ER S6E20 - English Transcript

E. R. Previously on E. R. A year ago I was living with Doug. Now I'm living alone with two babies. John. I wish you'd talk to somebody about your not sleeping. I'll be fine. Hello, David. How are you? Well, I'm still here, Elizabeth, it couldn't be too bad. I mean, this isn't right, Mark. It just isn't right. I know, dad. Nothing has gone as expected today. E. R. 6x20 "LOOSE ENDS" Mark. Mark, I'm cold. All right, Dad. I'll get you a blanket. Did you get any sleep? You look awful. I'm fine. I need to turn up your oxygen, Dad. If you have trouble breathing, I will have to put you on a mask. - No mask. - We'll see. - You ought to go back to work. - Maybe later. I wanna make sure you're comfortable. - In that case, how about a drink? - What? I'm craving a bloody mary. Your mother made them for brunch. - That's not a good idea. - You think it'll kill me? - With or without Worcestershire? - Without. But I'll take a dash of Tabasco. - What's all the racket? - Sorry, trying to get back into shape. - When did you get this equipment? - Couple of days ago. - Didn't mean to wake you. - No, I'm up with the birds. - How'd you sleep? - Like a baby. Good. You can get back to your regimen. Toast and coffee for breakfast? - I feel like pancakes today. - I think we can manage that. - Morning. - Morning. Everything all right? I only get your answering machine. Sorry. It's been crazy. Tess had a bad cold. The kitchen's being painted. We're at my mom's. Well, anyway, happy birthday. They're beautiful. I picked them from my garden. My neighbor's garden, actually. - How'd you know it's my birthday? - I have my ways. Dr. Kovac, we need you. GSW coming in. - See you later. - Okay. - Looking sharp. Where you been? - Checking out Lincoln Park condos. - Trendy. - And expensive. - Too many yuppies. - You're a yuppie. - No way. - Young urban professional. That's you. - I am not. Am I a Yuppie? - No, but you will be when you grow up. Dr. Greene won't be in tonight. I need someone to cover his shift. - All night? - You can flip for it. - I'll do it. - You will? As senior Resident, I'm responsible. Thank you. You can nap later. Malucci will cover you. - Your EMS meeting's at 10. - This morning? - Where's Carol? - Over there. - You didn't hear me calling? - What's up? I need the paramedic compliance data. - I'll get to it. - I put a memo in your box. - You didn't see it? - I must've forgot. The meeting's in two hours. I need that data. I will. I will get to it. - You'll do it? - I will do it. I made you French toast. You want the TV on? No. Lean forward. - You in pain? - When I take a breath. Probably pleurisy from the pneumonia. We'll try Toradol. This'll make you feel better. - Hungry? - No. Why don't you eat? For me. Just take one bite, please? I'll eat. What'd you give him? - Lasix, nitro and morphine. - Excellent. He's acidemic and retaining CO-2. - His pulse ox is dropping. 85. - Set us up for an intubation. - We'll put a tube down your throat. - Anything to help me breathe. This one's tough. Have you done a COPDer before? - I've never tubed. - Time to step up to the plate. A patient's in respiratory distress? On top of it. I'm going to teach Abby intubation. We can try this new Airway Cam. If you don't mind, slip this around your head. As she intubates, we can see exactly what she sees on the TV and make adjustments. Cool. You ready, Abby? Give your patient 20 of etomidate and start bagging him. Right. - Everything looks okay. - No bleeding? I can go home. You vomited blood. Fainted at work. The IV needs to stay in a bit longer. You said I could leave if everything checked out. Yes, but your potassium level's low. We need to replenish it. - Where'd you put the lab slip? - I got it off the computer. You've wasted enough of my time. Nurse, get my clothes. - What's wrong? - Just dizzy from sitting up too fast. You're dehydrated. You can go after this fluid runs in. All right. But that's it. Then I'm out of here. Can you make sure her discharge papers are in order? Sure. Her gag's absent, her tooth enamel's eroded, she's severely malnourished. She's anorectic and bulimic. And I don't want her leaving. - What can we do? - We'll have Psych put a hold on her. What is it? Hammer vs. scalp. We're going to CT. - Seen Carol? - Not since this morning. - I need data from her. - Page her? - Twice. - It's her birthday. - Maybe she went out for breakfast. - I certainly hope not. All right. Go for it. Enter on the right and sweep the tongue to the left. Slide it all the way down. Hold on. Advance slowly until you see the epiglottis. - See it. - So can we. - A little more. Lift it with your tip. - This is pretty cool. No, lift toward the handle. You could have fun with this. - See the vocal cords. - Pass the tube. Good. - Wasn't hard. - Easy with a good teacher. You're right. You're wheezing again. Want another breathing treatment? Having any chest pain? No. That last stuff worked pretty good. Just mixing up your antibiotics. - Damn it! - What? Broke. - Now what? - Cut my hand. - You're bleeding on the floor. - I know. - You should keep pressure on that. - I know. Keep your hand above your heart to stop the bleeding. - You need stitches. - I won't leave you here alone. You're the doctor. Your leg's circulation is poor. An arteriogram will check your blood flow. When he came, the doc couldn't feel a pulse in his foot. - When was that? - About a month ago, right? The doc took the dead skin off his toe, gave him some ointment. - My shoe fit poorly. Rubbed my toe raw. - The toe's gangrenous. Your leg has an ulceration. - We must operate. - How bad is it? We have to amputate below the knee. - Amputate? - How could this happen? That first doctor gave my dad some pills. - How could it be so serious? - Remember the doctor? Some foreign guy. - Kovac? - Yeah. Dr. Kovac. - I'm off to Mark's. - Is it his dad? No. Mark cut his hand. He needs sutures. - Make sure Psych sees Claire. - She won't leave. She's on a slow drip. She's got hours left on that bag. - Thanks. - I'm still massaging the data. I'll have to make the presentation in June. - Where were you? - Daycare. Tess is cranky. I postponed my meeting. I didn't have your report. - I didn't finish it. - You need to stay on top of the stats. - I'm just incredibly busy. - Give it to another nurse. - I can handle it. - Your babies take a lot of time. - If you need to cut back- - I'm fine. Things can't fall through the cracks. - I can handle it. - Good. - What? - Delivery guy dropped this off. - God! It's from Doug. - Let's see. What'd he give you? - Animal crackers. - A weird birthday present. It's a thing we used to do. When he'd go to the store, he came back with animal crackers. - I'd put one in his Christmas stocking. - Kind of a tradition? - I'll do the foreign body in the eye. - Carter got it. - I'll take the hip dislocation. - Carter got it. Tell him, if he wants to see all the patients, I can go home. He left you Mr. Barclay. Wound check. Swell. - Mr. Barclay? - Finally. I've waited here for three hours. Your CHF guy dropped his sats. You must go back to Chairs. - What's taking so long? - My patient's not breathing. - Would you take him? - Sure. I burnt my arm cleaning out a furnace. Remove the gauze and- - Hey, doc. - Excuse me. Kenny's been seizing for 20 minutes. - Please help him. - Don't worry. We'll take good care of him. Prep the Pedes ER. Hey, I was here first! - Ativan's on board. - Draw a CBC, lytes and cath a urine. - Pulse ox is dropping, 92. - Has he had seizures before? - No. - He's always been perfectly healthy. - Could he have ingested poison? - We keep everything locked up. - He had a sore throat last night. - Fever this morning? Just a little. I tried to get him to eat, he wanted to sleep. Next thing I knew, he was shaking. Push 600 of phenobarb. We must stop it. - You want to intubate? - If his sats keep dropping. - Blood glucose is really low. Under 40. - Seizures can lower blood sugar. Push 50 cc's of D-25 and get Weaver now. - Dr. Kovac? - Yes. Do you remember Chet Fulton? African-American, early 60s. Last month. Had vascular insufficiency and an ulcerated toe. - Do you have his chart? - Yeah. He's back with gangrene. I remember him. I d�brided the wound and gave him Trental. Sorry he's back. Well, now I have to do a below-the-knee amputation. It may have been avoided if he went to Vascular clinic. The chart shows I made the referral. High-risk patients with no insurance need follow-up. And I made an appointment with Vascular. I can't see to his care outside the ER. But did you put him on the callback list or phone him? - Do you call back everyone you see? - The high-risk ones I do. Really? Older African-American men are at high-risk for amputation. - You should know that. - I do. - Then why didn't you call him? - 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. - How long's he been seizing? - Thirty minutes. Dilantin, 300 mg. His blood sugar? - Still under 40. - Push another 50 of D-25. I don't understand. Why's the glucose so low? Could be an insulinoma or a metabolic disorder. Give me an ammonia, an insulin level and a uric acid. - Seizure stopped. - Start a dextrose drip. Check blood sugar every 20 minutes. He can't tolerate another seizure. Why isn't he awake? It's normal for him to sleep after something like this. - He will wake up, right? - Why not stay with him? He might be scared waking in a strange place. - Thanks. - Thank you, doctor. - Get a head CT and an EEG. - What do you think? I don't know. D-25 should've corrected the hypoglycemia. Check the labs and start hunting for zebras. Okay. - Is this your patient? - No, he's Carol's. - Can you change the IV bag? - I got a guy puking in Exam Two. Carol. - Your patient needs a new IV. - Right. - The IV ran dry. That's not like you. - I'm sorry. - Something wrong? - I'm fine. - Are you sure? - You have a problem with me? Say it. Don't get defensive. I'm just asking what's going on. I'm caring for 10 patients, my babies are in daycare. And you're constantly on my back. Stay on top of things and I won't bother you. Forty-five-year-old guy tried to beat the El train. Knocked down, but not run over. BP's 80 over 40. Intubated in the field. When is somebody gonna look at my arm? I came here on the bus- Would you sit down? And three - Got some rib fractures. - BP's 75 palp. Prep for a central line. This guy's gonna need some fluid. Absent breath sounds on the left. This dude's got a pneumo. Chest-tube tray. - Hold on. - Why can't I get a wound check? This guy's trying to die. Get out of here! I'll pop this in and his pressure will shoot back up. Don't assume that. He may be losing blood. Malik, stand by to resuscitate. - Did I ever tell you the story-? - I'd love to, but sick people await. Cliff-diver hit the rocks. I'm in. You done? - Not yet. - Pressure still 75. So much for your chest tube. May be blood in the belly. Get an ultrasound. - He stole my rig! - Who? - Your wound-check patient. - That sucks. - You're good at this. - Thank you. The way you did it, you hardly need to close the skin. That's the point. Is he giving you a hard time over there? No, he's being a very good patient. We'll remove those in five days. Shouldn't leave a scar. Thanks. Keep it dry for two days. Put a plastic bag on it when you shower. - I know. - I know you know. His breathing's difficult. Should I treat him? I can't breathe. But I can still hear every word you say. - Can I make you lunch? - I'm not hungry. But stay. Have some tea. I'd like that. - Heard your patient's unstable. - Blunt chest trauma. - Hypotensive despite a chest tube. - Probably cracked his spleen. His neck veins are elevated. May be fluid around the heart. - Could be the belly. - Check for a cardiac tamponade. - I'd check the belly. - Carter's right. He's got an effusion around the heart. Go for it. - Get me a spinal needle. - Now you can check the belly. Watch for injury current. - Looks pretty clean. - You hit the heart. Pull back. - I've got good return. - Pulse is stronger. - Need another syringe? - I'm okay. Call for an ICU bed. Good job, Carter. - Dr. Weaver? - Yeah. I did a Medline search on the boy with seizures. His symptoms are consistent with M-CAD, a rare metabolic disorder. Get a Genetics consult. Talk to the parents. Good pickup. - How are you doing? - Okay. Look. I'm sorry I came down so *** you - but I depend on you. - I need to be more on top of things. You're our best nurse, but something's going on with you. Can I do anything to help? Not really. I just need time to figure a few things out. I've worked with you for five years. I know you. I hate my life. I mean, I love my work. And I love my daughters, but How did I end up raising twins by myself? It's just I think you need some time. You have some sick days. - I've used them all up. - Check. You have some extras. Use them whenever you like. Thank you. You said Kenny would wake up. His genetic disorder prevents his burning fat for energy. When he got sick, his blood sugar dropped, causing his seizure. - Will he have brain damage? - We'll look at the EEG. I don't understand. He was born here. They didn't tell us he had this. Chicago hospitals don't test for rare metabolic disorders. - Do other hospitals? - In some states. If we'd known, could we have done anything? Dr. Chen, please. Tell us. If he had sugar water when he got sick you could have prevented the seizure. - Sugar water? - Oh, my God! - Our patient's in the O.R. - Did you cause myocardial damage? Not to worry. Easy as threading a needle. Hello? I'm in the ambulance, bringing in sick people. - What unit is this? - How should I know? I was flagged down on my way to Mercy. - Who is this? - Joe Barclay. - It's your wound-check guy! - What are you doing? Heading back. I got people here puking their guts out. - Is that the thief? - Are the patients stable? - I don't know, man. They're puking. - Not on the floor. I just cleaned it! I'm gonna let you take this one. You've already established a relationship. - Call me if there's any change. - I will. David, I'm leaving. I have to get back to the hospital. - A doctor's work is never done. - I'm afraid so. Wait. I have something I want to give you. Mark, get that little green box from the top dresser drawer. - It's not necessary. - I know. These belonged to Mark's mother. I gave them to her on her wedding day. I want you to have them. I can't. Please. They're lovely. Thank you. Don't just stand there. Help her put them on. She looks beautiful, doesn't she, Mark? Yeah. She does. - Hello, Jing. - No, it's Jing-Mei. What's the matter? Somebody die? We should screen babies for rare metabolic disorders. - What? - I cared for a little boy today. He seized because we didn't give him a $25 test when he was born. Well, if we tested for every genetic disorder we'd spend millions to identify a tiny handful of kids. But if I'd known what he had, I'd have treated him differently. I might have stopped the seizure more quickly. It's all an allocation of precious resources. We have to draw a line. - We should offer the tests. - We can't afford it. Tell that to my patient's family. They're waiting to see if their son comes out of a coma. - They wouldn't stop puking. - Strong radial pulse. - This guy is stable. - Soft on this one. We got a father/daughter MVA. Can you give me a hand? Start a liter of saline and titrate five to 10 of Compazine. - Let's go. - Come with me. - Can I get my wound checked? - Oh, yeah. Rear-ended while at a red light. Six-year-old girl complains of neck pain. - I want to stay with my daddy. - Dr. Dave will take care of you. I'll take the dad. Knee versus dashboard, facial lac. - Wife informed? - Divorced. She's in Pittsburgh. - Daughter's visiting. - Dislocated knee. - Pain's horrible. - Had six of MS. Ten of morphine. Ever reduced a patella? You will now. Did you see my patient? - I'm finishing the note. - Thank you. Don't thank me. I'm removing the Psych hold. You can't be serious. She's starving herself to death. She might be. But I can't make her stay against her will. She's got a job, she's not an immediate threat to herself or anybody. She could go into kidney failure. What's it take to get her treatment? Her consent. Many people do bad things to themselves. They smoke, they drink, eat fatty foods, but we don't lock them up. - So we do nothing? - It's her right to decide herself. - Even if they're bad ones. - There must be something I can do. If you convince her to stay, I'll admit her. Otherwise, you'll have to discharge her. Is the water too warm? No, no. - Where's Elizabeth? - She left a couple of hours ago. Do you have to go to work? No, Dad. I'm gonna stay right here. Okay? Here. Lie back. - Having any pain? - No. No. You all right? Yeah. You look tired. What is that soap? - Plain old Ivory. - That's what your mother used. I remember. Every night when she tucked me in she'd kiss me and I could smell the soap on her face. - This used to be my job. - What's that? Giving you a bath when you were a baby. I didn't know that. You're a good doctor. The day you became a doctor was the proudest day of my life. It's okay, Dad. You don't have to talk. I love you, Mark. I love you too, Dad. - You okay? - Yeah. When can I get up? - After I see your x-ray. - Get a CBC, dip a urine - check a bedside crit. - HemoCue's next door. - That's two of Versed. - He's pretty relaxed. I'll keep the hip flexed. Keeping the knee extended, apply gentle pressure medially. Like this? Perfect. How you guys doing? She's stable. Clearing the neck. - What is it? - Six-year-old, minor MVA. Probably just whiplash. I took a lateral C-spine. Careful. - Don't! - It's okay. We have to examine you. We'll cover you with a sheet. What is it? She has bruised thighs and bloody underpants. Could be a urethral injury from a pelvic fracture? We need a plain film and a cystourethrogram. Hold on. - Does this hurt, sweetheart? - No. There's no pelvic fracture. You have bloody underpants. Were you hurt? I want to go home. We're here to help you. I need to ask you a few questions, okay? Okay. Has anyone touched you where you go to the bathroom? What happened? Sometimes my daddy plays a game with me. It's okay. You can tell us. It hurts. Well, don't worry, he's never gonna hurt you again, okay? - Sick son of a ***. - Take it easy! - What are you doing? - He molested his daughter! - What? - She's got sign of abuse. What? I never touched her! Mr. Burke, I'm sorry. Dave, outside! Keep an eye on things. - You can't do that! - He *** her! You don't know. Call Social Services. Have Cleo do a pelvic. - I'll assist. - Not after that. - That little girl trusts me. - That's a bad idea. Well, I'm gonna assist. Okay, you'll feel a little sting. - Kerry was out for your blood? - She was upset. - I can talk to her. - No, we worked it out. You'd think she'd cut you slack on your birthday. Do you have plans to celebrate? No. I don't like leaving the girls when I've been working all day. No problem. I can cook you a birthday dinner. Even do the dishes. Okay. Better get these things to the lab. - Dr. Chen? - Is everything okay? I'm told that Kenny may have permanent brain damage. I'm so sorry. This is Kenny's baby sister. - The sitter dropped her off. - She's beautiful. I want you to give her the test you talked about. Please. I can't force her to stay. I hope she'll listen to you. - I'd do anything to help my daughter. - I'm sure you would. She's exhausted from not eating. My God! She's skin and bones. - You told the mother? - I had no choice. She's over 18. She has a disease. I had to do something. "I would not like them here or there. I would not like them anywhere." "I do not like green eggs and ham. I do not like them, Sam-I-am." You're gonna feel my hands now. "Would you like them in a house? Would you like them with a mouse? I do not like them in a house. I do not like them with a mouse." "I do not like them here or there. I do not like them anywhere." - That's good. - Almost through. She has bleeding from complete transection of her ***. - Can we keep reading? - Yeah, yeah. Yeah. "I do not like green eggs and ham. I do not like them, Sam-I-am." Want to order dinner? Going to Lucky Moon. Get me kung pao chicken, mu shu pork and a side of egg rolls. - You're hungry! - I'll save the mu shu for later- Pressure dropped to 80. - ST elevation in V-1 through V-4. - I'll tube him. - Start dopamine. - Pulse ox 82. I'll bag him. - Want me to call the cath lab? - Tell them we've got a hot Ml. - He's tachy at 130. - Get me some suction. - Want cricoid pressure? - Your bee sting kid's crashing. - I'm in. - Want me to take it? No. Get this guy's pressure up and take him to the cath lab. Pressure is down. Should I increase the dopamine? No. I hear a pansystolic murmur. - Mitral regurge? - He has a parasternal thrill. Could be a septal perforation. Get an 8 French. - Central line? - I'll float a Swan. - We don't do those. - We have no Swan modules. - Get one from the ICU. - It's against policy. I need to sample blood from the right side of his heart. Carter, we can't do this. - Fine. I'll do it myself. - I'm getting Dr. Kovac. - Did someone page me? - I did. Mark's father passed away a little while ago. How's Mark? He's all right. He'll call you after the funeral home leaves. I'll go over as soon as I finish. - Mind if Peter covers? He's still on. - Not at all. - Dr. Corday, we need you! - I'm leaving. I want this IV out now! - Please don't. She won't listen. - You're anorectic. You need to stay. - That's not what the shrink said. - We can't force you to stay. - You could die without treatment. - Take this damn thing out! All right. Remove the IV. I never said to call my mother. I'm an adult. I can do what I want. You're right. Sorry. I'm only trying to save you. I don't want your help. A friend of mine died today fighting for his life. You want to leave? Fine. Kill yourself. If you don't give a damn, neither do I. Discharge her. There. I'm in the RV. Draw blood from the distal port. - Blood's bright red. - He has a hole in his heart. - Leaking oxygenated blood. - Pressure's still low. Start Nipride. Call the O.R.- I told you to get him to the cath lab! - Going to the pulmonary artery. - We don't do Swans here. - I told him that. - He needs an angioplasty. - He'd have died in the cath lab. - What? I sampled blood from the right ventricle. Bright red. He perfed his septum. - What about his Ml? - They can bypass him when they fix the rupture. The O.R.'s waiting. We work together. Next time tell me what you're doing. - Can't you give me something? - Couple more sutures. - Then you go to jail. - You're hurting me! - Sorry. - He's killing me! - He needs more lidocaine. - Why? I did an infraorbital block. You missed the nerve. Infiltrate locally. It'll distort the wound- Infiltrate subcutaneously or I'll take over. Fine. You do it. Dr. Chen, we meet in such odd places. You paged me for a consult? First, I want you to meet the mother of the little boy I told you about. - Hey, I'm very sorry about your son. - Thank you. - I said we'd test her baby girl. - Excellent idea. I hear that if hospitals screened every newborn hundreds of lives might be saved. - Since the test only costs- - I'm sorry. - Can you show me where my consult is? - This isn't a surgical consult. - It's not? - No. I'm sponsoring a petition to offer expanded newborn genetic testing. I told Mrs. Lattimer and she wanted to meet you. Though Kenny didn't get the test, some good will come of this. So if you'd just sign on the bottom page As I tell all my Residents, what's good for County is good for me. - Seen Carol? - Not in a while. - If you do, tell her I'm looking for her. - Okay. - I hear you performed a heroic save. - Just did what I thought best. Attendings are here to supervise Residents. - Fine. - It's not fine. You don't perform dangerous procedures alone. Is that clear? Start the second IV en route. ETA is five minutes. Copy. See you in five. I'll set up Trauma One. Multiple stab wounds coming. - Interested? - No, thanks. - How's that little girl? - Cuts will heal. - See you tomorrow. - See you. There you are. I was looking for you. You all right? - I've been up here thinking. - Birthdays can make you do that. It's been quite a year. Yeah. For me too. I look forward to the next one. I'm sorry, I don't think I can have dinner with you tonight. - Did I do something wrong? - No. No, it's not you. It's me. I'm sorry. I gotta go. Mark? Hi. I'm so sorry. Can I help with anything? Not really. Called all his Navy pals in San Diego. I just spoke with Rachel. I'm filling out some forms. His taxes. Mom used to do his taxes, so they're a mess. And his house. I gotta sell the house. I promised I wouldn't sell the house when he came here. But I don't see a reason to keep it.