June 8, 2021

ER 8.18, Orion in the Sky: Delaying the Inevitable

Posted in TV tagged , at 5:03 pm by Jenn

The passing of the torch, I guess

Summary: Mark is shooting baskets by himself outside the hospital when Carter comes out, upset that one of his frequent patients finally died. He kept trying to get her to quit smoking, but she never did, and her COPD finally killed her. Carter’s mad that she didn’t take responsibility for her health and instead expected Carter to fix her all the time. Mark tells him that they can only do so much. As hard as it is to treat noncompliant patients, it’s even harder to be those patients.

Freaking Greg Pratt comes out to get Carter, and…hold on, I need a minute. I have to prepare myself to deal with this guy. Okay. Carter introduces him to Mark. Pratt is finishing up his internship and will become a resident over the summer. He thinks he’s seen pretty much everything and is ready for the ER. Ha ha ha ha, no one’s ready for the ER, Pratt.

Mark goes back to work, declining Abby’s offer of green tea to boost his immune system. Frank is giving people a career aptitude test, which is kind of weird in a place where the employees have supposedly already devoted their lives to one career. Gallant’s responses are placing him “somewhere between rock star and lion tamer.” Okay, that’s pretty cool.

Carter gives Pratt a brief tour of the ER before he meets Frank, who decides to nickname Pratt “Junior.” Weaver’s going easy on Mark, not loading him up with too many critical patients. He grabs Abby to help him with a patient, a woman named Norma who’s having trouble breathing. Weaver explicitly tells the others they need to lighten Mark’s load. Pratt’s the only one who doesn’t get why.

Luka brings Norma’s son Jeffrey to her trauma room and offers to take the case from Mark. Mark’s not happy about that. He tells Jeffrey that Norma (who has some sort of chronic illness) probably has aspiration pneumonia, and they can insert a special IV line to help her, but first they need to know if she has a DNR. Jeffrey tells him to wait for his sister Linda to arrive, since she’s a lawyer and handles all of that side of Norma’s illness. Mark says there isn’t time to wait; Jeffrey needs to decide how they treat Norma. He approves Mark’s suggestion.

Carter and Pratt go see a patient named Willa who was found unconscious at work. Her colleague says he thinks she has a mummy’s curse. No, wait, there’s a connection there, I swear! Willa is an Egyptologist, and she passed out on the floor of Nefertiti’s tomb. Carter’s like, “Sure, okay. I’ve heard crazier.” Chuny needs a doctor for another patient, so Pratt offers to leave, not realizing that his patient has a penile fracture. As he leaves, Chuny notices that he’s going into the wrong exam room. Carter just says he’ll figure it out. And that’s how Pratt tried to examine the penis of a man with a punctured eardrum.

Jeffrey calls Linda, who refuses to come to the hospital. Norma wanted to die at home, so Linda’s upset that Jeffrey had her taken to the hospital. Jeffrey says she’s right – he should have just let her die. Mark gently says it’s okay if he’s not ready to let his mother go. Jeffrey says he’ll always want more time with her. He can’t keep delaying her death forever. Mark determines that Norma won’t be able to breathe on her own for much longer, so Jeffrey needs to decide whether Mark can intubate her or if he should just let her die. He tells Mark to do everything he needs to save her.

Mark drops the tube he’s trying to insert, so…maybe he shouldn’t be working anymore. He leaves the trauma room and heads to the lounge. Frank tells him Jen is going to be a little late for their planned meeting that afternoon. Speaking of things that should be delayed as long as possible. Susan asks what Weaver’s aptitude-test results were, but Frank says she’s not participating. If he had to guess, she’d best be suited for a job as a prison warden or a beauty pageant organizer.

Weaver checks on Mark in the lounge, suggesting that he ease up on heavy cases. He insists he’s fine. Why is she being so passive about this? Be Weaver! Tell him what he can and can’t do! Mark says he just wants to keep doing his job, as usual. She notes that he can’t do everything he used to, thanks to his treatments and his tumor. She asks him to take over Pratt’s orientation. If Mark were anyone else, Weaver would send him home, but she thinks he can recognize his limitations.

So Mark and Pratt team up to examine a patient named Stan before Mark goes to Doc Magoo’s to meet with Jen. She finally has some compassion for her ex-husband. And it only took a brain tumor and a death sentence! Rachel was supposed to spend the summer with Jen, but Jen’s willing to let her stay with Mark so they can spend more time together. She’s sorry that things between her and Mark ended so badly. She’s even willing to take responsibility for the breakdown of their marriage, even though Mark says they’re both to blame. He wouldn’t change any of it.

He tries to talk to her about his updated will, but Jen’s too shaken up to listen. Mark tells her that he’s started a college fund for Rachel. Jen says they can talk about that over the summer, when he brings Rachel to St. Louis. He tells her he’s not sure he’ll be able to make that trip. Jen doesn’t care – she won’t discuss this right now. Mark notes that there might not be another time, but Jen isn’t ready to accept that.

Back at County, Mark helps Chen with a patient named Al (not to be confused with the other two Als who have been on the show; this one was in the very first episode). He’s homeless and possibly has schizophrenia, since he keeps talking about ghouls putting spikes through his shoes. Pratt finds that amusing, which means Pratt needs a lesson on mental illness. Mark is familiar with Al’s delusions and treats him respectfully. Pratt suggests a psych consult, to which Al responds, “Screw you, Junior.” Frank would be proud. Mark tells Pratt to work on his bedside manner.

He moves on to treat a man named Freddy who was found in an alley, possibly having overdosed. His girlfriend, Shane, insists that they’re both clean. When Freddy is revived by NARCAN, a medication used to reverse drug overdoses, he sits up and pulls out the tube the paramedics put down his throat. He gets combative, demands his wallet, and walks out. I guess he’s okay, then.

Shane goes with Freddy, telling Mark that he’s upset because the paramedics lost his stuff. An orderly is bringing a gurney down the hall and accidentally rams it into Shane, who falls down. Freddy and the orderly start wrestling each other. Shane reveals that she’s pregnant, and the hit from the gurney has kickstarted labor. Luka joins Mark and Abby to help her. He tells them that Freddy passed out, so at least they don’t have to worry about a combative patient anymore.

Shane isn’t sure when she’s due, but Luka determines that she’s about 28 weeks along. Mark thinks she might need an emergency C-section. He stumbles on his way to the trauma room next door, where Carter and Chuny are trying to treat Freddy. Abby brings him back to Shane, who’s about to deliver the baby. After the birth, Mark and Abby have trouble getting the baby to breathe, and Mark asks Shane what drugs she’s used while pregnant. Shane continues insisting that she’s clean.

Next door, Carter has trouble intubating Freddy, so Mark heads back over to help him. He slips on the floor, which is slick from blood and a leaky window that’s letting in rain from a thunderstorm. After he collects himself, he calmly works with Carter to get Freddy intubated. When he returns to Shane’s trauma room, where the baby’s doing a little better, Abby gives him Shane’s tox screen results. Mark lectures Shane on taking opiates and cocaine, drinking, and not getting prenatal care. Mark makes her confront the bad decisions she’s made and the effects they’ll have on her child. Okay, he should definitely not be working anymore.

Mark goes to the oncology ward for a round of chemo, looking at the pictures on the walls of pleasant outdoor scenes. Pratt calls from the ER, needing his help. Mark takes his IV with him, asking the nurse administering chemo to send someone to find him so he can get his other treatment. Al is worse, and he wouldn’t calm down until Pratt promised to get Mark. Abby hooks Mark’s IV bag to Al’s IV stand so they don’t have to maneuver around Mark’s stand. When Pratt asks why Mark has an IV, Mark quips that it’s to reduce his blood-alcohol content. Heh.

Abby tests Al’s blood sugar and sees that he hasn’t been taking his insulin. Al says there’s a lot to remember. Pratt wasn’t aware that Al had diabetes, which means he didn’t do a very good job getting his patient’s history. (Also, if Al comes in a lot, which it seems like he does, since Mark knows him so well, his chart should say that he has diabetes. You suck, Pratt.) Pratt just stands there, confused, while everyone else treats Al. He talks back to Mark after Mark gives him some helpful medical advice. Abby gives Pratt a look like, “You’re going to learn very quickly not to talk to anyone like that.”

Mark pulls Pratt away to chastise him for not giving Al a proper work-up. Pratt says it didn’t seem necessary. Mark tells him to stick to learning while Mark does the teaching. Pratt asks if he seems like a punk to Mark. Mark says no (I say yes), so Pratt says he doesn’t want to be treated like one. He doesn’t want this to be a situation where Mark’s the old guy showing the new guy the ropes. Mark tells him if he doesn’t like how this is working, he can leave.

Later, Carter defends Mark, saying he’s a good doctor. Pratt thinks he’s burned out. He can’t figure out what Mark’s problem is. Susan informs him that Mark has a brain tumor that’s going to kill him. When Weaver checks on the group, Carter tells her that Pratt was just saying how much he’s benefiting from Mark sharing his experiences. Heh. Pratt wishes the staff would tell him more things. Oh, the guy who’s seen everything hasn’t actually seen everything, huh?

Stan’s test results are back, and he has something his regular doctor should have caught. Mark laments that he’ll have to get the news from ER doctors he’s never met. Pratt apologizes – sort of – for being egotistical and forgetting that he’s there to learn. Mark guesses that someone told Pratt he’s dying, which made Pratt feel bad about being…well, a prat. Mark calls Stan’s doctor, who’s on vacation, and tears into him for not catching his patient’s super-obvious prostate cancer. I think Pratt’s impressed.

Linda’s finally at the hospital, and she’s not happy that Jeffrey approved treatments for Norma when she has a DNR. Linda has power of attorney and wants to take Norma home. She thinks the doctors can’t accept that Norma wants to die; it would be like they’d have to admit defeat. Mark approves of the plan, then goes to the hallway to meet the chemo nurse and get his other treatment. Elizabeth asks if he’s feeling okay, and he tells her he’s tired of people asking him that.

Mark takes his treatment in a bed next to Al’s, trying to comfort him as he gets upset about being separated from his cart. Mark watches through the window as Elizabeth removes Norma from the machines keeping her alive so she can die at home. The chemo nurse ignores everything around her, only focusing on how annoying it is to administer the treatment. Mark suddenly realizes this isn’t what he wants. He stops his treatment and offers to help Al find his cart.

Willa is conscious and a little embarrassed because she has aspergilloma, a fungus superstitiously called the curse of the mummy. She thinks her colleagues will mock her. Pratt explains that she probably got it on a recent trip to Egypt. Mark has trouble with his speech while giving medication orders, and Chuny’s concerned. Willa thinks she got sick because she works too much. Like Joni Mitchell said, you don’t know what you’ve got till it’s gone. “I hate that song,” Mark says.

Elizabeth comes to tell him that oncology is ready to give him his other treatment, but he tells her that he’s done. She doesn’t think he should make a big decision like this on his own, without thinking it over more. Mark says this could be the last important decision he gets to make. Elizabeth desperately wants him to keep receiving treatments, since they could prolong his life, but Mark knows they would only give him a couple more months. She wants that extra time for herself and the girls.

Elizabeth notes that they see patients all the time who are living past when doctors told them they would. She doesn’t want Mark to give up. Mark says he’s not – he’s making a choice. He’d rather have two good months than four months stuck in bed as a helpless patient. He hates the looks doctors and nurses give patients who are dying. Elizabeth still won’t listen, but Mark tells her he wants to die the way he’s lived.

He goes with Pratt to tell Stan that he has cancer. Pratt is possibly the last person I would want to hear bad news from, but Mark lets him deliver it anyway. When Pratt can’t figure out what to say, Mark steps in. Stan doesn’t think Mark’s being sincere when he says he knows what’s going through Stan’s mind right now. Pratt leaves the room, finally realizing that he’s in way over his head here.

Mark returns to Al, who wants to leave. Mark says he does, too. He tells Al that it’s going to become harder for him to take care of himself, so if he has any family who can take care of him, he should call them. Al says that he wants whatever’s going to happen to him to happen outside, not at the hospital. Mark signs his discharge papers and lets him go.

Mrs. Raskin, Mark’s old buddy from the first episode, is back with another painful hangnail. Mark loses his sympathy immediately, saying his inoperable brain tumor is worse than her problem. He leaves her to tend to a little girl named Katie who’s been waiting for treatment for two hours. She has a splinter under her fingernail and is afraid to have anyone look at it, since she knows it’ll hurt.

Mark tells her to close her eyes and picture something. Katie’s class has been studying Greek mythology, and sees Orion’s Belt. She explains that Orion couldn’t beat the scorpion, so he jumped into the sea. Artemis put him in the sky to keep him away from the scorpion. While she’s talking, Mark removes her splinter without her even noticing. He thanks her, telling her she was his very last patient.

Mark tells Haleh to deal with Mrs. Raskin (and tell her to never come back), then says good night to Pratt, who admits that he learned a lot today. In the lounge, Mark tells Weaver that Pratt is cocky and eager, which makes him a good fit for the ER. He takes some things from his locker as Weaver tries to work out the schedule for next month. He tells her to make sure her work doesn’t become her life.

After passing some patients on to Carter, Mark heads out, exchanging goodbye salutes with Al. He and Susan see each other across the ER but don’t speak. The only person Mark explicitly says goodbye to is Abby, who thinks he’s just leaving for the night, not forever. Carter walks Mark out to the ambulance bay, where Mark picks up the basketball and notes that it needs air. He tosses it to Carter and repeats what Morgenstern once said to him: “You set the tone.” Then he leaves work for the last time.

Thoughts: Jeffrey is played by Wilson Cruz. Shane is played by Lori Petty.

I thought I had more time before I had to deal with Pratt. Sigh. I NEEDED more time.

Mark absolutely shouldn’t have been working on major cases. They should have had him treating sprains and sore throats. I mean, come on.

I like the parallels between this episode and the first one, not just because there are callbacks but because they show how work can become routine. Kind of a “the more things change, the more they stay the same” situation. And that routine can become so normal that it just becomes your life, which is what Mark was warning Weaver against.

1 Comment »

  1. Nick Rivers said,

    It was a good idea to have the episode start with Mark shooting baskets, a nice homage back to the early days of ER when he spent so much time out there with Doug.

    I like Mekhi Phifer and this role was really damn obnoxious in the beginning. He mellows out, but jesus, it’s like they went casting for the exact polar opposite of Gallant on purpose, which… okay, an interesting balance and all, but why. I like that Mark did praise him to Weaver, though. It would have been fun to see the two of them work together more in the future.

    The Mark and Jen scene was really tough. They made Jen so unlikeable but she did get a bit of a raw deal in that marriage, though she could have found a more elegant way to extricate herself from it. Ahem. They were definitely both to blame for the failing of the marriage, but it’s hard not to look at them and remember the early days of ER. I’m glad they had Jen totally shaken by the realization that Mark was going to die; just because the marriage didn’t work out doesn’t mean everything they ever had together was completely erased from existence. And her completely avoiding the really difficult topic made a lot of sense as I know there’s a fight-or-flight reaction type thing to emotional shock, but… did she have absolutely no idea he’d ever had a brain tumor before? Why else would she fly up there?!

    The routine of work and work becoming your life… I wonder if the takeaway here is that Mark let the ER become his life. I feel like he definitely did during his marriage to Jen, then after they divorced it was all he really had, but during his marriage to Elizabeth I don’t know that I saw it the same way because she was so wed to the OR herself. Once Ella arrived, they both really struggled to put her at the center of their priorities due to their true first loves being the ER and OR. Ella’s arrival seemed to be a real strain for their marriage in general, not the least of which was Elizabeth’s neverending meltdowns over childcare. Maybe they were just doomed from the start no matter what came down the pike!


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