ER Episode Scripts

N/A - s11e12

Previously, on ER: I understand you want to define yourself as chief But? Is this the way you want to do it? - I suck.
- Nah, you don't suck.
You're you're still learning.
So, how are you doing? I've processed all of my feelings of anger, shame and guilt in an emotionally safe environment.
I've addressed the urge to use alcohol.
Oh, and I've consulted both a shaman and a guru, so really, I'm all good.
I must've really made an impression on you-- you didn't even notice I was gone for a week.
Are you high? Alex, hurry up! The bus is gonna be here! What time do you start? Noon.
Is Neela on today? Is Neela on? I don't know.
I think she is.
Funny how that keeps working out.
- What? - Nothing.
Come on, she's young, single, lonely.
She's got a crush on you.
I'm her teacher, she's just trying to learn.
Yeah, I'll bet she is.
Aw, come on.
What, everyone can see it.
Who's everyone? Uh, Pratt, Frank, Jerry, Morris, Chuny, Haleh.
Even Murray.
Murray? Yeah, the guy who works at the roach coach.
It's not funny, Luka, and you're doing everything to encourage it.
Mm.
That's not true.
Yeah, well, it better not be.
Or else I'm going to have to get into some nasty chick fight with Neela.
In the mud? Just don't hurt her.
The only person who's going to get hurt around here is you.
You got it? Yeah, I think it was April.
But the fact that I need a calendar to figure it out is not a good sign.
Did I meet him? He drove a motorcycle.
That was his defining characteristic? I'm afraid so.
What about you? Third year, my gross anatomy instructor.
He was very skilled at prosecting the brachial plexus.
You slept with your instructor? Dr.
Gibson had a very tender way with cadavers.
And you called him "Dr.
Gibson"? Only in bed.
So basically, neither one of us has got any in a ridiculously long time.
Well, at least we have work to keep our minds off Men.
Romance.
Sex.
Yeah, at least we have that.
Morning.
Hello, Luka.
Dr.
Kovac.
Uh, multiple MVA on their way in.
Patient satisfaction scores.
We're up .
6 points from two weeks ago.
- Is that good? - Yeah, it's good.
Very good.
I'm going to post it.
Um, Carter, I want to thank you.
I know that my taking over as chief has been stressful, and it's been a little weird for you, but you've made the transition a lot easier and I really appreciate it.
Susan, I can't think of anybody I'd rather have as a boss than you.
backed into a utility pole.
Okay, hop to.
And don't call me Susan at work.
What happened? Dad was teaching her to parallel park.
She just got her learner's permit.
I got a little bit dizzy.
Maybe I got the pedals mixed up.
New scores? Yep, we don't suck as bad as we used to.
And maybe by next week we'll suck a little less.
Must be your motivational speeches.
We're pairing attendings with interns.
Abby, you got me.
Neela, you got Kovac.
What? Yeah, big Croatian guy.
You can't miss him.
We've got a double MVC rolling in.
Abby, he's all yours today.
Who? You guys know each other, right? You know how to clear a c-spine clinically? Uh, you mean if it's not tender? That's a no.
Check the Nexus criteria, get back to me tomorrow.
I give you Rodney Dixon and Amanda Field.
Rear-ended by a truck while having sex in his car.
Good vitals on both.
I'd say.
They stuck together with super glue? We tried to disengage them at the scene, but Oh, it's killing me, man.
Broken pelvis plus uncontrollable lust equals Chest is clear, belly's benign.
Backseat of a car, huh? '66 Mustang Fastback.
I hope it's not totaled.
Fastback? That's a pretty tight squeeze.
I do Pilates.
It's got a 389 to one rear gear with a 31 spline axle.
Nice.
You were screwing in the back of an old Ford? What were we supposed to do? My husband was home.
Oh, God! Probably a small crack in the pelvis.
You've got this, right? Oh, I'm all over it.
We'll give you some morphine and wait for your Viagra to wear off.
Dr.
Lewis told me to present to you today.
She did? Something about interns having a primary attending.
I hope you'll show me that combat procedure you mentioned last shift.
The femoral tear? Oh, depends on, uh, whether we get a patient who needs emergent central access.
Well, whenever we do.
Sorry.
Infected anal fissure, parked in the hallway.
Pupils four millimeters and reactive.
Ten centimeters JVD.
My wife is not gonna be happy.
It's okay, Dad.
It was my idea.
Take it Mom wasn't aware of the driving lessons? If she had it her way, I'd never be let out of the house.
We're kind of separated for now.
Katie was with me this week.
She take any medications? Prednisone, Tacrilomus The anti-rejection drug? She had a kidney transplant last year.
I have polycystic kidney disease.
We were on the UNOS list for seven years waiting for a donor.
I'm a big fan of dialysis.
She's got blood type O with an Tough match.
Yeah, well, finally got big enough that I could give her one of mine.
Your kidney? What a dad, huh? Any other meds? Uh, yeah, she's on an anti-seizure drug, too.
The PKD gave her an aneurysm.
Mom's on the way, sweetie.
Thanks.
Okay, a few crackles at the base.
Bradycardic at 48.
Whoa, peaked T waves, widened QRS.
Amp of bicarb, 10 cc's of calcium gluconate.
What do you think's going on? Um, well, low heart rate, dizziness, and the EKG changes-- could be hyperkalemia.
What? No, no, no, that can't be that.
Hey, John? Since the transplant, her kidney has been fine.
Why don't we wait and see what the blood tests show and then we'll take it from there.
Excuse me for one second.
Do you need an intern on this? I got Ray.
Uh, what do you think about taking Neela instead? Why, is there a problem? Just do me a favor, okay? All right.
Send the Punjabi Powerhouse my way.
Painless jaundice in Three and ulnar styloid fracture.
I'll take those.
Uh, there was a little change-- you're with Carter today.
I thought I was with you? No, he needs you in Trauma One.
Isolated pubic ramus fracture.
Will I be, you know all right? No cast, no surgery, just rest and pain meds.
But you're going to have to be careful for a couple of weeks until it heals.
Careful? Yes, as in "abstinent.
" The safest sex of all.
Abstinent? Are you serious? You can't put any pressure on your pelvis or you're going to end up right back here, which is not what we want to see.
So it's the pelvis we should worry about? That's right.
But other positions? Yeah, sure, get yourself a six-pack, a copy of the Kama Sutra and shoot out the lights.
Did we do something to offend her? Pulse is up to 61, B.
P.
's stable.
Looks like the QRS complexes are narrowing.
- That's good.
- That is good.
Lab says the chemistry machine is down, it should be up in an hour.
So you can't say yet if it's a kidney problem? The urine dip shows four plus protein, but we really won't know anything until the labs come back.
I told them to hurry.
Honey, are you okay? I'm fine, Mom.
It was nothing.
I told you it was too soon for her to drive.
What were you thinking? She's 16.
She wants a learner's permit.
You never know when to stop, do you? Let's not do this here.
I need more of Katie's family history.
Can we all step outside and give Katie a chance to rest? I'll be back, okay, sweetie? I've been sick for so long, it just got to be too much for them.
She was on dilantin for a long time, but, uh, she didn't like it.
It changed the way she looked.
And she was still having these breakthrough seizures once a month.
It was manageable.
No, honey, she had them at school, in the movies She hated it.
So you switched her medication? Three months ago, we put her on Zarictal.
It was not my choice.
Zarictal? - Uh, it's new.
- And we can't afford it.
Medicare does not cover it.
I took a second job working night security over at the Maller's Building.
We lost our apartment.
She's been doing great.
Katie has been seizure-free for three months.
No infections, no febrile illnesses? Have they switched her dosage of, uh, Zarictal? Everything's been steady.
She was doing fine before.
I don't know why She wanted to drive.
Like other kids.
And with the seizures she couldn't get a license.
We almost lost her once, and you're worried about her being able to drive? I'm sorry.
I'm sorry.
Look, I don't want to fight, okay? I just think it's time that we accept that fact that she will never be totally healthy.
- Why? Why should I accept that? - Because that is the reality.
Not for me.
You have a neurologist? Yeah, he's been great.
Good.
Why don't we give him a call? I'd like to talk to him about the medications.
Sounds like a hard situation.
I want you to look up this new drug for me-- Zarictal.
Oh, yeah, I had a patient on that last year during my Internal Medicine rotation.
Really? I never heard of it before.
Well, it's pretty new.
Expensive, but very effective for seizure control.
You kids and your fancy book-learning.
I try to keep up.
Do a PDR and check a medline.
See if there's anything about renal dysfunction associated with the drug.
This is George Guidry.
He's got a skin breakdown around the shaft of his penis.
No he doesn't.
I think I do.
Any discharge? - Oh, yeah, definitely.
- I'm not talking about that.
No discharge, no fever, no blisters.
Do you use a condom? Not since my girlfriend broke up with me a few months back.
No vesicles, no chancre, no lymphadenopathy.
Let's take a gander.
You know, I just thought of something.
Could this be from too much You know.
Too much what? Since Lily left, I've been lonely, you know? Really, really lonely.
How lonely? Oh, six, sometimes seven times a day.
I found a case report in the Western Journal of Medicine.
It suggests a correlation between renal failure and Zarictal.
Mm, well, that ain't much.
No, but these might be.
From the Adverse Drug Coordinator from the Department of Health Services.
Three more possible cases they've forwarded to the FDA.
Four, that could be a pattern.
The physician relations number at the Keating-Ward Pharmaceuticals.
They make Zarictal.
Might as well see what they can tell us.
Hi, this is John Carter.
I'm a physician at County General in Chicago.
Very well, thank you.
I have a 16-year-old girl, status post renal transplant, who's been on Zarictal for three months.
Yes, and I was wondering if I could talk to somebody about the incidence of renal failure.
Yes, I will hold.
Does anybody even listen to that music? It's terrible.
Carter, QRS is widening on our PKD girl.
Lots of ectopy.
I'll hold.
Multifocal PVC's, runs of six.
Push 80 of lidocaine and mix up a drip at one mig a minute.
What's going on? It's possible that the elevated potassium is irritating Katie's heart.
B.
U.
N.
98, creatinine 12.
3, potassium 7.
2.
Sounds like she might be in kidney failure.
V fib.
Starting compressions.
Okay, charge the paddles to 200.
She's all right.
It's going to be okay.
I need everybody clear.
Procainamide's on board.
And clear.
Sinus.
There we go.
All right, set me up for a femoral Quinton and call dialysis for renal orders.
Katie, honey.
Yeah, she's responding.
O2 at 15 liters.
Are you sure she needs dialysis? It's the best way to remove the excess potassium from her system.
Does that mean she has to have another transplant? Uh, that is a distinct possibility, yes.
Okay, betadine in the area? They said they'd be in contact within a week.
And one per cent lido.
A week? That's the standard procedure.
What's that? We telephoned the company that makes Katie's seizure medication.
So is it the drugs? Is that why this is happening? The timing of the med switch makes me think it's a possibility, yes.
So, you mean her kidney's being damaged by the Zarictal is it? Gabriel, Hannah I came as soon as I heard.
Is she in status? No, It's her kidney.
This is Katie's neurologist, George Henry.
Dr.
Carter, I don't know if you remember me Yeah, how are you, Henry? What has it been, six years? Give or take.
Can you take them to the family room? I'll be right in to see you in a sec.
Oh, okay.
Yeah, that's fine.
I think I remember the way.
Come on, it's all right.
I gave pleasure boy some Neosporin, the number for a therapist and sent him packing.
Well done.
How about you? Everything all right? I'm fine.
Busy.
Why? Well, last week, when I ran into you on the El platform, I didn't realize your situation.
My situation? It's just that I I heard what you went through last week and I didn't want you to think I was insensitive.
Uh, no I was happy not to have to talk about it actually.
Okay.
I guess I'm blowing that now.
I just I want to make sure that there isn't anything that I can do.
Um, well, that's that's nice.
It is.
Thank you.
It's, um Here's "H" and "P" and get back to me.
Right.
Why did you put me with this guy? When did everybody become such schedule divas? Well, I don't need a med student.
I don't like them very much and I'm just better flying solo.
Is there something wrong with him? No, he's excellent.
He's-he's very good.
He's excellent.
I just Oh, no, you like him, don't you? - Okay, you know, forget it.
- Oh, yes, you do, you do! You're blushing.
We never had this conversation.
Hey, haven't you had enough of doctors?! Post a message on the Neurology and Renal news groups.
Find out if anybody else has anything on the drug's renal toxicity.
That could cause a bit of a stir.
Yeah all right.
Just ask for any information that might help us best determine the course of treatment.
You heard what he said.
I know.
I don't believe it's the drug.
I think there are other options We have a dialysis tech coming down and I called UNOS.
They're going to put Katie on the list for a new kidney.
John, that may be premature.
Why don't we do a biopsy? This may be a case of rejection, not failure and a biopsy would show us that.
What's the difference? Well, a drug-induced failure would require a transplant.
But, uh, rejection Rejection could be reversed with mmagents.
Well, let's do the biopsy.
Okay, I'll put that in motion.
Dr.
Henry, can I have a word with you outside, please? Excuse me one second.
My intern's been doing a little research.
She's found four cases of renal failure in patients on Zarictal.
That doesn't prove causation.
No, but it gets you going that way.
Keating-Ward sponsored a series of Phase Three clinical trials.
If there was any real risk, the FDA would never have approved the drug.
What, you never heard of Vioxx or Rezulin? This is a very successful anti-seizure medicine.
It has improved Katie's quality of life dramatically.
Dr.
Carter, dialysis is here.
All right, will you page Dubenko to come down for the biopsy? Sure.
These need your signature.
Well, I hope you're right.
Well, let's be certain.
You know, John, I was really surprised to find you still working here.
- Why is that? - I don't know.
I guess I thought you would have moved on by now.
I guess I'm just a masochist that way.
How about you? I thought you went to go do, uh bench research.
Yeah, well, I got tired of it.
You were good at it.
I've got a wife and two small children now.
That changes one's priorities.
You mean money? Yeah, well, my practice does offer me three times the salary of an academic position.
What about you, huh? Married? Children? Not yet.
Thanks.
I'll find you when the surgeon comes down.
Are you moonlighting as a word processor? Our PKD girl is on a new drug, we're trying to get information on.
- Hey, Sam.
- Hey, Dr.
Lewis.
- Morning.
- Hi.
Has anyone seen? Is that your coffee? Sorry.
It's the nursing schedule, not a cocktail napkin.
GCS 12, B.
P.
60 palp, brady at 52.
- He fell from the roof? - Taking down his Christmas lights.
He's gonna need central access.
- Need some help? - Yeah, come on down.
- Carter doesn't need you? - Not at the moment, no.
Okay, prime the rapid infuser.
Can't find a vein, he's too clamped down.
Pressure only 50.
Heart rate's 42.
Blood in the belly.
He needs access.
He's about to arrest.
Okay, set up for a saphenous cutdown.
Wouldn't a femoral be easier to find? And faster.
It's probably the same difference, but okay, femoral tear.
Cool, I've never done one before.
You'll do the next one.
Scalpel to Neela.
What? She's along for the ride.
I promised her.
You promised her? Ten centimeters vertical slash.
Starting here? Deep into the sub-Q.
Level one is primed.
Okay, and now you tear Got any sterile surgical markers? There's the femoral vein.
Cannulate it with the nine french.
Let me try.
No, I'll get it.
Just reach under.
Neela, focus on the field.
Seldinger technique.
You know what to do.
Two units ready to go.
Sam, can you ask Dubenko to come here when he's done? Yes, sir, Dr.
Kovac.
That's the lower lobe of the kidney, right there.
Mm-hmm, mark the depth.
Purple okay? - It's my favorite color.
- Me too.
Three centimeters.
They need you next door.
What is this gonna do? It will tell us if your body is rejecting the kidney.
Lidocaine.
That's a good thing, honey.
All right, hold still.
Little pinprick here.
There you go.
It would be, like, 20-something before I can get another one.
No, that's not gonna happen.
Biopsy gun.
You just need to tell your immune system to stop being so picky.
Firing.
Dr.
Carter, Dr.
Weaver's on the phone for you.
She sounds kind of - Kind of what? - Weaver-like.
Um, I'll call her back.
Purple, huh? I've always been partial to azure myself.
What's azure? Like your eyes.
Send that off for light microscopy, EM and IF staining.
Pack the wound with moist gauze.
What do we have here? Belly bleed needs a post-op head CT.
And we have FFP thawing.
Send it upstairs.
Pressure's up to 100 systolic, heart rate's 90.
Dr.
Kovac, I, uh I never knew it was possible to transfuse that fast.
Well, that's the beauty of the central venous cutdown.
Now you know how to do it.
So what made you recommend Zarictal? I went to a luncheon at Northwestern and I heard a neurologist present on the drug's efficacy.
A neurologist who was probably a paid consultant of Keating-Ward.
- George.
Dr.
Carter.
- So what? It stopped the seizures.
Is everything all right? Um if the biopsy doesn't give us what we want, if she needs another kidney could I give her my other one? That would require you being on dialysis for the rest of your life.
No, I understand that.
I don't know that it's even ethical for someone to donate their only remaining kidney.
So it's not possible? I just don't know of any responsible doctor that would agree to do it.
Gabe, listen, I I know that you're scared.
But let's just take this one step at a time, okay? Why don't you go in there and be with Katie.
Carter, some neurologist in Skokie sent this fax for you.
Thanks.
It's a "Dear Doctor" letter from the pharmaceutical company.
It says that there have been isolated cases of renal failure on Zarictal.
Yes, I know.
And it recommends monthly monitoring of renal function, which I've been doing with Katie.
BUN, creatinine.
- You got one of these? - Yes, and so did you.
Those letters were sent out to every physician in the country.
They're sent as a caution.
So you knew about this? Private practitioners get letters like that all the time.
I followed its recommendations.
But you know what the biopsy's going to show, 'cause it says so right here.
Well, I'm hoping that's not the case.
Dr.
Carter, do you have a moment? Is there a problem? No, Kerry, just You posted a warning about Zarictal on an Internet message board? I posted a request for some information.
I'm getting a lot of phone calls, John.
I hate getting phone calls.
Two neurologists, our own head of nephrology, the regional director from KW Pharmaceuticals.
I just wanted to be better informed on a patient.
By jumping to conclusions based on skimpy evidence? Whoa.
Tell it to the Milners.
They're gonna need a new kidney for their daughter.
You have one sick girl, that's unfortunate.
The FDA and the drug companies have access to thousands of patients before they release a drug to the public.
They didn't use any renal patients when they did their clinical trial.
They can't document every side effect, it's not feasible.
You're working beyond the limits of your responsibility.
Are you telling me how to do my job?! I'm telling you, the FDA has an adverse drug event division Which is run by political appointees funded by the drug companies.
the number one lobbyist in the country is the pharmaceutical industry.
Come here.
Come on.
- Pick up a bottle.
- Kerry.
Do it.
Pravastatin.
Saves millions from heart attacks and strokes.
Enoxaparin.
You know what this is? Yes, I do, it offers better PE prohylaxis and allows DVT patients to be treated at home.
Linezolid.
Fights off strains of MRSA that used to be fatal.
Kerry, I think he gets it.
- Does he? - Yeah, he does.
These drugs save lives.
And the companies that make them donate over $20 million in grants to County's academic programs.
Without that, we wouldn't have a hospital.
We'd be standing in a mini-mall right now.
Oh, so that makes it okay to suppress negative test results? Even at the risk of lives like that little girl's? Putting these drugs out here and seeing how they work is how we learn.
It's how medicine advances.
And that's not naive? Your job is to take care of your patients, not start a crusade.
Susan, you're the boss.
Tell him to keep his eye on the ball.
No more computer access for you.
It's like I forgot where I was.
I was just looking at him like he was a huge cupcake.
You want one? Ah, it's just a metaphor, thanks.
So you have a crush on Luka? That's kinda weird.
It's just a crush.
Crushes are by nature idealized, unrealistic What about Dr.
Gibson? That sounded real, gross, but real.
My God, you're right.
It's a pattern.
I'm a slut for authority.
Stop it.
- Well, what about you? - What about me? I heard you punched your med student.
So? He was bugging me.
So you're hung up on a subordinate.
No, I'm not.
I have a thing for a supervisor.
Oh, so what? I'm like the yin to your yang? What are we gonna do? Ignore it and hope it goes away.
Right.
No need to discuss it.
No.
Denial works.
Hey, Sam, dog bite in three.
I wrote for unasyn.
Put it in the rack and I'll get to it.
Sam, did you check on my biopsy results yet? Oh, yeah.
Dubenko's will be on his way down.
What about my patient in exam two? I'm waiting on a repeat CBC.
Sam? Done and sent.
Nice seeing you all.
Isometric vacuolization of the renal tubular cells consistent with drug toxicity.
So there's no chance that this is rejection? No tubulitis, no edema, no inflammation.
The girl needs a new kidney.
And it's from the new drug? I'd say so, but, I, um, I don't want to encourage you.
Encourage me? Some of my colleagues upstairs were suggesting that you've been all over the Internet with this.
Just trying to be thorough.
Word of friendly advice? Don't piss off the money people.
Hi, everybody.
Katie's biopsy results and unfortunately, they are not what we had hoped for.
So it's not rejection? No.
No, it's irreversibly damaged.
And is this, is this from the Zarictal? It could be from the Tacrolimus she's been on since the transplant.
I doubt that.
Her levels have been therapeutic for two years.
Wow.
So, this, uh, this, uh, uh, drug that I've been working two jobs to pay for just to make her life better has ruined her donated kidney? I'm afraid so.
You told me You told us it was working.
Sometimes drug interaction can only become apparent after the first year or two of release.
This couldn't have been anticipated.
So we're, we're back to waiting? UNOS will prioritize her for a new kidney.
That'll take what, three, four years, if we're lucky.
Okay, in the meantime, what I'd recommend is that we get a surgeon down here to see her about creating a forearm shunt to facilitate dialysis access.
We can take care of that.
So we're back to where we started.
She'll be on that dialysis machine all through high school, through college? Well, just because it took a while to get the kidney No, It didn't take "a while.
" There wasn't one.
I gave her mine.
We have given up a lot.
Made a lot of sacrifices.
You told me this drug was worth it.
Okay, uh, show me your incision.
Fifth ICS, anterior axillary line.
Go for it.
Pulse ox is 92 on five liters.
Push that in just superior to the rib.
Okay, spread the clamp.
Sats coming up.
And slip your finger into the pleural space.
Uh, I lost the tract.
Okay, keep your finger in there, just guide the tube.
I'm above the rib, but it won't pass.
There you go.
That is where you want to go.
All right, I got it.
Keep advancing.
A little bit deeper, 'cause you want all the ports in the pleural space.
Thoroseal's ready.
So is suction.
That's very good.
Hello? Uh, okay, sew it in.
Somebody put something in the water today? Call it "pulseless electrical activity following trauma.
" Right.
Change "blade" into "scalpel.
" Don't say "torn.
" Say "dissected.
" Call it the "field of exposure.
" You left out the size of the cordis.
Nine french.
Okay, write it down.
And not "blood.
" "Packed red cells.
" Okay, good job.
Just make the changes and I'll cosign.
I hope I didn't give you the wrong impression.
You're a resident, and I'm an attending.
I mean, I want to help you learn Yeah, I-I got it.
I understand.
I'm sorry.
It's just, I wouldn't want anything to get in the way I got it, I got it, I got it.
Thanks.
Vitals are stable.
I need to grab an amp of bicarb.
Katie's T-waves are back to normal which means her potassium has come down.
That's good.
- He went to work.
- Mr.
Milner? He took a second job as a security guard over at the Jewelry Center just to try to help pay for everything, you know? Nothing means more to him than Katie getting well.
Nothing.
Her illness just changed him.
It ruined our marriage.
It's important to stay optimistic.
A lot of good things could still happen, Mrs.
Milner.
MVC with passenger space intrusion, ETA seven.
Okay, we'll take it.
What's MVC? "Motor Vehicle Collision.
" Another new protocol.
No such thing as an accident.
I liked "MVA.
" I like walks in the springtime.
John, a minute, please? I'll catch up to you.
Um, I was aware of the potential for toxicity, but it was only one case report in an obscure journal.
Well, you could have found out more than that doing a simple medline search.
I can't do a medline search every time I put a patient on a new drug.
Besides, I've got 20 patients on Zarictal.
They're all doing well.
- 20?! - Yes.
What, are you on the Keating-Ward payroll? Listen, as part of an ongoing study, I send in a monthly update on each patient's progress.
And they compensate you? A small stipend for my time.
Hope your medical malpractice premiums are paid in full.
No, there's nothing wrong with it.
I am reimbursed for helping to monitor a new drug by doing thorough patient evaluations.
But the company will only pay attention to it if it says exactly what they want it to say.
Her seizures stopped.
She was very happy.
The father was thrilled.
Yeah? He's real thrilled now.
Listen, I am trying to be a cutting-edge clinician.
Guys? That's what the patients want.
I have to offer them the most efficacious meds on the market.
That problem is that last part, isn't it? - Yo? - What? Mr.
Milner? I was I was going to work and I thought, "Why?" What is the point now? Um, Gabe, p-put the gun away.
I put everything in your hands.
Everything.
And you let her down.
Katie can still live a long, productive life on dialysis.
Why, why, why shouldn't I? Why shouldn't I? You know what we should do right now? Let's go inside and see your family.
Come on.
Let's go inside and we'll see your family right now.
I want to give my kidney to her.
Hey, maybe I was wrong about that.
Maybe you can be the donor.
You're lying.
I know you're lying.
Fix her, okay? Yeah, we're gonna fix her.
Sats are down to 88.
- Can you see the cords? - Lots of blood.
All right, somebody go find his wife.
Okay, tube.
And get that girl out of here.
Come on, let's move her to another room.
Grey matter covers the occiput.
Why the hell would he do this? He was distraught.
Pupils fixed and dilated.
Pressure's only 80/60.
Start dopamine at 10 mikes.
No gag when I tubed him.
No corneal reflex.
Can he regain any function? No, he's as brain dead as they come.
I'll go talk to her.
No, no, no, wait, wait.
Let me.
I'm the family's doctor.
Transplant coordinator's down.
Technically, there's nobody else who can give consent.
The girl has a very rare tissue type, Amparo.
The father is a match.
I've made that clear to UNOS.
Look, I'm trying to get them to allow us to proceed.
For now, keep him on an FIO2 of a hundred.
And make sure the girl's NPO in the hope that she goes to the O.
R.
Just do everything that you can, okay? I will.
Go climb back under your rock.
Hey, I'm from the Trib.
It's a good paper.
Yeah, right.
You guys endorsed Bush.
Man, a guy shoots himself in the ambulance bay.
What's next, a plague of frogs? There's a small gang of press outside.
Someone from the ER has to go talk to them, get them the hell out of here.
Well, obviously, the guy was clinically depressed.
All we know is he's in critical condition.
We can't go into any details.
Heartfelt sympathy to the family, we're doing everything we can.
You're good with that, right? You want me to talk to them? You treated these people.
Just play up the fact that we're respecting the family's privacy, okay? MAP's only 90.
Can we go up on the dopamine? We're maxed out.
I got a P.
R.
N.
for levophed.
Sounds good.
Maybe we need to talk? Nah, we really don't.
It's just, he helped me to adjust coming back to work here.
He made things a lot easier.
And I guess I don't know, I got confused.
I get confused every time I look at him.
Did you work on this family? His daughter, yeah.
I'm sorry.
Levophed's going at two mikes.
Does Gabriel Milner have a daughter being treated in ER? Yes, he does.
Now, is it true that she's suffering from kidney failure? Uh, I can't say.
Didn't you indicate that earlier today on a medical website? No, I made some general informational queries that I can't discuss the specifics.
Do you want to go get something to eat? I know this awesome little Ethiopian place.
They make you eat with your hands, but I got sterile gloves in my bag so it's okay.
Dinner? But don't take it personally.
I'm not really a subtle guy.
But I was under the impression that there's sort of a thing happening here.
Maybe not a big thing, but still a thing.
A thing? Um Yeah, yeah, maybe there's a thing.
But you know what? It's not Nothing's gonna happen.
Why is that? Well, a lot of reasons, most of which I won't mention because I don't feel like sharing my checkered past with you - Why? - or my various neuroses.
But there's one really big reason that's a deal breaker for me.
- You miss the beard? - No.
You're my student.
I'm grading you.
Well, I think that that is not appropriate.
And have a good night.
You know, um what if I was willing to take an "F" right now? I forgot to mention to you that I'm dropping out of med school.
Yeah, who wants to be a doctor anyway? Don't you think it's incumbent upon you to share the information possible fatal side effects of a popular new drug? Katie Milner was on Zarictal for the three months.
And, yes, I believe the drug ruined her kidney.
"Out of respect for the family, that's all I can say.
" Is that so hard? They knew it all already anyway.
No, they didn't.
What you're alleging is potential slander that could cost the hospital millions in pharmaceutical support.
What, are you worried about free pens and coffee cups and drug samples? No, I'm worried about research, educational grants, a little thing that HIPPA likes to call "patient confidentiality.
" I didn't want to talk to them in the first place! "Out of respect for the family" You want to talk to them next time, then you do it.
- It's your damn ER.
- You're right.
I will.
Dr.
Lewis? Dr.
Weaver.
Oh, I wonder what she wants to talk to me about.
It's true, right? You did a good thing.
You say that like it matters.
You ready to go? UNOS gave us the go-ahead.
We're gonna do the transplant.
Oh, thank God.
They're bringing Mr.
Milner up.
Look, she doesn't know where the kidney's coming from.
I haven't told her yet.
That can wait.
Let's go inside and talk with the anesthesiologist.
You a medical student? First-year resident.
How's that going? Some days better than others.
I like it well enough.
What do you think they'll tell Katie? She'll tell her that her father loved her.
Maybe too much.
The transplant surgery's under way.
I can't take responsibility for how the system works.
But I can try to do my job better.
That's all any of us can do.
I don't know why I was surprised to find you here.
Of course you're still here.
Hope we see each other again under more favorable circumstances.
You were always good to me when I was a student.
I remember that.
Anspaugh wants to see us and Weaver in his office tomorrow morning.
Suture removal in curtain three.
If any of this rolls back onto you, I'm sorry.
Mr.
Klossey.
Hi, doc.
How are you today? What are we looking at here? I did this skiing on Michigan Avenue.
Cross-country, during the last big snow.
Little fall, gashed my arm, but I hadn't done it in ten years, so even that felt good.
Why'd you stop? Arthritis.
I had it bad.
Couldn't bowl, couldn't sit in those seats at Wrigley, take my niece for a walk.
So what happened? I saw an ad on TV for Renuvium.
A doc at the clinic gave me a prescription.
Fixed me right up.
Renuvium? Yeah.
A little red pill, once in the morning, let me do all those things I thought I had given up forever.
That's something, huh? Okay, this might hurt just a little bit.
Damn miracle of medicine, that's what it is.