ER (1994–2009): Season 10, Episode 6 - The Greater Good - full transcript

Pratt and Kovac clash over a miscarriage-prone young woman, Denny (ALLISON SMITH), who arrives to deliver a premature baby. Pratt wants to make heroic efforts to save the unborn child, while Kovac is adamantly against spending vast amounts of money to keep the forever sickly baby alive.

Previously on ER:

( groans )

Sam Taggart. New Nurse.

I started my surgical
rotation today.

I'm back in med school.

So, no more nursing?

No, I'm still going
to be taking

a few shifts for a while.
I need the money.

What are you
nut-meats doing?

Clearing Triage.

We'll provide good care,
and we're going to do it faster.



You're going to form
a line down the hall,

and you'll be examined
three at a time.

It's your new hospital?
Yep.

It's even crappier
than the last one.

I'm a 71-year-old man
who's going blind.

I've considered everything.

Promise me you're not going
to kill yourself

in the next
72 hours.

But, but Monday would be okay?

I'm off the hook by then.

LEWIS:
"The friend had,
in a weak hour,

"spoken with sobs
of his own death.

"He had delivered
a melancholy oration

"previous to his funeral,



"and had doubtless
in the packet of letters,

"presented various
keepsakes to relatives.

"But he had not died,

"and thus he had
delivered himself

into the hands of the youth."

( grinding )

Oh, sorry.

Are you taking your enalapril?

Uh, yeah.

Do you want me
to bump up your Lasix?

Coffee does the same thing.

It also raises
your blood pressure.

Well, as luck would have it,
you gave me a pill for that too.

You want...
you want more espresso?

Not unless
I'm going to fly to work.

"The latter felt immensely
superior to his friend,

but he inclined
toward condescension."

You don't... you don't have
to keep doing this.

Well, I've got time
to finish the chapter.

I've never read this before.
It's good.

You, you don't have to keep...
keep coming here.

I don't have this book.

Keep it. I'm...

I'm never going to read it
again.

That's why I'm here.
That and the coffee.

He died at 29.

Stephen Crane.

TB.

Just a little trivia.

Nice. Very cheery.

"He adopted toward him

"an air of patronizing
good humor.

His self-pride was
now entirely restored."

I like this place already.

I don't think they're
going to be giving away

free donuts every day.

Why not? Bars
give away free peanuts.

Only so you'll get thirsty
and buy more beer.

They gave away donuts,
people would buy more coffee.

Please!
Can you help me?

I think I'm having
a miscarriage.

How many weeks?
24.

First pregnancy?

First one to last
this long.

Oh, she's adorable.

Yeah, I found six of them
behind my apartment.

She's the last one.

They don't allow pets
in my building.

They're not allowed
in here either.

Hey, buddy,
you want a donut?

Frank!

What?
Dogs love donuts.

Want a pooch?
Free to a good home.

Dogs irritate
my asthma.

Hi, I'm Terra King
from Ladokern.

I have gifts and some snacks
for the residents.

Is there someplace
I can set up?

Lester, Lester, can you
take care of this, please?

What's wrong with him?

C'mon. Punch it,
cat daddy.

What are you guys watching?

Carjacking.

Pratt...

He needs to get on Lower Wacker
to lose the chopper.

This is Denny. She's having
vaginal bleeding at 24 weeks.

Can you take her?

Sure, sure, let's go.

You cheering for
the carjacker to get away?

No, no, we just want him
to get a few more blocks.

Once he's south of Van Buren

he'll be out of our catchment
and goes to Mercy.

If there's a crash....

There's always a crash.

Turn left.
Get on the expressway...

Yes, yes, go, go!
Oh, oh!
Go, go!

Ooh...
Damn it.

I realize you have
friends downstairs.

You mustn't let them
take advantage of you.

Well, the patient
was borderline.

Which is precisely my point.

He needs to stay in the ER
under observation.

If his condition worsens,
I'll go back down.

You know as well as I do
they're only too happy

to free up beds by dumping
patients onto surgery.

Dr. Corday,
they need you in post-op

and the ER is calling
for a gallstone panck consult.

All right, you go
down there.

Make your assessment
and call me.

Be strong.

Collies fracture.

Put on a sugar tong splint
and have him come back

in two days for casting
after the swelling goes down.

Vicodin for pain.

What about a wrist film?

It's not deformed.
Distal neuro-circ intact.

We'll get an x-ray
when we cast.

Malik, get six units
of O-neg down here

before the car crash
starts rolling in.

I already
ordered eight.

Tell me about the gallbladder.

Um, fat and 40
with a history of gallstones.

I gave her a shot
of Toradol.

She's afebrile.
Abdomen is non-tender.

Good.
Send her home.

No ultrasound?

No. No labs,
no IV, no x-rays.

Tell her to stick
to a low-fat diet.

How'd you do this?

I was using a utility knife
to open up a box.

Be more careful.
Keep it clean and dry.

Come back in two days
for a wound check.

What's this?

A 24-year-old female
with bladder infection,

positive for leuks,
icon is negative.

I ordered Bactrim
and Pyridium.

Good. Tell her to pee
after she has sex.

It's a good way
to prevent UTIs.

Coop, your
subconjunctival hemorrhage

probably happened from sneezing

and it will get better
in a week.

Reassure your patient
that he won't go blind

and get him out of here.

( applause )

Five patients
in two minutes.

That's got to be
some kind of record.

Just make sure
you're not skimping.

Skimping?
Yeah, on
the billing.

Check off a few more boxes
next time.

I'm not billing for treatment
we didn't provide.

It's called capitalism, Kovac.
It pays your salary.

Okay, there's
the heartbeat.

Amniotic fluid
index is good.

Excellent
fetal movement.

He's good?

Yeah, but you're dilated
three centimeters.

I've already had
two miscarriages.

I was supposed to start
bed rest next week.

I can't go
through this again.

I'm going to give you
some medicine

to prevent you
from going into labor.

Junior needs
a few more weeks
before he's done.

Start with .25 of terbutaline
sub-Q

and give four grams of mag.

Here, magnesium might
make you a little queasy.

I'll be back
in a few minutes to
check on you, okay?

Hey, Jerry, what's the ETA
on our car crash?

Two minutes
and counting.

Dr. Pratt,
can I present a patient?

Oh, you better
make it fast.

23-year-old woman with sudden
onset occipital headache,

grade 8 out of 10.

Worst headache
of her life?

Close, but not quite.

Thunderclap onset?

More like two minutes.
No history of migraine.

Neuro exam is non-focal.

Okay, okay,
get a head CT,

and rule out
subarachnoid hemorrhage,

and get ten of MS
for the pain.

Thanks.

Kevin Dunn, 32-year-old
driver, high-speed MVA

with prolonged extraction.

The jacker
or the victim?

Jacker. The victim's
right behind us.

Lap belt. Front-end impact.
BP: 104/84, pulse 106.

Creamed the next guy
real good.

Yeah, I know.
We were watching.

Should have turned left
on Stanton, Sparky.

I would have got away
if that jerk didn't cut me off.

( screaming )

Oh, looks like a big
flail segment

and a closed clavicle fracture.

Let's put him
in Trauma Two.

Driver numero dos.

Thomas Collins--
aka innocent victim.

High-speed restrained
impact with head injury.

Turn him. Turn him.
Turn him.

Let's go. Come on. Come on.

I put Mrs. Walters
in Exam Two.

She needs a little TLC,
maybe some Zoloft.

That makes two of us.
Look at them.

They're like kids
in a candy store.

One hospital I worked at
tried to ban the drug reps,

but the residents
all complained

because they like
all the free food.

Yeah, that's how they
get you hooked:

free food, free equipment...

Oh, don't forget
the boobs.

I imagine they have
to pay for those.

Keep Kovac away
from her.

He's been known to give away
free physicals.

Okay, Ernie, where were we?

I got worms.

What the hell is this?

Uh, looks like a hospital bill.

Accounting's on the fifth floor.

No, I was already there.
They wouldn't help me.

Well, I can't either.
This is the ER.

All right, Ernie,
those are maggots.

When was the last time
you changed this bandage?

Look, look,
I was already there, okay?

I sat in here
for 11 hours

with my sick kid

to have some quack

tell me it was a virus
and he'd get better on his own.

Did he?

They didn't do anything for him

and I get a bill
for over two grand?

I want to see the doctor
who stiffed me.

Carter.
I want to see this Carter guy.

He doesn't work
here anymore.

( yells )
All right, Ernie.

Here's what
we're going to do.

Fix you up
with a nurse,

maybe have
something to eat,

and a bath.

But your friends there--
they gotta go.

I want this fixed!

I wouldn't do that, sir.

Are you going to do something
about this bill?

Are you going to get off
your ass and do something?!

No...

But he is.

Dr. Kovac!

Zack Isley, six-foot
fall onto gravel,

no LOC, GCS 15.

Superficial lacs
and abrasions on head

and right upper extremity.

Complaining
of right shoulder pain.

Hey, Zack.
I'm Dr. Kovac.

What happened?

Nothing really. Just goofing
around, took a header.

Can you straighten
your arm?

Ah...
Okay, Curtain Two.

I just sprained it.

Why don't you
let me decide that.

We'll get you an x-ray.

Clean those cuts and scrapes.

Might even need
some stitches.

Really?

Ah, don't worry.
We'll numb you up.

You won't even feel it.

No, ah, no medicine.
I can take it.

Tough guy, huh?

Trauma panel, a clot,
lateral C-spine,

chest x-ray
and AP pelvis.

Poor guy's driving
down the street,

minding his own business,
then bam!

Wakes up two days
later in the ICU.

If he wakes up.

Can't see the pupils--
too much blood.

Laps and saline for Abby.
Chest is clear.

BP is 140/94, pulse 72.
IV is blown.

How are we doing
in here?

Well, he's going to
need to be tubed.

But we got it covered. Thanks.

Abby, can you start an IV?

Nurses start IVs.

Surgical students
do cut-downs.

Spank 'em, Abby.
That's the way.

Somebody get me
a central line kit?

Yeah, I'll send one back.

On the monitor,
BP: 106/80,

tachy at 111.

They need
a triple lurnen kit next door.

I can't see into
his oral airway.

No blood in the nares
or around the mouth.
You're good.

SonoSite
for Dr. Cooper.

Pain meds on the fly,
but let's complete the survey.

He's decreased on the left.
Size six sterile gloves, please.

BP's 104/86.
Sats 92.

All right, kids, you're on.
Show Dr. Chen what you know.

Free fluid in the abdomen
and pericolic gutter.

Try there.

You could use a little
more jelly on your belly.

You're
the attending.

NEELA:
And in Morrison's pouch.

Meaning?

Intra-abdominal injury

secondary to
high-speed mechanism.

He'll need the OR.

Start the chest tube.
I'll be right back.

Don't be a stranger.

The guy next door
needs a surgeon.

I'll call Corday.

Mommy, Mommy,
come save me.

I'll decide if he
needs surgery.

He's only responding
to pain.

Urine output's good.
Okay, laryngoscope.

Ah, no, Surgi-Girl,
go next door.

Start the workup.

Yeah, I was going
to intubate.

Next time.
Now, go, go, shoo.

Get me a staple gun.

I'll start putting
this guy back together.

I can feel the inside
of the chest wall.

Surgery is here.
Hello, surgery.

( alarm beeping )
Abby, can you turn
that damn thing off?

Yeah.

Okay, leave
the guide finger in

with the other hand.

Slide the tube through.

Got it.
Got it.

Sats are up. 98%.

Thanks.
Nice job.

Okay, Abby,
give me the bullet.

I, I was trying
to fix the monitor.

Oh, you're a med student,
a nurse, and a technician now.

What's next, cowgirl?

Yo, Abby.
I'm pushing the drugs.

You want this or not?
Yes.

I told you
to evaluate this patient.

I can do it.

I don't care who does it,
as long as it gets done.

Neela, go with
Dr. Pratt.

You can come back
and sew these in
when you're done.

Well?

No fracture or dislocation.

You probably just strained
the ligaments a bit.

Told you.

Maybe you should be a doctor.

Yeah, not with my grades.

I wasn't a great student
at your age.

I almost failed
lunch. Ow! Ow!

Sorry.

Kovac, this guy's here
for your patient.

Ron Kennedy,
I'm a social worker
from Stanton House.

We're a foster care facility.
Zack's one of our residents.

You mean prisoners.
Relax.

I'm his case worker.

Zack hopped a fence

while we were
on an outing
and ran off.

I escaped, you Nazi.

Listen, you'll have
to call my mom.

I'm not going back there.

Zack has a conduct disorder.
Screw you!

Hey, could you give us
a moment, please?

I think he's off his meds.

Back off, man!
Hey, stop it, Zack.

He needs Haldol.

And you need to go back
to the waiting room, okay?

Get the hell out of here!

Get back in bed, Zack.

He needs to be sedated!

Out!

Hey!

I'm not going back there.

Please, don't let them
take me back.

Please....

Third crit is down to 29.
Done.

All right, let's roll.

Call Corday, and tell her

I'm sending her up
a gift basket.

That looks good,
but if it comes out,

you owe Dr. Chen
and me a beer.

I'm more
of a cosmo girl.

The drink or
the magazine?
A little of both.

Did neurosurgery agree?

Yeah, diffuse
axonal injury.

No operative lesion.

They'll sign off after
the second apnea test.

He's brain-dead?
Yes.

Bad guy gets
patched up.

His victim ends
up a vegetable.

Well, we haven't saved
this guy yet.

You can change
that head dressing, Abby.

Okay. Which OR
is he going to?

That's not your business.
Call UNOS.

Your butt's down
here until the
coordinator arrives.

Aah! Ow!

You wouldn't feel it

if you let me use
just a little
analgesic gel.

For six months I've been
on Tegretol, lithium,

Risperdal, clonidine,
Benadryl and Klonopin, okay?

I've been so doped up
I didn't know what day it was.

Have you been cheeking
your meds?

Had to. Today's the first day
I felt normal in months.

That why you ran away?

I got tired of being
a freaking zombie.

Did you call my parents?

Your mother's on her way.

You're not going to let them
take me back, are you?

We'll talk about it

when your mom gets here, okay?

Hey, Pratt?

Huh?

This scan's negative.

Yeah. I'm still waiting

on a neurology consult

to evaluate
a possible subarachnoid.

Do an LP.

No. They'll be here any minute.

You're wasting time
and resources.

What's his problem?

You mean besides
being tackled

in the waiting room?

Possible new onset angina.

I've ordered nitro,

CBC, chem panel,
serial... troponins

and a chest x-ray.

And I'm still waiting on cards.

EKG's normal?

Yeah.

You smoke?

No.

Hypertension?

High cholesterol, diabetes?

No. I'm healthy.

I run about
12 miles a week.

Okay, let me guess.

The pain started
after your incident

in the waiting room.

Yeah.

It's an anxiety attack.

Over this stupid
hospital bill?

Probably.

Let me see it.

What was the complaint?

My kid came in
with a fever.

Your son didn't need that.

Certainly didn't
need a chem panel

and two sets of
blood cultures.

You should have only
been charged for, what-- $300.

Thanks.

Hey, Slavko.

What the hell do you
think this is--

some Zagreb Yugo dealership?

On the rare occasion

when we do get a patient
with insurance,

we don't give them deals.

I expect that kind of idiocy
from Pratt, not from you.

I thought I was
his favorite.

Hi. I'm Terra King.

Have you heard
of Quinamax?

It's our new once-a-day
antibiotic

with excellent coverage
for bronchitis

and otitis media.

Neither of which needs treatment
with antibiotics.

Now, it has great
gram-positive coverage,

making it ideal
for cellulitis.

LEWIS:
I have a patient

coming in at 3:00 to
check a didge level--

Ben Hollander.

When he shows up,
just let him in

and come find
me, okay?

Sure thing.

Hey, what's up?

I've got a
27-year-old
G3P-zero,

history of cervical
incompetence,

EGA 24 weeks.

Presented in
early labor,

cervical dilation
progressed from
three to six

on terb and mag.

Any fetal distress?

No. It looks good.

Heart rates in the 160s,
good variability.

Can you repeat the terb?

No. We maxed out,
and she's tachy.

Send her up to labor
and delivery, and tell them

to have a pedes
resuscitation team standing by.

If she's progressing
on tocolytics,

there's nothing
we can do.

She's revealing
both her upper

and lower teeth
when she laughs.

What?

Chen. It's a
sign of flirting.

There. Hair touching--

that's another one.

You better get
in there, sport,

before it's too late.

What are you talking about?

I was a cop
25 years.

You learn
body language.

Look at that.

She's mirroring his motion.

20 bucks says
she touches him next.

( laughing )

So what?
She slapped him.

First it's a slap,
then it's a tickle.

Before you know it,
she'll be spanking his ass.

Hey, Jerry, can you call up
to L&D and tell them

to make sure
that they have my...?

I need to find
a fire hydrant.

Hey, that's a cute puppy.
Can I hold it?

You can have it.

43-year-old man
with left flank pain

radiating to the groin.

Denies fever, vomiting.

Exams notable for CVA tenderness
on the left.

Urine heme-positive.

Okay. Diagnosis?

Kidney stones.

What else?

CBC, chem panel,
and CT urogram.

Okay. And give 30
of ketorolac IV push.

No.

No CBC, no chem panel,
and no CT.

You don't even
need a damn IV.

It's expensive
and it takes up nursing time.

Give him 60 of ketorolac IM

and a bedside ultrasound
to rule out hydronephrosis.

But you won't see
where the stone is.

Look, hospital
policy says...

90% of cases

pass on their own.

He's afebrile,
and his UA is negative.

And if it's too
big to pass?

It'll cause hydronephrosis,
and he'll come back.

He still thinks
he's in the Congo.

Get the CT.

You need to take him up.

That's not
how it works.

I come down,
I see, I present.

Yeah, I know how it works.

And I'm telling you
as a surgeon and head of the ER,

you need to take this guy up
to your service.

What do you need me to do,
write you a damn note?

"Dear Dr. Corday, please admit
Abby's patient to your service.

"He's very sick today
and requires an exp lap

before he gets septic and dies."

You hanging in there?

By a thread.

Dr. Lewis,
can you help me?

Sure. Which patient?

Actually,
it's about the doctors.

I'm getting conflicting advice
from Pratt and Kovac.

Welcome to County.

Kovac is the attending.
Pratt isn't.

Abby,

this is Patricia Collins.

Her husband was involved
in the car chase.

Oh, I'm sorry.

Hi. Abby Lockhart.
Hi.

I'm Neela.
Hi.

I worked on your husband.

Would you like to see him?

Yes.

I'll take Mrs. Collins in

while you're waiting
for the UNOS team.

This way, please.

I'm beginning
to hate her.

She's a med student.

I'm a med student.

You know,
now that you mention it,

she's pissing me off, too.

Come on.
Let's hate her together.

Now, the medicine I gave you
hasn't stopped you

from going into labor.

Your contractions are
increasing in frequency,

and your cervix is
continuing to dilate.

My husband had to go
to Seattle for work.

He didn't want to go,

but I said, "Don't worry.
I'll be fine."

I can't believe
I'm having another miscarriage.

No. You're not
miscarrying, Denny.

You're going to
have this baby.

I'm sending you
up to obstetrics.

They're set up to handle
a preemie delivery.

I don't want a preemie.

Our NICU cares for babies
like this all the time.

Yeah, babies with brain damage.

My sister-in-law
had a preemie.

It was sick for months.

They spent every day
in the NICU, and it still died.

This baby has a chance.

I don't want it this way!

Okay.

Okay.

Problem?

She doesn't want
to have the baby.

She's 24 weeks.

What's the weight?

520 grams on the ultrasound.

24 weeks, over
500 grams--

that's the hospital's
viability threshold.

So what? We're
going to spend

half a million
dollars

keeping one
baby alive

while we shut
down the lead

eradication program?

I've admitted three kids
for chelation this week.

Why stamp out
lead poisoning

when you can shoot your wad
on one little gorker

who can enjoy a lifetime
of special ed?

Good thinking, Pratt.

What am I supposed to do?

Mom doesn't want to do anything
to save this baby.

She doesn't
have any rights.

It's not up to Mom.

If it's over 500 grams,

pedes is going
to resuscitate.

Aren't you on
a surgical rotation?

Yup.
Then rotate.

What's this kid's chance
of having a normal life?

10%? Less?

It's hospital policy, Luka.

Then maybe she needs
to change the hospital.

Another
good idea.

Let's send her

to Santa Nina
Muerta Hospital.

It's called natural
selection, Pratt.

You ever heard of it?

It's worked for a
few million years.

So, tell me, what
should I do now?

Hospital policy exists
for a reason.

First learn the rules,
then learn when to break them.

What's in her best interest?

The laceration
is superficial,

and his shoulder
is only bruised,

but, uh, I do have
some concerns

about the
medication he's on.

Zack's had some problems.

Had.

I'm fine now.

I think he may be overmedicated.

Well, they told me
that was for his own good.

I had a drug problem.

I let him run wild.

And then he was always doing
this crazy stuff.

He got into fights.

It's called
self-defense.

He stole a car.

One time.

I'm not doing that
anymore.

They blamed it on me.

They said I was
an unfit mother.

Do you have custody?

Not at the moment.

Has Ben Hollander shown up yet?

Not that I've seen.

Can you look at a possible
scaphoid fracture in Exam Three?

Uh, yeah. Hold
on a second.

Mrs. Collins refused
to donate her husband's organs.

I've heard minority families
seldom agree

to organ donation anyway.

Well, what,
did you just let her leave?

I thought she could sit
with the body

until he went up to the ICU.

I'm looking for Dr. Pratt.

Greg!

There he is.

It's 2003. Who
doesn't have an
answering machine?

He promised me. We had
a therapeutic contract.

Look, I'm sure
he's just running late.

Maybe he stopped
to get a coffee or...

Jump off a bridge?

Hi. Are you
from neonatology?

Yeah. Vargas.
Where's your patient?

Her name is Den...

Hey, Lily,
where's Denny?

I haven't seen her.

Well, can you check
the women's bathrooms

for me, please?

Sure.
Just give me one
second, all right?

I'll find her.

She left.

Who?

My pregnant patient.

Did you talk to her?

No.

Well, she took
your advice.

She eloped.
That was always her prerogative.

( banging on window )

I need a doctor out here!

That doesn't mean

it was the best thing
for her to do.

Hey, you're supposed
to be teaching me here.

I'm trying,
but you're not listening.

Some lady is in
the back of my cab,

and I think she's
bleeding to death.

Denny, what happened?

I tried to make it
to Saint Joe's,

but the baby's coming.

Is she dying?

No. Run inside and tell them

I need a gurney
and a BOA kit. Go!

This was in her best interest?

She wouldn't have left
if you'd done what she asked.

KOVAC:
Type and cross Mom

for four units,
two large-bore IVs

and a liter of
LR running now.

It's too soon.

All right, Denny,
one big push.

( grunts )

Come on. Cord clamp.

It's a boy.

His eyelids are still fused.

Placenta's delivered.

( alarm beeping )

Bleeding's picking up.

Heart rate's in the 130s.

Yeah, uterine atony
from the tocolytics.

Run in another liter
of LR and 20 of pit.

Do we have
a pulse?

Yeah. It's slow,
under 100.

Should I start
compressions?

Bag him up first.

No. You need to
weigh him first

before you do
anything else.

Less than 500
grams, we stop.

All right, draw up some epi
and get ready with the tube.

KOVAC:
Do not tube that baby

until you get a weight.

DENNY:
No, please.

506.

( sighs )

Pratt, she doesn't want this.

I'm following hospital rules.

That doesn't make it right.

This kid is alive.

Systolic's down to 78.

.2 milligrams
of Methergine IM

and rush the blood bank.

Oh, all right, I'm in.

Bag him and give two cc's
of surfactant through the tube.

You got it.

Mrs. Collins, can I
get you anything,

or anyone I can call?

Tom's sister is coming.

She wanted to say good-bye.

( pager beeps )

Sorry.

PRATT:
Umbilical line kit

and a sterile 6 is for Neela.

She's gonna place the UVC.

KOVAC:
We shouldn't be
doing this, Pratt.

She has the right to
demand a natural death.

We have a Family Room,

if you'd like to wait for your
sister-in-law in there.

It's a little more quiet.

I want to stay with him
as long as I can.

Okay.

What's happening?

They're trying to save
a premature baby.

We just started
trying to have kids.

Mrs. Collins,
did Neela talk to you

about recovering
your husband's organs?

I told her I didn't want that.

He's been through enough.

Why? Does he have something

that could help the mom
or her baby?

I don't know.

Maybe.

But there are lots of others
who would benefit.

Tom was always going
out of his way

to do stuff for
other people...

to the point where they
would take advantage of
him, but he didn't care.

I would always tell him,

"Don't you know
nice guys finish last?"

He would always say,

"Guys who finish
last are nice."

He was so stupid.

What would they do...
if he was a donor?

The recovery team
would take him to the ICU,

and they run tests and they
start matching his organs

to people who need them.

Like his kidneys?

Mm-hmm.

Several organs can be recovered.

He could help as many
as 50 different people.

Tom would like that.

What all would they take?

Well, his kidneys,

which would go to two people
with end-stage renal disease,

and that would free them
from a lifetime of dialysis...

Ben Hollander, Susan Lewis.

No, I'm the doctor.
He's my patient.

County General.

Okay, then I'll talk
to the watch commander.

My mom around?

She's in a trauma.

You want to wait
in the Doctor's lounge?

Nah.

You get any freaks
in here today?

You know,
guys with elephant man disease

and axes stuck in their heads?

No.

Should you be looking
at that?

I'm going to become a doctor.

Dollars to donuts
that kid

is already dissecting
the neighborhood pets.

Every time
you put me on hold,

you're increasing the chance
he's in trouble.

Sure.
Hey.

You want to
see a puppy?

Why?

I don't know.
Because she's cute?

Where's the morgue?

Your mom says we aren't allowed
to let you go to the morgue.

I'll give you five bucks.

Does that kid ever
give you the creeps?

He's right at the age
where it starts.

Teen rebellion?

Devil worship.
Keep an eye on that puppy.

You were supposed
to be here hours ago.

Oh, I'm-I'm sorry.

Oh, these, uh, these are...
these are for you.

Sort of a peace offering

to make up, you
know, for my...

my-my tardiness.

You didn't have
to do that.

Well, there's
a guy outside,

you know, selling
them on the street,

so it's, you know,
it's no big deal.

Oh, and I...

I brought you, uh...

I brought you this.

We're not finished
reading it.

Well, I, you know,
I know how it ends.

Lily, can you set Ben up
for a blood draw?

Sure. This way, sir.

That patient
brought you flowers?

And a book.
He's a real Civil War buff.

I've been reading it to him.

He's losing his eyesight.

What? You're going
to his house?

Yeah. The guy was a possible OD
on didge a couple weeks ago.

I'm still not sure
it wasn't attempted suicide.

I just want to make sure
he's re-engaged

before I cut him loose.

This is a first edition.

Sounds like he's
engaged with you.

He has no one.
He's going blind.

He sacrificed everything for his
career and now he has nothing.

No one should end up
like that.

Where the hell is OB?

Paged them three times.

Denny, stay with us here.

EBL 1500cc's.

I'm hitting resistance.

When it bounces back like
that, you're in the liver.

Start over
and thread it again.

Get him upstairs, Pratt.

Kovac, I need to talk to you.

I'm kinda busy here.

What's the holdup
with that kid
from Stanton House?

His caseworker
is threatening
legal action.

Still waiting on a Tegretol
level to come back.

No you're not.
It's back.

He can't go back there, Kerry.

Their treatment program is
basically keeping him so drugged

that he can't
think straight.

BP's up to 98/55.

Good. He's a nice kid.

And you know him better
than the psychiatrist

who's been treating him
for two years?

She's got too many patients
to treat properly.

She also has privileges
in this hospital

and she's on her way
to administer Haldol

because the ER physician
apparently refused.

Everybody's so concerned
about the rules and policy

that they're forgetting
there is a kid caught
in the middle of all this.

Reform the foster
care system on
your own time.

Neela, come
with me.

Discharge
this patient.

Damn it, Kerry!

Take the baby.
Pratt, I need you here.

Somebody call for OB?

Now, that was fast.
Fill her in, Pratt.

Mom just delivered
a 24-weeker

now with severe atony,
EBL 1500cc's.

What's happening?

You're doing good.

It looks worse
than it is.

The tube in his mouth
helps him breathe.

The catheters
in his umbilical cord

give him fluid, nutrition
and medication.

But underneath it all,
he looks good for a 24-weeker.

Really...

Where's Zack?

Zack? Zack?

What did she give him?

Four milligrams Haldol IM.

Just to tide him over
till his PO meds kick in.

I'm sorry.

You never let me finish
telling you about Quinamax.

Now, it's our new
once-a-day antibiotic

with excellent coverage
for bronchitis and otitis media.

Now, I could put together
some packages for you
to take to the Congo.

I've heard
that's a pet project of yours.

Quinamax would be wonderful

for all the important work
you're doing over there.

You want me to take
your overpriced
antibiotic to Africa?

It has great coverage for
pneumococcus and H. flu.

Why hasn't there been a new drug
for malaria in three decades?

That's a really good question.

Because there's no profit
in treating poor people.

My company...

Your company spends
twice as much in marketing

as it does in development,

which is why prescription drug
costs have tripled

in the last ten years.

Get out of here.
I want you out of here.

You know, if this
is a bad time...

Frank, I'm going to go get
some coffee.

Page me if you need me.

Okay, Dr. Kovac, if you could...

You know,
I'll just come back

when you're not so busy.

Everything looks good.

Don't sound
so surprised.

Ben, I really appreciate
the gesture,

but I can't accept this.

Well, you said
you liked it.

I do, but that book
is worth a lot of money.

No, no, my first edition Brontes
are worth a lot of money.

I just think
it's... inappropriate.

I didn't mean
to hurt your feelings.

No, you didn't.

It's just that

you've done
a lot for me,

and you know,
I just wanted

to show my
appreciation.

I certainly never meant to
make you feel uncomfortable.

No, no, you didn't
make me feel uncomf...

It's no big deal.

I can help you
get a ride home

if you can wait a while.

You know, I'll
grab a cab.

Okay, same time next week
for another level.

Thank you for the flowers.

I feel officially lousy.

So, is it "Jing-My"
or "Jing-May"?

I'm getting conflicting
information.

Call me Deb.

Okay. What are you doing
after this, Deb?

You want to grab a beer,
shoot a little pool?

I can't.

I'm taking my parents
to the airport.

We can go out
after we drop them off.

You'll drive my
mother and father
to the airport?

Sure. It'll be good
for some embarrassing
childhood stories.

No, not my parents.

They're a little distant,
bordering on xenophobic.

My dad has six toes.
Just on one foot.

Has anyone seen Alex?

Yeah, he was hanging
around here earlier.

Could you find him
for me, please?

You should use your fireball.

This your first time playing?

Nope.

You want me to show you
how to do the dragon punch?

Nope.

He's going to kill you
with his psychocrusher move.

Told you.

I'm thirsty.

That's a good sign.

Can she have some ice chips?

Let's hold off
for a little while.

You lost a lot of blood
in your delivery.

We had to give you
a transfusion,

but the bleeding's
stopped now.

You're going to be fine.

And we're taking your baby
up to the NICU.

Good.

He's doing better.

Just take him away.

Denny, just...
Please.

Has Abby shown up yet?

OR Four.

Doing what?

I was paging you.

I was with this patient.

So I hear.

( sighing )

You convinced the family
to donate his organs?

Spending this much time
with a patient

is a luxury
we don't usually have.

You missed out on
an interesting volvulus repair.

Well, I just felt like
his wife needed me.

You already
do this well, Abby.

Sometimes being a doctor

is about distancing yourself
from your patient.

You don't have to stay.

I'd like to stick around
if that's okay.

( door closes )

( sighing )

What the hell is this?

A Labrador retriever.

Wrong answer.

Some sort of spaniel--
a terrier?

Who brought it
into the hospital?

Was it Pratt?

I'm sorry,
Dr. Romano.

I did.
She belongs to me.

This isn't
a petting zoo.

She's not a pet.

She's a seeing-eye dog,
aren't you?

Oh, how could you hate
a face this cute?

All right, come on.
Let's go home. Bye.

So, where is my son?

Did you tell him
where the morgue is?

I couldn't find him.

He's across the street
in the new Jumbo Mart.

Got you now.

That's cheating.

I thought you were
good at this game.

SAM:
What the hell are you doing?

My shift ended
an hour ago. Why?

I'm not talking to you.

You cannot
just wander off

without telling me
where you're going.

Did you eat all this?

Where did you
get the money?

He bought it for me.

Do you know
what time it is?

Did you take
your shot? No?

Look at him.

He's hyperglycemic
and ketotic.

Did you not notice anything
strange about his behavior?

He's diabetic.

God, I can smell
it from here.

I thought
he was a street kid.

I didn't know
he was your patient.

He's my son.

Hi. Sorry to bother you.

A-Are you stalking me?

I've got his first x-ray.

His heart and lungs
look good.

He's fighting.

I told you.

Look, Denny, maybe you should
get off your feet for...

I'm just want to stay
here a little while.

He shouldn't
have to die alone.

Was this a bad idea?

Oh, no, no,
I love, I love dogs.

I-I grew up with dogs.

My parents had a cattle farm
outside of Gary.

So, you were a farm boy?

I still would be
if my mother hadn't insisted

on my going to college.

What about your parents?

Want to hold her?
Oh, yeah.

My mom is a secretary.

Was a secretary.

She wanted me to be
a flight attendant.

Really?

Yeah, that
wasn't happening.

She, uh, died
a few years ago.

Oh, I'm, I'm sorry.

What about
your father?

He's still in Chicago.

He's a test pilot
for Barcalounger.

He must be pretty proud of you.

You're, uh,
you're not close?

Not really.

That's a shame.

Yeah.

It, uh, it happens.

I have a daughter
named, named Karen.

Yeah?

Yeah, I haven't...

I haven't talked
to her in years.

You should try to reconnect.

No, it's not,
not going to happen.

You should call her.

No, she, uh,
she blames me for things

when... when my wife died.

I didn't see that
coming, either.

Your wife died suddenly?

No, no, not really.

She, she had cancer.

She fought it
for a long time,

but we both knew she wasn't...
she wasn't going to beat it.

Still, I just,
I never expected it

to end that way, you know.

I just had trouble...
I had a hard time

accepting the...
finality of it, of it all.

Yeah.

340.

I didn't know
he had diabetes.

He's a kid.
You're an adult.

You're supposed
to be a doctor.

You didn't notice
he was acting weird?

Lots of kids
his age are weird.

What are you doing
playing video games

with a nine-year-old,
anyway?

You gave him ice cream, candy...
What's up with that?

Can I discharge
Mrs. Fionelli?

Find another attending.
I'm off.

Oh, all right.

Her pelvic sonogram
results came back.

She's got an
ovarian cyst,

so I was just going to put
her on a non-steroidal.

She had
an abdominal CT scan?

We were thinking
diverticulitis.

Flip over your chart.

What?

On the back
of your chart,

there's a price list
of all tests and labs.

You ordered a CBC--
that's what?

$140.

A chem panel and UA?

$350 and $90.

What else?

GC and chlamydia
cultures-- $300.

IV start and a liter
of saline-- at least $200.

Morphine's another $50.

Abdomen and pelvic CT,
$3,000 easy.

Did I miss anything?

Pelvic ultrasound--
$750.

$4,880.

You could have done
a negative urine ICON

to rule out ectopic
for 15 bucks,

performed
a thorough physical exam

and treated her
with a $2 dose of ibuprofen.

And this is why
we can't provide

health care
for everyone.

Hey, where's Logan?

Rule out subarachnoid?

She was in Curtain Two.

Dr. Kovac discharged her.

Oh, Neurology
finally came down?

Nope. I did an LP
about four hours ago.

You did what?

She'd been waiting all day.

Her fluid was clear--

no blood, no xanthochromia,
no subarachnoid.

A spinal tap is the quickest

and easiest way
to rule out an SAH,

and it's 100% sensitive.

She was my patient.

Yes,

and if I hadn't treated her,
she'd still be here.

Now she's at home
and feeling better.

Oh, so, that's it?

This is how
I'm supposed to learn?

Either I do it your way,

or you take it
away from me?

Pratt,
I'm trying to teach you

that the way you practice
medicine here is inefficient.

Oh, and letting babies die is?

You really think you
saved that kid today?

For what--

24-hour nursing care?

He's going to
probably require

a lifetime
of commitment.

Are you going to be around
to give it to him?

Listen, I'm sorry
I'm not in some mud hut

doing amputations
with a pocketknife.

We have the technology
and the expertise

to give that kid
a chance.

What's the sense of having it
if we don't use it?

That kid has about a
five percent chance

of having a normal life.

Do you have any idea
how many other kids

we could have treated
with those resources?

I do everything that I can
for my patients.

That's how I practice medicine.

This is Chicago,
not the damn Congo.

Maybe you should
just go back to Africa.

Maybe you should go to Africa.

I know you didn't
just say that to me.

Maybe then you'd learn
there's more to being a doctor

than ordering tests
and calling consults

for every patient
just to cover your ass.

Stay away from my patients.

From now on I'll present
to another attending.

You can just take
big bites, you know.

The mortician will
do what he can.

I need the practice.

All right, well,
take your time.

He's not going anywhere.

PATRICIA:
What all will they take?

LOCKHART:
His kidneys,

which would go to two people
with end-stage renal disease,

and that would free them
from a lifetime of dialysis.

His heart and lungs could go
to as many as three people

with cardiac
and pulmonary disease.

His pancreas and intestines
would go

to children as
well as adults.

His corneas

would allow two people
to see again.

His skin, bones
and other tissue

will help treat burn victims.

And his liver will be split
into multiple transplants

and used for children with birth
defects that used to be fatal.