ER s11e18 Episode Script
Refusal of Care
E.
R.
Previously on E.
R.
I was thinking that maybe we shouldn't be quite so together here.
- I thought everybody knows.
- I didn't tell anybody.
Dad's taking me to Florida.
You can take whatever you want.
I don't care.
But he's not going anywhere with you.
We'll catch the whales in the fall, kiddo.
- I'm going the other direction.
- What? All right.
I know what you want me to say and- And I can't say it, okay? But things with Wendall didn't work out.
Oh, I'm sorry.
Yeah.
It's weird.
She's actually not really even speaking to me.
E.
R.
11x18 "REFUSAL OF CARE" - Oh, my God.
Oh, my God.
- What? What? - You have to get up.
Get up, get up.
- What? What? What? - It's 7:32.
- Yeah? Rounds are at 8.
- I hit the snooze.
- No, you shut the alarm off.
Sorry.
I thought you were gonna go home and change.
- It's okay.
- No, it's gonna look weird.
- No, it won't.
- You're back in the ER.
- People will think- - What are they gonna think? That I don't do my laundry? That I sleep in the park? - What? - Abby needs to take a few pass-ons.
- She's late.
- Brushing up on your Spanish, huh? It helps me relate to the community.
- Oh, yeah? What's her name? - Okay, one left.
- Asthma going to the ICU.
Get an art line.
- Got it.
- Meaning? - I'll take care of it.
- Teach the residents how to do it? - Absolutely.
That's the board.
Alex has soccer after school.
I thought you could drop him off.
Isn't the carpool picking him up? Yeah, but he needs to work on his corner kick.
He's still pretty mad at me.
Well, think of it as an icebreaker.
Maybe we should give it a little more time.
- I'll see you tonight.
- All right.
Have a good nap.
- Morris! - Sorry.
I came in to work on our manuscript revisions.
We'll see if I have the time.
They're due by 5 p.
m.
- Today? - We don't wanna miss the deadline.
You two are publishing? "Oligoanalgesia in Long-Bone Fractures: A Retrospective Review.
" Accepted in the annals next month if we can make a few changes.
Some substantial changes.
Go to the doctors' lounge.
I'll be right in.
Consider it done.
You're working with Morris? Yeah.
You know, he's thorough, good with statistics.
And the only resident desperate enough to write it up? - You got it.
- Dr.
Lewis - would you let me run a trauma today? - Do you think you're ready for that? In a couple of months I'll be an R2 supervising the interns.
- It might be good to get practice.
- Need a bed.
- Hypothermia.
- All yours.
Elena Tabajas, 39.
Passed out at the immigration building.
- Tachy at 120.
- She's cold.
Some kind of a protest.
You need to call Benjamin Coe.
He's my lawyer.
- What? - Don't do anything until he's here.
CBC, chem panel, EKG, a liter of saline, O2 at 2 liters, and get a rectal temp.
- What are you doing? - We're giving you warm IV fluid.
Don't do that.
- It will help.
- No.
- What? - I'm on a hunger strike.
They want to deport my son.
- Elena, you're cold and dehydrated.
- Maybe now the INS will give us a new hearing.
Do you know the risks of refusing our care? Do you know that you could go into a coma and die? I don't want to lose my son.
Okay.
Cancel all the orders.
No fluid bolus? No labs, no EKG? You heard her.
Nothing.
No one is going to remember what I was wearing.
- No, people notice.
- Watch out.
Watch out.
- Are you all right? - Yup.
- Morning, Jake.
- Hey, Liza.
- How's the ER? - Good.
This is Abby, my girlfriend.
Liza's the night clerk on Surgery.
- Hi.
- Hi.
- We're kind of late, so - Me too.
Hey, stop by sometime.
Did you say "girlfriend"? - What? - Nothing.
Takes me right back to junior high.
- What do you want me to call you? - How about introducing me as "Abby"? You don't want people to know we're going out.
- We're late.
- No.
Hey, look, this is important.
Well, let's just talk about it later.
Yeah.
Yeah, I guess it can wait.
You look ridiculous.
What was I supposed to do? They only had small and extra large.
What's up, homey? - Sorry about being late.
- Nice scrubs.
- You should coordinate outfits every day.
- Yeah, it's cute.
Maybe we can find you some matching stethoscopes or Victim of assault for Abby and low blood sugar for your boy toy.
Okay.
All right, all right.
It's rough when everyone knows you're an item.
- That could work.
- What? "This is Abby.
She's my item.
" Ninety-six point one.
- Do you want a warm blanket? - Please.
- I am thirsty.
- Some orange juice? Only water.
Elena? - I'm Benjamin Coe from Legal Aid.
- I'm Dr.
Lewis.
How's she doing? Malnourished and dehydrated, heading for a coma.
Maybe we'll see some movement now.
This should get the INS to grant us a new hearing.
- Her son's an illegal alien? - Undocumented immigrant.
They can just send the kids back? Well, Elena has her green card.
She came here in '89.
Her brother brought Santiago up through Mexico seven years ago.
- How did the INS get involved? - Santiago got into trouble.
Attempted robbery.
They locked him up for two years in juvie.
Once he did time, they transferred him to Immigration.
He won't last in El Salvador.
The police there round up gang members.
Sometimes they get beaten to death, sometimes they just disappear.
If he goes home, they'll kill him.
- I brought her durable power.
- What's that? Says she's competent to start a hunger strike and refuse nutrition even if she's unconscious.
We can't give her an IV? That would be felony assault.
If you try to treat her, I'll call the police.
We need a kitchen.
The staff break room can accommodate a refrigerator- No, I mean a commercial kitchen.
The HIV daycare program should be able to provide a hot lunch.
I'll mention that to the architect.
So, John, if you're okay we're ready to go to the contractors for a bid.
I'm thinking 150 million is in the ballpark? That's a nice ballpark.
A leadership gift from the Carter Foundation would help get it rolling and we've drawn up a list of potential corporate donors.
We were hoping that you could make some calls on the hospital's behalf.
No, thanks.
Your personal involvement would be very useful in contacting the- We weren't happy with the idea of corporate sponsorship.
So we would be interested in covering the construction costs.
The entire thing? Plus an endowment to supply the center's annual budget to treat uninsured patients.
This is an incredibly generous offer.
We would appreciate a naming opportunity.
Of course.
Do you have some suggestions? I do, actually.
But I would like to discuss it further with a few family members first.
To the side.
Up and down.
- How many times were you punched? - Just once.
- Then he grabbed her purse.
- Where did this happen? - Twenty-third.
- Wabash.
Well, it- It was near the corner.
Did you file a police report? What's the point? They might catch the guy.
We didn't get a good look at him.
- Okay.
I'm going to take you to X-ray.
- Wanna look this way? Can-? Can I stay with her? No, I'm sorry.
Chuny, maybe Rebecca would like some coffee? - Can I have tea? - Sure.
You wanna come with me? Stay out of trouble, sweetie.
Okay, Roberta.
I just have a couple more questions for you.
Birdy.
Everybody calls me Birdy.
Who do you live with? Just my sister and me.
Been that way for 50 years.
- Is there anything you wanna tell me? - Like what? Like sometimes people are injured by their friends or their family members.
It- It was a kid, just some punk.
Are you sure? And you feel safe at home? Of course.
Okay.
I'm gonna order x-rays.
I left a voicemail for the caseworker at the INS.
- Can you talk to her? - And say what? - Hey, Frank? - Hold on.
Just tell them how sick she is.
Dr.
Lewis, I converted the tables to a TIFF file.
- You removed the P-values? - Oh, crap.
They want differences expressed as relative risk.
- I'll be back.
- Well, page Social Work again.
- I need a facial series in 4B.
- For Birdy? - You know her? - She and her sister panhandle on Wabash.
I give them a buck once in a while.
It's a travesty what we let happen to the elderly.
Hey, Wendall, I have a consult for you.
- Hunger-strike lady? - That's mine.
Sorry.
Elena Tabajas? - I read about her.
- You did? She was in the newspaper a few weeks ago.
Trying to get asylum for her son? A few weeks.
I had pancakes for breakfast.
I'm starving already.
I don't know what to say.
Well, I've been looking for some time for the right thing to donate to.
It seemed only fitting.
Have you thought about any future role in the outpatient center? Yeah.
I'd like to sit on the board.
And I suppose I might see a few patients.
You agree it's better to recruit someone with more experience as director? Definitely.
Yeah.
I don't want to run the place, Kerry.
Too much paperwork.
Good.
I've identified four outstanding candidates.
Well, I'd be happy to look over their CVs but I've actually been talking to Todd Becker.
- Todd Becker from Stanford? - Well, he's at Columbia now.
He's set up a network of clinics in Harlem and the South Bronx.
He'd be perfect.
- Why are you doing this? - Oh, he'd be a great director.
No, I mean the whole thing.
The center, the 150 million.
- What's going on? - City needs it.
There's no prevention, there's no primary care.
The whole system's broken.
Well, that's not new.
Why now? For 11 years I've been here patching up people who fall through the cracks and it hasn't been enough.
I wanna do more.
Dr.
Carter.
Tier-two trauma.
- MVC? - Fell down a flight of stairs.
- Chest and hip pain.
- Good vitals.
You guys get started.
I'll be right there.
So you'll send me that file? - What's that? - The guy from Columbia.
Todd Becker.
You're gonna love him.
I promise.
- Hey.
- Hi.
How are you? I'm okay.
I'm gonna finish an eval before Psych gets here.
Trauma panel, C-spine, chest and pelvis.
Type and cross for two.
- Did you fall down a flight of stairs? - From the very top.
- Was there carpeting? - Cement.
I slipped while I was mopping.
- Pulse ox, 92.
- Decreased breath sounds here.
What's this gonna cost? - That's what insurance is for.
- I don't have any.
Workers' comp will cover it.
I'm a temp.
Once a month, they pay me $50 to clean the warehouse.
You're in County.
We'll take care of you.
Put your right leg down, please.
I- I can't.
Looks like posterior hip.
I should go home and rest.
It- It- It just feels like a bruise.
You have a collapsed lung, your hip is out of joint - and you could be bleeding internally.
- I'm okay.
- Jake, chest tube on the left.
- Got it.
- Ray, you take the hip.
- Etomidate.
Please! Just- Just- Just take all this stuff off of me.
Ma'am? Ma'am.
Head trauma.
She's not thinking clearly.
- Yes, I am.
- No, you're not.
Keep going with that.
You'll thank us later for this, ma'am.
I spoke to Psychiatry.
They support her competency to refuse nutrition.
- Even if she's unconscious? - Even then.
So we're all in agreement.
No treatment, right? Dr.
Lewis, she's seizing.
Probably hyponatremia.
You need to let this happen.
Her only intake has been water.
Her serum sodium is too low.
- Got a vein.
- What are you doing? - Keeping her alive.
- She doesn't want to be treated.
- Sam.
- A patient takes an overdose we tie them down and pump their stomach.
But we let this woman die? - Yeah, what's the difference? - She isn't suicidal.
She wasn't depressed.
She's motivated by desire to achieve an end, not by a desire to kill herself.
- Same outcome.
- We have to respect her autonomy.
We have a duty to act in her best interest.
Heart rate's up, poor air exchange, getting dusky.
Dr.
Lewis, what do you wanna do? - How about oxygen? - Nothing.
- Five liters.
- Dr.
Lewis.
It's a comfort measure, it won't save her.
Go ahead.
You may not like what she's doing but she has the right to do it.
How long can this go on? After 30 minutes, there's a very high risk of brain damage.
- She's bleeding.
- Oh, God.
Can somebody find out if the INS has called? She bit her tongue.
Yankauer.
What is that? Stop.
Ativan, two milligrams.
Neela! We have a document stating she did not want to be treated for the consequences of her fast.
- Neela, get out of the room.
- It could have saved her life.
Thank you.
You're off the case.
Your sedative's gonna wear off in about two minutes.
-32 French.
- It won't budge.
Keep going.
I can't get this.
Try the Whistler technique.
I don't know that one.
All right.
Your arm goes under the bad knee, over the good one.
Stabilize the ankle with your right hand.
- Pass the chest tube? - Check the tract, wait.
Chuny, would you come over here and help me? Matter of fact, I'll stabilize the pelvis.
Ray, you get in the position I was just in.
- Okay.
- I can feel lung tissue.
She's starting to wake up.
Okay, listen.
Arms level.
Stand up straight.
The femoral head will slip over the acetabular rim.
- Was that it? - I heard a pop.
You got it.
Good job, Pratt, Ray.
All right.
Let's fix the lung up.
- There's some resistance.
- Okay.
Just give it a little more muscle.
Hey, man.
- Nice.
- What are you doing? Pull your pants up.
- Sterile gloves.
- Oh, that's a bummer.
- Dr.
Pratt, do you think you could-? - Hell, no.
- Ray? - No.
I need to do a post-reduction exam.
- Chuny? - That would be sexual harassment.
Okay.
All right.
Thank you very much, everybody.
0-silk, please.
Yes, Roberta and Rebecca Chaddock.
All inpatient records and ER visits for the past year.
Thanks.
- Anybody to present? - Yes.
Elder assault, possible abuse.
Social Services on it? Yes.
And I'm reviewing all the old charts.
- Good.
- Abby, I'm all yours.
I was just filling in Dr.
Carter.
- I can come back.
- No, that's okay.
Why don't you two go see the patient and you can bring me up to speed later.
Okay.
- My head hurts.
- Yeah.
That's from the seizure.
Elena, I don't know how much longer your body can take this.
Do you have to do that again? We're trying to respect your wishes but I would hate for you to do this unnecessarily.
It's not unnecessary if it helps save Santiago.
What if they don't give you a hearing? Want your son to live with your death on his conscience? I wasn't there when he was little.
My husband was killed in the war, so I came here.
I sent Santiago money for seven years.
When he was 12, I got tired of waiting for the papers to come through.
He was old enough.
So my brother Alfonso snuck him in.
You've done everything you could.
You don't have to do this.
Let us treat you.
I'm so tired.
We'll let you rest.
I can't believe she has to go through this.
She's a mother trying to save her son.
I'd throw myself in front of a train for Cosmo.
Where's Chuny? Okay.
All right.
We need a BOA kit.
His wife's having a baby? - Okay? - Should I get a gurney? She's crowning.
We need a bulb syringe and some towels.
Okay, now push it for me, mama.
Okay? Come on.
Push it! Push.
Come on.
Come on.
What? What are you doing? Are you crazy? Get off me! Hey, get off me! What the hell's the matter with this dude? Puje means push.
- You said puta.
- What does that mean? You called his wife a whore.
Okay, here we go, honey.
Hey, Dr.
Lewis.
- I'm getting coffee.
- Chuck's on line two.
- Sounds like Cosmo's sick.
- With what? No, I'm at the hospital now.
I'll take it in the lounge.
- I've got the doctor right here.
- Wait.
- I've prepared the graphs.
- This is not a good time.
Four hours before we have to turn it in.
Did you include the 95-percent confidence intervals? Catch me later.
- Hey, Chuck.
- No, she'll be right with you.
Any vomiting? He's alert? Good eye contact? Okay.
Well, just call me when his fever comes down.
Okay, listen, I gotta go.
All right.
Bye.
Bye.
Bye, Chuck.
I've got the INS.
This is Dr.
Lewis.
Yes, I am.
She's dying.
No, but there's something you can do.
You can give her son a new hearing.
She may not make it another day.
- Thank you.
- Sure.
I know she didn't want to be overfed, but I gave her Ativan.
Ativan doesn't have any calories.
Would you shock an end-stage cancer patient with a DNR? - What you did was just as wrong.
- She was suffering.
She was unconscious.
I couldn't just watch her die.
Then you should've left the room.
It doesn't seem right.
It's not.
It's just the rules.
Pre- and post-reduction hip.
- No fracture.
- And the lungs expanded nicely.
Good.
What happened to you? Had a rough delivery.
Hip lady's labs.
- Crit's okay? - Yeah, but calcium's 12.
4.
What caused the bump? - It's a long differential.
- But the top two causes are? - Hyperparathyroidism.
- And cancer.
Yeah.
You see these rib fractures here? There's lesions underneath that may have weakened the bone.
- Metastases.
- That isn't where the malignancy started.
No.
You have to go back and find the site of the primary tumor.
- Damn.
- Well, that sucks.
- She's a nice lady.
- Yeah.
I hear that's a risk factor for cancer.
The nose is slightly cracked and the knee is bruised.
Nothing serious.
Oh, she's a tough one.
You two have been mugged several times in the past year.
Occupational hazard.
How come you have to panhandle? Because they aren't hiring at Hooters.
Well, I'm serious.
It's dangerous.
Don't tell me you haven't been smacked in here.
What about Social Security? We have rent and heating bills, electrics, medications.
We should have Adult Services make a visit.
Again? They went out last summer.
The place was pretty messy.
Well, we would have cleaned it up if we knew they was coming.
You didn't have much food in the cabinets.
We like to eat out.
Is there anything we can do to help? We do just fine.
- I could request another home visit.
- Suit yourself.
I'll be back with your discharge instructions.
Yes, ma'am.
Still tachy at 120.
She can have some more water.
Dr.
Lewis, navicular fracture has his thumb spica.
- Is that the hunger-strike lady? - Yeah.
- There's gotta be a better way.
- She's got no money no political influence.
This is it.
Ortho clinic in a week.
You got it.
She should at least get to see her son.
If they know she's dying, maybe they'd let him visit.
Maybe he can get her to eat.
- Worth a shot.
- He'd better get here fast.
Thyroid feels good.
You say I got holes in my bones? It's in two of the ribs.
I should drink more milk.
I need to do a breast exam next.
What for? Well, your bone lesions could have been caused by the spread of a tumor.
You mean cancer? Possibly.
Have you felt this before? A mass? - Upper outer quadrant, five centimeters.
- Five? When did you first notice it? A couple years ago.
Why didn't you see a doctor? I've been fine.
Yeah, you could have caught this before it spread.
Surgery might not be as effective at this advanced stage.
You wanna cut me? I don't think so.
An operation might be part of the treatment plan.
- Where are my clothes? - Okay, take it easy.
You're all hooked up.
- I never should've come.
- You have to stay.
- I don't want you cutting into me.
- Okay, relax.
- Relax, please.
- No! - It's okay.
It's okay.
- No! - You don't cut into cancer! - Okay.
We're not going to.
- I know what happens when you- - Settle down.
- It spreads.
- Mrs.
Graham.
It spreads.
And you die.
Okay.
All right.
Okay? - Wound check in two days.
- We'll see you then.
- Thank you, doctor.
- Bye-bye.
Hey, hold on.
Why don't you guys have a nice dinner tonight.
You are so sweet.
Was that a 20? No wonder your patient-satisfaction scores are so high.
- You waiting on a run? - Sort of.
- See you later.
- Yeah.
Come on.
Keep moving.
Boxers would stick out more.
- It could be tighty whities.
- Thong.
- Maybe Abby can settle this.
- Settle what? Boxers or briefs? Actually, he goes commando.
- A hunger strike? - It's been 41 days.
Damn.
All I heard was she was protesting.
She's weak.
Lost a lot of weight.
- Can't you make her eat? - That's why you're here.
Do you want to go in? Elena? - Elena? - Someone's here to see you.
Take a step back.
- Is that necessary? - He's still in custody.
Can you give them a minute? As long as he keeps his distance.
I'm okay.
I haven't seen him in six months.
How long can she last? - It's hard to know.
- A few days at most.
- You should be helping her.
- We're trying.
No, you're not doing anything.
You're doctors.
You're supposed to help.
Please let these people help you.
People think that about cancer? It's an urban myth.
Not to her.
To her, it's a reality.
Yeah.
Superstition.
Yeah, well.
There's no screening, no early detection in her community.
She only sees friends diagnosed late.
Look.
Check this out.
Guy with colon cancer he comes and he presents with bowel obstruction.
Gets surgery, mets are everywhere.
They do the colostomy, they close him back up.
- Dead in six months.
- Exactly.
All his friends say, "He was fine till he got the surgery.
" How you doing, Mrs.
Graham? Had the chance to think about what we discussed? I don't want no surgery.
They put a thin needle into the lump and pull out some cells.
What happens then? Well, based on the findings, we can recommend the appropriate treatment.
Like what? Well, you know, that really depends on the tumor.
Could be radiation.
Could be chemotherapy.
Oh, no.
I don't want that.
Look, I'm sorry, ma'am, but is this about money? You know, because with cancer, you qualify for state aid.
It's not about money.
Look, if the biopsy shows a certain kind of tumor your options are very good.
You could take medication once a day and survive for years.
You're telling me I got cancer in my bones and all I got to do is take a pill? If it's the right kind of tumor.
I'll take the pill then.
Good.
First we have to do the biopsy to make sure it'll work.
No.
No needles, no surgery.
I've had it for two years and I been doing fine.
We can't help you if you don't let us.
Who's gonna help me get to the doctor all the time? Gonna stay with me when I'm spitting up all night? Who's gonna help me up the stairs when I'm too weak to walk? Who's gonna do that? You? - Why do you want to kill yourself? - To save you.
- She needs food.
- We know that.
- Then feed her.
Give her something.
- She wouldn't eat it.
- You can force it down her throat.
- Please.
I don't need help.
I can take care of myself! - All right.
Where can we put him? - Family room.
- Bring the van around.
- You want to help.
All you do is mess up! - Don't talk like that.
- You should've forgot about me! I was better off in El Salvador! Hey.
Hey! What is your problem? - She has the problem.
- She's doing this for you.
Well, I never asked her to! Come here.
Maybe we will force-feed her because your getting deported sounds like a good idea now.
- I'll go back home.
I don't care.
- So you wanna die? Look, it's not like she says.
I had a good life there.
- She ruined everything.
- She wanted you to be together.
Right.
Yeah.
She worked two jobs.
I hardly know her.
She wanted a better life for you.
Oh, yeah? You think it worked out? She loves you.
She isn't doing this for me.
She's doing this because she feels guilty.
- Let her go, if that's what she wants.
- You don't mean that.
Sure, I do.
Just let her die.
Do you have Mueller's chart? Oh, yeah.
- Sorry.
I'm doing three consults.
- That's all right.
I just need to cosign it.
You wanna grab some lunch? I I have to get up to the unit.
- Dinner? - I don't know.
Look, I feel bad about everything.
- Me too.
- Well, I'm sorry.
You know, I'm really good at getting in my patients' heads.
I wish I'd been able to figure out what was going on in yours.
I have to get up to the ICU.
There's a family waiting.
You left some stuff at my place.
I can bring them by sometime.
- I can come by tonight and pick it up.
- Okay.
Leave them in a bag on the steps.
Sure.
If that's what you want.
Thanks.
Doc, think she'll eat now? - Probably not.
- Too bad.
She'll die, the kid will get deported.
- What about the hearing? - Not sure if it'll change anything.
We'll see what my boss says.
Good to go.
- Thanks for your help.
- Can't say we didn't try.
Dr.
Lewis, Elena's unresponsive.
I checked the Internet.
Forty-five days.
- For what? - I.
R.
A.
prisoners in Belfast.
They started dying 45 days after fasting.
- How long has she been going? - Forty-one.
Oh, Sam.
Paramedic's on the MICN.
Hey.
Okay, I made all the revisions, rewrote the abstract and conclusion.
- I can't deal with this now.
- We got an hour.
Look it over.
I can e-mail it.
We'll make the deadline.
- It's important to me too.
Sorry.
- Dr.
Lewis, please.
- May I call you Susan? - No.
I need this publication for my Chief Resident application.
Trust me.
It's gonna take a hell of a lot more than that.
Convert the chest tube to a Heimlich valve.
Call for an ambulance and have a nurse drop in on her.
You're sending her home? We need to put a bit more pressure on her.
- I just tried.
- Not very hard.
- Well, we can't force her.
- Yeah, but we can help her.
Maybe in a couple days she'll change her mind and reconsider.
- If she goes home, she's not coming back.
- Respecting her wishes is first.
Then maybe she'll get into Oncology.
- Or she's lost a follow-up.
- This lady does not have a doctor.
She doesn't feel comfortable with the medical system.
That's what's making it tough.
I'm feeling a lot better.
Beta-blockers kicked in.
Your heart rate's down.
- Cool.
- Overactive thyroid can cause glaucoma - so I need to check your eye pressures.
- Go for it.
First, a drop.
Now, this might feel a little weird.
Excuse me.
I need a Heimlich valve.
- Go ahead.
- It's okay.
It's okay.
- You use proparacaine? - Yeah.
- Here.
- Did my eyeball come out? - Oh, my God! - Chuny 10 of morphine right away.
Jake, dribble the local.
Adrian, what's happening to you is called a subluxed globe.
Get me an Attending.
- Kovac is here.
- Everything's blurry! That's normal.
You're gonna be okay.
- Adrian, we need you to stay still.
- I can't! Okay, you have to.
Is that Legal Aid lawyer still here? No.
He had to go to class.
Turns out he's a third-year law student.
Cocky little bugger.
Hey.
Five more minutes and I'd have given her the Ativan myself.
Sam, your hunger-strike lady's asking for you.
- In there? - She's coming around.
Elena, what do you need? The bathroom.
The bathroom.
Where did this come from? I don't know.
I didn't have an order for an IV.
With an amp of multivites.
- Did you do this? - No.
What's going on? Well, Elena's awake.
With an IV.
- Yeah, I can see that.
- What is this? - We just- - Could you two step outside? I need to talk to Elena alone.
What happened? It's okay.
Elena, it's okay.
What? Who knew Lewis could start an IV all by herself? All right, I'll stop by.
Thanks.
Pratt, we'll run the board as soon as I help Abby.
- I need to go up to Oncology for a bit.
- Okay.
Okay, Adrian.
Keep looking down.
- You needed an Attending? - Welcome to your night shift.
Subluxed globe.
Scleral pressure's not doing it.
- Okay.
We need a Desmarres retractor.
- We don't have one.
- Do we have a paper clip? - A paper clip? Yeah.
You're sticking a paper clip in my eye? - Don't worry.
You won't feel a thing.
- Oh, God.
Okay, okay, okay.
How about some Versed? Don't you have an eye specialist or something? Everything's okay, Adrian.
Stay still.
Nice and relaxed.
Okay, insert between the upper lid and the superior rectus.
Right there.
It's- It's tough.
Jake, retract the lid superior.
- Got it.
- Good.
- A little bit more.
- Cover the end depress with your ring finger.
You're doing great.
Take a deep breath.
Let it out.
We're almost done.
Okay.
The eyelid is past the equator.
Okay.
Look up, Adrian.
Oh, my God.
I can see.
Nice.
I'm cold.
They're getting you some warm blankets.
Did you do this? It's just one bag.
After that, it's up to you.
But it was up to me already.
You know, I talked to some reporters.
You're getting a lot of attention.
Because I'm dying.
Here you go.
The INS is taking your demand for a hearing very seriously.
They don't want the bad press.
You have done all you can.
It's okay to eat now.
Not until they let him stay.
He wasn't always like this.
He was a good boy.
He did a stupid thing, and then, in jail, he joined the gang.
You try so hard, but you never know how they'll turn out.
All he has now is anger and hate.
But you want to keep going? He's still my son even though he doesn't care about me.
I think he does.
He just doesn't know how to show it.
The last thing he said to me on his way out was: "Please don't let her die.
" What time is the ambulance coming to take me home? Should be in about an hour.
There's someone I'd like you to meet.
As long as it's no surgeon.
She's not even a doctor.
Debra Graham, I'd like you to meet May Crawford.
- Hello.
- What are you? The social worker? No.
A psychologist.
I'm a secretary at an ad agency.
And a breast-cancer survivor.
It's been three years now.
We'll let you two talk.
I had some spots on my bones.
That's how they found it.
- Really? - Okay, where did you find her? A cancer support group upstairs.
They have patient navigators to help people get through the system.
Think it'll work? Maybe she'll listen to her more than she'll listen to us.
Hey.
Thought you were gonna leave the stuff on the steps.
Yeah, I got stuck doing an LP on a 300-pound guy.
- It's cold, huh? - Yeah.
Springtime in Chicago.
Wanna come in for a second and get warm? I don't think so.
You have my stuff? Yeah.
Hang on a second.
Thanks.
You need to get that? No.
The machine will pick it up.
Sure you don't wanna come in? I could make coffee.
Or some tea.
No, I should get going.
Yeah.
Good night, John.
Good night.
We did a good job getting that kid's eyeball back in.
Yes.
We're a pretty good team.
Yeah.
"This is Abby.
She's my teammate.
" "This is Abby.
She's my partner.
" No.
It sounds like we work at a law firm.
How about "my special friend"? What are you afraid that people will think? - What? - This morning, that's what you said.
I just don't want us to go too fast and get ahead of ourselves.
- You have two weeks to decide.
- Decide what? How fast you want to go, how you'd like to be referred to.
What happens in two weeks? - Big family thing.
- Oh, yeah? - Yeah.
It's like a Saturday brunch.
- Okay.
And before that, we're gonna have to go to church.
- Church? - Yeah.
My niece is getting baptized.
- I have to hold her.
- Oh, you're the godfather.
Yeah.
If something happens to the parents, I'm responsible.
That sort of thing.
So I'm going to a baptism as the godfather's? Fill in the blank.
Dr.
Carter? Ed Miyamoto.
The revised architect's plans will be in my office Friday.
Stop on by.
Hello.
If your current mortgage rate is more than- Hi, John.
About 6 in the morning here.
Just wanted to say hello.
You could call, but I'm leaving for work in an hour.
Bye.
Hey.
Hi.
It's me.
I wasn't sure I was gonna catch you.
Well, I just got home from work.
It was good.
I looked at the plans today.
Yeah.
And I've been thinking about a name for the building.
Well, how would you feel about "The Joshua Carter Center"? Yeah, after the baby.
For the first two days, it's pretty much all IV but we can try a small amount of clear liquids.
- That's it? - Just a few spoonfuls until your stomach gets used to it.
I swore I wouldn't stop until he was safe.
Bless us, O Lord, in these, thy gifts which we are about to receive from thy bounty through Christ our Lord.
Keep my son away from harm.
Amen.
- Amen.
- Amen.
Hello? Yeah.
Hey.
Okay, hold on.
Dr.
Lewis, it's Chuck on line four.
I'll take it in the hallway.
Okay.
Okay, put him on.
Hi, baby.
It's Mommy.
Yeah.
You need to go to bed for Daddy, okay? I'll be home soon.
No, I'm sorry.
I can't do that right now.
Yeah.
All right.
All right, I'll try.
"One hippo, all alone calls two hippos on the phone.
Three hippos at the door bring along another four.
Five hippos come overdressed.
Six hippos show up with a guest.
Seven hippos arrive in a sack.
Eight hippos sneak in the back.
Nine hippos come to work.
All the hippos go berserk.
"
R.
Previously on E.
R.
I was thinking that maybe we shouldn't be quite so together here.
- I thought everybody knows.
- I didn't tell anybody.
Dad's taking me to Florida.
You can take whatever you want.
I don't care.
But he's not going anywhere with you.
We'll catch the whales in the fall, kiddo.
- I'm going the other direction.
- What? All right.
I know what you want me to say and- And I can't say it, okay? But things with Wendall didn't work out.
Oh, I'm sorry.
Yeah.
It's weird.
She's actually not really even speaking to me.
E.
R.
11x18 "REFUSAL OF CARE" - Oh, my God.
Oh, my God.
- What? What? - You have to get up.
Get up, get up.
- What? What? What? - It's 7:32.
- Yeah? Rounds are at 8.
- I hit the snooze.
- No, you shut the alarm off.
Sorry.
I thought you were gonna go home and change.
- It's okay.
- No, it's gonna look weird.
- No, it won't.
- You're back in the ER.
- People will think- - What are they gonna think? That I don't do my laundry? That I sleep in the park? - What? - Abby needs to take a few pass-ons.
- She's late.
- Brushing up on your Spanish, huh? It helps me relate to the community.
- Oh, yeah? What's her name? - Okay, one left.
- Asthma going to the ICU.
Get an art line.
- Got it.
- Meaning? - I'll take care of it.
- Teach the residents how to do it? - Absolutely.
That's the board.
Alex has soccer after school.
I thought you could drop him off.
Isn't the carpool picking him up? Yeah, but he needs to work on his corner kick.
He's still pretty mad at me.
Well, think of it as an icebreaker.
Maybe we should give it a little more time.
- I'll see you tonight.
- All right.
Have a good nap.
- Morris! - Sorry.
I came in to work on our manuscript revisions.
We'll see if I have the time.
They're due by 5 p.
m.
- Today? - We don't wanna miss the deadline.
You two are publishing? "Oligoanalgesia in Long-Bone Fractures: A Retrospective Review.
" Accepted in the annals next month if we can make a few changes.
Some substantial changes.
Go to the doctors' lounge.
I'll be right in.
Consider it done.
You're working with Morris? Yeah.
You know, he's thorough, good with statistics.
And the only resident desperate enough to write it up? - You got it.
- Dr.
Lewis - would you let me run a trauma today? - Do you think you're ready for that? In a couple of months I'll be an R2 supervising the interns.
- It might be good to get practice.
- Need a bed.
- Hypothermia.
- All yours.
Elena Tabajas, 39.
Passed out at the immigration building.
- Tachy at 120.
- She's cold.
Some kind of a protest.
You need to call Benjamin Coe.
He's my lawyer.
- What? - Don't do anything until he's here.
CBC, chem panel, EKG, a liter of saline, O2 at 2 liters, and get a rectal temp.
- What are you doing? - We're giving you warm IV fluid.
Don't do that.
- It will help.
- No.
- What? - I'm on a hunger strike.
They want to deport my son.
- Elena, you're cold and dehydrated.
- Maybe now the INS will give us a new hearing.
Do you know the risks of refusing our care? Do you know that you could go into a coma and die? I don't want to lose my son.
Okay.
Cancel all the orders.
No fluid bolus? No labs, no EKG? You heard her.
Nothing.
No one is going to remember what I was wearing.
- No, people notice.
- Watch out.
Watch out.
- Are you all right? - Yup.
- Morning, Jake.
- Hey, Liza.
- How's the ER? - Good.
This is Abby, my girlfriend.
Liza's the night clerk on Surgery.
- Hi.
- Hi.
- We're kind of late, so - Me too.
Hey, stop by sometime.
Did you say "girlfriend"? - What? - Nothing.
Takes me right back to junior high.
- What do you want me to call you? - How about introducing me as "Abby"? You don't want people to know we're going out.
- We're late.
- No.
Hey, look, this is important.
Well, let's just talk about it later.
Yeah.
Yeah, I guess it can wait.
You look ridiculous.
What was I supposed to do? They only had small and extra large.
What's up, homey? - Sorry about being late.
- Nice scrubs.
- You should coordinate outfits every day.
- Yeah, it's cute.
Maybe we can find you some matching stethoscopes or Victim of assault for Abby and low blood sugar for your boy toy.
Okay.
All right, all right.
It's rough when everyone knows you're an item.
- That could work.
- What? "This is Abby.
She's my item.
" Ninety-six point one.
- Do you want a warm blanket? - Please.
- I am thirsty.
- Some orange juice? Only water.
Elena? - I'm Benjamin Coe from Legal Aid.
- I'm Dr.
Lewis.
How's she doing? Malnourished and dehydrated, heading for a coma.
Maybe we'll see some movement now.
This should get the INS to grant us a new hearing.
- Her son's an illegal alien? - Undocumented immigrant.
They can just send the kids back? Well, Elena has her green card.
She came here in '89.
Her brother brought Santiago up through Mexico seven years ago.
- How did the INS get involved? - Santiago got into trouble.
Attempted robbery.
They locked him up for two years in juvie.
Once he did time, they transferred him to Immigration.
He won't last in El Salvador.
The police there round up gang members.
Sometimes they get beaten to death, sometimes they just disappear.
If he goes home, they'll kill him.
- I brought her durable power.
- What's that? Says she's competent to start a hunger strike and refuse nutrition even if she's unconscious.
We can't give her an IV? That would be felony assault.
If you try to treat her, I'll call the police.
We need a kitchen.
The staff break room can accommodate a refrigerator- No, I mean a commercial kitchen.
The HIV daycare program should be able to provide a hot lunch.
I'll mention that to the architect.
So, John, if you're okay we're ready to go to the contractors for a bid.
I'm thinking 150 million is in the ballpark? That's a nice ballpark.
A leadership gift from the Carter Foundation would help get it rolling and we've drawn up a list of potential corporate donors.
We were hoping that you could make some calls on the hospital's behalf.
No, thanks.
Your personal involvement would be very useful in contacting the- We weren't happy with the idea of corporate sponsorship.
So we would be interested in covering the construction costs.
The entire thing? Plus an endowment to supply the center's annual budget to treat uninsured patients.
This is an incredibly generous offer.
We would appreciate a naming opportunity.
Of course.
Do you have some suggestions? I do, actually.
But I would like to discuss it further with a few family members first.
To the side.
Up and down.
- How many times were you punched? - Just once.
- Then he grabbed her purse.
- Where did this happen? - Twenty-third.
- Wabash.
Well, it- It was near the corner.
Did you file a police report? What's the point? They might catch the guy.
We didn't get a good look at him.
- Okay.
I'm going to take you to X-ray.
- Wanna look this way? Can-? Can I stay with her? No, I'm sorry.
Chuny, maybe Rebecca would like some coffee? - Can I have tea? - Sure.
You wanna come with me? Stay out of trouble, sweetie.
Okay, Roberta.
I just have a couple more questions for you.
Birdy.
Everybody calls me Birdy.
Who do you live with? Just my sister and me.
Been that way for 50 years.
- Is there anything you wanna tell me? - Like what? Like sometimes people are injured by their friends or their family members.
It- It was a kid, just some punk.
Are you sure? And you feel safe at home? Of course.
Okay.
I'm gonna order x-rays.
I left a voicemail for the caseworker at the INS.
- Can you talk to her? - And say what? - Hey, Frank? - Hold on.
Just tell them how sick she is.
Dr.
Lewis, I converted the tables to a TIFF file.
- You removed the P-values? - Oh, crap.
They want differences expressed as relative risk.
- I'll be back.
- Well, page Social Work again.
- I need a facial series in 4B.
- For Birdy? - You know her? - She and her sister panhandle on Wabash.
I give them a buck once in a while.
It's a travesty what we let happen to the elderly.
Hey, Wendall, I have a consult for you.
- Hunger-strike lady? - That's mine.
Sorry.
Elena Tabajas? - I read about her.
- You did? She was in the newspaper a few weeks ago.
Trying to get asylum for her son? A few weeks.
I had pancakes for breakfast.
I'm starving already.
I don't know what to say.
Well, I've been looking for some time for the right thing to donate to.
It seemed only fitting.
Have you thought about any future role in the outpatient center? Yeah.
I'd like to sit on the board.
And I suppose I might see a few patients.
You agree it's better to recruit someone with more experience as director? Definitely.
Yeah.
I don't want to run the place, Kerry.
Too much paperwork.
Good.
I've identified four outstanding candidates.
Well, I'd be happy to look over their CVs but I've actually been talking to Todd Becker.
- Todd Becker from Stanford? - Well, he's at Columbia now.
He's set up a network of clinics in Harlem and the South Bronx.
He'd be perfect.
- Why are you doing this? - Oh, he'd be a great director.
No, I mean the whole thing.
The center, the 150 million.
- What's going on? - City needs it.
There's no prevention, there's no primary care.
The whole system's broken.
Well, that's not new.
Why now? For 11 years I've been here patching up people who fall through the cracks and it hasn't been enough.
I wanna do more.
Dr.
Carter.
Tier-two trauma.
- MVC? - Fell down a flight of stairs.
- Chest and hip pain.
- Good vitals.
You guys get started.
I'll be right there.
So you'll send me that file? - What's that? - The guy from Columbia.
Todd Becker.
You're gonna love him.
I promise.
- Hey.
- Hi.
How are you? I'm okay.
I'm gonna finish an eval before Psych gets here.
Trauma panel, C-spine, chest and pelvis.
Type and cross for two.
- Did you fall down a flight of stairs? - From the very top.
- Was there carpeting? - Cement.
I slipped while I was mopping.
- Pulse ox, 92.
- Decreased breath sounds here.
What's this gonna cost? - That's what insurance is for.
- I don't have any.
Workers' comp will cover it.
I'm a temp.
Once a month, they pay me $50 to clean the warehouse.
You're in County.
We'll take care of you.
Put your right leg down, please.
I- I can't.
Looks like posterior hip.
I should go home and rest.
It- It- It just feels like a bruise.
You have a collapsed lung, your hip is out of joint - and you could be bleeding internally.
- I'm okay.
- Jake, chest tube on the left.
- Got it.
- Ray, you take the hip.
- Etomidate.
Please! Just- Just- Just take all this stuff off of me.
Ma'am? Ma'am.
Head trauma.
She's not thinking clearly.
- Yes, I am.
- No, you're not.
Keep going with that.
You'll thank us later for this, ma'am.
I spoke to Psychiatry.
They support her competency to refuse nutrition.
- Even if she's unconscious? - Even then.
So we're all in agreement.
No treatment, right? Dr.
Lewis, she's seizing.
Probably hyponatremia.
You need to let this happen.
Her only intake has been water.
Her serum sodium is too low.
- Got a vein.
- What are you doing? - Keeping her alive.
- She doesn't want to be treated.
- Sam.
- A patient takes an overdose we tie them down and pump their stomach.
But we let this woman die? - Yeah, what's the difference? - She isn't suicidal.
She wasn't depressed.
She's motivated by desire to achieve an end, not by a desire to kill herself.
- Same outcome.
- We have to respect her autonomy.
We have a duty to act in her best interest.
Heart rate's up, poor air exchange, getting dusky.
Dr.
Lewis, what do you wanna do? - How about oxygen? - Nothing.
- Five liters.
- Dr.
Lewis.
It's a comfort measure, it won't save her.
Go ahead.
You may not like what she's doing but she has the right to do it.
How long can this go on? After 30 minutes, there's a very high risk of brain damage.
- She's bleeding.
- Oh, God.
Can somebody find out if the INS has called? She bit her tongue.
Yankauer.
What is that? Stop.
Ativan, two milligrams.
Neela! We have a document stating she did not want to be treated for the consequences of her fast.
- Neela, get out of the room.
- It could have saved her life.
Thank you.
You're off the case.
Your sedative's gonna wear off in about two minutes.
-32 French.
- It won't budge.
Keep going.
I can't get this.
Try the Whistler technique.
I don't know that one.
All right.
Your arm goes under the bad knee, over the good one.
Stabilize the ankle with your right hand.
- Pass the chest tube? - Check the tract, wait.
Chuny, would you come over here and help me? Matter of fact, I'll stabilize the pelvis.
Ray, you get in the position I was just in.
- Okay.
- I can feel lung tissue.
She's starting to wake up.
Okay, listen.
Arms level.
Stand up straight.
The femoral head will slip over the acetabular rim.
- Was that it? - I heard a pop.
You got it.
Good job, Pratt, Ray.
All right.
Let's fix the lung up.
- There's some resistance.
- Okay.
Just give it a little more muscle.
Hey, man.
- Nice.
- What are you doing? Pull your pants up.
- Sterile gloves.
- Oh, that's a bummer.
- Dr.
Pratt, do you think you could-? - Hell, no.
- Ray? - No.
I need to do a post-reduction exam.
- Chuny? - That would be sexual harassment.
Okay.
All right.
Thank you very much, everybody.
0-silk, please.
Yes, Roberta and Rebecca Chaddock.
All inpatient records and ER visits for the past year.
Thanks.
- Anybody to present? - Yes.
Elder assault, possible abuse.
Social Services on it? Yes.
And I'm reviewing all the old charts.
- Good.
- Abby, I'm all yours.
I was just filling in Dr.
Carter.
- I can come back.
- No, that's okay.
Why don't you two go see the patient and you can bring me up to speed later.
Okay.
- My head hurts.
- Yeah.
That's from the seizure.
Elena, I don't know how much longer your body can take this.
Do you have to do that again? We're trying to respect your wishes but I would hate for you to do this unnecessarily.
It's not unnecessary if it helps save Santiago.
What if they don't give you a hearing? Want your son to live with your death on his conscience? I wasn't there when he was little.
My husband was killed in the war, so I came here.
I sent Santiago money for seven years.
When he was 12, I got tired of waiting for the papers to come through.
He was old enough.
So my brother Alfonso snuck him in.
You've done everything you could.
You don't have to do this.
Let us treat you.
I'm so tired.
We'll let you rest.
I can't believe she has to go through this.
She's a mother trying to save her son.
I'd throw myself in front of a train for Cosmo.
Where's Chuny? Okay.
All right.
We need a BOA kit.
His wife's having a baby? - Okay? - Should I get a gurney? She's crowning.
We need a bulb syringe and some towels.
Okay, now push it for me, mama.
Okay? Come on.
Push it! Push.
Come on.
Come on.
What? What are you doing? Are you crazy? Get off me! Hey, get off me! What the hell's the matter with this dude? Puje means push.
- You said puta.
- What does that mean? You called his wife a whore.
Okay, here we go, honey.
Hey, Dr.
Lewis.
- I'm getting coffee.
- Chuck's on line two.
- Sounds like Cosmo's sick.
- With what? No, I'm at the hospital now.
I'll take it in the lounge.
- I've got the doctor right here.
- Wait.
- I've prepared the graphs.
- This is not a good time.
Four hours before we have to turn it in.
Did you include the 95-percent confidence intervals? Catch me later.
- Hey, Chuck.
- No, she'll be right with you.
Any vomiting? He's alert? Good eye contact? Okay.
Well, just call me when his fever comes down.
Okay, listen, I gotta go.
All right.
Bye.
Bye.
Bye, Chuck.
I've got the INS.
This is Dr.
Lewis.
Yes, I am.
She's dying.
No, but there's something you can do.
You can give her son a new hearing.
She may not make it another day.
- Thank you.
- Sure.
I know she didn't want to be overfed, but I gave her Ativan.
Ativan doesn't have any calories.
Would you shock an end-stage cancer patient with a DNR? - What you did was just as wrong.
- She was suffering.
She was unconscious.
I couldn't just watch her die.
Then you should've left the room.
It doesn't seem right.
It's not.
It's just the rules.
Pre- and post-reduction hip.
- No fracture.
- And the lungs expanded nicely.
Good.
What happened to you? Had a rough delivery.
Hip lady's labs.
- Crit's okay? - Yeah, but calcium's 12.
4.
What caused the bump? - It's a long differential.
- But the top two causes are? - Hyperparathyroidism.
- And cancer.
Yeah.
You see these rib fractures here? There's lesions underneath that may have weakened the bone.
- Metastases.
- That isn't where the malignancy started.
No.
You have to go back and find the site of the primary tumor.
- Damn.
- Well, that sucks.
- She's a nice lady.
- Yeah.
I hear that's a risk factor for cancer.
The nose is slightly cracked and the knee is bruised.
Nothing serious.
Oh, she's a tough one.
You two have been mugged several times in the past year.
Occupational hazard.
How come you have to panhandle? Because they aren't hiring at Hooters.
Well, I'm serious.
It's dangerous.
Don't tell me you haven't been smacked in here.
What about Social Security? We have rent and heating bills, electrics, medications.
We should have Adult Services make a visit.
Again? They went out last summer.
The place was pretty messy.
Well, we would have cleaned it up if we knew they was coming.
You didn't have much food in the cabinets.
We like to eat out.
Is there anything we can do to help? We do just fine.
- I could request another home visit.
- Suit yourself.
I'll be back with your discharge instructions.
Yes, ma'am.
Still tachy at 120.
She can have some more water.
Dr.
Lewis, navicular fracture has his thumb spica.
- Is that the hunger-strike lady? - Yeah.
- There's gotta be a better way.
- She's got no money no political influence.
This is it.
Ortho clinic in a week.
You got it.
She should at least get to see her son.
If they know she's dying, maybe they'd let him visit.
Maybe he can get her to eat.
- Worth a shot.
- He'd better get here fast.
Thyroid feels good.
You say I got holes in my bones? It's in two of the ribs.
I should drink more milk.
I need to do a breast exam next.
What for? Well, your bone lesions could have been caused by the spread of a tumor.
You mean cancer? Possibly.
Have you felt this before? A mass? - Upper outer quadrant, five centimeters.
- Five? When did you first notice it? A couple years ago.
Why didn't you see a doctor? I've been fine.
Yeah, you could have caught this before it spread.
Surgery might not be as effective at this advanced stage.
You wanna cut me? I don't think so.
An operation might be part of the treatment plan.
- Where are my clothes? - Okay, take it easy.
You're all hooked up.
- I never should've come.
- You have to stay.
- I don't want you cutting into me.
- Okay, relax.
- Relax, please.
- No! - It's okay.
It's okay.
- No! - You don't cut into cancer! - Okay.
We're not going to.
- I know what happens when you- - Settle down.
- It spreads.
- Mrs.
Graham.
It spreads.
And you die.
Okay.
All right.
Okay? - Wound check in two days.
- We'll see you then.
- Thank you, doctor.
- Bye-bye.
Hey, hold on.
Why don't you guys have a nice dinner tonight.
You are so sweet.
Was that a 20? No wonder your patient-satisfaction scores are so high.
- You waiting on a run? - Sort of.
- See you later.
- Yeah.
Come on.
Keep moving.
Boxers would stick out more.
- It could be tighty whities.
- Thong.
- Maybe Abby can settle this.
- Settle what? Boxers or briefs? Actually, he goes commando.
- A hunger strike? - It's been 41 days.
Damn.
All I heard was she was protesting.
She's weak.
Lost a lot of weight.
- Can't you make her eat? - That's why you're here.
Do you want to go in? Elena? - Elena? - Someone's here to see you.
Take a step back.
- Is that necessary? - He's still in custody.
Can you give them a minute? As long as he keeps his distance.
I'm okay.
I haven't seen him in six months.
How long can she last? - It's hard to know.
- A few days at most.
- You should be helping her.
- We're trying.
No, you're not doing anything.
You're doctors.
You're supposed to help.
Please let these people help you.
People think that about cancer? It's an urban myth.
Not to her.
To her, it's a reality.
Yeah.
Superstition.
Yeah, well.
There's no screening, no early detection in her community.
She only sees friends diagnosed late.
Look.
Check this out.
Guy with colon cancer he comes and he presents with bowel obstruction.
Gets surgery, mets are everywhere.
They do the colostomy, they close him back up.
- Dead in six months.
- Exactly.
All his friends say, "He was fine till he got the surgery.
" How you doing, Mrs.
Graham? Had the chance to think about what we discussed? I don't want no surgery.
They put a thin needle into the lump and pull out some cells.
What happens then? Well, based on the findings, we can recommend the appropriate treatment.
Like what? Well, you know, that really depends on the tumor.
Could be radiation.
Could be chemotherapy.
Oh, no.
I don't want that.
Look, I'm sorry, ma'am, but is this about money? You know, because with cancer, you qualify for state aid.
It's not about money.
Look, if the biopsy shows a certain kind of tumor your options are very good.
You could take medication once a day and survive for years.
You're telling me I got cancer in my bones and all I got to do is take a pill? If it's the right kind of tumor.
I'll take the pill then.
Good.
First we have to do the biopsy to make sure it'll work.
No.
No needles, no surgery.
I've had it for two years and I been doing fine.
We can't help you if you don't let us.
Who's gonna help me get to the doctor all the time? Gonna stay with me when I'm spitting up all night? Who's gonna help me up the stairs when I'm too weak to walk? Who's gonna do that? You? - Why do you want to kill yourself? - To save you.
- She needs food.
- We know that.
- Then feed her.
Give her something.
- She wouldn't eat it.
- You can force it down her throat.
- Please.
I don't need help.
I can take care of myself! - All right.
Where can we put him? - Family room.
- Bring the van around.
- You want to help.
All you do is mess up! - Don't talk like that.
- You should've forgot about me! I was better off in El Salvador! Hey.
Hey! What is your problem? - She has the problem.
- She's doing this for you.
Well, I never asked her to! Come here.
Maybe we will force-feed her because your getting deported sounds like a good idea now.
- I'll go back home.
I don't care.
- So you wanna die? Look, it's not like she says.
I had a good life there.
- She ruined everything.
- She wanted you to be together.
Right.
Yeah.
She worked two jobs.
I hardly know her.
She wanted a better life for you.
Oh, yeah? You think it worked out? She loves you.
She isn't doing this for me.
She's doing this because she feels guilty.
- Let her go, if that's what she wants.
- You don't mean that.
Sure, I do.
Just let her die.
Do you have Mueller's chart? Oh, yeah.
- Sorry.
I'm doing three consults.
- That's all right.
I just need to cosign it.
You wanna grab some lunch? I I have to get up to the unit.
- Dinner? - I don't know.
Look, I feel bad about everything.
- Me too.
- Well, I'm sorry.
You know, I'm really good at getting in my patients' heads.
I wish I'd been able to figure out what was going on in yours.
I have to get up to the ICU.
There's a family waiting.
You left some stuff at my place.
I can bring them by sometime.
- I can come by tonight and pick it up.
- Okay.
Leave them in a bag on the steps.
Sure.
If that's what you want.
Thanks.
Doc, think she'll eat now? - Probably not.
- Too bad.
She'll die, the kid will get deported.
- What about the hearing? - Not sure if it'll change anything.
We'll see what my boss says.
Good to go.
- Thanks for your help.
- Can't say we didn't try.
Dr.
Lewis, Elena's unresponsive.
I checked the Internet.
Forty-five days.
- For what? - I.
R.
A.
prisoners in Belfast.
They started dying 45 days after fasting.
- How long has she been going? - Forty-one.
Oh, Sam.
Paramedic's on the MICN.
Hey.
Okay, I made all the revisions, rewrote the abstract and conclusion.
- I can't deal with this now.
- We got an hour.
Look it over.
I can e-mail it.
We'll make the deadline.
- It's important to me too.
Sorry.
- Dr.
Lewis, please.
- May I call you Susan? - No.
I need this publication for my Chief Resident application.
Trust me.
It's gonna take a hell of a lot more than that.
Convert the chest tube to a Heimlich valve.
Call for an ambulance and have a nurse drop in on her.
You're sending her home? We need to put a bit more pressure on her.
- I just tried.
- Not very hard.
- Well, we can't force her.
- Yeah, but we can help her.
Maybe in a couple days she'll change her mind and reconsider.
- If she goes home, she's not coming back.
- Respecting her wishes is first.
Then maybe she'll get into Oncology.
- Or she's lost a follow-up.
- This lady does not have a doctor.
She doesn't feel comfortable with the medical system.
That's what's making it tough.
I'm feeling a lot better.
Beta-blockers kicked in.
Your heart rate's down.
- Cool.
- Overactive thyroid can cause glaucoma - so I need to check your eye pressures.
- Go for it.
First, a drop.
Now, this might feel a little weird.
Excuse me.
I need a Heimlich valve.
- Go ahead.
- It's okay.
It's okay.
- You use proparacaine? - Yeah.
- Here.
- Did my eyeball come out? - Oh, my God! - Chuny 10 of morphine right away.
Jake, dribble the local.
Adrian, what's happening to you is called a subluxed globe.
Get me an Attending.
- Kovac is here.
- Everything's blurry! That's normal.
You're gonna be okay.
- Adrian, we need you to stay still.
- I can't! Okay, you have to.
Is that Legal Aid lawyer still here? No.
He had to go to class.
Turns out he's a third-year law student.
Cocky little bugger.
Hey.
Five more minutes and I'd have given her the Ativan myself.
Sam, your hunger-strike lady's asking for you.
- In there? - She's coming around.
Elena, what do you need? The bathroom.
The bathroom.
Where did this come from? I don't know.
I didn't have an order for an IV.
With an amp of multivites.
- Did you do this? - No.
What's going on? Well, Elena's awake.
With an IV.
- Yeah, I can see that.
- What is this? - We just- - Could you two step outside? I need to talk to Elena alone.
What happened? It's okay.
Elena, it's okay.
What? Who knew Lewis could start an IV all by herself? All right, I'll stop by.
Thanks.
Pratt, we'll run the board as soon as I help Abby.
- I need to go up to Oncology for a bit.
- Okay.
Okay, Adrian.
Keep looking down.
- You needed an Attending? - Welcome to your night shift.
Subluxed globe.
Scleral pressure's not doing it.
- Okay.
We need a Desmarres retractor.
- We don't have one.
- Do we have a paper clip? - A paper clip? Yeah.
You're sticking a paper clip in my eye? - Don't worry.
You won't feel a thing.
- Oh, God.
Okay, okay, okay.
How about some Versed? Don't you have an eye specialist or something? Everything's okay, Adrian.
Stay still.
Nice and relaxed.
Okay, insert between the upper lid and the superior rectus.
Right there.
It's- It's tough.
Jake, retract the lid superior.
- Got it.
- Good.
- A little bit more.
- Cover the end depress with your ring finger.
You're doing great.
Take a deep breath.
Let it out.
We're almost done.
Okay.
The eyelid is past the equator.
Okay.
Look up, Adrian.
Oh, my God.
I can see.
Nice.
I'm cold.
They're getting you some warm blankets.
Did you do this? It's just one bag.
After that, it's up to you.
But it was up to me already.
You know, I talked to some reporters.
You're getting a lot of attention.
Because I'm dying.
Here you go.
The INS is taking your demand for a hearing very seriously.
They don't want the bad press.
You have done all you can.
It's okay to eat now.
Not until they let him stay.
He wasn't always like this.
He was a good boy.
He did a stupid thing, and then, in jail, he joined the gang.
You try so hard, but you never know how they'll turn out.
All he has now is anger and hate.
But you want to keep going? He's still my son even though he doesn't care about me.
I think he does.
He just doesn't know how to show it.
The last thing he said to me on his way out was: "Please don't let her die.
" What time is the ambulance coming to take me home? Should be in about an hour.
There's someone I'd like you to meet.
As long as it's no surgeon.
She's not even a doctor.
Debra Graham, I'd like you to meet May Crawford.
- Hello.
- What are you? The social worker? No.
A psychologist.
I'm a secretary at an ad agency.
And a breast-cancer survivor.
It's been three years now.
We'll let you two talk.
I had some spots on my bones.
That's how they found it.
- Really? - Okay, where did you find her? A cancer support group upstairs.
They have patient navigators to help people get through the system.
Think it'll work? Maybe she'll listen to her more than she'll listen to us.
Hey.
Thought you were gonna leave the stuff on the steps.
Yeah, I got stuck doing an LP on a 300-pound guy.
- It's cold, huh? - Yeah.
Springtime in Chicago.
Wanna come in for a second and get warm? I don't think so.
You have my stuff? Yeah.
Hang on a second.
Thanks.
You need to get that? No.
The machine will pick it up.
Sure you don't wanna come in? I could make coffee.
Or some tea.
No, I should get going.
Yeah.
Good night, John.
Good night.
We did a good job getting that kid's eyeball back in.
Yes.
We're a pretty good team.
Yeah.
"This is Abby.
She's my teammate.
" "This is Abby.
She's my partner.
" No.
It sounds like we work at a law firm.
How about "my special friend"? What are you afraid that people will think? - What? - This morning, that's what you said.
I just don't want us to go too fast and get ahead of ourselves.
- You have two weeks to decide.
- Decide what? How fast you want to go, how you'd like to be referred to.
What happens in two weeks? - Big family thing.
- Oh, yeah? - Yeah.
It's like a Saturday brunch.
- Okay.
And before that, we're gonna have to go to church.
- Church? - Yeah.
My niece is getting baptized.
- I have to hold her.
- Oh, you're the godfather.
Yeah.
If something happens to the parents, I'm responsible.
That sort of thing.
So I'm going to a baptism as the godfather's? Fill in the blank.
Dr.
Carter? Ed Miyamoto.
The revised architect's plans will be in my office Friday.
Stop on by.
Hello.
If your current mortgage rate is more than- Hi, John.
About 6 in the morning here.
Just wanted to say hello.
You could call, but I'm leaving for work in an hour.
Bye.
Hey.
Hi.
It's me.
I wasn't sure I was gonna catch you.
Well, I just got home from work.
It was good.
I looked at the plans today.
Yeah.
And I've been thinking about a name for the building.
Well, how would you feel about "The Joshua Carter Center"? Yeah, after the baby.
For the first two days, it's pretty much all IV but we can try a small amount of clear liquids.
- That's it? - Just a few spoonfuls until your stomach gets used to it.
I swore I wouldn't stop until he was safe.
Bless us, O Lord, in these, thy gifts which we are about to receive from thy bounty through Christ our Lord.
Keep my son away from harm.
Amen.
- Amen.
- Amen.
Hello? Yeah.
Hey.
Okay, hold on.
Dr.
Lewis, it's Chuck on line four.
I'll take it in the hallway.
Okay.
Okay, put him on.
Hi, baby.
It's Mommy.
Yeah.
You need to go to bed for Daddy, okay? I'll be home soon.
No, I'm sorry.
I can't do that right now.
Yeah.
All right.
All right, I'll try.
"One hippo, all alone calls two hippos on the phone.
Three hippos at the door bring along another four.
Five hippos come overdressed.
Six hippos show up with a guest.
Seven hippos arrive in a sack.
Eight hippos sneak in the back.
Nine hippos come to work.
All the hippos go berserk.
"