ER (1994–2009): Season 9, Episode 19 - Things Change - full transcript
Dr. Romano continues to terrorize both the doctors and the patients in the ER. His arm is not healing well. Abby's brother Eric makes contact but she has much bigger problems when a psychotic patient attacks her and then runs out of the hospital. Dr. Carter is saddled with a slew of new students but learns that his grandmother has died. He's disappointed with Abby's reaction however. Dr. Kovac's friend from Croatia, Dr. Gordana Horvat, arrives to arrange for an operation on a young patient. Dr. Lewis and husband Chuck are re-evaluating their relationship.
Previously on ER...
A woman I went
to med school with
has a patient who's very sick--
a young boy...
And the surgical team
that performed it in Croatia
has disbanded since then.
( screaming )
What?
We got a guy in here,
says he's your husband.
We wanted burgers,
so we took a cab
to this drive-through--
Turns out to be
a mini-chapel.
So I spoke
to an attorney.
Uh, yeah, me, too.
He said annulling
the marriage should
be fairly easy.
That's what my guy said.
Any word on Eric?
I don't expect any.
It's like a bear
hibernating.
Any patient here
over six hours
is a failure of your
management skills, not mine.
Treat, turf, or dispo.
( grunts )
( cheering )
( whimpering )
Okay, okay, okay.
Okay... okay.
Okay, okay.
Okay, come on, come...
Please, please, please.
I'm sorry.
I'm sorry.
Okay.
LEWIS:
Clear.
Got a rhythm.
Sinus tach.
LEWIS:
Got a pulse.
Trying for pressure.
Good breath sounds.
Satting at 91.
Put him on 100%
non-rebreather.
Pupils...
four millimeters
and reactive.
B.P. is 90 palp.
All right, he's back,
whoever he is.
Hey.
Hey.
What's Kerry
doing down here?
Romano damage control.
Are you making
a lab run, Malik?
It ain't my lunch.
Thank you.
What do you got there?
That is my NGO pack
from L'Alliance de
Medicine Internationale.
I thought you said
you weren't going?
Yeah, I'm not.
Well, why did they send it
to you?
I guess they were hoping
that I'm going
to change my mind.
My shots are good
for a year.
You didn't sign
anything, did you?
No. It's a volunteer
organization.
They can't draft you.
Luka is still going
to the Congo.
I know. He doesn't
listen to me, either.
So, with Weaver
back down here,
does that mean that
Romano is history?
He moved his office
out of Exam One,
but that could just be
because the urine smell
is burning his eyes.
Oh, she's probably just
working a couple shifts
for appearance's sake,
just to keep people
from freaking out
or killing him.
We tried that.
ROMANO:
Carter!
They just keep
putting him back together.
Dr. John Carter,
meet your new med students.
My students?
Yeah. You are Chief Resident,
aren't you?
Yes.
And this is still a
teaching hospital,
is it not?
Yes, but...
Good, then start teaching.
Don't worry. He's a lot smarter
than he looks.
Dr. Carter's been with us
for what, four years now?
Nine.
Ah, well, hopefully, you'll all
be, uh, quicker studies.
Watch your backs!
Hey, you want this, Carter?
George Zito,
complaining of eight
out of ten chest pain.
That was 20 minutes ago.
Now it's a five.
Yeah, a cigarette would've done
the same thing.
You ever have
a heart attack
before, Mr. Zito?
You mean,
besides this one?
Pulse is 92.
B.P. is, uh, 155/100.
All right,
Trauma One.
Carter, Air Rescue's
bringing in an MVA
ten minutes out.
Yeah, and my dance
card is full.
I'll get Lewis.
So, who can tell me
the risk factors
for coronary
artery disease?
Chopper's bringing
a trauma in.
We're going to need a second
line for lidocaine.
Is it Unit 27,
the helicopter?
I don't know. Why?
Chuck flies with the 27.
Oh, right, Chuck.
Yeah, I know,
it's weird,
but there's something
about him.
He makes me feel good.
Not that way.
Well, that way, too.
You know what I mean.
Uh, his name's
James Shaw.
He's on Mellaril,
per Dr. Kazanjian.
Mellaril?
An anti-psychotic.
James, how many Mellaril
did you take?
They're all gone.
I need some more.
If you take too many pills,
your heart can stop.
The pills scramble the signal.
It keeps them from finding me.
Keeps who
from finding you?
They know my neural pattern.
No, nobody's
going to find
you here, James.
They monitor the 40 hertz range.
Abby.
Yeah.
Your brother's
on the phone.
What?!
Eric.
( whimpering )
Uh, okay, I-I'll
be right there.
You can tell
because it tastes like metal.
Is your brother okay?
I don't know.
I haven't heard from
him in two months.
Okay, I have to leave
before they scan this place.
James, listen to me.
James, they can't scan
you in here, okay,
because radiology is upstairs,
and the floors and
the walls are lined
with lead.
Okay, my
name's Abby.
I'm going to help you.
Okay.
Okay.
Give him five more
of Haldol.
Use restraints
if you have to.
Call his PMD,
and let him know he's here.
( sighing )
Can you watch him?
I have to take a phone call.
What line?
Hmm?
What line's
my brother on?
Oh, he, uh, he said
he'd call back in an hour.
Call back
from where?
I don't know.
Well, did he sound...
in trouble?
Did he sound
like he was all right?
I don't know.
He said he'd call
back in an hour.
Are you the only person
in this hospital
that doesn't know
about my crazy family?
What?
Can you just please
come and find me
when he calls back?
I don't care
where I am.
Drag me out of a
stall if you have to.
Yeah, can I?
Abby, could you help me
over here, please?
Sure, one second.
Hey, Mom, it's me.
( sighs )
Uh, Eric called,
and I was wondering
if you'd heard
from him.
Can you call me
at work? Thanks.
All right, I got a guy
who came in complaining
of a severe sore throat.
I want to send off
a culture and a CBC.
Okay.
This is Andrew.
Hi, Andrew.
ROMANO:
What is this guy
still doing here?
I'm still
working him up.
Yeah, wrong.
Hold this.
Take these--
they're for you.
I'm already
seeing eight.
Well, now you're seeing 12,
and I'm going
to give you four more
every 15 minutes, so I suggest
you start turfing people,
beginning
with sore throat boy here.
He has a low-grade fever
and adenopathy.
You know, if I wanted
a nurse's opinion...
well, I don't know
what I'd do,
because, quite frankly,
it's never happened.
Say "Ahh."
Ahh.
Yeah, he's got
no exudates.
Write him a scrip for erythro,
and get him out of this bed.
He's in a lot of pain.
Yeah, that is why they call it
a sore throat.
Viral pharyngitis will go away
on its own.
If it's viral,
why would you give him
antibiotics?
You've kept him here two hours.
Call it a consolation prize.
Hi. I'm Rocket Romano.
I'm the head
of the ER.
Uh, you look
a little lost.
Dr. Horvat.
You're a doctor?
Surgeon. I'm visiting
from Croatia.
Ah, what a
coincidence.
I'm also a visiting
surgeon.
Can I buy you a cup
of coffee or something?
Um...
Hey.
You've been here long?
No.
You two know
each other.
We went to the same
medical school.
No doubt.
Gordana is here to
observe a correction
of a congenital heart repair
on a young boy from Croatia.
You don't want
to get too close to this one.
Why not?
Let's just say
it's not
a good idea.
What a beautiful language.
Dr. Kovac,
I don't want
to keep you from
your patients,
and by the looks
of the board,
it looks like you're running
a little behind, so...
It's a pleasure meeting you.
He seems nice enough.
He's a prince.
It's good to see you.
It's good
to see you, too, Luka.
You look great.
You, too.
I wish I could have set up
your surgery here.
I toured Mercy's facilities,
it's a very modern hospital
with all-new equipment.
Maybe it's
just as well then.
That's not
what I meant.
It's okay, this place
is falling apart.
No money, no staff,
it's perfect for me.
Luka! 26-year-old
passenger in a rollover MVA.
Okay, Trauma Two.
Do you want to see
what American ER docs do?
I guess so.
He was initially awake
with a GCS of 13,
but he had a prolonged
extraction,
and we tubed him for LOC.
Susan, this is Gordana,
a surgeon from back home.
Hi. Did he talk
before he crashed?
Headache, belly pain?
No. He was just pretty much
cursing me out till he crumped.
Do you want me to call
a social worker down on this?
She may not be
mother of the year,
but I don't sense that
she'd hurt the child.
The baby's sick,
and the mother's evasive.
It could be
Munchausen's by proxy.
Let's just get
our test back.
Hey, is this a spot check,
or are you slumming?
Here, help me put this on.
I'm still
working shifts.
Wow, the perks down here
never stop, do they?
What are you
doing, Robert?
Observation and evaluation.
Oh, you mean
belittling
and bullying?
Gloves, too.
You want both?
( alarms )
Somebody page neurosurgery.
I thought I could smell blood.
No sats.
It's the Marilyn Manson
manicure.
What's that mean?
The nail polish
keeps the oxygen
saturation probe
from working.
Abby, when you get a chance,
grab some acetone,
and get a good nail on him.
ROMANO:
Crepitus around
the sternum.
You going to be up there
all day?
Just till
I secure
the airway.
I saw it go in.
No offense. I
check all the
paramedic tubes.
Yeah, since you guys miss
50% of the time.
Quiet, I can't hear
any breath sounds.
Bag him again.
Pressure's dropping
70 systolic.
I need a first crit.
Tube is through the cords.
I told you.
( alarm )
Did we get a blood
line on him?
You want to do it?
No, thanks.
Did anyone
page Corday?
She's still next door.
Does she need a
personal invite?
Triple lumen kit
and size eight
sterile gloves.
Pain is
non-reproducible.
First it's here,
now it's here, here.
That's not my fault?
Is there a problem?
Mrs. Reynolds
had a subjective
fever last night.
Which magically resolved,
along with her abdominal pain,
after passing gas.
You're going to charge
my insurance company 50 grand
to tell me I needed to fart?
Her belly
is definitely tender.
There could be
a pusatile mass.
So admit her
to service and
work her up.
Sorry.
Elizabeth!
Hey!
Hey!
Don't you "Hey" me.
If you want to
get a CT scan and
re-consult me, fine.
Or you can
send her home
and bring her back
for a re-check,
but I refuse
to admit her
just so that you
can clear ER beds
in 30 minutes.
Dr. Corday, can you take a look
at this patient?
( huffs )
Let me guess--
infectious gangrene
from a paper cut?
LEWIS:
I can't get a flash.
( whiny mimicking )
B.P. 66 systolic.
He's hypotensive.
His vasculature is collapsed.
LEWIS:
He probably has
an intraabdominal hemorrhage.
Tubed in the
field for LOC
but had belly pain.
Another liter up.
Ah, this clotted again.
What's your excuse
for not taking this
one up, Lizzie?
No exposed bowel?
Give it a rest, Robert.
He's got
intraperitoneal fluid.
All bleeding
eventually stops.
You can probably leave
this one here, too.
KOVAC:
O-silk and op site.
Hook up the infuser.
This isn't working.
We only have
so many rooms.
I'm going to
do a cut down.
( alarm )
He's slowing down.
Pulse is 72.
He's going
to need a box if
you guys don't
pull it together.
Sats are 80.
Run in the blood,
and get a post-line chest.
ROMANO:
All right, enough
Did you even listen
to his lungs?
Yes!
He's not moving
much air in this,
other one's worse.
Tension pneumo on the right.
Decreased on the right
with tracheal shift.
Chest tube tray?
Left lung's still up.
It's not from your line.
Probably the intubation.
We don't know that.
They should have heard it
in the helicopter
and needled it.
Betadine. Even if they did,
and I'm not--
saying they did--
you can't hear anything
in those choppers.
Knife.
Abby, watch
what you're doing.
I didn't drop it.
You did.
Could you step outside,
please?
Thank you.
KOVAC:
She's just
observing.
Well, I have enough people
in here just observing.
If you think
you can do it
all yourself,
Susan, we can
all step out.
LEWIS:
Might go faster.
Might go a lot faster
if he came in
properly intubated.
I'm glad to see
your morale boosting
and leadership skills
are rubbing off.
How do you say
"Bite my big one"
in Croatian?
He's bradying down,
if anybody's interested.
CARTER:
Take a deep
breath for me.
Is there any
pain with that?
No.
Is that Blumberg's sign?
No, Murphy's sign
for chololithiasis.
Do you think he has
diverticulitis?
No.
But the pain's in
the left lower quadrant.
He's too young.
What about
a kidney stone?
It causes
a lot more pain.
Ulcerative colitis?
Gives you
bloody diarrhea.
With the previous appy,
should you worry about
intestinal obstruction?
Maybe, but there's
no vomiting.
What about
a femoral hernia?
No mass.
Don't you have
a question?
We get a lunch break?
Are you going to do
a rectal?
Eventually.
I've never done
a rectal.
What about ultrasounding
the belly?
Okay, you and you
are shortness of breath.
You and you,
take vertigo.
And last but not least,
knee pain.
Watch each other
do an H&P,
discuss the case
with your partner,
present
back to me.
Should we start...?
Da, da, da, da,
no more questions.
Thanks, they were giving me
a headache.
Me, too.
Hey, Pratt.
I got something for you.
I'm seeing too many
patients already.
Not a patient.
Gallant, I got something
for you, too.
What's this?
You forget what today is?
What? Payday?
Ooh, match day.
Good luck, gentlemen.
I thought you matched
here already.
No, man, I was just doing
a one-year transitional.
I got County.
Oh, man, I'm
sorry about that.
Oh, no, man,
I asked for County.
Why?
Congratulations,
Gallant.
Glad you're going
to be with us.
Come on, come on.
Talk to me, baby,
talk to me, talk to me.
( laughing )
I got Northwestern, baby.
I'm going uptown.
( laughing )
What's this?
LOL with phlebitis in Exam Four.
Do you know
how many patients
I'm juggling?
Not enough if
you have time for
dancing in the hall.
( sighs )
How much out the right tube?
Nearly 600 cc's.
B.P.'s up to 92/66.
Let's hope his brain survived
the lack of perfusion.
Can you tell me
where curtain two is?
You just passed it.
Oh, nurse,
could I ask you a question?
In a minute.
Did my brother call back?
I thought he disappeared.
Where's Jerry?
On his break.
E.R. Hold, please.
That him?
No.
Could you tell Dr.
Kovac I'm leaving?
He should be back in a minute.
We just sent that trauma
upstairs.
And I'm Abby,
by the way.
Dr. Horvat.
Hi.
Hi.
You know Luka from Croatia?
We're old friends.
We went to
school together.
He was what you call
a character back then.
Luka?
Oh, yes. Always playing
practical jokes
on the other students
and our professors.
Really?
You could always
tell when Luka was
in the building
because you'd
hear him laughing.
You know that
laugh of his.
It's contagious.
He doesn't really
laugh much at work.
He seems like he's changed.
He's been through a lot,
I guess.
Still, I thought I'd find him
married to some
American supermodel
with three children
and a dog.
His wife, Danijela,
would have wanted that.
LEWIS:
Abby, page Psych again.
They got to see this guy.
Okay.
Excuse me.
He's getting restless.
Give him some more Haldol.
Okay.
Do I need
to apologize to her?
No, she seems pretty cool.
Then I'll apologize to you.
Sorry, I didn't mean
to turn into a bitch
in that trauma room.
No, don't worry about it.
I was a little unfocused.
Did you talk
to your brother?
No. He said he was
going to call back,
but he didn't.
Guys never call
when you want them to.
Hey, did air rescue leave yet?
What am I, air
traffic control now?
Why don't you use the
helicopter check system?
What's that?
Go up on the roof
and check.
If the helicopter
isn't there, they left.
Frank, are you taking anything
for your cholesterol?
No.
Good.
Hey, can you call
Dr. Meyers in Psych
and tell him I'm sending
a psychotic patient
up to his office
if he doesn't come down here
and assess this guy.
( heavy breathing )
How you doing, James?
Oh, um, okay... I um...
I need to go now,
'cause I...
um, 'cause I can feel
the pulses.
They're trying to use
the microwaves
to penetrate
my synaptic code.
Okay, James, you need
to relax, all right?
Okay.
I'm going to give you some
medicine to help you do that.
Okay.
Okay. Okay...
( grunting )
( yells )
No! Wait! No! Wait!
( groaning loudly )
Okay, stop it.
James...
look at me.
James, James, you know
I'm not trying to hurt you.
( heavy breathing )
I'm keeping you safe.
That's what I do.
Abby, your brother's
on line one.
Oh, yeah, thanks.
( breathing slows )
Eric?
Where are you?
Are you okay?
Well, what's going on? I...
Yes, he's here.
We caught him.
We have no
other choice.
He's not cooperating.
He knows things.
We have to proceed
with the surgical
interrogation.
Okay, are you on your meds?
Well, why didn't you go
to a hospital?
Okay, okay.
Well, what's the phone number
of the... of the booth
y-you're using?
Stop talking to them!
I won't let you...
( loud mumbling )
( fire alarm blares )
( James screaming )
( screaming continues )
Frank, call security
and cancel the fire alarm.
( James screaming )
James!
Look out, look out, look out.
( alarm continues blaring )
Hey, just hang out,
I'll be right back.
When are they going
to stop this?
Well, usually it
doesn't take more than
four or five hours.
( snickers )
You think I'm kidding?
Now you see why I want to get
the hell out of this place.
Well, it's not all bad.
You know what I mean.
You know, you can get a job
at Northwestern, too.
I left County once,
but I came back.
Something about this place
just gets in your blood.
Uh. ( chuckles )
It's probably the asbestos.
( chuckles )
So, you want to help me
celebrate later or what?
What do you
have in mind?
Hey, Dr. Chen,
she spiked a fever.
Oh, am I...
am I interrupting something?
Yeah.
No.
Listen, Mona Reynolds,
she dropped her pressure
in the CT scan,
and her temp's 39.6.
Find me later?
Her white count's 22.
She's in a lot of pain.
I paged Romano.
How are we doing,
Mrs. Reynolds?
( groaning ):
My gut's gonna bust!
Let me guess, she ruptured her
intraperitoneal pus.
GALLANT:
Pressure's 86/60.
We're going to need
another liter. She's septic.
Yeah, courtesy of Dr. Corday.
( groaning ):
Oh, my gut's killing me!
Yes, it will if we don't fix it.
( gags )
( coughs )
A simple please and thank you
would have sufficed.
Okay, let's grab
a two-gram dose of cefoxitin.
A gram of P.R. Tylenol
and four of M.S.
Should I page
Dr. Corday?
Screw that. If she can't
diagnose a subphrenic abscess,
she sure as hell can't fix one.
You know, you should
get a clean dressing.
Just grab me a 4x4.
Whoa. Ulcer looks necrotic.
You need to get that
debrided.
If I were you two, I would
concentrate on my patient.
She has a history of
peptic ulcer disease,
perforation two years ago,
chronic subclinical fevers,
weight loss, cough--
it's classic.
We still have to page Corday
to book an O.R.
Forget it.
She's already septic.
Open drainage
could kill her.
We'll have to this
under ultrasound.
Set her up in Trauma Two.
( coughs )
Short of breath, history of CHF,
noncompliant
with meds and diet.
Wet crackles on exam.
Orders?
CBC, chem panel,
40 of lasix,
chest X ray and EKG.
Great.
Good. Next.
Positional Vertigo with
positive berene test.
How's the cerebellar
function?
FNF, HTS, and R.A.M. all normal.
Ma'am, can you go
like this?
Good.
Hep lock, five of Compazine,
five of Valium. Next.
Knee pain.
History of rheumatoid arthritis.
No trauma or calf tenderness.
We're thinking
ruptured baker cyst.
Dr. Carter,
telephone call.
Okay, just a sec.
What did you order?
Ultrasound.
MALIK:
Hey, Carter,
your old guy
just coded.
All right, 600 ibuprofen.
Jerry, take a message.
Uh, I'm sorry,
he's with a patient.
Can I take a message?
Uh, just a second.
Dr. Weaver, can you take
this telephone call
for Dr. Carter?
He's running a code.
They say it's urgent.
Yeah, this is Kerry Weaver,
Dr. Carter's supervisor.
What's the problem?
Turn up the suction.
He's throwing PVCs.
Increase crichoid pressure.
You want Lidocaine?
Not just yet.
I got it, I'm in.
Bag him.
Carter, you got a phone call.
I'll take this.
I'm okay.
I got this.
Sats are coming up.
John, you really need
to take this call.
He's in V-tach.
All right, charge to 200.
It's your grandmother.
Good pulse with
compressions.
John...
Charge.
Uh, okay, clear.
Still in V-tach.
What did I say? 200?
Charge to 300,
and give me an amp of epi.
I'm sorry.
Is she dead?
I'm sorry.
Charge.
Clear.
Still
in fib.
360.
How long do you
keep trying?
CARTER:
And clear.
Another amp of epi.
It's been
25 minutes.
Does anyone survive
after this long?
Hold compressions.
Fine v fib.
Resume compressions.
Charge again to 360.
What else can you try?
Procainamide-- one gram,
30 migs per minute.
Is that okay
with lidocaine
and amiodarone?
Clear.
What's the most times
you've ever shocked somebody?
Still no change.
360 one more time.
But I thought
if you don't get them back
after three shocks,
you never will.
And clear.
Well, I guess
you heard wrong.
Sinus tach.
Good carotid pulse.
Let's finish the pronestyl load
and start a drip
at five per minute.
Pupils are fixed
and dilated.
Is he ever going
to wake up?
Well, let's just wait and see.
ABG on 100%. AC 14.
Tidal volume of 700.
Abby, I told you
not to call DCFS
on the baby Miles case.
I didn't.
I called a social worker.
Mom looked like
she could use some help.
Yeah, and Adele
called DCFS.
Hey, did you
find him?
Who?
No.
She lost
a psych patient.
I was in the process
of restraining him
when he bolted.
Wait, did you
call Security?
He had already left
the building.
Frank, could you get me
an address on this phone number?
Is this patient
a threat?
I don't know.
Where is this?
It's a phone booth.
Chuck.
Are you leaving?
Yeah. How's
the patient?
He went upstairs.
Hopefully
he's not brain dead
from the prolonged
hypotension.
It was a good
intubation, Sooze.
You saw it.
One, call me Susan,
and two,
his lung was down.
Look, do you know
how hard it is
to hear anything
on that chopper,
with the rotors
and the vibration
in the headphones?
I do know, but...
Look, that lung was up
when I transported him.
He had a tension pneumo.
You should have caught it.
You didn't.
I stood up for you.
What the hell's
that supposed to mean?
I don't need you
standing up for me.
What, you felt like you had to
because I'm a nurse
and you're a doctor?
No, that is not it.
Well, maybe a little.
I know how they bag
on the EMTs.
( laughing softly )
What is so funny?
Nothing. We just...
We bag on doctors all the time.
( chuckling )
You're protecting me.
Oh, you're too much, Dr. Lewis.
Chuck.
Yeah?
Chuck.
Susan.
Charles.
Susan.
There's a dead body in here.
I don't mind.
( laughs ):
It's gross.
It's disrespectful.
It's wrong.
Um, sorry, I-I was
looking for Carter.
Um, he was just
here, wasn't he?
Yeah.
Yeah, but, um, he left.
Okay.
Was that a dead body
in there?
American doctors can
be very unprofessional.
Kovac, uh, you ever drain
an intraperitoneal
abscess?
That's a surgical procedure.
I'm talking to her.
You're a surgeon?
Yes.
Good, come with me, now, now.
I got a
septic patient
moments away from
full-blown badness.
I need you to help
me put a catheter
in a pocket of pus
under ultrasonic guidance.
Think you
can do that?
Perhaps, but...
Good.
Pressure's better.
110/72 after the second liter.
What's her temp?
Still 39.
Cefoxitin
running in.
Good. I need you
to sign this.
( crying ):
What is it?
It's a consent
for the procedure.
What happens if I don't?
You'll probably die.
I don't think
I should do this.
It'll be okay.
I'll help you.
What are they saying?
Pillow talk.
The kidney stone
in Two is pain free.
You can send him
home with vicodin
and a strainer.
Uh, Eleanor Carter.
It might be under
Eleanor Ferguson.
Mrs. Drummond can
have ten of compazine.
She can come back tomorrow
if the pain persists.
Okay. What about the kid in,
uh, Curtain Three?
Dr. Lewis can take care
of everybody else.
Okay. Hey, you all right?
Yeah, I'll
be all right.
Thanks, Malik.
Yeah.
Uh, can you check again for me?
Hello? Hello?
Pressure's steady.
100 systolic.
Has anybody seen Abby?
No, sorry.
Finder needle.
Try not to perforate
the diaphragm.
CARTER:
What are you doing?
What does it look like?
A lawsuit.
Advancing.
No aspiration.
You're doing good.
Sorry to hear
about your grandmother, Carter.
Thank you.
Um, I need to go home.
Susan's going to cover for me.
How old was she?
78.
We should all be
so lucky.
Okay, there's pus.
Now pull out more.
Good. Wire.
Uh, fine,
go ahead.
A couple
more Croatians,
I could clean house
around here.
Trocar and pigtail.
Be right back.
Pull the needle out,
and put the Trocar
right over
the wire.
Hey, Carter.
Do you know anyone
in the State Department?
Um, why?
Uh, my friend Gordana
is trying to get a little boy
into this country
for an operation, but there
is some sort of a problem.
Luka,
I'm really sorry.
I can't help you with this
right now.
Jerry,
have you seen Abby?
Nope.
Can you find her
for me?
Sure.
Hey, Dad, it's me.
No, I didn't get ahold of Mom.
Yeah, are you sure
that you're going to make
the 5:30 flight?
Okay, well, no,
I'll just leave right from here
to come to the airport
to pick you up.
Okay.
( sniffles ):
No, I'm good.
Yeah, I know. Bye.
I've been
looking for you.
Hey, I've been looking
for you.
Carter.
Got a 26-year-old with stridor
in severe respiratory distress.
I can't tube him.
His epiglottis is
the size of my fist.
All right, nothing's open.
Put him in Three.
Pre-Op labs,
blood cultures times two,
soft tissue lateral of the neck,
three grams of Unasyn.
Pulse ox is down to 85.
He's barely
moving any air.
I saw this guy today
for a sore throat.
Romano told
me to turf him.
CARTER:
One, two, three.
We need a surgical airway.
You ever do a crike before?
No.
Well, you're about to.
Prep and drape the neck.
Abby, can you open
a Melker kit?
What comes next?
Find the cricho-
thyroid space.
Do it.
Can you leave right after this?
Yeah. I'm ready to go
right now.
Angle the needle
at 45 degrees.
Good,
'cause I really
don't want to do this alone.
Do what?
CARTER:
Aspirate air.
It's all the arrangements--
just everything
that has to be taken care of.
Guidewire next.
What are you talking about?
What are you
talking about?
Where were you going?
To get Eric.
What?
Needle out. 11 blade.
Yeah, he called
from a truck stop
outside of Des Moines.
Just enough to pass
the introducer.
Okay.
When did this happen?
This afternoon.
Oh, and I need you
to write me a scrip for Depakote
and Zyprexa.
( huffs )
Introducer... out.
Okay, bag him.
Sats are coming up.
Nice work, Pratt.
What's wrong?
My grandmother died today.
Just didn't wake
up from her nap.
Oh, Carter, I'm so sorry.
No one told me.
Hey, I got it.
Let's get out
of here.
Yeah, she called me,
like, three days...
She was on some
new committee.
She wanted me to
hear somebody speak
about a wetlands
learning center.
She knew I hated
that stuff.
I think she just
wanted to see me.
Well, you spent more time
with her than anybody.
( sighs ):
She called again
last night,
and I saw her number
on the caller ID,
and I just... I
didn't pick it up.
Well, she lived a very full
and happy life,
and you were
a big part of that.
She wasn't sick,
she wasn't in pain.
she was in her own bed.
That's not
a bad way to go.
And I'll be back
tonight.
The flight's
only an hour.
Do you have to go?
I mean, my
dad's flying in.
I got to do all the
funeral arrangements.
I just...
I have to go get him.
Why? I mean, Eric's
been gone for weeks.
What's one more day?
He's off his meds,
and if I don't go now,
he might disappear again.
I'll be back tonight.
John...
Go.
Go find your brother.
My grandmother
will still be dead
when you get back.
Well, what should
I tell Dr. Corday?
That she's welcome,
and that the least she can do
is admit this patient
to surgical ICU.
Good God,
it's the Stepford children.
Where's your handler?
Dr. Carter said
you'd be shepherding us
for the rest of the shift.
Oh, well, isn't he generous
with my life. Come on.
Wean him down to 50%
and check a gas in an hour.
Dr. Pratt, how would you like
to present some cases
to the future of medicine?
No, thanks.
It was not a request.
Okay, everyone,
listen up.
This is what happens when
your chief forces you
to clear beds at the cost
of proper examination.
Even a sore throat can result
in a near mortality.
Now, this particular
patient came in
complaining of odynophagia.
WOMAN:
It hurts to swallow.
I checked this guy's throat.
( laughs ):
See, posterior pharynx
looks benign...
but when pain
is out of proportion to exam,
one must then visualize
the epiglottis,
either with a lateral X ray
of the neck
or by looking down the throat
with a fiber-optic scope
or a right-angled mirror.
I can't help it
if the guy's a wimp.
Epiglottitis is a
pediatric illness, junior.
Maybe back in the day,
but we tend to see it in adults
now more and more...
if one takes the time
to look for it.
I had to crike this guy.
Well, good for you.
Don't ever do this.
Get out, now. Let's go.
Move. Move now, move!
What's the matter
with you?
Get out of here!
Congratulations, smart ass.
You just bought yourself
a month of midnights.
Good. I love the nightlife.
Where's your friend?
Dr. Horvat left.
I heard Romano had
her doing surgery
in the Trauma Room.
She drained an abscess.
It wasn't a big deal.
Unless there are
complications.
Uh, look,
I think you may
have gotten the
wrong impression
today in Exam Four,
when you were
looking for Carter.
You mean,
with the flight nurse?
Chuck, and technically,
we're married.
Oh, so it's technically okay
to boff your husband
in the hospital?
We weren't boffing.
We were talking.
( laughing ):
Good night, Susan.
It's still not the same
as a patient's mother.
Hey, at least
I used an empty room.
Oh.
Uh, thank you.
What are you
still doing here?
I'm, uh, picking up my dad
at the airport before I go home.
Good. Do you remember
any genetic disorders
that cause a buildup
of ethylene glycol?
Not off-hand,
but if it's not in Harrison's,
it probably doesn't exist.
I mean, there are hundreds
of rare ailments
that fall under
glycogen storage diseases,
amino acid disorders
of metabolism...
You could try a MEDLINE
search for substances
that would give you a false
positive for ethylene glycol.
You might get lucky.
You went, uh, pretty long
and hard on that guy earlier.
Yeah, I figured it was
the least I could do.
He was dying.
If you need to take
a couple days...
I'm not on
till Saturday.
Good night.
Okay, make
a three-centimeter incision
in the fifth intercostal space,
mid-axillary line.
What are you doing?
I am teaching.
All right, all right,
harder, honey--
you got to give it
all you got.
Stop.
Aim for the ispilateral nipple
at a 45-degree angle
while you keep aspirating.
Somebody broke his ribs
doing CPR.
Now he needs chest tubes
and volume for hypotension.
It could have
bagged his spleen too.
Then do an ultrasound.
Look, you coded him
for 35 minutes, Carter.
He's brain dead.
He'll probably arrest
in the next four hours,
and he's got no next of kin.
We might as well get the maximum
student benefit out of him.
You're in.
Unhook and run in 500 cc's.
No, I said stop.
I'm about to cannulate...
Get out of here.
Everybody, get out.
Hey.
What the hell's the matter
with you?
Look, you need to go home.
You need to get the hell
out of here right now.
( clattering )
Hey.
I didn't think you'd come.
( sighs )
I wasn't sure
you'd be here.
What's going on?
Oh, been traveling, uh,
you know...
here, there...
visiting old friends,
just, uh, trying to reconnect,
and, uh...
keep in touch.
Not with me.
Not with Maggie.
You know that guy?
No, do you?
Does he look familiar
to you?
He's been looking at me
like he knows me.
No.
They all have been.
I don't know.
Did you notice that
when you walked in?
This is a weird place,
isn't it?
Yeah.
I'm glad you came.
I got turned around.
I don't know
this area very well.
This is a strange part
of the country.
You about ready
to get out of here?
I need to pay for my coffee.
Okay.
I don't have any money.
Don't tell me
your HMO doesn't cover
somebody to do that for you.
Eh, you know
what they say--
you want something
done right...
Is that why you thought
you could perform
a surgical procedure in the ER?
It worked, didn't it?
Well, she's on dopamine
and still febrile.
The good news is,
we haven't had
to intubate... yet.
She could have died.
I still haven't ruled
that out.
It was a good call,
Robert.
Unfortunately,
the drainage was incomplete.
There were loculations
that you couldn't reach,
which means I'll have to do
an open laparotomy.
It's a damn shame
that you didn't catch
it the first time.
Subphrenic abscess
is a surgical disease.
They don't see it
much down here.
Robert, I would have caught it
if you'd let me,
and she'd be cooling down
on Zosyn before surgery.
Now she's more of a mess
than if you'd done nothing.
Did that hurt?
Nah, but I wish it had.
How long has it been
like this?
A few days.
More than a few, I'd guess.
I'm going to pack the cavity
with Iodiform gauze.
Is Gunn following this?
Yeah, Gunn, plastics,
ortho, hand, and ID.
Hyperbarics want me
to try them next.
And what's after that--
witchcraft, magnets?
( laughs ):
I'll try anything at this point.
You know, at some point,
maybe...
What?
It's nothing.
Say it.
At the point when the wound
becomes life-threatening,
because of gangrene or sepsis...
it may be in the patient's
best interest
to consider
a definitive surgical cure.
We're not giving up.
Tell Ante, to be strong,
he's going to be better soon.
I promise.
( sighs )
Any luck?
Every phone call leads
to another dead end.
No one can
tell you anything.
I can try talking
to Doctor Anspaugh.
He may be able to help
( sighs )
What?
You.
Luka Kovac.
ER doctor,
living in Chicago
You've made quite a life
for yourself.
It's along way
from that little room
you shared with Stipe and Tomo.
( laughs )
You could barely
stand up in there.
I know. I have scars from
hitting my head in that place.
You don't go back much?
You must be very busy.
Not as busy as a surgeon.
Everybody's busy in America.
Life is busy here,
not like back home.
You don't miss it?
Sometimes I miss the ocean.
The people...
Driving up the coast
on a summer day.
Do you remember that time
we drove to Vukovar
after the finals?
You hit that goat.
( laughs )
Oh, my God, that was horrible.
It was hilarious.
You and Tomo jumped out
and tried to revive him.
I was doing CPR, but Stipe
refused to do mouth-to-mouth.
And Tomo wanted
to put in a chest tube.
( laughs )
That poor goat.
I think that was
the first patient you ever lost.
( laughs )
Hey, John, it's me.
Um, I'm at a motel room
at the airport,
because we missed our plane...
and I'm sorry,
but I'm trying to get us on
the first flight out tomorrow,
and I'll try to call you later.
Bye.
Better?
Better.
Thanks for the clothes.
You can thank Carter.
They're his.
He also sent this.
What is it?
Depakote.
This is my life
now, isn't it?
It's up to you.
We all thought you were dead,
you know.
Except for Mom, of course.
She refused to believe it.
She know you
were coming?
Couldn't get
in touch with her.
For all I know,
she's missing, too.
( laughs )
It's not funny.
I know.
It's a little funny.
So, what happens now?
We go home.
Well, what about me?
I don't want
to live like this.
Can't keep doing this to you...
to me...
You have to get into a program.
Will you help me?
Don't I always?
Dr. Carter.
It's okay.
Where's your father?
He took a later flight.
He's going to be landing
in a couple hours.
Did my mother call?
No. I'm sorry.
Dr. Emerson was here earlier.
He said you can call him
at home tonight, if you'd like.
And Mr. Garrit called
from the funeral home.
He apologized for the delay.
They didn't come yet?
He should be here
any minute.
Can I get you
something to eat?
No, thank you.
Tea, perhaps?
No, I'm fine, thanks.
Dr. Carter...
she was a wonderful woman.
Yes, she was.
( sniffles )
( sobbing )
A woman I went
to med school with
has a patient who's very sick--
a young boy...
And the surgical team
that performed it in Croatia
has disbanded since then.
( screaming )
What?
We got a guy in here,
says he's your husband.
We wanted burgers,
so we took a cab
to this drive-through--
Turns out to be
a mini-chapel.
So I spoke
to an attorney.
Uh, yeah, me, too.
He said annulling
the marriage should
be fairly easy.
That's what my guy said.
Any word on Eric?
I don't expect any.
It's like a bear
hibernating.
Any patient here
over six hours
is a failure of your
management skills, not mine.
Treat, turf, or dispo.
( grunts )
( cheering )
( whimpering )
Okay, okay, okay.
Okay... okay.
Okay, okay.
Okay, come on, come...
Please, please, please.
I'm sorry.
I'm sorry.
Okay.
LEWIS:
Clear.
Got a rhythm.
Sinus tach.
LEWIS:
Got a pulse.
Trying for pressure.
Good breath sounds.
Satting at 91.
Put him on 100%
non-rebreather.
Pupils...
four millimeters
and reactive.
B.P. is 90 palp.
All right, he's back,
whoever he is.
Hey.
Hey.
What's Kerry
doing down here?
Romano damage control.
Are you making
a lab run, Malik?
It ain't my lunch.
Thank you.
What do you got there?
That is my NGO pack
from L'Alliance de
Medicine Internationale.
I thought you said
you weren't going?
Yeah, I'm not.
Well, why did they send it
to you?
I guess they were hoping
that I'm going
to change my mind.
My shots are good
for a year.
You didn't sign
anything, did you?
No. It's a volunteer
organization.
They can't draft you.
Luka is still going
to the Congo.
I know. He doesn't
listen to me, either.
So, with Weaver
back down here,
does that mean that
Romano is history?
He moved his office
out of Exam One,
but that could just be
because the urine smell
is burning his eyes.
Oh, she's probably just
working a couple shifts
for appearance's sake,
just to keep people
from freaking out
or killing him.
We tried that.
ROMANO:
Carter!
They just keep
putting him back together.
Dr. John Carter,
meet your new med students.
My students?
Yeah. You are Chief Resident,
aren't you?
Yes.
And this is still a
teaching hospital,
is it not?
Yes, but...
Good, then start teaching.
Don't worry. He's a lot smarter
than he looks.
Dr. Carter's been with us
for what, four years now?
Nine.
Ah, well, hopefully, you'll all
be, uh, quicker studies.
Watch your backs!
Hey, you want this, Carter?
George Zito,
complaining of eight
out of ten chest pain.
That was 20 minutes ago.
Now it's a five.
Yeah, a cigarette would've done
the same thing.
You ever have
a heart attack
before, Mr. Zito?
You mean,
besides this one?
Pulse is 92.
B.P. is, uh, 155/100.
All right,
Trauma One.
Carter, Air Rescue's
bringing in an MVA
ten minutes out.
Yeah, and my dance
card is full.
I'll get Lewis.
So, who can tell me
the risk factors
for coronary
artery disease?
Chopper's bringing
a trauma in.
We're going to need a second
line for lidocaine.
Is it Unit 27,
the helicopter?
I don't know. Why?
Chuck flies with the 27.
Oh, right, Chuck.
Yeah, I know,
it's weird,
but there's something
about him.
He makes me feel good.
Not that way.
Well, that way, too.
You know what I mean.
Uh, his name's
James Shaw.
He's on Mellaril,
per Dr. Kazanjian.
Mellaril?
An anti-psychotic.
James, how many Mellaril
did you take?
They're all gone.
I need some more.
If you take too many pills,
your heart can stop.
The pills scramble the signal.
It keeps them from finding me.
Keeps who
from finding you?
They know my neural pattern.
No, nobody's
going to find
you here, James.
They monitor the 40 hertz range.
Abby.
Yeah.
Your brother's
on the phone.
What?!
Eric.
( whimpering )
Uh, okay, I-I'll
be right there.
You can tell
because it tastes like metal.
Is your brother okay?
I don't know.
I haven't heard from
him in two months.
Okay, I have to leave
before they scan this place.
James, listen to me.
James, they can't scan
you in here, okay,
because radiology is upstairs,
and the floors and
the walls are lined
with lead.
Okay, my
name's Abby.
I'm going to help you.
Okay.
Okay.
Give him five more
of Haldol.
Use restraints
if you have to.
Call his PMD,
and let him know he's here.
( sighing )
Can you watch him?
I have to take a phone call.
What line?
Hmm?
What line's
my brother on?
Oh, he, uh, he said
he'd call back in an hour.
Call back
from where?
I don't know.
Well, did he sound...
in trouble?
Did he sound
like he was all right?
I don't know.
He said he'd call
back in an hour.
Are you the only person
in this hospital
that doesn't know
about my crazy family?
What?
Can you just please
come and find me
when he calls back?
I don't care
where I am.
Drag me out of a
stall if you have to.
Yeah, can I?
Abby, could you help me
over here, please?
Sure, one second.
Hey, Mom, it's me.
( sighs )
Uh, Eric called,
and I was wondering
if you'd heard
from him.
Can you call me
at work? Thanks.
All right, I got a guy
who came in complaining
of a severe sore throat.
I want to send off
a culture and a CBC.
Okay.
This is Andrew.
Hi, Andrew.
ROMANO:
What is this guy
still doing here?
I'm still
working him up.
Yeah, wrong.
Hold this.
Take these--
they're for you.
I'm already
seeing eight.
Well, now you're seeing 12,
and I'm going
to give you four more
every 15 minutes, so I suggest
you start turfing people,
beginning
with sore throat boy here.
He has a low-grade fever
and adenopathy.
You know, if I wanted
a nurse's opinion...
well, I don't know
what I'd do,
because, quite frankly,
it's never happened.
Say "Ahh."
Ahh.
Yeah, he's got
no exudates.
Write him a scrip for erythro,
and get him out of this bed.
He's in a lot of pain.
Yeah, that is why they call it
a sore throat.
Viral pharyngitis will go away
on its own.
If it's viral,
why would you give him
antibiotics?
You've kept him here two hours.
Call it a consolation prize.
Hi. I'm Rocket Romano.
I'm the head
of the ER.
Uh, you look
a little lost.
Dr. Horvat.
You're a doctor?
Surgeon. I'm visiting
from Croatia.
Ah, what a
coincidence.
I'm also a visiting
surgeon.
Can I buy you a cup
of coffee or something?
Um...
Hey.
You've been here long?
No.
You two know
each other.
We went to the same
medical school.
No doubt.
Gordana is here to
observe a correction
of a congenital heart repair
on a young boy from Croatia.
You don't want
to get too close to this one.
Why not?
Let's just say
it's not
a good idea.
What a beautiful language.
Dr. Kovac,
I don't want
to keep you from
your patients,
and by the looks
of the board,
it looks like you're running
a little behind, so...
It's a pleasure meeting you.
He seems nice enough.
He's a prince.
It's good to see you.
It's good
to see you, too, Luka.
You look great.
You, too.
I wish I could have set up
your surgery here.
I toured Mercy's facilities,
it's a very modern hospital
with all-new equipment.
Maybe it's
just as well then.
That's not
what I meant.
It's okay, this place
is falling apart.
No money, no staff,
it's perfect for me.
Luka! 26-year-old
passenger in a rollover MVA.
Okay, Trauma Two.
Do you want to see
what American ER docs do?
I guess so.
He was initially awake
with a GCS of 13,
but he had a prolonged
extraction,
and we tubed him for LOC.
Susan, this is Gordana,
a surgeon from back home.
Hi. Did he talk
before he crashed?
Headache, belly pain?
No. He was just pretty much
cursing me out till he crumped.
Do you want me to call
a social worker down on this?
She may not be
mother of the year,
but I don't sense that
she'd hurt the child.
The baby's sick,
and the mother's evasive.
It could be
Munchausen's by proxy.
Let's just get
our test back.
Hey, is this a spot check,
or are you slumming?
Here, help me put this on.
I'm still
working shifts.
Wow, the perks down here
never stop, do they?
What are you
doing, Robert?
Observation and evaluation.
Oh, you mean
belittling
and bullying?
Gloves, too.
You want both?
( alarms )
Somebody page neurosurgery.
I thought I could smell blood.
No sats.
It's the Marilyn Manson
manicure.
What's that mean?
The nail polish
keeps the oxygen
saturation probe
from working.
Abby, when you get a chance,
grab some acetone,
and get a good nail on him.
ROMANO:
Crepitus around
the sternum.
You going to be up there
all day?
Just till
I secure
the airway.
I saw it go in.
No offense. I
check all the
paramedic tubes.
Yeah, since you guys miss
50% of the time.
Quiet, I can't hear
any breath sounds.
Bag him again.
Pressure's dropping
70 systolic.
I need a first crit.
Tube is through the cords.
I told you.
( alarm )
Did we get a blood
line on him?
You want to do it?
No, thanks.
Did anyone
page Corday?
She's still next door.
Does she need a
personal invite?
Triple lumen kit
and size eight
sterile gloves.
Pain is
non-reproducible.
First it's here,
now it's here, here.
That's not my fault?
Is there a problem?
Mrs. Reynolds
had a subjective
fever last night.
Which magically resolved,
along with her abdominal pain,
after passing gas.
You're going to charge
my insurance company 50 grand
to tell me I needed to fart?
Her belly
is definitely tender.
There could be
a pusatile mass.
So admit her
to service and
work her up.
Sorry.
Elizabeth!
Hey!
Hey!
Don't you "Hey" me.
If you want to
get a CT scan and
re-consult me, fine.
Or you can
send her home
and bring her back
for a re-check,
but I refuse
to admit her
just so that you
can clear ER beds
in 30 minutes.
Dr. Corday, can you take a look
at this patient?
( huffs )
Let me guess--
infectious gangrene
from a paper cut?
LEWIS:
I can't get a flash.
( whiny mimicking )
B.P. 66 systolic.
He's hypotensive.
His vasculature is collapsed.
LEWIS:
He probably has
an intraabdominal hemorrhage.
Tubed in the
field for LOC
but had belly pain.
Another liter up.
Ah, this clotted again.
What's your excuse
for not taking this
one up, Lizzie?
No exposed bowel?
Give it a rest, Robert.
He's got
intraperitoneal fluid.
All bleeding
eventually stops.
You can probably leave
this one here, too.
KOVAC:
O-silk and op site.
Hook up the infuser.
This isn't working.
We only have
so many rooms.
I'm going to
do a cut down.
( alarm )
He's slowing down.
Pulse is 72.
He's going
to need a box if
you guys don't
pull it together.
Sats are 80.
Run in the blood,
and get a post-line chest.
ROMANO:
All right, enough
Did you even listen
to his lungs?
Yes!
He's not moving
much air in this,
other one's worse.
Tension pneumo on the right.
Decreased on the right
with tracheal shift.
Chest tube tray?
Left lung's still up.
It's not from your line.
Probably the intubation.
We don't know that.
They should have heard it
in the helicopter
and needled it.
Betadine. Even if they did,
and I'm not--
saying they did--
you can't hear anything
in those choppers.
Knife.
Abby, watch
what you're doing.
I didn't drop it.
You did.
Could you step outside,
please?
Thank you.
KOVAC:
She's just
observing.
Well, I have enough people
in here just observing.
If you think
you can do it
all yourself,
Susan, we can
all step out.
LEWIS:
Might go faster.
Might go a lot faster
if he came in
properly intubated.
I'm glad to see
your morale boosting
and leadership skills
are rubbing off.
How do you say
"Bite my big one"
in Croatian?
He's bradying down,
if anybody's interested.
CARTER:
Take a deep
breath for me.
Is there any
pain with that?
No.
Is that Blumberg's sign?
No, Murphy's sign
for chololithiasis.
Do you think he has
diverticulitis?
No.
But the pain's in
the left lower quadrant.
He's too young.
What about
a kidney stone?
It causes
a lot more pain.
Ulcerative colitis?
Gives you
bloody diarrhea.
With the previous appy,
should you worry about
intestinal obstruction?
Maybe, but there's
no vomiting.
What about
a femoral hernia?
No mass.
Don't you have
a question?
We get a lunch break?
Are you going to do
a rectal?
Eventually.
I've never done
a rectal.
What about ultrasounding
the belly?
Okay, you and you
are shortness of breath.
You and you,
take vertigo.
And last but not least,
knee pain.
Watch each other
do an H&P,
discuss the case
with your partner,
present
back to me.
Should we start...?
Da, da, da, da,
no more questions.
Thanks, they were giving me
a headache.
Me, too.
Hey, Pratt.
I got something for you.
I'm seeing too many
patients already.
Not a patient.
Gallant, I got something
for you, too.
What's this?
You forget what today is?
What? Payday?
Ooh, match day.
Good luck, gentlemen.
I thought you matched
here already.
No, man, I was just doing
a one-year transitional.
I got County.
Oh, man, I'm
sorry about that.
Oh, no, man,
I asked for County.
Why?
Congratulations,
Gallant.
Glad you're going
to be with us.
Come on, come on.
Talk to me, baby,
talk to me, talk to me.
( laughing )
I got Northwestern, baby.
I'm going uptown.
( laughing )
What's this?
LOL with phlebitis in Exam Four.
Do you know
how many patients
I'm juggling?
Not enough if
you have time for
dancing in the hall.
( sighs )
How much out the right tube?
Nearly 600 cc's.
B.P.'s up to 92/66.
Let's hope his brain survived
the lack of perfusion.
Can you tell me
where curtain two is?
You just passed it.
Oh, nurse,
could I ask you a question?
In a minute.
Did my brother call back?
I thought he disappeared.
Where's Jerry?
On his break.
E.R. Hold, please.
That him?
No.
Could you tell Dr.
Kovac I'm leaving?
He should be back in a minute.
We just sent that trauma
upstairs.
And I'm Abby,
by the way.
Dr. Horvat.
Hi.
Hi.
You know Luka from Croatia?
We're old friends.
We went to
school together.
He was what you call
a character back then.
Luka?
Oh, yes. Always playing
practical jokes
on the other students
and our professors.
Really?
You could always
tell when Luka was
in the building
because you'd
hear him laughing.
You know that
laugh of his.
It's contagious.
He doesn't really
laugh much at work.
He seems like he's changed.
He's been through a lot,
I guess.
Still, I thought I'd find him
married to some
American supermodel
with three children
and a dog.
His wife, Danijela,
would have wanted that.
LEWIS:
Abby, page Psych again.
They got to see this guy.
Okay.
Excuse me.
He's getting restless.
Give him some more Haldol.
Okay.
Do I need
to apologize to her?
No, she seems pretty cool.
Then I'll apologize to you.
Sorry, I didn't mean
to turn into a bitch
in that trauma room.
No, don't worry about it.
I was a little unfocused.
Did you talk
to your brother?
No. He said he was
going to call back,
but he didn't.
Guys never call
when you want them to.
Hey, did air rescue leave yet?
What am I, air
traffic control now?
Why don't you use the
helicopter check system?
What's that?
Go up on the roof
and check.
If the helicopter
isn't there, they left.
Frank, are you taking anything
for your cholesterol?
No.
Good.
Hey, can you call
Dr. Meyers in Psych
and tell him I'm sending
a psychotic patient
up to his office
if he doesn't come down here
and assess this guy.
( heavy breathing )
How you doing, James?
Oh, um, okay... I um...
I need to go now,
'cause I...
um, 'cause I can feel
the pulses.
They're trying to use
the microwaves
to penetrate
my synaptic code.
Okay, James, you need
to relax, all right?
Okay.
I'm going to give you some
medicine to help you do that.
Okay.
Okay. Okay...
( grunting )
( yells )
No! Wait! No! Wait!
( groaning loudly )
Okay, stop it.
James...
look at me.
James, James, you know
I'm not trying to hurt you.
( heavy breathing )
I'm keeping you safe.
That's what I do.
Abby, your brother's
on line one.
Oh, yeah, thanks.
( breathing slows )
Eric?
Where are you?
Are you okay?
Well, what's going on? I...
Yes, he's here.
We caught him.
We have no
other choice.
He's not cooperating.
He knows things.
We have to proceed
with the surgical
interrogation.
Okay, are you on your meds?
Well, why didn't you go
to a hospital?
Okay, okay.
Well, what's the phone number
of the... of the booth
y-you're using?
Stop talking to them!
I won't let you...
( loud mumbling )
( fire alarm blares )
( James screaming )
( screaming continues )
Frank, call security
and cancel the fire alarm.
( James screaming )
James!
Look out, look out, look out.
( alarm continues blaring )
Hey, just hang out,
I'll be right back.
When are they going
to stop this?
Well, usually it
doesn't take more than
four or five hours.
( snickers )
You think I'm kidding?
Now you see why I want to get
the hell out of this place.
Well, it's not all bad.
You know what I mean.
You know, you can get a job
at Northwestern, too.
I left County once,
but I came back.
Something about this place
just gets in your blood.
Uh. ( chuckles )
It's probably the asbestos.
( chuckles )
So, you want to help me
celebrate later or what?
What do you
have in mind?
Hey, Dr. Chen,
she spiked a fever.
Oh, am I...
am I interrupting something?
Yeah.
No.
Listen, Mona Reynolds,
she dropped her pressure
in the CT scan,
and her temp's 39.6.
Find me later?
Her white count's 22.
She's in a lot of pain.
I paged Romano.
How are we doing,
Mrs. Reynolds?
( groaning ):
My gut's gonna bust!
Let me guess, she ruptured her
intraperitoneal pus.
GALLANT:
Pressure's 86/60.
We're going to need
another liter. She's septic.
Yeah, courtesy of Dr. Corday.
( groaning ):
Oh, my gut's killing me!
Yes, it will if we don't fix it.
( gags )
( coughs )
A simple please and thank you
would have sufficed.
Okay, let's grab
a two-gram dose of cefoxitin.
A gram of P.R. Tylenol
and four of M.S.
Should I page
Dr. Corday?
Screw that. If she can't
diagnose a subphrenic abscess,
she sure as hell can't fix one.
You know, you should
get a clean dressing.
Just grab me a 4x4.
Whoa. Ulcer looks necrotic.
You need to get that
debrided.
If I were you two, I would
concentrate on my patient.
She has a history of
peptic ulcer disease,
perforation two years ago,
chronic subclinical fevers,
weight loss, cough--
it's classic.
We still have to page Corday
to book an O.R.
Forget it.
She's already septic.
Open drainage
could kill her.
We'll have to this
under ultrasound.
Set her up in Trauma Two.
( coughs )
Short of breath, history of CHF,
noncompliant
with meds and diet.
Wet crackles on exam.
Orders?
CBC, chem panel,
40 of lasix,
chest X ray and EKG.
Great.
Good. Next.
Positional Vertigo with
positive berene test.
How's the cerebellar
function?
FNF, HTS, and R.A.M. all normal.
Ma'am, can you go
like this?
Good.
Hep lock, five of Compazine,
five of Valium. Next.
Knee pain.
History of rheumatoid arthritis.
No trauma or calf tenderness.
We're thinking
ruptured baker cyst.
Dr. Carter,
telephone call.
Okay, just a sec.
What did you order?
Ultrasound.
MALIK:
Hey, Carter,
your old guy
just coded.
All right, 600 ibuprofen.
Jerry, take a message.
Uh, I'm sorry,
he's with a patient.
Can I take a message?
Uh, just a second.
Dr. Weaver, can you take
this telephone call
for Dr. Carter?
He's running a code.
They say it's urgent.
Yeah, this is Kerry Weaver,
Dr. Carter's supervisor.
What's the problem?
Turn up the suction.
He's throwing PVCs.
Increase crichoid pressure.
You want Lidocaine?
Not just yet.
I got it, I'm in.
Bag him.
Carter, you got a phone call.
I'll take this.
I'm okay.
I got this.
Sats are coming up.
John, you really need
to take this call.
He's in V-tach.
All right, charge to 200.
It's your grandmother.
Good pulse with
compressions.
John...
Charge.
Uh, okay, clear.
Still in V-tach.
What did I say? 200?
Charge to 300,
and give me an amp of epi.
I'm sorry.
Is she dead?
I'm sorry.
Charge.
Clear.
Still
in fib.
360.
How long do you
keep trying?
CARTER:
And clear.
Another amp of epi.
It's been
25 minutes.
Does anyone survive
after this long?
Hold compressions.
Fine v fib.
Resume compressions.
Charge again to 360.
What else can you try?
Procainamide-- one gram,
30 migs per minute.
Is that okay
with lidocaine
and amiodarone?
Clear.
What's the most times
you've ever shocked somebody?
Still no change.
360 one more time.
But I thought
if you don't get them back
after three shocks,
you never will.
And clear.
Well, I guess
you heard wrong.
Sinus tach.
Good carotid pulse.
Let's finish the pronestyl load
and start a drip
at five per minute.
Pupils are fixed
and dilated.
Is he ever going
to wake up?
Well, let's just wait and see.
ABG on 100%. AC 14.
Tidal volume of 700.
Abby, I told you
not to call DCFS
on the baby Miles case.
I didn't.
I called a social worker.
Mom looked like
she could use some help.
Yeah, and Adele
called DCFS.
Hey, did you
find him?
Who?
No.
She lost
a psych patient.
I was in the process
of restraining him
when he bolted.
Wait, did you
call Security?
He had already left
the building.
Frank, could you get me
an address on this phone number?
Is this patient
a threat?
I don't know.
Where is this?
It's a phone booth.
Chuck.
Are you leaving?
Yeah. How's
the patient?
He went upstairs.
Hopefully
he's not brain dead
from the prolonged
hypotension.
It was a good
intubation, Sooze.
You saw it.
One, call me Susan,
and two,
his lung was down.
Look, do you know
how hard it is
to hear anything
on that chopper,
with the rotors
and the vibration
in the headphones?
I do know, but...
Look, that lung was up
when I transported him.
He had a tension pneumo.
You should have caught it.
You didn't.
I stood up for you.
What the hell's
that supposed to mean?
I don't need you
standing up for me.
What, you felt like you had to
because I'm a nurse
and you're a doctor?
No, that is not it.
Well, maybe a little.
I know how they bag
on the EMTs.
( laughing softly )
What is so funny?
Nothing. We just...
We bag on doctors all the time.
( chuckling )
You're protecting me.
Oh, you're too much, Dr. Lewis.
Chuck.
Yeah?
Chuck.
Susan.
Charles.
Susan.
There's a dead body in here.
I don't mind.
( laughs ):
It's gross.
It's disrespectful.
It's wrong.
Um, sorry, I-I was
looking for Carter.
Um, he was just
here, wasn't he?
Yeah.
Yeah, but, um, he left.
Okay.
Was that a dead body
in there?
American doctors can
be very unprofessional.
Kovac, uh, you ever drain
an intraperitoneal
abscess?
That's a surgical procedure.
I'm talking to her.
You're a surgeon?
Yes.
Good, come with me, now, now.
I got a
septic patient
moments away from
full-blown badness.
I need you to help
me put a catheter
in a pocket of pus
under ultrasonic guidance.
Think you
can do that?
Perhaps, but...
Good.
Pressure's better.
110/72 after the second liter.
What's her temp?
Still 39.
Cefoxitin
running in.
Good. I need you
to sign this.
( crying ):
What is it?
It's a consent
for the procedure.
What happens if I don't?
You'll probably die.
I don't think
I should do this.
It'll be okay.
I'll help you.
What are they saying?
Pillow talk.
The kidney stone
in Two is pain free.
You can send him
home with vicodin
and a strainer.
Uh, Eleanor Carter.
It might be under
Eleanor Ferguson.
Mrs. Drummond can
have ten of compazine.
She can come back tomorrow
if the pain persists.
Okay. What about the kid in,
uh, Curtain Three?
Dr. Lewis can take care
of everybody else.
Okay. Hey, you all right?
Yeah, I'll
be all right.
Thanks, Malik.
Yeah.
Uh, can you check again for me?
Hello? Hello?
Pressure's steady.
100 systolic.
Has anybody seen Abby?
No, sorry.
Finder needle.
Try not to perforate
the diaphragm.
CARTER:
What are you doing?
What does it look like?
A lawsuit.
Advancing.
No aspiration.
You're doing good.
Sorry to hear
about your grandmother, Carter.
Thank you.
Um, I need to go home.
Susan's going to cover for me.
How old was she?
78.
We should all be
so lucky.
Okay, there's pus.
Now pull out more.
Good. Wire.
Uh, fine,
go ahead.
A couple
more Croatians,
I could clean house
around here.
Trocar and pigtail.
Be right back.
Pull the needle out,
and put the Trocar
right over
the wire.
Hey, Carter.
Do you know anyone
in the State Department?
Um, why?
Uh, my friend Gordana
is trying to get a little boy
into this country
for an operation, but there
is some sort of a problem.
Luka,
I'm really sorry.
I can't help you with this
right now.
Jerry,
have you seen Abby?
Nope.
Can you find her
for me?
Sure.
Hey, Dad, it's me.
No, I didn't get ahold of Mom.
Yeah, are you sure
that you're going to make
the 5:30 flight?
Okay, well, no,
I'll just leave right from here
to come to the airport
to pick you up.
Okay.
( sniffles ):
No, I'm good.
Yeah, I know. Bye.
I've been
looking for you.
Hey, I've been looking
for you.
Carter.
Got a 26-year-old with stridor
in severe respiratory distress.
I can't tube him.
His epiglottis is
the size of my fist.
All right, nothing's open.
Put him in Three.
Pre-Op labs,
blood cultures times two,
soft tissue lateral of the neck,
three grams of Unasyn.
Pulse ox is down to 85.
He's barely
moving any air.
I saw this guy today
for a sore throat.
Romano told
me to turf him.
CARTER:
One, two, three.
We need a surgical airway.
You ever do a crike before?
No.
Well, you're about to.
Prep and drape the neck.
Abby, can you open
a Melker kit?
What comes next?
Find the cricho-
thyroid space.
Do it.
Can you leave right after this?
Yeah. I'm ready to go
right now.
Angle the needle
at 45 degrees.
Good,
'cause I really
don't want to do this alone.
Do what?
CARTER:
Aspirate air.
It's all the arrangements--
just everything
that has to be taken care of.
Guidewire next.
What are you talking about?
What are you
talking about?
Where were you going?
To get Eric.
What?
Needle out. 11 blade.
Yeah, he called
from a truck stop
outside of Des Moines.
Just enough to pass
the introducer.
Okay.
When did this happen?
This afternoon.
Oh, and I need you
to write me a scrip for Depakote
and Zyprexa.
( huffs )
Introducer... out.
Okay, bag him.
Sats are coming up.
Nice work, Pratt.
What's wrong?
My grandmother died today.
Just didn't wake
up from her nap.
Oh, Carter, I'm so sorry.
No one told me.
Hey, I got it.
Let's get out
of here.
Yeah, she called me,
like, three days...
She was on some
new committee.
She wanted me to
hear somebody speak
about a wetlands
learning center.
She knew I hated
that stuff.
I think she just
wanted to see me.
Well, you spent more time
with her than anybody.
( sighs ):
She called again
last night,
and I saw her number
on the caller ID,
and I just... I
didn't pick it up.
Well, she lived a very full
and happy life,
and you were
a big part of that.
She wasn't sick,
she wasn't in pain.
she was in her own bed.
That's not
a bad way to go.
And I'll be back
tonight.
The flight's
only an hour.
Do you have to go?
I mean, my
dad's flying in.
I got to do all the
funeral arrangements.
I just...
I have to go get him.
Why? I mean, Eric's
been gone for weeks.
What's one more day?
He's off his meds,
and if I don't go now,
he might disappear again.
I'll be back tonight.
John...
Go.
Go find your brother.
My grandmother
will still be dead
when you get back.
Well, what should
I tell Dr. Corday?
That she's welcome,
and that the least she can do
is admit this patient
to surgical ICU.
Good God,
it's the Stepford children.
Where's your handler?
Dr. Carter said
you'd be shepherding us
for the rest of the shift.
Oh, well, isn't he generous
with my life. Come on.
Wean him down to 50%
and check a gas in an hour.
Dr. Pratt, how would you like
to present some cases
to the future of medicine?
No, thanks.
It was not a request.
Okay, everyone,
listen up.
This is what happens when
your chief forces you
to clear beds at the cost
of proper examination.
Even a sore throat can result
in a near mortality.
Now, this particular
patient came in
complaining of odynophagia.
WOMAN:
It hurts to swallow.
I checked this guy's throat.
( laughs ):
See, posterior pharynx
looks benign...
but when pain
is out of proportion to exam,
one must then visualize
the epiglottis,
either with a lateral X ray
of the neck
or by looking down the throat
with a fiber-optic scope
or a right-angled mirror.
I can't help it
if the guy's a wimp.
Epiglottitis is a
pediatric illness, junior.
Maybe back in the day,
but we tend to see it in adults
now more and more...
if one takes the time
to look for it.
I had to crike this guy.
Well, good for you.
Don't ever do this.
Get out, now. Let's go.
Move. Move now, move!
What's the matter
with you?
Get out of here!
Congratulations, smart ass.
You just bought yourself
a month of midnights.
Good. I love the nightlife.
Where's your friend?
Dr. Horvat left.
I heard Romano had
her doing surgery
in the Trauma Room.
She drained an abscess.
It wasn't a big deal.
Unless there are
complications.
Uh, look,
I think you may
have gotten the
wrong impression
today in Exam Four,
when you were
looking for Carter.
You mean,
with the flight nurse?
Chuck, and technically,
we're married.
Oh, so it's technically okay
to boff your husband
in the hospital?
We weren't boffing.
We were talking.
( laughing ):
Good night, Susan.
It's still not the same
as a patient's mother.
Hey, at least
I used an empty room.
Oh.
Uh, thank you.
What are you
still doing here?
I'm, uh, picking up my dad
at the airport before I go home.
Good. Do you remember
any genetic disorders
that cause a buildup
of ethylene glycol?
Not off-hand,
but if it's not in Harrison's,
it probably doesn't exist.
I mean, there are hundreds
of rare ailments
that fall under
glycogen storage diseases,
amino acid disorders
of metabolism...
You could try a MEDLINE
search for substances
that would give you a false
positive for ethylene glycol.
You might get lucky.
You went, uh, pretty long
and hard on that guy earlier.
Yeah, I figured it was
the least I could do.
He was dying.
If you need to take
a couple days...
I'm not on
till Saturday.
Good night.
Okay, make
a three-centimeter incision
in the fifth intercostal space,
mid-axillary line.
What are you doing?
I am teaching.
All right, all right,
harder, honey--
you got to give it
all you got.
Stop.
Aim for the ispilateral nipple
at a 45-degree angle
while you keep aspirating.
Somebody broke his ribs
doing CPR.
Now he needs chest tubes
and volume for hypotension.
It could have
bagged his spleen too.
Then do an ultrasound.
Look, you coded him
for 35 minutes, Carter.
He's brain dead.
He'll probably arrest
in the next four hours,
and he's got no next of kin.
We might as well get the maximum
student benefit out of him.
You're in.
Unhook and run in 500 cc's.
No, I said stop.
I'm about to cannulate...
Get out of here.
Everybody, get out.
Hey.
What the hell's the matter
with you?
Look, you need to go home.
You need to get the hell
out of here right now.
( clattering )
Hey.
I didn't think you'd come.
( sighs )
I wasn't sure
you'd be here.
What's going on?
Oh, been traveling, uh,
you know...
here, there...
visiting old friends,
just, uh, trying to reconnect,
and, uh...
keep in touch.
Not with me.
Not with Maggie.
You know that guy?
No, do you?
Does he look familiar
to you?
He's been looking at me
like he knows me.
No.
They all have been.
I don't know.
Did you notice that
when you walked in?
This is a weird place,
isn't it?
Yeah.
I'm glad you came.
I got turned around.
I don't know
this area very well.
This is a strange part
of the country.
You about ready
to get out of here?
I need to pay for my coffee.
Okay.
I don't have any money.
Don't tell me
your HMO doesn't cover
somebody to do that for you.
Eh, you know
what they say--
you want something
done right...
Is that why you thought
you could perform
a surgical procedure in the ER?
It worked, didn't it?
Well, she's on dopamine
and still febrile.
The good news is,
we haven't had
to intubate... yet.
She could have died.
I still haven't ruled
that out.
It was a good call,
Robert.
Unfortunately,
the drainage was incomplete.
There were loculations
that you couldn't reach,
which means I'll have to do
an open laparotomy.
It's a damn shame
that you didn't catch
it the first time.
Subphrenic abscess
is a surgical disease.
They don't see it
much down here.
Robert, I would have caught it
if you'd let me,
and she'd be cooling down
on Zosyn before surgery.
Now she's more of a mess
than if you'd done nothing.
Did that hurt?
Nah, but I wish it had.
How long has it been
like this?
A few days.
More than a few, I'd guess.
I'm going to pack the cavity
with Iodiform gauze.
Is Gunn following this?
Yeah, Gunn, plastics,
ortho, hand, and ID.
Hyperbarics want me
to try them next.
And what's after that--
witchcraft, magnets?
( laughs ):
I'll try anything at this point.
You know, at some point,
maybe...
What?
It's nothing.
Say it.
At the point when the wound
becomes life-threatening,
because of gangrene or sepsis...
it may be in the patient's
best interest
to consider
a definitive surgical cure.
We're not giving up.
Tell Ante, to be strong,
he's going to be better soon.
I promise.
( sighs )
Any luck?
Every phone call leads
to another dead end.
No one can
tell you anything.
I can try talking
to Doctor Anspaugh.
He may be able to help
( sighs )
What?
You.
Luka Kovac.
ER doctor,
living in Chicago
You've made quite a life
for yourself.
It's along way
from that little room
you shared with Stipe and Tomo.
( laughs )
You could barely
stand up in there.
I know. I have scars from
hitting my head in that place.
You don't go back much?
You must be very busy.
Not as busy as a surgeon.
Everybody's busy in America.
Life is busy here,
not like back home.
You don't miss it?
Sometimes I miss the ocean.
The people...
Driving up the coast
on a summer day.
Do you remember that time
we drove to Vukovar
after the finals?
You hit that goat.
( laughs )
Oh, my God, that was horrible.
It was hilarious.
You and Tomo jumped out
and tried to revive him.
I was doing CPR, but Stipe
refused to do mouth-to-mouth.
And Tomo wanted
to put in a chest tube.
( laughs )
That poor goat.
I think that was
the first patient you ever lost.
( laughs )
Hey, John, it's me.
Um, I'm at a motel room
at the airport,
because we missed our plane...
and I'm sorry,
but I'm trying to get us on
the first flight out tomorrow,
and I'll try to call you later.
Bye.
Better?
Better.
Thanks for the clothes.
You can thank Carter.
They're his.
He also sent this.
What is it?
Depakote.
This is my life
now, isn't it?
It's up to you.
We all thought you were dead,
you know.
Except for Mom, of course.
She refused to believe it.
She know you
were coming?
Couldn't get
in touch with her.
For all I know,
she's missing, too.
( laughs )
It's not funny.
I know.
It's a little funny.
So, what happens now?
We go home.
Well, what about me?
I don't want
to live like this.
Can't keep doing this to you...
to me...
You have to get into a program.
Will you help me?
Don't I always?
Dr. Carter.
It's okay.
Where's your father?
He took a later flight.
He's going to be landing
in a couple hours.
Did my mother call?
No. I'm sorry.
Dr. Emerson was here earlier.
He said you can call him
at home tonight, if you'd like.
And Mr. Garrit called
from the funeral home.
He apologized for the delay.
They didn't come yet?
He should be here
any minute.
Can I get you
something to eat?
No, thank you.
Tea, perhaps?
No, I'm fine, thanks.
Dr. Carter...
she was a wonderful woman.
Yes, she was.
( sniffles )
( sobbing )