ER S6E22 - English Transcript

E. R. Previously on E. R. What are you saying? There's more to the emergency medicine than treating and streeting patients. That's one more thing you don't have to teach me. I'm still in love with him. You'll find someone, Luka. You will. You're such wonderful man. You'll find her. You will. I told you I was allergic to sulfa. - What happened? - She must've pulled out her IV. - Why would she pull out her IV? - How the hell would I know that? E. R. 6x22 "MAY DAY" Multiple casualties. - All available units. - Stand by. - Three gunshots. One's fatal. - We should've landed earlier. The suspect was firing. - Shooting at the school? - Everywhere. A unit responded to a robbery. The suspects fired. I'll take this one. Where are my glasses? Where are my glasses? - Is he alert? - Sort of. - Name's Daniel. - Daniel, do you know where you are? - I lost my glasses. - Can you tell me where you are? School. - Exit wound out the right temple. - What kind of ammunition? A large assault rifle. Shot through the engine block. We'll never get her back with a wound like that. Stop compressions. My dad! Somebody call my dad! - I'm Dr. Kovac. What's your name? - Nicholas. Take a deep breath. Could you call my dad? Vinny Rosato. He works at Covin. -312-54 - How's he doing? Chest is clear. Titrate 4 of morphine. 54- 548 Don't worry. I'm sure the school has it. It'll take a while. We're evacuating. Why? - There might be another suspect. - Might be? - Can you feel your leg? - Yeah. - It's going to sleep. - Like pins and needles? - Paramedics? - Coming now. - You got any Ancef? - Red bag, side pocket. - Is yours stable? - Bullet fragment missed the brain. What about yours? One through the groin with a cold foot. We've got to revascularize- - Clear out! - What? Go now! He's in the building, coming out! - Let me examine him. - We have to search him. - Is he still breathing? - Yeah. He's clear. All right. - You shot him through the vest? - Right chest. BP. I'm here to help you. Can you talk? Go to hell. That's a "yes." Diminished breath sounds. BP's 100/65. His pulse is 88. Get a large bore IV. Let's roll him. No exit wound. Chest tube. Betadine, a Steri-Drape. Take that mask off. - You got this? - Yeah. Lidocaine. The eye's going by ambulance, the leg in the chopper. I might need to fly him. - Take him by ground. - I want him stable. Go to Mercy. County has the pediatric trauma center. Wait until I get the chest tube in. Take two units of O-neg to the chopper. I'm loading my kid. I said, wait! Kovac! The suspect is alive. We are waiting for confirmation. This is Thalin Elementary School - Is that Dr. Kovac? - It's hard to say. He's too short. - Has anyone seen the toolkit? - What? The one with the hammer, pliers, screwdriver. What for? A guy drilled a wood screw into his tibia. - Somebody getting that? - Thanks. - What are you watching? - Where have you been? Shooting near a school. Weaver sent Benton and Kovac. - Why did they go? - They don't get sick in the chopper. I already told you I had the flu. Okay? I got it. - You'll take it out with a screwdriver? - Got a better idea? MVA. Single auto versus parking structure. - ETA? - Five to 10. - I'll meet you in Trauma 2. - Why do you get it? I'll call you if he needs his oil changed. - Morning traffic's faster. - Your call. - Pulse is weak. - Are you still with me? - Heart rate's 120. - Chest output 500 cc's. He's bleeding out. A unit of O-neg. - BP's down to 70 palp. - Follow me. - Where are you going? - We'll transport. - Half liter bolus, then TKO. - He's bleeding out! - What? - He's bleeding out. I need the chopper. - Where will we put him? - Get the boy off. - He has a pulseless leg. - We need to revascularize. - I'm not transporting by ground. - His pressure is crashing. - Then give him blood. - Get out. - No way. - My patient is more critical. - Your patient killed people. - That's not our call! Close the door! - Let's go! Let's go! - Open up the door! - We have to wait for him to clear. - Stand back! - IV's in. - That's it. I'm out of here. - Screw you! - You're welcome. - Thank you, Doris. - Anytime. What have you got? Combative MVA. Ran into a parking lot booth. Get it off! - Anybody in it? - No. - I can't breathe! - Altered and hypertensive. - He'll need a head CT. - Get this off! - His neck is clear. - Remove the collar. - BP's up, 200/100. - Okay, hold still. - Get it off. - I am. Looks like a posterior hip dislocation. Titrate 200 of fentanyl and six of Versed. - I'll reduce it. - Look. - What's wrong? - A big goiter. - That's one of Versed. - And 50 of fentanyl. - Don't touch me! - Keep going. - Notice any hand tremors? - No. He was moving. - You think thyroid storm? - IV Inderal, 100 PTU. He's not on drugs? - No. His thyroid is hyperactive. - I'll kill somebody. I swear. - How much Inderal? - Titrate a mg every two minutes. He's out. Abby, ever reduce a hip? - No. - It's easy. Stabilize the pelvis. From above. Up. Got it? All right, I'll pull up. On three. One, two, three. Oh, my gosh! Carter! Are you all right? - Push another two of Versed. - Get Malucci. He'll do this. - I can do it. - Sit down. I said, I can do it. - Is he out this time? - Yeah. - Don't aggravate your injury. - Are you ready? - You ready? - Yeah. Maintain downward pressure. Don't be gentle. One, two, three. Okay. I got it. - Femoral head is back in place. - Good job. - It's like falling off a horse. - Heart rate's 110. We got a hot Ml in Curtain 3. - Got it from here? - Hard part's over. Get him up to Radiology. We'll get a postreduction film. Sorry about that. It takes a lot of countertraction. - Can you get him to Radiology? - Sure. Thank you. Did I leave his chart in here? Is it over on the mayo stand? No. - Just cleaning up. - Yeah. There it is. Over on the pulse ox. - What? - The chart. Over there. Thanks. This is a needle stick waiting to happen. - Can't be too careful. - That's right. Make sure they do a head, abdomen and pelvis. - Sure. - Hunt me down. Let me see the films. - Okay. - Thanks. - Yeah. - Thank you. - What's his last pressure? - Stable, 110/70. - How is he? - GSW to the groin, a pulseless leg. - And the arm? - Neurocirc is intact. - Foot sensation? - We're losing it. - Will I lose my leg? - Not if I can help it. Send Burns for an x-ray. Subramaniam needs a Dilantin level. - What's that? - Mr. Goodwrench is tuning up a patient. What? - Hold still, man. - What are you doing? Hey, boss. Let's take a break, okay? Okay. - Drilled a screw into his leg. - He needs more lidocaine. Says even aspirin interferes with his healing. - You tell him he's wrong? - The chief even tried. If he wants to be a ***, he can't scream. - He'll scare other patients. - I'll have him bite a bullet. I heard you got punted across the trauma room. - Who told you that? - I hear everything. - Haleh. - Yeah. - Malucci. - I know. - Are you hurt? - Just knocked the wind out of me. Another tough guy. Something rolling up? Rolling down. The kid from the shooting. - Don't jump off a gurney. - Yes, sir. - Did you call a Psych referral? - What patient? - That list I gave you. - Oh, yeah. How did it go? - Okay, I guess. Kind of tough to tell. - It could take a while. CBC, lytes, PT, PTT, type and cross for two units. - Can we give him morphine? - Another 4. Chest x-ray and pelvis. You want Ancef? We are just going to take a look at you here. Then we'll bring you upstairs. - One, two, three. - Did they call my dad? Call the police, the school, or whoever, to reach his father at work. It's on the news. His dad's looking for him. - Make sure. - Got it. - Lungs are clear. - BP 115/75. Pulse 80. Left entrance wound. Where's the exit? - Couldn't find one. - The bullet's inside. - It'll be on the pelvic film. - No pulse by Doppler. Let's look at the back. Missed everything. I assessed it in the field. I need to examine it myself. Okay. Let's roll him. We need to move you on your side so we can see your back. - Carter? - Carter. - Yeah, I got it. - Let's roll. - Did you hit your head? - Of course. It's rugby. - Any pain in your chest or belly? - No. I didn't want to come in. The fellas made me. - What are you doing? - Cutting off your shirt. We just got these jerseys. With a broken collarbone, it'll hurt to lift your hands. Pain is relative, mate. What was that? Someone who didn't want us to cut off his shirt. - Right. - Okay, Abby. Go ahead. You are blue. Did you know that? It happens when you sweat in these jerseys. - Maybe you should wash them first. - It's brand-new. Okay. - Let me know if you feel any pain. - Yeah, yeah. A mid-shaft fracture. Looks like it's broken. - Will I be able to play next week? - I doubt it. We'll see the x-ray. Be right back. Abby? - Get a clavicle film. - Great. - Everything okay? - Yeah. You sure? Do you have a minute? - I don't see a bullet. - Must be in the abdomen. Let's shoot a KUB. Your stomach doesn't hurt? It's just my leg. - PVC's on the cardiac monitor. - Where's the chest x-ray? - Run of five. - Bolus 60 of lidocaine. - What is it? - Just an extra heartbeat. - You won't believe this. - What? I found your bullet. - In his heart. - Through the femoral vein. From there to the IVC, to the atrium and ventricle. Tell O.R. we're on our way up. We need an open cardiac room with a perfusionist. - He may need a bypass. - I got it. Revascularize the leg at the same time. Put him in right lateral decubitus, reverse Trendelenberg. We don't want it to embolize into the lung. - We need to move you. - What's wrong? Remember I said we would take you upstairs? Well, we're going now. Hey, good effort. College student, stabbed in the abdomen. Hey, Peter. Type and cross for six units. Two of FFP. She'll fix you up. Hang in there. - You'll get my dad? - I will. Send up the O-neg if they need it. - Elizabeth needs a surgeon. - Congratulations. He's dead. - Who? - The man he abandoned. - I didn't. - He went into asystole near Mercy. - It was too late. -10 minutes would've mattered? - We won't know. - The shooter? The most critical patient is the priority! A bullet's in his heart! It can embolize and he'll lose his leg. Debate this later. Peter, get upstairs. Elizabeth needs some help! - You didn't care! - I was caring for the boy! That's enough! That's enough. Kerry, I need to talk to you. - I can't believe that guy! - BP 118/78. - Can you describe him? - It happened fast. Get an ultrasound and fetal monitor. - Do you need some help? - Yeah, I might. It's important. - He needed to get to a trauma center! - Calm down. I'm supposed to delay care while they take the shooter? - Go help Cleo! - One, two, three. Can you give me a physical description? - He was darker. Maybe Mexican. - What is it? Single right stab wound to the lower right quadrant four centimeters off the midline. - What was he wearing? - A gray sweatshirt, I think. Full trauma panel and check a HemoCue. - How far along are you, miss? - What? - What month are you in? - What do you mean? - Your pregnancy. When are you due? - I'm not pregnant. - You're eight months. - Got the ultrasound. - Better cath a urine. - Anything else you can tell me? No. He just ran up, grabbed my purse. - When I didn't let go, he stabbed me. - Okay. I'll be back. - Fetal heart tones are 142. - HemoCue's 13.4. - No intra-abdominal bleed. - The baby? Good cardiac activity. - I'm pregnant? - Very. Oh, my God! - Hold on. - What? - There. A blood clot. - Abruption? Could be. Twelve milligrams of betamethasone. Don't tell my parents. - What's your name? - Gloria. Gloria Milton. The stab wound damaged the placenta, causing it to bleed. - It cuts off oxygen to your baby. - I didn't know I had one. You do. Right now it looks okay. But we may need to do a C-section. - You mean cut me open? - Yes. 32 weeks is early. You're on steroids to help the baby's lungs. - I don't want an operation. - It may not be a choice. - The baby will die. - Nothing bad will happen to me? - Now you're all right. But- - Then don't. Don't cut me open. Don't do anything. - Hey, it's Dr. Torquemada. - Who? Nothing. Did you discharge your screamer yet? - It was tough. - You couldn't tell from out here. - He took on the hurt and won. - No brain, no pain? Some cultures see pain as a rite of passage. - Somebody call a staff meeting? - No. The kid made it up to the O.R. Benton's working on the leg. Good. Thanks. Age 13, the Masai warriors scar themselves with red-hot spears and yank out their bottom teeth, with no Novocain. Dave, give us a minute? - Oh, yeah. Sure. Sorry. - Carter, hold on. - What's up? - I think you know. The guy leaves a millimeter of coffee in the pot. - Abby saw you. - She saw me what? Abby. I saw you inject the fentanyl. - What? - In the trauma room, cleaning up. I was cleaning up. Chart says you drew up - What is this? - You gave 150 mics to the patient. Okay. Hold on. Slow down. - This is a mistake. - You stopped after three cc's. Haleh gave him a bunch of Versed. - And the rest of the fentanyl? - Must have wasted it down the sink. Somebody needs to witness you doing that. Come on. Come on. We do that all the time. We have a protocol for disposal of narcotics. Fine. Whatever. That doesn't mean that I injected it. Abby, if you thought you saw something why wouldn't you come talk to me? - It's appropriate to come to us. - Not when she's wrong! Are you still on medication? - Why? What? - For your back. Why? A little. Why? - What's "a little"? - That's between me and my doctor. So you're not overmedicating? You think I'm a drug addict? Do you honestly think I'm a drug addict? That I sneak around, injecting whatever narcotics I find? You guys, you know me. This is ridiculous. - So you deny this? - Yes, I deny it! Abby! I think you're seeing things. Maybe you're on drugs. I saw you with a needle once. If this is a misunderstanding, I apologize. This is a misunderstanding. You know why we had to ask you. Can I go back to work now? Thank you. And thank you, Abby. I really appreciate that. - He's lying, Mark. - I know. We'll call someone you can talk to. - It can be a friend, a roommate- - I don't want to talk to anyone. We don't have time. To save that baby, we need to operate. I told you I don't want it. Give it up for adoption. No one would know. I don't want an operation. So just leave me alone! All of you! - Okay. Okay. Okay. - Leave me alone! But you'll have to keep monitors on. - Why? - For your own safety. We need to know if you bleed internally. Dr. Kovac? Spin another crit. Cycle the dynamap every five minutes. I thought I'd seen everything. - Are you taking her? - Not if she says no. The abruption is progressing. She needs a C-section. - I made the consequences clear. - She doesn't care. You can't cut a woman open without her consent. - The baby will die. - I'm aware of that. - You can watch it happen? - There's nothing I can do. - You can operate. - No, I can't. - I'm calling another OB. - I am the department head. - We don't force C-sections. - What if she's incompetent? I don't know. She seemed coherent. - I think the wound was self-inflicted. - You can prove that? She claims she didn't know she was pregnant. She was lying, not crazy. What woman carries for 8 months, then won't let us help her baby? Call Psych. Give it a shot. - Then I can bring her up? - If they say yes. Side-biting clamp. We're lucky to have this extra time. Kovac didn't know the bullet moved to his heart. I'd have trouble helping someone who shoots at playgrounds. - BP's down, 80 palp. - Is that you? No. No active bleeding. Femoral vessels are clamped. Recheck the pressure. - Still falling, 70 palp. - What is it? Did the bullet embolize? Fluoroscope on. It is moving closer to the pulmonary artery. - We have blood dripping! - Where from? Take the towel off his shoulder. - He's bleeding out! - Saline sponge now! We need six more units of packed cells! What are you doing? - Locating the source. - I opened his heart. - We need to stop the bleeding. - Just wait! - Clamp the auricle. - I can't! Just for a second. The other bullet hit the artery. Clamp the subclavian. - I need to get this bullet out. - I'll do it myself. - Pressure's down to 60. - Give him a saline bolus. Come on. Damn it! I can't reach the artery. Crank the sternum open a little wider. He's in V-fib! Paddles! Paddles! - Get your hands out. - Hold on. - Clear! Now! - Got it. Go. I don't know what to tell you. I can't miss the tournament next week. You've broken your collarbone. Aside from hurting yourself, you'd be useless on the field. Put a cast on it. - We sling it and you rest. - It can't be that bad. - Could you get him a sling? - We only have smalls. He's large. - Hey, Mark. - Make that extra-large, mate. I'll be back to discharge you. So I talked to Legal. - Did you use his name? - No. I spoke in hypotheticals. Bottom line, we need more evidence. - He can't treat patients, right? - We have to be careful. How about a drug test? He's on medication. He'll test positive. I'm afraid just asking will push him further away. - What do you wanna do? - Get him some help. Let me talk to him. He might open up if it's not a threat. How could we have let this happen? He showed all the signs. I know. I know. But it's Carter. Your mind just doesn't go there. She's a little calmer. That's a good sign. - He'll talk her into it. - How do you know? - He has to. - Dr. Kovac. - Yeah? - Vinny Rosato. The boy's father. Oh, yes, yes. Hi, Mr. Rosato. - Your son is in surgery. - How bad is it? He was shot in the leg and the shoulder. The surgeons will repair those injuries. - A bullet moved to his heart. - He was shot in the heart? No. The bullet swept through the vein. But there shouldn't be any tissue damage. Can they get it out? We should take you upstairs. You can get updated information. - I'll take you. - Thank you, Cleo. She's certainly emotionally distraught. She could be depressed with a personality disorder. - Is she incompetent? - She's not psychotic. She understands not having the C-section can endanger her baby. - You mean kill it. - She's willing to risk it. It's no risk. She wants it to happen. - She stabbed herself. - You have no evidence. - She's a danger to others. - Who? The baby. Doesn't count. It's still her body. - Is the C-section needed for her? - There has to be a point. Is it? No. Without a court order, you can't touch her. I don't have time. That baby needs to come out now. We can try to expedite it. We know friendly judges. - You have to write up an affidavit. - Yeah. Whatever. When did you start smoking? That depends. Does it make me a druggie? Ask the Surgeon General. I'm worried about you, Carter. I'm okay. I got angry when I shouldn't have. Not that I didn't have a right. I'm okay. You didn't talk to anyone, did you? Any psychiatrists? - No. - Why not? I didn't feel like talking. I'm gonna be fine. Or I hope- I will be. It's been rough. You can understand. I got stabbed twice with a butcher knife. I'm in a lot of pain. This place isn't exactly the easiest work environment. Lucy's dead, partly my fault. I can't sleep. I had to take more pain medication just to function. I didn't steal it. It was prescribed to me. - Did you take the prescribed amount? - Yeah. More or less. I think you need help, Carter. I understand that you have to make this your business. But please, please let me deal with it. - When are you off? - Midnight. I don't want you to see any patients. Work on QA chart reviews. - I can see patients- - You have to trust me. Let me figure this out. We got to write this one up. That you lifted him up while I was operating? Cranking his chest and suturing too. - I have moves you haven't seen. - Oh, yeah? - Dibs on the bullet. - It's mine. - I was the one that called it. - I fished it out. - But I- - Hi, Cleo. - We just made a great save. - I can see that. We got the bullet out and Peter saved his arm and leg. His father's waiting to talk to someone. Okay. I'll do it. What's wrong? Nothing. I didn't know what to do, so I asked Dr. Greene. Sorry. I don't know you, but you're a good doctor. You've been through a lot that I couldn't handle. But I felt I had to tell them. You feel better? I have work to do. Here's your prescription. Take one every six hours for pain. You're gonna want to ice it. Mr. Tanner? Mr. Tanner? - Get Dr. Greene! - What is it? He barely has a pulse. I need a BP. - What did he present with? - Fractured clavicle. Tension pneumo. Get a 14-gauge needle on an open syringe. Let's go. - BP's 50 palp. Betadine? - Yep. Quickly, quickly. Get him on a pulse ox. I got it. Okay, check a pulse. Stronger. - A chest tube. - It's a broken collarbone. Not anymore. Satting at 95. Okay. Get me a 10-blade. - What are you doing? - Saving this guy's life. - You missed a rib fracture. - I'll take it from here. Needle decompressed. I need a Kelly. - I got it. - I'm almost in. Right, right. You take it. - Suction's ready. - BP's 100/60. You're welcome. I'm in. Hook me up. Abby. Call as soon as you know. Thank you. - He didn't sign? - They got there at 6:30. He had left. The clerk is tracking him down. - Can't we try another judge? - They're working on that. - I can't wait. - You can't do anything until we get it. - I've waited too long. - Promise me you won't do anything. No. I'm going to change her mind. - We need to do this tonight. - I don't believe it. He's so unpredictable. I thought he was bipolar. - No way. - He as much as admitted it to me. He's using. I don't know how long, but the behavior's there. But is this the right way? He might feel ganged up on. It's either this or we go to some committee. I'd rather approach him as a small group so he can clear it up. - And what about Romano? - No. We don't want him in. He can be stubborn. He might walk out. We'll be prepared. We'll be compassionate, but clear. He has two options. That's it. Are you with us, Peter? Kerry? - You needed me? - Yeah, Don. - What's the big emergency? - Have a seat. - Fetal heart rate down to 60. - Get a baby warmer. We don't have time to argue. This baby needs to come out. - I want another doctor. - You'll hemorrhage to death. You're trying to scare me. You should be scared. If not the baby, think of yourself. I don't believe you. You would've helped. Heart rate's down to 50. You're having a boy. I can tell from the ultrasound. You want to kill your son? Leave me alone. I want another doctor! Down to 40. That's it. Dr. Kovac. - Draw up the ketamine. - You can't. I'll take full responsibility! - What are you doing? - Don't. I don't want the baby! - C-section tray. - I don't want the baby! - Heart rate's down to 20. - Please, help me! - Cleo, set up the suction. - I won't. - Then get out of the way! - You'll lose your license. -10-blade! - Lost the heart rate. You can't do this. You can't. Is it over? Carter, got a minute? No. I'm done. If I can't see patients, I'll go home. Not yet. I need to talk to you. - Is this my suspension? - Not here. Come on. Oh, God! Give me a break. Carter, just listen. I'm on painkillers for my back. But I'm functioning. Dr. Carter? You would be wise to be quiet and listen. My van is parked outside. We have a ticket to Atlanta. There is a drug rehab The drug rehab center there treats doctors with addiction. I'm on prescribed painkillers. That doesn't make me an addict. I'm not finished. It's apparent to us that you have a drug problem. We can't allow you to continue working here or anywhere else as a physician. So you have two choices. Get in the van, go to the airport, check yourself in. And when you come back, we'll support you in any way we can. Or I'm fired? Yeah. Everyone in this room cares about you. - No one is judging you. - You are. You've already judged me. You have no idea what I've been through. But I've showed up. I haven't made excuses or complained. - That's not the point- - It is! Can anybody tell me that I have endangered patients? Can anybody here say that my performance has changed? That I'm a liability? You put a patient into anaphylactic shock by giving her Bactrim when she said she was allergic to it. You left a wire in someone's chest. Is this about mistakes? We all make mistakes. I saved you today. John, you've demonstrated compulsive drug-seeking behavior. - Tell me when. - Mainlining fentanyl. I didn't do that. Call me a liar, fine. I didn't do that. - Show us your wrists. - What? Show us your wrists! Are we looking for track marks? Yeah. Well, there. See? - You want me to roll up my sleeves? - Take off your watch. You know You know what? Forget it. Forget it. - This is your only chance. - I quit. Well Is that it? No. What are you doing? I don't need this. I've never needed this. I wanted to be a doctor, wanted to help people. I don't need their job. - Don't do this. - I'm not doing it. They are. - Carter, wait! - No. You want to *** it away? All you've worked for? - You're handing out the ultimatums! - Get in that van! - Like hell I am. - You won't do this! You believe I'm a junkie? You ambush me. You're out of control! Get into that van. - No. - Get in the van. Don't touch me. Don't touch me. Where does it end? It's fentanyl, then you're dead. Or like your cousin some babbling gork in a nursing home. You want to fight, that's cool, but get in the van. It's all right, man. It's all right, Carter. Good job. That's good. - He's crowning. - Almost there. One more push. Ready? And push. Push. The head is out. Okay. You can stop now. Clamp. And cut. - Does she want to see him? - Would you like to see him? No. - You want me to pronounce him? - No. I'll do it. Time of death, 19:47. Is he on the plane? - Peter hasn't called. - Wonder what he said? - I just hope Carter goes. - Yeah. Nice to see the ER brain trust diligently works after hours. - Hello, Robert. - ICU's a zoo. It's nice here. - Same old stuff. - Fun never stops. - Walt, the intussusception upstairs. - What about him? Tried to reduce with an enema. Big mess. We must go in. - Now? - Yeah. Not as sexy as a bullet out of the heart, but it's a life-saving procedure. - I'll be right up. - Thank you. Good night, all. - I guess I lost my ride. - That's right. I'll take the El. - You sure? - Yeah. See you at home. I'll try not to wake you. Good night. Good night. Wanna go get something to eat? No. I'll wait to hear that he got on. - Call me. - Okay. Thanks. - Just a minute. Dr. Weaver? - Yeah. Legal on line 3. They say to go ahead, the judge signed the order.