Previously on ER:
I'll be back to work next month.
Ray Barnett. I don't think we've officially met.
Katey.
- You two live together? - Oh, we were roommates.
Hope you had benefits.
You don't want to have anything to do with me.
What about your little brother?
He'd like to get to know you, Greg.
He just met me.
I mean, ain't we brothers?
Curtis Ames?
Left-sided paralysis following an embolic stroke.
But I thought the case had no merit.
Guy wants his day in court.
It doesn't reflect on your abilities as a physician.
Skiles has got them working. And, with big ol' Ben Wallace,
they're definitely going to the playoffs again.
I remember when the NBA used to mean something.
Oscar Robertson, Walt Frazier.
Now it's all a bunch of gangsters with tattoos.
- And cornrows. - And slam dunks.
Oh, my! Hey, now, oh, now, hey, now.
- Set of lungs on that one! - Boy, if I was 20 years younger...
You'd still be her granddaddy.
- Is that Dr. Gregory Pratt? - The one and only.
What are you doing down here on the South Side?
I heard you bought a condo on the Gold Coast.
You drive down here in the Beemer or the Benz?
Hey, I walked from my apartment.
- How long has your hand been shaking? - Long as I can remember.
- Been to the doctor? - What for?
Lou Sanders' wife was having headaches.
20 grand in tests so they could tell her to take an aspirin.
Lanny Cole checked in the hospital for a stomachache.
Next day, he checked out through the morgue.
So what are you saying? Nobody here goes to the doctor?
- Hell, no. Not me. - Well, you should.
That's right. Dr. Pratt needs to make them car payments.
But seriously, you need to get your pressure checked.
They do that at the drugstore.
- Your sugar, your prostate... - No !
I wouldn't let Halle Berry stick her finger up my ass.
I sure as hell ain't going to let you.
I'll see you fools later.
Now, that's what I'm talking about.
Greg!
- Greg! - Chaz. What's up, man?
What's up? It's been a while, man.
Yeah, man. Too long. What are you doing around here?
I'm just waiting for a friend before class.
Okay. Where'd you wind up at school?
- UIC. - That's good, man.
- So how's it going over there? - It's going all right.
I'm running a little late.
Yeah. Me, too. I got to get out of here.
We should kick it sometime.
Definitely. You know where I am.
- Cool. Good seeing you, man. - You, too. Be safe.
You'll probably be home before me, and Miriam has to leave at 6:00.
Okay.
Okay, Joe, let's review PEA, hmm?
Treatable conditions include hypovolemia,
tension pneumothorax,
cardiac tamponade, MI and...
and... what's another cause of PEA?
A reversible etiology of PEA.
- Massive pulmonary embolus. - See, how could I forget that?
You'll be fine.
I don't know. My brain is like...
Sorry.
Sorry, sorry.
- I have to review this. - Ten times?
I gave my deposition a year ago. It looks really bad
- if I contradict myself. - You didn't do anything wrong.
Just tell the truth. You didn't do anything... Sorry.
Okay.
Who's that, huh?
Want to go see who's at the door?
Who's at the door? It's Miriam.
She's going to take you to the park.
I suppose, if I really can't remember something, I could run it by the Attending,
but I just don't want to bug them all day, like I'm a med student or something.
You okay?
No. The guy's going to be so sympathetic to the jury...
But he doesn't have a case.
You're going to be fine.
If I lose, they report me to the National Data Bank.
It follows me wherever I go for the rest of my career.
I could be turned down for a job. It could cut back our income. It can...
- You want me to come to court? - No. You got a shift.
Well, they've been doing just fine without me for the past couple of months.
No. It's more important for you to be at work.
Okay.
Good luck.
- Thanks. - Call me.
The plaintiff's attorney will provoke you--
try to get under your skin.
So you need to stay cool.
If you get defensive, the jury will turn against you.
- Yeah. - And keep it brief.
If you elaborate, they'll think you're being evasive.
Don't worry about getting the whole story out at once.
I'll have a chance to ask follow-up questions later.
Right. Um... I'll... I'll meet you inside.
Mr. Ames, I'm... I'm sorry we're here.
I was hoping this wouldn't have to go to trial.
I came in with a cough,
and you sent me out a cripple.
I'm willing to pick up a few boards from the night shift.
Diverticular abscess awaiting
- CT guided drain... - Hey stranger, welcome back.
- Thanks. - I want to see pictures.
Diverticular abscess awaiting CT guided drainage.
- A-fib patient... - Hey, Abby.
This is kind of embarrassing, but I never got around to wrapping your baby gift.
- Oh, that's great. - Ray?
Thanks.
A-fib patient with rapid ventricular response...
I dispo'd Mr. Kerosene to psych.
He drank kerosene?
More like a high colonic.
Hi, Abby. I'm Tony Gates.
Hi. Didn't you used to be...?
A paramedic. Yeah. Now I'm an intern.
Next week, he wants to be a cowboy.
Astronaut.
I could use some help here.
- I got half his tongue on ice. - Oh, man. How did that happen?
Wife bit it off.
Why did she do that?
She says he talks too much.
All right, come on. Let's put him in Curtain Two.
Liter of saline and a crit. Ray, you're with me.
Abby, grab some charts and... Gates, you're with Abby.
Cunnilingus interruptus.
They did a Grand Rounds on it last year.
Abdominal fullness. This isn't too bad.
Congratulations on the bambino. It's a boy, right?
Yep.
- Can you check the BP? - All right.
Hey, Mr. Dolan. How you feeling?
Must be weird coming back after all this time, huh?
A little bit.
- 70 palp. - Pulsatile abdominal mass.
We'd better move him.
- Sam, this guy is hypotensive. - What?
- His vitals were normal at triage. - Not anymore.
Add a second line, four of O-neg.
- Labs? - Dr. Gates?
CBC with platelets, chem-7, protime, cross and type four.
Good, but add a hemocue, EKG, and let's get surgery in on this.
All right. What do you think? Abdominal aortic aneurysm?
Classic presentation for a triple-A.
You think it burst?
No. He'd be dead. It's probably a steady leak.
You set up for ultrasound?
We're going to have to call radiology for that.
- I'm talking about the ER ultrasound. - It's still out for repair.
- How are we supposed to...? - Radiology brings it over.
- How long does that take? - Depends on how busy they are.
Wow! Great to be back.
Pressure's up to 90 with saline.
All right. He looks like he's okay. I'll call for your ultrasound.
O-neg is here.
So, what's the big guy doing today? Watching the baby?
No. He's in court.
Mr. Ames, what made you go to the E.R.
on February 13, 2004?
Because I had a cough.
My boss, he brought me in.
I thought it was nothing, but...
he didn't want me working until I got it checked out.
- How long is the wait? - Don't talk, please.
How long until I see the doctor?
I don't know. Could be 12 hours.
12 hours?
12 is good. We're not that busy.
It's okay, Curtis. I'll get someone to cover you.
No, no. I can work.
How about I sign in and come back later tonight?
You'll lose your place in line.
So I just sit here in the waiting room for 12 hours?
That's how it works. Be right back.
This seems kind of crazy.
How about I just get checked tomorrow?
I need a note you're not contagious.
I got insurance issues.
Don't give this job away.
I'm going to be there tomorrow.
Dr. Kovac, when did you first see Mr. Ames?
I was working at the Admit Desk when he signed in at Triage.
So how long till I see the doctor?
Hard to say, sir.
If you're stable, it could be up to 12 hours.
Hours?!
We have a lot of sick people here.
Let me just sign in, and I'll just come back later tonight.
I'm sorry. We can't do that.
So I got to wait in the waiting room for 12 hours?
I'll be right back.
They can't do this!
Everything okay, Chuny?
Yeah. He'll settle down.
Do not give that job away! I will be there.
A lot of patients get angry about the wait.
Nurse Marquez was able to defuse the situation before it escalated.
I'm in.
You can do the next one. Sorry. I just had to...
No, that's cool. Good breath sounds. You haven't lost your touch.
- BP's 80. - All right, I need the ultrasound.
They're doing a rule out ectopic.
And where's surgery?
Their med student's right there.
- That's not doing us any good. - I paged them twice.
Listen. How did it go yesterday?
- How did what go? - Court. I heard you had to testify.
Oh. It was fine.
Uh, a lot of questions about procedure and policy.
But I don't think they have a case.
Here come the cavalry!
Enlighten me.
Hypotensive pulsatile abdominal mass.
Say no more. Red line to the O.R.
- We're waiting on ultrasound. - Wrong.
We're not waiting on ultrasound?
Neela, what happens when we wait for diagnostic tests
on a ruptured triple-A?
Attempts to stabilize are fruitless. Investigations delay
definitive therapies and increase the risk of exsanguination.
With a 90% mortality.
His crit's not so bad-- 32.
- Meaningless drivel. - What if it's not a triple A?
Then it's something else that requires surgery.
Radiology's bringing over ultrasound now.
He'll be dead by then.
- It'll be a few seconds. - Just zip it, Sparky.
- Look, we are admitting him. - Sparky?
Let's go!
Did you need me to keep bagging?
Sure, as long as you don't talk.
Oh, by the way, Abby Lockhart. Lovely to meet you.
At what point did you assume responsibility for Mr. Ames' care?
The nurse was concerned about his oxygen level,
so she asked me to see him.
Curtis Ames?
Hi, I'm Doctor Kovac.
What is that?
Uh, low oxygen.
Or just maybe a dirty fingernail.
Wood stains-- they don't wash off so good.
What kind of work do you do?
Custom carpentry.
Doors,
built-in bookshelves, armoires, you name it.
My father had a wood shop when I was a kid.
I used to play with the shavings from the lathe.
I love the smell.
How's it sound?
Well, like pneumonia.
You should be admitted to the hospital.
Admitted?
Yeah, stay for a couple of days.
No, no. I start a custom remodel today.
Your temp is 102, your oxygen level is down to 90
and your X ray shows your right middle lobe is full of infection.
Look, if you want to get better, we need to give you I.V. antibiotics, okay?
After he examined you, then what happened?
He left me alone with a nurse who couldn't start an I.V.
Okay, this time I get a flash.
Good. That's good, right?
But it won't thread... I'm sorry.
Keep pressure on this.
I know the drill.
Anyone ever tell you you have bad veins?
How about just giving me a shot in the butt?
The antibiotics are ordered I.V.
Can I talk to my doctor?
He's with a trauma patient right now.
How about after he's done?
It could be a while...
Here we go, fourth time's the charm.
And how long was it before Doctor Kovac came to your bedside?
It was more than an hour.
I saw him working on the computer,
he was talking to some nurses,
then...
he ate a bagel with cream cheese.
I think it was poppy seed.
And how did that make you feel?
Objection, irrelevant.
On the contrary, Your Honor, it goes to state of mind
and his ability to make decisions.
Overruled.
You may answer.
I felt alone...
forgotten.
Like nobody there cared about me.
I'm just saying he's a frail old man
who deserves the benefit of diagnostic confirmation.
The patient is now on the surgical service,
not the ER service.
Why don't you go downstairs and pull a cockroach out of someone's ear?
- Neela... - He's not stable, Abby.
BP's 90 systolic.
Five minutes for an ultrasound is not going to kill him.
I picked up a sterile sleeve.
Why do you people insist on annoying me?
It'll only take a few minutes.
10 blade... I want these two out of my O.R.
Shirley, call security.
All right, all right. Dab the bleeders, Katey.
Nice working with you guys.
Bovie.
- Stand back! - Irrigation! Saline!
Unplug the Bovie! Unplug the Bovie.
And turn off that oxygen, before the whole room goes up.
Dr. Kovac, when the nurses couldn't start an I.V.,
what action did you take?
I knew I needed to place a catheter into a deeper vein.
How you doing?
I didn't know you ordered acupuncture.
- I'm Sonya Ames. - Hi. Luka Kovac.
Thanks for taking care of him.
Well, since we can't get an I.V. in your arm,
I'd like to place a central line under your collarbone.
That sounds pretty involved.
We need a route to give I.V. antibiotics,
or we cannot treat the pneumonia effectively.
I'll numb up your skin and guide a catheter in
at the top of your chest.
There are risks of bleeding, infection, collapsed lung,
but all of those can be treated.
I've got to think about... I've got to think about it.
Wait. No, he doesn't.
If you need some time to consider...
He's just being stubborn. He hasn't been to a doctor in 20 years.
I never get sick, baby.
You can barely catch your breath, you've been coughing so much.
It's not that bad, really.
Listen, I just want him to get better. We'll do whatever it takes, okay?
Well, if you want the procedure you need to sign this form.
Now come on, baby, I've got to get back to work.
He didn't want to be in the E.R.
He didn't like doctors, so I felt I needed to treat him aggressively.
He said it was the only way to go.
If he left, I was worried he'd get worse and wouldn't come back.
He told me complications were extremely rare.
It was no big deal, that he does these every day.
His wife works, he's all alone.
My opinion didn't matter.
If he took pills, he could have died at home and no one would know.
He gave me and my wife no other options, no other choices.
We were both really, really scared.
- Can we grab you a sandwich? - No, thanks.
Hey, Timmy. Uh, is Abby around?
No, no, if she's in surgery, then don't bother.
That's okay, I'll try later. Thanks.
- Tricuspid regurg. - Ah, the irony.
A bad heart valve.
Left him with right-sided failure and a big, pulsating liver.
- So the mass was his liver? - Yep.
And the fire saved him from unnecessary surgery.
So a slightly scorched med student
and some burned drapes saved the guy's life.
Lucky guy. Had minor burns.
Excuse me.
Forget how to use that thing?
No, I just... I didn't want to be one of those crazy mothers
that checks in with the baby-sitter every hour.
My baby-sitter used to tie me to my high chair.
I'm sure yours is much better.
After your first dose of antibiotics,
how long were you in the E.R.?
A long time.
Over three days.
Three days?
In the E.R.?
They said that there were no other beds in the hospital, so...
Excuse me, I need to use the bathroom.
I'll let your nurse know.
I don't think that I'll be able to...
- I said I'll let your nurse know. - It's kind of urgent. Please.
So you stayed in the hall all that time?
I mean, they put me in the back at night
so that I could try to get some sleep.
- Get off me, bitch! Let me go! - Louie partied a little too hard.
I'd say we're dealing with coke, PCP, and EtOH.
- You're going to need hard restraints. - I'll rip your head off, I swear to God!
They kept saying I'd get a regular room after the first day, but...
it never happened.
Nurse?
I never got my breakfast.
You may be NPO.
What's that?
We have to look at your orders.
Where's Dr. Kovac?
He's not working today.
So who... who's my doctor, then?
I have to check.
Every 12 hours an oncoming resident
assumed responsibility for Mr. Ames' care.
His progress was discussed, and he was improving.
So it was the nurses who were watching him more closely?
Yes.
Dr. Kovac, the State recommends
an E.R. patient-to-nurse ratio of four-to-one.
Yet, during Mr. Ames' stay, the ratio was eight-to-one.
That's eight patients for every nurse.
How is that possible?
We can't control how many patients come into the E.R.
Dr. Kovac, you know that those standards are in place for patient safety.
So on a day when the standards were off by a factor of 100%,
did you discuss this with a hospital administrator?
No.
With a director of nursing?
- No, no, it's not uncommon... - With a nurse manager?
Look, we're always short staffed.
Did you bring this deficiency to anyone's attention
or do anything to address the situation?
It doesn't work like that.
Mariko Shimane, history of Crohn's Disease,
vomited blood twice.
Systolic's 88.
Two liters of saline, type and cross for four.
Is there anyone we can call, Mariko?
- Dr. Derezin. - From Gastroenterology, I paged him.
How about a family member?
It's just me and my son.
- Where is he? - Oregon.
Sophomore in college.
We can call him. I'm sure he'd want to know.
I'm in the hospital a lot.
Your condition's pretty serious.
That's what they always say.
Upper GI bleed?
Sure looks like it.
Hello, Mariko.
Sorry to bother you, Neil.
That's all right. Any blood in your stool?
Yeah.
She'd didn't mention that.
Red blood?
Yeah.
Endoscopy here or in the GI lab?
Excuse us for a minute.
Dr. Pratt, dude on line two says he's your brother.
Yeah, take a message.
And hey, Doc Lockhart, big daddy called while you were upstairs.
Thanks.
I can't scope her.
Why not?
Crohn's can cause inflammation, erosion into a vessel
anywhere along the intestinal tract.
- 25 feet of possibilities. - It's not something I can reach.
She needs surgical exploration.
I'll call the O.R.
So... what's the good news?
We're going to have to put you in another room.
Looks like you may need an operation.
Again?
Maybe it's time to call your son?
He's got mid-terms, no.
On the afternoon of his third hospital day
Mr. Ames complained of numbness in the left hand.
And what was your impression?
How long did it last?
About ten minutes.
Okay, squeeze my hands.
Okay.
Now spread your fingers like this.
Don't let me close them.
Good.
- What do you think happened? - It could be a number of things.
How's it feel now? Back to normal?
Yeah, yeah... Yeah, I guess.
The same on both sides?
It was kind of weird.
You probably compressed a nerve
while you were resting on your side.
I've slept on floors more comfortable than this-this bed.
Here, let me take care of that.
Hi, bed control. Yeah, this is Dr. Kovac.
Yeah, I need, I need a med surge bed for my patient, please.
And when did the numbness return?
It was about three hours later.
And was there something different about this episode?
I didn't have any feeling for a half an hour.
But you're okay now?
It's worse. Went up higher.
Where's Dr. Kovac?
He checked, he said you were okay.
I'm not okay. I need to talk to him.
Not right now.
Why? Where is he?
He's taking care of a patient with a heart attack.
Tell him to come and see me.
When he's through.
No, no, now.
Mr. Ames, there are people in this E.R. who are much sicker
and need immediate attention.
Hey.
If he won't come to see me, then I'm gonna...
- ...go see him. - Hey! Get back in the bed.
Something is seriously wrong, and I need to talk to my doctor.
I need you back on the monitor. Frank, help me get him back.
Take it easy there, fella. Take it easy.
Take it easy?! You people have ignored me for three days.
No one will tell me what's going on.
Nobody gives a damn about my care! No one will even talk to me!
- How am I supposed to take it easy?! - Mr. Ames, sit down.
I'm not sitting down until my doctor does what he's supposed to do!
I need some help here!
Open your eyes, sir.
Hey, let's get a gurney over here!
Mr. Ames?
Look at me.
Luka, he had a stroke.
Upgoing toe.
CT can take him now.
Okay, we're on our way.
Let's go.
We recognized the stroke, immediately moved him for close monitoring
and had him to CT as soon as possible.
From what I remember, it was... it was pretty chaotic.
Why should this guy have a stroke?
I have no idea. Follow my finger, sir.
Sir, look over here. Over here.
- Frank, I need a monitored bed. - There aren't any.
- Uh, okay, uh, Trauma Two, then. - GSW just took it.
- Let's move him to CT. - CT's backed up for half an hour.
- Okay, where can we put him?! - I'll see what I can find.
Okay, uh, chart. I need his chart.
- Chuny, where's the chart? - I never saw it.
It's okay, Mariko, just take some deep breaths.
- Where the hell's surgery? - Crenshaw called, said the patient's
not a candidate for anesthesia till the systolic's up to 80.
All right, well, let's tank her up.
Eight French cordis into the femoral.
You know, I had another idea.
Oh, man.
Hey, has anyone seen a pocket doppler?
Uh, yeah, top drawer by the sink.
What about an intra-aortic balloon?
This girl in heart failure?
No, it's a GI bleed.
What? We inflate the balloon in the chest,
completely block off the blood supply to the abdomen.
No, you can't do that.
Damn it.
Why not? That's a great idea.
Hey, she's not your patient. Adios, Gates.
Okay, could be a publishable case report.
It's a non-invasive way to occlude the aorta.
It'll stop the bleeding.
Oh, crap, crap. Crap.
What?
Pratt, can you come with me?
Four units of red cells, one of FFP, a ten-pack of platelets. We'll be right back.
Hey, hey, hey. What is this, some kind of postpartum power trip?
Okay, the aortic balloon will work.
It's an unproven therapy.
What, you'd rather let her bleed to death?
No, I'd rather have the surgeons take her up to the O.R.
It doesn't look like that's gonna happen.
And what's your problem with the balloon?
Because it cuts off all the circulation to the bowel, liver, kidneys and legs.
Everything could die from the chest down.
What are we doing in here?
You know, you used to be such a cowboy.
Why is this a big deal?
I don't agree with you.
Gates thinks it'll work.
Gates is a knucklehead who would defibrillate with a car battery
and some jumper cables.
I am the attending. The buck stops here.
So if there's going to be a bad outcome,
let surgery be to blame for not showing up in time.
So you let her die?
No, I just don't want to be the guy who kills her
with some crazy-ass therapy.
Look. This is her last chance.
She's pre-arrest.
If her pressure continues to drop despite massive transfusions...
Then maybe I would consider it. What are you doing?
I'm pumping. Sorry. My boobs were about to explode.
When did your wife arrive?
Right after the CAT scan.
By then I could talk again, you know.
It looks okay.
I... still can't move my arm...
and leg.
There's no mass, no bleeding.
That's... that's good.
Then why did he have a stroke?
Probably a blood clot in the brain artery.
But, uh... there is something we can try.
What?
What should I do?
A medicine called TPA could probably dissolve the clot.
You're saying that could work?
That I might... I can get better, right?
There's some chance of recovery 30% of the time.
And... full recovery, ten percent of the time.
We've got to do something.
What about the si... side effects?
There's always side effects.
Well, there's a ten percent chance of bleeding in the brain,
causing more disability and death.
Ten percent chance of recovery?!
There's a ten percent chance of-of death?
What if we don't use the drug?
There can be some improvement
with time and physical therapy,
but probably not full recovery.
Look... I... I've been in this hospital
long enough to know that if something can go wrong, it...
I don't want it.
And what do you recall of Mr. Ames' reaction
to your recommendation of TPA?
I brought in Dr. Saunders, a neurologist,
to try to explain options in an objective manner.
The statistics are averages for all patients,
even ones in their 70s and 80s.
Your risk of bleeding is much less, given your age
and the fact that it's been only 90 minutes since the onset of symptoms.
I don't... I don't know.
The TPA is your only shot at complete recovery.
Forget it.
I'm-I'm not taking it.
Settle down, baby.
Look, if it was me,
I'd-I'd take the TPA.
If it was you,
if it was you, you'd be in intensive care with-with-
ten doctors and nurses watching your ass every second, day and night.
You wouldn't be getting the runaround for three days.
Not sleeping, not eating.
Pissing in a pan. And now I'm supposed to trust you
with a medicine that can kill me,
when all I've seen since I've been here
is total incompetence!
Mr. Ames, did you refuse a therapy
that had the potential to reverse the stroke?
There were no guarantees.
Experts have agreed that TPA gave you the only chance
for a complete recovery.
And you didn't want it?
It was a lot more complicated than that, really.
Did you refuse a medicine that could've cured you?
I refused what they were pushing,
and you would've done the same thing.
So you did refuse the cure?
Systolic's only 50 after four unites.
All right, hang another two units.
I'm above the diaphragm. Go ahead, inject.
I'm putting in 40ccs of saline. Let's hope this damn thing works.
Doc Lock, you got a call.
Kind of busy right now.
- Balloon is up. - It's your baby-sitter.
They said it was important.
Pressure's up to 90.
All right, go ahead, go, take it.
We're out of the woods. Mark the time.
Surgeons have one hour to get it up and fix her, or the game is over.
- Hello. - They should be here any minute.
What's happening?
Well, we've got your bleeding controlled...
Is he hungry?
Did you try the stroller?
Thanks for joining us.
What's up with the fluoro? I thought E.R. docs had X-ray vision.
Okay, okay. Put the phone next to his ear.
...a Crohn's patient from intra-abdominal exsanguination.
Rather unconventional, dare I say, idiotic.
Well, it worked.
# If I go, there will be trouble #
...without the thoracacotomy. It's very cool.
What's not cool is that her kidneys will be dead within an hour.
- Let's go, clock is ticking. - Abby?
It's his favorite song, it puts him right to sleep.
# This indecision's bugging me #
Aren't you glad you don't work here anymore?
She's auditioning for American Idol.
# If you don't want me, set me free #
- Hey, nice work, Abby. - Thanks.
# Exactly whom I'm supposed to be? #
# Don't you know which clothes even fit me? #
Upstairs, the neurologists recognized a faint mid-systolic murmur.
What does that mean?
A murmur is from turbulent blood flow through the heart.
So because of the murmur, a cardiac echo was ordered
showing a patent foramen ovale.
Do you know what a patent foramen ovale is, Dr. Kovac?
A small hole between the upper chambers of the heart.
So that hole could have allowed a blood clot
from your subclavian catheter to pass
from the right side to the left side of the heart
and then... up to the brain.
Could happen. But that's extremely rare.
I didn't ask you how rare it was, Dr. Kovac.
I asked you whether a patent foramen provides a pathway for a clot
to travel to the brain and cause a stroke.
Yes.
So if you had heard the murmur, if you had pulled the catheter
when the numbness began, is it possible
that you could have prevented Mr. Ames' stroke?
Objection.
Calls for speculation.
Sustained.
When the numbness began, did you consider a cardiac source,
or did you ignore an important warning sign
of impending stroke?
I didn't ignore anything. I considered what was probable
and acted accordingly.
After Mr. Ames complained of numbness,
did you then appreciate his heart murmur?
The E.R. is a noisy place. You can't always hear subtle murmurs.
Dr. Kovac, I'm not asking you about the noise level in your E.R.
I'm asking did you at any time in the three days
that you cared for Mr. Ames recognize his heart murmur?
At the time of Mr. Ames' numbness,
there were 47 patients in the E.R.,
82 in the waiting room.
I was taking care of a young mother who was the victim of domestic violence,
nearly beaten to death, an eight-year-old, hit by a car...
and a 53-year-old heart attack victim...
Dr. Kovac, you're not answering my question.
I asked if he had a heart murmur that you failed to recognize.
It was reasonable to believe that Mr. Ames' numbness could wait!
Order!
Only one of you can speak at a time.
Your Honor, I move to strike that that entire tirade
be stricken from the record as non-responsive,
and I request that the court admonish the witness to answer my question.
Restate the question.
And, Doctor, I'm instructing you to answer it.
If you had heard the murmur,
is it possible that you could have prevented the stroke?
Objection.
Possibility is not the issue.
- Sustained. - Dr. Kovac,
is it true that you could have prevented the stroke?
- Well, Doctor? - Counselor, I'm warning you.
No need; I'm done with this witness.
... this family went home, and lost rectal thermometer
went up to surgery.
Gates needs you for an extubation in Trauma Two.
All right.
I'm here till 7:00, so call me if you get a break.
Hey, any news from Kovac?
- Not yet. - Greg?
Hey.
- Am I too early? - Yeah, yeah, yeah.
Just have a seat in Triage for a few minutes. I'll be right back.
- It's Abby, right? - Yes.
Oh, hi. Sorry about your arms.
It's okay; they fixed me up pretty good,
but the med school wants me to make a chart for their insurance.
It's no problem, I got it.
Thank you, Ray.
Thanks, Ray.
I guess we can do it in Curtain Four.
Great.
You might need a little debridement.
Go for it.
So, your shift almost over?
They're giving me two days off to heal.
Well, that's very generous of the surgeons.
First free night in forever.
Have you been to Rednofive?
Uh, no.
They remodeled, and I hear the DJ on Thursday nights is ridiculous.
You want to check it out tonight?
Both emergency and infectious disease experts agree
that Dr. Kovac gave superior treatment,
above and beyond the standard of care.
The stroke was a one-in-a-million complication
that no one could have either predicted or prevented.
Dr. Kovac treats the patients that no other doctor will treat.
His E.R. is the safety net for millions with no health insurance.
Every day, he is out there on the front lines,
providing the best health care possible
for the people who need it the most.
If you find against Dr. Kovac,
what message do you send to other health care providers like him,
who make that daily struggle their personal mission?
Dr. Kovac could have sent Mr. Ames home
with antibiotic pills,
but he didn't.
He assumed that Mr. Ames was unreliable,
that he couldn't be trusted.
And so Dr. Kovac took responsibility for his care.
And then, he abandoned that responsibility by subjecting Mr. Ames
to substandard conditions in an understaffed E.R.,
where that man was shoved into a corner and neglected.
And the warning signs of a major stroke were ignored,
resulting in a devastating disability.
Before the stroke,
Mr. Ames was a skilled craftsman.
He supported a wife and two children.
And now, with a paralyzed left arm,
loss of perception in his left visual field,
that livelihood has been taken away.
Loss of income,
loss of self-esteem
has resulted in profound stress
and led to a divorce
and separation from his children.
Mr. Ames now lives alone.
He's trying to get by on a disability benefit of $1,300 a month.
He cannot drive, he sees his children one day a week,
and he is being treated for depression.
Your award must fairly compensate Mr. Ames
for past and ongoing medical care,
for 25 years of lost wages,
and for the pain and suffering that this man will experience every day
for the rest of his life.
And you want to make sure that this part rests against your ribcage,
not your armpits.
And then, you just-- whoops!
I'm okay. I'm okay.
- You sure those things are safe? - Yeah.
I think they just need an adjustment, or...
you can go to the pharmacy and get a new pair.
Good idea.
Be careful.
Should we sign you in as a trauma patient?
I would say yes, but my shift is over.
Call me if your spleen ruptures.
Excuse me. Hi. Is Dr. Pratt around?
He's with a patient-- can I help you?
He told me he was going to be right back.
If you see him, will you let him know that Chaz is still waiting?
Okay.
Hey, Neela, you have a minute?
I have 12 hours; I'm on all night.
Okay, it's about Katey, your med student.
- Ray... - Hey, hey.
She asked me out, all right?
You know that residents are not allowed to date their students.
She's not my student, she never will be.
She's not doing an E.R. elective, so technically, it's not even against policy.
Well, then why even ask?
Thanks, appreciate your help.
I'm sorry, I got to go.
- Tell Greg I'll call him. - Okay.
- Hey, Mayday. - Hello.
What are you doing here?
- Small bowel obstruction. - Good times.
So, uh, how's the guy who went up in flames?
Minor partial thickness burns to the chest and abdomen.
You know, I hear his aorta was just fine.
You know, there's a lesson to be learned here. Wise men say,
- "Only fools rush in." - You missed a guy called Chaz.
He left?
You were saying?
Hey, Chaz, Chaz, hold up, man.
Sorry about that; I got caught up with a patient.
It's okay. I got to go.
No, come on, man. It sounded like something serious.
Nah, it's all good.
Hey.
Things just aren't going so well at home.
Really?
When I want to study, it's too noisy.
When I want to bring my friends over, Dad won't let me.
I'm always late to class, because the commute takes forever.
What about the dorm?
Costs too much.
When you saw me out there earlier, I was looking for apartments to share,
but... they all kind of sucked.
Look, I know this is going to sound crazy, but...
I was thinking maybe I could move into your place.
- My place? - Yeah, your place.
I mean, it's close to campus.
I can get a part-time job, to help you out with the rent.
I'm quiet.
We'll probably never even see each other.
You're serious?
Chaz, come on, man. You know, I got my own style.
Aw, come on.
You say the word, and I'm gonna clear out for you.
And if it doesn't work, I'll... I'll be gone...
real fast, man.
Never mind; it's a bad idea.
All right, look.
Let's try it for a month.
You for real?
Yeah, I'll talk to your mom.
Thank you. Thank you.
- I'm going to holler at you. - All right, man, take it easy.
Hey!
So, how was the first day back?
It was a piece of cake.
- Like riding a bike. - Yeah?
You miss your little man?
Yeah, but that's okay.
I'll bond with him again when I feed him at 11:00
and 2:00 and 5:00 a.m.
But you know what was nice about today?
For 12 hours, I talked like a grown-up to grown-ups.
Well, except for when you had to deal with the surgeons.
Yeah, but at least they don't spit up on you.
Much.
Good night.
Try to get some rest.
It's a nice idea.
How long do you think they'll deliberate?
Shouldn't take more than a day or two.
Ames' lawyer is a publicity hound.
Local news is having a field day trashing County.
It'll be good to get you in front of the press
as "the doctor found not guilty."
Well, you're very optimistic.
People need to hear our side of the story
to reassure them that the county health system works.
During that videotape,
did you see the looks on the jurors' faces?
Doctors get sued for ignoring and undertreating patients,
not for doing too much.
Plus, you did a great job on the stand.
Well, I don't think so.
I've been to at least a hundred trials.
I can tell when a jury likes the doctor.
He's just another greedy M.D. getting rich by overtreating.
What are you talking about?
I've read about it.
The drug companies give kickbacks to doctors
who use their expensive drugs.
The judge instructed us not to decide this case based on anything
we've heard outside of the courtroom.
They neglected this guy for three days.
His pneumonia was improving.
That doctor used a hand grenade to kill a mosquito.
To me, that's bad medical judgment.
You're not a doctor. We've got to to decide this thing
based on the expert witness definition of the standard of care.
Well, when you're talking about County General,
the term "standard of care" is a joke.
That's right; Kovac is part of the system.
We all know the system sucks.