ER s09e21 Episode Script

Previously on E.
R.
Oh, God! It's over.
It's time for me to cut my losses.
That's my brother.
Turner, you all right? - A bullet ripped into his spleen.
- You stay strong, little man, okay? - Where you going, Curtis? - Like I said, fix things.
Now you see why I want out of this place.
Well, it's not all bad.
You know what I mean.
You can get a job at Northwestern too.
You won't see me for a while.
I'm going to the Congo.
- West Africa.
- L'Alliance de Médecine Internationale.
- I thought you said you weren't going.
- Yeah, I'm not.
Dr.
Carter? Dr.
Carter? - Start dopamine at 10 mics.
- Dr.
Carter? And mix up Levophed.
Dr.
Carter? You left a note to wake you if you weren't up by 7.
Do you want some breakfast? No.
No, thanks.
I'll just get something there.
- Dr.
Carter.
- I'm up.
I'm up.
- Hey, you're late.
- Two minutes.
Late is late.
Fifty-seven-year-old, cirrhosis, vomiting blood.
GI lab can scope him at 9.
- Can I get a bagel? - I haven't had breakfast either.
- You mean dinner.
- Yeah, whatever.
Sixteen-year-old banger, GSW to belly.
O.
R.
should be grabbing him any minute.
- Like now? - Then there's the 14-year-old banger GSW to the upper leg.
Pulse deficit, in line for angiogram.
- Same shooting? - I stopped keeping track.
- DVT in 6.
On heparin.
- Since midnight? There's no tele beds.
This gang war's got every department backed up.
Where's Jim Carter when you need him? Bus full of Texans with food poisoning.
- Good morning.
- For you.
Apparently, I'm a vampire.
Wow, you got it so rough.
Three night shifts in a row.
- I been on graveyard two weeks straight.
- I did my residency, thank you.
They're insisting on being discharged by - I thought vampires liked eclipses.
- The moon blocks out the sun.
Big deal.
A billboard outside my apartment does that.
- Catch you tonight, Elvira.
- I thought this was it.
Almost.
One more night slumming it with you cats, then I'm heading it uptown.
You're late.
You can tell time.
So can Carter.
- So, what's he gonna do, fire me? - Did you catch the eclipse? - What? - A solar eclipse.
A celestial phenomenon that occurs only once every 18 years, 11 and a third days.
- No.
I slept through that.
- You slept through it? I have to sleep sometime.
- Couldn't wake up for 10 minutes? - Big deal.
Moon blocks out the sun.
I got a billboard outside my apartment that does the same thing.
You don't look so good.
Twelve-year-old near-drowning in 4, intubated and comatose.
- No movements, waiting on PICU.
- What's with the Buddhists? - They're here for the nun.
- We got some religious turf war? Buddhist nun.
Transpo's backed up taking her to the morgue.
- She's dead? - Reincarnated.
It's a cycle of karma.
Six-year-old in respiratory arrest from cyanide toxicity.
Acidosis is resolved with induced methemoglobinemia.
Waiting on PICU.
- How does a 6-year-old ingest cyanide? - That is a fatal Ml.
Family's waiting.
They want to see their father after he gets cleaned up.
You okay? - DVT in 6 waiting on coags.
- Hold on.
I gave you DVT this morning.
- Guy's been there 20 hours? - Take care of him.
All right, see you.
Nice knowing you.
I start at Northwestern next week.
Tonight's it for me.
That's right.
Good luck, Greg.
Yeah.
You too.
Do you realize how much ambulance traffic we get here? - They can't go around? - Clear the equipment away.
- It's equipment or a pile of concrete.
- Hey! Park the damn thing sideways.
- What is this? - Weaver's moving Triage.
- Something about more beds.
- So the patients can wait lying down? I don't ask.
I thought you were on vacation.
- Tomorrow.
- To Martha's Vineyard? - Nope.
- Thirty-two-year-old, struck by a cab.
- The Cape? - Rio de Janeiro.
- String bikini.
- With my dad.
- She ran into traffic.
- I wanted more time.
- There were others.
- Head trauma? - Proximal tibia on the right.
- We wanted time.
They forced us.
They wanted everyone to go together.
- Ma'am, are you taking any medication? - It's ending today.
Today's the last day.
- Can you tell us your name? - 2:16 p.
m.
The end of the world.
Great.
And I have to work.
I'm always working when the world ends.
- I can't swallow, man.
- Belly's soft.
Type and cross for four.
Blood bank's almost empty.
Red Cross doesn't restock until 9.
Crit's 30.
Let's stick with saline.
- Decreased on right.
Thirty-two French.
- Why can't I swallow? Am I dying? Not if we can help.
If you keep shooting each other, we'll run out of blood.
- I didn't shoot nobody.
- Carter.
You should look at this woman.
I've been here half an hour, I got half a dozen patients.
Be more specific.
Buddhist nun, end-stage breast cancer, vomiting pain meds, Exam 2.
This guy need to go up? Wouldn't have anywhere for him if he did.
Ten blade.
- Have a portable chest, full trauma panel.
- Yo, where you going? You have a collapsed lung.
Dr.
Corday is going to re-inflate it for you.
We'll keep an eye on you down here.
Try not to bleed too much.
- You my doctor? - No.
- I've been waiting an hour! - Have you came to rescue us? I'm swamped with physical improvements.
You take point down here.
- Did you fire Romano? - No, medical leave.
- What, his arm? - I can't discuss it.
- Carter, you know if CT's back up yet? - I didn't know it was down.
- She had a benign abdomen.
- She's unresponsive.
Add a tox screen.
She may be coming down from speed.
- She's nuts, right, out of it? - Unconscious is pretty out of it.
- So I don't check out her story? - The end of the world? - The part about men trying to kill her.
- I'd look into it.
I got chronic pancreatitis.
I'm puking- - Let me guess.
Need a shot of Demerol.
- Just do it fast.
Mastectomy, radiation, chemo.
Recurs with a pathologic fracture.
- She have an oncologist? - Surgeon's in Japan.
- I need it now.
- GSW, 10 minutes out.
All right, come find me.
Hello.
I'm Dr.
Carter.
Kito Shunko.
And this is the venerable Zuin-An.
- I'm sorry, Sister.
Zuin? - Zuin-An.
Are you comfortable with me doing a physical examination? - Yes.
- Okay.
When was her last chemo? Three months ago.
But it wasn't working anymore.
I shouldn't have even brought her here.
But she's in pain and hasn't had anything to drink in two days.
She'll feel much better with some intravenous fluids some anti-nausea and pain medication.
"So much sadness.
" Somebody overcooked their burger.
- It's arson.
Definitely arson.
- Could be electrical.
Place wasn't exactly a model of cook compliance.
- I've been brown-bagging since it closed.
- And now the cafeteria has a monopoly.
- Was anybody in there? - C.
F.
D.
did a sweep.
- Well, I guess we're closed then.
- We never close.
Neither did Doc Magoo's, and look what happened.
I wouldn't deprive you of your last shift.
Come on.
Declare internal disaster so that we can all go home.
No.
You're an internal disaster.
That's an external disaster.
Hey, Abby.
Got any marshmallows? Mr.
Mednick, you need to be on a monitor.
- What I need is some fresh air.
- Put out the cigarette.
- I'm almost done.
- Put it out! You have a bleeding ulcer.
- I know what I have.
- Okay, that's fine.
Smoke the whole pack.
Come and find me when you start vomiting blood.
- Hey, Abby.
Doc Magoo's is on fire.
- Yeah, I can see that.
- Single GSW to the- - Oh, my God! Now can we go home? - Lizzie, come to take the before pictures? - Shouldn't you be in pre-op? Some bovine threw me out here when a lap Nissen started circling the drain.
- Hand me that.
- The chart? No, the black marker.
Poor bastard came in trying to cure aggravated belching.
His wife's probably been in the coffee shop waiting for him to wake up.
Do me a favor.
Write "not this one, idiot" on my arm.
Oh, like it doesn't happen.
I'll be lucky to get out without both my legs amputated.
I should have you come in with me to stand guard over these gargoyles.
You can if you want to, you know.
If you're bored or curious.
I'm covering the ER.
- Well, they need you more than I do.
- I'll scrub in if I can.
You forgot "idiot.
" - I'll be there, Robert.
- Well, just in case you're not, "idiot.
" - Do you think I'm doing the right thing? - It doesn't matter what I think.
Well, that's a position I would usually advocate but now I'm asking.
You're doing the right thing.
Yeah.
- Something's in my eye.
Metal.
- Don't touch it.
- What's it look like? - CBC, chem, chest, carboxyhemoglobin.
Satting at 97.
Can someone check my daughter's ventilator? - I'll send a nurse.
- How bad am I burned? Mainly second-degree but I want to ultrasound your belly.
- Can we do another EEG? - I'll check.
SonoSite and a Wood's lamp.
- The tank blew my mask right off.
- You waiting for somebody? My husband.
- Check with the clerk at the front desk.
- No, he died.
He had a heart attack.
You need someone to take you to him? No.
He was here.
They took him.
We just wanted to stay here a minute.
- Susan needs help with a central line.
- Is there another room open? - Exam 1, maybe.
- No, it's all right.
We'll leave.
BP, 122/78.
Pulse, 114.
- TKO the saline.
- Come on, Paul.
- Dr.
Pratt? - My kid's hypotensive.
- I need the SonoSite and a pair of hands.
- Come on, Paul.
- Paul, now.
- Can I instill the Alcaine? Yeah.
Titrate eight of MS.
Keep his systolic over 100.
- Is the lung up? - It's a GSW to the right shoulder.
Good breath sounds.
Can you feel it when I touch you here? - I'm good, I told you.
- Pulse ox, 98 on two liters.
Okay.
Let's get a pocket Doppler.
CBC, type and screen.
- What is that? - GSW to the belly last week.
- We took out his spleen.
- You're out running again? They killed my brother and crippled my sister.
- We took care of them here? - Didn't help much, huh? Is Curtis your brother? What? You were his doctor? Dr.
Carter, Chen has a pediatric drowning, full arrest.
- Sinus tach on the scope, 110.
- How are his pulses? - Radial and ulnar.
- Follow serial crits.
- And then come find me with his films.
-12-year-old girl.
Fell into the water wh- Sir, relax and let the doctor do his job, okay? - How long was she under? - Don't know.
- Hold compressions.
- Not perfusing.
Compressions can put her into V-fib.
Let's do a rectal temp.
- How long since last epi? - Six minutes.
All right.
Push another.
5.
Heated humidified O2, warm saline, Bair Hugger.
Core temp is 86.
5.
Good enough.
Resume compressions.
Still no pulse.
Mg of atropine.
- How long has she been down? - About 45 minutes.
Okay.
Let's go with NG and bladder irrigation.
- When? - Five minutes.
We suctioned her.
- She triggered the vent.
- Thought she was decerebrate.
- She was.
- Wean it down to 50 percent.
Recheck another set of lytes.
Temperature.
- Ninety-seven point one.
- That's good, right? - What's her name? - Heather.
Heather, can you hear me? If you can hear me, squeeze my hand.
I got a pulse.
It's faint.
Let's try for a pressure.
- Rate's up to 72.
- All right.
Suction catheter.
- Pulmonary edema? - Or river water.
- Ectopy on the monitor.
- Heart's irritable.
Set vent temp to 42.
Four of PEEP.
Pupils are fixed and dilated.
Just follow the light with your eyes.
Good.
- Very good.
- You're doing great.
BP's steady, 110/72.
Sats are 93.
I bet you want that tube out, don't you? Okay, when I say "now," you take a deep breath and blow as hard as you can.
Deep breath.
- Ready with five of albuterol.
- And now.
Clear! - No change.
- All right, 300.
Stand by with 50 of lidocaine.
Second bolus of 25 in five.
Clear.
Sinus tach.
- Strong pulse.
- Come on, Heather.
- Wake up.
Open your eyes.
- She's posturing.
All right.
GCS 131.
Non-rebreather mask, - Daddy.
- Yes, honey? Try not to talk.
Cough all that stuff up.
Another chest and repeat the ABG.
Dad.
Mr.
Marks.
Yes.
Is she gonna be okay? She was in cardiac arrest.
She wasn't breathing on her own.
She's awake.
She's breathing on her own.
We don't know how long she was in the water.
- And her lungs show signs of damage.
- Her lungs are recovering.
It's possible that her brain may have been deprived of oxygen for a long time.
Oh, God.
Oh, my God.
- Her neurologic exam is back to normal.
- You saved her.
- I saw you save her.
- We got her heartbeat back.
But you need to know that 30 percent of all near-drownings die.
And another 30 suffer permanent brain damage.
We're just gonna have to wait and see.
- She's gonna be just fine.
- Thank you.
You're welcome.
All right.
- Can I? - Yeah, go ahead and see her.
They keep getting younger, don't they? - Is neurovascular intact? - Completely.
But I'd observe for an expanding hematoma.
You could take his staples out.
We could implant a zipper, make it easier for all concerned.
- Still waiting! - You got a bed.
- Still in pain.
- Malik, I need that EEG.
- Neurology's backed up.
- Who isn't? - Is she feeling more comfortable? - Yes.
Thank you.
She's sleeping.
Her dehydration has resolved.
And her vitals look better.
She says it won't be long.
She might be right.
If there's anybody who would wanna say goodbye They're coming from the temple.
She has a gift.
She can see inside of people.
She saw inside of me.
She was in prison for demonstrating for human rights in North Korea.
And I was in prison for Well, for other things.
She saved me.
I took it on myself to serve her purpose.
But now as I watch her embrace her death and rebirth I truly understand.
Only through our own acceptance do we realize our purpose.
- Is it scabies? - Impetigo.
It's a bacterial infection.
- What if it spreads, gets into his brain? - We'll treat it with antibiotics.
He must've gotten it from his friends, because he did not get that in my house.
Don't touch your face! - I fell.
- Is that how you hurt your wrist too? - Yeah.
- How'd you get to the hospital? My boyfriend.
Was he there when you fell? - Not so hard.
- It's gallstones, Anna.
No, I don't have gallstones.
Fatty foods bring out the pain.
I didn't even eat dinner.
I just had some pie.
- How much pie? - You know, a pie.
- You a smoker, Mr.
Dressler? - A little.
- Drink alcohol? - Beer mostly.
- Exercise? - Well, starting to get back into shape.
I was doing one of my wife's exercise videos, and Wasn't sure if it was the chicken wings I had last night - or a heart attack.
- Let's hope it was wings.
How long's this gonna stay on? About four to six weeks.
I have finals in a month.
Well, you can still study with a cast on.
Not exams.
State finals.
Cheerleading.
Well, you might have to give those pom-poms a rest.
- I'll give you Compazine for the nausea.
- My doctor tried that, it doesn't work.
- Then why does he prescribe Percocet? - That's what I'm asking you.
Demerol works.
A hundred and fifty milligrams.
- Big dose.
- It's big pain.
Okay.
One shot, one time, and then that's it.
I'm flagging your chart.
- You'll have to see a pain specialist.
- Good idea.
Haleh, 125 of Demerol for Mr? Dean.
John Dean.
Haldeman.
Bob Haldeman.
I'm serious.
One shot of Demerol, and that's it.
The ER is not a place to manage chronic pain.
Yeah, as soon as my chiropractor gets back, I'll get adjusted.
Good.
Because I'm flagging your chart.
Abby, flag his chart! - And Mr.
Johnson made a biscuit.
- A biscuit? - He took a dump on a gurney.
- That's beautiful.
Hey, Jerry what's the County-to-Northwestern biscuit ratio? - Gotta be 8-1.
- The odds are in my favor.
Banger number 17's rolling up.
Excuse me.
The nurse told me to come down here- Sit right there.
We'll get to you.
The old paint factory was the worst.
- Hot as hell.
- Couldn't see your hand in front of you.
- Isn't the fire outside, boys? - It's out.
Then shouldn't you roll up your hoses, head back to the station feed that little spotted dog, polish your poles? - Are you cranky or flirting? - What? - "Polishing your poles"? - GSW to the left chest.
- Pressure's 100 palp.
- Shot in the shoulder too? - No, that's an old one.
- Old one? - Call my mom.
- Let us get you inside first.
Steri-Strips on the belly.
- He's a baby.
- Knows how to take a bullet.
- What's your name? - Turner.
- Does it hurt here? - Yeah.
How about here? You want me to call your mom? - You don't want to talk to your mom? - She'll kick my ass.
- Maybe that's what you need.
- Look, man.
She don't understand.
I don't understand.
- Dropped my brother, that's all there is.
- No.
That is not all there is.
You're what, 13 years old? There's a lot more than that.
- Not where I live.
- You're not one of those guys.
Not yet.
You don't have to be.
- Somebody's gotta take care of business.
- Your business is your mother and sister.
Who will take care of business when you're killed? We need the room now! Mass suicide on Fulton.
Two more behind us.
C- spine, chest, pelvis, lumbar spine series and right tib-fib.
- You jump out a third-story window? - I was about to take it.
He forced me.
- Gram of Ancef.
- Set up for gastric decontamination.
Hang on, Turner.
- Why can't I feel my feet? - We'll take care of that.
- Sats are down to 87.
- Up him to 15.
X-ray for portable chest.
- Will somebody please call my mom? - No problem.
Just hold on.
Here.
Write down her number.
- Set up for Narcan and charcoal.
- What did they take? Drank poisoned Kool-Aid.
We found 60.
- Only 10 were breathing.
- They're on PVCs.
Okay, stop.
Pull the ambu-bag.
Pull it.
On-scene survivor said they were meeting the eclipse.
It's almond smell.
Cyanide.
Gallant, it's cyanide.
- We need antidote kits now.
- Pulse ox is 99.
- She's seizing! - Her cells can't use the oxygen.
ST elevation on the monitor.
All right, four of Ativan.
Lactic acidosis to the heart.
When amyl nitrate perles down, ET tube and bag.
Sodium nitrate to follow.
Chest tube on the left.
Type and cross for six.
- We need the room.
- Pupils mid-dilated, non-reactive.
- Move him into the hall.
- It's closing in, dark.
- Page Ophtho.
I'll be right there.
- Sats are down to 84.
- Rapid induction, 802.
- Bad stabbing victim rolling up.
- Pratt.
- Abby.
Ten blade.
- Don't worry.
We got you.
- Chart's in the rack.
AMA.
- Thirty-two French.
- This your mom's phone number? Turner? - Turner? I need a BP.
He's crashing.
- He can't count fingers.
It might be traumatic glaucoma.
Tinoptic, pilocarpine drops after mannitol.
Repeat ABG, lytes, lactate, methemoglobin and cyanide levels.
- ST segments are down.
- First troponin's elevated on Dressler.
Chest pain, Exam 4.
Tell Anesthesia he needs a Greenfield.
Inch of nitropaste, aspirin, five of metoprolol.
Check for acidosis.
- I'm more concerned about fat embolus.
- Spontaneous eye opening.
Sorry, sir, you're gonna have to catch the next eclipse.
- Lost the pulse.
Crank it.
- Fifteen hundred in the Thora-Seal.
- Suction to me.
- No tamponade.
Looks like the pulmonary.
- Starting internal compressions.
- Hilum's clamped.
Pratt, penetrating abdominal trauma.
- Carter, two more ODs with one apneic.
- Get Weaver.
We need more docs in here.
- Oh, man, what happened? - Oh, God.
- Found bleeding with stab wounds.
- Mom's next door.
They were hugging.
- Breathing? - Agonal.
Pediatric intubation tray.
Five-and-a-half ET tube- Pre-op labs, get four units O-neg and get Surgery here.
- They must not have given her enough.
- Must be a couple units on the clothes.
- There was blood all over.
- Loss of pulse.
Start compressions.
Ragged incision.
- They use a meat cleaver? - She's open down to the bladder.
Who would do this to their kid? There were 10.
This one had a chance.
- And that looks like a pregnant uterus.
- Where's the baby? - Oh, God.
Somebody ripped it out of her.
- Okay, I'm in.
- Take over.
- Have RT send a pediatric vent.
HemoCue's 5.
1.
Retinal arteries and veins are bright red.
O- neg wide open to the spine.
- That's consistent with cyanide.
- Check a femoral with compressions.
- Pharmacy only had one more cyanide kit.
- Oh, damn it! Hospital only stocks three of them.
- Lap and pressure.
- We need more kits.
You need to deliver the uterus.
Call Mercy, call Lakeside, Northwestern.
- Will they get here in time? - Just clamp it off.
- Bradying down.
- Okay, okay.
Side-biting clamp.
- Give what we've got to the daughter.
- Pressure going down to 80.
Nitrate popper freeze.
Daughter gets 30 cc's of sodium nitrate.
- Maybe the girl can wait.
- Give the mother whatever's left.
- That's a fallopian tube.
- That's an ineffective dose.
Uterine artery runs at the inferior margin.
She needs 10 cc's.
- Yeah! Clamp it now.
- I know! I got it.
I think I got it.
All right, stop compressions.
- Palpable pulse.
- Okay.
Okay, trauma kit.
Keep jamming with O-neg and hope she wakes up.
Keep methemoglobin under 40 percent.
Come back with her films.
- Thiosulfate's onboard.
- Call of six on the mom.
- Hundred of lidocaine.
Did you get a kit? - Twenty minutes.
- Crack the last amyl nitrite.
- Carter.
- Hey.
- Soft restraints? Yeah.
Purposeful movements.
We're getting some brain function back.
- Hey.
Hey, sweetie.
- How's that?! Huh?! How's that?! Clear.
Come on, Turner.
- Still in fib.
- How many units are in? - Six of packed cells.
One of FFP.
- Clear.
Turner! - How's that?! - Drop it! Drop the scalpel! - How's that?! - Drop it! Chest tube and intubation tray! No, wait.
Turner, you're bleeding.
Security! - I don't hear an air leak.
- Epi's had time to circulate.
Heart's filling well.
Checking the monitor.
Start a second line of saline, prep the left chest.
Turner! Time of death, 00:28.
- You didn't call him back? - I'm sure.
After four weeks? You don't know that.
Maybe his grandfather died or something.
There are phones in funeral homes.
We can get you a little Valium to take the edge off.
- Dr.
Romano? - What? Would you like Valium? Help you relax.
I don't wanna relax.
- No way.
- I thought you were crazy about him.
- How we doing, Dr.
Romano? - Never better.
- Can you scooch over for us? - Tank him up with a liter.
- Who's that scrubbing in? - Dr.
Starkman, third year.
No way! No residents! Jesus, where's this table been, in the freezer? I know.
It can get a little cold.
I'll be doing the procedure, Robert.
Once you're out, we'll make a circumferential cut- Yeah, I know the routine.
Get on with it.
Okay.
Set up a pre-op Doppler, a sterile Stryker set.
- I thought Corday was scrubbing in.
- What for? She was with an ER patient.
You want me to page her? - All right.
Mix up a gram of Ancef.
- May want to put that on the other hand.
Sorry.
Count backwards from 10, Dr.
Romano.
Ten nine eight Hold still.
- Tono-Pen's 20.
- Two drops of lodipine and Pred Forte.
- I'm losing my sight? - Maybe partly.
The burn and traumatic glaucoma.
Only in the one eye.
What's her pressure? - Need depth perception to be a firefighter.
- We're not even sure yet.
Where's OB? Coburn took a quick look, went to scrub.
Mia, you were stabbed.
We stabilized you.
But in order for us to save your uterus, you're gonna have to go into surgery.
Last crit was 19.
Pratt.
Pratt.
We don't know.
On a scale of one to 10, how bad is the pain? A high eight.
No, it's a nine.
Sorry to tell you this, it looks like you're having a heart attack.
We need to take you upstairs and unblock the vessel with a catheter.
- Dr.
Carter, your dad's on line three.
- Okay, thank you.
Do you want us to call your wife? My wife took the kids to Lincoln Park to watch the eclipse.
- I left a message for her.
- Not to worry.
They'll take you right up.
Integrilin bolus, then 15 mgs per hour.
Where is that girl's EEG? - Tech took it up.
- Well, then get Neurology on it! Hello? Hey, Dad.
How are you? Where are you? - John, what the hell happened? - What? - Where did he get a scalpel? - Too many patients, not enough staff.
And not enough medicine.
Which is why you prioritize based on severity of illness.
Really? Well, can't we just postpone for a couple days? - I'll stay in Chicago.
- This woman has- I'm on the phone, Kerry! I'm sorry.
No.
It's just one of those Okay.
Yeah.
We can reschedule.
Fatal arrhythmia.
That's what happens when you chug too much cyanide.
And are undertreated.
- The daughter was less critical.
- And could have died.
The girl didn't have a choice.
Waiting room rack is over 30.
I'll take lead for the rest of the shift.
Hey, you're bleeding.
You're bleeding, Carter.
- What? - Your back.
Malik, can you draw up HIV/hepatitis serologies on that stabbed gangbanger? - Already took him to the morgue.
- Have Pathology do it.
- Lab said they can take this guy in 30.
- No, now.
He's losing heart muscle.
Push half a dose of TNK.
It's just gonna be one more minute, Mr.
Dressler.
Doc, I got a really bad feeling here.
Don't worry.
We're gonna take care of you.
Do me a favor.
I need a piece of paper and a pen.
I wanna write a note to my kids just in case I - In case they get here, and I'm- - Yeah, absolutely.
- We have a good chance of reversing- - Dr.
Carter, we need you! Is he under? Well, I hope so.
I'm disarticulating at the elbow.
Way up there on the Bovie.
- He was asking for you.
- I was detained.
- I have an unstable pulseless tib-fib.
- Well, you're here now.
Two large-bore IVs, trauma labs, four of O-neg.
- What are you doing? - Ten-foot fall from scaffolding.
- Rebar through the right chest.
- C-collar and gurney.
Get him to Trauma.
Rebar's stuck in a concrete block.
Must be 500 pounds.
- Can't we just pull him off it? - No.
He'll bleed out.
Rebar's compressing torn vessels.
Have fire department bring extrication.
Get a portable monitor and an E cylinder.
- Up there? - And get a HemoCue.
- You can't take it out? - In the operating room.
Do you feel any numbness or weakness in your legs? No, not really.
Decreased on the right but no JVD or tracheal shift.
- Look.
- What? Some guy wants to talk to the doctor who treated the pregnant stab victim.
Take a message.
You okay? Sir? Just get a little winded sometimes.
You ought to get that thing fixed.
Half our budget comes from money people lose in that thing.
- What's your name? - Ray.
Ray Jamison.
- Mr.
Jamison, you have any chest pains? - More like palpitations.
Comes and goes.
I've been to a couple of clinics, they keep saying nothing's wrong.
- You don't have a doctor? - Medicare kicks in next year.
- Ever have an EKG? - Normal, they said.
But my ticker was on good behavior then.
You should take this.
He knows something about the assault.
I can get you something that at least looks like food.
- You don't need to do that.
- No.
I'm your doctor now.
- Thanks.
This is Dr.
Pratt.
- Is my wife okay? - Yeah, who's this? - She's alive? - Yeah, she's alive.
Why? - I've got the baby.
What? Let's get a 12-foot ladder.
- HemoCue's 9.
4.
- Titrate four of MS.
Where's the O-neg?! Right here! Do we need an air bag? - It's pretty tight.
- How much can we raise him? - Maybe an inch.
What's his pressure? - Up to 100.
Dr.
Carter, Exam 2's drowning in pulmonary edema! - Who? - The Buddhist nun.
I got it.
Go.
- In the alley? - The north side.
Why didn't he just bring it in? His wife came home with a baby and said she gave birth while he was at work.
He saw the news and put it together.
Here.
Grab a BOA kit.
- Susan.
Set up for neonatal resuscitation.
- Where? Is that for pain? She's in pain again.
No.
This is for the fluid in her lungs.
I can give her morphine.
But it will suppress her breathing even more.
- Where? - I don't know.
He just said in the alley.
No breath sound on the right.
It's a massive hemothorax.
He needs a chest tube tray.
Inflate.
I'll retract the supinator.
You divide.
Mosquito.
Radial nerve.
Bone saw.
Four of morphine onboard.
We better check BP.
No more BPs.
- Find anything? - No.
- Are you sure this wasn't a prank? - Wait, wait.
Listen.
- There must be three liters in there.
- Grab a sterile basin, the biggest we got.
- Tachy at 140.
Barely has a pulse.
- Hang another two.
- Doc, get rid of the O2.
- Make it fast.
Clamping the tube.
Go! And cut through the periosteum.
Want the final honors? No.
Why didn't he put him where we could see him? He didn't want it to get run over.
- Find him? - No.
Slide the backboard up here.
Hurry up.
- Pulse ox is down to 83.
- Get ready to put the O2 back on him.
- He's free.
- Roll him.
Arm's free.
Rasp back.
You don't want a bone spur.
Little more periosteum.
Three-0 Vicryl.
Hey, over here! Hey there, little guy.
Can you hear me? Hello? Yeah, barely.
What's going on? One of our doctors was hurt yesterday.
Had to be evacuated to Burundi.
- Hurt how? - We were expecting a fourth.
- But they're having trouble with her visa.
- Luka, you gotta speak up.
Can your contact at the State Department push her visa through? - What contact? - I thought you knew someone there.
My family had a friend that was ambassador to Uruguay- - Call him.
- I don't know him.
Can the Alliance fix it? Luka.
Not enough.
- Okay, I'll be right there.
- What? We're trying to travel to Matenda, but the main road is blocked.
There's a cholera epidemic in the refugee population.
We can't even get them rehydration solution.
You want somebody to pitch in for a couple weeks? - What? - I've already had my shots, my visa.
I thought you changed your mind.
Yeah.
But, you know, if you're stretched Okay, I gotta go.
Can you come now? - Yeah, okay.
- Get on a plane.
Call the Alliance- - Charge to 360.
When did he arrest? - Now.
- Clear! - Is that my Ml? - V-fib.
- Bigeminy flipped into V -tach.
- How many times did you shock? - Third one coming.
An amp of epi.
I'll intubate.
- What the hell's he still doing down here? - I told you Cath lab said 30 minutes.
All right.
Prep 100 of lidocaine.
He's a little tachy at 165.
Slight flow murmur.
Fontanelle's soft but sunken.
He's definitely dry.
He's full-term.
Mom's in post-op, stable.
They saved her uterus.
How is he? Heel stick a glucose, but I think we have a healthy baby.
He's a screamer.
Wouldn't you be? Literally ripped from your mother's womb by some lunatic.
- Hell of a way to come into the world.
- Yeah.
But life only gets better after that.
I'll bolus 20 per kilo, bring him up to mom.
I'll do it.
What? If Accu-Chek is less than 50, then I need to push D25.
Whatever you say, doctor.
- Asystole.
- All right.
Give me the pacing pads.
- Let's push three more of epi.
- Resume CPR.
The family's here.
The letter.
- What? - Pen and paper? - Did you give him a pen and paper? - No.
- Why not? - What? He asked for a pen and some paper to write a letter to his kids.
He didn't ask me.
There it is.
It's just a Subq bleeder.
- Clamp that off.
- You want cautery? No.
I'll use the silver nitrate sticks.
Don't contaminate the field.
Robert? Bovie that bleeder.
- Pick-ups.
- Robert, it's Elizabeth.
Lizzie.
She's one hell of a surgeon.
So beautiful.
Done.
That was just a small EBL.
But we can order a post-op CBC just to be safe.
You taking good care of me? I'm trying, yes.
I love you, Elizabeth.
You need to get some rest.
Let's put a fresh pressure dressing on.
And I'll check it later.
Hey, you have a visitor.
- Is that? - It's your baby.
- You had a boy.
- Is he okay? Yeah.
He's great, active, likes to play hide-and-seek.
My baby.
You wanna hold him? Yeah.
Come on, little guy.
Gotcha.
I gotcha.
He's still asystole.
- He's had two of atropine? - Oh, yeah.
All right.
Increase the pulse duration to 20 milliseconds.
Dr.
Carter.
- How long we been going? - Sixty-two minutes.
All right, stop.
You can stop.
Mrs.
Dressler, I'm Dr.
Carter.
Your husband came in with chest pain.
He was having a heart attack.
He's dead? We were about to move him up to the Cath lab to unblock the main artery when he went into cardiac arrest.
And I couldn't get him back.
Did he know? Did he know what was happening? Yeah, he wanted me to tell you that he loves you all very much.
- Hypotensive encephalopathy on Nipride.
- Let me guess.
No ICU beds.
Oh, the gang war continues.
Dyspareunia waiting on Gram's stain and wet mount.
Dyspareunia's better than no pareunia.
We have Mr.
Jamison here who is back in normal sinus - after I picked up an atrial flutter.
- I thought heart monitors did that.
- Feeling more comfortable? - It's a miracle.
What did you do? I flipped the circuit breaker back on.
But now you can be treated with a simple prescription.
- I come see you at your office? - This is my office.
- Or was.
- What? I just work in the hospital.
Well, that's too bad.
You're a fine doctor.
Thank you.
See you, sweetness.
I'll call you later.
Congratulations, Greg.
You survived the County experience.
Oh, no.
Not just survived it.
I whupped its ass.
- Hey.
- Hey.
Did you see the eclipse? Yeah.
Sort of.
Pretty freaky, huh? Yeah, I guess.
You have a rough shift? Yeah.
There was this guy, this Ml.
He asked me for a pen and some paper to write a note to his kids, and I couldn't save him, but I could have What? Nothing.
Nothing's right here.
Hey.
I haven't seen you in a week.
That's it? Luka called me looking for you.
He was under the impression I might know where you were.
You're going, right? To Africa.
It's not Rio.
But it's not here.
Are you supposed to be in there? It's a first-aid kit.
Damn near the only thing that survived.
- How was your last shift? - Lots of excitement.
Well, if you're ever bored, God knows we need the staff.
- Yeah.
- Dr.
Pratt.
You forgot to give Jamison his Dig prescription.
- Jing-Mei can do it.
- Point two five or.
125? No.
A lower dose.
Next appointment at the cardiology clinic is in four months.
That's okay? Just let me write it.
Aftercare instructions too? Return to the ER in a week for a Dig level.
Tell him to call Dr.
Pratt and make sure I'm on duty first.
I thought you were going to Northwestern.
Guess I'm more of a South Side doc.
- You staying here? - What the hell.
This place kind of grows on you.