Sunday, February 05, 2006

ER 12.13 Body & Soul

No “Previously on”’s, as we get the title “Body & Soul”. We hear the same music that played in Season 7’s “A Walk in The Woods”. And since I very clearly remember the opening scene from that episode, I have to go through my checklist in anxious anticipation of seeing some naked Luka soon. Let’s see … Marlboros? … check. Wine? … check. Remote control for the thermostat for when it starts getting too hot in here? …check. As we go to scene, a man in a wheelchair slowly rolls into frame … oh, wait, it’s my second favorite creepy actor – James Woods. He would be my first favorite, but I love me some Walken. “I got a fever … and the only prescription … is more cowbell! His face is slack, and his head is being supported. There are people out of focus in the background. Close-up on a girl’s feet on ice skates, spinning. Camera pans up to show the figure skater twirling. We are obviously at an ice rink and we see other people skating in the background. As the skaters round the rink, Woods in the wheelchair rolls on to the ice. People are looking at him, and one guy does a really bad fall that’s supposed to look like he was caught short and not wanting to hit Woods, but it was a totally lame-ass attempt at a fall and looked really cheesy. Woods is tooling around the rink, oblivious to the stares. It’s not clear how the wheelchair is moving, because he doesn’t seem to have use of his arms or legs and there is no control-type thingy attached to his head. There is what looks like a laptop computer fixed to the front of the chair. Woods is looking around, but not seeming to see anything. A rink attendant skates up to him and tells him that he can’t be out there. Woods doesn’t respond. Rink Attendant keeps trying to get his attention and tells him that it’s not safe and he can’t be there. This looks sad. But what makes me even sadder is that I have a bad feeling that I am shit out of luck on Luka being shirtless this episode. Damn.

Haleh and Ray go out into the Ambulance bay to meet an incoming. Haleh tells Ray that they found some guy wandering and disoriented. Ray bitches that it’s just what they need … another lost soul. Please don’t make me say “shut up” this early in the episode, Ray. It just sets the wrong tone. Haleh thinks you can never have enough of them. All right, you asked for it. Shut up, both of you! Pickman the Paramedic is using a chair lift to unload Woods from the rig. She tells them that he is Nate Lennox, 54, and that his Medic Alert bracelet says he’s ALS. Oh, shit. That sucks. Lou Gehrig’s Disease is like my ultimate worst nightmare. What a horrifying disorder. I can smell the angst already. Thanks, ER. Pickman tells them that Nate is paralyzed and unresponsive and that he rolled out onto the ice at Prospect Rink. Nate has oxygen tubes up his nose and is still not looking at anyone. Haleh wants to know if someone was with him, and Pickman says that she called the number on the bracelet and left a message. Ray asks Nate if he can hear him, but Nate doesn’t respond. Ray wants to know how he got out of the house and Pickman thinks it’s a good question.

They wheel him into Trauma Yellow as Haleh asks if Ray thinks Nate was abandoned, but Ray thinks there is someone taking care of him because he has clean clothes and looks like he was shaved that morning. Haleh says that his pulse ox is only 89 and Ray wants him on five liters by mask. Haleh thinks they’ll need some lifting help but Ray wants to leave him in the chair for now. Ray is still wearing his coat and the nurse in the background has a heavy sweater and muffler on and another walks through wearing a coat. Is the heat not working? Haleh’s not bundled up, so I don’t get it. But if they need to raise the temperature a bit, just have Luka come in. Always seems to work for me. Ray thinks if they lay Nate down it might compress his lungs and make things worse as Haleh slips the mask on Nate. Ray says that there are crackles bilaterally as Nate starts to move his eyes around. Ray calls for some tests as Nate eyes him. Ray tells Haleh to call for Nate’s medical records. Nate looks down and blinks and the chair starts moving, startling Ray and Haleh, who grab it and pull it back. Ray asks Haleh if she hit the joystick but she shakes her head and says no. Ray says that the sats are up to 92 as Nate again looks at him, then down and blinks. The chair moves forward again. Hee. Even incapacitated people want to get away from Ray, too. Ray grabs the chair back again. Ray says “don’t do that” and Haleh protests that she didn’t touch it and asks if there is a short or something. Ray looks at the computer screen and sees four large arrows pointing in different directions and a “Stop” sign in the middle. The up arrow is blinking. Ray now understands the computer has an eye sensor and that Nate is controlling the chair and he wants to get out of there. Haleh thinks he’s altered from too low oxygen. Nate keeps trying to move the chair forward as they hang on to keep him in place. Ray disconnects the battery. Sam, wearing a coat, too, comes in and asks if they need a hand. Ray tells her that they have an ALS with pneumonia and they could use a hep lock, which is a Heparin injection. Sam asks what his name is and Ray tells her. Sam’s sure she’s seen him before, a while back. And I like Sam’s hair. Straight, and framing her face. And not too blonde. Good choice, Sam. Keep it up. Maybe I won’t have to be “all about the hair” tonight. Though we haven’t seen Abby yet, so I’m not holding out a lot of hope. Nate is looking at the computer screen, which now displays a large keyboard. He looks at the letter keys, blinks and they appear on the screen. He blinks out “no help”, and a computer-generated voice says it out loud. Cool. Haleh can’t believe he did that with his eyes. And for those of us in the viewing audience who couldn’t possibly understand what we’re being shown, Ray has to add that it’s a speech synthesizer program. Duh, Ray. How could I ever watch this show without you around to explain things to me? Gee, it would be such a huge sacrifice, but one I’d be willing to make in the interests of possibly finding someone who annoys me less than you do. What a tall order. There can’t be more than a million actors out there that would fit that bill. Sam condescends to Nate that it’s okay, they are going to take care of him. Nate blinks that he wants out …and the computer keeps repeating “please let me out” as Nate looks to all of them.

After Opening Credits, Nate is still sitting in the chair, but has been dressed in a hospital gown. Some random tech guy grabs Nate’s chin and the back of his head and tells him that they are going to sit him forward as another tech gets behind him. We see Ray and Sam looking in the Trauma Room door from the Curtain Area. They are both still wearing their coats. Is it really that cold in there? And the disabled guy with pneumonia sits around in just the gown? Nice. Sam tells Ray that the sats are still borderline. Ray’s not sure how aggressive they need to be with this patient. Sam wants to know if he’s DNR and I got excited for a second thinking she meant Ray, but am a little disappointed when I realize she means Nate. Ray thinks if he were like that, he sure as hell would be. And I now understand the reason for the coats – hell has frozen over - because I am in complete agreement with Ray on this one. They re-enter the room and Ray tells Nate that his oxygen levels are falling and asks if he understands. Nate doesn’t look at them. Ray of course then has to ruin whatever temporary solidarity I may have had with him by speaking loudly and slowly to Nate, like he is both deaf and retarded, telling him that they need to know his wishes about resuscitation. Nice, Ray. Nate looks Ray up and down. Nate blinks out “okay” and then “home”. Ray asks if that means he doesn’t want heroic measures. Nate repeats “home”. Sam has to pick up on Ray’s earlier patronizing tone and slowly asks Nate that if he stops breathing, does he want them to use a machine, a ventilator. Nate blinks “hungry” and “food”. Ray shakes his head as Sam asks Nate if he has a living will, an advanced directive, which I can’t imagine he wouldn’t have given this horrible condition. Nate blinks “drugstore”. Sam doesn’t think they are getting through to him as she looks at Nate worriedly. Ray asks if he knows where he is. Nate looks down and blinks on a tab that says “ALS Description” and the voice starts saying “I have Amyotrophic Lateral Sclerosis also know as Lou Gehrig’s Disease. It is a progressive neurologic disorder that has weakened my muscles. All of my senses are intact. My mind is clear”. Ray doesn’t think it is today. Haleh comes in with Nate’s old records. Ray wants the name of his neurologist. Haleh wants to know if Ray wants to up the oxygen and Ray wants to go with BiPap, which is Bilateral Positive Airway Pressure. Thanks, Google. Ray thinks it will buy them time without having to intubate. Looking at the old charts, Sam remarks that she knew he looked familiar and that Nate should already be on BiPap, she and Neela had treated him a year ago when he came in for shortness of breath. Close-up on Nate as we hear him in voiceover sounding like it is a struggle to get the words out saying “Every time you have a thought …” and the scene cuts to:

Nate is in the wheelchair in a classroom auditorium, in front of a projector screen, where it looks like some kind of molecular model representation is being projected. It is 2004. He labors through “Every time you take a breath … every time you move a muscle … every time you … take a crap” as the students laugh. Nate continues really fighting to get the words out, “You should thank your ATP … AT … ATP …” The class looks at him, concerned. His words are getting harder to understand as he says “Oxidative phosphorylation …” and the slides behind him change. He’s having a hard time breathing but keeps trying until he slumps forward a bit. Cut to:

Nate, wearing the same clothes he did when teaching, is looking at himself in a bedpan, wearing a contraption on his head that looks like a cross between Doc Brown’s crazy mind-reading helmet from Back to The Future, and the helmets Pippin and Merry wore in the Battle for Middle Earth in Lord of the Rings: Return of the King. And yes, I am pathetic. We hear Sam tell him that the bedpan may distort things a little. They are in an Exam Room and Nate comments “hoo, boy”, as Sam smiles at him and Neela writes on his chart. Nate thinks the kids at school are going to make fun of him. Hee. Sam, with her Season 11 curly hair, asks if the contraption is too tight, and he says that it’s fine. It looks like the nose hose is hooked up to oxygen to help him breathe better. Nate complains that it’s like an oven in there, and Neela apologizes that the air conditioning is being fixed. Is this supposed to parallel the heat not working in present day, hence all the coat wearing? I’m sure once again that there won’t be an explanation. Nate says that he’s so hot, and Neela explains that the BiPap increases the tidal volume, and that his neurologist says that it will give him more energy and a longer survival. Malik walks in and he’s got shorter hair in this scene and not the huge ‘fro we’ve seen him with this current season. He tells Sam about the labs on her “heat stroke guy”. As she leaves, she tells Nate that she’ll be right back and he says “I’ll wait here”. Hee. I like Nate – he’s snarky. Neela listens to Nate’s chest and he asks where she went to med school. She tells them she went here to County, but that she was a Biochemistry major at Yale, so she placed out of his class. She says that she worked in Sandra Hamilton’s lab in her senior year and that they were in awe of his work on anti-sense RNA and that she cited several of his studies in her paper on gene inactivation in Trypanosoma brucei, which is the flagellate protozoan that causes “sleeping sickness”. Thanks, eMedicine. Nate’s surprised that she published as an undergraduate. Neela proudly says that she was second author. Nate’s impressed. He asks what she is doing there “in this, uh, cesspool”? Hee. Same thing I was thinking, Nate. If she went to Yale and was that advanced, what the hell was she doing going to med school at … County??? He wants to know if she’s just there for the big bucks. Hee. She just smiles as he asks what it’s going to be … Orthopedics? Plastic surgery? Neela tells him neither. She says that she can’t stand surgeons – they are arrogant workaholics who can’t relate to people unless they’re asleep – oh, yeah, this is so foreshadowing that she is definitely making the switch to Surgery. Hee. Although, at this point in Neela’s career, she couldn’t relate to people either. She didn’t start to get it until Luka forced her to deal with the empathetic thing in “Only Connect” in the middle of last season. A tall woman bursts into the room, apologizing to Nate that the car overheated and she had to take the El. She comes over and asks him what happened. It’s Ally Walker, who I loved as Samantha Waters on the show Profiler, part of the “Saturday Night Thrillogy” with The Pretender and Dark Skies on NBC in the mid-nineties. Good times. She’s looking beat here, and really, really thin. Nate tells her that he’s fine as Neela fills in that he had some shortness of breath and introduces herself. Ally says that she’s “Fran Bevens” and asks if they were able to reach Dr. Ames. Neela tells her that he’s already been down. Nate says Dr. Ames is consulting the speech pathologist. Fran thinks that’s good, but Nate doesn’t think he needs it. Fran tells him that it’s getting hard for people to understand what he’s saying. Nate thinks that they should start listening better. Hee. Sam and a doctor, who is apparently Ames, burst into the room. He says hello to Fran who hugs him and says “Jared … it’s good to see you”. This, and the fact that “Sam” walked in with him, takes me right back to my old Saturday night viewing, because Sam was her character’s name and Jared was the name of the main character on The Pretender. Again, good times. See, I told you I was pathetic. Ames asks Nate if he’s ready to start as Sam, not Ally-Sam but ER Sam, sets a laptop on the table in front of him. Nate says that he is trying to contain his enthusiasm. Sam asks how long they’ll be. Ames says “half hour”, but Nate corrects “15 minutes”. Neela tells them that they’ll be back with his aftercare instructions as Nate stops her. He tells her to think about what she’s doing and that she may realize that she doesn’t belong there. Call Dubenko and Snotty Surgeon because I think they’ll be needing to make room on their roster soon …

Sam asks Neela where Nate thinks she belongs as they walk towards Admit. Neela thinks he means back at the Jumbo Mart, and that he misses her slushies. Hee. I’ll bet Abby wishes you worked there, too, Neela, because then you could have given her the Employee Discount on the plastic snowglobe she bought Luka for Christmas. She could have saved a whole … fifty cents or something. Sam walks away as Neela approaches Abby, who says “please be kind” and Neela laughs as they walk towards the board. And whoa … nice hair, Abby. Except, not. Looks like she borrowed that wig from Cha-Cha. Really bad and it’s got these horrible blonde streaks in it. I get that they are trying to approximate her hair from the beginning of last season, but couldn’t they have done a pony tail or something that doesn’t scream “Wig!” so loudly? Because, really, it’s just terrible. And how did I know that it would be Abby to start off my “all about the hair” bitching? Thanks. Bitch. Neela starts rattling off patients. Abby notices the name “Lennox” and asks if it is Nate. Neela says “yeah, the biochemistry professor”, as Abby takes off towards the Exam Room. Neela calls after her that she has one more, but Abby says that she’ll figure it out.

She walks into the Exam Room and says hi to Nate, who asks if she likes his new look. Abby doesn’t think a lot of people could pull that off. Yeah, same could be said of that freakin’ wig, Abby, which you are so not pulling off right now. Fran tells her that it’s good to see her and Abby says “hi, Fran” to her, so they obviously all know each other. Abby then asks Nate what he’s doing. Nate snarks that he’s playing Medal of Honor and he just killed a convoy of Nazis. Abby grins at him because she knows just how many points that equates to in the game. Ames chimes in that Nate’s facial muscles are weakening and he needs to practice with assisted speech. Nate clicks the touchpad and the computer voice says “hey, I got a great idea”, as Nate pushes the joystick on the wheelchair. The chair lurches forward, knocking the laptop off the table, to which Nate says “oops”. Hee. I really like him – he’s an ornery bastard. Too bad I’m sure that he won’t be surviving this episode. Ames says that they can wait on speech therapy for the time being, as Abby picks the laptop up off the floor. Ames continues to Nate that he is just putting off the inevitable. Fran reaches into her purse and pulls something out, telling Nate that he needs to start wearing it. It’s a bracelet and she puts it on his wrist. He wants to know why he has to wear it and Abby tells him that it has his diagnosis on it and his name and phone number. Fran quietly tells him that they were lucky he was in class today, “otherwise who knows what might have happened?” Nate’s showing discomfort with the thing in his nose, so Ames adjusts it. Nate wants to know if he has to wear the head contraption all the time. Ames thinks that they’ll start with bedtime use because he’ll get the benefits of eight hours a night while he sleeps. Yeah, don’t believe it, Nate, because that’s what the orthodontist told me that about my retainer, too, and I ended up having to wear that stupid headgear 24/7. Nate looks down, dejected, and sadly says that he keeps waking up and something else is gone, as Fran watches him. Cut back to:

Today, Trauma Yellow. Fran is there, looking even more tired than in the flashback. Sam and another nurse, both in their coats, are helping Nate, who’s in a lifting harness, and has the head contraption on. Fran comments to no one in particular, “Thank God for the bracelet” as Sam asks if he’s comfortable. Fran tries to talk to him, but there’s no response. Ray tells her that he was speaking with the computer when he was first brought in. Sam says that they can’t get an IV in him and Fran explains that he always needs a central line. They lower Nate down to the bed. Fran questions that he was found at an ice rink. Ray asks if she has any idea why. Fran honestly doesn’t know. She says this was like any other day. She got up and shaved him, bathed him, fed him breakfast and then transferred him to the chair. He was watching TV so she went to take a quick nap. It’s got to be both physically and mentally exhausting taking care of someone who is that dependent on you for everything – no wonder she looks so drained. Ray wants to know how Nate got outside. Fran answers that he can open the front door with his computer. Luka walks in, and the temperature in the room goes up a few degrees. Okay, not really, but mine certainly did. Luka’s wearing a Luka Blue II shirt with tie on under a v-neck pullover sweater. Are you cold, Luka? ‘Cause since you’ve warmed me up a bit, I’d be more than willing to return the favor. Just saying. Fran says “Dr. Kovac?” Luka looks at her questioningly and she says who she is and that he treated Nate a few years back. He doesn’t seem to remember, but I don’t question at all that Fran would remember him. How could she forget? Ray fills Luka in about Nate’s pneumonia as Luka takes a look at the x-ray. Fran moves the computer, which is on a hospital tray table, in front of Nate. Ray says that Nate is altered, borderline oxygenation, even with the BiPap. Luka asks Fran if they can have a word. He, Fran, Ray and Sam step away from the bed. Luka tells her that they need to make a decision about intubating and ventilation. Fran asks if Luka thinks Nate can get over the pneumonia. Ray says that he could, or Nate could be intubated in the ICU, going downhill for four weeks. Sam pipes in that Nate doesn’t have a lot of reserve and there’s no guarantee that he’ll get better. Luka thinks this may be the natural end point of his disease. Fran thinks that maybe it’s time to focus on keeping him comfortable. Abby bursts into the room and walks over to Fran telling her that she just heard they were there. And like Luka, Abby’s just wearing a lab coat over her turtleneck and not a winter coat like Ray and Sam. I still don’t get the coat thing. Though I did say in the “I Do” recap that being that she’s from Minnesota, Abby may be impervious to the cold. She and Fran hug and Fran thanks her for coming by. Abby tells Luka that she’s taken care of Nate before, in a tone that pretty much says she’s taking over now. Oh, good. I feel so much better already. She walks over to Nate and listens to his chest, grinning at him as he looks at her. Fran tells her that Nate decided to go out by himself. Still grinning at him, Abby asks, kind of condescendingly, “why’d you do that, Nate?” Nate looks at the computer and blinks out “in motion”. Abby asks him “what’s in motion?” as the computer voice says “free”. Abby looks at the monitors and says that his pulse ox is down to 82, in a tone that says that she is disbelieving that they let it get that low. She moves behind Nate to lower the bed as Ray asks what she’s doing. She complains that his lungs are full of junk and his sats are down, so he needs to be intubated. Luka tells her that they’ve just been discussing how best to proceed. Abby snipes at him “well, helping him breathe would be a good way to start, don’t you think?” as she brandishes the scope with a flourish. She’s really being snotty here. You should watch how you talk to your baby’s daddy, Abby. And considering he’s like your boss and all, too. Fran tells her that she doesn’t think Nate would want that. Abby stops and looks at her, then over at Luka, shakes her head a little, and continues with the scope. Ray says “Abby …”, but she cuts him off calling for a Yankauer, holding out her hand. Luka tells her that they haven’t come to a consensus. Abby grabs the suction herself and sticks it down Nate’s throat. Why isn’t Luka stepping in a little here? I know it’s Abby, Luka, but she’s like half your size so you don’t need to be afraid of her. Though with the pregnancy hormonal stuff on top of her normal bitchy tendencies and control issues, maybe I don’t blame you. Fran says that she doesn’t feel comfortable with this. Abby tells her that she’s not intubating. Everybody just stands there and stares at her as she suctions out Nate’s throat, saying “large mucus plug at the chords”. Luka is watching her like he’s trying to figure out why she’s doing this. She puts the suction down and pulls the scope out, saying that should help. Ray says quietly “temporarily”. Abby lifts the head of Nate’s bed up as Sam says, impressed, that the sats are coming up. Oh, come on! Abby’s the only one who figured out that suctioning might help a little? Ridiculous. Abby thinks this will give them time to treat him with oxygen and antibiotics until he’s alert enough to tell them what he wants. Abby seems a little too pleased with herself, thus annoying me further. Luka rubs Nate’s sternum saying “Dr. Lennox?”, but there’s no response. Fran implores him to talk to them, as Abby watches, actually starting to look a little unsure.

After commercial, Luka, Ray and Sam, all wearing lead aprons, are using a fluoroscope. Ray is placing something in Nate’s subclavian. Luka says “okay, that’s as far as we go”, and gestures his head towards someone outside the room. Fran and Abby come in and Fran asks Luka how Nate did. So, was Abby out of the room because of the radiation? Have they told anyone about the pregnancy yet? If they didn’t, wouldn’t Sam and Ray think it strange that she wasn’t in there? Or did she just make it like she would keep Fran company in the hall? Again, I’m sure there will be no explanation. Annoying. Luka tells her that he did well and that they are starting the IV antibiotics. Sam asks when Nate last ate, and Fran says that she fed him this morning. Duh, Sam. Weren’t you paying attention earlier when Fran told you that she fed him breakfast before she took the nap, and that’s when he left the house? Again, annoying. Ray thinks Nate could use some calories. Abby and Fran are on opposite sides of Nate’s bed, looking at him. Abby asks him how he’s doing. Fran tells him he’s in the hospital. Abby tries to get his attention. She asks him if he remembers when they had talked about putting in a trach if he had trouble breathing, and that he said he wanted to keep going until they found a stem cell cure. Nate is looking at Fran. Ray asks Abby “why don’t we just let him rest?” Abby ignores him as Haleh comes in telling him that they have a snowmobile versus tree coming in. Ouch. She then says that Morris needs some help, and I am so with you on that, Haleh. Luka orders 500 of Azithro after the Rocephin as he walks out. Abby whines to Nate “Okay, we all need to agree on this. You told me you wanted a trach.” Fran protests “That was a long time ago, Abby”, and explains that Nate’s biggest fear now is that he’ll end up on life support, aware of everything, but with no way to communicate. Yikes. Abby snottily replies “He was communicating a half hour ago, wasn’t he?” Fran looks at her, kind of stricken. Ray thinks it could have been random eye movements. Sam asks Fran “400 cc’s of Jevity?”, which is an isotonic, fiber-fortified, high-nitrogen liquid formula providing complete, balanced nutrition for patients requiring short- or long-term tube feeding (thanks again, Google), and Fran quietly says “yeah”. Fran, looking conflicted, asks Abby, “so if we do the trach …” and Abby tells her “he’s out of here in a day”, and he can go home with a portable ventilator, and that Fran would have to learn how to suction and troubleshoot the vent. Fran wearily rubs her forehead. Abby sympathetically tells her that they can get her some help, and that she knows Fran is tired. Fran says that Nate is the one who’s tired. Abby protests “Fran” and Fran gives her a pointed look and says “I’m with him every day, Abby”, and nodding, adds quietly, “I know”. Sam tells them that they have a clogged G-tube. Abby asks Fran if she flushes it with water, and Fran says she does after every feeding. Ray pipes in that Nate needs nutritional support soon to fight off the infection. Sam keeps trying, but says it won’t go. Abby asks Fran if she knows when the tube was put in. Fran, a bit ashamed, says that she doesn’t. Ray reads the chart and says that it was placed in May 2002 and that Nate came in after a choking spell. Flash back to:

An awards dinner with a banner that reads “Congratulations, Class of 2002”. Anspaugh is at the podium. He is presenting the “Teacher of the Year” award. Fran and Nate are dressed up and sitting at a table. Nate is in the wheelchair, but seems to have much more mobility, little trouble speaking, and is feeding himself. We hear Anspaugh in voiceover saying that “this year’s award is unique in that the students have chosen not a clinician …” Fran is commenting to Nate on how she loves the fresh flowers and Nate bitches that they must think it will make up for cutting back on his teaching. Anspaugh continues “… but rather, a scientist, whose dynamism and passion for inquiry made a strong impression during their first year and stayed with the students throughout their training”, as Fran asks for a glass of wine and Nate puts some food in his mouth. He starts to choke as Anspaugh says “This year it gives me great pleasure to present the 2002 Teacher of the Year Award …” Fran worriedly asks Nate what’s wrong as he continues choking. Anspaugh says “… to Dr. Nathan Lennox”, as Nate starts gasping for breath and Fran loosens his tie. Cut to:

Anspaugh on the phone in the ER, and Pratt and Ames walking to Nate in the Curtain Area. Pratt tells him that his chest x-ray is negative for aspiration. Ames tells Nate that he got lucky. Nate deadpans that he is the luckiest man on the face of the Earth. Ames thinks it’s time for a feeding tube. Nate doesn’t think so. Pratt tells him that his chewing and swallowing muscles are getting pretty weak. Nate says that Fran will have to cut his meat smaller. Fran tells them that it takes Nate an hour to eat a meal and that he’s lost ten pounds, but Nate corrects that it’s more like five, and the rest is water weight and rolls his eyes. Hee. Fran has not moved her hands from Nate’s shoulders. Ames says that weight loss accelerates the progression of ALS and that the extra calories from the tube feeding will mean increased strength, more energy and longer survival. Nate says he’ll think about it as Anspaugh comes up. Ames asks if Romano is around, but Anspaugh says that he’s stuck in the OR with a pneumonectomy, but he’ll see about getting Nate on the schedule. Romano! And I guess since he’s stuck in surgery, we won’t get to see him. Memo to Paul McCrane – we would not have taken it as a sign of huge ego if you had put yourself in this scene. Really. You missed a prime opportunity to give those of us who actually miss Rocket Romano a huge thrill by letting us see him again. Hell, Hitchcock used to put himself in the films he directed. And I’m sure there won’t ever be another chance to do this. Bummer. And speaking of missing former cast members, I’m reminded once again how much I miss Susan … and Sherry Stringfield … and her hair. Damn, Ally Walker is tall. She’s towering over all the guys in this scene, though I imagine since Fran’s dressed up, she’s wearing high heels, but still. Nate bitches that he said he’d think about it. Anspaugh says that they’ll save him a spot and can always cancel it. Nate nods as Anspaugh says good night and walks away. Fran says that she’ll walk out with him and Ames, and tells Nate that she’ll be right back. Nate says goodnight to them, and yells after them to send the trophy to his mother. Pratt asks about the trophy and Nate says that he won the potato sack race at the county retreat. Hee. Pratt looks the wheelchair up and down and scoffs. Nate asks “Abby Lockhart around?” I’m guessing that since they’ve said that Nate is a biochem professor for the first year med students, Abby had him as a teacher during her first go round in med school. And apparently she not only knew him well from having treated him as a physician, but they had kept in touch even back when she wasn’t in med school. Since he’s asking for her, and May 2002 would make this the end of Season 8, he knows that she went back to nursing and is working in the ER. Pratt says that she’s not. Nate thinks it’s pretty quiet around there, and Pratt says that sometimes it’s slow. Nate gives him a look and says that it’s not just that. He wants to know if they are cutting back on staff or something. Pratt explains that one of the attendings, Mark Greene, died and a lot of people took off for his memorial. Mark!!! Wow, they haven’t mentioned him in a while, not since “The Show Must Go On”. Makes me think of how much I don’t miss him. And there’s Lily! Yay! Boy, they haven’t given her much to do this year. We’ve seen a lot of Chuny, Malik and Haleh, but Lily only showed up in “Blame It On the Rain” to save Abby from Dubenko’s indecent proposal. Maybe she’s only in it tonight because Paul McCrane loves her, since he directed that ep, too. Lily tells Pratt that Chen wants him in Exam 3 with the belly pain guy. Pratt thinks it’s a “slam-dunk diverticulitis”. Chen didn’t go to Greene’s funeral? Nice, Chen. You’re not even on this show anymore and you are annoying me. Abby and Luka went, and they didn’t work with him for as long as you did. I never noticed before that she wasn’t there. But then again, it’s Chen, and the writers didn’t even seem to notice her. Pratt bitches that he called Medicine and all Chen has to do is co-sign his chart. And Pratt’s acting like the total brat that he was when he came on this show that season. I so miss those days. Except, not. But it is nice continuity. Lily says that she’ll let him tell her that himself. Hee. I always liked Lily. Can we bring her back? And Randi. And Lydia. And Susan … and her hair. Pratt shakes his head pissily as Nate looks at him. Nate asks what year residency he’s in. Pratt says that he’s an intern. Nate smiles and says that Pratt’s pretty cocky for an intern. He tells Pratt that he is either real smart or really insecure. Nate’s a pretty intuitive guy. Pratt says that if he were Nate, he’d put his money on the first one, which so means that it’s actually the latter. Nate rolls his eyes and says “of course, because all the great minds want to work in the County ER”. Unlike you, Nate, who wants to teach at the County Med School. Pratt tells him that it’s temporary and that he’s planning on moving over to Northwestern soon. Nate sincerely congratulates him, and says “got in, huh?”, and Pratt arrogantly replies, “not yet, but believe me, I will”, as Nate smiles at him. A nurse gives Pratt the pre-op instructions for the G-tube and Pratt starts to explain them to Nate. Nate suddenly gets teary-eyed, then starts blubbering. Pratt looks at him, and uncomfortable, asks if he’s okay. He tells Nate that he knows it’s hard … but Nate interrupts that it isn’t him, it’s the disease, as Fran comes back. Fran pats him on the shoulder and wipes his eyes. She tells Pratt that nerve deterioration leads to pseudobulbar affect, his emotions can be very exaggerated. As Fran tries to comfort him, Nate says that it’s called emotional incontinence, and it sucks, and I’m so with you on that, Nate. I have emotional incontinence, too, that causes me to cry my eyes out any time I see the movie Beaches. Shut up! You try to keep dry eyes listening to Bette sing Wind Beneath My Wings at the end. Nate says “you get a little upset about something and the next thing you’re crying like a baby”. Pratt thinks there should be medicine he can take for that, but Nate says the side effects are too much. Nate adds that it’s the BDNF … he’s been injecting Nerve Growth Factor twice a day for a year. He says that the stuff turns ALS mice into Olympic athletes. What kind of events would they have at the rodent Olympics? Trap dodging? Wall scaling? Hole chewing? Nate cries that the human trials are worthless. Fran tells Pratt that results haven’t panned out on humans. Pratt’s sorry to hear it. Nate wails that Fran has to pour Ensure in his stomach tube all day long, as Pratt looks away, wishing he were anywhere but there. Fran keeps trying to get Nate to calm down as he heartbreakingly sobs “I just didn’t want to be a burden on anyone”. Flash back to:

Today. Close-up on Nate’s left eye as a tear rolls out. Fran asks if this should be hurting him. Ray says maybe just a little and that the G-tube is in. Sam says the balloon is up and to check the flow, as Abby injects something into it. Fran says that she thinks Nate is waking up a little bit. Abby tells Sam to go ahead and set up for PFT’s. Ray says that the flow is looking good. Sam hands Abby some kind of machine and Abby says they need to test his lung function. As Fran removes his nose tube, Abby tells Nate that she’s going to put it in his mouth and that Sam is going to pinch his nose. I don’t think that now is quite the time for nose tweaking, Sam. Oh, it’s apparently to keep the air from blowing out of it. Abby puts the mouthpiece in Nate’s mouth and Fran holds his head steady. Sam puts a clamp on Nate’s nose and Abby tells him to take a deep breath. Nate takes a wheezing breath and a machine beeps. Abby tells him to blow it out and the machine beeps again. She says “great” and removes the mouthpiece. Ray says that the forced vital capacity is 32% of normal. Sam starts to explain that it’s the amount of air he can move, but Fran says that she knows what it means, and hands Sam the nose hose. Abby leans over and talks to Nate. She looks him in the eye and tells him that his lung capacity has deteriorated. She says that the best way to help his breathing is for them to put in a trach, and that he’s going to need assisted ventilation. Fran looks at her warily, as Ray shoots her a “I can’t believe you’re back on this” look. Abby asks Nate if he wants them to do it. She continues that she’s not sure he’ll recover without it and that the trach is the best chance he has of clearing up his pneumonia. Nate blinks out “okay”. Abby thinks he’s given consent and tells Sam to call surgery. He then blinks out “I’m okay”. Fran says “Abby, I don’t think that’s what he meant”. Abby can’t believe it and says “What? He said ‘okay’”. Sam points at the screen and says that he said “I’m okay” after that which could mean leave him alone. Ray says that it’s not exactly informed consent. Abby leans back over and forcefully says “Nate, you want the trach, don’t you?” Nate’s not responding. Abby pissily says to everyone “You know, you all heard what he said!” Fran retorts that at a vital capacity of 30% some ALS patients enter into hospice care and it means they have six months to live. Crossing her arms, Abby shoots back that his FVC is low, yes, but that’s because of the pneumonia, and if they clear that up and his lung function will bounce right back. Ray thinks that’s the best case scenario. Sam puts in that Nate expressed his wishes in advance and now he’s too sick, he can’t give reliable consent. Luka comes in and asks how Nate’s PO2 is. Abby tells him that she wants to do a trach. Ray informs him that they have a consent issue. Abby tells Luka that she explained the procedure to the patient and she asked him if he wanted them to do it and he said “okay” on his computer. Luka asks “He did?” and Abby nods as Sam adds that he also said “I’m okay” after that. Fran doesn’t think that Nate understood. Luka looks unsure and Abby tells him that Nate was alert and looking at her the entire time and that he understood. Fran really doesn’t think that this is what he wants. Abby looks away disgustedly as Luka says that Fran has a durable power of attorney and that it’s her call. Abby looks over at Nate, and makes a decision. She can’t keep quiet and bitchily exclaims first to Luka, then to Fran “You know, look with all due respect”, and she is so not being respectful here, “I’m sorry, but … Nate expressed his wishes, and I think we have to go with that”. Everyone looks to Luka, who, kowtowing to his baby’s mother, because he’s knows he so won’t be getting any for a while if he doesn’t, with a hangdog look towards Fran says that “if there’s a chance that he asked for the procedure …” Fran interjects that she’s not sure that he did. Luka stutters that he thinks they have to do it, finally looking over towards Abby, ostensibly because he needs her approval, and to ensure that she does indeed have his balls. Jeez, Luka. Is this a pattern with him where his girlfriends can just walk all over him and use him to get their way at work? Carol did it in Season 6, Sam did it last year when he covered for her killing a patient, now Abby’s got him by the short hairs. And since Abby is carrying his child, we do know that he actually does have genitalia, even if he’s letting her keep it right now. As much as this seems that Luka is deferring to Abby here, I think that he actually is doing what he should given the ambiguity of Nate’s statements and his current non-communicative state, Luka’s really just erring on the side of caution. Ray starts to protest, but Luka cuts him off and tells him that he needs him next door to help him with a central line. Ray shoots a look at Abby before he and Luka walk out. Fran can’t believe what just happened. At least Abby has the grace not to look all smug here, or else I’d really have to smack her. Fran tells Sam that she’d like to page Dr. Ames and Sam says she’ll try to find him. Abby tells Sam to call Dubenko to put in the trach and RT to set up a vent. She looks over at Fran who glares back at her with a “what are you doing?” look. Abby walks out and Fran stares after her.

Okay, look, I love Abby … I really do. I know a lot of people out there don’t, but I think she’s an intriguing character– how many other shows have a lead who is so intrinsically flawed, where we are shown all the good and bad things about her, all of her fuck-ups, and who can be so completely frustrating sometimes yet is still always fascinating to watch? Of course, a lot of that is owed to how compelling Maura Tierney’s acting is, but also because I think there is something about Abby that makes us identify with her. And despite how difficult she is to deal with at times, we still end up rooting for her. However, that being said, she is just bugging the shit out of me right now with the pushiness. I hope we get an inkling as to why she’s acting so overbearing because she is just being insufferable.

After commercial, they are putting in Nate’s trach. Dubenko is talking Neela through the procedure, and Sam is assisting. They are wearing masks, but Abby and Fran, who are in yellow trauma gowns and standing at Nate’s head, are not. Weird. Neela ask Nate to close his eyes if he’s having any pain. He’s awake through this? Yikes. Don’t think I’d want to be awake while someone is cutting a hole in my throat, but that’s just me ‘cause I’m kind of pain intolerant. Abby assures Fran that it doesn’t look like he’s feeling anything. Dubenko tells Neela to aspirate air and confirm that she’s in, as Sam hands her the guidewire. Fran asks “So you’re in surgery now, Neela?”, but Neela says that she’s just doing an elective. Fran says quietly, “Well, things change, right?” as she watches Nate. Neela thinks they certainly do as Dubenko calls for the eleven French dilator. Sam says that the balloon’s good to go as Fran murmurs to Abby that she hopes Nate is okay with this. Abby doesn’t say anything, as Neela seems to have trouble advancing the dilator. Dubenko tells her to use a little more muscle as he pushes down and we hear a sickening crunch. Yuck. Nate gasps. Abby asks him if he’s doing all right, as Fran chews worriedly on her nails. Nate doesn’t answer and Dubenko tells Neela to remove the dilator, then says to slide the trach tube in. Blood starts to pool around it and Neela says there’s a bit of oozing. Dubenko thinks that direct pressure should take care of it and says that a little bit of bleeding can be normal as a monitor starts beeping. Sam says that Nate is tachy at 130. Abby says that she’ll open up his fluids. Fran asks Dubenko if Nate’s okay and he says that Nate may be sensitive to the blood loss. He tells Neela to take another look and she removes the pressure. Nate starts really bleeding. Fran gasps “Oh my God” as Abby catches her breath. Dubenko calls for pressure again and asks for a ten blade. Fran asks what he’s doing and he says that he’s converting to an open procedure and that they need deep hemostasis. Abby calls for two units of packed cells and Sam rushes over to the phone. Fran says “A blood transfusion?” Abby says it’s just a precaution and tells Sam to call for type specific and asks if she can see if his antibody screen is in his old chart. Neela tells Abby to grab a Yankauer. Fran loudly asks “What’s happening?” Dubenko says there is a minor complication. Fran doesn’t think it looks minor. She looks really scared. Abby says that the suction is on high. Fran tells her that she never should have let her do this. Dubenko wants a mosquito clamp. Sam says that the antibody screen is negative. Abby is suctioning out the blood from Nate’s throat as Dubenko and Neela work on the incision. Nate sounds like he’s choking. He’s looking around. This is awful. Sam notices and says that he looks like he’s in pain and they might want to give him some pain medication. Neela calls for four of morphine but Fran stops her. Looking at the chart, Sam says “yeah, don’t give him morphine. He had a bad reaction to it in 2001 when he came in with a broken wrist.” Flash back to:

2001. Nate, not in a wheelchair, and a student are hurrying through the door of a stairwell. Nate is holding his right arm close to his body, carrying papers in his left, and is limping a little. Student is telling him that the transgene will be suppressed, but Nate says that they’ll use two fluorescent reporters with different spectra. Nate is speaking very animatedly. Student ask why two and Nate says that one is for transfected cells and the other for translational fusion with the target gene. As they walk quickly down the steps, he reaches across his body with his left hand to steady himself with the railing. Student thinks it’s brilliant and Nate says that it’s simple as they cross the landing to the last set of stairs. Nate trips and falls down the steps, landing on his left hand. He groans in pain as we cut to:

Nate’s hand is suspended in a splint as Malik, with a huge ‘fro again, injects four of morphine into his IV. Nate tells Student to get back to work on the plasmid DNA vectors. Student questions “right now?” but Nate doesn’t want Gregorio beating them to the Nobel Prize. Would a brilliant, possible Nobel Prize winning scientist really be teaching at … County??? Yeah, okay, I buy that. Student hurries out past Luka, in scrubs, on the phone. Fran is standing at the foot of the bed and reminds Nate that he is not supposed to be taking the stairs. Nate tells her that they were servicing one of the elevators. She thinks he could have waited for the next one, but he angrily says that he was already late, and she demurs. She tells him that she’s cancelled his morning classes. He tells her not to be ridiculous and asks why she did that, as Luka gets off the phone. Fran says that she couldn’t get a hold of Baker and he’s the only one … as Nate starts to balk “Baker doesn’t …”, but they stop as Luka approaches the bed. Fran asks “What did he say?” Luka explains that he said he thinks it’s time to start using a wheelchair. Luka’s got a really short hairdo. And since they said this is 2001, then he’s most likely still dating Abby. Does that mean they played Hair Salon during their first go-round, too? Maybe that’s why they broke up – his work as Shampoo Boy was slipping because her hair looked a bit rat’s nest-ish in the early Season 8 episodes. And don’t think it’s not significant that they didn’t start their second go-round until after she finally got rid of the God-awful non-flattering bleached blonde tresses halfway through last season. Technically though, Luka didn’t sport this super short ‘do on the show until he returned from Bosnia in the second half of Season 8, and they weren’t together then. I hate half-baked hair continuity. Nate scoffs “You’ve got to be kidding”. Luka tells him that the weakness in his legs is progressing to the point that it’s not safe. Fran thinks that next time he could break his hip. That reminds me, once again, Weaver is not in this episode. And we haven’t seen Chi-Chi either. Or Morris. Not that I’m complaining about the last one. And Luka with the short hair and in scrubs … yum. Luka says that they have power wheelchairs, motorized scooters, and that Nate will still be very independent. Nate looks at him and cynically adds “Until my battery goes dead”. Luka tells him that he won’t be losing something, but he’ll be conserving energy so that he can do more things. Nate thinks they’re trying to turn him into an invalid. Here comes Luka’s High Horse to exposit that people with degenerative diseases do best when they have … as Nate interrupts and snarks “What? Hope?” Nate asks Luka if he reads the paper. Nate complains that Bush just banned federal funding for embryonic stem cell research. Luka looks down as Nate says a little brokenly that he is “trying to hold on to hope, Doctor, but nobody’s cooperating these days”. He looks at Fran, who looks back at him tenderly, then he looks away. Luka says that Dr. Ames has some papers on mobility assisted devices, but Nate says he doesn’t want them. Fran says that she’ll go pick them up, and thanks Luka, touching his arm. Hands off, bitch. I like you, Fran, and really don’t want to have to hurt you. As she leaves, Nate calls after her “Not for me … Not for me!” Luka grabs some gauze to start wrapping Nate’s hand. He pushes on a sensitive spot, and Nate groans in pain. Luka asks if Fran drives him to all his doctor visits. Nate responds “Mostly she just drives me crazy”. Hee. He keeps wincing in pain as Luka exams his hand. Luka asks how long they’ve been together. Nate looks at him and explains that they aren’t together, Fran works for him. Luka’s surprised and asks if it’s been for some time now. Nate says 15 years. Fifteen years? As a personal assistant? For a professor? What??? Nate tells Luka that Fran was right out of college and he needed an assistant who was “on the ball”. Yeah, I’ll bet you did, Nate. Nate says that she was ridiculously overqualified. He continues that the only thing that really surprised him was that she stayed after the first year. He says that she could have gone to law school, or business school … He adds admiringly, “But I have to say, she stuck with me”. Luka thinks she knows Nate pretty well, and he thinks that’s why he assumed that they were … Nate protests no, no, no, no, no, and chuckles. A little wistfully, he says that there was a point, a million years ago, when it almost happened, but then he came to his senses. He asks Luka if he’s married. Not looking at him, Luka shakes his head. Nate thinks that then he understands, who has time for family when you are devoted to your work? Luka thinks that some people try for a balance. Nate thinks that maybe if you’re an ER doc, “but if you’re trying to push back the frontiers of science, it’s 24/7.” Luka nods and says “right”. Nate eyes him and says that it’s not bad to be married to your career, as Luka looks at him skeptically. Nate says that his career is a good companion, and it never nags him. Nate gets a funny look on his face and starts to gag. Luka asks if he’s okay and puts an emesis basin under his chin just as Nate starts throwing up. Luka tells him that it’s a side effect of the morphine. Nate thinks that’s good to know. Hee. Luka holds up a needle and tells him that it will make him feel better. As we cut back to the present. What is the significance of this flashback with Luka? The first one with Neela pointed out that she was going down the wrong career path, and the second with Pratt highlighted that he masks deep-seated insecurity with bravado, but what is the point of this one? Where was Luka in his life at this time? We don’t know when in the year this is, but for most of 2001, Luka was in an often dysfunctional relationship with Abby. After they broke up, it wasn’t long before he took up with Nicole. He was prepared to marry her when he thought she was pregnant, because it was the “right thing to do”. Maybe I’m reading too much into it and there really is no meaning other than to show the progression of Nate’s disease. But what fun is that?

Sam injects two of versed into Nate’s IV. Abby is still suctioning, and Dubenko and Neela are still working on his neck. Abby says that the sats are only 89. Fran thinks that maybe they’ve done enough. Neela says that they need to find the source of the bleeding. Fran wants to know what happens if they can’t. Dubenko says that they may have to split open his chest. Fran puts her head in her hand and says “Damn it!” Abby tells her that it’s a detour and that they can get back on track. Fran looks at her and pointedly says “You don’t know that”. Sam tells Fran that if she likes, she can take her to the Family Room. Uh oh. Don’t do it, Fran. Though since it’s Sam and not Abby, you may be spared participation in a fishnet photo shoot. Fran says forcefully “No!” Sam tells her okay, and to stay there and hold Nate’s hand and talk to him. Dubenko calls for vascular clamp and pickups. Neela wants Frazier tip suction. Fran leans over to Nate and says that she’s so sorry, but Abby pushes her away saying “careful, careful”. Even though Abby was probably just trying to keep Fran from getting in Dubenko’s way, it still seemed kind of bitchy the way she pushed her away. Abby and Fran really appear to be in a kind of tug-of-war over Nate. And I’m not suggesting that it’s some kind of romantic triangle type thing, because God knows this show has had enough problems with geometric shapes involving Abby, but it’s more of fight about who knows what’s best for Nate. Fran covers her mouth in horror and watches. Dubenko finds the problem and says that it’s “deep to the manubrium”. Neela thinks he’s got it, as they show Nate’s face, with blood pouring out the sides of his mouth. Nice job with the suctioning, Abby. Maybe you should pay a little more attention to what you’re doing and less to manhandling Fran. Dubenko starts muttering “my, oh my” Abby asks him “what?” He replies that they poked through the left innominate vein, and that he’s never seen anything like that. Neela comments that Nate has very unusual anatomy. Fran says affectionately that when they made Nate, they broke the mold. Sam says that the sats are coming up and the BP is 120/75. Abby smiles and tells Fran that they are out of the woods. Fran nods and says “good”. Neela says that the trach is in, vent tubing. Abby leans over and tells Nate that he gave them a little scare there. She removes his nose hose and tells him that he’s not going to be needing it anymore. Fran holds his head and leans close to him, saying his name. He doesn’t respond. Fran strokes his hair as Neela asks him to open his eyes. Fran looks at Abby when Nate doesn’t react. Abby thinks it could just be because of the sedative. Dubenko looks over at her and says that there might be some damage. Fran looks scared as Neela tells her that the blood loss may have deprived the brain of oxygen. Abby looks between them, then down at Nate, unsettled.

Sam’s back to wearing the coat, even though she had it off during the procedure. Fran has hers on too, but Abby still just has the lab coat on, and Nate’s not all covered up either. I really just don’t get it. Sam is explaining to Fran how to suction out the trach. Nate starts coughing and Fran says that it’s making him cough. Duh, Fran. Abby and Sam aren’t deaf so I think they heard that. Abby tells her that it’s good and it’ll help clear the secretions. Sam tells her that’s all there is to it. Fran wants to know how often. Sam thinks two or three times a day, or more if he sounds junky. Abby tells Fran that they are going to get her some help at home. Fran chuckles and says she doesn’t think so. She asks if they know how many caregivers Nate has made her get rid of, and says that it’s just easier if she does it herself. Sam tells her that sometimes she needs a break. Fran assures her that she’s fine and that she’s cut back to 12 hours a day and they have night aides now, though they still wake her if there’s a problem. She says that it’s hard for her to see someone not giving him the best care. Abby moves the computer on the tray over to Nate’s bed. She calls his name, but there’s no response. She tells him to let them know when he’s ready to talk. Fran wants to know if she can take him home. Abby tells her in a couple of days. What happened to the “out of there in a day” schtick that you gave her earlier, Abby? Fran asks pointedly, “how about tonight?” Abby thinks that after everything that he’s been through that they should probably keep an eye on him. Sam looks from Abby to Fran, with a “oh no” expression. Fran says that she knows, but she promised him that she would keep him at home, and it’s what he wants. Abby says that he’ll do better in the hospital. Fran looks at her and says “yeah” then turning back to Nate, “… but I promised him”. Abby looks at her, then down, and thankfully, doesn’t say anything. Sam asks Fran how long she’s been with Nate. Fran laughs and says 21 years, and that it’s hard for her to believe sometimes. She says that it started out as just a job, but … after a while … She says that there was this one time that she traveled with him to Boston. It was in September of 1999, and that it’s beautiful there in the fall, and I am so with you on that, Fran. I love Boston. And she was with him for like 14 years before anything happened? I thought Nate said it was “a million years ago” when he told Luka about it, but at that point it would only have been two years prior. Just seems a bit odd. Nate was giving a paper at a molecular biology symposium and she was still prepping his slides and handouts five minutes before the talk. Camera switches to Abby who is listening to this and looking back and forth between Nate and Fran. Fran says that they worked so hard, Nate added a couple of days to the trip and they went to Cape Cod and the hotel was right on the beach. Fran doesn’t take her eyes off of Nate as she sadly and fondly continues that he took her sailing. She wipes away the tears as she tells them that it was one of those times in life when you think everything is just falling into place. Shaking away the sentimentality, she says that a couple of weeks later he got the diagnosis. Cut to:

1999. Nate’s office. He’s telling Fran “Oh, one more thing. I saw the neurologist today.” Fran asks if everything is okay. Nate says that all the blood tests are normal. Fran thinks that’s good. He says that there are no peri-ventricular lesions on the MRI, so it’s not MS. Fran says “great!” And Fran looks great here; younger and not yet worn down. Nate says he was kind of hoping for MS. Fran doesn’t understand. Looking at a computer screen and not at her, Nate explains that the EMG showed denervation of the muscles of the right hand and that he has motor neuron disease, ALS. Upset, Fran says “Oh my God”. Nate tells her that the average life expectancy is four years, as he goes into voiceover (V.O.) and we see him at the ice rink, putting on hockey gloves and carrying a stick. Nate’s V.O. says that five percent of patients progress and then plateau, as he starts to skate. V.O. continues that there’s some guy in his 60’s still playing golf forty years into the disease. Nate starts to skate faster around the rink. V.O. says that they are starting Nate on a new drug called Riluzole, and it’s very promising at slowing the progression of the degeneration. Back to Nate’s office as he tells Fran that there are going to be some challenges, but he’s very hopeful about all the new research and they are setting him up with a multi-disciplinary support team. Back to the rink as Nate starts to move a puck around while skating. V.O. tells us the team consists of physical and occupational therapist, nutritionist, speech pathologist, respiratory therapists … In the office, Fran assures Nate that she can help, too. He tells her that he is still going to need an assistant, now more than ever. Fran looks disappointed as she says that isn’t what she meant. Nate tells her that he has to put all of his energy into fighting the disease, as we cut back to the rink and Nate taking a shot on net.

Today. Fran continues that Nate didn’t want to start something only to have it taken away. She wipes at her eyes with a tissue as she says that Nate was afraid it would be too painful. Sam wants to know “for you or for him?” Fran nods and says “for both of us” as Nate’s computer says “hello”. They head over to the bed, and Sam smiles at him and says that it’s good to see he’s back. Nate blinks “my neck” and Fran tells him that they did a trach. Nate’s eyes widen at her as Abby says it was to treat his pneumonia. Nate blinks “Really?” and Abby, a little proudly, tells him yes, and that his oxygen levels are up, his tidal volume’s improved and he’s more alert. Nate smart-assedly blinks “I’ll never wear a turtleneck again”. Hee. They all chuckle and Sam asks Abby if she still wants an ICU bed. Abby says no and Sam says she’ll get a tele bed. Abby thanks her as Sam walks out. Abby moves over to Nate’s left side, and once again she and Fran are on opposite sides of Nate, literally and figuratively. Abby tells Nate that they are admitting him for antibiotics and respiratory therapy. Nate looks at Fran and then blinks “no trake”. Abby looks up at him, surprised. Confused, she says, glancing quickly over at Fran, “I thought you would’ve wanted this”. Nate looks at her, then blinks “Appreciate it”, then looks over at Fran, who tells him that it saved his life. He blinks “I understand”, and looks back at Fran. Abby tries to explain to him that he can live for a long time with this. He blinks on a pre-recorded message that plays as he looks at Abby, “My facial muscles are getting weaker. Once I lose my eye movement, I’ll be locked in. I’ll be seeing, hearing, and feeling my surroundings, but I’ll be unable to communicate my needs and wishes. I don’t want to get to that point.” Abby looks over at Fran, who is tenderly watching Nate. Abby starts to argue that the infection that he has is a temporary setback, as Nate rolls his eyes. She says that once he gets rid of it he’ll be right back to where he was. He blinks that he is going downhill. Abby protests that it will maybe be more slowly with good oxygenation and ventilation. Fran is still watching Nate as he tells Abby “had enough”. Abby forcefully says “No, you know what, in a couple of days you’re going to have a lot more energy and …” as Fran cuts her off and quietly says “He’s made up his mind”. Nate blinks “take out trake” and looks at Abby. Eyes a little shiny, Abby looks stubbornly and pleadingly at Fran, then chewing on her lips, looks down. She looks over at Nate, shaking her head. Not backing down, she tells him, “I can’t”. Nate looks at her for a moment, then over at Fran, who smiles at him, understandingly. Nate blinks “Fine. Then home”. Then says “Poker”. Uh oh, not a good idea, Nate. You don’t know who you’re dealing with – Maura Tierney won the Celebrity Poker Showdown, while James Woods didn’t even make it to the Championship Round. So, I don’t think I’d be challenging her if I were you. Fran looks at him for a second and then nods. She explains to Abby that Nate wants her to invite some of his friends over for poker. Abby thinks his friends can visit him in the hospital. You’ve got an answer for everything, don’t you, Abby? Nate looks at her, then blinks “beer”. Hee. Nate’s just as stubborn as Abby is. Fran nods again and tells Abby they’ve got beer. Abby tells Nate that he’s in no condition to go home. Boy, you’re lucky Nate is incapacitated, Abby, because I am so sure he would lay a much deserved smack down on you. Nate just looks at her, probably wishing he had control of his arms so that he can bitch-slap her, as we fade to black.

As they exit Trauma Yellow, Abby and Fran are on opposite sides of the wheelchair. Nate is all bundled up, with a purple blanket in his lap. Abby tells Nate that she’s “not comfortable with this”. Yeah, well, once again it’s all about you, isn’t it, Abby? Nate’s computer says “I am”. Fran says “why don’t we wait in the lobby?”, but Nate wants to wait outside. Fran’s not sure that the van is there yet. Nate wants fresh air. Abby tells him that it’s cold out there. Nate’s computer says “Oh, no. I might catch pneumonia”. Hee. Even with a hole in his neck, Nate’s still snarky. Abby purses her lips and looks away. She tells him that she’s sending a respiratory therapist home to assist him. Nate stops the wheelchair and tells her not to bother. Abby tells him that it’s to help Fran. Fran looks at Abby kindly as Nate says “Tonight, we turn off the vent …Go to sleep, won’t wake up”. Fran smiles slightly at him, looks down, then shares a look with Abby. Haleh calls Fran over to the desk to sign some papers. Fran tells Nate she’ll be quick and walks away. Nate makes the wheelchair go forward, away from Abby, and says that he knows the way out. She continues walking next to him and says that it is hospital policy that somebody has to accompany him to the van. He tells her she forgot her coat as she looks at him, frustrated.

As they go out into the ambulance bay, Abby tries to reason with him that he has a treatable condition, and that she’s just asking for two days in the hospital. He says “Can’t”. She wants to know why not. Nate says “I don’t want to be a soul trapped in a corpse”. Wow. That’s probably the saddest line I’ve ever heard. Horrifying to think about. Abby protests that he’s not there yet, but Nate says “Close”. Abby gets in front of the wheelchair and asks him to wait a minute. She asks “What happened to fighting this disease?” Nate says that he’s too tired. Abby thinks that once they treat the pneumonia he’s going to feel better and that he can even plateau. She tells him “look at Stephen Hawkings, he’s had this disease for 40 years”. Nate replies that he’s not Stephen Hawkings, shoots her a look and moves the wheelchair around her. Abby reminds him that he’s still advising students, writing books, and that he published a lead article in Cell two months ago. She pleads with him to wait, blocking his way again. He stops. Abby’s eyes are getting shiny again as she tells him that if he recovers from this, he can hang on until there’s a cure. He looks at her and asks “If I don’t recover?” Fighting back tears, she tells him “Then I’ll be there … to make sure you’re comfortable, take you off the vent and let you go.” Nate looks at her for a long moment, a little teary himself, then away, and moves the wheelchair around her again. Wiping away tears, Abby says “I bet you ten bucks you can get through this”. She crosses her arms as he stops, then slowly turns the chair around to face her. He asks, “ten bucks?” Abby says that all he has to do is go back into the hospital. Nate tells her he’s impressed and that she’s “become a pretty persuasive doctor”. By betting him $10? I know he plays poker, but is he that much of a gambler that he can’t resist a penny-ante bet? There’s got to be more to it. Once again wiping away the tears, Abby tells him that she’s not so sure she’d be there if it wasn’t for him, and smiles at him, fondly. Flash back to:

1999. A healthy Nate teaching in the classroom auditorium. He says that the air you breathe, all the food you eat, all leads to the production of one incredible molecule … ATP, adenosine triphosphate, as he projects a slide on the screen. Nate explains that it’s the end result of oxidative phosphorylation. “This is the force of life”. Nate is very excited and lively and the students seem enthralled. Abby is sitting in one of the rows, taking notes. Nate continues 7300 kilocalories per mole. He calls it “pure unadulterated energy”. He asks the students what they are doing right now. “Taking notes, crossing your legs, coughing, digesting your food, listening to your voice mail”, as he picks up someone’s cell phone, “while the professor is lecturing”. The students, including Abby, laugh. Nate gets more animated as he talks about how every action of the human body, every single thing it means to be alive, is powered by ATP. He reminds me of one of my favorite professors who made Physics bearable and even a little understandable with his energy and humor, that and the fact that anyone who uses Japanese animated cartoons like Speed Racer in the Mach 5 and Trixie in the helicopter to explain velocity factor is okay by me. Nate asks a bespectacled student how much he weighs. Spectacles replies “155”. Nate tells him to stand up. He explains that every day, the human body uses 180 pounds of ATP, as he lifts the student over his right shoulder. The class laughs as Nate pats Spectacles on the ass and says “yes, yes. More than you weigh”. Still carrying Spectacles, Nate says “And yet, this body only has half a pound of ATP”, as he smacks the ass again. Nate asks what’s going on. Yeah, Nate, what’s going on with all the ass smacking??? Over his shoulder, Spectacles guesses “You recycle it?” and Nate pumps his fist, smiles and says “Yes! Yes, you do!” and puts Spectacles down, thanking him. Nate runs up the side stairs of the classroom, telling them that you recycle it, otherwise you would burn off your ATP in five minutes and that the human body recycles it 300 times a day. Nate says that if you were a car, you’d get 150,000 miles to the tank. Maybe that’s the alternative fuel source that Bush should be looking into. Nate changes the slide and starts talking about electron transport jamming protons into the inter-membrane space of the mitochondria, as the camera closes in on Abby, wearing a shorter hairdo and looking as confused by all this as I am. Nate is going on that ATP synthase is, in fact, a rotary engine. He points at this really phallic looking image on the screen and talks about how the flow of protons spins the shaft, which, and again, because I’m 12, makes me laugh. Nate says that it sucks in ADP and blows out fresh ATP, as the camera closes in again on Abby, clearly not getting it. Nate’s getting a little scary here as he runs around and climbs up on stuff talking about how it’s “filled with the energy it takes to fuel the human body, the human mind, and yes, yes, the human spirit”. He’s acting kind of manic, which may explain why Abby feels such a connection with him, since she’s got lots of experience with the crazy. Nate tells them that they are done and thanks them. The class applauds, though Abby doesn’t. Weird. He tells them to read Chapter 19, Lehninger, electron transport in detail. Nate goes to gather up his stuff as Abby approaches him. She asks if he has a minute. He asks “and you are?” and she says “Abby Lockhart. I’m a first year”. Huh??? That can’t be right, can it? First of all, Abby was a third year med student when she came to the ER in the Spring of 2000. Secondly, she’s sporting the shorter hair that she had in the Fall of 2000, Season 7, when she had to drop out of med school at the beginning of her fourth year because her ex-husband didn’t pay the tuition, and go back to being a nurse. Again, half-assed hair continuity is annoying. And this is a much better wig that she has on than the blonde-streaked monstrosity they had her in earlier, and it really looks like her Season 7 hair. Abby tells him that she needs his signature to drop this class. He asks “You want to quit Biochemistry?” She explains that she failed the midterm and she’s not feeling very optimistic about the final. Nate dismissively tells her that it’s a required course. Abby says that maybe she’ll try again next year. Nate thinks that’s tough to do because second year curriculum is pretty busy. Abby waves her hand and says that she’s thinking about taking a year off to just reconsider her options. Nate says that he’s surprised. He asks her “So, you don’t want to be a doctor?” Abby stutters that she’s trying and that it’s a lot with biochemistry and physiology and microbiology, anatomy, as Nate nods at her like “well, duh”. Abby says that it’s just a lot … a lot to memorize. Maura Tierney is doing a really good job channeling her prior performance portraying the previous lack of confidence that plagued Abby. Nate throws his hands up and says “Ah, there’s your problem. Rote memorization is the path to failure”. Well, I don’t know, Nate. Seemed to work for the vocabulary part of the SAT’s. Abby looks uncertain as he asks her if she likes sports. She shrugs and waves her hand, shaking her head. He asks if she ice skates. She responds, “not really, no”. He folds his arms and asks if she dances, and then adds that everybody likes to dance. Well, everyone except Luka, ‘cause “Luka don’t dance”. Abby says that she took ballet when she was a kid. Really? Maggie had it together enough to get you in ballet classes, Abby? Nate asks if she liked it. Not really understanding his point, she uncomfortably says yes and that she was the Sugar Plum Fairy in The Nutcracker, third from the left. Hee. I so can’t see that. Nate chuckles, claps his hands together and says “excellent!”. He tells her that if she wants to learn she has to stop memorizing and think conceptually. Abby looks at him, unsure. He explains that biochemistry is “the dance of life”, and holds up a molecular model. He says that ballet is its central dogma. He circles around her, saying that adenine holds hands with thymine, cytosine with guanine, as Abby smirks, doubtfully. He zealously tells her that when they let go, “a line of gypsy dancers breaks free” as he pull the model apart “to look for new partners, and messenger RNA is created”. He drops part of the model and apologizes as they both bend to pick it up. Nate says that he’s not usually so clumsy. Oh, I guess this is where he has the first signs of the disease. Abby looks down and then says quietly, “Um, yeah … can you sign my form?” Nate looks at her and says that his office hours begin at 1:00 p.m. on Tuesdays, adding as he closes up his briefcase, “Show up”. Abby raises her eyebrows and asks disbelievingly, “You’re going to tutor me?” As he starts walking out he tells her to think of it as dance lessons and that he guarantees that after three weeks she will pass her make-up midterm with flying colors. What??? That’s all you have to do to get a make-up test after failing? Ask to drop the class? That so sucks and why didn’t my calculus prof tell me that??? What a gyp. Nate then says “In fact, I will bet you ten bucks”. Aha!!! I knew there had to be a reason that worked for Abby in the last scene. Abby worriedly tells him that it’s a very generous offer, but starts stammering, nervously playing with her hair and attempting to talk herself out of it, “I just … I – I just don’t … I think …”. Nate cuts her off, smiling at her and saying confidently “I know that you can do this”, as we see Fran in the doorway waiting for him. Abby says that she wishes she had his confidence. He tells her she will and “don’t give up”. He says that if nothing else, he will teach her how to fight. He says “I’ll see you Tuesday” and turns to leave. Abby, still looking uncertain, smiles and thanks him.

James Woods has been amazing throughout this episode. He’s normally a verbose and physical actor, as we saw in the final flashback, so to be forced to convey emotions and meaning through his eyes and face alone must have been an extreme challenge for him, one that he certainly rose to. Ally Walker was impressive as well. She totally embodied the weariness that Fran most surely must have felt from being Nate’s primary caregiver, all the while subtly reminding us of the emotional bond between them. But it was Maura Tierney who was great in these last scenes. Abby’s overbearingness and insensitivity to Fran was grating and infuriating, but we now have an understanding as to why she acted that way. In some ways, Abby did really understand Nate best, well enough to know that he’s a scientist for whom the exploration, the challenge, the fight, was everything, and that he was now giving in to his fears, much as she was when considering dropping out of med school. And just as he wouldn’t let her give up, she refused to let him. Very consistent with her character because even though she’s been shown to give up on herself in the past, she’s tenacious when it comes to the people she cares about. Getting the trach and vent was one more loss of function for Nate, and where in flashbacks we were shown his initial rejection of assistance devices, we also saw how he adapted to them and kept going, still working, writing, publishing. Like the title of the episode suggests, we are both, “Body” and “Soul”, and though the body may not function, the soul still can still go on. There were a few “two sides of the same coin” references in this episode: body/soul, work/home, professional/personal, independence/dependence, single-mindedness/self-sacrifice. In a way, Nate and Fran represented these two differing aspects. And as time went on and Nate’s disease progressed, in some respects the lines between the two became more blurred. This may be significant to Abby’s continuing storyline, as now that she is pregnant, she will have to struggle for the balance between the two in the future, her hard-won career vs. her newfound family, and not to have one completely overtake the other. I think Abby saw needing the trach as one more thing Nate could get past, one more adjustment he could make. And she reassured him that if she ended up being wrong, she would be there and she would take the burden of stopping his treatment. And while she really did care for him, as the doctor that he helped her become, it would be easier for her to let him go knowing that they had exhausted all the options, rather than forcing the decision on Fran, whose whole life revolved around Nate and would most likely have some guilt and questioning over whether it was the right thing.

Abby comes into frame at the ice rink much the same way Nate did in the beginning. This shot is also very reminiscent of the one of her emerging from Coburn’s office after choosing to go for something she really wanted and making the decision not to have the abortion in “If Not Now”. As with all the present day scenes, captioning tells us that it is “Today” and the music from the first scene is playing again. Abby steps out on to the ice. Apparently, she’s learned how to skate. Maybe Nate taught her. Or maybe she learned as another step towards “conquering her fears” type of thing. Though it is a bit ridiculous that a character supposed to be from Minnesota wouldn’t know how to skate. Isn’t everyone born there with skates on their feet? Oh, maybe that’s Canada. I think this means that she did convince Nate and he decided to continue to fight, so she is doing this both in recognition of the will to go on, and a letting go for herself. Interesting to note that Abby seems to get why Nate went to the ice rink, but Fran didn’t. Even though Fran appears to have put her life on hold and put aside any of her own aspirations to stay with Nate for all those years and they apparently had a strong emotional connection, Abby is the one that understood what “in motion” and “free” meant to Nate. Abby glides across the ice, seeming to get more confident as she goes, and smiling a little. I think skating on the ice represents a sort of freedom, one that Nate no longer had, trapped in a body that no longer worked. I think for Abby it’s a freedom from the insecurities that have always “trapped” her. To skate, you have to let a bit of yourself go – it’s all about movement and feeling, not analysis, you trip up when you think too much about it. Maybe this is the beginning of Abby opening up in other areas of her life, too.

Next week: Somebody shoots Cha-Cha, Weaver tells Chi-Chi that they think he did it, Morris busts Abby, saying "You are totally pregnant", Chi-Chi is shot too and the staff treats him ... and ... helicopters (never a good sign on this show) flying in like Apocalypse Now as I hear Jim Morrison singing “Riders on the Storm” in my head, and the announcer says... "the return ... of ... Dr. Carter" ... and oh, great, there's Carter. Just when I wasn’t missing you, you’re back. And with really short hair that I’m sure I’ll be bitching about.


At 8:40 PM, February 05, 2006, Blogger A. said...

Great recap and analysis. Thanks for the time you take to do them. In "Body & Soul," I also took the skating scenes framing this EP as a metaphor for the "dance of life" that informs biochemistry and Nate's philosophy of life. I guess i'm very naive but I thought ice skating wasn't a good thing to be doing while pregnant, but i'm sure that way of thinking has changed. Also, I like the episode but find ER episodes told backwards or via flashbacks as unwieldy and unnecessarily confusing. This one was done really well, but it's kinda a set up to make the audience misunderstand Abby's motivations like that for 2/3rds of the episode.


At 10:35 PM, February 05, 2006, Anonymous Anonymous said...

"And I now understand the reason for the coats – hell has frozen over - because I am in complete agreement with Ray on this one." Great laugh for a tough episode to watch. I walked away from the episode feeling really disjointed. Maybe it was the flashback story-telling mode but I didn't get the reason why Abby was so "know-it-all" through most of it, even at the end. Thanks to your recap, I have a better idea why Abby could have acted that way. Don't know if I agree with it, but I really hope you're right, that this epi is foreshadowing Abby learning to deal with the inevitable blending of her two life paths - career and family. No more bitchy Abby, please! Looking forward to next week's hair snarks. Thanks again!

At 11:02 AM, February 06, 2006, Anonymous Anonymous said...

Thank you so much for this recap. I didn't 'get' Abby's crabbiness at ALL. Now I have a new understanding and new respect for the episode. I am definitely going to watch my tape again...and maybe not tape over it...which is what I had planned to do. Also, thanks for helping me NOT be the ONLY one not happy to see Carter...and Africa...return!

At 12:09 PM, February 06, 2006, Anonymous Anonymous said...

I totally agree with you about Abby...there is just something about her that I identify with. Plus, I think that Maura's acting is top-notch. I like comic Abby much better though!

James Woods and Ally Walker were amazing! I enjoyed this epi, but I wish that it wasn't a sweeps episode (since we only get one more).

Carter...ACK! Not looking forward to Africa revisited.
Thanks for a great recap!

At 12:41 PM, February 06, 2006, Anonymous Anonymous said...

Another LOL recap for me. Thank you. I was glad to see you bit of analysis of Abby's motives. I, too, love Abby and MT so I was trying to be on her side through this epi. You comments helped me to see where her heart truly was and how hard it was for her to see Nate giving up.

Thanks again!!

At 9:30 PM, February 06, 2006, Anonymous Anonymous said...

Great recap. I'm sure this one was tough. I'm so with you on the Dr. Carter return....who needs that? I've soooo had enough of Africa. This show is called ER and that's what I want to see. If I want to see what doctors do in the Congo I'll watch the discovery channel.

At 9:40 AM, February 13, 2006, Anonymous Anonymous said...

Love your recaps, but since this was a story about professors and students, I have to recall the one and only playwriting class I ever took, in which the professor said "If you have to tell the audience what they're supposed to be feeling, they won't.." By the same token, if it takes several paragraphs to persuade viewers that "we" are all rooting for Abby even when she seems to be behaving like the Kathy Bates character in "Misery," it follows that "we" are not all coming to the same conclusion naturally. Not to bash Abby or any of her supporters, just to say that when you have a polarizing character, it stands to reason that for every viewer who loves her, there will be one who cannot. It's one of those laws of science type things--ask Nate.

As for Luka giving away the family jewels to his girlfriends, I always assumed that was what the snowglobe in "Hindsight" was supposed to symbolize! So hoping that Abby's return-of-globe this season is meaningful.

Again, thanks for your good work. It is much appreciated on a snow day.

At 8:30 PM, June 29, 2006, Blogger fitnessinstructor said...

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