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1
00:00:03,771 --> 00:00:05,473
Previously, on ER:
2
00:00:05,506 --> 00:00:07,608
I understand you want
to define yourself as chief...
3
00:00:07,641 --> 00:00:10,511
But?
Is this the way
you want to do it?
4
00:00:10,544 --> 00:00:11,745
I suck!
5
00:00:11,779 --> 00:00:13,281
Nah, you don't suck.
6
00:00:13,314 --> 00:00:15,583
You're...
you're still learning.
7
00:00:15,616 --> 00:00:17,351
LEWIS:
So, how are you doing?
8
00:00:17,385 --> 00:00:19,153
I've processed all of
my feelings of anger,
9
00:00:19,187 --> 00:00:20,821
shame and guilt in an
emotionally safe environment.
10
00:00:20,854 --> 00:00:22,523
I've addressed
the urge to use alcohol.
11
00:00:22,556 --> 00:00:24,158
Oh, and I've consulted both
12
00:00:24,192 --> 00:00:26,094
a shaman and a guru,
so really, I'm all good.
13
00:00:26,127 --> 00:00:27,761
I must've really made
an impression on you--
14
00:00:27,795 --> 00:00:30,131
you didn't even
notice I was gone for a week.
15
00:00:30,164 --> 00:00:31,532
Are you high?
16
00:00:38,806 --> 00:00:40,174
SAM:
Alex, hurry up!
17
00:00:40,208 --> 00:00:41,709
The bus is gonna
be here!
18
00:00:41,742 --> 00:00:43,344
What time do you start?
19
00:00:43,377 --> 00:00:44,845
Noon.
20
00:00:44,878 --> 00:00:46,214
Is Neela on today?
21
00:00:46,247 --> 00:00:47,215
Hmm?
22
00:00:47,248 --> 00:00:48,416
Is Neela on?
23
00:00:48,449 --> 00:00:49,583
I don't know.
24
00:00:49,617 --> 00:00:50,784
I think she is.
25
00:00:50,818 --> 00:00:54,088
Funny how that
keeps working out.
26
00:00:54,122 --> 00:00:54,855
What?
27
00:00:54,888 --> 00:00:56,424
Nothing.
28
00:00:56,457 --> 00:00:59,693
Come on, she's young,
single, lonely.
29
00:00:59,727 --> 00:01:01,329
She's got a crush on you.
30
00:01:01,362 --> 00:01:03,831
I'm her teacher,
she's just trying to learn.
31
00:01:03,864 --> 00:01:05,566
Yeah, I'll bet she is.
32
00:01:05,599 --> 00:01:06,634
Aw, come on.
33
00:01:06,667 --> 00:01:07,701
What, everyone
can see it.
34
00:01:07,735 --> 00:01:08,836
Who's everyone?
35
00:01:08,869 --> 00:01:11,139
Uh, Pratt, Frank,
36
00:01:11,172 --> 00:01:14,175
Jerry, Morris,
Chuny, Haleh.
37
00:01:14,208 --> 00:01:16,344
Even Murray.
38
00:01:16,377 --> 00:01:17,678
Murray?
39
00:01:17,711 --> 00:01:19,280
Yeah, the guy who works
at the roach coach.
40
00:01:19,313 --> 00:01:20,681
It's not
funny, Luka,
41
00:01:20,714 --> 00:01:22,250
and you're doing everything
to encourage it.
42
00:01:22,283 --> 00:01:24,518
Mm. That's not true.
43
00:01:24,552 --> 00:01:26,354
Yeah, well,
it better not be.
44
00:01:26,387 --> 00:01:28,756
Or else I'm going to have
to get into some...
45
00:01:28,789 --> 00:01:30,791
nasty chick fight
with Neela.
46
00:01:30,824 --> 00:01:34,162
In the mud?
Just don't hurt her.
47
00:01:34,162 --> 00:01:38,432
The only person who's going
to get hurt around here is you.
48
00:01:38,466 --> 00:01:39,600
You got it?
49
00:01:41,569 --> 00:01:43,437
Yeah, I think it was April.
50
00:01:43,471 --> 00:01:45,606
But the fact that I need
a calendar to figure it out
51
00:01:45,639 --> 00:01:46,840
is not a good sign.
52
00:01:46,874 --> 00:01:48,209
Did I meet him?
53
00:01:48,242 --> 00:01:50,211
No.
54
00:01:50,244 --> 00:01:52,513
He drove
a motorcycle.
55
00:01:52,546 --> 00:01:54,348
That was his defining
characteristic?
56
00:01:54,382 --> 00:01:55,383
I'm afraid so.
57
00:01:55,416 --> 00:01:57,185
What about you?
58
00:01:57,218 --> 00:02:00,754
Third year, my gross
anatomy instructor.
59
00:02:00,788 --> 00:02:01,922
He was very skilled
60
00:02:01,955 --> 00:02:03,691
at prossecting
the brachial plexus.
61
00:02:03,724 --> 00:02:05,826
You slept with
your instructor?
62
00:02:05,859 --> 00:02:09,197
Dr. Gibson had a very
tender way with cadavers.
63
00:02:09,197 --> 00:02:10,798
And you called
him "Dr. Gibson"?
64
00:02:10,831 --> 00:02:13,367
Only in bed.
65
00:02:13,401 --> 00:02:14,735
So basically,
neither one of us
66
00:02:14,768 --> 00:02:18,439
has got any in
a ridiculously long time.
67
00:02:18,472 --> 00:02:21,375
Well, at least we have work
to keep our minds off...
68
00:02:21,409 --> 00:02:24,578
Men. Romance. Sex.
69
00:02:24,612 --> 00:02:27,281
Yeah, at least
we have that.
70
00:02:27,315 --> 00:02:28,916
KOVAC:
Morning.
71
00:02:28,949 --> 00:02:29,950
Hello, Luka.
72
00:02:29,983 --> 00:02:32,420
Dr. Kovac.
73
00:02:32,453 --> 00:02:33,754
Uh, multiple MVA
on their way in.
74
00:02:35,223 --> 00:02:36,590
Patient satisfaction scores.
75
00:02:36,624 --> 00:02:39,593
We're up .6 points
from two weeks ago.
76
00:02:39,627 --> 00:02:40,661
Is that good?
77
00:02:40,694 --> 00:02:42,263
Yeah, it's good.
Very good.
78
00:02:42,296 --> 00:02:44,632
I'm going to post it.
79
00:02:44,665 --> 00:02:46,500
Um, Carter, I want
to thank you.
80
00:02:46,534 --> 00:02:49,303
I know that my taking over
as chief has been stressful,
81
00:02:49,337 --> 00:02:50,804
and it's been a little
weird for you,
82
00:02:50,838 --> 00:02:53,307
but you've made
the transition a lot easier
83
00:02:53,341 --> 00:02:54,442
and I really appreciate it.
84
00:02:54,475 --> 00:02:55,876
Susan, I can't think of anybody
85
00:02:55,909 --> 00:02:58,779
I'd rather
have as a boss than you.
86
00:02:58,812 --> 00:02:59,847
16-year-old driver
87
00:02:59,880 --> 00:03:01,849
backed into a utility pole.
88
00:03:01,882 --> 00:03:03,251
Okay, hop to.
89
00:03:03,284 --> 00:03:04,718
And don't call me Susan at work.
90
00:03:04,752 --> 00:03:06,287
What happened?
91
00:03:06,320 --> 00:03:08,289
Dad was teaching her
to parallel park.
92
00:03:08,322 --> 00:03:09,990
She just got her
learner's permit.
93
00:03:10,023 --> 00:03:11,592
I got a little bit dizzy.
94
00:03:11,625 --> 00:03:13,261
Maybe I got the pedals mixed up.
95
00:03:13,294 --> 00:03:14,262
CARTER:
Uh-huh.
96
00:03:16,297 --> 00:03:17,665
NEELA:
New scores?
97
00:03:17,698 --> 00:03:19,867
Yep, we don't suck
as bad as we used to.
98
00:03:19,900 --> 00:03:21,435
And maybe by next week
we'll suck a little less.
99
00:03:21,469 --> 00:03:22,970
Must be your
motivational speeches.
100
00:03:23,003 --> 00:03:24,672
We're pairing attendings
with interns.
101
00:03:24,705 --> 00:03:26,474
Abby, you got me.
Neela, you got Kovac.
102
00:03:26,507 --> 00:03:27,941
What?
103
00:03:27,975 --> 00:03:29,643
Yeah, big Croatian guy.
You can't miss him.
104
00:03:29,677 --> 00:03:32,280
We've got a double MVC
rolling in.
105
00:03:32,313 --> 00:03:33,414
Abby, he's all
yours today.
106
00:03:33,447 --> 00:03:35,316
Who?
Hey.
107
00:03:35,349 --> 00:03:37,585
You guys know each
other, right?
108
00:03:42,490 --> 00:03:44,325
Hi.
109
00:03:44,358 --> 00:03:45,926
You know how to clear
a c-spine clinically?
110
00:03:45,959 --> 00:03:48,028
Uh, you mean if it's not tender?
111
00:03:48,061 --> 00:03:49,363
That's a no.
112
00:03:49,397 --> 00:03:50,364
Check the Nexus criteria,
113
00:03:50,398 --> 00:03:51,599
get back
to me tomorrow.
114
00:03:51,632 --> 00:03:53,967
I give you Rodney Dixon
and Amanda Field.
115
00:03:54,001 --> 00:03:55,035
Rear-ended by a truck
116
00:03:55,068 --> 00:03:56,437
while having sex
in his car.
117
00:03:56,470 --> 00:03:57,405
Good vitals
on both.
118
00:03:57,438 --> 00:03:58,606
NEELA:
I'd say.
119
00:03:58,639 --> 00:04:00,308
They stuck together
with super glue?
120
00:04:00,308 --> 00:04:01,642
We tried to disengage
them at the scene, but...
121
00:04:01,675 --> 00:04:03,311
Oh, it's killing me, man.
122
00:04:03,344 --> 00:04:04,878
Broken pelvis plus
uncontrollable lust equals...
123
00:04:04,912 --> 00:04:06,414
( groaning )
124
00:05:00,368 --> 00:05:01,402
NEELA:
Chest is clear, belly's benign.
125
00:05:01,435 --> 00:05:02,370
JAKE:
Backseat
of a car, huh?
126
00:05:02,403 --> 00:05:03,671
'66 Mustang Fastback.
127
00:05:03,704 --> 00:05:05,038
I hope it's not totaled.
128
00:05:05,072 --> 00:05:07,441
Fastback? That's
a pretty tight squeeze.
129
00:05:07,475 --> 00:05:08,976
I do Pilates.
130
00:05:09,009 --> 00:05:11,779
It's got a 389 to one rear
gear with a 31 spline axle.
131
00:05:11,812 --> 00:05:12,713
Nice.
132
00:05:12,746 --> 00:05:14,382
You were screwing in
the back of an old Ford?
133
00:05:14,415 --> 00:05:15,616
What were
we supposed to do?
134
00:05:15,649 --> 00:05:16,684
My husband was home.
135
00:05:16,717 --> 00:05:17,951
Oh, God!
136
00:05:17,985 --> 00:05:19,387
Probably a small crack
in the pelvis.
137
00:05:19,420 --> 00:05:20,921
You've got this, right?
138
00:05:20,954 --> 00:05:23,624
Oh, I'm all over it.
139
00:05:23,657 --> 00:05:24,825
We'll give
you some morphine
140
00:05:24,858 --> 00:05:27,127
and wait for
your Viagra to wear off.
141
00:05:27,160 --> 00:05:30,664
Dr. Lewis told me
to present to you today.
142
00:05:30,698 --> 00:05:32,400
She did?
143
00:05:32,400 --> 00:05:34,502
Something about interns having
a primary attending.
144
00:05:36,003 --> 00:05:37,004
Okay.
145
00:05:37,037 --> 00:05:38,672
I hope you'll show me
146
00:05:38,706 --> 00:05:40,107
that combat procedure
you mentioned last shift.
147
00:05:40,140 --> 00:05:41,942
The femoral tear?
148
00:05:41,975 --> 00:05:44,845
Oh, depends on, uh,
whether we get a patient
149
00:05:44,878 --> 00:05:47,080
who needs
emergent central access.
150
00:05:47,114 --> 00:05:48,416
Well, whenever we do.
151
00:05:48,416 --> 00:05:49,517
Uh...
152
00:05:49,550 --> 00:05:51,552
Sorry.
153
00:05:51,585 --> 00:05:54,755
Uh...
154
00:05:54,788 --> 00:05:57,157
Infected anal fissure,
parked in the hallway.
155
00:05:57,190 --> 00:05:58,492
Okay.
156
00:06:02,095 --> 00:06:03,831
Pupils four millimeters
and reactive.
157
00:06:03,864 --> 00:06:05,433
Ten centimeters JVD.
158
00:06:05,433 --> 00:06:06,767
My wife is not
gonna be happy.
159
00:06:06,800 --> 00:06:09,437
It's okay, Dad.
It was my idea.
160
00:06:09,437 --> 00:06:11,171
Take it Mom wasn't aware
of the driving lessons?
161
00:06:11,204 --> 00:06:14,808
If she had it her way, I'd never
be let out of the house.
162
00:06:14,842 --> 00:06:16,544
We're kind of separated for now.
163
00:06:16,577 --> 00:06:17,845
Katie was with me this week.
164
00:06:17,878 --> 00:06:20,113
She take any
medications?
165
00:06:20,147 --> 00:06:21,148
Prednisone,
166
00:06:21,181 --> 00:06:23,050
Tacrilomus...
167
00:06:23,083 --> 00:06:24,485
The anti-rejection drug?
168
00:06:24,518 --> 00:06:26,186
She had a kidney
transplant last year.
169
00:06:26,219 --> 00:06:28,456
I have polycystic
kidney disease.
170
00:06:28,456 --> 00:06:29,623
We were on
the UNOS list
171
00:06:29,657 --> 00:06:31,459
for seven years
waiting for a donor.
172
00:06:31,459 --> 00:06:33,461
I'm a big fan of dialysis.
173
00:06:33,494 --> 00:06:35,463
She's got blood
type O with an 80%
174
00:06:35,463 --> 00:06:37,130
reactive antibody panel.
175
00:06:37,164 --> 00:06:38,599
Tough match.
176
00:06:38,632 --> 00:06:39,833
Yeah, well, finally
got big enough
177
00:06:39,867 --> 00:06:42,135
that I could
give her one of mine.
178
00:06:42,169 --> 00:06:43,804
Your kidney?
179
00:06:43,837 --> 00:06:45,873
What a dad, huh?
180
00:06:45,906 --> 00:06:48,542
Any other meds?
181
00:06:48,576 --> 00:06:51,011
Uh, yeah, she's on an
anti-seizure drug, too.
182
00:06:51,044 --> 00:06:53,013
The PKD gave her
an aneurysm.
183
00:06:53,046 --> 00:06:54,615
Mom's on the way, sweetie.
184
00:06:54,648 --> 00:06:56,584
Thanks.
185
00:06:56,617 --> 00:06:58,552
Okay, a few crackles
at the base.
186
00:07:00,554 --> 00:07:02,590
Bradycardic at 48.
187
00:07:02,623 --> 00:07:04,958
Whoa, peaked T waves,
widened QRS.
188
00:07:07,160 --> 00:07:10,197
Amp of bicarb,
10 cc's of calcium gluconate.
189
00:07:10,230 --> 00:07:11,665
What do you think's going on?
190
00:07:11,699 --> 00:07:15,636
Um, well, low heart
rate, dizziness,
191
00:07:15,669 --> 00:07:19,206
and the EKG changes--
could be hyperkalemia.
192
00:07:19,239 --> 00:07:20,641
What?
193
00:07:20,674 --> 00:07:22,242
No, no, no, that
can't be that.
194
00:07:22,275 --> 00:07:23,777
KOVAC:
Hey, John?
195
00:07:23,811 --> 00:07:25,513
Since the transplant,
her kidney has been fine.
196
00:07:25,546 --> 00:07:27,247
Why don't we wait and see
197
00:07:27,280 --> 00:07:28,549
what the blood tests show and
then we'll take it from there.
198
00:07:28,582 --> 00:07:29,817
Excuse me
for one second.
199
00:07:32,085 --> 00:07:33,053
Do you need
an intern on this?
200
00:07:33,086 --> 00:07:34,788
I got Ray.
201
00:07:34,822 --> 00:07:37,157
Uh, what do you think about
taking Neela instead?
202
00:07:37,190 --> 00:07:38,792
Why, is there a problem?
203
00:07:38,826 --> 00:07:40,127
Just do me a favor, okay?
204
00:07:40,160 --> 00:07:41,562
All right.
205
00:07:41,595 --> 00:07:43,531
Send the Punjabi Powerhouse
my way.
206
00:07:43,564 --> 00:07:44,865
Painless jaundice
in Three
207
00:07:44,898 --> 00:07:46,066
and ulnar styloid
fracture.
208
00:07:46,099 --> 00:07:47,835
I'll take those.
209
00:07:47,868 --> 00:07:49,570
Uh, there was
210
00:07:49,603 --> 00:07:51,004
a little change--
you're with Carter today.
211
00:07:51,038 --> 00:07:52,606
I thought I was with you?
212
00:07:52,640 --> 00:07:53,907
No, he needs you in Trauma One.
213
00:07:58,612 --> 00:08:00,948
Isolated pubic
ramus fracture.
214
00:08:00,981 --> 00:08:02,550
Will I be, you know...
all right?
215
00:08:02,550 --> 00:08:05,586
No cast, no surgery,
just rest and pain meds.
216
00:08:05,619 --> 00:08:06,987
But you're going
to have to be careful
217
00:08:07,020 --> 00:08:08,889
for a couple of weeks
until it heals.
218
00:08:08,922 --> 00:08:09,890
Careful?
219
00:08:09,923 --> 00:08:12,560
Yes, as in "abstinent."
220
00:08:12,560 --> 00:08:14,962
The safest sex of all.
221
00:08:14,995 --> 00:08:16,830
Abstinent? Are you serious?
222
00:08:16,864 --> 00:08:18,198
You can't put any
pressure on your pelvis
223
00:08:18,231 --> 00:08:19,600
or you're going
to end up right back here,
224
00:08:19,633 --> 00:08:21,569
which is not
what we want to see.
225
00:08:21,569 --> 00:08:23,571
So it's the pelvis
we should worry about?
226
00:08:23,604 --> 00:08:24,605
That's right.
227
00:08:24,638 --> 00:08:25,973
But other positions...?
228
00:08:26,006 --> 00:08:27,240
Yeah, sure,
get yourself
229
00:08:27,274 --> 00:08:29,009
a six-pack,
a copy of the Kama Sutra
230
00:08:29,042 --> 00:08:31,311
and shoot out the lights.
231
00:08:31,344 --> 00:08:33,614
Did we do something
to offend her?
232
00:08:33,647 --> 00:08:36,584
Pulse is up to 61,
B.P.'s stable.
233
00:08:36,617 --> 00:08:38,652
Looks like the QRS
complexes are narrowing.
234
00:08:38,686 --> 00:08:40,654
That's good.
That is good.
235
00:08:40,688 --> 00:08:41,855
Lab says the chemistry
machine is down,
236
00:08:41,889 --> 00:08:43,691
it should be up in an hour.
237
00:08:43,724 --> 00:08:45,258
So you can't say yet
if it's a kidney problem?
238
00:08:45,292 --> 00:08:46,860
The urine dip shows
four plus protein,
239
00:08:46,894 --> 00:08:47,928
but we really
won't know anything
240
00:08:47,961 --> 00:08:48,962
until the labs
come back.
241
00:08:48,996 --> 00:08:50,598
I told them to hurry.
242
00:08:50,631 --> 00:08:52,700
Honey, are you okay?
243
00:08:52,733 --> 00:08:55,603
I'm fine, Mom.
It was nothing.
244
00:08:55,636 --> 00:08:57,705
I told you it was too
soon for her to drive.
What were you thinking?
245
00:08:57,738 --> 00:08:59,907
She's 16. She wants
a learner's permit.
246
00:08:59,940 --> 00:09:01,341
You never know when
to stop, do you?
247
00:09:01,374 --> 00:09:03,010
Mom, please.
Let's not do this here.
248
00:09:03,043 --> 00:09:04,845
I need more of Katie's
family history.
249
00:09:04,878 --> 00:09:08,315
Can we all step outside and
give Katie a chance to rest?
250
00:09:08,348 --> 00:09:10,618
I'll be back,
okay, sweetie?
251
00:09:15,889 --> 00:09:17,758
I've been sick for so long,
252
00:09:17,791 --> 00:09:20,728
it just got to be
too much for them.
253
00:09:20,761 --> 00:09:23,230
GABRIEL:
She was on dilantin
for a long time, but, uh,
254
00:09:23,263 --> 00:09:24,765
she didn't like it.
255
00:09:24,798 --> 00:09:25,899
It changed the way she looked.
256
00:09:25,933 --> 00:09:27,267
And she was still having these
257
00:09:27,300 --> 00:09:28,301
breakthrough seizures
once a month.
258
00:09:28,335 --> 00:09:29,970
It was manageable.
259
00:09:30,003 --> 00:09:32,706
No, honey, she had them
at school, in the movies...
260
00:09:32,740 --> 00:09:33,841
She hated it.
261
00:09:33,874 --> 00:09:36,109
So you switched her medication?
262
00:09:36,143 --> 00:09:37,911
Three months ago,
we put her on Zarictal.
263
00:09:37,945 --> 00:09:39,680
It was not my choice.
264
00:09:39,713 --> 00:09:41,181
Zarictal?
265
00:09:41,214 --> 00:09:42,950
Uh, it's new.
And we can't
afford it.
266
00:09:42,983 --> 00:09:44,351
Medicare does
not cover it.
267
00:09:44,384 --> 00:09:46,787
I took a second job
working night security
268
00:09:46,820 --> 00:09:47,921
over at the Maller's
Building.
269
00:09:47,955 --> 00:09:49,322
We lost
our apartment.
270
00:09:49,356 --> 00:09:50,824
She's been doing great.
271
00:09:50,858 --> 00:09:53,193
Katie has been seizure-free
for three months.
272
00:09:53,226 --> 00:09:56,029
No infections,
no febrile illnesses?
273
00:09:57,798 --> 00:10:00,000
Have they switched her
dosage of, uh, Zarictal?
274
00:10:00,033 --> 00:10:01,201
Everything's been steady.
275
00:10:01,234 --> 00:10:02,836
She was doing
fine before.
276
00:10:02,870 --> 00:10:04,004
I don't know why...
277
00:10:04,037 --> 00:10:06,206
She wanted to drive.
278
00:10:06,239 --> 00:10:08,075
Like other kids.
279
00:10:08,108 --> 00:10:09,677
And with the seizures
she couldn't get a license.
280
00:10:09,710 --> 00:10:11,278
We almost
lost her once,
281
00:10:11,311 --> 00:10:15,115
and you're worried about
her being able to drive?
282
00:10:16,984 --> 00:10:19,653
I'm sorry. I'm sorry.
283
00:10:19,687 --> 00:10:21,789
Look, I don't
want to fight, okay?
284
00:10:21,822 --> 00:10:23,691
I just think it's time
that we accept that fact
285
00:10:23,724 --> 00:10:25,358
that she will never
be totally healthy.
286
00:10:25,392 --> 00:10:27,160
Why? Why should I accept that?
Because that
is the reality.
287
00:10:27,194 --> 00:10:29,429
Not for me.
288
00:10:29,462 --> 00:10:31,264
( sighs )
289
00:10:35,002 --> 00:10:37,170
You have a neurologist?
290
00:10:37,204 --> 00:10:38,338
Yeah, he's been great.
291
00:10:38,371 --> 00:10:40,340
Good. Why don't we
give him a call?
292
00:10:40,373 --> 00:10:42,876
I'd like to talk to him
about the medications.
293
00:10:45,846 --> 00:10:47,247
Sounds like
a hard situation.
294
00:10:47,280 --> 00:10:49,750
I want you to look up this
new drug for me-- Zarictal.
295
00:10:49,783 --> 00:10:51,284
Oh, yeah, I had
a patient on that
296
00:10:51,318 --> 00:10:53,386
last year during my
Internal Medicine rotation.
297
00:10:53,420 --> 00:10:54,822
Really? I never
heard of it before.
298
00:10:54,855 --> 00:10:56,323
Well, it's pretty new.
299
00:10:56,356 --> 00:10:58,091
Expensive, but very
effective for seizure control.
300
00:10:58,125 --> 00:11:00,861
You kids and your
fancy book-learning.
301
00:11:00,894 --> 00:11:01,995
I try to keep up.
302
00:11:02,029 --> 00:11:03,731
Do a PDR and
check a medline.
303
00:11:03,764 --> 00:11:05,198
See if there's anything
about renal dysfunction
304
00:11:05,232 --> 00:11:06,900
associated with the drug.
305
00:11:09,002 --> 00:11:11,071
Hi.
Hi.
306
00:11:11,104 --> 00:11:13,741
This is
George Guidry.
307
00:11:13,741 --> 00:11:15,108
He's got a skin
breakdown
308
00:11:15,142 --> 00:11:18,211
around the shaft
of his penis.
309
00:11:18,245 --> 00:11:19,747
No he doesn't.
310
00:11:19,747 --> 00:11:21,982
I think I do.
311
00:11:22,015 --> 00:11:23,250
Any discharge?
312
00:11:23,283 --> 00:11:24,451
Oh, yeah, definitely.
313
00:11:24,484 --> 00:11:25,886
I'm not talking about that.
314
00:11:25,919 --> 00:11:27,420
No discharge, no fever,
no blisters.
315
00:11:27,454 --> 00:11:29,089
Do you use a condom?
316
00:11:29,122 --> 00:11:30,290
Not since my girlfriend
317
00:11:30,323 --> 00:11:32,092
broke up with me
a few months back.
318
00:11:32,125 --> 00:11:34,928
No vesicles, no chancre,
no lymphadenopathy.
319
00:11:34,962 --> 00:11:39,032
Okay.
Let's take a gander.
320
00:11:39,066 --> 00:11:41,001
You know, I just thought
of something.
321
00:11:41,034 --> 00:11:44,171
Could this be from too much...
322
00:11:44,204 --> 00:11:47,340
You know.
323
00:11:47,374 --> 00:11:48,441
Too much what?
324
00:11:50,911 --> 00:11:52,145
Since Lily left,
325
00:11:52,179 --> 00:11:55,015
I've been lonely,
you know?
326
00:11:55,048 --> 00:11:59,853
Really,
really lonely.
327
00:11:59,887 --> 00:12:01,121
How lonely?
328
00:12:01,154 --> 00:12:04,224
Oh, six, sometimes
seven times a day.
329
00:12:12,265 --> 00:12:13,400
I found a case report
330
00:12:13,433 --> 00:12:14,835
in the Western
Journal of Medicine.
331
00:12:14,868 --> 00:12:16,136
It suggests
a correlation between
332
00:12:16,169 --> 00:12:18,138
renal failure
and Zarictal.
333
00:12:18,171 --> 00:12:20,073
Mm, well, that ain't much.
334
00:12:20,107 --> 00:12:22,409
No, but these might be.
335
00:12:22,442 --> 00:12:24,144
From the Adverse Drug
Coordinator
336
00:12:24,177 --> 00:12:26,313
from the Department
of Health Services.
337
00:12:26,346 --> 00:12:28,448
Three more possible cases
they've forwarded to the FDA.
338
00:12:28,481 --> 00:12:31,018
Four, that could
be a pattern.
339
00:12:31,051 --> 00:12:32,385
The physician relations number
340
00:12:32,419 --> 00:12:34,487
at the Keating-Ward
Pharmaceuticals.
341
00:12:34,521 --> 00:12:36,056
They make Zarictal.
342
00:12:36,089 --> 00:12:39,292
Might as well see
what they can tell us.
343
00:12:39,326 --> 00:12:41,394
Yes.
344
00:12:41,428 --> 00:12:43,063
Hi, this is John Carter.
345
00:12:43,096 --> 00:12:45,833
I'm a physician at
County General in Chicago.
346
00:12:45,833 --> 00:12:46,900
Very well, thank you.
347
00:12:46,934 --> 00:12:48,068
I have
a 16-year-old girl,
348
00:12:48,101 --> 00:12:50,070
status post
renal transplant,
349
00:12:50,103 --> 00:12:53,340
who's been on Zarictal
for three months.
350
00:12:53,373 --> 00:12:55,142
Yes, and I was wondering
if I could talk to somebody
351
00:12:55,175 --> 00:12:58,078
about the incidence
of renal failure.
352
00:12:58,111 --> 00:13:00,147
Yes, I will hold.
353
00:13:00,180 --> 00:13:01,481
( muzak plays )
354
00:13:01,514 --> 00:13:03,083
Does anybody even
listen to that music?
355
00:13:03,116 --> 00:13:04,317
It's terrible.
356
00:13:04,351 --> 00:13:06,519
Carter, GRS is widening
on our PKD girl.
357
00:13:06,553 --> 00:13:08,055
Lots of ectopy.
I'll hold.
358
00:13:11,892 --> 00:13:13,593
Multifocal PVC's,
runs of six.
359
00:13:13,626 --> 00:13:15,028
Push 80 of lidocaine
360
00:13:15,062 --> 00:13:16,163
and mix up a drip
at one mig a minute.
361
00:13:16,196 --> 00:13:17,597
What's going on?
362
00:13:17,630 --> 00:13:19,066
It's possible that
the elevated potassium
363
00:13:19,099 --> 00:13:20,300
is irritating
Katie's heart.
364
00:13:20,333 --> 00:13:22,269
B.U.N. 98, creatinine 12.3,
365
00:13:22,302 --> 00:13:23,971
potassium 7.2.
366
00:13:24,004 --> 00:13:26,073
Sounds like she might
be in kidney failure.
367
00:13:26,106 --> 00:13:27,607
V fib.
Starting compressions.
368
00:13:27,640 --> 00:13:29,209
CARTER:
Okay, charge
the paddles to 200.
369
00:13:29,242 --> 00:13:31,378
She's all right.
It's going to be okay.
370
00:13:31,411 --> 00:13:32,913
I need
everybody clear.
371
00:13:32,946 --> 00:13:34,347
( gasps )
372
00:13:36,950 --> 00:13:37,951
Procainamide's on board.
373
00:13:37,985 --> 00:13:39,019
And clear.
374
00:13:40,220 --> 00:13:41,554
Sinus.
There we go.
375
00:13:41,588 --> 00:13:43,356
All right, set me up
for a femoral Quinton
376
00:13:43,390 --> 00:13:44,892
and call dialysis
for renal orders.
377
00:13:44,892 --> 00:13:46,626
Katie, honey.
Katie, honey.
378
00:13:46,659 --> 00:13:49,162
Yeah, she's responding.
379
00:13:49,196 --> 00:13:50,497
JARVIK:
O2 at 15 liters.
380
00:13:50,530 --> 00:13:51,899
Are you sure
she needs dialysis?
381
00:13:51,932 --> 00:13:53,266
CARTER:
It's the best way
382
00:13:53,300 --> 00:13:54,968
to remove the excess potassium
from her system.
383
00:13:55,002 --> 00:13:57,270
Does that mean she has
to have another transplant?
384
00:13:57,304 --> 00:13:59,606
CARTER:
Uh, that is a distinct
possibility, yes.
385
00:13:59,639 --> 00:14:01,541
Okay, betadine
in the area?
386
00:14:01,574 --> 00:14:03,376
NEELA:
They said they'd be
in contact within a week.
387
00:14:03,410 --> 00:14:04,244
CARTER:
And one per cent lido.
388
00:14:04,277 --> 00:14:05,946
A week?
389
00:14:05,979 --> 00:14:06,914
NEELA:
That's the
standard procedure.
390
00:14:06,947 --> 00:14:07,915
GABRIEL:
What's that?
391
00:14:07,915 --> 00:14:09,282
We telephoned the company
392
00:14:09,316 --> 00:14:10,550
that makes Katie's
seizure medication.
393
00:14:10,583 --> 00:14:11,584
So is it the drugs?
394
00:14:11,618 --> 00:14:13,220
Is that why this
is happening?
395
00:14:13,253 --> 00:14:14,487
The timing
of the med switch
396
00:14:14,521 --> 00:14:16,623
makes me think
it's a possibility, yes.
397
00:14:16,656 --> 00:14:18,058
HANNAH:
So, you mean her kidney's
398
00:14:18,091 --> 00:14:19,459
being damaged
by the Zarictal is it?
399
00:14:19,492 --> 00:14:21,094
Gabriel, Hannah...
400
00:14:21,128 --> 00:14:22,595
I came as soon as I heard.
401
00:14:22,629 --> 00:14:23,596
Is she in status?
402
00:14:23,630 --> 00:14:25,365
No, It's her kidney.
403
00:14:25,398 --> 00:14:27,034
This is Katie's
neurologist,
George Henry.
404
00:14:28,601 --> 00:14:31,238
Dr. Carter, I don't know
if you remember me...
405
00:14:31,271 --> 00:14:32,439
Yeah, how are you,
Henry?
406
00:14:32,472 --> 00:14:34,007
What has it been,
six years?
407
00:14:34,041 --> 00:14:35,642
Give or take.
408
00:14:35,675 --> 00:14:37,244
Can you take them
to the family room?
409
00:14:37,277 --> 00:14:38,445
I'll be right in
to see you in a sec.
410
00:14:38,478 --> 00:14:40,113
Oh, okay.
Yeah, that's fine.
411
00:14:40,147 --> 00:14:41,548
I think I remember the way.
412
00:14:41,581 --> 00:14:45,118
Come on,
it's all right.
413
00:14:45,152 --> 00:14:46,419
JAKE:
I gave pleasure boy
414
00:14:46,453 --> 00:14:48,956
some Neosporin,
the number for a therapist
415
00:14:48,989 --> 00:14:49,957
and sent him packing.
416
00:14:49,957 --> 00:14:51,024
Well done.
417
00:14:51,058 --> 00:14:52,025
How about you?
418
00:14:52,059 --> 00:14:53,160
Everything all right?
419
00:14:53,193 --> 00:14:55,562
Um, yes,
I'm fine. Busy.
420
00:14:55,595 --> 00:14:57,297
Why?
421
00:14:57,330 --> 00:14:59,566
Well, last week,
when I ran into you
on the El platform,
422
00:14:59,599 --> 00:15:02,202
I didn't realize
your situation.
423
00:15:02,235 --> 00:15:03,536
My situation?
424
00:15:03,570 --> 00:15:06,506
It's just that I...
425
00:15:06,539 --> 00:15:08,308
I heard what you
went through last week
426
00:15:08,341 --> 00:15:09,442
and I didn't want you to think
I was insensitive.
427
00:15:09,476 --> 00:15:11,278
Uh, no...
428
00:15:11,311 --> 00:15:15,115
I was happy not
to have to talk
about it actually.
429
00:15:15,148 --> 00:15:17,050
Okay. I guess I'm blowing
that now.
430
00:15:17,084 --> 00:15:19,519
I just...
431
00:15:19,552 --> 00:15:23,090
I want to make sure that there
isn't anything that I can do.
432
00:15:23,123 --> 00:15:25,692
Um, well, that's...
that's nice.
433
00:15:25,725 --> 00:15:29,062
It is. Thank you.
It's, um...
434
00:15:29,096 --> 00:15:31,731
Here's "H" and "P"
and get back to me.
435
00:15:31,764 --> 00:15:33,233
Right.
436
00:15:34,734 --> 00:15:36,669
Why did you put me
with this guy?
437
00:15:36,703 --> 00:15:38,571
When did everybody become
such schedule divas?
438
00:15:38,605 --> 00:15:40,040
Well, I don't need
a med student.
439
00:15:40,073 --> 00:15:41,308
I don't like them
very much
440
00:15:41,341 --> 00:15:42,409
and I'm just better
flying solo.
441
00:15:42,442 --> 00:15:44,044
Is there something wrong
with him?
442
00:15:44,077 --> 00:15:45,512
No, he's excellent.
He's-he's very good.
443
00:15:45,545 --> 00:15:46,713
He's excellent.
I just...
444
00:15:46,746 --> 00:15:48,648
Oh, no,
you like him, don't you?
445
00:15:48,681 --> 00:15:49,649
Okay, you know,
forget it.
446
00:15:49,682 --> 00:15:51,084
Oh, yes, you do,
you do!
447
00:15:51,118 --> 00:15:52,252
You're blushing.
448
00:15:52,285 --> 00:15:54,054
We never had
this conversation.
449
00:15:54,087 --> 00:15:56,156
Hey, haven't you had
enough of doctors?!
450
00:15:58,191 --> 00:16:00,093
Post a message on
the Neurology
and Renal news groups.
451
00:16:00,127 --> 00:16:01,328
Find out if anybody
else has anything
452
00:16:01,361 --> 00:16:02,462
on the drug's renal
toxicity.
453
00:16:02,495 --> 00:16:05,065
That could cause
a bit of a stir.
454
00:16:05,098 --> 00:16:07,334
Yeah... all right.
455
00:16:07,367 --> 00:16:09,302
Just ask
for any information
456
00:16:09,336 --> 00:16:11,204
that might help us best
determine the course
of treatment.
457
00:16:11,238 --> 00:16:12,705
HANNAH:
You heard what he said.
458
00:16:12,739 --> 00:16:14,141
I know. I don't
believe it's the drug.
459
00:16:14,174 --> 00:16:16,243
I think there are
other options...
460
00:16:16,276 --> 00:16:17,610
We have a dialysis tech
coming down
461
00:16:17,644 --> 00:16:19,512
and I called UNOS.
462
00:16:19,546 --> 00:16:21,114
They're going to put Katie
on the list for a new kidney.
463
00:16:21,148 --> 00:16:22,782
John,
that may be premature.
464
00:16:22,815 --> 00:16:24,484
Why don't we do
a biopsy?
465
00:16:24,517 --> 00:16:26,686
This may be a case of
rejection, not failure
466
00:16:26,719 --> 00:16:28,755
and a biopsy
would show us that.
467
00:16:28,788 --> 00:16:30,690
What's the difference?
468
00:16:30,723 --> 00:16:34,427
Well, a drug-induced
failure would require
a transplant.
469
00:16:34,461 --> 00:16:37,430
But, uh, rejection...
470
00:16:39,666 --> 00:16:43,770
Rejection could be reversed
with immunosuppressive agents.
471
00:16:46,506 --> 00:16:49,242
Well, let's do the biopsy.
472
00:16:49,276 --> 00:16:51,711
Okay, I'll put that in motion.
473
00:16:51,744 --> 00:16:54,747
Dr. Henry, can I have a word
with you outside, please?
474
00:16:54,781 --> 00:16:56,716
Excuse me
one second.
475
00:16:59,386 --> 00:17:01,321
Um...
476
00:17:01,354 --> 00:17:03,156
My intern's been doing
a little research.
477
00:17:03,190 --> 00:17:04,657
She's found four cases
of renal failure
478
00:17:04,691 --> 00:17:06,126
in patients on Zarictal.
479
00:17:06,159 --> 00:17:08,495
That doesn't
prove causation.
480
00:17:08,528 --> 00:17:10,530
No, but it gets you
going that way.
481
00:17:10,563 --> 00:17:13,333
Keating-Ward sponsored
a series of Phase Three
clinical trials.
482
00:17:13,366 --> 00:17:14,734
If there was any real risk,
483
00:17:14,767 --> 00:17:16,736
the FDA would never
have approved the drug.
484
00:17:16,769 --> 00:17:18,205
( chuckles )
485
00:17:18,238 --> 00:17:19,806
What, you never heard
of Vioxx or Rezulin?
486
00:17:19,839 --> 00:17:22,142
This is a very successful
anti-seizure medicine.
487
00:17:22,175 --> 00:17:24,744
It has improved Katie's
quality of life
dramatically.
488
00:17:24,777 --> 00:17:26,579
Dr. Carter,
dialysis is here.
489
00:17:26,613 --> 00:17:28,681
All right, will you page Dubenko
to come down for the biopsy?
490
00:17:28,715 --> 00:17:30,783
Sure. These need
your signature.
491
00:17:32,185 --> 00:17:33,286
Well, I hope you're right.
492
00:17:33,320 --> 00:17:34,587
Well, let's
be certain.
493
00:17:34,621 --> 00:17:36,123
You know, John,
I was really surprised
494
00:17:36,156 --> 00:17:37,357
to find you
still working here.
495
00:17:37,390 --> 00:17:38,325
Why is that?
496
00:17:38,358 --> 00:17:40,160
I don't know.
497
00:17:40,193 --> 00:17:42,862
I guess I thought
you would have
moved on by now.
498
00:17:42,895 --> 00:17:44,397
I guess I'm just a masochist
499
00:17:44,431 --> 00:17:45,465
that way.
500
00:17:45,498 --> 00:17:47,134
How about you?
501
00:17:47,134 --> 00:17:49,369
I thought you went
to go do, uh...
bench research.
502
00:17:49,402 --> 00:17:51,171
Yeah, well, I got tired
of it.
503
00:17:51,204 --> 00:17:52,739
You were good at it.
504
00:17:52,772 --> 00:17:55,708
I've got a wife and
two small children now.
505
00:17:55,742 --> 00:17:57,777
That changes
one's priorities.
506
00:17:57,810 --> 00:17:59,312
You mean money?
507
00:17:59,346 --> 00:18:01,214
Yeah, well, my practice
does offer me
508
00:18:01,248 --> 00:18:03,683
three times the salary
of an academic position.
509
00:18:05,285 --> 00:18:06,853
What about you,
huh?
510
00:18:06,886 --> 00:18:08,221
Married?
511
00:18:08,255 --> 00:18:09,822
Children?
512
00:18:09,856 --> 00:18:11,491
Not yet.
513
00:18:12,525 --> 00:18:13,626
Thanks.
514
00:18:16,929 --> 00:18:19,332
I'll find you when
the surgeon comes down.
515
00:18:27,274 --> 00:18:29,476
Are you moonlighting
as a word processor?
516
00:18:29,509 --> 00:18:31,178
Our PKD girl
is on a new drug,
517
00:18:31,178 --> 00:18:32,279
we're trying to get
information on.
518
00:18:32,312 --> 00:18:34,247
Hey, Sam.
Hey, Dr. Lewis.
519
00:18:34,281 --> 00:18:35,348
Morning.
520
00:18:35,382 --> 00:18:36,383
Hi.
521
00:18:36,416 --> 00:18:38,185
Has anyone seen...?
522
00:18:39,286 --> 00:18:41,488
Is that your coffee?
523
00:18:41,521 --> 00:18:43,256
Sorry.
524
00:18:43,290 --> 00:18:45,192
It's the nursing schedule,
not a cocktail napkin.
525
00:18:45,225 --> 00:18:47,260
BARDELLI:
GCS 12, B.P. 60
palp, brady at 52.
526
00:18:47,294 --> 00:18:48,528
KOVAC:
He fell from the roof?
527
00:18:48,561 --> 00:18:49,862
Taking down
his Christmas lights.
528
00:18:49,896 --> 00:18:51,264
He's gonna need
central access.
529
00:18:51,298 --> 00:18:52,599
Need some help?
Yeah, come on down.
530
00:18:52,632 --> 00:18:53,766
Carter doesn't
need you?
531
00:18:53,800 --> 00:18:55,935
Not at the moment, no.
532
00:18:55,968 --> 00:18:58,538
Okay, prime
the rapid infuser.
533
00:18:58,571 --> 00:18:59,806
Can't find a vein,
he's too clamped down.
534
00:18:59,839 --> 00:19:00,807
Pressure only 50.
535
00:19:00,840 --> 00:19:02,275
Heart rate's 42.
536
00:19:02,309 --> 00:19:03,510
Blood in the belly.
537
00:19:03,543 --> 00:19:04,944
He needs access.
He's about to arrest.
538
00:19:04,977 --> 00:19:06,779
Okay, set up for
a saphenous cutdown.
539
00:19:06,813 --> 00:19:10,417
Wouldn't a femoral
be easier to find?
And faster.
540
00:19:10,450 --> 00:19:11,551
It's probably
the same difference,
541
00:19:11,584 --> 00:19:13,553
but okay, femoral tear.
542
00:19:13,586 --> 00:19:15,222
Cool, I've never
done one before.
543
00:19:15,255 --> 00:19:16,323
You'll do the next one.
544
00:19:16,356 --> 00:19:17,790
Scalpel to Neela.
What?
545
00:19:17,824 --> 00:19:18,958
She's along
for the ride.
546
00:19:18,991 --> 00:19:20,227
I promised her.
547
00:19:20,227 --> 00:19:22,462
You promised her?
548
00:19:22,495 --> 00:19:24,464
Ten centimeters vertical slash.
549
00:19:25,698 --> 00:19:26,699
Starting here?
550
00:19:26,733 --> 00:19:27,934
Deep into the sub-Q.
551
00:19:27,967 --> 00:19:29,602
Level one is primed.
552
00:19:31,438 --> 00:19:33,473
Okay, and now you tear...
553
00:19:34,774 --> 00:19:35,908
Whoa.
554
00:19:35,942 --> 00:19:37,444
Got any sterile
surgical markers?
555
00:19:37,477 --> 00:19:38,945
There's the femoral vein.
556
00:19:38,978 --> 00:19:39,879
Cannulate it
557
00:19:39,912 --> 00:19:40,947
with the nine french.
558
00:19:45,352 --> 00:19:46,253
Let me try.
559
00:19:46,286 --> 00:19:46,986
No, I'll get it.
560
00:19:47,019 --> 00:19:48,621
Just reach under.
561
00:19:53,560 --> 00:19:55,862
Neela, focus on the field.
562
00:19:55,895 --> 00:19:56,896
Seldinger technique.
563
00:19:56,929 --> 00:19:57,897
You know what to do.
564
00:19:57,930 --> 00:20:01,234
Two units
ready to go.
565
00:20:01,268 --> 00:20:04,437
Sam, can you ask Dubenko to
come here when he's done?
566
00:20:04,471 --> 00:20:06,306
Yes, sir, Dr. Kovac.
567
00:20:11,010 --> 00:20:12,845
That's the lower lobe of
the kidney, right there.
568
00:20:12,879 --> 00:20:13,980
Mm-hmm,
mark the depth.
569
00:20:14,013 --> 00:20:14,981
Purple okay?
570
00:20:15,014 --> 00:20:16,349
It's my favorite color.
571
00:20:16,383 --> 00:20:17,350
Me, too.
572
00:20:17,384 --> 00:20:18,418
Three centimeters.
573
00:20:18,451 --> 00:20:19,852
They need you next door.
574
00:20:19,886 --> 00:20:21,454
What is this gonna do?
575
00:20:21,488 --> 00:20:23,856
It will tell us if your body
is rejecting the kidney.
576
00:20:23,890 --> 00:20:24,924
Lidocaine.
577
00:20:24,957 --> 00:20:26,626
That's a good thing, honey.
578
00:20:26,659 --> 00:20:27,727
All right, hold still.
579
00:20:27,760 --> 00:20:29,596
Little pinprick here.
580
00:20:30,830 --> 00:20:33,300
There you go.
581
00:20:33,333 --> 00:20:35,368
It would be, like,
20-something
582
00:20:35,402 --> 00:20:37,670
before I can get another one.
583
00:20:37,704 --> 00:20:38,971
No, that's not
gonna happen.
584
00:20:39,005 --> 00:20:40,407
Biopsy gun.
585
00:20:40,440 --> 00:20:42,041
You just need to tell
your immune system
586
00:20:42,074 --> 00:20:43,576
to stop being so picky.
587
00:20:49,716 --> 00:20:51,551
Firing.
588
00:20:51,584 --> 00:20:52,919
( muffled pop )
Dr. Carter,
589
00:20:52,952 --> 00:20:54,521
Dr. Weaver's on
the phone for you.
590
00:20:54,554 --> 00:20:56,589
She sounds kind of...
591
00:20:56,623 --> 00:20:57,590
Kind of what?
592
00:20:57,624 --> 00:20:59,058
Weaver-like.
593
00:20:59,091 --> 00:21:01,428
Um, I'll call her back.
594
00:21:01,461 --> 00:21:02,695
Purple, huh?
595
00:21:02,729 --> 00:21:05,365
I've always been partial
to azure myself.
596
00:21:05,398 --> 00:21:06,666
What's azure?
597
00:21:06,699 --> 00:21:08,668
Like your eyes.
598
00:21:08,701 --> 00:21:09,736
Send that off for
light microscopy,
599
00:21:09,769 --> 00:21:11,371
EM and IF staining.
600
00:21:15,608 --> 00:21:16,843
Pack the wound
with moist gauze.
601
00:21:16,876 --> 00:21:18,345
What do we have here?
602
00:21:18,378 --> 00:21:20,046
Belly bleed needs
a post-op head CT.
603
00:21:20,079 --> 00:21:21,381
And we have FFP thawing.
604
00:21:21,414 --> 00:21:22,949
Send it upstairs.
605
00:21:22,982 --> 00:21:25,418
Pressure's up to 100 systolic,
heart rate's 90.
606
00:21:28,788 --> 00:21:32,024
Dr. Kovac, I, uh...
607
00:21:32,058 --> 00:21:35,027
I never knew it was possible
to transfuse that fast.
608
00:21:35,061 --> 00:21:37,730
Well, that's the beauty of
the central venous cutdown.
609
00:21:37,764 --> 00:21:39,632
Now you know how to do it.
610
00:21:42,869 --> 00:21:44,437
So what made you
recommend Zarictal?
611
00:21:44,471 --> 00:21:46,506
I went to a luncheon
at Northwestern
612
00:21:46,539 --> 00:21:48,541
and I heard a
neurologist present
on the drug's efficacy.
613
00:21:48,575 --> 00:21:49,709
A neurologist
who was probably
614
00:21:49,742 --> 00:21:50,843
a paid consultant
of Keating-Ward.
615
00:21:50,877 --> 00:21:52,445
George.
So what?
616
00:21:52,479 --> 00:21:53,446
Dr. Carter.
It stopped
the seizures.
617
00:21:53,480 --> 00:21:55,014
Is everything all right?
618
00:21:55,047 --> 00:21:58,951
Um... if the biopsy doesn't
give us what we want,
619
00:21:58,985 --> 00:22:02,121
if she needs another kidney...
620
00:22:02,154 --> 00:22:05,124
could I give her my other one?
621
00:22:05,157 --> 00:22:07,059
That would require you
being on dialysis
622
00:22:07,093 --> 00:22:08,060
for the rest of your life.
623
00:22:08,094 --> 00:22:09,529
No, I understand that.
624
00:22:09,562 --> 00:22:11,063
I don't know
that it's even ethical
625
00:22:11,097 --> 00:22:14,401
for someone to donate
their only remaining kidney.
626
00:22:14,401 --> 00:22:17,437
So it's not possible?
627
00:22:17,470 --> 00:22:18,971
I just don't know
of any responsible doctor
628
00:22:19,005 --> 00:22:20,473
that would agree to do it.
629
00:22:21,708 --> 00:22:23,042
Gabe, listen, I...
630
00:22:23,075 --> 00:22:24,811
I know that you're scared.
631
00:22:24,844 --> 00:22:27,614
But let's just take this
one step at a time,
632
00:22:27,647 --> 00:22:28,515
okay?
633
00:22:28,548 --> 00:22:30,016
Okay.
634
00:22:30,049 --> 00:22:31,117
Why don't you go in there
and be with Katie.
635
00:22:31,150 --> 00:22:32,752
JARVIK:
Carter,
636
00:22:32,785 --> 00:22:35,522
some neurologist in Skokie
sent this fax for you.
637
00:22:35,555 --> 00:22:36,723
Thanks.
638
00:22:39,859 --> 00:22:42,695
It's a "Dear Doctor" letter
from the pharmaceutical company.
639
00:22:42,729 --> 00:22:44,697
It says that there have
been isolated cases
640
00:22:44,731 --> 00:22:45,832
of renal failure
on Zarictal.
641
00:22:45,865 --> 00:22:47,099
Yes, I know.
642
00:22:47,133 --> 00:22:48,568
And it recommends
monthly monitoring
643
00:22:48,601 --> 00:22:49,869
of renal function,
644
00:22:49,902 --> 00:22:51,571
which I've been doing
with Katie.
645
00:22:51,604 --> 00:22:53,172
BUN, creatinine.
646
00:22:53,205 --> 00:22:54,474
You got one of these?
647
00:22:54,507 --> 00:22:55,608
Yes, and so did you.
648
00:22:55,642 --> 00:22:56,843
Those letters
were sent out
649
00:22:56,876 --> 00:22:57,910
to every physician
in the country.
650
00:22:57,944 --> 00:22:58,978
They're sent as a caution.
651
00:22:59,011 --> 00:23:00,647
So you knew about this?
652
00:23:00,680 --> 00:23:01,848
Private practitioners
get letters like that
653
00:23:01,881 --> 00:23:03,115
all the time.
654
00:23:03,149 --> 00:23:04,684
I followed
it's recommendations.
655
00:23:04,717 --> 00:23:06,085
But you know what
the biopsy's going to show,
656
00:23:06,118 --> 00:23:07,687
'cause it says so
right here.
657
00:23:07,720 --> 00:23:08,988
Well, I'm hoping
that's not the case.
658
00:23:09,021 --> 00:23:10,690
Dr. Carter,
do you have a moment?
659
00:23:12,224 --> 00:23:13,960
Is there a problem?
No, Kerry, just...
660
00:23:13,993 --> 00:23:15,662
You posted a warning
about Zarictal
661
00:23:15,695 --> 00:23:17,897
on an Internet
message board?
662
00:23:19,666 --> 00:23:21,501
I posted a request
for some information.
663
00:23:21,534 --> 00:23:22,835
I'm getting a lot
of phone calls, John.
664
00:23:22,869 --> 00:23:24,136
I hate getting phone calls.
665
00:23:24,170 --> 00:23:26,205
Two neurologists,
our own head of nephrology,
666
00:23:26,238 --> 00:23:28,107
the regional director
from KW Pharmaceuticals.
667
00:23:28,140 --> 00:23:29,709
I'm just wanted to
be better informed
on a patient.
668
00:23:29,742 --> 00:23:31,578
By jumping to conclusions
based on skimpy evidence?
669
00:23:31,611 --> 00:23:33,513
Whoa. Tell it
to the Milners.
670
00:23:33,546 --> 00:23:34,847
They're gonna need
a new kidney for
their daughter.
671
00:23:34,881 --> 00:23:36,749
You have one sick girl,
that's unfortunate.
672
00:23:36,783 --> 00:23:37,884
The FDA and
the drug companies
673
00:23:37,917 --> 00:23:39,719
have access
to thousands of patients
674
00:23:39,752 --> 00:23:41,053
before they release
a drug to the public.
675
00:23:41,087 --> 00:23:42,589
They didn't use any
renal patients
676
00:23:42,622 --> 00:23:44,491
when they did
their clinical trial.
677
00:23:44,524 --> 00:23:46,058
They can't document
every side effect,
it's not feasible.
678
00:23:46,092 --> 00:23:47,694
You're working
beyond the limits
Are you telling me
679
00:23:47,727 --> 00:23:48,961
of your responsibility.
how to do my job?!
680
00:23:48,995 --> 00:23:49,996
Are you telling me
how to do my job?!
681
00:23:50,029 --> 00:23:51,664
I'm telling you,
682
00:23:51,698 --> 00:23:52,999
Please.
the FDA has an adverse
drug event division...
683
00:23:53,032 --> 00:23:55,101
Which is run by
political appointees...
684
00:23:55,134 --> 00:23:57,103
whose job it is to monitor
these kinds of things...
Please, please, please.
685
00:23:57,136 --> 00:23:58,671
funded by the
drug companies.
686
00:23:58,705 --> 00:24:00,106
...the number one
lobbyist in the country
687
00:24:00,139 --> 00:24:01,207
is the pharmaceutical
industry.
Come here.
688
00:24:01,240 --> 00:24:02,842
Come on.
689
00:24:04,977 --> 00:24:06,012
Pick up a bottle.
690
00:24:06,045 --> 00:24:07,514
Kerry...
Do it.
691
00:24:10,617 --> 00:24:12,018
Pravastatin.
692
00:24:12,051 --> 00:24:14,521
Saves millions from
heart attacks and strokes.
693
00:24:14,554 --> 00:24:15,788
Enoxaparin.
You know what this is?
694
00:24:15,822 --> 00:24:17,690
Yes, I do, it offers
better PE prohylaxis
695
00:24:17,724 --> 00:24:18,791
and allows DVT patients
696
00:24:18,825 --> 00:24:20,226
to be treated
at home.
697
00:24:20,259 --> 00:24:21,894
Linezolid.
698
00:24:21,928 --> 00:24:24,096
Fights off strains of MRSA
that used to be fatal.
699
00:24:24,130 --> 00:24:25,231
Kerry,
I think he gets it.
700
00:24:25,264 --> 00:24:26,833
Does he?
Yeah, he does.
701
00:24:26,866 --> 00:24:28,535
These drugs save lives.
702
00:24:28,568 --> 00:24:29,902
And the companies
that make them
703
00:24:29,936 --> 00:24:31,671
donate over
$20 million in grants
704
00:24:31,704 --> 00:24:33,105
to County's
academic programs.
705
00:24:33,139 --> 00:24:35,141
Without that, we wouldn't
have a hospital.
706
00:24:35,174 --> 00:24:36,275
We'd be standing in
a mini-mall right now.
707
00:24:36,308 --> 00:24:37,610
Oh, so that makes it okay
708
00:24:37,644 --> 00:24:39,178
to suppress
negative test results?
709
00:24:39,211 --> 00:24:40,847
Even at the risk of lives
like that little girl's?
710
00:24:40,880 --> 00:24:42,281
WEAVER:
Putting these
drugs out here
711
00:24:42,314 --> 00:24:44,216
and seeing how they
work is how we learn.
712
00:24:44,250 --> 00:24:45,885
It's how medicine advances.
713
00:24:45,918 --> 00:24:47,887
And that's not naive?
714
00:24:47,920 --> 00:24:50,790
Your job is to take care
of your patients,
715
00:24:50,823 --> 00:24:52,892
not start a crusade.
716
00:24:54,761 --> 00:24:55,928
Susan, you're the boss.
717
00:24:55,962 --> 00:24:57,564
Tell him to keep
his eye on the ball.
718
00:24:59,899 --> 00:25:02,902
No more computer access for you.
719
00:25:08,808 --> 00:25:10,643
It's like I forgot where I was.
720
00:25:10,677 --> 00:25:14,614
I was just looking at him
like he was a huge...
721
00:25:14,647 --> 00:25:15,915
cupcake.
722
00:25:15,948 --> 00:25:17,216
You want one?
723
00:25:17,249 --> 00:25:19,686
Ah, it's just
a metaphor, thanks.
724
00:25:19,719 --> 00:25:25,157
So you have a crush
on Luka?
725
00:25:25,191 --> 00:25:26,893
That's kinda weird.
726
00:25:26,926 --> 00:25:28,661
It's just a crush.
727
00:25:28,695 --> 00:25:31,631
Crushes are by nature
idealized, unrealistic...
728
00:25:31,664 --> 00:25:32,832
What about
Dr. Gibson?
729
00:25:32,865 --> 00:25:37,336
That sounded real,
gross, but real.
730
00:25:37,369 --> 00:25:39,005
My God, you're right.
731
00:25:39,038 --> 00:25:40,172
It's a pattern.
732
00:25:40,206 --> 00:25:41,608
I'm a slut
for authority.
733
00:25:41,608 --> 00:25:43,075
Stop it.
734
00:25:43,109 --> 00:25:44,010
Well, what about you?
735
00:25:44,043 --> 00:25:45,277
What about me?
736
00:25:45,311 --> 00:25:47,279
I heard you punched
your med student.
737
00:25:47,313 --> 00:25:51,651
So? He was bugging me.
738
00:25:51,684 --> 00:25:53,085
So you're hung up
on a subordinate.
739
00:25:53,119 --> 00:25:54,153
No, I'm not.
740
00:25:54,186 --> 00:25:55,622
I have a thing
for a supervisor.
741
00:25:55,622 --> 00:25:56,856
Oh, so what?
742
00:25:56,889 --> 00:25:58,958
I'm like the yin
to your yang?
743
00:25:58,991 --> 00:26:02,061
What are we gonna do?
744
00:26:02,094 --> 00:26:04,263
Ignore it and hope
it goes away.
745
00:26:04,296 --> 00:26:05,732
Right.
No need to discuss it.
746
00:26:05,765 --> 00:26:07,767
No. Denial works.
747
00:26:11,237 --> 00:26:13,205
Hey, Sam, dog bite in three.
I wrote for unasyn.
748
00:26:13,239 --> 00:26:14,674
Put it in the rack
and I'll get to it.
749
00:26:14,707 --> 00:26:16,042
Sam, did you check
on my biopsy results yet?
750
00:26:16,075 --> 00:26:17,910
Oh, yeah. Dubenko's
will be on his way down.
751
00:26:17,944 --> 00:26:19,145
What about my patient
in exam two?
752
00:26:19,178 --> 00:26:20,813
I'm waiting
on a repeat CBC.
753
00:26:20,847 --> 00:26:21,347
Sam?
754
00:26:21,380 --> 00:26:23,215
Done and sent.
755
00:26:23,249 --> 00:26:25,652
Nice seeing you all.
756
00:26:29,722 --> 00:26:32,659
Isometric vacuolization
of the renal tubular cells
757
00:26:32,659 --> 00:26:34,060
consistent
with drug toxicity.
758
00:26:34,093 --> 00:26:35,828
So there's no chance
that this is rejection?
759
00:26:35,862 --> 00:26:39,031
No tubulitis, no edema,
no inflammation.
760
00:26:39,065 --> 00:26:40,099
The girl needs
a new kidney.
761
00:26:40,132 --> 00:26:41,901
And it's from
the new drug?
762
00:26:41,934 --> 00:26:43,169
I'd say so, but, I, um,
763
00:26:43,202 --> 00:26:44,737
I don't want
to encourage you.
764
00:26:44,771 --> 00:26:46,105
Encourage me?
765
00:26:46,138 --> 00:26:47,740
Some of my
colleagues upstairs
were suggesting
766
00:26:47,774 --> 00:26:50,142
that you've been all over
the Internet with this.
767
00:26:50,176 --> 00:26:51,143
Just trying
to be thorough.
768
00:26:51,177 --> 00:26:52,411
Word of friendly advice?
769
00:26:52,444 --> 00:26:54,280
Don't piss off
the money people.
770
00:26:55,815 --> 00:26:58,084
Hi, everybody.
771
00:26:58,117 --> 00:27:00,252
Katie's biopsy results
and unfortunately,
772
00:27:00,286 --> 00:27:02,288
they are not
what we had hoped for.
773
00:27:05,792 --> 00:27:08,294
So it's not rejection?
774
00:27:10,062 --> 00:27:13,766
No. No,
it's irreversibly damaged.
775
00:27:13,800 --> 00:27:15,267
( sighs )
776
00:27:18,104 --> 00:27:21,340
And is this, is this
from the Zarictal?
777
00:27:21,373 --> 00:27:22,909
It could be from
the Tacrolimus
778
00:27:22,942 --> 00:27:23,943
she's been on
since the transplant.
779
00:27:23,976 --> 00:27:25,311
I doubt that.
780
00:27:25,344 --> 00:27:27,079
Her levels have been therapeutic
for two years.
781
00:27:30,216 --> 00:27:33,285
Wow. So, this, uh, this, uh,
782
00:27:33,319 --> 00:27:35,454
uh, drug that I've been working
two jobs to pay for
783
00:27:35,487 --> 00:27:38,090
just to make her life better
784
00:27:38,124 --> 00:27:41,027
has ruined
her donated kidney?
785
00:27:43,863 --> 00:27:45,965
I'm afraid so.
786
00:27:45,998 --> 00:27:47,066
You told me...
787
00:27:47,099 --> 00:27:49,035
You told us
it was working.
788
00:27:49,068 --> 00:27:51,938
Sometimes drug interaction
can only become apparent
789
00:27:51,971 --> 00:27:54,273
after the first year
or two of release.
790
00:27:54,306 --> 00:27:57,744
This couldn't have
been anticipated.
791
00:27:57,777 --> 00:28:00,412
So we're, we're back
to waiting?
792
00:28:00,446 --> 00:28:03,015
UNOS will prioritize
her for a new kidney.
793
00:28:03,049 --> 00:28:05,184
That'll take what, three, four
years, if we're lucky.
794
00:28:05,217 --> 00:28:06,886
Okay,
in the meantime,
795
00:28:06,919 --> 00:28:08,788
what I'd recommend is that
we get a surgeon down here
796
00:28:08,821 --> 00:28:10,823
to see her about creating
a forearm shunt
797
00:28:10,857 --> 00:28:12,458
to facilitate
dialysis access.
798
00:28:12,491 --> 00:28:14,393
We can take care
of that.
799
00:28:14,426 --> 00:28:16,195
So we're back
to where we started.
800
00:28:16,228 --> 00:28:18,898
She'll be on that dialysis
machine all through high school,
801
00:28:18,931 --> 00:28:20,466
through college?
802
00:28:20,499 --> 00:28:22,401
Well, just because it took
a while to get the kidney...
803
00:28:22,434 --> 00:28:23,803
No, It didn't take
804
00:28:23,836 --> 00:28:26,205
"a while."
There wasn't one.
805
00:28:26,238 --> 00:28:28,140
I gave her mine.
806
00:28:31,110 --> 00:28:33,212
( sniffles )
807
00:28:42,021 --> 00:28:43,222
We have given up a lot.
808
00:28:47,026 --> 00:28:48,460
Made a lot of sacrifices.
809
00:28:48,494 --> 00:28:50,997
( sobbing )
810
00:28:57,169 --> 00:29:01,908
You told me
this drug was worth it.
811
00:29:18,858 --> 00:29:19,859
Okay,
812
00:29:19,892 --> 00:29:22,294
uh, show me your incision.
813
00:29:22,328 --> 00:29:25,331
Fifth ICS, anterior
axillary line.
814
00:29:25,364 --> 00:29:26,398
Go for it.
815
00:29:30,202 --> 00:29:32,038
SAM:
Pulse ox is 92
on five liters.
816
00:29:36,208 --> 00:29:38,177
Push that in
just superior
to the rib.
817
00:29:42,481 --> 00:29:43,449
Okay,
818
00:29:43,482 --> 00:29:45,084
spread the clamp.
819
00:29:45,117 --> 00:29:46,518
Sats coming up.
820
00:29:48,587 --> 00:29:52,024
And slip your finger
into the pleural space.
821
00:29:53,860 --> 00:29:55,327
Uh, I lost the tract.
822
00:29:55,361 --> 00:29:58,164
Okay, keep your finger in there,
just guide the tube.
823
00:29:59,531 --> 00:30:01,968
I'm above the rib,
but it won't pass.
824
00:30:03,169 --> 00:30:05,304
There you go.
825
00:30:06,572 --> 00:30:07,874
Okay.
826
00:30:10,276 --> 00:30:12,211
That is where you
want to go.
827
00:30:12,244 --> 00:30:13,212
All right, I got it.
828
00:30:13,245 --> 00:30:14,914
Okay.
829
00:30:14,947 --> 00:30:16,582
Keep advancing.
830
00:30:16,615 --> 00:30:17,950
A little bit deeper,
831
00:30:17,984 --> 00:30:19,318
'cause you want
all the ports
832
00:30:19,351 --> 00:30:20,552
in the pleural space.
833
00:30:23,389 --> 00:30:24,590
Thoroseal's ready.
834
00:30:24,623 --> 00:30:25,591
So is suction.
835
00:30:25,624 --> 00:30:27,293
That's very good.
836
00:30:29,561 --> 00:30:31,163
Hello?
837
00:30:32,398 --> 00:30:36,302
Uh, okay, sew it in.
838
00:30:36,335 --> 00:30:37,369
( air pumping )
839
00:30:41,240 --> 00:30:43,175
Somebody put something
in the water today?
840
00:30:43,209 --> 00:30:47,046
Call it "pulseless
electrical activity
following trauma."
841
00:30:47,079 --> 00:30:48,214
Right.
842
00:30:48,247 --> 00:30:50,516
Change "blade"
into "scalpel."
843
00:30:50,549 --> 00:30:51,417
Don't say "torn."
844
00:30:51,450 --> 00:30:52,484
Say "dissected."
845
00:30:52,518 --> 00:30:54,653
Call it the
"field of exposure."
846
00:30:54,686 --> 00:30:56,555
You left out the size
of the cordis.
847
00:30:56,588 --> 00:30:58,224
Nine french.
848
00:30:58,257 --> 00:30:59,358
Okay, write it down.
849
00:30:59,391 --> 00:31:01,460
And not "blood."
850
00:31:01,493 --> 00:31:03,429
"Packed red cells."
851
00:31:03,462 --> 00:31:05,064
Okay, good job.
852
00:31:05,097 --> 00:31:07,133
Just make the changes
and I'll cosign.
853
00:31:07,166 --> 00:31:08,167
Okay.
854
00:31:08,200 --> 00:31:09,301
Hey, Neela,
855
00:31:11,971 --> 00:31:15,441
I hope I didn't give you
the wrong impression.
856
00:31:15,474 --> 00:31:17,443
You're a resident,
and I'm an attending.
857
00:31:17,476 --> 00:31:19,078
I mean, I want
to help you learn...
858
00:31:19,111 --> 00:31:20,346
Yeah, I-I got it.
859
00:31:20,379 --> 00:31:22,314
I understand. I'm sorry.
860
00:31:22,348 --> 00:31:23,983
It's just, I wouldn't want
anything to get in the way...
861
00:31:24,016 --> 00:31:26,152
I got it, I got it,
I got it. Thanks.
862
00:31:41,167 --> 00:31:42,468
Vitals are stable.
863
00:31:42,501 --> 00:31:44,103
I need to grab
an amp of bicarb.
864
00:31:44,136 --> 00:31:45,371
Okay.
865
00:31:47,506 --> 00:31:49,976
Katie's T-waves
are back to normal
866
00:31:50,009 --> 00:31:52,111
which means her
potassium has
come down.
867
00:31:52,144 --> 00:31:53,980
That's good.
868
00:31:54,646 --> 00:31:57,216
He went to work.
869
00:31:57,249 --> 00:31:58,517
Mr. Milner?
870
00:31:58,550 --> 00:32:00,619
Mm-hmm.
871
00:32:00,652 --> 00:32:04,390
He took
a second job
872
00:32:04,423 --> 00:32:08,460
as a security guard
over at the Jewelry Center
873
00:32:08,494 --> 00:32:13,465
just to try to help pay
for everything, you know?
874
00:32:15,767 --> 00:32:19,571
Nothing means more to him
than Katie getting well.
875
00:32:19,605 --> 00:32:22,374
Nothing.
876
00:32:22,408 --> 00:32:26,245
Her illness
just changed him.
877
00:32:26,278 --> 00:32:27,646
It ruined our marriage.
878
00:32:27,679 --> 00:32:29,648
It's important
to stay optimistic.
879
00:32:29,681 --> 00:32:31,383
( scoffs )
880
00:32:31,417 --> 00:32:34,386
A lot of good things
could still happen,
Mrs. Milner.
881
00:32:39,391 --> 00:32:42,228
MVC with passenger space
intrusion, ETA seven.
882
00:32:42,261 --> 00:32:43,262
Okay, we'll take it.
883
00:32:43,295 --> 00:32:44,296
What's MVC?
884
00:32:44,330 --> 00:32:45,564
"Motor Vehicle Collision."
885
00:32:45,597 --> 00:32:46,598
Another new protocol.
886
00:32:46,632 --> 00:32:48,234
No such thing as an accident.
887
00:32:48,267 --> 00:32:50,269
I liked "MVA."
888
00:32:50,302 --> 00:32:51,737
I like walks
in the springtime.
889
00:32:51,770 --> 00:32:53,472
John, a minute, please?
890
00:32:53,505 --> 00:32:55,041
I'll catch up to you.
891
00:32:55,074 --> 00:32:58,277
Um, I was aware
of the potential
for toxicity,
892
00:32:58,310 --> 00:32:59,478
but it was only one
case report
893
00:32:59,511 --> 00:33:01,047
in an obscure journal.
894
00:33:01,080 --> 00:33:02,714
Well, you could have
found out more than that
895
00:33:02,748 --> 00:33:04,216
doing a simple medline search.
896
00:33:04,250 --> 00:33:06,085
I can't do a medline
search every time
897
00:33:06,118 --> 00:33:08,054
I put a patient
on a new drug.
898
00:33:08,087 --> 00:33:09,655
Besides, I've got 20
patients on Zarictal.
899
00:33:09,688 --> 00:33:10,689
They're all doing well.
900
00:33:10,722 --> 00:33:12,124
20?!
Yes.
901
00:33:12,158 --> 00:33:14,060
What, are you on
the Keating-Ward payroll?
902
00:33:14,093 --> 00:33:16,528
Listen, as part
of an ongoing study,
903
00:33:16,562 --> 00:33:19,631
I send in a monthly update
on each patient's progress.
904
00:33:19,665 --> 00:33:21,233
And they compensate you?
905
00:33:21,267 --> 00:33:23,202
A small stipend
for my time.
906
00:33:23,235 --> 00:33:24,736
Oh-ho.
907
00:33:24,770 --> 00:33:26,572
Hope your medical
malpractice premiums
are paid in full.
908
00:33:26,605 --> 00:33:28,174
No, there's nothing
wrong with it.
909
00:33:28,207 --> 00:33:30,076
I am reimbursed
for helping to
monitor a new drug
910
00:33:30,109 --> 00:33:32,144
by doing thorough
patient evaluations.
911
00:33:32,178 --> 00:33:33,745
But the company will only
pay attention to it
912
00:33:33,779 --> 00:33:35,681
if it says exactly what
they want it to say.
913
00:33:35,714 --> 00:33:38,117
Her seizures stopped.
She was very happy.
914
00:33:38,150 --> 00:33:39,385
The father was thrilled.
915
00:33:39,418 --> 00:33:40,786
Yeah? He's real
thrilled now.
916
00:33:40,819 --> 00:33:42,754
Listen, I am trying to be
a cutting-edge clinician.
917
00:33:42,788 --> 00:33:44,090
Guys?
918
00:33:44,090 --> 00:33:45,657
That's what
the patients want.
919
00:33:45,691 --> 00:33:48,294
I have to offer them
the most efficacious
meds on the market.
920
00:33:48,327 --> 00:33:50,396
That problem is
that last part,
isn't it?
921
00:33:50,429 --> 00:33:52,098
Yo?
922
00:33:52,131 --> 00:33:53,565
What?
923
00:33:56,268 --> 00:33:57,569
( clears throat )
924
00:33:57,603 --> 00:33:58,737
Mr. Milner?
925
00:34:01,173 --> 00:34:04,143
Hey.
Hey.
926
00:34:04,176 --> 00:34:05,411
Uh... ( clears throat )
927
00:34:05,444 --> 00:34:07,413
I was...
928
00:34:10,282 --> 00:34:13,319
I was going to work
and I thought, "Why?"
929
00:34:13,352 --> 00:34:15,421
Whoa!
Whoa!
930
00:34:15,454 --> 00:34:17,123
What is the point now?
931
00:34:17,123 --> 00:34:20,659
Um, Gabe, p-put the gun away.
932
00:34:22,494 --> 00:34:24,663
I put everything
in your hands.
933
00:34:24,696 --> 00:34:25,664
Everything.
934
00:34:25,697 --> 00:34:28,800
And you let her down.
935
00:34:28,834 --> 00:34:32,404
Katie can still live a long,
productive life on dialysis.
936
00:34:33,605 --> 00:34:35,574
CARTER:
Okay, whoa,
whoa, whoa.
937
00:34:35,607 --> 00:34:36,708
Huh?
938
00:34:36,742 --> 00:34:37,576
Why, why, why shouldn't I?
939
00:34:37,609 --> 00:34:38,810
Why shouldn't I?
940
00:34:38,844 --> 00:34:40,279
You know what
we should do right now?
941
00:34:40,312 --> 00:34:42,148
Let's go inside and
see your family.
942
00:34:42,181 --> 00:34:43,182
Come on.
943
00:34:43,215 --> 00:34:44,383
Let's go inside
944
00:34:44,416 --> 00:34:45,851
and we'll see
your family right now.
945
00:34:49,721 --> 00:34:53,725
I want to give my kidney to her.
946
00:34:55,394 --> 00:34:56,595
Okay.
947
00:34:56,628 --> 00:34:58,397
Hey, maybe I was wrong
about that.
948
00:34:58,430 --> 00:35:01,167
Maybe you can be the donor.
949
00:35:01,167 --> 00:35:01,900
You're lying.
950
00:35:01,933 --> 00:35:03,502
I know you're lying.
951
00:35:07,473 --> 00:35:08,840
Fix her, okay?
952
00:35:08,874 --> 00:35:10,342
Yeah.
953
00:35:10,376 --> 00:35:11,677
For me.
954
00:35:11,710 --> 00:35:12,711
Yeah, we're gonna fix her.
955
00:35:16,382 --> 00:35:17,616
( all gasp )
956
00:35:17,649 --> 00:35:19,285
Sats are down to 88.
Can you see the cords?
957
00:35:21,553 --> 00:35:23,255
Lots of blood.
958
00:35:23,289 --> 00:35:24,590
All right, somebody
go find his wife.
959
00:35:24,623 --> 00:35:27,293
Okay, tube.
960
00:35:27,326 --> 00:35:28,594
And get that girl
out of here.
961
00:35:28,627 --> 00:35:31,263
Come on, let's move her
to another room.
962
00:35:31,297 --> 00:35:32,898
Grey matter covers
the occiput.
963
00:35:32,931 --> 00:35:34,266
Why the hell would
he do this?
964
00:35:34,300 --> 00:35:36,202
He was distraught.
965
00:35:36,202 --> 00:35:37,703
Pupils fixed
and dilated.
966
00:35:37,736 --> 00:35:39,871
Pressure's only 80/60.
967
00:35:39,905 --> 00:35:41,340
Start dopamine at 10 mikes.
968
00:35:41,373 --> 00:35:42,808
RASGOTRA:
No gag when I tubed him.
969
00:35:42,841 --> 00:35:44,210
DUBENKO:
No corneal reflex.
970
00:35:45,277 --> 00:35:46,578
Can he regain any function?
971
00:35:46,612 --> 00:35:48,247
No, he's as brain
dead as they come.
972
00:35:48,280 --> 00:35:49,248
I'll go talk to her.
973
00:35:49,281 --> 00:35:51,250
No, no, no,
wait, wait.
974
00:35:51,283 --> 00:35:52,718
Let me.
975
00:35:52,751 --> 00:35:54,486
I'm the family's doctor.
976
00:35:57,489 --> 00:35:59,858
Transplant
coordinator's down.
977
00:35:59,891 --> 00:36:01,560
( cries ):
No! No!
978
00:36:01,593 --> 00:36:02,894
I'm so sorry.
979
00:36:02,928 --> 00:36:04,763
No!
I'm very sorry.
980
00:36:04,796 --> 00:36:06,265
( crying )
981
00:36:09,968 --> 00:36:11,570
HERNANDEZ:
Technically,
982
00:36:11,603 --> 00:36:13,539
there's nobody else
who can give consent.
983
00:36:13,572 --> 00:36:15,941
The girl has a very rare
tissue type, Amparo.
984
00:36:15,974 --> 00:36:17,376
The father is a match.
985
00:36:17,409 --> 00:36:18,910
I've made that
clear to UNOS.
986
00:36:18,944 --> 00:36:21,513
Look, I'm trying to
get them to allow us
to proceed.
987
00:36:21,547 --> 00:36:23,749
For now, keep him on
an FIO2 of a hundred.
988
00:36:23,782 --> 00:36:24,950
And make sure
the girl's NPO
989
00:36:24,983 --> 00:36:26,518
in the hope that
she goes to the O.R.
990
00:36:26,552 --> 00:36:29,355
Just do everything
that you can, okay?
I will.
991
00:36:29,388 --> 00:36:31,257
WEAVER:
Go climb back under
your rock.
992
00:36:31,257 --> 00:36:32,658
Hey, I'm from the Trib.
It's a good paper.
993
00:36:32,691 --> 00:36:34,360
Yeah, right.
You guys endorsed Bush.
994
00:36:34,393 --> 00:36:36,362
Man, a guy shoots himself
in the ambulance bay.
995
00:36:36,395 --> 00:36:37,596
What's next, a plague of frogs?
996
00:36:37,629 --> 00:36:38,997
There's a small gang
of press outside.
997
00:36:39,030 --> 00:36:40,632
Someone from the ER
has to go talk to them,
998
00:36:40,666 --> 00:36:42,334
get them the hell
out of here.
999
00:36:42,368 --> 00:36:44,270
Well, obviously, the guy
was clinically depressed.
1000
00:36:44,270 --> 00:36:46,272
All we know is he's
in critical condition.
1001
00:36:46,272 --> 00:36:48,507
We can't go into
any details.
1002
00:36:48,540 --> 00:36:49,708
( sighs )
1003
00:36:49,741 --> 00:36:51,277
Heartfelt sympathy
to the family,
1004
00:36:51,277 --> 00:36:52,478
we're doing
everything we can.
1005
00:36:52,511 --> 00:36:54,646
You're good
with that, right?
1006
00:36:54,680 --> 00:36:56,482
You want me
to talk to them?
1007
00:36:56,515 --> 00:36:58,317
You treated
these people.
1008
00:36:58,350 --> 00:36:59,885
Just play up the fact
that we're respecting
1009
00:36:59,918 --> 00:37:01,920
the family's privacy,
okay?
1010
00:37:01,953 --> 00:37:03,389
MAP's only 90.
1011
00:37:03,422 --> 00:37:04,823
Can we go up
on the dopamine?
1012
00:37:04,856 --> 00:37:07,859
We're maxed out.
I got a P.R.N. for levophed.
1013
00:37:07,893 --> 00:37:09,595
Sounds good.
1014
00:37:11,930 --> 00:37:14,366
Maybe we need to talk?
1015
00:37:14,400 --> 00:37:16,335
Nah, we really don't.
1016
00:37:17,903 --> 00:37:19,971
It's just, he helped
me to adjust
1017
00:37:20,005 --> 00:37:21,340
coming back to work here.
1018
00:37:21,373 --> 00:37:22,774
He made things
a lot easier.
1019
00:37:22,808 --> 00:37:25,977
And I guess...
1020
00:37:26,011 --> 00:37:30,349
I don't know,
I got confused.
1021
00:37:30,382 --> 00:37:33,785
I get confused
every time I look at him.
1022
00:37:36,555 --> 00:37:39,491
Did you work on this family?
1023
00:37:39,525 --> 00:37:42,461
His daughter, yeah.
1024
00:37:42,494 --> 00:37:44,396
I'm sorry.
1025
00:37:46,765 --> 00:37:48,667
Levophed's going
at two mikes.
1026
00:37:48,700 --> 00:37:50,035
REPORTER:
Does Gabriel Milner
1027
00:37:50,068 --> 00:37:51,703
have a daughter being
treated in ER?
1028
00:37:51,737 --> 00:37:53,572
( clears throat ):
Yes, he does.
1029
00:37:53,605 --> 00:37:56,642
Now, is it true
that she's suffering
from kidney failure?
1030
00:37:56,675 --> 00:37:58,344
Uh, I can't say.
REPORTER 2:
Didn't you indicate
1031
00:37:58,377 --> 00:38:00,045
that earlier today
on a medical website?
1032
00:38:00,078 --> 00:38:02,381
No, I made some general
informational queries...
Abby.
1033
00:38:02,414 --> 00:38:03,882
that I can't discuss
the specifics.
1034
00:38:03,915 --> 00:38:05,417
Hey.
Hi.
1035
00:38:08,520 --> 00:38:10,522
Do you want to go get
something to eat?
1036
00:38:10,556 --> 00:38:15,627
I know this awesome
little Ethiopian place.
1037
00:38:15,661 --> 00:38:17,563
They make you eat
with your hands,
1038
00:38:17,596 --> 00:38:22,434
but I got sterile gloves
in my bag so it's okay.
1039
00:38:22,468 --> 00:38:23,702
Dinner...?
1040
00:38:23,735 --> 00:38:25,671
Yeah.
1041
00:38:25,704 --> 00:38:27,105
No.
1042
00:38:27,138 --> 00:38:28,574
But don't take it
personally.
1043
00:38:30,576 --> 00:38:32,644
( chuckling )
1044
00:38:32,678 --> 00:38:34,546
Okay. Uh...
1045
00:38:34,580 --> 00:38:36,615
I'm not really
a subtle guy.
1046
00:38:36,648 --> 00:38:38,984
But I was under
the impression
1047
00:38:39,017 --> 00:38:41,387
that there's sort of
a thing happening here.
1048
00:38:41,387 --> 00:38:44,490
Maybe not a big thing,
but still... a thing.
1049
00:38:44,523 --> 00:38:46,024
A thing?
1050
00:38:46,057 --> 00:38:50,128
Um... Yeah, yeah,
maybe there's a thing.
1051
00:38:50,161 --> 00:38:51,597
But you know what?
It's not...
1052
00:38:51,630 --> 00:38:52,764
Nothing's gonna happen.
1053
00:38:52,798 --> 00:38:54,466
Why is that?
1054
00:38:54,500 --> 00:38:56,067
Well, a lot of reasons,
1055
00:38:56,101 --> 00:38:58,470
most of which I won't mention
because I don't feel like
1056
00:38:58,504 --> 00:39:00,005
sharing my checkered past
with you...
1057
00:39:00,038 --> 00:39:00,972
Why?
1058
00:39:01,006 --> 00:39:02,741
or my various neuroses.
1059
00:39:02,774 --> 00:39:04,109
But there's one
really big reason
1060
00:39:04,142 --> 00:39:06,978
that's a deal breaker
for me.
1061
00:39:07,012 --> 00:39:08,880
You miss the beard?
1062
00:39:08,914 --> 00:39:10,482
No.
1063
00:39:10,516 --> 00:39:12,150
You're my student.
1064
00:39:12,183 --> 00:39:14,520
Ah...
1065
00:39:14,553 --> 00:39:16,688
I'm grading you.
1066
00:39:16,722 --> 00:39:18,724
Uh-huh.
1067
00:39:18,757 --> 00:39:21,092
Well, I think that that
is not appropriate.
1068
00:39:23,028 --> 00:39:24,563
And have a good night.
1069
00:39:26,698 --> 00:39:27,999
You know, um...
1070
00:39:28,033 --> 00:39:32,904
what if I was willing
to take an "F" right now?
1071
00:39:32,938 --> 00:39:34,940
I forgot to mention to you
1072
00:39:34,973 --> 00:39:37,876
that I'm dropping out
of med school.
1073
00:39:37,909 --> 00:39:41,580
Yeah, who wants to be
a doctor anyway?
1074
00:39:43,048 --> 00:39:45,083
( chuckles )
1075
00:39:45,116 --> 00:39:46,918
REPORTER:
Don't you think
it's incumbent upon you
1076
00:39:46,952 --> 00:39:49,721
to share the information about
possible fatal side effects
1077
00:39:49,755 --> 00:39:51,089
of a popular new drug?
1078
00:39:54,059 --> 00:39:57,596
Katie Milner was on Zarictal
for the three months.
1079
00:39:57,629 --> 00:39:59,665
And, yes, I believe the drug
ruined her kidney.
1080
00:39:59,698 --> 00:40:02,968
"Out of respect for the family,
that's all I can say."
1081
00:40:03,001 --> 00:40:04,436
Is that so hard?
1082
00:40:04,470 --> 00:40:05,804
They knew it all
already anyway.
1083
00:40:05,837 --> 00:40:07,105
No, they didn't.
1084
00:40:07,138 --> 00:40:08,607
What you're alleging
is potential slander
1085
00:40:08,640 --> 00:40:10,175
that could cost
the hospital millions
1086
00:40:10,208 --> 00:40:11,543
in pharmaceutical
support.
1087
00:40:11,577 --> 00:40:12,778
What, are you worried
about free pens
1088
00:40:12,811 --> 00:40:14,713
and coffee cups
and drug samples?
1089
00:40:14,746 --> 00:40:17,516
No, I'm worried
about research,
educational grants,
1090
00:40:17,549 --> 00:40:19,618
a little thing that
HIPPA likes to call
"patient confidentiality."
1091
00:40:19,651 --> 00:40:20,852
I didn't want to talk to
them in the first place!
1092
00:40:20,886 --> 00:40:22,454
"Out of respect
for the family..."
1093
00:40:22,488 --> 00:40:24,089
You want to talk to them
next time, then you do it.
1094
00:40:24,122 --> 00:40:25,691
It's your damn ER.
1095
00:40:25,724 --> 00:40:26,858
You're right.
I will.
Dr. Lewis?
1096
00:40:26,892 --> 00:40:28,660
Dr. Weaver.
1097
00:40:28,694 --> 00:40:31,229
Oh, I wonder what
she wants to talk
to me about.
1098
00:40:31,262 --> 00:40:33,198
It's true, right?
1099
00:40:33,231 --> 00:40:36,635
You did a good thing.
1100
00:40:36,668 --> 00:40:37,936
( sighs heavily )
1101
00:40:37,969 --> 00:40:39,605
You say that
like it matters.
1102
00:40:41,507 --> 00:40:42,774
You ready to go?
1103
00:40:42,808 --> 00:40:43,809
Yeah.
1104
00:40:49,615 --> 00:40:51,182
UNOS gave us the go-ahead.
1105
00:40:51,216 --> 00:40:52,684
We're gonna do
the transplant.
1106
00:40:52,718 --> 00:40:53,852
Oh, thank God.
1107
00:40:53,885 --> 00:40:55,621
They're bringing
Mr. Milner up.
1108
00:40:55,654 --> 00:40:57,923
Look, she doesn't know where
the kidney's coming from.
1109
00:40:57,956 --> 00:40:58,990
I haven't told her yet.
1110
00:40:59,024 --> 00:41:00,626
That can wait.
1111
00:41:00,659 --> 00:41:02,728
Let's go inside and talk
with the anesthesiologist.
1112
00:41:10,602 --> 00:41:12,704
You a medical student?
1113
00:41:12,738 --> 00:41:17,108
First-year resident.
1114
00:41:17,142 --> 00:41:19,845
How's that going?
1115
00:41:19,878 --> 00:41:23,849
Some days better than others.
I like it well enough.
1116
00:41:26,885 --> 00:41:29,120
What do you think
they'll tell Katie?
1117
00:41:29,154 --> 00:41:34,693
She'll tell her that
her father loved her.
1118
00:41:34,726 --> 00:41:35,994
Maybe too much.
1119
00:41:42,968 --> 00:41:45,571
The transplant surgery's
under way.
1120
00:41:49,340 --> 00:41:53,645
I can't take responsibility
for how the system works.
1121
00:41:53,679 --> 00:41:57,148
But I can try to do
my job better.
1122
00:41:57,182 --> 00:41:59,284
That's all
any of us can do.
1123
00:41:59,317 --> 00:42:01,086
I don't know why
I was surprised
1124
00:42:01,119 --> 00:42:03,121
to find you here.
1125
00:42:03,154 --> 00:42:05,190
Of course
you're still here.
1126
00:42:07,025 --> 00:42:08,927
Hope we see
each other again
1127
00:42:08,960 --> 00:42:11,029
under more favorable
circumstances.
1128
00:42:11,062 --> 00:42:14,199
You were always good to me
when I was a student.
1129
00:42:14,232 --> 00:42:15,934
I remember that.
1130
00:42:29,214 --> 00:42:31,650
Anspaugh wants
to see us and Weaver
1131
00:42:31,683 --> 00:42:33,752
in his office
tomorrow morning.
1132
00:42:33,785 --> 00:42:35,186
Suture removal
in curtain three.
1133
00:42:35,220 --> 00:42:37,355
Hey...
1134
00:42:37,388 --> 00:42:41,893
if any of this rolls back
onto you, I'm sorry.
1135
00:42:46,665 --> 00:42:47,899
Mr. Klossey.
1136
00:42:47,933 --> 00:42:49,067
Hi, doc.
1137
00:42:49,100 --> 00:42:50,802
How are you today?
1138
00:42:50,836 --> 00:42:52,738
What are we looking
at here?
1139
00:42:52,771 --> 00:42:55,641
I did this skiing
on Michigan Avenue.
1140
00:42:55,674 --> 00:42:58,209
Cross-country,
during the last big snow.
1141
00:42:58,243 --> 00:43:00,245
Little fall, gashed my arm,
1142
00:43:00,278 --> 00:43:02,247
but I hadn't done it
in ten years,
1143
00:43:02,280 --> 00:43:04,683
so even that felt good.
1144
00:43:04,716 --> 00:43:05,851
Why'd you stop?
1145
00:43:05,884 --> 00:43:08,654
Arthritis.
I had it bad.
1146
00:43:08,654 --> 00:43:09,921
Couldn't bowl,
1147
00:43:09,955 --> 00:43:12,190
couldn't sit in
those seats at Wrigley,
1148
00:43:12,223 --> 00:43:14,259
take my niece for a walk.
1149
00:43:14,292 --> 00:43:17,228
So what happened?
1150
00:43:17,262 --> 00:43:20,265
I saw an ad on TV
for Renuvium.
1151
00:43:20,298 --> 00:43:23,234
A doc at the clinic
gave me a prescription.
1152
00:43:23,268 --> 00:43:25,403
Fixed me right up.
1153
00:43:25,436 --> 00:43:26,972
Renuvium?
1154
00:43:27,005 --> 00:43:29,775
Yeah. A little red pill,
once in the morning,
1155
00:43:29,808 --> 00:43:31,176
let me do all those things
1156
00:43:31,209 --> 00:43:33,779
I thought I had
given up forever.
1157
00:43:33,812 --> 00:43:35,380
That's something, huh?
1158
00:43:35,413 --> 00:43:37,015
Yeah.
1159
00:43:37,048 --> 00:43:40,752
Okay, this might hurt
just a little bit.
1160
00:43:40,786 --> 00:43:44,255
Damn miracle of medicine,
that's what it is.
80519
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