ER Season 16 Episode 3: "One Too Many Bullets"
Starring:
Noah Wyle (John Carter)
David Lyons (Simon Brenner)
John Stamos (Tony Gates)
Leland Orser (Lucien Dubenko)
Linda Cardellini (Samantha Taggart)
Scott Grimes (Archie Morris)
Alexis Bledel (Julia Wise)
Emily Rose (Tracy Martin)
Hallee Hirsh (Rachel Greene)
And Angela Bassett (Cate Banfield)
Special Guest Stars:
Sarah Michelle Gellar (Grace Summers)
David Boreanz (Angel Dank)
J.P. Manoux (Dr. Crenshaw)
Guest Stars:
Troy Evans (Frank)
Yvette Freeman (Haleh)
Laura Ceron (Chuny Marquez)
Julian Morris (Dr. Andrew Wade)
Dominic James (Alex Taggart)
Chloe Greenfield (Sara Gates)
Scene 1:
"How are you doing Simon?" Dr. Carter asked as he came into the trauma room. He had just gotten finished taking care of Samantha Taggart, so he thought he would come lend a hand where he was needed.
"He's got multiple gun shot wounds, but it looks like the shots missed any major organs or blood vessels," Brenner said while continuing to work on Angel.
Carter looked at the patient on the table and realized that it was Angel's lucky day. This thing could have gone much worse for him. "Do we have all the bullets?" he asked.
"We found two of them but there's a third wound," Dr. Martin said. "As soon as we find it, we'll get him up to surgery."
"Well Mr. Angel," Carter said to the unconscious patient. "Today is your lucky day."
Scene 2:
"He's hemorrhaging!" Julia Wise called out to the two attendings in the room. As the medical student she was just waiting for either Dr. Banfield or Dr. Morris to give her some instructions. She kept thinking that she had seen it all since she started at County General, but this place kept surprising her.
"Dr. Wise, go find me a surgeon!" Banfield barked. "We'll hold him together as long as we can."
"Dr. Dubenko just went up with Marcus," Wise reminded them. However, once she said it she knew she was going to regret it.
Dr. Banfield turned quickly to face her. "There is more than one surgeon in this hospital Dr. Wise! I suggest you go find someone who isn't busy and get them down here!"
Julia Wise rushed out of the trauma room, but their problems were not near over. In fact, they were just beginning. Another monitor in the trauma room proceeded to go off.
"Heart rate is falling," Haleh said from her position near the monitor.
"We need to find some way to give him a stable rhythm until they can open him up," Morris said in reference to the surgeons. "Rib spreader," he called out.
Dr. Banfield was on the same page. "Get internal paddles ready," she ordered to Haleh.
Morris carefully opened his chest with the rib spreader and was about to use the internal paddles when he noticed the cause of Pete's erractic heart beat.
"Shit!" Morris said in anger. "We can't shock his heart with a bullet lodged in there. If we do it will surely kill him."
"Where in the hell is Dr. Wise with those surgeons?" Banfield asked angrily.
"Dr. Banfield, we can't wait much longer for Julia to get back. This bullet can't stay in there much longer without killing him," Archie Morris informed her.
Cate Banfield thought about her options for a moment and did not any of them. If they waited for a surgeon, Pete might die if one did not arrive in time. Leaving the bullet in his heart was certainly not an option because it would surely kill him. This meant that one of them would have to go in and take it out, a thought that did not comfort Banfield one bit.
"Dr. Morris, how well did you do in your surgery rotation as a med student?" Banfield asked. "It is going to be up to one of us to save this man."
Scene 3:
Archie Morris thought back to his surgery rotation in medical school. He remembered how much he hated it. Surgery required you to be very precise. If you were off by even a millimeter it could spell disaster. And surgeons did not have the best bedside manner.
"Dr. Banfield, as the senior doctor here, I think you would be much better at this procedure than I would. Just let me know what I need to do to help you."
This was not the answer that Banfield was looking for. She was hoping that Dr. Morris would be confident enough in his abilities to do the procedure. Time was up though and they had to do something.
"Have gauze ready," Banfield told Morris. "This is going to get pretty messy."
"Hold on, I'll do it," Dr. Carter said as he entered the third trauma room right before Banfield started cutting.
"Dr. Carter can you do this?" Banfield asked him, still holding the cutting knife.
"Probably better than anyone in this room," Carter responded. "I spent a couple of years here in surgery. I still remember a few things."
"Then by all means, it's yours," Banfield said getting out of Carter's way.
Carter picked up a clamp and handed it to Morris. "Archie, I'm going to need you to clamp the blood vessel as soon as I remove the heart. We can't have our patient bleeding out."
"Wait…you're going to remove the heart?" Morris asked a little scared. "Do you know what you're doing? Have you done this before?"
"First time for everything," Carter said without losing focus on what he was doing.
"Let's get the bypass machine up and running," Banfield said. "We can keep him alive on bypass for a short time while we get the bullet out of his heart."
"I still have one question Carter," Morris began. "Once we get the heart out, how long do we have before Pete becomes brain dead as a result of lack of blood to the brain?"
"3 minutes tops before risk of brain damage," Carter replied.
"And then how do we put the heart back in his chest?" Morris asked.
"By that time we better hope there is a surgeon in here to clean up this mess because I have no clue how to get the heart back in Pete's chest."
Scene 4:
"That's a relief," Morris said jokingly. "For a minute there I thought this was going to be difficult."
"One more cut and…out," Carter said mostly to himself. "Archie figure out a way to stop all of that bleeding.
Morris clamped off the blood vessel as best as he could, but it was not stopping the bleeding as well as he would have hoped. Blood was still going everywhere.
"Pete's not going to need the bypass machine if I can't stop this bleeding," Morris said frustrated with himself and the situation.
"2 and a half minutes until brain damage," Haleh informed them.
"Alright, I'm going to need something to extract this bullet with," Carter said to Banfield. Banfield handed Carter a pair of small pliers.
"Be careful that you don't damage the heart," Banfield instructed him.
Julia Wise walked back into the trauma room flanked by two surgeons: Dr. Crenshaw and Dr. Wade.
Crenshaw took one look at the situation and was appalled immediately. "Who is in charge of this operation!?" he demanded.
"Bullet has been extracted," Carter said, holding it up with the pliers.
"I've stopped the bleeding as well as I can for now," Morris announced to the group.
"1 and a half minutes until brain damage," said Haleh.
Banfield looked directly at Crenshaw and Wade. "I don't want to hear any questions or deal with any sarcastic remarks. You have 1 minute 15 seconds to get this heart back into its body. There's been too much blood for the bypass machine to work effectively."
Crenshaw took the heart from Carter. "Andrew, we need to reattach this heart pronto," he stated calmly. "Dr. Morris, I'm going to need you to suction."
Crenshaw and Wade began to reattach the heart to the rest of the body. "You people did a real hack job on this guy's insides," Crenshaw commented as he worked.
"I can't maneuver around all of this blood," Wade said. "Suction"
"45 seconds until brain damage."
Scene 5:
Archie Morris did everything that he was told by the two surgeons, but he wasn't sure if they were going to be able to save Pete when everything was all over. "Serves the guy right," he thought to himself. He was the reason that there were now three people in the ER fighting for their life right now. His thoughts went to Sam. Was she ok?
"10 seconds until brain damage," Haleh said, letting them know how much time they had left.
A monitor started going off like crazy in the next room. Brenner and Martin were losing their patient. In an attempt to be a hero, Angel's heroic effort might end up costing him his life.
"Heart's in," Crenshaw said, but they were not out of the woods yet. "Internal paddles. Clear!"
There was still no sinus rhythm, and this was the thing that the group was most afraid of. If they managed to get the bullet out of the heart successfully they still had to get the heart started again.
"Again!" Crenshaw shouted. "Clear!"
"We've got a faint rhythm," Wise said reading the monitor. Things wouldn't stay calm for long however.
"He's hemorrhaging again!" Morris announced.
Tracy Martin burst in from next door. "We need a surgeon in here!"
"How serious is it?" Crenshaw asked, still frantically working to save this patient.
"He's crashing!" Tracy exclaimed.
"As you can see," Crenshaw told Martin, "we are quite busy in here."
Carter spoke up. "We have more than enough doctors in here to help out. Your resident could handle the situation next door."
Crenshaw thought for a split second before deciding. "Andrew, go see what is going on next door. However, I'm going to need a couple of hands in here."
"You'll have Dr. Morris, Dr. Wise, and myself to help you out. Dr. Carter, go with Dr. Wade and help wherever needed," Banfield directed.
"Mr. Wade, let's go!" Carter said, leading the young surgeon to the other trauma.
Scene 6:
"Charge to 350," Brenner instructed Chuny Marquez. "Clear!"
"Still no pulse," Tracy Martin said with noticeable worry in her voice. She had come to like her patient Grace Summers and knew that if they could not save her boyfriend, Angel, she would be completely devastated.
"Dr. Brenner," Carter said walking into the room. "I've brought someone who might be able to help you out."
Brenner looked up and saw Andrew Wade. "Resuming chest compressions," he notified everyone in the room before turning his attention to the newest surgical resident. "Andrew, we were able to get two of the three bullets out, but the third bullet lodged inside of him somewhere."
"Did you get a chance to do an x-ray?" Carter asked.
Brenner motioned for Tracy to take over doing compressions on Angel and then showed Carter and Wade the x-ray. "Looks like the bullet is now in his large intestine."
Carter and Brenner both looked at Wade who was thinking about his options. "We could remove that section of his large intestine" he told the two attendings. "Then we would just need to tie it off to stop the bleeding. That should stabilize him."
"Can you do it?" Brenner asked him while keeping an eye on Martin and their patient.
Wade hesitated for a moment and Brenner could tell that he was very unsure of himself. "I've never done such a major surgery before," Wade said. "I would need Dr. Dubenko or Dr. Crenshaw to help me."
"Chuny, page Dr. Dubenko and tell him to get down here as soon as he can," Carter told the nurse. He then turned to Tracy. "Tracy, let's intubate him so that he is stable enough for Dr. Wade here to begin the surgery."
"But…I…" Andrew said with a lot of nervousness.
"There are three doctors in this room that are fully capable of helping you," Brenner reminded Wade. "You can start it and Dubenko can come in and finish it off once he gets down here."
"Please Andrew, Tracy begged him. "His girlfriend is my patient. She will be crushed if she loses him. You have to try!"
"Alright," Andrew said emphatically. "Here goes nothing!"
Scene 7:
"I thought you said you got the heart back in!" Morris said desperately.
"The heart is back in," Crenshaw replied. "For some reason it isn't pumping blood properly. Blood isn't going everywhere it needs to go."
"How do you fix it?" Banfield asked.
In many ways it would be easy to let this man die. He somehow got a gun into the hospital and started shooting. His actions put innocent lives in danger. But these doctors were expected to try. They were supposed to do everything they could to save lives. Other people could figure out the value of the person.
"What if you took the heart back out and reattached it?" Wise asked.
Crenshaw thought about that option for a minute. On the one hand, repeating the procedure was extremely risky. They had barely gotten the heart in and out before and there were no guarantees that trying to do the same thing again would not kill the patient. On the other hand, doing nothing would virtually guarantee Pete's death. Regardless of what decision they were going to make, Crenshaw knew that they had to do something or this man would die.
"There are no guarantees that repeating the procedure will save this man's life," Crenshaw explained to the doctors in the room.
"So what do we do?" Morris asked.
"We do exactly what we did before," Crenshaw said. "And we hope we do a better job than we did the first time."
With help from Archie Morris, Cate Banfield, and Julia Wise, Dr. Crenshaw was able to extract the heart from Pete's body one more time. This time was going to be easier however because they did not have to remove anything from the heart; all they had to do was make a cleaner connection this time.
"How do we know if it's working or not?" Wise asked after the heart was back in for a second time.
"Heart rate continues to fall," Haleh announced to the group.
"That's how we know," Banfield told her as she grabbed the internal paddles.
"Clear!" she barked as she tried shocking Pete's heart back into proper rhythm.
"I don't think we are going to be able to save you Pete," Dr. Morris said to the big man.
Scene 8:
"I'm going to need a scalpel and some light on the situation," Andrew Wade told the doctors that were all in the trauma room with him. With the exception of Tracy Martin, all of the other doctors in the room were much more experienced than he was. Dr. Wade and Dr. Martin had just started their residencies. However, Dr. Wade was the only surgeon in the room.
"Here's your scalpel," Brenner said as he gave the surgical tool to Wade.
"Tracy, keep an eye on the monitors," Carter instructed her. "If his BP starts to drop we need to know as soon as possible so we can act instead of react."
"Understood Dr. Carter," Tracy said, nodding in agreement.
"Making the initial incision," Wade said as he began making his cuts.
"How difficult is this procedure?" Tracy Martin asked while keeping her eye on the monitors.
"We'll know in a minute," Andrew Wade said as he continued to work carefully. "Making the second incision now."
"Blood pressure is starting to fall," Martin informed them.
"It's still within the acceptable parameters," Carter told Wade. He could tell the young surgeon was feeling the pressure. "Keep going Andrew. You're doing fine."
"We're about halfway there," Andrew narrated as he continued to cut. "Now we need to remove the damaged portion of the intestine."
"His BP is approaching dangerous levels," Martin said. "We can't let him die!"
"If we tie off the intestine we can stop the bleeding and his BP will return to normal," Brenner said. "Andrew, can you finish off this procedure?"
The young surgeon looked around the room nervously. "I'd feel better if Crenshaw or Dubenko was in here to help me close."
Carter looked across to the trauma room next door. He could tell that Crenshaw had his hands full with a patient of his own. Dr. Dubenko had to be around there somewhere though, and they still had a small window in which to wait for him.
"If his BP falls any farther he'll go into shock," Brenner said with authority.
"It looks like our window is up," Carter thought to himself.
Scene 9:
"Dr. Wade, it's time to act," Carter told him. "Looks like you'll have to do this without Dr. Dubenko."
Just then the Chief of Surgery, Lucien Dubenko rushed through the doors to the trauma room. Dubenko had just gotten out of surgery on Marcus, Pete's son. The chief surgeon was able to save Marcus from dying and now he needed to help Dr. Andrew Wade save Angel, whose life was hanging in the balance after trying to be a hero.
"How far have you gone, Dr. Wade?" Dubenko asked his resident.
"I've removed the damaged portion of the small intestine. Now we just need to tie off the intestine to stop his bleeding."
"Alright," Dubenko started. "Dr. Wade, if you can suction out the excess blood I will show you how to tie off this intestine."
"Do you need anything from the rest of us?" Carter asked Dubenko.
Dubenko looked up at Dr. Carter. "No Dr. Carter," Dubenko said, motioning that it was ok for him to leave. "You can go see if they need any help next door."
As Carter left the trauma room, Tracy Martin also thought that she would take the opportunity to go check on one of her patients. "I'm going to go get Grace up to speed on what is going on," she said, leaving the trauma room.
"I guess that leaves you here with us Dr. Brenner," Dubenko said to the last doctor left in the room. "You and Dr. Wade can watch as I save this man's life."
It was a pretty well known fact that Simon Brenner and Lucien Dubenko did not see eye to eye on much of anything these days. If one of them said the sky was blue, the other one would insist that the sky was actually green. It all went back to their respective relationships with Neela Rasgotra. Lucien was a little overprotective of his former star pupil and often got into disagreements with Simon Brenner.
"Make sure you pay attention Andrew," Dubenko said as he started to close. "It is actually a fairly routine procedure. All you need to do to fix this is act like you are doing sutures on the intestine."
"Wow," Andrew said in amazement. "That wasn't very hard at all."
"BP is returning to normal," Chuny announced to the room.
"Dr. Brenner, you can inform the girlfriend that this man is going to be ok," Dubenko said.
Scene 10:
"Need a hand in here?" Carter asked as he re-entered the trauma room. It looked like Crenshaw, Morris, and Banfield were all working hard but the look on their faces was ominous at best.
"Pete keeps hemorrhaging and we can't stop it," Dr. Morris told him. "Every time we stop the bleeding from one place he starts bleeding even more out of another area."
"Crenshaw how can I help you?" Dubenko asked after finishing up with Angel next door.
"I don't think there is any thing more we can do for this patient Lucien,' Crenshaw informed his boss. "I think I'm about to call it."
"I'll call it," Banfield said, taking charge once again. "Time of death: 21:27"
"Who is going to tell his son?" Julia Wise asked the rest of the doctors.
"Is the son stable enough for us to go visit him?" Banfield asked Dubenko.
"Yes he is," Dubenko replied. "He's in the ICU. He got out of surgery an hour ago."
"I'll go inform the son," Carter volunteered.
"Good," Banfield confirmed. "Take Dr. Wise with you. It will be good practice for her to learn how to give bad news to the family."
Carter and Wise both headed up to the ICU leaving everyone else to stand over the dead body.
"Dr.'s Crenshaw and Wade, there is nothing more that we can do down here. Dr. Crenshaw, you are free to go home for the night. Dr. Wade, you can accompany me on the last set of rounds for the evening," Dubenko said to his surgeons.
"Haleh, can you clean this mess up?" Banfield asked.
"Yes Dr. Banfield."
"I'll stay here and help her," Archie Morris volunteered.
Banfield exited the room, leaving Haleh and Archie to clean up Pete's corpse.
"Do you ever think that some of the people we see in here deserve to die?" Archie asked.
"Hunny, I just patch them up the best I can. I've been doin' this too long to really think about anything else."
Scene 11:
"What do you mean Angel's life is in danger?" a horrified Grace asked Tracy Martin. "How did all of this happen?"
"Well," Tracy started slowly. "Apparently he went out to try and stop someone from shooting up the place. He got shot three times. We managed to retrieve two of the bullets but the third one has given us a bit of trouble."
"Trouble?" Grace exclaimed. "What do you mean by trouble?"
"The third bullet got lodged in Angel's colon," Tracy explained. "But don't worry Grace. The Chief of Surgery is in there right now working to remove that bullet and stop the bleeding."
Grace sat back in her hospital bed as tears started to roll down her face. She seemed dejected and that tore Tracy up inside. "Why does he always need to try and be a hero?" Grace asked to no one in particular. "Why can't he just be a regular guy who goes to work from 9 to 5 and then comes home? He doesn't always have to be a superhero you know."
Tracy wasn't sure what to say but knew that she had to say something to try to comfort Grace. "It's going to be ok Grace. The best surgeon in this hospital is in there with him right now."
"When can I see him?" Grace asked shakily. One could easily tell that she was trying her best not to break down into tears right then and there.
"You can see him now," came the Australian voice of Dr. Brenner as he entered the room.
"Is he ok?" Grace asked with noticeable hope in her voice.
"Yes he is. Dr. Dubenko was able to remove the third bullet by cutting out that section of Angel's colon. We've moved him up to the ICU," Brenner informed her.
A huge smile came over Grace's face and she started to cry tears of joy. "Thank you so much for saving him Dr. Brenner! And thank you Dr. Martin! Can you take me up to see him?"
"I most certainly can," Tracy said with a big sigh of relief.
The two blonde women proceeded to leave the hospital room where Dr. Brenner had given them the good news. Grace had gone from an extreme low to an extreme high.
"Oh, Dr. Brenner," she began. "Tell that surgeon thanks for me!"
Scene 12:
"Where is she!?" Alex Taggart asked frantically as he ran into the ER.
"Where is who?" Frank asked the teenager but then realized who he had to be referring to.
"My mom! Where is my mom?"
"Dr. Gates took her up to the ICU. I don't know if she is conscious or not yet kid but you can go up there and check."
Alex left the admit desk and raced down the corridors of the ER, only stopping to look at a sign that would point him in the right direction of the ICU. Tony had called him earlier to inform him that his mom had been involved in a shooting but he didn't know how bad it was or anything like that, which left his mind racing. He couldn't help but fear the worst.
"Alex, it is going to be ok," Sara said as she finally caught up to him at the elevators. "Your mom is going to be fine. Tony wouldn't let anything bad happen to her."
The doors to the elevator opened and the two of them got in. "You don't know that!" Alex said hysterically. "What if something bad has happened to her? What if she's really hurt?"
"I think the fact that they moved her up to the ICU is a good sign," Sara assured him. "They wouldn't have taken her out of the ER if she was still in really bad shape."
The doors to the elevator swung open and the two teenagers got out and proceeded to enter the ICU where they were greeted by someone behind the main desk.
"I'm sorry kids but visiting hours are over," she told them.
"It's alright, they're with me," Tony Gates said as he came out of Sam's room to meet the two of them.
"How is my mom?" Alex asked him.
"She's doing ok. She is still unconscious but she is breathing on her own. Now we just have to wait for her to wake up."
"Can I go in and see her?" Alex asked him eagerly.
Tony motioned for Alex to go be with his mom and then turned to Sara. "Hey kiddo, I love you so much!" he told her as he gave her a big hug.
Scene 13:
Marcus was just waking up when Dr. Carter and Dr. Wise came in to see him. Marcus might have been young but he could tell when someone had good news and when someone had bad news and these two doctors definitely had bad news.
"Hi Marcus, I'm Dr. Carter and this is Dr. Wise…"
"Let me guess," Marcus interrupted. "Something happened with my dad, right?"
Carter was not sure how to best go about breaking the news to Marcus. How do you tell a teenaged kid that one of their parents has died?
"Marcus, your dad was involved in a struggle while you were being taken up to surgery," Carter explained. "During the struggle a gun that your dad brought into the hospital went off and three people were injured…"
"My dad was one of them wasn't he?"
"Your dad sustained multiple gun shot wounds that we worked on for a long time. We tried to the best of our abilities but his injuries proved too severe and we lost him."
Marcus appeared stunned but seemed to be taking the news better than Dr. Wise had anticipated. He was quiet and somber but he did not cry. He was most likely rather upset but he did not give that appearance.
"Thank you for letting me know," Marcus said quietly.
Carter and Wise both exited the ICU just as Tracy and her patient Grace Summers entered it. While they were waiting for the elevator Julia had a question for Carter.
"Does it ever get easier? I mean, does it ever get easier dealing with all the death and having to tell the relatives?"
"Do you want the truth Julia?" Carter asked her. The young med student nodded.
"The truth is that it doesn't. You can be a doctor for a long time and it never gets easier dealing with death. It can't get easier. The minute that you're ok with people dying…the minute that it becomes easy to tell a patient's loved ones something tragic…that is when you need to go out and join a different profession."
"So you have to hate your job?"
"No. You have to hate losing people. No matter who they are, it is your duty as a doctor to do your best to save their life."
Scene 14:
Sara looked up at Tony with worry still in her eyes. "Is Sam going to be ok?"
Tony looked down at the young girl who he loved like she was his own daughter. For all intents and purposes she was. She might not be his biological daughter, but that did not stop Tony from loving her like she was.
"We'll have to see," Tony said while putting a hand on her head. "She just needs to wake up. But her bio-signs are stable and as long as they stay that way everything will be ok."
"Can you wake her up?"
Tony shook his head slowly. "I'm afraid not. It is up to her to wake up on her own. Sam is as strong as any person I know though. She'll come out of this."
Sara went to the window and looked in. Alex was sitting by Sam's bed, holding her hand. He wasn't saying anything, just sitting there quietly with his mother. Sara could tell that Alex was very worried.
"It's going to be important that you are strong for Alex," Tony told her as he came up behind her. "I know you two have grown very close. He's going to need you while Sam is in the hospital."
Sara nodded in agreement. "I know Tony. I'll do whatever I can for him." Then Sara had a thought. "Maybe he should come home and stay with us until Sam gets better."
"That's a great idea."
Alex came out of Sam's room and looked visibly shaken. Tony reached into his pocket and pulled out some money which he gave to Sara. "Why don't you guys go across the street and get something to eat."
"I need to stay with my mom," Alex said earnestly.
"And you also need to eat something. Go with Sara and get a burger or something. I'll stay with your mom until you get back."
"Will you call me if anything happens Tony?" Alex asked him before making a decision on whether to leave or not.
"I promise Alex. I will not let anything happen to your mother. You have my word."
The two young teenagers left and Tony went back in to Sam's room to sit with her. He ran her fingers through her hair. "Come back to me Sam," he pleaded. "I need you."