ER (1994–2009): Season 3, Episode 6 - Fear of Flying - full transcript
Susan Lewis must overcome her fear of flying when she and Mark Greene fly out to the scene of a serious accident involving a family of four. The mother's injuries are relatively minor but her husband is suffering from memory loss. Their teenage son undergoes surgery as does their 10 day-old daughter, Megan. When Benton is left to complete the operation on the baby, he makes an error and Dr. Keaton has to take over. Nurse Hathaway has started her pre-med studies but is wondering if she'll ever make it. Jeanie Boulet and Dr. Maggie Doyle find themselves trying to deal with the corpse of a patient who wants to be cryogenically preserved. Hathaway has to deal with a ward nurse, Rhoda Sterling, who is rotated to the ER but can't keep up with hectic pace and makes a near fatal error.
(female narrator)
Previously on "ER.."
(children)
'Do a trick. Do a trick.'
I like kids.
Fear of flying
cannot be conquered.
My mom got her
real estate license at 40.
'I helped her
with her homework.'
I can help you with yours,
if you want.
You're probably too tired
after your trip to dance.
‐ Well, kind of, but..
‐ So maybe later.
‐ Do you know what you're doing?
‐ Yeah, I'm just confirming‐‐
Well, if you have to keep
confirming, you don't know
what you're doing.
Carter, get in here.
I worked just as hard as
everyone else to get in here.
Yeah, well, you have
to work twice as hard
stay twice as late
to be twice as good.
[chopper whirring]
(Susan)
'Oh, God.'
(Mark)
The flight rotation was like
the highlight of my residency.
You'll be fine.
I'll be thousands
of feet in the air
in something shaped
like a baked potato
with a frat beanie on it.
Actually, it's only
hundreds of feet.
[whirring]
Oh, God!
Don't they have ambulances
in the sticks?
They don't have a trauma center
in Boone County
so if it's bad, we go.
How far?
Fifty, sixty miles.
No, no.
Didn't you know this was a
requirement for your residency?
What was I thinking?
Alright, deep breath.
Let it out slowly.
Okay.
My knees won't move.
Come on. Stay low.
Dee McManus, Susan Lewis.
Hi.
First flight?
Sum of the angles in a triangle
equals 180 degrees, right?
‐ Uh‐hmm.
‐ 'Hey, Carol.'
Hi, uh, Doug.
Hi.
Doug Ross,
this is William Litman.
'William is my lab partner.'
No kiddin'.
How's it goin'?
You know I have an intuitive
19th century Euclidean mind.
‐ 'Congratulations.'
‐ Thanks.
It's actually crippling
to the understanding
of the geometric projection
of the universe.
‐ I'm flunking out.
‐ Well, so what you working on?
'I used to be pretty good
at physics.'
'String theory, it explains
the multi dimensional
curvature of time and space.
‐ Oh!
‐ Oh is right.
So, the Riemannian manifold
is M dimensional space
'that locally looks like
N dimensional space'
when M is less than N.
[indistinct chatter on radio]
Susan, take a look.
It's beautiful.
W‐what are you doing?
I'm hyperventilating.
Leave me alone.
Oh, God.
You should really check out
the view, okay?
'Cause it helps you
set your gyroscope.
What was that?
[clears throat]
It was the pilot.
He was just adjusting
the rotor pitch.
Absolutely normal.
Right. Normal.
(man on radio)
'I got a visual on you,
air‐vac.'
'Do you read?'
There it is.
Oh, man.
'We're first on scene.'
We're gonna need the O‐neg
and blood Ys.
(man on radio)
'There's a field
to your 5 o'clock.'
Oh, God.
Oh, God.
[indistinct chatter on radio]
Oh, oh, God.
Oh, God.
Stay low and watch
the tail rotor.
We got five victims.
A truck and a van
hit head‐on.
Two ejected,
three are trapped.
Where's fire response?
Two engines and an ambulance
en route.
‐ ETA?
‐ Thirty minutes.
We're all volunteer out here.
Triage first.
Susan, you check the car.
(female #1)
'Relax, honey, it's okay.'
[baby crying]
'Talk to mommy, honey.'
It's alright, sweetie.
Now, you're in good hands.
‐ Oh, my God!
‐ It's okay.
[baby crying]
'Please get us out of this car.'
[theme music]
Yes, I'm still holding
for authorization.
Hello?
So, Dallas by three, you think?
ER, hold on. I don't think,
bubba. I know.
Oh, ICU's got no beds
till 1999
'and they're sendin' us
two vents.'
‐ Terrific.
‐ Way to go, Mr. Gomez.
‐ Good job.
‐ Chuny.
We need more IVACs in three.
Patrick Brazil,
metastatic prostate cancer.
Uh, cough, fever, two months
progressive weakness.
BP 150/70.
Oh, gave c, 300cc's of saline.
He's a no‐coder.
Oh, inn's full. Exam four.
I've been Mr. B's caretaker
for 22 years.
He wants to be cryogenically
preserved when he deanimates.
‐ He wants to what?
‐ Be put on ice when he croaks.
‐ Frozen?
‐ Like a popsicle.
(female #2)
'He's been waiting eight years
to join Mrs. B'
in their suspension capsule.
Easy, now. One, two, three.
His wife's been frozen
for eight years?
It was their 50th anniversary
present to each other.
Faint pulse,
poor respiratory effort.
They want to be
preserved together so that
they could come back
in the future.
Just like those dinosaurs
in that movie.
Oh, isn't it romantic?
Let's hang a dobutamine drip,
start at ten mics per kilo
and titrate
to a systolic of 100.
Settle down, Mr. Sotcheck.
Rescue 1‐16 for you
to rule out MI.
‐ Okay.
‐ We're swamped.
Who's covering
Haleh's vacation shift?
Got a float coming at 9:00.
The last nurse
who floated down here
hid in the bathroom all day.
‐ Who is it?
‐ Sterling, from Med‐Surg West.
‐ Rhonda Sterling?
‐ Yeah. What's wrong with her?
She's a floor nurse.
Oh, come on, guys.
Give her a chance.
‐ I'm not babysitting her.
‐ Me neither.
[fire extinguisher whooshing]
‐ Fire's out!
‐ What's your name?
Gail. She's only ten days old.
Please.
Is she alright?
She's moving and crying.
These are good signs.
[baby crying]
I'm Dr. Lewis.
What's your name?
‐ Zach.
‐ Uh‐huh.
‐ Gail, does your neck hurt?
‐ Is he alright?
‐ Gail?
‐ Please help him.
Get a c‐collar on her.
(Mark)
Sir? Sir, can you hear me?
That's brain matter.
Guy's a goner.
[siren wailing]
Okay, okay,
let's get him on oxygen.
‐ Where, Zach? Your neck?
‐ No. No!
‐ Does this hurt?
‐ Aah!
(Gail)
David? David!
Where's my husband?
Gail, where are you hurt?
Uh, my, my‐my right leg
and my side. David, please!
Dr. Greene's working on him.
[sobbing]
My husband's a doctor.
He has to check on the children.
(Mark)
Susan!
‐ Susan!
‐ He's a pediatrician.
‐ Go, I'll stand by.
‐ Okay.
I'm gonna go
check on your husband.
I'll be right back.
[indistinct chatter on radio]
Trucker's gone.
I need you over here.
He's still moving.
He's pulseless,
with massive head trauma.
I've got a tension hemopneumo
that we can save.
Needle him, left side.
He's decompressing.
32 French.
This guy's a pediatrician.
‐ Really?
‐ Yep.
His family's in the van.
Wife and newborn baby girl.
Both stable.
There's a boy
about eight years old.
Le Fort two facial fracture.
I'm worried about his airway.
I'm in. Hook it up
to the Foley bag.
(Susan)
'He's hemorrhaging.'
Grab two units O‐neg
out of the cooler.
‐ Okay.
‐ I'll start a line.
(Gail)
'Oh, David!'
Gail, we're getting you out.
Hang in there.
Yeah, I'm still holding.
Hey, you like Green Bay
minus seven over Washington?
I thought the world series
was over.
‐ Excuse me.
‐ Hang on one second.
(male #1)
'Please don't tell!'
[crying]
Please don't tell!
Mommy!
(male #2)
'Alright, where do you
want him?'
You won't tell my mom, will you?
Uh, curtain area three,
end of the hall.
Don't tell her!
Don't tell her!
Don't tell her, please!
'No! Don't tell her!'
‐ Uh..
‐ Carol Hathaway.
Carol.
Hi.
I was pulled off my ward
and assigned down here.
Rhonda, right?
What patient
you want me to take?
Oh, well, actually
we share patients here.
Let me show you.
Over here are the patients
that are waiting to be seen.
Nursing orders are flagged
and put over here.
‐ So, when you're gonna have a‐‐
‐ I'll take, uh, Mr. Washington.
Where is curtain area three?
‐ There.
‐ Thank you.
(Susan)
Secure his head.
Alright, we need
to start a second line.
(Dee)
Dr. Lewis, the boy
stopped breathing.
‐ 'Oh, my God!'
‐ Go, go, go.
‐ 'Oh, my God!'
‐ Watch his C‐spine.
Keep in‐line traction.
You're in the way.
Uh, there's too much blood.
I need suction.
6.0 tube.
Another 6.0.
‐ That was it.
‐ Damn it.
Okay, 5.5.
Mark, I need your help!
Get him on the chopper.
(Gail)
'David! No!'
We're taking care of them, Gail.
(Gail)
'Please, don't let him die.'
'Please.'
‐ I can't see. Turn it up.
‐ It is up.
(Mark)
There's better control
in the chopper.
'Let's bag him and move him.'
Ready?
One, two, three.
Doctor, I need you
to start this IV.
Okay.
Um, go on, I'll check it out.
Thanks.
What's up?
She needs an IV.
I tried and missed.
Oh, we usually,
we try a few times
before we call a doc,
especially an intern.
Up in Med‐Surg, we call
the doctor when we miss.
Alright, I'll, I'll do it.
Mrs. Fesmire needs 20 of KCL
in her IV in three.
Why don't you go do that?
Where's the potassium?
It's in the med room under P.
I can see the vocal cords.
I'm in.
‐ I'll be right back.
‐ Susan!
Alright, Fred. Fire it up.
Susan!
How much longer?
Twenty, thirty minutes.
[baby crying]
Gail, we're taking
your son and your husband
to County General Hospital
by helicopter.
‐ Are they alright?
‐ They're stable now.
But they need to go
to a trauma center.
B‐but how will I know
what's happening to them‐‐
I will‐I will get word
to you, Gail.
‐ Oh, please! Oh, please!
‐ I promise. I promise.
‐ Are you okay?
‐ Uh, yeah.
It's Dr. Greene calling
from the Whirlybird.
Why hasn't Mrs. Fesmire
gotten her potassium?
I'm on break.
I'm getting to her.
This is County General
on Beta two. Go ahead.
(Mark on radio)
'We're incoming on Air‐Vac One
with two major traumas.'
'Seven‐year‐old boy and his dad,
both multiple trauma.'
Never mind that,
grab Lydia and Chuny
and tell them to clear
the trauma rooms.
Go ahead, Air‐Vac One.
(Mark)
'I'm gonna need a vent.'
[flatline]
Goodbye, Mr. B.
You will keep him cold until
they come for him, won't you?
So that he could be
with his wife?
Mm. Okay.
‐ Please.
‐ Sure.
Thank you.
Should I clean out the fridge?
What have you got?
Dad's got a hemopneumo
and a head trauma.
Seven‐year‐old
had an obstructed airway.
He's getting shocky.
Good job, Susan.
‐ What?
‐ I said good job.
(Carol)
'Draw up meds.'
(Carter)
Watch that IV.
Fluids wide open.
Let's get a cross‐table, CBC.
Type and cross for four units
and dip a cath urine.
Draw up a saline flush,
crash cart.
‐ Where is the saline?
‐ 'BP's only 65 palp.'
‐ 'Pulse 160, thready.'
‐ 'Whoa. He's waking up.'
Hey, Zach. Hi, I'm Carol.
That tube in your throat
is helping you breathe, okay.
Set up for a lavage.
‐ Want a gas?
‐ Yep.
Blood gas kit, top drawer.
(Doug)
'Got it. You do that.'
Alright.
'See if you can give me a hand
right there.'
'Okay.'
We got a bloody tap.
Page Benton.
See if the dad will sign
the consent form for an ex‐lap.
Put that O‐neg
on the rapid infuser.
He conscious?
(Susan)
He's respondin' to pain.
Dr. Herlihy,
open your eyes.
Somebody needs to sign his son's
surgical consent if he can't.
‐ We'll do it.
‐ BP's low, 70 palp.
Pulse ox is only 85.
(Susan)
Lydia, ask Jerry
to track down the number
of the hospital in Verne County
'where they're taking
the mother and the baby.'
I promised I'd let her know
how they're doing.
Did the heart sound
seem distant to you?
‐ What are you thinking?
‐ Tamponade?
(Doug)
'Hang in there, Zach.
Will you hold him still?'
‐ Just hold him still.
‐ 'He's scared to death.'
He's got to be sedated.
Get him versed,
one milligram IV.
‐ Where is it?
‐ Top drawer.
‐ 'It's clotted.'
‐ 'BP's unchanged.'
I need that saline.
Let's go.
(Doug)
'Zach, we're gonna
give you something'
'to help you sleep, okay?'
It will help you sleep.
(Carol)
'Alright, here we go.'
'Hold him.'
'Whoa!'
What was that?
Does that hurt?
It hurts.
Are you sure that's saline?
Oh, my God! That's potassium.
‐ 'How much went in?'
‐ Uh, about a quarter cc.
‐ 'Insulin and glucose?'
‐ Where is it?
Second drawer.
Hold on. It's probably not
enough to stop his heart.
‐ I think we're gonna be okay.
‐ What do you got?
(Doug)
'Got a seven‐year‐old TC,
passenger, space intrusion
'airway compromise
at the scene, intubated.'
'Peritoneal lavage
was positive.'
BP's crashing, 60 palp.
‐ Pericardiocentesis tray.
‐ Pericardiocentesis tray.
Go ahead. I'll draw up
a central line.
Okay. Hook an alligator clip
to an EKG Lead. Use V‐1.
[pager beeping]
Not mine.
Uh, it's the patient's.
He's a doctor.
It might be his office.
Why don't you try
dialing the number?
Susan, Jerry called
Dwight Hospital.
The wife and baby
haven't arrived yet.
‐ Are they on their way?
‐ I don't know.
Well, find out.
‐ What do we have?
‐ Blunt abdominal trauma.
Hypotensive intraperitoneal
hemorrhage confirmed by lavage.
'Probably his spleen.
Facial trauma.'
Intubated in the field
with an RSI.
H&H is 11, 32.
'Type and cross four.
650cc's of saline.'
Versed on board.
Way to go, Carter.
‐ Alright, let's take him up.
‐ Can I tie?
(Keaton)
Where are his parents?
(Chuny)
'Second unit's in.'
(Mark)
'See, you've got, you've got
his partner to take call?'
Right. Okay.
Okay, we'll let you know.
40cc's non‐clotting blood..
...out.
Dr. Herlihy, you've been
in an accident.
You're in the ER.
‐ BP's back up, 120/80.
‐ What have we got?
I'm worried about
an intracranial bleed.
Is he stable enough
for a head CT?
The nurse goes with him.
‐ Am I on call?
‐ No, you're a patient.
You were involved in
a serious traffic accident.
Accident?
Your son, Zach, has just
been taken up to surgery.
Surgery?
He was injured in the accident.
Accident? What accident?
Get a rush on that head CT.
(Keaton)
'Zach, everything's
gonna be okay.'
We could have killed that boy.
I got confused.
You have no business
working the ER.
You think I don't know that?
I want you to restock supplies
for the rest of the day.
I don't want you anywhere
near my patients.
Yes, this is Carol Hathaway
in the ER.
Clear a CT room, please.
Where's the number
for chopper dispatch?
Mark, can I run
something past you?
Sure.
I've just got a sweet,
old guy who died
and I don't know what to do
about his cryogenics request.
His what?
He and his wife
bought a tank for two
so they could be frozen
side by side when they died.
‐ Where's his wife now?
‐ In the tank.
‐ Oh!
‐ I have an 800 number.
For a cryogenics company
in California.
Call it.
Yeah, still holding.
‐ What?
‐ Nothing.
Yeah, yeah, page me
as soon as you know.
Helicopter's standing by.
We may have to go back
and get the wife and the baby.
Okay, DeBakey.
(Keaton)
5.0 Prolene on a Castroviejo.
‐ Retract caudally.
‐ Retractor.
Splenic vein's repaired.
What about this pancreas?
(Benton)
The tail has most
of the devitalized tissue.
I'd resect rather than do
a subtotal pancreatectomy.
Good. I agree. Metz.
How would you repair
after resection?
Interrupted horizontal
mattresses
and a figure eight
in the pancreatic duct.
(Keaton)
'Go ahead. Do it, DeBakey.'
‐ 3.0 silk on a needle driver.
‐ Anything else to do?
Irrigate, run the bowel
under control
insert a Jackson‐Pratt drain
through a separate stab wound
and, uh, use cautery instead of
a scalpel to minimize bleeding.
‐ And after that?
‐ Close.
Keep it simple,
do exactly what
you just described.
No more, no less.
Okay.
Alright, cut the suture,
three millimeters, no longer.
Irrigate, normal saline.
Make sure it's warm.
Park her in the hall
until we can clear an exam room.
Jerry, you seen Susan?
Yeah, she got paged
to chopper duty.
You're kidding.
What's up?
‐ I need ice, lots of ice.
‐ Huh?
California Cryonics said
to put him on ice
until their local rep arrives.
They'd better hurry.
[chopper whirring]
(Dee)
'Dr. Lewis.'
Susan.
Are you sure you're alright?
Yeah, I wanna bring them in.
‐ I'll go.
‐ No, no, I'm fine.
Really? I, you can stay
here with Herlihy.
‐ No, really. I'm okay.
‐ Dr. Lewis.
‐ Alright.
‐ We gotta go.
‐ May I..
‐ Hmm?
...see your orders.
Okay, uh, John,
will you take these to ICU
and make sure
they're carried out
as meticulously as written?
‐ Sure.
‐ Peter.
Care to join me
in a sarcoma resection?
Uh, yeah, yeah,
I'd love to.
Good, uh, Gant can cover
in trauma call.
Scrub in in 45 minutes.
Don't you just love her?
[baby crying]
Where's Zach?
Where's my husband?
Your husband was unconscious
for quite a while.
He woke up confused
and disoriented.
He has a head injury?
‐ What about my son?
‐ He's in surgery.
Don't worry, Gail.
Your family's in good hands.
Move. Move.
‐ Does this hurt?
‐ Ah!
Yeah.
BP's okay. 115/65.
Let's get a C‐spine, H&H,
type and cross for four
'and dip a cath urine.'
[baby crying]
(Doug)
Got a good set of lungs on her.
Respiratory rate's kind of high.
Yeah, who knows
with all that crying?
It's 60. Pulse 160.
Abdomen's distended but she's
been taking in a lot of air.
Do you want
a pedes surgery consult?
Uh, yeah. Get a babygram,
CBC, and a gas.
Hey, darling, are you hurt
or you just mad at the world?
What will it be?
Do you believe in reincarnation?
Sure. Why not? Next life, I'm
coming back as Cindy Crawford.
Would you do us a favor?
A deceased patient of mine wants
to be cryogenically preserved.
We gotta freeze a dead guy.
You got any ice?
Neck looks okay.
CT was normal,
but dad's still altered
so they're doing an MRI.
Why did they take Megan away?
(Susan)
'She's just next door.
It's a little crowded in here.'
I called upstairs.
Zach's out of surgery.
He's gonna be alright?
He's in ICU. I'll check on him
as soon as I can.
Oh, God.
Oh, God. Oh, God.
[sobbing]
I need my husband.
'Please, where..'
'David.
Please, where's David?'
'Please.'
[crying]
(Gant)
Her abdomen's kind of firm.
She swallowed a lot of air.
It's a tough call to a newborn.
‐ What should we do?
‐ Alright, what is it, Gant?
Well, I'm not sure. Abdomen's
persistently distended.
She keeps cryin' and the resps
are high in the 60s
but the BP, the pulse
and color are okay.
Why didn't you drop an NG?
‐ We considered it‐‐
‐ Stool guaiac.
‐ In such a small baby?
‐ Alright.
Do it off
the rectal thermometer.
You didn't do
a full surgical evaluation
of the patient, Dr. Gant.
Ssh, shh!
[crying]
Ah, it's positive for blood.
Alright, prep a cutdown tray,
type and cross
for two units and page Keaton.
‐ Where's her mother?
‐ Trauma one.
Dr. Ross and I thought
it was an equivocal exam.
Ross is a pediatrician,
if you don't know
what you're doing,
call someone who does.
Hi, um, I'm Dr. Benton.
Your daughter
has internal injuries
that's gonna
require an operation.
But she‐she's
only ten days old.
It's okay.
Dr. Keaton will be with her
'and, look, she's the best
pediatric surgeon in Chicago.'
Now, we need your consent for
what's called
an exploratory laparotomy.
W‐w‐where's my husband?
I want him to sign for it.
(Mark)
Her husband's a pediatrician.
Uh, he can't do it right now.
He handles all the family
medical decisions.
I don't know
anything about this.
‐ You can do this, Gail.
‐ I don't know. I don't know.
Your baby needs it.
Okay. Okay.
Okay.
Cutdown tray. Use a volutrol.
We may have to transfuse.
(Doug)
Gant was on track.
I just talked him out of it.
Hang D5, 40 normal.
(Keaton)
What do you think, Peter?
(Benton)
'She has an acute abdomen.'
(Keaton)
'Hi, pretty girl.'
[baby crying]
‐ Vitals?
‐ BP's 80/40, pulse 160.
Resps 65, temp's 101.4.
Oh, pulse ox?
‐ Oh, what blue, blue eyes.
‐ 92 room air.
Oh, teacup,
that's too low, uh..
Let's get her on O2,
four liters by mask.
Aww!
Did you appreciate
the periumbilical redness?
'The abdomen's a little tense.'
‐ No, no, I missed it.
‐ Well, it's easy to miss.
‐ 'Why a cutdown?'
‐ No veins.
22 angio.
This was a nice pickup, Peter.
Thank you.
(Keaton)
Ah, yes.
There we go.
Wow, I couldn't see
or feel a vein.
Well, it's just a matter
of knowing where it is.
Let's get her
a cross‐table lateral
and check for free air.
She may be proofed.
Any thoughts on antibiotics?
Well, since you don't need
anaerobic coverage on newborns
I'd go with amp and gent.
You've been reading.
Dennis, since you did
the trauma assessment
why don't you scrub in
and follow the case through?
Uh, Peter,
let's go talk to mom.
(Carol)
'Good girl.'
There you go, Mr. Brazil.
Shrimp cocktail time.
Hubert Skinner,
California Cryonics.
‐ Mr. Brazil.
‐ Do you have some kind of ID?
It's all there.
Give him 10,000 units
of heparin stat.
I'll pack him up
and we'll be on our way.
‐ Is he a doctor?
‐ I don't think so.
What do we do?
Well, the heparin can't hurt
him being dead and all.
(Keaton)
In the newborn, I use
a transverse abdominal incision.
The rectus is thin,
so there's less pain post‐op.
(Benton)
'Adson.'
'We're using a respirator,
so atelectasis isn't an issue.'
Exactly. Uh, zap that
little bleeder.
‐ Cautery.
‐ 15 blade.
If there's a perforation
we should get a gush of air
when I nick the peritoneum.
Yup, there it is.
‐ She's easier to ventilate.
‐ Very little bleeding.
Dennis, why do we wanna
keep bleeding to a minimum?
Transfusions are dangerous.
You can't type and crossmatch
the blood as quickly
because of the baby's
fetal hemoglobin.
There it is.
Perfed jejunal.
You're teaching
your interns well.
He's in and out.
MRI was normal.
Dr. Herlihy,
do you remember my name?
Where's my wife and kids?
I'm Mark Greene.
Your family was involved
in a traffic accident.
Your wife's in the ER
with a tib‐fib fracture.
Zach had facial trauma
and hemoperitoneum.
‐ He's out of surgery, in ICU.
‐ What was it, his spleen?
‐ No. Pancreatic injury.
‐ What about Megan?
Megan just went up to rule out
intestinal perforation.
Why? What happened to her?
She was in the accident
with you.
What accident?
Dr. Herlihy,
do you know my name?
No.
Should I?
It's okay. It's okay.
Gently. To repair, we use a 4.0
silk interrupted Hufnagel.
Field looks dry.
You don't need
a two‐layer anastomosis.
Cautery alone
gives you hemostasis.
Hmm, let's irrigate.
Warm saline, please.
Dr. Keaton, Zach's
abdomen is distending.
Any change in his vitals
or pulse ox?
No, but I think
he might be bleeding again.
Damn. Peter, you think
you're ready to finish alone?
‐ Yeah.
‐ Nothing fancy.
‐ Just close.
‐ Okay, yeah, yeah, okay.
Alright, people, let's go.
Thank you.
One more. Thank you.
His abdomen is more distended
than before the surgery.
Has he regained consciousness?
No, no.
(Benton)
'Four by eight.'
Okay. Thank you.
Alright. Completely dry.
What's that?
Oh, looks like a little fibrin
debris on the liver surface.
‐ Should I call Dr. Keaton?
‐ No, no, no, no, no.
I'll clean it up.
'Come on.'
'Come on.'
'Okay, got it.'
Alright, let's close
the peritoneum first.
3.0 Vicryl.
Mm‐hmm.
Now..
...retract medially.
Cut.
Mm‐hmm. Good.
‐ Oh, there's a little blood.
‐ Where?
Oozing from the liver
where you just touched it.
Alright, um, I'll put
a little pressure on it.
You suction.
Gently, okay?
[grunts]
It's still oozing.
Alright, I don't wanna close
while it's bleeding.
I'll put a stitch in
for hemostasis.
4.0 chromic on an SH.
Now, move. Thank you.
Come on. Here we go.
Alright.
Retract caudally.
Come on, Gant, retractor.
Is Anesthesia standing by?
I called them.
You're right.
He is distended.
‐ Vitals?
‐ Stable. BP's 90/60.
Pulse is 96,
pulse ox is 99 percent.
‐ 'Should I clear an OR?'
‐ Hang on.
Uh, disconnect the NG
from the wall.
'Yep.'
Sometimes, you get
an erosive gastritis.
'Hook it back up.'
Clots can block the NG
causing acute dilatation.
Irrigate it out
and crisis resolved.
It's just experience, doctor.
[ECG monitor beeping]
‐ She's still bleeding.
‐ I can see that.
Alright, I'll put a gel foam
on the bleeding site.
And you apply pressure.
‐ Come on.
‐ You want me to get Dr. Keaton?
No.
We will suction.
Alright, I'm gonna oversaw.
2.0 chromic on an SH.
Heart rate's
starting to fluctuate.
Hey, give me a bolus
of normal saline, 40cc's.
Oh, damn it!
The liver's so fragile.
‐ My stitch cut right through.
‐ I should be getting Keaton.
I'm gonna take
an even bigger bite.
Gant, retract this way,
I can't see.
Pulse ox is falling, you need
to get this baby off the table.
(Benton)
'Alright, bag her faster,
damn it.'
‐ I'm‐I'm getting Keaton.
‐ No.
Go! Go!
[ECG monitor beeping]
You really think
it will help her
to see her husband
like this?
Megan's still in surgery,
Zach's in ICU
and your husband
just got out of X‐ray.
He's okay?
His tests are normal
but there's still memory loss.
‐ Could it be permanent?
‐ 'Probably not.'
You can see these kinds
of things in a concussion.
But‐but it might be.
We'll just have to wait
and see.
‐ Blood loss?
‐ A 100cc's.
That's a third of her volume.
Damn it.
What the hell did you do
to her liver?
I was just trying to peel
away some fibrin debris.
(Keaton)
'Cut me a one centimeter
square of gel foam.'
Move.
2.0 chromic on an SH.
It started to loose. Clear.
You ripped away
the liver capsule.
No way to control the bleeding.
I have to reset the left lobe.
Peter, handle the suction.
Dennis, retract distally.
Cautery. Crank it up to 18.
Pulse and BP
are destabilizing.
We'll have to transfuse
with unwashed O‐neg
80cc's, 2.0 chromic.
Keep 'em coming.
She's bradying down. Rate's 80.
You've got to get out.
3.0 Vicryl
for the peritoneum and muscle
and staples for the skin.
David?
Oh, my God. David.
What happened to you?
Didn't you tell him?
We did, many times.
Zach's condition
has stabilized.
He should wake up soon.
‐ Zach?
‐ It's okay. It's okay.
What about Megan?
Dr. Benton's closing right now.
[sighs]
That's wonderful news.
Was, was there a truck?
Yeah.
Yeah, there was a truck.
‐ What were you thinking?
‐ I told you there was debris.
Didn't I told you not
to do anything but close?
Look, in my judgment,
I thought‐‐
I didn't ask for your judgment.
Perry, Dennis,
set up a vent.
Call respiratory and get a blood
gas straight away.
FIL 2 in 100 percent
and stand by with..
[indistinct chattering]
Does that say chicken belt?
Conjunctivitis.
I hate chart QA.
[sighs]
What?
Nothing.
Thanks for helping me
in the chopper.
No problem.
Things can get really
pressured in here.
Just isn't a place for someone
who isn't experienced.
I can't have you
work here again.
Zach?
'Oh, God.'
Can I touch him?
Sure.
Zach, honey, it's mommy.
I'm gonna stay right here
until you wake up.
What about Megan?
No one from surgery's
talked to you?
No.
Okay, I'll go find out
what's going on.
Thank you.
Carter.
Why hasn't anyone
been down to talk to her?
I don't know. Benton
was closing her an hour ago.
Blood gas is improved.
Not by much.
Um, could you excuse us,
Kit, Dennis?
Thank you.
[sighs]
I'm sorry. I should never
have left you unsupervised.
There are nuances
in neonatal surgery.
The liver's more friable
in newborns.
I wanted a clean field
before I closed.
Yeah, you said that.
'But it seemed appropriate.'
What's at issue here
is that you ignored
my specific instructions.
No, I didn't ignore anything.
I followed standard
operative procedures.
'Look, I've done it
at least'
'a dozen times
in other patients.'
This is not another patient.
This is an infant.
Outside. Now.
You don't know anything
about pediatric surgery.
Look, I thought
it was necessary‐‐
Are you unwilling to learn
from your mistakes?
Does it say in the text
not to stitch a liver?
It isn't in the text,
you didn't know
what the hell you were doing,
the second you realized
you screwed up,
you should have called me.
Why did I find
three stitches in there?
‐ Because I was trying‐‐
‐ I'll tell you why.
Because you arrogantly
and blindly think
you have all the answers,
if that baby dies
it will be my responsibility,
but it will be your fault.
Dr. Keaton, she's crashing.
'Pulse ox is 86,
heart rate's down to 45.'
Decreased breath sounds
are on the right.
Atropine, .04.
Sounds like a pneumothorax.
‐ 'Chest X‐ray.'
‐ Don't need it.
Increased trans illumination
on the right side.
‐ It's a pneumo.
‐ Chest tube tray.
This is no longer
a teaching case. 12 French.
She's gonna need a repeat ABG.
Okay, pulse is up to 72
but it's thready.
Dynamap's not registering a BP.
Get ready with that thoraseal.
She's arresting!
Heart rate's down to 20.
Damn.
Let's start CPR.
Epi, 1 to 10,000.4,
atropine, .08 milligrams.
How's the blood gas?
PH 7.3, PO2 45.
PCO2 30 and 100 percent oxygen.
Ah, we're gonna have to put her
on a ECMO bypass.
Ah, Kit, call the tech, get two
units O‐negative prima system.
I'll cut down
to the internal jugular.
So that we bring her
back up to the OR?
No, we're gonna bring
the OR to her.
Dr. Greene?
Dr. Herlihy.
(David)
'What time is it?'
Eight o'clock.
‐ P. m.?
‐ Yeah.
Where's my family?
Your wife's upstairs
and both the kids
had laparotomies.
A bed opened up
for you in ICU.
How did they do?
Well, your son's
out of surgery in ICU.
I don't know
about your daughter.
H‐how do I find out
about my daughter?
I'll check on her for you.
Thank you, Dr. Greene.
Mark.
Mark.
Pedes OR called. His daughter
decompensated in surgery.
She's crashing in NICU.
She's still flatline.
Repeat .4 of epi.
Go ahead, Kit.
How long has she been down?
Twenty two minutes.
‐ Is the ECMO circuit primed?
‐ Yes.
Good. I'm ready.
Venous connection first.
Arterial.
Turn it on.
(Gant)
'We got a heartbeat.'
‐ And a pulse.
‐ Faint.
She's pinking up.
(Keaton)
'Okay, let's get a repeat gas.'
'We need to anti‐coagulate her.'
Kit, heparin, 150 units IV.
[clears throat]
Start drip
at ten units an hour.
How can we anti‐coagulate her?
We have to or her blood
will clot in the ECMO circuit.
Yeah, but won't she bleed out?
We have to hope
that she doesn't.
I‐I'll dictate
an operative report.
Meet me in pedes ICU
in five minutes.
‐ ICU?
‐ Yeah.
We gotta tell the parents.
Peter, how did it go?
How's the baby?
Not good.
(Gant)
Dr. Benton.
You didn't sign
the code sheet.
Hey, we're all human.
You know,
we all make mistakes.
Any other words
of wisdom, Gant?
You're a real prick,
you know that?
Mrs. Herlihy,
this is Dr. Keaton.
She's the doctor who operated
on both Zach and Megan.
Oh, Mrs. Herlihy
uh, Megan had a perforated
intestine from the accident.
'When we operated
to repair it..'
...there were complications.
Wh‐what are you saying?
Well, she's in the NICU now
on a device that helps
her heart and lungs
'oxygenate her blood.'
'There was bleeding
during the operation'
'and she went into shock.'
'Then her lung collapsed
and finally, her heart stopped.'
'But we got it started again'
by putting her
on a bypass machine.
Is she gonna die?
She's in extremely
critical condition.
It's..
It‐it is a possibility.
[instrumental music]
[music continues]
[sighs]
"The Lord is my shepherd.
"I shall not want.
"He makes me lie down
in green pastures.
He.."
"The Lord is my shepherd,
I shall not want.
"He makes me lie down
in green pastures.
He's.."
(Kit)
'Dr. Benton?'
I can't remember the words.
[instrumental music]
[theme music]
Previously on "ER.."
(children)
'Do a trick. Do a trick.'
I like kids.
Fear of flying
cannot be conquered.
My mom got her
real estate license at 40.
'I helped her
with her homework.'
I can help you with yours,
if you want.
You're probably too tired
after your trip to dance.
‐ Well, kind of, but..
‐ So maybe later.
‐ Do you know what you're doing?
‐ Yeah, I'm just confirming‐‐
Well, if you have to keep
confirming, you don't know
what you're doing.
Carter, get in here.
I worked just as hard as
everyone else to get in here.
Yeah, well, you have
to work twice as hard
stay twice as late
to be twice as good.
[chopper whirring]
(Susan)
'Oh, God.'
(Mark)
The flight rotation was like
the highlight of my residency.
You'll be fine.
I'll be thousands
of feet in the air
in something shaped
like a baked potato
with a frat beanie on it.
Actually, it's only
hundreds of feet.
[whirring]
Oh, God!
Don't they have ambulances
in the sticks?
They don't have a trauma center
in Boone County
so if it's bad, we go.
How far?
Fifty, sixty miles.
No, no.
Didn't you know this was a
requirement for your residency?
What was I thinking?
Alright, deep breath.
Let it out slowly.
Okay.
My knees won't move.
Come on. Stay low.
Dee McManus, Susan Lewis.
Hi.
First flight?
Sum of the angles in a triangle
equals 180 degrees, right?
‐ Uh‐hmm.
‐ 'Hey, Carol.'
Hi, uh, Doug.
Hi.
Doug Ross,
this is William Litman.
'William is my lab partner.'
No kiddin'.
How's it goin'?
You know I have an intuitive
19th century Euclidean mind.
‐ 'Congratulations.'
‐ Thanks.
It's actually crippling
to the understanding
of the geometric projection
of the universe.
‐ I'm flunking out.
‐ Well, so what you working on?
'I used to be pretty good
at physics.'
'String theory, it explains
the multi dimensional
curvature of time and space.
‐ Oh!
‐ Oh is right.
So, the Riemannian manifold
is M dimensional space
'that locally looks like
N dimensional space'
when M is less than N.
[indistinct chatter on radio]
Susan, take a look.
It's beautiful.
W‐what are you doing?
I'm hyperventilating.
Leave me alone.
Oh, God.
You should really check out
the view, okay?
'Cause it helps you
set your gyroscope.
What was that?
[clears throat]
It was the pilot.
He was just adjusting
the rotor pitch.
Absolutely normal.
Right. Normal.
(man on radio)
'I got a visual on you,
air‐vac.'
'Do you read?'
There it is.
Oh, man.
'We're first on scene.'
We're gonna need the O‐neg
and blood Ys.
(man on radio)
'There's a field
to your 5 o'clock.'
Oh, God.
Oh, God.
[indistinct chatter on radio]
Oh, oh, God.
Oh, God.
Stay low and watch
the tail rotor.
We got five victims.
A truck and a van
hit head‐on.
Two ejected,
three are trapped.
Where's fire response?
Two engines and an ambulance
en route.
‐ ETA?
‐ Thirty minutes.
We're all volunteer out here.
Triage first.
Susan, you check the car.
(female #1)
'Relax, honey, it's okay.'
[baby crying]
'Talk to mommy, honey.'
It's alright, sweetie.
Now, you're in good hands.
‐ Oh, my God!
‐ It's okay.
[baby crying]
'Please get us out of this car.'
[theme music]
Yes, I'm still holding
for authorization.
Hello?
So, Dallas by three, you think?
ER, hold on. I don't think,
bubba. I know.
Oh, ICU's got no beds
till 1999
'and they're sendin' us
two vents.'
‐ Terrific.
‐ Way to go, Mr. Gomez.
‐ Good job.
‐ Chuny.
We need more IVACs in three.
Patrick Brazil,
metastatic prostate cancer.
Uh, cough, fever, two months
progressive weakness.
BP 150/70.
Oh, gave c, 300cc's of saline.
He's a no‐coder.
Oh, inn's full. Exam four.
I've been Mr. B's caretaker
for 22 years.
He wants to be cryogenically
preserved when he deanimates.
‐ He wants to what?
‐ Be put on ice when he croaks.
‐ Frozen?
‐ Like a popsicle.
(female #2)
'He's been waiting eight years
to join Mrs. B'
in their suspension capsule.
Easy, now. One, two, three.
His wife's been frozen
for eight years?
It was their 50th anniversary
present to each other.
Faint pulse,
poor respiratory effort.
They want to be
preserved together so that
they could come back
in the future.
Just like those dinosaurs
in that movie.
Oh, isn't it romantic?
Let's hang a dobutamine drip,
start at ten mics per kilo
and titrate
to a systolic of 100.
Settle down, Mr. Sotcheck.
Rescue 1‐16 for you
to rule out MI.
‐ Okay.
‐ We're swamped.
Who's covering
Haleh's vacation shift?
Got a float coming at 9:00.
The last nurse
who floated down here
hid in the bathroom all day.
‐ Who is it?
‐ Sterling, from Med‐Surg West.
‐ Rhonda Sterling?
‐ Yeah. What's wrong with her?
She's a floor nurse.
Oh, come on, guys.
Give her a chance.
‐ I'm not babysitting her.
‐ Me neither.
[fire extinguisher whooshing]
‐ Fire's out!
‐ What's your name?
Gail. She's only ten days old.
Please.
Is she alright?
She's moving and crying.
These are good signs.
[baby crying]
I'm Dr. Lewis.
What's your name?
‐ Zach.
‐ Uh‐huh.
‐ Gail, does your neck hurt?
‐ Is he alright?
‐ Gail?
‐ Please help him.
Get a c‐collar on her.
(Mark)
Sir? Sir, can you hear me?
That's brain matter.
Guy's a goner.
[siren wailing]
Okay, okay,
let's get him on oxygen.
‐ Where, Zach? Your neck?
‐ No. No!
‐ Does this hurt?
‐ Aah!
(Gail)
David? David!
Where's my husband?
Gail, where are you hurt?
Uh, my, my‐my right leg
and my side. David, please!
Dr. Greene's working on him.
[sobbing]
My husband's a doctor.
He has to check on the children.
(Mark)
Susan!
‐ Susan!
‐ He's a pediatrician.
‐ Go, I'll stand by.
‐ Okay.
I'm gonna go
check on your husband.
I'll be right back.
[indistinct chatter on radio]
Trucker's gone.
I need you over here.
He's still moving.
He's pulseless,
with massive head trauma.
I've got a tension hemopneumo
that we can save.
Needle him, left side.
He's decompressing.
32 French.
This guy's a pediatrician.
‐ Really?
‐ Yep.
His family's in the van.
Wife and newborn baby girl.
Both stable.
There's a boy
about eight years old.
Le Fort two facial fracture.
I'm worried about his airway.
I'm in. Hook it up
to the Foley bag.
(Susan)
'He's hemorrhaging.'
Grab two units O‐neg
out of the cooler.
‐ Okay.
‐ I'll start a line.
(Gail)
'Oh, David!'
Gail, we're getting you out.
Hang in there.
Yeah, I'm still holding.
Hey, you like Green Bay
minus seven over Washington?
I thought the world series
was over.
‐ Excuse me.
‐ Hang on one second.
(male #1)
'Please don't tell!'
[crying]
Please don't tell!
Mommy!
(male #2)
'Alright, where do you
want him?'
You won't tell my mom, will you?
Uh, curtain area three,
end of the hall.
Don't tell her!
Don't tell her!
Don't tell her, please!
'No! Don't tell her!'
‐ Uh..
‐ Carol Hathaway.
Carol.
Hi.
I was pulled off my ward
and assigned down here.
Rhonda, right?
What patient
you want me to take?
Oh, well, actually
we share patients here.
Let me show you.
Over here are the patients
that are waiting to be seen.
Nursing orders are flagged
and put over here.
‐ So, when you're gonna have a‐‐
‐ I'll take, uh, Mr. Washington.
Where is curtain area three?
‐ There.
‐ Thank you.
(Susan)
Secure his head.
Alright, we need
to start a second line.
(Dee)
Dr. Lewis, the boy
stopped breathing.
‐ 'Oh, my God!'
‐ Go, go, go.
‐ 'Oh, my God!'
‐ Watch his C‐spine.
Keep in‐line traction.
You're in the way.
Uh, there's too much blood.
I need suction.
6.0 tube.
Another 6.0.
‐ That was it.
‐ Damn it.
Okay, 5.5.
Mark, I need your help!
Get him on the chopper.
(Gail)
'David! No!'
We're taking care of them, Gail.
(Gail)
'Please, don't let him die.'
'Please.'
‐ I can't see. Turn it up.
‐ It is up.
(Mark)
There's better control
in the chopper.
'Let's bag him and move him.'
Ready?
One, two, three.
Doctor, I need you
to start this IV.
Okay.
Um, go on, I'll check it out.
Thanks.
What's up?
She needs an IV.
I tried and missed.
Oh, we usually,
we try a few times
before we call a doc,
especially an intern.
Up in Med‐Surg, we call
the doctor when we miss.
Alright, I'll, I'll do it.
Mrs. Fesmire needs 20 of KCL
in her IV in three.
Why don't you go do that?
Where's the potassium?
It's in the med room under P.
I can see the vocal cords.
I'm in.
‐ I'll be right back.
‐ Susan!
Alright, Fred. Fire it up.
Susan!
How much longer?
Twenty, thirty minutes.
[baby crying]
Gail, we're taking
your son and your husband
to County General Hospital
by helicopter.
‐ Are they alright?
‐ They're stable now.
But they need to go
to a trauma center.
B‐but how will I know
what's happening to them‐‐
I will‐I will get word
to you, Gail.
‐ Oh, please! Oh, please!
‐ I promise. I promise.
‐ Are you okay?
‐ Uh, yeah.
It's Dr. Greene calling
from the Whirlybird.
Why hasn't Mrs. Fesmire
gotten her potassium?
I'm on break.
I'm getting to her.
This is County General
on Beta two. Go ahead.
(Mark on radio)
'We're incoming on Air‐Vac One
with two major traumas.'
'Seven‐year‐old boy and his dad,
both multiple trauma.'
Never mind that,
grab Lydia and Chuny
and tell them to clear
the trauma rooms.
Go ahead, Air‐Vac One.
(Mark)
'I'm gonna need a vent.'
[flatline]
Goodbye, Mr. B.
You will keep him cold until
they come for him, won't you?
So that he could be
with his wife?
Mm. Okay.
‐ Please.
‐ Sure.
Thank you.
Should I clean out the fridge?
What have you got?
Dad's got a hemopneumo
and a head trauma.
Seven‐year‐old
had an obstructed airway.
He's getting shocky.
Good job, Susan.
‐ What?
‐ I said good job.
(Carol)
'Draw up meds.'
(Carter)
Watch that IV.
Fluids wide open.
Let's get a cross‐table, CBC.
Type and cross for four units
and dip a cath urine.
Draw up a saline flush,
crash cart.
‐ Where is the saline?
‐ 'BP's only 65 palp.'
‐ 'Pulse 160, thready.'
‐ 'Whoa. He's waking up.'
Hey, Zach. Hi, I'm Carol.
That tube in your throat
is helping you breathe, okay.
Set up for a lavage.
‐ Want a gas?
‐ Yep.
Blood gas kit, top drawer.
(Doug)
'Got it. You do that.'
Alright.
'See if you can give me a hand
right there.'
'Okay.'
We got a bloody tap.
Page Benton.
See if the dad will sign
the consent form for an ex‐lap.
Put that O‐neg
on the rapid infuser.
He conscious?
(Susan)
He's respondin' to pain.
Dr. Herlihy,
open your eyes.
Somebody needs to sign his son's
surgical consent if he can't.
‐ We'll do it.
‐ BP's low, 70 palp.
Pulse ox is only 85.
(Susan)
Lydia, ask Jerry
to track down the number
of the hospital in Verne County
'where they're taking
the mother and the baby.'
I promised I'd let her know
how they're doing.
Did the heart sound
seem distant to you?
‐ What are you thinking?
‐ Tamponade?
(Doug)
'Hang in there, Zach.
Will you hold him still?'
‐ Just hold him still.
‐ 'He's scared to death.'
He's got to be sedated.
Get him versed,
one milligram IV.
‐ Where is it?
‐ Top drawer.
‐ 'It's clotted.'
‐ 'BP's unchanged.'
I need that saline.
Let's go.
(Doug)
'Zach, we're gonna
give you something'
'to help you sleep, okay?'
It will help you sleep.
(Carol)
'Alright, here we go.'
'Hold him.'
'Whoa!'
What was that?
Does that hurt?
It hurts.
Are you sure that's saline?
Oh, my God! That's potassium.
‐ 'How much went in?'
‐ Uh, about a quarter cc.
‐ 'Insulin and glucose?'
‐ Where is it?
Second drawer.
Hold on. It's probably not
enough to stop his heart.
‐ I think we're gonna be okay.
‐ What do you got?
(Doug)
'Got a seven‐year‐old TC,
passenger, space intrusion
'airway compromise
at the scene, intubated.'
'Peritoneal lavage
was positive.'
BP's crashing, 60 palp.
‐ Pericardiocentesis tray.
‐ Pericardiocentesis tray.
Go ahead. I'll draw up
a central line.
Okay. Hook an alligator clip
to an EKG Lead. Use V‐1.
[pager beeping]
Not mine.
Uh, it's the patient's.
He's a doctor.
It might be his office.
Why don't you try
dialing the number?
Susan, Jerry called
Dwight Hospital.
The wife and baby
haven't arrived yet.
‐ Are they on their way?
‐ I don't know.
Well, find out.
‐ What do we have?
‐ Blunt abdominal trauma.
Hypotensive intraperitoneal
hemorrhage confirmed by lavage.
'Probably his spleen.
Facial trauma.'
Intubated in the field
with an RSI.
H&H is 11, 32.
'Type and cross four.
650cc's of saline.'
Versed on board.
Way to go, Carter.
‐ Alright, let's take him up.
‐ Can I tie?
(Keaton)
Where are his parents?
(Chuny)
'Second unit's in.'
(Mark)
'See, you've got, you've got
his partner to take call?'
Right. Okay.
Okay, we'll let you know.
40cc's non‐clotting blood..
...out.
Dr. Herlihy, you've been
in an accident.
You're in the ER.
‐ BP's back up, 120/80.
‐ What have we got?
I'm worried about
an intracranial bleed.
Is he stable enough
for a head CT?
The nurse goes with him.
‐ Am I on call?
‐ No, you're a patient.
You were involved in
a serious traffic accident.
Accident?
Your son, Zach, has just
been taken up to surgery.
Surgery?
He was injured in the accident.
Accident? What accident?
Get a rush on that head CT.
(Keaton)
'Zach, everything's
gonna be okay.'
We could have killed that boy.
I got confused.
You have no business
working the ER.
You think I don't know that?
I want you to restock supplies
for the rest of the day.
I don't want you anywhere
near my patients.
Yes, this is Carol Hathaway
in the ER.
Clear a CT room, please.
Where's the number
for chopper dispatch?
Mark, can I run
something past you?
Sure.
I've just got a sweet,
old guy who died
and I don't know what to do
about his cryogenics request.
His what?
He and his wife
bought a tank for two
so they could be frozen
side by side when they died.
‐ Where's his wife now?
‐ In the tank.
‐ Oh!
‐ I have an 800 number.
For a cryogenics company
in California.
Call it.
Yeah, still holding.
‐ What?
‐ Nothing.
Yeah, yeah, page me
as soon as you know.
Helicopter's standing by.
We may have to go back
and get the wife and the baby.
Okay, DeBakey.
(Keaton)
5.0 Prolene on a Castroviejo.
‐ Retract caudally.
‐ Retractor.
Splenic vein's repaired.
What about this pancreas?
(Benton)
The tail has most
of the devitalized tissue.
I'd resect rather than do
a subtotal pancreatectomy.
Good. I agree. Metz.
How would you repair
after resection?
Interrupted horizontal
mattresses
and a figure eight
in the pancreatic duct.
(Keaton)
'Go ahead. Do it, DeBakey.'
‐ 3.0 silk on a needle driver.
‐ Anything else to do?
Irrigate, run the bowel
under control
insert a Jackson‐Pratt drain
through a separate stab wound
and, uh, use cautery instead of
a scalpel to minimize bleeding.
‐ And after that?
‐ Close.
Keep it simple,
do exactly what
you just described.
No more, no less.
Okay.
Alright, cut the suture,
three millimeters, no longer.
Irrigate, normal saline.
Make sure it's warm.
Park her in the hall
until we can clear an exam room.
Jerry, you seen Susan?
Yeah, she got paged
to chopper duty.
You're kidding.
What's up?
‐ I need ice, lots of ice.
‐ Huh?
California Cryonics said
to put him on ice
until their local rep arrives.
They'd better hurry.
[chopper whirring]
(Dee)
'Dr. Lewis.'
Susan.
Are you sure you're alright?
Yeah, I wanna bring them in.
‐ I'll go.
‐ No, no, I'm fine.
Really? I, you can stay
here with Herlihy.
‐ No, really. I'm okay.
‐ Dr. Lewis.
‐ Alright.
‐ We gotta go.
‐ May I..
‐ Hmm?
...see your orders.
Okay, uh, John,
will you take these to ICU
and make sure
they're carried out
as meticulously as written?
‐ Sure.
‐ Peter.
Care to join me
in a sarcoma resection?
Uh, yeah, yeah,
I'd love to.
Good, uh, Gant can cover
in trauma call.
Scrub in in 45 minutes.
Don't you just love her?
[baby crying]
Where's Zach?
Where's my husband?
Your husband was unconscious
for quite a while.
He woke up confused
and disoriented.
He has a head injury?
‐ What about my son?
‐ He's in surgery.
Don't worry, Gail.
Your family's in good hands.
Move. Move.
‐ Does this hurt?
‐ Ah!
Yeah.
BP's okay. 115/65.
Let's get a C‐spine, H&H,
type and cross for four
'and dip a cath urine.'
[baby crying]
(Doug)
Got a good set of lungs on her.
Respiratory rate's kind of high.
Yeah, who knows
with all that crying?
It's 60. Pulse 160.
Abdomen's distended but she's
been taking in a lot of air.
Do you want
a pedes surgery consult?
Uh, yeah. Get a babygram,
CBC, and a gas.
Hey, darling, are you hurt
or you just mad at the world?
What will it be?
Do you believe in reincarnation?
Sure. Why not? Next life, I'm
coming back as Cindy Crawford.
Would you do us a favor?
A deceased patient of mine wants
to be cryogenically preserved.
We gotta freeze a dead guy.
You got any ice?
Neck looks okay.
CT was normal,
but dad's still altered
so they're doing an MRI.
Why did they take Megan away?
(Susan)
'She's just next door.
It's a little crowded in here.'
I called upstairs.
Zach's out of surgery.
He's gonna be alright?
He's in ICU. I'll check on him
as soon as I can.
Oh, God.
Oh, God. Oh, God.
[sobbing]
I need my husband.
'Please, where..'
'David.
Please, where's David?'
'Please.'
[crying]
(Gant)
Her abdomen's kind of firm.
She swallowed a lot of air.
It's a tough call to a newborn.
‐ What should we do?
‐ Alright, what is it, Gant?
Well, I'm not sure. Abdomen's
persistently distended.
She keeps cryin' and the resps
are high in the 60s
but the BP, the pulse
and color are okay.
Why didn't you drop an NG?
‐ We considered it‐‐
‐ Stool guaiac.
‐ In such a small baby?
‐ Alright.
Do it off
the rectal thermometer.
You didn't do
a full surgical evaluation
of the patient, Dr. Gant.
Ssh, shh!
[crying]
Ah, it's positive for blood.
Alright, prep a cutdown tray,
type and cross
for two units and page Keaton.
‐ Where's her mother?
‐ Trauma one.
Dr. Ross and I thought
it was an equivocal exam.
Ross is a pediatrician,
if you don't know
what you're doing,
call someone who does.
Hi, um, I'm Dr. Benton.
Your daughter
has internal injuries
that's gonna
require an operation.
But she‐she's
only ten days old.
It's okay.
Dr. Keaton will be with her
'and, look, she's the best
pediatric surgeon in Chicago.'
Now, we need your consent for
what's called
an exploratory laparotomy.
W‐w‐where's my husband?
I want him to sign for it.
(Mark)
Her husband's a pediatrician.
Uh, he can't do it right now.
He handles all the family
medical decisions.
I don't know
anything about this.
‐ You can do this, Gail.
‐ I don't know. I don't know.
Your baby needs it.
Okay. Okay.
Okay.
Cutdown tray. Use a volutrol.
We may have to transfuse.
(Doug)
Gant was on track.
I just talked him out of it.
Hang D5, 40 normal.
(Keaton)
What do you think, Peter?
(Benton)
'She has an acute abdomen.'
(Keaton)
'Hi, pretty girl.'
[baby crying]
‐ Vitals?
‐ BP's 80/40, pulse 160.
Resps 65, temp's 101.4.
Oh, pulse ox?
‐ Oh, what blue, blue eyes.
‐ 92 room air.
Oh, teacup,
that's too low, uh..
Let's get her on O2,
four liters by mask.
Aww!
Did you appreciate
the periumbilical redness?
'The abdomen's a little tense.'
‐ No, no, I missed it.
‐ Well, it's easy to miss.
‐ 'Why a cutdown?'
‐ No veins.
22 angio.
This was a nice pickup, Peter.
Thank you.
(Keaton)
Ah, yes.
There we go.
Wow, I couldn't see
or feel a vein.
Well, it's just a matter
of knowing where it is.
Let's get her
a cross‐table lateral
and check for free air.
She may be proofed.
Any thoughts on antibiotics?
Well, since you don't need
anaerobic coverage on newborns
I'd go with amp and gent.
You've been reading.
Dennis, since you did
the trauma assessment
why don't you scrub in
and follow the case through?
Uh, Peter,
let's go talk to mom.
(Carol)
'Good girl.'
There you go, Mr. Brazil.
Shrimp cocktail time.
Hubert Skinner,
California Cryonics.
‐ Mr. Brazil.
‐ Do you have some kind of ID?
It's all there.
Give him 10,000 units
of heparin stat.
I'll pack him up
and we'll be on our way.
‐ Is he a doctor?
‐ I don't think so.
What do we do?
Well, the heparin can't hurt
him being dead and all.
(Keaton)
In the newborn, I use
a transverse abdominal incision.
The rectus is thin,
so there's less pain post‐op.
(Benton)
'Adson.'
'We're using a respirator,
so atelectasis isn't an issue.'
Exactly. Uh, zap that
little bleeder.
‐ Cautery.
‐ 15 blade.
If there's a perforation
we should get a gush of air
when I nick the peritoneum.
Yup, there it is.
‐ She's easier to ventilate.
‐ Very little bleeding.
Dennis, why do we wanna
keep bleeding to a minimum?
Transfusions are dangerous.
You can't type and crossmatch
the blood as quickly
because of the baby's
fetal hemoglobin.
There it is.
Perfed jejunal.
You're teaching
your interns well.
He's in and out.
MRI was normal.
Dr. Herlihy,
do you remember my name?
Where's my wife and kids?
I'm Mark Greene.
Your family was involved
in a traffic accident.
Your wife's in the ER
with a tib‐fib fracture.
Zach had facial trauma
and hemoperitoneum.
‐ He's out of surgery, in ICU.
‐ What was it, his spleen?
‐ No. Pancreatic injury.
‐ What about Megan?
Megan just went up to rule out
intestinal perforation.
Why? What happened to her?
She was in the accident
with you.
What accident?
Dr. Herlihy,
do you know my name?
No.
Should I?
It's okay. It's okay.
Gently. To repair, we use a 4.0
silk interrupted Hufnagel.
Field looks dry.
You don't need
a two‐layer anastomosis.
Cautery alone
gives you hemostasis.
Hmm, let's irrigate.
Warm saline, please.
Dr. Keaton, Zach's
abdomen is distending.
Any change in his vitals
or pulse ox?
No, but I think
he might be bleeding again.
Damn. Peter, you think
you're ready to finish alone?
‐ Yeah.
‐ Nothing fancy.
‐ Just close.
‐ Okay, yeah, yeah, okay.
Alright, people, let's go.
Thank you.
One more. Thank you.
His abdomen is more distended
than before the surgery.
Has he regained consciousness?
No, no.
(Benton)
'Four by eight.'
Okay. Thank you.
Alright. Completely dry.
What's that?
Oh, looks like a little fibrin
debris on the liver surface.
‐ Should I call Dr. Keaton?
‐ No, no, no, no, no.
I'll clean it up.
'Come on.'
'Come on.'
'Okay, got it.'
Alright, let's close
the peritoneum first.
3.0 Vicryl.
Mm‐hmm.
Now..
...retract medially.
Cut.
Mm‐hmm. Good.
‐ Oh, there's a little blood.
‐ Where?
Oozing from the liver
where you just touched it.
Alright, um, I'll put
a little pressure on it.
You suction.
Gently, okay?
[grunts]
It's still oozing.
Alright, I don't wanna close
while it's bleeding.
I'll put a stitch in
for hemostasis.
4.0 chromic on an SH.
Now, move. Thank you.
Come on. Here we go.
Alright.
Retract caudally.
Come on, Gant, retractor.
Is Anesthesia standing by?
I called them.
You're right.
He is distended.
‐ Vitals?
‐ Stable. BP's 90/60.
Pulse is 96,
pulse ox is 99 percent.
‐ 'Should I clear an OR?'
‐ Hang on.
Uh, disconnect the NG
from the wall.
'Yep.'
Sometimes, you get
an erosive gastritis.
'Hook it back up.'
Clots can block the NG
causing acute dilatation.
Irrigate it out
and crisis resolved.
It's just experience, doctor.
[ECG monitor beeping]
‐ She's still bleeding.
‐ I can see that.
Alright, I'll put a gel foam
on the bleeding site.
And you apply pressure.
‐ Come on.
‐ You want me to get Dr. Keaton?
No.
We will suction.
Alright, I'm gonna oversaw.
2.0 chromic on an SH.
Heart rate's
starting to fluctuate.
Hey, give me a bolus
of normal saline, 40cc's.
Oh, damn it!
The liver's so fragile.
‐ My stitch cut right through.
‐ I should be getting Keaton.
I'm gonna take
an even bigger bite.
Gant, retract this way,
I can't see.
Pulse ox is falling, you need
to get this baby off the table.
(Benton)
'Alright, bag her faster,
damn it.'
‐ I'm‐I'm getting Keaton.
‐ No.
Go! Go!
[ECG monitor beeping]
You really think
it will help her
to see her husband
like this?
Megan's still in surgery,
Zach's in ICU
and your husband
just got out of X‐ray.
He's okay?
His tests are normal
but there's still memory loss.
‐ Could it be permanent?
‐ 'Probably not.'
You can see these kinds
of things in a concussion.
But‐but it might be.
We'll just have to wait
and see.
‐ Blood loss?
‐ A 100cc's.
That's a third of her volume.
Damn it.
What the hell did you do
to her liver?
I was just trying to peel
away some fibrin debris.
(Keaton)
'Cut me a one centimeter
square of gel foam.'
Move.
2.0 chromic on an SH.
It started to loose. Clear.
You ripped away
the liver capsule.
No way to control the bleeding.
I have to reset the left lobe.
Peter, handle the suction.
Dennis, retract distally.
Cautery. Crank it up to 18.
Pulse and BP
are destabilizing.
We'll have to transfuse
with unwashed O‐neg
80cc's, 2.0 chromic.
Keep 'em coming.
She's bradying down. Rate's 80.
You've got to get out.
3.0 Vicryl
for the peritoneum and muscle
and staples for the skin.
David?
Oh, my God. David.
What happened to you?
Didn't you tell him?
We did, many times.
Zach's condition
has stabilized.
He should wake up soon.
‐ Zach?
‐ It's okay. It's okay.
What about Megan?
Dr. Benton's closing right now.
[sighs]
That's wonderful news.
Was, was there a truck?
Yeah.
Yeah, there was a truck.
‐ What were you thinking?
‐ I told you there was debris.
Didn't I told you not
to do anything but close?
Look, in my judgment,
I thought‐‐
I didn't ask for your judgment.
Perry, Dennis,
set up a vent.
Call respiratory and get a blood
gas straight away.
FIL 2 in 100 percent
and stand by with..
[indistinct chattering]
Does that say chicken belt?
Conjunctivitis.
I hate chart QA.
[sighs]
What?
Nothing.
Thanks for helping me
in the chopper.
No problem.
Things can get really
pressured in here.
Just isn't a place for someone
who isn't experienced.
I can't have you
work here again.
Zach?
'Oh, God.'
Can I touch him?
Sure.
Zach, honey, it's mommy.
I'm gonna stay right here
until you wake up.
What about Megan?
No one from surgery's
talked to you?
No.
Okay, I'll go find out
what's going on.
Thank you.
Carter.
Why hasn't anyone
been down to talk to her?
I don't know. Benton
was closing her an hour ago.
Blood gas is improved.
Not by much.
Um, could you excuse us,
Kit, Dennis?
Thank you.
[sighs]
I'm sorry. I should never
have left you unsupervised.
There are nuances
in neonatal surgery.
The liver's more friable
in newborns.
I wanted a clean field
before I closed.
Yeah, you said that.
'But it seemed appropriate.'
What's at issue here
is that you ignored
my specific instructions.
No, I didn't ignore anything.
I followed standard
operative procedures.
'Look, I've done it
at least'
'a dozen times
in other patients.'
This is not another patient.
This is an infant.
Outside. Now.
You don't know anything
about pediatric surgery.
Look, I thought
it was necessary‐‐
Are you unwilling to learn
from your mistakes?
Does it say in the text
not to stitch a liver?
It isn't in the text,
you didn't know
what the hell you were doing,
the second you realized
you screwed up,
you should have called me.
Why did I find
three stitches in there?
‐ Because I was trying‐‐
‐ I'll tell you why.
Because you arrogantly
and blindly think
you have all the answers,
if that baby dies
it will be my responsibility,
but it will be your fault.
Dr. Keaton, she's crashing.
'Pulse ox is 86,
heart rate's down to 45.'
Decreased breath sounds
are on the right.
Atropine, .04.
Sounds like a pneumothorax.
‐ 'Chest X‐ray.'
‐ Don't need it.
Increased trans illumination
on the right side.
‐ It's a pneumo.
‐ Chest tube tray.
This is no longer
a teaching case. 12 French.
She's gonna need a repeat ABG.
Okay, pulse is up to 72
but it's thready.
Dynamap's not registering a BP.
Get ready with that thoraseal.
She's arresting!
Heart rate's down to 20.
Damn.
Let's start CPR.
Epi, 1 to 10,000.4,
atropine, .08 milligrams.
How's the blood gas?
PH 7.3, PO2 45.
PCO2 30 and 100 percent oxygen.
Ah, we're gonna have to put her
on a ECMO bypass.
Ah, Kit, call the tech, get two
units O‐negative prima system.
I'll cut down
to the internal jugular.
So that we bring her
back up to the OR?
No, we're gonna bring
the OR to her.
Dr. Greene?
Dr. Herlihy.
(David)
'What time is it?'
Eight o'clock.
‐ P. m.?
‐ Yeah.
Where's my family?
Your wife's upstairs
and both the kids
had laparotomies.
A bed opened up
for you in ICU.
How did they do?
Well, your son's
out of surgery in ICU.
I don't know
about your daughter.
H‐how do I find out
about my daughter?
I'll check on her for you.
Thank you, Dr. Greene.
Mark.
Mark.
Pedes OR called. His daughter
decompensated in surgery.
She's crashing in NICU.
She's still flatline.
Repeat .4 of epi.
Go ahead, Kit.
How long has she been down?
Twenty two minutes.
‐ Is the ECMO circuit primed?
‐ Yes.
Good. I'm ready.
Venous connection first.
Arterial.
Turn it on.
(Gant)
'We got a heartbeat.'
‐ And a pulse.
‐ Faint.
She's pinking up.
(Keaton)
'Okay, let's get a repeat gas.'
'We need to anti‐coagulate her.'
Kit, heparin, 150 units IV.
[clears throat]
Start drip
at ten units an hour.
How can we anti‐coagulate her?
We have to or her blood
will clot in the ECMO circuit.
Yeah, but won't she bleed out?
We have to hope
that she doesn't.
I‐I'll dictate
an operative report.
Meet me in pedes ICU
in five minutes.
‐ ICU?
‐ Yeah.
We gotta tell the parents.
Peter, how did it go?
How's the baby?
Not good.
(Gant)
Dr. Benton.
You didn't sign
the code sheet.
Hey, we're all human.
You know,
we all make mistakes.
Any other words
of wisdom, Gant?
You're a real prick,
you know that?
Mrs. Herlihy,
this is Dr. Keaton.
She's the doctor who operated
on both Zach and Megan.
Oh, Mrs. Herlihy
uh, Megan had a perforated
intestine from the accident.
'When we operated
to repair it..'
...there were complications.
Wh‐what are you saying?
Well, she's in the NICU now
on a device that helps
her heart and lungs
'oxygenate her blood.'
'There was bleeding
during the operation'
'and she went into shock.'
'Then her lung collapsed
and finally, her heart stopped.'
'But we got it started again'
by putting her
on a bypass machine.
Is she gonna die?
She's in extremely
critical condition.
It's..
It‐it is a possibility.
[instrumental music]
[music continues]
[sighs]
"The Lord is my shepherd.
"I shall not want.
"He makes me lie down
in green pastures.
He.."
"The Lord is my shepherd,
I shall not want.
"He makes me lie down
in green pastures.
He's.."
(Kit)
'Dr. Benton?'
I can't remember the words.
[instrumental music]
[theme music]