ER (1994–2009): Season 11, Episode 12 - The Providers - full transcript

Previously, on ER:

I understand you want
to define yourself as chief...

But?
Is this the way
you want to do it?

I suck!

Nah, you don't suck.

You're...
you're still learning.

LEWIS:
So, how are you doing?

I've processed all of
my feelings of anger,

shame and guilt in an
emotionally safe environment.

I've addressed
the urge to use alcohol.

Oh, and I've consulted both



a shaman and a guru,
so really, I'm all good.

I must've really made
an impression on you--

you didn't even
notice I was gone for a week.

Are you high?

SAM:
Alex, hurry up!

The bus is gonna
be here!

What time do you start?

Noon.

Is Neela on today?

Hmm?

Is Neela on?

I don't know.

I think she is.

Funny how that
keeps working out.



What?

Nothing.

Come on, she's young,
single, lonely.

She's got a crush on you.

I'm her teacher,
she's just trying to learn.

Yeah, I'll bet she is.

Aw, come on.

What, everyone
can see it.

Who's everyone?

Uh, Pratt, Frank,

Jerry, Morris,
Chuny, Haleh.

Even Murray.

Murray?

Yeah, the guy who works
at the roach coach.

It's not
funny, Luka,

and you're doing everything
to encourage it.

Mm. That's not true.

Yeah, well,
it better not be.

Or else I'm going to have
to get into some...

nasty chick fight
with Neela.

In the mud?
Just don't hurt her.

The only person who's going
to get hurt around here is you.

You got it?

Yeah, I think it was April.

But the fact that I need
a calendar to figure it out

is not a good sign.

Did I meet him?

No.

He drove
a motorcycle.

That was his defining
characteristic?

I'm afraid so.

What about you?

Third year, my gross
anatomy instructor.

He was very skilled

at prossecting
the brachial plexus.

You slept with
your instructor?

Dr. Gibson had a very
tender way with cadavers.

And you called
him "Dr. Gibson"?

Only in bed.

So basically,
neither one of us

has got any in
a ridiculously long time.

Well, at least we have work
to keep our minds off...

Men. Romance. Sex.

Yeah, at least
we have that.

KOVAC:
Morning.

Hello, Luka.

Dr. Kovac.

Uh, multiple MVA
on their way in.

Patient satisfaction scores.

We're up .6 points
from two weeks ago.

Is that good?

Yeah, it's good.
Very good.

I'm going to post it.

Um, Carter, I want
to thank you.

I know that my taking over
as chief has been stressful,

and it's been a little
weird for you,

but you've made
the transition a lot easier

and I really appreciate it.

Susan, I can't think of anybody

I'd rather
have as a boss than you.

16-year-old driver

backed into a utility pole.

Okay, hop to.

And don't call me Susan at work.

What happened?

Dad was teaching her
to parallel park.

She just got her
learner's permit.

I got a little bit dizzy.

Maybe I got the pedals mixed up.

CARTER:
Uh-huh.

NEELA:
New scores?

Yep, we don't suck
as bad as we used to.

And maybe by next week
we'll suck a little less.

Must be your
motivational speeches.

We're pairing attendings
with interns.

Abby, you got me.
Neela, you got Kovac.

What?

Yeah, big Croatian guy.
You can't miss him.

We've got a double MVC
rolling in.

Abby, he's all
yours today.

Who?
Hey.

You guys know each
other, right?

Hi.

You know how to clear
a c-spine clinically?

Uh, you mean if it's not tender?

That's a no.

Check the Nexus criteria,

get back
to me tomorrow.

I give you Rodney Dixon
and Amanda Field.

Rear-ended by a truck

while having sex
in his car.

Good vitals
on both.

NEELA:
I'd say.

They stuck together
with super glue?

We tried to disengage
them at the scene, but...

Oh, it's killing me, man.

Broken pelvis plus
uncontrollable lust equals...

( groaning )

NEELA:
Chest is clear, belly's benign.

JAKE:
Backseat
of a car, huh?

'66 Mustang Fastback.

I hope it's not totaled.

Fastback? That's
a pretty tight squeeze.

I do Pilates.

It's got a 389 to one rear
gear with a 31 spline axle.

Nice.

You were screwing in
the back of an old Ford?

What were
we supposed to do?

My husband was home.

Oh, God!

Probably a small crack
in the pelvis.

You've got this, right?

Oh, I'm all over it.

We'll give
you some morphine

and wait for
your Viagra to wear off.

Dr. Lewis told me
to present to you today.

She did?

Something about interns having
a primary attending.

Okay.

I hope you'll show me

that combat procedure
you mentioned last shift.

The femoral tear?

Oh, depends on, uh,
whether we get a patient

who needs
emergent central access.

Well, whenever we do.

Uh...

Sorry.

Uh...

Infected anal fissure,
parked in the hallway.

Okay.

Pupils four millimeters
and reactive.

Ten centimeters JVD.

My wife is not
gonna be happy.

It's okay, Dad.
It was my idea.

Take it Mom wasn't aware
of the driving lessons?

If she had it her way, I'd never
be let out of the house.

We're kind of separated for now.

Katie was with me this week.

She take any
medications?

Prednisone,

Tacrilomus...

The anti-rejection drug?

She had a kidney
transplant last year.

I have polycystic
kidney disease.

We were on
the UNOS list

for seven years
waiting for a donor.

I'm a big fan of dialysis.

She's got blood
type O with an 80%

reactive antibody panel.

Tough match.

Yeah, well, finally
got big enough

that I could
give her one of mine.

Your kidney?

What a dad, huh?

Any other meds?

Uh, yeah, she's on an
anti-seizure drug, too.

The PKD gave her
an aneurysm.

Mom's on the way, sweetie.

Thanks.

Okay, a few crackles
at the base.

Bradycardic at 48.

Whoa, peaked T waves,
widened QRS.

Amp of bicarb,
10 cc's of calcium gluconate.

What do you think's going on?

Um, well, low heart
rate, dizziness,

and the EKG changes--
could be hyperkalemia.

What?

No, no, no, that
can't be that.

KOVAC:
Hey, John?

Since the transplant,
her kidney has been fine.

Why don't we wait and see

what the blood tests show and
then we'll take it from there.

Excuse me
for one second.

Do you need
an intern on this?

I got Ray.

Uh, what do you think about
taking Neela instead?

Why, is there a problem?

Just do me a favor, okay?

All right.

Send the Punjabi Powerhouse
my way.

Painless jaundice
in Three

and ulnar styloid
fracture.

I'll take those.

Uh, there was

a little change--
you're with Carter today.

I thought I was with you?

No, he needs you in Trauma One.

Isolated pubic
ramus fracture.

Will I be, you know...
all right?

No cast, no surgery,
just rest and pain meds.

But you're going
to have to be careful

for a couple of weeks
until it heals.

Careful?

Yes, as in "abstinent."

The safest sex of all.

Abstinent? Are you serious?

You can't put any
pressure on your pelvis

or you're going
to end up right back here,

which is not
what we want to see.

So it's the pelvis
we should worry about?

That's right.

But other positions...?

Yeah, sure,
get yourself

a six-pack,
a copy of the Kama Sutra

and shoot out the lights.

Did we do something
to offend her?

Pulse is up to 61,
B.P.'s stable.

Looks like the QRS
complexes are narrowing.

That's good.
That is good.

Lab says the chemistry
machine is down,

it should be up in an hour.

So you can't say yet
if it's a kidney problem?

The urine dip shows
four plus protein,

but we really
won't know anything

until the labs
come back.

I told them to hurry.

Honey, are you okay?

I'm fine, Mom.
It was nothing.

I told you it was too
soon for her to drive.
What were you thinking?

She's 16. She wants
a learner's permit.

You never know when
to stop, do you?

Mom, please.
Let's not do this here.

I need more of Katie's
family history.

Can we all step outside and
give Katie a chance to rest?

I'll be back,
okay, sweetie?

I've been sick for so long,

it just got to be
too much for them.

GABRIEL:
She was on dilantin
for a long time, but, uh,

she didn't like it.

It changed the way she looked.

And she was still having these

breakthrough seizures
once a month.

It was manageable.

No, honey, she had them
at school, in the movies...

She hated it.

So you switched her medication?

Three months ago,
we put her on Zarictal.

It was not my choice.

Zarictal?

Uh, it's new.
And we can't
afford it.

Medicare does
not cover it.

I took a second job
working night security

over at the Maller's
Building.

We lost
our apartment.

She's been doing great.

Katie has been seizure-free
for three months.

No infections,
no febrile illnesses?

Have they switched her
dosage of, uh, Zarictal?

Everything's been steady.

She was doing
fine before.

I don't know why...

She wanted to drive.

Like other kids.

And with the seizures
she couldn't get a license.

We almost
lost her once,

and you're worried about
her being able to drive?

I'm sorry. I'm sorry.

Look, I don't
want to fight, okay?

I just think it's time
that we accept that fact

that she will never
be totally healthy.

Why? Why should I accept that?
Because that
is the reality.

Not for me.

( sighs )

You have a neurologist?

Yeah, he's been great.

Good. Why don't we
give him a call?

I'd like to talk to him
about the medications.

Sounds like
a hard situation.

I want you to look up this
new drug for me-- Zarictal.

Oh, yeah, I had
a patient on that

last year during my
Internal Medicine rotation.

Really? I never
heard of it before.

Well, it's pretty new.

Expensive, but very
effective for seizure control.

You kids and your
fancy book-learning.

I try to keep up.

Do a PDR and
check a medline.

See if there's anything
about renal dysfunction

associated with the drug.

Hi.
Hi.

This is
George Guidry.

He's got a skin
breakdown

around the shaft
of his penis.

No he doesn't.

I think I do.

Any discharge?

Oh, yeah, definitely.

I'm not talking about that.

No discharge, no fever,
no blisters.

Do you use a condom?

Not since my girlfriend

broke up with me
a few months back.

No vesicles, no chancre,
no lymphadenopathy.

Okay.
Let's take a gander.

You know, I just thought
of something.

Could this be from too much...

You know.

Too much what?

Since Lily left,

I've been lonely,
you know?

Really,
really lonely.

How lonely?

Oh, six, sometimes
seven times a day.

I found a case report

in the Western
Journal of Medicine.

It suggests
a correlation between

renal failure
and Zarictal.

Mm, well, that ain't much.

No, but these might be.

From the Adverse Drug
Coordinator

from the Department
of Health Services.

Three more possible cases
they've forwarded to the FDA.

Four, that could
be a pattern.

The physician relations number

at the Keating-Ward
Pharmaceuticals.

They make Zarictal.

Might as well see
what they can tell us.

Yes.

Hi, this is John Carter.

I'm a physician at
County General in Chicago.

Very well, thank you.

I have
a 16-year-old girl,

status post
renal transplant,

who's been on Zarictal
for three months.

Yes, and I was wondering
if I could talk to somebody

about the incidence
of renal failure.

Yes, I will hold.

( muzak plays )

Does anybody even
listen to that music?

It's terrible.

Carter, GRS is widening
on our PKD girl.

Lots of ectopy.
I'll hold.

Multifocal PVC's,
runs of six.

Push 80 of lidocaine

and mix up a drip
at one mig a minute.

What's going on?

It's possible that
the elevated potassium

is irritating
Katie's heart.

B.U.N. 98, creatinine 12.3,

potassium 7.2.

Sounds like she might
be in kidney failure.

V fib.
Starting compressions.

CARTER:
Okay, charge
the paddles to 200.

She's all right.
It's going to be okay.

I need
everybody clear.

( gasps )

Procainamide's on board.

And clear.

Sinus.
There we go.

All right, set me up
for a femoral Quinton

and call dialysis
for renal orders.

Katie, honey.
Katie, honey.

Yeah, she's responding.

JARVIK:
O2 at 15 liters.

Are you sure
she needs dialysis?

CARTER:
It's the best way

to remove the excess potassium
from her system.

Does that mean she has
to have another transplant?

CARTER:
Uh, that is a distinct
possibility, yes.

Okay, betadine
in the area?

NEELA:
They said they'd be
in contact within a week.

CARTER:
And one per cent lido.

A week?

NEELA:
That's the
standard procedure.

GABRIEL:
What's that?

We telephoned the company

that makes Katie's
seizure medication.

So is it the drugs?

Is that why this
is happening?

The timing
of the med switch

makes me think
it's a possibility, yes.

HANNAH:
So, you mean her kidney's

being damaged
by the Zarictal is it?

Gabriel, Hannah...

I came as soon as I heard.

Is she in status?

No, It's her kidney.

This is Katie's
neurologist,
George Henry.

Dr. Carter, I don't know
if you remember me...

Yeah, how are you,
Henry?

What has it been,
six years?

Give or take.

Can you take them
to the family room?

I'll be right in
to see you in a sec.

Oh, okay.
Yeah, that's fine.

I think I remember the way.

Come on,
it's all right.

JAKE:
I gave pleasure boy

some Neosporin,
the number for a therapist

and sent him packing.

Well done.

How about you?

Everything all right?

Um, yes,
I'm fine. Busy.

Why?

Well, last week,
when I ran into you
on the El platform,

I didn't realize
your situation.

My situation?

It's just that I...

I heard what you
went through last week

and I didn't want you to think
I was insensitive.

Uh, no...

I was happy not
to have to talk
about it actually.

Okay. I guess I'm blowing
that now.

I just...

I want to make sure that there
isn't anything that I can do.

Um, well, that's...
that's nice.

It is. Thank you.
It's, um...

Here's "H" and "P"
and get back to me.

Right.

Why did you put me
with this guy?

When did everybody become
such schedule divas?

Well, I don't need
a med student.

I don't like them
very much

and I'm just better
flying solo.

Is there something wrong
with him?

No, he's excellent.
He's-he's very good.

He's excellent.
I just...

Oh, no,
you like him, don't you?

Okay, you know,
forget it.

Oh, yes, you do,
you do!

You're blushing.

We never had
this conversation.

Hey, haven't you had
enough of doctors?!

Post a message on
the Neurology
and Renal news groups.

Find out if anybody
else has anything

on the drug's renal
toxicity.

That could cause
a bit of a stir.

Yeah... all right.

Just ask
for any information

that might help us best
determine the course
of treatment.

HANNAH:
You heard what he said.

I know. I don't
believe it's the drug.

I think there are
other options...

We have a dialysis tech
coming down

and I called UNOS.

They're going to put Katie
on the list for a new kidney.

John,
that may be premature.

Why don't we do
a biopsy?

This may be a case of
rejection, not failure

and a biopsy
would show us that.

What's the difference?

Well, a drug-induced
failure would require
a transplant.

But, uh, rejection...

Rejection could be reversed
with immunosuppressive agents.

Well, let's do the biopsy.

Okay, I'll put that in motion.

Dr. Henry, can I have a word
with you outside, please?

Excuse me
one second.

Um...

My intern's been doing
a little research.

She's found four cases
of renal failure

in patients on Zarictal.

That doesn't
prove causation.

No, but it gets you
going that way.

Keating-Ward sponsored
a series of Phase Three
clinical trials.

If there was any real risk,

the FDA would never
have approved the drug.

( chuckles )

What, you never heard
of Vioxx or Rezulin?

This is a very successful
anti-seizure medicine.

It has improved Katie's
quality of life
dramatically.

Dr. Carter,
dialysis is here.

All right, will you page Dubenko
to come down for the biopsy?

Sure. These need
your signature.

Well, I hope you're right.

Well, let's
be certain.

You know, John,
I was really surprised

to find you
still working here.

Why is that?

I don't know.

I guess I thought
you would have
moved on by now.

I guess I'm just a masochist

that way.

How about you?

I thought you went
to go do, uh...
bench research.

Yeah, well, I got tired
of it.

You were good at it.

I've got a wife and
two small children now.

That changes
one's priorities.

You mean money?

Yeah, well, my practice
does offer me

three times the salary
of an academic position.

What about you,
huh?

Married?

Children?

Not yet.

Thanks.

I'll find you when
the surgeon comes down.

Are you moonlighting
as a word processor?

Our PKD girl
is on a new drug,

we're trying to get
information on.

Hey, Sam.
Hey, Dr. Lewis.

Morning.

Hi.

Has anyone seen...?

Is that your coffee?

Sorry.

It's the nursing schedule,
not a cocktail napkin.

BARDELLI:
GCS 12, B.P. 60
palp, brady at 52.

KOVAC:
He fell from the roof?

Taking down
his Christmas lights.

He's gonna need
central access.

Need some help?
Yeah, come on down.

Carter doesn't
need you?

Not at the moment, no.

Okay, prime
the rapid infuser.

Can't find a vein,
he's too clamped down.

Pressure only 50.

Heart rate's 42.

Blood in the belly.

He needs access.
He's about to arrest.

Okay, set up for
a saphenous cutdown.

Wouldn't a femoral
be easier to find?
And faster.

It's probably
the same difference,

but okay, femoral tear.

Cool, I've never
done one before.

You'll do the next one.

Scalpel to Neela.
What?

She's along
for the ride.

I promised her.

You promised her?

Ten centimeters vertical slash.

Starting here?

Deep into the sub-Q.

Level one is primed.

Okay, and now you tear...

Whoa.

Got any sterile
surgical markers?

There's the femoral vein.

Cannulate it

with the nine french.

Let me try.

No, I'll get it.

Just reach under.

Neela, focus on the field.

Seldinger technique.

You know what to do.

Two units
ready to go.

Sam, can you ask Dubenko to
come here when he's done?

Yes, sir, Dr. Kovac.

That's the lower lobe of
the kidney, right there.

Mm-hmm,
mark the depth.

Purple okay?

It's my favorite color.

Me, too.

Three centimeters.

They need you next door.

What is this gonna do?

It will tell us if your body
is rejecting the kidney.

Lidocaine.

That's a good thing, honey.

All right, hold still.

Little pinprick here.

There you go.

It would be, like,
20-something

before I can get another one.

No, that's not
gonna happen.

Biopsy gun.

You just need to tell
your immune system

to stop being so picky.

Firing.

( muffled pop )
Dr. Carter,

Dr. Weaver's on
the phone for you.

She sounds kind of...

Kind of what?

Weaver-like.

Um, I'll call her back.

Purple, huh?

I've always been partial
to azure myself.

What's azure?

Like your eyes.

Send that off for
light microscopy,

EM and IF staining.

Pack the wound
with moist gauze.

What do we have here?

Belly bleed needs
a post-op head CT.

And we have FFP thawing.

Send it upstairs.

Pressure's up to 100 systolic,
heart rate's 90.

Dr. Kovac, I, uh...

I never knew it was possible
to transfuse that fast.

Well, that's the beauty of
the central venous cutdown.

Now you know how to do it.

So what made you
recommend Zarictal?

I went to a luncheon
at Northwestern

and I heard a
neurologist present
on the drug's efficacy.

A neurologist
who was probably

a paid consultant
of Keating-Ward.

George.
So what?

Dr. Carter.
It stopped
the seizures.

Is everything all right?

Um... if the biopsy doesn't
give us what we want,

if she needs another kidney...

could I give her my other one?

That would require you
being on dialysis

for the rest of your life.

No, I understand that.

I don't know
that it's even ethical

for someone to donate
their only remaining kidney.

So it's not possible?

I just don't know
of any responsible doctor

that would agree to do it.

Gabe, listen, I...

I know that you're scared.

But let's just take this
one step at a time,

okay?

Okay.

Why don't you go in there
and be with Katie.

JARVIK:
Carter,

some neurologist in Skokie
sent this fax for you.

Thanks.

It's a "Dear Doctor" letter
from the pharmaceutical company.

It says that there have
been isolated cases

of renal failure
on Zarictal.

Yes, I know.

And it recommends
monthly monitoring

of renal function,

which I've been doing
with Katie.

BUN, creatinine.

You got one of these?

Yes, and so did you.

Those letters
were sent out

to every physician
in the country.

They're sent as a caution.

So you knew about this?

Private practitioners
get letters like that

all the time.

I followed
it's recommendations.

But you know what
the biopsy's going to show,

'cause it says so
right here.

Well, I'm hoping
that's not the case.

Dr. Carter,
do you have a moment?

Is there a problem?
No, Kerry, just...

You posted a warning
about Zarictal

on an Internet
message board?

I posted a request
for some information.

I'm getting a lot
of phone calls, John.

I hate getting phone calls.

Two neurologists,
our own head of nephrology,

the regional director
from KW Pharmaceuticals.

I'm just wanted to
be better informed
on a patient.

By jumping to conclusions
based on skimpy evidence?

Whoa. Tell it
to the Milners.

They're gonna need
a new kidney for
their daughter.

You have one sick girl,
that's unfortunate.

The FDA and
the drug companies

have access
to thousands of patients

before they release
a drug to the public.

They didn't use any
renal patients

when they did
their clinical trial.

They can't document
every side effect,
it's not feasible.

You're working
beyond the limits
Are you telling me

of your responsibility.
how to do my job?!

Are you telling me
how to do my job?!

I'm telling you,

Please.
the FDA has an adverse
drug event division...

Which is run by
political appointees...

whose job it is to monitor
these kinds of things...
Please, please, please.

funded by the
drug companies.

...the number one
lobbyist in the country

is the pharmaceutical
industry.
Come here.

Come on.

Pick up a bottle.

Kerry...
Do it.

Pravastatin.

Saves millions from
heart attacks and strokes.

Enoxaparin.
You know what this is?

Yes, I do, it offers
better PE prohylaxis

and allows DVT patients

to be treated
at home.

Linezolid.

Fights off strains of MRSA
that used to be fatal.

Kerry,
I think he gets it.

Does he?
Yeah, he does.

These drugs save lives.

And the companies
that make them

donate over
$20 million in grants

to County's
academic programs.

Without that, we wouldn't
have a hospital.

We'd be standing in
a mini-mall right now.

Oh, so that makes it okay

to suppress
negative test results?

Even at the risk of lives
like that little girl's?

WEAVER:
Putting these
drugs out here

and seeing how they
work is how we learn.

It's how medicine advances.

And that's not naive?

Your job is to take care
of your patients,

not start a crusade.

Susan, you're the boss.

Tell him to keep
his eye on the ball.

No more computer access for you.

It's like I forgot where I was.

I was just looking at him
like he was a huge...

cupcake.

You want one?

Ah, it's just
a metaphor, thanks.

So you have a crush
on Luka?

That's kinda weird.

It's just a crush.

Crushes are by nature
idealized, unrealistic...

What about
Dr. Gibson?

That sounded real,
gross, but real.

My God, you're right.

It's a pattern.

I'm a slut
for authority.

Stop it.

Well, what about you?

What about me?

I heard you punched
your med student.

So? He was bugging me.

So you're hung up
on a subordinate.

No, I'm not.

I have a thing
for a supervisor.

Oh, so what?

I'm like the yin
to your yang?

What are we gonna do?

Ignore it and hope
it goes away.

Right.
No need to discuss it.

No. Denial works.

Hey, Sam, dog bite in three.
I wrote for unasyn.

Put it in the rack
and I'll get to it.

Sam, did you check
on my biopsy results yet?

Oh, yeah. Dubenko's
will be on his way down.

What about my patient
in exam two?

I'm waiting
on a repeat CBC.

Sam?

Done and sent.

Nice seeing you all.

Isometric vacuolization
of the renal tubular cells

consistent
with drug toxicity.

So there's no chance
that this is rejection?

No tubulitis, no edema,
no inflammation.

The girl needs
a new kidney.

And it's from
the new drug?

I'd say so, but, I, um,

I don't want
to encourage you.

Encourage me?

Some of my
colleagues upstairs
were suggesting

that you've been all over
the Internet with this.

Just trying
to be thorough.

Word of friendly advice?

Don't piss off
the money people.

Hi, everybody.

Katie's biopsy results
and unfortunately,

they are not
what we had hoped for.

So it's not rejection?

No. No,
it's irreversibly damaged.

( sighs )

And is this, is this
from the Zarictal?

It could be from
the Tacrolimus

she's been on
since the transplant.

I doubt that.

Her levels have been therapeutic
for two years.

Wow. So, this, uh, this, uh,

uh, drug that I've been working
two jobs to pay for

just to make her life better

has ruined
her donated kidney?

I'm afraid so.

You told me...

You told us
it was working.

Sometimes drug interaction
can only become apparent

after the first year
or two of release.

This couldn't have
been anticipated.

So we're, we're back
to waiting?

UNOS will prioritize
her for a new kidney.

That'll take what, three, four
years, if we're lucky.

Okay,
in the meantime,

what I'd recommend is that
we get a surgeon down here

to see her about creating
a forearm shunt

to facilitate
dialysis access.

We can take care
of that.

So we're back
to where we started.

She'll be on that dialysis
machine all through high school,

through college?

Well, just because it took
a while to get the kidney...

No, It didn't take

"a while."
There wasn't one.

I gave her mine.

( sniffles )

We have given up a lot.

Made a lot of sacrifices.

( sobbing )

You told me
this drug was worth it.

Okay,

uh, show me your incision.

Fifth ICS, anterior
axillary line.

Go for it.

SAM:
Pulse ox is 92
on five liters.

Push that in
just superior
to the rib.

Okay,

spread the clamp.

Sats coming up.

And slip your finger
into the pleural space.

Uh, I lost the tract.

Okay, keep your finger in there,
just guide the tube.

I'm above the rib,
but it won't pass.

There you go.

Okay.

That is where you
want to go.

All right, I got it.

Okay.

Keep advancing.

A little bit deeper,

'cause you want
all the ports

in the pleural space.

Thoroseal's ready.

So is suction.

That's very good.

Hello?

Uh, okay, sew it in.

( air pumping )

Somebody put something
in the water today?

Call it "pulseless
electrical activity
following trauma."

Right.

Change "blade"
into "scalpel."

Don't say "torn."

Say "dissected."

Call it the
"field of exposure."

You left out the size
of the cordis.

Nine french.

Okay, write it down.

And not "blood."

"Packed red cells."

Okay, good job.

Just make the changes
and I'll cosign.

Okay.

Hey, Neela,

I hope I didn't give you
the wrong impression.

You're a resident,
and I'm an attending.

I mean, I want
to help you learn...

Yeah, I-I got it.

I understand. I'm sorry.

It's just, I wouldn't want
anything to get in the way...

I got it, I got it,
I got it. Thanks.

Vitals are stable.

I need to grab
an amp of bicarb.

Okay.

Katie's T-waves
are back to normal

which means her
potassium has
come down.

That's good.

He went to work.

Mr. Milner?

Mm-hmm.

He took
a second job

as a security guard
over at the Jewelry Center

just to try to help pay
for everything, you know?

Nothing means more to him
than Katie getting well.

Nothing.

Her illness
just changed him.

It ruined our marriage.

It's important
to stay optimistic.

( scoffs )

A lot of good things
could still happen,
Mrs. Milner.

MVC with passenger space
intrusion, ETA seven.

Okay, we'll take it.

What's MVC?

"Motor Vehicle Collision."

Another new protocol.

No such thing as an accident.

I liked "MVA."

I like walks
in the springtime.

John, a minute, please?

I'll catch up to you.

Um, I was aware
of the potential
for toxicity,

but it was only one
case report

in an obscure journal.

Well, you could have
found out more than that

doing a simple medline search.

I can't do a medline
search every time

I put a patient
on a new drug.

Besides, I've got 20
patients on Zarictal.

They're all doing well.

20?!
Yes.

What, are you on
the Keating-Ward payroll?

Listen, as part
of an ongoing study,

I send in a monthly update
on each patient's progress.

And they compensate you?

A small stipend
for my time.

Oh-ho.

Hope your medical
malpractice premiums
are paid in full.

No, there's nothing
wrong with it.

I am reimbursed
for helping to
monitor a new drug

by doing thorough
patient evaluations.

But the company will only
pay attention to it

if it says exactly what
they want it to say.

Her seizures stopped.
She was very happy.

The father was thrilled.

Yeah? He's real
thrilled now.

Listen, I am trying to be
a cutting-edge clinician.

Guys?

That's what
the patients want.

I have to offer them
the most efficacious
meds on the market.

That problem is
that last part,
isn't it?

Yo?

What?

( clears throat )

Mr. Milner?

Hey.
Hey.

Uh... ( clears throat )

I was...

I was going to work
and I thought, "Why?"

Whoa!
Whoa!

What is the point now?

Um, Gabe, p-put the gun away.

I put everything
in your hands.

Everything.

And you let her down.

Katie can still live a long,
productive life on dialysis.

CARTER:
Okay, whoa,
whoa, whoa.

Huh?

Why, why, why shouldn't I?

Why shouldn't I?

You know what
we should do right now?

Let's go inside and
see your family.

Come on.

Let's go inside

and we'll see
your family right now.

I want to give my kidney to her.

Okay.

Hey, maybe I was wrong
about that.

Maybe you can be the donor.

You're lying.

I know you're lying.

Fix her, okay?

Yeah.

For me.

Yeah, we're gonna fix her.

( all gasp )

Sats are down to 88.
Can you see the cords?

Lots of blood.

All right, somebody
go find his wife.

Okay, tube.

And get that girl
out of here.

Come on, let's move her
to another room.

Grey matter covers
the occiput.

Why the hell would
he do this?

He was distraught.

Pupils fixed
and dilated.

Pressure's only 80/60.

Start dopamine at 10 mikes.

RASGOTRA:
No gag when I tubed him.

DUBENKO:
No corneal reflex.

Can he regain any function?

No, he's as brain
dead as they come.

I'll go talk to her.

No, no, no,
wait, wait.

Let me.

I'm the family's doctor.

Transplant
coordinator's down.

( cries ):
No! No!

I'm so sorry.

No!
I'm very sorry.

( crying )

HERNANDEZ:
Technically,

there's nobody else
who can give consent.

The girl has a very rare
tissue type, Amparo.

The father is a match.

I've made that
clear to UNOS.

Look, I'm trying to
get them to allow us
to proceed.

For now, keep him on
an FIO2 of a hundred.

And make sure
the girl's NPO

in the hope that
she goes to the O.R.

Just do everything
that you can, okay?
I will.

WEAVER:
Go climb back under
your rock.

Hey, I'm from the Trib.
It's a good paper.

Yeah, right.
You guys endorsed Bush.

Man, a guy shoots himself
in the ambulance bay.

What's next, a plague of frogs?

There's a small gang
of press outside.

Someone from the ER
has to go talk to them,

get them the hell
out of here.

Well, obviously, the guy
was clinically depressed.

All we know is he's
in critical condition.

We can't go into
any details.

( sighs )

Heartfelt sympathy
to the family,

we're doing
everything we can.

You're good
with that, right?

You want me
to talk to them?

You treated
these people.

Just play up the fact
that we're respecting

the family's privacy,
okay?

MAP's only 90.

Can we go up
on the dopamine?

We're maxed out.
I got a P.R.N. for levophed.

Sounds good.

Maybe we need to talk?

Nah, we really don't.

It's just, he helped
me to adjust

coming back to work here.

He made things
a lot easier.

And I guess...

I don't know,
I got confused.

I get confused
every time I look at him.

Did you work on this family?

His daughter, yeah.

I'm sorry.

Levophed's going
at two mikes.

REPORTER:
Does Gabriel Milner

have a daughter being
treated in ER?

( clears throat ):
Yes, he does.

Now, is it true
that she's suffering
from kidney failure?

Uh, I can't say.
REPORTER 2:
Didn't you indicate

that earlier today
on a medical website?

No, I made some general
informational queries...
Abby.

that I can't discuss
the specifics.

Hey.
Hi.

Do you want to go get
something to eat?

I know this awesome
little Ethiopian place.

They make you eat
with your hands,

but I got sterile gloves
in my bag so it's okay.

Dinner...?

Yeah.

No.

But don't take it
personally.

( chuckling )

Okay. Uh...

I'm not really
a subtle guy.

But I was under
the impression

that there's sort of
a thing happening here.

Maybe not a big thing,
but still... a thing.

A thing?

Um... Yeah, yeah,
maybe there's a thing.

But you know what?
It's not...

Nothing's gonna happen.

Why is that?

Well, a lot of reasons,

most of which I won't mention
because I don't feel like

sharing my checkered past
with you...

Why?

or my various neuroses.

But there's one
really big reason

that's a deal breaker
for me.

You miss the beard?

No.

You're my student.

Ah...

I'm grading you.

Uh-huh.

Well, I think that that
is not appropriate.

And have a good night.

You know, um...

what if I was willing
to take an "F" right now?

I forgot to mention to you

that I'm dropping out
of med school.

Yeah, who wants to be
a doctor anyway?

( chuckles )

REPORTER:
Don't you think
it's incumbent upon you

to share the information about
possible fatal side effects

of a popular new drug?

Katie Milner was on Zarictal
for the three months.

And, yes, I believe the drug
ruined her kidney.

"Out of respect for the family,
that's all I can say."

Is that so hard?

They knew it all
already anyway.

No, they didn't.

What you're alleging
is potential slander

that could cost
the hospital millions

in pharmaceutical
support.

What, are you worried
about free pens

and coffee cups
and drug samples?

No, I'm worried
about research,
educational grants,

a little thing that
HIPPA likes to call
"patient confidentiality."

I didn't want to talk to
them in the first place!

"Out of respect
for the family..."

You want to talk to them
next time, then you do it.

It's your damn ER.

You're right.
I will.
Dr. Lewis?

Dr. Weaver.

Oh, I wonder what
she wants to talk
to me about.

It's true, right?

You did a good thing.

( sighs heavily )

You say that
like it matters.

You ready to go?

Yeah.

UNOS gave us the go-ahead.

We're gonna do
the transplant.

Oh, thank God.

They're bringing
Mr. Milner up.

Look, she doesn't know where
the kidney's coming from.

I haven't told her yet.

That can wait.

Let's go inside and talk
with the anesthesiologist.

You a medical student?

First-year resident.

How's that going?

Some days better than others.
I like it well enough.

What do you think
they'll tell Katie?

She'll tell her that
her father loved her.

Maybe too much.

The transplant surgery's
under way.

I can't take responsibility
for how the system works.

But I can try to do
my job better.

That's all
any of us can do.

I don't know why
I was surprised

to find you here.

Of course
you're still here.

Hope we see
each other again

under more favorable
circumstances.

You were always good to me
when I was a student.

I remember that.

Anspaugh wants
to see us and Weaver

in his office
tomorrow morning.

Suture removal
in curtain three.

Hey...

if any of this rolls back
onto you, I'm sorry.

Mr. Klossey.

Hi, doc.

How are you today?

What are we looking
at here?

I did this skiing
on Michigan Avenue.

Cross-country,
during the last big snow.

Little fall, gashed my arm,

but I hadn't done it
in ten years,

so even that felt good.

Why'd you stop?

Arthritis.
I had it bad.

Couldn't bowl,

couldn't sit in
those seats at Wrigley,

take my niece for a walk.

So what happened?

I saw an ad on TV
for Renuvium.

A doc at the clinic
gave me a prescription.

Fixed me right up.

Renuvium?

Yeah. A little red pill,
once in the morning,

let me do all those things

I thought I had
given up forever.

That's something, huh?

Yeah.

Okay, this might hurt
just a little bit.

Damn miracle of medicine,
that's what it is.