ER (1994–2009): Season 11, Episode 5 - Intern's Guide to the Galaxy - full transcript

Previously on E.R.:

Got it!

They warned me about

this place.

They weren't kidding.

So this is
the second time

you've been wrong about
one of my patients today.

You know what?
It's the last.

I wonder where
the damn social worker is.

Covering two hospitals
by herself

till midnight.
That's my excuse
for being late.



What's yours
for being an ass?

Dr. Lewis?

When do you need me
to start?

Shock, shock,

epi shock, lido shock,

consider mag two grams,
shock,

Procainamide, shock,
consider bicarb shock.

epi shock, lido shock,

consider mag two grams,
shock,

lido shock,

consider mag two grams,
shock,

Procainamide, shock,
consider bicarb shock...

Oh...

( loud bang )
Shoot!



You're going?

Yeah.

I'm sorry.
Rounds start at 7:00.

It's barely even light out.

Yeah, well, welcome to my life.

Nice meeting you.

Killing my plants,
ignoring my bills...

get it together.

What's the loading dose
of amiodarone?

Neela, stop.

And remind me to buy
toilet paper

on the way home.

This is weird.

Don't you think
this is weird?

Am I destined to spend
the rest of my youth

in a fetid,
windowless hospital?

You needed a job.

Now you're here.
Quit whining about it.

Yeah, but I'm not sure
if this is what I want.

Well, fake it.

Does everyone know

that I had a complete meltdown
and quit?

Hey, Dr. Jumbo Mart,
how you feeling?

Need a doctor over here!

15-year-old multiple G.S.W.
to the right chest.

Tachy with shallow resps,

18 gauge
in the right antecube.

Hey, man, what's your name?

He's apneic.
Throw me the bag.

Sam, we need
a trauma room.

Nothing's open, we've got 'em
lining the hallways.

Get an attending.

Lewis is doing
a subclavian,

and Resneck's
coding a guy.

He lost his pulse.

RAY:
All right,
Starting compressions.

8-O and a mac two.

RAY:
Mig of epi.

Have atropine
ready to go.

Tube.
Neela,

could you open
the shirt, please?

I'm in.

Neela,
listen to the chest.

Neela, come on!

SAM:
I.V.'s infiltrated.

I'll give it endotrachially.

No breath sounds
on the right.

Okay, he needs
a chest tube.

You carry a scalpel?

RAY:
Yeah, bone saw's
too bulky.

Could you take over
for me, please?

No carotid.

Atropine and another epi.

40 French on a kelly,

right here.

Huge hemothorax.

How come nobody told me you were
such a bad ass?

ABBY:
Got a pulse.

Oh, that's what I like to see,
interns with initiative.

Come on, trauma two's open.

Someone
call housekeeping!

Next!

...And finally,
in curtain three,

we have three-year-old G.B.,

here with R.W.

R.W.?

HIPPA's gone crazy
with patient privacy.

What's R.W. stand for?

Really Whiny?

Refusal to walk.

Refusal to walk
has its own abbreviation?

LEWIS:
Neela,

what's your differential?

Septic hip.

Intra-articular
infection,

toxic synovitis,
osteo, sickle crisis

and avascular
necrosis.

What about the work up?

C.B.C., Sed rate, cultures,

X ray, ultrasound
and arthrocentesis

if there's an effusion.

First day back

and she's showing up
the rest of you bums.

Dr. Pratt, what's
the most common pathogen

in septic arthritis?

Dr. Barnett,
septic arthritis?

Um, med students--
for a new dishwasher

and a lifetime supply

of Ensure-- what is
the most common bug

in septic arthritis?

Staph aureus.
Staph aureus.

LEWIS:
Followed by Strep

and Hemophilus.

I've got to go. Chuck's in
the car with the baby.

Guess the Dream Team's
reunited.

( laughing ):
Cool.

Good morning, Urbanus.

Guess I'm with you
again?

KOVAC:
Over 60 in triage--

some of them were here
when I left last night.

Okay, Pratt, run the board.

Let's move
some patients, huh?

Okay, people, come on,
listen up.

For the past month,

we've been
cutting you newbies
a lot of slack.

You have?

Today, the training wheels
come off.

You're doctors now.

Time to stop thinking
like med students

and take on
a real patient load.
I want you

to discharge 25 patients
this shift... each.

25?

Just two an hour.

Med students, present
your patients to interns.

Interns run your cases
by me or an attending
before ordering

labs or scans.

All right, here we go.
Ray,

asthmatic in two.

Abby, P.P.D. reading.

Neela,

teenager with a cough--
something easy

to get you started.

25 each and I'm counting.

Only ones left.

I guess that makes us
a team.

Oh...

Jane Figler,
fourth-year medical student.

That was quite a flash
entrance you made.

Thanks.

With all the rumors
going around

about how you freaked out,

it's great how
you came in and...
Excuse me.

Can you sign
my procedure log?

Chest tube in your first
five minutes.

You trying to impress me?

Just so you know...

I don't want or need you
to go easy on me.

Believe me, I won't.

If you need help,
just ask.

Dude, I forgot--
Kuharczuk in curtain
four needs a pelvic.

You're signing out
a pelvic? That's weak.

I gotta get out of here, man.

I'm back in 11 hours.

She's yours.

By the way-- nice move,
starting late.

Makes internship shorter.

Okay, so, I gotta ask.

Why'd they kick you out
of Michigan?

Chocolate? Okay.

History of two ICU admissions

and a prior intubation
a few months ago.

We got to be aggressive
with this guy.

Chuny, chocolate?

Ah, no, thanks.
I'm trying to watch it.

You? You can eat
whatever you want.

Okay.

What do you need, Ray?

Could you please hit
our wheezer in three

with 60 of pred?

You got it.
All right.

Lesson number one--
feed the nurses.

It'll make your jobs
50% easier.

Hi. Chocolate?

Too early. We like bagels
in the morning.

No, no, no. Come on,
take one for later.

Ooh, hazelnut.

Where do we keep
the peak flow meters?

In drug lock up...

and yes, I will get it
for you, Ray.

You're the best, Sam.

Well, the result
is borderline.

But your use of steroids
and your recent incarceration

put you
at increased risk.

For what?

TB.

So I do have it.

Not necessarily.

Okay, can I see
a doctor?

Sir, I am the doctor.

We're going to get you
a chest X-ray

and a couple more tests.

So, do we call it positive
and treat with I.N.H.?

Let's see what
the chest X-ray says.

Does a positive P.P.D.

involve type-3 or type-4
hypersensitivity?

Sorry. Obscure question.

Just trying
to impress you.

NEELA:
Community-acquired
pneumonia, mycoplasma,

viral pneumonitis,
Reactive airways,

pulmonary edema,
tracheal foreign body...

Stop.

His chest is clear;
it's a cold.

Fluids, ibuprofen
and home.

I've got a guy
with an equivocal P.P.D.

and a butt-load
of risk factors--

does he have to take I.N.H.?

Well, call I.D.,
check it out.

Okay, let's
check it out.

No, no, he'll go look it up.

Doesn't take two
of you to open a book.

Delegate to your student
and find a new patient.

Look at that;
look at Ray.

He discharged
his second patient already.

Come on,
pick it up, ladies.

He's making you look bad.

Need a doc over here.

Hey, go.

Dropped right in front of us,
transient L.O.C.

Never even
signed in.

Hello, my name
is Dr. Rasgotra,

Can you tell me
your name?

Juan Enriquez.

Forgot to eat breakfast,
that's all.

Let's get him up.

Oh, he's bleeding.

Pulse is racing.

I'm okay...
Chuny, what's open?

Exam two.

I'm just gonna go home.

What are the bruises from?

I noticed them last night
on my legs,

but I didn't really think
much of it.

When I woke up
this morning, it
was much worse.

Six-year-old with
a lead level of 59.

The city notified
the family

three weeks ago
to come in.

Three weeks ago?

Okay, what does that tell us?

He's got bad parents?

No, It tells us
his lead exposure is chronic--

he's adapted to it.

If he was acutely poisoned
he'd have symptoms

and there's no way
parents would wait to come in.

Does this case
belong in the E.R.?

No. But they wouldn't wait
eight hours in this cesspool

unless they didn't have
someplace else to go.

System's broken, people.

Can't blame the victims.

Good morning, Mister... Lucas.

I'm Dr. Barnett.

Heard you have a lead problem.

Am I getting a shot?

No, man, we wouldn't do that
to you.

They, uh,

tested him at school.
I don't know
how he got it.

The city will send someone
to your house

to look
for lead sources.

He's always been sick,
born early.

But look at you now,
tough guy.

You a pro football player?

No.

He had breathing problems
when he was a baby.

How 'bout basketball?

Aren't you the new point guard
for the Bulls?

No, I'm in first grade.

Lucas, dude,
you're playing it cool

but I know you're famous.

So I'm going to have to ask
for your autograph,

okay?

Do a quick head to toe,
all right?

Hey, lead clinic, please.

Oh, and he had a seizure
once when he was two

when he was sick.

Febrile seizure.
It's very common.

Hey, it's Dr. Barnett
in the E.R.

I have a seven-year-old
with elevated lead

who needs chelation.

Okay. Thank you
very much.

Okay, you're all set.

A nurse will walk you
over to the clinic.

Okay. Thanks, Doc.

Punch it.

I'm going to sell
your autograph on eBay
for a million dollars.

A billion dollars.

All right.

Let's go.

Five minute discharge, boys.

Watch and learn.

URBANUS:
Are troponins useful

in ruling out coronary aneurysms
in Kawasaki's?

Aren't enough
good studies on kids.

So, do ex-preemies have a
problem with lead metabolism?

No. Patients will tell you all
kinds of irrelevant crap--

they don't know
what's important.

You were so patient
with the dad.

Well, the key is to look like
you're listening

while you're doing
your charting.

Multitask.

Guys, it is the key

to survival in the E.R.

Here you go.

Is that really the best advice
you can come up with?

Second best.

First was feed the nurses.

Well, they're students.

They should focus
on taking a thorough history

and learn about
efficiency later.

Med school teaches them
to practice medicine
in fantasy land.

We're never be able to clear out
that waiting room

if it takes us two hours working
up a slam-dunk case.

There's no such thing as
a slam dunk case.

Not when you're
an intern.

Suit up, we've got
a trauma coming.

46-year-old jet ski crash.
Bluntinjuries to head and neck.

Tachy and hypotensive,
78 palp.

G.C.S. 1,1,1 in the field.

Check on our asthmatic--

this may take a while.

Okay, on my count--
one, two, three.

Got a 911 page-- looks like
I'm in the right place.

Yeah. Jet ski accident.

Abby, your patient.

Too much trauma to the face.

can't evaluate the airway.
!
Poor aeration.
He's going to need a crike.

RAY:
Weak carotid.
Crike tray to me.

Can I hear some vitals?
How's our access?

One peripheral.

Start another one.

And hang a liter of L.R.

Do we have a pressure yet?
Get the rapid infuser.

His wife is here.

You got this?

WOMAN:
Oh, my God.

Ma'am, why don't we
give the doctors

a little room to work.

I'll explain everything
to you outside.

I'll take the airway.

Why don't you call
the blood bank.

Full trauma panel,
type and cross for six.

Sat's only 84.

We're going to need
a portable chest

and respiratory down here.

Get him a blanket,
he's cold.

Hi. I need four units of
O-neg in the E.R. please.

What happened
there, doctor?

That was your patient.

No. it's a trauma, no medical
record number yet. Thanks.

Don't say please and thank
you to the blood bank

and don't let the
boys bully you.

ABBY:
I-I wasn't
letting the boys...

You play with your hair
when you're nervous.
What?

He's clamped down.
I can't get a vein.

Get back in there.
Your patient needs
a central line.

Chest X-ray's clear,

C.T.'s negative, B.P. better
after two liters.

What does that mean, huh?
Is it bad?

It's too soon to make
any kind of diagnosis.

Just hang in there,
Mr. Enriquez.

Sounds like
the fluid helped you.

You ordered CT, films
and labs

without talking
to me first?

You were busy
and it seemed urgent.

Where's your student?

She's in sutures,
taking out stitches.

You know, I really
don't get it.

You're proactive, delegating,

and yet you're
still in last place.

Here-- med refill,
five minutes, go.

Ray and Abby are stuck
in the trauma,

this is your chance
to catch up.

Femoral's in.

Sats down to 78.
Mosquito clamp.

His neck's too mangled,
anatomy's distorted.

Feel the landmarks.

Jet skis account
for only 20%

of boats but are involved
in 44% of injuries.

Know why that is?

Dr. Lockhart?
No. 3-O nylon.

No is right.

No throttle, no steering,
no way to stop.

I still can't find...

You're fine.
Make your cut,

extend with the clamp.

Good.

Perfect.

Insert the tube.

So if this poor guy
hit a pylon

driving his jet ski
30 miles an hour,

what was the equivalent G-force
of the collision?

Got it. Give me the bag.

Seven Gs. This guy's
head was subjected

to seven Gs of force.
Think about it.

That's equivalent
to how many pounds?

We're doctors, not physicists.

Pressure's dropping.

V tach. Lost the pulse.
Take the airway.

Starting compressions.

An impact
of 990 pounds

dropped on his head.

That's what you're up against.

That's not all I'm up against.

You're going to shock him?

Charging at 200.

Uh-oh, Lockhart,
watch yourself.

I'm nowhere near the bed.
Exactly.

Clear.
Was I supposed
to grab

the paddles out
of his hands?

Mig of epi, have lido on deck.

You did it again.
Did what?

The hair.

I mean, eight years of school--

most people would
just like suck it up.

Diarrhea times 11 months.

What'd your parents say?

My dad would have
ripped my head off.

Why don't you start
the history and I'll catch up.

PRATT:
All right, guys,
talk to me.

Homeless guy
with gnarly feet--

clotrimazole,
new socks, home.

Seven-year-old
with lice.

Permethrin shampoo,

wash all the linens,
repeat in a week.

PRATT:
Good work, guys.

Keep 'em coming.

You're still in
the lead with 11.

Abby's at seven, Neela four.

Ray gets credit for those?

He's in the trauma-- he didn't
even see those patients.

He delegated.

The students are
part of his team.

That's not fair,
he's got two.

Can you handle two students?

JANE:
You better go
in with me.

There's a patient

crouched in the corner
and every time I go near her

she starts like,
yelling in Chinese.

That's galea we're looking at.
He's basically scalped.

Doesn't have to be pretty,

just tamponade the bleeding.

He's maxed out on dopa,
pressure still sucks.

Of course it does.
Why, Lockhart?

Spinal shock.
Yep. No sympathetic tone.

What do you want to do about it?

Epi drip.
Why?

Get the B.P. up,

increase the cerebral
oxygen delivery.

Right-- ready
for the cruel twist?

Systolic's 58,
come on, guys.

Epi drip, one mike
per kilo per minute.

Didn't I just say that?

Ischemic brain
needs oxygen.

But did you know oxygen

also forms free radicals
after traumatic injury?

Mother nature is such a bitch.

V tach.

No pulse.

Paddles to Lockhart.

ABBY:
Charge at 360.

Clear.

Free radicals cause
secondary cell death.
You following?

Clear.

Can we take a break
from chemistry class
while we code him please?

The difference between
a physician and a witch-doctor

is an appreciation of the
science beneath the disease.

These trauma algorithms
should be

automatic
for you by now.

Oh no... oh God.

Barnett, take over
compressions.

WOMAN:
Look at his face.

CARTER:
His brain is

gravely ill,

and it's starting
to compromise his heart.

I didn't see it happen.

I told him not
to rent that thing.

I'm sorry. His body
is shutting down.

Going again.

You know,
I was running this.

Really?
I hadn't noticed. Clear.

Procainamide.

What?

Fine. It's all yours.

Clear.

So why'd you decide
to come back then?

It's not like anything changed.

I don't know.

Neela, knee sprain
won't leave

until she gets a prescription
for some memory pill

she saw on TV.

Positive tox on
the kindergarten teacher.

Thanks.

Jane, get knee lady
out of here

and meet me in curtain two.

Yeah. What do you want me
to tell her about
the memory pill thing?

It's not an acute issue,
she can ask her primary doc.

Pratt, fix this order.

And please teach your
interns the difference

between micrograms
and milligrams.

What do you want
me to do?

I can't be with
them every minute.

Excuse me.

If I've made a mistake
on an order,

I'd appreciate it very much
if you'd confront me directly.

I'd like to be treated
the same as everybody else

and subjected
to the same scrutiny.

Neela, we weren't
talking about you.

Oh.

Pupils fixed and dilated.

No gag, no corneals.

ABBY:
Here. Sit down.

Thank you.

So what now?

We wait.

At least
he's in sinus.

All that means is that the
brain's no longer capable

of telling
the body to die.

Kovac needs some help.

I got it.

Elena Flemming, 32,
poly-pharmacy overdose.

Paramedics couldn't get a line.

I'll give it a try.

Elena, what'd you take?

Just the stuff that was
in my cabinet.

What was in
your cabinet?

Usual stuff, I don't remember.

Urbanus, catch the paramedics,

see if they got
any meds from the home.

What's your plan?

C.B.C., lytes,
serum and urine tox,

Tylenol and salicylate levels,

activated charcoal
and K.U.B.

to check for iron fragments.

Good. And call psych
and social services.

Elena, were you trying
to kill yourself?

I don't know.

Looks pretty rough in there.

The guy is brain dead.

Do they have kids?

Three.

They coming?

No, they're too young.

You okay?

Yeah, just part of the job.

Bruised guy's C.B.C.'s
finally back.

It's full of blasts.

You ever tell anyone they
had leukemia before?

Part of the job.

ICU can't find a bed
for our jet ski trauma

and they're not expecting
to find one any time soon.

Looks like this guy's
going to be with us for a while.

Why don't you call social
services for the wife.

Whoa. What are you guys

still doing here?

I can't send them out

until the chart's signed
by an attending.

Okay, a seven-year-old
was sent by the city

for a lead level of 59.

Asymptomatic, dispo to lead
clinic for chelation.

Did you get a repeat level?

Figured they'd
get it there.

Uh, come on.

Is that cool?

No, Ray, that's not cool.

You've been a doctor
for a month.

You know that you can't
sign off on a patient

before you run it
past an attending first.

So why don't you to get
a repeat level,

and then I'll
sign the chart.

Where are you going?

I need to go to church.

You're too sick to go
anywhere right now.

( muttering in Spanish )

I need to talk to you about
the results of your blood test.

Juan...

I got one in my eye now.

Look.

Your platelet count
is very low.

That's why you're
bleeding so easily.

( muttering in Spanish )

Juan, your blood smear showed
some abnormal white cells.

The abnormal cells are
crowding out the healthy ones

in your bone marrow.

( muttering continues )

Juan, please listen.

We can help you.

You can't... you can't help me.

Nobody can.

Yesterday I hit
a man with my car.

It was an accident,

but today I wake up like this.

Your blood pressure's
still a bit low.

You need to be in bed.

I want to review your smear

and check on a few more labs,
and then I'll be back

to go over everything with you,
okay?

( muttering in Spanish )

Why didn't you tell him
he has leukemia?

Overdose only had antacids
and a pretty full bottle

of Benadryl
in the medicine cabinet.

Okay, she'll sleep off
the antihistamine

and be good to go.

What the hell
is going on here?!

I've been here for almost
four hours

and there's nothing
wrong with me!

Sir, we honestly don't know.

You could have TB, even
though you don't feel sick.

We are going to recommend
treatment for nine months.

You want me to take medicine
for a disease

you don't even know
I've got?

Most people tolerate
the medicine well.

There are risks however...

You people are really something.

Mr. Decoyte...

I want a better doctor.

Whoa, whoa, whoa.

I'm Dr. Pratt.
Can I help you?

I've been here
all day

for a stupid skin test

and no one here seems to know
if I've got TB or not.

Sir, the safest thing
for us to do

is to treat it as if
you do have TB.

If I were in
your position, trust me,

I would do
the same thing.

Fine. Then get me out of here.

PRATT:
Please, have a seat
in the waiting area.

We'll get your discharge
paperwork and your prescription.

A good doctor knows how to make
"I don't know" sound reassuring.

Lymphoblastic leukemia has a
remission rate of over 80%.

How'd he take it?

Thought I should
know a bit

about the treatment
before I tell him.

Can you page
Oncology again?

Okay, halftime score--
Ray 14, Neela seven.

The nurses were
tied up in traumas.

It slowed things down.

Oh, so you're gonna
blame the nurses

while you're
sitting here

on your ass
browsing Medline?

Ray's using the
same nurses

and discharged twice
as many patients. My man.

All right, no more
than 10 minutes in the room.

At seven you start
saying your good-byes.

Which means you better start
wrapping things up in five.

Uh, there's...

a jammed finger
in sutures.

Go check it out.

Ray, how is it that you
get lice and athletes foot

and I get new-onset leukemia,
tertiary syphilis

and a referral from Kazakhstan?

Wow, you got some cool cases.

Our boy in four.

Think it could be
intussusception?

You get jammed finger,
I get intussusception.

Are you accusing me
of cherry-picking charts, Neela?

That hurts.

Evans Syndrome
with varicella,

unexplained vision loss,
idiopathic proteinuria,

LOC NOS, cystic
fibrosis with SBO.

Oh, and drug-seeking heroin
addict with a butt abscess

who threw an emesis basin
at my head.

Yeah, she was a winner.

Fine.
I'm just slow then.

You're not slow, you're
just... differently-abled.

Don't let Pratt
get to you, okay?

Abby's slower than you are, not
that he'd ever call her on it.

but attendings love her,
nurses protect her...

Must be nice to be
the teacher's pet.

Screw you, Ray.

Oh, hi.

Uh, good.
You're all here.

We didn't get to finish
talking about my research

with free radicals

and superoxide dismutase.

It's good stuff.
Hold up, hold up, hold up.

Come on, you might
learn something.

Step into my office.

Right over here.

Free radicals are the link
to so many disease processes

in the human body--
ischemia, cancer, aging...

I think that's a
permanent marker.

They form after tissue
is deprived of oxygen.

Why are they bad?

Lockhart, we went
over this in the trauma.

We did?

Okay.

What happens
when the radical

encounters mitochondria
of a healthy cell? Lockhart?

Why don't you let me do
some research on this

and I'll present to
you in the morning?

Easy question

and I just told you the answer.

Okay.

Let's try this.

Draw an oxygen atom.

I'm not trying
to trick you-- this is easy.

Just draw
an oxygen atom.

Look, you guys,

everything that we do in E.R...

every intervention,
ultimately

operates at a molecular level.

I don't understand
how any of you expects

to manipulate
the complicated machinery

of the human body

if you don't
understand the basics.

Okay.

There.

I've done
the hard part for you.

That's
an oxygen atom.

Now, all you have to do
is add the electrons.

I have patients to see.

You couldn't
tell, really.

You didn't
even seem upset.

I know how to draw
a damn oxygen atom.

That guy just
gives me the creeps.

Okay that's
truly disgusting.

Look, don't knock it.

It's fast, high in
protein and free.

Sutures is a la casa,

exam four, splint and home,

and fever and weight loss is
just waiting on a chest film.

Okay. Abby's 17, Neela 12--
that brings you to 21

It's only 4:00.

When I hit 25, can
I go home early?

Dr. Lockhart,
what have you got?

Diverticulitis versus
biliary colic in two.

In four, M.I. versus reflux,

and in three, sepsis
versus viral syndrome.

In admit,
Abby versus Ray.

Neela, you're getting
your ass kicked.

Start making decisions and
move those patients out.

Ray's logged 21 discharges
with three hours left.

Guess 25 was too easy.

Yeah, right.

I better up the
target to 30.

30?

Hey, double your speed.

You both
just might make it.

TAGGART:
Pratt!

Your lacrosse
player's sedated.

Come do his lid lac.

What? It wasn't like
it was my idea.

Dr. Barnett?

Wendall Meade,
Social Services.

Yes, I paged you
like four times.

Yeah. In like 15 minutes.

If I don't answer you
right away, there's a reason.

Okay. I need you

to talk to
trauma one's wife.

He's brain dead.

Interesting name,
Trauma One.

CARTER:
Ben Coleman.

Wife's name is Stacy.

He's an intern.

I see, so referring
to patients by name

instead of room assignment
is a second-year skill?

Did you go though the Care
Pathway with Ms. Coleman?

The what?

The checklist that
systematically covers

all post-mortem issues
with a patient's family.

You need a list

to check off questions
you'd ask anyway?

I'll see her
when you're done.

Contact dermatitis
versus candida.

Call it dermatitis.

Topical steroids
and send her home.

If it resolves,
we were right.

If it doesn't?

She'll come back.

Your overdose
is waking up

and here's the U.A. on
the tarantula dealer.

Ah... U.T.I. versus
kidney failure.

If I'm right, she takes
antibiotics and gets better.

If I'm wrong, she becomes
hyperkalemic and dies.

I'm trying to embrace
uncertainty.

Oh.

How am I doing?

Not so good.

You know...

you haven't had anything to
eat or drink all shift.

Go to Oncology and get a
copy of the chemo protocols.

Isn't that Oncology's job?

They said it might be
a couple of hours

before they get
to see him.

I want to be prepared
to cover all the bases

for when we go
back in there.

Uh... I'm on
an E.R. rotation.

Shouldn't I be,
like, cracking chests

instead of making copies?

I got a 15-year-old

skateboarder
versus fire truck.

Truck swerved
and missed him

but the ladder
clipped his leg.

Looks like an angulated tib-fib.

Leave him there. We'll find him
an open stretch of hallway.

I'll take this.
I've got it.

My med student's
driving me mad.

Wanna trade?

Were we that annoying?

I wasn't.
Hi. I'm Dr. Lockhart.

Does your arm hurt?

You got hit by a fire truck
and just broke a leg?

Lucky guy.

Hey!

Hello, in there!

We're your doctors.

We'll try to keep this brief.

My sister is coming.

How am I going
to tell our kids?

Well, the social worker
will be here to see you.

She can help you
with all that.

Would you like to
speak with clergy?

Any denomination?

Okay.

I'm sorry to have
to bring this up so soon,

but we only have
a limited amount of time

to make this decision.

Is it okay if I
don't tell them yet?

Have you thought about
whether you'd like

to donate your
husband's organs?

...I think it's okay.

Okay.

Let them have
one last night

before their lives
change forever.

Well, you're looking better.

( chuckles )

Just don't make me drink
any more of that mud.

Well, the
good news is...

Your tox screen
came back negative

and your EKG was normal,

so, from a medical
standpoint, you're clear.

Good.

Can I get out of here?

I wasn't trying
to commit suicide.

What were you trying to do?

Abby!

is the baby in three
a real ALTE

or just a
choking episode?

I don't know. I
haven't presented him yet.

The parents are refusing
blood draws and X rays.

Okay. I'll, uh... I'll go
find them when I'm done.

I need Psychiatry
to see you

before I can
send you home.

I'm not crazy.

Just stupid.

Abby!

Is I.V. contrast contraindicated

in someone with wheat
and peanut allergies?

I don't think so.

Can you find out?

C.T.'s calling for your MVA.

Okay, um, hold them off
and I'll look into it.

I'm going to page Psych for you
and get you an ETA, okay?

The condom broke.

Abby.

What?

Your abdominal pain's
gonna leave AMA

if he's not sent up
soon, that's what.

I tried to admit to Medicine
as a calculous cholecystitis,

but they think it might be

a retrocecal appendix.

Well, what do you think?

I don't know. I'm waiting
for Surgery to see him.

Keep it moving, Abby.
Three an hour now

if you're
gonna make it.

Thank you
for your concern.

So, the condom broke?

I'm a temp
at a commodities firm

and I slept with one
of the traders last night.

He left a note on my bed.

"I got HIV.
See a doctor."

Oh.

Five years of needles

and I managed
to stay negative

and I cleaned myself up,
turned everything around

and then because of one stupid
night, now I'm gonna get AIDS?

I can't get sick.

I have a kid.

( pager ringing )

( knocking )

Okay.

Just because you've been exposed
doesn't mean you're infected.

The incidence of transmission
from one exposure

is actually relatively low.

You know,

it might be better

if I told him
he has leukemia alone.

I wouldn't want to
cramp your style.

Seen Juan Enriquez anywhere?

That leukemia guy? He
was out here a while ago.

He's gone.
I'm sure
he'll be back.

There's another patient
in his bed.

Nobody would have

discharged him!

Damn it!

Doughnut?

He's gone.
Who?

My leukemia patient.

I'm such an idiot.

I hadn't even told
him he had cancer,

but I think he knew.

Okay, you're not making
a lot of sense right now.

He thinks he's being
punished by God

for something
that he did.

Should have realized
he was a flight risk.

No, no. If he was
set on splitting,

there's nothing you could
have done about that.

I could have told him
that it's treatable.

He has a good shot at
complete remission.

Look, there isn't enough time to
help the people who want help.

Don't beat yourself up
over the people who don't.

He was distraught,
and I left him alone

so I could go
and do research.

Dude, where'd you go?
Jane's gonna hang

with us, okay?

You seem stressed out.

It's about time
for the nurses'
nighttime feeding.

Better go.

Beastie Boys.

He's out.

Have you ever heard of...

prescribing prophylactic
triple cocktail

after a known HIV exposure?

Sure, the hospital
gives it to health
workers all the time

for needle sticks.
I'm not talking about

a health worker.

One of my patients
had unprotected sex

with an HIV-positive guy
last night.

Nah, it's really
only available

for occupational exposures--
too expensive.

Okay, on my count,

pull the distal
segment out and down

while I give
counter traction.

One, two, three.

Only healthcare workers
are worthy of HIV prophylaxis?

We can't give preventive meds
to every one-night stand

when we still can't
afford to treat people
who are actually...

I'm not talking about
every one-night stand.

I'm talking
about one patient

who's here now,
and she's asking
for my help.

And what about the patient
who walks in tomorrow?

And the next day?

Put him in a long leg splint

and stay with him
until he wakes up.

The guy'd been here
for eight hours

and hadn't been told
he had leukemia?

What the hell were
you waiting for?

Oncology couldn't
get down here,
and I was trying

to figure out exactly
what to tell him.

He wasn't gonna
hear anything after
you said cancer.

He was distraught--
I thought it was important
I get my facts straight.

Why didn't you call the
social worker, psych,
get a guard at the door?

Because I thought
it was better for him...
No, no, it's not about him,

it's about you and your
need to be perfect.

You need to stop being
a slow A-plus and start
becoming a fast B,

or you're not gonna make
it here as an intern.

Now, find him before he
bleeds out and he dies.

Yes, I'm looking
for funding

for HIV medication
for an uninsured E.R. patient,

so if anyone ever actually
checks this machine,

please call Dr. Lockhart
in the E.R.

What?

I look at you and Ray--
you're both so confident
in the traumas...

Neela, it's your first day--
give yourself at least a week

to be better than
the rest of us.

I don't even know
why I'm here.

Listen, every shift
at about this time,

I start fantasizing about
working in a tollbooth.

Neela, what's going on with
that football player in three?

Uh, knee pain times two days.

No drawer sign,
no A.P. or lateral laxity.

Point tenderness?

When he's bearing weight.

Rest,

ice and an ace wrap, right?

Yeah. Excuse me.

...with my husband?
I'm sorry, Mrs...

( screaming ):
No, you can't do this! No!

Looking good today,
Dori. Donut?

I'm not helping with
the dis-impaction.

Donut?
Babinka?

Don't act immune to my charms

just because you brought
your own sweets.

He does this every day?

Twice. Start of each
nursing shift.

And it actually works?
Apparently.

Abby, you're
lagging.
Yeah, well,

I have more patients
on the board than anyone else.

Which is meaningless
if you can't dispo
any of them.

You're taking up rooms,
jamming the flow.

You know, yesterday
I got a hot M.I.

to the cath lab
in 15 minutes,

reduced a perilunate
dislocation,

and caught a case of malaria.

Today I'm in some kind
of bizarre vortex.

Okay, okay, cough
times two days.

In and out.
Doubt it.

Probably turn into
myocarditis

versus tracheo-esophogeal
fistula.

You know, all of my patients
need three consults

and a huge workup,
and then even then,

there's no definitive
diagnosis.

Well, I guess...
No! And I'm not gonna pretend
things are cut-and-dry

just to get another
hash mark on your board.

I just want
one patient today

that has a clear problem
that I can help.

Okay.
Okay.

( clears throat )

Sam, how come Brennan still
hasn't gone to the scanner?

'Cause CT's been
backed up for hours.

Charlie's the CT tech
from 3:00 to 11:00.

He loves bear claws.

The rest of the donuts
go to the nurses' station.

Should I make sure someone sees
me so they know who it's from?

Yeah.

You don't find all this
wheeling and dealing
a little bit slimy?

Yeah, but sometimes you
got to play some games
to get stuff done.

Excuse me, ladies,
let's review the standings.

Ray still in the lead

with 25.
RAY:
Make that 26.

Ah. Abby at 19,
Neela brings up the rear

with 16.

File this under Neela.

And why would
you do that?

Because you'll owe me.

Hey.

There's a patient
with an E.R. wrist band

who's upstairs
in the chapel.

Been up there
a couple of hours.

Hey, where you going?
You're only at 16.

Uh, Employee Health.

This is Abby Lockhart
in the E.R.

I've been stuck by a needle.

Let's roll, guys.

Curtain two needs
a thumb spica,

and we need to take off
a toenail in four.

Dr. Barnett,
did you fill this out?
What?

This is the postmortem checklist
for the jet-ski guy

in Trauma One.
Ah, yeah, yeah.

And did you actually talk
to Stacy Coleman

or did you just
fill this out
to save time?

( chuckles ):
What?

Well, you checked off
that she wanted to have

her husband's organs donated.

She said she never
consented to that.

No-no-no-no-no.
I asked her all
the questions.

Well, a transplant surgeon

was just in there
prepping to harvest--

she thought her husband
was getting better, so...

Okay, can we talk about this
someplace else, please?

UNOS has already been
on the phone

with a college kid
from Madison

who thought she was
gonna be getting a heart.

Are you worried about
getting yelled at

in front of some
medical students?
The lady said

she was fine with it.
No, Ray, she did not!

Did you take the time
to make sure...

I asked her all
the questions.

Did you take the time
to explain it to her?!
How am I supposed

to take care of four
patients an hour...

Nobody said
this job was easy!

When you take shortcuts

and you drop details,
people get hurt.

We'll send this in
for hep B, hep C and HIV.

You can call tomorrow
for results.

And, uh... never stick your hand
in a full sharps container.

Stupid.

AZT and 3TC
in a combined pill.

The other is your
protease inhibitor,

B.I.D. on an empty stomach.

Two quarts of water a day,
and we'll see you

in two weeks
to check your LFTs.

Juan...

we've been looking
for you.
( whispering )

Have you been down here
the whole time?

( continues whispering )

Juan, you have leukemia.

Leukemia is
very treatable,

and you have
an excellent chance of a cure.

I know...

it feels like something bigger
than you is making this happen.

But something also led you here.

We will help you
get through this.

There's a reason why you came
to this hospital today.

Hey.
Hi.

I, uh, I heard you
got a needle stick.

You okay?

Oh, yeah.
I'm, yeah, fine.

You want to go home early?

No. I'm fine. Really.

Excuse me.

Hey, Wendall.
Yeah?

Did you get to
see my overdose?

Yeah, I left a note
in the chart.

Elena's able to contract
for safety.

I'm comfortable discharging
with outpatient follow-up.

Great.
Listen, I heard
about your needle stick.

Are you all right?
I am.

Page me if you want
to talk.
I will.

You're back.

Can I do anything?

Do you feel okay?
Yes, I'm fine.

A little woozy from
all the blood they took, though.

I'll get you some water.
Great.

Or maybe how about an iced tea
from across the street?

Yeah, you got it.
Thanks.

Hey, Sam, did
the radial fracture
get ancef'd yet?

Uh, yeah, just a minute.

I got to give this
message to Ms. Coleman.

Hey. I'll do it.

Mrs. Coleman?

They took him
to the morgue.

Your sister called.

She took your kids to
your house for the night.

Hey, I guess...

we had some kind
of misunderstanding
back there.

I'm not even sure
what it was about.

If there's anything I can do...

Can I call you a cab
or something?

I'm sorry for your loss.

Just the man
I was looking for.

Do you know how
often I hear that?

Are you okay in there?

Yes. It was just
a little mix-up.

What've you got there?

Um...

I need a favor.

I'm... into favors.

These are for my
patient in Exam Three,
but as you can see,

they have my
name on them.
HIV meds.

Yeah.

Do you have any friends
in the pharmacy

that could doctor
those labels?

Yeah, I think
I'm falling in love.

How was your first day?

Hard.

You gonna come back
tomorrow?

Yep.

Juan Enriquez's priest called,
still no word from him.

Actually, he's on
the oncology ward
starting chemo.

I found him
in the chapel.

( sighs ):
Oh, great.

Hey, thanks for
your help today.

Sure.

You off?

Yeah.

Yeah, me, too.

If you wait for a second,
I'll, uh, walk out with you.

Okay.

I, uh, think I hear
rounds starting.

Just make sure
you drink

at least two quarts
of water a day

and see your doctor
in two weeks

and get your
liver function tested.

I don't know what to say.

Thank you.

Sure. Take care
of yourself, okay?

Okay. Bye-bye.

Bye.

You have dinner plans
tonight?

No.

Maybe that was too subtle.

Would you like to have dinner
with me tonight?

It wasn't too subtle,
Urbanus, I got it.

Answer's still no?

Yeah.

Okay.

Good morning.

Hey, you buy your
T-shirt like that

or you just rip
it up yourself?

Hey, I met
my discharge quota today.

So did I.
Uh, not quite,
Dr. Barnett.

29. You're one
short, buddy.

After-work cocktail?

Totally gross.
After that,

let's go get
a real drink, then.

Mm, not a chance.
I'm exhausted.

Come on, guys,
Lewis is handing out
the paychecks today.

How can he still have
so much energy after
a day like this?

Well, work is easy
when you have the entire staff

literally eating
out of your hand.

I just don't understand
how he can finish

all his work exactly
at the end of his shift.

I still have, like, an hour's
worth of charting to do.

Two hours.
Hello, Abby, Neela.
Survive?

Okay, let's round,

so the day crew
can get out of here.

In two,
we have DZ with V and HA.

Finishing a liter,
P.O. challenge and home.

Oh, right, who can tell me

what the criteria is
for scanning a headache.

NEELA:
Worst headache
of a patient's life.

ABBY:
Thunderclap onset.

RAY:
Morning nausea.

NEELA:
History of trauma.