Big ups to Stedman's Medical Dictionary and Wing Chun.
Previously on ER: Holling didn't want to get hooked up to a bunch of tubes and spend the end of his life puking; Elizabeth urged Mark to respect Holling's wishes, but Mark wanted to "help" Holling, which Elizabeth suggested Mark do by listening to Holling; Cleo and Carter discovered that Husky Lad had Type II diabetes, but Husky Dad didn't have the insurance to cover the treatment, so Carter ignored Cleo's warnings about serious complications and falsified Husky Lad's chart to indicate that he had gastroenteritis; Sars and Wing Chun whipped out their banjos and played "Dueling Health-Care-System Soapboxes," then went back to drooling over Goran Visnjic when they realized the writers would probably forget Husky Lad's entire existence. For the record: Oops.
As we fade up, Jing-Mei "Flower" Chen updates "Critical" Kerry Weaver on the status of various patients. Robert "When In" Romano appears behind them and wishes them good morning, and says that he heard they had a double trauma coming in and thought they could use some help. Kerry tells him that it's two minor traumas and they can handle it, but Romano says something about how he might as well flip these two burgers. In answer to the "whaaaaaat?" looks he gets from Chen and Kerry, Romano explains that Ray Kroc, owner of McDonald's, used to get behind the counter once a year and make burgers and milkshakes, so Romano thought he'd do the same and "get back in the trenches, where the little people work." And Romano would know from little people, I guess. Chen and Kerry both comment rather acidly on Romano's disparaging phraseology, and he tells them he wants to make sure "the ship is ship-shape." Enter two guys yelling and flailing at each other; one guy tackles the other to the ground, and Romano jumps in to break it up, and eventually the ER staff gets the two guys separated, and one of them -- Mitch Pileggi, a.k.a. Skinner from The X-Files -- snarls, "Get away from me, ya dumb-ass punk!" The Shaky Camera Of Chaos cuts back and forth between them as they continue to argue, and "I'm Sorry" Dave "I'm Afraid I Can't Do That" Malucci bolts out of the lounge and into the fray, and Skinner shouts, "You ran into me!" and the other guy, a tall black man, bawls, "You cut me off!" and Dave makes the mistake of calling the black man "bud," so the black man wants to know who Dave is calling "bud," and he hurls himself at Dave, and Dave pins him against the front desk and sneers, "You, that's who, bud," like, Dave couldn't wait until AFTER the credits to whip it out? But we don't see him again after the opening sequence, so I guess he couldn't. Finally, the road-ragers get wrangled into curtain two as the paramedics give the ER team the bullet: MVA collision, both Skinner and Bud have multiple abrasions and a couple of cuts. Kerry orders Skinner put in restraints. Skinner and Bud continue the "I didn't start it / shut up / no you shut up" rondelet, and Romano orders both of them to settle down, and Bud plays nice for five seconds and then starts up out of bed and shakes Chen and a paramedic off of him and throws an equipment tray in Skinner's direction, and Skinner in turn gets free of Kerry and Romano and grabs a fountain pen from Romano's pocket and buries it in the left side of Bud's face, and Chen goes, "Auuuuugh!" and the rest of the team goes, "Ohhhhh," and Romano muscles Skinner back into bed as Dave looks at the impacted pen in Bud's cheek and says, "Oh, man, this is nasty," like, shut up and go drink some breast milk, Dave. Kerry ties on Skinner's wrist restraints and sarcastically asks Romano if this is what he meant by flipping burgers, then says she has other things to do if Romano doesn't "need any of the little people," and he says he has it under control. Kerry leaves. Dave asks Romano if he should just "yank" the pen out, and Romano says no, they have to check for damage to the facial nerve, "not to mention damage to my pen." Bud garbles through a mouthful of blood, "I've been stabbed, and you're worried about a pen?" "Oh, shut up," Romano tells him -- snerk -- and we go to credits.
Ah, NBC -- putting the "nots" back in "Jason And The Argonauts."
Waiting area. David "Holling" Greene takes his oxygen delivery tube out of his nose. Mark "Color Me Bald" Greene, without looking up from his magazine, says flatly, "Put it back on, Dad." Holling says he doesn't need it and it makes him want to sneeze, but Mark reaches over and hooks it back over Holling's ears anyway, and Holling goes on that he doesn't need Mark waiting around. Mark says patiently that he doesn't want Holling taking it off, which he'll do if Mark goes anywhere, and Holling tells him grouchily to get used to it, because he's made up his mind, and he's not going to "do [his] dying" in Mark's bitty little apartment. ["Uh, where did Holling live before -- Windsor Castle? Mark's apartment looks plenty big to me." -- Wing Chun] Mark, unruffled, says that maybe they should "think about moving." Holling snaps at Mark to stop it, he knows what Holling means, and even if Holling does stay in Chicago, he wants to get his own place. Mark asks dryly how that's going to work. Holling doesn't look at Mark and says he'll get someone in to help if he needs it. Mark thinks that Holling will "just ignore it" like he's done for the last year: "I know you, Dad." "No, you don't," Holling grouses. "You might know this disease, but you don't know what I want." Mark doesn't want to have this conversation right now. "Then don't," Holling snaps, and rubs his forehead. ["What happened to the rapprochement over the slides that they enjoyed last week?" -- Wing Chun]
Elsewhere, "And The Lord Said, 'Let There Be'" Luka Kovac tells a patient that his chest x-ray is clear and he has a hematocrit of thirty-two. Goran Visnjic has a new haircut, which he must have gotten at Salon Duran Duran -- seriously, a little purple eyeshadow and he's Nick Rhodes. He's still hotter than Death Valley, though. Anyway, the gravelly-voiced patient asks Luka about his potassium, and Luka tells him it's fine and listens to his lungs as Gravelly says that he figured as much, since he just had dialysis the day before. Then Gravelly asks, "So, is it a man or a woman?" Luka thinks it's a man. Gravelly asks what happened, and Luka says he doesn't know. Gravelly theorizes, "Must have been an accident, right? Isn't that usually the deal?" Luka says yes, he thinks so, "in Minneapolis," and Gravelly says the kidney is getting flown in from there, so apparently Gravelly has gotten hooked up with a kidney transplant. Luka tells Gravelly that "one of our surgeons, Dr. Corday, has gone to procure the organ." Heh . . . he said "organ." Chitchat about coolers and making it to the top of the UNOS list. "You're lucky," Luka tells him, and Gravelly bitches that if he were lucky, he wouldn't need the kidney to begin with. Luka laughs, "That's true." Gravelly grumps that he's hungry. Luka tells him he can't eat or drink anything, because he cleared Gravelly for the surgery, so they just have to wait for the kidney to get there. Okay, show of hands: who sees where this is leading? Yep, thought so.
Skinner bitches that the other guy really "was the one who started it" and sips water from a cup. "I know, Dad, you said that already," his daughter says, trying to calm him down. Chen shoots Skinner a nervous look and continues stitching the cut on his arm. Skinner goes to put the cup down, but his arm spasms and he knocks the cup and a whole pitcher of water over. He curses. Chen tells him it's all right as the daughter goes to clean up. "No, it is not all right!" Skinner thunders at Chen. The daughter tells him to relax, and Chen suggests that they just finish the sutures, and she reminds him that he needs to hold still. "I think I know that, okay?" he growls at her. Chen and the daughter exchange a look, which Skinner sees and which prompts him to apologize, and he asks his daughter to get him some more water. Chen finishes up, and the daughter tails her out of the room on the pretense of going to the bathroom and murmurs, "What's going on, is he all right?" Chen says sort of snottily that Skinner is "a little upset by what's happened." The daughter says she's never seen Skinner like this before; Chen asks if Skinner has always had a temper, and the daughter says no, but "this week, since [she's] been visiting, he just seems off," and he loses his balance a lot and lashes out at people. Chen stops and asks if Skinner's ever had seizures or bad headaches, and the daughter says no and asks, "Is there something wrong with him?" Chen says she wants to run some tests and get a head CT and then she'll know more. She points the daughter in the direction of the ladies' room.
Cleo "Intel Inside" Finch gives Peter "Peter Silicon-Eater" Benton the bullet on a patient with abdominal pain; Peter listens to the patient's heart and the patient's wife looks on with dismay as Cleo says that the patient is taking codeine for back pain, but that the abdominal pain is worsening and the patient has "a positive surgical history for an appy," which Cleo thinks might mean a bowel obstruction. And now, for the semi-informative sidebar du jour. When a patient has had an appendectomy, the resulting scar tissue can get wrapped around portions of the small intestine and tie the intestine off. It doesn't happen often, but when it does, it's life-threatening. It happened to my best friend, and the campus health center didn't catch it and she almost died, so let me break it down for you: if you've had your appendix out, and you start throwing up a lot and it doesn't stop after a day or so, and you have a high fever and a lot of cramping but no diarrhea, go to the emergency room and don't let them discharge you until they've taken a full abdominal x-ray series and ruled out the scar-tissue thing. Not to keep my fellow hypochondriacs up nights or anything. Okay, end sidebar. From the bed, Gravelly grunts at Cleo, "Has my kidney gotten here yet?" Cleo tells him she doesn't know, and Gravelly grouses that he's still hungry and he could have eaten, but Cleo goes back to ignoring him. Peter asks about fever and vomiting, and the patient says no on both counts, and Peter says he hears good bowel sounds and doesn't feel guarding or rebound, and he and Cleo go out into the hall to look at the x-rays. As it turns out, the patient is just constipated from the codeine. Peter tells Cleo to tell the patient to cut back on the pain meds, and to prescribe a laxative; then he takes out a prescription pad and tells Cleo to tell the pharmacy to give the patient 10 mg of bisacodyl a day. (Bisacodyl is a laxative, usually administered in the form of a rectal suppository. The things I look up online for these recaps . . .) "Sorry, thought it was serious," Cleo purrs. "Well, to him, it is," Peter points out. Heh.
Kerry and Carol "Her Holiness" Hathaway wheel a dull-eyed female patient down the hall on a gurney as another woman, presumably the patient's mother, says that the patient has had trouble breathing for the last two days; the patient has a fever and "lots of secretions," and the mother "suctioned her, but she got worse." The mother adds that the patient "was diagnosed with Sanfilippo's syndrome when she was two." (Sanfilippo's syndrome is a genetic metabolic disorder whose characteristics include an enlarged liver, severe mental retardation, and skeletal abnormalities. Hey, you're welcome.) The mother gives Kerry and Carol a complete rundown of her daughter Angie's medical equipment -- and it's a long list -- and says in answer to Carol's question that Angie can't talk, or feed herself, and she recently lost her hearing as well, and then she lists Angie's medications, also myriad. Kerry hears rales bilaterally and thinks Angie probably has pneumonia. Carol reports a temp of 102 as Angie's mother says that Angie came in about a month before with pseudomonas (a bacterial infection of some sort). Kerry orders various pulmonary tests, and Angie's Mom tells Kerry what the doctors usually prescribe for Angie when she has pneumonia, so Kerry says she'll use the same medications. Angie's Mom says she's going home to get a few dolls and things so Angie will feel more at home, and all of a sudden -- ching ching CHING -- I find myself on the set of Who Wants To Be A Recycled Subplot? and Reege asks me, "Final answer?" and I say all serious and biting my lip, "Uh -- Lois, the woman with Down's syndrome who needed a heart transplant?" and I win the million bucks, and I box up the cash and send it to LA so the ER writers can buy themselves a clue . . . oh, wait, that didn't happen at all. Actually, Angie's Mom just asks if they have a TV/VCR so Angie can watch a Muppets tape. Carol says sure, they'll bring one in. AM thanks her and bustles off. Carol shoots Kerry an inexplicable "ohhh-kay" look.
Cleo meets an ambulance outside, and Braided Paramedic gives her the bullet on -- drum roll, please -- Husky Lad! Lad had the flu for two days, and Husky Dad found Lad in bed this morning, "barely responsive"; Dad followed the ambulance in his own car. Cleo theorizes that Lad might have encephalitis or meningitis. Chuny murmurs that Lad has come in before, and Cleo asks her to pull the old chart, and as they hustle past the front desk, Constipation Guy's wife calls to Cleo that the nurse signed Constipation Guy out, and CG asks about the medicine he has to take. Cleo tells the rest of the team to go ahead and wheels back to the desk to ask Randi if a prescription came in from the pharmacy; Randi hands it over, and Cleo presses it into CG's hand and says over her shoulder as she takes off towards Husky Lad's trauma room, "Okay, there you go, once a day till the constipation resolves," or I think she did, since I couldn't hear her very well over the sound of Foreshadowing doing a clog dance in my living room.
In the trauma room, Braided Paramedic hands it off to Cleo, who thanks her by name, thus ending the mystery of what to call her. Braided Paramedic = "Pam." Thank you, writers. Cleo orders a bunch of tests; nurses alert her that Husky Lad is tachy and his pressure is dropping. Cleo's voice module says something about "septic, going into shock" and discovers that HL is severely dehydrated as well. Chuny says that the urine dip is positive for glucose, no ketones. Cleo wants to see what the old chart says, and she asks the room, "Does this kid have Type II diabetes?" Yosh flips through the chart and says that HL came in five months before for gastroenteritis, and Cleo asks for the blood glucose, which Chuny hasn't quite finished yet; Cleo orders a bolus of saline to rehydrate HL, and Chuny mutters, "Blood glucose is over 400." "What?" Cleo demands, whipping off her stethoscope to indicate surprise. "Are you sure?" Chuny checked it twice. Cleo sets her faceplate and says, "He's in a hyperosmolar coma," orders IV insulin and a bunch of other fluids, and says to herself, "This kid's been sick for awhile," then asks Yosh for HL's blood glucose levels from five months ago. Yosh says, "They didn't do one." "You're kidding," Cleo says, taking off her scope again to make sure we understand she's shocked, and asks about a urine dip, and Yosh says he doesn't see one in the chart. "Who took care of this kid?" Cleo wants to know. "Carter," Yosh says, and Cleo, shaking her head, orders him to page Carter: "Get him up here now."
Luka goes to meet Elizabeth "Once Briton, Twice Shy" Corday in the ambulance bay. Elizabeth bitches that the trip from Minneapolis "took forever," and Luka tells her that "unfortunately, we have some time," because Gravelly developed unstable angina and Luka had to rule him out as a surgical candidate. Elizabeth asks if Luka notified UNOS, which he did; UNOS located another candidate in Chicago, and she's on her way in. For the benefit of the radio audience (tm owen), Elizabeth says she hopes the second candidate makes it "while the kidney is still viable." Simon Le Bon, I mean, "Luka" furrows his brow and says "yeah" all somberly.
Cleo tells a nurse that she'll send Husky Dad up when he gets to the hospital, and to check Husky Lad's potassium and bicarb levels in two hours. John "Cock-A-Doodle-Hair-Do" Carter limps up, sporting a rooster-esque hairstyle which I suspect involved a blindfold, excessive amounts of bourbon, and a Rotato, and asks what's up. Cleo refreshes Carter's memory on Husky Lad; Carter doesn't remember him. Cleo says it took her a minute to remember HL herself, and she fills Carter in on the Type II diabetes and the insurance problems, then muses aloud that "I guess you doctored the chart." Carter doesn't know what she's talking about, or pretends not to; Cleo tells him that HL could have died of cerebral edema or an infarction because she rehydrated him without knowing he had diabetes. Carter makes a show of looking befuddled as Cleo tells him, "[HL's] electrolytes were so out of whack he could have died," and she tries to convey "on the verge of tears" but can only come up with "needs a new sound card." "What the hell were you thinking?" she asks, and just then Lily comes up to tell Carter his headache patient's having a seizure, and before Carter can say anything, Cleo monotones that if anyone starts asking questions, she won't cover for him, and she stomps off. Carter makes a "the hell?" face, and when Chuny walks by and quips, "Nice hair," Carter asks her for HL's chart. She says she just sent it up to the PICU, and Carter says he knows that and to get it anyway, and he gives Chuny a gentle shove and then chews on his lip and looks perturbed.
Heather Locklear is the only L'Oreal spokeskeleton who doesn't get on my nerves.
Back from commercials with a young woman telling Luka, "Henry is so excited," as Luka listens to her lungs. She adds, "Wouldn't you know this would be the day he had to go to St. Louis?" "He's on his way back?" Luka asks, and she tells him in a loopy voice, "Oh yeah. I think he could fly under his own power," and Luka smiles. Mrs. Henry brings Luka up to date on her treatment thus far, and she makes a joke about infusions and oil changes while Luka examines her abdomen, and she starts to talk about "after the transplant" when Luka interrupts her: "Have you had any peritonitis?" A few times, she says, but not for at least six months. Luka shrugs and says okay and tells her everything looks good, and she kind of giggles, probably because, from where she sits, everything looks really good, if you know what I mean, and I think you do (tm Nicole). She thanks him, and he modestly says he didn't have that much to do with it, "but you're welcome."
Angie's Mom comes back with a big box of toys, trailed by Carol. Kerry greets AM and asks if Carol explained "the situation" to her, and AM says yes, "you have to start another IV." Kerry says they've tried, "but Angie is a very tough stick," and AM says she knows -- Angie has a lot of scarring from IVs. Carol says they thought they'd put in a central line, which Kerry explains is the best way to deliver the medicine Angie needs, and AM nods and says she understands, so Carol says, "Great," and hands her a clipboard so AM can sign the release form, but AM says she can't do that. Kerry says gently that it's a very simple procedure, but AM says that isn't why; she can't sign because she isn't Angie's real mom, she's Angie's foster mom, and has been for the last four years: "We wanted to adopt, but we couldn't afford the medical expenses." Carol asks about Angie's birth parents, and when AM says that they abandoned Angie, Kerry folds her lips and looks down; AM continues that Angie has a legal guardian through DCFS. Kerry tells Carol to try to track down Adele. "Isn't there anything else you can do?" AM asks. Kerry tells her they'll keep trying to set up another IV. AM strokes Angie's forehead and Kerry murmurs a soothing "okay, sweetie" to Angie.
Upstairs in the PICU, Carter checks on Husky Lad and greets Husky Dad before asking Kit how HL is doing. A lot better, Kit reports; Carter asks about HL's lytes. "Potassium's normalizing," she says. "He'll be here a couple of days -- but I think he's out of the woods." Carter asks Husky Dad if he has a minute, and they step outside; the door to the PICU closes behind them, and Carter asks HD what happened. HD says that HL's getting more exercise and "we're working on" the diet issues. Carter puts up his hands and asks again what happened. "You understood I had an insurance problem," HD mutters, but Carter counters with, "You understood that your son had a very serious condition." HD starts to say something, but Carter isn't interested: "Yeah, I cut you some slack, but you agreed to monitor his food, his exercise, and his medication." HD, defensively: "You know how kids are." Carter, with an unjustified air of superiority: "Yeah, which is why they have parents, to be responsible for them." HD stammers that the insurance thing "is all worked out" and HL "is completely covered," but Carter is on a hot buttered roll of condescension: "At what expense, his life? You know, he almost died this morning." HD looks at the floor while telling Carter that he'd never led HD to believe "it could get this bad," and that HL has "been doing just fine, and then suddenly this morning --" and Carter interrupts with a skeptical smile, "Oh, great -- great, so you've got no culpability here at all, is that right, Husky Dad?" HD finally gets annoyed, as he should, and snaps, "You were his doctor," and he goes on to point out that Carter thought HL would get by for a few months with no problems: "I remember, that's what you said. If you didn't know this would happen . . . how am I supposed to?" Carter takes a breath as if to respond, then just purses his lips instead. HD goes back into the PICU. I won't go into the whole medical-coverage harangue again, because you've heard it -- or lived it -- before, but I will say that, while I don't disagree with the decision Carter made, he took a risk, and he shouldn't turn around and blame the guy who doesn't have the medical training when it didn't pay off. ["Because I live in an ivory tower in the middle of Socialized Medicineland, I never thought it was the right decision. I agree with Sarah that Carter really has no right whatever to blame Husky Dad for being so persuasive when the final call was Carter's, and no one else's. And that's...one to grow on." -- Wing Chun]
Downstairs, Carol and Kerry try to get an IV into Angie, Angie's Mom stands near the bed, and Adele explains to someone on the other end of the phone that it isn't an emergency, but the medical team does need IV access. A short pause before Adele tells the person on the other end that yes, they do know how often Angie has been hospitalized, but that has nothing to do with the current situation. Pan across to Carol, who complains that "her veins are sclerosed, I can't get a thing." "Neither can I, this is ridiculous," Kerry says, and she crutches over to Adele and takes the phone from her as Adele tells her it's "Steven Galbraith," who I assume is Angie's legal guardian. Kerry introduces herself and says that Angie's pic line is infected; she gets interrupted, then says, "You should know what a pic line is, you're her guardian. [A pic line is a IV catheter designed for long-term use.]" Another pause before Kerry tells the guardian she knows Angie has an incurable disease, but Angie's treatable "at this time," and then the guardian interrupts her again, and then Kerry says that "it's not a matter of life or death yet, but it could be -- Mr. Galbraith, have you ever seen Angie? Have you seen her? Because I'm looking at her right now, and I'm seeing an eminently treatable girl who would -- well, thank you. Thank you for nothing," and she hangs up the phone. She snaps off her gloves and tells the others that the guardians wants Angie given pain meds and made as comfortable as possible. She sighs.
"There it is," Luka says, and we cut to Mrs. Henry staring wide-eyed at the ceiling as the ultrasound slushes in the background. She turns to look at Luka, and he turns the monitor towards her and points at it: "A heartbeat. You are definitely pregnant. I think you're about eight weeks along." Mrs. Henry is in denial: "I wish Henry would get here." Luka asks if she'd been trying to get pregnant, and she says yes, "for almost two years, with no luck -- until now." She looks down at her belly, then over at Luka: "This takes me out of the running, doesn't it?" Luka makes a regretful moue and explains that, after the transplant, she'll have to take powerful immuno-suppressants, and these drugs could cause birth defects or a miscarriage. Mrs. Henry puts a hand to her mouth as if she might cry; Luka tells her that, if she decides not to have the child, they can go ahead with the surgery. He goes on to say that he doesn't want to pressure her, but "we have only so much time for the kidney," and he makes encouraging motions with his eyebrows. Mrs. Henry, exhibiting a strange lack of affect, won't stay on task: "How could this happen? I've waited so long . . . for both." "Mrs. Henry," Luka prompts. "I want to keep the baby," she says. Luka nods and says, "Okay," and he seems to agree with her decision.
Elizabeth runs into Holling at the elevator, and he asks her where he can find the snack bar. She says she'll join him if he doesn't mind, which he doesn't.
Cut to Mark looking at a CT scan and asking Chen, "His daughter says his behavior's been unusual?" Chen throws out the synonyms "erratic" and "volatile" and mentions that the daughter says Skinner's usually "a pretty easygoing guy." She adds that she thought he might have "some kind of mass or lesion." "No signs of that," Mark says, taking the x-rays down from the light board. "Any new stress at home or at work?" "He claims no," Chen says. Mark reviews the symptoms -- uncontrolled movements, loss of balance, and personality change -- and asks about family history. Chen says Skinner's mother is still living, but Skinner doesn't know much about his dad, who died when Skinner was fourteen. "So," Mark says, obviously going somewhere with this, "that'd make him early, mid-forties." Mark then asks what Skinner's father died of, and Chen says, "Suicide, apparently." Mark half-nods to himself and tells Chen, "We need to go talk to him."
In the cafeteria, Holling comments that he wishes Elizabeth could "talk some sense into Mark." Elizabeth says that Mark's worried about Holling; Holling knows that, but Mark thinks he can "control what's happening" to Holling: "I wish he could. But we all know he can't." He knows it's a cliché to say you don't want to be a burden to your children, but he doesn't want Mark "to have to deal with everything." "Well, he's going to, one way or another," Elizabeth says sadly. Holling asks if Elizabeth could imagine her mother allowing Elizabeth to take care of her, and Elizabeth remarks wryly that Mama Corday would sooner "push off in a canoe and head out to sea." Holling laughs that he doesn't need to go to that extreme. He wants to check out a hospice; if he stays in Chicago, his staying will make Mark happy at least. Elizabeth doesn't think anything about the situation will make Mark happy.
"Huntington's disease?" Skinner repeats, and Mark says grimly, "That's what we're thinking." Skinner's never even heard of it. Chen explains that it's a neurological disease that causes all the symptoms Skinner's suffering from. "And progressive dementia," Mark adds. "You mean like Alzheimer's," Skinner says flatly, and Chen allows that "there are similarities." Skinner takes a moment to absorb this before asking what he can do about it, and Mark says quietly, "I'm afraid there's no cure." Skinner asks how bad it will get, and Mark says he'll have to discuss that with a geneticist, and Skinner says hoarsely, "You're telling me I'm going to lose control of everything, physically and mentally, and there's nothing I can do about it?" Mark says, potential new treatments aside, no. Skinner's face works for a minute before he whispers, "I'm forty-six years old. How could I get such a thing?" "It's genetic, Skinner," Mark tells him. "You inherited it." He tells Skinner that the disease generally manifests itself in the early forties, then says carefully that it may explain why Skinner's father killed himself. Skinner frowns, then begins to look decidedly terrified before asking, "That means I could have passed this on to Jo?" Chen confirms that "there is a fifty-fifty chance." Skinner's eyes bulge out and he sighs.
An insurance guy questions Cleo about Husky Lad, and she confirms that HL has Type II diabetes; he asks about her treatment of HL, and she tells him. More questions and answers about HL and his first admission, and Cleo says a lot of things like "looks that way" and "evidently" and "I really couldn't say," and she asks for an unnecessary consult with Mark in an attempt to shake Insurance Guy. Insurance Guy takes the opportunity to ask Mark what he knows about the case, and Mark asks for the old chart and asks Cleo, "What was the glucose?" Cleo answers, "980." Mark says, "No, not today, back in November." Cleo pauses slightly before saying, "Should be in the chart." Naturally, Mark leafs through and finds neither a glucose nor a urine dip, and he tells IG he'll have to look into it and call IG back. IG goes on his way, and Mark finishes the so-called consult, and he follows Cleo down the hall and asks if "there was something [she] didn't want to say in front of" IG; Cleo dissembles that "[HL] was Carter's patient" and picks up speed, and before Mark can question her further, Cleo pulls away, and Elizabeth materializes on his other side.
Mark asks if Elizabeth shouldn't be in surgery, and she sighs that they "can't seem to give this kidney away," that they've gone through several potential donors, blah blah blah fishcakes. Then she mentions that the Morgan Center is going to call Mark. Mark asks if it's the hospice or the rehab, and Elizabeth says it's the hospice, and she looks a little green around the gills as Mark asks her what patient, but she goes ahead and tells Mark that Holling asked her about it: "I think he's leaning towards palliative care." Mark asks her all accusingly if she went ahead and "called the place," and she says defensively that Holling asked her to, and they go back and forth about it, and Elizabeth asks what Mark would have her do, and Mark wants Holling to talk to him about it, and Elizabeth reminds Mark that Holling's "a grown man," and Mark adds that Holling has a stubborn streak "a mile long," and Elizabeth tells him firmly that it's a hospice or Mark's apartment, and Mark snaps that he's "aware of" his options, he'll get a nurse's aide during the day and then he'll "do the rest." Elizabeth asks if Mark has talked to Holling about this plan, and Mark doesn't answer directly, saying instead all passive-aggressively that "I'm handling it, okay? Or at least I was," and Elizabeth says she didn't mean to interfere, and Mark leans towards her and says, "Then don't," and Elizabeth stares at him open-mouthed before her face hardens and she asks, "Is this what's best for your father or what's best for you?" Mark tells her again to "stay out of it, please." "Fine," she snaps, and jogs up the stairs.
We come back from commercial to see Luka on the phone, saying he can send Mrs. Henry upstairs. He hangs up and tells Mrs. Henry they can "squeeze" her in, and she says faintly, "I can't see my own OB/GYN?" I have to say, this character is weird; she just has bizarre, inapt reactions to whatever Luka tells her. Anyway, Luka explains that she has to see someone upstairs because of possible complications with renal failure. Just then, Lydia comes up to the desk with a tall guy and introduces him to Luka as Steve Maldonado, the guy on the transplant list. Luka shakes his hand, and Steve asks if he's the surgeon, and Mrs. Henry chews on her finger and makes a random "I have a boo-boo" face, like, SNAP OUT OF IT, Mrs. Henry; Luka shoots her a sympathetic look as Steve blabbers on about how he went to the movies and then his pager when off when he came home, blah dee blah. Luka is all "yeah, anyhow" and tells him the nurses need to draw Steve's labs, and he sort of shoos Steve off with Lydia, and Mrs. Henry wishes him luck, and she turns back to the desk with the same boo-boo face on, and Luka asks her if she's all right, and she says, "My inappropriate responses to everything should indicate that I've lost touch with reality." Okay, so she doesn't say that, she just tells him, "If I could have both, I would be," with a goofy smile that suggests she's had to choose between vanilla and chocolate ice cream, like, Mrs. Henry? Glad you could join us. Now SHUT UP. Luka looks like he feels the same way, so he just looks down with a smile on his face all "damn, what an idiot" and gives her a piece of paper with the office number of the OB on it, and she finally leaves with her little suitcase.
Chen comes in to tell Skinner she's made him an appointment with a geneticist to "discuss the results." Skinner says he's just been ordered to appear in court that same day for the pen incident, and Chen says that, because uncontrolled temper is a symptom of Huntington's disease, "they might not hold [Skinner] responsible." Skinner calls that "a lousy excuse." Chen doesn't answer, asking instead how Jo, his daughter, is doing. Skinner says she's meeting her fiancé in the lobby. Chen asks if Jo wants to have the test, presumably meaning one to determine whether Jo has Huntington's also; Skinner admits that he "didn't tell her." Chen tells him he has to, because if Jo has the gene, she'll eventually get the disease herself, and Skinner retorts that his father didn't tell him, "and I'm glad he didn't." Chen "she has the right to know" blah blah blah Skinner what's the point in her knowing if she can't do anything about it blah blah blah Chen she can "make different choices" if she knows ahead of time blah blah blah Skinner "she might not have a life" blah blah blah patient confidentiality-cakes. Skinner gives a little speech about how he loves his daughter and she's had a good life, and he won't ruin it.
Cut to an absolutely adorable child attired in a flower costume. Cleo asks Little Flower's mother if Little Flower has always had asthma, and LF's mother says yes, "since he was about three." Little Flower protests that he's fine, and his mother says no, he isn't; she could hear him wheezing from out in the audience. LF complains that she yanked him right off the stage, and he never wants to go back to school. Awww. Lily runs up to tell Cleo she's got a bounceback patient from that morning, "paramedics brought him in -- collapsed at home, loss of consciousness," and Cleo determines that it's Constipated Guy. Foreshadowing takes a bow as Cleo ditches the Flower family to see what happened.
Trauma room. CG is not doing so well, and as Romano and Carter work on him, Cleo comes into the room and asks CG's wife what happened. She basically says that CG pulled an Elvis -- he got off the toilet "and just fell over." CG is having a heart attack, apparently, and Romano questions Cleo, who says CG came in with abdominal pain but didn't have "a surgical belly" or heart problems either. "His heart is fine!" CG's wife wails from the doorway. Romano asks about medications, and Cleo tells him codeine, and CG's wife adds that he also took "what [Cleo] gave me," and Cleo says dismissively, "A laxative," and Carter looks suspicious as CG's wife digs out the pill bottle and tries to read without her glasses: "Biso -- bisopro --" Carter jumps in: "Bisoprolol?" CG's wife says, "Yes!" and Cleo shouts, "No! No, we gave him bisacodyl," and she snatches the bottle from CG's wife, and Carter half-laughs, "Oh-ho, which one was it?" Cleo reads the label and says in a panicky voice, "This is bisoprolol, but it's not what we gave him." Romano looks disgusted and slams the chart closed as CG's wife yells at CG to wake up, and Lily escorts CG's wife out with Carter calling orders; Romano bitches Cleo out for prescribing a beta blocker at double the starting dosage and causing an MI. Cleo says she didn't write the prescription, she only handed it to CG, and Romano demands to know who did write it.
Lydia tells Luka that the labs came back on Steve. Luka tells her to get ready to move Steve, and Lydia makes her patented "I'm the messenger, please don't kill me" face and says that Luka will want to "look at this." Luka eyes the chart: "You're kidding?" "Nope," Lydia says grimly.
Elsewhere at the desk, Mark and Chen discuss whether she can tell Jo about Skinner's diagnosis. Chen has information that could "radically" affect Jo's life, and she feels she's hiding it; Mark says that Skinner's her patient, not Jo, and she isn't allowed to tell Jo without Skinner's permission -- she can only convince Skinner to tell Jo himself. Chen says she tried that. Mark says that that's all she can do.
Back to Luka, now stomping with Eyebrows Of Great Foreboding into Steve's room and asking curtly, "Your renal failure was caused by rhabdomyolysis [for those of you dissecting along at home, that's an acute disease that destroys skeletal muscle]?" "Yeah, from muscle breakdown," Steve says. "And what caused that?" Luka wants to know, hand on his hip. Steve doesn't know. Luka thinks Steve does know. Steve theorizes that he got in a car accident a few years before and crushed his leg, "that could have done it." "Not using drugs?" Luka demands. Steve says, more asking than answering, "No?" Luka rolls his eyes before telling Steve that he tested positive for cocaine. Steve says defensively, "I'm sorry, I didn't realize I was this high on the list," and explains that he doesn't do it all the time, he went to a party, "I was depressed -- the damn dialysis --" and Luka, nostrils flaring like a bull in a Warner Brothers cartoon, interrupts to tell him that "you'd better get used to it." "What, you're not gonna give me the transplant?" Steve asks. The cocaine destroyed Steve's kidney's the first time and Steve is "still using," Luka says, so "why would we give you another one?" Steve says he won't get high after the operation, he's "not stupid," and Luka bitches him out for not telling Luka about the blow and wasting Luka's time, and Steve whines that he isn't an addict and he needs the kidney, and Luka says the kidney is only viable for a short time and now he has less than an hour to find someone else. Steve asks, deflating, if Luka means someone who deserves the kidney. "Yes," Luka snaps.
Jo introduces her fiancé, Glen, to Chen. Jo and Glen share their theory that Skinner is suffering from depression. Chen comments shiftily that "it's hard to say." Skinner walks gingerly out of the room, and Jo asks if he's ready to go. Skinner and Chen exchange a significant look, and Skinner says he's ready. He thanks Chen, and so does Jo, and Chen nods a sad "you're welcome" and watches them go.
Carol strolls into Angie's room to find Kerry putting in the central line. Carol says she thought Romano had nixed that. "He did," Kerry says, removing the guide wire. Carol gloves up and asks, "But you're doing it anyway?" as Kerry goes on to say that she has emergency consent from another physician and that's all she needs, and she dismisses Carol: "I've got this, Carol." "But you're going to need op-site," Carol says, and Kerry gives Carol the out again: "I said I've got it." "Kerry --" "It's my decision," Kerry says softly, "it doesn't involve you." Carol starts to look sanctimonious, then switches gears to "grateful" and says, "Okay," and they exchange a look before Carol snaps her gloves off and leaves the room. Kerry adjusts the dial on the antibiotic delivery system.
Ah, The Seventies. Because we needed yet another poorly-thought-out cultural homage to the tackiest decade in the human history. Well, except for the "needed" part.
In a trauma room, Cleo and Peter lean against a counter and Carter sits -- in the sink, or something, while Romano leafs through the riot act looking for a good passage to read them: "Looks like a 'p' to me, bisoprolol." Peter says impatiently that "it's a 'c' -- why would I order a beta-blocker for constipation?" Romano hands a copy of the scrip to Carter and asks what he thinks it says; Carter says diplomatically that he can see how the pharmacy could have read it wrong. Then he adds, in a reasonably inappropriate, but still very funny, tone of mock reproval, "But they really should have called." Hee! You had to be there, I guess. "Sure. Blame them, you coward," Romano quips. Cleo thinks it "could have been read both ways." Romano motions Abby "The Hutt" Lockhart in from the hall and asks for her opinion too; she thinks that "it looks like a 'q.'" More blaming; Carter tries to come to Cleo's defense, but Romano tells him it has nothing to do with him, "so shut up" (heh), and Abby asks if she can leave now that she's earned her weekly paycheck. Romano fulminates about the "growing level of incompetence" in the ER lately, and Cleo calls what happened "an honest mistake," and Romano says, "No, it was tag-team negligence." An awkward silence follows; then Romano bans both Peter and Cleo from writing prescriptions until further notice. They protest, but Romano tells them to get Carter or "one of the other colleagues" to write their scrips. Carter smiles a small, wicked smile. Peter wants to know for how long, and Romano says until Peter's penmanship improves and Cleo learns how to read, and Cleo snaps, "I know how to read," and Romano yells, "Then do it!" Cleo regards him with a look of dull disdain, but then, that's the only look Cleo has. Peter looks like he might burst out laughing at the Napoleon complex unfolding before him. Romano stomps out. Carter makes a "yikes!" face at Peter. "Thank you, Carter," Peter says evenly. Carter doesn't leave, so Peter says, "Thank you, Carter," again, and Carter gets the hint and manages to leave without giggling. Left alone, Peter and Cleo play round two of the blame game. Peter: you should have read the label, "they teach you that on the first day." Cleo: your writing "wasn't legible." Peter: [exit, stomping]. Cleo: "Bzzzzt. Ffffff. 404: File not found."
Cut to a zoom shot of Elizabeth sneering, "You called UNOS?" Oh, Luuuuuuka! You got some 'splainin' to do! Luka talks fast: he had to get the person on the list, a Mrs. Nussbaum, who's coming in from Indiana in forty minutes. Elizabeth complains that that puts her past the twelve-hour mark with the kidney; Luka thought "we were at ten hours." Elizabeth kvetches at him that they'll need to do all the labs and pre-op crap, what if Mrs. Nussbaum ate a heavy meal, they'll have to wait on the anesthesia, and Luka tries to calm her down and asks her to wait and assess the patient when she gets there. Elizabeth says Luka should have checked with her before he called UNOS. Luka was in a hurry "and we had to move on." Elizabeth says that Luka "may not like [Steve], but we have a match, in-house, who's ready for surgery." Luka can't believe she'd give the kidney to Steve. Elizabeth would rather put a healthy kidney into Sketchy Steve than no kidney into anyone. Luka reminds her that Steve knew he had a spot on the UNOS list and he still snorted cocaine; getting increasingly agitated, he says that Steve won't stop using after the transplant and "he'll burn his way through another organ." Heh -- "organ." Elizabeth carps that they've already gone through three people, and Mrs. Nussbaum might not get there in time or might not qualify for the transplant, and then the kidney goes to waste. Let it go to waste then, Luka sputters; he'd rather see it go to waste than go to Steve. "It's not your risk to take!" an offended Elizabeth snaps. Luka: "The guy made his choice. Give the person a chance to get here." Elizabeth rolls her eyes and tells Luka he has thirty minutes to produce Mrs. Nussbaum or she's taking Steve up to surgery. "I'm not releasing him," Luka growls. Elizabeth, coldly: "I don't need you to."
Angie's room. Romano enters to find Angie's Mom and Angie watching Kermit's opening monologue. He picks up the chart and observes mildly, "She likes this one, huh?" "It's her favorite," AM says sadly, adding that most doctors think Angie can't distinguish between episodes, "but I notice a difference. At least, I think I do." Romano regards her sadly and nods, then freezes while looking at the chart and says tightly, "Dr. Weaver put in a central line?" In a quavering voice, AM says she knows Romano "thinks it's too much, but -- I'm not ready to give her up yet." Romano stares at her for a long moment before putting on a tiny smile and saying gently, "I understand," and then excuses himself. AM thanks him as he leaves, and he turns back to her and says, "You're welcome," with a warm smile -- well, with Romano's version of a warm smile.
At the front desk, Carol updates Kerry on a strep throat. Oh, here we go. Kerry pauses when she sees Romano coming down the hall, and Carol notices the pause and turns to look, and Kerry -- to her credit, because in the same position, I'd have hidden in the bathroom -- crutches down the hall to meet him. As Carol looks on, Romano asks very quietly if he didn't make himself clear before. "No, I -- I think you made your position known," Kerry says, sounding pretty unconcerned. "And you decided to ignore it?" Romano says, still quietly, but as if he might blow up at any moment. "I took it under advisement," Kerry says. At the desk, Carol makes an "oh, no" face. Romano's even response: "I see, okay -- well, then, you're suspended, sign out your patients and go home." Kerry, not taking him seriously, starts to say, "Robert --" "Right now, Kerry," he interrupts firmly, "right now." "'Suspended,'" she repeats in disbelief, and Romano finishes for her, "Effective immediately and until further notice." Carol rolls her eyes, then looks down. Kerry snorts and crutches away from Romano, past Carol, to the desk, where she slaps the chart in her hand down and keeps going without a word. Carol looks over at Romano, who looks pretty pleased with himself, and he stares back at her all "go ahead, make my day," and then he walks off. Carol shakes her head.
The lounge. Carter limps to his locker, and Mark asks if he's going home. Carter says yes -- unfortunately, because he has one of his grandparents' dinner parties waiting for him, which he can't get out of because he lives with them now. Mark has "a question for" Carter, and he presents Husky Lad to Carter as a hypothetical; Carter sees where Mark's going and diagnoses "probably gastroenteritis." Carter adds that it "sounds like a trick question," so he'd probably also order a CBC and a urine dip to rule out a UTI. "That's what I thought you'd do," Mark says. Carter asks how it turned out. Mark says they have the CBC, but he doesn't know about the urine, "because you didn't order one." Mark starts to fill him in on Husky Lad, but Carter heard about it: "Cleo told me." He asks Mark if HL will be okay, and Mark says pointedly that HL should be, but it "would've been nice if we'd caught it earlier," and he hands Carter the chart. Carter says a bit too casually, "Yeeeeah, kid must not have looked that sick. What did I say, stomach flu?" "Yep," Mark says, putting on his coat. Carter nods and makes a point of saying that he wishes he could remember Husky Lad: "I feel bad. I must've misdiagnosed." "He didn't have any insurance," Mark says, trying to lead the witness, but Carter won't bite, saying, "Really. What are they gonna do?" "Well, they're okay, they have it now," Mark says meaningfully, and he eyes Carter's reaction. Carter, blithely: "Oh, good." Mark catches Carter's eye again and asks, "Is there anything else you want to tell me, Carter?" Carter pretends to think for a minute, then shakes his head and apologizes for making "a mistake." Mark nods and says flatly, "Have a nice party," and he takes off. Carter arches an eyebrow and says, "Thanks." I can't tell if we're meant to think he got away with it or not, but I suppose he did.
Hallway. Luka sees Steve's gurney by the elevator. He stops. The elevator door opens, and Lydia and Elizabeth roll Steve into the elevator. Elizabeth stares defiantly at Luka, then gets into the lift and presses a button, and as she waits for the doors to close, she keeps giving Luka The Stare Of Great Challenge. Luka purses his lips and looks tragic, as he does so well.
Casa Femmebot. Okay, I really can't give a detailed account of this scene because I had to run to the bathroom and heave up everything I'd eaten since fifth grade, but it breaks down like this: Peter comes over to Cleo's gigantic apartment and finds Cleo lifting weights; he apologizes Peter-style, so in other words he doesn't really, while Cleo does bicep curls; Cleo tells him his apology sucked rocks and heads for the shower, but turns around to ask him if he's "coming" with her; he follows her; they start doing it on the stairs; I watch dinner in reruns.
The Greenehouse. Mark comes in to find the TV on and no Holling in sight. He turns the television off while calling to his father, and Holling emerges and crabs about the oxygen cylinder, and Mark says Holling's reserve tank is low, blah dee blah. Holling has made mac-and-cheese, and Mark inspects it as Holling calls from the living room that he saw Elizabeth that day. Mark says Elizabeth told him; Holling asks if she said anything about the hospice. Mark, prior to taking a bite of mac, says he checked it out, and "there weren't any spots available"; I believe we're to infer that he's lying. Holling looks disappointed and asks when a spot will open up. Mark doesn't know, there's a waiting list. Holling asks what's the point of a waiting list, and Mark sits beside him on the couch and shrugs all disingenuously, "Looks like you're stuck with me for a while." "Yeah," Holling says wryly, leaning forward to turn the TV back on.
Oh, no. No, no, no, no, no. Cut to Hathaway Saints' Registry & Child-Care Facility, with Carol coming out on the porch and exclaiming, "Luka! What are you doing?" She comes down the steps and douses the flaming barbecue grill with beer to put out the fire. As even the dimmest-witted audience member makes the connection between the flames and Luka's feelings, Luka observes that the grease from the meat (no comment) must have dripped into the fire. Oh, brother, I don't think I can go on. Okay, so Carol tells him that's what the water bottle is for, and he says she didn't tell him that, and she hands him the beer, "what's left of it," and says it "really cooled off out here, huh?" Yeah, "huh" yourself, sister. Luka asks, "Girls asleep?" Carol sits down and says, "One of them. The other one's still fussing." Do mothers, in conversation with their friends, refer to their children as "one" and "the other"? That just sounds weird to me. But looky here, it functions as the set-up anvil for how well Luka knows the little family, because he smiles, "Let me guess -- Kate." Carol makes a "whatever" face and says, "You had a fifty-fifty shot." Luka pokes the meat (again, no comment) and says, grinning, "No, she is the troublemaker." Carol looks down and says, "Yeah." Luka asks if the steaks are cut too thick (nope, still no comment) and might still be rare inside, and she tells him not to worry -- if he messes them up, she has "a steak-and-kidney pie in the freezer." Ba-dum-bum. Carol Hathaway, folks. Give her a hand. "Kidney, huh?" Luka snorts as Carol giggles evilly at him. "Very funny." Carol says that the nurses almost took a poll; they thought he'd have to take the kidney home with him. "I might as well have," he grouses, looking up at Carol and taking a sip of beer. "Nah, you probably scared the guy into rehab," Carol says, looking off into the middle distance. Luka half-nods in response, and then his gaze fixes on her and he gets The Look. Oh, man, not The Look. When Carol looks back at him, she says, "What's wrong?" "What's wrong"? Girl, please -- did the turnip truck just drop you off? Because even if she doesn't want it, every female over the age of twelve knows what The Look means when she gets it, and here's another word to the wise: if a Man Who Looks Like That gives you The Look, you don't use the word "wrong" anywhere nearby. Jeez. So anyway, Luka snaps out of it and looks up: "Wow, is that snow?" Cut to an overhead-cam shot of them standing together, and Carol bitches, "Oh, man -- hello! It's April!" as Plot-Prolonging Flakes spiral down around them. As we fade to end credits, Carol says they can finish cooking inside, and Luka says no, he "came here to barbecue" (for the last time, no comment), and she asks, "Do you want to freeze?" and he says that it's just a little snow, and she offers to get him a sweater, but Luka doesn't think any of her sweaters will fit him, and Carol laughs that she'll "find something." Yeah, I'll bet she will. Bitch.