ER s09e19 Episode Script

Things Change

Previously on E.
Woman I went to med school with has a patient who's very sick.
Young boy.
And the surgical team that performed it in Croatia has disbanded since then.
What! I got a guy here says he's your husband.
We wanted burgers.
So we took a cab to this drive-through.
Turns out to be a mini-chapel.
- So I spoke to an attorney.
- Yeah, me too.
- He said annulling it should be fairly easy.
- That's what my guy said.
Any word on Eric? I don't expect any.
It's like a bear hibernating.
Any patient here over six hours is your failure, not mine.
Treat, turf or dispo.
Okay, okay, okay.
Okay, okay, okay.
Got a rhythm.
Sinus tach.
- Got a pulse.
- Trying for a pressure.
- Good breath sounds.
- Satting at 91.
Put him on 100 percent non-rebreather.
Pupils four millimeters and reactive.
BP is 90 palp.
All right.
He's back, whoever he is.
- Hey.
- Hey.
- What's Kerry doing here? - Romano damage control.
- Making a lab run? - Ain't my lunch.
Thank you.
What you got there? That is my NGO pack from L'alliance de Medicine Internationale.
- I thought you said you weren't going.
- Yeah, I'm not.
Why did they send it to you? They're hoping that I'm gonna change my mind.
- My shots are good for a year.
- You didn't sign anything? No.
It's a volunteer organization.
They can't draft you.
- Luka is still going to the Congo.
- I know.
He doesn't listen to me, either.
So with Weaver back down here, does that mean that Romano is history? He moved his office out of exam one.
Could be the urine smell burned his eyes.
She's probably working a couple shifts for appearance's sake to keep people from killing him.
- We tried that.
- Carter.
- They keep putting him back together.
- Dr.
Carter, meet your new students.
- My students? - Yeah.
You're chief resident, aren't you? - Yes.
- And this is still a teaching hospital? - Yes, but- - Good, then start teaching.
Don't worry, he's a lot smarter than he looks.
He's been with us four years.
- Nine.
- Well, hopefully you'll be quicker studies.
Watch your backs.
You want this, Carter? George Zito, complaining of 8/10 chest pain.
- That was 20 minutes ago.
It's five.
- Relieved by nitro spray.
- Cigarette would've done the same thing.
- Had a heart attack before? - You mean besides this one? - Pulse 92.
BP's 155/100.
- All right, Trauma 1.
- Carter.
Air rescue's bringing in an MVA, - Yeah, my dance card is full.
- I'll get Lewis.
So who can tell me the risk factors for coronary artery disease? Chopper's bringing a trauma in.
We're gonna need a second line for lidocaine.
Is it unit 27? The helicopter? - I don't know.
Why? - Chuck flies with the 27.
- Oh, right.
- Yeah, I know.
It's weird.
But there's something about him.
He makes me feel good.
Not that way.
Well, that way too.
You know what I mean.
His name's James Shaw.
He's on Mellaril, per Dr.
Mellaril, anti-psychotic.
James, how many Mellaril did you take? They're all gone.
I need some more.
If you take too many pills, your heart can stop.
The pills scramble the signal.
It keeps them from finding me.
- Keeps who from finding you? - They know my neural pattern.
Nobody's gonna find you here.
They monitor the 40hz range.
- Abby.
- Yeah? - Brother's on the phone.
- What? Eric.
I'll be right there.
- You can tell because it tastes like metal.
- Your brother's okay? - I haven't heard from him in two months.
- I must leave before they scan this place.
Listen to me.
James, they can't scan you in here.
Okay, because radiology is upstairs and the floors and the walls are lined with lead.
Okay, my name's Abby.
I'm gonna help you.
- Okay.
- Okay.
Give him five more of Haldol.
Use restraints if you have to.
- Call his PMD, let him know he's here.
- Okay.
Can you watch him? I have to take a phone call.
What line? What line's my brother on? He said he'd call back in an hour.
Call back from where? I don't know.
Well, did he sound in trouble? Did he sound like he was all right? He said he'd call back in an hour.
Are you the only person here that doesn't know about my crazy family? - What? - Just, can you please come find me when he calls back? Drag me out of a stall if you have to.
Yeah, can I? - Could you help me over here, please? - One second.
Hey, Mom, it's me.
Eric called and I was wondering if you'd heard from him.
Can you call me at work? Thanks.
I got a guy who came in complaining of a severe sore throat.
- I wanna send off a culture and a CBC.
- Okay.
- This is Andrew.
- Hi, Andrew.
What is this guy still doing here? - I'm still working him up.
- Yeah, wrong.
Hold this.
- Take these.
- I'm already seeing eight.
Now you're seeing 12.
I'll give you four more every 15 minutes.
So I suggest you start turfing people, beginning here.
- He has low-grade fever and adenopathy.
- If I wanted a nurse's opinion Well, I don't know what I'd do, because, quite frankly, it's never happened.
Say "Ah.
" He's got no exudates.
Write a scrip for Erythro and get him out of this bed.
- He's in a lot of pain.
- That is why they call it a sore throat.
Viral pharyngitis will go away on its own.
If it's viral, why would you give him antibiotics? You kept him here two hours.
Call it a consolation prize.
I'm Rocket Romano.
I'm head of the ER.
You look a little lost.
- Dr.
- You're a doctor.
I'm visiting from Croatia.
What a coincidence.
I'm also a visiting surgeon.
Can I buy you a cup of coffee or something? - Hey, you been here long? - No.
- You two know each other? - We went to the same medical school.
- No doubt.
- Gordana is here to observe a correction of a heart repair.
Young boy from Croatia.
What a beautiful language.
Kovac, I don't wanna keep you from your patients.
By the looks of the board, you're running behind.
So it's a pleasure meeting you.
in a rollover MVA.
Trauma 2.
You wanna see what American ER docs do? - I guess so.
- He was initially awake with a GCS of 13.
He had a prolonged extraction and we tubed him for LOC.
Susan, this is Gordana, a surgeon from back home.
Did he talk before he crashed? Headache, belly pain? No.
He was just cursing me out till he crumped.
You want me to call a social worker down on this? She's not mother of the year, but I don't sense she'd hurt the child.
Baby's sick and the mother's evasive.
Could be M√ľnchausen by proxy.
- Let's get our tests back.
- Is this a spot check? - Help me put this on.
- Still working shifts.
The perks down here never stop, do they? - What are you doing, Robert? - Observation and evaluation.
Oh, you mean belittling and bullying? - Gloves too.
- You want both? - Page Neurosurgery.
- I thought I could smell blood.
- No sats.
- It's the Marilyn Manson manicure.
Grab acetone and get a good nail on him.
Crepitus around sternum.
Gonna be all day? Till I secure the airway.
- I saw it go in.
- No offense.
I check all paramedic tubes.
- Since you guys miss half the time.
- Quiet.
I can't hear any breath sounds.
- Bag him.
- Pressure dropping, 70 systolic.
- Need a first crit.
Tube's through cords.
- Told you.
We get a blood line on him? - You wanna do it? - No, thanks.
- Anyone page Corday? - She's still next door.
- She need a personal invite? - Triple lumen kit and- Non-reproducible.
First it's here.
Now it's here, here.
- Not my fault.
- There a problem? Mrs.
Reynolds had a subjective fever.
Which magically resolved along with her abdominal pain after passing gas.
You're gonna charge my insurance Her belly is tender.
There could be a pulsatile mass.
- So admit her and work her up.
- Sorry.
Don't you "hey" me.
If you wanna get a CT scan and reconsult me, fine.
Or send her home and bring her back.
But I refuse to admit her just so you can clear ER beds in 30 minutes.
Corday, can you take a look at this patient? Let me guess.
Infectious gangrene from a paper cut? - Systolic.
- He's hypotensive.
His vasculature is collapsed.
Probably has an intra-abdominal hemorrhage.
Tubed in the field for LOC but had belly pain.
- Another liter up.
- It's clotted again.
What's your excuse for not taking this one up? No exposed bowel? Give it a rest.
He's got intraperitoneal fluid.
All bleeding eventually stops.
You can probably leave this one too.
O- silk and OpSite.
Hook up the infuser.
- It's not working.
- We only have so many rooms.
- I'm gonna do a cut-down.
- He's slowing down.
Pulse is 72.
- He'll need a box.
Pull it together.
- Sats are 80.
Run in the blood and get a post-line chest.
Enough Transylvanian play-by-play.
- Did you listen to his lungs? - Yes.
Well, he's not moving much air.
Tension pneumo on the right.
Decreased on the right, tracheal shift.
Chest tube tray.
- Left lung's still up.
It's not your line.
- The intubation.
- We don't know that.
- They should've heard it and needled it.
Even if they did, and I'm not saying they did you can't hear anything in those choppers.
- Damn it.
Watch what you're doing.
- I didn't drop it.
You did.
Could you step outside, please? Thank you.
- She's just observing.
- Yeah? I have enough people in here just observing.
If you think you can do it all yourself, Susan, we can all step out.
- Might go faster.
- Might go a lot faster if he came properly intubated.
Glad to see your leadership skills rubbing off here.
How do you say "bite my big one" in Croatian? He's bradying down, if anybody's interested.
Take deep breaths for me.
- Is there any pain with that? - No.
- Is that Blumberg's sign? - No, Murphy's sign for cholelithiasis.
- Think he has diverticulitis? - No.
- Pain's in the left lower quadrant.
- Too young.
- Kidney stone? - Causes more pain.
- Ulcerative colitis? - Gives you bloody diarrhea.
With the appy, do you worry about intestinal obstruction? - Maybe.
But there's no vomiting.
- What about a femoral hernia? No mass.
Don't you have a question? We get a lunch break? - Are you going to do a rectal? - Eventually.
- I've never done a rectal.
- Ultra-sounding the belly? Okay.
You and you are shortness of breath.
You and you, take vertigo.
And last but not least, knee pain.
Watch each other doing H & P, discuss with your partner - present back to me.
- Should we start-? No more questions.
- Thanks.
They're giving me a headache.
- Me too.
Hey, Pratt.
I got something for you.
- I'm seeing too many patients already.
- Not a patient.
Gallant, I got something for you too.
What's this? - You forget what today is? - What? Payday? - Match day.
- Good luck, gentlemen.
- I thought you matched here already.
- I was just doing a one-year transitional.
I got County.
- Oh, man, I'm sorry about that.
- Oh, no, man.
I asked for County.
- Why? - Congratulations, Gallant.
Glad you're gonna be with us.
Talk to me.
Talk to me.
Talk to me.
I got Northwestern, baby.
I'm going uptown.
- What's this? - LOL with phlebitis in Exam Four.
- Know how many patients I'm juggling? - Not enough if you have time to dance.
- How much on the right tube? - Nearly 600 cc's.
BP's up to 92/66.
Let's hope his brain survived the lack of perfusion.
- Where is Curtain 2? - Just passed it.
- Nurse-? - Could I ask a question? In a minute.
- Did my brother call back? - I thought he disappeared.
- Where's Jerry? - On his break.
- ER.
Hold, please.
- Is that him? No.
Excuse me.
- Could you tell Dr.
Kovac I'm leaving? - He should be back in a minute.
We just sent that trauma upstairs.
- And I'm Abby, by the way.
- Dr.
- Hi.
- Hi.
You know Luka from Croatia? We're old friends.
We went to school together.
He was what you call a character back then.
- Luka? - Oh, yes.
Always playing practical jokes on the other students, on our professors.
Really? You could always tell when Luka was in the building because you'd hear him laughing.
You know that laugh of his.
It's contagious.
He doesn't really laugh much at work.
He seems like he's changed.
He's been through a lot, I guess.
Still, I thought I'd find him married to some American supermodel with three children and a dog.
His wife Danijela would have wanted that.
Abby, page Psych again.
They gotta see this guy.
Excuse me.
- He's getting restless.
Give him Haldol.
- Okay.
- Do I need to apologize to her? - No.
She seems pretty cool.
Then I'll apologize to you.
Didn't mean to turn into a bitch - in the trauma room.
- Don't worry.
I was unfocused.
- Did you talk to your brother? - No.
Said he was gonna call back but didn't.
Guys never call when you want them to.
- Hey, did air rescue leave yet? - What am I, air traffic control now? - Use the helicopter check system.
- What's that? Go up on the roof and check.
If the helicopter isn't there, they left.
- Taking anything for your cholesterol? - No.
Call Myers in Psych and tell him I'm sending a psychotic patient to him if he doesn't come down here and assess this guy.
How you doing, James? Okay, I need to go now, because I can- Because I can feel the pulses.
They're trying to use the microwaves to penetrate my synaptic code.
- Okay, you need to relax, all right? - I just need to leave.
- Okay.
- I'm gonna give you medicine - to help you do that.
- Okay.
No! Please! No, wait! Hey.
Don't do that.
Stop it.
James, look at me.
You know I'm not trying to hurt you.
I'm keeping you safe.
That's what I do.
- Abby, your brother's on line one.
- Yeah, thanks.
Where are you? Are you okay? Well, what's going on? I- Yes, he's here.
We caught him.
We have no other choice.
He's not cooperating.
He knows things.
We have to proceed with the surgical interrogation.
Are you on your meds? Well, why didn't you go to a hospital? Well, what's the phone number of the booth you're using? Stop talking to them.
I won't let you talk to them.
Frank, call Security and cancel the fire alarm.
James! Look out, look out, look out.
Hey, just hang out.
I'll be right back.
When are they gonna stop this? Well, usually it doesn't take more than four or five hours.
You think I'm kidding? Now you see why I want out of this place.
Well, it's not all bad.
You know what I mean.
- You can get a job at Northwestern too.
- I left County once, but I came back.
Something about this place just gets in your blood.
It's probably the asbestos.
So you wanna help me celebrate later or what? - What do you have in mind? - Hey, Dr.
She spiked a fever.
Oh, am I interrupting something? - Yeah.
- No.
Mona Reynolds, she dropped her pressure in the CT scan and her temp's 39.
Find me later.
Her white count is 22.
She's in a lot of pain.
I paged Dr.
- How are we doing, Mrs.
Reynolds? - My gut's gonna burst.
Let me guess.
She ruptured her intraperitoneal pus.
Pressure's 86/60.
We're gonna need another liter.
She's septic.
- Courtesy of Dr.
- Oh, my gut's killing me.
It will if we don't fix it.
A simple "please" and "thank you" would have sufficed.
Let's grab a two-gram dose of Cefoxitin a gram of p.
Tylenol and four of MS.
- Should I page Dr.
Corday? - Screw that.
If she can't diagnose a subphrenic abscess, she can't fix one.
- You should get a clean dressing.
- Grab me a four-by-four.
Also looks necrotic.
You need to get that debrided.
If I were you two, I would concentrate on my patient.
She has a history of peptic ulcer disease, perforation chronic subclinical fevers, weight loss, cough.
It's classic.
- We must page Corday to book an O.
- Forget it.
She's already septic.
Open drainage could kill her.
We'll have to do this under ultrasound.
Set her up in Trauma 2.
History of CHF, noncompliant with meds and diet.
Wet crackles on exam.
Orders? CBC, 40 of Lasix, chest x-ray and EKG.
- Good.
- Positional vertigo, positive berene test.
- How's the cerebellar function? - FNF, HTS and RAM all normal.
Ma'am, can you go like this? Good.
Hep-Lock, five of Compazine, five of Valium.
Knee pain.
History of rheumatoid arthritis.
No trauma or calf tenderness.
- We think ruptured Baker cyst.
- Dr.
Carter, phone call.
- Okay, just a sec.
What'd you order? - Ultrasound.
Hey, Carter.
Your old guy just coded.
All right.
600 of ibuprofen.
Take a message.
I'm sorry, he's with a patient.
Can I take a message? Just a second.
Weaver, can you take this telephone call for Dr.
Carter? He's running a code.
They say it's urgent.
This is Kerry Weaver, Dr.
Carter's supervisor.
What's the problem? - Suction.
- He's throwing PVCs.
- Cricoid pressure.
- You want lidocaine? Not just yet.
I got it.
I'm in.
Bag him.
You got a phone call.
I'll take this.
- I got it.
- Sats are coming up.
- You really need to take this call.
- He's in V-tach.
- Charge to 200.
- It's your grandmother.
Good pulse with compressions.
- John.
- Charged.
- Okay, clear.
- Still in V-tach.
Charge to 300.
Give me an amp of epi.
- I'm sorry.
- Is she dead? I'm sorry.
- Still in fib.
- How long do you keep trying? - Clear.
Another amp of epi.
It's been 25 minutes.
- Does anyone survive after this long? - Hold compressions.
- Fine V-fib.
- Resume compressions.
Charge to 360.
- What else can you try? - Procainamide.
- One gram, 30 mgs per minute.
- With lidocaine and amiodarone? What's the most times you've ever shocked somebody? - Still no change.
One more time.
I thought if you don't get him back after three, you never will.
And clear.
Well, I guess you heard wrong.
Sinus tach.
Good carotid pulse.
Finish the Pronestyl load and start a drip at five per minute.
Pupils are fixed and dilated.
- Is he ever gonna wake up? - Let's just wait and see.
ABG on 100 percent.
AC 14.
Tidal volume of 700.
Abby, I told you not to call DCFS on the Baby Miles case.
I didn't.
I called a social worker.
Mom needed help.
- Yeah, and Adele called DCFS.
- Hey, did you find him? - No.
- Oh, she lost a Psych patient.
I was in the process of restraining him when he bolted.
Did you call Security? He'd already left the building.
Can you give me an address on this number? - Is this patient a threat? - I don't know.
- Where is this? - It's a phone booth.
- You leaving? - Yeah.
How's the patient? Hopefully he's not brain dead from the prolonged hypotension.
It was a good intubation, Suz.
You saw it.
One, call me Susan, and two, his lung was down.
Do you know how hard it is to hear on that chopper with rotors and the vibration and the headphones? - I do know.
But- - That lung was up when I transported him.
- He had pneumo.
You should've caught it.
- You didn't.
- I stood up for you in there.
- What's that supposed to mean? You felt like you had to because I'm a nurse and you're a doctor? No, that is not it.
Well, maybe a little.
I know how they bag on the EMTs.
- What is so funny? - Nothing.
We just- We bag on doctors all the time.
You're protecting me.
- Oh, you're too much, Dr.
- Chuck.
- Yeah? - Chuck.
- Susan.
- Charles.
- There's a dead body in here.
- I don't mind.
It's gross.
It's disrespectful.
It's wrong.
I'm sorry.
I was looking for Carter.
- He was just here, wasn't he? - Yeah.
- Yeah.
But he left.
- Yeah, he- Okay.
You ever drain an intraperitoneal abscess? - That's a surgical procedure.
- You're a surgeon? - Yes.
- Good.
Come with me now.
I got a septic patient moments from badness.
I need you to help me put a catheter in a pocket of pus.
Think you can do that? - Perhaps, but- - Good.
Pressure's better.
- What's her temp? -39.
Cefoxitin running in.
I need you to sign this.
- What is it? - A consent for the procedure.
- What happens if I don't? - You'll probably die.
- What are they saying? - Pillow talk.
Kidney stone in Two is pain-free.
Send him home with Vicodin and a strainer.
Eleanor Carter.
It might be under Eleanor Ferguson.
Drummond can have Compazine.
She can come back if pain persists.
- The kid in Curtain Three? - Lewis can take care of everybody else.
Hey, you all right? Yeah, I'll be all right.
Thanks, Malik.
Can you check again for me? Hello? Hello? - Pressure's steady.
100 systolic.
- Has anybody seen Abby? - No, sorry.
- Find a needle.
- Try not to perforate the diaphragm.
- What are you doing? - What's it look like? - A lawsuit.
No aspiration.
- Sorry to hear about your grandmother.
- Thank you.
I need to go home.
- Susan's gonna cover for me.
- How old was she? -78.
- We should all be so lucky.
There's pus.
Pull out more.
Couple more Croatians, I'd really clean house.
- Trocar and pigtail.
- I'll be right back.
Pull the needle out and put the trocar right over the wire.
Hey, Carter.
Do you know anyone in the state department? - Why? - My friend is trying to get a little boy into this country for an operation- Luka, I'm really sorry.
I can't help you with this right now.
- Jerry, have you seen Abby? - Nope.
- Can you find her for me? - Sure.
Hey, Dad, it's me.
No, I didn't get ahold of Mom.
Are you sure that you're gonna make the 5:30 flight? Okay.
No, I'll just leave right from here to come to the airport to pick you up.
No, I'm good.
Yeah, I know.
- I've been looking for you.
- I've been looking for you.
I got a 26-year-old with stridor in severe respiratory distress.
I can't tube him.
- His epiglottis is the size of my fist.
- Nothing's open.
Put him in Three.
Pre-op labs, blood cultures times two, soft tissue lateral to the neck.
Three grams of Unasyn.
Pulse ox is 85.
He's barely moving any air.
I saw this guy for a sore throat.
Romano told me to turf him.
One, two, three.
Needs a surgical airway.
You ever do a crike? - No.
- Well, you're about to.
Prep and drape the neck.
Abby, can you open a Melker kit? - What comes next? - The cricothyroid space.
- Do it.
Can you leave right after this? - Yeah.
I'm ready to go right now.
Angle the needle at 45 degrees.
Because I don't wanna do this alone.
- Do what? - Aspirate air.
Good, you're in.
All the arrangements.
Everything that has to be taken care of.
Guide wire next.
- What are you talking about? - What are you talking about? - Where are you going? - To get Eric.
- What? - Needle out, 11 blade.
He called from a truck stop outside of Des Moines.
- Just enough to pass the introducer.
- Okay.
- When did this happen? - This afternoon.
Oh, and I need you to write me a scrip for Depakote and Zyprexa.
Introducer out.
Okay, bag him.
Sats are coming up.
Nice work, Pratt.
What's wrong? My grandmother died today.
Just didn't wake up from her nap.
Oh, Carter, I'm so sorry.
No one told me.
- Hey, I got it.
- Let's get out of here.
Yeah, she called me, like, for three days.
She was on some new committee.
She wanted me to hear somebody speak about a wetlands learning center.
She knew I hated that stuff.
I think she just wanted to see me.
Well, you spent more time with her than anybody.
Then she called again last night.
And I saw her number on the caller ID.
And I just- I didn't pick it up.
Well, she lived a very full and happy life and you're a big part of that.
She wasn't sick.
She wasn't in pain.
She was in her own bed.
It's not a bad way to go.
And I'll be back tonight.
The flight's only an hour.
Do you have to go? I mean, my dad's flying in.
I gotta do all the funeral arrangements.
I just- I have to go get him.
Why? I mean, Eric's been gone for weeks.
What's one more day? He's off his meds.
And if I don't go now, he might disappear again.
I'll be back tonight.
- John.
- Go.
Go find your brother.
My grandmother will still be dead when you get back.
- What should I tell Dr.
Corday? - That she's welcome.
And the least she can do is admit this patient to Surgical ICU.
Good God, it's the Stepford children.
Where's your handler? He said you'd shepherd us the rest of the shift.
Oh, isn't he generous with my life.
Come on.
Wean him down to 50 percent and check a gas- Would you like to present some cases to the future of medicine? - No, thanks.
- It's not a request.
Okay, listen up.
This is what happens when your chief forces you to clear beds at the cost of proper examination.
Even a sore throat can result in a near mortality.
Now, this particular patient came in complaining of odynophagia.
- It hurts to swallow.
- I checked this guy's throat.
See, posterior pharynx looks benign.
But when pain is out of proportion to exam, one must visualize the epiglottis either with a lateral x-ray or looking down the throat with a fiber-optic scope or a right-angled mirror.
Can't help it if the guy's a wimp.
Epiglottitis is a pediatric illness, junior.
Maybe back in the day.
But we tend to see it in adults now more and more.
If one takes the time to look for it.
- I had to crike this guy.
- Well, good for you.
Don't ever do this.
Get out, now.
Let's go.
Move, now! Move! What's the matter with you? Get out of here.
You just bought yourself a month of midnights.
- Move.
- Good.
I love the nightlife.
Where's your friend? Dr.
Horvat left.
I heard Romano had her doing surgery in the trauma room.
She drained an abscess.
It wasn't a big deal.
Unless there are complications.
I think you may have gotten the wrong impression today in Exam Four - when you were looking for Carter.
- You mean with the flight nurse? Chuck.
And technically we're married.
Oh, so it's technically okay to boff your husband in the hospital? - We weren't boffing.
We were talking.
- Good night, Susan.
It's not the same as a patient's mother.
Hey, at least I used an empty room.
Thank you.
What are you still doing here? I'm picking up my dad at the airport before I go home.
Do you remember any genetic disorders that cause a buildup of ethylene glycol? Not offhand.
But if it's not in Harrison's it probably doesn't exist.
There are hundreds of rare ailments that fall under glycogen storage diseases amino acid disorders, metabolism- Try a Medline search for substances that give you a false positive for ethylene glycol.
Might get lucky.
You went pretty long and hard on that guy earlier.
I figured it was the least I could do.
He was dying.
- If you need to take a couple days- - I'm not on until Saturday.
Good night.
Crash resuscitation means lines, tubes, fluids ASAP.
Like, now.
In a real case, you'd have a minute.
Make a three-centimeter incision in the fifth intercostal space, mid-axillary line.
- What are you doing? - I am teaching.
Give it all you got.
- Stop.
- Aim for the ipsilateral nipple while you keep aspirating.
Somebody broke his ribs doing CPR.
He needs chest tubes and volume for hypotension.
Could've bagged his spleen.
- So do an ultrasound.
- Look, you coded him for 35 minutes.
He's brain dead.
He'll arrest in the next four hours.
No next of kin.
Might as well get the maximum student benefit.
- Run in 500 cc's.
- No, I said stop.
- I'm about to cannulate- - Everybody get out.
This is a patient, not a cadaver lab.
- Look, you need to go home- - Get the hell out of here right now.
I wasn't sure you'd come.
I wasn't sure you'd be here.
What's going on? Traveling.
You know.
Here, there.
Visiting old friends.
Just trying to reconnect and keep in touch.
Not with me.
Not with Maggie.
- You know that guy? - No, do you? Does he look familiar to you? He's been looking at me like he knows me.
- No.
- They all have.
I don't know.
Did you notice when you walked in? This is a weird place, isn't it? - Yeah.
- I'm glad you came.
I don't know this area.
This is a strange part of the country- About ready to get out of here? - I need to pay for my coffee.
- Okay.
I don't have any money.
Don't tell me your HMO doesn't cover somebody to do that for you.
You know what they say, you want something done right Is that why you thought you could perform surgery in the ER? Hey, it worked, didn't it? She's on dopamine and still febrile.
The good news is we haven't had to intubate yet.
She could've died.
I still haven't ruled that out.
It was a good call, Robert.
Unfortunately, the drainage was incomplete.
There were loculations you couldn't reach so I'll have to do an open laparotomy.
Damn shame that you didn't catch it the first time.
Subphrenic abscess is a surgical disease.
They don't see it much here.
Robert, I would've caught it if you'd let me.
And she'd be cooling down on Zosyn before surgery.
Now she's more of a mess than if you'd done nothing.
Did that hurt? No, but I wish it had.
How long's it been like this? - A few days.
- More than a few, I'd guess.
I'm gonna pack the cavity with lodoform gauze.
Is Gunn following this? Gunn, Plastics, Ortho, Hand and ID.
Hyperbarics want me to try them next.
What's after that? Witchcraft? Magnets? I'll try anything at this point.
You know, at some point maybe- What? It's nothing.
Say it.
"When the wound becomes life-threatening because of gangrene or sepsis it may be in the patient's best interest to consider a definitive surgical cure.
" Luka Kovac.
Hey, John, it's me.
I'm at a motel room at the airport because we missed our plane.
And I'm sorry.
I'm trying to get us on the first flight out tomorrow, and I'll try to call you later.
Better? Better.
- Thanks for the clothes.
- Thank Carter.
They're his.
- He also sent this.
- What is it? Depakote.
- This is my life now, isn't it? - It's up to you.
We all thought you were dead, you know.
Except for Mom, of course.
She refused to believe it.
- She know you were coming? - Couldn't get in touch with her.
For all I know, she's missing too.
- It's not funny.
- I know.
It's a little funny.
So, what happens now? We go home.
Well, what about me? I don't wanna live like this.
I can't keep doing this to you.
You have to get into a program.
Will you help me? Don't I always? - Dr.
- It's okay.
- Where's your father? - He took a later flight.
He'll land in a couple hours.
Did my mother call? No.
Emerson was here earlier.
He said you can call him tonight if you'd like.
And Mr.
Garrett called from the funeral home.
He apologized for the delay.
They didn't come yet? They should be here any minute.
Can I get you something to eat? - No, thank you.
- Tea? No, I'm fine.
She was a wonderful woman.
Yes, she was.