ER Episode Scripts

s13e23

Previously on ER If you want to stay with me, you can.
- What-What are you trying to do? - I'm trying to wake you up.
Doesn't anybody here watch the news? Homeland Security raised our threat level to orange this morning.
- And what does that mean exactly? - It means it's an election year.
It means there's a severe risk of terrorist activity, and the hospital is on full alert.
Here.
- What is that? - Emergency Protocols.
Biohazard Preparedness Plan, Evacuation Procedures.
There's your basic guide to the apocalypse.
Well, are we supposed to do anything differently? Keep your ID handy and report anything strange or suspicious.
Everything down here is strange or suspicious.
Which reminds me, the new warden is here.
Moretti? - Oh, lucky you.
- Yeah, right.
I heard the ICU nurses used to take vacation when he was on service.
Hey, well, can you blame them? The guy fired half the ICU attendings when he took over up there.
Hey, Dr.
Moretti.
- I wish we could all go.
- Ah, it's probably better this way.
I'll get my father settled and be back soon enough so we can still go on that honeymoon.
- I don't need a honeymoon.
- I do.
Besides, I'd like to meet your father.
And Joe wants to meet his grandpa.
Don't you, Joe? Unless you don't want me to meet your family because I'm hideously ugly by Croatian standards.
I'll miss you both.
I already do.
Be good for your mom, okay? - Bye.
- Bye.
I'll call you when I get there.
Or you could call me from the airport.
Or when you land in Frankfurt, or from the plane.
Say bye to Daddy.
Say bye.
He's been sitting there for 20 minutes.
It's a little creepy if you ask me.
The guy is a burn-out.
That's why they sent him down here.
The ER is the elephant graveyard for doctors.
You are an eternal ray of sunshine, Frank.
Yeah? Think about it.
Where did they send Romano after he lost his arm? Last year, it was Clemente, now it's this guy.
Dollars to donuts, we find him hanging in an exam room by July.
- Hey, what are you doing here? - What, you and Kovac split up already? No.
Uh, Luka's father got sick.
He had to fly back to Croatia.
- Hope he's not flying today.
- Why? - Frank! - What? - What's going on? - Need a doc here.
Uh, what happened? Was horsing around, put it through a glass coffee table.
He lost a lot of blood.
All over my carpet.
Let's get him a room and clean him up.
Thanks, Sam.
All right, keep this up.
- Calder? - That's me.
This way.
- 98/56.
- Yeah, I always run a bit low.
Do paramedic patients stop at Triage? If they're ambulatory, they can.
What meds are you on? - Enalapril, Lipitor and Glyburide.
- You diabetic? - Okay, let's get your blood sugar.
- How often is your Glucometer Q.
A'd? Every morning at 7:00 by the day shift.
You ask a lot of questions for somebody who's supposed to be in charge.
Well, he's he's new.
- Blood sugar's 128.
- It's been worse.
It's not so bad.
Once we get you registered, they'll make you a chart, and a doctor will see you.
- Is that you? - Oh, no.
No.
Not today.
I'm just a fly on the wall.
Oh, sorry.
You're through the fascia into the extensor muscles.
That one will need layered closure.
Any medical problems? Yeah, I got a detached retina.
Had a run-in at the local bar.
- I got a bad back, service-related.
- You're in the military? Army.
We did a tour in Iraq together.
Yeah.
I decided to head over to the peace rally, pick up some chicks.
- Were you three in combat? - We were.
Kyle here drove a desk.
Hardly, man.
As you can tell, I'm the brain of this trio.
I was with Intelligence, worked as a translator.
- He taught us how to swear in Arabic.
- Where'd you pick that up? I did some missionary work over in Jordan for two years after high school.
- Yeah, he's our Stormin' Mormon.
- Can you wiggle your fingers? - Oh, that hurts.
- Let's check the volar wounds.
That would be an arterial injury.
Okay, four milligrams morphine.
I'll be right back.
- Hey, I got a good one for you.
- Oh, no, thanks.
No, it'll be quick-- hand through a glass coffee table.
- Neurovascular? - Maybe some tendon damage.
Come on, I got Moretti circling around down here like a turkey vulture.
- Have you heard from Ray? - Yeah, he's taking some time off.
He won't return my calls, and I've tried and tried his parents.
- He's not at his apartment.
- I heard his band's back in town.
Maybe he's playing rock star again.
- All right, does it hurt when I press? - No.
- All right, how about, how about here? - Uh, bingo.
- It's bearable, though.
- What's in your chem panel, Doctor? Lytes, BUN, creatinine, calcium, LFT's.
These are liver function tests.
I thought you weren't working today.
Well, you make it very hard to resist, Mrs.
Calder.
You're cute, but he's a flirt.
Hey, are you ready to present? Yeah.
This is, uh, Dr.
Lockhart.
She's my supervisor.
Type II diabetic with, uh, gastroenteritis and dehydration.
Afebrile, uh, abdomen's benign, and she's getting fluids and Compazine.
Okay, try Reglan in case it's gastroparesis, and show me the labs when they get back.
- Nice to meet you.
- Excuse me.
We haven't officially met yet.
I'm Kevin Moretti.
- I'll be replacing your husband.
- Excuse me? - No, as Chief, only as Chief.
- Yeah.
I'm, uh I'm Abby Lockhart.
- Yes.
You used to be a nurse.
- Yes, I was.
That must give you an interesting perspective.
Uh, I guess so, yeah.
Also, being married to one of the attendings must prove very challenging at times.
Hey, Abby, could use some help over here.
Got Saltzman, 27, fell off a roof with his brother.
Brother-in-law-- I landed right on his back.
- I think I knocked the wind out of him.
- What were you doing? I was putting up a satellite dish.
How tall was the building? Two stories? Yeah, well, he refused to be boarded and collared, so he's all yours.
Come on, let's go.
Exam three.
Is uh, is he going to wake up? Let's just take care of you first, huh? Okay.
I just I need to talk to him as soon as he does.
Hey, Abby, can you give our soldier guy another four of morphine? - First dose didn't touched him.
- There was no first dose.
- He's addicted to codeine.
- What? He's followed at the VA.
They have to be notified of all ER visits.
His caseworker said he has a no-narcotic contract.
Well, we can't assess his injury without anesthesia.
What, you want him backsliding back into addiction? Do an axillary block.
A nerve block will control the pain without narcotics.
I know.
I was hoping to give our resident a chance to figure it out.
- Oh, you've done it before? - Oh, yeah.
I mean, usually it's a pain team kind of thing.
A couple of cc's of lido in the-the axilla, right? Well, more like 40.
I'll walk you through it.
My husband was a lieutenant stationed near Mosul.
What unit? He was a doctor with the 57th CASH.
He's out now? No.
Uh, he was killed in country a little over a year ago by an IED.
Sorry to hear that, ma'am.
So, what's the verdict? Has a partial lac of the flexor carpi ulnaris.
Needs a volar splint.
Good luck.
Thanks.
Maybe I'll see you at the rally.
Maybe.
My arm still hurts like hell, Doc.
You got to give me something.
I got a high tolerance for pain meds 'cause of my back.
Tolerance or addiction? We talked to the VA.
They told us about your contract.
So, what, they said I was an addict? That's crap, man.
Look, I was at Walter Reed for six weeks.
I was supposed to go get physical therapy, see a pain guy.
They're so busy with amputees and guys worse off than me, that the wait was like four months.
Got discharged before I even got an appointment.
- Hey, Neela.
- Hey.
I'm just on my way home.
- Long night.
- Yeah, well nobody ever told you to become a surgeon, right? Well, actually, yes, they did, a number of people.
Listen, this-this whole thing is weird to me.
I don't know how to do this.
What? Break up? Yeah.
Uh, you know, I know it's probably over, and and I deserve it, but I just wanted to know if we could still be friends? Can I call you tonight just to talk? Well, I might go to this rally.
I kind of feel like I should.
Gates! Your Mr.
Pollard stopped breathing! Uh, he's just holding his breath.
He does that for attention.
He was holding breath for ten minutes.
All right, I'll-I'll try to get a hold of you tomorrow? Yeah, sure.
Can you wiggle your fingers? Hey, Dawn, can I get some Bacitracin and some sterile gauze, please? Take it easy, sir.
Well, it looks like your brother-in-law's waking up.
- Can I talk to him now? - What the hell? Just relax, sir.
You're in County Hospital.
You had a little fall, but you're doing okay now.
- Yeah, I just need a minute with him.
- Go ahead.
In private.
All right, make it quick.
I'll be right back.
Hey.
Hey! Hey! What's he doing here? Oh, oh, oh.
No, no, no.
Whoa.
I can explain.
- No.
Somebody call the cops.
- He's No.
- This is not what you think.
He - All right, Mr.
Saltzman, your brother-in-law accidentally landed on you when you two fell off the roof.
What roof? He's not my brother-in-law.
He's got a woman tied up in his apartment.
- I heard her screaming.
- No, no, no, no, no, I can explain.
- He beat me up when I tried to rescue her.
- I think you might have to explain it to the cops.
That lady you and Gates worked up-- gave her two liters of saline, - her pressure's down to 90/65.
- Oh, crap.
Well? I'm listening.
Okay, are you familiar with RACK? Risk Aware Consensual Kink? No.
I really need something for the pain.
Well, we gave you a nerve block.
It should have kicked in by now.
Well, it didn't.
It's killing me.
You know why they named the largest military hospital in the world after Walter Reed? No.
Yellow fever was wiping out the troops during the Spanish-American War, and Walter Reed was the one who discovered that the disease was being transmitted by mosquitoes.
And he greatly reduced infection with aggressive insect control.
Of course, everybody ended up dying of cancer from the pesticides, but it was a valiant effort.
Excuse us.
Can I talk to you for a second, Morris? Maybe the injection didn't get into the sheath.
I drew blood from his hand with a needle, he didn't even flinch.
- He's a soldier.
- No.
He's lying.
He can't feel his arm.
- There's no problem with the nerve block.
- You think he's faking? I think he's either drug-seeking or he has issues.
- I'll call psych.
- No, no, not here, at the V.
A.
They have better continuity of care, and they have a good support system - for returning vets.
- It could be months before he gets an appointment.
They're overwhelmed.
Then do a hospital-to-hospital transfer.
They'll have to take him today.
Belly's still benign.
- Could be an occult infection.
- An infection? But I feel so much better.
- Even my nausea's gone.
- Well, with diabetes, there can often be nerve damage, so you can develop an abdominal condition - without feeling any symptoms.
- You think she's septic? - No fever, no white count.
- Well, can't always count on those.
Let's get two sets of blood cultures, 3.
375 of Zosyn, start dopamine at five mikes, CT with IV and oral contrast.
- Got it.
- More tests? Kevin Um, you're a bit of a mystery, ma'am, but we're gonna figure out what's going on.
I came in here to get some medicine to stop the vomiting.
I've been here for six hours now.
Well, we can't risk sending you home with a serious condition.
It's not serious.
Do you think it could be serious? Well, I've seen a lot of doctors in here, but if you think it could be serious, you're the touchstone, Kevin.
Okay.
We're going to get started on these right away for you, Mrs.
Calder.
- You're on top of this, Doctor.
- Touchstone? What's that all about? It's a black siliceous mineral used to test the purity of gold.
- The miners used to take the metal - Yes, I know what it means.
Well, then you should, you know, take it as a compliment.
- You might turn out to be gold.
- Fool's gold.
Yeah, pyrite.
But only an expert can tell the difference.
- Who is your boy friend? - Um, his name is Paxton he came in with his brother-in-law, I think.
- And his name is? - You know what? I got this, Frank.
- Okay.
- Hi, I'm Dr.
Lockhart.
Hillary Milbauer.
So you saw my boyfriend? I did.
And you're you're the woman that was tied up? And gagged and screaming.
- That's me.
- Right, okay.
I told you, I was just trying to defend myself.
Then why didn't you call the cops? Because I'm not supposed to be running a business out of my apartment.
- That's her! That's his victim! - That is my girlfriend.
- All right, Abby, what's going on? - This is Hillary Milbauer.
Apparently, these two operate an adult Web site out of their apartment.
Yeah, I already got that part from Scorsese here.
- He broke in and attacked us.
- You were screaming! - I was trying to save you.
- I told you, it's just an act.
It's like erotic performance art.
Um, do you think it's possible you misinterpreted the situation, Mr.
Saltzman? I know what I saw.
What he was doing to her was unnatural.
Unsanitary.
It's still throbbing, dude.
You got to give me something for the pain.
We're transferring you to the V.
A.
Someone there will see you today.
I'm going to recommend you speak with a psychiatrist.
You think this is all in my head? Is that what you think? Hey, I can't get her finger out without tearing it apart.
Can you help me? - Yeah.
I'll be right back.
- Why am I being punished?! It's real, okay?! The pain's real! - Vivian here loads her own shotgun shells.
- My father taught me years ago.
He used to pay me a penny a shell.
- Now I sell custom loads on the Internet.
- I love this country.
- See, it's wedged in there, right? - Got to get this skin out of the spring.
Tried to open it.
I'm trying to get the Look.
Kyle? Hang on.
Kyle, you need to stay in bed.
- What are you doing? - Hey! Kyle! Kyle, open! Open the door.
Can you open it? - He took my swipe card.
- Find another one.
Security! Kyle, Kyle, don't do this.
Come on, man.
- Come on, stop! - Leave me alone, man! Kyle, open this door! Open it! - We'll get you something for the pain! - Come on, don't! Security! Kyle, stop! Please, come on! Kyle, stop! Sam, where the hell's that key?! Move away from the door, sir! Please, move away! Move away from the door! - Kyle! Move, move, move.
- Watch your head.
Come on.
All right, spit it out! Spit it out! - What'd he take? - You name it, he took it.
Set up to lavage.
Let's go! No.
No! No! Kyle! Kyle, calm down! Monitor, Foley, start a line.
- What labs do you want? - Acetaminophen and aspirin levels.
No.
There's no point in sending that now.
We'll get a four-hour level.
Foley, alkanalize his urine, and let's put in an Ewald tube.
That's the plan-- just mixing up nebulized lido for the OG.
No, there's no time for that.
You're going to place an Ewald without anesthesia? Thing's like a garden hose.
Hard restraints, please.
Come on, lidocaine neb takes five minutes.
Yeah, which is 12% of gastric transit time.
Do you want him to get 12% poisoned? You want 12% of the arrhythmias, 12% of the liver failure? I don't think so.
Not while we still have time to get the junk out of his stomach.
- Okay, okay, okay, okay.
- No! Get it away! - Okay! - Get it away from me! Sir, hey, hey! Please, come on, we're trying to help you.
Would you put a little muscle into it, please? All right.
All right, come on, screw the V.
A.
This guy needs Fentanyl and Versed.
Nope.
The risk of aspiration is too high when you try to sedate during lavage.
So we'll intubate, we'll protect his airway! No.
The risk is too high; it's not worth it.
GI bleeder just puked a liter of blood.
Okay.
Put the tube in, and lavage until all the pill fragments come out and until that fluid runs clear.
Please please Please! They tried to save my legs, but the the crush injuries were too severe.
But it could be a lot worse, you know? I could be dead.
They're going to fit me for prosthetics as soon as the flaps IO.
So I guess, in the meantime, I can pimp out my wheelchair, maybe put some flames down the side.
I'll have a whole new set of legs, a cool van.
- Hey, I can park in the good spaces now.
- Ray, stop.
Uh, do you want something to drink? - I'm going to get a coffee.
- No, thanks, I'm good.
Um, I'll call your parents, see if I can get an ETA.
That's great.
Is there anything I can do? No.
Would you like me to tell anyone at County? No.
I really don't want you to do anything.
I was so worried about you.
I even went to our your apartment.
Well, it's up for lease if you want to move back in.
No ramps.
You know, the night this After you left the wedding I tried calling you, - 'cause I wanted to talk.
I was hoping - I know, I know.
I was checking the message when I got hit.
So I know.
How much bicarb is he getting? Two amps per liter, quarter normal at 200 per hour.
Okay, check his urine pH.
I don't get it.
- What's going on with this guy? - Looks like textbook PTSD to me.
No, he never saw combat.
That's what his buddies said; - he was an interpreter.
- Oh, he saw plenty.
Who do you think translates during those interrogations? I seem to have misplaced Hello, what's this? Uh, we had to intubate.
I thought I specifically told you not to.
Maybe I was using my inner voice again.
I know that's a bad habit.
He was losing his gag reflex, became hypoxic.
I don't see anything about hypoxia here.
Uh, well, it was, you know, hectic.
I haven't had a chance to update the chart.
Do you have any pill fragments? Yeah, we, uh, we did.
We got this.
Not enough.
Gates, it's Sarah.
She doesn't sound good.
Move away from that, please.
Can I see that? - Toxic bradycardia.
- We're on it.
Yeah? Are you? Really? On it? Because one might argue that you are in fact underneath it, that if you hadn't dicked around so long with the intubation, you wouldn't be digging your way out of an overdose right now.
Let me know when you learn to roll over.
Parents coming to take you home? My mom's been here for a few days.
I've never been to Baton Rouge.
Maybe I could come visit you.
Don't.
What? Just don't tell me you're going to do something when I know you won't.
Why don't you think I'd come visit you? Because that's what our relationship is, Neela.
You give me hope, and I, like a fool, believe you.
- Ray, that's not true.
- It is true.
I've waited for you I trusted you.
I fought for you And I even fell in love with you.
But for what? So you could just keep running back to Gates? I'm not.
That's what I've been trying to tell you.
It's over.
Tony and I are done.
Well, it doesn't really matter now, does it? - Yeah, baby, that's good! Don't stop.
- Oh, yeah, you like that, don't you? Am I a bad girl? Do you want to spank me? Yeah.
I'm gonna spank you.
You're a bad girl.
- What's going on in here? - I told you it was too loud.
Come here.
What are you guys watching? Oh, it's a website hosted by a couple of our patients.
- Does that look consensual to you? - Oh yeah, that's sensual.
- Consensual.
- What, did you fail anatomy? You cannot do that with your body unless you really want to.
- Is that woman in this hospital? - Abby Mrs.
Calder's pressure dropped down to 65 systolic again.
I gave orders for dopamine over an hour ago.
She maxxed out at 20 mikes.
- She's hypotensive? - It's impossible.
- Don't stop, baby.
- Yeah, you like that, don't you? How do you like that, is that what you want? Oh, yeah, baby, that's good! - Don't stop, baby! - Oh, yeah, you like that don't you? - Am I a bad girl? - Oh, yeah you are a very bad girl.
- And I would love to spank you.
- Oh, yeah, girl! Hi, Dr.
Morris, sorry, I didn't mean to startle you.
No, you didn't.
I was, I was looking up something medical.
What's going on? Sorry, I called you at work.
I don't, I didn't know what else to do.
That's okay.
Where are your grandparents? They're inside.
- Hey, Jim? What's going on? - Hey, Tony.
We're taking Sarah this weekend, remember? Yeah.
So, uh, what's with all the boxes? Helen and I think it would be best for Sarah to spend the summer with us.
Really, that's, that's what you think, huh? Shouldn't that be something we should talk about that? - I never said I wanted to go.
- Sarah, you love staying with us, huh? This isn't helping.
We're trying to make it easy for her.
Oh, you think this is easy? - Jim? - It's okay.
She doesn't want to go.
She clearly doesn't want to go - We appreciate everything - Let me handle this, Hellen.
You know what, no-- she's not going with you this weekend.
- Yes, Tony, she is.
- You can't make me! What's this? It's an emergency court order for custody.
We heard you hired a lawyer.
I'm calling the police.
All right, let's mix up Levophed.
Radiology's reading the CT right now.
Why don't you run in another liter.
- Is she bleeding? - Uh, repeat crit's 38, stable.
- Could it be anaphylaxis? - No.
No new food or drugs.
- And she doesn't have any skin lesions.
- Let's do early goal directed therapy.
She needs a central line with an 02 sat monitor.
Is there anything else that we could be doing? - Dr.
Moretti? - I'll be right back.
Hey, you know we could use some help in here.
Man, that guy's a real weirdo.
- Levophed's up.
- Okay, thanks a lot.
No intra-abdominal pathology whatsoever on CT.
- No abscess? - Nope.
- Diverticulitis? - Nothing.
- What the hell is going on? - I don't know maybe it's an infection from another source? Urine? CSF? Her pressure's not moving, and her sats are dropping.
Do you want to intubate? Yeah, I'll tube her; Abby, you do the central line.
Hey, Mrs.
Calder.
Hang in there, okay? - One percent lidocaine.
- 20 of etomidate, 100 of sux.
- I'd wait on that if I were you.
- Let's get the suction on high, somebody check the cuff.
Pressure is up to 110 over 70.
- Am I dying? - Not anymore.
- So what'd you give her? Epi? - No, please, that would be too easy.
- What'd you inject? - You tell me.
Mr.
and Mrs.
Riley have legal custody of the girl.
Oh, come on.
That's crap.
I've raised her since she was this big.
- She's practically my own kid.
- Technically, she's not, and they're the next-of-kin.
She doesn't want to go.
Go ask her, - ask her if she wants to go.
- I'm afraid she doesn't have a choice.
All right, you know what, let's just settle down, all right? - We'll handle this like adults.
- Hold on.
- This is getting way out of hand, guys.
- Settle down, sir.
So you're just gonna let them take her? I suggest you get yourself a lawyer and try to work something out.
I have a lawyer.
Can I at least go say good-bye to her? - Please? - Yeah.
Look it's going to be okay.
It's going to be okay.
- Don't let them do this.
- It's okay, all right? I'll make sure it's okay.
Look, it's not going to be for that long.
You'll go, you'll have fun.
You know, you'll ride the horses, it'll be good.
I don't care about the stupid horses! I don't want to go! I'll come visit you.
I'll come visit you this weekend, I promise.
This is not permanent, okay? Look at me.
Look at me.
You know I love you.
I love you more than anything in this entire world, right? Right? Okay, so I need you to be strong for me.
I need you to go with your grandparents but you have to trust me, okay? All right, and it's not be for a long time, I promise.
I promise you.
I love you, baby girl.
Did you figure it out yet, Pratt? - Huh? - What I gave to Mrs.
Calder? Come on, think, think, think, think, think, think.
Where is that intern? The one with the temper problem? - The who started all this - Oh, you mean Gates? He had to go.
- Go? - Yeah, family emergency.
Well, he caused an emergency here.
He was the primary caregiver, and he dropped the ball on that patient from the get-go.
Come on, it was a tough call.
There's enough blame to go around.
Backing up your interns? That's good.
Shows leadership and maturity which, based on your record, I didn't think you were capable of.
Bravo, Pratt.
- Thanks.
- Yep.
And as for blame, you're right.
There is plenty to go around all the way up to the attending level.
That's why I called a staff meeting.
Look, it wasn't perfect, but she's okay.
She got good care.
The hell she did.
Let me ask you something.
I mean, what's going on with you? I mean, you stand around all day like some strange Peeping Tom.
Now, all of a sudden you're the king of the ER.
This is our department, Moretti.
And I don't care how long you've been a doctor, you haven't been here, and you haven't worked with all of us.
Gee, I am so sorry that I skipped my daily dose of testosterone.
We do the best we can with limited resources.
No, you know, see, that's where you're wrong.
It is not the resources that are limited-- it is the minds of the people working on the floor.
Hydrocortisone.
That's what you gave her.
I would have gotten there if you'd given me another minute or so.
Neela.
This is Jacy, Ray's mom.
- I'm so sorry.
- Uh, no, I - I've heard a lot about you.
- Ray and I are good friends.
He said you were the best roommate he ever had.
Well, that's 'cause I did all his laundry for him.
I used to think sometimes that was the only reason he came home.
I'm, um, going to take him home now.
Gonna I'm going to get him better.
You'll get through this, I promise.
Thank you, Katey.
You've been wonderful.
You come on down to Baton Rouge whenever you can get away.
- You know I will, ma'am.
- Okay.
- You're a good person, Katey.
- Shut up! - Shut up! - Well, I know you're upset You did this, you selfish bitch.
Nobody else, okay? You did.
So live with that.
Okay, you're going to be a little hoarse for a while.
Yeah.
This is going to help you breathe a little easier.
You want to tell me why you did this? Kyle, obviously you're hurting, man, let me help you.
You were you were shouting in Arabic when we were trying to help you.
Something, something about med What does that mean? "Please, don't hurt me.
"I've done nothing wrong.
God have mercy.
" I must have translated it a million times in Iraq.
Not that it mattered.
They didn't listen to me any more than they listened to prisoners.
- Who didn't listen to you? - The interrogators.
You saw them beat the prisoners? Beat, burn, other things You you mean torture? Most of the men they questioned didn't even know anything.
They were innocent.
I tried to convince the interrogators, but they didn't believed me.
So they just kept hurting them.
And I just kept translating their cries.
It's not your fault.
We're going to get you some help.
I don't want to go back to the V.
A.
, man.
You're not.
Not right now.
You're going to stay with us for a while, okay? Okay.
Hi, this is Neela, I'm not here to take your call at the moment, but you can leave your message after the tone.
Forgot about this thing.
Might take a while.
Uh, I'll get out here.
Look around and what do you see? I see faces of every different color, men and women, young and old, rich and poor and yet we all share something in common.
We're all here today for the same reason.
We love our country! We might have gotten here in different ways.
Through a family member or a loved one, through serving in Iraq, through an evolving sense not only of right and wrong, but also the division between what is justified and what can never be explained.
Let's begin at the beginning.
Triage.
Three-hour wait for vitals, eight to 12-hour wait for a bed.
Well, we push them through as fast as we can.
Well, we almost pushed Esther Calder six feet under, but a combination of blind faith, dumb luck, her resilience and my attention to detail thwarted all the attempts that we made to kill her.
I triaged her.
She did not wait very long.
She waited two hours with intense nausea.
Then after that, another two hours before she got back to a bed.
And then after that, another hour before a doctor saw her.
So, what's that, like five hours? That's not so bad.
It can be better.
It will be better.
What if the triage nurse had standing orders for labs and IV fluids and anti-emetics with a patient like this? What would happen? The very charming Mrs.
Calder would be brought right back, she would get relief, she would registered at her bedside.
We would knock four hours off her stay time, and we would be on top of her problems before she crashed.
That is a wonderful theory.
- You're taking this personally, Sam.
- Yeah, I'm a nurse, I do triage.
Yeah, I take it personally when you criticize the job I'm doing.
Good.
Okay, good.
I'd be worried about you if you didn't.
Now, the interns.
The peripatetic Dr.
Gates did an inadequate history.
He ordered tests without consulting an attending.
It was busy.
That's not unusual.
See again, you're arguing that incompetence and sloppiness are the norm, and that's no way to impress me.
The resident-- Abby, right? You assumed that Gates had done a thorough H and P, and he had not.
It looked like gastroenteritis.
Based on the incomplete H and P which he took and you accepted at face value.
Your intern led you down the primrose path.
You sold that to the attending Dr.
Pratt, and then the three of you blithely walked Mrs.
Calder right along with you to death's door.
- Oh, come on.
- Sepsis was a viable diagnosis.
- Viable? - Yeah.
Viable? Nobody took a decent history! Fact: made on the basis of history alone.
But nobody bothered to talk to the patient.
You knew what meds she was on now, that's the easy part, but what meds was she on a month ago? One month ago she did a two-week course of high-dose prednisone for URI-associated bronchospasm.
The steroids suppressed her adrenal glands.
She had adrenal insufficiency.
Yes, fine, but that's a pretty rare condition.
We don't see it that often.
No, you see it.
- You just don't recognize it.
- All right, we get the point.
You want us to be more careful.
No, that's a very reductive version of what I want.
What I want is for us to live in mortal fear of doing something wrong, of missing something and having somebody else pay the price for that.
And I want us to use that fear to make us better.
I am not here because I need the work.
I'm here because I want to save the world.
And the way were going to do it is we're going to reinvent the way we practice medicine every day.
Right now, right here, on the front.
I have another shift to start, so go.
I've worked here for a long time, and uh you might think that this is the way to motivate people, but it's not.
Thank you for your input.
- Yeah, listen, all I'm saying is - I know; I said thank you.
I think that all of you are just going to have to take a little time to get used to my management style.
And you in particular, are going to have to take a little time to get used to working with a chief that you're not sleeping with.
It's not political.
It's not about Republican or Democrat.
It's about young lives lost every day.
Every day.
And knowing when to say, "We've done what we could, "and maybe it's time for us to go home.
Let those people sort this out for themselves.
" That's what my brother came to think eventually.
- Stay the course! Finish the job! - After being over there two years and seeing what was going on, seeing what the results were - Get off the stage! - Unfortunately, the letter in wich he expressed that was written the night before he got killed by a sniper's bullet