ER s01e19 Episode Script

Sleepless in Chicago

-Carter! -Dr.
Did you pick up my labs? -Where's Deb? -Sick.
Who said so? What is that? -Two feet of necrotic bowel.
-For what? Taking it to the desk.
Research is picking it up.
Soon, l hope.
Guy infarcted, needed a crash hemicolectomy.
-When? -A couple of hours ago.
-Who did the procedure? -Jagman.
Jagman? Damn! Why didn't you admit the woman with sores? Her problem isn't surgical.
She needs to be d├ębrided.
Otherwise, she won't heal.
Maybe medicine will help, but she's not coming on my service.
Those Dale Carnegie classes are really starting to show.
He's been on for 48 hours straight.
Traded a few shifts to be with his mom, and now it's.
Payback time.
There's a Code Brown in 2.
Find a nurse, clean it up now! Move.
Unfortunately, payback rolls downhill.
-Did l miss her breakfast? -Just starting.
The Family Development person came by for three hours.
Brown called.
She said you passed with flying colors.
They're expediting your application.
Helen, l can't thank you enough.
How's she been? Fever's gone, but l think she's homesick.
She misses the nurse she was close to in Russia.
Can l ask if she wants to live with me? Sure.
Yes, l have a VCR.
Hey, Doug.
ls that Mark Greene, the future ER attending? -You found out.
-Not from you, schmuck.
l didn't want it to get out until Morgenstern made the announcement.
-Word's out.
What did Jen say? She signed on for another year with the judge.
ln Milwaukee? Oh, no.
lt's been awful.
But if l can make this shot there's still hope for my marriage.
There's hope.
When did the rash appear? Two days ago, with a fever.
lt started on your chest? Yeah.
Then it spread.
l think l'm allergic to one of the medications.
-What are you taking? -Here.
P-43B, ZX-7.
l've never heard of these.
They're experimental.
l'm a test subject.
l answer those ads in the paper: ''lf you suffer from asthma, nicotine addiction, panic attacks, call this number.
Earn extra cash.
'' -They pay you? -Oh, yeah.
l'm doing this one where they inject radioactive isotopes into my brain.
That one pays real well.
We'll call the numbers on the vials, to see which drug is causing your reaction.
But for now, your test subject days are over.
How much you make a year? -Did you stick Mr.
Penny for blood gases? -Yes.
-Discharge the abscess? -Just need your signature.
l wasn't called for the bowel infarction? You traded shifts.
-l was the resident on call.
-You've been on for 48 hours straight.
What does that have to do with it? Have you slept? l need very little sleep.
l am capable-- l didn't think so.
You shouldn't be treating patients in your condition.
l've never done a bowel infarction.
Jagman has done two.
-This isn't a competition.
-Oh, no? Then why do we have to keep logs of every procedure? As a record.
Not a scorecard.
You're keeping score and you know it.
That's enough.
Your fatigue is impairing your judgment.
-Go and lie down, two hours.
-That won't be necessary.
This isn't a suggestion.
You will not see another patient until you've slept.
Are you kidding? We don't have time for this.
Turf the kid to Medicine.
l tried.
Got into an argument with Warner.
She won't come down.
Screaming doesn't work with her.
You have to use ''soft sell.
'' Observe.
Morning, Jer.
What do you got? Full house, take your pick.
Ross, Diane Leeds in Risk Management called for you.
What did she want? -She said she wants to go out with you.
-What? Just kidding.
Think it was about that guy you decked.
Did l ever tell you you're my least favorite clerk? l am not a clerk.
l'm an ''emergency service coordinator.
'' Doug, we got a burn in 1 .
Write these labs.
l'll take that knee lac in 5.
-l noticed Exam 4 is open.
-What? ln case you wanna go lie down, take a nap or something.
lt was a great catch, Joyce.
l never would've thought of sickle cell.
Yes, you do.
Anyway, l do have a favor.
This kid on experimental meds is getting worse.
Susan can't make anything of it.
Could you please come down here and bail her out? Thank you.
-Here you go.
She's on her way down.
How did this happen? lt's my fault.
The knob came off the radiator and she grabbed the metal part.
Wiggle your fingers for me.
Just wiggle them.
-You okay? -lt's my fault.
lt's a second-degree burn that won't affect the use of her hand.
We're gonna clean it up with saline.
Bonnie, you hang in there, okay? Never seen a star-shaped radiator knob.
l'm gonna call other hospitals.
See if she's been seen anywhere else.
Excuse me! Excuse me! Malik, get a gurney! What happened? He just finished breakfast when he keels over starts shivering, his eyes roll back in his head.
-What is it? -A seizure, grand mal type.
Curtain 2 is open.
No tongue abrasions.
No signs of incontinence.
You related? -No, l manage the restaurant.
-Thank you.
Just a sec.
lf he's okay, have him call me, okay? l know this sounds bad, but he didn't pay the check.
He had the champagne brunch, steak and eggs.
lt was a $35 meal! Neighbor found him at the bottom of the stairs.
-Vitals? -80 over 60, heart's racing at 1 28.
-lV in? -No.
Couldn't find a vein.
Haleh, prep for a central line.
-Let's get him across on my count.
-Get a cordis tray.
We're gonna do this nice and gentle.
Do you hear me? One, two, three.
Here we go.
Watch the line.
Capillary refill's poor.
The old guy's got a G-tube.
-His name? -Joseph Klein.
BP's 50 palp.
-Pedal edema.
-Congestive heart failure.
-No breath sounds.
Lung's collapsed.
-Must have broken a rib.
-He's a train wreck.
Get a chest tube tray.
Can you understand me? Talk to me.
He can't.
Look at his neck.
No voice box.
Can we give him something? -Stand by with morphine, 2 mg.
-Who's got keys? Unit of Lasix.
Get some restraints in here.
He wants the morphine now.
-Over here, now.
Move! -Line's in.
Load the dopamine, 400 mg.
We'll take care of you.
lt's gonna be okay.
-Pressure's 1 20 over 80.
Not bad.
-Reflexes are normal.
-l don't see signs of a seizure, do you? -No.
Has an irregular heartbeat.
-He just opened his eye.
-Really? Hello in there.
l know you're busy having a coma.
Do you wanna tell us why, Mr? Do we have a name? Actually, we have several.
Art Moss, Sam Hart and Gene Finch.
Me again.
l wanna let you know that you actually do have a medical problem.
We're going to have to go in.
Rib spreader! Helluva way to get a free meal.
-Can you get bloods? -BP? Still low.
60 palp.
lncrease the dopamine.
1 0 mics.
-Got a number 1 0 blade? -On the tray.
Hang in there, Mr.
Let's have it.
Came in with congestive heart failure, tension pneumo.
He's on high-dose dopamine.
Peter's putting in a chest tube.
l'll take it from here.
l got it.
l'll take it from here.
Either get some sleep or go home.
l won't tell you again.
Klein's old chart came up.
Can l see it? Check to see what meds he's on.
Chest tube's in.
We got breath sounds.
Pulse ox up to 90 from 82.
Train is back on the tracks.
Nice job, everybody.
Klein has terminal cancer.
The last time he was here, he signed a paper requesting no heroic measures be taken to prolong his life.
You and Jen are going another year like this? l guess we're gonna have to.
Congrats on the new attending gig.
Jen is adamant about Milwaukee? She wants me to move there.
l can't give up this job as attending.
-Can l help you? -Dr.
Greene, right? John Koch.
MlT, Sloan School of Management.
-What can l do for you? -They didn't call you? l'm here to observe your department.
Doing research for the Andover Project.
White House press conference, profile on CNN? -Must've missed it.
-We're building a new hospital for the 21 st century, scrapping the old model in favor of a more collaborative paradigm.
Like a team approach? Yes, but on a comprehensive scale.
We're rethinking the hospital architecturally, organizationally ergonomically.
We hope to build the model on which all future hospitals will be based.
So you'd like to see how it shouldn't be done? On the contrary.
l want to keep what works and change what doesn't.
-Feel free to look around.
l may have a solution to you and your wife's geographic impasse.
-Excuse me? -Kenosha.
Midway between Chicago and Milwaukee.
Commute's barely an hour.
You can live under one roof and keep your jobs.
l'm John Carter.
You might remember me from earlier.
l brought a pad and a pen, in case you want to say something.
l'll put them here on the end of the table.
l'm sorry about what happened earlier.
Your blood pressure's still pretty low, so l contacted your HMO and they'll take you to their hospital, once you've stabilized.
But that might be a while.
There's no next of kin listed in your chart.
ls there anyone l can call? Can you understand me? l'm sorry, l didn't-- ''Roger.
'' Roger.
ls he a family member? ls it your son? Do you know his telephone number? Bloomington.
He lives in Bloomington.
He lives in Bloomington, and his name is Roger Klein.
Okay, great.
l will be back in a little bit.
Any interest in becoming charge nurse? Me? Not on your life.
Why do you ask? Because Tag and l are gonna be foster parents to that little Russian girl.
The one with AlDS? Tatiana.
l wanna spend as much time as l can with her.
l'm cutting back my shifts.
Really? What? lt seems like a tough way to start off a marriage.
You think it's a bad idea? lt doesn't matter what l think.
l'm certainly no expert on marriage.
Forget l said anything.
Mercy General's calling about a kid with a burned hand.
l'll be right back.
-Didn't mean to wake you.
-You didn't.
-Came for a blood gas kit.
-Any traumas come in? Two-car accident.
lt went up to the O.
Who's doing it? Never mind, don't tell me.
Half-hour to go.
Watch the charts.
Bring me anything surgical.
l thought we had to wait until we're called for a consult.
Just do it, all right? Can we see you outside, please? l'll be right back.
Your daughter was seen at another hospital with a star-shaped burn.
We want to know what's going on.
-She touched the radiator.
-This is not a radiator burn, ma'am.
Now, what really happened? -lt's personal.
-Maybe l can talk with her alone.
l'm sure there's a reasonable explanation for what's happening.
But if you want me to help Bonnie you have to tell me the truth.
Most people don't understand.
l'm pretty understanding.
You promise you won't tell the doctor? She touches herself.
Down there.
l tell her not to.
l give her three chances.
Then l use the paperweight.
The paperweight? l put it on the stove.
l didn't mean to hurt her.
l guess l just left it on too long.
lt's not as bad as it sounds.
My mother did the same thing to me.
The doctor's gonna want a plastic surgeon to see her hand so you need to stay.
All right.
First name, Roger.
l don't know the street.
l need a $20 taxi voucher to send Mrs.
Von Avery home.
l'm out of vouchers, but l have petty cash.
When is somebody gonna come and pick up this bowel? l don't know, Jer.
-Thank you.
-Excuse me, could you change a 20? -Sure.
One, two, three, four, five.
Five is 1 0, 1 5 and 20.
Actually, could l have a 1 0 for two of the fives? Right there.
Here you are.
You gave me 1 9.
Nineteen? You're an honest man.
You wanna get that? l got it.
l have ones here.
Why don't l give you a buck.
That'll make 20.
You can give me the 20 back l gave you and that'll make us even.
Thanks, sport.
When did this one come in? -Couple minutes ago.
Patient's 52, with a history of calcium oxalate stones.
Pyelogram showed a 6mm kidney stone in the calyx consistent with obstructive uropathy.
Lithotripsy unsuccessful, paged Urology.
Started an lV for hydration, gave him 5 mg morphine for the pain.
lt ain't working.
Furst, l'm Dr.
When did the pain increase? Been getting worse for two days.
My internist, Dr.
Feldman said if it didn't pass today, get it cut out.
l couldn't agree more.
Let's move him.
Get him up there.
-Peter, hold up.
-What? Where're you taking my patient? -To O.
He's got an obstructed stone.
-Wait a minute! -What? -l haven't examined him yet.
-l have.
-You're supposed to wait for a consult.
Please let him go.
l'm dying here.
You wanna examine him? Here.
Go ahead, examine him.
Don't pull this crap again.
-This is all so unnecessary.
-Excuse me? This territorialism.
Friction between departments.
lt's all an outdated, patriarchal system based on confrontation.
Where he who yells loudest wins, even though he may be totally wrong.
That's how it is.
lt doesn't have to be.
Picture a hospital without departments.
Where every floor is staffed by a team of specialists.
No time wasted on battles about ''Your service, my service.
'' They've been replaced by a more evolved, harmonious feminine model, in which the patient belongs to us.
Sounds good.
Does it exist? lt will.
l'm building it.
And you are again.
? John Koch.
MlT, Sloan School of Management.
She doesn't wanna wait for the plastic surgeon.
She wants to take her home.
-Where's the social worker? -l paged her.
-The police? -Supposed to be on their way.
Okay, follow my lead.
We apologize for the delay.
The plastic surgeon wants to do more tests on her.
Nurse Hathaway's going to take her up to Radiology.
Can l go with her? l'm sorry.
Hospital policy.
l wanna stay with my mommy.
lt's okay, sweetheart.
Come on.
l want my mommy! -l don't want her to go.
-This is her.
Calm down! Get her feet! Give me back my baby! You lied, you lying bitch! You lying bitch! Please don't take my baby! All right, people.
Let's get him prepped.
Doc, knock me out, will you? Just take it easy.
Help is on the way, okay? All right.
Here we go.
-Christ! l haven't put him out yet.
-l didn't cut him.
What's going on? Folks, we can all scrub out.
The stone hath passed.
Thank God! How are you feeling? l saw in your chart that you used to teach high school English.
Was that here in Chicago? The hospital has a good library.
l could get some books-- Maybe some Conrad? l spoke to three Roger Kleins in the Bloomington area none of them were your son.
The phone company checked the unlisted numbers.
l couldn't find him.
ls there anyone else l can call? How long has it been since you spoke to your son? Ten years.
Twenty years.
l'm sorry.
Excuse me! My fault.
You okay? Yeah, fine.
Six lousy bucks.
-l've got it.
Where's the vial? -Here.
Quick, he's coming.
What? You people have too much time on your hands.
You should've heard that little girl.
She cried for 45 minutes.
When the social worker took her -she was still crying.
-She's better off.
-Growing up without a mother? -Her mother's a monster.
l don't believe that.
l think she was damaged a long time ago.
l hope with therapy she'll improve so she can get her back.
You're more hopeful than l am, thank God.
l hear you're fostering Tatiana.
You're gonna dissuade me, like everybody else? No.
l think it's a wonderful thing you're doing.
-Really? -Absolutely.
You'd make a great mother.
Got a 1 6-year-old GSW to the neck.
ETA seven minutes.
Please no dead kids today.
How is he? BP's falling, respiration's down.
l don't think he'll make it till morning.
l didn't know which you'd like, so l brought a few.
Not a fan of Melville, l see.
Oh, God.
Excuse me for a second.
Did you do the physical on the leg in 2? Not yet.
l thought l'd spend some more time with Mr.
She's been waiting half an hour.
Why are you wasting time on a DNR? Because he's dying and he has no family.
This is your surgical rotation not pastoral care.
lt's not your job to become his family.
There's more to patient care than cutting them open.
And that's what nurses are for.
Do the H and P on the leg pain and renew everyone's meds.
l've got a drunk to stitch up.
Stitch him up.
lt's interesting how modern medicine dismantles the rituals of death.
We do everything to make it routine, a non-event.
People don't die here, they ''code.
'' We can do better.
Can't believe l didn't think of it before.
Kenosha! Kenosha.
We can live there, be a family and commute.
Never been there.
lt's great.
lt's right on the lake.
Got great schools.
-Birthplace of Don Ameche.
-Well, there it is.
Here's our next lucky contestant.
Who's this Diane Leeds who keeps calling you? Very desirable woman who'll never go out with me.
Why not? One of her friends is one of my exes.
Turned you down? Never bothered asking her out.
You're afraid to ask her out? Nobody likes rejection.
What do you got? .
38 caliber.
Shot in the neck.
He's bleeding profusely, BP's 60 over 40.
How did it happen? He was robbing a store.
Cop shot him.
Turn him over to me.
l got it.
Let's go! -What's his story? -He's the cop.
Get me a blood on pressure bag, cross and type for 6 and an intubation tray.
-Bag's dry.
-Hang a liter of saline.
Squeeze it fast, he's bleeding out.
Neck's still bleeding.
Load up on the O-negative.
No breath sounds.
Need to clamp this bleeder.
Where's Benton? Anybody see Benton? l'll be back.
-Got the O-neg.
-No pulse.
-Blood Y-tubing.
-Shot in the heart.
Thoracotomy tray.
Don't they wear vests? -They're supposed to.
-l need some help in here! -Coming.
Susan, you got this? -l got it.
Where's Benton? Blood coming out of his mouth.
-Bullet holes in his chest? -Tube's in.
No, just the neck.
-Bleeding in his lungs.
-lf l press harder, he'll stroke out.
-What have we got? -1 6-year-old bullet to the carotid artery, thready pulse -blood in his lungs.
-What's going on there? Cop took a bullet into his heart.
Susan's cracking his chest.
Wait a second.
Get somebody else down.
l'm gonna go help Susan.
l need some elbow room.
Thank you.
Lungs are full of blood.
-Suction, right now.
Here we go.
-l have a retractor here.
His brain's not getting blood.
He's young.
He's got collaterals to keep him perfused.
Vascular clamp.
Right now.
Come on, Carol.
Now! Thank you.
Lungs are clear.
And he is clamped.
Move him.
Right now.
Get him out! -Rib spreader.
-Coming up.
l need more O-neg.
Let's see.
What do we have in here? Hole in the ventricle.
Give me suction, 3.
0 proline on an atraumatic needle.
Call the O.
l might have a save here.
Where is Carter? He's missing out on a valuable education here.
l'll do a horizontal mattress, take two bites go under the coronary artery so l don't obstruct it.
Better do it quick.
His pressure's dropping.
Now listen, boys and girls.
The trick here is to plug up the hole without closing off the artery.
Which is what l've just done.
Pulled it through the ventricle.
l stitched it.
-Who clamped the kid who went up? -l did.
l'm getting a pulse.
Nice job.
Looks like that rest did you some good.
Take him up.
-What a way to end the day.
-Taking off? -See you tomorrow.
-See you.
-l don't believe you.
-Me? l finished the file on the guy you attacked last week.
Then l hear about your quarrel with a woman.
This time l was the attackee.
Are you all right? Not the first time l've been clawed by a female.
-You're paying for your bad karma.
-You've no idea.
l don't know what Legal will say about defending you a second time.
-You defended me the first time? -That's my job.
l need you to write out a statement.
And don't take so long getting it back to me this time.
Listen, Diane.
You wanna get some dinner sometime? l don't think that's a good idea.
l guess you were right.
l'm right.
l'm right.
You got a minute? -Dr.
Greene, Endo on 6.
-l'll take it at the nurse's station.
l wanna make sure bleeding varices gets presented next week.
-You won't be there? -No, l'll be in Boston.
l'm taking over the Residency Program at the Brigham.
Greene here.
Can you hold on? Harvard? Always an ambition of mine.
l couldn't be happier.
l took care of your becoming an attending next year.
l recommended you to the chief.
You're the guy, no need to look further.
-Thank you.
l appreciate it.
-lt's almost a lock.
The new guy has to approve it, but don't worry.
l'm in my office another two weeks.
Come by, we'll have a drink.
''Sailing these seas or on the hills Or waking in the night Thoughts, silent thoughts of Time and Space and Death, like waters flowing Bear me indeed as through the regions infinite Whose air l breathe Whose ripples here lave me all over Bathe me, O God, in the mounting to Thee l in my soul to range-- in range of Thee.
O thou transcendent, nameless, vibrant.
'' Did you do notes on all your patients? l'm doing them now.
They're supposed to be in by end of shift.
Looks like you've just begun.
sHave them first thing in the morning.
You'll be up all night.
That's what happens when you spend too much time with one patient.
l consider it time well spent.
He died 1 0 minutes ago.
Why did you put in for a surgical sub-internship? l want to be a surgeon.
You're wasting your time.
You don't think like a surgeon.
Why? Because l don't think like you? l want those notes first thing in the morning.
'' Da.
''C'' is for cat.
And Carol.
Brown from Family Development is here for you.
Something came up in your background check.
You attempted suicide last year.
l wish you'd told us sooner.
l'm afraid we can't place Tatiana with you.
The state will not approve it.
But l'm fully recovered now-- lf it had happened three years ago, maybe.
But one year.
We just can't.
l'm sorry.
l'm working on it right now.
How about next Friday? You're asking me out? No, l'm responding to you asking me out.
That was three hours ago.
Change your mind? No, l don't think so.
So we're on? lf it means that much to you, okay.
l don't think l like the way this date is starting out.
lt'll get better.
We'll see.
Hey, my man's on time.
Where's everybody at? Jackie and the kids went up to the lake early.
Mom went to bed.
She said to remind you that your mother wakes up early.
Six a.
She'll be wanting her medicine.
l'll set the alarm.
You really going out on the ice? lt's that or spend the day in a three- room cabin with your sister, the kids and no TV? Hell, yeah, l'm going out on the ice.
What time you all coming back? About 8:00 tomorrow night.
Thanks a lot.
l really appreciate this.
Yeah, sure.
There's some leftover meat loaf in the fridge.
Catch me a walleye.
Yeah, right.
Later, man.
-Can l? -Yeah.
Come on in.
What is it? l lost her.
l've been in therapy.
l've worked hard for 9 months.
All they care about is that l took some pills.
zWho? -Ms.
Brown, Foster Care.
-Tatiana? They won't let me have her.
lt's like l'm defective or something.
God, l'm kidding myself, that l could do this.
lt's so stupid.
You're ice cold.
You should've seen her.
She's seven years old.
l tried to explain it.
Listen to me.
lt's not your fault.
You hear me? lt's not your fault.
But l promised her l'd be there and now l'm not.
How could you have known? Maybe l shouldn't have thought about doing this.
You were exactly what she needed.
You are the only person who thinks that.
l know you.
Can l stay here? Has Tag heard yet? He never wanted her.
-Carol, no.
Why don't l drive you home? l know.
Design's been approved, we've set a construction date for June and we've recruited world-class physicians, like Borges and Folkman to our advisory board.
That's impressive.
They know we're onto something.
We're getting resources and l'm approached daily by exceptional doctors about joining us.
-Are you interested? -Me? From what l've seen, your expertise and temperament auger a very promising medical career.
l'm flattered.
And yes, l am interested.
There he is.
Marty, we were worried about you.
Why you gotta do this? -Do l know you people? -Please be good.
Don't make me use the restraints.
This is almost amusing.
This is a mistake.
This is Dr.
Koch from MlT, Sloan-- Sloan School of Management.
lt's his latest thing.
A few months ago, he passed as an OB and delivered two babies.
He's smart.
Reads a lot.
You're saying you're not-- lt'll get sorted out.
lt'll get sorted out.
l just was planning to observe the Psych Ward anyway.
Come on.
Come on, Marty.
l didn't expect you.
Where's Rach? l didn't bring her.
We need to talk.
Yeah, we do.
l can't do this anymore, Mark.
Not living together, never seeing each other.
l know.
So let's stop it.
You'll leave the hospital? A compromise.
We can live between Chicago and Milwaukee: Kenosha.
lt's just an hour each direction.
We can be a family again.
What? lt can work.
You want me to commute two hours a day so you can take a job? So we can all be together again.
That's two hours less for Rachel.
lt's bad enough she's not growing up with you.
Whose fault is that? lt was your idea to go to Milwaukee.
Would you rather l leave her here with you? ln 7 years, you've never given anything up for me.
Why are you intent on making me give up a job l've spent years trying to get? You do what you want when you want, and you expect me and Rachel to be there for you when you have time for us.
Jen, come on.
l don't think we're gonna make it.
We're gonna make it.
This isn't working.
We'll make it work.
We went a year, we can go another.
l'll come up more often.
Rachel, she can come down here.
-You're not listening.
-l am.
l'm listening.
l'm leaving you.
l'm sorry.
Jackie? l need my medicine.
Peter? Mom?! Dr.
Benton's mother, 75 years old.
History of CVA, fell down the stairs.
Possible hip fracture.
BP's 90 over 60, heart rate 1 1 0.
Leg shortened and externally rotated.
l got an lV of saline going.
O-2 by naso-canular, 1 0 liters.
CCS 354, LOC at the scene.
-l've got her lV.
-She's waking up now.
Let's move her.
Careful of her hip.
On three.
One, two, three.
Call Radiology, get Neuro down here.
-Check her pupils in response to pain.
Benton, what happened? Mrs.
Benton? Can you hear me? lf you can hear me, squeeze my hand.
Carter, you try.
l'm John Carter.
We'll take care of you.
Can you understand me? Peter, what happened? Can you understand me? Talk to me.