ER s15e07 Episode Script
Heal Thyself
Hello, I'm Eriq La Salle.
This week we lost the creator of our show, Michael Crichton.
A gentleman, gracious and witty.
Brilliant writer, intelligent, unfailingly kind.
But most of all, Michael was a good friend and we will miss him.
RUSSELL: Baby.
Where are you?.
[FOOTSTEPS APPROACHlNG.]
-What are you doing in here?.
-I hate this wallpaper.
We'll redo it.
I don't know what you were thinking last night, talking about that.
It was a dinner party, I didn't pick the topic.
Well, you certainly didn't hesitate to dive right in.
Maybe that's because you won't talk about it when we're alone.
You think I blame you for what happened?.
You think I'd still be here if I did?.
I try not to worry about who you blame.
No offense, living with a teenage boy is like living with an animal.
Only, cows make better conversation.
Butt abscess.
Needs dressing.
At least a cow's not a predator.
Sarah's friends are like a pack of she-wolves with cell phones.
Look, a new one just for you.
Anal warts.
This is so ass.
Looks like the Gates-Taggart merger's in full swing.
-You mean the Brady Bunch from hell?.
-It's going great, she'll never admit it.
-Really?.
Okay.
-Never been happier, loves to complain.
This much we know.
-What's that supposed to mean?.
-Sorry?.
The VA sent these records over and some guy called from the Wounded Warriors' Project.
-What's that all about?.
-ls the ladies' this way?.
Down the hall and to the left.
BERTHA: Thank you, dear.
-Hey, is Banfield on?.
She should be in soon.
-That about our homeless vet?.
-Yeah.
-What's the story?.
-I'm gonna figure it out.
Hey, uh, Bertha.
Bertha, this is not a good time.
Bertha! Whoa.
Go get her, big boy.
And Hoberman's still waiting on a cholecystectomy.
When are you gonna clear out all these boarders?.
DUBENKO: We're working on it, Sam.
Oh, you might wanna get more than one intern down here doing your babysitting.
-How's Dr.
Wade managing?.
-Customers seem satisfied.
Yeah?.
What about you?.
Are you satisfied?.
I need to loosen up a bit.
I have a tendency to micromanage-- Yeah, Cate mentioned that.
-Cate who?.
-Dr.
Banfield.
You know, department head coffee klatch.
Great.
You know, autonomy's a fine teaching device, Neela Iet's just make sure it doesn't lead to slowness or distraction.
Okay?.
You guys ready?.
Good.
Ready to round.
Where's your intern?.
BERTHA: When are you going to get me a bed in a real room?.
Uh, soon.
Uh, we're a little backed up.
I was meant to go under yesterday.
I haven't had anything to eat but some Jim Jones juice and Jell-O that made my poop red.
-Red?.
Wait, you mean--?.
-Now this?.
The mattress is made of cement and I've seen airport runways that were less noisy.
Am I smudged?.
Uh.
-Just-- NEELA: Hello?.
-What are you doing?.
-Um.
[CELL PHONE RlNGlNG.]
[GRUNTlNG.]
Oh, God.
Hey.
I'm in the middle of my run.
[SlRENS WAlLlNG.]
We can talk about this later.
No, I'm not.
It's just that.
Listen, I gotta go now, Russell.
[LUlS SHOUTlNG lN SPANlSH.]
[LUlS SHOUTlNG lN SPANlSH.]
NEELA: Six down, two to go.
ANDREW: That's not so bad.
That's just the ER.
We have 40 more waiting upstairs.
ANDREW: Right, 67-year-old woman presents with-- -God, with the age again.
-neck mass and dysphagia.
-Dis-what?.
-Uh, pain on swallowing.
Saying it fancy doesn't make you seem smarter, Andrew.
It makes you seem insecure.
It's a shorthand doctors use, to save us time.
Yes, in theory.
Uh, her son noticed the mass about three months ago when she visited him in Michigan.
Ann Arbor.
He's a professor at the university there.
Oh.
Fine needle aspiration showed a degenerative albeit benign cyst.
Thyroidectomy is indicated for symptomatic relief.
All right, that's thorough.
Next?.
ANDREW: Review of systems positive for headache, back pain, constipation.
Let's stick to the thyroid.
That's what we're here for.
I'm with you, Bollywood.
Uh, no palpitations, diaphoresis, heat intolerance.
However-- Her TSH is normal so we know there's no hyperthyroidism.
Right?.
-Right.
But there is-- -Okay then.
Moving on.
Three-year-old, near-drowning with hypothermia, core temp's 84.
Bradycardic in the 6Os with a thready pulse.
-Dr.
Banfield?.
-A ride-along?.
I was out.
I saw the rescue team.
T ook almost 2O minutes to find the girl.
ALVARADO: Twenty minutes?.
She was underwater that whole time?.
[SPEAKlNG lN SPANlSH.]
Grandpa took her on a walk because she was acting fussy.
[LUlS SPEAKlNG lN SPANlSH.]
Everything was good, she was happy.
[SPEAKlNG lN SPANlSH.]
ALVARADO: And then the baby was just gone.
TECH: Go deep.
Go.
RUSSELL: Go, go, go! [GRUNTS.]
Chase me.
Nice pass.
That's why they call it a Hail Mary.
BANFlELD: Ha, ha, ha.
-Mwah.
[BANFlELD AND RUSSELL LAUGHlNG.]
You didn't chase me.
Because I'm the quarterback.
Now, buttonhook.
I'm tired.
Aw.
One more touchdown, then we get ice cream.
RUSSELL: Booker and Banfield, that's all the Bears are gonna need this year.
[WHOOPS THEN LAUGHS.]
BANFlELD: What's your plan? She has a pulse, so warm her up and wait.
-So?.
-Access, warm saline get Respiratory down with a vent.
Get Bair Hugger, prep for intubation.
I'll be right in.
-I have a favor to ask.
-Not now.
-I need your help getting an MRl.
-An emergency, call the radiologist.
It's not an emergency but it needs to happen today.
I have a homeless vet.
Cognitive deficits, behavioral changes.
Let Neuro work it up.
They said they want him as an outpatient, which is never gonna happen.
He's not an ER patient anymore, it's out of our hands.
He was in lraq.
GATES: A war hero.
Served in the same unit I did back in Desert Storm.
I hear the harmonica playing, Dr.
Gates, but work is work, the rest is irrelevant.
Dr.
Banfield, I get this whole tough-boss thing and it works for you it really does, but cut me some slack.
I need your help.
[PAPERS RUSTLlNG.]
[BANFlELD SlGHS.]
Dr.
Banfield, the old ball and chain on line two.
Thank you.
Tell him I'm in with a patient, Frank.
I'll call him later.
GATES: Max Gonzalez sergeant first class.
You figured out who I am, huh?.
Mm-hm.
Hundred and first airborne, first squadron, 75th cav.
Yeah.
Yeah, that's right.
They called us the Widowmakers.
So you remember it?.
My memory's a work in progress.
But it's getting better.
-So thanks for that.
-Don't you wanna hear more?.
Not really.
Awarded a silver star in 'O6, later wounded in a rocket attack killed a bunch of buddies.
Doctors documented altered behavior.
Anger, depression, hostility.
-They gave me some pills.
-Yeah.
SSRls.
-Antidepressants.
-Didn't help much.
They discharged you on a 5-1 3.
Do you remember what that is?.
-Yeah, it meant that I could go home.
GATES: No, it meant the Army -could stop giving you medical care-- -lt meant I could get out of there.
Because they said you had a personality disorder.
Something wrong with you before you enlisted.
Maybe there was.
That's what my old man always said.
What if there wasn't?.
What if it was a lie?.
Your symptoms are consistent with a traumatic brain lnjury, TBl.
You could have suffered when that rocket hit.
So you're saying what?.
They dumped me?.
I'm saying I think they missed it mistreated it and sent you packing for the cheapest possible price.
I wanted out, doc.
Trust me, I wanted out.
Yeah, because you needed out, but not like this.
I don't wanna be here, I don't like it here.
I know how it is to come back from war and feel adrift.
Max, just give me a couple hours to help you.
[ELEVATOR BELL CHlMlNG.]
Tube's in.
Get Pharmacy to send more warm saline, as much as they've got.
-ABG's back, she's acidotic, 7.
22.
MARTlN: Should we use a high vent rate?.
The mother's out here.
Someone should probably talk to her first.
Dr.
Morris, update the family.
I kind of have my hands full here.
Dr.
Martin.
Okay, but, uh, shouldn't you?.
I mean, she's your patient, right?.
-What's the CO2?.
-Forty.
Standard rate, the pH might normalize as we get the temp up.
Hello.
You the mom?.
Sandra Herrero, is my daughter okay?.
It's hard to know yet, we're trying to warm her up now.
She's very strong for her age.
She's a good girl, very sweet, so she'll be okay?.
The cold water may have protected her heart and brain.
We're just waiting to see.
Please, I know you know.
So tell me, is my baby gonna be all right?.
RUSSELL: Why can't you ever give a straight answer?.
[LAUGHlNG.]
You wanna have baby?.
Another baby?.
Now?.
-Well, not right now, but-- -Ha, ha.
Excuse me?.
Is--?.
Is this your son?.
There's something wrong with him.
Daryl?.
RUSSELL: What?.
-Daryl! Daryl! -It's happening again.
-You're okay.
-Call an ambulance?.
-No.
I'm a doctor.
WOMAN: He doesn't look good.
-He's burning up.
BANFlELD: Just febrile seizure.
Get him home, cool him down.
Maybe we should be safe.
It's just like last time.
Look, it's stopping already.
Are you sure?.
I've been doing this too long to make promises.
But I'll tell you losing control is not going to help her.
If that's what you gotta do, do it outside.
In here, you be the mom, you be calm you put energy into helping your girl fight back because that's what she needs.
Can l--?.
Can I go be with her now?.
Yes.
[BELL CHlMES AND ELEVATOR DOORS OPEN.]
-Still seven boarders here.
-Cate's gonna kill me -if we don't clear them.
BANFlELD: Yes, she is.
How long is this gonna go on?.
You people are practically living here.
And by ""you people"" you mean?.
-Surgeons.
-Of course.
We're trying to clear overflow as quickly as possible.
SAM: Miss Mendenhall is crashing.
-Well, that's one way.
SAM: BP down to 6O, palp.
-We've got a massive Gl bleed.
Saline wide open on pressure bags prep for central line, two units on rapid infuser.
Let's go.
-How's her airway?.
SAM: Not great, even on 1 OO.
Okay.
Tube her, Neela.
Hey.
-She complain of abdominal pain?.
-No.
Any history of blood per rectum?.
Uh, no.
Not so far as I know.
NEELA: Suction's on high.
DUBENKO: Okay.
Call Gl.
Endoscopy if we get her pressure up.
SAM: Lost the pulse.
-Ah, damn it.
Starting compressions.
Dr.
Banfield, our frozen girl's having runs of v-tach.
ALVARADO: I've got the amiodarone.
Give 75 milligrams and set up an infusion.
MARTlN: Got it.
-BP's 67/32.
Valecia's temperature's dropped a little.
We're working on that.
-It's supposed to go up.
-I said stay calm.
I'm stepping up rewarming with some pleural lavage.
You see that?.
Huh?.
-How are coags?.
Platelet count?.
ALVARADO: Not back yet.
Specimen clotted, we had to send it again.
We should not have to wait an hour.
We'll give platelets and FFP empirically.
BANFlELD: Why do we have to fight the same battles every damn day?.
Go on, do it.
[SlGHS.]
[BANFlELD PANTlNG.]
DUBENKO: How long have we been going?.
Thirty-nine minutes.
It's time for another epi.
-lt won't do any good.
-What about the Gl consult?.
They won't scope a patient without a pulse.
-Dopamine?.
-Eight units of packed cells, two FFP.
We've replaced her entire blood volume twice.
If the heart could come back, it would have by now.
We're done.
ANDREW: Uh-uh.
-We're done.
Two, three, four.
[EKG FLATLlNlNG.]
Eleven-fifty-eight a.
m.
-Any relatives?.
-A son.
-Sorry?.
-She said she had a son in Michigan.
I'll call him.
Okay.
I'll get started on the paperwork for the coroner.
Could you get me--?.
Could you get me a death kit please?.
-I can take care of that if-- -Please.
Pull the curtain behind you.
[ANDREW SNlFFlNG.]
I'm sorry.
I'm sorry.
T omorrow's not good enough, she needs it now.
-What's the hold-up?.
-There's no ECMO unit in the hospital.
-What?.
That can't be.
-County only has two machines.
One's in use, the other's out for repairs.
Systolic's down to 44.
Valecia needs a machine that will warm her blood and do the work of her heart and lungs.
We don't have that here, so we have to transfer her to another hospital.
It's gonna take hours for a hospital to accept her, a transport team to pick up.
Time is critical.
So let's not waste it.
-Call transport.
Go.
-This girl's not stable enough.
Increase rewarming, get the heart in better shape before we ship her out.
She still has a pulse and a BP.
Now is our window.
Dr.
Banfield.
She's here now.
We gotta work with what we have.
BANFlELD: We don't need to go to the hospital.
RUSSELL: You don't know that.
He's groggy, he's post-ictal.
Just like what happened the other time.
That wasn't the same.
He was fine in 1 0 minutes.
He had a full workup, he stayed overnight.
-Spinal tap, CT.
-You're not being objective.
They terrified him and found nothing.
It was nothing.
Febrile seizures recur.
The pediatrician warned us about it.
What if this is different?.
If he is not better in 20 minutes, we'll take him in.
[EKG BEEPlNG.]
She's in v-tach again.
MORRlS: We got a pulse?.
ALVARADO: Thready femoral.
Okay, Morris.
Lead the way.
Let's move her to a trauma room.
Prep for peritoneal lavage.
T en more liters of warm saline and grab a thoraseal.
Wait.
You're leaving?.
Get it started.
I'll be in soon.
It was probably diverticulosis.
So she blew an artery in her colon wall and bled to death.
It wasn't foreseeable.
She had none of the predictors.
-Like bloody stool?.
-Yep, that would be one.
She had it.
-Well, it's not here.
You never said.
ANDREW: She had it.
Did you do a rectal exam?.
Check for occult blood?.
Did you ask her about any specific signs of Gl bleeding?.
She, uh-- She said something about the food making her stool red.
-Why didn't you bring this up at rounds?.
-Because she had so many complaints.
Her headache could have been a brain bleed, her backache a ruptured triple-A.
It's your job to decide what needs to be considered and when to speak up.
If you're submissive when someone's life's on the line, you're not ready-- I try to speak up and nobody listens! Let's discuss this later.
There's no way to be ready for something like this.
But in the end, it'll make you better.
You can't be a great doctor until you've killed a patient.
Yeah.
I've heard that before.
I think it's called a rationalization.
It's only been 1 5 minutes.
It's too long, I'm-- I'm calling 91 1.
[BANFlELD SlGHS.]
Russ, he's waking up.
Hey, sweetie.
How you feeling?.
Hey little man, you had us scared.
Can't have our number one wide-out on the injured reserve list.
Here, have some water.
[RETCHES.]
BANFlELD: Call an ambulance! Call an ambulance! [PHONE RlNGlNG.]
Oh, don't bother, that's my private line.
ER.
GATES: Vindication.
Look.
""Diffuse axonal injury in the parasagittal white matter, consistent with TBl.
"" -Yeah, and this is vindication because?.
-This is gonna save Max's life.
Put him on a path of getting healthy, medical coverage.
You convince Neuro to readmit him.
GATES: I can, with your help.
-Dr.
Gates.
-lndulge that inner softy one more time.
-This is the last time.
I wanna hug you.
You'll be the one with traumatic injury.
You're the best.
-Dr.
Banfield.
-Yeah?.
-Valecia lost her pulse.
GATES: Hey, Suri.
-What happened to my patient?.
-That bed's been empty.
-Anybody see him leave?.
-I don't know.
Frank.
I had a guy in there from radiology, Max Gonzalez, a vet.
-He had a duffel bag?.
You seen him?.
-That guy was real jumpy.
He went outside for a smoke maybe 1 5 minutes ago.
[SlRENS WAlLlNG.]
Max! Hey, Max! [CAR HORNS HONKlNG.]
Max! Wait up! What happened?.
Went into v-fib.
Didn't respond to the shock, she's still too cold.
This is why I wanted to transfer.
This is what I was worried about.
Think she'd be better off coding in a rig?.
Please.
I stayed calm.
I did what you said.
Please help her.
BANFlELD: Please.
You don't need to do that.
-Okay.
Don't want him to pull the lV.
-I'll hold his hand instead.
[LUlS SPEAKlNG lN SPANlSH.]
[SPEAKlNG lN SPANlSH.]
It's getting harder to bag.
Might be pulmonary edema.
Get sterile.
You can help with the thoracotomy.
Thoracotomy?.
Why?.
Myocardial irrigation.
I'm gonna open your daughter's chest, flush saline over her heart.
No, please, don't.
Something else! -I know it's scary.
-Try something else! If we don't get her heart beating, she'll die.
I'm gonna need a 1 0 blade.
[SlREN WAlLlNG.]
Is there a fire, Mama?.
No, baby, we're in an ambulance.
We're gonna make sure you're okay.
Where's daddy?.
He in the car right behind us.
MORRlS: Are you sure about this? We are not gonna let this baby slip away.
Not here and not now.
PlCKMAN: Okay, ma'am we're here.
[DOORS OPEN.]
Welcome to County General, I'm Dr.
Greene.
Are you the mom?.
BANFlELD: What's our core temp?.
ALVARADO: Still 86.
Take it again.
-Just did it two minutes ago.
-Take it again.
[SPEAKlNG lN SPANlSH.]
-lnternal paddles.
-She's still too cold.
MORRlS: There's nothing to lose.
Clear.
[SANDRA SPEAKlNG lN SPANlSH.]
-No change.
-Go again.
Why are you doing that?.
BANFlELD: We've gotta get her heart going.
Nothing's working.
Why isn't anything working?.
We're just getting started here.
HALEH: Ceftriaxone's in.
Finish the bolus, then run fluids at 1 OO an hour.
-He needs a D-stick, a serum CK.
-Hour ago he didn't need anything.
-Why don't we have labs back?.
-You in the medical field?.
ER attending at U of C, where trauma labs are back in 1 0 minutes.
HALEH: Welcome to our world.
-Sat's 91 on 1 OO percent.
-Come on.
Come on, Daryl, wake up.
All right.
Crank the O2.
What about an ABG?.
With your son's depressed consciousness, we need to consider-- Why don't we do a head CT first?.
We have one scanner, your son's in line behind two criticals.
-You have a critical patient here.
-Cate, let them do this.
GREENE: Is Elizabeth working today?.
-I can check.
GREENE: Mm.
Forget it.
Call the lab and get them to read the CBC over the phone.
[MACHlNE BEEPlNG.]
HALEH: Pulse ox is 87.
Daryl, honey, wake up and breathe for us.
Six of etomidate and 3O of sux.
No, no tube.
He's just post-ictal.
Your son's vomited blood, he's been altered for over an hour.
-My son has a history of seizures.
-Seizure can't account for that.
A Mallory-Weiss tear, atypical presentation.
He's hypoventilating and his brain needs oxygen.
-Why don't you check an ABG--?.
GREENE: Listen.
I need you to be the mom now, I'm gonna be the doctor.
It works best that way.
-He's right.
-Who's running the floor?.
I am.
And I've been doing this job for a while.
So you need to trust me.
BANFlELD: Clear.
She should be warm enough now to respond to the shock.
Clear! I don't understand this.
Otoscope.
Mr.
Herrero, did you see her hit anything on the way down?.
[SPEAKlNG lN SPANlSH.]
[SPEAKlNG lN SPANlSH.]
On some rocks?.
Anything?.
[SPEAKlNG lN SPANlSH.]
She was really cranky, so he took her out.
[SPEAKlNG lN SPANlSH.]
He's asking if it's his fault.
If he did something wrong.
GREENE: CAT scan shows signs of hypoattenuation in the distribution of the MCA.
I'm not a doctor.
Can you explain that?.
-Your son had a stroke.
-What?.
-[ST AMMERS.]
Why would he have that?.
GREENE: I can't explain that yet.
HALEH: He's bradying down.
-You need to give thrombolytics.
GREENE: Not without a CBC.
All right, O.
2 of epi and prep some atropine.
Let's keep neurosurge in the loop.
-You said he didn't need anything.
-Ninety-nine out of a 1 00-- Stop talking like a doctor.
That's our son, damn it.
Heart rate's down to 40.
No pulse.
GREENE: Starting compressions.
Is there any sickle cell in your family?.
-Thalessemia?.
-No.
Can think of any reason why your son had a stroke?.
No.
Start atropine.
Mark, they're waiting for you upstairs.
I'm a little busy here.
Yeah, I can take over.
It looks like you need a break.
-Any meds?.
-No, he doesn't take anything.
I'll see if they can hold your chemo.
Is it possible that he ingested something?.
Something from your medicine cabinet?.
Maybe it's an ingestion.
She's up to 94 now.
BANFlELD: What medicines in the house?.
MORRlS: Clear.
SANDRA: Just aspirin.
BANFlELD: Anything else?.
-Prescription meds, over the counter.
-Still v-fib.
[LUlS SPEAKlNG lN SPANlSH.]
-What?.
What does he take?.
-For blood pressure, carda--?.
-Valecia could have gotten them?.
-No.
It has a child-proof cap.
[LUlS SPEAKlNG lN SPANlSH.]
Diltiazem.
Diltiazem! MORRlS: Very toxic in kids.
Blanca, half a gram of calcium, lV push.
I'll check Trauma 1.
Lab says that specimen's hemolyzed.
They just let it sit around for an hour.
Not the first time.
It's all right, I always draw an extra red top.
-Let me look at that.
-What?.
What is it?.
The buffy coat.
BANFlELD: You can't diagnose anything from-- Look at the ratio of whites to reds.
Haleh, call Oncology, have them get that leukapheresis machine down here now.
Oncology?.
You're gonna do that without a diagnosis?.
The seizure, the stroke.
It's sludging.
It all fits.
Oh, God.
GREENE: Jerry, I want you to drag a hematologist to a microscope and make him look at this boy's smear.
JERRY: Right away, Dr.
Greene.
Is someone gonna tell me what is happening here?.
Leukemia.
Daryl's got leukemia.
[LUlS SPEAKlNG lN SPANlSH.]
-What's he doing?.
-""Little Frog Tail.
"" It's a nursery rhyme.
[LUlS SPEAKlNG lN SPANlSH.]
If you don 't heal today [SPEAKlNG lN SPANlSH.]
BANFlELD: You'll heal tomorrow -Another round of epi.
-T oxicology's on their way.
Dr.
Martin, make those compressions count.
ALVARADO: Calcium's on board.
[SPEAKlNG lN SPANlSH.]
-Pushing epi.
-Epi's in, infusion's on the way.
-ls this the leukapheresis case?.
GREENE: We almost have access.
-Switch with me.
-Platelets are up.
Platelets?.
We don't even know if he's thrombocytopenic.
He's oozing around his lVs, there's no way he's not.
Uh, platelets could worsen the viscosity.
Needs a femoral line.
I can't if he can't clot.
-We have no choice.
-He could stroke out.
Listen to me, we have no choice.
-Calcium's back, 4.
2.
-Going in the right direction.
Not fast enough.
Push another half gram.
Got it.
Repeat the level with calce, phos, sodium.
-Potassium, BUN, creatinine, LDH.
RUSSELL: It's been over 1 0 minutes.
Is this gonna-- This gonna help?.
This machine improves blood flow.
Give his heart a chance to rebound.
When will we know it's working?.
-lt takes a little time.
MORRlS: It's been 30 minutes.
[DEFlBRlLLATOR POWERlNG UP.]
Clear! [ELECTRlClTY BUZZES.]
No change.
Come on.
Come on, now.
Clear.
GREENE: V-tach.
-Could be hyperkalemic from tumor lysis.
Five of insulin, amp of D-50.
Clear.
-Still v-tach.
-Going again.
Clear.
-Dr.
Greene.
-Mix 20 of kayexalate.
Labs are back.
White count 1 67,000 -Iarge myeloblasts.
-No.
No.
No, no, no.
No, no.
Yes! Yes! Sinus rhythm! Clear.
Clear.
MARTlN: Oh, my God.
-We got a pulse.
-He's been down for almost an hour.
SANDRA: Is she back?.
You got her back?.
His brain's been deprived of oxygen.
Call Surgery, we need to get her upstairs so they can close the chest.
I'm gonna stop now.
[EKG FLATLlNlNG.]
[LUlS SPEAKlNG lN SPANlSH.]
SANDRA: You saved her.
You saved her.
[SPEAKlNG lN SPANlSH.]
[RUSSELL SOBBlNG.]
RUSSELL [SOBBlNG.]
: No.
[LUlS SPEAKlNG lN SPANlSH.]
RUSSELL [SOBBlNG.]
: No.
RUSSELL: No.
[RUSSELL SOBBlNG AND LUlS SPEAKlNG lN SPANlSH.]
She'll be in surgery for an hour while we clean and close.
SANDRA: We can go with her?.
[SPEAKlNG lN SPANlSH.]
Have them re-check the calcium.
I wanna thank you.
It's what we do.
-When it goes right.
-There was a minute there.
It was like I was losing everything.
-You can't imagine-- -I'm glad it all worked out for you.
She's a beautiful child.
GREENE: We're still waiting on the coroner.
Something else you need?.
I wanna clean him up.
We probably have some gauze.
I want the tube out.
GREENE: Normal procedure is we have to wait for the coroner before-- I'm familiar with procedure.
Where's your husband?.
He's calling our families.
[GREENE SlGHS.]
I know, uh nothing I can say will probably mean much to you right now, ahem, but l.
I've seen enough grief in my life to know how devastating it can be and how hard it can be to find the resilience.
I just hope you and your husband find.
[DOOR OPENS.]
Greene.
A minute in the hall?.
Excuse me.
So Oncology is mad at me.
Why do you suppose that is?.
I've had my hands full, Robert.
Well, I just used all my pull and influence to persuade them to keep the chemo suite open one hour, so get up there or I'm gonna sell your vincristine on the black market.
-I'm still-- -Stop complaining.
Nobody told you to go and get cancer.
I have to go.
I'll be back as soon as I can.
You never answered my question.
I can't let you extubate him.
You know that.
You're free to cut the tube.
Those are the ones you never forget.
You shouldn't be doing that.
I keep a secret stash in the back of the fridge crack one open when something really amazing happens.
In five years here, this is like the third one I've drunk.
One beer every 2O months I can overlook.
So forgive me for noticing but what happened in there?.
Something changed.
The situation evolved.
It was a kid, right?.
We all have one.
Some case you blew.
A patient you should have saved.
Yours was a kid?.
[SlGHS.]
Yeah.
How old?.
He was 5 years old.
[SlGHS.]
Those are the worst.
He was my son.
He died here.
In Trauma 1.
Your son died in this ER?.
And you're working here?.
I'm not sure why I've done anything I've done since that day.
Why'd I not leave my apartment for almost two years?.
Then I see the news about the tsunami and I fly to a place Why'd I do that?.
Why did I come back?.
Why did my son have leukemia?.
I never understood any of it.
I'm sorry for your-- For your loss.
I-- I don't really know what to say.
When your parents are gone, you're an orphan.
Spouse dies, you're a widow, or a widower.
But when you lose your baby there's no word for that.
See to it she gets this before you go.
[FOGHORN HONKlNG.]
GREENE: Hey.
Listen l-- I would really like to see you.
I-- I miss you, Elizabeth.
Please.
Please, don't-- Don't-- Don't cry.
Yeah.
Tonight.
Yeah.
Yeah, I'll come over.
I'll see you then.
I'm sorry I wasn't there when they came for Daryl but l, uh-- I had to be somewhere.
It was an atypical presentation.
Nobody could have picked it up.
If I had just brought him in earlier.
He had acute leukemia, that's why he died.
It might have given me another day.
A little more time.
They said we can go now.
I appreciate your effort, Dr.
Greene.
Take care, both of you.
Good luck.
BANFlELD: Baby.
Where are you?.
You never cried.
At the hospital at the funeral.
I've been-- I've been really angry about that.
You never cried about anything since that day.
Maybe we've been fooling ourselves.
Maybe we've been done for a long time, but never figured it out.
I never blamed you.
Never.
I used to think every day that if God told me I could die and go to heaven and be with Daryl, I would do it.
I wondered if that made me an awful person that I'd give up my life with you give up everything we could still have in the future.
But I never really got away from the feeling like I need to be with him.
Dreaming of him.
I never got away from the idea that somehow I'd be able to hold him again.
[BANFlELD LAUGHlNG.]
I've been afraid for so long.
I don't want to be afraid anymore.
[SOBBlNG.]
This week we lost the creator of our show, Michael Crichton.
A gentleman, gracious and witty.
Brilliant writer, intelligent, unfailingly kind.
But most of all, Michael was a good friend and we will miss him.
RUSSELL: Baby.
Where are you?.
[FOOTSTEPS APPROACHlNG.]
-What are you doing in here?.
-I hate this wallpaper.
We'll redo it.
I don't know what you were thinking last night, talking about that.
It was a dinner party, I didn't pick the topic.
Well, you certainly didn't hesitate to dive right in.
Maybe that's because you won't talk about it when we're alone.
You think I blame you for what happened?.
You think I'd still be here if I did?.
I try not to worry about who you blame.
No offense, living with a teenage boy is like living with an animal.
Only, cows make better conversation.
Butt abscess.
Needs dressing.
At least a cow's not a predator.
Sarah's friends are like a pack of she-wolves with cell phones.
Look, a new one just for you.
Anal warts.
This is so ass.
Looks like the Gates-Taggart merger's in full swing.
-You mean the Brady Bunch from hell?.
-It's going great, she'll never admit it.
-Really?.
Okay.
-Never been happier, loves to complain.
This much we know.
-What's that supposed to mean?.
-Sorry?.
The VA sent these records over and some guy called from the Wounded Warriors' Project.
-What's that all about?.
-ls the ladies' this way?.
Down the hall and to the left.
BERTHA: Thank you, dear.
-Hey, is Banfield on?.
She should be in soon.
-That about our homeless vet?.
-Yeah.
-What's the story?.
-I'm gonna figure it out.
Hey, uh, Bertha.
Bertha, this is not a good time.
Bertha! Whoa.
Go get her, big boy.
And Hoberman's still waiting on a cholecystectomy.
When are you gonna clear out all these boarders?.
DUBENKO: We're working on it, Sam.
Oh, you might wanna get more than one intern down here doing your babysitting.
-How's Dr.
Wade managing?.
-Customers seem satisfied.
Yeah?.
What about you?.
Are you satisfied?.
I need to loosen up a bit.
I have a tendency to micromanage-- Yeah, Cate mentioned that.
-Cate who?.
-Dr.
Banfield.
You know, department head coffee klatch.
Great.
You know, autonomy's a fine teaching device, Neela Iet's just make sure it doesn't lead to slowness or distraction.
Okay?.
You guys ready?.
Good.
Ready to round.
Where's your intern?.
BERTHA: When are you going to get me a bed in a real room?.
Uh, soon.
Uh, we're a little backed up.
I was meant to go under yesterday.
I haven't had anything to eat but some Jim Jones juice and Jell-O that made my poop red.
-Red?.
Wait, you mean--?.
-Now this?.
The mattress is made of cement and I've seen airport runways that were less noisy.
Am I smudged?.
Uh.
-Just-- NEELA: Hello?.
-What are you doing?.
-Um.
[CELL PHONE RlNGlNG.]
[GRUNTlNG.]
Oh, God.
Hey.
I'm in the middle of my run.
[SlRENS WAlLlNG.]
We can talk about this later.
No, I'm not.
It's just that.
Listen, I gotta go now, Russell.
[LUlS SHOUTlNG lN SPANlSH.]
[LUlS SHOUTlNG lN SPANlSH.]
NEELA: Six down, two to go.
ANDREW: That's not so bad.
That's just the ER.
We have 40 more waiting upstairs.
ANDREW: Right, 67-year-old woman presents with-- -God, with the age again.
-neck mass and dysphagia.
-Dis-what?.
-Uh, pain on swallowing.
Saying it fancy doesn't make you seem smarter, Andrew.
It makes you seem insecure.
It's a shorthand doctors use, to save us time.
Yes, in theory.
Uh, her son noticed the mass about three months ago when she visited him in Michigan.
Ann Arbor.
He's a professor at the university there.
Oh.
Fine needle aspiration showed a degenerative albeit benign cyst.
Thyroidectomy is indicated for symptomatic relief.
All right, that's thorough.
Next?.
ANDREW: Review of systems positive for headache, back pain, constipation.
Let's stick to the thyroid.
That's what we're here for.
I'm with you, Bollywood.
Uh, no palpitations, diaphoresis, heat intolerance.
However-- Her TSH is normal so we know there's no hyperthyroidism.
Right?.
-Right.
But there is-- -Okay then.
Moving on.
Three-year-old, near-drowning with hypothermia, core temp's 84.
Bradycardic in the 6Os with a thready pulse.
-Dr.
Banfield?.
-A ride-along?.
I was out.
I saw the rescue team.
T ook almost 2O minutes to find the girl.
ALVARADO: Twenty minutes?.
She was underwater that whole time?.
[SPEAKlNG lN SPANlSH.]
Grandpa took her on a walk because she was acting fussy.
[LUlS SPEAKlNG lN SPANlSH.]
Everything was good, she was happy.
[SPEAKlNG lN SPANlSH.]
ALVARADO: And then the baby was just gone.
TECH: Go deep.
Go.
RUSSELL: Go, go, go! [GRUNTS.]
Chase me.
Nice pass.
That's why they call it a Hail Mary.
BANFlELD: Ha, ha, ha.
-Mwah.
[BANFlELD AND RUSSELL LAUGHlNG.]
You didn't chase me.
Because I'm the quarterback.
Now, buttonhook.
I'm tired.
Aw.
One more touchdown, then we get ice cream.
RUSSELL: Booker and Banfield, that's all the Bears are gonna need this year.
[WHOOPS THEN LAUGHS.]
BANFlELD: What's your plan? She has a pulse, so warm her up and wait.
-So?.
-Access, warm saline get Respiratory down with a vent.
Get Bair Hugger, prep for intubation.
I'll be right in.
-I have a favor to ask.
-Not now.
-I need your help getting an MRl.
-An emergency, call the radiologist.
It's not an emergency but it needs to happen today.
I have a homeless vet.
Cognitive deficits, behavioral changes.
Let Neuro work it up.
They said they want him as an outpatient, which is never gonna happen.
He's not an ER patient anymore, it's out of our hands.
He was in lraq.
GATES: A war hero.
Served in the same unit I did back in Desert Storm.
I hear the harmonica playing, Dr.
Gates, but work is work, the rest is irrelevant.
Dr.
Banfield, I get this whole tough-boss thing and it works for you it really does, but cut me some slack.
I need your help.
[PAPERS RUSTLlNG.]
[BANFlELD SlGHS.]
Dr.
Banfield, the old ball and chain on line two.
Thank you.
Tell him I'm in with a patient, Frank.
I'll call him later.
GATES: Max Gonzalez sergeant first class.
You figured out who I am, huh?.
Mm-hm.
Hundred and first airborne, first squadron, 75th cav.
Yeah.
Yeah, that's right.
They called us the Widowmakers.
So you remember it?.
My memory's a work in progress.
But it's getting better.
-So thanks for that.
-Don't you wanna hear more?.
Not really.
Awarded a silver star in 'O6, later wounded in a rocket attack killed a bunch of buddies.
Doctors documented altered behavior.
Anger, depression, hostility.
-They gave me some pills.
-Yeah.
SSRls.
-Antidepressants.
-Didn't help much.
They discharged you on a 5-1 3.
Do you remember what that is?.
-Yeah, it meant that I could go home.
GATES: No, it meant the Army -could stop giving you medical care-- -lt meant I could get out of there.
Because they said you had a personality disorder.
Something wrong with you before you enlisted.
Maybe there was.
That's what my old man always said.
What if there wasn't?.
What if it was a lie?.
Your symptoms are consistent with a traumatic brain lnjury, TBl.
You could have suffered when that rocket hit.
So you're saying what?.
They dumped me?.
I'm saying I think they missed it mistreated it and sent you packing for the cheapest possible price.
I wanted out, doc.
Trust me, I wanted out.
Yeah, because you needed out, but not like this.
I don't wanna be here, I don't like it here.
I know how it is to come back from war and feel adrift.
Max, just give me a couple hours to help you.
[ELEVATOR BELL CHlMlNG.]
Tube's in.
Get Pharmacy to send more warm saline, as much as they've got.
-ABG's back, she's acidotic, 7.
22.
MARTlN: Should we use a high vent rate?.
The mother's out here.
Someone should probably talk to her first.
Dr.
Morris, update the family.
I kind of have my hands full here.
Dr.
Martin.
Okay, but, uh, shouldn't you?.
I mean, she's your patient, right?.
-What's the CO2?.
-Forty.
Standard rate, the pH might normalize as we get the temp up.
Hello.
You the mom?.
Sandra Herrero, is my daughter okay?.
It's hard to know yet, we're trying to warm her up now.
She's very strong for her age.
She's a good girl, very sweet, so she'll be okay?.
The cold water may have protected her heart and brain.
We're just waiting to see.
Please, I know you know.
So tell me, is my baby gonna be all right?.
RUSSELL: Why can't you ever give a straight answer?.
[LAUGHlNG.]
You wanna have baby?.
Another baby?.
Now?.
-Well, not right now, but-- -Ha, ha.
Excuse me?.
Is--?.
Is this your son?.
There's something wrong with him.
Daryl?.
RUSSELL: What?.
-Daryl! Daryl! -It's happening again.
-You're okay.
-Call an ambulance?.
-No.
I'm a doctor.
WOMAN: He doesn't look good.
-He's burning up.
BANFlELD: Just febrile seizure.
Get him home, cool him down.
Maybe we should be safe.
It's just like last time.
Look, it's stopping already.
Are you sure?.
I've been doing this too long to make promises.
But I'll tell you losing control is not going to help her.
If that's what you gotta do, do it outside.
In here, you be the mom, you be calm you put energy into helping your girl fight back because that's what she needs.
Can l--?.
Can I go be with her now?.
Yes.
[BELL CHlMES AND ELEVATOR DOORS OPEN.]
-Still seven boarders here.
-Cate's gonna kill me -if we don't clear them.
BANFlELD: Yes, she is.
How long is this gonna go on?.
You people are practically living here.
And by ""you people"" you mean?.
-Surgeons.
-Of course.
We're trying to clear overflow as quickly as possible.
SAM: Miss Mendenhall is crashing.
-Well, that's one way.
SAM: BP down to 6O, palp.
-We've got a massive Gl bleed.
Saline wide open on pressure bags prep for central line, two units on rapid infuser.
Let's go.
-How's her airway?.
SAM: Not great, even on 1 OO.
Okay.
Tube her, Neela.
Hey.
-She complain of abdominal pain?.
-No.
Any history of blood per rectum?.
Uh, no.
Not so far as I know.
NEELA: Suction's on high.
DUBENKO: Okay.
Call Gl.
Endoscopy if we get her pressure up.
SAM: Lost the pulse.
-Ah, damn it.
Starting compressions.
Dr.
Banfield, our frozen girl's having runs of v-tach.
ALVARADO: I've got the amiodarone.
Give 75 milligrams and set up an infusion.
MARTlN: Got it.
-BP's 67/32.
Valecia's temperature's dropped a little.
We're working on that.
-It's supposed to go up.
-I said stay calm.
I'm stepping up rewarming with some pleural lavage.
You see that?.
Huh?.
-How are coags?.
Platelet count?.
ALVARADO: Not back yet.
Specimen clotted, we had to send it again.
We should not have to wait an hour.
We'll give platelets and FFP empirically.
BANFlELD: Why do we have to fight the same battles every damn day?.
Go on, do it.
[SlGHS.]
[BANFlELD PANTlNG.]
DUBENKO: How long have we been going?.
Thirty-nine minutes.
It's time for another epi.
-lt won't do any good.
-What about the Gl consult?.
They won't scope a patient without a pulse.
-Dopamine?.
-Eight units of packed cells, two FFP.
We've replaced her entire blood volume twice.
If the heart could come back, it would have by now.
We're done.
ANDREW: Uh-uh.
-We're done.
Two, three, four.
[EKG FLATLlNlNG.]
Eleven-fifty-eight a.
m.
-Any relatives?.
-A son.
-Sorry?.
-She said she had a son in Michigan.
I'll call him.
Okay.
I'll get started on the paperwork for the coroner.
Could you get me--?.
Could you get me a death kit please?.
-I can take care of that if-- -Please.
Pull the curtain behind you.
[ANDREW SNlFFlNG.]
I'm sorry.
I'm sorry.
T omorrow's not good enough, she needs it now.
-What's the hold-up?.
-There's no ECMO unit in the hospital.
-What?.
That can't be.
-County only has two machines.
One's in use, the other's out for repairs.
Systolic's down to 44.
Valecia needs a machine that will warm her blood and do the work of her heart and lungs.
We don't have that here, so we have to transfer her to another hospital.
It's gonna take hours for a hospital to accept her, a transport team to pick up.
Time is critical.
So let's not waste it.
-Call transport.
Go.
-This girl's not stable enough.
Increase rewarming, get the heart in better shape before we ship her out.
She still has a pulse and a BP.
Now is our window.
Dr.
Banfield.
She's here now.
We gotta work with what we have.
BANFlELD: We don't need to go to the hospital.
RUSSELL: You don't know that.
He's groggy, he's post-ictal.
Just like what happened the other time.
That wasn't the same.
He was fine in 1 0 minutes.
He had a full workup, he stayed overnight.
-Spinal tap, CT.
-You're not being objective.
They terrified him and found nothing.
It was nothing.
Febrile seizures recur.
The pediatrician warned us about it.
What if this is different?.
If he is not better in 20 minutes, we'll take him in.
[EKG BEEPlNG.]
She's in v-tach again.
MORRlS: We got a pulse?.
ALVARADO: Thready femoral.
Okay, Morris.
Lead the way.
Let's move her to a trauma room.
Prep for peritoneal lavage.
T en more liters of warm saline and grab a thoraseal.
Wait.
You're leaving?.
Get it started.
I'll be in soon.
It was probably diverticulosis.
So she blew an artery in her colon wall and bled to death.
It wasn't foreseeable.
She had none of the predictors.
-Like bloody stool?.
-Yep, that would be one.
She had it.
-Well, it's not here.
You never said.
ANDREW: She had it.
Did you do a rectal exam?.
Check for occult blood?.
Did you ask her about any specific signs of Gl bleeding?.
She, uh-- She said something about the food making her stool red.
-Why didn't you bring this up at rounds?.
-Because she had so many complaints.
Her headache could have been a brain bleed, her backache a ruptured triple-A.
It's your job to decide what needs to be considered and when to speak up.
If you're submissive when someone's life's on the line, you're not ready-- I try to speak up and nobody listens! Let's discuss this later.
There's no way to be ready for something like this.
But in the end, it'll make you better.
You can't be a great doctor until you've killed a patient.
Yeah.
I've heard that before.
I think it's called a rationalization.
It's only been 1 5 minutes.
It's too long, I'm-- I'm calling 91 1.
[BANFlELD SlGHS.]
Russ, he's waking up.
Hey, sweetie.
How you feeling?.
Hey little man, you had us scared.
Can't have our number one wide-out on the injured reserve list.
Here, have some water.
[RETCHES.]
BANFlELD: Call an ambulance! Call an ambulance! [PHONE RlNGlNG.]
Oh, don't bother, that's my private line.
ER.
GATES: Vindication.
Look.
""Diffuse axonal injury in the parasagittal white matter, consistent with TBl.
"" -Yeah, and this is vindication because?.
-This is gonna save Max's life.
Put him on a path of getting healthy, medical coverage.
You convince Neuro to readmit him.
GATES: I can, with your help.
-Dr.
Gates.
-lndulge that inner softy one more time.
-This is the last time.
I wanna hug you.
You'll be the one with traumatic injury.
You're the best.
-Dr.
Banfield.
-Yeah?.
-Valecia lost her pulse.
GATES: Hey, Suri.
-What happened to my patient?.
-That bed's been empty.
-Anybody see him leave?.
-I don't know.
Frank.
I had a guy in there from radiology, Max Gonzalez, a vet.
-He had a duffel bag?.
You seen him?.
-That guy was real jumpy.
He went outside for a smoke maybe 1 5 minutes ago.
[SlRENS WAlLlNG.]
Max! Hey, Max! [CAR HORNS HONKlNG.]
Max! Wait up! What happened?.
Went into v-fib.
Didn't respond to the shock, she's still too cold.
This is why I wanted to transfer.
This is what I was worried about.
Think she'd be better off coding in a rig?.
Please.
I stayed calm.
I did what you said.
Please help her.
BANFlELD: Please.
You don't need to do that.
-Okay.
Don't want him to pull the lV.
-I'll hold his hand instead.
[LUlS SPEAKlNG lN SPANlSH.]
[SPEAKlNG lN SPANlSH.]
It's getting harder to bag.
Might be pulmonary edema.
Get sterile.
You can help with the thoracotomy.
Thoracotomy?.
Why?.
Myocardial irrigation.
I'm gonna open your daughter's chest, flush saline over her heart.
No, please, don't.
Something else! -I know it's scary.
-Try something else! If we don't get her heart beating, she'll die.
I'm gonna need a 1 0 blade.
[SlREN WAlLlNG.]
Is there a fire, Mama?.
No, baby, we're in an ambulance.
We're gonna make sure you're okay.
Where's daddy?.
He in the car right behind us.
MORRlS: Are you sure about this? We are not gonna let this baby slip away.
Not here and not now.
PlCKMAN: Okay, ma'am we're here.
[DOORS OPEN.]
Welcome to County General, I'm Dr.
Greene.
Are you the mom?.
BANFlELD: What's our core temp?.
ALVARADO: Still 86.
Take it again.
-Just did it two minutes ago.
-Take it again.
[SPEAKlNG lN SPANlSH.]
-lnternal paddles.
-She's still too cold.
MORRlS: There's nothing to lose.
Clear.
[SANDRA SPEAKlNG lN SPANlSH.]
-No change.
-Go again.
Why are you doing that?.
BANFlELD: We've gotta get her heart going.
Nothing's working.
Why isn't anything working?.
We're just getting started here.
HALEH: Ceftriaxone's in.
Finish the bolus, then run fluids at 1 OO an hour.
-He needs a D-stick, a serum CK.
-Hour ago he didn't need anything.
-Why don't we have labs back?.
-You in the medical field?.
ER attending at U of C, where trauma labs are back in 1 0 minutes.
HALEH: Welcome to our world.
-Sat's 91 on 1 OO percent.
-Come on.
Come on, Daryl, wake up.
All right.
Crank the O2.
What about an ABG?.
With your son's depressed consciousness, we need to consider-- Why don't we do a head CT first?.
We have one scanner, your son's in line behind two criticals.
-You have a critical patient here.
-Cate, let them do this.
GREENE: Is Elizabeth working today?.
-I can check.
GREENE: Mm.
Forget it.
Call the lab and get them to read the CBC over the phone.
[MACHlNE BEEPlNG.]
HALEH: Pulse ox is 87.
Daryl, honey, wake up and breathe for us.
Six of etomidate and 3O of sux.
No, no tube.
He's just post-ictal.
Your son's vomited blood, he's been altered for over an hour.
-My son has a history of seizures.
-Seizure can't account for that.
A Mallory-Weiss tear, atypical presentation.
He's hypoventilating and his brain needs oxygen.
-Why don't you check an ABG--?.
GREENE: Listen.
I need you to be the mom now, I'm gonna be the doctor.
It works best that way.
-He's right.
-Who's running the floor?.
I am.
And I've been doing this job for a while.
So you need to trust me.
BANFlELD: Clear.
She should be warm enough now to respond to the shock.
Clear! I don't understand this.
Otoscope.
Mr.
Herrero, did you see her hit anything on the way down?.
[SPEAKlNG lN SPANlSH.]
[SPEAKlNG lN SPANlSH.]
On some rocks?.
Anything?.
[SPEAKlNG lN SPANlSH.]
She was really cranky, so he took her out.
[SPEAKlNG lN SPANlSH.]
He's asking if it's his fault.
If he did something wrong.
GREENE: CAT scan shows signs of hypoattenuation in the distribution of the MCA.
I'm not a doctor.
Can you explain that?.
-Your son had a stroke.
-What?.
-[ST AMMERS.]
Why would he have that?.
GREENE: I can't explain that yet.
HALEH: He's bradying down.
-You need to give thrombolytics.
GREENE: Not without a CBC.
All right, O.
2 of epi and prep some atropine.
Let's keep neurosurge in the loop.
-You said he didn't need anything.
-Ninety-nine out of a 1 00-- Stop talking like a doctor.
That's our son, damn it.
Heart rate's down to 40.
No pulse.
GREENE: Starting compressions.
Is there any sickle cell in your family?.
-Thalessemia?.
-No.
Can think of any reason why your son had a stroke?.
No.
Start atropine.
Mark, they're waiting for you upstairs.
I'm a little busy here.
Yeah, I can take over.
It looks like you need a break.
-Any meds?.
-No, he doesn't take anything.
I'll see if they can hold your chemo.
Is it possible that he ingested something?.
Something from your medicine cabinet?.
Maybe it's an ingestion.
She's up to 94 now.
BANFlELD: What medicines in the house?.
MORRlS: Clear.
SANDRA: Just aspirin.
BANFlELD: Anything else?.
-Prescription meds, over the counter.
-Still v-fib.
[LUlS SPEAKlNG lN SPANlSH.]
-What?.
What does he take?.
-For blood pressure, carda--?.
-Valecia could have gotten them?.
-No.
It has a child-proof cap.
[LUlS SPEAKlNG lN SPANlSH.]
Diltiazem.
Diltiazem! MORRlS: Very toxic in kids.
Blanca, half a gram of calcium, lV push.
I'll check Trauma 1.
Lab says that specimen's hemolyzed.
They just let it sit around for an hour.
Not the first time.
It's all right, I always draw an extra red top.
-Let me look at that.
-What?.
What is it?.
The buffy coat.
BANFlELD: You can't diagnose anything from-- Look at the ratio of whites to reds.
Haleh, call Oncology, have them get that leukapheresis machine down here now.
Oncology?.
You're gonna do that without a diagnosis?.
The seizure, the stroke.
It's sludging.
It all fits.
Oh, God.
GREENE: Jerry, I want you to drag a hematologist to a microscope and make him look at this boy's smear.
JERRY: Right away, Dr.
Greene.
Is someone gonna tell me what is happening here?.
Leukemia.
Daryl's got leukemia.
[LUlS SPEAKlNG lN SPANlSH.]
-What's he doing?.
-""Little Frog Tail.
"" It's a nursery rhyme.
[LUlS SPEAKlNG lN SPANlSH.]
If you don 't heal today [SPEAKlNG lN SPANlSH.]
BANFlELD: You'll heal tomorrow -Another round of epi.
-T oxicology's on their way.
Dr.
Martin, make those compressions count.
ALVARADO: Calcium's on board.
[SPEAKlNG lN SPANlSH.]
-Pushing epi.
-Epi's in, infusion's on the way.
-ls this the leukapheresis case?.
GREENE: We almost have access.
-Switch with me.
-Platelets are up.
Platelets?.
We don't even know if he's thrombocytopenic.
He's oozing around his lVs, there's no way he's not.
Uh, platelets could worsen the viscosity.
Needs a femoral line.
I can't if he can't clot.
-We have no choice.
-He could stroke out.
Listen to me, we have no choice.
-Calcium's back, 4.
2.
-Going in the right direction.
Not fast enough.
Push another half gram.
Got it.
Repeat the level with calce, phos, sodium.
-Potassium, BUN, creatinine, LDH.
RUSSELL: It's been over 1 0 minutes.
Is this gonna-- This gonna help?.
This machine improves blood flow.
Give his heart a chance to rebound.
When will we know it's working?.
-lt takes a little time.
MORRlS: It's been 30 minutes.
[DEFlBRlLLATOR POWERlNG UP.]
Clear! [ELECTRlClTY BUZZES.]
No change.
Come on.
Come on, now.
Clear.
GREENE: V-tach.
-Could be hyperkalemic from tumor lysis.
Five of insulin, amp of D-50.
Clear.
-Still v-tach.
-Going again.
Clear.
-Dr.
Greene.
-Mix 20 of kayexalate.
Labs are back.
White count 1 67,000 -Iarge myeloblasts.
-No.
No.
No, no, no.
No, no.
Yes! Yes! Sinus rhythm! Clear.
Clear.
MARTlN: Oh, my God.
-We got a pulse.
-He's been down for almost an hour.
SANDRA: Is she back?.
You got her back?.
His brain's been deprived of oxygen.
Call Surgery, we need to get her upstairs so they can close the chest.
I'm gonna stop now.
[EKG FLATLlNlNG.]
[LUlS SPEAKlNG lN SPANlSH.]
SANDRA: You saved her.
You saved her.
[SPEAKlNG lN SPANlSH.]
[RUSSELL SOBBlNG.]
RUSSELL [SOBBlNG.]
: No.
[LUlS SPEAKlNG lN SPANlSH.]
RUSSELL [SOBBlNG.]
: No.
RUSSELL: No.
[RUSSELL SOBBlNG AND LUlS SPEAKlNG lN SPANlSH.]
She'll be in surgery for an hour while we clean and close.
SANDRA: We can go with her?.
[SPEAKlNG lN SPANlSH.]
Have them re-check the calcium.
I wanna thank you.
It's what we do.
-When it goes right.
-There was a minute there.
It was like I was losing everything.
-You can't imagine-- -I'm glad it all worked out for you.
She's a beautiful child.
GREENE: We're still waiting on the coroner.
Something else you need?.
I wanna clean him up.
We probably have some gauze.
I want the tube out.
GREENE: Normal procedure is we have to wait for the coroner before-- I'm familiar with procedure.
Where's your husband?.
He's calling our families.
[GREENE SlGHS.]
I know, uh nothing I can say will probably mean much to you right now, ahem, but l.
I've seen enough grief in my life to know how devastating it can be and how hard it can be to find the resilience.
I just hope you and your husband find.
[DOOR OPENS.]
Greene.
A minute in the hall?.
Excuse me.
So Oncology is mad at me.
Why do you suppose that is?.
I've had my hands full, Robert.
Well, I just used all my pull and influence to persuade them to keep the chemo suite open one hour, so get up there or I'm gonna sell your vincristine on the black market.
-I'm still-- -Stop complaining.
Nobody told you to go and get cancer.
I have to go.
I'll be back as soon as I can.
You never answered my question.
I can't let you extubate him.
You know that.
You're free to cut the tube.
Those are the ones you never forget.
You shouldn't be doing that.
I keep a secret stash in the back of the fridge crack one open when something really amazing happens.
In five years here, this is like the third one I've drunk.
One beer every 2O months I can overlook.
So forgive me for noticing but what happened in there?.
Something changed.
The situation evolved.
It was a kid, right?.
We all have one.
Some case you blew.
A patient you should have saved.
Yours was a kid?.
[SlGHS.]
Yeah.
How old?.
He was 5 years old.
[SlGHS.]
Those are the worst.
He was my son.
He died here.
In Trauma 1.
Your son died in this ER?.
And you're working here?.
I'm not sure why I've done anything I've done since that day.
Why'd I not leave my apartment for almost two years?.
Then I see the news about the tsunami and I fly to a place Why'd I do that?.
Why did I come back?.
Why did my son have leukemia?.
I never understood any of it.
I'm sorry for your-- For your loss.
I-- I don't really know what to say.
When your parents are gone, you're an orphan.
Spouse dies, you're a widow, or a widower.
But when you lose your baby there's no word for that.
See to it she gets this before you go.
[FOGHORN HONKlNG.]
GREENE: Hey.
Listen l-- I would really like to see you.
I-- I miss you, Elizabeth.
Please.
Please, don't-- Don't-- Don't cry.
Yeah.
Tonight.
Yeah.
Yeah, I'll come over.
I'll see you then.
I'm sorry I wasn't there when they came for Daryl but l, uh-- I had to be somewhere.
It was an atypical presentation.
Nobody could have picked it up.
If I had just brought him in earlier.
He had acute leukemia, that's why he died.
It might have given me another day.
A little more time.
They said we can go now.
I appreciate your effort, Dr.
Greene.
Take care, both of you.
Good luck.
BANFlELD: Baby.
Where are you?.
You never cried.
At the hospital at the funeral.
I've been-- I've been really angry about that.
You never cried about anything since that day.
Maybe we've been fooling ourselves.
Maybe we've been done for a long time, but never figured it out.
I never blamed you.
Never.
I used to think every day that if God told me I could die and go to heaven and be with Daryl, I would do it.
I wondered if that made me an awful person that I'd give up my life with you give up everything we could still have in the future.
But I never really got away from the feeling like I need to be with him.
Dreaming of him.
I never got away from the idea that somehow I'd be able to hold him again.
[BANFlELD LAUGHlNG.]
I've been afraid for so long.
I don't want to be afraid anymore.
[SOBBlNG.]