ER s15e01 Episode Script

Life After Death

Gates, the board's a mess.
You're only seeing three patients.
Feel free to pitch in.
My job is to supervise and teach.
-Your job is to move the meat.
When I was a resident, I had what's called a work ethic.
-Y es.
You set the bar high.
-Oh, you bet I did.
It's not as easy as it looks, I gotta keep an eye on you guys.
MORRlS: Exam 3 is clear.
Bring me syncope, impetigo and nausea.
FRANK: Poor guy.
I heard he just quit.
-No way.
-I'm looking for Dr.
-Me too.
When you see her, tell her I need one more prescription.
JASON: There's something in his eye.
GATES: What happened?.
Down the street from the explosion.
They said it was an ambulance.
-Who went in that rig?.
-Get Bardelli on the radio.
Set up the trauma rooms.
-Dumar, you seen Sam?.
-All right.
Let's roll.
-I didn't get a call.
WOMAN [ON RADlO] : Unit 62 respond to explosion and car fire 800 block South Michigan.
This is unit 62 responding.
[SlREN WAlLlNG] GATES: Hold on.
Hold on Hold on, hold on.
Ow! FlREMAN: Grab another line.
[COUGHlNG] [PRATT GROANS] -Greg, are you okay?.
-Yeah, I think so.
What about--?.
What about the guys in the back?.
[GASPlNG] -Hey, Bardelli.
-Hey, Bards.
Come on.
Wake up, man.
You need to sit, wait for the paramedic.
-I'm an ER doc at County, so is he.
-We can help.
All right.
You can assess him.
-How's your neck?.
Any pain?.
-My stomach.
ABBY: Oh, man.
Dannaker, we need a saw.
You get your guy to the sidewalk.
I got him.
All right, just hang in there, Bards.
What are you doing here?.
-Wrong place, wrong time.
GATES: How's your breathing?.
PRATT: Something hit my jaw.
ABBY: I think I broke my wrist.
-Bardelli's impaled.
He needs two large bore lVs, some O2-- Don't worry.
There're on it, okay?.
You're the patient.
-Sit down.
-I can still work with one.
Come on, guys.
This is stupid.
We could be helping out, triaging.
You've been walking on this?.
You have an open fracture.
-lt just stings a little.
GATES: lrrigate with saline.
It's just a little blood, I'm all right.
-When I said I thought you needed-- -Shut up.
[PAGER BEEPlNG] We've got trauma.
Okay, everyone needs to sign in at the window.
-We'll get to you as soon as we can.
GATES: Clear a path.
-Gates, are they okay?.
-Y eah, so far.
Out of the way.
How're you doing, Bards?.
-Pressure's up to 90.
-Hold an O.
for him.
Hey, Greg.
Sorry about this.
Broken jaw, open fibula.
Pulse ox is borderline.
-Hang tough, Greg.
PRATT: Mm-hm.
-Oh, God.
What happened?.
-Got a facial fracture.
Shouldn't talk.
Neela, Brenner.
I need you with Bardelli.
-We're on it.
SAM: One, two, three.
MORRlS: Trauma panel, chest, facial series and tib-fib.
-Sats are 93.
SAM: Open up, buddy.
Need a gram of Ancef, a hundred of gent.
-Some jelly for the belly.
SAM: 1 1 O over 7O.
Small lac to the oropharynx.
-Everybody, stop.
Stop, stop.
Give me one percent with epi gel foam.
Morris, Sam, stay here.
Abby, go fix your wrist.
-Gates, get in there with Bardelli.
-I'm fine.
You heard the man.
Hey, Brenner, you better be teaching in there, man.
GATES: What do you guys need?.
-Lateral C-spine.
Deep breath.
-How is he?.
-He's good enough to boss us around.
BRENNER: Kaya, pre-op antibiotics.
Ceftriaxone covers gram positives and negatives.
Okay, but not the anaerobes.
Ertepenum gets them all.
T ony, do you mind calling my mom?.
I don't want her to hear something on the news.
-No problem.
MARQUEZ: First unit of O-neg is up.
-Might as well intubate.
-He's got a good airway.
BRENNER: Need it for surgery.
-We have anesthesiology.
Put in a central line, take him to O.
I'm gonna make that call.
You guys all right?.
HALEH: How's that feel?.
-Much better.
[GAlNES CHUCKLES] -There you are.
Gaines, this is not a good time.
Oh, dear.
Should l--?.
-Come back later.
Oh, yes.
-Did I see Luka stop by today?.
-And I think things are gonna be okay.
I'm glad to hear that.
Everything was going really well until the ambulance blew up.
[GROANS] Thanks.
-How about we x-ray your ankle?.
-No, it's just a sprain.
Thank you.
Hold up.
I'll take those.
MORRlS: Bleeding stopped with epi.
PRATT: Yeah, I told you it would.
-This doesn't make sense.
There's no fracture.
The tibia and fibula are intact.
-Did they x-ray the wrong leg?.
-Pratt, that's not your bone.
-Two-inch bony fragment.
-Yeah, it's someone else's.
-Someone from the back of the rig?.
-Most likely.
-Good thing you sat up front.
-Let me numb it up.
-No, just pull that out.
-Without local?.
-You sure?.
[GRUNTS] Send that up for HlV and hepatitis.
-Pulse ox down to 88.
GATES: Put him on 1 OO percent.
MORRlS: Pneumothorax on the chest x-ray?.
No, diffuse bilateral contusions.
Blast lung.
Shock wave caused bleeding throughout the chest.
I know.
It might get worse before it gets better.
SAM: I'll get the non-rebreather.
Hey, how come he's not in the O.
BRENNER: Surgery wants a central line first.
SAM: How you doing, Lou?.
-Hanging in there.
-How's Greg?.
-Uh, sats are down.
BRENNER: Hang two more o-neg.
We're giving her real time guidance in the sterile field.
KAY A: Is that the lJ?.
BRENNER: Perfect.
-Can you see, doctor?.
-It's crystal clear.
MORRlS: Decreased breath sounds.
SAM: Pulse ox is dropping.
The damaged alveoli are filling with fluid.
We need to talk about intubation.
Do it.
-Etomidate and sux are ready.
-Push it.
GATES: Lower his head.
SAM: Assisting ventilations.
Morris, don't screw this up.
-Abby, you want to give it a try?.
-With this?.
-I think he wanted you to do it.
You know, I need to step back and keep an eye on the big picture.
I'm running this, you're doing it.
-All right.
Laryngoscope and suction.
-Sats up to 9O.
I need a doctor in here.
I got it.
Check the cuff.
MORRlS: We have an end-tidal detector?.
SAM: Ready to go.
She has tight wheezing she was in back of a burning car.
-I couldn't get my seat belt off.
That must have been scary, huh?.
Can you sit forward?.
I'm Dr.
I have moderate persistent asthma.
I'm on inhaled Beclomethasone, Albuterol and an oral leukotriene modifier.
You know a lot.
Can you tilt your head back?.
Who's with her?.
Uh, the nanny.
She's calling her mom right now.
No evidence of thermal damage.
I'll be back.
Keep her on ten an hour.
Order a portable chest.
You got it.
MORRlS: See the cords?.
GATES: Too much blood.
What about cricoid?.
Anatomy's distorted.
You're making it worse.
SAM: Pulse ox down to 8O.
All right.
That's enough, bag him up.
You do this, Arch, you're better at it.
Come on.
-Open up a 7-O and a bougie.
-I need the rapid infuser.
-What's with Bardelli?.
-Might bleed out.
GATES: Neela still in there?.
MARQUEZ: Oh, yeah.
-Let's take another look.
ABBY: We're here if she needs us.
MARQUEZ: They're tubing him.
-It's not slowing down.
-Okay, apply more pressure.
The blood's from deeper inside.
Maybe a mesenteric artery.
BRENNER: Need the O.
-You over-transfused.
Got his pressure up, blew a clot.
Was fine when he got here.
Why didn't you say something?.
Because I didn't hear, I was busy with the central line.
-What have we got?.
Abdominal penetration.
-Exit wound hemorrhage.
-TKO the fluids, hang FFP and platelets.
Are you back at work?.
I heard the news on the radio, I figured you might need my help.
Crap, they still haven't got it.
-I see the epiglottis.
GATES: That's as far as I got too.
-Everything's to the right.
-Use my hand.
-I'll hold when you see cords.
-Sats are drifting down.
Forget it.
There's no way.
-Wanna try the bougie?.
-I can't see the larynx.
-Fiber optic's here.
-I'll set it up.
-Too much blood for that.
-You want to try again?.
He needs oxygen.
He needs a crike.
-We can try to go retrograde-- -We're criking.
SAM: No crike trays.
-Check the hall.
Pulse ox in the seventies.
Okay, forget the tray.
I need an 1 1 blade and a Shiley.
-I got 1 0 blade here.
-Where the hell are the Shileys?.
Run of v-tach, open the crash cart.
-Sam, you have bandage scissors?.
-Y eah?.
Get over here.
Morris, what are you doing?.
Bag him.
-Morris, what are you doing?.
-Hey! Cut the drip chamber right here.
Bag him up.
-Good chest rise.
-What the hell was that?.
-Sats are coming up.
-All right.
All right.
You still need a crike tray?.
Rose Franklin, 1 0 foot fall.
BRENNER: Another one from the explosion?.
Got knocked down an access well.
-Concussion, hip fracture.
BRENNER: Warm up the head CT.
One, two, three.
Ma'am, are you having any pain?.
-Trauma panel, UA, type and hold -c-spine, chest and pelvis.
-How you doing, Rose?.
-Norman Chapman, tibia fracture.
-Rose, it's Norman.
I'm right here.
-She's a relative?.
She's a complete and total stranger.
Norman's a real hero.
He jumped right in to save her.
-Ten feet down at least, right?.
-At least.
[CHUCKLES] I broke my leg when I landed and then I crawled out with her on my back.
Start your primary assessment.
-Hey, am I gonna have to miss work?.
-What do you do?.
NORMAN: I'm a website debugger.
-Like a programmer?.
Uh, not really.
I beta test websites.
I click on them a couple thousand times try to get them to crash.
Chuny, I heard they brought Bardelli in.
Oh, yeah.
They took him up to the O.
Who was he riding with?.
GATES: They'll have to wire his jaw and then he'll go to the lCU until his lungs heal.
With all the facial trauma, we had to crike him.
His vitals are stable, he's oxygenating well.
You have any questions?.
[SlGHS] I'm good.
MORRlS: lnflate the cuff, hook up the vent.
ABBY: Hey, Chaz.
How are you doing, man?.
You can't talk with that thing?.
Good, so you get to listen to me tell everybody about how many times I kicked your ass on the court.
""I'm busy now.
Can I ignore you some other time?.
"" I'll check on you later, okay.
MALlK: Dr.
-My mom.
-How's she doing?.
Okay, well, her pulse ox is up to a hundred, which is good.
[JASMlNE GlGGLES] -You're funny.
Come on.
-You okay?.
-Yeah, I'm fine.
-You don't look fine.
-She's acting weird.
Can you sit up, sweetie?.
Well, the wheezing's improved.
-Dropped her BP.
-What's happening?.
Bolus 250 of saline.
Repeat CBC, and abdominal ultrasound.
-Need to check for internal bleeding.
-Shouldn't you have done that?.
You've been in the other room this whole time.
What's up with his neck?.
That wasn't there before.
-Get surgery, right now.
-Call for four units.
There's a pulsatile mass.
It's expanding.
There's no bleeding in the chest or abdomen.
-Then what is it?.
-I don't know.
-I'm checking on a bunch of things.
I'll get back to you as soon as I get some more results, okay?.
-Hey, excuse me, are you a doctor?.
You think my leg is broken?.
-X-ray's been ordered.
-Never rock against the teeth.
Um, you know what?.
-Does this hurt?.
It's probably fractured.
I jumped into a courtyard to save that lady.
-You see the cords?.
Every day, I get a pop and I get pretzels from the snack bar.
T oday, I thought, "" l' m gonna get a burger.
"" And it was like fate put me there to save her.
-That's great.
BRENNER: I'm in, bag her.
She was talking when I brought her in.
Is she gonna be okay?.
It's a possible epidural, we're gonna take her to head CT.
-She's strong, she'll pull through.
-Okay, I have to-- I don't know how I did it.
I was in pain, I was desperate and I was in a deep hole.
Then I remembered: ""When you feel there's no hope, You're at the end of your rope "" -What's the rush?.
-It's Greg.
""And there's a hero inside of you.
"" Ha-ha-ha! The song was right.
[CHUCKLES] MORRlS: A second Yankauer.
GATES: Hang another two units.
-What happened?.
-Expanding neck hematoma.
MORRlS: He dehisced the lac.
NEELA: A sponge stick.
-Do you think he's gonna aspirate?.
-Trach tube has a cuff.
-He was doing okay.
NEELA: Piece of mandible cut his carotid.
-We should have seen this.
-Unless he cut the artery, it took time.
Got it.
NEELA: Okay, Betadine and cut-down tray.
ABBY: What are you doing?.
NEELA: I need to tie off his carotid.
SAM: Tying off his carotid?.
-lt'll cut off blood to half his brain.
-Paralysis and aphasia.
-Collaterals through the circle of Willis.
There's an open artery.
I can let him bleed out or accept the risk of a stroke.
Think he's gonna die if you don't?.
You understand?.
Should I call Dad?.
-How about Bettina?.
-Try her cell.
Some burning with lido.
Abby, right now.
Multifocal PVC's, runs of v-tach.
Where's the blood gas?.
-Her pH is very low.
-What is that?.
NEELA: Retract anterior.
MORRlS: Superficial bleeders.
They have enough doctors in there.
My daughter needs you.
Okay, all right.
She's got a profound gap acidosis, but her oxygen level is normal.
-Did she ingest anything?.
-Uh, yeah.
That's it.
That's probably it.
Mix two grams of hydroxo-cobalamin.
That's the antidote.
Sometimes, when a car interior burns, it releases cyanide.
As soon as it gets here we'll give it to her.
Fix the light, I can't see a damn thing.
GATES: Try to stop the-- -Everybody, stop! Stop! Shh.
Quiet! Let her work.
Releasing the clamp.
Field is dry.
-You got it.
-All right.
-Okay, I'll close with steri-strips.
SAM: Systolic at 1 OO.
Give me that.
MALlK: You're supposed to run this in over 30 minutes.
-ls that safe?.
It's okay to push it faster if the heart's in trouble.
This binds with the cyanide to form a vitamin.
MALlK: Normal sinus.
ABBY: See?.
She's coming around.
MORRlS: Damn it.
GATES: Starting compressions.
-Call for bypass.
NEELA:1 4 French femoral catheters.
They're waiting for you.
Somebody going on bypass?.
It's Pratt.
They're doing CPR.
[EKG BEEPlNG] MORRlS: Lines are primed.
NEELA: Clear of bubbles.
Ready to go.
We can stop bagging and compressions because the bypass-- It does all the work of the heart and the lungs.
-Pulse ox is coming up.
-That's good.
He's in an agonal rhythm.
But we don't treat it now.
We wait for the bypass to work.
-ls it a compound fracture?.
-No, it's spiral.
You have to fall a long way to get a spiral?.
-Yeah, it takes a bit of force.
-Yeah, I know.
-Did you hear about how this happened?.
-Several times.
Swelling, but no bleed on Head CT.
Actually, that's a bad concussion.
And a nasty pelvic fracture.
You're doing okay, Rose?.
It's Norman.
I'm right here.
Hey, open your eyes.
It might take a bit of time.
-How long?.
-I can't really say.
All leads are isoelectric.
-So his brain's not working?.
-Not right now.
-He wasn't down for that long.
-We started CPR right away.
-He never had prolonged hypoxia.
MORRlS: Guys, guys.
-lt could have been an air embolus.
-That would do it.
A blast injury puts air into the circulation.
And the air goes up into the brain.
-And that's it?.
DOCTOR: Well, the brain can still recover.
We'll wait four hours.
Then we'll check Auditory Evoked Responses and an Apnea Test before making any decisions.
I'll come back.
ABBY: We should get Bettina.
SAM: I left a message on her cell.
NEELA: Keep trying.
Listen, I don't think we all need to be in here.
There's nothing more we can do for now.
We'll take shifts.
There's a lot of patients.
He would tell us to get out there and take care of business.
That's what he'd say.
MARQUEZ: Pressure's down.
90 over 60.
-500 of saline, check a crit.
KAY A: Is she bleeding in her pelvis?.
Wasn't that impressive on the CT.
Maybe we got behind on her fluids.
-I wanna push Vitamin K.
-What for?.
-She's probably on Coumadin.
-We never got a history.
She's in A fib.
ST segments are consistent with digoxin use.
-She's probably on a blood thinner too.
-Makes sense.
I suppose Vitamin K couldn't hurt.
Let's get her to trauma.
Call the blood bank for FFP.
-Pretty smart for a med student.
-Book smart, she's got a ways to go.
Whoa, wait up, guys.
I was crutch training.
-We're moving to another room.
-You gotta keep me in the loop here.
It's an ancient Chinese proverb, ""He who saves a life is responsible for it.
"" No cardiac activity.
It's only been two hours.
I need to ask you about something.
Listen, in Greg's wallet, he has an organ donor card.
I wanna make sure that's okay.
He's not dead yet.
If it comes to that, then do what he wanted.
You've been here a long time.
Take a break.
I'm fine.
Hi, Bettina, it's Sam again from the ER.
Call us when you get this.
Excuse me.
Excuse me.
Crit's down to 24.
BRENNER: Did you re-check her ProTimes?.
-ProTime's good.
-Only 8O over 4O.
-She might not make it to angio.
KAY A: We could try preperitoneal packing.
-Excuse me?.
Suprapubic incision, leave the peritoneum intact.
Lap pads on either side of bladder.
-We had good success in Nicaragua.
-ln Nicaragua?.
I volunteer summers in a rural hospital.
High trauma, low tech.
NEELA: I thought ortho was admitting.
-Uh, unstable pelvis.
-You ever hear of preperitoneal packing?.
-Yeah, they do it in Europe.
It works.
-Shall l?.
-Y eah.
Ten centimeter incision.
KAY A: Just like a C-section.
-You've done those too?.
Where are we with Greg?.
It's been four hours, the neurologist is back.
All the way down to the pre-sacral space.
-Uh, can someone help Norman, please?.
-Pressure's up.
Angio can take her.
Well, she doesn't need the O.
You're lucky to have such an experienced med student.
Okay, let's go.
[EEG BEEPS] MORRlS: EEG remained isoelectric.
-No brain stem-evoked responses.
Blood gas after ten minutes.
PC02 is 74.
Anything over 6O means brain death.
I'm so sorry, Chaz.
What are you doing?.
Chaz, there are no vital signs to monitor.
Not yet.
Can you please just keep this thing going a couple more hours?.
No, no.
He could come back.
Maybe he'll come back.
His heart's gone, his brain's gone.
We're pronouncing him.
He's still warm.
Yeah, that's just the bypass machine.
We need to keep him on it to perfuse the organs.
Neela's gonna take him to the O.
I wanna stay with him.
[SNlFFS] -I wanna push his gurney.
-Of course.
He's going upstairs.
DVT's admitted and Biliary colic goes home with instructions -to lay off the cheeseburgers.
It's pretty quiet in here, guys.
You can take another hour.
And do what?.
I, uh, I wanted to be there, but I thought it was more important to cover Morris.
-lt was a really beautiful service.
A bunch of stuff came.
It's a gift basket from Dr.
Weaver in Florida.
And this, it's.
Comes all the way from Africa.
-John Carter?.
It means a person's souI'll live forever.
We're supposed to leave it by the grave.
We should get caught up with your patients, and we'll jump in.
I need to change.
MORRlS: Hey, guys.
I was gonna drop Bettina off at home, but she wanted to stop by.
Since I didn't get to speak to you all at the church.
You were.
You were a family to Greg.
He loved you all very much.
You should know that.
[AUTOMATED DOOR BELL BUZZES] DUMAR: I've got a sick one, here.
-We're on it.
Fever, low BP, altered, and a broken leg.
I remember that guy.
He'll talk your ear off.
Not today.
Two liters of saline.
Set up for intubation.
-Hey, Abby.
-lt was nice to see Luka at the funeral.
-ls he coming to lke's?.
-No, he had a plane to catch.
-It's good to see you together.
-Amen to that.
-Neela, they need you in Trauma.
-Do I have time to get into my scrubs?.
Of course not.
Luka said something about an interview in Boston.
Yeah, we were thinking about moving, but now I'm not so sure.
It's hard to imagine leaving this place.
What do you need?.
Fever and sepsis.
We're looking for the source.
-Well, it feels fluctuant.
-Would you like the honors?.
-Please don't make me put on gloves.
Eighteen gauge.
Little pus.
-He needs a wash-out in the O.
-That sounds about right.
[CELL PHONE RlNGS] Excuse me.
Yeah, no worries, I can talk.
Are you feeling better?.
I just needed a minute.
I meant, better from the surgery.
Oh, yeah.
I'm, uh-- I'm going back to work on Monday.
Oh, that's good.
I mean, that you're ready.
But it's also good that you have a little more time off as well, you know.
Oh, man.
I'm not sure how to do this.
Do what?.
I've been holding onto something.
And I didn't know the right time.
And now I know there's never gonna be a right time.
[CRYlNG] This is for you.
It was in Greg's pocket on the day he died.
You know, that guy got hurt last week, trying to be a hero.
I've been thinking a lot about last week.
And about how Pratt wouldn't let me get on that ambulance.
So I don't wanna waste time.
I wouldn't be with you if I didn't think we could have something real.
I feel the same.
Sam, Gates, you guys know about lke's?.
MORRlS: We'll try to start around 8:30.
If anyone has anything they wanna say, you know.
Share a story or a memory.
That would be the time.
You know, can you hang up or take that someplace else?.
-Sorry, that was Anspaugh.
-Uncle Donnie?.
He thought that everyone should know they were going to offer Greg the job.
He was going to be the chief of the ER.
Excuse me.
Wait up.
-Hey, we're all going to lke's tonight.
-I don't think so.
Everybody's gonna be there.
-I already went to the funeral.
-This is different.
I've been doing it all day.
Shaking hands, getting hugs.
They say, ""Are you okay?.
"" And I smile and I nod.
I can't do it anymore.
I've lost a lot of people in my life, but not like this.
Not a brother.
But I think you're gonna miss out on something if you don't go.
-Tonight's about remembering him.
-You all get to do that.
He worked here for eight years.
I only knew him for a couple.
I was trying to catch up on the 1 8 that I missed out on.
-I was just starting to know him.
-I'm sorry.
Have a good time at your party.
I looked on a medical website.
It was probably a virus.
I didn't even think about under my cast.
Not a good idea to scratch your skin with a wire coat hanger.
The itching was driving me nuts.
Hey, let me ask you something.
Is this an unusual case?.
Do you think you could write this up for the journals?.
I think you need rest.
And so do l.
BRENNER: Hello there.
Someone wanted to see you.
Oh, my God.
I didn't know you made it.
They wouldn't give information.
-I couldn't see you, I'm not a relative.
-Norman, easy.
-Oh, it's so good to see you.
-Thank you.
-Thank you for saving me.
NORMAN: You look fantastic.
We'll let the two of you catch up.
-So are you going to lke's?.
-Should I wait for you?.
He's taking a leak and he finds Morris hiding in a stall on his cell phone getting advice about a case.
And he storms back to the desk and tells me: ""That kid couldn't find his ass with both hands.
"" [ALL LAUGHlNG] -And Pratt was always right.
-Y eah, very funny.
Very funny.
Excuse me, everybody.
Um, tonight's not about speeches or anything but I was gonna say something, I was wondering if anybody else-- -lf-- -Hold on.
This is from the church.
I thought it should be here.
Who, uh--?.
Who wants to start?.
A couple of years ago, after Michael died Greg helped me through the hardest time of my life and I don't think I ever thanked him enough for that.
[CLEARS THROAT] Before I met Greg, I was, uh, pretty clueless.
He taught me that anything is possible.
He taught me not to be scared.
And helped me to realize who I was and the kind of person I wanted to be.
I got this from UNOS.
A 1 5-year-old girl in Nebraska a father of three in Maryland, and a college student in T exas all got organs from Greg.
He saved three lives that day.
You know, uh, sometimes after a really gnarly shift Greg would drag me over here.
He'd buy me a beer and we would, uh-- We would share an order of his all-time favorite deep-fried mozzarella sticks.
He'd say that the clams might be frozen, the mushrooms might be bad.
But you can't go wrong with mozzarella.
I invite all of you to dip deep into the marinara and, uh, raise your cheese as we embrace the memory of our colleague our mentor, our chief and our dear friend.
God, we miss you.
-To Greg.