Chicago Med (2015–…): Season 2, Episode 17 - Monday Mourning - full transcript

- Lunch, one o'clock?
- 12:30.

Yeah, right.

Hey.

- Morning.
- Hey.

- Morning, Dr. Halstead.
- Good morning.

Yeah, yeah, yeah. Wait.

Dr. Wheeler, you got one in 3.

- Be there in a minute.
- Okay.

- Morning, Jeff.
- Hey, man.

This is obviously a tremendous shock.

Dr. Wheeler was one of us.



And the burden of processing
all that has happened

will be a long and... and difficult one,

so there would be no judgment on anyone

who would prefer not to be here today.

At times like this,
talking about anything,

even the weather, never hurt anyone,

so my colleague Dr. Richardson

has made herself available all day.

She'll be up in her office
if anybody wants to stop by.

Okay? All right, thank you.

Ms. Goodwin, in my experience,

the key to maintaining
morale in times like this is

to keep things running smoothly.

- Of course.
- Okay if I take Dr. Reese



to fill in for the day?

Dr. Charles?

- Sure.
- Thank you.

Maggie, waiting room's full.
Let's keep 'em moving.

- Trying, Dr. Choi.
- What have we got?

Kid who fell in the river
about five minutes out,

Good Samaritan right behind.

Bunch of runny noses and earaches,

and abdominal pain in 6.

Dr. Manning, you're on the kid.

Clarke and Sexton, stand by to assist.

Reese, you're on deck.
Everyone else, take a room.

Let's go. Don't worry.
We'll get through this.

Hi. I'm Dr. Choi.
Heard you're having some belly pain.

- Yeah. It's not a big deal.
- He fell down the stairs.

Really? How'd that happen?

Aah! It was nothing.

He was carrying a pretty
heavy box of books.

We're packing up to move next week.

And everyone thinks
reading's good for you.

Might have a broken rib.
I'd like to get some scans

and make sure there's
nothing else going on,

but it doesn't look too serious.

I'll be back to check
on you in a little bit.

Um...

- Is there anything else?
- No. It's...

It's just...
he's been a little clumsy lately.

But that's normal, right?
Tripping over his feet?

He's just growing into his body.

It's probably nothing,
but since we got some time,

I'll run some blood to rule out
any infections or toxicities

just to be sure.

Thank you.

- Need any help?
- We got it.

- Mags, put him in Baghdad?
- Already on it, Dr. Choi.

Dustin Banks, eight years old.

Fell through the ice into the river.

15 minutes before he was pulled out.

Heart's in Brady-arrest.
Core temp 27 degrees Celsius.

Cold and dead, Sexton?
What do you think?

That he's not dead
until he's warm and dead?

You just won the first
shift of compressions.

All right. On my count.

One, two, three.

April, I need to intubate.
50 of sux, 10 of etomidate.

- On it.
- Can he hear me? Dustin!

Whoa, whoa, whoa, whoa.

The doctor will be with you
as soon as she can, okay?

Jim Kessler, 58. Had a STEMI

after jumping in the
river to save the kid.

Aspirin and nitro in the field.
Sinus rhythm now 120/80.

Mr. Kessler, I'm Dr.
Reese. Can you hear me?

- Sure can.
- Great.

On the count of three, let's move him.

One, two, three.

- Meds are in.
- Maggie, get an ECMO unit.

Pneumonia season.

Every single one's in use upstairs.

He's not gonna wake up
till he's 95 degrees.

What about bypass?

They're both in surgery.

We can get one down here
in about 90 minutes.

Then we're gonna have to
keep his heart beating

- until we get it.
- Compressions for 90 minutes?

In five-minute shifts.
And we'll warm him

the best we can with a left lung lavage.

Jeff, we need two 32-french chest tubes.

April, get a warmer and all
the saline in the hospital.

Let's go.

Left lung lavage? Sure it'll work?

We're gonna try.

Dr. Manning, this is David Banks,
Dustin's father.

- Is he gonna be okay?
- It's too soon to tell.

The benefit of hypothermia is
it preserves brain function.

But if we don't warm him fast enough,

the cold will eventually
overwhelm his body,

so we're gonna circulate warm
saline through his chest cavity

until we can put him on bypass, okay?

Okay, the warmer's on its way,
but for this amount of saline,

Central Supply needs a doctor's order.

Okay. I promise you we are
gonna do everything that we can.

Your EKG shows ST elevations.
Definitely a heart attack.

Ever had any heart problems before?

Little chest pain here and there.

My doc's got me on some pills.

Okay, well, he should've told you

not to jump in a frozen river.

The shock is probably what
tipped you over the edge.

Everybody's a Monday
morning quarterback.

I don't know what that means,

but I do know that we need to assess

the extent of your
coronary artery disease,

so I want to send you
up to the cath lab.

Long as there's some hot cocoa
in it for me, you got a deal.

All right. I'll check
back in with you soon.

Activate the STEMI protocol.

And call Dr. Rhodes for a consult.

You got it.

He got off lucky.

He could've gone into cold shock,
v-fib, coagulopathy.

What a great but crazy thing to do.

He probably didn't even think about it.

Just saw a kid in trouble and reacted.

Thank you.

Hey, Nat.

Hey, Jay.

It's a tough day?

Yeah.

Just hang in there.

Thank you.

All right.
All Kevin's scans show are a broken rib

and a pretty good bruise on his kidney,

so I agree with Dr. Choi.

There's no neurologic reason he fell.

He simply slipped.

I'd like nephrology to get
a look just to be safe,

but then he should be okay to leave.

So, he'll be all right to
drive across country next week?

- Mom.
- Shh. Let the doctor talk.

Might be a little uncomfortable,

but he'll be fine.

- Thank you for all your help.
- You got it.

Bring some pillows.

Lead levels and Lyme titers?

Pretty aggressive workup for a
kid who just slipped and fell.

Nothing wrong with covering our bases.

Hey, Maggie?

How's the resuscitation going?

Getting 20 people from
5 different departments

to work seamlessly together...

What could go wrong?

- Well, you keep me updated.
- Yeah.

Did Dr. Wheeler have

any interpersonal issues
with anyone on staff?

I mean, I don't know. I don't think so.

But he was making some
pretty big mistakes lately.

Yeah, and it was getting worse
after the drinking incident.

Was there anything

that, um, might have
been weighing on him?

I mean, you can tell that he
was losing his confidence.

Um, okay, then.
I'll let you get back to work.

All right.

I'm sorry. Can I help you?

- I was told to ask for you.
- Okay.

I'm Dr. Wheeler's father.

I need help! Can somebody help me?

- What happened?
- I don't know.

He... he can't move.

Kevin, squeeze my fingers.

Just... wait, wait.

Can you feel my hand?

All right, let's get him to CT, now.

What? What's happening?

I think your son's having a stroke.

My God, Kevin, no.

So, the episodes that
he's been having recently

could've been TIAs.

They may have been coming for some time.

Well, it's possible.
But the CT looks negative.

It is. However, there can be a delay

before an embolic stroke
shows up on the scan.

Exactly. Which is why we need an MRI.

- Right.
- An MRI? That'll take an hour.

His stroke could be evolving
right before our eyes.

- If it is a stroke.
- His left side's

completely paralyzed...
What else could it be?

I don't know. That's why I want an MRI.

Every minute we wait to break
up the clot in his brain

increases the odds of his
paralysis becoming permanent.

He needs tPA.

Whoa, well, he's also
got a bruised kidney.

TPA could cause a massive hemorrhage.

We cannot risk that

until we know for sure
what we're treating.

You've still got more than
a two-hour window for tPA.

I can get him in and out
of the MRI in 40 minutes.

Good. Do it.

I'm sorry about your resident.

He wasn't my resident.

Yeah. Thanks.

Yeah, it's awful.

I mean, residency...
Who doesn't consider doing it?

Still,
you never think anybody actually will.

- You thought about suicide?
- Of course. Didn't you?

No.

That's unusual.

You have moderate three-vessel disease.

But given the fact that you've
already had a cardiac event,

it is my recommendation

that we do a coronary
artery bypass graft.

This is pretty major surgery, right?

It is, but you are an
excellent candidate.

So I'd like to give your
heart a day to rest,

and then we can get you on
the schedule for tomorrow.

If you say so, let's do it.

Great. By the way,
it's a pleasure to meet you.

I hear that you are quite the hero.

No.

Just lucky I happened to be there.

Well, either way, thank you.

H-how did you know he needed help?

What do you mean? He was drowning.

No. I understand.
But what went through your head

the moment before you jumped in?

Was it... was it an actual decision,

or was it more like an
instinct kicking in?

I don't know.

We should let you get your rest.

Dr. Reese will be back

when we have a room
ready for you upstairs.

Dr. Reese?

Dr. Reese, are you okay?

What? Yeah. I'm fine.

Yeah, everything's fine.
I'm gonna go check on the room.

Where is he? My son, Dustin. Where...

Mrs. Banks? Hi. I'm Dr. Manning.

Your son is right here.

But let me just explain to you
what's going on first, okay?

Cheryl, I don't know what happened.
I was right...

This is your fault!

You are a terrible father.

Mrs. Banks, please,

let me just explain to
you what's going on, okay?

Hey. How come you're getting a snack?
It's time for lunch.

I'm sorry. We've been slammed.
I got to get back.

Okay. But you could've texted

and saved me the drive across town.

I told you I haven't had a second.

You had time to get a snack, though.

- Fine. You win.
- That's a great answer.

I'm sorry my dying patient
inconvenienced you.

- Come on, April.
- What do you want me to say?

That's just how you justify
everything... your work.

Now you're gonna start in on my work?

Nah. I'm going. Rather
eat by myself anyway.

You ever seen this before?

A resident ending it like this?

Unfortunately, I have.
Yeah. Several times.

You know that 400 doctors

take their own lives every year, right?

Most of any profession.

I don't have a lot of
evidence to back this up,

but I got a strong hunch
it's got something to do

with taking people who have
a powerful desire to help

and throwing them into a game

where the odds are just
stacked against them.

I mean, this I do know:
Situations like this,

it's never just one thing.

It's always a complex
set of circumstances,

and, um, you know,
trying to figure it out,

trying to assign blame...

It's pretty pointless.

Hey, thanks for getting
him a bed so fast.

Tough day?

You and Dr. Wheeler were friends?

No. I hardly knew him.

He came to me...

twice...

asking about pills, about therapy.

And that wasn't really
what he was asking for.

He was asking for help.

I don't know why he came to me,
but he did, and now he's dead.

What kind of terrible
psychiatrist am I gonna be?

You can't jump in and
save everyone, Reese.

It's just not possible.

It's not that I didn't
jump in to save him.

I didn't even see that he was drowning.

Dr. Rhodes, better come here.

BP's dropping, ST segments are elevated.

He's barely got a pulse.

He's in cardiogenic shock.
It must be another MI.

We're gonna balloon-pump him.

Bolus heparin, start
dopamine, dobutamine.

- Get him on high-flow O2.
- Got it.

I'll tell the cath lab we're coming.

There's no time. We're gonna do it here.

We're...

How will we know if
we're in the right place?

If he bleeds out,
we'll know we punctured the iliac.

If he stops breathing,
then we perforated into the mediastinum.

But if we don't get his blood
pressure back up right now,

none of that's gonna matter anyways.

Hang in there, Jim.

Let me know when you see it.

Almost there. Got it.

Almost there, Jim.

I got you.

All right, turn it on.

Come on, come on, come on, come on...

Pressure's coming up. 70/35.

80/40.

Okay. Get him ready to go upstairs.

Still no improvement.

He's always been so healthy.

What could cause a
stroke in a 15-year-old?

Not much. And he's negative
for the usual suspects,

so if his MRI is positive,
we'll have to start looking

for less common causes.

I'm not gonna have to
stay overnight, am I?

Kevin, not now.

Dr. Halstead, Dr. Choi?

Excuse us.

Yeah.

Still no evidence of a stroke.
This can't be right.

Well, it may not be.

It says it's a poor study
due to patient movement.

So it's inconclusive.

Tell MRI we're sending him
back up for a repeat scan.

Are you kidding? If this is a stroke,

we're running out of time.

Doesn't his affect strike you as weird?
So little concern?

He's a confused teenager
who's probably also in shock.

Well, I don't like
it. It doesn't add up.

And we should figure
it out after we treat

what may soon become
permanent paralysis.

I'm not gonna risk a massive hemorrhage

and a transfusion for no reason.

He's going back to MRI.

- Hey.
- Hey.

I just spoke with CCU.
Mr. Kessler's pressure

still isn't coming up.

Okay. We'll give it a few more minutes,

and if it doesn't improve,
I'll have to operate.

Okay.

Wheeler came to me, too, Reese,

when we had that
pile-up in the blizzard,

and the pregnant woman almost bled out.

He took it hard.

I had the chance to reassure him,
but I didn't.

All right. I appreciate
that you're trying

to make me feel better, but it doesn't.

I'm gonna go check on Mr. Kessler.

- Whoa! Whoa, whoa, whoa.
- Noah.

Sorry. Sorry, sorry, sorry.

Let me... Let me help you.

Hey, um, I saw you and
Tate getting a little edgy.

- Are you okay?
- I'm fine.

Yeah? Okay, good.
I just don't want you to, you know...

What? Screw things up?

What? No, no.

I just want you to be happy...

with a guy... who was a all-pro
wide receiver three times.

Three times, right?

Okay, everybody,
the bypass machine just opened up.

We need to get him upstairs now.

So you'll be able to warm him up?

Much faster, yes.

And it hasn't been too long, right?
He might still be okay?

We won't know about his
neurological function

until he wakes up,
but this is definitely a step

in the right direction.

- Thank you, Dr. Manning.
- Of course.

I can't tell you how much
we both appreciate this.

- He's ready to go.
- Okay. Let's do it.

- Hold on.
- Ms. Goodwin?

They need the bypass machine
upstairs for an emergency case.

What do you mean, an emergency?

It's for Mr. Kessler,
the man who saved your son.

They need to operate on him immediately.

But it was promised to us!
We've been waiting for it.

Plus that man would
want Dustin to have it.

There can't be a bigger
emergency than this.

My son is dying.

Are you just gonna stand
there and do nothing?

Mrs. Banks, Dustin still has options,

other ways of continuing to warm.

Mr. Kessler does not.
Without surgery, he will die.

My son is going to die. Tell her.

Put him back on the monitors.

Wait. Wait!

Are you giving up?

No. But Ms. Goodwin is right.

We can try peritoneal
lavage to speed things up.

You are his doctor.
You're supposed to fight

for your patients.

My son is only eight years old.

What kind of a monster are you?

Mrs. Banks.

Mrs. Banks, I am truly, truly sorry.

- April, set up for the lavage.
- On it.

The waiting room's
backed up again, Maggie.

I'm doing my best, Dr. Choi.

We need to do better.

Too many people losing focus today.
It's dangerous.

Is that right?

That patient in there, Kevin,

15-year-old with hemi-paresis,

but his attending is fixated on his mood

rather than his symptoms.

What do you mean?

He seems a little detached.

But he's just a kid
trying to play it cool.

So now we're wasting valuable
time ordering scan after scan

when we should be treating him.

Well, I mean, surely this attending

gave you his reasons, right?

He did.

But I think the incident this morning

is clouding his judgment.

I'm not sure he should be working today.

Really?

Dr. Charles,
we're in the business of saving lives,

and the moment people lose
confidence in their leader,

the fight is lost.

We've already had one casualty today.

I won't have another.

Kevin, how are you?

I'm Dr. Charles. Hey.

I understand you're
having a little trouble

with your left side.

- Yeah.
- Yeah.

How you doing with that?
I know it can be a little scary.

It's not that big a deal.

Excuse me, Dr. Charles,

this patient's schedule for an MRI.

Yes. Okay.

- Well, um, nice to meet you.
- Yeah.

Metz and DeBakeys.

Let's get him cannulated for bypass,

and get me a sheet of woven patch.

Woven patch? I thought we were
doing a three-vessel CABG.

Change of plans. This isn't an MI.

Page Dr. Reese. Tell her I need her now.

3.0?

- How's he doing?
- Still only 89 degrees.

Look, I know Dr. Wheeler
had a difficult time here.

Did he ever talk to you about it?

- No.
- Was there anyone

he might have talked to?

A confidant?

- Honestly, I have no idea.
- Okay.

- Ms. Goodwin?
- Yes?

I spent eight months
working alongside someone

who was in so much pain
that he took his own life,

and I never even noticed.

Am I a monster?

No, Dr. Manning.

No, you're not.

Excuse me. I'm looking for my friend.

Is this the visitors entrance?

For the ED, yeah.

Has he been admitted yet?

I don't know.
He said he can't move his arm or leg.

It sounds really bad.

His name wouldn't be Kevin,
by any chance, would it?

Yeah, it is.

Is your buddy,
like, a real cool customer?

You know, like a James Dean type?

Who's James Dean?

What I mean is, um,

is he the kind of guy
that doesn't really get

too worked up about stuff?

Kevin? You're kidding.

They're making him move to California.

- Of course he's worked up.
- He's got to move?

Yeah. They're just dragging him away.

You're gonna miss him?

Yeah.

Sorry... tell me your
name. I'm Dr. Charles.

- Emmett.
- Emmett. Nice to meet you.

Um, I think that there might be a chance

that we could help your friend.

- Could we go see him together?
- Yeah. Okay.

Dr. Rhodes, why did you bring me here?

I can't assist on a bypass graft.

We're not doing a bypass graft.

- What? But I...
- Look.

A ventricular septal defect?

From necrosis.

Lack of blood flow from his
heart attack at the river

caused a small patch of muscle to die.

That's impossible to find.
How did you even know to look?

You see this discoloration?

I missed this once.

Guy died before we even
got him off the table.

I know that you feel like
you let Wheeler down,

like you missed the signs
of him needing help.

As doctors, all we can
do is learn from that

and try not to miss them again.

Maggie,
when's Kevin Roth getting back from MRI?

Didn't you get Dr. Choi's message?

He took your patient to
interventional radiology.

What?

Do not administer that tPA!

Dr. Choi, now.

The hell are you doing?

His window's nearly
closed. I had no choice.

No, you don't have a choice.
I'm your attending.

And you're not willing to
do what the patient needs.

So, you're 100% sure of the
correct clinical course?

Because to me, this is
not a clear-cut case.

Doesn't mean we can avoid
making the hard decisions.

Even if those decisions might kill him?

Gentlemen, if we could take a beat,

this young man might
help us shed some light

on the situation.

- Hey, man.
- Emmett,

what are you doing here?

I was worried.

You were worried about me?

Yeah, man. Your text
said you couldn't move.

I didn't know if you
were dying or paralyzed.

I just came as fast as I could.

Mr. Wheeler, I'm sorry.

I'll give you some time.

Why did he do it?

Even if he was having trouble, why?

I don't know.

Did you ever see Jason do that trick

where you'd pull a card out of the deck

and it turns out it's in his pocket?

Yeah. When he was a kid.

Yeah. I saw him do it once

up on the pediatric oncology ward.

I guess he used to go up
there a couple times a week

to do magic for the kids.

And man, did they love it.

He did this thing where he would
pull a lemon out of his ear,

and then out of one of the kids' ears,

and then out of another,

and they'd be rolling on the ground.

Just ten minutes in their day
where they didn't have to think

about whatever terrible
illness they had.

I didn't know your son very well.

And I've seen a lot of
doctors come through here.

He would've been a good one.

Thank you.

Yeah.

- We had no idea.
- It seems like he's been

harboring thoughts and feelings

that he wasn't comfortable expressing,

and his body found a way
to express them for him.

So he wasn't actually paralyzed?

No. But he was
experiencing real symptoms.

It's why we call it a
conversion disorder.

It's the physical manifestation
of a psychological desire.

Desire? Sounds like you're saying

he wanted to be paralyzed.

I'm saying he didn't want to move.

And his subconscious decided

that having a serious
medical condition might be

- a good way to accomplish that.
- That sounds crazy.

Crazy, no. Complicated, sure.

But if you think about it as a whole,

an understandable response
to what must have seemed

like an impossible situation.

I mean, having to leave somebody
that he couldn't tell you about,

somebody for whom he had
very strong feelings.

But if he was so upset,

why didn't he seem to care
about being paralyzed?

Compartmentalization is
just part of the condition.

Your son cares.

I mean, he cares a great deal.

Just to be safe, we'd
like to observe him

in the hospital overnight.

Then probably a good
idea for the three of you

to sit down and have a talk.

They're getting a room for him upstairs.

I'll let you know when it's ready.

Thank you.

Damn.

The funny thing about feelings:

You know, we think that if we
push them down hard enough,

that they'll disappear.

Never quite works out that way.

I could've killed him.

Yeah, well, you didn't.

Cheryl?

Cheryl, I was watching him every second,

and then Ben called about this thing,

and I had to look it up on my phone.

And I know you never take your
eyes off the kids for a minute,

and I'm always working,

and you're a far better
parent than I am.

I'm sorry.

I don't know what else to tell you.

I'm just so sorry.

I'm tagging you out.

There's a couch in the
lounge that's free.

I'll grab you in 20.

Thanks.

There's something else I have to do.

Hey.

Hey.

Listen, I'm sorry about earlier,

going off on you like that.

- Okay.
- But...

But what?

I know that you blame
me for the miscarriage.

- April...
- No. Admit it.

No matter how many times you're told

that my working had
nothing to do with it,

you just... you won't let it go.

But it's bigger than that.

You would've had me
quit my job a year ago,

before I was even pregnant.

You want a different kind of woman.

I want you.

I love you.

I just imagined a
different kind of life.

I know.

I hope you find everything you want.

You too. You too.

Amazing what the mind can do, isn't it?

Keeps me employed. That's for sure.

You know, Wheeler...

Maybe what happened wasn't my fault,

but I didn't help.

Hey, join the club.

Look, not for nothing,
helping people is just...

Just about the hardest job there is.

You've been doing it... what?
25, 30... several years?

What... what's the secret?

Well, I'm still looking for that,

but if I had to guess,
I'd say it had something to do

with, you know, just keep showing up,

keep doing your job,
put one foot in front of the other,

'cause when you start to
get all tangled up in here,

you know, that's when, I mean,
it can just paralyze you.

Yeah.

Still, it's gonna be a while
before I can sleep again.

Dr. Halstead?

I think we're lucky to have you here.

You keep up the good work.

Hey. I think he's waking up.

- Hey, buddy.
- Dustin!

He's trying to breath. Hang on, Dustin.

We're gonna take this tube out, okay?

Hang in there, buddy.

We're right here, buddy, okay?

We'll take this out.

- Dustin?
- Can you hear us, buddy? Hey.

There we go.

- All right, sweetheart.
- Dustin!

Bilateral breath sounds are present.

Pupils are equal and reactive to light.

Hey, Dustin, if you can hear me,

can you tell me who this is?

Mom?

My God.

Let's d/c the lung lavage,
but keep the peritoneal going

- until he's 98 degrees, okay?
- Got it.

We're gonna need to
observe him for a few days,

but this is a very good sign.

Dr. Manning?

Yes?

I'm sorry about what I said earlier.

Thank you. Thank you for
everything that you've done.

I'm just happy we were
able to save your boy.

How about that?

I guess every now and then we get lucky.

Yeah.

How'd it go with Dr. Richardson?

She stay busy?

Nobody showed.

- Nobody?
- Yeah, but that's... you know,

it takes time.

Trust me.
People are dealing in their own way.

When I took this job, Daniel,

I wanted to create an environment

where we would never lose someone.

Everyone would look out for each other.

I thought I did.

But then today I found out

there was a very troubled
young man in our midst,

and not a single person knew him.

I failed.

- Sharon, come on.
- No, no.

You... you got to wonder
about all the ones

who don't jump off the ledge...

What's going through their heads,

how this job is affecting them.

I worry about these people, Daniel.

I worry about them.

I know you do. I know you do.

I wish I could protect them.

He's right here, Ethan.

I'm so sorry.

They won't need me in the ED tomorrow,

so I'll be back on your service.

Thank you.

Thanks. I'll see you tomorrow.

Everybody comes to you, don't they?

With all their pain?

And you just have to absorb it.

How are you doing today?

It was awful. It's just awful.