Chicago Med (2015–…): Season 3, Episode 9 - On Shaky Ground - full transcript

After discovering that a patient's family might have been abusive, Dr. Choi and April contemplate calling child services. Dr. Manning and Dr. Halstead struggle to see eye to eye in guiding ...

.
- Hey, guys, I need your
help over here.
We're going to Treatment six.
- Joanna Harris,
25-year-old female,
22 weeks pregnant,
hemorrhaging vaginally.
- What happened?
- Nothing.
I was working at my computer,
and then the next thing I know,
I'm bleeding.
- Okay, let's get her
transferred on my count.
- All right.
- One, two, three.
- [groans]
- Are you cramping?
- Yes.
- Maggie, CBC, type RH, coags,
and get her
on the fetal monitor.
- Got it.
- Heart tones look good,
healthy placenta,
no previa.
Do you want to know
the sex of the baby?
- We already do.
It's a boy.
- We're naming him Ian.
- All right, I'm going to
check your cervix now, okay?
- Okay.
- She's one centimeter dilated,
50% effaced.
Looks like you're
going into labor.
- What? What?
It's too early.
- Yes.
Bolus a liter of LR
and start her on 30 milligrams
of nifedipine PO.
- [groans]
- Got it--
just try to breathe, okay?
Breathe through it.
Breathe through it.
We're going to give you
some medication
to stop the contractions.
- What if you can't stop labor?
- Unfortunately, we don't
consider a fetus viable
until 24 weeks.
- And even if he did survive,
he would probably have
severe deficits.
Brain damage, paralysis...
- Oh, my God!
Oh, my God.
Oh, my God...
[crying]
- If the baby does come today,
we will need you to decide
if you would like us to perform
all life-saving measures.
- As opposed to what,
just letting him die?
- We would provide
comfort measures.
- Want to make sure that
the baby doesn't have any pain.
[mournful music]
- I don't--I don't know.
I mean, are we just going
to let our baby go?
- What kind of life
would we be giving him?
Think about it.
It'd be cruel.
*
If he's born today, please,
just make him comfortable.
- Yes.
- Don't let my baby suffer.
- We won't.
I promise.
*
- [crying]
*
[alarm buzzes]
[metal detector beeps]
- Fred.
- Dr. Charles.
[metal detector beeps]
- Hey, doc.
How's it going?
- What's up, Conway?
How's the baby?
- Still not sleeping
through the night.
- Have you ever, uh,
tried chamomile tabs?
You can get them at
any health food store.
- Hmm.
Thanks for the tip, doc.
- Hey, Dr. Charles.
- Dr. Reese, this is
Officer Kowalski.
He will be our escort
for the day.
- Hi.
- First time?
- Mm-hmm.
- You'll be fine.
Just don't feed the animals.
Uh, sign the visitor waiver,
please.
- Waiver?
- Basically says that if
we, um, get taken hostage,
that the state won't
negotiate our release.
Just standard procedure.
Hey, look.
Your determination
to explore exposure therapy
is nothing less than admirable,
but it doesn't mean we have
to do it here,
so if you're having
second thoughts,
now would be the time
to tell me.
You're absolutely sure
you want to do this?
- Yes.
This is what I want.
[tense music]
*
[door buzzes]
*
[prisoners yelling distantly]
*
- Ava!
Hello.
- Hello, Dr. Jaffrey!
- How great to see you.
- Your trip was all right?
- Well, as all right as an
18-hour flight can possibly be.
- [laughs]
You already know Dr. Latham.
- Course.
- This is Dr. Rhodes,
another CT Fellow.
- Ah.
Great.
- Dr. Jaffrey's not only one of
the world's greatest
heart surgeons,
but was also my mentor
in Cape Town.
Taught me everything I know.
- I have read your book,
Dr. Jaffrey.
It's an honor to meet you.
- Oh, please.
I'm just another patient today.
- There's a tumor
on the upper lobe
of Dr. Jaffrey's right lung.
- It's invaded his
superior vena cava,
obstructing blood flow to his
head and upper extremities.
- We'll need to remove
a portion of the lung
and resect the tumor.
- And I want my star pupil
to oversee the procedure.
- Thank you for
your confidence, Dr. Jaffrey.
We're getting an OR prepped
as we speak.
- Ah, just one thing.
Um...
I don't tolerate
anesthesia well.
- Well, we can talk
to the anesthesiologist
about adjusting your cocktail.
- Uh, no.
Uh, I think I have
a better idea.
Place a high epidural
and load me up
with bupivacaine.
- Hold on.
You would like to be...
awake for the surgery.
- Well, strictly
as an observer, of course.
- No, it's just that we would
be taking an unnecessary risk.
The epidural site
could hemorrhage
from the blood thinners
alone...
You--you could be paralyzed.
- Not if we do it off-pump.
- Right.
We can construct
a temporary graft
from the brachiocephalic vein
to the right atrium,
clamp the superior vena cava,
and remove the tumor.
- Certainly eliminate
the need for a bypass.
- Exactly.
- Absolutely.
We'll do it--that is,
of course,
if it's okay with Dr. Latham.
- Good.
- I think Dr. Jaffrey
has alleviated my concerns.
I'll make the arrangements.
- Thank you.
[desolate music]
Hmm.
*
- I'll let Vorspan know
about the high epidural.
- Did we really just agree
to allow a patient
to be fully awake
while we perform
open-heart surgery?
- Dr. Jaffrey is well aware
of the risks
and has given us his consent.
- There's no way that
we can guarantee
we'll neutralize
all of his pain,
and even if we do,
every time his lungs inflate,
it'll obstruct our field.
- I have faith
in our anesthesiologists
and Dr. Bekker.
- Awake surgery
is extremely risky
and should only be performed
when medically necessary.
- I understand your concern,
Dr. Rhodes,
but I trust
Dr. Jaffrey's judgment
and respect his desire
to observe.
If I were in his situation,
I certainly would.
Seeing my own beating heart.
[chuckles]
[somber music]
*
- Debra McCormick,
14-year-old female,
GCS 13.
Possible overdose.
- Dr. Choi, April,
you're going to treatment four.
- We got it.
- Found her on Lower Wacker,
passed out and freezing.
Probably homeless.
- I'm not homeless,
damn it!
I live with my friends.
- Okay, can you tell us
what happened?
- Nothing.
I tripped and fell.
I'll be fine.
- Let's transfer on my count.
Ready?
One, two, three.
Let's get her started
on IV fluids
and order a tox screen,
CBC, CMP,
and a white count
with differential.
- Yes, Doctor.
- Do you have a family member
we can contact?
- No.
- You sure?
Call Child Services.
- No, please don't do that.
They never help.
They just keep sending me back
to my mom
and her drunk boyfriend,
and he hates me.
[breathing heavily]
- For now, you just rest
and get warm, okay?
We'll run some tests
and be back
to check on you soon.
- What do we do?
- She's a minor.
We have to call Child Services.
- Not if they're just
gonna put her back
in an unsafe environment.
- We don't even know
she's telling us the truth.
- Ethan, I've seen this
too many times.
Child Services sends
a girl home,
she winds up right back here,
beaten, raped.
- There's a little dive
on Roosevelt
that's got the best dry rub
north of Memphis.
Let me take you
to dinner tonight.
- I thought we discussed this.
- We did, and I decided
to back off,
but then I changed my mind.
- Barry...
- Come on,
just think about it.
- Unless you're gonna
help me with these charts,
I've got work to do.
- I'll take that as a "maybe."
- What good is calling
Child Services?
She's already been through
the system.
She still ended up
in the street.
- So what's the answer?
Just let her be homeless?
14-year-old girl.
- Hm.
Looks like this young lady's
in a tough spot.
Most potential foster parents
are only interested in babies
or young children.
It's nearly impossible
to place a teen.
Does she have
any extended family?
- Not that she's told us about.
- Well, April's right.
In all likelihood,
Child Services will just
send her back
to the abusive home she fled.
- But they'll follow up,
make sure she's safe.
- In a perfect world, yes.
In reality,
they don't have the resources.
Let me call some contacts
in social services,
see if there isn't a group home
with a vacancy.
- Thank you, Ms. Goodwin.
- Mm-hm.
- Thank you.
- [screams]
- Dr. Manning,
she's having contractions.
We need help here.
- [yells]
[desolate music]
- What's happening?
What's wrong?
- She's fully dilated.
- No, you have
to stop the labor!
- I'm sorry, but the nifedipine
is not working.
Okay?
There's nothing else we can do.
- Need to move her
to labor and delivery.
- No time.
Maggie, get a preset pack,
a warmer, and page OB
and tell them
this baby is coming now.
- Got it.
Jackie, come with me.
- I'm gonna need you
to push for me, okay?
All right, you ready?
Push.
- [groans]
- Good.
All right, can you push again?
One more.
And push.
- [groans]
- Doing great.
You're doing great.
All right.
Just one more big one.
Can you do that?
Just one more big one.
Ready?
Push.
Go, push.
Push.
[somber music]
- [crying]
- The embryonic sac
is still intact.
*
- [crying]
- ...All right.
Stay with me.
Stay with me.
- [sobs]
Wait.
Where are you taking him?
- Hey, hey, hey.
It's gonna be okay.
Relax.
It's okay.
- [crying]
*
- Will.
*
- He's alive.
- And he's active.
Responsive.
*
- Let's get this baby up
to the NICU.
.
- Who's first on your list?
- Hector Ramirez.
- You're gonna have to wait.
Ramirez is a level three.
We gotta clear the floor
and bring in
additional officers
to escort him out.
All right, gentlemen.
Let's take it to your cells.
[prisoners grumbling]
- Any particular reason
you tried to sabotage this?
- How about we're taking
an unnecessary risk
all so you can rack up
a splashy surgery?
- Oh, so it's about the credit.
Jealous, maybe?
- No.
No, I am just worried about
Dr. Jaffrey dying on the table.
- He knows what he's doing.
Plus, this "splashy surgery,"
as you call it,
will be good for the hospital
and the CT program.
- How very selfless of you.
- Dr. Bekker, we're ready.
- Coming, Dr. Rhodes?
- That's my cousin, Kiki.
- Hey.
- Hey.
Your labs came back negative.
No sign of infection or
any immune deficiencies.
- Great.
Kiki's come to take me home.
- N--we can only release you
with the permission of a parent
or legal guardian.
- Forget it.
I'm still going.
Kiki, would--
- Deb!
What--what's happening to her?
- She's seizing.
- Step back, step back.
- Deb!
- Two milligrams Ativan.
[dramatic music]
Call radiology.
We need to get her upstairs
for a head CT, now.
- Ativan in.
*
- You're okay, Deb.
You're okay.
[somber music]
*
Ready?
- Yep.
*
[heart monitor beeping]
*
[baby cries weakly]
*
- Parents were clear
about their wishes?
- Yes.
They have decided
not to perform
any resuscitative measures.
- Mm.
- Is there any chance
this baby could be viable?
- Unfortunately not.
His heartbeat's weak
and his weight
is under 500 grams.
- Yeah, but at 490 grams,
he's not that far off.
- Natalie...
- No, his coloring
and muscle tone are good,
and he's making a decent
respiratory effort.
Doesn't that say something?
- Not enough.
This baby's not
going to survive.
The best we can do
is make him comfortable.
*
- [sighs]
[machine whirring]
- Eh, she's got a mass
in her sinus,
possibly a tumor.
We need a biopsy.
- Yeah, but look at
the cross-sections.
- I don't understand.
- Neither do we.
- It's moving.
- You feeling any pain, Deb?
- No, it just feels weird.
- Stop moving.
- What was that?
- I have a pretty good idea.
Forceps and speculum.
- W-what's happening?
- Just... stay still.
- A cockroach.
- What?
Oh...
- I want to take another look
at that CT.
- So, Hector Ramirez,
you know, anxiety, depression,
history of intermittent
explosive disorder.
- All clear, doc.
- May I?
- Dr. Reese, I really think--
- Dr. Charles.
Hello, Mr. Ramirez.
I am Dr. Reese.
I, um...
[clears throat]
- Dosage.
- Right, um,
how have you been feeling
since Dr. Charles
altered your dosage?
- [barking]
[prisoners clamoring]
- Knock it off, Ramirez.
- [barks]
[laughs]
- We gotta take a little break.
Let's get Ramirez
back to his cell.
- [laughs]
- Look at me, look at me.
Take a deep breath.
Take a deep breath.
It'll pass, okay?
It'll pass.
[prisoners laughing
and yelling]
- [laughs]
- Okay, we need to take
a little break.
- Get Ramirez back in his cell.
- Okay, please escort
Dr. Reese back outside.
It's okay.
I'll be there in a bit.
It's all right.
- [laughs]
Whoo! Whoo!
[howls]
.
- Your vitals look good, but we
would like to keep you
a few more hours
just for observation.
- What about my baby?
Did he...
- Your baby was born
just over one pound,
below the threshold of what
experts consider viable.
- And you know that for sure?
- Defining viability
is not an exact science.
Unfortunately, there's no way
of knowing anything
with certainty.
- What do you mean?
You--you mean
our baby could survive?
- The neonatologist says no.
- But you--
do you think he has a chance?
- It--it's possible.
- But highly unlikely.
Once again,
even if he did survive,
he'd be deprived of
any real quality of life.
[somber music]
- It's too much.
It's just...
Too much.
- Okay, okay.
- [cries]
- It's okay.
Hey, it's okay.
It's okay.
It's gonna be okay.
Come here.
- Hey, what were you thinking
in there?
- That this baby still might
have a chance.
- Well, Dr. Grant,
who deals with this every day,
completely disagrees
with your assessment.
- Still, there's
a slight chance
with medical support,
that he could pull through.
- Natalie, if we were talking
about any other
terminally ill patient,
would you be telling me
to prolong life at any cost?
- Of course not.
- We should be helping
these parents get through this,
not making it harder for them.
*
- But... how did a cockroach
get up my nose?
- It crawled.
It was attracted to the glucose
in your cerebrospinal fluid.
It's sweet.
- Eww.
- Where do you live?
Uh, never mind.
I'm gonna go
scrub for surgery.
- Surgery?
- Your cerebrospinal fluid
is leaking into
your nasal cavity
because of a small
cranial fracture.
Have you had
a recent head injury?
- [breathes raggedly]
- Did somebody hurt you?
[melancholy piano music]
You can tell us.
- Look,
I don't want to
get involved with the police.
- Just tell them, D.
*
- My mom's boyfriend.
He hit me.
That's...
That's why I won't go back.
*
- Still think Child Services
is the right call?
*
- Barry...
Nothing has changed.
- Hey, I'm here to
drop this off for Deb.
14-year-old
I brought in this morning.
Seemed like she could use
a warmer coat.
- Oh.
- Client left this in the ambo
a while back.
It's already been dry cleaned,
so...
- I'll make sure she gets it.
- Thanks.
- Dr. Jaffrey?
Still no discomfort?
- Uh, a little pulling.
Some pressure.
- Yeah, I can believe that.
- Ah, my ventricles.
Contractions still look strong.
No fatty deposits.
My coronary artery
is pristine.
- Very healthy heart,
Dr. Jaffrey.
- You eat a lot of oatmeal,
Dr. Jaffrey?
- [laughs] Good one.
[chuckles]
- I'm ready for the scalpel.
- Uh, what?
Why a scalpel?
- I need to divide
the azygos vein.
- But shouldn't you do
the entire dissection first?
Save that till last?
- I... I...
- She's got a good angle
on it now.
- Yeah, but what happens
if something goes wrong?
I mean, good Lord,
you won't have enough
collateral blood flow
to bypass the obstruction.
- Dr. Jaffrey,
I want to remind you
that you're awake to observe
this operation, not conduct it.
- Oh, sorry.
Force of habit.
Sorry.
Please proceed, Dr. Bekker.
[heart monitor beeps]
- I understand.
Thank you.
I got Deb on a couple of
wait lists for group homes,
but none of them have
a room available.
- So where does that leave us?
- I could speak
to Child Services,
make sure they know about
the abusive boyfriend.
- Even if the boyfriend leaves,
odds are the mom's going
to allow him to come back.
- But when Deb
gets out of surgery,
she'll need a clean place
to recover.
She's not gonna get that
on the street.
- Well, you both make
good points,
but as the physician
on this case, Dr. Choi,
it's your call.
- There was a cockroach
in her nose.
[desolate music]
I'm sorry, April,
but we have
to call Child Services.
*
- How's he doing?
- He's holding on.
*
- Is he still alive?
- Mm-hmm.
- Can I see him?
- Yes.
Please.
*
- My God.
He's so small.
He...
*
- Would you like to hold him?
- Natalie...
*
- Yes.
*
- His skin...
I can see right through it.
*
My poor baby.
[monitors beep rapidly]
What's happening?
- He's de-satting.
His lungs can't provide
enough oxygen.
I'm sorry it's--
but it's what we expected.
- He's dying?
- I'm afraid so.
- [sobs]
You--you have to help him.
- Are you asking us
to resuscitate?
- Yes, please.
- Well, hold on.
M-Mrs. Harris,
I want to remind you
that you and your husband
made a decision already.
- You heard her. Nurse!
- Can you--
- Just save my baby.
- I need a .5 French ET tube
and a laryngoscope.
Will, see if you can get us
umbilical vein access.
Will, I need access!
*
- Come on, Ian.
*
- His airway's too small.
- God...
Oh, God... [cries]
- There. I'm in.
*
[monitor beeps]
Sats are back up to 91%.
- Does that mean
he's gonna be okay?
*
- For now.
*
.
[thunder rumbling]
- You shouldn't feel bad.
- Why not?
I am the one who
asked for this.
It was stupid.
- Not stupid.
Ambitious.
- I have no business
trying to treat
a patient like that.
I can't help him or myself.
- You know, the irony is,
that guy is so much more
scared of you
than you are of him.
- I doubt that.
- What, are you kidding me?
Guy like Hector--
not gonna let you in.
A shrink?
He's utterly terrified
of what you might find,
you know, what he might
have to face,
you know, so he does
the jailhouse thing.
- What do you mean?
- Convicts survive
by demonstrating dominance,
by going straight
to attack mode.
It's how they do it.
- So he manipulated me.
- These guys are experts at--
at spotting vulnerability.
You know?
And Mr. Ramirez
exploited yours.
- And so he got the response
he was hoping for.
I want to go back in.
- How are you feeling?
- Okay, I guess.
- Dr. Abrams said
everything went great,
and the paramedic
who brought you in
dropped this off for you.
- Great.
Did you...
call Child Services?
- I'm sorry, Deb.
There was nothing I could do.
[somber music]
*
- Oh, my God.
Is he in pain?
- He might be experiencing
some discomfort
from the ventilator
and the leads.
- But it's all necessary,
right?
To keep him alive?
- Yes.
- Hope this was
the right thing to do.
- Honey, look, he's moving.
He's hearing your voice.
He can recognize it, right?
From when he was in the womb?
- It's possible.
- Put your hand inside.
- Uh...
*
- Is that okay?
- Yes, of course.
*
[baby whimpers]
- [sighs]
Did you see that?
He's touching my finger.
- That's amazing.
- What does that mean?
- It's likely just a reflex.
- But it does show
that your son
has some motor function,
which is a good thing.
*
- Talk to him.
- [laughs]
Hey, Ian.
*
It's me.
Daddy.
*
- I'm coming around
to the anterior edge,
just about ready
to take the last section.
Hand me the bipolar.
- W--surely you don't intend
to use a cautery knife.
- I thought it would help to...
- It'll help her keep ahead
of the bleeding while she cuts.
- No, no, no.
You do not touch me
with that torture device.
Did I fail to teach you
proper surgical technique?
[uneasy piano music]
- You always said
it's important
to maintain hemostasis.
- Yes, after the cutting and
the tying of the vessels
individually,
not charring them with a bloody
cautery knife.
- There's a lot of cooks
in this kitchen.
- Yes, well,
my well-being's at stake here.
- I understand, Dr. Jaffrey.
I'm fine.
Give me the Metz.
*
There.
I've got everything.
*
I'm ready to reconstruct
the vena cava.
Give me a 20-millimeter
Dacron graft
and a 3-0 Prolene stitch.
- What?
No, no, no, no, no.
3-0 is far too heavy
for a graft this size.
- I-I thought the 3-0
was appropriate.
- No.
All right, that's it.
You're out.
- That's enough, Dr. Jaffrey.
- It's my heart,
and I'll tell you
when it's enough.
Rhodes.
Rhodes!
You're in.
Take the instruments.
Now.
*
- Dr. Latham,
I believe that it's time
to put our esteemed patient
under general anesthesia.
- What? No!
- I think it's in
his best interest.
- No, wait a minute.
We had an agreement.
Come on.
- Allen, if you would please.
- No.
Allen, the--you do not--
you wouldn't dare!
*
You...
What... No...
- How about that?
So quiet you can hear
a heart beat.
*
Now, Dr. Bekker,
I believe you were about
to sew in the graft
with a 3-0 stitch.
*
- Suture and DeBakey's.
*
- I apologize for ending
our session prematurely.
If you don't mind,
I would like to continue.
[inmates laugh]
*
- [chuckles]
*
- May we proceed?
*
- [barks]
[inmates cheering]
- [voice raised]
I'm here to help you, Hector,
but I can't do that
if you keep barking at me.
- [growls]
[alarm buzzes]
- Calm down! You hear me?
- [chuckling]
- Now, how's your new dosage
of sertraline working out?
Any drowsiness
or changes in appetite?
- [chuckles]
- How about
nausea, diarrhea,
problems sleeping?
*
- Feels I'm gonna
puke sometimes.
*
- Okay.
Okay, I can prescribe
a medication called Zofran
for that.
*
- [growls]
*
- Well, the surgery went well,
but it's going to be
a few days
before we can discharge her.
- Okay.
- She has concerns
about being placed
back with her mother,
whose boyfriend is abusive.
We need to find
alternative housing.
- Uh, first thing we'll do
is try to create
a plan with
her immediate family.
- Excuse me.
Her immediate family
is the problem.
- We'll do everything we can
to--to make the home safe
for Amy.
- Amy?
- Deb.
The patient's name's
Deb McCormick.
- Oh.
Really?
Ah.
[laughs]
Here it is.
Debra McCormick.
Where to?
So where is she?
- Call security.
[somber music]
*
- April, did you help her run?
- No.
- April.
- Okay, she...
told me she was going to leave.
I didn't stop her.
- I could write you up
for this.
- You saw.
That case worker is clueless.
He is not equipped
to help Deb.
But if you want
to write me up,
be my guest.
*
[monitors blare]
- Wha--
- What is that?
[monitors blare]
What's happening to him?
- Help him!
- He's bradycardic.
Page Dr. Grant.
I'm gonna start
chest compressions.
Push .5 of epi, IV.
- Come on, come on.
- Please,
I need you to stand back.
- Don't hurt him.
[heart monitors beeping]
- Blood pressure's falling.
Epi in?
- Yes, Doctor.
- Hold compressions.
[heart monitor flatlining]
No pulse.
*
- [sobs]
*
- [quietly]
Natalie...
*
- I am so sorry.
*
.
[distant sirens wailing]
- I shouldn't have pushed them.
- Natalie, it was
a very tough call.
- You didn't think so.
- I could've been wrong.
- Barry?
So, I'm not big into
the Memphis dry rub,
but if you were to offer me
some decent seafood...
- Yeah?
What's gotten into you?
- I don't know.
Maybe...
I've lost my mind.
- We were able to
completely remove the tumor
and reconstruct
the superior vena cava.
- Dr. Jaffrey?
- You disappoint me.
[melancholy music]
- Dr. Jaffrey,
everything went perfectly,
all according to
Dr. Bekker's plan.
You were right
to put your trust in her.
She is a first-rate surgeon.
*
- Get some rest, Dr. Jaffrey.
I'll be back
to check on you soon.
*
Connor...
*
I have to go put in
my surgical notes.
*
- April, that for Deb?
*
- You told me
a couple of weeks ago
about your own sister
and her struggles.
If she came in here,
needing help,
would you hand her over
to an agency that
you knew would only
make things worse?
*
- Um...
*
You did, um...
You did very well today.
*
Really.
*
- Again, I'm very, very sorry.
- Thank you.
*
- I don't know what to say.
*
- We got to hold our child.
I only hope that
he was able to feel our love.
- I'm sure he was.
- Thank you.
*
- That had to make you
feel a little better.
- It did.
*
- But what are you
gonna do next time?
*
[people chatting]
*
- What's he doing here?
- Don't worry.
He's here to help.
- Where's Deb?
- This way.
*
- I'm not going
with Child Services.
- I'm not here
to take you away.
*
I brought you antibiotics.
Twice a day, with a meal.
*
Will you make sure
she takes these?
*
April's going
to show your friends
how to keep the wound clean.
*
- Thanks.
- Let me take a look
at that dressing.
*
.
[dramatic synth music]
*
[wolf howls]
[Universal fanfare]