ER s11e05 Episode Script

An Intern's Guide to the Galaxy

E.
R.
Previously on E.
R.
Got it! They warned me about this place.
They weren't kidding.
We know this is the second time you've been wrong about my patients today.
And you know what? It's the last.
I wanna know where the damn social worker is.
Covering two hospitals by herself till midnight.
That's my excuse for being late.
What's yours for being an ass? Dr.
Lewis? When do you need me to start? E.
R.
11x05 "INTERN'S GUIDE TO THE GALAXY" Shock, shock, epi, shock, lido, shock, consider mag two grams, shock procainamide, shock, consider bicarb, shock shock, epi, shock, lido, shock consider mag two grams, shock lido, shock, consider mag two grams, shock procainamide, shock, consider bicarb, shock.
- You going? - Yeah.
I'm sorry.
Rounds start at 7.
It's barely even light out.
Yeah, well, welcome to my life.
Nice meeting you.
I'm killing my plants, ignoring my bills.
I have to get it together.
- What's a loading dose of amiodarone? - Neela, stop.
And remind me to buy toilet paper on the way home.
This is weird.
Don't you think this is weird? Am I destined to spend my youth in a fetid, windowless hospital? You needed a job and now you're here.
Quit whining.
- I'm not sure if this is really what I want.
- Well, fake it.
Does everyone know I had a meltdown and quit? Hey, Dr.
Jumbo Mart.
How you feeling? Need a doctor over here.
Fifteen-year-old, multiple GSW to the chest.
Tachy with shallow resps, - What's your name? - He's apneic.
Throw me that bag.
Sam, we need a trauma room.
Nothing's open.
We got them lining the hallways.
- Get an Attending.
- Lewis is doing a subclavian.
He's lost his pulse.
- Starting compressions.
- Eight-0.
- Mg of epi.
Have atropine ready to go.
- Got it.
- Tube.
- Neela, could you open his shirt, please? I'm in.
Neela, listen to the chest.
Neela, come on! - IV's infiltrated.
- I'll give it endotrachially.
No breath sounds on the right.
- Okay.
He needs a chest tube.
- Open a chest-tube tray.
- You carry a scalpel? - Yeah.
Bone saw's too bulky.
Could you take over for me, please? - No carotid.
- Atropine and another epi.
Forty French on a Kelly, right here.
A huge hemothorax.
How come nobody told me you were such a badass? Got a pulse.
That's what I like to see, interns with initiative.
Come on.
Trauma 2's open.
Someone call Housekeeping.
Next? And finally, in Curtain 3, we have 3-year-old GB here with RW.
- RW? - She's going crazy - with this patient-privacy thing.
- What's RW stand for? - Really whiny? - Refusal to walk.
"Refusal to walk" has its own abbreviation? Neela, what's your differential? - Septic hip.
- Intra-articular infection toxic synovitis, osteo, sickle crisis and avascular necrosis.
- What about the workup? - CBC, sed rate, cultures, x-ray and arthrocentesis if there's an effusion.
First day back and she's showing up you bums.
Dr.
Pratt, what's the most common pathogen found in septic arthritis? Dr.
Barnett, septic arthritis? Med students, for a new dishwasher and a lifetime supply of Ensure: What is the most common bug in septic arthritis? - Staph aureus.
- Followed by strep and hemophilus.
I gotta go.
Chuck's waiting in the car.
- I guess the dream team is reunited.
- Cool.
Yeah.
Good morning, Urbanus.
Guess I'm with you again? Over 60 in Triage.
Some of them were here when I left last night.
Okay, Pratt, run the board.
Let's move some patients, huh? Okay, people, come on, listen up.
For the past month, we've been cutting you a lot of slack.
- You have? - Today the training wheels come off.
You're doctors.
It's time to stop thinking like students and take on a real patient load.
I want you to discharge - Twenty-five? - It's just two an hour.
Med students, present your patients to interns.
Interns, run your cases by me or an Attending before ordering labs or scans.
All right, here we go.
Ray, asthmatic in two.
Abby, PPD reading.
Neela, teenager with a cough.
Something nice and easy to get you started.
Twenty-five each.
And I'm counting.
Only ones left.
I guess that makes us a team.
Jane Figler, fourth-year medical student.
- It was quite a flash entrance you made.
- Thanks.
With rumors about how you freaked out, it's great how you - came in and set everyone straight- - Excuse me.
Can you sign my procedure log? Chest tube in your first five minutes.
Trying to impress me? Just so you know, I don't want you to go easy on me.
Believe me, I won't.
If you need help, just ask.
Dude, I forgot.
Kuharczuk in Curtain 4 needs a pelvic.
You're signing out a pelvic? That's weak.
I gotta get out of here, man.
I'm back in 11 hours.
She's yours.
And by the way, nice move starting late.
Makes internship shorter.
Okay, so I gotta ask.
- Why did they kick you out of Michigan? - Chocolate? Okay.
History of two ICU admissions and prior intubation a few months ago.
We gotta be aggressive with this guy.
Chuny, chocolate? - No, thanks.
I'm trying to watch it.
- You? You can eat whatever you want.
Okay.
What do you need, Ray? Could you please hit our wheezer in 3 with 60 of pred? - You got it.
- All right.
Lesson number one: Feed the nurses.
It'll make the jobs 50 percent easier.
Hi.
Chocolate? Too early.
We like bagels in the morning.
- No, no.
Come on, take one for later.
- Hazelnut.
- Where do we keep peak-flow meters? - In drug lockup - and, yes, I will get it for you, Ray.
- You're the best, Sam.
The result is borderline but your steroid use and your incarceration put you at risk.
- For what? - TB.
- So I do have it? - Not necessarily.
- Okay, can I see a doctor? - Sir, I am the doctor.
We're gonna get you a chest x-ray and a couple more tests.
Do we call it positive and treat with INH? See what the x-ray says.
Does a positive PPD involve type three or type four hypersensitivity? Sorry.
Obscure question, just trying to impress you.
Community-acquired pneumonia, mycoplasma viral pneumonitis, reactive airways, pulmonary edema - tracheal foreign body- - Stop.
His chest is clear.
It's a cold.
Fluids, ibuprofen and home.
I've got a guy with an equivocal PPD and a load of risk factors.
- Does he have to take INH? - Call ID, check it out.
- Okay.
Let's look it up.
- No, no.
He'll go look it up.
It doesn't take two to open a book.
Delegate to your student and find a new patient.
See, look at Ray.
He's discharged his second patient already.
Come on, pick it up, ladies.
He's making you look bad.
- Need a doc over here! - Hey, go.
Dropped right in front of us.
Transient, LOC.
Never even signed in.
Hello, my name is Dr.
Rasgotra.
- Can you tell me your name? - Juan Enriquez.
I forgot to eat breakfast, that's all.
- Let's get him up.
- Oh, he's bleeding.
- Pulse is racing.
- I'm- I'm okay.
- Chuny, what's open? - Exam 2.
- I just gotta go- Gotta go home.
- Just a second.
What are the bruises from? I noticed them last night on my legs, but I really didn't think much of it.
When I woke up this morning, it was- It was much worse.
- Okay, let's go.
- Seven-year-old with a lead level of 59.
The city notified the family three weeks ago to come in.
Three weeks ago? Okay, what does that tell us? - He's got bad parents? - It tells us his lead exposure is chronic.
If he was poisoned, he'd have symptoms and there's no way they would wait.
- Does this case belong in the ER? - No.
They wouldn't wait here unless they didn't have someplace else.
System's broken.
Can't blame the victims.
Good morning, Mr.
Lucas.
I'm Dr.
Barnett.
Heard you have a lead problem.
- Am I getting a shot? - No, man.
We wouldn't do that to you.
They tested him at school.
I don't know how he got it.
The city will send somebody to your house to look for sources.
He's always been sick.
Born early.
But look at you now, tough guy.
- You a pro football player? - No.
He had breathing problems when he was a baby.
How about basketball? - Aren't you the point guard for the Bulls? - No, I'm in first grade.
Lucas, dude, you're playing it cool but I know you're famous.
So I'm gonna have to ask for your autograph.
Okay? Do a quick head-to-toe.
Okay.
- Hey, lead clinic, please.
- Just a minute.
He had a seizure once when he was 2 - when he was sick.
- Febrile seizure.
It's very common.
Hey, it's Dr.
Barnett in the ER.
Yeah, I have a 7-year-old with an elevated lead who needs chelation.
Okay.
Thank you very much.
Okay, you're all set.
A nurse will walk you over to the lead clinic.
- Okay.
Thanks, doc.
- Punch it.
I'm gonna sell your autograph on eBay for a million dollars.
- A billion dollars.
- All right.
Let's go.
Five-minute discharge, boys.
Watch and learn.
Are troponins useful in ruling out coronary aneurysms in Kawasaki's? Aren't enough good studies on kids.
Do ex-preemies have a problem with lead metabolism? No.
Patients will tell you all kinds of irrelevant crap.
- They don't know what's important.
- You're so patient.
The key is to look like you're listening while you're doing your charting.
Multitask.
Guys, it is the key to survival in the ER.
There you go.
Is that really the best advice you can come up with? - Second best.
First was feed the nurses.
- Well, they're students.
They should focus on taking a history and learn efficiency later.
Med school teaches them to practice medicine in fantasyland.
Never gonna clear that room if it takes us two hours working up a case.
No such thing as a slam-dunk case, not as an intern.
Suit up.
We got a trauma coming in.
Jet ski crash.
Injuries to head and neck.
Tachy and hypotensive, 78 palp.
GCS one, one, one in the field.
Check out the asthmatic.
This may take a while.
- On my count.
One, two, three.
- Okay, on my count.
Got a 911 page.
Looks like I'm in the right place.
Yeah, jet ski accident.
Okay, Abby, your patient.
- Too much trauma- - Poor aeration.
We're gonna need a crike.
Weak carotid.
Crike tray to me.
- Can I hear vitals? - Access? - One peripheral.
- Start another one.
- Hang a liter of LR.
- Do we have a pressure yet? - His wife is here.
- Get this? Why don't we give the doctors room to work and I'll explain everything to you.
Why don't you call the blood bank.
- Full trauma panel, type and cross for 6.
- Sats only 84.
We need a portable chest and respiratory down here.
Get him a blanket.
He's cold.
- Blood bank.
- Hi, I need four units of O-neg in the ER.
- What happened? That was yours.
- No, it's a trauma.
- No medical-record number yet.
Thanks.
- Don't say thank you - and don't let the boys bully you.
- I wasn't letting the boys- You play with your hair when you're nervous.
I can't get a vein.
Get back in there.
Your patient needs a central line.
Chest x-ray's clear.
CT's negative - BP's better after 2 liters.
- What does that mean? Is it bad? - It's too soon to make any diagnosis.
- Just hang in there.
It sounds like the fluids helped you.
You ordered a CT, films and labs without talking to me first.
- You were busy.
- So where's your student? - She's in Sutures taking out stitches.
- You know, I really don't get it.
I mean, you're proactive, you're delegating and yet you're still in last place.
Here.
Med refill, five minutes.
Go.
Ray and Abby are stuck in Trauma.
This is your chance to catch up.
- Femoral's in.
- Sats down to 78.
Neck's too mangled.
Anatomy's distorted.
Feel the landmarks.
Jet skis account for 20 percent of boats but are involved in 44 percent of injuries.
- Know why that is, Dr.
Lockhart? - No.
Three-0 nylon.
No is right.
No throttle, no steering, no way to stop.
- Still can't find- - You're fine.
Make your cut.
Extend with the clamp.
Good.
Perfect.
Insert the tube.
So if this poor guy hit a pylon driving his jet ski 30 miles an hour what was the equivalent G-force? - Got it.
Give me the bag.
- Seven G's.
This guy's head was subjected to - We're doctors, not physicists.
- Pressure's dropping.
- V-tach.
Lost the pulse.
Take the airway.
- Starting compressions.
The impact of 999 pounds dropped on his head.
- That's what you're up against.
- Not all I'm up against.
- You're gonna shock him? - Charging to 200.
- Watch yourself.
- I'm not near the bed.
Exactly.
You want me to grab the paddles out of his hand? Mg of epi, have lido on deck.
- You did it again.
- Did what? The hair.
I mean, eight years of school.
Most people would just suck it up, you know? - Diarrhea times eleven months? - What did your parents say? - My dad would have ripped my head off.
- Why don't you start the history.
All right, guys, talk to me.
Homeless guy with gnarly feet.
Clotrimazole, new socks, home.
Seven-year-old with lice.
Permethrin shampoo, repeat in a week.
Good work, guys.
Keep them coming.
Still in the lead with 11, Abby seven, Neela four.
Ray gets credit for those? He's in Trauma, he didn't even see them.
- The students are part of his team.
- That's not fair.
He's got two.
Can you handle two students? You better go in with me.
There's a patient crouched in the corner.
Every time I go near her, she starts, like, yelling in Chinese.
That galea.
He's basically scalped.
- Just tamponade the bleeding.
- He's maxed out on dopa.
- His pressure still sucks.
- Of course.
Why? - Spinal shock.
- Yep.
No sympathetic tone.
- What do you want to do? - Epi drip.
Get the BP up, increase the cerebral oxygen delivery.
Right.
Ready for the cruel twist? Systolic's 58.
Come on, guys.
- Epi drip, one mic per kilo per minute.
- Didn't I just say that? Ischemic brain needs oxygen, but oxygen also forms free radicals after brain injury.
- Mother Nature is such a bitch.
- V-tach.
- No pulse.
- Paddles to Lockhart.
Charge to 360.
Clear.
Free radicals cause secondary-cell death.
You following? Clear.
Can we take a break from chemistry class? Difference between a physician and a witch doctor is appreciation of science.
These trauma algorithms should be automatic for you by now.
- Oh, God.
- Barnett, take over compressions.
Look at his face.
His brain is gravely injured.
The brain is starting to compromise his heart.
I didn't see it happen.
I told him not to rent that thing.
I'm sorry, his body is shutting down.
- Going again.
- You know, I was running this.
Really? I hadn't noticed.
Clear.
Procainamide.
What? Fine.
It's all yours.
Clear.
So, wait, why did you decide to come back, then? - It's not like anything has changed.
- I don't know.
Neela, knee sprain won't leave until she gets a prescription for some memory pill she saw on TV.
- Positive tox on the kindergarten teacher.
- Thanks.
Get knee lady out of here and meet me in Curtain 2.
- What do you want me to tell her? - She can ask her primary doc.
Pratt, fix this order.
Teach your interns the difference between micrograms and milligrams.
- I can't be with them every minute.
- Excuse me.
If I've made a mistake on an order, I'd appreciate it if you'd confront me.
I'd like to be treated the same - and subjected to the same scrutiny.
- Neela, we weren't talking about you.
Pupils fixed and dilated.
No gag, no corneals.
- Here.
Sit down.
- Thank you.
So, what now? - We wait.
- At least he's in sinus.
That means that the brain is no longer capable of telling the body to die.
- Kovac needs some help.
- I got it.
Elena Flemming, 32, poly-pharmacy overdose.
Paramedics couldn't get the line.
Let me give it a try.
Elena, what did you take? - The stuff that was in my cabinet.
- What was in your cabinet? Usual stuff.
I don't remember.
Urbanus, catch the paramedics, see if they got any meds from the home.
- What's your plan? - CBC, lytes, serum and urine tox Tylenol and salicylate levels, activated charcoal - and KUB to check for iron fragments.
- Good.
And call Psych and Social Services.
Elena, were you trying to kill yourself? I don't know.
- Looks pretty rough in there.
- Guy is brain-dead.
- They have kids? - Three.
- Coming? - No, they're too young.
- You okay? - Yeah, it's part of the job.
Bruised guy's CBC is finally back.
It's full of blasts.
You ever told anyone they had leukemia before? Part of the job.
ICU can't find a bed for our jet ski trauma.
- They're not expecting to find one.
- He's gonna be with us for a while.
Why don't you call Social Services for the wife.
What are you guys still doing here? Can't send them out until the chart's signed by an Attending.
Okay, a 7-year-old was sent by the city with a lead level of 59.
Asymptomatic, dispo'd to lead clinic for chelation.
- Did you get a repeat level? - Figured they'd get it there.
- Come on.
- Tell me- - Is that cool? - No, Ray, that's not cool.
You've been a doctor for a month.
You know you can't sign off before you run it past an Attending.
So why don't you get a repeat level and then I'll sign the chart.
- Where are you going? - I- I need to go to church.
You're too sick to go anywhere right now.
I need to talk to you about the results of your blood test.
Juan? I got one in my eye now.
Look.
Your platelet count is very low.
That's why you're bleeding so easily.
Juan, your blood smear showed some abnormal white cells.
The abnormal cells are crowding out the healthy ones in your bone marrow.
Juan, please listen.
We can help you.
You can't- You can't help me.
Okay, nobody can.
Yesterday I hit a man with my car.
It was an accident.
But today I wake up like this.
Your blood pressure's still a bit low.
You need to be in bed.
I want to review your smear and check on more labs.
And then I'll be back to go over everything with you, okay? Why didn't you tell him he has leukemia? Overdose only had antacids and a bottle of Benadryl in the medicine cabinet.
She'll sleep off the antihistamine and be good.
What the hell is going on here? I've been here for four hours and there's nothing wrong with me.
Sir, we honestly don't know.
You could have TB even though you don't feel sick.
We are going to recommend treatment.
You want me to take medicine for a disease you don't even know I've got.
People tolerate the medicine.
There are risks.
You people are really something.
- Mr.
Decoyte- - I want a better doctor! I'm Dr.
Pratt.
Can I help you? I've been here all day for a stupid skin test.
And no one here seems to know if I've got TB or not.
The safest thing for us to do is to treat it as if you do have TB.
If I were in your position, I would do the same thing.
- Fine.
Then get me out of here.
- Please, have a seat in the waiting area.
We'll get your discharge paperwork and your prescription.
A good doctor knows how to make "I don't know" sound reassuring.
Lymphoblastic leukemia has a remission rate of over 80 percent.
- How did he take it? - I should know the treatment before I tell him.
Can you page Oncology? Okay, halftime score.
Ray fourteen, Neela seven.
The nurses were tied up in traumas.
It slowed things down.
So you're gonna blame the nurses while you're on your ass? Ray's using the same nurses and discharged twice as many patients.
- My man.
- No more than 10 minutes in the room.
At seven, you start saying goodbye.
You better start wrapping things up in five.
There's a jammed finger in Sutures.
- Go check it out.
- Ray, how is it that you get lice and I get new-onset leukemia and a referral from Kazakhstan? You got some cool cases.
Our boy in 4.
I think it could be intussusception.
You get jammed finger, I get intussusception.
Are you accusing me of cherry-picking charts, Neela? That hurts.
Evans Syndrome with varicella, unexplained vision loss idiopathic proteinuria, LOC NOS, cystic fibrosis with SBO.
And drug-seeking heroin addict with a butt abscess who threw an emesis basin at my head.
Yeah, she was a winner.
Fine.
I'm just slow then.
You're not slow.
You're just differently abled.
Don't let Pratt get to you.
Abby's slower.
Not that he'd ever call her out on it.
But Attendings love her, nurses protect her.
- Must be nice to be the teacher's pet.
- Screw you, Ray.
Oh, hi.
Good, you're all here.
We didn't finish talking about my research with free radicals and superoxide dismutase.
It's good stuff.
Hold up, hold up.
Come on, you might learn something.
Step into my office.
Right over here.
Free radicals are the link to so many disease processes in the human body.
- Ischemia, cancer, aging.
- I think that's permanent marker.
They form after tissue is deprived of oxygen.
Why are they bad? Lockhart, we went over this in the trauma.
We did? Okay, what happens when the radical encounters mitochondria of a healthy cell? Lockhart? Why don't you let me do some research - and I'll present to you? - I just told you the answer.
Okay, let's try this.
Draw an oxygen atom.
I'm not trying to trick you.
This is easy.
Just draw an oxygen atom.
Look, you guys everything that we do in the ER every intervention ultimately operates at a molecular level.
I don't understand how any of you expects to manipulate the complicated machinery of the body if you don't understand the basics.
Okay.
There.
I've done the hard part for you.
That's an oxygen atom.
Now, all you have to do is add the electrons.
I have patients to see.
You couldn't tell, really.
You didn't even seem upset.
I know how to draw a damn oxygen atom.
That guy just gives me the creeps.
Okay, that's truly disgusting.
Look, don't knock it.
It's fast, high in protein and free.
Sutures is à la casa, Exam 4 splint and home and fever is just waiting on a chest film.
Okay.
That would be 17, Neela 12.
That brings you to 21.
- It's only 4:00.
- When I hit 25, can I go home early? - Dr.
Lockhart, what have you got? - Diverticulitis versus biliary colic in 2.
In 4, Ml versus reflux, and in 3, sepsis versus viral syndrome.
In Admit, Abby versus Ray.
Neela, you're getting your ass kicked.
Start making decisions and move those patients.
Ray's logged 21 discharges with three hours left.
- I guess 25 was too easy.
- Yeah, right.
- I better up the target to 30.
- Thirty? Double your speed, you might make it.
Pratt, your lacrosse player's sedated.
Come do his lid lac.
What? It wasn't like it was my idea.
Dr.
Barnett? Wendall Meade, Social Services.
- Yes.
I paged you like four times.
- Yeah, in like 15 minutes.
If I don't answer you right away, there's a reason.
Okay.
I need you to talk to Trauma 1 's wife.
He's brain-dead.
- Interesting name, "Trauma 1.
" - Ben Coleman.
Wife's name is Stacy.
- He's an intern.
- I see.
So referring to a patient by name instead of room is a second-year skill.
- Did you go through the care pathway? - The what? The checklist that systematically covers all postmortem issues with the patient's family.
You need a list to check off questions you'd ask anyway? I'll see her when you're done.
- Contact dermatitis versus candida.
- Call it dermatitis.
Topical steroids and send her home.
It resolves, we were right.
- If it doesn't? - She'll come back.
The overdose is waking up.
And here's the UA on your tarantula dealer.
UTI versus kidney failure.
If I'm right, she takes antibiotics and gets better.
If I'm wrong, she becomes hyperkalemic and dies.
I'm trying to embrace uncertainty.
- How am I doing? - Not so good.
You know, you haven't had anything to eat or drink all shift.
Go to Oncology and get a copy of the chemo protocols.
- Isn't that Oncology's job? - They said it might be a couple of hours.
I wanna be prepared to cover all the bases for when we go back in there.
I'm on an ER rotation.
Shouldn't I be cracking chests instead of making copies? I got a 15-year-old skateboarder versus firetruck.
The ladder clipped his leg.
Looks like an angulated tib-fib.
Leave him.
We'll find him a hallway.
- I've got it.
- I'll get it.
- My med student is driving me mad.
- Wanna trade? - Were we that annoying? - I wasn't.
Hi, I'm Dr.
Lockhart.
Does your arm hurt? You got hit by a firetruck and just broke a leg? Lucky guy.
Hey, hello in there.
We're your doctors.
We'll try to keep this brief.
My sister is coming.
How am I gonna tell our kids? Well, the social worker will be here to see you.
She can help you with all that.
Would you like to speak with clergy? Any denomination? Okay.
I'm sorry to bring this up so soon, but we only have a limited amount of time - to make this decision.
- Is it okay if I don't tell them yet? Have you thought about donating your husband's organs? - I think it's okay.
- Okay.
Let them have one last night before their lives change forever.
Well, you're looking better.
Just don't make me drink any more of that mud.
Well, the good news is your tox screen came back negative and your EKG was normal.
So from a medical standpoint, you're clear.
Good.
Can I get out of here? - I wasn't trying to commit suicide.
- What were you trying to do? Abby? Is the baby in 3 a real ALTE - or just a choking episode? - I don't know.
I haven't presented him.
The parents are refusing blood draws and x-rays.
Okay, I'll go find them when I'm done.
I need Psychiatry to see you before I can send you home.
I'm not crazy, just stupid.
Abby, is IV contrast contraindicated in someone with wheat and peanut allergies? - I don't think so.
- Can you find out? - CT's calling for your MVA.
- Okay.
Hold them off and I'll look into it.
I'm gonna page Psych for you and get you an ETA, okay? The condom broke.
- Abby.
- What? Your abdominal pain is gonna leave AMA if he's not sent up soon.
I tried to admit as acalculous cholecystitis but they think it's a retrocecal appendix.
- What do you think? - I don't know.
- I'm waiting for Surgery to see him.
- Keep it moving.
- Three an hour now.
- Thank you for your concern.
So the condom broke? I'm a temp at a commodities firm and I slept with one of the traders last night.
He left a note on my bed: "I got HIV.
See a doctor.
" Five years of needles and I managed to stay negative.
I cleaned myself up, turned everything around and because of one stupid night, now I'm gonna get AIDS? I can't get sick.
I have a kid.
Just because you've been exposed doesn't mean you're infected.
The incidence of transmission from one exposure is actually relatively low.
You know, it might be better if I told him he has leukemia alone.
I wouldn't wanna cramp your style.
- Seen Juan Enriquez anywhere? - That leukemia guy? - He was out here a while ago.
- He's gone.
- He'll be back.
- There's a patient in his bed.
Nobody would have discharged him.
- Damn it.
He's gone.
- Doughnut? - Who? - My leukemia patient.
I'm such an idiot.
I hadn't even told him, but I think he knew.
You're not making a lot of sense right now.
He thinks he's being punished by God.
I should have realized he was a flight risk.
No, there's nothing you could have done.
I could have told him it was treatable.
He has a shot at remission.
There isn't enough time to help the people who want help.
Don't beat yourself up over people who don't.
He was distraught, and I left him alone so I could go and do research.
- Dude, where did you go? - Jane's gonna hang with us, okay? You seem stressed out.
It's about time for the nurses' nighttime feeding.
Better go.
Beastie Boys.
He's out.
Have you ever heard of prescribing prophylactic triple cocktail after a known HIV exposure? Sure.
The hospital gives it to health workers all the time for needle sticks.
I'm not talking about a health worker.
One of my patients had unprotected sex with an HIV-positive guy last night.
It's really only available for occupational exposures.
Too expensive.
Okay, on my count pull the distal segment out and down while I give counter traction.
One, two, three.
Only health-care workers are worthy of HIV prophylaxis? We can't give preventive meds to every one-night stand when we still can't afford to treat people who are actually infected.
I'm talking about one patient who's here now and she's asking for my help.
And what about the patient who walks in tomorrow and the next day? Put him in a long leg splint and stay with him until he wakes up.
The guy's been here for eight hours and hadn't been told? What were you waiting for? Oncology couldn't get here.
I was figuring out what to tell him.
- He wasn't gonna hear anything.
- It was important I get my facts straight.
- Why didn't you call a social worker? - I thought it was better for him- No, it's not about him, it's about you and your need to be perfect.
Stop being a slow A-plus and start becoming a fast B or you're not gonna make it.
Now, find him before he bleeds out and he dies.
Yes.
I'm looking for funding for HIV medication for an uninsured ER patient.
If anyone ever actually checks this machine please call Dr.
Lockhart in the ER.
What? I look at you and Ray, you're so confident in- It's your first day.
Give yourself at least a week - to be better than the rest of us.
- I don't even know why I'm here.
Listen.
Every shift at about this time I start fantasizing about working in a tollbooth.
Neela, what's going on with that football player in 3? Knee pain times two days.
No drawer sign, no AP or lateral laxity.
- Point tenderness? - And he's bearing down weight.
- Rest, ice and Ace wrap, right? - Yeah.
Excuse me.
No, you can't! No, no, no! There's nothing wrong with him- - Looking good today, Dori.
Doughnut? - I am not helping with the disimpaction.
- Doughnut? - Babinka? Don't act immune to my charms just because you brought your own sweets.
- He does that every day? - Twice.
Start of each nursing shift.
- It actually works? - Apparently.
- Abby, you're lagging.
- Well, I have more patients on the board.
Which is meaningless if you can't dispo them.
You're taking up room, jamming the flow.
Yesterday, I got a hot Ml to the lab in 15 minutes reduced a perilunate dislocation and a case of malaria.
Today, I'm in some kind of bizarre vortex.
Okay, okay.
Cough times two days.
In and out.
Doubt it.
Probably turn into myocarditis versus tracheoesophageal fistula.
All of my patients need three consults and a huge workup and even then, there's no definitive diagnosis.
I guess you're gonna have- No, I'm not gonna pretend things are cut and dry! I just want one patient today that has a clear problem that I can help.
- Okay.
- Okay.
Sam, how come Brandon still hasn't gone to the scanner? - Because CT's been backed up for hours.
- Charlie's the CT tech from 3 to 11.
He loves bear claws.
The rest of the doughnuts go to the nurses' station.
- Should I make sure someone sees me? - Yeah.
You don't find all this wheeling and dealing a bit slimy? Yeah, but you gotta play games to get stuff done.
Excuse me.
Let's review the standings.
- Ray, still in the lead with 25.
- Got 26.
Abby at 19, Neela brings up the rear with 16.
File this under Neela.
- And why would you do that? - Because you'll owe me.
Hey, there's a patient with an ER wristband who's upstairs in the chapel.
- Been up there a couple of hours.
- Where are you going? You're only at 16.
- Employee Health.
- Can I help you? This is Abby Lockhart in the ER.
I've been stuck by a needle.
Let's roll.
Curtain 2 needs a thumb spica and we need to take off a toenail in 4.
- Dr.
Barnett, did you fill this out? - What? This is the postmortem checklist for the jet-ski guy in Trauma 1.
Yeah, yeah.
Did you actually talk to Stacy Coleman, or did you just fill this out to save time? What? Well, you checked off that she wanted to have her husband's organs donated.
She said she never consented to that.
No, no, no.
I asked her all the questions.
While the transplant surgeon was prepping to harvest she thought her husband was getting better, so Okay.
Can we talk about this someplace else, please? UNOS has been on the phone with a kid who thought she was getting a heart.
Are you worried about getting yelled at? - The lady said she was fine with it.
- No, Ray, she did not! - Did you make sure she was-? - I asked her all the questions.
Did you take time to explain it to her? - How am I supposed to-? - Nobody said this job was easy.
When you take shortcuts and you drop details, people get hurt.
We'll send this in for hep B, hep C and HIV.
You can call tomorrow for results.
And never stick your hand in a full sharps container.
Stupid.
AZT and 3TC in a combined pill.
The other is your protease inhibitor, BID, on an empty stomach.
Two quarts of water a day.
And we'll see you in two weeks to check your LFTs.
Juan.
We've been looking for you.
Have you been down here the whole time? Juan, you have leukemia.
Leukemia is very treatable and you have an excellent chance of a cure.
I know it feels like something bigger than you is making this happen but something also led you here.
We will help you get through this.
There's a reason why you came to this hospital today.
- Hey.
- Hi.
I heard you got a needle stick.
Are you okay? Oh, yeah.
Yeah, fine.
- You wanna go home early? - No.
I'm fine, really.
Excuse me.
- Hey, Wendall? - Yeah? - Did you get to see my overdose? - Yeah.
I left a note in the chart.
I'm comfortable discharging with outpatient follow-up.
- Great.
- Listen, I heard about your needle stick.
- Are you all right? - I am.
- Page me if you wanna talk.
- I will.
You're back.
Can I do anything? - Do you feel okay? - Yes, I'm fine.
A little woozy from all the blood they took, though.
- I'll get you water.
- Great.
How about an iced tea from across the street? - Yeah, you got it.
- Thanks.
Hey, Sam, did the radial fracture get Ancef yet? Yeah.
Just a minute.
I gotta give this message to Mrs.
Coleman.
I'll do it.
Mrs.
Coleman.
They took him to the morgue.
Your sister called.
She took your kids to your house for the night.
Hey, I guess we had some kind of misunderstanding back there and I'm not even sure what it was about.
If there's anything I can do Can I call you a cab or something? I'm sorry for your loss.
- Just the man I was looking for.
- Do you know how often I hear that? - Are you okay in there? - Yeah, it's- It was just a little mix-up.
What do you got there? I need a favor.
I'm into favors.
These are for my patient in Exam 3 but as you can see, they have my name on them.
- HIV meds.
- Yeah.
Do you have any friends in the pharmacy that could doctor those labels? Yeah.
I think I'm falling in love.
- How was your first day? - Hard.
- You gonna come back tomorrow? - Yep.
Juan Enriquez's priest called.
Still no word from him? He's on the Oncology Ward starting chemo.
I found him in the chapel.
Great.
- Hey, thanks for your help today.
- Sure.
- You off? - Yeah.
Yeah, me too.
If you wait for a second - I'll walk out with you.
- Okay.
I think I hear rounds starting.
Make sure you drink at least two quarts of water a day and see your doctor in two weeks and get your liver function tested.
I don't know what to say.
- Thank you.
- Sure.
- Take care of yourself, okay? - Okay.
Bye-bye.
Bye.
- You have dinner plans tonight? - No.
Maybe that was too subtle.
Would you like to have dinner with me tonight? - It wasn't too subtle, Urbanus.
I got it.
- Answer still no? Yeah.
Okay.
Good morning.
You buy your t-shirt like that or you rip it yourself? - Hey, I met my discharge quota today.
- So did I.
Not quite, Dr.
Barnett.
Twenty-nine, you're one short, buddy.
- Afterwork cocktail? - That's totally gross.
- Good.
Let's go get a real drink then.
- Not a chance.
- I'm exhausted.
- Come on, guys.
Lewis is handing out the paychecks today.
How can he still have energy after a day like this? Work is easy when you have the entire staff literally eating out of your hand.
I don't know how he can finish his work at the end of his shift.
- I still have an hour's worth of charting.
- Two hours.
Hello, Abby, Neela.
Survive? Okay, let's round so the day crew can get out of here.
In 2, we have DZ with V and HA.
- Finishing a liter, PO challenge and home.
- All right.
Who can tell me what the criteria is for scanning headaches? - Worst case - Thunderclap onset.