ER s10e12 Episode Script


Previously on E.
- And welcome back.
- How have you been? - Good.
- I'm back in med school.
- Really? I know I'm supposed to feel like I wanna carry a baby.
But I don't.
Once that baby's inside of you, it's- I mean, it's incredible.
- I mean, it's- - Kerry, I don't want it.
Abby, would you be interested in studying together some time? - Sorry? - I'm good at the academic stuff.
But you're good with everything else.
Maybe we could help each other.
10x12 "NICU" Four-day-old full-term male.
Mottled, lethargic, retractions.
- NICU been called? - They’re on the way.
Pratt's intubating.
- Suction.
Tube's too big.
Give me the 3-0.
- I'm Dr.
What's his name? Jacob.
It won't advance.
Sats are good, try again.
Anatomy's distorted.
Here, go for it.
- Just brought him home.
- He started gasping while I was feeding him.
Okay, Pratt, bag him.
- Equal breath sounds.
-200 of cefotax for presumed sepsis.
- Where the hell is NICU? - Is he gonna be okay? We’re taking care of him.
Systolic murmur, weak femoral pulses, distress while feeding.
- What's your diagnosis? - Ductal-dependent cardiac lesion.
Matt Gillespie, R3, Pediatrics.
Sam, PGE infusion at.
05 mics, quickly.
Oh, doing your NICU rotation, huh? Just when I was used to my double life in the ER.
What's happening? - We think Jacob has a heart problem.
- You think? ABG's back, metabolic acidosis, minus 18.
What does that mean? It means his body's not getting enough oxygen but the breathing tube should help.
Sam, 10 of bicarb, 50 of saline.
I only have two hands and he only has one line.
- Abby, bag him.
- Tell Cards to meet us in the NICU.
- Start the Prostins on the way.
- We'll take it.
- We don't need help.
- If he starts crashing - you'll need extra hands.
- Push this.
It can be difficult to diagnose congenital heart disease.
His doctor saw him yesterday.
She missed this? Sometimes symptoms don't present right away.
- How serious is this? - We don't know yet.
Cards will meet us just in case.
- In case of what? - Cardiology will talk to you.
I want to know what's going on.
- It's possible he may need a septostomy.
- What? A what? - Everybody off the elevator.
Out! - I can explain everything to you.
- Mean's down to 34.
- He needs pressors.
Aeration's good, sats are 93.
He's in very good hands.
Back off the FIO2.
We don't want to flood the lungs.
He'll be okay once he's got the Prostins.
- When'd you two start your rotation? - Five minutes ago.
Well, the NICU's great: intubations, chest tubes, umbilical lines.
You'll get to do all sorts of teeny, tiny, kick-ass procedures.
Cards is waiting and Raab is pissed.
You trying to give him a pneumo? - Good luck.
- You’re gonna love it.
- Let's get out of here.
- I hate the NICU.
Those guys are screwed.
Humphrey Fowler, ex-33-weeker, day of life: 58.
Status: post-RDS, on vanco for MRSA, day 19 of 21.
- Who names their kid Humphrey? - It's the last one.
- Post-op, day 46 for CCAM repair.
- CCAM? Congenital cystic adenomatoid malformation.
Was on the oscillator, weaning the map and amp.
Born with one lung.
Other than that, he's great.
- Okay.
- You didn't keep flow sheets, index cards? - It's all up in here.
- Tell me you’re joking.
You don't need any paperwork for this kid.
Bad hypoxic encephalopathy.
His brain's mush.
But his vitals are good.
He can go on indefinitely.
- Family won't withdraw support? - Two months and about $2 million later Mom's still holding out for a miracle.
They’re here every day.
He's a paperweight.
There's nothing to do.
Come on, they’re waiting for us.
Thank you so much for joining us.
I'm Dr.
Raab, director of Neonatology.
We round twice a day, 7 and 4.
You will come ready to present overnight data and exams on your patients.
Everyone scrubs for a full three minutes before you enter the NICU.
No jewelry on the hands, spreads bacteria.
- Not even my wedding band? - No, and cut your fingernails.
In 1993, two children were abducted from this unit.
Explains the little LoJacks around their ankles.
You will be issued a code for this door.
- Do not give your code to anyone.
- I tattooed mine on my scrotum.
No one will ever see it there.
Gillespie, back already? Another month in the box.
Your standup routine might go over on other rotations but the NICU is a tough room.
- Who do we have here? - Lloyd Roberts, ex-38-weeker - admitted for TTN and detox.
- What's TTN? Transient tachypnea of the newborn results from delayed clearance of fetal lung fluid.
Continue, Kate.
Born to 23-year-old G4P4 mom who used meth and heroin during pregnancy.
Do we need to keep our voices down? Confidentiality doesn't exist here.
The quieter we talk, the harder they listen.
- Kate, your plan? - DC the O2, continue amp and gent advance the feeds, morphine taper.
- Did you name him yet? - Everyone, meet Virgie.
Twenty-years-plus as a NICU nurse.
Her mission: to protect the babies from the likes of you.
Haven't had a Thor in a while.
We have a tradition of giving the babies tough-guy nicknames.
Hard to fight with a name like Lloyd.
Latest gas on Jacob Kolber.
Acidosis is worse.
What was the final read on the echo? Come on, people, who picked him up? Lockhart, he's yours.
Examine your patient.
Cardiology confirmed a critical coarct.
- Which is? - A narrowing of the aorta usually at the ductus arteriosus.
- And why do we care? - Because blood can't get to the lower half of the body.
Why is that bad? His legs need blood.
If you don't know, don't guess.
Decreased perfusion means acidosis shock and heart failure.
His means have been drifting down.
Lungs are wet.
I can barely palpate the femorals.
Ten of bicarb, start dopa at 12, crank up the Prostins to 0.
- He needs the O.
- The cardiologist said to try medicine first.
- Medicine isn't working.
- CT Surg said they'll - get to him in the next 48 hours.
- This boy can't wait 48 hours.
If not to the O.
, they can take him to the cath lab for dilation and stenting.
- Stenting? - Another way to open a blockage.
- Blocked? You said it was too narrow.
- So narrow, blood isn't getting through.
Tom, send off LFTs and creatinine.
Check for end-organ damage.
You got it.
I want to talk to that cardiologist again, all right? Mr.
and Mrs.
Kolber, Jacob is very sick but all this is really a plumbing problem.
Nothing that a CT surgeon can't fix.
- Surgery will cure him? - It should, yes.
Lockhart, he needs a nickname.
How about Jake? Sounds tough to me.
Jacob to Jake.
Very creative.
Thin mec, Delivery Room 3.
What are you waiting for? Go.
Fifty cc saline bolus.
Push it, Tom.
Lockhart, what are you waiting for? Go.
You could learn something.
I'd like to stay here, if that's okay.
Covering deliveries is part of your job.
Tom, we need another i-STAT to see where we are.
- Dr.
Raab- - And he needs a Foley and another PIV.
I can do that.
He's my patient.
Get CT Surg on the phone and tell them your patient needs the O.
right now.
Not in 48 hours - not sometime today, now.
- I'll be right back.
So when the DR phone rings we drop everything and run? Yep, 24/7.
It means some potentially sick-ass baby's being born.
- Kid ends up fine, but you never know.
- Can I do the intubation? If it's indicated.
Oh, you like this stuff.
- The technology's fascinating.
- What's wrong with us? We should be in the easy, lucrative specialties: Derm, Radiology.
Okay, little gunner, welcome to your very first delivery.
Matt, just in time.
Six weeks early, no prenatal care.
- You have a boy.
- First get rid of the gunk.
And dry him like crazy.
Warms the baby up and reminds him to breathe.
- Good pulse but the cry's weak.
- It's all about ventilation.
- Get them to breathe, the rest follows.
- Decel down to the 20s.
- Got it.
One more big push.
- Hand me the bag.
- You can do better than that.
Wake up.
- Matt.
- Head's out, here we go.
- We were visiting my cousin.
- Baby come too soon.
- Don't worry.
Just needs help getting started.
- Thirty-two-weekers usually do fine.
- Matt, it's twins.
Dude, thanks for the heads-up.
We would have brought down a second team.
Neela, second setup.
You know what to do.
Okay, buddy, you just bought yourself a tube.
Call the NICU for backup.
It's a girl.
This baby's not breathing.
A NICU admission is like running a marathon without training.
It's an endurance test for patients, for families, and for you.
Eat when you can, sleep when you can, and when it's time to go home get the hell out of here.
Let's round.
Jiang Han's up to 1830 grams.
Room air, q.
3 feeds.
Feeder and grower, behaving himself nicely.
Inga's ABG.
Sister's a mess.
Inga? - Inga? - You had to come up with nicknames and you failed to.
Dirk and Inga.
I was going to call her Surinder.
It's Punjabi for "warrior.
" - You're thinking too much.
- Inga doesn't sound tough.
Neela, present your patient.
Her pneumonia is worse.
Ventilation's crap.
Pa02 in the 40s all day.
I think we should consider ECMO.
Cardiopulmonary bypass? Isn't that incredibly dangerous on a 2-kilo kid? We need to do something before the prolonged hypoxia causes brain damage.
- Who can tell me the risk of ECMO? - Overwhelming infection.
Could happen anyway, ECMO or not.
- Head bleed.
- Parents could end up with a little potato.
- We'll get daily head ultrasounds.
- Won't prevent a bleed - just detect it after.
- She was well till she became bacteremic.
It's risky, but ECMO could get her through.
She's not getting enough oxygen.
- If we do nothing, she'll die.
- Are you sure? How can anyone be sure about something like that? Neela, call the profusion team to start ECMO.
Rounds are over.
She already thinks I'm an idiot, so there's really nothing to lose.
I have your sign-out.
You should get out of here.
I need to talk to Inga's parents about ECMO.
I'm gonna be here all night anyway.
I'll talk to them.
I'll do it.
- Did you change Rocky's diaper? - Yeah.
- Why did you do that? - Because it was dirty.
My ins and outs are all off now.
All right.
I'm sorry.
Not good enough.
Go find it.
- It's in the trash.
- Find it, weigh it, and I might let you get some sleep tonight.
and Mrs.
Do you have the results back on the cardiac cath? Cards will talk to you as soon as they have an official report.
I've been waiting.
I'll take an unofficial report.
I'll ask Abby if she's heard.
- I need to talk to you.
- Waiting's driving me crazy.
The waiting is hard.
You know how long it takes to recover from something like this? - A rough estimate? - It's too soon to say.
Would you two come with me? How long you been here? Eight days.
We were visiting from Suzhou in China when the babies come.
Are they doing okay? - Our son is very strong.
- Mr.
Tseng? ECMO stands for Extracorporeal Membrane Oxygenation.
- Ready for circuit.
- The machine puts oxygen in the blood and sends it back to Inga's body.
- It does the work of her heart and lungs.
- Let's go.
I'm clamped on high.
I know it looks scary, but it's her best chance.
- Chance of what? - A good outcome.
She be healthy? - I hope so.
- Chow time for Dirk.
One of you want to feed him? - I go.
- I've got control down low.
- Releasing arterial.
- Releasing venous.
Clamping bridge.
ECMO on, 20-25.
It'll be a while before we know how she's going to respond.
I'll let you know.
If she was born in China, she'd already be dead.
You don't know that.
My husband and I are lucky.
We went to school, we have jobs as teachers.
But it's not like here.
We wanted our daughter to be born in America so she'd have more options.
And she already does.
We don't have hospitals like this.
It wasn't an accident, then.
You meant to deliver here.
We sold everything to come stay with my aunt have the babies in Chicago.
You're just going to start over, with nothing? Her life will be better.
Isn't that why your parents sent you to this country too? - Tom, can you help me out? - Not now.
Gotta hang vanco.
Transducers, art lines, no butterflies.
They're in the cabinet by the sinks on the left.
Been here for nine weeks.
- Hi.
- Hi.
Just came to check on Jacob.
He looks great.
His suck is still weak, but Abby tells me to keep trying.
- He'll get there.
- You keep trying.
It says here that he may need surgery again in a few years.
Is that true? That sounds like a question for Cardiology.
Occasionally the area where the aorta was repaired gets blocked from scarring but usually they can take care of it and avoid another surgery.
That's good to know.
Thanks, Abby.
I better get back to work.
But I'll be by later.
It was nice to see you, Mrs.
Looks like you're doing well here.
- Right.
- Abby, take a look at the CO2.
- Back off on the rate, check it in an hour.
- You got it.
Parents love you.
Nurses wouldn't give you the time of day - unless you knew what you were doing.
- Yeah? Tell that to my Attending.
You should see me on rounds.
So Kem and I had our first official tour of the labor and delivery suites today.
How can you call one room a suite? They're counting the bathroom.
- You're gonna be a dad.
- Yeah.
- How's it feel? - Scary.
Especially in this room.
I start thinking about all the things that can go wrong all the mistakes you can make.
You're gonna be a great father.
Full-term forceps in 2.
That's my cue.
Hey, Abby.
You're gonna be a great doctor.
Let's go.
Baby time.
Got a finger in this kid's pleural cavity.
You go.
- Alone? Is that even legal? - I'm right behind you.
- Get set up, I'll meet you there.
- I'll go with you.
- Are you kidding? You have to go home.
- You can't go to a delivery on your own.
I dream about blood sugars, TPN orders, gent doses, boxed kidneys.
Get used to it if you're going into neonatology.
I haven't slept well for days.
You know, all this whining about how tired you are, but you never leave.
I hate to break it to you, but we'll make it through this night without you.
Just trying to help.
NICU's here.
Thirty-five-weeker, maternal diabetes, failure to progress.
I thought this was just a forceps delivery.
- That too.
- Here comes a contraction, Sarah.
That's it, baby.
Big push.
We're almost there.
What do you mean "we"? Hi, I'm Abby from the NICU team.
- Something wrong? - We're called for forceps deliveries.
- It's standard procedure.
- Baby's heart rate's dropping.
Let's go.
Baby's getting tired! She's not the only one.
Nuchal cord.
Bad decel, 54.
Okay, Sarah, one more.
That's it.
Here she comes.
Okay, Sarah, one more.
That's it.
Here she comes.
A girl? It's a girl? It's a girl! - It's a girl! - Good work, baby.
Good work.
Poor tone.
Check the heart rate.
- I can't feel it.
- Well, listen, then.
Shallow resps.
How is she? How's my girl? Come on, baby.
Wake up.
Wake up.
Hold on, I'm gonna get a picture.
- Neela, what's the pulse? - I'm counting.
It's not that hard.
Tap it out.
Where the hell is Matt? Oh, look at all that hair.
I'm sorry, I'm going to need some room, okay? Okay.
She's okay.
You hear that baby? She got some lungs.
- Everything cool? - Yeah.
She's gonna have to come upstairs to monitor her sugars but, yeah, she looks good.
- Congratulations.
- Thank you.
Thank you.
Girl, you look just like your daddy.
Except three shades lighter.
Babies are supposed to be light when they're born, I told you.
Don't listen to your daddy, Daphne.
You're perfect.
It's Matt.
He's a little late.
It's Inga.
- What happened? - Hypertensive.
Crit bottomed out.
- Ultrasound shows huge brain bleed.
- Are you sure? Yeah, like we said, it's always a risk with ECMO.
- She's got to come off.
- She'll die.
We can't leave her on, the bleed will get worse.
- Hey, Matt, they need you in L&D.
- There's a C-section.
I gotta go.
Order 20 per kilo of packed cells.
I'll be back soon.
Surgery's on their way to decannulate.
- I talked everyone into this.
- Nobody, not even you could talk Raab into ECMO if she didn't think it was the right thing.
She's seizing.
5 of Ativan.
I can't take a verbal from a student.
Raab's gone, Matt's in a delivery.
- I could lose my job.
- She's seizing.
That's the least of her worries.
Let's see what Matt says.
- Versed will do the same.
- You can't without a cosigned order.
- Watch me.
- I'm telling Dr.
You do that.
- She'll kick you guys off the rotation.
- Kick me off.
- Neela has nothing to do with it.
- What am I going to tell her parents? Versed's in.
- Go home.
- "Mr.
and Mrs.
Tseng, I'm sorry.
- I screwed up.
Inga's brain is toast.
" - Stop it.
You didn't do this.
- I've gotta call them.
- Just go.
Raab will do it.
- They should hear it from me.
- You're a med student.
The Attending can handle it.
Just go.
Good night, Neela.
Excuse me, can someone get the door, please? Hello? Anyone? Get me the hell out of here! Oxygen is perfect the whole time.
When can we take Dirk home? - As soon as Dr.
Raab writes her a note.
- Thank you, Neela.
Inga's not breathing over her ventilator at all.
That's not a good sign, is it? It'll take time before we know how much neurological function she'll get back but her lungs are much better.
- She's a strong girl.
- Yes, she is.
- I'm waiting for Dirk's discharge summary.
- I'll get on that.
Cher's a lovely name, it's just how you spelled it.
I just wanted it to be different.
As long as you're aware.
Poor Chair, she's doomed.
Hopefully she'll meet a nice Ottoman someday.
Heard any funny dead-baby stories lately? Here's a good one: Inga's hydrocephalus is worsening.
EEG shows continued seizure activity.
She's not dead, but she might never wake up.
It's a real laugh.
Bad day, Neela? Millions of dollars keeping these babies alive.
Half die anyway.
Why bother? Time for rounds.
Forty years ago, Inga was considered a micro-preemie, borderline viable.
In many parts of the world, that's still the case.
We saved her so she can endure a lifetime of seizures, lung disease, cerebral palsy.
We gave Inga a chance.
Her brother's going home today, a normal kid.
But Inga's here now, gorked out in a level-three nursery.
Look, we do our best.
Some kids will end up hospitalized for life, and some will go to the prom.
Neela, there are no guarantees in this work.
If you can't live with that, I suggest you become a bank teller.
We'll pick up again when I get back.
Don't listen.
My cousin's a bank teller.
Got held up at gunpoint last year.
Still here? I discharged Daphne an hour ago.
I'm just waiting for the nurse to take out that IV.
- I can do it.
- You're letting a student touch your IV? That's brave.
She's territorial.
They teach that in nursing school.
Abby, we need you over here.
- Just keep some pressure there.
- Okay.
Come on, come on.
- She's gonna miss you guys.
- No, she won't.
She'll be home.
He's been tachypneic, sats dropping.
He's tiring out.
- Put him back on O2? - He's going to need more than that.
- Diastolic is in the teens.
- Widening pulse pressure.
Okay, 50 cc's of saline cultures, start him on amp and cefotax.
What's happening, Abby? - He's apneic.
Pulse down to 105.
- Bag him.
- Five As and Bs in the last hour.
- Did anybody page Raab? -911.
- Okay, Mrs.
Kolber- Kyle? Jacob's having trouble breathing likely due to blood infection.
- From what? - We sent out cultures.
- He was okay.
- Sepsis can come on quickly.
We're starting antibiotics, but we have to put the breathing tube back.
- We were talking about going home.
- He's tough.
He'll get through this.
Get together.
Photo for the wall.
Fentanyl's in.
Go ahead, Abby.
One more with Dr.
- Oh, it's okay.
- We insist.
- Suction.
- Take your time.
- Heart rate's good.
- Smile.
I see the cords.
Goodbye, Jiang Han.
Ready to see the outside world? We're going to keep calling him Dirk since the name has bring him luck.
Thank you, Dr.
Mei Fan.
Mei Fan? I want you to have this.
- Thanks.
- It's strange to be going.
Lots of parents are nervous when their babies are discharged.
It'll be great.
You'll love having him home.
I know you're right.
Bye, Neela.
See you tomorrow.
- What are my vent settings? -24 over eight.
We'll adjust from there.
Order a Versed drip and a chest film.
You wanna call the tech? Okay, nothing to do now but wait for the antibiotics to kick in.
I don't know if I can take another round of this.
One of those better be for me.
I just needed to get outside for a minute.
The NICU's so confining, claustrophobic.
There's a reason why Matt calls it the "the box.
" - Raab's right, you know.
- Did you eat anything? I like science, complete answers, a plan for everything.
I can't deal with uncertainty.
It gets easier.
I planned neonatology since I started medical school.
I'm supposed to be loving this.
Well, the whole purpose of rotation is to try on different specialties.
- I mean, it's okay if you don't- - I had a baby brother.
He died when he was 6 days old.
I was only 3.
I remember sitting in my mom's hospital room eating ice cream.
But I don't actually remember him.
The NICU's just so sad all the time.
How can you stand it? I don't know.
When I was an OB nurse, preemies freaked me out.
I thought they looked like frogs.
I was pretty sure I was gonna hate the NICU.
But you don't.
No, I don't.
It's not just about the babies.
You know, so much of it is about taking care of the parents.
And it turns out tragic family dynamics are my specialty.
It's Matt.
There's a delivery.
Full-term, mom's febrile, PPROM, suspected chorio.
- Good work, Sandy.
- Oh, my God.
We're almost there.
Honey, we're almost there.
The little boy is officially here.
- You did it.
- We have a baby.
Amniotic fluid's clouding.
Kid's had late variables.
Abby? - Wait, you're bagging him? - You need to wait over there.
No, that's my son.
I'm a doctor.
- It's okay, Matt.
It's okay.
- Honey, what's wrong? Just a little blow-by.
Let them work.
What's wrong? He's too quiet.
Give him a minute.
Good chest excursion.
Thank you very much.
That's what we like to hear.
Congratulations, Mom.
And Mom.
He's beautiful.
- Is he really all right? - He'll go upstairs for antibiotics because of the chorio.
But right now, he looks great.
I love you.
I had no idea.
Nobody did.
Would you like to cut the cord, Dr.
Weaver? Hello, Henry.
- Your usual.
- Thank you.
Bad night? Jake is maxed out on dopa and epi, third-spacing like mad.
In the past two hours, his belly blew up in front of our eyes.
I think it's NEC.
Surgery's on their way.
His parents here? No, they're on their way.
I finally convinced them to go home and then I had to call them back.
- Any word from Inga's parents? - No.
Three days and not a single phone call.
KUB on Jake Kolber.
Free air under the diaphragm and pneumatosis.
Oh, damn it.
He's perfed.
Pedes surgery's gonna meet us in the O.
Come on, let's go.
- Can we wait for his parents to see him? - His bowel's dying, there isn't time.
We need to save the viable tissue before there's nothing left to save.
He's thrombocytopenic.
Platelets and FFP are on hold in the O.
- Abby, where are you going? - To surgery.
His intestines were injured and they need to cut out the injured part.
I'm Dr.
The injury's compromised your son's already tenuous condition.
The sooner we get him to the O.
, the better.
Would you like to see your little brother up close? Abby.
Kids aren't allowed in NICU.
Just five seconds.
There he is.
- Can he hear me? - Yes, he can.
It's okay.
You won't hurt him.
I'm Miranda, your big sister.
Come on, honey.
- Thank you, Abby.
- Thank you.
Good morning.
Where is your prayer group? I told them not to come.
I think he's getting a diaper rash.
I'll order some nystatin.
He's 3 months old today.
You should go home.
I thought that if I prayed hard enough if I showed God how much I believed You must be exhausted.
I don't want him to suffer anymore.
My patient has been bumped three times for so-called emergencies.
Been waiting over 24 hours for ORIF, happened again.
- Came up to see what's so important.
- Jake Kolber.
It's the congenital-heart-disease baby you guys admitted to us.
Do you remember? No.
Circumferential necrosis to the jejunum.
- There's really nothing viable here.
- Damn.
Abby? The bowel's completely infarcted.
I'm sorry.
We're closing.
So that's it.
Can't live without a gut.
I'm sorry.
- Where you going? - I'm gonna go tell the family.
Give yourself a minute.
They don't need to hear this immediately.
What am I to do, go out and get a latte while they wonder what's going on? All right, listen.
Maybe you would want to wait for the Attending to tell them.
Is that what you would do? Kyle.
Oh, God.
Oh, my God.
Is this the Chinese interpreter? Excuse me.
No, I don't understand what you're saying.
I've already called them.
I was connected to you.
Please don't put me on hold again.
Hello? Yes, I'm still here.
I'm not sure if I need Mandarin or Cantonese.
How long will it take? An hour, maybe longer.
You helped this family, Abby.
They will remember you for the rest of their lives.
I'm hoping you'll give neonatology serious consideration.
Are you mocking me? Because it's really, really not a good time.
You're one of the best students I've ever had.
Thank you.
- What? - The Tsengs have gone to China with Dirk.
- What? - That was Mrs.
Tseng's cousin.
They went back yesterday.
She doesn't know how to reach them.
Come on.
We've got work to do.
Tell me this is our last day.
- Good morning.
How's Henry today? - He's great.
He's raring to get out of here.
All cultures came back negative, but we need to treat for another seven days.
Unless you two allow us to do the LP.
I do taps on babies all day in the ER and never think twice about it.
Just do the spinal tap.
We wanna take our baby home.
- Okay.
Abby, you're on.
- Okay.
Raab, I would be more comfortable if you did the procedure, if you don't mind.
No problem.
I'll be back after rounds.
Okay, thanks.
Let Abby do it.
It's okay, Sandy.
What's going to happen to Inga? If she survives, she'll either be adopted - or put in a long-term care facility.
- Should I call Social Work? Go ahead, but nobody's going to China to look for them.
Her mother wouldn't leave her here.
They're young, scared.
Maybe they think Inga would be better off this way.
- In a hospital, alone? - If you were in a foreign country with no money, no job, and no place to live, who knows? - You might do the same thing.
- No, I wouldn't, and neither would you.
You can't begin to know what you would do and you don't know the first thing about me.
People are complicated.
That's not an excuse for abandoning a baby.
Neela, if you stay that judgmental, you're gonna hate this job.
CSF on the first attempt with Dr.
Mom breathing down your neck.
I'm impressed.
You should see how good I am when I'm not post-call.
Wait a minute.
You stuck a needle in my kid's back and you've been working for 36 hours? Actually, it's only been 31 hours.
Tube four, crystal clear.
Owen Miller.
Bad hypoxic brain injury.
Mom's your real patient.
She's letting go, needs help.
- Mrs.
Miller, this is David.
- Hi.
I'm your new medical student.
Ex-34-weeker with mec asp and pneumomediastinum.
Got him off high frequency last night.
- "Mec asp"? - Meconium aspiration.
It's a foreign language, but you'll pick it up fast.
Zero red blood cells.
Champagne tap.
Hey, before we go, do you mind taking a picture? - Thanks.
- Get your butt back down to the ER where you belong.
- Bye.
- Bye.
- Congratulations.
- Thanks.
- You all signed out? - Yeah.
Ever been to the Sky Bar? This is disgusting.
I told you.
Why are cigars associated with babies? This stinky thing has no place in a nursery.
It's Freudian.
Something about men wanting to have sex with their mothers.
Thank you.
You know what else I don't get? Why we're drinking cider instead of champagne.
You're supposed to get champagne for a champagne tap.
- Is Weaver that cheap? - Weaver knows I don't drink champagne.
So you still thinking about neonatology? Not in a million years.
I hope you didn't let Raab discourage you.
It's more than that.
She thinks you should go into NICU, you know.
You should.
No, thanks.
- I bet every Attending tries to recruit you.
- Oh, please.
Look who's talking.
Your mind is a sponge.
Maybe, but you've got that thing.
I don't know what it is, but it's much harder to learn.
I think all that cider's going to your head.