ER Episode Scripts

s15e01

There.
You got us.
- Gates is my boyfriend.
- Ah, you got in! It's a little on the pricey side, but for you, there will be a discount.
You can't abandon me in the middle of my training.
- You're not my responsibility.
- You need to get laid.
- Oh, is that right? - Yeah, I'm pretty certain of it.
We're going to be okay.
So let's just get past it.
Let's just go someplace new.
We've got room for one more.
Who's it going to be? Gates, the board is a mess.
You're only seeing three patients.
- Feel free to pitch in.
- No, no, no, my job is to supervise and teach.
Your job is to move the meat.
You know , when I was a resident, I had what was called a work ethic.
- Yes, you set the bar high.
- You bet I did.
And now, as an attending-- it's not as easy as it looks.
I gotta keep a close eye on all you guys.
Exam Three is clear.
Bring me syncope, impetigo and nausea.
Poor guy heard he just quit.
No way.
- I'm looking for Dr.
Lockhart.
- Me, too.
When you see her, tell her I need one more prescription.
- He's got something in his eye.
He can't see.
- What happened? - We were down the street from the expsision - Explosion? Over on Michigan, they said it was an ambulance.
- Who went in that rig? - Get Bardelli on the radio.
Set up the trauma rooms.
- Dumar, you seen Sam? - No.
- All right, let's roll.
- I didn't get a call.
Unit 62, respond to an explosion and car fire.
This is Unit 62 responding.
Go! Drive! Hold on, hold on Hold on! Hold on! Greg, are you okay? Yeah, I think so.
What about what about the guys in the back? Hey, Bardelli.
Hey, Bards, come on, wake up, man.
Ma'am, you need to sit and wait for the paramedics.
I'm an E.
R.
doc at County; so's he.
- Yeah, we can help.
- All right, you can assess him, but that's it.
How's your neck? Any pain? My stomach - Oh, man! - Dannaker, we need a saw.
You get your guy to the sidewalk.
I got him.
All right, just hang in there, Bards.
Take it easy.
Take it slow.
Abby, what are you doing here? - Wrong place, wrong time.
- How's your breathing? - Something hit my jaw.
- All right, sit down.
I think I broke my wrist.
Bardelli's impaled.
We need two large bore I.
V.
s, some O-2 Don't worry about it.
They're on it, okay? You're the patient now.
- You two, sit down.
- I can work with one hand.
Oh, come on, guys, this is stupid.
- We can be helping out, triaging.
- Have you been walking on this? - You have an open fracture.
- Just stings a little.
Irrigate with saline.
It's just a little blood.
I'm all right.
Sous-titres : Willow's - You know, when I said I thought you needed - Shut up.
We've got trauma.
Okay, everyone needs to sign in at the window.
We'll get to you as soon as we can.
Coming through.
Clear a path.
- Gates, are they okay? - Yeah, so far.
Come on, come on, out of the way-- move, move, move! - How you doing, Bards? - Pressure's up to 90.
Hold an O.
R.
for him.
Hey, Greg.
Sorry about this.
- Broken jaw, open fibula.
- Pulse ox is borderline.
Hang tough, Greg.
Oh, God, what happened? He's got a facial fracture, he shouldn't talk.
Neela, Brenner, I need you with Bardelli in Two.
- We're on it.
- One, two, three Trauma panel, chest, facial series and tib-fib.
- Need an ultrasound for a FAST.
- Sats 93, up him to five.
- Open up, buddy.
- I need a gram of Ancef, 100 of gent.
Some jelly for the belly.
Small lac to the oropharynx - Hey, hey, hey.
- Everybody stop, stop, stop! All right, get me one percent with epi gel foam.
Morris and Sam, you stay here.
Abby, go fix your wrist.
- Gates, get in there with Bardelli.
- I'm fine.
I don't need Go, go! Go.
You heard the man.
Hey, Brenner! You better be aching in there, man.
- All right, come on.
- What do you guys need? Lateral c-spine.
Deep breath, please.
How is he? - He's good enough to boss us around.
- Kaya, pre-op antibiotics.
Ceftriaxone covers gram positives and negatives.
Okay, but not the anaerobes.
Ertepenum gets 'em all.
Tony, you mind calling my mom? I don't want her to hear something on the news - No problem.
- First unit of O-neg is up.
- Might as well intubate.
- What for? He's got a good airway.
- He's going to need it for surgery.
- That's why we have anesthesiologists.
I'm gonna put in a central line and take him right up to the O.
R.
I'm going to go make that call.
You guys all right? Yeah.
- How's that feel? - Much better.
Oh, there you are.
Mrs.
Gaines, this is really not a good time.
Oh oh, dear.
- Yeah, shall I? - Come back later.
Oh, yes.
Did I see Luka stop by today? And? And I think things are going to be okay.
I'm glad to hear that.
Everything was going really well until the ambulance blew up.
How about we X-ray your ankle now? It's just a sprain.
Thank you.
Hold up here.
I'll take those.
- Bleeding stopped with epi.
- Yeah, I told you it would.
- This doesn't make sense.
- What? There's no fracture.
The tibia and fibula are intact.
- Did they X-ray the wrong leg? - No.
Pratt, that's not your bone.
What? - It's a two inch bony fragment.
- Yeah, someone else's.
- Someone from the back of the rig? - Most likely.
Ugh, gnarly.
Good thing you sat up front.
Yeah.
Let me numb it up.
No, just pull it out.
- Without local? - You sure? - Yeah.
- Okay.
Send that up for HIV and hepatitis.
- Pulse ox down to 88.
- Put him on 100%.
- Pneumothorax on the chest X-ray? - No diffuse bilateral contusions.
Blast lungs.
The shock wave caused bleeding and bruising throughout the chest.
I know.
It might get worse before it gets better.
I'll get the non-rebreather.
How come he's not in the O.
R.
? Surgery wants a central line first.
- How you doing, Lou? - Hangin' in there.
How's Greg? Sats are down.
Hang two more O-neg.
We're giving her a real-time guidance in the sterile field.
- Is that the I.
J.
? - Perfect.
- Can you see, Doctor? - It's crystal clear.
- Decreased breath sounds.
- Pulse ox is dropping.
The damaged alveoli are filling with fluid.
We need to talk about intubation, Greg.
Okay - Let's do it.
- Etomidate and sux are ready.
- Push it.
- Lower his head.
Assisting ventilations.
Morris Don't screw this up.
Abby, you want to give it a try? With this? Gates? - I think he wanted you to do it.
- Okay, you know, I need to take a step back and keep an eye on the big picture.
I'm running this, you're doing it.
All right, laryngoscope and suction.
Sats up to 90.
I need a doctor in here.
I got it.
- Check the cuff.
- We have an end-tidal detector? - Yes, it's ready to go.
- This is Jasmine.
She has tight wheezing, she was in the back of a burning car.
I couldn't get my seat belt off.
That must have been scary, huh? Can you sit forward? I'm Dr.
Lockhart.
I have moderate persistent asthma.
I'm on inhaled Beclomethasone, Albuterol, and an oral leukotriene modifier.
Wow, you know a lot.
Can you tilt your head back? - Who's with her? - Uh, the nanny.
- She's calling her mom right now.
- Okay, no evidence of thermal damage.
I'll be back.
Keep her on ten an hour; order a portable chest.
You got it.
- Do you see the cords? - Too much blood.
What about cricoid? Anatomy's distorted.
Now you're making it worse.
Pulse ox down to 80.
All right that's enough, bag him up.
You do this, Arch-- you're better at it.
Here, come on.
Open up a 7-O and a bougie.
I need the rapid infuser.
- What's going with Bardelli? - He might be bleeding out.
- Neela still in there? - Oh, yeah.
- Let's take another look.
- We're here if she needs us.
- Chuny? - They're tubing him.
- It's not slowing down.
- Okay, apply more pressure.
The blood's from deeper inside.
Maybe a mesenteric artery.
- You need to take him to the O.
R.
- You over-transfused, got his pressure way up and he blew a clot-- he was fine when he got here.
Why didn't you say something when I ordered the blood? I didn't hear.
I was busy with the central line.
Okay, what do we got? Through and through abdominal penetration, exit wound hemorrhage.
TKO the fluids, hang FFP and platelets; let's take him up.
- Are you back at work? - Heard the news on the radio, I'm still on duty, I figured you might need my help.
Crap, they still haven't got it.
- I see the epiglottis.
- That's as far as I got, too.
- Everything's pushed to the right.
- Use my hand as a guide - and I'll hold when you see the cords.
- Sats are drifting down - Forget it.
There's no way.
- You want to try the bougie? I can't see the larynx.
- Fiber optic's here.
- I'll set it up.
- There's too much blood for that.
- You want to try again? He-he-he-he needs oxygen.
He needs a crike.
- We could try to go retrograde? - I said we're criking.
- No crike trays.
- Check the hall.
- Pulse ox is in the 70s.
- Okay, forget the tray.
- I need an 11 blade and a Shiley.
- I got a ten blade here.
Where the hell are the Shileys? Run a V-tach.
Open the crash cart.
- Sam, you have bandage scissors? - Uh, yeah.
Get over here.
Morris, what are you doing? Bag him.
- What are you doing?! - Morris! Okay, cut the drip chamber, right here.
Bag him up.
Good chest rise.
What the hell was that? Sats coming up.
All right.
All right! You still need a crike tray? - Rose Franklin, ten-foot fall.
- Another one from the explosion? Yeah, got knocked down an access well.
- Concussion, hip fracture.
- Okay, warm up the head CT.
One, two, three.
Ma'am are you having any pain? Trauma panel, UA, type and hold, c-spine, chest and pelvis.
- How you doing, Rose? - Norman Chapman, tibia fracture.
- Hey, Rose, it's Norman.
I'm right here.
- He's a relative? No, no, no, she's a complete and total stranger.
Norman's a real hero.
He jumped right in to save her.
Yeah.
Ten feet down at least, right? At least.
I broke my leg when I landed, and then I crawled out with her on my back.
Wow.
Okay, start your primary assessment.
Hey, am I gonna have to miss work? - What do you do? - Uh, I'm a Web site debugger.
- Like a programmer? - Uh, not really.
I beta-test Web sites.
I click on 'em a couple thousand times.
Try to get 'em to crash.
Hey, Chuny, heard they brought Bardelli in.
- Yeah, they took him up to the O.
R.
- Who's he riding with? We're gonna have to wire his jaw in the O.
R.
and he'll go to the ICU until his lungs heal.
With all the facial trauma, we had to crike him.
His vitals are stable, he's oxygenating well.
Do you have any questions? I'm good.
Inflate the cuff, hook up the vent.
Hi, Chaz.
How you doing, man? You can't talk with that thing? Good.
So you get to listen to me tell everybody about how many times I kicked your ass on the court.
"I'm busy now.
Can I ignore you some other time?" I'll check on you later, okay? - Dr.
Lockhart, Mrs.
Escalante.
- Hi.
- Hi, Mom.
- Hello.
How's she doing? Um, okay, well, her pulse ox is up to a hundred, which is good-- ow! - You're funny.
- Jasmine, come on, honey.
- You okay? - Yeah, I'm fine.
- You don't look fine.
- She's acting a little weird.
Can you sit up, sweetie? The wheezing's improved.
- Dropped her BP.
- What's happening? Bolus 250 of saline, a repeat CBC and abdominal ultrasound-- - I need to check for internal bleeding.
- Well, shouldn't you have done that before? I mean, you've been in the other room this whole time.
What's up with his neck? That wasn't there before.
- Get Surgery right now! - Call for four units.
There's a pulsatile mass.
It's expanding.
There's no bleeding in the chest or abdomen.
- Then what is it? - I don't know.
- I'm checking on a bunch of things.
- Mom.
See you soon as I get some more results, okay? Hey, excuse me.
Are you a doctor? - Yeah.
- Do you think my leg is broken? X ray's been ordered.
Never rock against the teeth.
Um, you know what? Does this hurt? It's probably fractured.
Hey, I jumped into a courtyard to save that lady.
- Really? - You see the cords? Yeah.
Every day, for my afternoon break, I get a pop and I get pretzels from the snack bar on the fourtr.
But today I thought, "You know what? I'm gonna get a burger.
" And it was like fate just put me there to save her.
- That's great.
- I'm in.
Bag her.
She was talking when I brought her in-- is she gonna be okay? - You know, I'm, I'm not really - It's a possible epidural.
- We're gonna take her to head CT.
- Ah, she's strong.
She'll pull through.
Okay, I have to I don't know how I did it.
I was in pain, I was desperate, and I was in a deep hole.
And then I remembered: "When you feel like there's no hope - "and you're at the end of your rope - Hey, what's the rush? - It's Greg.
- and there's a hero inside of you.
" The song was right! - Okay, we need a second Yankauer! - Hang another two units.
- What happened? - Expanding neck hematoma.
- He dehisced the lac.
- Get a sponge stick on it.
- Do you think he's gonna aspirate? - No, the trach tube has a cuff.
- Open up, Greg.
- He was doing okay.
I think a piece of mandible cut his carotid.
- Should have seen this sooner.
- Unless you cut the wall of the artery - and it took time to blow.
- Got it.
- Okay, betadine and cutdown tray.
- What are you doing? - I need to tie off his carotid.
- Tie off his carotid? - It'll cut off the blood to half his brain.
- Right-sided paralysis and aphasia.
- He's got collateral through the circle of Willis.
- You hope.
There's an open artery.
I can either let him bleed out or we can accept the risk of a stroke.
You think he's gonna die if you don't? You understand? Should I call Dad? How about Betina? I'll try her cell.
There's some burning with lido.
Abby, right now.
Multi-focal PVCs runs of V-tach.
Where's the blood gas? - Her pH is really low.
- What is that? - Superficial bleeders.
- Hemostats.
They haven't enough doctors in there, okay? My daughter needs you! Um, she's got a profound gap acidosis but her oxygen level is normal.
Did she ingest anything? Uh, yeah.
That's it.
That's probably it.
Cyanide.
Mix two grams of hydroxo-cobalamin.
That's the antidote.
Sometimes when a car interior burns, it releases cyanide.
As soon as it gets here, we'll give it to her.
Fix the light! I can't see a damn thing.
- Try to stop the blood! - Stop, stop! Shh! Quiet! Let her work.
Releasing the clamp.
Fid is dry.
Morris? - You got it.
- All right.
I'll close with steri-strips.
Systolic at 100.
Give me that.
You're supposed to run this in over 30 minutes.
Is that safe? It's okay to push it faster if the heart's in trouble.
This binds with the cyanida.
- Normal sinus.
- See? She's coming around.
- V-fib! - Damn it! - Starting compressions! - Call for bypass! Trauma One.
They're waiting for you.
Somebody going on bypass? It's Pratt.
They're doing CPR.
- Lines are primed.
- Clear of bubbles.
Ready to go.
We can stop the bagging and the compressions because the bypass It does all the work of the heart and the lungs.
- Pulse ox is coming up.
- That's good.
He's in an agonal rhythm.
We don't treat it now.
We wait for the bypass to work.
- Is it a compound fracture? - No, it's spiral.
You have to fall a long way to get a spiral fracture? - Yeah, it takes a bit of force.
- Yeah, I know.
- Kaya, did you hear about how this happened? - Several times.
Swelling, but no bleed on head CT.
Excellent! Actually, that's a bad concussion.
And a nasty pelvic fracture.
Hey, you doing okay, Rose? It's Norman.
I'm right here.
Hey, open your eyes.
That might take a bit of time.
How long? I can't really say.
All leads are isoelectric.
So his brain's not working? Not right now.
- He wasn't down for that long.
- We started CPR right away.
He never had prolonged hypoxia.
- Could have been an air embolus.
- That would do it.
A blast injury puts air into the circulation.
And the air goes up into the brain.
And that's it? The brain can still recover.
We'll wait four hours, then we'll check Auditory Evoked Responses and an Apnea Test before making any decisions.
I'll come back.
We should get Betina.
I left a message on her cell.
Keep trying.
Listen, I don't think we all need to be in here.
There's nothing more we can do for now.
We'll take shifts.
There's a lot of patients.
He would tell us to get out there and take care of business.
That's what he'd say.
Tony? - Check a crit.
- Is she bleeding in her pelvis? Wasn't that impressive on the CT.
Maybe we got behind on her fluids.
- I want to push vitamin K.
- What for? - 'Cause she's probably on coumadin.
- Well, we never got a history; she can't speak.
She's in A-fib.
ST segments are consistent with digoxin use.
- She's probably on a blood thinner, too.
- Makes sense.
I suppose vitamin K couldn't hurt.
Let's get her to trauma.
Kaya, call the blood bank for FFP.
Pretty smart for a med student.
Book smart; she's got a ways to go.
Whoa, whoa, whoa, wait up, guys.
I was crutch training.
We're moving to another room.
You got to keep me in the loop here.
I got to know these things.
It's an ancient Chinese proverb: "He who saves a life is responsible for it.
" No cardiac activity.
It's only been two hours.
I need to ask you about something.
See, in Greg's wallet, he has an organ donor card.
I want to make sure that's okay.
He's not dead yet.
If it comes to that, then do what he wanted.
Chaz, you been here a long time.
Why don't you take a break? I'm fine.
Hi, Betina.
It's Sam again, from the E.
R.
Call us when you get this.
Excuse me.
Excuse me.
Crit's down to 24.
- Did you recheck her protime? - Protime's good, surgery's coming.
- Only 80/40.
- She might not make it to angio.
We couldryry prpreritoneal packing.
Excuse me? Suprapubic incision, leave the peritoneum intact.
Pack three lap pads on either side of the bladder.
- We had good success in Nicaragua.
- In Nicaragua? I volunteer summers in a rural hospital.
High trauma, low tech.
I thought ortho was admitting.
Uh, unstable pelvis.
You ever hear of preperitoneal packing? They do it in Europe; it works.
Shall I? Ten centimeter incision.
- Just like a C-section.
- You've dee those, too? - Where are we with Greg? - It's been four hours; the neurologist is back.
Good.
All the way down to the presacral space.
- Uh, can someone help Norman, please? - Pressure's up.
Angio can take her.
- Okay, that sounds like a plan.
- She doesn't need the O.
R.
You're lucky you have such an experienced med student.
Okay.
Let's go.
EEG remained isoelectric.
- No brainstem evoked responses.
- Blood gas after ten minutes.
PC O-2 is 74.
Seventy four? Anything over 60 means brain death.
I'm so sorry, Chaz.
What are you doing?! Chaz, there-there are no vital signs to monitor.
N-Not yet.
Can you please just keep this thing going a couple more hours? No, no, he-he could come back.
Maybe he'll come back! His heart's gone, his brain's gone.
We're pronouncing him.
He's still warm.
Yeah, that's just the bypass machine.
We need to keep him on it to perfuse the organs.
Neela's going to take him to the O.
R.
now.
I want to stay with him.
I want to push his gurney.
Of course.
He's going upstairs.
DVT's admitted and biliary colic goes home with instructions to lay off the cheeseburgers.
Great.
Thanks.
It's, uh, pretty quiet in here, guys.
You can take another hour.
And do what? I, um, I wanted to be there, but I thought it was more important to cover for Morris.
- It was a really beautiful service.
- Yeah.
A bunch of stuff came.
It's a gift basket from a Dr.
Weaver in Florida.
And-And this, it's, uh, comes all the way from Africa.
John Carter.
Yeah.
It means a person's soul will live forever.
We're supposed to leave it by the grave.
Why don't you get caught up with your patients, and we'll jump in.
I need to change.
Hey, guys.
I was gonna drop Betina off at home, but she wanted to stop by.
Since I didn't get to speak to you all at the church, you were you were a family to Greg.
He loved you all very much.
You should know that.
- We got a sick one here.
- We're on it.
Fever, low BP, altered and a broken leg.
I remember that guy; he'll talk your ear off.
Not today.
Two liters of saline, set up for intubation.
Hey, Abby.
It was nice to see Luka at the funeral.
- Is he coming to Ike's? - No, he had a plane to catch.
- It's good to see you together.
- Amen to that.
- Neela, they need you in Trauma.
- Do I have time to get into my scrubs? Of course not.
Luka said something about an interview in Boston.
Yeah.
We were thinking about moving.
But now I'm not so sure.
It's hard to imagine leaving this place.
What do you need? Fever and sepsis.
We're looking for the source.
Bingo.
Feels fluctuant.
Would you like the honors? Please don't make me put on gloves.
Full of puss.
- Okay, he needs a wash-out in the O.
R.
- That sounds about right.
Excuse me.
Hello.
Yeah, no worries, I can talk.
Are you feeling better? I just needed a minute.
I meant, better from the surgery.
Oh, yeah.
I'm, uh, I'm going back to work on Monday.
Oh, that's good.
I mean, I mean, that, you know, you're ready.
But, you-- it's also good that you have a little more time off, as well, you know.
Oh, man.
What? I'm not sure how to do this.
Do what? I've been holding onto something.
And I didn't know the right time.
And now I know that there's never going to be a right time, so This is for you.
It was in Greg's pocket on the day he died.
You know, that guy got hurt last week trying to be a hero.
Yeah.
I've been thinking a lot about last week and about how Pratt wouldn't let me get on that ambulance.
So I don't want to waste time.
I just want you to know I wouldn't be with you if I didn't think that we could have something real.
I feel the same.
Sam, Gates, you know about Ike's? - Yeah.
- We'll try to start around 8:30.
If anyone has anything they want to say, you know.
Share a story or a memory.
That would be the time.
Can you hang up or take that someplace else? Sorry, that was Anspaugh.
Uncle Donnie? He thought that everyone should know that they were going to offer Greg the job.
He was going to be the Chief of the E.
R.
Excuse me.
Chaz, wait up.
Hey, we're all going to Ike's tonight.
I don't think so.
Everybody's going to be there.
- I already went to the funeral.
- This is different.
Been doing it all day.
Shaking hands, getting hugs.
They say, "Are you okay?" and I smile and I nod.
I can't do it anymore.
I've lost a lot of people in my life, but not like this, not a brother.
But I think you're gonna miss out on something if you don't go.
- Tonight's about remembering him.
- You all get to do that.
He worked here for eight years.
I only knew him for a couple.
I was trying to catch up on the 18 that I missed out on.
I was just starting to know him.
I'm sorry.
Have a good time at your party.
I looked on a medical Web site, and they said it was probably a virus.
I didn't even think about what was going on underneath my cast.
Not a good idea to scratch your skin with a wire coat hanger.
The itching was driving me nuts.
Hey, let me ask you something.
Is this an unusual case? Do you think you could, like, write this up for the journals? Noan, I think you need to rest.
And so do I.
Hello, there.
Someone wanted to see you.
Oh, my God! I didn't know you made it! They wouldn't give me information on the phone, and I couldn't see you 'cae I'm not a relative.
- Norman, easy.
- Oh, it's so good to see you.
Thank you.
Thank you for saving me.
- You look fantastic.
- We'll, uh, let the two of you, uh, catch up.
So, are you going to Ike's? - Should I wait for you? - No.
He's taking a leak, and he finds Morris hiding in a stall, on his cell phone, getting advice about a case.
He storms back to the desk and tells me, "That kid couldn't find his ass with both hands.
" - And Pratt was always right.
- Yeah, very funny, very funny.
Okay, excuse me, everybody.
Tonight's not about speeches or anything, but I was going to say something, and I was wondering if anybody else Hold on.
Sorry.
This is from the church.
I thought it should be here.
Who, uh, who wants to start? A couple of years ago, after Michael died, Greg helped me through the hardest time of my life, and I don't think I ever thanked him enough for that.
Chaz.
Before I met Greg, I was, uh, pretty clueless.
He taught me that anything is possible.
And he taught me not to be scared.
It helped me to realize who I was.
And the kind of person I wanted to be.
I got this from UNOS.
A 15-year-old girl in Nebraska, father of three in Maryland and a college student in Texas all got organs from Greg.
He saved three lives that day.
You know, uh, sometimes, after a really gnarly shift, Greg would drag me over here, he'd buy me a beer, and we would, uh, we would share an order of his all-time favorite: deep-fried mozzarella sticks.
Yeah, he'd say that the clams might be frozen, the mushrooms might be bad, but you can never go wrong with mozzarella.
So I invite all of you to dip deep into the marinara and, uh, raise your cheese as we embrace the memory of our colleague, our mentor, our chief and our dear friend.
God, we miss you.
- To Greg.
- Dr.
Pratt.
Greg.