Rampage

"Rampage"
Season 7, Episode 22
Air date	May 17, 2001
Written by	Jack Orman
Directed by	Jonathan Kaplan
Episode Guide
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Rampage is the 22nd episode and the 7th season finale of "ER"

Synopsis

The ER staff finds themselves being pushed to the limit and beyond when Derek Fossen, the father of Ben Fossen who Greene treated last week goes on a rampage through Chicago, unleashing a trail of destruction while Chen moves one step closer to achieving her dream of becoming Chief Resident and Weaver confronts Romano over Romano firing Legaspi.

Cleo and Benton are both left extremely concerned when Cleo cuts her hand while treating a patient who's HIV-positive and Carter considers his future.

NBC Description

DR. GREENE'S NEW FAMILY COULD BE IN DANGER AS SHOOTER GOES ON RAMPAGE THROUGH CHICAGO IN SEASON FINALE: The ER is overwhelmed with gunshot victims when a distraught father (guest star Ted Marcoux) goes on a murderous spree at a foster care facility and a horrified Dr. Greene (Anthony Edwards) realizes that his personal connection with the madman may prove fatal for his new wife (Alex Kingston) and their baby.

In the midst of the chaos: Dr. Carter (Noah Wyle) is put in the awkward position of helping Dr. Chen (Ming-Na) apply for the promotion that he himself was denied, Dr. Benton (Eriq La Salle) is unexpectedly assaulted by his ex-girlfriend Carla's husband (guest star Victor Williams) and Dr. Finch (Michael Michele) cuts her hand while treating an HIV-positive patient.

Meanwhile, Dr. Romano (Paul McCrane) betrays his prejudice when he tries to force out Dr. Legaspi (guest star Elizabeth Mitchell). Laura Innes, Goran Visnjic, Maura Tierney and Erik Palladino also star.

Plot

Elizabeth has fallen asleep on her couch while up with Ella in the middle of the night. She wants Mark to stick around, but he has to go to work. He dozes off on the train, waking up to find a homeless man staring at him through the window. He gets off the train and is buying a newspaper when some ambulances race by. He runs to County, knowing he’ll be greeted by a mass trauma.

Several pediatric and adult traumas come in. Carter tells Mark that someone started a mass shooting at a foster-care facility. Mark quickly wishes he’d listened to Elizabeth and called in sick. Cleo and Mark desperately attempt to save a young girl who was shot in the head with mannitol and defibrillation. At least one patient is probably not going to survive, a little girl named Helen. The brainstem injury was determined to be fatal by Dr. Weaver and she is pronounced dead. A boy named Martin tells Chen that Helen was brought to the facility after her foster mother bailed on her. Enjoy Hell, Helen’s former foster mother. Martin also tells Weaver that the gunman was mad at a woman named Mrs. Buckley who was shot dead.

Chen asks Carter if he turned in her peer reference – she was able to convince Weaver to let her apply for chief resident after all. He promises to turn it in today. Weaver tells Benton to send some surgeons to the ER to help with all the shooting victims. A police officer named Napolitano finds Weaver and asks her to get him a bullet from one of the shooting victims so they can start collecting evidence.

One of the survivors of the shooting talks to Legaspi about what she experienced. Legaspi goes to talk to Weaver about her letter, but Frank interrupts to tell Legaspi that Romano wants to talk to her. Legaspi says she’ll call him back later, but Romano won’t take no for an answer. Weaver complains that Romano isn’t in the ER, helping with shooting victims, since they might have as many as eight people who need surgery. Chuny announces that there’s a ninth patient coming in with gunshot wounds, the victim of a carjacking. Legaspi tells Weaver she appreciates the letter, but they won’t be getting back together.

Mark and Cleo can’t save Helen, so Chuny pulls Cleo away to tend to the carjacking victim, Mr. Jeffries. He lets Cleo know that he has AIDS. He was getting out of the car to let the carjacker take it, but the man shot him anyway. Benton joins Cleo to tend to him, but he’s delayed when Roger suddenly arrives and punches Benton. He orders Benton to stay away from Carla. Benton’s very confused, but Roger’s convinced that something happened between him and Carla. Benton promises Cleo that he’s wrong.

Napolitano asks Mr. Jeffries if the carjacker was wearing a yellow windbreaker. The police are pretty sure he’s the same person who shot up the foster-care facility. As Luka and Abby treat the facility’s gardener (shot for no reason while the shooter was leaving), Luka tells Abby that he saw her med school reinstatement form on the counter and sent it in for her so she wouldn’t miss the deadline. Abby tells him she changed her mind about going back to school, so she wasn’t going to fill in the form. Now she’ll have to come up with the tuition money.

Two more gunshot victims are on their way in – the police tracked Mr. Jeffries’ car to a house and found a mother and son shot inside. The shooter still hasn’t been found. Weaver tells Romano to help out, but he’s busy yelling at Legaspi for not taking his phone call. Legaspi refuses to deal with post-op complications in the psychiatric ward (I guess because there’s no other place to put patients, with so many shooting victims coming in), so Romano tells her he’ll get someone else to finish her shift and fires her.

Abby recognizes one of the next shooting victims as Mrs. S., the woman who brought Ben into the ER the week before. Her son, Ted, seems to only have minor injuries, but Mrs. S. is hurt worse. She tells Mark that the shooter is Derek. He’s trying to find Ben, and he told Mrs. S. that since she took his son from him, he was going to take her son away from her. Mrs. S soon vomits blood and passes out, dropping her vitals. Mark determines she has severe bleeding from the bullet in her chest and quickly takes her into the trauma room.

Mrs. S loses her blood pressure and is comatose, Mark relays Mrs. S.’s information to Napolitano while he, Romano, and Abby try to save her. Next door, Benton determines that Mr. Jeffries needs surgery due to a bleeding vessel, but Mr. Jeffries doesn’t want it because of his past infections with his HIV. He’s already dying of AIDS, so he doesn’t see the point in prolonging his life. He’d rather die from his injuries than the painful effects of his disease.

Mrs. S's heart stops beating so she starts dying which forces Romano to crack her chest, performing a thoracotomy. Shoving their hands into her hacked up chest they discover that the bullet has shredded the esophagus and aorta, with nothing left to clamp or repair. Romano doesn’t think they can save Mrs. S., and though Mark is willing to try harder, Romano tells him it’s a waste of time and Mark declares her dead. Mark laments losing two patients before lunch.

Carter tells Martin, who only has a gunshot wound to his arm, that they’ve found a mass inside him that might be osteosarcoma cancer. Martin’s mother died of cancer, which is how he wound up in foster care. So Martin’s having a great day.

Carter tries to make small talk with Abby, who has discovered that he’s keeping a secret: He’s looking at a job opening at another hospital. He doesn’t think he can advance at County. Abby tells him to talk to Weaver about an eventual attending position. Carter thinks she would have brought it up if she thought it would be a good fit. Abby notes that she might not think he’s interested.

Luka interrupts, and after Carter leaves, Luka asks if Abby’s still mad at him for sending in her reinstatement form. She admits that she’s not sure she still wants to be a doctor. Med school is expensive and will take a long time to complete. Luka offers to help her with the money. He thinks she wouldn’t have started med school if she didn’t really want to be a doctor. Abby says nursing may be enough for her – is it not good enough for him?

Weaver treats Ted, who hasn’t been told that his mother died. Mark decides to put that off until they can reach Ted’s father. Napolitano confirms Derek’s identity with Mark; he has a record for domestic abuse. The police found Ben’s foster parents and are going to get him. Frank overhears and asks if Napolitano thinks Derek will come to County. After all, he’s going after the people who took his son from him, and that started with Mark. Mark doesn’t appreciate the idea. Weaver thinks Derek’s too smart to come to a hospital crawling with cops. Mark notes that he hasn’t been showing the best judgment, so they can’t know that.

Weaver asks about Derek’s weapon, a semiautomatic that Frank is sure he’s been reloading. He, Mark, and Weaver bicker over whether guns kill people or people kill people. Weaver remarks that you can’t commit mass murder with a Chinese throwing star, so obviously the gun plays a part. Haleh reports that a cop is being brought in after being dragged by a car. Frank guesses the driver was Derek, who has now committed assault with a deadly weapon. Weaver and Mark tell him in unison to shut up.

Benton and Cleo are in disagreement about whether to honor Mr. Jeffries’ wishes not to have surgery (Cleo is pro, Benton is con). Benton thinks they’re really at odds because Cleo still thinks something happened between him and Carla. He tells her that Carla was upset when he went by her apartment, but he didn’t do anything, and he didn’t want to do anything. Cleo asks why he didn’t tell her she made a pass at him. Benton knew they would just fight, but Cleo thinks he doesn’t trust her.

Mr. Jeffries is declining, so Benton tries to talk him into a blood transfusion, but he refuses. He doesn’t talk to his only remaining family, and he’s outlived the two people he loved, so he doesn’t see the point in staying alive. He’s ready to die, so Benton needs to let him. Mark chats with Ted, who just wants to see his mom. Mark lies that she’s in surgery. The injured cop is brought in, and he confirms that Derek was driving the car that dragged him. Another cop reports that the car Derek stole was found parked outside a house. A woman was found inside with gunshot wounds.

Weaver argues with Romano over his decision to end Legaspi’s shift early and fire her. She doesn’t think he has the authority to fire an employee, even though Romano says she has a history of violating hospital policies. Weaver accuses him of looking for a reason to get rid of her. Haleh interrupts the argument to reveal that the latest shooting victim has been brought in, and she’s someone they know: Adele.

They join Mark, who tells them that Adele appears to be paralyzed because of the bullet to her spine. She wonders how Derek was able to find out where she lives, since they only interacted at the hospital. Mark realizes that if Derek was able to get her address, he can get Mark’s, too, which means Elizabeth and Ella are in danger. He tells Napolitano to send cops to his house. As they arrive, Mark tries calling Elizabeth, but she doesn’t answer the phone. Dr. Weaver and Romano hop on the case.

Mark leaves a message, then goes back to helping Weaver and Romano with Adele. Napolitano tells Mark that no one came to the door when the police knocked, but Mark can authorize them to force entry. He does, and the police start searching the house. Weaver suggests that Elizabeth went out on an errand and isn’t home. Romano decides to have her paged. Adele remains paralyzed and goes into neurogenic shock. Mark puts in the central line and Adele is started on solumedrol, a dopamine drip, and IV crystalloids.

Mr. Jeffries is now unconscious and unresponsive, so Benton wants to override his refusal of care. Cleo won’t sign the consent form to let him. Elizabeth left her pager at home, so only the cops hear it go off. Benton gets Romano to approve Mr. Jeffries’ surgery, then tries to convince Cleo that Mr. Jeffries is unable to make his own medical decisions because his AIDS has altered his brain function. As they’re bickering, Abby comes into the trauma room, accidentally slamming the door into Cleo. Cleo is holding one of Mr. Jeffries’ blood samples, and the vial breaks, cutting through her glove and into her hand. Benton immediately calls the pharmacy to get a rapid HIV test for her.

Romano argues with the OR staff on the phone until he finally gets the surgery arranged. A neurosurgeon is notified to help attending trauma surgeon Romano. Adele is sent to surgery with the possibility that it will relieve her paralysis and fix her spine. Right before Romano takes her up to the neurosurgery OR suite Kerry attempts to intercept and ask about Legapski to which Romano dismisses her question. Napolitano tells Mark that the cops didn’t find Elizabeth anywhere in the house or yard. Their van is still there. A call on the police scanner reports another shooting victim, a cab driver shot by his passenger. Meanwhile, Lydia thinks Ted is starting to catch on that his mother isn’t really in surgery.

Martin has a rare form of cancer, plus no parents, so…yeah, a really bad day for Martin. Mark decides it’s time to tell Ted that Mrs. S. was hurt too badly for the doctors to be able to save her. He promises that she wasn’t in any pain. Benton gives Cleo some preventive meds, trying to assure her that her chances of contracting HIV from Mr. Jeffries’ blood are low.

Weaver goes to the psychiatric ward to try to convince Legaspi that Romano can’t legally fire her. Legaspi is sure that Romano has been gunning for her (…maybe not the best choice of words for this episode, but I’ll ignore myself) for a long time and has just been building a case against her. She doesn’t see the point in fighting it. Weaver is willing to help her, which Legaspi finds ridiculous, since Weaver won’t even fight for their relationship.

Mark tries to call some neighbors to see if they’ve seen Elizabeth. Napolitano tells him they found Derek, who shot some people in Lincoln Park, then was taken down by a random citizen. Mark enlists Cleo to tend to the cab driver as Napolitano talks to another officer about the driver’s shooting. They’re pretty sure Derek was responsible, since the last address entered into the driver’s log was Mark’s. The police think the driver heard Derek’s description on the radio and realized who he was, so Derek shot him. Napolitano notes that that means Derek never got to Mark’s house.

As Haleh tells Mark that Derek is being brought in, Carter and Abby take a break outside and talk about Martin. They acknowledge that their own problems don’t really compare to his. Abby says that Luka offered to help her with tuition, and though she knows he means well, it frustrates her that she always has to explain her feelings for him. Carter tells her to stop – he’s not one of her female friends, and he doesn’t want her to talk to him about her relationship like he is. He doesn’t want to sit on the sidelines, waiting for Abby and Luka to break up. His friendship with Abby may be convenient for her, but it’s not enough for him. It’s not clear if Abby is being willfully ignorant or if she truly doesn’t get what he’s trying to say: He wants to date her.

Mark and Luka treat Derek, as if any hospital would let a man give medical attention to the guy who was on his way to murder him and his family. Carter tells Martin that, in a way, he was lucky that he was shot, because it led the doctors to find his cancer. Catching it this early gives him a better chance of survival. It’s still only 70%, so Martin isn’t that optimistic. Also, he has to deal with a gunshot wound and the related trauma, so…not the best attempt at cheering someone up, Carter.

Carter finds Chen, who’s treating the man who shot Derek. He started carrying a gun after he was mugged in the park last year. Carter and Chen are judgmental about that, but the man argues that he stopped a mass shooter, so they should be grateful. Before leaving to tend to another victim, Carter tells Chen that he turned in her peer review. He jokes that he had to make up stuff so it would be glowing.

Mark and Luka keep treating Derek, telling Napolitano that he’ll probably recover, even though he was shot five times. Napolitano is disgusted that he gets to live after shooting 19 people and killing eight or nine of them. Elizabeth finally calls Mark; she was at the farmers’ market and had no idea that anything was going on. Mark just says it’s a long story and everything’s fine.

Weaver catches Romano between operations and tries to talk him into rescinding Legaspi’s termination. She accuses him of trying to fire her because she’s a lesbian. Romano says she’s just a pain. Weaver asks if she’s the same kind of pain Maggie Doyle (also a lesbian) was. She warns that if he doesn’t rethink his decision, he’ll be the one who’s fired.

Romano won’t back down, so Weaver follows him into the men’s room and threatens to quit if he doesn’t let Legaspi stay. Romano warns her not to give him an ultimatum. She’s the chief of emergency medicine, not the hospital’s lesbian advocate. “I am both – I am the chief of emergency medicine and I am a lesbian,” she replies. If necessary, Weaver will go to the county, the press, and the ACLU. Romano just stares at her as she leaves. It takes her until she gets on an elevator to realize that she just came out.

Derek is stable enough to go to the OR, and Mark makes eye contact with Ted as he takes Derek to an elevator. Haleh is with him, but she forgot something, so she leaves Mark alone with Derek. Derek’s heart goes into arrhythmia, and Mark acts on instinct, grabbing paddles to shock him. Then he pauses, remembering what his patient has done. Mark stops the elevator, then shocks the air instead of Derek. He does it again, making eye contact with Derek to drive home that Mark won’t save him. He shocks the air again, watching as the life drains out of Derek.

Characters

• Mark Greene
• John Carter
• Kerry Weaver
• Elizabeth Corday
• Robert Romano
• Luka Kovač
• Abby Lockhart
• Cleo Finch
• Dave Malucci
• Jing-Mei Chen
• Peter Benton

Trivia

• Victor Williams & Julianna Margulies also worked together on episode 6.9 The Good Wife: Sticky Content of The Good Wife as Carter Greyson & Alicia Florrick respectively.

Quotes

Robert Romano: You had better choose your battles very carefully, Kerry. You are the Chief of Emergency Medicine. Not the County's lesbian advocate.

Kerry Weaver: That's where you are wrong, Robert. I am the Chief of Emergency Medicine and I am a lesbian. And if you pursue this matter any further I'll take it to the County Board of Supervisors, the ACLU, the press and anyone else who cares to listen. So I suggest that you choose your battles very carefully.