Chicago Med (2015–…): Season 1, Episode 17 - Withdrawal - full transcript
April and Dr. Halstead treat an alcoholic homeless man with a broken leg.
Have you seen my coat?
It's right here.
Don't touch that. Get away, get away.
It's really taking to you.
Ha, funny.
No, he really has.
It's because I'm the one with the food.
That's why I took to you.
Really?
That mean if I feed you some seeds
you'll forget about
teaching this course?
And miss two months in Bethesda?
It's the vacation capital
of Montgomery County.
Get away, get away.
Don't touch that. Get away.
Hmm.
They charge you twice
for your cable again?
No, I got offered a job.
Yeah? That's great.
I guess.
It's in California.
Oh.
But I mean, that's okay, right?
It's nice out there.
Yeah, definitely.
It's just... just far.
Have you heard from Rush yet?
Northwestern?
Uh, still waiting.
Course, there's always a chance
things could work out here.
Very slim chance.
Hey, you two.
Patients incoming.
You're going to Treatment 6.
April, you got this?
- Yeah.
- Thank you.
Right here.
What do we got?
Chuck Gleason, 42-year-old male.
Found at the bottom of
some stairs on Lower Wacker
with a fractured left tibia.
Okay, on my count.
One, two, three.
Oh.
He looks dehydrated.
Let's call ortho and start some fluids.
- Oh.
- On it.
Starter 1, let's get him set up.
Let's pull the board out.
You got a drink, April?
Could really use a drink.
Are you guys friends?
Frequent flier.
Alcohol.
And everything that goes with it.
How 'bout you, buddy?
You got a drink?
Unfortunately,
this is a hospital, not a bar.
When did this happen?
Yesterday.
Oh.
101.
All right, let's get a
chest X-ray and a UA.
Okay.
Okay, Mr. Gleason,
you broke your leg pretty bad.
We're gonna have to evaluate this and...
- He's seizing.
- Mr. Gleason?
All right, milligram of Ativan.
- On it.
- It's a grand mal seizure.
He ever had this before?
Not that I've seen.
Milligram of Ativan.
He's withdrawing.
He's going into delirium tremens.
You know.
Never seen him get DTs before.
It's gonna be bad, isn't it?
Is it ever good?
- Hey. Thanks for the bird.
Kids are gonna love it.
Definitely. Glad he'll have a nice home.
Yeah. Anything I need to know?
Nope.
Just enjoy.
All right, you're a good man, Doc.
Cirrhosis, hepatitis,
cardiomyopathy, renal failure.
Reads like the index
of "Harrison's Guide
to Internal Medicine."
Ah.
Ah!
Mr. Gleason, when was your last drink?
Two nights ago, which is why
I need to get the hell out of here.
Afraid I can't do that.
Talk to this guy, will you please?
I'm sorry, Chuck, the
doctor's in charge.
No, I'm in charge, okay?
I'm in charge. I know my rights.
I don't have to stay here
if I don't want to stay here.
That's very true,
but you're not going
to get far on that leg
without ortho taking care of it.
Okay, fine, man.
It's cool.
W-w-what are we talking about here,
two hours?
Mr. Gleason,
you're going through delirium tremens.
Your body is so used to
the presence of alcohol
that it's reacting
violently to its absence.
Blah, blah, blah!
We need to keep you here a day
or so till you get through it.
Ain't gonna happen, man.
Okay?
I seen what happens with the DTs.
I can't go through that, please.
We can't stop them,
but we have given you a sedative
to make it easier.
I'm sorry, but at this point,
it's no longer safe for you to leave.
Okay.
Okay.
Hey, Maggie, can you call ortho
and see what's taking so long?
Sure can.
Hey.
Where's your wedding ring?
I-I don't know.
Um... I had it on when I got here.
You didn't put it in your locker?
No, I never take it off.
Well, where else have you been?
Re-trace your steps.
I've been in and out of five rooms,
washing my hands.
I mean, who knows how many
gloves I've taken on and off?
Maggie.
All right, all right, I got this.
Everyone, listen up.
We're missing a gold wedding band,
so take a room and
search every inch of it.
From now on, nothing leaves the ED.
Every sheet, every gown,
every piece of trash
gets bagged and stored
until I search it.
Got that?
Hey, we're gonna find it, okay?
I'm gonna check in the lounge.
- Okay.
- Thank you.
Okay.
So this is Rose Wechsler, 83.
Arrived from her nursing
facility confused and agitated.
Ms. Wechsler, good morning.
Baloney.
Are you here for the sink?
You know, I'm not.
But it would help me out a great deal
if you would tell me what year it was.
Check your damn calendar.
No wonder you people
never show up on time.
That's completely my fault.
Do you mind if I just shine...
What are you, some kind of a maniac?
Get the hell out of here!
Thank you.
Out!
Lovely to meet you.
What do you think?
Nursing home delirium.
Acute cognitive dysfunction
from some combination
of dehydration, stasis, over-medication,
and a lack of human engagement.
Could be.
She's neurologically intact but
her mucous membranes are dry.
If you're right, fluids
will perk her up.
Mm, yeah, for now.
What?
Well, I'm sorry,
it's just that her records indicate
she led a remarkable life.
Was one of the first female test pilots,
trained at NASA.
Even if fluids work,
it's sad seeing someone
like that wind up like this.
Well...
Incoming! Dr. Choi.
We're going to Baghdad.
On it.
Talk to me.
Frank McCormick. Here's his EKG.
42, lost his rhythm again in the van.
Shocked from v-fib in the field.
Hang in there, Frank,
it's going to be okay.
Excuse us, ma'am.
Let's rotate.
All right, let's
transfer him on my count.
One, two, three.
Transfer.
Dr. Choi, what have you got?
STEMI. A big one.
He flipped back into v-fib.
- On it.
- STATs are dropping.
- Frank.
- Paddles to Dr. Choi.
Ma'am, ma'am, is this your husband?
- Yes.
- He had a heart attack.
Please step outside.
- Oh, my God.
- Come with me
and stand right there.
- Charge 200.
- Charging.
- Clear.
- Clear.
Charging.
Clear.
Heart rate's back to 65.
Pressure's 115 over 60.
All right, let's get
him up to the cath lab.
Based on his EKG, he's
gonna need a bypass.
Okay, let's go.
Watch the lines.
Wait.
Did you say he needs
a bypass? Yes, ma'am.
We got your husband's rhythm back,
but he's still not out of the woods.
We need to find the blockage
that caused his heart attack
and most likely,
we will graft new vessels on around it.
But that means going on a
heart-lung machine, right?
Yes, it does.
Then I'll have to refuse.
Refuse? What?
My husband can't have any surgery
that involves the
administration of blood.
We're Jehovah's Witnesses.
Stop!
Stop it! Get it off of me.
They're inside of this thing now.
Chuck, you're hallucinating again.
It's part of the DTs.
We're gonna increase your sedatives.
I don't want a sedative.
How many times do I
got to tell you that?
I don't need a sedative.
I don't need a sedative.
I need a drink.
You know I can't do that.
Then get the hell out of here!
Hey, how long have I known you?
Years.
Every time you come in
here, you are sicker.
One of these times you're
going to be too far gone.
Chuck, listen to me.
You're never gonna beat
this if you give in now.
I'm never gonna beat this.
I ain't beating nothing.
Please help. Make it stop.
Please, please, make it stop.
I'm trying to help you.
I told you... I told you how to help me,
but you don't listen.
Going to increase your sedatives,
and I'm going to get
you a clean blanket.
I don't need a clean blanket.
I need a drink.
Youse are killing me with all your help!
Frank, we respect your beliefs, we do.
But the fact is, you're going
to have another heart attack.
The only question is when.
You page me?
This is Dr. Downey,
our top cardiothoracic surgeon.
I was just explaining to the McCormicks
that unfortunately surgery
is the only option that we have left.
And I was explaining that
we need an alternative
that doesn't involve the
administration of blood.
It is his own blood.
It's re-circulated.
Blood contains the gift of life.
Once it leaves the body,
it's contaminated forever.
I know you think we're being difficult,
but this isn't just about the danger
that Frank's body is in right now.
It's about he and I being able
to spend eternity together.
We understand, but you have to...
What about bloodless surgery?
What's that?
It's where we do it off-pump.
Operate on the heart
while it's still beating.
You can do that?
Yes.
Though it comes with significant risks.
For the McCormicks,
the heart-lung machine is a risk.
Stopping the heart,
removing the blood to oxygenate it,
then putting it back
violates their faith,
so let's do it without the machine.
Excuse us for a moment.
He's got bad three vessel disease.
He's a terrible candidate.
It's too high of a risk.
Higher than not doing anything at all?
Let's at least give them some time
to see if they want to
choose the safer option.
We don't want to wait.
We want to do the bloodless surgery.
Okay.
I'll inform the OR.
Please, it's a lot...
Please.
You need to up his benzos.
I already did, twice.
Then give him a
milligram of Haldol, too.
I'll tell you, when I
was a clinical nurse
I used to dread DT patients.
I know, such misery.
And most of the time
they're back in two months
to do it all over again.
Mm-hmm.
I lost my wedding ring recently,
didn't find it for three days.
What did Bert say?
You know, he didn't say anything,
which was weird because
he's usually so observant.
Huh.
Oh, excuse me. Daniel.
What are you doing tonight?
Mm, working, why?
Well, an old friend of Bert's and mine
has moved to town
and I thought we could all go to dinner.
You know, sounds like a blast
but I really am slammed.
Come on, Daniel.
Bert's been so grumpy lately,
and he always cheers up
when he talks to you.
What's going on?
It's a long story,
but you'd really be helping me out.
Besides, Maribel loves
Scotch and ballroom dancing.
You haven't been out in a while.
You know, there's a reason for that.
There's this new study out,
says dating can lead to marriage.
It's just a friendly dinner.
Yeah, and I'm still paying
two and a half alimonies.
Those friendly dinners
can get expensive.
Ooh, Ms. Reese,
any word on that nursing home patient?
Actually, there is.
- Daniel.
- I got to go.
Thank you so much for the invite.
Best to Bert.
We'll do it next time.
So the good news is,
Ms. Wechsler's doing much better
after some fluids.
She's awake and alert.
That is good news.
Yes, though she does still have a fever
and is reporting lower abdominal pain.
Fluids and scans?
All negative except for a
slightly elevated white count,
but I'm already doing an
infectious workup now.
Sounds like a great plan.
What's the bad news?
This is Wanda Stern.
In from the same nursing home.
She has a 101 fever
and feels Nixon is just
what this country needs
to run out the commies.
Fluids and labs?
Fluids and labs.
Hey.
Sorry about your ring.
It's so stupid.
I can't believe I lost it.
No, no, no. Come on.
These things, they happen.
No, illnesses happen.
Bad weather happens.
This is on me.
Look, I'm on all your patients,
so don't worry, okay?
Just... try to take it easy.
I feel so terrible.
Like, like I betrayed Jeff,
like I didn't care enough.
Hey, April?
April.
What's in the bag?
Nothing, it's a personal item.
Is that a bottle of booze?
You were going to give
that to Mr. Gleason?
My nursing supervisor
did it all the time.
April, it's against protocol.
Since when do you care about that?
I care about getting our
patient through this.
Does he look like he's
getting through this?
He needs a drink.
I didn't say it would be easy, but that?
That's just a Band-Aid.
I come in here every day and
I put Band-Aids on patients
and most of them thank me for it.
And he may thank you,
but you're not helping him.
And you are?
Standing around while
he dies in front of us?
This man has a chance
to get past his problem
and make a new start.
He's telling us that
he doesn't want that,
and it's up to us to listen.
No, no, no, no.
It's not my job to listen.
I'm a doctor.
It's my job to decide
what is best for him.
That is exactly why I'm a nurse.
Hey.
Uh, Frank McCormick
is going into surgery.
I need you to load his
angio into the system.
You doctor Rhodes?
Uh, yep.
Should be up now.
_
Yeah, thanks.
No luck yet, huh?
Not yet, but we haven't
even gone through the trash.
Are you okay?
Yeah, uh...
My head is... spinning.
I feel like I'm gonna throw up, but...
oh, Maggie.
Natalie, I'm gonna find your ring,
but in the meantime,
I want you to go in there,
have a drink of water,
and lie down.
Okay? Mmhmm.
All right.
Natalie?
I don't know why you guys
are ordering all these tests.
I'm anemic. It was nothing.
That's not what the EKG's saying.
I'm seeing elevated ST segments
in the anterior and lateral leads.
Where?
Tell echo we're bringing her upstairs.
Echo?
I have no cardiac
history, no risk factors.
You guys are just being overly
cautious because it's me.
Nat, that's darn right
that's what we're doing.
Stop being stubborn and
listen to the man, please?
Let's go.
Ugh.
On Wednesdays,
I go downstairs to the beauty shop.
My neighbor Sheila always does my hair.
Okay.
How about the card room?
I play a lot of canasta.
- In the south lobby?
- No, darling.
Uh, in the north.
Oh.
How we doing, ladies?
Any luck?
Wanda here is lovely,
and though I appreciate your
theory that our conditions
may arise from the same source,
I'm afraid the only thing we
have in common is Sinai Gardens.
Ah.
Ms. Reese, could I, um...
could I talk to you for a moment?
Mm-hmm.
Keep at it.
Their labs are all negative,
but both are febrile with leukocytosis,
and infections in the elderly
can present quite
differently than normal.
I think we need to start
looking for zebras.
Rickettsia, leptospirosis...
Ms. Stern had some
redness in her left eye.
You notice that?
Probably from the chlorine in the pool.
She likes to do water aerobics.
But consider the symptoms.
Acute delirium, severe dehydration,
lower abdominal pain, one itchy red eye.
Like I said, in an 85-year-old,
it could be anything.
If these women were
closer to you in age,
what might you suspect?
No.
No, no, no, no, no.
Why not?
No. Because they're old ladies.
They can't have gonorrhea.
Are you trying to tell me
that because they're old,
they can no longer be sexually active?
Well, come on, they barely have
the energy to play canasta,
whatever that is.
I say we keep digging.
Ahem. There's a gentleman
from the retirement home out there
inquiring about the status
of your two patients.
Says his name is Clyde.
Hmm.
Maybe they, um,
have something in common after all.
We're gonna need some swabs.
Dr. Halstead!
What happened?
He just started vomiting blood.
Must have ruptured an esophageal varix.
Prep a Minnesota tube and call for MTP.
I need to intubate.
It's from years of alcoholic cirrhosis.
The vessels get dilated and tortured.
But why's this all happening right now?
Must have ruptured
from all the vomiting.
Right, tube.
Got an airway.
Bag him.
Good breath sounds bilaterally.
We need to stop this bleeding.
- Minnesota tube.
- Yes, Doctor.
- What do you need?
- Start a groin line.
Get a rapid transfuser,
and give him two of blood, stat.
I need more suction.
I got it.
Send a runner to
Central for the infuser,
and call the blood bank.
I'm on it.
I can't see a damn thing.
All right, I'm gonna
have to go in blind.
Line's in.
Start the MTP.
Pressure's down to 80 over 40.
He's bleeding out.
Come on.
Come on.
Got it!
- Blood's going.
- Good.
Ready to inflate the internal balloons.
Syringe.
Want an X-ray for placement?
No time.
As soon as the balloons are inflated,
we'll know whether the pressure
they're placing on the vessels
is enough to staunch the bleeding.
Bleeding's stopped.
For now.
Call GI to cauterize the vessels.
Okay.
I'm doing everything I can.
Dr. Halstead?
Dr. Manning's results from echo.
Knock, knock.
Hey.
Did you get my echo results?
Yeah, good news.
You definitely did not
have a heart attack.
You see?
That's what I've been saying.
But you did have a cardiac event.
Uh, takotsubo cardiomyopathy.
Let me see that.
Um, spasm on your coronary artery.
Would explain the shortness
of breath and chest pain.
Scary for sure, but
completely reversible.
Yeah, we should have you
out of here in a day or two.
Losing my wedding ring.
That's what triggered this.
Hey, it's not always easy
to pinpoint the cause
of the stress. You...
you just can't know.
Will, no, you don't
have to sugar-coat it.
I know the colloquial term for this.
Broken heart syndrome.
This is about, uh...
This is about Jeff.
Chance of another episode
is incredibly low.
You will get past this,
I promise.
Yeah.
I came as soon as Maggie called me.
How is she?
Hi, uh... she's gonna be okay.
Oh.
Hi.
And LAD is finished.
Raising the heart ventrally
to get at the RCA.
Uh-huh.
Two-thirds of the way there.
This is the big one.
Right there.
Scalpel and Gerald.
Scalpel.
Blood pressure bottomed out.
You got to lower the heart back down.
Okay.
Okay.
Marty?
It's not coming back.
He's in v-fib.
We got to put him on the pump.
No, we'll defibrillate him,
continue as planned.
And then what?
This is gonna happen again.
- Clear.
- Clear.
Still v-fib.
We have to put him on the pump.
We don't have a choice.
Charge to 50.
Charging.
Clear.
This isn't working.
We need to get the perfusionist
and the bypass team in here now.
That's not an option, Dr. Rhodes.
Then we will get his wife in here
and we will get her consent.
It's his ball game.
I don't understand. Is Frank okay?
Please, put this on.
We're not getting the pressure back.
Frank, oh, my God.
Your husband is dying.
I'm pumping his heart with my hands.
Mrs. McCormick.
If you don't authorize this right now,
you'll never see him alive again.
Is there really no other way?
No.
Do what you have to.
Forgive me, Jehovah.
Why don't you come with me outside?
Right, let's hook him
up and get to work.
This is the right thing to do.
Thank you.
Yeah. That was Julia.
She needs me to relieve her.
I could bring Owen back
here a little later.
Maybe later tonight.
Okay, all right, well, you just, uh...
you just call me and... and let me
know what you'd like, all right?
Oh, uh, Helen, actually,
I'm sorry.
One last thing. Mmhmm.
Do you know where Jeff got my ring?
Well, not right offhand,
but I-I could look that up.
Please.
You're not thinking about
replacing the ring, are you?
Yes, I am.
Do you really think that's a good idea?
Why wouldn't it be?
Natalie, I know you loved Jeff.
Jeff loved you,
but maybe losing the ring is a sign.
A sign?
Natalie...
what do they call this?
Broken heart syndrome.
Your grieving is so great
that it has put you in a hospital bed
and is keeping you from
coming home to see your son.
So, maybe you just...
you need to let go a little bit.
How could you say that?
I would never let go of Jeff.
I don't mean let go of him.
Just...
move forward.
You just...
you call me and let me know
if you need anything from home.
The clap?
Yikes.
Have Rose and Wanda been told?
How did they take it?
You'd have to ask them.
Mr. Glickman,
partner notification
is an important part
of gonorrhea treatment,
and while we really don't
want to be intrusive...
A gentleman never tells.
But if there are others,
they should be informed.
There's Cookie.
Beautiful blue eyes.
Cookie?
Sylvia, marvelous sense of humor.
So you're sleeping with
four different women?
Ms. Reese.
You make it sound tawdry.
It's not like that.
At our age, there are very few men left,
and people need companionship.
I make them happy, they make me happy.
And I love them, all of them.
All of them.
I think of it as assisted loving.
We'll get you a shot of
ceftriaxone and azithromycin.
The nurse will be with you shortly.
Don't touch that. Get away.
Hey, Dr. Choi.
Earl said to give this back to you.
What... what do you mean?
Made such a racket,
wouldn't let him get any sleep.
Said he's going to get a gerbil.
Don't touch that. Get away, get away.
Sorry, Maggie, I got to go.
Hey, what am I supposed to do with it?
I don't know.
Put him in the doctors' lounge.
Get away, get away.
Come on.
Hm.
Oh, Frank, I was so scared.
Told you it'd be all right.
Jehovah lit the path.
It was His will.
These doctors,
maybe you should do
every surgery this way.
Mr. McCormick, you should know
that there were complications
with the surgery.
What kind of complications?
We had to use the bypass
machine after all.
I thought we made our wishes clear.
Did they tell you they were doing this?
They did.
And you gave them your permission?
How could you do this to me?
I did it for you. For us.
You weren't going to
survive the surgery.
And now how am I supposed
to survive eternity?
Frank, I'm sorry.
- Get out.
- Please.
Get out.
You had no right.
You had no right.
That is why we don't disregard patients'
wishes.
Have you read the fine print
of what they believe in?
They can accept all
the fractions of blood
but they can't accept them all together.
Does that make any sense to you?
Doesn't have to make sense to us.
If he believed he would live longer
if his wounds were
dressed in green bandages,
then we give him green bandages.
Not if the green bandages
are going to kill him.
Yeah, even if it kills him.
David, do you really believe that?
Or is this just because this is the day
that your liver is going to be ablated?
I saw your name on the board in IR.
The mass on my liver isn't shrinking.
We're going to try and reduce it again.
In fact, I should mosey down there.
You're a good surgeon, Dr. Rhodes,
but saving a life isn't
always the answer,
and you will never be a great surgeon
until you understand that.
Hey, hey, hey.
Look what I found.
Where did you find it?
In a linen bag,
stuck to the hem of a fitted sheet.
That's why you quadruple check, right?
Thank you, Maggie.
I thought it was gone for good.
Well, now it's back.
Mm.
We're gonna beat 'em to the finish line.
Here it comes. Hold on tight.
- Up we go.
- Whoo!
Thank you very much.
Thank you again for all your help.
Ms. Wechsler, can I ask you something?
Sure.
You're a strong, successful woman.
You flew jets.
Aren't you angry with him?
I tell you, Ms. Reese,
some men spend their
whole lives with women
but never bother to
learn what pleases them.
Clyde learned.
Let's go, Rosebud,
before this thing turns
back into a pumpkin.
Thank you very much.
Going flying.
He seems like a nice enough guy,
but no one is worth lying,
cheating, or disease.
Where are you getting
lying and cheating?
You heard what he said.
Didn't hear that.
This looks like more of an...
open relationship to me.
Well, you would think by
their age they'd be past that.
Past wanting physical intimacy?
If my boyfriend ever suggested
an open relationship,
I'd kill him.
Huh.
You might be surprised how things
you once thought were so important
become less so when you get older.
My life definitely
become bigger, messier,
far more interesting than
I ever thought it could
when I was younger.
And you know what?
It hasn't always been such a bad thing.
Well, I'm not that young.
I'm almost 26.
So you know, I was
thinking, if you guys...
You know,
your friend's still going out to dinner,
I wouldn't be opposed.
Great, you changed your mind.
Yeah, got hungry.
Well, not too hungry I hope.
My friend's a vegan.
A vegan? And you're telling me now?
That's curious.
Important thing is,
it'll make Bert happy.
You know I live to serve.
T-shirt and a pair of jeans.
I paid for it.
How much?
Mr. Gleason seems much improved.
Yeah.
When did his tremors subside?
Uh, about 20 minutes ago.
And no more hallucinations?
Mm-mmm.
Did we up his benzos?
No, why?
Nurse Sexton.
Pretty miraculous turnaround
for our frequent flier,
don't you think?
It looks like he'll pull through, yeah.
Did you give him a drink?
No.
Well, someone did, so who was it?
Goodwin?
I guess once a nurse, always a nurse.
Excuse me, a word, please?
Sure.
You gave Mr. Gleason a drink?
He was likely going to die without one.
I've seen it happen.
So it doesn't matter if that
was against hospital policy,
'cause I'm pretty sure if that were me,
I'd be raked over the
coals right now by you.
Damned if you do and
damned if you don't.
I admit, it's a bit
of a double standard.
What can I say?
This patient...
he had a chance to kick his addiction.
Now it's gone.
Dr. Halstead,
an addict doesn't just kick a habit.
He's got to want to quit,
and right now he doesn't.
Listen, you can't force a
person to move on from something
if they're not ready.
You know they found Dr. Manning's ring.
Want to come up with me to see her?
I'll be up a little later.
Any shortness of breath?
Mr. McCormick, I am sorry.
We were just trying to deal
with the circumstances...
The best you could.
I know.
Do you even think about
God's will or just your own?
You familiar with... Peter 5:2?
"Be a shepherd to the flock
that is under your care.
"Watch over them.
"Not for what you'll get out of it,
but because you are eager to serve God."
You entrusted me to watch over
not just your body but your soul.
You're alive... .
because I couldn't
imagine life without you.
I misplaced my faith.
Today, I didn't serve God.
But I have to believe that a god of love
is also a god of forgiveness.
_
It's right here.
Don't touch that. Get away, get away.
It's really taking to you.
Ha, funny.
No, he really has.
It's because I'm the one with the food.
That's why I took to you.
Really?
That mean if I feed you some seeds
you'll forget about
teaching this course?
And miss two months in Bethesda?
It's the vacation capital
of Montgomery County.
Get away, get away.
Don't touch that. Get away.
Hmm.
They charge you twice
for your cable again?
No, I got offered a job.
Yeah? That's great.
I guess.
It's in California.
Oh.
But I mean, that's okay, right?
It's nice out there.
Yeah, definitely.
It's just... just far.
Have you heard from Rush yet?
Northwestern?
Uh, still waiting.
Course, there's always a chance
things could work out here.
Very slim chance.
Hey, you two.
Patients incoming.
You're going to Treatment 6.
April, you got this?
- Yeah.
- Thank you.
Right here.
What do we got?
Chuck Gleason, 42-year-old male.
Found at the bottom of
some stairs on Lower Wacker
with a fractured left tibia.
Okay, on my count.
One, two, three.
Oh.
He looks dehydrated.
Let's call ortho and start some fluids.
- Oh.
- On it.
Starter 1, let's get him set up.
Let's pull the board out.
You got a drink, April?
Could really use a drink.
Are you guys friends?
Frequent flier.
Alcohol.
And everything that goes with it.
How 'bout you, buddy?
You got a drink?
Unfortunately,
this is a hospital, not a bar.
When did this happen?
Yesterday.
Oh.
101.
All right, let's get a
chest X-ray and a UA.
Okay.
Okay, Mr. Gleason,
you broke your leg pretty bad.
We're gonna have to evaluate this and...
- He's seizing.
- Mr. Gleason?
All right, milligram of Ativan.
- On it.
- It's a grand mal seizure.
He ever had this before?
Not that I've seen.
Milligram of Ativan.
He's withdrawing.
He's going into delirium tremens.
You know.
Never seen him get DTs before.
It's gonna be bad, isn't it?
Is it ever good?
- Hey. Thanks for the bird.
Kids are gonna love it.
Definitely. Glad he'll have a nice home.
Yeah. Anything I need to know?
Nope.
Just enjoy.
All right, you're a good man, Doc.
Cirrhosis, hepatitis,
cardiomyopathy, renal failure.
Reads like the index
of "Harrison's Guide
to Internal Medicine."
Ah.
Ah!
Mr. Gleason, when was your last drink?
Two nights ago, which is why
I need to get the hell out of here.
Afraid I can't do that.
Talk to this guy, will you please?
I'm sorry, Chuck, the
doctor's in charge.
No, I'm in charge, okay?
I'm in charge. I know my rights.
I don't have to stay here
if I don't want to stay here.
That's very true,
but you're not going
to get far on that leg
without ortho taking care of it.
Okay, fine, man.
It's cool.
W-w-what are we talking about here,
two hours?
Mr. Gleason,
you're going through delirium tremens.
Your body is so used to
the presence of alcohol
that it's reacting
violently to its absence.
Blah, blah, blah!
We need to keep you here a day
or so till you get through it.
Ain't gonna happen, man.
Okay?
I seen what happens with the DTs.
I can't go through that, please.
We can't stop them,
but we have given you a sedative
to make it easier.
I'm sorry, but at this point,
it's no longer safe for you to leave.
Okay.
Okay.
Hey, Maggie, can you call ortho
and see what's taking so long?
Sure can.
Hey.
Where's your wedding ring?
I-I don't know.
Um... I had it on when I got here.
You didn't put it in your locker?
No, I never take it off.
Well, where else have you been?
Re-trace your steps.
I've been in and out of five rooms,
washing my hands.
I mean, who knows how many
gloves I've taken on and off?
Maggie.
All right, all right, I got this.
Everyone, listen up.
We're missing a gold wedding band,
so take a room and
search every inch of it.
From now on, nothing leaves the ED.
Every sheet, every gown,
every piece of trash
gets bagged and stored
until I search it.
Got that?
Hey, we're gonna find it, okay?
I'm gonna check in the lounge.
- Okay.
- Thank you.
Okay.
So this is Rose Wechsler, 83.
Arrived from her nursing
facility confused and agitated.
Ms. Wechsler, good morning.
Baloney.
Are you here for the sink?
You know, I'm not.
But it would help me out a great deal
if you would tell me what year it was.
Check your damn calendar.
No wonder you people
never show up on time.
That's completely my fault.
Do you mind if I just shine...
What are you, some kind of a maniac?
Get the hell out of here!
Thank you.
Out!
Lovely to meet you.
What do you think?
Nursing home delirium.
Acute cognitive dysfunction
from some combination
of dehydration, stasis, over-medication,
and a lack of human engagement.
Could be.
She's neurologically intact but
her mucous membranes are dry.
If you're right, fluids
will perk her up.
Mm, yeah, for now.
What?
Well, I'm sorry,
it's just that her records indicate
she led a remarkable life.
Was one of the first female test pilots,
trained at NASA.
Even if fluids work,
it's sad seeing someone
like that wind up like this.
Well...
Incoming! Dr. Choi.
We're going to Baghdad.
On it.
Talk to me.
Frank McCormick. Here's his EKG.
42, lost his rhythm again in the van.
Shocked from v-fib in the field.
Hang in there, Frank,
it's going to be okay.
Excuse us, ma'am.
Let's rotate.
All right, let's
transfer him on my count.
One, two, three.
Transfer.
Dr. Choi, what have you got?
STEMI. A big one.
He flipped back into v-fib.
- On it.
- STATs are dropping.
- Frank.
- Paddles to Dr. Choi.
Ma'am, ma'am, is this your husband?
- Yes.
- He had a heart attack.
Please step outside.
- Oh, my God.
- Come with me
and stand right there.
- Charge 200.
- Charging.
- Clear.
- Clear.
Charging.
Clear.
Heart rate's back to 65.
Pressure's 115 over 60.
All right, let's get
him up to the cath lab.
Based on his EKG, he's
gonna need a bypass.
Okay, let's go.
Watch the lines.
Wait.
Did you say he needs
a bypass? Yes, ma'am.
We got your husband's rhythm back,
but he's still not out of the woods.
We need to find the blockage
that caused his heart attack
and most likely,
we will graft new vessels on around it.
But that means going on a
heart-lung machine, right?
Yes, it does.
Then I'll have to refuse.
Refuse? What?
My husband can't have any surgery
that involves the
administration of blood.
We're Jehovah's Witnesses.
Stop!
Stop it! Get it off of me.
They're inside of this thing now.
Chuck, you're hallucinating again.
It's part of the DTs.
We're gonna increase your sedatives.
I don't want a sedative.
How many times do I
got to tell you that?
I don't need a sedative.
I don't need a sedative.
I need a drink.
You know I can't do that.
Then get the hell out of here!
Hey, how long have I known you?
Years.
Every time you come in
here, you are sicker.
One of these times you're
going to be too far gone.
Chuck, listen to me.
You're never gonna beat
this if you give in now.
I'm never gonna beat this.
I ain't beating nothing.
Please help. Make it stop.
Please, please, make it stop.
I'm trying to help you.
I told you... I told you how to help me,
but you don't listen.
Going to increase your sedatives,
and I'm going to get
you a clean blanket.
I don't need a clean blanket.
I need a drink.
Youse are killing me with all your help!
Frank, we respect your beliefs, we do.
But the fact is, you're going
to have another heart attack.
The only question is when.
You page me?
This is Dr. Downey,
our top cardiothoracic surgeon.
I was just explaining to the McCormicks
that unfortunately surgery
is the only option that we have left.
And I was explaining that
we need an alternative
that doesn't involve the
administration of blood.
It is his own blood.
It's re-circulated.
Blood contains the gift of life.
Once it leaves the body,
it's contaminated forever.
I know you think we're being difficult,
but this isn't just about the danger
that Frank's body is in right now.
It's about he and I being able
to spend eternity together.
We understand, but you have to...
What about bloodless surgery?
What's that?
It's where we do it off-pump.
Operate on the heart
while it's still beating.
You can do that?
Yes.
Though it comes with significant risks.
For the McCormicks,
the heart-lung machine is a risk.
Stopping the heart,
removing the blood to oxygenate it,
then putting it back
violates their faith,
so let's do it without the machine.
Excuse us for a moment.
He's got bad three vessel disease.
He's a terrible candidate.
It's too high of a risk.
Higher than not doing anything at all?
Let's at least give them some time
to see if they want to
choose the safer option.
We don't want to wait.
We want to do the bloodless surgery.
Okay.
I'll inform the OR.
Please, it's a lot...
Please.
You need to up his benzos.
I already did, twice.
Then give him a
milligram of Haldol, too.
I'll tell you, when I
was a clinical nurse
I used to dread DT patients.
I know, such misery.
And most of the time
they're back in two months
to do it all over again.
Mm-hmm.
I lost my wedding ring recently,
didn't find it for three days.
What did Bert say?
You know, he didn't say anything,
which was weird because
he's usually so observant.
Huh.
Oh, excuse me. Daniel.
What are you doing tonight?
Mm, working, why?
Well, an old friend of Bert's and mine
has moved to town
and I thought we could all go to dinner.
You know, sounds like a blast
but I really am slammed.
Come on, Daniel.
Bert's been so grumpy lately,
and he always cheers up
when he talks to you.
What's going on?
It's a long story,
but you'd really be helping me out.
Besides, Maribel loves
Scotch and ballroom dancing.
You haven't been out in a while.
You know, there's a reason for that.
There's this new study out,
says dating can lead to marriage.
It's just a friendly dinner.
Yeah, and I'm still paying
two and a half alimonies.
Those friendly dinners
can get expensive.
Ooh, Ms. Reese,
any word on that nursing home patient?
Actually, there is.
- Daniel.
- I got to go.
Thank you so much for the invite.
Best to Bert.
We'll do it next time.
So the good news is,
Ms. Wechsler's doing much better
after some fluids.
She's awake and alert.
That is good news.
Yes, though she does still have a fever
and is reporting lower abdominal pain.
Fluids and scans?
All negative except for a
slightly elevated white count,
but I'm already doing an
infectious workup now.
Sounds like a great plan.
What's the bad news?
This is Wanda Stern.
In from the same nursing home.
She has a 101 fever
and feels Nixon is just
what this country needs
to run out the commies.
Fluids and labs?
Fluids and labs.
Hey.
Sorry about your ring.
It's so stupid.
I can't believe I lost it.
No, no, no. Come on.
These things, they happen.
No, illnesses happen.
Bad weather happens.
This is on me.
Look, I'm on all your patients,
so don't worry, okay?
Just... try to take it easy.
I feel so terrible.
Like, like I betrayed Jeff,
like I didn't care enough.
Hey, April?
April.
What's in the bag?
Nothing, it's a personal item.
Is that a bottle of booze?
You were going to give
that to Mr. Gleason?
My nursing supervisor
did it all the time.
April, it's against protocol.
Since when do you care about that?
I care about getting our
patient through this.
Does he look like he's
getting through this?
He needs a drink.
I didn't say it would be easy, but that?
That's just a Band-Aid.
I come in here every day and
I put Band-Aids on patients
and most of them thank me for it.
And he may thank you,
but you're not helping him.
And you are?
Standing around while
he dies in front of us?
This man has a chance
to get past his problem
and make a new start.
He's telling us that
he doesn't want that,
and it's up to us to listen.
No, no, no, no.
It's not my job to listen.
I'm a doctor.
It's my job to decide
what is best for him.
That is exactly why I'm a nurse.
Hey.
Uh, Frank McCormick
is going into surgery.
I need you to load his
angio into the system.
You doctor Rhodes?
Uh, yep.
Should be up now.
_
Yeah, thanks.
No luck yet, huh?
Not yet, but we haven't
even gone through the trash.
Are you okay?
Yeah, uh...
My head is... spinning.
I feel like I'm gonna throw up, but...
oh, Maggie.
Natalie, I'm gonna find your ring,
but in the meantime,
I want you to go in there,
have a drink of water,
and lie down.
Okay? Mmhmm.
All right.
Natalie?
I don't know why you guys
are ordering all these tests.
I'm anemic. It was nothing.
That's not what the EKG's saying.
I'm seeing elevated ST segments
in the anterior and lateral leads.
Where?
Tell echo we're bringing her upstairs.
Echo?
I have no cardiac
history, no risk factors.
You guys are just being overly
cautious because it's me.
Nat, that's darn right
that's what we're doing.
Stop being stubborn and
listen to the man, please?
Let's go.
Ugh.
On Wednesdays,
I go downstairs to the beauty shop.
My neighbor Sheila always does my hair.
Okay.
How about the card room?
I play a lot of canasta.
- In the south lobby?
- No, darling.
Uh, in the north.
Oh.
How we doing, ladies?
Any luck?
Wanda here is lovely,
and though I appreciate your
theory that our conditions
may arise from the same source,
I'm afraid the only thing we
have in common is Sinai Gardens.
Ah.
Ms. Reese, could I, um...
could I talk to you for a moment?
Mm-hmm.
Keep at it.
Their labs are all negative,
but both are febrile with leukocytosis,
and infections in the elderly
can present quite
differently than normal.
I think we need to start
looking for zebras.
Rickettsia, leptospirosis...
Ms. Stern had some
redness in her left eye.
You notice that?
Probably from the chlorine in the pool.
She likes to do water aerobics.
But consider the symptoms.
Acute delirium, severe dehydration,
lower abdominal pain, one itchy red eye.
Like I said, in an 85-year-old,
it could be anything.
If these women were
closer to you in age,
what might you suspect?
No.
No, no, no, no, no.
Why not?
No. Because they're old ladies.
They can't have gonorrhea.
Are you trying to tell me
that because they're old,
they can no longer be sexually active?
Well, come on, they barely have
the energy to play canasta,
whatever that is.
I say we keep digging.
Ahem. There's a gentleman
from the retirement home out there
inquiring about the status
of your two patients.
Says his name is Clyde.
Hmm.
Maybe they, um,
have something in common after all.
We're gonna need some swabs.
Dr. Halstead!
What happened?
He just started vomiting blood.
Must have ruptured an esophageal varix.
Prep a Minnesota tube and call for MTP.
I need to intubate.
It's from years of alcoholic cirrhosis.
The vessels get dilated and tortured.
But why's this all happening right now?
Must have ruptured
from all the vomiting.
Right, tube.
Got an airway.
Bag him.
Good breath sounds bilaterally.
We need to stop this bleeding.
- Minnesota tube.
- Yes, Doctor.
- What do you need?
- Start a groin line.
Get a rapid transfuser,
and give him two of blood, stat.
I need more suction.
I got it.
Send a runner to
Central for the infuser,
and call the blood bank.
I'm on it.
I can't see a damn thing.
All right, I'm gonna
have to go in blind.
Line's in.
Start the MTP.
Pressure's down to 80 over 40.
He's bleeding out.
Come on.
Come on.
Got it!
- Blood's going.
- Good.
Ready to inflate the internal balloons.
Syringe.
Want an X-ray for placement?
No time.
As soon as the balloons are inflated,
we'll know whether the pressure
they're placing on the vessels
is enough to staunch the bleeding.
Bleeding's stopped.
For now.
Call GI to cauterize the vessels.
Okay.
I'm doing everything I can.
Dr. Halstead?
Dr. Manning's results from echo.
Knock, knock.
Hey.
Did you get my echo results?
Yeah, good news.
You definitely did not
have a heart attack.
You see?
That's what I've been saying.
But you did have a cardiac event.
Uh, takotsubo cardiomyopathy.
Let me see that.
Um, spasm on your coronary artery.
Would explain the shortness
of breath and chest pain.
Scary for sure, but
completely reversible.
Yeah, we should have you
out of here in a day or two.
Losing my wedding ring.
That's what triggered this.
Hey, it's not always easy
to pinpoint the cause
of the stress. You...
you just can't know.
Will, no, you don't
have to sugar-coat it.
I know the colloquial term for this.
Broken heart syndrome.
This is about, uh...
This is about Jeff.
Chance of another episode
is incredibly low.
You will get past this,
I promise.
Yeah.
I came as soon as Maggie called me.
How is she?
Hi, uh... she's gonna be okay.
Oh.
Hi.
And LAD is finished.
Raising the heart ventrally
to get at the RCA.
Uh-huh.
Two-thirds of the way there.
This is the big one.
Right there.
Scalpel and Gerald.
Scalpel.
Blood pressure bottomed out.
You got to lower the heart back down.
Okay.
Okay.
Marty?
It's not coming back.
He's in v-fib.
We got to put him on the pump.
No, we'll defibrillate him,
continue as planned.
And then what?
This is gonna happen again.
- Clear.
- Clear.
Still v-fib.
We have to put him on the pump.
We don't have a choice.
Charge to 50.
Charging.
Clear.
This isn't working.
We need to get the perfusionist
and the bypass team in here now.
That's not an option, Dr. Rhodes.
Then we will get his wife in here
and we will get her consent.
It's his ball game.
I don't understand. Is Frank okay?
Please, put this on.
We're not getting the pressure back.
Frank, oh, my God.
Your husband is dying.
I'm pumping his heart with my hands.
Mrs. McCormick.
If you don't authorize this right now,
you'll never see him alive again.
Is there really no other way?
No.
Do what you have to.
Forgive me, Jehovah.
Why don't you come with me outside?
Right, let's hook him
up and get to work.
This is the right thing to do.
Thank you.
Yeah. That was Julia.
She needs me to relieve her.
I could bring Owen back
here a little later.
Maybe later tonight.
Okay, all right, well, you just, uh...
you just call me and... and let me
know what you'd like, all right?
Oh, uh, Helen, actually,
I'm sorry.
One last thing. Mmhmm.
Do you know where Jeff got my ring?
Well, not right offhand,
but I-I could look that up.
Please.
You're not thinking about
replacing the ring, are you?
Yes, I am.
Do you really think that's a good idea?
Why wouldn't it be?
Natalie, I know you loved Jeff.
Jeff loved you,
but maybe losing the ring is a sign.
A sign?
Natalie...
what do they call this?
Broken heart syndrome.
Your grieving is so great
that it has put you in a hospital bed
and is keeping you from
coming home to see your son.
So, maybe you just...
you need to let go a little bit.
How could you say that?
I would never let go of Jeff.
I don't mean let go of him.
Just...
move forward.
You just...
you call me and let me know
if you need anything from home.
The clap?
Yikes.
Have Rose and Wanda been told?
How did they take it?
You'd have to ask them.
Mr. Glickman,
partner notification
is an important part
of gonorrhea treatment,
and while we really don't
want to be intrusive...
A gentleman never tells.
But if there are others,
they should be informed.
There's Cookie.
Beautiful blue eyes.
Cookie?
Sylvia, marvelous sense of humor.
So you're sleeping with
four different women?
Ms. Reese.
You make it sound tawdry.
It's not like that.
At our age, there are very few men left,
and people need companionship.
I make them happy, they make me happy.
And I love them, all of them.
All of them.
I think of it as assisted loving.
We'll get you a shot of
ceftriaxone and azithromycin.
The nurse will be with you shortly.
Don't touch that. Get away.
Hey, Dr. Choi.
Earl said to give this back to you.
What... what do you mean?
Made such a racket,
wouldn't let him get any sleep.
Said he's going to get a gerbil.
Don't touch that. Get away, get away.
Sorry, Maggie, I got to go.
Hey, what am I supposed to do with it?
I don't know.
Put him in the doctors' lounge.
Get away, get away.
Come on.
Hm.
Oh, Frank, I was so scared.
Told you it'd be all right.
Jehovah lit the path.
It was His will.
These doctors,
maybe you should do
every surgery this way.
Mr. McCormick, you should know
that there were complications
with the surgery.
What kind of complications?
We had to use the bypass
machine after all.
I thought we made our wishes clear.
Did they tell you they were doing this?
They did.
And you gave them your permission?
How could you do this to me?
I did it for you. For us.
You weren't going to
survive the surgery.
And now how am I supposed
to survive eternity?
Frank, I'm sorry.
- Get out.
- Please.
Get out.
You had no right.
You had no right.
That is why we don't disregard patients'
wishes.
Have you read the fine print
of what they believe in?
They can accept all
the fractions of blood
but they can't accept them all together.
Does that make any sense to you?
Doesn't have to make sense to us.
If he believed he would live longer
if his wounds were
dressed in green bandages,
then we give him green bandages.
Not if the green bandages
are going to kill him.
Yeah, even if it kills him.
David, do you really believe that?
Or is this just because this is the day
that your liver is going to be ablated?
I saw your name on the board in IR.
The mass on my liver isn't shrinking.
We're going to try and reduce it again.
In fact, I should mosey down there.
You're a good surgeon, Dr. Rhodes,
but saving a life isn't
always the answer,
and you will never be a great surgeon
until you understand that.
Hey, hey, hey.
Look what I found.
Where did you find it?
In a linen bag,
stuck to the hem of a fitted sheet.
That's why you quadruple check, right?
Thank you, Maggie.
I thought it was gone for good.
Well, now it's back.
Mm.
We're gonna beat 'em to the finish line.
Here it comes. Hold on tight.
- Up we go.
- Whoo!
Thank you very much.
Thank you again for all your help.
Ms. Wechsler, can I ask you something?
Sure.
You're a strong, successful woman.
You flew jets.
Aren't you angry with him?
I tell you, Ms. Reese,
some men spend their
whole lives with women
but never bother to
learn what pleases them.
Clyde learned.
Let's go, Rosebud,
before this thing turns
back into a pumpkin.
Thank you very much.
Going flying.
He seems like a nice enough guy,
but no one is worth lying,
cheating, or disease.
Where are you getting
lying and cheating?
You heard what he said.
Didn't hear that.
This looks like more of an...
open relationship to me.
Well, you would think by
their age they'd be past that.
Past wanting physical intimacy?
If my boyfriend ever suggested
an open relationship,
I'd kill him.
Huh.
You might be surprised how things
you once thought were so important
become less so when you get older.
My life definitely
become bigger, messier,
far more interesting than
I ever thought it could
when I was younger.
And you know what?
It hasn't always been such a bad thing.
Well, I'm not that young.
I'm almost 26.
So you know, I was
thinking, if you guys...
You know,
your friend's still going out to dinner,
I wouldn't be opposed.
Great, you changed your mind.
Yeah, got hungry.
Well, not too hungry I hope.
My friend's a vegan.
A vegan? And you're telling me now?
That's curious.
Important thing is,
it'll make Bert happy.
You know I live to serve.
T-shirt and a pair of jeans.
I paid for it.
How much?
Mr. Gleason seems much improved.
Yeah.
When did his tremors subside?
Uh, about 20 minutes ago.
And no more hallucinations?
Mm-mmm.
Did we up his benzos?
No, why?
Nurse Sexton.
Pretty miraculous turnaround
for our frequent flier,
don't you think?
It looks like he'll pull through, yeah.
Did you give him a drink?
No.
Well, someone did, so who was it?
Goodwin?
I guess once a nurse, always a nurse.
Excuse me, a word, please?
Sure.
You gave Mr. Gleason a drink?
He was likely going to die without one.
I've seen it happen.
So it doesn't matter if that
was against hospital policy,
'cause I'm pretty sure if that were me,
I'd be raked over the
coals right now by you.
Damned if you do and
damned if you don't.
I admit, it's a bit
of a double standard.
What can I say?
This patient...
he had a chance to kick his addiction.
Now it's gone.
Dr. Halstead,
an addict doesn't just kick a habit.
He's got to want to quit,
and right now he doesn't.
Listen, you can't force a
person to move on from something
if they're not ready.
You know they found Dr. Manning's ring.
Want to come up with me to see her?
I'll be up a little later.
Any shortness of breath?
Mr. McCormick, I am sorry.
We were just trying to deal
with the circumstances...
The best you could.
I know.
Do you even think about
God's will or just your own?
You familiar with... Peter 5:2?
"Be a shepherd to the flock
that is under your care.
"Watch over them.
"Not for what you'll get out of it,
but because you are eager to serve God."
You entrusted me to watch over
not just your body but your soul.
You're alive... .
because I couldn't
imagine life without you.
I misplaced my faith.
Today, I didn't serve God.
But I have to believe that a god of love
is also a god of forgiveness.
_