ER s01e20 Episode Script

Love's Labor Lost

Montana to Rice! -They're on different teams.
-Since when? When l watched their last game at Carol's.
-But that was way back.
-l'll say.
-Go long.
-Me go long? -l'm out of shape.
You go long.
-l'll go long.
-Too far for the lvy League arm? -Car! Hey, you butthead! What are you, out of your mind? Not another one! Go get a gurney, Doug.
l'm not playing catch with you anymore.
-Nice of them to drop him off.
-What are friends for? Three-month-old seizing in 1 .
Temp's 1 05.
-l got him, Doug.
Go! -ls Dr.
Benton--? -Give her three more of morphine.
-Call X-ray down here, stat.
-Susan, l need you in here.
-What x-rays do you want? -Move, Carter.
Please, Petey.
Oh, it hurts! Okay, Ma, okay.
Listen, all right? Get an x-ray of the hip, chest and pelvis.
-What about a C-spine? -Get out of here! Carter, come with me.
Pulse, weak.
He's bleeding.
-Multiple trauma.
Gown up! -O-2, 1 5 liters.
-What's Benton doing? -His mom broke her hip.
-That's bad at her age.
-What about labs? CBC, type and cross 8 units.
Run the saline wide open.
Carter, Deb, the guy's out of it.
Primary survey's done.
Now what do you get? -Get a CT.
-Narcan, 0.
-And then you gotta get the-- -Glucose, 85.
Get smart nurses and nod sagely.
Get her another 5 of morphine.
CBC, Chem-7, UA, EKG hip, chest and pelvis.
Move! Come on! Don't take it off! Call the chief of Orthopedics.
Tell him to get down here now! -We need to undress you, Mrs.
Not in front of Petey.
-What? She doesn't want to be naked in front of her son.
All right, Ma.
l'll be outside, okay? Here's the blood clav.
l'll be right out here.
He's going down the tubes.
-Can l intubate? -No.
lt could be a neck fracture.
Always look everywhere.
We'll roll him.
Ready, and now.
There we go! Single gunshot wound.
And back.
Heart's racing.
1 80.
-He barely has a pulse.
-Put the blood on a pressure bag.
Cap refill's bad.
-No pulse.
He's arrested.
-All right.
Carter, take over CPR.
-We gotta crack his chest.
-l got it.
Thoracotomy tray! We do a thoracotomy when? -Penetrating trauma and full arrest? -Exactamundo! l need the rib spreader.
Towel, scalpel.
Move your hands, Carter.
Put the blood on the pump.
Rib spreader.
l'm in.
Pericardium's dry.
ls O.
on alert? -They just finished that perfed appy.
-Tell them they've got another customer.
-There it is.
-Nice save, Mark.
Got a faint pulse.
Let's go! l gotta go.
l'm on tonight.
-l'll have the place emptied out.
-Deal! You taking the El home? l'll go with you.
l'm back tonight -could you finish the nurse's notes? -Sure.
Who the hell stat-paged me here for some old lady with a broken hip? -l'm Dr.
Benton-- -Pulled me out of a meeting.
This is my mother and she broke her hip, sir.
Well, that she did, Dr.
Blair, put her on your O.
No, no.
Sir, l want you to do the surgery.
ER admits go to the teaching-- l don't want a resident operating on my mother.
-l'll scrub in.
-So you'll be holding the knife? l wanna scrub in too.
-l'll be in there.
-That's not good enough.
l know this is your mother but you are way over the line, son.
l'll page you when we're done.
Now back off.
-So you tried to sand it off? -lsn't that what you do? Yeah, but we don't use a power sander.
Longet's a diabetic, as well as an amateur dermatologist.
Vera didn't want me just crossing it out.
Well, one gram of Ancef.
Update his tetanus.
And get Plastics to see him.
They may have to do a graft.
-They can move that serpent head.
-Onto the body of a goddess? l'll be right back.
-Did you eat lunch? -No, the cafeteria's already closed.
-VoilĂ ! -Thank you.
Hey, you're gonna be an ER attending.
Congratulations! lt's not a lock.
Can l borrow your pen? A lifetime of this, huh? The ER's great.
Free time's your own.
What free time? After your residency, you get skilled in every aspect of medicine.
You see a variety of cases.
You have an immediate effect upon your patients' lives.
But mainly it's like joining the circus.
l'm telling you, the opening goes in the back.
Oh, my God, l'm as big as a house! -l'm Dr.
Mark Greene.
-Sean O'Brian.
l'm Jodi.
-Hop up on that bed.
-l don't think l can hop anywhere.
What seems to be the problem? Our baby's due in two weeks and l have to pee every 30 seconds.
lt burns and my stomach hurts.
Sounds like a bladder infection.
Does this hurt? No, just don't push too hard.
l gotta go again.
Thirty-six minus four.
Baby's about five or six pounds.
-You have any other medical problems? -No, no.
-ls that cold? -Yes.
Let's take a quick listen here.
-l love that sound.
-lt's great.
lt's great.
-Any cramping? Any vaginal bleeding? -No.
Can you feel the baby move? Can you give me a urine sample? Are you kidding? Yes, l think l can do that.
l want you to follow my finger with just your eyes.
Now squeeze your eyes tight like this.
Okay, press against my hand with your face.
Okay, show me your teeth.
-Will Grandma be able to walk again? -Yeah, she'll be fine.
l know what you're thinking, Jackie.
Why don't you just say it? -Shut up, Peter.
-No, go ahead and say it.
l mean, it's my fault that this happened, right? l'm so pigheaded and self-centered.
Just shut up and sit down.
BP's 90 over 60.
l found him in the greenhouse, passed out in the back.
He visits at my work and this is the shape he's in.
-Hydrate with saline.
-l don't want to go.
You'll go where l tell you to go.
l am not losing another son to alcohol and drugs.
She's 38 weeks, but l think her dates are off.
The baby's small on exam.
lnitial BP is 1 30 over 90, but over a couple of hours BP's been fine.
Around 1 20 over 80.
FHT's normal, no cramps or spotting.
l got your test results.
UA shows white cells too numerous to count.
Bacteria, 2 plus protein.
CBC's normal.
No fever.
Simple cystitis.
Fluids, rest and a course of Bactrim.
lt's a bladder infection.
-Who are they? -Med students.
-They're so young.
-l know.
lt's disgusting, isn't it? Near-term antibiotic of choice is Macrodantin.
Now, l want you to take these.
Lots of fluids.
Rest and follow up with your doctor in the morning.
The sulfas compete with bilirubin for the binding sites on albumin increasing the risk of neonatal jaundice.
He saves lives, he teaches, he slices and dices.
Deb, will you work up a weak and dizzy in 3, please? Doctors? Would you sign a get-well card? Sure.
-Who's this for? -Me.
-What is it? -Hemorrhoids.
That's right here.
Ross, kid's crashing! -What? Alcohol level's down to 0, his pulse is down 40.
Pupils pinpoint.
Haleh, get a BP.
Frothing at the mouth.
-ls it drugs? -He's incontinent.
-Negative drug screen.
-BP's 70 over 50.
Where do you work? -Wrigleyville Nursery.
-Nursery, as in school? No, like in plants.
-Outside or in the office? -Both.
Mag of atropine, lV push.
Tear off his clothes, wear gloves.
Start a drip.
A milligram an hour.
What's wrong? lnsecticide poisoning.
What chemicals do you carry? We use everything.
We were spraying in the greenhouse today.
-Will he be okay? -l think so.
l'm gonna call the nursery.
-What do you have? -Elderly man with hemorrhoids.
Yuck! Everyone's so old and sick around here.
This is a hospital.
-Yeah, l guess.
Where's Benton? -He's in surgery with his mom.
-Hi, guys.
-Working the graveyard? Seven p.
, no Benton.
l may get home by 8:00, for once.
Somebody help me.
My wife's unconscious in the car.
Greene! Please, somebody help me! She's pregnant.
Hurry! She's passed out.
Freeze right there! lt's my mother.
l wanna scrub in.
You take one more step and l'll have your ass hanging on my wall right next to your residency.
-l wanna help.
-Don't test me.
Out! Now divide the iliotibial tract.
Watch her airway.
Get a stat BP.
Oh, my God! What's going on? Carter, help Mr.
O'Brian, we need to work.
-Start a second lV.
-BP's high, 1 60 over 1 1 0.
You're okay, babe! She's eclamptic! Load her with mag sulfate, four grams, lV.
Do you need blood? She needs a Chem-24, a coag panel and put her on a fetal monitor.
Cap refill's fair.
O'Brian? -Yeah.
-Your wife has eclampsia.
-ls she gonna die? No, we need to get her admitted and-- She's seizing! Grab a bite block! ls the mag in? -Got it.
-Restrain her.
Do something! Somebody help her! Help her.
Push another four mag sulfate.
You'll be okay.
lV's out! The other one's blown.
l'll throw in an external jugular.
Two migs of Ativan.
-Where's the prep pad? -Restrain her.
Restrain her.
lt's in.
O-2 to 1 5 liters.
Okay, seizure's stopping.
Let's hyperventilate her.
Get doptones.
Let me do a quick pelvic.
Let's get a blood gas.
Fetal heart tones, strong at 1 40.
-That's good news.
-30cc's of saline.
Two cm dilated.
Eighty percent effaced.
Membrane's intact.
Call upstairs, see who's on call for OB.
What the hell is going on? Your wife has a disorder of late pregnancy known as eclampsia.
The blood vessels spasm, causing lack of oxygen to the brain which leads to the seizures.
We're relaxing them with medicine.
-What about the baby? -We'll need to deliver.
-When? -Soon.
Very soon.
Who's in Trauma 1 ? A pregnant woman with an eclamptic seizure.
She's postdictal but coming around.
BP's stabilized? Mag sulfate going? l'll take over.
Go home.
l'd like to see her through the OB.
-l can handle it.
-lt's not you, it's me.
l saw her earlier and l diagnosed UTl.
Sent her out and she seized in the parking lot.
l thought the protein in her urine was due to cystitis and l blew off one borderline BP.
l'd feel better if l saw her through.
Fundal placenta.
Looks okay.
BP, 1 20 over 70.
That's very nice.
-Look at little Hunter.
-ls that a boy or what? -Four plus turtle sign.
What's that? Looks like a little head peeking out right there.
You give a score of zero or two for each category.
-Movement? -He seems very active.
Every night, around the same time.
Score two.
Also breathing, tone, amount of fluid.
He's an eight.
Anything less than a six, then you worry.
You do the AFl.
You divide the abdomen into four.
Find the deepest pockets of fluid without fetal parts or umbilical cord.
You mark each corner of the quadrant.
Measure and then add up.
ls that what this number is over here? That's the baby's heart rate.
That should be between 1 20 and 1 60.
So 1 40's perfect.
The baby's in great shape.
Biophysical profile's 8.
AFl's 1 4.
Cervix is favorable.
l've got a non-stress test started.
l feel very comfortable.
l've delivered a couple hundred babies.
lt's 9:00, so we'll see you in about an hour? What did Coburn say? She's at St.
Luke's, and she says she'll be here as soon as she's finished with her repeat C-section.
She wants me to start an induction.
That is, of course, if l feel comfortable.
She said that? What a bitch! Hey, Drake? -How do things look? -Great.
BP's have been perfectly normal.
Oh, boy.
How can l--? Excuse me.
-He can't be more than 1 2 years old.
-He's the OB resident on call.
l just spoke with Dr.
Coburn, our OB attending.
And she agrees that we need to deliver you soon.
-Will you have to do a C-section? -l want to deliver naturally.
Your eclampsia's under control, the baby's good and the cervix is favorable.
l'd say we do a trial of labor.
And if it doesn't work? l think it will work.
l want to give it a try.
Let's do it! Excuse me.
Do you feel competent to handle this without me? -l think l can muddle through.
-l'll check back with you at 2300? Roger.
Carol, could you give Mrs.
O'Brian .
5 Pitocin lV? -You're inducing down here? -We'll start here and then get her up to OB.
-How frequent are the contractions? -Every 1 0 minutes or so.
-Okay, let's have Dr.
Greene decide.
-You're kidding! We can't call him Baby X when we call our parents.
All right.
Let's take a quick look.
lt's five centimeters dilated.
Ninety percent effaced.
Station, minus two.
Membrane's intact.
-You wanna look too? -May l? Why not? Everybody else has been poking around in there.
-lan, Patrick, Dermot.
-Sounds like the cast of Finian's Rainbow.
-Hunter? Hunter O'Brian? You agree with my assessment? Your labor's progressing along nicely and quickly.
The baby's great.
ls it normal for the heart rate to be going down like that? As long as it's only briefly, and it stays over 1 20.
Jared's on both lists.
lt's not my favorite.
Compromise is the soul of marriage.
Jared, it is.
-Hope you feel better.
-Thank you.
You're welcome.
The OB case is still here? They're still busy upstairs.
l gotta call again.
Greene! Something's wrong.
The baby's heart-- The monitor's down to 90.
lt's not supposed to go that low.
Hey, Ma.
Hanging in there? How are you doing? -Why so long in the recovery? -She's 76.
-Estimated blood loss? -500cc's.
Post-op orders? She may be your mother, but she's my patient.
We're taking the O.
She's going to 604.
lt was bound to happen sooner or later, Peter.
Sweetie, let's try a deep, cleansing breath.
-Let's exhale on the count of-- -Shut up, Sean! Call OB and get the FeSS in here.
How are we doing? -l'll have an epidural.
-Contractions are three minutes apart.
-No kidding! -Tracing showing decreased activity.
What's that? The baby's heart rate is reacting less than it should.
But babies sleep in 20-minute cycles, so what we want to do is wake him up.
Rise and shine! There we go.
He was just sleeping.
The heart rate's back up.
Get an ETA on Coburn.
l'm Dr.
Urami, anesthesiology.
l'm here to do your epidural.
Yes, please.
Let's do that.
-How's that epidural? -Wonderful.
l'm gonna show these pictures of Jared to my students.
-Eighth graders? -You know, like ''show and tell.
'' ln math class? Now we can get a pressure reading inside the uterus.
This scalp electrode monitors the pulse rate more exactly.
Enjoying the show? Yeah.
l mean no.
She's eight centimeters dilated, completely effaced.
-Won't be long.
-There's another decel.
Variable with a late component.
Let's infuse 500cc's normal saline through the uterine catheter.
-Like a regular lV? -Yeah.
And we need to get her up to OB.
l'll light a fire under someone.
-ls something wrong? -No, we're okay.
-Page Coburn again.
Why can't l send her up? She's inches away and the epidural's wearing off.
Well, then find Drake! Hurry up.
Wanna try some breathing? Your fantasy about me quitting work and staying home to have kids? Forget it! This is it.
Repetitive lates.
We need to deliver.
-l need to take a look.
-Try some single breaths.
Fully dilated, 1 00% effaced.
lt's time to start to push.
Already? -Here? -Here.
Run and get Carol.
Try some breathing! l love you so much, babe.
So much! Shut up! Get a baby warmer and a newborn resuscitation tray in 3, stat! Nine, ten! Take a breath, take a breath.
-Welcome back.
-Did l go home? Push! One, two, three.
Eight, nine, ten! l'm not ready to be a mother.
-Bear down.
-l can't! lt's gonna rip me apart.
One, two, three, four.
l can't! l can't! Get it out! Carter! Go up to OB and drag Drake down.
Tell him to bring some forceps.
Go! She's not progressing.
The baby's rate is low.
l'll start the pudendal block.
Okay, l'll gown up.
-OB's got C-sections and deliveries.
-No one will blame you if you wait.
-The monitor says now.
-Why put your ass on the line? l've come this far, l'm gonna see it through.
-Where's Coburn? -ln transit.
What, is she coming by camel? Get her BP.
BP's still climbing.
Go, Mark.
Baby's bradying down.
Now don't push.
Don't push.
Before l break the plates, cut a median episiotomy.
Here comes the head.
-Get a blanket ready.
-Damn! -Get him out! -He's stuck.
-Shoulder dystocia.
-What's that? Shoulder's hung up on the pubic bone.
Oh, my God! Lead's off.
McRobert's maneuver.
-Push her legs up towards her head.
-Lift your legs.
Straight up in the air.
Somebody push on the abdomen.
-What are you doing? -Trying to free his shoulders.
Carter, not fundal pressure.
Down here.
Down here.
lt's jammed! Stat page OB! Oh, my God, do something! Let's try a Woods.
l need to extend the episiotomy.
lf l can rotate the posterior shoulder.
l love you, baby.
Try to deliver the posterior shoulder.
He's jammed in.
Come on.
Come on! Come on! Why can't you deliver this baby? Mr.
O'Brian, please.
lt's not working.
Let her go.
Let her go.
lt's not working.
What are you doing? We gotta push the baby back in.
Then what? We're almost through.
Susan, get your hand in here.
Grab a cesarean tray.
Run! Climb on up, hold her head in.
Throw a sheet over her.
Get her into Trauma 1 .
Find out if Benton's still here.
Splash and crash.
-Where are you taking her? -We gotta do an emergency C-section.
-Have you done this before? -l've scrubbed in many times.
l want somebody else! lf we wait five more minutes, your baby's brain dead.
Oh, my God.
Go, go! Do it! Please get out of the way.
Let them work.
l love you so much.
We're almost home.
We're almost out of here.
Call Respiratory.
O'Brian, wait outside.
l love you! l'm right here.
l'm right here.
BP's sky high.
1 70 over 1 20.
-What about anesthesia? -No time.
l'll throw in a local.
-She's seizing! -Grab the bite block.
Let's paralyze and intubate.
Versed, four migs.
Norcuron, 1 0.
lntubation tray.
-Get Respiratory down here.
Suction standing by.
O-2 at 1 5.
Carter, try and get in here.
We're just gonna bag her for now.
Get that typed blood cross-matched and down here.
-Where's that coag panel? -Get a vent ready.
BP's 200 over 1 30! Everybody just take a deep breath, all right? Hydralazine, 1 0 migs.
Another bolus of mag sulfate.
Somebody call NlCU and get somebody down here for the baby.
Somebody physically go up to the OB and drag somebody down here, okay? Go! Get the suction in.
Let's see.
ls that the fascia? Yeah, that looks right.
-Grab with those clippies.
-Hydralazine's in.
Grab an army, navy.
The long scissors.
Retract there.
-l'm in.
-lsn't there something about a bladder flap? -Pickups.
-l'm dividing the peritoneum.
Okay, we're in.
Grab that side and pull.
Get a retractor in there.
We need exposure.
Pull! Oh, man! That's wide enough.
All right.
Now, scalpel.
Cut across the lower segment of the uterus.
You're asking me? l'm asking God.
No, here.
-You're not all the way through.
-l don't wanna cut the baby.
Open a pack of lap pads.
Retract this way, more.
-There, l think l'm in.
-Oh, my God.
There's two liters in there.
-She's got an abruption! -She's bleeding out! -Gown up! -Get the baby out! Open those lV lines.
Hurry, Mark.
Get him out! -Get the baby.
-Pump in saline.
Forget that cross-match! Eight units O-neg down here, stat! -Hurry up.
-l've got him.
He's big.
-Suction his airway.
-BP's okay, 1 20 over 80.
-Come out.
-Hurry up.
The cord's free.
Suction his nose.
Umbilical clamp.
He's not breathing.
Okay, clamp.
All right, bag him.
Carter, get in here.
Get in here.
Follow my hand down.
Feel the aorta? -lt's pulsing.
-Yeah, l do.
-Push down on it.
Got it? -l think so.
-Don't think, do.
-l got it.
-ls he alive? -BP's holding.
1 1 0 over 70.
Move, move! Start CPR.
l'm gonna intubate.
-Heel stick a glucose.
-Tone is flaccid.
We need a blood gas.
-l can't see.
Suction! -O-neg's here.
All right, pump it in.
l think l'm in.
Bag him.
Quick listen.
-Chest expands while we're bagging.
-Okay, we got it.
Tape it and keep bagging.
Blood sugar's 20.
Give him D-1 0.
-He's got no veins.
-Hyperventilate him.
l'm gonna try an umbilical line.
What about some epi? Here's the epi.
Release that clamp after l tie this off.
Release the clamp.
Oh, my God.
How can you see? l don't know.
Grab a bag of O-neg.
Stick the pins per kilo.
Come on.
That's the umbilical vein.
Hook it up while l advance it.
Okay, it's going.
Glucose at 5 mil per kilo.
Follow me down.
Come on, little guy.
Come on.
He moved! lt's going.
1 00! -Re-gown me.
-He's pinking up! She's had three units, two liters, saline.
-Vitals? -BP's 80 over 50.
Pulse, 1 1 2.
l can live with that and so can she.
-Baby's Apgar's much better.
-That's good.
-Re-gown, Susan.
-Look who's here.
What's going on in here? l intubated.
Baby went bad.
l tried forceps and got a shoulder dystocia.
She seized.
l paralyzed and did a crash section.
There were two liters of blood in her uterus.
-You knew she'd abrupted? -Once l got in.
-Baby nearly died.
-Who's this? And what's he doing? John Carter, med student.
l'm pressing the aorta.
lt's a mess! What'd you use, a chain saw? l couldn't stand around waiting while that baby died.
Get an NlCU transport team and the OB resident on call.
You should've let me know you were in over your head.
We've got hemostasis.
Someone call Respiratory.
Okay, Carson.
You can let go of the aorta.
Wait! Wait! Stop, stop.
Looks good.
Bleeding's stopped.
Go talk to the father.
-ls my baby okay? -He was apneic at first.
But his Apgar's encouraging-- -Stop hiding behind that medical crap! -Your baby's gonna be fine.
Don't take my son! And Jodi? There was bleeding.
She's had transfusions, but she's stabilized.
Coburn is in there with her now.
-She's closing the incision.
-How can this happen? What we need to do now is get your son upstairs.
Now! Go! -Everything's okay, right? -Go be with your baby.
-She'll be okay, right? -She's stabilized.
Go with your son.
l've never seen such a chain of errors.
-l did what you said.
-You miss preeclampsia! -You underestimate the fetal weight.
-l expected OB backup! You miss a placental abruption! Blood clot.
Right there! You do an ill-advised forceps delivery on a baby that's too big.
Then you do a hack job of a C-section! lt was me in the barrel with a baby down the tubes.
What saved you from disaster was dumb luck.
lf not for me, the mother'd be dead and the baby a vegetable! -Who's on OB call? -Drake.
-She's just covering herself.
-She was right.
lt was my screwup.
You were great.
l couldn't have done it.
lt was my fault that she went sour.
She's my patient.
-No one will blame you.
-No, they don't have to.
She's crashing! -How many units has she had? -BP's falling.
70 over 40.
-l can't get a blood gas.
-Run a resuscitation.
-Cap refill's bad.
-l'll throw in an arterial line.
-Put blood bags on a rapid infuser.
-Get the kit! Hook up the transducer.
Give her a mig of atropine.
Check a manual BP.
She's bleeding from the puncture.
-Somebody put pressure on it.
-l got it.
-lV site's oozing too.
-l don't hear it.
65 palp.
Hang a dopamine drip.
Pull her off that respirator and bag her.
Blood's stopped clotting.
She's going into DlC! Oh, damn! Order 1 0 units, cryoprecipitated platelets.
-Multifocal PVCs! -What now? Lidocaine, 1 00 migs, lV push.
Start a drip.
Mark the time: 0542.
Charging 260.
Clear! -She's oozing from every cut surface.
-We're chasing our tails in here.
-Time down? -33 minutes.
More PVC.
She's maxed out on lidocaine.
Add Pronestyl, 30 migs a minute, up to 200.
-No pulse.
We're losing her! -Get a dopamine drip.
-Charging to 300.
-Out of the way! Again.
-Give her 300, lV push.
-Blood gas is bad, 302 over 50.
lt's been five minutes since her last epi.
Another seven.
Mark, she's gone.
lt's thirty minutes past too late.
l'm calling it.
Time of death: lt's not flatlined.
lt's fine V-fib.
Another 7 migs epi.
l just wanted to tell you that l thought what you did was a heroic thing.
lt's one stop the other way, right by the station.
-l gotta get going.
-Come on! Not only does Shorty's have the greasiest eggs stuff falls from the ceiling when the El goes by.
Sounds attractive, Susan.
l got a million things to do.
Are you sure you're okay? l'm fine.
Scout's honor.
ls Jen home?