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.