June 14, 2022

ER 11.5, An Intern’s Guide to the Galaxy: Embrace Uncertainty

Posted in TV tagged , , , at 5:01 pm by Jenn

This could have been an episode about Neela getting her groove back, but noooo, they had to make it about Ray

Summary: Neela is quizzing herself on her morning run before the first day of her internship. Abby’s having a much less active morning, piling an unread newspaper on top of other newspapers she no longer has time to read. Ray tries to get dressed in the dark so he doesn’t disturb the woman he spent the night with. “Nice meeting you,” she says as he leaves.

Abby and Neela head to County, one trying to convince the other that she’s not always going to feel trapped and doomed when she goes to work. Neela’s worried that everyone knows she had a meltdown and left medicine. Ray greets her as “Dr. Jumbo Mart” as he arrives on a skateboard, holding on to the back of an ambulance.

The three of them jump right in on their first patient, a 15-year-old who was shot multiple times. Sam tells them there are no available trauma rooms. They lose the teen’s pulse in the waiting area, so they wind up cutting open his chest right there. (Ray conveniently carries a scalpel with him.) Neela takes a few moments to get going, but once she does, it’s like she never took a break. Once they’re done, Ray teases the other waiting patients by raising his bloody hands and calling out, “Next?”

Susan fills Abby, Neela, and Ray in on the current patient load, using abbreviations for everything because they’re supposed to pay more attention to privacy. Neela again proves that she hasn’t forgotten everything she learned. The interns are joined by some med students, but only Ray seems to not hate them. Carter tells Pratt to take charge of clearing the board, so Pratt tells the interns to discharge 25 patients during their shift. That’s about two every hour.

The med students pair up with the interns, and Neela gets one named Jane Figler. She praises Neela for helping save the patient in the waiting area, but Neela blows her off when she mentions how there are rumors that Neela “freaked out.” She tells Pratt that she doesn’t want him to go easy on her just because she’s easing into her new role. Not that Pratt was planning to do that anyway.

Jane thinks Neela was kicked out of her job in Michigan, and she wants to know why. Oh, this is going to be a great pairing. Ray has much more luck with his students, who are eager to learn his tricks for getting people to do what he needs. He starts by giving the nurses treats so they’ll be more likely to help him. Abby’s stuck with Urbanus (I think he’s the guy who was hitting on her before), and their first patient is a man named Rick who may have TB. Pratt urges Abby to delegate tasks to students so she can see more patients. She and Neela need to be more like Ray, who’s already discharged his second patient.

Chuny calls for a doctor in the waiting room to tend to a man named Juan who passed out. He blames low blood sugar because he didn’t have breakfast, but he hit his head when he fell, so now he has another problem. Three problems, actually – he has bruises all over his body that suddenly appeared the night before. There’s no way that isn’t a bad sign.

Ray and his students discuss their next patient, a kid named Lucas who’s experiencing the effects of a chronic exposure to lead. His father, Brandon, says he was tested at school, and he’s not sure how Lucas was exposed. He was born early and has always had health problems, including breathing issues and a seizure. Ray brushes that off because the seizure happened while Lucas was sick, something common in small children with high fevers. Ray quickly passes Lucas off to the lead clinic, having spent just a few minutes with him.

Urbanus wants to impress Abby by asking questions that make him look smart. Ray’s students praise him for being patient with Brandon and letting him talk about stuff that probably isn’t relevant to Lucas’ condition. Abby thinks med students should spend more time learning how to take a full patient history and less time worrying about efficiency. Ray says they have to be efficient so they don’t have patients waiting around all day.

Paramedics bring in a 46-year-old man named Mr. Coleman who was injured in a jet-ski crash. Carter lets Abby run the trauma, but Ray either doesn’t hear that or doesn’t care. Carter goes to talk to Mr. Coleman’s wife, Stacy, and let Abby and Ray work things out themselves. Dubenko chastises Abby for letting Ray take over her case. She also shouldn’t be so polite to the blood bank over the phone. Oh, come on. Dubenko continues that Abby shouldn’t let the male doctors bully her or play with her hair when she’s nervous. Dude, leave her alone.

Neela ordered a bunch of tests for Juan without consulting Pratt, since he was busy. He doesn’t get how she’s in last place for patient discharges, since she’s doing everything right. Maybe because she’s not treating this like a competition? Because it shouldn’t be a competition? Dubenko quizzes Abby on jet-skis while walking Ray through a procedure. Abby tries to block him out as he continues paying more attention to her than to their care of the patient.

Jane still has questions for Neela about what happened when she quit her internship in Michigan. Neela, since you’re too polite to tell her to stuff it, ask Abby to do it for you. Ray’s students discharge two more patients, and Neela’s annoyed that he’ll get credit for them despite not having seen them himself. Pratt counts them since he’s delegating. Neela complains that Ray has two students, so he has an advantage. Pratt asks if she can handle two students. I’m not sure Jane has actually done anything, so Neela could definitely use the help?

Abby and Ray continue working on Mr. Coleman as Dubenko continues spewing stuff that doesn’t matter since it’s not going to help the patient. He just wants the doctors to appreciate the science behind what they’re doing. Carter brings Stacy back in and gently tells her that Mr. Coleman is getting worse. Abby gets fed up with Ray edging her out and tells him to take over shocking Mr. Coleman.

Jane: still talking. Chuny tells Pratt to teach the students the difference between micrograms and milligrams. Neela thinks she made the error and tells Pratt that if he has a problem with her work, he should confront her directly. He tells her this isn’t about her. Mr. Coleman is stable but unresponsive, so the doctors have nothing else to do for him except let Stacy sit with him. Abby leaves them to help Luka with his patient, a woman named Elena who overdosed on unknown pills. Now that Abby doesn’t have Ray trying to overshadow her, she’s much more confident.

Ray tells Neela that the Colemans have three kids but they’re too young to come say goodbye to their father. He says he’s okay handling a patient who’s going to die, since it’s just part of the job. Neela gets Juan’s test results, which show that he has leukemia. Carter advises Ray to call a social worker to come be with Stacy. Lucas and Brandon are still in the hospital since an attending hasn’t signed off on Lucas’ discharge. Carter disapproves of Ray’s attempt to send Lucas home without testing his lead levels again.

Neela and Jane go to talk to Juan, who prays as Neela starts to tell him that he has cancer. He thinks he’s being punished because he hit someone with his car yesterday. Neela doesn’t know how to address that, and she chickens out of telling him more about his condition. Rick is upset to be kept waiting for hours when he hasn’t received a definitive diagnosis yet. He objects to the idea of taking medicine for something Abby isn’t even sure he has. He demands a better doctor. Pratt steps in and advises him to follow Abby’s instructions. He tells Abby that part of being a doctor is being reassuring even when you don’t know what’s wrong.

Neela decides to do some research on treatment for leukemia so she can provide that info to Juan along with his diagnosis. Halfway through the discharge competition, Ray has a score of 14 while Neela only has 7. She says she got slowed down when the nurses were dealing with traumas. Pratt notes that Ray has access to the same nurses and is doing twice as well as she is. Yeah, but if the nurses are helping Ray, they can’t necessarily help Neela at the same time. Neela thinks she’s also getting more complicated cases than Ray, but he tells her that’s not true. He advises her not to let Pratt get to her. He also calls Abby the teacher’s pet since the staff loves her.

Dubenko wants to teach the interns and med students about free radicals. Dude, Pratt is going to kill you. He keeps singling out Abby, who won’t play along. He writes on a light board and the wall with a marker, telling the doctors that they need to understand the basics of the science of how human bodies work before they can treat patients. He wants Abby to draw an oxygen atom but Abby won’t do it. Later, she tells Neela that she didn’t refuse because she doesn’t know what the atom looks like; she just didn’t want to deal with Dubenko.

Ray is up to 21 discharged patients and asks if he can leave early if he hits 25 by 4:00. Abby’s stepping things up but Neela is still lagging. Pratt decides to up the quota to 30, since Ray met the previous quota so easily. Wendall comes to the ER and Ray asks her to talk to “trauma 1’s wife.” Wendall doesn’t appreciate him referring to a patient that way. Carter provides the names of the patient and his wife. Wendall disapproves of Ray further when she learns that he hasn’t gone through a checklist he’s supposed to review with a patient’s family after a death.

Abby gives Urbanus instructions for a patient despite not knowing if she has the condition she’s getting antibiotics for. She tells him she’s “trained to embrace uncertainty.” He notes that she hasn’t eaten or drunk anything all shift, then hands her a Coke. Neela is spending a lot of time on Juan’s case, and Jane thinks she’s moved into a territory that shouldn’t be covered by Jane’s ER rotation.

Paramedics bring in a 15-year-old who was clipped by a firetruck but doesn’t seem to have serious injuries. In fact, he’s so unphased that he’s listening to music. “We’ll try and keep this brief,” Abby tells him dryly. Ray tries to go through the checklist with Stacy, who’s more concerned about how to tell her kids that their father’s dead than she is about things like organ donation. She says it’s okay, though it’s not clear she’s actually listening to Ray.

Elena is stable and didn’t take anything too dangerous; she tells Abby she didn’t try to kill herself. Abby wants her to talk to a psychiatrist anyway. Chuny and Sam both interrupt while they’re talking, and Pratt comes in just as Elena is about to tell Abby what happened. Once Abby gets rid of him, Elena explains that she had sex with a man who has HIV (though she didn’t know that until he left her a note the next morning). The condom broke, and out of fear, she made a stupid decision. Abby tells her that one sexual encounter with someone who has HIV carries a fairly low risk of infection.

Neela goes back to Juan, but he’s already left. She tells Ray about the case and laments that she didn’t give Juan all the information he needs. She could have reassured him, but instead she left him alone. Ray’s students decide to let Jane join their team, since Neela clearly isn’t helping Jane get anything out of this rotation. While working on the firetruck patient together, Abby asks Luka about a preventive treatment that can keep someone who was exposed to HIV from getting infected. It’s only available to health-care workers right now, since it’s expensive.

Neela has to tell Pratt that Juan ran away before she could finish up with him. He’s furious. Abby tries to get more information on treatment for Elena, also furious because it’s not available to the public even though it could prevent the spread of HIV. She tries to reassure Neela that feeling like she’s made a mistake with her career is normal at this point in the day. Carter spots Wendall trying to calm Stacy as she refuses to let a surgeon take Mr. Coleman up to have his organs harvested.

Ray offers donuts to the nurses, a habit he’s developed at the start of each nursing shift, according to Abby. Pratt chastises Abby for not discharging more patients. She complains that she keeps getting complicated cases and would like just one patient who has a clear problem she can fix. She asks Sam why one of her patients hasn’t gone up for a scan yet. They’re backed up, but Ray knows the tech likes bear claws, so he offers his box of donuts to Abby to give him one. Abby thinks he’s creepy for being like this, but Sam says he gets the job done.

Pratt updates the scoreboard – Ray 26, Abby 19, Neela 16. A security guard reports that there’s a patient in the chapel with an ER wristband. Neela immediately runs off to get Juan. Abby calls the employee health department and lies that she was stuck by a needle. Carter brings Mr. Coleman’s checklist to Ray, asking if he actually went through it with Stacy. She says she didn’t consent to donating her husband’s organs. Now a patient who was expecting to receive his heart will have to keep waiting for a transplant. When Ray insists that Stacy gave consent, Carter yells that he can’t take shortcuts or miss details.

Abby gets some blood drawn and is rewarded with the treatment regimen she can give Elena. Neela finds Juan and tells him straight out that he has leukemia, but it’s treatable and his prognosis is good. She knows he feels like he’s being punished, but something led him here. She promises that the doctors at County will get him through this. There’s a reason he came here today.

Carter heard about Abby’s “needle stick” and offers to let to let her go home early. She says she’s fine, then confirms that Wendall is okay letting Elena be discharged. Urbanus is super-worried about Abby and agrees to get her an iced tea, since she feels woozy from having her blood drawn. Ray intercepts a message Sam was going to give to Stacy and takes it to her himself so he can follow up with her. She doesn’t seem to get that there was a miscommunication problem, or that Ray was responsible for it.

Abby has learned that favors work, so she asks Ray if he has any connections in the pharmacy who can doctor the labels on her prescriptions so Elena can have them instead. “I think I’m falling in love,” he tells her. Keep it in your pants, Ray. Carter checks in with Neela, who says her first day was hard but she’s not going to call it quits. She even got Juan to agree to treatment. Carter sees Wendall leaving and offers to walk out with her.

Abby gives Elena her medication and sends her home. Urbanus asks Abby out but she turns him down. Pratt teases Ray for wearing a ripped shirt, but Ray thinks he’s untouchable since he met his quota. However, the real winner of the competition is Sam, who discharged 75 patients in one shift. Also, Ray is one short. He invites Abby and Neela to go out, but they can’t believe he still has energy at the end of the shift. The interns start wrapping things up by passing their patients off to the more senior doctors so they can go home, then come back in a few hours and do this all over again.

Thoughts: Jane is played by Sara Gilbert.

Ray bugs me but there’s no denying that he’s a good doctor and has excellent bedside manner (usually). I like how he calls Lucas “Mr. Lucas.”

So Carter has nothing to say about Pratt pitting the interns against each other and basically making them race? He just addresses it with Ray?

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