ER Episode Scripts

N/A - s11e05

Previously on E.
R.
: Got it.
They warned me about this place.
They weren't kidding.
So this is the second time you've been wrong about one of my patients today.
You know what? It's the last.
I wonder where the damn social worker is.
Covering two hospitals by herself till midnight.
That's my excuse for being late.
What's yours for being an ass? Dr.
Lewis? When do you need me to start? Epi shock, lido shock, consider mag two grams, shock, Procainamide, shock, consider bicarb shock.
Shock, epi shock, lido shock, consider mag two grams, shock, lido shock, consider mag two grams, shock, Procainamide, shock, consider bicarb shock.
- You're going? - Yeah.
I'm sorry.
Rounds start at 7:00.
It's barely even light out.
Yeah, well, welcome to my life.
Nice meeting you.
Killing my plants, ignoring my bills get it together.
What's the loading dose of amiodarone? Neela, stop.
And remind me to buy toilet paper on the way home.
This is weird.
Don't you think this is weird? Am I destined to spend the rest of my youth in a fetid, windowless hospital? You needed a job.
Now you're here.
Quit whining about it.
Yeah, but I'm not sure if this is really what I want.
Well, fake it.
Does everyone know that I had a complete meltdown and quit? Hey, Dr.
Jumbo Mart, how you feeling? Need a doctor over here! to the right chest.
Tachy with shallow resps, Hey, man, what's your name? He's apneic.
Throw me the bag.
Sam, we need a trauma room.
Nothing's open, we've got 'em lining the hallways.
Get an attending.
Lewis is doing a subclavian, and Resneck's coding a guy.
He lost his pulse.
All right.
Starting compressions.
Mig of epi.
Have atropine ready to go.
Tube.
Neela, could you open the shirt, please? I'm in.
Neela, listen to the chest.
- Neela, come on! - I.
V.
's infiltrated.
I'll give it endotrachially.
No breath sounds on the right.
Okay, he needs a chest tube.
You carry a scalpel? Yeah, bone saw's too bulky.
Could you take over for me, please? No carotid.
Atropine and another epi.
Huge hemothorax.
How come nobody told me you were such a bad ass? Got a pulse.
Oh, that's what I like to see, interns with initiative.
Come on, trauma two's open.
Someone call housekeeping! Next! And finally, in curtain three, we have three-year-old G.
B.
, here with R.
W.
R.
W.
? HIPPA's gone crazy with patient privacy thing.
What's R.
W.
stand for? Really Whiny? Refusal to walk.
Refusal to walk has its own abbreviation? Neela, what's your differential? Septic hip.
Intra-articular infection, toxic synovitis, osteo, sickle crisis and a vascular necrosis.
What about the work up? C.
B.
C.
, Sed rate, cultures, X ray, ultrasound and arthrocentesis if there's an effusion.
First day back and she's showing up the rest of you bums.
Dr.
Pratt, what's the most common pathogen in septic arthritis? Dr.
Barnett, septic arthritis? Um, med students-- for a new dishwasher and a lifetime supply of Ensure-- what is the most common bug in septic arthritis? Staph aureus.
Followed by Strep and Hemophilus.
I've got to go.
Chuck's in the car with the baby.
Guess the Dream Team's reunited.
Cool.
Good morning, Urbanus.
Guess I'm with you again? Over 60 in triage-- some of them were here when I left last night.
Okay, Pratt, run the board.
Let's move some patients, huh? Okay, people, come on, listen up.
For the past month, we've been cutting you newbies a lot of slack.
You have? Today, the training wheels come off.
You're doctors now.
Time to stop thinking like med students and take on a real patient load.
I want you to discharge each.
Just two an hour.
Med students, present your patients to interns.
Interns run your cases by me or an attending before ordering labs or scans.
All right, here we go.
Ray, asthmatic in two.
Abby, P.
P.
D.
reading.
Neela, teenager with a cough-- something nice and easy to get you started.
Only ones left.
I guess that makes us a team.
Oh Jane Figler, fourth-year medical student.
That was quite a flash entrance you made.
Thanks.
With all the rumors going around it's great how you came in and Excuse me.
Can you sign my procedure log? Chest tube in your first five minutes.
You trying to impress me? Just so you know I don't want or need you to go easy on me.
Believe me, I won't.
If you need help, just ask.
Dude, I forgot-- Kuharczuk in curtain four needs a pelvic.
You're signing out a pelvic? That's weak.
I gotta get out of here, man.
I'm back in 11 hours.
She's yours.
By the way-- nice move, starting late.
Makes internship shorter.
Okay, so, I gotta ask.
Why'd they kick you out of Michigan? Chocolate? History of two ICU admissions and a prior intubation a few months ago.
We got to be aggressive with this guy.
Chuny, chocolate? Ah, no, thanks.
I'm trying to watch it.
You? You can eat whatever you want.
Okay.
What do you need, Ray? Could you please hit our wheezer in three with 60 of pred? - You got it.
- All right.
Lesson number one-- feed the nurses.
It'll make your jobs Hi.
Chocolate? Too early.
We like bagels in the morning.
No, no, no.
Come on, take one for later.
Ooh, hazelnut.
Where do we keep the peak flow meters? In drug lock up and yes, I will get it for you, Ray.
You're the best, Sam.
Well, the result is borderline.
But your use of steroids and your recent incarceration put you at increased risk.
For what? TB.
So I do have it? Not necessarily.
Okay, can I see a doctor? Sir, I am the doctor.
We're going to get you a chest X-ray and a couple more tests.
So, do we call it positive and treat with I.
N.
H.
? Let's see what the chest X-ray says.
Does a positive P.
P.
D.
involve type-3 or type-4 hypersensitivity? Sorry.
Obscure question.
Just trying to impress you.
Community-acquired pneumonia, mycoplasma, viral pneumonitis, Reactive airways, pulmonary edema, tracheal foreign body Stop.
His chest is clear; it's a cold.
Fluids, ibuprofen and home.
I've got a guy with an equivocal P.
P.
D.
and a butt-load of risk factors-- does he have to take I.
N.
H.
? Well, call I.
D.
, check it out.
Okay, let's check it out.
No, no, he'll go look it up.
Doesn't take two of you to open a book.
Delegate to your student and find a new patient.
Look at that; look at Ray.
He discharged his second patient already.
Come on, pick it up, ladies.
He's making you look bad.
Need a doc over here.
Hey, go.
Dropped right in front of us, transient L.
O.
C.
Never even signed in.
Hello, my name is Dr.
Rasgotra, can you tell me your name? Juan Enriquez.
Forgot to eat breakfast, that's all.
Let's get him up.
Oh, he's bleeding.
Pulse is racing.
I'm okay - Chuny, what's open? - Exam two.
I'm just gonna go home.
What are the bruises from? I noticed them last night on my legs, but I didn't really think much of it.
When I woke up this morning, it was much worse.
Seven-year-old with a lead level of 59.
The city notified the family three weeks ago to come in.
Three weeks ago? Okay, what does that tell us? He's got bad parents? No, It tells us his lead exposure is chronic-- he's adapted to it.
If he was acutely poisoned he'd have symptoms and there's no way parents would've waited 3 weeks to come in.
Does this case belong in the E.
R.
? No.
But they wouldn't wait eight hours in this cesspool unless they didn't have someplace else to go.
System's broken, people.
Can't blame the victims.
Good morning, Mister Lucas.
I'm Dr.
Barnett.
Heard you have a lead problem.
Am I getting a shot? No, man, we wouldn't do that to you.
They, uh, tested him at school.
I don't know how he got it.
The city will send someone to your house to look for lead sources.
He's always been sick, born early.
But look at you now, tough guy.
You a pro football player? No.
He had breathing problems when he was a baby.
How 'bout basketball? Aren't you the new point guard for the Bulls? No, I'm in first grade.
Lucas, dude, you're playing it cool but I know you're famous.
So I'm going to have to ask for your autograph, okay? Do a quick head to toe, all right? Hey, lead clinic, please.
Oh, and he had a seizure once when he was two when he was sick.
Febrile seizure.
It's very common.
Hey, it's Dr.
Barnett in the E.
R.
I have a seven-year-old with elevated lead who needs chelation.
Okay.
Thank you very much.
Okay, you're all set.
A nurse will walk you over to the clinic.
Okay.
Thanks, Doc.
Punch it.
I'm going to sell your autograph on eBay for a million dollars.
- A billion dollars.
- All right.
Let's go.
Five minute discharge, boys.
Watch and learn.
Are troponins useful in ruling out coronary aneurysms in Kawasaki's? Aren't enough good studies on kids.
So, do ex-preemies have a problem with lead metabolism? No.
Patients will tell you all kinds of irrelevant crap-- they don't know what's important.
You were so patient with the dad.
Well, the key is to look like you're listening while you're doing your charting.
Multitask.
Guys, it is the key to survival in the E.
R.
Here you go.
Is that really the best advice you can come up with? Second best.
First was feed the nurses.
Well, they're students.
They should focus on taking a thorough history and learn about efficiency later.
Med school teaches them to practice medicine in fantasy land.
We're never be able to clear out that waiting room if it takes us two hours working up a slam-dunk case.
There's no such thing as a slam dunk case.
Not when you're an intern.
Suit up, we've got a trauma coming.
Blunt injuries to head and neck.
Tachy and hypotensive, 78 palp.
G.
C.
S.
1,1,1 in the field.
Check on our asthmatic-- this may take a while.
Okay, on my count-- one, two, three.
Got a 911 page-- looks like I'm in the right place.
Yeah.
Jet ski accident.
Abby, your patient.
Too much trauma to the face.
Can't evaluate the airway.
Weak carotid.
Crike tray to me.
- Can I hear some vitals? - How's our access? One peripheral.
Start another one.
And hang a liter of L.
R.
- Do we have a pressure yet? - Get the rapid infuser.
His wife is here.
You got this? Ma'am, why don't we give the doctors a little room to work.
I'll explain everything to you outside.
I'll take the airway.
Why don't you call the blood bank.
Full trauma panel, type and cross for six.
Sat's only 84.
We're going to need a portable chest and respiratory down here.
Get him a blanket, he's cold.
Hi.
I need four units of O-neg in the E.
R.
please.
What happened in there, doctor? That was your patient.
No.
it's a trauma, no medical record number yet.
Thanks.
Don't say please and thank you to the blood bank and don't let the boys bully you.
I-I wasn't letting the boys You play with your hair when you're nervous.
What? He's clamped down.
I can't get a vein.
Get back in there.
Your patient needs a central line.
Chest X-ray's clear, C.
T.
's negative, B.
P.
better after two liters.
What does that mean, huh? Is it bad? It's too soon to make any kind of diagnosis.
Just hang in there, Mr.
Enriquez.
Sounds like the fluid helped you.
You ordered CT, films and labs without talking to me first? You were busy and it seemed urgent.
Where's your student? She's in sutures, taking out stitches.
You know, I really don't get it.
You're proactive, delegating, and yet you're still in last place.
Here-- med refill, five minutes, go.
Ray and Abby are stuck in the trauma, this is your chance to catch up.
Femoral's in.
Sats down to 78.
Mosquito clamp.
His neck's too mangled, anatomy's distorted.
Feel the landmarks.
Jet skis account for only 20% of boats but are involved in 44% of injuries.
Know why that is? Dr.
Lockhart? No.
3-O nylon.
No is right.
No throttle, no steering, no way to stop.
I still can't find You're fine.
Make your cut, extend with the clamp.
Good.
Perfect.
Insert the tube.
So if this poor guy hit a pylon driving his jet ski 30 miles an hour, what was the equivalent G-force of the collision? Got it.
Give me the bag.
Seven Gs.
This guy's head was subjected to seven Gs of force.
Think about it.
That's equivalent to how many pounds? We're doctors, not physicists.
Pressure's dropping.
V tach.
Lost the pulse.
Take the airway.
Starting compressions.
An impact of 990 pounds dropped on his head.
That's what you're up against.
That's not all I'm up against.
You're going to shock him? Charging at 200.
- Uh-oh, Lockhart, watch yourself.
- I'm nowhere near the bed.
Exactly.
You want me to grab the paddles out of his hands? Mig of epi, have lido on deck.
- You did it again.
- Did what? The hair.
I mean, eight years of school-- most people would just like suck it up.
Diarrhea times 11 months?! What'd your parents say? My dad would have ripped my head off.
Why don't you start the history and I'll catch up.
All right, guys, talk to me.
Homeless guy with gnarly feet-- clotrimazole, new socks, home.
Seven-year-old with lice.
Permethrin shampoo, wash all the linens, repeat in a week.
Good work, guys.
Keep 'em coming.
You're still in the lead with 11.
Abby's at seven, Neela four.
Ray gets credit for those? He's in the trauma-- he didn't even see those patients.
He delegated.
The students are part of his team.
That's not fair, he's got two.
Can you handle two students? You better go in with me.
There's a patient crouched in the corner and every time I go near her she starts like, yelling in Chinese.
That's galea we're looking at.
He's basically scalped.
Doesn't have to be pretty, just tamponade the bleeding.
He's maxed out on dopa, pressure still sucks.
Of course it does.
Why, Lockhart? Spinal shock.
Yep.
No sympathetic tone.
What do you want to do about it? - Epi drip.
- Why? Get the B.
P.
up, increase the cerebral oxygen delivery.
Right-- ready for the cruel twist? Systolic's 58, come on, guys.
Epi drip, one mike per kilo per minute.
Didn't I just say that? Ischemic brain needs oxygen.
But did you know oxygen also forms free radicals after traumatic brain injury? Mother nature is such a bitch.
V tach.
No pulse.
Paddles to Lockhart.
Charge at 360.
Clear.
Free radicals cause secondary cell death.
You following? Clear.
Can we take a break from chemistry class while we code him please? The difference between a physician and a witch-doctor is an appreciation of the science beneath the disease.
These trauma algorithms should be automatic for you by now.
Oh God.
Barnett, take over compressions.
Look at his face.
His brain is gravely injured, and it's starting to compromise his heart.
I didn't see it happen.
I told him not to rent that thing.
I'm sorry.
His body is shutting down.
Going again.
You know, I was running this.
Really? I hadn't noticed.
Clear.
Procainamide.
What? Fine.
It's all yours.
Clear.
So why'd you decide to come back then? It's not like anything's changed.
I don't know.
Neela, knee sprain won't leave until she gets a prescription for some memory pill she saw on TV.
Positive tox on the kindergarten teacher.
Thanks.
Jane, get knee lady out of here and meet me in curtain two.
Yeah.
What do you want me to tell her about the memory pill thing? It's not an acute issue, she can ask her primary doc.
Pratt, fix this order.
And please teach your interns the difference between micrograms and milligrams.
What do you want me to do? I can't be with them every minute.
Excuse me.
If I've made a mistake on an order, I'd appreciate it very much if you'd confront me directly.
I'd like to be treated the same as everybody else and subjected to the same scrutiny.
Neela, we weren't talking about you.
Pupils fixed and dilated.
No gag, no corneals.
Here.
Sit down.
Thank you.
So what now? We wait.
At least he's in sinus.
All that means is that the brain's no longer capable of telling the body to die.
Kovac needs some help.
I got it.
Elena Flemming, 32, poly-pharmacy overdose.
Paramedics couldn't get a line.
I'll give it a try.
Elena, what'd you take? Just the stuff that was in my cabinet.
What was in your cabinet? Usual stuff, I don't remember.
Urbanus, catch the paramedics, see if they got any meds from the home.
What's your plan? C.
B.
C.
, lytes, serum and urine tox, Tylenol and salicylate levels, activated charcoal and K.
U.
B.
to check for iron fragments.
Good.
And call psych and social services.
Elena, were you trying to kill yourself? I don't know.
Looks pretty rough in there.
The guy is brain dead.
- Do they have kids? - Three.
They coming? No, they're too young.
You okay? Yeah, just part of the job.
Bruised guy's C.
B.
C.
's finally back.
It's full of blasts.
You ever tell anyone they had leukemia before? Part of the job.
ICU can't find a bed for our jet ski trauma and they're not expecting to find one any time soon.
Looks like this guy's going to be with us for a while.
Why don't you call social services for the wife.
Whoa.
What are you guys still doing here? I can't send them out until the chart's signed by an attending.
Okay, a seven-year-old was sent by the city for a lead level of 59.
Asymptomatic, dispo to lead clinic for chelation.
Did you get a repeat level? Figured they'd get it there.
Uh, come on.
Is that cool? No, Ray, that's not cool.
You've been a doctor for a month.
You know that you can't sign off on a patient before you run it past an attending first.
So why don't you to get a repeat level, and then I'll sign the chart.
Where are you going? I need to go to church.
You're too sick to go anywhere right now.
I need to talk to you about the results of your blood test.
Juan I got one in my eye now.
Look.
Your platelet count is very low.
That's why you're bleeding so easily.
Juan, your blood smear showed some abnormal white cells.
The abnormal cells are crowding out the healthy ones in your bone marrow.
Juan, please listen.
We can help you.
You can't you can't help me.
Nobody can.
Yesterday I hit a man with my car.
It was an accident, but today I wake up like this.
Your blood pressure's still a bit low.
You need to be in bed.
I want to review your smear and check on a few more labs, and then I'll be back to go over everything with you, okay? Why didn't you tell him he has leukemia? Overdose only had antacids and a pretty full bottle of Benadryl in the medicine cabinet.
Okay, she'll sleep off the antihistamine and be good to go.
What the hell is going on here?! I've been here for almost four hours and there's nothing wrong with me! Sir, we honestly don't know.
You could have TB, even though you don't feel sick.
We are going to recommend treatment for nine months.
You want me to take medicine for a disease you don't even know I've got? Most people tolerate the medicine well.
There are risks however You people are really something.
Mr.
Decoyte I want a better doctor.
I'm Dr.
Pratt.
Can I help you? I've been here all day for a stupid skin test and no one here seems to know if I've got TB or not.
Sir, the safest thing for us to do is to treat it as if you do have TB.
If I were in your position, trust me, I would do the same thing.
Fine.
Then get me out of here.
Please, have a seat in the waiting area.
We'll get your discharge paperwork and your prescription.
A good doctor knows how to make "I don't know" sound reassuring.
Lymphoblastic leukemia has a remission rate of over 80%.
How'd he take it? Thought I should know a bit about the treatment before I tell him.
Can you page Oncology again? Okay, halftime score-- Ray 14, Neela seven.
The nurses were tied up in traumas.
It slowed things down.
Oh, so you're gonna blame the nurses while you're sitting here on your ass browsing Medline? Ray's using the same nurses and discharged twice as many patients.
My man.
All right, no more than At seven you start saying your good-byes.
Which means you better start wrapping things up in five.
Uh, there's a jammed finger in sutures.
Go check it out.
Ray, how is it that you get lice and athletes foot and I get new-onset leukemia, tertiary syphilis and a referral from Kazakhstan? Wow, you got some cool cases.
Our boy in four.
Think it could be intussusception.
You get jammed finger, I get intussusception.
Are you accusing me of cherry-picking charts, Neela? That hurts.
Evans Syndrome with varicella, unexplained vision loss, idiopathic proteinuria, LOC NOS, cystic fibrosis with SBO.
Oh, and drug-seeking heroin addict with a butt abscess who threw an emesis basin at my head.
Yeah, she was a winner.
Fine.
I'm just slow then.
You're not slow, you're just differently-abled.
Don't let Pratt get to you, okay? Abby's slower than you are, not that he'd ever call her out on it but attendings love her, nurses protect her Must be nice to be the teacher's pet.
Screw you, Ray.
Oh, hi.
Uh, good.
You're all here.
We didn't get to finish talking about my research with free radicals and superoxide dismutase.
It's good stuff.
Hold up, hold up, hold up.
Come on, you might learn something.
Step into my office.
Right over here.
Free radicals are the link to so many disease processes in the human body ischemia, cancer, aging I think that's a permanent marker.
They form after tissue is deprived of oxygen.
Why are they bad? Lockhart, we went over this in the trauma.
We did? Okay.
What happens when the radical encounters mitochondria of a healthy cell? Lockhart? Why don't you let me do some research on this and I'll present to you in the morning? Easy question and I just told you the answer.
Okay.
Let's try this.
Draw an oxygen atom.
I'm not trying to trick you; this is easy.
Just draw an oxygen atom.
Look, you guys, everything that we do in E.
R every intervention, ultimately operates at a molecular level.
I don't understand how any of you expects to manipulate the complicated machinery of the human body if you don't understand the basics.
Okay.
There.
I've done the hard part for you.
That's an oxygen atom.
Now, all you have to do is add the electrons.
I have patients to see.
You couldn't tell really? You didn't even seem upset.
I know how to draw a damn oxygen atom.
That guy just gives me the creeps.
Okay that's truly disgusting.
Look, don't knock it.
It's fast, high in protein and free.
Sutures is a la casa, exam four, splint and home, and fever and weight loss is just waiting on a chest film.
Okay.
Abby's 17, Neela 12-- that brings you to 21.
It's only 4:00.
When I hit 25, can I go home early? Dr.
Lockhart, what have you got? Diverticulitis versus biliary colic in two.
In four, M.
I.
versus reflux, and in three, sepsis versus viral syndrome.
In admit, Abby versus Ray.
Neela, you're getting your ass kicked.
Start making decisions and move those patients out.
Ray's logged 21 discharges with three hours left.
Guess 25 was too easy.
Yeah, right.
I better up the target to 30.
Hey, double your speed.
You both just might make it.
Pratt! Your lacrosse player's sedated.
Come do his lid lac.
What? It wasn't like it was my idea.
Dr.
Barnett? Wendall Meade, Social Services.
Yes, I paged you like four times.
Yeah.
In like 15 minutes.
If I don't answer you right away, there's a reason.
Okay.
I need you to talk to trauma one's wife.
He's brain dead.
Interesting name, Trauma One.
Ben Coleman.
Wife's name is Stacy.
He's an intern.
I see, so referring to patients by name instead of room assignment is a second-year skill? Did you go through the Care Pathway with Ms.
Coleman? The what? The checklist that systematically covers all post-mortem issues with a patient's family.
You need a list to check off questions you'd ask anyway? I'll see her when you're done.
Contact dermatitis versus candida.
Call it dermatitis.
Topical steroids and send her home.
If it resolves, we were right.
- If it doesn't? - She'll come back.
Your overdose is waking up and here's the U.
A.
on the tarantula dealer.
Ah U.
T.
I.
versus kidney failure.
If I'm right, she takes antibiotics and gets better.
If I'm wrong, she becomes hyperkalemic and dies.
I'm trying to embrace uncertainty.
Oh.
How am I doing? Not so good.
You know you haven't had anything to eat or drink all shift.
Go to Oncology and get a copy of the chemo protocols.
Isn't that Oncology's job? They said it might be a couple of hours before they get to see him.
I want to be prepared to cover all the bases for when we go back in there.
Uh I'm on an E.
R.
rotation.
Shouldn't I be, like, cracking chests instead of making copies? I got a 15-year-old skateboarder versus fire truck.
Truck swerved and missed him but the ladder clipped his leg.
Looks like an angulated tib-fib.
Leave him there.
We'll find him an open stretch of hallway.
I've got it.
My med student's driving me mad.
Wanna trade? Were we that annoying? I wasn't.
Hi.
I'm Dr.
Lockhart.
Does your arm hurt? You got hit by a fire truck and just broke a leg? Lucky guy.
Hey! Hello, in there! We're your doctors.
We'll try to keep this brief.
My sister is coming.
How am I going to tell our kids? Well, the social worker will be here to see you.
She can help you with all that.
Would you like to speak with clergy? Any denomination? Okay.
I'm sorry to have to bring this up so soon, but we only have a limited amount of time to make this decision.
Is it okay if I don't tell them yet? Have you thought about whether you'd like to donate your husband's organs? I think it's okay.
Okay.
Let them have one last night before their lives change forever.
Well, you're looking better.
Just don't make me drink any more of that mud.
Well, the good news is Your tox screen came back negative and your EKG was normal, so, from a medical standpoint, you're clear.
Good.
Can I get out of here? I wasn't trying to commit suicide.
What were you trying to do? Abby! Is the baby in three a real ALTE or just a choking episode? I don't know.
I haven't presented him yet.
The parents are refusing blood draws and X rays.
Okay.
I'll, uh I'll go find them when I'm done.
I need Psychiatry to see you before I can send you home.
I'm not crazy.
Just stupid.
Abby! Is I.
V.
contrast contraindicated in someone with wheat and peanut allergies? I don't think so.
Can you find out? CT's calling for MVA.
Okay, um, hold them off and I'll look into it.
I'm going to page Psych for you and get you an ETA, okay? The condom broke.
Abby.
What? Your abdominal pain's gonna leave AMA if he's not sent up soon, that's what.
I tried to admit to Medicine as a calculous cholecystitis, but they think it might be a retrocecal appendix.
Well, what do you think? I don't know.
I'm waiting for Surgery to see him.
Keep it moving, Abby.
Three an hour now if you're gonna make it.
Thank you for your concern.
So, the condom broke? I'm a temp at a commodities firm and I slept with one of the traders last night.
He left a note on my bed.
"I got HIV.
See a doctor.
" Five years of needles and I managed to stay negative and I cleaned myself up, turned everything around and then because of one stupid night, now I'm gonna get AIDS? I can't get sick.
I have a kid.
Okay.
Just because you've been exposed doesn't mean you're infected.
The incidence of transmission from one exposure is actually relatively low.
You know, it might be better if I told him he has leukemia alone.
I wouldn't want to cramp your style.
Seen Juan Enriquez anywhere? That leukemia guy? He was out here a while ago.
He's gone.
- I'm sure he'll be back.
- There's another patient in his bed.
Nobody would have discharged him! Damn it! - Doughnut? - He's gone.
- Who? - My leukemia patient.
I'm such an idiot.
I hadn't even told him he had cancer, but I think he knew.
Okay, you're not making a lot of sense right now.
He thinks he's being punished by God for something that he did.
No, no.
If he was set on splitting, there's nothing you could have done about that.
I could have told him that it's treatable.
He has a good shot at complete remission.
Look, there isn't enough time to help the people who want help.
Don't beat yourself up over the people who don't.
He was distraught, and I left him alone so I could go and do research.
Dude, where'd you go? Jane's gonna hang with us, okay? You seem stressed out.
It's about time for the nurses' nighttime feeding.
Better go.
Beastie Boys.
He's out.
Have you ever heard of prescribing prophylactic triple cocktail after a known HIV exposure? Sure, the hospital gives it to health workers all the time for needle sticks.
I'm not talking about a health worker.
One of my patients had unprotected sex with an HIV-positive guy last night.
Nah, it's really only available for occupational exposures too expensive.
Okay, on my count, pull the distal segment out and down while I give counter traction.
One, two, three.
Only healthcare workers are worthy of HIV prophylaxis? We can't give preventive meds to every one-night stand when we still can't afford to treat people who are actually I'm not talking about every one-night stand.
I'm talking about one patient who's here now, and she's asking for my help.
And what about the patient who walks in tomorrow? And the next day? Put him in a long leg splint and stay with him until he wakes up.
The guy'd been here for eight hours and hadn't been told he had leukemia? What the hell were you waiting for? Oncology couldn't get down here, and I was trying to figure out exactly what to tell him.
He wasn't gonna hear anything after you said cancer.
He was distraught-- Why didn't you call the social worker, psych, get a guard at the door? Because I thought it was better for him No, no, it's not about him, it's about you and your need to be perfect.
You need to stop being a slow A-plus and start becoming a fast B, or you're not gonna make it here as an intern.
Now, find him before he bleeds out and he dies.
Yes, I'm looking for funding for HIV medication for an uninsured E.
R.
patient, so if anyone ever actually checks this machine, please call Dr.
Lockhart in the E.
R.
What? I look at you and Ray; you're both so confident in the traumas Neela, it's your first day give yourself at least a week to be better than the rest of us.
I don't even know why I'm here.
Listen, every shift at about this time, I start fantasizing about working in a tollbooth.
Neela, what's going on with that football player in three? Uh, knee pain times two days.
No drawer sign, no A.
P.
or lateral laxity.
Point tenderness? When he's bearing down weight.
Rest, ice and an ace wrap, right? Yeah.
Excuse me.
No, you can't do this! No! Looking good today, Dori.
Donut? I'm not helping with the dis-impaction.
Donut? Babinka? Don't act immune to my charms just because you brought your own sweets.
He does this every day? Twice.
Start of each nursing shift.
- And it actually works? - Apparently.
Abby, you're lagging.
Yeah, well, I have more patients on the board than anyone else.
Which is meaningless if you can't dispo any of them.
You're taking up rooms, jamming the flow.
You know, yesterday I got a hot M.
I.
to the cath lab in 15 minutes, reduced a perilunate dislocation, and caught a case of malaria.
Today I'm in some kind of bizarre vortex.
Okay, okay, cough times two days.
In and out.
Doubt it.
Probably turn into myocarditis versus tracheo-esophogeal fistula.
You know, all of my patients need three consults and a huge workup, and then even then, there's no definitive diagnosis.
Well, I guess No! And I'm not gonna pretend things are cut-and-dry just to get another hash mark on your board.
I just want one patient today that has a clear problem that I can help.
Okay.
Okay.
Sam, how come Brennan still hasn't gone to the scanner? 'Cause CT's been backed up for hours.
Charlie's the CT tech from 3:00 to 11:00.
He loves bear claws.
The rest of the donuts go to the nurses' station.
Should I make sure someone sees me so they know who it's from? Yeah.
You don't find all this wheeling and dealing a little bit slimy? Yeah, but sometimes you got to play some games to get stuff done.
Excuse me, ladies, let's review the standings.
- Ray still in the lead with 25.
- Make that 26.
Ah.
Abby at 19, Neela brings up the rear with 16.
File this under Neela.
And why would you do that? Because you'll owe me.
Hey.
There's a patient with an E.
R.
wrist band who's upstairs in the chapel.
Been up there a couple of hours.
Hey, where you going? You're only at 16.
Uh, Employee Health.
This is Abby Lockhart in the E.
R.
I've been stuck by a needle.
Let's roll, guys.
Curtain two needs a thumb spica, and we need to take off a toenail in four.
Dr.
Barnett, did you fill this out? What? This is the postmortem checklist for the jet-ski guy in Trauma One.
Ah, yeah, yeah.
And did you actually talk to Stacy Coleman or did you just fill this out to save time? What? Well, you checked off that she wanted to have her husband's organs donated.
She said she never consented to that.
No-no-no-no-no.
I asked her all the questions.
Well, a transplant surgeon was just in there prepping to harvest she thought her husband was getting better, so Okay, can we talk about this someplace else, please? UNOS has already been on the phone with a college kid from Madison who thought she was gonna be getting a heart.
Are you worried about getting yelled at in front of some medical students? The lady said she was fine with it.
No, Ray, she did not! Did you take the time to make sure I asked her all the questions.
Did you take the time to explain it to her?! How am I supposed to take care of four patients an hour Nobody said this job was easy! When you take shortcuts and you drop details, people get hurt.
We'll send this in for hep B, hep C and HIV.
You can call tomorrow for results.
And, uh never stick your hand in a full sharps container.
Stupid.
AZT and 3TC in a combined pill.
The other is your protease inhibitor, B.
I.
D.
on an empty stomach.
Two quarts of water a day, and we'll see you in two weeks to check your LFTs.
Juan we've been looking for you.
Have you been down here the whole time? Juan, you have leukemia.
Leukemia is very treatable, and you have an excellent chance of a cure.
I know it feels like something bigger than you is making this happen.
But something also led you here.
We will help you get through this.
There's a reason why you came to this hospital today.
- Hey.
- Hi.
I, uh, I heard you got a needle stick.
You okay? Oh, yeah.
I'm, yeah, fine.
You want to go home early? No.
I'm fine.
Really.
Excuse me.
Hey, Wendall.
Yeah? Did you get to see my overdose? Yeah, I left a note in the chart.
Elena's able to contract for safety.
I'm comfortable discharging with outpatient follow-up.
Great.
Listen, I heard about your needle stick.
- Are you all right? - I am.
- Page me if you want to talk.
- I will.
You're back.
Can I do anything? - Do you feel okay? - Yes I'm fine.
A little woozy from all the blood they took, though.
- I'll get you some water.
- Great.
Or maybe how about an iced tea from across the street? - Yeah, you got it.
- Thanks.
Hey, Sam, did the radial fracture get ancef'd yet? Uh, yeah, just a minute.
I got to give this message to Ms.
Coleman.
I'll do it.
Mrs.
Coleman? They took him to the morgue.
Your sister called.
She took your kids to your house for the night.
Hey, I guess we had some kind of misunderstanding back there.
I'm not even sure what it was about.
If there's anything I can do Can I call you a cab or something? I'm sorry for your loss.
Just the man I was looking for.
Do you know how often I hear that? Are you okay in there? Yes.
It was just a little mix-up.
What've you got there? I need a favor.
I'm into favors.
These are for my patient in Exam Three, but as you can see, they have my name on them.
- HIV meds.
- Yeah.
Do you have any friends in the pharmacy that could doctor those labels? Yeah, I think I'm falling in love.
- How was your first day? - Hard.
- You gonna come back tomorrow? - Yep.
Juan Enriquez's priest called, still no word from him.
Actually, he's on the oncology ward starting chemo.
I found him in the chapel.
Oh, great.
Hey, thanks for your help today.
Sure.
You off? Yeah.
Yeah, me, too.
If you wait for a second, I'll, uh, walk out with you.
Okay.
I, uh, think I hear rounds starting.
Just make sure you drink at least two quarts of water a day and see your doctor in two weeks and get your liver function tested.
I don't know what to say.
Thank you.
Sure.
Take care of yourself, okay? Okay.
Bye-bye.
Bye.
You have dinner plans tonight? No.
Maybe that was too subtle.
Would you like to have dinner with me tonight? It wasn't too subtle, Urbanus, I got it.
Answer's still no? Yeah.
Okay.
Good morning.
Hey, you buy your T-shirt like that or you just rip it up yourself? Hey, I met my discharge quota today.
So did I.
Uh, not quite, Dr.
Barnett.
- After-work cocktail? - Totally gross.
After that, let's go get a real drink, then.
Mm, not a chance.
I'm exhausted.
Come on, guys, Lewis is handing out the paychecks today.
How can he still have so much energy after a day like this? Well, work is easy when you have the entire staff literally eating out of your hand.
I just don't understand how he can finish all his work exactly at the end of his shift.
I still have, like, an hour's worth of charting to do.
Two hours.
Hello, Abby, Neela.
Survive? Okay, let's round, so the day crew can get out of here.
In two, we have DZ with V and HA.
Finishing a liter, P.
O.
challenge and home.
Oh, right, who can tell me what the criteria is for scanning a headache.
Trasncript: RaceMan.