ER (1994–2009): Season 11, Episode 13 - Middleman - full transcript
While examining a young boy, Pratt finds a suspicious gash across his chest and calls Wendall for a consult. Kovac and Pratt examine a man who was shot when he confronted his boss with a gun. Jake tries to convince Abby to date him despite his being a student.
Previously on E.R:
...and yes, I believe
the drug ruined her kidney.
What your alleging
is potential slander
that could cost
the hospital millions
in pharmaceutical support.
Abby, he's all yours today.
Who?
Hi.
Nothing's gonna happen.
Why is that?
You're my student.
Welcome, roomie.
God, I'm gonna
regret this.
If we want to make
our patients happier,
we need to teach
our residents
to connect
with them better.
Might want to start
with Pratt.
I'm not an intern,
okay?
So, stop acting
like one.
WOMAN:
Oh...
Mmm... ah...
Ah...
Mmm....
Whoo...
No more hot water.
Sorry about that, baby.
I should have warned you.
This building needs
a bigger water heater.
I'm freezing.
Let me see what I can do
about that.
Come on in there.
( quiet moaning )
How about we call in sick?
I'm arguing
a motion today.
It's my first time
in front of this judge.
Okay, well, let's just try
to hook up after my shift, then.
I can't. I'm going to
a friend's
birthday dinner
at Dandelion.
Dandelion... oh.
Pretty swank.
Yeah, we're splurging.
It's girls' night out.
She's turning 30.
Hmm, well, you know,
after today,
I'm on nights
for a week, so...
Yeah...
Don't worry.
I'll make it up to you.
Greg, I-I-I like you.
I really do.
But I just don't think
there's a future.
What?
I-I'm looking for a guy
who's a little further
along in his life.
You're a student.
You live like a student.
I'm not a student.
I'm a resident.
Listen, Greg, you're great,
but...
I'm looking for a guy
I can get serious with.
An adult.
Hamster bite, itchy eyes...
For Abby-- twisted ankle.
Med students--
how do you know
when you want
to order a film?
Uh, Ottawa rules?
Which are?
Point tenderness
over the lateral
or medial malleolus.
What else?
Interns, help them out.
Inability to walk on the scene.
RAY:
Or take four steps
in the ER.
Hey, man.
Vomiting diabetic
for you.
Saved the best for you.
Vertigo times six hours.
'Morning.
CURTIS:
This board's a mess.
Sam, the diabetic in Exam Three
needs a d-stick,
chem 7 and an IV.
Ray, how you gonna learn
to put in lines
if you always have someone
do it for you?
Aren't IVs a nurses' thing?
If you're an R2 or below,
you're doing your own.
I can get an IV
into a scalp vein.
Good. Keep your skills up, then.
CARTER:
The man has a point.
Today, everybody does
their own lines.
I will take this.
I need the practice.
I'm moving on to surgery
in a few days.
RAY:
Why make up arbitrary rules
if it's just going
to slow us down?
CURTIS:
Because I can.
Somebody woke up
on the wrong side
of the waterbed
this morning.
Yeah, me.
You have a waterbed?
I can't make
this schedule.
We don't have
enough attendings.
We could hire
a few part-timers.
We can barely afford to pay
the doctors we already have.
Sam, call CT.
Vertigo guy's gonna need
a head with contrast.
You're gonna need an attending
to sign off on that.
What?
Residents can't order CTs.
Since when?
We have to cut down
on unnecessary CTs
or we're going to have
to buy another scanner.
Well, this
is a necessary scan.
You were in there two seconds.
Did you do
a neuro exam?
It could be a cerebellar mass.
Or an inner ear infection.
Do the exam,
present to an attending,
and then we'll see
about your CT.
Third-year resident...
I've been ordering
my own scans
since I've been here.
What's that about?
It's about me
making the rules.
Come on, that's stupid.
Come on, man,
back me up.
It's her E.R.
Sorry, Pratt.
It sucks to be you.
Mr. Turner, I'm Dr. Pratt.
How can I help you?
Where are my pain meds?
What seems
to be the problem?
What do you think?
I am in pain.
I need pain meds... now.
Mr. Turner, I can't help you
until you tell me...
Vicodin!
Morphine! Go!
Oh, Pratt,
you got to help me.
I've been stuck
for 30 minutes
with a homeless woman
named Rocky who says
she knows you.
Yeah, she's a frequent flier
with a positive review
of systems.
Chief complaints:
Headache times two years,
tingling feet,
chronic cough, insomnia,
intractable emesis,
pruritus ani...
Am I supposed
to work this all up?
She's just lonely.
Knows exactly what to say
to guarantee she'll be here
for hours.
I can't spend
any more time in there.
Her breath
is killing me.
Okay, call in social work.
Have them hold her hand.
Half an hour with Wendall,
she'll be cured.
Half hour with Wendall,
I'd be cured.
Oh, Pratt, I'm applying
for a Robert Wood Johnson grant
to look at the effects
of Prevnar on occult bacteremia.
Good luck with that.
Hey, do we have
a hand-out for the
local rehab programs?
We need to pull
all the charts on kids
under two who have had
a septic workup
and record the demographic data
on these forms.
We?
Yeah, fill out my chart review,
I'll put your name
on the paper.
I'm not into research
and I don't care
about publishing.
You should.
You're going to be out there
looking for a job
in a couple of years,
staring at a big blank page
where your articles
are supposed to be listed.
When they hire the guy
from Harvard
who's got
a five page C.V.
and published three books
during his residency,
you're gonna look back
on this time
and wish you'd stepped up.
You know, actually, I'm
writing something right now.
It's about the abuse
of power by attendings
in the county
hospital system.
I need these back
in a week.
I use the ABCD mnemonic.
Airway... Bones...
Cardiac... Diaphragm.
And then finally, you
look at the lung fields.
Is the problem
that I'm a student
or that I'm your student?
Looking for infiltrates,
opacities, vascularity,
and pneumothorax.
I'm just trying
to isolate the issue.
We've covered this.
I'm your supervisor.
Temporarily.
Your evaluation form
is sitting in my box right now.
( chuckling )
Okay, 72-year-old female
with nausea.
Are you gonna let
some false sense of hierarchy
get in the way
of this?
One more word
and I'll flunk you.
Hi, Mrs. McDow.
Feeling a little queasy?
A little.
Chest bothering you?
I think I'm having
heart pangs.
Ever had anything
like this before?
Sometimes,
when I'm walking Ferdinand.
He's a mutt,
but I love him.
Pulse is racing.
My husband brought
him home from the pound
just a few months
before he passed away.
Sorry to hear that.
What's your plan?
O2, aspirin, Nitropatch,
morphine and Lopressor?
Okay, Mrs. McDow, we're going
to get you some medication.
That should help with the pain
and then my student here
is going to get you an EKG
and check out your heart.
You're the boss.
Yes, she is.
Okay, say "ahhh."
Ahhh.
He's only been at this school
a month.
Already missed five days.
You can close now.
You have a sore throat?
How about a stuffy nose?
He's kind of quiet.
Just said he didn't feel
well enough to go to school.
Okay. You want to open
your ears for me, young man.
( cell phone rings )
How long has he had ear tubes?
WOMAN:
I'm not sure.
He's my husband's kid.
Been living in Detroit
with his mom until a month ago.
Mom's doing six months
for selling meth.
He had nowhere else
to go... work.
What's this?
How'd you do that?
Does it hurt?
No.
Strep culture you asked for.
Thanks. Thomas, how did
you get that scratch?
Hey, it's okay.
You can tell me
what happened.
I don't remember.
Oh, Jane...
I'm applying for
a Pharmyxia educational grant.
Okay.
I need to give them
a current inventory
of all textbooks and computers
and I thought it would
be a perfect job
for a medical student.
Really?
Yeah, take stock
of all computers,
educational CDs,
textbooks--
anything at all that
can be used
for educational purposes--
and record them
on these forms.
You poaching my student?
Attending scut comes
before intern scut.
Sorry.
WOMAN:
I missed so much work
I got fired.
So then I'm home
sulking all the time
and my boyfriend bailed.
Well, chronic pain can put
a strain on relationships.
Have you two considered...
Counseling? Forget it.
We've already been down
that road.
Ms. Slattery, here's
your note for work.
I've signed
your discharge.
You're all set.
I don't know
why I bother.
There are pain clinics
and support groups
you could try...
You know,
you people
always give the same
useless advice.
Therapy...
support groups...
I've tried that.
I've tried everything.
Nothing helps.
I told you
I didn't need social work.
Hang in there.
We're all done here.
Good luck.
What was that about?
It's back pain.
You heard her,
nothing works.
So you called me
out of the NICU
to see a patient who
doesn't want my help?
She needed someone
to complain to
and I needed
to get some work done.
I'm not a baby-sitter.
Hey, Wendall, I need you
to talk to the kid
in Exam Three.
He has a gash
on his chest,
won't even tell me
how it got there.
See, Ray?
A real social work consult.
OLBES:
Lysander Martin,
37-year-old GSW
to right chest.
You ready?
Get started without me.
We should
go in together--
Tachy at 114,
His name's Thomas.
B.P. 135/80,
sats 92 on
a high-flow mask.
Mr. Lysander,
I'm Doctor Kovac.
Lysander's my first name.
Lysander Martin.
Interesting name.
It's from Shakespeare.
My mom wanted to name me
after a romantic hero.
Okay.
She got it wrong.
One-two-three!
Decreased breath sounds
on the right.
I've always wanted to ride
in an ambulance.
He'll need a chest tube.
DUBENKO:
Got the trauma page.
Hi, I'm Dr. Dubenko,
trauma surgeon.
So many doctors.
Are you all here for me?
37-year-old with
a single GSW to chest.
Good airway.
Lysander Martin was shot.
Lysander Martin was gunned down.
I don't believe it!
This guy's a talker.
No kidding.
Wound looks...
...through and through.
...through and through.
I don't even feel the pain.
Is that, like,
the endorphins or something?
DUBENKO:
Hello, doctors,
he's decreased
on the right.
Needs a chest tube.
MAN:
This Lysander Martin?
Yeah.
You need to put
that mask back on.
What's that for?
He's being charged
with assault.
WENDALL:
Nobody is going
to be mad at you.
Right?
Of course not.
All done.
So you can talk to us,
you know.
It's okay.
You're safe here.
I... was climbing
a fence at school.
I slipped on the top.
So you got this cut
from a fence?
It's the wire kind.
With the sharp
things sticking out.
I didn't want to say because
I ripped my shirt.
It was Casey's.
Great, Thomas.
It's okay,
I don't care.
You know, I'd like
a couple of minutes
with Thomas alone,
if that's alright.
It's just a scratch.
Is that absolutely
necessary?
They're going to kill me at work
if I don't show up soon.
You can't go until his rapid
strep's back anyway.
( pager beeping )
Cardiac unit.
Excuse me.
I'll be right back.
LOCKHART:
She's got a right
bundle branch.
That's pretty common.
I have that, too.
I also have an aberrant
re-entrant
conductance pathway.
That explains a lot.
Yeah, my EKG's kind of wild.
I assume you want
another 12 lead.
Yes. Thank you.
Um, there are a few
findings on your EKG
that are consistent
with ischemia,
which would mean that
your heart muscle
isn't getting enough blood.
That can't be good.
Oh, well, we'll check
another EKG
and see if they've progressed.
Thank you, dear.
And I'll be back.
Oh, Abby, I'm asking
all the residents
to keep a running tally of
time spent on paper charting.
Are you thinking about switching
to an automated system?
Yeah, if we can get
the money.
Just keep track
of all start
and stop times
on all your documentation.
And could you ask the rest
of the house staff
to fill out these forms
and then just collect
the surveys when you're
done with them?
Thank you.
What's the time survey about?
I'm applying for an
informatics grant
from Genadon.
Genadon Pharmaceuticals.
Yes. Why?
I just felt that the residents
should be treating patients,
not doing free research
for drug companies.
Well, maybe they'd be able
to if someone hadn't spilled
their guts on television.
I was right.
You know, the
makers of Zarictal
give this hospital
over $50,000 in
educational grants here.
That's money for computers,
conferences, support staff.
I can't count on
those funds now.
So you're just going to go
to another drug company?
Can't we be a little bit
more creative than that?
You know the county health
system is bleeding out.
Unrestricted grants from
pharmaceutical companies
help pay the bills.
There's no such thing
as "unrestricted" grants
from pharmaceutical companies.
The very fact that
we rely on that money
is a serious
conflict of interest.
Yeah, and I never thought
I'd be kissing corporate ass
when I went to medical school.
Welcome to adulthood.
We owe it our patients.
To keep our doors open.
This compromises
our independence.
Oh, you know what,
most of us had
to make compromises
just to get through med school
and residency.
That's probably a foreign
concept to someone
who's never had to worry
about money a day in their life.
It must be nice.
PRATT:
A little pressure here...
and I'm in.
Sat's at 98.
KOVAC:
Nice, Pratt.
Morrison's looks good, no fluid.
So you still haven't told us
how you got shot,
Mr. Martin.
Lysander, please.
Call me Lysander.
Midsummer Night's Dream.
Spends the whole play being
pushed around by Puck.
Puck is evil.
Oh-silk.
Why are you looking
in the abdomen?
The injury's in the chest.
Bullet could have ricocheted.
Nipples to navel--
no man's land.
You know, I've always hated
those ER truisms.
Entrance and exit wounds
are aligned,
the bullet went
straight through.
The man needs a chest tube.
Leave it at that.
It's done.
Good. Oxygen,
pain control, ICU, next.
Do I need an operation?
KOVAC:
It's not clear.
No.
How can you be so sure
without looking?
You want to scan
the belly?
Yeah.
Call down.
Why do you ER docs radiate
the hell out of people
instead of trusting
your own clinical judgment?
Hang up, Pratt.
I trust my clinical judgment
and I want a CT.
CT that's a CAT scan, right?
Yeah.
Scanner's down for repairs,
could be a couple of hours.
Good.
If the bullet nicked the bowel
he doesn't have hours.
He needs an X-lap.
Can we please let the surgeons
decide who needs the surgery?
Are these guys fighting over me?
Come on, Kovac,
let it go.
He's my patient.
Oh. Okay.
Vitals Q hour,
chest tube to suction,
morphine PRN.
There. Now he's
officially admitted
to the trauma service.
You're just boarding him
till the bed's ready.
Okay? Now he's my patient.
You can go.
Two small coffees
in large cups please.
I hate when they don't leave
enough room for milk.
If we miss that
intestinal injury,
guy's going to get
septic and die.
Why does Dubenko think
he can act
like that with the ER staff?
Hubris?
I love that word.
And one more sugar please.
He doesn't get to you?
Doctor Hair?
I think he's kind of cute.
What?!
Surgery and ER have these
battles in every hospital
I've ever worked in.
It's not personal.
Surgeons have to believe
they're better and smarter
than everyone else.
It's a defense mechanism to make
up for their terrible lifestyle.
The guy needs an X-lap.
It's a pissing match, Luka.
Let it go.
Come on, you're
taller and sexier
and you already
got the girl.
This isn't about ego.
It's not?
19 year-old male,
arrow to the abdomen.
What's your name?
Oh, God, it hurts!
It's Dan.
His name's Dan.
Airway's fine, tachy to 130s,
BP 98 over 50.
Could use a little
help over here.
I need more
of that stuff. Please.
Hang in there, Dan,
we're going to
fix you up, buddy.
Alright,
what happened?
They made me balance
an apple on my head
while they all
took shots at it.
Who did?
DKE brothers.
I'm a pledge.
It's a hazing stunt?
They said the arrow had
a plastic tip, couldn't hurt me.
They were wrong.
We actually didn't think
he'd let us do it.
God, I'm glad I'm not a guy.
Alright, little guy,
here's a note for school.
Thank you.
Remember, no more
climbing fences
till your
double digits, okay?
Just keep the wound dry
till it's all scabbed over.
Thank you, Doctor.
Any time.
Wait a minute.
Can you guys
hold on one second?
Dr. Pratt...
We really need to go.
Just one minute.
I wasn't done.
I asked you to find out
what happened and you did.
Thank you.
If you're going to bother
to call me to consult,
you should at least wait
for my assessment
before releasing him.
And your assessment was that
the injury is consistent
with the story,
so what's the problem?
I haven't completed
my evaluation.
I can't sign off until
I've interviewed him alone.
I don't need you
to sign off.
Hey, I got
a 16-year-old girl
with abdominal pain.
I was wondering if you'd do
the sexual history.
I think she'd rather
talk to a woman.
You know, I am sick and tired
of you all using
Social Work as a crutch
whenever your patient's
needy or smells bad
or you just don't want
to spend time with them.
Actually, she smells
kind of good.
Thanks.
You should have paged me
before you discharged him.
So which is it--
are we calling you too
often or not enough?
I'm sorry,
but if I don't leave now
I may lose my job.
Don't worry about it.
You're all set.
When are you guys going
to take this thing out of me?
It's not safe
doing it down here.
We're going to do it
up in the OR.
Dubenko's on
his way.
Damn it, this guy's
got no veins.
I'm not having
any luck either.
Anyone look
on the feet?
Abby, set up for
a central line,
Ray, get ready
to tube him.
Alright.
Sterile 6s to Jane.
Jake said you were
cool like that.
Like what?
Letting med students
do procedures.
Actually, that's how
he sold me on the switch.
What switch?
Has anyone reached my mom?
TAGGART:
We're working on it.
He's swapping his remaining
shifts with me
so he can do nights
with Neela supervising.
Oh.
Okay, Dan, we're going to put
a breathing tube down your
throat for the OR.
And when you wake up, this thing
will be out of you,
and you'll be
all fixed up.
Yay. 18 gauge
in the dorsal arch.
20 etomidate, 100 of sux.
Said he wants to get a sense
of how
the other interns
do things.
Mm-hmm.
Oh, systolic's down
to 62.
Okay, Abby, why don't
you go next door
and get
the rapid infuser.
Yeah. Flush the line
with saline--
I'll be right back.
Etomidate is in.
Okay, suction.
We hardly ever do
DPLs anymore.
Yeah, because CT
makes us lazy.
It's archaic.
DPL has a higher
sensitivity
with occult
intra-abdominal injury.
Dubenko doesn't want us
near this guy.
It's safe, it's faster
and it's indicated in
penetrating thoracic injury.
Lover thoracic injury.
Is there always
this much debate?
Only with
the really important stuff.
Cool.
I'm stealing your rapid infuser.
Send Jane in.
She should see this.
Okay, we're going to put
a small catheter
into your belly.
We're going to run a liter
of saline in and out.
If the fluid comes
back clear, you're good.
If there's any blood,
you're going to need the OR.
Makes sense to me.
He's not our patient.
Dubenko's going to freak out.
Hey.
Hey.
The kid with the arrow
in his belly
went up to the OR.
That's good.
I was never in
a fraternity, boy, but...
What?
I said I was never
in a...
Look, I'm sorry.
Maybe sometimes I'm not
the best team player.
I was out of line.
I just have so many
balls in the air.
I'm sorry
I took it out on you.
It was a lot easier being
a resident, wasn't it?
Attendings made all
the tough calls,
protected us from all that
administrative crap.
Didn't seem like
that at the time.
Students want
to be residents,
residents want
to be attendings.
Yep, and attendings
just want to be left alone.
I'm not doing any more
consults down here today.
Why? Who's covering?
No one. The ER's
blacklisted.
What?
They all brag about
the ER's multidisciplinary
approach,
but in the end doctors only
listen to other doctors.
What happened?
Have the residents call
a candy-striper
if they need somebody
to keep their patients
company today, okay?
Okay, grasp the fascia with
the towel clips and pull up.
Are you a student?
No, she is.
Now just pop
the angiocath
through to the
peritoneal cavity...
and aspirate as you go.
Want me to hold the clamps
while you do that?
No. I've got it.
How long have you been a doctor?
Three years.
I'm in.
Nothing back.
I've worked at the same
place for the last 14.
Extend with the scalpel
and thread in your tubing.
Dr. Kovac,
urosepsis guy's coding,
Morris is in there alone.
Okay, dump in
a warm liter of saline
and let gravity
pull it back out.
Takes about 20 minutes.
And if Dubenko sees this?
Call me.
You want me
to go with him?
Yeah.
He seems like
a cool boss.
He's just one of them.
I have a bunch
of bosses.
I've had the same one
for the whole time.
Jack Meegly.
He's a year younger than I am
and he's made me
call him Mr. Meegly.
Sounds like a jerk.
Last night I had my crew
rearrange this display
so that the cell phones were
separated from the CDs.
This morning he came by
and he made me
change it all back.
Apparently I don't have
the authority
to change the displays
in my own damn department.
Sucks to be the middle man.
For the last 14 years
I've been working holidays
and covering his ass,
while he cheats on his wife
with the girls
in cosmetics.
200 CCs in.
Today I had enough.
I went to the firearm section,
I took a gun out of the case,
I grabbed some bullets,
I went into
Meegly's office
and fired into the air.
You're kidding.
Uh-uh.
You know, I didn't want
to hurt him.
I was just mad.
TAGGART:
That explains the handcuffs
and your friend outside.
So what happened next?
He, uh, was calm.
He grabbed the gun
out of my hands,
and then he, uh...
He shot you?
The story of my life.
Damn. Thought I had it bad.
Sorry for the delay, Mr. Martin,
ICU should have a bed
in about...
Dr. Pratt,
what are you doing?
A DPL.
Yeah, I see.
Well, why stop there?
Get sterile, Pratt.
We're going in.
What?
Yeah. Scrub up,
you're assisting.
He's not serious.
You guys are so sure
he needs an ex-lap,
let's open him up
right here.
Let's go.
I'm not really
getting surgery, am I?
Oh, no, I was just
making a point.
Where's Kovac?
Sam's out looking for him.
You know, quick,
friendly tip of advice--
next time you're caught
between a surgeon
and anyone else in the hospital,
listen to the surgeon.
How about this time?
He's got to finish
what he started.
Gravity's going
to pull the fluid
out of your belly
into the bag.
If it comes out red
then we know you're
bleeding inside.
You ER docs
convince yourselves
of the worst possible
diagnosis,
then radiate,
bleed and bludgeon
in order to prove
that you're right.
That's not true.
Dr. Kovac is always on us
to avoid unnecessary tests.
So obsessed with
the dramatic save
that you fail
to develop any finesse.
Finesse?
Sledgehammers
and carpet bombing
where discretion and restraint
are what's required.
He would not have pushed
to do the procedure
if he didn't think we were
going to find something.
Dr. Kovac has you doing
an invasive procedure
on somebody else's patient.
You have something to say,
say it to me, not my resident.
Maybe you and I should
discuss this out in the hall.
No, we can discuss it
right here.
Very well.
My patient is fully aware
that you and your resident
ignored my instructions
and proceeded with
this ridiculous test.
It's okay. Really.
After years of taking care
of the cases
that you guys blow off,
I've learned to develop
some intuition.
Your intuitive approach
is very sweet,
but I like to practice
evidence-based medicine.
Okay? Let's look at the
evidence, shall we?
It's pink, does that
mean I'm bleeding?
No. May I?
Last vitals: 72,
18, 114/66...
Note: I am reading this
through the fluid.
How does that correlate
to cell count?
10,000 RBCs, tops.
Is that bad?
No.
It's nothing.
A tablespoon of blood.
Probably from
Dr. Pratt's incision.
You don't know that
for sure.
Should we get another doctor
in here?
You know, like a tie breaker
or something?
Maybe break the tie?
Look, if he was bleeding
we'd be looking at
tomato juice,
not pink lemonade.
He could have a small tear
that's intermittently oozing.
I'm getting very tired
of this game.
And since I can't trust you
to stay away from my patient
I'm going to go
and find him a bed myself.
He's not mad at me, is he?
A blocked blood vessel
deprived your heart of oxygen
which caused
the abnormal rhythm.
That's why you passed out.
The cardiologist is going
to thread a catheter
through your groin,
into your heart
and unblock the vessel.
Will it hurt?
No, you'll be sedated.
Curtain B is open.
Is there any family you'd
like us to call for you?
My son lives in Seattle.
There any friends who
could come be with you?
No, it's just me and my dog now.
I'll tell you what, Gertie.
My shift is almost over
and I love the cath lab.
I'm going to come
hang out with you
while they do your procedure.
You want to stay here with me?
I'll be quiet, I'm not going
to bug you or anything.
Privacy please,
I need to do my assessment.
That was nice of you.
I wasn't lying, I really
do like the cath lab.
Hey, listen, um...
you did a great job on
your rotation this month.
I probably should have
mention that sooner.
Thank you.
And I want you to know...
just let me know
if you need any help
down the line.
Sure.
And I think it's good
that you switched
to have some shifts with Neela.
She's very smart
and i-it's good to have variety.
Abby, I was wondering
about something.
Yeah?
Do you think
Gertie's blockage
is in the circumflex
or the LAD?
Hey, you know,
the next time
you decide to start
a turf war with Dubenko,
do me a favor,
leave me out of it.
This isn't about power,
it's about the patient.
Yeah, but he's seen
hundreds of GSWs.
What makes you so sure
you're right and he's wrong?
If you have a strong gut
feeling about something,
you have to listen to it.
Come on, we were wrong.
We don't know that yet.
Made us look like fools.
Is that what
you're worried about?
What?
Nothing will get a doctor
into bigger trouble
than the fear
of looking stupid.
Trust me.
So, um...
you're on nights for
the rest of the rotation?
Yeah.
I guess this is it.
I'm on days.
Too bad.
Okay. Bye.
Bye.
Abby, I'm sure Neela's
a good doctor
but that's not why
I switched shifts.
No?
No, I switched shifts
so that after today,
I would no longer
be your student.
Oh.
So, tonight, I want you
to fill out that evaluation,
seal the envelope,
and turn it in.
Because tomorrow night...
you and me, we're going out.
No, we're not.
Yes, we are.
No, we're not.
No, we're not.
Did you ever think
about surgery?
You kind of seem the type.
No, thanks. A month in
the Death Star is enough for me.
Death Star?
Surgical ICU.
Pratt, excessive yawning
a sign of something?
Yeah, sleepiness.
Well, Lysander doesn't
seem sleepy.
He seems kind of wired.
He's yawning?
Yeah, a lot.
Detective Burowski's
been waiting two hours.
Can we go in now?
Not yet.
Call Dubenko.
Are you the mom?
Teacher's aide.
He's in after-school day care.
We found him like this
on the playground.
How many rounds of epi?
Three. No pulse
in the field.
Dr. Carter, full arrest
on a school yard.
Blunt injuries to the head,
chest and abdomen.
Okay, Trauma Two.
Somebody page Wendall.
Why?
She and Pratt
saw this kid today.
What?!
What are you doing,
Pratt?
Just give me a
minute, you'll see.
You okay like that?
I'm sliding a little bit.
Maybe this will help.
Can I make a call?
Sure.
What's the number?
555-0198.
Thanks.
What is this, medieval
torture day in the ER?
Observant nurse noticed
frequent yawning
in an alert patient.
You got 30 seconds, Pratt.
Which could be a sign
of diaphragmatic injury.
You're kidding me, right?
It's a theory.
Hard to prove.
But wouldn't necessarily
show up on the DPL.
Exactly.
It's the machine.
I got a bed for him
in the ICU upstairs, okay?
Hi, Sally?
It's Lysander from Electronics.
Methylene blue
in the abdomen
should seep through
the diaphragmatic tear.
And come out the chest tube.
I've been shot
and I'm hanging upside down
with a tube in my belly and
a vacuum cleaner in my chest.
And in case I don't make it...
You're going
to make it.
I just wanted to let you know
that your husband cheats on you.
And...
...that I love you.
Meegly's wife...
she works in Appliances.
I met her when she was
just a trainee.
Okay, I want my patient
upstairs, now.
Blue.
Sam, Chuny's at the bloodbank,
we need a nurse in here.
Coming.
( alarms )
Hold compressions.
What can I do?
You can work on access.
Oh, my God, it's Thomas.
The kid with
the chest lac.
Still PEA, rate 66.
Alright, resume.
Hematoma right parietal area,
ecchymosis and swelling
to the right mandible
and bilateral maxillae.
What in the hell?
Can't get a pressure.
Who did this?
They found him down
on the schoolyard.
Is his mother here?
Brother?
BARNETT:
Bruising and edema
to bilateral thighs.
How did this happen?
Isn't it funny
how you can be
so completely
sure of a diagnosis
then find out
you were totally wrong?
You should write up
the case, Dr. Pratt.
So do you think
you'll be able
to do the surgery
laparoscopically
or are you going
to have to go open?
Don't know yet, we'll
have to run the bowel.
So you think that the bullet
may have been bouncing around
the abdomen after all?
Know what?
It's possible.
And Dr. Kovac
was right?
Goodnight, Dr. Pratt.
Thank you.
I think this has been
the best day of my life.
( chuckles )
Hey, Chuny, what's
going on in there?
Abused kid.
You don't want to know.
You guys need
an extra set of hands?
It's Thomas.
Oh, man.
Hanging the first unit.
Switch out.
You look tired.
I just started.
Switch out.
I should have finished
my interview.
PEA at the scene.
There was a sock
shoved down his throat.
How many rounds of meds
did you give him?
Too many.
How much volume?
Third liter's going in.
I blew it.
Wendall...
We should pace him.
He's oozing from
his IV sites.
DIC. Call for cryo and FFP.
No, Pratt.
Anybody got an ETA
on the family?
Another epi, another atropine,
and let's treat the DIC.
He's a kid.
We're not stopping yet.
SAM:
Atropine's in.
Pratt, you want me
to switch in?
We need central access.
That won't change
anything.
Ray, throw in a femoral.
He's got two large-bore IVs
with good flow.
What's the time?
It's 43 minutes.
Family's here.
Why don't you go see
if they're ready to come in?
How is he?
This is Thomas's dad.
His injuries
are very severe.
Do you want to see him?
Sometimes it helps to see how
hard the doctors are working.
Casey, go back
and sit down.
I don't think
he needs to see this.
GARY:
I want to be with him.
I saw them.
Who?
I saw them pull Thomas behind
the swings after school today.
Who did you see?
They had a thing
about his clothes.
I gave him my shirt
yesterday,
but they still
wouldn't leave him alone.
Did they cut him?
I tried to get Thomas
to tell you,
but they said they'd kill
him if he said anything.
He was scared.
Everyone's scared of them.
Casey, tell me who they are.
I promise you'll be safe.
I still have to be in school
with them every day.
Who?
There's four of them.
They're sixth-graders.
PH is 6.8.
Amp of bicarb.
Hold compressions.
Okay, that's it.
6:25.
Please.
He's still got a rhythm.
A non-perfusing rhythm
at the rate of 28.
We haven't even tried
transcutaneous pacing.
48 minutes
of cerebral hypoxia.
How much fluid
did you give him?
Three liters of NS,
four of O-neg.
Ten rounds of epi
and atropine.
Pratt.
Greg.
GARY:
Oh, no!
He's fixed and dilated
with a pH that's not
compatible with life.
( sobbing )
Mr. Bryson,
Mrs. Bryson,
I'm very sorry.
( sobbing uncontrollably )
( sobbing continues )
( sobbing continues )
Hi.
Hi.
I was just about
to put this
in your box,
med student evaluations.
How's it going with him?
He's very thorough,
he's got a good fund
of knowledge...
That's not what I meant.
And I'm sorry I didn't get
to those time surveys today.
We're so screwed
at this point,
another day doesn't
matter.
What's going on?
Was Carter's press conference
really that big a deal?
If Keating-Ward pulls funding,
others will follow suit.
Drug companies don't want
to be associated
with a department
that overreacts
during a post-marketing
surveillance.
Well, Admin somehow always finds
the money to keep us open.
I could lose my job.
Why?
You didn't personally run
county health
into the ground.
No. But my tenure's up
for review and I'm way short.
They made you
department head.
I think you've
proved your worth.
The committee's only concern
is how much money I bring in.
That sucks.
I have to bring in
$100,000 a year
to even be in the ballpark.
There's a quota?
Oh, yeah.
We're being pimped out
by the University.
You don't bring in the cash,
you're out.
Pharmaceutical grants
are an easy way
to raise a bunch of money fast.
I can't lose my job.
I have Chuck and Cosmo now.
Just talked to the OR.
Lysander had a three-centimeter
diaphragmatic laceration.
Okay.
You saved his life.
We all miss things,
Pratt.
The social worker saw
this kid, too.
I pulled rank on her.
Attending trumps resident,
resident trumps intern,
we all trump the social worker.
It's a great system.
Most of the time it works.
How do you stand it?
What?
The responsibility.
Busy shift?
The usual. What about you?
What'd you do today?
Tried to sleep,
couldn't,
watched bad TV,
ate cereal.
I hate working nights.
Okay, bring it on.
Torticollis in Two
waiting for the
Benadryl to kick in,
and Tinea Capitis has
a scrip for Griseo,
but he needs to see
an attending.
That's it?
Yep, I'm outta here.
Hey, anyone wanna go
to Ike Ryan's?
Luka's working,
Alex is at a sleepover.
I need a drink.
No, thanks,
I'm exhausted.
Ooh, I'm in.
Dr. Lewis, the inventory
of teaching materials
you asked for.
Thank you, Jane.
You're the only person who
actually did what I asked.
Uh, textbooks and journals
are in the front section,
and computer stuff's
is in the back.
Alright.
Come on out with us,
I'll buy you a drink.
I can't.
There is something
you could do for me, though.
Shoot.
Write me
a recommendation.
Okay.
Way to work it, Jane.
Ray, you coming out
with us?
Oh, I never drink
with attendings.
Gets too weird.
Ray, the plumber came
and the shower's fixed.
Oh, hallelujah,
I love you.
You owe me 80 bucks.
Ready to sign out?
Please don't give me
the speech
about how we win some
and how we lose some.
I wasn't going to.
I didn't complete
my assessment.
I didn't do my job.
Well, what do you think
would have happened?
Please don't.
Don't what?
Try and cheer me up.
( sobbing ):
I should have
saved that kid!
Can I help you, sir?
Uh, no. Actually,
I'm looking for someone.
What's the name
of the party?
Really. I'm good. Thanks.
Oh, my God!
Oh, that's awful.
Hi.
I'm sorry, ladies.
I didn't mean to interrupt.
This will only take a minute.
Greg?
I went to work this morning
thinking about what you said.
What are you doing here?
And I just need
to tell you something.
The work that I do?
It's as real and as serious
as it gets.
I don't know how you define
an "adult,"
but I assure you,
I'm all grown up.
Look, I'm sorry,
I didn't mean to offend you.
I don't know what
you're looking for,
but I hope you find it.
Good luck.
Abby.
What are you doing here?
Big problem.
What?
You never signed off
on my ABG or IV placement.
So you staked out my apartment
so I could sign your book?
All student-teacher relations
have to be wrapped up
by tomorrow.
That is very important.
I see.
Sign it.
How do you know
where I live?
Residency office.
They just, uh, gave out
my address just like that?
You could have
been anybody.
It's disturbing, really.
They even gave me
your phone number, too.
Well, I guess they thought you
look like a nice boy.
I'm not that nice.
Maybe I should change my number.
Good idea.
Okay, well, congratulations,
Jake.
Your ER rotation
is officially over.
...and yes, I believe
the drug ruined her kidney.
What your alleging
is potential slander
that could cost
the hospital millions
in pharmaceutical support.
Abby, he's all yours today.
Who?
Hi.
Nothing's gonna happen.
Why is that?
You're my student.
Welcome, roomie.
God, I'm gonna
regret this.
If we want to make
our patients happier,
we need to teach
our residents
to connect
with them better.
Might want to start
with Pratt.
I'm not an intern,
okay?
So, stop acting
like one.
WOMAN:
Oh...
Mmm... ah...
Ah...
Mmm....
Whoo...
No more hot water.
Sorry about that, baby.
I should have warned you.
This building needs
a bigger water heater.
I'm freezing.
Let me see what I can do
about that.
Come on in there.
( quiet moaning )
How about we call in sick?
I'm arguing
a motion today.
It's my first time
in front of this judge.
Okay, well, let's just try
to hook up after my shift, then.
I can't. I'm going to
a friend's
birthday dinner
at Dandelion.
Dandelion... oh.
Pretty swank.
Yeah, we're splurging.
It's girls' night out.
She's turning 30.
Hmm, well, you know,
after today,
I'm on nights
for a week, so...
Yeah...
Don't worry.
I'll make it up to you.
Greg, I-I-I like you.
I really do.
But I just don't think
there's a future.
What?
I-I'm looking for a guy
who's a little further
along in his life.
You're a student.
You live like a student.
I'm not a student.
I'm a resident.
Listen, Greg, you're great,
but...
I'm looking for a guy
I can get serious with.
An adult.
Hamster bite, itchy eyes...
For Abby-- twisted ankle.
Med students--
how do you know
when you want
to order a film?
Uh, Ottawa rules?
Which are?
Point tenderness
over the lateral
or medial malleolus.
What else?
Interns, help them out.
Inability to walk on the scene.
RAY:
Or take four steps
in the ER.
Hey, man.
Vomiting diabetic
for you.
Saved the best for you.
Vertigo times six hours.
'Morning.
CURTIS:
This board's a mess.
Sam, the diabetic in Exam Three
needs a d-stick,
chem 7 and an IV.
Ray, how you gonna learn
to put in lines
if you always have someone
do it for you?
Aren't IVs a nurses' thing?
If you're an R2 or below,
you're doing your own.
I can get an IV
into a scalp vein.
Good. Keep your skills up, then.
CARTER:
The man has a point.
Today, everybody does
their own lines.
I will take this.
I need the practice.
I'm moving on to surgery
in a few days.
RAY:
Why make up arbitrary rules
if it's just going
to slow us down?
CURTIS:
Because I can.
Somebody woke up
on the wrong side
of the waterbed
this morning.
Yeah, me.
You have a waterbed?
I can't make
this schedule.
We don't have
enough attendings.
We could hire
a few part-timers.
We can barely afford to pay
the doctors we already have.
Sam, call CT.
Vertigo guy's gonna need
a head with contrast.
You're gonna need an attending
to sign off on that.
What?
Residents can't order CTs.
Since when?
We have to cut down
on unnecessary CTs
or we're going to have
to buy another scanner.
Well, this
is a necessary scan.
You were in there two seconds.
Did you do
a neuro exam?
It could be a cerebellar mass.
Or an inner ear infection.
Do the exam,
present to an attending,
and then we'll see
about your CT.
Third-year resident...
I've been ordering
my own scans
since I've been here.
What's that about?
It's about me
making the rules.
Come on, that's stupid.
Come on, man,
back me up.
It's her E.R.
Sorry, Pratt.
It sucks to be you.
Mr. Turner, I'm Dr. Pratt.
How can I help you?
Where are my pain meds?
What seems
to be the problem?
What do you think?
I am in pain.
I need pain meds... now.
Mr. Turner, I can't help you
until you tell me...
Vicodin!
Morphine! Go!
Oh, Pratt,
you got to help me.
I've been stuck
for 30 minutes
with a homeless woman
named Rocky who says
she knows you.
Yeah, she's a frequent flier
with a positive review
of systems.
Chief complaints:
Headache times two years,
tingling feet,
chronic cough, insomnia,
intractable emesis,
pruritus ani...
Am I supposed
to work this all up?
She's just lonely.
Knows exactly what to say
to guarantee she'll be here
for hours.
I can't spend
any more time in there.
Her breath
is killing me.
Okay, call in social work.
Have them hold her hand.
Half an hour with Wendall,
she'll be cured.
Half hour with Wendall,
I'd be cured.
Oh, Pratt, I'm applying
for a Robert Wood Johnson grant
to look at the effects
of Prevnar on occult bacteremia.
Good luck with that.
Hey, do we have
a hand-out for the
local rehab programs?
We need to pull
all the charts on kids
under two who have had
a septic workup
and record the demographic data
on these forms.
We?
Yeah, fill out my chart review,
I'll put your name
on the paper.
I'm not into research
and I don't care
about publishing.
You should.
You're going to be out there
looking for a job
in a couple of years,
staring at a big blank page
where your articles
are supposed to be listed.
When they hire the guy
from Harvard
who's got
a five page C.V.
and published three books
during his residency,
you're gonna look back
on this time
and wish you'd stepped up.
You know, actually, I'm
writing something right now.
It's about the abuse
of power by attendings
in the county
hospital system.
I need these back
in a week.
I use the ABCD mnemonic.
Airway... Bones...
Cardiac... Diaphragm.
And then finally, you
look at the lung fields.
Is the problem
that I'm a student
or that I'm your student?
Looking for infiltrates,
opacities, vascularity,
and pneumothorax.
I'm just trying
to isolate the issue.
We've covered this.
I'm your supervisor.
Temporarily.
Your evaluation form
is sitting in my box right now.
( chuckling )
Okay, 72-year-old female
with nausea.
Are you gonna let
some false sense of hierarchy
get in the way
of this?
One more word
and I'll flunk you.
Hi, Mrs. McDow.
Feeling a little queasy?
A little.
Chest bothering you?
I think I'm having
heart pangs.
Ever had anything
like this before?
Sometimes,
when I'm walking Ferdinand.
He's a mutt,
but I love him.
Pulse is racing.
My husband brought
him home from the pound
just a few months
before he passed away.
Sorry to hear that.
What's your plan?
O2, aspirin, Nitropatch,
morphine and Lopressor?
Okay, Mrs. McDow, we're going
to get you some medication.
That should help with the pain
and then my student here
is going to get you an EKG
and check out your heart.
You're the boss.
Yes, she is.
Okay, say "ahhh."
Ahhh.
He's only been at this school
a month.
Already missed five days.
You can close now.
You have a sore throat?
How about a stuffy nose?
He's kind of quiet.
Just said he didn't feel
well enough to go to school.
Okay. You want to open
your ears for me, young man.
( cell phone rings )
How long has he had ear tubes?
WOMAN:
I'm not sure.
He's my husband's kid.
Been living in Detroit
with his mom until a month ago.
Mom's doing six months
for selling meth.
He had nowhere else
to go... work.
What's this?
How'd you do that?
Does it hurt?
No.
Strep culture you asked for.
Thanks. Thomas, how did
you get that scratch?
Hey, it's okay.
You can tell me
what happened.
I don't remember.
Oh, Jane...
I'm applying for
a Pharmyxia educational grant.
Okay.
I need to give them
a current inventory
of all textbooks and computers
and I thought it would
be a perfect job
for a medical student.
Really?
Yeah, take stock
of all computers,
educational CDs,
textbooks--
anything at all that
can be used
for educational purposes--
and record them
on these forms.
You poaching my student?
Attending scut comes
before intern scut.
Sorry.
WOMAN:
I missed so much work
I got fired.
So then I'm home
sulking all the time
and my boyfriend bailed.
Well, chronic pain can put
a strain on relationships.
Have you two considered...
Counseling? Forget it.
We've already been down
that road.
Ms. Slattery, here's
your note for work.
I've signed
your discharge.
You're all set.
I don't know
why I bother.
There are pain clinics
and support groups
you could try...
You know,
you people
always give the same
useless advice.
Therapy...
support groups...
I've tried that.
I've tried everything.
Nothing helps.
I told you
I didn't need social work.
Hang in there.
We're all done here.
Good luck.
What was that about?
It's back pain.
You heard her,
nothing works.
So you called me
out of the NICU
to see a patient who
doesn't want my help?
She needed someone
to complain to
and I needed
to get some work done.
I'm not a baby-sitter.
Hey, Wendall, I need you
to talk to the kid
in Exam Three.
He has a gash
on his chest,
won't even tell me
how it got there.
See, Ray?
A real social work consult.
OLBES:
Lysander Martin,
37-year-old GSW
to right chest.
You ready?
Get started without me.
We should
go in together--
Tachy at 114,
His name's Thomas.
B.P. 135/80,
sats 92 on
a high-flow mask.
Mr. Lysander,
I'm Doctor Kovac.
Lysander's my first name.
Lysander Martin.
Interesting name.
It's from Shakespeare.
My mom wanted to name me
after a romantic hero.
Okay.
She got it wrong.
One-two-three!
Decreased breath sounds
on the right.
I've always wanted to ride
in an ambulance.
He'll need a chest tube.
DUBENKO:
Got the trauma page.
Hi, I'm Dr. Dubenko,
trauma surgeon.
So many doctors.
Are you all here for me?
37-year-old with
a single GSW to chest.
Good airway.
Lysander Martin was shot.
Lysander Martin was gunned down.
I don't believe it!
This guy's a talker.
No kidding.
Wound looks...
...through and through.
...through and through.
I don't even feel the pain.
Is that, like,
the endorphins or something?
DUBENKO:
Hello, doctors,
he's decreased
on the right.
Needs a chest tube.
MAN:
This Lysander Martin?
Yeah.
You need to put
that mask back on.
What's that for?
He's being charged
with assault.
WENDALL:
Nobody is going
to be mad at you.
Right?
Of course not.
All done.
So you can talk to us,
you know.
It's okay.
You're safe here.
I... was climbing
a fence at school.
I slipped on the top.
So you got this cut
from a fence?
It's the wire kind.
With the sharp
things sticking out.
I didn't want to say because
I ripped my shirt.
It was Casey's.
Great, Thomas.
It's okay,
I don't care.
You know, I'd like
a couple of minutes
with Thomas alone,
if that's alright.
It's just a scratch.
Is that absolutely
necessary?
They're going to kill me at work
if I don't show up soon.
You can't go until his rapid
strep's back anyway.
( pager beeping )
Cardiac unit.
Excuse me.
I'll be right back.
LOCKHART:
She's got a right
bundle branch.
That's pretty common.
I have that, too.
I also have an aberrant
re-entrant
conductance pathway.
That explains a lot.
Yeah, my EKG's kind of wild.
I assume you want
another 12 lead.
Yes. Thank you.
Um, there are a few
findings on your EKG
that are consistent
with ischemia,
which would mean that
your heart muscle
isn't getting enough blood.
That can't be good.
Oh, well, we'll check
another EKG
and see if they've progressed.
Thank you, dear.
And I'll be back.
Oh, Abby, I'm asking
all the residents
to keep a running tally of
time spent on paper charting.
Are you thinking about switching
to an automated system?
Yeah, if we can get
the money.
Just keep track
of all start
and stop times
on all your documentation.
And could you ask the rest
of the house staff
to fill out these forms
and then just collect
the surveys when you're
done with them?
Thank you.
What's the time survey about?
I'm applying for an
informatics grant
from Genadon.
Genadon Pharmaceuticals.
Yes. Why?
I just felt that the residents
should be treating patients,
not doing free research
for drug companies.
Well, maybe they'd be able
to if someone hadn't spilled
their guts on television.
I was right.
You know, the
makers of Zarictal
give this hospital
over $50,000 in
educational grants here.
That's money for computers,
conferences, support staff.
I can't count on
those funds now.
So you're just going to go
to another drug company?
Can't we be a little bit
more creative than that?
You know the county health
system is bleeding out.
Unrestricted grants from
pharmaceutical companies
help pay the bills.
There's no such thing
as "unrestricted" grants
from pharmaceutical companies.
The very fact that
we rely on that money
is a serious
conflict of interest.
Yeah, and I never thought
I'd be kissing corporate ass
when I went to medical school.
Welcome to adulthood.
We owe it our patients.
To keep our doors open.
This compromises
our independence.
Oh, you know what,
most of us had
to make compromises
just to get through med school
and residency.
That's probably a foreign
concept to someone
who's never had to worry
about money a day in their life.
It must be nice.
PRATT:
A little pressure here...
and I'm in.
Sat's at 98.
KOVAC:
Nice, Pratt.
Morrison's looks good, no fluid.
So you still haven't told us
how you got shot,
Mr. Martin.
Lysander, please.
Call me Lysander.
Midsummer Night's Dream.
Spends the whole play being
pushed around by Puck.
Puck is evil.
Oh-silk.
Why are you looking
in the abdomen?
The injury's in the chest.
Bullet could have ricocheted.
Nipples to navel--
no man's land.
You know, I've always hated
those ER truisms.
Entrance and exit wounds
are aligned,
the bullet went
straight through.
The man needs a chest tube.
Leave it at that.
It's done.
Good. Oxygen,
pain control, ICU, next.
Do I need an operation?
KOVAC:
It's not clear.
No.
How can you be so sure
without looking?
You want to scan
the belly?
Yeah.
Call down.
Why do you ER docs radiate
the hell out of people
instead of trusting
your own clinical judgment?
Hang up, Pratt.
I trust my clinical judgment
and I want a CT.
CT that's a CAT scan, right?
Yeah.
Scanner's down for repairs,
could be a couple of hours.
Good.
If the bullet nicked the bowel
he doesn't have hours.
He needs an X-lap.
Can we please let the surgeons
decide who needs the surgery?
Are these guys fighting over me?
Come on, Kovac,
let it go.
He's my patient.
Oh. Okay.
Vitals Q hour,
chest tube to suction,
morphine PRN.
There. Now he's
officially admitted
to the trauma service.
You're just boarding him
till the bed's ready.
Okay? Now he's my patient.
You can go.
Two small coffees
in large cups please.
I hate when they don't leave
enough room for milk.
If we miss that
intestinal injury,
guy's going to get
septic and die.
Why does Dubenko think
he can act
like that with the ER staff?
Hubris?
I love that word.
And one more sugar please.
He doesn't get to you?
Doctor Hair?
I think he's kind of cute.
What?!
Surgery and ER have these
battles in every hospital
I've ever worked in.
It's not personal.
Surgeons have to believe
they're better and smarter
than everyone else.
It's a defense mechanism to make
up for their terrible lifestyle.
The guy needs an X-lap.
It's a pissing match, Luka.
Let it go.
Come on, you're
taller and sexier
and you already
got the girl.
This isn't about ego.
It's not?
19 year-old male,
arrow to the abdomen.
What's your name?
Oh, God, it hurts!
It's Dan.
His name's Dan.
Airway's fine, tachy to 130s,
BP 98 over 50.
Could use a little
help over here.
I need more
of that stuff. Please.
Hang in there, Dan,
we're going to
fix you up, buddy.
Alright,
what happened?
They made me balance
an apple on my head
while they all
took shots at it.
Who did?
DKE brothers.
I'm a pledge.
It's a hazing stunt?
They said the arrow had
a plastic tip, couldn't hurt me.
They were wrong.
We actually didn't think
he'd let us do it.
God, I'm glad I'm not a guy.
Alright, little guy,
here's a note for school.
Thank you.
Remember, no more
climbing fences
till your
double digits, okay?
Just keep the wound dry
till it's all scabbed over.
Thank you, Doctor.
Any time.
Wait a minute.
Can you guys
hold on one second?
Dr. Pratt...
We really need to go.
Just one minute.
I wasn't done.
I asked you to find out
what happened and you did.
Thank you.
If you're going to bother
to call me to consult,
you should at least wait
for my assessment
before releasing him.
And your assessment was that
the injury is consistent
with the story,
so what's the problem?
I haven't completed
my evaluation.
I can't sign off until
I've interviewed him alone.
I don't need you
to sign off.
Hey, I got
a 16-year-old girl
with abdominal pain.
I was wondering if you'd do
the sexual history.
I think she'd rather
talk to a woman.
You know, I am sick and tired
of you all using
Social Work as a crutch
whenever your patient's
needy or smells bad
or you just don't want
to spend time with them.
Actually, she smells
kind of good.
Thanks.
You should have paged me
before you discharged him.
So which is it--
are we calling you too
often or not enough?
I'm sorry,
but if I don't leave now
I may lose my job.
Don't worry about it.
You're all set.
When are you guys going
to take this thing out of me?
It's not safe
doing it down here.
We're going to do it
up in the OR.
Dubenko's on
his way.
Damn it, this guy's
got no veins.
I'm not having
any luck either.
Anyone look
on the feet?
Abby, set up for
a central line,
Ray, get ready
to tube him.
Alright.
Sterile 6s to Jane.
Jake said you were
cool like that.
Like what?
Letting med students
do procedures.
Actually, that's how
he sold me on the switch.
What switch?
Has anyone reached my mom?
TAGGART:
We're working on it.
He's swapping his remaining
shifts with me
so he can do nights
with Neela supervising.
Oh.
Okay, Dan, we're going to put
a breathing tube down your
throat for the OR.
And when you wake up, this thing
will be out of you,
and you'll be
all fixed up.
Yay. 18 gauge
in the dorsal arch.
20 etomidate, 100 of sux.
Said he wants to get a sense
of how
the other interns
do things.
Mm-hmm.
Oh, systolic's down
to 62.
Okay, Abby, why don't
you go next door
and get
the rapid infuser.
Yeah. Flush the line
with saline--
I'll be right back.
Etomidate is in.
Okay, suction.
We hardly ever do
DPLs anymore.
Yeah, because CT
makes us lazy.
It's archaic.
DPL has a higher
sensitivity
with occult
intra-abdominal injury.
Dubenko doesn't want us
near this guy.
It's safe, it's faster
and it's indicated in
penetrating thoracic injury.
Lover thoracic injury.
Is there always
this much debate?
Only with
the really important stuff.
Cool.
I'm stealing your rapid infuser.
Send Jane in.
She should see this.
Okay, we're going to put
a small catheter
into your belly.
We're going to run a liter
of saline in and out.
If the fluid comes
back clear, you're good.
If there's any blood,
you're going to need the OR.
Makes sense to me.
He's not our patient.
Dubenko's going to freak out.
Hey.
Hey.
The kid with the arrow
in his belly
went up to the OR.
That's good.
I was never in
a fraternity, boy, but...
What?
I said I was never
in a...
Look, I'm sorry.
Maybe sometimes I'm not
the best team player.
I was out of line.
I just have so many
balls in the air.
I'm sorry
I took it out on you.
It was a lot easier being
a resident, wasn't it?
Attendings made all
the tough calls,
protected us from all that
administrative crap.
Didn't seem like
that at the time.
Students want
to be residents,
residents want
to be attendings.
Yep, and attendings
just want to be left alone.
I'm not doing any more
consults down here today.
Why? Who's covering?
No one. The ER's
blacklisted.
What?
They all brag about
the ER's multidisciplinary
approach,
but in the end doctors only
listen to other doctors.
What happened?
Have the residents call
a candy-striper
if they need somebody
to keep their patients
company today, okay?
Okay, grasp the fascia with
the towel clips and pull up.
Are you a student?
No, she is.
Now just pop
the angiocath
through to the
peritoneal cavity...
and aspirate as you go.
Want me to hold the clamps
while you do that?
No. I've got it.
How long have you been a doctor?
Three years.
I'm in.
Nothing back.
I've worked at the same
place for the last 14.
Extend with the scalpel
and thread in your tubing.
Dr. Kovac,
urosepsis guy's coding,
Morris is in there alone.
Okay, dump in
a warm liter of saline
and let gravity
pull it back out.
Takes about 20 minutes.
And if Dubenko sees this?
Call me.
You want me
to go with him?
Yeah.
He seems like
a cool boss.
He's just one of them.
I have a bunch
of bosses.
I've had the same one
for the whole time.
Jack Meegly.
He's a year younger than I am
and he's made me
call him Mr. Meegly.
Sounds like a jerk.
Last night I had my crew
rearrange this display
so that the cell phones were
separated from the CDs.
This morning he came by
and he made me
change it all back.
Apparently I don't have
the authority
to change the displays
in my own damn department.
Sucks to be the middle man.
For the last 14 years
I've been working holidays
and covering his ass,
while he cheats on his wife
with the girls
in cosmetics.
200 CCs in.
Today I had enough.
I went to the firearm section,
I took a gun out of the case,
I grabbed some bullets,
I went into
Meegly's office
and fired into the air.
You're kidding.
Uh-uh.
You know, I didn't want
to hurt him.
I was just mad.
TAGGART:
That explains the handcuffs
and your friend outside.
So what happened next?
He, uh, was calm.
He grabbed the gun
out of my hands,
and then he, uh...
He shot you?
The story of my life.
Damn. Thought I had it bad.
Sorry for the delay, Mr. Martin,
ICU should have a bed
in about...
Dr. Pratt,
what are you doing?
A DPL.
Yeah, I see.
Well, why stop there?
Get sterile, Pratt.
We're going in.
What?
Yeah. Scrub up,
you're assisting.
He's not serious.
You guys are so sure
he needs an ex-lap,
let's open him up
right here.
Let's go.
I'm not really
getting surgery, am I?
Oh, no, I was just
making a point.
Where's Kovac?
Sam's out looking for him.
You know, quick,
friendly tip of advice--
next time you're caught
between a surgeon
and anyone else in the hospital,
listen to the surgeon.
How about this time?
He's got to finish
what he started.
Gravity's going
to pull the fluid
out of your belly
into the bag.
If it comes out red
then we know you're
bleeding inside.
You ER docs
convince yourselves
of the worst possible
diagnosis,
then radiate,
bleed and bludgeon
in order to prove
that you're right.
That's not true.
Dr. Kovac is always on us
to avoid unnecessary tests.
So obsessed with
the dramatic save
that you fail
to develop any finesse.
Finesse?
Sledgehammers
and carpet bombing
where discretion and restraint
are what's required.
He would not have pushed
to do the procedure
if he didn't think we were
going to find something.
Dr. Kovac has you doing
an invasive procedure
on somebody else's patient.
You have something to say,
say it to me, not my resident.
Maybe you and I should
discuss this out in the hall.
No, we can discuss it
right here.
Very well.
My patient is fully aware
that you and your resident
ignored my instructions
and proceeded with
this ridiculous test.
It's okay. Really.
After years of taking care
of the cases
that you guys blow off,
I've learned to develop
some intuition.
Your intuitive approach
is very sweet,
but I like to practice
evidence-based medicine.
Okay? Let's look at the
evidence, shall we?
It's pink, does that
mean I'm bleeding?
No. May I?
Last vitals: 72,
18, 114/66...
Note: I am reading this
through the fluid.
How does that correlate
to cell count?
10,000 RBCs, tops.
Is that bad?
No.
It's nothing.
A tablespoon of blood.
Probably from
Dr. Pratt's incision.
You don't know that
for sure.
Should we get another doctor
in here?
You know, like a tie breaker
or something?
Maybe break the tie?
Look, if he was bleeding
we'd be looking at
tomato juice,
not pink lemonade.
He could have a small tear
that's intermittently oozing.
I'm getting very tired
of this game.
And since I can't trust you
to stay away from my patient
I'm going to go
and find him a bed myself.
He's not mad at me, is he?
A blocked blood vessel
deprived your heart of oxygen
which caused
the abnormal rhythm.
That's why you passed out.
The cardiologist is going
to thread a catheter
through your groin,
into your heart
and unblock the vessel.
Will it hurt?
No, you'll be sedated.
Curtain B is open.
Is there any family you'd
like us to call for you?
My son lives in Seattle.
There any friends who
could come be with you?
No, it's just me and my dog now.
I'll tell you what, Gertie.
My shift is almost over
and I love the cath lab.
I'm going to come
hang out with you
while they do your procedure.
You want to stay here with me?
I'll be quiet, I'm not going
to bug you or anything.
Privacy please,
I need to do my assessment.
That was nice of you.
I wasn't lying, I really
do like the cath lab.
Hey, listen, um...
you did a great job on
your rotation this month.
I probably should have
mention that sooner.
Thank you.
And I want you to know...
just let me know
if you need any help
down the line.
Sure.
And I think it's good
that you switched
to have some shifts with Neela.
She's very smart
and i-it's good to have variety.
Abby, I was wondering
about something.
Yeah?
Do you think
Gertie's blockage
is in the circumflex
or the LAD?
Hey, you know,
the next time
you decide to start
a turf war with Dubenko,
do me a favor,
leave me out of it.
This isn't about power,
it's about the patient.
Yeah, but he's seen
hundreds of GSWs.
What makes you so sure
you're right and he's wrong?
If you have a strong gut
feeling about something,
you have to listen to it.
Come on, we were wrong.
We don't know that yet.
Made us look like fools.
Is that what
you're worried about?
What?
Nothing will get a doctor
into bigger trouble
than the fear
of looking stupid.
Trust me.
So, um...
you're on nights for
the rest of the rotation?
Yeah.
I guess this is it.
I'm on days.
Too bad.
Okay. Bye.
Bye.
Abby, I'm sure Neela's
a good doctor
but that's not why
I switched shifts.
No?
No, I switched shifts
so that after today,
I would no longer
be your student.
Oh.
So, tonight, I want you
to fill out that evaluation,
seal the envelope,
and turn it in.
Because tomorrow night...
you and me, we're going out.
No, we're not.
Yes, we are.
No, we're not.
No, we're not.
Did you ever think
about surgery?
You kind of seem the type.
No, thanks. A month in
the Death Star is enough for me.
Death Star?
Surgical ICU.
Pratt, excessive yawning
a sign of something?
Yeah, sleepiness.
Well, Lysander doesn't
seem sleepy.
He seems kind of wired.
He's yawning?
Yeah, a lot.
Detective Burowski's
been waiting two hours.
Can we go in now?
Not yet.
Call Dubenko.
Are you the mom?
Teacher's aide.
He's in after-school day care.
We found him like this
on the playground.
How many rounds of epi?
Three. No pulse
in the field.
Dr. Carter, full arrest
on a school yard.
Blunt injuries to the head,
chest and abdomen.
Okay, Trauma Two.
Somebody page Wendall.
Why?
She and Pratt
saw this kid today.
What?!
What are you doing,
Pratt?
Just give me a
minute, you'll see.
You okay like that?
I'm sliding a little bit.
Maybe this will help.
Can I make a call?
Sure.
What's the number?
555-0198.
Thanks.
What is this, medieval
torture day in the ER?
Observant nurse noticed
frequent yawning
in an alert patient.
You got 30 seconds, Pratt.
Which could be a sign
of diaphragmatic injury.
You're kidding me, right?
It's a theory.
Hard to prove.
But wouldn't necessarily
show up on the DPL.
Exactly.
It's the machine.
I got a bed for him
in the ICU upstairs, okay?
Hi, Sally?
It's Lysander from Electronics.
Methylene blue
in the abdomen
should seep through
the diaphragmatic tear.
And come out the chest tube.
I've been shot
and I'm hanging upside down
with a tube in my belly and
a vacuum cleaner in my chest.
And in case I don't make it...
You're going
to make it.
I just wanted to let you know
that your husband cheats on you.
And...
...that I love you.
Meegly's wife...
she works in Appliances.
I met her when she was
just a trainee.
Okay, I want my patient
upstairs, now.
Blue.
Sam, Chuny's at the bloodbank,
we need a nurse in here.
Coming.
( alarms )
Hold compressions.
What can I do?
You can work on access.
Oh, my God, it's Thomas.
The kid with
the chest lac.
Still PEA, rate 66.
Alright, resume.
Hematoma right parietal area,
ecchymosis and swelling
to the right mandible
and bilateral maxillae.
What in the hell?
Can't get a pressure.
Who did this?
They found him down
on the schoolyard.
Is his mother here?
Brother?
BARNETT:
Bruising and edema
to bilateral thighs.
How did this happen?
Isn't it funny
how you can be
so completely
sure of a diagnosis
then find out
you were totally wrong?
You should write up
the case, Dr. Pratt.
So do you think
you'll be able
to do the surgery
laparoscopically
or are you going
to have to go open?
Don't know yet, we'll
have to run the bowel.
So you think that the bullet
may have been bouncing around
the abdomen after all?
Know what?
It's possible.
And Dr. Kovac
was right?
Goodnight, Dr. Pratt.
Thank you.
I think this has been
the best day of my life.
( chuckles )
Hey, Chuny, what's
going on in there?
Abused kid.
You don't want to know.
You guys need
an extra set of hands?
It's Thomas.
Oh, man.
Hanging the first unit.
Switch out.
You look tired.
I just started.
Switch out.
I should have finished
my interview.
PEA at the scene.
There was a sock
shoved down his throat.
How many rounds of meds
did you give him?
Too many.
How much volume?
Third liter's going in.
I blew it.
Wendall...
We should pace him.
He's oozing from
his IV sites.
DIC. Call for cryo and FFP.
No, Pratt.
Anybody got an ETA
on the family?
Another epi, another atropine,
and let's treat the DIC.
He's a kid.
We're not stopping yet.
SAM:
Atropine's in.
Pratt, you want me
to switch in?
We need central access.
That won't change
anything.
Ray, throw in a femoral.
He's got two large-bore IVs
with good flow.
What's the time?
It's 43 minutes.
Family's here.
Why don't you go see
if they're ready to come in?
How is he?
This is Thomas's dad.
His injuries
are very severe.
Do you want to see him?
Sometimes it helps to see how
hard the doctors are working.
Casey, go back
and sit down.
I don't think
he needs to see this.
GARY:
I want to be with him.
I saw them.
Who?
I saw them pull Thomas behind
the swings after school today.
Who did you see?
They had a thing
about his clothes.
I gave him my shirt
yesterday,
but they still
wouldn't leave him alone.
Did they cut him?
I tried to get Thomas
to tell you,
but they said they'd kill
him if he said anything.
He was scared.
Everyone's scared of them.
Casey, tell me who they are.
I promise you'll be safe.
I still have to be in school
with them every day.
Who?
There's four of them.
They're sixth-graders.
PH is 6.8.
Amp of bicarb.
Hold compressions.
Okay, that's it.
6:25.
Please.
He's still got a rhythm.
A non-perfusing rhythm
at the rate of 28.
We haven't even tried
transcutaneous pacing.
48 minutes
of cerebral hypoxia.
How much fluid
did you give him?
Three liters of NS,
four of O-neg.
Ten rounds of epi
and atropine.
Pratt.
Greg.
GARY:
Oh, no!
He's fixed and dilated
with a pH that's not
compatible with life.
( sobbing )
Mr. Bryson,
Mrs. Bryson,
I'm very sorry.
( sobbing uncontrollably )
( sobbing continues )
( sobbing continues )
Hi.
Hi.
I was just about
to put this
in your box,
med student evaluations.
How's it going with him?
He's very thorough,
he's got a good fund
of knowledge...
That's not what I meant.
And I'm sorry I didn't get
to those time surveys today.
We're so screwed
at this point,
another day doesn't
matter.
What's going on?
Was Carter's press conference
really that big a deal?
If Keating-Ward pulls funding,
others will follow suit.
Drug companies don't want
to be associated
with a department
that overreacts
during a post-marketing
surveillance.
Well, Admin somehow always finds
the money to keep us open.
I could lose my job.
Why?
You didn't personally run
county health
into the ground.
No. But my tenure's up
for review and I'm way short.
They made you
department head.
I think you've
proved your worth.
The committee's only concern
is how much money I bring in.
That sucks.
I have to bring in
$100,000 a year
to even be in the ballpark.
There's a quota?
Oh, yeah.
We're being pimped out
by the University.
You don't bring in the cash,
you're out.
Pharmaceutical grants
are an easy way
to raise a bunch of money fast.
I can't lose my job.
I have Chuck and Cosmo now.
Just talked to the OR.
Lysander had a three-centimeter
diaphragmatic laceration.
Okay.
You saved his life.
We all miss things,
Pratt.
The social worker saw
this kid, too.
I pulled rank on her.
Attending trumps resident,
resident trumps intern,
we all trump the social worker.
It's a great system.
Most of the time it works.
How do you stand it?
What?
The responsibility.
Busy shift?
The usual. What about you?
What'd you do today?
Tried to sleep,
couldn't,
watched bad TV,
ate cereal.
I hate working nights.
Okay, bring it on.
Torticollis in Two
waiting for the
Benadryl to kick in,
and Tinea Capitis has
a scrip for Griseo,
but he needs to see
an attending.
That's it?
Yep, I'm outta here.
Hey, anyone wanna go
to Ike Ryan's?
Luka's working,
Alex is at a sleepover.
I need a drink.
No, thanks,
I'm exhausted.
Ooh, I'm in.
Dr. Lewis, the inventory
of teaching materials
you asked for.
Thank you, Jane.
You're the only person who
actually did what I asked.
Uh, textbooks and journals
are in the front section,
and computer stuff's
is in the back.
Alright.
Come on out with us,
I'll buy you a drink.
I can't.
There is something
you could do for me, though.
Shoot.
Write me
a recommendation.
Okay.
Way to work it, Jane.
Ray, you coming out
with us?
Oh, I never drink
with attendings.
Gets too weird.
Ray, the plumber came
and the shower's fixed.
Oh, hallelujah,
I love you.
You owe me 80 bucks.
Ready to sign out?
Please don't give me
the speech
about how we win some
and how we lose some.
I wasn't going to.
I didn't complete
my assessment.
I didn't do my job.
Well, what do you think
would have happened?
Please don't.
Don't what?
Try and cheer me up.
( sobbing ):
I should have
saved that kid!
Can I help you, sir?
Uh, no. Actually,
I'm looking for someone.
What's the name
of the party?
Really. I'm good. Thanks.
Oh, my God!
Oh, that's awful.
Hi.
I'm sorry, ladies.
I didn't mean to interrupt.
This will only take a minute.
Greg?
I went to work this morning
thinking about what you said.
What are you doing here?
And I just need
to tell you something.
The work that I do?
It's as real and as serious
as it gets.
I don't know how you define
an "adult,"
but I assure you,
I'm all grown up.
Look, I'm sorry,
I didn't mean to offend you.
I don't know what
you're looking for,
but I hope you find it.
Good luck.
Abby.
What are you doing here?
Big problem.
What?
You never signed off
on my ABG or IV placement.
So you staked out my apartment
so I could sign your book?
All student-teacher relations
have to be wrapped up
by tomorrow.
That is very important.
I see.
Sign it.
How do you know
where I live?
Residency office.
They just, uh, gave out
my address just like that?
You could have
been anybody.
It's disturbing, really.
They even gave me
your phone number, too.
Well, I guess they thought you
look like a nice boy.
I'm not that nice.
Maybe I should change my number.
Good idea.
Okay, well, congratulations,
Jake.
Your ER rotation
is officially over.