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Refusal of Care

One for the Road
Damaged
Try Carter
Fear
An Intern's Guide to the Galaxy
Time of Death
White Guy, Dark Hair
A Shot in the Dark
'Twas the Night
Skin
Only Connect
The Providers
Middleman
Just As I Am
Alone in a Crowd
Here and There
Back in the World
Refusal of Care
Ruby Redux
You Are Here
Carter est Amoureux
The Show Must Go On

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Buy the Season 11 DVD

Episode 241 "Refusal of Care"
Original Air Date: April 21, 2005
Written by: Joe Sachs
Directed by: Gloria Muzio
Guest Stars:

  • Thandie Newton - Kem Likasu (voice)
  • Pat Carroll - Rebecca Chadwick
  • Louise Fletcher - Roberta "Birdie" Chadwick
  • Arlen Escarpeta - Santiago Tabajas
  • Yolanda Lloyd Delgado - Elena Tabajas
  • Judyann Elder - Debra Graham
  • James Molina - Adrian
  • Fred Koehler - Benjamin Coe
  • Verda Bridges - May
  • Jarrod Bunch - Carranza
  • Dawnnie Mercado - Marta
  • Ivo Nandi - Emilio
  • Rob Narita - Miyamoto
  • Moira Price - Liza

Staff:

  • Scott Grimes - Dr. Archie Morris
  • Madchen Amick - Wendall Meade
  • Eion Bailey - Jake Scanlon
  • Laura Ceron - Chuny  Marquez

  • Troy Evans - Frank Martin

  • Monte Russell - Paramedic Zadro White


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Abby and Jake are sleeping. Abby turns over and sees the time and frantically tells Jake to get up. He begins putting on the clothes he had from the day before while Abby tells him that people will get curious. Pratt begins talking in Spanish saying that Abby is late. Susan asks him if he is brushing up on the language and he remarks that he is doing it to better relate to the community. Neela walks in asking what her name is and Pratt looks at her with a glare. Luka signs out his last patient to Pratt while Sam enters admit and tells him that Alex has soccer after school and that she thought he could drop him off. Luka questions that he thought the carpool was picking him up, but she tells him that he needs some practice with his corner kick. Luka tells her that he thinks Alex is still mad at him and she grins saying that it could be an icebreaker. Nearly running Sam over, Morris approaches Susan with the details on the article they are writing. She tells him she will get to it when she has the time and he tells her that they are due by 5. She says for him to meet her in the doctor’s lounge and he agrees. Carter comes in from behind and asks if she is publishing with him and she states that he is thorough and good with statistics and he adds that he is the only one desperate enough to write one up. Neela approaches Susan asking her what the odds are of her running a trauma. Susan asks her if she is ready. Neela tells her that in a couple months she will be an R2 supervising the Interns and it would be good to get the practice. Medics bring in a hypothermia patient named Elena and Susan gives it to her. Elena tells them to call her lawyer and not to do anything until her arrives. While trying to treat her she tells them that she is on a hunger strike because immigration wants to deport her son. Susan asks her if she knows the repercussions of refusing their care and Elena nods. Susan goes on to ask if she knows that without the care that she could die. Elena states that she does not want to loose her son. Susan tells her team to cancel all the orders and takes her exit. Abby and Jake make their way into work. Jake goes on about not worrying whether people notice he is still in the same clothes from the day before. Abby retorts that people do notice, while Jake pulls her off before getting splashed by a falling newspaper bundle into a mud puddle. As they continue to walk a night desk clerk from the OR stops and says hello. Jake introduces Abby to her as his girlfriend. Parting ways, Abby asks if he really called her his girlfriend. Almost getting splashed by a racing cab, Jake asks her what the big deal is and questions what he should call her. Abby retorts ‘How about just Abby’. Jake laughs and says that she doesn’t want anyone to know that they are going out. She tries changing the subject and he tells her this is important. She tells him they can talk about it later as an ambulance races by them and splashes them. As he looks down at his wet clothes, Jake replies ‘Yeah, I guess it can wait until later’

 

Jake and Abby emerge at admit. It seems they didn’t have Jake’s size in scrubs and Chuny can’t resist by saying ‘Wassup homey’. Ray pokes fun at their matching outfits while Pratt hands out their cases. Sam takes Elena’s temperature while Susan offers a warm blanket. Elena’s lawyer Benjamin arrives and asks how she is. Susan tells him that she is malnourished and dehydrated and heading for a coma. He states that maybe they will see some action now, and maybe the INS will grant them a new hearing. Susan asks if Elena’s son is an illegal alien and he corrects her saying ‘undocumented immigrant’. Sam asks if they can send the kids back without a parent and he explains that Elena has her green card and has been in the States since 1989. He adds that her son, Sonny was brought up by his uncle 7 years prior, but got into trouble 2 years back. Sonny was put into juvenile detention and after serving his time the INS got involved. Elena mumbles that he will never make it in El Salvador. He tells them that the police round up gang members and they either get beaten to death or simply disappear. Elena adds that if he goes home that they will kill him. Benjamin hands over Elena’s ‘Durable Power’ and Susan further explains that the document states that Elena is competent of starting a hunger strike and can even refuse care if she is unconscious. Sam asks about an IV and Benjamin tells her that is felony assault. He adds that if they try to treat her that he will call the police. Kerry, John and a developer go over the blueprints for a clinic. Kerry asks Carter if he wants to go over the bid for the contractors. Kerry tells him that she needs him to go through the list of potential corporate donors and make some calls on behalf of the hospital. John replies ‘No thanks’ while Kerry explains that his personal involvement would be very useful. John interrupts saying that they were never keen on having corporate sponsors so they are going to fund the construction costs. Kerry looks at him and asks ‘The whole thing?’ John nods and tells her that they are also going to supply an endowment to add to the yearly budget to treat uninsured patients. The developer looks at Kerry and expresses his appreciation to John, who asks for the chance to name the hospital. The developer asks if he has any ideas and John replies that he does but he would like to run it over with ‘a few family members first’. Abby treats an older woman who came in with her sister. She had been hit in the face by a purse-snatcher. Abby asks Chuny to escort the patient’s sister to the waiting room while she questions the patient, whose goes by ‘Birdie’. Abby asks her whom she lives with and Birdie explains that she and her sister had been living together for 50 years. Abby urges her patient to tell her if maybe her sister had hurt her, but Birdie is adamant about it being some young kid. Benjamin comes to admit and tells Susan that there would be a person calling from the INS and that he wanted her to talk to them. Susan asks him what she is supposed to say and he tells her to explain to them just how sick she really is. Morris enters telling Susan that he was finished, but she asks him about removing the P-values and he leaves again to correct the papers once again. Abby tells Frank that she needs a facial x-ray. He asks her if they are for Birdie and Abby questions if he knows her. Frank explains that he usually gives the panhandling sisters money every so often. Wendall approaches admit and Abby tells her that she has a case for her. Wendall asks if it is the hunger strike lady and Susan tells her that is her patient. Kerry voices that she doesn’t know what to say. He explains that he had been searching for the right thing to donate to. She asks if he wants any role in the outpatient center and he tells her he would like to sit on the board and occasionally see a few patients. She asks if it is his idea to recruit someone with more experience as director. He laughs stating he doesn’t want to run the place, and she tells him there is someone she knows of 4 candidates that might be good. John states that he knows of someone named Todd Becker. Kerry asks why he is doing all this and he tells her that the city needs it, and that he has been at County for 11 years patching up the people that have fallen through the cracks and it hasn’t been enough and he wants to do more. Pratt calls him over for a MVC trauma, he sends the team, which includes Jake and Ray to the trauma room and tells them he will be right there. Kerry asks for him to send her the file on Todd and he tells her that she will like him. He runs into Wendall and they exchange an awkward hello. Ray checks the patient’s pupils and she asks how much it will cost. Ray states that is what insurance is for and she tells them she doesn’t have any. Chuny tells her workers compensation will cover her and she tells them she is a temp office cleaner. She tells them she should just go home and rest but Pratt tells her that she has a collapsed lung and a dislocated hip. The patient begins getting upset and pulls away the equipment that has been hooked up to her. The team struggles with her and end up sedating her. Wendall explains to Susan and Neela that she spoke with psych and they support her request to refuse nutrition. Benjamin asks if they are under the agreement of no treatment. Sam calls out that Elena is seizing and Benjamin tells them that this needs to happen. Sam preps to give her an IV and makes it clear that Elena is no different then any other patient. The doctors clash with the lawyer and social worker while Susan looks on in defeat. Sam asks her what she wants to do and she tells Sam to give her oxygen. Benjamin reacts and Susan tells him that it is merely a comfort measure and it won’t save her life. Elena begins bleeding from the mouth and Neela decides to take matters into her own hands and injects Elena with Ativan. Susan yells at her and tells her to leave the room. Neela explains that she just saved her life and Susan thanks her sarcastically and dismisses her from the case.

 

John tells his team that the sedative is about to where off. Ray attempts to place the hip back in, but voices that he can’t do it. John tells him to try the Whistler technique, but Ray admits he doesn’t know that one. Pratt steps in and begins walking him through, and the hip pops back in without difficulty. While Jake is doing his procedure on the collapsed lung, his pants slip down to his ankles. He asks the team to help him out but everyone seems to have an excuse. Abby orders her films on Birdie and sees Jake through the window. Chuny comes in and takes a picture while John asks Abby if she needs to present to someone. She explains Birdie’s case while Wendall approaches them. Another awkward moment for Wendall and John passes and the two ladies head over to Birdie’s exam room. Elena wakes from her seizure and tells Susan that her head hurts. Susan states that she’s not sure how much more of this Elena’s body can take. Sam and Susan both try to sway her to finish the strike either way it won’t help anyone. Elena tells them that she wasn’t there for her son at first and told them the story of how her brother snuck her son into the States. Elena explains she is tired and Susan tells her that they will let her rest.  Sam voices that she can’t believe she has to do this and Susan explains that she is a mother trying to save her son and that she would throw herself in front of a train for Cosmo. A Spanish man tries to tell Frank that his wife is in the car and she’s in labor. Abby and Pratt both overhear and go to help the man’s wife. Pratt tries to tell the woman what to do but ends up calling her the Spanish word for ‘whore’ rather then ‘push’. Infuriated, the husband pulls Pratt out of the car and begins strangling him. Abby replaces Pratt and tells him what word he should have used and what he originally said. Frank flags Susan to tell her that Chuck was on the phone saying that Cosmo was sick. Morris swoops in saying that he is finished editing the article and she asks him if he included the 95% confidence intervals and he sighs and takes his exit. Susan takes Chuck’s call in the lounge. She asks him questions, while Benjamin is on his cell phone with the INS asking the person on the other end if they want to speak to Susan. She takes his phone and explains to them Elena’s condition and hands it back to Benjamin. He thanks her and leaves the room. Susan heads to the coffee machine, and sees Neela there. Neela explains that the Ativan that she gave Elena has no calories. Susan asks her if she would shock an end stage cancer patient with a DNR and comments that what she did was every bit as wrong. Neela comments that she was suffering and Susan comments that she was unconscious. Neela adds that she couldn’t watch her die and Susan adds that she should have left the room. Ray and John go over a patients films and Pratt walks up to them with an ice bag on his shoulder. John asks him what happens and his scoffs that he had a rough delivery. He passes John the blood test results on the temp worker, and it comes to light that she has cancer. Abby tells Birdie that her nose was slightly cracked but nothing major. Wendall states that the two ladies had been mugged several times. Abby asks them why they don’t get a job. Abby suggest a home visit and Wendall tells her that a worker went out last summer and the place was rather messy, but Wendall states she will set another one up. Abby excuses herself to get Birdie’s discharge instructions. Sam and Susan talk about Elena and they both think that maybe if her son came in that he might be able to convince her to eat. She sends Sam to call them. Pratt and Ray examine the temp lady and Pratt tells her that he needs to do a breast examine. He finds a lump in her chest and asks her if she had felt that before and she nods. Ray asks and Pratt tells him is a mass about 5 cm long. Pratt tells her that surgery maybe part of the treatment process and she refuses. She gets agitated and tries to get up and she tells them that cancer can spread and then you die.

 

Abby walks Birdie and her sister out and gives them some money to have a good meal. Sam witnesses Abby’s kindness and makes the remark ‘No wonder your patient satisfaction scores are so high’. Abby walks back into the hospital while Sam greets the immigration people with Elena’s son. Chuny, Frank, Neela and Ray look at the pictures of Jake from earlier. Chuny questions Abby on whether he has boxers or briefs and she tells them he goes commando. Sam and Susan brief the son on Elena’s condition. He goes in to tell Elena her son is there and she is happy to see him. Santiago tells Susan and Sam that they aren’t doing anything to help his mother. He begs his mother to let the doctors help. Pratt and Ray discuss Debra, the cancer patient. They go in to check on her and ask her if she had thought anymore about the surgery. She still refuses and Pratt tells her that they will do a biopsy on the mass first. She asks what comes next and Ray tells her that upon the results that they would go ahead with the preferred method of treatment. Pratt explains to her that her chances are very good and that there is a wide variety of treatment options. Santiago grows in frustration over his mothers stubbornness and gets sent to the family room to calm down. Susan follows him out into the hall and tells him that she is doing this for him. She pulls them into the family room and tells him that him being deported sounded like a good idea. He tells her that he was fine in El Salvador and he doesn’t need her. He adds that she only feels guilty and to let her die. Susan replies that he doesn’t mean that and he does. DOC takes him away and Susan stares through the window helplessly. John asks Wendall for a chart and then asks her out. She declines saying that she has to get back to her unit. He suggests dinner and she again declines saying that she has other plans. She tells him she does a really good job at getting into her patients heads, but she couldn’t do that with him. He tells her that she left some things at his place and offers to bring it by. She tells him that she can get it later on that night and he agrees to the idea. DOC guard asks Susan if she think Elena will eat. Susan states negatively that she doubts it and thanks him for all his help. Frank gives them a paper he printed which says that people can only last 45 days without food. Morris flags Susan again saying he made all the revisions and things were ready. She tries to blow him off and he tells her that he needs that publication for his Chief Resident application. She tells him it will take more then that. John tries to talk Debra into the biopsy and fails. He tells Pratt to call an ambulance and have someone check in on her and he seems displeased with the arrangement. Abby and Jake treat a hyperthyroid patient. Jake inserts some drops into the patients eye to check for glaucoma. He places a probe to push the eyeball and it pops out of the socket. The patient begins to freak out while Abby and Jake frantically try to figure out what to do. Abby tells Chuny to get an attending and she replies that she thinks Luka just came in. Sam and Neela talk about Benjamin and Sam tells her that if another 5 minutes went by that she would have give the Ativan to Elena herself. Ray walks by and announces that Elena is looking for Sam. Sam notices an IV bag hooked up and asks who put that there. Neela tells her that she doesn’t know. Susan enters and asks what is up. Sam tells her that Elena is up and has an IV. Susan plays stupid and asks for a minute with Elena alone. She tells her that everything is going to be ok.

 

Luka tells Pratt to run the board while he goes to help Abby. He asks for a decimal retractor and Abby tells him they don’t have one. He asks for a paper clip and the patient grows increasingly worried. Jake hands him the paper clip and instructs Abby on what to do. Elena states that she is cold and asks Susan if she put the IV in. She tells her it’s only one bag and after that it’s up to Elena. Susan tells her that INS is taking her demands for a new hearing very seriously and reiterates that Elena has done all she can. Elena tells her that her son was never bad, and tells them in depth what happened since he came to her. Debra asks Ray when her ambulance will be there for her and he tells her about an hour. Pratt announces there is someone he wants Debra to meet. He introduces Debra to May and tells her that May is a cancer survivor and leaves them to talk. Wendall stops by John’s place to collect her things. As she is on her way down the steps, John arrives and apologizes that he was late. He invites her in but she replies that she doesn’t think so. He gives her the bag with her things and she leaves. Jake and Abby go over what a good team they make and cracks ‘This is Abby, my team mate’. They continue the conversation they had before they started their shifts. He tells her that she has two weeks to figure out what she wants to be referred to because he was taking her to a family gathering. John listens to the messages on his machine and hears Kem. He calls her and tells her that he wanted to know what she thought of them naming the clinic after their late son. Sam brings Elena in some food and Susan tells her that it will be mostly IV for the first 48 hours but they can try a few spoonfuls of liquid food. She prays over her food and begins eating. Sam answers the phone and tells Susan it’s for her. Susan takes the phone out in the hall and smiles when it’s Cosmo. Her son asks her to sing him their bed time story. As people pass her she recites it.

Reviewed by Kristyna on May 28, 2005

NBC Review

THE STAFF OF COUNTY GENERAL MUST DEAL WITH THE MORAL ISSUES SURROUNDING A HUNGER STRIKE VICTIM - A woman is brought in suffering from the effects of a hunger strike, but she will not accept food or help until she has proof that the INS will grant her sonÓs deportation case a new hearing. Neela (Parminder Nagra), Sam (Linda Cardellini), and Dr. Lewis (Sherry Stringfield) are incapable of treating her as long as she and her lawyer refuse aid -- which goes against all the doctors' training. Meanwhile, Abby (Maura Tierney), despite her suspicions, is unable to prove that 72-year-old Birdy Chaddock (Louise Fletcher) is the victim of elder abuse. Also starring Noah Wyle, Mekhi Phifer, Eion Bailey.