ER Episode Scripts

N/A - s15e19

Let me go, you bastards! Let me go! Let me go! OK, what have we got? She's not going to tell Banfield.
Anybody could have missed it.
You wouldn't have.
No, you shut up! I wasn't the one out with that bitch all night! I have no idea how long I'm going to be stuck in this place.
You're going to have to reschedule my entire day.
Please? Just a sec! I'll be with you in a second! Please! What? I found a baby.
I think it's dying.
You found it? In front of my apartment.
Outside? In the vestibule by the mailboxes.
It's inside, but it's still cold.
I need an infant warmer, IV access and a rectal temp.
I'll try an antecubital vein.
CBC, chem panel and accucheck.
And a blood culture, too.
How old do you think? Can't be more than a couple of weeks.
Looks kind of dry.
Umbilical stump is still on, but it's clean.
Somebody tied it off with a string.
Tenting.
Dehydrated.
He.
You got a boy.
Fontanelle's sunken.
How's that IV Coming? Got it.
I'm drawing the bloods.
Send the lytes critical.
What fluids you want? Probably about six pounds.
Temp is 35.
7.
All right.
Was there a note, anything? Ma'am, was there Where did she go? Who? The girl who brought him in.
She was here a minute ago.
He's seizing.
All right.
Sleep OK? Um K's down to 4.
8.
Take a deep breath.
Another.
Good.
Lungs are clearing.
Yeah, I'm actually starting to feel You were lucky.
Skip dialysis this week? No.
Staying away from the salt, weighing yourself? Yes, of course.
Your morning labs come back OK, we can discharge you this afternoon.
Maggie will go over the dietary restrictions with you.
Make sure you stick to the programme.
I really don't Pay attention to your fluid intake, all right, Doctor? That was brisk.
I really don't need to go over the dietary restrictions again.
No! Put that down! Who are you? You eat anything? No.
Liquids? Not since last night.
Who paged me back down here again? That was me.
How are his lungs? -Drying out.
I was gonna order a follow-up chest X-ray.
Do it now.
Sats? Ninety-two.
Somebody want to tell me what's going on? Co-ags, clot in the blood bank, electrolytes.
What's going on? I'm Dr Kurtag from the transplant team.
UNOS called.
There's a chance they may have found you a kidney.
Hi.
I'm Carol Hathaway.
Who's who? Chris Zafares, OSHU Portland.
Lungs.
Jon Pares, St Luke's Boise.
Liver.
Mila Ratkovich, Salt Lake City medical.
Pancreas.
Neela Rasgotra, Chicago.
Heart.
What's the hold-up? bike home from the movies, drunk driver hit him.
Grandma said yes to organ donation and then changed her mind.
Why? We took her in to say goodbye, she squeezed his hand.
She got a spinal cord reflex.
The kid squeeze back? Yeah.
So, what now? Well, I've ordered a CBF study.
Doug Ross, attending physician.
Hi.
How long's that gonna take? An hour, maybe two.
And the grandmother's got consent? Yeah.
No mom or dad to ask? Dad's gone, the grandma's trying to find the mother.
I've been talking to the grandmother.
You give her some time, she's gonna do the right thing.
-So sit tight, have some coffee, watch some TV.
We'll get back to you as soon as we can.
Still no mom? The number the grandmother gave me is disconnected.
Busy downstairs? Yeah, I gotta get back.
Grandmother's alone, she's frightened.
She could use some support.
I asked her if I could call anyone else for her, and she said, "No, just please find my daughter.
" Well, let's hope we didn't bring all these people out here for nothing.
Yeah.
Mm.
Hi.
I've got to go.
Did you run the test? We'll get the results back soon, but I don't want you to get your hopes up.
I've heard of people that have been in a coma for a very long time and then they suddenly wake up.
We don't think Billy is in a coma.
He squeezed my hand.
I know.
But it was probably just a spinal cord reflex.
The test that we ran earlier indicates there is no brainstem activity.
He squeezed my hand.
I'll come and find you when the new test results come in, OK? There were five kids riding their bikes home and the car only hit Billy.
Can I get you something? Some coffee? No.
Thank you.
Why is he seizing? What do you think? Sepsis? Maybe.
Oh, um, electrolytes? Glucose was 88.
Add an ammonia level, serum ketones, and lactate level.
What are you thinking? Inborn errors of metabolism.
Pretty rare.
Yeah, well, we don't know if we don't look.
Ativan's on board.
OK, good.
We still need an etiology.
Infection? Is that a statement or a question? Ceftriaxone, 150 milligrams.
Set up for a cath DUA and an LP.
Labs are back.
Bingo.
Sodium is 115.
Daria, why so low? Uh, dehydration? Or maybe the mom was watering down the formula.
Watering it down? Trying to make it stretch further.
I've seen it before.
Formula's expensive.
Hypertonic saline.
What about the risk of central pontine myelinolysis? He seized.
We have to correct his sodium.
Yeah, but if you fix it too quickly, He could sustain permanent brain damage.
That's why we're not going to do it too quickly.
of three percent saline.
Hey.
She's hanging in there.
It's amazing, isn't it? No heart, but she's still alive.
So they told you? That another heart might be coming? They're not going to screw it up again.
Now that was a one in a million thing.
You know, having someone that you really care about, who you really love, who's sick that's a lot like running a marathon.
You just got to take one step at a time, one day at a time.
But if you keep running and having faith that it'll happen, then one day, eventually, you'll finish the race.
-Repeat sodium is 122.
Hemogram and the rest of the lytes are normal.
We're definitely headed in the right direction.
Keep normal saline going at 10cc's per hour.
Do you really think it was just that, just the fluids? Looks likely.
Maybe he's hungry.
No.
No, no, no, no.
I-I-I- I try to keep the relationship with the babies strictly professional.
Daria? Hmm? Me?! Hm.
Oh, for God's sake Get family services down here and call the PICU.
They're going to have to watch him overnight, follow his electrolytes.
Did the girl ever show up again? What girl? The one who brought him in.
No, I haven't seen her.
The police are gonna want to talk to her - family services, too.
I'll look around outside.
OK.
Hey, I think he likes you.
It's just the grasp reflex.
Sure it is.
Cappuccino machine's broken, so no lattes.
No lattes in Seattle? That some sort of cruel joke? So, you're almost done with your surgical residency, huh? Yep.
You gonna stay at County? You guys are from Chicago, right? Yeah.
We have one kidney heading to Tacoma, Another was supposed to go to Spokane, but the guy got the flu.
UNOS kicked out a match in Chicago.
Northwestern.
Thought maybe you wouldn't mind hauling an extra cooler back on the plane with your heart.
Did the grandmother sign off? Not yet.
The CBF just came back.
We're gonna go talk to her now.
Now, the CBF allows us to measure the blood flow in the brain by injecting radioactive isotopes into the bloodstream.
Now, this is a normal brain.
That's the radioactivity.
Now, this is a dead brain which is, essentially, silent.
That's your grandson's brain.
There's no blood flow, no corneal or jaw reflex, no gag reflex.
He failed the apnea test and now, the CBF.
Nora, Billy's gone.
She needs to see him.
I'm sorry? His mother needs to see him.
Uh Did-did you reach her? I tried the numbers you gave me.
Maybe there's another number I could try.
I don't know.
Does she live in Seattle? I don't know what she would want me to do.
If there's an address, I could send someone out to try and find her.
His mother needs to be here.
How you doing? Uhhungry.
Yeah, well, don't eat.
Thirsty, too.
We'll get you some ice chips to suck on.
Half a cup.
Where are we? There's been a delay.
What kind of delay? No idea.
Kidney's coming from the west coast.
But they say it's gonna happen? They say there's been a delay.
Soon as your kidney's in the air, we'll haul you up to pre-op.
Somay not happen? What, you were doing something more important today? No, it's just If it takes a little longer, all the better to finish drying out your lungs.
We've got two days on a kidney once it's out of the donor.
After I see your next set of labs, I may want to hold off a day anyway.
OK.
We can't browbeat her into donating.
She didn't give you any more info on Mom? No.
Who's in there with her? Neighbour.
You OK? I'm just tired.
Why don't you go home? You've been on since last night.
I can finish this.
No, I'm gonna stick around.
How were the girls this morning? Complaining.
Thursday.
Spelling test.
You know, I'm a very good speller.
Yeah.
Why don't you grab yourself some coffee? Stay awake.
OK.
I'm gonna try and intercept the neighbour.
Oh.
Find out more about the family situation.
OK.
So you guys are from Chicago, huh? Yep.
Where? I used to work there.
County.
No kidding.
I did my residency there.
Really? What? You a surgeon? No, paediatrics.
Emergency paediatrics.
Is Kerry Weaver still kicking around? No, she, uh, left a couple of years ago.
Mm-hmm.
Peter Benton? Susan Lewis? Was, um, Abby Lockhart around when you were there? No.
How about Gregg Pratt? No.
You're in surgery, right? Yeah.
How about Anspaugh? Yep, he's still there.
Yeah? -Yeah.
Well you say hello to him for me.
Tell him Doug Ross said hi.
-Sure.
Bye.
I didn't even hear the murmur.
Well, they can be transient, tough to pick up.
An IV drug user with a fever? I should've been thinking endocarditis as soon as I saw the chart.
We've all missed one of those.
That's what Laverne said.
Laverne is a wise woman.
You should listen to her.
Look, just don't say anything to Banfield, OK? I already questioned her clinical judgment once today.
Evaluations are coming out this week.
with multiple sclerosis, Presents with fever and vomiting for two days.
BP 102/64, heart rate's 120.
I tried to get a line in, but I couldn't.
Uh, she really can't hold her head up very much anymore.
OK.
Hey, Frank, what do you got open? Uh, curtain two.
OK.
Can she hear me, understand me? Oh, yes, she understands.
But she doesn't speak very much.
But, uh, she's sharp as a tack, doc.
OK.
I'm Dr Gates.
Uh, you've been vomiting? Her name's Marjorie.
OK, ready? On three, guys.
One, two, three.
So, Marjorie, you've been vomiting for a few days? Uh-huh.
What medications is she taking? Oh, I got a list here.
Oh, here.
Baclofen for muscle spasm, Clonazepam for tremors, Ditropan for bladder and Zoloft for depression.
OK.
Here, sweetheart.
Can you open your mouth? Good.
All right, now take a deep breath, will you please? Good, Marjorie.
Very good.
OK.
Let's do ten of IV Reglan, a gram of rectal Tylenol, CBC, chem panel, UA And what am I leaving out, Daria? Oh, umchest X-ray.
Portable chest, right.
Yeah.
I thought you were NPO.
What the hell are you doing? I'm working.
What are you doing? I'm waiting.
Nice socks.
My feet got cold.
You look ridiculous, Carter.
I didn't know you were on staff here.
Yeah.
Renal failure? It's a long story.
Are you on my transplant team? No, I'm, uh, I'm general surgery.
I just, I saw a "J Carter" on the board, figured I'd check it out.
Uh-huh.
Kurtag, right? Yeah, I just met him today.
Is he any good? Oh, he's terrific.
He trained with Tullius at the Brigham.
Uh, bit of a prick though.
Yeah, I kind of picked up on that already.
So I thought you were still in Africa.
I thought you were still in private practice out in suburbia-ville.
Yeah, well, Reese is 13 now.
He's 13? Oh, my God.
How does that happen? What about you? You got kids? No.
You're married though, right? In theory.
Sorry.
Don't be.
It's just another long story.
I, uh, I guess I should get back.
Yeah? OK.
Yeah.
It's really good to see you.
Yeah.
Hey, did they tell you what time you're going up? No.
No, we're in a bit of a holding pattern, waiting for the kidney to arrive.
All right.
I've got a hernia.
I'll check back in on you though.
That would be great.
What's up? Transpo team from Salt Lake is losing their patient.
I spoke to the neighbour.
Billy's mom split six, seven years ago.
Meth.
Neighbour does not think grandma's seen her since.
Talk to Nora about it? No.
She wants to talk to you.
OK.
Hi.
I'm Doug Ross.
I'm Susan Knefsey.
I'm gonna go find a cup of coffee.
You want anything? OK.
Nice to meet you.
It was nice to meet you.
Uh, your daughter what's her name? Billy's mother.
Melissa.
Yeah.
You have other children? When was the last time you saw her? What was Billy like? He's wonderful.
Smart funny, handsome He loves music.
Especially the kind that I can't stand, and he plays it really loud.
Yeah.
Uh Lots of friends.
There's always kids coming in and out of the house.
Big heart.
He really cares about people.
Even the little kids.
I mean, it's really unusual, you know? Sounds like a great kid.
Yeah.
Generous? Yeah.
Yes.
What parts do theyuse? Well, uh, Carol, you? Pancreas, kidneys, liver, lungs corneas to help the blind see again.
Bones, tendons, cartilage, ligaments to help people walk.
He can change lives for the better.
Five lives, maybe ten.
Maybe dozens.
Billy's heart could possibly save someone else's life before dark.
It's not gonna make up for what you lost, but it is something.
Guys, you want to hold up here, just for a second? Can I? Yes.
Mr Manning? Oh.
Call me Paul, please.
OK, Paul, the results are back, and, um, your wife has a urinary tract infection that's spread to her kidneys.
We need to admit her to the hospital for IV Antibiotics.
Oh, well, can't it be done at home? Home treatment is not as effective.
But she'd prefer it at home.
I understand, but, you know, a kidney infection can be life-threatening in a woman of your wife's age.
Um, I think she's trying to get our attention.
Oh, uh She's thirsty.
All right.
Daria, can you get some water, please? No, no, no water.
Water'll choke her.
Here, I got something here that I know will work better.
A little peach juice.
Here, we're gonna have some peach juice, darling, OK? Here we go.
Here we go, darling.
There you go.
Easy, easy, easy.
She just doesn't want to be in another hospital.
OK.
We'll see what we can do.
We'll be back.
Easy, girl, easy.
You're really gonna let him take her home? That's what she wants.
She has a treatable infection.
She's 84, she's frail, she's disabled Maybe this infection is a blessing.
You're gonna send her home to die from a treatable infection? for Mrs Manning in curtain two.
You got it.
Look, they know what they're asking.
If she wants to die at home, who are we to say she shouldn't? Hey, hold the elevator, please.
How's the child doing? Stabilised, but we're gonna have to keep him for a couple of days, make sure he's OK.
Woman who dropped him off give you an address, anything? No, mm-mm.
She told one of the desk clerks she was late for work and then left.
We'll begin a search for the parents or family.
I contacted the police, and they don't have any reports of missing babies.
If no-one shows up before, uh, you discharge him, then they'll take him to the ERC and get foster proceedings started.
He's a cutie.
Mm, yeah.
I'm gonna need to appoint someone from the hospital staff to be his protective custodian while he's in here.
You up for it? Uh Sure.
Good.
I'll get the paperwork.
Where's our plane? What happened to our plane, the plane that came in from Chicago? The G-5? They had to leave.
Theywhat?! How much time do we have? Eight hours.
Eight hours until this heart needs to be beating in a chest, or we might as well chop it up and use it in shepherd's pie.
Hi.
Uh, we need a plane.
Excuse me? I-I need a plane, now, to Chicago.
Do you have an aircraft reserved with us? No.
Our plane left, and we need another.
Something about their service hours.
Oh.
Well, I don't have anything available right now.
I could make a few calls, see if I can get a flight crew to come in.
How long will that take? I could get a crew here In three hours, maybe four.
No, we don't have four hours.
You see this? There's a heart in here, a human heart.
In there? Yeah, and there's a woman in Chicago dying who needs this heart.
I don't know if they'll do it.
They're supposed to be going to Cleveland.
You like reggae music? What? Carter.
Carter! Hey.
You OK? Yeah.
Well, they gave me Kyexelate to lower my potassium.
Oh.
Oh, that is just cruel.
What? I'm dying of thirst.
I'm starving, too.
What else you got, a burger hidden in your scrubs there? No, just an energy bar.
Mmm.
That's just wrong.
Mmm.
Peanut butter.
Oh, God.
Mm, mm, mm.
So, where is everybody? Who? Your people, your family.
My folks, uh, are in the Bahamas for winter.
They know what's going on? They couldn't make it back, even if they wanted to.
Come on, man, fire up the jet, They could be back here before you leave post-op.
No more jet.
Really? The recession, man.
Haven't you heard? Tell me about it.
My mortgage was just reset.
So, uh How long were you in Africa? Four years.
Yeah? Is that where you met your ex? Mm-hmm.
Kem.
She's not my ex yet.
Would you like to see a picture of her? Sure.
OK? You married a sister? She's half Congolese.
She was raised in France.
Wow.
Hey, she's gorgeous, man.
You gonna let this get away? Not my choice, really.
She know what's going on? That you're here waiting for a transplant? Mm-mm.
She's in Paris.
Her mom's sick.
It's a whole < Dr Carter! Excuse me.
Is everything OK? We are moving you.
Where's Kurtag? Could you grab that bag? Heads up.
Let's go.
Wish me luck, huh? Yeah.
Mom? They found a heart? < You should call her.
Who? Your wife.
She'd want to know.
Maybe come.
Now, uh I don't know.
Being on your deathbed, and all, she could swoop in, be by your side.
Very romantic.
Deathbed.
I know your surgeon.
You know what, uh, Reese is going to a bulls game with a friend's family.
I'll stick around for a little bit, make sure Kurtag gets all the sponges out.
You don't have to do that.
Eh, I'll just be at home on the sofa watching Sportscenter anyway.
They take her in already? Yeah.
You mind if I stick around? That would be nice.
Was that it? Mm-hmm.
Somebody order a kidney? Hey, we'd just about given up on you.
Get lost? Stopped, got my nails done in Boise.
Figured, "What's the hurry?" Flight was good? You like reggae? What? Take care, huh? Does anybody know when he's coming? How about a rough estimate? More than a minute, less than a hockey season.
More than an hour, less than the life-span of a giant redwood tree? Carter.
Sorry.
I'm hungry, thirsty, I'm tired, I'm cold, my arm just fell asleep.
Stop being a baby.
Plus, I feel like I'm hanging out of this thing.
Could someone cover up my crotch, please? He's here.
We have a visitor.
I don't remember being asked if Dr Benton could scrub in for this.
I'm a friend of the patient.
He asked if I would observe.
Uh-huh.
Put him under.
Let's do this.
Whoa, whoa.
What about the checklist? Excuse me? Safe surgery checklist? I've had ten cases today, Doctor.
All the more reason to take the necessary precautions.
It'll only take a minute.
One minute.
John Carter here for a right cadaveric renal allograft? Correct.
Does the patient have a known allergy? No.
Does anaesthesia anticipate a difficult airway? No.
Is the risk of bleeding greater than 500cc's? I sure as hell hope not.
Let's go, put him under.
Whoa, whoa, whoa, everybody slow down.
Now let's just take our time, and introduce the room.
What's next, we all hold hands and sing "Kum Ba Yah?" Sheila Lane, scrub nurse.
Paula Cheney, circulating nurse.
Kay Schumaker, anaesthesiologist.
Randall Okerman, chief surgical resident.
Ethan Dean, surgical intern.
Peter Benton, observing general surgeon.
Any concerns from the surgical team? Only that you're wasting my time.
Any nursing concerns? We don't have any reperfusion solution.
We won't be needing it.
I'll have some sent up.
Were any antibiotics given within the last 60 minutes? Just starting them now.
Ten blade.
Hold on, hold on, hold on.
If you run the antibiotics prior to incision, you cut the risk of infection by half.
Dr Benton, you're a guest here, and I don't like guests.
As a friend of the patient, you're welcome to sit, observe and shut up.
Ten blade.
That sucks.
-What? Not much atrial puff.
The pulmonary artery's a little short as well.
We can still use it, right? It's been seven-and-a-half hours.
We're already at the limits of ischaemic time.
Pulse ox is 97.
Fixing this is only going to prolong the delay.
We don't have a choice.
Sure we do.
Leave her on ecmo, wait for another heart.
What about using the pericardium as the buttress? You can use it to graft to the native atrium.
We're really on the edge here.
Even with prolonged ischaemia, she's still got a better chance of surviving with this heart.
We leave her on the ecmo, she's gonna die.
Dr Rasgotra, take us through the steps.
Donor left atrium to the native atrial cuff.
Arterial and venous anastomoses are complete.
Releasing the clamps.
Suture lines look good, no leaks.
Shouldn't we be pinking up by now? What happened to sitting quietly in the corner, Dr Benton? No, seriously.
Shouldn't it be? Sometimes it takes a minute.
I don't have a parenchymal pulse.
Crap.
We've got an arterial thrombosis.
Re-clamp and take down the sutures.
Satinsky, please.
Where's the clot? Renal artery's obstructing the blood flow.
Gonna have to take it out and start all over again.
Problem solved.
Flush with heparin, saline and reperfusion solution.
Reperfusion solution? We've got it.
We're all set.
Oh, well, it's a good thing we just had some laying around, huh? How long did it take to get the reperfusion solution up from the pharmacy? What happens if you don't have the reperfusion solution? You've made your point, doctor.
I disagree, doctor.
I think that this is an excellent teaching opportunity, though.
You would have had The organ would have taken a major blow, and there's a good chance we would have ended up with a non-functioning kidney.
Wouldn't you agree, doctor? If we're all done teaching here, perhaps some of you would like to assist me in getting this kidney back into the patient's body.
Where do you get a copy of that checklist? Now, people! How long? Nine hours and 14 minutes.
I've got the airway.
Get the trans-oesophageal echo ready Cut.
Anastamoses are irrigated.
Temp's up to 34.
OK, moment of truth.
Remove the cross clamp.
No oozing at the graft sites.
We've got fibrillation, people.
Paddles to Dr Rasgotra.
Go.
Charged to ten.
Clear! Still fib.
Going again.
Clear! Fib.
Go again.
Come on, Joanie, sweetheart, you can do it.
Clear! Hey.
Where'd you go this morning? We were looking all over for you.
Is he OK? Yeah, we're gonna keep him in the hospital for a few days, but, uh, he's fine.
Um, what's your name? What? Your name.
Family services needs to get a report to the police.
They need to get the address of the apartment building where you found him, see if we can find somebody who knows anything about him.
I tried, you know, to take care of him.
I tried really hard.
You did a good job.
Bringing him here was the right thing to do.
I thought I was gonna be able to handle it, but after he was born, it was just so hard, and I couldn't deal with it.
You're the mother? Derrick said he was gonna stay with me and take care of us, but he split a few months ago.
My parents don't want me around.
They hate me.
I just thought that if I So he's really OK? Yeah.
Look, do you want to hold him? No.
I just wanted to make sure he's gonna be all right.
No, please, stay.
Look, you don't have to decide anything right now.
The weeks after childbirth are stressful, traumatic.
You may be experiencing postpartum depression.
We can help you with that.
There are support groups.
Look, you're just overwhelmed but that'll pass.
You just have to give it time! Please, wait! He'll have a good home, OK? Make sure he has a good home.
It's been too long, hasn't it? These things take time.
Would you like to see her? Here, press for Fentanyl.
You're still here? I don't want to miss all the fun.
What about Reese? He's at home with cleo.
Oh You and Cleo still Yeah.
So, how did it go? Well Oh, that is a beautiful sight.
Hey, um Is my personal belonging bag around here someplace? Yeah, it's right here.
There's a cell phone in there.
Would you dial a number for me? Sure.
Here.
There's a speed dial toggle to the left there.
John, I know how to use a cell phone.
It's under K.
Kem.
Hey.
Did I wake you? I have some really good news.
She's just there.
Oh, go on.
It's OK.
OK.
Hi, Mom.
Carol Hathaway.
Really? Oh, that's fantastic.
No, no, I appreciate it.
Yeah.
See you in the morning.
Thanks.
Hey Hm.
Hey.
That was Cindy.
Chicago called them.
The heart worked.
Went to a 36-year-old woman with a daughter.
Hm.
And the kidney, too.
Went to some doctor.
Hm.
Not bad for a day's work, huh? Not bad.
I love you.
I love you.