ER s13e05 Episode Script

Ames v. Kovac

Skiles has got them working.
And with Ben Wallace, they're going to the playoffs.
I remember when the NBA used to mean something.
Oscar Robertson, yeah.
Walt Frazier, yeah.
Now it's all a bunch of gangsters with tattoos.
And cornrows.
And slam dunks.
Oh, my, hey, now.
- Healthy set of lungs on that one.
- Lf I was 20 years younger You'd still be her granddaddy.
[ALL LAUGH] - Is that Dr.
Gregory Pratt? - The one and only.
What are you doing down here on the South Side? I heard you bought a condo on the Gold Coast.
You drive down here in the Beemer or the Benz? I walked from my apartment.
How long's your hand been shaking? - Long as I can remember.
- Been to the doctor? What for? Lou Sander's wife was having headaches.
Twenty grand in tests so they could tell her to take aspirin.
Lanny Cole checked in the hospital for a stomachache.
Next day, he checked out through the morgue.
So, what, nobody here goes to the doctor? - Not me.
- Well, you should.
That's right.
Dr.
Pratt needs to make them car payments.
Ha-ha-ha.
Seriously, you need your pressure checked.
- They do that at the drugstore.
- Your sugar, your prostate ALL: Oh! I wouldn't let Halle Barry stick a finger up my ass.
I sure as hell ain't gonna let you.
I'll see you fools later.
Now, that is what I'm talking about.
MAN 1: Ooh! MAN 2: Uh-huh.
Greg.
Greg.
Chaz, what's up, man? - What's up? It's been a while.
- Too long.
What are you doing here? I'm waiting for a friend before class.
- Okay, where'd you wind up at school? - UIC.
That's good.
How's it going over there? It's going all right.
I'm running a little late.
Yeah, me too.
I gotta get out of here.
- We should kick it sometime.
- Definitely.
You know where I am.
All right? Cool.
Good seeing you, man.
You too.
Be safe.
You'll probably be home before me, and Miriam has to leave at 6.
Okay, okay.
Joe, let's review P.
E.
A.
Hm? Treatable conditions include hypovolemia tension pneumothorax, cardiac tamponade, MI and And what's another cause of P.
E.
A? Huh? Reversible etiology of P.
E.
A.
- Massive pulmonary embolus.
- How could I forget? - You'll do fine.
- I don't know, my brain is like Oh.
Sorry.
Sorry.
Sorry.
- I have to review this.
- Ten times? I gave my deposition a year ago.
It looks really bad if I contradict myself.
Didn't do anything wrong.
Tell the truth - Okay.
- Sorry.
[DOORBELL BUZZES] Who's that, huh? Wanna go see who's at the door? Hm? Who's at the door? It's Miriam.
She's gonna take you to the park.
Suppose if I can't remember something, I can run it by the Attending.
But I just don't wanna bug them all day like I'm a med student or something.
- You okay? - Ah.
That guy is gonna be so sympathetic to the jury.
But he doesn't have a case.
You're gonna be fine.
If I lose, they report me to the national data bank.
It follows me wherever I go for the rest of my career.
I could be turned down for a job, it could cut back our income, it can - Want me to come to court? - No, you got a shift.
Well, they've been doing fine without me for the past couple months.
No, it's more important for you to be at work.
Okay.
Good luck.
- Thanks.
- Call me.
The plaintiff's attorney will provoke you, try to get under your skin.
So you need to stay cool.
If you get defensive, the jury will turn against you.
- Yeah.
- Keep it brief.
If you elaborate, they'll think you're evasive.
Don't worry about getting the story out.
I'll ask follow-up questions later.
Right.
I'II, uh, meet you inside.
[TOILET FLUSHES] [STALL DOOR OPENS] Mr.
Ames, I'm sorry we're here.
I was hoping this wouldn't have to go to trial.
I came in with a cough, and you sent me out a cripple.
We need to pick a few boarders from the night shift.
Diverticular abscess awaiting Hey, stranger.
Welcome back.
Thanks.
I wanna see pictures.
Diverticular abscess awaiting CT-guided drainage.
- A-fib patient - Hey, Abby.
This is embarrassing, but I never got to wrap your baby gift.
- Oh, that's great.
- Ray.
- Thanks.
- A-fib with rapid ventricular response I disposed Mr.
Kerosene to Psych.
He drank kerosene? More like a high colonic.
Hey, Abby.
I'm Tony Gates.
Hi.
Didn't you used to be? Paramedic.
Now I'm an intern.
- Next week, he wants to be a cowboy.
- Astronaut.
[MUFFLED SHOUTING] I could use some help here.
I got half his tongue on ice.
PRATT: Oh, man, how'd that happen? - Wife bit it off.
- Why'd she do that? She says he talks too much.
All right, come on, let's put him in Curtain 2.
A liter of saline and a crit.
Ray, you're with me.
Abby, grab some charts, and, Gates, you're with Abby.
Cunnilingus interruptus.
- They did a grand rounds on it last year.
- Abdominal fullness isn't too bad.
Congratulations on the bambino.
A boy, right? Yup.
- Can you check a BP? - Yeah.
Hey, Mr.
Dolan, how are you feeling? Must be weird coming back, huh? A little bit.
- Seventy palp.
- Pulsatile abdominal mass.
We better move him.
Sam, this guy is hypotensive.
What? His vitals were normal at triage.
- Not anymore.
- Add a second line, four of O-neg.
SAM: Labs? - Dr.
Gates? CBC with platelets, Chem-7, ProTime, type and cross four.
ABBY: Good, but add a HemoCue, EKG, and let's get Surgery on this.
What do you think, abdominal aortic aneurysm? - Classic presentation for triple A.
- You think it burst? No, he'd be dead.
Probably just a steady leak.
You set up for ultrasound? GATES: Call Radiology for that.
- I'm talking about the ER ultrasound.
That's still out for repair.
- How are we? - Radiology brings one.
- How long? - Depends on how busy they are.
Wow, great to be back.
Pressure's up to 90 with the saline.
All right, looks like he's okay.
I'll call for your ultrasound.
O-neg's here.
So, what's the big guy doing today? Watching the baby? No, he's in court.
WOMAN: Mr.
Ames, what made you go to the ER on February 13th, 2004? Because I had a cough.
My boss, he brought me in.
I mean, I thought it was nothing but he didn't want me working until I got it checked out.
- How long is the wait? - Don't talk, please.
How long until I see the doctor? I don't know.
Could be 12 hours.
[COUGHING] Twelve hours? Twelve is good.
We're not that busy.
It's okay, Curtis.
I'll get someone to cover.
No, no, I can work.
How about I just sign in and I come back later tonight? You could lose your place in line.
So I just sit in the waiting room for 12 hours? That's how it works.
Be right back.
This seems kind of crazy.
How about I get checked tomorrow? I need a note you're not contagious.
I got insurance issues.
Don't give this job away.
I'm gonna be there tomorrow.
MAN: Dr.
Kovac, when did you first see Mr.
Ames? I was working at the Admit desk when he signed in at triage.
AMES: How long until I see the doctor? MARQUEZ: It's hard to say.
If you're stable, it could be up to 12 hours.
AMES: Hours? We have a lot of sick people here.
Let me just sign in and I just come back tonight.
I'm sorry.
We can't do that.
So I gotta wait in the waiting room for 12 hours? I'll be right back.
This is crazy.
I can't do this.
Everything okay, Chuny? Yeah, he'll settle down.
Do not give the job away.
I will be there.
A lot of patients get angry about the wait.
Nurse Marquez was able to defuse the situation before it escalated.
I'm in.
You can do the next one.
- Sorry, I - Good breath sounds.
You haven't lost your touch.
- BP's 80.
- All right, I need the ultrasound.
GATES: They're doing a rule-out ectopic.
ABBY: Where's Surgery? - Their med student's right there.
Well, that's not doing us any good.
I paged them twice.
Listen, how did it go yesterday? - How'd what go? - Court.
I heard you had to testify.
It was fine.
A lot of questions about procedure and policy.
But I don't think they have a case.
Here come the cavalry.
Enlighten me.
Hypotensive pulsatile abdominal mass.
Say no more.
Redline to the O.
R.
We're waiting on ultrasound.
CRENSHAW: Wrong.
- We're not waiting on ultrasound? Neela, what happens when we wait for diagnostic tests on a ruptured triple A? Attempts to stabilize are fruitless.
Investigations delay therapy, increase risk of exsanguination.
With a 90-percent mortality.
His crit's not so bad, 32.
Meaningless drivel.
- What if it's not triple A? - Then something else.
GATES: Radiology's bringing over the ultrasound now.
- He'd be dead.
- It'll be seconds.
Zip it, Sparky.
Look, we're admitting him.
- Sparky? - Let's go.
Did you need me to keep bagging? Sure, as long as you don't talk.
Oh, by the way, Abby Lockhart.
Lovely to meet you.
Shh.
When did you assume responsibility for Mr.
Ames' care? The nurse was concerned about his oxygen level so she asked me to see him.
Curtis Ames? Hi, I'm Dr.
Kovac.
What? What is that? [MONITOR BEEPING] Uh, low oxygen.
Or just maybe a dirty fingernail.
Wood stains.
They don't wash off so good.
What kind of work do you do? Custom carpentry.
Doors, built-in bookshelves, armoires, you name it.
My father had a wood shop when I was a kid.
I used to play with the shavings from the lathe.
I love the smell.
[COUGHING] - How did it sound? - Well, like pneumonia.
- You should be admitted to the hospital.
- Admitted? Yeah, stay for a couple of days.
No, no, no.
I start a custom remodel today.
Your temp is 102, your oxygen level is down to 90 and your x-ray shows your right middle lobe is full of infection.
Look, if you wanna get better, we need to give you IV antibiotics, okay? WOMAN: After he examined you, then what happened? He left me with a nurse who couldn't start an IV.
MARQUEZ: Okay, this time, I get a flash.
Good.
That's good, right? But it won't thread.
I'm sorry.
Keep pressure on this.
I know the drill.
Anyone ever tell you you have bad veins? How about just giving me a shot in the butt? The antibiotics are ordered IV.
Can I talk to my doctor? He's with a trauma patient right now.
How about after he's done? It could be a while.
Here we go.
Fourth time's a charm.
WOMAN: And how long was it before Dr.
Kovac came to your bedside? It was more than an hour.
Uh, I saw him working on a computer.
He was talking to some nurses.
Then he had a bagel with cream cheese.
I think it was poppy seed.
And how did that make you feel? Objection, irrelevant.
On the contrary, Your Honor it goes to state of mind and ability to make decisions.
Overruled.
You may answer.
I felt alone.
Forgotten.
Like nobody there cared about me.
ABBY: I'm just saying, he's a frail old man who deserves the benefit of diagnostic confirmation.
CRENSHAW: The patient is now on the surgical service, not the ER service.
Go downstairs, pull a cockroach out of someone's ear.
ABBY: Neela.
NEELA: He's not stable, Abby.
SHIRLEY: BP's 90 systolic.
ABBY: Five minutes for an ultrasound is not gonna kill him.
GATES: I picked up a sterile sleeve.
CRENSHAW: Why do you insist on annoying me? GATES: Only take a few minutes.
CRENSHAW: Ten blade.
Want these two out of my O.
R.
- Shirley, call Security.
ABBY: All right, all right.
NEELA: Dab the bleeders.
GATES: Nice working with you.
CRENSHAW: Bovie.
Stand back.
NEELA: Irrigation saline.
SHIRLEY: Code red.
KATEY: Oh, my God! CRENSHAW: Unplug the Bovie.
Unplug the Bovie.
And turn off that oxygen before the whole room goes up.
MAN: Dr.
Kovac, when the nurses couldn't start an IV what action did you take? I knew I needed to place a catheter into a deeper vein.
How are you doing? I didn't know you ordered acupuncture.
I'm Sonya Ames.
Hi, Luka Kovac.
Thanks for taking care of him.
Well, since we can't get an IV in your arm I'd like to place a central line under your collarbone.
That sounds pretty involved.
We need a route to give IV antibiotics or we cannot treat the pneumonia effectively.
I'll numb up your skin and guide the catheter in at the top of your chest.
There are risks of bleeding, infection, collapsed lung but all of those can be treated.
[COUGHING] I gotta think about it.
I gotta think about it.
Wait, no, he doesn't.
He If you need some time to consider He's just being stubborn.
He hasn't been to a doctor in 20 years.
I never get sick, baby.
You can barely catch your breath, you've been coughing so much.
AMES: It's not that bad, really.
I just want him to get better.
We'll do whatever it takes, okay? Well, if you want the procedure, you need to sign this form.
Now, come on, baby, I've gotta get back to work.
[AMES SIGHS] KOVAC: He didn 't wanna be in the ER.
He didn't like doctors.
So I felt I needed to treat him aggressively.
He said it was the only way to go.
If he left, I was worried he'd get worse and wouldn't come back.
He told me complications were rare.
It was no big deal, that he does these every day.
- His wife works, he's all alone.
- My opinion didn't matter.
If he took pills, he could've died at home and no one would know.
He gave me and my wife no other options, no other choices.
We were both really, really scared.
- Can we grab you a sandwich? - No, thanks.
Hey, Timmy, uh, is Abby around? No, no, if she's in surgery, then don't bother.
It's okay.
I'll try later.
Thanks.
Tricuspid regurg.
Ah, the irony.
A bad heart valve.
Left him with right-sided failure and a big pulsating liver.
- So the mass was his liver? - Yep.
And the fire saved him from unnecessary surgery.
A slightly scorched med student and some burned drapes saved the guy's life.
Lucky guy.
Had minor burns.
Excuse me.
Forget how to use that thing? No, I just Didn't wanna be one of those mothers who checks in with the babysitter every hour.
My babysitter used to tie me to my high chair.
I'm sure yours is much better.
WOMAN: After your first dose of antibiotics how long were you in the ER? A long time.
Over three days.
Three days? In the ER? They said that there were no other beds in the hospital, so Excuse me, I need to use the bathroom.
- I'll let your nurse know.
- I don't think that I'll be able to - I said, I'll let your nurse know.
- It's kind of urgent, please.
Plea WOMAN: So you stayed in the hall all that time? AMES: They put me in the back at night so that I could try to get some sleep.
[BUZZER SOUNDS] OLBES: Louie partied a little too hard.
I'd say we're dealing with coke, PCP and ETOH.
Pulled out his line.
- You're gonna need hard restraints.
LOUIE: I'll rip your head off, I swear.
AMES: They kept saying I'd get a regular room after the first day but it never happened.
Nurse? Ahem.
Nurse, I, uh, never got my breakfast.
You may be NPO.
What is that? I have to look at your orders.
Where's, uh, Dr.
Kovac? He's not working today.
So who's my doctor, then? I have to check.
KOVAC: Every 12 hours an oncoming Resident assumed responsibility for Mr.
Ames' care.
His progress was discussed.
He was improving.
WOMAN: So it was the nurses who were watching him more closely? KOVAC: Yes.
WOMAN: The state recommends an ER patient-to-nurse ratio of 4-to-1.
Yet during Mr.
Ames' stay, the ratio was 8-to-1.
That's eight patients for every nurse.
How is that possible? Well, we can't control how many patients come into the ER.
Dr.
Kovac, you know that those standards are in place for patient safety.
So on a day when the standards were off by a factor of 100 percent did you discuss this with a hospital administrator? - No.
- With the director of Nursing? - No, no, it's not uncommon - With a nurse manager? Look, we're always short-staffed.
WOMAN: Did you bring this deficiency to anyone's attention or do anything to address the situation? It doesn't work like that.
Mariko Shimane, history of Crohn's disease, vomited blood twice.
Systolic's 88.
Two liters of saline, type and cross four.
Is there anyone we can call, Mariko? - Doctor Derezin.
- From Gastroenterology.
- How about a family member? - Just me and my son.
- Where is he? - Oregon.
Sophomore in college.
We can call him.
He'd wanna know.
I'm in the hospital a lot.
Your condition is pretty serious.
That's what they always say.
Upper GI bleed? Sure looks like it.
- Hello, Mariko.
- Sorry to bother you, Neil.
That's all right.
Any blood in your stool? - Yeah.
- She didn't mention that.
- Red blood? - Yeah.
Endoscopy here or in the GI lab? Excuse us for a minute.
Dr.
Pratt, dude on Line 2 says he's your brother.
Yeah, take a message.
And, Doc Lockhart, Big Daddy called while you were upstairs.
- Thanks.
- I can't scope her.
Why not? Crohn's can cause inflammation, erosion into a vessel along the intestinal tract.
Twenty-five feet of possibilities.
Not something I can reach.
She needs surgical exploration.
- I'll call the O.
R.
- So, what's the good news? We're gonna move you to a different room.
It looks like you need an operation.
Again? Maybe it's time to call your son? He's got midterms, no.
On the afternoon of his third hospital day Mr.
Ames complained of numbness in the left hand.
MAN: And what was your impression? KOVAC: How long did it last? AMES: About 10 minutes.
Okay, squeeze my hands.
Okay.
Now spread your fingers like this.
Don't let me close them.
Good.
Well, what do you think happened? It could be a number of things.
How's it feel now? Back to normal? Yeah.
Yeah.
Yeah, I guess so.
The same on both sides? It's kind of weird.
You probably compressed a nerve while you were resting on your side.
I've slept on floors more comfortable than this bed.
Here, let me take care of that.
Hi, Bed Control? Yeah, this is Dr.
Kovac.
Yeah, I need a med-surge bed for my patient, please.
WOMAN: And when did the numbness return? It was about three hours later.
WOMAN: And was there something different about this episode? - Didn't have any feeling for half an hour.
- You're okay now? It's worse.
Went up higher.
Where is Dr.
Kovac? He checked.
He said you were okay.
I'm not okay.
I need to talk to him.
Not right now.
Why? Where is he? He's taking care of a patient with a heart attack.
Tell him to come and see me.
- When he's through.
- No, no, now.
Mr.
Ames, there are people in this ER who are much sicker and need immediate attention.
Hey.
If he won't come to see me, then I'm gonna go to him.
Get back in bed.
Something's wrong.
I need to talk to my doctor.
I need you on the monitor.
Frank, help me.
- Take it easy, fella.
- Take it easy? You people have ignored me for three days.
No one tells me what's going on.
Nobody gives a damn, no one will talk to me.
- Mr.
Ames, sit down.
- How am I supposed to take it easy? I am not sitting down until my doctor does what he's supposed to do.
MARQUEZ: I need some help here.
- Open your eyes, sir.
FRANK: Let's get a gurney over here.
Mr.
Ames? Look at me.
Luka, he had a stroke.
Up-going toe.
- CT can take him now.
- Okay, we're on our way.
KOVAC: We recognized the stroke, immediately moved him for monitoring and had him to CT as soon as possible.
From what I remember is, it was pretty chaotic.
- Why should this guy have a stroke? - No idea.
Follow my finger, sir.
Sir, look over here.
Over here.
Frank, I need a monitored bed.
FRANK: There aren't any.
Okay, Trauma 2, then.
GSW just took it.
KOVAC: Let's move him to CT.
FRANK: CT is backed up for a half-hour.
KOVAC: Where can we put him? MARQUEZ: I'll see what I can find.
KOVAC: Chart, I need his chart.
FRANK: I'm looking for it.
KOVAC: Where's the chart? MARQUEZ: I never saw it.
- It's okay, take deep breaths.
- Where's Surgery? Crenshaw called, patient's not a candidate for anesthesia till systolic's up to 80.
PRATT: All right, tank her up.
- Eight French cordis in femoral.
You know, I have another idea.
Oh, man.
Hey, has anyone seen a Pocket Doppler? - Uh, yeah, top drawer by the sink.
- All right.
What about an intra-aortic balloon? This girl in heart failure? - No, it's a GI bleed.
- What? Inflate the balloon in the chest block off the blood supply to the abdomen.
- No, you can't do that.
- Damn it.
Why not? That's a great idea.
She's not your patient.
Adiós, Gates.
Could be a publishable case report.
A non-invasive way to occlude the aorta.
It'll stop the bleeding.
Oh, crap, crap, crap.
What? Pratt, can you come with me? Four units of red cells, one of FFP, a 10-pack of platelets.
We'll be right back.
Hey, hey, hey, what is this? Some kind of post-partum power trip? - Hey, the aortic balloon will work.
- It's an unproven therapy.
- You'd let her bleed to death? - No, have the surgeons take her to O.
R.
Doesn't look like that's gonna happen.
What's your problem? It cuts off all circulation to the bowel, liver, kidneys and legs.
Everything could die from the chest down.
What are we doing in here? You know, you used to be such a cowboy.
- Why is this a big deal? - I don't agree.
Gates thinks it'll work.
Gates is a knucklehead who'd defibrillate with a car battery and jumper cables.
I am the Attending.
The buck stops here.
So if there's gonna be a bad outcome let Surgery be to blame for not showing up.
So you'd let her die? No, I just don't wanna be the guy who kills her with some crazy-ass therapy.
Oh, look, this is her last chance.
She's pre-arrest.
If her pressure continues to drop despite massive transfusions I would consider What are you doing? I'm pumping.
Sorry, my boobs are about to explode.
WOMAN: When did your wife arrive? Right after the CAT scan.
By then I could talk again, you know.
Looks okay.
I still can't move my arm and leg.
There's no mass, no bleeding.
That's That's good.
Then, why did he have a stroke? Probably a blood clot in a brain artery.
But, uh, there is something we can try.
What? What should I do? A medicine called TPA could probably dissolve the clot.
You're saying that could work? That I might? I can get better, right? There is some chance of recovery and, uh, full recovery We've gotta do something.
What about the side effects? There's always side effects.
Well, there is a 10 percent chance of, uh, bleeding in the brain causing more disability and death.
Ten percent chance of recovery? There's a 10 percent chance of death? What if we don't use the drug? There can be some improvement, uh, with time and physical therapy but probably not a full recovery.
Ah Look, look.
I've been in this hospital Iong enough to know that if something can go wrong it I don't want it.
And what do you recall of Mr.
Ames' reaction to your recommendation of TPA? I brought in Dr.
Saunders, a neurologist to try to explain options in an objective manner.
The statistics are averages for all patients, even ones in their 70s and 80s.
KOVAC: Your risk of bleeding is much less, given your age and the fact that it's been only 90 minutes since the onset of symptoms.
I don't know.
The TPA is your only shot at complete recovery.
Forget it.
I'm not taking it.
Settle down, baby.
Look, if it was me, I'd take the TPA.
If it was you, you'd be in intensive care with 10 doctors and nurses watching your ass every second, day and night.
SONYA: Curtis.
You wouldn't be getting the runaround for three days.
Not sleeping, not eating, pissing in a pan.
And now I am supposed to trust you with a medicine that can kill me when all I've seen since I've been here is total incompetence? MAN: Mr.
Ames, did you refuse a therapy that had the potential to reverse the stroke? There were no guarantees.
Experts have agreed that TPA gave you the only chance for a complete recovery.
And you didn't want it? It was, uh, a lot more complicated than that, really Did you refuse a medicine that could have cured you? I refused what they were pushing, and you would have done the same thing.
So you did refuse the cure.
Systolic's only 50 after four units.
All right, hang another two units.
Uh, I'm above the diaphragm.
Go ahead, inject.
I'm putting in 40 cc's of saline.
Let's hope this damn thing works.
Doc Lock, you got a call.
- Kind of busy right now.
- Balloon is up.
It's your babysitter.
They said it was important.
Pressure's up to 90.
All right, go ahead.
Go, take it.
We're out of the woods.
Mark the time.
Surgeons have one hour to get her up and fix her or the game is over.
- Hello? SAM: They should be here any minute.
WOMAN: What's happening? - We've got your bleeding controlled Is he hungry? Did you try the stroller? SAM: Thanks for joining us.
What's up with the fluoro? I thought ER docs had x-ray vision.
Put the phone next to his ear.
Stopped a Crohn's patient from intra-abdominal exsanguination.
Rather unconventional.
Dare I say, idiotic? SAM: It worked.
BP's 122/78.
Cross-clamp without thoracotomy.
It's cool.
What's not cool, her kidneys will be dead in an hour.
- Go, clock's ticking.
- Abby? It's his favorite song.
Puts him to sleep.
[SINGING " SHOULD I STAY OR SHOULD I GO"] - Aren't you glad you don't work here? - She's auditioning for American Idol.
- Hey, nice work, Abby.
- Thanks.
Upstairs, the neurologists recognized a faint mid-systolic murmur.
What does that mean? A murmur is from turbulent blood flow through the heart.
WOMAN: So because of the murmur, a cardiac echo was ordered showing patent foramen ovale.
Do you know what a patent foramen ovale is, Dr.
Kovac? A small hole between the upper chambers of the heart.
So that hole could have allowed a blood clot from your subclavian catheter to pass from the right side to the left side of the heart.
And then up to the brain? It could happen, but that's extremely rare.
I didn't ask you how rare it was, Dr.
Kovac.
I asked whether a patent foramen provides a pathway for a clot to travel to the brain and cause a stroke? - Yes.
- So if you had heard the murmur if you had pulled the catheter when numbness began is it possible that you could have prevented Mr.
Ames' stroke? Objection.
Calls for speculation.
Sustained.
When the numbness began, did you consider a cardiac source or did you ignore an important warning sign of impending stroke? I didn't ignore anything.
I considered what was probable and acted accordingly.
After Mr.
Ames complained of numbness did you then appreciate his heart murmur? The ER is a noisy place.
You can't always hear subtle murmurs.
Dr.
Kovac, I'm not asking you about the noise level in your ER.
I'm asking, did you, at any time in the three days that you cared for Mr.
Ames recognize his heart murmur? At the time of Mr.
Ames' numbness, there were 47 patients in the ER 82 in the waiting room.
I was taking care of a mother who was the victim of domestic violence nearly beaten to death, an 8-year-old hit by a car - Dr.
Kovac.
- And a 53-year-old heart-attack victim.
There are always sicker patients in the ER and it was reasonable to believe that Mr.
Ames' numbness could wait.
JUDGE: Order.
Only one can speak at a time.
Your Honor, I move to strike that tirade be stricken as nonresponsive and I request the court admonish the witness to answer.
JUDGE: Restate the question.
And, doctor, I'm instructing you to answer.
WOMAN: If you had heard the murmur is it possible you could have prevented the stroke? MAN: Objection.
- Possibility is not the issue.
JUDGE: Sustained.
Dr.
Kovac, is it true that you could have prevented the stroke? - Well, doctor? - Counselor, I'm warning you.
No need, I'm done with this witness.
Scabies family went home and Lost Rectal Thermometer went up to Surgery.
Gates needs you for an extubation in Trauma 2.
- All right.
- I'm here till 7.
Call if you get a break.
Any news from Kovac? - Not yet.
CHAZ: Greg.
Hey.
- Am I too early? - Yeah, just have a seat in triage.
- I'll be right back.
- All right.
It's Abby, right? Yes.
Oh, hi, sorry about your arms.
It's okay.
They fixed me up pretty good.
Med school wants me to make a chart for insurance.
Oh, it's no problem, I got it.
- Thank you, Ray.
- Thanks, Ray.
- I guess we can do it in Curtain 4.
- Great.
RAY: Might need a little débridement.
- Go for it.
- So your shift almost over? - Mm-hm.
They're giving me two days off to heal.
- That's very generous of the surgeons.
- First free night in forever.
Have you been to Rednofive? Uh, no.
They remodeled, and I hear the DJ on Thursday nights is ridiculous.
You wanna check it out tonight? MAN: Both emergency and infectious-disease experts agree that Dr.
Kovac gave superior treatment and above and beyond the standard of care.
The stroke was a one-in-a-million complication that no one could have either predicted or prevented.
And Dr.
Kovac treats the patients that no other doctor will treat.
His ER is the safety net for millions with no health insurance.
Every day, he is out there on the front lines providing the best health care possible for the people who need it the most.
If you find against Dr.
Kovac what message do you send to other health-care providers like him who make that daily struggle their personal mission? Dr.
Kovac could have sent Mr.
Ames home with antibiotic pills, but he didn't.
He assumed that Mr.
Ames was unreliable, that he couldn't be trusted and so Dr.
Kovac took responsibility for his care.
And then he abandoned that responsibility by subjecting Mr.
Ames to substandard conditions in an understaffed ER where that man was shoved into a corner and neglected.
And the warning signs of a major stroke were ignored resulted in a devastating disability.
Before the stroke, Mr.
Ames was a skilled craftsman.
He supported a wife and two children.
And now, with a paralyzed left arm, loss of perception in his left visual field that livelihood has been taken away.
Loss of income, loss of self-esteem, has resulted in profound stress and led to a divorce and separation from his children.
Mr.
Ames now lives alone.
He's trying to get by on a disability benefit of $ 1300 a month.
He cannot drive, he sees his children one day a week and he is being treated for depression.
Your award must fairly compensate Mr.
Ames for past and ongoing medical care, for 25 years of lost wages and for the pain and suffering that this man will experience every day for the rest of his life.
ABBY: And you wanna make sure that this part rests against your rib cage not your armpits, and then Oop.
I'm okay.
I'm okay.
- You sure those things are safe? - Yeah, they just need an adjustment.
Or you can go to the pharmacy and get a new pair.
Good idea.
Careful.
NEELA: Should we sign you in as a trauma patient? I would say yes, but my shift is over.
Call me if your spleen ruptures.
- Excuse me, hi.
- Hi.
- Is Dr.
Pratt around? - He's with a patient.
Can I help you? He told me he was gonna be right back.
Will you let him know Chaz is waiting? Okay.
- Hey, Neela, you have a minute? - I have 12 hours.
I'm on all night.
- It's about Katey, your med student.
- Ray.
Hey, hey, she asked me out, all right? Residents are not allowed to date their students.
Not my student.
Never will be.
She's not doing an ER elective, it's not against policy.
Well, then, why even ask? Thanks.
Appreciate your help.
I'm sorry, I gotta go.
- Tell Greg I'll call him.
- Okay.
- Hey, Mayday.
- Hello.
- What are you doing here? - Small bowel obstruction.
Good times.
So, uh, how's the guy who went up in flames? Minor partial burns to the chest and abdomen.
You know, I hear his aorta was just fine.
There's a lesson to be learned here.
Wise men say only fools rush in Oh, you missed a guy called Chaz.
He left? You were saying? Hey, Chaz, Chaz, hold up, man.
Sorry about that.
I got caught up with a patient.
It's okay.
I gotta go.
Now, come on, man.
Sounded like something serious.
- It's all good.
- Hey.
Things are just not going so well at home.
Really? When I wanna study, it's too noisy.
When I wanna bring my friends over, Dad won't let me.
I'm always late to class because the commute takes forever.
What about the dorm? Costs too much.
When you saw me earlier, I was looking for apartments.
But they all kind of sucked.
Look, I know this is gonna sound crazy but I was thinking, maybe I could move into your place.
[LAUGHS] My place? Yeah, your place.
I mean, it's close to campus.
I can get a part-time job to help you with the rent.
I'm quiet.
We'll probably never even see each other.
You're serious? Ah, Chaz, come on, man.
You know, I got my own style.
Oh, come on.
You say the word, and I'm gonna clear out for you.
And if it doesn't work out, I'll be gone real fast, man.
Never mind, it's a bad idea.
All right, look Let's try it for a month.
For real? Yeah, I'll talk to your mom.
- Thank you.
- All right.
Thank you.
- I'm gonna holler at you.
- All right, man, take it easy.
- Hey.
Ha-ha-ha.
- Yeah.
So, uh, how was the first day back? It was a piece of cake.
Like riding a bike.
Oh, yeah? You miss your little man? Yeah, but that's okay.
I'll bond with him again when I feed him at 11 and 2 and 5 a.
m.
But you know what was nice about today? For 12 hours, I talked like a grownup to grownups.
Well, except for when you had to deal with the surgeons.
Yeah, at least they don't spit up on you.
Much.
Good night.
Try to get some rest.
It's a nice idea.
How long do you think they'll deliberate? Shouldn't take more than a day or two.
Ames' lawyer is a publicity hound.
The local news is having a field day trashing County.
It'd be good to get you in front of the press as the doctor found not guilty.
Well, you are very optimistic.
People need to hear our side of the story to reassure them that the County health system works.
During that videotape, did you see the looks on the jury's faces? Doctors get sued for ignoring and undertreating patients not for doing too much.
Plus, you did a great job on the stand.
I don't think so.
I've been to at least a hundred trials.
I can tell when a jury likes the doctor.
WOMAN 1: He's just another greedy MD getting rich by overtreating.
WOMAN 2: What are you talking about? - I've read about it.
The drug companies give kickbacks to doctors who use their expensive drugs.
WOMAN 2: The judge instructed us not to decide this case based on anything we've heard outside.
WOMAN 1: They neglected this guy for three days.
WOMAN 2: His pneumonia was improving.
MAN: That doctor used a hand grenade to kill a mosquito.
To me, that's bad medical judgment.
WOMAN 2: You're not a doctor.
We've got to decide this based on the expert witness definition of the standard of care.
WOMAN 1: Well, when you're talking about County General the term "standard of care" is a joke.
MAN: That's right.
Kovac is part of the system.
And we all know the system sucks.