ER s11e12 Episode Script

The Providers

E.
R.
Previously on E.
R.
I understand you want to define yourself as chief.
But? Are you sure that this is the way you want to do it? I suck.
No, you don't suck.
You're still learning.
So how are you doing? I processed feelings of anger, shame and guilt in an emotionally safe environment.
I've addressed the urge to use alcohol.
And I've consulted both a shaman and a guru, so I'm all good.
I must've made an impression on you.
You didn't notice I was gone for a week.
Are you high? E.
R.
11x12 "THE PROVIDERS" Alex, hurry up! The bus is gonna be here! - What time do you start? - Noon.
Is Neela on today? - Is Neela on? - I don't know.
I think she is.
It's funny how that keeps working out.
- What? - Nothing.
Come on.
She's young, single, lonely.
She's got a crush on you.
I'm her teacher.
She's just trying to learn.
Yeah, bet she is.
- Come on.
- What? Everyone can see it.
- Who's everyone? - Pratt, Frank Jerry, Morris, Chuny, Haleh.
Even Murray.
- Murray? - That guy who works at the roach coach.
It's not funny, Luka.
You're doing everything to encourage it.
- That's not true.
- Yeah? Well, it better not be.
Or else I might have to get into some nasty chick fight with Neela.
In the mud? Just don't hurt her.
The only person who's going to get hurt around here is you.
You got it? Yeah, I think it was April.
But the fact that I need a calendar to figure it out is not a good sign.
- Did I meet him? - No.
He drove a motorcycle.
- That was his defining characteristic? - I'm afraid so.
- What about you? - Third year.
My gross anatomy instructor.
He was very skilled at prosecting the brachial plexus.
You slept with your instructor? Dr.
Gibson had a very tender way with cadavers.
And you called him Dr.
Gibson? Only in bed.
So basically, neither one of us has gotten any in a ridiculously long time.
Well, at least we have work to keep our minds off men, romance, sex.
- Yeah, at least we have that.
- Morning.
- Hello, Luka.
- Dr.
Kovac.
Multiple MVA on their way in.
Patient-satisfaction scores were up - Is that good? - Yeah, it's good.
Very good.
I'm gonna post it.
Carter, I wanna thank you.
I know that my taking over as chief has been stressful.
It's been a little weird for you but you've made the transition a lot easier, and I appreciate it.
Susan, I can't think of anybody I'd rather have as a boss than you.
Sixteen-year-old driver backed into a utility pole.
Okay, hop to it.
And don't call me Susan at work.
What happened? - Dad was teaching her to parallel park.
- She just got her learner's permit.
I got a little bit dizzy, and maybe I got the pedals mixed up.
New scores? Yep, we don't suck as bad as we used to.
Maybe by next week, we'll suck less.
- Must be your motivational speeches.
- We're pairing Attendings with interns.
- Abby, you got me.
Neela, you got Kovac.
- What? Big Croatian guy.
You can't miss him.
We've got a double MVC rolling in.
Abby, he's all yours today.
- Who? - Hey.
You guys know each other, right? Hi.
You know how to clear a C-spine clinically? You mean, if it's not tender? That's a no.
Check the NEXUS criteria.
Get back to me tomorrow.
I give you Rodney Dixon and Amanda Field.
Rear-ended by a truck while having sex in his car.
- Good vitals on both.
- I'd say.
- Are they stuck together with super-glue? - We tried to disengage them but- - Oh, it's killing me, man.
- Broken pelvis plus lust equals- Oh, God! - Chest is clear, belly's benign.
- Back seat of a car, huh? '66 Mustang fastback.
I hope it's not totaled.
- Fastback? That's a pretty tight squeeze.
- I do Pilates.
It's got a 389-1 rear gear with a 31 spline axle.
- Nice.
- You were screwing in an old Ford? What were we supposed to do? My husband was home.
- Oh, God.
- Probably a small crack in the pelvis.
You've got this, right? Oh, I'm all over it.
We'll give you morphine and wait for your Viagra to wear off.
Dr.
Lewis told me to present to you today.
- She did? - Something about interns having a primary Attending.
- Okay.
- I hope you'll show me that combat procedure you mentioned last shift.
The femoral tear.
Oh, it depends on whether we get a patient - who needs emergent central access.
- Well, whenever we do.
Sorry.
- Infected anal fissure in the hallway.
- Okay.
- Pupils, four millimeters and reactive.
- Ten centimeters JVD.
My wife is not gonna be happy.
It's okay, Dad.
It was my idea.
I take it Mom wasn't aware of the lessons.
If she had it her way, I would never be allowed out.
We're kind of separated for now.
Katie was with me this week.
Does she take any medications? Prednisone, tacrolimus - The anti-rejection drug? - She had a kidney transplant.
I have polycystic kidney disease.
We were on the UNOS list for seven years waiting for a donor.
Yeah, I'm a big fan of dialysis.
She's got blood type O with an 80 percent reactive antibody panel.
- Tough match.
- Yeah, well finally got big enough that I could give her one of mine.
Your kidney? What a dad, huh? Any other meds? Yeah, she's on an anti-seizure drug too.
The PKD gave her an aneurysm.
Mom's on the way, sweetie.
Thanks.
Okay.
A few crackles at the base.
Bradycardic at 48.
Peak T waves, widened QRS.
All right, amp of bicarb, What do you think is going on? Well, low heart rate, dizziness and EKG changes.
Could be hyperkalemia.
What? - No, no, that can't be.
- Hey, John.
Since the transplant, her kidney has been fine.
Why don't we see what the blood tests show then we'll take it from there.
Excuse me for one second.
- Do you have an intern on this? - I got Ray.
- What do you think about taking Neela? - Why? Is there a problem? Just do me a favor, okay? All right, send the Punjabi Powerhouse my way.
Painless jaundice in 3 and ulnar styloid fracture.
I'll take those.
There was a change.
You're with Carter today.
- I thought I was with you.
- No, he needs you in Trauma 1.
Isolated pubic ramus fracture.
Will I be, you know, all right? No cast, no surgery.
Just rest and pain meds.
But you're gonna have to be careful for a couple of weeks until it heals.
- Careful? - Yes, as in abstinent.
The safest sex of all.
- Abstinent? Are you serious? - Can't put any pressure on your pelvis or you'll end up back here.
Not what we want.
- It's the pelvis we should worry about? - That's right.
But other positions? Yeah, sure.
Get yourself a six-pack, the Kamasutra, and shoot out the lights.
Did we do something to offend her? Pulse is up to 61.
BP's stable.
Looks like the QRS complexes are narrowing.
- That's good.
- That is good.
The chemistry machine is down.
Should be up in an hour.
- You can't say if it's a kidney problem? - The urine dip shows four-plus protein.
- We won't know until the labs come back.
- I told them to hurry.
- Honey, are you okay? - Yeah, I'm fine, Mom.
- Sweetie- - It was nothing.
I told you it was too soon for her to drive.
- What were you thinking? - She's 16.
She wants a permit.
You never know when to stop.
- Let's not do this here.
- Please.
I need more of Katie's family history.
Could we step outside and give Katie a chance to rest? I'll be back, okay, sweetie? I've been sick for so long, it just got to be too much for them.
She was on Dilantin for a long time but she didn't like it.
It changed the way she looked.
- She was still having these seizures- - It was manageable.
No, honey.
She had them at school, in the movies.
- She hated it.
- So you switched her medication? - Three months ago we put her on Zarictal.
- It was not my choice.
- Zarictal? - It's new.
And we can't afford it.
Medicare does not cover it.
I took a second job working night security at the Mallers Building.
- We lost our apartment.
- She's been doing great.
Katie has been seizure-free for three months.
- No infections? - No.
No febrile illnesses? Have they switched her dosage of Zarictal? - Everything's been steady.
- But she was doing fine before.
- I don't know why- - She wanted to drive.
Like other kids.
- With seizures, she couldn't get a license.
- We almost lost her and you're worried about her being able to drive? I'm sorry.
I'm sorry.
Look, I don't want to fight, okay? I think it's time that we accept the fact she will never be totally healthy- - Why? - That's reality! Not for me.
I You have a neurologist? - Yeah, he's been great.
- Good.
Why don't we give him a call.
I'd like to talk to him about the medications.
- Sounds like a hard situation.
- Look up this new drug for me.
I had a patient on that last year during my internal medicine rotation.
Really? Never heard of it before.
It's pretty new.
Expensive, but very effective for seizure control.
You kids and your fancy book learning.
- Yeah, well, I try to keep up.
- Do a PDR and check a Medline.
See if there's renal dysfunction associated with the drug.
Okay.
- Hi.
- Hi.
This is George Guidry.
He's got a skin breakdown around the shaft of his penis.
- No, he doesn't.
- I think I do.
- Any discharge? - Oh, yeah.
Definitely.
- I'm not talking about that.
- No discharge, no fever, no blisters.
Do you use a condom? Not since my girlfriend broke up with me.
No vesicles, no chancre, no lymphadenopathy.
Okay.
- Let's take a gander.
- Yeah.
You know, I just thought of something.
Could this be from too much? You know Too much what? Since Lily left, I've been lonely, you know? Really really lonely.
How lonely? Six, sometimes seven times a day.
I found a report in the Western Journal of Medicine.
It suggests a correlation between renal failure and Zarictal.
- Well, that ain't much.
- No, but these might be.
From the adverse drug coordinator from the Department of Health Services.
Three possible cases they've forwarded to the FDA.
Four? That could be a pattern.
The Physician Relations number at Keating-Ward Pharmaceuticals.
They make Zarictal.
Might as well see what they can tell us.
- Yes.
- Keating-Ward Pharmaceuticals.
This is John Carter.
I'm a physician at County General in Chicago.
- How are you today, doctor? - Very well.
I have a 16-year-old girl.
Status: post-renal transplant who's been on Zarictal for three months.
You say that's three months? Could I talk to somebody about the incidence of renal failure? - Hold.
- Yes, I will hold.
Does anybody even listen to that music? It's terrible.
Carter, QRS is widening on our PKD girl.
- Lots of ectopy.
- I'll hold.
- Multifocal PVCs, runs of six.
- Push 80 of lidocaine, and mix up a drip.
- What's going on? - It's possible the elevated potassium is irritating Katie's heart.
BUN, 98.
Creatinine, 12.
3.
Potassium, 7.
2.
Most likely she might be in kidney failure.
V- fib.
Starting compressions.
Charge the paddles to 200.
- It's going to be okay.
It's okay.
- And everybody clear.
Clear.
- Procainamide's onboard.
- And clear.
- Sinus.
- There we go.
Set up for a femoral Quinton.
Call Dialysis for renal orders.
Katie, honey? Katie, honey? - That's it.
- Yeah, she's responding.
- O2 on 15 liters.
- Are you sure she needs dialysis? It's the best way to remove the excess potassium from her system.
- She has to have another transplant? - That is a distinct possibility, yes.
- Oh, no.
- Okay, Betadine the area.
- They said they'd be in contact in a week.
- And one percent lido.
- A week? - That's the standard procedure.
- What's that? - We telephoned the company that makes Katie's medication.
So is it the drug? Is that why this is happening? The timing of the med switch makes me think that is a possibility, yes.
But her kidney is being damaged by the Zarictal, is that-? Gabriel, Hannah, I came as soon as I heard.
- Was she in status? - No, it's her kidney.
This is Katie's neurologist, George Henry.
Dr.
Carter, I don't know if you remember me- Yeah, how are you, Henry? What has it been, six years? Give or take.
Can you take them to the family room? I'll be right in to see you.
Oh, okay.
Yeah, that's fine.
I think I remember the way.
Come on.
It's all right.
I gave pleasure boy some Neosporin, a therapist's number, and sent him packing.
- Well done.
- How about you? Is everything all right? Yes, I'm fine.
Busy.
Why? Well, last week when I ran into you on the El platform I didn't realize your situation.
My situation? It's just that I I heard what you went through.
I didn't want you to think I was insensitive.
No, I was happy not to have to talk about it actually.
Okay.
Guess I'm blowing that now.
I just I wanna make sure that there isn't anything that I can do.
Well, that's- That's nice.
It is.
Thank you.
It's I- Here's an H & P, and get back to me.
Right.
Why did you put me with this guy? When did everyone become schedule divas? I don't need a med student.
I don't like them, and I'm better flying solo.
- Is there something wrong with him? - No, he's excellent.
He's very good.
- He's excellent.
I just- - Oh, no.
You like him? - You know what, forget it.
- Yes, you do! You do! You're blushing.
We never had this conversation.
Hey, haven't you had enough of doctors? Put a message on the neurology and renal newsgroups, see if there's anything - on the drug's renal toxicity.
- That could cause a bit of a stir.
Yeah.
All right just ask for any information that might help us best determine treatment.
- You heard what he said.
- I don't believe it's the drug.
- I think that there are other options.
- We have a dialysis tech coming down.
I called UNOS.
They're gonna put Katie on the list.
John, that may be premature.
Why don't we do a biopsy.
This may be a case of rejection, not failure, and a biopsy would show us that.
What's the difference? Well, a drug-induced failure would require a transplant.
But rejection Rejection could be reversed with immunosuppressive agents.
Well, let's do the biopsy.
Okay, I'll put that in motion.
Dr.
Henry, can I have a word with you outside, please? Excuse me one second.
My intern's been doing research.
She's found four cases - of renal failure in patients on Zarictal.
- Well, that doesn't prove causation.
It gets you going that way.
Keating-Ward sponsored a series of phase-three clinical trials.
If there was any real risk, the FDA would never have approved the drug.
What, you never heard of Vioxx or Rezulin? This is a successful anti-seizure medicine.
It has improved Katie's quality of life dramatically.
Dr.
Carter, dialysis is here.
Page Dubenko to come down for the biopsy? Sure.
These need your signature.
- Well, I hope you're right.
- Let's be certain.
I was really surprised to find you still working here.
- Why is that? - I don't know.
I just guess I thought you would've moved on by now.
I guess I'm just a masochist that way.
How about you? I thought you wanted to go do bench research.
- Yeah, well, I got tired of it.
- You were good at it.
Well, I've got a wife and two small children now.
It changes one's priorities.
You mean, money? My practice does offer me three times the salary of an academic position.
Well, what about you, huh? Married? Children? Not yet.
Thanks.
I'll find you when the surgeon comes down.
Are you moonlighting as a word processor? Our PKD girl's on a new drug we're trying to get information on.
- Hey, Sam.
- Hey, Dr.
Lewis.
- Morning.
- Hi.
Has anyone seen-? Is that your coffee? Sorry.
It's a schedule, not a cocktail napkin.
GCS, 12.
BP, 60 palp.
Brady at 52.
- Fell from the roof? - Taking down lights.
- He's going to need central access.
- Need help? - Come on down.
- Carter doesn't need you? Not at the moment, no.
Okay, prime the rapid infuser.
- Can't find a vein.
- Pressure's only 50.
- Heart rate's 42.
- Blood in the belly.
He needs access.
He's about to arrest.
- Set up for a saphenous cutdown.
- Wouldn't a femoral be easier to find? And faster.
Probably the same difference.
But, okay, femoral tear.
Cool, I've never done one.
You'll do the next one.
Scalpel to Neela.
What? She's along for the ride.
- I promised her.
- You promised her? Ten centimeters, vertical flash.
- Starting here? - Deep into the sub-Q.
Level one is primed.
Okay, and now you tear Got any sterile surgical markers? There's the femoral vein.
Cannulate it with the 9 French.
- Let me try.
- No, I'll get it.
Just reach under.
Neela, focus on the field.
Seldinger technique.
You know what to do.
Two units ready to go.
Sam, can you ask Dubenko to come here when he's done? Yes, sir, Dr.
Kovac.
That's the lower lobe of the kidney there.
- Mark the depth.
- Purple okay? - That's my favorite color.
- Me too.
- Three centimeters.
- They need you next door.
What is this gonna do? It'll tell us if your body is rejecting the kidney.
Lidocaine.
- That's a good thing, honey.
- All right, hold still.
Little pinprick here.
There you go.
It's going to be, like, 20-something before I can get another one.
- No, that's not going to happen.
- Biopsy gun.
You just need to tell your immune system to stop being so picky.
Firing.
Dr.
Carter.
Dr.
Weaver's on the phone.
- She sounds kind of - Kind of what? - Weaver-like.
- I'll call her back.
Purple, huh? I've always been partial to azure myself.
- What's azure? - Like your eyes.
Send that off for light microscopy, EM and IF staining.
Pack the wound with a moist gauze.
- What do we have here? - Belly bleed needs a post-op head CT.
- We have FFP thawing.
- Send it upstairs.
Pressure's up to 100 systolic.
Heart rate's 90.
Dr.
Kovac, I I never knew it was possible to transfuse that fast.
Well, that's the beauty of the central venous cutdown.
Now you know how to do it.
- What made you recommend Zarictal? - A luncheon at Northwestern.
I heard a neurologist present on its efficacies.
A neurologist who's a paid consultant of Keating-Ward.
- So what? It stopped- - George? Dr.
Carter? Is everything all right? If the biopsy doesn't give us what we want if she needs another kidney could I give her my other one? That would require you being on dialysis for the rest of your life.
- No, I understand that.
- I don't know it's even ethical for someone to donate their only remaining kidney.
So it's not possible.
I don't know of any responsible doctor that would agree to do it.
Gabe, listen.
I- I know that you're scared.
But let's just take this one step at a time.
- Okay? - Okay.
- Go in there and be with Katie.
- Carter.
Some neurologist in Skokie sent this fax for you.
Thanks.
It's a "Dear doctor" letter from the pharmaceutical company.
It says there have been isolated cases of renal failure on Zarictal.
Yes, I know.
It recommends monthly monitoring of renal function which I've been doing with Katie.
BUN, creatinine.
- You got one of these? - Yes, so did you.
Letters were sent to every physician in the country.
They're a caution.
- So you knew about this.
- Private practitioners get letters like that all the time.
I followed its recommendations.
But you know what the biopsy's gonna show, says so right here.
- Well, I'm hoping that's not the case.
- Dr.
Carter, do you have a moment? - Problem? - No, Kerry just- You posted a warning about Zarictal on an Internet message board? I posted a request for information.
I'm getting a lot of phone calls.
I hate phone calls.
Neurologists, our head of nephrology, the director from KW Pharmaceuticals- Just wanted to be better informed.
By jumping to conclusions based on skimpy evidence? Tell it to the Milners, their daughter needs a new kidney.
You have one sick girl, that's unfortunate.
The drug companies have access to thousands of patients before they release a drug- They didn't use any renal patients when- They can't document every side effect.
You're working beyond your responsibility.
You telling me how to do my job? I'm telling you the FDA has an Adverse Drug Event division- Which is run by political appointees funded by the drug companies.
The number one lobbyist in the country is the pharmaceutical industry.
Come here.
Come on.
- Pick up a bottle.
- Kerry- Do it.
Pravastatin.
Saves millions from heart attacks and strokes.
- Enoxaparin.
Know what this is? - Yes, I do.
It offers better PE prophylaxis and allows DVT patients to be treated at home.
Linezolid.
Fights off strains of MRSA that used to be fatal.
- I think he gets it.
- Does he? - Yeah, he does.
- These drugs save lives.
The companies that make them donate $20 million to our academic programs.
Without that, we have no hospital.
We'd be standing in a mini-mall.
- That makes it okay to suppress results? - Who says that's what they're doing? Putting these drugs out here, seeing how they work is how we learn.
- It's how medicine advances.
- And that's not naive? Your job is to take care of your patients, not start a crusade.
Susan, you're the boss.
Tell him to keep his eye on the ball.
No more computer access for you.
It's like I forgot where I was.
I was just looking at him like he was a huge - cupcake.
- You want one? It's just a metaphor.
Thanks.
So you have a crush on Luka.
That's kind of weird.
It's just a crush.
Crushes are by nature idealized, unrealistic.
What about Dr.
Gibson? That sounded real.
Gross, but real.
My God, you're right.
It's a pattern.
- I'm a slut for authority.
- Stop it.
- Well, what about you? - What about me? - I heard you punched your med student? - So? He was bugging me.
- So you're hung up on a subordinate.
- No, I'm not.
- I have a thing for a supervisor.
- So, what, I'm like the yin to your yang? What are we gonna do? Ignore it, hope it goes away.
- Right.
No need to discuss it.
- No, denial works.
- Sam, dog bite in 3.
I wrote for Unasyn.
- I'll get to it.
- You check on my biopsy results yet? - Yeah, Dubenko is on his way.
- What about my patient in Exam 2? - I'm waiting on a repeat CBC.
Sam? Done and sent.
Nice seeing you all.
Isometric vacuolization of the renal tubular cells - consistent with drug toxicity.
- No chance that this is rejection? No tubulitis, no edema, no inflammation.
- The girl needs a new kidney.
- And it's from the drug? I'd say so - but I don't want to encourage you.
- Encourage me? Some of my colleagues were suggesting you've been all over the Internet with this.
- I was trying to be thorough.
- Word of advice? Don't piss off the money people.
Hi, everybody.
This is Katie's biopsy results.
And unfortunately, they are not what we had hoped for.
So it's not rejection? No.
No, it's irreversibly damaged.
And is this from the Zarictal? No, it could be from the tacrolimus she's been on.
I doubt that.
Her levels have been therapeutic for two years.
So this drug I've been working two jobs to pay for just to make her life better has ruined her donated kidney? I'm afraid so.
You told me- You told us it was working.
Sometimes drug interaction can only become apparent after the first year or two of release.
This couldn't have been anticipated.
So we're back to waiting? Well, UNOS will prioritize her for a new kidney.
That will take three, four years, if we're lucky? In the meantime, I'm gonna recommend we get a surgeon down here to see about creating a forearm shunt to facilitate dialysis access.
- I can take care of that.
- Okay.
- We're back to where we started.
- She'll be on that machine all through high school? Through college? Just because it took a while to get the kidney- No, it didn't take a while, there wasn't one.
I gave her mine.
We have given up a lot.
Made a lot of sacrifices.
You told me this drug was worth it.
Okay, show me your incision.
Fifth ICS, anterior axillary line.
Go for it.
Pulse ox is 92 on five liters.
Push that in just superior to the rib.
Okay, spread the clamp.
Sats are coming up.
And slip your finger into the pleural space.
- I lost the tract.
- That's okay.
Keep your finger in there.
Just guide the tube.
I'm above the rib, but it won't pass.
There you go.
Okay.
That is where you want to go.
- All right, I got it.
- Okay.
Keep advancing.
A little bit deeper, because you want all the ports in the pleural space.
Thora-Seal's ready, so is suction.
That's very good.
Hello? Okay, sew it in.
Somebody put something in the water today? Call it "pulseless electrical activity following trauma.
" - Right.
- Change "blade" into "scalpel.
" Don't say "torn," say "dissected.
" Call it the "field of exposure.
" You left out the size of the cordis.
-9 French.
- Okay, write it down.
And not "blood.
" "Packed red cells.
" Okay, good job.
- Just make the changes, and I'll co-sign.
- Okay.
Hey, Neela.
I hope I didn't give you the wrong impression.
You're a Resident and I'm an Attending, and I want to help you learn- Yeah, I got it.
I understand.
I'm sorry.
No, it's just- I wouldn't want anything to get- I got it, I got it.
I got it, thanks.
Vitals are stable.
- I need to grab an amp of bicarb.
- Okay.
Katie's T waves are back to normal which means her potassium has come down.
That's good.
He went to work.
Mr.
Milner? He took a second job as a security guard over at the jewelry center just to try to help pay for everything, you know? Nothing means more to him than Katie getting well.
Nothing.
Her illness just changed him.
Ruined our marriage.
It's important to stay optimistic.
A lot of good things could still happen, Mrs.
Milner.
MVC with passenger-space intrusion.
ETA, 7.
- Okay, we'll take it.
- What's MVC? Motor vehicle collision, another new protocol.
- No such thing as an accident.
- I liked MVA.
- I like walks in the springtime.
- John, a minute, please? I'll catch up to you.
I was aware of the potential for toxicity.
But it was only one case report in an obscure journal.
Well, you could have found out more doing a simple Medline search.
I can't do a Medline search every time I put a patient on a new drug.
- I've got 20 patients on Zarictal.
- Twenty? They're all doing well.
What, are you on the Keating-Ward payroll? Listen, as part of an ongoing study I send in a monthly update on each patient's progress.
And they compensate you? A small stipend for my time.
- Hope your malpractice premiums are paid.
- There's nothing wrong with it.
I am reimbursed for helping monitor a drug by doing thorough patient evaluations.
That the company only pays attention to if it says what they want it to.
Her seizures stopped.
She was very happy.
- The father was thrilled.
- He's real thrilled now.
Listen, I am trying to be a cutting-edge clinician.
- That's what the patients want.
- Guys.
I have to offer the most efficacious meds on the market.
Well, the problem is that last part, isn't it? The market.
What? Mr.
Milner? - Hey.
- Hey.
I was I was going to work, and I thought, "Why? " What is the point now? Gabe, put the gun away.
I put everything in your hands.
Everything.
And you let her down.
Listen, Katie can still live a long, productive life on dialysis.
Okay, whoa.
- Come on, why shouldn't I? - Please.
You know what we should do? Let's go inside and see your family.
Come on, let's go inside and we'll see your family right now.
I want to give my kidney to her.
Okay.
Hey, maybe I was wrong about that.
Maybe you can be the donor.
You're lying.
I know you're lying.
- Fix her, okay? - Yeah.
- For me.
- Yeah, we're gonna fix her.
- Sats down to 88.
- Can you see the cords? Lots of blood.
- All right, somebody go find his wife.
- Okay, tube.
And get that girl out of here.
Come on, move her to another room.
Gray matter covers the occiput.
- Why the hell would he do this? - He was distraught.
Pupils fixed and dilated.
Pressure's only 80/60.
- Start dopamine at 10 mics.
- No gag when I tubed him.
No.
No corneal reflex.
- Can he regain any function? - No, he's as brain-dead as they come.
- I'll go talk to her.
- No.
No, no, no, wait.
Let me.
I'm her family's doctor.
Transplant coordinator's down.
Technically, there's nobody else who can give consent.
The girl has a very rare tissue type, Amparo.
- The father is a match.
- I've made that clear to UNOS.
Look, I'm trying to get them to allow us to proceed.
For now, keep him on Fi02 of 100.
Make sure the girl's NPO in the hope she goes to the O.
R.
- Just do everything that you can, okay? - I will.
- Go back under your rock.
- I'm from the Trib.
It's a good paper.
Yeah, right.
You guys endorsed Bush.
Man, a guy shoots himself.
What's next, a plague of frogs? There's a gang of press outside.
Someone has to go talk to them - get them the hell out of here.
- Obviously, the guy was depressed.
All we know is he's in critical condition.
We can't go into any details.
"Heartfelt sympathy to the family.
We're doing everything we can.
" Good? - You want me to talk to them? - You treated these people.
Just play up the fact we're respecting the family's privacy, okay? M.
A.
P.
is only 90.
Can we go up on the dopamine? We're maxed out.
I got a p.
r.
n.
for Levophed.
Sounds good.
Maybe we need to talk? No, we really don't.
It's just he helped me to adjust coming back to work here.
He made things a lot easier, and I guess I don't know, I got confused.
I get confused every time I look at him.
Did you work on this family? His daughter, yeah.
I'm sorry.
Levophed's going at two mics.
Does Gabriel Milner have a daughter being treated in ER? - Yes, he does.
- Now, is it true - she's suffering from kidney failure? - I can't say.
Didn't you indicate that earlier on a medical website? - No, I made some general queries - Abby.
- Hi.
- Hey.
Do you want to go get something to eat? I know this awesome little Ethiopian place.
They make you eat with your hands but I got sterile gloves in my bag, so it's okay.
- Dinner? - Yeah.
No.
But don't take it personally.
Okay.
I'm not really a subtle guy.
But I was under the impression that there's sort of a thing happening here.
- Maybe not a big thing, but still, a thing.
- A thing? Yeah.
Yeah, maybe there's a thing but you know what, nothing's gonna happen.
- Why is that? - Well, a lot of reasons which I won't mention because I don't feel like sharing my checkered past.
- Why? - Or my various neuroses.
But there's one really big reason that's a deal breaker for me.
You miss the beard? No.
You're my student.
I'm grading you.
Well, I think that that is not appropriate.
And have a good night.
You know, what if I was willing to take an F right now? Yeah, I forgot to mention to you that I'm dropping out of med school.
Yeah.
Who wants to be a doctor anyway? It's incumbent upon you to share the information if you have possible fatal side effects of a popular new drug? Katie Milner was on Zarictal for three months and, yes, I believe the drug ruined her kidney.
"Out of respect for the family, that's all I can say.
" Is that so hard? - They knew it all already.
- No, they didn't.
You're alleging potential slander that could cost the hospital millions in support.
What are you worried about, free pens, coffee cups and drug samples? I'm worried about research grants, a thing HIPAA calls "patient confidentiality.
" - I didn't want to talk to them! - "Out of respect for the family.
" You wanna talk to them, then you do it.
It's your damn ER.
- You're right, I will.
- Dr.
Lewis, Dr.
Weaver.
Oh, I wonder what she wants to talk to me about? It's true, right? You did a good thing.
You say that like it matters.
- You ready to go? - Yeah.
UNOS gave us the go ahead.
We're gonna do the transplant.
- Oh, thank God.
- They're bringing Mr.
Milner up.
She doesn't know where the kidney's coming from.
I haven't told her yet.
That can wait.
Let's go inside and talk with the anesthesiologist.
You a medical student? First-year Resident.
How's that going? Some days are better than others.
I like it well enough.
What do you think they'll tell Katie? They'll tell her that her father loved her.
Maybe too much.
Transplant surgery's underway.
I can't take responsibility for how the system works but I can try to do my job better.
That's all any of us can do.
I don't know why I was surprised to find you here.
Of course you're still here.
Hope we see each other again, under more favorable circumstances.
You were always good to me when I was a student.
I remember that.
Anspaugh wants to see us and Weaver in his office tomorrow morning.
- Suture removal in Curtain 3.
- Hey if any of this rolls back onto you, I'm sorry.
- Mr.
Klossey? - Hi, doc.
How are you today? What are we looking at here? I did this skiing on Michigan Avenue, cross-country, during the last big snow.
Little fall, gashed my arm.
But I hadn't done it in 10 years, so even that felt good.
- Why did you stop? - Arthritis.
I had it bad.
Couldn't bowl, couldn't sit in those seats at Wrigley take my niece for a walk.
So, what happened? I saw an ad on TV for Renuvium.
A doc at the clinic gave me a prescription.
Fixed me right up.
- Renuvium? - Yeah, a little red pill once in the morning, let me do all those things I thought I had given up forever.
- That's something, huh? - Yeah.
Okay, this might hurt just a little bit.
Damn miracle of medicine, that's what it is.