ER (1994–2009): Season 15, Episode 14 - A Long, Strange Trip - full transcript
A usually eventful day or two at the ER includes admittance of an old man who has flashbacks of the hospital ER as it was 40 years before. His caretaker arrives and turns out to be a former ER staff member. Meanwhile a mother dying of cancer is given some tests after the old man indicates he thinks she has been mis-diagnosed. Sam's sister Kelly visits and tries to get Sam to agree to take on the care of their sick mother. A man who has lived most of his life in an iron lung needs an operation and a poor epileptic woman is brought in after shoplifting.
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Frank, we got to get
these tele admits up.
I'm all over it.
There's at least
30 in the rack.
What were you guys
doing last night?
Playing Guitar Hero
and doing Jell-O shots.
Two messages from Kelly.
Kelly who?
She said you'd know.
That's her phone
number at Swissotel.
Car crash victim coming in.
Oh, OK, clear
Trauma One and get surgery.
We're gridlocked.
Quick dispo in Curtain One.
Grady?
Off duty
and going to Jumbo Mart
for enough caffeine to get
me through my charting.
Well, who else is on?
Well, we got,
er, Brenner, Morris...
What do you need?
That's OK.
I haven't picked
up a patient yet.
No, go, er,
meet the trauma.
It's busy.
I got time.
OK, fooling around
with her boyfriend
and they lost
the condom.
She's fully dressed in
the middle of the ER.
She should be in a gown
in a private room
with a chaperone for a pelvic.
Yeah, there's
no need, actually.
What?
Go on. Go get the history.
Hello. I'm Dr Gates.
Tammy.
So, the, er, proverbial
lost condom, huh?
Yeah.
It's kind of embarrassing.
Well, don't worry.
Tell me what happened.
The condom came off,
and I couldn't reach it.
My boyfriend tried to help,
but he's useless.
I went to the bathroom
and gagged myself,
but I couldn't
vomit it up either.
I'm not gonna...
suffocate, am I?
Dr Rasgotra.
Dr Brenner.
Mm.
How was your night?
Four hours of sleep.
Well, you would've got
a lot less than that
if you were in my bad.
Next time, you should
spend the night with
me in the call room.
What, you mean on a twin bed
with scratchy sheets
and phone interruptions
every hour?
(GIGGLES)
That's kind of hot.
You know, I was
thinking of, um,
getting Neil Young
tickets for Saturday.
That sounds good.
You like him?
Yeah, I love him.
Especially
his early stuff.
Really?
Yeah. Old Man,
Only Love Can Break Your Heart...
Heart Of Gold.
Heart Of Gold.
Neela!
Uh, trauma coming in.
Thank you.
(CLEARS THROAT)
Are we out of sugar?
I don't think so.
What are they doing?
Our old medical records
are going in remote storage.
Let me ask you something,
kind of man to man.
Do you believe in
the three-date rule?
You seeing someone new?
I don't know if we're actually
"seeing" each other.
We had lunch together
in the cafeteria.
I bought her a burger
one night at Ike's.
Wow, sounds serious.
I like her.
I just can't tell if
she's interested in me.
Well, I'm pretty sure
I'm not the right guy to ask
for relationship advice.
Hey. The run
got diverted to Mercy.
Whoa. Whoa-whoa-whoa-whoa.
Hey. You all right?
Tony... Archie,
I need some help.
Grab a gurney.
Looks like this guy
got beat up.
What's your name, sir?
Oliver.
Oliver what?
No wallet, no ID.
Pupils are equal.
You know where you are?
Hospital.
Oriented to place.
What year is it?
Who's the President?
Sir, do you know
who the President is?
CROWD: Hey, hey, LBJ,
how many kids
did you kill today?
Hey, hey...!
Chicago is a police state!
(MAN SHOUTING, PROTESTORS SHOUTING)
Hey, hey, LBJ!
You don't have to talk.
We'll take good care of you.
Relax, brother,
enjoy the ride.
I looka great today.
Hey. Why so quiet?
No, they're extra quiet
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Decent breath sounds.
Looks like he got kicked
a bunch of times.
Yeah, or fell.
He looks too good
to be homeless.
No blood in the belly.
Abrasion where somebody
stole his watch.
Definite assault.
We already called in the police.
Chest is normal. The head CT's
gonna be normal, too.
Not if there's a brain bleed.
These old altered guys,
it's always something metabolic.
Just order
some more IV fluids,
and let me go clear the board.
No. Stay on this.
Buff him up, find
out where he belongs.
Scanner's ready.
Potentially unstable.
Dr Gates can monitor him
in Radiology.
Last BP was
110/65.
Hold it, hold it! Excuse us.
Are you a student driver?
I'm sorry.
I'm sorry you had
to pull me out of my car.
Is the oxygen helping, Donna?
I think so.
Have you ever had any
trouble breathing before?
Not till last week.
Mom, I parked the car.
Thanks, honey.
That's my son Dylan.
Hey.
She couldn't even talk.
So you were saying
about last week?
They told me
I had lung cancer.
Where are you being treated?
Uh, nowhere yet.
We were supposed
to go to Northwestern,
but in the car
her breathing got so bad
that I-I pulled into here.
I have papers and X-rays, if...
The Willow Ridge Medical Centre.
That's our local hospital.
That's where they diagnosed me.
OK.
Do you smoke
cigarettes, Donna?
10 to 15%
of lung cancer occurs
in non-smokers.
We've been
on the internet a bit.
It's in the left
upper lobe.
Liver function tests
are elevated.
OK. And did they explain the
brain CT results to you, Donna?
Two spots.
They thought that, um,
surgery and chemo and radiation
could buy me some time.
Uh, stage-four lung cancer
has a five-year survival rate of 5%,
but 1 in 20 survive.
(BRENNER) OK, well,
we'll have our surgeons
and oncologists consult.
I was hoping
to go to Northwestern.
Yeah, you're too sick to move.
Yeah, I'm gonna cancel
the audition, Mom.
No, Dylan, you're not
cancelling anything.
No. Get to orchestra
hall on time,
and you can stay with
Aunt Harriet tonight.
OK?
OK.
Dr Morris, I'm looking for
an old guy, victim of assault.
He should be
right back.
OK.
You know,
I could be wrong,
but I thought I saw
you and Officer Diaz
eating lunch
the other day.
Yeah, we-we were
on a case together.
Really. Cos I've
had cases with you,
but we've never
had lunch together.
Plus, it must've
been a funny case,
cos I noticed
a lot of smiling.
Yeah, well, Officer Diaz
is a nice lady.
We all know that.
And I know you know
that cops stick together.
Yeah.
So be careful.
If you break her heart,
we may have to break you.
Head CT was normal,
just as I predicted.
And guess what?
He's hypernatremic.
How bad is
his sodium?
165. Dry as a bone.
Does this guy talk?
Not really.
I'll check for
Missing Person reports.
Did you calculate the
free water deficit?
Yep, six litres.
OK. Hypernatremia shouldn't
be corrected at a rate...
One milli-equivalent
per litre per hour.
Need a doctor here.
You can have Dr Gates.
Well... No, shouldn't
I stay here and finish?
No, you've been
wanting off this case
from the get-go. See ya.
He's starting to
open his eyes.
That's a good sign.
Mm-hmm.
(MORRIS) Oliver... Oliver,
try to squeeze my hand.
Oliver...
Curtain Three is open.
Hi, I'm Dr Gates.
Damien.
My wife, Corazon.
Hello.
Sam, did you
ever call Kelly?
I didn't think so, cos
now she's coming to see you.
Let me know when
she gets here.
You don't see
many of these.
It's a negative pressure
ventilator.
When the air is sucked
out of the chamber,
it flows into his lungs.
I had polio when I was three.
Don't breathe too
well on my own.
Is that why
you're here today?
Uh, no - fever,
abdominal pain,
possible appendicitis.
I'm a retired RN.
I need to get a BP.
Yeah, and I'm gonna need
to examine his belly.
There are portholes
on the side.
Just stick your arms through
the neoprene.
All right.
Hmm.
Are you, er,
in this all the time?
We have three kids,
so no, not all the time.
I use it 18 hours a day.
How long have you
guys been together?
45 years.
I got an e-mail from Yale.
They want another two
letters of recommendation.
Well, that seems
a bit pointless
if Dubenko can offer you
a position here.
I'm not sure he thinks
I'm right for the job.
Oh, man.
That's the head CT.
This must be
the lung mass.
Yikes. Where's
the patient?
LFTs and CBC.
Looks like the horse
is out of the barn.
Mm. Son's at bedside.
No dad.
Donna, this is Dr Rasgotra,
Dr Dubenko.
Her son.
Dylan, hello.
Hi. Nice to meet you.
Um, I've reviewed the films,
and I'm sorry to say
that the tumour is
far too advanced for surgery.
Are you sure?
With cancer in the liver,
the brain and bones,
I'm afraid
that an operation
would only mean
pain and suffering
without prolonging
your life.
It's in my bones?
We think so.
What about
chemotherapy?
It's possible, but...
We'll see what the,
er, oncologists say.
Have you thought about
your wishes for life support?
Perhaps this is better
discussed later.
I made a living will
about ten years ago.
I don't want to be kept alive
if I have a terminal illness.
Mom...
Then you might want
to explore the hospices...
OK, we-we don't
need to talk...
What's a hospice?
What is that?
It's a way to keep people
comfortable
in the final stages
of their illness.
Are you saying that...?
Look, um, we're gonna
come back, um,
after you've had a little bit
more time to consider.
Yeah.
OK.
Doctors?
What are you doing?
What?
I asked for a surgical opinion,
not for the Grim Reaper.
I was being truthful.
They have barely processed
the cancer diagnosis and
you walk in there...
What, do you want me
to sugar-coat it?
You want me to lie?
No, I want you to give them
a little bit of hope.
Well, maybe there is something
positive to offer - a thoracentesis?
Yes, that's a good idea.
That should make her feel a better.
Good. Well, why don't
we lead with...?
Frank said you guys have
fresh coffee.
I hope you have
half-and-half.
OK...
I'll just just make
a...fresh pot.
Oh, OK.
Hi, I'm Kelly.
Hi, I'm Dr Gates.
Oh. What kind
of doctor are you?
Well, this is an ER, so...
That must be
complicated.
You got to know a lot of
stuff about everything.
How long you
worked here?
A couple years.
Cool.
Yeah, I've only been
in town for two nights
and I'm craving
deep-dish pizza.
Oh, Lou Malnati's.
Oh, yeah?
Yeah, that
sounds great.
What are you doing
for dinner?
I don't think that would
be such a good idea.
Why not?
I just got out
of a relationship.
Oh.
When you fall off a bike,
you get right back on it.
Got a sesame seed...
Kelly?
Sammy.
(GASPING) Wha...?
What are you...?
Oh, my God!
Hi.
What are you...?
Oh, my God,
l-look, look at you.
Look at you. Hi.
I'm really sorry
to barge in on you at work.
You know,
I got your message,
but I've been busy
at work and...
That's fine.
So, how do you two know
each other?
Uh, Tony,
this is my sister, Kelly.
(CHUCKLES)
If I can tie up a few loose ends,
I could take a break.
I'll be fine - just, you know,
me and the Home Shopping Network.
Ortho's on line four
and they need you at the lung tap.
Go save some lives.
Stay out of trouble.
That's your sister, huh?
She seems very nice.
Yeah.
(GATES) Ortho?
Sam, cytology
and culture on this.
(RASGOTRA) Take a deep breath.
(BREATHING DEEPLY)
Much easier.
Good. We can pull
three litres.
Dylan, it's late,
you should go.
I'm not going.
He has an audition today for the
Juilliard School in New York.
Impressive.
What instrument?
English horn.
I used to play
the viola.
The English horn
is lovely.
Honey, they're only here
once a year.
You might never get
another shot.
I'm much better.
You think it's OK
if he goes?
Yeah, I don't see
why not.
(DUBENKO) I think it'd
be best to stay.
With the extent of your disease,
things could suddenly take
a turn for the worse.
You mean
that could happen today?
That's pretty unlikely.
Yeah, I should,
I should stay.
Dylan...
Mom, I'm staying.
Let's wait a bit
and see how she's doing, OK?
Sam, you seen the old guy?
Not in a while.
Oxygen's off,
so are the monitors.
Looks like he eloped.
Great.
What happened?
I think we lost a patient.
Check the bathroom.
(DUBENKO) Sam, we can see
your polio guy now.
I'm gonna need you
on a paramedic run.
Hey, Frank, tell my sister
it's gonna be a while.
I got to find
a demented grandpa,
pick up
an incoming off a rig
and pull a patient
out of an iron lung.
(ZADRO) April Robinson, syncopal
episode at Walgreen's, still altered.
(MORRIS) Any seizure activity?
No.
What's up
with the handcuffs?
She passed out after getting
busted for shoplifting.
(MORRIS) How convenient.
(ZADRO) No, she's real -
blood sugar's over 400.
12 lead EKG negative for MI.
I gave a litre of saline and got her
sats up with suctioning.
What do we have?
(ZADRO) This lady fainted
at Woolworth's!
Any heart history?
You got me.
She doesn't have a pulse.
When did she
stop breathing?
(ZADRO) Doc, they pay me to drive
them to the hospital, that's it.
She's lucky I had
an oxygen tank.
She needs a cardiac
arrest cart.
(MORRIS) It may be
too late for that.
(RASGOTRA) Dilated appendix,
non-compressible.
So I'll need surgery?
Yes, most definitely.
Can it be done
with the laparoscope?
We'll try.
Sometimes, though,
we have to convert
to a conventional procedure.
(DAMIEN) You mean
opening up my belly?
I use my abdominal muscles
to help me breathe.
His friend had colon surgery
and ended up traked for life.
All right, well,
we'll do the best we can.
Dr Rasgotra will be back
with the consent form.
He's a perfect candidate for NOTES.
What?
Natural Orifice Transluminal
Endoscopic Surgery.
You want to remove his
appendix through his mouth?
Well, in his
compromised state,
he needs the least invasive
procedure, and NOTES is it.
Yeah, we don't do that here.
It's experimental.
But there's a Dr Horta
from San Diego
doing clinical trials
at Northwestern.
He's had over 50 cases.
You're cutting a hole
in his stomach, Neela.
You're setting yourself
up for peritonitis.
It's a two-millimetre
incision that's occluded
by a balloon and transport.
When you're done, you close
immediately with G-prox.
They've had great success.
You want to call
this guy in?
Well, it's a chance
to be state-of-the-art.
See if he's willing to help
and available today.
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You can taste we care.
Neela wants me
in Curtain Two.
Drop the insulin to five
an hour before you go.
What's going on here?
Your diabetes is out of control.
Paramedics brought you
to the ER.
Think of it as a pit stop
before jail.
What are you talking about?
Why don't you
take it easy?
Why don't you step out until
she's medically cleared.
I didn't do anything.
Well, surveillance camera shows you
pocketing lipstick and mascara.
I was gonna to pay for that.
I got distracted.
You can't keep me.
My daughter needs me
home with her.
You should of thought about that
before you pinched Maybelline.
Hey, come on, Officer.
Can I ask you a question?
"I was gonna pay for it"!
What a load of crap.
You know,
she doesn't seem like a crook.
Does she have any priors?
Any priors?!
You have been hanging
out with Claudia.
(GATES) Hey, Morris,
we found him.
Excuse me.
Outside, barely conscious.
Pulse ox 78 on room air.
Probably blossoming some
pulmonary contusions
from the trauma.
All right.
Open an airway tray at 8-0.
Where's Sam?
(MORRIS) On her way.
Are we really
gonna do this?
Yeah.
This guy could be sharp
as a tack once his sodium's normal.
What do you need?
Sublingual captopril,
four of morphine.
Hey, Sammy,
I've been here
for, like, two hours.
It's kind of a bad time.
I know. I just... I can't
really wait around.
I've got a bunch
of appointments.
Ma'am, can you just let us...?
(GATES) Has everyone
met Sam's sister?
(MORRIS) I didn't know
You had a sister.
Hello.
Hi.
Sam, take a break.
Chuny'll take over.
Yeah, you know, looks
like you could use one.
Hey, Doc,
we busted the mugger.
I got an empty wallet...
and a retirement
watch from County.
Maybe he worked here.
Suction on high.
Call for a vent!
(GATES) End tidal CO2 detector.
(TAGGART) 'You look good.'
I mean, considering
the last time I saw you,
we were both in pigtails.
Yeah... Yeah, it's been
a really long time.
Mm.
We got some catching up.
You want to go to dinner?
I get off at eight.
Uh, no, you know,
my flight's at 7.30
and I've got my last
meeting at five.
What kind of meetings?
Uh, well, I'm here
for the apparel show.
Oh, my God! I remember those
dresses you used to make
for your Cabbage Patch Kids!
Oh, my... You actually turned
that into a job?!
Yeah.
Uh, my clothing line
just got bought by Billabong
for about $2 million.
You're kidding.
No.
You're kidding me.
Yeah, it's, er...
Well, I've got to travel
to Europe and Japan
to launch
the new collection.
Wow!
Wow. What, did you just come
all the way from Dallas
to rub it in my face?
No... No, um, I came
to talk about Mom.
I had to move her
to assisted living.
You know,
her emphysema got worse.
Yeah, well, three packs
a day'll do that.
She also had a stroke.
(SIGHS)
You know, I visit her,
like, twice a week.
And it's not a lot,
but it makes her happy.
(SIGHS HEAVILY)
And I'm going to be travelling
for months at a time, so...
You know, I... I want
to move her to Chicago.
No, don't.
Please don't.
Look, I'll pay
for everything -
her moving expenses,
her living expenses.
All you've got to do
is just go visit her.
Look, I've been doing this
for a really long time now, OK?
I think it's your turn.
No, it's not.
Look, she's your mother.
You know, even after everything,
she's still your mother.
Who I haven't spoken to
since I was 15.
Well, you know, maybe it's time
that changed, too.
All right, I'm in. Bag him.
AC 14, tidal volume 500.
Have Frank check
personnel records,
see if we can figure out
who he is.
(RASGOTRA)
Post-expansion pulmonary edema.
Let's get her son
back over here now.
He went to his audition.
I thought he was gonna stay.
I told him he could go.
How soon can he get back?
I don't know.
We need bipap and set up
for an intubation.
Intubation?
She has a living will,
she asked for no heroic measures.
OK, Donna, Donna, I need
to ask you a question.
Donna? Donna?!
I should call her son.
Exactly what
I didn't want to have happen.
OK, start with the bipap.
It's non-invasive,
in the spirit of her wishes.
That's a good idea.
This isn't a surgical
problem, Dr Brenner.
You're the primary physician
on the case, so you call it.
Let's go, Neela.
Did you reach the son?
No. I might have to intubate.
With a DNR?
Can you even do that?
Well, temporarily.
I can always remove it later.
I promised her son that she
would be alive when he got back.
I see.
(BRENNER) There's fluid
around the heart.
We can drain that,
buy her some time.
(FRANK) Neela.
Dr Horta's here
on your porta-lung appy.
Peri-vac kit and betadine.
Well, um, good luck.
(TAGGART)
'Serum ketones are negative.'
Is that a problem?
(MORRIS) Well, medically,
it's good news.
But it means we have no reason
to keep you
in the hospital overnight.
So I'm going to jail?
I think they let you out
if you pay a fine.
I don't have the money.
What about a loan?
They won't give you credit
if you don't have a job.
Ever since I got laid off,
I've been cleaning houses.
Barely covers the rent.
My daughter.
Your daughter...?
Pregnant.
On bed rest.
I'm trying to buy her
a crib and stuff.
You talk to a social worker
about getting some help.
I have worked hard
my whole life.
I've raised two babies.
Never been on welfare.
I had to get my medicine.
So why would you...
Steal a tube of lipstick?
I return it for store credit.
Use the credit...
to buy my insulin.
It works.
Dr Morris.
We're making some progress
ID'ing your old guy.
There's a patient missing
from a nursing home on Dearborn.
Fits his age and description.
You hear that, Oliver?
Sounds like we found
out where you belong.
Systolic's down to 80.
Run in a litre.
(GATES) You need a hand?
I just need to thread the
catheter over the guide wire.
There's the pericardial fluid.
It should help.
I'll check another
blood pressure, Doctor?
(SLAPPING RAIL)
What's wrong?
What do you need? You in pain?
Relax.
You're OK.
Hit him with
some Versed, Tony.
(GATES) "TB".
TB?!
By any chance,
does your lady have tuberculosis?
No, she's got cancer.
You sure? Do you have confirmation
on the path report?
It'd be unusual,
but...TB could explain everything.
Infection in the lung,
the bone, liver, the brain,
around the heart.
You need a sputum
stain for AFB.
(MARQUEZ) Better get a mask on her.
You think your guy was a doctor?
Oliver,
were you a doctor?
I'm sorry, I wouldn't have
pulled you out
if it wasn't important.
Real quick -
what's the fine for shoplifting?
And the maximum jail time?
(SIGHS)
No, the guys
didn't put me up to this.
Thank you. Get back to class.
You don't look like
you have good news.
Could be up to six months.
(GROANS)
You know, all the jails
are overcrowded.
It won't be that long.
No, her daughter's having
her baby next week!
Hey, Morris.
OK, I will be back
as soon as I can.
Excuse me.
My captain wanted to know
how much longer
she's gonna be.
Uh...this needs
to run in over an hour.
I thought
she was ready.
Yeah, if I discharge her too
soon, she'll bounce right back.
I got to call the station.
You know what sucks?
There are guys out there
stealing cars and shooting guns,
and you're here all day
baby-sitting a decent lady.
I'm just doing my job.
Where's Brenner?
He ran to the lab.
We think this lady has TB.
Yeah, and this guy
might have figured it out.
Really?
How long does
an AFB stain take?
Less than an hour.
(MORRIS) "To OMK.
35 years of service."
Oh, my God.
Do you know who this is?
Yeah, this is...
this is Dr Oliver Kostin.
As in Kostin's
Textbook Of
Emergency Medicine.
He's a legend.
Dr Morgenstern!
The one and only.
Hey, Chuny.
So good to see you.
So good to see you.
This is Dr Morris
and Dr Gates.
Hi.
Dr Morgenstern
ran this place back in the day.
What are you
doing here?
I got a call from
the nursing home - Ollie...
you gotta stop
wandering.
Are you his doctor?
No. His proxy.
His wife died a few years ago.
They never had
any children, so I got
a durable power of attorney
for health care.
You must have been close.
He taught me everything.
Treated me like a son.
He knows you're here.
Then he's having a good day.
What's his baseline?
Multi-infarct dementia,
and going downhill fast.
Ooh...he had
a great mind.
Now there's nothing left.
Well, something's
going on in there.
He thinks that lady
has tuberculosis.
(CHUCKLES)
Does she?
(MARQUEZ) We don't know yet.
The... The swelling
behind the right ear.
Could be scrofula.
It's a TB-infected
lymph node.
Used to be in the textbooks -
it's not any more.
So if he's right,
he's still capable...
No.
It's a flash of an old memory.
Every once in a while,
a stimulus -
a sight or a sound - brings up
something from the past,
but it doesn't last long.
For all intents
and purposes,
he doesn't interact
with the present.
He hardly speaks.
I brought a copy
of his DNR order.
So we shouldn't
have tubed him?
He never wanted
to end up like this.
Could we take him
off the vent?
Maybe...move him
into a private room?
Sure.
What about Trauma One?
He might be getting
a few visitors.
You know, the ER
used to end right here.
He designed your trauma rooms.
And got 'em built 40 years ago.
Dr Horta cleared
his entire schedule
to come operate on you.
Thanks, Doc.
My pleasure.
We'll see you upstairs.
I'll be right
behind you, honey.
I'm...really looking
forward to this.
It's gonna blow your mind.
Oh, Lucien.
This is Dr Horta
from San Diego.
Oh, um, hi.
Yeah, I've all about you.
So, um, this thing's
really gonna happen?
We're all set to go.
You should scrub in.
I can't. I've got a couple of
cases, pre-op cases, to check in on.
Let the residents do it.
Go ahead. I'll be in and out,
you guys.
Let's take the stairs.
OK.
Nice to meet you.
Yeah.
Lucien, heard about
the NOTES appy.
Pretty cool.
Yeah, it is...pretty cool.
Excuse me, Officer.
when they're sending you
off to jail?
You need to be
on bed rest.
This is crazy, Mom.
This isn't you.
Dr Morris,
this is April's
daughter, Kendra.
Hello.
Hello. Is she OK now?
Her diabetes is
back under control.
Mom! Why would you do
something like this?
I don't know.
I guess I wasn't thinking.
Your mother was trying to help.
This is between
her and me, thank you.
Mom, talk to me.
BP's way up - 170/100.
We should let her rest.
Yeah, I think
you're upsetting her.
What do you think
she's doing to me?
Sam, cycle the dinamap.
Ow! (GASPS)
Is that a contraction?
Kyle, grab a gurney,
let's get her up to OB.
No problem.
Slow, deep breaths.
I'm OK.
I don't need all that.
No, we have to
monitor your baby.
Morris, positive AFB.
Whoa!
Well, the whole
ER's been exposed.
Everybody needs
testing and follow-up.
We all assumed
it was a tumour,
but the other hospital
cytology was equivocal.
Chuny, we're intubating.
You are?
Positive TB stain.
She doesn't have cancer,
she has a treatable infection.
(MARQUEZ) All right.
Glide-scope's ready.
Good call, Oliver.
TB is the great imitator.
That's what he taught us.
(BRENNER) 20 of etomidate,
100 of succinyl choline.
(MAN) 'Dr Kostin...
Dr Kostin, are you mad?'
You can't give succinyl
choline down here.
I just did.
Paralytics and intubation
require an anaesthesiologist.
I'll keep that in mind.
Your patient's too sick
for the emergency ward.
Patients like this die
up to the ICU
without an airway.
OK, gentlemen.
My work is done.
(BRENNER) Beautiful shot
of the cords.
Passing the tube.
Nice.
Sats are fine.
(MORRIS) Cuff is down.
All right.
Deep breath in, Oliver.
(INHALES)
And out.
(COUGHS)
David.
Where do we start rounds?
Right here, Ollie.
You're right
where you need to be.
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Look, I...
I have to get back.
But I'm really glad
you got in touch.
Yeah.
Yeah, you know, I've...
been trying for 15 years.
Hasn't been easy.
and then the next day,
you took off,
just pregnant by some dude.
I didn't take off.
Mom kicked me out of the house.
Well, you could have called.
She wouldn't let me talk to you.
Written a letter.
I did.
She must have tore them up.
I... I... I never knew that.
I had a baby. I had to work.
After a while,
I just stopped trying.
I figured you probably hated me.
I didn't.
(WRY CHUCKLE) Um...you know,
um, after you left,
this is the only guidance
that I got.
My diary?!
Yeah, yeah,
you must have left
in a hurry, cos I found it
underneath your mattress.
Oh, my God.
Are you kidding me? What?!
Did you read this?
Yeah, of course.
Like 100 times.
You taught me how to...
how to French kiss,
how to pierce my ears,
how to roll a joint.
Six Flags?
Yeah, when I was seven,
that was like the happiest day
of my entire life.
Oh, my God.
Mom took us home early
because you puked your
funnel cake all over Shock Wave.
Ah! you are so wrong.
No, she... (LAUGHS)
..she took us home
because, when she went
to the bathroom,
you went and tried to bum
a cigarette off the hot dog guy.
I did not!
Yes, you did.
Geez...
You were grounded
for an entire week.
Oh!
I was so stupid.
She's really bad, huh?
Yeah, it won't be long.
(FRANK) 'Well, ICU
could take Trauma One.'
OK, let's move Dr Kostin.
Dylan...how'd it go?
It's OK.
Where's my mom at?
She's in a different room
on a breathing machine,
but, um, something
amazing happened.
It turns out your mom
doesn't have cancer.
Are you serious?
It's tuberculosis.
Um, th-they told us tha...
The cells from
the other hospital
were suggestive of cancer,
but they weren't definitive.
So, we ran a special stain
and we found TB.
(VOICE BREAKING) Um, thank you.
Thank you.
That's incredible.
She's not out of the woods yet.
If it's a drug-resistant strain,
then she's gonna have
a very rough course.
But it's better
than cancer, right?
I mean, her prognosis,
it's good?
Now, we're gonna
have to keep you
in isolation for
a couple of days
until we find out
you're not infectious.
Not a problem.
Donna, there's someone
here to see you.
Mom, I heard the great news.
I kind of rocked it.
They're not supposed
to give you any feedback
but the head of the
woodwind department said,
"See you in September."
Sam, I'm going to be
up in the OR for a bit.
Prescription for insulin
and, er, an appointment
with a diabetes clinic.
Where you taking her?
County jail.
Are you OK?
I got some medicine
to stop the contractions.
I have to wait a week
till the baby's ready.
We should be going.
Hold on.
You've got nothing to say?
You're not gonna
explain this to me?
Maybe later.
She's had kind of a rough day.
I thought I was going to have
some help with this baby,
but I'll do it on my own.
I just thought you wanted
to be a part of it.
But if this is how
you want it, fine!
Come here... You know what,
come here.
What are you doing?
Please come with me.
What's going on?
I need you to understand
what your mother
has been doing.
Shoplifting make-up.
To trade for insulin.
She loves you. She's made a lot of
sacrifices for you and your baby.
She almost died today because
she ignored her own health
to buy you a crib.
I didn't know.
Yeah, she's too proud
to say it.
I know it's hard, but try
to appreciate what you have.
Stump is tied off.
Endo-shears.
Nicely done.
Tension as you pull, Neela.
(BRENNER) They're still at it.
Yeah, you're just in time
for the big finish.
(RASGOTRA) Appendix is out.
How cool was that?
(OVER SPEAKER) Very.
(BRENNER) You heard about
the TB case?
Yeah.
(HORTA) G-prox, please.
Yeah, we were all guilty
of "diagnosis momentum".
Despite incomplete evidence,
we heard the word "cancer"
and we all ran
down the wrong path.
It's a glimpse of
the future in there.
Yeah, I wasn't
on board at first,
but Neela persisted, so...
Well, that's a good
quality to have.
Especially in an attending.
There are a lot of candidates
this year, you know.
It's going
to be very competitive.
Well, whoever gets her
will be lucky.
Think he's really mad at me?
Well, it did undermine
his authority.
But it was in the
interest of the patient.
Yeah, I agree.
I think he must
be in Trauma One.
I just hope it doesn't
hurt my chances here.
Well, if it does,
then they're all crazy.
I can't imagine anyone
more brilliant and skilled
and compassionate...
and sexy.
And you'd better take a nap,
because you're going
to need it for later.
I was pre-med,
volunteering at the hospital,
when they made him
chief in '68.
Back then, the ER
was a glorified walk-in clinic
where you were seen
by unsupervised interns
and residents with no training.
And the community ERs
were even worse,
staffed by
moonlighting dermatologists
and psychiatrists, or drunks
who'd been banned
from private practice.
There was no 911...
no paramedics.
And if you needed an ambulance,
you called a funeral home.
(ENGLISH HORN PLAYING SOMBRE MELODY)
What the hell is that?
Hmm.
Ollie once said,
"You stand a better chance
"of surviving a gunshot wound
in Vietnam
"than a car crash in Chicago."
But he changed all that.
He developed the 911 system,
he trained
thousands of paramedics,
and started one of the finest
residency programmes
in emergency medicine.
(VOICE BREAKING) You're all here
cos of this guy.
Gunshot wound to the left chest,
dumped from a moving car.
Lost the pulse.
Starting compressions.
Thoracotomy tray.
I'll tube him.
Four of O-neg and betadine.
(BRENNER) Yankauer!
(TAGGART) Rapid infuser is primed.
Prep for a subcalvian.
(GATE) I need a cricoid.
(BRENNER) Hold compressions.
(RASGOTRA)
OK, opening the chest, now.
Shot in the chest
outside of a liquor store.
(KOSTIN) Ready...and lift.
Hold an elevator!
He's got to go right
up to the trauma ward!
Someday, we're going to take care
of guys like this down here.
The surgeons will never
sign off on that.
You wait and see.
Dream on, Dr Kostin.
(RASGOTRA)
Foley's in the heart defect.
(BRENNER) Inflating to 20cc's.
(TAGGART) Bleeding's slowing down.
He's had six of O-neg,
six of FFP.
(GATES) I got a pulse,
strong pulse.
(RASGOTRA) OK, cardio-thoracic
Team's here.
(MORRIS) Take him away, guys.
(TAGGART) Door to OR, 12 minutes.
(BRENNER) Not bad.
Yep.
Could walk out of the hospital.
(RASPY, LABOURED BREATHING)
How you doing, Ollie?
Another two of morphine.
Got it.
Let's TKO his fluids.
(ALARM)
He's bradying down.
Might as well
turn off the alarm.
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Frank, we got to get
these tele admits up.
I'm all over it.
There's at least
30 in the rack.
What were you guys
doing last night?
Playing Guitar Hero
and doing Jell-O shots.
Two messages from Kelly.
Kelly who?
She said you'd know.
That's her phone
number at Swissotel.
Car crash victim coming in.
Oh, OK, clear
Trauma One and get surgery.
We're gridlocked.
Quick dispo in Curtain One.
Grady?
Off duty
and going to Jumbo Mart
for enough caffeine to get
me through my charting.
Well, who else is on?
Well, we got,
er, Brenner, Morris...
What do you need?
That's OK.
I haven't picked
up a patient yet.
No, go, er,
meet the trauma.
It's busy.
I got time.
OK, fooling around
with her boyfriend
and they lost
the condom.
She's fully dressed in
the middle of the ER.
She should be in a gown
in a private room
with a chaperone for a pelvic.
Yeah, there's
no need, actually.
What?
Go on. Go get the history.
Hello. I'm Dr Gates.
Tammy.
So, the, er, proverbial
lost condom, huh?
Yeah.
It's kind of embarrassing.
Well, don't worry.
Tell me what happened.
The condom came off,
and I couldn't reach it.
My boyfriend tried to help,
but he's useless.
I went to the bathroom
and gagged myself,
but I couldn't
vomit it up either.
I'm not gonna...
suffocate, am I?
Dr Rasgotra.
Dr Brenner.
Mm.
How was your night?
Four hours of sleep.
Well, you would've got
a lot less than that
if you were in my bad.
Next time, you should
spend the night with
me in the call room.
What, you mean on a twin bed
with scratchy sheets
and phone interruptions
every hour?
(GIGGLES)
That's kind of hot.
You know, I was
thinking of, um,
getting Neil Young
tickets for Saturday.
That sounds good.
You like him?
Yeah, I love him.
Especially
his early stuff.
Really?
Yeah. Old Man,
Only Love Can Break Your Heart...
Heart Of Gold.
Heart Of Gold.
Neela!
Uh, trauma coming in.
Thank you.
(CLEARS THROAT)
Are we out of sugar?
I don't think so.
What are they doing?
Our old medical records
are going in remote storage.
Let me ask you something,
kind of man to man.
Do you believe in
the three-date rule?
You seeing someone new?
I don't know if we're actually
"seeing" each other.
We had lunch together
in the cafeteria.
I bought her a burger
one night at Ike's.
Wow, sounds serious.
I like her.
I just can't tell if
she's interested in me.
Well, I'm pretty sure
I'm not the right guy to ask
for relationship advice.
Hey. The run
got diverted to Mercy.
Whoa. Whoa-whoa-whoa-whoa.
Hey. You all right?
Tony... Archie,
I need some help.
Grab a gurney.
Looks like this guy
got beat up.
What's your name, sir?
Oliver.
Oliver what?
No wallet, no ID.
Pupils are equal.
You know where you are?
Hospital.
Oriented to place.
What year is it?
Who's the President?
Sir, do you know
who the President is?
CROWD: Hey, hey, LBJ,
how many kids
did you kill today?
Hey, hey...!
Chicago is a police state!
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Hey, hey, LBJ!
You don't have to talk.
We'll take good care of you.
Relax, brother,
enjoy the ride.
I looka great today.
Hey. Why so quiet?
No, they're extra quiet
because Mama's Bolognese Extras
is extra tasty.
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Decent breath sounds.
Looks like he got kicked
a bunch of times.
Yeah, or fell.
He looks too good
to be homeless.
No blood in the belly.
Abrasion where somebody
stole his watch.
Definite assault.
We already called in the police.
Chest is normal. The head CT's
gonna be normal, too.
Not if there's a brain bleed.
These old altered guys,
it's always something metabolic.
Just order
some more IV fluids,
and let me go clear the board.
No. Stay on this.
Buff him up, find
out where he belongs.
Scanner's ready.
Potentially unstable.
Dr Gates can monitor him
in Radiology.
Last BP was
110/65.
Hold it, hold it! Excuse us.
Are you a student driver?
I'm sorry.
I'm sorry you had
to pull me out of my car.
Is the oxygen helping, Donna?
I think so.
Have you ever had any
trouble breathing before?
Not till last week.
Mom, I parked the car.
Thanks, honey.
That's my son Dylan.
Hey.
She couldn't even talk.
So you were saying
about last week?
They told me
I had lung cancer.
Where are you being treated?
Uh, nowhere yet.
We were supposed
to go to Northwestern,
but in the car
her breathing got so bad
that I-I pulled into here.
I have papers and X-rays, if...
The Willow Ridge Medical Centre.
That's our local hospital.
That's where they diagnosed me.
OK.
Do you smoke
cigarettes, Donna?
10 to 15%
of lung cancer occurs
in non-smokers.
We've been
on the internet a bit.
It's in the left
upper lobe.
Liver function tests
are elevated.
OK. And did they explain the
brain CT results to you, Donna?
Two spots.
They thought that, um,
surgery and chemo and radiation
could buy me some time.
Uh, stage-four lung cancer
has a five-year survival rate of 5%,
but 1 in 20 survive.
(BRENNER) OK, well,
we'll have our surgeons
and oncologists consult.
I was hoping
to go to Northwestern.
Yeah, you're too sick to move.
Yeah, I'm gonna cancel
the audition, Mom.
No, Dylan, you're not
cancelling anything.
No. Get to orchestra
hall on time,
and you can stay with
Aunt Harriet tonight.
OK?
OK.
Dr Morris, I'm looking for
an old guy, victim of assault.
He should be
right back.
OK.
You know,
I could be wrong,
but I thought I saw
you and Officer Diaz
eating lunch
the other day.
Yeah, we-we were
on a case together.
Really. Cos I've
had cases with you,
but we've never
had lunch together.
Plus, it must've
been a funny case,
cos I noticed
a lot of smiling.
Yeah, well, Officer Diaz
is a nice lady.
We all know that.
And I know you know
that cops stick together.
Yeah.
So be careful.
If you break her heart,
we may have to break you.
Head CT was normal,
just as I predicted.
And guess what?
He's hypernatremic.
How bad is
his sodium?
165. Dry as a bone.
Does this guy talk?
Not really.
I'll check for
Missing Person reports.
Did you calculate the
free water deficit?
Yep, six litres.
OK. Hypernatremia shouldn't
be corrected at a rate...
One milli-equivalent
per litre per hour.
Need a doctor here.
You can have Dr Gates.
Well... No, shouldn't
I stay here and finish?
No, you've been
wanting off this case
from the get-go. See ya.
He's starting to
open his eyes.
That's a good sign.
Mm-hmm.
(MORRIS) Oliver... Oliver,
try to squeeze my hand.
Oliver...
Curtain Three is open.
Hi, I'm Dr Gates.
Damien.
My wife, Corazon.
Hello.
Sam, did you
ever call Kelly?
I didn't think so, cos
now she's coming to see you.
Let me know when
she gets here.
You don't see
many of these.
It's a negative pressure
ventilator.
When the air is sucked
out of the chamber,
it flows into his lungs.
I had polio when I was three.
Don't breathe too
well on my own.
Is that why
you're here today?
Uh, no - fever,
abdominal pain,
possible appendicitis.
I'm a retired RN.
I need to get a BP.
Yeah, and I'm gonna need
to examine his belly.
There are portholes
on the side.
Just stick your arms through
the neoprene.
All right.
Hmm.
Are you, er,
in this all the time?
We have three kids,
so no, not all the time.
I use it 18 hours a day.
How long have you
guys been together?
45 years.
I got an e-mail from Yale.
They want another two
letters of recommendation.
Well, that seems
a bit pointless
if Dubenko can offer you
a position here.
I'm not sure he thinks
I'm right for the job.
Oh, man.
That's the head CT.
This must be
the lung mass.
Yikes. Where's
the patient?
LFTs and CBC.
Looks like the horse
is out of the barn.
Mm. Son's at bedside.
No dad.
Donna, this is Dr Rasgotra,
Dr Dubenko.
Her son.
Dylan, hello.
Hi. Nice to meet you.
Um, I've reviewed the films,
and I'm sorry to say
that the tumour is
far too advanced for surgery.
Are you sure?
With cancer in the liver,
the brain and bones,
I'm afraid
that an operation
would only mean
pain and suffering
without prolonging
your life.
It's in my bones?
We think so.
What about
chemotherapy?
It's possible, but...
We'll see what the,
er, oncologists say.
Have you thought about
your wishes for life support?
Perhaps this is better
discussed later.
I made a living will
about ten years ago.
I don't want to be kept alive
if I have a terminal illness.
Mom...
Then you might want
to explore the hospices...
OK, we-we don't
need to talk...
What's a hospice?
What is that?
It's a way to keep people
comfortable
in the final stages
of their illness.
Are you saying that...?
Look, um, we're gonna
come back, um,
after you've had a little bit
more time to consider.
Yeah.
OK.
Doctors?
What are you doing?
What?
I asked for a surgical opinion,
not for the Grim Reaper.
I was being truthful.
They have barely processed
the cancer diagnosis and
you walk in there...
What, do you want me
to sugar-coat it?
You want me to lie?
No, I want you to give them
a little bit of hope.
Well, maybe there is something
positive to offer - a thoracentesis?
Yes, that's a good idea.
That should make her feel a better.
Good. Well, why don't
we lead with...?
Frank said you guys have
fresh coffee.
I hope you have
half-and-half.
OK...
I'll just just make
a...fresh pot.
Oh, OK.
Hi, I'm Kelly.
Hi, I'm Dr Gates.
Oh. What kind
of doctor are you?
Well, this is an ER, so...
That must be
complicated.
You got to know a lot of
stuff about everything.
How long you
worked here?
A couple years.
Cool.
Yeah, I've only been
in town for two nights
and I'm craving
deep-dish pizza.
Oh, Lou Malnati's.
Oh, yeah?
Yeah, that
sounds great.
What are you doing
for dinner?
I don't think that would
be such a good idea.
Why not?
I just got out
of a relationship.
Oh.
When you fall off a bike,
you get right back on it.
Got a sesame seed...
Kelly?
Sammy.
(GASPING) Wha...?
What are you...?
Oh, my God!
Hi.
What are you...?
Oh, my God,
l-look, look at you.
Look at you. Hi.
I'm really sorry
to barge in on you at work.
You know,
I got your message,
but I've been busy
at work and...
That's fine.
So, how do you two know
each other?
Uh, Tony,
this is my sister, Kelly.
(CHUCKLES)
If I can tie up a few loose ends,
I could take a break.
I'll be fine - just, you know,
me and the Home Shopping Network.
Ortho's on line four
and they need you at the lung tap.
Go save some lives.
Stay out of trouble.
That's your sister, huh?
She seems very nice.
Yeah.
(GATES) Ortho?
Sam, cytology
and culture on this.
(RASGOTRA) Take a deep breath.
(BREATHING DEEPLY)
Much easier.
Good. We can pull
three litres.
Dylan, it's late,
you should go.
I'm not going.
He has an audition today for the
Juilliard School in New York.
Impressive.
What instrument?
English horn.
I used to play
the viola.
The English horn
is lovely.
Honey, they're only here
once a year.
You might never get
another shot.
I'm much better.
You think it's OK
if he goes?
Yeah, I don't see
why not.
(DUBENKO) I think it'd
be best to stay.
With the extent of your disease,
things could suddenly take
a turn for the worse.
You mean
that could happen today?
That's pretty unlikely.
Yeah, I should,
I should stay.
Dylan...
Mom, I'm staying.
Let's wait a bit
and see how she's doing, OK?
Sam, you seen the old guy?
Not in a while.
Oxygen's off,
so are the monitors.
Looks like he eloped.
Great.
What happened?
I think we lost a patient.
Check the bathroom.
(DUBENKO) Sam, we can see
your polio guy now.
I'm gonna need you
on a paramedic run.
Hey, Frank, tell my sister
it's gonna be a while.
I got to find
a demented grandpa,
pick up
an incoming off a rig
and pull a patient
out of an iron lung.
(ZADRO) April Robinson, syncopal
episode at Walgreen's, still altered.
(MORRIS) Any seizure activity?
No.
What's up
with the handcuffs?
She passed out after getting
busted for shoplifting.
(MORRIS) How convenient.
(ZADRO) No, she's real -
blood sugar's over 400.
12 lead EKG negative for MI.
I gave a litre of saline and got her
sats up with suctioning.
What do we have?
(ZADRO) This lady fainted
at Woolworth's!
Any heart history?
You got me.
She doesn't have a pulse.
When did she
stop breathing?
(ZADRO) Doc, they pay me to drive
them to the hospital, that's it.
She's lucky I had
an oxygen tank.
She needs a cardiac
arrest cart.
(MORRIS) It may be
too late for that.
(RASGOTRA) Dilated appendix,
non-compressible.
So I'll need surgery?
Yes, most definitely.
Can it be done
with the laparoscope?
We'll try.
Sometimes, though,
we have to convert
to a conventional procedure.
(DAMIEN) You mean
opening up my belly?
I use my abdominal muscles
to help me breathe.
His friend had colon surgery
and ended up traked for life.
All right, well,
we'll do the best we can.
Dr Rasgotra will be back
with the consent form.
He's a perfect candidate for NOTES.
What?
Natural Orifice Transluminal
Endoscopic Surgery.
You want to remove his
appendix through his mouth?
Well, in his
compromised state,
he needs the least invasive
procedure, and NOTES is it.
Yeah, we don't do that here.
It's experimental.
But there's a Dr Horta
from San Diego
doing clinical trials
at Northwestern.
He's had over 50 cases.
You're cutting a hole
in his stomach, Neela.
You're setting yourself
up for peritonitis.
It's a two-millimetre
incision that's occluded
by a balloon and transport.
When you're done, you close
immediately with G-prox.
They've had great success.
You want to call
this guy in?
Well, it's a chance
to be state-of-the-art.
See if he's willing to help
and available today.
Long shot.
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Mum! Look at my glasses!
..bringing back the clean...
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It's amazing what comes clean...
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Oh, ow!
Mmmm...!
You can taste we care.
Neela wants me
in Curtain Two.
Drop the insulin to five
an hour before you go.
What's going on here?
Your diabetes is out of control.
Paramedics brought you
to the ER.
Think of it as a pit stop
before jail.
What are you talking about?
Why don't you
take it easy?
Why don't you step out until
she's medically cleared.
I didn't do anything.
Well, surveillance camera shows you
pocketing lipstick and mascara.
I was gonna to pay for that.
I got distracted.
You can't keep me.
My daughter needs me
home with her.
You should of thought about that
before you pinched Maybelline.
Hey, come on, Officer.
Can I ask you a question?
"I was gonna pay for it"!
What a load of crap.
You know,
she doesn't seem like a crook.
Does she have any priors?
Any priors?!
You have been hanging
out with Claudia.
(GATES) Hey, Morris,
we found him.
Excuse me.
Outside, barely conscious.
Pulse ox 78 on room air.
Probably blossoming some
pulmonary contusions
from the trauma.
All right.
Open an airway tray at 8-0.
Where's Sam?
(MORRIS) On her way.
Are we really
gonna do this?
Yeah.
This guy could be sharp
as a tack once his sodium's normal.
What do you need?
Sublingual captopril,
four of morphine.
Hey, Sammy,
I've been here
for, like, two hours.
It's kind of a bad time.
I know. I just... I can't
really wait around.
I've got a bunch
of appointments.
Ma'am, can you just let us...?
(GATES) Has everyone
met Sam's sister?
(MORRIS) I didn't know
You had a sister.
Hello.
Hi.
Sam, take a break.
Chuny'll take over.
Yeah, you know, looks
like you could use one.
Hey, Doc,
we busted the mugger.
I got an empty wallet...
and a retirement
watch from County.
Maybe he worked here.
Suction on high.
Call for a vent!
(GATES) End tidal CO2 detector.
(TAGGART) 'You look good.'
I mean, considering
the last time I saw you,
we were both in pigtails.
Yeah... Yeah, it's been
a really long time.
Mm.
We got some catching up.
You want to go to dinner?
I get off at eight.
Uh, no, you know,
my flight's at 7.30
and I've got my last
meeting at five.
What kind of meetings?
Uh, well, I'm here
for the apparel show.
Oh, my God! I remember those
dresses you used to make
for your Cabbage Patch Kids!
Oh, my... You actually turned
that into a job?!
Yeah.
Uh, my clothing line
just got bought by Billabong
for about $2 million.
You're kidding.
No.
You're kidding me.
Yeah, it's, er...
Well, I've got to travel
to Europe and Japan
to launch
the new collection.
Wow!
Wow. What, did you just come
all the way from Dallas
to rub it in my face?
No... No, um, I came
to talk about Mom.
I had to move her
to assisted living.
You know,
her emphysema got worse.
Yeah, well, three packs
a day'll do that.
She also had a stroke.
(SIGHS)
You know, I visit her,
like, twice a week.
And it's not a lot,
but it makes her happy.
(SIGHS HEAVILY)
And I'm going to be travelling
for months at a time, so...
You know, I... I want
to move her to Chicago.
No, don't.
Please don't.
Look, I'll pay
for everything -
her moving expenses,
her living expenses.
All you've got to do
is just go visit her.
Look, I've been doing this
for a really long time now, OK?
I think it's your turn.
No, it's not.
Look, she's your mother.
You know, even after everything,
she's still your mother.
Who I haven't spoken to
since I was 15.
Well, you know, maybe it's time
that changed, too.
All right, I'm in. Bag him.
AC 14, tidal volume 500.
Have Frank check
personnel records,
see if we can figure out
who he is.
(RASGOTRA)
Post-expansion pulmonary edema.
Let's get her son
back over here now.
He went to his audition.
I thought he was gonna stay.
I told him he could go.
How soon can he get back?
I don't know.
We need bipap and set up
for an intubation.
Intubation?
She has a living will,
she asked for no heroic measures.
OK, Donna, Donna, I need
to ask you a question.
Donna? Donna?!
I should call her son.
Exactly what
I didn't want to have happen.
OK, start with the bipap.
It's non-invasive,
in the spirit of her wishes.
That's a good idea.
This isn't a surgical
problem, Dr Brenner.
You're the primary physician
on the case, so you call it.
Let's go, Neela.
Did you reach the son?
No. I might have to intubate.
With a DNR?
Can you even do that?
Well, temporarily.
I can always remove it later.
I promised her son that she
would be alive when he got back.
I see.
(BRENNER) There's fluid
around the heart.
We can drain that,
buy her some time.
(FRANK) Neela.
Dr Horta's here
on your porta-lung appy.
Peri-vac kit and betadine.
Well, um, good luck.
(TAGGART)
'Serum ketones are negative.'
Is that a problem?
(MORRIS) Well, medically,
it's good news.
But it means we have no reason
to keep you
in the hospital overnight.
So I'm going to jail?
I think they let you out
if you pay a fine.
I don't have the money.
What about a loan?
They won't give you credit
if you don't have a job.
Ever since I got laid off,
I've been cleaning houses.
Barely covers the rent.
My daughter.
Your daughter...?
Pregnant.
On bed rest.
I'm trying to buy her
a crib and stuff.
You talk to a social worker
about getting some help.
I have worked hard
my whole life.
I've raised two babies.
Never been on welfare.
I had to get my medicine.
So why would you...
Steal a tube of lipstick?
I return it for store credit.
Use the credit...
to buy my insulin.
It works.
Dr Morris.
We're making some progress
ID'ing your old guy.
There's a patient missing
from a nursing home on Dearborn.
Fits his age and description.
You hear that, Oliver?
Sounds like we found
out where you belong.
Systolic's down to 80.
Run in a litre.
(GATES) You need a hand?
I just need to thread the
catheter over the guide wire.
There's the pericardial fluid.
It should help.
I'll check another
blood pressure, Doctor?
(SLAPPING RAIL)
What's wrong?
What do you need? You in pain?
Relax.
You're OK.
Hit him with
some Versed, Tony.
(GATES) "TB".
TB?!
By any chance,
does your lady have tuberculosis?
No, she's got cancer.
You sure? Do you have confirmation
on the path report?
It'd be unusual,
but...TB could explain everything.
Infection in the lung,
the bone, liver, the brain,
around the heart.
You need a sputum
stain for AFB.
(MARQUEZ) Better get a mask on her.
You think your guy was a doctor?
Oliver,
were you a doctor?
I'm sorry, I wouldn't have
pulled you out
if it wasn't important.
Real quick -
what's the fine for shoplifting?
And the maximum jail time?
(SIGHS)
No, the guys
didn't put me up to this.
Thank you. Get back to class.
You don't look like
you have good news.
Could be up to six months.
(GROANS)
You know, all the jails
are overcrowded.
It won't be that long.
No, her daughter's having
her baby next week!
Hey, Morris.
OK, I will be back
as soon as I can.
Excuse me.
My captain wanted to know
how much longer
she's gonna be.
Uh...this needs
to run in over an hour.
I thought
she was ready.
Yeah, if I discharge her too
soon, she'll bounce right back.
I got to call the station.
You know what sucks?
There are guys out there
stealing cars and shooting guns,
and you're here all day
baby-sitting a decent lady.
I'm just doing my job.
Where's Brenner?
He ran to the lab.
We think this lady has TB.
Yeah, and this guy
might have figured it out.
Really?
How long does
an AFB stain take?
Less than an hour.
(MORRIS) "To OMK.
35 years of service."
Oh, my God.
Do you know who this is?
Yeah, this is...
this is Dr Oliver Kostin.
As in Kostin's
Textbook Of
Emergency Medicine.
He's a legend.
Dr Morgenstern!
The one and only.
Hey, Chuny.
So good to see you.
So good to see you.
This is Dr Morris
and Dr Gates.
Hi.
Dr Morgenstern
ran this place back in the day.
What are you
doing here?
I got a call from
the nursing home - Ollie...
you gotta stop
wandering.
Are you his doctor?
No. His proxy.
His wife died a few years ago.
They never had
any children, so I got
a durable power of attorney
for health care.
You must have been close.
He taught me everything.
Treated me like a son.
He knows you're here.
Then he's having a good day.
What's his baseline?
Multi-infarct dementia,
and going downhill fast.
Ooh...he had
a great mind.
Now there's nothing left.
Well, something's
going on in there.
He thinks that lady
has tuberculosis.
(CHUCKLES)
Does she?
(MARQUEZ) We don't know yet.
The... The swelling
behind the right ear.
Could be scrofula.
It's a TB-infected
lymph node.
Used to be in the textbooks -
it's not any more.
So if he's right,
he's still capable...
No.
It's a flash of an old memory.
Every once in a while,
a stimulus -
a sight or a sound - brings up
something from the past,
but it doesn't last long.
For all intents
and purposes,
he doesn't interact
with the present.
He hardly speaks.
I brought a copy
of his DNR order.
So we shouldn't
have tubed him?
He never wanted
to end up like this.
Could we take him
off the vent?
Maybe...move him
into a private room?
Sure.
What about Trauma One?
He might be getting
a few visitors.
You know, the ER
used to end right here.
He designed your trauma rooms.
And got 'em built 40 years ago.
Dr Horta cleared
his entire schedule
to come operate on you.
Thanks, Doc.
My pleasure.
We'll see you upstairs.
I'll be right
behind you, honey.
I'm...really looking
forward to this.
It's gonna blow your mind.
Oh, Lucien.
This is Dr Horta
from San Diego.
Oh, um, hi.
Yeah, I've all about you.
So, um, this thing's
really gonna happen?
We're all set to go.
You should scrub in.
I can't. I've got a couple of
cases, pre-op cases, to check in on.
Let the residents do it.
Go ahead. I'll be in and out,
you guys.
Let's take the stairs.
OK.
Nice to meet you.
Yeah.
Lucien, heard about
the NOTES appy.
Pretty cool.
Yeah, it is...pretty cool.
Excuse me, Officer.
when they're sending you
off to jail?
You need to be
on bed rest.
This is crazy, Mom.
This isn't you.
Dr Morris,
this is April's
daughter, Kendra.
Hello.
Hello. Is she OK now?
Her diabetes is
back under control.
Mom! Why would you do
something like this?
I don't know.
I guess I wasn't thinking.
Your mother was trying to help.
This is between
her and me, thank you.
Mom, talk to me.
BP's way up - 170/100.
We should let her rest.
Yeah, I think
you're upsetting her.
What do you think
she's doing to me?
Sam, cycle the dinamap.
Ow! (GASPS)
Is that a contraction?
Kyle, grab a gurney,
let's get her up to OB.
No problem.
Slow, deep breaths.
I'm OK.
I don't need all that.
No, we have to
monitor your baby.
Morris, positive AFB.
Whoa!
Well, the whole
ER's been exposed.
Everybody needs
testing and follow-up.
We all assumed
it was a tumour,
but the other hospital
cytology was equivocal.
Chuny, we're intubating.
You are?
Positive TB stain.
She doesn't have cancer,
she has a treatable infection.
(MARQUEZ) All right.
Glide-scope's ready.
Good call, Oliver.
TB is the great imitator.
That's what he taught us.
(BRENNER) 20 of etomidate,
100 of succinyl choline.
(MAN) 'Dr Kostin...
Dr Kostin, are you mad?'
You can't give succinyl
choline down here.
I just did.
Paralytics and intubation
require an anaesthesiologist.
I'll keep that in mind.
Your patient's too sick
for the emergency ward.
Patients like this die
up to the ICU
without an airway.
OK, gentlemen.
My work is done.
(BRENNER) Beautiful shot
of the cords.
Passing the tube.
Nice.
Sats are fine.
(MORRIS) Cuff is down.
All right.
Deep breath in, Oliver.
(INHALES)
And out.
(COUGHS)
David.
Where do we start rounds?
Right here, Ollie.
You're right
where you need to be.
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Look, I...
I have to get back.
But I'm really glad
you got in touch.
Yeah.
Yeah, you know, I've...
been trying for 15 years.
Hasn't been easy.
and then the next day,
you took off,
just pregnant by some dude.
I didn't take off.
Mom kicked me out of the house.
Well, you could have called.
She wouldn't let me talk to you.
Written a letter.
I did.
She must have tore them up.
I... I... I never knew that.
I had a baby. I had to work.
After a while,
I just stopped trying.
I figured you probably hated me.
I didn't.
(WRY CHUCKLE) Um...you know,
um, after you left,
this is the only guidance
that I got.
My diary?!
Yeah, yeah,
you must have left
in a hurry, cos I found it
underneath your mattress.
Oh, my God.
Are you kidding me? What?!
Did you read this?
Yeah, of course.
Like 100 times.
You taught me how to...
how to French kiss,
how to pierce my ears,
how to roll a joint.
Six Flags?
Yeah, when I was seven,
that was like the happiest day
of my entire life.
Oh, my God.
Mom took us home early
because you puked your
funnel cake all over Shock Wave.
Ah! you are so wrong.
No, she... (LAUGHS)
..she took us home
because, when she went
to the bathroom,
you went and tried to bum
a cigarette off the hot dog guy.
I did not!
Yes, you did.
Geez...
You were grounded
for an entire week.
Oh!
I was so stupid.
She's really bad, huh?
Yeah, it won't be long.
(FRANK) 'Well, ICU
could take Trauma One.'
OK, let's move Dr Kostin.
Dylan...how'd it go?
It's OK.
Where's my mom at?
She's in a different room
on a breathing machine,
but, um, something
amazing happened.
It turns out your mom
doesn't have cancer.
Are you serious?
It's tuberculosis.
Um, th-they told us tha...
The cells from
the other hospital
were suggestive of cancer,
but they weren't definitive.
So, we ran a special stain
and we found TB.
(VOICE BREAKING) Um, thank you.
Thank you.
That's incredible.
She's not out of the woods yet.
If it's a drug-resistant strain,
then she's gonna have
a very rough course.
But it's better
than cancer, right?
I mean, her prognosis,
it's good?
Now, we're gonna
have to keep you
in isolation for
a couple of days
until we find out
you're not infectious.
Not a problem.
Donna, there's someone
here to see you.
Mom, I heard the great news.
I kind of rocked it.
They're not supposed
to give you any feedback
but the head of the
woodwind department said,
"See you in September."
Sam, I'm going to be
up in the OR for a bit.
Prescription for insulin
and, er, an appointment
with a diabetes clinic.
Where you taking her?
County jail.
Are you OK?
I got some medicine
to stop the contractions.
I have to wait a week
till the baby's ready.
We should be going.
Hold on.
You've got nothing to say?
You're not gonna
explain this to me?
Maybe later.
She's had kind of a rough day.
I thought I was going to have
some help with this baby,
but I'll do it on my own.
I just thought you wanted
to be a part of it.
But if this is how
you want it, fine!
Come here... You know what,
come here.
What are you doing?
Please come with me.
What's going on?
I need you to understand
what your mother
has been doing.
Shoplifting make-up.
To trade for insulin.
She loves you. She's made a lot of
sacrifices for you and your baby.
She almost died today because
she ignored her own health
to buy you a crib.
I didn't know.
Yeah, she's too proud
to say it.
I know it's hard, but try
to appreciate what you have.
Stump is tied off.
Endo-shears.
Nicely done.
Tension as you pull, Neela.
(BRENNER) They're still at it.
Yeah, you're just in time
for the big finish.
(RASGOTRA) Appendix is out.
How cool was that?
(OVER SPEAKER) Very.
(BRENNER) You heard about
the TB case?
Yeah.
(HORTA) G-prox, please.
Yeah, we were all guilty
of "diagnosis momentum".
Despite incomplete evidence,
we heard the word "cancer"
and we all ran
down the wrong path.
It's a glimpse of
the future in there.
Yeah, I wasn't
on board at first,
but Neela persisted, so...
Well, that's a good
quality to have.
Especially in an attending.
There are a lot of candidates
this year, you know.
It's going
to be very competitive.
Well, whoever gets her
will be lucky.
Think he's really mad at me?
Well, it did undermine
his authority.
But it was in the
interest of the patient.
Yeah, I agree.
I think he must
be in Trauma One.
I just hope it doesn't
hurt my chances here.
Well, if it does,
then they're all crazy.
I can't imagine anyone
more brilliant and skilled
and compassionate...
and sexy.
And you'd better take a nap,
because you're going
to need it for later.
I was pre-med,
volunteering at the hospital,
when they made him
chief in '68.
Back then, the ER
was a glorified walk-in clinic
where you were seen
by unsupervised interns
and residents with no training.
And the community ERs
were even worse,
staffed by
moonlighting dermatologists
and psychiatrists, or drunks
who'd been banned
from private practice.
There was no 911...
no paramedics.
And if you needed an ambulance,
you called a funeral home.
(ENGLISH HORN PLAYING SOMBRE MELODY)
What the hell is that?
Hmm.
Ollie once said,
"You stand a better chance
"of surviving a gunshot wound
in Vietnam
"than a car crash in Chicago."
But he changed all that.
He developed the 911 system,
he trained
thousands of paramedics,
and started one of the finest
residency programmes
in emergency medicine.
(VOICE BREAKING) You're all here
cos of this guy.
Gunshot wound to the left chest,
dumped from a moving car.
Lost the pulse.
Starting compressions.
Thoracotomy tray.
I'll tube him.
Four of O-neg and betadine.
(BRENNER) Yankauer!
(TAGGART) Rapid infuser is primed.
Prep for a subcalvian.
(GATE) I need a cricoid.
(BRENNER) Hold compressions.
(RASGOTRA)
OK, opening the chest, now.
Shot in the chest
outside of a liquor store.
(KOSTIN) Ready...and lift.
Hold an elevator!
He's got to go right
up to the trauma ward!
Someday, we're going to take care
of guys like this down here.
The surgeons will never
sign off on that.
You wait and see.
Dream on, Dr Kostin.
(RASGOTRA)
Foley's in the heart defect.
(BRENNER) Inflating to 20cc's.
(TAGGART) Bleeding's slowing down.
He's had six of O-neg,
six of FFP.
(GATES) I got a pulse,
strong pulse.
(RASGOTRA) OK, cardio-thoracic
Team's here.
(MORRIS) Take him away, guys.
(TAGGART) Door to OR, 12 minutes.
(BRENNER) Not bad.
Yep.
Could walk out of the hospital.
(RASPY, LABOURED BREATHING)
How you doing, Ollie?
Another two of morphine.
Got it.
Let's TKO his fluids.
(ALARM)
He's bradying down.
Might as well
turn off the alarm.
(DEEP, EXTENDED EXHALE)
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