HawthoRNe (2009) s02e02 Episode Script

The Starting Line

Richmond traffic this morning.
295, 195 to Downtown Expressway to Powhite Parkway.
No accidents reported.
Likewise on the 288.
That's a look at traffic this hour on WBMA.
I'm Jim Ross.
Thanks, Jim.
Wait, let me help you with that.
Sir! Sir! The cancer center's down the hall.
I was just trying to help the girl out.
They don't know each other? She would have caught cold! I know.
I'm so sorry.
What are you doing here in enemy territory? Well, I have a meeting with Gail.
Are they poison? Well, I figure we'll be going a couple of rounds, so hopefully her blood sugar will crash.
Gail's diabetic.
Any bear claws? Seeing as she's my boss in the ER, could you please make it work out with her? I will try, but most likely, we're gonna both end up on gurneys.
All right.
My office.
This ain't gonna be good.
I know you're worried about passing the Joint Commission inspection.
Actually, I'm not.
I feel like, if we put our heads together, we'll pass.
Well, what do you propose? Well, there's a procedure to improve patient safety and increase efficiency in the ER.
It's known as SBAR.
Situation, Background Assessment and Recommendation.
We tried it and it didn't fly.
You know, sometimes when you're putting in new processes, it takes a minute to get things running smoothly What else you got? What about Lean? It's a process for admitting.
Another swing and miss.
We gonna be here a minute.
You want some coffee? Yeah, how about I'm gonna get us some coffee? Valerie Dayton, 39, collapsed dropping her kids off at school.
Low-grade fever, BP 100 over 60.
Trauma 1.
- Hi, ladies.
- Mrs.
Dayton, can you hear me okay? Are you experiencing any pain? My chest is tight.
Okay, let's get an EKG and a chest X-ray.
Do you have any allergies? Have you taken any medications, any drugs? Hey, Bobbie, are these her girls? Yeah.
Excuse me, young man.
Nice to meet you.
Can you call a volunteer from upstairs to come and get these beautiful girls? Yeah.
No problem.
We're gonna do the best we can to take care of your mommy, but right now, I'm gonna make sure you guys are taken care of.
How about some juice and coloring books? Okay? We set? On my count.
One, two, three.
I'm sorry, you look very familiar.
Were you a patient at Trinity at some point? Last year.
I had a heart valve replaced.
That's right.
I remember.
Mitral valve.
Okay, in that case, let's get an echo, as well.
Listen, I just want you to know, I'm gonna have a volunteer come take care of your girls, okay? Please, can't they just stay here? I wish they could, but I can't have kids in the patient area.
They'll be fine.
They're in good hands, I promise.
And if you have any other questions, ask one of these guys to find me.
All right? Take care.
Thank you.
What are you doing? I'm just taking some blood.
See if you're pregnant You don't need to worry about that.
Tox screen.
You don't need to worry about that, either.
They're just routine.
Instituting a fast track for suture removal and basic follow-up would cut wait times in half.
That means dedicating an exam room.
I don't have space for that.
Come on, Gail, really? Is it gonna be like this? I mean, there's CNOs all over the country implementing these procedures.
Those nurses wear suits, not scrubs.
So, you mean to tell me you have a problem with the title "Chief Nursing Officer"? Don't you think the title "Director of Nursing" is a little archaic? It puts us below the CFO, the CEO I didn't order alphabet soup.
And I'm not about to let some stranger from a failed hospital start meddling with my ER.
If we don't pass this inspection, your ER will be shut down.
I'm Doctor Hyun.
Calling in another doctor, that can't be a good sign.
Mitral valve was replaced last year.
It appears to have become infected.
Ah, she's got some regurgitation, but no sign of congestive heart failure.
That's good, right? Not exactly.
Your valve will eventually fail.
You'll need another replacement.
If it's an infection, why can't you just give me some antibiotics? We will, but the valve is already damaged, and those things don't get better, they get worse.
Have you been exposed to someone in a high-risk situation? Sick kids in your daughters' class, perhaps? No need to delay.
We need to schedule an MVR right away.
I don't have any insurance.
That's tomorrow's problem.
Be back in a minute.
Hey, Dot.
Who's next? We got a kid with a hard-on that won't quit.
Excuse me? Priapism.
Oh, dear.
Marcus, I need an open exam.
There are none.
But, uh, give me a second.
Best we can do at the moment.
You can't put my grandson on display like a county fair.
I told you we should have taken him to the pediatrician.
Dad, his doctor wouldn't be able to see him till later this afternoon.
It's been too long as it is.
How long has it been, exactly? He's been this way, erect, all night.
Somebody shoot me.
Have you sustained any injuries? Does scarred for life count? I've treated a couple kids who have experimented with that EcstasylViagra combination.
A little bit of that stuff goes a long way.
He would never do that.
Has anything like this ever happened before? No, never.
A couple of times.
It always went away on its own.
He masturbates.
For crying out loud, Jo Ellen.
The nurse needs to know.
Has R.
's father ever experienced anything like this before? No, he's, uh I'm adopted.
He's adopted.
What do you know about the birth parents? They're perfectly healthy.
You better have the records sent over from the adoption agency just in case.
You make the call.
I'll stay here with him.
I'll be right back.
Kid really wants to lose his erection, you should show him a picture of my 80-year-old neighbor, Ada, pruning her rose garden in the nude.
I like a girl who's a free spirit.
You'd like her a lot more in a bra and knickers, trust me.
I'm already dreading spring.
Hey, Bobbie.
What's this? Oh, he's got to be in a lot of pain.
I know.
A constant biggie.
I don't know which is worse, the pain or the humiliation.
I'd want to crawl under a rock.
Some men would pay a lot for that particular problem.
None that you know, I'm sure.
Hello, I'm Christina Hawthorne, Director of Nursing.
Why don't we get you upstairs into a private room in peds, okay? We still haven't seen a doctor.
Here's Dr.
I'll get that room ready.
Oh, good.
Thank you.
Hello, mate.
So, how long has this been going on for? Several hours, you said? Well, the first thing I think we should try is, uh, icing.
And fortunately for R.
, we have some special packs which are in the shape of a donut.
Apparently, they work brilliantly.
Well, good.
How are you? I'm good.
I'm just, uh, you know, doing the, uh The old doctor thing.
How are you? I'm good.
Yeah, I'm good.
Good, good.
Listen, um, about the other night, uh I'd really like a do-over.
A do-over? Yeah.
A do-over.
Well, I'm around.
You messed this up, didn't you? He came to the house the other night.
That sounds like a good start.
How'd it end? We almost kissed.
Soon you'll be holding hands.
And then promise rings.
Bobbie, my husband just died.
Two years ago.
Well, you know, it's I got I've got my hands full here.
I've got Gail.
I've got the inspection.
Why not wait till Camille starts college? Or finishes? Bobbie, that lady Valerie's asking for you.
We'll finish this later.
Hi, babies.
The doctors are gonna fix me up.
After that, no more hospitals.
I promise, okay? Okay, girls.
Come with me.
You guys ready? Hey, Bobbie, hold up.
She's on her way to the OR.
The surgery's been canceled.
Why? She's got a drug problem.
The doctors want to treat her addiction before any surgery.
If she gets another infection, a third valve replacement is a huge risk.
But they said I'd die if I don't get one now.
I'm so sorry.
I got hooked on painkillers after my surgery.
I tried to stop.
But when the prescriptions got cut off, I was desperate and sick.
And that's how you got the infection? Please don't let them take my girls.
I didn't mean to hide anything.
I thought my condition was severe enough that I would get treated, and that would be it.
Valerie, you're gonna get your surgery.
After three months.
We're gonna find you the right rehab facility.
What happens to my girls? Do you have any family? Not that can take them.
Please Recovering from the operation was so hard by myself.
That's how I got addicted in the first place.
There are services that can help.
Like what? Foster care? My girls shouldn't have to pay for my mistake.
Valerie, we're gonna get you through this, okay? How? Hey, Gail.
Can you help me understand how a patient's lifesaving surgery gets canceled? It was delayed, not canceled.
That delay could kill her.
The woman uses drugs.
If we replace her valve again, she just might reinfect it.
My kids play this game where they shoot popcorn kernels out their nose for distance.
So you deliberately shoved a popcorn kernel up your nose? Well, yeah.
They like it.
The results are in for the patient in bed three.
Thank you.
So, you mean to tell me we shouldn't treat this man because of his stupidity? He's stupid.
She's an addict.
Gail, she made a mistake.
We've all made mistakes.
Does that mean we don't deserve a second chance? Do you know what people do with second chances? Exactly what they did the first time.
Why are you putting this on me? Because I need your help to get this woman the operation that she needs.
Well, you'll have to take that up with the Ethics Committee.
It was their call, not mine.
Ethics Committee? I'm sure your hospital had one.
No, we had consults, not a formal committee.
Who's on this committee? I'm Director of Nursing.
Well, then, I need to be, too.
Five seats.
No vacancies.
Who else? Ms.
Hawthorne? I overheard your conversation with Gail.
Now, you know you're not supposed to be eavesdropping.
I know.
I'm sorry.
But I just thought you might want the 411 on the Ethics Committee.
Reverend Samuels always gives his approval on these kind of things.
I would hope so.
Gail and that accountant dude are the ones that say, "No.
" And they vote? Not sure.
Now, what is a bean counter doing on an ethics committee? Always been that way.
No, I've never heard of that.
It's usually, you know, Ethics Committee.
They have medical professionals, like physicians, nurses, social workers.
Not accountants.
Yeah, the ethicist, Dr.
Jameson, and the Chief of Surgery are on the committee, too.
Paul Hyun? Okay.
That's who I need to talk to.
You done good, Marcus.
Thank you.
So, what's the matter? You hate my wife? What? She thinks you hate her.
I love Dana.
It's you I hate.
She thinks a double-date would be fun, thinks you're avoiding her.
I'd be happy to date your wife.
But twice? That's a little serious.
Not her.
We're talking about your new lady friend.
What's his name again? Well, any kind of date would be tough right now.
What, did you blow it already? No, not me.
I'm sorry, dude.
Yeah, it's nothing.
Look, if I know you, you're probably trying too hard.
Double-date might be low-pressure enough even you can handle it.
Hi, I'm Kelly.
I'll be your nurse today.
Has anyone explained to you what's going on with your body right now? Not exactly.
Priapism is a circulation issue.
It's when blood flows in, but doesn't flow out, and it deprives the area of oxygen, which makes it rigid.
And painful.
For some reason, your blood vessels aren't doing their job.
But the ice is gonna help with the swelling.
How long do I leave the ice pack on for? Oh, I'll handle that.
You just relax.
It's okay.
She's a nurse.
Should I do it? Oh, God.
Let her do her job.
Maybe you should give us a moment.
We'll be right out here.
, this is gonna make you feel so much better.
I'm going to lift your gown and examine you, okay? So, you like baseball? Yeah.
You? Not at all.
Yeah, no, I get it.
Okay, thanks.
Doctor Hyun.
I'm Christina Hawthorne, Director of Nursing.
Christina, I've heard all about you.
Yeah, I know, uh, you and Tom go way back.
Tom? Oh, so you're the one.
I actually meant from Gail.
She's, uh, not a fan.
Well, from everything I've heard from Tom, he says you're a lot more open-minded than Gail.
She runs a tight ship.
What can I do you for? Um, I wanted to talk to you about Valerie Dayton's surgery.
The MVR? That surgery's been postponed.
Sending a woman to rehab with a compromised valve is risky, don't you think? Ever have your mitral valve replaced? Recovery's a bitch.
She's gonna want her pain meds, and without any treatment, she'll be back in here for valve number three in no time.
Well, send her to rehab first, and she might not make it back.
Look, I'm not saying I won't do the operation.
I'm just saying she needs some incentive to get clean, take responsibility for her own care.
There's no prior drug use.
She got addicted from her first surgery.
We'll get her the right help.
Trust me.
In the meantime, it's been great meeting you.
Oh, I told Tom we should all grab dinner.
I just met your friend, Paul.
He said something about a dinner double-date.
Well, I hope you didn't rip him a new one.
Well, he is rejecting a lifesaving surgery of a heart-valve replacement.
I was hoping I could get you to help me to get him to reconsider.
Why? Because she needs it.
Well, Paul told me about that patient.
He seems to have good reasons to reject the procedure.
Tom, this is clearly a mistake.
She needs that surgery first.
Yeah, and I have to agree with him.
If she doesn't get sober, treatment's impossible.
It's not worth the risk.
So, you're not gonna help me? Listen, I don't want this to be an issue.
It's not.
Well, about dinner, I'll just tell Paul some other time.
Are they gonna give me something for the nausea? Doctor wants to try nafcillin.
Another antibiotic? She had a reaction to the vancomycin.
What's going on with my kids? A social worker is coming to talk to you.
Please, if you let them put me in rehab, they'll take my girls.
Your kids would need some sort of placement even if you got your surgery first.
Because I'm an addict.
It's not that simple.
A spinal tap is the only way to rule out meningitis.
And then what? Then we try a therapeutic aspiration to treat the priapism.
A what? That essentially means we drain the blood that's accumulated.
Drain it how? We use a needle to draw the blood directly from the cavernosa area.
How many damn needles is my grandson gonna have to endure? You can't give him some medicine? It won't go away on its own? He's in so much pain.
I mean, this is the best way to alleviate it.
Worst-case scenario, we take him to surgery to insert a shunt.
I don't want any surgery until we know what's causing this.
One step at a time.
As long as you're holding my grandson's hand, I won't worry.
Any chance of permanent damage? Not if we move quickly.
Thank you.
Any luck getting those medical records from the adoption agency? I told you, there's no history of anything like this.
We'll figure out the cause.
We will.
So, your parents make you work here? No, just me and my gram.
But, you know, colleges take that volunteering and extracurricular work very seriously.
You're already in college.
Yeah, but med school's right around the corner.
Yeah, in, like, four years.
Doesn't hurt to start thinking ahead, you know.
I mean, what about you? I mean, you're gonna be a senior next year.
What schools you thinking about applying to? University of Hawaii.
Really? What do they offer? Surfing? Sea-shell collecting? It's just kind of a fun backup.
And what's the other options? Virginia Commonwealth has this graphic- design program.
You know, Yale has a graphic-design program.
But there won't be any luaus on the beach.
I think I can manage.
So, you gonna ask me out or what? Um.
Uh You're the boss's daughter.
I don't think that's gonna go over too well.
My mom is cool.
So, what time you picking me up? Look You're messing up my ride, baby.
I mean, I paid a lot of money for that.
Yeah, it looks like it.
See that spot right there? Now I got a dent.
All because of you.
That was there.
Candy! Finally! I've been trying to get you for days.
How is everything? Okay, hold on.
Excuse me, sir? Sir? Sir? This is a private office.
This is where I wait for chemo.
Ray, who are you talking to? Nobody.
How is it out there? Are you safe? Candy? Thank you for serving! Uh, you're welcome.
Who is that? I don't know.
She's a piece of ass.
Sir, please.
I may be carcinogenic, but I'm not dead.
You know what, Ray? Uh, I can't really talk right now.
Were you attacked? Not now, Ray.
We'll talk later.
Let's get you to chemo, okay? Sir, I'll take No, no.
It's okay.
It's okay, sir.
I'll take you to Oncology.
How many rounds of antibiotics has she had already? This would be her third.
So, we're pumping her up with all these antibiotics instead of giving her the surgery? This is ridiculous.
Surely someone on that ethics committee can see that.
Well, this entire hospital seems hell-bent on giving this woman a death sentence.
Looks like Camille's found something redeeming about the place.
See you later.
Nice catch.
Thank you.
We're gonna go get something to eat later, and I told him you're cool with it, so don't screw this up for me.
He's in college.
He's a freshman.
Yeah, what is he majoring in, seducing children? Mom, he's right there.
Marcus? Hey, what are you doing? Who did you say heads the Ethics Committee? Dr.
What's he like? She is very smart, very nice.
Silver spoon.
Old Virginia money.
So I guess her people knew our people, huh? I'm gonna get back to work.
Yeah, he really, really needs to get back to work.
Have a great time tonight.
Don't do anything your mother wouldn't do.
I'm sorry, but we've got to get R.
down to the OR.
You said if we move quickly, he wouldn't need surgery.
It's too late to aspirate.
There are signs of vascular damage.
We need to insert a shunt now.
I don't want you cutting on him until you know what's going on.
Can you at least tell us what's wrong with him first? Jo Ellen, listen to me.
Once the current problem is treated, and we have your son's full medical history, we'll be able to The agency can't find the records.
Okay, we'll continue running tests, then.
Your grandson needs this surgery.
We have to trust them.
Damn it.
Go ahead.
Tell OR we're coming down.
Come in.
Hi, I'm Christina Hawthorne.
I'm the new Director of Nursing.
I'm here to talk to you about Valerie Dayton.
Erin Jameson.
Come on in.
Take a seat.
It's my understanding that Valerie's valve replacement has been denied.
Actually, it's been postponed until after her rehab.
I don't think she'll last that long.
I was hoping she could get her surgery first, recover with supervision, and then go to rehab.
She has an addiction.
We need to treat that first.
If her valve worsens, we'll repair it.
Well, I guess what I'm trying to say is that she might not make it back to get anything repaired.
I'm sorry, you said that you're the new Director of Nursing.
But Gail's still here.
Morrissey split the department.
Gail handles ER, critical care.
And I have everything else.
Isn't this patient in the ER? She is.
And that's part of Gail's jurisdiction? Can we please not play 20 questions right now? Valerie needs her treatment.
Dayton is being treated for her addiction.
And once she completes that She won't complete it because her valve will give out first.
Do you have some personal association with her? She's a patient in this hospital.
The findings from Ms.
Dayton's psych consult and the medical evidence were weighed carefully.
Did you weigh that this woman has two little girls? Unfortunately, we can't consider that.
The children aren't part of her medical condition.
Her children could end up in foster care.
I'm sorry, where did you say that you're from again? Trinity.
Well, here we like to work through our issues, and trust me, I've dedicated my life to ethics.
Well, trust me, I think I know a little something about what's right and what's wrong.
That doesn't mean that you understand ethics, how it's studied or applied.
Well, this is not a clinical study.
May I finish, please? It certainly doesn't mean that your opinion factors into the equation.
If the patient is unhappy with our proposed treatment, she is free to go elsewhere.
Yeah, well, she doesn't have anyplace else to go.
I'm sorry.
Paxton, I need to speak with you.
I'll stay with him.
The adoption agency found the medical records.
I told you all there is to know.
But you didn't mention that R.
's birth father was African-American.
Why is that important? Because priapism is a symptom of sickle-cell anemia.
The blood work should confirm it Please don't bring that up.
If this is a sickle-cell crisis, he may need surgery again, and you're gonna have to explain that Whites can get sickle cell, too, can't they? R.
doesn't know that he's biracial? We're white.
Why complicate his life that way? He can't know.
Why not? My father is still upset over the War of Northern Aggression.
He'd never forgive R.
, or me, for bringing him into the family.
Are you sure your dad is the one with the problem? R.
is my son.
Please, I'm begging you, don't say anything.
So, the morphine didn't help.
Did my screaming give that away? Ah, Nurse Stein.
Thought I was gonna have to send out a search party for you.
I got sidetracked.
We're gonna move Annette here up to Dilaudid, .
2 mill every 10 minutes.
Starting? In 10 minutes.
All right.
My back is spasming.
I can't wait.
This should do the trick.
No, this is a joke.
I come in here for a simple procedure, I get a staph infection from this pit, and you people can't even help me.
It's okay.
Oh, for You are useless! You think there was a conspiracy to give you a post-op infection? It was an accident.
Nurse Stein A lot of stuff happens in hospitals.
Most of it's bad.
Just like the rest of the world.
One more thing, lady.
She's being a saint right now, putting up with your entitled nonsense.
So just give her a break.
I'm sorry about Nurse Stein's behavior.
If he were a man, I'd punch him.
You got a minute? Yeah, what's up? Um, the 14-year-old with priapism.
Yeah? Well, it turns out that he has sickle cell.
Sickle cell? And his mom doesn't want him to know.
She's afraid he's gonna find out that he's half black.
Mom wasn't planning on letting that cat out the bag.
It's her choice.
But that doesn't seem right.
It's the law.
Once a parent makes their wishes known, there is nothing we can do.
I'm sorry, Kelly.
Yeah, me, too.
We got off on the wrong foot.
These are really beautiful photos.
Where'd you get them? I took them in Cuba.
Have you ever been? No.
I hate to think what it'll be like in You took this one, too? In Senegal.
I don't see any family photos.
No kids? Nope.
Not yet.
Maybe it's the mother in me.
Maybe I am too emotional.
I just can't stop thinking about those two little girls who have only their mother to take care of them.
You should come meet them.
It won't make a difference.
Don't you owe it to your patients to weigh all factors in their equation? Um, she's not my patient.
You've never even met Valerie? She's over here.
How's your sciatica? It hasn't been giving you any more trouble, has it? So far so good.
Okay, well, if it starts up again, you better let me know, because I know a great orthopedist.
Is there anything I could help you with? I'm just gonna check on this patient.
Sorry, this is doctorlpatient only.
Hi, I'm Dr.
How are you doing? Nurse.
Nurse Stein.
Ray, I'm not gonna chase you.
What is wrong? Nothing's wrong.
Oh, so you spoke to that patient like that for sport? It's nothing.
I just couldn't stand the way she was talking to you, okay? Pain or no pain, it's It's not right.
You're sweet.
I'll see you later.
I've heard enough.
Thank you.
Excuse me.
This is a closed meeting.
Is this the Ethics Committee? 'Cause I got an ethics complaint.
I believe some of you have met Christina Hawthorne, one of our nursing directors.
I want to put a complaint in against this committee.
You see, it's my understanding that an ethics committee is a consult, a place where people with ethical dilemmas can come and get help.
But, see, you, on the other hand, have turned into a death panel.
Christina You got this woman out here who needs a new valve, and now you want to play God? Well, I'm about to throw a flag on the play or whatever y'all throw Christina! 'cause it ain't right.
We are reversing our recommendation.
Valerie will be treated for her addiction, and have the valve replaced simultaneously.
And I'd like to thank you for making us take another look.
Thank you.
You worry so much as a parent.
That's perfectly natural.
How am I ever gonna help R.
with this? I don't know the first thing about African-American culture, or being biracial.
Well, you can learn together.
Just take it as it comes.
You make it sound so simple.
It won't be.
But do it anyway.
I just sent Valerie to the ICU.
She's having her surgery in the morning.
And you may want to avoid the ER for a few days.
Gail has your picture up for most wanted.
Welcome to my life.
Headed out? I am.
I'm gonna have a hot bath with my favorite drink.
Red wine and ginger ale.
With Tom? No.
I told you, um You're gonna blow this, and not in the fun way.
Bobbie, it's just that I, um What? When I first met Michael, I was very young, and very inexperienced.
You've only slept with one man.
My husband.
And since he's died Why? How many have you been with? That's not the issue.
Tom's a great guy.
But he's gonna run out of patience before you run out of excuses.
You up for going out tonight? Yeah.
Not with Paul or anything.
I figured just us.
Maybe we could double-date or something this weekend.
I like it.
I'm going home to shower.
Pick you up at 8:00? Okay.
The doctor said the surgery went great.
It won't ever happen again, right? Actually, uh, you have sickle-cell anemia.
Sickle cell? Kelly, would you mind giving us a minute? Not at all.
I, uh I got something to tell both of you.
Sounds like you moved mountains for me.
I just got you to the starting line.
I'm really gonna do this.
For my girls.
I was counting on that.
Hey, Tom, it's Christina.
Um, I had a patient here crash, and, uh, got a lot of sick calls in.
It's a lot to do here.
It's a zoo.
It's really chaotic, so I'll see you in the morning, okay? Mind if I sit in here with you for a while? Please.