ER Episode Scripts

N/A - s15e20

Previously on ER Told you to get a desk job.
- Bastard shot me in the back.
Lucien, I've withdrawn my application.
I'm not staying at County.
I have to talk about every stupid damn thing that bothers me? No! I truly believe.
.
.
.
There's something better out there for both of us.
Better? Something more right.
So.
.
- So Listen - I'm sorry.
I'm sorry things got so weird - I really think that you shouldn't, I I know I kind of sprung things on.
.
.
.
you - OK You go first.
I know I've been somewhat closed off about all of this, but.
.
But I was afraid that if I discussed it with you, you'd convince me to stay.
I certainly would have tried.
But, you know what, it's a good thing you're going.
It is? - Yep.
Adjusting to a new environment, a new way of doing things You will gain so much confidence from that.
Ah, well, I hope so.
And then when you're sick of your third-rate community trauma center.
.
Ah, now it's third-rate? You always, always have a job here.
Really? - Yeah.
Six months, six years, I don't know.
Not sure when, but you will be back! County is in your blood.
And until then, my friend, good luck! Get out of here! Lucien, I don't know if I can do this without you.
Of course you can.
You'll see.
Now go.
Get out of here.
Please, go.
Please.
The MRI is going to tell us if there's blood in his brain.
That's the hard part.
- And if there is, then what? Brain surgery? - Possibly.
Jay, I know how much you need to talk to him.
OK, I'm going to do everything that I can to make that happen.
He has to wake up.
Doctor Brenner.
Doctor Brenner! Hey, where you been? Frank really outdid himself.
I took Mr.
Walters up to MRI, they'll try and squeeze him in.
What? - Nothing.
If it does turn out to be an aneurysm, they can embolize it if it's caught early.
You don't think Neela noticed that you weren't there? I meant to go but I was dealing with this neur You couldn't find five minutes to stop by? Gates, I'm signing out to Morris for a while.
It's me, I'm at the airport.
I could really use some of your sage wisdom right now.
Will you call me when you get this? Thanks.
What can I get you? - Glenfidd, straight please.
Need some warming up, darling? Off to some place sunny? - Yes, actually.
Beach vacation? Business trip? Sort of.
- Sort of? It's a new job.
I'm moving.
Really? What do you do? I euh.
.
- Neela! I couldn't let you go like this.
What're you drinking? - What've you got on tap? No, I'll just have a water with a lime, thanks.
Thank god for the storm or you'd be somewhere in Missouri by now.
Your geography is pretty good for a foreigner.
Look, I um, I just I thought if I didn't catch you now, we'd never speak again.
Today's been strange and difficult.
Yeah.
Yeah, I know.
For me too.
Oh and don't mutter in Spanish when you're angry, it's a cliche! I understand a lot more than you think I understand.
Fine, you win! I'll stay home with my haircurlers, spending my days knitting and baking.
You know that's not what I'm talking about.
- What would you like, applepie or cherry? Come on, if you'd just listen to.
.
- Archie, this conversation is over.
Well, OK, have a great day! And please accept my sincere apology for giving a rat's ass! Everything OK? -Everything's fine.
What we got? One story fall with LOC, that's all I know.
What the hell is that? - It's a little something for Neela.
It's her last day.
- Piņata? - What is she, five? I had this custom made! It's a Ghandi piņata.
- That is scary.
Not to mention offensive.
Yeah, who's going to want to bash Ghandi's head in with a bat? You have no sense of culture.
Darrion Walters, 53, fell head first down a flight of stairs after a few too many.
I slipped on a rug.
-Observed LOC, awake at the scene, disoriented.
Mr.
Walters, do you know what day it is? I told you I slipped on a rug.
OK, guys, what do you want? - Head CT, C-spine, trauma labs .
.
tox screen and ETOH levels.
- I'm on it.
And surgery will need to see him.
- Neela's already on the floor.
She's delirious, how's the CBC? - The moon, the stars! The tides have changed! - Getting a repeat now.
Gravity is the horse's force.
- Do you remember what happened today? Nobody will listen! - She drove her motorcycle into the museum of science.
.
and industry warning people about the end of the world.
Psych history? - Yeah, so it seems.
I'll check if she has a record here.
- The equilibrium is shifting! Oh, for you too? I thought it was just me, it being my last day here.
It's Claudia's first day back at work.
- Good for her.
Is it? I'm not sure it is.
LFT's and lyfates are normal.
I think you might be my last surgical case.
I thought I was OK with it.
It's her job and I respect that.
But she got shot.
Why couldn't I fall for a nice librarian or something? You know, a librarian in Springfield died last month.
Bookshelf fell on her.
I swear, it's in the paper.
Guys, we need a surgeon in here.
Andrew, check the tox screen and let Dubenko know.
.
.
.
we've got a possible laparotomy.
What've you got? -53-yr-old male.
.
fell down a staircase, multiple contusions to head, hip and back.
decreased on the left with SATS in the 80's.
Hello, I'm Dr.
Rasgotra, do you remember falling? I was dizzy, I guess I tripped.
Sounds like ETOH is involved.
- Belly's benign but I figured you'd want to sign off Oh, happy to help.
Thank God! - I'm fine.
You're not fine! Just a few scrapes and this headache won't go away.
Alright, a little pinch here.
- What're you doing? He may have broken a rib when he fell.
And punctured a lung.
- A tube will help inflate it.
When is this going to stop, it's not even 10 AM.
Mom, don't start.
- I woke up this morning with a headache.
It's called a hangover.
- Just needed something for the pain.
He's a drunk, but you've probably figured that out by now.
Come on, let the doctors work.
Two people ahead of us for CT.
Type and cross and let me know when the scan is back, please.
Excuse us, sorry, my mom's been through some messy stuff.
Morris We all have messes in our past.
I shouldn't have been so hard on you.
It wasn't the best way to end things.
You were right.
- I was righteous, .
.
which isn't my best quality.
Honestly.
My whole adult life, I've been doing.
.
exactly what you said.
I'm not sure what you mean.
Disappearing.
Using sex as an escape.
Worse, as a wapen, a way of.
.
disarming people.
Look at you two, so sweet, like nobody else is in the room.
You want another round? - Uh, sure.
I'm in, O-silk, elastic pads.
I'll get the thoraseal.
Hey guys, look.
Irregular rythm, looks like A-fib.
Nice pickup.
Do you have a history of atrial fibrilation? He didn't tell you? You didn't tell them? I don't know, I forgot.
Forgot? That's a load of crap.
It's OK.
What meds is he on? Uh, calcium blockers and something to thin his blood.
He's bad about taking his meds.
He drinks, he forgets.
or at least that's what he says.
But really it's a death wish.
He thinks if he doesn't take his pills, he'll figure out a way to disappear.
Don't talk about me like I'm not here.
Today, of all days.
You couldn't control yourself.
What's so special about today? It's been ten years.
God, here we go, he has this pathetic need to tell everyone.
Mom, please.
Um, today's the anniversary of their son's death, so everyone's a bit.
.
.
.
tense.
My dad blames himself.
I let Timmy go.
I'll be outside.
Mom! - Sam, add an ROR and rush the head scan please.
You keep thinking it's going to get easier.
It doesn't.
Hey, we've got a staircase fall in 1 with a pneumo and headache, and a motorcycle crash in 2 with a seatbelt sign.
OK, sounds good.
Who do you want me to see first? Well, motorcycle girl looks like she might need the OR, and you know what, this will be case nr 2500.
Yeah, can you believe it, I.
.
.
.
have had 2499 surgeries in this internship.
Wow, that's impressive.
Good number.
- I do what I can.
Ah surgeons, perfect timing, I have a question for you.
How's he doing? - CBC's good.
Hi, I'm Dr.
Dubenko.
- Reckoning is here! OK, why are escatological delusions so common among psychotic patients? Esca what? - Escatology, pertaining to the end of the world.
I checked the records, no psych hospitalisation at County.
She definitely doesn't look familiar.
There's no hiding from the.
.
- OK, sweet dreams, my dear.
OK, so, your girlfriend gets shot on the job.
Uh-huh.
- And seeing that you care about her, and want her to, I don't know, not die You gently suggest that she might do another job.
Is that sexist? - No - Yes No - Yes.
No, toma-to, tom-ato.
What? - Rigid abdomen, probably needs the OR, Andrew, you can scrub in.
- Awesome.
She's seizing.
- Look out.
Two of ativan.
- Crank up the O2.
Call me when she's ready for the scanner, I'll swing by and take a look.
Andrew, let's go.
- Do you want me to cover the ER? Forget about the ER, meet us upstairs.
You've got to lock case nr 2500.
What's with him? Denial, avoidance.
Fear.
There are so many things I've missed out on, because I was afraid.
You're obviously not afraid to fly in really bad weather.
You know, when I was six, my um.
.
my aunt took me to a toy store and gave me five pounds and.
.
said I could buy anything I wanted.
I wandered around the store for what seemed like hours.
Terrified that I would choose the wrong thing.
Wrong doll my sister would love, wrong book, my brothers would take it, wrong teddy, the kids at school would think I was a baby.
I left the store with nothing.
My father put the money in the bank.
Sensible kid.
- Well,.
.
the point is for as long as I can remember, I've carried this irrational dread of making a mistake.
It's with me all the time.
And why on earth I decided to become a doctor, where the cost of a mistake is so high.
It's insane.
- Yeah, it's masochistic.
I know.
This is my way of saying, I know I helped screw things up.
I'm not following.
There's so many times in my life I've failed to take a chance.
even when it was clear to everyone else, including me, that I should have.
It's why I've gotta go.
Even if it.
.
scares the hell out of me.
I don't want to be that person anymore.
Don't worry, Neela, I didn't come to try and convince you to stay.
Then why are you here? I really, really don't know.
How did you get passed security? Don't you need a ticket? You bought a ticket.
Any good ideas of things to do in Detroit? Detroit? - It was the only way.
It just seemed wrong.
Terribly wrong.
To let you go.
And not even say goodbye.
Do you want to take a walk? Head looks good, Mr.
Walters.
No bleeding.
You didn't need to stay for this.
I know, I wanted to.
Jay was my boy's best friend.
He pulled Tim out of the water.
Did CPR for an hour until the coast guard got there.
Let's not go there, OK? After the funeral.
.
everyone got on with their lives.
Jay came by every day to check on us.
It was just an excuse to flirt with your daughter.
Looks like it worked We've been married three years now.
I lost Tim.
And he became like a son to me.
Alright, alright.
At least you're affectionate when you're drunk.
What, are you guys having a party in here? We need the scanner.
Hi, Mr.
.
? - Walters.
How're you feeling? - My head's killing me.
But the CT is clear.
No bleed, no edema? Who's that? - The other case.
Did you think of tapping him? Um, tap him, why? I don't want to miss a subaracnoid.
It fits with the course of his symptoms, and doesn't show up on a CT.
That's pretty rare.
- It's extremely rare.
I know, but the course of his dizzyness, headache from the fall, He was drinking.
His ETOH level wasn't all that high, not for a chronic alcoholic.
We don't tap all our negative CT's.
If it was up to me, we would.
Let's not risk missing something we could fix.
You on board with this? Me? I trust her instincts, She's going to be her own boss, starting tomorrow, so, don't have much leverage, really.
The ad said 'snake charmer'.
I brought tarantula's too, if you think she'd like that.
I was thinking of a turbon, and a flute, and a snake and a basket.
Not this SM kennel.
People dig the outfit.
It won't work.
For your trouble.
What was that? When Neela first got here, we got off on the wrong foot.
I said some things about her ethnic background.
That was six years ago, I'm sure she's over it.
I'd just like to show her how much I've changed.
Why don't you try something simple like flowers? Flowers? - Yeah.
But that's not even remotely original or cultural.
Just because her parents were born in India, doesn't mean she'll appreciate some kind of Indian cliche.
In fact, she may, very well, find it offensive.
What? She's English, Frank.
So a Ghandi piņata, or a turbon snake charmer is going to end up working against you here.
Well, thank you, Sam.
I'll take that under advisement.
No free fluid.
- Aorta's intact.
IVC.
- Kidney's look functional As do the intestines? I know how to read an abdominal scan.
Of course you do.
What's going on? - Make sure the head's clear, I'll meet you in the OR.
The OR? But the scan's perfect.
She's got a rigid abdomen, no matter what the scan says.
Her vitals are good, her counts are unchanged.
Why not watch her in the ICU, move her at first sign of unstability.
By then she'll be unstable.
- Lucien, you've Small bowel perforation, mesenteric injury.
Let's not miss something we can fix.
Right? Meet you in the OR in ten.
Sometimes there can be a head bleed we can't see on the CT.
A more sensitive test is to place a needle in the spinal canal, and remove some fluid.
If the lab finds red bloodcells, there's a problem.
What are the risks? Infection and bleeding, but we'll.
.
we'll take precautions to avoid both.
What do you think, Jay? The apparatus has arrived, we should step out.
Hang in there, dad.
Dr.
Brenner, no disrespect, but um, this is stupid.
Look, his mental status is getting worse, we don't have a good explanation, subarachneal bleed is a reasonable theory.
Except for the fact that he's on Kumonin, which means the chances of creating bleeding complications is much higher than even finding the problem.
His INR is less than two, clearly, there is something subtle that lead Neela to ask for this.
Yeah, it's her last day, she doesn't want to make a mistake.
She'll feel just as bad if the procedure leads to an uncontrolable spinal bleed.
Is that your LP kit? I'm not going to do it.
We'll use fluorine, give FFP, it'll be fine.
You'll be there to assist.
We could go in laparoscopically, have a quick look.
- We're doing it open.
Her recovery time would be easier.
I'm aware of the advantages of laparoscopy.
Serial ultrasound was fine, normal CT, vitals are good, crit is stable You're the one who wanted to log 2500 surgeries.
Don't rush a patient's surgery because you're mad at me.
I'm not mad at you, I'm amused by your narcissism, but the patient has a surgical abdomen.
I suggest perhaps that it is your judgment that is clouded by the significance of the day.
- Lucien, please, why don't you just say what you need to say.
I don't need to say anything.
One minute, you're strange and loopy, the next, you're gritting your teeth.
Look, it isn't personal.
Maybe you can just wish me luck.
I'd like to but I can't.
What? I can't accept the fact that you've accepted a job at an academically and clinically inferior institution just to spite me.
- Now who's a narcissist? Patient is prepped, ancef is running.
I can't wish you luck, because I want you to hate it.
You're unbelievable.
I haven't spent all these years, helping you to become this incredible talent, just so you can move away to a second-rate city and work at a B-list institution.
Ten-blade to Dr.
Wade.
Sweet! - It's not B-list, you're being a snob.
You know you're better than that place.
- They have a busy trauma service and a catchment area that extends over half a state.
No medical school, no research.
- Which allows me time in the OR instead of a lab.
Why can't you respect that? I just imagined something better for you.
- No, it's not what you imagined for you, which is fine but it's my life.
You know, if I stay here I'll always be little Neela.
It's time to move on.
- You just contaminated yourself.
Hyper-pigmentation.
- Starting the incision.
Andrew, wait, stop.
Go run and get the Woods lamp.
Why? - Just get it, go now.
Bingo.
- Wow.
What the hell? - Call hemo, they'll need to admit her.
Hemo? - This woman doesn't have internal bleeding, she has acute porfiria.
What? - Disorder of the heme's synthetis pathway.
Rigid abdomen, hyper-pigmentation on the extremities, psychoses, seizures, it all fits.
Yeah, she's the right age for first presentation.
OK, reverse the anaesthesia, she doesn't need surgery.
I guess 2499 will have to be enough.
That's a big needle.
If we've done our job right, he won't feel a thing.
You do a lot for their family.
I have no choice, I married into it.
Lily's worth it though.
- That's better.
I don't feel right.
Hold on, almost done.
Gary, you OK? - Take the needle out! I'm almost done.
- Take the needle out, Brenner, he's bradying down.
- Damnit.
Another unit of FFP.
Mr.
Walters? Talk to him.
- His heart-rate is 48.
Wake up, do you hear me? I'm in.
- Amp of epi, I've lost a pulse.
What's happening? - His heart is beating dangerously slow.
Could be a vague reflex, or something to do with what's going on in his brain.
He overdosed on calcium blockers? Good call, let's get 500 of calcium glucanate.
Atropine and let's sit up for a dopler infusion.
Alright, let's pace it.
- It was a fight, OK? It was a stupid fight! Increase the voltage, we need another set of hands in here! I meant to tell you so many times, it's not what you think.
Increase the volume.
- It's not what you think.
He slipped, it was an accident.
- Alright, quiet! We got capture.
- Strong carotid, this is good.
I'll let the family know he's OK.
Jay, what's going on? I met a man today who accidentally killed his best friend.
- That's awful.
They were out on a boat, and they got into a fight over a girl.
The guy punched his friend and he tripped and fell overboard.
And that was that.
- They brought the friend to the ER? This happened 10 years ago.
The guy never told the family until today.
For years, they were.
.
Their lives just stopped.
That's sad.
- Yeah Thank you for helping me see that I was stuck.
I'm the last person who should be telling.
.
Neela, look, you were right.
I can't love anyone until I sort some stuff out.
But maybe because of you I've started to do that.
Simon.
.
This is why I came here.
Neela, this really.
.
God, this mattered so much to me.
Thank you.
Thank you for saying that.
It's going to be weird not to see you all every day.
Frank, did a soft collar ever come down from central? Yes.
- Were you going to tell me or keep me waiting? I forgot, so shoot me.
Don't tempt me, could you get it please? No.
- No? I'm going to miss this.
Neela, Morris has a complicated hand lac he wants you to look at.
Oh OK, might be my last consult.
Curtain three.
- Dr.
Rasgotra, can you lay hands on my rule-out appy? Page Andrew, I have a plane to catch.
Alright, cool.
Wow, what happened here? Ah, Dr.
Rasgotra, this is Ed McDowell.
And this is what happens when a tug of war gets out of hand.
Get it? Out of 'hand'? Company pic-nic.
The winning team gets the closest parking for a year.
Wow.
Rope was wrapped around my hand so tight, it went numb, I didn't even feel it cutting through my skin.
Well, you're lucky 'cause you almost ripped the whole thing off.
I was so focused on the game, I just couldn't let go.
I was going to have ortho do it, but.
.
the edges approximate nicely, there's no neuro-vascular damage, so.
.
thought I would get.
.
It got through the glove? Yes, damnit.
I'm sorry.
- It's not your fault, really.
I'll be right back.
You need to irrigate that and make a report.
Infection by a needle is a very low risk.
- I know.
But you still need to check for HIV, hepatitis.
-I know.
What's going on today? A PCP vigilante chucks a mailstand at my head.
A 7-yr-old republican bit me, while I was irrigating his lac.
And now this.
.
Oh my god.
I'm an ass.
- Not following.
Dr.
Rasgotra, come with me, please.
Frank, I can't, I'm gonna be late.
- It's important, I swear.
Frank, I'll be late for the pla.
.
- Surprise! Amazing! - Frank did it all.
Wow.
- Admit it, you thought we forgot.
No.
- Or didn't care? No, maybe.
.
How could you think that? Nobody stands up to our boneheaded attendings like you do.
Who's going to get all the tough central lines? Or fight with radiology residents? Or teach me how to do like, everything? To Neela! Haleh! I think this is what you were looking for.
I didn't know if this wall really existed, or if it was just a rumor.
I knew this day would come.
But so soon? - Stop it, Haleh, you'll make me cry.
Excuse me, can you help me, sir? You need to find a triage nurse.
No, I'm sorry, I work here.
Lucky you.
- I'm supposed to start today, Neela Rasgotra.
Rag-what? You're a really good surgeon, Neela.
A few more years and you could be great.
Thank you.
I was wondering, if you didn't mind too much.
.
do you think you could lead the way and.
.
stand up there with me when we do this? Do you mean like, be your maid of honor? I'd be honored.
Out in the ambulance this morning, I was uh.
.
I was thinking about asking you out.
I was thinking of saying yes.
with a rare blood disorder still alive tonight Dr.
Brenner.
Dr.
Brenner! Oh god, thank god it's you.
Please tell me I'm not making a horrible mistake.
- Of course you're not making a mistake.
But how does one know? How does one ever know? - You're doing that thing you do.
What thing? - That existential crisis spin-out thing that never leads you anywhere.
Hey, maybe you should have a drink.
I've had three.
- Hey, slow down everybody.
Slow down! Thursday's my day to do this childcare swap thing.
.
I hate Thursdays.
- Abby, you'd tell me if you thought I was making a mistake, right? I would.
- Promise? Neela, if this doesn't make sense, then I don't know what does.
Now just get off the phone and get on a damn plane.
OK.
I'm hanging up now.
- OK.
You still there? - Yes.
I'm getting on the plane.
- Good idea.
".
.
We apologise for the delay, we'll keep you advised.
" Hey Sam, what happened to our staircase guy? - OP came back positive for blood right as they were signing him in to MRA.
Tony's upstairs with them in angio.
- OK, thanks.
Hey Dr.
Brenner, have you seen Archie around? I'm here.
What's going on? Come with me.
I stuck myself with a needle today.
And it made me realise that I was an ass this morning about your work thing.
An ass.
.
I get it, Archie.
What's with the pie? A symbol of my temporary chauvinism, and a gesture of apology.
My original idea was to.
.
bake you a pie wearing nothing but an apron, but I uh.
.
had to work late and I don't own an apron.
Me either.
See, we're perfect.
So if you can handle being with a guy that gets stuck by needles, kicked by patients, takes an occasional slug of radiation to his cojones.
.
What are you talking about? Well, then I can certainly stomache some occasional gunfire.
As long as your promise not to get shot again.
(Spanish: I'll do my best, Archie Morris) What? Just wanted to see how much Spanish you really understand.
See that? - Yeah, I think so.
Ten millimeter aneurysm at the tip of the junction.
Headache he had this morning was probably the initial leak.
- No, the leak was tiny.
No way it would show up on a CT.
More contrast, please.
By all rights, this thing should've been missed.
Nice work.
Neela was right.
We use electrolitically detachable coils to fill the lumen.
Cool.
Cloth forms around the coils, blocking off the aneurysm, leaving the vessel open.
Down the neck racial.
.
Damnit.
- Stop the heparine Stop! - What's happening? Coil went beyond the confounds of the road map.
You mean you ruptured the aneurysm? Looks that way.
Contrast! - Doesn't he need the OR now? Not necessarily, if the bleeding stops, we can potentially continue with softer coil.
- I'm not waiting around to test that theory.
Heart-rate's down again.
- This is Dr.
Brenner from the ER, we need an OR and a neuro-surgeon for an accute cerebral hemorrhage.
Excuse me, Dr, I believe that's my call to make.
Get the portable monitor, get this out of the way.
Systolic's 62.
- That's good.
It'll limit with the bleeding.
- And deprive the brain of oxygen! What're you doing? - I'm taking care of my patient.
Get the thermostat covered.
- This is out of line! I'm going to write you guys up! Hey.
You're still here? - Yeah, I crashed in the callroom for a bit.
The surgeons were able to clip the aneurysm quickly, so.
.
the bleeding was contained to a very small area.
Is he going to have brain damage? He's got a very good chance of doing well.
But we won't know the answer to that for a while.
Where's your wife? - She went home to shower.
I don't know what she's going to do now.
About us.
- You two will work it through.
Easy for you to say.
- The truth is a timebomb, but once it's out, it can't hurt you anymore.
You can move on, you can move forward.
Get some rest, Jay.
I'll drop by later.
Thanks.
I'd appreciate that.
How're you doing? Fine.
You? Fine.
Andrew, what do you think of the patient's tachycardia? Probably volume-related, but could be due to fever, .
.
pain, infection.
- Good, more? Uh, drug withdrawal, toxins, vascular.
- More? Uh, trauma.
.
Genetic? - Neela never taught you 'vindicate'? It's my favorite mnemonic for post-op rounds.
Excuse us, Dr.
Brenner.
If you run through this on all your post-ops, you will never miss a major complication, OK? V is for? - Vascular.
I is for? - Infection? You can come in now.
What happened to you? - Um, I'm sorry, I've been up all night.
I see.
So, how was your week? - Can you excuse me for a second? Finally.
Are you really here? - Yeah, I really am.