ER (1994–2009): Season 2, Episode 13 - It's Not Easy Being Greene - full transcript
It's his day off, but Mark shows up for work anyway. After a patient dies and Morgenstern wants to speak to him, Mark soon regrets coming in after all.
[panting]
[siren wailing]
[panting]
Ah.
Ah!
I love it when those
endorphins kick in.
You're not on today, are you?
I thought I'd drop by.
Ease up your work
load a little bit.
After I take a shower.
It's his day off?
That's dedication for you.
Dedication?
Man, that's sad.
(female #1)
'Don't move, Mrs. Zarian.'
It's a little bit of glass,
and it's almost free.
‐ Susan, were your ears burning?
‐ Huh?
David Morgenstern and I
were just talking about you.
He feels you're
the top contender
for chief resident next year.
Oh. Thanks.
This year's field was pretty
disappointing but we found
your work to be
consistently solid.
'Now, I‐I know you're concerned
about the responsibilities'
taking time away
from the baby
but that doesn't
have to be the case.
Keep the bevel facing out.
'By applying
time‐management techniques'
you can work more efficiently
reduce on‐the‐job stress
and get home at
a reasonable hour.
Mrs. Zarian..
I've got a book on the subject
if you're interested.
No pressure. I just want to
let you know how we're thinking.
‐ Son of a bitch!
‐ What?
They cut me back
to three shifts a week.
They're cutting
back on nurses?
Nurse managers, because of
our outrageous salaries.
Man, I still need $12,000
worth of work on my house.
Damn. They bumped me up
to six shifts a week.
'So much for my weekend.'
I know where you can
make some quick cash.
Talk to me.
I joined this guy
Alvin's Investment Club.
Put up a $2,000 membership fee
and in a week to ten days
you collect
$10,000 to $20,000.
From?
From the fees of
the new people who join.
It's called a pyramid scam
and it's illegal.
Well, that's not
what Alvin says.
Trust me. If you're not
in early you lose your shirt.
When did you get in?
Hey.
Hey yourself.
Alright, let's see
what we got here.
[sighs]
Where'd you learn
to do subcu sutures?
From your med student.
Well, I obviously taught
him well, didn't I?
(male #1)
'Benton.'
I'll see you later.
Listen, I thought
I should warn you.
You might want to invest
in a new suit or two
and maybe some luggage,
well, see you're going to Paris
to present our
clamp‐and‐run study
to the L'Institut Francais
De Chirurgie.
‐ Are you serious?
‐ Oui.
Simon did a chi‐square
analysis of our results.
Our p‐value is .06
which means we're
one successful outcome
away from statistical
significance.
‐ W‐we can publish?
‐ Soon.
One more aneurysm will
burnish our numbers to a glow
that will blind
the most dubious skeptics.
And after that, MacGruder
and I head to DC
to play dog‐and‐pony
for the FDA.
Now, Simon doesn't fly,
so he stays here
which makes you
the next natural choice
for clamp‐and‐run
ambassador to Europe.
Whoa, whoa. I don't
know what to say.
Look, okay, I'm‐I'm honored‐‐
Good, it's good practice
for the future.
Don't worry, you've got
to find another patient soon
because some Norwegians
are doing a similar study.
And, Peter, we cannot let
the Vikings pillage our thunder.
Hey, Malik, you seen Carter?
Yeah, he called and
said he'd be late.
He should coming any minute.
[moaning]
(female #1)
Oh! No, wait. Wait! Wait!
[moaning]
Yeah! Oh, God!
John.. Oh, God! Oh, God!
[moaning]
[panting]
Oh, baby!
[chuckles]
I think we broke my record.
Yeah.
‐ Oh, John.
‐ What?
Mmm!
Your control is phenomenal.
‐ Yeah?
‐ Yeah.
Yeah. Thank you.
[laughing]
[alarm beeps]
You know, uh,
the interesting thing?
You may find this
hard to believe
but that wasn't
always the case.
‐ No? No.
‐ It's hard to believe.
It's true, though.
But I found if I
could distract myself
and think about
the mundane things.
Then I could delay
the inevitable.
Well, what kind of things
you think about?
Um, let's see.
Sometimes, I, uh, take
a mental inventory
of the machines
in the OR.
Thora‐Seal, ventilators,
auto‐infusers.
Then, as the degree
of difficulty increases
I run the procedures
appendectomies, thyroidectomies
bowel resections.
Yuck!
What?
While we're making love
you're thinking
about bowel resections?
Well, given your
earlier testimonial
I figured this
is a classic case
of the ends
justifying the means.
‐ What?
‐ I'm kidding.
‐ Get out!
‐ I'm just kidding. Ow!
[theme music]
[music continues]
So last night, I get a letter
from Jen's lawyer
politely informing me
that she's suing me
for full custody of Rachel.
Oh, no.
Yeah, it seems I've been
a distant and absent father.
This after commuting
from Milwaukee for half a year.
Well, it sounds like
a lot of lawyer BS.
I can't imagine she'd
actually go through with it.
I was climbing
the walls all night.
Now, that's why you're here.
Tiny prick.
I beg your pardon?
I need a TB test too.
So I hear Morgenstern
has really turned up
the pressure on you
becoming chief resident.
Yeah, it's a good opportunity
but can I do it and not
work killer hours?
You know how well I managed
to balance work and family.
Guess that answers that.
You'll be able
to work it out.
Take your paper work home,
hours won't be that bad.
Ow.
You have to cut
Kerry Weaver some slack.
What do you mean?
You go out of your way
to avoid her
and if she is gonna
be training you
you're gonna have to work
together hand‐in‐hand.
Oh, there's an image.
Hey, what are you doing
here on your day off?
Well, I went for a jog
and ended up here
and I figured, what the hell,
might as well save some lives.
One another good reason
not to exercise.
32‐year‐old male, post‐ictal.
Five‐minute
grand mal seizure.
Alright.
I'll take it.
Let's start a chart.
On his day off?
[chuckles]
(Peter)
Those TPN orders should
have been called in an hour ago.
Sorry. I forgot.
I thought you wanted
a residency here.
Well, you keep on
forgetting, you're gonna
end up in North Dakota.
We've got six slots,
300 applications.
‐ When do interviews start?
‐ They already have.
I'm on my way
upstairs. You stay.
Vucelich needs one more
aneurysm for his study.
Abdominal pains, chest
pains, traumas, call me.
(Carol)
'How often do you get
dizzy spells, Mrs. Henry?'
Oh, I get three or four a day.
Usually when
I'm working in the shed.
You garden this
time of year?
I'm a vermiculturist.
‐ I raise earthworms.
‐ Really?
Mm‐hmm. Big ones from Belgium.
Finest castings in the world.
And by castings, you mean..
Worm dung.
Black gold.
It's the best fertilizer
money can buy.
It fixes the nitrogen
in the soil.
And you sell the stuff?
Well, I sell the worms.
You're blood pressure's
a little high.
So, uh, it pays well?
‐ Yeah. Six figures.
‐ Huh.
Has he had a seizure before?
No. He's a health nut.
He runs every day.
We're gonna have
to get a CAT scan
of his head to pinpoint
the cause of the seizure.
Alan?
'Alan?'
Wh‐when's he gonna come back?
It takes little time to
recover from a seizure.
‐ 'Well, how long?'
‐ 'Usually about 30 minutes.'
Multi‐focal PVCs.
What?
His heart rhythm's a little off.
Probably oxygen deprivation
from the seizure.
Has he had a murmur before?
No.
It's probably nothing serious.
Let's get an echo of his
heart after the CT
just to be safe.
Lidocaine bolus, 100 milligrams
then start a drip.
No. Uh, Carter, John Carter.
I was calling because I thought
maybe you were trying to get
in touch with me to set up
an interview for the residency.
No, huh?
Well, I am available, uh, any‐‐
Uh‐huh.
Okay. Um.. Bye.
I hear Vucelich doubled his
finder's fee for an aneurysm.
‐ Could be.
‐ Aha.
I made 1,000 bucks.
Patient presented with
a history of ulcers
but he says the pain's
different this time.
‐ Rigid belly?
‐ Hard to tell, he's so fat.
But see the calcifications
on the descending aorta?
‐ No. Where?
‐ Here.
No, it's too lateral.
Probably just schmutz
on his lungs.
So, I shouldn't call Vucelich?
Yeah, if you want
to get yelled at.
Harper, I need you
to get this guy to CT.
Coming. Can you do me a favor
and return this
X‐ray to his room?
‐ Yeah. Which room?
‐ 'Six.'
‐ Hey, you done with that?
‐ Yes.
Wow! That's a mother
of an aneurysm.
How can you tell?
Calcification on
the descending aorta.
Yeah.
Yeah.
We're gonna run a CAT scan on
his head to rule out lesions
that could have caused
a seizure.
Uh‐oh.
What's wrong?
He's in V‐tach.
Let's get him to trauma.
‐ Haleh?
‐ 'I'm here.'
‐ 'I got a pulse.'
‐ What's wrong with him?
His heart rhythm's
gotten worse.
Are you sure he hasn't
taken any medication?
‐ No.
‐ Any non‐prescription drugs?
‐ No, never. He‐‐
‐ Okay.
We're going to get
this under control.
Can someone take Mrs. Wimbur
to the waiting room?
‐ But I just wanted‐‐
‐ It's okay. Thank you.
Let's get another 50
of lidocaine, IV push.
Heart's racing. 200.
Rhythm is all over the place.
Looks like
torsade de pointes.
Alright, Harper,
get lytes and a tox screen.
And check to see if we
got any records on this guy.
Anything that will give us
a clue as to what's going on.
Lido's on board.
What's your gut say, Haleh?
Low potassium?
‐ Lydia?
‐ Cocaine.
His wife says he's tox‐free.
'We'll know soon enough.'
(Haleh)
'Heart rate's up to 210.'
Alright. Let's try
and cardiovert.
Paddles. Start him at 100.
[beeping]
‐ Hands off.
‐ Clear.
‐ 'Faint pulse.'
‐ There we go.
‐ That's a nice rhythm.
‐ 'He's moved his head.'
Rate's down to 160.
180. Whoops, here we go again.
Alright.
Lidocaine's not working.
Let's try bretylium,
500, IV push.
Prep transvenous pacemaker.
Charge to 200.
Hands off.
What makes you think
it's an aneurysm, Carter?
The calcium plaque
on the descending aorta.
Well, you just saved
this man's life
and made a group of Norwegian
surgeons very unhappy.
‐ Good work.
‐ Thank you.
Where's the patient?
Uh, room six.
To room six.
Hey, way to go, Carter.
Labs are back,
lytes are normal.
Tox screen's negative.
We were both wrong.
What the hell's wrong
with this guy?
‐ Rate's up to 220.
‐ Faint pulse.
Pacer's in.
Let's overdrive him to 230.
‐ Maximum gain.
‐ 'Got it.'
'See if I can grab hold
of this rhythm.'
‐ 'You're on.'
‐ You've got capture.
Lovely. Let's take
it down slowly.
210.
(Wright)
'200.'
‐ 180.
‐ It's jumping back up.
‐ Lost capture.
‐ We lost the pulse.
Let's start CPR.
Add pronestyl,
100 migs. IV push.
Paddles. Set 'em at 360.
‐ What time is it?
‐ 08:45.
Mark that time.
‐ Hands off. Clear.
‐ 'Clear.'
[indistinct chatter]
‐ Wide‐complex tachycardia.
‐ Still no pulse.
‐ Time?
‐ '9:05.'
‐ How long's he been down?
‐ 20 minutes.
Tried the pacer.
He went into V‐fib.
Shocked him, 15‐20 times.
He keeps running
these chaotic rhythms.
(Susan)
Could he be hypokalemic?
No. Lytes are fine.
‐ Cocaine?
‐ Tox screen's negative.
‐ Acidotic?
‐ Good question.
Let's get another gas.
‐ 'How much pronestyl?'
‐ 'That makes 900.'
'Time?'
09:22.
Another 100 of pronestyl.
Got your blood gases here.
pH 7.24, PO2's 110.
‐ 'He's still in fib.'
‐ 'He's going down.'
(Doug)
We're gonna have to do
all the antiarrhythmics?
Still got a few more.
Stand by with the amiodarone.
‐ Back off. Clear.
‐ Clear.
‐ Time?
‐ 09:32.
‐ Still no pulse.
‐ Try magnesium sulfate.
‐ Clear.
‐ 'Clear.'
‐ Time?
‐ 9:41.
High dose epi, five milligrams.
Clear. Hit of epi in.
‐ Time?
‐ '9:45.'
‐ Clear.
‐' Clear.'
‐ Clear.
‐ 'Clear.'
32‐years‐old.
Time of death, 9:55.
Uh..
Why?
There was an electrical
disturbance
in your husband's heart
that caused it to beat
in an irregular way.
I wish I could tell you
what caused it to happen
but the truth is, I don't know.
Well, that's not good enough.
I mean, we came in here,
and his heart was okay
and you said it wasn't
anything serious
so somebody must
have screwed up.
‐ No.
‐ How did you let this happen?
‐ Mrs. Wimbur.
‐ What did you do to him?
[crying]
Uh, hello, Alvin.
Oh. Well, do you, uh,
have his new number?
‐ So, Kerry‐‐
‐ One...second.
Yes, Susan?
I've been thinking about
your invitation this morning.
And I would like to throw
my hat in for chief resident.
I'm glad. I look forward
to showing you the ropes.
Me too.
Nobody signed up for
the gallbladder in two yet.
I've got it.
How long does
a CAT scan take?
Hopefully not more than an hour.
But sometimes
there's a wait.
I'm a little concerned
about my worms in the truck.
You brought your worms with you?
Just one bin. I was making a
delivery when the dizziness hit.
You think someone
will steal them?
No. They're locked up.
You don't leave $5,000
worth of worms unsecured.
‐ But they could freeze.
‐ Uh‐huh.
Listen, if I gave you my keys
could you bring them in
out of the cold?
Oh, we can't have
animals in the hospital.
Oh, there's no danger.
You know, worms are the only
disease‐free organisms on Earth.
‐ It's a fact.
‐ I really shouldn't.
Oh, please.
They're my worms.
‐ Alright.
‐ Oh, thank you.
Oh and could you
feed them, please?
What do they eat?
Uh, table scraps,
as long it's vegetarian.
Nothing too greasy because fat
doesn't sit well with worms.
Mrs. D'Angelo, I see
you've been with us before.
Gallstones flaring up again?
They're killing me.
I can't sleep, I can't eat
and every three weeks,
I end up back here.
Pain pills didn't help?
I took twice as much,
didn't do anything.
Yeah. You shouldn't do that.
Please, doctor, get a surgeon
to take these damn stones out.
It's been going on like
this for six months now.
[groans]
Okay. Sorry.
Okay. I'll get an ultrasound
to see if there's any blockage
unless your condition
is life‐threatening
any surgery would be
considered elective
and unfortunately‐‐
It's an 18‐month
waiting list.
Yeah, I'm afraid so.
My neighbor got hers
out the next day.
Does your neighbor have
private insurance?
Is it my fault
I'm on Medicaid?
Okay, we'll start
with the ultrasound
and see what we have.
Thank you.
His name is Alan Wimbur.
You guys just picked him up.
I was hoping you could do
the autopsy today.
Hey, Jerry, where's
the ultrasound?
Got me.
Let me know, 'cause
I'd like to observe.
Autopsy?
I want to find out what
happened to his heart.
You should go home.
His wife accused me
of killing him.
She's probably gonna sue.
People get upset, feel they need
to blame someone.
I heard a murmur on exam.
Before getting an echo,
I wanted to get a CT.
Yeah, don't even think about it,
a guy comes in with a seizure
first thing you want is a CT.
Thanks. I was just checking.
Dr. Greene, Dr. Morgenstern's
office just called.
He'd like to see you upstairs.
Oh, word travels fast.
Satinsky?
You're making
excellent time, Peter.
‐ Suction!
‐ Let Carter suction!
It's his reward for having
a hound‐like ability
to hunt down an aneurysm.
I just feel privileged
for giving me the opportunity.
Well, now that's what
I call suction.
Thank you. Thank you.
MacGruder, is this patient warm?
[beeping]
Uh, shoot, shoot, shoot.
‐ MacGruder!
‐ Temp is 106.
DC the fluorescein. He has
malignant hyperthermia.
Is he reacting to
the anesthesia?
‐ Yeah.
‐ Give him dantrolene.
Get ice packs, cooling blankets.
Peter, get out.
If we don't get his
temp down, he's gonna have
scrambled eggs for brains.
Side‐biting clamp.
Who took this patient's history?
‐ I did.
‐ How could you miss?
He was intolerant
to fluoroethane.
‐ I asked‐‐
‐ Dammit!
I lay out a banquet, and you
crap all over my table!
He never had
an operation before.
‐ Cooling blankets are here.
‐ Lift him up. Get him under.
Peter, come on
over here. Come on.
Come on. Evert the Gore‐Tex.
Log roll him over.
Suction, Peter.
Another 5.0 proline.
More ice. Tie that off, Peter.
So he never had
an operation before, huh?
‐ No.
‐ Well, you're right.
There was no way of knowing.
My apologies. Metz. Metz.
Are you free for lunch?
[beeping]
‐ Susan?
‐ Yeah.
Medical records sent
down the chart
on your gallstone lady.
‐ Thanks.
‐ Well, I took a peek.
I know she's been on cefoxitin.
Cefotaxime has better
biliary penetration.
Okay.
I know it's hard memorizing
all the antibiotics out there
but it's well worth the time.
‐ Right.
‐ Who's the ultrasound for?
Same lady.
Didn't she have one last month?
She's complaining of more pain.
I want to rule out
obstruction and cholangitis.
Remember Charcot's triad.
Cholangitis is indicated
by pain, fever, and jaundice
of which your patient
only has one.
I think you can rule her without
the expense of an ultrasound.
If you're gonna be chief,
you gotta watch the bottom line.
Mark.
I don't believe you've
met Kathy Snyder
one of the hospital
attorneys.
‐ Hello.
‐ Hello.
So this is about this cardiac
arrest who died this morning?
I haven't heard
anything. Have you?
Uh...no.
Kathy wanted to talk about
the O'Brien Lawsuit.
Oh. Did we get a court date?
We've worked out a settlement
with Mr. O'Brian's attorney.
Hmm. I'm not sure
that I wanna settle.
‐ The hospital is sure.
‐ 'It's a good thing, Mark.'
Mr. O'Brian gets compensated
for the loss of his wife
and you can put this behind you.
If I settle, this is gonna
follow me my entire career.
Every time I apply for
a staff job or insurance‐‐
Take it to trial, we could lose
two million easily.
You want to lug that
around your entire career?
I have been over this
1,000 times.
I didn't do anything wrong.
'It was a very
complicated delivery.'
I did as good a job as any
emergency physician could have.
Other emergency physicians would
and have disagreed with you.
A pregnant woman comes in
with pre‐eclampsia
and for whatever reason,
you didn't pick up on it.
Her condition was masked
by a urinary infection.
Look, I don't want to argue
details with you, Mark.
You make thousands
of diagnoses a year.
99% of them are right on.
'You made a mistake,
as we all do.'
‐ I don't accept that.
‐ Mark, please‐‐
No, this is about
my reputation as a doctor.
I'm not gonna settle.
Take my name off of it.
You can't separate
yourself from the suit.
Well, I'll hire my own lawyer,
and I'll fight it myself.
Ugh. That's a lot of worms.
Hey, big fella.
Woman says she makes
a fortune selling these.
‐ To whom?
‐ Landscapers, farmers.
‐ Could be a great sideline.
‐ You're kidding, right?
No, these guys could pay
for the hole in my roof.
I cleaned the spoiled food
out of the fridge.
‐ Veggie?
‐ That's what you asked for.
They don't like grease.
How do they feel about yogurt?
I don't hear any complaining.
Eat up, little worms.
John.
Hi.
‐ Told you it was an aneurysm.
‐ You were right.
Did Vucelich know
who I was?
Didn't you tell
him about me?
‐ That I found it?
‐ I meant to.
I mean, I should have.
The whole thing
happened really fast.
I was gonna say something
and they just assumed that..
Hmm.
What are you doing in here?
The hospital decided
to settle the O'Brian suit.
Uh, isn't that good news?
Morgenstern thinks
I'm at fault
for not picking up
the pre‐eclampsia.
That's not fair.
He wasn't even there.
You were there.
It was as complicated a case
as I've ever seen.
You did everything you could.
You think I should have
caught the pre‐eclampsia?
It was a difficult diagnosis.
Any one of us
could have missed it.
If you were called up
on the witness stand
and asked,
did Mark Greene screw up?
What would you say?
I'm sorry, Mark.
[dramatic music]
Come on, dude, be bold.
We start our own
investment club.
We collect right
off the bat.
‐ No, thanks, man.
‐ Oh, what's to lose?
What'd you lose? Two grand?
Hey, Alvin is gonna
come through.
Jerry, can you find out
why that worm lady
isn't back from CT?
Yeah, she had palpitations.
So they're doing
a cardiac work‐up.
Okay. Call me when
she comes down.
Jerry, medical records
copy a chart for me?
Yeah. O'Brian, right?
Yep. Thanks.
Hey, what happened to those
worms in radiology?
They're doing a consult.
No, no, no, those earthworms,
I put a bucket of earthworms
in there and‐and they're gone.
Well, I didn't take 'em.
Hey, Ray, I'm Dr. Ross.
I understand you've been
having some headaches
and missing some school.
Yeah. They hurt pretty bad.
Mm‐hmm. Okay.
Where in your head
does it hurt?
Uh, here.
How long you been having these?
About a month.
How often?
Um, all the time, I guess.
Do you feel dizzy?
‐ Uh, yeah.
‐ Okay. Pull, like that.
You play sports?
JV Football.
Middle linebacker.
Alright, I was a running back.
We used to hate you guys.
Squeeze my hand. Mm‐hmm.
Okay. You ever get
headaches playing sports?
‐ No.
‐ No.
Okay. Well, we'll get
you a CAT scan.
You know what that is?
No? It's when we take
a picture of your brain.
We want to make sure
it's still in there.
Alright.
I'll be back in a minute.
[whispering]
[indistinct chatter]
Tradition holds they serve olive
and walnuts with the drink.
Dr. Vucelich, Dr. Benton,
I'm sorry to interrupt you.
I misled you both earlier.
The finder's fee for
the aneurysm this morning
should go to Harper Tracy.
'She's a third‐year
medical student.'
'She caught it.'
Well, taking credit
for a colleague's work
is a very dangerous
precedent, Mr. Carter.
I can assure you that
it will never happen again.
Well, your assurance
rings hollow just now.
One has to wonder if this is
a momentary lapse of integrity
on your part or a sign
of a fundamental flaw
in your character.
'Well, time will tell.'
In any event, the patient's
secondary condition
means he's not an appropriate
candidate for the study
so there will be
no finder's fee.
Is there anything else?
No.
Strange boy.
The patient is being excluded?
What's that? Oh, yes.
It seems he has
a history of..
...excuse me,
neurological problems
which exceed the parameters
of the protocol, so..
What were we
talking about, Peter?
Oh, I remember, George Cinq,
walnuts, olives .
'Actually, I was an habitue of
this bistro called Le Milieu'
'and there was a..'
Mrs. D'Angelo,
feeling any better?
No. Are you going
to do that test?
I consulted
with another doctor.
And we feel the ultrasound
is unnecessary.
You don't have any new symptoms.
You're not even gonna check?
Given that you
don't have a fever
or any other symptoms
there's no way I can
justify the expense.
The expense.
I see.
I can take it from here.
I know the routine.
Ow, the nurse gives me
a few pills that don't work
and I'm pushed out the door.
I checked the elective
surgery waiting list
and they can get you in
by the end of the year.
It's February 1st.
‐ 'Help!'
‐ 'Oh, God, what happened?'
They were out by the trash.
Must have been there an hour.
Wendy, would you get
some warming blankets.
Heat up some saline.
We'll do a warm water lavage.
We could get a few
of those warming lamps
they use on newborns.
Great idea. Go to OB,
see if they'll lend us some.
Alright. Oh, damn it!
‐ The lid's frozen.
‐ Oh, God! Alright.
‐ Rib spreader, rib spreader.
‐ What are you doing?
I'm gonna knock it
loose, like a jar.
‐ What you got?
‐ Hypothermia, earthworms.
‐ Five grand worth.
‐ Earthworms?
Yeah, they're Belgian.
They don't take kindly to cold.
Got it, got it!
‐ Oh, no!
‐ Oh, it's frozen solid.
Well, may be they're still
alive underneath.
Surgical mallet.
Reflex hammer.
Thanks. Alright.
'Oh, no. What am I
gonna tell Mrs. Henry?'
Good news, buddy. Your brain's
right where it should be.
‐ Let's talk about school.
‐ Why?
'Cause school can cause stress,
and stress can cause headaches.
Do you having any
trouble with your classes
or students, or teachers,
anything like that?
‐ No.
‐ No? Alright.
What about your girlfriend?
You've problems wit her?
Which one?
There's a problem right there.
How many girlfriends
do you have?
A few. I don't know.
Mm‐hmm. Alright.
You're not doing drugs,
or you smoking pot?
‐ No.
‐ No?
No. No.
You okay?
‐ Yeah, I'm fine.
‐ Mm‐hmm.
What's the matter?
I can't.
‐ I can't.
‐ What?
There's something
wrong with me.
Mm‐hmm. Okay.
All guys who are
your age, they think
that there's something
wrong with them.
No. I'm different.
How are you different?
The girls at school..
I..
I don't feel anything
when I'm around them.
I think I'm gay.
I know I am.
I mean, what am I
supposed to tell my dad?
My brothers?
I am just sick of..
Of being this fake person.
Haleh, will you call psych?
See if we can get a resident
down to take a look
at the kid in one
preferably somebody
from adolescent medicine.
What's the problem?
Kid thinks he's gay.
He needs
somebody to talk to.
I'm going to lunch.
I'll check the charts.
Try and make
yourself useful, huh?
Okay.
Hey, good catch this morning
on the aneurysm.
Harper, Carter,
give me a hand.
‐ What happened?
‐ She collapsed in the lobby.
Acute shortness
of breath, chest pain.
Pulse is high.
Carter, start on an oxygen mask.
Harper, what do we order?
Uh, EKG, chest film,
blood gas, chem seven
CBC, cardiac enzymes.
‐ 'And?'
‐ Myoglobin.
'Myoglobin. Do it!'
(Chuny)
'She has neck‐vein distension.'
Temp's 101.
Susan!
Chief complaint?
Shortness of breath,
chest pains.
She has a history
of renal failure.
What's the differential?
‐ Susan?
‐ Harper.
Uh, acute MI, pulmonary
embolism, pneumonia
pericarditis, congestive
heart failure‐‐
‐ Pleural effusion.
‐ Pleural effusion. Stop that!
Do I hear prompting
from the peanut gallery?
Okay, let's get a gas
cooking and get an EKG.
We'll see how her
heart's doing.
After you.
[indistinct chatter]
Whoo! Hell of a way
to spend your day off.
Yeah, wish I never
would have come in, believe me.
What's that? Jody O'Brian?
It's the first time I've looked
at that since the big day.
She had two high
BPs, proteinuria.
I missed the pre‐eclampsia.
If I hadn't, she'd be alive.
It could have happened
to any of us, any day.
It's not supposed
to happen to me.
‐ Well, you are arrogant.
‐ Arrogant?
It's like there's
you and the pope.
You guys are infallible
and of course,
there's the rest of us.
Yeah?
Well, after today,
the Pope's on his own.?
Good.
I think I might have killed
that guy this morning.
Mark! Hey, mark!
When I first checked his heart,
I heard a murmur.
He must have had
a congenital defect.
That guy crashed ten minutes
after he got in there.
There's nothing you could
have done about that.
Yeah, yes, there is.
I could have gotten an echo
and then I could've got
him straight to the OR.
You're holding yourself
to a ridiculous standard, Mark.
I got to get to an autopsy.
It's your day off. Go home.
‐ Low‐voltage EKG.
‐ BPs falling.
She's decompensating.
Where's that blood gas?
I'll check. You got it?
These numbers don't make sense.
‐ Uh‐oh.
‐ What?
Looks like you hit a vein
instead of an artery.
‐ Is that the blood gas?
‐ Yeah, no. I mean, yeah.
But I screwed up. I tapped
a vein instead of an artery.
No, I screwed up.
I tapped a vein.
Well, whoever screwed up,
do it again and do it right.
Carter, you do it.
(Wright)
'Non‐specific ST changes.'
(Kerry)
'Where are we? Susan.'
'I don't know
where you are, Kerry.'
But I'm at pericardial effusion.
Or pump failure or an embolism.
Let's get an echo!
(Susan)
'Positive Ewart's sign.'
Pressure's down, 50/30.
Pericardiocentesis tray!
'Don't you think you should
confirm your diagnosis'
before sticking a needle
into her heart?
I've made my diagnosis.
'Alligator clamp
is on the needle.'
The diagnostic gold standard
is an echocardiogram.
Fine. You wait while
the tech comes down.
I'll see if there's any fluid
around her heart. Okay.
[indistinct chatter]
I'm in.
‐ Anything yet?
‐ 'Nope. Not yet.'
Here it comes.
What do you know?
Looks a little cloudy.
I wonder if it's transudate
or exudate fluid.
Anyone know the gold standard
to differentiate the two?
Kerry?
Measure LDH to protein.
What's the LDH ratio
to identify exudate fluid?
I'd have to look it up.
It's .5 to 1.
‐ Greene?
‐ Yeah.
Well, you guys should
come down here more often.
Brush up on your gross anatomy.
You guys find
anything conclusive?
Why? What are you looking for?
Something wrong with the heart.
Think you missed something?
Possibly.
Well, you came
at just the right time.
Size and shape normal.
380 grams. Okay.
Who wants to section this?
Bill, I think, it's your turn.
Martin, will you
hand him a knife?
[instrumental music]
[indistinct chatter]
Doug, it's been an hour
and psych still hasn't
come down for that boy.
Alright. I'll call 'em.
Why don't you talk
to him yourself?
'Cause there's nothing
physically wrong with him
and I have four other patients.
Is it because the kid's gay?
What?
You heard me.
If you mean, is it because
that boy's particular problems
fall out of my frame
of reference
or my area of expertise,
then the answer is yes.
If you mean, is it
because I'm homophobic
then the answer is no.
Okay?
No congenital
or valvular anomalies.
Endocardium, normal.
Myocardium of normal
thickness and color.
Blood vessels
at base, normal.
Coronary ostia are in
the usual anatomical position.
Arteries show no sign
of plaque. He's normal.
No sign of
anything congenital?
Were you here
just a second ago?
What was the cause of death?
Typical ER thinking.
Gotta be cause and effect.
'Down here, we operate on
a slightly different gestalt.'
Sometimes, there are answers,
but many times...mystery.
That's not very satisfying.
Hmm. You think
you're a scientist?
You want explanations,
hard answers, algorithms of care
that's dog crap.
Medicine's an art.
And art is ambiguous.
Alright. Preliminary results,
idiopathic dysrhythmia.
No known cause of death.
‐ Nurse?
‐ Ah!
Hi. How are
you feeling?
Oh, tired.
They gave me
a million‐dollar workup
and couldn't find
anything wrong.
I just want to take
my worms and go home.
I have some
bad news for you.
Your worms were
mistaken for trash
and put outside
in the snow.
By the time I found out,
they were frozen solid.
We bought them in,
we tried to warm them
with blankets and warm water.
We used all our
capabilities
but we couldn't get them back.
I'm very sorry.
Can I see them?
What's that?
Vucelich's study protocol.
"Parameters for
exclusionary status."
Are you excluding someone?
Vucelich did.
Anyone I know?
Guy we worked on today.
He went bad.
He ever drop people
who do well?
Why are you
reading this now?
Has he dropped
someone before this?
Mrs. Rubadoux.
He's.. He's not.. I mean..
Vucelich wouldn't drop bad
outcomes just to pretty up
his numbers, would he?
I don't know.
I don't need you trying
to hide my mistakes.
If I screw up,
let me deal with it.
You're right.
‐ Don't lie on my behalf.
‐ I won't.
‐ It's insulting.
‐ I got it, okay?
I gave you the credit.
What do you want?
‐ What is with you today?
‐ It's this residency thing.
My chances of getting in here
are one in 50 something.
I don't even have
an interview set up yet.
I'm gonna end up
in North Dakota.
‐ Dammit!
‐ What?
I forgot Dr. Benton's
night TPN orders.
None of his post‐ops are
getting their IV supplements.
I got to run.
Susan.
One...second.
Yes, Kerry?
According to
"The Washington Manual"
the determinative
LDH ratio isn't .5 to one.
It's .6.
Oh, you got me again.
If you're gonna be chief,
get your facts straight.
You know what?
If being chief means
having you breathing
down my back all day long
to hell with it.
Life's too short.
I don't want you
as my mentor.
Just stay out of my way.
That's the first time
I've ever seen you
act like a chief resident.
Maybe Morgenstern was right.
[indistinct chatter]
[sighs]
Hey, where you goin'? I was
just coming to talk to you.
I was just telling my dad
how good I've been feeling.
It was taking a long time,
and the nurse said
the CAT scan, it was okay?
Yeah, it's normal.
No tumors or uh..
I hate to tell you what's
been going through my head.
No, he's fine.
Thank God.
Uh, could be migraines?
Uh, yes it could also
be stress‐related
which is something
I wanted to talk
to‐to Ray about, if I could‐‐
I know what it is.
It's that damn trig.
Every time I have one of those
quizzes, I get headaches.
‐ You're kidding?
‐ No, I do.
‐ 'Could that be what it is?'
‐ Uh, it could.
Because if that's it, I mean,
I know the prescription.
Applying the seat of your pants
to the seat of the chair.
‐ Yeah.
‐ 'Button your coat.'
I'm sorry about this,
I spent the whole damn day
in the waiting room.
It's okay.
Listen, Ray, if you wanna,
uh, talk about this
or anything else at all,
you just call me here, okay?
Sure.
(Carl)
'Uh, I thought that she was
still at Beth Israel'
'doing protein kinase,
or whatever it is she does.'
'Oh, right, right..'
He's on the phone.
Be off in a minute.
No‐No. I don't need him anyway.
Uh, look, I just want to get the
records on one of the patients.
‐ Which one?
‐ Rubadoux, Sylvie.
I believe she was dropped.
(Carl)
'Claire, could you come
in here for a second?'
'I can't find
my pocket schedule.'
Help yourself.
(Carl)
'Yeah, I'm sorry. My life
is unraveling as we speak..'
(Claire)
What jacket did you
wear at the lecture?
(Carl)
'Claire, let's be serious.'
'How can I possibly know
what jacket I was wearing?'
'Why don't you just find my
schedule like I asked you to?'
'Who‐who's that?
Who's been asking? No, tell me.'
'Kemper's been asking?'
'Well, you can tell Kemper
that I am centimeters away.'
'With any luck I'll be in
"The New England Journal.."'
[indistinct chatter]
...tell them I've
checked into McClean
to ride out a fugue state.
21, 22, 23, 24, 25, 26..
Damn, man. Where did you
get all that?
Alvin came through.
No guts, no glory.
You've got to be kidding me.
Life ain't fair.
Are you gonna report
that to the IRS?
I assume that's
a rhetorical question.
Well, I'm gonna
make my fortune
the old‐fashioned,
legal way.
Delivering
Chinese food?
No. Raising earthworms.
I got a dozen in there.
I thought those
worms froze to death.
No, most of them moved
into the middle of the bin
for warmth and survived.
Isn't that brilliant?
‐ You took that lady's worms.
‐ I did not.
She gave me enough
to start my own colony.
It's my ticket
out of this dump.
Come on, guys,
let's go home. Goodnight.
‐ Goodnight.
‐ Bye.
Ah!
Sorry. Didn't mean
to scare you.
No, you didn't.
I just finished
your discharge summaries.
I called in your TPN orders
and I rounded the
patients upstairs.
‐ Can I go home now?
‐ Goodbye, Carter.
I'm sorry about
what happened earlier.
Mm‐hmm.
Goodnight.
‐ Carter?
‐ Yeah.
Were those TPN orders
called in on time?
Yeah.
No. I screwed up again.
They were 45 minutes late.
I know. I called the pharmacy.
[instrumental music]
So are we sworn
enemies forever?
No.
Denial is a funny thing.
It keeps you from asking
the scary questions.
Which ones?
The ones I've been asking
myself all day today.
Am I dangerous?
Should I be practicing medicine?
We all ask those questions
and the answers are
no and yes.
In that order.
I hope so.
I lost my family for this job.
You're wallowing.
Yes, I am wallowing.
First good wallow
I've had in a while
so don't ruin it.
Well, I'm gonna drive home.
You want a ride?
Nope. I jogged in,
I'm gonna jog out.
Hey, you want to hear
something funny?
Definitely.
You know that guy
who died this morning?
It wasn't my fault.
I did everything right,
and he died anyway.
So what's the lesson on that?
You can't win.
[sighs]
Oh, man.
You are wallowing.
Goodnight.
Goodnight.
‐ Susan?
‐ Yeah.
Did‐did anybody
think it was odd
my coming in today?
No.
Oh. I was just checking.
‐ Goodnight.
‐ Goodnight.
[dramatic music]
[siren wailing]
[music continues]
[panting]
[theme music]
[siren wailing]
[panting]
Ah.
Ah!
I love it when those
endorphins kick in.
You're not on today, are you?
I thought I'd drop by.
Ease up your work
load a little bit.
After I take a shower.
It's his day off?
That's dedication for you.
Dedication?
Man, that's sad.
(female #1)
'Don't move, Mrs. Zarian.'
It's a little bit of glass,
and it's almost free.
‐ Susan, were your ears burning?
‐ Huh?
David Morgenstern and I
were just talking about you.
He feels you're
the top contender
for chief resident next year.
Oh. Thanks.
This year's field was pretty
disappointing but we found
your work to be
consistently solid.
'Now, I‐I know you're concerned
about the responsibilities'
taking time away
from the baby
but that doesn't
have to be the case.
Keep the bevel facing out.
'By applying
time‐management techniques'
you can work more efficiently
reduce on‐the‐job stress
and get home at
a reasonable hour.
Mrs. Zarian..
I've got a book on the subject
if you're interested.
No pressure. I just want to
let you know how we're thinking.
‐ Son of a bitch!
‐ What?
They cut me back
to three shifts a week.
They're cutting
back on nurses?
Nurse managers, because of
our outrageous salaries.
Man, I still need $12,000
worth of work on my house.
Damn. They bumped me up
to six shifts a week.
'So much for my weekend.'
I know where you can
make some quick cash.
Talk to me.
I joined this guy
Alvin's Investment Club.
Put up a $2,000 membership fee
and in a week to ten days
you collect
$10,000 to $20,000.
From?
From the fees of
the new people who join.
It's called a pyramid scam
and it's illegal.
Well, that's not
what Alvin says.
Trust me. If you're not
in early you lose your shirt.
When did you get in?
Hey.
Hey yourself.
Alright, let's see
what we got here.
[sighs]
Where'd you learn
to do subcu sutures?
From your med student.
Well, I obviously taught
him well, didn't I?
(male #1)
'Benton.'
I'll see you later.
Listen, I thought
I should warn you.
You might want to invest
in a new suit or two
and maybe some luggage,
well, see you're going to Paris
to present our
clamp‐and‐run study
to the L'Institut Francais
De Chirurgie.
‐ Are you serious?
‐ Oui.
Simon did a chi‐square
analysis of our results.
Our p‐value is .06
which means we're
one successful outcome
away from statistical
significance.
‐ W‐we can publish?
‐ Soon.
One more aneurysm will
burnish our numbers to a glow
that will blind
the most dubious skeptics.
And after that, MacGruder
and I head to DC
to play dog‐and‐pony
for the FDA.
Now, Simon doesn't fly,
so he stays here
which makes you
the next natural choice
for clamp‐and‐run
ambassador to Europe.
Whoa, whoa. I don't
know what to say.
Look, okay, I'm‐I'm honored‐‐
Good, it's good practice
for the future.
Don't worry, you've got
to find another patient soon
because some Norwegians
are doing a similar study.
And, Peter, we cannot let
the Vikings pillage our thunder.
Hey, Malik, you seen Carter?
Yeah, he called and
said he'd be late.
He should coming any minute.
[moaning]
(female #1)
Oh! No, wait. Wait! Wait!
[moaning]
Yeah! Oh, God!
John.. Oh, God! Oh, God!
[moaning]
[panting]
Oh, baby!
[chuckles]
I think we broke my record.
Yeah.
‐ Oh, John.
‐ What?
Mmm!
Your control is phenomenal.
‐ Yeah?
‐ Yeah.
Yeah. Thank you.
[laughing]
[alarm beeps]
You know, uh,
the interesting thing?
You may find this
hard to believe
but that wasn't
always the case.
‐ No? No.
‐ It's hard to believe.
It's true, though.
But I found if I
could distract myself
and think about
the mundane things.
Then I could delay
the inevitable.
Well, what kind of things
you think about?
Um, let's see.
Sometimes, I, uh, take
a mental inventory
of the machines
in the OR.
Thora‐Seal, ventilators,
auto‐infusers.
Then, as the degree
of difficulty increases
I run the procedures
appendectomies, thyroidectomies
bowel resections.
Yuck!
What?
While we're making love
you're thinking
about bowel resections?
Well, given your
earlier testimonial
I figured this
is a classic case
of the ends
justifying the means.
‐ What?
‐ I'm kidding.
‐ Get out!
‐ I'm just kidding. Ow!
[theme music]
[music continues]
So last night, I get a letter
from Jen's lawyer
politely informing me
that she's suing me
for full custody of Rachel.
Oh, no.
Yeah, it seems I've been
a distant and absent father.
This after commuting
from Milwaukee for half a year.
Well, it sounds like
a lot of lawyer BS.
I can't imagine she'd
actually go through with it.
I was climbing
the walls all night.
Now, that's why you're here.
Tiny prick.
I beg your pardon?
I need a TB test too.
So I hear Morgenstern
has really turned up
the pressure on you
becoming chief resident.
Yeah, it's a good opportunity
but can I do it and not
work killer hours?
You know how well I managed
to balance work and family.
Guess that answers that.
You'll be able
to work it out.
Take your paper work home,
hours won't be that bad.
Ow.
You have to cut
Kerry Weaver some slack.
What do you mean?
You go out of your way
to avoid her
and if she is gonna
be training you
you're gonna have to work
together hand‐in‐hand.
Oh, there's an image.
Hey, what are you doing
here on your day off?
Well, I went for a jog
and ended up here
and I figured, what the hell,
might as well save some lives.
One another good reason
not to exercise.
32‐year‐old male, post‐ictal.
Five‐minute
grand mal seizure.
Alright.
I'll take it.
Let's start a chart.
On his day off?
[chuckles]
(Peter)
Those TPN orders should
have been called in an hour ago.
Sorry. I forgot.
I thought you wanted
a residency here.
Well, you keep on
forgetting, you're gonna
end up in North Dakota.
We've got six slots,
300 applications.
‐ When do interviews start?
‐ They already have.
I'm on my way
upstairs. You stay.
Vucelich needs one more
aneurysm for his study.
Abdominal pains, chest
pains, traumas, call me.
(Carol)
'How often do you get
dizzy spells, Mrs. Henry?'
Oh, I get three or four a day.
Usually when
I'm working in the shed.
You garden this
time of year?
I'm a vermiculturist.
‐ I raise earthworms.
‐ Really?
Mm‐hmm. Big ones from Belgium.
Finest castings in the world.
And by castings, you mean..
Worm dung.
Black gold.
It's the best fertilizer
money can buy.
It fixes the nitrogen
in the soil.
And you sell the stuff?
Well, I sell the worms.
You're blood pressure's
a little high.
So, uh, it pays well?
‐ Yeah. Six figures.
‐ Huh.
Has he had a seizure before?
No. He's a health nut.
He runs every day.
We're gonna have
to get a CAT scan
of his head to pinpoint
the cause of the seizure.
Alan?
'Alan?'
Wh‐when's he gonna come back?
It takes little time to
recover from a seizure.
‐ 'Well, how long?'
‐ 'Usually about 30 minutes.'
Multi‐focal PVCs.
What?
His heart rhythm's a little off.
Probably oxygen deprivation
from the seizure.
Has he had a murmur before?
No.
It's probably nothing serious.
Let's get an echo of his
heart after the CT
just to be safe.
Lidocaine bolus, 100 milligrams
then start a drip.
No. Uh, Carter, John Carter.
I was calling because I thought
maybe you were trying to get
in touch with me to set up
an interview for the residency.
No, huh?
Well, I am available, uh, any‐‐
Uh‐huh.
Okay. Um.. Bye.
I hear Vucelich doubled his
finder's fee for an aneurysm.
‐ Could be.
‐ Aha.
I made 1,000 bucks.
Patient presented with
a history of ulcers
but he says the pain's
different this time.
‐ Rigid belly?
‐ Hard to tell, he's so fat.
But see the calcifications
on the descending aorta?
‐ No. Where?
‐ Here.
No, it's too lateral.
Probably just schmutz
on his lungs.
So, I shouldn't call Vucelich?
Yeah, if you want
to get yelled at.
Harper, I need you
to get this guy to CT.
Coming. Can you do me a favor
and return this
X‐ray to his room?
‐ Yeah. Which room?
‐ 'Six.'
‐ Hey, you done with that?
‐ Yes.
Wow! That's a mother
of an aneurysm.
How can you tell?
Calcification on
the descending aorta.
Yeah.
Yeah.
We're gonna run a CAT scan on
his head to rule out lesions
that could have caused
a seizure.
Uh‐oh.
What's wrong?
He's in V‐tach.
Let's get him to trauma.
‐ Haleh?
‐ 'I'm here.'
‐ 'I got a pulse.'
‐ What's wrong with him?
His heart rhythm's
gotten worse.
Are you sure he hasn't
taken any medication?
‐ No.
‐ Any non‐prescription drugs?
‐ No, never. He‐‐
‐ Okay.
We're going to get
this under control.
Can someone take Mrs. Wimbur
to the waiting room?
‐ But I just wanted‐‐
‐ It's okay. Thank you.
Let's get another 50
of lidocaine, IV push.
Heart's racing. 200.
Rhythm is all over the place.
Looks like
torsade de pointes.
Alright, Harper,
get lytes and a tox screen.
And check to see if we
got any records on this guy.
Anything that will give us
a clue as to what's going on.
Lido's on board.
What's your gut say, Haleh?
Low potassium?
‐ Lydia?
‐ Cocaine.
His wife says he's tox‐free.
'We'll know soon enough.'
(Haleh)
'Heart rate's up to 210.'
Alright. Let's try
and cardiovert.
Paddles. Start him at 100.
[beeping]
‐ Hands off.
‐ Clear.
‐ 'Faint pulse.'
‐ There we go.
‐ That's a nice rhythm.
‐ 'He's moved his head.'
Rate's down to 160.
180. Whoops, here we go again.
Alright.
Lidocaine's not working.
Let's try bretylium,
500, IV push.
Prep transvenous pacemaker.
Charge to 200.
Hands off.
What makes you think
it's an aneurysm, Carter?
The calcium plaque
on the descending aorta.
Well, you just saved
this man's life
and made a group of Norwegian
surgeons very unhappy.
‐ Good work.
‐ Thank you.
Where's the patient?
Uh, room six.
To room six.
Hey, way to go, Carter.
Labs are back,
lytes are normal.
Tox screen's negative.
We were both wrong.
What the hell's wrong
with this guy?
‐ Rate's up to 220.
‐ Faint pulse.
Pacer's in.
Let's overdrive him to 230.
‐ Maximum gain.
‐ 'Got it.'
'See if I can grab hold
of this rhythm.'
‐ 'You're on.'
‐ You've got capture.
Lovely. Let's take
it down slowly.
210.
(Wright)
'200.'
‐ 180.
‐ It's jumping back up.
‐ Lost capture.
‐ We lost the pulse.
Let's start CPR.
Add pronestyl,
100 migs. IV push.
Paddles. Set 'em at 360.
‐ What time is it?
‐ 08:45.
Mark that time.
‐ Hands off. Clear.
‐ 'Clear.'
[indistinct chatter]
‐ Wide‐complex tachycardia.
‐ Still no pulse.
‐ Time?
‐ '9:05.'
‐ How long's he been down?
‐ 20 minutes.
Tried the pacer.
He went into V‐fib.
Shocked him, 15‐20 times.
He keeps running
these chaotic rhythms.
(Susan)
Could he be hypokalemic?
No. Lytes are fine.
‐ Cocaine?
‐ Tox screen's negative.
‐ Acidotic?
‐ Good question.
Let's get another gas.
‐ 'How much pronestyl?'
‐ 'That makes 900.'
'Time?'
09:22.
Another 100 of pronestyl.
Got your blood gases here.
pH 7.24, PO2's 110.
‐ 'He's still in fib.'
‐ 'He's going down.'
(Doug)
We're gonna have to do
all the antiarrhythmics?
Still got a few more.
Stand by with the amiodarone.
‐ Back off. Clear.
‐ Clear.
‐ Time?
‐ 09:32.
‐ Still no pulse.
‐ Try magnesium sulfate.
‐ Clear.
‐ 'Clear.'
‐ Time?
‐ 9:41.
High dose epi, five milligrams.
Clear. Hit of epi in.
‐ Time?
‐ '9:45.'
‐ Clear.
‐' Clear.'
‐ Clear.
‐ 'Clear.'
32‐years‐old.
Time of death, 9:55.
Uh..
Why?
There was an electrical
disturbance
in your husband's heart
that caused it to beat
in an irregular way.
I wish I could tell you
what caused it to happen
but the truth is, I don't know.
Well, that's not good enough.
I mean, we came in here,
and his heart was okay
and you said it wasn't
anything serious
so somebody must
have screwed up.
‐ No.
‐ How did you let this happen?
‐ Mrs. Wimbur.
‐ What did you do to him?
[crying]
Uh, hello, Alvin.
Oh. Well, do you, uh,
have his new number?
‐ So, Kerry‐‐
‐ One...second.
Yes, Susan?
I've been thinking about
your invitation this morning.
And I would like to throw
my hat in for chief resident.
I'm glad. I look forward
to showing you the ropes.
Me too.
Nobody signed up for
the gallbladder in two yet.
I've got it.
How long does
a CAT scan take?
Hopefully not more than an hour.
But sometimes
there's a wait.
I'm a little concerned
about my worms in the truck.
You brought your worms with you?
Just one bin. I was making a
delivery when the dizziness hit.
You think someone
will steal them?
No. They're locked up.
You don't leave $5,000
worth of worms unsecured.
‐ But they could freeze.
‐ Uh‐huh.
Listen, if I gave you my keys
could you bring them in
out of the cold?
Oh, we can't have
animals in the hospital.
Oh, there's no danger.
You know, worms are the only
disease‐free organisms on Earth.
‐ It's a fact.
‐ I really shouldn't.
Oh, please.
They're my worms.
‐ Alright.
‐ Oh, thank you.
Oh and could you
feed them, please?
What do they eat?
Uh, table scraps,
as long it's vegetarian.
Nothing too greasy because fat
doesn't sit well with worms.
Mrs. D'Angelo, I see
you've been with us before.
Gallstones flaring up again?
They're killing me.
I can't sleep, I can't eat
and every three weeks,
I end up back here.
Pain pills didn't help?
I took twice as much,
didn't do anything.
Yeah. You shouldn't do that.
Please, doctor, get a surgeon
to take these damn stones out.
It's been going on like
this for six months now.
[groans]
Okay. Sorry.
Okay. I'll get an ultrasound
to see if there's any blockage
unless your condition
is life‐threatening
any surgery would be
considered elective
and unfortunately‐‐
It's an 18‐month
waiting list.
Yeah, I'm afraid so.
My neighbor got hers
out the next day.
Does your neighbor have
private insurance?
Is it my fault
I'm on Medicaid?
Okay, we'll start
with the ultrasound
and see what we have.
Thank you.
His name is Alan Wimbur.
You guys just picked him up.
I was hoping you could do
the autopsy today.
Hey, Jerry, where's
the ultrasound?
Got me.
Let me know, 'cause
I'd like to observe.
Autopsy?
I want to find out what
happened to his heart.
You should go home.
His wife accused me
of killing him.
She's probably gonna sue.
People get upset, feel they need
to blame someone.
I heard a murmur on exam.
Before getting an echo,
I wanted to get a CT.
Yeah, don't even think about it,
a guy comes in with a seizure
first thing you want is a CT.
Thanks. I was just checking.
Dr. Greene, Dr. Morgenstern's
office just called.
He'd like to see you upstairs.
Oh, word travels fast.
Satinsky?
You're making
excellent time, Peter.
‐ Suction!
‐ Let Carter suction!
It's his reward for having
a hound‐like ability
to hunt down an aneurysm.
I just feel privileged
for giving me the opportunity.
Well, now that's what
I call suction.
Thank you. Thank you.
MacGruder, is this patient warm?
[beeping]
Uh, shoot, shoot, shoot.
‐ MacGruder!
‐ Temp is 106.
DC the fluorescein. He has
malignant hyperthermia.
Is he reacting to
the anesthesia?
‐ Yeah.
‐ Give him dantrolene.
Get ice packs, cooling blankets.
Peter, get out.
If we don't get his
temp down, he's gonna have
scrambled eggs for brains.
Side‐biting clamp.
Who took this patient's history?
‐ I did.
‐ How could you miss?
He was intolerant
to fluoroethane.
‐ I asked‐‐
‐ Dammit!
I lay out a banquet, and you
crap all over my table!
He never had
an operation before.
‐ Cooling blankets are here.
‐ Lift him up. Get him under.
Peter, come on
over here. Come on.
Come on. Evert the Gore‐Tex.
Log roll him over.
Suction, Peter.
Another 5.0 proline.
More ice. Tie that off, Peter.
So he never had
an operation before, huh?
‐ No.
‐ Well, you're right.
There was no way of knowing.
My apologies. Metz. Metz.
Are you free for lunch?
[beeping]
‐ Susan?
‐ Yeah.
Medical records sent
down the chart
on your gallstone lady.
‐ Thanks.
‐ Well, I took a peek.
I know she's been on cefoxitin.
Cefotaxime has better
biliary penetration.
Okay.
I know it's hard memorizing
all the antibiotics out there
but it's well worth the time.
‐ Right.
‐ Who's the ultrasound for?
Same lady.
Didn't she have one last month?
She's complaining of more pain.
I want to rule out
obstruction and cholangitis.
Remember Charcot's triad.
Cholangitis is indicated
by pain, fever, and jaundice
of which your patient
only has one.
I think you can rule her without
the expense of an ultrasound.
If you're gonna be chief,
you gotta watch the bottom line.
Mark.
I don't believe you've
met Kathy Snyder
one of the hospital
attorneys.
‐ Hello.
‐ Hello.
So this is about this cardiac
arrest who died this morning?
I haven't heard
anything. Have you?
Uh...no.
Kathy wanted to talk about
the O'Brien Lawsuit.
Oh. Did we get a court date?
We've worked out a settlement
with Mr. O'Brian's attorney.
Hmm. I'm not sure
that I wanna settle.
‐ The hospital is sure.
‐ 'It's a good thing, Mark.'
Mr. O'Brian gets compensated
for the loss of his wife
and you can put this behind you.
If I settle, this is gonna
follow me my entire career.
Every time I apply for
a staff job or insurance‐‐
Take it to trial, we could lose
two million easily.
You want to lug that
around your entire career?
I have been over this
1,000 times.
I didn't do anything wrong.
'It was a very
complicated delivery.'
I did as good a job as any
emergency physician could have.
Other emergency physicians would
and have disagreed with you.
A pregnant woman comes in
with pre‐eclampsia
and for whatever reason,
you didn't pick up on it.
Her condition was masked
by a urinary infection.
Look, I don't want to argue
details with you, Mark.
You make thousands
of diagnoses a year.
99% of them are right on.
'You made a mistake,
as we all do.'
‐ I don't accept that.
‐ Mark, please‐‐
No, this is about
my reputation as a doctor.
I'm not gonna settle.
Take my name off of it.
You can't separate
yourself from the suit.
Well, I'll hire my own lawyer,
and I'll fight it myself.
Ugh. That's a lot of worms.
Hey, big fella.
Woman says she makes
a fortune selling these.
‐ To whom?
‐ Landscapers, farmers.
‐ Could be a great sideline.
‐ You're kidding, right?
No, these guys could pay
for the hole in my roof.
I cleaned the spoiled food
out of the fridge.
‐ Veggie?
‐ That's what you asked for.
They don't like grease.
How do they feel about yogurt?
I don't hear any complaining.
Eat up, little worms.
John.
Hi.
‐ Told you it was an aneurysm.
‐ You were right.
Did Vucelich know
who I was?
Didn't you tell
him about me?
‐ That I found it?
‐ I meant to.
I mean, I should have.
The whole thing
happened really fast.
I was gonna say something
and they just assumed that..
Hmm.
What are you doing in here?
The hospital decided
to settle the O'Brian suit.
Uh, isn't that good news?
Morgenstern thinks
I'm at fault
for not picking up
the pre‐eclampsia.
That's not fair.
He wasn't even there.
You were there.
It was as complicated a case
as I've ever seen.
You did everything you could.
You think I should have
caught the pre‐eclampsia?
It was a difficult diagnosis.
Any one of us
could have missed it.
If you were called up
on the witness stand
and asked,
did Mark Greene screw up?
What would you say?
I'm sorry, Mark.
[dramatic music]
Come on, dude, be bold.
We start our own
investment club.
We collect right
off the bat.
‐ No, thanks, man.
‐ Oh, what's to lose?
What'd you lose? Two grand?
Hey, Alvin is gonna
come through.
Jerry, can you find out
why that worm lady
isn't back from CT?
Yeah, she had palpitations.
So they're doing
a cardiac work‐up.
Okay. Call me when
she comes down.
Jerry, medical records
copy a chart for me?
Yeah. O'Brian, right?
Yep. Thanks.
Hey, what happened to those
worms in radiology?
They're doing a consult.
No, no, no, those earthworms,
I put a bucket of earthworms
in there and‐and they're gone.
Well, I didn't take 'em.
Hey, Ray, I'm Dr. Ross.
I understand you've been
having some headaches
and missing some school.
Yeah. They hurt pretty bad.
Mm‐hmm. Okay.
Where in your head
does it hurt?
Uh, here.
How long you been having these?
About a month.
How often?
Um, all the time, I guess.
Do you feel dizzy?
‐ Uh, yeah.
‐ Okay. Pull, like that.
You play sports?
JV Football.
Middle linebacker.
Alright, I was a running back.
We used to hate you guys.
Squeeze my hand. Mm‐hmm.
Okay. You ever get
headaches playing sports?
‐ No.
‐ No.
Okay. Well, we'll get
you a CAT scan.
You know what that is?
No? It's when we take
a picture of your brain.
We want to make sure
it's still in there.
Alright.
I'll be back in a minute.
[whispering]
[indistinct chatter]
Tradition holds they serve olive
and walnuts with the drink.
Dr. Vucelich, Dr. Benton,
I'm sorry to interrupt you.
I misled you both earlier.
The finder's fee for
the aneurysm this morning
should go to Harper Tracy.
'She's a third‐year
medical student.'
'She caught it.'
Well, taking credit
for a colleague's work
is a very dangerous
precedent, Mr. Carter.
I can assure you that
it will never happen again.
Well, your assurance
rings hollow just now.
One has to wonder if this is
a momentary lapse of integrity
on your part or a sign
of a fundamental flaw
in your character.
'Well, time will tell.'
In any event, the patient's
secondary condition
means he's not an appropriate
candidate for the study
so there will be
no finder's fee.
Is there anything else?
No.
Strange boy.
The patient is being excluded?
What's that? Oh, yes.
It seems he has
a history of..
...excuse me,
neurological problems
which exceed the parameters
of the protocol, so..
What were we
talking about, Peter?
Oh, I remember, George Cinq,
walnuts, olives .
'Actually, I was an habitue of
this bistro called Le Milieu'
'and there was a..'
Mrs. D'Angelo,
feeling any better?
No. Are you going
to do that test?
I consulted
with another doctor.
And we feel the ultrasound
is unnecessary.
You don't have any new symptoms.
You're not even gonna check?
Given that you
don't have a fever
or any other symptoms
there's no way I can
justify the expense.
The expense.
I see.
I can take it from here.
I know the routine.
Ow, the nurse gives me
a few pills that don't work
and I'm pushed out the door.
I checked the elective
surgery waiting list
and they can get you in
by the end of the year.
It's February 1st.
‐ 'Help!'
‐ 'Oh, God, what happened?'
They were out by the trash.
Must have been there an hour.
Wendy, would you get
some warming blankets.
Heat up some saline.
We'll do a warm water lavage.
We could get a few
of those warming lamps
they use on newborns.
Great idea. Go to OB,
see if they'll lend us some.
Alright. Oh, damn it!
‐ The lid's frozen.
‐ Oh, God! Alright.
‐ Rib spreader, rib spreader.
‐ What are you doing?
I'm gonna knock it
loose, like a jar.
‐ What you got?
‐ Hypothermia, earthworms.
‐ Five grand worth.
‐ Earthworms?
Yeah, they're Belgian.
They don't take kindly to cold.
Got it, got it!
‐ Oh, no!
‐ Oh, it's frozen solid.
Well, may be they're still
alive underneath.
Surgical mallet.
Reflex hammer.
Thanks. Alright.
'Oh, no. What am I
gonna tell Mrs. Henry?'
Good news, buddy. Your brain's
right where it should be.
‐ Let's talk about school.
‐ Why?
'Cause school can cause stress,
and stress can cause headaches.
Do you having any
trouble with your classes
or students, or teachers,
anything like that?
‐ No.
‐ No? Alright.
What about your girlfriend?
You've problems wit her?
Which one?
There's a problem right there.
How many girlfriends
do you have?
A few. I don't know.
Mm‐hmm. Alright.
You're not doing drugs,
or you smoking pot?
‐ No.
‐ No?
No. No.
You okay?
‐ Yeah, I'm fine.
‐ Mm‐hmm.
What's the matter?
I can't.
‐ I can't.
‐ What?
There's something
wrong with me.
Mm‐hmm. Okay.
All guys who are
your age, they think
that there's something
wrong with them.
No. I'm different.
How are you different?
The girls at school..
I..
I don't feel anything
when I'm around them.
I think I'm gay.
I know I am.
I mean, what am I
supposed to tell my dad?
My brothers?
I am just sick of..
Of being this fake person.
Haleh, will you call psych?
See if we can get a resident
down to take a look
at the kid in one
preferably somebody
from adolescent medicine.
What's the problem?
Kid thinks he's gay.
He needs
somebody to talk to.
I'm going to lunch.
I'll check the charts.
Try and make
yourself useful, huh?
Okay.
Hey, good catch this morning
on the aneurysm.
Harper, Carter,
give me a hand.
‐ What happened?
‐ She collapsed in the lobby.
Acute shortness
of breath, chest pain.
Pulse is high.
Carter, start on an oxygen mask.
Harper, what do we order?
Uh, EKG, chest film,
blood gas, chem seven
CBC, cardiac enzymes.
‐ 'And?'
‐ Myoglobin.
'Myoglobin. Do it!'
(Chuny)
'She has neck‐vein distension.'
Temp's 101.
Susan!
Chief complaint?
Shortness of breath,
chest pains.
She has a history
of renal failure.
What's the differential?
‐ Susan?
‐ Harper.
Uh, acute MI, pulmonary
embolism, pneumonia
pericarditis, congestive
heart failure‐‐
‐ Pleural effusion.
‐ Pleural effusion. Stop that!
Do I hear prompting
from the peanut gallery?
Okay, let's get a gas
cooking and get an EKG.
We'll see how her
heart's doing.
After you.
[indistinct chatter]
Whoo! Hell of a way
to spend your day off.
Yeah, wish I never
would have come in, believe me.
What's that? Jody O'Brian?
It's the first time I've looked
at that since the big day.
She had two high
BPs, proteinuria.
I missed the pre‐eclampsia.
If I hadn't, she'd be alive.
It could have happened
to any of us, any day.
It's not supposed
to happen to me.
‐ Well, you are arrogant.
‐ Arrogant?
It's like there's
you and the pope.
You guys are infallible
and of course,
there's the rest of us.
Yeah?
Well, after today,
the Pope's on his own.?
Good.
I think I might have killed
that guy this morning.
Mark! Hey, mark!
When I first checked his heart,
I heard a murmur.
He must have had
a congenital defect.
That guy crashed ten minutes
after he got in there.
There's nothing you could
have done about that.
Yeah, yes, there is.
I could have gotten an echo
and then I could've got
him straight to the OR.
You're holding yourself
to a ridiculous standard, Mark.
I got to get to an autopsy.
It's your day off. Go home.
‐ Low‐voltage EKG.
‐ BPs falling.
She's decompensating.
Where's that blood gas?
I'll check. You got it?
These numbers don't make sense.
‐ Uh‐oh.
‐ What?
Looks like you hit a vein
instead of an artery.
‐ Is that the blood gas?
‐ Yeah, no. I mean, yeah.
But I screwed up. I tapped
a vein instead of an artery.
No, I screwed up.
I tapped a vein.
Well, whoever screwed up,
do it again and do it right.
Carter, you do it.
(Wright)
'Non‐specific ST changes.'
(Kerry)
'Where are we? Susan.'
'I don't know
where you are, Kerry.'
But I'm at pericardial effusion.
Or pump failure or an embolism.
Let's get an echo!
(Susan)
'Positive Ewart's sign.'
Pressure's down, 50/30.
Pericardiocentesis tray!
'Don't you think you should
confirm your diagnosis'
before sticking a needle
into her heart?
I've made my diagnosis.
'Alligator clamp
is on the needle.'
The diagnostic gold standard
is an echocardiogram.
Fine. You wait while
the tech comes down.
I'll see if there's any fluid
around her heart. Okay.
[indistinct chatter]
I'm in.
‐ Anything yet?
‐ 'Nope. Not yet.'
Here it comes.
What do you know?
Looks a little cloudy.
I wonder if it's transudate
or exudate fluid.
Anyone know the gold standard
to differentiate the two?
Kerry?
Measure LDH to protein.
What's the LDH ratio
to identify exudate fluid?
I'd have to look it up.
It's .5 to 1.
‐ Greene?
‐ Yeah.
Well, you guys should
come down here more often.
Brush up on your gross anatomy.
You guys find
anything conclusive?
Why? What are you looking for?
Something wrong with the heart.
Think you missed something?
Possibly.
Well, you came
at just the right time.
Size and shape normal.
380 grams. Okay.
Who wants to section this?
Bill, I think, it's your turn.
Martin, will you
hand him a knife?
[instrumental music]
[indistinct chatter]
Doug, it's been an hour
and psych still hasn't
come down for that boy.
Alright. I'll call 'em.
Why don't you talk
to him yourself?
'Cause there's nothing
physically wrong with him
and I have four other patients.
Is it because the kid's gay?
What?
You heard me.
If you mean, is it because
that boy's particular problems
fall out of my frame
of reference
or my area of expertise,
then the answer is yes.
If you mean, is it
because I'm homophobic
then the answer is no.
Okay?
No congenital
or valvular anomalies.
Endocardium, normal.
Myocardium of normal
thickness and color.
Blood vessels
at base, normal.
Coronary ostia are in
the usual anatomical position.
Arteries show no sign
of plaque. He's normal.
No sign of
anything congenital?
Were you here
just a second ago?
What was the cause of death?
Typical ER thinking.
Gotta be cause and effect.
'Down here, we operate on
a slightly different gestalt.'
Sometimes, there are answers,
but many times...mystery.
That's not very satisfying.
Hmm. You think
you're a scientist?
You want explanations,
hard answers, algorithms of care
that's dog crap.
Medicine's an art.
And art is ambiguous.
Alright. Preliminary results,
idiopathic dysrhythmia.
No known cause of death.
‐ Nurse?
‐ Ah!
Hi. How are
you feeling?
Oh, tired.
They gave me
a million‐dollar workup
and couldn't find
anything wrong.
I just want to take
my worms and go home.
I have some
bad news for you.
Your worms were
mistaken for trash
and put outside
in the snow.
By the time I found out,
they were frozen solid.
We bought them in,
we tried to warm them
with blankets and warm water.
We used all our
capabilities
but we couldn't get them back.
I'm very sorry.
Can I see them?
What's that?
Vucelich's study protocol.
"Parameters for
exclusionary status."
Are you excluding someone?
Vucelich did.
Anyone I know?
Guy we worked on today.
He went bad.
He ever drop people
who do well?
Why are you
reading this now?
Has he dropped
someone before this?
Mrs. Rubadoux.
He's.. He's not.. I mean..
Vucelich wouldn't drop bad
outcomes just to pretty up
his numbers, would he?
I don't know.
I don't need you trying
to hide my mistakes.
If I screw up,
let me deal with it.
You're right.
‐ Don't lie on my behalf.
‐ I won't.
‐ It's insulting.
‐ I got it, okay?
I gave you the credit.
What do you want?
‐ What is with you today?
‐ It's this residency thing.
My chances of getting in here
are one in 50 something.
I don't even have
an interview set up yet.
I'm gonna end up
in North Dakota.
‐ Dammit!
‐ What?
I forgot Dr. Benton's
night TPN orders.
None of his post‐ops are
getting their IV supplements.
I got to run.
Susan.
One...second.
Yes, Kerry?
According to
"The Washington Manual"
the determinative
LDH ratio isn't .5 to one.
It's .6.
Oh, you got me again.
If you're gonna be chief,
get your facts straight.
You know what?
If being chief means
having you breathing
down my back all day long
to hell with it.
Life's too short.
I don't want you
as my mentor.
Just stay out of my way.
That's the first time
I've ever seen you
act like a chief resident.
Maybe Morgenstern was right.
[indistinct chatter]
[sighs]
Hey, where you goin'? I was
just coming to talk to you.
I was just telling my dad
how good I've been feeling.
It was taking a long time,
and the nurse said
the CAT scan, it was okay?
Yeah, it's normal.
No tumors or uh..
I hate to tell you what's
been going through my head.
No, he's fine.
Thank God.
Uh, could be migraines?
Uh, yes it could also
be stress‐related
which is something
I wanted to talk
to‐to Ray about, if I could‐‐
I know what it is.
It's that damn trig.
Every time I have one of those
quizzes, I get headaches.
‐ You're kidding?
‐ No, I do.
‐ 'Could that be what it is?'
‐ Uh, it could.
Because if that's it, I mean,
I know the prescription.
Applying the seat of your pants
to the seat of the chair.
‐ Yeah.
‐ 'Button your coat.'
I'm sorry about this,
I spent the whole damn day
in the waiting room.
It's okay.
Listen, Ray, if you wanna,
uh, talk about this
or anything else at all,
you just call me here, okay?
Sure.
(Carl)
'Uh, I thought that she was
still at Beth Israel'
'doing protein kinase,
or whatever it is she does.'
'Oh, right, right..'
He's on the phone.
Be off in a minute.
No‐No. I don't need him anyway.
Uh, look, I just want to get the
records on one of the patients.
‐ Which one?
‐ Rubadoux, Sylvie.
I believe she was dropped.
(Carl)
'Claire, could you come
in here for a second?'
'I can't find
my pocket schedule.'
Help yourself.
(Carl)
'Yeah, I'm sorry. My life
is unraveling as we speak..'
(Claire)
What jacket did you
wear at the lecture?
(Carl)
'Claire, let's be serious.'
'How can I possibly know
what jacket I was wearing?'
'Why don't you just find my
schedule like I asked you to?'
'Who‐who's that?
Who's been asking? No, tell me.'
'Kemper's been asking?'
'Well, you can tell Kemper
that I am centimeters away.'
'With any luck I'll be in
"The New England Journal.."'
[indistinct chatter]
...tell them I've
checked into McClean
to ride out a fugue state.
21, 22, 23, 24, 25, 26..
Damn, man. Where did you
get all that?
Alvin came through.
No guts, no glory.
You've got to be kidding me.
Life ain't fair.
Are you gonna report
that to the IRS?
I assume that's
a rhetorical question.
Well, I'm gonna
make my fortune
the old‐fashioned,
legal way.
Delivering
Chinese food?
No. Raising earthworms.
I got a dozen in there.
I thought those
worms froze to death.
No, most of them moved
into the middle of the bin
for warmth and survived.
Isn't that brilliant?
‐ You took that lady's worms.
‐ I did not.
She gave me enough
to start my own colony.
It's my ticket
out of this dump.
Come on, guys,
let's go home. Goodnight.
‐ Goodnight.
‐ Bye.
Ah!
Sorry. Didn't mean
to scare you.
No, you didn't.
I just finished
your discharge summaries.
I called in your TPN orders
and I rounded the
patients upstairs.
‐ Can I go home now?
‐ Goodbye, Carter.
I'm sorry about
what happened earlier.
Mm‐hmm.
Goodnight.
‐ Carter?
‐ Yeah.
Were those TPN orders
called in on time?
Yeah.
No. I screwed up again.
They were 45 minutes late.
I know. I called the pharmacy.
[instrumental music]
So are we sworn
enemies forever?
No.
Denial is a funny thing.
It keeps you from asking
the scary questions.
Which ones?
The ones I've been asking
myself all day today.
Am I dangerous?
Should I be practicing medicine?
We all ask those questions
and the answers are
no and yes.
In that order.
I hope so.
I lost my family for this job.
You're wallowing.
Yes, I am wallowing.
First good wallow
I've had in a while
so don't ruin it.
Well, I'm gonna drive home.
You want a ride?
Nope. I jogged in,
I'm gonna jog out.
Hey, you want to hear
something funny?
Definitely.
You know that guy
who died this morning?
It wasn't my fault.
I did everything right,
and he died anyway.
So what's the lesson on that?
You can't win.
[sighs]
Oh, man.
You are wallowing.
Goodnight.
Goodnight.
‐ Susan?
‐ Yeah.
Did‐did anybody
think it was odd
my coming in today?
No.
Oh. I was just checking.
‐ Goodnight.
‐ Goodnight.
[dramatic music]
[siren wailing]
[music continues]
[panting]
[theme music]