ER 12.13, Body & Soul: Dance Lessons

January 10, 2023

ER 12.13, Body & Soul: Dance Lessons

Ally Walker, who plays Fran, should be a lot more famous than she is. She’s really good

Summary: A man named Nate Lennox is at a skating rink, watching people ice skate from his power wheelchair. He goes out onto the ice in his chair, which an employee tells him is unsafe. Nate ignores him. He’s sent to County, where paramedic Doris tells Ray and Haleh that his medic-alert bracelet says he has ALS (AKA Lou Gehrig’s disease).

Ray wonders how Nate got out of his home unaccompanied. Haleh thinks he could have been abandoned. Ray notes that he’s wearing clean clothes and recently had a shave, so he’s obviously being well cared for. Nate’s chair keeps rolling away, and Ray realizes that he uses a computer screen with an eye sensor to move around. He guesses that Nate wants to leave. Sam comes in to help, recognizing Nate. He uses a speech-synthesizer program (like Stephen Hawking) to state that he doesn’t want any help. He wants to leave.

Since Nate has pneumonia and isn’t getting enough oxygen, Ray won’t let him go. However, he’s not sure how aggressive Nate’s treatment should be. Ray wouldn’t want to live like him. He tells Nate that his oxygen levels are dropping and they need to know if he wants heroic measures. Nate just repeats that he wants to go home. Ray isn’t sure he knows where he is. Haleh brings in Nate’s medical records, and Sam remembers that she and Neela treated him for shortness of breath about a year ago.

2004: Nate leads a med-school lecture, despite having trouble speaking. When he goes to County, Sam and Neela give him a respiratory treatment. Neela knows who Nate is, since she went to his med school, though she didn’t take his class; she had credits that transferred from Yale. She’s very familiar with his work and cited it in a paper she co-authored as an undergrad. He asks why she’s in the “cesspool” that is County and what her specialty will be. He figures it’ll be some kind of surgery, but she thinks surgeons are awful.

Nate’s assistant, Fran, arrives and is happy to hear that he’s going to have a consultation with a speech pathologist. She gently tells him that it’s getting harder to understand what he’s saying. He replies that people just need to listen better. A doctor named Ames, who they know well, brings in a computer for Nate to use. Nate tells Neela to think about what she’s doing, because she might realize that she doesn’t belong at County. Neela jokes to Sam that maybe he misses her slushies back at the mini-mart. Heh.

Her shift is ending, so she passes her patients on to Abby. Abby recognizes Nate’s name and goes to see him. He’s not happy about being given the computer to help with his speech, so he knocks it to the floor. Ames gets the message but warns that Nate is delaying the inevitable. At the very least, Fran and Abby want him to wear a medic-alert bracelet. Ames also wants him to wear a respiratory aid at night. Nate laments that every time he wakes up, he’s lost another function.

Today: Fran is grateful that Nate was wearing his medic-alert bracelet. She’s not sure why he went to the ice rink. He slipped out of the house while she was taking a nap. Luka comes in, and though Fran remembers him from a past appointment, he doesn’t seem to remember her or Nate. He tells Fran that they’ll need to make a decision about either intubating Nate or putting him on a ventilator. This may be the “natural endpoint” of his disease. Fran gets that the best thing might be to just make Nate comfortable.

Abby joins the group, asking Nate why he went out by himself. He uses the computer to say, “In motion” and “free.” She declares that he needs to be intubated, but Fran says she’s not sure he would want that. Abby clears Nate’s airway and says they’ll wait until he’s more coherent and can tell them what he wants.

After a little more treatment, Abby reminds Nate that they once discussed him getting a trach tube. He said he wanted to stay alive until there was a stem-cell cure. Haleh comes in to gather help for a trauma, and Luka leaves. Abby pushes Nate to state whether or not he wants a trach. Fran tells her that conversation was a long time ago. Now Nate’s worried about ending up on life support, unable to communicate. They can’t be sure if he was really communicating earlier or if he was just making random eye movements.

Abby tells Fran that if they do the trach, Nate will be able to go home quickly. She thinks Fran could use some help at home, since she’s clearly exhausted. Fran doesn’t want help and doesn’t seem to think she needs it, but it doesn’t look like she’s doing everything well enough to keep Nate healthy. He has a G-tube for feeding, which was placed in 2002 after he had a choking spell.

2002: Nate and Fran are at a dinner for the graduating class. Nate starts choking just as Anspaugh is announcing that he won the Teacher of the Year Award. Pratt is his doctor at County, and he tries to convince Nate that it’s time for him to get a feeding tube. Ames points out the benefits, including a longer life. Anspaugh comes by and says he’ll put Nate on the surgical schedule, since Romano isn’t available right now. They can cancel if Nate changes his mind.

Alone with Pratt, Nate asks if Abby’s around. It’s a quiet night, and he thinks something’s off. Pratt tells him that Mark just died, so a lot of people took off for his memorial. To drive home that we’re in the past, Lily mentions that Chen wants Pratt to do something. Pratt gives Lily attitude that she definitely doesn’t deserve, and Nate tells Pratt he’s pretty arrogant for an intern. Oh, you have no idea. Nate says he’s either very smart or very insecure. Hmm, could be both. Pratt says he plans to move on to Northwestern, assuming he gets in.

As he starts giving Nate information about the procedure to insert the feeding tube, Nate gets teary. Fran returns and explains that one of the side effects of ALS is an inability to regulate emotions. Nate calls it “emotional incontinence.” Pratt thinks there must be something he can take for that, but Nate doesn’t want to deal with the medication’s side effects. He’s upset that he’s a burden on Fran already, and it just keeps increasing.

Today: The staff takes care of the feeding-tube problems, then tests Nate’s lung function. It’s not good, so Abby pushes for a trach again. She tells Nate it’s his best chance of recovering from the pneumonia. Nate finally seems to agree, saying, “Okay,” but then he says, “I’m okay.” Fran and Sam think he’s refusing the trach. Fran believes he’s ready to die, but Abby doesn’t want to stop treating him.

They present the situation to Luka, who says that since Fran has Nate’s power of attorney, she gets to make the call. Abby thinks that Nate expressed his wishes and they need to respect that. Luka tentatively tells Fran that if that’s the case, they can’t go against Nate’s wishes. Fran asks Sam to find Ames, and Abby tells her to get Dubenko so they can do the trach procedure.

Neela does it as part of her surgical elective, but when Nate starts bleeding, Dubenko has to change to another procedure. Fran regrets giving in to Abby. Neela calls for morphine, but Fran says no. Sam reads in Nate’s chart that he had a bad reaction to it back in 2001.

2001: Nate falls down some stairs while chatting with a student. While he’s being treated for a broken wrist at County, he tells the student to get back to work – they’re aiming for a Pulitzer Prize. Fran is annoyed that Nate took the stairs instead of an elevator. Luka is the treating doctor, and he tells Nate that Ames thinks it’s time for him to start using a wheelchair, because of the loss of strength in his legs.

Nate shouldn’t look at it as losing the ability to walk; he’ll be conserving his energy so he’ll be able to do more things. Nate resists turning into an invalid. He’s not optimistic about a cure for ALS; Bush Jr. just banned federal funding for the research that would find one. Nate’s trying to hold on to hope, but it’s getting harder and harder.

Fran leaves to talk to Ames, and Luka chats with Nate about her. Even though she acts like his wife, she’s his employee. He’s surprised she stuck around, since she could have gone to law school or business school. They almost got together at one point, but he wised up. Nate asks if Luka’s married, and Luka just shakes his head. Nate thinks it’s because he understands that work is more important than family.

Luka notes that some people can find balance. Nate says that that’s okay for ER doctors, but not scientists who are trying to make breakthroughs like he is. He doesn’t see a problem with being married to his career. It’s a good partner. Just then, he vomits from the morphine. As far as bad reactions go, that’s not too horrible.

Today: Fran thinks that if the staff can’t get Nate’s bleeding under control, it’s a sign that they’ve done enough. Abby says it’s a detour and they can get back on track. Dubenko finds the problem – Neela poked through something she shouldn’t have because Nate has unusual anatomy. They finish the procedure but Nate may have suffered damage from lack of oxygen to his brain.

Sam shows Fran how to take care of the trach, since Fran still wants to do everything for Nate herself. She thinks it’s easier since he’s made her get rid of a lot of caregivers. She lets others take care of Nate at night, but it’s hard for her to see other people give him what she doesn’t think is the best care. Abby brings over Nate’s computer to see if he’ll communicate, but he ignores her. Fran wants to take him home, since she promised to keep Nate there as much as possible.

She’s been working for him for 21 years. It started as a job, but now it’s much more. In 1999, he was presenting a paper at a symposium in Boston, and they decided to add a couple days to the trip just to relax. They went sailing in Cape Cod, and she felt like everything in her life was falling into place. He was diagnosed just a couple weeks later.

1999: Nate has gotten an MRI and some blood tests, and he tells Fran that he has ALS. The average life expectancy is four years, but some patients progress, then plateau. Then again, there are a couple of patients who live with it for decades. As he goes to an ice rink to play hockey, he tells Fran about all his treatment options. Fran offers to help out in more than just her usual capacity.

Today: Nate put his research aside so he could put all his energy into fighting his disease. Fran explains that he didn’t want to start something and then have it taken away. Sounds like she means a relationship instead of something professional. Nate finally uses the computer to talk, indicating that his mental state is normal again. He wants the trach removed. He appreciates that Abby fought for it, but he’s ready to end things before he loses his ability to communicate and expresses his wishes and needs.

Abby thinks this is a temporary setback and they can slow down his decline. Fran quietly says that Nate has already decided. He repeats that he wants the trach removed. Abby shakes her head and says she can’t do it. Nate asks to leave, adding, “Poker.” Fran explains that he wants to play poker with his friends at home. Abby tells Nate that he can’t go home like this.

Either they wear her down or someone overrules Abby because Nate is allowed to go home. He plans to turn off his ventilator and die tonight. Abby keeps trying to convince him to stay in the hospital a couple more days, but he refuses to be “a soul trapped in a corpse.” She asks when he stopped trying to fight the disease. He says he’s too tired.

Abby tells him that if he receives treatment for the pneumonia, he’ll plateau. He could live another 40 years, like Stephen Hawking. He’s still advising and publishing; he still has a pretty full life. If he beats the pneumonia, he could hang on until there’s a cure. Nate asks what will happen if he doesn’t beat it. Abby promises to be with him at the end, making sure he’s comfortable. She’ll willingly take him off the ventilator and let him go. She bets him $10 he’ll recover. Nate is impressed with the doctor she’s become, and she tells him she isn’t sure she’d have made it this far without him.

1999: Abby is in Nate’s class pre-diagnosis, when he’s passionate about teaching and captivates his students. It’s easy to see why he’s later named Teacher of the Year. Afterward, Abby asks him to approve her decision to drop the class. She failed the midterm and doesn’t think she’ll do any better on the final. It’s a required course, so he notes that she’ll have to take it at some point. She says she’s thinking of taking a year off and reconsidering things.

Nate’s surprised and thinks she doesn’t really want to be a doctor. Abby’s overwhelmed because of everything she has to memorize. He asks if she likes sports or skating or dancing. She admits that she liked taking ballet as a kid. He tells her to stop memorizing and start thinking conceptually. Biochemistry is a dance of life. He says some stuff about molecules that I don’t get, then drops the figure he’s holding, saying he’s not usually so clumsy.

Abby still wants to drop the class, but Nate invites her to come see him during office hours for “dance lessons.” After three weeks of extra help, he guarantees that she’ll ace a makeup midterm. He bets her $10. Abby is still overwhelmed and uncertain, but Nate is positive that she can improve. “If nothing else, I will teach you how to fight,” he says.

Today: Abby goes to the skating rink and enjoys the freedom she has to move around however she wants. No word on how Nate is or whether he took her bet.

Thoughts: Nate is played by human garbage pile James Woods.

Paul McCrane (Romano) directed this episode.

Can we not with the “here’s how one patient influenced the lives of a bunch of County staff” episodes? Especially when it’s a patient we’ve never seen before?

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