Chicago Med (2015–…): Season 2, Episode 14 - Cold Front - full transcript

Hey, we're going in 152...

- On the right.
- Got it.

Okay, Craig, you take over bagging.

Got it.

Lacerated forehead,
possible crushed airway.

Jeff, dispatch said mass casualty.

Only been on site a few minutes,

but it's at least a dozen vehicles...
maybe more.

We need help over here!

Sir...

Come here, come here.



- I've lost my teeth!
- Gauze!

Here you go.

Okay, bite down, bite down.
Hold the pressure.

All right, here. Let's move over here.

There you go. Lay down.

Casey has just radioed in.

They're popping the
windshield on a minivan...

Need medical on site.

Red, thirty yards in, eye of the pileup.

- We're on it.
- Go.

- Jeff.
- I'm with ya.

- Go back that strip in, got it?
- Got it.

Choi, got a family of
four trapped inside.

Lot of intrusion on the vehicle.



All polytrauma.

All right, we're on it. Adam...

Got it.

My son... save him. My son.

We're gonna get you all out of here,
all right?

Help the boys. Please.

- Help them please.
- Bleeding head lac...

Transected his temporal artery.

Give me two hemostats.
I've gotta clamp it off.

Copy.

All right, I'm on the boys.

Hang in there, guys.

Almost there, guys.

Help my... my boys, please.
Help... help my...

Hey, Adam, need a C-collar.
You're gonna be okay.

- Jeff, what do you got?
- I got some serious leg damage,

- possible abdominal injuries.
- Let's give them some morphine.

Can you get a read on body weight?

I don't know... 60, 65 pounds each.

- Push 4 milligrams IM.
- I got it.

All right, take it easy.

Just take it easy. Just take it easy.

It's okay.

Bleeding's under control.
Let's get him out of here.

Okay, you hang in there, guys.

I'm gonna give you something to
make you feel better, all right?

Place two 16-gauges on the right,

and let them know he's red-tagged.

Jeff, stay with the kids.

I got you!

- Clear! Clear!
- Back up!

All right.

He needs oxygen!

Need a backboard!

All right, sir,
we're gonna get you out of here.

Sir, can you hear me?
Try to stay calm, okay?

Two, three...

Pick him up.

God.

Hey! I need a little help over here!

Pregnant woman!

Hey, you there?

Hey! A little help over here!

Hey!

Okay, everyone, listen up.

- Glad you made it in.
- It wasn't easy.

We've got a predawn pileup...
Multiple traumas en route.

White-out conditions...
Staff snowed in at home...

No supplies coming in.

We need to make do with who
and what we've got on hand.

All right, Dr. Manning and Halstead,

let's decompress the ED.

Anybody who's stable kicks
back into the waiting area.

Copy.

- Dr. Wheeler, be ready to glove up.
- Got it.

April, we need every room we've got.

Let's clear the hallways, supply room...

Anywhere we can fit a
bed. Let's go, people.

On it.

Doris, put out a hospital-wide alert,

- and page the triage team.
- Okay.

Back to the waiting room?
I've already waited an hour.

I apologize, Mr. Kellogg,

but we'll get to you as soon as we can,
all right?

What is the only indication for AVR

in an asymptomatic patient
with severe stenosis?

Left ventricular systolic dysfunction.

Correct, Dr. Bardovi.

This patient is stable.
Close his incision.

Why?

We are expecting an
influx of trauma patients.

Per emergency protocol,

you and I will be in charge of triage.

We need to ensure that
operating rooms are available

to the most critical patients.
This man is not one of them.

- Close him up.
- Yes, Doctor.

All right, look alive.

Here we go. Incoming.

38-year-old male pulled
from his minivan.

Mom and two kids are on the way.

Here's the triage team.

GCS 12, hypotensive.

Clamped his temporal artery...
Belly's distended.

All right, he's surgical.

Stabilize him, and
get him up to the O.R.

- Dr. Manning?
- Got it.

All right. Dr. Choi...

40-year-old male... GCS 15...

Satting 90% on a face mask.

- Dr. Halstead?
- Got it.

No, I got this one.

Severe burn...
make him warm, comfortable, and move on.

There's nothing more you can do.

- Naima?
- 63-year-old female...

Went through the windshield.

Triple zeros... Down
for nearly 20 minutes.

Stand down.

Thrown from a vehicle with
a high deceleration injury.

- Most likely a torn aorta.
- We can't be sure.

Regardless, asystole for 20 minutes.

This is not a survivable injury.
Hold compressions.

- Wait, let's warm her up first.
- Dr. Rhodes,

understand that today we
need to focus our efforts

on patients with the
best chance of survival.

Please.

I need Helene, my wife.

Mr. Winter, we'll find her.

Just try to relax.

He needs an IO.

Mr. Winter,
I'm gonna have trouble finding a vein.

I need to put an IV in your leg.
It'll only take a second.

- Dr. Choi, what are you doing?
- Putting in an IO.

- Can I speak with you?
- Hang on, one second.

- Almost...
- Now.

I'm in. He's 95% TBSA.

Calculate his fluid based on Parkland,

and run everything through the warmer.

Copy.

I thought I told you to make
him comfortable and move on.

Dr. Latham, standing
by while a patient dies

is not in my job description.

He has full thickness
burns over 90% of his body.

There's no chance of recovery.

He's awake, talking,
lucid, not in any pain.

As you well know, he's not in pain

because his cutaneous nerves
have been destroyed by the burn.

Very soon,
his organs will began to shut down.

He is going to die.

And treating him will
only take resources away

from patients who have
a chance of survival.

- Maggie!
- Jeffrey.

26-year-old female found
passed out in the snow.

35 weeks pregnant... Vitals stable.

Dr. Wheeler, you're
going to Treatment 2.

- Got it.
- Stop.

Green is not the proper designation.

An expectant mother
always takes priority.

- Is my baby gonna be okay?
- Don't worry.

We're gonna make sure both
of you are taken care of.

I'll get some blankets.

On my count, one, two, three.

They said you lost consciousness.

- Do you know what happened?
- I don't remember.

It all happened so fast.

I saw a cut on my arm,
and I went for help.

Next thing I know,
they're bringing me here.

Well, your vitals look good.

- What about my baby?
- I'm checking now.

- Baby's heartbeat is strong.
- Dr. Wheeler...

Traumas are coming in
hot. You done here?

Let's get her undressed,
and put her on a fetal monitor.

Everything looks good.
I'll be back soon.

Pulled from the
minivan... This is mom...

Susan, 38 years old, GCS 15.

Right arm fracture...
Complaining of back pain.

Son and nephew are coming in behind us.

My husband, Blake... How is he?

We've sent him up to the O.R. already.

Belly's clear.

Get her CT for head and TLS spine.

Make sure there are no
vertebral fractures.

- Take care of the boys.
- We will.

9-year-old nephew, Josh...
GCS 15... vitals stable.

Got pinned in the backseat.

Bilateral femoral fractures... One open.

His parents are traveling abroad.

He's been staying with
his aunt and uncle.

- All right, Dr. Manning?
- Yep.

Hi, I'm Dr. Manning.

I'm gonna take good care of you, okay?

I'm gonna give her a hand.

All right, you're going to Treatment 5.

- Yep.
- Talk to me.

Benjamin... 10-year-old son... GCS 15.

Abdominal pain...

Mildly hypotensive from
possible blood loss.

Systolic 100 over palp.

Dr. Halstead, red tag.

- April.
- You're going to Treatment 4.

My hips! My hips!

Hang in there, champ.
We're gonna get you fixed up.

4, here.

Okay.

Okay, on my count, one, two, three.

- Thank you, gentlemen.
- Yep.

Breath sounds clear and
present bilaterally.

Hang another liter of
saline on the level one.

Yep.

How'd you get to be so strong?

You're doing great.

Chest and belly clear.

Okay, honey.

BP 86 over 47. Heart rate 135.

I know, I know, I know.

Okay, okay, that's it, just breathe.

Unstable pelvis and hypotensive.

Close it down to stop the bleeding?

Yeah, grab a sheet.
I need some help in here!

What do you need?

This might hurt.
Give him 25 mics of Fentanyl.

Copy.

Okay, honey. Okay.

All right, all right.

Okay, make sure it's tight.

Heart rate's coming down.

Bleeding's temporized for now.

Let's get X-rays... Chest and pelvis.

Let me know the second
there's an opening

in interventional radiology.

We need to embolize the bleeding.

Got it.

Chest and abdomen are clear.

Cold foot...
I can't get a pulse on this leg.

Fractures probably kinking
the femoral artery.

- We've gotta reduce this now.
- Let's push two milligrams

of versed and 25 mics of Fentanyl.

Okay, Josh, we're gonna have
to do something right now,

and I need you to be so brave for me.

- Can you do that?
- Okay.

Yeah? Yeah? Are you ready?

All right, one, two, three.

It's all done. That's it.

It's over. Great job.

All right, get a
post-mold splint on him.

Page ortho. He's gonna need surgery

to wash out and ex-fix that fracture

as soon as we can get an O.R.

Are you all right?

Okay, can you keep
being brave like that?

Dr. Rhodes...

You are so brave... So brave.

- What happened?
- I... I... I don't know.

She was alert and talking
a few minutes ago.

- No pulse.
- All right, Clarke, intubator.

April, a milligram of epi.
Wheeler, get on her chest now.

- She's hemorrhaging.
- Abruption from the trauma?

That might explain just a vaginal bleed,
but not this.

She's bleeding around her IV.

Dr. Rhodes...

All right,
likely an amniotic fluid embolism.

Impact from the accident
forced amniotic fluid

into her bloodstream...
Disrupted her clotting factors.

Trigger the MTP.

We need to get this baby out now.

- Page OB?
- No, there's no time.

We've got about four minutes to deliver,

or we're gonna lose her and the baby.

- Tubes in.
- Take over bagging.

Okay, splash prep her abdomen.
Give me the knife.

Clarke, pull.

There we go.

It's a girl. April, cut the cord.

Clarke, start packing her abdomen.

On it.

There we go.

Okay. The baby looks good.

April, let's get her up to the NICU.

- On my way.
- Okay.

All right, Wheeler, hold compressions.

She's in v-fib.

Paddles.

- Charge to 200.
- Charge.

- No.
- Charge again.

- Charge.
- Clear.

Sinus tach. BP 70 over 33,

heart rate 130, oxygen rate 95%.

All right, set up a
Neo drip at a 100 mics.

100 mics.

She looks like she's
lost about three liters.

How much have we given her?

Two packed red blood cells,
one FFP, two cryo.

Second patch is on its way
with more blood and cryo.

All right. She's still bleeding.

Tell the blood bank to
keep sending us O-Neg.

We'll finish packing her here,

and then we'll send her up to OB,
so they can close her.

Right.

Hey, Mr. Winter. How are you feeling?

Cold.

That's to be expected.

The damage to your skin
caused you to lose heat.

We have another warmer
coming in for you.

Mr. Winter...

You're in burn shock.

Your organs are gonna shut down soon.

I'm...

I'm dying?

Yes.

Keep me alive till my wife gets here.

I wanna say goodbye.

We'll do everything we can.

Mr. Winter,
your airways are starting to swell.

We need to intubate you,
and put you on a ventilator.

But I won't be able...

to talk.

When your wife gets here,
I'll remove the tube,

and you'll be ab...

And you'll be able to say goodbye.

20 of etomidate and 15 rocuronium.

All right, now for waiting room drama.

His name is Jack Kellogg.

Came in for a Xanax refill.

How long you have to wait around here?

Got bumped from his treatment room.

Doesn't seem like an emergency to me.

- Might just be hunting for drugs.
- He's fine, he's fine...

But if you think differently,
I'll send him upstairs.

Did he threaten to hurt
anybody or himself?

No. He's just a pain in the ass.

- I'll talk to him.
- All right.

Mr. Kellogg?

I'm Dr. Charles.

I've been waiting for over two hours.

Nobody cares. I'm just a number.

I'm very sorry. We have a major pileup

on the highway,
and we're in a triage situation...

It's not my problem.

Okay, well, what seems
to be the trouble?

Cut the crap, all
right? Blah, blah, blah.

- I'm out of my meds.
- Did you call your doctor?

He's out. Why else would I be here?

How hard is it for you to
write me a prescription?

Well, we wanna make sure you
get the right medication,

- the proper dosage.
- Dr. Charles...

- Could you hold on a second?
- I'm sorry,

but there's an emergency
in the psych ward.

A patient attacked a
nurse. They need you.

Mr. Kellogg, I'm very sorry.

We are gonna take excellent care of you,

but you're gonna have to
wait a little bit longer.

- For God's sake.
- I will be right back,

and I'm gonna make you one
of our first priorities.

First priority. Yeah, sure.

Look at me! I'm a human being.

I'm a human being!

A human being!

Should we put him on a psych hold?

No, he's not dangerous, just pissed off.

Daniel?

We're slammed and short personnel.

I need to pull Dr.
Reese off your service,

and put her to work here.

Go to it.

- Reese, with me.
- Okay.

Heart rate's 150. BP 70 over 40.

What are his injuries?

Femoral fractures in both legs...

Lots of soft tissue injuries.

Looks like bilateral thigh hematomas.

So blood's accumulating in his legs.

We need to transfuse him.

Yes, but first let's get a
liter of lactated ringers...

Dopamine at 10...

Titrate to systolic BP of 90.

Maggie, need some help in here!

Coming!

Blood pressure's coming
up... 80 over 50.

- 90 over 60.
- He's stable for now.

Call up to the blood bank,

and tell him we need two units
of O-Negative for this boy.

I need the same for his
cousin in the next room.

Okay, hold on.

You're both gonna have to talk
to Ms. Goodwin about this.

Because of emergency surgeries,

and a pregnant mother's
serious bleeding disorder,

we have used almost
all of our O-Negative.

We can either treat Benjamin or Josh,
but not both.

Benjamin needs an angio embolization

more urgently than Josh needs surgery.

How can you say that?
Josh isn't compensating

for his blood loss as well.
He's in worst shape.

I understand you're trying
to protect your patient,

but you're being emotional.

"Emotional"?

And what are you being?

Our recommendation needs to be based

solely on clinical criteria.

So I'm handing it over
to the triage team.

Dr. Rhodes, your opinion?

I have to agree with Dr. Halstead

that Benjamin needs angio embolization

more urgently than Josh needs surgery.

Not the issue. We're here to decide

who has the best chance
of survival, so...

Unfortunately,
even if Benjamin gets the embolization,

there's only a 15% chance

that the bleeding in
his pelvis will stop.

Exactly.

Whereas with Dr. Manning's patient,

as the pressure in his thighs builds,

the bleeding will eventually slow.

Worst case, Josh loses a leg,
but there is no question

he has the best chance of survival.

- I don't understand.
- We're very sorry,

but it's up to you to decide

which of the boys gets the blood.

Decide who gets the blood?

The doctors have their opinion,

but it is a decision you and
your husband should make,

and he's still in surgery.

But, without blood,

is one of them gonna die?

It is a possibility,

but we are gonna do whatever
we can to prevent that.

And you want me to decide
between my son and my sister's?

But how?

Our recommendation is to give
the blood to your nephew, Josh.

Josh? Why?

Because he has the greater
chance of survival.

- That means Ben...
- We are gonna do our best

to keep him alive until
we have more blood.

How can you make me do this?

I can't.

- I can't.
- If you'd prefer,

we can make the decision on your behalf.

Mrs. Porter, I assure you,

we will do what's medically
and ethically correct.

You'll be all right.
No, no, just stay still...

Dr. Rhodes,
I hear we're running out of O-Neg.

No, we have run out of O-Neg.

Wait...

Is this because of the woman

with the amniotic fluid embolism?

- Partly, yes.
- Dr. Rhodes!

She didn't present with
any of the symptoms...

No hypotension,
shortness of breath, chills...

Wheeler, nobody's blaming you.

I understand. We're
going to do all we can.

Leah, there was a fella
out here before...

- A Mr. Kellogg?
- That guy...

Yeah, did you see what happened to him?

Stormed out... Said he
was tired of waiting.

You should've heard the language.

I don't appreciate being
talked to like that.

Yeah.

His color's already improving.

Heart rate's down to 119.
BP's up, 118 over 84.

Albumin and platelets
aren't gonna cut it.

- That kid needs blood.
- I know.

Hey.

We've contacted Mr. Winter's wife.

She's doing her best to get here.

Mr. Winter, did you hear that?

BP's down to 80 over 40.

Hey. Hey.

Hang in there.

- Hey.
- Hey.

How's Mr. Winter?

I'm sorry.

Yeah.

And I'm sorry to have to tell you this,

but we're out of ventilators.

- No.
- We've got emergency cases,

who are coming out of
surgery, who need 'em.

The... the only choice we've got

is to take 'em from
our terminal patients.

I can't.

That ventilator's not
gonna save his life, Ethan.

You know that.

All he wants is to
stay alive long enough

to say goodbye to his wife.
She's trying to get here.

- Man, I understand...
- Look, in the field,

so many times, a wounded soldier
will call out for a loved one...

A mother, a wife.

There's nothing I can do.

Come on, man.

Let's give this man his dying wish.

I'm sorry, man.

I can do it for you.

I can take him off
the ventilator myself.

No...

He's my patient.

I will.

Mr. Winter...

As you know,

your condition is going to
continue to deteriorate.

I'm sorry, but the hospital
is in an emergency situation,

and I've just been informed
that I need to disconnect you

from this ventilator.

It's needed for other patients

who have a better chance of surviving.

I know.

Here's what I can do.

I can help you breathe manually,

until your wife gets here, all right?

April, pull the ventilator.

I'll bag him myself.

Thank you, Doris.

I just told Dr. Choi to take
his patient off the ventilator.

Right.

Dr. Latham, don't you feel anything?

Do you mean, am I empathetic?
Do I feel what others feel?

Dr. Rhodes, one can lack empathy,

but still feel compassion.

Sarah...

You liking psychiatry?

Parts of it.

Yeah, I'm thinking about psychiatry.

I'm not sure the E.D. is the best fit.

Let me ask you something.

Day's got me a little stressed.

Could you write me a
prescription for Klonopin?

Um...

don't you have your own doctor?

Actually, no. I... I
never felt the need.

I only want a few pills...
You know, take the edge off.

Jason, I'm sorry,
but I'd have to ask Dr. Charles.

Really?

Hey, you know what, never mind.

I didn't mean to put you on the spot.

It's no big deal.

- You sure?
- Yeah, I'll be fine.

Forget I asked.

Wait,
do you wanna talk to his resident?

Wait, he's right here.

Dr. Charles,
the brother of that patient that you saw

in the waiting room... The one who left.

Jack Kellogg, great.

This is Dr. Charles.

Please tell your brother that I'm...

What?

I'm...

I'm so, very s...

I-is there anything that we can...

Hello?

Jack Kellogg shot himself. He's dead.

Dr. Charles?

I changed lanes.

Next thing I know, we were hit.

Truck came out of nowhere.

I'm just glad you're okay.

What about the boys?

They're both at the hospital
and receiving treatment.

Thank God.

Josh broke his legs,

and Benjamin suffered a pelvic fracture.

Pelvis?

You can fix that, right?

I'm afraid it's a bit more

complicated than that, Mr. Porter.

Both boys lost a lot of blood,

and both needed transfusions.

However, the accident,

combined with the storm
created a shortage.

We only had enough for one.

For one?

Honey, please, it was
an impossible choice.

I don't understand. What are you saying?

You gave the blood to Josh?

She didn't. We did.

We decided that Josh had
the best chance of survival.

Survival?

What... what about Benny?

We are doing everything that we can,

- but he needs blood.
- Okay, I'll donate.

I'm sorry, sir, but neither
you nor your wife are a match.

- You must've approved this.
- I...

I can't believe it.

You should've made them
give the blood to Ben.

Josh, he's my sister's son.
How could I just...

So you're okay with
letting our own son die?

What kind of mother are you?

I cannot imagine the difficulty

this must be for the two of you,

but again,
we are doing everything that we can.

Excuse me. I'm sorry.

Sixteen critical, 24 stable,
seven treated and released.

All remaining have been
accounted for and assigned

- their proper designation.
- Thank you, Dr. Latham.

Ms. Goodwin,
if Benjamin doesn't get blood soon,

he's not gonna make it.

Dr. Manning, we discussed this.

I know, but I have an idea.

So let's adjust her Ativan to Q2-hours,

and with Q4-hour vitals.

- See if that doesn't calm her down.
- Yes Doctor.

Dr. Charles...

um, about what happened
with that patient...

Yeah, that was unfortunate.

No, what I mean, um,

is there was no way you could've known.

It's emergency medicine, Dr. Reese.

We make these evaluations very quickly,

and these kind of things happen.

Of course. I...

I was just concerned,
because of your history.

Look,
I have lost patients to suicide before,

and I undoubtedly will again.

I... I appreciate your concern,

but it's just the...
It's the cost of doing business.

Okay.

Okay.

Thank you.

Good.

Okay.

- Hey.
- Hey.

Came as soon as I could.

Yeah. Replenishing the bank,

and hoping to find a
match for your patient.

Dr. Halstead jumps to
the front of the line.

- Done.
- Thank you.

- Thank you, Maggie.
- Don't thank me.

Thank her. It was her idea.

Paramedics just brought in a hemothorax.

Dr. Rhodes needs you
to put in a chest tube.

What about his wife?
Have we heard anything?

She's stuck in the storm...
Still trying to get here.

Then ask Dr. Rhodes to have

one of the other residents do it.

Dr. Choi...

He just needs a little more time.

I'm so sorry.

Time of death, 15:37.

BP's down. Heart rate's up to 152.

- We can add another pressor.
- He's peri-arrest.

His heart's working to compensate.

We've tried every stopgap we have.

Without oxygen-rich-red-blood-cells...

I'm afraid there's nothing
more we can do for him.

Ms. Goodwin, we typed
a few universal donors

in the doctors' lounge.
What is taking so long?

Everything has to go through the lab.

If we transfuse blood
that hasn't been screened

for HIV and hepatitis,

we are in direct violation
of FDA guidelines.

We'll just have to wait.

Now hold on, I'm O-Negative.

I'm screened routinely by the Navy.

I don't know if military testing

meets our standards.

Please. If this could save my boy...

- Heart rate's up to 160.
- Connect me to a bag now.

We can push whole blood directly
through the rapid transfuser.

Ms. Goodwin...

Okay, do it.

I put him in room PCHEN.

Earl, I got your text.
What's the emergency?

I found this guy holed
up in a patient room...

Not even registered. Had his feet up,

watching TV like he owns the place.

Said he was Dr. Charles' patient,

so I brought him here.

But your brother called and said...

It wasn't my brother. It was me.

Dr. Charles thought you were dead.

Well, maybe I finally
got through to him.

Think he'll see me now?

Mr. Kellogg...

I am so grateful that
you're still alive,

and that I get to treat you.

- I just want my meds.
- Yeah.

It doesn't really work that way.

You see, your behavior indicates

a pretty profound personality disorder.

Off the cuff, among other things,

I'd say you're probably
a malignant narcissist

with overt sadistic impulses.

You've got no right to talk to me...

- Shut your mouth.
- Dr. Charles...

- Maybe I should just go.
- No, no, no, no.

I'm so sorry, but I gotta put you on

a 72-hour psychiatric hold...
For your own good.

What? Seventy-two hours?

You wanted my attention,
and now you have it.

BP's coming up. Heart rate's going down.

Thank you, Ethan.

Of course.

Good news,
we should be able to get him up to

interventional radiology soon.

Susan?

His father was right.
I was willing to let him die.

No.

No, we made the decision
to give Josh the blood,

but that doesn't mean we
ever gave up on your son.

I'm his mother. I
should've fought for him.

What will he think when he finds out?

Hi, I'm looking for my husband.

They said he was burned in the accident.

His name is Rod Winter.

His doctor is not
available right now,

but if you can wait
in the waiting room...

Mrs. Winter,

hi, I'm Dr. Rhodes.

I can speak with
you about your husband.

Please.

Blood finally arrived.

Good.

Hey, I'm sorry for calling you
"emotional" earlier.

You know, you spend a lot
of time apologizing to me.

Well... there are very few
people I care more about.

Good night, Will.

Night, Natalie.

Snow's letting up.

Supplies coming in finally.

Rough day.

I was glad to be back in the E.D.

You can fix peoples' bodies,
but their minds...

Whoo.

I envied you today...

Making those decisions clinically,

not letting your emotions interfere.

Dr. Rhodes,
are you saying you envy my autism?

A little bit, yeah.