Previously on ER: The writers, possibly awed by the moistness of the nation's loins when he recited Hamlet in Croatian, began crafting an excuse to get Luka workin' the native tongue on a regular basis. They settled on a Croatian boy being treated by Luka's former med-school colleague, Gordana; he needs a specialized heart procedure that no local surgeons can do. Susan, meanwhile, went to Vegas, and did by accident what so many people set out to do there: got sloshed and married, in that order. And did you hear? Abby has a brother! Who's depressed! And missing! And unstable! And depressed! Speaking of, Romano's been demoted to ER Chief, and it upset him, so he took it out on everyone else. This got him punched in a bar.
A hand reaches out and grabs moldy pizza off the ground, throwing it into a rattling junk cart. The hand belongs to the Crazy Death Hobo that tools around near the hospital, bringing vague omens and unique aromas. He passes a building, from behind which a shaking, sweating man staggers. "Okay, okay, okay," the man whispers, trying to steady himself. He fumbles for his pills, which fall into a puddle; with a noisy swish, we're taken to his drugged-up, hallucinating point of view. Tentacles reach up from the sludge and fasten around his wrist, trying to yank him down. Apparently American Idol isn't the only show with an underworld creature -- unless this is Tsathoggua, and he's migrating, angrily trying to get revenge on the world for finally voting Carmen Rasmusen off the show. In which case, he ought to be here to collect Abby. Anyway, the hallucinating man dithers around in a world of lights and blurry people and gurgling noises, and tries to climb away up a fire-escape ladder. He falls, landing on garbage bags. He's screaming.
Cut inside Trauma Green. Dr. Susan "Bride of Chucky" Lewis is trying to save the man, and does indeed get a pulse. "All right, he's back," she says. "Whoever he is." We smash into the credits actually unable to believe that this is the hook that's meant to keep us watching, because we totally don't care who Tsathoggua's Attempt At Supper is, and we know this was just the show letting the editors and the director have a little fun time.