ER (1994–2009): Season 4, Episode 21 - Suffer the Little Children - full transcript

Previously on "ER.."

It was really lovely last night.

I would really like you
to consider, um, a date.

Seeing as I‐I do
work for you..

...I don't think it
would be such a good idea.

‐ Oh, I see, you have a policy.
‐ Yeah, yes‐‐

No fraternization
with people at work.

Oh, well, Okay.

‐ It's okay.
‐ He's in heroin withdrawal.

The mother's been stealing
his methadone between fixes.

So she split?



Peter, have you ever heard
of the Velvet Lounge?

Of course.

I saw in "The Tribune"
they're having

a jam session there tonight.

That's on the south side.
You don't want to go there.

What, you mean
it's a rough area?

No, I just mean
it's not a good idea.

Listen, when I was in Belfast,
I went to the Bog side

to hear Lick the Tins.

It's an IRA stronghold.

It's not the same thing.

'Now, what are
the plans for his discharge?'

Well, his vitals are stable.

‐ Any vomiting or diarrhea?
‐ No.



He's keeping down PO's

and he's back
on his dose of methadone.

I'd like to start
him on a course

of long‐term withdrawal.

Mrs. Thorvaldsen
from DCFS come by?

Yes. We had a team meeting.

Everybody understands that this
baby cannot live with a mother

that steals his methadone.

We all agree with your notes.

The home
environment is unsuitable

'and social services
has found a foster family.'

People that have
experience with drug babies?

‐ Mother's a retired nurse.
‐ Yeah.

Hi.

Just making sure you don't
slip through the cracks, kiddo.

'Hi, Carter.'

I wanted to catch you
before you got in.

‐ Anything wrong?
‐ No, everything's great.

Uh, actually, you met my friend
the other night from Philly.

Max? Yeah, you
showing him the town?

Remember I told you
that I was involved

with somebody
and it wasn't quite over yet?

Yeah, I figured
he was the guy.

Yeah.

What about his
heroin addiction?

Oh, it wasn't heroin.

It was painkillers,
Percocet.

He's doing okay.
Actually, he's here for a job.

He's, uh, coming in this morning
to do a feasibility study

on setting up
a pedes unit in the ER.

That doesn't sound
like a coincidence.

Listen, uh..

...Carter, before
you run into him

I've‐I've given you a really
one‐sided picture of Max.

He's, he's smart,
he's very dedicated.

He's a,
he's a really good guy.

You want me to like him?

I just don't want
you to judge him

for things I've
said in the past.

Sounds like you guys are
already back together.

I don't know about that.

Honestly, I don't.

Where is he now?

My place.

Malik, who left
this with my mail?

Mr. Dougherty
from Salutech.

Yeah, well,
see that it gets returned.

Some salesman from
Salutech left me a pen.

Well, yeah,
I got mine right here.

He also left a bunch
of free samples.

Well, I won't be bribed
into using their products.

Kerry, Mark, you
know Dr. Keinholz

chief of pediatrics

and Dean of
the med school.

‐ Nice to see you.
‐ This is Dr. Rosher.

‐ 'Doctors Greene and Weaver.'
‐ Nice to meet you.

Dr. Rosher's a pediatrician
and assistant professor at Chop.

He's evaluating the need

for pediatric emergency
centers at urban ER's

and we feel very fortunate

that he's responded
to our call for a study here.

I thought this matter
was still under discussion.

Well, it happens that Dr. Rosher
is free at this time.

I just finished a similar study
at Hennepin County.

Listen, I have to scrub
in a few minutes, but I'm sure

you'll provide all the support
that Dr. Rosher needs.

‐ Sure, no problem.
‐ Thank you, doctors.

So, they sprung me
on you. Sorry.

No, it's fine, I'd
be happy to review

our pediatric census
statistics with you.

First, I'd like to get
a sense of the place.

Sure, you can
follow me around, Dr. Rosher.

I hate formality.
I'm Max.

‐ Mark.
‐ Kerry.

Is there any place
that I can stash

these things maybe
get a cup of coffee?

Uh, Randi, could you show
Dr. Rosher to the lounge?

‐ Sure.
‐ Thanks.

You know where
this comes from?

Doug Ross,
lobbying upstairs.

It's just
a feasibility study.

You think he doesn't
have an agenda?

He's trying
to find fault with

the way we handle
pediatric patients.

We have nothing to hide.
We take great care of kids.

Hey, Jeanie, do you
have a busy morning?

Not so bad. Why?

Our talk on managing
abdominal pain

with the med students
is next week.

Could you see if the slides
are ready at graphics?

‐ Sure.
‐ Thank you.

I would warn you, if you
don't see me making the coffee..

...I would avoid it.

Mocha, Vanilla, Amaretto.
It's my own very personal stock.

Mm.

Thanks. You're..

Randi, acting unit
service coordinator.

‐ How's it going?
‐ Hi.

Meeting everyone?

Yeah.

I encountered
the usual dynamic.

The attendings
see me as the spy.

Sent in to undermine
their authority.

Mm.

How are you doing?

It's a little awkward
seeing you here.

Was it awkward last night?

No.

No.

But now you're nervous.

I don't know.

I don't know, you just show up
and you're back in my life

and that's not exactly
how I planned it.

I never planned it
any other way.

‐ Peter?
‐ 'Yeah.'

Have you got a case
to present for morning report?

Should I wait outside?

Uh, when have you
ever waited outside?

Oh. You don't see me
as a shy English rose?

Elizabeth, I see you
as many things.

Shy is not one of them.

‐ Busy morning?
‐ A par thyroidectomy.

Mm‐hmm.

Hey, um,
I know you like jazz

so I was thinking maybe we could

go to the Coq d'Or
at the Drake Hotel.

I heard the guy on the piano
over there is pretty good.

Sure. That'd be great.

‐ Yeah?
‐ Yeah.

Peter?
Oh, hi, Lizzie.

Are we frequenting
the, uh, men's locker room?

Peter, I've got a pyloroplasty
at 3:00 p. m., any interest?

I'm scrubbing in with Anspaugh.

‐ 'Got it.'
‐ Oh, uh, I'm free.

Oh, that's alright.
I got a backup.

Did he see us?

I don't know.

Right, at least one exam room
with color murals and toys.

And then in chairs,
you section off

so the kids don't sit
next to some nut case.

So you're in favor of setting up
a whole department.

I'll get myself in trouble
talking about this

in front of my buddy.

No need for caution
on my account.

I'm keeping an open mind.

A department here
would be great

but I would settle for
a full‐time pedes attending.

That's the position
Doug is bucking for.

Whether it's me or somebody
else, it's important.

I won't lie to you,
I want the job.

So you have
a problem with that.

Hey, set up a pedes department,
what's next?

Geriatric emergency medicine?

Dr. Del Amico,
meet Dr. Rosher.

Stay on your toes,
he's doing a study on us.

I think she was
born on her toes.

Max was my attending
at Chop.

Ah, another ally.

Well, I'm really feeling
outnumbered by pediatricians.

Actually, I'm double‐boarded
in emergency medicine and peds.

'Dr. Rosher.'

I've pulled together
some charts which I believe

could be relevant
to your study.

Oh, sure.

And I've set up
a place for you in the lounge.

Actually, I'm in the middle
of a tour right now.

Oh, well,
you know, I have time

to go over them
with you right now.

I'll see someone gets you if any
special pedes cases come in.

One Tina Marie Chambliss.
She wouldn't give her age.

Complains of fever
and facial erythema

following a facelift
five days ago.

She came in an ambulance?

It was a blepharoplasty
and a rhytidoplasty.

Looks like
a wound infection.

Uh, could we sign her in
under a different name?

I don't want her to be mobbed,
while she's here.

‐ Mobbed?
‐ Let the doctors do their work.

Hey, ma'am, you gonna have
to scoot on over here.

Uh, go on, honey.
I can tell you're in good hands.

Ma'am, I'm gonna
have to examine your face.

I just look so awful.

Emmet, stay by me, honey.
Don't leave me.

Oh, I'm right
here, sweetie.

Channeling my love
to help you mend.

‐ Temp's 102.
‐ That's good.

Let's get a CBC,
blood cultures

start a line.

Do you have any allergies?

Uh, she's allergic
to sulfa antibiotics

'and she had a cough
from the ace inhibitors.'

Dr. Emmet Chambliss,
her husband.

‐ I'm charged with her care.
‐ So you're her physician?

Uh, doctor of divinities.

Um, I'm diabetic.
You probably should know that.

Malik, add a Chem 7.
Give her a gram of Ancef.

Do you take insulin?

Uh, she gets 24 NPH
with ten of regular

in the morning,
12 of NPH, five at night.

He gives me the shots.
I can't stand needles.

Oh, what's that you're
putting on my face?

Uh, saline, just salt water.

Well, I‐I hope it's
not too harsh for my skin.

Uh, this is the cleanser
we normally use.

It's hypoallergenic.

Dr. Del Amico, I think you've
got a handle on this one.

Yeah, thanks.

What about our broadcast?

Oh, don't worry, honey.

I can get a mobile truck
with a satellite uplink

with just one phone call.

But how long am I
going to be sick?

Uh, you have
a serious infection.

You're going to need
some IV antibiotics.

Probably gonna be
a couple of days.

‐ Doug.
‐ 'Yeah.'

I've got a two‐year‐old kid
with severe rat bites.

Can we give him
something for the pain?

Yeah, I'll take
a look at him.

He's in exam two.

‐ What's the weight?
‐ 14 kilos.

Hey.
When did this happen?

About 6:00 a. m.,
they heard him scream.

'There were rats this big,
biting his fingers.'

'Eatin' him, because
of his screams'

'they thought he was
fighting with his brother.'

He's current on his vaccines
and up to date his tetanus.

She says they attack all of
the children in the building.

Okay, we're gonna start an IV.
Titrate morphine for his pain.

This one's through
the palmar fascia.

Plastics should
do it in the OR.

'Let's irrigate this wound.'

Tell 'em I'm gonna speak
to the authorities

to make sure there are
no more rats in the building.

He says they come
but they never do anything.

Well, this time they will.

‐ Hi, Bob.
‐ Well, hey, Jeanie. What's up?

I had the flu
a couple of weeks ago

and I can't seem
to shake a cough.

We're seeing
a lot of viral pneumonia.

You, uh, talk to a doc?

No, I didn't
wanna go through

a big work‐up for nothing.

So you want a quick chest film?

Could you?

You know two weeks ago,
I cut my hand

and I just wanted
a few stitches.

Next thing, I'm on a gurney
hooked to an IV for six hours.

'All these docs overreact.'

Should I flash your name
for your medical record?

No, that's okay.

'No problem. No paperwork.
That's what I like.'

Take a deep breath
and hold.

Have you seen Dr. Rosher?

I got a six‐year‐old
with pityriasis.

Dr. Weaver's holding him
hostage in the lounge.

Mark, I gave Dr. Rosher
enough reading material

I don't think we need to worry
about occupying his time.

I want him
to see how we work.

I'm gonna get him out of there.

Lizzie, meet
Tancred Baumgartner, 64.

History of hypertension
and peripheral vascular disease

80 pack year smoker.

‐ 80 pack years?
‐ Two packs a day for 40 years.

But I'm cutting back
I'm going to get hypnotized.

Mm‐hmm. So what brought you
in today, Mr. Baumgartner?

‐ Terrible pain in my legs.
‐ How far can you walk?

Six months ago, I could walk two
blocks before I had to rest.

Now he complains of calf pain
when he walks to the toilet.

I've got him on the schedule
for a fem‐pop bypass.

You should review
his films.

Don't worry,
Mr. Baumgartner.

We'll put a spring
back in your step.

You know, I've been
meaning to ask you

uh, have you given
any more thought

to that impressive offer
you got recently?

‐ Well, which impressive offer?
‐ There's been more than one?

I'm talking about
the senior lecturer's position

at the Gloucestershire
Royal Hospital.

I decided to pass.

Really? Did you
already let them know?

I've written them
a letter, yes.

‐ Ouch.
‐ What?

Takes guts, Lizzie.

You don't know if you
have a future here.

And have him lay flat on
his back for the next two hours.

I'll hand‐carry
the specimens to the lab.

Yeah, I'd appreciate that.

And, Kerry, would you
take a look at this X‐ray?

Sure.

Oh, and, uh, don't forget
to get a gram stain.

What have you got?

Thirty one‐year‐old woman
with a three week history

of dry cough
and intermittent fever.

‐ Is she a smoker?
‐ 'No.'

Any travel
outside the country?

I don't think so.

Did you ask
about her HIV status?

I don't know if
she's been tested.

What do you see?

There might be
an early infiltrate

at the right base
or it may just be atelectasis.

‐ Where's the lateral?
‐ That's all we have.

Alright, repeat the film,
have her take a deeper breath

then and get
a lateral this time.

Also there's no name
on this film.

Let the techs know that,
that's really unacceptable.

Oh, and, Jeanie,
uh, the slides?

Sorry?

This morning
I asked you to get

the slides from graphics,
did you forget?

Uh, no, just haven't
had the time yet.

Should I have
someone else do it?

No, I'll get them right now.

Okay.

We need some help here.

We were coming from visiting
my folks up in St. Lioba

and our son
passed out in the car.

‐ Need a gurney.
‐ 'You got it.'

'Hey, Malik.'

We're also gonna need
high flow oxygen too, Malik.

‐ I'll set it up.
‐ Any history of heart disease?

‐ Uh, no.
‐ Is he on any medications?

No. He's perfectly healthy.

He never gets sick.

My God, what's wrong with him?

He's tachy at 150.

Resps are high, 28.

Why is he
breathing so fast?

‐ Does he have asthma?
‐ No.

Alright, Connie, put him
on a pulse ox and an EKG.

And I want a CBC, Chem 7,
blood gas, a chest film.

I'll start a line.
Sam. Sam, can you hear me?

‐ What's wrong with him?
‐ He's cyanotic.

You see how blue his lips are?

Means, he's not
getting enough oxygen.

Why?

That's what we're
gonna try and figure out.

How are you doing?

Oh, just trying
to look decent again.

I don't think
that's a good idea.

Oh, I can't
be seen on TV

without my woolly bears
and makeup.

‐ You ever see us on JGCN?
‐ No.

Jesus Gospel Cable Network?

The makeup could make your
infection worse, Mrs. Chambliss.

Oh no, now, honey,
you call me Tina Marie.

Hello, doctor.
Isn't she an angel?

I'm seeing the power of prayer
and modern medicine.

Well, we have her
blood test results

and there is
reason for concern.

My face?

No. Actually, your
kidneys are the problem.

I'm passing water.

Your BUN and
creatinine are elevated

indicating a problem
with your kidneys

probably from
your diabetes.

Emmet.

Doctor, what does
this exactly mean?

'It could simply
be dehydration.'

I'll, uh, give you IV fluids

'and, uh, hope your
renal function improves.'

I'm also gonna do a neuro exam

check sensation
in your extremities.

Whatever suits you, honey.

‐ Feel that?
‐ Mm‐hmm. Little pricks of pain.

Mm‐hmm. That's good.

That means you're not losing
feeling in your feet and toes.

Look out, Emmet,
she might test your heart.

I'm just kidding,
sweetie. Kidding.

So, if my kidneys fail,
what then?

Uh, if it progresses
to renal failure

'you'll need dialysis.'

This means a full
prayer vigil, Emmet.

Yes. Yes, we'll pray
for those kidneys.

Malik, I've got to find
somebody in public health

who can deal with a rat problem.

I know there's an office
for rodent control.

I've got a contact there.
Let me put you onto him.

It's really bad,
they were eating this kid alive.

In Philly, I got better effort
out of animal control

than public health.

This woman, Ms. Weldon
she's a real crusader.

She'll get them in there,
poison, traps

whatever they have to do.

Dr. Greene,
Dr. Carter wants

to see you
in trauma two.

Thanks, Yosh.

Here. Mention my name.

I treated her son once.
Come on.

You picked a good day
for pedes cases.

He seems a little better.
Why won't he wake up?

‐ Isn't the oxygen helping him?
‐ Yeah, it's helping.

For the moment
he's relatively stable.

I just haven't determined
what's wrong with him yet.

Dr. Carter,
meet Dr. Rosher.

‐ We've actually met.
‐ Yep, hi.

‐ What do you got?
‐ This is Sam Adams.

He's 11 years old, altered

'presented with
cyanosis, tachypnea tachycardia'

driving back from his
grandparents' farm.

He's still cyanotic
despite O2, ten liters.

'What are you thinking?'

Either a VQ mismatch or
something...toxic‐metabolic.

‐ Pulse ox?
‐ 92. It's pretty good.

Was he in a camper
or the back of a pickup?

No, he was in
a car with us.

Chest and cardiac exam?

No wheezing or rales,
regular rate

without murmur,
rub or gallop.

‐ Blood gas?
‐ PC02's 35, PO2's 380.

Suggesting?

That there's oxygen
dissolved in his blood

but he's still cyanotic.

What kind of farm was he on?

‐ My father raises tulips.
‐ 'Greenhouses.'

Yeah, I already
asked about that.

Well, because some
of the pesticides

you find in hothouses
contain cyanide.

Mm, if it were cyanide he would
have pinked up with the oxygen.

Besides, I've got
good pulses and there's

no smell of almonds.

So your best educated guess?

Methemoglobinemia.

Do another blood gas,
check that.

Go for it.

It's a tough case,
leaving it with an intern.

Think it's ill‐advised?

‐ You know Dr. Carter.
‐ I don't.

He's figured it out.

Diagnosis was correct.

But you didn't tell him.

He's here to learn,
not to be told.

Boy, is that
a mark against me?

Not in my book.

500cc fluid bolus
is on board.

‐ TKO the line.
‐ Okay. I got it.

There it is.
There's the answer.

Look at that arterial blood.

That's his blood?
It‐it looks more like chocolate.

‐ It's methemoglobin.
‐ What?

It's, uh, form of hemoglobin

that can't carry
oxygen to the body.

How‐how did he get that?

It's caused from a drug or
toxin, but we can treat it.

Take that up to the lab
and bring back methylene blue.

Peter?

Hey. I thought
you had a fem‐pop.

Done. I'm assisting
Anspaugh on a lung biopsy

and then Shenk
on a triple‐a.

Look, I think
Romano saw us.

‐ Why? What did he say?
‐ You know how he is.

He didn't say it directly

but he told me I
should have accepted

that position at
Gloucestershire Royal.

In so many words,
he was saying

he wasn't continuing
my sponsorship.

I suppose it's a matter
of insult to injury.

Why? Because
he came onto you?

Peter, the man has
an elephantine ego.

I don't care.
I'm not going for that.

Maybe it was inevitable.

Being sponsored by him

was difficult
at the best of times.

You know what?
Elizabeth, listen to me.

He doesn't own you.
He can't do this, okay?

Look, we'll talk later.
I have to scrub, okay?

Yeah.

Good, and we'll need
to explore and see

if there's
any flexor tendon injury.

Okay, right.

Chuny, will you take the parents

to the surgical
waiting room and see

if pedes has
a post‐op bed assignment.

Doug, Dr. Nagarvala
is here to see you.

Alright. What's up?

I'm sorry to bother you

but a woman came from
DCFS, a Ms. Newman.

She said there'd been
a change in the case status

and she's taking Josh
back to live with his mother.

‐ When‐when did that happen?
‐ Just now.

I came down
as soon as she left.

None of the doctors agree.

We're going to make
a formal appeal.

No, there's no,
there's no time for that.

I need the number for the county
health department in St. Lioba.

St. Lioba, home of
the White Corn Festival.

I went there with bikers once.
They had pink corn.

‐ You ever see that? It's gross.
‐ Can't say that I have.

When you get that number,
will you just page me?

Oh, how's it going?

I got a kid with
methemoglobinemia.

Oh, that's a great case.
What was the inducer?

Tox screen was negative,
but he was on a farm.

So I'm gonna get
the local health authorities

to, um, check it out.

Are you taking care of
Dr. Chambliss and Tina Marie?

Yes.

'Cause my mom
watches them by the hour

and she called and said they
announced on the cable station

that they're broadcasting from
here live saying she's dying.

‐ No. That is not happening.
‐ 'She's not dying?'

No, and they're not doing
the broadcast from here.

Dr. Greene said no way.

'Cause she
and my aunt are sitting

next of the TV
with their credit cards in hand.

Are you guys talking
about those televangelists?

‐ Yes.
‐ Yeah Dr. Emmet and Tina Marie.

Well, they must have
some kind of clout.

I just got a call
from administration

saying we're to let
them do a broadcast.

Adele! Hey, Adele.

Hi. You're tough
to catch up to.

‐ Josh is my patient.
‐ Yeah, I read the report.

So, you understand the situation
he's in with his mother?

Sure, but there's been
a substantial change

in the environmental
circumstances.

Josh's mother now
lives with her aunt

and children's services
feels that the aunt

can take care of Josh.

Josh was born
addicted to methadone.

I know his medical history

but I've got an obligation
to return the child.

‐ Alright.
‐ Look, can you hold this?

Yeah.

We'll carefully monitor
Josh's progress.

We understand the situation.

Eve, as long as he
needs the methadone

the mother's gonna
steal it from him.

Look, I'm sorry.
He has to go home.

Oh yeah, okay, how's the aunt
going to pay for the meds?

‐ Well, he's on Medicaid.
‐ Okay, alright, yeah.

Some of these meds
are off formulary.

Now, I gonna have to fill out
a treatment authorization

request for him
to get them, right?

‐ Dr. Ross.
‐ I take him back in.

We give him an exam
and we send him home

with everything he needs.

Okay, how long is this gonna
take? Because the mother's‐‐

Long enough to fill out
some forms, that's all.

‐ Here we go, come on.
‐ Okay.

‐ Alright.
‐ Okay.

Okay, come here.
I got him. I got him.

Alright.
Alright.

Alright, well, just‐just give me
a second to lock up my car.

‐ Alright, here we go.
‐ Okay.

‐ Come on, you, you got it?
‐ Yep. Got everything.

Okay, here we go.

'Alright, Josh,
deep breaths for me.'

I'm hearing
basilar rales on the left.

Do a CBC, blood culture
and a chest film.

‐ Why? Wh‐wh‐what's wrong?
‐ Could be pneumonia.

‐ Pneumonia?
‐ You want to hear for yourself?

So what do I say
to the mother?

I mean, how long does
he have to stay?

Well, three or four hours
for the test results

and if it is pneumonia we have
to put him on IV antibiotics.

So it means
he's gonna spend the night?

Could be. Yeah.

‐ Okay.
‐ Alright.

Kid looks pretty good.
No fever.

‐ 'You sure you heard rales?'
‐ There's no rales.

‐ I'm keeping him.
‐ What's going on, Doug?

A seven month old baby
who's been admitted two times

for withdrawal I'm not
sending him home to be

a methadone source
for his mother.

Can't child services
take care of it?

I'm gonna do ultra rapid detox
and end his addiction today.

Ultra rapid?
What's that mean?

Quickly withdraw the kid
under deep sedation.

He's gonna go cold turkey
right here in the ER?

I talked to a pediatric
anesthesiologist in California.

I know the procedure.
It can be done here safely.

How long is that gonna take?

Twelve to eighteen hours.

You're going to keep him
hidden here for 12 hours?

Carol, I don't
have a choice.

Well, you can't
do it alone.

‐ Yes, I can.
‐ No, you can't.

No, I don't want you
putting anything at risk.

Yeah, well, we get caught

we'll both help each other
through real estate school.

I'm going to put him
on a cardiac monitor

and a pulse ox. I'm gonna
do an arterial line.

We're going to
need a ventilator, okay?

Okay.

Here's the second dose.

Just run that
over five minutes.

How you doing?

I feel a bit tired,
but otherwise I'm okay.

Are my mom
and dad around?

Yeah, yeah. They went
to make some phone calls.

I can have
somebody go get 'em.

No hurry.

'How's your patient?'

I mean, aside
from his color?

‐ It's improving.
‐ Good call, John.

I just got to figure out
what caused it now

see if anybody
else is at risk.

I've heard a lot
about you from Anna.

‐ Really?
‐ Yeah.

She told me you'd
become close friends.

I heard what you went
through with your cousin.

I'm sure she
was a big help.

She told you
about that, huh?

Well, you know Anna,
she doesn't keep secrets.

Yeah. I don't really see
how that concerns you, though.

Well, what she's learned
about drug addiction

she had the misfortune
to learn through me, John.

I understand
it's a private thing

I meant no offense.

No, Forget it.

‐ Dr. Romano.
‐ Peter.

I thought you were a dried
fruits and nuts kind of guy.

Nothing healthy in here.

I'm not here to eat.
I was looking for you.

And you found me.
You don't mind if I eat?

No.

So, what's up?

Listen, what
Elizabeth and I do

in our personal lives
should not impact her career.

What you're doing
in your personal lives?

And what would that be?

I know you saw us
in the locker room

then hinted to her
that she wouldn't receive

your sponsorship next year.

Now, we both know
that's not right.

Look, I, uh, I had no idea
you and Lizzie were an item.

I swear I didn't.

But don't worry.
I mean, I'm happy for you.

So you didn't see us?

No, but you're
having an affair, terrific.

Actually, it puts certain
things in perspective.

Hey.

Congratulations.

Excellent choice.

‐ Need some help?
‐ No, thanks, Lydia.

‐ I got it.
‐ Who needs a vent?

Nobody.
Uh, respiratory called.

They need it upstairs.

‐ Mr. Chambliss.
‐ Uh, Dr. Chambliss.

I just want you to know that I
think that this broadcast

from the ER is inappropriate.

Oh, I assure you,
just like I assured

your public affairs people
you'll be referred

to in the most
positive way.

‐ Dr. Del Amico?
‐ Hmm?

I want you to stay in
the room during the broadcast

and if you feel that
Mrs. Chambliss' health

is being compromised
in any way, call me.

No problem.

A little help here!

I got it.

‐ 'Alright, What do we got?'
‐ Cylla Voliotis, age 12.

Blunt trauma to the right eye.

Concussion, possible
right facial fracture.

Okay, let's go to trauma one.
You the mother?

No, I'm a phys ed teacher.

It happened on
the school playground

she was running
and hit a lamppost.

Alright, did the school
call the mother?

Uh, they're trying but

I have an emergency
consent form.

Good, good. Okay everybody,
nice and easy on my count.

One, two, three.

It hurts so bad,
I can't stand it.

I know. Don't worry.
We're gonna take care of you.

‐ Morphine?
‐ Yeah, let's start with four.

‐ Partially extruded globe.
‐ Does she have vision?

‐ Can you see, darlin'?
‐ It's all red and blurry.

Okay, how many fingers
am I holding up?

‐ Three.
‐ Good, good!

Iris and lens are intact.

No vitreous hemorrhage
or detached retina.

Okay, let's get one percent
Lidocaine with epi

Betadine and a Steridrape.

No optho consult?

No. We've done this before.

Alright, he's out.
Let's tube him.

How do we know when
the withdrawal's complete?

After 12 hours of the narcan
blocking the narcotic..

...they have
a 98 percent success rate.

When he wakes up he shouldn't
have any withdrawal symptoms.

I'm in.

‐ Pulse ox 98.
‐ BP?

'110/70.'

Good breath sounds.

‐ Heart rate?
‐ One twenty.

‐ He's a little tachy.
‐ Alright.

We'll let him
settle down a bit.

How's it going,
Cylla?

I'm scared.

Alcaine's in.

Good. Okay.

Well, you feel that?

What?

Okay, I think we're
about ready to go.

So, what kind of music
do you like?

Spice Girls.

Oh, really? Who's your
favorite Spice?

Yosh, methyl cellulose.

What is it, Sporty Spice,
All Spice?

Uh, Cylla Spice?

No. I like Posh.

Okay, good. I need you
just to hold still.

Okay, hold still.

‐ 'Sterile applicator.'
‐ 'Here you go.'

I'm just gonna
invert the lashes.

Okay.

There.

I can see a little better.

Yeah. Yosh, eye shield.

Yeah, it's gonna
be a little blurry

for a while
and a little sore.

Let me know when
her parents arrive.

She'll need
an orbital CT.

And, uh, optho
can see her.

'Praise the Lord! Yes!'

'Praise him
for his blessing'

'prompted by your prayers
and offerings.'

It is only by your faith
that I will survive my ordeal.

Only hours ago when pain
coursed through me.

'Emmet.'

Emmet, you tell them.

Brothers and sisters the Lord
has put another trial before us.

Tina Marie has just learned
from this lovely lady.

No, she's not a movie star.

This is Tina Marie's doctor.

Now, will you tell us the nature
of Tina Marie's illness?

Well, she has cellulitis
and renal insufficiency.

Uh, and what does that mean?

Um, she has a problem
with her kidneys.

‐ But she will survive?
‐ Yes.

Yes! She will survive through
the power of Christ Jesus

and by your prayers
and golden offerings.

Oh, Emmet, Emmet, Emmet.

I can feel the power
of prayer right now!

I can feel it!
It has started!

We all feel it, honey.

Do you feel it, doctor?

‐ No.
‐ Well, come on!

Here, take Tina Marie's hand.

We will have
a prayer interface.

People are watchin'
and waitin' for you, honey.

Yeah?

Feel the power of the love
that courses through us.

God, through you,
who has saved my life.

Kerry, I've got
another set of X‐rays.

Let's have a look.

Is there a name on these?

They're mine.

These are
much better images.

Did you look at these?

No.

Well, it looks clean.

Why did you order them?
Cough? Fever?

‐ Yeah.
‐ What about night sweats?

No, but I have
trouble sleeping.

Forgetfulness?

The, uh, those slides I
put in your mailbox, but, um..

Yeah, there's been
forgetfulness.

Jeanie, I want you
to know something.

Whatever your status even if you
have a measurable viral count

no one's going
to overreact.

There's going to be
a job for you here.

We should draw some blood.

‐ 'He didn't see us?'
‐ 'Yeah, that's what he claims.'

So I read him wrong and
you told him all about us?

I told him our lives
are none of his business

and nothing that we do should
affect your standing here.

You got heavy with him.

Yeah.

I don't know, maybe I should
have kept my mouth shut.

Well, taking up my cause
was very gallant of you, Peter

but it seems
we've gone public.

Good breaths sounds
bilaterally.

Heart rate's down
to a 100 pulse ox 99.

He's stable.
Let's start a second line.

I want to be ready for anything
before we give him narcan.

'Are there gonna be
side effects?'

It could make him
hypertensive.

We have Nipride,
but no Esmolol.

I want both ready
on drips.

‐ I'll go get them.
‐ 'No, I'll do it.'

Kerry Weaver might wonder

why you're here
after your shift.

Suction.

Lizzie, can you
retract distally?

Good. I've got
the room I need.

Now, we can all settle back.

So, Shirley,
let me ask you something.

Suppose you asked
someone out on a date..

‐ I'm married.
‐ Yeah.

Just hypothetically,
we have a lengthy procedure.

So, you ask this person
on a date and they beg off

claiming they don't
get involved

with fellow colleagues
from the workplace.

‐ You've got some oozing.
‐ I've got it.

Then you find out this person
is having a love affair

with a fellow colleague.

Now, why do you
suppose they lied?

The fellow colleague
is married.

A married person's response

but let's say
that he's not married.

They didn't want to offend
someone's overblown ego.

That's a thought.

But suppose this person
made up that silly story

about keeping sex
and work separate

just so they could continue
playing the field?

That's absurd.
Clamp again, right here.

I don't‐don't know.
Shirley?

I agree. They're probably
still shopping around.

I thought your shift
ended hours ago.

Yeah, I got involved.

Esmolol?

Teenager with
a tachyarrhythmia.

How about Adenosine?

Already tried it.

Lasted for
a few seconds.

I got it under control.

Dr. Carter, I just got
this fax for you.

Mm.

This is the explanation
for the, uh, methemoglobinemia.

‐ Really?
‐ Yeah.

It's from a, uh,
local health service

near the grandparents' farm.

See, ground water
from several local areas

has been found to have heavy
concentration of nitrites

due to an inorganic
waste contamination.

Oh, I'd draw blood
on the parents.

They might be borderline.

Yeah, I did that already.

I'm just waiting
on the test results.

Randi, did you get
labs back on Chambliss?

Yep, they're in here.

Thank you.

Is that a pedes case?

If it is,
I'll put it in my study.

Sorry. It's a repeat glucose
on the televangelist.

Oh. I heard you
looked great on TV.

Someone saw me?

The nurses, they had
it on in the lounge.

What a nightmare.
They're total frauds.

Not serious?
But I‐I phoned in a big pledge.

Uh, the woman
used her disease

to‐to milk money
out of poor people

who probably
believe all of it.

It's a living.

You know, at least
they're not practicing law

or polluting streams,
selling insurance.

So, what's the,
what's the deal on getting

a genuine Philly cheesesteak
in this town, huh?

Forget about it. I've looked
everywhere. They don't exist.

How about an Italian. I'm on
a very substantial per diem.

And I'm on call.

Well, if you're still
partial to Chinese take‐out

how about a candle‐lit dinner
for two in the doctors' lounge?

Sure, I'd love to.

Uh, Jeanie, when you have
a minute, could I see you?

Sure, Kerry.

You can go now,
I'll bandage him up.

Thanks, Yosh.

I got your labs back.

I'm very happy to say
it's all good news.

Your viral load remains
non detectable.

Your white count's normal
and you're not even anemic.

Guess I was getting myself
worked up over nothin'.

I can understand.

But remember,
I took responsibility

for monitoring your health

so you shouldn't be
on your own looking at X‐rays.

Yeah, you're right.
That won't happen again.

What do you think
about the forgetfulness?

Yeah, well, you've
complained of sleeplessness.

I haven't slept much
in the last month.

Have you been taking anything?

Well, lately,
I've been taking Halcion

which could explain, okay..

The fact is, Jeanie

I mean, you've had
such a rough time

with Al moving away
and‐and Scotty..

...that alone could
explain your symptoms.

Yeah, you're right.

If you ever want to talk..

Thanks, Kerry.
That'd be good.

I'd like that.

Good.

The figures are ten percent
above our projections

and I think there'll be real
cassette sales on this one.

Well, what about
next time?

Do I die on the TV?

Don't make stupid jokes.

Um, your blood sugar's
still elevated.

I need to give you
a little more insulin.

Uh, I'm gonna make some
phone calls, sweetie.

How often do you, uh, test your
blood sugar at home, Tina Marie?

Oh, um, what‐what's that
you're supposed to do?

Um, oh, four times a day?
I don't know.

To prevent
complications, yes.

Well, what kind
of complications?

Um, blindness,
heart attack

loss of peripheral
circulation.

Well, those are all
good prayer vigils.

I'm not joking.

You need to take
responsibility for your health.

Take your problem seriously.

Honey, my problems
are all I got.

You mean, you wouldn't
make a living without them?

Well, I sure as heck
wouldn't have Emmet.

You're such a lovely thing.

Are you married?

No.

Emmet and I were married
when we were in high school.

Oh, we were crazy in love.

You'd never know it
to see us now, would you?

It's not for me to make
a judgment about that.

I tell you one thing,
Emmet won't leave me.

Ever.

God has..

...has given me
the way to keep him close.

He may not love me..

...but he loves the way
caring for me makes him look.

Well, I wouldn't be
in a marriage without love.

Oh, honey,
everyone thinks that..

...but things change..

...and you make do.

So be careful.

Thank you.

So, I suppose
the Coq d'Or's a bit dressy.

Yeah, uh, but you know what?

Actually, I didn't
make reservations there.

‐ Our date's off?
‐ No, no.

We're going
to the Velvet Lounge.

That's fantastic.

You know, people are gonna look
at us like we're crazy, right?

Yeah, but you know
that doesn't bother me, Peter.

Yeah, well, I wish
I could say the same.

Look, I can't change what
I am any more than you can.

Whatever feelings I have
for you are based on..

...on who you are

not what I want you to be.

Elizabeth, you're not from here.

'I mean, you know what, you
didn't grow up the way I did.'

Yeah, I wish I could
say one, two, three

and all my feelings
about your skin color

would disappear,
but it doesn't work like that.

‐ Do you understand that?
‐ Yes.

But I don't want
to subject you to something

you're not ready for.

You know, I've never
met anybody

that makes me laugh or blush
or whatever the way you do.

I‐I‐I'm trying to
work through this

but, you know,
you've gotta trust me, alright?

Mm‐hmm.

Come on, let's go
to the Velvet Lounge.

Hey. Philly cheesesteaks.

Right here. I found them
in Chicago and they deliver.

Can you believe that?

You want one?
More than enough.

No thanks.

Oh, come on, you get
a free angioplasty

with a small order.

Free quadruple bypass
with the dinner special.

No?

Listen, I was
wondering, maybe, uh..

...you'd like to join Anna
and I for dinner sometime.

Ah, you really want
an ally, don't you?

No. It's about
your friendship with her.

I don't want her
to cut herself off

from people she likes.

Make it easier for her
to go back to you?

Am I hearing jealousy?

Maybe once, but not now.

It's just that I
think that you're trouble.

'Maybe I'm wrong.'

Sort of hope I am.

But that's what I think.

So I might laugh
at your jokes

and never give you any
indication of how I feel.

'But I wanted you
to know that.'

Enjoy your dinner.

Hey, Mark, you know,
I've been thinking

there's a storage area
off the hallway

that could be outfitted
as a pediatric exam room.

The janitor's closet?

It's small, but children's
beds are small.

And we could hang
the IV bags up on

those hooks they use
for the brooms.

Uh‐huh, this is a joke.

Well, maybe
I'm just facing reality.

I mean, you're
obviously behind the idea.

You gave Dr. Rosher
a grand tour.

Yeah, and by the way,
he was very impressed

with the way we handle
our pedes cases.

Oh, Mark, Doug is your friend.

You‐you think Rosher's report

will help him get
an attending position.

I appreciate loyalty.

I just don't think it should
be at the expense of the ER.

My friendship with Doug
has nothing to do with this.

I don't happen
to believe that a pedes unit

or a pedes attending in this ER
is a big improvement.

Dr. Greene, uh, Jeanie wants
you to sign off on a suture job.

Will you go on record
with that to Anspaugh?

Yes, absolutely,
when the time's right.

Where is she?

Pulse ox 89.

What's going on?

Decreased breath sounds
on the left.

Maybe it's a collapsed lung.

Should I get
a portable X‐ray?

Well, it can't be.
His pressure's not that high.

Put him
on 100 percent oxygen.

Could be a mucous plug.

I'll get a suction catheter.

Looks good.
Infected abrasion?

‐ Right here.
‐ She cleaned it up good, huh?

I'll change the dressing
when you come in to see Haleh.

Sure. On Thursday.

'It's the secretions, let go.
Hook up the vent.'

'Pulse ox 98.'

What the hell's this?

Let me explain this to you.
This boy is my patient.

Ketamine drip.
What are you doin' in here?

I'm doing an ultrarapid detox.
Everything's under control.

'Like hell it is.'

Is this baby even
a registered patient?

‐ Mark, he‐‐
‐ Is he on the board?

If you just let me explain
the circumstances, the mother‐‐

You don't have
consent, do you?

You've got an intubated kid
under deep sedation.

'Mark, Doug's got
this under control.'

We've gotta move
this kid.

You're not even gonna
hear me out on this?

‐ No, I don't need to.
‐ BP's 190/100.

I tried .3 mics
per kilo per minute.

Gina, bag him.

Alright, let's get
to the PICU.

We can do it right here.

‐ Where's the chart?
‐ I don't have a chart.

Is this how you practice
medicine? Let's go.

Right here, I wrote everything
down on that piece of paper.

Oh, that's great, that's great.

I don't believe this.
Inga, call the PICU.

Tell them we've got
a critical patient coming up.

‐ I'm gonna need a name.
‐ What's the name?

Listen, we don't have
to do this.

‐ What's the baby's name?
‐ Josh McNeal.

Baby McNeal,
about six months old.

‐ Ketamine drip, intubated.
‐ What's going on?

I found Doug in exam four
detoxing this baby.

‐ What?
‐ I found him by accident.

Carol, did you know about this?

‐ I was helping him.
‐ Helping him?

The baby was stable‐‐

Yeah, this is a violation
of every ER policy.

They've got a bed
ready in PICU.

Tell them I'll bring him up,
set‐up with basic too.

‐ I'm going up with it too.
‐ Yeah, you're damn right.

You're going,
you're gonna explain this

to the hospital
administration

and the executive
committee.

‐ Let's go!
‐ 'You lied to me, Doug.'

You looked me right
in the face and lied to me.