ER (1994–2009): Season 10, Episode 12 - NICU - full transcript

Previously on ER:

Welcome back.

How have you been?

Good.

I'm back in med school.

Really?

I know
I'm supposed to feel

like I want to carry
a baby, but I don't.

Once that baby's inside of you,
it's, I mean, it's incredible.

Kerry, I don't want it.

Abby, would you be
interested



in studying
together sometime?

Sorry?

I'm good at the academic
stuff, you know?

But you're good
with everything else.

Maybe we could
help each other.

Okay.

TAGGART:
Four-day-old full-term male.

Mottled, lethargic, retractions.

Has NICU been called?

They're on the way.

Pratt's intubating.

Suction.
Tube's too big.

Give me the 3-0.
I'm Doctor Carter.

What's his name.
Jacob.



It won't advance.

Sat's are good,
try again.

Anatomy's distorted.
Here, go for it.

Just brought him home.

He started gasping

and sweating while
I was feeding him.

Mm-hmm.

Okay, Pratt, bag him.

Equal breath sounds.

200 of cefotax
for presumed sepsis.

Where the hell is NICU?

Is he going to be okay?

Yeah, we're taking
care of him.

Systolic ejection
murmur, weak
femoral pulses,

and distress
while feeding.

What's your diagnosis,
Pratt?
Ductal dependent

cardiac lesion.

Matt Gillespie,

R3, pediatrics.

Sam, P.G.E. infusion

at point oh-five mikes,
quickly.

Oh, doing your
NICU rotation, huh?

Just when I was getting used
to my double life in the ER.

Wait, wh-wh-wh-what's
happening? Please.

PRATT:
We think Jacob might have
a heart problem.

Wait, you think?

ABG's back,

metabolic acidosis,
minus 18.

Wh-Wh-What does that mean?

It means that his body's
not getting enough oxygen,

but the breathing tube and fluid
should help with that.

Sam, ten of bicarb,

50 of saline.
I only have two hands,

and he only has
one line.

Abby, bag him.

Neela, tell cards
to meet us in the NICU.

Sam can start the
prostins on the way.

We'll take it
from here.
I'll help you up.

We don't need any help.
No. If he starts crashing,

you're going to need
an extra set of hands.

SAM:
Here, push this.

It can be very difficult
to diagnose congenital
heart disease.

Well, his doctor
saw him yesterday.
She missed this?

Well, there may have been
nothing to miss.

Sometimes, the symptoms
don't present right away.

Well, how serious
is this?
We don't know yet.

Cards will meet us
with the echo and a
Rashkind, just in case.

In case of what?
Uh, cardiology
will talk to you.

I just want
to talk to someone

who knows what the hell
is going on.

Listen, he may
need a septostomy.
What? A what?

All right, everybody
off the elevator. Out!
Why don't we take the next one?

That way, I can explain
everything to you.

SAM:
Mean's down to 34.

He needs pressors.

Aeration's good,
sat's are 93.

He's in

very good hands.

Back off the FIO2.

We don't want to flood
the lungs.

He'll be okay
once he's got the
prostins on board.

When'd you two
start your rotation?

About five minutes ago.

Well, the NICU's great:
intubations, chest tubes,

umbilical lines--
you'll get to
do all sorts

of teeny, tiny,
kick-ass procedures.

KATE:
Cards is waiting

and Raab is pissed.

You trying to give him
a pneumo?

Good luck, you two.
Yeah, you're going
to love it.

Let's get out of here.
I hate the NICU.

Those guys are screwed.

Humphrey Fowler, Ex 33 weeker,
day of life 58.

Status post RDS,
on vanco for MRSA,

day 19 of 21.

Who names their
kid Humphrey?

Please, Abby,
it's the last one.

Post-op day 46
for C-CAM repair.

C-CAM?
Congenital cystic
adenomatoid malformation.

Was on the oscillator,
weaning the map and amp.

Born with only one lung,
but other than that,

he's doing
great, okay?
Okay.

You didn't keep flow
sheets, index cards?

It's all up in here.

Please tell me
you're joking.

( singing )
You don't need
any paperwork for this kid.

Bad hypoxic
encephalopathy.

His brain's mush...

but, um, his
vitals are good.

He can go on like
this indefinitely.

Family won't
withdraw support?

Two months
and about $2 million later,

Mom's still holding out
for a miracle.

They're here every day.

He's a paperweight.

There's nothing to do.

Come on, they're
waiting for us.

Thank you so much
for joining us.

I'm Doctor Raab,
director of Neonatology.

We round twice a
day, 7:00 and 4:00.

You will come
ready to present
overnight data

and exams on
your patients.

Everyone scrubs
for a full three minutes

before you enter the NICU.

No jewelry on the hands--
spreads bacteria.

Not even my
wedding band?
No, and cut your fingernails.

In 1993, two children

were abducted
from this unit.

That explains the
little LoJacks around
their little ankles.

You will be issued a code
for this door.

Do not give your code
to anyone.

I tattooed mine
on my scrotum.

Believe me, no one'll
ever see it there.

Dr. Gillespie,
back already?

Another month
in the box.

Your stand-up routine might
go over on other rotations,

but the NICU
is a tough room.

Who do we have here?

Lloyd Roberts,
ex 38 weeker

admitted for TTN.
and detox.

What's TTN?
Transient Tachypnia
of the Newborn,

resulting from delayed
clearance of the
fetal lung fluid.

Good.

Continue, Kate.

Born to 23-year-old G4P4 mom

who used methamphetamine
and heroin during pregnancy.

Don't we need to be keeping
our voices down?

Confidentiality
doesn't exist here.

The quieter we talk,

the harder they listen.

Kate, your plan?

DC the O2,
continue amp and gent,

advance the feeds,

morphine taper.

Did you name him yet?

Everyone, meet Virgie.

20-years-plus
as a NICU nurse.

Her mission:
to protect the babies

from the likes of you.

Haven't had a
Thor in a while.

We have a tradition

of giving the babies
tough-guy nicknames.

Hard to fight

with a name
like Lloyd.

Latest gas on Jacob Kolber.

Acidosis is worse.

What was the final read
on the echo?

Come on, people,
who picked him up?

Lockhart, he's yours. Go.

Examine your patient.

Cardiology confirmed
a critical coarct.

Which is...?
Narrowing of the aorta,

usually near the
ductus arteriosus.

And why do we care?

Because blood can't get
to the lower half of the body.

Why is that bad?

His legs need blood?

If you don't know,
don't guess.

Decreased perfusion
means acidosis,

shock and heart failure.

His means
have been drifting down.

LOCKHART:
Lungs are wet.

I can barely palpate
the femorals.

Ten of bicarb,

start dopa at 12,
crank up the prostins
to point one.

He needs the O.R.

But the cardiologist said
you'd try medicine first.

The medicine
isn't working.

CT surg is backed
up, said they'd

get to him in the
next 48 hours.

This boy is not waiting
48 hours.

If they can't take him
to the O.R.,
they can take him

to the cath lab
for dilation and stenting.

Stenting?

Another way to
open a blockage.

It's blocked? You said
it was just too narrow.

So narrow, the blood
isn't getting through.

Tom, uh, send off
LFTs and creatinine,

check for
end-organ damage.

TOM:
You got it.

KYLE:
I-I-I want to talk
to that cardiologist again,

all right?

Mr. and Mrs. Kolber,

Jacob is very sick,

but all this is really
just a plumbing problem.

Nothing that a CT
surgeon can't fix.

Surgery will cure him?

It should, yes.

Dr. Lockhart,
he needs

a nickname.

How about Jake?

Sounds tough to me.

Jacob to Jake--
very creative.

Thin mec,
delivery room three.

What are you
waiting for? Go!

50 cc saline bolus,
push it, Tom.

Dr. Lockhart, what
are you waiting for?

Go-- you could
learn something.

Yeah, I'd like
to stay here, if that's okay.

Covering deliveries
is part of your job-- go.

Tom, we need
another I-STAT
to see where we are.

Dr. Raab...

And he needs a foley
and another PIV.

I can do that.

He's my patient.

Get CT Surg on the phone
and tell them your patient

needs the O.R.
right now.

Not in 48 hours,
not sometime today,
right now.

I'll be right back.

NEELA:
So when the DL phone rings

we drop everything
and run?

Yup, 24/7.

It means some
potentially sick-assed
baby's being born.

Kid ends up being fine
but you never know.

Can I do the intubation?

If it's indicated,
I mean.

Oh, you like
this stuff.

The technology's
fascinating...

What's wrong with us?

We should be in
the easy,

lucrative specialties:
Derm... radiology...

Okay, little gunner,

welcome to your
very first delivery.

Hey, Matt, just in time.

Six weeks early,
no prenatal care.

You have a boy.

First thing,
get rid of the gunk

and dry him like crazy.

Warms the baby
and reminds him to breathe.

( speaking Chinese )

Good pulse but the cry's weak.

With neonates, it's all
about ventilation.

Get them to breathe well
and the rest will follow.

Decel down to the 20s..

You got it--
one more big push.

Hand me the bag.

Come on, you can do
better than that.

Wake up!
Matt!

Head's out, here we go.

We were visiting
my cousin.

Baby come too soon.

Don't worry, Dad.

Just needs
a little help
getting started here.

32-weekers usually do
just fine.
Matt!

Cord clamps.

Dude, thanks for
the heads up.

We would have brought
down a second team.

Neela,
second set-up.

The ABCs...
you know what to do.

Okay, buddy, you just bought
yourself a tube.

Call the NICU for back up.

It's a girl.

This baby's not breathing.

RAAB:
A NICU admission

is like running a marathon
without training for it.

It's an endurance test
for patients,

for families and for you.

Eat when you can,
sleep when you can,

and when it's
time to go home,

get the hell
out of here.

Let's round.

Jiang Han's
up to 1830 grams.

Room air, q3 feeds.

GROUP:
* Blessed be
the tie that binds... *

RAAB:
Feeder and grower.

Behaving himself
nicely.

VIRGIE:
Inga's ABG.

Sister's a mess.

( singing continues )
Inga?

Inga?

You had a week to
come up with nicknames,

and you failed to.

Dirk and Inga.

I was going to
call her Surinder.

It's Punjabi
for "warrior."

You're thinking
too much.

Inga doesn't
sound tough.

Neela,
present your patient.

Her pneumonia is worse.

RAAB:
Acidotic.

Ventilation's crap.

VIRGIE:
Pa02 in the 40s all day.

I think
we should consider ECMO.

Cardiopulmonary bypass?

Isn't that
incredibly dangerous

on a two-kilo kid?

We need to
do something

before the
prolonged hypoxia

causes brain damage.

Who can tell me
the risk of ECMO?

Overwhelming infection.

Could happen anyway,
ECMO or not.

Head bleed.

Parents could end up
with a little potato.

We'll get daily
head ultrasounds.

That won't
prevent a bleed,

just detect it
after the fact.

She was doing well
until she became bacteremic.

I know it's risky,

but ECMO
could get her through this.

She's not getting enough oxygen.

If we do nothing, she'll die.

Are you sure?

How can anyone
be sure

about something
like that?

Neela, call the profusion team
to start ECMO.

Rounds are over.

Thanks.

She already thinks
I'm an idiot,

so there's really
nothing to lose.

I have your sign-out.

You should get out of here.

I need to talk to Inga's
parents about ECMO.

I'm going to be here
all night anyway.

Go. I'll talk to them.

No. I'll do it.

Did you change
Rocky's diaper?

Yeah.

Why did you do that?

'Cause it was dirty.

My ins and outs
are all off now.

All right. I'm sorry.

Not good enough; go find it.

It's in the trash.
Find it, weigh it,

and I just might
let you get some
sleep tonight.

Mr. and Mrs. Tseng...

Sorry. Do you have
the results back

on the cardiac cath?

I'm sure Cards will
come talk to you

as soon as they have
an official report.

I've been waiting for hours.

I'll take an unofficial report.

I'll ask Abby
if she's heard.

I need to
talk to you.

Waiting's driving
me crazy.

The waiting is hard.

Do you know how long
it takes to recover

from something like this?

Just, you know,
rough estimate?

It's too soon to say.

Would you two come with me?

How long you been here?

Eight days.

We were visiting
from Suzhou, China,

when the babies came.

Are they doing okay?

Our son is very strong.

Mr. Tseng?

ECMO stands for Extra Corporal
Membrane Oxygenation.

Ready for circuit.

The machine puts oxygen
in the blood

and sends it back
to Inga's body.

It does the work of
her heart and lungs.

Let's go.
I'm clamped on high.

I know it looks scary,

but it's her
best chance.

Chance of what?

A good outcome.

She'll be healthy?

I hope so.

TOM:
Chow time for Dirk.

One of you
want to feed him?

I'll go.

JANE:
I've got control down low.

Releasing arterial.

Releasing venous.

Clamping bridge.

ECMO on, 2025.

It'll be while before we know
how she's going to respond.

I'll let you know.

MEI FAN:
If she was born in China,

she'd already be dead.

You don't know that.

My husband and I are lucky.

We went to school,
we have jobs as teachers.

But it's not like here.

We wanted our daughter
to be born in America,

so she'd have more options.

And she already does.

We don't have hospitals
like this.

It wasn't an accident, then.
You meant to deliver here.

We sold everything
to come stay with my aunt,

have the babies in Chicago.

You're just going to start over,
with nothing?

Her life will be better.

Isn't that why your parents
sent you to this country, too?

Tom, can you help me out?

Not now.
Gotta hang vanco.

( sighing ):
Transducers, art lines,
no butterflies.

They're in the cabinet
by the sinks

on the left.

Been here for nine weeks.

Thanks.

Hi.
Hi.

Just came to check
on Jacob.

He looks great.

Mm-hmm.
His suck is still weak,

but Abby tells me
to keep trying.

He'll get there.

You keep trying.

It says here that
he may need surgery

again in a few years--
is that true?

That sounds like
a question for cardiology.

Occasionally the area

where the aorta
was repaired

gets blocked from scarring,

but usually they can take care
of it in the cath lab

and avoid another surgery.

That's good to know.
Thanks, Abby.

I better get back to work.

But I'll be by later.

It was nice to see you,
Mrs. Kolber.

Looks like you're
doing well here.

Right.

Abby, take a look
at the CO2.

Uh, back off on the rate
and check it again
in an hour.

You got it.

The parents love you.

Nurses wouldn't give you
the time of day

unless they thought you knew
what you were doing.

Yeah.

Tell that to my attending.

You should see me on rounds.

( chuckles )

So Kem and I had our

first official tour
of the labor and
delivery suites today.

How can you call one room
a suite?

That counting the bathroom?

Ah.

You're gonna be a dad.

Yeah.

How's it feel?

Scary.

Especially in this room.

I start thinking about all
the things that can go wrong,

all the mistakes you can make.

You're going to be
a great father.

VIRGIE:
Full term forceps
in two!

That's my cue.

Hey, Abby...

...you're going to be
a great doctor.

Okay... Let's go. Baby time.

Can't-- Got a finger in this
kid's pleural cavity. You go.

Alone?

Is that even legal?

I'm right behind you.

Get set up,
I'll meet you there.

I'll go with you.

Are you kidding?
You have to go home.

You can't go to a delivery
on your own.

I dream about blood sugars,

TPN orders, gent doses,
boxed kidneys.

Better get used to it
if you're going into
neonatology.

I haven't slept well
for days.

You know, all this
whining about how
tired you are,

but you never leave.

I hate to break it
to you, Neela,

but we will make it
through this night
without you.

Just trying to help.

( woman groans and pants )

( woman screaming )

ALYSHA:
NICU's here.

35 weeker, maternal diabetes,
failure to progress.

I thought this was just
a forceps delivery.

That, too.

Here comes
a contraction, Sarah.

( screaming )

That's it, baby. Big push!
We're almost there!

What do you mean "we"?

Hi, I'm Abby from the NICU team.

Is there something wrong?

We're called in
for all forcep deliveries.

It's standard procedure.

Baby's heart
rate's dropping.

( screaming )

REITMAN:
Come on, let's go!

The baby's
getting tired!

SARAH:
Oh, she's not the only one.

ALYSHA:
Nuchal cord.

Bad decel, 54.

REITMAN:
Okay, Sarah, one more.

( screaming )
That's it.

Here she comes.

Okay, Sarah,
one more.

( screaming )

That's it.

Here she comes.

( screaming ):
A girl?!

It's a girl?

It's a girl!

It's a girl!

Good work, baby.

( laughing )
Good work.

Poor tone.
Check the heart rate.

I can't feel it.

Well, listen, then.
Shallow resps.

FATHER:
How is she? How's my girl?

Come on, baby...
wake up.

Wake up.

Hold on, I'm gonna
get a picture...

Neela, what's the pulse?
I'm counting.

It's not that hard.
Tap it out.

Where the hell is Matt?

Wow, look at
all that hair.

I'm sorry, I'm going
to need some room, okay?

Okay.

( baby crying loudly )

She's okay.

You hear that, baby?

She got some lungs.

ALYSHA:
Everything cool?

Yeah.

She's gonna have to
come upstairs to
monitor her sugars,

but, yeah,
she looks good.

Congratulations.

Thank you.
Thank you.

Ooh, girl, you look
just like your daddy.

Except you're three
shades lighter.

Babies are supposed to
be light when they're
born-- I told you.

Don't listen to
your daddy, Daphne.

You're perfect.

( pager beeping )

It's Matt.

He's a little late.

It's Inga.

What happened?

Hypertensive.
Crit bottomed out.

Ultrasound shows
huge brain bleed.

Are you sure?!

Yeah, like we said,

it's always a risk
with ECMO.

She's got to come off.

But she'll die.

Well, we can't leave her on,
the bleed will get worse.

Hey, Matt,
they need you in L&D.

Ah, there's a C-section.
I gotta go.

Um, order 20 per kilo
of packed cells.

I'll be back soon.

Surgery's on their way
to decannulate.

I talked everyone
into this.

Nobody, not even you,
could talk Raab into ECMO

if she didn't think
it was the right thing.

NEELA:
She's seizing.
Point five of ativan.

I can't take a verbal
for a benzo from a med student.

Raab's gone and Matt's
in a delivery.

Give her the ativan.

I could lose my job.
She's seizing.

That's the least
of our worries.

Let's just wait

to see what Matt says
when he comes back.

Versed will do
the same thing.

You can't give that
without a co-signed order.

Watch me.

I'm telling Dr. Raab.

You do that.

She'll kick you guys
off the rotation.

She can kick me off.
Neela has nothing to do with it.

What am I going to
tell her parents?

Versed's in.

You should go home.

Mr. and Mrs. Tseng,
I'm sorry.

I screwed up.
Inga's brain is toast.

Stop it.
You didn't do this.

I've got to call them.

Just go.
Raab'll do it.

They should hear it from me.

You know, you're a med student.

I think the attending
can handle it.

Just go.

Good night, Neela.

( gasping )

Excuse me, can someone
get the door, please?

Hello? Anyone?

Get me the hell out of here!

Oxygen is perfect

the whole time.

When can we
take Dirk home?

As soon
as Dr. Raab writes her note.

Thank you,
Neela.

Inga's not breathing
over her ventilator at all.

That's not a good
sign, is it?

It will take time
before we know

how much neurological function
she'll get back,

but her lungs are much better.

She's a strong girl.
Yes, she is.

I'm still waiting for you

to fill out Dirk's
discharge summary.

I'll get on that.

Cher's a lovely name,
it's just, uh,

h-how you've spelled it.

I just wanted
it to be different.

Okay.

As long as you're aware.

Poor Chair-- she's doomed.

Unless she meets a
nice ottoman some day.

Heard any funny dead
baby stories lately?

Here's a good one:

Inga's hydrocephalus
is worsening.

EEG shows continued
seizure activity.

She's not dead,
but she might never wake up.

It's a real laugh.

Bad day, Neela?

Millions of dollars
keeping these babies alive.

Half of them die anyway.

Why bother?

Time for rounds.

40 years ago,

Inga was considered
a micro-preemie,

borderline viable.

In many parts of the world,
that's still the case.

And we saved her

so she can endure a
lifetime of seizures,

chronic lung disease,
cerebral palsy.

It's a real advance.

We gave Inga a chance.

Her brother's going home today,
a normal kid.

But Inga's here now,

gorked out in a
level three nursery.

Look, we do our best.

Some kids will end up

hospitalized

for life, and some will go
to the prom.

Neela,

there are no
guarantees
in this work.

If you can't

live with that, I'd suggest

you become a bank teller.

( pager beeping )

We'll pick up again
when I get back.

Don't listen to her.

My cousin's a bank teller.

Got held up
at gun point last year.

Still here?

I discharged Daphne
an hour ago.

Yeah, we're just waiting

for the nurse
to take out that IV.

LOCKHART:
I can to it.

You're letting
a med student
touch your IV?

That's brave.

She's territorial.

They teach that
in nursing school.

TOM:
Abby,

we need you
over here.

Just keep some
pressure there.

Okay.

Come on, come on.

She's going to miss you guys.

RASGOTRA:
No, she won't.

She'll be home.

TOM:
He's been tachypnic

all morning,
sat's dropping.

He's tiring out.

You put him back on oh-two?

He's going to need
more than that.

( alarms )

Diastolic is
in the teens.

Widening pulse pressure.
He's septic.

Okay, 50cc's of saline,

cultures, start him
on amp and cefotax.

What's happening, Abby?
( alarm )

TOM:
He's apneic.

Pulse down to 105.

Bag him.

TOM:
Five As and Bs
in the last hour.

Did anybody page Raab?

911.
Okay, Mrs. Kolber...
Kyle?

Jacob's blood pressure
has dropped.

He's having trouble breathing,

most likely due
to a blood infection.

From what?
We're sending out cultures.

We won't know
for a few days.

He was okay
this morning.

Sepsis can come on
quickly like this.

We're starting antibiotics
to fight the infection,

but we're going to have to put
the breathing tube back in.

We were talking
about going home.

He's a tough guy.

He'll get through this.

Get together.

Photo for the wall.

Smile.

Fentanyl's in.

Go ahead, Abby.

One more with Dr. Neela.

Oh, it's okay.

SHUANG:
We insist.

Neela?

Suction.

Take your time.

Heart rate's good.

Smile.

I see the cords. Tube.

Good-bye, Jiang Han.

Ready to see
the outside world?

We're going
to keep calling him Dirk

since the name has
bring him luck.

Thank you, Dr. Neela.

Mei Fan,

( speaking Chinese )

( sighs )

Mei Fan?

( baby crying )

I want you to have this.

Thanks.

It's strange to be going.

Lots of parents are nervous

when their babies
are discharged.

It'll be great.

You'll love
having him home.

I know you're right.

Bye, Neela.

See you tomorrow.

TOM:
What are my
vent settings?

RAAB:
24 over eight. We'll
adjust from there.

Order a versed drip
and a chest film.

You want to call the tech?

RAAB:
Okay, nothing
to do now but wait

for the antibiotics
to kick in.

I don't know if I can take
another round of this.

( softly crying )

Here. Sit.

One of those better be for me.

I just needed to get outside
for a minute.

The NICU's so confining,
claustrophobic.

There's a reason why Matt
calls it the "the box".

Raab's right, you know.

Did you eat anything?

I like science,
complete answers,

a plan for everything.

I can't deal
with uncertainty.

It gets easier.

I'd sort of planned
neonatology since I
started medical school.

I'm supposed to
be loving this.

Well... the whole purpose
of rotation

is to try on
different specialties.

I mean, it's okay
if you don't...

I had a baby brother.

He died when he
was six days old.

I was only three.

Oh.

I remember sitting in my mom's
hospital room eating ice cream.

But I don't actually
remember him.

The NICU's just so
sad all the time.

How can you stand it?

I don't know.

When I was an OB nurse
the preemies freaked me out,

thought they looked
like frogs.

I was pretty sure
I was going to hate the NICU.

But you don't.

No, I don't.

It's not just about the babies.

You know, so much of it is about
taking care of the parents.

And it turns out...
( pager beeping )

tragic family dynamics
are my specialty.

It's Matt.
There's a delivery.

MATT:
Full term,

mom's febrile,
P-PROM, suspected chorio.

REITMAN:
Good work, Sandy.

Oh, my God.

We're almost there.
Honey, we're almost there.

LOPEZ:
The little boy is
officially here.

( joyful crying )

You did it.

We have a baby.

MARINA:
Amniotic fluid's cloudy,

kid's had late variables.

Abby?

Wait, you're
bagging him?

Sorry, you need to
wait over there.

No, that's my son.
I'm a doctor.

It's okay, Matt.
It's okay.

Honey, what's wrong?

It's just a little blow-by.
Let them work.

What's wrong?

He's too quiet.

Give him a minute.

Good chest excursion.

( baby crying )

Thank you very much.
That's what we like to hear.

Congratulations, Mom.

And Mom.

He's beautiful.

Is he really all right?

He'll have to go upstairs
for antibiotics

because of the chorio.

But right now,
he looks great.

I love you.

Hello, little baby.

I had no idea.

Nobody did.

Would you like to cut
the cord, Dr. Weaver?

( sniffles )

( baby crying )

( mouths ):
Hello, Henry.

Hey.

Your usual.

Thank you.

Bad night?

Jake is maxed out
on dopa and epi,

third-spacing like mad.

In the last two hours

his belly blew up
in front of our eyes.

I think it's NEC.

Surgery's on their way.

God. His parents here?

No, they're on their way.

I finally convinced them to
go home and get some rest,

and then I had to call
them back an hour later.

Any word
from Inga's parents?

No.

Three days and not
a single phone call.

KUB on Jake Kolber.

Free air under the diaphragm
and pneumatosis.

Oh, damn it. He's perfed.

Pedes surgery's
going to meet us
in the O.R.

Come on.
Let's go.

Can we wait
for his parents?

They should see him
before he goes up.

His bowel's dying--
there isn't time.

We need to save
the viable tissue

before there's
nothing left to save.

He's thrombocytopenic.

Platelets and FFP are
onboard in the O.R.

Abby, wh-where are you going?

To surgery.

His intestines were injured
as a result of the infection,

and they need to cut
out the injured part.

I'm Dr. Corday.

The injury has compromised
your son's already
tenuous condition.

The sooner we get him
to the O.R., the better.

Okay.

Hey. Would you like

to see your little
brother up close?

Abby.

Kids aren't allowed in NICU.

Just five seconds.

There he is.

Can he hear me?

Yes, he can.

It's okay. You won't hurt him.

I'm Miranda, your big sister.

Come on, honey.

Thank you, Abby.

Thank you.

Good morning.

Morning.

Where is everyone?

I told them not to come.

I think he's getting
a diaper rash.

I'll order some nystatin.

He's three
months old today.

You should go home.

I thought that... if
I prayed hard enough...

if I showed God
how much I believed.

You must be exhausted.

I don't want him
to suffer anymore.

My patient has been bumped
three times

for so-called emergencies.

Been waiting over 24 hours
for ORIF, happened again.

Came up here to see
what's so damn important.

Jake Kolber.

It's the congenital heart
disease baby

you guys admitted to us
a few weeks ago.

Do you remember?

No.

SURGEON:
Circumferential necrosis
to the jejunum.

There's really
nothing viable here.

Damn.

Abby?

The bowel's completely
infarcted.

I'm sorry.

We're closing.

So that's it.

Can't live without a gut.

I'm sorry.

( groans )

Where you going?

I'm going to go
tell the family.

Just give yourself
a minute, okay?

They don't need
to hear this immediately.

What am I supposed to do,
go out and get a latte

while they stand out there
wondering what's going on?

All right, listen.

Maybe you want to wait for
the attending to tell them.

Is that what you would do?

Kyle.

( crying )

( crying ):
Oh, God.

Is this the Chinese interpreter?

Excuse me.

No, I don't understand
what you're saying.

I've already called them.

I was connected to you.

Please don't put me
on hold again.

Hello?

Yes, I'm still here.

I'm not sure
if I need Mandarin or Cantonese.

How long will it take?

An hour, maybe longer.

( sighs )

You helped this family, Abby.

They will remember you
for the rest of their lives.

Yeah.

I'm hoping you'll give

neonatology serious
consideration.

Are you mocking me?

Cause it's really,
really not a good time.

No.

You're one of the best students
I've ever had.

Thank you.

Bye.

What?

The Tsengs have gone back
to China with Dirk.

What?

That was Mrs. Tseng's cousin.

They went back yesterday.

She doesn't know
how to reach them.

Come on. We've
got work to do.

Tell me this is our last day.

Good morning.
How's Henry today?

He's great.

He's raring to get
out of here.

All the cultures
came back negative,

but we still need to treat
for another seven days.

Unless you two allow
us to do the LP.

I do taps on babies
all day in the E.R.,

and never think twice about it.

Honey, shh.
Just do the spinal tap.

We want to take our baby home.

Okay. Abby, you're on.

Okay.

Uh, Dr. Raab,

I would be much
more comfortable

if you did the procedure,
if you don't mind.

No problem.

I'll be back after rounds.

Okay, thanks.

Let Abby do it.

Kerry...

It's okay, Sandy.

Dr. Raab, what's going
to happen to Inga?

If she survives,
she'll either be adopted

or put in a long-term
care facility.

Should I call social work?

Go ahead, but nobody's going
to China to look for them.

This doesn't make sense.

Her mother wouldn't
just leave her here.

They're young.
They're scared.

Maybe they think Inga would
be better off this way.

In a hospital, alone?

If you were in a foreign
country, with no money,

no job, and no place
to live, who knows?

You might do the same thing.

No, I wouldn't
and neither would you.

You can't begin to know
what you would do

in the same situation,

and you don't know
the first thing about me.

People are complicated.

That's not an excuse
for abandoning a baby.

Neela, if you stay
that judgmental,

you're going to hate this job.

( fussing softly )

( sighs )

CSF on the first attempt

with Dr. Mom breathing
down your neck.

I'm impressed.

You should see how good I am
when I'm not post-call.

Wait a minute. Wait, wait.

You stuck a needle
in my kid's back

and you've been working
for 36 hours?

Actually,
it's only been 31 hours.

Tube four, crystal clear.

( cries )

Owen Miller. Bad hypoxic
brain injury at birth.

Mom's your real patient.

She's inching towards
letting go, needs
a lot of help.

Mrs. Miller,

this is David.

Hi. I'm your new medical
student.

Ex 34 weeker with mec asp
and pneumomediastinum.

Got him off high frequency
last night.

That's a big step.

"Mec asp"?

Meconium aspiration.

It's like a foreign language,

but you'll pick it up fast.

Zero red blood cells.

Champagne tap.

Hey, before we go,
do you mind taking a picture?

Thank you.

( contended sigh )

Thanks.

Get your butt back down

to the E.R.
where you belong.

Bye.
Bye.

Congratulations.

Thanks.
Thanks.

( snap )

You all signed out?

Yeah.

Ever been to the Sky Bar?

( coughing )

This is disgusting.

I told you.

Why are cigars associated
with babies?

This stinky thing really
has no place in a nursery.

It's Freudian.

Something about men wanting
to have sex with their mothers.

Thank you.

( chuckles )

You know what
else I don't get?

Why we're drinking cider
instead of champagne.

You're supposed
to get champagne
for a champagne tap.

Is Weaver that cheap?

Weaver knows
I don't drink champagne.

So, you still thinking
about neonatology?

Not in a million years.

I hope you didn't let
Raab discourage you.

It's more than that.

She thinks you should go
into NICU, you know.

Yeah.

You should.

No, thanks.

I bet every attending
tries to recruit you.

( chuckles ):
Oh, please.

Look who's talking.

Your mind is a sponge.

Maybe, but... you've
got that thing.

I don't know what it is,
but it's much harder to learn.

I think all that cider's
going to your head.