Chicago Med (2015–…): Season 7, Episode 6 - When You're a Hammer Everything's a Nail - full transcript
.
She's out.
I'll take it from here.
Dr. Blake.
You're a transplant surgeon.
I got this.
She tried to scrub in.
How'd you guess?
I know my mom.
You need a roof over
your head, heat, running water.
You just wanna
call the shots.
You owe me $1,200.
Do what you want
with it, Mom.
I screwed up everything
today.
I know how tough
internship can be.
Boards aren't gonna study
for themselves.
You pulled my patient's
Vas-COM?
I just think we should err
on the side of safety.
It did seem medically
warranted to get her
on better monitoring.
So I just put in
another Vas-COM.
Is something going on?
Dr. Halstead tells me
you're progressing well.
I have excellent doctors
to thank for that.
And we're very impressed
with your staff.
Well, Dr. Halstead
is one of our finest.
Don't forget Dr. Cooper.
Hey, there, what'd I miss?
We were just discussing
Eleanor's marked improvement.
How she looks much
less edematous.
Yeah, right, it's terrific.
I've been able to strategically
manage her fluids
using the Vas-COM.
Sorry, I didn't mean
to interrupt.
I just came in to take a quick
peak at her cardiac output.
It's all right.
I have to go anyway.
I have a meeting.
I'll walk you out,
Miss Goodwin.
You two take care.
Still can't believe
Cooper put in another Vas-COM.
I thought it was confirmed
that Vas-COM
didn't contribute
to her embolic events.
It didn't, but with Eleanor's
clotting issues, it's risky.
♪
I heard you were here
late last night.
I had
a difficult septic patient.
I didn't wanna just leave him
for the night shift.
They can handle
a septic patient.
I wanted to see it through.
Did you get any sleep?
Didn't we just have
this conversation a week ago?
And I'm allowed to ask you if
you're taking care of yourself.
Mom, you know
you're parked in a red zone.
Oh, no one cares.
You wanna see what I've done?
Sure.
I found those pillows
off a couch
someone left on the sidewalk.
And look what I pulled
out of a dumpster
behind Merchandise Mart.
It's silk. Feel it.
Wow.
And back--back there,
I--I hung up a prism.
Remember that one
when you were little?
All the Rainbows?
Yeah, I remember.
And I see you have a cooler.
I brought some groceries
with me,
some fresh fruits
and vegetables.
What's with your arm?
Oh--oh no, it's not--
it's not a big deal.
Mom, let me see.
Oh, what did you do?
I was working on the van
and I--I knocked aside
that stick thingy
that holds the hood up.
It got me pretty good.
Oh, you're burning up.
I'm wearing layers.
Oh, mom. Oh, man.
This is infected.
No, I washed--I washed it.
No, we gotta get you
to the hospital.
No, no, no, no, it's fine.
I can take care of myself.
Mom--Mom? Mom, Mom.
No, I'm calling an ambulance.
Mom?
I don't care
if it's your hospital.
I don't wanna be here.
I can hear you fine, Mom.
But you won't listen to me.
Hey, Maggie,
can we get a room,
and is Vanessa available?
Sure, Vanessa,
you're going to treatment 3.
♪
Hey, this is my mom, Terri.
She cut her arm pretty badly.
Hi, Terri, I'm Dr. Taylor.
Good for you.
Mom, please.
I don't like hospitals.
What?
All right, on three.
♪
The IV's for fluids.
You're dehydrated, Mom.
So get me a glass of water.
You happen to catch them
when they came in?
I did, yeah.
Not at all what I imagined.
In med school, Stevie was the
one who had it all together.
Head of the class,
full scholarship.
I just figured she was raised
by some genius scientists
who made her in a lab.
Huh.
I thought scholarships
are usually for students
in need of financial aid.
Your bilirubin levels
are high
but they seem to have plateaued
at the moment.
How are you feeling, Sheldon?
Like every second
could be my last.
A real thrill.
I know how difficult
this has been.
I want you to meet Dr. Marcel.
He's taken an interest
in transplant surgery,
and he's been shadowing me.
Hey, Sheldon.
Dr. Marcel, are you going
to get me a liver?
Oh, well, uh,
we're working on it.
You're at the top
of the transplant list.
So there's a good chance
that the next one
that matches
has your name on it.
Okay, I'll try not to die
in the meantime.
You do that.
Bye.
He got his humor.
That's a good sign.
I'm not sure
if it's really humor
or his hepatic encephalopathy.
How long has he been waiting?
Eight months.
Wow.
Kinda makes you feel helpless.
It's definitely not the ED.
Someone lands here, and you
can't just get right to work
resetting a bone.
In transplant surgery,
unfortunately,
it's all about waiting.
Dr. Scott, you're up.
You're going to treatment 4.
And by the way,
we're short-staffed today,
so I'm gonna be assisting you.
Oh, let's do it.
Who's the patient?
9-year-old Siobhan Murphy.
She fell down
a flight of stairs.
Those her parents?
Yeah, Kate and Brandon.
That guy looks familiar.
Mr. and Mrs. Murphy.
I'm Dr. Scott.
This is our charge nurse,
Maggie,
and you must be Siobhan.
Uh-oh, I know that look.
We're pretty sure
Siobhan broke her arm.
She fell down the stairs
of our apartment complex.
Do I know you?
Oh, I don't think so.
All right, Siobhan,
what happened?
I guess I tripped.
She's never been the world's
most coordinated person.
So just a normal
run-of-the-mill trip?
Nothing in front of you
but you're own two feet?
I don't really remember much.
When I fell, I hit my head.
Since then,
it's all been a little foggy.
So we need to get a head CT
to check
on that brain fog, yeah?
Okay.
May I look at your arm?
Let me see.
Get an X-ray on the arm.
Uh-huh.
Okay, Siobhan, so we are
gonna take a few pictures
of your arm
and the inside of your head.
Sound like a plan?
Okay.
I will be right back
with an X-ray technician.
Hey, what was that
between you and the dad?
I realized how I know him.
I arrested him for assault
and battery 10 years ago.
Really?
Hey, is that gonna be an issue?
Are you sure you should be
on this case?
I can call peds
and get somebody else.
Oh, no, no, no. It's fine.
I'm good.
♪
I'm sorry, you're missing
a whole column over here.
You need to re-do this.
Okay, I'm sorry.
Dr. Marcel, you made it.
Hey, sorry I'm late.
I got caught up
with a patient in the ICU.
Remember, there's a reason
why it's called
the Emergency Department, yeah?
Dr. Archer, Dr. Marcel,
we have trauma incoming.
Nancy, you're good?
Lacey, talk to me.
John Doe, age unknown,
most likely
a long-distance swimmer.
Crew team found him floating
in Lake Michigan,
fished him out
and performed CPR.
CFD defibrillated him once,
got a rhythm,
and intubated in the field.
Why are you still doing
compressing him?
I lost pulse
about 30 secs ago.
Gave him a milligram of epi.
Okay, here we go.
Nice and easy, okay?
All right, we're gonna transfer
on my count.
One, two, three.
Continuing compressions.
Pulse?
No pulse.
Continue CPR.
He's in V-fib.
Give me the paddles,
charge to 200.
Charging.
Okay, clear.
We got a pulse. Sinus rhythm.
All right, he's hypothermic.
Can we get
some warm blankets, please?
♪
All right,
pupils are fixed and dilated.
That brain's been
without oxygen for a while.
Nancy, CT for a panscan,
please.
And also,
let's call CPD up in here.
They can run his prints.
Maybe they can identify him.
Hey.
I just wanted to say
I'm sorry about your mom.
You're surprised.
Surprised?
She looks like
a street person, right?
You weren't expecting that.
If you need any help...
Thank you.
It's nice of you,
but I've been dealing
with this a long time.
Just forwarded
your mom's labs.
Yeah, it's about
what I expected.
Are you sure you don't want
an attending instead of me?
This way I can stay
on top of her case.
Okay, well,
how do you wanna handle this?
You take the lead.
She's more likely
to listen to you anyway.
Terri, you definitely have
an infection in your arm
that has spread
to your bloodstream.
We have to treat it like MRSA
until your cultures come back.
We already knew
it was infected.
Yes, Mom,
but this particular type
of infection is resistant
to most forms of antibiotics.
I thought she was my doctor.
We can still treat it, Terri.
We'd like
to put in a PICC line.
It's a catheter
we'll leave in your arm.
Because if you do have MRSA--
It's a minimum of six weeks
of intravenous antibiotics.
Out of the question.
It's not really optional.
You can't force me to take
some medicine I don't want.
We have no intention
of forcing anything.
But if the infection goes
untreated, then it could spread
to your heart valves
and turn into endocarditis.
Which could kill you.
Six weeks I have to keep
coming back to the hospital?
No.
We could also make
arrangements
for a home health nurse
to come to your house.
Or wherever you're staying.
She's ashamed of me
because I live in a van.
Once the infection
is cleared, then we can--
No, no, I'm not letting you
put some thing in my arm
so you can reel me back
like a fish whenever you want.
.
How long has this been
going on, Gordon?
Just a few days--
A week.
Marielle's been nagging me
to get this looked at,
but sure it's just a cold.
What kind of cold
makes it hard to breathe?
It's called a chest cold,
hon.
COVID PCR test
came back negative.
Let's get a CBC, BMP, ABG,
blood and sputum cultures
and chest X-ray.
You got it.
We're gonna get to the bottom
of this, Gordon.
You sit tight.
Don't worry.
I won't let him go anywhere.
She's a tyrant, doc.
Wouldn't even let me
get a motorcycle.
30 years,
he still talks about that.
Just my two cents.
But you should keep
listening to her.
Thank you.
And here is
your large green tea
with extra honey, Dr. Charles.
Thank you, Olivia.
Dr. Charles,
do you have a minute?
Yeah, of course.
What's going on?
Uh, my, uh,
my mom came in earlier.
I think you saw.
Yeah, I did.
Yeah, I was hoping
that you might talk to her.
She has a MRSA infection,
but she won't get
treatment for it.
Oh, boy.
Yeah, she's always
been this way.
I can't even get her to commit
to taking her
blood pressure medication,
much less
intravenous antibiotics.
Frustrating, right?
Yeah.
She and I kinda speak
a different language.
It's kinda why I was hoping
that you might have
a better chance
of changing her mind.
Happy to give it a shot.
Anything else you think
that I should know?
You'll see pretty quickly
what you're up against.
Okay, it's just, you know,
don't wanna be flying blind,
that's all.
It's complicated,
my mom and I.
My dad left before
I could even remember.
We spent my childhood bouncing
from apartment to apartment.
Sometimes leaving
in the middle of the night
to avoid paying
the last month's rent.
Pretty chaotic.
Yeah, at the time
I thought it was normal.
It was all I knew.
And she wanted
to make a home for us.
She really tried.
She just couldn't
get out of her own way.
How--how do you mean?
She couldn't hold down a job.
She'd mouth off to a boss,
get fired.
Right.
She started drinking.
Started using.
We wound up on the street.
Oh, man.
I'm pretty sure she has some
undiagnosed mental illness.
Right.
Yeah, you'll see.
I thoroughly appreciate
how absolutely brutal
this must be for you.
And I also get how it might
really simplify your ability
to treat your mom if I were
to declare her incompetent.
If that's what it takes.
But you also know
that in order for me
to take away a patient's
decisional capabilities,
it's--they just have to meet
a very specific
set of criteria.
I just--I just don't want you
to get your hopes up, okay?
But I'm only too happy
to speak to your mom,
and I--I really appreciate all
the detail you give me, okay?
Thank you.
You bet.
♪
It's an isolated fracture
of the ulna,
but it should heal up
just fine after
about a month and a half
in a cast.
The good news is, Siobhan,
you get to pick the color.
What's your favorite color?
Purple.
You know, I always forget
what two colors make purple.
I know it's blue and---
Red.
Ah, okay.
We got a purple expert, y'all.
It seems like the brain fog
has lifted.
So there's no problem there.
Thank God.
I did wanna ask
about Siobhan's history.
I saw in the electronic
medical records that she landed
at East Mercy's emergency room
about a year ago.
That was another
terrible accident.
Siobhan just doesn't
pay attention sometimes.
Her head's in the clouds.
We'd come inside
from the grocery store.
It had been raining, and I was
unloading the groceries,
and I--I left my umbrella
on the kitchen tile.
And when I finally went
to pick it back up again,
there was this puddle
of water underneath and--
That's all we can think of.
I--I thought
that I cleaned it up,
but I guess
I must have missed some and--
Yeah, she had
a head CT then too.
Yeah, she--she fell
and hit--hit the back
of her head
on the kitchen counter.
It took four staples to...
But like we said, Siobhan's
always been kind of clumsy.
And what do you think,
Siobhan?
Are you clumsy?
I guess I do fall down a lot.
We'll have an orthopedic
resident coming soon
and cast Siobhan's arm.
And we'll go make sure he
brings his purple casting tape.
Call DCFS.
Wait,
what are you talking about?
There's a pattern
of suspicious injuries.
Yes, but they explained
what happened
and--and Siobhan confirmed it.
What do you think
she's gonna say, huh?
If there's one thing I learned
from my days at CPD,
is that the more convoluted
the story sounds,
the more likely it is not true.
Yes, but to call DCFS on that
with what little we saw?
Do you know what it could do
to those parents?
If you won't call them,
I will.
No, I--
So your mom is--
she's depressed.
She--she's definitely anxious.
I wouldn't be surprised
if a proper clinical evaluation
would yield
a bipolar diagnosis.
But right now she has capacity.
Even if she refuses
to take care of herself?
It doesn't disqualify her
from making
her own medical decisions.
What if it kills her
this time?
She seems to be aware
of the risk.
I didn't wanna suggest this
before running it by you first,
but there is
a pill form of antibiotics
that's had
some success with MRSA.
Linezolid, I know, but she'll
never stick to the regimen.
You know, could be
different this time.
Why?
Well, for instance, with her
blood pressure medication,
right, that she won't take,
we don't experience
high blood pressure physically.
But your mom,
she has a high fever.
Her arm is swollen.
She's in a lot of pain.
It's possible
that her physical symptoms
could compel her to act.
And if they don't?
Unfortunately,
it's her decision to make.
I'll talk to her.
I'll see what I can do.
Thank you.
Of course.
♪
So how's our John Doe?
Well,
head CT is really tight,
brain is very swollen,
bad anoxic injury.
I mean, the prognosis
is not good.
Any word from CPD?
Only that his prints
didn't turn up any records.
Oh. So what now?
There's gotta be somebody
out there
looking for this poor man.
Let's give 'em a chance
to come out of the woodwork.
Right.
Just the man
we're looking for.
Oh, there she is.
Heard you're being
discharged today.
How you feeling?
I'd feel better
if I were walking
out of here on my own two feet.
But my mother is taking me home
and insisting
on the wheelchair.
Ah.
A little
overly concerned about
adhering to hospital policy,
if you ask me.
I am afraid you'd sue
the hospital
if given the chance.
Uh-oh.
I wanted to thank you again,
Dr. Marcel.
Yeah, it was my pleasure.
Just happy it all worked out.
Is that the John Doe
that I heard about?
Yeah.
How's he doing?
Not good.
He suffered
major oxygen deprivation
for an extended period of time.
So likely looking at
irreversible brain damage
at this point.
Avery, I'm gonna
call you an Uber.
A minute ago you're insisting
I stay in the wheelchair.
I'm sorry, sweetie.
I just remembered
I have some charting to do.
I'm gonna circle back.
I'm interested in seeing
what happens with this patient.
♪
What's going on, Mags?
DCFS.
Suspicion of child abuse.
Yeah, that is always hard.
I just hate seeing families
go through this.
Somebody help!
Something's wrong.
Give us some space.
Sats down to 64,
not responsive.
Start bagging.
We have to intubate.
What's happening to him?
He's not protecting
his airway.
He can't breathe.
Why--why?
I don't know yet.
20 of etomidate, 100 of sux.
Oh, God.
You've got to save him.
Hey, I promise.
I'll do everything I can.
Gordon is all I have, please.
.
Vanessa, come here.
You remember how I said
my mom won't take her pills?
Mm-hmm.
Check this out.
What am I looking at?
New technology
called a nanodrug.
It's a smart drug that works
with the digital
feedback system.
I don't understand.
It's for patients that forget
to take their medicine.
Their caregivers can track
the exact date and time
that a patient ingest
their pills on a phone app.
How?
Watch.
Each pill is embedded
with a microscopic nanosensor.
When it dissolves
in the stomach acid,
the sensor then sends a signal
to a patch
on the patient's body.
And that patch
tells the phone app.
I could track whether
my mom's taking them or not.
But her antibiotics
don't have nanosensors.
Well, researchers at Med
are working
on their version of this.
They said they can
add nanosensors to any pills.
So when my mom's are ready
at the pharmacy,
let me know, okay?
It's--it's cool, I admit it.
But how are you gonna
get her to sign off on this?
I mean,
does she have to know?
What is it? What's wrong?
I'm having trouble
oxygenating him.
Hi, there. I'm Dr. Cooper.
Matt, there must've
been a mistake.
I asked for the pulmonologist
on call.
Your request came to my unit,
and as the critical care doctor
on call, you got me.
Excuse me.
Are you the patient's wife?
Marielle.
Marielle, this is what I do.
Okay.
I'm--I'm confident I can
address your husband's issues.
All right.
Gordon came in
with a bad case of pneumonia.
I had to intubate him.
But I'm having difficulty
achieving
adequate gas exchange.
I thought he was fighting
the ventilator,
so I sedated him with propofol
but his airway pressures
are still up.
Not--not exactly sure
what the problem is.
I think an early ARDS.
Already started him
on the ARDs net protocol.
ARDS?
Acute Respiratory
Distress Syndrome.
There are tiny elastic sacs
at the base of the lungs.
It seems Gordon's are not
properly exchanging oxygen.
So to improve his gas
exchange, we need
to sedate him more deeply
and then paralyze him.
Paralyze him?
Yeah, I know
that sounds extreme.
In this case, it's necessary
to reduce the pressures
inside his chest.
And to do that,
you need to paralyze him?
Hey, can I talk to you
outside for a second?
Sure, yeah.
Marielle, we'll--we'll be
right back
Paralyzing people in this
context often leads
to increased morbidity
and mortality.
I mean, there must be
something else we can do.
Believe me, Will,
I wish there were another way.
But unless we paralyze him and
get him oxygenated, he'll die.
Put him on an atracurium drip.
Use dexmedetomidine
instead of propofol
and, uh, I'll be back
in a little bit, okay?
♪
What do we got?
Heart rate's 30. Dropping.
Milligram of Atropine.
Let's go.
I don't feel a pulse.
Are you in?
Atropine's in.
Okay.
Okay, we got a pulse.
Heart rate's 60.
80.
Holding at 84.
Good, good.
Nice work.
You know,
I can see from his labs
that his bilirubin levels
are good.
That's good news for his liver.
You should check
his blood type.
Nancy.
Yeah.
Look, I'm not
so sure about that.
Crockett,
we gotta think about Sheldon.
Dr. Blake, you know,
unless this patient
has a relatively
legal representative
to speak on his behalf,
his organs are off-limits.
Which is why we got to track
down a relative
or a legal representative.
Pamela, I don't believe
this is your patient.
He isn't, Dean.
I'm just passing by.
Oh, in that case, I'd prefer
you keep passing as Dr. Marcel
is very busy
keeping this man alive.
I'll be in touch, Crockett.
Boy, I had no idea you
and the renowned
Dr. Blake were so chummy.
I've been assisting her
on some cases.
Oh, right.
Is that why you were late
this morning?
I'm considering applying
for a fellowship
in transplant surgery.
That's good for you.
But when you're down here,
you represent the ED,
and these patients deserve
just as much care
and concern
as any patient upstairs.
♪
Kate, Ms. Gastern's
ready for you.
Brandon would do anything
for Siobhan.
He's a great dad.
Oh, it's not
for me to decide.
It was one bar fight.
It was the wrong place
at the wrong time.
He hasn't even had a drink
since Siobhan was born.
So Brandon recognized
Dr. Scott this morning?
It was the only crime
that Brandon ever committed.
Of course he would recognize
the officer who arrested him.
And--and that's why we were
when eggshells when Dr. Scott
was asking us
all those questions.
I understand.
If we lose our little girl,
I don't know what we'll do.
I've known Madeline Gastern
for a long time.
She'll give you a fair shake.
Okay.
Dylan, I have to ask you.
Is your relationship
with Brandon Murphy
affecting your perception
of this case?
Listen, all the evidence
we found today
points to child abuse.
It's all right here
in Siobhan's medical files.
Dylan, all I'm asking is that
you take a look at everything
that's gone down today.
Are you absolutely sure
there's no other explanation?
♪
How can you stand it here?
The smell, and --
and it's freezing.
Will you please just let me go?
We were waiting on your
prescription to be filled,
but good news, it's ready.
Your antibiotics.
Twice a day with food.
This is a 14 day supply,
and you need to refill
your prescription twice.
I'll take care
of the refills, mom.
I can do it.
If you could just lift
your gown a couple of inches
for me, Terri,
I'm gonna place this patch.
What--what do I need
a patch for?
It helps track your meds.
Tracking?
What are you talking about?
Who's tracking them?
You?
Get that away from me
and these too.
Stop telling me what to do.
I'm just trying to help you!
I'm not taking your pills,
and I'm not staying
in your hospital.
Get me out of here now.
♪
.
Yeah, paralyzed him
as you suggested,
but I'm not seeing
any improvement.
Oxygenation is still
extremely poor.
Okay, let's try
some vent changes.
I'll do a recruitment maneuver.
What's that?
So I'm going to expand
Gordon's lungs to allow
for a better exchange
of oxygen for CO2.
I'm--I'm sorry.
If you think of Gordon's
lungs like two balloons,
I'm going to blow them up so
they can take in more oxygen.
Is that safe?
You know, it's not
a procedure I've done before.
Look, Dr. Halstead
is an excellent doctor,
but he's not a lung specialist.
He doesn't have experience
using the ventilator
in this manner.
We're all going
to do this together.
All of us, okay?
Time me, Dr. Halstead.
30 seconds.
♪
You saw that, right?
I did.
I don't know
what to do anymore.
Say you--you've essentially
been parenting your mother
for most of your life, right?
I never thought of it
like that, but yes.
It's hard work.
And for what?
So stupid to think that
I could ever get her to change.
Obviously,
that's not gonna happen.
Okay, now that you're not
asking me for my advice--
No, I am.
Okay, well then maybe it's
time for a different approach.
Something perhaps
less parental?
Like what?
Let her just do
whatever she wants?
Just walk away?
Well, you see the thing about
taking a step back, though,
is that it might benefit
the both of you.
Well, it seems
pretty optimistic.
I don't know,
I mean, at the very least,
you would be getting
a very much-deserved break.
And I think that might be
a really good thing.
In three, two, one.
No change.
Set the timer 30 again.
Wait, sats are climbing.
80, 84.
89.
91 and holding.
That's good, right?
Yes.
Yeah.
You did it.
So is he okay?
He's much better than he was.
I'm hopeful that he will be.
Thank you so much,
Dr. Cooper.
Yeah, I'm happy I could help.
All right.
♪
Here we are, Mr. Sussman.
Uh, what's all this?
Dr. Archer,
this is Marc Sussman.
And he's here because--
That's him.
That's my cousin, Ricky.
Oh, man.
We'll give you guys
some space.
How?
Did you see the scar
along Ricky Sussman's hip?
Yeah, I thought it might've
been from a hip replacement.
Yeah, it was.
When I looked back at the CT
I saw his prosthesis
had an identification chip.
So I had it scanned,
called around
several device manufacturers
until one claimed
the chip's serial number.
That got you to his name.
From there, tracking down
his cousin was pretty easy.
I suppose
if his cousin decides
to withdraw life support
and donate his organs,
then you and Dr. Blake might
just get
what you've been hoping for.
Now, hold on.
We had a moral
obligation for Ricky's sake
to find his next of kin.
You tell yourself that.
♪
Hey, Maggie,
can you get Brandon Murphy
and bring him
into the consultation room?
I think I might've figured out
what's been happening here,
and it's not child abuse.
Uh, should I step out?
Actually, if you don't mind,
I'd like Ms. Gastern
to hear this,
as I believe Siobhan's medical
status might clear things up.
I went back
and took a look at her scans.
This is Siobhan's head CT
from East Mercy last year.
And this is the one
we took this morning.
They look exactly
the same to me.
That's what I initially
thought too.
But then I noticed this.
Siobhan's cerebellum has shown
some signs of atrophy
in this last year.
Atrophy?
Meaning there's been
a loss of brain cells.
It's subtle, but if you look
really close,
you can see
that this part of the brain
is somewhat smaller
in appearance.
Might explain why she's
always been a little clumsy.
Has that gotten worse
this year?
I--I suppose so.
I believe that
that is a result
of these changes
in her cerebellum,
which is the part of the brain
that controls coordination.
Are you saying Siobhan
has a brain disorder?
Not exactly.
I believe she has an illness
which causes her
to not produce an important
enzyme called HEXA.
The name of the disease
is Tay-Sachs.
Tay--Tay-Sachs?
I think I've heard of that.
With your permission,
I would like to test
Siobhan to see if she has it.
Of course.
Anything to figure out
what's causing this.
I'm gonna help you
figure this out.
♪
I hated having to put
my faith in Cooper,
but he did everything right.
And without him,
I would have lost my patient.
What if he's not the guy
we think he is?
What if all our suspicions
around dubious consulting fees,
kickbacks, malpractice,
what if it's just projection?
Well, that's why we have
to be absolutely positive
before we make
any public accusations.
I just hope we're doing
the right thing, that's all.
I hear the relative met
with Organ Donors of America.
Since the patient suffered
an irreversible brain injury,
cousin wants us
to withdraw support
and pursue DCD organ donation.
All fingers crossed his liver
is a match for Sheldon's.
Mm-mm.
It's not?
Nope, Organ Donors of America
will be transporting
the patient's liver
to a recipient in Milwaukee.
Well, I guess we'll just have
to keep on waiting.
You know, I have to say,
I'm not exactly comfortable
with what I did today.
Your patient had
no chance of recovery.
And now thanks to his cousin,
both you and the hospital
are relieved
of any ethical concerns
regarding his end-of-life
decision-making.
More importantly,
someone in Milwaukee gets
a chance to extend their life.
What's the problem?
Just not sure whose interests
I had at heart today.
Crockett, it's a sad fact,
but in this business,
only 7% of transplants
come from living donors.
For someone to live,
someone else has to die.
If you can't handle that,
then maybe you weren't cut out
for transplant surgery
after all.
♪
.
Finishing up the discharge
paperwork for Siobhan.
Finally get them home.
How are they doing?
They're coping.
But it's tough.
There is no cure for Tay-Sachs.
But the fact that it's
late-onset is a good thing.
The decline
is much more gradual,
and Siobhan's symptoms
aren't really that severe.
You did good today, Dylan.
It was a nice catch.
Yeah, wouldn't have happened
if it wasn't for you.
Sometimes you gotta
check yourself.
Thanks for reminding me.
I have officially
filed your paperwork,
and you're free to leave.
Here are your clothes.
When you see Stevie,
tell her I--
Actually,
don't tell her anything.
Hey, listen, I might've been
a little abrupt this morning.
You? No.
You were in the right.
I was being nosy.
No. It's--it's no big deal.
No, I was mothering you,
and I--I shouldn't.
I won't do it again.
I don't know.
Maybe you looking out for me
isn't such a bad thing.
In that case, get some sleep.
Okay.
♪
Dylan, I wonder
if you can help me out.
Yeah, what's up, Stevie?
Do you know anyone I can call
to get an
illegally parked van towed?
I'm not getting anywhere
with the city.
Yeah, I know a dude over at
Department of Streets
and Sanitation
that could
probably have it towed.
Texting you
his number right now.
Great, thank you.
I appreciate it.
♪
Hey, Stevie,
how's your mom doing?
She's gonna be okay.
Thank you.
Good.
You know what, I gotta run.
Yeah.
Time of death, 19:34.
No!
I'm so sorry.
No, no, Ellie!
Ellie, no, no.
♪
Is there any chance
the Vas-COM caused this?
Eleanora was hypercoagulable.
If she had
another embolic event,
it's certainly possible.
Then Dr. Cooper
may have killed her.
♪
What are you doing here?
Waiting, like you.
I think I wanna do this.
Help people like him.
♪
No, no, no!
Mom?
It's gone! They towed it!
What?
They said a tow truck
came and took it!
Hey, it's okay.
Hey.
So what are you gonna do?
All my stuff was in there.
My tent, my blankets,
everything.
Hey, Mom,
stay with me tonight, okay?
Please. No, it's cold out here.
You can't stay out here.
Please, come on. Let's go.
Mom, please.
♪
Hey, I know how upsetting
this is, okay?
But we'll figure it out, okay?
Just go.
And I'm--I'm sorry
about before.
I never should have tried
to trick you.
And I was coming here
to try to persuade you
one last time
to take your antibiotics.
But here.
Mom, whatever you decide,
it's up to you.
♪
♪
She's out.
I'll take it from here.
Dr. Blake.
You're a transplant surgeon.
I got this.
She tried to scrub in.
How'd you guess?
I know my mom.
You need a roof over
your head, heat, running water.
You just wanna
call the shots.
You owe me $1,200.
Do what you want
with it, Mom.
I screwed up everything
today.
I know how tough
internship can be.
Boards aren't gonna study
for themselves.
You pulled my patient's
Vas-COM?
I just think we should err
on the side of safety.
It did seem medically
warranted to get her
on better monitoring.
So I just put in
another Vas-COM.
Is something going on?
Dr. Halstead tells me
you're progressing well.
I have excellent doctors
to thank for that.
And we're very impressed
with your staff.
Well, Dr. Halstead
is one of our finest.
Don't forget Dr. Cooper.
Hey, there, what'd I miss?
We were just discussing
Eleanor's marked improvement.
How she looks much
less edematous.
Yeah, right, it's terrific.
I've been able to strategically
manage her fluids
using the Vas-COM.
Sorry, I didn't mean
to interrupt.
I just came in to take a quick
peak at her cardiac output.
It's all right.
I have to go anyway.
I have a meeting.
I'll walk you out,
Miss Goodwin.
You two take care.
Still can't believe
Cooper put in another Vas-COM.
I thought it was confirmed
that Vas-COM
didn't contribute
to her embolic events.
It didn't, but with Eleanor's
clotting issues, it's risky.
♪
I heard you were here
late last night.
I had
a difficult septic patient.
I didn't wanna just leave him
for the night shift.
They can handle
a septic patient.
I wanted to see it through.
Did you get any sleep?
Didn't we just have
this conversation a week ago?
And I'm allowed to ask you if
you're taking care of yourself.
Mom, you know
you're parked in a red zone.
Oh, no one cares.
You wanna see what I've done?
Sure.
I found those pillows
off a couch
someone left on the sidewalk.
And look what I pulled
out of a dumpster
behind Merchandise Mart.
It's silk. Feel it.
Wow.
And back--back there,
I--I hung up a prism.
Remember that one
when you were little?
All the Rainbows?
Yeah, I remember.
And I see you have a cooler.
I brought some groceries
with me,
some fresh fruits
and vegetables.
What's with your arm?
Oh--oh no, it's not--
it's not a big deal.
Mom, let me see.
Oh, what did you do?
I was working on the van
and I--I knocked aside
that stick thingy
that holds the hood up.
It got me pretty good.
Oh, you're burning up.
I'm wearing layers.
Oh, mom. Oh, man.
This is infected.
No, I washed--I washed it.
No, we gotta get you
to the hospital.
No, no, no, no, it's fine.
I can take care of myself.
Mom--Mom? Mom, Mom.
No, I'm calling an ambulance.
Mom?
I don't care
if it's your hospital.
I don't wanna be here.
I can hear you fine, Mom.
But you won't listen to me.
Hey, Maggie,
can we get a room,
and is Vanessa available?
Sure, Vanessa,
you're going to treatment 3.
♪
Hey, this is my mom, Terri.
She cut her arm pretty badly.
Hi, Terri, I'm Dr. Taylor.
Good for you.
Mom, please.
I don't like hospitals.
What?
All right, on three.
♪
The IV's for fluids.
You're dehydrated, Mom.
So get me a glass of water.
You happen to catch them
when they came in?
I did, yeah.
Not at all what I imagined.
In med school, Stevie was the
one who had it all together.
Head of the class,
full scholarship.
I just figured she was raised
by some genius scientists
who made her in a lab.
Huh.
I thought scholarships
are usually for students
in need of financial aid.
Your bilirubin levels
are high
but they seem to have plateaued
at the moment.
How are you feeling, Sheldon?
Like every second
could be my last.
A real thrill.
I know how difficult
this has been.
I want you to meet Dr. Marcel.
He's taken an interest
in transplant surgery,
and he's been shadowing me.
Hey, Sheldon.
Dr. Marcel, are you going
to get me a liver?
Oh, well, uh,
we're working on it.
You're at the top
of the transplant list.
So there's a good chance
that the next one
that matches
has your name on it.
Okay, I'll try not to die
in the meantime.
You do that.
Bye.
He got his humor.
That's a good sign.
I'm not sure
if it's really humor
or his hepatic encephalopathy.
How long has he been waiting?
Eight months.
Wow.
Kinda makes you feel helpless.
It's definitely not the ED.
Someone lands here, and you
can't just get right to work
resetting a bone.
In transplant surgery,
unfortunately,
it's all about waiting.
Dr. Scott, you're up.
You're going to treatment 4.
And by the way,
we're short-staffed today,
so I'm gonna be assisting you.
Oh, let's do it.
Who's the patient?
9-year-old Siobhan Murphy.
She fell down
a flight of stairs.
Those her parents?
Yeah, Kate and Brandon.
That guy looks familiar.
Mr. and Mrs. Murphy.
I'm Dr. Scott.
This is our charge nurse,
Maggie,
and you must be Siobhan.
Uh-oh, I know that look.
We're pretty sure
Siobhan broke her arm.
She fell down the stairs
of our apartment complex.
Do I know you?
Oh, I don't think so.
All right, Siobhan,
what happened?
I guess I tripped.
She's never been the world's
most coordinated person.
So just a normal
run-of-the-mill trip?
Nothing in front of you
but you're own two feet?
I don't really remember much.
When I fell, I hit my head.
Since then,
it's all been a little foggy.
So we need to get a head CT
to check
on that brain fog, yeah?
Okay.
May I look at your arm?
Let me see.
Get an X-ray on the arm.
Uh-huh.
Okay, Siobhan, so we are
gonna take a few pictures
of your arm
and the inside of your head.
Sound like a plan?
Okay.
I will be right back
with an X-ray technician.
Hey, what was that
between you and the dad?
I realized how I know him.
I arrested him for assault
and battery 10 years ago.
Really?
Hey, is that gonna be an issue?
Are you sure you should be
on this case?
I can call peds
and get somebody else.
Oh, no, no, no. It's fine.
I'm good.
♪
I'm sorry, you're missing
a whole column over here.
You need to re-do this.
Okay, I'm sorry.
Dr. Marcel, you made it.
Hey, sorry I'm late.
I got caught up
with a patient in the ICU.
Remember, there's a reason
why it's called
the Emergency Department, yeah?
Dr. Archer, Dr. Marcel,
we have trauma incoming.
Nancy, you're good?
Lacey, talk to me.
John Doe, age unknown,
most likely
a long-distance swimmer.
Crew team found him floating
in Lake Michigan,
fished him out
and performed CPR.
CFD defibrillated him once,
got a rhythm,
and intubated in the field.
Why are you still doing
compressing him?
I lost pulse
about 30 secs ago.
Gave him a milligram of epi.
Okay, here we go.
Nice and easy, okay?
All right, we're gonna transfer
on my count.
One, two, three.
Continuing compressions.
Pulse?
No pulse.
Continue CPR.
He's in V-fib.
Give me the paddles,
charge to 200.
Charging.
Okay, clear.
We got a pulse. Sinus rhythm.
All right, he's hypothermic.
Can we get
some warm blankets, please?
♪
All right,
pupils are fixed and dilated.
That brain's been
without oxygen for a while.
Nancy, CT for a panscan,
please.
And also,
let's call CPD up in here.
They can run his prints.
Maybe they can identify him.
Hey.
I just wanted to say
I'm sorry about your mom.
You're surprised.
Surprised?
She looks like
a street person, right?
You weren't expecting that.
If you need any help...
Thank you.
It's nice of you,
but I've been dealing
with this a long time.
Just forwarded
your mom's labs.
Yeah, it's about
what I expected.
Are you sure you don't want
an attending instead of me?
This way I can stay
on top of her case.
Okay, well,
how do you wanna handle this?
You take the lead.
She's more likely
to listen to you anyway.
Terri, you definitely have
an infection in your arm
that has spread
to your bloodstream.
We have to treat it like MRSA
until your cultures come back.
We already knew
it was infected.
Yes, Mom,
but this particular type
of infection is resistant
to most forms of antibiotics.
I thought she was my doctor.
We can still treat it, Terri.
We'd like
to put in a PICC line.
It's a catheter
we'll leave in your arm.
Because if you do have MRSA--
It's a minimum of six weeks
of intravenous antibiotics.
Out of the question.
It's not really optional.
You can't force me to take
some medicine I don't want.
We have no intention
of forcing anything.
But if the infection goes
untreated, then it could spread
to your heart valves
and turn into endocarditis.
Which could kill you.
Six weeks I have to keep
coming back to the hospital?
No.
We could also make
arrangements
for a home health nurse
to come to your house.
Or wherever you're staying.
She's ashamed of me
because I live in a van.
Once the infection
is cleared, then we can--
No, no, I'm not letting you
put some thing in my arm
so you can reel me back
like a fish whenever you want.
.
How long has this been
going on, Gordon?
Just a few days--
A week.
Marielle's been nagging me
to get this looked at,
but sure it's just a cold.
What kind of cold
makes it hard to breathe?
It's called a chest cold,
hon.
COVID PCR test
came back negative.
Let's get a CBC, BMP, ABG,
blood and sputum cultures
and chest X-ray.
You got it.
We're gonna get to the bottom
of this, Gordon.
You sit tight.
Don't worry.
I won't let him go anywhere.
She's a tyrant, doc.
Wouldn't even let me
get a motorcycle.
30 years,
he still talks about that.
Just my two cents.
But you should keep
listening to her.
Thank you.
And here is
your large green tea
with extra honey, Dr. Charles.
Thank you, Olivia.
Dr. Charles,
do you have a minute?
Yeah, of course.
What's going on?
Uh, my, uh,
my mom came in earlier.
I think you saw.
Yeah, I did.
Yeah, I was hoping
that you might talk to her.
She has a MRSA infection,
but she won't get
treatment for it.
Oh, boy.
Yeah, she's always
been this way.
I can't even get her to commit
to taking her
blood pressure medication,
much less
intravenous antibiotics.
Frustrating, right?
Yeah.
She and I kinda speak
a different language.
It's kinda why I was hoping
that you might have
a better chance
of changing her mind.
Happy to give it a shot.
Anything else you think
that I should know?
You'll see pretty quickly
what you're up against.
Okay, it's just, you know,
don't wanna be flying blind,
that's all.
It's complicated,
my mom and I.
My dad left before
I could even remember.
We spent my childhood bouncing
from apartment to apartment.
Sometimes leaving
in the middle of the night
to avoid paying
the last month's rent.
Pretty chaotic.
Yeah, at the time
I thought it was normal.
It was all I knew.
And she wanted
to make a home for us.
She really tried.
She just couldn't
get out of her own way.
How--how do you mean?
She couldn't hold down a job.
She'd mouth off to a boss,
get fired.
Right.
She started drinking.
Started using.
We wound up on the street.
Oh, man.
I'm pretty sure she has some
undiagnosed mental illness.
Right.
Yeah, you'll see.
I thoroughly appreciate
how absolutely brutal
this must be for you.
And I also get how it might
really simplify your ability
to treat your mom if I were
to declare her incompetent.
If that's what it takes.
But you also know
that in order for me
to take away a patient's
decisional capabilities,
it's--they just have to meet
a very specific
set of criteria.
I just--I just don't want you
to get your hopes up, okay?
But I'm only too happy
to speak to your mom,
and I--I really appreciate all
the detail you give me, okay?
Thank you.
You bet.
♪
It's an isolated fracture
of the ulna,
but it should heal up
just fine after
about a month and a half
in a cast.
The good news is, Siobhan,
you get to pick the color.
What's your favorite color?
Purple.
You know, I always forget
what two colors make purple.
I know it's blue and---
Red.
Ah, okay.
We got a purple expert, y'all.
It seems like the brain fog
has lifted.
So there's no problem there.
Thank God.
I did wanna ask
about Siobhan's history.
I saw in the electronic
medical records that she landed
at East Mercy's emergency room
about a year ago.
That was another
terrible accident.
Siobhan just doesn't
pay attention sometimes.
Her head's in the clouds.
We'd come inside
from the grocery store.
It had been raining, and I was
unloading the groceries,
and I--I left my umbrella
on the kitchen tile.
And when I finally went
to pick it back up again,
there was this puddle
of water underneath and--
That's all we can think of.
I--I thought
that I cleaned it up,
but I guess
I must have missed some and--
Yeah, she had
a head CT then too.
Yeah, she--she fell
and hit--hit the back
of her head
on the kitchen counter.
It took four staples to...
But like we said, Siobhan's
always been kind of clumsy.
And what do you think,
Siobhan?
Are you clumsy?
I guess I do fall down a lot.
We'll have an orthopedic
resident coming soon
and cast Siobhan's arm.
And we'll go make sure he
brings his purple casting tape.
Call DCFS.
Wait,
what are you talking about?
There's a pattern
of suspicious injuries.
Yes, but they explained
what happened
and--and Siobhan confirmed it.
What do you think
she's gonna say, huh?
If there's one thing I learned
from my days at CPD,
is that the more convoluted
the story sounds,
the more likely it is not true.
Yes, but to call DCFS on that
with what little we saw?
Do you know what it could do
to those parents?
If you won't call them,
I will.
No, I--
So your mom is--
she's depressed.
She--she's definitely anxious.
I wouldn't be surprised
if a proper clinical evaluation
would yield
a bipolar diagnosis.
But right now she has capacity.
Even if she refuses
to take care of herself?
It doesn't disqualify her
from making
her own medical decisions.
What if it kills her
this time?
She seems to be aware
of the risk.
I didn't wanna suggest this
before running it by you first,
but there is
a pill form of antibiotics
that's had
some success with MRSA.
Linezolid, I know, but she'll
never stick to the regimen.
You know, could be
different this time.
Why?
Well, for instance, with her
blood pressure medication,
right, that she won't take,
we don't experience
high blood pressure physically.
But your mom,
she has a high fever.
Her arm is swollen.
She's in a lot of pain.
It's possible
that her physical symptoms
could compel her to act.
And if they don't?
Unfortunately,
it's her decision to make.
I'll talk to her.
I'll see what I can do.
Thank you.
Of course.
♪
So how's our John Doe?
Well,
head CT is really tight,
brain is very swollen,
bad anoxic injury.
I mean, the prognosis
is not good.
Any word from CPD?
Only that his prints
didn't turn up any records.
Oh. So what now?
There's gotta be somebody
out there
looking for this poor man.
Let's give 'em a chance
to come out of the woodwork.
Right.
Just the man
we're looking for.
Oh, there she is.
Heard you're being
discharged today.
How you feeling?
I'd feel better
if I were walking
out of here on my own two feet.
But my mother is taking me home
and insisting
on the wheelchair.
Ah.
A little
overly concerned about
adhering to hospital policy,
if you ask me.
I am afraid you'd sue
the hospital
if given the chance.
Uh-oh.
I wanted to thank you again,
Dr. Marcel.
Yeah, it was my pleasure.
Just happy it all worked out.
Is that the John Doe
that I heard about?
Yeah.
How's he doing?
Not good.
He suffered
major oxygen deprivation
for an extended period of time.
So likely looking at
irreversible brain damage
at this point.
Avery, I'm gonna
call you an Uber.
A minute ago you're insisting
I stay in the wheelchair.
I'm sorry, sweetie.
I just remembered
I have some charting to do.
I'm gonna circle back.
I'm interested in seeing
what happens with this patient.
♪
What's going on, Mags?
DCFS.
Suspicion of child abuse.
Yeah, that is always hard.
I just hate seeing families
go through this.
Somebody help!
Something's wrong.
Give us some space.
Sats down to 64,
not responsive.
Start bagging.
We have to intubate.
What's happening to him?
He's not protecting
his airway.
He can't breathe.
Why--why?
I don't know yet.
20 of etomidate, 100 of sux.
Oh, God.
You've got to save him.
Hey, I promise.
I'll do everything I can.
Gordon is all I have, please.
.
Vanessa, come here.
You remember how I said
my mom won't take her pills?
Mm-hmm.
Check this out.
What am I looking at?
New technology
called a nanodrug.
It's a smart drug that works
with the digital
feedback system.
I don't understand.
It's for patients that forget
to take their medicine.
Their caregivers can track
the exact date and time
that a patient ingest
their pills on a phone app.
How?
Watch.
Each pill is embedded
with a microscopic nanosensor.
When it dissolves
in the stomach acid,
the sensor then sends a signal
to a patch
on the patient's body.
And that patch
tells the phone app.
I could track whether
my mom's taking them or not.
But her antibiotics
don't have nanosensors.
Well, researchers at Med
are working
on their version of this.
They said they can
add nanosensors to any pills.
So when my mom's are ready
at the pharmacy,
let me know, okay?
It's--it's cool, I admit it.
But how are you gonna
get her to sign off on this?
I mean,
does she have to know?
What is it? What's wrong?
I'm having trouble
oxygenating him.
Hi, there. I'm Dr. Cooper.
Matt, there must've
been a mistake.
I asked for the pulmonologist
on call.
Your request came to my unit,
and as the critical care doctor
on call, you got me.
Excuse me.
Are you the patient's wife?
Marielle.
Marielle, this is what I do.
Okay.
I'm--I'm confident I can
address your husband's issues.
All right.
Gordon came in
with a bad case of pneumonia.
I had to intubate him.
But I'm having difficulty
achieving
adequate gas exchange.
I thought he was fighting
the ventilator,
so I sedated him with propofol
but his airway pressures
are still up.
Not--not exactly sure
what the problem is.
I think an early ARDS.
Already started him
on the ARDs net protocol.
ARDS?
Acute Respiratory
Distress Syndrome.
There are tiny elastic sacs
at the base of the lungs.
It seems Gordon's are not
properly exchanging oxygen.
So to improve his gas
exchange, we need
to sedate him more deeply
and then paralyze him.
Paralyze him?
Yeah, I know
that sounds extreme.
In this case, it's necessary
to reduce the pressures
inside his chest.
And to do that,
you need to paralyze him?
Hey, can I talk to you
outside for a second?
Sure, yeah.
Marielle, we'll--we'll be
right back
Paralyzing people in this
context often leads
to increased morbidity
and mortality.
I mean, there must be
something else we can do.
Believe me, Will,
I wish there were another way.
But unless we paralyze him and
get him oxygenated, he'll die.
Put him on an atracurium drip.
Use dexmedetomidine
instead of propofol
and, uh, I'll be back
in a little bit, okay?
♪
What do we got?
Heart rate's 30. Dropping.
Milligram of Atropine.
Let's go.
I don't feel a pulse.
Are you in?
Atropine's in.
Okay.
Okay, we got a pulse.
Heart rate's 60.
80.
Holding at 84.
Good, good.
Nice work.
You know,
I can see from his labs
that his bilirubin levels
are good.
That's good news for his liver.
You should check
his blood type.
Nancy.
Yeah.
Look, I'm not
so sure about that.
Crockett,
we gotta think about Sheldon.
Dr. Blake, you know,
unless this patient
has a relatively
legal representative
to speak on his behalf,
his organs are off-limits.
Which is why we got to track
down a relative
or a legal representative.
Pamela, I don't believe
this is your patient.
He isn't, Dean.
I'm just passing by.
Oh, in that case, I'd prefer
you keep passing as Dr. Marcel
is very busy
keeping this man alive.
I'll be in touch, Crockett.
Boy, I had no idea you
and the renowned
Dr. Blake were so chummy.
I've been assisting her
on some cases.
Oh, right.
Is that why you were late
this morning?
I'm considering applying
for a fellowship
in transplant surgery.
That's good for you.
But when you're down here,
you represent the ED,
and these patients deserve
just as much care
and concern
as any patient upstairs.
♪
Kate, Ms. Gastern's
ready for you.
Brandon would do anything
for Siobhan.
He's a great dad.
Oh, it's not
for me to decide.
It was one bar fight.
It was the wrong place
at the wrong time.
He hasn't even had a drink
since Siobhan was born.
So Brandon recognized
Dr. Scott this morning?
It was the only crime
that Brandon ever committed.
Of course he would recognize
the officer who arrested him.
And--and that's why we were
when eggshells when Dr. Scott
was asking us
all those questions.
I understand.
If we lose our little girl,
I don't know what we'll do.
I've known Madeline Gastern
for a long time.
She'll give you a fair shake.
Okay.
Dylan, I have to ask you.
Is your relationship
with Brandon Murphy
affecting your perception
of this case?
Listen, all the evidence
we found today
points to child abuse.
It's all right here
in Siobhan's medical files.
Dylan, all I'm asking is that
you take a look at everything
that's gone down today.
Are you absolutely sure
there's no other explanation?
♪
How can you stand it here?
The smell, and --
and it's freezing.
Will you please just let me go?
We were waiting on your
prescription to be filled,
but good news, it's ready.
Your antibiotics.
Twice a day with food.
This is a 14 day supply,
and you need to refill
your prescription twice.
I'll take care
of the refills, mom.
I can do it.
If you could just lift
your gown a couple of inches
for me, Terri,
I'm gonna place this patch.
What--what do I need
a patch for?
It helps track your meds.
Tracking?
What are you talking about?
Who's tracking them?
You?
Get that away from me
and these too.
Stop telling me what to do.
I'm just trying to help you!
I'm not taking your pills,
and I'm not staying
in your hospital.
Get me out of here now.
♪
.
Yeah, paralyzed him
as you suggested,
but I'm not seeing
any improvement.
Oxygenation is still
extremely poor.
Okay, let's try
some vent changes.
I'll do a recruitment maneuver.
What's that?
So I'm going to expand
Gordon's lungs to allow
for a better exchange
of oxygen for CO2.
I'm--I'm sorry.
If you think of Gordon's
lungs like two balloons,
I'm going to blow them up so
they can take in more oxygen.
Is that safe?
You know, it's not
a procedure I've done before.
Look, Dr. Halstead
is an excellent doctor,
but he's not a lung specialist.
He doesn't have experience
using the ventilator
in this manner.
We're all going
to do this together.
All of us, okay?
Time me, Dr. Halstead.
30 seconds.
♪
You saw that, right?
I did.
I don't know
what to do anymore.
Say you--you've essentially
been parenting your mother
for most of your life, right?
I never thought of it
like that, but yes.
It's hard work.
And for what?
So stupid to think that
I could ever get her to change.
Obviously,
that's not gonna happen.
Okay, now that you're not
asking me for my advice--
No, I am.
Okay, well then maybe it's
time for a different approach.
Something perhaps
less parental?
Like what?
Let her just do
whatever she wants?
Just walk away?
Well, you see the thing about
taking a step back, though,
is that it might benefit
the both of you.
Well, it seems
pretty optimistic.
I don't know,
I mean, at the very least,
you would be getting
a very much-deserved break.
And I think that might be
a really good thing.
In three, two, one.
No change.
Set the timer 30 again.
Wait, sats are climbing.
80, 84.
89.
91 and holding.
That's good, right?
Yes.
Yeah.
You did it.
So is he okay?
He's much better than he was.
I'm hopeful that he will be.
Thank you so much,
Dr. Cooper.
Yeah, I'm happy I could help.
All right.
♪
Here we are, Mr. Sussman.
Uh, what's all this?
Dr. Archer,
this is Marc Sussman.
And he's here because--
That's him.
That's my cousin, Ricky.
Oh, man.
We'll give you guys
some space.
How?
Did you see the scar
along Ricky Sussman's hip?
Yeah, I thought it might've
been from a hip replacement.
Yeah, it was.
When I looked back at the CT
I saw his prosthesis
had an identification chip.
So I had it scanned,
called around
several device manufacturers
until one claimed
the chip's serial number.
That got you to his name.
From there, tracking down
his cousin was pretty easy.
I suppose
if his cousin decides
to withdraw life support
and donate his organs,
then you and Dr. Blake might
just get
what you've been hoping for.
Now, hold on.
We had a moral
obligation for Ricky's sake
to find his next of kin.
You tell yourself that.
♪
Hey, Maggie,
can you get Brandon Murphy
and bring him
into the consultation room?
I think I might've figured out
what's been happening here,
and it's not child abuse.
Uh, should I step out?
Actually, if you don't mind,
I'd like Ms. Gastern
to hear this,
as I believe Siobhan's medical
status might clear things up.
I went back
and took a look at her scans.
This is Siobhan's head CT
from East Mercy last year.
And this is the one
we took this morning.
They look exactly
the same to me.
That's what I initially
thought too.
But then I noticed this.
Siobhan's cerebellum has shown
some signs of atrophy
in this last year.
Atrophy?
Meaning there's been
a loss of brain cells.
It's subtle, but if you look
really close,
you can see
that this part of the brain
is somewhat smaller
in appearance.
Might explain why she's
always been a little clumsy.
Has that gotten worse
this year?
I--I suppose so.
I believe that
that is a result
of these changes
in her cerebellum,
which is the part of the brain
that controls coordination.
Are you saying Siobhan
has a brain disorder?
Not exactly.
I believe she has an illness
which causes her
to not produce an important
enzyme called HEXA.
The name of the disease
is Tay-Sachs.
Tay--Tay-Sachs?
I think I've heard of that.
With your permission,
I would like to test
Siobhan to see if she has it.
Of course.
Anything to figure out
what's causing this.
I'm gonna help you
figure this out.
♪
I hated having to put
my faith in Cooper,
but he did everything right.
And without him,
I would have lost my patient.
What if he's not the guy
we think he is?
What if all our suspicions
around dubious consulting fees,
kickbacks, malpractice,
what if it's just projection?
Well, that's why we have
to be absolutely positive
before we make
any public accusations.
I just hope we're doing
the right thing, that's all.
I hear the relative met
with Organ Donors of America.
Since the patient suffered
an irreversible brain injury,
cousin wants us
to withdraw support
and pursue DCD organ donation.
All fingers crossed his liver
is a match for Sheldon's.
Mm-mm.
It's not?
Nope, Organ Donors of America
will be transporting
the patient's liver
to a recipient in Milwaukee.
Well, I guess we'll just have
to keep on waiting.
You know, I have to say,
I'm not exactly comfortable
with what I did today.
Your patient had
no chance of recovery.
And now thanks to his cousin,
both you and the hospital
are relieved
of any ethical concerns
regarding his end-of-life
decision-making.
More importantly,
someone in Milwaukee gets
a chance to extend their life.
What's the problem?
Just not sure whose interests
I had at heart today.
Crockett, it's a sad fact,
but in this business,
only 7% of transplants
come from living donors.
For someone to live,
someone else has to die.
If you can't handle that,
then maybe you weren't cut out
for transplant surgery
after all.
♪
.
Finishing up the discharge
paperwork for Siobhan.
Finally get them home.
How are they doing?
They're coping.
But it's tough.
There is no cure for Tay-Sachs.
But the fact that it's
late-onset is a good thing.
The decline
is much more gradual,
and Siobhan's symptoms
aren't really that severe.
You did good today, Dylan.
It was a nice catch.
Yeah, wouldn't have happened
if it wasn't for you.
Sometimes you gotta
check yourself.
Thanks for reminding me.
I have officially
filed your paperwork,
and you're free to leave.
Here are your clothes.
When you see Stevie,
tell her I--
Actually,
don't tell her anything.
Hey, listen, I might've been
a little abrupt this morning.
You? No.
You were in the right.
I was being nosy.
No. It's--it's no big deal.
No, I was mothering you,
and I--I shouldn't.
I won't do it again.
I don't know.
Maybe you looking out for me
isn't such a bad thing.
In that case, get some sleep.
Okay.
♪
Dylan, I wonder
if you can help me out.
Yeah, what's up, Stevie?
Do you know anyone I can call
to get an
illegally parked van towed?
I'm not getting anywhere
with the city.
Yeah, I know a dude over at
Department of Streets
and Sanitation
that could
probably have it towed.
Texting you
his number right now.
Great, thank you.
I appreciate it.
♪
Hey, Stevie,
how's your mom doing?
She's gonna be okay.
Thank you.
Good.
You know what, I gotta run.
Yeah.
Time of death, 19:34.
No!
I'm so sorry.
No, no, Ellie!
Ellie, no, no.
♪
Is there any chance
the Vas-COM caused this?
Eleanora was hypercoagulable.
If she had
another embolic event,
it's certainly possible.
Then Dr. Cooper
may have killed her.
♪
What are you doing here?
Waiting, like you.
I think I wanna do this.
Help people like him.
♪
No, no, no!
Mom?
It's gone! They towed it!
What?
They said a tow truck
came and took it!
Hey, it's okay.
Hey.
So what are you gonna do?
All my stuff was in there.
My tent, my blankets,
everything.
Hey, Mom,
stay with me tonight, okay?
Please. No, it's cold out here.
You can't stay out here.
Please, come on. Let's go.
Mom, please.
♪
Hey, I know how upsetting
this is, okay?
But we'll figure it out, okay?
Just go.
And I'm--I'm sorry
about before.
I never should have tried
to trick you.
And I was coming here
to try to persuade you
one last time
to take your antibiotics.
But here.
Mom, whatever you decide,
it's up to you.
♪
♪