Haleh wheels in a young man trailed by his brother. The patient complained of chest pain, has a pulse of 110 and hasn't responded to Narcan. "We thought it was the meatball sandwich he had for lunch," his brother says, worried. Malucci establishes that there's no known family history of heart disease, and orders a series of tests that lead me to believe he's testing the patient's blood and anticipates intubation. And if not, at least I got to toss around the word "intubation." Malucci edges up toward the patient's head and yells, "Paul, can you hear me?" His pulse drops to 98. I don't believe the two things are related. Paul's brother explains that Paul's first art show opens Monday, so he's been an insomniac all week. "Does he do drugs?" Malucci asks, with the air of one who has already decided upon the answer. "No, I don't think so," Paul's brother muses. "This is the first time I've seen him since he moved to Chicago." And here marks Malucci's first mistake: the assumption that he's smarter than the process. Haleh passes him an EKG, and Dave orders a tox screen while noticing that Paul's ST elevations are off the charts. "He's having a major MI," he proclaims. The brother is stunned that a twenty-seven-year-old could be suffering a huge heart attack, at which point Malucci again smarms that it's common among cocaine users, because the drug can constrict arteries. "Oh God," Paul's brother says, as though Dave just told him that his pencil's broken and they're fresh out of sharpeners. Malucci orders 40 ccs of tenecteplase. Setting his jaw in his best action-hero imitation, Dave intones, "We gotta bust the clot." Haleh refuses to administer thrombolytics -- blood-thinning agents that destroy clots -- until an Attending or Chief Resident signs off on the procedure. "Come on, time is heart muscle!" barks Malucci, making a mental note to write that down and maybe have it emblazoned on a "Men of the ER" t-shirt. Haleh isn't impressed by his verbal stylings and insists on running it past Chen or Weaver. "Get one of them!" he shouts.