ER rec(r)ap: Refusal of Care (Season Eleven, Episode Eighteen)
(original air date 21 April 2005)

THIS WEEK'S PROGNOSES:

• Carter: Still trying to redeem himself.
• Lewis: Destined for the mom hall of fame.
• Abby: Stoic and satisfying.

Morning — Abby's in bed with that guy whose name I can never remember. I'm too squicked out to try. She doesn't look entirely comfortable, though, so at least I have that — and she especially doesn't look comfortable when she realizes it's 7:32 and rounds are at 8:00. Then she starts to get nervous about people at work seeing what's-his-name in the same clothes he was wearing yesterday. It's supposed to be cute or something, but I'm still squicked.

The admit desk — Pratt is brushing up on his Spanish. He mumbles something about relating to the community or whatever, but of course Neela sees right through that and says "Oh, yeah, what's her name?" Also, he needs to try a little harder: he says "ella" like "el-ya," which might get him somewhere in Russia but isn't likely to do much in the "community" he's trying to charm.

Residents — Lewis is working on a paper with Morris. Yeah, she's as excited about it as we are. Meanwhile, Neela wants to run a trauma, but Lewis isn't sure she's ready. But it wouldn't really be dramatic to make doctors wait until they're ready, would it? So a woman rolls in and Neela gets to work. The woman doesn't want any care, though, because she's on a hunger strike — the INS is trying to deport her son. Lewis wonders why coma and death would be better than losing a son, but then concedes when the woman insists.

Romance — As they walk to work through the soggy streets, Jake (oh, right, that's his name) protects Abby from splashes. Sort of. He also introduces her to someone:

Abby: "Did you say 'girlfriend'?"
Jake: "What?"
Abby: "Nothin'. Takes me right back to junior high."
Jake: "What do you want me to call you?"
Abby: "How 'bout introducing me as 'Abby'?"

And then an ambulance drives by and they both get sloshed with mud. Awwww. So cute, I may retch.

Inside, they both change into scrubs, and everyone teases them about their matching outfits. More retching from me.

Legal aid — The hunger strike woman, whose name is Elena, doesn't even want orange juice — "only water." Her lawyer, Benjamin, shows up. He looks about 12. But he seems to know his stuff; he tells them the story of Elena's son, Santiago, who got in trouble and is likely to be "disappeared" or beaten to death if he gets sent back to El Salvador.

Benjamin also has Elena's durable power of attorney, which says she's competent to refuse care even if she's unconscious. Even an I.V. would be felony assault. Isn't the law a wonderful thing?

A board room — Holy crap, there's Kerry. She's still alive? And she's talking to Carter about the HIV center/clinic/whatever he's trying to fund — and by fund, he means cover everything. Finally, rich boy makes good. Yawn.

Some little old ladies — A woman, Roberta, is dazed after being punched by a purse snatcher. She and her sister Rebecca don't want to file a police report. Hey, wait, Roberta is Louise Fletcher. I don't think I've seen her since she played that evil Kai on Deep Space Nine.

Abby is immediately suspicious of Rebecca, thinking that maybe she was the puncher and the purse-snatching is just a story. Gah. When I'm that age, the only thing I'm going to want to punch is my pillow, in anticipation of my 8th nap of the day.

It turns out Frank knows the sisters — they're panhandlers, and he gives them a buck every now and then. Abby is aghast. Well, maybe. She has her stoic work face on, so it's hard to tell.

In the hallway, Kerry (who looks sexy in that necklace) is chatting with Carter about his generosity. She wonders what's going on with him. He says that for 11 years he's been patching people up, and it's not enough. Okay, the first problem with that is the idea of this show having been on the air for 11 years. No wonder I feel old every time I watch.

Falling down — Pratt and Jake are helping a woman who fell down some concrete steps and doesn't have any insurance. She's a temp, so worker's comp is out of the question too. Her hip is out of joint, she has a collapsed lung, and she's bleeding internally, but she starts to tear off all the tubes and restraints because she'd really rather just go home and rest. Everyone pushes her back down on the gurney and tells her she'll thank them for it later. So only the people with lawyers are allowed to refuse care, I guess.

A desire to achieve an end — Elena is seizing, but Benjamin the baby-faced lawyer says they still can't treat her. Neela starts talking about duty, and even though Lewis knows the law, she orders 5 liters of oxygen as a comfort measure. Neela is not as interested in the law as she is in the fact that Elena has bit her tongue, which is now bleeding — so Neela pumps some ativan into Elena's arm. The lawyer is not happy.

Lewis: "Neela, get out of the room."
Neela: "It could have saved her life."
Lewis: "Thank you. You're off the case."

In verifying that I've spelled "ativan" properly, I learned that one can purchase it online with little or no reason or prescription. Where's the law when you really need it?

Lewis, by the way, is starting to look tired and old. Eleven years will do that to a person, even a person who had the sense to leave the show for most of it.

Ouch — Pratt and Ray are doing some sort of painful hip relocation maneuver.

Jake's too-big scrub bottoms fall down somewhere in the middle of it all, and nobody's willing to help him hike them up. Abby sees Jake's state of undress from the hallway and does a hilarious "what-the-hell-no-I'm-stoic-on-the-job" series of expressions. She sort of half-watches as Chuny takes a picture of pantsless Jake, but then Abby walks off with Wendall to visit the elderly sisters. Way to not stand by your man, Abby!

Dedicated — Elena says more about her son Santiago, and how her brother snuck him into the U.S., and it all turns into a story of guilt and too much suffering. But Lewis understands: she says she'd throw herself in front of a train for Cosmo. You'd do that, but you couldn't spend half a minute thinking about a better name for him?

Elsewhere, a frantic man hollers in Spanish, and Abby understands him perfectly. What? She has too many talents for me to keep track of.

The man's wife is out in the car, ready to give birth, so Abby and Pratt go to help. Pratt, he of the newly minted Spanish pseudo-skills, tries to say "push" but says "puta" instead. The husband throws Pratt to the ground and starts to pummel him while Abby tends to the new mom.

Okay, that was funny. Abby explains Pratt's mistake to him while keeping that stoic-but-amused expression going.

The lounge of bad-ass moms — Lewis goes from phone to phone, taking names: first she talks to Chuck about Cosmo — it seems Cosmo is feverish, but there's no vomiting and good eye contact, so she tells Chuck to call her when the fever comes down. Then she grabs the legal aid lawyer's cell phone and tells the INS to grant Elena's son a new hearing because Elena might not last another day. All hail the supermom!

Over by the coffee pot, Neela (hey, that's an anagram of Elena. Weird.) tries to defend herself, but Lewis stands her chief-like ground:

Neela: "I couldn't just watch her die."
Lewis: "Then you should have left the room."
Neela: "It doesn't seem right."
Lewis: "It's not. It's just the rules."

That was almost worthy of Kerry.

Bad news — Ray and Carter check out the pre- and post-reduction scans of the temp worker's hip. Pratt brings the lab results by; apparently they indicate one of two things, and the worst of the two is cancer. Yes, it's not enough drama to uninsured, underemployed, and roughly cared for: the meek shall inherit the cancer.

Funny 'cause it's sad — Rebecca and Roberta talk to Abby and Wendall. It seems the sisters have been mugged several times in the last year. Roberta calls it an "occupational hazard."

Abby: "Howcome you have to panhandle?"
Rebecca: "Because they aren't hiring at Hooters."

Snort!

The sisters make lots of excuses about their lifestyle and lack of food and general state of distress, but Abby and Wendall are still suspicious, so they order another home visit from Adult Services. Rebecca and Roberta exchange a look that I can't quite fathom.

Hope springs eternal — Lewis and Sam decide that maybe Elena's son might be able to get her to eat. And you just thought of this? Apparently your entire brains are devoted to medicine, but not really to care.

Delivering the bad news — Hey, there's that dykey nurse who has been on this show for 11 years with not a single line. I think her name is Shirley. Nice work if you can get it.

Pratt does a breast exam on the woman who fell down the stairs. He feels a mass — five centimeters. Yow. The woman admits she first noticed it a couple of years ago, but didn't see a doctor. And she doesn't want surgery now either. She wants to get dressed and get the hell out of there. You and me both, sister.

I hope I die before I get old — Rebecca and Roberta head home, but Abby's not quite done with them. She gives them some money for a nice dinner, which is sweet, but I'm kinda distracted by how sexy Abby is in scrubs. Sam's watching too, for very different reasons:

Sam: "Was that a $20? No wonder your patient satisfaction rate is so high."

That ain't the only reason, I'm guessin'.

Sam is there to greet Santiago, who looks like a very hardened criminal. Sheesh.

The latest pool — Ray, Frank, Pratt, Neela, and Chuny are looking at the digital picture of Jake with his scrub bottoms around his ankles. They figure boxers would stick out more; so Neela votes for "tighty-whities" (which sounds much better with a British accent) while Frank just says "thong."

Ray: "Maybe Abby can settle this."
Abby: "Settle what?"
Chuny: "Boxers or briefs?"
Abby: [sees the picture] "Actually, goes commando."

Eww. And ha.

Facing the music — Santiago and Elena say hello. The guards are not very friendly about it. Santiago tells his mom to let the doctors help her.

Urban myths — Mrs. Graham, the woman who fell down the stairs and also has cancer, doesn't want surgery because she thinks cutting into cancer makes it spread. Pratt and Ray try to convince her that her options are very good, but she's not ready to hear it. And she's not having any needles or surgery, because she doesn't have anybody to help her if things get bad. Pratt knows he can't really argue.

I don't need your help — Santiago gets all criminal-like and tells his mom she's just messing everything up: "You shoulda just forgot about me. I was better off in El Salvador."

Ouch.

Lewis goes after him and yells at him, like the supermom she is: "You know what? Maybe we will force-feed her, because your getting deported sounds like a really good idea right now."

That was good, but then it sucks, because Santiago is ready to let his mom die.

Tension — Wendall and Carter are in a tiny room together. It's not comfy. Carter invites her to lunch or dinner or whatever will help him assuage his guilt, but Wendall's cool enough to not let him do that. Carter reminds her that she left some stuff at his place, so she says she'll come by tonight to pick it up. Carter gets all hopeful, but Wendall tells him to just leave the stuff in a bag on the steps. Woo!

Reliable information — Lewis and Sam talk about Elena. Frank says he "checked the Internet," where he learned that fasting IRA prisoners generally start dying after 45 days. What? So Sam and Lewis couldn't look this up in, hmm, I dunno, a medical book?

The system — Carter lets Mrs. Graham go home, because he believes in respecting patients' wishes. Pratt protests, but Carter says the real problem is that Mrs. Graham doesn't trust the medical system. Yeah, she's probably been watching this show for 11 years, so who can blame her?

Now that's freaky — Abby and Jake are helping a guy who has and overactive thyroid, which can cause glaucoma. So Jake checks his eye pressure: he puts some sort of drop in the guy's eye, and then does something weird with some instrument, and then the guy's eyeball pops out. Yeah, you heard me: his eyeball comes right out of its socket. Chuny says "Oh, my god!" Abby explains that it's called a "subluxed globe" and tells Chuny to get an attending right away. Ewwww.

I knew he looked like a kid — It turns out Elena's lawyer is not really a lawyer but a third-year law student. Sam tells Neela that the Ativan move was really okay. Ray says Elena's coming around, so they go see her, and find an IV of "multivites." Who did that, they wonder? You guessed it: Lewis.

Sam: "Wow."
Neela: "What?"
Sam: "Who knew Lewis could start an IV all by herself?"

Bwa ha blah blah blah.

Pop-eye — Abby is trying to push the guy's eye back in, but it's not working.

Luka: "We need a Desmarres retractor."
Abby: "We don't have one."
Luka: "Uh... do we have a paper clip?"

Pop-eyed dude is not excited about the idea of the paper clip, but Luka tells him he won't feel a thing. Abby tries to do what Luka's telling her to do, but at one point she squinches her eyes shut as if she can't stand to look at the popped eye. Ick!

But it all comes out — err, goes back in — okay, and I blink like mad in sympathy.

You've done all you can — Lewis tells Elena to eat again, but Elena's not ready. She says that all her son has now is anger and hate, but he's still her son, even though he doesn't care about her. Lewis gets all greeting-card-ish and lies, saying that Santiago said "Please don't let her die," which is true except for the "Please don't" part.

Relating to the community — Pratt introduces Mrs. Graham to a breast cancer survivor. Mrs. Graham is not impressed at first, but then she listens. Perhaps maybe Pratt has finally done some good.

Carter's house — Wendall is there to get her stuff, but Carter is just getting home. It's cold out, but Wendall doesn't want to go in. You know, Wendall, you just might be strong enough to date Abby. What have you got to lose? Nothing, so she leaves. Poor whiny Carter is alone again, naturally.

Speaking of Abby — Jake is still trying to figure out what to call Abby, since she wasn't fond of "girlfriend." She suggests "my special friend," which is ridiculous; even "fuck buddy" would be better. Jake wants to know what she's afraid of.

Abby: "I just don't want us to go too fast and get ahead of ourselves."

Jake says she has two weeks to decide, because he has a big family thing coming up and his niece is getting baptized. Abby grins and plays along, but I don't like it for one minute.

Carter's answering machine — There's a message from Kem. Carter calls her back and tells her he's planning to name the new clinic after their stillborn baby. Aww. None of us saw that coming a mile away.

Welcome back — Sam and Lewis give Elena a little bit to eat. The phone rings while Elena eats her jello; it's Lewis's husband. Elena cries into the jello cup as Lewis talks to Cosmo on the phone. Lewis starts to recite a poem about hippos as life goes on in the ER.

NEXT WEEK ON ER: What? Another new episode? And three more after that? What are we to do? Well, I guess we'll welcome Danny Glover, for one thing. And we'll watch Carter go bye-bye. Bon voyage, whiny rich boy!

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