Émission TV: ER - 15x22
What've we got coming in?
The 54's got an unconscious kid.
Sorry, I should've asked if you wanted coffee.
That's alright.
I've had a couple of 100 cups already, feel like I have ants crawling all over me.
Probably just flees from the homeless guy with the dogs.
I saw a rat over there by the dumpsters.
I thought it was a cat at first.
Call Jerry.
I'll have maintenance bring down a couple of extra traps.
More like a couple of shotguns.
That thing was the size of a bever.
Here we go, girls.
Alright.
What've we got?
15-yr-old female found passed out by the toilettes after playing a drinking game at a slumber party.
Non-responsive, sats 93 over 2 litres.
PA 72 palp.
Couldn't get a line.
Her name's Stacey.
Stacey, can you hear me?
Stacey?!
How long has she been down?
Not sure.
A bunch of kids from the party were in the car behind us.
Jerry, what's open?
They're both open, take your pick.
Alright, SATS, DTOH level, tox screen, D- stick and lytes.
Nonrebreather, she's hypoxic.
Ready for transfer.
1, 2, 3.
Firemen are bringing in an altered old lady, found her out in the rain.
How is escalator lady?
Ortho took her up to screw a hip.
Explosive diarrea guy?
Loperamide must be working, He's sleeping.
Belly pain back from CT?
Nope.
I hate working nights.
Really?
I like it.
Nights?
Lets me babysit my grandkids What've you got?
Found her out in the rain.
Looks like she slipped and fell.
We called for a paramedic unit, but she passed out.
We're only a couple blocks away, figured it'd be quicker to bring her in ourselves.
She's cold.
Warm saline, humidified O2 and the Bair Hugger.
Jerry?
Trauma 2.
Open your eyes, mam.
Polse is weak and thready.
Looks like she broke her wrist when she fell.
She hit her head too.
She'll need a CT.
Pupils equal and reactive.
14 litres by mask.
CBC, chem pannel, UA, EKG and chest X-ray.
Core temp is 32�C.
Hugger's ready.
What's your name, dear?
We got a name?
ID?
Nothing but a nightgown.
Excuse me.
Blood alcohol level is back: 4.20 Alright, no gag reflex, she needs a tube Systolic's only 66.
DA of 4.20.
What is that, like a gallon of tequila?
A bunch of the girl's friends are out there.
They wanna come back and see if she's OK.
Does she look like she's OK, Jerry?
Another 250 in the IO.
Where's my access?
Veins blows out every time.
Mac 3 and 7-0.
Damnit.
Lost it with the flush.
Gloves and a Cordis.
The tube won't pass.
Get a cric tray.
Respiration is shallow.
It's still raining?
I was thinking about renting a boat and rowing to work.
How are the inmates?
Cranky.
What's with the iCarly crew out in the waiting room?
They came in with a kid with alcohol poisoning.
Gates has been flogging it for hours.
OK, kids, looks like it's just us.
Grab a coffee.
We'll work the board in 15 minutes.
PV in 3 needs an H&V, honey.
Lucky you.
What's a PV?
Projectile vomiting.
The guy's like a champion.
Puke went 8 feet.
We thought he might've broken a window.
Isn't this a nurse's job?
And why God created med students.
Did you finish your overnight lab paperwork or leave your usual mess for me to clean up?
Love you too, Frank.
So long, sucker.
Ouch!
What?
Didn't see you put anything in the donut jar.
No pay, no eat.
I swear, 5 bucks last week.
Morris, your old lady standing in the rain is back from CT.
Good night.
I think I even put a 10 in there the week before that.
Sure you did.
Next time, write your name on it, just so I'll know.
You don't trust me?
You got it, champ.
Money with your name on it before you leave today, Morr-ass!
Got a 3-yr-old with otitis media.
The mom pour hot garlic oil into the kid's ear.
Looks like he has second degree burns.
What the hell was that?
PV patient.
Thought he'd be out of ammo by now.
The otitis kid?
Find Brenner, I'm off.
I gotta finish up with a few patients first.
CT negative for fracture or bleed.
No anemia, EKG's normal.
Chemistry's are OK.
It's cold.
She's awake?
Started coming around in the CT.
Hello there.
What's your name?
Beverly.
What's your last name?
My name's Beverly Temp's up to 36�C (97�F).
That means you don't need this big blanket anymore.
Do you remember what happened to you, Beverly?
No.
You were out in the rain.
You got cold.
We think you slipped and broke your wrist.
My wrist hurts.
Tubular stocknet Oh, your hands are so warm.
And soft and strong...
Just like my Bobby's Alright, what do you see here?
She must've aspirated when she was unconscious in the bathroom.
And?
That her brain is oxygen deprived and she still may be altered when she sobers up.
2 grams of Ceftriaxone with 500 Clinda.
And repeat an ETOH, please.
So what do we do now?
Now we wait.
You mind if I take off?
My shift ended like 20 minutes ago, and I'm beat.
Yeah, go.
Go.
Her friends are still out front, asking if they can come back.
Yeah, send 'em in.
You think that's a good idea?
Letting them see her like this?
They helped her get here, they should see the consequences.
So, it's OK with you if I go?
Yeah, go.
Get some rest.
Go ahead.
Hey, did I wake you?
No, I'm uhm...
just getting Alex off to school.
Happy birthday.
I got the date right, didn't I?
Yep.
You want me to sing for you?
No, God no.
Mom, let's go, I don't wanna be late.
Are you going to do anything special?
Like what?
I don't know.
Get a tattoo, go skydiving.
Hang out with your friends.
Come on!
I gotta go.
Happy birthday.
Thank you.
Hi, I'm Dr.
Gates.
Dick and Heather White.
You're Stacey's parents?
No, Stacey stayed at our house last night.
Her parents were in Springfield for a wedding.
So you've contacted them?
Yes, they're already coming.
They should be here soon.
Is she going to be OK?
She's in a coma and she may have brain damage.
We won't know if she's OK until she wakes up.
Why does she need the tube?
To give her some oxygen and protect her lungs.
Keeps her from choking to death on her own saliva.
What were you guys drinking?
Vodka.
Vodka and Kool-Aid.
We were playing 'I never'.
Stacey won.
Where did you get the vodka?
Kids drink.
We all know that.
We just wanted them to be doing it somewhere safe.
So you supplied the alcohol?
I'd rather they drink at home than out where they could be driving.
Can I give her something?
Come on, girls.
Let's go.
Call the cops.
Get 'em down here.
9- month-old with bronchiolitis on continuous nebs, waiting on the PICU.
In 2, we have testicular pain after a pummel horse incident.
That sport should be outlawed.
28-year-old with leukemia cutis, oncology is going to see him.
Then we have a DKA.
The A is gone, still the K, so he needs to come in.
What's that smell?
The guy's a guyser Who?
The PV guy.
It's like dodging artillery in there.
I don't think the wipes are going to do it.
Once we're done here, grab some scrubs and ditch the clothes.
Don't ditch, burn.
The guy in 3 torched his fingers making cr�me br�l�e Displaced fib going to ortho, and hallucinating trombone player needs a tox screen and a psych consult And with that, my job here is done.
OK, Sanchez, testicular pain trombone player and displaced fib.
Julia, lukemia cutis, cr�me br�l�e, and the DKA, Chaz...
we have a group of prospective medical students coming in her today for their interviews, and Dr.
Anspaugh asked me to show them around, but as I don't really want to and you're the logo on this particular totem pole, you're elected.
Med students?
Prospective med students.
Right now, they're just a bunch of over-educated, fiercely ambitious seniors, trying to claw their way over each other trying to get into a prestigious programme.
So show them a good time.
Sssh.
I'm gonna put it back!
Money's in the jar, Frank.
I'm out the door.
Beverly's daughter showed up.
Who?
Old lady with the broken wrist.
Hello, I'm Dr Morris.
Temp's 37.2�C (99F).
All her labs check out.
She scared us half to death.
Mom, you scared us half to death!
I went in to make sure she was getting up and her bed was empty.
I looked around the house, around the yard.
I ran up and down the street in the rain.
Tom got the car.
He went all around the neighborhood.
I went over to the church, to Emma's!
I called the police and about 20 hospitals.
I was out of my mind with worry.
Out of my mind!
She's gonna be fine...
Sometimes she wanders out of the house, into the yard, but she never leaves the yard.
You can't leave the yard, mom!
She broke her wrist.
We've put a ca...
You're gonna give me a stroke!
You can get that from stress, can't you, Doctor?
A stroke?
Well, yes, stress can cause...
What am I supposed to do about this?
Should I sew a lo-jack in your gown so I can find you when you wander off?
We're just glad she's safe now.
OK, so you'll have to bring her back in a couple of day for a cast check.
Come back sooner if there's any pain, redness or swelling.
Take care, Beverly.
Dr Morris.
No, no, no.
Get away from me or I'll hit you.
The kid...
I mean it..
right in the face!
Freedom!
What was that all about?
Hell if I know.
Police are here on your alcohol poisoning girl.
You're kidding.
Wait a minute.
You called the cops?
Damn right I called the cops.
Easy.
This isn't our fault.
Whose fault is it?
All the parents do it.
She had a blood alcohol level of 4.20, that's not like giving a kid a sip of wine at dinner.
Back up.
So you're going to have me arrested now?
Damn right they're going to arrest you.
That kid almost died, she could have permanent brain damage.
4.20?
What the hell were you doing when those kids were in there trying to drink themselves to death?
Watching tv?
Were you in the kitchen mixing up another batch of vodka and Kool Aid?
Hey!
No, settle down.
Stay down!
Ma'm, please!
Stay down!
I want to call my lawyer.
Better have a good one.
Hey, Doc, you know what?
Shut the hell up.
Wow, shouldn't we be building an arc?
The news said we could get as much as five inches today.
I'm glad I'm not an EMT anymore on a day like this.
You get wet early, you stay wet the whole shift.
You never get dry.
Here we go.
37-yr-old construction worker, Took a 15 feet fall from the scaffolding.
Abdominal pain, pain in the thigh.
No pulse in the right foot.
Bag his femoral artery.
Let's get him in.
PA 90 palp with 3 litres of saline over 45 minutes.
Kind of a long transport time.
We had to wait until firemen sawed off the bar.
His name is Dickie DeAngelo.
That looks nasty.
Look at this idiot.
Who drives into that?
What, did he think it was just a puddle?
Dr Gates, that alcohol poisoning girl's parents are here.
Hey Doc, do you have time for a kid with a belly ache?
The grandma only speaks Spanish.
My Spanish is pretty shaky.
I've been taking a course, but..
It's gotta be better than mine.
All I got is: "�Hola.
Que paso?"
4- yr-old boy.
All I can think of is something to do with his stomach.
Administrative, social worker and councelling offices are all on the second floor along with the wellness classrooms and the therapy rooms.
Oh my god.
This is beautiful.
36 exam rooms, radiology suite, two dental suites, shower facilities for the homeless, OB-GYN, optomotry, pharmacy, diagnostics, rapid HIV testing and support, reproductive health.
I can't believe you're actually able to pull this off.
You had doubts?
No, I was sure you would fail.
Tell me, will you be able to get funding for the county to staff this?
No, I'll be fundraising for the rest of my life.
but we have enough to open the doors.
Try to keep us going for the first year, while I try to build us up some endowment.
Carter, I knew you were rich, but I didn't know you were this rich.
The ill-begotten gains of my Carter forefathers put to good use.
Redemption?
Maybe so.
Your grandma would be so proud.
Grandfather would be rolling over in his grave.
He thought the Carter money was going to last longer than the pyramids.
You spent it all?
No, but most of it.
You've done a great thing here, John.
A truly great thing.
Paramedics are pulling in with a 47-yr-old male with chest pain.
and I've got a 60-yr-old man short of breath.
Julia, take the shortness of breath.
Chaz, you're with me for the rule-out MI.
He looked like crap, so I brought him right back.
Sats were 72 %, so I went ahead and hooked him up with some oxygen.
Hello, I'm Dr Wise.
And you are..
Mr.
Gandhi?
My mom was a Mahatma fan.
And how long have you been sick?
About...
20 years.
More recently?
The trouble breathing?
A couple of weeks.
Do you have lung disease?
Not that I know of.
Heart problems?
No.
Any fever?
Just can't breathe.
Portable chest, 100% nonrebreather, EKG, first day labs IV?
Start a saline lock.
Wear gloves.
What?
I have AIDS.
Here it is.
Then..
he swallowed it.
I won't get it back.
God won't be happy that you swallowed my necklace.
How can we get it back, Dr.?
Um, we can't get it back.
It has to stay in his stomach forever?
No, no.
We have to wait and hope that Jesus will uhm..
eleminate.
Eleminate?
Yes, you know, through his..
His poo?
Yes, through his poo.
Should we intubate?
Not yet.
Tachypnic, still hypoxic on 100%?
What do you see?
Bilateral efusions.
That explains the shortness of breath.
Hmm, and that gives us something to fix.
Two thoracenthesis trays, please.
We'll still have to tube him if he has underlying pneumonia.
One step at a time.
What are you two talking about?
You have a lot of fluid outside your lungs.
It's making it hard for you to breathe.
What can you do for that?
We can drain the fluid, which will make you feel a lot better.
So let's put your mask back on and lean forward.
Let's dangle your legs.
That's alright.
Now we're going to clean the skin with a bit of Betadine.
You're going to feel a sting while we numb the skin, Mr.
Gandhi.
Gandhi?
Yeah, his mother was an admirer.
Now you're going to feel some pressure while the needle passes through the ribs.
Fluid looks a little bloody.
OK, let's send it up for a cell count, culture, Grams and BAFE.
You'll be coughing as your lungs expand, but it's a good thing, that means it's working.
No change?
We're going to have to move her, we need the trauma room for a MVC.
Come on guys.
Why don't you go home.
I'll call you if anything changes.
Frank, I'm going home, call me if anything changes with the Taylor girl.
Who?
Alcohol poisoning.
Oh, another one of those kids showed up asking about her.
She's the one with braids out in waiting.
Hi, I'm Dr Gates.
Are you here to see Stacey Taylor?
OK, well, she's in a coma, and they don't know when or if she'll regain consciousness.
Were you at the party last night?
No.
I heard what happened.
Are you here by yourself?
You know, her friends and uhm..
her parents are on the second floor.
Maybe you wanna go up there, you'd be more comfortable.
I should've done something.
Well, you weren't there, right?
Stacey was texting me.
My parents wouldn't let me go.
I was really angry I wasn't there.
So she was texting me all night, to tell me about the party.
She told me she was sick..
really sick and throwing up.
And I..
thought it was funny.
I should've called somebody..
I could've...
Maybe I could've...
The ER is the nerve center where it all begins.
Between the ER and the urgent care, we see over 200000 patients a year.
As med students, this will be your first rotation.
4 years to see if you've got what it takes to be on the frontline of urban medecine, or if you're a little bit more suited for dermatology, plastics,...
something a little bit more..
more safe, that you could practice out in the suburbs.
Triage is our first stop.
We rely on our talented nursing staff to determine who's going to be first and who's going to have to wait.
And wait and wait.
These highly trained professionals can tell the difference between a hot MI and a common indigestion just by looking at a guy.
After triage, the patient is brought back.
The chart is racked.
You pick up the next in line, no matter what.
When you get caught swapping fecal incontinence for knee pain, you'll never hear the end of it.
Glad you learned your lesson.
Our curtain areas are for our subacute patients.
Over there is the break room where we got bad coffee and stale bagels.
Trust me, you don't want to be going over there.
Uhm, excuse me!
Keep up, OK?
So here's the deal about being a med student.
Some docs like to teach, but most just see us as a pain in the ass.
So they won't be issuing any formal invitations to the cool stuff.
You've got to keep your eye open and go after the action.
It's not going to come to you.
Come on.
Another epi and shock him again.
This is Dr.
Brenner, one of our fine ER attendings.
Dr Brenner, this is the tour of the prospective med students that you asked me to...
Chaz, get them the hell out of here!
OK, so who wants to see the suture rooms?
Clear!
Anybody seen Brenner?
Down in trauma with a chest pain.
You okay?
Just got results back from a patient.
Bad news?
You want company?
No, I should do it.
No time like the present.
Right.
Post-op film came back.
Your lungs have re-expanded.
No pneumonia.
Are you feeling better?
I can breathe again.
You said you've been sick for a number of years.
Well, I got the AIDS diagnosis in 1987.
I started AZT as soon as it was out.
It's great that you've been able to fight it off this long.
Come on, Doctor, no holding back.
I can take it.
Believe me.
Your test results came back.
There were atypical lymphocytes.
Large immunoblastic cells.
What does that mean?
It means that you have cancer.
It's a little nasty out there today.
If it keeps up, we're going to start handing out life jackets.
How are you?
I'm on the mend.
Everything working down there?
No complaints for the plumbing.
Wish I could say the same.
I was up 6-7 times last night.
Kinda quiet today, huh?
Yeah, I'm thinking of pulling out a crossword puzzle just to fill the time.
I just had lunch with Susan Lewis and Kerry Weaver.
Really?
How is the old dragon lady?
She's good.
Susan actually looks fantastic.
What're they doing in town?
Tonight's the opening of the Carter Center.
They came in for it.
Open bar, free food on fancy little crackers.
All that.
Housekeeping needs to clean up Trauma 2, it's still a mess after that shotgun accident kid.
They're down in radiology trying to mop up a roofling.
What's up?
A pregnant woman coming in NVA.
Here they are.
Hey, store that for me, would you?
Sure.
36-yr-old female, nine months pregnant with twins.
Broke her water at home.
Contraction!
Traffic collision on the way to the hospital.
Hit by a CPA bus.
Is this your first pregnancy?
Fourth!
Shock on passenger, abdominal pain and contusions.
Tachy at 120, BP's normal.
Get me off of this!
As soon as we assess you m'am.
Let's get her inside.
Go!
On my count.
1, 2, 3.
My husband should be here any minute.
He was on his way to meet me at Mount Sinai.
Check the perineum, I'll do a primary survey.
I've gotta push!
Not yet.
I've got to!
Sterile gloves and an OB kit.
What do we need, Julia?
CBC, coagulation, type, RH.
And?
Fetal monitor.
Yes, fetal monitor.
Would you care to pitch in, Dr.
Carter?
Oh, I thought you'd never ask.
Don't move your neck until we've made sure that it's not broken.
I'm fine!
I guess the C-spine is clear.
She's crowning.
Alright, mom, you can push now.
The head is out.
OK, get ready.
Twins come quickly.
Delivering the shoulders.
It's a girl.
Ombilical clamp.
Is she OK?
She's got a great set of lungs.
The baby looks great.
Apgar 9, -1 for color.
Congratulations, mom, one down, one to go.
Hey baby, wanna meet your mother?
Hi, you're beautiful!
We paged OB down for the twins, has anybody seen 'em?
Coburn's out on an emergency C-section, said she'd send out a resident as soon as she could free one up.
The husband just showed.
He's the anxious guy.
Mr.
Salamunovich?
Yes, Chris.
Is Lisa OK?
The first baby's out and healthy and we're waiting on the second.
Can I help you?
You don't remember me.
Should I?
It's amazing how little has changed around here.
My dad used to be on staff.
Mark Greene.
I'm his daughter, Rachel.
We have three boys under the age of 10 at home.
Three?
Yep, it's a madhouse.
But I wanted a girl, so before Chris went in to get snipped, we decided to try one more time.
We ended up with twins.
What are the chances of that huh?
Hey little Camille.
We're still going with Camille for the first one, right?
Yeah, fine by me.
It's my grandmother's name.
Honey, keep an eye on the clock.
Pre-school pickup's in an hour.
I'll just have my mom go get them.
No, no, you should...
Another contraction.
OK, big push this time.
Big push.
Fetal heart rate is down.
What does that mean?
It could be a sign of distress.
OK, mom, let's get this baby out.
I can see the head.
Meconium.
Give me suction now, please What's meconium?
It's in the baby's intestine prior to birth, it could pass on through the amniotic fluid and get into their lungs during birth.
How bad is that?
Clamp.
And cut.
If it gets into the baby's lungs, then she has to be intubated.
It has to be sucked out.
It's another girl, honey.
She's not crying.
That's intentional.
We don't want her to breathe in the mec.
Laryngoscope and suction.
Mom's heart rate's up to 140.
Some bleeding here.
2 liters of saline, wide open.
A lot of bleeding.
Exercise traction on the chord.
Let's get two units from the blood bank.
Meconium in the epiglottis.
Cyanotic.
Weak tonicity.
Is she OK?
Systolic's down to 90.
Prepare the rapid infuser.
Where the hell is OB?
Is that the placenta?
That looks like uterine inversion Get a Cordis.
Get me some sterile gloves.
The uterus has turned itself inside out and pushed itself through the cervix.
I need to push it back in.
It won't go!
IV Nitro, right now!
Set up for an intubation on mom.
Two units of FFP.
Tell the blood bank to send 4 units.
Pressure's only 65/45.
Second unit is in.
Get two more.
No, it won't go.
4 units of mag.
What's happening?
If I can't get to your wife's uterus, we're going to have to take her up to the OR put her under anasthesia and see if we can fix it there.
Heart rate's up to 140.
You try one more time.
Really push hard.
Really push.
Come on, get in there!
Really push!
It's in.
It's in?
Great.
Hold off on the nitro.
20 of PIT and a liter wide open.
Keep pressure on the cervix with your fingers.
No, no, push in, all the way up to your fore-arm.
With your other hand I want you to massage the uterus at the ombilicus.
OB's here.
Heard you had twins.
Yeah, we just reduced an inverted uterus, she's still bleeding with a creta.
Call the OR, tell Coburn I'm bringing her up.
What're you going to do?
You're the dad?
We need to stop the bleeding or else we may need to give her a hysterectomy.
What about the twins?
First one's good.
Second aspirated some mec.
I'll page pediatrics.
Should I let go?
Don't let go until they tell you to in the OR.
Should I go with Lisa or should I stay?
She'll be under general anasthesia for a while but we'll give you updates from the operating room.
Your wife mentioned something about having to pick up kids at school.
If you need to make a call, you can use that phone on the wall there.
What's going on?
Why did you come to pick me up today?
I couldn't sleep.
Get in.
But I was gonna go to Madison's study for the trig test.
I'll give you a ride.
I have to meet Alex to finish the car.
So what's up...
Tony?
Have you ever played 'I never'?
It's a drinking game.
I haven't been drinking, OK? "
I've never"?
I've heard of it.
Some kids at school play it at parties and stuff.
How many drinks do you think it'd take to be drunk enough to die?
What?
How many?
What'd you weigh?
90 pounds?
How many drinks would you have to down before the alcohol would kill you.
What do you think?
I don't know.
5?
10?
20?
50?
I don't know, 20?
Try 6.
Six?
Yeah, that could kill you.
Give me your phone.
Give me your...
I'll give it back to you, just give it..
Do me a favor.
Next time you're at a party and you're drinking, and you've had too much to drink, and you're throwing up or your friends are, or someone's texting you, saying they're throwing up..
Hit that. "
Help" Who does it call?
Me.
And I'll come, no questions asked.
I'll help you, I'll help your friends.
I'll make sure you're OK.
No questions asked?
When did it stop raining?
How's the second twin doing?
Intubated, waiting for pediatrics.
Did the mom get to the OR OK?
Yeah.
I'm going across the street for coffee, anybody want a latte?
Sure.
Double, non-fat.
Mocha frap, extra foam.
Excuse me, I'm not sure I'm in the right place.
My daughter-in-law is here somewhere, having twins?
Is her name Lisa?
Come with me.
Go right in here, just check in with that nurse at the desk.
Julia, there's a call for you; oncology.
Hey, you guys know a doctor who used to work here named Greene?
His daughter was on my tour today, she's applying to med school.
Rachel?
Yeah, I think so.
You're kidding me!
Is she still around?
I dropped the tour off at the dean's office.
They're doing their interviews this afternoon.
Look at you.
You're all grown up.
How old are you?
22.
Oh my god, I remember you when you were...
Now you're going to medical school, huh?
Took your MCATS and everything?
Where are you doing your undergraduate?
Duke.
Great.
Yeah, Elizabeth's on faculty there, so I get a good deal on tuition.
Elizabeth Corday?
Yeah, actually she flew up with me.
Elizabeth is in Chicago?
What're you both doing later tonight?
I don't know, I think we're seeing some old friends.
No, no, you have to come to this thing that we're doing.
Rachel Greene!
This is my number.
Give this to Elizabeth, have her call me.
It's good to see you.
Good to see you, good luck in there.
Pathology says it's primary effusion lymphoma.
Who's this?
My guy who couldn't breathe What's his prognosis?
Medium survival is 2 months.
And his options?
Chemo and radiation could give him another couple of months.
You told him he has cancer?
Yeah, couple of hours ago.
Brave.
Or maybe just relieved.
Relieved?
Dr Brenner?
To finally know how and when after all these years.
Back and forth, keep it smooth.
Excellent.
Good.
That'll do it.
Yeah, man, that looks good.
I think you were right about the color.
I don't know.
The cobalt blue would've been cool too.
No.
The red is more your mother.
Yeah, all fire.
It's better than cold and distant.
If you say so.
I know so.
She's going to love this.
Definitely Sorry I've been gone so long, something came up.
Oh, that's OK.
Gerry came by.
Gerry Gugliemotto, Dr Wise.
She's very nice.
Great to meet you.
Nice to meet you.
Gerry brought me gardenias.
I just love gardenias, don't you?
The smell.
The rest of your labs came back.
Everything looks clear.
Except for the cancer.
But it means your body could tolerate chemotherapy.
No.
No thanks.
It could buy you a few more months.
I've already had an extra 20 years, Doc.
I should've died with all my friends, in the eighties.
You're still here.
Tommy and Bill.
Jeff and David.
Remember Michael Thomas?
Of course I do.
Little Bobby?
So many people I've loved.
I've been trying to live for them, you know?
Keep their memories alive.
But I've had my time.
No regrets.
I went skydiving last year in Hawa�.
It was the most remarkable thing I was floating...
free.
I couldn't feel my body.
I'm afraid of heights, but I wasn't, up there.
I guess I hope that's kind of what death is like, Doc.
Floating...
free in the air...
above everything.
Just...
watching the world drift by.
Is there anything I can do for you?
Yeah, there is.
I don't want it to hurt.
We can help with that.
66-yr-old woman, ruling in for MI.
She's going to the cath lab any second.
Hoola-girl needs an X-ray of her wrist.
We got an SPO who's NPO and not happy about it.
Sickler with a fever.
Dislodged G-tube on an old gal that came in from Lakeshore, and a 3-week-old with lethargy and cardiomegaly, admitted for echo.
And as you can see, the hallucinating trombone guy's still here.
Tox was negative, but we're trying to find a psych bed somewhere in Chicago.
My alcohol poisoning girl still here?
The family didn't want here admitted here, so they're transferring her to Mercy, but Mercy hasn't picked her up yet.
Hey Jerry, look at this inbox.
It's empty.
All of my dayshift paperwork is completed.
Look.
It's a thing of beauty, it's a clerical Mona Lisa.
I just wanted you to see what it looks like so you can try...
try to replicate that for when I come in tomorrow.
Tough day?
About the same as any other.
Good night, y'all.
Good night.
Watch out for the guy in 3.
He's a grabber.
Thanks.
You look nice.
I got a thing to go to.
You saw a med school applicant today: Rachel Greene.
She's pretty great.
She a student of yours?
No, she's Mark Greene's daughter.
So you have no first hand knowledge of her academic qualifications?
No.
But I've known her since she was a kid and Marc was a great doctor.
I'm sure the apple didn't fall too far from the tree.
She did well on the interview.
I can't say if she'll make the final list, but she made the first cut.
So he's a bit of boozer?
Stinks of bourbon by noon Doesn't it affect his work?
No, that's the irritating thing.
Drunk as a skunk, and he's still a wonderful surgeon.
Is that Neela?
Yeah.
Hey, how's the teaching going?
Got most of the R3's.
Very polite, they follow me around like duckling.
I'm sure they're in awe of the depth of your surgical brilliance.
Either that, or your exceptional beauty.
I think they may just be stupid.
Hey, is that Neela?
Hey, how's life on the bayou?
The bayou is like a 100 miles away, Morris.
Pediatrics finally showed up to extubate the mec kid.
Thanks.
I gotta go.
I'll speak to you later.
How's the mom?
Still in surgery, I think.
She's still in the OR?
As far as I know, yeah.
Do you mind if I tag along with you?
See you, Neela.
Bye.
Hey Joe, how're we doing?
Suctioned out the trach and the stomach.
No mec below the chords.
Satting at 100%.
Vigorous tone, good respiratory effort.
I think we can extubate.
Oxygen is ready.
Here we go.
Good air movement.
Can I hold her?
By all means.
How 'bout you go and grab the rest of the kids?
Oh, I gotta go.
Good work, Doctors.
Thanks, Joe.
Yeah.
What's the mom still doing in the OR?
She's probably already out.
Sometimes they forget to call.
Hey guys, do you want to meet your sisters?
Yeah.
Yeah.
Come on.
Where's my mom?
82-yr-old woman with a history of MS and pyelonephritis, on home IV care.
Now with altered mental status and resperatory distress.
BP 60 palp.
Gave 500 cc of saline to get her pressure up, but it's all going to her lungs.
She's been coughing and groaning terrible.
She's burning up.
Pulmonary edema.
Probably septic.
It's the second time we're in here.
We've been taken care of by Dr.
Gates.
Her parents around?
They've been here all day.
They must be around here somewhere.
Hey, Tony?
Old lady with MS just came in with sepsis.
Husband said you've been treating her.
You look tired.
Thanks Are you OK?
Yeah, this...
this 17-yr-old girl came in last night with alcohol poisoning, BA 4.20.
Still hasn't come around.
She was texting her friend all night, telling her she was throwing up.
Her friend thought it was cool.
Mr.
Manning.
Marjorie's not doing too well, huh?
I know a lot of us never actually thought that this day would come.
In fact...
I think I was one of them.
But here we are, in this beautiful facility finally ready to provide state-of-the-art out-patient services to the HIV/AIDS community, the homeless, families in need.
Medical care, dental care, daycare,..
counseling Services that have been sorely lacking at County for many years.
I...
I don't want to try your patience, by rambling on too long.
But I hope you'll bare with me for a moment while I talk about why we chose the name 'The Joshua Carter Center'.
My wife and I had a son, and we named him Joshua.
And he died.
Excuse me.
And it seems so senseless..
That we...
My wife and I, we've struggled to find some..
sort of meaning in it.
And in the aftermath of our small tragedy, we..
realised that we could make a difference in other people's lives, other people experiencing their own small tragedies.
And that made, somehow,...
the loss of Joshua barable.
Thank you so much for coming.
Bravo.
I didn't embarass myself?
I wouldn't go that far.
You came.
I didn't think you would.
Neither did I.
Sorry I was late, flight was delayed.
It was a beautiful speech.
Hey, John, I want you to mee Wendy Spencer from the Fort Foundation.
Right over here.
Your wife has low blood pressure from the sepsis but giving her IV fluids would only cause more damage to the lungs.
We discussed this when you wanted to take her home, Paul, that this would most likely happen.
I didn't realise.
Please, do something.
Marjorie has a DNR, she doesn't want us to intervene.
Oh, I've got her power of attorney here.
Here...
That means I can decide for her, right?
Your wife has a degenerative disease that left her debilitated.
without enough strength to fight off this infection.
Even with agressive treatment...
she would only live a week or two in the ICU on machines.
A ventilator, dialysis, IV pumps to keep her pressure up.
It's only going to prolong the pain and suffering.
I'm not ready to lose her.
It's time to talk about how to make her as comfortable as possible.
Excuse me, I'm here to check on a patient.
And you are?
Dr Wise from the ER.
I called but I got put on hold.
Yeah, we're swamped.
Couple of people called in sick.
Stomach flue.
We brought a woman up, inverted uterus, bleeding with an accreta.
Her name's Salamunovich.
Dr.
Zwerling just went out to find the family They're still downstairs.
They have a bun
The 54's got an unconscious kid.
Sorry, I should've asked if you wanted coffee.
That's alright.
I've had a couple of 100 cups already, feel like I have ants crawling all over me.
Probably just flees from the homeless guy with the dogs.
I saw a rat over there by the dumpsters.
I thought it was a cat at first.
Call Jerry.
I'll have maintenance bring down a couple of extra traps.
More like a couple of shotguns.
That thing was the size of a bever.
Here we go, girls.
Alright.
What've we got?
15-yr-old female found passed out by the toilettes after playing a drinking game at a slumber party.
Non-responsive, sats 93 over 2 litres.
PA 72 palp.
Couldn't get a line.
Her name's Stacey.
Stacey, can you hear me?
Stacey?!
How long has she been down?
Not sure.
A bunch of kids from the party were in the car behind us.
Jerry, what's open?
They're both open, take your pick.
Alright, SATS, DTOH level, tox screen, D- stick and lytes.
Nonrebreather, she's hypoxic.
Ready for transfer.
1, 2, 3.
Firemen are bringing in an altered old lady, found her out in the rain.
How is escalator lady?
Ortho took her up to screw a hip.
Explosive diarrea guy?
Loperamide must be working, He's sleeping.
Belly pain back from CT?
Nope.
I hate working nights.
Really?
I like it.
Nights?
Lets me babysit my grandkids What've you got?
Found her out in the rain.
Looks like she slipped and fell.
We called for a paramedic unit, but she passed out.
We're only a couple blocks away, figured it'd be quicker to bring her in ourselves.
She's cold.
Warm saline, humidified O2 and the Bair Hugger.
Jerry?
Trauma 2.
Open your eyes, mam.
Polse is weak and thready.
Looks like she broke her wrist when she fell.
She hit her head too.
She'll need a CT.
Pupils equal and reactive.
14 litres by mask.
CBC, chem pannel, UA, EKG and chest X-ray.
Core temp is 32�C.
Hugger's ready.
What's your name, dear?
We got a name?
ID?
Nothing but a nightgown.
Excuse me.
Blood alcohol level is back: 4.20 Alright, no gag reflex, she needs a tube Systolic's only 66.
DA of 4.20.
What is that, like a gallon of tequila?
A bunch of the girl's friends are out there.
They wanna come back and see if she's OK.
Does she look like she's OK, Jerry?
Another 250 in the IO.
Where's my access?
Veins blows out every time.
Mac 3 and 7-0.
Damnit.
Lost it with the flush.
Gloves and a Cordis.
The tube won't pass.
Get a cric tray.
Respiration is shallow.
It's still raining?
I was thinking about renting a boat and rowing to work.
How are the inmates?
Cranky.
What's with the iCarly crew out in the waiting room?
They came in with a kid with alcohol poisoning.
Gates has been flogging it for hours.
OK, kids, looks like it's just us.
Grab a coffee.
We'll work the board in 15 minutes.
PV in 3 needs an H&V, honey.
Lucky you.
What's a PV?
Projectile vomiting.
The guy's like a champion.
Puke went 8 feet.
We thought he might've broken a window.
Isn't this a nurse's job?
And why God created med students.
Did you finish your overnight lab paperwork or leave your usual mess for me to clean up?
Love you too, Frank.
So long, sucker.
Ouch!
What?
Didn't see you put anything in the donut jar.
No pay, no eat.
I swear, 5 bucks last week.
Morris, your old lady standing in the rain is back from CT.
Good night.
I think I even put a 10 in there the week before that.
Sure you did.
Next time, write your name on it, just so I'll know.
You don't trust me?
You got it, champ.
Money with your name on it before you leave today, Morr-ass!
Got a 3-yr-old with otitis media.
The mom pour hot garlic oil into the kid's ear.
Looks like he has second degree burns.
What the hell was that?
PV patient.
Thought he'd be out of ammo by now.
The otitis kid?
Find Brenner, I'm off.
I gotta finish up with a few patients first.
CT negative for fracture or bleed.
No anemia, EKG's normal.
Chemistry's are OK.
It's cold.
She's awake?
Started coming around in the CT.
Hello there.
What's your name?
Beverly.
What's your last name?
My name's Beverly Temp's up to 36�C (97�F).
That means you don't need this big blanket anymore.
Do you remember what happened to you, Beverly?
No.
You were out in the rain.
You got cold.
We think you slipped and broke your wrist.
My wrist hurts.
Tubular stocknet Oh, your hands are so warm.
And soft and strong...
Just like my Bobby's Alright, what do you see here?
She must've aspirated when she was unconscious in the bathroom.
And?
That her brain is oxygen deprived and she still may be altered when she sobers up.
2 grams of Ceftriaxone with 500 Clinda.
And repeat an ETOH, please.
So what do we do now?
Now we wait.
You mind if I take off?
My shift ended like 20 minutes ago, and I'm beat.
Yeah, go.
Go.
Her friends are still out front, asking if they can come back.
Yeah, send 'em in.
You think that's a good idea?
Letting them see her like this?
They helped her get here, they should see the consequences.
So, it's OK with you if I go?
Yeah, go.
Get some rest.
Go ahead.
Hey, did I wake you?
No, I'm uhm...
just getting Alex off to school.
Happy birthday.
I got the date right, didn't I?
Yep.
You want me to sing for you?
No, God no.
Mom, let's go, I don't wanna be late.
Are you going to do anything special?
Like what?
I don't know.
Get a tattoo, go skydiving.
Hang out with your friends.
Come on!
I gotta go.
Happy birthday.
Thank you.
Hi, I'm Dr.
Gates.
Dick and Heather White.
You're Stacey's parents?
No, Stacey stayed at our house last night.
Her parents were in Springfield for a wedding.
So you've contacted them?
Yes, they're already coming.
They should be here soon.
Is she going to be OK?
She's in a coma and she may have brain damage.
We won't know if she's OK until she wakes up.
Why does she need the tube?
To give her some oxygen and protect her lungs.
Keeps her from choking to death on her own saliva.
What were you guys drinking?
Vodka.
Vodka and Kool-Aid.
We were playing 'I never'.
Stacey won.
Where did you get the vodka?
Kids drink.
We all know that.
We just wanted them to be doing it somewhere safe.
So you supplied the alcohol?
I'd rather they drink at home than out where they could be driving.
Can I give her something?
Come on, girls.
Let's go.
Call the cops.
Get 'em down here.
9- month-old with bronchiolitis on continuous nebs, waiting on the PICU.
In 2, we have testicular pain after a pummel horse incident.
That sport should be outlawed.
28-year-old with leukemia cutis, oncology is going to see him.
Then we have a DKA.
The A is gone, still the K, so he needs to come in.
What's that smell?
The guy's a guyser Who?
The PV guy.
It's like dodging artillery in there.
I don't think the wipes are going to do it.
Once we're done here, grab some scrubs and ditch the clothes.
Don't ditch, burn.
The guy in 3 torched his fingers making cr�me br�l�e Displaced fib going to ortho, and hallucinating trombone player needs a tox screen and a psych consult And with that, my job here is done.
OK, Sanchez, testicular pain trombone player and displaced fib.
Julia, lukemia cutis, cr�me br�l�e, and the DKA, Chaz...
we have a group of prospective medical students coming in her today for their interviews, and Dr.
Anspaugh asked me to show them around, but as I don't really want to and you're the logo on this particular totem pole, you're elected.
Med students?
Prospective med students.
Right now, they're just a bunch of over-educated, fiercely ambitious seniors, trying to claw their way over each other trying to get into a prestigious programme.
So show them a good time.
Sssh.
I'm gonna put it back!
Money's in the jar, Frank.
I'm out the door.
Beverly's daughter showed up.
Who?
Old lady with the broken wrist.
Hello, I'm Dr Morris.
Temp's 37.2�C (99F).
All her labs check out.
She scared us half to death.
Mom, you scared us half to death!
I went in to make sure she was getting up and her bed was empty.
I looked around the house, around the yard.
I ran up and down the street in the rain.
Tom got the car.
He went all around the neighborhood.
I went over to the church, to Emma's!
I called the police and about 20 hospitals.
I was out of my mind with worry.
Out of my mind!
She's gonna be fine...
Sometimes she wanders out of the house, into the yard, but she never leaves the yard.
You can't leave the yard, mom!
She broke her wrist.
We've put a ca...
You're gonna give me a stroke!
You can get that from stress, can't you, Doctor?
A stroke?
Well, yes, stress can cause...
What am I supposed to do about this?
Should I sew a lo-jack in your gown so I can find you when you wander off?
We're just glad she's safe now.
OK, so you'll have to bring her back in a couple of day for a cast check.
Come back sooner if there's any pain, redness or swelling.
Take care, Beverly.
Dr Morris.
No, no, no.
Get away from me or I'll hit you.
The kid...
I mean it..
right in the face!
Freedom!
What was that all about?
Hell if I know.
Police are here on your alcohol poisoning girl.
You're kidding.
Wait a minute.
You called the cops?
Damn right I called the cops.
Easy.
This isn't our fault.
Whose fault is it?
All the parents do it.
She had a blood alcohol level of 4.20, that's not like giving a kid a sip of wine at dinner.
Back up.
So you're going to have me arrested now?
Damn right they're going to arrest you.
That kid almost died, she could have permanent brain damage.
4.20?
What the hell were you doing when those kids were in there trying to drink themselves to death?
Watching tv?
Were you in the kitchen mixing up another batch of vodka and Kool Aid?
Hey!
No, settle down.
Stay down!
Ma'm, please!
Stay down!
I want to call my lawyer.
Better have a good one.
Hey, Doc, you know what?
Shut the hell up.
Wow, shouldn't we be building an arc?
The news said we could get as much as five inches today.
I'm glad I'm not an EMT anymore on a day like this.
You get wet early, you stay wet the whole shift.
You never get dry.
Here we go.
37-yr-old construction worker, Took a 15 feet fall from the scaffolding.
Abdominal pain, pain in the thigh.
No pulse in the right foot.
Bag his femoral artery.
Let's get him in.
PA 90 palp with 3 litres of saline over 45 minutes.
Kind of a long transport time.
We had to wait until firemen sawed off the bar.
His name is Dickie DeAngelo.
That looks nasty.
Look at this idiot.
Who drives into that?
What, did he think it was just a puddle?
Dr Gates, that alcohol poisoning girl's parents are here.
Hey Doc, do you have time for a kid with a belly ache?
The grandma only speaks Spanish.
My Spanish is pretty shaky.
I've been taking a course, but..
It's gotta be better than mine.
All I got is: "�Hola.
Que paso?"
4- yr-old boy.
All I can think of is something to do with his stomach.
Administrative, social worker and councelling offices are all on the second floor along with the wellness classrooms and the therapy rooms.
Oh my god.
This is beautiful.
36 exam rooms, radiology suite, two dental suites, shower facilities for the homeless, OB-GYN, optomotry, pharmacy, diagnostics, rapid HIV testing and support, reproductive health.
I can't believe you're actually able to pull this off.
You had doubts?
No, I was sure you would fail.
Tell me, will you be able to get funding for the county to staff this?
No, I'll be fundraising for the rest of my life.
but we have enough to open the doors.
Try to keep us going for the first year, while I try to build us up some endowment.
Carter, I knew you were rich, but I didn't know you were this rich.
The ill-begotten gains of my Carter forefathers put to good use.
Redemption?
Maybe so.
Your grandma would be so proud.
Grandfather would be rolling over in his grave.
He thought the Carter money was going to last longer than the pyramids.
You spent it all?
No, but most of it.
You've done a great thing here, John.
A truly great thing.
Paramedics are pulling in with a 47-yr-old male with chest pain.
and I've got a 60-yr-old man short of breath.
Julia, take the shortness of breath.
Chaz, you're with me for the rule-out MI.
He looked like crap, so I brought him right back.
Sats were 72 %, so I went ahead and hooked him up with some oxygen.
Hello, I'm Dr Wise.
And you are..
Mr.
Gandhi?
My mom was a Mahatma fan.
And how long have you been sick?
About...
20 years.
More recently?
The trouble breathing?
A couple of weeks.
Do you have lung disease?
Not that I know of.
Heart problems?
No.
Any fever?
Just can't breathe.
Portable chest, 100% nonrebreather, EKG, first day labs IV?
Start a saline lock.
Wear gloves.
What?
I have AIDS.
Here it is.
Then..
he swallowed it.
I won't get it back.
God won't be happy that you swallowed my necklace.
How can we get it back, Dr.?
Um, we can't get it back.
It has to stay in his stomach forever?
No, no.
We have to wait and hope that Jesus will uhm..
eleminate.
Eleminate?
Yes, you know, through his..
His poo?
Yes, through his poo.
Should we intubate?
Not yet.
Tachypnic, still hypoxic on 100%?
What do you see?
Bilateral efusions.
That explains the shortness of breath.
Hmm, and that gives us something to fix.
Two thoracenthesis trays, please.
We'll still have to tube him if he has underlying pneumonia.
One step at a time.
What are you two talking about?
You have a lot of fluid outside your lungs.
It's making it hard for you to breathe.
What can you do for that?
We can drain the fluid, which will make you feel a lot better.
So let's put your mask back on and lean forward.
Let's dangle your legs.
That's alright.
Now we're going to clean the skin with a bit of Betadine.
You're going to feel a sting while we numb the skin, Mr.
Gandhi.
Gandhi?
Yeah, his mother was an admirer.
Now you're going to feel some pressure while the needle passes through the ribs.
Fluid looks a little bloody.
OK, let's send it up for a cell count, culture, Grams and BAFE.
You'll be coughing as your lungs expand, but it's a good thing, that means it's working.
No change?
We're going to have to move her, we need the trauma room for a MVC.
Come on guys.
Why don't you go home.
I'll call you if anything changes.
Frank, I'm going home, call me if anything changes with the Taylor girl.
Who?
Alcohol poisoning.
Oh, another one of those kids showed up asking about her.
She's the one with braids out in waiting.
Hi, I'm Dr Gates.
Are you here to see Stacey Taylor?
OK, well, she's in a coma, and they don't know when or if she'll regain consciousness.
Were you at the party last night?
No.
I heard what happened.
Are you here by yourself?
You know, her friends and uhm..
her parents are on the second floor.
Maybe you wanna go up there, you'd be more comfortable.
I should've done something.
Well, you weren't there, right?
Stacey was texting me.
My parents wouldn't let me go.
I was really angry I wasn't there.
So she was texting me all night, to tell me about the party.
She told me she was sick..
really sick and throwing up.
And I..
thought it was funny.
I should've called somebody..
I could've...
Maybe I could've...
The ER is the nerve center where it all begins.
Between the ER and the urgent care, we see over 200000 patients a year.
As med students, this will be your first rotation.
4 years to see if you've got what it takes to be on the frontline of urban medecine, or if you're a little bit more suited for dermatology, plastics,...
something a little bit more..
more safe, that you could practice out in the suburbs.
Triage is our first stop.
We rely on our talented nursing staff to determine who's going to be first and who's going to have to wait.
And wait and wait.
These highly trained professionals can tell the difference between a hot MI and a common indigestion just by looking at a guy.
After triage, the patient is brought back.
The chart is racked.
You pick up the next in line, no matter what.
When you get caught swapping fecal incontinence for knee pain, you'll never hear the end of it.
Glad you learned your lesson.
Our curtain areas are for our subacute patients.
Over there is the break room where we got bad coffee and stale bagels.
Trust me, you don't want to be going over there.
Uhm, excuse me!
Keep up, OK?
So here's the deal about being a med student.
Some docs like to teach, but most just see us as a pain in the ass.
So they won't be issuing any formal invitations to the cool stuff.
You've got to keep your eye open and go after the action.
It's not going to come to you.
Come on.
Another epi and shock him again.
This is Dr.
Brenner, one of our fine ER attendings.
Dr Brenner, this is the tour of the prospective med students that you asked me to...
Chaz, get them the hell out of here!
OK, so who wants to see the suture rooms?
Clear!
Anybody seen Brenner?
Down in trauma with a chest pain.
You okay?
Just got results back from a patient.
Bad news?
You want company?
No, I should do it.
No time like the present.
Right.
Post-op film came back.
Your lungs have re-expanded.
No pneumonia.
Are you feeling better?
I can breathe again.
You said you've been sick for a number of years.
Well, I got the AIDS diagnosis in 1987.
I started AZT as soon as it was out.
It's great that you've been able to fight it off this long.
Come on, Doctor, no holding back.
I can take it.
Believe me.
Your test results came back.
There were atypical lymphocytes.
Large immunoblastic cells.
What does that mean?
It means that you have cancer.
It's a little nasty out there today.
If it keeps up, we're going to start handing out life jackets.
How are you?
I'm on the mend.
Everything working down there?
No complaints for the plumbing.
Wish I could say the same.
I was up 6-7 times last night.
Kinda quiet today, huh?
Yeah, I'm thinking of pulling out a crossword puzzle just to fill the time.
I just had lunch with Susan Lewis and Kerry Weaver.
Really?
How is the old dragon lady?
She's good.
Susan actually looks fantastic.
What're they doing in town?
Tonight's the opening of the Carter Center.
They came in for it.
Open bar, free food on fancy little crackers.
All that.
Housekeeping needs to clean up Trauma 2, it's still a mess after that shotgun accident kid.
They're down in radiology trying to mop up a roofling.
What's up?
A pregnant woman coming in NVA.
Here they are.
Hey, store that for me, would you?
Sure.
36-yr-old female, nine months pregnant with twins.
Broke her water at home.
Contraction!
Traffic collision on the way to the hospital.
Hit by a CPA bus.
Is this your first pregnancy?
Fourth!
Shock on passenger, abdominal pain and contusions.
Tachy at 120, BP's normal.
Get me off of this!
As soon as we assess you m'am.
Let's get her inside.
Go!
On my count.
1, 2, 3.
My husband should be here any minute.
He was on his way to meet me at Mount Sinai.
Check the perineum, I'll do a primary survey.
I've gotta push!
Not yet.
I've got to!
Sterile gloves and an OB kit.
What do we need, Julia?
CBC, coagulation, type, RH.
And?
Fetal monitor.
Yes, fetal monitor.
Would you care to pitch in, Dr.
Carter?
Oh, I thought you'd never ask.
Don't move your neck until we've made sure that it's not broken.
I'm fine!
I guess the C-spine is clear.
She's crowning.
Alright, mom, you can push now.
The head is out.
OK, get ready.
Twins come quickly.
Delivering the shoulders.
It's a girl.
Ombilical clamp.
Is she OK?
She's got a great set of lungs.
The baby looks great.
Apgar 9, -1 for color.
Congratulations, mom, one down, one to go.
Hey baby, wanna meet your mother?
Hi, you're beautiful!
We paged OB down for the twins, has anybody seen 'em?
Coburn's out on an emergency C-section, said she'd send out a resident as soon as she could free one up.
The husband just showed.
He's the anxious guy.
Mr.
Salamunovich?
Yes, Chris.
Is Lisa OK?
The first baby's out and healthy and we're waiting on the second.
Can I help you?
You don't remember me.
Should I?
It's amazing how little has changed around here.
My dad used to be on staff.
Mark Greene.
I'm his daughter, Rachel.
We have three boys under the age of 10 at home.
Three?
Yep, it's a madhouse.
But I wanted a girl, so before Chris went in to get snipped, we decided to try one more time.
We ended up with twins.
What are the chances of that huh?
Hey little Camille.
We're still going with Camille for the first one, right?
Yeah, fine by me.
It's my grandmother's name.
Honey, keep an eye on the clock.
Pre-school pickup's in an hour.
I'll just have my mom go get them.
No, no, you should...
Another contraction.
OK, big push this time.
Big push.
Fetal heart rate is down.
What does that mean?
It could be a sign of distress.
OK, mom, let's get this baby out.
I can see the head.
Meconium.
Give me suction now, please What's meconium?
It's in the baby's intestine prior to birth, it could pass on through the amniotic fluid and get into their lungs during birth.
How bad is that?
Clamp.
And cut.
If it gets into the baby's lungs, then she has to be intubated.
It has to be sucked out.
It's another girl, honey.
She's not crying.
That's intentional.
We don't want her to breathe in the mec.
Laryngoscope and suction.
Mom's heart rate's up to 140.
Some bleeding here.
2 liters of saline, wide open.
A lot of bleeding.
Exercise traction on the chord.
Let's get two units from the blood bank.
Meconium in the epiglottis.
Cyanotic.
Weak tonicity.
Is she OK?
Systolic's down to 90.
Prepare the rapid infuser.
Where the hell is OB?
Is that the placenta?
That looks like uterine inversion Get a Cordis.
Get me some sterile gloves.
The uterus has turned itself inside out and pushed itself through the cervix.
I need to push it back in.
It won't go!
IV Nitro, right now!
Set up for an intubation on mom.
Two units of FFP.
Tell the blood bank to send 4 units.
Pressure's only 65/45.
Second unit is in.
Get two more.
No, it won't go.
4 units of mag.
What's happening?
If I can't get to your wife's uterus, we're going to have to take her up to the OR put her under anasthesia and see if we can fix it there.
Heart rate's up to 140.
You try one more time.
Really push hard.
Really push.
Come on, get in there!
Really push!
It's in.
It's in?
Great.
Hold off on the nitro.
20 of PIT and a liter wide open.
Keep pressure on the cervix with your fingers.
No, no, push in, all the way up to your fore-arm.
With your other hand I want you to massage the uterus at the ombilicus.
OB's here.
Heard you had twins.
Yeah, we just reduced an inverted uterus, she's still bleeding with a creta.
Call the OR, tell Coburn I'm bringing her up.
What're you going to do?
You're the dad?
We need to stop the bleeding or else we may need to give her a hysterectomy.
What about the twins?
First one's good.
Second aspirated some mec.
I'll page pediatrics.
Should I let go?
Don't let go until they tell you to in the OR.
Should I go with Lisa or should I stay?
She'll be under general anasthesia for a while but we'll give you updates from the operating room.
Your wife mentioned something about having to pick up kids at school.
If you need to make a call, you can use that phone on the wall there.
What's going on?
Why did you come to pick me up today?
I couldn't sleep.
Get in.
But I was gonna go to Madison's study for the trig test.
I'll give you a ride.
I have to meet Alex to finish the car.
So what's up...
Tony?
Have you ever played 'I never'?
It's a drinking game.
I haven't been drinking, OK? "
I've never"?
I've heard of it.
Some kids at school play it at parties and stuff.
How many drinks do you think it'd take to be drunk enough to die?
What?
How many?
What'd you weigh?
90 pounds?
How many drinks would you have to down before the alcohol would kill you.
What do you think?
I don't know.
5?
10?
20?
50?
I don't know, 20?
Try 6.
Six?
Yeah, that could kill you.
Give me your phone.
Give me your...
I'll give it back to you, just give it..
Do me a favor.
Next time you're at a party and you're drinking, and you've had too much to drink, and you're throwing up or your friends are, or someone's texting you, saying they're throwing up..
Hit that. "
Help" Who does it call?
Me.
And I'll come, no questions asked.
I'll help you, I'll help your friends.
I'll make sure you're OK.
No questions asked?
When did it stop raining?
How's the second twin doing?
Intubated, waiting for pediatrics.
Did the mom get to the OR OK?
Yeah.
I'm going across the street for coffee, anybody want a latte?
Sure.
Double, non-fat.
Mocha frap, extra foam.
Excuse me, I'm not sure I'm in the right place.
My daughter-in-law is here somewhere, having twins?
Is her name Lisa?
Come with me.
Go right in here, just check in with that nurse at the desk.
Julia, there's a call for you; oncology.
Hey, you guys know a doctor who used to work here named Greene?
His daughter was on my tour today, she's applying to med school.
Rachel?
Yeah, I think so.
You're kidding me!
Is she still around?
I dropped the tour off at the dean's office.
They're doing their interviews this afternoon.
Look at you.
You're all grown up.
How old are you?
22.
Oh my god, I remember you when you were...
Now you're going to medical school, huh?
Took your MCATS and everything?
Where are you doing your undergraduate?
Duke.
Great.
Yeah, Elizabeth's on faculty there, so I get a good deal on tuition.
Elizabeth Corday?
Yeah, actually she flew up with me.
Elizabeth is in Chicago?
What're you both doing later tonight?
I don't know, I think we're seeing some old friends.
No, no, you have to come to this thing that we're doing.
Rachel Greene!
This is my number.
Give this to Elizabeth, have her call me.
It's good to see you.
Good to see you, good luck in there.
Pathology says it's primary effusion lymphoma.
Who's this?
My guy who couldn't breathe What's his prognosis?
Medium survival is 2 months.
And his options?
Chemo and radiation could give him another couple of months.
You told him he has cancer?
Yeah, couple of hours ago.
Brave.
Or maybe just relieved.
Relieved?
Dr Brenner?
To finally know how and when after all these years.
Back and forth, keep it smooth.
Excellent.
Good.
That'll do it.
Yeah, man, that looks good.
I think you were right about the color.
I don't know.
The cobalt blue would've been cool too.
No.
The red is more your mother.
Yeah, all fire.
It's better than cold and distant.
If you say so.
I know so.
She's going to love this.
Definitely Sorry I've been gone so long, something came up.
Oh, that's OK.
Gerry came by.
Gerry Gugliemotto, Dr Wise.
She's very nice.
Great to meet you.
Nice to meet you.
Gerry brought me gardenias.
I just love gardenias, don't you?
The smell.
The rest of your labs came back.
Everything looks clear.
Except for the cancer.
But it means your body could tolerate chemotherapy.
No.
No thanks.
It could buy you a few more months.
I've already had an extra 20 years, Doc.
I should've died with all my friends, in the eighties.
You're still here.
Tommy and Bill.
Jeff and David.
Remember Michael Thomas?
Of course I do.
Little Bobby?
So many people I've loved.
I've been trying to live for them, you know?
Keep their memories alive.
But I've had my time.
No regrets.
I went skydiving last year in Hawa�.
It was the most remarkable thing I was floating...
free.
I couldn't feel my body.
I'm afraid of heights, but I wasn't, up there.
I guess I hope that's kind of what death is like, Doc.
Floating...
free in the air...
above everything.
Just...
watching the world drift by.
Is there anything I can do for you?
Yeah, there is.
I don't want it to hurt.
We can help with that.
66-yr-old woman, ruling in for MI.
She's going to the cath lab any second.
Hoola-girl needs an X-ray of her wrist.
We got an SPO who's NPO and not happy about it.
Sickler with a fever.
Dislodged G-tube on an old gal that came in from Lakeshore, and a 3-week-old with lethargy and cardiomegaly, admitted for echo.
And as you can see, the hallucinating trombone guy's still here.
Tox was negative, but we're trying to find a psych bed somewhere in Chicago.
My alcohol poisoning girl still here?
The family didn't want here admitted here, so they're transferring her to Mercy, but Mercy hasn't picked her up yet.
Hey Jerry, look at this inbox.
It's empty.
All of my dayshift paperwork is completed.
Look.
It's a thing of beauty, it's a clerical Mona Lisa.
I just wanted you to see what it looks like so you can try...
try to replicate that for when I come in tomorrow.
Tough day?
About the same as any other.
Good night, y'all.
Good night.
Watch out for the guy in 3.
He's a grabber.
Thanks.
You look nice.
I got a thing to go to.
You saw a med school applicant today: Rachel Greene.
She's pretty great.
She a student of yours?
No, she's Mark Greene's daughter.
So you have no first hand knowledge of her academic qualifications?
No.
But I've known her since she was a kid and Marc was a great doctor.
I'm sure the apple didn't fall too far from the tree.
She did well on the interview.
I can't say if she'll make the final list, but she made the first cut.
So he's a bit of boozer?
Stinks of bourbon by noon Doesn't it affect his work?
No, that's the irritating thing.
Drunk as a skunk, and he's still a wonderful surgeon.
Is that Neela?
Yeah.
Hey, how's the teaching going?
Got most of the R3's.
Very polite, they follow me around like duckling.
I'm sure they're in awe of the depth of your surgical brilliance.
Either that, or your exceptional beauty.
I think they may just be stupid.
Hey, is that Neela?
Hey, how's life on the bayou?
The bayou is like a 100 miles away, Morris.
Pediatrics finally showed up to extubate the mec kid.
Thanks.
I gotta go.
I'll speak to you later.
How's the mom?
Still in surgery, I think.
She's still in the OR?
As far as I know, yeah.
Do you mind if I tag along with you?
See you, Neela.
Bye.
Hey Joe, how're we doing?
Suctioned out the trach and the stomach.
No mec below the chords.
Satting at 100%.
Vigorous tone, good respiratory effort.
I think we can extubate.
Oxygen is ready.
Here we go.
Good air movement.
Can I hold her?
By all means.
How 'bout you go and grab the rest of the kids?
Oh, I gotta go.
Good work, Doctors.
Thanks, Joe.
Yeah.
What's the mom still doing in the OR?
She's probably already out.
Sometimes they forget to call.
Hey guys, do you want to meet your sisters?
Yeah.
Yeah.
Come on.
Where's my mom?
82-yr-old woman with a history of MS and pyelonephritis, on home IV care.
Now with altered mental status and resperatory distress.
BP 60 palp.
Gave 500 cc of saline to get her pressure up, but it's all going to her lungs.
She's been coughing and groaning terrible.
She's burning up.
Pulmonary edema.
Probably septic.
It's the second time we're in here.
We've been taken care of by Dr.
Gates.
Her parents around?
They've been here all day.
They must be around here somewhere.
Hey, Tony?
Old lady with MS just came in with sepsis.
Husband said you've been treating her.
You look tired.
Thanks Are you OK?
Yeah, this...
this 17-yr-old girl came in last night with alcohol poisoning, BA 4.20.
Still hasn't come around.
She was texting her friend all night, telling her she was throwing up.
Her friend thought it was cool.
Mr.
Manning.
Marjorie's not doing too well, huh?
I know a lot of us never actually thought that this day would come.
In fact...
I think I was one of them.
But here we are, in this beautiful facility finally ready to provide state-of-the-art out-patient services to the HIV/AIDS community, the homeless, families in need.
Medical care, dental care, daycare,..
counseling Services that have been sorely lacking at County for many years.
I...
I don't want to try your patience, by rambling on too long.
But I hope you'll bare with me for a moment while I talk about why we chose the name 'The Joshua Carter Center'.
My wife and I had a son, and we named him Joshua.
And he died.
Excuse me.
And it seems so senseless..
That we...
My wife and I, we've struggled to find some..
sort of meaning in it.
And in the aftermath of our small tragedy, we..
realised that we could make a difference in other people's lives, other people experiencing their own small tragedies.
And that made, somehow,...
the loss of Joshua barable.
Thank you so much for coming.
Bravo.
I didn't embarass myself?
I wouldn't go that far.
You came.
I didn't think you would.
Neither did I.
Sorry I was late, flight was delayed.
It was a beautiful speech.
Hey, John, I want you to mee Wendy Spencer from the Fort Foundation.
Right over here.
Your wife has low blood pressure from the sepsis but giving her IV fluids would only cause more damage to the lungs.
We discussed this when you wanted to take her home, Paul, that this would most likely happen.
I didn't realise.
Please, do something.
Marjorie has a DNR, she doesn't want us to intervene.
Oh, I've got her power of attorney here.
Here...
That means I can decide for her, right?
Your wife has a degenerative disease that left her debilitated.
without enough strength to fight off this infection.
Even with agressive treatment...
she would only live a week or two in the ICU on machines.
A ventilator, dialysis, IV pumps to keep her pressure up.
It's only going to prolong the pain and suffering.
I'm not ready to lose her.
It's time to talk about how to make her as comfortable as possible.
Excuse me, I'm here to check on a patient.
And you are?
Dr Wise from the ER.
I called but I got put on hold.
Yeah, we're swamped.
Couple of people called in sick.
Stomach flue.
We brought a woman up, inverted uterus, bleeding with an accreta.
Her name's Salamunovich.
Dr.
Zwerling just went out to find the family They're still downstairs.
They have a bun