ER S13E1 - English Transcript

Previously on E. R. Sam, this is Mary Warner. She's studying to be an E. M. T. Pull the blinds, ***! What's going on? No, no, don't shoot! Luka! He needs to be intubated. Please. You're gonna walk us out of here like Old Steve's going back to lockup. Something's wrong. - Think about Alex. - I already did. Find Kovac. Jerry's hurt. - You okay, honey? - I think so. Callahan, cordon off that area. Don't let any witnesses leave. All right, come on around. Hey, you folks back off the perimeter. Hey idiots, back off the barricade. What happened after that? I think they took one of our nurses. In a van-- they just plowed right by. Sam. With a nurse Was there a nurse with them? I saw a lady. The one guy was dragging her out. She works here. Her name's Samantha Taggart. You need to find her. - Lily, how'd you get through? - I snuck through oncology. - Is everybody okay? - I'm not sure yet. Call the O. E. M. C. and put us on medical bypass. We're closed for internal disaster. And page Kovac. - It's his damn E. R. - I'll get on it. - Dr. Weaver? - Yeah. Main area's clear. We're working our way back through the rest. Thanks. Admitted patients need to go up to the wards. Don't wait for open beds. They can board them in the hallways for now. Okay. Everybody else is getting triaged. And we need to assess all equipment for any possible damage. Some techs are starting on that. I came in as soon as I heard. Thanks, Frank. Call Pratt. We need him here. Frank? Jerry's gonna be okay. Found this lady near the stairs. Finish checking the back hall. Hey, is somebody with this boy? It's okay, honey. Hi. I'm Kerry. Are you with somebody? Jerry was taking care of me. Where are his parents? They were on their way in. I'll take him up to daycare until they get here. Come on, honey. You should have somebody take a look at that. I'm good. This is nothing. Looks like something to me. Yeah, lots of folks got it worse. Haleh? How's Jerry doing? We're waiting on his second thoraseal. Abby's getting it. I'll be right in. Dr. Weaver, any word on Sam? I told you we should have waited. Waited? We waited long enough. We would have walked right out of there if you hadn't let her play doctor. - He okay? - His insulin levels are peaking. - He needs some food. - Peaking? Yeah. He's diabetic. What, did you forget? How far till the switch? About ten minutes. Well, hurry up. We'll get him something soon. - Systolic's down to 70. - Call for type specific. Another two liters on the infuser. How you doing, Jerry? Decreased breath sounds on the right. Yeah, because his chest tube is clamped. You want him to bleed out? He needs to get up to the O. R. We're still waiting on that thoraseal. Okay, I'll go find it. Hey, sats are dropping. Okay, eight oh ET. Sux and etomidate. Abby? Abby! Abby, open your eyes. Open your eyes, come on. Come on, wake up. I need some help now! Where the hell is Kovac? I'm coming in right now. There's been a shooting. Jerry took a couple of hits. They're trying to stabilize him right now. And Abby? They found her in a pool of blood. Frank wasn't too sure about anything else. Listen I'm dropping you off before I go in, and I'll check in on you later. No, I'm coming with you. County General as fast as you can, please. Sats 98 on room air. Deep breath in and out. What the hell happened? That training girl stabbed me with veck. Sam did an intubation. How is Abby? I need to check on her. Six liters oh-two. Call me if his pulse ox drops below 94. Easy, Luka. Come on. You need to be monitored for at least an hour. - I'm fine, Kerry, okay? - Luka, you were paralyzed and intubated. You belong in the I. C. U. Hey Oh. All right, get get him a stool. Pressure's up to 110 on two liters, crits 35. - Fetal heart tones 160. - Sounds good. Hey, Abby. Abby, how are you doing? Oh, you passed out. You were bleeding. Got a cramp. Probably vagalled from the pain. Has it stopped now? Seems to have slowed down. No sign of abruption. Baby is moving around, looks healthy. Congratulations. It's a boy. Could be a placenta previa. Uh. Uh, no. I I don't I don't have a previa. They saw a low-lying placenta on the 20-week ultrasound. That would explain the bleeding. You may need a C-section. I don't need a C-section. Call Coburn. She was paged. Dr. Weaver, Psych's here. Okay, I'll be right there. Kerry, move me to O. B. No. We still need a sterile spec exam. Dr. Weaver, send me up to O. B. - Vitals? - Plus 85. B. P. , 112/78. All right, take her up. Hey, we're having a rough time with the airway. It's okay. I got it. You should help with intubation. Oh, no, I'm staying with you. No, no, no, I'm just going up for NST. Just come up after he's tubed. Luka, it's Jerry. Okay, page me if something changes, okay? County E. R. Sorry, ma'am, we're closed. You have to call Mercy. Clinic is taking in any walk-ins with stress reaction. Good. Thanks. Abel, stay with him - until he's settled upstairs. - Okay, Dr. Weaver. And we should discuss doing a critical incident debriefing at some point. Maybe in a few hours. Let's just get through this shift. I don't care if you're both docs, you can't just barge in here! Chris, it's okay. It's okay. - What's up with Jerry? - He's red-lined in the O. R. - And Abby? - She's good. We sent her up to O. B. just to be safe. They just called. Dr. Coburn's on her way in right now. - Okay, great. - Abby, how are you? Oh, I think I just must have hit my belly when I fell. I'm fine. - How's the baby? - Fetal heart tones 155. Thank God. - I'm just going up for monitoring. - I'll come with you. - No, no. - Come on, it'll be fun. We can play "Who Had the Worst Day?" I'm fine. Really. All right. I'll come and check on you later. Come on, come on. Let's go. Mom, I don't feel good. He needs to eat something. No. We're gonna get some miles behind us first. No. He can't wait. Okay, get him something to hold him over, but make it quick. - Come on, Alex. - No. Alex stays with me. - I'll take her. Let's go. - I'll be right back, okay? Hey, get me some chips! I'm hitting the head. Come on. Stand up straight. Be a man. You're not a little kid anymore. I think you're going to really like Canada. I like Chicago. More cricoid, Ray. I'm about to crack the larynx. It's a big, floppy epiglottis. I can't see the cords. It's a long neck. Pull out and bag. Give me the flipper. If we can't get this in, then we're going to need a straight, long blade. You okay? Let me know when the sats are up. Tight wheezing throughout. All right, sit down, Luka. Haleh, get him an albuterol neb. - I'm okay. - It's bronchospasm. You probably aspirated some saliva. - I can do this. - Look, if you don't get treated, I'm going to have two patients to intubate. Okay, grab an L. M. A. just in case. Pressure's down again. Auto transfuse from the thoraseal? Okay, let me take a look. How is he? He's okay, Frank. Did somebody call his mom? I'll do that right now. She can meet us up in the O. R. Yeah, let's hope so. Hey, grab what you need. You planning on paying for those? No stealing, baby. Yeah, these people work for a living. - He's bradying down. - Should I get Weaver? If you enter the trachea, you'll feel clicks when you pass over the cartilagenous rings. Heart rate's only 50. Click. Click. Click. Okay, hold it right there. Ray, pass an eight-oh. All right. Here you go. Okay, advance the tube. - No, it doesn't want to pass. - Down to 40. Amp of atropine. Rotate counterclockwise. It's caught up on something. There we go! Okay. End tidal CO2? - Sensor is yellow. - Yellow means yes. I thought you were bringing him up. A little problem. We're ready to roll. - How's his pressure? - Up to 95 systolic. Four units O neg, two liters autotransfused off the cell saver. Everybody upstairs is doing everything we can to help you guys out. Well, baby looks good. But you are definitely contracting. - I don't feel anything. - Sometimes you don't. I think the belly trauma put you into preterm labor. The baby's head dropped down, caused a little placental bleeding. Okay, well, it's too soon, so give me terbutaline. Well, you need magnesium. I know you know that Abby. I remember all the times you gave it when you were a nurse up here. Mag makes you feel like crap, so why don't we just start with the terb? Terbutaline can mask the signs and symptoms of abruption. I didn't know that. Today, you're the patient, not the doctor. I'm not having an abruption. Not right now. But the trauma puts you at risk. And if you do abrupt, we need to know right away. So you can do a C-section. Uh, four gram load, then two an hour. You let me know if you have any more pain. You got my chips? Yeah, yeah, yeah. Oh, is that the key to the restroom? Yeah, but I'm warning you, it's nasty in there. No, no, we need to leave. Let the girl take a pee. We can't hold it in like you guys. Hey, can I have my chips? I'm starving. Thank you. Next time you try something like that, I'll take it out on your kid. You're definitely not contracting. Contractions don't last this long. When did the pain start? About 15 minutes ago. How bad, one to ten? I don't know-- like a four maybe. But it's probably just a bruise from when I fell down. I just need some Tylenol or something. There's no evidence of abruption. Great. See? I told you. CBC with platelets. PT/PTT, fibrinogen, D-dimer and FDPs. Why? What for? Only 20% of abruptions have ultrasound findings. Let's send the labs to be sure. The baby looks great. The heart rate's good, - excellent variability. - Abby, Abby, hey. Here's what I would say to you if you weren't a doctor: If the placenta separates from the womb and bleeds, then the baby can be deprived of oxygen. Now, even if we don't see a blood clot, the labs will give us advance warning before the baby's in trouble. Okay. - 12 of betamethasone. - Oh, come on! We have to mature the baby's lungs in case of an emergent birth. No, no, no, no, no! I have two and a half months left to go. This baby is not coming until then. That's what we're all hoping for. I can wait two more weeks. The risk of prematurity goes way down at that point. I can wait. I'll go on bed rest, I'll use a bedpan, I won't move. You know that I want you to have a healthy baby. Then why do you keep focusing on a worst-case scenario? That's her job. Eight monitored beds are good to go. Night staff's been called? They're all coming in except two. Did you check on Sam? My guy at the district called-- they still have no leads. O. E. M. C. 's on the line. They want to know where we're at. Okay, tell them we can take four critical paramedic runs, then back and bypass till we see how we're doing. We got a lot of people showing up outside for treatment. We'll take care of it. Chuny, let's set up fast track in the west lobby. We'll speed through anybody who doesn't need X rays or labs. - Pratt. - All right, I'll help set it up. Great. How long is this going to take? - What are you doing? - Shut up. You're going to get us all killed. Relax. We can make it. The train's probably a mile away. Oh, son of a ***. All right everybody be cool-- nobody gets hurt. License and proof of insurance. We're on our way to the lake so my son can get some fishing in before dark. It's his birthday. I'll be right back. That's good. He's just going to give us a ticket. What's he doing back there? He's a local yokel, man. This is the most excitement he's had all day. He's probably calling for backup. Sammy Every cop within a thousand-mile radius knows what you three look like. He's taking too long. Screw it. So, they're trying to find the source of the bleeding and tie it off. Oh, my Jerry's not the hearty type. I only hope he doesn't wilt under all this. He had a good blood pressure and a good pulse when we left the ER. Oh, the ER. This would never have happened if he didn't insist on working at the fakakta cesspool. Well, as long as the surgeons find the bleeding and stop it, he should be fine. He could have gone to law school, you know. Oh, I didn't realize that. I myself sent the application to Harvard. Harvard. But no, he wouldn't go. That's, uh Jerry got into Harvard, wow. No, they rejected him. Four times. - But that's not the point. - No, of course it isn't. So how much is all this going to cost us? Um, I don't really know. I'm sure his health insurance will cover it. Oh, but they don't cover the deductibles, do they? You know who covers the deductibles? Me. I cover the deductibles. Why don't you wait here, okay? And I will talk about this with you as much as you want, but I'll go see how he's doing first, okay? He doesn't have any savings, you know. But why would he? He can barely survive off that weekly insult you people call a paycheck. How's he doing? The bullet nicked the right ventricle. Damn it. I was hoping it missed the heart. Another three-oh prolene on a pledget. Eighth unit going up. Systolic's 85. A cardiac defect isn't so bad. I mean, it's repairable, right? It's not like he needs a pneumonectomy. Metz. Looks dry. Barely any oozing. V-tach. Internal paddles. Lost the pulse. Oh, God. - Charged. - Clear. - Still tach. - Come on, Jerry. Charge to 50. Clear. - No change. - Damn it. Starting internal compressions. Why is he in V-tach? Elevated potassium? T-waves aren't peaked, but we've got S. T. elevations. He's having a heart attack. What about hypocalcemia? Could be. High doses of citrates with the transfusions. Amp of calcium chloride. - Excuse me, Dr. Dubenko? - Not now, Neela. Epi's on board. I'm sorry to interrupt, but is it possible the suture is tying off the coronary artery? What? Say that again. If you occluded the coronary artery with the stitch, you'd have an MI. That's a good call. I'm near the RCA. 11 blade. Charged to 20. You could see inside the field? I just had a hunch. Sutures cut. Clear. Sinus. Way to go. Okay we'll go on a bypass for a coronary graft. Call the profusionists. We'll reposition for a clam shell. Neela, scrub in. I need another set of hands down here. Oh, man! They know where we're going, they know what we're driving. Just let us out. Please, you don't need us anymore. You're not prisoners, you're my family! You're going to get your family killed. Is that what you want? Steve! What are you doing? Now the cops are going to be crawling everywhere. So what? We'll get further off the grid. They didn't even know what direction we were headed until now. Then we'll change the direction, ***. Steve, please, just let us out, okay? I can go back and check on that cop. Shut the hell up, Sam! Shut up! You're not leaving. Nobody's leaving. Do you understand that? Does everybody understand that? Whoa, whoa, hey, hey, chill. Hey, hey, hey, easy man. - You okay? - Mm-hmm, I'm fine. Sam probably saved your life. I hope she's all right. How's he doing? Good. Turn and see for yourself. No, the magnesium has drained all my life force. We're so not ready for this. No one's ever ready for this. Yeah, but we don't even have a car seat or a stroller. We have a crib. We don't even have a name. I was kind of hoping we could name him after my father. - Really? - Yeah. He would really love to have a grandson named Mongo. Mo Mongo? It's a very popular name in Croatia. I'm just kidding! My father's name is Joseph. I don't care how we're going to call him. It's not funny. Oh, my God! What is it, contraction? I don't know. I think my water broke. What are you doing? Opening up your saline. Need some help in here! Are you sure it's not a contraction? Nothing on the monitor. What's that? His heart rate's dropping. Oh, God. How low? Okay, get on your left side now. Abby Sharp pain, gush of blood. Baby's heart rate is in the 60s. We're going to the OR. - Is it abruption? - Looks that way. - Stat page Anesthesia. - No, I-I want a spinal. General anesthesia is quicker. I want to be awake, Luka. You're okay. You're going to be okay. No, we keep going. No, I want to sit tight for a while. I don't think so. Babe, what do you think? We split up? - Yeah. - Not until we get another car! All you do is slow us down. You and this dumb *** - Shut up! Shut up! - Hey, hey! Take it easy. They're fighting. Yeah. They don't know what to do. They know they're in trouble, the cops are coming for us. - Mom? - Yeah? Is Dad gonna hurt us? Everything's going to be okay, buddy. Keep your voice down. They might hear you. Come here. Just come here. Hey, buddy, I need you to help me do something, but you got to do it so no one else knows, okay? Okay. Come on. Can you help me? Find some keys, ok? I think the other guy has the keys. Or a gun or something. - A gun? - Anything. Mom, I'm scared. Okay, I know you're scared, and I know I messed up a lot, but I would never, ever let anybody hurt you no matter what. I swear to God. Go! Go! Hey. You guys hungry? What's up, Frank? You know, I always believed that nothing'd ever really change. I'm old enough that I know that there's always going to be trouble: war, taxes. Bad guys now are pretty much the same as bad guys have always been. That's not how I feel today. I feel like the world's getting worse and worse and worse, and what we're watching is the slow, steady descent of the human race. No, no, I don't buy that. I think that, uh, today was just a rough day for the home team. Straight across the sternum? Exactly. Ten blade. Lap pads. Oh, boy. - What? - Lots of oozing. Cross-clamping the aorta. Cardioplegia going in. Ice. Opening the uterus. Hang two units of packed cells. Greater saphenous is isolated. Cannulate, check for leaks, then pass it up. Bandage scissors. Cord is cut. Come on, little guy, give me a cry. - Pulse is less than 60. - Let's bag him. Intubation tray, 3-0 E. T. tube. Add 20 units Pit to the bag. Draw up methergine and hemabate. - 20 Joules. - Charged. Clear. Sinus rhythm. We have a pulse. - All right, Neela! - That's our girl. Hole punch for the proximal. I'm in. Ambu bag. Abruption clot. Consumed all of your clotting factors. Uterus is not responding to massage. Let's pack it off. Draw up epi . 03. Holding compressions. Pulse up to 120. Get ready to move. Damn it! What? The uterus is boggy and hemorrhagic. The sutures are making it worse, not better. Nothing after 20 minutes. She's not clotting at all. Am I in DIC? Well, the FFP should reverse it now that the baby's out. What if it doesn't? Pressure's down to 80/50. Two more units. We got to control this bleeding. - Go to the NICU. - No, I'm staying with you. No, I want you to stay with the baby. - Abby - Shut up, shut up, shut up! Please, just shut up! I want you to stay with the baby! I'll try to ligate the uterine arteries. Go. I will call you if you need to be here. I don't want him to be alone. This'll help. You see that one up there? That real bright one? Dead. By the time we see it, it's already gone. We'll get him his insulin way before he needs it. He'll be fine. You know, Steve, I was going to ask you what happened to you to turn you into this. But then I realized it was always in the cards from the moment that I met you. You were on your way to becoming exactly what you are right now. I love him. I know you don't believe that, especially right now but I do. Yeah, you love him, right. That's why you get some woman to *** him from school and tie him up and leave him in a van. You don't even remember his medicine. Hey, hey. You're right to be pissed. You're right, it was my fault. It was my fault for ever letting us get separated in the first place. But now we got to stay together. The three of us. There's no other way. I'd rather we were all dead. Hey I don't want you to be afraid of me. You don't need to be afraid of me anymore. As long as we stay together, you and Alex are safe. Where are we in factor replacement? Four of red cells, two units FFP, pack of platelets. You've had uterotonics, packing, an O'Leary stitch and a B-lynch brace. Still bleeding? The blood has penetrated the thickness of the uterine wall. I don't know what else to do. We can keep waiting for you to clot, or we can start thinking about a hysterectomy. How long can we wait? Too many transfusions will put you back into DIC, and then the bleeding gets even worse. Last crit is 21. Stay ahead two units. Uh Jerry is in Recovery. I thought you would want to know. Um Have we heard anything about Sam? No. This is a scary place. I I remember the feeling just walking in. I know your baby is a lot sicker than Henry was, but everything turned out okay for my boy, Luka, and I know that it will for yours, too. Uh they're concerned about prolonged hypotension, and, uh he is on, uh so there's, uh there's a risk of toxicity. And They're they're going to to, uh do periodic ultrasounds to check for intraventricular hemorrhage. There's nothing more you can do for him right now. You should go be with Abby. She doesn't want him to be alone. He won't be. Okay, so Morris got you through the E. R. The first circle of hell. And Neela got you through surgery. The second. I guess it's up to me to get myself through recovery. Yeah, those are circles three through nine. Well, here's one way to start-- the incentive spirometer. It'll keep you from getting pneumonia. You suck on it to make the Ping-Pong balls rise twice an hour. Do you know what time it is? I've been out there, watching the same cable news over and over. Hey, Ma. I missed my water aerobics. You were supposed to take me. I know, I know. Oy vey, you gave me such a scare, my shaina boychik. I'm sorry, Ma. I'm sorry. Oh, look at that. Look at that punim. I'm I'm Hey. Hey. How's he doing? He's fine. Still intubated? Yeah, but he's satting well, you know? Pressure's holding with dopamine. He's making urine. Brain scan? Clear. Well, those are all good things. Yeah. All good things. Is one going to be enough? What? One baby. Um My uterus wouldn't stop bleeding, and Coburn did everything she could, but, um You had a hysterectomy? Well, one's all we need. So, um I'm not going to be able to see him for a while. I can't get to the NICU for at least 24 hours. You don't have to wait that long. That's what I told him. To wave to Mom. Yeah, he's a smart one. - Joseph. - Hmm? I don't remember much about my dad, but, uh I remember when I was little, he used to love to watch boxing. And especially Joe Frazier, because he thought he was the best pure fighter, so I'd like to call him Joe, if that's okay. I'll be right back. Do you need anything? Steve? Steve? Steve, I have to pee.