ER (1994–2009): Season 11, Episode 6 - Time of Death - full transcript
From 11:22 to 12:06 we can follow everything that happens to Charlie Metcalf (played by Ray Liotta), a patient who is at death's door. We are shown the minutiae of a treatment which are usually glossed over in the "regular" episodes, interlaced with images from Charlie's delusions which give an insight into the regrets he has about his wasted life.
( pounding machine )
( pounding machine )
( baby crying )
( shushing )
All right.
Who do I gotta screw to get
some health care around here?!
Well, honey,
why don't you try an intern?
They're always hard up.
Come on, Jeremy,
I'll take you back.
Where?
To see the doctor.
My dad here yet?
No. He's on his way.
Can I give my
ticket to you?
Just a little longer, sir.
D-D-Don't make me late.
My baggage already
went through.
Right.
Come on, Jeremy.
11-year-old boy
with multiple lacs.
Hey, how you
doing, little man?
TV fell on him.
Kids were
home alone.
Okay, we'll get
to him real soon.
Standard of care is primary
closure within six hours.
Standard of care
is for rookies.
Get him started, Jane. Dr. Pratt
will be right there.
And, I got a real
winner for you.
Belly pain with
combustible breath.
You talking about
that creepy homeless guy?
"Creepy" I'll give you, but
I don't think he's homeless.
How 'bout we wait
till he sobers up?
I'll be home
and in bed by then.
He needs to be
examined, Pratt.
I'll take care of it.
Thank you.
How long's he been here?
Oh, about two hours.
He thinks he's in an
airport or something.
He's altered?
Yeah, a little.
If you ask me, we need
to have one line
for legitimate patients,
another line
for all the rest.
Yeah, well, good thing
nobody asked you.
Luka, our UTI,
dislocated shoulder
and rapid hair loss all
need to be signed out.
I haven't been this starved
since the last
Burning Man festival.
Who wants some 'za?
You had a burger a
couple of hours ago.
Fast metabolism.
Pratt, wheezing guy was driving
insomnia lady crazy
so I moved him
into Exam Three.
Okay, beautiful.
Okay, who's the lucky bastard
that gets to take my blood?
I need CBC, LFTs and amylase.
I'll do it.
Is this about your needle stick?
Yeah.
You gotta do
what you gotta do, right?
Hey, this is Dr. Barnett
from County.
I'll take six-- no, no, no,
make that seven. I'll take
two pepperoni,
two sausage and pepper,
two Hawaiian
and one with the works.
It's, let's see,
11:23 right now.
So we'll get that
at 12:03, right?
All right, man. Cool.
Seven pies. What
the hell was that about?
Guaranteed delivery
within 40 minutes
or there's no charge, but
what the guy doesn't know
is that Wacker's closed
and the Loop
is a parking lot.
There is such a thing
as a free lunch, my friend.
Luka. Belly-pain guy's
going down.
Somebody bring a gurney!
Sir. Open your
eyes, sir.
Hey, doctor, no way. Uh-uh.
I was here before him.
Vitals were normal
when I triaged him
a couple of hours ago.
That nurse told me
I was next.
Diaphoretic, carotid's
weak and thready.
70 systolic.
Hey, is that what it takes,
huh? Flopping around
on the floor
like I'm dying?
Yeah, don't push me!
Watch me! Hey!
One, two, three.
Get him on O2 right away.
Here we go!
Hey! Look at me! Look!
My bag. My bag.
I want the bag?
I got it!
Stat EKG in case
he's having an M.I.
What about me, huh?
I could be having an M.I., too!
Any history
of hepatitis?
Abby, can you give us a hand?
What about
my blood draw?
I'll write you a note.
Get a 12-lead going.
Where am I?
Sam, you've got the IV.
Where am I?
What are you doing?
Okay. Hey, Pratt,
can you spare Jane?
Definitely.
Document everything we do
at the time we do it.
Isn't that usually
a nurse's job?
There's a nursing shortage,
Jane-- haven't you heard?
What are you doing? Stop!
Hey, hey,
hey, now.
Okay. I may not
always know
what to write.
We'll tell you.
Start with two liters of
02 at 11:25. Pulse ox 98.
Ow.
That's my bag.
Gimme my bag back.
I'll give you your bag back
right down here.
Get your hands
off of me!
Hey!
Calm down.
Knock it off.
Okay? We're here
to help you,
and we can try this
the nice way,
or we can try other options.
This is how you help?
Yeah, that's
right, sir.
Okay.
EEG is ten
centimeters.
EEG's printing.
Chart it.
11:26.
Got your line.
What do you want sent?
KOVAC:
Abby?
CBC, chem 20, PT/PTT,
troponin. Type and hold.
And add a serum ammonia.
EKG looks good.
Hey.
No ischemic
changes.
Excuse me. Excuse me.
Hey.
Hey!!
My name is Charlie.
Metcalf, okay?
Okay?
Okay.
Okay?
Okay.
Ouch! Don't.
Okay, okay. I'm not gonna
hurt you, okay?
Dr. Kovac.
Okay, let's get him gowned.
We need you to work
with us, Mr. Metcalf.
This'll be
much easier, okay?
What's the trouble?
Possible extensor tendon lac.
Okay. Can you move your
toes up and down?
How'd that happen?
My sister pulled
the television down on me.
It was an accident.
I guess it's true,
then, huh? TV really is
bad for kids.
KOVAC:
Where were your parents?
JEREMY:
My dad was at work.
KOVAC:
Baby-sitter?
We can't afford one.
I watch after Steffie.
Can't afford
a baby-sitter,
but they got
one big-ass TV.
Luka.
Somebody called the dad?
Yeah, the neighbor
who brought them in.
Get him cleaned up
and send for X rays.
We have three TVs.
That IV making you feel better?
Yeah. Yeah, look,
before-- I-I'm sorry.
I-I just...
Shh.
11:27. 300 cc bolus is in.
Pulse down to 110.
No murmur rubs
or gallops. Multiple
spider angiomas
on the chest wall.
Watch my stomach.
Watch my...
( Metcalf coughs )
You seen a
doctor lately?
Um, it's been a
of couple years.
Do you have
a primary-care physician?
No, not at the present time.
Need a 5-O nylon.
( groans )
Who were you seeing
a couple of years ago?
I don't remember the guy's name.
Some doctor in Taylorville.
Taylorville? You lived there?
Yeah.
There's a prison
there, right?
Yeah, it's
a correctional facility.
What's the big deal?
I knew somebody
who spent time there once.
Small world.
Positive fluid wave.
Liver's small.
JANE:
Ascites?
Yeah.
What's that?
It means you have fluid
in your belly.
So, what were you in for?
A mistake.
What, you mean
you weren't framed?
Spleen is enlarged.
Chart a BP. 100/70 at...
11:28.
Caput medusa.
What kind of mistake?
I killed a guy.
Palmar erythema
and muscle atrophy.
Oh, yeah? For what?
For asking too many damn
questions, that's for what.
Hemocue 7.2
My dad here yet?
No, not yet.
Hey, kid!
Don't look at him.
Just look this way, okay?
Hey, pally.
Don't worry about him.
Mr. Metcalf?
What?
Mr. Metcalf?
You're very anemic
and could be
losing blood
from an ulcer.
Are you a drinker?
( laughs ):
Yeah.
Were you drinking
in jail?
Yeah, but you're
not gonna rat me
to my parole board,
are you darling?
It's important we know
what you've been taking.
Pruno, breakfast of felons.
Now, I drink wine, beer,
anything I can get my hands on.
Pruno?
Yeah, it's fruit... ow.
fruit and bread
from the cafeteria.
You put it in
a garbage bag
with toilet water and
then you let it ferment.
Ow. Ow, ow, ow, ow.
Ferment where?
Under the bed.
Strain it through
your socks
and then you're ready to go.
If you're desperate enough,
it tastes like a martini.
Oh, yeah?
Yeah. You don't know
what it's like to need a drink.
I can imagine.
Okay. To check
for blood loss,
we're going to have
to do a rectal exam.
A what? No, no, no, no, no.
I spent the last nine years
avoiding rectals. No.
It's the only way
for me to know
that there's any
gastrointestinal...
You're gonna stick
your finger up my ass?
My gloved
and lubricated finger, yeah.
No.
I'm sure it's smaller
than your bowel movements.
Listen, boss-- exit
only. You understand?
Exit only.
If you're bleeding internally,
it could be life-threatening.
Okay. fine.
Can I...? Maybe we can
cover me up or something.
JEREMY:
I don't want it.
Would I hurt you?
No! I don't want it!
Look at me, I'm not going
to hurt you, okay?
I want my dad!
You don't
have to worry.
Where's my dad?
Look at me, I'm not
going to hurt you, okay?
I want my dad!
I don't want to get a shot!
Look at me. I'm not gonna
hurt you, okay?
Pally?
What's your name?
Jeremy.
Jeremy, you know,
the way I see it,
doctors are mean.
They wanna make us cry,
but you know what?
If you don't, I won't.
What do you say?
Let's show 'em.
Let's both not cry.
Okay, kid?
Okay, Jeremy.
It's okay.
It's okay. It's all right.
See?
( groaning )
That's it.
Don't worry
It's okay.
There it is.
Get that. That's it.
See? Hey, that wasn't
bad, was it?
We have to put a tube down your
nose into your stomach
to figure out
what's causing the bleeding.
No, the docs in the joint
gave me one of those
for my pancreatitis.
We're going to numb it up
so it won't be too bad.
Great.
We won't keep
the tube in
any longer
than necessary, okay?
Sit him up.
( groans )
You know, I used
to be an artist.
Open.
Pressure's up
to 110/76.
What kind of artist?
I-I did some painting.
A mural for my wife's church,
You know.
Mostly I, uh, I earned
my living as a contractor,
a carpenter-- that sort of
thing-- fixing old places up.
You all could use
my help around here.
Okay, if you swallow it
while we pass it,
it'll go down easier.
All right, all right, all right.
Okay.
It's going down.
Keep swallowing. It's
going down. That's good.
Very good.
All set.
Relax.
Okay. Hook it up to low suction.
Yeah, I was mixed up before.
I get confused in my head.
I-I-I'm better now.
Like you think you're
going on a trip?
When you were in
the waiting room,
you kept asking me what
time your flight was.
Sometimes it's a train or a bus.
Sometimes it's a boat.
One time, I was
getting ready to parachute.
So is that what the
suitcase is all about?
No, I always
have that.
You leave anything
behind at the flop,
it won't be there
when you get back.
The scumbags steal it.
NG output one liter at 11:32.
KOVAC:
Blood's too dark for an ulcer.
Varices?
What's that?
That's when the elevated
pressure in your liver backs up.
KOVAC:
The veins
of the esophagus
become engorged and fragile
and can bleed a lot,
sometimes uncontrollably.
Emesis basin!
Oh, you made me worse. Get...
Get it out of me.
Mr. Metcalf.
Get it out!
Okay.
That has to stay in.
Get it out of me!
Okay, soft restraints.
Get the tube out.
Pressure's dropping,
82/66, tachy at 130.
Another liter and two units
of type-specific,
and call G.I.
down here now.
Get these off. ( stammering )
Trauma One
is open.
Okay.
Mr. Metcalf, is there anyone
we can call for you?
You mentioned you had a wife.
No.
Children,
siblings?
No. No. Nobody that'll come.
Okay, let's get him
up to X ray.
Stef, you stay with him.
Okay, sweetie? I'll see you
back here in an hour.
Pratt, with us.
Make it four units
type-specific.
Type-specific'll take too long.
Get O-neg out
of the cooler!
Get these things off me.
Don't tie me down!
You can't keep
tying me down!
Let's go, people.
Prime the rapid infuser.
Subclavian
on the right?
Yeah. Prep the chest.
Let's go, people.
Prime the rapid infuser.
Subclavian on the right.
Prepping the chest.
O-neg here.
Squeeze in the first units.
Sam, second on the infuser.
Pratt...
Push the octreotide
You've been paying
attention, huh?
You need me
to do something?
Yes, cycle the dynamap
when it's ready.
A little sandostatin's
not going to make his
chances any better.
Diminished blood flow
through the portal system.
Yeah, but what's the point?
The odds of him making it
are what, 30%?
Another 200cc's
out the NG tube.
He's that sick,
even though he was
just lucid and talking?
He's right on the edge.
All he needs is a little push.
You know what, Pratt?
We got a lot
of hands in here.
If you don't
want to help...
So you want
attending now?
What, no one wants
to be a nurse anymore?
Pratt, come on.
Prick.
That's enough.
Heart rate's up
to 140.
Is he taking any meds?
Check his bag. He said all his
stuff is in there.
First unit's up.
11:35.
Pushing 15 mikes of octreotide.
All right.
The guide wire's
passing.
Yo, hair of the dog.
151 proof.
This guy's a class act.
Where are you with
your extension tubing?
What is your
problem, Pratt?
We're killing ourselves
for a non-compliant
alcoholic, ex-con drifter
with end-stage liver failure.
You want to get out?!
Then get out!
You know what? It's Friday.
I don't do lost causes
on Friday.
It's a religious thing.
Second unit's going in.
Is there anything else
in that bag
we need to know about?
No, but there's a picture.
It looks like him
and his wife and a kid maybe.
A bunch of letters
and a journal.
Pressure's 98 over 62
at 11:37.
I don't know.
Some kind of painting.
Where's my passport...?
Where's your what?
Give me my passport.
I can't go without my shoes.
Go where, Mr...?
Whoa, whoa, whoa.
Let me, let me go.
Let me go.
Head up to 20 degrees.
Let me go.
And check on G.I.
again.
Let me go. Thank you.
I'll be right back.
Get 'em off.
Get 'em off.
Do you have
a problem with me?
No.
Sam?
I was out of line.
Okay, let's go.
The guy's a waste.
Dying from something
that he's doing to himself.
Last time I checked,
alcoholism was still a disease.
So is suicide.
He should catch some of that
and save us the trouble.
We get ones
like this every day.
Then maybe I need
a day off.
This personal?
I guess.
Good.
You and I have
to talk about it.
You like riding me, don't you?
I don't think I do.
Ever since I was
an intern
you've been on my back.
Maybe a couple of times.
Why?
You're good, Pratt,
but I think you could be better.
There's a number
you wrote down here
with a name.
"Bobby?" Should we
call him, Charlie?
No. No, don't call him,
please.
I don't want anybody
to call him, okay?
No calling.
I-I don't want to see him.
I don't want to see him!
Mr. Metcalf, the veins
at the end of your esophagus
are bleeding a lot.
This is a result
of your cirrhosis.
That also means
you have less than
50% chance of surviving.
This is surviving
for how long?
A few months?
Months? Months? What?
Not that long.
PRATT:
What we need to know is
if you stop breathing
or your heart gives out,
do you want us
to use heroic measures?
Heroic what?
You want us to do CPR,
shock your heart
or put you on
a breathing machine?
Wait, wait, wait, wait.
You saying now?
You're, you're saying now,
you mean like, today?
No, no, no.
Look, no, I have
a lot of things
that I have to do.
I'm just not ready.
Okay.
I'm not ready. I'm, I'm...
Okay, the man wants it all.
Okay.
I'm Adler from G.I. How bad?
About 21/////2 liters of output.
Pre-load the scope
with a Saeed six-shooter.
What? What's a six-shooter?
We're going to look
down your esophagus
and try to band the veins
to stop the bleeding.
What's the deal
with your suction?
Turn it up.
I did.
Nothing's coming
out, great.
Check in two, Abby?
Jane, get on the phone
about a portable unit.
You guys have suction
in here?
Last time I checked.
What time is it?
11:40. Why?
They got 23 minutes,
or we're eating for free.
Is your patient stable?
Smoke inhalation
with wheezing.
Okay, we need the room.
You into pepperoni, Abby?
Do you have ADD?
Come on! Let's go.
Give us two minutes
to finish the...
We need it now, Ray.
We're good in here.
This guy may just need
to be tubed.
This guy might need
to be pronounced.
I hope you're not a veggie,
'cause I got meat on everything.
See you later.
Cetacaine and bite block.
A little more
numbing spray,
Charlie.
Push two of versed.
All right, Charlie,
once we're ready to start,
you're going to have to keep
this in between your teeth
because it stops you
from biting down
on the fiber-optic scope.
Check your monitor.
Is this Bobby, Charlie?
Is that your son?
Yeah.
And your wife?
Evelyn.
Pretty.
You want me to call her?
No, she's gone.
It's been a long time.
What about Bobby?
Must be all grown up
by now, huh?
Yeah, he's 19.
He's going to be 20 next month.
He's in college.
Let's try
to reach him, okay?
I haven't talked to him
since he was little.
His aunt gave me that number
when I got out of prison, but...
Well, it's all
the more reason
to use it now.
Let's pull the NG.
Okay, Charlie,
here we go.
( Charlie coughs )
( grunting )
How's his pressure?
108 over 58.
Okay, ready to go.
Hi, I'm looking
for Bobby Metcalf?
Okay. You know what?
Can you actually
wake him up for me?
( coughs )
Hi, Bobby, my name
is Samantha Taggart.
I'm an ER nurse at
the County General
in Chicago.
Grade-two varices?
Grade three.
Yeah, we have your father here,
and, uh... Yeah.
And he's pretty sick.
Four columns,
two hemorrhagic.
Two bands at each bleeding site,
one at the others.
SAM:
Uh, no, he's, well,
he's out of jail.
I don't know.
For a while, I think.
Systolic's down to 90.
Is there any way
you can come down here
and be with him?
Probably the versed.
500cc saline bolus.
Uh, no. You know what.
He can't talk right now
because he's in a procedure.
Sucking the varix into the cap.
Okay, hold on.
He wants to talk to you.
Sorry. That needs
to stay in.
And...
firing.
Okay, let's talk.
Okay, you guys,
I'm gonna put Mr.
Metcalf's son
on the phone
for a minute, okay?
( son breathing into phone )
Bobby?
Dad?
Is it you?
Yeah... it's me.
So you're sick huh? You dying?
No, no, no, no.
Nurse, is he dying?
He's very sick.
What am I supposed to say...
huh, Dad?
It's been a long time,
There's so many things I...
Yeah?
I don't know. I...
Hey, Dad?
Yeah?
Nice knowing you.
( receiver clicks )
( sobbing )
I told you you
shouldn't call him.
Firing.
Good.
Turn up my section.
Can you band it?
Not if I can't see it.
Mr. Metcalf?
Mr. Metcalf?
BP 62 over 38.
I can't even feel
a pulse.
Bobby?
Bobby?!
( whistles )
Bobby?!
He's bleeding out.
Okay, turn him over.
Another two units
on the infuser. Ambu-bag!
( birds chirping )
Come on in. The water's warm.
Try the femoral.
Get another
four units up here.
FFP after these two!
Hey! Hey, you dumb son
of a bitch!
Hey, you dumb son of a bitch!
Thought we lost you
there for a second.
Bobby?
Uh, we had him on the phone.
Is he coming?
No. No, he's not coming, man.
JANE:
BP's 86/42 at 11:44.
ABBY:
You want the FFP?
PRATT
Yeah, and another unit
of packed cells.
Dr. Kovac.
How long have you been
out of touch with him?
Your son.
Long time.
Since I went to prison.
Well, even in prison,
he's still your kid.
Blood's here.
You don't know what it's like.
I know if I had a kid,
I'd want to do
everything I could
to stay with him.
KOVAC:
I need a Linton tube,
Kelly and a 60cc syringe.
You think you know,
but you don't.
How it could all
switch on you.
How life could
turn on a dime.
Gets broke and you can't s...
you can't see a way to fix it.
KOVAC:
Mr. Metcalf,
the specialist,
uh, here thinks
we can control
your breathing
with the scope.
ABBY:
So you want a Linton tube?
METCALF:
Wha... What?
We pass a large balloon
into your stomach.
So it helps us keep pressure
on your veins.
All right, well,
what's to lose?
I'll test the balloon.
IT was April 10, 1992.
Bobby was turning eight.
My wife asked me to go get
some stuff for the party,
but I... I-I st...
I stayed so I could finish
putting together
this robot for him.
You know, so I made her go.
From the street,
I hear a thud...
and the scream.
And I go to the window
to look out.
And... and she's...
she's lying there
like she's asleep
on the street.
And the ice cream cake...
the ice cream cake was
all around her on the pavement.
SAM:
Five syringes.
So there I am,
there I am with this...
with this little boy to raise.
And what do I do?
I start drinking...
and getting high.
I couldn't keep it together.
I couldn't keep
it together.
And then I stabbed some guy
in a bar,
Just for... just for...
just for nothing.
For nothing.
'Cause he looked at me wrong.
SAM:
This one's good.
KOVAC:
We can go up to 750
for hemostasis.
Okay, ready,
Mr. Metcalf?
( coughs )
( gagging, coughing )
( coughing )
( gags )
( gagging continues )
KOVAC:
So, where was your son
after that?
With my wife's folks.
Listen for bowel sounds.
METCALF:
At first, they would bring him
by on visiting days, but...
after a while that stopped.
And then the letters started
coming back unopened.
You know what?
I-I-I-I don't feel good.
Something's wrong.
Something's wrong.
BUN 74, creatinine 8.2.
Okay, call renal
and throw in a Foley.
Hey, we should think about TIPS.
What's that?
KOVAC:
TIPS stands for
Trans-jugular
Inter-hepatic
Porta-systemic Shunt.
Uh, we put a catheter
from your neck to your belly.
By bridging the two vessels,
we can bypass the liver
and slow down the bleeding.
And how much time
would that give me?
It's hard to say.
No urine output.
ABBY:
Hepatorenal syndrome.
Your... your kidneys
are not working.
ABBY:
He needs dialysis.
PRATT
I'll make the call.
RAY:
GSW to the belly.
KOVAC:
Not here, Chuny.
There's nowhere else.
'Kay, move him over,
and keep traction
on the Linton.
Hold on.
'Kay, go ahead.
KOVAC:
Okay, let's transfer him.
One, two, three.
RAY:
There's no meds,
no allergies, no past history.
NG, Foley
and portable chest.
Bastard shot me
for stealing my own spliff.
I need another nurse in here.
Said it was his,
but it was mine.
Rolled it myself
this morning.
What's going on?
They just need
to stabilize him.
I want my own
damn room!
Get the hell out
of here, man!
Screw you, jerk-off.
KOVAC:
Okay, doctors only
talking now.
Damn, that's hard.
Even a gunshot wound
to the belly
don't buy a man
some privacy.
Ow!
KOVAC:
'Kay, two grams of Cefoxitin
I.V. piggyback.
That's a house
we rented one summer.
There was a lake nearby.
I-I took Bobby fishing...
Periumbilical GSW
with intestinal prolapse.
DUBENKO:
Hey, what about
the on-deck batter?
We're waiting
for a TIPS and IR.
DUBENKO:
That sounds bad.
Let's get him up for an ex-lap.
Portable monitor, let's go.
KOVAC:
What about X rays?
DUBENKO:
We'll get them upstairs.
RAY:
T minus eleven minutes
on those pizzas.
PRATT:
IR's already on the floor,
and Renal's on the way.
Luka, he's getting tremulous.
Haven't had a drink
since last night.
It's alcohol withdrawal.
Who's Dr. Pratt?
Hey, that'd be me.
Hey. Ramirez, nephrology.
All right, who's this guy?
We're gonna need
central access.
KOVAC:
He's got a subclavian.
That's great, let's consent him
and start the run.
What? What is he talking about?
He's here for
the dialysis that
we discussed.
I never discussed it.
You discussed it.
I never... I never
discussed it.
Alfonso,
how are you?
Is this a TIPS patient?
Yeah, and we
should go first.
Uh, wha... wh-what
are you talking about?
That's what's gonna
prolong his life.
RAMIREZ:
Yeah, without the dialysis,
he'll bleed out the minute
you spike through his liver.
What? What? Spike my liver?
Will his pressure
even tolerate dialysis if
the varices keep bleeding?
I-I don't understand.
I can support
his pressure.
The Linton tube
is supporting his pressure,
and only barely.
Wh-What are you
talking about?
Dr. Kovac.
Well, he's gonna need dialysis
three times a week.
Yeah, for the rest
of his life.
Hey... hey...
TIPS is not a cure.
It's a bridge to
a liver transplant.
We all know that's
not gonna happen.
Hey, hey,
hey, hey.
I'm right here.
Yeah.
Talk to me.
Sorry.
Now, you can't fix my kidneys?
You're gonna need dialysis,
three times a week.
And what about my liver problem
and the... and the bleeding?
The TIPS is
a temporary measure.
Your best hope is for
a liver transplant.
I-I-I don't understand.
Wh-Wh-What are the odds of that?
KOVAC:
Based on your history
of drinking,
not good.
Is there... is there any chance
that I'm gonna be walking
out of here?
With the dialysis
and the TIPS...
METCALF:
I mean today.
What are the chances that I'm
gonna walk out of here today?
None.
I-I-I don't want it.
I don't want anything, then.
If you don't have
the TIPS procedure,
we can't control the bleeding--
you'll die.
Yeah, I get it.
I get it.
Just stop everything.
No more
blood transfusions?
No breathing machine?
No, it's over.
No CPR?
No.
I need it to be very clear,
Charlie--
if we don't continue
with the treatment,
do you understand
what will happen?
Yeah.
Yeah.
Okay, Mr. Metcalf is a DNR.
11:57.
Wait, wait a minute,
wait a minute.
Hey, he's not competent.
Come on.
It's what he wants, Pratt.
Can you, uh...
can you do something for this?
Hey, could we put him
on an alcohol drip.
You gonna get me drunk?
Just enough to stop
the tremors, Charlie.
Charlie,
let us do the procedure.
You don't have to do this.
Just call...
could you, um...
try Bobby again.
Try my boy, get
him on the phone.
If he knows it's really over,
he'll come.
Okay? He'll come.
TAGGART:
Hey. Bobby Metcalf...?
Oh, yeah.
It's the hospital calling again.
Yeah, do you think
you could do that?
Okay, thank you.
What happened?
He went to class.
His roommate's going
to see if he can find him.
Can you take this out?
It's uncomfortable.
That tube's keeping you alive.
It's uncomfortable. Please.
Okay.
Is there, um...
is-is there a window?
Can you open a window
and get some fresh air in here?
Please?
Sam.
Please.
All right.
Here we go.
That's right,
blow it out.
( gags and coughs )
( gagging )
( passing traffic )
( people chattering )
( distant music playing )
What is that, Lincoln Street?
Harrison.
I worked here over a year,
and I never even
thought about
what's outside that window.
I've worked here six.
It's from the tube.
I'll take care of it.
Ten percent ethanol
at 100cc's an hour.
You know, your booze works fast.
Mad Dog IV, just for you.
All this stuff, you know,
it's just blinders.
It's just a screen.
I don't want anything
separating me
from what's happening.
I'm not gonna run and hide
from this.
Pulse ox and dynamap
can come off.
Last sat's 92.
My brother Lou died...
when we were kids.
My mom, she said...
Oh...
She said, "Charlie, Lou's
gone away on a long trip."
Don't you just
leave me here.
I want to see a doctor now.
Last B.P.'s 90/60.
When is my turn, huh?!
When's it going to
be my turn?! Huh?!
People!
When is it?!
When is my turn?!
170...
91...
What are you saying?
It's your vitals.
Is it starting?
What, Charlie?
Am I going?
It's starting.
Don't you people
have a system?
Isn't there
any method at all?
Don't worry, you won't be alone.
Good.
That's good.
Someone will stay
with you.
Sam, you got this?
Yeah.
Could you, um... touch me?
Sorry?
My face.
Please?
Maybe we should anchor.
What?
Do you think
we should keep going?
I don't know, Charlie.
What about him?
What do you think he wants?
I don't know.
I don't think he knows.
Is it too late?
Not if you don't
want it to be, Charlie.
( papers drop on floor )
Watch it!
Oh, no.
Oh, no.
Oh, no.
( tapping )
I feel drunk again.
Yeah.
Thank you.
Okay, Mr. Metcalf,
we're going to keep
a heart monitor on
and the alcohol drip
for comfort.
Okay.
But I'm going to take you
off the octreotide now
which is the last
support measure.
Okay.
It shouldn't be long now.
Okay.
I never believed in God.
That might bite me
in the ass now, huh?
God will get over it.
Do you need this?
Can I take it?
Take it.
Take it.
What?
What can I take?
No, never mind.
Never mind.
What's it going to be like
there?
Peaceful.
Come back.
Charlie.
Charlie...
Get all my stuff?
Oh, yeah.
Yeah.
Make sure he gets it.
I will.
Yeah, and give this to him.
You never knew your dad.
No.
That's too bad.
I don't let it bother me.
I bet it bothers him.
Bobby.
Let me in.
Open up.
Let me in.
BOBBY ( whispering ):
Charlie, can you hear me?
Charlie, can you hear me?
( quietly ):
Hey, pally.
You made it.
Uh, how do I look?
( whispering ):
You look okay.
I'm so sorry.
( breath quivering )
I'm so sorry.
( sniffling )
Oh, don't think about that.
Okay?
Just take it easy.
( quietly ):
It's okay... son.
It's...
( heart monitor flatlines )
( sniffles )
Um...
( sniffles )
12:04.
Oh.
( Pratt sniffling )
I'll take that.
( sniffling )
( sighs )
Can someone just
tell me that?
How much longer?
Ma'am, you need
to wait in the room.
Oh.
Let's go.
Well, it's about time.
You been with the same patient
for almost 45 minutes.
Whatever happened to "treat 'em
and street 'em" Pratt?
Do as I say,
not as I do.
All right, well, the TV
kid's back from X ray.
He's in triage with his dad
and his sister.
Things go south?
He was a nice guy.
Just a drunk.
All right, well, there's pizzas
over here if you get hungry.
Got you one with anchovies.
Oh, and the delivery guy
got here at 12:04.
You know what that means?
It means he didn't
make it on time.
No, it means lunch is
on the house, my friend.
Hey, Jeremy,
little man,
back so soon?
How are you doing?
I'm Dr. Pratt.
Yeah, I'm the one
who treated your son.
( pounding machine )
( baby crying )
( shushing )
All right.
Who do I gotta screw to get
some health care around here?!
Well, honey,
why don't you try an intern?
They're always hard up.
Come on, Jeremy,
I'll take you back.
Where?
To see the doctor.
My dad here yet?
No. He's on his way.
Can I give my
ticket to you?
Just a little longer, sir.
D-D-Don't make me late.
My baggage already
went through.
Right.
Come on, Jeremy.
11-year-old boy
with multiple lacs.
Hey, how you
doing, little man?
TV fell on him.
Kids were
home alone.
Okay, we'll get
to him real soon.
Standard of care is primary
closure within six hours.
Standard of care
is for rookies.
Get him started, Jane. Dr. Pratt
will be right there.
And, I got a real
winner for you.
Belly pain with
combustible breath.
You talking about
that creepy homeless guy?
"Creepy" I'll give you, but
I don't think he's homeless.
How 'bout we wait
till he sobers up?
I'll be home
and in bed by then.
He needs to be
examined, Pratt.
I'll take care of it.
Thank you.
How long's he been here?
Oh, about two hours.
He thinks he's in an
airport or something.
He's altered?
Yeah, a little.
If you ask me, we need
to have one line
for legitimate patients,
another line
for all the rest.
Yeah, well, good thing
nobody asked you.
Luka, our UTI,
dislocated shoulder
and rapid hair loss all
need to be signed out.
I haven't been this starved
since the last
Burning Man festival.
Who wants some 'za?
You had a burger a
couple of hours ago.
Fast metabolism.
Pratt, wheezing guy was driving
insomnia lady crazy
so I moved him
into Exam Three.
Okay, beautiful.
Okay, who's the lucky bastard
that gets to take my blood?
I need CBC, LFTs and amylase.
I'll do it.
Is this about your needle stick?
Yeah.
You gotta do
what you gotta do, right?
Hey, this is Dr. Barnett
from County.
I'll take six-- no, no, no,
make that seven. I'll take
two pepperoni,
two sausage and pepper,
two Hawaiian
and one with the works.
It's, let's see,
11:23 right now.
So we'll get that
at 12:03, right?
All right, man. Cool.
Seven pies. What
the hell was that about?
Guaranteed delivery
within 40 minutes
or there's no charge, but
what the guy doesn't know
is that Wacker's closed
and the Loop
is a parking lot.
There is such a thing
as a free lunch, my friend.
Luka. Belly-pain guy's
going down.
Somebody bring a gurney!
Sir. Open your
eyes, sir.
Hey, doctor, no way. Uh-uh.
I was here before him.
Vitals were normal
when I triaged him
a couple of hours ago.
That nurse told me
I was next.
Diaphoretic, carotid's
weak and thready.
70 systolic.
Hey, is that what it takes,
huh? Flopping around
on the floor
like I'm dying?
Yeah, don't push me!
Watch me! Hey!
One, two, three.
Get him on O2 right away.
Here we go!
Hey! Look at me! Look!
My bag. My bag.
I want the bag?
I got it!
Stat EKG in case
he's having an M.I.
What about me, huh?
I could be having an M.I., too!
Any history
of hepatitis?
Abby, can you give us a hand?
What about
my blood draw?
I'll write you a note.
Get a 12-lead going.
Where am I?
Sam, you've got the IV.
Where am I?
What are you doing?
Okay. Hey, Pratt,
can you spare Jane?
Definitely.
Document everything we do
at the time we do it.
Isn't that usually
a nurse's job?
There's a nursing shortage,
Jane-- haven't you heard?
What are you doing? Stop!
Hey, hey,
hey, now.
Okay. I may not
always know
what to write.
We'll tell you.
Start with two liters of
02 at 11:25. Pulse ox 98.
Ow.
That's my bag.
Gimme my bag back.
I'll give you your bag back
right down here.
Get your hands
off of me!
Hey!
Calm down.
Knock it off.
Okay? We're here
to help you,
and we can try this
the nice way,
or we can try other options.
This is how you help?
Yeah, that's
right, sir.
Okay.
EEG is ten
centimeters.
EEG's printing.
Chart it.
11:26.
Got your line.
What do you want sent?
KOVAC:
Abby?
CBC, chem 20, PT/PTT,
troponin. Type and hold.
And add a serum ammonia.
EKG looks good.
Hey.
No ischemic
changes.
Excuse me. Excuse me.
Hey.
Hey!!
My name is Charlie.
Metcalf, okay?
Okay?
Okay.
Okay?
Okay.
Ouch! Don't.
Okay, okay. I'm not gonna
hurt you, okay?
Dr. Kovac.
Okay, let's get him gowned.
We need you to work
with us, Mr. Metcalf.
This'll be
much easier, okay?
What's the trouble?
Possible extensor tendon lac.
Okay. Can you move your
toes up and down?
How'd that happen?
My sister pulled
the television down on me.
It was an accident.
I guess it's true,
then, huh? TV really is
bad for kids.
KOVAC:
Where were your parents?
JEREMY:
My dad was at work.
KOVAC:
Baby-sitter?
We can't afford one.
I watch after Steffie.
Can't afford
a baby-sitter,
but they got
one big-ass TV.
Luka.
Somebody called the dad?
Yeah, the neighbor
who brought them in.
Get him cleaned up
and send for X rays.
We have three TVs.
That IV making you feel better?
Yeah. Yeah, look,
before-- I-I'm sorry.
I-I just...
Shh.
11:27. 300 cc bolus is in.
Pulse down to 110.
No murmur rubs
or gallops. Multiple
spider angiomas
on the chest wall.
Watch my stomach.
Watch my...
( Metcalf coughs )
You seen a
doctor lately?
Um, it's been a
of couple years.
Do you have
a primary-care physician?
No, not at the present time.
Need a 5-O nylon.
( groans )
Who were you seeing
a couple of years ago?
I don't remember the guy's name.
Some doctor in Taylorville.
Taylorville? You lived there?
Yeah.
There's a prison
there, right?
Yeah, it's
a correctional facility.
What's the big deal?
I knew somebody
who spent time there once.
Small world.
Positive fluid wave.
Liver's small.
JANE:
Ascites?
Yeah.
What's that?
It means you have fluid
in your belly.
So, what were you in for?
A mistake.
What, you mean
you weren't framed?
Spleen is enlarged.
Chart a BP. 100/70 at...
11:28.
Caput medusa.
What kind of mistake?
I killed a guy.
Palmar erythema
and muscle atrophy.
Oh, yeah? For what?
For asking too many damn
questions, that's for what.
Hemocue 7.2
My dad here yet?
No, not yet.
Hey, kid!
Don't look at him.
Just look this way, okay?
Hey, pally.
Don't worry about him.
Mr. Metcalf?
What?
Mr. Metcalf?
You're very anemic
and could be
losing blood
from an ulcer.
Are you a drinker?
( laughs ):
Yeah.
Were you drinking
in jail?
Yeah, but you're
not gonna rat me
to my parole board,
are you darling?
It's important we know
what you've been taking.
Pruno, breakfast of felons.
Now, I drink wine, beer,
anything I can get my hands on.
Pruno?
Yeah, it's fruit... ow.
fruit and bread
from the cafeteria.
You put it in
a garbage bag
with toilet water and
then you let it ferment.
Ow. Ow, ow, ow, ow.
Ferment where?
Under the bed.
Strain it through
your socks
and then you're ready to go.
If you're desperate enough,
it tastes like a martini.
Oh, yeah?
Yeah. You don't know
what it's like to need a drink.
I can imagine.
Okay. To check
for blood loss,
we're going to have
to do a rectal exam.
A what? No, no, no, no, no.
I spent the last nine years
avoiding rectals. No.
It's the only way
for me to know
that there's any
gastrointestinal...
You're gonna stick
your finger up my ass?
My gloved
and lubricated finger, yeah.
No.
I'm sure it's smaller
than your bowel movements.
Listen, boss-- exit
only. You understand?
Exit only.
If you're bleeding internally,
it could be life-threatening.
Okay. fine.
Can I...? Maybe we can
cover me up or something.
JEREMY:
I don't want it.
Would I hurt you?
No! I don't want it!
Look at me, I'm not going
to hurt you, okay?
I want my dad!
You don't
have to worry.
Where's my dad?
Look at me, I'm not
going to hurt you, okay?
I want my dad!
I don't want to get a shot!
Look at me. I'm not gonna
hurt you, okay?
Pally?
What's your name?
Jeremy.
Jeremy, you know,
the way I see it,
doctors are mean.
They wanna make us cry,
but you know what?
If you don't, I won't.
What do you say?
Let's show 'em.
Let's both not cry.
Okay, kid?
Okay, Jeremy.
It's okay.
It's okay. It's all right.
See?
( groaning )
That's it.
Don't worry
It's okay.
There it is.
Get that. That's it.
See? Hey, that wasn't
bad, was it?
We have to put a tube down your
nose into your stomach
to figure out
what's causing the bleeding.
No, the docs in the joint
gave me one of those
for my pancreatitis.
We're going to numb it up
so it won't be too bad.
Great.
We won't keep
the tube in
any longer
than necessary, okay?
Sit him up.
( groans )
You know, I used
to be an artist.
Open.
Pressure's up
to 110/76.
What kind of artist?
I-I did some painting.
A mural for my wife's church,
You know.
Mostly I, uh, I earned
my living as a contractor,
a carpenter-- that sort of
thing-- fixing old places up.
You all could use
my help around here.
Okay, if you swallow it
while we pass it,
it'll go down easier.
All right, all right, all right.
Okay.
It's going down.
Keep swallowing. It's
going down. That's good.
Very good.
All set.
Relax.
Okay. Hook it up to low suction.
Yeah, I was mixed up before.
I get confused in my head.
I-I-I'm better now.
Like you think you're
going on a trip?
When you were in
the waiting room,
you kept asking me what
time your flight was.
Sometimes it's a train or a bus.
Sometimes it's a boat.
One time, I was
getting ready to parachute.
So is that what the
suitcase is all about?
No, I always
have that.
You leave anything
behind at the flop,
it won't be there
when you get back.
The scumbags steal it.
NG output one liter at 11:32.
KOVAC:
Blood's too dark for an ulcer.
Varices?
What's that?
That's when the elevated
pressure in your liver backs up.
KOVAC:
The veins
of the esophagus
become engorged and fragile
and can bleed a lot,
sometimes uncontrollably.
Emesis basin!
Oh, you made me worse. Get...
Get it out of me.
Mr. Metcalf.
Get it out!
Okay.
That has to stay in.
Get it out of me!
Okay, soft restraints.
Get the tube out.
Pressure's dropping,
82/66, tachy at 130.
Another liter and two units
of type-specific,
and call G.I.
down here now.
Get these off. ( stammering )
Trauma One
is open.
Okay.
Mr. Metcalf, is there anyone
we can call for you?
You mentioned you had a wife.
No.
Children,
siblings?
No. No. Nobody that'll come.
Okay, let's get him
up to X ray.
Stef, you stay with him.
Okay, sweetie? I'll see you
back here in an hour.
Pratt, with us.
Make it four units
type-specific.
Type-specific'll take too long.
Get O-neg out
of the cooler!
Get these things off me.
Don't tie me down!
You can't keep
tying me down!
Let's go, people.
Prime the rapid infuser.
Subclavian
on the right?
Yeah. Prep the chest.
Let's go, people.
Prime the rapid infuser.
Subclavian on the right.
Prepping the chest.
O-neg here.
Squeeze in the first units.
Sam, second on the infuser.
Pratt...
Push the octreotide
You've been paying
attention, huh?
You need me
to do something?
Yes, cycle the dynamap
when it's ready.
A little sandostatin's
not going to make his
chances any better.
Diminished blood flow
through the portal system.
Yeah, but what's the point?
The odds of him making it
are what, 30%?
Another 200cc's
out the NG tube.
He's that sick,
even though he was
just lucid and talking?
He's right on the edge.
All he needs is a little push.
You know what, Pratt?
We got a lot
of hands in here.
If you don't
want to help...
So you want
attending now?
What, no one wants
to be a nurse anymore?
Pratt, come on.
Prick.
That's enough.
Heart rate's up
to 140.
Is he taking any meds?
Check his bag. He said all his
stuff is in there.
First unit's up.
11:35.
Pushing 15 mikes of octreotide.
All right.
The guide wire's
passing.
Yo, hair of the dog.
151 proof.
This guy's a class act.
Where are you with
your extension tubing?
What is your
problem, Pratt?
We're killing ourselves
for a non-compliant
alcoholic, ex-con drifter
with end-stage liver failure.
You want to get out?!
Then get out!
You know what? It's Friday.
I don't do lost causes
on Friday.
It's a religious thing.
Second unit's going in.
Is there anything else
in that bag
we need to know about?
No, but there's a picture.
It looks like him
and his wife and a kid maybe.
A bunch of letters
and a journal.
Pressure's 98 over 62
at 11:37.
I don't know.
Some kind of painting.
Where's my passport...?
Where's your what?
Give me my passport.
I can't go without my shoes.
Go where, Mr...?
Whoa, whoa, whoa.
Let me, let me go.
Let me go.
Head up to 20 degrees.
Let me go.
And check on G.I.
again.
Let me go. Thank you.
I'll be right back.
Get 'em off.
Get 'em off.
Do you have
a problem with me?
No.
Sam?
I was out of line.
Okay, let's go.
The guy's a waste.
Dying from something
that he's doing to himself.
Last time I checked,
alcoholism was still a disease.
So is suicide.
He should catch some of that
and save us the trouble.
We get ones
like this every day.
Then maybe I need
a day off.
This personal?
I guess.
Good.
You and I have
to talk about it.
You like riding me, don't you?
I don't think I do.
Ever since I was
an intern
you've been on my back.
Maybe a couple of times.
Why?
You're good, Pratt,
but I think you could be better.
There's a number
you wrote down here
with a name.
"Bobby?" Should we
call him, Charlie?
No. No, don't call him,
please.
I don't want anybody
to call him, okay?
No calling.
I-I don't want to see him.
I don't want to see him!
Mr. Metcalf, the veins
at the end of your esophagus
are bleeding a lot.
This is a result
of your cirrhosis.
That also means
you have less than
50% chance of surviving.
This is surviving
for how long?
A few months?
Months? Months? What?
Not that long.
PRATT:
What we need to know is
if you stop breathing
or your heart gives out,
do you want us
to use heroic measures?
Heroic what?
You want us to do CPR,
shock your heart
or put you on
a breathing machine?
Wait, wait, wait, wait.
You saying now?
You're, you're saying now,
you mean like, today?
No, no, no.
Look, no, I have
a lot of things
that I have to do.
I'm just not ready.
Okay.
I'm not ready. I'm, I'm...
Okay, the man wants it all.
Okay.
I'm Adler from G.I. How bad?
About 21/////2 liters of output.
Pre-load the scope
with a Saeed six-shooter.
What? What's a six-shooter?
We're going to look
down your esophagus
and try to band the veins
to stop the bleeding.
What's the deal
with your suction?
Turn it up.
I did.
Nothing's coming
out, great.
Check in two, Abby?
Jane, get on the phone
about a portable unit.
You guys have suction
in here?
Last time I checked.
What time is it?
11:40. Why?
They got 23 minutes,
or we're eating for free.
Is your patient stable?
Smoke inhalation
with wheezing.
Okay, we need the room.
You into pepperoni, Abby?
Do you have ADD?
Come on! Let's go.
Give us two minutes
to finish the...
We need it now, Ray.
We're good in here.
This guy may just need
to be tubed.
This guy might need
to be pronounced.
I hope you're not a veggie,
'cause I got meat on everything.
See you later.
Cetacaine and bite block.
A little more
numbing spray,
Charlie.
Push two of versed.
All right, Charlie,
once we're ready to start,
you're going to have to keep
this in between your teeth
because it stops you
from biting down
on the fiber-optic scope.
Check your monitor.
Is this Bobby, Charlie?
Is that your son?
Yeah.
And your wife?
Evelyn.
Pretty.
You want me to call her?
No, she's gone.
It's been a long time.
What about Bobby?
Must be all grown up
by now, huh?
Yeah, he's 19.
He's going to be 20 next month.
He's in college.
Let's try
to reach him, okay?
I haven't talked to him
since he was little.
His aunt gave me that number
when I got out of prison, but...
Well, it's all
the more reason
to use it now.
Let's pull the NG.
Okay, Charlie,
here we go.
( Charlie coughs )
( grunting )
How's his pressure?
108 over 58.
Okay, ready to go.
Hi, I'm looking
for Bobby Metcalf?
Okay. You know what?
Can you actually
wake him up for me?
( coughs )
Hi, Bobby, my name
is Samantha Taggart.
I'm an ER nurse at
the County General
in Chicago.
Grade-two varices?
Grade three.
Yeah, we have your father here,
and, uh... Yeah.
And he's pretty sick.
Four columns,
two hemorrhagic.
Two bands at each bleeding site,
one at the others.
SAM:
Uh, no, he's, well,
he's out of jail.
I don't know.
For a while, I think.
Systolic's down to 90.
Is there any way
you can come down here
and be with him?
Probably the versed.
500cc saline bolus.
Uh, no. You know what.
He can't talk right now
because he's in a procedure.
Sucking the varix into the cap.
Okay, hold on.
He wants to talk to you.
Sorry. That needs
to stay in.
And...
firing.
Okay, let's talk.
Okay, you guys,
I'm gonna put Mr.
Metcalf's son
on the phone
for a minute, okay?
( son breathing into phone )
Bobby?
Dad?
Is it you?
Yeah... it's me.
So you're sick huh? You dying?
No, no, no, no.
Nurse, is he dying?
He's very sick.
What am I supposed to say...
huh, Dad?
It's been a long time,
There's so many things I...
Yeah?
I don't know. I...
Hey, Dad?
Yeah?
Nice knowing you.
( receiver clicks )
( sobbing )
I told you you
shouldn't call him.
Firing.
Good.
Turn up my section.
Can you band it?
Not if I can't see it.
Mr. Metcalf?
Mr. Metcalf?
BP 62 over 38.
I can't even feel
a pulse.
Bobby?
Bobby?!
( whistles )
Bobby?!
He's bleeding out.
Okay, turn him over.
Another two units
on the infuser. Ambu-bag!
( birds chirping )
Come on in. The water's warm.
Try the femoral.
Get another
four units up here.
FFP after these two!
Hey! Hey, you dumb son
of a bitch!
Hey, you dumb son of a bitch!
Thought we lost you
there for a second.
Bobby?
Uh, we had him on the phone.
Is he coming?
No. No, he's not coming, man.
JANE:
BP's 86/42 at 11:44.
ABBY:
You want the FFP?
PRATT
Yeah, and another unit
of packed cells.
Dr. Kovac.
How long have you been
out of touch with him?
Your son.
Long time.
Since I went to prison.
Well, even in prison,
he's still your kid.
Blood's here.
You don't know what it's like.
I know if I had a kid,
I'd want to do
everything I could
to stay with him.
KOVAC:
I need a Linton tube,
Kelly and a 60cc syringe.
You think you know,
but you don't.
How it could all
switch on you.
How life could
turn on a dime.
Gets broke and you can't s...
you can't see a way to fix it.
KOVAC:
Mr. Metcalf,
the specialist,
uh, here thinks
we can control
your breathing
with the scope.
ABBY:
So you want a Linton tube?
METCALF:
Wha... What?
We pass a large balloon
into your stomach.
So it helps us keep pressure
on your veins.
All right, well,
what's to lose?
I'll test the balloon.
IT was April 10, 1992.
Bobby was turning eight.
My wife asked me to go get
some stuff for the party,
but I... I-I st...
I stayed so I could finish
putting together
this robot for him.
You know, so I made her go.
From the street,
I hear a thud...
and the scream.
And I go to the window
to look out.
And... and she's...
she's lying there
like she's asleep
on the street.
And the ice cream cake...
the ice cream cake was
all around her on the pavement.
SAM:
Five syringes.
So there I am,
there I am with this...
with this little boy to raise.
And what do I do?
I start drinking...
and getting high.
I couldn't keep it together.
I couldn't keep
it together.
And then I stabbed some guy
in a bar,
Just for... just for...
just for nothing.
For nothing.
'Cause he looked at me wrong.
SAM:
This one's good.
KOVAC:
We can go up to 750
for hemostasis.
Okay, ready,
Mr. Metcalf?
( coughs )
( gagging, coughing )
( coughing )
( gags )
( gagging continues )
KOVAC:
So, where was your son
after that?
With my wife's folks.
Listen for bowel sounds.
METCALF:
At first, they would bring him
by on visiting days, but...
after a while that stopped.
And then the letters started
coming back unopened.
You know what?
I-I-I-I don't feel good.
Something's wrong.
Something's wrong.
BUN 74, creatinine 8.2.
Okay, call renal
and throw in a Foley.
Hey, we should think about TIPS.
What's that?
KOVAC:
TIPS stands for
Trans-jugular
Inter-hepatic
Porta-systemic Shunt.
Uh, we put a catheter
from your neck to your belly.
By bridging the two vessels,
we can bypass the liver
and slow down the bleeding.
And how much time
would that give me?
It's hard to say.
No urine output.
ABBY:
Hepatorenal syndrome.
Your... your kidneys
are not working.
ABBY:
He needs dialysis.
PRATT
I'll make the call.
RAY:
GSW to the belly.
KOVAC:
Not here, Chuny.
There's nowhere else.
'Kay, move him over,
and keep traction
on the Linton.
Hold on.
'Kay, go ahead.
KOVAC:
Okay, let's transfer him.
One, two, three.
RAY:
There's no meds,
no allergies, no past history.
NG, Foley
and portable chest.
Bastard shot me
for stealing my own spliff.
I need another nurse in here.
Said it was his,
but it was mine.
Rolled it myself
this morning.
What's going on?
They just need
to stabilize him.
I want my own
damn room!
Get the hell out
of here, man!
Screw you, jerk-off.
KOVAC:
Okay, doctors only
talking now.
Damn, that's hard.
Even a gunshot wound
to the belly
don't buy a man
some privacy.
Ow!
KOVAC:
'Kay, two grams of Cefoxitin
I.V. piggyback.
That's a house
we rented one summer.
There was a lake nearby.
I-I took Bobby fishing...
Periumbilical GSW
with intestinal prolapse.
DUBENKO:
Hey, what about
the on-deck batter?
We're waiting
for a TIPS and IR.
DUBENKO:
That sounds bad.
Let's get him up for an ex-lap.
Portable monitor, let's go.
KOVAC:
What about X rays?
DUBENKO:
We'll get them upstairs.
RAY:
T minus eleven minutes
on those pizzas.
PRATT:
IR's already on the floor,
and Renal's on the way.
Luka, he's getting tremulous.
Haven't had a drink
since last night.
It's alcohol withdrawal.
Who's Dr. Pratt?
Hey, that'd be me.
Hey. Ramirez, nephrology.
All right, who's this guy?
We're gonna need
central access.
KOVAC:
He's got a subclavian.
That's great, let's consent him
and start the run.
What? What is he talking about?
He's here for
the dialysis that
we discussed.
I never discussed it.
You discussed it.
I never... I never
discussed it.
Alfonso,
how are you?
Is this a TIPS patient?
Yeah, and we
should go first.
Uh, wha... wh-what
are you talking about?
That's what's gonna
prolong his life.
RAMIREZ:
Yeah, without the dialysis,
he'll bleed out the minute
you spike through his liver.
What? What? Spike my liver?
Will his pressure
even tolerate dialysis if
the varices keep bleeding?
I-I don't understand.
I can support
his pressure.
The Linton tube
is supporting his pressure,
and only barely.
Wh-What are you
talking about?
Dr. Kovac.
Well, he's gonna need dialysis
three times a week.
Yeah, for the rest
of his life.
Hey... hey...
TIPS is not a cure.
It's a bridge to
a liver transplant.
We all know that's
not gonna happen.
Hey, hey,
hey, hey.
I'm right here.
Yeah.
Talk to me.
Sorry.
Now, you can't fix my kidneys?
You're gonna need dialysis,
three times a week.
And what about my liver problem
and the... and the bleeding?
The TIPS is
a temporary measure.
Your best hope is for
a liver transplant.
I-I-I don't understand.
Wh-Wh-What are the odds of that?
KOVAC:
Based on your history
of drinking,
not good.
Is there... is there any chance
that I'm gonna be walking
out of here?
With the dialysis
and the TIPS...
METCALF:
I mean today.
What are the chances that I'm
gonna walk out of here today?
None.
I-I-I don't want it.
I don't want anything, then.
If you don't have
the TIPS procedure,
we can't control the bleeding--
you'll die.
Yeah, I get it.
I get it.
Just stop everything.
No more
blood transfusions?
No breathing machine?
No, it's over.
No CPR?
No.
I need it to be very clear,
Charlie--
if we don't continue
with the treatment,
do you understand
what will happen?
Yeah.
Yeah.
Okay, Mr. Metcalf is a DNR.
11:57.
Wait, wait a minute,
wait a minute.
Hey, he's not competent.
Come on.
It's what he wants, Pratt.
Can you, uh...
can you do something for this?
Hey, could we put him
on an alcohol drip.
You gonna get me drunk?
Just enough to stop
the tremors, Charlie.
Charlie,
let us do the procedure.
You don't have to do this.
Just call...
could you, um...
try Bobby again.
Try my boy, get
him on the phone.
If he knows it's really over,
he'll come.
Okay? He'll come.
TAGGART:
Hey. Bobby Metcalf...?
Oh, yeah.
It's the hospital calling again.
Yeah, do you think
you could do that?
Okay, thank you.
What happened?
He went to class.
His roommate's going
to see if he can find him.
Can you take this out?
It's uncomfortable.
That tube's keeping you alive.
It's uncomfortable. Please.
Okay.
Is there, um...
is-is there a window?
Can you open a window
and get some fresh air in here?
Please?
Sam.
Please.
All right.
Here we go.
That's right,
blow it out.
( gags and coughs )
( gagging )
( passing traffic )
( people chattering )
( distant music playing )
What is that, Lincoln Street?
Harrison.
I worked here over a year,
and I never even
thought about
what's outside that window.
I've worked here six.
It's from the tube.
I'll take care of it.
Ten percent ethanol
at 100cc's an hour.
You know, your booze works fast.
Mad Dog IV, just for you.
All this stuff, you know,
it's just blinders.
It's just a screen.
I don't want anything
separating me
from what's happening.
I'm not gonna run and hide
from this.
Pulse ox and dynamap
can come off.
Last sat's 92.
My brother Lou died...
when we were kids.
My mom, she said...
Oh...
She said, "Charlie, Lou's
gone away on a long trip."
Don't you just
leave me here.
I want to see a doctor now.
Last B.P.'s 90/60.
When is my turn, huh?!
When's it going to
be my turn?! Huh?!
People!
When is it?!
When is my turn?!
170...
91...
What are you saying?
It's your vitals.
Is it starting?
What, Charlie?
Am I going?
It's starting.
Don't you people
have a system?
Isn't there
any method at all?
Don't worry, you won't be alone.
Good.
That's good.
Someone will stay
with you.
Sam, you got this?
Yeah.
Could you, um... touch me?
Sorry?
My face.
Please?
Maybe we should anchor.
What?
Do you think
we should keep going?
I don't know, Charlie.
What about him?
What do you think he wants?
I don't know.
I don't think he knows.
Is it too late?
Not if you don't
want it to be, Charlie.
( papers drop on floor )
Watch it!
Oh, no.
Oh, no.
Oh, no.
( tapping )
I feel drunk again.
Yeah.
Thank you.
Okay, Mr. Metcalf,
we're going to keep
a heart monitor on
and the alcohol drip
for comfort.
Okay.
But I'm going to take you
off the octreotide now
which is the last
support measure.
Okay.
It shouldn't be long now.
Okay.
I never believed in God.
That might bite me
in the ass now, huh?
God will get over it.
Do you need this?
Can I take it?
Take it.
Take it.
What?
What can I take?
No, never mind.
Never mind.
What's it going to be like
there?
Peaceful.
Come back.
Charlie.
Charlie...
Get all my stuff?
Oh, yeah.
Yeah.
Make sure he gets it.
I will.
Yeah, and give this to him.
You never knew your dad.
No.
That's too bad.
I don't let it bother me.
I bet it bothers him.
Bobby.
Let me in.
Open up.
Let me in.
BOBBY ( whispering ):
Charlie, can you hear me?
Charlie, can you hear me?
( quietly ):
Hey, pally.
You made it.
Uh, how do I look?
( whispering ):
You look okay.
I'm so sorry.
( breath quivering )
I'm so sorry.
( sniffling )
Oh, don't think about that.
Okay?
Just take it easy.
( quietly ):
It's okay... son.
It's...
( heart monitor flatlines )
( sniffles )
Um...
( sniffles )
12:04.
Oh.
( Pratt sniffling )
I'll take that.
( sniffling )
( sighs )
Can someone just
tell me that?
How much longer?
Ma'am, you need
to wait in the room.
Oh.
Let's go.
Well, it's about time.
You been with the same patient
for almost 45 minutes.
Whatever happened to "treat 'em
and street 'em" Pratt?
Do as I say,
not as I do.
All right, well, the TV
kid's back from X ray.
He's in triage with his dad
and his sister.
Things go south?
He was a nice guy.
Just a drunk.
All right, well, there's pizzas
over here if you get hungry.
Got you one with anchovies.
Oh, and the delivery guy
got here at 12:04.
You know what that means?
It means he didn't
make it on time.
No, it means lunch is
on the house, my friend.
Hey, Jeremy,
little man,
back so soon?
How are you doing?
I'm Dr. Pratt.
Yeah, I'm the one
who treated your son.