ER s03e07 Episode Script

No Brain, No Gain

Previously on ER - What's your name? - Gail.
She's 10 days.
Is she okay? Pulse ox is falling.
You need to get this baby off the table.
- I'm getting Keaton.
- No.
- I don't want you near my patients.
- I don't need your approval.
If the baby dies, it's my responsibility but your fault.
- Hi, Mark.
- Hi, Susan.
Excuse me? You just called me Susan.
- No, I didn't.
- You did.
Guess she's on your mind.
- Not necessarily.
- I wish you could just get married.
You're perfect for each other.
You almost went on vacation together.
- You knew about that? - Everybody knew.
- Why did you back out? - She didn't want me to go.
- She wanted you to go.
- Did she? Nobody told me.
Just do us a favor and ask her out.
We need some fresh gossip.
Oh, man! I need some sleep.
You? At least you get off in 11 hours.
I've got 18 to go.
- Where's Benton? Still in the ER? - No, still where he's been lately.
- Still with that baby? - The man is obsessed.
Damn it, Edson! I told you to keep an eye on him.
That's what I told the nurses.
He's probably in the cafeteria.
He better not have eaten.
Have you seen a male patient about this tall, kind of peculiar? - Lost one? - Great case.
Guy's got a big tumor in his throat.
He needs esophagectomy.
Anspaugh brought some hotshot from Japan, and the patient goes AWOL.
You guys help me find him, and I'll get you in on the surgery.
- We'll keep our eyes open.
- Thanks.
He's got a sweet tooth, so check the vending machines.
Last shift, he left me three lines to change.
I had to pick up his labs.
- Have you had breakfast yet? - I'm starving.
- You paged me? - Her abdomen is distended.
She's hemorrhaging.
We need to take her off the anticoagulants.
- Take her off the machine.
- Can she live off it? I doubt she'll last the day, but there's no other choice.
- We should take her to the O.
R.
- Her platelets are too low.
- Then we gotta transfuse her.
- We just did.
We got to try something.
At this point, the best thing we can do is to do nothing.
I also think that for the time being, you should be more of an observer.
- You mean on this case? - On all the cases.
Dr.
Keaton, I'd do anything to undo what I did.
But I can't.
This isn't a punishment, but you tend to act without thinking.
If you want to grow as a surgeon, you got to learn more patience.
Hear ye.
Hear ye.
Who wants taffy? - Homemade, per chance? - Saltwater.
Pulled it myself.
- Don't mind if I do.
- Excuse me.
Do you have change for the candy machine? - Let me see.
Quarters okay? - Yes.
- Excuse me, cuz.
You owe me a buck.
- I don't have one.
Then you're SOL.
- Conni's sick.
Call in a float.
- I already did.
Call them back.
I want to approve whoever they send.
Can someone call Security? There's a man urinating in the phone booth.
- That's why.
- Did anyone hear me? Yes, but you don't need Security.
You need a mop.
I don't mop.
- Way to go, Jerry.
- How was I supposed to know? I wonder how long we can sit here before anyone notices we're missing.
- You just jinxed it.
- What do you mean? - That's what I mean.
- It's Benton.
Couldn't happen to a nicer - What's that? - The ER.
- Do you want to trade? - No way.
Hi, John.
I got that review article you dropped off on congenital hernias.
I heard you were doing one.
I didn't know if you had read it.
- I actually helped edit it.
- Oh! Well, then It was very sweet of you.
See you.
- Anything I should know about? - Please! And when was your last bowel movement? Technically, that would've been Monday afternoon.
Which is a little unusual for me.
I'm a morning person.
And then sometimes in the evening, I pass a little gas.
Gas in the evening.
- We don't take lengthy histories here.
- I believe in being thorough.
When the patient is in for an extended stay, that may be appropriate.
- But down here, we keep it short.
- That's not the way I do things.
The longer it takes, the longer the patient waits in distress.
That's all right.
We were having a nice little chat.
Anything else? - Where were we? - Gas in the evenings.
We'll need some saline, some 4.
0 nylon and a suture setup.
I know the squirrels are cute, Arthur, but I wouldn't try petting one again.
He was trying to eat it.
- You all right, Wendy? - It's not me.
- He's choking! - His airways are blocked.
It's my taffy! It was meant for the staff.
He's dying, Wendy! Do you want to give me a hand? One, two, three! There's more.
How much did you make? Get a McGill and hook up the suction.
Arthur, go to the waiting room.
What's a patient from Surgical doing here? Call upstairs.
I think we just found Dale's AWOL patient.
- Where do you want him? - What's this? Took two bullets to chest and belly.
- How long has he been down? - 15 minutes.
No signs of life.
Let's transfer him over.
Give me 4 units of O-negative.
On my count.
One, two, three.
- Here's one entry.
- What happened? - Some gang thing.
- He's a banger.
Flatline.
- How long was he down? - 5 to 10 minutes.
- Anyone give him CPR? - No.
- So he was down for 20 minutes? - At least.
Pupils are fixed and dilated.
This kid is dead.
Very dead.
- Calling it? - Yes.
Time of death: 8:26.
This the GSW? - He's been down for 20 minutes.
- Giving up on him? There was no sign of life in the field.
Lydia, start bagging him.
Thoracotomy tray.
- Peter, I called it.
- Let's get a cutdown on the ankles.
This kid has been down for 20 minutes.
His brain is mush.
- Ten-blade.
- His parents don't want him opened.
- They want us to do our best.
- Lydia, go get Mark.
Put the O-neg on the rapid infuser.
Rib-spreader! - God, it's like rubber! - It's all the cornstarch.
Scissors.
Yes.
I think it is coming loose.
- What are you doing to my patient? - He swallowed two pounds of taffy.
Here it is! Shame on you, Mr.
Percy.
You're not supposed to eat before surgery.
- Nothing can get past that tumor.
- We need to move.
Let's take him up.
Hey, Dale.
Remember me? Oh, yes.
I'd ask you to join us, but we're a little crowded.
We can make room.
After all, Carter saved your keister.
- Did you consent Mr.
Percy? - Yes.
All that's left is an art line.
Carter, do the line.
Edson, prep the O.
R.
Dr.
Okida likes the temperature to be 67 degrees.
- Got the O-neg running? - Two lines, wide open.
- What's the story? - Kid was down 20 minutes.
I called it.
- Peter's now playing God.
- He was out in the cold.
- He's started, might as well finish.
- The kid is dead.
He was my patient.
I assessed him as unsalvageable.
He's not just your patient, Doug.
High-dose epi.
Start internal massage.
Like this? - Anything? - Still flatline.
He jumped.
- He's got a rhythm.
- That's the epi, not his heart.
- That's more than the epi.
- You got him back.
- His heart's back.
His head's dead.
- You don't know that.
Call the O.
R.
Tell them we're on our way.
Here we go, people.
Let's move.
Thanks, Haleh.
Here we go.
- Hello, Dr.
Lewis.
- What's the matter, E-Ray? - I just don't feel like myself.
- Fever? No, but I had an MRI yesterday on my shoulder.
An old conga injury.
And ever since I just feel off.
Could it be radiation sickness? MRIs aren't radioactive.
They just scramble your electrons a bit.
- Forever? - No, just for a few seconds.
That's odd.
My watch stopped.
- Oh, my God! - What? My watch stopped last night.
Right after the MRI.
And the toaster.
- What toaster? - My toaster.
It shorted out this morning.
I've had that toaster for 10 years.
Could the MRI have rearranged my molecules, causing me to radiate some sort of bizarre electronic interference? No.
Follow the light with your eyes.
What light? That's funny.
What have we got? and pulmonary artery.
Got his heart back in the ER.
- Down time? - 15 minutes.
Closer to 20.
But he was out in the cold, so we can save his brain.
- Giving odds? - Dr.
Greene agreed to keep trying.
This could take all day.
- He's bleeding from the belly.
- I'd go for a midline incision.
- I thought I was supposed to observe.
- I'll make an exception.
It's all yours.
All right.
Mark 9:35 as start time.
- Mark, we've got a 10-foot-fall.
- Where from? A tree.
Taking pictures in Grant Park.
- Dizzy? Nauseous? - Dizzy, yes.
Nauseous, no.
- What were you taking pictures of? - Birds.
- Haven't they gone south? - Not the ones I'm interested in.
Seems okay to me.
Why don't you take her to Curtain Area 2? - Susan.
- Hi.
You want to go out tonight? Yes, sure.
I'd love to.
But I can't.
I have something planned.
- So you can't.
- I guess not.
- Maybe some other time.
- Sure.
We need to talk.
Dr.
Lewis? Dr.
Morgenstern is on the line.
I'll call you tonight.
Okay, Mr.
Percy.
We need Mr.
Percy? - Mr.
Percy? - Who's there? It's Dr.
Carter.
I take it you have some reservations about the surgery.
Do you have change for the candy machine? You can't eat with the tumor in your throat.
Eloise put a Hershey bar in the blender, and I drank it.
Do you know that you're about to have an operation? There's no blender here.
I asked.
Has someone gone over the risks with you? Another time, she blended up Snickers.
The trouble was that the nougat got caught in the straw.
- You ever have a Zagnut? - I love Zagnuts.
- They're my favorites.
- Mine too.
Mr.
Percy, do you want to have this operation? Can I just have change for the candy machine? Is it ready? - Not quite.
- What are you doing? - Mixing an enema.
"White and brown.
" - Milk and molasses.
- Did a doctor order this? - I know when it's needed.
We give people an enema in a box.
We don't spend time mixing up a recipe.
- I do.
- Not anymore.
I'll take over.
Change the beds in Exam 4.
- You can't do this.
- I'm the charge nurse.
- I don't want a new nurse.
- You're in luck.
You can go home.
Where are your clothes? Hello.
Your CT is fine.
I don't see any birds in here.
I let you in on a secret.
I'm more than just a bird watcher.
I'm a comparative anthropologist doing field study on the mating rituals of man and bird.
- Sounds interesting.
- Yes.
Take those two over there.
Notice the occasional lateral-body contact initiated by her, and then reciprocated by him.
Identical to the courtship dance of the sharp-tailed grouse.
Check out the two at the desk.
Do you see how he puffs his chest and strokes his goatee? Same as the slender-billed shearwater.
- Look at that! - What? - Her frontal-neck presentation.
- What does that mean? In the nuthatch, it's an invitation to love.
She is shameless! See how she strokes her throat with her finger? The spoonbill would bend over and shake her tail feathers in his face.
I need some moist lap pads to pack off the liver.
Bad news for the gallbladder.
A bullet tore through the common duct.
- What's your plan? - Pack and stitch off liver put in 3 or 4 Jackson-Pratts, move on to the gallbladder.
Sounds good.
I'd love to stay, but I have a cystic hygroma.
Is Dr.
Maxwell available to supervise? He's resecting a bowel, but Dr.
Breedlove is around.
- Breedlove would be perfect.
- 3.
0 on a needle.
Let's move! - Did my blood test come back? - Not yet.
Damn.
The computer just went down.
Why don't you have a seat right there? Here's your aftercare, your prescription and your enema.
- Instructions are inside.
- I know all about them.
Someone from the home will be here any minute.
I'll believe that when I see it.
- Mark, what are you doing? - Do you see what I see? Susan's talking to Morgenstern.
So what? He's stroking himself, puffing out his chest like a slender-billed something.
She's giving him full frontal neck.
- What are you talking about? - You'd know if you were a nuthatch.
- Mark, are you okay? - She turned me down.
- Susan? - Now I know why.
- Oh, God! She's stroking her neck.
- So? Why doesn't she just bend over and shake her tail feathers in his face? - Did you consent Mr.
Percy? - Yes, why? He couldn't reiterate the risks to me.
He only wants to talk about chocolate.
He's just in denial.
This is a high-risk procedure on a guy that can't carry a conversation.
- He signed the consent.
- He's not qualified to make decisions.
- Let's get a shrink down here.
- You want to delay the surgery because you aren't comfortable with the patient's mental status? I'll get a stat Psych consult.
If he agrees with me, I'll tell Anspaugh.
- What happened? - Doug tried to explain things and the guy just went bozo.
- It's a scratch on his finger! - A serious infection.
- Who are you to tell me what to do? - I'm his doctor.
The boy has an infected human bite.
The father refuses to let me treat him.
- It's a free country.
We want to go.
- Hold on.
Can I see the x-ray? The infection could be in the joint.
Let me see you guys outside.
We'll be right with you.
- He could loose his finger.
- There's no signs of osteomyelitis.
- The dad won't come back with him.
- IV is the best way to go.
But we shouldn't call the police if he can be treated with oral antibiotics.
Fine.
You do what you want.
- Psych consult come down? - Still waiting.
- Time's up.
- Mr.
Percy.
Do you want to go through with this surgery or not? Can I have change for the candy machine? - Art line in? - It's in.
- Let's take him, Oki.
- Okey-dokey.
Dr.
Anspaugh, the patient is more interested in candy than surgery.
Don't worry.
You can have all the candy you want when the tumor is out.
Coming, John? - I'm due for my break.
- We don't take scheduled breaks.
It's in the contract.
Is a little flexibility too much to ask? Whose patient is she? She's been discharged to her nursing home.
They won't take her.
She just had an accident.
The loose, runny kind that makes a puddle on the floor.
I believe the mop is over there.
- More O-chromic on a liver needle.
- Cut.
Box! You Benton? Sam Breedlove.
Where are we? Finished pneumonectomy.
Almost done with liver.
Gallbladder to go.
Take wider bites, and don't tie so tight.
- More 3.
0 Vicryl.
- Good stuff, Vicryl.
- Closest thing to catgut.
- Surgeons still use that? Not these days.
It's a shame.
Nothing ties like catgut.
- Got a bleeder.
- Is it new? - Where is it coming from? - Aorta.
We got a pumper.
Put your finger on it! - Statinski.
- I got it.
- Clamps here.
- Clamps.
- Still falling.
- D Ábride hole and sew.
- Vascular needle now.
- Internal paddles.
Charging 20.
Clear.
- Still in fib.
- Charging 30.
- No change.
- Charging 40.
Clear.
- Still at it? - Lot of work to save an organ donor.
- Wait! Lost it.
- Charging 40.
Clear.
Charging.
Clear! 50.
- Susan and Morgenstern? - It makes sense.
She's been preoccupied lately, distracted, avoiding me.
I did see her and Morgenstern having lunch the other day.
See? I waited too long.
That's my chance.
Blew it.
- Can't believe we got him back.
- Kid's got good protoplasm.
Set him up for an apnea test.
See if he's got any brain left.
- Do you think he's got a chance? - He's made it this far.
Dr.
Benton? The boy's mother.
Do you want to talk to her? Not yet.
I want to assess his brain function first.
- I will talk to her.
- Don't get her hopes up.
- How's the Herlihy baby? - Still alive the last time I checked.
My foot! Sal Urbanski.
Playing football in the street, went for man in Buick.
Right foot ripped off at the ankle.
In shock.
Lost a liter at the scene.
- Where's the foot? - Between his legs.
- Why is he holding a football? - It's his lucky ball.
Let's get 6 units O-neg, CBC, type and cross.
On my count.
One, two, three.
Get his foot on ice.
Someone call Vascular and page the Reimplantation team.
Stand by with morphine, 4 mgs.
The pressure dressing isn't working.
I need a thigh cuff.
Thank you.
Oki is freeing up the esophagus posteriorly with his fingers.
Dale, you're in a position to displace it laterally.
- I can free it up anteriorly.
- You stick to suction, Carter.
- I can feel it coming loose.
- Suction.
Suction! As Oki cuts along sternocleidomastoid down towards the carotid sheath what should he watch out for? - Not to nick any arteries? - Dale? - The vagus nerve that runs through the sheath.
- Very good.
Dale is smart.
Those little bubbles on the lung normal? Those little bubbles there, where Dale just moved the esophagus.
- You tore the lung pleura.
- I didn't feel it tear.
Congratulations, you've just given Mr.
Percy a pneumothorax.
- I can put in a chest tube.
- Yes, do that now.
Dale, can you hold this for me, please? Scalpel.
- Chest tube.
Thirty-two French.
- Scissors.
- Got it.
- That was a nice catch, Carter.
- Where is my suction? - I'm sorry.
- Give me the football, sir.
- Don't lose it.
Ditka signed it.
I'll put it with your clothes.
- BP down to 60.
- Let's get another line going.
Start the rapid infuser.
Someone called for a vascular surgeon? - It's about time.
- Don't get fresh with me, lassie.
- Ice is here.
- Put it on the foot.
- I'm in trouble.
- Can't find a vein? - No.
Itchy in my mush.
- Your mustache? Would you be so kind? Left side, near my nose.
That's my spot.
- That's my spot.
- Want me to help you? - No.
Susan's got it.
I'm in.
- Hook it up.
Let's get him upstairs.
The Reimplantion team awaits.
- Have we got the foot? - Right here.
- See you later.
- Yes.
Dr.
Benton, the boy's mother wanted to watch.
- I said I had to come and ask you.
- All right.
Tell her to come in.
- This is Mrs.
Dorset.
- I'm Dr.
Benton.
I took him off the ventilator to test if his brain'll trigger him to breathe.
- I don't understand.
- Lf we see your son take a breath that means that his brain functions are intact.
If there's no attempt to breathe in, that's a sign of brain death.
PCO-2 is 60.
- It's high enough to make him breathe.
- How long will it take? We'll know in 10 seconds.
I'm sorry.
You wanted to see me? Yes, I did.
How many shifts do you work a week? - Four? - Usually.
As long as we don't work the same four, we'll get along great.
- Is this about the kid's finger? - You don't respect my decisions.
You can't take professional differences personal.
It is personal.
You have been Mr.
Moral since I came in with that OD.
What do you expect when you drag your dirty laundry through the door? But it's not personal, right? Who are you kidding? Mrs.
Urbanski, the surgeons are trying to reattach your husbands foot.
- But is he all right? - He lost blood, but he will be fine.
- Here's his stuff.
- Thank you.
He seemed concerned about his Mike Ditka football.
- He loves the Bears.
- I'll find someone to bring you up.
Wendy? Can you bring Mrs.
Urbanski up to Surgery for me? - How are we doing? - Ready when you are.
- Let's bring in the foot.
- What the hell? Oh, my God! I'm sorry.
In and out in two hours.
Oki's amazing.
- I'm glad you invited me along.
- I'm glad we did.
Otherwise we might not have seen the pneumothorax.
- Want to eat before my flight? - Lf you're buying.
Why don't you join us, Carter? Edson, monitor Mr.
Percy in Recovery.
It was an honest mistake.
It was incompetent.
And because you didn't ice it, it can't be reattached.
- Please don't write me up.
- Lf anyone deserves that, it's you.
Do the dirty work for them.
That's what they want.
Whose dirty work? Hospital Administration.
I'm nine months from getting maximum pension.
That's why I'm sent where I don't know what I'm doing.
They want to get rid of people like me to get cheaper aides.
If they know the difference between a football and a foot, I'll take them.
I will not let you put me through the humiliation of a review board.
- Not after 22 years.
- Watch me.
Don't bother.
I quit.
Dr.
Keaton says that her oxygen level is as low as it can go.
It's only a matter of time.
Thank you for everything you have done for Megan.
- What happened to the float? - She quit, thank God.
She said that Admin tried to make her quit before her pension maxed out.
- That's why she was floated down here.
- She gave me the same line.
- They're floating me to Neuro.
- What? Starting tomorrow, the hospital's floating me there three times a week.
- When does your pension max out? - In a year.
So maybe it was personal.
Go ahead and say it.
I'm a sanctimonious judgmental, self-righteous, sexually frustrated, little man.
- You're not little.
- Thank you.
I hate to think that my personal pique could color my professional decisions.
But it happens.
And it probably happened today.
You don't need to beat me up about making a mess out of my life.
I like to do that myself.
That may not be the healthiest approach.
- I'm seeing a shrink.
- That's a good step.
- Man or a woman? - Woman.
Don't worry.
She's 62 years old.
Freudian? Sorry, I couldn't resist.
I hate you.
You know that? I know.
When a whippoorwi// ca//s And the evening is nigh I hurry to my blue heaven You'// see a smiling face A fireplace, a cozy room A /ittle nest that's nestled By a clear rose's bloom Just Mo//y and me And baby makes three We're happy in my blue heaven Take it, Oki.
Rough day? - You knew it would be, didn't you? - I had an idea.
I did exactly what you said.
Rushed ahead, didn't think.
Did you actually believe that you could save that boy? I never worked so hard or performed more surgery than I did today.
When I took that vent off, I actually thought that kid would breathe.
Did you check on the Herlihy baby? Couple of hours ago.
I can't face those parents.
You should check on her before you go.
The guy walks in the room, and every vending machine goes kaput.
- I don't believe you.
- Jerry, I've got the keys.
- Are we going through with this? - Yes, I'm desperate.
You are nuts.
MRIs don't cause negative force fields.
I think we better take the stairs.
Dale, my hale and hearty friend, today was a blast.
Not bad.
Too bad Mr.
Percy stroked out.
- What did you say? - Didn't you hear? Went to check on him, and he couldn't even talk.
- You're kidding.
- No.
Nothing left to do but turn and water him.
Shame you backed off on that Psych consult.
You could've saved his life.
You smug son of a bitch! What the hell is going on here? We were just discussing the finer points of informed consent.
What is wrong with you guys? She and Morgenstern are going out.
I can live with that.
What bothers me is that she didn't tell me about it.
If I was going out with Morgenstern, I wouldn't tell anybody.
Susan and I are supposed to be friends.
How did this happen? - How serious is it? - Ask her.
Do you want me to go to her and say, "What's up with you and Morgenstern?" - That would be one way.
- That's not my style.
Mark, you might want to think about changing your style.
Okay, E-Ray.
What's that key sequence? Control, A-Q-R, and then push the pound key.
- Hurry up.
Someone's coming.
- Close the door.
Okay, here goes.
Control, A-Q-R, pound.
Good job, Jerry.
Don't leave me too long.
Fifteen minutes should be enough.
This Radiology tech stuff isn't so hard.
I can feel the difference.
I'm me again.
Now turn it off.
- What's the sequence for that? - Isn't there a switch? - Which one? - There should be a kill switch.
- A big, red button.
- What about this? - Oh, my God! - Jerry, what are you doing? - I don't know! - What are you doing? - I don't know! - Pull the plug! - Oh, my God! - Pull the plug! Medicine is supposed to be a noble profession, not a motorcycle club.
- Why were you fighting? - It was stupid, Dr.
Keaton.
Abby.
I'm listening.
There was a patient scheduled for high-risk surgery.
Clearly not compos mentis.
And I knew that I should've called the Psych consult down to clear him.
But I didn't.
I was too afraid of pissing off the surgeons to speak up.
- What happened? - He stroked out.
He should never have had the surgery.
And I knew it.
At least you care about your patients.
A lot of surgeons don't.
They don't? - Dr.
Keaton - Abby.
Abby.
- Who is it? - It's Mark.
- I just called you.
- Are you alone? So I'll make this easy.
- I know about you and Morgenstern.
- You do? How long have you been seeing each other? - You mean as in "going out"? - Yes.
- Mark, we're not.
- You're not? - Are you sure? - Yes.
Are you seeing anybody? Maybe we should sit down.
Morgenstern has been helping me get my transcripts together.
- I'm leaving my Residency.
- You're quitting? - Transferring.
- Where? Phoenix.
When I was there visiting Chloe and Susie I just got this feeling, like this is where I'm supposed to be now.
And I don't really have anything here in Chicago.
- I mean - I know what you mean.
And after I've decided, I just feel happy.
For the first time in a long time.
I'm finally moving on with my life.
That's great.
God.
So you're sure? Yes, I am.
I don't know what to say.
I know.
I'm going to miss you.
I'm going to miss you too.
- Kit, is the pulse-ox monitor right? - Yes, it is.
- What did you do? - Nothing.
About an hour ago, she just started getting better.
It's a miracle.