ER s02e02 Episode Script

Summer Run

Previously on E.
You're an Attending now.
Got a problem with another department, you solve it.
I'm Kerry Weaver.
I heard you hired Kerry Weaver as chief.
That's definitely a move in the right direction.
How was school today? They're teaching us how to use Word and the spreadsheets.
- Whoa! I got a pumper! - He's gonna need an airway.
- Stop moving around.
Now! - Scissors! - It's Hathaway, right? - Yeah.
This is Shep.
Why don't you stay? You know I can't.
"Summer Run" How you doing, Nurse Hathaway? If I were driving, we would've been there by now, Paramedic Shepard.
- You gotta love these late summer runs.
- Especially up to Humboldt Park.
You ever been to California and Division? Yeah, that little outdoor café? Cappuccinos every morning.
Yeah, well, slip that vest on before you order.
We always promise these rides will be exciting.
Might have to wait on those cappuccinos.
Yeah, right.
Excuse me! Pardon me! Come on.
We got this one.
Hathaway, come here.
He's cyanotic.
Man, looks like he lost about 4 liters.
Doesn't look good.
Pupils are fixed and dilated.
Multiple gunshot wounds.
Chest, abdomen.
He's lost a lot of blood.
- Hey, Raul? - Yeah? - We got Payaso over here.
- No breathing, no pulse.
- We're in full arrest.
How about you? - Brains all over the asphalt, bro.
Well, come over here.
We need you.
You can help me tube him.
- Here.
- Check his rhythm.
- Where's the ambu-bag? - Behind you.
A little cricoid pressure.
Got it! You bag him.
I'm gonna stick him.
Goddamn it! - His name is Payaso? - It's a nickname.
Means "little clown.
" - Worked on him three times before.
- You're really pissing me off, Payasito! - Crackhead at 14.
- We need a line.
I can't get a vein anywhere here.
- Pedro! - Can we get a little crowd control here? - Please, everybody, move back! - Back up, please.
Coming through! Excuse me.
One, two, three.
Give them room, give them room.
Back it up.
Move it back! Everybody, back up! Back, back! Everybody, back! I need you all to move back, please.
Back up! Out of the way! County General.
ETA, seven minutes.
Give him another amp of epi in two minutes.
Got it.
Welcome to hell.
- Lydia, you seen Carter? - Not lately.
- Hey, Kerry.
- Hey, Peter.
These your sprouts? One ER rotation together, and that's what you remember? They're dead.
I need the space.
So how is it going? My first day here, and I've only upset Doug Ross.
That's not too bad, huh? You must be losing your touch.
- Good to see you again, Kerry.
- Thanks, Peter.
- No can do.
- That's not the attitude that we encourage around here, Bob.
- No can do, Dr.
- You love saying that, don't you? - Anybody seen Carter? Anybody seen the chocolate doughnut that Bob refuses to bring me? He's in Exam 4.
Weaver said no more food errands.
- Inappropriate use of personnel.
- You just love Dr.
Weaver, don't you? Appeals to that whole Germanic thing in you.
I am Polish.
- Screaming twins.
Curtain 2.
- All right.
- Morning, Susan.
- What've you got? Fourteen-year-old, multiple gunshot wounds.
Asystole, 2 amps epi, - How long has he been down? - Thirty-five minutes.
- Looking for miracles? - Two liters of saline already in.
- On my count.
One, two, three.
- Here we go.
Slumming with the paramedics? Yeah, recertifying for my MICN, so pretty much.
Come on, Payaso, you've survived worse than this before.
- He's in fib.
- Let's shock him.
Two hundred.
- Four units O-neg.
- Got the loop.
- Three hundred.
Clear? - Clear.
- 360? - Yeah.
Clear? - Amp of epi here.
- No breath sounds on the left side.
- Hemothorax.
Chest-tube tray.
- Got your O-neg.
Another amp of epi? Yeah, let's high-dose him.
Five milligrams.
Oh, man, the blood's pouring out.
He's still asleep.
God, we had such a night last night.
You wouldn't believe it.
Triple MVA.
Car versus horse trailer in the middle of Chicago.
What a mess.
I had such a blast.
But we didn't get to bed till 5, and now I am late for rounds.
So if you're still here when he wakes up, would you tell him I said thanks? Thanks.
Carter! There's already 1500cc's in the Pleuravac.
Thoracotomy tray? - Time down? - Forty-four minutes.
- There's a bucketful.
Get some lap pads.
- Somebody get a light in here.
Double MVA at the back door.
What've you got? - Multiple gunshot wounds, in full arrest.
- Susan.
High dose epi, atropine, - He's exsanguinated into the left chest.
- You might want to help your pals.
- I work here.
Nurse manager.
- Kerry Weaver.
Chief Resident.
- How long has he been in arrest? - Forty-five minutes.
- Let's call it.
We need the room.
- It's my case, Kerry.
We got a 7-year-old kid and his mom coming in, who we can save.
- We've got a 14-year-old on the table.
- Who we can't.
Call it.
- What was that time? - Forty-five down.
Susan! All right, I'm calling it.
Time of death, 7: 19.
Someone call Housekeeping.
- Poor tidal volume.
No response.
- Another gurney, please! - Let's tube him and use number six.
- Mannitol.
We need X-ray in here! - Welcome to hell.
- Who's on for neurosurgery? - Carrera.
- Page him.
Tube's in.
Absolutely nothing happened, I can assure you.
She must've made the other bed.
That's where she was sleeping.
We didn't do anything.
- Carter, do I look like your father? - No, actually, not at all.
I don't care what you did or didn't do, except for oversleep, which you did.
Despite your nap, I assume you're fully prepared for this morning's surgery.
- Absolutely.
- Good.
- Because I'm gonna work your ass off.
- Great.
- Because we're doing the - Thoracic outlet syndrome.
I'll just be over there.
- You scared me.
- I know.
I do that to a lot of people.
I'm sorry.
And I'm sorry I didn't realize who you were earlier.
- Oh, that's all right.
- You enjoying paramedic ride-along? It's fun being out for a change.
I've been reorganizing a little bit.
- Can I run some things by you? - Okay.
The doctors need to write down their orders when they give them.
No more of this three-hours-later crap, then blaming the nurses.
That'd be great.
And I think that Residents are capable of cleaning up after procedures, don't you? - Are you gonna tell them that? - Sure.
Why not? They'll stop peeking through the charts, picking the most interesting cases.
I mean, you don't get a choice.
Why should they, right? - It's gonna be a bumpy ride.
- Already is.
So thoracic outlet syndrome I really haven't had a chance to - It's the lung, right? - Don't get me started on the Brigham.
- What? - They bring me in to set up their Emergency Medicine training program.
Keep me on the line for six months.
Damn thing never got out of committee.
- Bunch of mud-phuds.
- Mud-phuds? MD-Ph.
Bench scientists doing research.
Running gels, chopping up DNA.
Northern blots, Western blots, Southern blots.
- Blots? - Don't get me wrong.
They're good people.
They're smart people.
But they couldn't diagnose a cold if it stood up and sneezed on them.
So you must be pretty glad to be back, then? You bet you.
Give me a good sick body, needs a little slicing, and I'm a happy man.
Go find Benton, will you? I believe we're ready.
Maybe it's just too complicated for tonight.
No, no, I want to see you.
- I promised Jackie I'd - Dr.
Benton, I think all he needs is active resistance therapy for that left leg.
Yeah, that's good.
I promised Jackie that I'd pick up Steven after football practice.
Walt's down with the flu.
My class is over at 7.
I can make it by 7:30.
- How about 8? - Al's off at 10.
Oh, man.
Yeah, it's yummy, yummy.
- Hey, Bob, you seen Big Susie? - At the desk.
You look very sharp.
Thank you.
Did you hear that, bumpkin? She says I look sharp.
- Hey, Susie.
- Chloe, what are you doing here? I'm running so late.
Will you take the baby to daycare, please? We're learning Windows.
I can't miss class this morning.
It's complicated.
How are things at Midwest Biz? - You know the academy? - Night school two years ago.
If you need help, I'm pretty good at all that computer stuff.
Oh, thanks, Jerry.
- She should've been here an hour ago.
- I know, but don't I look sharp? - Yeah, you do.
- I know.
Thank you, Susie.
So you're gonna pick her up after work, okay? Because I got that job fair.
- That's tonight? - I put it on our weekly schedule.
Oh, yeah, that's right, that's right.
I forgot.
Bye, Susie.
Bye, sweetie.
- You need any help? - No.
Oh, sorry about that.
Okay, yeah.
- So just hold up his arm.
- He's a pretty big guy.
- Oh, yeah, 380, easy.
- Big arm.
You'd think we'd have some kind of pulley thing for this.
Watch the pleura.
Don't want to puncture it.
We do.
- We do? - Hold it up higher, Carter.
Keep the neurovascular bundle out of the way.
Let's Bovie this little fella, please.
- So the pulley thing, it's not working? - Periosteal elevator.
- What did he do? - Overslept.
- Well, this will teach him a lesson.
- Yeah, well, that's what we're here for.
To teach him.
Right, Carter? Don't move that arm.
Just out of curiosity, how long is this surgery? I need the rib cutter.
And Bovie, please.
So Rachel had her pancakes, then threw up at 6:30.
Jen had a breakfast meeting.
I missed the first train out.
While I'm waiting for two hours at the station I start talking to this guy named Gozukizil.
So he's heard I'm a doc, right? Next thing you know, he's pulling down his pants.
He wants to show me some mole on his butt.
I don't think I'm cut out for commuting.
Mark, that's really interesting, but it's been a lousy morning.
I've got a crying baby in my arms.
Here's the diaper bag.
So maybe we can talk when I get back from daycare.
Oh, I see Kerry Weaver made it in.
Have you had a chance to meet her yet? Oh, yeah.
She's in, all right.
And I've definitely met her.
Great call on the new Chief Resident, Mark.
Really special.
Hi, Al.
It's me.
Listen, I'm sorry, honey.
I hate to do this again but they changed the study-group schedule.
Yeah, for tonight.
- I know, but what can I do? - Well, how about a late dinner? No, I probably won't get out till midnight.
No problem.
It was running fine this morning.
Started right up.
Yeah, I'll be careful.
Okay, thanks.
And, Al, I'm sorry.
I'll see you tonight.
Sticky bag lady for you.
- Maple syrup would be my guess.
- Yeah, it was a real mystery.
She fell trying out her new Rollerblades down Michigan Avenue.
- Wanna take her, Susan? - I really would.
But I've already taken the next patient in line.
Rhinorrhea with otitis.
Exam 5.
Conni, let's get a room.
Oh, man, I hate the sticky ones.
- Oh, you got another one? - Yeah.
Flagged us down on the way in.
- She asked for you personally.
- Loretta, right? - Same room? - Sure.
Why not? - Looks like the old PID shuffle.
- Pelvic inflammatory disease.
Occupational hazard.
I just bring them in.
I don't need to know what they have.
Five hundred milligrams tetracycline and a dose of mebendazole for the baby with the pinworm.
There you go.
I've written them all down.
Are you happy? - And those would be generic, Dr.
Ross? - Yes, Haleh, those would be generic.
Beals, I'm Dr.
This is Haleh Adams.
- And you must be Byron.
- Yeah.
He burned himself.
Let me see.
Let's take a look.
Yeah, boy.
It looks kind of cool and gory-looking, though, huh? Do you feel that? Yeah? - It happened while you were at work? - The manager called me.
He had the cops and the fire department there.
They were all yelling, so I brought him here.
- The manager? - Yeah, we live in a motel.
The Harbor View.
Although there's no harbor, and there's no view.
Byron set the room on fire.
I guess we probably don't live there anymore.
What is the differential diagnosis for pelvic pain? - Ectopic pregnancy.
- Appendicitis.
- And - Stress in the workplace.
What else? Mittelschmerz, PID, endometriosis ruptured ovarian cyst, to name a few more.
- My money's on PID.
- You had it before? Yeast infection, urinary tract infection - Not much I haven't had.
- Tests? CBC, lytes, pregnancy, cultures for GC and chlamydia.
Barinski? - Pelvic ultrasound? - Not quite yet.
Let's assume for the moment that it is PID.
How do you want to treat her? Ceftriaxone and Zithromax.
She is way ahead of you here.
- Joanie, how is she? - Susan, thanks for coming up so quickly.
Oh, what's wrong, little one? Are you okay? She's burning up.
It's just a slight fever, but you know the rules, no fevers or infections.
Thank you for calling me.
I'm wanna get her checked out.
I'm sure it's nothing serious, Susan.
- Did you call Chloe? - No, this is one of her class days.
- You're the contact.
- Oh, right.
You may want to take her downstairs first.
Yes, yes.
Thank you.
I don't know who's in worse shape, mom or kid? Let's worry about the kid first.
Get ahold of Jack Chandler, Child Psychiatry.
I don't know if he's on, but track him down.
He owes me a favor.
Okay? - Okay.
- Thank you, Haleh.
Doug, I need you for Little Susie.
Fever from daycare.
- Maybe she should go to Pedes.
- Let me look.
- What's the story with this little one? - She's burning up! Well, not really.
I'll check her out.
It might be roseola.
She looks like she might be getting a rash.
- I don't actually see that.
- Maybe she's bacteremic.
- Is there anything going around? - Always, always.
Now, listen, why don't you go on your break and let your friendly pediatrician take a look.
- Yeah, okay.
- Come here.
- Thanks.
- Dr.
Lewis? Dr.
Weaver asked if you could take the bounce-back back pain in Exam 6.
Bounce-back back pain, right, sure.
And, Bob, could you do me a favor and call my sister for me? Chloe Lewis, Midwest Business Academy.
The number's on a card in my wallet in my bag, in a drawer, in a desk, in the lounge.
Tell her Susie's sick, and she needs to come pick her up.
- Bag, drawer, desk, lounge.
Got it.
- Thank you.
So, what do you wanna do? How about some Jim Beam and call it day? - We should get CBC and Chem-7.
- Lytes? Lytes are in the Chem-7.
But before we order any tests why don't we observe the patient.
What's wrong with him? Okay, does the fact that he's bright yellow suggest anything? He's jaundiced.
Probable alcoholic hepatitis.
I'd start him on a banana bag and check his LFTs.
Carter, take this whiny guy.
Frequent flyer complaining of stomach pain, Exam 4.
Betadine, Kerlix, adult no-necks God, I love County.
Private hospitals get all bent out of shape if you steal their supplies.
Stealing supplies? We were just saying how it's not really considered theft here at County.
I know.
I was joking.
There's a Mrs.
Rodriguez here.
You brought in her son this morning, that 14-year-old.
Anyway, someone said you knew the family.
I think it's probably best if they hear it from someone they know.
I don't know the family.
I've never seen them before.
This is not what I do.
Why don't we put this stuff down.
- What was his name again? - Payaso.
No, that's a nickname.
It's Carlos, I think.
Rodriguez, I'm Carol Hathaway.
I'm a nurse here at the hospital.
Go ahead.
Your son, Carlos, was brought in this morning.
He had multiple gunshot wounds to his chest.
We tried to save him for 45 minutes.
We used all our capabilities, but his heart stopped and he died.
I'm very sorry.
His name is Rawlings, 51 years old.
Acute onset of right groin pain last evening with nausea and vomiting times three.
No bowel movement in the last 24 hours.
And a previously reducible mass that suddenly became tender and nonreducible after sneezing.
He's currently on no medications and has no allergies.
Upon physical exam, a small, tender, nonreducible mass in the right groin.
Consistent with a strangulated hernia.
Let's get him up to the O.
Let's move.
IV and Foley are in.
CBC and lytes are back.
's been notified.
- Carter, you ordered all that? - Yeah.
Good pickup.
- Thanks.
I was examining him - Let's just get him up.
Come on, move! Clear! Clear! I think you're the only Resident whose handwriting the nurses can read.
Well, that's something.
So let them read it.
Write down the meds when you're ordering them, okay? I don't want a screwup because some nurse forgot the heparin.
- The nurses here are pretty good.
- The nurses here are downright great.
And I think they deserve that from the rest of us.
Oh, good, Doug.
How is she? She's fine, except for the noise factor and a slight cold.
- She'll be fine in a day or so.
- Thanks, Doug.
Oh, it's okay.
It's okay.
You just have a little cold, is all.
That's all.
It's okay.
- Dr.
- Yes.
It's okay.
- Your sister isn't there.
- Did they say where she went? No, they said she hasn't been there in three weeks.
What do they call it, "drop off"? - Dropped out? - Yes.
You're kidding, Bob, right? Why don't you give me a hand.
Susan? Susan? Bob tells me you've been sitting here for 20 minutes.
Are you in some kind of a fugue state? We've got a trauma coming in.
A bank robber.
Some little old lady mowed him down while he was fleeing the scene.
Hit him with her car.
It's all very exciting.
Malik will watch the baby.
I slid the peanut under the spermatic cord.
- What's a peanut? - Oh, sorry.
I keep forgetting you haven't done surgery.
It's a small clamp with some gauze on the end of it.
I'm sorry.
Are you sure you don't mind this? I could probably practice on some patient.
No, no.
You're actually pretty good at it.
Yeah, but I missed one earlier this morning and In that case, I think the veins are a little over there.
It's a pretty complicated surgery, actually.
I was surprised that Dr.
Benton let me Bovie those bleeders.
You're kidding.
I didn't think med students got to Bovie anything.
It's very rare.
Did you do it in that surgery this morning? The thoracic outlet syndrome? No, that's standard stuff.
They didn't really need me too much on that.
Hey, that looks pretty good.
Maybe I could draw some blood later? Sure.
BP's 100/50, pulse 120.
Blunt trauma to the abdomen, both legs and head.
Car threw him about 15 feet.
Knocked him out of his sneakers.
Cops kept questioning him, as if he wasn't gorked out or something.
They were following us all the way in.
- On my count - One, two, three, now.
- Love your work.
- Always.
- Let's go.
Hurry up, Conni.
- Look, we got a child bank robber.
Get a CBC, type and cross-match Get a Foley, and we need x-rays cross-table C-spine, chest, pelvis and both lower extremities.
Conni, could you please call for the portable now? Conni, get some O-neg down here while you're at it.
- How are you doing? - Really well.
- Has your day gotten better? - Goodbye lateral breath sounds.
Actually, no.
Seems to be tension in the workplace.
Holy moly, check this out.
Lottery time.
- You think anyone will notice? - I know I won't.
Can we get the peritoneal lavage prepped? And where the hell's the Foley? All right, let's get that lavage going.
Hey, you boys want one of these? - What? - It's kind of a policy thing with us.
Wet-Naps are for wimps.
Oh, yeah? Well, it might help clean off some of that primordial ooze.
What? - Hey, why's 23 here? - Maybe there are multiple victims.
Hey, Larkey, the boys at Dispatch screw up again? No, we were out cruising for snow cones.
Heard the call.
- Is this the seizure? - Heat prostration.
Fell down, started mumbling in Lithuanian which our junior ticket taker there diagnosed as a seizure.
Well, it looks like you have everything under control here.
- Your rig's a little sloppy, though.
- Some of us are trying to work here.
Hey, Larkey.
So where are those snow cones? You did excellent work today, Carter.
A lot of students freeze up on their first Bovie, but you were calm, steady.
- Morgenstern was impressed.
- Really? So was I.
Choledocholithotomy, first thing in the morning.
- And then I could scrub in? - 7 a.
- About the IV thing that happened - Carter! Just don't oversleep.
I'd always heard banks put dye in with stolen money.
Well, guess it's better than being puked on but harder to get out, I hear.
- Yeah.
Don't suppose we get to keep the money.
- God knows County could use it.
- No, I don't suppose.
I understand your niece has a cold.
Fluids and fever-control measures.
Yeah, Malik's looking after her in Room 5.
I saw her.
She is quite adorable.
Thank you.
Susan You got a little spot right there.
Under your chin.
- Can I come in? - What is this, Grand Central? - Are you all right? - It's just dye, Mark.
- That's not what I meant.
- It hasn't been a very good day.
I know you're worried about the baby, but it's just a cold.
Rachel got them all the time.
She still gets them.
You don't need to tell me that children get colds.
Doug Ross and Kerry Weaver told me that.
I get it.
I didn't know you and Kerry were close enough to be talking about Little Susie.
- She told me about calling that code.
- She's irritating as hell, and you know it.
- I'll admit that she has a style - Problem? Challenge.
You'd think, on her first day, she'd at least try and be nice.
Well, maybe she thinks that way about you.
You think you're gonna be able to handle this okay? Do I have a choice? - Take a look.
- No, thank you.
- It's great.
- It's high, which means it's scary.
- Compared to what you do for a living? - I'm very careful down there.
I'm being careful.
- And I'm a wimp for using a Wet-Nap? - Now, that's different.
- Oh, it's a policy kind of thing? - Yeah.
It's like whoever is driving gets to pick the music.
Except for country, which is unacceptable.
And whoever drives gets to pick where we stop for lunch.
They decide who stays in the ambo and who goes up on the Ferris wheel.
- Raul never gets to drive, does he? - No.
So if you're so afraid of heights, what are we doing up here? I figured we should have a little quality time.
- So this is a sacrifice on your part? - Yes, you could say that.
Not to mention the sacrifice Raul is making in staying on the ground.
Who? Okay, one more time.
Excuse me, Dr.
Ross? Mrs.
Beals? Could you excuse me just for a second? It's not really Mrs.
, but that's okay.
I need to make the afternoon shift, or I'll lose my job.
Byron will be okay with you, right? - You can't leave yet.
- I have to, or they'll fire me.
- I'll take Byron with me.
- He has to see the child psychiatrist.
He's in there with him now.
Ross, please.
I really need this gig.
All right, we'll watch out for Byron.
- You get back as soon as you can.
- Thanks.
Oh, thank you, Haleh.
- When did you reach Jack Chandler? - I haven't.
- Where's my mom? - She'll be back.
Gym class, right? I don't even go to school.
I don't have to anymore.
Where's my mom? Dr.
Myers, can I see you down the hall? Just for a second.
Byron, we'll be right back.
Okay, buddy? So this kid is a real mess.
Who are you, and what are you doing in there? Psych Resident.
I'm trying to help him.
You can't poach this case out of the ER.
Hey, I was called down here.
- By who? - By whom.
By Dr.
Chief Resident? Code red! Somebody call the damn fire department! Rip it out! Rip it out! I got it.
Byron? Byron? - Where's the kid? - What kid? - What kid? - Call Security.
Byron? Hey, are you okay? Come here.
Let me see.
- Everything's gonna be all right.
- Where's my mom? You kind of had me scared there for a minute.
- Where's my mom? - We'll get your mom.
- Where's my mom? - It's okay.
- Where's my mom? - It's all right.
This thing break down on you again? Should've called me.
I'd have helped.
You know Peter Benton, don't you? I did physical therapy for his mother last year.
My husband, Al.
Yeah, you came by the house once, right? Yeah, right.
Right, yeah.
- Surgeon, right? - Resident.
Well, yeah, you know Surgical Resident.
- You know anything about distributors? - Peter's brother-in-law's a mechanic.
His mother talked about her family a lot.
All the time.
Sounds like my mom, doesn't it? Is there anybody you want me to call? No, no, I think we got it.
Why don't you give it a try.
Yeah, okay.
There you go.
We got it.
I gotta get her some new wheels, man.
This thing's shot.
- Hey, it's good to see you again.
- Yeah.
Take care.
- Mrs.
Beals - I told you, there is no Mrs.
Cindy, okay? Please don't leave yet.
Byron's a very sick little boy.
He needs psychiatric help.
He could've burned himself up in there.
I'll take him to work.
He likes that.
He'll be okay.
Listen, taking him to work is not gonna solve any of his problems.
Well, neither are you.
Look, I really appreciate your help and I'll do all the follow-up for his hand.
My cousin is gonna put us up.
She's waiting in the car.
She's got a bunch of kids home, so we really do have to go.
Someone gonna answer the phone? - Hey, Bob, what's going on? - What happened to you? What do you mean? We were goofing around on that last run.
You know, sticking our heads out the window, the way dogs like to do.
It's a good look, Carol.
- Bob, have you seen Dr.
Weaver? - Suture Room.
- The bounce-back migraine is here again.
- Not now, Jerry.
I'm only trying to get you out in time for your train.
- Curtain 2.
- Thank you.
We run out of Vicryl before nylon, and lidocaine with epi is always low.
And 25 days and Kerry, would this be a good time? Thank you, Dr.
- I appreciate your staying late.
- Sure.
Who gave you the right to call a Psych Resident on one of my patients? The 9-year-old pyromaniac? Seemed appropriate.
We were waiting for Jack Chandler, who, as you know specializes in children.
- Chandler is not on call today.
- He was giving me a curbside consult.
- He's out playing golf.
- He was gonna stop by.
He owes me a favor.
You're asking an extremely distraught to hang around, delay treatment, for a chat with your buddy? Instead you send in some prepubescent Resident who upsets the kid, so he sets the curtains on fire.
He set the curtains on fire because you left him alone.
Chandler comes in on a curbside he won't write anything in the chart or follow-up.
Where does that leave the kid? Where's he left now? His mother took him out of here AMA.
And whose fault is that? The Psych Resident wasn't managing this case.
You were.
- I'm out of here.
- Doug.
I said that I'm off! - Doug, come on.
Wait a minute.
- Did I miss something here today? Let's just say that the last train to Milwaukee is in 48 minutes and I plan to be on it.
- So now is not a good time to tell you about a blunt trauma to the chest pulling up? See you tomorrow.
You okay? I'm afraid to move.
Every time I do, she starts to cry.
- It's an amazing sound, really.
- Tell me about it.
I got two at home.
- And a new one on the way.
- Congratulations.
I didn't even know.
No one does.
I guess I just announced it.
But when you gotta move them, you gotta move them.
Take your chances.
Oh, Conni, I'm sorry about my attitude today in that trauma.
You were pretty pissy, all right.
But it was worth it just to see you take that green splash.
- Here.
Wanna try a handoff? - Yeah.
Shooting! We need a 12-lead EKG on him.
Let this be a lesson, Daniel.
Never try to catch a running back with your chest.
- I can't breathe too well here.
- Take it easy.
You're gonna be okay.
- It's just a bruise? - He's hyperventilating.
You would be too if you took a helmet to your solar plexus.
Get a pulse ox.
- BP's falling, 70/40.
- Pulse ox is 92.
Oh, great.
Put him on a mask.
Six liters.
- Is something wrong? - Yeah, Dan, you should've tackled lower.
Blood gas is back.
PO-2, 65.
PCO-2, 28.
pH, 7.
He's hyperventilating, but his PO-2 is way too low.
Shortness of breath, acute hypoxia in an otherwise healthy 15-year-old.
JVD, muffled heart sounds, crashing BP.
- Pericardial tamponade? Blunt trauma? - It happens.
What's a pericardial tamponade? Is that something bad? I can't breathe too well.
I can't breathe.
- Twelve-lead? - No time.
Pericardiocentesis tray.
It's a bizarre thing, Daniel, which makes you a bizarre guy.
But we like that about you.
There's bleeding in the sac around your heart, so it's not beating right.
We're gonna numb the area and then we're gonna insert a needle and drain the blood.
You're gonna stick a needle in my heart? Don't worry, I've done it a thousand times.
- John, move in for a better look.
- Sure.
I'm using a subxiphoid approach.
Forty-five degree angle.
We're aiming at the left shoulder drawing back as you advance the needle.
- Cool.
- See, Dan, there's nothing to it.
BP's coming up, 100/60.
Mark, didn't you say something about catching a train? - Oh, no.
Oh, God.
Good night.
- Good night.
When were you gonna tell me? I tried, Susie.
I really did.
Hey, I got another job for a couple days, waitressing.
Made 110 bucks.
School was too hard.
They had all these different programs.
You had to move this file into this file.
It made me feel so stupid.
All the other girls in the class already knew how to type and how to write business letters.
I thought a letter was, like, a letter.
They had all the right clothes.
I didn't have any of that stuff, except for what I borrowed from you.
Even then, it doesn't look right on me.
I really wanted this.
For Susie.
And to show you that I could do it.
I didn't tell you because I knew that I would disappoint you.
And because I thought that just maybe this time I wasn't gonna screw up.
But What happened to the waitressing job? Good night, Chloe.
Hold on! Hey, wait! Damn! Enjoying the view? I'm glad you came by.
I wasn't sure you would.
- I wasn't sure you'd want me to.
- No, no, no, I'm glad.
Look, you know, Jeanie, I thought I could do this, but We can't.
I know.
We talked about all this before.
It's just, it's hard.
Yeah, well, so is this.
You gotta tell him.
You gotta tell him.


ER s10e21 Episode Script

Previously on E.
No, I work at a burger joint.
Caught myself by putting my hands on the grill.
You're too young to have high blood pressure, E.
- This is my dad.
- Hi.
The longer you stay, the harder it's gonna be on him when you leave.
Well, maybe I won't leave this time.
She left the money to me.
She left the house to me.
She trusted me to make the right decisions.
I doubt she'd agree that's what you're doing now.
Pleasure meeting you.
I look forward to getting the wedding announcement.
10x21 "MIDNIGHT" - What else did we get? - Another book from Elizabeth Corday.
Who's that? Surgeon.
- The American Way of Birth.
- Don't let Dr.
Ford catch you reading that.
Oh, yeah? Why not? Because it argues that the shift from home births and midwives to hospital births and C-sections is the result of American OBs' greed.
- All right, what do you think? - I'll read it today.
No, about the paint.
Maybe something with more blue.
Maybe? You know, Americans are way too neurotic and technology-reliant.
I mean, with all your money and equipment your infant mortality rate is still terrible.
Oh, you'd rather be back in Kivu, giving birth on a concrete floor? You're, like, 34th or something, behind Guam.
I like the second one.
Too much gray.
Well, why don't we ask George? - George? - You don't like George? - Oh, please.
- I like George.
It's the name of first president of the United States, the quiet Beatle.
- Current occupant of the White House.
- Well, no name is perfect.
Hey, George.
It's Dad.
Listen, would you rather be born on the filthy dirt floor of a primitive mud hut in Central Africa, or-? I do not live in a mud hut.
Or in a modern hospital surrounded by the finest doctors and equipment in the world? Kick once for America, twice for the mud hut.
- I resent your characterization- - He's deciding.
- He's not deciding.
- He's deciding.
- You know what, he's sleeping.
- No.
- I'm back.
- Hey, you get there in time? Yeah.
It's a nice-looking school.
It's kind of heavy-duty security, though.
They have a drug shootout there recently or something? What the hell is this? Honey, you knew what that was when I met you at 15.
Where did he get it? He saw it with my stuff, and he wanted to know what it was.
So you gave it to him? - He knows not to take it to school.
- A condom? Hey, look.
Come on, I'm sorry, all right? It's no big deal.
I shouldn't have had the thing in my damn pocket.
Picked up a few, just in case.
- You're not on the pill right now, right? - Me? A boy can dream, can't he? You look good, baby.
I missed you.
- What are you doing? - What you like.
It's still what you like, isn't it? No.
I gotta go finish laundry.
Hey, can you hang with Alex tonight? I got something I gotta do.
A date? Yeah, sure.
I can't believe we graduate tomorrow.
Neither can future patients.
Today, ill-prepared students.
Tomorrow, doctors with the fate of countless helpless victims in incapable hands.
They ought to make them wear caution signs.
" Danger: New Doc" in big letters on your coats.
Thanks for the pep talk.
Happy to lend encouragement to the newbies.
- Jerk.
- Bastard.
How long will it take me to get to O' Hare at midnight? - Midnight? - My family's arriving from London.
- I had to get the cheapest flight.
- How many are coming? - Nineteen.
- How many? Really.
Eighteen if my uncle's hip is still dodgy.
Your families coming? Father and mother, Dad's new wife, Mom's new boy- - Abby, any family jetting in? - No.
We're not that close.
We're more like survivors of a particularly brutal carjacking than a family.
Hello, ladies.
Let's get a move on.
It's your last chance to learn something before you start screwing up your malpractice premiums.
- Wanker.
- Turd.
- Is Alex coming with us? - No.
It'd be fine with me if he did.
- Just you and me.
- Where do you wanna go? Just hang out.
I miss you.
Eighty-five-year-old male, combative and uncooperative wandering around naked at board and care.
Give me my watch back, you bastards! - Thinks we took his watch.
- I want it back, you son of a bitch! It's on his wrist.
- You want restraints? - Not yet.
CBC, chem panel, UA and chest x-ray.
Somebody call the cops.
And let's see if we can find a reason for his deterioration.
Hey, back so soon? - Lucky me, huh? - Abby, you free? What, everybody just decide to not file anything for two months? Frank, my man! Thank God you're back.
You start blubbering, I swear I'm gonna smack you.
- Back to work already? - Wife threw me out of the house.
I think I was getting on her nerves.
She was definitely getting on mine.
- John? - Yeah.
- God, how long have I been asleep? - About an hour.
- Here, drink this.
- No, thanks.
- No, really, I don't want it.
- Come on, come on, come on.
- You been doing your kick counts? - What? No.
The baby squirms like mad all the time.
You've been reading too many books.
I'll count, okay? Just go do something useful.
Unpack a box, paint, do something.
- Go, go.
- Okay, okay.
Remember that kid with high blood pressure? - Nope.
- Burnt his hands on a grill? His belly CT came back.
No pheo, no coarc, no renal artery stenosis.
Nothing indicates cause for high blood pressure.
- So? - He has primary hypertension.
What? That big kid who flips burgers? - What'd you tell him on discharge? - To lose weight, get some exercise.
Gave him a scrip for hydrochlorothiazide.
And referred him to Family Medicine Clinic.
- Voilà.
You're a miracle worker.
- Look at his cardiac echo.
- Left ventricular hypertrophy.
- You call the clinic? - He hasn't made an appointment.
- Call and remind him.
He has end-organ damage.
He could have CHF or arrhythmia.
Neela, he's a kid, okay? That would take decades.
Call him, tell him to get his butt to the clinic sometime before he's 30.
No fever, no pneumonia, no UTI.
- Something metabolic? - Pulse ox is 98.
Sodium's okay.
Sugar's normal.
No anion gap.
- Mr.
Ferguson, you have to stay in bed.
- I have to go feed the cat.
We'll make sure the cat's taken care of, but you have to stay in bed.
- What else? - Could be toxic ingestion but there's no toxidrome.
I think it's just a worsening of his dementia.
Five hundred cc saline bolus and D5 half at 100 an hour? Yep.
You graduate tomorrow? - Eight short years later, yeah.
- You got your boards results yet? - No.
- Dr.
Kovac, you got a minute? They gonna let you graduate? I can walk, but I don't get my diploma until I pass.
- You haven't passed your boards yet? - I took them last week.
Wow, I had to take mine, like, six months before my graduation.
Morris, what do you need? Hey, Malik.
Can you hang 500 saline for the old guy in Exam 3? - You got it.
- Dr.
Corday is a surgeon.
She'd be on the sixth floor.
I went there first.
They told me to come here.
- Yeah? Well, they were wrong.
- Rachel? - Jerry, how've you been? - Oh, my God.
Look at you.
- You're all grown up.
- Frank, you remember Rachel, right? Rachel Greene.
Greene's daughter.
No bleeding, right, and no contractions? Nothing hurts? Hey, slow down, honey.
You're scaring me.
Did your membranes rupture? Could've happened in the shower.
I saw Dr.
Ford yesterday, and the membranes are fine.
Hey, you can't park here.
- It's okay.
I'm a doctor.
- Good for you.
You gotta move it.
It's a tow-away zone! Thank you.
When he does come in would you get him to call me back, please? Thanks.
Bloody hell.
" Bloody hell " already? It's not even lunchtime.
I'm trying to find a hypertensive No answer at home.
Hasn't turned up for work, either.
Organ damage in a hypertensive teenager? Is that even possible? - Anybody know whose patient that is? - Mine.
Larry Godiva's taking another afternoon stroll.
Thank you.
One of you Samantha Taggart? - You a process server? - No.
Then that's me.
Better eat them quick.
They gonna start melting soon.
- Ice cream? - Anybody want a sundae? Somebody sent you ice cream? Yeah, she's here right now.
With a boy, yeah.
Right, okay.
All right, thanks, bye.
- I called your mother.
- How is she? She's surprised you're here.
BJ, could you give us a few minutes, please? Cafeteria's on the first floor.
Could you get me some fries, Diet Coke? Cool.
- You good? - Yeah, fine, thanks.
So your mother tells me that you're not living at home anymore.
- Moved in with a friend from school.
- Living with her family? No, got our own place.
How's Ella? Can't wait to see her- Excuse me, Elizabeth.
Can I borrow you for a moment? Yeah.
I'll be right back.
I've got a bad mesenteric occlusion.
May need the O.
Fine, sure.
I got those Itzhak Perlman tickets for Sunday.
- Shaw's first? - Right, yeah, yeah.
- Where'd you say the patient was? - Angiography suite.
I'll be right there.
I'm sorry, Rachel.
I have to get back to work.
Who was that? - Colleague, Dr.
- Handsome.
- So we can stay with you, right? - How long for? Couple of days.
I wanted to check out U of I, maybe Northwestern.
You know you're always welcome.
- Separate bedrooms, of course.
- Of course.
I was 15 when we met.
I was scooping ice cream at the mall little apron, white hat, whole bit.
- Anything left? - Help yourself.
Hey, you just had bypass surgery, like, seven weeks ago.
A treat now and then is not gonna kill anybody.
In your case, that little truism might not be completely accurate.
Steve and his buddies would come after work.
He was working construction then.
He was all tan, sweaty, little cowboy boots.
- How old was he? - Twenty-three.
- And you were 15? - Yep.
Disgraceful, huh? He'd come to my school and pick me up in this old Mustang GT O he was always fixing up.
We'd go out driving or go play "X-Men" in the arcade.
Lots of times, we'd just park somewhere and steam up the windows.
And your parents had nothing to say about this? They had plenty to say, but I didn't listen.
- So, what happened? - Alex happened.
When was the last time you were sure you felt the baby move? In the bath, this morning.
- No bleeding, no cramping? - No.
A little buzz here.
And again, a little buzz.
You sure you had that positioned over the head? Yes.
The amniotic-fluid index? If she's got poly- John, sit down.
Take Kem's hand.
I've been looking for over five minutes.
There's no heartbeat.
There's no gross body movement.
There's no response to acoustic stimulation.
I'm sorry.
I'm so sorry.
The baby died.
It could have been an infection, a cord accident erythroblastosis, preeclampsia.
We may never know.
I'm gonna admit you so we can get started on induction.
An induction? We should get this baby out as fast as possible.
I have to go through labor? I'm sorry.
I'll go order the epidural and get started on your paperwork.
Vicki? - Blood pressure was fine.
- Yeah.
- Rh-positive, she's afebrile.
- We're gonna do an autopsy after the delivery and see what we can find.
I'll ripen the cervix with misoprostol.
We'll start Pitocin about four hours after.
- How long will that take? - Twelve to 24 hours.
Sometimes it's longer for first-time moms.
LV wall thickness is 18.
- Is this Burger Boy again? - No one's answering the phone.
Seventeen-year-olds do not have trouble with high blood pressure.
Left ventricular hypertrophy in teens can lead to heart failure.
- And sudden death from cardiac arrhythmia.
- You're a cardiologist now? - I looked it up on the internet.
- Everything on the internet is true.
I wanna go by his house and see if he's there.
He lives 10 minutes away.
I can take a BP cuff, some IV supplies and oxygen.
Don't forget a thoracotomy tray in case he needs a heart transplant.
Where does he live? Morgan Taylor Homes? Bring an armored personnel carrier and a squad of Rangers.
- You can't go in there.
- I'm taking my lunch.
- I'll be back in 30 minutes.
- Hey, Mother Teresa.
I get off at 6.
I'll take you.
But you owe me vindaloo after.
Who's got the geriatric flasher? - Ferguson has dementia.
- Had him in self-restraints.
- Keeps getting loose.
- Use the Posey vest.
I don't wanna see his "wee Willy Wonka" wagging around here anymore.
- I'll go make sure he's okay.
- Nail him to the bed if you have to.
Hey, Kovac, Security's on the line.
They say your car alarm's going off in the garage.
It's driving them crazy.
So you like Indian food? I love Indian food: chicken tikka, masala, naan.
I love it.
When you open your match letter, maybe I can take you out to celebrate.
- Might not be anything to celebrate.
- You're gonna do great.
You're smart cute.
You work your ass off.
Got nothing to worry about.
Not like Lockhart.
Some residency program's gonna get a shock when they find she hasn't passed boards.
- I need to go and see a patient.
- So are we on? Sure, maybe.
Your TV control is here, on-button, volume, channels.
It's gonna feel a little tight.
This is the call button, straight to nurses' station.
If you need anything- - All set.
- You thirsty? I'll get you some ice chips.
You know, your alarm's a little sensitive.
You might wanna raise the motion-detection threshold a bit.
It's a nice ride.
- What'd it set you back? - What do you want? The sports package.
Should hold up pretty good on resale.
I really screwed this thing up with my family.
But I'm gonna make it right this time.
And I need time to make it right.
Let Sam see how much I've changed.
Time to be a father to my son.
We belong together, Sam, Alex and I.
And Sam knows that.
You paid that kid $ 10 to watch your car? I want there to be wheels on there when we get back.
Thanks for doing this.
He's here, we yell at him to get to the clinic.
If not, just leave a note, and that's it, okay? - Lifts are over there, I think.
- Trust me, the elevators don't work.
- Thirty-nine, right? - Yeah.
- So much wire mesh.
- So they don't throw things on folks below.
- Like trash? - Like bricks.
Nobody's home.
Got the note? Come on, would you? I'm starving.
- Elgin? - Great.
It's Neela from the hospital.
I just get a little winded climbing the stairs.
It's no big deal.
- You remember Dr.
Pratt, right? - What's up, man? You been taking your hydrochlorothiazide? Why not? Because you told me if I exercised a little, I'll feel better.
I said you could stop taking it in six months if you exercised and lost weight.
- Is that dinner? Cheeseburgers.
- Yeah.
My mother's working tonight.
I have to pick up the kids from Ms.
Johnson at 7.
Can someone look after the kids so you can come to the hospital for more tests? - I'm feeling okay.
- Take your pills.
Come in next week for a blood pressure check, okay? - All right.
Thanks, doc.
- You got it.
He needs an EKG and a chest x-ray.
He needs to pick up his family and get them fed.
You found him.
You told him what he needs.
Unless you plan on adopting the kid, let's get something to eat.
- What time is your graduation ceremony? - Noon.
- You're not gonna go? - I'm off.
Thanks, but no.
It's boring.
It's boring, and I'm not even sure I'm gonna go myself.
To your own graduation? Yes.
It seems pointless considering the fact that I might not actually get to practice medicine, so I would rather no one come.
- Abby, got a minute? - Yeah.
But thanks.
- Anything new on Henry? - No, no, thank you.
Abby, did you get confirmation of your match list yet? Couple of weeks ago, yeah.
Well, with your clinical skills, I'm sure you'll do very well.
Off the record, I can tell you that we ranked you in our top 20.
If County's top of your list, you're guaranteed to match here.
I thought we weren't supposed to talk about that.
No, of course not.
You found out I failed my boards.
Well, I took them again last week.
The hypothetical concern would be that if you don't pass again and you match with a program, whatever that program might be you would be ineligible to begin your internship.
And the program would be short an intern.
Programs can still delete applicants from their match lists until Friday.
That way, the applicant would match with his or her second choice.
And if he or she didn't pass their boards, the second-choice program would be the hospital short a body.
Well, I guess if that happened If that happened, the applicant that was deleted would lodge a complaint with the National Board indicating he or she'd been approached by the chief of staff in violation of clearly stated rules governing how matches are conducted.
Where to? I'm starving.
I'm gonna have to take a rain check.
- Everything all right? - Yeah, yeah, fine.
I'm just just tired.
This have something to do with Steve? Because I keep telling him he's gotta find another place to crash.
I just think it's maybe confusing for Alex.
Alex isn't confused.
It's not that simple.
Can I give you a lift? No, that's okay.
Hey, it's morning in Kinshasa.
You want me to call your family? Kem, do you want me to call your family? You sure? - What's that? - Have you told anybody? No.
Been here with you.
I don't want anyone to know.
Okay - You didn't restock.
- No, I didn't.
- Just restock when you use something.
- I will, when I actually use it.
You need anything? Do you? I don't want anyone to know, okay? Ella's asleep? Guy named Dave called.
Wanted to know if you were still up for a movie Saturday night.
He has a daughter, the same school as Ella.
Guy at the hospital, tall British guy.
- You dating him too? - How are you liking school? - Don't worry.
I'm going to college.
- Do I look worried? My mom's worried.
Rachel, why are you here? I just wanna look at a couple of colleges.
I need a prescription for Plan B.
The morning-after pill? Why didn't you go to your mother? Five centimeters, 100 percent effaced.
You're moving along.
- How much longer? - Hard to say.
Hours still.
My legs are completely numb.
We can turn the epidural down.
I'll come back and check on your progress.
I'm gonna go get a cup of coffee or something.
You'll be okay for a couple of minutes? One more big push.
That's it.
That's it.
Long night, huh? - Yeah.
- Your first? - Yeah.
- I got three already.
All girls.
This one gonna be a girl too.
Even our cat's a girl.
You know what time it is? - Yeah.
It's almost midnight.
- Midnight.
I am dying for a cigarette.
But you gotta go all the way down halfway across the building to get to one of them smoking areas.
So I'll probably see you around the hallway later on, huh? - Good luck.
- You too.
Didn't mention anything about the ice cream.
Was a big hit.
- God, you're beautiful, Sam.
- Yeah, this is me at my finest.
No, really.
- You're all grown up.
- You're drunk.
A little bit.
Hey, did you go to the hospital and say something to Luka? Sam, I want another chance.
Well, I don't want you going to the hospital, okay? I gotta get up early.
Come on.
Do you remember those cottonwood trees down by the river we used to go to? Used to lay under those trees for hours, just drinking Schnapps and rum-and-Cokes with no ice.
Making love, Dave Matthews coming from my car stereo.
Listen, Steve.
Sammy, I love you, sweetie.
I love you, Sammy.
Please, Steve.
Please, Steve, what? Let me- Let me by, please.
- I can't feel anything.
- Head's almost out.
One, two, three, four, five, six- - Bear down.
Hard as you can.
- Shoulder's out.
- I got it.
I got it.
- It's almost over.
He's out.
He's out.
It's over.
True knot.
Your baby twisted and squirmed in such a way that he tied a knot in his umbilical cord.
Send 5 cc's of cord blood to the lab for Rh factor.
There's nothing you could have done to prevent this.
Not genetic.
It's not an infection.
It was just bad luck.
- Would you like to see him? - No.
Are you sure? John? It's okay, son.
It's okay.
- Stillborn? - Yeah, true knot in the cord.
- How terrible.
- I can't even imagine.
- I'll try and get up there after rounds.
- Those poor people.
- Seven months old? - Almost eight.
Yeah, tough break.
What? I was being sincere.
This is the admit area where we keep track of all of the patients we have in the ER.
That's Jerry.
He makes this whole place work, and he's very big.
That's Frank, works with Jerry.
Had a massive heart attack and shouldn't be eating that doughnut.
And this is the ER staff.
- Staff, this is my family.
- Nice to meet you.
Okay, well, lovely to see you all.
Down this way are the trauma and exam rooms where we save the lives of unfortunate souls who end up here.
On a busy shift, we'll see over 120 patients, sometimes as many as 200.
Back there is the Suture Room, where we attend to minor skin wounds.
That's a naked patient.
Let's step through this way.
- Is that too tight? - No, it's fine.
Would you like a lock? To keep? Good morning.
You look radiant.
I was up half the night.
Doing what, one might wonder? I was hoping you could do me a very large favor.
Will there be a very large reward? I need you to write me up a scrip for Reglan Yasmin and two packets of Plan B.
John? I'm off in a few minutes.
I asked them to get a room for you downstairs.
I wanna watch Kem for the rest of the day.
Just make sure there's no bleeding.
Has she held the baby yet? I've been doing this for over 20 years.
There's nothing more difficult than what you've been through.
But if Kem doesn't say goodbye to her child she will regret it for the rest of her life.
And a three-month supply of oral contraceptives.
- Birth control pills? - You'll still need to use condoms.
- Who's Dr.
Lawson? - He's a friend.
Why didn't you do it? When your mother discovers these in your dresser drawer, I'd rather she didn't know they came from me.
Was he that British guy from yesterday? Your gynecologist back home can write you a refill for the Yasmin when it runs out.
Do you like him more than the guy from Ella's school? Rachel.
They're both nice, you know, but it's just an occasional meal.
It's a movie.
You know, I have Ella.
I'm very busy with my work.
It's okay.
Dad would've wanted you to be happy.
Do you miss him? Yeah.
Yeah, I do.
Me too.
I appreciate you both coming.
But you should go home.
I don't want you to miss your graduation.
That is today, right? I was gonna miss it anyway.
They didn't have any bagels, but the coffee was fresh.
I was just saying, Dad, how much I appreciate you guys all being here but I think that we're okay.
And I think you guys can go.
You know, if you- I know.
You too, Dad.
You can go.
Oh, thanks.
I think I'll stay.
Lester, have you seen Abby? Abby.
Have you seen her? No.
Kem? They want us to move to another room soon.
And they're gonna take the baby when we go.
Would you like to hold him? Campbell, Edward Barrington the third.
Ann Marie Barstow.
Corazon, Linda Benitez.
Bennings, Jonathan Bett.
- What did I miss? - Molly Ivins gave a kick-ass speech.
- Who? - They haven't gotten to Abby yet.
I thought you were on bed rest.
Please, I'm already a week late.
I am desperate to get this kid out.
Lily Yay Lin Chang.
Lee Son Chow.
Robert David Betterman.
- I can't breathe.
- Wet crackles to the apex.
He's in pulmonary edema.
Hey, I know you.
Pratt's patient? Pratt, think this one's yours.
- Pulse ox is 78.
- He needs Lasix.
What's going on? - 17-year-old with pulmonary edema.
- Elgin? - We need a nitro spray.
- Had two in the field.
- Want an intubation tray? - What? No.
- Just got a little hypertension.
- He has a little congestive heart failure.
Start a nitro drip at 40 mics and 25 sublingual captopril.
- Sats dropping to low 80s.
- Page Cardiology.
We need a stat echo down here now.
Never seen a kid this young in heart failure before.
- I don't see Abby, do you? - No, said she probably wouldn't come.
To her own graduation? Lester Rodney Kertzenstein.
Andrashi Lapoor.
Abigail Marjorie Lockhart.
Robin Jay Nancy.
Neela Rasgotra.
- Neela! - Neela! When your brother died the thing I hated the most were other people's platitudes.
There are no words.
You don't know where you'll find the strength, but somehow you do.
You can have another child.
It was an accident.
A tragic unforeseeable accident.
The whole thing was an accident.
No, it wasn't.
You love each other.
Everybody can see that.
I don't know that she'll want to have another baby with me.
Sure she will.
Just give it some time.
Abby? - Congratulations.
- Thanks.
Hey, this is so great.
Good for you.
We're gonna get something to eat.
Wanna join us? - No, I'm tired.
But thanks.
- Okay.
And thank you guys for coming.
- See you at work.
- Okay.
I'll be back.
Hey, Mom, it's Abby.
No, no, everything's fine.
We just haven't talked in a while, so Yeah, it's good to hear your voice too.
Hey, Mom? Guess what.
I graduated today.
Can you believe it? Kem.
And when they come, they're gonna take the baby and we're never gonna see him again.
I don't know what the right thing is to say.
I don't know what the right thing to do is.
It was an accident.
It was nothing that you did wrong.
It was nothing that we did wrong.
It just happened.
But we have to say goodbye to our son now.
Please, help me.
Yeah? - He's beautiful.
- Oh, my God.
I love you so much.
I love you so much.


Sequence as source of identity

[19 February 2013]

For reasons not worth going into (it’s a long story) I was once involved in a discussion of how to tell, given a sequence of objects of a given kind and two descriptions (or variable references) denoting items X and Y in the sequence, whether X and Y are identical or distinct. (This topic came up during a discussion of whether we needed clearer notions of identity conditions for this class of objects.)

One of my interlocutors suggested that we did not need to specify any identity conditions at all. Since X and Y were presented to us in a sequence, we could always tell whether X and Y are the same or different by looking at their position in the sequence. If X and Y are both at the same position in the sequence, then X must be identical to Y, and if X and Y are at different positions in the sequence, then X and Y must be distinct from each other.

Now, the first claim (if X and Y are at the same position in the sequence, then X = Y) is obviously true. And the second (if X and Y are at different positions in the sequence, then X ≠ Y) is manifestly false, though sadly my interlocutor never stood still long enough for me to point this out. Let X be “the Fibonacci number F1” and Y be “the Fibonacci number F2“. These occur at different positions (1 and 2) in the Fibonacci series, but both expressions denote the integer 1. So we cannot safely infer, from the fact that X and Y identify things at different positions in a sequence, that X and Y identify different things.

As I discovered the other day, Frege turns out to have a word to say on this topic, too. I wish I had had this quotation ready to hand during that discussion.

… die Stelle in der Reihe kann nicht der Grund des Unterscheidens der Gegenstände sein, weil diese schon irgendworan unterschieden sein müssen, um in einer Reihe geordnet werden zu können.

… their positions in the series cannot be the basis on which we distinguish the objects, since they must already have been distinguished somehow or other, for us to have been able to arrange them in a series.

(Gottlob Frege, Die Grundlagen der Arithmetic, 1884; rpt Stuttgart: Reclam, 1987; tr. by J. L. Austin as The Foundations of arithmetic 1950, rpt. Evanston, Illinois: Northwestern University Press, 1980, § 42.)

Regular approximations (again)

[9 April 2012]

For a while it has seemed to me interesting and potentially useful that any context-free language L can be approximated by regular languages which accept either a subset or a superset of L. (See earlier posts from 2008 and 2009.)

Apart from the intrinsic interest of the fact, this means that it’s possible in principle to define XSD simple types using those regular approximation languages, which in turn means it’s possible to use XSD validation to catch at least some syntactic errors in strings which should be members of L.

Some time ago, I had occasion to translate the ABNF of RFC 3986 and RFC 3987 into XSD regular expressions (possible in that case without an approximation, since the languages defined by those to RFCs are all regular). The mechanism I used was simple: each ABNF production turned into an entity declaration, and each non-terminal on the right-hand side of a rule turned into an entity reference.

Today I was reviewing that work and it occurred to me that if we could find a regular approximation by algebraic manipulation of the grammar (without any detour through finite-state automata), it would make it much simpler to write the necessary XSD patterns.

But how?

Given a context-free grammar for L, can we identify algebraic rules which would allow us to derive a regular grammar for a regular approximation to L?

Automatic theorem provers and proof trees

[13 December 2010]

When I took an introductory course in symbolic logic, all those many years ago, we used a textbook (Richard C. Jeffrey, Formal logic: its scope and limits [New York: McGraw-Hill, 1967], in case you’re curious) which presented a proof method based on proof trees, which had the nice property that for valid inferences it’s guaranteed to terminate, and that for invalid inferences it will never terminate with a false positive. Allen Renear informs me that the locus classicus for proof trees is Raymond M. Smullyan, First-order logic (2d ed. New York: Dover, 1995), which I have been reading lately with pleasure.

All the theorem provers I’ve read about, however, seem to require more or less active participation and guidance from the user; like the proof-tree method, they produce a proof only when a proof exists, but unlike the proof-tree method they aren’t guaranteed to find a proof if one exists.

So I’ve been wondering: why aren’t there automatic theorem provers based on the proof-tree method?

Or are there?

There must be fifty ways …

[7 April 2010]

The old Paul Simon song “There must be fifty ways to leave your lover” keeps running through my head. I can see close to fifty ways to define the XPath 1.0 data model in terms of (a) a set of nodes and (b) two relations defined on that set, which are taken as primitive; all other relations (i.e. all the other axes of XPath) are defined in terms of those two primitive relations.

Strictly speaking, I make it forty-eight ways. First, pick any single relation from any of the following four groups:

  1. parent, child, ancestor, descendant
  2. prevsib, nextsib, preceding-sibling, following-sibling
  3. prevnode, nextnode, document-order preceding (>>), document-order-following (<<)

That’s twelve possibilities.

Second, pick any single relation from either of the other two groups; that makes eight possible choices, times twelve first choices, for ninety-six ordered pairs of relations. But the order doesn’t matter, so we have forty-eight distinct pairs.

In recent days, taking some pairs not quite at random, defining the constraints they must satisfy in order to be a suitable basis for defining an XPath 1.0 tree, and defining all the other relations in terms of the chosen primitives, I have learned a couple of mildly interesting things.

  • It’s more convenient to take parent as a primitive, than child.
  • It’s more convenient to take one of the single-step relations (parent, child, nextsib, prevsib, nextnode, prevnode) than one of their transitive closures (ancestor, descendant, etc.).

The nextsib relation, for example, needs to be acyclic, functional, injective, and not transitive. If it is, then its transitive closure following-sibling will automatically be suitable. But if you start with following-sibling and specify (as you will need to) that it is transitive and acyclic, that does not suffice to guarantee that its transitive reduction nextsib is functional and injective. You can of course simply say that a following-sibling relation is suitable if and only if (a) it’s transitive, (b) it’s acyclic, and (c) its transitive reduction is functional and injective, but now you’re forcing the reader to work with two relations, not just one: both following-sibling and its transitive reduction. It would be interesting either to find a way to constrain the closure directly to ensure the necessary properties in the reduction, or else to find a proof that there is no way to constrain a closure to ensure that its reduction is functional and injective without explicitly referring to the reduction.

  • From any relation in any group, the other relations in that group are (relatively) easy to derive in terms of inversion, transitive closure, or transitive reduction. Defining a relation in the third group typically proves more interesting. And while it’s more convenient to choose the primitive relations from among the reductions, it turns out that at least in some cases it’s easiest to define the third group in terrms of one of the closures. For example, given the parent and next-sibling relations, it proves easier to define document-order-following in terms of the primitives than to define next-node.

It occurs to me to wonder whether there are ways to define XPath 1.0 trees that don’t reduce to or include one of these forty-eight.

One way to define the XPath data model

[6 April 2010; addenda and copy editing 7-8 April 2010]

After discovering earlier this year that the definition of the XPath 1.0 data model falls short of the goal of guaranteeing the desired properties to all instances of the data model, I’ve been spending some time experimenting with alternative definitions, trying to see what must be specified a priori and what properties can be left to follow from others.

It’s no particular surprise that the data model can be defined in a variety of different ways. I’ve worked out three with a certain degree of precision. Here is one, which is not the usual way of defining things. For simplicity, it ignores attributes and namespace nodes; it’s easy enough to add them in once the foundations are a bit firmer.

Assume a non-empty finite set S and two binary relations R and Q on S, with the following properties [Some constraints are shown here as deleted: they were included in the first version of this list but later proved to be redundant; see below] :

  1. R is functional, acyclic, and injective (i.e. for any x and y, R(x) = R(y) implies x = y).
  2. There is exactly one member of S which is not in the domain of R (i.e. R(e) has no value), and exactly one which is not in the range of R (i.e. there is one element e such that for no element f do we have e = R(f)).
  3. Q is transitive and acyclic.
  4. The transitive reduction of Q is functional and injective.
  5. It will be observed that R essentially places the elements of S in a sequence without duplicates. For all elements e, f, g, h of S, if Q includes the pairs (e, f) and (g, h) and if g falls between e and f in the sequence defined by R (or, more formally, if the transitive closure of R contains the pairs (e, f), (e, g), and (g, f)), then h also falls between e and f in that sequence.
  6. The transitive closure of the inverse of R (i.e. R-1*) contains Q as a subset.
  7. The single element of S which is not in the domain of R is also neither in the domain nor the range of Q.

It turns out that if we have any relations R and Q defined on some set S, then we have an instance of the XPath 1.0 data model. The nodes in the model instance, the axes defining their interrelations, and so on can all be defined in terms of S, R, and Q.

For the moment, I’ll leave the details as an exercise for the reader. (I also realize, as I’m about to click “Publish”, that I have not actually checked to see whether the set of constraints given above is minimal. I started with a short list and added constraints until S, R, and Q sufficed to determine a unique data model instance, but I have not checked to see whether any of the later additions rendered any of the earlier additions unnecessary. So points for any reader who identifies redundant constraints in the list given above.)

[When I did check for minimality, it turned out that several of the constraints included in the list above are redundant. The fact that relation R is functional and injective, for example, follows from the others shown. Actually it follows from a subset of them. The deletions above show one way of reducing the number of a priori constraints: they all follow from the others and can be dropped. None of the remaining items follows from the others; if any of them are deleted, the constraints no longer suffice to ensure the properties required by XPath.]


Recipe - Silly Water

  • Plain water
  • Fruit and vegetables, for flavor: lemon, lime, cucumber, orange, melon slices, raspberries, etc. Have children suggest and try out different things!

  1. Mix up your own silly water by adding the fruit or vegetable of choice to a pitcher of ice water. Let the fruit or vegetable sit for at least 10 minutes for the flavor to infuse the water before serving.
  2. Serve and conduct a taste test. Do the children like the flavored water? Ask children which silly water would they drink again, or what other flavors they would like to try.

Extension Activities

  • Instead of a regular taste test, conduct a "blind" taste test, where children have to identify the fruit or vegetable while blindfolded. Which flavor is easiest to guess? Which is hardest?
  • Have children bring in a fruit or vegetable from home to put in a pitcher of water for snack!


Scholars A-Z

Born on 800 Died on 860
Died on 925
Ādamī is noted for his work on instruments. Ibn al‐Ādamī, presumably his son, wrote an influential astronomical handbook with tables (zīj) that was based on Indian sources. The father is mentioned in Ibn al‐Nadīm's Fihrist (dating from the 10th century), where he is called al‐Ādamī. Because of the s...
Born on 740 Died on 828
Died on 834
One of the earliest examples of town and city history is that of al-Azraqî. In his Akhbar Makka al-M'usharrafa (Chronicles of Mecca the Glorious) he describes the history and character of Mecca. For more detail click here.


Serving Software Downloads in 976 Categories, Downloaded 29.989.191 Times

Capture Solution XE 12.2

Capture Solution XE
Capture Solution XE is software for screen capture.
Capture Solution XE makes out movie file(AVI, WMV, MP4, RM, MOV) from screen of monitor.
- Can make an image file from the screen. (BMP, JPG, PNG)
- Can make a video file from the screen. (AVI, WMV, MP4, RM(RMVB), MOV)
- Can apply Codec(DivX, XviD, ...) to the video stream in real time.
- Can make a AVI or WMV file by CS Player after Lossless capture.
- Can make an audio...


Prayers Prayed While Implementing Umrah

In performing the Umrah worship, there is much preparation done. One of them is the preparation of faith and taqwa. Before performing Umrah, we usually also do rituals, so we understand exactly what the journey of worship that we will pass. One of the important points of this ritual is the prayer of the Umrah. There are many prayers that must be fulfilled when carrying out a series of Umrah worship.

When manasik or when registering Umrah, usually we will get a prayer book from travel or travel agency that we follow. In the book, there are many prayer groups that we will read during the Umrah trip. All of which are good if memorized, but if it is difficult, we are not forbidden to carry a prayer book as a guide.

The collection of prayers are:

1. Prayer safar or traveling include: prayer out of the house, the prayer while driving, a prayer when he arrived at the destination, the intention of Umrah, shalawat talbiyh prayer, a prayer as he entered the city of Medina, prayer Masjid unlawful entry, prayer see the temple, prayer crossing The grave of Abraham and others.

2. Prayer tawaf include: 1-7 rounds tawaf prayer, the prayer after tawaf, after praying sunnah prayer in maqam Ibrahim, prayer drinking zam-zam water, after praying sunnah prayer mutlaq in Hijr.

3. Prayer Sai include: prayer when about to climb the hill of Safa before starting Sai, Sai prayer before traveling to 1 to 7, prayers at the hill of Marwah after completion Sai.

4. Prayer Pilgrimage in Medina which includes: entrance Nabawi mosque prayers, prayer greeting when in maqam Rsulullah SAW, prayer greetings to Abu Bakr Asshidiq, prayer greetings to Umar, when in raudhah prayer, prayer greeting when he was in Baqi, prayer greeting to Utsman bin Affan, a prayer to Hamzah, a prayer to the martyrs of Uhud, prayer leave Medina, and many more.

Some prayers do not have to be memorized, just read from the book. Reading a prayer book while worshiping is allowed. There are also some very concise umrah prayers and we can memorize. The prayers are:

1. Umrah intentions

2. Prayers or recitations of talbiyah as recited when Hajj

3. Prayer when drinking water zam zam

source : Doa Saat Umroh


Spring Break

What a gorgeous day in the Finger Lakes region of New York! They had a record setting temperature - 74 degrees! Yet there were snow drifts in the woods an on the side of the roads.

I'm so fortunate to get to stay at The Hammocks at Canandaigua while I'm here. It's a beautiful apartment community that has everything you could wish for including a clubhouse, theater room, fitness center, community gardens and best of all a fire pit. Wish you were here to enjoy it with me.


Third through 8th graders take the test in March and it's not too soon to put the test in perspective.

Educators say CMTs measure skills students should know but they should not be the only measure of competence. Yet, this ''high stakes" test" will determine which schools will be labeled "failing" for not improving the performance of their students to satisfy the federal legislation, No Child Left Behind.

In 2007, 315 schools, one third of the state's schools, did not satisfy the law. More are expected when CMT results are released this summer.

It's hard to make a fair test. The state's population of students from different cultures continues to grow and research shows that culture plays a big role in a student's response on a test.

"Yes, it does have profound implications and it's increasing as communities in the area and the state- (not Danbury which already is diverse) like Bethel, become more diverse,'' said Danbury associate superintendent William Glass. "The mix of cultures, beliefs, values, and idiosyncrasies and vocabulary are colliding and compounding factors that make it difficult to eliminate test bias."

Students asked to write an essay about going to the attic and writing about something found in a trunk showed a bias against children in poverty. They didn't know what an attic was nor a trunk, other than the part of a tree or elephant.

In a 1997 paper "You can't Take it With you" psychology professor Patricia Greenfield of the University of California at Los Angeles talked about the problems when a dominant cultural group test participants from a minority or less powerful group using tests that originated in the dominant culture.

When cultures are different, the results of the tests can be unreliable, because of the differences in cultural behavior.

For instance, she wrote, "our research has shown that when children of Latino immigrant parents go to school, the emphasis on understanding rather than speaking, on respecting the teacher's authority rather than expressing one's own opinions leads to negative academic assessment."

She described a study of parent teacher conferences in which a teacher complained that the children did not speak up and equated it to a bad attitude. "Hence a valued mode of communication in one culture- respectful listening - becomes the basis for a rather sweeping negative evaluation in the school setting where self assertive speaking is the valued mode of communication."

She wrote that tests reflect the values, knowledge and communication strategies of their culture of origin and it makes them appropriate measures within their own culture but ethnocentric when taken into a new culture.

The state is not prepared to make new tests, which cost $1 million per grade per language to translate.

Schools must do better for all children and should be accountable, but when the list of failing schools come out next summer, remember the inherent problem of the tests.


Elife. September 25, 2017; 6

A quantitative hypermorphic CNGC allele confers ectopic calcium flux and impairs cellular development.

Chiasson DM , Haage K , Sollweck K , Brachmann A , Dietrich P , Parniske M .

The coordinated control of Ca(2+) signaling is essential for development in eukaryotes. Cyclic nucleotide-gated channel (CNGC) family members mediate Ca(2+) influx from cellular stores in plants(1-4). Here we report the unusual genetic behavior of a quantitative gain-of-function CNGC mutation (brush) in Lotus japonicus resulting in a leaky tetrameric channel. brush resides in a cluster of redundant CNGCs encoding subunits which resemble metazoan voltage-gated potassium (Kv1-Kv4) channels in assembly and gating properties. Plants homozygous for brush are impaired in root development and infection by nitrogen-fixing rhizobia which segregated as a recessive monogenic trait. The brush allele exhibited quantitative behavior since overexpression of the cluster subunits was required to suppress the brush phenotype. The results reveal a mechanism by which quantitative competition between channel subunits for tetramer assembly can impact the phenotype of the mutation carrier.

PubMed ID: 28933692
Article link: Elife.

My Xenbase: [ Log-in / Register ]
version: [4.5.0]


Winter of the Gods

Dead Wake: The Last Crossing of the Lusitania

Lucia, Lucia

Lucia, Lucia, like all of Trigiani’s books, includes themes of family and tradition.  It is set in New York City, just after World War II has ended.  Lucia is the only daughter of an Italian grocer.  Her brothers, loud and rambunctious, work for her father, while she is allowed to work as a seamstress at a high-end department store.  Lucia loves her family and culture, but struggles to make peace between responsibility and a desire to be more.


My user has view project permission, I want them to be able to add issues. Can they?

When sharing a project, a user can be allowed to add issues using the advanced settings option.

If the project is set as a Request Queue, review the Queue Setup Rules. Make sure the rules allow people from the project to submit issues.


Kerri's Story

 Kerri lost 35 pounds; her husband serving in Iraq lost 40 pounds despite having to eat in the field or in the  military facility; their 36 month old daughter also follows tjhe plan and is a happy, healthy child

Matt was deployed to Iraq. He has been eating Eat To Live for eight months in military dining facilities and in the field. It's challenging, eating veggies, fruits, and whole grains, but they do provide it, you just have to filter your way through the chow hall and seek out the good foods. I also sent him boxes and boxes of healthy nuts and seeds, dried fruits, nut butters, and healthy crackers (not perfect there, but he needs energy in the desert).

People always question his diet, some in disbelief and some generally interested, like anywhere else in the world. So many people (as you all have encountered) have excuses for not wanting to eat healthy and modify their diet and lifestyle, because it's too hard, too many obstacles, etc., but here's a person who has been able to be successful in Iraq in the middle of a war for eight  months! I am so proud of him. I attribute  it to his determination, personal health goals. I wish continued success to everyone,

Just a side-note, he and I have lost 35 and 40 pounds respectively. He is at his ideal weight, and I'm working toward getting to my ideal weight. My 36 month old daughter also eats Eat To Live and is the happiest, healthiest, child I know!

Results may vary.


Abstract Art Painting - mint green painting

Title: "Sweet Mint, " 201

I consider myself a colorist, focusing more on featuring intense colors rather than forms. My abstract paintings are modern, bold, feminine and colorful. As I layer colors on the canvas, my pictures tend to evolve, with each layer adding texture and depth. I am inspired by trends in fashion, decor, garden design, architecture, and always the ocean!

I hope that my art brings warmth, style, and color to every room.

Legal imprint


Chemical Sensors: Simulation and Modeling: Volume 2: Conductometric-Type Sensors (BOK)

Ghenadii Korotcenkov

1 619,00 1 61900
Sendes vanligvis innen 5-15 dager
Chemical sensors are integral to the automation of myriad industrial processes and everyday monitoring of such activities as public safety, engine performance, medical therapeutics, and many more. This 4 volume reference work covering simulation and modeling will serve as the perfect complement to Momentum Press' 6 volume reference works "Chemical Sensors: Fundamentals of Sensing Materials" and "Chemical Sensors: Comprehensive Sensor Technologies", which present detailed information related to materials, technologies, construction and application of various devices for chemical sensing. "Volume 2: Conductometric-Type Sensors" covers phenomenological modeling and computational design of conductometric chemical sensors based on nanostructured materials such as metal oxides, carbon nanotubes and graphene. This volume contains an overview of the approaches used to quantitatively evaluate characteristics of sensitive structures in which electric charge transport depends on the interaction between the surfaces of the structures and chemical compounds in the surrounding.

Språk Engelsk Engelsk Innbinding Innbundet
Utgitt 2012 Forfatter Ghenadii Korotcenkov
Momentum Press
ISBN 9781606503126
Antall sider 300 Dimensjoner 18,5cm x 28,4cm x 3,3cm
Vekt 1100 gram Leverandør Bertram Trading Ltd
Emner og form Industrial chemistry, Precision instruments manufacture


Time: D H M S

Once upon a time there were 23 health insurance cooperatives created via ACA provisions, spread across a similar number of states (a few operated in more than one, while some states had more than one co-op operating within it).

The first one to fall was CoOportunity, which operated in Iowa and Nebraska. Their enrollments were halted in the middle of the 2nd Open Enrollment period, and they were liquidated before OE2 even finished.

As noted in the Virginia and Maryland updates, I've started going through the earlier state rate filings and revising them to include:

  • Updated/revised carrier rate filings;
  • Additional market withdrawls and/or expansions;
  • Corrections to CSR factor impact, etc.

The original versions of each state writeup includes screen shots of the actual filing documents and explainers behind specific requests; I don't have time for that with most of the updates, so I'm bundling several states together. Here's Connecticut, Oregon and Vermont's revisions:

As noted the other day, now that I've compiled the initial 2018 rate filing requests for 46 states + DC (the remaining 4 states aren't public yet), it's time to go back to the earlier states I analyzed and see whether there's been any updates/corrections to my original estimates. I started running the numbers back in early May, and a lot has changed since then, with carriers dropping out of the exchanges, expanding to fill the gaps or simply refiling with revised pricing requests.

Maryland was the second state I analyzed; I originally came up with the following average:

This strikes me as rather ominous...

Date: August 10, 2017
Title: Information on Risk Adjustment Methodology and Rate Filing Deadlines

Question: What changes will be made to the risk adjustment methodology to account for recent rating practices that assume issuers of silver-level QHPs facing increased liability for enrollees in cost-sharing reduction plan variations?

For the past two years, Virginia has been the first state in the nation to post their initial rate filings for the following year. I originally compiled their individual market 2018 change requests back in early May, and came up with the following at the time:

UnitedHealthcare had previously announced they were dropping out of Virginia, but I didn't have an enrollee number for them, and Aetna had also just announced their withdrawl from the state. I hadn't yet finalized my "CSR/Mandate Penalty" factor layout yet; at the time I assumed the 30.6% weighted average requested assumed full CSR/mandate sabotage and reduced that number by 17 points based on the Kaiser Family Foundation's "19% national average CSR rate hike" estimate analysis, which estimated the CSR impact at 17 points for Virginia.

Regular readers know that I've spent the past 4 months painstakingly tracking and analyzing the 2018 individual market rate filings for pretty much every insurance carrier in every state across the country.

I've completed this process for 46 states + DC. I've confirmed (well, really, Louise Norris confirmed for me) that the filing data for the four missing states--Kansas, Missouri, Nevada and Utah--won't be made available publicly for another couple of weeks, which is irritating...but those four states combined only make up about 5% of the total population anyway; unless their average rate increase requests are significantly higher (or lower) than the average of the rest of the states, they aren't gonna move the needle up or down by more than a tenth of a point or so.

Like Wisconsin and Michigan, Ohio has a high number of carriers statewide...although the per-county competition is still lacking in some areas. Even so, their rate hike requests are still pretty high even with CSR payments being made...and dramatically higher if they aren't.

One interesting tidbit: Check out the CareSource filing letter (first one below the table). They don't mention CSRs or mandate enforcement...but they do specify that a full 5 points of their 23.9% increase request is tied to prescription drug inflation (see Shkreli, Martin)...and even more noteworthy, they say that another 5 points is due specifically to "a number of previously [Medicaid-] qualified individuals" being kicked over to the private exchange,

I had already posted a partial look at the New Jersey rate hike situation a couple of weeks ago with a video in which Topher Spiro of the Center for American Progress interviewed NJ Congressman Frank Pallone about the situation. Since his comments weren't official and only referred to Horizon Blue Cross, I didn't make it an official part of the Rate Hike spreadsheet, but now I've managed to plug in the remaining carriers and here's how it looks. As expected, with Horizon holding a commanding 70% market share, the statewide average is around 8.5% if CSR payments are made and the mandate is enforced versus 21.6% if CSR payments aren't made and the mandate isn't enforced.

Also, check out Horizon's cover letter explaining the rate hike...they're not screwing around with who to pin the blame on.

North Dakota's numbers are pretty straightforward. Only three carriers, none of whch say anything about CSR or mandate concerns, so I have to assume that their requested rate increases are the best-case scenario. In addition, the KFF estimates suggest only a 5 point additional CSR factor anyway. This results in roughly a 23% average hike if CSRs are paid vs. a 28% increase if they aren't.

Last year, Blue Cross Blue Shield of Oklahoma, as the only carrier participating on the ACA exchange in the state, jacked up their premiums by a jaw-dropping 76%. This resulted in the highest statewide average rate hike in the country of 71% overall.

Well, that certainly seems to have done the trick: This year BCBSOK (still the only on-exchange player and holding over 99% of the market anyway) is requesting a (relatively) modest 8.3% average rate increase...and their filing specifically calls out both the CSR and mandate enforcement factors as being major reasons. Assuming the Kaiser Family Foundation's estimates are accurate, that means that if the CSR payments were guaranteed for 2018, BCBSOK should actually be lowering their rates slightly, to the tune of around 2.4%.

Adding in the steep hikes from off-exchange only CommunityCare (which only has 1,400 enrollees) brings the averages in at a 1.9% rate drop if CSRs are paid, and an 8.7% increase if they aren't.

The good news is that Wisconsin has one of the most robust and competitive exchange markets in the country. The bad news is that, contrary to popular opinion, "competition" doesn't by itself magically lower prices, at least not by enough. Both Anthem and Molina are leaving the ACA exchange (although Anthem is technically sticking around off-exchange), but there's over a dozen other carriers still duking it out.

According to the 11 carriers I have enrollment numbers for, the statewide average rate increase being requested is around 20.8% assuming CSR payments are made; using the Kaiser Family Foundation estimates, that translates into roughly 32.4% assuming they aren't made. Unfortunately, I can't seem to dig up the enrollment data for four carriers: Aspirus, Compcare, Wisconsin Physician Service and WPS (I think the last two are actually subsidiaries fo the same company). Wisconsin's total individual market should be roughly 280,000 people, and when you add up all the numbers I have (including Anthem/Molina) it only comes to around 180,000, so there appear to be roughly 100,000 enrollees missing among those 4 carriers, or over 35%.

I've been operating for nearly 4 years now. It started out as a nerdy hobby thing in my spare time, but quickly overtook my life. I always planned to shut it down after the first Open Enrollment Period ended back in April 2014...and then in March 2015...and again in 2016. Year after year, people clamored for me to keep it going one more year.

At this point a year ago I really planned on winding things down as of around April 2017. My reasoning was simple: If Hillary Clinton succeeded Barack Obama as President, there probably wouldn't be that much ongoing interest in my work here. After all, I figured, it's not like there are websites devoted to breathlessly tracking Social Security enrollments in real time. After four years, I assumed that interest in the site would drop off enough that it would be time to archive the site and refocus on my day job. Yes, that's right: I have a day job as a freelance website developer. I know that's hard to believe given how much time I spend on ACA/healthcare matters, but it's true...and frankly, I've been increasingly neglecting that business more and more of late, right when I should have been building it back up again.

I admit to being a bit confused about the distinction between BCBSSC and BlueChoice HealthPlan, which is also a BCBS carrier...I'm guessing one is for HMOs, the other for PPOs or something. In any event, BlueChoice plans appear to only be available off-exchange, and are thus not subject to the CSR issue. BCBSSC is, however, and the Kaiser Family Foundation estimates that their Silver plans would have to go up 23% if CSR payments are cut off. 87%% of SC exchange enrollees are on Silver plans, so that should be roughly 20.2% across all policies.

If CSR payments are made, South Carolina is looking at around a 13.2% average rate hikes; if they aren't, it's an uglier 32.5%.

We're heading into the home stretch now, with the only remaining "supersize" state, FLORIDA. FL has the largest exchange-based individual market enrollment, and the 2nd largest total individual market enrollment of any state in the country, surpassing California for a variety of local economic/demographic reasons. The Kaiser Family Foundation estimates that FL carriers would have to add about 25% to their Silver plan premiums in order to make up for CSR reimbursements if Trump pulls the plug and/or Congress doesn't formally appropriate them. Since 80% of FL exchange enrollees are on Silver plans, that translates to roughly a 20% additional "Trump Tax" for the CSR factor alone. Note that while none of the carriers mention the CSR issue (meaning they all assume the payments will be made), Molina does call out the individual mandate enforcement issues as being part of their 37.5% rate increase request. Unfortunately, they don't put a hard number on this.

New Hampshire's a bit of a head-scratcher this year: Of the three carriers on the individual exchange next year (each of whcih has a significant chunk of the market), Centene is requesting virtually no rate increases whatsoever...while the other two are asking to raise their rates by over 40% apiece.

Even more odd: Harvard Pilgrim's 42.5% seems to assume the worst regarding CSRs/mandate enforcement...yet Matthew Thornton (BCBS) is asking for 45.3% while assuming CSRs will be paid.

Finally, Kaiser assumes around a 10% Silver rate increase in NH if CSRs aren't paid, which translates into about 5.6% spread across the entire membership. Result: 29.1% if CSRs are paid, 34.7% if they aren't.