ER s03e19 Episode Script

- Previously on ER - ER's nothing compared to Surgery.
You and your husband must be excited.
It's just me and the baby.
I love having Rachel around, and she seems happy.
I can't wait till Mommy gets back.
What makes you think your judgment is superior to mine? Why did you order a glucose-tolerance test? Every time I look up a test question, I find out I got it wrong.
I want to support you, Carla.
I want to be a father to my kid.
- What are you doing? - I thought you were at rounds.
- What time is it? - 6:35.
Oh, God! Anspaugh's going to kill me.
Where's my? Give me my thing, my stethoscope.
Take mine.
- Did you brush your teeth? - Yes, Dad.
- Did you floss? - Yes.
All right, I was just checking.
I told you I could make a good breakfast.
- You're wearing your Brownie uniform.
- It's Thursday.
Was I supposed to talk to your troop today? I'm sorry, I forgot to change my shift.
- You promised.
- I have to work today.
- Can I do it next week? - I knew you'd forget.
I don't work Saturday.
We can go to Six Flags, ride the roller coaster.
Dr.
Edson, present the case.
The patient is fluid-overloaded.
I gave her a Lasix sandwich.
Dr.
Carter, how nice of you to join us.
What would you do with Mrs.
Pritzker? - What's her problem? - She is fluid-overloaded.
Well, I wouldn't give her anything to drink.
Let's continue our discussion of diuresis.
Carter, what electrolyte imbalance can result from Lasix? - Hypokalemia.
- Where does Lasix affect the kidney? - At the loop of Henle.
- Ascending or descending limb? - Ascending.
- Where does Lasix get its name? - I don't know.
- It lasts six hours.
Dr.
Ryke, present the next patient, please.
- Man, what did he have for breakfast? - Me.
- Hey, Carol! Good morning! - Says who? - I won't ask how your day is going.
- I got my MCAT results.
I shouldn't have taken the test.
I don't know what I was thinking.
- Why didn't you talk me out of it? - How bad did you do? I don't know.
I haven't opened it.
- Are you nuts? Open the envelope.
- I'm not in the mood for bad news.
- I'll open that envelope.
- Doug! Give it back! - Does anybody have a letter opener? - Don't you dare.
- Good morning, Dr.
Einstein.
- Excuse me? We have to move fast to beat the other med schools.
Your MCAT.
I'm on the Admissions Committee.
They sent your scores.
Don't consider the Ivy League until you've looked at our program.
- Oh, my God! - Eighty-fifth percentile.
Looks like Carol Hathaway's going to medical school.
- So you disappointed the Brownies.
- I forgot I had to work.
- Tough being a doctor and a daddy.
- That's what Jen used to say.
- Mark, you work on Saturday.
- I can't.
I have plans with Rachel.
There's no one else.
Walters and Foster are on vacation.
- At the same time? - Mark approved the schedule.
- Can't you cover for me? - I've got the graveyard.
You blew it again.
Put the lancet in the pen, and push the trigger.
Is this necessary? When you have gestational diabetes, you have to test your blood every day.
You calibrate the machine, put in a strip and apply a drop of blood.
Slow down.
Blood glucose of 120 is where you want to be.
One-sixty is too much.
Anything under 80 means you have to eat.
Okay, 210.
You need a shot of insulin.
Where is it? The nurse is bringing it.
- She'll be here in a hour? - No, at 10:00.
Okay.
You'll be fine.
- I've got to go.
- Already? Yeah, I'm late for work.
Just go.
Carol, they need a puke cleanup in 3.
- Your puke-cleaning days are over.
- Reason enough to go to med school.
Carol hit a home run on her MCAT.
- Don't forget us.
- I haven't even applied yet.
- Jerry, what are you doing? - I saw a mouse by the elevator.
Sounds like Heidi.
Dr.
Russel lost a gene-knockout founder.
A genetically-engineered mouse.
It's worth 500,000 bucks.
- There's a $5000 reward.
- Dead or alive? Alive.
It's worthless if it's dead.
- Carol, can you watch the phones? - It's not my job.
I'm on break.
No, no.
Doctors don't do phones.
- How were rounds? - I got massacred.
- Anspaugh? - Exiled me down here.
Ever since I second-guessed him, he's been out to get me.
- What are you doing? - Practicing laparoscopic maneuvers.
In case I ever get back into Surgery.
- Can I try? - Yeah.
Put your hands through those graspers and stack the dice one on top of the other.
- This is tricky.
- Wait till you tie knots.
Carter, Benton needs you in Trauma 2.
- Mind if I tag along? - No, be my guest.
Mrs.
Meeks, it looks like you've got a small fish bone down there.
- Jerry, turn off the light.
- I'm looking for Heidi.
- We're the only ones in here.
- Heidi's a mouse.
- A mutant mouse.
- We're in the middle of an exam.
There it is! Heidi, don't be afraid.
Uncle Jerry won't hurt you.
What'd you do that for? Here you go.
Open wide.
How much did you borrow for med school? - 110 grand.
- Oh, my God! - How long did it take to pay off? - I'll be paying it off for 15 years.
- I've got a sick kid here.
- I couldn't wake him up.
- How long was he down? - Two minutes.
Gave epi down the tube.
Joel has a hypoplastic left heart.
They put a Blalock shunt in.
- What's your name? - Andrea Thompson.
I'm Carol Hathaway.
This is Dr.
Ross.
Give me an arm board and a The surgeon's name was Lewis.
His cardiologist is Ferris.
- Hook up a 12-lead and get an echo.
- He's on dig, Lasix and potassium.
Chuny, escort Mrs.
Thompson out of here.
Please, I want to stay.
Carol? Okay, but stay back there.
We need to work.
- I'm in.
Bolus, 100 of saline.
- Did he clot off his shunt? He may have.
Blood-gas kit.
- What's that for? - I don't have time to explain.
- She shouldn't be in here.
- It's her child.
Chuny, get this up to lab.
Bullet missed the spine.
Renal artery intact.
I want four-by-fours.
He's bleeding.
Dr.
Benton, Carla Reece on the phone.
She says it's an emergency.
- Damn! It's not working.
- Where's the source? - Soft-tissue arterioles.
- Lost the BP.
- He's bleeding out.
- Give me a Foley and some saline.
What are you going to do? If I insert the Foley and inflate the balloon, the bleeding might stop.
- Foley going in.
- Inject the saline.
Did you learn this in Journa/ of Trauma? People Magazine.
A girl got stuck in a well trying to rescue her puppy.
- What happened to the puppy? - Don't ask.
- He's coming around.
- Let's get him back over.
Let's get him up to the O.
R.
Good work, Carter.
Is this the gunshot? We'll take it.
- Can I scrub in? - We've got it.
Carter tamponaded the bleeding with a Foley, saved his life.
Edson, take his history and get him prepped.
Let's go.
- You can't win them all.
- Man, are you in the doghouse! Got the blood gas, 7.
23.
PO-2's 90.
- Call Respiratory for a vent.
- Lost his pulse.
- What's wrong? - Chest-tube tray, tension pneumo.
- What are you doing? - Eighteen French.
- What's happening? - His lung collapsed.
- What's he doing? - Putting in a chest tube.
- Why are you cutting him? - Carol, poke a Kelly in here.
IV's infiltrated.
- We'll do a femoral cutdown.
- Can you tell me what's going on? - Cutdown tray, please.
- Carol? - Come with me.
I'll explain it.
- I want to stay with my baby.
Not now.
The doctor needs to work.
We've put a chest tube in to re-expand his lung.
Dr.
Ross is putting fluids through a catheter in his leg.
- When he's done, can I come back? - Yes, but wait here right now.
If he gets sicker, come and get me.
I don't want my baby to die alone.
I will.
- What are those things? - Humane traps from the lab.
- We're trying to trap a mouse.
- Can you move them off the counter? - Call an exterminator.
- The mouse is worth 500,000 bucks.
- Got a hot one.
Brenda Smythe.
- What's the problem? - Voil ð.
- My wife and I were camping.
I needed to urinate and found this old bucket.
- Why didn't you go into the bushes? - That's irrelevant.
- And you are? - Her husband, John Smythe.
And you? Mark Greene.
- Is Joel all right? - His blood pressure's up.
- Is he conscious? - Not yet.
- I want to talk to the doctor.
- He's doing an echocardiogram.
Joel got fluids and will regain consciousness soon.
I want to be there when he wakes up.
I'll come and get you as soon as Dr.
Ross finishes the test.
Can I get you a cup of coffee or something to eat? No.
Thank you, Carol.
Why did you let Edson steal your thunder? - It's not like I had a choice.
- You made the save.
When Anspaugh gives an order, you smile and nod.
You couldn't pay me enough to be a surgeon.
Too cutthroat.
- They're all jerks.
No offense.
- None taken.
Could you get me some crutches? I saw some in the hall.
Carla, I can't just take off.
Can't you call another nurse? Okay, just calm down.
I'll be there.
I'll pick up some insulin.
- Everything all right? - Listen, I've got to go.
If you have any problems, check with Greene or Weaver.
And check on my post-ops.
I'll be back in an hour.
- I'm sorry, it's really stuck.
- It must've created a vacuum.
- What do you intend to do? - I'm thinking.
Maybe we could grease up a Foley and slide it in? I need a church key.
A can opener.
Maybe the kitchen has one.
Miss Wilkerson has a Swiss army knife.
I thought you said her name was Smythe.
Pet name.
Here's your bucket, Mr.
Smythe.
Thank you, doctor.
Carter? It's Gunderson.
You admitted him through ER, right? He's tachycardic.
BP's down to 60 palp.
- Any surgical complications? - No.
Suddenly he started gasping.
- What's he on? - Morphine and Ancef.
His tongue's swollen.
- What's going on? - Looks like an allergic reaction.
- Where's Edson? - In Surgery.
Let's give epi, 3 mls of 1 in 10,000.
IV.
Get me a trach kit.
He's in respiratory arrest.
Betadine! Needle.
Introducer.
SAT's falling.
I'm in.
Hook him up.
Pull Edson out of Surgery.
I want to talk to him now.
- BP's up to 80.
- Look, the little guy's waking up.
Hi, Joel.
Don't be afraid.
Your mommy's right outside.
Still got a few PVCs.
Give him another 10 of procainamide.
- Can we bring the mother back in? - Wait till the procainamide kicks in.
Carol, I've got a case for you.
Pseudocyst with acute pancreatitis.
- I've got to push some meds.
- Let the nurses do that.
Let us lifers push meds.
Go play doctor.
Go ahead, he's doing fine.
As soon as he's stable, bring the mom in.
She's got the biggest pseudocyst I've ever appreciated.
They were going to send a nurse at 4:00, but I didn't want to wait.
You did the right thing by calling me.
- I'm sorry you had to leave work.
- It's okay.
Pull your robe back.
I have to inject in your thigh.
- How often do I have to do this? - Twice a day.
Are you watching? Stick the needle in and push.
- There you go.
- I hate the push part.
Can you do this by yourself the next time? - Are you going back to the hospital? - Yeah, I have to get back to work.
Eat something in a couple of hours.
Your blood sugar mustn't be too low.
Oh, gosh! I have to go to the grocery store.
- You're not supposed to stand up.
- What else am I supposed to do? - What about your sister? - Her little one's got strep.
I can be down there and back in 15 minutes.
- I'll do it.
- Peter, no.
- Go back to work, please.
- Carla, I said I'll do it.
Never mind if you're going to get snippy.
Who are you calling? This is Dr.
Benton.
Tell Anspaugh that I'm taking a personal day.
No, I don't need to speak to him.
Just give him the message, please.
- What happened? - Anaphylaxis.
He almost died.
- What did you give him post-op? - Ancef.
- He's allergic to it.
- What? He's allergic to the antibiotic you gave him.
- Didn't you take a history? - I thought you took one.
Don't give me that crap.
Anspaugh told you to do it.
I took a full history.
The patient never mentioned any allergies.
Then why is this space under allergies blank? You'd better think up an answer.
Anspaugh's going to want one.
- Ow! - Just a little bit further.
There we go! We've an excellent faculty.
Two Nobel laureates and the best attendings.
- What are the causes of pancreatitis? - You're putting me on the spot.
If you're going to be a med student, you better get used to it.
- Alcohol and gallstones? - Excellent.
Now you try.
- Can you feel the pseudocyst? - I'm not sure.
- Ow! - Sorry.
- Use both hands, and press harder.
- Sorry, sorry.
- Like this.
- Ow! Sorry.
- Can you feel the cyst? - I think so.
Order 2 more units of blood for the kid in Trauma 1.
Wait, I want to teach you how to do an ultrasound! - His SATs are falling.
- He thrombosed his shunt.
We've lost the rhythm.
- How long's he been down? - Ten minutes.
Why didn't you get his mother? I'm getting her.
- I don't want her in here.
- I promised.
I've got this boy's heart in my hands.
I don't want her here.
I'm getting her.
- Is Joel awake? - Come quick! Joel's gone into cardiac arrest.
They've opened his chest.
Andrea, it's really bloody in there.
Are you sure you want to see this? Okay, come on.
Time of death? - 11:52.
- Oh, my God! Oh, my God! - I thought he was going to make it.
- I feel awful.
- I promised not to let him die alone.
- There was no way of knowing.
I should have been there.
Instead, I was off appreciating a cyst.
- Dr.
Ross? Kid with a fever in 5.
- Do you want to do this? No, I'm not done yet.
Andrea, I'm so sorry.
I called the mortuary.
They're on the their way.
What am I going to do with all his clothes? I can give them to my sister.
Would you like to see him? Hold him one last time? - The doctor closed his wound.
- I have to make a call.
The call can wait.
Andrea, I know this is hard but I've learned that parents need to say goodbye.
Come on.
I'll stitch you up in no time, Mr.
McCollum.
- Leg hurts like hell.
- I'll get some lidocaine.
Hey, what kind of dump is this? - It's a rat! - That's Jerry's mouse.
- Tomorrow I'm bringing my cat.
- This place should be closed down.
I could use the time off.
- What's wrong? - My foot! Damn it! It's one of Jerry's traps.
Wendy, grab hold.
I'm going to count.
One, two, three - It's not coming.
- Where are the wire cutters? Tell Jerry to get these things out of here before I kill him.
Where's Benton? He should've been back hours ago.
- I heard he took a personal day.
- Dr.
Benton? Carter, Dale alerted me that Mr.
Gunderson had a crisis earlier.
- I'm glad he told you.
- Anyone have his chart? Nasty little anaphylactic reaction.
You think it was caused by? The antibiotic given post-operatively.
Ancef.
Doesn't look like there was anything we could have done.
- Excuse me? - Patient states, "No drug allergies.
" - Is that your handwriting? - Yes, sir.
- Can I take a look? - Certainly.
A thorough history, the best defense against malpractice.
Good work.
I thought this would be more comfortable.
Thank you.
Do you want to hold him? You take all the time you need.
- You're back.
- He got a button stuck up his nose.
Unusual.
How did it get there? I was wiping my nose on my cuff when I had to sneeze and I inhaled the button.
- The button's still on his cuff.
- He changed his shirt.
Perhaps an ear, nose and throat specialist is in order? - Why don't you lie back? - What are you doing, doctor? Hold the unblocked nostril closed while I put this mask over your mouth.
Haleh, hold the basin under his chin.
Just relax.
Very impressive.
- May I keep the button? - Sure.
I'll get your discharge papers.
Get a Psych consult down here before they hurt themselves.
- I'd take the turkey tetrazzini.
- Hey, Jackie.
- What are you doing here? - Shopping.
- In the afternoon? - I took today off.
- Peter, you never take a day off.
- I had to.
Carla needed me.
- Is she all right? - She just needs to stay off her feet.
- Boy, are you in trouble! - It's just for today.
A pregnant woman needs a lot of help.
When I was pregnant with Steven, Walt did the cooking and the laundry.
It's crazy.
It's like she's a different woman.
It's just the hormones.
One time, Walt switched the channel in the middle of Oprah.
I chased him out of the house with a croquet mallet.
Well, I'm losing it.
I'm so proud of you, taking a day off to help her out like this.
Will you be able to take more time off? I don't know.
I hadn't thought about that.
Who's Carla going to depend on if you're not around? Yeah.
Come on.
Let's go down to the baby section.
You've got a lot to learn.
Looks like he got him with an ice pick.
- I'll undress him.
- Let Chuny do that.
I want you to assess the patient.
Start with the ABCs, Dr.
Hathaway.
His airway is patent.
He's breathing shallow, appearance dusky.
I'll get the intubation tray.
Chuny can do it.
You're going to intubate.
Take a breath and hold it.
If you run out of breath, you're taking too long.
Enter laterally, sweeping the tongue out of the way.
Don't rock back.
Can you see the epiglottis? Good.
Now visualize the cords.
Can you see them? - Pulse ox is falling, 89.
- You're doing great.
Make sure you lift the scope Good job.
Let's get him to X-ray.
- Looks like Kerry's got a new pet.
- Stop it, Chuny.
- She jammed the button up his nose? - And she had a bucket on her butt.
- What's wrong with them? - Sounds like they're nuts.
- Button-extraction response time? - 7.
5 minutes.
- This is Dr.
Pomerantz.
- Psychiatric consult, I presume? We've been expecting you.
As you probably have ascertained, we're not what we appear to be.
- What are you? - John Smythe and Brenda Wilkerson.
Clinical researchers.
We're doing a study on problem solving in emergency departments and foreign-body extractions elicit the greatest range of responses.
And you came up with the most innovative solutions we've ever seen.
At Mercy, the button in the nose took five hours and two consults.
They wanted to operate.
Just who is sponsoring this study? An independent consortium of health care professionals and the government.
The highest levels of government.
No promises, but you might be contacted by H.
R.
C.
Hillary.
If she gets her ass stuck in a bucket, she'll know who to call.
I'll tell her you said so.
- What are you doing down here? - Hiding.
Me too.
- You're a smoker! - A secret smoker.
Don't tell anyone.
- Who died? - What? Why the long face? Edson falsified a chart to cover his ass.
He forgot to take a patient's history.
- Anspaugh must have roasted his butt.
- I didn't tell him.
You didn't? - Would you have? - Hell, yeah! Changing a chart's unethical, not to mention illegal.
Surgeons don't rat on each other.
It's like the Marines: - "All for one, and one for all.
" - That's the Three Musketeers.
You know what I mean.
You've got to be a team player.
Anspaugh gave me that lecture last week.
I think you're scared.
- Well, we'll be in touch.
- Bye, Super Doc.
- What a couple of kooks! - They could make you famous.
You could be known as the most innovative doctor in the country.
Tell that to my daughter.
I stood up her Brownie troop.
I know, I know.
I just can't seem to get it together.
Super Doc can't figure out a way to keep his Brownie commitments? Carol, an intoxicated gentleman needs an NG tube.
Interested? - You can't go in there.
- Why not? There's a free bed.
She needs to be alone.
Her child died today.
Your compassion is admirable, but we have to put our patients somewhere.
- Treat the drunk in the hall.
- He's a patient too.
- You've done it before.
- When there were no beds.
Well, there aren't any beds now.
If you're going to be a med student, stop thinking like a nurse.
I'm not a med student yet.
CBC, Chem-7.
Type and cross for four.
- Is this a surgical belly? - I already called upstairs.
- Might as well get started.
- What's the story? - A painter fell 20 feet onto a Volvo.
- They say Volvos are the safest cars.
Edson, start a central line.
Carter, do a peritoneal lavage.
I'll get the DPL kit.
Carter, what's the criteria for a positive diagnostic peritoneal lavage? Red blood cell count greater than And if you can read a newspaper through the fluid, it's negative.
Dale, weren't you giving Dr.
Anspaugh new information about Gunderson? - John filled me in.
- The allergic reaction? I called Mr.
Gunderson's mother and briefed her on the situation.
- She's flying in from Louisville.
- Good.
Caring for the patient.
Is that it? - That's it.
- Really? John said there was more.
Something I should know about? No.
- DPL's positive.
- Let's get him up to surgery.
Edson, you start with an ex-lap.
If he needs a splenectomy, you'll do it.
Well, you sure told him.
- Liar, liar, pants on fire.
- Save it.
- Do they teach forgery at Harvard? - Go to hell.
What did you say? I just adjusted the chart.
Is that such a big deal? Run it by Anspaugh.
See what he thinks.
- I can't do that.
- Sure you can.
If this goes on my record, my chances of a fellowship are zilch.
- Are you going to make me tell him? - John, please.
I'll do anything you want.
I'll put in a good word with Anspaugh.
I'll make it up to you.
I don't want to have anything to do with you.
If you ever try anything like this again, I'll bury you.
That's a promise.
These are resuscitation paddles.
If someone's heart stops beating normally we zap them with electricity to start it.
It's like Frankenstein.
Got an MVA coming in.
Kerry's got it, but we need the room.
Who wants to look at blood cells under the microscope? Let's go to the lab.
Thanks, Dad.
- Very creative.
- So I've been told.
Would you like to go out with the most innovative doctor in the world? - You like bowling? - "Like" may be too strong a word.
I have to take Rachel.
Can Emma come too? - Oh, it's that kind of date.
- The best I can do.
- I'll dust off my bowling shoes.
- You own bowling shoes? There's all sorts of things you don't know about me, doctor.
Thank you for letting me have this time with my baby.
- Is there someone I can call? - My sister's on her way.
I used to say this prayer with Joel every night: Now I lay me down to sleep.
I pray the Lord my soul to keep.
If I should die before I wake, I pray the Lord my soul to take.
You think I'm a coward? Who am I to say? I'm not a surgeon.
You've got your own rules.
Maybe that's a load of crap, and I'm hiding behind it.
I don't know what to do.
- Talk to another surgeon.
- Right, they're all so empathetic.
There's got to be somebody whose judgment you trust.
- Should I talk to Benton? - I would.
- How about a Heinie? - A beer? I keep a couple in the back for when I get off work.
You know, you're great.
- So are you.
- Seriously.
And you're honest, funny, beautiful.
I don't suppose that you? Not a chance.
- Well, cheers.
- Cheers.
These things cost 60 bucks.
Who's going to pay for it? - Take it out of your reward.
- No trap, no mouse, no reward.
- He's under there.
- She's under there? Oh, no! You killed her.
- I didn't mean to.
- She's still breathing.
- How much is that reward? - Five grand.
Wendy, get a small pediatric O-2 mask and 5 cc's of Dopram.
Jerry, start mouth-to-mouth resuscitation.
I worked for a vet who resuscitated a guinea pig.
- I'm not breathing in a rat's mouth.
- I will, but we split the reward.
Hook the mask up to 5 liters O-2.
She moved! - I think she's going to be all right.
- I'll take her up to the lab.
- Nothing doing.
- Give me the rat.
I'll take her back and collect the reward.
I'll give you 10 percent for being in the room while we resuscitated her.
Damn it! I'm heading out.
Is Dr.
Benton coming tomorrow? Yes.
We're sending over his surgery schedule and charts by messenger.
- Is this them? - Yep.
He must have moved.
Cancel the messenger.
I'll take these to him.
I have to talk to him.
- Lily, are you up for nurses night? - Sure.
- Jenny, how about you? - Be there or be square.
I hear you intubated a guy like a pro today.
Kerry has been showing me things all day.
Made me feel like a beginner.
The truth is, I'm really, really good at my job.
So why do I want to change that? Watch me, Mom! - Good try, honey! What's the score? - 2-1, still.
We could be here all night.
Did you get all your paperwork done? I'm going to be up late tonight, but I can access my patient reports on-line.
Figured it's worth it.
Easy, honey! Think they're getting along okay? I think there's something there.
Yeah? - We should do this more often.
- Next time without kids.
- You read my mind.
- That's my job.
- Dad! I got one! - That is really great.
There we go.
It's 2-2.
One plate of spaghetti marinara al dente.
Just one plate? Hospital's sending over some charts, so I have to go home and prepare.
- Why don't you do it here? - I don't have my books.
I'm gonna need another shot in an hour.
That's why I taught you how to do it.
Fine.
Just go home.
Look, Carla I can't be here all the time.
- You wanted to be involved.
- I am.
On your terms, as always.
Ever think about what I want? - You never ask me what I want.
- What do you mean? - Nothing.
Just drop it.
- Uh-uh.
- You never wanted this baby.
- I didn't say that.
No, but that's what you meant.
Go home.
I don't need you here doing me no favors.
- What?! - Hey, Carla.
It's for you.
- Carter, what are you doing here? - I just came to drop these by.
Thank you.
Good night, Carter.
- Hey! I didn't expect to see you.
- It's nurses night out, right? I thought Weaver was fitting you for a lab coat.
White adds 10 pounds, so I'll stick to pink.
- You're having second thoughts? - Let's just say I like what I do.
- Another round? - I'll get it.
- You want to play? - Sure.
- Come on, girl.
- It's a quarter a ball.
I think I can handle that.
All right.
What am I, stripes? Two, in the corner.