Chicago Med (2015–…): Season 2, Episode 23 - Love Hurts - full transcript

Get them off! Get them
off of me, please!

Get them off of me!

They're on me! Get them off of me!

Get them off of me!

Robin Charles, early 30s.

Delusional and combative.

Lacerations on the soles of her feet.

- Treatment 6.
- She's on 4 milligrams

of risperidone...
Nothing given in the field.

- Vitals?
- No. Too agitated.

Couldn't get her hooked up.



Get them off of me!

Are we set? On my count.
One, two, three. Gentle.

Robin, do you know where you are?
Do you know who I am?

- Help me! Help me, please!
- We need to sedate her.

5 of olanzapine, 50 of Benadryl.

Shh.

2 of Ativan. 2 of Ativan!

No! No!

Dr. Rhodes?

So, you, um... You
starting to figure out

why I didn't want her
leaving the hospital?

She was rational. She was lucid.

- I warned you.
- Robin was fine, okay?

Suddenly she just...



Suddenly, look at her now!

This is on you.

You did this.

I gave her 5 milligrams of olanzapine,

and she responded well,

so we're gonna titrate up to 10 a day.

Past that, Med isn't the place for her.

Robin belongs in a
long-term locked facility.

Dr. Latham.

Go, Dr. Rhodes.
We'll text you if there's any change.

Go.

Okay.

Thank you.

Daniel...

You should go home and get some rest.

You have to take care of yourself.

Are you taking your meds?

Well, at least go up to
your office and lie down.

You see this?

Mandatory penis examinations.

Under Illinois state law,

all male emergency department
workers are required

to have a yearly penis exam,
to be administered by Dr. Stohl.

Please contact him directly.

Want me to prep you a treatment room?

Graduation week.

Childish pranks,

not to mention the binge drinking

and the stunts!

Every year, we have
an ED full of morons.

Youth, Dr. Stohl.

Yeah.

No. No, there are no exams.

It's a practical joke!

Dr. Shore, Dr. Halstead, don't forget...

Keoni's Luau tonight, my grad party.

- We'll be there.
- Absolutely.

Great.

Mai Tais and poke.

Piña colada for me.

- See you later.
- Hey.

- You and Nina look happy.
- Yeah.

Hey, you two need to know that...

Robin Charles is in 6.

What happened?

- Psychotic break.
- My God.

You're up. Incoming. Poly trauma.

Go, go, go, go, go.

22-year-old male, peds versus auto.

GCS 12, BP 100/70, heart rate 125.

Got a student ID.
Kid's name is Marwan Haddad.

Hit-and-run.
The car dragged him, like, half a block.

- Sexton, fast his belly.
- On it.

Chest and pelvis.

And left lower leg.
Probably a tib-fib fracture.

Let's move him.

One, two, three.

Poor breath sounds on the left side.

- Christina.
- It's okay. It's okay.

I'm Dr. Manning. This is Dr. Halstead.

We're gonna take really
good care of you, okay?

Christina.

Easy. Easy.

Belly's clear.

He's shocky. I'm intubating.

Bilateral rib fractures.
Bilateral pulmonary contusions.

And hemothorax on the left.
Sexton, chest tube.

Doris, hang two units of
O-neg on the level one.

- Got it.
- We got a medical history?

No. I spoke to his roommate.
Marwan's a Syrian refugee.

He's here to go to school.
That's about all the guy knows.

His parents are on a plane.
They're flying in from Germany

- to go to his graduation.
- Poor guy.

- Chest tube's in.
- Good work.

Can you imagine?
The kid survives cluster bombs in Aleppo

just to come to Chicago
and get hit by a car.

Let me know when he wakes up, all right?

I want to get a statement,
figure out who did this.

- Absolutely.
- Thanks, Jay.

Dr. Rhodes, I have news for you.

I should say "good morning."

- Good morning, Dr. Latham.
- If I'm not mistaken,

you don't seem to be your usual self.

- Tired?
- No. I'm all right. Thanks.

- Okay. Good.
- Did you page me?

Yes. You remember when I told you

that you weren't my first
choice for this fellowship?

- Yeah.
- It was a South African woman

from Groote Schuur.

Well, the hospital has
allowed for another

second-year CT fellow, so she's here,

joining our team.

Dr. Rhodes, meet Dr. Bekker.

- Ava.
- Connor.

I'm sure you two will
enjoy working together.

I'll leave you two to get acquainted.

He's very odd. Asperger's?

Dr. Latham is a great surgeon,
teacher, and friend.

Loyal. That's sweet.

You know what, Dr. Bekker? I'm not sure

we will enjoy working together.

Leah?

Okay.

Mr. Kellogg, I'm the charge nurse.

Is Dr. Charles ready to see me?

I texted him I was coming.

He may not be checking his messages.

He had a family emergency.

He told me that I could see
him any time. He promised.

I'm sorry. But I can have
one of his residents see you.

I'm not talking to some underling.

Is Dr. Charles here?

Yes, but I don't think
he's going to be available.

You tell him that I'm not
gonna be treated this way.

I'm gonna stay right here
and wait until he comes out.

Okay.

Hey, get me a cup of coffee.

The vending machine's right there.

April, about last night...

No. It's just as much my fault.

It never happened.

Dr. Choi, April, you're up.

Cesar?

Don Crocker, 47-year-old male,

shortness of breath, chest pains.

You're going to Treatment 4.

Passed out on the stairs.
Neighbor found him.

Lucky.

Heart rate's at 110.
12 lead in the ambo.

All right, Mr. Crocker, I'm Dr. Choi.

We're gonna take good care of you,
all right?

Okay.

Let's transfer on my count.
Ready? One, two, three.

12 lead shows a stemi.
Activate the team.

Mr. Crocker, you're
having a heart attack.

- Aspirin?
- Yeah. 81 milligrams

and 4 of morphine.

Mr. Crocker, is there
anyone we should call?

Friends? Family?

- No.
- Someone at work?

Work from home. Most days
don't even leave the apartment.

- So, no one?
- No.

All right, Mr. Crocker,
you've got fluid backing up

into your heart and lungs...
That's why you're

having difficulty breathing.

April, let's give him
10 milligrams of Lasix

and place a Foley...
We're gonna get the excess water

out of your system.

Okay.

- Mr. Crocker?
- He's lost consciousness.

All right, I've got a pulse.
Take him up to the Cath Lab.

I'll intubate him
there. Page Cardiology.

- Ready?
- Yep.

Why'd she do it? Cut her hair.

A woman changes her hair like that,
it's a big deal, right?

It means something.

Absolutely.

Yeah. So?

Well, don't ask me.

My God. What?

Are you coming to my party tonight?

I don't know. I haven't
thought about it.

Okay.
Well, it won't be the same without you.

All right. Look, I'm busy, okay?

Okay. But you are...

coming to my party.

Hey.

Glad you took my advice.

She's sleeping.
At least let me buy you some breakfast.

Cup of coffee, maybe.

Dr. Charles?

I have been reviewing Robin's history

just to make sure we
haven't missed anything,

and, well, some of her symptoms...

They're not consistent with
a psychiatric disorder.

- Dr. Reese...
- Let her finish.

Two days ago when Robin
came to the hospital,

she was running a mild fever, 100.2,

and her BP was elevated.

Now, at the time,
we didn't think anything of it...

That's 'cause it's a very mild fever.

And of course her BP was elevated.

She was on a forced
hold. She was agitated.

But when Robin was brought in today,

it seemed she was experiencing
visual hallucinations.

Now, auditory hallucinations
indicate a mental disorder,

but visual hallucinations
should be considered organic

until proven otherwise.

I think we all wish that
Robin had a treatable

physical condition rather than...

I want to check her ceruloplasmin levels

and run an FTA-ABS as
well as an MRI and EEG

to rule out scelerosis and epilepsy.

Of course. Do it.

What's the matter with you?

She's trying to make me feel better.

And bless her, but she's
grasping at straws. Come on.

Are you so blinded by your fear

that Robin inherited
her problems from you

that you won't even
entertain an alternative?

False hope, Sharon.
Come on. I don't need any.

You don't know that.

Where's the Daniel who
leaves no stone unturned

when diagnosing a patient?

Where's the Daniel who never gives up?

Don't you think your own
daughter deserves that much?

Thanks.

- Hey, what are we looking at?
- He needs a new valve.

Ava Bekker, CT fellow,

Ethan Choi, Chief Resident of the ED.

So, we crack his chest,
replace the valve.

Well, we don't need to crack his chest.

Mr. Crocker's been assessed
as intermediate risk,

and transcatheter aortic
valve replacement, TAVR,

is now FDA approved for
patients at that level.

We get excellent results with
open aortic valve replacement.

With TAVR,
you're just inviting complications.

I don't agree. Why put the patient

through a long operation
and a long pump run?

He can have a functional heart
again in under two hours.

- The less invasive, the better.
- Exactly.

Excuse me.
You're an emergency medicine resident.

- Why are you even talking?
- Excuse you?

Because I value Dr. Choi's opinion.

And I think you'll find
that Dr. Latham will

back me on the TAVR.

Fine.

I'm sorry you got brought into this.

I didn't know about Robin.
I'm sure you want to be with her.

Yeah, I'm all right, but thanks.

This won't take long.

I'll let you know how he does.

Thanks, man.

- What level of oxygen is he on?
- 100%.

Left upper lobe is
segmentally collapsed.

Probably plugged up from
a clot in his airway.

Yeah. Let's get a bronchoscopy.

Yeah, clear out any obstructions.

Hey, I never asked,

why'd you decide to cut your hair?

Time for a change.

I'm looking for Marwan Haddad.

- Are you family?
- We go to school together.

Well, he's being treated right now.

Why don't you wait in the lobby,
and I'll tell you

when you can see him, okay?

Dr. Choi,

take a look at this girl in 2.

Probable distal radial
fracture and concussion.

This young genius tied
a rope around a rafter

and tried to swing across
the school cafeteria.

- What?
- You'll see.

By the way, I'm
missing my coffee mug.

Yeah, some cretin obviously thought

it would be amusing to steal it.

I'll make sure to look out for it,
Dr. Stohl.

Thank you.

Closed distal radius fracture.

Monkey suit.

Of course. Swinging from the rafters,

- got to have a monkey suit.
- So stupid.

No. You should've seen people's faces

when they saw you.

It was so clutch.

Senior prank.
We're graduating from high school.

We'll need the Ortho
resident to see her.

I'm afraid we're gonna have to
cut this suit to set your arm.

- No! It's a rental.
- I'm sorry.

Your friend lost
consciousness when she fell?

Yeah. I was kind of worried.

Concussion is always a concern.

I want to get a CAT scan, head and neck,

just to be sure.

Don't worry.
You'll be out of here in no time.

I'll call Ortho.

Dr. Choi, you're coming
to my party tonight, right?

Thanks,
but I'm not gonna be able to make it.

Early call tomorrow.

You sure? One Mai Tai.

Sorry.

Okay.

The valve is in position and open.

- Injecting dye now to check it.
- Fluoro.

Left coronary artery looks good,
but I'm not seeing the right.

Could be occluded. Can
you get the wire in?

Let me try and cannulate
the right coronary artery.

Can't, the lumen's blocked.

There's no flow on the right side.

Seeing right side ST changes.

Calcium deposit must have broken off

from the old valve and occluded the RCA.

His heart is dying.
We've got to open him up now.

What we should have
done in the first place.

And we're already making
calls to find her another bed.

We'll keep Robin here until
we can get her transferred

to a long-term facility.

We'll take good care of her.

I've dialed back on her sedation.

Robin? Honey?

Get away from me. Get away.

Get away from me. Get away from me!

Make him go!

Dan, Dan, Dan, we got this.

You were right.

The tests I ran... There's no indication

of any organic medical condition...
I'm sorry.

Robin's showing dyskinesia.
Did you notice that before?

The jerky movements?

Yeah,
I assumed it's from the antipsychotics.

Yeah. It could be.

Did you order a paraneoplastic panel?

For auto-antibodies? Why?

- Could we just run one?
- Of course.

Graft is in place.
Let's get him off of bypass.

Unclamping the aorta.

Let's get his heart beating on its own.
Defibrillate.

Clear. Sinus rhythm.

Cut to 2 liters.

Hold on. His right heart is ballooning.

Back on full support.
Marty, what's he on?

Dobutamine at 8, dopamine at 5.

Give him a milrinone loading dose,
epinephrine bolus

of 50 micrograms, and
start inhaled nitric.

That's not gonna cut it.
His heart isn't coming back.

He's not leaving this room without ECMO.

Won't that just set him up
for complications later?

Why do all the residents
in this hospital

think they can offer their opinions?

No ECMO. His heart is strong
enough to come back on its own.

I disagree.

Noted, but this is my case.

All right, cut to 2 liters.

The heart's coming back.

Septum is midline, SVR acceptable.

- Pressure's holding.
- Good call, Dr. Rhodes.

Yeah.

Let's decannulate.

His sats are down to 80.

There's his latest X-ray.

No improvement.

How much vent support are we giving him?

- Maxed out.
- He's on bronchodilators,

and he's still not
getting enough oxygen.

75%.

If we don't correct his hypoxia,

we're looking at anoxic brain injury.

Let's get him up to the ICU

and put him on cardiopulmonary support.

Right.

Your patient has a friend here.
Girlfriend, maybe.

- Good. I'll go talk to her.
- Okay.

Thanks, Nat.

How long you been waiting?

I don't know... About an hour.

Typical. They lie to you here.

Stand up for your rights.

Hi. Are you Marwan's girlfriend?

Is your name Christina?

Yes.

How do you know my name?

When he first came in,
he called out for you.

Do you know anything that
may help me treat him?

Any medical history? Medications?

We haven't known each other that long.

Okay. We're taking Marwan up
to the Intensive Care Unit.

If you want, you can come wait up there.

All right.
I'll have someone come grab you, okay?

Dr. Stohl,

I... I found your mug.

Where?

Thank you.

I'll, um, call maintenance
to get it down.

Hello?

It's a joke. There are no inspections!

It's a joke!

Get me maintenance.

Here's the paraneoplastic panel.

Wow. Look at that.

You were right, Dr. Reese.

It is objective. It's physical.

Well done.

Where's the tumor?

There.

It's so tiny.

And all that.

Page Dr. Latham.

Good news. Your CT was negative.

You're gonna be fine.

See? I told you!

It isn't that.

She never does anything wrong.

Straight As, all honors.

She got into Harvard.

Well, we'll start the
discharge paperwork.

Parents on their way?

Yes. The school had trouble
getting ahold of them, but yeah.

Hey.

So, what's with you and Dr. Choi?

Nothing. What are you talking about?

Come on, April.

I'm your brother.

No. There's nothing
with me and Dr. Choi.

I... Noah!

I just broke up with Tate.

You think I'm gonna jump
into another relationship?

Maybe Dr. Choi is

no All-Pro football player,
but he is one hell of a doc...

with decent earning potential...
I'm just saying.

- Maggie, where's Robin?
- Let me call you back.

They took her upstairs.
She's getting a scan.

Doctor...

I saw Robin's scheduled for surgery.

She has anti-NMDA Receptor Encephalitis.

It's very rare.
Dr. Charles had the idea to test for it.

It's some autoimmune response?

Gone awry.
Robin has a mediastinal teratoma...

A benign one,
but her body's attacking the tumor,

and it's also attacking the brain.

Yeah, and the resulting inflammation is

what's caused her psychiatric symptoms.

So, when the tumor's removed?

Hopefully the psychosis
should resolve itself.

Wait. What's going on?

Come on in.

I'll remove the teratoma
via mediastinoscopy,

a minimally invasive procedure.

Shouldn't take more than 90 minutes.

You're gonna be okay.

I love you.

Dr. Latham, I would like to assist.

Absolutely not.
Given your relationship to the patient,

it would be inappropriate
and ill-advised.

I do not want you in my OR.

It would still be your surgery.

I just want to be there.

Dr. Rhodes, my understanding

of human behavior may be limited,

but you are not acting in
the professional manner

that I am accustomed to.

Like any other friend or family member,

you will sit in the waiting room.

Dr. Bekker will assist.

As soon as your parents get here,
you can go.

How can I explain what I did?

I don't even understand it myself.

I do. You got into Harvard.

Sometimes we work so hard,
hold ourselves so tight,

when we finally reach our goal,
we go a little crazy,

swing from the rafters.

I don't know.

Listen to me.
You're gonna go to a fantastic school,

get a great job, and ten years from now,

you'll just think of
this as a happy memory.

Noah says you're
not coming to his party?

I'd really like it if you did.

Should be done soon.

I was wrong to take Robin
out of the hospital.

I'm sorry.

Well,

I have certainly been wrong too.

Seeing the whole thing through
the prism of my own fears.

Since I was a kid, I always wondered

if there was something I could've done

to stop my mom from killing herself.

I obviously couldn't save my mom,

but I was sure as hell
gonna try and save Robin.

You know, at one point I
considered bringing that up.

Decided it probably
wouldn't have been helpful.

Yeah, probably not.

Well,

she's not gonna want to
have anything to do with me

after this is all
over... That's for sure.

Any word?

No, not yet.

Everything okay?

- Yeah.
- Yeah.

She did well. The tumor's out.

Now we just have to rid
Robin's body of the antibodies

with plasmapheresis.

Should take two hours,
and hopefully she'll be okay.

Hey, Reese, been looking for you.

I thought you might want this back.

It was a gift. Why would I want it back?

You know, when people break up,
you give stuff back.

It's a Rubik's cube, Joey.
Not a diamond ring.

Keep it.

One more thing.

I'm dating Valerie.
I just thought you should know.

I'm glad you found someone.

Thanks.

Christina?

How are you doing?

We are doing everything
we can for Marwan.

I'm pregnant.

We didn't mean it to happen.

We thought we were being careful.

We were going to get
married after graduation.

Nobody knows.

You haven't told your families?

We were going to tell
his parents tonight.

I am so sorry you both
have to suffer like this.

Dr. Choi?

Mr. Crocker.

They did have to open your chest,

but you came through just fine.

- Thank you.
- Sure.

For... for caring.

- Hey.
- Hey. How's Robin?

She's good. Thanks. You saw Mr. Crocker?

Yeah. Pretty young to have
that kind of heart trouble.

Could be genetics, or...

He said he's alone, right?

He's not married. No friends. No family.

- No.
- Loneliness puts you at risk

for heart disease. That for real?

Yeah. I think we all know
that love can hurt, right?

But loneliness... That'll kill you.

What is it, Natalie?

Look at his X-rays.

Diffuse airway disease.

Even with CPS, his lungs
are getting worse. Fast.

This poor kid.

What, his parents just
flying here to bury him?

Why can we not figure out
what's wrong with him?

We've been so focused on his injuries.

Maybe there's an underlying condition

not related to the accident

that we don't know about.

When Marwan got his bronchoscopy,

his tidal volume dipped...
It shouldn't have.

Right. The paralytics should've

relaxed his chest wall,

so why are his airways
still so constricted?

Why can't he breathe?

What if it's as simple
as Marwan's got asthma?

That would make sense.
He needs steroids.

Natalie, if we're wrong,
that'll put him at risk

for infection and myopathy,

and that could wind up killing him.

Well, we are out of options.

If we don't do something
now, he will die.

Candace, 125 milligrams
of Solu-Medrol IV.

Dr. Halstead, Dr. Manning?
The patient's parents are here.

They just arrived.

Great.

- Hi.
- Hello.

Thank you for taking care of him.

How is he?

He was seriously injured,
and our main focus right now is

his lung function.

Is Marwan by
any chance asthmatic?

Yes, yes, since he was a child.

It comes and goes.

- His X-ray is ready.
- Please, come with us.

My God.

Bilateral consolidation's
markedly improved.

His airway pressures are coming down.

- What does that mean?
- It means

we think your son's gonna be all right.

Thank you.

Candace, let's start weaning
him off cardiopulmonary support.

You can stay with your son.

Marwan's recovering.

You should go introduce yourself.

I don't know.

They should know who you are.

Are you good?

Yeah.

Some days, I really love my job.

Asthma. Astute diagnosis, doc.

Hey, don't give me all the credit.

I wouldn't have gotten
there if it wasn't for you.

You're the genius.

Marwan's awake. I got
a statement from him.

- Great. I'll go check on him.
- Thanks, Nat.

So, it's Noah's
graduation party tonight.

- Yeah. Should be fun.
- Yeah.

Natalie asked me to go with her.

You mind?

No. Of course not.

You sure?

Yeah.

All right, you know,
I'll tell her I pass.

You need to get your act together.

- Hey.
- Is it time to go?

Nina? I haven't been fair to you.

You deserve someone as committed
to you as you are to him,

and I haven't been that person.

This is about Natalie, isn't it?

You lied to me.

You said there was nothing between you.

I don't know if she has feelings for me,

but I have feelings for her,
and I can't go on pretending.

All this time? Pretending?

Nina, I care about you...

Get out of here, Will.

Go!

I'll get my stuff out of your apartment.

Sooner the better.

There are balloons in my office.

Hundreds of them. I can't get in.

I'll call housekeeping.

Maggie...

Do people hate me?

No, Dr. Stohl.

It's quite the reverse.

Then why?

You know the saying:

"You only hurt the ones you love."

A tumor?

Yeah.

Reaction to your antibodies

caused your psychiatric symptoms.

So, I was crazy,

but I wasn't crazy?

Yeah, something like that.

Okay.

You should know something.

It was your dad that came
up with the diagnosis.

Robin, he's hardly left your side.

You should talk to him.

Hi, sweetie.

Honey.

Robin, I... I...

So, I think we can call today a draw.

Didn't realize we were in a competition.

Come on.

You know, you're quite
the gossip magnet.

Your mother committed suicide,

you drove your girlfriend crazy,

and you murdered your
attending, Dr. Downey.

Well, then, you'd better watch yourself,
hadn't you?

I like dangerous men.

I want you.

Come on.

April.

Dr. Choi.

Ethan.

- You're still here?
- Five minutes, and I'm gone.

It's so good to hear about Robin.

Yeah.

Well, we made it through another year,
Daniel.

Gonna get a new bunch of
residents to drive us crazy.

Le plus ca change, baby.

Le plus ca change.

Good night, Sharon.

Good night.

Dr. Charles.

Mr. Kellogg?

I've been waiting here all day.

You haven't answered any of my messages.

I'm very sorry. I've had a...

An unusual day.

Is there any way we could talk
first thing in the morning?

Liar!