ER s01e16 Episode Script

February Fifth, 1995

-What do they need us for? -A lady's been trapped in a car for an hour.
They can't move her until we intubate.
-They always drive this fast? -Yep.
-They ever hit anybody? -All the time.
-How can you eat through this? -Hungry.
All right, we're here.
Grab the O-neg, stay close.
Cherokee missed the runway, slammed into a car.
Guy in the plane's toast.
A lady's pinned in the back seat.
Fire's been trying to get to her.
Plane's leaking fuel.
They can't use the jaws.
-l'm freezing.
Anybody got a coat? -Get the doctor a coat.
We managed two large lVs.
BP's 70 over 30.
Golden hour's almost over.
Head trauma, ALOC.
We've been bagging her but she's been gagging.
Husband and kids are already at the hospital.
Carter, follow me in.
Get that O-neg going, all right? lf we don't get her out in a couple minutes, she won't make it.
Start with Pavulon.
Versed to sedate.
Cricoid pressure.
l got it.
Finally, succinylcholine.
What the hell is that? -lt's aviation fuel.
-l wouldn't smoke.
-Think gasoline comes out of camel hair? -Can we get in here? -Two seconds.
-New coat? -Christmas.
-lt was.
All right, let's go! Release pressure.
All right, clear out.
Slide out, Carter.
Keep bagging.
Start the chopper! Let's move it, let's move it! They're coming out.
Move her.
Move her fast.
Thank you.
May l? Thanks.
Watch out.
So you decide on a specialty yet? -My folks are set on cardiology.
-Well, what are you thinking? -l'm thinking this is pretty exciting.
-lt's not bad.
Stress, late nights, hard work, no pay.
-lt's hard to beat.
-Watch her head! Let's go, guys.
Move her, move her.
Both femurs broken possible spinal cord injury, pressure's 80.
We're gonna notify the O.
before we get there.
You fly before? Oh, yeah, lots of times.
-What's the M.
? -County General.
Faster! Make sure you get that fire out.
-She gonna make it? -She is now.
Watch that tail rotor! We're gonna move her on three.
Ready? One, two, three.
No room! Can't go.
Stay here.
Grab our stuff and ride back with the paramedics.
She's free.
Long backboard.
Hell of a life, isn't it? -What? -lt's a hell of a life.
l said, l wanna have sex with your wife.
Watch your back, please.
Coming through.
-God, he's in a foul mood.
-Today's a good day.
-You finish your presentation? -Not yet.
l was gonna grab a few minutes.
You? l am so far behind, l may not even finish.
-Benton's gonna kill me.
-Just do your best.
How can we prepare when we follow him on 36-hour shifts? Ms.
Chen, if this surgical rotation is too much, there's always dermatology.
right femur, pressure's 60 over 40.
-Abdomen's rigid.
-All right.
Let's get some O-neg going, wide open.
Already did it.
-What's your name, sir? -Bill McClintock.
McClintock, is it tender here? -Were you wearing a seat belt? -No.
-You will next time, l bet.
-Peritoneal lavage? Carter, look at this abdomen.
Either he's bleeding out and needs to go to the O.
or he's giving birth to a basketball.
-Haleh, call up to the O.
-l already called.
Benton, head trauma in 1 .
-All right, l'll be right there.
Chen, get a Foley catheter started.
You ever do one before? ln for a treat.
Carter, since when does it take two students to start a Foley? Clean it with Betadine, put K-Y on the catheter and thread it in.
-Give it to me.
-42 years old, collapsed playing handball.
Two liters NS in.
1 5 liters O-2.
Name's Jonathan Weiss.
Am l having a heart attack? Am l having a heart attack? -Do you have a history of cardiac trouble? -No.
l'll get a CBC, Chem-7, enzymes, coag panel and chest film.
He's pale.
He's not oxygenating.
Pressure's still 40 palp.
-What do we got, Susan? -Possible Ml.
-l don't wanna die.
-We don't want you to die.
So you do your part and we'll do ours.
His breathing's not improving.
Could be a pulmonary embolism.
-What? -A blood clot in your lungs, Mr.
Have you had any surgery recently? Been in any kind of car accident, trauma? Spent a lot of time traveling, sitting? EKG? -T wave inversions.
l'm thinking heart.
-l'm not.
VQ scan! He has no risk factors.
l need that chest film.
And l need an echo.
Well, that can't hurt.
Let's do it.
Conally? Where are you? Right here.
Under the sheet.
Why are you under the sheet? l've been dead for two days.
But you are still suffering from headaches? Oh, boy, am l ever.
And what precipitates these headaches? Death.
What was that? Nervous tic.
l've had it for years.
Blood gases are back.
PO-2's low.
-Where's the chest film? -Right here.
The pulse ox is down to 51 .
-Pulmonary artery's enlarged.
-He's crashing.
-Perfusion scan? -VQ mismatch.
You were right.
Forget that.
Get him to Trauma.
We need a fluoroscope.
Somebody get Morgenstern.
Rolando, we got a Trauma room? Yeah.
Two's open.
-Gonna do an embolectomy? -First time for everything.
-What's going on? -Saddle embolus, Mark's going in.
He's doing an extraction in the ER? Mr.
Smitrovich is in 4.
CBC, Chem-7, blood gases, lV started.
Luchesse's in 6.
Abdominal pain, vomiting blood NPO, a nasogastric tube-- -Dr.
Benton? -What is it? lf Dr.
Greene is doing an embolectomy, we-- l'd like to observe it.
Who's stopping you? Go.
You wanna go too? Get out of here.
-What's the matter with you? -Luchesse? Vomiting blood, NPO, nasogastric tube, gastric lavage.
You ordered a gastric lavage? No, l wrote it down.
You still have to sign it.
-l write my own orders.
-Nurse? lf you're having a problem today, don't take it out on me.
l write the orders, you carry them out, understood? -Nurse! -What? lsoproterenol's going.
Ease the catheter in slowly and thread it up to the pulmonary artery.
Be careful not to puncture the vena cava.
-How's Mr.
Weiss doing? -Resps are up to 45.
Pulse ox down to 63.
Hang in there, you'll be feeling better before you know it.
Carter, Chen, why don't you get over here so you can see.
See that? l'm in the right ventricle.
ls that cool, or what? -Carter, you see the embolus? -Yeah, it's huge.
Position the cup against the clot.
Start your syringe suction and aspirate the embolus into the cup.
Got it.
Now work back down.
Just like snaking a drain.
Well, folks, l got a date with a bile duct.
Carry on, one and all.
-Pulse ox up to 85.
-Resps are coming down.
How you feeling, Mr.
Weiss? l can breathe.
l can breathe.
Okay, Harold.
So something bit you? -Pet snake.
-Oh, yeah? l used to keep frogs.
Frogs are amphibians.
My snake eats frogs.
-What kind of snake? -Yellow eyelash pit viper.
-You have a pet pit viper? ls it poisonous? -Very.
l'll call poison control.
Are you feeling weak, Harold, nauseous, any chills? No.
Can you tell if it's poisonous just by looking? l don't think so.
Because l got him right here in the bag.
We're gonna keep him in the bag, okay? No.
He's cold-blooded and l had him on the El all day.
He'll sleep.
He was here a minute ago.
Don't contradict me in front of nurses.
l wasn't contradicting you, we disagreed on a diagnosis.
l'd appreciate your showing more restraint.
The man was dying.
-l'm asking you for respect.
-l wasn't being disrespectful-- Yes or no? l respect you, Susan.
Thank you.
Now, try to show it once in a while.
-l'll get animal control in here.
-What's going on? Doug, what's going on? This is Dr.
Ross in ER.
Pit viper got loose.
-A snake? -A big snake.
Greene? 36-year-old woman with breast cancer brought in from Dignity House.
Two modified radical mastectomies, spread to her lymph nodes.
-Who are you? -Anita Risberg, a nurse at the hospice.
-Mark Greene.
She have chemo? -Tamoxifen.
But it's metastasized.
-You got her on morphine? few days, it's just not enough.
l got worried if l up the dose, it'd cause further respiratory depression.
You're right.
What's her name? Grace.
Grace Holsten.
Hi, Grace.
l'm Mark Greene.
We'll make you more comfortable.
Doctor, please let me die.
Please let me die.
Animal control guy believes it's a tree snake.
He thinks it'll crawl up high where it's warm.
Sorry, doc.
l'll spend the rest of the day on my hands and knees.
Lydia, Doug.
Come over here.
lt took 6 months and a couple thousand requisition forms, but l finally did it.
Guess what's under the sheet? -Come on, guess.
-We don't wanna guess.
Oh, come on, please? -New day bed for the lounge? -Nope.
-New vending machines? -Nope.
New crash carts.
-That's great.
-Wow! Where'd you get those? Cardiology wanted them, but l was relentless.
An abdominal pain in 3 and a gunshot victim coming in.
Now, no raiding off the new crash carts.
Everything on these carts stays on the carts.
Thank you.
Benton, about this afternoon's trauma presentation.
-l'm not fully prepared.
-You've known for weeks.
-Yes, sir, l know that-- -Don't call me sir, Ms.
Yes, sir.
l mean, doctor.
l'm sorry.
l only need a half-hour or so.
What about you, Mr.
Carter? Do you also need more time? No.
l'm all set.
Well, when you find you have the time to rejoin us, please do so.
complaining of abdominal pain.
-Where's his chart? -ln the rack.
At the desk.
Carter, go get his chart.
l'll need a CBC, Chem-7, coag panel and drop a nasogastric tube.
You gonna write this down? l'm not comfortable taking verbal orders.
l think you better write everything down for us.
-Us? -The nurses.
Here's his chart.
Start writing.
Grace we've added fentanyl to the morphine.
See if that helps.
lf it doesn't work, we have three choices.
We can insert a catheter into your spinal cord to deliver the morphine.
Or we can surgically cut the spinal tracts that carry the pain from your legs and back.
Or we can increase your morphine but your dosage is so high it might depress your breathing.
Can you stop this pain? l'm not sure.
We're trying.
Try harder.
-Resps? -Fourteen.
Let me know if her breathing gets any worse.
Don't even ask.
Mark, keep me company.
-Good call on that pulmonary embolism.
Oncology found a small polyp.
lf he hadn't tossed a clot who knows how far that would've gone before rearing its ugly head.
-What's all this? -Some kind of tree snake got loose.
Really? l was impressed about your concern for the students.
Making sure they were involved and learning.
You're a fine teacher.
Given any thought as to what you'll do next year? Start repaying med school loans.
Sent a few letters but l haven't started.
Why don't you think about joining the staff here? As an attending? You won't make as much money as the cowboys at private hospitals but there are other rewards, ephemeral as they may be.
-Well, think about it anyway.
-No, l'd be honored.
Here's my bus.
-Thank you.
-Thank you.
You earned it.
to the leg and abdomen.
We scooped and ran.
lV's wide open, had two liters, no palpable pressure.
All right, let's look alive.
Let's wheel him in.
Let's move.
-Grab me that dynamap.
-That lV infiltrated? -Hang the blood Y-tubing.
Ready, lift.
-Get an H and H.
-l don't get a pulse.
He's still breathing.
Tried to apply pressure but he was a sieve.
Name's Yummy Jackson.
-Drive-by? -Drug deal gone bad.
Gang thing.
At 1 2 years old? Kid had a Tech-9 and a Ruger on him when we found him.
-Trauma 1 , get in here now! -Watch that line.
-She's still in a lot of pain.
l'm sorry the fentanyl isn't helping much.
lt's helping a little.
Can we do anything to make you more comfortable? You can shoot me.
l'm sorry, l didn't bring my gun to work today.
l don't think it's safe to up the morphine any higher.
Afraid it'll kill me? lt might.
There's not a lot more that the ER can do to help you.
Do you want me to admit you to the hospital? Can l go back to the hospice? Yes, but they're gonna need to bring you back here for a higher dosage.
Can l take a little while to decide? Sure.
Can l help you? Excuse me, can l help you? You can't be back here.
You must go now.
Oh, my God.
-Son of a bitch! -Get out the way.
You're too late.
He's already dead.
lt's madness.
You can clearly see the posterior dislocation of the knee consistent with this sledding injury which occurred when the impact applied direct force to the anterior tibia while the knee was flexed.
lnjury to the.
-l'm really nervous.
-Don't worry about it.
l picked too easy a topic.
Benton doesn't expect that much.
lt's your first rotation.
--with horizontal traction and realignment of the joint.
Angiography should be considered with attention paid to the five P's: Pain, pallor, paresthesias pulselessness and paralysis.
All right.
Who's next? Carter.
While attempting a Rollerblading maneuver this 1 2-year-old male fell on his outstretched right hand resulting in a Salter-Harris type ll epiphyseal fracture of the proximal humerus.
To avoid damage to the growth plate, the humeral head, in angulation and external rotation, must be reduced by abducting and externally rotating the arm and then slowly bringing the arm down.
lf the reduction is not accomplished, the arm must be maintained in a cast in the Statue of Liberty position.
ls that it? Any questions? Ms.
You'll do great.
Facial fractures.
You'll find an outline and recent research articles.
Would you pass it down? Here we see examples of a depressed fracture of the left frontal bone with disruption to the orbital rim.
Both the result of blunt-force trauma when the patient's face intercepted a tire iron.
John, if you would, please? The projector.
Thank you.
Orbital rim and frontal sinus fractures along with other fractures to these facial bones often result in concomitant CNS injury.
Diagnosis is established with radiographic studies and computerized tomography, preferably using a three-dimensional image of the patient's skull.
As you can see, the frontal sinus and orbital rim fractures here are easily appreciated.
How's her breathing? Depressed but okay.
She's finally out.
Maybe we got the balance right, and she can get some sleep.
-Who's Kathy? -Her little girl.
Does she know she's here? She lives out West somewhere with Grace's ex-husband.
Seattle, l think.
Grace gave up custody when she entered the hospice.
She lost her child? She entered the hospice to die.
Life goes on.
Then again, sometimes it doesn't.
-Old hospice joke.
-Oh, God! Oh, God! -God, it hurts.
-The fentanyl's wearing off.
-Lie down.
Lie down.
-lt hurts.
Her resps are too low, l can't give her any more morphine.
-l can't stand it.
l can't stand it.
-l'm sorry.
l'm so sorry.
-lt hurts so much, doctor.
-There's nothing else l can do.
Please kill me.
Please! -Relax.
Just relax.
-Please kill me.
Please, please! Susan! -What have we got? -A 52-year-old male collapsed.
Hypotensive, 80 over 60, tachycardic at 1 20.
Hypertension treated with Altace and Tenormin.
-Are those skates? -He's a hockey ref, collapsed during a game.
Some of the kids followed us.
he's had 8 migs morphine.
He's diaphoretic.
Call Cardiology.
l need an EKG and enzymes.
You gotta wait in the waiting room.
-Will he be okay? -We don't know yet.
Malik! -Can you take them to Waiting? -ln a minute.
We're gonna do everything we can, okay? Okay, get the ambu-bag.
-Lost his pulse.
-He's in fib.
Crash cart.
Turn off the O-2.
-Where's the cart? -Here.
Where's the new cart? Watch that line.
Paddles! -l put one in here an hour ago.
-Carol, 200.
-Somebody already stole my new cart! -Clear! ls Jake around? He went to get a soda.
Nice digs.
This is how the other half lives? l could do with a little less glass, actually.
There's no blood on the carpet, so it's a step up from the ER.
Mind if l sit? l've had my shots.
Cindy was right.
You are kind of charming.
ls that bad? Depends.
-Jake's a great kid.
-He is a great kid.
l hope you don't mind if we shoot hoops now and then.
l won't pass along any misogyny with the basketball tips.
lf misogyny's genetic, he's inherited plenty from his father.
-Does he see his dad much? -They communicate by check when it comes.
lf you don't like me, you don't have to hide it.
-You can just come out and show it.
-l didn't know l was being subtle.
Hey, yourself! Dr.
Ross came to see if you wanna play basketball.
We'll be about a half an hour.
-And put the jacket on.
-l'll make sure he wears it.
D5 NS 1 00cc's per hour.
NG tube, gastric lavage CBC, Chem-7, amylase.
Call the O.
, book a room.
What does this say? -NG tube.
-By that you mean a nasogastric tube? -Yes.
-And this? -Dextrose 5, normal saline.
-An lV? Yes, an lV.
Well, l've examined the patient.
And l believe she needs a fine, surgical hand like yours to get an lV going properly.
l'll have Carter do it.
And the nasogastric tube? You'll notice she has a deviated septum and l don't feel comfortable putting one in.
l'll do it myself.
Tell the lab his coag panel's cooking.
Here are his chest films.
lf you can find those hockey kids, tell them he's gonna be okay.
Susan? Susan.
Susan, come on.
-l'm busy, Mark.
-l need to talk to you about a patient.
End-stage breast cancer, bone-Mets to her back and legs.
Morphine's not working.
Neither's the fentanyl.
She's in agony.
There's nothing l can do to help her.
Spinal morphine therapy, cordotomy? She refused both of them.
She just wants to die.
Well, it sounds like she's going to, soon.
She wants me to help her.
Her resps are down to 1 2.
lf l give her a little more morphine, her breathing will stop.
What would you do? l don't know.
l gotta go.
How long are you gonna keep this up? -You weren't there for me.
-lt was professional, not personal.
We're not married, we work together.
Professional is personal.
l miss you.
You could have told me you were doing facial fractures.
And that computer thing.
l looked stupid.
No, no.
Keep irrigating that.
l can give you the graphics program.
lt's easy to use.
That's not the point.
l need a good recommendation from Benton if l'm gonna get a surgical residency.
-Vertical mattress, 4-0 nylon.
-You're going into surgery? Yeah.
Why do you say it like that? No.
l mean, l think you'd be great.
No, you don't.
You sounded surprised.
l do know surprised when l hear it.
You just sounded surprised.
You really wanna go into surgery? l don't know.
l might.
Well, look, John, l've seen my mother's surgical residents and the ones around here, and it just doesn't seem like you.
What do you mean, your mother's residents? Your mother's a surgical attending? She's chief of surgery.
Could l get more four by four's? Chief of surgery? Where? What hospital? St.
Why even come to school? You won't have trouble getting a residency.
lt's not like that.
She won't help me at all.
She didn't even want me to go into medicine.
Just don't say anything to anyone.
They jump to conclusions and l end up having to prove myself all over again.
Okay? Please? l found the snake.
Billy don't please.
Mark, l need you in 2.
Rule out Ml.
Mark? l love you.
-Cardiology would steal our crash carts? -They steal everything.
-Are you sure they're up here? -They were two hours ago.
Connie and Bob, stay with the carts.
You guys come with me.
l think we're in the ladies' room.
Come on, come on.
Let's go! -Dunphy's there! -What do we do? Sheri Dunphy? Not a problem.
Sheri? Doug, hi.
How've you been? Good.
You look great.
You lost some weight.
-l got married last year, remember? -l'm still in mourning.
-Why are you up here? -ls the Cath lab still up here somewhere? -lt's where it's always been.
-Can you give me a hand? -Nope, l can't.
l'm out of here.
-l got a patient.
A 6-year-old, tetrology of fallot.
-Yeah, okay.
-All right.
He's unbelievable.
That's why l slept with him on the first date.
First date? No kidding.
He rang the doorbell and we were on the kitchen floor.
Kitchen floor? Jeez, l gotta start dating again.
Kids are having fun.
They're the hockey players from my Ml.
Haven't been picked up yet.
How'd he do? He's not dead, if that's what you mean.
No that's not what l meant.
He's gonna be fine.
How is she? She died a couple minutes ago.
Respiratory failure? l was listening to those kids playing and watching the snow fall.
You know, if you stand right here-- Right over here you can see the El from here.
Faces looking out the windows into the darkness.
Life goes on, Mark.
Do you wanna get something to eat? l can't.
Jennifer and Rachel are in town.
-Another time, maybe.
See you tomorrow.
Stop now.
Stop! Where are their parents? -l'm having problems with Haleh.
-So l heard.
Reschedule her so we don't have to work together.
You're the one who needs to be rescheduled.
You won't do it? No.
The nursing schedule is my prerogative.
Even if that situation endangers patient care? You work every day and every third night.
She's got four kids.
When is she supposed to work? -She refuses to follow my instructions.
-Why should she? You're in training.
She graduated.
Don't give me that.
We are not equals.
She may not know how to cross-clamp an aorta but she's worked in emergency for 20 years.
lf you'd ever hop off that pedestal you're on you might see that the nurses make this place work, not you.
l smell food.
-l'm actually cooking.
-Like, from scratch and everything? Yeah, who knows? lt might become an annual tradition.
l don't know.
l remember you cooking something last summer.
l think it was meatloaf, maybe.
lt was definitely brown.
Semiannual, then.
-When did you get home? -Seven or so.
The traffic was awful.
Where's Rach? She's in the bathtub.
God, what a week! l'm exhausted.
-How was your day? -Great and awful.
Tell me great.
l'm too tired for awful.
Morgenstern offered me a job as attending physician next year.
-What'd you say? -l said yes.
Without discussing it with me first? An attending.
l figured l'd be spending nights and weekends at some community hospital in Winnetka.
ls this a problem? Can you tell him you need time to think about it? l don't need to think about it.
This is a great opportunity! l won't know until March if Judge Franklin needs me to clerk next year.
You're considering spending another year in Milwaukee? lf he wants me to, yes.
-But l assumed-- -Exactly! You assume things would be the way you want.
The last six months haven't exactly been the way l want them-- l've been living by myself, without my wife, without my daughter.
''My wife, my daughter'' ! lt's only been six months.
What about the last six years? What about medical school, rotations and residency? Who was a paralegal so we had food? Who was in night school for years, finishing college? Was that you? No, that was me.
So now l want it to be about me for a change, not you.
How are you doing, Mr.
Conally? You still dead? Oh, yeah, very.
-My head feels better, though.
-Well, that's good.
You just let us know if we can get you anything else, okay? Night.
Good night.
-You're late.
lt's almost 1 0:00.
l got held up at the hospital.
Where's Walt and my sister? Something at your niece's school.
lf you say you'll be here at 8, l need you to be here at 8.
l've got an early shift tomorrow.
How was your first day? -How long ago was your mom's stroke? -8 months.
And it was a right parietal CVA? She's still suffering from left hemiparesis.
-Has she had any physical therapy at all? -Of course she has.
ln the beginning.
My mother doesn't have problems getting around.
That's the problem.
She's always wandering off.
She's masking well, but she has limited use of her left arm and leg.
And she's got bruises all over her left side from running into things.
And you should have warned me about the incontinence.
Yeah, well, that's just a sometime thing.
Not tonight, it wasn't.
Can you help my mother? l can't make her any younger, but l can probably improve her mobility.
She's a great lady.
l wish l'd known her before the stroke.
l heard a lot about you.
She wouldn't stop talking about her Petey.
l'm sorry about that.
You're the baby in the family, right? l'm the youngest in the family, yeah.
My baby sister too.
My mom just loves her to death.
lt still pisses me off.
Good night.