ER (1994–2009): Season 11, Episode 19 - Ruby Redux - full transcript
Jules 'Ruby' Rubadoux is back in the ER. He's still angry with Carter about the death of his wife.
Previously on ER:
What do you want
me to call you?
How about you
introducing me
as "Abby."
You don't want people
to know we're going out.
I'm Dr. Pratt.
Olivia Evans.
I'm with Cease-Fire.
"Cease-Fire"?
Violence prevention program?
What's she like?
She's a health
professional, Ray.
Don't be such a dog.
Where did
this happen?
23rd.
Wabash.
Uh, well, it-it
was near the corner.
Did you file a police report?
What's the point?
She and her sister
panhandle out on Wabash.
I give 'em a buck
once in a while.
I need this publication
for my chief resident
application.
Trust me, Morris,
it's going to take
a hell of a lot more
than that.
Yeah, I called Syd
and, no,
he doesn't have anything new
to show us.
We need
a new realtor.
He showed us
17 houses.
Not one of them
even close.
You don't think
the problem could
be us, do you?
All right, what
about this one? Nah.
You know,
it just doesn't seem fair
to schedule it like that.
You work all night,
now you got to rush
back, you're tired.
What do you mean,
I'm tired?
Do I look like I'm tired?
Of course not.
No, you look
chipper.
Oh, a smudge.
It's just
you're worrying so much.
You know, they don't
schedule tenure meetings
around the candidates.
Hey, at least you're
over-thinking
the wardrobe.
I am not worrying
and I am not over-thinking.
You know, tenure means
financial security--
we could get a house,
start a college fund
for Cosmo.
What if Cosmo
doesn't want to
go to college?
What?!
Baby, I can go back
to work.
I know.
And you can make
more money
at a private hospital.
No, it's not about
the money.
I want to be at County.
It's where I belong.
Okay, I'm going to
leave these here.
Promise me you'll
step over them.
I promise.
All right, I got
to go, baby.
I love you.
And you, too.
Oh, Susan...
All right, I have one
meeting after this,
and then
I will be home.
Susan...
How do I look?
You look great
except, uh...
Smudge!
( laughs )
( groans )
Jules Rubadoux, 85.
Who're you?
I'm Dr. Rasgotra.
You're a doctor?
You got a high school
diploma?
85, fainted.
I did not faint.
I was tripped.
It was witnessed.
Syncopal event
at his bridge club,
unconscious
30 seconds.
Who told you that,
those old geezers?
They're unconscious
most of the day.
Must've been a long ride.
Oh, tell me
about it.
Get out of here
and bring back the omelet!
Now!
Okay, we'll see
what we can do.
Delirium, tachycardia,
hyperthermia, mydriasis--
And it better not
have spinach in it!
What does that
make you think?
Don't try to get high
by snorting crushed
antihistamines?
I hate spinach!
Come on, guys,
this is classic.
Mad as a hatter,
red as a beet...
Dry as a bone?
Anticholinergic toxicity.
Bingo. What's your plan?
I.V., tox screen,
activated charcoal.
Yes.
What else?
EKG-- rule out
cardiac effects.
Mm-hmm.
Ativan for
the agitation.
Excellent.
And what happens
if the delirium worsens
despite benzos?
Physostigmine.
The only acetylcholinesterase
inhibitor
that crosses
the blood-brain barrier.
Everybody get that?
Where do I sign
to get out of here?
We need to examine
you first.
If I wanted help,
I wouldn't come
to this place looking for it.
I want another hospital.
We're just going
to check you out.
I don't want
this place.
It won't take long.
And I don't want
your doctors.
Dr. Carter,
we need you.
Okay.
Especially that one.
I don't want that one
anywhere near me.
He killed my wife!
Sam, what's the deal
with my lymphoma guy?
CT was ready for him
40 minutes ago.
Oh, man,
I totally spaced.
I'll go take him.
Uh, don't bother.
They've got a seizing
ICU player up there.
Be backed up for awhile.
Okay. Oh! Crap! Sorry.
That was the
Guatemalan blend.
I said I was sorry.
Come on, people.
Let's move some bodies.
Ray, transfer from
the Seashore House
with fever and incontinence.
I got stuck
with the last dump
from the Shore.
Abby, I'll trade you--
whatever you get.
No, Ray,
I don't think so.
Neela, 85 year-old
with syncope.
This is the one
you brought in.
The nasty guy that
yelled at Carter?
Afraid so.
And as much as I hate
doing this to you,
I'm outta here.
Exam Three.
And I've also served
on the curriculum
and admissions committees
for the last three years.
ANSPAUGH:
We appreciate that.
We're also looking for
excellence in teaching.
You've won
the resident
teaching award
three years running.
That's very impressive.
Almost seven years
as an attending,
only four
publications?
No original research?
Nothing as first author?
I just submitted a review
article on oligoanalgesia
and I have other studies
lined up.
I'm just waiting to hear
about the grants.
Emergency medicine's
a broad smorgasbord.
Sometimes it's hard
to find your niche.
Excuse me?
The university is willing
to float junior faculty
for a few years, but...
But tenured
attendings need
to demonstrate the ability
to carry their own weight.
You mean bring in grant money.
Okay, my focus
hasn't been research,
but I've spent
the last seven years
becoming a very good
clinician and teacher.
That's clear, Susan.
And we put a great deal
of value on that.
Well, I don't want you
to do anything
until I can talk
to my own doctor,
Stanley Obelmeyer.
Right. We have
a call in to him.
Yeah? Well, Stanley's
not going to like
what you guys are doing,
prodding me here.
Mr. Rubadoux,
I can't hear
anything
while you're talking.
Well, you've been listening
for five minutes.
You've been talking
for five minutes.
Did anyone ever tell you
you have a murmur?
A what?
A murmur.
It's the sound
of blood rushing
through the heart.
You think I have that?
I'm pretty
sure, yeah.
Oh, pretty sure?
Is that all you can say?
I'd like to run
some tests.
What tests?
EKG, chest X ray.
Look, no offense,
but I don't want some nurse
calling the shots
around here.
Mr. Rubadoux,
I am not a nurse.
I am a doctor.
Well, you're not my doctor
and I'm not going
to listen
to anything else
until I talk to him!
Okay.
Okay!
Geez.
I'm Dr. Pratt.
Can you take a deep
breath for me, please.
Sat's 88 on
a non-rebreather.
Is he dead?
Is my husband dead?
He's right
behind us.
The doctors are
working on him.
He's alive!
Whoa, whoa!
I'll get you next time,
you son of a bitch!
Wife fired a couple
of rounds to the
chest and abdomen.
Pulse 133, BP 90 palp,
went apneic in the rig.
Access?
Two large-bore IVs,
got a liter en route.
Another day,
another happy couple.
All right, on my count.
One, two, three.
Two of versed
right away.
Your husband stabbed you?
He cornered me in the kitchen,
had a knife to my throat.
Ooh! Definite
EtOH on board.
Have you been drinking,
Mrs. Casey?
I didn't know what to do,
so I grabbed his gun
from the kitchen drawer.
Decreased breath sounds
on the right.
You have
a collapsed lung.
I need to put in a tube
to re-inflate it.
Sam, you were supposed
to check
the airway boxes
this morning.
I don't think so.
According
to the schedule.
I thought it was Malik's turn.
All I know, we're out
of eight-ohs in there.
Malcolm, who's sorry
now, you bastard!
Chuny, what'd you do,
take a vacation?
Not my fault
Sam didn't stock
the shelves this
morning.
Tube.
I can barely palpate
a femoral.
Heart rate's up to 140.
Okay, hang the 0-neg
and call for type specific.
Ray, he needs an IJ.
And a surgeon.
O.R. Three's on hold.
You got this?
Uh-huh.
I need to check
next door.
How's she doing?
Her lungs are down.
She's stable,
but she's agitated.
Sam, where's that versed?
What are they
doing in there?
I was getting it.
Okay, I was
just right here.
I got it
covered, Luka.
Okay.
They better not send him home.
I'm changinq
all the locks!
I'm not going
to let him in!
Mary, Mary, you need
to calm down
and answer some
questions for me, okay?
Where are you?
Some hospital.
And what year is it?
2005.
Good. And where
do you live?
West Garfield.
West Garfield?
Do you got a problem with that?
Bilateral crackles,
three over six,
harsh systolic murmur,
JVD and the liver's down
four centimeters.
You heard him.
He doesn't want
to see me.
Why don't you present
to Kovac?
Tied up in a trauma.
We're still waiting
on a call from his doc
and the only way
I got him to calm down
was by promising
to bring in an
experienced physician--
which means an attending
which means you.
Any cardiac history?
Chronic CHF and evidence
of an old infarct.
HALEH:
I sent off troponins.
I'll get an EKG
when you're done.
ABBY:
And did Obelmeyer call yet?
Uh-uh.
Hello, I'm Dr. Carter.
Don't worry,
I remember your name.
Ten years,
I don't forget.
I understand...
Do you remember
my name--
Rubadoux?
It's a very unusual name.
You don't
even remember.
And you don't remember my wife
then, either, do you?
Just some other
old person,
give 'em the old song and dance
and ship 'em off.
Okay. Well, we're waiting
to hear from your doctor,
so in the meantime...
I knew she didn't have
much time left,
but why did you have
to put her through
all that?
My sweet Sylvie,
keeping a smile
every step of the way.
Let's take
a quick listen.
No, no, no, no, no.
I want my own doctor.
Uh, Mr. Rubadoux,
he's the attending.
He has to examine you.
What do you mean, "has to"?
What, is there a law
around here or rule
when you come into this place?
Yes, actually, there is.
All right, make it fast.
( wry laugh )
What was that about?
A very unsatisfied
customer.
He needs an echo.
Yeah, I called Kayson.
He's on it.
Radiology called
about that kid
with the huge head--
hydrocepha... something.
Hydrocephalus.
Yeah, I'll call neurosurg.
Even more of a handful
now than before.
You remember him?
Don't let him get
to you, Carter.
It was a long time ago,
and you were just a student.
Dr. Lewis,
thought you were off.
What're you doing here?
Don't ask.
I've been paging you.
I was in a meeting, Jerry.
I turned my pager off.
Got slammed with
a double trauma,
so as long as
you're here...
I'm not here!
The Chief Resident''
meeting
got changed
to 3:30.
What?
That's why I've been paging you.
I just worked all night.
I can't stay till 3:30.
( groans )
Rubadux?
Rubadoux, Sylvie.
How will this take?
Ten-year-old chart,
could be a while.
I'll wait.
Certainly thinks
highly of you.
Hmm. That's very flattering,
coming from him.
Oh, and don't get me wrong,
he was brilliant,
but he drove us crazy.
Made us do a full work-up
on every single sniffle.
Well, that's my Dr. Obelmeyer,
nothing if not thorough.
Dilated left ventricle,
gradient's 86.
Those calcifications?
Shh!
I'm listening to the doctor,
please.
Ejection fraction's
only 45.
But seeing
as he presented
with both syncope
and failure,
there's really
only one option.
Mr. Rubadoux, you have
critical aortic stenosis.
One of the valves
in your heart has narrowed.
We have to operate
to open that valve.
Operate?
Mm-hmm.
When?
As soon as possible.
Your heart's
not generating enough force
to push blood through
that constriction.
And you can do something
about that?
We have to run a few tests,
but yes, we can.
I'll talk to Anspaugh.
You check his BUN,
creatinine and order PFTs.
Hang in there, Mr. Rubadoux.
Call me Ruby.
Ruby.
Hey, pretty lucky, huh?
Same school as my doc.
Nothing personal,
but they both have
a little bit more water
under the bridge,
if you know
what I mean.
I know what you mean.
Did you understand
everything he said?
Yeah... Yeah, I-I need
a heart operation.
Do you have
any questions?
Heart surgery's
a big deal.
I know that.
What am I, an idiot?
Well, do you also know that,
given your age,
the risks of surgery
are higher.
What risks?
Complications.
I need to get
some more information
on your lung function
and your kidneys.
I have something wrong
with my kidneys?
No. I don't know.
I don't know yet.
Yeah, well, why don't you come
back when you're less confused?
Okay, Mr. Rubadoux,
I just want you
to understand
that this surgery
is very serious
and that
we don't know yet
if you're even
a good candidate
and that it's important you
consider all of your options.
Listen, doll...
can you fix my heart?
No.
Then I'm going
with the guy who can, all right?
Bye.
Prior MI, marginal
ventricular function
and his creatine's 2.3.
He's 85.
He has significant
coronary artery disease,
renal insufficiency
and a history of COPD.
What do you think
about his lungs?
We can go ahead
and check his PFTs,
but he's an old guy, they're
not going to be perfect.
Anything else you want
us to do down here?
Send coags, have him
typed and crossed.
Excuse me, I'm sorry.
Don't you think,
just maybe,
open-heart surgery
might not be such a
good idea for this man?
Don't you think, just maybe,
that's the surgeon's call?
Actually, no, I think
it's the patient's call.
This guy could spend
the rest of his life
on a beach in Miami
or hooked up
to a ventilator
here at County.
He wants the surgery,
Dr. Lockhart.
She's just trying to advocate
on behalf of her patient.
Well, the CICU's full.
Mr. Rubadoux needs a bed.
Perhaps she could advocate
for him up there.
Anspaugh's
on his way down.
What?
So, how's it going
in there?
I'll take
a 12-year-old gangster
over a domestic violence
case any day.
When she said she was
from West Garfield,
I figured I should
give you a call.
But I wasn't too sure,
if this was a Cease-Fire
kind of thing.
Every shooting is
a Cease-Fire
kind of thing.
And if she gets out
of this mess,
there's a lot
we could do for her.
I don't know, she seems
pretty far gone to me.
How do you stay
so optimistic?
How do you?
What, stay optimistic?
I don't.
Three years in this place,
I'm jaded as hell.
You just saw a drunk,
battered woman
who shot her abusive husband
and saw some hope
in the situation.
I did?
You wouldn't have
called me
if you didn't think
I could help.
I see right through you,
Dr. Pratt.
Is that right?
We'll follow up with her
after she's discharged.
Oh, so that's it?
You're done?
For now.
Well, shouldn't
you stick around?
I'm pretty sure she's bound
to have more questions,
once the sedation
wears off.
I'm sure you can handle it.
Yeah, but the thing is,
I don't know too much
about domestic violence
counseling.
I would love to give you
a lengthy tutorial
but I'm out of time.
How about later?
You can school me
over dinner.
Pick me up
at the office at 7:00.
( coughing ):
Is this going to take long?
REBECCA:
We already been here
quite awhile.
We'll need to be
going soon.
Well, you had
a low-grade
temperature
when the nurse
took it earlier.
Beautiful girl.
REBECCA:
Caramel skin.
Like a young
June Allyson.
Maureen O'Sullivan.
Susan Hayward.
Ava Gardner.
Myrna Loy.
Sophia Loren.
Sophia Loren?!
Okay, I heard some crackles
on the right side,
which could be a sign
of a lung infection.
You'll need to have
a chest X ray.
Crackles?
The other doctor didn't say
anything about crackles.
That's right.
You were in here
over a week ago.
You saw Dr. Lockhart.
Lovely woman.
Like a young Patty Duke.
Your aortic valve, right here,
is stiff and stuck shut.
What we're going do--
is we're going to cut out
all the stenotic material
and replace it
with a porcine valve.
So its definite
he's having surgery?
It is...
...isn't it?
I mean, it's...
It's the only way to go, right?
We could treat your condition
with digoxin and diuretics,
but that would just be
a short-term solution.
At this stage
of your disease,
surgery's the only
definitive treatment.
Just so you know, Dr. Anspaugh,
his FEV 1 is only 53%.
Thank you, Dr. Lockhart.
Make him NPO
after midnight.
And don't his decreased
lung capacity
and renal insufficiency
strongly con...
What I mean is: shouldn't we
be discussing the risks?
RUBADOUX:
We talked about
all that.
The risks, the complications,
the kidneys.
ANSPAUGH:
And we're going
to talk
about them again,
Mr. Rubadoux.
Call me Ruby.
Will you excuse me
for just a minute?
Certainly.
Dr. Lockhart.
I take it
you have a problem
with Mr. Rubadoux's
decision to have surgery.
I'm concerned it's not
an informed decision, yes.
And is that because you failed
to adequately explain the risks?
Do you think I would operate
on this man
if he didn't fully
understand the consequences?
Why would I do that?
Because I have nothing better
to do tomorrow?
No, certainly...
If you have concerns,
you ask the consulting doctor
to step outside.
You do not, in front
of a patient,
attempt to subtly disagree
with a senior cardiologist
and the Chief of Surgery.
That kind of behavior is
helpful to no one.
Do you understand?
Yes.
I have concerns.
JAKE:
Knowing you as
well as I do,
I'm going to guess you really
hate it when people do this.
Uh, with the
"come from behind,
and put your hands
over the eyes" thing?
Mm-hmm.
Yeah, words cannot express
exactly how much I hate it.
Pretty cool that I knew
that, don't you think?
Bad timing?
Yes.
You want to talk
about it?
No.
So I'm back.
Oh, my God, Jake,
I'm sorry.
I'm sorry.
How was San Francisco?
Amazing faculty,
lots of O.R. time.
I thought Boston was first
until I saw UCSF,
but, unfortunately,
it's a long shot.
Well, they wouldn't
have invited you
if they weren't
interested.
Hey, Frank,
where's Carter?
MRI.
Thanks.
So... UCSF, huh?
Yes. I liked it.
But, you know, I still
could match right here.
Yep.
What would happen
if I did that?
Well, Jake, then you'd be
working at County.
Dirk Harmon, 14, crashed
head-first into a retaining wall
while luging
down Sheridan Road.
Luging?
Street luge. Don't you ever
watch those guys on ESPN?
When do you watch ESPN?
Pulse 72, BP 112/65,
sats 100.
What's up?
I'm Dr. Pratt.
How fast were you going?
40, maybe 50.
All right.
Come on,
you guys.
He was one of
the top qualifiers
at Super Mass.
But I'm really
more into dual.
Where do you find hills
big enough in Chicago?
Luka.
You do snow too?
Totally.
Hello, everyone!
He just rammed his
head into a wall.
Yeah!
Yeah!
Hey, dude, my hands are numb.
Weird.
When did that start?
Just noticed it.
Pratt, hold the c-spine.
Let's move him
carefully.
Hey, I need to talk to you
about the Rubadoux thing.
Birdie Chaddock,
72-year-old female
with cough
and low-grade temp.
Sats are fine,
no shortness of breath.
Right middle lobe
infiltrate on the film.
She was your
patient last week,
so, perhaps, for
continuity of care...
She was in with
the same thing?
No, she had
facial contusions.
Her sister
was with her?
Oh, yeah, she's here
this time, too.
Okay, If she's got
family support,
treat her like an outpatient,
send her home.
They're panhandlers,
both of them.
Everybody's got
to make a living.
What is wrong with you?
She's not going to get better
back out on the streets.
Why don't you call
Social Services
to come down.
Maybe they can
hook her up
with elder assistance.
Now, they did express interest
in leaving as soon as possible.
Call Social Services.
Okay, about
Mr. Rubadoux--
nobody is painting him
a clear picture.
Surgery is a lousy choice.
It's his choice.
He does not have
an objective view.
17-year-old, avulsed finger.
Need you to sign so we can treat
without the parents.
How'd he do it?
Slammed his hand
in the car door.
Somebody needs to talk to him.
You're his doctor.
You're the attending.
And he's old school.
He needs to hear it
from a guy.
It's that time again--
Girl Scout cookies.
And I'm feeling
the pressure.
Okay.
Okay, I will find you
later, all right? Just...
Okay.
What is going
on with you?
Why do you keep
blowing this off?
I'm not blowing this off.
You just tried to stop
our conversation again
to buy Girl Scout cookies.
You need to talk
to this guy.
I'm not the one to do it.
Okay, I don't know
exactly what went on
between you and him,
but right now...
Okay, look, Abby,
every once in awhile
you're going to find
one of these old guys
who would rather be treated
by a gray-haired guy
with a white coat.
And you have to figure out a way
of getting through to them.
I have been trying
to do that for over an hour.
This guy's a wall.
Well, then you
did your job.
Move on.
Dr. Lewis?
( louder ):
Dr. Lewis?
Yes, Jerry?
Are you sleeping?
( saw buzzing )
Probably not, huh?
The chief residency meeting
is starting.
Thank you, Jerry.
Are you really up?
Because I have to leave now.
Yes, Jerry.
( saw buzzing )
1800 of solumedrol, going in.
What have you got?
Keep your eyes
closed, Dirk.
Traumatic C-spine injury,
I didn't want to just
yank the helmet off.
Pretty cool, huh?
Dude, one move,
they'll slice right
through your head.
Shut up, man,
this is gnarly.
Compared to
the Gravity Games,
this is nothing, man.
Except for a little
cord compression.
Anybody seen Carter?
No, he's probably at
the chief residency meeting
which is where Luka and I
are supposed to be.
Anspaugh wants
a central line
on our aortic stenosis
patient.
Pratt, go help Abby.
I'll finish that.
Okay. Sterile nines
and prep for acordis.
Nice suit, Morris.
Thank you.
It's important for
the Chief Resident
to project a certain...
professionalism.
And I must say,
life in the ER
doesn't offer enough
opportunity to dress up.
Sorry I'm late.
You haven't missed anything.
Dr. Lewis, if you don't mind...
The lights, please.
( clears throat )
The Chief Resident
in a busy urban ER
must wear many hats:
teacher, mentor,
counselor, friend.
( clears throat )
Over the course
of the next hour...
Hour?
I will review my
proposed strategy
for making
the Resident's schedule
and address how the new ACGME/
RRC work-hour mandates apply.
I will also identify
common stumbling blocks
that may affect a schedule
and present my patented
"win-win" approach
to problems and changes.
Next slide.
Whoa, you can't just leave.
Oh, yes, at our age,
we can.
I'm sorry that Social
Services is backed up,
but we actually need them
to see you before you go.
We saw them
the last time we were here.
Lovely woman.
Oh, a regular young...
No, no, God,
no, please.
Please, just...
Dr. Barnett,
we are grateful
and we're going to do
the best we can,
but it's important
that we leave now.
Don't cannot miss
the rush hour
at the el.
And if we got you
into any trouble.
I'm so sorry.
We could write
you a note.
I... a note?
It's just not going to be
good enough.
You see...
last week, two of my other
patients, they left on me,
and my boss is really
unhappy with me.
Oh?
Mm-hmm.
And he says if this
ever happens again,
they're going
to send me to...
Away?
Well, to... the morgue.
The morgue.
Yeah.
It's a big demotion.
He's clever.
Oh, yeah.
You got to
give him that.
Page me from MRI,
I want to see the scan.
Sam, what's going on?
Nothing.
I'm cleaning up
and restocking.
This about luge boy?
I can't believe you
were encouraging him.
I wasn't.
Pratt and Ray, that
I can understand.
Sam, I wasn't.
And you're overreacting.
( laughs )
A little bit?
Oh...
I'm just having
a bad day.
I have a headache.
Just... hey, just tell them
you want to leave early.
I'm fine.
No, really, just tell them
you want to go home,
and if there are any complaints,
they can talk to me, okay?
Okay.
Okay.
I'm okay.
Okay, aim your needle
inferiorly
and watch the screen
as you enter the vein.
How we doing,
Mr. Rubadoux?
I don't know,
you tell me.
You're doing just great.
Got a flash.
Guide wire.
( alarm beeping )
What's that?
What's going on?
It's okay, Mr. Rubadoux.
Throwing PVCs.
Pull back.
( alarm beeping )
Run of V-tach.
Abby, come on,
pull back.
I am, I'm nowhere
near the myocardium.
I don't feel right.
( alarm beeps )
V-tach again.
All right,
I'm coming out.
What's happening?
Hang in there,
Mr. Rubadoux.
A hundred of lido.
Mr. Rubadoux...
Mr. Rubadoux...
All right, let's get him
into a trauma room right now.
Come on, let's go.
With the Morris Modified
Circadian Scheduling System,
we can build some much-needed
flexibility into the program.
A sample sequence
might go like this:
three days, two off,
three evenings, two off,
three nights, two...
( pager beeps )
911. It's the ER.
Liar.
Morris, I apologize.
I'll put a hard copy of
the presentation in your box.
Yeah, that'd be great.
WEAVER:
Get on with it,
Dr. Morris.
Uh, three nights, two off,
and repeat until
the end of the block.
Next slide.
Good news, Social Services...
Hello.
Hi.
This is our niece
Shelley.
I just found out
they were here.
Thank you for
taking care of them.
We wanted to leave,
didn't we, Doctor?
Yes, we did try,
right?
You made us stay.
Yes, I did.
So now Shelley's here,
we can go with her.
Oh, no, no, no.
You have to wait...
Could we talk?
Oh, yes, go ahead.
That's fine.
Okay.
Listen, we're waiting
on Social Services
to come down here.
Yes, and they're wonderful,
they've been so helpful.
But, you know, it's been
such a long day
and they're both,
they're really getting tired.
It shouldn't be
too much longer.
They're both so stubborn,
those two.
I've been trying to get them
to move in with me.
You know, they just,
they want their independence,
so they can panhandle.
Isn't that unbelievable?
Yeah.
I told them that I could
get them right home,
into a hot bath--
our oldest moved in
with her boyfriend,
we've got the extra
bedroom now.
( stammering ):
I've tried everything.
I don't know
what else to do.
I don't know how
to make them accept
some family support.
Okay, let me talk
to them, all right?
Okay.
Birdie, Rebecca...
Still V-tach.
All right, another epi,
chase it with lido.
All right.
Switch out.
Set up to intubate.
What happened?
Anspaugh wanted
a central line.
It was going fine till
he started having
runs of V-tach.
Must have
an irritable myocardium.
360, clear.
No change.
Why's Anspaugh even
opening this guy up?
Critical A.S.
Epi's in.
Move that.
The man can't tolerate
a central line,
he sure as hell
isn't going to do
well in the O.R.
He wants the surgery.
So what?
So, we're giving it to him.
Those guys upstairs got
nothing better to do?
Oh, damn it.
I think I broke his rib.
All right, clear.
Normal sinus.
That's what I'm talking
about, Mr. Rubadoux.
The Chief Resident position
is 90% administrative.
Morris can handle that.
Yeah, but even the med
students think he's a joke.
Maybe we should get
someone from the outside.
That's very difficult
on the staff.
You came from
the outside.
How'd the Morris meeting go?
Oh, you just missed
a fascinating lecture
on circadian
scheduling.
We're not giving it to him,
though, right?
We're considering it.
Are you out of your mind?
Hey, if you don't show
up to the meetings...
I was stuck in a trauma.
What did Carter say?
Maybe we should vote.
You can't vote.
You weren't there.
Uh, I don't care.
I've been on 36 hours,
I have to go home.
And I'm late.
John, what happened
in that Morris meeting?
I don't know, I left.
Kerry's leaning
towards him.
Yeah, well, okay.
"Well, okay"?
We've had worse.
No, I don't
think so.
Well, then maybe
she won't give it to him.
Hey, Frank, can you
come and find me
when the labs are back
on Gase in Two.
Yeah, got it.
You were gonna take that haggard
mom, five kids, Exam Three.
Rubadoux's back to baseline,
he's complaining
about his chest tube and
telling the nurses, "No Jell-O."
Good.
And I told Kayson and Anspaugh
about the broken ribs
and the resultant
pneumothorax.
What about
the surgery?
Not right away.
They're going
to stabilize him in CICU
for a few days,
let the pneumo resolve,
but everyone
remains hopeful.
Just waiting on a bed.
Can I help you?
Yeah, how you doing, man?
I'm looking for Olivia Evans.
Supposed to meet her here.
She's in the back.
Follow me.
Okay.
WOMAN:
...and three grandmothers
reclaimed the corner
of 78th and Hermitage
by opening a bakery.
Turned one
of the roughest corners
in our city
into a coffee klatch.
( applause )
Dr. Pratt, just in time.
Everyone,
this is Greg Pratt,
he's an ER doc
at County.
( all greeting )
How y'all doing?
Dr. Pratt gets
to see firsthand
how senseless shootings
are overwhelming
our city's hospitals,
and we were just talking about
various job opportunities
in the neighborhood,
so maybe you'd
like to say something
about jobs in healthcare?
Um...
( chuckles )
Felix, get back here!
This is for
Tasha's ear infection,
twice a day for a week.
Holly's the one
with the ears.
Right, uh,
Tasha has the eczema.
Apply to the affected area
three times a day for a week.
Just like the ears.
Uh, no. Ears twice a day.
Rash, three.
Found him.
He was running off
with your hammer.
Thanks, Chuny.
Give me that.
No give me.
Just a minute.
( kids shouting )
I'm going to go.
I thought I'd say
good night.
Could use
a little help over here.
One, two,
three, four, five.
I'm off.
I'll be home by 8:00, want
to grab dinner at Intermezzo?
I'm kind of beat,
let's just stay in tonight.
Okay, see you later.
Good night.
Coffee?
Yup.
Sorry to hear it.
Really awful this
time of night.
Oh, I know.
When I was a student
on my surgical rotation,
Rubadoux's wife was very sick.
She was part of this
research study.
When her results, um...
when she was no longer useful,
there was a lot of pressure
to get her out, so I did.
I dumped her
into a nursing home.
Did she belong in one?
We all figured she'd end up
back in the hospital,
but she'd be on
the medical service
and not ours.
So?
Surgery dumps another
patient on medicine.
Happens every day.
I told Rubadoux that, um,
she was going to get better.
I told him that her situation
was going to improve.
I told him
what he wanted to hear.
You know,
when you're a student...
you know, you're so
desperate for approval,
you want everybody to like you.
You want your patients
to like you,
you want their families
to like you.
You got to be efficient,
too, though.
You got to impress
your superiors.
Yeah, you don't have to tell me,
I'm still on the bottom
rung of the ladder.
I mean,
when the Chief of Surgery
says get rid of her,
you get rid of her.
Yeah.
And then she came back
about three days later,
and she died and...
Rubadoux was so surprised.
I don't know.
Ultimately, it was
the attending's call.
It wasn't my responsibility.
You want to help
with this?
Take it easy, man.
You, too, man.
All right.
One of my guys has a
real thing for science.
Maybe I could bring him
down to County sometime,
have you show
him around?
Sure.
Some of these kids
have never been out
of the neighborhood.
They don't realize
there's a big city
out there.
Yeah, I know what you mean.
I was ten years old
before I saw Lake Michigan.
You're from
Chicago?
Mm-hmm.
Any relation to, uh,
Charlie Pratt?
Charlie Pratt
who works
for Parks and Recs
over on Lamont?
Yeah, the older
fellow.
No, I don't know him.
Hey, that was
a really nice
meeting tonight.
I gotta run.
Oh. Okay.
It's nice meeting you.
You, too.
You're still
speaking to me?
Yeah, I think so.
Because
I'm not sorry.
I wanted you to come
and see what we do
'cause you
never come on your own.
And I'm not apologizing
about the tuna
casserole,
but since you're being
such a good sport,
I'm willing
to buy dessert.
So... ice cream
or Key lime pie?
I'm sorry, what?
Dessert?
Um...
Past your bedtime?
No, no, it's just
that, uh...
I have this patient
I have to check
back on in the ER.
Well, then, um, I guess...
I guess you better be going.
I'll call you.
$15.95.
Where you going, Ray?
Look, I know I'm on
for another half-hour,
but I have taken
care of everything.
I filled in Abby
on all my cases.
Is Abby your attendant?
Right.
Uh, ulnar fracture
up getting casted in ortho,
malignant otitis
admitted to ENT,
tongue lac wants a vasectomy--
you know,
as long as he's down here--
going to follow up with urology.
Oh, and the Olsen twins,
they decided to leave
with their niece
and a z-pack,
follow up in a week.
What did Social
Services say?
They actually
didn't make it down.
I mean, in time.
But you released
them anyway?
I felt comfortable they had
a strong family support system.
These are the
panhandlers, right?
Mm-hmm.
But you felt comfortable
releasing them
to a family member,
who obviously hasn't been
that much of a help so far.
Their niece, yes, she has
admitted that it's been
a hard time getting them
to accept her help,
but they are moving in
with her now.
And is Social Services
going to do a follow-up?
I mean,
seeing as how
you prevented them
from doing their job today.
I will make those arrangements.
I need to know everything
about your patients.
I need to know the status
of every single one of them.
I need to know how they are,
where they are,
where they're going,
why they're going.
You're still an intern, Ray.
I'm the attending.
I'm responsible.
I'm... sorry.
FRANK:
Hernia guy's HMO
is refusing
to cover admission.
He's not stable for transfer,
I'm not discharging him home.
You want to tell
them that?
I'll call them.
Conscious sedation
for Mr. Garrity.
Kovac was there.
He can sign.
Okay.
You won't believe this,
but your tibial fracture is
requesting an organic cast.
I'll be right there.
Mr. Rubadoux?
I'm not feeling well,
so, if you don't mind...
I just wanted to...
say that I'm sorry.
I couldn't believe it
when I saw you.
You're still here.
Been ten years since
my... my Sylvie's gone
and you're still here.
Yeah.
Huh.
And you didn't even remember.
Oh, well.
( deep sigh )
They gave me
six other doctors, so...
I won't need you this time.
I made a mistake with your wife.
And I made a
mistake with you.
You don't think I know that?
Huh?
You don't think
I regret ever bringing my poor
Sylvie down to this damn place?
You and your
fancy tests:
"We'll put her through this,
we'll put her through that.
"Oh, Sylvie?
"Well, she'll practically
be back on stage,
dancing again."
Well, we did try.
You tried? You tried?!
It became a very
complicated situation.
And I didn't have
the experience
to handle it properly.
All you had to be
was a human being.
You lied to me.
And I believed you.
My Sylvie, my Sylvie...
she was really something.
Mr. Rubadoux...
...what you have wrong with
you-- aortic stenosis--
can oftentimes be
corrected with surgery.
But that doesn't mean
that that's the right
thing for you to do.
You're 85 years old,
you have chronic
respiratory problems.
The chances of you coming
through this surgery
and getting back to the shape
that you're in
right now, pretty slim.
If you go
ahead with it,
there is a good chance
that you will never
leave this
hospital again.
You'll be connected
to a ventilator
and you will live out
the remainder of your life
in the intensive care unit.
Now, without the surgery,
it's true you're not
going to get any better,
but I believe
that you will
leave this hospital
under your own power,
and you will have more time with
the people that you love.
You will have more time...
being the person
that you are today.
And, yes, ten years ago,
I lied to you about your wife.
But I am not
lying to you right now.
What do you want
me to call you?
How about you
introducing me
as "Abby."
You don't want people
to know we're going out.
I'm Dr. Pratt.
Olivia Evans.
I'm with Cease-Fire.
"Cease-Fire"?
Violence prevention program?
What's she like?
She's a health
professional, Ray.
Don't be such a dog.
Where did
this happen?
23rd.
Wabash.
Uh, well, it-it
was near the corner.
Did you file a police report?
What's the point?
She and her sister
panhandle out on Wabash.
I give 'em a buck
once in a while.
I need this publication
for my chief resident
application.
Trust me, Morris,
it's going to take
a hell of a lot more
than that.
Yeah, I called Syd
and, no,
he doesn't have anything new
to show us.
We need
a new realtor.
He showed us
17 houses.
Not one of them
even close.
You don't think
the problem could
be us, do you?
All right, what
about this one? Nah.
You know,
it just doesn't seem fair
to schedule it like that.
You work all night,
now you got to rush
back, you're tired.
What do you mean,
I'm tired?
Do I look like I'm tired?
Of course not.
No, you look
chipper.
Oh, a smudge.
It's just
you're worrying so much.
You know, they don't
schedule tenure meetings
around the candidates.
Hey, at least you're
over-thinking
the wardrobe.
I am not worrying
and I am not over-thinking.
You know, tenure means
financial security--
we could get a house,
start a college fund
for Cosmo.
What if Cosmo
doesn't want to
go to college?
What?!
Baby, I can go back
to work.
I know.
And you can make
more money
at a private hospital.
No, it's not about
the money.
I want to be at County.
It's where I belong.
Okay, I'm going to
leave these here.
Promise me you'll
step over them.
I promise.
All right, I got
to go, baby.
I love you.
And you, too.
Oh, Susan...
All right, I have one
meeting after this,
and then
I will be home.
Susan...
How do I look?
You look great
except, uh...
Smudge!
( laughs )
( groans )
Jules Rubadoux, 85.
Who're you?
I'm Dr. Rasgotra.
You're a doctor?
You got a high school
diploma?
85, fainted.
I did not faint.
I was tripped.
It was witnessed.
Syncopal event
at his bridge club,
unconscious
30 seconds.
Who told you that,
those old geezers?
They're unconscious
most of the day.
Must've been a long ride.
Oh, tell me
about it.
Get out of here
and bring back the omelet!
Now!
Okay, we'll see
what we can do.
Delirium, tachycardia,
hyperthermia, mydriasis--
And it better not
have spinach in it!
What does that
make you think?
Don't try to get high
by snorting crushed
antihistamines?
I hate spinach!
Come on, guys,
this is classic.
Mad as a hatter,
red as a beet...
Dry as a bone?
Anticholinergic toxicity.
Bingo. What's your plan?
I.V., tox screen,
activated charcoal.
Yes.
What else?
EKG-- rule out
cardiac effects.
Mm-hmm.
Ativan for
the agitation.
Excellent.
And what happens
if the delirium worsens
despite benzos?
Physostigmine.
The only acetylcholinesterase
inhibitor
that crosses
the blood-brain barrier.
Everybody get that?
Where do I sign
to get out of here?
We need to examine
you first.
If I wanted help,
I wouldn't come
to this place looking for it.
I want another hospital.
We're just going
to check you out.
I don't want
this place.
It won't take long.
And I don't want
your doctors.
Dr. Carter,
we need you.
Okay.
Especially that one.
I don't want that one
anywhere near me.
He killed my wife!
Sam, what's the deal
with my lymphoma guy?
CT was ready for him
40 minutes ago.
Oh, man,
I totally spaced.
I'll go take him.
Uh, don't bother.
They've got a seizing
ICU player up there.
Be backed up for awhile.
Okay. Oh! Crap! Sorry.
That was the
Guatemalan blend.
I said I was sorry.
Come on, people.
Let's move some bodies.
Ray, transfer from
the Seashore House
with fever and incontinence.
I got stuck
with the last dump
from the Shore.
Abby, I'll trade you--
whatever you get.
No, Ray,
I don't think so.
Neela, 85 year-old
with syncope.
This is the one
you brought in.
The nasty guy that
yelled at Carter?
Afraid so.
And as much as I hate
doing this to you,
I'm outta here.
Exam Three.
And I've also served
on the curriculum
and admissions committees
for the last three years.
ANSPAUGH:
We appreciate that.
We're also looking for
excellence in teaching.
You've won
the resident
teaching award
three years running.
That's very impressive.
Almost seven years
as an attending,
only four
publications?
No original research?
Nothing as first author?
I just submitted a review
article on oligoanalgesia
and I have other studies
lined up.
I'm just waiting to hear
about the grants.
Emergency medicine's
a broad smorgasbord.
Sometimes it's hard
to find your niche.
Excuse me?
The university is willing
to float junior faculty
for a few years, but...
But tenured
attendings need
to demonstrate the ability
to carry their own weight.
You mean bring in grant money.
Okay, my focus
hasn't been research,
but I've spent
the last seven years
becoming a very good
clinician and teacher.
That's clear, Susan.
And we put a great deal
of value on that.
Well, I don't want you
to do anything
until I can talk
to my own doctor,
Stanley Obelmeyer.
Right. We have
a call in to him.
Yeah? Well, Stanley's
not going to like
what you guys are doing,
prodding me here.
Mr. Rubadoux,
I can't hear
anything
while you're talking.
Well, you've been listening
for five minutes.
You've been talking
for five minutes.
Did anyone ever tell you
you have a murmur?
A what?
A murmur.
It's the sound
of blood rushing
through the heart.
You think I have that?
I'm pretty
sure, yeah.
Oh, pretty sure?
Is that all you can say?
I'd like to run
some tests.
What tests?
EKG, chest X ray.
Look, no offense,
but I don't want some nurse
calling the shots
around here.
Mr. Rubadoux,
I am not a nurse.
I am a doctor.
Well, you're not my doctor
and I'm not going
to listen
to anything else
until I talk to him!
Okay.
Okay!
Geez.
I'm Dr. Pratt.
Can you take a deep
breath for me, please.
Sat's 88 on
a non-rebreather.
Is he dead?
Is my husband dead?
He's right
behind us.
The doctors are
working on him.
He's alive!
Whoa, whoa!
I'll get you next time,
you son of a bitch!
Wife fired a couple
of rounds to the
chest and abdomen.
Pulse 133, BP 90 palp,
went apneic in the rig.
Access?
Two large-bore IVs,
got a liter en route.
Another day,
another happy couple.
All right, on my count.
One, two, three.
Two of versed
right away.
Your husband stabbed you?
He cornered me in the kitchen,
had a knife to my throat.
Ooh! Definite
EtOH on board.
Have you been drinking,
Mrs. Casey?
I didn't know what to do,
so I grabbed his gun
from the kitchen drawer.
Decreased breath sounds
on the right.
You have
a collapsed lung.
I need to put in a tube
to re-inflate it.
Sam, you were supposed
to check
the airway boxes
this morning.
I don't think so.
According
to the schedule.
I thought it was Malik's turn.
All I know, we're out
of eight-ohs in there.
Malcolm, who's sorry
now, you bastard!
Chuny, what'd you do,
take a vacation?
Not my fault
Sam didn't stock
the shelves this
morning.
Tube.
I can barely palpate
a femoral.
Heart rate's up to 140.
Okay, hang the 0-neg
and call for type specific.
Ray, he needs an IJ.
And a surgeon.
O.R. Three's on hold.
You got this?
Uh-huh.
I need to check
next door.
How's she doing?
Her lungs are down.
She's stable,
but she's agitated.
Sam, where's that versed?
What are they
doing in there?
I was getting it.
Okay, I was
just right here.
I got it
covered, Luka.
Okay.
They better not send him home.
I'm changinq
all the locks!
I'm not going
to let him in!
Mary, Mary, you need
to calm down
and answer some
questions for me, okay?
Where are you?
Some hospital.
And what year is it?
2005.
Good. And where
do you live?
West Garfield.
West Garfield?
Do you got a problem with that?
Bilateral crackles,
three over six,
harsh systolic murmur,
JVD and the liver's down
four centimeters.
You heard him.
He doesn't want
to see me.
Why don't you present
to Kovac?
Tied up in a trauma.
We're still waiting
on a call from his doc
and the only way
I got him to calm down
was by promising
to bring in an
experienced physician--
which means an attending
which means you.
Any cardiac history?
Chronic CHF and evidence
of an old infarct.
HALEH:
I sent off troponins.
I'll get an EKG
when you're done.
ABBY:
And did Obelmeyer call yet?
Uh-uh.
Hello, I'm Dr. Carter.
Don't worry,
I remember your name.
Ten years,
I don't forget.
I understand...
Do you remember
my name--
Rubadoux?
It's a very unusual name.
You don't
even remember.
And you don't remember my wife
then, either, do you?
Just some other
old person,
give 'em the old song and dance
and ship 'em off.
Okay. Well, we're waiting
to hear from your doctor,
so in the meantime...
I knew she didn't have
much time left,
but why did you have
to put her through
all that?
My sweet Sylvie,
keeping a smile
every step of the way.
Let's take
a quick listen.
No, no, no, no, no.
I want my own doctor.
Uh, Mr. Rubadoux,
he's the attending.
He has to examine you.
What do you mean, "has to"?
What, is there a law
around here or rule
when you come into this place?
Yes, actually, there is.
All right, make it fast.
( wry laugh )
What was that about?
A very unsatisfied
customer.
He needs an echo.
Yeah, I called Kayson.
He's on it.
Radiology called
about that kid
with the huge head--
hydrocepha... something.
Hydrocephalus.
Yeah, I'll call neurosurg.
Even more of a handful
now than before.
You remember him?
Don't let him get
to you, Carter.
It was a long time ago,
and you were just a student.
Dr. Lewis,
thought you were off.
What're you doing here?
Don't ask.
I've been paging you.
I was in a meeting, Jerry.
I turned my pager off.
Got slammed with
a double trauma,
so as long as
you're here...
I'm not here!
The Chief Resident''
meeting
got changed
to 3:30.
What?
That's why I've been paging you.
I just worked all night.
I can't stay till 3:30.
( groans )
Rubadux?
Rubadoux, Sylvie.
How will this take?
Ten-year-old chart,
could be a while.
I'll wait.
Certainly thinks
highly of you.
Hmm. That's very flattering,
coming from him.
Oh, and don't get me wrong,
he was brilliant,
but he drove us crazy.
Made us do a full work-up
on every single sniffle.
Well, that's my Dr. Obelmeyer,
nothing if not thorough.
Dilated left ventricle,
gradient's 86.
Those calcifications?
Shh!
I'm listening to the doctor,
please.
Ejection fraction's
only 45.
But seeing
as he presented
with both syncope
and failure,
there's really
only one option.
Mr. Rubadoux, you have
critical aortic stenosis.
One of the valves
in your heart has narrowed.
We have to operate
to open that valve.
Operate?
Mm-hmm.
When?
As soon as possible.
Your heart's
not generating enough force
to push blood through
that constriction.
And you can do something
about that?
We have to run a few tests,
but yes, we can.
I'll talk to Anspaugh.
You check his BUN,
creatinine and order PFTs.
Hang in there, Mr. Rubadoux.
Call me Ruby.
Ruby.
Hey, pretty lucky, huh?
Same school as my doc.
Nothing personal,
but they both have
a little bit more water
under the bridge,
if you know
what I mean.
I know what you mean.
Did you understand
everything he said?
Yeah... Yeah, I-I need
a heart operation.
Do you have
any questions?
Heart surgery's
a big deal.
I know that.
What am I, an idiot?
Well, do you also know that,
given your age,
the risks of surgery
are higher.
What risks?
Complications.
I need to get
some more information
on your lung function
and your kidneys.
I have something wrong
with my kidneys?
No. I don't know.
I don't know yet.
Yeah, well, why don't you come
back when you're less confused?
Okay, Mr. Rubadoux,
I just want you
to understand
that this surgery
is very serious
and that
we don't know yet
if you're even
a good candidate
and that it's important you
consider all of your options.
Listen, doll...
can you fix my heart?
No.
Then I'm going
with the guy who can, all right?
Bye.
Prior MI, marginal
ventricular function
and his creatine's 2.3.
He's 85.
He has significant
coronary artery disease,
renal insufficiency
and a history of COPD.
What do you think
about his lungs?
We can go ahead
and check his PFTs,
but he's an old guy, they're
not going to be perfect.
Anything else you want
us to do down here?
Send coags, have him
typed and crossed.
Excuse me, I'm sorry.
Don't you think,
just maybe,
open-heart surgery
might not be such a
good idea for this man?
Don't you think, just maybe,
that's the surgeon's call?
Actually, no, I think
it's the patient's call.
This guy could spend
the rest of his life
on a beach in Miami
or hooked up
to a ventilator
here at County.
He wants the surgery,
Dr. Lockhart.
She's just trying to advocate
on behalf of her patient.
Well, the CICU's full.
Mr. Rubadoux needs a bed.
Perhaps she could advocate
for him up there.
Anspaugh's
on his way down.
What?
So, how's it going
in there?
I'll take
a 12-year-old gangster
over a domestic violence
case any day.
When she said she was
from West Garfield,
I figured I should
give you a call.
But I wasn't too sure,
if this was a Cease-Fire
kind of thing.
Every shooting is
a Cease-Fire
kind of thing.
And if she gets out
of this mess,
there's a lot
we could do for her.
I don't know, she seems
pretty far gone to me.
How do you stay
so optimistic?
How do you?
What, stay optimistic?
I don't.
Three years in this place,
I'm jaded as hell.
You just saw a drunk,
battered woman
who shot her abusive husband
and saw some hope
in the situation.
I did?
You wouldn't have
called me
if you didn't think
I could help.
I see right through you,
Dr. Pratt.
Is that right?
We'll follow up with her
after she's discharged.
Oh, so that's it?
You're done?
For now.
Well, shouldn't
you stick around?
I'm pretty sure she's bound
to have more questions,
once the sedation
wears off.
I'm sure you can handle it.
Yeah, but the thing is,
I don't know too much
about domestic violence
counseling.
I would love to give you
a lengthy tutorial
but I'm out of time.
How about later?
You can school me
over dinner.
Pick me up
at the office at 7:00.
( coughing ):
Is this going to take long?
REBECCA:
We already been here
quite awhile.
We'll need to be
going soon.
Well, you had
a low-grade
temperature
when the nurse
took it earlier.
Beautiful girl.
REBECCA:
Caramel skin.
Like a young
June Allyson.
Maureen O'Sullivan.
Susan Hayward.
Ava Gardner.
Myrna Loy.
Sophia Loren.
Sophia Loren?!
Okay, I heard some crackles
on the right side,
which could be a sign
of a lung infection.
You'll need to have
a chest X ray.
Crackles?
The other doctor didn't say
anything about crackles.
That's right.
You were in here
over a week ago.
You saw Dr. Lockhart.
Lovely woman.
Like a young Patty Duke.
Your aortic valve, right here,
is stiff and stuck shut.
What we're going do--
is we're going to cut out
all the stenotic material
and replace it
with a porcine valve.
So its definite
he's having surgery?
It is...
...isn't it?
I mean, it's...
It's the only way to go, right?
We could treat your condition
with digoxin and diuretics,
but that would just be
a short-term solution.
At this stage
of your disease,
surgery's the only
definitive treatment.
Just so you know, Dr. Anspaugh,
his FEV 1 is only 53%.
Thank you, Dr. Lockhart.
Make him NPO
after midnight.
And don't his decreased
lung capacity
and renal insufficiency
strongly con...
What I mean is: shouldn't we
be discussing the risks?
RUBADOUX:
We talked about
all that.
The risks, the complications,
the kidneys.
ANSPAUGH:
And we're going
to talk
about them again,
Mr. Rubadoux.
Call me Ruby.
Will you excuse me
for just a minute?
Certainly.
Dr. Lockhart.
I take it
you have a problem
with Mr. Rubadoux's
decision to have surgery.
I'm concerned it's not
an informed decision, yes.
And is that because you failed
to adequately explain the risks?
Do you think I would operate
on this man
if he didn't fully
understand the consequences?
Why would I do that?
Because I have nothing better
to do tomorrow?
No, certainly...
If you have concerns,
you ask the consulting doctor
to step outside.
You do not, in front
of a patient,
attempt to subtly disagree
with a senior cardiologist
and the Chief of Surgery.
That kind of behavior is
helpful to no one.
Do you understand?
Yes.
I have concerns.
JAKE:
Knowing you as
well as I do,
I'm going to guess you really
hate it when people do this.
Uh, with the
"come from behind,
and put your hands
over the eyes" thing?
Mm-hmm.
Yeah, words cannot express
exactly how much I hate it.
Pretty cool that I knew
that, don't you think?
Bad timing?
Yes.
You want to talk
about it?
No.
So I'm back.
Oh, my God, Jake,
I'm sorry.
I'm sorry.
How was San Francisco?
Amazing faculty,
lots of O.R. time.
I thought Boston was first
until I saw UCSF,
but, unfortunately,
it's a long shot.
Well, they wouldn't
have invited you
if they weren't
interested.
Hey, Frank,
where's Carter?
MRI.
Thanks.
So... UCSF, huh?
Yes. I liked it.
But, you know, I still
could match right here.
Yep.
What would happen
if I did that?
Well, Jake, then you'd be
working at County.
Dirk Harmon, 14, crashed
head-first into a retaining wall
while luging
down Sheridan Road.
Luging?
Street luge. Don't you ever
watch those guys on ESPN?
When do you watch ESPN?
Pulse 72, BP 112/65,
sats 100.
What's up?
I'm Dr. Pratt.
How fast were you going?
40, maybe 50.
All right.
Come on,
you guys.
He was one of
the top qualifiers
at Super Mass.
But I'm really
more into dual.
Where do you find hills
big enough in Chicago?
Luka.
You do snow too?
Totally.
Hello, everyone!
He just rammed his
head into a wall.
Yeah!
Yeah!
Hey, dude, my hands are numb.
Weird.
When did that start?
Just noticed it.
Pratt, hold the c-spine.
Let's move him
carefully.
Hey, I need to talk to you
about the Rubadoux thing.
Birdie Chaddock,
72-year-old female
with cough
and low-grade temp.
Sats are fine,
no shortness of breath.
Right middle lobe
infiltrate on the film.
She was your
patient last week,
so, perhaps, for
continuity of care...
She was in with
the same thing?
No, she had
facial contusions.
Her sister
was with her?
Oh, yeah, she's here
this time, too.
Okay, If she's got
family support,
treat her like an outpatient,
send her home.
They're panhandlers,
both of them.
Everybody's got
to make a living.
What is wrong with you?
She's not going to get better
back out on the streets.
Why don't you call
Social Services
to come down.
Maybe they can
hook her up
with elder assistance.
Now, they did express interest
in leaving as soon as possible.
Call Social Services.
Okay, about
Mr. Rubadoux--
nobody is painting him
a clear picture.
Surgery is a lousy choice.
It's his choice.
He does not have
an objective view.
17-year-old, avulsed finger.
Need you to sign so we can treat
without the parents.
How'd he do it?
Slammed his hand
in the car door.
Somebody needs to talk to him.
You're his doctor.
You're the attending.
And he's old school.
He needs to hear it
from a guy.
It's that time again--
Girl Scout cookies.
And I'm feeling
the pressure.
Okay.
Okay, I will find you
later, all right? Just...
Okay.
What is going
on with you?
Why do you keep
blowing this off?
I'm not blowing this off.
You just tried to stop
our conversation again
to buy Girl Scout cookies.
You need to talk
to this guy.
I'm not the one to do it.
Okay, I don't know
exactly what went on
between you and him,
but right now...
Okay, look, Abby,
every once in awhile
you're going to find
one of these old guys
who would rather be treated
by a gray-haired guy
with a white coat.
And you have to figure out a way
of getting through to them.
I have been trying
to do that for over an hour.
This guy's a wall.
Well, then you
did your job.
Move on.
Dr. Lewis?
( louder ):
Dr. Lewis?
Yes, Jerry?
Are you sleeping?
( saw buzzing )
Probably not, huh?
The chief residency meeting
is starting.
Thank you, Jerry.
Are you really up?
Because I have to leave now.
Yes, Jerry.
( saw buzzing )
1800 of solumedrol, going in.
What have you got?
Keep your eyes
closed, Dirk.
Traumatic C-spine injury,
I didn't want to just
yank the helmet off.
Pretty cool, huh?
Dude, one move,
they'll slice right
through your head.
Shut up, man,
this is gnarly.
Compared to
the Gravity Games,
this is nothing, man.
Except for a little
cord compression.
Anybody seen Carter?
No, he's probably at
the chief residency meeting
which is where Luka and I
are supposed to be.
Anspaugh wants
a central line
on our aortic stenosis
patient.
Pratt, go help Abby.
I'll finish that.
Okay. Sterile nines
and prep for acordis.
Nice suit, Morris.
Thank you.
It's important for
the Chief Resident
to project a certain...
professionalism.
And I must say,
life in the ER
doesn't offer enough
opportunity to dress up.
Sorry I'm late.
You haven't missed anything.
Dr. Lewis, if you don't mind...
The lights, please.
( clears throat )
The Chief Resident
in a busy urban ER
must wear many hats:
teacher, mentor,
counselor, friend.
( clears throat )
Over the course
of the next hour...
Hour?
I will review my
proposed strategy
for making
the Resident's schedule
and address how the new ACGME/
RRC work-hour mandates apply.
I will also identify
common stumbling blocks
that may affect a schedule
and present my patented
"win-win" approach
to problems and changes.
Next slide.
Whoa, you can't just leave.
Oh, yes, at our age,
we can.
I'm sorry that Social
Services is backed up,
but we actually need them
to see you before you go.
We saw them
the last time we were here.
Lovely woman.
Oh, a regular young...
No, no, God,
no, please.
Please, just...
Dr. Barnett,
we are grateful
and we're going to do
the best we can,
but it's important
that we leave now.
Don't cannot miss
the rush hour
at the el.
And if we got you
into any trouble.
I'm so sorry.
We could write
you a note.
I... a note?
It's just not going to be
good enough.
You see...
last week, two of my other
patients, they left on me,
and my boss is really
unhappy with me.
Oh?
Mm-hmm.
And he says if this
ever happens again,
they're going
to send me to...
Away?
Well, to... the morgue.
The morgue.
Yeah.
It's a big demotion.
He's clever.
Oh, yeah.
You got to
give him that.
Page me from MRI,
I want to see the scan.
Sam, what's going on?
Nothing.
I'm cleaning up
and restocking.
This about luge boy?
I can't believe you
were encouraging him.
I wasn't.
Pratt and Ray, that
I can understand.
Sam, I wasn't.
And you're overreacting.
( laughs )
A little bit?
Oh...
I'm just having
a bad day.
I have a headache.
Just... hey, just tell them
you want to leave early.
I'm fine.
No, really, just tell them
you want to go home,
and if there are any complaints,
they can talk to me, okay?
Okay.
Okay.
I'm okay.
Okay, aim your needle
inferiorly
and watch the screen
as you enter the vein.
How we doing,
Mr. Rubadoux?
I don't know,
you tell me.
You're doing just great.
Got a flash.
Guide wire.
( alarm beeping )
What's that?
What's going on?
It's okay, Mr. Rubadoux.
Throwing PVCs.
Pull back.
( alarm beeping )
Run of V-tach.
Abby, come on,
pull back.
I am, I'm nowhere
near the myocardium.
I don't feel right.
( alarm beeps )
V-tach again.
All right,
I'm coming out.
What's happening?
Hang in there,
Mr. Rubadoux.
A hundred of lido.
Mr. Rubadoux...
Mr. Rubadoux...
All right, let's get him
into a trauma room right now.
Come on, let's go.
With the Morris Modified
Circadian Scheduling System,
we can build some much-needed
flexibility into the program.
A sample sequence
might go like this:
three days, two off,
three evenings, two off,
three nights, two...
( pager beeps )
911. It's the ER.
Liar.
Morris, I apologize.
I'll put a hard copy of
the presentation in your box.
Yeah, that'd be great.
WEAVER:
Get on with it,
Dr. Morris.
Uh, three nights, two off,
and repeat until
the end of the block.
Next slide.
Good news, Social Services...
Hello.
Hi.
This is our niece
Shelley.
I just found out
they were here.
Thank you for
taking care of them.
We wanted to leave,
didn't we, Doctor?
Yes, we did try,
right?
You made us stay.
Yes, I did.
So now Shelley's here,
we can go with her.
Oh, no, no, no.
You have to wait...
Could we talk?
Oh, yes, go ahead.
That's fine.
Okay.
Listen, we're waiting
on Social Services
to come down here.
Yes, and they're wonderful,
they've been so helpful.
But, you know, it's been
such a long day
and they're both,
they're really getting tired.
It shouldn't be
too much longer.
They're both so stubborn,
those two.
I've been trying to get them
to move in with me.
You know, they just,
they want their independence,
so they can panhandle.
Isn't that unbelievable?
Yeah.
I told them that I could
get them right home,
into a hot bath--
our oldest moved in
with her boyfriend,
we've got the extra
bedroom now.
( stammering ):
I've tried everything.
I don't know
what else to do.
I don't know how
to make them accept
some family support.
Okay, let me talk
to them, all right?
Okay.
Birdie, Rebecca...
Still V-tach.
All right, another epi,
chase it with lido.
All right.
Switch out.
Set up to intubate.
What happened?
Anspaugh wanted
a central line.
It was going fine till
he started having
runs of V-tach.
Must have
an irritable myocardium.
360, clear.
No change.
Why's Anspaugh even
opening this guy up?
Critical A.S.
Epi's in.
Move that.
The man can't tolerate
a central line,
he sure as hell
isn't going to do
well in the O.R.
He wants the surgery.
So what?
So, we're giving it to him.
Those guys upstairs got
nothing better to do?
Oh, damn it.
I think I broke his rib.
All right, clear.
Normal sinus.
That's what I'm talking
about, Mr. Rubadoux.
The Chief Resident position
is 90% administrative.
Morris can handle that.
Yeah, but even the med
students think he's a joke.
Maybe we should get
someone from the outside.
That's very difficult
on the staff.
You came from
the outside.
How'd the Morris meeting go?
Oh, you just missed
a fascinating lecture
on circadian
scheduling.
We're not giving it to him,
though, right?
We're considering it.
Are you out of your mind?
Hey, if you don't show
up to the meetings...
I was stuck in a trauma.
What did Carter say?
Maybe we should vote.
You can't vote.
You weren't there.
Uh, I don't care.
I've been on 36 hours,
I have to go home.
And I'm late.
John, what happened
in that Morris meeting?
I don't know, I left.
Kerry's leaning
towards him.
Yeah, well, okay.
"Well, okay"?
We've had worse.
No, I don't
think so.
Well, then maybe
she won't give it to him.
Hey, Frank, can you
come and find me
when the labs are back
on Gase in Two.
Yeah, got it.
You were gonna take that haggard
mom, five kids, Exam Three.
Rubadoux's back to baseline,
he's complaining
about his chest tube and
telling the nurses, "No Jell-O."
Good.
And I told Kayson and Anspaugh
about the broken ribs
and the resultant
pneumothorax.
What about
the surgery?
Not right away.
They're going
to stabilize him in CICU
for a few days,
let the pneumo resolve,
but everyone
remains hopeful.
Just waiting on a bed.
Can I help you?
Yeah, how you doing, man?
I'm looking for Olivia Evans.
Supposed to meet her here.
She's in the back.
Follow me.
Okay.
WOMAN:
...and three grandmothers
reclaimed the corner
of 78th and Hermitage
by opening a bakery.
Turned one
of the roughest corners
in our city
into a coffee klatch.
( applause )
Dr. Pratt, just in time.
Everyone,
this is Greg Pratt,
he's an ER doc
at County.
( all greeting )
How y'all doing?
Dr. Pratt gets
to see firsthand
how senseless shootings
are overwhelming
our city's hospitals,
and we were just talking about
various job opportunities
in the neighborhood,
so maybe you'd
like to say something
about jobs in healthcare?
Um...
( chuckles )
Felix, get back here!
This is for
Tasha's ear infection,
twice a day for a week.
Holly's the one
with the ears.
Right, uh,
Tasha has the eczema.
Apply to the affected area
three times a day for a week.
Just like the ears.
Uh, no. Ears twice a day.
Rash, three.
Found him.
He was running off
with your hammer.
Thanks, Chuny.
Give me that.
No give me.
Just a minute.
( kids shouting )
I'm going to go.
I thought I'd say
good night.
Could use
a little help over here.
One, two,
three, four, five.
I'm off.
I'll be home by 8:00, want
to grab dinner at Intermezzo?
I'm kind of beat,
let's just stay in tonight.
Okay, see you later.
Good night.
Coffee?
Yup.
Sorry to hear it.
Really awful this
time of night.
Oh, I know.
When I was a student
on my surgical rotation,
Rubadoux's wife was very sick.
She was part of this
research study.
When her results, um...
when she was no longer useful,
there was a lot of pressure
to get her out, so I did.
I dumped her
into a nursing home.
Did she belong in one?
We all figured she'd end up
back in the hospital,
but she'd be on
the medical service
and not ours.
So?
Surgery dumps another
patient on medicine.
Happens every day.
I told Rubadoux that, um,
she was going to get better.
I told him that her situation
was going to improve.
I told him
what he wanted to hear.
You know,
when you're a student...
you know, you're so
desperate for approval,
you want everybody to like you.
You want your patients
to like you,
you want their families
to like you.
You got to be efficient,
too, though.
You got to impress
your superiors.
Yeah, you don't have to tell me,
I'm still on the bottom
rung of the ladder.
I mean,
when the Chief of Surgery
says get rid of her,
you get rid of her.
Yeah.
And then she came back
about three days later,
and she died and...
Rubadoux was so surprised.
I don't know.
Ultimately, it was
the attending's call.
It wasn't my responsibility.
You want to help
with this?
Take it easy, man.
You, too, man.
All right.
One of my guys has a
real thing for science.
Maybe I could bring him
down to County sometime,
have you show
him around?
Sure.
Some of these kids
have never been out
of the neighborhood.
They don't realize
there's a big city
out there.
Yeah, I know what you mean.
I was ten years old
before I saw Lake Michigan.
You're from
Chicago?
Mm-hmm.
Any relation to, uh,
Charlie Pratt?
Charlie Pratt
who works
for Parks and Recs
over on Lamont?
Yeah, the older
fellow.
No, I don't know him.
Hey, that was
a really nice
meeting tonight.
I gotta run.
Oh. Okay.
It's nice meeting you.
You, too.
You're still
speaking to me?
Yeah, I think so.
Because
I'm not sorry.
I wanted you to come
and see what we do
'cause you
never come on your own.
And I'm not apologizing
about the tuna
casserole,
but since you're being
such a good sport,
I'm willing
to buy dessert.
So... ice cream
or Key lime pie?
I'm sorry, what?
Dessert?
Um...
Past your bedtime?
No, no, it's just
that, uh...
I have this patient
I have to check
back on in the ER.
Well, then, um, I guess...
I guess you better be going.
I'll call you.
$15.95.
Where you going, Ray?
Look, I know I'm on
for another half-hour,
but I have taken
care of everything.
I filled in Abby
on all my cases.
Is Abby your attendant?
Right.
Uh, ulnar fracture
up getting casted in ortho,
malignant otitis
admitted to ENT,
tongue lac wants a vasectomy--
you know,
as long as he's down here--
going to follow up with urology.
Oh, and the Olsen twins,
they decided to leave
with their niece
and a z-pack,
follow up in a week.
What did Social
Services say?
They actually
didn't make it down.
I mean, in time.
But you released
them anyway?
I felt comfortable they had
a strong family support system.
These are the
panhandlers, right?
Mm-hmm.
But you felt comfortable
releasing them
to a family member,
who obviously hasn't been
that much of a help so far.
Their niece, yes, she has
admitted that it's been
a hard time getting them
to accept her help,
but they are moving in
with her now.
And is Social Services
going to do a follow-up?
I mean,
seeing as how
you prevented them
from doing their job today.
I will make those arrangements.
I need to know everything
about your patients.
I need to know the status
of every single one of them.
I need to know how they are,
where they are,
where they're going,
why they're going.
You're still an intern, Ray.
I'm the attending.
I'm responsible.
I'm... sorry.
FRANK:
Hernia guy's HMO
is refusing
to cover admission.
He's not stable for transfer,
I'm not discharging him home.
You want to tell
them that?
I'll call them.
Conscious sedation
for Mr. Garrity.
Kovac was there.
He can sign.
Okay.
You won't believe this,
but your tibial fracture is
requesting an organic cast.
I'll be right there.
Mr. Rubadoux?
I'm not feeling well,
so, if you don't mind...
I just wanted to...
say that I'm sorry.
I couldn't believe it
when I saw you.
You're still here.
Been ten years since
my... my Sylvie's gone
and you're still here.
Yeah.
Huh.
And you didn't even remember.
Oh, well.
( deep sigh )
They gave me
six other doctors, so...
I won't need you this time.
I made a mistake with your wife.
And I made a
mistake with you.
You don't think I know that?
Huh?
You don't think
I regret ever bringing my poor
Sylvie down to this damn place?
You and your
fancy tests:
"We'll put her through this,
we'll put her through that.
"Oh, Sylvie?
"Well, she'll practically
be back on stage,
dancing again."
Well, we did try.
You tried? You tried?!
It became a very
complicated situation.
And I didn't have
the experience
to handle it properly.
All you had to be
was a human being.
You lied to me.
And I believed you.
My Sylvie, my Sylvie...
she was really something.
Mr. Rubadoux...
...what you have wrong with
you-- aortic stenosis--
can oftentimes be
corrected with surgery.
But that doesn't mean
that that's the right
thing for you to do.
You're 85 years old,
you have chronic
respiratory problems.
The chances of you coming
through this surgery
and getting back to the shape
that you're in
right now, pretty slim.
If you go
ahead with it,
there is a good chance
that you will never
leave this
hospital again.
You'll be connected
to a ventilator
and you will live out
the remainder of your life
in the intensive care unit.
Now, without the surgery,
it's true you're not
going to get any better,
but I believe
that you will
leave this hospital
under your own power,
and you will have more time with
the people that you love.
You will have more time...
being the person
that you are today.
And, yes, ten years ago,
I lied to you about your wife.
But I am not
lying to you right now.