ER s10e04 Episode Script

Shifts Happen

E.
R.
Previously on E.
R.
- What do you want? - Foot rub.
I'll settle for coffee.
I'm Gillian.
I was working with Luka and John in the Congo.
- John asked Luka to give you this.
- He wrote me a letter? I think he wanted to try and explain why he stayed.
I don't wanna talk about Carter anymore.
- Then why are you mad? - I'm not mad.
I'm sure you'll find yourself a new bang buddy.
Good night.
You're not her doctor.
You're her nurse.
When I ask you not to do something, don't do it.
I hate my job.
E.
R.
10x04 "SHIFTS HAPPEN" Pardon me.
Excuse me.
- I need a paper.
- We're closed.
Come on, man, show me some love.
Come on.
Old news by now.
- Thanks.
- Excuse me, coming through.
So she's had her bath? Good.
Good.
Yeah, could you put her on for me so I could say good night? Okay, then.
Well, give her a kiss good night for me, then and I shall see you in the morning.
No, I won't work too hard.
Yeah.
Okay, bye.
Everything okay? Yeah.
She's watching Clifford.
You know, everyone's allowed a little downtime.
Even Ella's mother.
You disagree? I don't know.
It's just, sneaking out of the house like this it all feels a little unseemly.
You say unseemly, I say sexy.
- That too.
- Not to mention fun.
- Our shift starts in- - My car's fast.
- You've just had a shower.
- Water's cheap.
You're half dressed.
You're not.
Mr.
Drake in 2 is waiting on a second troponin.
Psych needs to evaluate the woman in 4 who says she's been pregnant for the past seven years.
- Eloise is back? - With the mother of all yeast infections.
I gave her a Fluconazole-Haldol cocktail.
Frequent flier? Logs in more hours than me, which is saying something.
- Have we met? - No.
Damn, is everybody new around here or what? - Fresh out of nursing school.
- Or fresh off the boat.
I haven't seen anything like this since shore leave in Manila.
- Think fast, truant.
- You still here, Weezy? Hell, yeah.
Home sweet home, and right on time, buddy.
No, see, this is mi casa, not su casa.
You're just visiting from white-bread Iowa or wherever.
- It's white-bread Florida, actually.
- Hey, Pratt.
Is there a warfarin-phenobarb interaction? Up the warfarin, you've got increased hepatic metabolism.
Secondly, I'll more than make up for being a few minutes late.
And third, I'm not your buddy.
Hey, Coop.
Cubbies, Friday night, behind home plate, you and me? Hell, yeah.
Suds and dogs - I'm there, daddy.
- Cool.
You two gonna kiss next? Ortho on line one for you.
Well, unless there's a phone in the can, take a message.
Pratt? We have a rectal-mass guy in 2 personally asking for you.
I have a man with urticaria I need to present.
- Give me a minute.
- Can you supervise my pelvic exam? - In a sec.
- What's the dose of IV Reglan? - How many of you newbies are there? - Med students? Lots of us.
- Am I the only second-year here? - I'm sorry.
I didn't see Dr.
Cooper.
I would've asked Dr.
Morris, but- He's stuck with a patient in 2.
The sprained ankle? Damn it, Morris, I have 30 patients on the rack and 40 in Triage.
A little multitasking on your part would be helpful.
You're not doing that clown any favors by picking up his slack.
Okay, not a single chart's been picked up in the past 45 minutes.
- It's called a work ethic, people.
- Since when is Weaver on graveyard? God forbid you take a patient the last hour of your shift.
- You might stay an extra 20 minutes.
- Once a month.
Keeps up her skills.
I worked all day too, you think I'm not tired? Never thought I'd say this, but I kind of miss Little Stumpy.
Pratt, you forgot to sign your Q.
A.
forms last night.
Get me out of here! You wanna grab this first? - I'm off the clock.
- Come on, you heard Weaver.
- Open tibia fracture after a motorcycle- - I never gave permission for this! - You have his films? - Right here.
Name's Mathers, and he's not a happy camper.
- How you doing? - I don't wanna be in this hellhole! - That's how I'm doing! - Saint T's shipped him because- They dumped me because I don't have insurance.
You're here, sir, because you require a higher level of care than they're capable of giving.
I work for a living.
I'm not some County welfare case.
Hey, this look like TV to you? What are you doing? - Get a gram of Ancef and 6 of MS.
- God, I deserve better than this.
No, the best thing for you was coming to County.
You're about to receive Chicago's finest health care.
- Won't anyone help deliver my baby? - Eloise, you've been pregnant for seven years, you can wait 10 more minutes.
All right, listen up, listen up.
We're the A team, people.
You know what that means? That means we have exactly 12 hours to clear this place out and show those quacks at the day shift how it's done! Most people are pleased with its lifelike appearance and attention paid to detail- They should've clipped my nails, then.
With a minimum of motion, your own muscle signals will trigger the arm so that- Yeah, I read the brochure.
Let's go.
To bend the arm, simply contract your biceps.
That's it.
Biceps up, triceps down.
- Biceps up, triceps down.
- They pay you to state the obvious? Okay.
Pausing, as you just did, causes the arm to lock.
How do you unlock it? Well, it requires a quick co-contraction, but that's too advanced for now.
We're not ready to move on to the hand yet.
We don't have to.
How do you put it on? Donning and doffing are complex tasks.
- Harness first, or stump in the socket? - Dr.
Romano, it's late- I want my damn arm, all right? I've waited long enough! Let's go.
Screwy thing is, if I was on welfare, Medicaid would've covered me, right? - Right.
- Now, remember open fractures can lead to gram-negative osteomyelitis which is why we add gentamicin.
- Veins are sclerosed.
- Excuse me.
Ever use IV drugs, Mr.
Mathers? Years ago.
Doesn't mean I should be butchered at County.
You're right.
That's why we're gonna have our best work your central line.
- Neela? - Right.
- Wait.
What is she, 10? - No, almost 16.
Lester, I need you to call Ortho.
Tell them that Dr.
Pratt's patient needs to be in the O.
R no later than three hours from now.
- It was a pleasure working with you, sir.
- Doesn't she need to be supervised? Hey, Mike.
Can you spot this one for me, man? What? I've had to take a whiz since I got here.
Freddie, if you don't get up, you're gonna lose your gurney - and spend the night on the floor.
- But I like a firm mattress.
- What's his blood alcohol? -0.
429, but it smells a lot higher.
He's not going anywhere on his own.
Come on, up you go, Freddie.
- Anybody ever tell you you're beautiful? - All the time.
Come on.
Mag and thiamine, keep him till he's sober and tell Housekeeping there's vomit in the hall.
- I think I'm gonna be sick.
- She new? She's wearing white pants, isn't she? Why, you wanna date her? Hey, hold on, now.
I thought things were good between us.
Cards on the table, no hard feelings.
We talked about this.
Oh, no feelings whatsoever.
Pratt, ready for you to present.
- Okay.
Let me take a leak first.
- No.
Rick Mathers, open tib, on Ancef and gent.
Awaiting Ortho for a washout and ORIF.
He has a history of IVDA, needs a central line.
Better have more than that.
Exam 4, ureteral colic, waiting on a CT urogram, pain-free with Toradol.
- How's his renal function? - BUN, 15.
Creatinine, 1.
1.
Curtain 2, febrile PID, got foxy-doxy.
She's being admitted to GYN.
And in here we've got Betsy Wimbel, 28, exacerbation of Crohn's disease with abdominal pain and diarrhea.
Percocet's not touching her.
- It's cramping again.
- Another 100 of Demerol for Betsy, please.
- Steroids? - Gram of Solu-Medrol.
And I called GI to get her admitted for intractable pain.
- Sounds good.
- Yeah.
- Should be going upstairs any time now.
- Thank you, Dr.
Pratt.
- I appreciate your going to bat for me.
- It's nothing.
Anything for you, Betsy.
- I like your style, man.
- Oh, yeah? Well, get your own.
- Numb it! Numb it! - Hold still, Mr.
Mathers.
We're almost done.
- You aiming for the sternal notch? - Still no flash.
All right, you're too inferior.
Aim more cephalad.
- She has to avoid the subclavian artery.
- I know, I know.
- God! - Here, let me try it.
- No.
- Are you following the landmarks? - Yes.
- Oh, God! - What's going on in here? - They're stabbing me to death here! - Four attempts at a central line.
- Here, I'll take that.
What, a Chink now? What is this, the damn U.
N.
? You aim above and posterior to the index finger in the sternal notch.
Hello.
- God! - I thought I was.
Advancing got a flash.
Guide wire.
I'm more comfortable with the IJ approach.
Well, you need to learn them both.
All right, I'm in.
Thank God somebody here knows what they're doing.
Gallant, can you sew it in for me? - I was off an hour ago.
- Me too.
- She hates me, doesn't she? - Who, Dr.
Chen? She thinks I'm interested in her boyfriend, but I'm not.
- Should I talk to her? - I would leave it alone.
- They broke up.
- She and Dr.
Pratt? When? Last week.
Let go of my sleeve, Freddie.
- But I love you.
- Dr.
Chen? Let's see if you feel that way in the morning.
- Another 2 of lorazepam.
- Do you have a moment? Actually, I'm on my way out.
Put Freddie in Curtain 2 and give him to Dr.
Morris, wherever he is.
Thank you.
We got off on the wrong foot, and I'd very much like to remedy that.
What? Dr.
Pratt's a bit of a flirt, of which I'm sure you're well aware but I want you to know, I did nothing to bring it on.
In fact, I think he rather can't help himself.
But if I did anything to worsen the situation, I apologize.
And I hope you wouldn't penalize me over something which I had no control.
- Penalize you? - Be hard on me.
Show me up in front of the others.
Look Neela.
I'm hard on all my med students, especially the women because I have to be, for their own good.
If I were you, I'd worry more about my skills and less about Dr.
Pratt.
All right, Mr.
Costan's discharged.
Mrs.
Provost, admitted to Cards.
Lemony Jones is AMA.
And don't bother me unless you've got some money for me, please.
- Who's got bigmouth Freddie? - Chen assigned him to Morris.
Yeah, well, he's mine now.
- Keep pushing Ativan till he shuts up.
- Yeah, right.
- One more patient.
- No, not now.
Later.
You won't even have to go very far.
He's right over here.
His name is- Hey, stop.
Okay? Just stop.
Betsy, nobody's been in to see you yet? - No.
Is it gonna be much longer? - Let me get on the horn to Gl and tell them my girl's tired of waiting on her consult, okay? - Can I talk now? - Yeah, go ahead.
Ed Gamble, 28, developed an expressive aphasia while fighting with his wife.
Stopped talking mid-sentence.
It was all very dramatic.
- I can talk now.
- Have you had a full neuro exam? No, but my husband passed the idiot test with flying colors.
Excuse me.
What's up? Weaver knows, but just in case, dislocated shoulder check post-reduction film.
Pancreatitis, 30 grams of morphine.
Make sure he's breathing.
I'm gone unless you need me to stay.
- Why would I need that? - It's crazy busy and only one Attending - on the floor? - No, I got it this.
- I was hoping you'd say that.
- For you.
Morris is MIA.
He's got an LOL waiting on a pelvic for over 14 hours.
- You leaving? - Yeah, finally.
chronic emphysema, on home O2.
Told her granddaughter she couldn't breathe, kid called 911.
- Ma'am, what's your name? - Winnie Crawford.
- She's not moving air.
- Let's get Miss Crawford into Trauma 1.
- Abby? - My shift's over.
You.
You wanna be a doctor? Move it! By the way, your loan's not going to go through.
Not with a FICO of 428.
They gave you my credit rating? I saw the application on the fax.
Couldn't lease a moped with a score that low.
Get her on 100 percent non-rebreather.
- Is Grandma okay? - We're trying to help her.
Hang a liter of saline.
We have an IV yet? She doesn't like hospitals.
Working on it.
Pressure's 86/52.
- Don't do that! - I need a 7-0 tube and a Mack 3.
- Stop it! - Somebody get her into the family room.
She wouldn't like it.
She's DNR! - What did you say? - Sweetie do you know what DNR means? She doesn't wanna be naked.
Hypoxic on 15 liters, respiratory failure.
We have to tube her.
Not if she's DNR.
The child wouldn't know the term unless it'd been discussed.
Doesn't matter.
Without documentation, we resuscitate.
Put her on a vent, she'll never come off.
Morphine and oxygen till we know.
Erika, do you know where your parents are? My mom's out with her boyfriend.
Okay, take her to the family room.
Get a number for the mom.
Come with me, all right? Okay, shut your eyes and don't let me open them.
You think it's bad? - I asked for a divorce - You didn't ask.
and he starts with the mute act, a childish variation on his cold-shoulder act.
- Sorry to interrupt.
- Excuse me.
Intubated benzo overdose, waiting for an ICU bed.
Radiator-fluid burn needs Thermazene dressing.
Incised thrombosed hemorrhoid needs to go home for sitz bath.
- Why you telling me? Those are Morris'.
- I cannot find him.
- Plus, I'm late for dinner.
- Give it to me.
Thank you.
Have a good night.
- Yeah.
- He's doing it again.
- He's doing what? - Not talking.
Look, obviously this is Ed's way of keeping me hooked.
That, or he's really lost it.
Either way, he needs help.
- Okay.
- Thank you.
Hey, I need you to do me a favor.
I need you to call Psych for a consult on Mr.
Gamble.
- Yes, doctor.
- Dr.
Pratt - I have a patient who was bit by a rat.
- Come on.
Should I send off for a CBC? For what, rabies? - Nurse.
Come on.
- That woman blew her nose on my smock.
Maybe she's not a Tweety fan.
I need you to update his tetanus, and I need you to test his flexor tendons.
No, don't test me, man, just test the rat.
This is not what I went to nursing school for.
I quit.
Irrigate, put him on Keflex and chuck that rat in the bio bin.
- I've still gotta take a piss.
- I've got a lady with dysmenorrhea.
Here, take that.
If it's obstruction, what would the diameter be? So then over 10 millimeters, then I should call Surgery? Son of a bitch.
- Hang up! - What? You're a second-year Resident, not a med student.
You can't be calling your mother, father, your cousin who's a podiatrist to help get you through a shift.
Now, get on the floor and do your damn job! And for God's sake, light a match or something.
- Hi.
- Hey.
Figured I owed you a visit.
And Gillian invited me for dinner.
It's 10:00.
I didn't think you'd take me up on it.
Sorry, I can't stay but there's still some Thai left in the fridge if you want.
See you in a couple months.
- Thanks.
- Okay.
- Need any help with that? - No, no, I'm good.
Bye, Abby.
- Where's she going? - Back to Montreal.
Her boyfriend's been bugging her to go back home.
- I thought you two were- - It's complicated.
This guy Mathers is approaching the six-hour mark.
He needs a washout in the O.
R.
, or he'll get some serious osteo- Well, we're a little busy down here too.
Dumb- Your acute abdomen is acutely constipated.
- Give him an enema and some Colace.
- How did I know you'd say that? You know you shouldn't have called me down.
Hey, I got a board to clear.
Look, put a fresh saline dressing - on my open-fracture guy, would you? - Yes, doctor.
- You do speak English, right? - Yes, doctor.
Looks like we're making progress.
Only 30 on the board.
And 50 in Triage.
Guess we better fuel up.
Feel like making a burger run? My treat.
- Cafeteria's closed.
- McDonald's isn't.
You got feet.
- Excuse me, doctor.
- I see you're talking again.
It sort of comes and goes.
Were you able to determine anything? No, not yet, but we got a special doctor coming to see you.
So you better get into bed before you miss him.
- You think it's stress? - I don't know.
You pull me out of a movie for Betsy Wimbel? - Is there a problem? - She's in here three times a month and still manages to squeeze Demerol out of Residents like you - who don't pull her old charts.
- That's all fine and dandy but she's got real disease, guaiac-positive stool and intractable pain.
She's a manipulative drug-seeker.
We don't support her habit.
So examine her, put a note in her chart stating that you won't admit.
Bump her steroids, give her a few Vicodin and do not call me again.
I'm just asking you to take care of your patient.
Actually, she's your patient now.
Hey, Lester.
Medicate and discharge my Crohn's patient.
Tell her you're sorry, but she won't be admitted.
You seem to be getting your strength back.
I couldn't run a four-minute mile, but I'm doing okay.
Still a little anemic.
Are you glad to be home? Yes and no.
I miss it.
You're not in your own head all the time.
You're a part of something that's in constant motion over there.
Any break from it you get is a luxury not just something to be taken for granted.
And that's different from County how? It's its own addiction, I guess.
- Yeah, it certainly hooked Carter.
- Yeah.
How are you doing with that? Without him, you mean? I'm fine.
I'm better than fine.
So you're happy? Getting there.
- I made a few decisions.
- Like what? I don't wanna jinx myself.
- Work wants me back.
- Tonight? Pretend you didn't get a page.
I need the money.
See you soon, then? Yeah.
Good night.
Corina Wybel is waiting on amylase and Mathers is still in Sutures.
He didn't go up to surgery yet? - Hey, I thought you left.
- What can I say the attrition rate for nurses here sucks.
Tweety girl? Yeah, writing was on the wall for that one.
- It's a drag you got called back in.
- Not really.
Double overtime.
How's it going? - Are you talking to me? - Yeah.
Fine.
Glad to hear it.
You're one of the best nurses on the floor.
With all the changes that Robert's been making, I'd hate to lose you.
- Thanks.
- Abby, do you know where I can find - paper and crayons for a little girl? - Is she a patient? - No, but- - Your evaluation as a med student revolves around how many patients you can carry not how many children you can babysit.
Take a cue from some of your colleagues and get busy.
The wrist film's negative.
ACE wrap and he's out of here with R.
I.
C.
E.
- Got it.
- Scombroid patient had 2 liters tolerating p.
o.
's, discharge with a clear liquid diet.
Threatened A.
B.
is Rh-positive.
Send her home with pelvic rest.
No intercourse, no tampons, no douching.
Thanks.
Morris, why do I have a board full of nasty and you're studying radiology? Damian here came in with wheezing.
He's got a quarter in his upper esophagus.
So, what's your point? - I'm thinking it'll just pass.
- In my poop? So that's it, we just wait till it comes out? No, being that he's symptomatic, we call in a specialist - who can take it out with an endoscope.
- Is that an operation? - No cutting involved.
- Who's the Gl consult on call? Hampton, a very special friend of mine.
You page her.
- Pratt! - Pulse ox 98 on 2 liters.
Street-racing MVA, first of three.
Sicker ones coming in behind.
- Witness said the car rolled three times.
- It was at least four.
Excuse me.
Janie Timmons, 16, restrained but loose after rolls.
- Unknown LOC.
GCS, 234.
- Janie, can you hear me? - CSF out the ears.
- And blood in the airway.
Page Neurosurg and Trauma.
Bet you she's got a bleed in her brain.
Wait a minute.
Where we going? What's open? Nothing.
End-stage emphysema in 1, a possible DNR.
- Possible? Let's go.
- Yeah.
Look out! - Triple MVA, we need this room.
- She needs a monitored bed.
- Not if she's DNR.
- We're waiting for confirmation.
She's got end-stage emphysema.
Consider it confirmed.
Come on, let's go.
- Excuse me.
- Let's go.
Come on, come on.
Out, out.
His '64 Mustang lost out to a Z28.
Good vitals, unknown LOC, chest abrasion, closed fracture of the humerus.
- It's a classic.
People always challenge.
- We'll get a C-spine in CT.
- But he needs a chest and AP pelvis.
- That'll take a while.
Okay, if CT opens first, we'll have to send him there.
- You wanna go when he does? - I can't.
I'm the only Attending and Pratt's the senior on the floor.
Abby, you go.
It's my fault.
They're young.
They're allowed to be stupid.
No one's allowed to be that stupid, Mr.
Vangoss.
I got bone sticking out of my legs! Six Flags, only better.
Cranial nerves grossly intact.
I have been here six hours! Somebody needs to shut him up.
- Clinically clear.
- It was like a total G-force, you know? - Good breath sounds.
- Hey, where's Janie? - Yeah, you're just now asking? - The belly's tender.
- Take the rectal.
- What? Needs someone to find out about his girlfriend, doesn't he? You're going up my butt? Just one finger.
Multiple lacs, scalp and occiput.
Pratt, your guy in Sutures is having a meltdown.
Later.
- Skull fracture with a step-off.
- Sats are down to 90.
Threatening to sue everybody and their brother.
Mostly you.
She's blowing some teeth.
- Hey, where the hell are you going? - Bathroom.
Sats, 88.
Eighty-six.
Eighty-five.
Eighty-three All right, after I secure the airway chest tube and subclavian on the right.
Psych won't see your aphasia patient unless you clear a head CT first.
The guy's freaking out because his wife's leaving.
He doesn't need a head CT.
Okay, give me the tube.
Okay.
Pulse is down to 65.
You better kick it.
Pratt, Hampton called from Gl.
She's not gonna see the quarter kid till morning - but she plans on seeing Romano first.
- I'm in.
Is that all she said? No, actually, she said you're an asshole too.
Night.
Wow, it's 1 in the morning.
I guess it's lunchtime.
- You gotta try this.
- Sure.
What is it? - Dinuguan.
- Oh, yeah? What's that? Cooked pork blood.
Did I ever mention I was half Jewish? Hey, Randi.
I'm still waiting on Ortho for my open-fracture guy.
- As soon as they call, tell them- - They said you should irrigate him.
- They're kind of busy right now.
- Nice.
Neela, find Morris and have him supervise you on doing a poor man's washout on Mr.
Mathers.
- Any idea where he is? - No, but that's an MSP: Med student problem.
I love being an R2.
So, what do you think? - I think it's a little loud.
- If I to stay up, everybody does.
No, he hasn't gone to Radiology yet.
That's the problem.
High-speed MVA, blunt trauma.
He really needs a belly CT.
Can't you just sneak us in? Thank you.
Okay, Mr.
Vangoss, we're going up to the CT room.
I was 17 when that song first came out.
- You probably weren't even born yet.
- Oh, I was around.
- Hi.
- Hi.
Elizabeth.
Hold the door.
We're full, I'm afraid.
Well, I'll catch the next one.
He's cute.
- Did you guys ever get together? - Who? Dorset.
Didn't he ask you out or something? I suppose you could say we're dating.
Really.
What? - What? - What? You think it's too soon? I didn't say that.
I think it's too soon.
- I just said he was cute.
- Yeah.
Too soon.
You're not too good at this, are you? It should start to feel numb soon.
- What the hell is that stuff? - Sterile saline, washes the germs out.
And you're just now getting around to this? We thought you'd be in the O.
R.
by now.
This will buy us an extra hour or two.
- Before what? - Neela, what do you think you're doing? - Temporary washout.
- Which is not a procedure a med student performs without Resident supervision.
Great, she's not even a doctor? Stop what you're doing and tell me who the Resident is on this case.
Dr.
Pratt, but he asked Dr.
Morris to supervise on his behalf.
And where's Dr.
Morris? I'm surrounded by incompetence.
Hey, how do you think I feel? This one's been trying to kill me all night.
No mass, no hemorrhage, normal ventricles, no shift.
- So he's clear? - Crystal.
Hey, Mr.
Gamble, your head CT looks good.
- Everything's fine.
- So, what do I do now? I've arranged for you to speak with one of our mental-health specialists.
- I'm not crazy.
- No, you're not.
You're just stressed- Then give me something for that, but don't send me to a shrink.
God, the last thing I need is for Gloria to have proof I'm nuts.
Pratt, dislocated patella.
COPD exacerbation.
I&D on a pilonidal cyst.
And don't pass these off on that idiot Morris.
- I know you think I'm a wuss- - Mr.
Gamble, I don't have time- Just give me something to get me through the night.
Hey, I want you to give Ed here - and discharge him.
- Obecalp? You know what obecalp is? Yes, doctor.
Thank you.
- Thank you very much.
- Yeah.
Whatever works, right? Erika.
What does DNR mean? It stands for "do not resuscitate.
" Which means someone doesn't want to be kept alive by machines if they should get very sick.
Let's get you back to the other room where you can rest.
Can I stay here? She says she sleeps better with me.
Sure.
- Good night.
- Night.
I'm glad you have time for a Kodak moment.
I know I sure as hell don't.
We still got 20 on the board and 35 in Triage.
Sorry.
She's by herself here.
It's hard, isn't it? Learning where your time is best spent whether it's with the patient or their family.
You know, that's really rough.
Now, if you're done playing house, do an I&D on Mr.
Brier's pilonidal cyst.
Hey, hey.
He's tough, but he's got the goods, you know? Yeah.
Hey, have you ever heard of obecalp? Because I can't find it in the PDR.
It's "placebo" spelled backwards.
Who's prescribing it? Dr.
Pratt.
Obecalp? Look, the guy's playing games with his wife.
He gets panicky whenever I mention Psych and he begs me to give him something to calm his nerves.
So I give him saline.
And it looks like he feels a lot better.
No harm, no foul.
Ever hear of truth-telling? Deceptive practices? Not only have you breached every principle of medical ethics you've also opened us up to a lawsuit if this patient finds out.
Dr.
Weaver, your MVA guy is crashing in CT.
Damn it.
Severa, I guess we better pull the plug on Mr.
Gamble's obecalp.
I never gave it to him.
Doctor, how long before my son is taken care of? - Your son? - Damian, the quarter? Right, right.
Well, it looks like the Gl doctor who performs the procedure won't be able to see him till the morning.
- When in the morning? - I'm not sure.
But he's stable, and I don't see a problem.
We've been here for 14 hours.
No one's done a damn thing.
Damian's scared to death.
She needs to get to bed.
We all do.
- I know it's hard- - This is an emergency room.
There's a quarter in my son's throat.
He can't breathe.
That's an emergency, isn't it? What happened? He got altered and his sats drifted down.
- Did you finish the scan? - No.
- How long has he been down? - Under five minutes.
- Let's tube him.
- Pulmonary edema? More than likely.
Okay, stop compressions.
- Still no pulse.
- Never, never send an even slightly unstable patient to CT without a doctor.
- You told me to bring him- - I'm talking to me.
I'm in.
You coming? Pratt's trying the old Foley trick.
- What? - Yeah, that's what's so cool.
- Okay, Foley and a 2 Mack blade.
- All right, sats is 96, BP steady.
All right, come on.
Okay, so now what we wanna do is put this tube just past the quarter.
And once we do that we're gonna blow up the little balloon with saline and hopefully pull the quarter back into his mouth.
Couldn't he aspirate the quarter into his lungs? Not if I grab it first.
Now, here's the tricky part.
Okay.
And Presto.
Dr.
Pratt.
Here.
One for the piggy bank.
Oh, Abby, you're back.
Can you cover for Melinda in Triage? Sure.
Love to.
Triage is my personal favorite.
Thanks for asking.
Where's Weaver? The bars are closing.
We're gonna get slammed.
She's still in CT, which means the R2s are in charge, and that scares me.
You and me, man.
All right, let's get the party started.
You, come on.
Come show me some love.
Come here.
Please tell me it's not just 3.
Shut the hell up! How's anybody supposed to sleep around here?! Yo, Abby, any time now.
- Okay, where we at? - Now serving number 47.
- This is Jay Jay.
He has a toothache.
- Thank you.
- Hey, Jay Jay, how you feeling? - Tooth hurts.
When did you first notice it? About a year ago.
- Excuse me.
- Have a seat.
I'll be right with you.
No, we've already been seen.
My son was feeling a little queasy.
It might just be the anesthesia, but could you get Dr.
Pratt to maybe-? - Oh, my God.
- Pratt.
Pratt! - Damian? - Here, help me lie him down.
- What did he come in for? - He swallowed a quarter.
Blood looks arterial.
- Page Surgery and Vascular.
- Aorto-esophageal fistula? - Pratt, I need you at Curtain 1.
- Not now.
Get a gurney.
- Watch your back.
- What's going on? Probable aorto-esophageal fistula after a foreign-body removal.
- You did endoscopy? - I used a Foley.
- Are you out of your mind? - It worked fine.
The quarter was in there too long.
After he was discharged, this happened.
- We'll take it from here.
- Trans-esophageal erosion needs immediate aortic repair.
Not all ER Residents can walk on water.
You're lucky this happened while they were still here otherwise this boy would be dead.
Add five of PEEP once he's on a vent.
Andy, what did the NG aspirate show on Maloney? - Hey, Pratt.
- Let me find out.
- Pratt! - Lungs clear.
- Let's get some O2 and check a D-stick.
- Watch it.
Syncopal episode? Only groans with a sternal rub.
We were ready to go, then he slumped to the floor.
Let's get him on the bed.
One, two, three, up.
All right, put him on a monitor and get me some vitals.
- I'm on it.
- I thought he was kidding.
Pupils asymmetric, mild ptosis.
He was fine other than being a nut case.
Young, healthy guy with transient loss of speech.
SonoSite.
And a negative CT.
Turn that damn music off! Listen, man, I got this.
It's okay.
- Any risk factors for stroke? - No.
Decreased tone on the right.
- Oh, my God, he had a stroke? - Call CT.
Have them clear a room.
- I think I have something here.
- This is my patient.
- It might be a carotid dissection.
- Let me see that.
- Tapering occlusion of the left carotid.
- What is that? Your husband has a tear in one of his main arteries, it caused a clot.
Your open-fracture patient demands to be euthanized.
- Mr.
Mathers is still here? - I got your back on this.
Get consent for TPA, 0.
9 migs per kig.
Okay, that's enough of Triage.
Let it be someone else's turn for a change.
- And I know you're talking about me.
- Hey, Abby, is Exam 2 open? I'm on a break.
Hi, I'd like to find out if I qualify for a cash advance.
Sorry, I have to go.
- Neela.
- Yeah? Grandma's dead.
Little girl's sleeping.
We need the bed.
Hey, how you doing? Sleepy.
Morphine's kicked in.
That and it's 4:30 in the morning.
Am I gonna lose this thing or what? My leg.
No.
Because I'm not the kind of guy who can get along without it.
I work for a living, you know.
Look, I know I've said it before but we're gonna get you in the O.
R.
real soon.
That's what I hear.
- Get Coop to cover for me.
- Where are you going? To do something that should've been done hours ago.
Starts screaming right in the middle of the course.
Wonder what he would've done if he were four over par.
Hey.
How you guys doing? Dr.
Pratt from the ER.
Size 81/2 gloves, please.
- What are you doing? - Holding your retractors.
Reamer to me.
Drill for the cup screws.
Been calling you guys for hours on that open tibia fracture.
Well, now that I'm here to help, you can free somebody up for the consult.
Just show me where to pull.
It's all right.
Hello? Hi.
Is Richard here? Honey, your ex-wife is here.
- How old now? - Fourteen months.
What do you want? I need a favor.
- Abby, it's 8:00 in the morning.
- Yeah, I know.
I don't have a lot of time.
I need you to cosign a loan.
- Why don't you just declare bankruptcy? - Look, I'm not in trouble, okay? - I just need you- - Want me to support you? No.
I never asked for alimony.
I didn't contest anything in court.
- I didn't even take the damn furniture.
- You could have.
You must know how much I hate doing this.
I wouldn't do it unless it was absolutely necessary.
I don't want your money.
I just want your signature.
- Oh, good morning.
- Yeah, hi.
I just got in, and already I've heard from the Ortho, Psych and Gl departments not to mention Dr.
Weaver about your medical high jinks.
The carotid clot was a total zebra, Ortho was taking their time and Hampton refused to get down here for a- You are a screwup, Pratt.
And just to be clear, I didn't like you before I knew that.
Kenyan roast.
Can't beat it for flavor or punch.
Triple espresso, yes, I can.
Hey, your septic pancreatitis is still waiting on an ICU bed.
- Thanks.
How'd it go? - Good.
- Hey.
- Hey.
- How's the quarter kid? - Corday said he's gonna be fine.
Hey, Coop.
I heard you caught a carotid dissection.
Nice.
Thanks, man.
Did rotation with the stroke team in June.
Anybody could've missed it.
Yeah, well, started Mr.
Gamble on anticoagulants - tear should heal on its own.
- And he keeps talking.
- You headed home? - Yeah, why, you're not? I'm gonna hit the gym first.
Hey, Coop.
- Thanks, man.
- Yeah, sure.
Anything for a buddy.