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Man on computer: Welcome to "Current Issues in Medical Ethics."

Some of you are here for continuing education,

some because of remedial ethical transgressions.

What if medical care is indicated for one patient,

- but contraindicated for the other? - Mmm.

This is a very difficult situation

which we find frequently in our practices.

What if a mother's decision seems based

on unusual or countercultural belief systems?

Take a moment to reflect on this.

Chapter 11: "Utilitarian versus Consequential Ethics."

Ethical rights, human rights.

Ethical quandaries, distinctive surgeons.

Patients obviously have a right to their own beliefs,

but does a fetus have rights, too?

And if so, when do these rights accrue?

These complicated questions require

rigorous and continuing discernment.

Getting On - S03E01 This Is About Vomit, People

sync and correction by solfieri www.MY-SUBS.com

Dennis: It itches so bad!

Stop, Dennis. Stop scratching.

Okay, front, Sammy. Oh, my God.

Neck.

Okay, now both of you, stop scratching.

Okay. We try hard.

Dawn: Wait, wait, wait, wait.

Bye. Bye.

Come on, bud.

I'll drop your sleeping bag off at the cleaners.

Don't worry, it'll all come out.

Come on, bud.

- Margeurite? - Mm-hmm?

A patient vomited outside 106.

I was just checking on Mrs. Bibb and just noticed it.

I'm not sure how long it's been there, but I think somebody needs to clean it up.

Sure thing.

So Peola says, "I look white, so I'm not gonna be black."

"I'm gonna pass as white."

I mean, that's what the whole movie was about.

And her mama, Delilah, she said,

"Well, I is yo' mammy, you can't 'ax' me that."

Then there's that. Peola and Delilah.

Yeah, she was the greatest colored actress of her day,

and all she wants to do is be this white woman's maid for no money.

And I hit Darnell, "Why are you making me watch this old fossil?"

And it was her damn pancake mix anyway. I'ma get you a pillow.

Do you have any spare linens?

Oh, hey. Uh, no, we are all out.

Come on, honey, let's get you into bed.

Dennis, Sammy, and I drove back from Big Bear this morning.

Traffic was horrible. Dennis smoked a joint to calm down.

I thought you didn't approve.

Didi... you can't change other people.

Okay, you can only change yourself.

And he had a prescription.

Oh, here you go. I'll be right back.

Hello, hello.

Oh, good morning, Dr. James.

I thought you had your ethics seminar until noon.

Finished early. Truthfully, Dawn,

all those ethical issues are fascinating,

but nothing I've not considered before.

Every day we drive to work,

should we go first or do we wait for the pedestrians?

Who is that very distinguished-looking tall glass of water?

I don't know. Wouldn't throw him out of bed for eating crackers, huh?

Uh-huh. Huh?

Y'all know somebody threw up over here?

Yeah. I asked Antoine to clean it up.

I'm gonna run up to four to pillage from Oncology,

we're out of everything. No pillows, no blankets, no thermals.

Oh, will you pick up some Foleys and some saline? We're almost out.

Hey.

The most important thing to learn is when it is appropriate

to take the forefront and when you should step back and observe.

- This is Debra Mister. - Thank you, Dawn.

Good morning, Mrs. Mister. Is there a Mr. Mister?

Yes.

Debra is recovering from complications

from an abdominal hysterectomy,

a hemorrhaging in the vaginal cuff.

Post-op remainder of your vaginal vault.

A post hysterectomy cuff cellulitis and a pelvic abscess.

Fancy talk for bacterial infection.

- Fever, abdominal pain? - Yes, it's very painful.

Well, I'm a specialist in this area,

and my research has come to fruition

with a very exciting partnership

with a very prestigious pharmaceutical company.

This is my potentially groundbreaking vaginal cream

with Barbet Pharmaceuticals, currently in a phase two trial

which I'm hoping you will become a very important part of.

What makes it different from all the other vaginal creams

presently on the market, you ask?

I introduced tiny time-released cellulite moisturizing balls,

and the skins of the balls are a natural cellulose

produced from a sustainable monocrop. Feel the balls.

So we're also testing the Barbet Anal Horn

used to evacuate an impacted bowel.

And once inserted and firmly in place,

the distinguishing hand pump inflates the O-ring for a tight seal.

It's probably of more importance to us,

the practitioners, right, Dawn?

But if that pops while it's inside you, that's not dangerous.

However, it could be a little bit shocking.

Morning, Dawn. You went camping

for your eight-month anniversary, I understand.

Yes, I did. It was heaven.

Since when do you like camping, Dawn?

Poison ivy and spider bites.

Did you go fishing? Did you catch some fish?

Yes, as a matter of fact, we did.

What kind of fish did you catch?

Rainbow cutthroat trout, for your information.

Oh, yeah? How'd you clean them, Dawn?

Did you slit their little bellies and take out their roe?

Mrs. Brock?

There you are! Right on time.

Morning, Mrs. Brock.

I see corn flakes and I see a boiled egg.

- Do you boil your own eggs? - Yes, I do.

Well, you must always remember to turn the burner off,

and never wear flammable fabrics while cooking

'cause you wouldn't want to immolate.

And I do have the results of your scans,

but I wanted to consult with my tech... just to make sure.

So it's been a week now.

Do you like your personalized physician remote unit?

Huh? You like your little robot?

- It's good company. - Oh, that's good.

But it's the same old me as on the phone,

but now I'm a robot,

so I can be a little bit more interactive.

I can go forward, back,

and forward. Oh!

Dawn!

Hello. I'd say you look a little bit lost.

You're right, I think I am.

I'm looking for administration.

An Aussie, or Kiwi.

Either way, part of the Commonwealth which we, of course, are not.

Kiwi. I'm visiting, first day.

- Oh, which explains that. - Explains what?

The look of fresh enthusiasm.

Jet lag. I was in Tegucigalpa until my flight last night.

Dr. Ron Rudd. And you are...?

Well, no one who's been to Honduras. That's for sure.

No, I'm just a humdrum doctor

with her nose to the grindstone.

Dr. Research with a soupcon of ennui.

I wouldn't say that.

You know the location of Tegucigalpa

and Honduras is not as exotic

as it is my belief that everyone in the world

has a right to medical care and ethical human rights.

Ethical right, I too am a keen student of medical ethics.

Well, as a friendly native, I can certainly show you to administrations.

What brings you to Mount Palms?

An internship in long-term care.

- Long-term care? - Yes.

Billy Barnes?

They brought me in to run the department.

From what I gather, they had some pretty big ethical and moral issues

a few months back, coincidentally.

Unscrupulous admissions in a hospice program.

- Doctor...? - Minnie.

- Minnie? - Marcia.

- Dr. Minnie Marcia? - Yeah.

Uh, will you excuse me a moment, Minnie?

Please tell Paul I need to speak with him immediately.

Marvin Douglas, please.

A beach vacation in Thailand?

Yeah, he's my lawyer, so yes, I'd like to leave... a message.

Marvin, it's Jenna James.

It's been a few months, but we need to talk.

I've just met someone who purports to be my replacement.

The agreement that we signed with Mount Palms excluded me from prosecution.

Right? I'm in the clear,

and you would know if I wasn't, right?

Okay. So how long have you and Mr. Mister been married?

- June 18th, 1963. - Aw, congratulations.

That's so great. I just think it's so important to be married.

I mean, I used to think that my life would finally begin once I got married,

and it's so true.

You know, in ways you just can't even imagine when you're single.

It saves you from being a superficial self-indulgent person.

I just feel so sorry for anyone who's not married.

- Antoine. - Hey, hey.

When you gonna get around to cleaning up that vomit? It's starting to smell.

Oh, we're out of wipes and towels.

Well, make do. Use coffee filters or something.

Look, honestly, I told Margeurite I wasn't gonna do it.

I mean, if she saw it, why didn't she do it, right?

We got a "No Bodily Fluids" clause in our contract.

RNs, they're not the only ones with a union, you know?

They're responsible for the vomit and stool, all right?

- Oh my God. - What are you doing?

- I'm cleaning it. - No, you're not.

Yes, I am. Somebody has to.

You're an LPN. Okay, you're a member of our union.

The RNs won't let you in their union,

and our union says you don't have to do that.

Don't let nobody push you around.

Excuse me, ain't nobody pushing me around, okay?

I'm just doing the work that everybody stands around and talks about doing.

You know why all the history books are written by men?

'Cause women was too busy getting the work done. That's why.

Okay, well, when was the last time anybody gave you a raise?

Gave you a better pension, huh? Don't do it, D.

Dawn, hello.

Um, do you know if there's anything going on?

- Regarding what? - Anything, uh, on the ward?

- No. - Or in the hospital?

- No, like what? - Uh, I don't know.

I just... Anything, maybe involving personnel or such as that.

No, I do not.

Hey, so coffee was a great idea.

- Thanks for the invite. - Yeah.

You know, Minnie, Skirball's having a conference this weekend

on medical ethics run by a mate of mine, if you're...

Sure. What happens to the old personnel once you step in?

- Mostly they stay, I think. - Oh, good.

- What do you know about it? - Mm, not much.

Well, place got itself in a real mess from what I hear.

The doctor who runs the joint... one of those hysterics...

Passed her sell-by, holding on to a position with a death grip.

- Bunions, bunions, bunions. - Oh, hey, hey. Let me hold that for you.

- Oh. When do you start? - Friday.

Wow. How are they gonna do that?

How are they... How are they planning

on getting the old crone to release her bony grip?

From what I gather, the hospital's finally ready to settle

with CMA after a six-month investigation,

then CMA turns its big guns onto her.

Mm! Needs sugar.

We don't know all the details the final settlement agreement will necessitate,

but we may possibly need to bring a new leadership element into Billy Barnes.

We're merely covering our bases, nothing's etched in stone.

Even a week ago, if you had've asked me

could I imagine being here today,

the answer's no, not in a million years.

You know where I was three weeks ago?

Wrapping up my fourth cleft palate tour in Honduras.

Rick: Yes, Nurse Ortley?

Just... I have a quick question.

If this is all happening, I just want to be sure

that we're not involved in any infractions

like it was stated in our previous agreement.

- What? - I just want to be sure our jobs are safe is all.

- He seems like a bimbo to me, like a phony. - Mmm.

Hoity-toity. "Look at me." Dr. Thunder from Down Under. I can't stand him.

I hear those Doctors Without Borders are into sex tourism,

lady-boys, and chicks with dicks.

Yeah, Marvin Douglas.

I know he's in Phuket.

A tsunami? Just...

Give me the voice mail. Marvin, it's Jenna James.

I understand that you're having a tsunami, but we need to talk.

You call me when you get to higher ground.

There's been a double-cross in hospice.

They're coming after me now,

my new relationships with Big Pharma,

and I'm running the Barbet Anal Horn trials. It's...

Oh God, I can't even breathe.

I'm having trouble swallowing.

Hi, it's Jenna James, eating crow.

There is some secret settlement afoot.

No, I can't meet you at the hospital.

Well, you can't afford to be seen with me

any more than I can afford to be seen with you.

Jenna: Hey.

What are we all talking about?

Oh, there's just an email that we all got about

the Domestic Abuse Prevention and Remembrance event

in the Healing Garden this afternoon.

Oh, yeah. I got an email in my spam folder today that said,

"Do you want more lovers?" And I was like,

"No, my God, no! I don't want any!"

Didi: So the white girl is having all these fancy parties,

but the black girl, Peola, she can't attend.

They want to send her to school down South

so they can get her to accept the fact that she's black.

Well, I hope she quits and gets a job as a white person

working in some sort of store or cigar shop or something.

Ms. Birdy, you do love oranges.

I used to buy them by the bagful when I was a girl.

I was only allowed three a day,

so I hid them under the mattress.

Well, my tree is full of them, so I'll bring them for you,

much as you like and you can keep them here in a drawer.

It's me, open up.

You look well.

You were willing to let them throw me under the bus, but now you need me.

I do, because now they're gonna throw me under the bus with you.

Do you have your files?

Yes. Together with yours, they tell the whole story.

Now, take a look at this top sheet.

Mmm.

Oh!

So let's do this, 4:00 today. I have to be in San Diego.

- Tomorrow's too late. - Well, I don't trust you to do it alone.

Well, what do you want me to do?

Didi: Why is that dog in here?

Oh, you weren't here Thursday. It's the new pet therapy program.

His name's Ruffles. Patients adore him.

Yes, Dennis, I got the link about the mattress pads.

Just pick... pick whichever pad you prefer.

No, I appreciate the fact that you're being sensitive about this.

Because I haven't wet my bed since high school.

Oh, and Sammy needs to be picked up from Costco by 6:00.

Okay, thanks.

We got a problem with Dr. James' vaginal cream trials.

They're supposed to be a vaginal suppositories,

but there's seepage oozing out of Ms. Bates' behind.

- What's the problem? - Well, you administered

the Well-Wet suppositories for Dr. James' Phase Two trials?

- Yes, I did. - Okay, Pats, they're vaginal suppositories

and you put it up their rectums.

I thought we understood the difference now.

I don't think that's what I did.

They were lying on their sides, I told them to pull up their knees.

Did you look under the sheet, like really close?

Of course I did.

There's been a mistake in applying your trial cream.

What was intended obviously to have been a vaginal application

may have turned out instead mistakenly to have been applied rectally.

This drug is meant to revive the vaginal mucosa.

There's no vaginal mucosa in the rectum.

I know that.

Did you bother to ask the patients to open their legs?

Did you even look? Did you just toss it in like a dart?

Neither patient could turn over without assistance, but I have back issues.

I suffer two compressed vertebrae,

one potentially herniated disk.

I know I have to help out around the ward because of staff cutbacks,

but we only have one Hoyer and Margeurite was using it.

Stop it.

How many other vaginas do you suppose you've missed?

How many other rectums might you have inadvertently penetrated?

Dawn! Can you help me with this?

Dawn: What's the problem?

It's stuck. It's just all stuck.

- I was fooling around and something moved... - Let me see.

- The vision camera thing and now it's too high. - Okay.

- I can't see and it's like a gimbal-pivot thing. - Have you tried this?

- I don't know. - Okay.

She's usually sitting in her chair right on the dot.

Maybe she's boiling an egg or something...

- but time is a bit of the essence here, Dawn. - Okay. Can you...

Her test was bad. Thin mitral walls,

distended aortic chamber. She could like blow at any minute.

- Can you maybe call out to her? - Mrs. Brock?

Mrs. Brock? I don't have time for this, Dawn. Not today.

- Can I try? - Yes, be my guest, Dawn.

You think you can do better?

Okay. Just don't jam it, Dawn. It's delicate technology.

Who knows what she might have dropped there.

Could be a blanket in the wheels.

- I got it. - Let's go! Good for you, Dawn.

Good for you. Get up. You win the prize.

Get up, get up, get up. Mrs. Brock?

Mrs. Brock? Mrs. Brock?

What's going on here?

I thought I asked that this be cleaned up.

Do I have to do everything around here?

I can't do it all, I just can't.

So you're openly saying you won't clean that up?

All due respect, that's what I'm saying.

I can't believe you won't do it.

Well, why don't you clean it up?

Patsy: Because Margeurite is busy with her nursing duties.

Didi, did you know that there was vomit on the floor?

I guess I heard something about that, yeah.

Okay, could you please clean it up?

But... I... guess I could.

No, I'm asking you. Would you please clean it up, now?

I just... I don't think I feel comfortable with that.

But this isn't about Didi. This is between me and Margeurite

because I have a "No Bodily Fluids" clause.

And if you saw it first, seems to me first come, first serve.

- Fuck it. - Patsy: I'm still supervising nurse, okay?

Well, I'm not in your union though.

My union says I'm not allowed.

No, no, your union says you can't be forced to.

Right, so stop trying to force me.

I mean, if you don't want to clean it, get yourself a better union.

All right, forget it. Give me a rag and I'll clean it up.

No. No, Antoine. You will not.

Do not touch it. Okay, nobody is touching the puke

'cause now the puke is an incident.

Mm, you love me.

Stop looking at me. Okay?

I've had it with you trying to pick apart my happiness.

It's almost predatory the way you stare at me.

Pfft! Please, don't flatter yourself.

You just can't stand it that I am happy.

Are you happy, Dawn? I'd say the jury's still out on that.

You know what? You just need to go get yourself a girlfriend or a boyfriend.

- We were friends, Dawn. - We were more than friends, Patsy.

- Yeah, but you ended it. - You are the one who ended it.

But, Dawn, you went off and got married

and then called me an unimportant non-entity

at the Amneo wine and cheese.

All I wanted was someone to love me, and to... to take care of me.

You know? To see me and cherish me, and put me first.

But all I got was this pothead with... with mild PTSD

and a developmentally challenged uncle-in-law.

And... and... and I have to take care of both of them,

at no small cost to myself.

And I get so anxious that I pee the bed a little bit at night

'cause there's no one there for me.

- Patsy, there's no one there for me. - I know.

- No one. - I know.

And you say you haven't noticed any blood or pain?

No. Not really.

I mean, I do pee the bed a little bit at night.

Nocturnal incontinence can be one of many

of the chronic symptoms of catastrophic end-stage renal failure.

You have 10% kidney function,

and we need to get you on emergency dialysis immediately.

Catastrophic? What?

How could I have no symptoms

and then 90% kidney failure in one fell swoop?

It happens more than you might think.

- Dialysis? - Yes.

- So, I... I... I should... I should tell my husband? - Yes.

- This is a big deal, Dr. Gladner. - This is a big deal, Dawn.

- Am I gonna die? - I don't think you should be thinking that.

This is an off-the-record inter-union sit-down

to just iron out some differences between the two unions.

I'm the rep for all RNs in Pacific Nurses Local 24.

Who reps American Health Care Workers Local 33?

- Me. - Who are you?

Delores Pores Huertas.

Doctor!

Yeah. Are you there? Can you hear me?

Reception okay where you are? Yeah, are you there? Can you hear me?

Supervising Nurse De La Serda asked RN Macaw

who asked Transporter Robertson and LPN Ortley

to clean up the vomit. Both refused.

Why are you pushing us? Seriously?

W-We're here for our patients, first.

Man, I clean 20 behinds a day and wipe another 40.

But just... don't y'all feel a little small in all this?

Can... Can we just take the high road?

Okay, well, we have a document.

"AHW members have no contractual obligation"

to handle any materials containing bodily fluids,

such as urine, saliva, sweat, feces, vomit, or semen."

So that just... that seems open and shut to me.

That was between you and the hospital,

- that has nothing to do with us. - It has been determined

that the Ebola virus can survive on fluids and surfaces

for several days and that people can be infected thereafter.

What... What does that have to do with anything?

- You tell me. - Patsy: That vomit does not contain Ebola.

How you know that? You don't know that.

We're in a situation where we all face the same thing.

I mean, like, wheelchairs...

Sometimes it takes me 15 minutes just to find a wheelchair.

Why? Because Oncology is taking them from Ortho,

Ortho from Med-Surg, Med-Surg from the Welcome Desk

and y'all know everybody's stealing from us.

This is about vomit, people.

I saw you do it.

Didi: We can make this place work better.

Hm? Who has enough washcloths?

Show of hands for washcloths.

How can I bathe a patient without washcloths? Anybody?

Now, there's a way to go about this,

but we need to hire professional consultants to do this.

Now McGreevy, he worked with United Methodist

to defang the union. Excuse me, just a second.

Paul, we need to talk. We know what you've been up to.

- Yes? - We know that you're throwing us to the wolves

and you've hired my replacement.

Well, that's preposterous, and who's we?

Me and my Deep Throat. Shall I tell you what we know?

There was a sudden ballooning in hospice enrollment

toward the end that even I can't account for.

- Jenna, I truly have no idea... - Can you hear him?

- Suzi: Yes, I can. - What you're talking about.

We have the records. Your ICU and ORs

were instructed to dump dying patients seconds before they died

into hospice so that you could lower the hospital's official death rate,

and then you used those phony numbers

to get a higher Medicaid reimbursement rate.

Suzi and Jenna: Your abuse of hospice is far more worse

than our program of generous enrollment.

- Exactly. - Stop putting that thing in my face.

Suzi and Jenna: Dumping patients into hospice

to remove them from your death rolls

is unethical, immoral, and illegal.

I got this because I know a little bit about ethics, Paul.

The CMA's ethical position is that somebody has to be guilty.

My ethical position is that between you and me, it isn't me.

Minnie? I've been looking all over creation for you.

- Cinderella, your slipper. - Thank you.

Minnie? Th-This is... Dr. Jenna James.

Ron, you're so well-versed in medical ethics.

- If you heard that a hospital's ICU and OR... - Oh, Ron.

- Would you just show Ron the... - Ron: Does somebody want to tell me what's going on?

No, no, no. We're good.

My sins, Paul, were innocent,

and they were for the benefit of science and humanity.

Yours were crass and craven.

And you know me long enough, you know all my lapses,

you know all of my shortcomings.

My soul is not dark.

I deserve to be protected.

Putting you on speaker.

Suzi: Sir, what part of "We have you by the balls" do you not understand?

I do like Ron.

Man: You got that side secure?

Do you want us to turn you off now?

No. I can do it from my end.

I want to stay on a little while longer.

Watch your step.

Didi: Hey, uh, stop that.

Don't... don't do that. Uh, stop. Bad dog. D...

Dawn! Dawn, don't.

Kiss, kiss, kiss.

- Didi: Dawn! - What?

Dawn, I heard about Mrs. Brock.

I hope she's in a better place.

You know, I once had a Hindu patient who had a near-death experience.

She saw that she was gonna be reincarnated as a cat,

so she came back to do more good deeds

so she could be something better.

You know, she... She had to do more Japa.

You can well guess how I regarded that.

But now, I think that we should all be ashamed to die

until we've scored some victory for humanity.

And... time's a wasting.