ER (1994–2009): Season 3, Episode 21 - Make a Wish - full transcript
Mark Greene returns to work after his assault but he is clearly suffering from post-traumatic stress and has come back too soon. John Carter is beginning to have serious doubts that surgery is the right specialty for him and asks Dr. Weaver what it would take to change his residency to emergency medicine. It's Carol Hathaway's birthday and Doug Ross offers to save her from the embarrassment of any party her friends might throw her by inviting her out to dinner. Carla Reece goes into premature labor and gives birth to a baby boy.
Previously on "ER."
Rejoice, lost man.
Chaos is your destiny.
In this scare, this baby
is not gonna wanna to come out.
Carter, two of the best
transplant surgeons
in the county let us
look over their shoulders
and you just get up and leave.
Is that a problem?
‐ Okay, I'll stay on the couch.
‐ Me too.
Looking for a...head doctor.
Which one?
Bald, white guy, little glasses.
Great. Just walk away!
Is Dr. Benton done with
that thyroidectomy yet?
So he's still in there?
Dr. Benton!
Carter, what are you doing here?
Let's get an ABG
in 20 minutes. Okay?
I thought you were
covering the ER today.
I'm on it in a few.
Listen, I need to talk to you.
Well, you better
make it fast.
I've got two
admissions, a clinic
and an aneurysm
with Dean Rowe.
I've been thinking about that
kidney donor case last week.
The one where I left to
go check on the patients
during the debriefing.
Instead of listening
to two of the finest
transplant surgeons
in the country?
Yeah. I guess so.
And I've just been wondering,
you know, I don't know.
Maybe...maybe I'm
in the wrong place.
Well, if you're still here
in two minutes, you are.
No, I mean surgery.
Obviously, I love
it, and I still feel
very challenged by it
but...are there ever days
when you don't feel
quite satisfied?
Carter, sometimes
the patient dies.
‐ Yeah, I know, but otherwise?
‐ Otherwise what?
Well, it just
feels like sometimes
they exist for us
to do procedures.
Well, that's what
they come here for.
And we don't need to know
anything else about them
like how worried they are or
where they went to high school
or...whether they
like cats or dogs.
Carter, what are
you talking about?
Well, sometimes, I like
to know the other stuff.
What for? I mean if you..
Ah, damn. Um,
listen, we'll, uh..
...we'll talk later.
I'm tellin' you, it was
at least 50 questions
about my family background.
Yeah, nothing like
the head of security
to make you feel insecure.
He almost withheld
my photo ID because
I didn't know my
stepmother's maiden name.
Who knows their
stepmother's maiden name?
Wow, he didn't
cut you much slack
on that there picture either.
You'd think I was tryin' to walk
into the front door
of the White House.
This is easier. I've done it.
Randi, can you get
these over to radiology?
Now?
Unless you're doing
something urgent
that I can't quite see.
‐ No. Dr. Ross.
‐ Yeah?
Pedes called, you're covering
deliveries for John Lavagnino.
Broke his kneecap
playing soccer.
Okay. Alright,
good morning to you.
Oh, not for Anna.
She just had her security
clearance interview.
Oh, yeah. Did you
get strip searched?
‐ They check for track marks?
‐ Practically, yeah.
They're cracking down because
of what happened to Mark.
He starts back today, right?
Uh, I wish he'd
take another week.
Let's make sure
we're grabbing cases.
Keep his load light
for the first few days.
I don't want him
workin' at all.
I want him to help
me plan Carol's
surprise birthday party.
‐ Doug.
‐ Happy birthday, Carol.
I got the vomiting
and diarrhea in four.
‐ Happy birthday.
‐ Thank you.
And I'm taking the..
...quadruple bounce‐back
migraine in five.
Nothing like
a little drug‐seeking
behavior to start your day, huh?
Doug, you promised me you
wouldn't tell anybody
about my birthday.
‐ Yeah, that was last year.
‐ Yeah.
And you told
everybody then too.
At least I'm consistent.
‐ Argh!
‐ Hey!
You're right, coffee..
...can wait.
What's this?
Uh, it's a coffee pot.
That is not a coffee pot.
It's called a French press.
Oh, no more
aluminum percolator?
No. We're going to have
great coffee, which can wait.
‐ What's that?
‐ Uh, the microwave.
I'm just heating up
some cinnamon buns.
‐ The microwave.
‐ Mm‐hmm.
‐ I always wanted a microwave.
‐ I know.
But...you would
never let me get one.
You said that i‐it
broke down the vitamins.
I know. I'm sorry. I was wrong.
Now, just come back over here.
This is nice.
I mean, this
is really nice.
What happened?
She's getting close.
Nine centimeters.
‐ What?
‐ I'm alright, Peter.
She failed tocolysis,
and her contractions are strong.
They went from four
to nine in no time.
Why didn't you call me sooner?
Last time they gave me
that stuff and it was fine.
Couldn't you have
done something else?
Peter, this baby's coming.
What are you talking
about it's coming?
It's‐it's two months early.
'I know that.'
‐ You‐you should have called me.
‐ I just did.
Hoping that you might
want to participate
in the birth of your child.
If that's what
you'd like to do
I suggest you gown
up and get in here.
Hi.
Dr. Greene, right? How are you?
I'm fine, thank you.
Who are you?
Anna Del Amico.
We met last week.
I‐I mean, we didn't
actually meet.
But I was there when
you were attacked.
Oh, in the men's room?
No. In the trauma
room afterwards.
I don't remember either room,
so I don't remember you either.
I start my emergency
residency in July.
I'm doing an ER‐pedes
elective until then.
That was my...first day.
I'm sorry it had
to be so exciting.
No, I'm just glad you're
okay. So, welcome back.
Thank you.
Where is everybody?
Mark, what you doing here?
Getting back to work.
Doug and Carol are
bringing in an MVA.
‐ Hi.
‐ Hey, Mark, how you doing?
‐ Mark, welcome back.
‐ It's nice to be back.
‐ What do we got?
‐ Bicycle versus tour bus.
Don't worry, buddy. We got it,
alright? You just take it easy.
Settle in nice
and easy. Here we go.
Dr. Greene, you look great.
Dr. Ross, OB called.
They need you for that delivery.
They said it's kinda urgent.
Alright, find Dr. Del Amico.
See if she can take it.
Mark, I'll talk to you later.
‐ She's at the desk.
‐ Who?
Dr. Del Amico.
She's at the desk.
Oh, right. Thanks.
‐ Help me shift her down.
‐ Breathe, Carla. Breathe.
Come on, baby, breathe.
You can do it, you can do it.
‐ How much mag did you give her?
‐ Six gram load.
Had her on three
an hour until she hit
four centimeters.
Then we had to let her go.
Dorgan, scalp electrode.
Keep breathing, Carla.
You're doing great.
Dorgan. What kind
of name is that?
'Irish, through and through.'
And you know, we have
a lot of experience
having a lot of babies.
Is she at risk
for chorioamnionitis?
Oh, come on, Carla, breathe.
Don't yell at me! Damn it!
Did you give her
any antenatal steroids.
Twelve milligrams betamethasone.
What about her blood sugar?
She's got gestational diabetes.
You're doing great, Carla.
You just hang in there.
'It's not going
to be much longer.'
'You're gonna be
able to push soon.'
What about a second dose?
This baby's going to have RDS.
‐ Peter, what is RDS?
‐ No, no. It's‐it's okay, Carla.
It‐it just means that the baby's
lungs, they haven't matured yet.
‐ What?
‐ 'It's okay.'
What? Uh‐h‐h..
You, hold her hand, you help
her breathe, you help her focus.
That's your only
job here, okay?
Now get over there and help
the mother of your child.
There'll be two additional
security cameras here.
And two at
the employees' entrance.
That's right.
Now the ambulance
bay doors
will be changed over
to bulletproof glass
which will also add
to your triage section.
And the hospital's
agreed to additional
armed security
in your waiting room.
What about the bathrooms?
Any security cameras in there?
Unfortunately, privacy issues
won't allow us to do that.
Yeah, my assailant's
privacy would have
definitely been violated.
We can only do what
we can do, Dr. Greene.
Thank you, Mr. Biggers.
Mark, it's nice to
see you up and around.
‐ But what are you doing here?
‐ Working.
It's nice to see
you too, Chuny.
Mark, these additional
security measures
may not help,
but they can't hurt.
You know what? I think
everyone's overreacting.
What we should really
be changing is the way
that we deal with patients
and their families.
Yeah, like, can't we
keep them outta here?
They're a pain in the ass.
Your compassion knows
no bounds, Randi.
Oh, uh,
Detective Warrington called.
He can't make it by
till later this afternoon.
Okay.
You really think
that's who did this?
Some patient
or family member?
I think that gives
them a good reason.
Look, Louise Pierson,
ankle x‐ray, three hours ago.
Where is it?
Discharge orders written
over an hour and a half ago.
Chart's still here
so the guy's still here.
I mean, come on,
med‐surg admission
five thirty this
morning, still here.
Neuro consult, ETA,
7:15 this morning.
Where are they? We keep
these people hanging around.
I'd get pissed off
enough to clobber somebody.
Before records clobbers me
I need you to sign off
these charts from last week.
Okay.
Uh. I got them. Uh.
I'm fine.
Push, push.
You're almost there.
Come on, keep going. Keep going.
‐ Hi. I'm Del Amico from pedes.
‐ Janet Coburn.
‐ I thought Ross was covering.
‐ He's got a teenager MVA.
This is Carla Reese, mother
Peter Benton, father.
Hey, how're you
doing there Carla?
You just keep on
pushing so I can take
a look at this
little baby of yours.
Mr. Benton, how are you doing?
It's Dr. Benton.
He's a surgical resident.
What? Are you new here?
Just came over from
children's in Philadelphia.
‐ Are you a resident?
‐ 'Yes. That would be correct.'
'How many deliveries
did you attend'
over there, Dr. Del Amico?
I stopped counting around 200.
We've got a late
decel here, Dr. Coburn.
‐ Carla's at 32 weeks.
‐ 'Any meconium?'
‐ 'No. Fluid's clear.'
‐ Heart rate's dropping.
‐ Where's the NICU nurse?
‐ On her way.
Down to 120.
‐ Why isn't he coming?
‐ He's coming, baby.
‐ He's comin'.
‐ Alright.
Let's get this
baby outta here.
Dorgan, I need
vacuum extraction.
‐ Why vacuum extraction?
‐ We're at a 100 here.
That's why.
Number for respiratory therapy?
'3‐3‐9‐4.'
Uh, I brought
some stuff in today
because I knew you'd
be starting back.
What are you doing?
Well, you know,
I know you're gonna be
a little resistant to this
but you'll feel a lot safer
if you carry something
on you for a while.
I don't even know
what this stuff is.
I've got cops in my family,
so I can get anything.
Electronic stun gun,
personal taser.
I don't think so.
Well, at least,
take the pepper spray.
Look, I appreciate it, really.
But, uh, it's not for me.
Well, I'm not suggesting
that you start packin' a gun.
Although...that's what I do.
You carry a gun?
Under the front
seat of my car.
I was at the drive‐thru once,
waiting for some fries
and this punk walks up,
sticks a knife in my face
and wants my wallet.
So I reach under
the seat, grab the .357
stick it up his nose, and
whoa, could that kid run.
‐ Dr. Greene, welcome back.
‐ Thanks.
Uh, listen, thanks, Maggie
but I'm gonna pass
on the armaments.
‐ Carter, you in the ER all day?
‐ Yeah.
Great. 'Cause I think
I'm gonna need your help.
I don't really have full
mobility yet for procedures.
Uh‐huh. What is all this stuff?
Well, I was just trying
to get Dr. Greene to..
Oh! Oh, my God!
Oh, my God! I'm going to die!
‐ Sit down, sit down.
‐ Oh, my God!
‐ Maggie, help me!
‐ Oh, just sit, just sit.
Alright, I'll‐I'll
get a nurse.
I'll get,
I'll be right back.
Just don't move.
Don't‐don't touch your eyes.
That's it, Carla,
push, push, push.
Come on, Carla, breathe.
We got him.
It's okay, baby.
It's okay.
Blue and floppy.
Ready the liter.
'Peter, what is it?
I can't hear him.'
What is it? What's
going on? What's wrong?
'Dele suction.'
'Please tell me
what's going on.'
I don't like his color.
Come on, little guy. Pink up
for us, come on, let's go.
‐ What's the apgar?
‐ Zero for color.
‐ What's the apgar?
‐ Peter, back off.
Let her work.
'Muscle tone zero,
one for reflex.'
‐ Two for heart rate.
‐ One minute apgar.
‐ Four out of ten.
‐ What're you doing?
You got to do
something. Let's go!
Peter, please tell
me what's going on.
It's okay, baby.
It's okay. They got him.
‐ 'He's got retractions.'
‐ No movement.
‐ I need to tube him.
‐ '2.5.'
Heart rate down. Eighty‐five.
Start compressions.
Draw up .02 epi.
Dorgan call the NICU.
Tell them we're on the way.
I'm sorry!
‐ I know it's not funny, but‐‐
‐ No, it's funny.
My whole life is
just one big fun fest.
Anspaugh hates me.
Benton looks at me like
I'm some kind of an alien.
'I think those things are
in your favor, actually.'
Right? Thank you.
So, when you were, uh,
thinking about med school
you were really willing to
start everything over, huh?
All that work?
As opposed to your
five, six more years
of surgical residency
you've got ahead of you?
I guess, yeah,
I see your point.
Carter, are you back
among the living?
‐ Yes, absolutely.
‐ We got an MVA coming in.
Six, seven minutes.
You know, it's not
my place to say
but he looks kind of bad.
You okay there, Carla?
I'm just going to get
everything ready for you.
Be right back.
Just hang in there, Carla.
You're almost there.
Peter.
What are we going to do?
Have you seen him?
I'm gonna go check on him
as soon as I get you settled.
Shh, shh. Just,
just take it easy.
Just be a couple
of more minutes.
‐ Housekeeping hasn't finished.
‐ Okay.
One, two, three.
‐ Ah!
‐ 'Rib?'
‐ Yeah.
‐ 'Gonna kick you outta here.'
‐ I'm fine.
‐ Normal vital signs.
Oxygen at 5 liters. GCS, 11.
You guys mind if I
steal some saline?
No, go ahead. Help yourself.
Pupils are equal and reactive.
‐ No hemotympanum.
‐ Chest is clear.
‐ Abdomen, soft and flat.
‐ Pulse is 80, BP 120/75.
‐ What's his name?
‐ Uh, Harry Smith.
Harry, can you hear me?
You know where you are?
Let's order something, Carter.
‐ CBC, Chem‐7, type and screen.
‐ You want to dip a urine?
Yeah, let's get
a C‐spine, chest and pelvis.
‐ Police said it was a DUI?
‐ 'I don't know.'
The guy was swerving
in and out of lanes
on the Eisenhower
only going about 35.
‐ 'Then he hit a light pole.'
‐ Alright.
Let's get a blood alcohol level.
There's no alcohol
on his breath.
Hey! Thanks for the supplies!
Any time.
‐ Ah!
‐ 'He's seizing'
Get some Ativan, two mgs.
Where's Tabash?
Well, he's with
another patient.
‐ 'What's he ordered?'
‐ 'Everything.'
CBC, lytes, blood
cultures, what?
‐ Yes. All that.
‐ ABG?
‐ Chest x‐ray?
‐ Yes.
'Dr. Benton.'
Your son is stable
at the moment.
What labs have
you ordered?
Well, we've done
a complete septic workup.
No, I need to know
exactly what you've ordered.
What, uh, labs,
what antibiotics.
Dr. Benton, your
son's heart rate is 170
and his pulse ox
is 91 on 100% oxygen.
We've taken a chest x‐ray, drawn
blood for CBC, lytes and ABG
and sent off a blood
culture, a urine culture
an endotracheal
aspirate culture
a spinal fluid culture
and started him on 100
milligrams of ampicillin
and six milligrams
of gentamicin.
He was hypotensive with
a blood pressure of 30/18
so he's received five percent
albumin 10cc's per kilo
and we've started dopamine
five mics per kilo per minute.
And we'll titrate
to a map of 40.
Now, what you
need to know
what you need to share
with this child's mother
is that at the moment
the baby is
stable, but critically ill.
Probably has a serious
infection in his blood
and we don't know if
his lungs can provide
enough oxygen
to sustain life.
Unfortunately,
we have no choice
but to wait and see how he
responds to the present therapy.
Let's see how he's
doing in an hour.
And that's when we
should talk again.
What's your son's
name, Dr. Benton?
He doesn't have one.
Carol? Hi. I got some
good news and bad news.
Well, you're gonna tell
me both. So go ahead.
The bad news is, your
brothers and sisters‐in‐arms
are planning a little surprise
birthday party for you tonight.
Doug, you did this
joke on me this morning.
No, no. This is real.
'Cause I got invited.
Well, I'm not listening.
The good news is I know
how much you
hate your birthday.
‐ So I got you out of it.
‐ I do not hate my birthday.
You've always
hated your birthday.
So I told them
you cannot possibly
make it because..
...you're having
dinner with me.
I do not believe
a word of this.
Mm‐hmm, okay,
how many people
have wished you
happy birthday today?
‐ Just Kerry, this morning.
‐ Mm‐hmm.
And how many people know
that it is your birthday?
You know theirs, right?
Well, yeah. We've worked
together for years.
Mm‐hmm, okay, now
what is the one reason
why you don't wish
someone happy birthday
when it is their birthday?
Oh, God...'cause they're
planning a surprise party.
Oh! That's all I'm saying.
But why is it
that I somehow feel
you've trapped me into this?
Trapped you? I saved you.
You should be buying me dinner.
I'll pick you up any time.
You name the place and, uh..
'Got some gauze out here.'
Okay, I'm out of here
as of an hour ago.
Randi, can you send that Carla
Reese chart up to OB, please?
‐ Sure, I got it.
‐ Did you say Carla Reese?
Yeah, she just delivered
a baby about an hour ago.
‐ Carla?
‐ 'You know her?'
No, not really.
I‐I remember her.
She...came through
the ER a month or so ago.
She wasn't anywhere
near being due.
Yeah, I know. The baby's
only 32 weeks. A little boy.
‐ Is he okay?
‐ I don't know.
He's in the NICU. Apgar
was poor, had to intubate.
‐ It's touch and go.
‐ Is she doing alright?
She didn't have any
other complications
if that's what you mean.
Yeah, I don't know how many
preemies I've resuscitated
but somehow I still
haven't gotten used to it.
‐ I'll see you all tomorrow.
‐ See you.
Jeanie, were you
taking that woman
with the eye pain,
or was that Maggie?
No. I'm taking her.
I was just about to head in.
Don't keep
the patients waiting.
They might get angry
and beat you up.
Dr. Greene's on a bit
of a rampage about that.
He'll settle back in.
Just needs a couple more days.
‐ 'Hey, Mark?'
‐ Hey, Doug.
I keep missing you all
day today. How you doing?
I'm fine, you know.
Feels good to be back.
‐ Not too soon?
‐ No.
I mean, yeah, it was nice
having time with Rachel
but a week at home is
about all I could take.
Yeah. So, any word
from the police?
Uh, they're going to
come by this afternoon.
I gave them a list of names
of patients and family members
who might have had any
reason to be that angry.
At least, the ones
I can remember.
‐ So, you‐you okay with this?
‐ Yes, and, no.
Hasn't been the most
pleasant experience
but it's kind of
a wake‐up call.
You know, a reminder that
I can be abrupt with people
and it will sure
as hell backfire.
‐ Well, I don't know‐‐
‐ Hey, Doug.
You've got a five‐year‐old
with a wrist fracture in four.
Ah, child in pain.
Music to my ears.
I'll catch up with you
later. Get some lunch?
‐ Okay.
‐ Okay.
'I'm so sorry, Peter.'
The chest x‐ray showed
a diffused, patchy infiltrate
and the endotracheal aspirate..
...showed
gram‐negative bacteria.
He's got pneumonia,
sepsis, premature lungs
and respiratory
distress syndrome.
They just gave him surfactant
to, uh, try to
open up his lungs.
How's Carla doing?
She asked me to wait
outside in the hall.
Probably haven't shared
this with anyone, have you?
'Your family,
the people you work with?'
You do have friends, Peter.
'A community.'
I hope everything
will be alright.
And you need to stop
standing in the hall.
'Keep your hands at
your side, Mr. Lensky.'
‐ I can't. It hurts.
‐ Yes, I think we know that.
Pulse is 130, BP is
180/95. Pre‐op labs?
Yeah.
And you been taking
a lot of ibuprofen lately?
Uh, yeah. About, uh,
eight tablets a day.
Mm‐hmm.
But that's
'cause I twisted my knee
not because of this stomachache.
Dr. Carter.
Do you have a minute?
Sure, Connie, let's get,
uh, an upright chest x‐ray
and give ten
of morphine, slow IV push.
That'll help with your pain,
Mr. Lensky. I'll be right back.
I'm just double‐checking.
This guy's the writhing
and groaning in exam two
that Dr. Greene
was concerned about?
Yeah, but I didn't
know he was concerned.
Well, he was worried
the guy was waiting too long
for a surgical consult.
Ah, well, Mr. Lensky's
got a board‐like abdomen
absent bowel sounds
and rebound
and guarding
in all four quadrants.
‐ A perfed ulcer?
‐ Sounds like it.
‐ I ordered a film.
‐ Have Anspaugh check it out.
Okay.
Colles' fracture.
Gonna have to do
a closed reduction?
Yep. His dad's still
too flipped out to watch?
His dad's sacked
out in curtain three
having self‐medicated
with ten of valium.
Oh, that's helpful,
maybe we should get
a lollipop for Russell here.
‐ Fentanyl oralet?
‐ Mellow him out.
I'm gonna have to order
it from Central Pharmacy.
‐ It may take a while.
‐ Okay.
‐ Maybe we can try it without.
‐ Alright.
Russell, I think what
we're gonna do here
buddy, is we're gonna‐‐
‐ I'll just get that lollipop.
‐ Yeah, get right on it.
I wanna give it
a little longer
but basically,
the surfactant didn't do much.
He's still
requiring 100% oxygen
with high pressures
on the ventilator.
Okay, well, his
mother's gonna wanna know
everything that might happen.
Dr. Benton,
every parent in here
wants to know
what might happen.
We just can't know for sure.
You know, I, uh..
...I did a pedes surgery
elective earlier this year
but I'm not up to speed
on all of the, uh, sequelae.
‐ You mean like retinopathy?
‐ Yeah, exactly.
I mean, although his eyesight
should be the least of
our worries right now.
'We need to be more
concerned about'
intraventricular hemorrhage
periventricular leukomalacia
necrotizing enterocolitis
'and in a few weeks
bronchopulmonary dysplasia.'
Alright, what do we do?
Well, I'm concerned about
the high vent pressures
causing lung damage
'so I wanna switch him over'
to an oscillating ventilator
and...we wait.
Hey, Dr. Greene,
you got a second?
Yeah. What is it?
I got the, uh, head CT
back on Harry Smith
Harry Smith.
The slow‐moving MVA
from this morning?
‐ Hmm.
‐ It's negative, no bleed.
But I was talking
to his mother
'who is over there filling out'
some paper work.
She said Harry was on his way
to a pre‐employment physical
for a new job.
She also let it
drop that she was..
...pretty relieved
that the cops
didn't find any
marijuana on him.
Carter, is this leading
to helping the patient?
His urine is like water.
Check this out.
Specific gravity, 10‐0‐5.
Huh‐uh. I think we
should give him Lasix.
I think it might
be hyponatremia.
Water intoxication?
He's worried about
a urine drug test
maybe he thinks
he can dilute it
or wash out his
system or something.
Dr. Greene,
transfer that LOL
back to her nursing home.
Did you hear anything
from that police detective
the one who said
he was coming by?
Um, haven't heard,
haven't seen.
That's a good thought, Carter.
Why don't you call
the lab and see
if his lytes are back?
Okay.
Does that hurt? No?
That's why Dr. Ross
gave you that shot.
Nurse Hathaway,
she's gonna pull down
on your arm
and I'm gonna push.
And we're gonna pop that
little bone right here
right back in place, okay?
'Ready to start?'
Where's my dad?
'Uh..'
Taking a nap.
Uh, but he wanted us
to be here with you.
He sings to me.
He sings to you, does he?
So you'll do it?
Oh, I think Dr. Ross would love
to sing to you, Russell.
You know, Nurse Hathaway
would like to join in.
'But she doesn't
know the words.'
Oh, I believe I do
too know the words
to whatever it is Dr. Ross
is going to sing to you.
Uh‐huh.
Uh‐h‐h..
♪ Hello muddah ♪
♪ Hello faddah ♪
♪ Here I am at ♪
♪ Camp granada ♪
♪ It is very ♪
♪ Entertaining ♪
Pop it right there.
♪ And they say
we'll have some fun ♪
♪ If it stops raining ♪
Wrap that up.
♪ I went hiking ♪
♪ With Joe Spivey ♪
♪ He did develop ♪
♪ Poison ivy ♪
You brought me
all the way
down here for this?
I think he might have
perfed his stomach ulcer.
Well, of course he has.
It's free air
under the diaphragm.
It's a slam‐dunk,
no‐brainer.
Alright, drop
an NG, consent him
and redline him to the OR.
Carter.
'I realize you needed backup'
'but any senior resident
could have handled this.'
So, please, think
twice next time.
Good news, Mr. Lensky.
Now, we'll be able to
fix you up right away.
‐ What is it?
‐ You have an ulcer.
Which has eaten
through the lining
of your stomach,
but with surgery
it can be easily repaired.
Surgery?
Yeah. It's a fairly routine‐‐
I‐I can't do surgery.
Well, let me explain.
It really is the only option.
‐ Uh, no. I feel better already.
‐ That's the morphine.
Nothing's really changed
with your condition.
Mr. Lensky, wait
a second. Listen to me.
No, you listen to me.
I will not have surgery
and you can't make me have it.
Now, leave me alone.
I wanna go.
Can you tell me why
you feel so strongly?
Did something happen to you?
To somebody else?
Mr. Lensky, I'm
trying to help you here.
'But I can't help
you if you leave.'
And I can't help
you if you won't
tell me what the problem is.
Of all the stupid things..
...the gallbladder.
My dad was such a believer
in modern doctors,
modern medicines.
"They'll pop this thing out,
I'll be home tomorrow."
Fifty eight years
old and he dies
having his stupid
gallbladder taken out.
And the surgeon..
...all he could talk about
was how simple it was.
No big deal.
Afterwards, he came out
to the waiting room
he couldn't even look
my mother in the eye.
He gave us
the news and spouted
some fancy medical words
and all I could think was,
"You lying son of a bitch!"
We shouldn't have
believed him, Dr. Carter.
How can I believe you?
I stayed in there, I talked
to him about his father's
gallbladder operation,
I explained why
his surgery was gonna
be completely different.
I couldn't get the guy to budge.
I don't know what to do.
Not much you can do,
it's his decision.
Well, he needs
to get to the OR.
Not to mention the fact
that Anspaugh's gonna take
my head off one more time.
I know we can't override the
consent for emergency surgery‐‐
No, we can't, but I
read a paper somewhere
about forme fruste, ulcers
that spontaneously seal off.
Do a paper chase search,
see what you can come up with.
Maybe I should do
a Hypaque upper GI.
'See what's going on in there.'
‐ Good idea.
‐ Carter.
These labs came back
for you on Harry Smith.
"Sodium 115?"
I don't believe it.
I was right.
This guy's been drinking
buckets of water.
He's also waking up
if you wanna talk to him.
Yeah, yeah.
Where's Dr. Greene?
Can I get you
anything to drink?
Uh, sure. I'll take
a pop if you've got one.
So, it's good news.
All the leads you
gave us came out clear.
What?
Yeah, every one checked out.
The patients, the families?
Everyone you gave us.
There wasn't
anything on anyone?
Doc, usually, people are
pretty glad to hear that.
They don't like things
happening in their own backyard.
Right. Right.
You okay?
Sure.
I see you made
a pretty quick recovery.
Yeah. It wasn't as bad as
I thought it was gonna be.
'We'll keep
investigating, of course.'
Gotta go.
‐ Dr. Greene.
‐ Uh, later, Carter.
I was, uh, I was right about
the water intoxication guy.
Sodium was 115.
He drank three gallons.
That's great, Carter.
Great, terrific, wonderful.
Admit to medicine.
It's not that it's
a better or a worse option
it just may be the only
other thing to consider.
Babies can respond
to inhaled nitric oxide
and it can improve
their oxygenation.
‐ In full‐term babies.
‐ That's correct.
It's still being studied
in premature infants.
'We're participating in
a national multi‐center trial.'
There is a small
series which showed
that nitric did
improve oxygenation
by 50% on average.
Now, half of those kids did
develop bleeding in the brain
'but no one knows
if the gas caused that.'
Bleeding in the brain.
There would be a risk of
retardation and cerebral palsy.
Yeah, but if we keep
doing what we're doing now
then there's a risk
of permanent lung disease.
Yes, and possible brain damage
if the oxygen
level falls too low.
Well, that's
a hell of a choice.
How do I make that decision?
Dr. Benton, I wish I
could answer that question
for every parent I talk
to every single day.
'Dr. Tabash?'
Talk it over with
the baby's mother
and let me know soon.
‐ Okay.
‐ Excuse me.
Mark.
I'm an idiot, Kerry.
I'm a complete idiot.
Was that the police detective
you'd been waiting for?
It wasn't an angry patient.
It wasn't a family member
of an angry patient.
It wasn't Chris Law.
It wasn't Mr. Gunther.
It wasn't that crazy guy
who was yelling about Krishna.
They checked everybody out.
Yeah.
I thought I was remembering
it piece by piece
like it was a puzzle, it
was all gonna come together.
But the Chicago
Police Department
was nice enough to inform me
that I am simply the victim
of a random act of violence.
Well, you knew that, Mark,
patient or no patient.
No, what I knew is
that everything I do
every day of my life, I do
because I'm not the victim.
I treat the victim,
I cure the victim.
I watch them
roll the victim out
like a piece of meat,
but the truth is
I'm the piece of meat.
Yeah, but we can't
think about that, can we?
Because we're the ones who
see what goes on out there.
We're the ones who know
that every single day
some child is not gonna
make it home from school.
Some father is not gonna
make it home from work.
But if we allowed ourselves
to think that could be us
we couldn't walk out
our own front door.
The problem is, that is us.
No, Mark, the problem is
it makes us like
everyone else.
Dr. Anspaugh, I was just
coming up to see you.
Where in the hell
is that perfed ulcer?
We should have had him
in and out two hours ago.
Actually, that's
why I wanted to talk.
Mr. Lensky prefers
not to have surgery.
Well, nobody wants
surgery. So...what?
But I've discovered he
doesn't really need it.
Of course, he needs it.
There's a hole in his stomach.
If we don't repair that perf
he's at risk for
peritonitis, sepsis, death.
If you look..
...there's the ulcer,
but there actually is no leak.
It spontaneously sealed
itself off against the liver.
This patient was
redlined to the OR.
Who in the hell
ordered an upper GI?
I did.
You were supposed
to consent him.
‐ He doesn't want surgery.
‐ He needs surgery.
Maybe not,
I found an article
that shows me that he
could be treated medically.
Which is what he wants.
You think this is
about what he wants?
Yeah.
I guess, a little bit.
Well, you're wrong, Carter.
This job is about determining
what a patient needs
and the best way
for us as surgeons
to meet that need
and as surgeons...we cut.
Dr. Anspaugh, as a doctor,
if I can find a way
to do what my patient wants
that's medically acceptable
then I think that's
what I should do.
And I don't believe I
should cut somebody open
just because I can.
It bothers me, Carter..
...that this patient
is willing to risk death
rather than undergo
a simple surgical procedure
but you know...
it bothers me even more..
...that you are so
willing to help him do that.
‐ Oh!
‐ Sorry.
Mark! I still really need you
to sign off on these QA reviews.
I don't have time right now.
But I'm off in five.
I just wanted to get‐‐
Lily, why don't
you just leave them
at the desk
for me, alright?
Done. Done. Done.
You look very nice
tonight, Dr. Ross.
Thank you, E‐Ray.
E‐Ray, can you
file these for me?
I'll certainly ask
Ms. Kelly if she'll do that.
‐ Ms. Kelly?
‐ She's our temp clerk tonight.
‐ Why do we have a temp?
‐ I'm sorry, Carol.
But I don't think that's
any of your business.
‐ Okay. Goodnight.
‐ Goodnight!
‐ Grab a burger?
‐ Yeah.
He is so strange.
Where did we find him?
‐ Mark. Hey.
‐ Nina, hi.
Damn, I was
supposed to call you.
Yes, although I hate having
you think of it that way.
It's been really busy.
Good first day back?
Completely fabulous.
Did you call Dr. Gillum?
That PTSD guy?
Well, you are post‐trauma.
Look, I know I need some
time to settle back in
but it's not like I'm
a postal worker with an AK‐47.
I‐I know you're not.
I'm‐I'm just trying to
help any way that I can.
I know, and‐and I
appreciate it.
I'm‐I'm fine.
Everything's getting
back to normal.
Mark, I don't like you
trying to cover with me.
I don't like you trying
to be a shrink with me.
How's Rachel doing?
She's, uh, sleeping over at
a friend's house tonight.
‐ Great. Tell her I say hi.
‐ Sure.
Hey, Peter, how you doing?
How is she?
Well, remarkably
well, considering.
She's a pretty strong lady.
Oh, God, Dr. Coburn,
I wanted to apologize
for my behavior this
morning in the delivery.
Thank you,
but it's unnecessary.
I've never met a father
who could handle it
sensibly, calmly, maturely.
If I ever do, that's the guy
I'm really gonna slap around.
Yeah.
Today was the first
day I was ever afraid.
Well, I'm glad to
hear that, Peter.
Better get back in here.
I'll check on her
again before I leave.
Hey, Carla.
I made the bed.
Isn't that the stupidest
thing you've ever seen?
I spoke to Dr. Tabash.
'He presented another
option for the baby.'
'I think we should consider it.'
There are a lot
of serious risks involved
so I'm gonna try to
explain them to you, and, uh..
...and then we have
a decision to make, okay?
You don't have to change for me.
I'm not changing for you.
You said we were
gonna grab a burger.
We can get some burgers
at the pump room.
Doug, I'm not wearing
scrubs to the pump room.
Okay, well..
I don't know, I think
it would be rather daring.
Surprise!
Happy birthday! Happy birthday!
Oh, God, I hate
you for this.
Worked out well,
don't you think?
What are you doin'?
Waiting for you.
Come on, right this way.
What are you doing?
Come on. Come on,
just come over here.
‐ Have a seat.
‐ Okay.
‐ What's this?
‐ A little something for you.
A garage door opener.
Go ahead, try it.
I always wanted one of these.
I know.
You always said
they were stupid.
Well, they are stupid.
I‐I don't get why a person
can't just open
the damn door.
I think this is the nicest
thing you've ever done for me.
That's pretty pathetic.
I love it.
I love it.
Let's have a beer.
Okay.
Go ahead.
Ah‐h‐h.
'This is special, Doug.'
'I love having 20 people over'
especially when I have
so much to serve them.
Here. Peel an orange.
Will you lighten up?
They brought booze.
Okay, I'll lighten
up, I'll, uh
I'll just have
a sip of this milk.
You just drink that right
out of the carton like that?
What's wrong with that?
Well, it's just kind
of a guy thing to do.
Um, you know, uh..
So, Doug, what‐what
is all this about?
What's what about?
This little dance
you did today.
This, this party...you.
Well, I know
you haven't had
very good birthdays last
couple of years, and..
The‐the ones I
spent with you?
The ones I forgot, and, uh..
...I just thought it was time
for you to have a nice one.
You want a sip of milk?
Yes, well, I
would love a sip
of this milk.
Thank you.
Thank you.
‐ Dr. Weaver. Hey.
‐ Hi.
Can I talk to you for a minute?
Uh...sure.
I know this isn't the right
time or the right place
but I was just curious, um..
...what would be
involved with getting
into emergency medicine?
W‐what do you mean?
Well, if one wanted to change
his residency, would you have
to redo your intern year?
Has one talked to
Dr. Greene about this?
Ah. No.
You saw how he
was in the hall.
♪ Happy birthday to you ♪
♪ Happy birthday to you ♪
♪ Happy birthday dear Carol ♪
♪ Happy birthday to you ♪
Oh, my God!
‐ 'Blow them out.'
‐ Come on. Make a wish.
There's so many
candles on this cake.
What am I, 55?
‐ Yeah.
‐ Wait, wait. Hold on.
Hold on. One second.
Oh! I almost forgot.
‐ Oh! Wait a minute.
‐ 'Yeah. Beautiful.'
Ah!
Me too.
It's so your wishes come true.
‐ 'Make it a good one!'
‐ 'Alright.'
‐ 'Make a wish!'
‐ 'Happy birthday!'
‐ 'Alright, Carol!'
‐ 'Alright, Carol! You go girl.'
‐ 'Happy birthday!'
‐ 'Oh, my God!'
‐ 'You still look so young.'
‐ 'Happy birthday.'
‐ 'Make a wish. Make a wish.'
‐ 'Happy birthday.'
Rejoice, lost man.
Chaos is your destiny.
In this scare, this baby
is not gonna wanna to come out.
Carter, two of the best
transplant surgeons
in the county let us
look over their shoulders
and you just get up and leave.
Is that a problem?
‐ Okay, I'll stay on the couch.
‐ Me too.
Looking for a...head doctor.
Which one?
Bald, white guy, little glasses.
Great. Just walk away!
Is Dr. Benton done with
that thyroidectomy yet?
So he's still in there?
Dr. Benton!
Carter, what are you doing here?
Let's get an ABG
in 20 minutes. Okay?
I thought you were
covering the ER today.
I'm on it in a few.
Listen, I need to talk to you.
Well, you better
make it fast.
I've got two
admissions, a clinic
and an aneurysm
with Dean Rowe.
I've been thinking about that
kidney donor case last week.
The one where I left to
go check on the patients
during the debriefing.
Instead of listening
to two of the finest
transplant surgeons
in the country?
Yeah. I guess so.
And I've just been wondering,
you know, I don't know.
Maybe...maybe I'm
in the wrong place.
Well, if you're still here
in two minutes, you are.
No, I mean surgery.
Obviously, I love
it, and I still feel
very challenged by it
but...are there ever days
when you don't feel
quite satisfied?
Carter, sometimes
the patient dies.
‐ Yeah, I know, but otherwise?
‐ Otherwise what?
Well, it just
feels like sometimes
they exist for us
to do procedures.
Well, that's what
they come here for.
And we don't need to know
anything else about them
like how worried they are or
where they went to high school
or...whether they
like cats or dogs.
Carter, what are
you talking about?
Well, sometimes, I like
to know the other stuff.
What for? I mean if you..
Ah, damn. Um,
listen, we'll, uh..
...we'll talk later.
I'm tellin' you, it was
at least 50 questions
about my family background.
Yeah, nothing like
the head of security
to make you feel insecure.
He almost withheld
my photo ID because
I didn't know my
stepmother's maiden name.
Who knows their
stepmother's maiden name?
Wow, he didn't
cut you much slack
on that there picture either.
You'd think I was tryin' to walk
into the front door
of the White House.
This is easier. I've done it.
Randi, can you get
these over to radiology?
Now?
Unless you're doing
something urgent
that I can't quite see.
‐ No. Dr. Ross.
‐ Yeah?
Pedes called, you're covering
deliveries for John Lavagnino.
Broke his kneecap
playing soccer.
Okay. Alright,
good morning to you.
Oh, not for Anna.
She just had her security
clearance interview.
Oh, yeah. Did you
get strip searched?
‐ They check for track marks?
‐ Practically, yeah.
They're cracking down because
of what happened to Mark.
He starts back today, right?
Uh, I wish he'd
take another week.
Let's make sure
we're grabbing cases.
Keep his load light
for the first few days.
I don't want him
workin' at all.
I want him to help
me plan Carol's
surprise birthday party.
‐ Doug.
‐ Happy birthday, Carol.
I got the vomiting
and diarrhea in four.
‐ Happy birthday.
‐ Thank you.
And I'm taking the..
...quadruple bounce‐back
migraine in five.
Nothing like
a little drug‐seeking
behavior to start your day, huh?
Doug, you promised me you
wouldn't tell anybody
about my birthday.
‐ Yeah, that was last year.
‐ Yeah.
And you told
everybody then too.
At least I'm consistent.
‐ Argh!
‐ Hey!
You're right, coffee..
...can wait.
What's this?
Uh, it's a coffee pot.
That is not a coffee pot.
It's called a French press.
Oh, no more
aluminum percolator?
No. We're going to have
great coffee, which can wait.
‐ What's that?
‐ Uh, the microwave.
I'm just heating up
some cinnamon buns.
‐ The microwave.
‐ Mm‐hmm.
‐ I always wanted a microwave.
‐ I know.
But...you would
never let me get one.
You said that i‐it
broke down the vitamins.
I know. I'm sorry. I was wrong.
Now, just come back over here.
This is nice.
I mean, this
is really nice.
What happened?
She's getting close.
Nine centimeters.
‐ What?
‐ I'm alright, Peter.
She failed tocolysis,
and her contractions are strong.
They went from four
to nine in no time.
Why didn't you call me sooner?
Last time they gave me
that stuff and it was fine.
Couldn't you have
done something else?
Peter, this baby's coming.
What are you talking
about it's coming?
It's‐it's two months early.
'I know that.'
‐ You‐you should have called me.
‐ I just did.
Hoping that you might
want to participate
in the birth of your child.
If that's what
you'd like to do
I suggest you gown
up and get in here.
Hi.
Dr. Greene, right? How are you?
I'm fine, thank you.
Who are you?
Anna Del Amico.
We met last week.
I‐I mean, we didn't
actually meet.
But I was there when
you were attacked.
Oh, in the men's room?
No. In the trauma
room afterwards.
I don't remember either room,
so I don't remember you either.
I start my emergency
residency in July.
I'm doing an ER‐pedes
elective until then.
That was my...first day.
I'm sorry it had
to be so exciting.
No, I'm just glad you're
okay. So, welcome back.
Thank you.
Where is everybody?
Mark, what you doing here?
Getting back to work.
Doug and Carol are
bringing in an MVA.
‐ Hi.
‐ Hey, Mark, how you doing?
‐ Mark, welcome back.
‐ It's nice to be back.
‐ What do we got?
‐ Bicycle versus tour bus.
Don't worry, buddy. We got it,
alright? You just take it easy.
Settle in nice
and easy. Here we go.
Dr. Greene, you look great.
Dr. Ross, OB called.
They need you for that delivery.
They said it's kinda urgent.
Alright, find Dr. Del Amico.
See if she can take it.
Mark, I'll talk to you later.
‐ She's at the desk.
‐ Who?
Dr. Del Amico.
She's at the desk.
Oh, right. Thanks.
‐ Help me shift her down.
‐ Breathe, Carla. Breathe.
Come on, baby, breathe.
You can do it, you can do it.
‐ How much mag did you give her?
‐ Six gram load.
Had her on three
an hour until she hit
four centimeters.
Then we had to let her go.
Dorgan, scalp electrode.
Keep breathing, Carla.
You're doing great.
Dorgan. What kind
of name is that?
'Irish, through and through.'
And you know, we have
a lot of experience
having a lot of babies.
Is she at risk
for chorioamnionitis?
Oh, come on, Carla, breathe.
Don't yell at me! Damn it!
Did you give her
any antenatal steroids.
Twelve milligrams betamethasone.
What about her blood sugar?
She's got gestational diabetes.
You're doing great, Carla.
You just hang in there.
'It's not going
to be much longer.'
'You're gonna be
able to push soon.'
What about a second dose?
This baby's going to have RDS.
‐ Peter, what is RDS?
‐ No, no. It's‐it's okay, Carla.
It‐it just means that the baby's
lungs, they haven't matured yet.
‐ What?
‐ 'It's okay.'
What? Uh‐h‐h..
You, hold her hand, you help
her breathe, you help her focus.
That's your only
job here, okay?
Now get over there and help
the mother of your child.
There'll be two additional
security cameras here.
And two at
the employees' entrance.
That's right.
Now the ambulance
bay doors
will be changed over
to bulletproof glass
which will also add
to your triage section.
And the hospital's
agreed to additional
armed security
in your waiting room.
What about the bathrooms?
Any security cameras in there?
Unfortunately, privacy issues
won't allow us to do that.
Yeah, my assailant's
privacy would have
definitely been violated.
We can only do what
we can do, Dr. Greene.
Thank you, Mr. Biggers.
Mark, it's nice to
see you up and around.
‐ But what are you doing here?
‐ Working.
It's nice to see
you too, Chuny.
Mark, these additional
security measures
may not help,
but they can't hurt.
You know what? I think
everyone's overreacting.
What we should really
be changing is the way
that we deal with patients
and their families.
Yeah, like, can't we
keep them outta here?
They're a pain in the ass.
Your compassion knows
no bounds, Randi.
Oh, uh,
Detective Warrington called.
He can't make it by
till later this afternoon.
Okay.
You really think
that's who did this?
Some patient
or family member?
I think that gives
them a good reason.
Look, Louise Pierson,
ankle x‐ray, three hours ago.
Where is it?
Discharge orders written
over an hour and a half ago.
Chart's still here
so the guy's still here.
I mean, come on,
med‐surg admission
five thirty this
morning, still here.
Neuro consult, ETA,
7:15 this morning.
Where are they? We keep
these people hanging around.
I'd get pissed off
enough to clobber somebody.
Before records clobbers me
I need you to sign off
these charts from last week.
Okay.
Uh. I got them. Uh.
I'm fine.
Push, push.
You're almost there.
Come on, keep going. Keep going.
‐ Hi. I'm Del Amico from pedes.
‐ Janet Coburn.
‐ I thought Ross was covering.
‐ He's got a teenager MVA.
This is Carla Reese, mother
Peter Benton, father.
Hey, how're you
doing there Carla?
You just keep on
pushing so I can take
a look at this
little baby of yours.
Mr. Benton, how are you doing?
It's Dr. Benton.
He's a surgical resident.
What? Are you new here?
Just came over from
children's in Philadelphia.
‐ Are you a resident?
‐ 'Yes. That would be correct.'
'How many deliveries
did you attend'
over there, Dr. Del Amico?
I stopped counting around 200.
We've got a late
decel here, Dr. Coburn.
‐ Carla's at 32 weeks.
‐ 'Any meconium?'
‐ 'No. Fluid's clear.'
‐ Heart rate's dropping.
‐ Where's the NICU nurse?
‐ On her way.
Down to 120.
‐ Why isn't he coming?
‐ He's coming, baby.
‐ He's comin'.
‐ Alright.
Let's get this
baby outta here.
Dorgan, I need
vacuum extraction.
‐ Why vacuum extraction?
‐ We're at a 100 here.
That's why.
Number for respiratory therapy?
'3‐3‐9‐4.'
Uh, I brought
some stuff in today
because I knew you'd
be starting back.
What are you doing?
Well, you know,
I know you're gonna be
a little resistant to this
but you'll feel a lot safer
if you carry something
on you for a while.
I don't even know
what this stuff is.
I've got cops in my family,
so I can get anything.
Electronic stun gun,
personal taser.
I don't think so.
Well, at least,
take the pepper spray.
Look, I appreciate it, really.
But, uh, it's not for me.
Well, I'm not suggesting
that you start packin' a gun.
Although...that's what I do.
You carry a gun?
Under the front
seat of my car.
I was at the drive‐thru once,
waiting for some fries
and this punk walks up,
sticks a knife in my face
and wants my wallet.
So I reach under
the seat, grab the .357
stick it up his nose, and
whoa, could that kid run.
‐ Dr. Greene, welcome back.
‐ Thanks.
Uh, listen, thanks, Maggie
but I'm gonna pass
on the armaments.
‐ Carter, you in the ER all day?
‐ Yeah.
Great. 'Cause I think
I'm gonna need your help.
I don't really have full
mobility yet for procedures.
Uh‐huh. What is all this stuff?
Well, I was just trying
to get Dr. Greene to..
Oh! Oh, my God!
Oh, my God! I'm going to die!
‐ Sit down, sit down.
‐ Oh, my God!
‐ Maggie, help me!
‐ Oh, just sit, just sit.
Alright, I'll‐I'll
get a nurse.
I'll get,
I'll be right back.
Just don't move.
Don't‐don't touch your eyes.
That's it, Carla,
push, push, push.
Come on, Carla, breathe.
We got him.
It's okay, baby.
It's okay.
Blue and floppy.
Ready the liter.
'Peter, what is it?
I can't hear him.'
What is it? What's
going on? What's wrong?
'Dele suction.'
'Please tell me
what's going on.'
I don't like his color.
Come on, little guy. Pink up
for us, come on, let's go.
‐ What's the apgar?
‐ Zero for color.
‐ What's the apgar?
‐ Peter, back off.
Let her work.
'Muscle tone zero,
one for reflex.'
‐ Two for heart rate.
‐ One minute apgar.
‐ Four out of ten.
‐ What're you doing?
You got to do
something. Let's go!
Peter, please tell
me what's going on.
It's okay, baby.
It's okay. They got him.
‐ 'He's got retractions.'
‐ No movement.
‐ I need to tube him.
‐ '2.5.'
Heart rate down. Eighty‐five.
Start compressions.
Draw up .02 epi.
Dorgan call the NICU.
Tell them we're on the way.
I'm sorry!
‐ I know it's not funny, but‐‐
‐ No, it's funny.
My whole life is
just one big fun fest.
Anspaugh hates me.
Benton looks at me like
I'm some kind of an alien.
'I think those things are
in your favor, actually.'
Right? Thank you.
So, when you were, uh,
thinking about med school
you were really willing to
start everything over, huh?
All that work?
As opposed to your
five, six more years
of surgical residency
you've got ahead of you?
I guess, yeah,
I see your point.
Carter, are you back
among the living?
‐ Yes, absolutely.
‐ We got an MVA coming in.
Six, seven minutes.
You know, it's not
my place to say
but he looks kind of bad.
You okay there, Carla?
I'm just going to get
everything ready for you.
Be right back.
Just hang in there, Carla.
You're almost there.
Peter.
What are we going to do?
Have you seen him?
I'm gonna go check on him
as soon as I get you settled.
Shh, shh. Just,
just take it easy.
Just be a couple
of more minutes.
‐ Housekeeping hasn't finished.
‐ Okay.
One, two, three.
‐ Ah!
‐ 'Rib?'
‐ Yeah.
‐ 'Gonna kick you outta here.'
‐ I'm fine.
‐ Normal vital signs.
Oxygen at 5 liters. GCS, 11.
You guys mind if I
steal some saline?
No, go ahead. Help yourself.
Pupils are equal and reactive.
‐ No hemotympanum.
‐ Chest is clear.
‐ Abdomen, soft and flat.
‐ Pulse is 80, BP 120/75.
‐ What's his name?
‐ Uh, Harry Smith.
Harry, can you hear me?
You know where you are?
Let's order something, Carter.
‐ CBC, Chem‐7, type and screen.
‐ You want to dip a urine?
Yeah, let's get
a C‐spine, chest and pelvis.
‐ Police said it was a DUI?
‐ 'I don't know.'
The guy was swerving
in and out of lanes
on the Eisenhower
only going about 35.
‐ 'Then he hit a light pole.'
‐ Alright.
Let's get a blood alcohol level.
There's no alcohol
on his breath.
Hey! Thanks for the supplies!
Any time.
‐ Ah!
‐ 'He's seizing'
Get some Ativan, two mgs.
Where's Tabash?
Well, he's with
another patient.
‐ 'What's he ordered?'
‐ 'Everything.'
CBC, lytes, blood
cultures, what?
‐ Yes. All that.
‐ ABG?
‐ Chest x‐ray?
‐ Yes.
'Dr. Benton.'
Your son is stable
at the moment.
What labs have
you ordered?
Well, we've done
a complete septic workup.
No, I need to know
exactly what you've ordered.
What, uh, labs,
what antibiotics.
Dr. Benton, your
son's heart rate is 170
and his pulse ox
is 91 on 100% oxygen.
We've taken a chest x‐ray, drawn
blood for CBC, lytes and ABG
and sent off a blood
culture, a urine culture
an endotracheal
aspirate culture
a spinal fluid culture
and started him on 100
milligrams of ampicillin
and six milligrams
of gentamicin.
He was hypotensive with
a blood pressure of 30/18
so he's received five percent
albumin 10cc's per kilo
and we've started dopamine
five mics per kilo per minute.
And we'll titrate
to a map of 40.
Now, what you
need to know
what you need to share
with this child's mother
is that at the moment
the baby is
stable, but critically ill.
Probably has a serious
infection in his blood
and we don't know if
his lungs can provide
enough oxygen
to sustain life.
Unfortunately,
we have no choice
but to wait and see how he
responds to the present therapy.
Let's see how he's
doing in an hour.
And that's when we
should talk again.
What's your son's
name, Dr. Benton?
He doesn't have one.
Carol? Hi. I got some
good news and bad news.
Well, you're gonna tell
me both. So go ahead.
The bad news is, your
brothers and sisters‐in‐arms
are planning a little surprise
birthday party for you tonight.
Doug, you did this
joke on me this morning.
No, no. This is real.
'Cause I got invited.
Well, I'm not listening.
The good news is I know
how much you
hate your birthday.
‐ So I got you out of it.
‐ I do not hate my birthday.
You've always
hated your birthday.
So I told them
you cannot possibly
make it because..
...you're having
dinner with me.
I do not believe
a word of this.
Mm‐hmm, okay,
how many people
have wished you
happy birthday today?
‐ Just Kerry, this morning.
‐ Mm‐hmm.
And how many people know
that it is your birthday?
You know theirs, right?
Well, yeah. We've worked
together for years.
Mm‐hmm, okay, now
what is the one reason
why you don't wish
someone happy birthday
when it is their birthday?
Oh, God...'cause they're
planning a surprise party.
Oh! That's all I'm saying.
But why is it
that I somehow feel
you've trapped me into this?
Trapped you? I saved you.
You should be buying me dinner.
I'll pick you up any time.
You name the place and, uh..
'Got some gauze out here.'
Okay, I'm out of here
as of an hour ago.
Randi, can you send that Carla
Reese chart up to OB, please?
‐ Sure, I got it.
‐ Did you say Carla Reese?
Yeah, she just delivered
a baby about an hour ago.
‐ Carla?
‐ 'You know her?'
No, not really.
I‐I remember her.
She...came through
the ER a month or so ago.
She wasn't anywhere
near being due.
Yeah, I know. The baby's
only 32 weeks. A little boy.
‐ Is he okay?
‐ I don't know.
He's in the NICU. Apgar
was poor, had to intubate.
‐ It's touch and go.
‐ Is she doing alright?
She didn't have any
other complications
if that's what you mean.
Yeah, I don't know how many
preemies I've resuscitated
but somehow I still
haven't gotten used to it.
‐ I'll see you all tomorrow.
‐ See you.
Jeanie, were you
taking that woman
with the eye pain,
or was that Maggie?
No. I'm taking her.
I was just about to head in.
Don't keep
the patients waiting.
They might get angry
and beat you up.
Dr. Greene's on a bit
of a rampage about that.
He'll settle back in.
Just needs a couple more days.
‐ 'Hey, Mark?'
‐ Hey, Doug.
I keep missing you all
day today. How you doing?
I'm fine, you know.
Feels good to be back.
‐ Not too soon?
‐ No.
I mean, yeah, it was nice
having time with Rachel
but a week at home is
about all I could take.
Yeah. So, any word
from the police?
Uh, they're going to
come by this afternoon.
I gave them a list of names
of patients and family members
who might have had any
reason to be that angry.
At least, the ones
I can remember.
‐ So, you‐you okay with this?
‐ Yes, and, no.
Hasn't been the most
pleasant experience
but it's kind of
a wake‐up call.
You know, a reminder that
I can be abrupt with people
and it will sure
as hell backfire.
‐ Well, I don't know‐‐
‐ Hey, Doug.
You've got a five‐year‐old
with a wrist fracture in four.
Ah, child in pain.
Music to my ears.
I'll catch up with you
later. Get some lunch?
‐ Okay.
‐ Okay.
'I'm so sorry, Peter.'
The chest x‐ray showed
a diffused, patchy infiltrate
and the endotracheal aspirate..
...showed
gram‐negative bacteria.
He's got pneumonia,
sepsis, premature lungs
and respiratory
distress syndrome.
They just gave him surfactant
to, uh, try to
open up his lungs.
How's Carla doing?
She asked me to wait
outside in the hall.
Probably haven't shared
this with anyone, have you?
'Your family,
the people you work with?'
You do have friends, Peter.
'A community.'
I hope everything
will be alright.
And you need to stop
standing in the hall.
'Keep your hands at
your side, Mr. Lensky.'
‐ I can't. It hurts.
‐ Yes, I think we know that.
Pulse is 130, BP is
180/95. Pre‐op labs?
Yeah.
And you been taking
a lot of ibuprofen lately?
Uh, yeah. About, uh,
eight tablets a day.
Mm‐hmm.
But that's
'cause I twisted my knee
not because of this stomachache.
Dr. Carter.
Do you have a minute?
Sure, Connie, let's get,
uh, an upright chest x‐ray
and give ten
of morphine, slow IV push.
That'll help with your pain,
Mr. Lensky. I'll be right back.
I'm just double‐checking.
This guy's the writhing
and groaning in exam two
that Dr. Greene
was concerned about?
Yeah, but I didn't
know he was concerned.
Well, he was worried
the guy was waiting too long
for a surgical consult.
Ah, well, Mr. Lensky's
got a board‐like abdomen
absent bowel sounds
and rebound
and guarding
in all four quadrants.
‐ A perfed ulcer?
‐ Sounds like it.
‐ I ordered a film.
‐ Have Anspaugh check it out.
Okay.
Colles' fracture.
Gonna have to do
a closed reduction?
Yep. His dad's still
too flipped out to watch?
His dad's sacked
out in curtain three
having self‐medicated
with ten of valium.
Oh, that's helpful,
maybe we should get
a lollipop for Russell here.
‐ Fentanyl oralet?
‐ Mellow him out.
I'm gonna have to order
it from Central Pharmacy.
‐ It may take a while.
‐ Okay.
‐ Maybe we can try it without.
‐ Alright.
Russell, I think what
we're gonna do here
buddy, is we're gonna‐‐
‐ I'll just get that lollipop.
‐ Yeah, get right on it.
I wanna give it
a little longer
but basically,
the surfactant didn't do much.
He's still
requiring 100% oxygen
with high pressures
on the ventilator.
Okay, well, his
mother's gonna wanna know
everything that might happen.
Dr. Benton,
every parent in here
wants to know
what might happen.
We just can't know for sure.
You know, I, uh..
...I did a pedes surgery
elective earlier this year
but I'm not up to speed
on all of the, uh, sequelae.
‐ You mean like retinopathy?
‐ Yeah, exactly.
I mean, although his eyesight
should be the least of
our worries right now.
'We need to be more
concerned about'
intraventricular hemorrhage
periventricular leukomalacia
necrotizing enterocolitis
'and in a few weeks
bronchopulmonary dysplasia.'
Alright, what do we do?
Well, I'm concerned about
the high vent pressures
causing lung damage
'so I wanna switch him over'
to an oscillating ventilator
and...we wait.
Hey, Dr. Greene,
you got a second?
Yeah. What is it?
I got the, uh, head CT
back on Harry Smith
Harry Smith.
The slow‐moving MVA
from this morning?
‐ Hmm.
‐ It's negative, no bleed.
But I was talking
to his mother
'who is over there filling out'
some paper work.
She said Harry was on his way
to a pre‐employment physical
for a new job.
She also let it
drop that she was..
...pretty relieved
that the cops
didn't find any
marijuana on him.
Carter, is this leading
to helping the patient?
His urine is like water.
Check this out.
Specific gravity, 10‐0‐5.
Huh‐uh. I think we
should give him Lasix.
I think it might
be hyponatremia.
Water intoxication?
He's worried about
a urine drug test
maybe he thinks
he can dilute it
or wash out his
system or something.
Dr. Greene,
transfer that LOL
back to her nursing home.
Did you hear anything
from that police detective
the one who said
he was coming by?
Um, haven't heard,
haven't seen.
That's a good thought, Carter.
Why don't you call
the lab and see
if his lytes are back?
Okay.
Does that hurt? No?
That's why Dr. Ross
gave you that shot.
Nurse Hathaway,
she's gonna pull down
on your arm
and I'm gonna push.
And we're gonna pop that
little bone right here
right back in place, okay?
'Ready to start?'
Where's my dad?
'Uh..'
Taking a nap.
Uh, but he wanted us
to be here with you.
He sings to me.
He sings to you, does he?
So you'll do it?
Oh, I think Dr. Ross would love
to sing to you, Russell.
You know, Nurse Hathaway
would like to join in.
'But she doesn't
know the words.'
Oh, I believe I do
too know the words
to whatever it is Dr. Ross
is going to sing to you.
Uh‐huh.
Uh‐h‐h..
♪ Hello muddah ♪
♪ Hello faddah ♪
♪ Here I am at ♪
♪ Camp granada ♪
♪ It is very ♪
♪ Entertaining ♪
Pop it right there.
♪ And they say
we'll have some fun ♪
♪ If it stops raining ♪
Wrap that up.
♪ I went hiking ♪
♪ With Joe Spivey ♪
♪ He did develop ♪
♪ Poison ivy ♪
You brought me
all the way
down here for this?
I think he might have
perfed his stomach ulcer.
Well, of course he has.
It's free air
under the diaphragm.
It's a slam‐dunk,
no‐brainer.
Alright, drop
an NG, consent him
and redline him to the OR.
Carter.
'I realize you needed backup'
'but any senior resident
could have handled this.'
So, please, think
twice next time.
Good news, Mr. Lensky.
Now, we'll be able to
fix you up right away.
‐ What is it?
‐ You have an ulcer.
Which has eaten
through the lining
of your stomach,
but with surgery
it can be easily repaired.
Surgery?
Yeah. It's a fairly routine‐‐
I‐I can't do surgery.
Well, let me explain.
It really is the only option.
‐ Uh, no. I feel better already.
‐ That's the morphine.
Nothing's really changed
with your condition.
Mr. Lensky, wait
a second. Listen to me.
No, you listen to me.
I will not have surgery
and you can't make me have it.
Now, leave me alone.
I wanna go.
Can you tell me why
you feel so strongly?
Did something happen to you?
To somebody else?
Mr. Lensky, I'm
trying to help you here.
'But I can't help
you if you leave.'
And I can't help
you if you won't
tell me what the problem is.
Of all the stupid things..
...the gallbladder.
My dad was such a believer
in modern doctors,
modern medicines.
"They'll pop this thing out,
I'll be home tomorrow."
Fifty eight years
old and he dies
having his stupid
gallbladder taken out.
And the surgeon..
...all he could talk about
was how simple it was.
No big deal.
Afterwards, he came out
to the waiting room
he couldn't even look
my mother in the eye.
He gave us
the news and spouted
some fancy medical words
and all I could think was,
"You lying son of a bitch!"
We shouldn't have
believed him, Dr. Carter.
How can I believe you?
I stayed in there, I talked
to him about his father's
gallbladder operation,
I explained why
his surgery was gonna
be completely different.
I couldn't get the guy to budge.
I don't know what to do.
Not much you can do,
it's his decision.
Well, he needs
to get to the OR.
Not to mention the fact
that Anspaugh's gonna take
my head off one more time.
I know we can't override the
consent for emergency surgery‐‐
No, we can't, but I
read a paper somewhere
about forme fruste, ulcers
that spontaneously seal off.
Do a paper chase search,
see what you can come up with.
Maybe I should do
a Hypaque upper GI.
'See what's going on in there.'
‐ Good idea.
‐ Carter.
These labs came back
for you on Harry Smith.
"Sodium 115?"
I don't believe it.
I was right.
This guy's been drinking
buckets of water.
He's also waking up
if you wanna talk to him.
Yeah, yeah.
Where's Dr. Greene?
Can I get you
anything to drink?
Uh, sure. I'll take
a pop if you've got one.
So, it's good news.
All the leads you
gave us came out clear.
What?
Yeah, every one checked out.
The patients, the families?
Everyone you gave us.
There wasn't
anything on anyone?
Doc, usually, people are
pretty glad to hear that.
They don't like things
happening in their own backyard.
Right. Right.
You okay?
Sure.
I see you made
a pretty quick recovery.
Yeah. It wasn't as bad as
I thought it was gonna be.
'We'll keep
investigating, of course.'
Gotta go.
‐ Dr. Greene.
‐ Uh, later, Carter.
I was, uh, I was right about
the water intoxication guy.
Sodium was 115.
He drank three gallons.
That's great, Carter.
Great, terrific, wonderful.
Admit to medicine.
It's not that it's
a better or a worse option
it just may be the only
other thing to consider.
Babies can respond
to inhaled nitric oxide
and it can improve
their oxygenation.
‐ In full‐term babies.
‐ That's correct.
It's still being studied
in premature infants.
'We're participating in
a national multi‐center trial.'
There is a small
series which showed
that nitric did
improve oxygenation
by 50% on average.
Now, half of those kids did
develop bleeding in the brain
'but no one knows
if the gas caused that.'
Bleeding in the brain.
There would be a risk of
retardation and cerebral palsy.
Yeah, but if we keep
doing what we're doing now
then there's a risk
of permanent lung disease.
Yes, and possible brain damage
if the oxygen
level falls too low.
Well, that's
a hell of a choice.
How do I make that decision?
Dr. Benton, I wish I
could answer that question
for every parent I talk
to every single day.
'Dr. Tabash?'
Talk it over with
the baby's mother
and let me know soon.
‐ Okay.
‐ Excuse me.
Mark.
I'm an idiot, Kerry.
I'm a complete idiot.
Was that the police detective
you'd been waiting for?
It wasn't an angry patient.
It wasn't a family member
of an angry patient.
It wasn't Chris Law.
It wasn't Mr. Gunther.
It wasn't that crazy guy
who was yelling about Krishna.
They checked everybody out.
Yeah.
I thought I was remembering
it piece by piece
like it was a puzzle, it
was all gonna come together.
But the Chicago
Police Department
was nice enough to inform me
that I am simply the victim
of a random act of violence.
Well, you knew that, Mark,
patient or no patient.
No, what I knew is
that everything I do
every day of my life, I do
because I'm not the victim.
I treat the victim,
I cure the victim.
I watch them
roll the victim out
like a piece of meat,
but the truth is
I'm the piece of meat.
Yeah, but we can't
think about that, can we?
Because we're the ones who
see what goes on out there.
We're the ones who know
that every single day
some child is not gonna
make it home from school.
Some father is not gonna
make it home from work.
But if we allowed ourselves
to think that could be us
we couldn't walk out
our own front door.
The problem is, that is us.
No, Mark, the problem is
it makes us like
everyone else.
Dr. Anspaugh, I was just
coming up to see you.
Where in the hell
is that perfed ulcer?
We should have had him
in and out two hours ago.
Actually, that's
why I wanted to talk.
Mr. Lensky prefers
not to have surgery.
Well, nobody wants
surgery. So...what?
But I've discovered he
doesn't really need it.
Of course, he needs it.
There's a hole in his stomach.
If we don't repair that perf
he's at risk for
peritonitis, sepsis, death.
If you look..
...there's the ulcer,
but there actually is no leak.
It spontaneously sealed
itself off against the liver.
This patient was
redlined to the OR.
Who in the hell
ordered an upper GI?
I did.
You were supposed
to consent him.
‐ He doesn't want surgery.
‐ He needs surgery.
Maybe not,
I found an article
that shows me that he
could be treated medically.
Which is what he wants.
You think this is
about what he wants?
Yeah.
I guess, a little bit.
Well, you're wrong, Carter.
This job is about determining
what a patient needs
and the best way
for us as surgeons
to meet that need
and as surgeons...we cut.
Dr. Anspaugh, as a doctor,
if I can find a way
to do what my patient wants
that's medically acceptable
then I think that's
what I should do.
And I don't believe I
should cut somebody open
just because I can.
It bothers me, Carter..
...that this patient
is willing to risk death
rather than undergo
a simple surgical procedure
but you know...
it bothers me even more..
...that you are so
willing to help him do that.
‐ Oh!
‐ Sorry.
Mark! I still really need you
to sign off on these QA reviews.
I don't have time right now.
But I'm off in five.
I just wanted to get‐‐
Lily, why don't
you just leave them
at the desk
for me, alright?
Done. Done. Done.
You look very nice
tonight, Dr. Ross.
Thank you, E‐Ray.
E‐Ray, can you
file these for me?
I'll certainly ask
Ms. Kelly if she'll do that.
‐ Ms. Kelly?
‐ She's our temp clerk tonight.
‐ Why do we have a temp?
‐ I'm sorry, Carol.
But I don't think that's
any of your business.
‐ Okay. Goodnight.
‐ Goodnight!
‐ Grab a burger?
‐ Yeah.
He is so strange.
Where did we find him?
‐ Mark. Hey.
‐ Nina, hi.
Damn, I was
supposed to call you.
Yes, although I hate having
you think of it that way.
It's been really busy.
Good first day back?
Completely fabulous.
Did you call Dr. Gillum?
That PTSD guy?
Well, you are post‐trauma.
Look, I know I need some
time to settle back in
but it's not like I'm
a postal worker with an AK‐47.
I‐I know you're not.
I'm‐I'm just trying to
help any way that I can.
I know, and‐and I
appreciate it.
I'm‐I'm fine.
Everything's getting
back to normal.
Mark, I don't like you
trying to cover with me.
I don't like you trying
to be a shrink with me.
How's Rachel doing?
She's, uh, sleeping over at
a friend's house tonight.
‐ Great. Tell her I say hi.
‐ Sure.
Hey, Peter, how you doing?
How is she?
Well, remarkably
well, considering.
She's a pretty strong lady.
Oh, God, Dr. Coburn,
I wanted to apologize
for my behavior this
morning in the delivery.
Thank you,
but it's unnecessary.
I've never met a father
who could handle it
sensibly, calmly, maturely.
If I ever do, that's the guy
I'm really gonna slap around.
Yeah.
Today was the first
day I was ever afraid.
Well, I'm glad to
hear that, Peter.
Better get back in here.
I'll check on her
again before I leave.
Hey, Carla.
I made the bed.
Isn't that the stupidest
thing you've ever seen?
I spoke to Dr. Tabash.
'He presented another
option for the baby.'
'I think we should consider it.'
There are a lot
of serious risks involved
so I'm gonna try to
explain them to you, and, uh..
...and then we have
a decision to make, okay?
You don't have to change for me.
I'm not changing for you.
You said we were
gonna grab a burger.
We can get some burgers
at the pump room.
Doug, I'm not wearing
scrubs to the pump room.
Okay, well..
I don't know, I think
it would be rather daring.
Surprise!
Happy birthday! Happy birthday!
Oh, God, I hate
you for this.
Worked out well,
don't you think?
What are you doin'?
Waiting for you.
Come on, right this way.
What are you doing?
Come on. Come on,
just come over here.
‐ Have a seat.
‐ Okay.
‐ What's this?
‐ A little something for you.
A garage door opener.
Go ahead, try it.
I always wanted one of these.
I know.
You always said
they were stupid.
Well, they are stupid.
I‐I don't get why a person
can't just open
the damn door.
I think this is the nicest
thing you've ever done for me.
That's pretty pathetic.
I love it.
I love it.
Let's have a beer.
Okay.
Go ahead.
Ah‐h‐h.
'This is special, Doug.'
'I love having 20 people over'
especially when I have
so much to serve them.
Here. Peel an orange.
Will you lighten up?
They brought booze.
Okay, I'll lighten
up, I'll, uh
I'll just have
a sip of this milk.
You just drink that right
out of the carton like that?
What's wrong with that?
Well, it's just kind
of a guy thing to do.
Um, you know, uh..
So, Doug, what‐what
is all this about?
What's what about?
This little dance
you did today.
This, this party...you.
Well, I know
you haven't had
very good birthdays last
couple of years, and..
The‐the ones I
spent with you?
The ones I forgot, and, uh..
...I just thought it was time
for you to have a nice one.
You want a sip of milk?
Yes, well, I
would love a sip
of this milk.
Thank you.
Thank you.
‐ Dr. Weaver. Hey.
‐ Hi.
Can I talk to you for a minute?
Uh...sure.
I know this isn't the right
time or the right place
but I was just curious, um..
...what would be
involved with getting
into emergency medicine?
W‐what do you mean?
Well, if one wanted to change
his residency, would you have
to redo your intern year?
Has one talked to
Dr. Greene about this?
Ah. No.
You saw how he
was in the hall.
♪ Happy birthday to you ♪
♪ Happy birthday to you ♪
♪ Happy birthday dear Carol ♪
♪ Happy birthday to you ♪
Oh, my God!
‐ 'Blow them out.'
‐ Come on. Make a wish.
There's so many
candles on this cake.
What am I, 55?
‐ Yeah.
‐ Wait, wait. Hold on.
Hold on. One second.
Oh! I almost forgot.
‐ Oh! Wait a minute.
‐ 'Yeah. Beautiful.'
Ah!
Me too.
It's so your wishes come true.
‐ 'Make it a good one!'
‐ 'Alright.'
‐ 'Make a wish!'
‐ 'Happy birthday!'
‐ 'Alright, Carol!'
‐ 'Alright, Carol! You go girl.'
‐ 'Happy birthday!'
‐ 'Oh, my God!'
‐ 'You still look so young.'
‐ 'Happy birthday.'
‐ 'Make a wish. Make a wish.'
‐ 'Happy birthday.'