ER S15E21 - English Transcript

I got a meeting at nine. Maybe the weekend would be better. -He's getting discharged tomorrow. You're about to start a shift. -I can get someone to cover. It's OK to be nervous. -We don't know anything about this baby. Most times you don't. He seems pretty perfect right now. I'd rather do this when we can spend some real time with him. Let's just start with 5 minutes, and take it from there. Good morning! -Yes, it is. I'll pick you up at 8:30. -What should I wear? Something fancy. -I hate surprises. OK, it involves fine dining and some other things. Archie! -It's going to be a big night. Big night? Are you popping the question? -Are you crazy? We're still in the honeymoon phase. A year from now we'll hate each other's guts. . . And I thought romance was dead. -The big surprise is I've been studying an instructional dvd for two weeks. Morris, what happens in your bedroom, stays in your bedroom. I'm taking salsa dancing, she's Puerto Rican, it's in her blood. And I have to work on it. -Yes you do. Dr. Morris, you should be dressed for work before you start your shift. I'm not on today. I'm volunteering at camp Del Corazon. Is that today? -Camp Del what? Yeah, a program for kids who've had open-heart surgery. Kids with heart diseases running around? -Yeah, we should get some business down here. No, it's nothing too strenuous, arts and crafts, face painting, . . maybe a little sharades. -Excuse me. Cate, can we? I'm going upstairs to check on . . Felix Kirsch, found unconscious in Lincoln Park, scalp hematoma and blood from his right ear. Trauma rooms are full. -Curtain two! Started seizing, we pulled up, gave him four of ativan. Alright, drop another two, did he fall? Might've been mugged, police were there. We have to consider cardiac, metabolic and toxicologic ideologies. Alright, that's more like it. I'll just start him off. -Ready, one, two, three. Now. OK. Felix, open your eyes. look at me, Felix. He's post-ictal. Did you call his parents? Didn't have time for that. -Here's his ID. Ruptured his eardrum. I can come back after work. -No, no,. . Pupils equal and reactive. Since you've got everything under controle, I'm going to pediatrics for a few minutes. -Alright. Gram of Dilantin over 20. How are you doing today, hm? Did you get a good night's sleep? Did you? Did you? He likes the rocker. I want you to meet someone. I want you to meet my husband, his name's Russell. Hello! -Did you wash your hands? Yes. Settle down, little man. He seemed happier with you. Do you want to take him? -Oh, no, no. . No need to fuss, Russell's a good guy. -That's better. He's tracking objects with his eyes. He smiles at people. Yes, you do. -The milestones of a two-month-old. Yeah, you're an advanced young man. My protective custodianship is over when he's discharged. If we're serious about adopting, we have to take a state-certified parenting class. When do wo start? Let's start now. Hey, Archie! Archie Morris? -Yeah. I'm Vera, I'm the niece of the Big Kahuna. Kahuna, this is Archie. -Hi, been looking forward to meeting you. Jump in and just follow my lead. On second thought, you see that kid over there? His name is Logan, see if you can get him to join us. OK. -Yeah. Hey Logan, how's a going? Looks like fun out there. It's lame. Yeah, I never cared much for dancing when I was a kid either. Do you play basketball? No. -What do you like? You're wasting your time, 'cause I don't want to be here. OK? My parents made me come. Have you been out of the country? Two months ago, Machu Pichu. I might not need a scalpel then. Kayson called about a biopsy. -I'll call him back. He faxed the report. Thanks. Hey Doc, do I need a tetanus shot? If it's been more than 5 years, yeah. Oh my god. Botfly larva, it's uhm, endemic to South America. Are they taking over my body? The fly lies eggs on you and the larva barrs under the skin. You'd know if there's any more. I'll be back. Your bookshelves are empty. -You need some artwork. I'm still in boxes. They way they're working me, It'll be a good year before I get settled in. Neela's showing us her office. Hey, look, Simon's here. Hey there, this is my new home. That's impressive! Oh, check this out. Wow, assistant professor of surgery. We get residents from Tulane, so I do have a faculty position. I'll be sure to tell Dubenko. I brought the stuff you wanted from home. Who're you talking to? -County. Oh yeah? Hey guys! Hi Ray! -Hey Um, I'm going to be late for the OR. Just wanted to check in. Call any time. -Yeah, we miss you. Take care. -Bye. The rule of the friendship bracelet is that you can't keep it for yourself. You have to give it to someone really special. Who are you giving yours to, Xena? I haven't decided yet. You can give it to your husband. -I don't have one of those. Do you have a boyfriend? -Not right now. You? -Boyfriend? Yeah right. Why not? -Guys tend to avoid me. What? Come on, you're pretty, you're smart, . . I'm a freak with scars and a bad heart. I had a cardiac arrest in math class, the paramedics had to give me CPR. It's kind of a buzz kill to the guys. That and my internal defribillator. What's your heart defect? Tetralogy of Fallot. So, you had a BT-shunt? -I have hypoplastic left heart syndrome. I needed a Norwood, Glenn and Fontan before my transplant. The great thing about camp is that we all fit in. You don't have to worry about your scar. Just be yourself and go crazy. What's up, Xena? Just a little arts and crafts. I've got to cool down. Hey, Emily, do you want to check out the slime slide? I have to get something from my backpack. Is she not supposed to exercise? -No, she's in good shape, it's just. . it's her first time at camp and her parents don't let her do very much. Thread to 40 centimeters. I'll take the needle out, OpSite. Titrate to 10 cc's an hour. You did great, Felix. This is Dr. Kirsch, Felix' dad. Hi, I'm Dr. Gates. -I'm Dr. Banfield, we spoke. Hey there. -Hey. Are you a physician? No, a physics professor. The world famous Enrico Fermi institute. Are you OK? How did you hit your head so hard? I don't remember. We're trying to figure out if he fell or something made him faint. You know, I've heard that uhm. . sometimes sleep deprivation can lead to seizures. It can. He was up all last week burning the midnight oil. But he aced all his midterms. Indeed I did. You want to have a seat? Thank you. It could be a while before they take him upstairs. "How much of human life is lost in waiting?" Ralph Waldo Emerson. We'll be right back. -Is it OK if I take him to curtains? Um, that'll be fine. Can you imagine having a dad like that? -I like him. He's concerned, he's devoted, . . Think about the pressure that kid's under, fits the profile. Acting out, doing drugs. -We'll check it out, but I doubt it. I'll have psych come down for an assesment. -Knock yourself out. Dr. Banfield. There's someone here to see you. That's um, Megan. I dropped off a baby a couple of weeks ago. I remember. I can't sleep at night. Your baby's doing fine. He is? -Yes. He's well taken care of. Are you alright? No. I made a mistake. I want him back, I want to keep him. My mom says she can help. And I'll be getting a cheque from the state, so we'll be OK. -What about high school? I can go back. -You know, being a mom isn't so easy. I've seen girls younger than me doing it. -So are you sure about this? OK, I'll talk to our social worker, but uhm. . it might be a while. -I'll wait. Megan. You know. . You seem a little confused, are you sure you don't want to think about it? -I already have. I made a bad decision and. . I just want to do what's right. -Alright, so there's a tear in the dura mater. Outer most, toughest of three meninges covering the brain. AP Biology. -You'll be on bedrest for about I canceled my appointments, but I've got classes, OK if I'm back at 6? No problem. -I'm not going anywhere. Alright. My cellphone's on. See ya, kiddo. -OK, what do you remember about this morning? I cut through the park on my way to school. Sometimes I jump over these rocks. I guess I slipped. -Anything else? So tell me, how does a freshman end up in AP Biology? All my classes are AP. -Sounds like a lot of stress. Not really. Have you been sad lately? -Alex on line two, he says it's important. After a concussion, as time goes by, you can start to remember more, so tell me if that happens. I got something to tell you when you're done. Hello? What do you mean, it doesn't fit? I specifically ordered for a How was camp? -Amazing, wish I could stay all day. Alright, I'll call for return authorization, they were not supposed to send a 6 cd changer. OK, OK, bye. Getting a new stereo? No, actually, my car got broken into. Wow, I'm sorry. Oh, PD has some new info. Witnesses saw a fight in Lincoln Park this morning, where they found your kid and at least 4 teenagers, grabbing and shoving each other. Frank. -Thanks. What's Neela doing on your computer? It's a screenshot, you missed her videochat. Oh, how is she? Never thought she'd be happy in Louisiana, but I was wrong, she looks good, she sounds good. I've got three new ones to present. Come on, why am I the only attending on the floor? Good afternoon, Hedda Langford, Congratulations. Complaints of right leg pain and swelling. It got so bad I couldn't walk. -Any shortness of breath? No, just the leg. -And good vitals. Trauma two. -Dr. Brenner, Paramedics are 5 minutes out with hot MI. OK, call the Cath lab and call me when they're here. Has the baby been moving? -Maybe a little less. But I could be imagining things. Let's get some fetal hearttones and prep the SonoSite. Simon? -Yeah? You want me to take her upstairs? -What for? After 20 weeks, we like to send them to OB. Baby's viable, they get better monitoring. That'd be fine if she had belly pain. They can check out her leg. We'll do a better job, I'm worried about a blood clot. Mom comes first, not the baby. Alright, then she needs an NST. So get a fetal monitor. Are you OK? -Yeah. You seem a little. . There's supposed to be double attending coverage, but I'm looking after 40 patients by myself. Set up a duplex scan. Keep going, man! Good job! This is pretty cool. -It's a baby wall. I've been up on one twice that size. You wanna race me to the top? I'll give you ten bucks if you win. -You think you can bribe me? That is so pathetic. No, I can't. -It's not as hard as it looks, really. I don't want to. -Hey. What's going on? -She's afraid to try. You know what? Have you ever had a dream where you were flying? What was it like? Don't look at the ground, one more step! You know, I'm coming down guys. No, keep going. OK, I'll keep going. Oh no, I don't think I can do this. That was awesome. Hey. Russ, I've got some bad news. Definite DVT, there's a large blood clot in the thigh. How does that happen? As the uterus grow, it presses the pelvic veins. Pregnancy makes the blood more coagulable. So we need to treat you with a blood thinner called Heparin. Is that safe for the baby? -Yeah. Are you sure? It took us three years to get pregnant. Well, heparin doesn't cross the placenta. -What if you don't give it to me? A piece of the blood clot could break off and travel to your lungs. It's called a pulmonary embolism. And you can die from that. My brother-in-law is an OB, do you mind if we discuss this with him? It's a good idea. I think we're wasting valuable time, this is a no-brainer, heparin's safe, it'll safe your life and your baby's life, Sam, let's prep a 5000 unit Bolus, please. Excuse me. Hey. Hey! -What's their problem? They just need some time. -Banfield can deal with them, 'cause I'm supposed to go over to this heart-camp. Oh, well, they're going to love you with that attitude. Well, then maybe I won't go. Look, I know it's a hard time. It'll get better. What are you talking about? Neela. Neela Look. . Sam, tell your gossip circle not to worry, I've moved on and I'm fine, OK? You really need me here? You're my designated runner. -OK. OK, OK. OK, two done. -OK, bring me home, baby. Bring me home, Vera. Faster, we can get a grand slam, bring it home! What happened? What's going on, honey? -My defibrillator's frying. Let me check the carotid. She's in V-tach. Now do a Hennepin with him sitting up. Back in the socket. Alright, immobilizer and post-reduction film. When we lived in San Diego, I saw a surfer threw his shoulder out. San Diego's nice. We were there for about two years. Ah, how long have you lived here? Since September. Are you having any eye pain? Archie, I know I volunteered, but if you've got enough help then. . We're completely short staffed now, you need to get over there. This is so not necessary. -Good, 'cause it won't take long. ICD discharge. I gotta grab the programmer, we're going to interrogate. Who was that? -The Big Kahuna. Chief of pediatric cardiology at Rush. Runs the camp. -Norma sinus, 84. Send lytes and a troponine. Hey, I'm Vera. Felix. What happened? -I have a defibrillator in my chest. Cool. -I think it shocked me by accident. Did it hurt? -A little. Like a horse kicked me. Hey Roho, Xena, can you call upstairs and tell them I'm alright? Roho, Xena? OK, so Vera says she's fine and she'll be back soon. OK, so we have to get from this side to the other side, without going through the same hole twice. Can I go first? Sure, go ahead. Wow, it's like Cirque du Soleil. Hey. -What? If everyone goes through the web, it kind of builds a team. That's stupid. -He doesn't have to do it. It would mean a lot to the kids if you'd join in. Wouldn't mean a lot to me. Why don't you do it for them? You really want me to go to the other side? Yeah. I did it. Look at me, I'm on the other side. Bingo. That'll tell you if it was V-tach? This will tell us everything. Excuse me. Felix is getting a bed at 7. How's your headache? It gets better. -How'd you get a name like Felix? After Felix Bloch. He's a physicist who won the Nobel Prize for nuclear magnetic resonance. Like in MRI scans. Yeah, his work lead to that. He was a giant, studied with Heisenberg and Shrdigger. Schrdigger had a cat. You know about that? -He didn't actually have a cat. It was like a thought experiment. The cat in the box was either alive or dead, depending on a random event. OK, I'm completely confused. -That makes two of us. Great news, it was just sinus tach. When you ran, your pulse rate went up to 180. That means she can go back? -She got shocked 6 times. . I think we've gotta keep you in the hospital. -I'm not getting admitted. Not during camp. -Honey, this thing zapped you at a heart rate of 160. So if you exerct yourself at all. -Why don't you set it higher? That's a good idea. We can do that. OK. OK, no shocks until 200. But only till after the dance, alright? Alright. Two weeks later and she can just walk in like nothing happened? That's what she did. -There must be a time limit. There isn't. -She's in high school. We're in a much better position to care for that baby. That's not the issue. -We have resources, we. . we have a home. We have maturity. Doesn't that count for something? She's his mother, that counts more than anything. It's not a done deal, the caseworker still has to talk to the mom and grandmother. It'll take a week for the determination. You let me know how that goes. -Russ, come on. You know the system. Maybe there's something else to do. We keep working, we keep praying, we keep going. I've been doing that for 7 years. There you go. They really need me, I have to cancel tonight. You could come down here? You would? Really? Do you want a sleeping bag? -It was nice to meet you. Maybe I'll see you around. -Yeah. You can take Felix to the dance. It's only for kids who've had open-heart surgery. He has an open skull fracture. That's close. -Also a catheter in his spinal column. He has to stay on bed rest. Let me see what I can do. So, how's it going in here? OK. -Dr. Gates, take a seat. I get frustrated because I like to get to the bottom of things. I need to know the truth. Did you know Felix' parents have to move every year too? Academic careers, new universities. Doesn't give you much chance to put down roots. Make friends. When you feel like an outsider, you can fall in with dangerous kids. Like drugs. -My urine test was negative. You have Tardieu spots. Little red dots near your eyes. Now, maybe you don't remember, but it can happen when someone tries to choke you. Felix? Did someone grab you around the neck? Not the neck. The chest. It's called suffocation roulette. You hold your breath and someone squeezes you from behind. First one to pass out loses. Kids die from playing that game. Or brain damage. -You're too smart to be doing that. They're my friends. Dr. Banfield, we need you in trauma 2 right away. My pregnant DVT lady has sudden onset chest pain. She's on heparin? -For the past hour. Pressure? -110 over 65, already did an EKG. Tell me about your pain. -It hurts when I take a breath. Could the blood clot have gone to her lungs? Yes, there's a new right access of deviation and S1Q3 But she's on Heparin. -It's not a perfect drug. What do we do now? -We could try TPA. It's a powerful blood clot medicine, if it works you're back to normal. There's only a 1% risk of death. What about the baby? There are no good studies. TPA definitely carries a risk of miscarriage or fetal death. How big of a risk? -10%, maybe more. What about a venacava filter? If we put a filter in your main vein here, We could prevent future clots from travelling to your lung. But it takes time. -We don't want to hurt the baby. What would you do? I don't care. I don't care if we have to stay in here all day. Me neither. They keep bugging me to play their stupid games. They don't get it, they don't understand. We could flush some tennis balls down the toilet, that would back them up for days. Or, I know where there's some spray paint, we could tag 'camp sucks' all over the walls of the gym. Or we can pull some fire-alarms, make them evacuate all the patients. Or we can just sit here and do nothing. You think I'm being a jerk? No, I think that you're not letting yourself have a good time. It's not a good time. Because Sean's not here. Sean? I met him in September, we were in for heart catheters. We both had trunchus arteriosis. You know what that is? -Yeah. Ever since we were babies, we've had the same operations. He had never been to camp. I kept telling him how great it was, made plans, talked every day. He thought he could win the Kahuna's fart contest. We were going to have so much fun. He had to go to surgery last week, for a conduit replacement. Died on the table. Logan, I'm sorry. Hello? Yeah, I know, I'll be there as soon as I can. Not a good week all around. What? A good friend of mine is in the ICU. I tried really hard to get her a heart transplant, but. . now she's back, in rejection. It's pretty bad. What're you doing here? I stopped by but she's in a coma. I've been intubated like ten times. When I'm deeply sedated, I can hear everything. I can even tell who's in the room. She'll know if you're there. Trached a month ago for myasthenia gravis, bleeding this morning, opened up in triage. Tracheo-innomina fistula for pression necrosis. Four units of O-neg. -Have surgery hold an OR. It's pouring out faster than we can transfuse. Enflate a trach cuff, I can tamponade the bleeding. You want the rapid infuser? -Absolutely. This isn't helping, any more air and I'll burst the cuff. Give me a number 4 Shiley. That's a pediatric size. -Wait and see. Hemocue's only 8. 2. OK, put your finger in the trach hole and compress against the posterior sternum. Like this? -Well done, now go to the OR. Thank you. We took her to radiology for the filter, she crashed before they started. PA 70 palp, tachy at 120. -We need to intubate her. What's going on? -It's likely to be another blood clot. I think you need to think about TPA. No, we don't want it, we don't want to hurt the baby. Things have changed since then. -No, honey, . . Honey, talk to me, I need your help here. What are you doing? Wait, wait, wait, what're you doing? Baby looks great. Placenta's perfect. No sign of bleeding. The clot in your lung has completely dissolved. I thought I was going to lose both of you. Well, we like it when things work out. Dr. Banfield. You gave TPA without consent. Yes, I did. -Well What if there had been a bad outcome? She's young and healthy and was about to die. Do I need consent to shock a heart if she has cardiac arrest? I guess we got lucky. You saved that lady? Yep, and her baby too. Uh, I'll get these to the lab. You're still here? The guy with the bleeding neck. . He's OK after sugery. Is there some place we can talk? In here. What's on your mind? I've been thinking about it and. . I want him to be proud of me. Yes. To do that, I have to make something of myself. And be someone who did something important. Like you. Like me? Make a difference, you know. That's a good goal. I don't know if I could do that if I quit school right now. Having a kid is going to be really hard. That's true. The nurses told me you were my baby's custodian. Does that mean you wanted to adopt him? My husband and I were thinking about it. I'm just scared I'll never see him again. That doesn't have to happen. You can watch him grow up. Get to know him, be a part of his life, it's called an open adoption. How do we do that? If we all agree, we can work it out. What is taking so long? Give us two minutes. -OK, I'm timing you. Tony, we're on next and we didn't even do a soundcheck. You can start without us. -Go on, I'll wait. Archie! Hey, I'm so glad you're here. His name is Roho. Who are you? -This is my friend Claudia. Do you have a scar? -A big one. From here to here. What do you think? Beautiful! -Looking good there, Felix. Good to be the king. -Alright, let's go. Hello, is this thing on? Alright, hello Chicago! Prepare to be blown away! I have one question. How're you feeling out there? I said, how you feeling? Hey Roho, how you feeling? Wow. #I feel good. Dr. Brenner. -Hey. What're we stopping here for? Checking on a patient. You people have some very unusual therapies. Seems quite effective. #I feel nice, like sugar and spice,. . -Ssshh Everybody's sleeping! Room number 209. -Can I stay for a while? We'll be quiet. -You need to get back to camp. And visiting hours were over three hours ago. But you can say good night. Good night! Good luck, Felix. Alright, hey, give them some privacy. Quite a day today, huh? Yeah. Oh, thanks for coming out to dinner with my mom. You're welcome. -Took the heat off of me, for some reason, she loves you. Want to go to her colonoscopy with me next week Excuse me, privacy? Hey! Back to your tent! Boys stay on the boys' side, got that? Let me know if you hear anything out there, alright? -Yes, sir! Thirsty? -No. You hungry? -Ugh, I had too many smores. Not quite as good as Charlie Trotters would've been. This was way more fun! Really? -Definitely! You are something else. You went from a night on the town, to a night in a pub tent, without a hitch. -Life's too short to whine. It is. You spend a day with these kids. . you realize This is totally random but sometimes I imagine a night, you know, in the future. A night where I would take you out, spend money, make a big deal about it, and it would end like this. When I ask you to marry me. What do you think? I think I'd say yes. Dr. Morris. I can't fall asleep. She's never been to a sleepover before. She's homesick. Well, what do you need Em? My dad tells me a bedtime story every night. Not a problem, alright! OK, let me see. Alright, once upon a time. . there was a little bloodcell. who couldn't find his way to the lungs. He was blue all the time. But he wished that he was red. He needs a Rastelli operation. What? No, no, no, a Blalock-Taussig. He has tetrology. -Hey, who's telling the story anyway huh? Three ounces down the hatch. How about a nice burp for Russell? That was a good one. He's a quick one. There we go. High five! Yes, now tomorrow we'll work on that fistbump, OK?