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"A Hole in the Heart"
Season 4, Episode 22
Air date May 14, 1998
Written by Lydia Woodward
Directed by Leslie Linka Glatter
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A Hole in the Heart is the 22nd episode and the 4th season finale of "E.R." It was first aired on May, 14 in 1998. It was written by Lydia Woodward and directed by Leslie Linka Glatter.


Mark and Weaver threaten Doug over his unauthorized treatment of infant Josh McNeal. Dr. Max Rosher ingratiates himself with Anspaugh. Corday receives a letter from Romano informing her that he won't be sponsoring her the following year. A despondent patient shocks Carol with an unusually violent act.

Weaver becomes upset when Anspaugh tells her that even though she has been Acting Chief of Emergency Medicine for a year, the hospital still plans a nationwide search for a permanent one. Carter accuses Max of taking some Percocet from a medicine cabinet.

Benton arranges a hearing test after a day care worker tells him Reese is not responding to sounds as the other children do.

NBC Description

FRIENDS AND FAMILY AT CENTER OF SEASON FINALE: Repercussions from Dr. Ross' (George Clooney) treatment of a drug-addicted baby complicate his personal and professional relationships.

Nurse Hathaway's (Julianna Margulies) instincts regarding a patient who attempted suicide turn out to be tragically correct.

Dr. Greene (Anthony Edwards) treats two Elvis impersonators injured in a parachuting accident.

Dr. Weaver (Laura Innes) is angered when hospital politics stand in the way of patient care and her own ambitions.

While Dr. Corday (Alex Kingston) is concerned with the future of her fellowship, Dr. Benton (Eriq La Salle) is faced with a new worry regarding his son.

After helping the wife of a coma patient with a difficult decision, Dr. Carter (Noah Wyle) confronts Dr. Del Amico (Maria Bello) with his suspicions regarding Dr. Rosher (guest star James LeGros, 'The Myth of Fingerprints'). Gloria Reuben also stars.

Short summary

At the hospital daycare, one of the child-care workers suggests to Peter Benton that he may want to have baby Reece's hearing checked. Doug Ross dodges a bullet by admitting upfront his error in detoxifying a baby without permission. Having been acting Chief for over 6 months, Kerry Weaver puts her name forward to replace David Morgenstern as Chief of Emergency Medicine only to be told she will have to compete for the job. The doctors treat a couple of Elvis impersonators who sky dive into Lake Superior. When drugs go missing from the ER, John Carter suspects Anna Del Amico's ex-boyfriend.




Guest Stars

  • James Le Gros as Dr. Max Rocher
  • Carrie Snodgress as Mrs. Lang
  • Tara Chocol as Vicki McNeal
  • Gina Mastrogiacomo as Ms. Myra
  • Roger Robinson as Mr. Wass
  • Kenneth Tigar as Dr. Keinholz
  • Michael Rispoli as Victor Nable
  • Catie and Kristy Dinsmoor as Amy Nable
  • Rick Alviti as Junior Elvis
  • Alice Amter as Dr. Miriam Nagarvala
  • Page Leong as Gloria
  • Pete Willcox as Over-the-Hill Elvis


  • This episode is Maria Bello's final appearance.
  • This episode premiered immediately following the series finale of "Seinfeld".


Doug (to Weaver): I don't care about your rules.

Weaver: I hope you also don't care about being an ER Pediatric Attending. Because you've just given up any chance of that.


Carol (to Mark): I was there because I wanted to be there, not because Doug asked me.

Mark: I'm sure you were. Doug can be pretty passionate about these kids.

Carol: Oh, give me a little credit, Mark. You think I'm a fresh-faced nursing student who can't resist the doctor's spell?

Mark: I'm only saying that Legal and Administration are going to be going over every detail of this case. And I'd hate to see it reflect badly on your record.

Carol: So you're saying I should fudge my involvement?

Mark: Tell the truth. Tell them you were doing your job. Tell them you were assisting a doctor.

Carol: The truth is I insisted on being there because I believe Doug was working in the best interest of the patient. And that much is my responsibility every bit as much as it is his.


Benton (to Corday): You're running all over the hospital, asking every surgeon to sponsor you.

Corday: Okay, so what do you suggest?

Benton: Elizabeth, you haven't even checked out other hospitals, other parts of the country.

Corday: I've built up relationships here or so I thought.

Benton: I'm not saying I would want you to leave Chicago.

Corday: No, but you're not passionate about my fight to stay.