ER's in middle American are inferior to big city ones

The Dr.'s musta came from .............America. Not from some foreign country, whose county paid for their medical training with the hope that when they graduate, they would come back and practice in their home country. Once they graduated, they stayed here, leaving their country in need of qualified medical staff.

Not only is Ava a egotistical bitch, she's a condescending egotistical bitch.