ER (1994–2009): Season 13, Episode 5 - Ames v. Kovac - full transcript

Previously on ER:

Okay, I'll be back
to work next month.

Ray Barnett. I don't think
we've officially met.
Katey.

You two
live together?

Oh, we were
roommates.

Hope you had benefits.

You don't want to have
anything to do with me.

What about yourlittlebrother?

He'd like to get
to know you, Greg.

He just met me.

I mean, ain't we brothers?



Curtis Ames?
Left-sided

paralysis following
an embolic stroke.

But I thought
the case had no merit.

Guy wants his day in court.

It doesn't reflect
on your abilities
as a physician.

Skiles has got them working.
And, with big ol' Ben Wallace,

they're definitely
going to the
playoffs again.

Yeah, I remember when
the NBA used to mean something.

Oscar Robertson,
Walt Frazier.

Now it's all a bunch
of gangsters with tattoos.

And cornrows.
And slam dunks.

Oh, my! Hey, now,
oh, now, hey, now

Set of lungs
on that one!

Boy, if I was
20 years younger...



You'd still be
her granddaddy.

(all laughing)

Is that Dr. Gregory Pratt?

The one and only.

What are you doing down
here on the South Side?

I heard you bought a condo
on the Gold Coast.

You drive down here
in the Beemer or the Benz?

Hey, I walked from my apartment.

How long has your
hand been shaking?

Long as I can remember.

Been to the doctor?

What for? Lou Sanders' wife
was having headaches.

20 grand in tests so they could
tell her to take an aspirin.

Lanny Cole checked
in the hospital

for a stomachache. Next day, he
checked out through the morgue.

So what are you saying?
Nobody here goes to the doctor?

Hell, no.
Not me.

Well, you should.
That's right.

Dr. Pratt needs
to make them car payments.

But seriously, you need
to get your pressure checked.

They do that
at the drugstore.

Your sugar,
your prostate...

No!
No!
No!

I wouldn't let Halle Berry
stick her finger up my ass.

I sure as hell ain't going
to let you.

I'll see you
fools later.

Now, that's what
I'm talking about.

Ooh!
Uh-huh!

Greg! Greg!

Chaz. What's up, man?

What's up? It's
been a while, man.

Yeah, man. Too long.
What are you doing
around here?

I'm just waiting
for a friend before class.

Okay. Where'd you
wind up at school?

UIC.
That's good, man.

So how's it going
over there?

It's going all right.
I'm running a little late.

Yeah. Me, too. I got
to get out of here.

We should
kick it sometime.

Definitely. You
know where I am.

Cool. Good seeing you, man.

You, too. Be safe.

You'll probably be home
before me,

and Miriam
has to leave at 6:00.

Okay. Okay, Joe,

let's review PEA, hmm?
Treatable conditions

include hypovolemia,
tension pneumothorax,

cardiac tamponade,
MI and... and...

What's another
cause of PEA?
Hmm?

A reversible
etiology of PEA.

Umm... Massive
pulmonary embolus.

See, how could
I forget that?

You'll be fine.

I don't know.
My brain is like...

Oh!
Oh! Sorry.

Sorry, sorry.

I have to review this.

Ten times?

I gave my deposition
a year ago.

It looks really bad
if I contradict myself.

You didn't do
anything wrong.
Just tell the truth.

You didn't do
anything... Sorry.

(doorbell rings)

Okay.

Who's that, huh?

Want to go see
who's at the door? Hmm?

Who's at the door?
It's Miriam.

She's going to take you
to the park.

I suppose, if I really
can't remember something,

I could run it
by the Attending,

but I just don't want
to bug them all day,

like I'm a med student
or something.

You okay?

No. The guy's going
to be so sympathetic
to the jury...

But he doesn't
have a case.

You're going
to be fine.

If I lose,
they report me

to the National
Data Bank.

It follows me
wherever I go

for the rest
of my career.

I could be turned
down for a job.

It could cut back
our income. It can...

You want me
to come to court?

No. You got a shift.

Well, they've been doing
just fine without me

for the past
couple of months.

No. It's more
important for you
to be at work.

Okay. Good luck.

Thanks.

Call me.

MAN:
The plaintiff's attorney

will provoke you--
try to get under your skin.

So you need
to stay cool.

If you get defensive,
the jury will turn against you.

Yeah.
And keep it brief.

If you elaborate,
they'll think
you're being evasive.

Don't worry about getting
the whole story out at once.

I'll have a chance to ask
follow-up questions later.

Right. Um... I'll, uh...

I'll meet you inside.

(unzips fly)

(door latch clicks)

Mr. Ames, I'm...
I'm sorry we're here.

I was hoping this wouldn't
have to go to trial.

I came in
with a cough,

and you sent me
out a cripple.

We need to pick up
a few boarders from
the night shift.

Diverticular
abscess awaiting
CT guided drain...

Hey stranger, welcome back.
Thanks.

I want to see pictures.

Diverticular abscess
awaiting CT guided drainage.

A-fib patient...
Hey, Abby.

This is kind of embarrassing,

but I never got around
to wrapping your baby gift.

Oh, that's great.

Ray?
What?

Thanks.
A-fib patient

with rapid ventricular
response going to tele.

I dispo'd Mr. Kerosene
to psych.

He drank kerosene?

More like
a high colonic.

Hi, Abby. I'm Tony Gates.

Hi. Didn't
you used to be...?

A paramedic. Yeah.
Now I'm an intern.

Next week, he wants
to be a cowboy.

Astronaut.

(muffled yelling)

I could use
some help here.

I got half
his tongue on ice.

Oh, man. How
did that happen?

(muffled yelling)
Wife bit it off.

Why did she do that?

(muffled yelling)
She says he
talks too much.

All right, come on.
Let's put him in Curtain Two.

Liter of saline and a crit.
Ray, you're with me.

Abby, grab some charts and, uh,
Gates, you're with Abby.

Cunnilingus
interruptus.

They did a Grand Rounds
on it last year.

Abdominal fullness.
This isn't too bad.

Congratulations
on the bambino.

It's a boy, right?
Yep.

Can you check
the BP?
All right.

Hey, Mr. Dolan.
How you feeling?

Must be weird
coming back

after all this
time, huh?

A little bit.
70 palp.

Pulsatile
abdominal mass.

We'd better move him.

Sam, this guy
is hypotensive.

What? His vitals were normal
at triage.

Not anymore.

Add a second line,
four of O-neg.

Labs?
Dr. Gates?

CBC with platelets,
chem-7, protime,
type and cross four.

Good, but add a hemocue,
EKG, and let's get
surgery in on this.

All right.
What do you think?

Abdominal
aortic aneurysm?

Classic presentation
for a triple-A.

You think it burst?

No. He'd be dead.
It's probably
a steady leak.

You set up for ultrasound?

We're going to have
to call radiology for that.

I'm talking
about the ER ultrasound.

It's still out
for repair.

Well, how are
we supposed to...?

Radiology
brings it over.

How long
does that take?

Depends on how
busy they are.

Wow! Great
to be back.

Pressure's up to 90
with saline.

All right.
He looks like he's okay.

I'll call for your ultrasound.

O-neg is here.

So, what's the big guy
doing today?

Watching the baby?

No. He's in court.

WOMAN:
Mr. Ames,
what made you go

to the E.R.
on February 13, 2004?

Because I had a cough.

My boss, he
brought me in.

I thought
it was nothing,

but he didn't
want me working

until I got
it checked out.

How long is the wait?

Don't talk, please.
(beep)

(coughs) How long until
I see the doctor?

I don't know.
Could be 12 hours.

12 hours?
(coughing)

12 is good.
We're not that busy.

It's okay, Curtis.
I'll get someone to cover you.

No, no. I can work.
(coughing)

How about I sign in
and come back later tonight?

You'll lose your
place in line.

So I just sit here in the
waiting room for 12 hours?

That's how it works.
Be right back.

This seems kind of crazy.

How about I just
get checked tomorrow?

I need a note
you're not contagious.

I got insurance issues.

Don't give this job away.

I'm going to be there tomorrow.

WALTON:
Dr. Kovac, when did
you first see Mr. Ames?

I was working
at the Admit Desk

when he signed in
at Triage.

AMES:
So how long till
I see the doctor?

MARQUEZ:
Hard to say, sir.

If you're stable,
it could be up to 12 hours.

AMES:
12 hours?!

(coughing)

We have a lot
of sick people here.

Let me just sign in, and I'll
just come back later tonight.

I'm sorry.
We can't do that.

So I got to wait in
the waiting room for 12 hours?

I'll be right back.

They can't do this!

Everything okay, Chuny?

Yeah. He'll
settle down.

Do not give
that job away!

I will be there.

A lot of patients get angry
about the wait.

Nurse Marquez was able
to defuse

the situation
before it escalated.

I'm in.
You can do the next one.

Sorry. I just had to...

No, that's cool.
Good breath sounds.

You haven't
lost your touch.

BP's 80.

All right,
I need the ultrasound.

They're doing
a rule out ectopic.

And where's surgery?

Their med student's
right there.

Well, that's not
doing us any good.

I paged them twice.

Listen.
How did it go yesterday?

How did what go?

Court. I heard you
had to testify.

Oh. It was fine.

Uh, a lot of questions
about procedure and policy.

But I don't think
they have a case.

Here come the cavalry!

Enlighten me.

Hypotensive pulsatile
abdominal mass.

Say no more.
Red line to the O.R.

GATES:
We're waiting
on ultrasound.

Wrong.
We're not waiting on ultrasound?

Neela, what happens when we wait
for diagnostic tests

on a ruptured triple-A?

Attempts to stabilize are
fruitless.

Investigations delay definitive
therapies

and increase the
risk of exsanguination.

With a 90% mortality.

His crit's not
so bad-- 32.

Meaningless drivel.
Uh, what if it's not
a triple A?

Then it's something else
that requires surgery.

Radiology's bringing
over ultrasound now.

He'll be dead by then.
It'll be a few seconds.

Just zip it, Sparky.
Look, we are admitting him.
Sparky?

Let's go!

Did you need me
to keep bagging?

Sure, as long as
you don't talk.

Oh, by the way, Abby Lockhart.
Lovely to meet you.

Shh!

When did you
assume responsibility
for Mr. Ames' care?

The nurse was concerned about
his oxygen level,

so she asked me to see him.

Curtis Ames?

Hi, I'm Doctor Kovac.

What is that?

Uh, low oxygen.

Or just maybe
a dirty fingernail.

Wood stains-- they don't
wash off so good.

What kind of work
do you do?

Custom carpentry.

Doors, built-in bookshelves,
armoires, you name it.

My father had a wood shop
when I was a kid.

I used to play with the
shavings from the lathe.

I love the smell.

(coughs)

How's it sound?

Well, like pneumonia.

You should be admitted
to the hospital.

Admitted?

Yeah, stay for
a couple of days.

No, no. I start
a custom remodel today.

Your temp is 102, your oxygen
level is down to 90

and your X ray shows
your right middle lobe
is full of infection.

Look, if you want
to get better,

we need to give you
I.V. antibiotics, okay?

KELLERMAN:
After he examined you,
then what happened?

He left me alone with a nurse
who couldn't start an I.V.

CHUNY:
Okay, this time
I get a flash.

Good.
That's good, right?

But it won't
thread... I'm sorry.

Keep pressure
on this.

I know the drill.

Anyone ever tell you
you have bad veins?

How about just giving me
a shot in the butt?

The antibiotics
are ordered I.V.

Can I talk to my doctor?

He's with a trauma patient
right now.

How about after he's done?

It could be a while...

Here we go,

fourth time's the charm.

KELLERMAN:
And how long was it

before Doctor Kovac came
to your bedside?

It was more than an hour.

Uh... I saw him working
on the computer,

he was talking
to some nurses,

then... he ate a bagel
with cream cheese.

I think it was poppy seed.

And how did that make you feel?

Objection, irrelevant.

On the contrary, Your Honor,
it goes to state of mind

and his ability
to make decisions.

Overruled.
You may answer.

I felt alone...

forgotten.

Like nobody
there cared about me.

LOCKHART:
I'm just saying
he's a frail old man

who deserves the benefit of
diagnostic confirmation.

CRENSHAW:
The patient is now on
the surgical service,

not the ER service.

Why don't you go downstairs
and pull a cockroach

out of someone's ear?

Neela...
He's not stable, Abby.

BP's 90 systolic.

Five minutes for an ultrasound
is not going to kill him.

GATES:
I picked up a sterile sleeve.

CRENSHAW:
Why do you people insist
on annoying me?

GATES:
It'll only take a few minutes.

10 blade...
I want these two
out of my O.R.

Shirley, call security.

All right, all right.

Dab the bleeders, Katey.

Nice working with you guys.
Bovie.

Stand back!

Irrigation! Saline!

(panicked shouts)

What the hell happened?

Unplug the Bovie!

Unplug
the Bovie.

And turn off that oxygen,
before the whole room goes up.

Dr. Kovac, when the nurses
couldn't start an I.V.,

what action
did you take?

I knew I needed to place a
catheter into a deeper vein.

How you doing?

I didn't know you
ordered acupuncture.

(coughs)
I'm Sonya Ames.

Hi. Luka Kovac.

Thanks for
taking care of him.

Well, since we can't get
an I.V. in your arm,

I'd like to place
a central line under
your collarbone.

That sounds
pretty involved.

We need a route
to give I.V.
antibiotics,

or we cannot treat
the pneumonia effectively.

I'll numb up your skin
and guide

a catheter in at the top
of your chest.

There are risks of bleeding,
infection,

collapsed lung,
but all of those

can be treated.

I've got to think about...
(coughs) I've got to
think about it.

Wait. No, he doesn't.

If you need some time
to consider...

He's just being stubborn.

He hasn't been to
a doctor in 20 years.

I never get sick, baby.

You can barely

catch your breath, you've
been coughing so much.

It's not that
bad, really.

Listen, I just want
him to get better.

We'll do whatever
it takes, okay?

Well, if you want
the procedure

you need to sign
this form.

Now come on, baby,
I've got to get back to work.

(pen clicks)

(sighs)

(signing form)

KOVAC:
He didn't want to be
in the E.R.

He didn't like doctors,

so I felt I needed to treat him
aggressively.

He said it was
the only way to go.

If he left, I was worried
he'd get worse

and wouldn't come back.

He told me complications
were extremely rare.

It was no big deal,
that he does these every day.

His wife works, he's all alone.

My opinion didn't matter.

If he took pills, he could
have died at home

and no one would know.

He gave me and my wife
no other options,

no other choices.

We were both really,
really scared.

Can we grab
you a sandwich?

No, thanks.

Hey, Timmy.
Uh, is Abby around?

No, no, if she's
in surgery, then don't bother.

That's okay, I'll try later.

Thanks.

Hmm?
Tricuspid regurg.

Ah, the irony.
A bad heart valve.

Mm-hmm, left him
with right-sided failure
and a big, pulsating liver.

So the mass
was his liver?

Yep, and the fire saved him
from unnecessary surgery.

So a slightly scorched
med student

and some burned drapes
saved the guy's life.

Lucky guy.
Had minor burns.

Excuse me.

Forget how to use
that thing?

No, I just...

I didn't want to be one
of those crazy mothers

that checks in with
the baby-sitter every hour.

My baby-sitter used to tie
me to my high chair.

I'm sure yours
is much better.

KELLERMAN:
After your first dose
of antibiotics,

how long were you
in the E.R.?

A long time.

Over three days.

Three days? In the E.R.?

They said that

there were no other beds
in the hospital, so...

Excuse me, uh, I need
to use the bathroom.

I'll let
your nurse know.

(coughs) I don't think that
I'll be able to...

I said I'll let
your nurse know.
It's kind of urgent. Please.

KELLERMAN:
So you stayed

in the hall all that time?

AMES:
I mean, they put me
in the back at night

so that I could try
to get some sleep.

MAN:
Get off me, bitch!
Let me go!

OLBES:
Louie partied
a little too hard.

I'd say we're dealing
with coke, PCP, and EtOH.
I'm gonna puke all over you!

You can't do this!
Pulled his line.

You're going to
need hard restraints.
I'm gonna mess you up!

I'll rip your head off,
I swear to God!

AMES:
They kept saying I'd get
a regular room

after the first day, but...
it never happened.

Nurse?

(clearing throat)

Nurse?

I never got my breakfast.

You may be NPO.

What's that?

We have to look
at your orders.

Where's Dr. Kovac?

He's not working today.

So who... who's
my doctor, then?

I have to check.

KOVAC:
Every 12 hours
an oncoming resident

assumed responsibility
for Mr. Ames' care.

His progress was discussed,
and he was improving.

KELLERMAN:
So it was the nurses who
were watching him more closely?

Yes.

Dr. Kovac, the State
recommends an E.R.
patient-to-nurse ratio

of four-to-one.

Yet, during
Mr. Ames' stay,

the ratio
was eight-to-one.

That's eight patients
for every nurse.

How is that
possible?

We can't control how many
patients come into the E.R.

Dr. Kovac, you know
that those standards
are in place

for patient safety.

So on a day when the standards
were off

by a factor of 100%,

did you discuss this with
a hospital administrator?
No.

With a director of nursing?

No, no, it's not uncommon...
With a nurse manager?

Look, we're always
short staffed.

Did you bring this deficiency
to anyone's attention

or do anything to address
the situation?

It doesn't work like that.

Mariko Shimane, history
of Crohn's Disease,

vomited blood twice.

Systolic's 88.

Two liters of saline,
type and cross for four.

Is there anyone we
can call, Mariko?

Dr. Derezin.

From Gastroenterology,
I paged him.

How about a
family member?

It's just me and my son.

Where is he?

Oregon.
Sophomore in college.

We can call him.
I'm sure he'd
want to know.

I'm in the hospital a lot.

Your condition's
pretty serious.

That's what they
always say.

Upper GI bleed?

Sure looks like it.

Hello, Mariko.

Sorry to bother you,
Neil.

That's all right.
Any blood in your stool?

Yeah.

TAGGART:
She'd didn't
mention that.

Red blood?

Yeah.

Endoscopy here or
in the GI lab?

Excuse us for a minute.

Dr. Pratt, dude on line
two says he's your brother.

Yeah, take a message.

And hey, Doc Lockhart,
big daddy called while
you were upstairs.

Thanks.
I can't scope her.

Why not?

Crohn's can cause
inflammation, erosion

into a vessel anywhere
along the intestinal tract.

25 feet of possibilities.

It's not something
I can reach.

She needs surgical
exploration.

I'll call the O.R.

So...
what's the good news?

We're going tomove you to a
different room.

Looks like you may
need an operation.

Again?

Maybe it's time
to call your son?

He's got mid-terms, no.

On the afternoon of his
third hospital day

Mr. Ames complained
of numbness in the left hand.

WALTON:
And what was your impression?

KOVAC:
How long
did it last?

About ten minutes.

Okay, squeeze
my hands.

Okay.

Now spread your
fingers like this.

Don't let me close them.

Good.

What do you
think happened?

It could be a number
of things.

How's it feel now?
Back to normal?

Yeah, yeah...

Yeah, I guess.

The same on both sides?

It was kind of weird.

You probably
compressed a nerve

while you were resting
on your side.

I've-I've slept on floors more
comfortable than this-this bed.

Here, let me take care of that.

Hi, bed control.

Yeah, this is Dr. Kovac.

Yeah, I need, I need a med surge
bed for my patient, please.

KELLERMAN:
And when did the numbness

return?

It was about
three hours later.

And was there something
different about this episode?

I didn't have any feeling
for a half an hour.

But you're okay now?

It's worse.
Went up higher.

Where's Dr. Kovac?

He checked, he said
you were okay.

I'm not okay.
I need to talk to him.

Not right now.

Why? Where is he?
(coughs)

He's taking care of
a patient with a heart attack.

Repeat the 12 lead and call
the cath lab.
Tell him to come
and see me.

When he's through.
No, no, now.

Mr. Ames, there are
people in this E.R.
who are much sicker

and need
immediate attention.

Hey.
If he won't come to
see me, then I'm gonna...

Hey! Get back
in the bed.
...go see him.

Something is seriously
wrong, and I need to
talk to my doctor.

I need you back
on the monitor.

Frank, help me
get him back.

Take it easy
there, fella.

Take it easy.
Take it easy?!

You people have ignored
me for three days.

No one will tell me
what's going on.

Nobody gives a damn
about my care!

No one will even
talk to me!

How am I supposed
to take it easy?!
Mr. Ames, sit down.

Easy!
I'm not sitting down

until my doctor does
what he's supposed to do!

(groans)

CHUNY:
I need some help here!

Open your eyes, sir.

FRANK:
Hey, let's get a
gurney over here!

Mr. Ames.

Look at me.

Luka, he had a stroke.

Upgoing toe.

CT can take him now.

Okay, we're on our way.

Let's go.

KOVAC:
We recognized the stroke,

immediately moved him
for close monitoring

and had him to CT
as soon as possible.

From what I remember,
it was... it was pretty chaotic.

Why should this guy
have a stroke?
I have no idea.

Follow my finger, sir.

Sir, look over here.
Over here.

Frank, I need
a monitored bed.

There aren't any.

Uh, okay, uh,
Trauma Two, then.

GSW just took it.

Let's move him to CT.

FRANK:
CT's backed up
for half an hour.

Okay, where can
we put him?!

MARQUEZ:
I'll see what I can find.

Okay, uh, chart.
I need his chart.

I'm looking for it.
Chuny, where's the chart?

I never saw it.

It's okay, Mariko, just
take some deep breaths.

Where the hell's surgery?

Crenshaw called,
said the patient's

not a candidate for anesthesia
till the systolic's up to 80.

All right, well,
let's tank her up.

Eight French cordis
into the femoral.

You know, I had another idea.

Oh, man.

Hey, has anyone seen
a pocket doppler?

Uh, yeah, top drawer
by the sink.
All right.

What about an
intra-aortic balloon?

This girl
in heart failure?

No, it's a GI bleed.

What? We inflate the balloon
in the chest,

completely block off the
blood supply to the abdomen.

No, you can't do that.

Damn it.

Why not?
That's a great idea.
Hey, she's

not your patient.
Adios, Gates.

Okay, could be
a publishable case report.

It's a non-invasive way
to occlude the aorta.

It'll stop the bleeding.

Oh, crap, crap.

Crap.
What?

Pratt, can you come with me?

Four units of red
cells, one of FFP,

a ten-pack of platelets.
We'll be right back.

Hey, hey, hey.

What is this, some kind of
postpartum power trip?

Okay, the aortic balloon
will work.

It's an unproven therapy.
What, you'd rather
let her bleed to death?

No, I'd rather have the surgeons
take her up to the O.R.

It doesn't look like
that's gonna happen.

And what's your problem
with the balloon?

Because it cuts off
all the circulation

to the bowel, liver,
kidneys and legs.

Everything could die
from the chest down.

What are we doing in here?

You know, you used
to be such a cowboy.

Why is this a big deal?

I don't agree with you.

Gates thinks it'll work.

Gates is a knucklehead
who would defibrillate

with a car battery
and some jumper cables.

I am the attending.
The buck stops here.

So if there's going
to be a bad outcome,

let surgery be to blame
for not showing up in time.

So you let her die?

No, I just don't
want to be the guy

who kills her with
some crazy-ass therapy.

Look.

This is her last chance.

She's pre-arrest.

I mean, if her pressure
continues to drop

despite massive
transfusions...

Then maybe I would
consider it.

What are you doing?

I'm pumping.
Sorry.

My boobs were about to explode.

(electronic pumping)

KELLERMAN:
When did your wife arrive?

Right after the CAT scan.

By then I could talk again,
you know.

It looks okay.

I... st... still can't
move my arm...

and leg.

There's no mass,
no bleeding.

That's... that's good.

Then why did he
have a stroke?

Probably a blood clot
in the brain artery.

But, uh...

there is something
we can try.

What?

What should I do?

A medicine called TPA

could probably
dissolve the clot.

You're-You're saying
that could work?

That I might...

I can get better, right?

There's some chance
of recovery

30% of the time.

And, uh, full recovery,

ten percent
of the time.

We've got to do something.

What about the si...
side effects?

There's always side effects.

Well, there's a
ten percent chance

of bleeding in the brain,

causing more
disability and death.

Ten percent chance
of recovery?!

There's a ten percent
chance of-of death?

What if we don't
use the drug?

There can be
some improvement,

uh, with time and
physical therapy,

but probably not
full recovery.

(sobbing)

Look...

I... I've been in this hospital

long enough to know that
if something can go wrong,

it...

I don't want it.

WALTON:
And what do you

recall of Mr. Ames' reaction to
your recommendation of TPA?

I brought in Dr. Saunders,
a neurologist,

to try to explain options

in an objective manner.

The statistics are averages
for all patients,

even ones
in their 70s and 80s.

KOVAC:
Your risk of bleeding is
much less, given your age

and the fact that it's
been only 90 minutes

since the onset
of symptoms.

I don't... I don't know.

The TPA is your only shot
at complete recovery.

Forget it.
I'm-I'm not taking it.

Settle down, baby.

Look, if it was me,

I'd-I'd take the TPA.

If it was you, if it was you,
you'd be in intensive care

with-with-with
ten doctors and nurses

watching your ass every second,

day and night.
Curtis...

You wouldn't be getting
the runaround for three days.

Not sleeping,

not eating.
Pissing in a pan.

And now I'm supposed
to trust you

with a medicine
that can kill me,

when all I've seen
since I've been here

is total incompetence!

WALTON:
Mr. Ames, did you refuse
a therapy

that had the potential
to reverse the stroke?

There were no guarantees.

Experts have agreed that TPA

gave you the only chance
for a complete recovery.

And you didn't want it?

It was a lot more complicated
than that, really.

Did you refuse a medicine that
could've cured you?

I refused what they were
pushing,

and you would've done
the same thing.

So you did refuse the cure?

Systolic's only 50
after four unites.

All right,
hang another two units.

I'm above the diaphragm.
Go ahead, inject.

I'm putting in
40ccs of saline.

Let's hope this
damn thing works.

Doc Lock, you got a call.

Kind of busy right now.
Balloon is up.

It's your baby-sitter.
They said it was important.

Pressure's up to 90.

All right, go ahead,
go, take it.

We're out of the woods.
Mark the time.

Surgeons have one hour
to get it up and fix her,

or the game is over.

Hello.
TAGGART: They should be
here any minute.

What's happening?
Well, we've got your
bleeding controlled.

But now we're getting
ready to take you
up to the O.R.

Is he hungry?
Did you try the stroller?

Thanks for
joining us.

What's up with the fluoro?
I thought E.R. docs
had X-ray vision.

Okay, okay.

We put a balloon in the thoracic
Put the phone
next to his ear.

...aorta to stop
a Crohn's patient from
intra-abdominal exsanguination.

Rather unconventional,
dare I say, idiotic.

TAGGART:
Well, it worked.
BP's 122/78.

* If I go, there will
be trouble.. *
It's like a cross clamp

without the thoracacotomy.
It's very cool.

What's not cool
is that her kidneys

will be dead
within an hour.

Let's go,
clock is ticking.
Abby?

It's his favorite song,
it puts him right to sleep.

* This indecision's bugging me *

Aren't you glad you don't
work here anymore?

She's auditioning
for American Idol.

* If you don't want me,
set me free *

Hey, nice work, Abby.

Thanks.

* Exactly whom I'm
supposed to be? *

* Don't you know which clothes
even fit me? *

Upstairs, the neurologists
recognized a faint

mid-systolic murmur.

What does that mean?

A murmur is from turbulent blood
flow through the heart.

So because of the murmur,
a cardiac echo was ordered

showing a patent foramen ovale.

Do you know what a patent
foramen ovale is, Dr. Kovac?

A small hole between the upper
chambers of the heart.

So that hole
could have allowed
a blood clot

from your subclavian catheter
to pass

from the right side
to the left side of the heart

and then... up to the brain.

Could happen.
But that's extremely rare.

I didn't ask you how rare
it was, Dr. Kovac.

I asked you whether a patent

foramen provides
a pathway for a clot

to travel to the brain
and cause a stroke.

Yes.

So if you had heard the murmur,
if you had pulled

the catheter when the numbness
began, is it possible

that you could have prevented
Mr. Ames' stroke?

Objection.

Calls for speculation.

Sustained.

When the numbness began,

did you consider
a cardiac source,

or did you ignore an
important warning sign

of impending stroke?

I didn't ignore anything.

I considered what was probable
and acted accordingly.

After Mr. Ames
complained of numbness,

did you then appreciate
his heart murmur?

The E.R. is a noisy place.

You can't always
hear subtle murmurs.

Dr. Kovac,
I'm not asking you

about the noise level
in your E.R.

I'm asking did you at
any time in the three

days that you cared
for Mr. Ames

recognize his heart murmur?

At the time
of Mr. Ames' numbness,

there were 47 patients
in the E.R.,

82 in the waiting room.

I was taking care
of a young mother

who was the victim
of domestic violence,

nearly beaten to death,

an eight-year-old,
hit by a car...
Dr. Kovac.

And a 53-year-old
heart attack victim.
Dr. Kovac.

Dr. Kovac, you're not
answering my question.

There are always
sicker patients...
LAHN: Order!

I asked if he had a heart murmur
Order! Order!

that you failed
to recognize.
It was reasonable to believe

that Mr. Ames' numbness
could wait!
Order.

Order!

Only one of you can speak
at a time.

Your Honor, I move to
strike that that entire tirade

be stricken from the record
as non-responsive,

and I request that the
court admonish the witness

to answer my question.

LAHN:
Restate the question.

And, Doctor, I'm instructing
you to answer it.

If you had heard
the murmur,

is it possible that you could
have prevented the stroke?

WALTON:
Objection.

Possibility is not the issue.

LAHN:
Sustained.

Dr. Kovac, is it true that you
could have prevented the stroke?

Well, Doctor?

Counselor, I'm warning you.

No need, I'm done
with this witness.

Scabies family went home,

and lost rectal thermometer
went up to surgery.

Gates needs you for
an extubation in Trauma Two.
All right.

LOCKHART:
I'm here till 7:00,
so call me if you get a break.

Hey, any news from Kovac?
Not yet.

Greg?

Hey.

Am I too early?
Yeah, yeah, yeah.

Just have a seat in
Triage for a few minutes.

I'll be right back.
All right.

It's Abby, right?

Yes. Oh, hi.

Sorry about your arms.

Oh, it's okay,
they fixed me up pretty good,

but the med school
wants me

to make a chart
for their insurance.

It's no problem,
I got it.

Thank you, Ray.

Thanks, Ray.

I guess we can do
it in Curtain Four.

Great.

You might need
a little debridement.

Go for it.

So, your shift
almost over?
Mm-hmm.

They're giving me
two days off to heal.

Well, that's very generous
of the surgeons.

(chuckles)
First free night
in forever.

Have you been to Rednofive?

Uh, no.

They remodeled,

and I hear the DJ on Thursday
nights is ridiculous.

You want to check
it out tonight?

WALTON:
Both emergency

and infectious disease
experts agree

that Dr. Kovac
gave superior treatment,

above and beyond
the standard of care.

The stroke was
a one-in-a-million

complication that no one
could have either predicted

or prevented.

Dr. Kovac treats
the patients that no
other doctor will treat.

His E.R. is the safety net
for millions

with no health insurance.

Every day,

he is out there
on the front lines,

providing the best
health care possible

for the people
who need it the most.

If you find against Dr. Kovac,
what message do you send

to other health care providers
like him, who make

that daily struggle
their personal mission?

Dr. Kovac could have sent
Mr. Ames home

with antibiotic pills,
but he didn't.

He assumed that Mr. Ames
was unreliable,

that he couldn't be trusted.

And so Dr. Kovac took
responsibility for his care.

And then, he abandoned
that responsibility

by subjecting Mr. Ames
to substandard conditions

in an understaffed E.R.,
where that man was shoved

into a corner and neglected.

And the warning signs
of a major stroke were ignored,

resulting in
a devastating disability.

Before the stroke, Mr. Ames
was a skilled craftsman.

He supported a wife
and two children.

And now, with a paralyzed
left arm, loss of perception

in his left visual field, that
livelihood has been taken away.

Loss of income,

loss of self-esteem
has resulted in profound stress

and led to a divorce and
separation from his children.

Mr. Ames now lives alone.

He's trying to get by
on a disability benefit

of $1,300 a month.

He cannot drive, he sees
his children one day a week,

and he is being treated
for depression.

Your award must fairly
compensate Mr. Ames

for past and ongoing
medical care,

for 25 years of lost wages,

and for the pain and suffering

that this man
will experience every day

for the rest of his life.

LOCKHART:
And you want to make sure
that this part

rests against your
ribcage, not your armpits.

And then, you
just-- whoops!

I'm okay. I'm okay.

You sure those
things are safe?

Yeah, I think they just
need an adjustment,

or you can go to the
pharmacy and get a new pair.

Good idea.

Be careful.

Should we sign you in
as a trauma patient?

I would say yes,
but my shift is over.

Call me if your
spleen ruptures.

Excuse me. Hi.
Hi.

Is Dr. Pratt around?

He's with a patient--
can I help you?

He told me he was going
to be right back.

If you see him, will you let him
know that Chaz is still waiting?

Okay.

RAY:
Hey, Neela, you
have a minute?

I have 12 hours,
I'm on all night.

Okay, it's about Katey,
your med student.

Ray...
Hey, hey.

She asked me
out, all right?

You know that residents

are not allowed
to date their students.

She's not my student,
she never will be.

She's not doing
an E.R. elective,

so technically,
it's not even against policy.

Well, then why even ask?

Thanks, appreciate
your help.

I'm sorry, I got to go.

Tell Greg I'll call him.
Okay.

Hey, Mayday.
Hello.

What are you doing here?

Small bowel obstruction.

Good times.

So, uh, how's the guy
who went up in flames?

Minor partial thickness
burns to the chest and abdomen.

You know, I hear his aorta
was just fine.

You know, there's a lesson
to be learned here.

Wise men say,
"Only fools rush in."
Hey.

Oh, you missed a
guy called Chaz.

He left?

You were saying?

Hey, Chaz,
Chaz, hold up, man.

Sorry about that, I got
caught up with a patient.

It's okay. I got to go.

No, come on, man.

It sounded like
something serious.

Nah, it's all good.

Hey.

Things just aren't
going so well at home.

Really?

When I want to study,
it's too noisy.

When I want to bring
my friends over,
Dad won't let me.

I'm always late to class,

because the commute
takes forever.

What about the dorm?

Costs too much.

When you saw me
out there earlier,

I was looking for
apartments to share,

but... they all
kind of sucked.

Look, I know this is
going to sound crazy,

but... I was thinking

maybe I could move
into your place.

(chuckles)

My place?

(laughing):
Yeah, your place.

I mean, it's close to campus.

I can get a part-time job,
to help you out with the rent.

I'm quiet.

We'll probably never
even see each other.

You're serious?

Chaz, come on, man.

You know,
I got my own style.

Aw, come on. You say the word,
and I'm gonna clear out for you.

And if it doesn't
work, I'll...

I'll be gone...
real fast, man.

Never mind,
it's a bad idea.

All right, look.

Let's try it for a month.

You for real?

Yeah, I'll talk to your mom.

(chuckles)
Thank you.

All right.
Thank you.

(chuckles)

I'm going to
holler at you.

All right, man,
take it easy.

(sighs)

Hey!
Yeah.

(chuckles)

So, how was the
first day back?

It was a piece of cake.

(chuckling):
Like riding a bike.

Yeah? You miss
your little man?

Yeah, but that's okay.

I'll bond with him again
when I feed him

at 11:00 and 2:00
and 5:00 a.m.

(laughs)

But you know what
was nice about today?

For 12 hours, I talked
like a grown-up to grown-ups.

Well, except for
when you had to deal
with the surgeons.

Yeah, but at least they
don't spit up on you.

Much.
(chuckles)

Good night.

Try to get some rest.

It's a nice idea.

How long do you think
they'll deliberate?

Shouldn't take more
than a day or two.

Ames' lawyer is a
publicity hound.

Local news is having a
field day trashing County.

It'll be good to get you
in front of the press

as "the doctor
found not guilty."

Well, you're very
optimistic.

People need to hear our
side of the story

to reassure them that the
county health system works.

During that videotape,

did you see the looks
on the jurors' faces?

Doctors get sued
for ignoring

and undertreating patients,
not for doing too much.

Plus, you did a great
job on the stand.

Well, I don't think so.

I've been to at least
a hundred trials.

I can tell when a jury
likes the doctor.

WOMAN:
He's just another greedy M.D.

getting rich by overtreating.

What are you
talking about?
I've read about it.

The drug companies
give kickbacks

to doctors who use
their expensive drugs.

Mm-hmm.
WOMAN 2:
The judge instructed us

not to decide this case
based on anything

we've heard outside
of the courtroom.

WOMAN 1:
They neglected this
guy for three days.

WOMAN 2:
His pneumonia
was improving.

MAN:
That doctor used a hand grenade
to kill a mosquito.

To me, that's bad
medical judgment.

You're not a doctor.

We've got to to decide
this thing

based on the expert witness
definition

of the standard of care.

Well, when you're talking
about County General,

the term "standard
of care" is a joke.

That's right,
Kovac is part of the system.

We all know the system sucks.