Quincy M.E. (1976–1983): Season 7, Episode 2 - The Golden Hour - full transcript

Request permission to reroute this
patient to Hill Memorial Trauma Center.

This is Dr. Fuller. You have
no authority to request a reroute.

He's only got one chance
and I'm gonna give it to him.

Nurse! Nurse, come quick!

She was in the hospital at least
five hours before the operation.

The one you expect to live dies,
and the one you expect to die lives.

I'll never be guilty of
keeping my mouth shut

when it comes to the
need for trauma centers.

It's gonna be a rough ride.

Gentlemen, you
are about to enter

the most fascinating
sphere of police work,



the world of forensic medicine.

Looking for
somebody, little girl?

Daddy! Oh, sorry
I'm late, but I made it.

Mrs. Curtis just told me. I got
the lead in the spring recital.

That's terrific, honey!
What'd I tell ya?

Keep workin' the way you
were and it'll all come your way.

- Oh, I still can't believe it!
- Oh, I'm so happy for you.

Oh, you shoulda seen Libby's face.
The lead, Daddy. Isn't that unreal?

I don't know why I bothered to bring
the car. I shoulda let you fly home.

C'mon, star.

Oh, I can't wait to tell Mom.
Oh, and I've gotta call Miriam, too.

There's so much
to learn for this part.

Listen, babe.

You just pay attention
to your old man, huh?



Take a nice deep
breath and slow it down.

There's plenty of
time for everything.

Are you gonna come to
my opening night, Daddy?

Are you kidding?

I'm gonna come every night.

- Oh, Daddy. I love you.
- Easy...

Don't touch him.

Leave him alone. Somebody,
please call the paramedics.

Cover the girl.

Okay, honey, don't
worry about a thing.

You're gonna be all
right. Don't try to move.

Take it easy. We're gonna
get you outta here real soon.

Where do you hurt?

My chest hurts.

Right, your chest.

Now just try to relax.

What's your name?

Anders...

Bruce Ander...

Anderson.

Okay, Mr. Anderson.

Good.

Just relax now.

Sher...

Sherry!

- Sher... Sherry!
- Sherry's fine.

Relax, relax, Mr. Anderson.

My father. Help my father.

Don't worry about your
father. We're taking care of him.

I just want you to lie still
here, okay, and try to relax.

I'll be right back.

What do ya got?

She's got a probable
fracture of the lower left leg...

Possibly a couple
of fractured ribs.

Some abdominal tenderness,
but her vital signs are good.

Okay, the guy's got chest
pains and rapid pulse.

We'd better get some EKG
leads on him and get an IV started.

We're also gonna need
cervical collars for both of them.

I really think we're gonna
have our hands full with just him,

so call OCD, have 'em send a
second ambulance just for the girl.

Okay.

OCD, this is Rescue one-eleven.

We need another
ambulance at this location.

Valley View, this is
Rescue one-eleven.

We're at the scene of a traffic
accident. How do you copy?

This is Valley View
to Rescue one-eleven.

I read you loud
and clear. Go ahead.

We got two victims of an

auto-versus-tree. Patient
number one is a female

passenger approximately
sixteen years old.

Patient number two is a male driver,
approximately forty-five years old.

Patient number one has

probable fracture of the left
tibia-fibula, she's got some

possible rib fractures on the
left, and also some left-sided

tenderness of the abdomen.
She's conscious and coherent,

skin is dry, warm,
and normal color.

Vital signs to follow.

Patient number two also
is conscious and coherent,

he's complaining of some
pain in his right chest,

his skin color is pale,
temperature is cool,

slightly diaphoretic. BP is 130
over 80, pulse 100 and regular,

respiratory rate 26.

We've got the C-collars in place
and request permission to start IV's.

Rescue one-eleven,
this is Valley View.

Start IV's with
lactated ringers.

Rescue one-oh-eight coming your
way with patient number one, Valley View.

- What is their ETA?
- ETA, eight minutes.

Blood pressure's down,
Mike. 90 over 60, pulse 120.

Valley View, this is
Rescue one-eleven.

I've got an update on the
vitals of patient number two

blood pressure is
down to 90 over 60,

pulse is 120,

is becoming increasingly diaphoretic,
and his level of consciousness is dropping.

Valley View to
Rescue one-eleven.

Inflate the legs
of the mast suit.

Keep the IV wide open.

Are you prepared to transport?

Valley View,
that is affirmative.

We are near the county line.

Request permission to reroute this
patient to Hill Memorial Trauma Center.

Negative, one-eleven,
this is Dr. Fuller.

You have no authority
to request a reroute.

Transport patient immediately
to this location and fast.

Valley View from Rescue one-eleven.
We're having problems copying you.

We're gonna transport this patient
to Hill Memorial Trauma Center.

Over and out.

Rescue one-eleven,
this is Dr. Fuller.

Come in, Rescue one-eleven,

one-eleven, come in...

Are you crazy? You
can't overrule a doctor!

Listen, this guy is suffering
from multiple trauma.

He's only got one chance

and I'm gonna give it
to him. Now come on!

Blood pressure's down
to 60, Doctor. Palpated.

Meg, get a subclavian
line into him.

Abdomen's grossly
distended and tense.

Type and cross
twelve units of blood

get a stat CBC,

insert a Foley catheter
and an NG tube.

All right, Amy, how's
his pressure now?

It's fifty-five sistolic, sir.

Got internal hemorrhage.

We gotta get him to the O.R.

Jim, I need a chest
and abdominal x-ray.

Come on, Jim, now!

Move aside, boys, here it comes.

Well,

appears like you got
some broken bones.

But I'm gonna have to send
you up for x-rays just to be sure.

- How ya doing?
- All right.

Good. You lie still.

Miss Davis'll take you
up in a minute, okay?

Sherry, your
mom's been notified.

She's on her way.

My father, what about my father?

Now, he's been taken
to another hospital.

Now, don't worry about a thing.

The whole right lobe
of the liver's crushed.

It looks like the
vena cava is ok.

Let's set up to
resect that right lobe.

How's his pressure?

Still holding, Doctor.

Let's get goin'. I don't know
how much more this guy can take.

Sherry, baby, are you all right?

Pretty sore, I guess,
but I'm okay, Mom.

Mrs. Anderson, your daughter has
a broken leg and some broken ribs.

I'd like to keep an
eye on her, but...

She ought to be able to
go home in a few days.

And my husband... The nurse
didn't seem to know where...

He isn't here.

The paramedics took him to Hill
Memorial, the trauma center there...

- Trauma?
- Oh, Mom

I'm sure they're doing
everything they can.

How badly?

I mean...

- He'll be all right, won't he?
- I suggest you call 'em.

You can use this
phone if you like.

- Excuse me.
- Mom...

Don't worry, please...

Daddy's going to be
all right. He has to be.

I'm concerned about
pulmonary complications

I want cultures, blood
gases and a chest X-ray.

It's Dr. North.

No, it's all right, I'll...

Hello, Dr. North,
this is Mrs. Anderson.

Yes, Mrs. Anderson,

your husband is
recovering from surgery.

He is in our intensive
care unit right now.

He was bleeding internally
when they brought him in

and we had to operate immediately
to repair damage to his liver.

How is he, Doctor?

His condition is
critical but stable.

Dr. North, I don't
know what to do.

My daughter was also hurt in the
accident. I'm with her now at Valley View.

Should I come over?

I can't advise you on that.

But there's really nothing you
can do for your husband right now.

He's still sedated from surgery
and we're monitoring him carefully.

Look, Mrs. Anderson,
your husband's under fifty.

His heart is strong.

I think he's got an
excellent chance.

Thank God!

Sherry! Sherry, what's wrong?

Nurse! Nurse, come quick!

Sherry...

Sherry?

Sherry?

Patient number six is
the one I'm worried about.

Excuse me, Dr. Fuller, the Anderson
girl, I think she's going into shock.

Get a surgeon over here right
away. Helen, come with me.

Hello? This is Valley View
Hospital calling Dr. Hammer.

Do you know when he'll be back?

I know, I know, but
this is an emergency.

Yes, I'll try Dr. Petri.

Hello, Dr. Petri? This is
Valley View Hospital calling.

Yes, it is an emergency.

Who is available?

Yes, Doctor, I'll try.

Yes, Dr. Baker?

Yes, I'll hold.

Yes.

Yes.

Fine, Dr. Brown. I'll tell
them that you're on your way.

O.R.? Dr. Brown'll
be here in 25 minutes.

How is she? Can I see her now?

Mrs. Anderson...

I'm sorry.

- What do you mean, sorry?
- We did everything
humanly possible.

But...

But, you told me she
was gonna be all right.

I know, I'm sorry. There
were complications.

Complications?

What do you mean, complications?

The accident
happened Tuesday night.

Her father was taken to the
trauma center at Hill Memorial.

She ended up at Valley View.

Where she underwent surgery.

Well, the report says the eleventh
and twelfth rib on the left are fractured

and some contusions over
the chest and shoulders.

That probably explains the
complications with the spleen.

According to this,

she was in the hospital at least
five hours before the operation.

Five hours?

What're you talkin' about, Sam?

You crazy?

Look at that spleen, Sam.

There's a subcapsular hematoma.

The force of the crash
lacerated the spleen.

But the tough capsule surrounding
it let the blood accumulate inside.

It was a delayed rupture.

Her spleen was filling up with blood
like a balloon and it suddenly blew out.

The spleen bleeds so
easily in this kind of trauma.

Why didn't they
suspect it at the hospital?

I don't know.

But there's no question, this
was a preventable trauma death.

But you can't say they were
negligent at Valley View.

No, not negligent, ignorant.

This girl should have
been rushed into surgery

and had her spleen removed
at the first sign of bleeding.

A case like hers can
deteriorate so fast.

That's why trauma
teams are so vital!

They could have had her in
the operating room within minutes

with the right equipment,
the right specialists...

Instead, those doctors fiddled
around with a broken leg while

that bomb was
ticking away inside her.

The poor girl
never had a chance.

That's not true, Sam.

She did have a chance.
Only it was taken from her.

The paramedics out in
the field, they did their job.

They got her to an
emergency room.

With the injuries she had
that should've been enough.

No, she was brought to the well,

only the doctors in
charge let her die of thirst.

All right, the big
danger now's the lungs.

Better keep an eye on that wedge pressure.
I want to know if there's any increase.

Jim.

Quincy, what're you doin' here?

I heard you were with
Anderson. I wanted to talk to him.

Ah, no way!

- Do you know him?
- In a way...

I just did the autopsy
on his daughter.

- You mind if I see it?
- No.

Holy mackerel!

Yeah, it's amazing, isn't it?

What the human body'll endure?

These are the kind of injuries you'd
expect to find in a coroner's report,

not a hospital file.

He's not out of the woods yet.

We'll be watching
him pretty closely.

I wish someone had watched
his daughter that closely.

The one you expect to live dies,
and the one you expect to die lives.

The irony is neither
of 'em should be dead.

Not with all we know,

not with all this.

- Quincy, have you
got a couple a minutes?
- Sure.

I think I need a,
uh, friendly ear.

- I'll buy you a cup a coffee.
- Thanks.

It's always hard. The waste.

The absolute futility
of unnecessary deaths.

The first time I had
to face it, though,

I think that was the
worst, the worst one of all.

I'd just come onto
the day shift, ya know.

A little nine-year-old,

he'd been run over, practically
in front of the hospital.

He'd been there all night long,

but now, suddenly,
everybody was in a panic.

I remember, he was

the most beautiful
kid I'd ever seen.

And, they'd done
nothing all night except

clean his bruises, maybe take a
couple of stitches in his forehead.

By the time I got to him,
he was in convulsions

and then his heart stopped.

Like a wire coming
loose inside a toy.

Nobody had bothered to
check his distended abdomen.

So...

He bled to death.

His life just slipped
right through our fingers

and was gone.

And I swore I'd devote
my life to stopping that

stupid waste.

You must have some
sense of fulfillment.

That's what your trauma
center here is doing.

Did you say doing? Or did?

'Cause, believe me, a month
from now, this center is gonna

be a footnote in the history of
enlightened medical advancement.

What're you talking about?

Filed away under "G"
for "good intentions".

Why?

Our administrator just spent

twenty-seven and a half
minutes of his computerized time

telling me that we are
drowning in a sea of red ink.

Not blood, nothing
quite that precious, just...

Red ink.

Insolvency, I
think he called it.

Not enough patients
to keep us afloat.

Well, it takes time to get
a trauma center going.

Time and money.
For neurosurgeons,

cardiac surgeons,
anesthesiologists,

all the rest of the specialists.
And not just on call,

but living in
perpetual red alert.

Do you have any
idea what that costs?

But you're doing fantastic work.
Why should there be a lack of patients?

Ah, Quincy, we don't
get half enough patients.

Because our county
has an out-of-date and

inflexible law that directs all
paramedics to take trauma victims

to the nearest emergency room.

Not the best, just the nearest.

Anderson would be dead now if he'd
been taken to the nearest emergency room.

More specifically, if a
paramedic with a lot of guts

hadn't thumbed his nose
at orders given by a doctor.

But don't get me wrong.
Valley View is a fine hospital,

a caring hospital.

But when a patient's life
depends upon immediate surgery,

there had better be
a good staff on hand

and a surgeon who
is really ready to move.

Not someone you gotta wake
up at two o'clock in the morning,

and while he's rubbing
the sleep out of his eyes,

your patient is losing the
most precious time he has.

God help him if he's not
taken to a trauma center.

And that goes for the

president of the United
States or the Pope in Rome.

The first hour. The golden one.

Sixty minutes

that separates this
world from the next.

Well, who's fighting it?

Ah.

A lot of politicians,

doctors,

hospital administrators who

can't see past the landscaping
on their own grounds.

But Jim, you're a young man.

You're not just gonna
fold up, are ya? Chuck it in?

Ah, tell you the truth, Quincy,

I'm gettin' tired of
fighting 'em alone.

Well, you're not alone anymore.

Where can I find the paramedic?
The guy who brought in Anderson?

His name's Mike Harvey. You
can get his address from Personnel.

I heard he was suspended
for insubordination.

Then he won't mind a free lunch.
Now, I want you to hang in there.

- I'll talk to you again, soon!
- Okay.

Thank you, Diane.

I still can't believe it.

That young girl?

Mike, it's very important that I know what
condition she was in when you got to her.

She was stable.

Her vital signs were good.

She had a, a broken leg,
a couple of fractured ribs,

some tenderness in the
upper abdomen. That's it.

And that's what you reported to
the base station at Valley View?

Absolutely.

I just don't understand
how she died.

Internal injuries.

- Her spleen was ruptured.
- Did they operate?

Not until it was academic.

Oh, doggone it. I should've taken
her to the trauma center, too. I knew it.

But I figured they
could handle the girl.

- How's her father makin' out?
- Stable.

You know you saved his life.

Then it was worth
losing my job over.

Would you do it again,
knowing you'd lose your job?

You bet I would.

Look, I've been in this
business for nine years.

Three of those were in
Vietnam with a M.A.S.H. unit.

I've seen guys practically
brought back from the dead.

I know what a trauma center
like Hill Memorial can do.

You know they
want to shut it down?

Oh... Well, that is typical.

That's perfect,

I'll tell you something... I
know of a place, not Valley View

but another hospital,

where they coddle us
paramedics. I mean they have these

fancy, uh, lounges with food
and donuts and coffee, all for us.

You know why? Because they get
75% of their patients from paramedics.

The only problem is
that it's a lousy hospital.

But are they talkin'
about shutting that down?

Oh, no. They, they want
to scrap Hill Memorial.

Oh, it's all wrong.

Mike, if push came to shove, would
you tell your story to the papers?

Yes.

- Yes, I would.
- It might mean you'd
never get your job back.

What job?

If I do it their way, I'm not a
paramedic, I'm a chauffeur.

According to records, she
received thorough medical attention.

Yeah, the operation
was a success,

but the patient died.

Well, losing a patient
is never easy, Doctor.

But we're not going to
let that tarnish the image

that Valley View Hospital has
worked so hard to establish.

Ah, Dr. Fuller.

This is Dr. Quincy from the
Medical Examiner's Office.

About the Anderson case?

Oh, well, sometimes you do everything
you can and it's just not enough.

Did "everything" include
monitoring her for internal bleeding?

Her blood pressure was good.
Her vital signs were stable.

Under the circumstances, I don't see how
we could have anticipated hemorrhaging.

The fractured ribs over her spleen
might have made you suspicious.

Did you do a peritoneal lavage?

Did anybody notice any
signs of internal bleeding?

Yes. And as soon as we did,
we rushed her into surgery.

- You rushed her?
- Yes.

She bled for two hours before
you could even find a surgeon.

You misdiagnosed it, then you
couldn't find a surgeon to save her life.

Well, sometimes, Dr. Quincy, in
spite of everything, the patient dies.

They're just terminal.

That's a lotta trite baloney.

The girl's father, the man that was
taken to Hill Memorial Trauma Center,

against your instructions,

his condition looked terminal,
but I think he's gonna make it.

Because everything was done for him.
He was rushed into immediate surgery.

What're the implications?

That I'm less of a
doctor than James North?

Less competent? Hmm?

Less sensitive to my patients?

What exactly am I
being accused of?

I feel bad enough
about Sherry Anderson

without the things
you're implying.

Oh, I'm not implying
anything, Doctor.

I'm saying it.

I hold you and the hospital
responsible for that child's death.

As a coroner, I've seen
too many needless deaths

in emergency
rooms and I'm mad...

Mostly at myself for not
having spoken up sooner.

But I guarantee you,

I'll never be guilty of
keeping my big mouth shut

when it comes to the
need for trauma centers.

So, hold onto your hats...

It's gonna be a rough ride.

Ah, listen to this one, Sam.

Saul Gutierrez, thirty-six.

They got him to the
emergency room less than

thirty minutes after
a head-on collision.

They treated him for
shock and lacerations.

Three hours later, he
died of abdominal bleeding

halfway through
a full set of x-rays!

Here's one who had a
relatively minor stab wound,

but they missed the fact that
it pierced the intercostal artery.

I had no idea we have
this many in just one year.

That's not the real shocker.

It's the number of people who
never should've passed through here,

the utterly needless deaths.

Even if we gave those emergency
rooms the benefit of the doubt,

eliminate the most
serious injuries,

the numbers they still
lose are staggering.

Only we're not talkin' about
numbers, it's people they're losin'.

Like this.

The hematocrit showed
a significant drop.

The patient was
bleeding internally,

but the emergency
room doctor just assumed

it was from her fractured limbs.

Five and a half
hours later, she had

cardiac arrest to go
along with her splints.

Our autopsy showed
it was a ruptured liver.

Quince, what is
going on? I mean,

is it wholesale incompetence?

Oh, no, no, no.

It's a question of where
the competence lies.

A doctor could be
a first-rate surgeon,

but unless he's trained in trauma,
works on trauma cases every day,

one day he's gonna
overlook something

at a time when that patient
can't afford an oversight.

I mean, you can get
away with observing

a gall bladder for a couple of days.
You can't do that with a ruptured liver.

You have to move and move fast!

Why haven't we seen it before?

Because we've been dealing with
these cases in isolation, one at a time.

We haven't noticed
the overall pattern.

It's scary.

It's worse than
that, it's disgraceful.

But by the time we're through,
everybody in this county

is gonna know what
a trauma center is.

Especially the politicians
that can help us.

Fifty-nine out of a
hundred trauma patients

who die in emergency
rooms die needlessly?

Do you realize what you're
saying? I'm not saying it, sir.

The record's doin' the talking.

Dr. Quincy, I have watched

the emergency care
system in this county grow

into what I still believe is
one of the best in the country.

That may be. But in trauma cases, it
can be a lot better. I mean a lot better.

And you obviously
have the solution.

I didn't have to look far, sir.

- Hill Memorial?
- Hill Memorial.

Wonderful.

Your answer to this whole mess
happens to be a financial white elephant.

It's a white elephant because
neighboring hospitals won't

allow trauma victims
to be routed there.

You forget, county regulations

require the paramedics to take
the patient to the nearest hospital.

No, no, no, the nearest
appropriate hospital.

Are you suggesting the other
hospitals are inappropriate?

No, not for the emergencies
they were designed for.

But for major trauma cases, for the
most part, yes, they are inappropriate.

I mean, you send burn
victims to a burn center.

You send trauma
victims to a trauma center.

Quincy, you must know.

The Board has a medical
advisory committee.

They're considering
all kinds of proposals.

There's no time for window shopping!
Something has to be done now.

You're really worked
up about this, aren't you?

The other day,

a young girl who should be
getting ready for a school recital

was brought to my table instead.

I can't let her
remain a statistic.

I'll make sure the committee
has this on the front burner.

Thank you.

I'll be seeing Dr. Fry tomorrow.

Fry? From Valley View?

He's head of our advisory
committee. I appointed him myself.

He's one of the most enlightened
men in the medical community.

Yeah, especially when it comes
to maintaining the status quo.

Trust me, Quincy.

It's my responsibility.

All I'm saying is that
Dr. Quincy seems to be

blowing this whole thing
up way out of proportion.

It sounds as though
Dr. North is his friend

and he'll do anything that
he can in order to help him.

Whatever the reason,

he was pretty damned convincing.

Look, Richard, anyone can go
around spouting a lot of facts and figures

and then use them to
prove whatever he wants to.

Well, if there's
one shred of truth,

I would hate to be
linked with this thing.

I'm telling you that
it's a lot of garbage.

They're failing over
at Hill Memorial.

The whole experiment
isn't working.

So, what they've got to do
is to steal emergency cases

from every other
hospital in the county.

Then it all boils
down to business.

Dollars and cents.

Hospitals have to be
financially viable. Thank you.

In order to exist.

And emergency rooms do
pay a good part of the freight.

We've known each
other a long time,

and I've never lied to you.

All Dr. North wants
is to just serve some

personal dream of his and to
hell with the rest of the system.

What do you think, counselor?

I think we have to go
along with Nelson here.

I never said I
wasn't going along.

What I want to know is what
do we do to protect ourselves?

Nothing.

In my opinion, nothing.

Time has a way of
taking care of all problems.

If Hill Memorial survives, fine.

If they go under...

They'll have nobody to
blame but themselves.

May I speak to Supervisor
Hawley please? This is Doctor...

She recognizes my voice.

When do you expect him back?

Well, I don't wanna be rude. I been
tryin' to talk to him for three days now.

Yeah, well not as sorry as I am.

Well, there's
nothing here, Quince.

Hawley's not ignoring our
study, he's trying to bury it.

What we know is not
gonna help Hill Memorial

if it's the best-kept secret in town. So,
I think it's time that the cat got cute.

- The cat?
- The one I'm gonna
let outta the bag.

Incredible!

If these figures are correct,

we're talking about hundreds
of needless deaths each year.

- You're sure you'll
back me upon this?
- No question about it.

Good. We can get it
in the evening edition.

Harry...

I'd really like you to hold off.

What?

You give me the medical news story
of the year and you want me to sit on it?

Trust me. We can save more
lives if we don't publish it now.

Give me 72 hours and I'll let you
know whether you can run with it.

Then why did you
bring it to me now?

Because I do need a favor.

I want you to go to press,

but I only want you
to print one paper.

Dammit, Quincy. You
could've given me a heart attack!

- Wonder where they
would've taken you?
- That's not funny!

It wasn't supposed to be.
I had to get your attention.

- This is blackmail.
- Yep.

- You admit it?
- Yep.

- And you still intend
to publish that story?
- Yep.

Will you stop yepping me
and tell me what you want.

An open mind...

Do your own study. Get
an independent panel to

look at the records of
emergency rooms in this county.

Will you abide by their
judgment, whatever it is?

Give me an honest count, I will.

Don't get insulting.

I'll put enough people on this
to give us some answers fast.

Listen, whatever the answer
is, I want this thing settled.

And I hope you're wrong
about all those needless deaths.

So do I.

Why doesn't he call?

I can't hang around any longer.
I gotta get back to the hospital.

Wait a minute. They just brought
the supervisor their findings.

He should be calling any minute.

Really, Quincy, I gotta get back.
Listen, call me the instant you hear, okay?

Where you goin'?

I have to go out to lunch.

Oh, keep me company until he calls,
will ya? I'll send out for some pizza.

Oh, I'll take a
raincheck on the pizza.

- Chinese food?
- Chinese food gives me gas.

Chinese food gives you gas?

Besides, I got a luncheon
date, Quince. See ya later.

Hello?

No, Mr. Fujiyama is not here.

He had a luncheon date.

Quincy underestimated
the problem.

The rate of preventable deaths
is not 59%, it's more like 80%.

Believe me, Doctor, I was
just as shocked as you are.

What this means is that hundreds

of trauma victims all over this
county are dying needlessly,

including that
poor Anderson girl.

Valley View Hospital wasn't
responsible for that girl's...

It's not the hospital,
it's the system.

Read the report again.

I'll tell you what.

We're gonna give
North what he wants.

All the help he needs to expand
the jurisdiction of Hill Memorial.

And you, Doctor,

are going to give him
your full cooperation.

To the county's new trauma system
and the guy who made it possible.

Hawley called you himself, huh?

None other. About two hours ago.

- And he was contrite?
- Contrite?

Are you kidding? Get
out your shopping list.

He's not only gonna give you what
you want, he's gonna give you the world.

Just incredible.

Hill Memorial is not just gonna
survive, it is gonna flourish.

More important,
it'll save a lotta lives.

On that note, I'd like to
propose an old Italian toast,

L'Chaim, to life.

Old Italian?

That's who taught me
Yiddish, an old Italian.

Somebody down there?

Hill Memorial, this is
Rescue one-eleven.

Valley View base is pretty tied
up. Can you handle this run?

Rescue one-eleven,
Hill Memorial.

Affirmative. Over.

Hill Memorial from Rescue
one-eleven. We have a male patient,

age fifty-five, with multiple stab
wounds to the anterior chest.

He's disoriented and
combative. BP is 78, palpated.

Pulse 140 and weak.
Respiration's 32.

He is cool, moist,
and very pale.

We've got him on
oxygen at ten liters

and the mast suit is
in place, not inflated.

Be advised we are close
to Valley View. Over.

I copy one-eleven.
This is Hill Memorial.

Inflate the mast
suit completely.

Start a large bore IV
with ringers wide open.

Attempt a second IV on route and
transport Code 3 to our facility. Over.

Hill Memorial from one-eleven.
Please repeat the destination.

Rescue one-eleven. Transport
Code 3 to Hill Memorial Trauma Center.

Clear.

We've given him two liters
of lactated ringers, Doctor.

His blood pressure's
still going down.

- Is the pressure in
the mast suit good?
- Yes.

I can tell already. His neck
veins are visibly distended.

Get a CVP line into him.

- Were his veins
like this in the field?
- No.

Get a stat chest x-ray
and a chest tube setup.

The x-ray
technician's in room 4.

Never mind then, just
get the chest tube in.

Do a cutdown on the CVP.

Cross and type six units
of blood and put a foley in.

Doctor, there's a knife
wound in the fifth intercostal.

I can tell the stab's
pretty close to the heart.

Is there a cardiac
surgeon around?

He's just finishing in the O.R.

Doctor, I can't palpate a
pressure and I've lost the pulse.

Sorry, we can't wait. We gotta crack
this chest right now. Gimme the gloves.

Get a scalpel
and a rib spreader.

- I'll prep his chest.
- No, don't bother.

Just put a beta down on him.
We're cuttin' him open right now!

Lab. Fujiyama.

Oh, just a minute,
please. For you, Quince...

Supervisor Hawley.

Hi, Supervisor, I'm glad you
called. I was gonna call you.

I have some ideas
about the trauma center.

Whatever it is, Quincy,
it doesn't matter.

I just wanted to tell you my dearest
friend just died at Hill Memorial.

He was very close to Valley View

when the paramedics got to him.

Dr. Fry tells me
he would've lived

if he hadn't spent those
extra minutes in transit.

And in case it isn't
entirely obvious to you,

you can forget what I told you
about the trauma system. Just forget it.

All the sutures are tight
and carefully aligned.

All the cut-downs are precise. There
are no signs of hematoma or false starts.

The broken ribs are
perfectly positioned.

I don't see any sign of
subsequent hemorrhage.

Under the circumstances,
I'd say North did one terrific job

of controlling the bleeding.

Time just ran out for Marshall.

So, the low blood pressure
resulted in insufficient perfusion.

His brain just didn't
get enough oxygen.

Looks like the cause
of death was hypoxia.

- Finish up here, will ya, Sam?
- Will do.

Jim, our preliminary findings indicate
the cause of death was hypoxia.

There wasn't enough blood
flow to keep his system going.

Quincy, we got him goin'
again, we got fluids in him.

His blood pressure wasn't
down for that much time.

Sorry, Jim,

we have to finish the
micros and the toxicology,

but there's no indication
of any other cause of death.

He bled to death,
it's as simple as that.

They'll kill us with
that, you realize.

They'll claim it was the
added transit time it took to get

him to us that was responsible.

And from what you're
telling me, they may be right.

I asked for Dr. Fry
to meet you here.

After all, he is head of
our advisory committee

and I don't like getting
snowed by technical jargon.

I didn't come here
to snow you, sir.

I'm surprised you came at all after
what your highly-touted Dr. North did.

He tried to save
your friend's life.

- He tried and failed.
- Oh, but that's acceptable,
isn't it?

Because it happened
at the trauma center.

But if it had happened at
Valley View Hospital, what then?

Would you be inclined
to forgive and forget?

As a matter of fact, it couldn't
have happened at Valley View

'cause we were less
than a mile away!

That's not true.

What was the cause
of death, Quincy?

The direct cause.

Our preliminary
finding was hypoxia.

A fatal reduction of
oxygen to the brain

because of insufficient blood
flow. It led to cardiac arrest.

Because of the loss of blood.

The brain won't last six
minutes deprived of oxygen.

The record shows it took the paramedics
twelve minutes to get him to Hill Memorial.

I realize that.

But I don't believe that a conventional
emergency room could have saved his life.

This is ludicrous!

You want to have your
cake and eat it too?

Could you have
saved his life, Dr. Fry?

Absolutely! He would've been in
surgery ten minutes sooner instead of

chasing across town
in an ambulance.

- If you could've
found a surgeon.
- We would've found a surgeon!

As far as the trauma
system proposals go,

I asked Dr. Fry's committee to submit
their conclusions to me and they did.

And I'm sure you've
reached your conclusion.

Yes. Yes, I have.

You can tell Dr. North

if he abets any more paramedics
violating the closest hospital rule,

we're prepared to
take appropriate action.

And his dream, Dr. Quincy,

might just turn
into a nightmare.

Fry has the board convinced
that Marshall would've lived

if he'd been brought
to Valley View.

I tell ya, if I had any thoughts of
goin' to the hospital administration

for a reprieve, they're
out the door now.

He's playing his advantage
just like Heifetz plays the violin.

Dr. North,

that hit and run?

- Yeah.
- We've got him in a shock suit

and when we pumped
up the pressure,

he developed a large hematoma on
his arm and he's swelling up like crazy.

All right, apply a pressure dressing
to the arm and get him into the O.R.

- Got it.
- Doctor, wait a minute.

Lemme see if I've got this
straight about your patient.

The compression
of the shock suit

brought the blood pressure
up, causing the vessel to give

and to bleed into the tissue.

Is that what you're saying?

That's right. But the vessel was
already damaged during the accident.

See, Quincy, if we didn't
bring the blood pressure up,

the brain wouldn't get enough
oxygen and the patient'd die.

- Exactly.
- What're you getting at?

Maybe that's what
happened to Marshall.

We found contusions
on the skull.

That could account
for a damaged vessel.

Now pumping up the shock suit

would've brought
the blood pressure up

causing that damaged vessel to
bleed into the tissue of the brain.

But you did a gross
examination of the brain.

There was only minimal bleeding.

Maybe we didn't look far enough.

Maybe there was bleeding
within one of those sections.

- I suppose it is possible.
- I'll call you later.

I'm gonna take another
look at that brain.

Okay, Sam, take a look.

In the brain stem, just
below the midbrain.

See the lesions?

Yeah. Bleeding
into the midbrain.

That's what killed him.

His blood pressure was down
when he fell and he hit his head.

Then when his blood pressure rose
to normal because of the treatment,

the IV and the shock suit,

the injured portion of the
brain began to bleed profusely,

tearing the tissues. That's what
stopped the heart and the lungs.

But then, don't we
still have a brain death?

Oh, yes. But with
one very big difference.

There is not an emergency
procedure that exists,

nor any doctor alive that
could've kept Marshall from dying.

Time had nothing to do with it.

This was never a
preventable death.

The injuries were irreversible.

- I want some frozen
sections from that.
- Right away.

It was a no-win situation.

As soon as the patient's blood
pressure was sufficient to keep him alive,

it burst the damaged
vessels and death occured.

How can you rule out hypoxia?

If there was a lack of oxygen,
these nerve cells, as you know,

would've lost their nuclei

and the cells would've
become very dense, turn redder.

They're definitely not that.

They're not acidophilic.

No. The neurons
are completely intact.

Dr. Fry, would you
please translate?

These cells indicate that Ted
didn't die of prolonged bleeding.

If he'd shown up ten minutes sooner, the
brain would've stopped ten minutes sooner.

I'm afraid Dr. Quincy's right.

Dr. Fuller?

Gentlemen, excuse me.

I have to get back to E.R.

Rescue thirty-five
to Valley View.

We're at the scene of
a motorcycle accident.

We have a twenty-five-year-old
male. Pale, cool, diaphoretic.

Valley View to Rescue
thirty-five, what're his vitals?

Blood pressure 80 over
40. Pulse 115 and regular.

Respiratory rate
is 32 and shallow.

His abdomen appears
distended but is not rigid.

We have him on O2
at six liters a minute.

Request orders for an IV. Over.

Roger, thirty-five.

Start with two large bore IV's of
lactated ringers to run wide open.

Increase the O2 to
ten liters a minute.

Observe spinal and
cervical precautions. Over.

Roger, Rescue thirty-five.

We'll be transporting
code three.

ETA eight minutes
to Valley View. Over.

Thirty-five, negative on your
destination to Valley View.

Transport patient immediately
to Hill Memorial Trauma Center.

Repeat.

Hill Memorial Trauma Center.

We'll alert. Over.

Glad to hear it, Doc.
Rescue thirty-five, clear.

Like he said,

that's terrific.

- Cream cheese and
banana on raisin bread?
- Oh, that's mine, Diane.

- Banana?
- Yeah, I need the potassium.

Need potassium,
eat a hand grenade.

Cremated cheeseburger
for the gourmet cop.

What? Am I supposed to
eat it raw just to please you?

If it's not pink, it's not fit
for human consumption.

Human consumption. I wouldn't
bring that subject up around here.

Eat!

Hi!

Quincy, I've been
covering for you for weeks.

You promised to be at the lab
after breakfast, not after lunch.

Supervisor Hawley
took longer than I thought

- I'll see ya.
- Aren't ya gonna eat with us?

No, I'm takin' mine with
me. I can't afford the time.

Well, how did it go?

Terrific! Mike got his
job back and a raise!

- As a paramedic,
not a chauffeur.
- Yeah.

I had to hold the
supervisor down.

He wants to make every emergency
room in town a trauma center.

Yeah, and that's wrong.

We, ah, we finally got
him to understand that just

a few strategically-placed
trauma centers

is the way to go. You know,
there's not really a large-enough

patient population to
support too many centers.

We just need enough
so that no trauma

victim is more than fifteen
minutes away from one.

- Well,
there goes our vacation.
- What vacation?

Well, you know, since
you've been on this case,

we've had it a
little easy, ya know.

Well, you are right.

Your vacation is over. You
know the Murdock case?

Murdock case,
sure. We solved it.

Oh, no. I told you
you had the wrong guy.

Sam called me
yesterday, complaining.

So, you better learn to listen to
me more than your other technical.

You guys are gonna be sued.

You gotta learn
to listen to me...

- Oh, c'mon.
- Forensic
medicine has got to know.

That's right, that's how
we knew the other guy...