ER (1994–2009): Season 9, Episode 5 - A Hopeless Wound - full transcript

[theme music]

(male narrator)
Previously on "ER."

When you're waiting
on a patient's results

it's not necessary
for you to boff

that patient's mother
in the storage closet.

I'm so sorry, Robert.

What about my arm,
or about my being there?

‐ A memo from Weaver.
‐ What?

(Kerry)
'I've made Abby
the new nurse manager.'

The job is yours,
like it or not.

"Like it or not"?



I don't care
to argue about it.

Duroziez's sign
is a to and fro murmur

when the stethoscope is
placed over the femoral artery.

What's another peripheral
sign of aortic insufficiency?

‐ Weak pulse.
‐ No.

‐ Poor cap refill.
‐ No.

Those are both
signs of shock.

It begins with "Q."
Anyone?

‐ Dequervain's.
‐ No, that begins with a "D."

Although there is a "Q" in
it so, you're getting warmer.

Does Quinke's sign
ring any bells?

And it manifests itself how?

With a visible.
Puh..

‐ Pulsation.
‐ Correct. Where?



On the...nnn.

‐ Neck.
‐ Navel?

Nail bed.

Goodnight.

(Elizabeth)
'Go home.'

Rounds start
at 7:00 A. M.

Be sure to read
Sabiston's chapter

on the acute abdomen.

So much for the
future of medicine.

Jacy, would you be sure
to ring Mr. Ingles?

Remind him not
to eat anything after midnight.

I don't want to have to
reschedule his hernia yet again.

‐ Mm hmm.
‐ I'm going trick‐or‐treating.

‐ Oh, what's Ella this year?
‐ A cow.

Wasn't she a cow last year?

No, last year she was Dorothy

I was the cowardly lion, Mark..

‐ Mark was the scarecrow.
‐ Right.

I get to be a farmer this year.

Happy Halloween.

‐ Dr. Corday.
‐ Yeah.

Your med
student called, Nathan.

What, the one who didn't
bother to show up today?

He said he'd be here in a
few minutes to speak with you.

Well, it's too late.

Dr. Romano would also like to

talk with you before you leave.

Tell him you couldn't find me.

(Robert)
'I heard that!'

(male #1)
'Check this guy out.'

(Frank)
'What the hell are
you supposed to be?'

Hey, you want a
candy, little fella?

(Frank)
'Put some meat
on those bones.'

Hi, thought everybody
was getting dressed up today.

We were supposed to,
there was a memo.

I didn't bring
anything to change into.

Well, neither did I.

Yeah, but you're
still a nurse.

You should have called me.

What, and then I would be

the only one in costume?

I don't think so.

Frank, where's your costume?

I don't observe
pagan holidays

that celebrate
devil worship.

Well, this is only
for Satanists.

‐ What?
‐ It's kind of working for you.

[chuckling]
Shut up.

(Chuny)
'If you give me an order
and I think it's wrong'

'I'm going to ask
you to clarify it.'

Not in front of the patients.

I only questioned the dosage.

‐ You made mistakes in the past.
‐ I have not.

‐ 'Is there a problem here?'
‐ Yeah, you've got no guts.

‐ I'm not working with him.
‐ Why?

Because he treats
nurses like idiots.

(Luka)
If your boots fit..

‐ Shoes.
‐ Whatever.

You wearing that
for your shift?

Yes. It's Halloween.

(Abby)
'You know, Jerry
sent out a memo.'

Ooh, naughty nurse.

‐ Not a naughty nurse.
‐ I like it.

Umm, like a, it's
an old fashioned nurse.

Looks naughty to me.

So, you're what,
like a kurva nurse?

What's that?

How do you say, a slut?

You know,
like a tramp, a whore..

Yeah, I got it.

You know, maybe
I should have worn

that schoolgirl
outfit you bought me.

[chuckling]

She's making a joke.

Cautery.

Robert, what you doing?

A laparoscopic
cholecystectomy.

But you can't be.

(Robert)
'I had no choice.'

'This poor swine
is full of stones.'

Oh, for heaven's sake,
it's a pig.

I hope you're not
expecting me to scrub in.

No, just giving my
right hand a workout.

It's been five months.
So, I gotta keep my skills up.

Stapler, though,
even with one arm

I'm a better surgeon
than the rest of the hacks

in this hospital.

Robert, you're
not cleared to do surgery

even on barn animals.

Were you aware that Weaver
put through a proposal

to hire PAs to cover
afternoon rounds

for post‐call surgical
residents? Grasper.

Yes, I thought it
was a very good idea.

That's not the point.

Point is, nobody
talked to me about it

and last time I
checked, I was still head

of both surgery
and this hospital.

The residency
review committee‐‐

Oh, sweet Mary and Joseph
will you look at the size

of that gallbladder?

Geez, you could
feed a small Amish

family, for
a week with that thing.

Look, I know Weaver's
been forming alliances

with some of the tribal elders
while I was recuperating but

'I would've expected a little
more loyalty from you, Lizzie.'

‐ Robert.
‐ 'Just rewrite the proposal.'

'As if it were
generated from us'

'and keep me abreast of any'

'other covert Weaver ops, okay?'

'The last thing I need
is Mata Hari'

'leading a palace coup.'

‐ What the hell?
‐ He's extubated.

Up, get him back under.
100 of Brevital.

Hold him down!
Lizzie, hold him down!

(Robert)
'Bloody hell.
He's a pig, grab a horn Lizzie.'

[theme music]

[music continues]

(Marty)
'Flex, flex, keep going.'

90 degrees, that's good.

Not my elbow
I'm worried about.

What the hell is going on

down there, Brenda?

Alright, the wrist.

And flex.

Keep going.

A little bit more.

Ten degrees.

Wrong, check it again.

Ten.

It was 15 last week.

Fluctuations
are normal, Robert.

With this type of injury
you've got to give yourself

at least nine months.

How does this affect my odds?

You've still got
a long way to go.

Yeah, I know. The odds.

For full flexion, extension

and opposition
of the digits, 20%.

But even then, without
radial and ulnar deviation

'of the thumb, I'm not sure
you'll be able to operate.'

But you could still
be chief of staff.

Most of your job
is administrative anyway.

Thanks for the
pep talk there, Marty.

[door shuts]

Excuse me.

I'm looking for Dr. Corday.

(Romano)
'Yeah, aren't we all?'

You a bill collector
or a suitor?

Med student.

You must be a slow learner.

It's a career change.

Cowboy and fireman
didn't work out, huh?

I'm supposed to start
my surgical rotation today.

‐ I'm Paul Nathan.
‐ Dr. Romano.

‐ What happened?
‐ Tennis elbow.

(female #1)
'Fire at a Halloween party,
at least 30 victims.'

‐ Gave ten of morphine IM.
‐ How you doing?

Not...good.

‐ What's your name?
‐ Amy.

Last name?

There was a fire
at the party downstairs.

‐ What's your last name?
‐ Was anybody with her?

(female #2)
'Hard to say, the whole
apartment building's burning'

'there's a lot of confusion.'

(Abby)
'Soot in the nostrils'

'and intraoral burns.'

I'm gonna need
an intubation tray.

Get Corday
on that crushed pelvis.

‐ Excuse me.
‐ Not right now.

Ed Jemena, 35.

Full thickness burns
to the hands and forearms.

This guy was on fire,
I tried to put him out

but I didn't have
anything to use but my hands.

‐ Luka, can you get this?
‐ Yeah. What's open?

‐ Curtain two.
‐ I need a trauma room.

You're lucky to get a bed.

‐ 'Okay, yes?'
‐ Oh, Paul Nathan.

‐ Radiology?
‐ No, um, surgery.

‐ Resident?
‐ Med student.

Okay, good enough
Cellulitis to the leg after

a bug bite to the ankle.

Well, what do I do?

Mark the leading edge

with the marker.

(Susan)
'Nice catch.
Whoa, we're full in here.'

‐ 'What do you have?'
‐ 'Doctor, excuse me!'

You all need to stay
in your assigned spots.

If a doctor or
a nurse can't find you

it's gonna cause
a delay in your treatment.

Doctor, doctor, can you tell me
what's happened to my things?

My apartment's
on the fourth floor.

I'll see what I
can find out for you.

‐ And the fire was on two.
‐ Will they let us go home?

Check with the fire department.

What did they
say how it started?

‐ Was there a gas leak.
‐ I'm sorry, I don't know.

(female #3)
'Carter, we need you!'

The fruits upstairs
were smoking dope, that's what.

No one was smoking
anything, alright?

What's that for?

It's to keep an eye
on the infection.

And what are
they giving him to stop it?

Uh, excuse me. Unasyn.

And that will get rid
of the infection?

Well, it should.
It's an antibiotic.

‐ Hey, are you a doctor?
‐ Med student.

I need that mayo stand.

Put it under his arm.

Got this?

‐ I'm supposed to be‐‐
‐ Good.

‐ I need a cut down..
‐ What are you going to do?

We're gonna make you better.

Why can't I
feel my hands?

Uh, the burns have
damaged your nerves.

Is it permanent?

I don't know.

‐ Where's Terry?
‐ 'Who's Terry?'

My partner.

He's dressed like a jungle girl.

Etomidate's on board.

I need to see Terry.

Trauma panel, ABG
and carboxyhemoglobin.

‐ Prime a line of ringers.
‐ What is this?

(Elizabeth)
'Rubber mask
melted to the face.'

I can barely
open the mouth.

Better try fiber optic.
I got the subclavian.

‐ I thought you left, Lizzie.
‐ Me, too.

I'm supposed
to be trick‐or‐treating.

A little old for
that, don't you think?

Open a crike tray
just in case.

Guide wire's passing well.

Preload an eight‐o tube
on a scope.

(Lily)
'Pulse ox down to 85.'

(Gregory)
'15 blade.'

(Elizabeth)
'Turn cc syringe.'

'Let's check the balloon.'

(Lily)
'I need a different
light source.'

Don't open the tray
unless the intubation fails.

‐ We don't want this...oh!
‐ I'm sorry, sorry.

Got the line. Run
the first liter wide open.

Robert, you okay?

‐ Oh silk, Neosporin and opsite.
‐ Robert?

‐ I'm okay.
‐ Keep bagging on 15 liters.

‐ Get the sats above 90.
‐ If you've got this, Lizzie

I'm gonna go check
on the rest of the kids.

(Jing‐Mei)
'Take slow, deep breaths.'

‐ 'I'm trying.'
‐ 'Have you ever had asthma?'

‐ 'No.'
‐ What's this?

Smoke inhalation with wheezing.

Increased breath sounds?

On the right
possible pneumothorax.

‐ May need a chest tube.
‐ Vitals?

‐ I've got it.
‐ Yeah, I'm sure you do.

Get a chest X‐ray
and show it to me.

Digital escarotomy.

Yeah, he needs
the same on the left.

I agree.

How old do you think she is?

(Abby)
'Uh.'

Young.

Hey, Dr. Corday?

Yeah?
What have you got?

Urine 60 an hour,
but it's bloody.

80% burns, she's gonna need 12
liters in the first eight hours.

Okay, send her
for CT abdomen and pelvis.

'I still need
to do an airway in here.'

‐ Dr. Corday?
‐ Yes?

Oh, uh, I'm Paul Nathan.
I was supposed to begin

'my surgical
rotation with you today.'

Yes, you were.

She's got a critical
patient next door.

‐ Where should I put these?
‐ Here. Put them right there.

(John)
'No free fluid.'

Liver and spleen look okay.

Scope is prepped.

Standing by
with the number five Shiley.

‐ Rounds started at 7:00 A. M.
‐ I know I was‐‐

Not interested in
excuses, thank you.

‐ Did you get my letter?
‐ Yep.

Dr. Corday,
your nanny is on the phone.

For God's sake, Frank,
take a look around.

Take a message.

I did, she said
to remind you she

has a flight to catch at 10:30.

Well, I can't
leave now, can I?

What do you want me to tell her?

Tell her to bring Ella here.

(Frank)
'Day care's closed, you know.'

I know.

Pulse ox 81.

He's throwing PVCs
We should crike him.

Is there anything I can do?

Yes. Be quiet.

(Elizabeth)
'Okay, bag him.'

You really want
to make up for it

go out there and
work up some patients.

‐ Yeah, but shouldn't I‐‐
‐ You wanna be a doctor?

‐ That's why you're here.
‐ Yes, but‐‐

Then grab
a patient, do an H&P

and present the
case to an attending.

(female #4)
'I told Martin 100 times'

'you need to put new batteries
in the smoke detector.'

'No, no.'

'God forbid he should
spend $3 on a nine‐volt.'

'The whole building
could have burned down.'

‐ Um, his X‐rays are back.
‐ Oh, okay, good.

How's he doing?

Better than most
by the looks of things.

Yeah.

Okay, next time I go hiking

I'm wearing long pants.

And bug repellent.

Your infection's spreading.

Uh, is everything okay?

I'll be right back.

‐ Excuse me, you're a surgeon?
‐ That's the rumor.

Uh, I think there's
something here you should see.

You're a med student, you
haven't learned to think yet.

I've got a rapidly
spreading cellulitis.

Excuse me.
How rapid?

Well, I just drew
this 20 minutes ago.

[whistles]

And look,
this looks like Sub Q air

consistent with neck fash.

Yeah, nice catch.
Let's roll.

Alright, get that side. We gotta
take your boyfriend upstairs.

‐ Upstairs?
‐ Yeah, to surgery.

‐ What's he on?
‐ 'Three grams of Unasyn.'

Okay, switch it
to six million units

of Pen G and 900 of Clinda.

Where's he going?

Newbie caught a neck fash.

‐ What?
‐ What's that mean?

Your boyfriend may have what
we call necrotizing fasciitis.

It's a virulent
skin infection.

But they gave him antibiotics.
He said it would help.

The infection's
spreading too fast.

So, wait wh‐what
are you gonna do?

We're gonna take
you up to the OR.

‐ To Remove the infected tissue.
‐ What?

Alright, everybody
off, off, off, the elevator.

Take the stairs next time you'll
live longer, come on move it.

If we don't stop this
it will continue to move along

and you will develop an
overwhelming infection

which will lower
your blood pressure.

You could die.

Oh, my God.

‐ Think we caught that in time?
‐ I hope so. Thank you.

I'm Susan Lewis.

Paul Nathan.

You coming?

‐ In a minute, yeah.
‐ You okay?

Yeah, it's just

it takes me a moment
to get going sometimes.

Uh...I have
Parkinson's disease.

(Robert)
'Lizzie, get up here!'

I'll be up
in five minutes, Robert.

'You said that ten minutes ago!'

I'm with a critical patient.

Find somebody else now, Lizzie!

Good ET Placement.
No infiltrates.

Check ABG, repeat CBC,
and work on a burn unit bed.

What about him?

‐ Who?
‐ Him.

Yeah, what about him?

Pardon me.

I found your CPK,
lytes and UA results.

You headed up to surgery
on the "neck fash"?

Yes, as a matter of fact.

Okay, well...
I guess we're done here.

I am. You still
owe eight hours.

I'm on rounds
at 6:00 A. M.

Welcome to surgery.

Excuse me. Uh, where can I find
somebody who was brought in?

Admit.

Come here.
Follow me.

Who you looking for?

Wynn Mathison.
He's in a tiger costume.

Excuse me, could
you please direct

me to the victims of the fire?

Keep your
habit on, my man.

‐ Excuse me?
‐ Yo, Dr. Pratt?

You'll get to be with your drag
queen friends soon enough.

I have food and housing
vouchers for the displaced.

Oh, I‐I'm sorry, sister.

Can someone please tell
me what room he's in?

‐ Dr. Pratt?
‐ What?

He's with the guy
in the tiger mask.

Can we get some oil
of wintergreen in here?

I hate the smell
of rotting flesh.

Suction.

Especially when it's
increasing by the minute.

Come on, that bacteria's moving

faster than you are, Edson.

‐ Bovie.
‐ Systolic's down to 95.

Bolus 500.
Lap pad.

Still not bleeding.
Myonecrosis.

‐ Yeah, it's in the muscle.
‐ Ten blade.

Okay, if it's
vascularized, don't cut it.

That's my plan.

Start there
and carry the incision

four centimeters inferior.

No, that's eight.
God damn it!

We need clean borders.

‐ Where the hell is Corday?
‐ She's in the scrub room.

(Dale)
'If I don't remove
enough tissue the infection'

'could be left
to smolder inside.'

Get her the hell in here!

Maybe she can debride this guy's

wound without using a chainsaw.
Hey!

'Chris, it's me,
Elizabeth.'

Listen you needn't come here.

I shouldn't be
longer than an hour.

Dr. Corday, he's
asking for you.

Be right there.

(Elizabeth)
'Okay, Chris,
but could you possibly'

'take Ella to your
house to finish packing?'

Yeah, I could pick
you both up after work.

I could drive you
to the airport.

Save you the cost of cab fare.

Yeah. Okay. Thank you.
Thank you so much.

Yeah, I'll see you soon.

Corazon, uh, would
you mind taking the phone?

Not at all.

[metal clinking]

Oh.

Damn.

Was that your wedding ring?

Yep. Yep.

I can't see it.
Can you call engineering?

They're closed
till morning.

I'm sorry.

No, it's not your fault.

Don't hate me.
He wants to talk.

(Robert)
'Lizzie, get your ass in here!'

I've lost my wedding ring.

'Oh, boo‐hoo, this
guy's about to lose a leg!'

I'd say "chop‐chop," but that
would be in extremely bad taste.

Can you call someone

get them
to tape this off for me?

Make sure no more
water is run down it?

Sure.

(Robert)
'Would somebody
please call Tiffany's'

'search and rescue team?'

I'm coming!

He's got 20% surface
area burns, mainly upper body.

‐ Oh, God.
‐ 'Decent prognosis.'

(Gregory)
'We provide ventilatory
support until the lungs heal.'

Then we extubate him.
Might take a week, maybe less.

What‐what about his face?

He'll need skin grafts.

There will definitely
be some scarring.

[sobbing]

Wynn. Wynn, it's me, Terry.

(Terry)
'I'm right here.'

He can't hear you.
He's sedated.

You should probably
have your eye looked at.

(Terry)
'Later, okay?'

Can I touch him?

I wouldn't.

Yo, newbie. Come on.

[machine beeping]

Check jungle perv's eye
with the slit‐lamp.

He may have
a corneal burn.

‐ Where's that?
‐ 'You still here?'

Yeah, uh, slit‐lamp.
Where is it? How does it work?

Exam three. Try
the on/off switch.

Hey, hey.

‐ You changed.
‐ What?

I just put
on some scrub pants.

Oh, come on.

You know, Carter

my outfit is really
starting to bug me, too.

But we agreed to stay
in costume the entire shift.

Yeah, I am.

No, you're not.

It's half a costume.

It's always, like,
50% commitment.

Are you serious or you kidding?

Do you even know what I've been
dealing with down here?

Yeah, me too. In pumps.

Wanna see the whole costume?

‐ No.
‐ Here's the whole costume.

‐ Forget it.
‐ I'm a skeleton! Look at me!

Carter really likes
Halloween, huh?

Perpetual erection.

Accidentally drank his
daughter's mandrake smoothie.

Police found him
chasing women down the street.

‐ Where do you want him?
‐ In a cold shower.

Curtain three's open.

Okay, get a line in
and push four of Ativan.

Are you open, baby?

[lecherous laughter]

Perfect.

[laughing]
Whoo!

First day labs, charcoal
and a Foley for the tox screen.

Release me!
I'm the Marquis De Sade!

How am I supposed to pass
a catheter through that?

‐ Inject phenylephrine.
‐ Into the shaft?

I'm Rod Stewart!

He won't hold still
long enough for a blood draw

much less
let me touch his penis.

Oh, she can touch it!

(Luka)
'Or we can wait for the'

'mandrake to metabolize.'

Why not just give him Haldol

make it easier on everybody?

It might make
his symptoms worse.

‐ Hey!
‐ Hey, hey.

He just grabbed my ass.

Well, I couldn't reach hers.

I said four of Ativan.

‐ Ask Abby. I'm done.
‐ Oh.

Okay, you could be a
little bit more sensitive.

To what?

[laughing]

♪ Choo choo
choo choo choo ♪

(Elizabeth)
'It's amazing how
quickly this spreads.'

(Dale)
'Any idea how he got it?'

(Elizabeth)
'A cut, a scratch, some
other trivial injury.'

Dopamine's at ten mikes.

More suction.

‐ Scalpel.
‐ Easy, Lizzie.

Just me, or is this constant
commentary rather distracting?

It's not you.

Just remove
the infected tissue

and let antibiotics

and hyperbaric oxygen
therapy do the rest.

‐ You're not serious.
‐ Hell, yes, I am serious.

I'm already into
the posterior compartment.

It's still necrotic soup.

Six hours in the chamber will
increase his oxygen saturation.

‐ Create a bacteriocidal effect.
‐ Robert.

And give this guy
a chance of a functioning leg.

Do you two have a
problem with that?

How's a guy with
Parkinson's get into med school?

Probably some kind of disability
quota they have to fill.

Forget med school.
How's he expect to practice?

Wouldn't want him
taking out my appendix.

He seems to have
it under control.

You know,
it's a progressive disease.

What's he gonna be
like in ten years?

‐ Could be dead.
‐ Or want to be.

Happy Abby, always
looking on the bright side.

Dr. Weaver, I thought
you were out sick.

I was until an apartment fire
set us back 30 patients.

(Pratt)
'35, if you count
the bad popcorn balls.'

‐ Oh, wonderful.
‐ Thanks for coming in, Kerry.

Yeah, I shouldn't
have answered my phone.

‐ Want your messages?
‐ No!

I want the air conditioning on!

I'm sweating like a pig!

It's freezing in here.

That's what you get for
bringing Weaver in on Halloween.

You know it's
the biggest holiday

of the year for her kind.

‐ Lesbians?
‐ Wiccan.

She's probably riding that
crutch around like a broom.

Oh, come on, Frank.

All women get like that when

they're going
through the change.

‐ Pratt!
‐ What?

She's having
hot flashes, she's moody.

‐ That is so sexist
‐ 'And stupid.'

‐ She's too young.
‐ Early onset.

You've got early onset.

Whatever you say,
nasty ratchet.

It's nurse, okay?

Not nasty, not naughty,

not wet, certainly not head.

Just nurse.

Abby, you're gonna
talk to Kovac, right?

Yes.

County general
on bravo one.

I finished
with the slit‐lamp.

I numbed him
with Alcaine.

Who are you?

Meet Nathan our
newest oldest med student.

I'm on surgical
rotations with Dr. Corday.

We have to clear trauma.
BOA with newborn hypoxia.

She asked that I stay
and assist in any‐‐

Good. Follow me.

Don't worry.
She doesn't bite.

Much.

Simone Philip, 42.

Had a home birth,
newborn in respiratory distress.

(Weaver)
'Simone, did you have a
difficult or complicated labor?'

No, it went well.
I didn't even tear.

One minute Apgar with
seven, but he had a little.

‐ Who are you?
‐ I'm the midwife.

What's wrong with him?

We're gonna find out, alright?

Take him to trauma one.

‐ Wh‐where is that?
‐ 'I'll take him.'

‐ No, I...it's okay.
‐ I got it, I got it.

I got it.

Simone, you've
lost a lot of blood.

Something's wrong
with my baby, I know it.

Lily, stirrups.
Gallant, labs.

Oh, maybe I should have
had him in a hospital.

Simone,
you did everything right.

(Michael)
'CBC, PT/PTT'

DIC screen, type
and cross for four units.

We're taking care of
your baby. Let's help you now.

BP is 80/60.

‐ Squeeze in another two liters.
‐ What's happening?

You're losing a lot of blood
from a retained placenta.

No, I mean with my baby.

Dr. Kovac is taking
good care of your son.

I'm gonna pull gently
on the umbilical cord.

Simone?

I need you to stay with me.

Oh.

Pulse ox is 82.
He's retracting.

Pedes intubation tray,
number three ET uncuffed.

What do you hear?

Wet crackles throughout.

(Luka)
'Fluid in the alveoli.'

'Okay, let's have a look.'

Unhook the bag
from the mask.

You can bag
the ET once I'm in.

I've never done that.

Squeeze the bag
every two seconds

just like he was doing.

Never pass the tube
till you see the cords.

Okay. I'm in.

Call for a pedes vent and set
me up for an umbilical line.

Relax. Relax, the
hard part's over.

Good.

Notify the NICU team.

What do I tell them is wrong?

I have no idea.

(Elizabeth)
'It's no good.
We're into the quads.'

(Dale)
'We'll have to do an AKA.'

'Keep debriding.
We're not there yet.'

If we treat this
conservatively, and it spreads

we're committed to
a hip disarticulation

'to stay ahead of the bacteria.'

It's worth the risk.

Of his being no ambulatory?

With an above‐the‐knee
amputation at least

he can use a prosthetic.

And if it gets into his hip

it'll spread
to the abdominal wall

and he'll get septic.

I am trying to
save this man's leg.

‐ Dry the field.
‐ What about his life?

He's young.
It's the same thing.

Oh, come on, Robert,
of course it's not.

(Elizabeth)
'Look, this Kelly'

'slices through
Sub Q fat like butter.'

Alright, fine, keep cutting
until you hit viable muscle.

It's above the distal
third of the thigh.

It's a hopeless wound.

Fine, take it.

‐ 'Robert.'
‐ I said take the leg.

[slams equipment]

Bovie, pickups.

[man and boy laughing]

Tommy.

How are you feeling?

He seems, he seems
a lot better, thanks.

Good, well, uh just keep
him on clear fluids tonight

and I'll have
a nurse sign you out.

Okay. Thanks.

‐ What's wrong with him?
‐ Shh, shh.

We'll, uh, we'll
talk about it later.

[indistinct chattering]

How you holding up?

I'm good. Uh, I think
the robot can go home.

Okay. I'll get Carter
to dispo him.

Okay.

Can I get you a cup
of coffee or something?

No, fine, thank you.

‐ Uh, I like your outfit.
‐ Mm‐hmm?

It's very retro.

[chuckles]
Thank you.

Um, listen, if..

...if you ever need anything.

‐ Uh,
‐ Like a straitjacket?

[both chuckling]

Is your... dyskinesia
usually this bad?

I don't wanna freeze up
when I'm at work

so I up the medication,
and this is what you get.

At least it helps
to dispel the myth.

You know, we don't
all have rhythm.

[both chuckling]

If that happened to me I'd
probably jump on a world cruise

not go to med school.

I already saw the world.

In fact, I was in Italy

when I first realized that
I had a problem.

I was sipping wine in this
little cafe in Florence

and I noticed that my
little finger was shaking.

I just figured it was from
living on espresso and martinis.

How did you find
out it wasn't?

Well, I used to hate doctors

so it took a while
for me to check it out

but, once I did, it really
put things in perspective.

Yeah, I guess
being sick does that.

Her baby's not
doing well, huh?

No.

‐ How you doing, Simone?
‐ Good. He seems better, huh?

Maintenance fluids are
at 5cc's per kilo per hour.

My mother had me at home.

I thought it would
be good for him.

Um, his tests came back.

I'm afraid your baby has a
disease called sialidosis.

What's that?

His body lacks
an enzyme that breaks down

the waste proteins
inside the cells

and there is already
extensive damage to the liver

the bones and the
nervous system.

[sighs]

I've been staring at him

for over an hour now and..

(Simone)
'I still..'

'...can't figure out
what I want to call him.'

Would you
excuse us, please?

Uh, yeah. Sure.

[Luka sighs]

Children with, uh, sialidosis

are mentally retarded..

(Luka)
'...often blind.'

'He'll never
speak or walk.'

His life expectancy
is less than two years.

(female #5)
'Dr. Kovac,
NICU's on line one.'

Thanks.

[sighs]
Excuse me.

Is there anyone
you'd like me to call?

[sighs]

[quietly]
No. There's just us.

I don't think it
will be necessary.

Thank you.

You having a bad night?

No worse than usual.

That was a little bit
insensitive don't you think?

Hey, I had to tell a mother
her baby was gonna die.

I didn't need an
audience, okay?

Okay.

I'm starting to get some
complaints about you.

‐ From patients?
‐ Nurses.

Don't look
so concerned about it.

Okay, first you accused
Chuny of being an idiot

and then later when she was
sexually harassed by a patient‐‐

Sexually harassed?

The guy grabbed her butt!

Yeah, that's
sexual harassment, Luka.

Oh, come on, Abby,
you were there.

The guy's intoxicated with
mandrake, he's harmless.

This one's all yours.

‐ What patient?
‐ Mr. Hard‐on.

I was checking his vitals
and he grabbed my boob.

Okay, what's his status?

He's gonna die if he tries

that again, that's his status.

See, every time
a nurse has a problem

she complains to me.

Everyone complains,
it's part of the job.

Yes, and it's part of my job as
nurse manager to counsel you.

What?

You can give nurses orders,
you cannot critique their work.

If you have a problem with a
nurse you have to come to me.

Okay, what about you?

Who do I complain to
if I have a problem with you?

Well, here's an idea, maybe you

should try fighting
for the nurses

instead of fighting with them.

Hey, maybe you should sew
some swastikas on that costume.

You could be
a naughty Nazi nurse, huh?

You totally suck, you know that?

Hey, careful, creating

a hostile work environment!

‐ Where's Dr. Kovac?
‐ I don't know page him.

The baby with sialidosis
is febrile to 102.

Chuny, where's Kovac?

Don't know, don't care.

He feels like
he's on fire.

Why hasn't he gone
up to the NICU?

You'd have to ask Dr. Kovac.

Can you do something for him?

He needs to be pan‐cultured.

‐ How much does he weigh?
‐ 3 kilos.

Okay, 150 milligrams IV.

Piggyback of cefotaxime and amp.

Set up for a spinal tap.

He has sialidosis.

Yeah, and he also has an

infection 60 migs of Tylenol.

I'll make
arrangements for your baby

to be sent up to
the neonatal unit.

We're gonna do
everything we can for him.

Thank you.

Why are you still here?

Uh, my piano
recital was canceled.

Hey, it's me, Elizabeth.
I'm on my way home now.

I'll see you soon. Bye.

We did the right thing.

Trying to convince me or you?

Look, I went through
a period of adjustment..

...when I became a mother every
time I had to treat a child.

(Elizabeth)
'You get over it.'

Oh, please, spare me the
two‐dollar

psychoanalysis, Lizzie.

Fine.

Hey, look, look, look.

I know most people
don't like me, I don't care.

I don't like most people.

But I'm good at what I do.

I save people's lives.

Every day.

People who no one else can help.

If I can't do that..

Robert.

I know you're frustrated.

You're an excellent
surgeon, and you will be again

I promise you.

You will be.

I'm being paged.

Elizabeth?

Uh..

(Elizabeth)
'I'm being paged.'

[door opens]

[phone ringing]

[indistinct chattering]

(Female #6)
'Elizabeth.'

‐ I‐I just tried calling you.
‐ I'm sorry, I couldn't wait.

I have to leave
for the airport now.

Well, what about
a later flight?

‐ This is the later flight.
‐ Oh.

I threw her pajamas

some crackers,
a couple toys in here

just in case she had
to stay for awhile, I'm sorry.

No, no, no, it's alright, it's
my fault. We got slammed.

I'm back Sunday night,
so I'll see you Monday morning.

Yeah, yeah.
Have a safe flight.

‐ Okay, bye, Ella.
‐ Bye.

Hey, did Chris take
you trick‐or‐treating?

[alarms sounding]

What is it?

Dropped her pressure
to 60 palp.

'Dopamine is up,
we've got two liters going'

and I'm working on an art line.

(John)
'Any word from her family yet?'

No, we still don't
have a last name.

‐ Lily, could you?
‐ Oh, sure.

‐ There, it's okay.
‐ Hello, little cowgirl.

I'll be with you soon, alright?

Could it be hemorrhagic?

(John)
'CT was negative
I'm thinking hypoxia.'

If we don't find her family soon

they're just going
to be ID‐ing the body.

Her pulse ox is
only 82 on 100%.

She needs suctioning, Abby.

Set up ultrasound
she may have thrown a clot.

(John)
'I don't know, second
crit was only 32.'

‐ What happened to mom?
‐ In the washroom.

Where are the suction catheters?

Try the cabinet.

What are you doing?

Weaver ordered antibiotics.

No. Who did the LP?

She wanted a full
septic workup.

‐ This is my patient.
‐ The baby spiked a fever.

This baby is in a
chronic vegetative state.

You are prolonging his suffering
and the suffering of the mother.

We still treat
kids like this.

‐ You should have asked me.
‐ We couldn't find you.

I told you to leave once
already this is not your case.

‐ Luka.
‐ Abby!

(Luka)
'You need to
check with me before'

'you push meds on my patients.'

I have to do
a cut‐down here.

Morrison's pouch looks dry

but it could be retroperitoneal.

What the hell was
all that about?

You want peep on the vent?

Not until we get
her pressure up.

(John)
Nathan, why do you
think she's hypotensive?

‐ Blood loss?
‐ Not in this case.

Hypoxia can cause
myocardial dysfunction.

That's it I'm filing a
grievance against him.

Not now, Chuny. IV's dry,
she needs a fresh one.

I'll get it.

Panic value potassium's 8.2.

Damn it, that's rhabdo from the

crush injury
10cc's of calcium gluconate.

(Elizabeth)
'PVC's.'

(John)
'Let's push bicarb ten units of'

'regular
insulin an amp of D‐50.'

Get me kayexelate and call
renal she may need dialysis.

‐ What the hell are you doing?
‐ I accidentally‐‐

It's okay.

Go see if Frank's
found the girl's family.

No, I'll start another one.

(John)
'Line's in,
is the transducer ready?'

‐ Where's the saline?
‐ I said, go find the family.

‐ 'Run of five.'
‐ '100 of Lidocaine.'

Prep the groin
for a Quinton catheter.

Sats are falling, 79.

Pressure's down to 50.

Being a little hard
on him, don't you think?

V‐tach, charge to 200.
What are you talking about?

Nathan, he's doing a pretty
good job, considering.

‐ Considering what?
‐ He has Parkinson's.

Excuse me?

(Elizabeth)
'Clear.'

Still V‐tach.

Procainamide's on board.

Stand by with amiodarone.

Clear.

No change.

How long?

‐ How long?
‐ Uh...12 minutes.

Clear.

‐ Sinus tach.
‐ Alright.

Way to go.

Good femoral pulse.

Set up a Pronestyl
drip, then a repeat K.

Labs on your baby.

Thank you.

Glad to see you
two have made up.

Hey, I'm being professional.

She's the one
having trouble.

I warned her.

Warned her about what?

[sighs]
Nothing.

Oh, my God.

You're such a jerk.

‐ What?
‐ You slept with her?

[scoffs]

That's what this is all about.

What's your problem?

‐ One time.
‐ One time. One time with Chuny.

One time with
a patient's mother in radiology.

Hey, you never complained.

Yeah, I never let
it affect my work.

You two need to
figure this out.

‐ So, what do you want me to do?
‐ I don't know.

Tell her you're sorry.
Tell her it was wrong.

‐ Just fix it.
‐ I'm not gonna kiss her ass.

That's how this whole
problem started.

Have them check a gas on 50%.

I'm gonna wait
right here for you, Wynn.

Don't worry about anything.

I love you.

[sighs]

I should've told them
I was his brother.

ICU has strict rules.

He'll need around‐the‐clock
attention tonight

but his lungs are rebounding.

You know what,
you should probably go home.

They'll let you
see him in the morning.

Home?

Our whole lives were
in that apartment.

This dress is all I have.

I've been watching
his heart rate.

It goes down when I touch
him, when he knows I'm here.

Has his fever gone down?

A little.

I waited so long for him.

Five years.

Two miscarriages, in vitro.

I lost two boyfriends

because I was so
determined to have a child.

I was about to give up..

...and then suddenly..

...he was here.

He's here.

We'll keep
treating the infection

but he could start going
into organ failure soon.

(Luka)
'His systems will shut down.'

[quietly]
You're so beautiful.

You're my baby.

His heart could stop beating.

(Luka)
'I need to know
what you want to do'

'if something
like that happens.'

I don't know.

To keep him alive,
I may have to open his chest.

'Maybe even
shock him.'

And I'm not sure you want me
to do something like that.

No.

[quietly]
I...I don't know.

(Simone)
'I don't know.'

Tell the unit
I flushed the Quintin.

He's tenacious.
You've gotta give him that.

(Elizabeth)
'I wish he'd told me.'

Not an easy thing
to lead with.

Oh, there's mommy.

There's mommy.

Hi, uh, Lily had to run
Wynn's ABG up to the lab.

Thank you.

Did you reverse
her hyperkalemia?

Yeah, just enough to
get her to dialysis.

She still has
the burns, though.

Yeah, but you got her back.

May I? Oh, I'm sorry, yeah.

Hey.
Thank you.

So, did we
reach the parents?

No, uh, the girl
was actually baby‐sitting.

Wasn't even her building.

You know, you might
have told me sooner

saved me some
embarrassment.

About your condition.

Well, I certainly didn't
mean to embarrass you.

How long has it been?

Eight years. I was
misdiagnosed for the first two.

And you were late
today because?

My neurologist wanted an MRI.

I'm sorry.

I wouldn't have
made you stay.

What the hell, fresh start.

Try to make as many
rounds as you can

complete the
required reading

take the exam.

I've been reading
and taking tests for two years.

This is my hands‐on training.

‐ It's a surgical rotation.
‐ I understand that.

Probably the most
physically demanding

emotionally exhausting

stressful six weeks

any would‐be
physician ever experiences.

Part of becoming a doctor.

I'm offering you
a pass, Mr. Nathan.

Trust me, you should take it.

I'm here to treat patients.

You have a degenerative
neurologic disease.

I know what I have.
It doesn't mean I need a pass.

[phone ringing]

(Frank)
'ER.'

I don't want special treatment.

I just want to learn
like other students.

You're not like other students.

‐ No, I'm older and smarter.
‐ 'Okay, Dr. Corday.'

(Frank)
'Burn unit needs you.'

I'm on my way out, Frank.

It's your melted mask guy.

Okay. I'll
be right there.

She's on her way.

Look, go home,
think about it.

Report back
day after tomorrow.

(Elizabeth)
'I'm sure you
could use the rest.'

I'm fine.

It's just not
very practical.

Okay, let's go.

Dr. Weaver?

What?

‐ What time is it?
‐ Are you okay?

Yeah, yeah, I was..

I was just gonna lay
lay down for a second.

Can you pronounce a patient?

Did we ever hear
back from the NICU?

‐ Uh, no, there was no need.
‐ Oh, come on.

It's been three hours.

We can't board their patients.

They have to call
in a nurse from home

or if they won't, I want to
speak to their medical director.

Weaver.

Cardiac arrest
half hour ago.

Excuse us.

You should've come to get me.

How long did
Dr. Kovac work on him?

He didn't.
She signed a DNR.

Where is he?

‐ Who?
‐ Kovac.

He's home. His shift
ended at ten.

Alright, I'm gonna
move her to a quiet room.

Call the social worker

get her referrals
for grief counseling.

(Abby)
'Are you leaving soon?'

I'm just, uh,
finishing up with Woody here.

You're the most beautiful
nurse in this hospital.

Well, thank you.

(Woody)
'You've got class.'

‐ May I play with your breasts?
‐ Hey!

‐ Excuse me.
‐ 'Please?'

Last request of a man
on his deathbed.

You're not dying,
Woody, you're drunk.

I wanna go to heaven on the
bosom of a beautiful woman.

I don't think
your HMO covers that.

How much longer you
have that outfit for?

Tomorrow at noon, why?

Thought maybe I
could talk you

into giving me
a sponge bath.

What's in it
for me, boney boy?

Oh, I'll give you a bone,
nasty, naughty little nurse.

(Robert)
'Elizabeth!'

Uh...Robert,
can we talk tomorrow?

I really have
to get Ella home.

I thought you might
want this before you left.

It's my ring.

Amazing what you can do with a
laparoscopic camera and a snare.

Thank you.

De nada.

Uh..

...look,
about, uh, about today.

uh, let's not.

It was a momentary..

...weakness on my part.

It won't happen again.

You'll work
through this, Robert.

Of course I will.

‐ Goodnight.
‐ 'Night.'

[instrumental music]

♪ If you ♪

♪ Dream of me ♪

♪ Like I ♪

♪ Dream of you ♪

♪ In a place that's warm ♪

♪ And dark ♪

♪ In a place where I ♪

♪ Can feel the ♪

♪ Beating of your heart ♪

♪ Remembering ♪

♪ Your touch ♪

♪ Your kiss ♪

♪ Your warm embrace ♪

♪ I'll find my way ♪

♪ Back to you ♪

♪ If you'll be waiting ♪

[instrumental music]

(Elizabeth)
The patient has gastroenteritis

vomits to excess,
has hematemesis

no history of PUD.

What are you thinking?

Well?

(Nathan)
'Mallory‐Weiss tear.'

Laceration of
the distal esophagus

results in an upper GI bleed.

You're both correct and tardy.

Sorry.

Don't be sorry,
be punctual.

What if that patient vomits
and develops chest pain?

Boerhaave's syndrome.

Spontaneous rupture
of the esophagus

associated
with retching.

Usually tears into
the left pleural space.

♪ Your touch ♪

♪ Your kiss ♪

[theme music]