ER s13e22 Episode Script

Sea Change

Previously on ER So you quit your job and get married in the same week? I'm a new guy now.
Maybe some of that love will rub off on all of us here and help us find someone as special as you two have.
I got them the honeymoon suite at the Ritz for a few nights, but they say they can't use it on account of Joe and everything.
Oh, it's go time.
You're a real prick, you know that? Stop it! Tony! I don't love you.
So that's it? - We're done? - Yeah.
Because Ray couldn't get over you? Have you seen my other sock? I just bought these.
Nobody wears socks in Hawaii.
- Ugh, I can't believe it's almost 9:00.
- I can't believe Joe's still asleep.
Couldn't find anyone to cover your shift for today? No, that's the problem with surprise weddings.
It's hard to plan.
I'll stop by later.
I have to tie up loose ends with Anspaugh.
- You've got to be kidding me.
- What? Married five days and I'm already getting mail addressed to Mrs.
Luka Kovac.
You know, being married isn't gonna change the fact that I don't cook - or sew or keep track of your socks.
- Okay.
That's fine in Chicago, but on our honeymoon you're going to be serving me Martinis wearing only this.
Got me a bikini.
I'm a liberated modern husband.
I like to shop.
Abby and Luka are crazy.
Who turns down three free nights in the honeymoon suite at the Ritz? Hope? Oh, my Oh You know, when I was eight, I found this book in my parents' bedroom, Sex and the Christian Marriage.
And the very first page, it said, "Orgasms bring a couple closer to God.
" So that night at the dinner table, I asked my parents what an orgasm was.
What'd they say? An orgasm is a very special kind of prayer.
Which is fine and actually kind of sweet, but, like, later that week, I had my first sleepover at a friend's house.
So her mom asks me what my bedtime routine is and I said, - "bath, toothbrushing, orgasm, sleep.
" - You did not.
I did.
I was never invited back.
- Champagne? It's 8:00 in the morning.
- I have no sense of time in this place.
Arch, you got to be at work in, like, an hour.
- Dirty word.
- What is? - Work.
- Oh.
Well, I don't have to be in till 4:00, so you go ahead and then I'll check us out of the room.
No, no, no.
We're staying another night.
- Another three nights.
- What? That's crazy.
This room must be like a thousand dollars a night.
They comped us.
Why would they do that? I guess we're spending so much on room service, we made it worth their while.
- Now mimosa? - Nimosa.
Damn it.
Hey, hey, Betina, hey.
Hold up.
All right, all right, look, look.
I got it now.
I figured you out.
Figured me out? You've had it with the guys who are trying to be cool and you're ready for someone real.
Got someone you want to set me up with? Come on now, help me out, okay? I've seen the light.
Or maybe you're just saying what you think I need to hear to go out with you? Oh, it's not like that.
Greg I like you.
But I have been dating guys like you for years.
You will do whatever it takes to get the girl, but in the end, it's just about the chase.
Betina, I'm not like that anymore.
I've changed.
This is it? They closed the ER for a paint job? Well, it's only been a few days.
You can't expect a drastic change overnight.
Mine point exactly, Dr.
See you later.
I've got radiology rounds in the ICU.
- Wait! - Pratt - I got a hypotensive patient here, 87/45.
- All right, what's the baseline? - She runs low.
Always has.
- Why is it that you know that an I don't? - She's febrile, too, 103.
- Okay, any vomiting, any coughing? Just a little belly pain.
I could see my doctor tomorrow when I get home.
- Where's home? - Boston.
- We're here for her physics conference.
- I'm gonna cut his eyes out - and send him home in a box! - Need some help here! Sam, liter of saline, find her a monitored bed, and I'll be in as soon as I can.
Can't you just give me an antibiotic? We've been waiting in triage nearly three hours.
I know, I'm sorry, that's the way it goes around here.
You know what, let me see if there's an open bed.
I'll be right back.
Sam meet my parents, Barb and Len.
They're visiting from Long Island.
- Oh, hi.
Nice to meet you.
- Hey, Weston, come on, man, you're up.
- This guy needs a chest tube.
- I'll find you guys later.
Well, you must be very proud of Larry.
Have a good tour.
You're even prettier than he said you were.
We're so happy he finally found a girlfriend.
- Let me out of here, you bastard! - Where had they move the ortho stuff? I'm sorry for springing my parents on you like that.
I am not your girlfriend, Larry, you know that, right? Oh, come on.
Sam We made out at a wedding.
That's what drunk single people do at weddings.
Doesn't mean we're an item.
Well, I'm not the type to take sex casually, Sam.
We did not have sex.
- Depends on how you define sex.
- Larry, we did not have sex.
Outercourse doesn't count? - Oh, my God.
- What? - Ace or splint? - Ace is cool.
So where are all the so-called improvements you guys did while you were closed? Oh, what, you didn't see the new admit desk? Or how about our electrical outlets? They are a new shade of red.
All right.
How did you hurt your ankle? Running all over the hospital with Dr.
Who? Dr.
He's head of the ICU.
- I'm doing a month up there with him.
- Wiggle your toes.
I'm wearing a pager for the Rapid Response team.
- The what? - It's Moretti's latest invention.
When nurses get a bad feeling about the patients, they call us and we run.
- Like a code team.
- More like a pre-code team.
Why don't you let me have the docs take a look at your ankle just to be sure? - As long as it's not Ray.
- Yeah, you got it.
Okay, Morris you finally close the deal with Hope or not? Hey, all I can say this is the first time I left our hotel room in three days.
Mostly we're just praying.
Lot of special prayers, huh? Hey, what about you and our favorite radiologist? Come on, you got to respect a woman's privacy, right? - You sly dog.
- Anybody seen Ray around? No.
He's a couple hours late.
He's probably still hung over from the wedding.
He was in pretty bad shape.
- And, Sam, whoo, baby, wild night, huh? - Please shut up.
Katey Alvaro's in curtain two.
She twisted her ankle.
- Doesn't look broken, but take a look.
- I'm on it.
Larry? I'm gonna kill him.
Hey, anybody see our physicist in curtain three? Yeah, I got to slow down in SVT, but she's next for sure.
Excuse me, we're still waiting for a doctor.
I'm sorry, we're really busy.
- How are you feeling? - Run down.
I've been working my ass off for the last six months prepping for this conference.
Six months? Try 20 years.
You've been working on quantum processing your entire career.
- Quantum processing? - Oh, theory in physics which says that an atom can exist in two places at the same time and I showed that it can work in a larger matrix.
I have no idea what you just said, but it sounds impressive.
It pretty much blew the lid off the entire field.
Well, I think what you've got is probably viral, but I'm going to send some blood tests to be safe.
Sam, we're gonna do dinner at 8:00 at Osteria Angelo.
Great! Have a good time.
Yeah, I'm sorry.
I don't mean to sound like uptight mainlander, but I find it hard to believe that you can't rent a car with a car seat in it.
Right, we'll bring our own.
Yes, mahalo for nothing.
Sophia Van Brummellen, 35, fell down a 15-foot flight of stairs.
I'm Dr.
Can you tell me your name? - I'm gonna be sick.
- Okay, roll her on her side.
- Please be okay.
Let her be okay.
- Abby, need some help here.
- Um, hello.
- What happened? - She fell down stairs - I want to hear it from her.
She slipped and she fell down-- her head was bouncing down the stairs; when she got to the bottom, she wasn't moving and she wasn't talking.
I'm Dr.
Lockhart, any medications or allergies? - No, she's healthy.
- My Okay, hang in there, - we're going to take care of you.
- What's her access? - 18 gauge in the right antecube.
- She's seizing.
Ativan, two migs, let's get Trauma down here.
I need a second line and 50 of Manninol right away.
We've got a dilated stomach with exaggerated incisura.
Call Ultrasound.
Why? Caterpillar sign; could be pyloric stenosis.
Pratt, I need an antibiotics order for our physicist in Three.
Micro called, she's got gram positive cocci on the stain.
That's probably just contaminated, she looks too good to be septic.
She's still febrile and tachy, and how would you know how she looks? You haven't seen her since we brought her back an hour ago.
I've got an obstructed newborn, a perfed ulcer on his sixth unit of blood, and my aphasic boxer just dropped his pressure in CT.
Give her two grams of Ceftriaxone and I'll see her as soon as I can, okay? Guess what? I'll be house-sitting for Luby while they're away.
- Luby? - Luka and Abby.
You know, like Brangelina, Bennifer, Tomkat.
I hear it's a nice place, and Abby says it's okay if you sleep over.
What? Are you for real? I didn't think it would be right to have sex in their bed without at least asking.
- Load with a gram of Dilantin.
- What is that? A medicine to keep her from seizing again.
If you want to be here, you're going to have to step back.
More suction.
It's cranked all the way up.
Nothing's coming out.
- Come on, Gates.
- I'm trying, I can't see crap.
- Sat's are down to 86.
- Is that bad? - Abby, switch with Gates.
- I haven't even tried yet.
- Exactly.
- I'm being blamed for equipment failure? Don't make this about you, please.
- What are you doing? - The tube will protect her airway - and allow us to breathe for her.
- Is he still mad about the Propofol? Yeah, that or the thing that happened at the wedding.
- What happened at the wedding? - Nothing.
Yeah, it's the propofol.
Wants me to kiss the ring.
Why don't you just apologize and get it over with? 'Cause I have nothing to apologize for.
Post-op morbidity and mortality are up seven percent this year.
- Really? Why? - I don't know, but I'm going to find out.
I'm conducting an internal audit into the post-op unit.
I want every med, every hiccup meticulously recorded.
- Nurses are going to hate you.
- No, they're going to hate you.
You're in charge of the investigation.
ER Trauma call.
Not you, Dusty.
I want you hands-on at the PACU unit.
You're not doing consults till the audit's over.
Oh, boo.
Surgery's here.
What do you got? A 35-year-old fell down a flight of stairs.
Head trauma, intubated, FAST negative, labs pending.
Came in altered, five-centimeter scalp lac.
Access? First crit 37, second one cooking.
- Want me to bag for you? - No, I got it.
- Bolus is done.
- Hey, Run D five half at 75 an hour.
You don't want a fluid overload till we know what's going on in her head.
- It was a nice wedding.
- Thanks.
Sorry I got so crazy.
I think because I knew I was leaving.
I let it all hang out.
I mean, you hardly even know me, and then I had to go and be like that.
Don't worry about it.
- Dr.
Morris, your TPA patient is seizing.
- I'm busy here.
Find Pratt.
Don't worry about it.
I got it.
Mae Lee, call CT.
Tell 'em we're coming up.
- Is there a Megan Strand here? - That's me.
Neighbors heard screaming in your house this morning.
We were having an argument.
Where the hell is my Ceftriaxone? No, it's Pratt.
Hell, no, I'm not new! Are you? Listen, just send the stuff down, all right? I ordered the antibiotics over an hour ago.
Learned helplessness is pervasive in the ER.
Can't have a home-schooled pharmacy tech wag the dog.
You rang? What's going on? Who are you? I'm Dr.
Kevin Moretti.
I'm the clinical director of the ICU.
They called me down here 'cause your wife's condition is deteriorating.
- Talk to me.
- Fever to 103.
- Stain showed gram positive cocci.
- Yeah, we thought it was a contaminant.
Which is stupid.
Katey, set up for a subclavian, prime the line and get a CVP monitor.
Draw a lactate now, you, and, uh, give me six units of packed blood cells standing by in the blood bank.
- Who was the attending on this case? - Me.
Really? Well, you dropped the ball, didn't you? - Excuse me? - She's septic.
It's obvious.
You should have anticipated this.
She's young, she's healthy.
She had no reason She doesn't need a reason.
A reason.
Breathe, please.
Katey, do you see any signs of impending shock here? Tachycardia out of proportion with the fever, widening pulse pressure.
See that? Even a medical student could see it coming from a mile away.
Must be some new-attending thing.
We'll take care of your wife, sir.
Don't worry about it.
- I can manage my own patients, thank you.
- Really? Then why did one of your nurses activate my team? Excuse me.
I knew you were getting slammed.
She needed attention.
The Rapid Response team doesn't even cover the ER! Well, if you can't handle slam dunk cases like this, maybe we should.
Give me one percent lido.
Let's go.
Explain this again.
I don't understand.
- My wife is healthy.
- All right, calm down, sir.
Look, the bacteria could have seeded the bloodstream through the lungs, - a cut in the skin, her intestines.
- Second liter's in.
Goal-directed resuscitation for septic shock is so easy, yet so difficult for you ED types.
- She's in shock? - Systolic's only 82.
That would be a yes.
The key is to preserve effective tissue perfusion while avoiding excessive myocardial oxygen consumption.
Translation-- get oxygen to the body without stressing the heart.
We need CVP monitoring and continuous central venous sats to keep track of that.
See that? He's learning already.
That requires ICU-level monitoring.
We're too busy down here.
We can't do that.
Really? You can't? You can, and you will.
- Watch.
- We don't have the nursing capacity.
Patients come in, we stabilize them, then we send them up.
That's how it works.
Yeah? You forget about that eight hours that they sit around in triage.
- And wait another five to get a bed.
- Look, it's not great, but it's the reality.
Reality is nothing more than a persistent illusion.
Einstein said that.
I'm a physicist.
Memorized everything that guy ever wrote.
See that? Even more reason not to sit around and let your - organs rot away like rancid meat.
- Nobody's organs are rotting.
Free air under the diaphragm.
Probably a perfed diverticulum.
- What's that mean? - Um, what that means is, an infection in your intestines has eroded through the wall.
We need to get in there, clean up and repair the hole.
Lucien, don't you tired of ER docs waiting around for the surgeons to come down and save the day? Give 'em a break, Kevin.
You know what it's like down here.
I'm going to call the OR, tell them we're bringing her up.
It's true-- I know that we're just monkeys on a minor planet on an average star, but let's not pretend that sepsis is beyond our reach.
If you're trying to quote Hawking, you mangled it.
- I think I'm in love.
- Alison! What are you doing here, Blake? Hey, look, she called me, all right? - Hey, whoa, guys, hey! - You don't get to do this! - Hey, hey, come on.
- She wants me here, okay? Take it easy, all right? Stay away from my wife! - Where are you taking her? - CT scan.
- Can I go, too? - No, no, no.
Why don't you stay here? Dr.
Gates will be with her the whole time.
Is everything okay? No, my girlfriend's in a coma.
It's all my fault, so, no, everything is not okay.
All your fault? How is that? I left my roller blades at the top of the stairs.
It's polished concrete.
It's very slippery.
We were fighting, and she tripped.
Well, did you explain to the cops what happened? - I'm sure they'll sort it out.
- Yeah.
No, it's been a bad year.
How so? Moved to Chicago five months ago for my job.
Ever since, we've been fighting constantly.
These huge, dish-breaking fights.
And we never used to do that.
You know? It's like the city's changed her.
Well, transitions are hard.
Been together ever since college.
Been through a lot.
You know, us coming out to her family, and her brother dying.
You think you can make it through that kind of stuff, you think you can make it through anything.
Who knew, after 15 years, and everything would turn so much? It's scary.
Quantum information processing, teleportation.
You know, we've been chasing the same questions since grad school.
I'm sorry if he feels threatened by it, but there are certain conversations she can only have with me.
- Vice versa.
- But it's only work, right? Yeah, we're both married.
Happily married.
Can't say that the idea has never crossed my mind, but Alison and I just really click.
I don't know anybody else, male or female, who challenges me like she does.
They have this thing.
They're together in the lab all day, and then she gets home, and everything's, "Blake said this, Blake did that.
" Something about it has always felt weird.
He's her work husband.
Yeah, people spend more time at work than they do at home.
Share experiences, develop a verbal shorthand.
Of course, some intimacy develops.
The two men in my life-- they don't get each other.
Really? Never would have noticed that.
- The OR's ready.
- Okay.
Two planets revolving around the same sun.
Collision is inevitable, right? They try to stay out of each other's orbits to keep the solar system in order, but it's a useless exercise.
- Disorder rules.
- Oh, yeah.
The universe always reverts to equilibrium.
- I'll see you upstairs, okay? - Wait! Honey, I'm sorry.
I went a little crazy.
I want you to do something for me.
- So, am I going to have a scar? - No.
The edges came together nicely.
- It'll be small.
- Hey.
I have to head back up to the ICU, but I wanted to suggest that you write this case up for M and M next week.
What's M and M? Uh, it's a conference where we present our mistakes and learn from them.
- You made a mistake with Alison? - No.
Will you please excuse us for a minute? - What-what are you trying to do? - Trying to wake you up.
Why are you talking like that in front of a patient? How does that help anyone? Where'd you go to medical school? - Here.
- And your residency? - Here.
- Mm-hmm.
Your internship? Why are you asking? You know it was here.
Because I think that you have been lulled into complacency by too many years in this place.
You know what? You got a problem with the ER, you talk to Kovac.
Well, no, it's too late for Kovac.
He's the old guard.
I think you could really turn things around here.
You know what? Now, you're really starting to bore me.
How about this? How about you go up and harass your own department, and stay out of mine? It's always nice to talk to you, Dr.
Will someone please make this jerk disappear? - Who? - The guy is toxic.
What guy? Oh, hey, excuse me.
Excuse me? Can you hold up? - Did you finish interviewing Megan Strand? - Yeah.
We're just waiting to see if we can get a statement from Sophia when she wakes up.
Oh, that might be a while.
She's intubated, but, listen, I was talking to Megan, and her affect seems totally appropriate.
The injury matches her story, and I'm just I don't know.
I'm not getting that abuse vibe.
- Thanks, Doc.
- Yeah.
Make sure you write that in the record.
It'll be helpful if this goes to court.
- Right.
- How much ? No-no promotional rate? What about frequent flyer programs? Triple A? Fine.
Uh, three more nights at the honeymoon suite.
Charge the card.
Don't get snarky.
I'm too fragile.
Oh, I thought things were going well with you and Hope.
Yeah, they are.
Really well.
Staircase girl has a head bleed.
Frontal parenchymal bleed? Yeah, less common than a sub or epidural, but consistent with a fall.
Okay, I'll call Neurosurge.
Hey, Neela, hey.
- Have you heard anything from Ray yet? - Why, no.
I thought he'd be here.
Yeah, well, I mean, that the ER closed, maybe schedules got confusing.
- Yeah.
- I'll try paging him again.
Hey, Mayday, I hear you're taking the gastroschisis kid up.
Yeah, I'm just about to write the admission orders.
Operating on adhesions create new adhesions? Possibly, but we don't have a choice if he's acutely obstructed.
All right.
I'll keep him NPO.
Hey, Morris, you got a snake breeder with a fang in her leg.
Nice seeing you, Tony.
Thanks for the consult.
Hey, what? What did I do? - This is easy for you, isn't it? - What? "Hey, Mayday, did you see my gastroschisis kid?" Like nothing happened.
- Come on, Neela, you're not being fair.
- I mean, how can you be so casual? Hey, you're the one that broke up with me, remember? - Everything just rolls right off of you.
- All right, you know what? Why don't you tell me how upset you want me to be? On a scale of one to ten, what, a seven? And then, when you're feeling needy, we'll crank it up to an eight, put it down to a five when you want to get your work done.
- Now you're just being an ass.
- You think this doesn't upset me? It does.
This is painful for me, but you want what you want.
You know, so I just We're trying to figure how to work without the drama.
But now I realize something-- you, you like this.
You want the drama.
- That's not true.
- It is true.
- I don't want the drama.
- No matter how I act, - you're gonna be upset.
- You're the one at the wedding being Because that's the only way you can maintain this stupid, narcissistic game.
I hope that never happens to us.
They managed to repair her damaged intestine, but her blood pressure dropped very low.
It'll be a while before we know anything.
Six hours ago she was giving a talk in front of hundreds of people.
How did she end up here? Well, sometimes things just happen.
There's really no way to make sense of it.
She's not in pain? I'll make sure she has a morphine order.
How's she doing? Still needs dopa to keep her systolic above 85.
And I think she's third spacing.
She had a touch of DIC, lost two liters in the OR.
Hey, um, why didn't you scrub in? Well, I wasn't sure that you'd want me to.
Why wouldn't I? - Men are impossible.
- Listen, Neela, about Do you think I'm a narcissist? Well, to a certain extent, all surgeons are.
Yeah, it's good for the job.
Hey, guys, uh, Mae Lee's off to the airport.
I just wanted to thank you guys for an amazing experience.
- Good-bye, Mae Lee.
- Yeah, strong work this month, Mae Lee.
- It's the ER.
- One final consult before you go? Call me if you're ever in San Francisco.
Little freak tried to kiss me at the wedding.
What's she still doing here? Get her to the ICU.
Oh, runs of v-tach, she's not ready to move.
Oh, come on.
It's a hundred feet of corridor, and it'd be better for her to code in the ICU instead of here.
- Well, for her or for us? - I'm serious, Neela.
You know, we got five full ORs, we need to make room.
Let's go.
She loves tulips.
uh yellow.
No, no, no, no, no, uh, white.
Two, two dozen white tulips Hey, newlyweds, to be delivered to room 1258 at the Ritz.
How, how's it feel, guys? You know Morris is staying in our honeymoon suite? - What? - Yup.
With Hope.
They won't leave.
Did you wake up the next day feeling different? - Uh, not really.
- Yeah.
- Just a little.
- Well not that much.
Well, your wedding was awesome.
I just hope that thing I did didn't make you lose your security deposit.
- What thing? - What? Hey, everyone, in the ER, for the first time, Mr.
and Mrs.
Luka Kovac! Oh, sorry, Abby, Dr.
and Mrs.
Luka Kovac.
Doctor and doctor.
Hey, Chief, aren't you supposed to be in Bora Bora by now? Uh, Hawaii.
And I just attended my last department head meeting - so I'm officially no longer your chief.
- You're kidding.
It's like your wedding happened and now everything's changed.
You're married, uh, I'm with Hope, uh, you're not the chief anymore, there's new ramps in the bathroom-- It's a brave new world.
Gates is still a pain in the ass, though.
At least there's something you can count on.
You done, Morris? You had enough? Tony, there's a lawyer out there who says he needs to talk to you.
Thanks, Dawn.
Hide, Gates.
I'll tell him you went home sick.
- I'm going.
See you at home.
- Okay.
Uh being married does feel a little different.
Yeah, it does.
Aww look at that.
- Lucien.
- Hey, Luka.
Abby, I saw the Cheetos bezoar.
Send him home on Miralax, have him follow up with GI.
- Okay, done.
- Nice wedding, by the way.
I offered to replace the bidet.
What bidet? Abby! Your head injury in Trauma Two lost her pulse.
Clear! - Still v-fib.
- Going again.
And clear! I was on the phone, they paged me.
What's going on? Sophia's heart went into a dangerous rhythm.
- Oh, my God.
- Epi's in.
All right, back up, back up! Clear! - Resuming CPR.
- Oh, no, no, baby, don't do this.
- Lidocaine's ready.
- Okay, is neurosurge involved? No, there's nothing to evacuate, the bleed's parenchymal.
- You can't leave me now, you hear me? - Go ahead, give the lido.
Things that we said and the way we were, it's not us, right? - You're my rock, always calm.
- Another epi, charge 360.
Megan, when you said Chicago changed her, what did you mean? That she's so testy, and, and paranoid.
Please don't die.
Okay, clear.
Please clear.
Watch out.
- We have a pulse.
- She's back.
What do you think of this film? Uh Frontal lobe bleed, no shift.
You think it could be a preexisting AVM exacerbated by the head trauma? I mean, a frontal lobe mass would explain the personality and the behavioral changes-- - You're a romantic, Abby.
- What? You don't want to believe that after years of partnership, they started hating each other.
Call Radiology.
If you're right, she needs angio.
The girl's lived with you for ten years.
You're the closest thing she's had to a father.
So, that's gotta count for something, right? It does.
Given the situation, I'd say you have equal standing to seek custody.
Equal? The same as her grandparents? Even though I'm not a blood relative? Yep.
Especially if Sarah wants to stay with you.
Well, I just thought because I wasn't related This is good.
All right, okay, good, good.
What, what else? What's next? Well, first thing is to talk to Sarah.
Make sure she wants to stay.
She does.
I know she does.
I've got two adolescents at home.
- Talk to her.
- All right, then what? Then call the grandparents and let them know.
- So, that's it? - That's it.
Injecting the cyanoacrylate.
Amazing pickup, Abby.
What made you think of AVM? Well, her girlfriend kept going on about how she'd become like a totally different person lately.
Lots of couples go through that, they don't all have arterio-venous malformations in their brain.
Well, it was just a hunch, I guess.
Congrats on the wedding.
You think it's going to be strange to be a husband and wife working together? No, it's definitely strange to have people refer to us that way.
Get used to it.
- Are you married? - Oh, no.
Only people I ever meet are doctors.
And doctors make crummy husbands.
No offense.
You know, I used to think it'd be cool to end up with a composer or an artist, someone that would bring something totally different to the dinner table, but you know, it's really nice to go home to somebody who understands all this.
I can see that.
No more antegrade opacification of contrast.
- So the embolization worked? - Yep.
- Great.
- Very nice.
What are you doing here? Oh, I just came to check on the patient.
Uh wait a minute, I thought that Morris was the attending, so you Okay, uh, thanks, Betina.
I'm going to give Megan the good news.
I was on a little break, so I thought I'd bring you some coffee.
Oh, don't drink coffee.
Well, that's, uh good to know.
Now, listen, Betina I just want to hangout with you for a while.
- No plans, no games, just me.
- And the patient here on the table.
You can stay but don't touch anything.
Hospital day 12 for this Vitals stable overnight, pressures in the 90 to Who was the first person to measure blood pressure, anybody? It was a clergyman in the year 17 blah, blah, blah.
And he took a glass tube and he stuck it into the carotid artery of a horse and he was very surprised to see the blood rise up into the air about nine feet.
Why he did this exactly, I have no idea.
I mean it's very, you know, impractical for human beings.
And I'm sure the horse didn't appreciate it.
Sorry about that.
Go ahead, go ahead.
F-Finish, Katey, go.
Uh next we have a 64-year-old presenting Hi, we need a room! This is Alison MacKenzie, our septic with the bowel perf.
Lost a lot of blood, having some ectopy, and didn't tolerate the trip down the hall too well.
Tachy, on two pressors.
CVP is only six.
- Run of v-tach.
- Can I ask you a question? Why didn't you stabilize this patient in post-op instead of bringing us this shocky, fragile mess? Well, she got four units of blood and Look, I'm not an idiot, I know about the post-op audit that Dubenko's doing.
He doesn't want this patient in his PACU because it'll mess up his data.
- No, that's not what's happening here.
- He'd rather have her code and die - in the ICU than on his watch.
- Die? Yeah, well, we'll try to avoid that.
- You tell Lucien this can't happen again.
- You know, this wasn't his idea.
- Yeah, right.
- You know, I - I thought she was ready to move.
- V-tach! No pulse.
- Starting compression.
- Oh, no, this can't be happening.
- Charge to 200.
- Nice job, Neela.
Let's just stay focused on the patient, shall we? Clear.
Katey, someone on the phone says they've got to talk to you right now, - it's an emergency.
- I'm in the middle of a code.
No, go, just go, just go.
And there's a guy outside begging to come in to see this patient.
- He's not family.
He can't be here.
- You might want to rethink that.
What? Look, your wife is doing everything she can not to die right now.
She could probably use all the support she could get.
- Epi's in.
- Okay, going again.
Well, her heart is beating at a normal rhythm, but her blood pressure is still dangerously low.
Isn't there something you can do about that? We've maxed out the medications.
They're not helping.
It's possible that the part of her brain that controls the blood pressure isn't functioning properly.
- What? - Why not? Because she received 45 minutes of CPR.
Her brain was deprived of oxygen during that time.
And when that happens, we often see some degree of neurologic injury.
She walked in here today with a stomach ache and now you're telling me her brain is damaged.
Look, I don't want to take away all hope, but I want to be realistic here.
If she survives there most likely will be neurologic deficits.
- When will we know? - Well, there's no way to predict.
It's a waiting game now, I'm afraid.
I see.
You can go.
Please go.
Before she went into surgery, she asked me to give this to you.
I resented it for so long this thing you two have.
Even now I've got to share her with you.
What did he give him? I don't know.
- Some kind of treasured lab secret.
- Well, how do you know? Well, you work in the ICU long enough, you start to recognize these scenes are frighteningly familiar.
They kiss their spouse, their kids, they say good-bye to friends A certain percentage have a deep, dark secret, like an illegitimate child or a secret debt or something, but occasionally you see something like this.
Information that must be passed on.
A computer password or a combo to a safe or something.
- You're pretty jaded.
- Many long, tortuous cases.
You know, the human psyche was not designed to deal with this.
Cave dwellers had to deal with a lot more actual death, but they were not subjected to the slow, mechanized torture that is the ICU.
Well, why do you do it then? To save the salvageable and to give the rest a dignified death.
Just a little low on dignity these days.
Well, I'd have a hard time working here.
Surgeons just like to get in, do their job, and get out.
Yeah, well, that's your job, but we are left to deal with the dregs and it's not pretty.
I just want us all to do better.
I'm sick of seeing people die.
She had what's known as an arterial venous malformation in the part of her brain that's responsible for mood and personality.
That explains why she seemed different to you.
And it's fixed now? Yes, the radiologist was able to clot off the veins using a special kind of glue.
- And she'll go back to the way she was? - Uh, that's the hope, yeah.
Did you hear that, baby? It's all going to be okay.
All right, she's waking up, so we're going to take out her breathing tube now.
Nifs are good and she's following commands perfectly.
Okay, I'll need you to cough on the count of three.
Okay? Ready? One, two, three.
Megan I'm sorry.
I am so, so sorry.
I was upset.
I just I didn't mean to push you.
Chocolate-covered strawberries, room 1258.
No, n-n-no, I haven't checked out.
- No, there must be some mistake.
- There's not a mistake.
- I checked out of the hotel.
- What? No.
W-Why? - I-I paid for three more nights.
- I know you did, which is crazy.
- I got them to refund your card.
- I don't, I don't want a refund.
Let's call them.
Archie, stop.
No, look the flowers, the spa treatments-- it's all lovely, but I don't need it.
- Time to get back to real life.
- I don't want real life.
I-I-I like fake life where we, where we wake up together and take bubble baths and eat bonbons for breakfast.
I don't want our crazy wedding fling to end.
Who said anything about it ending? I wasn't sure if Dr.
Morris, I have not done this with anyone in a long, long time, and it's not because I haven't had the opportunity.
I decided to sleep with you because it means something.
This isn't a fling.
At least not for me.
She snapped; she had a momentary lapse.
It's not like she's a chronic abuser.
We don't know that, and even if we did, it doesn't matter.
Hey, guys.
Did Ray ever show up? - No.
- No.
- Well, did he call? It's not like Megan was trying to throw her down the stairs.
Oh, please, give me a break.
She pushed her.
If this didn't happen, Sophia's AVM wouldn't have been diagnosed.
Excuse me, is Dr.
Pratt still in? Nurses' station.
All I'm saying is one incident doesn't make it abuse.
She responded to anger with violence.
That's, like, the definition.
- Dr.
- Oh, boy.
- I thought I was done with you already.
- Millicent Lawford.
MI in the ER waiting room, sat there seven hours without being triaged.
Gertie Minton.
Renal failure, 12 hours to be seen, and then arrested from hyperkalemia.
Derek Shank, in the ER three days without DVT prophylaxis, died-- died-- of a PE before he made it to the floor.
- We can do better for these people.
- Okay, look, look, I get your point, okay? But the problems are systemic.
Too many people, not enough resources.
Now, how do you suppose that we address that? Well, first, I think we start by not believing that this is the best we can do.
Because it's not.
- Right.
- These are for you.
So I could totally tell that Melissa was copying off my paper, but if I tell on her, then I'm a snitch, and if I don't, - then I'm like an accomplice, right? - Right.
And I know, I know, she's just cheating herself, but it still seems like she wouldn't do that.
Yeah, and, uh, we learned in chemistry today how to freebase cocaine.
Really? Tony, you're totally not listening to me.
Sarah, when your grandparents wanted you to move in with them, I thought that, maybe, it was the best thing.
I don't want to go to a new school, Tony.
I don't want to go and live with them.
I was scared and I I just didn't think I had what it takes to do this, but then when we took the test, I realized that I wish it had gone the other way.
I wanted to be your dad.
I wanted that, too.
So I work a lot and I'm messy and I may embarrass you at father-daughter dances but I really love you, Sarah.
You're my family.
And it turns out that if you want to stay with me, you can, if you-- I mean, if you still want to.
- I missed you guys.
- Missed you, too.
How was your shift? Oh who cares? It's done.
No work for two weeks, the honeymoon starts now.
Does that mean you're ready to change into the bikini? - Maybe after Joe goes to bed.
- Joe, go to bed now.
I got him.
Sweetie You playing soccer? Hello.
Hey, Donald, it's Kevin.
Look, I'm glad I caught you.
Do you remember the thing that we discussed earlier about the ER? Yeah, well, I can't believe I'm saying this, but, um, I think I've changed my mind.
I have changed my mind.
I'll do it.
- Have a good one.
- Oh, good night.
Oh, good night, good night.
Stay out of the ICU.
That guy's a dick.