September 24, 2019

ER 4.18, Gut Reaction: I Don’t Know What Varices Are, But Rupturing One Can’t Be Good

Posted in TV tagged , , , , , at 4:57 pm by Jenn

Goodbye, doomed preteen

Summary: Carol has gone on a shopping spree for the clinic, thanks to a new donation from Millicent. She checks in with Mark, who’s volunteered to organize this year’s ER banquet, to be held that night. Unfortunately, things haven’t gone as planned. The caterer couldn’t work with their budget, so Jerry made other plans with a Swedish caterer. Mark is skeptical.

Weaver asks Mark about a memo from the dean concerning a pediatric attending. She’s upset to learn that Doug took the idea to the dean; she doesn’t think the position is necessary. Mark thinks that once the dean allows some further investigation, he’ll agree and the whole thing will be dismissed.

Doug tries to convince a mother to let him examine her toddler, but she insists on leaving, since she had to wait three hours and now has to go to work. Doug decides this is serious enough to stop the mother from leaving, and he threatens to call the police and have her arrested for child endangerment if she doesn’t stay. Weaver tries to play peacemaker, then points out to Mark that this might not be the kind of person they want as an attending.

The mom gives in and stays, and though she’s calm by the time she’s allowed to leave with her daughter, she’s not happy. Lydia hopes it doesn’t rain that night so everyone dressing up for the banquet can keep their clothes dry. Jerry says it won’t rain, but Carol says the news reports otherwise. She asks Carter if she can ride to the banquet with him and Anna. Carter says he’s not going with Anna. Carol asks if they broke up; she thought they were dating because she picked up some chemistry. Carter pleads platonic friendship, but Carol urges him to ask Anna out.

Elizabeth complains to Benton that Romano keeps tabs on her too closely; she wishes she could change that, but she might lose her work visa. Benton thinks Morgenstern would sponsor her instead. Elizabeth wasn’t impressed when she met him and doesn’t think that arrangement would be any better. She’s been offered a job back in England but would like to stay in the States, where men actually listen to women.

In a trauma room, Elizabeth gets a big surprise: Allison Beaumont, the young woman whose leg and voice she helped save, is now a paramedic. She’s brought in a patient who has diagnosed himself with something the other doctors haven’t picked up yet. Dr. Swanson is a pathologist, and Benton thinks he’s right about his diagnosis.

Carter urges Anna to go to the banquet, even though she thinks it sounds cheesy. She decides to go since he’s going, and he offers to drive her. Mark hasn’t paid the deposit on the banquet space, and the florist was unable to deliver the flowers there. He decides to have them sent to the hospital instead. Jerry offers to line up music, since the band fell through, but Mark is done with his unimpressive assistance. He books an act called the Machine.

Doug tells Mark that the girl he treated earlier is sick enough to justify the lengths he went to in order to have her treated. He wants Mark to make sure Weaver knows he was right. Mark offers to call the mother, Mrs. Bevins, to have her bring the girl back for IV antibiotics. Doug claims he can be diplomatic and handle it himself. Uh, maybe get Carol to handle that, Doug.

Swanson needs surgery, so Morgenstern comes to the ER to see what’s going on. He recognizes Swanson’s name, as Swanson was one of his med-school professors. Swanson even inspired Morgenstern to become a surgeon. Benton tells Swanson he needs surgery, which Swanson would like to have done laparoscopically. Elizabeth doesn’t think that’s a good idea, but Morgenstern disagrees. Benton sides with him. Morgenstern invites Elizabeth to assist so she can see for herself that Morgenstern has the better idea.

Mark becomes even more skeptical about Jerry’s food plans when he learns that Jerry’s mother is making borscht. At least it’ll be free! Romano comes down for a consult, second-guessing Mark’s diagnosis. The bone-marrow drive for Scott hasn’t yielded a match for him, but Anna did match with a patient in another state. Romano offers to do the extraction as soon as he’s done with his next patient. He makes it out to be a minor thing, though it involves drilling holes in Anna’s pelvis.

Doug asks Carol if she thinks he has what it takes to be an attending. Carol admits that “diplomatic” doesn’t exactly describe him; a better word would be “insouciant,” which Doug isn’t familiar with. Scott’s still in the hospital, listening to Green Day and trying to avoid eating hospital food. His pain is worse, even with Doug’s PCA. Anspaugh comes by, and Scott’s nickname for him, Dr. Bad News, proves fitting, as Anspaugh announces that they haven’t found a bone-marrow match. They can try experimental chemo, but it sounds like a long shot. Jeanie promises to stay with Scott if he wants to try it.

Elizabeth isn’t looking forward to surgery with Morgenstern, but she can’t put her finger on why she doesn’t really like him. She admits that she doesn’t have much experience with laparoscopic procedures. Benton teases that she always goes after attendings when she’s nervous. She offers to swap procedures with him and observe the laparoscopic surgery when she’s done with hers.

Morgenstern reviews one of his old teaching tapes before he does the procedure. Weaver tells him that Swanson said very nice things about him. Morgenstern likes that Swanson cares about science and people’s souls. She invites him to the banquet that night. Doug offers Scott more pain medication, then says that Anspaugh is worried that he doesn’t completely understand what he’s in for with the experimental chemo. Since Jeanie’s going to stay by his side, Scott wants to go for it.

Carol tries to call Millicent – the check she wrote didn’t clear, and all the supplies Carol bought for the clinic are getting repossessed. Carter realizes that she put a stop payment on the check and asks what Carol did. Carol isn’t sure; the only possibility is bad press from giving out birth control to teens. Carter isn’t sure how Carol can fix this. He hopes it’s just a misunderstanding.

Morgenstern is fine with the Benton/Elizabeth switch in surgery, and has Shirley put on some Peruvian pan-flute music. Anna tells Carter that she matched for a bone-marrow transplant, which means she won’t make it to the banquet that night. She wasn’t aware that the donation will leave her sore for a few days. Carter has performed a bunch of them, so she asks him to do hers, thinking he’ll help her stay calm. He’s surprised that she’s a little bit of a chicken about the procedure and agrees to do it.

Weaver tells Mark that she enjoyed last year’s banquet and wishes he’d been able to book the same space this year. Mark says it was available, but he wanted to hold it in a place called the Shangri-Lodge. It’s less pretentious. Mark questions Romano’s orders for their shared patient, and when Romano ignores him, Mark says loudly that he’ll manage his patients in his ER his way. Romano backs down, glad to see that Mark has a spine.

Morgenstern and Benton’s procedure seems to be going fine, though Morgenstern feels hot. Benton notices that Morgenstern is in the wrong anatomy, but Morgenstern doesn’t want to be questioned. Benton just wants to make sure Morgenstern doesn’t nick one of Swanson’s varices. Morgenstern accuses Benton of screwing something up, then blames him when something goes wrong and Swanson starts bleeding.

Doug tells Jeanie that he’s not sure Scott really wants to do the experimental treatment. He thinks Scott has a crush on Jeanie and wants to please her. Jeanie denies this, saying she wants Scott to make his own decisions. Doug gets that, but he’s not sure Scott can actually decide for himself. Things with Swanson get worse, and as Elizabeth comes in to observe, Benton decides they need to open him surgically. Morgenstern won’t help, so Benton shoves him out of the way and takes over. Morgenstern just watches silently.

Carter gets ready for Anna’s procedure as she talks about having a bad experience with tonsil surgery as a kid. She thought she was going to die, and she promised God that she would always be a good person if He let her live. The drape on Anna’s back falls off and Carter gets to admire her butt for a few moments. This is, sadly, the closest they will ever get to being naked with each other.

Swanson doesn’t survive his surgery, and Benton asks the pathologist, Upton, if he can sit in on the autopsy the next afternoon. Anspaugh has been made aware of the situation, and he talked to the anesthesiologist about Benton and Morgenstern’s disagreement in the OR. He asks Benton to gather all the charts for the case, as well as the tape from the OR – they usually record laparoscopic procedures.

Carter tells Carol that Millicent’s stunt with the clinic money might not be about her. He’s disappointed that Anna went home and will probably skip the banquet. Scott offers to give Jeanie a ride in the Viper he’ll definitely be able to buy one day, because he’s totally going to beat this cancer. She notes that he doesn’t talk about his friends much. He says he’d rather be with her.

Carol is contemplating taking out a home loan so she can keep the clinic open. Before Doug can give his opinion, Mark pulls him away to treat baby twins in respiratory distress. Benton goes look for the Swanson tape, but there’s nothing in the machine. Mark, Doug, and Carol work on the babies together; one is stable but the other stops breathing. Doug calmly walks Mark through a procedure to help her.

Morgenstern tells Benton that today’s disaster was a one-time thing, as far as he’s concerned, and he’ll support Benton in whatever comes next. He plans to say that Swanson’s cause of death was ruptured varices. Benton says Morgenstern accidentally cut his gastric artery. Morgenstern denies ever cutting the wrong thing in his 20-year career. Benton screwed something up with his clamp.

Benton denies this and says the tape will show what really happened. Morgenstern says there’s no tape. He notes that Benton’s actions in the OR could be considered insubordination, and could even be grounds for dismissal. Benton says he wouldn’t have acted so forcefully if Swanson’s life weren’t at stake. Morgenstern advises him to focus on the medicine when they present the case at a morbidity and mortality seminar. Hypotheticals and accusations should be set aside.

Carter appeals to Millicent to give Carol back her donation. He knows Millicent is upset with him; she shouldn’t take it out on the clinic. Millicent says that’s not the case, but come on. She complains that her grandsons don’t want the family involved in their lives, but they’re happy to live off the family trust. Carter says that, in that case, Millicent can keep her money.

Weaver catches Morgenstern on his way out of the hospital and again invites him to the banquet, hoping it’ll cheer him up. He blows her off. Weaver then tries to talk to Mark again about the pediatric-attending position, which Mark is now leaning toward being a good idea. Weaver warns that it’s a policy change that could undermine their authority. Mark says that attendings run the best emergency department. Weaver says she agrees, seeming to think that Mark is on her side.

Mark pulls Doug away from the Bevins girl, whom Doug is amusing with bubbles, because the writers wanted to come up with yet another way to make people swoon over Clooney. Mark tells Doug that if he really wants to be an attending, he should go for it. Outside – where (sorry, Jerry) it’s raining – Romano warns Benton that he’s in for a fight over what happened in the OR. Benton’s a resident and Morgenstern’s the chief, so one of their statements is going to carry a lot more weight than the other’s.

The Shangri-Lodge is…well, there are taxidermy animal heads on the walls. That’s all you need to know. There’s no band, no food, and only one drink ticket for each guest. Doug and Carol can’t hide their laughter when they lie to Mark that it’s nice. The Machine arrives, but it’s just one guy who plays a keyboard and cymbals at the same time. Carter tells Carol that he couldn’t get Millicent to listen, but apparently he did, because she sent another check over to the clinic after he left.

Anna made it to the banquet after all, high on painkillers. Carter addresses their obvious chemistry and says he didn’t want to make a move because he didn’t want to harm their friendship. Anna feels the same, but there’s another guy – she’s not completely done with her ex. Carter resigns himself to just being friends with her. Scott goes into arrest, and Jeanie rushes to help save him. The rest of the team wishes that Scott’s family had agreed to sign a DNR instead of keeping him alive for a short, miserable time period.

The banquet food is bad and the music isn’t much better, but the ER staff is trying to enjoy themselves anyway. Mark thanks his co-workers, who are like his family, for sticking by him through the past year. They always give their best, and they make the ER a place they can all be proud to work. Doug gets everyone to serenade him.

At Doc Magoo’s, Benton tells Elizabeth about Swanson’s surgery, insisting that all the mistakes were Morgenstern’s. It’s the two surgeons’ words against each other, and Elizabeth didn’t see enough to know what happened. She thinks he should stick to his convictions if he’s positive he knows what happened.

At the banquet, everyone forms a conga line, and Mark dances with Weaver. She tells him that the separate pieces of the party were awful, but it’s still been a great experience. Jeanie tells Scott that he needs to make the decision about his medical care by himself and for himself. He tearfully tells her he doesn’t want any more chemo. They fantasize about driving off in his viper, going to the beach, and watching the sunset together.

Thoughts: Things I get strangely proud of while recapping medicalese: I spelled “laparoscopically” right on the first try. (I did not, however, spell “insouciant” right.” I thought the A was an E.)

As a doctor, Anna should probably know more about what bone-marrow donations involve.

Mark, about tiny stethoscope decorations: “Dumb idea?” Chuny: “No, just tacky.” Thanks, Chuny.

Imagine being so mad at your grandson for keeping a secret that you defund a free clinic.

2 Comments »

  1. Nick Rivers said,

    The whole Scott Anspaugh storyline was less cringeworthy this time around. Maybe I’ve matured in the last 24 years or however long it’s been since it first aired. The kid did a good job and Gloria Reuben knocked it out of the mother-effin park in this episode. And I like that Doug was the one to see straightaway that Scott’s crush on Jeanie was clouding his true feelings about the chemo trial.

    The Morgenstern-Benton storyline pissed me off more this go-round than it did originally. Maybe it’s changed now that I’ve seen the Fargo side of William H. Macy and know how well he can play a weasel.

    So if Morgenstern is the chief of surgery, what is Anspaugh’s role exactly? I thought he came on board to take over for Morgenstern. I think Anspaugh is chief of staff, but the hierarchy is really confusing to me. I get that chiefs oversee attendings who oversee residents who oversee interns who oversee med students, but the higher-ups confound me.

    • Jenn said,

      Was Morgenstern chief of emergency medicine and Anspaugh chief of surgery? You’re right, it’s really confusing.


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