Previously, on ER: Carter told the media that Zorictal killed Angela Chase, and Susan yelled at him for costing the hospital financial support. Jake, Abby's medical student, asked her out, and she said no, since he's her student. Neela and Ray became roommates, and Neela knew she would regret it. Luka thought they needed to teach the residents to connect with patients, and Carter suggested that Luka start with Pratt. Susan yelled at Pratt for acting like an intern.
A woman makes orgasmic sounds as a shower runs. The camera pans across an apartment to reveal lots of discarded clothing, and then Pratt, lying in bed alone and grinning. A woman walks out of the bathroom and complains that they're out of hot water. Those were not the noises one makes when the shower goes cold. I tend to make noises that involve a lot of cursing and screaming. Maybe I'm the weird one. Pratt says he should have warned her. The woman claims she's freezing, and Pratt pulls her in for some kisses. He suggests that they call in sick, but she protests that she's arguing a motion today. Pratt thinks they can hook up later, but she says that she's going out for a friend's thirtieth birthday dinner at a fancy restaurant. Pratt says that, after today, he'll be on night shifts, so this is their last opportunity to hang out for a while. And by "hang out," he clearly means "have sex." Pratt promises to make it up to her. The woman pulls away and says that she likes Pratt, but that she doesn't think they have a future. Pratt is shocked. The woman says that she's looking for a guy who's a little further along in his life, since he is a student and lives like one. Pratt, not getting it, says he's not a student. The woman says she's just looking for a guy who's a grown-up. She starts to get dressed, and Pratt scoffs.
Carter hands out charts to the interns and students and quizzes them on when to order a film. The students (Jake and Darlene) struggle, so Abby and Shane West help out. Pratt shows up, and Carter hands off a chart for a patient who has had vertigo for six hours. Sam walks in, and Shane tells her about a patient who needs an IV. Pratt asks how he's going to learn to put in a line if he always passes it off. Shane thinks that IVs are a nurse's thing. Pratt says that today, they won't be. Abby brags that she can get an IV into a scalp vein. Well, she also used to be a pediatric nurse, so that makes sense. Teacher's pet. Carter agrees with Pratt that everyone should do his or her own lines. Jake offers to handle Shane's patient, saying that he needs the practice because he's headed to his surgery rotation . Shane asks why they need to make up arbitrary rules that will only slow them down. Pratt responds, "Because I can."
Abby snarks, "Somebody woke up on the wrong side of the waterbed this morning." Susan walks in and says, "Yeah, me." Shane thinks Susan really has a waterbed. Shut up, Shane. Susan tells Carter that she can't do the schedule because they don't have enough Attendings. Carter suggests hiring part-timers, but Susan says that they can barely afford the doctors they have. Pratt returns to tell Sam to order a head CT, and Sam says he'll need an Attending to sign off on that. Pratt is surprised to learn that residents can't order CTs now. Susan explains that they're trying to cut down on unnecessary and expensive tests. Pratt insists that it's necessary. Susan says he was only with the patient for two seconds, and that he probably didn't even do a neuro exam. Pratt sighs and says it could be a cerebellum mass. Susan says it could also be an inner ear infection, and that Pratt still needs to do a thorough exam before an Attending signs off. Pratt complains that he's a third-year resident, and he's been ordering his own CTs since he's been there. So he only likes arbitrary rules when he gets to make them up. Pratt says it's stupid, and asks Carter to back him up. Carter reminds him that it's Susan's ER. Susan sing-songs, "Sorry, Pratt. It sucks to be you."
Pratt pulls back a curtain and asks the patient, Mr. Turner, about his complaint. Mr. Turner wants pain meds, and he wants them now. Pratt sternly says that he can't write any prescriptions unless Mr. Turner has a legitimate need, and for that to happen, Pratt needs to know what's wrong. Mr. Turner snarls, "Vicodin. Morphine. Go!" You'd think Pratt would respond well to that treatment, since that's pretty much how he treats his patients. Instead, Pratt throws the curtain closed in disgust. Malarkey asks Pratt for help with a homeless patient named Rocky who claims she knows Pratt. Pratt waves and tells Malarkey that Rocky is just lonely, and knows exactly what to say so that she'll be allowed to stick around for a few hours. Malarkey complains that Rocky's breath is killing him, and Pratt advises him to call Social Work to hold Rocky's hand. Malarkey makes a leering comment about Wendall. Shut up, Malarkey.
Susan walks up and tells Pratt that she's applying for a Robert Wood Johnson grant. Hey, I know that foundation from their support of NPR, which makes two mentions of NPR-related subjects in as many weeks. Someone's a fan. Anyway, Pratt wishes Susan luck, and asks for a handout on rehab for Mr. Turner. Susan presses ahead, explaining that they need to pull some charts and fill out some forms for the application. Pratt isn't interested. Susan promises to put his name on the paper. Pratt says, "I'm not into research and I'm not interested in publishing." Maybe he shouldn't work at a teaching hospital, then. Susan says that he'll be sorry when he's looking for a job and they hire someone from Harvard with a five-page CV including three books published. Pratt says he's writing something about "the abuse of power by Attendings in the county hospital system." Susan half-chuckles and says she needs the forms back in a week.
Abby helps Jake to interpret an X-ray. Jake asks, "Is the problem that I'm a student, or that I'm your student?" Abby ignores him, and Jake says he's just trying to isolate the issue. Abby walks off, saying that she's his supervisor. Jake says it's just temporary. Abby says that his evaluation form is sitting in her box, right now. Dirty! Abby grabs another chart and tries to get back to work as Jake asks if she's going to let "some false sense of hierarchy get in the way of this?" Abby says that if he doesn't shut up, she'll flunk him.
Jake and Abby walk into a curtain area and speak to their patient, Mrs. McDow, a seventy-two-year-old woman with nausea. Jake asks if her chest is bothering her, and she says that she thinks she's having heart pains. Jake takes her pulse while Abby asks if this has ever happened before. Mrs. McDow says it does sometimes, while she's walking her dog. She keeps talking about how her husband brought the dog home from the pound as Jake reports that her pulse is racing. Mrs. McDow adds that her husband passed away, and Abby expresses her condolences. Jake reels off a list of medications for the woman, and Abby explains that they're going to give her medicine now to help with the pain, and then Jake will get her an EKG. Mrs. McDow responds, "You're the boss," and Jake agrees, "Yes, she is!"
Pratt looks into a kid's throat as the kid's mom says that he's only been in his new school for a month and he's already missed five days. Pratt asks if he has a sore throat or stuffy nose, and the kid kind of shrugs. His older brother says that he's quiet, and the mom adds that he just said he didn't feel well enough to go to school. So he's faking it. What kind of mom can't figure that one out? Pratt checks the kid's ears as the mom's cell phone rings. Pratt asks how long the kid has had tubes in his ears. The mom doesn't know, and explains that she's really the stepmom. The boys lived with their mother until she went to jail for selling meth. The older brother looks embarrassed that Stepmonster just blurted that out. Pratt goes to listen to the kid's chest, and when the kid lifts up his shirt, he reveals a giant scratch across his chest. Not like a cat scratch. More like a dinosaur scratch. Pratt asks about it, and the Stepmonster and the brother act like they've never seen it before. Sam walks in with a strep culture kit and flinches when she sees the scratch. Pratt asks Thomas (the kid) how he got it. Thomas is silent. He looks at his brother, and then shrugs. Pratt assures the kid that it's okay to tell him, and Thomas says he doesn't remember.
Susan tells Darlene that she's applying for a completely different grant than the one she was talking about either. Susan needs someone to take an inventory of all their educational materials and record them on some forms, and she thought it would be a perfect job for Darlene. Darlene looks less than thrilled. Shane comes up and accuses Susan of "poaching [his] student." Darlene tells him, "Attending scut comes before Intern scut. Sorry."
Wendall talks to a patient who has a sad story about how her life fell apart due to chronic pain. She missed so much work that she got fired, and her boyfriend bailed on her. Wendall starts to suggest counseling, but the patient has already tried it. Shane waltzes up and gives the patient a note to excuse her from work, as well as her discharge papers. I thought she lost her job? The woman says she doesn't know why she bothers seeing doctors. Wendall tries to sell her on the idea of a pain clinic or a support group. The patient says she always gets the same useless advice, and that she's tried everything and nothing works. She reminds Shane that she told him she didn't need social work. Shane's great advice is "Hang in there. We're all done here." In other words, go buy that poster with the kitten on it, but make sure you leave the ER to do it. Wendall wishes her luck and then, once they are out of the patient's earshot, asks Shane why he called her out of the NICU to see a patient that didn't want her help. Shane says he knew he couldn't do anything for the patient's back pain, and the patient just needed someone to hear her complaints. Wendall protests that she's not a babysitter. Pratt walks up and asks Wendall to see Thomas, and Wendall tells Shane that a possibly abused child is a situation that warrants calling her.
Luka and the paramedics roll in a guy with a gunshot wound to the right chest. Pratt jumps into the mix, and tells Wendall to go in to see Thomas alone, despite her protests. Pratt addresses the patient as Mr. Lysander. The patient removes his oxygen mask to explain that Lysander is his first name, and that his mom wanted to name him after a romantic hero, but that she got it wrong. This guy (played by the same guy who played the technology expert in Ocean's Eleven) babbles a lot, so unless it's important to the character or plot, I'm just going to say "Lysander babbles." They wheel Lysander into Trauma Yellow. Just as Luka is ordering Pratt to put in a chest tube, Dubenko swaggers in and introduces himself. Lysander is impressed that there are so many doctors working on him, so at this point, I thought the wound was self-inflicted to get attention or something. Lysander babbles. Dubenko gets Lysander to sit up and pronounces that the bullet went through and through. He listens to Lysander's lungs and says that he needs a chest tube. Luka makes a face, and Pratt sarcastically holds up the tube that he was already prepared to put in before Dubenko arrived. A cop comes in and handcuffs Lysander to the gurney, explaining that he's being charged with assault.
Sam patches up Thomas while Wendall assures him that no one will be mad at him if he tells them what happened. Sam tries to encourage him to speak up. Thomas opens his mouth, and then looks at his brother and shuts up. After a moment, Thomas says that he was climbing the fence at school and he slipped and hurt himself. He says that he didn't want to admit it because he ripped his shirt, which belonged to his brother, Casey. Wouldn't someone notice a bloody, ripped shirt? Like a teacher or something? The Stepmonster starts to get mad, but Casey assures her that he doesn't care about his shirt. Wendall watches them argue, and then asks to speak to Thomas alone. The Stepmonster asks if it's "absolutely necessary," because she really needs to get to work. Sam points out that they can't leave until they get the results of the strep test anyway. Wendall gets a page and leaves, promising to return.
Abby examines Mrs. McDow and says that she has "a right bundle branch." Jake assures the patient that it's pretty common, since he has it too. He adds that he also has "an aberrant re-entrant conductance pathway." Abby jokes that it explains a lot. Jake says that his EKG is "kind of wild." Haleh brings them back to the present by asking a question about treating, you know, the patient in front of them. Abby tells Mrs. McDow that her EKG is consistent with ischemia, meaning that her heart muscle isn't getting enough blood. Mrs. McDow is worried, and Jake says they'll check another EKG to see if it's progressed. Mrs. McDow thanks him.
Abby walks out of the room. Susan tells her that she's asking all of the residents to keep track of the amount of time spent on each patient. Abby asks if she's thinking of switching to an automated system. Susan says she'd like to if they had the money, and then asks Abby to get everyone on staff to fill out some forms and collect them when they're completed. Susan unloads a giant stack of folders on Abby, and walks off without waiting for a response, probably wisely.
Carter sneaks up behind Susan and asks what the time survey is about. Susan says she's applying for an informatics grant from a pharmaceutical company. Carter gets his knickers in a twist, because he thinks residents should be treating patients instead of doing free research for drug companies. Susan says that might be possible if someone hadn't dissed a drug company on television. Carter insists that he was right. Susan explains what the drug companies' money can do for the hospital, as well as how screwed they are without it. Carter snips, "So you're just going to go to another drug company? Can't we be a little more creative than that?" Oh, whatever, Richie Rich. If you feel so strongly about it, why don't you ask to be considered for Susan's job, and come up with your own creative solution to the problem? Or better yet, why don't you just give the hospital a grant from the Foundation of Carter's Enormous Inheritance? He's such a bitch. Susan says that drug companies are pretty much County's only chance. Carter thinks the money carries strings, and represents "a serious conflict of interest." And while I'm sure he's ethically in the right, his superior attitude and condescending delivery are mega-annoying. Susan agrees sadly, "Yeah. And I never thought I'd be kissing corporate ass when I went to medical school. Welcome to adulthood." Carter isn't ready to give up, and says, "We owe it to our patients." Susan agrees: "To keep our doors open." Carter smugs that this compromises their independence. Susan, fed up, says, "Oh, you know what? Most of us had to make compromises just to get through med school and residency. That's probably a foreign concept to someone who's never had to worry about money a day in their life. It must be nice." Yeah! Exactly. You go, Susan. Unfortunately, Carter is still all smirky, and also wearing corduroy pants, like, when did he become a middle-aged college professor? Wasn't there a time when Noah Wyle was supposed to be one of the hospital's resident hunks?
Pratt successfully inserts a chest tube into Lysander, who is relaxing with his arms behind his head, thoroughly enjoying the whole situation. Pratt asks how Lysander got shot. Dubenko interrupts to explain that Lysander was a character in Midsummer Night's Dream who "spent the whole play being pushed around by Puck." Dubenko asks Luka why he's doing an ultrasound on the abdomen when the wound is in the chest. Luka says that the bullet could have ricocheted. Dubenko points out that the exit and entrance wounds are aligned, so the bullet must have traveled straight through. Pratt finishes sewing in the chest tube, and Dubenko says that Lysander can go to the ICU. Lysander asks if he needs an operation, and Dubenko says no as Luka says it's not clear yet. Pratt looks at Luka like, "Did you just contradict a surgeon? Awesome!" Luka says that they can't be sure whether Lysander needs an operation without looking in his belly, and Pratt offers to call for a CT. Dubenko asks, "Why do you ER doctors radiate the hell out of people instead of trusting your own clinical judgment?" Luka says he does trust his clinical judgment, which is why he wants a CT. Pratt hangs up and reports that the scanner is down for a few hours. Luka says that if the bullet nicked the bowel, Lysander can't wait a few hours, and thus needs an immediate ex-lap. Dubenko suggests that they let the surgeons decide when surgery is needed. Lysander asks Pratt excitedly if the doctors are fighting over him. No, they're fighting over dick size, but pretending it's about you. Dubenko condescends, "Come on, Kovac. Let it go." Luka says that Lysander is his patient. Dubenko fills out a chart and says that Lysander is officially admitted to Trauma Service, and that the ER is just supporting him until a bed opens up. So now Lysander is Dubenko's patient. Dubenko concludes his little Performance of the Macho by snipping to Luka, "You can go." I still don't get the Dubenko attraction some of the forum posters have. He's weird, and kind of a dick. I can understand enjoying him as a character -- I was one of the biggest Romano fans out there. But finding him attractive? I just don't get it. But, to each his or her own.
Sam and Luka are at the Jumbo Mart, getting coffee. Well, Sam is getting coffee. Luka is still obsessing about Lysander: "If we missed an intestinal injury, the guy's going to get septic and die. Why does Dubenko think he can act like that with the ER staff?" Sam uses her Word-A-Day calendar skills and suggests that it's hubris. Luka asks why Dubenko doesn't bother Sam. She responds, "Dr. Hair? I think he's kind of cute." Ew. How could she like both Luka and Dubenko? That's unnatural.
As Luka and Sam walk back across the street, Sam explains that Surgery and ER have butted heads in every hospital she's ever worked in, and that it's nothing personal. Sam adds, "Surgeons have to believe that they're better and smarter than everyone else. It's a defense mechanism to make up for their terrible lifestyle." Like ER doctors have such great schedules. Although I guess they're not on call in the same way that surgeons are. Anyway. Luka is still obsessing, and Sam tells him, "It's a pissing match, Luka. Let it go! Besides, you're taller and sexier, and you already got the girl." Damn, Goran Visjnic is fine in those sunglasses. Luka insists that it's not about ego, and Sam sarcastically asks, "It's not?"
Carter and the paramedics roll in a guy with an arrow sticking out of his stomach. I feel like we've seen this one before, or maybe the patient had an arrow in his head. Arrowbelly is moaning about the pain. Shane rolls up and asks what happened. Arrowbelly explains that they made him balance an apple on his head while they all shot an arrow at him. Carter asks who "they" are, and Arrowbelly says it was "the DKE brothers." I think that's a real fraternity. I wonder if they'll sue. That reminds me of the time that my older brother and his best friend convinced me to stand against the side of the garage while they whipped small bits of clay at me to see how close they could come without actually hitting me. Hey, I was, like, six. It seemed like a good idea at the time. Until one of them hit me and I started crying. Anyway, I was six, not nineteen, and it was clay, not arrows. Arrowbelly says that they told him that arrows had a plastic tip and wouldn't hurt him. Darlene says sardonically, "They were wrong." Arrowbelly's friend says that they didn't think he would let them do it. Darlene sighs, "God, I'm glad I'm not a guy." Yeah, because fraternities have the monopoly on stupid hazing techniques. Girls are bitches too, man.
Pratt hands Thomas a note for school and reminds him not to climb any more fences until he's much older. He gives Stepmonster the aftercare instructions, and the family prepares to leave. Wendall walks up, shocked, and asks them to hold on one second. Stepmonster says that she really has to go to work, but agrees to wait for a moment. Wendall asks Pratt why he's discharging them, because she didn't complete her assessment. Pratt says she found out what happened, so her work there is done. Wendall says that if Pratt wants her to consult, he needs to wait for her assessment. Pratt says that she said the injury was consistent with Thomas's story. Wendall says again that she hasn't completed her evaluation, and that she won't sign off until she's interviewed Thomas alone. Pratt scoffs that he doesn't need her to sign off. I think Wendall is wearing a long-sleeved t-shirt, which doesn't seem very professional. Malarkey runs up and says he has a sixteen-year-old girl with abdominal pain, and that he wants Wendall to do the sexual history, because the patient would rather talk to a woman. So why not get Jane or someone to do it? Wendall says sharply, "I am sick and tired of you all using social work as a crutch whenever your patient's needy or smells bad or you just don't want to spend time with them." Malarkey says that the girl actually smells kind of good, and Wendall takes the chart. Wendall returns to Pratt, saying that he should have paged her before discharging Thomas. Pratt asks if she's saying they call her too often, or not enough. Before Wendall can respond, Stepmonster walks up and says she's going to lose her job if they don't leave right now. Pratt assures her that she's all set, and Wendall just stands there, mouth open, and watches them leave.
In Trauma Green, Arrowbelly asks when they're going to take the arrow out. Carter says they'll do it up in the operating room. Shane reports that Dubenko is on his way. Shane can't find a vein for an IV, and neither can Abby. Sam asks if anyone checked his feet, and ties off an ankle. Carter tells Abby to set up for a central line, and Abby passes it off to Darlene, who says that Jake said she was cool about letting students do procedures. She adds, "Actually, that's how he sold me on the switch." Abby hasn't heard anything about a switch. Arrowbelly asks if anyone called his mom, and Sam promises that they're working on it. Darlene explains that Jake switched shifts with her so that he can finish his rotation by working nights with Neela supervising. Carter tells Arrowbelly that they're going to intubate, and Shane promises that, when he wakes up, he'll be recuperating sans arrow. Sam gets a vein in the foot. Darlene keeps explaining that Jake said he wanted to get a sense of how other interns work. Carter notes that Arrowbelly's blood pressure is dropping, and tells Abby to go door and get the rapid infuser.
Abby walks into Trauma Yellow as Pratt and Luka gown up to perform a DPL (which I'm going to look up later, but I'm going to assume is some sort of lavage, based on what happens ). Pratt says they hardly do them anymore, because it's archaic. Luka thinks CTs have made doctors lazy, and that DPL is a more highly sensitive test under these circumstances. Pratt reminds him that Dubenko didn't want them touching his patient. Luka says DPL is "safe, it's faster, and it's indicated in penetrating thoracic injury." Lysander asks if there is always this much debate, and Abby pipes up that it's only for the really important stuff. Lysander is excited. Abby says she's stealing their rapid infuser, and Luka tells her to send Darlene in to watch the procedure. Luka explains to Lysander that they are going to make an incision in his belly, and then run a liter of saline through. If the fluid is clear, Lysander is fine, but if there's any blood in it, he needs an operation. Lysander thinks it makes sense. Pratt says again that Lysander's not their patient, and that Dubenko will freak out.
Carter walks into the break room, where Susan is drinking coffee. He reports that Arrowbelly went up to the OR. Susan is quiet, and it's awkward. Carter says he was never in a fraternity. He stops and apologizes to Susan for not being the best team player. Susan sighs with relief that they're apologizing, and says she was out of line, because even though she's juggling a lot, she shouldn't have taken it out on Carter. She totally should have! He was being a dick. Carter says it was lot easier being a resident, because the Attendings made all the tough calls and protected them from administrative crap. Susan says it didn't seem that way at the time, because "students want to be residents, residents want to be Attendings." That's why I've learned (at my day job) to just realize that I like my current job instead of bucking for promotion. I'll take quality of life over money any day. At least while I make enough money to fund my opulent lifestyle (e.g. buy Pop-Tarts by the case and keep my dog in rawhide bones). Carter says that Attendings just want to be left alone. He smiles at Susan as he walks out, and she smiles back.
Wendall tells Carter that she's not consulting for the ER for the rest of the day. Carter asks who is covering, and Wendall says that no one is: "The ER's blacklisted." Can she do that? Carter is shocked. Wendall is pissed that doctors only listen to other doctors, and tells Carter to call a candy striper if they need someone to keep a patient company. Yeah, but then the candy stripers will try to pass it off on the Girl Scouts who are volunteering that week, who will just fuck off and go eat some cookies, and then where will we be? Carter watches Wendall walk away and blinks in surprise.
Luka gives Pratt instructions on how to perform the DPL. Lysander asks if he's a student, and Pratt, annoyed, says that Darlene is. Pratt continues to work. Darlene offers to hold a clamp, but Pratt refuses. Lysander asks who long Pratt has been a doctor, and Pratt says, as he finishes the incision, that it's been three years. Chuny pops in to say that one of Luka's patients is coding, and that Malarkey is in there alone. Luka tells Pratt to dump in a warm liter of saline and let gravity pull it out; it should take about twenty minutes. Pratt asks what they should do if Dubenko shows up, and Luka says they should call him. Darlene asks if she should follow Luka, and Pratt says she should, leaving him and Sam alone with Lysander.
Lysander says that Luka seems like a good boss, and Pratt says he's one of many bosses. Lysander says he's had the same boss all fourteen years of his job. His name is Jack Meegly, and insists on being called Mr. Meegly even though Lysander is older than he is. Sam thinks the guy sounds like a jerk. Pratt threads in some tubing and starts the saline flowing. Lysander says that he rearranged a display in his store last night, and Meegly made him change it all back the morning. Lysander is pissed that he doesn't have the authority to change the displays in his own department. Pratt sympathizes, "Sucks to be the middleman." Lysander says that he's worked holidays to cover for Meegly while he cheats on his wife with a girl who works in cosmetics. Today, Lysander had enough, so he went to the firearms section, grabbed a gun and some bullets, went into Meegly's office, and fired the gun into the air. Pratt raises his eyebrows. Lysander smirks and says he didn't mean to hurt the guy. Sam says that explains the handcuffs and the cop stationed outside. Pratt asks what happened . Lysander says that Meegly grabbed the gun out of his hands, and then he trails off, holding back tears. Sam asks, "He shot you?" Meegly rolls his eyes and says, "Story of my life." Pratt says, "I thought I had it bad."
Dubenko walks in to give Lysander an update on when he'll get an ICU bed, and stops short when he sees what Pratt is doing. Sam gets real busy with the IV. Dubenko wonders, "Why stop there? Get sterile, Pratt. We're going in." Pratt doesn't think Dubenko is serious. Dubenko says if they're so sure he needs an ex-lap, they'll do it right there. That doesn't seem sterile. Lysander looks alarmed. Pratt pulls a face, and then there's a weird fade to commercial.
And then there's a weird break back from commercial, where we enter in the middle of Dubenko explaining that he was just trying to make a point. He asks where Luka is, and Pratt says that Sam's out looking for him, even though moments earlier, Sam was standing right there. There must have been something cut out of this scene. Dubenko tells Pratt, "Quick, friendly tip of advice: time you're caught between a surgeon and anyone else in the hospital, listen to the surgeon." Lysander asks what they're going to do now, and Dubenko says Pratt will have to finish what he started. Pratt explains the procedure to Lysander again, even though Luka did just that not ten minutes ago. Weird. Dubenko says that ER docs convince themselves of the worst possible diagnosis and then "radiate, bleed, and bludgeon" to prove that they're right. Pratt sticks up for Luka, and says that he's always on them to do fewer tests. Dubenko says they are "so obsessed with the dramatic save that [they] fail to develop any finesse." He's not done. He adds, "Sledgehammers and carpet bombing when discretion and restraint are what is required." And people really like this character? Pratt says they wouldn't have pushed for the procedure if they didn't think they'd find something. Dubenko says that Luka did an invasive procedure on somebody else's patient. Didn't Dubenko get the memo that said that ER docs can do whatever the hell they want, and damn the rules?
Luka walks in and tells Dubenko to talk to him instead of his resident. Dubenko suggests that they discuss it in the hallway. Luka doesn't want to. Dubenko stomps over and says that his patient is fully aware that Luka and Pratt ignored Dubenko's instructions to do "this ridiculous test." Lysander assures him that it's okay. Luka says that after years of taking care of cases that surgery blows off, he's developed some intuition. Dubenko shoots back, "Your intuitive approach is very sweet, but I like to practice evidence-based medicine." Dubenko suggests that they look at the evidence. He pulls up the bag into which the saline was draining, which is pink. Lysander asks if that means he's bleeding. Dubenko says no, and slaps the bag on top of a chart. He can read every word through the fluid. Darlene asks how that correlates to cell count, and Dubenko says it's ten thousand red blood cells, tops, and that Pratt probably released that many with his incision. Pratt says that Dubenko doesn't know that for sure. Lysander asks if they should bring another doctor in to act as a tie-breaker. Dubenko says, "If he was bleeding, we'd be looking at tomato juice, not pink lemonade." Luka says, "He could have a small tear that's intermittently oozing." Dubenko sighs that he's tired of this game, and that since Luka won't stay away from his patient, he's going to find him a bed. Dubenko leaves, and Lysander asks if he's mad at him.
Abby and Jake wheel Mrs. McDow up to the cath lab. Abby explains that she has a blocked blood vessel, which caused her to pass out, so the cardiologist will insert a catheter into her heart to unblock the vessel. Mrs. McDow asks if it will hurt, and Abby promises she'll be sedated. Abby offers to call a family member. Mrs. McDow has a son in Seattle. Jake asks if she has any friends to join her, and Mrs. McDow says it's just her and her dog. Jake says that his shift is almost over, and he loves the cath lab, so he'll hang with her. Abby smiles at him. Mrs. McDow asks in disbelief if he wants to stay with her. Jake says he'll be quiet and he won't bug her or anything. Abby and Jake leave the curtain area so that a nurse can do an assessment. Abby tells Jake that was a nice offer, and Jake says he really does like the cath lab. Abby tells him he did a great job on his rotation, and that she probably should have mentioned it sooner. Jake thanks her. Abby tells him to let her know if he needs any help down the line. Jake chuckles. Abby says awkwardly that it's good that he switched to work with Neela, because she's smart and it's good to have variety. Jake says he was wondering about something. Abby says cautiously, "Yeeeeah?" He asks where she thinks Gertie's blockage is. Heh.
Pratt tells Luka to leave him out of it the time he wants to start a turf war with Dubenko. Luka says it's not about power, it's about the patient. Pratt says that they've seen hundreds of gunshot victims, so he doesn't know why Luka thinks that he's right and Dubenko is wrong. Luka says that if you have a strong gut feeling about something, you have to listen to it. Pratt wants Luka to admit they were wrong, but Luka says they don't know that yet. Pratt thinks it made them look like fools. Luka says, "Is that what you're worried about? Nothing will get a doctor into bigger trouble than the fear of looking stupid. Trust me."
Abby and Jake head for the elevator. Abby asks if he's on nights for the rest of his rotation. Jake says he is. Abby says that she's on days, so this is the end for them. Jake says it's too bad. Abby abruptly turns and gets into the elevator. I'm sorry that Maura Tierney isn't on a sitcom anymore, because she has great comic timing. I'm glad that Abby has had some more light-hearted moments this season, because she can pull them off. Anyway, Jake stops the elevator door from closing, just like you knew he would. He says he's sure Neela's a good doctor, but that's not why he switched shifts. He did it so that, after today, he wouldn't be Abby's student anymore. He tells her to fill out his evaluation tonight, seal the envelope, and turn it in. He concludes, "Because tomorrow night: you and me, we're going out." Abby blushes and says they're not. Jake says they are. They continue to trade "No, we're not" and "Yes, we are" until the elevator door closes. Some people got a creepy stalker vibe from Jake, and I think part of that is because Eion Bailey seems high all the time. But I think either the writers, the director, or Maura Tierney herself went to great lengths to show that Abby is encouraging him and reciprocating his interest, but trying to do the right thing professionally by saying no. At least that's my interpretation. If Abby really meant that she didn't want to date him, and wasn't all coy and giggly about it, then Jake's actions would seem a lot creepier.
Darlene asks Pratt if he ever though about going into surgery, because he's good at it. Pratt isn't interested. Sam walks up and asks if excessive yawning is a sign of something. Pratt says, "Yeah, sleepiness." Thanks, Dr. Smart-Ass. Sam says that Lysander seems alert, but won't stop yawning. The cop walks up and asks if they can interrogate him. Pratt says not yet, and rushes off, yelling at someone to call Dubenko.
Shane and Malarkey help the paramedics bring in a kid, accompanied by a teacher's aide from his afterschool program. She says that they found the kid unconscious on the playground. Nice supervision, afterschool program people. The paramedic reports that there was no pulse in the field and that he's had three rounds of epi. Shane yells to Carter that the kid had a full arrest in the school yard and has blunt injuries to the head, chest, and abdomen. Malarkey looks at the kid and tells someone to page Wendall. Shane asks why, and Malarkey explains that she and Pratt saw the kid earlier today. Because it's Thomas! Which you probably already figured out.
Luka comes into Trauma Yellow and asks Pratt what's he doing. Lysander is lying with his feet elevated higher than his head. Pratt says that Luka will see in a minute. Lysander asks to make a call, and Darlene dials the phone for him. Dubenko walks in and asks if it's "medieval torture day in the ER." Doesn't he know that's every other Tuesday? Pratt explains, "An observant nurse noticed frequent yawning in an alert patient." Sam smiles at the "observant nurse" part, happy to actually get some credit, from Pratt of all people. Dubenko says that Pratt has thirty seconds. Pratt says it could be a sign of diaphragmatic injury. Dubenko thinks he's kidding. Luka says it's hard to prove, but wouldn't necessarily show up on the DPL. Pratt injects some blue liquid into the belly, and Luka explains that if they're right, the fluid will go through the diaphragmatic tear and come out the chest tube. Lysander gets an answering machine for someone named Sally, and leaves a message saying that he's been shot and he's hanging upside down, so if he doesn't make it, he wanted to tell her that her husband cheats on her and he loves her. Sam, Luka, Pratt, and Dubenko all look kind of touched. Jane hangs up the phone as Lysander explains that he called his boss's wife. Dubenko says he wants his patient upstairs now. Sam hauls up the results of the experiment -- the blue fluid came out the chest tube. Luka and Pratt raise their eyebrows at each other.
Shane yells to Sam that Chuny's at the blood bank, and that they need a nurse in Trauma Green. Carter is bagging the kid while Malarkey gives compressions. Sam asks what she can do, and Carter tells her to work on access. Sam recognizes Thomas from earlier. Shane does an exam and lists off all the injuries. They rip Thomas's shirt off, and his chest is covered in bruises. Sam says she can't get a pressure. Wendall walks in and asks who did this. Carter says they found him down in the schoolyard. Wendall asks if his mother or brother is there, and then asks, "How did this happen?" No one answers, because no one knows.
Pratt helps Dubenko to roll Lysander to the elevator, gloating, "Isn't it funny how you can be so completely sure of a diagnosis and then find out that you were totally wrong?" Irony anvils! Dubenko suggests with good humor that Pratt write up the case. Pratt asks if they'll do the surgery laparoscopically or not. Dubenko won't know until after they run the bowel. Pratt gets Dubenko to admit that Luka might have been right. Lysander calls out a thank you as he's wheeled into the elevator, and adds that it's been the best day of his life.
Pratt chuckles and asks Chuny what's going on in Trauma Green. Chuny says, "Abused kid. You don't want to know." Pratt apparently does want to know, and he follows Chuny inside and asks if they need an extra set of hands. Someone says that it's Thomas. Pratt rushes inside and tells Shane he'll take over compressions. Wendall pouts that she should have finished her interview: Thomas had a sock shoved down his throat. Pratt is more concerned with running the code. Wendall says that she blew it. Malarkey reports that Thomas is oozing from his IV sites. Pratt wants to push more meds and continue, but Carter asks if there's an ETA on the family. Pratt continues giving compressions, and defends his actions by saying that Thomas is just a kid, and that they're not stopping yet.
Malarkey offers to switch in as Pratt says that they need central access, and tells Shane to "throw in a femoral." Carter says that won't change anything, because they've already got two IVs in with good flow. Carter asks how long they've been at it, and Shane says it's been forty-three minutes. Sam announces that the family is here. Carter tells Sam to see if they're ready to come in. Sam rolls her eyes and heads out.
Thomas's dad asks how he is, as the Stepmonster introduces him. Sam says that Thomas's injuries are very severe, and asks if they want to see him. The parents aren't sure. Wendall says that sometimes it helps to see how hard the doctors are working. Casey, the brother, walks over, and the Stepmonster yells at him to go sit down, because she doesn't think he needs to see this. Sam watches Casey carefully, for some weird reason. I guess she's trying to figure out if he had anything to do with it. Thomas's dad wants to go in, so the parents enter. Casey stands outside the door and watches and Sam continues to stare at him.
Casey says that he saw them taking Thomas behind the school today, and that they had a thing about his clothes. That's why Casey gave Thomas his shirt, but they still wouldn't leave Thomas alone. Sam asks if they were the ones who cut Thomas. Casey says he tried to get Thomas to tell them, but that they said they'd kill him if he said anything. Casey adds that Thomas was scared of them, just like everyone else is. Wendall says if Casey says who they are, she promises that he'll be safe. Casey shakes his head and says he still has to go to school with them every day. Wendall asks again, "Who?" Casey says they are four sixth-graders. Sam looks sad.
Pratt continues to do compressions and calls for more medication. Carter tells Pratt to hold compressions. The monitors start beeping. The parents look on sadly. Carter calls the time of death. Thomas's dad says, "Please." Everyone looks upset. Pratt resumes compressions and says that Thomas still has a rhythm. Carter says that it's "a non-perfusing rhythm at a rate of 28," which means that the heart isn't pumping strongly or quickly enough to move the blood through all parts of the body. Should I be worried that I'm really starting to understand the medical jargon, to the point that I'm starting to make diagnoses of family members based on this knowledge? Probably. Pratt isn't ready to give up. Carter points out that it's been forty-eight minutes of cerebral hypoxia, meaning that Thomas hasn't been getting oxygen to the brain. Sam and Malarkey list off all the medications they've pushed, but Pratt won't stop the compressions. Carter gently puts his hand over Pratt's and says, "Greg. He's fixed and dilated with a pH that's not compatible with life." Thomas's dad and the Stepmonster start sobbing as Carter extends his condolences. Sam switches off the monitor. Outside, Wendall tries to comfort Casey. Pratt walks off, blinking back tears.
Susan walks into the lounge, where Abby announces that she was just about to turn in her med-student evaluation. Susan asks, "How's it going with him?" Abby says he's thorough, with good knowledge, and Susan says that's not what she meant. Abby blinks and says she didn't get to the surveys. Susan sighs and says that they're so screwed at this point, it probably doesn't matter. Abby asks what's going on, and whether this is really all because of Carter's press conference. Susan says that if one drug company pulls funding, the others will follow suit, because they "don't want to be associated with a department that overreacts to a post-marketing surveillance." Abby says that Admin always seems to find a way to keep the ER open. Susan says she could lose her job. Abby thinks that's ridiculous. Susan says that her tenure's up for review and she's way short. Abby says that they made Susan department head, and that she's proved her worth. Susan yells that the committee is only concerned with how much money she brings in, and that she has to bring in $100K even to be considered. Abby is surprised that there's a quota. Susan says that if you don't bring in the cash, you're out, and pharmaceutical grants are an easy way to raise money fast. Susan's beeper goes off, and as she walks out, she says that she can't lose her job, especially now that she has Chuck and Cosmo to support. And God knows that Cosmo will still be living at home in thirty years, since no self-respecting woman (or man) would date him with that name.
On his way out for the day, Pratt stops and stares at Thomas's still body. Luka walks up and reports that Lysander did have a diaphragmatic laceration. Pratt isn't that interested. Luka adds, "You saved his life." Pratt doesn't react. Luka says that they all miss things, and that the social worker saw the patient too. Pratt says that he pulled rank on her: "Attending trumps resident, resident trumps intern, we all trump the social worker. It's a great system." Luka reminds him that most of the time it works. Pratt asks, "How do you stand it?" Luka asks what he means, and Pratt says, "The responsibility."
Neela walks in and asks Abby if she had a busy shift. Abby says it was normal, and asks Neela what she did that day. Neela says she tried to sleep, but couldn't, so she watched bad TV and ate cereal. Abby runs down the patients she's signing over. Sam asks if anyone wants to join her for a drink, since Luka is working and Alex is at a sleepover. I wondered why Sam had to explain why she's going out, but then I realized that some viewers would accuse Sam of neglecting her child or her relationship if she didn't. Abby begs off, but Susan is in. Darlene hands off the materials Susan asked her for earlier, and Susan thanks her and says she's the only one who came through. Susan offers to buy her a drink. Darlene says she can't, but that she would like Susan to write her a recommendation. Susan agrees, and Shane bleats, "Way to work it, [Darlene]!" Sam asks Shane if he's coming out with them. Shane says he can't drink with Attendings because it's too weird. Neela tells Shane that the plumber came and the shower's fixed. Shane is psyched, and Neela asks him for eighty bucks for his share. But she smiles at him. I really, really hope that's not going anywhere.
Wendall and Carter walk down the street outside. Wendall begs him not to give her the speech about how they win some and they lose some. Carter says he wasn't going to. Wendall beats herself up about not doing her job. Carter asks what she thinks would have happened if she did, but she asks him not to try to cheer her up. Carter moves around so that they are facing each other, and Wendall starts sobbing and says she should have saved that kid. Carter hugs her.
Pratt heads to the fancy restaurant where his ex-lover is celebrating. He walks in over the host's protests, and heads straight to the woman's table. She's surprised to see him. He apologizes to the group for interrupting and says, "I went to work this morning thinking about what you said and I need to tell you something. The work that I do? Is as real and as serious as it gets. And I don't know how you define an 'adult,' but I assure you, I'm all grown up." The woman says she didn't mean to offend him. Pratt smiles and shakes his head. He says that he doesn't know what she's looking for, but he hopes she finds it. He finishes, "Good luck" and walks out. Was that supposed to convince me that Pratt is going to lose the Prattitude? Because it's going to take a little more than that. Frankly, I think that was pretty immature, showing up at the restaurant in front of her friends.
Abby walks up to her front door and finds Jake waiting for her. He calls out to her so that she won't be surprised. You'd think someone who was (a) beaten up by a psycho neighbor and (b) kidnapped recently would be a little more freaked out by someone showing up on her doorstep. I know in the movies and TV, it's supposed to be romantic, but given Abby's history, I'd think she'd be a little more creeped out. Even if Jake is hot. I guess it's more like when Doug used to just show up at Carol's house, and in real life she would be annoyed, but it's George Freaking Clooney, so she just had sex with him. Boy, I miss Doug. Anyway, Abby asks what he's doing there. Jake says that she never signed off on his charts. Abby asks if he staked out her apartment just so she could sign his book. Jake reminds her, "All student-teacher relations have to be wrapped up by tomorrow. That is very important." Abby joins him on the stoop and signs off on his book. She asks how he knew where she lives. Jake says he asked at the residency office. Abby is surprised they gave out her address so easily. Jake says it's disturbing, really, and that they even gave out her phone number. Abby says they must have thought he looked like a nice guy. Jake says he's not that nice. Abby says she might need to change her number. Jake thinks that's a good idea. Abby congratulates him for officially finishing his ER rotation. They stare at each other for a minute, and then Abby moves in for a kiss. That's another example where I thought they were trying to show that Abby wants this as much as Jake does, to counter the creepy stalker angle. They start making out. A truck goes by on the street, and they're already inside.