Paul Young: Hope in a Hopeless World (1993) - full transcript
Previously on ER:
When you're waiting
on a patient's results
it's not necessary
for you to boff
that patient's mother
in the storage closet.
I'm so sorry, Robert.
About my arm,
or about my being there?
A memo from Weaver.
I've made Abby
the new nurse manager.
The job is yours,
like it or not.
"Like it or not"?
I don't care
to argue about it.
Duroziez's sign
is a to and fro murmur
when the stethoscope
is placed
over the femoral artery.
What's another peripheral sign
of aortic insufficiency?
Weak pulse.
No.
Poor cap refill.
No.
Those are both signs
of shock.
It begins with
"Q." Anyone?
DeQuervain's.
No, that begins
with a "D"
although there is
a "Q" in it
so, you're
getting warmer.
Does Quinkie's sign
ring any bells?
And it manifests
itself how?
With a visible...
puh...
Pulsation.
Correct. Where?
On the... nnn...
Neck.
Navel?
Nail bed.
Good night.
Go home.
Rounds start
at 7:00 a.m.
Be sure to read
Sabiston's chapter
on the acute abdomen.
So much for the future
of medicine.
Jacy, would you be sure
to ring Mr. Ingles?
Remind him not to eat anything
after midnight.
I don't want to have to
reschedule his hernia yet again.
I'm going trick-or-treating.
Oh, what's Ella this year?
A cow.
Wasn't she a cow
last year?
No, last year she was Dorothy,
I was the Cowardly Lion, Mark...
Mark was the Scarecrow.
Right.
I get to be a farmer this year.
Happy Halloween.
Dr. Corday.
Yeah.
Your med student called--
Nathan.
What, the one
who didn't bother
to show up today?
He said he'd be here
in a few minutes
to speak with you.
Well, it's too late.
Dr. Romano would also
like to talk with you
before you leave.
Tell him you couldn't find me.
ROMANO:
I heard that!
FRANK:
What the hell are
you supposed to be?
Hey, you want a
candy, little fella?
FRANK:
Put some meat
on those bones.
Hey. Hi.
I thought everybody
was getting dressed up today.
We were supposed to;
there was a memo.
I didn't bring anything
to change into.
Neither did I.
Yeah, but you're
still a nurse.
You should have called me.
What, and then I would be
the only one in costume?
I don't think so.
Frank, where's your costume?
I don't observe
pagan holidays
that celebrate
devil worship.
Well, this
is only for Satanists.
It's kind of working
for you.
( chuckling ):
Shut up.
If you give me an order
and I think it's wrong
I'm going to ask you
to clarify it.
Not in front
of the patients.
I only questioned
the dosage.
You've made mistakes
in the past.
I have not.
CARTER:
Is there a problem here?
Yeah, you've got no guts.
I'm not working
with him.
Why?
Because he treats nurses
like idiots.
KOVAC:
If your boots fit...
Shoes.
Whatever.
Are you wearing that
for your shift?
Yes. It's Halloween.
You know, Jerry
sent out a memo.
Ooh, Naughty Nurse.
Not a Naughty Nurse.
I like it.
It's an old-
fashioned nurse.
Looks naughty to me.
So, you're what,
like a kurva nurse?
What's that?
How do you say,
a slut?
You know,
like a tramp, a whore...
Yeah, I got it.
You know, maybe
I should have worn
that schoolgirl
outfit you bought me.
( chuckling )
She's making a joke.
Cautery.
Robert, what
are you doing?
A laparoscopic
cholecystectomy.
But you can't be.
I had no choice.
This poor swine
is full of stones.
Oh, for heaven's sake.
I hope you're
not expecting
me to scrub in.
No, just giving my
right hand a workout.
It's been five months.
I got to keep
my skills up.
Stapler. Though, even
with one arm
I'm a better surgeon
than the rest of the hacks
in this hospital.
Robert, you're not cleared
to do surgery
even on barn animals.
Were you aware that Weaver
put through a proposal
to hire P.A.s to cover
afternoon rounds
Yes; I thought it
was a very good idea.
That's not the point.
The point is,
nobody talked to me about it
and last time I checked,
I was still head
of both surgery
and this hospital.
The Residency
Review Committee...
Oh, sweet Mary
and Joseph
will you look
at the size
of that gallbladder?!
Look, I know Weaver's
been forming alliances
with some of the
tribal elders while
I was recuperating
but I would have expected
a little more loyalty
from you, Lizzie.
Just rewrite the
proposal as if it
were generated from us
and keep me abreast
of any other covert
Weaver ops, okay?
The last thing I
need is Mata Hari
leading a
palace coup.
What the hell?!
He's extubated.
Get him back under!
100 of brevitol!
Hold him down!
Lizzie, hold him down!
Bloody hell!
He's a pig!
90 degrees-- that's good.
It's not my elbow
I'm worried about.
What the hell is going
on down there? Brenda!
All right,
the wrist.
And flex.
Keep going.
A little bit more.
Ten degrees.
Wrong.
Check it again.
Ten.
It was 15 last week.
Fluctuations
are normal, Robert.
With this type
of injury
you've got to
give yourself
at least nine months.
How does this affect my odds?
You've still got
a long way to go.
Yeah, I know. The odds.
For full flexion,
extension
and opposition
of the digits-- 20%.
But even then, without radial
and ulnar deviation
of the thumb, I'm
not sure you'll be
able to operate.
But you can still
be Chief of Staff.
Most of your job
is administrative anyway.
Thanks for the pep talk there,
Marty.
( door shuts )
Excuse me.
I'm looking for Dr. Corday.
ROMANO:
Aren't we all?
Are you a bill
collector
or a suitor?
Med student.
You must be
a slow learner.
It's a career change.
Cowboy and fireman
didn't work out, huh?
I'm supposed to start
my surgical rotation today.
I'm Paul Nathan.
Dr. Romano.
What happened?
Tennis elbow.
Ah.
HARMS:
Jane Doe, 80% surface area.
Gave ten of morphine I.M.
How you doing?
Not... good.
What's your name?
Amy.
Last name?
There was a fire
at the party downstairs.
What's
your last name?
Was anybody with her?
Hard to say.
There was a lot
of confusion.
LOCKHART:
Soot in the nostrils
and intraoral burns.
I'm going to need
an intubation tray.
Get Corday
on that crushed pelvis.
Excuse me.
Not right now.
Ed Jemena, 35.
Full thickness burns
to the hands and forearms.
This guy was on fire.
I tried to put him out
but I didn't have anything
to use but my hands.
Luka, can you
get this?
Yeah. What's open?
Curtain two.
I need a trauma room.
You're lucky
to get a bed.
Okay, yes?
Oh, Paul Nathan.
Radiology?
No, um, surgery.
Resident?
Med student.
Okay, good enough.
Cellulitis to the leg
after a bug bite to the ankle.
What do I do?
Nice catch.
Whoa, we're full
in here.
What do you have?
Doctor,
excuse me!
You all need to stay
in your assigned spots.
If a doctor or a nurse
can't find you
it's going to cause
a delay in your treatment.
Doctor, Doctor, can you tell me
what's happened to my things?
My apartment's
on the fourth floor.
I'll see what I can find out
for you.
And the fire
was on two.
Will they let us go home?
Check with the fire department.
Did they say
how it started?
I'm sorry, I don't know.
Carter, we need you!
The fruits upstairs
were smoking dope, that's what.
No one was smoking
anything, all right?
What's that for?
It's to keep an eye
on the infection.
And what are they giving him
to stop it?
Uh, excuse me.
Unasyn.
And that will get rid
of the infection?
Well, it should.
It's an antibiotic.
Hey, are you a doctor?
Med student.
I need that mayo stand.
Put it under his arm.
Got this?
I'm supposed to be...
Good.
What are you going to do?
We're going to
make you better.
Why can't I
feel my hands?
Uh, the burns have
damaged your nerves.
Is it permanent?
I don't know.
Where's Terry?
Who's Terry?
My partner.
He's dressed like a jungle girl.
Etomidate's
on board.
I need to see Terry.
Trauma panel, ABG
and carboxyhemoglobin.
Prime a line
of ringers.
What is this?
CORDAY:
Rubber mask
melted to the face.
I can barely
open the mouth.
Better try fiberoptic.
Got the subclavian.
I thought you left, Lizzie.
Me, too.
I'm supposed
to be trick-or-treating.
A little old for that,
don't you think?
Open a crike tray
just in case.
Guide wire's passing well.
Preload an eight-
oh tube on a scope.
Pulse ox
down to 85.
15 blade.
JARVIK:
I need a different
light source.
Don't open the tray
unless the intubation fails.
We don't want this... oh!
I'm sorry, sorry.
Got the line.
Run the first
liter wide open.
Robert, are
you okay?
Oh silk, neosporin
and opsite.
Robert?
I'm okay.
Keep bagging on 15 liters.
Get the sats above 90.
If you've got this, Lizzie
I'm going to go check
on the rest of the kids.
CHEN:
Take slow,
deep breaths.
MAN:
I'm trying.
CHEN:
Have you ever
had asthma?
No.
What's this?
Smoke inhalation
with wheezing.
Increased breath sounds?
On the right;
possible pneumothorax.
May need a chest tube.
Vitals?
I've got it.
Yeah, I'm
sure you do.
Get a chest x ray
and show it to me.
Digital escarotomy.
Yeah. He needs the same
on the left.
I agree.
How old do you think she is?
Uh...
Young.
Hey, Dr. Corday?
Yeah?
What have you got?
Urine 60 an hour,
but it's bloody.
80% burns, she's going
to need 12 liters
in the first
eight hours.
Okay, send her
for C.T. abdomen and pelvis.
I still need
to do an airway.
Dr. Corday?
Yes?
Oh, uh, I'm Paul Nathan.
I was supposed to begin
my surgical
rotation with
you today.
Yes, you were.
She's got a critical patient
next door.
Oh. Where should I put these?
Here. Put them right there.
CARTER:
No free fluid.
Liver and spleen
look okay.
Scope is prepped.
Standing by
with the number five shiley.
Rounds started
at 7:00 A.M.
I know; I was...
Not interested in
excuses, thank you.
Did you get my letter?
Dr. Corday,
your nanny is on the phone.
For God's sake,
Frank, take a
look around.
Take a message.
She said to remind you
she has a flight to catch
at 10:30.
Well, I can't leave now,
can I?
What do you want me to tell her?
Tell her to bring Ella here.
Day care's closed,
you know.
I know.
Pulse ox 81.
He's throwing P.V.C.s.
We should crike him.
Is there anything I can do?
Yes. Be quiet.
Okay, bag him.
You really want
to make up for it
go out there and work
up some patients.
Yeah, but shouldn't I...?
You want to
be a doctor?
Yes, but...
Then grab a patient
WOMAN:
I told Martin 100 times
you need to put new batteries
in the smoke detector.
No, no.
God forbid he should spend $3
on a nine-volt.
The whole building
could have burned down.
Um, his x
rays are back.
Oh, okay, good.
How's he doing?
Better than most by
the looks of things.
Yeah.
Okay, next time
I go hiking
I'm wearing
long pants.
And bug repellent.
Your infection's
spreading.
Uh, is everything okay?
I'll be right back.
Excuse me, you're a surgeon?
That's the rumor.
Uh, I think there's something
here you should see.
You're a student-- you haven't
learned to think yet.
I've got a rapidly
spreading cellulitis.
Excuse me.
How rapid?
Well, I just drew
this 20 minutes ago.
( whistles )
And look.
This looks
like sub-q air
consistent with neck fash.
Yeah, nice catch.
Let's roll.
We got to take your
boyfriend upstairs.
Upstairs?
Yeah, to surgery.
What's he on?
Three grams
of Unasyn.
Okay, switch it
to six million units
of Pen G and 900 of clinda.
Where's he going?
Newbie caught a neck fash.
What?
What's that mean?
Your boyfriend may have
what we call
necrotizing fasciitis.
It's a virulent
skin infection.
But they gave him
antibiotics.
The infection's
spreading too fast.
So, what
are you going to do?
We're going to take
you up to the O.R.
and remove the
infected tissue.
What?
All right, everybody
off the elevator!
Take the stairs;
you'll live longer.
If we don't stop this
it will continue
to move along
and you will develop an
overwhelming infection
which will lower
your blood pressure.
You could die.
Oh, my God.
Think I caught that in time?
I hope so.
Thank you.
I'm Susan Lewis.
Paul Nathan.
You coming?
In a minute, yeah.
You okay?
Yeah, it's just
it takes me a moment
to get going sometimes.
Uh... I have
Parkinson's Disease.
I'll be up in five minutes,
Robert.
You said that ten minutes ago!
I'm with a critical patient.
Find somebody else now, Lizzie!
Good E.T. placement.
No infiltrates.
Check ABG, repeat CBC,
and work on a burn unit bed.
What about him?
Who?
Him.
Yeah, what about him?
Pardon me.
I found his CPK, lytes
and UA results.
You headed up to surgery
on the "neck fash"?
Yes, as a matter of fact.
Okay, well...
I guess we're done here.
I am. You still
owe eight hours.
I'm on rounds
at 6:00 a.m.
Welcome to surgery.
( grunts )
Excuse me.
Uh, where can I find somebody
who was brought in?
Admit.
Come here.
Follow me.
Who you looking for?
Wynn Mathison.
He's in a tiger costume.
There was a fire...
Excuse me,
could you please direct me
to the victims
of the fire?
Keep your habit
on, my man.
Excuse me?
Dr. Pratt?
You'll get to be
with your drag queen friends
soon enough.
I have food and housing vouchers
for the displaced.
Oh, I-I'm sorry,
Sister.
Can someone please tell
me what room he's in?
Dr. Pratt?
What?
He's with the guy
in the tiger suit.
( sighs )
Can we get some oil
of wintergreen in here?
I hate the smell
of rotting flesh.
Suction.
Especially when it's
increasing by the minute.
Come on, that bacteria's
moving faster than
you are, Edson.
Bovie.
Systolic's down to 95.
Bolus 500.
Lap pad.
Still not bleeding.
Myonecrosis.
Yeah, it's in the muscle.
Ten blade.
Okay, if it's vascularized,
don't cut it.
That's my plan.
Start there
and carry the incision
four centimeters inferior.
No, that's eight.
Damn it!
We need clean borders.
Where the hell is Corday?
She's in the scrub room.
If I don't
remove enough tissue
the infection could be
left to smolder inside.
Get her the hell in here!
Maybe she can debride this guy's
wound without using a chainsaw.
Hey!
Chris, it's me,
Elizabeth.
Listen,
you needn't come here.
I shouldn't be longer
than an hour.
Dr. Corday, he's
asking for you.
Be right there.
to finish packing?
Yeah, I could pick you both up
after work.
I could drive you
to the airport--
save you the cost of cab fare.
Yeah. Okay. Thank you.
Thank you so much.
Yeah, I'll see you soon.
Corazon, uh, would you mind
taking the phone?
Not at all.
( metal clinking )
Oh...
Damn.
Was that
your wedding ring?
Yep. Yep.
I can't see it.
Can you call Engineering?
They're closed
till morning.
I'm sorry.
It's not your fault.
Don't hate me.
He wants to talk.
Lizzie, get your ass in here!
I've lost
my wedding ring.
Oh, boo-hoo, this guy's about
to lose a leg!
I'd say chop-chop, but that
would be in extremely bad taste.
Can you call someone
get them
to tape this off for me?
Make sure no more water
is run down it?
Sure.
Would somebody please call
Tiffany's
Search and Rescue Team?!
I'm coming!
He's got 20% surface area burns,
mainly upper body.
Oh, God.
Decent prognosis.
We provide
ventilatory support
until the lungs heal.
Then we extubate him.
Might take a week,
maybe less.
What-what about his face?
He'll need skin grafts.
There'll definitely be
some scarring.
( sobbing )
Wynn. Wynn, it's me, Terry.
I'm right here.
He can't hear you.
He's sedated.
You should probably have
your eye looked at.
Later, okay?
Can I touch him?
I wouldn't.
Yo, newbie.
Come on.
Check jungle perv's eye
with the slit-lamp.
He may have
a corneal burn.
Where's that?
You still here?
Yeah, uh, slit-lamp.
Where is it?
How does it work?
Exam Three. Try
the on/off switch.
Hey, hey.
You changed.
What? I just put on
some scrub pants.
Oh, come on.
You know, Carter
my outfit is really starting
to bug me, too.
But we agreed to stay
in costume the entire shift.
Yeah, I am.
No, you're not.
It's half a costume.
It's always, like,
50% commitment.
Are you serious
or you kidding?
Do you even know what I've been
dealing with down here?
Look, me, too.
In pumps.
Want to see
the whole costume?
No.
Here's the whole costume.
Forget it.
I'm a skeleton!
Look at me!
( growling )
Carter really likes
Halloween, huh?
Perpetual erection.
Accidentally drank
his daughter's
mandrake smoothie.
Police found him
chasing women down the street.
Where do you want him?
In a cold
shower.
Curtain Three's open.
Okay, get
a line in
and push four
of Ativan.
Are you open, baby?
( lecherous laughter )
Perfect.
Whoo!
( laughing )
First day labs, charcoal
and a Foley for the tox screen.
Release me!
I'm the Marquis De Sade!
How am I supposed to pass
a catheter through that?
Inject phenylephrine.
Into the shaft?
I'm Rod Stewart!
He won't hold still long enough
for a blood draw
much less
let me touch his penis.
Oh, she can touch it!
Or we can wait for the
mandrake to metabolize.
Why not just give him Haldol,
make it easier on everybody?
It might make
his symptoms worse.
Hey!
Hey, hey.
He just grabbed
my ass.
Well, I couldn't reach hers.
I said four of Ativan.
Ask Abby.
I'm done.
Okay, you could be a
little bit more sensitive.
To what?
( laughing )
* Choo-choo-choo,
choo, choo *
* Choo-choo,
choo-choo-choo-choo... *
CORDAY:
It's amazing how
quickly this spreads.
EDSON:
Any idea how
he got it?
A cut, a scratch, some
other trivial injury.
Dopamine's at ten mikes.
Need more suction.
Scalpel.
Easy, Lizzie.
Is it just me, or
is this constant
commentary
rather
distracting?
It's not you.
Just remove the
infected tissue
and let antibiotics
and Hyperbaric Oxygen
Therapy do the rest.
You're not serious.
Hell, yes, I am serious.
I'm already into
the posterior compartment.
It's still necrotic soup.
Six hours in
the chamber
will increase
his oxygen saturation
create a bacteriocidal effect...
Robert...
...and give this guy
a chance of a functioning leg.
Do you two have a
problem with that?
How's a guy with Parkinson's
get into med school?
Probably some kind
of disability quota
they have to fill.
Forget med school.
How's he expect
to practice?
Wouldn't want him
taking out my appendix.
He seems to have
it under control.
You know,
it's a progressive disease.
What's he going to be
like in ten years?
Could be dead.
Or want to be.
Happy Abby, always
looking on the
bright side.
Dr. Weaver, I thought
you were out sick.
I was until an apartment fire
set us back 30 patients.
PRATT:
35, if you count
the bad popcorn balls.
Oh, wonderful.
Thanks for
coming in,
Kerry.
Yeah, I shouldn't
have answered my phone.
Want your messages?
No!
I want
the air conditioning on!
I'm sweating like a pig!
It's freezing in here.
That's what you get for
bringing Weaver in on Halloween.
It's the biggest holiday
of the year for her kind.
Lesbians?
Wiccan.
She's probably riding that
crutch around like a broom.
Oh, come on, Frank.
All women get like that
when they're going
through the change.
Pratt!
What? She's having
hot flashes.
She's moody...
That is so sexist.
And stupid.
She's too young.
Early onset.
You've got early onset.
Whatever you say,
Nasty Ratched.
( sighs )
It's nurse, okay?
Not Nasty, not Naughty,
not Wet, certainly not Head.
Just nurse.
( laughs )
Abby, you're going to
talk to Kovac, right?
Yes.
County General
on Bravo One.
I finished
with the slit-lamp.
I numbed him
with alcaine.
Who are you?
Meet Nathan--
our newest oldest
med student.
I'm on surgical rotations
with Dr. Corday.
We have to clear trauma.
BOA with newborn hypoxia.
She asked that I stay
and assist in any...
Good. Follow me.
Don't worry.
She doesn't bite.
Much.
Simone Phipps, 42.
Had a home birth,
newborn in respiratory distress.
WEAVER:
Simone, did you have
a difficult or
complicated labor?
No, it went well.
I didn't even tear.
One minute Apgar with seven,
but he had a little...
Who are you?
I'm the midwife.
What's wrong with him?
We're going to
find out, all right?
Take him to Trauma One.
Wh-Where is that?
LOCKHART:
I'll take him.
No, I... it's okay.
I got it, I got it.
I got it.
Simone, you've lost
a lot of blood.
Something's wrong
with my baby,
I know it.
Lily, stirrups.
Gallant, labs.
Oh, maybe I should have
had him in a hospital.
Simone,
you did everything right.
GALLANT:
CBC, PT/PTT
DIC screen, type and cross
for four units.
We're taking
care of your baby.
Let's help you now.
BP is 80/60.
Okay, squeeze in
another two liters.
What's happening?
You're losing a lot of blood
from a retained placenta.
No, I mean with my baby.
Dr. Kovac is taking
good care of your son.
I'm going to pull gently
on the umbilical cord.
Simone?
I need you to stay with me.
Oh...
Pulse ox is 82.
He's retracting.
Pedes intubation tray,
number three ET uncuffed.
What do you hear?
Wet crackles throughout.
KOVAC:
Fluid in the alveoli.
Okay, let's have a look.
Unhook the bag
from the mask.
You can bag the ET
once I'm in.
I've never done that.
Squeeze the bag
every two seconds
just like he was doing.
Never pass the tube
till you see the cords.
Okay. I'm in.
Call for a pedes vent
and set me up
for an umbilical line.
Relax. Relax, the
hard part's over.
Good.
Notify the NICU team.
What do I tell them is wrong?
I have no idea.
CORDAY:
It's no good.
We're into the quads.
EDSON:
We'll have
to do an AKA.
Keep debriding.
We're not there yet.
If we treat this
conservatively,
and it spreads
we're committed to
a hip disarticulation
to stay ahead
of the bacteria.
It's worth the risk.
Of his being
nonambulatory?
With an above-the-knee
amputation
at least he can
use a prosthetic.
And if it gets
into his hip
it'll spread to
the abdominal wall
and he'll get septic.
I am trying to save
this man's leg.
Dry the field.
What about his life?
He's young.
It's the same thing.
Oh, come on, Robert,
of course it's not.
CORDAY:
Look, this kelly
slices through sub-Q
fat like butter.
All right, fine, keep cutting
until you hit viable muscle.
It's above the distal
third of the thigh.
It's a hopeless wound.
Fine, take it.
CORDAY:
Robert...
I said take the leg.
( slams equipment )
Bovie, pickups.
( man and boy laughing )
Tommy.
How are you feeling?
He seems, he seems
a lot better, thanks.
Good. Well, uh
Just keep him
on clear fluids tonight
and I'll have
a nurse
sign you out.
Okay. Thanks.
What's wrong
with him?
Shhh, shhh....
How you holding up?
I'm good. Uh, I think
the robot can go home.
Okay. I'll get Carter
to dispo him.
Okay.
Can I get you a cup of
coffee or something?
No, fine, thank you.
Uh, I like your outfit.
Mm-hmm?
It's very retro.
( chuckles ):
Thank you.
Um, listen, if you
ever need anything...
Like a straitjacket?
( both chuckling )
Is your... dyskinesia
usually this bad?
I don't want to freeze up
when I'm at work
so I up the medication,
and this is what you get.
At least it helps
to dispel the myth.
You know, we don't all
have rhythm.
( both chuckling )
If that happened to me
I'd probably jump
on a world cruise
not go to Med
school.
I already saw the world.
In fact, I was in Italy
when I first realized
I had a problem.
I was sipping wine in this
little cafe in Florence
and I noticed that my little
finger was shaking.
I just figured
it was from living
on espresso
and martinis.
How did you find
out it wasn't?
Well, I used
to hate doctors
so it took a while
for me to check it out
but, once I did, it really put
things in perspective.
Yeah, I guess being
sick does that.
Her baby's not
doing well, huh?
No.
How you doing,
Simone?
Good. He seems better, huh?
Maintenance fluids
are at 5cc's
per kilo per hour.
My mother had me at home.
I thought it would
be good for him.
Um, his tests
came back.
I'm afraid your baby has a
disease called sialidosis.
What's that?
His body lacks
an enzyme
that breaks down
the waste proteins
inside the cells
and there is already
extensive damage
to the liver
the bones and the
nervous system.
( sighs )
I've been staring at him
for over an hour now
and I still...
can't figure out
what I want to call him.
Would you
excuse us, please?
Uh, yeah. Sure.
( Kovac sighs )
Children with, uh, sialidosis
are mentally retarded
often blind.
He'll never
speak or walk.
His life expectancy
is less than two years.
MAN:
Dr. Kovac
NICU's on line one.
Thanks.
( sighs )
Excuse me.
Is there anyone
you'd like me to call?
( shudders )
( quietly ):
No. There's just us.
I don't think it
will be necessary.
Thank you.
You having a bad night?
No worse than usual.
That was a little bit
insensitive
don't you think?
Hey, I had to tell
a mother her baby
was going to die.
I didn't need an
audience, okay?
Okay.
I'm starting to get some
complaints about you.
From patients?
Nurses.
Don't look so
concerned about it.
Okay, first you accused
Chuny of being an idiot
and then later
when she was sexually
harassed by a patient....
Sexually harassed?!
The guy grabbed
her butt!
Yeah, that's
sexual harassment, Luka.
Oh, come on, Abby,
you were there.
The guy's intoxicated
with mandrake;
he's harmless.
This one's all yours.
What patient?
McFadden.
I was checking his vitals
and he grabbed my boob.
Okay, what's
his status?
He's going to die if he tries
that again; that's his status.
See, every time a nurse
has a problem
she complains to me.
Everyone complains,
it's part of the job.
Yes, and it's part
of my job as Nurse Manager
to counsel you.
What?
You can give nurses orders;
you cannot critique their work.
( groans )
If you have a problem
with a nurse
you have
to come to me.
Okay, what about you?
Who do I complain to
if I have a problem
with you?
Well, here's an idea--
maybe you should
try fighting for the nurses
instead of fighting
with them.
Hey, maybe you
should sew some
swastikas on that costume.
You could be a naughty
Nazi nurse, huh?
You totally suck, you know that?
Hey, careful!
Creating a hostile work
environment!
Where's
Dr. Kovac?
I don't know; page him.
The baby with sialidosis
is febrile to 102.
Chuny, where's Kovac?
Don't know, don't care.
He feels like
he's on fire.
Why hasn't he gone
up to the NICU?
You'd have to ask
Dr. Kovac.
Can you do
something for him?
He needs to be pan-cultured.
How much does he weigh?
3 kilos.
Okay, 150 milligrams
I.V. piggyback of
Cefotaxime and Amp.
Set up for a spinal tap.
He has sialidosis.
Yeah, and he also
has an infection;
60 migs of Tylenol.
I'll make arrangements
for your baby
to be sent up to
the neonatal unit.
We're going to do
everything we
can for him.
Thank you.
Why are you
still here?
Uh, my piano recital
was canceled.
Hey, it's me,
Elizabeth.
I'm on my way home now;
I'll see you soon. Bye.
We did
the right thing.
Trying to convince
me or you?
Look, I went through
a period of adjustment
when I became a mother;
every time I had
to treat a child.
You get over it.
Oh, please, spare me
the two-dollar
psychoanalysis, Lizzie.
Fine.
Hey, look, look, look...
I know most people don't like
me; I don't care.
I don't like most people.
But I'm good at what I do.
I save people's lives.
Every day.
People who no one else can help.
If I can't do that...
Robert... I know
you're frustrated.
You're an excellent surgeon,
and you will be again
I promise you.
You will be.
I'm being paged.
Elizabeth?
Uh...
I'm being paged.
( door closes )
Elizabeth.
I-I just tried
calling you.
I'm sorry, I couldn't wait.
I have to leave for
the airport now.
Well, what about
a later flight?
This is the later
flight.
I threw her pajamas,
some crackers
a couple toys
in here
just in case she had
to stay for awhile.
I'm sorry.
No, no, no,
it's all right,
it's my fault.
We got slammed.
I'm back Sunday night,
so I'll see you
Sunday morning.
Yeah, yeah.
Have a safe flight.
Bye, Ella.
Bye.
Hey, did Chris take you
trick-or-treating?
( alarms sounding )
What is it?
Dropped her pressure
to 60 palp.
Dopamine is up,
we've got two liters going
and I'm working on
an art line.
Any word from her
family yet?
No, we still don't have
a last name.
Lily, could you?
Oh, sure.
There, it's okay.
Hello, little
cowgirl.
I'll be with you
soon, all right?
Could it be hemorrhagic?
CT was negative; I'm
thinking hypoxia.
If we don't find her family soon
they're just going to
be ID-ing the body.
Her pulse ox is only 82
on 100%.
She needs suctioning, Abby.
Set up ultrasound;
she may have thrown a clot.
I don't know, second
crit was only 32.
I still want four units
of type specific.
What happened
to Mom?
In the washroom.
Where are the suction catheters?
Try the cabinet.
What are you doing?
Weaver ordered
antibiotics.
No. Who did the LP?
She wanted a full
septic workup.
This is my patient.
The baby spiked
a fever.
This baby is in a chronic
vegetative state.
You are prolonging his suffering
and the suffering of the mother.
We still treat
kids like this.
You should have asked me.
We couldn't
find you.
I told you to leave
once already; this
is not your case.
Luka.
CORDAY:
Abby!
KOVAC:
You need to check with me before
you push meds on my patients.
I have to do
a cut-down here.
Morrison's pouch looks dry,
but it could be retroperitoneal.
What the hell was
all that about?
You want PEEP on the vent?
Not until we get
her pressure up.
CARTER:
Nathan, why do you
think she's hypotensive?
Blood loss?
Not in this case.
Hypoxia can cause
myocardial dysfunction.
That's it; I'm filing a
grievance against him.
Not now, Chuny.
IV's dry; she needs
a fresh one.
I'll get it.
Panic value
potassium's 8.2.
Damn it, that's rhabdo
from the crush injury;
10cc's of calcium
gluconate.
PVC's.
Let's push bicarb;
ten units of regular insulin
an amp of D-50.
Get me kayexelate and call
renal; she may need dialysis.
( gasps )
What the hell are
you doing?
I accidentally...
It's okay.
Go see if Frank's found
the girl's family.
No, I'll start another one.
Line's in,
is the transducer ready?
Where's the saline?
I said, go find
the girl's family.
Run of five.
100 of Lidocaine
prep the groin
for a quinton catheter.
Sats are falling, 79.
Pressure's down to 50.
Being a little hard on him,
don't you think?
V-tac, charge to 200.
What are you talking about?
Nathan, he's doing a pretty
good job, considering.
Considering what?
He has Parkinson's.
Excuse me?
CORDAY:
Clear.
Still V-tach.
Procainamide's
on board.
Stand by with amiodarone.
Clear.
No change.
How long?
How long?
Uh... 12 minutes.
Clear.
Sinus tach.
All right.
Way to go.
Good femoral pulse.
Set up a pronestyl
drip, then a repeat K.
Labs on your baby.
( sarcastically ):
Thank you.
Glad to see you
two have made up.
Hey, I'm being professional.
She's the one
having trouble.
I warned her.
Warned her about what?
( sighs ):
Nothing.
( laughs ):
Oh, my God.
You're such a jerk.
What?
You slept with her?
( scoffs )
That's what this
is all about.
What's your problem?
One time.
One time.
One time with Chuny
one time with a patient's mother
in radiology.
Hey, you never
complained.
Yeah, I never let it
affect my work.
You two need to figure
this out.
So, what do you
want me to do?
I don't know.
Tell her you're sorry.
Tell her it was wrong.
Just fix it.
I'm not going to kiss her ass.
That's how this whole
problem started.
Have them check a gas on 50%.
I'm going to wait
right here for you, Wynn.
Don't worry
about anything.
I love you.
( sighs heavily )
I should've told them
I was his brother.
ICU has strict rules.
He'll need around-the-clock
attention tonight
but his lungs
are rebounding.
You know what,
you should probably go home.
They'll let you see him
in the morning.
Home?
Our whole lives were
in that apartment.
This dress
is all I have.
I've been watching
his heart rate.
It goes down when I touch him,
when he knows I'm here.
Has his fever gone down?
A little.
I waited so long for him.
Five years.
Two miscarriages,
in vitro.
I lost two boyfriends
because I was so determined
to have a child.
I was about to give up...
and then suddenly...
he was here.
He's here.
We'll keep treating
the infection
but he could start going
into organ failure soon.
His systems
will shut down.
( quietly ):
You're so beautiful.
You're my baby.
His heart could stop beating.
I need to know
what you want to do
if something like
that happens.
I don't know.
To keep him alive,
I may have to open his chest.
Maybe even
shock him.
And I'm not sure you want me
to do something like that.
No...
( quietly ):
I... I don't know.
I don't know.
Tell the unit I flushed
the quintin.
He's tenacious.
You've got to give
him that.
I wish he'd told me.
Kind of a hard thing
to lead with.
Oh, there's Mommy.
There's Mommy.
Hi, uh, Lily had to run
Wynn's ABG up to the lab.
Thank you.
Did you reverse
her hyperkalemia?
Yeah, just enough to
get her to dialysis.
She still has
the burns, though.
Yeah,
but you got her back.
May I?
Oh, I'm sorry, yeah.
Hey.
Thank you.
So, did we reach
the parents?
No, uh, the girl
was actually baby-sitting.
Wasn't even her building.
You know, you might
have told me sooner
saved me some
embarrassment.
About your condition.
Well, I certainly didn't mean
to embarrass you.
How long has it been?
Eight years.
I was misdiagnosed
for the first two.
And you were late
today because...?
My neurologist wanted
an MRI.
I'm sorry.
I wouldn't have
made you stay...
What the hell, fresh start.
Try to make as many
rounds as you can
complete the
required reading
take the exam.
I've been reading
and taking tests for two years.
This is my hands-on
training.
It's a surgical rotation.
I understand that.
Probably the most
physically demanding,
emotionally exhausting
stressful six weeks
any would-be physician
ever experiences.
Part of becoming
a doctor.
I'm offering you
a pass, Mr. Nathan.
Trust me, you should take it.
I'm here to treat patients.
You have a degenerative
neurologic disease.
I know what I have.
It doesn't mean I need a pass.
FRANK:
E.R.
I don't want special treatment.
I just want to learn
like other students.
You're not like other students.
No, I'm older and smarter.
FRANK:
Burn Unit needs you.
I'm on my way out, Frank.
It's your melted mask guy.
Okay. I'll
be right there.
Look, go home,
think about it.
Report back day
after tomorrow.
I'm sure you could
use the rest.
I'm fine.
It's just not
very practical.
Okay, let's go.
Dr. Weaver?
What?
What time is it?
Are you okay?
Yeah, yeah, I was...
( sighing ):
I was just going to
lay down for a second.
Can you pronounce
a patient?
Did we ever hear
back from the NICU?
Uh, no, there was no need.
Oh, come on.
It's been three hours.
We can't board their patients.
They have to call in a nurse
from home
or if they won't,
I want to speak to
their medical director.
Dr. Weaver...
Cardiac arrest
half hour ago.
Excuse us.
You should've come
to get me.
How long did Dr. Kovac
work on him?
He didn't.
She signed a DNR.
Where is he?
Who?
Kovac.
He's home. His
shift ended at 10:00.
All right, I'm going to move her
to a quiet room.
Call the social worker
get her referrals
for grief counseling.
Are you leaving soon?
I'm just, uh,
finishing up with Woody here.
You're the most
beautiful nurse
in this hospital.
Well, thank you.
You've got class.
May I play with
your breasts?
Hey!
Excuse me.
Please?
Last request of a
man on his deathbed.
You're not dying, Woody--
you're drunk.
I want to go
to heaven
on the bosom of
a beautiful woman.
I don't think your HMO
covers that.
How much longer you
have that outfit for?
Tomorrow at noon, why?
Thought maybe I
could talk you
into giving me
a sponge bath.
What's in it for me,
Boney Boy?
Oh, I'll give
you a bone
nasty naughty
little nurse.
( laughing )
ROMANO:
Elizabeth!
Uh... Robert,
can we talk tomorrow?
I really have
to get Ella home.
I thought you might want this
before you left.
It's my ring.
Amazing what you can do
with a laparoscopic camera
and a snare.
Thank you.
De nada.
Uh... look,
about, uh, about today...
Uh, let's not.
It was a momentary
weakness on my part.
It won't happen again.
You'll work through
this, Robert.
Of course I will.
Good night.
Night.
CORDAY:
The patient has gastroenteritis
vomits to excess,
has hematemesis
no history of PUD.
What are you thinking?
NATHAN:
Mallory-Weiss tear.
Laceration of the distal
esophagus
results in an upper GI bleed.
You're both correct and tardy.
Sorry.
Don't be sorry,
be punctual.
What if that patient vomits
and develops chest pain?
Boerhaave's syndrome.
Spontaneous rupture
of the esophagus
associated
with retching.
Usually tears
into the left
pleural space.
When you're waiting
on a patient's results
it's not necessary
for you to boff
that patient's mother
in the storage closet.
I'm so sorry, Robert.
About my arm,
or about my being there?
A memo from Weaver.
I've made Abby
the new nurse manager.
The job is yours,
like it or not.
"Like it or not"?
I don't care
to argue about it.
Duroziez's sign
is a to and fro murmur
when the stethoscope
is placed
over the femoral artery.
What's another peripheral sign
of aortic insufficiency?
Weak pulse.
No.
Poor cap refill.
No.
Those are both signs
of shock.
It begins with
"Q." Anyone?
DeQuervain's.
No, that begins
with a "D"
although there is
a "Q" in it
so, you're
getting warmer.
Does Quinkie's sign
ring any bells?
And it manifests
itself how?
With a visible...
puh...
Pulsation.
Correct. Where?
On the... nnn...
Neck.
Navel?
Nail bed.
Good night.
Go home.
Rounds start
at 7:00 a.m.
Be sure to read
Sabiston's chapter
on the acute abdomen.
So much for the future
of medicine.
Jacy, would you be sure
to ring Mr. Ingles?
Remind him not to eat anything
after midnight.
I don't want to have to
reschedule his hernia yet again.
I'm going trick-or-treating.
Oh, what's Ella this year?
A cow.
Wasn't she a cow
last year?
No, last year she was Dorothy,
I was the Cowardly Lion, Mark...
Mark was the Scarecrow.
Right.
I get to be a farmer this year.
Happy Halloween.
Dr. Corday.
Yeah.
Your med student called--
Nathan.
What, the one
who didn't bother
to show up today?
He said he'd be here
in a few minutes
to speak with you.
Well, it's too late.
Dr. Romano would also
like to talk with you
before you leave.
Tell him you couldn't find me.
ROMANO:
I heard that!
FRANK:
What the hell are
you supposed to be?
Hey, you want a
candy, little fella?
FRANK:
Put some meat
on those bones.
Hey. Hi.
I thought everybody
was getting dressed up today.
We were supposed to;
there was a memo.
I didn't bring anything
to change into.
Neither did I.
Yeah, but you're
still a nurse.
You should have called me.
What, and then I would be
the only one in costume?
I don't think so.
Frank, where's your costume?
I don't observe
pagan holidays
that celebrate
devil worship.
Well, this
is only for Satanists.
It's kind of working
for you.
( chuckling ):
Shut up.
If you give me an order
and I think it's wrong
I'm going to ask you
to clarify it.
Not in front
of the patients.
I only questioned
the dosage.
You've made mistakes
in the past.
I have not.
CARTER:
Is there a problem here?
Yeah, you've got no guts.
I'm not working
with him.
Why?
Because he treats nurses
like idiots.
KOVAC:
If your boots fit...
Shoes.
Whatever.
Are you wearing that
for your shift?
Yes. It's Halloween.
You know, Jerry
sent out a memo.
Ooh, Naughty Nurse.
Not a Naughty Nurse.
I like it.
It's an old-
fashioned nurse.
Looks naughty to me.
So, you're what,
like a kurva nurse?
What's that?
How do you say,
a slut?
You know,
like a tramp, a whore...
Yeah, I got it.
You know, maybe
I should have worn
that schoolgirl
outfit you bought me.
( chuckling )
She's making a joke.
Cautery.
Robert, what
are you doing?
A laparoscopic
cholecystectomy.
But you can't be.
I had no choice.
This poor swine
is full of stones.
Oh, for heaven's sake.
I hope you're
not expecting
me to scrub in.
No, just giving my
right hand a workout.
It's been five months.
I got to keep
my skills up.
Stapler. Though, even
with one arm
I'm a better surgeon
than the rest of the hacks
in this hospital.
Robert, you're not cleared
to do surgery
even on barn animals.
Were you aware that Weaver
put through a proposal
to hire P.A.s to cover
afternoon rounds
Yes; I thought it
was a very good idea.
That's not the point.
The point is,
nobody talked to me about it
and last time I checked,
I was still head
of both surgery
and this hospital.
The Residency
Review Committee...
Oh, sweet Mary
and Joseph
will you look
at the size
of that gallbladder?!
Look, I know Weaver's
been forming alliances
with some of the
tribal elders while
I was recuperating
but I would have expected
a little more loyalty
from you, Lizzie.
Just rewrite the
proposal as if it
were generated from us
and keep me abreast
of any other covert
Weaver ops, okay?
The last thing I
need is Mata Hari
leading a
palace coup.
What the hell?!
He's extubated.
Get him back under!
100 of brevitol!
Hold him down!
Lizzie, hold him down!
Bloody hell!
He's a pig!
90 degrees-- that's good.
It's not my elbow
I'm worried about.
What the hell is going
on down there? Brenda!
All right,
the wrist.
And flex.
Keep going.
A little bit more.
Ten degrees.
Wrong.
Check it again.
Ten.
It was 15 last week.
Fluctuations
are normal, Robert.
With this type
of injury
you've got to
give yourself
at least nine months.
How does this affect my odds?
You've still got
a long way to go.
Yeah, I know. The odds.
For full flexion,
extension
and opposition
of the digits-- 20%.
But even then, without radial
and ulnar deviation
of the thumb, I'm
not sure you'll be
able to operate.
But you can still
be Chief of Staff.
Most of your job
is administrative anyway.
Thanks for the pep talk there,
Marty.
( door shuts )
Excuse me.
I'm looking for Dr. Corday.
ROMANO:
Aren't we all?
Are you a bill
collector
or a suitor?
Med student.
You must be
a slow learner.
It's a career change.
Cowboy and fireman
didn't work out, huh?
I'm supposed to start
my surgical rotation today.
I'm Paul Nathan.
Dr. Romano.
What happened?
Tennis elbow.
Ah.
HARMS:
Jane Doe, 80% surface area.
Gave ten of morphine I.M.
How you doing?
Not... good.
What's your name?
Amy.
Last name?
There was a fire
at the party downstairs.
What's
your last name?
Was anybody with her?
Hard to say.
There was a lot
of confusion.
LOCKHART:
Soot in the nostrils
and intraoral burns.
I'm going to need
an intubation tray.
Get Corday
on that crushed pelvis.
Excuse me.
Not right now.
Ed Jemena, 35.
Full thickness burns
to the hands and forearms.
This guy was on fire.
I tried to put him out
but I didn't have anything
to use but my hands.
Luka, can you
get this?
Yeah. What's open?
Curtain two.
I need a trauma room.
You're lucky
to get a bed.
Okay, yes?
Oh, Paul Nathan.
Radiology?
No, um, surgery.
Resident?
Med student.
Okay, good enough.
Cellulitis to the leg
after a bug bite to the ankle.
What do I do?
Nice catch.
Whoa, we're full
in here.
What do you have?
Doctor,
excuse me!
You all need to stay
in your assigned spots.
If a doctor or a nurse
can't find you
it's going to cause
a delay in your treatment.
Doctor, Doctor, can you tell me
what's happened to my things?
My apartment's
on the fourth floor.
I'll see what I can find out
for you.
And the fire
was on two.
Will they let us go home?
Check with the fire department.
Did they say
how it started?
I'm sorry, I don't know.
Carter, we need you!
The fruits upstairs
were smoking dope, that's what.
No one was smoking
anything, all right?
What's that for?
It's to keep an eye
on the infection.
And what are they giving him
to stop it?
Uh, excuse me.
Unasyn.
And that will get rid
of the infection?
Well, it should.
It's an antibiotic.
Hey, are you a doctor?
Med student.
I need that mayo stand.
Put it under his arm.
Got this?
I'm supposed to be...
Good.
What are you going to do?
We're going to
make you better.
Why can't I
feel my hands?
Uh, the burns have
damaged your nerves.
Is it permanent?
I don't know.
Where's Terry?
Who's Terry?
My partner.
He's dressed like a jungle girl.
Etomidate's
on board.
I need to see Terry.
Trauma panel, ABG
and carboxyhemoglobin.
Prime a line
of ringers.
What is this?
CORDAY:
Rubber mask
melted to the face.
I can barely
open the mouth.
Better try fiberoptic.
Got the subclavian.
I thought you left, Lizzie.
Me, too.
I'm supposed
to be trick-or-treating.
A little old for that,
don't you think?
Open a crike tray
just in case.
Guide wire's passing well.
Preload an eight-
oh tube on a scope.
Pulse ox
down to 85.
15 blade.
JARVIK:
I need a different
light source.
Don't open the tray
unless the intubation fails.
We don't want this... oh!
I'm sorry, sorry.
Got the line.
Run the first
liter wide open.
Robert, are
you okay?
Oh silk, neosporin
and opsite.
Robert?
I'm okay.
Keep bagging on 15 liters.
Get the sats above 90.
If you've got this, Lizzie
I'm going to go check
on the rest of the kids.
CHEN:
Take slow,
deep breaths.
MAN:
I'm trying.
CHEN:
Have you ever
had asthma?
No.
What's this?
Smoke inhalation
with wheezing.
Increased breath sounds?
On the right;
possible pneumothorax.
May need a chest tube.
Vitals?
I've got it.
Yeah, I'm
sure you do.
Get a chest x ray
and show it to me.
Digital escarotomy.
Yeah. He needs the same
on the left.
I agree.
How old do you think she is?
Uh...
Young.
Hey, Dr. Corday?
Yeah?
What have you got?
Urine 60 an hour,
but it's bloody.
80% burns, she's going
to need 12 liters
in the first
eight hours.
Okay, send her
for C.T. abdomen and pelvis.
I still need
to do an airway.
Dr. Corday?
Yes?
Oh, uh, I'm Paul Nathan.
I was supposed to begin
my surgical
rotation with
you today.
Yes, you were.
She's got a critical patient
next door.
Oh. Where should I put these?
Here. Put them right there.
CARTER:
No free fluid.
Liver and spleen
look okay.
Scope is prepped.
Standing by
with the number five shiley.
Rounds started
at 7:00 A.M.
I know; I was...
Not interested in
excuses, thank you.
Did you get my letter?
Dr. Corday,
your nanny is on the phone.
For God's sake,
Frank, take a
look around.
Take a message.
She said to remind you
she has a flight to catch
at 10:30.
Well, I can't leave now,
can I?
What do you want me to tell her?
Tell her to bring Ella here.
Day care's closed,
you know.
I know.
Pulse ox 81.
He's throwing P.V.C.s.
We should crike him.
Is there anything I can do?
Yes. Be quiet.
Okay, bag him.
You really want
to make up for it
go out there and work
up some patients.
Yeah, but shouldn't I...?
You want to
be a doctor?
Yes, but...
Then grab a patient
WOMAN:
I told Martin 100 times
you need to put new batteries
in the smoke detector.
No, no.
God forbid he should spend $3
on a nine-volt.
The whole building
could have burned down.
Um, his x
rays are back.
Oh, okay, good.
How's he doing?
Better than most by
the looks of things.
Yeah.
Okay, next time
I go hiking
I'm wearing
long pants.
And bug repellent.
Your infection's
spreading.
Uh, is everything okay?
I'll be right back.
Excuse me, you're a surgeon?
That's the rumor.
Uh, I think there's something
here you should see.
You're a student-- you haven't
learned to think yet.
I've got a rapidly
spreading cellulitis.
Excuse me.
How rapid?
Well, I just drew
this 20 minutes ago.
( whistles )
And look.
This looks
like sub-q air
consistent with neck fash.
Yeah, nice catch.
Let's roll.
We got to take your
boyfriend upstairs.
Upstairs?
Yeah, to surgery.
What's he on?
Three grams
of Unasyn.
Okay, switch it
to six million units
of Pen G and 900 of clinda.
Where's he going?
Newbie caught a neck fash.
What?
What's that mean?
Your boyfriend may have
what we call
necrotizing fasciitis.
It's a virulent
skin infection.
But they gave him
antibiotics.
The infection's
spreading too fast.
So, what
are you going to do?
We're going to take
you up to the O.R.
and remove the
infected tissue.
What?
All right, everybody
off the elevator!
Take the stairs;
you'll live longer.
If we don't stop this
it will continue
to move along
and you will develop an
overwhelming infection
which will lower
your blood pressure.
You could die.
Oh, my God.
Think I caught that in time?
I hope so.
Thank you.
I'm Susan Lewis.
Paul Nathan.
You coming?
In a minute, yeah.
You okay?
Yeah, it's just
it takes me a moment
to get going sometimes.
Uh... I have
Parkinson's Disease.
I'll be up in five minutes,
Robert.
You said that ten minutes ago!
I'm with a critical patient.
Find somebody else now, Lizzie!
Good E.T. placement.
No infiltrates.
Check ABG, repeat CBC,
and work on a burn unit bed.
What about him?
Who?
Him.
Yeah, what about him?
Pardon me.
I found his CPK, lytes
and UA results.
You headed up to surgery
on the "neck fash"?
Yes, as a matter of fact.
Okay, well...
I guess we're done here.
I am. You still
owe eight hours.
I'm on rounds
at 6:00 a.m.
Welcome to surgery.
( grunts )
Excuse me.
Uh, where can I find somebody
who was brought in?
Admit.
Come here.
Follow me.
Who you looking for?
Wynn Mathison.
He's in a tiger costume.
There was a fire...
Excuse me,
could you please direct me
to the victims
of the fire?
Keep your habit
on, my man.
Excuse me?
Dr. Pratt?
You'll get to be
with your drag queen friends
soon enough.
I have food and housing vouchers
for the displaced.
Oh, I-I'm sorry,
Sister.
Can someone please tell
me what room he's in?
Dr. Pratt?
What?
He's with the guy
in the tiger suit.
( sighs )
Can we get some oil
of wintergreen in here?
I hate the smell
of rotting flesh.
Suction.
Especially when it's
increasing by the minute.
Come on, that bacteria's
moving faster than
you are, Edson.
Bovie.
Systolic's down to 95.
Bolus 500.
Lap pad.
Still not bleeding.
Myonecrosis.
Yeah, it's in the muscle.
Ten blade.
Okay, if it's vascularized,
don't cut it.
That's my plan.
Start there
and carry the incision
four centimeters inferior.
No, that's eight.
Damn it!
We need clean borders.
Where the hell is Corday?
She's in the scrub room.
If I don't
remove enough tissue
the infection could be
left to smolder inside.
Get her the hell in here!
Maybe she can debride this guy's
wound without using a chainsaw.
Hey!
Chris, it's me,
Elizabeth.
Listen,
you needn't come here.
I shouldn't be longer
than an hour.
Dr. Corday, he's
asking for you.
Be right there.
to finish packing?
Yeah, I could pick you both up
after work.
I could drive you
to the airport--
save you the cost of cab fare.
Yeah. Okay. Thank you.
Thank you so much.
Yeah, I'll see you soon.
Corazon, uh, would you mind
taking the phone?
Not at all.
( metal clinking )
Oh...
Damn.
Was that
your wedding ring?
Yep. Yep.
I can't see it.
Can you call Engineering?
They're closed
till morning.
I'm sorry.
It's not your fault.
Don't hate me.
He wants to talk.
Lizzie, get your ass in here!
I've lost
my wedding ring.
Oh, boo-hoo, this guy's about
to lose a leg!
I'd say chop-chop, but that
would be in extremely bad taste.
Can you call someone
get them
to tape this off for me?
Make sure no more water
is run down it?
Sure.
Would somebody please call
Tiffany's
Search and Rescue Team?!
I'm coming!
He's got 20% surface area burns,
mainly upper body.
Oh, God.
Decent prognosis.
We provide
ventilatory support
until the lungs heal.
Then we extubate him.
Might take a week,
maybe less.
What-what about his face?
He'll need skin grafts.
There'll definitely be
some scarring.
( sobbing )
Wynn. Wynn, it's me, Terry.
I'm right here.
He can't hear you.
He's sedated.
You should probably have
your eye looked at.
Later, okay?
Can I touch him?
I wouldn't.
Yo, newbie.
Come on.
Check jungle perv's eye
with the slit-lamp.
He may have
a corneal burn.
Where's that?
You still here?
Yeah, uh, slit-lamp.
Where is it?
How does it work?
Exam Three. Try
the on/off switch.
Hey, hey.
You changed.
What? I just put on
some scrub pants.
Oh, come on.
You know, Carter
my outfit is really starting
to bug me, too.
But we agreed to stay
in costume the entire shift.
Yeah, I am.
No, you're not.
It's half a costume.
It's always, like,
50% commitment.
Are you serious
or you kidding?
Do you even know what I've been
dealing with down here?
Look, me, too.
In pumps.
Want to see
the whole costume?
No.
Here's the whole costume.
Forget it.
I'm a skeleton!
Look at me!
( growling )
Carter really likes
Halloween, huh?
Perpetual erection.
Accidentally drank
his daughter's
mandrake smoothie.
Police found him
chasing women down the street.
Where do you want him?
In a cold
shower.
Curtain Three's open.
Okay, get
a line in
and push four
of Ativan.
Are you open, baby?
( lecherous laughter )
Perfect.
Whoo!
( laughing )
First day labs, charcoal
and a Foley for the tox screen.
Release me!
I'm the Marquis De Sade!
How am I supposed to pass
a catheter through that?
Inject phenylephrine.
Into the shaft?
I'm Rod Stewart!
He won't hold still long enough
for a blood draw
much less
let me touch his penis.
Oh, she can touch it!
Or we can wait for the
mandrake to metabolize.
Why not just give him Haldol,
make it easier on everybody?
It might make
his symptoms worse.
Hey!
Hey, hey.
He just grabbed
my ass.
Well, I couldn't reach hers.
I said four of Ativan.
Ask Abby.
I'm done.
Okay, you could be a
little bit more sensitive.
To what?
( laughing )
* Choo-choo-choo,
choo, choo *
* Choo-choo,
choo-choo-choo-choo... *
CORDAY:
It's amazing how
quickly this spreads.
EDSON:
Any idea how
he got it?
A cut, a scratch, some
other trivial injury.
Dopamine's at ten mikes.
Need more suction.
Scalpel.
Easy, Lizzie.
Is it just me, or
is this constant
commentary
rather
distracting?
It's not you.
Just remove the
infected tissue
and let antibiotics
and Hyperbaric Oxygen
Therapy do the rest.
You're not serious.
Hell, yes, I am serious.
I'm already into
the posterior compartment.
It's still necrotic soup.
Six hours in
the chamber
will increase
his oxygen saturation
create a bacteriocidal effect...
Robert...
...and give this guy
a chance of a functioning leg.
Do you two have a
problem with that?
How's a guy with Parkinson's
get into med school?
Probably some kind
of disability quota
they have to fill.
Forget med school.
How's he expect
to practice?
Wouldn't want him
taking out my appendix.
He seems to have
it under control.
You know,
it's a progressive disease.
What's he going to be
like in ten years?
Could be dead.
Or want to be.
Happy Abby, always
looking on the
bright side.
Dr. Weaver, I thought
you were out sick.
I was until an apartment fire
set us back 30 patients.
PRATT:
35, if you count
the bad popcorn balls.
Oh, wonderful.
Thanks for
coming in,
Kerry.
Yeah, I shouldn't
have answered my phone.
Want your messages?
No!
I want
the air conditioning on!
I'm sweating like a pig!
It's freezing in here.
That's what you get for
bringing Weaver in on Halloween.
It's the biggest holiday
of the year for her kind.
Lesbians?
Wiccan.
She's probably riding that
crutch around like a broom.
Oh, come on, Frank.
All women get like that
when they're going
through the change.
Pratt!
What? She's having
hot flashes.
She's moody...
That is so sexist.
And stupid.
She's too young.
Early onset.
You've got early onset.
Whatever you say,
Nasty Ratched.
( sighs )
It's nurse, okay?
Not Nasty, not Naughty,
not Wet, certainly not Head.
Just nurse.
( laughs )
Abby, you're going to
talk to Kovac, right?
Yes.
County General
on Bravo One.
I finished
with the slit-lamp.
I numbed him
with alcaine.
Who are you?
Meet Nathan--
our newest oldest
med student.
I'm on surgical rotations
with Dr. Corday.
We have to clear trauma.
BOA with newborn hypoxia.
She asked that I stay
and assist in any...
Good. Follow me.
Don't worry.
She doesn't bite.
Much.
Simone Phipps, 42.
Had a home birth,
newborn in respiratory distress.
WEAVER:
Simone, did you have
a difficult or
complicated labor?
No, it went well.
I didn't even tear.
One minute Apgar with seven,
but he had a little...
Who are you?
I'm the midwife.
What's wrong with him?
We're going to
find out, all right?
Take him to Trauma One.
Wh-Where is that?
LOCKHART:
I'll take him.
No, I... it's okay.
I got it, I got it.
I got it.
Simone, you've lost
a lot of blood.
Something's wrong
with my baby,
I know it.
Lily, stirrups.
Gallant, labs.
Oh, maybe I should have
had him in a hospital.
Simone,
you did everything right.
GALLANT:
CBC, PT/PTT
DIC screen, type and cross
for four units.
We're taking
care of your baby.
Let's help you now.
BP is 80/60.
Okay, squeeze in
another two liters.
What's happening?
You're losing a lot of blood
from a retained placenta.
No, I mean with my baby.
Dr. Kovac is taking
good care of your son.
I'm going to pull gently
on the umbilical cord.
Simone?
I need you to stay with me.
Oh...
Pulse ox is 82.
He's retracting.
Pedes intubation tray,
number three ET uncuffed.
What do you hear?
Wet crackles throughout.
KOVAC:
Fluid in the alveoli.
Okay, let's have a look.
Unhook the bag
from the mask.
You can bag the ET
once I'm in.
I've never done that.
Squeeze the bag
every two seconds
just like he was doing.
Never pass the tube
till you see the cords.
Okay. I'm in.
Call for a pedes vent
and set me up
for an umbilical line.
Relax. Relax, the
hard part's over.
Good.
Notify the NICU team.
What do I tell them is wrong?
I have no idea.
CORDAY:
It's no good.
We're into the quads.
EDSON:
We'll have
to do an AKA.
Keep debriding.
We're not there yet.
If we treat this
conservatively,
and it spreads
we're committed to
a hip disarticulation
to stay ahead
of the bacteria.
It's worth the risk.
Of his being
nonambulatory?
With an above-the-knee
amputation
at least he can
use a prosthetic.
And if it gets
into his hip
it'll spread to
the abdominal wall
and he'll get septic.
I am trying to save
this man's leg.
Dry the field.
What about his life?
He's young.
It's the same thing.
Oh, come on, Robert,
of course it's not.
CORDAY:
Look, this kelly
slices through sub-Q
fat like butter.
All right, fine, keep cutting
until you hit viable muscle.
It's above the distal
third of the thigh.
It's a hopeless wound.
Fine, take it.
CORDAY:
Robert...
I said take the leg.
( slams equipment )
Bovie, pickups.
( man and boy laughing )
Tommy.
How are you feeling?
He seems, he seems
a lot better, thanks.
Good. Well, uh
Just keep him
on clear fluids tonight
and I'll have
a nurse
sign you out.
Okay. Thanks.
What's wrong
with him?
Shhh, shhh....
How you holding up?
I'm good. Uh, I think
the robot can go home.
Okay. I'll get Carter
to dispo him.
Okay.
Can I get you a cup of
coffee or something?
No, fine, thank you.
Uh, I like your outfit.
Mm-hmm?
It's very retro.
( chuckles ):
Thank you.
Um, listen, if you
ever need anything...
Like a straitjacket?
( both chuckling )
Is your... dyskinesia
usually this bad?
I don't want to freeze up
when I'm at work
so I up the medication,
and this is what you get.
At least it helps
to dispel the myth.
You know, we don't all
have rhythm.
( both chuckling )
If that happened to me
I'd probably jump
on a world cruise
not go to Med
school.
I already saw the world.
In fact, I was in Italy
when I first realized
I had a problem.
I was sipping wine in this
little cafe in Florence
and I noticed that my little
finger was shaking.
I just figured
it was from living
on espresso
and martinis.
How did you find
out it wasn't?
Well, I used
to hate doctors
so it took a while
for me to check it out
but, once I did, it really put
things in perspective.
Yeah, I guess being
sick does that.
Her baby's not
doing well, huh?
No.
How you doing,
Simone?
Good. He seems better, huh?
Maintenance fluids
are at 5cc's
per kilo per hour.
My mother had me at home.
I thought it would
be good for him.
Um, his tests
came back.
I'm afraid your baby has a
disease called sialidosis.
What's that?
His body lacks
an enzyme
that breaks down
the waste proteins
inside the cells
and there is already
extensive damage
to the liver
the bones and the
nervous system.
( sighs )
I've been staring at him
for over an hour now
and I still...
can't figure out
what I want to call him.
Would you
excuse us, please?
Uh, yeah. Sure.
( Kovac sighs )
Children with, uh, sialidosis
are mentally retarded
often blind.
He'll never
speak or walk.
His life expectancy
is less than two years.
MAN:
Dr. Kovac
NICU's on line one.
Thanks.
( sighs )
Excuse me.
Is there anyone
you'd like me to call?
( shudders )
( quietly ):
No. There's just us.
I don't think it
will be necessary.
Thank you.
You having a bad night?
No worse than usual.
That was a little bit
insensitive
don't you think?
Hey, I had to tell
a mother her baby
was going to die.
I didn't need an
audience, okay?
Okay.
I'm starting to get some
complaints about you.
From patients?
Nurses.
Don't look so
concerned about it.
Okay, first you accused
Chuny of being an idiot
and then later
when she was sexually
harassed by a patient....
Sexually harassed?!
The guy grabbed
her butt!
Yeah, that's
sexual harassment, Luka.
Oh, come on, Abby,
you were there.
The guy's intoxicated
with mandrake;
he's harmless.
This one's all yours.
What patient?
McFadden.
I was checking his vitals
and he grabbed my boob.
Okay, what's
his status?
He's going to die if he tries
that again; that's his status.
See, every time a nurse
has a problem
she complains to me.
Everyone complains,
it's part of the job.
Yes, and it's part
of my job as Nurse Manager
to counsel you.
What?
You can give nurses orders;
you cannot critique their work.
( groans )
If you have a problem
with a nurse
you have
to come to me.
Okay, what about you?
Who do I complain to
if I have a problem
with you?
Well, here's an idea--
maybe you should
try fighting for the nurses
instead of fighting
with them.
Hey, maybe you
should sew some
swastikas on that costume.
You could be a naughty
Nazi nurse, huh?
You totally suck, you know that?
Hey, careful!
Creating a hostile work
environment!
Where's
Dr. Kovac?
I don't know; page him.
The baby with sialidosis
is febrile to 102.
Chuny, where's Kovac?
Don't know, don't care.
He feels like
he's on fire.
Why hasn't he gone
up to the NICU?
You'd have to ask
Dr. Kovac.
Can you do
something for him?
He needs to be pan-cultured.
How much does he weigh?
3 kilos.
Okay, 150 milligrams
I.V. piggyback of
Cefotaxime and Amp.
Set up for a spinal tap.
He has sialidosis.
Yeah, and he also
has an infection;
60 migs of Tylenol.
I'll make arrangements
for your baby
to be sent up to
the neonatal unit.
We're going to do
everything we
can for him.
Thank you.
Why are you
still here?
Uh, my piano recital
was canceled.
Hey, it's me,
Elizabeth.
I'm on my way home now;
I'll see you soon. Bye.
We did
the right thing.
Trying to convince
me or you?
Look, I went through
a period of adjustment
when I became a mother;
every time I had
to treat a child.
You get over it.
Oh, please, spare me
the two-dollar
psychoanalysis, Lizzie.
Fine.
Hey, look, look, look...
I know most people don't like
me; I don't care.
I don't like most people.
But I'm good at what I do.
I save people's lives.
Every day.
People who no one else can help.
If I can't do that...
Robert... I know
you're frustrated.
You're an excellent surgeon,
and you will be again
I promise you.
You will be.
I'm being paged.
Elizabeth?
Uh...
I'm being paged.
( door closes )
Elizabeth.
I-I just tried
calling you.
I'm sorry, I couldn't wait.
I have to leave for
the airport now.
Well, what about
a later flight?
This is the later
flight.
I threw her pajamas,
some crackers
a couple toys
in here
just in case she had
to stay for awhile.
I'm sorry.
No, no, no,
it's all right,
it's my fault.
We got slammed.
I'm back Sunday night,
so I'll see you
Sunday morning.
Yeah, yeah.
Have a safe flight.
Bye, Ella.
Bye.
Hey, did Chris take you
trick-or-treating?
( alarms sounding )
What is it?
Dropped her pressure
to 60 palp.
Dopamine is up,
we've got two liters going
and I'm working on
an art line.
Any word from her
family yet?
No, we still don't have
a last name.
Lily, could you?
Oh, sure.
There, it's okay.
Hello, little
cowgirl.
I'll be with you
soon, all right?
Could it be hemorrhagic?
CT was negative; I'm
thinking hypoxia.
If we don't find her family soon
they're just going to
be ID-ing the body.
Her pulse ox is only 82
on 100%.
She needs suctioning, Abby.
Set up ultrasound;
she may have thrown a clot.
I don't know, second
crit was only 32.
I still want four units
of type specific.
What happened
to Mom?
In the washroom.
Where are the suction catheters?
Try the cabinet.
What are you doing?
Weaver ordered
antibiotics.
No. Who did the LP?
She wanted a full
septic workup.
This is my patient.
The baby spiked
a fever.
This baby is in a chronic
vegetative state.
You are prolonging his suffering
and the suffering of the mother.
We still treat
kids like this.
You should have asked me.
We couldn't
find you.
I told you to leave
once already; this
is not your case.
Luka.
CORDAY:
Abby!
KOVAC:
You need to check with me before
you push meds on my patients.
I have to do
a cut-down here.
Morrison's pouch looks dry,
but it could be retroperitoneal.
What the hell was
all that about?
You want PEEP on the vent?
Not until we get
her pressure up.
CARTER:
Nathan, why do you
think she's hypotensive?
Blood loss?
Not in this case.
Hypoxia can cause
myocardial dysfunction.
That's it; I'm filing a
grievance against him.
Not now, Chuny.
IV's dry; she needs
a fresh one.
I'll get it.
Panic value
potassium's 8.2.
Damn it, that's rhabdo
from the crush injury;
10cc's of calcium
gluconate.
PVC's.
Let's push bicarb;
ten units of regular insulin
an amp of D-50.
Get me kayexelate and call
renal; she may need dialysis.
( gasps )
What the hell are
you doing?
I accidentally...
It's okay.
Go see if Frank's found
the girl's family.
No, I'll start another one.
Line's in,
is the transducer ready?
Where's the saline?
I said, go find
the girl's family.
Run of five.
100 of Lidocaine
prep the groin
for a quinton catheter.
Sats are falling, 79.
Pressure's down to 50.
Being a little hard on him,
don't you think?
V-tac, charge to 200.
What are you talking about?
Nathan, he's doing a pretty
good job, considering.
Considering what?
He has Parkinson's.
Excuse me?
CORDAY:
Clear.
Still V-tach.
Procainamide's
on board.
Stand by with amiodarone.
Clear.
No change.
How long?
How long?
Uh... 12 minutes.
Clear.
Sinus tach.
All right.
Way to go.
Good femoral pulse.
Set up a pronestyl
drip, then a repeat K.
Labs on your baby.
( sarcastically ):
Thank you.
Glad to see you
two have made up.
Hey, I'm being professional.
She's the one
having trouble.
I warned her.
Warned her about what?
( sighs ):
Nothing.
( laughs ):
Oh, my God.
You're such a jerk.
What?
You slept with her?
( scoffs )
That's what this
is all about.
What's your problem?
One time.
One time.
One time with Chuny
one time with a patient's mother
in radiology.
Hey, you never
complained.
Yeah, I never let it
affect my work.
You two need to figure
this out.
So, what do you
want me to do?
I don't know.
Tell her you're sorry.
Tell her it was wrong.
Just fix it.
I'm not going to kiss her ass.
That's how this whole
problem started.
Have them check a gas on 50%.
I'm going to wait
right here for you, Wynn.
Don't worry
about anything.
I love you.
( sighs heavily )
I should've told them
I was his brother.
ICU has strict rules.
He'll need around-the-clock
attention tonight
but his lungs
are rebounding.
You know what,
you should probably go home.
They'll let you see him
in the morning.
Home?
Our whole lives were
in that apartment.
This dress
is all I have.
I've been watching
his heart rate.
It goes down when I touch him,
when he knows I'm here.
Has his fever gone down?
A little.
I waited so long for him.
Five years.
Two miscarriages,
in vitro.
I lost two boyfriends
because I was so determined
to have a child.
I was about to give up...
and then suddenly...
he was here.
He's here.
We'll keep treating
the infection
but he could start going
into organ failure soon.
His systems
will shut down.
( quietly ):
You're so beautiful.
You're my baby.
His heart could stop beating.
I need to know
what you want to do
if something like
that happens.
I don't know.
To keep him alive,
I may have to open his chest.
Maybe even
shock him.
And I'm not sure you want me
to do something like that.
No...
( quietly ):
I... I don't know.
I don't know.
Tell the unit I flushed
the quintin.
He's tenacious.
You've got to give
him that.
I wish he'd told me.
Kind of a hard thing
to lead with.
Oh, there's Mommy.
There's Mommy.
Hi, uh, Lily had to run
Wynn's ABG up to the lab.
Thank you.
Did you reverse
her hyperkalemia?
Yeah, just enough to
get her to dialysis.
She still has
the burns, though.
Yeah,
but you got her back.
May I?
Oh, I'm sorry, yeah.
Hey.
Thank you.
So, did we reach
the parents?
No, uh, the girl
was actually baby-sitting.
Wasn't even her building.
You know, you might
have told me sooner
saved me some
embarrassment.
About your condition.
Well, I certainly didn't mean
to embarrass you.
How long has it been?
Eight years.
I was misdiagnosed
for the first two.
And you were late
today because...?
My neurologist wanted
an MRI.
I'm sorry.
I wouldn't have
made you stay...
What the hell, fresh start.
Try to make as many
rounds as you can
complete the
required reading
take the exam.
I've been reading
and taking tests for two years.
This is my hands-on
training.
It's a surgical rotation.
I understand that.
Probably the most
physically demanding,
emotionally exhausting
stressful six weeks
any would-be physician
ever experiences.
Part of becoming
a doctor.
I'm offering you
a pass, Mr. Nathan.
Trust me, you should take it.
I'm here to treat patients.
You have a degenerative
neurologic disease.
I know what I have.
It doesn't mean I need a pass.
FRANK:
E.R.
I don't want special treatment.
I just want to learn
like other students.
You're not like other students.
No, I'm older and smarter.
FRANK:
Burn Unit needs you.
I'm on my way out, Frank.
It's your melted mask guy.
Okay. I'll
be right there.
Look, go home,
think about it.
Report back day
after tomorrow.
I'm sure you could
use the rest.
I'm fine.
It's just not
very practical.
Okay, let's go.
Dr. Weaver?
What?
What time is it?
Are you okay?
Yeah, yeah, I was...
( sighing ):
I was just going to
lay down for a second.
Can you pronounce
a patient?
Did we ever hear
back from the NICU?
Uh, no, there was no need.
Oh, come on.
It's been three hours.
We can't board their patients.
They have to call in a nurse
from home
or if they won't,
I want to speak to
their medical director.
Dr. Weaver...
Cardiac arrest
half hour ago.
Excuse us.
You should've come
to get me.
How long did Dr. Kovac
work on him?
He didn't.
She signed a DNR.
Where is he?
Who?
Kovac.
He's home. His
shift ended at 10:00.
All right, I'm going to move her
to a quiet room.
Call the social worker
get her referrals
for grief counseling.
Are you leaving soon?
I'm just, uh,
finishing up with Woody here.
You're the most
beautiful nurse
in this hospital.
Well, thank you.
You've got class.
May I play with
your breasts?
Hey!
Excuse me.
Please?
Last request of a
man on his deathbed.
You're not dying, Woody--
you're drunk.
I want to go
to heaven
on the bosom of
a beautiful woman.
I don't think your HMO
covers that.
How much longer you
have that outfit for?
Tomorrow at noon, why?
Thought maybe I
could talk you
into giving me
a sponge bath.
What's in it for me,
Boney Boy?
Oh, I'll give
you a bone
nasty naughty
little nurse.
( laughing )
ROMANO:
Elizabeth!
Uh... Robert,
can we talk tomorrow?
I really have
to get Ella home.
I thought you might want this
before you left.
It's my ring.
Amazing what you can do
with a laparoscopic camera
and a snare.
Thank you.
De nada.
Uh... look,
about, uh, about today...
Uh, let's not.
It was a momentary
weakness on my part.
It won't happen again.
You'll work through
this, Robert.
Of course I will.
Good night.
Night.
CORDAY:
The patient has gastroenteritis
vomits to excess,
has hematemesis
no history of PUD.
What are you thinking?
NATHAN:
Mallory-Weiss tear.
Laceration of the distal
esophagus
results in an upper GI bleed.
You're both correct and tardy.
Sorry.
Don't be sorry,
be punctual.
What if that patient vomits
and develops chest pain?
Boerhaave's syndrome.
Spontaneous rupture
of the esophagus
associated
with retching.
Usually tears
into the left
pleural space.