Chicago Med (2015–…): Season 1, Episode 11 - Intervention - full transcript

- Alicia, we can't
agree to this.

This is too much.

- Then we'll go to mediation,

and if you still think
it's too much,

we'll go to court.

I'm very confident
in our chances.

- Can't we find a compromise?

I'm sure everyone here
would like nothing more

than to put this behind us.

- Easy for you,

but since Dr. Halstead
resuscitated Mrs. Baker



against her wishes,

she's been confined
to this hospital,

fed through a tube,

and hooked up to a series
of wires, tanks,

and catheters
with no end in sight.

This is not something she'll
ever be able to put behind her.

- I never wanted any of that.

I did what I did
to give you time so--

- Dr. Halstead.

- Dr. Halstead.

- Ms. Goodwin,
you have our terms.

- Okay,
so it's my first surgery,

and I'm holding this thing
called a "Bovie."

- For cauterizing
blood vessels.



- Yeah, yeah, so the surgeon,
he tells me to buzz.

He's talking about the Bovie,

but I have no idea,

so finally I just look at him,

and I say, "Bzz."

- You did not.

- Hi.
- Hey.

- Don't you have
patients to see?

- Yeah, I'm on my way.

It's just another kid
with a earache.

- And we've got 20 more
in the waiting room.

You drinking baby formula?
- Oh, yes.

It's all they had
in the back.

The vanilla's actually
pretty good.

- Incoming!

- 35-year-old male
found down in his kitchen.

Hypotensive at 80 over 40,
rate 134,

Dr. Rhodes, can you get this,
please? We're slammed.

- I'm on it.
Reese, come with me.

Ready?
One, two, three.

- All right,
let's get him hooked up.

Prep a saline line.

We're gonna need another one
wide open.

- O2 sats are 85 and dropping.

- What's happening to me?

- We're gonna find that out.
We're gonna intubate.

Give me a 7.5 ET tube,
20 of etomidate,

and 1 milligram per kilo of roc.

- Septic shock?

- Maybe, but we need
to find a source.

Your respiratory muscles
are weak.

I'm gonna intubate you
so that they can rest.

Give him 3 grams Unasyn.

Send for a CBC, CMP,
coags, and lactate.

Give me a blood gas
and blood and urine for culture.

- There's no bleeding
or deformity in his legs.

- We're almost ready.

Heartrate is erratic.
- Watch his pressure.

- All right, I am in.

- Dr. Rhodes.

- O2 sats are 98
and he's stable.

- No.

We need to get him
up to the OR now.

I have a feeling
we're already too late.

- Patient's spouse is here.
He's very anxious.

Any updates I can give him?

- Tell him his husband's
got necrotizing fasciitis

and we're debriding the muscle
to try and stop the infection.

- Dr. Rhodes, is that okay?

- Uh, yeah.
That's fine.

- Did a med student seriously
just go over my head to you?

- Zoe.

- Hi.

that you helped me get
into the clinical trial?

- Jennifer Baker?

- Could you find out
how she's doing?

You know, side effects,
tumor burden.

- Isn't she still suing you?

- I just want to know
if she's at least showing

some improvement.

- Will,
it's a Phase III study.

All that information
is confidential.

I'll see what I can do.

- Thank you.
- Okay.

[indistinct P.A. chatter]

- Hey.

- Hey.
- So how are you doing?

- I'm good.
- That's good.

We should, you know,
talk.

- Yeah, but not here.

- Yeah.
No.

- No.
- Right.

- Okay.

- You're gonna be fine.
- Hi. I'm Dr. Manning.

This is Dr. Halstead.

You must be Shiloh.

I heard you had a bit
of a headache, huh?

She's also had a 103 fever
since last night.

- Did you try Tylenol
or ibuprofen?

- Tylenol usually works,

but this time it
didn't touch her.

That's why we're here.

- How about any nausea
or vomiting?

- She threw up once.
That definitely concerned me.

- But there hasn't been
any purulent discharge,

so I doubt it's bacterial.

- Well, we can't
rule anything out yet.

- So you're going
to do cultures, right?

Anyone you know
have similar symptoms?

- No, not that I know of.

- Do you feel stiff
or achy back here?

- Yeah. When I move my head.

- Wait.
Are you thinking meningitis?

and neck stiffness,
it's definitely possible.

- Possible or probable?

Because she hasn't shown
increased drowsiness

or experienced any photophobia.

- Are you MDs?

- No. Engineers.

- Well, like we said,
meningitis is a possibility,

so the next step
is to do some tests.

- What kind of tests?

- Well, we're gonna do
two pokes in your arm

and one poke in your back

so we can figure out
what's going on

and get rid of this headache.

Is that okay with you?

Yeah?
Okay.

All right, well,
we'll be back in.

Thank you.

- Professor told me hardest part
of pediatrics--never the kids.

Nice.

Who sent you those?

- Not mine.

Goodwin's anniversary.
32 years.

Dr. Choi, incoming.

- Got it.
- Treatment six.

- Ken Gallagher.
57-year-old male with an LVAD.

Called 911 with
severe abdominal pain

and epigastric tenderness.
Vitals are stable.

- Mr. Gallagher,
on a scale of one to ten,

how bad is your pain?

- A zillion.
- All right, let's move him.

On my count.
One, two, three.

- High dose antibiotics
set up please.

- That's a left ventricle
assist device, right? An LVAD?

- Unfortunately, yes.

- No guarding
or rebound tenderness.

- There's a hole in my stomach.
It never stops.

- You've been diagnosed
with an ulcer?

- Diagnosed, scoped,
transfused, scoped again.

- Doesn't sound like
you've had an easy time.

Okay, you're gonna feel
a little p--

- Feel a little pressure.
Like I said, not my first rodeo.

- All right.
You on any ulcer meds?

- Three of 'em.
What is it this time?

Abscess?
Breakthrough bleeding?

- May be a trace
of blood in there.

Get me an NG tube,
and call GI for an endoscopy.

- No, no. Can't I just show you
my last six endoscopies?

It's still the same stomach.

- Well, I'll give you something
for the pain, but we have to try

and figure out how to get
this ulcer under better control.

- I'll tell you how.
Get rid of this thing.

- Not a good idea.
That thing,

the LVAD,
is pumping your blood for you.

- Yeah, and all my problems
started right after I got it.

but it's better you follow up
on that with your cardiologist.

- My cardiologist is
an arrogant SOB.

Come on.
- Fine.

I'll have cardiothoracic
down to take a look.

- Thank you.

Man, do I hate that stuff.

- It's a lot worse without it.

Okay.

I have a feeling
you know the drill.

- Ron.
- Hey, Dan.

- I haven't seen you
in a while.

- Oh, it'd be more often

if you'd show up at poker
now and again.

- Maybe I'd show up more often

if you didn't keep
taking my money.

- Yeah,
I'd stop taking your money

if you didn't touch your chin
whenever you bluffed.

- Wait.

I have a tell?
Really?

Really?

- Anyway, I try to stay
out of here.

Private practice doc
in a hospital

is never good news.

- Patient of yours
get admitted?

- Necrotizing fasciitis.

- Oh, man.
That is a bear.

- Been seeing me
for ten years.

Good guy.
I'll see you, Dan.

- Take it easy.

- Nat, the little girl
with the fever, Shiloh Kane.

Her lab results.
They said it was urgent.

- April, get the patient
from two into isolation

and order a chest X-ray
and CT head,

and put the rest of the family
in another room

and no matter what,
do not let anyone leave.

- Okay.
- What's going on?

- Get me on the phone
with the CDC.

Immediately.

- How dangerous is this?

- It depends.

Haemophilus influenza B
can often be contained

with the antibiotics

we're giving her now,
but not always.

- And if it's not contained?

- It can cause hearing loss,
brain injury...

- Well, I've never even
heard of it.

How'd she get it?

- Well, that is the question.

It's part of the standard
vaccination regimen.

Is Shiloh vaccinated?

- No.

- Are any of them?

- Type B is transmitted
by saliva,

which makes incidental contacts
like Dr. Halstead

and I not at risk,

but any of her long-term
close contacts are.

but in the meantime, you'll
each need to be immunized.

- I'm not sure we want that.

- Mr. Kane, I think it's very--

- Your children
are at serious risk.

- We feel vaccinations
pose a serious risk as well.

But left alone, the body has
a perfectly good immune system,

and once you start injecting it
with foreign proteins

and preservatives,
you can't help but change that.

- Right now,
all our other children

seem to be fine,

and Shiloh's in there all alone.

Can we just go be with her?

- Of course you can.

We'll send someone
in to watch your other children.

Thank you.

- So what?

You're just gonna
let them off the hook?

- They're scared to death
right now.

It is not the time to push.

I will talk to them
again later, okay?

- His coloring is pristine.

The LVAD is working perfectly.

I just don't see what else
we can do at this time.

- This is not pristine.
- I understand.

Unfortunately, GI ulcers are not
uncommon with these devices.

- Yeah, apparently
neither is torture.

I can't live like this.

- Well, fortunately,
the LVAD is temporary.

Just a bridge until you can get
a heart transplant.

- Come on, do you know
where I am on the list?

Your heart will fail
before I get one.

- That's not true.
There are a lot of factors.

- You're a surgeon, right?

- Mm-hmm.
- Take it out.

- Excuse me?
- Take the damn thing out.

- Mr. Gallagher, I'm--I'm--
I'm--I'm sure you understand.

Your heart is too weak
to pump on its own.

The device
is doing it for you.

- I don't care,

and I don't have a family.

It's my heart.
I want it out.

- That's not possible,

because if we take it out,
you will die.

- I'm sorry.

- Is Dr. Unger coming back?

- Dr. Unger?
I don't know. Was he--

- He was starting
to explain things,

but his office kept paging him,
so he had to go.

- Oh.

- But it sounded bad.

- Necrotizing fasciitis

is what people call
"flesh-eating bacteria,"

but that's a misnomer.

It doesn't actually eat.
It just spreads very quickly.

Even with surgery
and antibiotics,

once it starts moving,
we hardly ever catch up.

- That's what
Dr. Unger was saying.

- Is he Elias's
regular doctor?

- Yeah.

I mean, not regular.

He hardly ever went.

Monday was the first time
he'd been in, like...

two years.

- He saw Dr. Unger
two days ago?

- Yeah.

He had a pimple on his arm
that was bugging him.

- And what did Dr. Unger do?

- He didn't think
it was anything to worry about.

I mean, it was just a pimple.

It hurt him more yesterday,
so we called,

but we never heard back.

I-I guess it wasn't
just a pimple.

- No.

- Jennifer's nurses say
she's tolerating the trial

really well.

No nausea or vomiting.
No muscle pain.

No cognitive dysfunction.

It's as good as a report
as you could ask for.

- Thank you.

I really appreciate this.

- Hey.
Sweet, sweet man, your husband.

If you want, I'll have someone
take them to your office.

- No. Keep 'em here for now.

They brighten up the place.

- Works for me.
What are you guys doing tonight?

- Same as every year.
Gibson's.

Bert orders the T-bone,
and I get the sea bass.

- Best steak house
in Chicago and you get the fish?

- It's delicious.

- Do you know a doctor
in private practice named Unger?

- Yeah.

- Is he reputable?

- Why?

- He missed a diagnosis,
and now that patient's

probably going to die.

- Truthfully, he's missed a few
in the last few months.

- Can you pull up a list
of his patients

who've been here recently?

April.
- [sighs]

Okay.
Just keep my name out of it.

- Mm-hmm.

- You didn't get this
from me.

[alarm chiming]
- Code blue.

- He's in respiratory distress.
What happened?

- Get the crash cart.

Let's get him flat.

He's unresponsive.

- Prep a tray.

- He's wet as a sponge.
We're gonna intubate.

- I can't find the pulse.
- He won't have one.

LVAD's the pump.
It bypasses the heart.

His heart's too weak
to pump blood on its own.

That's why his lungs are soaked.

- Prepping now.

I got a 14 and a 16 standing by.

- No.

The LVAD battery.
He did this to himself.

- What do we got?
- Respiratory distress

and acute heart failure.

- I'll start a subclavian.

He take that out himself?

- Suicide mission.
Not today, buddy.

- And I'm in.

Vent setting's AC 16,
tidal volume 500,

peep of 5, and O2 at 100%.

- Battery's back in.
- Pushing pressors.

[electronic beeping]

- He's pinking up.

- BP is 100 over 65
and climbing.

- He's stable.
- Nice save.

- I'll call upstairs.

He's gonna need to be admitted.

- Dr. Halstead,
I need a word with you.

Why were you poking
around the clinical trial wing?

- I didn't talk to her.
- I instructed you

not to go anywhere near
Jennifer Baker.

- But I heard good news.

Jennifer hasn't had any
of the usual side effects.

She's doing great
in her treatment.

- That's beside the point.

You blatantly disregard
the one thing

I asked you not to do.

- This could mean she's
on the road to remission,

and then I'm sure
they'll drop the lawsuit.

- You don't know that.

You know, I have tried
to be supportive of you,

but one more misstep
and I will suspend you.

You will be barred
from this hospital

until the lawsuit is settled,

and when it is,
I will recommend to the board

that you be terminated.

I'm done.

- Excuse me, Ms. Goodwin.

- What is it?

- Um,
what exactly is the protocol

for reporting
medical misconduct?

- Nurse? Doctor? Who?

- Doctor.

Dr. Unger.

- Let's take this
up to my office.

- Over
the past two years,

Dr. Unger has increasingly
missed routine diagnoses.

In the past three months alone

there have been
four separate incidents.

A UTI that led
to pyelonephritis,

that turned
into a ruptured appendix,

a leg rash that turned out
to be a DVT,

and now an infected pimple

that's led
to necrotizing fasciitis.

- You know this guy.
What are your thoughts?

- We went
to medical school together,

and he's a caring,
thorough physician.

Been my personal doctor
for years.

Never missed a thing.

- He missed those,

and they're only the ones
that came in here.

- Thank you, Reese.
We'll look into it.

In the meantime, don't share
your concerns with anyone else.

- I worry about his patients.

Dr. Unger should lose
his license.

At the very least,
his hospital privileges.

- That's not your call to make.

Thank you.

- So why'd you really
ask me in here?

- I'm starting an investigation.

I didn't want you blindsided.

This could get ugly.

- Hey there.

Where are your parents?

- My dad took my brother
and sister home.

My mom's in the bathroom.

She'll be right back.

- Well, that's okay.
I just came in to check on you.

- Why do you have
to wear the mask?

- Because the bacteria
that's making you sick

is contagious, which means
other people can get it,

and I have to be
particularly careful

because I have a newborn baby,

and I wouldn't want
to get him sick.

- People always going to
have to wear masks around me?

- No, because this medicine
that we're giving you,

it's gonna make you all better.

You let me know
if there's anything

that you need, okay?

- Even strawberry Jell-O?

- Absolutely.

[knocking at door]

- Yes?

- Dr. Downey, you mind?

- Nope.

- What's that?

- "Ka Hana No'eau I Ka Hulu."

The art of the feather.

- Oh.

- I am a rank amateur,

but it's good for the hands.

What's on your mind?

- I have a patient.

He's had an LVAD
for four months.

Been experiencing
unremitting pain, fatigue.

He has little to no control
over his bodily functions.

- That happens,
unfortunately.

- It's been rough,

and he is not a candidate
for a artificial heart.

- Where is he
on the transplant list?

- Pretty far down.

Chances of being moved up
are slim to none.

- And he wants you
to take it out.

- Yeah.

- Do it.

- But he'll die.

- I am a cardiothoracic surgeon.

The patient has asked you
to remove it, yes?

- In no uncertain terms.

- Then honor his wishes.

I hope when my time comes

to be so lucky
as to have someone

extend me
the same consideration.

- Bad news?

- Well, Goodwin
took the paddle to me.

I'm okay.

- My shift's over
in a little,

and I was gonna go
to Shiloh's school

to help give out booster shots.

Why don't you come with us?

- Sure.
- All right.

Van will be outside in ten.

- Okay.

- Hey. You have a second?
- What's up?

- Did you give Keflex to the kid
with the ear infection in three?

- Because he was supposed
to get azithro.

He's allergic to Keflex.

- What happened?
- I mean, nothing terrible.

He's okay.

But it could have been lethal.

- Who else was on that side?

Doris?

Robert?

- No, she was on a break,

and he was with other patients.

I'll keep asking around.

- You man your desk.
I'll find out.

- Yeah?
Okay, thanks.

- Come on, girl, just--
- [laughs]

- Where's Mr. Gallagher?

- Dr. Rhodes just
took him to surgery.

- Surgery?
- To remove his LVAD.

- You're removing the LVAD?
You didn't consult me.

- The only person I needed
to consult was the patient.

- I thought we were
on the same page with this.

What you're doing
is assisted suicide.

- The patient
understands the consequences.

He made an informed decision.

- What about you?

You're killing him.

- It is what the patient wants.

It's ethical, and it's legal.

- I can't let you do it.

- Are you really gonna
try and stop me, Dr. Choi?

- Noah.
- Whoa.

- What?

- The kid
with the ear infection.

You were supposed
to give him azithro.

- I did.
- No,

you gave him Keflex instead.

- Really? Are you sure?
- Oh, my God.

The kid is allergic to Keflex.

- O-okay. D-did he--did
he go into anaphylactic shock?

- No, luckily,
they caught it in time.

- [sighs]
Okay.

- Okay?
It's not okay.

This could have been
really serious.

- But it wasn't.

- Don't you understand
what you did?

- I made a mistake,
but nobody died.

Anybody could have
done what I did.

Who sets up the pharmacy bin?

[both speaking foreign language]

- Don't look for
someone else to blame.

- I'm just saying...

Wait, wait, are you--
are you gonna write me up?

- I don't know.

- April, you'd do that to me?

if anything like this
happens again--

- Look, it won't. It won't.
I will be really careful.

Okay?

Don't worry.

It's all good.

It's all good.

- Hey.
- Hi, I'm the principal.

We're lining the kids
up in the auditorium.

Here are the consent forms.
- Thank you.

[alarm chiming]
- Code blue, ICU.

- Excuse me, sir.

Excuse me.

There's no pulse.

- What--what's happening?

- He's unresponsive.

- He's in V-tach.
- Cardiac arrest.

- What?
Elias!

- Give me the paddles.
Charge to 200.

- Charging to 200.

[electroning whining]

- Here.

Clear?
- Clear.

- Nothing.
Stand by.

- All right, 1 milligram of epi.
- Got it, milligram of epi.

- 1 of epi.

- Elias, come on.

Elias!

- Again. Clear.
- Clear.

- Please, please, save him.
Please, please.

Come on.
Save him.

- Again. Clear.
- Clear.

- Another milligram of epi.

- Doctor...

- Oh, my God, no.

- Time of death 15:22.

- [sobbing]
No! No!

[sobbing]

- I'm sorry, Jim.
- Don't touch me.

- What changed your mind?
- Downey.

- Right, you and Downey,
the dynamic duo.

Oh, that wasn't fair.

I still don't agree
with your call,

but I can see why you made it.

- Awful day today.

- So what happened with
this--with this patient?

- It presented as a superficial
skin infection.

Elias didn't have
any fever, no nausea.

He certainly didn't manifest
any risk factors

for necrotizing fasciitis.

He was nondiabetic,
not in renal failure.

So I gave him an oral doxy,

and I sent him on his way.

I misdiagnosed him.

I feel like hell.

- Hey, everybody
makes mistakes,

but tell me if I'm wrong.

Maybe you didn't used
to make so many?

- Our own little morbidity
immortality, huh?

Dan, I see upwards
of 50 patients a day now.

Between the lousy reimbursements
and my overhead,

I need that many
just to stay afloat,

I had to hire two people
just to deal with it.

- Health care bureaucracy.

I mean, it's tough on
both the patient and the doc.

- You know,
when a young person

comes and they ask me,
"Should I go into medicine?"

you know what I tell them?

No way.

Go get an MBA
and enjoy your life.

- That didn't hurt, did it?

Oh, you are so brave.

- Was that the shot?
- Nope.

That's just the alcohol
to make sure your arm is clean.

- Is that the shot?
- Nope.

I'm gonna give it to you
on the count of three, okay?

One, two--

- Where's three?

- That's it.
You got the shot.

- Mrs. Schroeder's
not feeling well.

- Have your teacher call 911,

and tell the other doctor
I need him.

Can you breathe?

- Natalie!

- Epiglottitis.
Airway's blocked.

Mouth-to-mouth isn't working.
Get me something.

[gasps]

Help me hold her hands down.

Hurry.

- Natalie, here.

- I know it's hard,

but try slow even breaths, okay?

- Mouth-to-mouth?
She's type B, Natalie.

What were you thinking?
- I had to do something.

[sirens wailing]

The ambulance is on its way.
You're gonna be okay.

.

- Theresa Schroeder.
Haemophilus influenza B.

- The ENT is waiting
for you in trauma three.

- All right.

- Terry? Shiloh's teacher?

- This is what happens
when you don't vaccinate.

- You don't know that
this was Shiloh's fault.

- That lady almost died,
and she may have infected

my friend,
who has a newborn baby.

- Terry's probably sick
because her immune system

is shot from a lifetime
of vaccinations.

- You docs,
you think you know it all.

How--how many times
you been wrong?

Urine therapy?
Radium for diarrhea?

How many approved drugs
need to be pulled every year

'cause they're killing people?

Fen-phen or Vioxx, Raptiva.

- There's no evidence
the HIB vaccine

has any negative side effects.

- How can you be sure?

Kids get the vaccine
when they're babies.

Who knows what
the long-term effects will be?

- For Shiloh's
long-term health and happiness,

we'll risk
a treatable childhood illness.

- So no child
should be vaccinated, right?

You want your kids in a school

where no one's protected
from polio, smallpox.

- Will, enough.
- No.

You trot out this pseudoscience,

but what you really want
is for every other kid

to be vaccinated
so yours can be safe.

- He has no right
to speak to us like that.

- You're right, he shouldn't
have spoken to you that way.

I'm very sorry.

- Hey.

You know they're
never gonna vaccinate

their other kids
after that, right?

- I know.

I know.

I shouldn't have
shot my mouth off.

- It was
because of me, wasn't it?

Because I was exposed.

I think it was very gallant.

- You do?

- Maybe we should talk
about that kiss.

- You asked why
I treat you so badly,

why I say things

I wouldn't say
to anybody else.

I'm like a little kid
with a crush on a girl,

so what does he do?

He pulls her pigtails.

Look, I understand if you don't
feel the same way.

- No.
Listen, pl--please.

I don't know
what I would do without you.

But there is
just so much in my life

that I haven't figured out yet.

- You don't have to explain,
Natalie; I--I--I get it.

- No, I don't--
I don't think you do.

I am not trying
to let you down gently

or put you off.

I'm just not
in that place yet.

- Okay.

I'm gonna go check
on the teacher.

You should get a booster.

- Okay.

[electronic beeping]

[sustained beep]

- I'm sorry, Dr. Unger.
I didn't have a choice.

I'll need your hospital ID.

- Okay.

- It's not hard to make a still.
It's basic chem.

- Noah?

- Hey.

that I am gonna file
an incident report.

- What's going on?
Is someone making you do this?

- No, no.
It's my decision.

- Seriously?

- Yeah.

- Hey, hey, look, look.

I get it.
I screwed up.

But you're supposed to be here
for me, not dime me out.

[scoffs]

You know what?
You--you're just pissed

because I'm the doctor
and you're not.

- Noah, you are my brother,
and I love you...

- Mm.
- But you need to grow up.

Look at me.
If you're gonna be a doctor,

I want you to be
a good one.

- Dr. Halstead,
what are you doing?

- Agh, car wouldn't start.
Waiting on a tow.

- Ah, always a perfect way
to end the day.

- Yeah.
- Mm.

- Ms. Goodwin?

I'm sorry I've been
so much trouble.

- Yes, Dr. Halstead.

You have been
a monumental pain in the ass.

- I know.
- Good.

- Oh, and congratulations
on your anniversary.

- Thank you.

- I heard you've been
married a long time.

- I have.

- How do you do that?

- Stay out of each other's way

and never forget
an anniversary.

Good night.

- Good night.

- That was...

Whew.

It was a rough day.

- I have something
to show you.

- [grunts]

Johns Hopkins, huh?

- Head of trauma.

- That's quite an offer.

- Yeah, it is.

- I hope
you let them down gently.

You know, Baltimore
gets very cold too.

- I know.

- Looks like we had
the same kind of day.

Sweet and strong, please.

- I had a patient
who wanted his LVAD removed.

He got what he wanted.

Now he's dead.

- Huh.

I guess I took out
an LVAD myself today.

- How do we ever know
what we're doing is right?

- It's tricky.

I mean, the first part
of the Hippocratic oath

is clear, right?

"Do no harm."

Then it goes on to say,

"I will remember that
there is art to medicine

as well as science."

So it's tricky.

- It ever get any easier?

- Hope so.

[glasses clink]