ER (1994–2009): Season 4, Episode 22 - A Hole in the Heart - full transcript

Previously on "ER.."

Peter?
Oh, hi, Lizzie.

I think it's about time you
and I had a little sit down.

‐ Is there a problem?
‐ Am I hearing jealousy?

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

What about his
heroin addiction?

Uh, it wasn't heroin.

It was pain killers,
Percocet.

I'm gonna do
an ultrarapid detox.

I'm gonna end
his addiction today.

You're gonna keep him
hidden here for 12 hours?



Found Doug in exam four
detoxing this baby.

What? You're going
to explain this

to the hospital
administration

and the executive
committee.

'You lied to me Doug.'

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

That is not fair, Doug.

You never would
let me do this

in the ER,
no matter what I told.

Yeah, you didn't even have
the ability to monitor.

EKG, pulse ox,
end title CO2

and invasive BP
with a radial art‐‐

You never got consent.

Consent from who? A mother
who chugs his methadone?



DCFS would have
followed through

you let someone
else do their job‐‐

Followed through for what?

A child whose development
is already stunted?

Been expecting you. Your desk
clerk called a minute ago.

‐ Admit orders?
‐ There aren't any.

Here's everything you need
is right there.

Start him on labetalol,
titrate point five

q five minutes
to a diastolic of 60.

Hey, Doug. Alexander Babcock,
pediatric anesthesiologist.

Kerry weaver, acting chief
of emergency medicine.

This is Josh McNeal,
seven months old hypertensive‐‐

This boy was born
addicted to heroin.

His mother's been stealing
his methadone.

I put him
on an ultrarapid detox.

Wow, I've heard
a couple of those

being done across the country.

Then you know, it's still
an experimental procedure.

BP is not bad, 150/90.

This boy needs
to be stabilized

and put back
on methadone

until administration
and legal can review this case.

‐ What did you use to induce it?
‐ Ketamine.

Until he's stabilized
and then narcan for the detox.

‐ Propofol's better.
‐ Yeah, I agree.

We just didn't
have it on the ER.

No, but we got it up here.

Kit, let's DC the ketamine.

'And start him on
three migs of Propofol'

and then 150 mics
per kilo per minute.

You're continuing with this?

'The approach seems
medically reasonable.'

And if it gets the boy
off the methadone‐‐

You cannot perform
procedures

on children
without permission.

Dr. Ross may have
gone overboard

but it seems
in the best interests

of the child to complete
what's been started.

'Who's gonna be on
for the follow through?'

I am. I'm off work till
tomorrow, so I'll stay.

'Okay. Excuse me.'

Your actions are
totally irresponsible, Doug.

You've broken every rule and
regulation we have in the ER.

Whatever happens here
won't change that.

...make sure
that this boy

gets a decent
shot at a normal life.

I don't care about
your rules or regulations.

I hope you
also don't care

about being an ER
pediatric attending

because you've just given up
any chance of that.

‐ Mark, 7 o'clock.
‐ What?

7 o'clock. Rise and shine.

Oh.

Listen, did you hear from
the, uh, PICU about that baby?

Haleh just went off duty.

She didn't mention anything.

Am I supposed
to wake up Dr. Weaver?

Ah, she stayed, too?

Uh, snoozing in exam four.

‐ Ah, let her sleep.
‐ 'Come on, girls.'

‐ Oh, sweep, sweep, sweep!
‐ Oh, Randi's in my way!

I'm supposed to be
in the front!

‐ Curling, Jerry?
‐ We were inspired by Nagano.

Only three years and nine months
left till Salt Lake City.

These crazy white folk.

Hey, Mark, you and Dr. Weaver
having a slumber party?

No, not exactly.

Did you hear
anything from Doug?

No. Not since
the fireworks.

Is that why you
spent the night?

Uh, I was just nostalgic
from my residency.

I thought Carol was
working this morning.

She is,
but she's on a break.

There's no new patients
on the board.

‐ Why'd you wake me?
‐ Haleh said 7 o'clock.

I think that was
for Dr. Weaver.

Oh, forget it.
I'll just get some breakfast.

Uh, listen, can you
call Anspaugh's office

and find out what
his schedule is this morning?

I need a meeting
with him as soon as he can.

Okay.

'You didn't answer
my question.'

'I have no idea
how they got their name.'

But the drinks
go down so smoothly

at the Velvet Lounge.

I wouldn't know that.

Ah‐ha, that's what
this is about.

I was drinking
and you weren't.

You know I don't drink.

Yeah, and you think
I drink too much.

Oh, damn it.
We missed the 7:10.

Well, that's okay,
we can get

the next one
and cross over at Madison.

No, I can't. I told you.

I've gotta go to Carla's
and pick up Reese for daycare.

Are you always like
this after a night out?

What? You know,
we saw the whole show.

I don't, I don't think we
needed to stay for another set.

I thought we were
having a good time.

We were.

Until I made
that song request.

The look on your face.

Elizabeth, you know,
there's some places

that you go to listen
to the music, just listen.

Oh, so it's not
like the pub

where you can
play darts

nobody cares if you
drink too much

or put something
stupid on the jukebox

or even dance, God forbid.

I'm just saying a place like
that it just wasn't cool.

Well, if you ask me being cool
seems somewhat limiting.

You taking this one?

Uh, yes, I think I will.

Uh, I'll see you in there?

‐ Yeah.
‐ Okay.

Why didn't you wake me?

I have a meeting
with Anspaugh at 8:00.

We woke up Dr. Greene
by mistake.

But now he's gone
for breakfast and we just got

two bounce back migraines.

Yeah, one of which
could be mine.

A guy with fractured
clavicle complaining

of coldness to his hand
and a suicide gesture a guy with

uh, superficial intension
marks to his left wrist.

Well, who else is on?

Well, Del Amico, Jeanie and
Carter are due any minute.

In other words, they're late
and I'm the only one here.

Why is that?

‐ Uh..
‐ Thank you, Lydia.

Be right out.

Carol, thought
you might want a refill.

Oh, I've just got one. Thanks.

Heard it's supposed to rain.

Do you wanna talk
about last night, Mark?

It's very serious
what Doug did.

You mean what we did,
don't you?

I think people understand

that it's the nature
of your job

to assist a doctor
when they ask you.

I was there 'cause
I wanted to be there

not because Doug asked me.

I'm sure you were.

Doug can be pretty
passionate about these kids.

Oh, give me
a little credit, Mark.

What do you think,
I am some fresh‐faced

nursing student
under the great doctor's spell?

I'm only sayin' that
legal and administration

are gonna be going over
every detail of this case

and I'd hate to see it
reflect badly on your record.

So you're saying I should
fudge my involvement?

Tell the truth. Tell them
you were doing your job.

A nurse assisting a doctor.

The truth is,
I insisted on being there

because I believe
Doug was working

in the best interests
of the patient

and that's my job,
every bit as much as it is his.

I gotta get back.

We practically had our noses
pressed up against the glass.

The tracks
were right beneath us.

It was unbelievable.

You've never
done that before?

No. I didn't even
know you could.

All you have to do is ask.

‐ Hey.
‐ Hi.

Hey, Carter, have you
ever ridden in the front car

of the El, huh,
with the driver?

I don't think so.

Anna and Dr. Rosher just did.

‐ Max, please. Max.
‐ 'Max, see you.'

‐ Well, that sounds exciting.
‐ Yeah.

Uh, Max just asked
the guy if he could

and he said sure.

Pretty clever.

Well, thank you, John.

I can see you're
gonna give me that one

but maybe not
the next one, right?

I gotta go pry a kid's leg
out of a shopping cart.

'Call maintenance,
good set of bolt cutters'

'usually does the trick, right?'

It does feel cold.

That's what
I've been saying.

It's the damndest feeling.

Nails are cyanotic,
cap refill's poor

and he barely has
a radial pulse.

That doesn't sound good.

Well, I want
to get an ultrasound

and possibly an angiogram
to rule out a blood clot

which might be cutting off
the blood supply to your hand.

Sure, whatever you need to do.
I've got great insurance.

Well, you'd get excellent care
here even if you didn't.

Kerry, can I talk
to you a minute?

Of course, Lily, can you get
consents for Mr. Wass'

procedure
and schedule it, please.

Okay.

I've got a call
in to Anspaugh's office

to talk about this
Doug Ross situation.

Yeah, I'm gonna see him
in a few minutes.

I think, both of us should
be involved in this.

No, my meeting's
about something else.

It's been on his calendar
for a couple of weeks.

I'll set up another for
the two of us while I'm there?

Make sure you
let me know what time.

Don't worry, Mark.
I will.

Randi, send home
the rule‐out appy in three

with a diagnosis
of constipation.

I don't suppose there's a good
trauma on its way, is there?

No, but this letter
came down for you

from Dr. Romano's office.

He's a weird little dude,
ain't he?

Did he drop
this off himself?

No. It was his
secretary, I think.

Where is he now,
do you know?

It's not really my job to keep
track of stuff like that.

On our way in on the El today
he drank all of his juice

without spilling a drop.

‐ Go ahead and play.
‐ Yeah.

There you go.

He's not crying‐‐

Is he pretty responsive
to you these days?

Well, as responsive
as a one‐year‐old can be. Why?

Sometimes it's hard
to get his attention.

I was wondering if maybe
you'd had his hearing checked.

‐ What?
‐ Uh, it's not a problem.

Just things we notice.

Reese.
Reese, come here, man.

Come here. Come here.

Aw. I know, I know, shh.

‐ Seems pretty responsive to me.
‐ Hmm.

Okay, you know what,
he probably just gets distracted

by all these other kids.

Okay, okay. Got to go.

Listen, um, Carla's gonna
pick him up around 4:00, okay?

Sure. That's fine,
Dr. Benton.

Oh, who's hiding?
Who's hiding?

'Hi, Reese. What are you
playing with today, huh?'

Well, it just feels
so ridiculous.

I never really meant
to kill myself.

So it wasn't
just an accident.

Um, well, you see,
my wife and I

we had a fight,
you know, and, um..

...so, I went out
to my workshop.

Uh, I brought a glass
of orange juice with me..

...and I dropped
the glass and, um..

...when it broke,
there was a shard lying there

and I just...you know,
I don't know

because I was just so angry.

So it was impulsive.

It was stupid,
is what it was.

I worried the hell
out of my wife.

Although it's nice
to know she cares.

Mr. Nable, this is
Jeanie Boulet.

Hi. I'm a physician assistant.

I'm gonna be
suturing up your cuts.

Shouldn't take more
than a couple of stitches.

And we have
a psychiatric resident

coming down
to talk with you.

Oh, I'm fine, okay?

I, uh, this was just a mistake.
I really don't need that.

We're sure it was but it's
required in a case like this.

Oh, man.

Kerry.

‐ Hi.
‐ 'Hi.'

We're just finishing up here.

'Doug Ross called
an emergency meeting

to fill us in
on the case of Josh McNeal.

I'm familiar with it.

'Because of the unusual
circumstances'

I thought it was best
to bring everybody up to speed.

'Doug has admitted to clearly
stepping over the line here.'

But at least he
prevented the baby

'from going home
to his mother .'

'Anesthesia and pediatric
should have been'

involved from the get‐go.

Yeah, and he should've
gotten the mother's consent.

'Probably wouldn't
have gotten it'

'if it meant losing
her source for methadone.'

'I know that Max is doing
the feasibility study'

on an ER pediatric
department.

I didn't want to do
anything to jeopardize that.

Uh, even if I'm not involved,
I think, it's s‐still

the best thing
for County General.

Doug, I don't want
to minimize

the ramifications
of this but I do thank you

for coming forward so quickly.

Okay, sure. If you'll excuse me
I wanna get to PICU.

'Doug, thanks.
We'll talk.'

Uh, Don, I don't think
I need to tell you

that Doug Ross'
actions violated

every policy we have
regarding patient care.

I know, and there'll be
a full review and QA.

It may not go
so well for him

but, uh, I must say

he's certainly there
for his patients.

Anyway, I'm sorry this
has eaten into our time.

What is it that you wanted
to talk to me about?

Well, uh, as you know,
when David Morgenstern

had his MI last fall
I took over as acting chief

of emergency medicine.

And you've done
a fine job, Kerry.

With the exception
of that little

Ellis West, Synergix fiasco.

With Dr. Morgenstern
having resigned

it seems appropriate
for me to now step up

and be chief
of emergency medicine.

Well, the department is
running quite well

and we certainly owe you
a debt of gratitude

for jumping in
the way you did.

Well, I think everyone's
responded to my authority

and there shouldn't be a problem
with a simple change in title.

Well, I'm glad
to hear that you'd like

to be considered
for the position.

We will of course
be doing a national search

for the best candidate,
but I'm happy

to have you throw
your hat in the ring.

A national search?

County policy,
as I'm sure you know.

Excuse me.

Don Anspaugh.

‐ How's he doing?
‐ Pretty stable.

Turned off the Propofol
a half hour ago.

When's Doug gonna extubate?

Well, I figured I'd give him
a couple more minutes.

‐ Hey.
‐ Hey.

I was in the middle
of a pretty decent dream.

‐ Was I there?
‐ Mm, big time.

You think I did
the right thing?

Yeah, I do.

Even if we both
get fired for it?

Well, you know..

...that would just be
icing on the cake.

Kit, you ready to extubate him?

He's breathing spontaneously.

Vitals?

Afebrile.
BP's stable, 90/70.

Alright.

Suction cath.

Okay, buddy.

'Prove us right.'

Get ready to bag him.

I'll do it.

Okay.

Here we go.

Pulse ox?

Holding steady, 98 percent.

Do you think
he's gonna make it?

Too soon to tell.

Shirley, I'm looking
for Dr. Romano.

He's not here.

Well, do you have
his surgical schedule?

No, I mean,
he's really not here.

He went to some
head‐and‐neck conference

in Costa Rica.

He doesn't do
head‐and‐neck surgery.

Maybe he wants to learn.

Maybe he's just
playing golf.

When's he due back?

Teresa does all
the travel scheduling.

Well, that's lovely.
Where can I find her?

Right here, except
she's on a break.

I wanted to bring you
up‐to‐date on a patient

we got a seven‐month‐old boy
born addicted to heroin.

His mother was stealing
his methadone.

You know the case?

Doug Ross briefed us
with your chief of staff

and bunch of the pedes
muckety‐mucks.

So there was a meeting?

Kerry Weaver, I'm sure
can give you the highlights.

Anspaugh stayed pretty calm,
but, man, I got to tell you

if that had
happened at Chop

Doug would've
been out on his ass.

Anyway, I got
to go to chart hell.

‐ Carol, you seen Kerry?
‐ No. Sorry.

We were concerned
when you expressed your anger

in such a self‐destructive way.

Look, I know I should handle it
better, okay and I will.

But I really don't
wanna stay overnight.

Look, I'm not
a crazy person, okay?

‐ This was just stupid.
‐ Okay.

Um, I just need to talk to you
just for a minute, Dr. Myers.

Excuse us a moment.

‐ He doesn't want to stay?
‐ Nope.

And I don't really have
a reason to keep him.

Well, I just pulled up
his old records.

He's been here three times
in the past year.

Migraines,
abdominal pain, back pain.

You think he's drug seeking?

I think they're signs
of wanting help.

There's no doubt he's depressed

but that's not grounds
for admission.

Hell, I'd have
to admit half the city.

So you're just
gonna release him?

He's responsive.

He doesn't seem
suicidal or psychotic

and he's willing to come into
the psych clinic for follow‐up.

I just wish there
was more we could do.

Guy's fighting with his wife,
job's not going too well.

‐ Like I said..
‐ I know. Half the city.

Dr. Carter,
you seen Dr. Weaver?

Usually, she's everywhere.

Hey, Dr. Greene,
do you think it's too late

to reconsider
my ER residency?

Oh, it's that time of year, huh?

You getting bored?

Well, I just spent my morning

cleaning out
an old guy's ears

and dislodging
a five‐year‐old

from a shopping cart,
and, uh..

Any unsickly patient
is fine with me.

Stop complaining,
Carter.

By 9 o'clock,
I'd been puked on twice.

Yes, but I also did two
bowel disimpactions.

Either one of you wanna
answer the phones instead?

Carter, why don't you take
the coma patient in four?

Hey, Dr. Greene.

Paramedics on their way
in with a double trauma.

‐ Double?
‐ Yeah.

Two Elvis impersonators

crashed into Lake Michigan.

‐ Sounds cool.
‐ Ooh.

Maybe, Dr. Greene,
I could, uh..

No, take the coma patient.

Jeanie, Anna.

How about getting
a handle on the Elvi?

Okay.

'Pick an Elvis. Any Elvis.'

We got your over‐the‐hill Elvis.

We got your Junior Elvis,
parachuted out of a plane

supposed to land
on a Navy pier.

Lines got tangled,
splashdown is in the lake.

But that freaky little twerp was
up there picking his pimples.

He can't skydive
to save his life.

Yeah, well, at least
I can do Elvis.

It's more than I can say
for your old cracker face.

Listen, you little fathead,
I was doing Elvis

before you was even born.

And I'll be doing him
after you're dead.

Shall we?

You need to undergo

anticoagulation therapy

in order to prevent
any further clotting.

Here in the hospital?

Not necessarily.

There's a fairly
new drug, Enoxaparin

which you inject
under the skin

in your abdomen
twice a day.

My wife's a nurse.
I guess, she could do that.

You're an excellent
candidate for the medication.

Otherwise, you'd have
to stay in the hospital

for at least
a couple days.

No way.
I don't want to do that.

I'll take the drug.

Okay, good.

'Kerry.'

I need to talk
to you now.

Sure.

Nurse Jarvik will see
that you're discharged.

‐ Sure. Thanks.
‐ You're very welcome.

What do you got?

Oh, two jokers
fell in the lake

out of an airplane
or something.

Listen, that Doug Ross meeting
happened this morning.

‐ It sure did.
‐ Yeah.

Well, I asked specifically
to be notified.

Yeah. Well, hey, Mark,
nobody told me either.

I just walked
in on it.

You know, you could've
mentioned something to me

so I didn't have
to hear about it third‐hand.

I had a few patients.

Can somebody give
the bullet, please?

‐ I already gave it.
‐ Well, give it again.

Uh, Junior Elvis‐‐

Uh, Jeanie,
Kerry and I've got this.

‐ Why don't you go help Anna?
‐ Gladly.

And tell that wannabe
his "Heartbreak Hotel"

sucks the big one.

'...oriented and alert,
vitals normal.'

'BP 120 over 70.'

Cap refill's fine.

BP's high,
180 over 120.

‐ Good luck in here.
‐ Better here than in there.

Those two are
making these Elvis'

sound like boy scouts.

♪ Well since my baby left me ♪

♪ I found a new place
to dwell.. ♪

Chuny, let's spin a crit
and dip the urine.

You want a chem‐7?

Sure.

So, why didn't
they tell us?

Well, why don't you
ask your pal Doug?

Do you think there's going to be
an inquiry into that case?

Well, hopefully,
Doug will let us know.

Why are you angry
at me about this, huh?

I didn't detox a baby
and not tell anybody about it.

No, but always
giving him an inch

you let him
get away with a mile.

So this is all my fault.

You know,
it's not a question of fault

Mark, it's a
question of style.

I mean, you close your eyes

and you hope these
things will disappear.

Here.

And whenever I try
to come down firmly

on an issue,
you tell me to pull back

you fight me,
and it'll just disappear.

Well, it's not disappearing
this time, is it?

Kerry, I don't think this is the
time or place to discuss this.

Chuny, let's repeat
a BP, please.

Mm‐hmm.

Oh, Mrs. Lang,
this is Dr. Carter.

How do you do,
Mrs. Lang?

I've just been going
over your chart.

I see that your husband has..

I couldn't wake Bill
up this morning.

He was diagnosed
14 months ago

with brainstem
glioblastoma.

They tried to do
radiation therapy

but that didn't work.

He's had some visual
disturbances

and some paralysis

but we were not
expecting this.

Well, we are gonna do
everything that we can.

'Carol, let's order
an MRI with gadolinium'

'and let's get in
a neurosurgery consult'

and the oncology fellow
on call.

Sure.

I hope it's okay
we opened up the window.

Bill, he just loves
the smell of the rain.

It's fine, Mrs. Lang.

Last time I complain about
a kid in a shopping cart.

‐ What?
‐ Never mind.

‐ Oh, hi, Adele.
‐ Hey, Carol.

This is Vicki McNeal.

This is Josh McNeal's mother.

Baby Josh. Right. Hi.

'She'd like
to see her son.'

‐ Okay, thank you.
‐ Dr. Benton.

Listen, Randi, an audiologist
is going to call.

An audi, what?

Someone who does hearing tests.

Just write it down
for me, please.

Okay, but we've
got an MVA coming

at the back door.

A Mazda versus
a milk truck.

I'm just signing charts.
I'm not covering the ER.

I know. But I can't
locate Dr. Corday.

I called upstairs
and they said something

about her checking out
Costa Rica.

‐ What?
‐ That's what I said.

About the MVA?

Uh, damn it.

Alright, Dumar,
what do we have?

Sam Wiser, 32, head‐on TC,
passenger space intrusion

with head, neck
and abdominal trauma.

Did she say anything
about consent?

I don't even know
what Adele told her.

Ms. McNeal.

Is he going
to be alright?

'Well, he's stable. His blood
pressure's holding steady.'

He's pretty sleepy,
but that's to be expected

after a prolonged sedation
and intubation.

'What's intubation?'

That's when they
put a tube down his throat

to help him breathe.

He was asleep while
they were doing it

so he didn't feel anything.

I explained to Vicki
about the ultrarapid detox

'and how the drugs
will be out of his system.'

She said Josh
will be able to sit up

like other babies of his age.

We have every reason to believe
he'll be able to catch up.

The procedure went well

so we just have
to wait and see.

So what I wanted
to know then, Dr. Ross, is..

...could you do
the same thing for me?

I'm gonna kill you.

Why? You offered.

Did you get
my patty melt?

Yes, I got your
patty melt.

Hey, will you, uh..

Will you help
this gentleman here?

He's‐he's looking
for Dr. Weaver.

Sir.

Can I help you?

Yes, I'm looking
for Dr. Weaver.

Dr. Weaver?

Mr. Wass,
what are you doing back?

The pharmacist couldn't
fill the enoxaparin.

It's $500, and he said

my insurance won't cover it.

They'll only cover
something called

Heparin or...Comadin?

‐ Coumadin.
‐ Is that what I should be on?

No, you need to be
hospitalized for those.

You know, I'll call the
insurance company

and straighten it out.

Randi, could get Mr. Wass'
insurance information

and put a call in, please?

Carol.

You know, I had a meeting with
Dr. Anspaugh this morning

and there is going to be an
executive committee review

of the Josh McNeal case.

Yeah, Doug told me.

Yeah, I think it would be
in your best interest

to document your
participation

while it's still
fresh in your mind.

Oh, that experience
isn't going away any time soon.

No, you should hope neither
you nor Doug Ross is, either.

Dr. Weaver?
Mr. Wass' insurance?

Thank you.

Yeah, it's Dr. Weaver.

No, no, no.

I don't want
the claims department.

I need a medical supervisor.

Mrs. Lang?

MRI is backed up.

It's going to be
a little while longer.

I've got
Nurse Hathaway checking.

He is going to wake up,
isn't he?

I mean, his doctors thought
we had longer than this.

We really
won't know anything

until we get those
test results back.

Is there a phone
that I could use?

I want to call
my daughter.

She's a freshman
in college.

Tulane Drama School.

She didn't want to go
because of her dad

but Bill, he insisted.

He said that it was enough

that his life
was being put on hold.

I don't know.

Maybe we made a mistake.

'Looks like an avocado.'

Dr. Corday!

Sorry, I'm late.

I understand you were
on trauma call

when Mr. Wiser
was brought in.

'Yes, but Dr. Benton was
kind enough to cover for me'

'while I was away.'

You've reviewed
the chart, of course?

'Avulsed gallbladder.'

Can I get some
suction here, please?

Let's say you find
a significant pancreatic injury

crushed duodenum
and common bile duct.

What are you
going to do?

A whipple, of course.

which, as I think you know

I performed solo back in England

prior to my fellowship.

Yes, I think I did know that.

'And speaking of fellowships'

I wanted to ask you,
Dr. Anspaugh

about the possibility
of sponsorship for next year.

You don't want
to continue with Dr. Romano?

It seems Dr. Romano doesn't
wish to continue with me.

What?

Yes, he served me
notice this morning

and apparently he's unavailable

at some head‐and‐neck conference
in Costa Rica.

I'm afraid it's too late
in the year to arrange

another fellowship
at County General.

We're way beyond
the application deadlines.

I was hoping there might be

some sort of
individual consideration

seeing as I've already
spent a year here.

'The committee always
seems to frown on that.'

You definitely want to stay
in the United States?

Very much so, yes.

'If it's just staying
in America you want'

you could always
find Joe Schmo to marry you.

Shirley.

Sorry, Dr. Anspaugh.

‐ Dr. Weaver?
‐ Your guidelines are wrong.

My patient needs
anticoagulation therapy

and there's no reason for him to
be admitted to this hospital.

‐ Dr. Weaver.
‐ What is it, Jerry?

They just brought
that renal‐failure guy in.

Okay, tell them to get started
and I'll be there when I can.

You know,
I would like to get your name.

Rufhauer? Rufhauer.

Louis Palmieri, 84,
end‐stage renal failure.

Found in bed
in full cardiopulmonary arrest.

His femoral dialysis catheter
had been disconnected

and he exsanguinated through it.

Sheets were drenched with blood.

Is he going to be alright?

Would you stand back,
please, ma'am.

No pulse, no heart sounds.

Intubated in the field. Gave him
two amps epi, two of Atropine.

Reattached saline to the
catheter, ran in two liters.

That does it.

‐ Still no pulse?
‐ No.

Amp of bicarb
and high dose epi

five milligrams.

Please be okay, Louis, huh?

No heart sounds. He's PEA.

Well, let's spin a crit
and get four units o‐neg.

Want to try
a transthoracic pacemaker?

‐ 'May as well.'
‐ What are you doing?

Trying to get
his heart going.

‐ Turn up the gain.
‐ You a relative?

‐ Not exactly.
‐ It's not capturing.

I know, but you did
come in with him.

Yeah. I drop by his house

a couple of times a week.

Mrs. Lang..

...your husband's
MRI results are done.

The tumor is blocking his, uh..

Is creating a blockage

that's increasing the
inter‐cranial pressure.

‐ And that's causing the coma?
‐ Yes.

So can it be unblocked?

Yes. A neurosurgeon
can perform a ventriculostomy.

So Bill could
come out of this?

He could. Um..

The outcome is problematic.

Your husband would have
very little time

and it may cause him
a great deal of pain.

And he would most likely die
of respiratory failure.

But Bill would wake up?

I mean, I could talk to him
again and he could hear me?

Yes.

Or he could stay
the way he is now

and die peacefully.

She wants to handle
the funeral arrangements?

Says he has
no family.

What's her relationship?

Friend.

I don't want
to sound judgmental

but she looks
like a hooker.

She is. She's been, uh,
attending him twice a week.

Mm‐hmm. Did you say
he had a Foley catheter?

Yeah.

Excuse me, Ms., uh..

Myra.

Ms. Myra. I wonder if you could
tell me exactly what happened.

I've been seeing Louis,
Mr. Palmieri

twice a week now,
for the past couple of years.

It wasn't a lot of money

but then I was only providing

a little manual relief.

But today,
my charm bracelet here

got caught
on that little tube

and when I pulled back,
the whole thing popped out

and the next thing I know
is there's blood everywhere.

So I called 911 right away.

‐ I see.
‐ 'Dr. Weaver.'

They're looking for you
at the front desk.

Some insurance company's
on the phone.

I'll be right there.

Excuse me.

I say give her the body.

Hey, Carter, you were here
a little while ago

talking to Dr. Greene?

Hmm.

Have you seen
a vial of Percocet?

I lost it somewhere
around the drug lock‐up.

No, I haven't, but
I'll keep my eyes open for you.

'First day's tour is always
the highlight of these visits.'

'Now I get to pore over these.'

'I went through
the last two weeks.'

'You guys do a lot of kids.'

‐ Elizabeth.
‐ Oh, Peter.

I'm afraid
I haven't much time right now.

I'm trying to catch Langstaff
after her gastroplasty.

‐ Langstaff?
‐ Yes.

I've heard she isn't
too keen on her fellow.

Thinking of letting
the chap go.

So, I thought
I should get a word in.

Well, don't you
think you should wait

to see if she
does let him go?

No, I think
it's a good idea

to let her know
I'm available.

And desperate.

Excuse me?

I mean, you know,
asking Dr. Anspaugh

in the middle
of an operation?

He didn't seem
put off by it. Why are you?

I'm not put off.

Listen, if it's about me
hanging you up in the ER

I'm sorry, and I really
appreciate your covering for me.

I wasn't hung up.
I mean, yeah.

I would've appreciated
a page or something

letting me know
about Romano's letter.

Uh, look, I would have
discussed it with you

but Romano is
my first priority.

That bastard didn't
even give me a reason.

He's not required to.

He sponsored you.
I mean, it's his call.

You're certainly taking
all this in your stride.

I'm just trying to show you that
it's not necessarily about you.

No, Peter. From where I stand,
it's very much about me.

You have no idea how hard
I worked to get here.

No, I do know what
it takes to get here.

Well then, why aren't
you being more supportive?

Because I think you're going
about it the wrong way.

You know, you're
running all over the hospital

asking every surgeon
to sponsor you.

Okay, so what do you suggest?

Elizabeth, you haven't
even checked out

other hospitals,
other parts of the country.

I've built up relationships
here or so I thought.

I'm not saying I would
want you to leave Chicago.

No, but you're
not exactly passionate

about my fight to stay.

Whatever goes on
between you and I‐‐

Peter, there you are.

'You ready to scrub
on that small bowel infarction?'

Yes, sir.

Please let me finish.

Surely you understand

that admitting
the patient is not only..

I need you to
sign off on these charts.

I'm not working today.

Well, these are
from yesterday's.

I told you
I'm not working today.

Mark, Josh McNeal
is doing much better.

I wish you would've
told me about the meeting.

‐ Well, I didn't get a chance.
‐ No!

...your policy
is not sound, Dr. Stork.

It's obscene, I mean, you're
spending $10,000 to save $500.

'Then so be it.'

I will admit
Mr. Wass to this hospital

'and I look forward
to billing you'

for every damn dime
we can possibly spend.

Jerry, admit Mr. Wass
to medicine.

Kerry, you want me
to call the company?

‐ Maybe that will help.
‐ I don't know.

I don't know
what helps anymore

and, you know, I don't care.

‐ Because I quit.
‐ What?

I quit as acting chief
of emergency medicine.

Let somebody else
act for a while.

Kerry, could wait a minute?

You know, why am I
the only idiot around here

who's worrying
about policy?

Doug Ross has...
he's got the right idea.

I mean, break the rules
if you think

it helps the patient,
everything else be damned.

Where do I get by
trying to follow them?

‐ Look, Kerry, wait.
‐ 'No.'

Hey, if anybody's
looking for me I'll be outside.

Cool.

Hey.

Hey, Carter.

Getting some air?

Yeah. I need it
after my last case.

Yeah. Me, too.

Listen, I was just
talking to Lydia Wright.

And, uh, she
mentioned to me

that some Percocet
has been missing

from the drug lock‐up.

That's low, Carter.

Hey, I'm not accusing
anybody. I'm just..

You know, you're my friend
so I thought you should know.

Well, Max is clean.

Maybe he is, but..

But what?

That's what Chase
used to say to me.

I got to get back.

The vitals are stable.
The boy's alert.

Looks to me like you got
your next journal article.

Yeah, right after they
draw and quarter me

in front of the executive
committee. Thank you.

We don't always get results
this good up here.

I'm gonna go check
on the Yezerski kid.

Okay.

What will happen now?
Back to his mother?

Ah, who knows?

I gave her
a list of names of doctors

who do ultrarapid
detox on adults

but it doesn't change
the psychological addiction.

Well, at least
she's trying.

Come on, buddy.

Hey, I was just gonna
come looking for you.

You knocking
off already?

No, I got to go
over to St. Mark's

see how the unit's are doing.

What time you off?

7:00.

You wanna go out to Johnny D's

grab some dinner?

Yeah. Sure.

Uh, feeling good about
getting through those charts?

Yeah, I mean,
it'll be a week or two

before I can
get a report out.

That is, if you can stand
to have me around that long.

Any hints on what
your recommendation will be?

'What usually happens
when I recommend in favor'

of an ER pedes department is..

'...they ask me to run it.'

'I've always said no'

but this time, I could be
convinced to say yes.

You mean, stay in Chicago?

Only if you want me to.

Wow. I hadn't really
thought that far ahead.

I heard some
Percocet was missing.

Yeah. I heard that, too.

I didn't take it.

I didn't suspect
that you did.

You'd be crazy not to.

Well, I didn't want to suspect
that you did, anyway.

Don't feel bad about it.

I know, I've used up
all my free passes with you

but I'm telling you the truth..

...and I'm willing to prove it..

...every day.

It's not that I don't
believe you. It's just‐‐

'Anna?'

Labs are back on that MI.

Thanks, Lily.
I'll be right there.

Alright.
Go. Be a doctor.

I'll call you later.

Sure.

Where's Mrs. Lang?
Where's her husband?

Mark Greene signed a transfer

to White Memorial
a half hour ago.

Why White Memorial?

I don't know. Maybe
his doctor's there.

Oh. Are they going to do
the ventriculostomy?

She didn't say.

Didn't you tell her there wasn't
much they could do for him?

Yeah, I just would've
liked to have known

what she was going to chose.

Why?

Why? Um, I don't know.

It just seems
unsettled, unfinished.

We never know what
happens to people

when they leave here.

Okay.

Oh, uh, you haven't seen
Anna around, have you?

No.

Ah, there it goes again.

‐ There goes what again?
‐ That car alarm.

It keeps
starting up and shutting off

and starting up.

Really annoying.

It's out in the ambulance bay

and I called security

but who knows
where they ever are?

Mark, Kerry, this is the
accident report on Josh McNeal

if you want to go
over anything.

You mean, like maybe
why you lied to me?

You wouldn't
have understood, Mark.

Oh, yeah. Well, you didn't
really give me a chance.

You know what? Take it outside.
We got work to do.

Dr. Weaver, if you're
no longer acting chief

who do I give
these budget review forms to?

I'll take 'em.

This kid was
more important.

You're always got a patient
excuse to hide behind.

When it's necessary,
I'm willing to go out on a limb.

Go on a limb? You took the whole
tree with you this time.

I was trying
to support you.

You've come
to pedes attending, Mark?

You were never
going to support me

if it meant giving up
that much authority.

We'll never know now,
will we?

Because you did
what you always do.

You go after
something you want

and when you're just about
to get it, you sabotage it.

Is that what
you're so angry about?

Look, I'm not angry,
okay. I'm disappointed.

You like being
disappointed in me, Mark.

It validates the fact
that you are the adult

and I'm the screw‐up.

You never wanted to grow up.

You don't want me to. You like
our friendship the way it is.

We go out, we have
a couple of beers

we come here, you're the boss

and for good reason,
based on your actions.

Based on your inability
to see me as an equal, Mark.

It was bad enough
when Kerry stepped up.

I supported her in that.

You supported her
on the surface, yes.

Underneath,
you resented her.

Like you resent what
I'm doing with Josh McNeal.

Have you seen Mark? I need his
signature on the Haney chart.

Uh, he and Dr. Ross
are outside, sharing.

Okay.

Mr. Nable?
What are you doing here?

Mr. Nable, are you hurt?

Are you okay?

Come on. Come with me.
Come on.

I'm so sorry.

Where is all this
blood from, Mr. Nable?

Come this way. I'm gonna
check you over, okay?

You just sit down
right here.

That's my car, um..

The alarm's always doing
that. I don't know why.

You drove here?

Okay. We're gonna get someone
to turn that alarm off for you.

Do you have
a remote button or something?

‐ Oh, God.
‐ There weren't enough bullets.

‐ Alright. Um, uh, Jeanie.
‐ Yeah?

‐ Can you stay with Mr. Nable?
‐ What's going on?

Just be careful.

Jerry, stick this
away somewhere

and call security
to help Jeanie.

Doug, Mark!
Come on! The car!

Come on!

What is it?

‐ It's locked.
‐ Who's in here?

Can you see anyone?

I can't see anything.

There's something
in the back seat.

It's two kids.

I'll break a window.

'Hang on.'

It's a woman in the front,
two kids in the back.

Mark, hit the locks.
The door won't open.

Got it. Alright.

Jerry! Get us three gurneys.

'Backboards and head collars.'

Get some help now, too.

I got a 40‐year‐old woman

gunshot wound to the left neck

'a weak carotid pulse.'

‐ She's barely breathing.
‐ I got a 13‐year‐old.

‐ A GSW to the abdomen.
‐ 'What's going on?'

There's some kinda accident
in the ambulance bay.

Jerry, hurry up
and get those out there.

I got the
flashlights.

Everyone use blood precautions.

‐ What is it?
‐ Get outside.

See if you can help.
Lydia, call for o‐neg.

‐ How much?
‐ At least 15 units.

Randi, close us
to trauma and page surgery.

‐ Kerry, I need to talk to you.
‐ In a minute.

‐ No, now. This is the guy.
‐ What guy?

Whatever's happened out there,
I think Mr. Nable..

Okay, call security now
move him to curtain three

and have them post
someone at the door.

Yosh, help Jeanie with this man.

Jerry, push the
gurney closer.

C‐collar secure.

Anything else I can do?

Yeah. Help lift her.

‐ Watch her head.
‐ Okay.

‐ Gently, gently.
‐ Alright.

Anna, grab her legs.
I'll support her neck, okay?

‐ Okay. I'm underneath her.
‐ Support's in.

Mommy. Where's my mommy?

‐ It's okay, honey.
‐ Slide her out

Really, really
gently, really slow.

Get this side.

She's got a weak
carotid pulse.

Flat neck veins,
decent respiratory effort

trachea midline.

We're going to
roll him now. We're rolling.

‐ Nice and easy.
‐ Slide him in.

Hang on. Let's roll
him back. Nice and easy.

‐ 'Come on, Malik.'
‐ Malik, give me a hand.

Top of the board.

On my count.
One, two...three.

‐ 'Three.'
‐ 'Three.'

‐ 'I'll start a line.'
‐ Which one have you got?

Little girl.

Good breath sounds
on the left.

A few crackles
at the right base.

Hi. I'm Dr. Weaver.

We're going to take
very good care of you.

What's your name, sweetie?

Amy.

CBC, Chem 20,
two lines saline

wide open
cross for eight.

Not moving much air.

I got to tube him. 6.5!

Pulse 120.

BP's 70 over 50.

‐ Suction.
‐ I got it.

We need o‐negative
on the rapid infuser.

I'll get it.

Hey, Jeanie,
what's going on?

A guy shot his wife
and two kids.

‐ Oh, man. Damn.
‐ Yeah.

'Hold on.
We're going to help you.'

The other doctors are
helping your children.

We'll tell you
as soon as we know anything.

‐ They are in good hands.
‐ Elizabeth?

Intubated.
Had a respiratory arrest.

‐ Where's the wound?
‐ Left neck.

BP's 80 palp.

Start Dopamine,
ten mics per kilo per minute.

We'll need high dose
Solu‐Medrol.

How much?

50 milligrams
per kilo over 20 minutes

then five per kilo per hour.

Lily, send off
the pre‐op labs.

We need X‐ray in here
for a portable c‐spine.

Dr. Benton, there's a Jackson
Kroopf on the phone for you.

Who?

Something about a hearing test.

Tell him
I'll call him back.

Carotid's okay.
What about yours?

Strong and regular.

It looks like
it missed the major vessels.

Any sub‐q air on your side?

No. Tube went straight in.
Trachea's intact.

What's her name?

Husband's name is Nable.

Mrs. Nable,
can you squeeze my hand?

That was good.
Try again.

'X‐ray's here.'

‐ 'Where's Mark?'
‐ Next door.

Mark, the police
are here for Mr. Nable.

They need you
to medically clear him.

Yeah, I'll be
there in a minute.

Jeanie, find out
this boy's name.

‐ Yeah.
‐ It'd be nice to know his name.

Chest tube, 28 French,
set up the Thora‐Seal.

Hang two more units
on the infuser.

It's getting hard to bag.

Yeah. Poor air entry
on the left.

Lost the pulse.

‐ Asystole.
‐ Alright. Start compressions.

‐ I'm not feeling a pulse.
‐ Okay.

He's bleeding out.
Let's get a central line kit.

‐ Doug, you got to crack him.
‐ Thoracotomy tray.

Give me a ten blade.

Mr. Nable, we need
to know your son's name.

Is he going to be alright?

They're working
on him right now.

I turned the gun..

There weren't
any more bullets.

I need a chest tube.

Whoa, what
are you doing?

There's an obvious hemopneumo.

The wound is in the
seventh intercostal space.

It could be strictly
intra‐abdominal.

She might not need
a chest tube.

The exam's consistent
with a hemopneumo.

Hang on a minute.
She's stable.

Lydia, let's get an X‐ray.

I don't think
she's too stable.

Amy, does it hurt
anywhere else, honey?

Take my hand, sweetheart.

Are my mom
and my brother okay?

Yeah. They're taking
care of them right now.

I thought we were
just gonna drive here

and everything would be okay.

I know.

Why did my daddy have a gun?

'My mom told him he
could take us all with him'

'if we came straight here
to talk to somebody.'

It's okay.

I thought we were just
gonna talk to somebody.

‐ 'Malik, prime the lines.'
‐ 'Satinsky. Suction.'

Do it.

What do you have?

A hole in the heart,
right ventricle.

Keep your finger on it.

Line's in. Hook it up.

Two‐o silk
on an atraumatic needle.

Rapid infuser ready.

I'll occlude. You sew.

Hold compression.

Keep your finger
on the defect.

Alright.
Don't stick me.

Chuny, we need
more blood.

Okay. Hold this.

‐ How's she doing?
‐ She'll make it

but there's an injury
to the spinal cord.

We're taking
her up to CT Now.

Alright, people.
Let's move.

Keep me apprised.

Anna, did you call the OR?

They're waiting for us.

You're gonna
be okay, Amy.

We're just gonna take you
upstairs to get some surgery.

And we'll let you
know how your mom

and your brother
are doing, okay?

Tell the surgeon to call us
as soon as he knows anything.

‐ How's the boy?
‐ Still working on him.

I think we should call
that psych resident Myers.

Yeah, I already did,
he was at home.

‐ But he's coming back in.
‐ Great.

She was gonna take..

...Amy and Steven with her.

I couldn't let her do that.

What do you see on the scope?

He's in v‐fib.
Internal paddles.

What do you need?

Charge to 15.

His heart's filling.

Four units in,
epi's on board.

Charging.

Clear.

'Still v‐fib.'

Again.

‐ 'Clear.'
‐ 'Clear.'

‐ Still in fib.
‐ Charge to 30.

Carol, intracardiac calcium.

‐ 'Clear.'
‐ 'Clear.'

He's got a rhythm.

Sutures still holding.

Strong carotid pulse.

‐ His name's Steven.
‐ Alright.

Alright.
Call the blood bank.

Have them send up eight units

type‐specific to the OR.

‐ You got it.
‐ Grab those lines.

‐ Help me bag him.
‐ Yeah.

'Lydia, stat page
the thoracic surgeon.'

Chuny, call the OR.

Tell them that
we're on our way.

Carol, Lidocaine 1.5 milligrams
per kilogram bolus

and start him on
two milligram per kilogram drip.

Got it.

Malik, hang a gram of Ancef

and call for platelets and FFP.

BP's 80 palp.

Lydia, tell security
to hold the elevator.

Secure the subclavian and attach
an end title CO2 monitor.

Bag him at 24 a minute.
He's probably acidotic.

Everybody ready?
Alright. Let's get him up.