders for p.
r.
n.
Klonopin.
It has a long half-life.
You might wanna consider restraints.
Dr.
Chen, Rescue 3-8 has two critical and six serious from a structure-fire collapse.
Give me it.
I'll call Resp.
Make sure they have vents ready.
Page Trauma and Burn Fellows, set up rapid infusers and get Lewis out of that damn meeting! She discovered he'd had a bad reaction to morphine and sought out an alternative.
It was smart on her part.
She didn't tell you what that alternative was? No.
Not specifically.
Did you hear Dr.
Gallant give the order to push Demerol? No.
But to be fair, I had stepped out of the room briefly.
- What are you guys looking for exactly? - The truth.
Meaning you think there's some sort of cover-up? Excuse me.
Dr.
Lewis, FD's are rolling up with criticals.
- What do we got? - Tommy Mason, 33.
Full-thickness burns to the face, neck and chest.
Unconscious at the scene.
BP's 90 palp, tubed for agonal resps.
- Residential fire? - Abandoned warehouse.
Should've let it burn.
Nobody to save.
Sam, Gallant, you take the next one.
Pratt, you come with me.
What happened? Industrial fire, 17 got hit pretty bad.
- How did your meeting go? - Fine.
Andy Fash, 22.
Smoke inhalation.
Passed out and took a fall.
- Dislocated knee.
- BP's 132/80.
- Belly pain.
- Good pulse on the foot.
- Pelvis is stable.
- I'm cool.
How's Mason? - We don't know yet.
- I'll get the next one.
- This the second critical? - Next rig.
Took a while to fish her out.
- Abby, you take this one.
- By myself? Chen and Pratt, next room.
Gallant, Neela, with me.
Injury on scene with prolonged extrication.
Hi, I'm Dr.
Lewis.
- It's Sandy.
- Hey, doc.
Got a flash.
Wire.
Sandy, you need to stay still, okay? BP's 80 palp.
Tell Gemmill to stop trying to get a look at my boobs.
- Chest is up.
- Rib fractures.
- Pneumothorax.
She needs a chest tube.
- I was about to say that.
Pulse ox to 78.
How about doing it instead of talking? Ten blade.
- Tegaderm for the line.
- Sandy, how are you doing? I've been better.
- I remember you.
- How's the baby? You have carbonaceous material in both nares.
We need to think about securing your airway.
You wanna shut me up by sticking a tube down my throat? We wanna help you breathe better.
- I want- I wanna talk to Kerry first.
- Okay.
Cut in the fifth intercostal space.
- Mid-axillary line.
- Yeah, I'm aware of that.
Free fluid in both pericolic gutters.
Sandy, you need the O.
R.
We're gonna have to intubate.
- What's taking her so long? - I paged her.
Okay, I'm in.
Please.
Okay, okay.
Put her on 100-percent non-rebreather.
The minute she's here, I'll intubate you.
- Need another doc.
- Go, Gallant.
Just a chest tube.
- Not a student.
They want a doc.
Neela, have you ever done a horizontal mattress? - Yes.
- Dazzle me.
- What do you need? - Glove up.
Sixty percent surface area burns with hypoxia.
This guy needs an escharotomy.
Wide prep, 10 blades for both of us.
We'll open a square over the entire chest down to the sub-Q.
BP's down to 70 palp.
Gallant, check the ET for a leak.
May have to re-intubate.
- Yes, ma'am.
- Ready? Every time.
Anterior axillary line all the way down to the 1 Oth rib.
Join the top and bottom transversely.
Mike, you should be able to bag him now.
Nope.
Sats are dropping.
- Hold up.
Eighteen angiocath.
- What? Tracheal shift.
Puncture wound.
Tension pneumo on the left.
Gotta needle him.
Hemostat and 4-0 vicryl.
- Pulse is stronger.
Sats coming up.
- Nice catch, Gallant.
Hey, Abby needs some help with a knee reduction.
- Pratt.
- I'm in the middle of tying off a bleeder.
Gallant can take over.
- Sterile gloves.
- What's up? Lateral dislocation with equivocal pedal pulses wheezing, maybe smoke inhalation.
Is he hanging in there? Chest was so bad, he couldn't breathe.
He's intubated and doing better.
Systolic's 120 with 50 on board.
- Lopez? - We don't know yet.
He's had 250 mics of fentanyl.
I told the old-timers I'd race them to the top.
All right, this is gonna hurt.
Have to pull on your lower leg to move it back onto the knee.
Seventeen years between them.
I got eight months.
Come on, stabilize the distal femur.
Let's get ready to pull.
- Tommy got up there first.
Then Sandy.
- Enough counter-traction? - Remember thinking the old guy won.
- Yeah.
Ready? - Then I saw them both drop.
- Okay, one, two, three.
- Where's Sandy? - Trauma One.
- How bad is it? - She's conscious.
- Excuse me.
Sandy? - Crit's 24 after two units.
Sandy? - Oh, God.
- Hey, baby.
- What did you go and do? - Roof collapse.
Bilateral rib fractures, pneumothorax.
Intra-abdominal bleed, pubic rami fractures.
We need to get her to the O.
R.
It's a good thing I pumped, huh? Chest tube output going down.
Pulse ox: 87.
- She's on 100 percent? - Yeah.
- Why isn't she intubated? - She refused until you got here.
I wanted to say, "Hey.
" - Type-specific's here.
- It's okay.
It's gonna be okay.
Sandy? Sandy? Sandy, you need to stay awake, sweetie.
Need to stay awake.
Sandy! - Stay awake.
-20 etomidate, 120 of sux.
- Pressure's drifting.
- Stay awake.
- Number two mac.
- Sandy, I need to do this.
Sats in the 70s.
We should bag.
- Kerry? - Push the drugs.
I need an end-tidal CO2 detector.
- Etomidate first? - Kerry- - No.
- You need to let us do it.
Please.
She's my wife.
How long am I gonna be in this? When you dislocate, you tear up a bunch of knee ligaments.
Those heal, right? Even with surgery, there still could be some instability.
I've wanted to do this since I was a kid, you know? There are some new artificial ligaments.
But if it's really bad, you may need knee replacement.
Mason says it's a calling.
So, what happens when you can't answer it? Good pulses.
Check his airway.
I'll see if they need me next door.
- What happened? - Cardiac injury.
- I lost the pulse.
- Start compressions.
Thoracotomy tray to Dr.
Gallant.
- You're serious? - Why not? He's earned it.
Ten blade, then Mayo scissors.
Put up a screen.
They don't need to see this.
Okay.
Rib spreader.
Open the pericardium with the Metz.
Stay anterior or you'll cut the phrenic nerve.
You do remember the anatomy of the phrenic nerve.
Edema and secretions.
Tube's not advancing.
You asked for an 8-0.
- Come on.
Come on, honey.
- Switch to a seven-and-a half? - Come on.
You can do this.
Sats: 83, 82 - I'm switching to fiber-optic scope.
- Suction and crichoid.
- Eighty-one, 80 - Kerry? - I see cords.
- Get a tube.
- Seventy-nine, 78 - I'm in.
Bag her.
Good yellow on CO2 monitor.
- Pressure's 120 palp.
- Four of Ativan and six of Pavulon.
Are you okay, Dr.
Weaver? - Portable vent? - Just keep bagging her.
Okay, Mr.
Fash, we're gonna move you to- Are you all right? - I can't breathe.
- I hear stridor.
Okay, try continuous albuterol at 20 per hour.
Pratt? - Pratt, I need you in here.
- This guy needs me a little bit more.
I'll start an atrial line.
He needs four units, now! Okay, we can try a Foley.
This guy's in respiratory distress.
Upper-airway burn.
Crank up the O2.
Ventricle's starting to fill.
Crank it up.
Abby, does he need intubation? Just bag him.
I'll be there in a few minutes.
- All right.
Ambu mask at 100 percent.
- What's happening? Okay.
You need to try to relax, all right? Just relax.
No reading on the pulse ox.
- He's out.
- All right.
Try a jaw thrust.
There's no chest excursion.
I can't bag him.
Twenty cc's for the balloon.
Extend his neck.
- We did! - Okay, good hemostasis with the Foley.
Another 2 units and we might save this guy.
- Okay, fine.
Etomidate and sux.
- You got it.
Push the drugs, Abby.
One of us will be right there.
- Run of six.
- Heart's still empty.
Where's he losing it? - Abby, try a 6-0.
Take a look.
- Okay, sponge stick and suction.
Clamp the hilar vessels.
What do you see? Nothing! Larynx is swollen shut.
- His sats are down to 72.
- This is ridiculous.
- I can't ventilate him.
- Just keep bagging.
I'll be right there in a second.
All right.
Eleven blade and a five shiley.
- What? - You heard me.
- All right.
- Okay, hilum's clamped.
- So is the aorta.
- V-tach.
Internal paddles.
Charge to 30.
Clear.
Abby, how're you doing in there? You okay? Yep.
Tube and curved Kelly.
Ectopy on the monitor.
- You do this before? - Nope.
Charged.
- Clear.
- No change.
- Amp of epi.
- Sixty.
- Charged.
- Never mind.
- Why? - I criked him.
- By yourself? - Sats are up.
He's fine.
- Well, now, that's a med student.
- Okay, going again, 100 of lidocaine.
- Charged.
- Clear.
Still V-fib.
- Asystole.
- Okay, come on.
Five of epi.
High dose should give us a shockable rhythm.
Stop compressions.
Don't bother, man.
Twelve twenty-seven.
- Should we let those guys in? - After we close the chest.
Oh-silk on a needle driver.
BP's 82/60.
Want more blood? Another two units and squeeze in the FFP.
Fractured liver, pelvis, ribs humerus.
God, what's not broken? - Kerry, do you have the C-spine film? - It's Sandy.
What? Oh, God.
Who's operating? Anspaugh, hopefully, and Dean.
Ignacio's anesthesia.
Shirley's circulating.
- Good.
That's good.
- Platelets are here.
Do you want to stay with her? - What? - Would you like to observe? Yes.
Yes, I would.
All right.
Chest tube on mortar seal.
You got it.
- The O.
R.
's ready.
- All right, let's go then.
I'll say a prayer for you, Dr.
Weaver.
Kerry, she'll pull through.
She's a fighter.
I'm right here.
I'm not going anywhere.
Have the blood bank send four units.
Already had six.
- How is she? - Lung collapsed.
We're able to re-inflate it.
She's lacerated her liver, which we need to repair now.
- Mija.
Oh, my God! - What happened? Where you taking her? Try not to be scared.
She needs an operation.
Sandy.
Mija.
- Mija? - She's not conscious, ma'am.
- Where's Henry? - With my wife.
- Is Sandy gonna be all right? - Yes.
I will be with her in the O.
R.
, but there's a waiting room upstairs.
And I'll call you the minute that she gets out of surgery.
- Take care of her.
- We will.
- I'll take them up.
- Thanks.
No.
No.
I can tell you exactly what happened.
I mean, we had a very recent discharge summary documenting an adverse reaction to morphine.
The patient was in pain.
I gave the order to administer Demerol.
I shouldn't have.
End of story.
Not exactly.
Luis Sanchez's chart is incomplete.
No Attending note.
Any idea why that is? Maybe Carter didn't have a chance to do it before it was sequestered by Legal.
He was leaving for Africa that night so So he was distracted, is what you're saying.
No.
I'm not saying that at all.
Think he needed time to get facts straight? What? No.
It was a busy night.
We had a lot of patients.
Is Dr.
Carter typically available to you? Of course he is.
What are you doing? I thought you were helping.
I am.
By preparing you for the difficult questioning you may face in a deposition.
Do you feel supported by Dr.
Carter as an Attending? Yes.
He's a great teacher.
One of the finest physicians I've worked with.
I respect his opinion tremendously.
So why didn't you present to him? It doesn't make sense because he was probably 30 feet away the whole time.
Was Dr.
Carter informed of the decisions you were making in your treatment plan? No.
I wanted to handle it myself.
I thought I was better at this job than I guess I am.
I'm completely responsible.
Nobody else is.
Will you state if deposed? Yes.
When is that supposed to take place? The deposition? We're not sure.
We haven't heard from the family yet.
- I might not be able to do it for a while.
- Why is that? The Army called me up.
I'm gonna be deployed to Iraq.
Excuse me.
- I got Halpern's records.
- It'd be nice to see you.
- Gallant? - It's always nice.
- Halpern, right.
Refresh my memory.
- Call back.
- Desperately seeking Vicodin.
- Yeah.
You hear anything about Sandy Lopez? - No, you? - No.
Puts it in perspective, huh? So Mr.
Halpern managed to hit up every local hospital for Vicodin this year.
- Know what his tox screen showed? - Narcotics and benzos? Nope.
Nothing.
He's clean.
Aspirin and caffeine.
Excuse me.
Could you find out about my sister? They told me she's in surgery and you'd know.
- You're Sandy's brother? - I'm one of them.
Is she okay? - Let me make a call.
- Thanks.
Falciform ligament's clamped.
- Systolic's in the 90s.
- Two more units going in.
How long have you two been together? Three years.
One of which included a pregnancy.
That gets you bonus time in the equation.
- Okay, there's lots of blood.
Suction.
- Looks venous.
HemoCue's 8.
3.
We met here.
At the hospital? It was the last place I expected to find anyone.
Right.
The spleen looks good.
But there's a grade-four hepatic lac.
Bovie.
I miss Mark too.
Let's pack off the liver.
Shirley? Shirley, can you wipe my brow? Lap pads.
I need lots of them.
What's the therapeutic range of procainamide? Four to 10 mics per mil.
Measure its active metabolite.
Procain plus NAPA should be under 40.
- Did you open that envelope yet? - Yes.
And let me guess.
You passed.
Yes.
You're not a bit excited about that? I'm a little excited about it, I suppose.
Don't have to tell my parents I flunked.
I don't know.
I'm not sure it means anything.
I suppose we should at least go celebrate passing tonight.
Well, I'm not much in the mood myself.
Yeah.
Susan, what are you doing? Please let these be Braxton Hicks.
- What's wrong? - You need to isolate the segmental veins.
- Trying.
- Kerry? - How is she doing? - Systolic's down to 78.
She must have a retrohepatic caval injury.
- Oh, God.
- Okay, clamp the suprarenal IVC.
All right, I'll take over.
- Large-angled Satinsky.
- Come on, baby.
Please don't scare me like this.
IVC clamped.
Mark time.
CVP dropped to zero.
Start an epi infusion.
Keep her temp up.
All right, supra-hepatic cava clamped.
- You sure you should be in here? - She's fine.
Bradycardia.
- She's lost her filling pressure.
- Can you unclamp? - If we do, she'll bleed out.
- And if we don't her heart stays empty and she arrests.
Oh, God.
- Systolic's only 60.
- Mig of atropine.
Let's prep the chest for a Schrock.
- Ten blade.
- Heart rate's down to 58.
Sternal saw.
We have to put in an atrial-caval shunt.
To do that, we have to open up the chest.
It'll improve her preload and get blood back to the heart.
- Kerry! - Do it.
Nicotine, coffee and aspirin.
You're setting yourself up for an ulcer.
I don't drink coffee.
Okay, soda then.
A lot of caffeine in your system.
Over-the-counter migraine tablets.
They don't do squat, though.
Nothing works but Imitrex.
That's a pretty expensive medication.
Especially for someone who doesn't work much, not insured anywhere.
Yeah, well, thanks a lot, Uncle Sam.
How long have you had the headaches? Ever since I pulled sand duty in the Gulf.
What branch? - Army.
- Yeah, me too.
Don't count on the benefits.
Spent a year in the desert.
Came home with migraines.
V.
A.
says it's not service-related.
Won't give me a dime.
That why you sell the Vicodin? Pay for the Imitrex? What unit? Forty-third Battalion.
Medical Corps.
You gonna turn me in? No.
But I'm not gonna give you the Vicodin either.
That's fair enough.
You stay low.
Watch your back.
You didn't say how your meeting went.
It's gonna be fine.
Look, I'm sorry I've been- I don't know.
bitchy about this whole thing.
It's just not comfortable for me.
Lying and having someone else cover my mistakes.
And it just sort of keeps on compounding, one on top of the other.
I'm being deployed to Iraq.
I'm headed for Texas tomorrow morning.
You haven't finished your residency.
I know.
I'm gonna finish up the last few electives down there.
They called you up, just like that? Yeah.
You're a coward.
- What? What? - A coward and a liar.
I never asked you to do this for me, but you did.
Now you're leaving.
And I'm supposed to live with the fact that I killed a man and that you helped to lie for me to cover it up? - Listen, Neela- - Michael, go to bloody Iraq.
And tell yourself you've done something noble.
- I had to protect you and Dr.
Carter.
- No.
You didn't.
Well, at least the contractions stopped.
So the sub-Q terb worked? She's still 1 centimeter dilated and 50 percent effaced.
You can sit up now.
So I should just take it easy, cut back on a few shifts? You're having regular contractions.
Your cervix has softened, shortened and dilated.
- Bed rest, huh? Plain and simple.
- For how long? Three to five weekers do well, full-terms do better? Oh, no way.
I can't stay in bed for five weeks! You can and you will.
Schedule an appointment for an NST with my office in a week.
This blows.
The whole day blows.
Yeah.
- What else happened? - Nothing.
- Oh, I failed my boards.
- What? Need a 182 to pass.
I got a 167.
Oh, Abby.
- I'm sorry.
- It's okay.
Well, how were you supposed to study? You're pulling double shifts.
It's fine.
It's not like a burning building collapsed on me or anything.
I'll take them again.
Atrium's oozing.
Another 2-0, I'll oversew the purse string.
V- fib.
Charge to 30.
I love you so much.
Come on! Clear.
Clear.
- No change.
- Okay.
Teflon pledgets.
Oh, there's blood pouring out of her ET tube.
- DIC.
- More platelets and FFP! Clear! Asystole.
Resume cardiac massage.
- Mig of atropine! - You can stop.
She's gone.
Kerry.
Can you take it out? - By law, we're not supposed to- - Please.
Of course.
I'm so sorry.
We wanted more.
I had to twist her arm to have a baby but once Henry was here, she said, " I can do this.
Eight more and we got a team.
" Sandy had a big family.
I only had her and Henry.
What am I supposed to do now? Would you like me to talk to the family? No.
No, I'll go do it.
Hey, you hiding out or taking inventory? Oh, just looking for Reglan.
You leaving? I've been ordered to sit on my sofa for five weeks.
Sounds good to me.
Yeah, I bet.
Do people know? No, not really.
You prefer it that way? You know Look, what you did was stupid but there were a lot of circumstances that conspired to kill Luis Sanchez.
The nursing home should have put a medic alert on him.
You should have gotten a full med list, but you didn't.
If it goes to court, the Army will send me back to testify.
No, I doubt it'll happen.
People don't sue doctors they like.
And for whatever reason, Mrs.
Sanchez liked you.
Take care of yourself over there, okay? Yeah.
You have a healthy, happy baby, Dr.
Lewis.
Hey.
- You get called in early? - No.
My shift doesn't start for an hour.
I wanted to see you.
Maybe we can get a coffee or something? Sandy Lopez died today.
- Who? - Weaver's Sandy.
Take care of yourself, Dr.
Kovac.
Sam.
Ace.
- So how long have you got? - Here? - About an hour.
- On your tour of duty? A year at least.
Maybe longer.
So you're just gonna sneak out in the cover of darkness? No " Hi, " " Bye, " " Kiss my ass.
" Nothing.
- You know, I'm not much for sendoffs.
- I don't care what you call it.
There's a war going on.
Gonna miss having you around, man.
- Yeah, right.
- No, I'm serious.
You're an honorable guy.
I'm not sure I've ever met one.
Don't go getting yourself killed.
Alex? Alex? Alex, get out here.
Mom, guess what.
Alex, turn it down, okay? I've had a crappy day, and I got a major headache.
You look good, though.
Dad's here.
Is there anything I can do? Need me to watch Henry, or do you need a ride home? He's with Sandy's family.
Dr.
Weaver.
It's okay.
Dr.
Weaver, it's okay.
It's okay.
It's okay.
- Got anything else? - No, that's about it.
You'll need this.
Rabbit's foot.
It's American for good luck, isn't it? Thanks.
You're welcome.
You'd better come back.
You know that, don't you? Yeah, I will.
You just better be a damn good doctor when I do.
You ready? Bye, Michael.
- Hi, Eduardo.
- Hey.
I'm here to get Henry.
Is he awake? Hey, listen.
He's not here.
I think he's with my aunt or something.
No, no.
You told me that Theresa- It's nothing personal, okay? I mean, I always really liked you.
Wait a minute.
You said that Theresa was taking care of him.
We're his blood relatives.
What are you talking about? What's going on here? Where's Henry? I don't know.
Where is my son? Sandy's son.
I don't understand what you're talking about.
I don't understand what you're talking about.
Where is he? - I hear him.
- No, that's mine.
- No! Let me in.
Let me inside.
- No.
- I know my own son- - No.
No, no, Kerry.
He's not- No! Let me in! I know my son's voice! Why won't you let me inside? - I'm really sorry, okay? - Please! Please! - No! - Why are you doing this? Why are you doing this? Let me in! That is my baby! Give me my son! Give me back my son!
R.
Previously on E.
R.
- You did it.
- We have a baby.
Will you be home late again tonight? - Med list.
- Why didn't you have it? Phenelzine? She'll be a star in internal medicine or research You have to be more decisive.
Shall we try the high-dose epi? I assessed it, I ordered it, I pushed it.
- I gave her the order.
- You falsified the chart.
That's a felony.
Nothing I did on this shift can convince me or anyone else that I belong here.
She's not an ER doc.
E.
R.
10x18 "WHERE THERE'S SMOKE" We need more wipes.
Where's your mom? She's late.
- Hey, 9 ounces.
- Nice.
Can't say I don't produce.
Better put on your shirt.
She already thinks we're pervs.
Come on, baby.
You gonna be good for your grandma? Yeah, you're always a good boy, aren't you? That's my baby.
That's my baby.
I'm sorry.
My battery was dead.
- I had to get a jump.
- That's all right.
- Hi, baby.
- Hands.
Wait, hands, hands.
- Hi, Ma.
- Hi, hija.
Carlos is going to buy me a new battery.
Really? What you need is a new car, Mom.
- Yeah? - Preferably with an air bag.
Yes, well, you going to buy it for me? Yeah, right.
My brother's a saint because he's getting a battery but I gotta pick up the tab for a whole new car.
He didn't sleep well last night so you might wanna put him down early for his morning nap.
Oh, okay.
Poor lindo.
Just like your mother, only don't be so stubborn, okay? - You ready to go, babe? - Yeah.
- Say goodbye to Mama.
- Goodbye, baby.
- And Mommy too.
- Say goodbye.
- Come on, baby.
- Okay.
It's all right, papa.
Don't worry.
We'll be back.
- Your son has a set of pipes on him, huh? - Yeah.
- He gets that from your side of the family.
- Oh, yeah? What are you trying to say? I got a big mouth? You want a turkey or peanut butter sandwich? Both.
You want turkey with peanut butter? - You used to make it for me, remember? - No, I didn't.
Well, somebody did.
Hey, what are sodomy laws? I'll get it.
- What are you doing here? - Just got off work.
- Thought I'd stop by, say hello.
- Hey.
Guess he misses us or something.
I have to be at work in, like, 40 minutes, and he has to be at school, like, now.
- You know, if he wants, I could stay.
- Nice try.
Gina got a ticket for double-parking last time.
Go.
When are you gonna stop working night shifts? Soon.
- And what are sodomy laws? - Out! You know I have a couple of minutes before I have to leave.
Really? A lot can happen in a few minutes.
I'm sorry.
It doesn't have to be anything fancy.
I'm really tired.
How tired? Not that tired.
How did you score? - On your boards? - Don't know.
I can't bring myself to look.
- Any luck, I failed.
- Now, that's a positive attitude.
Part of me is afraid I'll be given a license to practice medicine one day.
- Isn't that the point? - If I was good at it, yeah.
Between annoying Attendings, butting heads with nurses and being responsible for a patient's death because I tried to be aggressive writing's on the wall for me, wouldn't you say? You're not good until you've killed someone.
Spoken like someone who hasn't.
So how you doing? Fine.
And I don't have much of a poker face, do I? Abby, pilonidal cyst in Four.
Gallant, shingles in Two.
Neela, vaginal bleeding in One.
Get to work.
Sorry, I'm late.
Had a meeting with Risk Management.
Oh, my God.
Are you okay? My feet are swollen, my back is killing me and apparently, my waddle's too slow for people.
Got a long day.
The sooner we start, the better.
All right.
We're doing interviews on the phenelzine death.
- I'll need some time off the floor.
- Are we being sued? Not yet.
Need to clarify the hospital's defense.
All right, Gallant, you're up last at 11:30.
The Attending's up last since he's the one who will be named in the suit.
God knows Carter's got assets.
That why he left the country? All right, we'll start at the bottom and work our way up.
Neela, that's you.
The guy's records fell through the cracks.
It's not like anyone did anything wrong.
What's the matter with you? This chick is hot.
- A little overweight, but in a good way.
- Not interested.
- Mike, she's your type.
- I'm busy.
- Lieutenant James on line one.
- Tell him I'll call him back.
Busy doing what? Playing soldier? You need a life.
Dr.
Gallant, you treat the immersion burn in Exam Four? - Problem? - I tell you You did excellent with the débridement.
Magna cum laude.
- Ever thought of switching to surgery? - I'm pretty well committed.
- If you change your mind - She has legs up to here: - Pratt.
- You're playing games.
Susan's with Risk Management, so present to me.
- Yeah, okay.
You all right? - Yeah.
Why? - How's your dad doing? - Oh, he's much better, thanks.
Okay.
We have a homeless John Doe, approximately 70 years old found in a makeshift tent in Lincoln Park, cold and altered.
His sugar's at 435, so I gave him 8 units of insulin sub-Q.
- How long has he been outside? - Rectal temp's 92.
3.
Overnight? Diabetic ulcerations on the feet.
Also has high blood pressure: 180/95.
And evidence of a prior MI on the EKG.
- Pretty bad cataracts too.
- You sure he's homeless? - Well, he fits the bill, right? - Nails are groomed.
Check Missing Persons.
Maybe he's a wanderer.
Sir.
Sir.
Oh, great.
- Here.
- Seems like he's incontinent too.
Kerry.
My department's in utter chaos.
Since Robert, there's been no leadership.
Scheduling's a nightmare.
And nobody's representing us at the bargaining table.
- Our salaries have been cut back.
- I know.
- Well, what will you do? - Have the new department head assess the situation and get back to me about it.
- You selected a chairman? - Dr.
Weaver, Sandy on two.
Chairwoman.
Can you find out if it's urgent? Unless you prefer to be gender non-specific and simply referred to as chair.
Only dinner.
Call her back.
I'm late for a medical executive committee meeting.
I don't understand.
When was this decided? Two months ago.
Still need final approval, but that shouldn't be an issue.
Fine, but it would have been nice to have been asked.
Three months.
I don't know.
Something like that.
You don't want it? Maybe.
I don't know.
It would have been nice to be given a choice in the matter.
How long has your back been hurting, Mr.
Halpern? A couple of days now.
Did you fall or strain yourself? I slipped on the stairs about a week ago.
Might have triggered something.
I had a slipped disk a few years back.
- You have surgery for it? - No, no.
I couldn't afford it.
It just flares up once in a while.
I usually just take Vicodin.
Let me guess.
You're allergic to Tylenol and ibuprofen and Vicodin is the only thing that works.
Yeah, I don't really like the stuff, but what am I gonna do, you know? - Abby? - Tand L spine and get some urine? Yep.
We'll be right back.
Then run a tox screen.
Check his records.
Make sure he's not drug-seeking.
You read my mind.
So you think you'll match at County? I don't know.
So you basically let a desk clerk get in the way of your getting a medical history? I suppose I did.
Did you inform Dr.
Gallant that you didn't have Mr.
Sanchez's med list? - Yes.
- And yet he gave the order for Demerol? Yes.
- Do you have anything else? - No, I'm good.
Okay.
Thanks, Neela.
I have a friend who's doing a study on neuroprotective agents in stroke.
They're looking for students to work in the lab.
Research? Just check it out.
This is crazy.
If Susan knew she was in inquisition, she should have scheduled another Attending.
Abby: chest pain, scalp lac, itchy groin rash.
- Already got eight.
- I've got 12.
What's your point? Dr.
Chen, old frozen guy is waking up.
- He asked for some water.
- Oh, hey, Kovac called.
He said next time he's gonna have a triple latte.
- That make sense? - Yeah.
- Aren't you two living together now? - No.
For what it's worth, I think Luka's a good guy.
- Oh, wait.
You didn't-? - Sleep with him? No.
I went in a completely different direction.
Hi, I'm Dr.
Chen.
Can you tell me your name, sir? Jones.
First name is Bob.
Is there any family we can contact, Bob? No.
I'm homeless.
Mr.
Jones, your hemoglobin A1 C suggests that your diabetes was under control until recently.
What happened? No missing-persons report that fits.
Well, we'll just have to call Social Services get him placed somewhere.
Yes.
I need somewhere to live.
All right, re-check d-stick, urine ketone- You know what, why am I doing this? He's Pratt's patient.
So the Klonopin's working? Okay.
No, that's good.
Just give me a call if he gets agitated again.
All right.
What are you doing? Talking to your father's nurse.
She tried to call, but you were busy.
He tried to fry a steak while she was stripping his bed.
- What? - Yeah.
Set off all the smoke alarms scared himself, but he's okay now.
Oh, my God.
I gave her verbal orders for p.
r.
n.
Klonopin.
It has a long half-life.
You might wanna consider restraints.
Dr.
Chen, Rescue 3-8 has two critical and six serious from a structure-fire collapse.
Give me it.
I'll call Resp.
Make sure they have vents ready.
Page Trauma and Burn Fellows, set up rapid infusers and get Lewis out of that damn meeting! She discovered he'd had a bad reaction to morphine and sought out an alternative.
It was smart on her part.
She didn't tell you what that alternative was? No.
Not specifically.
Did you hear Dr.
Gallant give the order to push Demerol? No.
But to be fair, I had stepped out of the room briefly.
- What are you guys looking for exactly? - The truth.
Meaning you think there's some sort of cover-up? Excuse me.
Dr.
Lewis, FD's are rolling up with criticals.
- What do we got? - Tommy Mason, 33.
Full-thickness burns to the face, neck and chest.
Unconscious at the scene.
BP's 90 palp, tubed for agonal resps.
- Residential fire? - Abandoned warehouse.
Should've let it burn.
Nobody to save.
Sam, Gallant, you take the next one.
Pratt, you come with me.
What happened? Industrial fire, 17 got hit pretty bad.
- How did your meeting go? - Fine.
Andy Fash, 22.
Smoke inhalation.
Passed out and took a fall.
- Dislocated knee.
- BP's 132/80.
- Belly pain.
- Good pulse on the foot.
- Pelvis is stable.
- I'm cool.
How's Mason? - We don't know yet.
- I'll get the next one.
- This the second critical? - Next rig.
Took a while to fish her out.
- Abby, you take this one.
- By myself? Chen and Pratt, next room.
Gallant, Neela, with me.
Injury on scene with prolonged extrication.
Hi, I'm Dr.
Lewis.
- It's Sandy.
- Hey, doc.
Got a flash.
Wire.
Sandy, you need to stay still, okay? BP's 80 palp.
Tell Gemmill to stop trying to get a look at my boobs.
- Chest is up.
- Rib fractures.
- Pneumothorax.
She needs a chest tube.
- I was about to say that.
Pulse ox to 78.
How about doing it instead of talking? Ten blade.
- Tegaderm for the line.
- Sandy, how are you doing? I've been better.
- I remember you.
- How's the baby? You have carbonaceous material in both nares.
We need to think about securing your airway.
You wanna shut me up by sticking a tube down my throat? We wanna help you breathe better.
- I want- I wanna talk to Kerry first.
- Okay.
Cut in the fifth intercostal space.
- Mid-axillary line.
- Yeah, I'm aware of that.
Free fluid in both pericolic gutters.
Sandy, you need the O.
R.
We're gonna have to intubate.
- What's taking her so long? - I paged her.
Okay, I'm in.
Please.
Okay, okay.
Put her on 100-percent non-rebreather.
The minute she's here, I'll intubate you.
- Need another doc.
- Go, Gallant.
Just a chest tube.
- Not a student.
They want a doc.
Neela, have you ever done a horizontal mattress? - Yes.
- Dazzle me.
- What do you need? - Glove up.
Sixty percent surface area burns with hypoxia.
This guy needs an escharotomy.
Wide prep, 10 blades for both of us.
We'll open a square over the entire chest down to the sub-Q.
BP's down to 70 palp.
Gallant, check the ET for a leak.
May have to re-intubate.
- Yes, ma'am.
- Ready? Every time.
Anterior axillary line all the way down to the 1 Oth rib.
Join the top and bottom transversely.
Mike, you should be able to bag him now.
Nope.
Sats are dropping.
- Hold up.
Eighteen angiocath.
- What? Tracheal shift.
Puncture wound.
Tension pneumo on the left.
Gotta needle him.
Hemostat and 4-0 vicryl.
- Pulse is stronger.
Sats coming up.
- Nice catch, Gallant.
Hey, Abby needs some help with a knee reduction.
- Pratt.
- I'm in the middle of tying off a bleeder.
Gallant can take over.
- Sterile gloves.
- What's up? Lateral dislocation with equivocal pedal pulses wheezing, maybe smoke inhalation.
Is he hanging in there? Chest was so bad, he couldn't breathe.
He's intubated and doing better.
Systolic's 120 with 50 on board.
- Lopez? - We don't know yet.
He's had 250 mics of fentanyl.
I told the old-timers I'd race them to the top.
All right, this is gonna hurt.
Have to pull on your lower leg to move it back onto the knee.
Seventeen years between them.
I got eight months.
Come on, stabilize the distal femur.
Let's get ready to pull.
- Tommy got up there first.
Then Sandy.
- Enough counter-traction? - Remember thinking the old guy won.
- Yeah.
Ready? - Then I saw them both drop.
- Okay, one, two, three.
- Where's Sandy? - Trauma One.
- How bad is it? - She's conscious.
- Excuse me.
Sandy? - Crit's 24 after two units.
Sandy? - Oh, God.
- Hey, baby.
- What did you go and do? - Roof collapse.
Bilateral rib fractures, pneumothorax.
Intra-abdominal bleed, pubic rami fractures.
We need to get her to the O.
R.
It's a good thing I pumped, huh? Chest tube output going down.
Pulse ox: 87.
- She's on 100 percent? - Yeah.
- Why isn't she intubated? - She refused until you got here.
I wanted to say, "Hey.
" - Type-specific's here.
- It's okay.
It's gonna be okay.
Sandy? Sandy? Sandy, you need to stay awake, sweetie.
Need to stay awake.
Sandy! - Stay awake.
-20 etomidate, 120 of sux.
- Pressure's drifting.
- Stay awake.
- Number two mac.
- Sandy, I need to do this.
Sats in the 70s.
We should bag.
- Kerry? - Push the drugs.
I need an end-tidal CO2 detector.
- Etomidate first? - Kerry- - No.
- You need to let us do it.
Please.
She's my wife.
How long am I gonna be in this? When you dislocate, you tear up a bunch of knee ligaments.
Those heal, right? Even with surgery, there still could be some instability.
I've wanted to do this since I was a kid, you know? There are some new artificial ligaments.
But if it's really bad, you may need knee replacement.
Mason says it's a calling.
So, what happens when you can't answer it? Good pulses.
Check his airway.
I'll see if they need me next door.
- What happened? - Cardiac injury.
- I lost the pulse.
- Start compressions.
Thoracotomy tray to Dr.
Gallant.
- You're serious? - Why not? He's earned it.
Ten blade, then Mayo scissors.
Put up a screen.
They don't need to see this.
Okay.
Rib spreader.
Open the pericardium with the Metz.
Stay anterior or you'll cut the phrenic nerve.
You do remember the anatomy of the phrenic nerve.
Edema and secretions.
Tube's not advancing.
You asked for an 8-0.
- Come on.
Come on, honey.
- Switch to a seven-and-a half? - Come on.
You can do this.
Sats: 83, 82 - I'm switching to fiber-optic scope.
- Suction and crichoid.
- Eighty-one, 80 - Kerry? - I see cords.
- Get a tube.
- Seventy-nine, 78 - I'm in.
Bag her.
Good yellow on CO2 monitor.
- Pressure's 120 palp.
- Four of Ativan and six of Pavulon.
Are you okay, Dr.
Weaver? - Portable vent? - Just keep bagging her.
Okay, Mr.
Fash, we're gonna move you to- Are you all right? - I can't breathe.
- I hear stridor.
Okay, try continuous albuterol at 20 per hour.
Pratt? - Pratt, I need you in here.
- This guy needs me a little bit more.
I'll start an atrial line.
He needs four units, now! Okay, we can try a Foley.
This guy's in respiratory distress.
Upper-airway burn.
Crank up the O2.
Ventricle's starting to fill.
Crank it up.
Abby, does he need intubation? Just bag him.
I'll be there in a few minutes.
- All right.
Ambu mask at 100 percent.
- What's happening? Okay.
You need to try to relax, all right? Just relax.
No reading on the pulse ox.
- He's out.
- All right.
Try a jaw thrust.
There's no chest excursion.
I can't bag him.
Twenty cc's for the balloon.
Extend his neck.
- We did! - Okay, good hemostasis with the Foley.
Another 2 units and we might save this guy.
- Okay, fine.
Etomidate and sux.
- You got it.
Push the drugs, Abby.
One of us will be right there.
- Run of six.
- Heart's still empty.
Where's he losing it? - Abby, try a 6-0.
Take a look.
- Okay, sponge stick and suction.
Clamp the hilar vessels.
What do you see? Nothing! Larynx is swollen shut.
- His sats are down to 72.
- This is ridiculous.
- I can't ventilate him.
- Just keep bagging.
I'll be right there in a second.
All right.
Eleven blade and a five shiley.
- What? - You heard me.
- All right.
- Okay, hilum's clamped.
- So is the aorta.
- V-tach.
Internal paddles.
Charge to 30.
Clear.
Abby, how're you doing in there? You okay? Yep.
Tube and curved Kelly.
Ectopy on the monitor.
- You do this before? - Nope.
Charged.
- Clear.
- No change.
- Amp of epi.
- Sixty.
- Charged.
- Never mind.
- Why? - I criked him.
- By yourself? - Sats are up.
He's fine.
- Well, now, that's a med student.
- Okay, going again, 100 of lidocaine.
- Charged.
- Clear.
Still V-fib.
- Asystole.
- Okay, come on.
Five of epi.
High dose should give us a shockable rhythm.
Stop compressions.
Don't bother, man.
Twelve twenty-seven.
- Should we let those guys in? - After we close the chest.
Oh-silk on a needle driver.
BP's 82/60.
Want more blood? Another two units and squeeze in the FFP.
Fractured liver, pelvis, ribs humerus.
God, what's not broken? - Kerry, do you have the C-spine film? - It's Sandy.
What? Oh, God.
Who's operating? Anspaugh, hopefully, and Dean.
Ignacio's anesthesia.
Shirley's circulating.
- Good.
That's good.
- Platelets are here.
Do you want to stay with her? - What? - Would you like to observe? Yes.
Yes, I would.
All right.
Chest tube on mortar seal.
You got it.
- The O.
R.
's ready.
- All right, let's go then.
I'll say a prayer for you, Dr.
Weaver.
Kerry, she'll pull through.
She's a fighter.
I'm right here.
I'm not going anywhere.
Have the blood bank send four units.
Already had six.
- How is she? - Lung collapsed.
We're able to re-inflate it.
She's lacerated her liver, which we need to repair now.
- Mija.
Oh, my God! - What happened? Where you taking her? Try not to be scared.
She needs an operation.
Sandy.
Mija.
- Mija? - She's not conscious, ma'am.
- Where's Henry? - With my wife.
- Is Sandy gonna be all right? - Yes.
I will be with her in the O.
R.
, but there's a waiting room upstairs.
And I'll call you the minute that she gets out of surgery.
- Take care of her.
- We will.
- I'll take them up.
- Thanks.
No.
No.
I can tell you exactly what happened.
I mean, we had a very recent discharge summary documenting an adverse reaction to morphine.
The patient was in pain.
I gave the order to administer Demerol.
I shouldn't have.
End of story.
Not exactly.
Luis Sanchez's chart is incomplete.
No Attending note.
Any idea why that is? Maybe Carter didn't have a chance to do it before it was sequestered by Legal.
He was leaving for Africa that night so So he was distracted, is what you're saying.
No.
I'm not saying that at all.
Think he needed time to get facts straight? What? No.
It was a busy night.
We had a lot of patients.
Is Dr.
Carter typically available to you? Of course he is.
What are you doing? I thought you were helping.
I am.
By preparing you for the difficult questioning you may face in a deposition.
Do you feel supported by Dr.
Carter as an Attending? Yes.
He's a great teacher.
One of the finest physicians I've worked with.
I respect his opinion tremendously.
So why didn't you present to him? It doesn't make sense because he was probably 30 feet away the whole time.
Was Dr.
Carter informed of the decisions you were making in your treatment plan? No.
I wanted to handle it myself.
I thought I was better at this job than I guess I am.
I'm completely responsible.
Nobody else is.
Will you state if deposed? Yes.
When is that supposed to take place? The deposition? We're not sure.
We haven't heard from the family yet.
- I might not be able to do it for a while.
- Why is that? The Army called me up.
I'm gonna be deployed to Iraq.
Excuse me.
- I got Halpern's records.
- It'd be nice to see you.
- Gallant? - It's always nice.
- Halpern, right.
Refresh my memory.
- Call back.
- Desperately seeking Vicodin.
- Yeah.
You hear anything about Sandy Lopez? - No, you? - No.
Puts it in perspective, huh? So Mr.
Halpern managed to hit up every local hospital for Vicodin this year.
- Know what his tox screen showed? - Narcotics and benzos? Nope.
Nothing.
He's clean.
Aspirin and caffeine.
Excuse me.
Could you find out about my sister? They told me she's in surgery and you'd know.
- You're Sandy's brother? - I'm one of them.
Is she okay? - Let me make a call.
- Thanks.
Falciform ligament's clamped.
- Systolic's in the 90s.
- Two more units going in.
How long have you two been together? Three years.
One of which included a pregnancy.
That gets you bonus time in the equation.
- Okay, there's lots of blood.
Suction.
- Looks venous.
HemoCue's 8.
3.
We met here.
At the hospital? It was the last place I expected to find anyone.
Right.
The spleen looks good.
But there's a grade-four hepatic lac.
Bovie.
I miss Mark too.
Let's pack off the liver.
Shirley? Shirley, can you wipe my brow? Lap pads.
I need lots of them.
What's the therapeutic range of procainamide? Four to 10 mics per mil.
Measure its active metabolite.
Procain plus NAPA should be under 40.
- Did you open that envelope yet? - Yes.
And let me guess.
You passed.
Yes.
You're not a bit excited about that? I'm a little excited about it, I suppose.
Don't have to tell my parents I flunked.
I don't know.
I'm not sure it means anything.
I suppose we should at least go celebrate passing tonight.
Well, I'm not much in the mood myself.
Yeah.
Susan, what are you doing? Please let these be Braxton Hicks.
- What's wrong? - You need to isolate the segmental veins.
- Trying.
- Kerry? - How is she doing? - Systolic's down to 78.
She must have a retrohepatic caval injury.
- Oh, God.
- Okay, clamp the suprarenal IVC.
All right, I'll take over.
- Large-angled Satinsky.
- Come on, baby.
Please don't scare me like this.
IVC clamped.
Mark time.
CVP dropped to zero.
Start an epi infusion.
Keep her temp up.
All right, supra-hepatic cava clamped.
- You sure you should be in here? - She's fine.
Bradycardia.
- She's lost her filling pressure.
- Can you unclamp? - If we do, she'll bleed out.
- And if we don't her heart stays empty and she arrests.
Oh, God.
- Systolic's only 60.
- Mig of atropine.
Let's prep the chest for a Schrock.
- Ten blade.
- Heart rate's down to 58.
Sternal saw.
We have to put in an atrial-caval shunt.
To do that, we have to open up the chest.
It'll improve her preload and get blood back to the heart.
- Kerry! - Do it.
Nicotine, coffee and aspirin.
You're setting yourself up for an ulcer.
I don't drink coffee.
Okay, soda then.
A lot of caffeine in your system.
Over-the-counter migraine tablets.
They don't do squat, though.
Nothing works but Imitrex.
That's a pretty expensive medication.
Especially for someone who doesn't work much, not insured anywhere.
Yeah, well, thanks a lot, Uncle Sam.
How long have you had the headaches? Ever since I pulled sand duty in the Gulf.
What branch? - Army.
- Yeah, me too.
Don't count on the benefits.
Spent a year in the desert.
Came home with migraines.
V.
A.
says it's not service-related.
Won't give me a dime.
That why you sell the Vicodin? Pay for the Imitrex? What unit? Forty-third Battalion.
Medical Corps.
You gonna turn me in? No.
But I'm not gonna give you the Vicodin either.
That's fair enough.
You stay low.
Watch your back.
You didn't say how your meeting went.
It's gonna be fine.
Look, I'm sorry I've been- I don't know.
bitchy about this whole thing.
It's just not comfortable for me.
Lying and having someone else cover my mistakes.
And it just sort of keeps on compounding, one on top of the other.
I'm being deployed to Iraq.
I'm headed for Texas tomorrow morning.
You haven't finished your residency.
I know.
I'm gonna finish up the last few electives down there.
They called you up, just like that? Yeah.
You're a coward.
- What? What? - A coward and a liar.
I never asked you to do this for me, but you did.
Now you're leaving.
And I'm supposed to live with the fact that I killed a man and that you helped to lie for me to cover it up? - Listen, Neela- - Michael, go to bloody Iraq.
And tell yourself you've done something noble.
- I had to protect you and Dr.
Carter.
- No.
You didn't.
Well, at least the contractions stopped.
So the sub-Q terb worked? She's still 1 centimeter dilated and 50 percent effaced.
You can sit up now.
So I should just take it easy, cut back on a few shifts? You're having regular contractions.
Your cervix has softened, shortened and dilated.
- Bed rest, huh? Plain and simple.
- For how long? Three to five weekers do well, full-terms do better? Oh, no way.
I can't stay in bed for five weeks! You can and you will.
Schedule an appointment for an NST with my office in a week.
This blows.
The whole day blows.
Yeah.
- What else happened? - Nothing.
- Oh, I failed my boards.
- What? Need a 182 to pass.
I got a 167.
Oh, Abby.
- I'm sorry.
- It's okay.
Well, how were you supposed to study? You're pulling double shifts.
It's fine.
It's not like a burning building collapsed on me or anything.
I'll take them again.
Atrium's oozing.
Another 2-0, I'll oversew the purse string.
V- fib.
Charge to 30.
I love you so much.
Come on! Clear.
Clear.
- No change.
- Okay.
Teflon pledgets.
Oh, there's blood pouring out of her ET tube.
- DIC.
- More platelets and FFP! Clear! Asystole.
Resume cardiac massage.
- Mig of atropine! - You can stop.
She's gone.
Kerry.
Can you take it out? - By law, we're not supposed to- - Please.
Of course.
I'm so sorry.
We wanted more.
I had to twist her arm to have a baby but once Henry was here, she said, " I can do this.
Eight more and we got a team.
" Sandy had a big family.
I only had her and Henry.
What am I supposed to do now? Would you like me to talk to the family? No.
No, I'll go do it.
Hey, you hiding out or taking inventory? Oh, just looking for Reglan.
You leaving? I've been ordered to sit on my sofa for five weeks.
Sounds good to me.
Yeah, I bet.
Do people know? No, not really.
You prefer it that way? You know Look, what you did was stupid but there were a lot of circumstances that conspired to kill Luis Sanchez.
The nursing home should have put a medic alert on him.
You should have gotten a full med list, but you didn't.
If it goes to court, the Army will send me back to testify.
No, I doubt it'll happen.
People don't sue doctors they like.
And for whatever reason, Mrs.
Sanchez liked you.
Take care of yourself over there, okay? Yeah.
You have a healthy, happy baby, Dr.
Lewis.
Hey.
- You get called in early? - No.
My shift doesn't start for an hour.
I wanted to see you.
Maybe we can get a coffee or something? Sandy Lopez died today.
- Who? - Weaver's Sandy.
Take care of yourself, Dr.
Kovac.
Sam.
Ace.
- So how long have you got? - Here? - About an hour.
- On your tour of duty? A year at least.
Maybe longer.
So you're just gonna sneak out in the cover of darkness? No " Hi, " " Bye, " " Kiss my ass.
" Nothing.
- You know, I'm not much for sendoffs.
- I don't care what you call it.
There's a war going on.
Gonna miss having you around, man.
- Yeah, right.
- No, I'm serious.
You're an honorable guy.
I'm not sure I've ever met one.
Don't go getting yourself killed.
Alex? Alex? Alex, get out here.
Mom, guess what.
Alex, turn it down, okay? I've had a crappy day, and I got a major headache.
You look good, though.
Dad's here.
Is there anything I can do? Need me to watch Henry, or do you need a ride home? He's with Sandy's family.
Dr.
Weaver.
It's okay.
Dr.
Weaver, it's okay.
It's okay.
It's okay.
- Got anything else? - No, that's about it.
You'll need this.
Rabbit's foot.
It's American for good luck, isn't it? Thanks.
You're welcome.
You'd better come back.
You know that, don't you? Yeah, I will.
You just better be a damn good doctor when I do.
You ready? Bye, Michael.
- Hi, Eduardo.
- Hey.
I'm here to get Henry.
Is he awake? Hey, listen.
He's not here.
I think he's with my aunt or something.
No, no.
You told me that Theresa- It's nothing personal, okay? I mean, I always really liked you.
Wait a minute.
You said that Theresa was taking care of him.
We're his blood relatives.
What are you talking about? What's going on here? Where's Henry? I don't know.
Where is my son? Sandy's son.
I don't understand what you're talking about.
I don't understand what you're talking about.
Where is he? - I hear him.
- No, that's mine.
- No! Let me in.
Let me inside.
- No.
- I know my own son- - No.
No, no, Kerry.
He's not- No! Let me in! I know my son's voice! Why won't you let me inside? - I'm really sorry, okay? - Please! Please! - No! - Why are you doing this? Why are you doing this? Let me in! That is my baby! Give me my son! Give me back my son!