September 13, 2022

ER 11.18, Refusal of Care: Do More

Posted in TV tagged , , , at 4:58 pm by Jenn

From nurse to patient

Summary: Abby and Jake are asleep – drink! When she wakes up, she realizes they overslept and only have half an hour to get to the hospital for rounds (he’s on another ER rotation). She’s worried that people will talk when he shows up wearing the same clothes he had on the previous day, since he spent the night at her place.

At County, Pratt practices his Spanish, claiming he wants to relate better to the community. “Oh, yeah? What’s her name?” Neela asks. Heh. Luka’s done with a night shift, so Sam asks him to take Alex to soccer practice that afternoon. Luka thinks they should continue keeping their distance from each other, since Alex is still upset with Luka for not letting him go off with Steve.

Morris has teamed with Susan for a paper, and he’s taking it surprisingly seriously. Carter guesses that Susan’s working with him because he’s the only resident desperate enough to write about their topic. Neela asks Susan to let her run a trauma so she can feel a little more ready for the next year of her residency. Susan tells her to take the next patient, a woman named Elena who passed out. But Elena tells Neela, Susan, and Sam not to do anything until her lawyer has arrived. She’s on a hunger strike to protest her son’s deportation, and she’d rather gets the INS’s attention than stay alive.

Abby and Jake head to the hospital together, debating whether anyone will remember what he was wearing the day before. They run into a co-worker Abby doesn’t know, and Jake introduces her as his girlfriend. That makes her feel like they’re in middle school. Jake thinks she doesn’t want people to know they’re dating. They keep getting splashed with water and mud, and I guess it’s supposed to be funny. It also gives their colleagues a chance to tease them for matching when they change into scrubs. Frank clarifies that everyone thinks Abby and Jake are dating.

Elena accepts a warm blanket and water, but nothing else. Her lawyer, Coe, arrives and agrees with Elena that her condition might get the proper authorities to pay attention to her cause. You know, if it doesn’t land her in a coma first. They’re trying to get a new hearing for Elena’s teenage son, Santiago.

Elena came to the States in 1989 and has a green card. Her brother brought Santiago to Chicago seven years ago, and after Santiago was arrested for attempted robbery, he was transferred to immigration. Elena’s desperate to keep him from being deported to El Salvador – she’s convinced that he’ll be killed there. Coe has paperwork stating that Elena is competent to start a hunger strike and refuse nutrition even if she loses consciousness. Just giving her an IV would constitute felony assault. Coe will call the police if the staff tries to treat her without her consent.

Carter’s still working on his clinic, and he’s gotten support for HIV/AIDS treatment, as well as a daycare for either those patients’ children or for children who have HIV and AIDS themselves (it’s not clear). Weaver says they’re ready to start bidding with contractors, and she’d like for Carter to get personally involved in finding corporate sponsors. Carter says his family’s foundation will cover all the construction costs, plus an endowment for uninsured patients. He doesn’t want any corporate sponsors. In exchange, he wants to name the clinic, but he’d like to discuss that with some people first.

Abby examines an elderly woman named Birdie who was mugged. She and her sister, Rebecca, name two different streets where the crime occurred, and they claim they didn’t get a good look at the mugger. When Chuny takes Rebecca to get something to drink, Abby asks if Birdie wants to tell her anything in private. She suspects that Birdie was actually hurt by someone she lives with. Birdie promises that she’s safe in her home with Rebecca.

Coe asks Susan to talk to Elena’s case worker at the INS when she calls. Susan isn’t sure what to tell her. Frank tells Abby that he’s familiar with Rebecca and Birdie – they’re panhandlers. He’s upset that they’ve been left to beg for money in their advanced age. Wendall comes to the ER to talk to Elena and mentions that she recently read an article about Elena’s hunger strike. Frank can’t imagine going without food for as long as Elena has. He’s already hungry just a couple of hours after breakfast. Frank and I finally have something in common: The inability (and lack of desire) to skip a meal.

Weaver’s pleased with Carter’s philanthropy and asks how much involvement he wants to have with the clinic. He’d like a seat on the board and might see some patients, but he doesn’t want to be the director. Weaver has already collected some names of potential directors, and Carter has his eye on someone. She asks why Carter is suddenly building a clinic and donating all this money. He says Chicago needs it. Weaver gets that, but why is Carter moving forward now? He tells her that he’s been at County for 11 years and they haven’t done enough. He wants to do more.

While Carter tries to talk to Wendall but instead gets the brush-off, Pratt, Ray, and Jake tend to a woman named Debra who fell down a flight of stairs at work. She’s worried about how big her hospital bill will be. Chuny notes that she’s eligible for workers’ comp, but Debra is a temp, so she doesn’t qualify. She tries to downplay her condition, which is tough to do when you have a collapsed lung and possible internal bleeding. She protests her treatment but Pratt tells the team to keep working, since he thinks Debra is combative because she has a head injury.

After a talk with psych, Wendall tells Susan and Neela that Elena has been declared competent to refuse nutrition. Coe tries to get them to agree not to treat Elena, but before they can, Elena starts seizing. Coe tells the team to let her seize. Sam wants to treat her, but Wendall stands by Elena’s decision. Neela argues that they have a duty to tend to their patient. It’s up to Susan, who’s the most senior person on the case, but all she’ll allow is oxygen as a comfort measure. Neela goes a step farther, giving Elena Ativan to stop her seizure. Susan kicks her off the case.

Pratt and Ray have sedated Debra so they can fix her dislocated hip. Carter oversees as Pratt shows Ray what to do instead of doing it himself like he might have just a few weeks ago. While Jake’s doing some procedure on Debra, his scrub pants fall down. He’s wearing sterile gloves, so he asks Pratt to pull them back up for him. Pratt the homophobe refuses, and Ray pretends he’s too busy. Chuny claims she can’t because of sexual harassment liability. Someone should go get Abby.

Speaking of Abby, she spots Jake through the window and does a double take. Chuny snaps a picture of him, like, who’s liable for sexual harassment now? Abby tells Carter that she’s reviewing Rebecca and Birdie’s old charts because she suspects they’re the victims of elder abuse. She’s also asked Wendall to get involved, which leads to more awkwardness between her and Carter.

Elena’s stable but Susan isn’t sure she can keep going without nutrition. The staff wants to respect her wishes but not if this all ends up being for nothing. Sam notes that Santiago still might not get a new hearing, and he would have to live with his mother’s death on his conscience. Elena feels guilty for not being around when Santiago was little. She had him snuck into the States when he was 12, so his immigration status is on her. Sam thinks she’s done all she could and should accept treatment. Elena still won’t consent.

A man who doesn’t speak English tries to communicate with Frank at the admit desk. Abby is able to figure out that his wife is in their car, in labor. Pratt joins her to go to the car, where the wife is already ready to deliver. Pratt’s shaky grasp of Spanish fails him when he confuses “empuja” (push) with “puta” (whore). While the husband beats Pratt up for that, Abby calmly takes over the delivery.

Frank tells Susan that Chuck is on the phone for her, and that Cosmo might be sick. She has to deal with Morris and ignore Coe for a minute before she can take the call. Coe has gotten in touch with someone from INS, and he appreciates Susan for telling whoever it is that if Santiago doesn’t get a new hearing, Elena will probably die.

Neela tries to defend her actions with Elena, but Susan thinks that giving her Ativan was the equivalent of trying to revive a patient with a DNR. Neela says Elena was suffering; Neela couldn’t just watch her die. Susan tells her that she should have left the room. She agrees that withholding treatment from a patient who needs it isn’t right, but they have to follow the rules.

Pratt rejoins Ray and Carter, who have discovered that Debra may have cancer. Ray’s sad for her, since she’s nice. “I hear that’s a risk factor for cancer,” Pratt quips. Wendall meets with Rebecca and Birdie, noting that they’ve been mugged a number of times in the past couple of years. Birdie says it’s an “occupational hazard.” Abby ask why they have to panhandle. “Because they aren’t hiring at Hooters,” Rebecca jokes. Abby suggests calling social services, who’ve already been to the sisters’ place. They have excuses for everything, including reasons not to change their lives.

Sam wonders if INS might let Santiago visit Elena, since she could be dying. Susan notes that he might be able to get her to eat. Pratt and Ray go back to Debra, and during a breast examination, Pratt detects a mass. She’s aware of it but never got it checked out. She’s not interested in surgery now, thinking that if you operate on cancer, it spreads and kills you.

Abby gives Rebecca and Birdie some money as she sees them off. “No wonder your patient satisfaction scores are so high,” Sam teases. Santiago arrives in an INS van as Neela, Frank, Ray, and Chuny wonder if Jake wears boxers or briefs. Okay, this is definitely sexual harassment. They ask Abby, who says he goes commando. Abby, don’t encourage them!

Santiago knew that Elena was protesting his detention but wasn’t aware that she’s been on a hunger strike for 41 days. He gets to see Elena for the first time in six months, and he urges her to let the staff treat her. Pratt and Ray discuss Debra, whose reaction to her diagnosis doesn’t surprise Pratt. She’s from an area where people don’t get preventive treatment, so by the time they get a diagnosis, it’s too late to save them. Then their friends blame the surgery, since they were fine before it.

They return to Debra, trying to talk her into a biopsy so they can figure out how to treat her. Ray thinks she’s resisting because of money; if she does have cancer, she’ll qualify for state aid. Debra says it’s not about money. The doctors can’t get through to her, since she’s been sick for two years now and has been getting by fine. They tell her they want to help her, but other than medicine, they can’t – they can’t get her to and from treatments or take care of her when she’s sick from chemo.

Santiago asks Elena why she’s risking her life. He tells Susan and Sam to force her to eat. He doesn’t want Elena’s help; he can take care of himself. He wishes she’d forgotten about him and left him in El Salvador. As the guards with him remove him from the room, Susan asks what his problem is. Santiago says he didn’t ask his mother to go on a hunger strike on his behalf. Susan thinks it might be better if he gets deported.

He tells her that his life in El Salvador was good, no matter what Elena says. She ruined it. Susan notes that Elena wanted them to be together. Santiago didn’t spend much time with his mother, though, since she had to work two jobs. Susan tells him that she wanted a better life for him. “You think it worked out?” Santiago asks, holding up his handcuffed wrists. He thinks Elena’s doing this for herself, not him, because she feels guilty. If she wants to die, they should let her.

Carter asks Wendall if she wants to get lunch or dinner with him, but she doesn’t seem interested. They both admit that they feel bad about how things ended between them. She wishes she’d been able to figure out what was going on in his head, like she can with patients. He offers to bring her some stuff she left at his place. She says she’ll come by and get it – he can just leave it on the front steps. Ooh, ouch.

Susan doesn’t think Santiago’s visit will get Elena to break her hunger strike. An INS agent says it’s too bad that she’ll die and Santiago will get deported anyway. There’s still a chance that he’ll get a new hearing, though it might not do anything. Sam lets Susan know that Elena is now unconscious and unresponsive. Frank has learned from the Internet that the longest some IRA prisoners in Belfast were able to go without food was 45 days, four days longer than Elena.

Morris has been working on his and Susan’s paper all day, and he’s sure that they can get it submitted on time. Susan doubts it, but he’s desperate, since he needs something to make him look better as a candidate for chief resident. She tells him it’ll take more than being published. Carter chats with Debra but is also unable to convince her to have a biopsy or get treatment. Pratt’s not happy, but Carter reminds him that they have to respect her wishes. They can’t do anything if she doesn’t trust the medical system.

Abby and Jake treat a man named Adrian who’s having problems with his thyroid. While Jake’s doing something with his eye, he starts coughing and his eyeball BULGES OUT OF THE SOCKET. AHHHHHHHH! This show should come with a trigger warning. Sam confides to Neela that she only would have waited about five minutes longer than Neela did to give Elena Ativan. Elena’s awake now, and when Sam and Neela go check on her, they discover that someone has given her an IV that contains multivitamins. Neither of them gave orders for it. Sam guesses it was Susan.

Luka arrives for a new shift and helps Abby and Jake with Adrian. Apparently they just need a paper clip. ARE YOU KIDDING ME? Adrian’s kind of freaked out, but much less than you’d expect. It helps that Abby, Jake, and Luka are all so calm. They fix him up and it’s like nothing happened. BUT I WILL NEVER FORGET.

Susan tells Elena that she gets to choose if she wants more nutrition after her IV is done. She’s getting attention from the press now, and INS is taking her seriously. She’s done all she can, so it’s okay for her to end her hunger strike. Elena refuses until Santiago is allowed to stay in the States.

She tells Susan and Sam that he wasn’t always like this. He did one stupid thing, then joined a gang in jail. She tried hard when he was younger, but you can never know how your child will turn out. Susan and Sam get that no matter how hurt and angry Santiago is, Elena would still do anything for him. Susan thinks he still cares about her. She lies that the last thing he said to her before he left was, “Please don’t let her die.”

Pratt brings in a woman named May to talk to Debra. She’s a breast cancer survivor whose illness started the same way as Debra’s. Pratt tells Ray that the cancer ward has “navigators” who help patients through the treatment process. (What an awesome idea!) He thinks Debra might listen to May more than she’s listened to the doctors.

Wendall goes to Carter’s brownstone, but he hasn’t put her stuff outside, since he’s just now getting home. He invites her inside but she declines. As he’s giving her things to her, the phone rings, but this time he doesn’t answer. Abby and Jake leave work together, brainstorming how to label each other since she objects to “boyfriend” and “girlfriend.” He thinks she’s scared of something, but she says she just doesn’t want to move too fast. He tells her she has two weeks to get that sorted out. Then he wants to take her to a big family gathering, his niece’s baptism.

It’s a good thing Carter didn’t answer the phone while Wendall was there because Kem called. He immediately calls back after listening to her message and tells her he’d like to name the clinic the Joshua Carter Center. Joshua is what they named the baby. Back at County, Elena has agreed to eat. She prays over the meal, and Sam and Susan join her to say, “Amen.” She cries as she breaks her hunger strike with Jell-o. Meanwhile, Susan talks to Cosmo over the phone, reciting his favorite book, Hippos Go Berserk. Unlike Elena, Susan’s biggest problem is that her son just doesn’t want to go to sleep.

Thoughts: Birdie is played by Louise Fletcher.

If Elena wouldn’t let the staff treat her, why didn’t they just release her? Doesn’t refusing medical care mean you’re not a patient anymore? Also, she was taking up a bed.

I’m surprised that Sam, who we’ve seen sympathize with parents in the past, isn’t more supportive of Elena’s efforts.

I bet they charged Adrian $90 for that paper clip.

Though we don’t find out what happens to Debra or what she decided, when Susan’s on the phone in the last scene, we see Debra passing by with May, holding her hand. I think May got through to her.

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