A Hole In The Heart
Kerry's battles took center stage for most of the episode. The man she treated, Mr. Watson, looked to have an arterial embolus, or a clot in an artery of the arm. If this was the case, I think she messed up in the treatment of the man. In either arterial or venous clots, you will eventually need to anti-coagulate, but the arterial ones may need to be treated more aggressively, since there could be a chance of losing the limb. These patients need either thrombolytics (like streptokinase, urokinase, or TPA) or surgery to remove the clot. Then they're placed on heparin and then coumadin. The low risk patients with venous clots can be treated at home with enoxaparin shots twice a day while starting coumadin. Several studies have shown it's efficacy and safety, though this is a fairly new procedure. Several years ago all patients with venous clots were always admitted for anti-coagulation. From this guy's history and exam, it was an arterial embolus, not venous, and thus he should have been hospitalized from the beginning.
Now for her power play. After having been through four years of college, four years of med school, three years of residency and then the chief residency before becoming staff, Kerry should know that every major position at a university, med school, and major teaching hospital will be filled after conducting a national search. During my similar years, opening positions always had an acting chief, who may have been the number two in command, but that person often did not get the job. It's ironic that Kerry is Ms. policy and procedure, and she doesn't want the hospital go through official policy and procedure in filling a chief position.
The man in a coma had a glioblastoma (one form of brain tumor) in his brainstem. This is a pretty aggressive tumor, and has a terrible prognosis. The chemo and radiation he got may increase his life span a few months, but not much more. Upon diagnosis, he probably had less than two years to live, even if he got surgery, chemo, and radiation. In his case, the tumor had grown to the point of blocking the flow of cerebrospinal fluid around the brain and spinal cord. (This is the fluid that you take out in a spinal tap.) Based on what I got from Carter, that is causing increased pressure in the head and leading to the coma. The surgery could divert the fluid, and he might wake up, but then again, he might not.
One thing to look out for will be to find out what Peter does next year. A surgical residency is five years. He started as a second year, so he should have finished his residency as of this year, the fourth season, and needs to find a job. He could have a fellowship, but they haven't told us about it yet. Next season he should have a staff job or be in a fellowship, hopefully trauma if he is to stay in the ER.