ER s02e03 Episode Script

Do One, Teach One, Kill One

Previously on E.
It's my case, Kerry.
I'm calling it.
Time of death, 7: 19.
She's irritating as hell, and you know it.
- I'll admit that she has a style - Problem? Challenge.
School was too hard.
It made me feel so stupid.
He set the curtains on fire because you left him alone.
When his fellowship comes up for renoval in November I'm not gonna sign off on it.
We talked about all this before.
You've got to tell him.
"Do One, Teach One, Kill One" - Good morning.
- Good morning.
To what do I owe this? It's been a great few days.
I kind of wish it wasn't gonna end.
Me neither.
The thought of getting on that train I was thinking Maybe I'd stay in Chicago some nights, when I have to work the next day.
- Stay where? - I don't know.
Maybe Doug's.
- Doug's? - You disapprove? It's just the thought of all those pretty girls padding around in their underwear.
Beats the YMCA.
You have nothing to worry about.
It was my understanding that a sub-internship involved more responsibilities.
You wanna do Whipples? Trisegmentectomies? I just thought I'd have my own patients.
- What do we got? - This is Ed.
I'm thirsty, doc.
- When we finish, I'll get you water.
- How about a Scotch and water? Patient experienced shortness of breath while in Molly's Saloon.
BP, 120/80.
Pulse, 112.
Respirations, 28.
History of emphysema, congestive heart failure, pneumonia.
Diminished breath sounds were noted at the base of the patient's right lung.
Intrigued, I tested vocal fremitus, per Bates, second edition leading me to a diagnosis of pleural effusion, confirmed by this radiograph which shows fluid in the patient's right costophrenic sulcus.
- Thank you, Professor Carter.
What do you wanna do? - Tap the fluid.
- Tap? - How many taps have you done? - Eight or nine.
- Run the procedure.
- Prep and drape as usual.
- What's on tap? - Procure a 14-gauge needle All right.
Call me if you need me.
Oh, and, Carter, consider Ed here your patient.
Harper, have you ever seen a pleural tap? It's 2B, guys.
- Getting tired of life in the fast lane? - Just of your jokes, Shepard.
Fifteen more minutes, I'm recertified.
I won't have to hear them.
- Those were jokes? - Up here.
- Smells like he's gone already.
- I wish.
Been sitting there for weeks.
Using himself as a toilet.
He hasn't paid his rent in six months.
I'm losing tenants because of the smell.
He must weigh a ton.
How do we move him? I brought a dolly.
- Man, his BP's 220/130.
- We'd better take him in.
- Do I have to? - You don't want to go to the hospital? I'd rather stay here with my rabbits.
- All right, if he doesn't wanna go - The sheriff said you'd take him.
- We don't run an eviction service here.
- We can't just leave him.
- He doesn't want to come.
- He's not competent to decide that.
- How do we know that? - Look at him.
So he's eccentric.
- I just cleaned the rig.
- Shep! Raul - Ready? - Ready.
One, two, three.
- Good morning, Jerry.
- Hey, Dr.
- Hello, little girl.
- Yeah.
- Yeah.
- Hello.
How's Chloe? She's become disenchanted with computer classes.
She's now going to find her bliss at the Diesel Mechanics Academy.
Good school.
How come I'm already signed up for four patients already? Courtesy of Doc Weaver.
- I'm not on for another 10 minutes.
- Eight.
Morning, baby.
Kerry, I appreciate the vote of confidence but I'm used to signing up for patients one at a time.
Mark and I decided residents should carry at least four patients.
Jerry, are my labs ready? I'm on a tight deadline.
The interviews have to be today.
Harve from Radiology is coming down at noon to take your picture.
- Morning, Susan.
- Yeah, right.
- What publication is this? - Nursing newsletter.
- The swimsuit issue? - A cover story on our newest Attending.
And I want quotes from all of you.
So get your thinking caps out.
- You're a shameless self-promoter.
- Yeah, yeah.
Nice shirt, Jer.
- Consent on Bed 5.
- Just leave it.
- I need your Juan Hancock.
- Hey, Jeanie.
Look, we need to talk.
Seven o'clock.
Same spot.
Any problems, beep me.
All right? Girlfriend? Carotid bruits, papilledema.
Mitchell? Do you have headaches or loss of consciousness? Sometimes I sort of drift off.
Well, it's a good thing that you're here.
He's at risk for a cerebral hemorrhage.
Let's start him with a Nipride drip and get a CT.
Can I borrow your pen? - Burning the candle? - Paramedic ride-along all night.
- Hey.
How's he doing? - He's clean.
Yeah, it's more than I can say for my rig.
What's the matter, Mitchell? What's gonna happen to my rabbits? Oh, they'll be okay.
How? Who's gonna feed them? No.
No way.
If nobody feeds them, they're all gonna die.
Shep? What happened? Mother couldn't wake him up from his nap.
- Is he breathing? - Barely.
Pulse is weak.
- Did he swallow something? - I don't think so.
- Has he been sick? - Yes.
- He been on any kind of medication? - Yes.
- Bactrim, phenytoin, AZT - AZT? He's got AIDS? - AIDS? Yes.
- Dilantin.
You have him on phenytoin and Dilantin at the same time? It's the same thing.
He's OD'd on Dilantin.
- Let's get an intubation tray, damn it.
- I give too much? Yes, you gave too much.
Way too much.
CBC, Chem-7.
Pull that thing off.
There we go.
Get a Dilantin level and set up for a gastric lavage.
We have to pump his stomach.
I'll hold his head.
Okay, here we go.
- He's in.
- All right, bag him.
Let's get that lavage.
Come on, little guy.
I need some Cetacaine.
Grab some Surgilube with 30 grams of charcoal.
You go in right over the top of rib number eight at the posterior axillary line, advancing and aspirating as you go.
- I gotta call home.
- Your wife? No, not for me.
Why buy the cow when you get the milk for free? Take care to avoid the neurovascular bundle.
I gotta call Olaf, my roomie.
I left half a sandwich in the fridge, and I don't want anything to happen to it.
Now is not a good time, because we're about to draw fluid.
- I bet he's over at Molly's.
- Who's Molly? She's a bar.
My bar.
- VoilĂ .
- Oh, that's better.
That's better.
- Why'd it stop? - Sometimes you hit an adhesion.
- Damn.
- Should I get Benton? No.
- Whoops.
- What'd you do?! What'd you do?! - I'm gonna get Benton.
- No, he's my patient.
Yeah, yeah.
Get him, get him, get him.
- Dilantin level is 40.
- Double dose.
No surprise.
What's her name? - Ma'am, what's your name? - Mei-Sun.
- What's your little boy's name? - Chia-Chia.
I'm gonna tell you what we're doing.
We've washed all the medicine out.
Now we're putting charcoal in his stomach to absorb what's left.
Doug? Hey.
Hi, buddy.
Don't be scared, all right? You got a little sick, and your mom brought you to the hospital.
She's right here.
Come on.
- What happened? - I pushed it too far.
You were supposed to tap his lung, not biopsy his liver.
Let's get him up to the O.
, now! He needs a room.
Move! I don't believe this.
There goes next year's surgical residency.
Carter! I've known Mark Greene since he was a wet-behind-the-ears med student.
He had the most beautiful curly blond hair, and so polite.
All I'd do was ask, and he would be cleaning the bedpans and changing the sheets.
He was the best scut-puppy I ever had.
So would you say that, back then, he was sort of "green"? No, Wendy, I would never say that.
Okay, retract the liver inferiorly and rotate the right lobe.
- There she blows.
- Hit the hepatic vein.
- Nice shot, Carter.
- 5-O proline.
I'm really sorry, Dr.
When I felt resistance it felt exactly like an adhesion, and with the patient's history of emphysema Oh, one-handed.
Peter, you've been practicing.
Carter, it happens.
It's all right.
My best student once did a sigmoidoscopy.
Punched through and saw the appendix.
- Sound familiar, Peter? - Metz.
I'm more concerned now with the condition of this man's liver.
Feel that.
Hard as a rock and shriveled like an old shoe.
- Gallon-a-day drinker.
- At least.
Look at the size of those mesenteric veins.
What does that suggest, Carter? - Portal hypertension.
- What are the hallmarks of that? Caput medusa, esophageal varices, hemorrhoids, ascites, splenomegaly.
I wouldn't give this liver three weeks.
- NG's returning blood.
- Varices are bleeding.
Lucky we're here.
- Portal bypass? - We could, but with a liver this oozy - Have you ever done a TIPS procedure? - No, but I'd like to.
I bet.
In fact, it's an excellent case for teaching.
Sylvia, round up all surgical residents who aren't busy.
Tell them we're starting a TIPS.
Standing room only.
What do you know, Carter? You did this guy a favor.
- Mr.
Holthouse? - Yes? - I'm Dr.
What is that? - Tibetan singing bowl.
I get anxious in hospitals.
It helps me to relax.
I understand you're feeling dizzy this morning.
Yes, I've had these spinning sensations on and off all week.
- Headaches? - No.
Some nausea though.
- Spots before your eyes? - No.
Say, you're under a lot of stress right now, aren't you? - Who isn't? - I can see the tension in your face.
I could suggest some relaxation techniques.
I'm a lot more relaxed than I look.
Open your mouth.
Hey, big guy.
Love the tie.
Thank you, Malik.
Thank you very much.
- What's the occasion? - Well, since you asked I've been promoted.
- To what? Supervising emergency-service coordinator.
More money, huh? Unfortunately, no.
- Better benefits? - No.
More responsibility? - No.
- Well, congratulations.
Mark, that big guy, Mitchell, he's seizing.
Let's make some room.
Bite block.
Point-five Ativan IV push.
- Positive Babinski.
- Pinpoint pupils.
Does not bode well.
- Pressure's up, 250/140.
- All right, jack up the Nipride.
- Load him up with Dilantin.
- How much? Let's see.
He's about 400 pounds.
- Divided by 2.
2 is - 181 kilograms.
Times 12 milligrams per kilogram would be I have a facility for simple math.
All right, we'll start with a gram and we'll titrate up.
Come on, Mitchell, stay with us.
Stay with us, Mitchell.
Come on.
- Vitals are coming back to normal.
- Get him to Pedes ICU.
Hey, there, Chia-Chia.
How you doing? I'm Doug.
- He doesn't like doctors.
- Bet he sees a lot of us.
- Where do you take him? - Pediatric clinic upstairs.
- Who's the doctor? - Always a different one.
- They're pretty busy.
- Yes.
Very nice, but sometime we wait four, five hour.
It's hard for him.
I have to make sure this medication problem doesn't happen again, so I have to ask you - I mean, can you read English? - Yes, I follow direction.
This one from two week ago.
And this one from yesterday.
Two prescriptions for the same thing.
You did exactly what they asked you to.
I'm sorry that I was angry with you.
This is not your fault.
This is the doctors at the clinic's fault.
Okay, all right.
Next time bring Chia-Chia here.
You give this to the nurse out front, and she will bring you straight back.
No waiting.
Okay? - Oh, oh, I thought he didn't like doctors.
- Chia-Chia, no.
It's okay.
He can hang on to it for a while.
You can keep that.
- Mr.
Holthouse? - Over here.
I see you're feeling much better.
Yeah, but I still have that spinning feeling, even upside-down.
Have a seat.
Tony'll take you for a CAT scan.
- Doesn't that cause cancer? - Susan, a word, please.
- Why are you ordering a CT for vertigo? - Why are you questioning my orders? - Because it's a $ 1500 procedure.
- I have to rule out acoustic neuroma.
He's had five bouts of dizziness in a week.
Wouldn't know from his chart.
I haven't had time.
I've had other patients.
So do I.
I manage to keep track of details.
- So have I, on my note cards.
- Well, I don't have access to those.
Put them on the chart.
And in the future, run all procedures by me.
- Hey, what happened? - Subarachnoid hemorrhage.
He went just like that.
- What are you doing with him? - Landlady called animal control.
They rounded them up.
It was awful.
This guy followed me down the hall.
- Is he clean? - Sure, he's clean.
And he's soft too.
Poor fat guy.
He never hurt anybody.
Just sat around with his bunnies, singing that nutty song.
What was it? Vienna.
No, he's a patient of yours.
Chia-Chia Loew.
A 4-year-old with AIDS.
Try to remember, because you almost killed him by giving him Dilantin when one of your cohorts already had him on phenytoin.
Do you people talk to each other? Making friends again? Idiots at the Pedes clinic doubled up a kid's prescription.
Almost killed him.
- Get her off my back.
- Her? Weaver.
She just dressed me down in the hallway for ordering a CT.
- We're getting pressure from upstairs.
- She treats me with disdain.
- You want me to talk to her? - Yeah.
Tell her to cut me some slack.
See how Peter's snaking the sheath through the vena cava to the right hepatic vein.
- I'm in.
- Now comes the fun part.
Remove the guide wire.
Rotate the needle counterclockwise 90 degrees.
- Pressure's dropping.
- Give him pressors and keep me posted.
Puncture the cirrhotic tissue and enter the portal vein, creating a new pathway.
- Balloon stent's in.
- Expand the balloon slowly - Easy - We have circulation.
- Portal pressure's coming down.
- And the liver is reborn.
- Hallelujah.
- He's getting tachy, 180.
Fixed his liver.
Not much we can do for his heart.
Run of five.
- Get out of there, Peter.
- I'm getting out.
- He's fibrillating.
- Carter, CPR.
Come on, Ed.
Come on.
- Charge it to 200.
Clear! - Stand back.
- Hey, Kerry.
How's it going? - Pretty good.
But there's something we need to talk about.
Susan Lewis.
This is a bit awkward.
I mean, I know you two are friends.
She seems to resent my being here, and it's creating some tension.
- You know, I've picked up on that.
- It has nothing to do with her ability.
She's really quite competent, but her attitude is openly hostile.
It's probably a communication thing.
You're very authoritative, which is great.
But your assertiveness might be off-putting to some.
I'm aware of that.
That's why I bend over backwards to be sensitive with Susan.
I'd rather you not say anything, but this is a potential problem area.
Thank you.
Picture-perfect procedure, Benton.
Save the tape.
We'll show it at M&M.
Carter, you can present.
It'll be your first time.
I'll tell him.
- My first official patient.
- Carter, the guy was a train wreck.
He died of heart failure.
It had nothing to do with you perfing his liver.
If he hadn't been on the operating table Then his liver would've failed in a month.
- I'll tell the family.
- He didn't have any.
Carter, it's how you learn.
It'll make you a better doctor.
What can I say about Mark Greene that hasn't been said? Everybody knows how he overcame adversity as a child of Quakers.
His years in exile, his political writings and limericks his mod period with the turtlenecks, his blue period and of course his ruthless march to power and the silencing of his rivals.
Ross? Dr.
Ross! Which one do you think? - It's for the nursing newsletter? - Yeah.
You think this one? I'm looking for the supervising emergency-service coordinator.
- You've found him.
- Oh.
Hi, I'm Randi.
I'm the new clerk.
I understand I'll be working under you.
I was expecting a guy, because of the name.
Randi, right.
I get that a lot.
Personnel said that you would have some immunization forms for me to fill out.
You'll need a rubella and a Heptovax.
Lab's on the second floor.
They said I'd need a physical, and that somebody here could do it.
Jerry, you got any charts for me? Any patients? Anything? All right.
I'll be at Pedes ICU.
Carol, quick.
Three-hundred-pound angel-duster broke out of restraints.
- Climbed on the ambulance.
- What is this, crazy-fat-guy day? - I'm telling you, this dude is mad.
- Call security.
Go find Mark Greene.
The tests show nothing serious.
I think your dizziness is caused by labyrinthitis.
- What's that? - Inflammation of the inner ear.
- Nothing serious.
You swim? - No.
I don't know how.
But I do spend a lot of time floating in my sensory-deprivation tank.
Not for the next two weeks you don't.
- No standing on your head, either.
- Dr.
Lewis I'd like for you to have this.
- No, thanks.
- Please.
It's a spare.
It's not necessary.
I think it is.
Oh, God, not another one.
- Watch out, Carol.
- Relax.
- Where am I?! Where am I?! - Hey, buddy, relax.
Just calm down.
Where's Mara? Mara! Mara? - Mara? - Just back off there, Mara.
- What's he on? - PCP.
I got him.
- You get away from me! - Are you all right? Are you okay? - Nobody touches me! - He's cut.
Stay here.
I'm taking him in.
- Mara! - Where the hell is security?! - My God! I can't see! - Let's shoot him.
- Let me talk to him.
- Make it stop! Make it stop! Okay, okay.
Hey, what you doing up there, big guy? - Mara? - Yeah.
Why don't you come down here.
It's much safer.
Okay? - Mara? - Yes, babe.
Come on down.
Mara! Where's Mara?! Mara! Mara! What are you doing? Hey, what are you doing? Hey, hey, no! Oh, my God! Oh, Mark, did you and you-know-who have a you-know-what? - You bet.
- Good.
And these extensions are for internal use only.
Lewis, can you do an employee physical? - On? - Randi? - Hi.
- Hi.
Breathe in.
Breathe out.
You're fine.
Where's the form? Do you have my roommate as a patient? Ed Menke? Yes.
You must be Olaf? I'm afraid I have some bad news about Ed.
He He had fluid in his lungs.
During the course of trying to remove it, we I accidentally punctured his liver.
We successfully stopped the bleeding and did some additional surgery.
But, unfortunately, his heart gave out, and he died on the table.
I'm very sorry.
Yeah, they told me that upstairs.
They said you had his property.
- Property? - He took the remote-control doohickey.
It's his TV, and he's kind of tightfisted about it, but I don't think he's gonna mind now.
- Double dose of Haldol.
- It's about time.
- Why don't you try and, you know - Right.
Hey! Hey! Hey! Big guy! Hi.
So are you from Chicago? Jeez.
Come on.
You can do better than that.
You weren't even close.
Come on.
Oh, God! 0 and 2, big guy.
Why don't you just try to put some mustard on it.
That's it.
That's it.
Yeah! Yes! Bull's- eye! Nice work.
With a regimen of ultrasound and TENS, he could regain the use of his legs.
- Jeanie.
Did you get my message? - Yeah.
All right.
Seven o'clock.
Prisoner found in his cell spitting blood.
Swallowed a dozen razor blades.
- Suicide try? - Maybe he wanted a field trip.
- Set up for endoscopy? - Yeah.
Get a KUB.
And I'll need a rat-tooth on the scope so I can grab the blades.
Coming through! Hey, Chloe, what are you doing up here? Oh, hi.
Just talking to my baby.
Why don't you listen to her breathing.
Sounds like she's got pneumonia.
It's just gurgling.
Come here.
- You picking little Susie up? - What? - You picking little Susie up? - No, I'm just taking her for a walk.
- Big Susie know that you're here? - I'm gonna go wait outside.
- You okay? - Yes.
I'm just a little tired, that's all.
See you.
No bleeding in the esophagus or antrum.
H & H back? - Normal.
Fourteen and 42.
- Got one.
Razor blade coming up.
- How's his pressure? - 120/80.
Won't that slice up his throat? - No, because he taped the blades.
- So much for suicide.
What's this about? Not trying to escape, are you? - What's this? - Prisoner swallowed razor blades.
No blood in the gut? You're done.
Pull out the scope.
- He's tubed.
I'm not gonna stop now.
- I told you all procedures go through me.
Go get Mark.
Greene, we need you in Trauma 1.
- What's up, guys? - Prisoner swallowed taped razors.
- Kerry wants to leave them.
- Gut's not bleeding.
- It could.
- Hasn't yet.
I say let them pass.
It's a judgment call, guys.
If he bleeds, we go in, we take them out.
For now, pull the scope out.
Excuse me.
- You had a patient named Menke, right? - Yeah.
Why? Dr.
Hicks had his liver taken out for a cirrhosis study at the Standhal clinic.
She said you should arrange to get it over there.
Ugly little thing, ain't it? An exciting case? Here's one: Guy comes in, hypovolemic shock.
Defibrillated 10, 15 times.
We maxed out on lidocaine, added bretylium finally shocked him back to sinus.
He goes bradycardic.
So I float a transvenous pacemaker, get capture.
He stops breathing.
I had to climb on, intubate him cowboy-style on the table.
Wow! What happened? He died.
Please enter the patient's number before proceeding.
Jerry? Dr.
Weaver loaded an audio program onto the computer.
With her own voice?! Where's Greene? He and Dr.
Ross went to the gift shop.
Don't forget to log off.
Don't forget to log off.
Don't forget to log off.
- Are you sure you don't mind? - You kidding? Anytime.
- How about tonight? - Tonight I may have company.
Depending on the weather patterns over Greenland.
Ross! Next time you get the urge to pick up the phone and scream at one of my residents, ask for me instead.
Your resident screwed up.
You're not in the position to make that judgment.
Your job is hanging by a thread, and I'm the guy with the knife.
You pull this prima-donna crap again and it'll take more than your friend here to save you.
Hey, didn't see much of you today.
Whatever happened to old Ed? - Ed? - Yeah.
- They transplanted him? - He died.
- From the tap? - No.
Not directly.
- So are they taking away your sub-i? - Are you kidding? Hicks and Benton were so excited about getting to do a TIPS they were glad I screwed up.
Thing is, I didn't really care either.
All I thought was, "There goes my surgical career.
" So here he is.
What a way to go, huh? Well, from the looks of things, he knew how to have a good time.
What do you say we give him a sendoff? What? Get your coat.
- Hey, quite a day, huh? - I'm telling you.
- Head okay? - Yeah, knock on wood.
- Hey, I'm sorry about that.
- Yeah.
Hey, don't worry about it.
- We were pretty good out there today.
- Not bad, huh? Yeah.
We should go out.
- Really? - Definitely.
Right now is not a really good time for me, but I've got your number.
You're gonna blow me off, just like that? No.
Look, I'm just getting over a relationship, so Good night.
You know what your problem is, Hathaway? You've gone out with too many doctors.
- You've been checking up on me? - I'm interested, so I ask.
You're shopping in the wrong part of the store.
- What? - You're lost among the Guccis.
And where should I be? Automotive.
- Shaw's, Friday night, 8:00? - Okay.
Hey, buddy.
Hey What's the matter? It's my fault.
No, it's not your fault.
I told you.
It's the doctors' at the clinic.
No, it's my fault he has AIDS.
I gave it to him.
No, that's nobody's fault.
I gave it to him and now he's sick.
And I'm not.
It is punishment.
It's okay.
- Peter, what are you doing here? - I waited 45 minutes.
- You couldn't even call me? - I was gonna call.
- So now you're even lying to me? - What? - I thought we could talk to each other.
- I needed time to think.
How much time? What was I supposed to do, get a postcard? - Keep your voice down.
- Don't tell me what Hi.
It's easy for you, Peter.
I'm the one who's had to go home to my husband.
You just hand out ultimatums.
You demand answers I knew your answer last week.
- Peter - What? I'm not ready to walk out on my marriage.
Yeah, right.
You You take care of yourself, all right? What about the weather over Greenland? It's this stewardess I've been seeing.
I met her at work.
- A patient? - Sort of.
I put a cast on her.
With her flight schedule, I never know when she might show up.
- Guess the weather was bad.
- Well, it's just as well.
- Is there a doctor in the house? - Hey.
Oh, hello.
- Hulda, that's Mark.
Mark, that's Hulda.
- Hello.
You know, the Finns are remarkably unselfconscious.
I see that.
- I cooked you lutefisk.
- Great.
- Set your bag down.
- Yeah.
- Now, we are out of here.
- Susie! Hey, Susie! - Chloe? - Yeah.
- Who're you with? - Oh, that's my friend Ruth.
Hi, Ruth.
- Oh, God, you're loaded.
- Oh, come on Chloe! - Look, everything is gonna be okay.
- What are you on? - I'm going on a trip.
- The hell you are.
The flea markets, Susie.
You can make a fortune selling old stuff.
- Just stay there.
I'll come around.
- No, Susie, I can't.
We gotta go.
- You're not abandoning this baby! - I'll be back.
I just gotta make us some money, so I can buy us a house.
Chloe, what are you doing? Don't! Don't do this! I'm dying inside, Susie.
I gotta go.
No, I know.
Chloe, it's fine.
- Don't be mad, please.
- It's okay.
I just wanna do something right, okay? It's okay, I'm not.
I'm not! Chloe, it's okay.
- Bye-bye, baby.
Mama loves you.
- Don't go! Chloe, it's okay.
- Hey! Chloe! - Bye-bye.
- Bye-bye.
- Chloe.
Chloe! - Chloe! It's okay.
- Bye-bye, baby.
Chloe! - This place is a lot nicer than I expected.
- Yeah, it's not bad.
- What's that? - A liver.
- What'll it be? - Whatever's on tap.
Very cruel.
- Two? - Yes, please.
- Which stool's Ed's? - Your boyfriend's sitting on it.
- You friends of his? - We knew him.
- He's dead, you know.
- We know.
- To Ed.
- To Ed.
Thank you.
For what?