ER s08e13 Episode Script
Damage Is Done
E.
R.
Previously on E.
R.
Mark, she's out of control.
- You need to stop lying.
- You don't believe me.
- You search my room and private things.
- I was looking for drugs.
I'm getting my job back with the following conditions.
I didn't agree to any conditions.
- I failed your brother.
- Mom.
He was tired before we left for France.
It delayed the diagnosis by less than a month.
I just stood by while it was eating him alive.
- Stop it! Stop it! - Shut your lying, filthy mouth! - Well, it's not the way it seems.
- Our walls are pretty thin, Joyce.
Rachel, I want you to stay here.
E.
R.
8x13 "DAMAGE IS DONE" Chamomile tea? Feeling better? Well, I haven't been to the bathroom in 10 minutes.
I guess that's progress.
- Hey, at least someone's happy.
- She should be.
She T.
P.
'd the bathroom, the hallway and half the kitchen while I made tea.
God.
She's not even walking yet.
- Did you take your temperature? - Yeah.
- But- - Okay.
- Should I call or do you want to? - I'm presenting at grand rounds.
- Not with the stomach flu, you're not.
- Mark.
Hi, I'm calling for Dr.
Corday.
Yeah, she's projectile vomiting.
Do you still want her to come in? - Very funny.
- Thank you.
I'm calling right back.
I just need loperamide.
Then I'll be fine.
What you need to do is stay in bed.
- What about Ella? - Katherine's coming over.
Who's gonna look after her till then? I'm not doing anything today.
- Hey, Rach.
- I can watch her if you want.
I wouldn't want you to give up your Saturday.
- It's freezing out anyway.
- Sold.
I'm late.
You, stay in bed.
Hello.
Haleh, gallstone in 4 needs Toradol.
Can you check the labs on Cathy Jensen? - Upper GI bleed? - Yeah.
- Is Dr.
Chen in yet? - Nope.
- Get the message he was looking for you? - No.
Oh, really? - In just a swim cap? - Yeah.
And a Speedo.
- You've gotta try it.
- In January in Lake Michigan? - It has a spiritual quality.
- You wanted to see me, Robert? Yes.
Just discussing with Dr.
Lewis what a tough year it's been.
What with personnel changes, lawsuits and whatnot.
Can you believe Dr.
Romano's a member of the Polar Bear Club? Can you excuse us? Stay.
I've found a solution - for the administrative bottleneck- - Bottleneck? - Your QAs are a month behind.
- Which you'll have by day's end.
I'm sorry.
Does she really need to be here for this? Actually, I have a patient.
- Well, that was elegant.
- Look, you can't expect me to do low-priority administrative work while I'm clocking more clinical shifts than anybody in my department.
You're overburdened.
That's why I asked Dr.
Lewis to pitch in.
How? Covering meetings, overseeing teaching in your absence.
Which is what Chief Resident does.
Carter's not an Attending.
Dr.
Lewis is.
- Why are you doing this? - I'm feeling unappreciated here.
- I'm trying to lighten your load.
- No, you're not.
You're jerking my chain.
- Why would I do that? - Because you can.
Well, for the time being, consider Dr.
Lewis your unofficial assistant.
No, I don't need any help! And try to keep the public displays of affection to a minimum.
This is a workplace, not a parade.
- I have messages for you, Dr.
Weaver.
- Thank you.
So you're gay, huh? Yeah, Frank.
I'm gay, all right? You know you're going to hell, right? - An entire bottle of wine? - Topped off with a couple of Xanax.
Was she embarrassed? Kind of hard not to be when you're puking your guts out.
- Know what the worst part about it was? - You had to put her to bed? It was a 40-year-old bottle of Bordeaux! Is this a new thing? She's been taking them for years.
Really? Mortality reviews.
It seems you get to finish them for me.
- I guess.
- They're due by day's end.
- Great.
- Should I have some soup sent over? - Is Elizabeth still sick? - Yeah.
Listen, if you change your mind, call me, okay? And hang in there.
Love you.
She's been on the toilet all night.
I'm not sure, but that may be more than I need to know.
So Romano conned you into picking up the slack, huh? Oh, God! I agreed to help.
Was that stupid? A little bit around the edges.
Kerry's lucky to have you.
I don't think she sees it that way.
She's never liked me.
She doesn't like anyone.
- Don't people work around here? - Glutton for punishment, huh? - Yeah.
Something like that.
- Oh, hi.
Welcome back.
- Yeah.
To you too.
- Thank you.
You're here.
I was hoping you'd come earlier.
- Why? - I wanted to acquaint you with the new forms for the CPT codes.
I'll be fine.
Suit yourself.
Good for you, girl.
You still owe me $20 for Cleo's going-away present.
Suddenly I feel like I never left.
You lost your locker.
Keep your stuff in here for the time being.
Wait.
There's dirt in here.
No.
It's doughnut sprinkles.
Donald Brower, 35.
Face, neck and chest injuries from some sort of explosion.
Unknown LOC, GCS 14 hypotensive, 80 palp, pulse 130.
Mr.
Brower, can you hear me? - Can you tell me what happened? - Mail - Sorry? - exploded.
- What happened? - He opened some kind of letter bomb.
- Daughter's in that rig.
- Give it to me.
Jessica Brower, 6.
Near amputation of right hand.
BP is 100/70, pulse 120.
- Estimated blood loss? - Three hundred cc's.
Couple of litres at wrist, controlled with the cuff.
I'm Dr.
Lewis.
We're gonna take care of you, all right? - It hurts! - Yeah, I know it does, sweetheart.
- How's the airway? - He's talking now.
- GCS 14 here.
- BP, 80/40.
Sir, can you see out of this eye? - I'll get it.
- What-? Peaked iris, probable globe rupture.
Follow the light.
Decreased breath sounds on the left.
He needs a chest tube.
- Betadine and chest tube tray.
- This is her birthday.
- Whose birthday, Mr.
Brower? - I let Jessica pull on the bow.
Do you know why someone would send you a bomb? - My wife.
- Your wife? - Mr.
Brower? - Sinus tach at 120.
- Is that chest tube in yet? - That's the pleura.
- Open your eyes, Mr.
Brower.
- Pressure's dropping, 70 systolic.
- He's out.
Vascular clamp.
- Another thoracostomy tray.
I've got it, Kerry.
I wonder how Susan's doing over there with the kid.
Okay, I'll put in the second chest tube and you get the airway.
Airway's fine.
- Gram of Ancef, IV piggyback.
- Where are we? Superficial flash burns, face is fine.
Lungs are clear, pelvis is stable.
- All the money's on the hand.
- Pressure's steady at 100/70.
No visible deformity to shoulder or elbow.
Hold on.
We need to take a look at your hand, all right? - Thumb's intact.
- First HemoCue's eight.
Ring and little finger are missing.
We need Hand Surgery, Ortho, Plastics.
- Let the cuff down.
- Surgery'll be here in a minute.
I said take the cuff down.
Okay, Jessica.
Okay, sweetheart.
You just relax.
- Just need to know the exact injury.
- Well, now you know.
- You want hemostats? - Yeah.
Just direct pressure.
Blood supply intact.
Probably salvageable.
We're okay here, Kerry.
Sinus at 100.
CBC, lytes, BUN, creatinine, coags and- We already ordered pre-op labs.
- Fine.
- Two more of morphine.
- Let's get an x-ray tech down here.
- Carter, your mom's here.
Brought a kid from her leukemia center.
I got it.
Yeah? They come in on a rig? No.
She brought him in herself.
He has weakness and a slight fever.
Thanks.
And she's nicer than I remembered.
Oh, John.
Thank goodness you're here today.
- Who's your friend? - Mickey is the center's Child of the Year.
We were photographing him for the spring mailer.
And he suddenly became lightheaded and warm.
So you brought him here? We tried phoning his doctors, but it's Saturday.
Is there someplace else I should have taken him? - Did they give him anything yet? - Your friend gave him some Tylenol.
- How long has he had leukemia? - I'm not sure.
He's been in remission a year.
Call his parents? - He's an orphan.
- So he lives in a foster home? With three other special-needs children.
And foster parents he barely knows.
Hey, Mickey, how you doing? - Not so good.
- Yeah? We're gonna see if we can figure out a way to make you feel better.
- Okay.
- A private room would help.
Swing your legs up there for me.
Unit six going up.
Pressure, 90/50.
AC 12 on 100 percent.
Tidal volume 500, PEEP of five.
- You holding up okay? - Yeah.
- Fluid in Morrison's pouch.
- You can't let Kerry get to you.
And in the left pericolic gutter.
Where is Surgery? - Like riding a bicycle.
- Yeah, one with square wheels.
- Ectopy! - V-tach! Charge the paddles, open a thoracotomy tray.
Get ready.
There's no pulse.
He'll be fine.
Charge to 200.
Clear! - Charge to 300.
- Ten blade.
Clear.
- Asystole.
- Go ahead.
Open the chest.
- A-positive is up.
BP's 100/60.
- TKO the other fluids.
- Bring another dose of fent.
- Jessica? - Are you her mother? - Yeah.
She's stable.
She's had extensive damage to her hand.
- We need to get her to O.
R.
- Can you hear me? We've given her pain medication.
She may not respond.
- It's Mommy.
- Why don't you come to Pre-op.
The surgeon will need to talk to you.
Where's my husband? He's in there.
They're working on him.
Mrs.
Brower? Mrs.
Brower? - P.
E.
A.
- Don? - V-fib.
- Oh, God! Shock him.
You the wife? Your husband's injuries caused his heart to stop beating.
- We're trying to bring him back.
- A thoracotomy.
- Charge again.
- You a doctor? - Researcher.
- Clear.
- Still V-fib.
- Witnessed arrest.
- Charge again.
- Ten percent chance.
Clear.
- I told him not to worry.
- Still V-fib.
- Charge again.
- I told him it was safe.
Clear.
Agonal rhythm.
He's been down for 30 minutes.
You can stop.
He's gone.
- Are you being treated for your diabetes? - Look, I'm blind.
I'm not stupid.
I do okay.
It's not easy to get someone to measure my insulin.
But that's life.
Look, you know, I'm just here for the toenails, right? Yes, sir.
Yes, sir.
You know, they're getting worse all week.
I think it was the new shoes.
When did you have them clipped? - Oh, April maybe.
- They're pretty overgrown.
Well, listen.
You think it's hard to get someone to give you a sugar shot just try asking them to clip these puppies.
Well, you know, I can do that for you.
Of course you can.
You're a gifted doctor.
Or at least you will be.
Hold on.
Someone smells beautiful.
Bless you.
- Hi, I'm Dr.
Chen.
- I've heard a lot about you.
I mean, good things.
And the bad things aren't really your fault.
- Excuse me? - Manny has a sixth sense about people.
- Or so he says.
- Well, with my eyes I had to get something out of the deal.
What is this? It's Mr.
Kindlevich's Seeing Eye dog.
- Well, where's his harness? - He isn't official.
But trust me.
He's my eyes.
I need him.
All right.
Just keep him on a leash, a short one.
- Yes, ma'am.
- Dr.
Chen, can I speak with you privately? What do you want? You know, eventually this has to stop.
This attitude, this resentment you have towards me.
- Does it? - We have to work together.
I can't allow patient care to be compromised because you dislike me.
- I wouldn't let that happen.
- Good.
Because the last thing I need is a divisive medical staff.
Then maybe you should quit.
The police want to talk to you.
I told them to wait until after your daughter's surgery.
- Has it started? - Yes.
I should have told him about the threats.
We're trying to create stem cells.
Using embryos? DNA.
Cloning.
This was meant for me, not him.
Not Jessica.
Could I observe the surgery? - It's probably not a good idea.
- I'm a doctor.
You're also a mother.
I'll see what I can do.
- Easy, kid.
Easy.
- Almost there.
Hey! - Sorry about that.
- Damn medical students! He's all bark.
You know, you remind him of his son.
I'm black, sir.
I can't see.
Did you want two sets of cultures? - My best friend Eddie has the flu.
- Yeah.
There's a lot of that going around.
- We were shooting outside.
- It's freezing.
I tried to tell the photographer.
He wouldn't listen.
Abby is gonna draw some of your blood.
- I have a good vein here.
- Okay.
Take a deep breath.
Exhale.
You don't have to watch.
I'm fine.
Just a couple more vials and we'll be all done.
- Where are you going? - I have other patients.
Yeah.
It's the head.
You want to play with it? - Hi! - Are you feeling any better? Hardly.
- Is she keeping you busy? - Yeah.
I tried to get her down for a nap earlier, but she wouldn't do it.
Sometimes stroking her earlobes helps lull her to sleep.
Can I get you anything to eat? Oh, Rachel, I don't think I can keep anything down.
How about some tea? Sure.
Sure.
Hello, sweetie pie.
Careful.
You don't want to get her sick.
Yeah.
Okay.
Why did I wear these shoes? - Because you forgot that around here- - Comfort first.
- Yes.
- No, I didn't forget.
It's just I'm not ready to go back to ugly, sensible shoes.
I heard that you did some really nice work in that trauma today.
Doesn't count if they don't make it.
Why did you treat pyelo with Bactrim? Because the PMD sent a culture two days ago.
I have the sensitivities.
There's been resistance to Bactrim.
Not for her.
Well, if you don't have a culture, you start with Levaquin or an aminoglycoside.
- Hey, looks like you made a friend.
- Hey, hey, hey, hey, knock it off.
- Gallant, get this dog out of here.
- Thanks a lot.
- This is a hospital, not a kennel.
- What'd I do? Tried to let her off the hook.
Whose side are you on? I'm not on anybody's side.
I'm trying to play this very neutral.
No.
You have to be on someone's side.
It better be mine.
- Deb, she's my boss.
- You like her, don't you? I don't dislike her.
- That makes a lot of sense.
- What makes a lot of sense? - Oh, your taste.
- Excuse me? John, it's obvious.
You have a thing for older women.
- What? - Yeah.
Weaver, Lewis and, oh, that pediatric surgeon.
What was her name? - Oh, come on! - Come on.
Younger women just too much for you? I can handle myself either way.
- Yeah, sure you can.
- Your mom's asking for you.
- What do you want to tell her? - Where's my kid? - I'm with a patient.
- What'd you do with my kid? - How's the leg? - Much better.
- What you got? - Leslie, unrestrained driver.
Slow-speed MVA.
Drove her car into some bushes.
Found her and daughter on the curb.
Only injury's a scalp lac.
- Where's the daughter? - Behind us.
- Hey, Leslie.
I'm Dr.
Carter.
- Oh, I just bet you are, sweet face.
BP, 130/80, no LOC.
And enough alcohol - on her breath to start a fire.
- Hey, I resent - Hi.
What's your name? - Stacy Miller.
Thirteen years old.
No LOC.
Says she wasn't hurt.
We're gonna check you out, make sure you're okay.
- You feeling pain anywhere? - Yeah, a big one.
You guys a bunch of frigging perverts or something? In my ass.
Excuse me? - That looks pretty superficial.
- What? The cut on your head.
There's a cut on my head? I'm sorry.
I'm just kidding.
You know- - Softer hands, honey.
- I'm sorry.
But I ain't "honey.
Why is everybody so serious around here? A pretty serious thing happened to you.
No, no, no.
See, this is a bump.
What's seriously wrong is what's in here.
You having chest pain? I have a broken heart.
Two great weeks, and he leaves me without a word.
What the hell kind of fiancé is that? Trauma panel, urine tox and a dip.
B.
A.
L.
and hang a banana bag.
- Suture kit? - I'll get it.
"Banana bag"? - Is that the daughter? - Yeah.
Lucky me, huh? Stacy, we need to get you into a gown so I can examine your chest and belly.
I said I wasn't hurt.
You want to get out of here, right? Go home, clean the house.
Get your homework done.
- How did you know? - I'm very smart.
Besides, the quicker you get into this, the quicker you get out.
At least you were being responsible.
Mom says seat belts are too confining.
Nice example to set, driving drunk and beltless.
She wasn't driving.
I was.
- You're 13.
- Almost 14.
- You don't have a driver's license.
- Neither does my mom.
She still drives.
I just take over when she's had too much to drink.
You been doing this for a while now? Three years.
Not one accident.
Till now.
Okay.
We'll be right back.
We just need to get some more supplies.
That is completely nuts.
Or brilliant, depending on your point of view.
A 13-year-old driving her lush mom is good? No.
But neither is a lush mom driving her 13-year-old around.
Somebody's gotta be the adult.
Everything was going along fine Elizabeth, you awake? - What's wrong? - I don't know.
She's sweaty.
- And she just started crying.
- Let me see.
Let me see.
- Did you give her milk? - No.
Just mashed bananas.
Here, just take her a moment.
I'll just get the thermometer.
Oh, sweetie.
How long's she been crying? Elizabeth, she just threw up.
Oh, dear.
- Oh, come here, sweetie.
- Maybe she caught what you have.
Oh, it's okay.
- What's this? - What? - Get the phone.
- What is it? It's a pill fragment.
She swallowed something.
Oh, my God! Her heart's pounding.
It's okay.
Rachel! It's okay, sweetie pie.
It's okay.
It's okay.
It's all right, darling.
- It's all right, darling.
Answer, damn it! - Oh, my God! It's okay.
- It's E.
- What? It's Ecstasy.
I had some in my backpack.
Yes, sorry.
No, hold on.
Hold on.
- How many? - What? - How many pills are missing? - Just one or two.
Yeah, sorry.
I have a baby with an amphetamine overdose.
- What's your address? - Yes.
1211 Dupont Drive.
Please hurry.
It's all right.
It's all right.
DUI's a pretty serious offense.
Yeah, but letting her sober daughter drive was worse? I don't know if it's worse.
It's child endangerment.
You gotta get Social Services involved.
Stacy goes into foster care? That may not be such a bad thing.
So you want to call the cops, or should I? Abby, we need to find Dr.
Greene.
Okay.
- Abby? - I'll take care of it.
Oh, sorry.
Sorry.
I got a little busy there.
Has his fever broke? No.
And he's very uncomfortable.
- No one's given him anything to eat.
- I'll make sure he gets something.
I talked to the Pedes Oncology fellow.
He's gonna come see him.
- Aren't you going to do something? - Yeah.
I sent off his labs.
No, I mean in terms of treating him.
There's no obvious infection.
The oncologist can take it from here.
It may be a while, if you want to go home.
I can't leave.
His foster parents still can't get here? No.
Somebody from the center can relieve you.
I'm from the center.
Are you sure that you want to do this? I mean, stay involved? Do you think she'll remember him? When my daughter was 6 she broke her arm in two places riding her bike.
And the only thing she remembers from that year is seeing Muppets on Ice.
They remember the good things.
She won't forget her father.
- Mrs.
Brower.
- Yes? I'm Dr.
Romano.
I finished my part of the surgery, which went well.
Will they need to amputate? She's a doctor.
There's stable bone on the remaining digits blood supply and enough skin to cover grafts.
So she'll have use of the hand.
Limited use.
But kids can adapt.
Corday and the paramedics are on their way with your daughter.
What? Came over the MICN as an Ecstasy overdose.
- Did they say how much Rachel took? - All I know is, she's vomiting.
- Is she awake? - They didn't say.
- Who didn't say? - I didn't take the call.
Haleh did.
- What are her vitals? - I'm sorry.
I don't know anything.
I knew she was doing this.
I knew it.
I should have trusted my instincts.
I gotta take the stairs.
- Move! Move! - Sorry.
I got the charcoal! We need a Pedes ICU bed! - Where are they? - Trauma 1.
Move! Move! Move! How's her airway? She's breathing on her own, tachy at 180 and febrile.
- Oh, God! - She's diaphoretic.
- Let's get a rectal temp.
- What the hell happened? - She swallowed Rachel's Ecstasy.
- What? I'm not sure how.
She's sympathomimetic toxidrome.
And we couldn't get a line in the rig.
- Where was it? - What? It was in her backpack! She had four pills.
Two have disappeared.
And Ella vomited a fragment of one.
Bolus 100 of IV saline.
Ten milligrams of charcoal by NG.
- Prep a milligram of Ativan.
- They blew two veins in the field.
- I'm gonna try an interosseous.
- No! No! She's got a good antecubital! - Oh, God! - Heart rate's 250.
Looks like a narrow-complex SVT.
I need a glove full of ice.
And prep one of adenosine.
Dr.
Corday, what is her weight? Ten kilograms at the pediatrician's last week.
Okay, here we go.
Come on, sweetheart.
Come on.
- Twenty-four gauge in right AC.
- Push the adenosine.
Lungs are wet.
She's in failure.
We need to break tachycardia! The CHF is rate-related! Could somebody get me a stool, please? - Still in SVT.
Are you all right? - Yes, I'm fine.
- Worry about my daughter! - We're gonna need the crash cart.
- What? - She's hypoxic with pulmonary edema in SVT.
The protocol is to synch cardiovert at half a joule per kilo.
No! No, we're not shocking her.
She's hemodynamically stable.
Maybe we should get Dr.
Weaver in here.
No.
Let's try two of adenosine.
Abby, get Dr.
Weaver.
Mr.
Kindlevich, you still being treated? No, discharged.
Just waiting for the van to pick us up.
- Stinky! - Why don't you have a seat? Here we go.
Just step straight back.
There you go.
- He never leaves.
- Well, I'm sure he'll be back soon.
Stinky! Stinky? Is that you? Stinky? Stinky? Oh, Stinky! Oh, Stinky.
He needed to take care of business.
Gallant, you're a student, not a dog walker.
- Bless you.
- I think I'm allergic to dogs.
Apparently.
Next time use a plastic bag.
Dr.
Weaver! They need you in Trauma 1.
Dr.
Greene's daughter's in trouble.
- Second round's onboard.
- Stats down to 90.
Put her up to 50 litres of O-2.
- Still in SVT? - Yes.
- Have-? - Push 3 adenosine.
Mark, we both know how difficult it can be working on a family member.
- Okay, get ready with diltiazem.
- And your own child in particular.
- I got it, Kerry.
- No.
- No, you need to step aside.
- I said I've got it, Kerry.
Calcium channel blockers can cause cardiovascular collapse and death in kids under 1.
Mark.
- Push one milligram of Inderal.
- You're soaking wet.
- Please.
- Your pulse's thready.
You have a fever.
It's just gastroenteritis.
- Sinus rhythm.
- Thank God! - Number 8 French NG for the charcoal.
- Let's get Elizabeth to bed.
- And run in two litres of saline.
- I'm not leaving! If you don't, you're gonna pass out.
That won't help anyone, least of all Ella.
She's okay.
She's stable now, okay? Go lie down.
- I want to be able to see her.
- I'll set you up in Exam 2.
- Damn it! - Pulse ox is down to 88.
Lungs are full of fluid.
Fifteen of Lasix.
- Think about intubation.
- I can get her out of failure.
- She's retracting.
- Using accessory muscles.
She's in respiratory distress.
Give the diuretics a chance to work.
Put her in the Broselow tape.
Bag her on 100 percent.
- No.
You'll hyper-inflate the stomach! - Mark, your baby is hypoxic.
You want to avoid unnecessary procedures.
But if we don't intubate, you're making a big mistake.
- Now, step aside.
- Rate- The failure was rate-related.
We broke the SVT.
But now she's in pulmonary edema.
If this wasn't your baby, we would have intubated her a long time ago.
I'm trying to save her life.
Pre-medicate with.
2 of atropine, Induce with 3.
2 of etomidate and paralyze with 22 of sux.
- What size tube? -4.
0 uncuffed.
- A number-one straight blade.
- Call for a Pedes vent.
Tidal volume of 100 cc's.
- We should be doing something.
- There's nothing we can do.
They got three doctors.
I think we'd just be in the way.
- Yeah.
Did you hear how it happened? - Yeah.
It is amazing the drugs that kids can get ahold of.
Oh, my God! Is that Rachel? Yeah.
John? Mickey's been upstairs an hour.
He hasn't been seen by a doctor.
Yeah.
That's not uncommon.
Well, it's unacceptable.
I was gonna get coffee.
You want some? Yes.
I'd love some.
I was hoping you could tell me what all this means.
- You stole his lab slips? - Yes.
I heard that they were back but no one gave us the results.
What is it? He's in blast crisis.
He's had a recurrence.
His bone marrow's full of leukemia cells.
He's not gonna be able to fight infection.
- Is there something we can do? - I'm sure they're giving him antibiotics.
The oncologist will know exactly what to do.
Yes, of course.
But he's just a number to them.
Maybe if you spoke to the doctors, they'd take him more personally.
Why are you doing this? You've been here all day.
You've been holding his hand, clipping his chart, bugging the staff.
- I'm trying to help a sick child.
- Mom, he has leukemia.
- I know that.
- And he may not survive.
If you've got some kind of twisted need to relive this, that's fine.
I'm not gonna do it again.
I made my peace a long time ago.
Let's pull the tube back five millimeters.
- Are you in the main stem? - At the carina.
You should be in bed.
Heart rate's down to 100.
Pulse ox is 99.
When can we extubate? They'll probably keep her sedated in the PICU rest her overnight in the vent and extubate her first thing in the morning.
Mark, we need them to get a rollaway in the room.
- I'm staying the night.
- Elizabeth, you're sick.
- Well, you're not leaving, are you? - No.
Mark? - I found her wandering the hallway.
- Dad? Rachel, where have you been? I was just waiting outside.
Is she okay? Does she look okay? - I'm sorry.
- You're sorry? - Mark? - Stay out of this.
You bring drugs into our house and leave them out for a baby? - It wasn't mine.
- Stop lying! They were for a party.
I wasn't sure I was gonna take them.
Your sister did.
But she's gonna be okay, right? It was one pill.
Are you really that stupid? - Ella is 9 months old! - I know.
- She almost died.
- Dad, don't- Don't what? What? Don't call you a liar? Because that's what you are! You promised you weren't doing drugs! I'm sorry.
She could have brain damage learning disabilities, low IQ, memory impairment.
- She could still die! - I know, Dad! Please, please, Dad.
I'm sorry! Dad, I'm- Daddy, I'm sorry.
Dad, I'm - She still seems a little warm.
- We'll get a repeat temp.
She can have ibuprofen by NG.
I'll check the orders.
Is this the overdose? Do we have a post-intubation film? I want someone else.
Let's see how she's satting on 70 percent.
No, no, no.
You're not touching her.
- What's the problem? - Page me another doctor.
- There's no one else on service.
- If we're going to control toxicity - we need to wean down the oxygen.
- Yes.
Well, I want my own pediatrician.
- Is this your daughter? - You are not touching her! I have to.
I'm the Critical Care Attending.
No! No! You do not touch my child! Do you hear me? - You stay away from her! - Lizzie! - We have to check the blood gas! - Get out! You heard what she said.
Out! Get Dr.
Rosato in here.
Kerry? Yeah.
How's she doing? Vitals are stable.
Satting well on 50 percent.
- Sounds like her lungs are drying up.
- Yeah, we've got a long ways to go.
My prayers are with you all.
Kerry thank you.
- Taking off? - Yep.
If I hang around here much longer, I'm gonna start to cry.
- Is your mom still upstairs? - Don't know.
Don't care? Hi.
- Hey, I thought you left.
- I wanted to say thanks.
The officer said that they'd book her for the DUI but that I could post bail in a couple hours.
Wait.
They're charging your mother with the DUI? And I made an appointment at that treatment center.
- Great.
- But you were driving.
- No, I wasn't.
- I thought you said she was driving.
- No, I didn't.
- What? Anyway, I gotta catch a bus.
Good luck.
You said you were gonna call the police.
You said I was gonna call.
I asked, "Will you take care of this?" She's her mother's best chance for recovery.
I think you know that.
- Good night, Carter.
- Good night.
Hey, Gallant.
Your guy's dead.
Hey.
Rachel's here.
Did you call the police? She wants to talk to you.
I can't.
- Elizabeth- - I'm sorry, Mark.
I can't.
Let's get you something to eat, okay? I want to stop by.
But they probably want to be by themselves.
You want to go in on dinner for them? Have it sent over so they don't have to leave? Yeah.
That'd be nice.
- Bye, Kerry.
- Bye.
- Good night, Dr.
Weaver.
- Good night.
Stinky! What are you doing here? I've been trying to catch him.
He's running in circles.
And he comes back here.
I think he knows Animal Control's coming.
Oh, for God's sake! Go inside and take an antihistamine.
Yes, ma'am.
Come here.
I don't like dogs.
And I don't like your name.
Give me a break.
All right, come on.
You better be housebroken.
Because if you're not, you're going right back to the pound.
- Who is it? - Abby, it's me.
Let me in.
- Joyce? - Please hurry.
Hey.
What's wrong? - Joyce? - Turn out the lights.
- What? - Turn out all the lights.
- Well, what's going on? - I'm sorry.
I had to get out.
I hope it's okay that I came here.
Well, of course it is.
But- Joyce? Joyce, you in there? No, no, no, no.
Don't go.
He's probably just looking anyplace he can think of.
Open up, damn it! - I'm calling the police.
- No.
It'll just make it worse.
- He just needs to calm down.
- Joyce, you in there? Joyce, we can't hide in here all night.
Joyce! He'll go away.
- When? - Open up, damn it! Bitch! I think he's gone.
Can I stay here for a while? Sure.
She's pretty tired.
Okay.
How you feeling? - Kind of better.
- Yeah? They treating you okay up here? They don't tell me much.
They tell her mostly.
You know what's happening to you, Mickey? I know it's back.
But I don't think it'll be as bad this time.
I was by myself before.
She looks asleep.
But she's not.
Hey, you want me to? You want me to take over for a while? No.
She is gonna come out of this.
Well, she may not.
She may never open her eyes again.
Elizabeth.
I don't understand why this has happened.
It'll be okay.
Mark, you don't know that, do you? No.
No.
R.
Previously on E.
R.
Mark, she's out of control.
- You need to stop lying.
- You don't believe me.
- You search my room and private things.
- I was looking for drugs.
I'm getting my job back with the following conditions.
I didn't agree to any conditions.
- I failed your brother.
- Mom.
He was tired before we left for France.
It delayed the diagnosis by less than a month.
I just stood by while it was eating him alive.
- Stop it! Stop it! - Shut your lying, filthy mouth! - Well, it's not the way it seems.
- Our walls are pretty thin, Joyce.
Rachel, I want you to stay here.
E.
R.
8x13 "DAMAGE IS DONE" Chamomile tea? Feeling better? Well, I haven't been to the bathroom in 10 minutes.
I guess that's progress.
- Hey, at least someone's happy.
- She should be.
She T.
P.
'd the bathroom, the hallway and half the kitchen while I made tea.
God.
She's not even walking yet.
- Did you take your temperature? - Yeah.
- But- - Okay.
- Should I call or do you want to? - I'm presenting at grand rounds.
- Not with the stomach flu, you're not.
- Mark.
Hi, I'm calling for Dr.
Corday.
Yeah, she's projectile vomiting.
Do you still want her to come in? - Very funny.
- Thank you.
I'm calling right back.
I just need loperamide.
Then I'll be fine.
What you need to do is stay in bed.
- What about Ella? - Katherine's coming over.
Who's gonna look after her till then? I'm not doing anything today.
- Hey, Rach.
- I can watch her if you want.
I wouldn't want you to give up your Saturday.
- It's freezing out anyway.
- Sold.
I'm late.
You, stay in bed.
Hello.
Haleh, gallstone in 4 needs Toradol.
Can you check the labs on Cathy Jensen? - Upper GI bleed? - Yeah.
- Is Dr.
Chen in yet? - Nope.
- Get the message he was looking for you? - No.
Oh, really? - In just a swim cap? - Yeah.
And a Speedo.
- You've gotta try it.
- In January in Lake Michigan? - It has a spiritual quality.
- You wanted to see me, Robert? Yes.
Just discussing with Dr.
Lewis what a tough year it's been.
What with personnel changes, lawsuits and whatnot.
Can you believe Dr.
Romano's a member of the Polar Bear Club? Can you excuse us? Stay.
I've found a solution - for the administrative bottleneck- - Bottleneck? - Your QAs are a month behind.
- Which you'll have by day's end.
I'm sorry.
Does she really need to be here for this? Actually, I have a patient.
- Well, that was elegant.
- Look, you can't expect me to do low-priority administrative work while I'm clocking more clinical shifts than anybody in my department.
You're overburdened.
That's why I asked Dr.
Lewis to pitch in.
How? Covering meetings, overseeing teaching in your absence.
Which is what Chief Resident does.
Carter's not an Attending.
Dr.
Lewis is.
- Why are you doing this? - I'm feeling unappreciated here.
- I'm trying to lighten your load.
- No, you're not.
You're jerking my chain.
- Why would I do that? - Because you can.
Well, for the time being, consider Dr.
Lewis your unofficial assistant.
No, I don't need any help! And try to keep the public displays of affection to a minimum.
This is a workplace, not a parade.
- I have messages for you, Dr.
Weaver.
- Thank you.
So you're gay, huh? Yeah, Frank.
I'm gay, all right? You know you're going to hell, right? - An entire bottle of wine? - Topped off with a couple of Xanax.
Was she embarrassed? Kind of hard not to be when you're puking your guts out.
- Know what the worst part about it was? - You had to put her to bed? It was a 40-year-old bottle of Bordeaux! Is this a new thing? She's been taking them for years.
Really? Mortality reviews.
It seems you get to finish them for me.
- I guess.
- They're due by day's end.
- Great.
- Should I have some soup sent over? - Is Elizabeth still sick? - Yeah.
Listen, if you change your mind, call me, okay? And hang in there.
Love you.
She's been on the toilet all night.
I'm not sure, but that may be more than I need to know.
So Romano conned you into picking up the slack, huh? Oh, God! I agreed to help.
Was that stupid? A little bit around the edges.
Kerry's lucky to have you.
I don't think she sees it that way.
She's never liked me.
She doesn't like anyone.
- Don't people work around here? - Glutton for punishment, huh? - Yeah.
Something like that.
- Oh, hi.
Welcome back.
- Yeah.
To you too.
- Thank you.
You're here.
I was hoping you'd come earlier.
- Why? - I wanted to acquaint you with the new forms for the CPT codes.
I'll be fine.
Suit yourself.
Good for you, girl.
You still owe me $20 for Cleo's going-away present.
Suddenly I feel like I never left.
You lost your locker.
Keep your stuff in here for the time being.
Wait.
There's dirt in here.
No.
It's doughnut sprinkles.
Donald Brower, 35.
Face, neck and chest injuries from some sort of explosion.
Unknown LOC, GCS 14 hypotensive, 80 palp, pulse 130.
Mr.
Brower, can you hear me? - Can you tell me what happened? - Mail - Sorry? - exploded.
- What happened? - He opened some kind of letter bomb.
- Daughter's in that rig.
- Give it to me.
Jessica Brower, 6.
Near amputation of right hand.
BP is 100/70, pulse 120.
- Estimated blood loss? - Three hundred cc's.
Couple of litres at wrist, controlled with the cuff.
I'm Dr.
Lewis.
We're gonna take care of you, all right? - It hurts! - Yeah, I know it does, sweetheart.
- How's the airway? - He's talking now.
- GCS 14 here.
- BP, 80/40.
Sir, can you see out of this eye? - I'll get it.
- What-? Peaked iris, probable globe rupture.
Follow the light.
Decreased breath sounds on the left.
He needs a chest tube.
- Betadine and chest tube tray.
- This is her birthday.
- Whose birthday, Mr.
Brower? - I let Jessica pull on the bow.
Do you know why someone would send you a bomb? - My wife.
- Your wife? - Mr.
Brower? - Sinus tach at 120.
- Is that chest tube in yet? - That's the pleura.
- Open your eyes, Mr.
Brower.
- Pressure's dropping, 70 systolic.
- He's out.
Vascular clamp.
- Another thoracostomy tray.
I've got it, Kerry.
I wonder how Susan's doing over there with the kid.
Okay, I'll put in the second chest tube and you get the airway.
Airway's fine.
- Gram of Ancef, IV piggyback.
- Where are we? Superficial flash burns, face is fine.
Lungs are clear, pelvis is stable.
- All the money's on the hand.
- Pressure's steady at 100/70.
No visible deformity to shoulder or elbow.
Hold on.
We need to take a look at your hand, all right? - Thumb's intact.
- First HemoCue's eight.
Ring and little finger are missing.
We need Hand Surgery, Ortho, Plastics.
- Let the cuff down.
- Surgery'll be here in a minute.
I said take the cuff down.
Okay, Jessica.
Okay, sweetheart.
You just relax.
- Just need to know the exact injury.
- Well, now you know.
- You want hemostats? - Yeah.
Just direct pressure.
Blood supply intact.
Probably salvageable.
We're okay here, Kerry.
Sinus at 100.
CBC, lytes, BUN, creatinine, coags and- We already ordered pre-op labs.
- Fine.
- Two more of morphine.
- Let's get an x-ray tech down here.
- Carter, your mom's here.
Brought a kid from her leukemia center.
I got it.
Yeah? They come in on a rig? No.
She brought him in herself.
He has weakness and a slight fever.
Thanks.
And she's nicer than I remembered.
Oh, John.
Thank goodness you're here today.
- Who's your friend? - Mickey is the center's Child of the Year.
We were photographing him for the spring mailer.
And he suddenly became lightheaded and warm.
So you brought him here? We tried phoning his doctors, but it's Saturday.
Is there someplace else I should have taken him? - Did they give him anything yet? - Your friend gave him some Tylenol.
- How long has he had leukemia? - I'm not sure.
He's been in remission a year.
Call his parents? - He's an orphan.
- So he lives in a foster home? With three other special-needs children.
And foster parents he barely knows.
Hey, Mickey, how you doing? - Not so good.
- Yeah? We're gonna see if we can figure out a way to make you feel better.
- Okay.
- A private room would help.
Swing your legs up there for me.
Unit six going up.
Pressure, 90/50.
AC 12 on 100 percent.
Tidal volume 500, PEEP of five.
- You holding up okay? - Yeah.
- Fluid in Morrison's pouch.
- You can't let Kerry get to you.
And in the left pericolic gutter.
Where is Surgery? - Like riding a bicycle.
- Yeah, one with square wheels.
- Ectopy! - V-tach! Charge the paddles, open a thoracotomy tray.
Get ready.
There's no pulse.
He'll be fine.
Charge to 200.
Clear! - Charge to 300.
- Ten blade.
Clear.
- Asystole.
- Go ahead.
Open the chest.
- A-positive is up.
BP's 100/60.
- TKO the other fluids.
- Bring another dose of fent.
- Jessica? - Are you her mother? - Yeah.
She's stable.
She's had extensive damage to her hand.
- We need to get her to O.
R.
- Can you hear me? We've given her pain medication.
She may not respond.
- It's Mommy.
- Why don't you come to Pre-op.
The surgeon will need to talk to you.
Where's my husband? He's in there.
They're working on him.
Mrs.
Brower? Mrs.
Brower? - P.
E.
A.
- Don? - V-fib.
- Oh, God! Shock him.
You the wife? Your husband's injuries caused his heart to stop beating.
- We're trying to bring him back.
- A thoracotomy.
- Charge again.
- You a doctor? - Researcher.
- Clear.
- Still V-fib.
- Witnessed arrest.
- Charge again.
- Ten percent chance.
Clear.
- I told him not to worry.
- Still V-fib.
- Charge again.
- I told him it was safe.
Clear.
Agonal rhythm.
He's been down for 30 minutes.
You can stop.
He's gone.
- Are you being treated for your diabetes? - Look, I'm blind.
I'm not stupid.
I do okay.
It's not easy to get someone to measure my insulin.
But that's life.
Look, you know, I'm just here for the toenails, right? Yes, sir.
Yes, sir.
You know, they're getting worse all week.
I think it was the new shoes.
When did you have them clipped? - Oh, April maybe.
- They're pretty overgrown.
Well, listen.
You think it's hard to get someone to give you a sugar shot just try asking them to clip these puppies.
Well, you know, I can do that for you.
Of course you can.
You're a gifted doctor.
Or at least you will be.
Hold on.
Someone smells beautiful.
Bless you.
- Hi, I'm Dr.
Chen.
- I've heard a lot about you.
I mean, good things.
And the bad things aren't really your fault.
- Excuse me? - Manny has a sixth sense about people.
- Or so he says.
- Well, with my eyes I had to get something out of the deal.
What is this? It's Mr.
Kindlevich's Seeing Eye dog.
- Well, where's his harness? - He isn't official.
But trust me.
He's my eyes.
I need him.
All right.
Just keep him on a leash, a short one.
- Yes, ma'am.
- Dr.
Chen, can I speak with you privately? What do you want? You know, eventually this has to stop.
This attitude, this resentment you have towards me.
- Does it? - We have to work together.
I can't allow patient care to be compromised because you dislike me.
- I wouldn't let that happen.
- Good.
Because the last thing I need is a divisive medical staff.
Then maybe you should quit.
The police want to talk to you.
I told them to wait until after your daughter's surgery.
- Has it started? - Yes.
I should have told him about the threats.
We're trying to create stem cells.
Using embryos? DNA.
Cloning.
This was meant for me, not him.
Not Jessica.
Could I observe the surgery? - It's probably not a good idea.
- I'm a doctor.
You're also a mother.
I'll see what I can do.
- Easy, kid.
Easy.
- Almost there.
Hey! - Sorry about that.
- Damn medical students! He's all bark.
You know, you remind him of his son.
I'm black, sir.
I can't see.
Did you want two sets of cultures? - My best friend Eddie has the flu.
- Yeah.
There's a lot of that going around.
- We were shooting outside.
- It's freezing.
I tried to tell the photographer.
He wouldn't listen.
Abby is gonna draw some of your blood.
- I have a good vein here.
- Okay.
Take a deep breath.
Exhale.
You don't have to watch.
I'm fine.
Just a couple more vials and we'll be all done.
- Where are you going? - I have other patients.
Yeah.
It's the head.
You want to play with it? - Hi! - Are you feeling any better? Hardly.
- Is she keeping you busy? - Yeah.
I tried to get her down for a nap earlier, but she wouldn't do it.
Sometimes stroking her earlobes helps lull her to sleep.
Can I get you anything to eat? Oh, Rachel, I don't think I can keep anything down.
How about some tea? Sure.
Sure.
Hello, sweetie pie.
Careful.
You don't want to get her sick.
Yeah.
Okay.
Why did I wear these shoes? - Because you forgot that around here- - Comfort first.
- Yes.
- No, I didn't forget.
It's just I'm not ready to go back to ugly, sensible shoes.
I heard that you did some really nice work in that trauma today.
Doesn't count if they don't make it.
Why did you treat pyelo with Bactrim? Because the PMD sent a culture two days ago.
I have the sensitivities.
There's been resistance to Bactrim.
Not for her.
Well, if you don't have a culture, you start with Levaquin or an aminoglycoside.
- Hey, looks like you made a friend.
- Hey, hey, hey, hey, knock it off.
- Gallant, get this dog out of here.
- Thanks a lot.
- This is a hospital, not a kennel.
- What'd I do? Tried to let her off the hook.
Whose side are you on? I'm not on anybody's side.
I'm trying to play this very neutral.
No.
You have to be on someone's side.
It better be mine.
- Deb, she's my boss.
- You like her, don't you? I don't dislike her.
- That makes a lot of sense.
- What makes a lot of sense? - Oh, your taste.
- Excuse me? John, it's obvious.
You have a thing for older women.
- What? - Yeah.
Weaver, Lewis and, oh, that pediatric surgeon.
What was her name? - Oh, come on! - Come on.
Younger women just too much for you? I can handle myself either way.
- Yeah, sure you can.
- Your mom's asking for you.
- What do you want to tell her? - Where's my kid? - I'm with a patient.
- What'd you do with my kid? - How's the leg? - Much better.
- What you got? - Leslie, unrestrained driver.
Slow-speed MVA.
Drove her car into some bushes.
Found her and daughter on the curb.
Only injury's a scalp lac.
- Where's the daughter? - Behind us.
- Hey, Leslie.
I'm Dr.
Carter.
- Oh, I just bet you are, sweet face.
BP, 130/80, no LOC.
And enough alcohol - on her breath to start a fire.
- Hey, I resent - Hi.
What's your name? - Stacy Miller.
Thirteen years old.
No LOC.
Says she wasn't hurt.
We're gonna check you out, make sure you're okay.
- You feeling pain anywhere? - Yeah, a big one.
You guys a bunch of frigging perverts or something? In my ass.
Excuse me? - That looks pretty superficial.
- What? The cut on your head.
There's a cut on my head? I'm sorry.
I'm just kidding.
You know- - Softer hands, honey.
- I'm sorry.
But I ain't "honey.
Why is everybody so serious around here? A pretty serious thing happened to you.
No, no, no.
See, this is a bump.
What's seriously wrong is what's in here.
You having chest pain? I have a broken heart.
Two great weeks, and he leaves me without a word.
What the hell kind of fiancé is that? Trauma panel, urine tox and a dip.
B.
A.
L.
and hang a banana bag.
- Suture kit? - I'll get it.
"Banana bag"? - Is that the daughter? - Yeah.
Lucky me, huh? Stacy, we need to get you into a gown so I can examine your chest and belly.
I said I wasn't hurt.
You want to get out of here, right? Go home, clean the house.
Get your homework done.
- How did you know? - I'm very smart.
Besides, the quicker you get into this, the quicker you get out.
At least you were being responsible.
Mom says seat belts are too confining.
Nice example to set, driving drunk and beltless.
She wasn't driving.
I was.
- You're 13.
- Almost 14.
- You don't have a driver's license.
- Neither does my mom.
She still drives.
I just take over when she's had too much to drink.
You been doing this for a while now? Three years.
Not one accident.
Till now.
Okay.
We'll be right back.
We just need to get some more supplies.
That is completely nuts.
Or brilliant, depending on your point of view.
A 13-year-old driving her lush mom is good? No.
But neither is a lush mom driving her 13-year-old around.
Somebody's gotta be the adult.
Everything was going along fine Elizabeth, you awake? - What's wrong? - I don't know.
She's sweaty.
- And she just started crying.
- Let me see.
Let me see.
- Did you give her milk? - No.
Just mashed bananas.
Here, just take her a moment.
I'll just get the thermometer.
Oh, sweetie.
How long's she been crying? Elizabeth, she just threw up.
Oh, dear.
- Oh, come here, sweetie.
- Maybe she caught what you have.
Oh, it's okay.
- What's this? - What? - Get the phone.
- What is it? It's a pill fragment.
She swallowed something.
Oh, my God! Her heart's pounding.
It's okay.
Rachel! It's okay, sweetie pie.
It's okay.
It's okay.
It's all right, darling.
- It's all right, darling.
Answer, damn it! - Oh, my God! It's okay.
- It's E.
- What? It's Ecstasy.
I had some in my backpack.
Yes, sorry.
No, hold on.
Hold on.
- How many? - What? - How many pills are missing? - Just one or two.
Yeah, sorry.
I have a baby with an amphetamine overdose.
- What's your address? - Yes.
1211 Dupont Drive.
Please hurry.
It's all right.
It's all right.
DUI's a pretty serious offense.
Yeah, but letting her sober daughter drive was worse? I don't know if it's worse.
It's child endangerment.
You gotta get Social Services involved.
Stacy goes into foster care? That may not be such a bad thing.
So you want to call the cops, or should I? Abby, we need to find Dr.
Greene.
Okay.
- Abby? - I'll take care of it.
Oh, sorry.
Sorry.
I got a little busy there.
Has his fever broke? No.
And he's very uncomfortable.
- No one's given him anything to eat.
- I'll make sure he gets something.
I talked to the Pedes Oncology fellow.
He's gonna come see him.
- Aren't you going to do something? - Yeah.
I sent off his labs.
No, I mean in terms of treating him.
There's no obvious infection.
The oncologist can take it from here.
It may be a while, if you want to go home.
I can't leave.
His foster parents still can't get here? No.
Somebody from the center can relieve you.
I'm from the center.
Are you sure that you want to do this? I mean, stay involved? Do you think she'll remember him? When my daughter was 6 she broke her arm in two places riding her bike.
And the only thing she remembers from that year is seeing Muppets on Ice.
They remember the good things.
She won't forget her father.
- Mrs.
Brower.
- Yes? I'm Dr.
Romano.
I finished my part of the surgery, which went well.
Will they need to amputate? She's a doctor.
There's stable bone on the remaining digits blood supply and enough skin to cover grafts.
So she'll have use of the hand.
Limited use.
But kids can adapt.
Corday and the paramedics are on their way with your daughter.
What? Came over the MICN as an Ecstasy overdose.
- Did they say how much Rachel took? - All I know is, she's vomiting.
- Is she awake? - They didn't say.
- Who didn't say? - I didn't take the call.
Haleh did.
- What are her vitals? - I'm sorry.
I don't know anything.
I knew she was doing this.
I knew it.
I should have trusted my instincts.
I gotta take the stairs.
- Move! Move! - Sorry.
I got the charcoal! We need a Pedes ICU bed! - Where are they? - Trauma 1.
Move! Move! Move! How's her airway? She's breathing on her own, tachy at 180 and febrile.
- Oh, God! - She's diaphoretic.
- Let's get a rectal temp.
- What the hell happened? - She swallowed Rachel's Ecstasy.
- What? I'm not sure how.
She's sympathomimetic toxidrome.
And we couldn't get a line in the rig.
- Where was it? - What? It was in her backpack! She had four pills.
Two have disappeared.
And Ella vomited a fragment of one.
Bolus 100 of IV saline.
Ten milligrams of charcoal by NG.
- Prep a milligram of Ativan.
- They blew two veins in the field.
- I'm gonna try an interosseous.
- No! No! She's got a good antecubital! - Oh, God! - Heart rate's 250.
Looks like a narrow-complex SVT.
I need a glove full of ice.
And prep one of adenosine.
Dr.
Corday, what is her weight? Ten kilograms at the pediatrician's last week.
Okay, here we go.
Come on, sweetheart.
Come on.
- Twenty-four gauge in right AC.
- Push the adenosine.
Lungs are wet.
She's in failure.
We need to break tachycardia! The CHF is rate-related! Could somebody get me a stool, please? - Still in SVT.
Are you all right? - Yes, I'm fine.
- Worry about my daughter! - We're gonna need the crash cart.
- What? - She's hypoxic with pulmonary edema in SVT.
The protocol is to synch cardiovert at half a joule per kilo.
No! No, we're not shocking her.
She's hemodynamically stable.
Maybe we should get Dr.
Weaver in here.
No.
Let's try two of adenosine.
Abby, get Dr.
Weaver.
Mr.
Kindlevich, you still being treated? No, discharged.
Just waiting for the van to pick us up.
- Stinky! - Why don't you have a seat? Here we go.
Just step straight back.
There you go.
- He never leaves.
- Well, I'm sure he'll be back soon.
Stinky! Stinky? Is that you? Stinky? Stinky? Oh, Stinky! Oh, Stinky.
He needed to take care of business.
Gallant, you're a student, not a dog walker.
- Bless you.
- I think I'm allergic to dogs.
Apparently.
Next time use a plastic bag.
Dr.
Weaver! They need you in Trauma 1.
Dr.
Greene's daughter's in trouble.
- Second round's onboard.
- Stats down to 90.
Put her up to 50 litres of O-2.
- Still in SVT? - Yes.
- Have-? - Push 3 adenosine.
Mark, we both know how difficult it can be working on a family member.
- Okay, get ready with diltiazem.
- And your own child in particular.
- I got it, Kerry.
- No.
- No, you need to step aside.
- I said I've got it, Kerry.
Calcium channel blockers can cause cardiovascular collapse and death in kids under 1.
Mark.
- Push one milligram of Inderal.
- You're soaking wet.
- Please.
- Your pulse's thready.
You have a fever.
It's just gastroenteritis.
- Sinus rhythm.
- Thank God! - Number 8 French NG for the charcoal.
- Let's get Elizabeth to bed.
- And run in two litres of saline.
- I'm not leaving! If you don't, you're gonna pass out.
That won't help anyone, least of all Ella.
She's okay.
She's stable now, okay? Go lie down.
- I want to be able to see her.
- I'll set you up in Exam 2.
- Damn it! - Pulse ox is down to 88.
Lungs are full of fluid.
Fifteen of Lasix.
- Think about intubation.
- I can get her out of failure.
- She's retracting.
- Using accessory muscles.
She's in respiratory distress.
Give the diuretics a chance to work.
Put her in the Broselow tape.
Bag her on 100 percent.
- No.
You'll hyper-inflate the stomach! - Mark, your baby is hypoxic.
You want to avoid unnecessary procedures.
But if we don't intubate, you're making a big mistake.
- Now, step aside.
- Rate- The failure was rate-related.
We broke the SVT.
But now she's in pulmonary edema.
If this wasn't your baby, we would have intubated her a long time ago.
I'm trying to save her life.
Pre-medicate with.
2 of atropine, Induce with 3.
2 of etomidate and paralyze with 22 of sux.
- What size tube? -4.
0 uncuffed.
- A number-one straight blade.
- Call for a Pedes vent.
Tidal volume of 100 cc's.
- We should be doing something.
- There's nothing we can do.
They got three doctors.
I think we'd just be in the way.
- Yeah.
Did you hear how it happened? - Yeah.
It is amazing the drugs that kids can get ahold of.
Oh, my God! Is that Rachel? Yeah.
John? Mickey's been upstairs an hour.
He hasn't been seen by a doctor.
Yeah.
That's not uncommon.
Well, it's unacceptable.
I was gonna get coffee.
You want some? Yes.
I'd love some.
I was hoping you could tell me what all this means.
- You stole his lab slips? - Yes.
I heard that they were back but no one gave us the results.
What is it? He's in blast crisis.
He's had a recurrence.
His bone marrow's full of leukemia cells.
He's not gonna be able to fight infection.
- Is there something we can do? - I'm sure they're giving him antibiotics.
The oncologist will know exactly what to do.
Yes, of course.
But he's just a number to them.
Maybe if you spoke to the doctors, they'd take him more personally.
Why are you doing this? You've been here all day.
You've been holding his hand, clipping his chart, bugging the staff.
- I'm trying to help a sick child.
- Mom, he has leukemia.
- I know that.
- And he may not survive.
If you've got some kind of twisted need to relive this, that's fine.
I'm not gonna do it again.
I made my peace a long time ago.
Let's pull the tube back five millimeters.
- Are you in the main stem? - At the carina.
You should be in bed.
Heart rate's down to 100.
Pulse ox is 99.
When can we extubate? They'll probably keep her sedated in the PICU rest her overnight in the vent and extubate her first thing in the morning.
Mark, we need them to get a rollaway in the room.
- I'm staying the night.
- Elizabeth, you're sick.
- Well, you're not leaving, are you? - No.
Mark? - I found her wandering the hallway.
- Dad? Rachel, where have you been? I was just waiting outside.
Is she okay? Does she look okay? - I'm sorry.
- You're sorry? - Mark? - Stay out of this.
You bring drugs into our house and leave them out for a baby? - It wasn't mine.
- Stop lying! They were for a party.
I wasn't sure I was gonna take them.
Your sister did.
But she's gonna be okay, right? It was one pill.
Are you really that stupid? - Ella is 9 months old! - I know.
- She almost died.
- Dad, don't- Don't what? What? Don't call you a liar? Because that's what you are! You promised you weren't doing drugs! I'm sorry.
She could have brain damage learning disabilities, low IQ, memory impairment.
- She could still die! - I know, Dad! Please, please, Dad.
I'm sorry! Dad, I'm- Daddy, I'm sorry.
Dad, I'm - She still seems a little warm.
- We'll get a repeat temp.
She can have ibuprofen by NG.
I'll check the orders.
Is this the overdose? Do we have a post-intubation film? I want someone else.
Let's see how she's satting on 70 percent.
No, no, no.
You're not touching her.
- What's the problem? - Page me another doctor.
- There's no one else on service.
- If we're going to control toxicity - we need to wean down the oxygen.
- Yes.
Well, I want my own pediatrician.
- Is this your daughter? - You are not touching her! I have to.
I'm the Critical Care Attending.
No! No! You do not touch my child! Do you hear me? - You stay away from her! - Lizzie! - We have to check the blood gas! - Get out! You heard what she said.
Out! Get Dr.
Rosato in here.
Kerry? Yeah.
How's she doing? Vitals are stable.
Satting well on 50 percent.
- Sounds like her lungs are drying up.
- Yeah, we've got a long ways to go.
My prayers are with you all.
Kerry thank you.
- Taking off? - Yep.
If I hang around here much longer, I'm gonna start to cry.
- Is your mom still upstairs? - Don't know.
Don't care? Hi.
- Hey, I thought you left.
- I wanted to say thanks.
The officer said that they'd book her for the DUI but that I could post bail in a couple hours.
Wait.
They're charging your mother with the DUI? And I made an appointment at that treatment center.
- Great.
- But you were driving.
- No, I wasn't.
- I thought you said she was driving.
- No, I didn't.
- What? Anyway, I gotta catch a bus.
Good luck.
You said you were gonna call the police.
You said I was gonna call.
I asked, "Will you take care of this?" She's her mother's best chance for recovery.
I think you know that.
- Good night, Carter.
- Good night.
Hey, Gallant.
Your guy's dead.
Hey.
Rachel's here.
Did you call the police? She wants to talk to you.
I can't.
- Elizabeth- - I'm sorry, Mark.
I can't.
Let's get you something to eat, okay? I want to stop by.
But they probably want to be by themselves.
You want to go in on dinner for them? Have it sent over so they don't have to leave? Yeah.
That'd be nice.
- Bye, Kerry.
- Bye.
- Good night, Dr.
Weaver.
- Good night.
Stinky! What are you doing here? I've been trying to catch him.
He's running in circles.
And he comes back here.
I think he knows Animal Control's coming.
Oh, for God's sake! Go inside and take an antihistamine.
Yes, ma'am.
Come here.
I don't like dogs.
And I don't like your name.
Give me a break.
All right, come on.
You better be housebroken.
Because if you're not, you're going right back to the pound.
- Who is it? - Abby, it's me.
Let me in.
- Joyce? - Please hurry.
Hey.
What's wrong? - Joyce? - Turn out the lights.
- What? - Turn out all the lights.
- Well, what's going on? - I'm sorry.
I had to get out.
I hope it's okay that I came here.
Well, of course it is.
But- Joyce? Joyce, you in there? No, no, no, no.
Don't go.
He's probably just looking anyplace he can think of.
Open up, damn it! - I'm calling the police.
- No.
It'll just make it worse.
- He just needs to calm down.
- Joyce, you in there? Joyce, we can't hide in here all night.
Joyce! He'll go away.
- When? - Open up, damn it! Bitch! I think he's gone.
Can I stay here for a while? Sure.
She's pretty tired.
Okay.
How you feeling? - Kind of better.
- Yeah? They treating you okay up here? They don't tell me much.
They tell her mostly.
You know what's happening to you, Mickey? I know it's back.
But I don't think it'll be as bad this time.
I was by myself before.
She looks asleep.
But she's not.
Hey, you want me to? You want me to take over for a while? No.
She is gonna come out of this.
Well, she may not.
She may never open her eyes again.
Elizabeth.
I don't understand why this has happened.
It'll be okay.
Mark, you don't know that, do you? No.
No.