ER s13e01 Episode Script

Bloodline

OFFICER 1: Staging area, north of County MAN 1: Coming through.
[HELICOPTER WHIRRING] WATCH COMMANDER: Callahan, cordon off the area.
Don't let the witnesses leave.
MAN 2: All right, come on, here.
You folks back off the perimeter.
- Back off the barricades.
OFFICER 2: Come on, now, listen to him.
There's a car coming in.
What happened after that? WATCH COMMANDER: Lift those cords up, right now.
- They took one of our nurses.
- Got in the van and just plowed right by.
Was Sam? Was there a nurse with them? - I saw a lady, guy was dragging her.
- She works here, Samantha Taggart.
You need to find her.
WATCH COMMANDER: Holding area to the left.
- Lily, how'd you get through? - Through Oncology, everybody okay? I'm not sure yet.
Call OEMC and put us on medical bypass.
We're closed for internal disaster.
- And page Kovac, it's his damn ER.
- I'll get on it.
- Dr.
Weaver.
- Yes? - Main area clear, working our way back.
- Thanks.
Admitted patients need to go up to the wards, don't wait for open beds.
They can board them in the hallways for now.
Okay, everybody else is getting triaged.
We need to assess all equipment for any possible damage.
MARQUEZ: Some of the techs are starting on that.
- I came in as soon as I heard.
- Thanks, Frank.
Call Pratt, we need him here.
Frank.
OFFICER: Requesting backup, any available Jerry is gonna be okay.
I found this lady near the stairs.
- Finish checking the back hall.
- Hey, is somebody with this boy? [SOBBING] It's okay, honey.
It's okay.
Hi, I'm Kerry.
Are you with somebody? Jerry was taking care of me.
- Where are his parents? - They were on their way in.
I'll take him up to Daycare until they get here.
Come on, honey.
Have somebody take a look at that.
- I'm good, this is nothing.
- Looks like something to me.
Lots of folks got it worse.
Haleh, how's Jerry doing? We're waiting on a second Thora-Seal.
Abby's getting it.
- I'll be right in.
- Dr.
Weaver.
Any word on Sam? - I told you we should've waited.
RAFE: We waited long enough.
We would've walked out if you hadn't let her play doctor.
STEVE: He okay? His insulin level is peaking.
He needs some food.
- Peaking? - Yeah, he's diabetic.
What, did you forget? - How far till the switch? MARY: About 10 minutes.
Hurry up.
We'll get him something soon.
- Systolic's down to 70.
- Call for type specific.
- Another two liters on the infuser.
- How you doing, Jerry? - Breath sounds on the right.
- His chest tube is clamped.
- You want him to bleed out? - He needs to get up to the O.
R.
- Still waiting on that Thora-Seal.
- I'll go find it.
- Hey, sats are dropping.
- 8-0 ET, sux and etomidate.
WEAVER: Abby? Abby.
Abby, open your eyes.
Open your eyes, come on.
Come on, wake up.
I need some help, now.
[RATTLING] I'm coming in right now.
There's been a shooting.
Jerry took a couple hits.
- They're trying to stabilize him now.
- Abby? Found her in a pool of blood.
Frank wasn't sure about anything else.
I'm dropping you off before I go in.
- I'll check on you later.
- I'm coming with you.
County General, as fast as you can.
Sats, 98 on room air.
Deep breath in and out.
[COUGHING] What the hell happened? That trainee girl stabbed me with Beck.
Sam did the intubation.
How's Abby? I need to check on her.
Six liters O2.
Call me if his pulse ox drops below 94.
- Easy, Luka, come on.
- I'm fine.
Oh You need to be monitored for at least an hour.
- I'm fine, Kerry, okay? - Luka, you were paralyzed and intubated.
You belong in the ICU.
Hey.
All right, get him a stool.
Pressure's up to 110 on two liters, crit's 35, fetal heart tones, 160.
- Sounds good.
- Hey, Abby.
How are you doing? - How'd I get here? - You passed out, you were bleeding.
I had a cramp.
- Probably vagal from the pain.
- Has it stopped now? It seems to have slowed down.
MORRIS: No sign of abruption, baby's moving around.
Looks healthy.
Congratulations, it's a boy.
Could be a placenta previa.
Uh No, I don't have previa.
They saw a low-lying placenta on the 20-week ultrasound.
That would explain the bleeding.
You may need a C - I don't need a C-section, call Coburn.
- She was paged.
- Dr.
Weaver, Psych's here.
- I'll be right there.
Kerry, move me to OB.
- No, we still need a sterile spec exam.
- Dr.
Weaver, send me up to OB.
- Vitals? - Pulse, 85.
BP, 112/78.
All right, take her up.
- Having a rough time with the airway.
- It's okay, I got it.
- Help with the intubation.
- I'm staying with you.
No, no, I'm just going up for NST.
- Just come up after he's tubed.
- No.
Luka, it's Jerry.
Page me if something changes, okay? [CLEARS THROAT] [PHONE RINGS] County ER.
Sorry, we're closed.
You have to call Mercy.
Clinic's taking any walk-ins with stress reaction.
Good, thanks.
Abel, stay with him until he's settled upstairs.
Okay, Dr.
Weaver.
We should discuss a critical-incident debriefing.
In a few hours, let's get through this.
- I don't care, you can't just barge in.
- Chris, it's okay, it's okay.
- What's up with Jerry? - He is redlined to the O.
R.
- And Abby? - She's good.
We sent her up to OB, just to be safe.
They just called.
Dr.
Coburn is on her way in right now.
- Okay, great.
- Abby, how are you? Oh, I think I must have hit my belly when I fell, I'm fine.
- How's the baby? - Fetal heart tone is 155.
- Thank God.
- I'm just going up for monitoring.
- I'll come with you.
- No, no.
Come on, it will be fun.
We can play Who Had the Worst Day? I'm fine.
Really.
All right, I'll come and check on you later.
Come on, come on, let's go.
- Mom, I don't feel good.
- He needs to eat something.
No, gonna get some miles behind us first.
No, he can't wait.
Okay, get him something to hold him over, but make it quick.
- Come on, Alex.
- No, Alex stays with me.
- I'll take her, let's go.
- I'll be back, okay? MARY: Hey, get me some chips.
I'm hitting the head.
Come on, stand up straight.
Be a man.
You're not a little kid anymore.
Oh, shoot.
I think you're gonna really like Canada.
I like Chicago.
MORRIS: More cricoid, Ray.
RAY: I'm about to crack the larynx.
MORRIS: It's a big floppy epiglottis.
I can't see, it's a long neck.
Eighty-two on the pulse ox.
Pull out the bag.
Give me the flipper.
If we can't get this in then we're gonna need a straight long blade.
You okay? Let me know when the sats are up.
[COUGHING] Tight wheezing throughout.
All right, sit down.
Get him an albuterol neb.
- I'm okay.
- It's bronchospasm.
- You probably aspirated some saliva.
KOVAC: Guys, I can do this.
If you don't get treated, I'm gonna have two patients to intubate.
Grab an LMA, just in case.
Pressure's down again.
RAY: Autotransfuse from the Thora-Seal.
- Okay, let me take a look.
[MACHINES BEEPING] [COUGHS] How is he? He's okay, Frank.
Did somebody call his mom? I'll do that right now.
She can meet us up in the O.
R.
Yeah, let's hope so.
Hey, grab what you need.
You planning on paying for those? No stealing, baby.
Yeah, these people work for a living.
HALEH: He's bradying down.
- Should I get Weaver? If you enter the trachea, you'll feel clicks when you pass over the cartilaginous rings.
Heart rate's only 50.
Click.
Click.
- Click.
KOVAC: Hold it right there.
Ray, pass an 8-0.
All right.
RAY: Here you go.
Okay, advance the tube.
- No, it doesn't wanna pass.
- Down to 40, amp of atropine.
Rotate counterclockwise.
It's caught up on something.
[COUGHS] There we go.
Okay.
End-tidal CO2.
- Sensor is yellow.
- Yellow means yes.
- Thought you were bringing him.
- Problem.
We're ready.
- His pressure? - Up to 95 systolic.
Four units.
Two liters autotransfused off cell saver.
Everybody upstairs is doing everything we can to help you guys out.
Well, baby looks good, but you are definitely contracting.
- I don't feel anything.
- Sometimes you don't.
I think the belly trauma put you into preterm labor.
Baby's head dropped down, caused placental bleeding.
Okay, well, it's too soon, so give me terbutaline.
Come on, you need magnesium.
I know you know that.
I remember all the times you gave it when you were a nurse.
Mag makes you feel like crap.
So why don't we just start with terb? Terbutaline can mask the signs and symptoms of abruption.
I didn't know that.
Today you're the patient, not the doctor.
I'm not having an abruption.
Not right now, but the trauma puts you at risk.
And if you do abrupt, we need to know right away.
So you could do a C-section? - Four-gram load, then two an hour.
NURSE: Yeah.
- Let me know if you have any more pain.
- Okay.
MARY: You got my chips? RAFE: Yeah, yeah, yeah.
- That the key to the restroom? - Yeah, but it's nasty there.
No, no, we need to leave.
Let the girl take a pee.
We can't hold it in like you guys.
Hey, can I have my chips? I'm starving.
Thank you.
[YELPS] Next time you try something like that, I'll take it out on your kid.
- You're definitely not contracting.
- Contractions don't last this long.
COBURN: When did the pain start? - About 15 minutes ago.
How bad, one to 10? I don't know, like a four, maybe.
But it's probably just a bruise from when I fell down.
I just need some Tylenol or something.
- Well, there's no evidence of abruption.
- Great.
See? I told you.
CBC with platelets, PT/PTT fibrinogen, D-dimer and FDPs.
Why? What for? Twenty percent of abruptions have ultrasound findings.
Let's send the labs to be sure.
[SIGHS] Baby looks great, heart rate's good, excellent variability.
Abby, Abby, hey, Abby.
Here's what I would say to you if you weren't a doctor.
The placenta separates from the womb and bleeds the baby can be deprived of oxygen.
Now, even if we don't see a blood clot the labs will give us advanced warning before the baby's in trouble.
Okay.
- Twelve of betamethasone.
- Oh, come on.
We have to mature the baby's lungs in case of an emergent No, no, no.
I have two and a half months left to go.
This baby is not coming until then.
- That's what we're all hoping for.
- I can wait two more weeks.
The risk of prematurity goes way down at that point.
I can wait, I'll go on bed rest, I'll use a bedpan, I won't move.
You know that I want you to have a healthy baby.
Why do you keep focusing on a worst-case scenario? That's her job.
- Eight monitored beds good to go.
- Night staff's been called? - All coming in except two.
- You check on Sam? My guy at the district called, still no leads.
OEMC's on the line, wanna know where we're at.
Tell them we can take four critical paramedic runs.
Back on bypass till we see how we're doing.
- Got people for treatment.
- We'll take care of it.
Chuny, let's set up fast track in the west lobby.
Speed through anybody who doesn't need x-rays or labs.
- Pratt.
- All right, I'll help set it up.
[DINGING] Great.
How long is this gonna take? - What are you doing? RAFE: Shut up.
- You're gonna get us all killed.
- Relax, train's probably a mile away.
Oh, son of a bitch.
[SIREN WAILING] All right, everybody be cool.
Nobody gets hurt.
License and proof of insurance.
We're on our way to the lake so my son can get some fishing in before dark.
It's his birthday.
I'll be right back.
That's good.
He's just gonna give us a ticket.
What's he doing back there? STEVE: He's a local yokel, man.
This is the most excitement he's had all day.
- Probably calling for backup.
- Sammy.
Every cop within a 1000-mile radius knows what you look like.
- He's taking too long, screw it.
- Ah So they're trying to find the source of the bleeding and tie it off.
Oh, my Jerry's not the hardy type.
I only hope he doesn't wilt under all this.
He had a good blood pressure and good pulse when he left the ER, so Oh, the ER.
This would never have happened if he didn't insist on working at that fakakta cesspool.
Well, as long as the surgeons find the bleeding and stop it, he should be fine.
He could have gone to law school, you know.
- I didn't realize that.
- I myself sent the application to Harvard.
Harvard.
But, no, he wouldn't go.
Oh, that's, uh - Jerry got into Harvard, wow.
- No, they rejected him.
Four times.
- But that's not the point.
- No, of course it isn't.
- So how much is all this gonna cost us? - Um I don't really know.
I mean, I'm sure his health insurance will cover it.
Oh, but they don't cover the deductibles, do they? You know who covers the deductibles? Me, I cover the deductibles.
Why don't you wait here, okay? And I will talk about this with you as much as you want.
But I'll go see how he's doing first.
He doesn't have any savings, you know.
But why would he? He can barely survive off that weekly insult you people call a paycheck.
- How's he doing? - A bullet nicked the right ventricle.
Damn it, I was hoping it missed the heart.
DUBENKO: Another 3.
0 Prolene on a pledget.
SHIRLEY: Eighth unit going up.
ARl: Systolic's 85.
I mean, a cardiac defect isn't so bad.
It's repairable, right? It's not like he needs a pneumonectomy.
DUBENKO: Metz.
Looks dry, barely any oozing.
[MACHINE BEEPING] ARl: V-tach.
DUBENKO: Internal paddles.
ARl: Lost the pulse.
DUBENKO: Twenty joules.
Oh, God.
SHIRLEY: Charged.
DUBENKO: Clear.
[MACHINE BEEPING] ARl: Still tach.
- Come on, Jerry.
DUBENKO: Charge to 50.
Clear.
ARl: No change.
- Damn it.
DUBENKO: Starting internal compressions.
Why is he in V-tach? Elevated potassium? ARl: T-waves aren't peaked, but we've got ST elevation.
He's having a heart attack.
ARl: What about hypocalcemia? DUBENKO: Could be high doses of citrates with the transfusions.
Amp of calcium chloride.
- Excuse me, Dr.
Dubenko.
- Not now, Neela.
Epi's onboard.
I'm sorry to interrupt, but is it possible the suture is tying off a coronary artery? - What? - Lf you occluded the coronary artery with the stitch, you'd have an MI.
That's a good call.
I'm near the RCA.
- Eleven blade.
SHIRLEY: Charged to 20.
You could see inside the field? I just had a hunch.
DUBENKO: Sutures cut.
Clear.
[BEEPING SLOWS] ARl: Sinus.
- Way to go.
DUBENKO: Okay, we'll go on bypass for a coronary graft.
Call the perfusionist.
We'll reposition for a clamshell.
Neela, scrub in.
I need another set of hands here.
[SIREN WAILING] Whoa, whoa.
RAFE: Woo-hoo-hoo! - Oh, man.
- They know where we're going.
- Just let us out, please.
- You don't need us.
- You're not prisoners, you're family.
You're gonna get your family killed.
Is that what you want? Steve! What are you doing? - Cops are gonna be crawling everywhere.
- We'll get further off the grid.
They didn't know what direction we headed.
Then we'll change the direction.
Steve, please, just let us out, okay? I can go back and check on that cop.
Shut the hell up, Sam.
Shut up, you're not leaving.
Nobody's leaving.
Do you understand that? - Does everybody understand that? - Whoa.
Hey, buddy, chill out.
We're okay, hey, hey.
Hey, easy, man.
[COUGHS] - Are you okay? - I'm fine.
Sam probably saved your life.
Yeah, I hope she's all right.
- How's he doing? - Good.
Turn and see for yourself.
The magnesium has drained all my life force.
We're so not ready for this.
No one is ever ready for this.
Yeah, but we don't even have a car seat or a stroller We have a crib.
We don't have a name.
I was kind of hoping we could name him after my father.
- Really? - Yeah.
He would really have loved to have a grandson named Mongo.
Mongo? Yeah, it's a very popular name in Croatia.
I'm just kidding, my [CHUCKLING] My father's name is Josip.
I don't care how we're gonna call him.
It's not funny.
Oh, my God.
- What is it, contraction? - I don't know, I think my water broke.
- Ugh.
What are you doing? - Opening up your saline.
We need some help in here.
Are you sure it's not a contraction? Nothing on the monitor.
[MACHINE BEEPING] - Oh, what's that? - His heart rate's dropping.
- Oh, God, how low? - Okay, get on your left side now.
COBURN: Abby.
Sharp pain, gush of blood.
Heart rate's in the 60s.
We're going to the O.
R.
- Is it an abruption? COBURN: Looks that way.
- Stat, page Anesthesia.
- No, I want a spinal.
General anesthesia is quicker.
I wanna be awake for the birth.
You're okay.
You're gonna be okay.
[PANTING] RAFE: No, keep going.
STEVE: I wanna sit tight for a while.
I don't think so.
Babe, what do you think, split up? MARY: Yeah.
STEVE: Not until we get another car.
All you do is slow us down, you and this dumb bitch.
- Oh, shut up, shut up.
- Hey, hey, take it easy.
They're fighting.
Yeah, they don't know what to do.
They know that they're in trouble, they know the cops are coming to find us.
- Mom.
- Yeah? Is Dad gonna hurt us? Everything's gonna be okay, buddy.
Keep your voice down.
They might hear you.
Just come in here, come in here.
[DOOR SLAMS] Buddy, I need you to help me do something.
But you gotta do it so no one else knows, okay? Okay.
Come on.
- Find some keys, okay? - I think the other guy has the keys.
- Or a gun or something.
- A gun? - Anything.
- Mom, I'm scared.
Okay, I know you're scared, and I know I messed up a lot but I would never, ever let anybody hurt you, no matter what.
I swear to God.
[GUNSHOTS] Go, go.
Hey.
Are you guys hungry? What's up, Frank? You know, I always believed that nothing ever really changed.
I'm old enough that I know that there's always gonna be troubles.
War, taxes.
Bad guys now are pretty much the same as bad guys have always been.
That's not how I feel today.
I feel like the world's getting worse and worse and worse.
And what we're watching is the slow, steady descent of the human race.
Uh No, no, I don't buy that.
I think that, um, today was just a rough day for the home team.
- Straight across the sternum? - Exactly.
Ten blade.
COBURN: Lap pads.
Oh, boy.
- What? - Lots of oozing.
NEELA: Cross-clamping the aorta.
DUBENKO: Cardioplegia going on.
NEELA: Ice.
COBURN: Opening the uterus.
Hang two units of packed cells.
NEELA: Greater saphenous is isolated.
Cannulate, check for leaks, then pass it up.
COBURN: Banded scissors.
Cord is cut.
NICU RESIDENT: Come on, little guy, give me a cry.
NICU NURSE: Pulse is less than 60.
NICU RESIDENT: Let's bag him.
Intubation tray, 3-0 ET tube.
NICU NURSE: Add 20 units Pit to the bag.
Draw up Methergine and Hemabate.
DUBENKO: Twenty joules.
SHIRLEY: Charged.
[MACHINE BEEPING WILDLY] NEELA: Clear.
[BEEPING SLOWS] SHIRLEY: Sinus rhythm.
ARl: We have a pulse.
All right, Neela.
DUBENKO: Hole punch for the proximal, NICU RESIDENT: I'm in.
Ambu-bag.
COBURN: Abruption clot.
Consumed all of your clotting factors.
Uterus is not responding to massage.
Let's pack it off.
NICU RESIDENT: Draw up epi, .
03.
NICU RESIDENT: Holding compressions.
NICU NURSE: Pulse up to 120.
NICU RESIDENT: Get ready to move.
COBURN: Damn it.
- What? The uterus is boggy and hemorrhagic.
The sutures are making it worse, not better.
PERRY: Nothing after 20 minutes.
She's not clotting at all.
Am I in DIC? COBURN: The FFP should reverse that now that the baby's out.
KOVAC: What if it doesn't? PERRY: Pressure's down to 80/50.
COBURN: All right, two more units.
We gotta control this bleeding.
- Go to the NICU.
- No, I'm staying.
- Stay with the baby.
- Abby.
Shut up, shut up, please, just shut up.
I want you to stay with the baby.
COBURN: Try to ligate the uterine arteries.
Go, I will call you if we need you.
I don't want him to be alone.
[SIGHS] [STEVE CLEARS THROAT] [GROANS] This will help.
You see that one up there? The real bright one? Dead.
By the time we see it, it's already gone.
We'll get him his insulin way before he needs it.
He'll be fine.
You know, Steve, I was gonna ask you what happened to you to turn you into this.
Then I realized it was always in the cards from the moment that I met you.
You were on your way to becoming exactly what you are right now.
I love him.
I know you don't believe that.
Especially right now.
But I do.
Yeah, you love him, right.
That's why you get some woman to snatch him from school and tie him up and leave him in a van.
You don't even remember his medicine.
Hey, hey.
You're right to be pissed.
You're right.
It was my fault.
It was my fault for ever letting us get separated in the first place.
But now we gotta stay together.
The three of us.
There's no other way.
I'd rather we were all dead.
Hey.
I don't want you to be afraid of me.
You don't need to be afraid of me anymore.
As long as we stay together, you and Alex are safe.
COBURN: Where are we in factor replacement? PERRY: Four of red cells, two units FFP, pack of platelets.
COBURN: You've had uterotonics, packing an O'Leary stitch and a B-Lynch brace.
Still bleeding? Blood has penetrated the thickness of the uterine wall.
I don't know what else to do.
We can keep waiting for you to clot.
Or we can start thinking about a hysterectomy.
How long can we wait? Too many transfusions put you back into DIC.
And then the bleeding gets even worse.
PERRY: Last crit is 21.
COBURN: Stay ahead two units.
[MACHINE BEEPING] Uh, Jerry is in recovery.
I thought you'd wanna know.
Um Have we heard anything about Sam? No.
This is a scary place.
I remember the feeling just walking in.
I know your baby is a lot sicker than Henry was but everything turned out okay for my boy, Luka.
And I know that it will for yours too.
Uh They're concerned about prolonged hypotension.
And, uh, he's on 100 percent oxygen.
So there's a risk of toxicity.
And Um They're going to, uh, do periodic, uh, ultrasounds to check for intraventricular hemorrhage.
There's nothing more you can do for him right now.
You should go be with Abby.
She doesn't want him to be alone.
He won't be.
Okay, so Morris got you through the ER.
The first circle of hell.
- And Neela got you through surgery.
- The second.
I guess it's up to me to get myself through recovery.
Yeah, those are circles three through nine.
Well, here's one way to start, the incentive spirometer.
PRATT: It'll keep you from getting pneumonia.
NEELA: Suck it to make the balls rise.
Twice an hour.
Do you know what time it is? I've been out there watching the same cable news over and over.
- Hey, Ma.
- I missed my water aerobics.
- You were supposed to take me.
- I know, I know.
Oy, vey, you gave me such a scare, my sheyn boytshik.
Oh, I'm sorry, Ma, I'm sorry.
Oh, look at that, look at that punim.
I'm - Hey.
- Hey.
- How's he doing? - He's fine.
Still intubated? Yeah, but, uh, he's satting well, you know.
Pressure's holding with dopamine.
He's making urine.
- Brain scan? - Clear.
- Well, those are all good things.
- Yeah, all good things.
Is one gonna be enough? What? One baby.
Um My uterus wouldn't stop bleeding and Coburn did everything she could, but You had a hysterectomy? Well, one is all we need.
So, um, I'm not gonna be able to see him for a while.
I can't get to the NICU for at least 24 hours.
You don't have to wait that long.
That's when I told him to wave to Mom.
- Yeah, he's a smart one.
ABBY: Ha-ha.
- Joseph.
- Hmm? I don't remember much about my dad, but, uh I remember when I was little, he used to love to watch boxing.
And especially Joe Frazier because he thought he was the best pure fighter, so I'd like to call him Joe, if that's okay.
I'll be right back.
Do you need anything? Okay.
[SOBBING] Steve.
Steve.
Steve, I have to pee.
[GUNSHOTS]