Chicago Med (2015–…): Season 4, Episode 14 - Episode #4.14 - full transcript
Can I confess something?
Course you can.
So I picked a coffee shop
for our first date
in case I needed
to make a quick getaway.
In case I was a dud?
Smart.
Very smart.
I get it, trust me.
But I'm going to guess that,
because you're letting me walk you home,
maybe not a dud?
You guessed right.
Yeah, I've been here
about nine years now.
Love Lakeview.
Wrigley's right there.
Britt, what are you doing out here?
I'm sorry.
I went to the store,
wanted some chocolate milk,
but I forgot my keys.
And your jacket?
This is my daughter, Britt.
She's supposed to be staying
inside the apartment.
Please, Mom. Can you just let me in?
Yes, yes, come on.
Um, Britt has a problem.
She's been clean a few
weeks now and doing great.
It's just the withdrawal
symptoms are hard.
Whoa, whoa, whoa, whoa, whoa.
You okay?
My chest,
it hurts when I breathe.
Okay, um, we need to
get her to a hospital.
What? No.
I'll let 'em know we're coming.
Incoming.
- Take Baghdad.
- Yep.
Cesar?
Gabriel Park, 16,
single GSW to the abdomen.
GCS 15, BP 98/66,
heart rate 118, sats 100%.
I can't move my leg.
Gabriel, I'm Dr. Rhodes.
You hang in there.
What happened?
Gunman held up the family store.
We were in the back,
stocking the freezer.
And Gabriel was working the register.
Mr. and Mrs. Park,
why don't you come with me
- and let Dr. Rhodes work, okay?
- All right.
On my count.
One, two, three.
Single bullet hole,
interior abdomen.
Let's get a chest x-ray and log roll.
On my count, one, two, three.
There we go.
No exit wound.
All right, back down.
Let's find out where this bullet is.
Everybody clear.
We're gonna take care of you, Gabe.
X-ray's up.
There it is.
All right,
trans abdominal trajectory.
He needs surgery.
Please, my left leg, I can't feel it.
Gabriel, I'm going to do
everything I can to fix
your leg, but right now I need
to look inside your belly
and make sure that everything is okay.
You understand me?
Good.
Call for blood.
Let's move him over to the hybrid OR.
Page my team.
Let's go.
Will.
What's up, Jay?
They just brought that kid in.
He was shot in a convenience store.
Okay.
So we caught the guy,
and we got the gun
that he used.
Good.
Why are you telling me?
CPD ran the serial number
on it, and it's your gun...
The one that was stolen.
- Hey.
Any word on the boy?
I heard it was your gun.
Don't say it, okay?
The last thing I need
right now is a lecture.
I wasn't going to.
It's not like I put the gun
in the shooter's hand.
It was stolen from me.
I know that.
Look, I know this is
a terrible situation.
I just hope you're talking
to someone.
Your therapist or...
Why do you even care?
You said we were done, remember?
Hey, any update on Britt Mills?
Other than learning from her mom you two
were on your first date?
It had to be awkward to find
her daughter like that.
Yeah.
Britt's echocardiogram
is showing endocarditis.
It happens sometimes with
intravenous drug users.
I bet bacteria from a needle
worked its way to the heart.
What's cardiology saying?
They advise against surgery.
I think we should treat with a
six week course of antibiotics,
so we need to put in a PICC line.
PICC line? I don't know.
I mean she's only been
clean a few weeks.
Leaving a catheter in her arm?
That's almost an invitation to relapse.
But if we don't, she'll have
to come into the hospital
twice a day for infusions.
Got to be another way.
- Dr. Rhodes.
- Thanks.
Connor, is the kid gonna be okay?
Yeah, he'll definitely live.
We repaired a bunch of small
bowel where the bullet
tore through, but it's still
lodged in his spinal canal.
How bad is it?
Too soon to tell, but, when he came in,
he said he lost feeling in his left leg.
We're sending him up to CT,
get a better idea of what's going on.
Neurology's gonna take a look at him.
We got it.
Maggie, female mid-30s,
syncopal episode in the field.
Down maybe 30 seconds before
roused by bystanders.
Sydney?
- Hey, Maggie.
- Hey.
Dr. Lanik, you're going to treatment 3.
Went from GCS 12 to 14
with a sternal rub,
supplemental oxygen, and
250 mils normal saline.
- Monitor showing multiple PVCs.
- I fainted.
Yes, and we're going to
take very good care of you.
BP's a little low, 100/66,
and heart rate, 78.
But I'm not sure if she's beta blocked.
Okay, transfer on my count.
One, two, three.
She's got a tunneled cath
in the left upper chest.
That's for dialysis. She's
on the list for a kidney.
- Hey, order a 12-lead EKG.
- All right.
- Am I gonna be okay?
- Yes, you are.
Where's that x-ray?
Okay, clear.
Ms. Curry? Ooh, mild fluid overload.
- So?
- Cardiac enzymes,
BMP, CBC, blood cultures times two.
Yeah, give her a dose of Vanc.
25 milligrams per kilogram. On it.
Repeat her vitals and let me
know when her labs are back.
Okay.
Okay.
- You know this patient?
- She grew up near me.
Came in a couple weeks ago with sepsis.
I should have seen her immediately.
Feels like somebody sitting on my chest
and my back at the same time
ever since we got back from
that cross country ski
trip two days ago.
I never felt anything like this.
This isn't like him.
Patrick's always so healthy,
even if he sort of let himself
go the last few years.
Really, Alice?
It's your medical history.
It's relevant, isn't it?
Uh, yeah.
Does the pain extend down
your arm or up to your jaw?
- No.
- Does this hurt?
Out of ten, ten being the most painful.
Mm, I guess a five.
Okay, let's get a CBC, CMP, troponins,
and set Mr. Novak up for an EKG.
Patrick?
- No pulse.
- What?
- He's not breathing, bag him.
- Got it.
But he's got normal sinus rhythm.
There's no pulse.
He's in PEA. Call a code.
- Patrick?
- We need help in here!
- Need an airway!
- Look.
He just opened his eyes.
He's breathing on his own.
Oh, thank God.
Honey, are you okay?
- Patrick?
- Asystole.
- Milligram of epi, now.
- Wha...
Intubate him.
Hold off. Patient's
breathing on his own.
Can someone tell me what is happening?
Your husband is in cardiac arrest,
but as long as I'm doing compressions,
he's getting oxygen to his brain.
We'll keep at it until
his heart takes over.
Honey, Patrick. I'm right here.
You're saying it's not
just the withdrawal?
I have a heart infection?
Symptoms of endocarditis
usually come on slowly
and they're often mistaken
for heroin withdrawal.
The chest pains you were
feeling this morning.
We can treat endocarditis
with long-term antibiotics,
which normally involve leaving
a catheter in the arm.
A PICC line.
It's okay, I'm used to needles.
Britt, we really get how
tricky early sobriety can be
and we just want to put you in
the best possible position to succeed.
So if we're gonna give
you this PICC line,
there's something else we'd
also like you to consider.
- What?
- Well, it's a drug
called Naltrexone that blocks
the effects of opioids
on the brain's limbic system,
essentially making it
impossible to get high.
There's a drug that'll stop me
from getting high?
Let's do that.
Listen, Naltrexone is by
no means a magic bullet,
and it comes with certain
very real risks.
The thing is, Britt, you can't take it
unless you've been opioid
free for at least 14 days.
If there are any opioids in your system,
the Naltrexone could trigger
severe side effects.
- I'm clean.
- For over two weeks.
Okay, well, it's also crucial
for you to understand,
if you were to use, it could
very well lead to an overdose.
I'm not going to. Ever.
She's been trying so hard.
Okay, well, we just
need to do a urine test
to be safe and, uh... and we're set.
- Okay.
- This is great, I mean...
- Ava.
- Hello, Connor.
Um...
how's the hand?
Ah, it's much better. It was my fault.
I should have gotten my
hand out of the way.
Well, maybe I could have
been a little more careful.
Look, I am sorry that
I haven't been able
- to come by to check on you.
- It's okay.
I know we're not in the
best of places right now.
- Yeah.
- Dr. Rhodes.
Once again, you are doing
your best to ruin my day.
- Maybe I should go.
- No, no, you stay, Dr. Bekker.
This concerns you, too. Two
months ago, you operated on
a gunshot victim, Shawn Corcoran?
- Yeah?
- And you assisted?
He died, and someone is alleging
that you brought him to the ICU
with his abdomen left open
when you should have closed him.
And then, you lightened his
anesthesia prematurely
while contributing to his death.
Who made these allegations?
It was an anonymous complaint.
Unfortunately, the hospital
oversight committee is obliged
to do a root cause
analysis into the case.
- You'll both be interviewed.
- And then what?
Well, if the committee finds
that the charges have merit,
you, Dr. Rhodes, will be brought before
a peer review board.
But hopefully that does not happen.
Your hybrid OR has cost
this hospital a fortune,
but it has made for some good PR.
The last thing I need is a
scandal involving its chief.
Connor, peer review? You
could lose your license.
Yeah.
Mr. Davis, you're back.
Yeah, it's starting to
feel like we live here.
But I'm just a little bit
worried about Sophie.
- What's the matter with her?
- She's not eating
like she should, and she's
sleeping more than usual.
All right, well, why don't
you lay her down right here
and I'll take a look, okay?
Okay. You're okay.
- Just right here.
- Hey.
You're all right.
- 100.1.
- She is running a fever.
I'm not seeing anything unexpected.
Okay.
Don't worry, we'll figure this out.
Put in an IV and check the
patency of the g-tube.
It could just be she's not
getting her fluids and nutrition in.
- Right.
- This have anything to do
- with her heart condition?
- I don't know yet.
Um, it could just be that, right now,
she's not getting the
nourishment she needs.
But let's just check the tube first,
and then, we'll go from there, okay?
- Okay.
- All right.
Ms. Hawkins, your tests
show potassium 9.2,
chloride 115, BUN 105, and creatinine 6.
- What that mean?
- It means your dialysis
hasn't been working.
When was the last time that
you went to the center?
A few days ago. Why?
And did they mention any
problems with your flow rates?
Because your catheter is clotted.
Maybe told you to come to the
hospital and get it replaced?
Oh, something like that, maybe, yeah.
But then I got too sick.
That's okay, we'll get it all fixed up,
and get you emergency dialysis.
Mm-hmm, meanwhile, we need
to lower your potassium.
Let's give her an amp of bicarbonate,
ten units regular
insulin, an amp of D50,
and then, 8.4 grams of patiromer.
Got it.
All of that?
It's really bad, isn't it?
Mm-hmm. You need a new kidney.
I'm gonna see if I can get you moved up
on the transplant list.
Maggie...
You're taking such good care of me.
Thank you.
No more ski trips, I promise.
I know you didn't want to go.
Dr. Halstead, should we get him on ECMO?
We can't put a patient on ECMO
unless we have a plan to get him off it.
- Then what can we do?
- This is it.
There's nothing else.
I'm not gonna stop until
his pulse comes back.
You need a break. Let me
take over for a while.
All right. Switch.
Hey, you good?
I'll be right back.
Based on my experience,
it's definitely the
best course of action.
Okay.
Hey, Sam.
What's the report on the GSW victim?
Since when is he your patient?
Come on, Sam.
Bullet lodged in his cord at T12,
hematoma surrounding the cord.
Kid's hemiplegic on his left side,
right leg still works.
Wait, so there's a chance
he'll regain feeling
in his left leg when you
pull the bullet out?
No, we're leaving it in.
Removing the bullet risks
substantial bleeding along
with more potential damage
to the spinal cord, which could result
in the kid being paraplegic.
Well, isn't that worth the risk
if it means he might
gain full function back?
Well, I'd rather have one
good leg than two bad ones.
Wait, look, we're talking
about a kid, here.
Okay, with his whole life ahead of him.
Halstead, no one asked for
your uninformed opinion,
and the family's made their decision.
Go back to the ED and put
a Band-Aid on someone.
Good news, the urine tox
screen came back clean.
I wasn't worried.
Monique, let's administer the
first dose of Naltrexone,
then send her up to the
IR for a PICC line.
Could you turn on your side, please?
- Mm-hmm.
- Honey...
Are you... are you sure about this?
This is a really big step.
Yes, Mom. I'm sure.
- Just a little pinch, okay?
- Mm-hmm.
- That's it.
- Thank you, both.
I understand what she does for a living,
but she's been responsible
with her health.
No...
She's not high risk.
Yes. I understand.
That about Sydney?
Yeah, she's on the bottom
of the transplant list
because she's a sex worker.
When she came in, I kept her waiting.
I didn't take her seriously.
I didn't realize that she was septic.
Maybe if I hadn't kept her waiting,
this wouldn't have happened.
Maggie, you don't know that.
You know, we grew up a couple
blocks from each other.
Huge difference, those couple blocks.
[somber music[
April?
I want you to do a blood draw on me.
A blood draw?
Maggie, you cannot be serious.
Treatment 4's open. Let's go.
- She's not breathing.
- Sats are down to 60%.
- Start bagging.
- Sats are coming back up.
- 88, 93.
- Need to intubate.
I'm in. Bag her.
Call for a vent and get a chest x-ray.
- She's stable for now.
- What's wrong with her?
I don't know yet, but we're
gonna get to the bottom of it.
Come back, Patrick. Please?
Just come back.
Dr. Halstead, it's been ten minutes.
No.
Stay with me please, baby.
Excuse me. Will, I need a word.
Gabriel and his parents are now saying
they want the surgery
to remove the bullet.
Glad to hear it.
You had no right interfering
with my patient.
Hey, all I did was make sure
they knew their options.
No, you went in there and
advocated for a surgery
that they had decided against.
Connor, this kid shouldn't have to live
the rest of his life
with only one good leg.
No, he shouldn't, but
what happened happened,
and we can't change that.
Well, maybe we can.
Maybe he can go back to the way he was.
Will, I get it, man. It was your gun.
You might have some messed up idea
that this was somehow your fault,
but pushing for that surgery,
the kid could wind up in a wheelchair.
Or he could be made whole again.
I have a patient to attend to.
Help, help! Somebody help my daughter!
- Excuse me.
- Need noodle.
- Not noodle, uh...
- She's seizing,
5 milligrams of Ativan.
Okay, meds are in.
Dan, help her, help her, help her!
BP 154 over 94. Heart rate 118.
Sats 92%. She's stable.
How did that happen?
Was it the injection?
No, only if Britt had
drugs in her system.
Hm, but... but she didn't.
Did she?
Maggie, come with me.
We need the room.
I'm on the transplant committee.
I am notified about every HLA match.
Did you really think I wouldn't find out
that you planned to donate a kidney?
Well, I hoped you wouldn't,
because I didn't want to have
this discussion with you.
Maggie, undergoing
surgery for a patient,
an irreversible procedure,
is a violation of
professional boundaries.
I'm sorry, but I don't care.
So who are you doing it for?
For her or for you?
- For me?
- Well, look.
I've gone through Sydney's records.
She was already in septic shock
when she came in, Maggie.
We did everything we could for her.
So if this is coming out of some
misplaced sense of guilt...
She's at the bottom of
the transplant list.
She's never gonna get a kidney,
and she's gonna die if
I don't give her mine.
But have you stopped to
consider your own health?
- Wha...
- Donating puts you at risk,
Maggie, for infection,
hypertension, intestinal obstruction...
Those are very rare side effects.
Okay, but what if your
remaining kidney fails?
People who donate kidneys do
just fine, and you know that.
It is still an ethical violation
and I can't... I just...
I can't let you do this.
Sharon, there's nothing that you can do
that's gonna stop me.
Actually, there is.
You're out of paid sick leave days.
You can't take the
time off to recover...
Not without jeopardizing
your employment.
Lose my job? You would do that?
Maggie, yes, I would.
She could have died.
My baby could have died.
I'm just stumped as to how...
How she passed the urine test.
I don't know.
Jackie.
It was mine. It was my urine.
She swore that she was clean,
and then, when you said
she was gonna have to do a
drug test, she told me.
She told me she'd shot up a week ago.
And you went ahead anyway?
She... she said that
it wasn't that much.
That it wouldn't matter.
You have to understand,
this has been going on
for such a long time.
I've tried everything.
I got her a therapist.
I-I got her a job.
I hardly ever leave her alone.
And still, every morning,
I wake up and I find
that she's figured out some
other way to get high.
The Naltrexone gave me hope
that it would save her.
Also could've killed her.
Jackie, I cannot even imagine
how brutal this must be.
But I'm gonna be very honest with you.
As a parent, I understand the
need to protect your child,
and as long as you keep doing that,
she's never going to get better.
The committee's running a little behind.
Ava, you are blameless in all of this.
I made every decision in the OR.
Dr. Bekker, they're ready for you.
- Hi.
- Hi.
Sophie's MRI shows an abscess...
an area of swelling
in the right frontal lobe of her brain.
It's an infection.
How... why...
It can happen in children with
congenital heart disease.
Bacteria originating from the heart
- travels up to their brain.
- Mm-hmm.
So the neurosurgeons would
like to take her up to
the operating room to
have a catheter placed
and the abscess drained.
A catheter in her head?
The good news is, is that
the abscess is small enough
so that she won't need a craniotomy...
surgery.
When my wife found out she
had a brain aneurysm.
The doctors said it was small enough
that she didn't need to have surgery,
and then it killed her.
I can't make you any promises,
but I can tell you that this is
an entirely different situation.
I'm hopeful. You should be, too.
Okay.
Let me check for a pulse.
- Move.
- Patrick, come back!
Oh, no. No, you hang on, Patrick.
Please.
Oh, you hang on, Patrick.
- Dr. Halstead.
- Oh, God.
No...
I'm sorry.
It's my fault.
I did this to him.
Okay, we are ready to
start your dialysis.
Huh?
- Sydney?
- She's in V-Fib.
Ugh, it's her potassium. Call a code.
Code blue! Get Lanik in here.
Start bagging.
Still in V-fib. Paddles.
Charge to 200.
Charged.
Clear.
Still in V-fib.
Milligram of epi.
- Epi is in.
- Charge again.
- Charged.
- Clear.
Back in sinus rhythm.
Another round of insulin, glucose,
- and two amps of bicarb.
- Got it.
Sydney, I'm right here.
- Sam, don't do the surgery.
- Are you on drugs?
You're the one who pushed for this.
I was wrong.
It wasn't a clinical decision.
It was emotional.
Yeah, well, it's too late.
- Please, talk to the family.
- I already have.
You made such a compelling
case for surgery
that they're determined
to go through with it.
Well, tell them you
refuse to do the surgery.
I did.
They said they'd get another surgeon.
At least if I do it, there's
a decent chance of success.
Come in.
Maggie?
I'm applying for the Family
Medical Leave Act...
to get the time off I'll need
for recovery from surgery.
You're determined to do
this no matter what I say?
Yes.
Why, Maggie?
Why is this patient so
different from any other?
She isn't.
I see so much suffering every day...
Day after day... and there's
nothing I can do about it.
But this time I can, this one time.
I can.
It's just impossible to
think that I would stand by
and let her do this to herself.
Well, it's completely counterintuitive.
I mean, as parents, we're programmed
to fix our children's problems, right?
Dr. Charles, did you release Britt?
- She's gone.
- Britt?
Britt! Britt!
She took her clothes, too.
Where's she gonna go with a PICC line?
She went to get high.
Let's just hope she doesn't OD.
Hey.
You were right.
I felt guilty.
Hoped I could turn back the clock.
Make it like the whole
thing never happened.
Yeah.
If he wakes up worse than before,
I'll never forgive myself.
Let's just hope for the best.
Connor.
I heard you're facing the
oversight committee.
What's that all about?
Old case, pro forma. It's no big deal.
She's not answering any of my texts.
I knew I shouldn't have
taken my eyes off her.
Jackie...
You don't understand. I'm her mother.
I have to find her.
And how many times have
you done that already?
Dr. Rhodes?
Dr. Rhodes, please.
Dr. Latham, I want it
to be clear that I bear
full responsibility for Mr.
Corcoran's surgery
and its outcome.
Be that as it may, we didn't call you in
to hear your statement. We
called you in to apologize.
- Apologize?
- Dr. Bekker made it
eminently clear that
all of your decisions
were sound both medically and ethically.
I reviewed Mr. Corcoran's
chart and, given the severity
of his injuries, find
no reason to disagree.
I'm not sure that Dr. Bekker
knows the details of the case.
Dr. Rhodes, the committee
has determined that
you are not at fault for Mr.
Corcoran's death.
You may go.
You told them that I did everything
in the patient's best interest?
Yeah.
You and I both know
that some of my actions
were questionable.
We have no way of knowing
if they had any effect on the outcome.
Still, the oversight committee
should have heard...
Why, so you can face peer
review and lose your license?
Connor, I did it for you.
I'd do anything for you.
Sam?
I was able to remove the bullet
without causing any more trauma.
So?
He'll be fine.
Thank you.
You know, your behavior
today has been erratic,
irrational, and impulsive:
hardly qualities one wants
to see in a physician.
You need to get your
head out of your ass.
There's nothing you can do right now.
We just have to wait and see
how Sophie responds to the antibiotics.
Why don't you go home
and get some sleep?
Okay.
Come in.
Mrs. Goodwin, um...
I'm not entirely comfortable
with how things were left
with the oversight committee.
I am.
I just don't think that Mr.
Corcoran's case
was accurately presented.
I'm guessing you're talking
about when you lightened
his sedation so Detective Halstead
could interview him.
- Yes.
- And wasn't that done
in an attempt to save
Will Halstead's life?
I assume when you made that decision
you hoped Mr. Corcoran would survive.
Mrs. Goodwin, lightening Mr.
Corcoran's sedation
might have contributed to his death.
Might have. There's no way to know.
He was gravely injured
when he was brought in.
You know, I was reminded today,
in our effort to help people that
we sometimes find ourselves
in situations where
what's right and what's
wrong isn't entirely clear.
And we can only hope that
the decisions we do make
are coming from the right place.
Go home, Dr. Rhodes.
- Hey.
- Gabriel pulled through.
He's gonna be fine.
Glad to hear it. For both of you.
Yeah.
Sam Abrams told me to get
my head out of my ass.
He's right.
Don't be too hard on yourself.
It was a tough call. I get it.
- I gotta find Nat.
- Night.
Congratulations, Connor.
Heard you got a pass.
And I'm sure you thought
I was the snitch.
You know, the thought crossed my mind.
I wish I could take credit,
but your patient croaked
in the ICU and I didn't
even know about it,
so I guess the question
is, who was the snitch?
Why now?
Months after the fact.
Got an enemy out there.
So you'll be in tomorrow?
Yeah, I'll see you in the morning.
- Dr. Manning?
- You can call me Natalie.
Natalie.
If it weren't for you,
I don't know how I would
get through this.
- So thank you.
- Yeah.
- Have a good night.
- You too.
- Natalie.
- Yeah?
What's going on?
What?
I came to apologize and tell you
I wanna start taking therapy seriously.
That's great.
But I find you hugging this guy.
- Will, I...
- No, tell me something.
Was it all really about me
having a gun or was it about
another guy and you
just couldn't tell me?
I don't even know what to say to that.
That man just lost his wife.
His baby could die.
He is all alone.
He needs someone to be there for him.
So do I, Natalie.
So do I.
What are you doing out here?
Aren't you going home?
I've been thinking who
was in the hybrid OR
who knew about my decision who
had the expertise to judge it.
You think it was Marty?
Or Sofia?
No, if they'd had a problem
they would have raised it at the time.
I think it was you.
What?
I-I defended you.
Exactly. You're...
You're like a pyromaniac that
sets a fire just to put it out.
Why in God's name would I do that?
For the same reason you
slept with my father
and put your hand where
you knew I would cut it.
- What?
- To keep me tied to you.
Risk my health?
Like you said, you'd do anything, right?
This is insane.
My God, can you hear yourself?
Ava, I think you got a problem
and I think you need to get some help.
I've done nothing but
support you and help you.
You're the one with the problem, Connor.
You're the one who should get some help.
Course you can.
So I picked a coffee shop
for our first date
in case I needed
to make a quick getaway.
In case I was a dud?
Smart.
Very smart.
I get it, trust me.
But I'm going to guess that,
because you're letting me walk you home,
maybe not a dud?
You guessed right.
Yeah, I've been here
about nine years now.
Love Lakeview.
Wrigley's right there.
Britt, what are you doing out here?
I'm sorry.
I went to the store,
wanted some chocolate milk,
but I forgot my keys.
And your jacket?
This is my daughter, Britt.
She's supposed to be staying
inside the apartment.
Please, Mom. Can you just let me in?
Yes, yes, come on.
Um, Britt has a problem.
She's been clean a few
weeks now and doing great.
It's just the withdrawal
symptoms are hard.
Whoa, whoa, whoa, whoa, whoa.
You okay?
My chest,
it hurts when I breathe.
Okay, um, we need to
get her to a hospital.
What? No.
I'll let 'em know we're coming.
Incoming.
- Take Baghdad.
- Yep.
Cesar?
Gabriel Park, 16,
single GSW to the abdomen.
GCS 15, BP 98/66,
heart rate 118, sats 100%.
I can't move my leg.
Gabriel, I'm Dr. Rhodes.
You hang in there.
What happened?
Gunman held up the family store.
We were in the back,
stocking the freezer.
And Gabriel was working the register.
Mr. and Mrs. Park,
why don't you come with me
- and let Dr. Rhodes work, okay?
- All right.
On my count.
One, two, three.
Single bullet hole,
interior abdomen.
Let's get a chest x-ray and log roll.
On my count, one, two, three.
There we go.
No exit wound.
All right, back down.
Let's find out where this bullet is.
Everybody clear.
We're gonna take care of you, Gabe.
X-ray's up.
There it is.
All right,
trans abdominal trajectory.
He needs surgery.
Please, my left leg, I can't feel it.
Gabriel, I'm going to do
everything I can to fix
your leg, but right now I need
to look inside your belly
and make sure that everything is okay.
You understand me?
Good.
Call for blood.
Let's move him over to the hybrid OR.
Page my team.
Let's go.
Will.
What's up, Jay?
They just brought that kid in.
He was shot in a convenience store.
Okay.
So we caught the guy,
and we got the gun
that he used.
Good.
Why are you telling me?
CPD ran the serial number
on it, and it's your gun...
The one that was stolen.
- Hey.
Any word on the boy?
I heard it was your gun.
Don't say it, okay?
The last thing I need
right now is a lecture.
I wasn't going to.
It's not like I put the gun
in the shooter's hand.
It was stolen from me.
I know that.
Look, I know this is
a terrible situation.
I just hope you're talking
to someone.
Your therapist or...
Why do you even care?
You said we were done, remember?
Hey, any update on Britt Mills?
Other than learning from her mom you two
were on your first date?
It had to be awkward to find
her daughter like that.
Yeah.
Britt's echocardiogram
is showing endocarditis.
It happens sometimes with
intravenous drug users.
I bet bacteria from a needle
worked its way to the heart.
What's cardiology saying?
They advise against surgery.
I think we should treat with a
six week course of antibiotics,
so we need to put in a PICC line.
PICC line? I don't know.
I mean she's only been
clean a few weeks.
Leaving a catheter in her arm?
That's almost an invitation to relapse.
But if we don't, she'll have
to come into the hospital
twice a day for infusions.
Got to be another way.
- Dr. Rhodes.
- Thanks.
Connor, is the kid gonna be okay?
Yeah, he'll definitely live.
We repaired a bunch of small
bowel where the bullet
tore through, but it's still
lodged in his spinal canal.
How bad is it?
Too soon to tell, but, when he came in,
he said he lost feeling in his left leg.
We're sending him up to CT,
get a better idea of what's going on.
Neurology's gonna take a look at him.
We got it.
Maggie, female mid-30s,
syncopal episode in the field.
Down maybe 30 seconds before
roused by bystanders.
Sydney?
- Hey, Maggie.
- Hey.
Dr. Lanik, you're going to treatment 3.
Went from GCS 12 to 14
with a sternal rub,
supplemental oxygen, and
250 mils normal saline.
- Monitor showing multiple PVCs.
- I fainted.
Yes, and we're going to
take very good care of you.
BP's a little low, 100/66,
and heart rate, 78.
But I'm not sure if she's beta blocked.
Okay, transfer on my count.
One, two, three.
She's got a tunneled cath
in the left upper chest.
That's for dialysis. She's
on the list for a kidney.
- Hey, order a 12-lead EKG.
- All right.
- Am I gonna be okay?
- Yes, you are.
Where's that x-ray?
Okay, clear.
Ms. Curry? Ooh, mild fluid overload.
- So?
- Cardiac enzymes,
BMP, CBC, blood cultures times two.
Yeah, give her a dose of Vanc.
25 milligrams per kilogram. On it.
Repeat her vitals and let me
know when her labs are back.
Okay.
Okay.
- You know this patient?
- She grew up near me.
Came in a couple weeks ago with sepsis.
I should have seen her immediately.
Feels like somebody sitting on my chest
and my back at the same time
ever since we got back from
that cross country ski
trip two days ago.
I never felt anything like this.
This isn't like him.
Patrick's always so healthy,
even if he sort of let himself
go the last few years.
Really, Alice?
It's your medical history.
It's relevant, isn't it?
Uh, yeah.
Does the pain extend down
your arm or up to your jaw?
- No.
- Does this hurt?
Out of ten, ten being the most painful.
Mm, I guess a five.
Okay, let's get a CBC, CMP, troponins,
and set Mr. Novak up for an EKG.
Patrick?
- No pulse.
- What?
- He's not breathing, bag him.
- Got it.
But he's got normal sinus rhythm.
There's no pulse.
He's in PEA. Call a code.
- Patrick?
- We need help in here!
- Need an airway!
- Look.
He just opened his eyes.
He's breathing on his own.
Oh, thank God.
Honey, are you okay?
- Patrick?
- Asystole.
- Milligram of epi, now.
- Wha...
Intubate him.
Hold off. Patient's
breathing on his own.
Can someone tell me what is happening?
Your husband is in cardiac arrest,
but as long as I'm doing compressions,
he's getting oxygen to his brain.
We'll keep at it until
his heart takes over.
Honey, Patrick. I'm right here.
You're saying it's not
just the withdrawal?
I have a heart infection?
Symptoms of endocarditis
usually come on slowly
and they're often mistaken
for heroin withdrawal.
The chest pains you were
feeling this morning.
We can treat endocarditis
with long-term antibiotics,
which normally involve leaving
a catheter in the arm.
A PICC line.
It's okay, I'm used to needles.
Britt, we really get how
tricky early sobriety can be
and we just want to put you in
the best possible position to succeed.
So if we're gonna give
you this PICC line,
there's something else we'd
also like you to consider.
- What?
- Well, it's a drug
called Naltrexone that blocks
the effects of opioids
on the brain's limbic system,
essentially making it
impossible to get high.
There's a drug that'll stop me
from getting high?
Let's do that.
Listen, Naltrexone is by
no means a magic bullet,
and it comes with certain
very real risks.
The thing is, Britt, you can't take it
unless you've been opioid
free for at least 14 days.
If there are any opioids in your system,
the Naltrexone could trigger
severe side effects.
- I'm clean.
- For over two weeks.
Okay, well, it's also crucial
for you to understand,
if you were to use, it could
very well lead to an overdose.
I'm not going to. Ever.
She's been trying so hard.
Okay, well, we just
need to do a urine test
to be safe and, uh... and we're set.
- Okay.
- This is great, I mean...
- Ava.
- Hello, Connor.
Um...
how's the hand?
Ah, it's much better. It was my fault.
I should have gotten my
hand out of the way.
Well, maybe I could have
been a little more careful.
Look, I am sorry that
I haven't been able
- to come by to check on you.
- It's okay.
I know we're not in the
best of places right now.
- Yeah.
- Dr. Rhodes.
Once again, you are doing
your best to ruin my day.
- Maybe I should go.
- No, no, you stay, Dr. Bekker.
This concerns you, too. Two
months ago, you operated on
a gunshot victim, Shawn Corcoran?
- Yeah?
- And you assisted?
He died, and someone is alleging
that you brought him to the ICU
with his abdomen left open
when you should have closed him.
And then, you lightened his
anesthesia prematurely
while contributing to his death.
Who made these allegations?
It was an anonymous complaint.
Unfortunately, the hospital
oversight committee is obliged
to do a root cause
analysis into the case.
- You'll both be interviewed.
- And then what?
Well, if the committee finds
that the charges have merit,
you, Dr. Rhodes, will be brought before
a peer review board.
But hopefully that does not happen.
Your hybrid OR has cost
this hospital a fortune,
but it has made for some good PR.
The last thing I need is a
scandal involving its chief.
Connor, peer review? You
could lose your license.
Yeah.
Mr. Davis, you're back.
Yeah, it's starting to
feel like we live here.
But I'm just a little bit
worried about Sophie.
- What's the matter with her?
- She's not eating
like she should, and she's
sleeping more than usual.
All right, well, why don't
you lay her down right here
and I'll take a look, okay?
Okay. You're okay.
- Just right here.
- Hey.
You're all right.
- 100.1.
- She is running a fever.
I'm not seeing anything unexpected.
Okay.
Don't worry, we'll figure this out.
Put in an IV and check the
patency of the g-tube.
It could just be she's not
getting her fluids and nutrition in.
- Right.
- This have anything to do
- with her heart condition?
- I don't know yet.
Um, it could just be that, right now,
she's not getting the
nourishment she needs.
But let's just check the tube first,
and then, we'll go from there, okay?
- Okay.
- All right.
Ms. Hawkins, your tests
show potassium 9.2,
chloride 115, BUN 105, and creatinine 6.
- What that mean?
- It means your dialysis
hasn't been working.
When was the last time that
you went to the center?
A few days ago. Why?
And did they mention any
problems with your flow rates?
Because your catheter is clotted.
Maybe told you to come to the
hospital and get it replaced?
Oh, something like that, maybe, yeah.
But then I got too sick.
That's okay, we'll get it all fixed up,
and get you emergency dialysis.
Mm-hmm, meanwhile, we need
to lower your potassium.
Let's give her an amp of bicarbonate,
ten units regular
insulin, an amp of D50,
and then, 8.4 grams of patiromer.
Got it.
All of that?
It's really bad, isn't it?
Mm-hmm. You need a new kidney.
I'm gonna see if I can get you moved up
on the transplant list.
Maggie...
You're taking such good care of me.
Thank you.
No more ski trips, I promise.
I know you didn't want to go.
Dr. Halstead, should we get him on ECMO?
We can't put a patient on ECMO
unless we have a plan to get him off it.
- Then what can we do?
- This is it.
There's nothing else.
I'm not gonna stop until
his pulse comes back.
You need a break. Let me
take over for a while.
All right. Switch.
Hey, you good?
I'll be right back.
Based on my experience,
it's definitely the
best course of action.
Okay.
Hey, Sam.
What's the report on the GSW victim?
Since when is he your patient?
Come on, Sam.
Bullet lodged in his cord at T12,
hematoma surrounding the cord.
Kid's hemiplegic on his left side,
right leg still works.
Wait, so there's a chance
he'll regain feeling
in his left leg when you
pull the bullet out?
No, we're leaving it in.
Removing the bullet risks
substantial bleeding along
with more potential damage
to the spinal cord, which could result
in the kid being paraplegic.
Well, isn't that worth the risk
if it means he might
gain full function back?
Well, I'd rather have one
good leg than two bad ones.
Wait, look, we're talking
about a kid, here.
Okay, with his whole life ahead of him.
Halstead, no one asked for
your uninformed opinion,
and the family's made their decision.
Go back to the ED and put
a Band-Aid on someone.
Good news, the urine tox
screen came back clean.
I wasn't worried.
Monique, let's administer the
first dose of Naltrexone,
then send her up to the
IR for a PICC line.
Could you turn on your side, please?
- Mm-hmm.
- Honey...
Are you... are you sure about this?
This is a really big step.
Yes, Mom. I'm sure.
- Just a little pinch, okay?
- Mm-hmm.
- That's it.
- Thank you, both.
I understand what she does for a living,
but she's been responsible
with her health.
No...
She's not high risk.
Yes. I understand.
That about Sydney?
Yeah, she's on the bottom
of the transplant list
because she's a sex worker.
When she came in, I kept her waiting.
I didn't take her seriously.
I didn't realize that she was septic.
Maybe if I hadn't kept her waiting,
this wouldn't have happened.
Maggie, you don't know that.
You know, we grew up a couple
blocks from each other.
Huge difference, those couple blocks.
[somber music[
April?
I want you to do a blood draw on me.
A blood draw?
Maggie, you cannot be serious.
Treatment 4's open. Let's go.
- She's not breathing.
- Sats are down to 60%.
- Start bagging.
- Sats are coming back up.
- 88, 93.
- Need to intubate.
I'm in. Bag her.
Call for a vent and get a chest x-ray.
- She's stable for now.
- What's wrong with her?
I don't know yet, but we're
gonna get to the bottom of it.
Come back, Patrick. Please?
Just come back.
Dr. Halstead, it's been ten minutes.
No.
Stay with me please, baby.
Excuse me. Will, I need a word.
Gabriel and his parents are now saying
they want the surgery
to remove the bullet.
Glad to hear it.
You had no right interfering
with my patient.
Hey, all I did was make sure
they knew their options.
No, you went in there and
advocated for a surgery
that they had decided against.
Connor, this kid shouldn't have to live
the rest of his life
with only one good leg.
No, he shouldn't, but
what happened happened,
and we can't change that.
Well, maybe we can.
Maybe he can go back to the way he was.
Will, I get it, man. It was your gun.
You might have some messed up idea
that this was somehow your fault,
but pushing for that surgery,
the kid could wind up in a wheelchair.
Or he could be made whole again.
I have a patient to attend to.
Help, help! Somebody help my daughter!
- Excuse me.
- Need noodle.
- Not noodle, uh...
- She's seizing,
5 milligrams of Ativan.
Okay, meds are in.
Dan, help her, help her, help her!
BP 154 over 94. Heart rate 118.
Sats 92%. She's stable.
How did that happen?
Was it the injection?
No, only if Britt had
drugs in her system.
Hm, but... but she didn't.
Did she?
Maggie, come with me.
We need the room.
I'm on the transplant committee.
I am notified about every HLA match.
Did you really think I wouldn't find out
that you planned to donate a kidney?
Well, I hoped you wouldn't,
because I didn't want to have
this discussion with you.
Maggie, undergoing
surgery for a patient,
an irreversible procedure,
is a violation of
professional boundaries.
I'm sorry, but I don't care.
So who are you doing it for?
For her or for you?
- For me?
- Well, look.
I've gone through Sydney's records.
She was already in septic shock
when she came in, Maggie.
We did everything we could for her.
So if this is coming out of some
misplaced sense of guilt...
She's at the bottom of
the transplant list.
She's never gonna get a kidney,
and she's gonna die if
I don't give her mine.
But have you stopped to
consider your own health?
- Wha...
- Donating puts you at risk,
Maggie, for infection,
hypertension, intestinal obstruction...
Those are very rare side effects.
Okay, but what if your
remaining kidney fails?
People who donate kidneys do
just fine, and you know that.
It is still an ethical violation
and I can't... I just...
I can't let you do this.
Sharon, there's nothing that you can do
that's gonna stop me.
Actually, there is.
You're out of paid sick leave days.
You can't take the
time off to recover...
Not without jeopardizing
your employment.
Lose my job? You would do that?
Maggie, yes, I would.
She could have died.
My baby could have died.
I'm just stumped as to how...
How she passed the urine test.
I don't know.
Jackie.
It was mine. It was my urine.
She swore that she was clean,
and then, when you said
she was gonna have to do a
drug test, she told me.
She told me she'd shot up a week ago.
And you went ahead anyway?
She... she said that
it wasn't that much.
That it wouldn't matter.
You have to understand,
this has been going on
for such a long time.
I've tried everything.
I got her a therapist.
I-I got her a job.
I hardly ever leave her alone.
And still, every morning,
I wake up and I find
that she's figured out some
other way to get high.
The Naltrexone gave me hope
that it would save her.
Also could've killed her.
Jackie, I cannot even imagine
how brutal this must be.
But I'm gonna be very honest with you.
As a parent, I understand the
need to protect your child,
and as long as you keep doing that,
she's never going to get better.
The committee's running a little behind.
Ava, you are blameless in all of this.
I made every decision in the OR.
Dr. Bekker, they're ready for you.
- Hi.
- Hi.
Sophie's MRI shows an abscess...
an area of swelling
in the right frontal lobe of her brain.
It's an infection.
How... why...
It can happen in children with
congenital heart disease.
Bacteria originating from the heart
- travels up to their brain.
- Mm-hmm.
So the neurosurgeons would
like to take her up to
the operating room to
have a catheter placed
and the abscess drained.
A catheter in her head?
The good news is, is that
the abscess is small enough
so that she won't need a craniotomy...
surgery.
When my wife found out she
had a brain aneurysm.
The doctors said it was small enough
that she didn't need to have surgery,
and then it killed her.
I can't make you any promises,
but I can tell you that this is
an entirely different situation.
I'm hopeful. You should be, too.
Okay.
Let me check for a pulse.
- Move.
- Patrick, come back!
Oh, no. No, you hang on, Patrick.
Please.
Oh, you hang on, Patrick.
- Dr. Halstead.
- Oh, God.
No...
I'm sorry.
It's my fault.
I did this to him.
Okay, we are ready to
start your dialysis.
Huh?
- Sydney?
- She's in V-Fib.
Ugh, it's her potassium. Call a code.
Code blue! Get Lanik in here.
Start bagging.
Still in V-fib. Paddles.
Charge to 200.
Charged.
Clear.
Still in V-fib.
Milligram of epi.
- Epi is in.
- Charge again.
- Charged.
- Clear.
Back in sinus rhythm.
Another round of insulin, glucose,
- and two amps of bicarb.
- Got it.
Sydney, I'm right here.
- Sam, don't do the surgery.
- Are you on drugs?
You're the one who pushed for this.
I was wrong.
It wasn't a clinical decision.
It was emotional.
Yeah, well, it's too late.
- Please, talk to the family.
- I already have.
You made such a compelling
case for surgery
that they're determined
to go through with it.
Well, tell them you
refuse to do the surgery.
I did.
They said they'd get another surgeon.
At least if I do it, there's
a decent chance of success.
Come in.
Maggie?
I'm applying for the Family
Medical Leave Act...
to get the time off I'll need
for recovery from surgery.
You're determined to do
this no matter what I say?
Yes.
Why, Maggie?
Why is this patient so
different from any other?
She isn't.
I see so much suffering every day...
Day after day... and there's
nothing I can do about it.
But this time I can, this one time.
I can.
It's just impossible to
think that I would stand by
and let her do this to herself.
Well, it's completely counterintuitive.
I mean, as parents, we're programmed
to fix our children's problems, right?
Dr. Charles, did you release Britt?
- She's gone.
- Britt?
Britt! Britt!
She took her clothes, too.
Where's she gonna go with a PICC line?
She went to get high.
Let's just hope she doesn't OD.
Hey.
You were right.
I felt guilty.
Hoped I could turn back the clock.
Make it like the whole
thing never happened.
Yeah.
If he wakes up worse than before,
I'll never forgive myself.
Let's just hope for the best.
Connor.
I heard you're facing the
oversight committee.
What's that all about?
Old case, pro forma. It's no big deal.
She's not answering any of my texts.
I knew I shouldn't have
taken my eyes off her.
Jackie...
You don't understand. I'm her mother.
I have to find her.
And how many times have
you done that already?
Dr. Rhodes?
Dr. Rhodes, please.
Dr. Latham, I want it
to be clear that I bear
full responsibility for Mr.
Corcoran's surgery
and its outcome.
Be that as it may, we didn't call you in
to hear your statement. We
called you in to apologize.
- Apologize?
- Dr. Bekker made it
eminently clear that
all of your decisions
were sound both medically and ethically.
I reviewed Mr. Corcoran's
chart and, given the severity
of his injuries, find
no reason to disagree.
I'm not sure that Dr. Bekker
knows the details of the case.
Dr. Rhodes, the committee
has determined that
you are not at fault for Mr.
Corcoran's death.
You may go.
You told them that I did everything
in the patient's best interest?
Yeah.
You and I both know
that some of my actions
were questionable.
We have no way of knowing
if they had any effect on the outcome.
Still, the oversight committee
should have heard...
Why, so you can face peer
review and lose your license?
Connor, I did it for you.
I'd do anything for you.
Sam?
I was able to remove the bullet
without causing any more trauma.
So?
He'll be fine.
Thank you.
You know, your behavior
today has been erratic,
irrational, and impulsive:
hardly qualities one wants
to see in a physician.
You need to get your
head out of your ass.
There's nothing you can do right now.
We just have to wait and see
how Sophie responds to the antibiotics.
Why don't you go home
and get some sleep?
Okay.
Come in.
Mrs. Goodwin, um...
I'm not entirely comfortable
with how things were left
with the oversight committee.
I am.
I just don't think that Mr.
Corcoran's case
was accurately presented.
I'm guessing you're talking
about when you lightened
his sedation so Detective Halstead
could interview him.
- Yes.
- And wasn't that done
in an attempt to save
Will Halstead's life?
I assume when you made that decision
you hoped Mr. Corcoran would survive.
Mrs. Goodwin, lightening Mr.
Corcoran's sedation
might have contributed to his death.
Might have. There's no way to know.
He was gravely injured
when he was brought in.
You know, I was reminded today,
in our effort to help people that
we sometimes find ourselves
in situations where
what's right and what's
wrong isn't entirely clear.
And we can only hope that
the decisions we do make
are coming from the right place.
Go home, Dr. Rhodes.
- Hey.
- Gabriel pulled through.
He's gonna be fine.
Glad to hear it. For both of you.
Yeah.
Sam Abrams told me to get
my head out of my ass.
He's right.
Don't be too hard on yourself.
It was a tough call. I get it.
- I gotta find Nat.
- Night.
Congratulations, Connor.
Heard you got a pass.
And I'm sure you thought
I was the snitch.
You know, the thought crossed my mind.
I wish I could take credit,
but your patient croaked
in the ICU and I didn't
even know about it,
so I guess the question
is, who was the snitch?
Why now?
Months after the fact.
Got an enemy out there.
So you'll be in tomorrow?
Yeah, I'll see you in the morning.
- Dr. Manning?
- You can call me Natalie.
Natalie.
If it weren't for you,
I don't know how I would
get through this.
- So thank you.
- Yeah.
- Have a good night.
- You too.
- Natalie.
- Yeah?
What's going on?
What?
I came to apologize and tell you
I wanna start taking therapy seriously.
That's great.
But I find you hugging this guy.
- Will, I...
- No, tell me something.
Was it all really about me
having a gun or was it about
another guy and you
just couldn't tell me?
I don't even know what to say to that.
That man just lost his wife.
His baby could die.
He is all alone.
He needs someone to be there for him.
So do I, Natalie.
So do I.
What are you doing out here?
Aren't you going home?
I've been thinking who
was in the hybrid OR
who knew about my decision who
had the expertise to judge it.
You think it was Marty?
Or Sofia?
No, if they'd had a problem
they would have raised it at the time.
I think it was you.
What?
I-I defended you.
Exactly. You're...
You're like a pyromaniac that
sets a fire just to put it out.
Why in God's name would I do that?
For the same reason you
slept with my father
and put your hand where
you knew I would cut it.
- What?
- To keep me tied to you.
Risk my health?
Like you said, you'd do anything, right?
This is insane.
My God, can you hear yourself?
Ava, I think you got a problem
and I think you need to get some help.
I've done nothing but
support you and help you.
You're the one with the problem, Connor.
You're the one who should get some help.