ER s11e10 Episode Script

Skin

E.
R.
Previously on E.
R.
You look like an old-fashioned doctor.
I am an old-fashioned doctor.
Give yourself at least a week to be better than the rest of us.
You're doing a great job.
I wanted to make you aware that there are still many, many, many problems for you to work on.
And if there's one word I can't emphasize enough, Susan it's leadership.
That's it.
Carry on.
E.
R.
11x10 "SKIN" Right.
Down from last year, I can see that.
Patient satisfaction scores? Yes.
Rush had a higher average.
They also have a bigger budget.
How'd we do? All right, fine.
I'm on it.
- Weaver? - Yup.
Otherwise known as the four-letter word beginning with a "C.
" Crab? Seventy-three percent of respondents would not recommend this ER to others.
Our patients hate us.
More precisely, they hate Residents for not listening not spending enough time.
Ray, Morris, Pratt, all scored 2.
5 or lower.
- It could be worse.
- The best being a five.
Last in the class, Neela, at 2.
12.
- How about Abby? - Not bad, 4.
15, but she has other issues.
They don't make interns like they used to.
They're focused on the science at first.
Once convinced they've mastered it, they're free to focus on humanistic skills.
They're works in progress.
They have to be taught.
But you can't teach empathy.
Or common sense.
- Ray? - Yeah? People want to see a doctor, not a rock star.
Put on some scrubs.
We do have a dress code here, people.
No stains, no tattered clothes, no leather, no piercings.
Got it? You mean visible piercings, right? And if your shift starts at 7:00 and you come in at 7:02 that's two minutes off another Resident's life which is wrong and salary-reducible.
You say something? You think it's the tone of a woman's voice that makes it easier to ignore? Sorry? I got a call from a renal Attending about a dialysis order you finagled last week.
- "Finagled"? - And in order to appease them I agreed to review three months' worth of your charts.
- Wait a minute- - There were concerns.
You started a central line with no procedure notes.
Well, wait.
You reviewed all of my cases? You admitted unstable angina patient into telemetry before troponin was back.
Yes.
Well, the bed was ready, the lab was slow.
And here we have: "Patient presents with rash.
Discussed with Dr.
Cohen, agrees with the plan.
" The problem is no one in Derm, including Dr.
Cohen, ever heard of this patient.
Abby, these are legal documents.
In a court, these- He had Lyme Disease.
I didn't call Derm, I called Cohen in ID.
And who are you? - What? - MVA, ETA two minutes.
You get promoted, everyone's a slouch and I'm falsifying legal documents? - Look, I'm- - Forget it.
I'm on break.
- Residents don't get breaks.
- I'm waiting for the MVA, then.
Help, my brother's bleeding.
You a doctor? - What happened? - They shot him! - Where'd he get hit? - You gotta help.
I think he's dying.
Hey! Hey! What-? - Go! - What are you doing? - Go, man, come on.
- Hey! Get off me.
What are? Stop this car.
What are you doing? Help! Help! Loose.
Loose! Stop, hey.
Help! Shut up.
- He's in the back.
- What? Get in the back of the car! Got me from behind, came out the front.
- Oh, my God.
- Fix him! He needs to go to the hospital.
Fix my brother, bitch, before I blow your head off! Try to stay calm, all right? - Trying.
- How long have you been short of breath? Day or so.
My regular doctor's on vacation.
- I'm pretty particular about who I see.
- Smart lady.
Dr.
Barnett will be with you right away.
Señora, you need to settle down.
Ma'am, the splinter is out.
It can't possibly still hurt, okay? Neosporin and wound-care instructions? - Yeah, you got it.
- So was she faking or what? No.
That's what's affectionately known in the ER as "Hispanic panic.
" Okay.
Let's see, we've got cough and dyspnea on exertion.
How are we feeling, Miss Mitchell? Ms.
So-so, I guess.
Okay.
"Ms.
" it is.
We're gonna run a few tests, get back, and examine you as soon as possible.
- ICON, CBC, and chest x-ray.
- EKG too? You the man.
I thought "Ms.
" went out in the '80s.
Here you go, for the urinalysis.
Is there any chance that I could see another doctor? He's lost a lot of blood.
I don't think there's anything I can do.
All right, let me try to stop the bleeding.
Do you have a napkin, or a towel, or anything? No.
All he's got is CD's and crap.
CJ, you got any towels in your ride? Use whatever you got until we get some supplies.
Listen to me.
You need more than supplies, you need surgery.
No.
- Just patch me up, I'm good.
- You need to go to a hospital.
Make a list of everything I'm gonna need.
Get her some paper.
- If she moves, shoot.
- Okay, wait, wait, wait.
I can't just patch you up.
I can't.
Even if I could, it wouldn't help.
You have internal injuries, okay? You could bleed to death.
Bullet went clean through.
You use a needle and thread if you got to.
And get us some antibiotics or whatever.
You got a medicine pad, right? Start writing.
Cause of ulcerative colitis is not known.
Probably some combination of external agents and host factors.
- More common in women or men? - Women.
Right.
And peak incidence is bi-modal.
Who can tell me the age range? - Excuse me.
Miss? - Yes? I know you're not my doctor, but melanoma, when spreading, how long? It's impossible to say, sir.
It depends on the number of metastatic sites location of the primary lesion a number of factors.
I'll make sure your doctor comes to see you.
That was tough.
Yes.
But there are some biological explanations for excessive emotionality.
Who can tell me the differential diagnosis of crying? Starting with the obvious.
Limbic-system lesion, temporal lobe meds would do it.
It could also be a thyroid dysfunction.
Other ideas? A sense of doom has been associated with acute Ml.
Right.
Inappropriate weeping can also be produced by- Neela.
That man's just been told his cancer has spread.
Don't you think he has a reason to cry? Well, yes, of course he does.
But there are also other organic causes of crying which warrant consideration.
Excuse me.
This man's looking for anyone who worked on Monday.
- I did.
Can I help you? - My wife died here.
Jenna Putnam.
I was hoping to talk to anybody that might remember her.
I don't believe she was my patient.
I'm sorry.
Maybe you can ask at the nurses' station.
Someone there should be able to help you.
Dr.
Carter? This gentleman's wife died here last week.
I'm very sorry for your loss.
Thank you.
I was up in Maine, and then by the time I got back You know, she was by herself.
You know.
And, well, I was just wondering if maybe she said anything or, you know, if she was scared? - What was her name? - Jenna Putnam.
I'll look into it, I'm a social worker.
It might take me a while.
Do you want me to call you at home, or? Could I wait here? Is that okay? All right.
Is there any way to know what room she was in? Not really.
No.
All right, thank you.
- Sad.
- Yeah.
- It's nice of you, by the way.
- It's my job.
Yes? It's forward of me, but I was wondering if you'd- It's bad enough I got saddled with the shifts Chen dumped on me.
Now I got Residents bailing too.
Have you seen Abby? No.
Why? She went to wait on a rig, she's been MIA since.
- We can talk later.
- Okay.
When was this? Hey, I got a couple more GSWs en route.
ETAs five.
- Okay.
Half an hour ago, 40 minutes.
- She went out to meet a rig? I called her on some stuff, she got bent out of shape and stormed off.
I guess I hurt her feelings and she declared herself "on break.
" You know what? Malik, text message Abby and tell her to get back on the job.
You don't got a cell phone? Not with me.
My brother's got one.
Plays this funny little song when somebody calls.
He's like the captain of the ship, you know? - What's his name? - CJ.
What's yours? Mostly they call me Little C.
Why? Because CJ's really, really sick.
And I know your friend thinks- Loose? He's our cousin.
Well I know he thinks CJ can be helped this way, but he can't.
Okay? You need to listen to me.
Listen to me.
I'm a doctor.
Your brother's gonna die unless he gets an operation.
So we have to take him to the hospital.
Here's your stuff.
Get busy! Another? Some kind of gang war going on? This one's got multiple GSWs to the abdomen and legs.
- I ain't in no gang- - Spontaneous resps, tachy at 121.
BP's holding, 106/64.
- I'm Dr.
Lewis.
What's your name? - I was just waiting on the bus.
Second GSW's coming in on another rig.
This one's the youngest.
She looks 13.
Jerry, did you get hold of Abby yet? Paging her now.
I need some light back here.
I can't see anything.
- What you gotta do first? - Put his intestines back in.
- Is that hurting him? - Yeah.
I have to keep pressure on this to stop him from losing more blood.
Just do what you gotta do.
I can't do anything while we're moving.
I think I hit something.
Oh, man, it's a little kitty cat.
Hey, I think it's still alive.
Give me the gun.
Here.
I need you to help me lift his head up.
Come on.
All right, CJ.
I need you to swallow this, okay? Okay.
CJ.
Come on, dog.
Good, man.
Drink it all down.
That's good.
Don't be stupid, all right? Pay attention.
- Come on.
Sew me up.
- Not yet.
Give the codeine a little time to work.
- One exit wound, right flank.
- My dad usually drives me.
- The other bullets must be in the belly.
- Through left thigh.
- Distal pulse is good.
- It was for his birthday.
Hang in there, Tisha.
Ray, call the O.
R.
, we're on our way.
- Me? - There's blood in the Foley.
Page Urology, the bladder's been hit.
- Want me to call in a dinner order too? - Roll on my count.
One, two, three I was just going to the mall.
- Sats only 84.
- She needs an airway.
- Neela, go.
- Pratt, go.
- Pratt.
- Twenty of etomidate and 100 of sux.
- Set me up with a 75.
- Tachy at 133.
BP's 82/50.
Central line kit, sterile gloves and a gram of cefotetan.
- Can I do the femoral? - Last resort in abdominal trauma.
Could pour blood and fluids into a severed vessel.
How about a subclavian, then? No.
Call the blood bank.
Tell them to send type-specific to the O.
R.
- Systolic's dropping, 78.
- Okay, another liter, mix up dopamine.
- Bag her.
- Urology knows.
- Good.
Now call for an X-ray and a vent.
- Are you serious? Second GSW coming in.
Can you spare a Resident? - Yes, she can.
- Take Pratt too.
We can handle this.
BP's 82/59.
How much dopamine? None.
Aim for a relative hypotension in a young person with internal bleeding.
If you jack up the BP, she'll just bleed more.
Like this, she can tolerate.
Fine.
Pretty controversial approach.
But, hey, I just work here.
Saline flush and 0 silk.
Hey, Malik.
Can you waste this ketamine for me? - Done deal.
- Thanks.
Excuse me, sir? I can feel her presence.
It's very strong here.
Sorry? I'm pretty sure this is where my wife died.
She was in a car accident this week.
Do you remember her? I'm not quite sure that I was working on that day.
Well, she has red hair.
Well, she had.
Flaming.
What was her name? Jenna.
Hazel eyes.
Ringing any bells? - This is stupid.
This is stupid.
- No.
- No.
I'm feeling better.
- No.
It's a needle and thread.
- It's not gonna work.
- He said he was feeling better.
You're gonna bleed to death.
Sewing you up like this is pointless.
- You need surgery.
- Do it.
- I can barely see what I'm doing.
- You heard him.
This should numb it a little bit.
All right, it's good.
It's good! All right.
Okay.
Listen brace yourself.
What you doing to me, woman? - It's just an IV, dude.
- What you call me? We'll give you something for the pain when we get this in.
- Ray, secondary survey, let's go.
- Yeah.
You're okay, homey.
- Bullet grazed the scalp.
- You buy a book to talk like that? He's saying you're lucky the bullet didn't cause more damage.
You the lucky one.
You free! Wound's superficial, chest clear, pelvis stable.
- Distal pulse is good.
- I bet you like hip-hop too.
Mr.
Cool Guy.
Send for a CBC, trauma panel, PT, PTT, type and screen, and five of morphine.
- That's what I'm talking about.
- Shut up.
- Bolus is in.
- TKO.
What else? That's it.
Entrance and exit sites, left arm.
Small laceration, right arm.
- Dr.
Barnett, that lady's asking for you.
- Thanks.
Whoa, you didn't roll him yet.
- Pratt's got him.
- Excuse me? - He's got a better connection.
- What? He's not comfortable with me, what do you want? Ray, we're in the middle of a trauma.
Nobody gets to be comfortable.
I got a patient who needs me.
- How's he doing? - He's gonna die if he doesn't get to a hospital.
Listen.
Can I ask what's the plan here? To stay out of sight until the cops are gone.
Then we can get him home.
To get something to eat.
I need to talk about your patient satisfaction scores.
- Problem? - They sucked.
Abby, you there? Abby, you can't be serious.
Come on, walking off a shift? If you're there, pick up.
Fine.
All right, call me if you get this message.
- Wow, was she really that pissed off? - Abby left? Yeah.
Now I'm pissed.
Here, Neela.
Go satisfy a patient.
Weeping pregnant teenager in Curtain 3.
Make eye contact, introduce yourself, stay in the room more than two minutes.
- I'm about to go and do a digital block.
- I'm not really asking.
Dr.
Lewis? That patient of Ray's is still waiting to see you.
Oh, yeah, yeah, yeah.
What'd she say? - Fatigue and shortness of breath.
- No, about Ray.
- I don't know.
She didn't say.
- Hi.
I'm Dr.
Lewis.
What's the problem? - Just a little winded mostly.
- Any fever? Coughing up any junk? No.
- A little effusion here.
- What's that mean? Just some fluid around your lungs.
But heart looks good.
No pneumonia.
- Does that hurt? - No.
I just- I didn't tell the other doctor that Sam, could you go check on her labs? Sure.
- Why is Lewis seeing my patient? - The patient- The labs got back a second ago.
What the hell does she want from me? Ms.
Mitchell, I'm so sorry to keep you waiting.
I think I can explain to you why you've been so tired lately.
You're pregnant.
Congratulations.
I think I got this.
No, you don't.
Come again? Excuse us.
I still need to work up the effusion.
But I don't need a chaperone for- She requested another doctor.
Why would she do that? Maybe because she's a he and didn't feel comfortable telling you that she's a pre-op transsexual.
But it was a positive pregnancy test.
Yeah.
Which in a man, means only one thing.
Eleven fifty-two, please.
- Busy night, huh? - A little.
Three cheeseburgers, three fries.
Three sodas.
One bottled water, one Frosty.
Anything else? - Have a nice night.
- Thanks.
You too.
So snowboarding, you and I, overnight at Telluride next Friday? What? Don't tell me you're a skier.
That, and I have other plans.
Dr.
Carter, I think my A little young for that.
Go ahead, order the films.
Look, I I realize this might sound a bit weird.
Me and Abby have been roommates for a while.
But you've known her for a lot longer.
I was wondering if I should be worried.
- She's not back yet? - No.
I can't imagine her just walking off her shift, can you? No.
But that doesn't mean that she wouldn't.
Hello? Hey.
- What? - I need to use the bathroom.
Please.
You just drove right past the gas station.
You just drove past the gas station.
Where are you going? Excuse me.
Where are you going? You know what? It's okay.
It's okay.
Never mind.
- Look, I really don't- Okay.
- Get out.
I said get out.
- Let's move.
- Okay.
You said you had to go.
Go.
But you ain't going alone.
- Right here? - Drop them and go.
Come on.
Scared of big black men, huh? No.
I'm scared of big black guns.
- Yeah.
Soon, hopefully.
- CJ? - I don't know exactly.
- CJ, how are you doing? I'm not sure.
Yeah.
Okay, I guess.
See that? Now look here.
Just got mine a few weeks ago.
- Healed nice.
- What's it mean? - It's getting cold though.
- I don't know exactly.
He don't wanna tell me.
Told me not to get one.
- Whatever.
Find out soon enough.
- Yeah.
All right, dog.
Yeah, peace.
Cops been all over the 'hood.
Boo said he'll call when they're gone.
We'll take him home then.
Yo, give me those, man.
What? My comics? For real? - I need them for the fire.
- Dog, I'm right in the middle of a story.
I'll tell you a story.
So there's this punk and his girl, right? They was parked out in the middle of nowhere.
Know what I'm saying? Kind of like this.
They was in the car.
Working it.
Getting things all hot and sweaty.
You know what I'm saying? But on the radio Can I have one of those? Gives you cancer.
She has been under a lot of pressure.
It's still not like her.
- She can also be very emotional.
- Easily hurt, stubborn.
Then again, she might just be going out for a walk.
Probably just blowing off smoke someplace.
Steam.
Did you two finish your QA reports? - No.
Not quite exactly, no.
- When were those due again? This sucks.
- Susan.
- You know why? - It sets a tone.
- What tone? If my Attendings don't take me seriously, why should the staff? You're taken seriously.
All right, what do I have to do, pull rank? I'm the chief of this department.
If I set a deadline, it needs to be honored.
- Okay, I'm sorry.
- No, forget sorry.
Just do what I ask when I ask it.
Dr.
Carter, that gang kid's crashing.
I guess the fire helped.
He ain't shivering no more.
CJ? CJ? He's apneic.
Get him on his back.
- What's apneic? - He's not breathing.
No, no.
He's warm right now.
- He doesn't have a pulse.
- What are you doing? - Trying to get his heart started.
- What happened? He was just fine five minutes ago.
- Sats down to 79.
- What did the CT show? Keeps getting bumped for more acute cases.
More acute than this? - Seizure stopped.
- The wound was superficial.
- The guy had a GCS of 15.
- Tangential GSWs - can cause intracranial bleeding.
- You saw him.
- He was lucid and talking.
- Bilateral papilledema.
- Fifty of mannitol.
- He's not moving air.
Intubate, and this time run him through the scanner.
Eight-oh on a mac two.
- He needs a hospital.
- He ain't gonna let us do that.
He's unconscious.
He can't tell you what to do anymore.
CJ, can you hear me? - Can you hear me, CJ? - He can't hear you.
- Just do something.
- I am.
Watch your back.
- Sedation's wearing off.
- Dose him again when we get inside.
The movement will jack up his ICP.
What did CT say? Diffused hemorrhagic contusions with edema.
- Ventricles are collapsed.
- He's bradying down.
- Blown pupil.
Neurosurg ready for him? - They said the bleed was inoperative.
If we don't decompress the brain, he'll herniate and die.
Sam, page Neurosurg again.
They're stuck in the O.
R.
with a shunt revision.
- We'll do a ventriculostomy here.
- Cool.
- Sam, let's get Neela up for this.
- What? - I've only gotten to do it once before.
- Yeah.
And she's never done it at all.
Somebody needs to help me do this.
- Do what? - The breathing part.
One breath after I count to five.
I can't do it myself anymore.
You.
Okay, fine.
You do the compressions, I'll do the breathing.
Get in here.
Here.
Put your hands like this.
Here, you press down hard five times.
One, two, three, four, five.
I'll give a breath.
Ready? One, two, three, four, five.
- Go.
Go.
- Come on.
Do it.
- Go ahead.
- One, two, three- - I need a flush.
- Sorry, it took a while to find her.
Checked Jumbo Mart.
Abby's not there.
What's this? A ventriculostomy.
- I've made the skin incision.
- What? - Three-oh silk.
- Getting your flash, Pratt.
Separate the attachments of the temporal muscle from the bone.
- Is it normal to have this much bleeding? - Yes.
Sterile gauze and retractor.
- I can't see.
- More gauze, Sam.
Frontal bones exposed.
Nice.
You'll use the twist drill to penetrate the outer cranium.
Hold it perpendicular to the skull toward the ipsilateral medial canthus.
Like this? Perfect.
You can do this, okay? - Hey.
Oh, sorry.
- What is it? I just need Neela when she has a sec.
Is this about my pregnant teenager? No.
A guy whose wife died last week.
He's been hanging around the hospital.
Wants to talk to the doctor who handled her.
That'd be you.
One, two - three, four, five.
- Where are we? - One, two, three - I don't know.
- four, five.
- He really needs help.
Can't- Can't do it no more.
Can't do it no more.
I got it.
One, two, three four, five.
One, two, three, four, five.
Hey.
Hi.
Dr.
Lewis was pulled onto a critical case and won't be available for a while.
Now, I'm sure you'd prefer her to do this.
But we don't have a lot of time.
And, unfortunately, I'm going to have to be the one to tell you.
We think you have testicular cancer.
What? Yeah, your urine was positive for a hormone called Beta HCG.
Now, in women that hormone means pregnancy.
In men it means testicular cancer.
- Are you sure? - Yeah.
We ran a number of blood tests that support the diagnosis.
We will do a testicular ultrasound.
But, yeah, I'm sure.
But listen, it's treatable.
Even if it spreads - your chances are great, okay? - That's funny.
- What? - I was getting rid of the equipment.
Ms.
Mitchell you mind if I ask you why you wanted another doctor? It's like you put on a show here like you're not comfortable in your own skin.
I don't trust that kind of energy.
I know it too well.
Three, four, five.
He dying? Two, three four, five.
He ain't dying, bitch.
You hear me? - Don't you let him die! - Three, four, five.
Come on! One, two, three.
- Come on.
- No, wait.
- Wait.
Please.
- I said, let's go.
Got no shovel here.
We'll do it somewhere else.
You don't have to do this.
You don't have to do this.
Lay down.
Let's go.
I said, lay down.
- Transducer's reading on the portable.
- Bring a dose of Ativan.
- Pratt, walk him up to ICU.
- Me? Yeah, just to be safe.
Thank you.
That was incredible.
You're gifted technically, Neela.
That's what makes you feel best.
Now all you have to do: Take the confidence you have when you do a procedure like that and put it in the other half of your game.
- Not sure I know what you mean.
- Here's her chart.
Jenna Putnam, multiple injuries sustained in MVC.
- Your signature.
- I still can't believe it.
You handle what, 20, 30 cases a day? Easy to see how you could forget.
But it was just Monday.
- I don't know what to tell him.
- Yes, you do.
Dr.
Kovac, I have no memory of that man's wife.
- Are you telling me to lie? - No.
I'm telling you to trust yourself enough to comfort.
Mr.
Putnam? Yes? I'm sorry I didn't recognize your wife's name earlier.
Oh, no.
That's okay.
But you do remember her now, though? She was lovely.
She talked about how much you meant to her.
How much she loved you.
And I don't think she was scared.
Hey.
Changed my plans.
- I'm sorry? - Telluride.
I'm in.
If the offer's still open.
Yeah.
Yeah.
- What? - Nothing.
Oh, it's something.
I can tell.
I just Are you all right moving forward with - this? - Yeah.
Are you? Yeah.
Yeah.
- Good.
- Okay.
She wasn't even in the room? - Nope.
- He pulled her from somewhere else? Hey, Carter, I need your opinion.
- Talk to you later? - Yeah.
- What's up? - Neurosurg called to find out why Kovac did a ventriculostomy in the ER which is difficult enough to explain.
Factor in the idea that he actually let Neela perform it.
- And so? - A, it's a very difficult procedure.
B, in a delicate situation like that it's customary to let the senior Resident have first crack at it - and Pratt was right there.
- Hey, I told her it was no big deal.
Well, I'm gonna talk to Kovac about it.
- Are you kidding? - No, I'm not kidding.
- You don't think that's an overreaction? - Thanks for your support.
Susan, I understand you want to define yourself as chief.
- I do, we all do.
- But? Are you sure that this is the way you want to do it? Stop crying, man.
It won't bring him back.
It's almost 10:00.
They'll be getting up around the block.
Listen.
I'm not gonna tell anybody.
Okay, I really won't.
I just wanna go home.
Hiding out, are you? Maybe.
Sometimes I'd use the utility closet instead.
Worse lighting, but more privacy.
- So how's it going? - Good.
Actually, it blows.
Every time I turn around, I'm offending someone or hurting someone's feelings or acting like a total - crab.
- Tell me about it.
It sucks to be in charge.
So, what do you do? Get used to not being liked.
That's it? That's your advice? Look, it's what we as women have the hardest time with.
We want to be liked, care what people think.
The fact is, when you're in a position of authority, you'll piss people off and you're gonna lose friends.
Thanks.
Hope it helps.
Hi, this is Abby.
Leave a message.
Hey, it's Susan.
You're probably not there.
Don't know, maybe you're at the movies or down by the river having a smoke.
If that's the case, I should be pissed.
If it's not, I'm worried.
Hopefully I'll see you before you get this message.
Sorry about today.
This is it.
Let's go.
We got business to take care of.
Get out.
Thanks anyway.