Code Black (2015–2018): Season 1, Episode 10 - Cardiac Support - full transcript
Leanne is rattled at the thought of losing Jesse as he fights for his life after suffering a massive heart attack. Also, Mario asks the residents to cover for him when he searches the city for a patient's son, disobeying Neal's di...
[ Telephones ringing ]
Gina: I'm pretty sure
it's like "game of thrones"
in this place right now.
Everyone's aiming their arrows
at the new queen.
Temporary queen.
But here I am,
and I have a job to do.
So I've been working my way
through Taylor's staff notes.
No small feat because
they're written in, you know,
martian snark,
and I see here that you
haven't taken
a day off in a month,
haven't had a vacation
in three years.
I appreciate the dedication,
but from a liability standpoint,
I'm gonna need you
to work the regular schedule.
[ Cellphone vibrates ]
When you've been here
longer than five minutes,
you'll understand that angels
is not a regular hospital.
Got to go.
- Go save some lives.
Good talk.
[ Door opens, closes ]
Jody: Angels base, we don't
have thorazine on the rig.
How far out are you?
We're on your...
[ Radio static ]
142, say again?
Did you say on the ramp?
[ Radio crackling ]
142, this is angels base.
Do you copy?
[ Screams ]
142?
[ Sirens wailing ]
What do we have?
I don't know.
What's he doing?
Looks like he stalled.
Why isn't anyone getting out?
[ Thud ]
Christa, go get security.
[ Indistinct radio chatter ]
What the...
[ man groaning ]
Hell no.
- Jesse!
- Aah!
Hey, get back, get back!
- Drop it!
- Take it easy!
All right, get him down.
- Get him.
- [ Screams ]
Get that arm.
Ready?
Go!
- Hey, you all right?
- I'm okay.
Pupils reactive.
- Restraints!
- Hold still.
How is she?
Get a c-collar.
Angus: The hulk looks like
he has superficial injuries.
Minor abrasions
on his elbows and knees.
Minimally conscious.
Moving spontaneously.
- Positive battle signs.
- Dilated pupils.
He's obviously on something.
I think he's gonna need
a hefty dose of ativan.
Breath sounds bilaterally.
Minor abrasions everywhere.
Man: Get on his leg!
Keep him down!
All right, bite marks
on the shoulder and clavicle.
De-gloving of the left knee,
probably
from the oxygen tank valve.
Let's move her.
Count of three.
1, 2, 3.
That's it.
Great.
[ Groans ]
Careful.
Okay.
[ Screaming ]
- Let's go.
- [ Groans ]
Let's get him inside now.
[ Groaning ]
Let's bring it in bed one.
I'm sorry.
I can't hear you.
We have traumas coming in.
- [ Groans ]
Angus: Tighten the restraints
over there.
- [ Groans ]
- You okay, mama?
You went down pretty hard.
- You call that hard?
- [ Screams ]
- Okay, Jody.
Just try and breathe deeply
for me.
You're in center stage
at angels.
Risa, methylene blue, please.
Inject it into the capsule
through the skin.
My partner, Jeff.
How is he?
He's here.
We're working on him.
Do you know what happened?
We picked a guy
in pershing square, passed out.
We were on our way to angels
when we woke
and he just went crazy.
Hold on. I'm sorry.
Almost done, all right?
Hang in there.
- Joint looks intact.
Close it up, please,
and push eight of morphine.
- Do we know what he's on?
- No.
Never seen anything like it.
[ Groans ]
You got to stop.
You got to stop it.
Okay, you've give him
elephant-dose benzos.
- Yeah, with minimal effect.
- Suggestions, young squire?
Knock this zombie out
till whatever he took wears off.
- Let's get some propofol.
- [ Groans ]
Sir, we're gonna give you
a chemically-induced time out.
Amy, prep rsi, please.
[ Monitors beeping rapidly ]
Whoa, whoa, whoa.
What is this, Christa?
Uh, blood in the airway
caused by the trauma.
And how do we proceed?
We need to see if the bleeding's
coming from the left
or right lung.
I'll grab the bronchoscope.
Or we could use our instincts.
Deformity's on the right side
of the chest, correct?
Excuse me.
More than likely, the bleeding's
in the right lung.
Dr. Rorish.
Jesse, airway dl sux
and etomidate.
You're not attempting
a blind intubation, are you?
- Jesse, mask, please.
How will you see the bleeding
source without a scope?
Thank you.
There we go.
Okay, so bleeding is
on the right side,
so we need to intubate
on the left.
We should call pulm.
Leanne, do you hear me?
- It's hard not to.
We know how
to use a scope, Gina.
If I wait for the gear,
he'll die.
Tube, please.
[ Monitor beeping rapidly ]
I'm in.
[ Beeping steadies ]
We're running low
on nasal packing.
I'll go get some.
You want to take over here?
Thank you.
All right, Christa.
We'll need
a ct head/neck, please.
[ Key pad beeping ]
Let's go find you.
Ooh, man.
Where is it?
[ Coughing ]
[ Gasps, yelling ]
[ Thud ]
Oh!
¶¶
We was trying to help this guy
and this is what we get...
Nearly killed.
Leanne: The ct scan confirms
that he has
a basilar skull fracture,
but, Dr. Lorenson,
tell us why he's lucky.
It doesn't appear to be severe
enough to require surgery.
But you have to keep him
for a few days.
Yes.
The fracture exposed the brain
and spinal fluid.
We need to watch him
to make sure
it doesn't develop
into an infection.
Luckily, you'll both be back
on the rig before you know it.
Have you seen Jesse?
- Mnh-mnh.
Not since we were
in center stage.
Okay, Dr. Savetti has
some paperwork
for you to fill out
so he can discharge you.
I think I'll stick around
for a while.
Sleeping beauty may need me
to save his butt again.
Hey, that guy who attacked us...
What the hell was he on?
It was like he was possessed.
Angus: Negative.
You want him to put negative tox
screen on the report?
I ran the test twice.
They were both negative.
Young squire, how many times
do we tell you,
don't rely on tests?
Dr. Savetti.
Can you help your erstwhile
colleague here?
He's looking for clues into this
young man's drug of choice.
His pupils are dilated
so we know
it's either sympathomimetic
or anticholinergic.
So cocaine, meth, LSD,
angel dust...
Yeah, all covered
in the tox panel.
All right.
Wait.
His fingertips are yellow.
You knew.
I suspected
when I saw him earlier.
Dr. Leighton,
you missed that.
I must have overlooked it
when he was trying to kill me.
What is this?
- Looks like spice resin.
Spice resin?
Is he a chef?
Spice is a street name
for synthetic pot.
Dealers spray chemicals
on dried plants.
It doesn't show up
on a drug test.
- Idiots smoke this stuff?
- Yeah, it's a cheap high.
Well, not so cheap.
He's on his way up to icu.
If and when he awakens,
he probably won't remember
any of this.
See, out of nasal packing.
Jesse went for it
a half-hour ago.
[ Breathes deeply ]
Hello.
I'm Dr. Rorish.
What do you got?
15-year-old Aubrey shopping
with her mom...
We found her
on the dressing room floor.
My heart was suddenly racing.
And that's all I remember.
EKG showed atrial fibrillation,
normal rhythm restored
with metoprolol.
Any congenital heart issues?
Heart? No, no, no.
She's perfectly fine.
She was totally healthy.
She's only 15.
Actually, I've been feeling
a little run-down lately.
Sometimes
I can't catch my breath.
- For how long?
- Last few weeks.
- Babe, why didn't you tell me?
- You know how you get.
How do I get?
What, concerned?
- Controlling.
- I am not controlling.
Okay, look,
the ambulance brought us here,
but I need her to go
to our doctor in Beverly hills,
so can we expedite
the discharge paperwork?
I'd like to keep her here
for a while.
She's my daughter,
and I need her to be seen
by someone that I know
and that I trust.
I'm happy to call her doctor.
I mean, how old are you?
What, 26?
Excuse me, but I probably
just saved her life.
No offense, but we can't be
a part of someone's
learning curve.
- You're not controlling at all.
- Aubrey, not now.
Leanne:
Okay, okay, okay.
How about we all
just take a minute,
and then we'll call
her doctor together.
I'll explain what happened,
and you two can decide
together what's best.
Dr. Pineda.
- [ Sighs ]
¶¶
[ keypad beeps ]
Gina: Oh, crap.
[ Sighs ] Jesse.
Jesse.
[ Grunts ]
Jesse.
[ Sighs ]
Somebody, help!
I need help in here!
Come on.
You can't die
in my first week, Jesse, please.
Someone!
Somebody get help in here!
I need help in here!
Someone!
You've lost your cool like that
more than once recently.
I'm sorry.
I'm just tired.
I'm worried about Carla and she
won't even speak to me.
Somebody get help!
This program is
the second-hardest thing
you'll ever face.
Carla's illness is the first.
You may have to decide
if you can do both.
Somebody,
please help me in here now!
Excuse me, Dr. Pineda.
What do you have?
47-year-old male
clipped by incoming Metro train,
thrown back
against station wall.
Blunt trauma to chest, abdomen.
No loc, minimal ebl.
BP 80 over 50.
Man: Someone has to get Eli!
[ Screams ]
Mario: Center stage, please.
He's going to bed three.
Gina:
I need help in here!
Someone!
[ Keypad beeping ]
Oh, my God.
Get a gurney in here now!
- I need a chest X-Ray, please.
- Eli.
On me.
1, 2, 3.
[ Groans ]
Eli.
- Roll him, please.
- Ow!
Gently, gently.
Take it out slowly.
Is Eli your son?
- Yes.
- Okay.
David: [ Groaning ]
I was supposed to pick him up
he's at the bus stop at western
and third, waiting for me.
He has down syndrome.
Is there someone we can call?
No, he'll get scared
if I'm not there.
He could get lost.
- X-Ray ready.
Woman: Clear for X-Ray.
Clear.
[ Whirring, beeping ]
What do you see?
Multiple rib fractures,
vascular markings all the way
to the periphery.
No hemothorax.
Clavicular dislocation,
but not compressing the airway.
Good.
He needs ultrasound.
My son's afraid of the dark.
[ Groans ]
And that's pelvic free fluid.
Talk to me through it,
Dr. Savetti.
Most likely a leak
from the bladder.
Could have been blown open
by the impact of the train.
You're gonna need surgery,
David.
Ow. Wait, please.
There's a Yoda doll
in my coat pocket.
It's his.
You'll need it.
- Need it for what?
- When you go get him.
It's how he'll know you're safe.
All right,
the paramedics can pick him up.
We'll get him here.
- You promise?
Yeah, I promise.
- Clear a path.
- What is it?
- Oh, my God.
- We didn't get a call.
- Can you see who it is?
- Oh, no.
- I can't believe it.
- Hey, what's going on?
- What happened to him?
- Is he conscious?
- What's going on?
- Find Dr. Rorish.
Malaya: I need the cath team
activated now.
Holy...
Dr. Rorish, it's Jesse.
Gina: Get a crash cart
and a defibrillator.
Man:
Get an airway ready.
Let me in.
Jesse.
You are not leaving me.
I need someone
from cardiology down here now.
- Oh, my God.
- 12 lead, stat.
- Got it.
- Leanne, are you okay?
I can come and help.
- Yeah, stay with your patient.
Okay, Malaya, talk to him.
Hold his hand.
Angus, ultrasound.
What does it say?
Dr. Leighton!
If you can't be useful to me,
get out.
Fight, mama.
You hear me?
You have to fight!
Markedly reduced
ventricular function.
Ef is 20%, maybe 30%.
I don't see an embolus
or a rupture.
Let's get these on.
Leanne:
Okay, massive heart attack.
Diffuse s.T. Elevations
in ii, III, and avf.
Probably the inferior
right ventricle.
Christa, vitals?
BP borderline...
90s over 60s.
Heart rate 80s.
He's sat'ing well.
I activated a code stemi.
Take a look at this
EKG, and I want to know
the exact time this happened.
Malaya, what's
the single-most important thing
we can do to save
this patient's life?
He needs a cath lab.
The heart attack was caused
by a blockage
in one of his arteries.
He needs a stent to break it up.
- How long do we have?
90 minutes from door to stent.
Are we in the window?
Um, he hasn't q'ed out yet.
He still has
hyper-acute t-waves.
This probably happened
less than an hour ago.
He's conscious.
Jesse.
I know you're scared,
but I got you, mama.
You hear me?
Gina:
Cardiology's here.
Cath lab's ready for him.
I'm going with you.
[ Clears throat ]
Look, I get this is tough.
I know Jesse's daddy, but...
- mama.
Jesse's mama.
Mama.
Maybe I don't quite get it,
but I have an er to run.
I need you to say
something motivational,
get the people back to work.
I would, but coming from me,
it might seem like
I'm a cold, unfeeling bitch.
From you, they'll understand.
Okay?
[ Clears throat ]
Uh, hey, everyone.
Look, I know mama is
on all of our minds.
Let's give ourselves a moment
to say a prayer for him,
and then we have to get back
to our patients
and give them
the same care and attention
that we've just given to Jesse.
'Cause you all know
mama's number-one rule.
We're not allowed...
All: To kill
a guest in mama's house.
¶¶
- Dr. Guthrie?
- Yes.
She is here about a patient
that came in
just before shift change.
Kyle eldrich?
Yeah, he's my husband.
I'm Debbie.
Stabbing victim.
This young man
was taken up to the O.R.
Yeah, how is he?
Please.
His wounds are severe.
He's being prepped for surgery.
Okay, see, he has to be okay.
'Cause he just got back
from a tour in Afghanistan.
- Oh, he's active duty?
- Yeah.
68 whiskey.
68 whiskey?
I'll check on him.
Thank you.
Guthrie: Hey, son.
Your patient's wife
just got here.
She was asking about him.
Well, he's holding on.
I'll know more
when I get inside.
Well, I just wanted you to know
that this young man is army,
just like you and me.
Matter of fact,
same m.O.S. And unit as you.
- Yeah?
- Yeah.
- He's a whiskey?
- Yeah.
Boy, those medics
saved me more than once
when I was still in the service.
Let's repay the favor, huh?
Yeah.
Nothing I'd like more...
But you saw his chart.
Eight penetrating wounds,
ebl nearly a liter.
BP still 70s over 40s
after six units of o-neg.
That's why I'm glad he has you.
- No pressure.
- [ Chuckles ]
Hey.
You want to scrub up, soldier?
You sure?
Why not?
[ Pager beeps ]
Aw, man, they...
They're swamped down there.
But rain check?
I'll let you know how he does.
Yeah, yeah.
He's gonna pull through.
He has to.
I can't imagine this place
without Jesse.
So we'll keep her here
for a few hours,
I'll monitor her, and I'll
call you if anything changes.
Thank you.
Right now, she's stable.
I just want to make sure
she stays that way.
Okay, thank you,
and I'm sorry about before.
No, I'm the one who's sorry.
You're supposed to worry
about your daughter.
What the hell
is this doing here?
Isabel, did the paramedics
forget to take this with them?
They got called out and didn't
get a chance to go for the boy.
I'm waiting on a call back
from social services.
Are you kidding me?
That kid could be
out there somewhere alone.
He could be in trouble!
Yell at me again, I'm gonna
put you over my knee.
I'd like to see that.
- What's going on?
- Eli's still out there.
No one went to go find him.
I got to go get him.
Hey, hey!
We're all on edge.
Someone's got to get that kid.
I promised his father.
Well, you can't go...
Not now.
We're already down a doctor
and a nurse.
I'll be quick.
Dr. Savetti,
you're not going.
Call social services or ask
the police to get the boy.
- Okay, what is it?
- I need a favor.
I am not taking
that impacted bowel from you.
I need you guys to cover for me
while I go find
my patient's kid.
But Dr. Hudson said
to stay in-house.
We could all get into trouble,
I know.
I can't just leave
that kid out there.
I'm in.
It's a kid with down syndrome
alone out on the street.
[ Sighs ] Okay.
I'm in.
Guys, we could get suspended
or worse.
Okay, you better hurry.
I'm not a very good liar.
- One time, at summer camp...
- Angus.
Thanks, I'll be quick.
Malaya,
Aubrey Clark is crumping.
- Oh.
- I'll help.
She can't get enough air
and her monitor keeps screaming.
She's in sinus, but sats are
only in the 80s on four liters.
- Diffuse crackles throughout.
- Okay.
Okay, would you help her?
Please fix this!
I'm gonna raise
the bed so you can
breathe a little easier, okay?
I need a bipap
and an ultrasound.
Page respiratory, stat.
- Okay, wait a minute.
What are you doing?
Her heart isn't pushing
her blood forward effectively.
It's backing up into her lungs,
which is affecting
her breathing.
We're going to start
a device called bipap
that blows high-pressured air
into the lungs.
[ Gasping ]
Okay, start at 10 over 5.
40 of lasix.
- Yep.
Aubrey, this is gonna make you
feel better, okay?
Ultrasound.
That looks like a poor squeeze.
This is global hypokinesis.
[ Monitor beeping rapidly ]
Sats back in the 90s.
Okay, you see, this is why
she's got to get
out of here
because this is getting worse.
Based on this ultrasound,
this is early heart failure.
She's not going anywhere.
- What?
- [ Gasping ]
- Okay, wait a minute.
What is causing this,
and what can we do?
- Okay.
- Hey, hey, hey.
Absent family history
or congenital issues,
this condition could be caused
by cocaine or methamphetamine.
Is that possible?
- No, no.
No, my daughter's not a druggie.
Let's do a tox screen anyway.
No, we don't need
to do a tox screen.
You see, this is why
I need real doctor here!
Mrs. Clark, right now,
I'm all you've got,
so back off
and let me do my job.
- Malaya, easy.
- You said you were gonna help.
Tox screen, please.
- Okay, you got it.
¶¶
Heather:
It's a big blockage.
You're lucky to be alive.
Heather, aren't you
a surgical resident?
Yes, but we have to do
an interventional
cardiac rotation
as part of our residency.
I just started mine.
Well, I'm sure
you're quite capable,
but I'd prefer an attending.
Looks like
a great doctor to me.
Score.
I'm flattered and offended
at the same time.
Light sedation
feels pretty good to you, huh?
For sure, for sure.
Want to dance?
Jesse, stop talking.
Don't worry, Dr. Rorish.
I'm very good.
I scared you, huh?
Well, you're the one
shaking in his boots.
[ Laughs ]
You cried.
And it was an ugly cry, too.
You made a face like this.
[ Imitates crying, laughs ]
[ Sighs ]
Listen.
Before I'm dead,
there's something
I got to tell you.
Shut up.
You're not dead.
Neither are you.
What are you talking about?
You're alive.
I know that.
I don't think you do.
You're alive.
They're not.
Jesse, what are you doing?
What I'm telling you is
that if I die today,
my one wish would be
that you live.
Really live.
I'm pretty sure
that's their wish, too.
Dr. Rorish.
What?
The artery wall in this area
appears very thin.
I'm afraid I may rupture it
if I move too quickly.
We don't have time to wait.
I think I can get past it
without causing any damage.
All right.
We're through.
Okay, there's the blockage.
Now I just need
to move the stent in place.
And inflate it.
[ Sighs ]
You officially have
an unblocked artery.
- That's it?
- No.
Now you have to listen to me
when I say,
"take the salad.
Lay off the fries."
A man's got to live.
[ Indistinct conversations ]
Have you, uh...
Have you seen Dr. Savetti?
[ Coughs ]
- You okay, Dr. Leighton?
- Mm-hmm.
I'm good.
Gina got us this pizza.
Have you tried it?
Ooh, it is good.
No, maybe later.
Have you seen Dr. Savetti?
Me?
Yeah, you.
I believe he took a patient
for a ct scan.
Yeah, I hear
they're really backed up.
Mm-hmm.
If I, uh, run into Mario,
I'll send him your way.
You're not lying to cover
for Mario, are you?
Are you asking me
as an attending or as a friend?
What's the difference?
The answer is no.
I don't know where Mario is.
If I find out the residents
are lying to cover for Mario,
there will be a reprimand,
and I won't protect you.
I didn't ask you to.
[ Dogs barking ]
Eli?
I was looking for you
at your bus stop.
I see you found your way home.
My dad told me not
to talk to strangers.
Well, I'm Dr. Savetti.
Your dad sent me
to come get you.
He gave me this.
Can I tell you a secret?
Sure.
I like Yoda, too.
When I was a kid,
my dad, he, uh...
He wasn't a good guy like yours.
He'd go out a lot at night
and leave me alone.
Were you scared?
Hell, yeah.
But I had a star wars videotape
and I'd play it
and it made me feel safe.
What's a videotape?
You're messing with me, huh?
[ Laughs ]
All right, come on.
Let me call your dad
and see if I can tell him
you're all right.
Angels, trauma one,
risa speaking.
Hey, risa.
It's Mario.
Can you tell me if a patient,
David Jacobs, is in recovery?
Seatbelt.
- Sure, hold on.
Mario, he is still in surgery.
You want me to check on him...
Where are you?
And be careful how you answer.
I found David's son.
Get back to the hospital
immediately, Dr. Savetti.
I hear he's okay?
He seems to be.
Thanks to you.
Well, I needed to win
you over somehow.
I figured if I saved
Jesse's life, you might like me.
[ Chuckles ]
Good strategy.
Thank you.
Forget about it.
And I'm gonna need you
to work a regular schedule.
What?
Too soon?
[ Chuckles ]
Cole:
Your husband pulled through
a very difficult surgery,
but he is still
in critical condition.
Yeah, but he's gonna make it.
Well, we have to wait and see.
We found extensive internal
bleeding due to the damage
in his stomach and bowel,
but he's a whiskey.
I'm sure he's tough.
Yeah, he's gonna be fine.
I know it.
Has anyone looked at that arm?
Oh, it's fine.
Mrs. eldrich,
how did you know
that your husband was
in the hospital?
Were you there when it happened?
Is that a...
Virgin Mary there?
I went to catholic school.
I used to go to mass
every Sunday with my mom.
Debbie.
What happened to your arm?
Did Kyle try to hurt you?
- God, no.
No, he'd never.
Do you mind if I take a look?
Please.
Kyle's been trying to...
Get me quit my habit.
He's taking me to meetings
and all that.
I waited until he was asleep...
To go out and score tonight.
He must have been following me
because he knew where I was.
And I was... I was high
by the time he came in,
wanting to drag me home.
The people I was with
got spooked, and before...
Before I knew it,
some son of a bitch
had his knife out and...
And you just left him there.
Why the hell
was he following me?
I am his wife.
I'm not...
I'm not his daughter.
- Did you at least call 911?
- Yes, of course.
But I was... I was coming down
and I needed a fix.
I wasn't seeing straight.
- You just left him there.
Guthrie: Cole.
Your husband survived terrorists
and mortar attacks
but he couldn't survive you.
- Stop.
No, she needs to hear this.
You did this to him.
It should be you
in that damn icu, not him.
Cole, that's enough.
Oh, Jesus.
I'm so sorry.
[ Sighs ]
I'm so sorry.
You know, we have a command
hierarchy for a reason.
We allow the residents
to ignore it
and there are consequences
for the patients.
I knew you had a tough job,
but I didn't know how hard.
I'm confused.
About what?
You're the one who said
that every resident is a lock
and you just have to find
the right combination.
I still believe that.
Mario just did two things
he could have never done before.
He put himself at risk
for a patient
and he reached out for help.
He disobeyed you, yes.
But he also proved your point...
That they're all teachable.
So you
wouldn't discipline him?
Me? [ Scoffs ]
I'd throw him out of the program
if I knew he did this.
But...
I don't know a thing about it.
I got to go check on Jesse.
¶¶
So...
I'm sorry, I just...
I just came to check on him.
Maybe I'll just come back.
[ Door closes ]
[ Laughs ]
I heard you had to take
eldrich back into surgery.
He's dead.
Oh, man.
Three liters of blood
in the belly.
- [ Sighs ]
- The liver's shredded to pieces.
I tried,
but I couldn't save him.
Yeah, I'm sure you did
the best you could.
I'll go talk to his wife.
- No, he was my patient.
I don't think
that's a good idea, son.
You already said enough.
You don't get to make
that decision.
Wait a minute, Cole!
It's my responsibility.
- Yeah.
- Excuse me.
Have you seen
Kyle eldrich's wife?
- Ugh, I'm so sorry.
- What is it?
She overhead some
of the trauma nurses talking.
She knows her husband
didn't make it.
Well, where is she?
She said she was gonna go
clean up in the ladies' room.
¶¶
Debbie?
Debbie.
Debbie:
[ Crying ] I don't want this.
I don't want this.
I don't want this.
[ Toilet flushes ]
Help me.
- It's okay. It's okay.
- Help me.
It's okay.
Angus: We were able to wean your
daughter off bipap with lasix.
- Mm-hmm.
- That is the good news.
Her tox panel came back.
There's no meth
or cocaine in her system.
Yeah, I told you.
But her thyroid levels
are so high
they can't be measured
by our laboratory.
She's in a thyroid storm.
What...
What is a thyroid storm?
A side effect of thyroid meds
is weight loss.
Sometimes patients abuse
those meds to get thin,
but the excessive hormones
in the blood
can reach toxic levels.
It's called a thyroid storm.
It can cause heart failure
and abnormal rhythms.
Aubrey, we've noticed
from your medical records
that you've lost quite
a few pounds over the last year.
From diet and exercise.
You don't have a prescription
for thyroid medication,
but we've known some girls
to sneak their mom's pills.
Do you have a prescription,
Mrs. Clark?
Yes, I do.
Aubrey:
I've never taken my mom's pills.
The only thing I take
are my vitamins.
Mom, you believe me, right?
Yes, honey, of course I do.
Mrs. Clark, could you
step out with me, please?
You did this, didn't you?
What are you talking about?
She could die,
and you're still lying.
Who the hell do you think
you are, young lady?
My name is Dr. Pineda.
Are you gonna tell
the truth or not?
Leanne:
What's going on here?
She's giving her daughter
her thyroid medication
without her knowledge.
Am I right?
Malaya: Answer me!
Am I right?
Are you gonna let her talk
to me like this?
You bet your ass I am.
She could die if you
don't tell me the truth.
Did you give her
your medication... yes or no?
Yes. Yes, but I didn't think
that this was gonna hurt her.
You wanted her to lose weight
so you gave her
your medication and you
told her it was a vitamin.
Mom!
Is that true?
Honey, I never ever
meant to hurt you.
I just wanted... I wanted you
to like yourself, honey.
And it worked!
Didn't it?
It worked.
I wish there was a drug
to make you like me, mom.
[ Monitor beeping rapidly ]
Aubrey. Aubrey, honey!
- She's in vtac.
Angus, let's get her back
in bed.
Honey!
[ Coughing ]
[ Monitor beeping rapidly ]
- He's bleeding out again.
- He's been fine until now.
I thought Dr. Rorish fixed the
bleed with the breathing tube.
Me, too.
I need thoracic,
or I.R. Or...
Oh, he's starting to vomit.
The tube could come out.
Do something!
- [ Coughs ]
- Oh, my God.
- Should I page Dr. Rorish?
- No!
Hudson, we need a surgeon.
- How's my heart rate?
- 210.
It's fast, but it's
not irregularly irregular.
I don't think it's afib.
It's worse.
It's a paroxysmal svt.
Get me to center stage.
I need leanne.
[ Monitor beeping rapidly ]
Aubrey!
Leanne: Malaya, pads.
[ Defibrillator whirs ]
- Charging. Ready?
- Okay, clear.
And now.
[ Gasps ]
[ Sighs ]
[ Beeping steadies ]
Angus:
She's in sinus rhythm.
- Is she gonna be okay?
- She's gonna be okay.
She's gonna need
anti-thyroid medication.
Isabel, call the pharmacy.
- Mom?
- Oh, honey, I'm so sorry.
I... I'm so sorry.
Woman: Doctor.
- Coming through.
- What happened?
I missed you.
Heather, what is it?
Paroxysmal supraventricular
tachycardia.
Uh, Mario, get over here.
Heart rate in the 200s.
- What's his BP?
- High 100s over 60s.
Okay, post m.I.,
this kind of heart rate places
excessive demand on
already stressed cardiac tissue.
How do we proceed from here?
Jesse: Are you still
really teaching now?
I mean, this is me on the table.
Mario?
- Adenosine.
- That's right... a medication...
that will
literally stop your heart.
Why?
- Because it...
Heather. Why would we want
to stop his heart?
To restart it like a computer.
Exactly.
It should restore
normal heart rhythm.
What's the catch?
Jesse: I'll tell you
what the catch is.
You're gonna do it
while I'm still awake,
and it's gonna hurt like hell.
I'm sorry, mama.
Get it done already.
He was fine all shift
after we intubated him.
I've checked the BP twice.
It's still low.
Okay, this breathing tube
has to come out.
I need to take a look at
the bronchi to see the bleeding.
What, extubate him?
He could bleed out.
No, patients with bleeding lungs
don't die from losing blood.
They drown in it.
Hey.
Jesse, I'm gonna
tell you something.
I must be about to die because
you're gonna say
something touchy-feely.
You're not gonna die
because I need you.
Okay?
I need you.
I know.
I love you, too.
Risa, grab another airway.
Dr. Lorenson, tube out, now.
Be ready to re-intubate.
¶¶
Okay, I think I see the bleed.
It's in the left mainstem.
Oh, my God.
We intubated
the wrong mainstem earlier.
Nobody used the bronchoscope
the first time?
Dr. Rorish
intubated blind.
Okay.
Thread the new breathing tube
over my scope.
Risa:
Sat's in the 80s.
You ready?
I'm ready.
Okay, stand by.
Okay.
Sat 75%.
And I am in.
Dr. Lorenson,
inflate the tube, please.
Good breath sounds on the right,
not on the left...
Just what we want.
Let get some fluids in him,
please, and up to the I.R.
Sat's normalizing.
Dr. Rorish, we're ready.
Okay.
Jesse, you ready?
Save my life, daddy.
[ Sighs ]
All right.
[ Groaning ]
[ Flatline ]
[ Beeping steadies ]
- Sinus rhythm.
- Blood pressure's back.
He's good!
[ Cheers and applause ]
He's good.
Marion: Oh, my God.
Oh.
Okay, mama.
You're not going anywhere, okay?
- [ Sighs ]
- You're not going anywhere.
Oh, I love you.
Did you find an open bed
in the addiction clinic
for Mrs. eldrich?
The way you talked
to that woman, Cole,
in her state,
your temper almost killed her.
I told her
what she needed to hear.
No.
You told her what
you needed her to hear.
We both know what that temper
has cost you in the past, son.
I hoped
that you when you came here,
you'd have put all
of that behind you.
I don't need a father-and-son
talk from you.
This isn't
a father-and-son talk.
This is a senior faculty member
telling a new attending
that his behavior
is unacceptable.
[ Elevator dings ]
He'll wake up soon.
I'm here, dad.
My friend Mario
told me you're gonna be okay.
[ Chuckles ]
Eli?
Dad.
Don't worry, dad.
I'm gonna take care of you.
Do you have an explanation
for what you did today?
Not really.
Not really.
That's it?
That's an appropriate answer?
I was trying to be mayonnaise.
Mayonnaise?
Something Jesse said
from that movie,
"officer and a gentleman."
They called him mayonnaise
'cause he's white
and his name's Mayo.
I've seen the movie.
I'm talking about...
I was just trying
to do the right thing, man.
For Jesse.
All right.
What about the others?
Do they get a pass?
This time.
Thank you.
Thank you.
[ Sighs ]
There were, uh, complications
with your patient, Jeff,
the paramedic.
He's fine, but the bleed was
on the left side,
not on the right.
I intubated the wrong side?
I could have killed him.
Well, you didn't.
I corrected it, so...
don't do that, leanne.
Don't internalize this.
We all make mistakes.
Not like that one.
What is it Jesse says?
"Lean on each other.
That's what
siblings are for."
You think he's all you have,
but you're wrong, leanne.
You have me.
You have all of us.
Thank you.
¶¶
Cole:
What are you doing?
Living.
Gina: I'm pretty sure
it's like "game of thrones"
in this place right now.
Everyone's aiming their arrows
at the new queen.
Temporary queen.
But here I am,
and I have a job to do.
So I've been working my way
through Taylor's staff notes.
No small feat because
they're written in, you know,
martian snark,
and I see here that you
haven't taken
a day off in a month,
haven't had a vacation
in three years.
I appreciate the dedication,
but from a liability standpoint,
I'm gonna need you
to work the regular schedule.
[ Cellphone vibrates ]
When you've been here
longer than five minutes,
you'll understand that angels
is not a regular hospital.
Got to go.
- Go save some lives.
Good talk.
[ Door opens, closes ]
Jody: Angels base, we don't
have thorazine on the rig.
How far out are you?
We're on your...
[ Radio static ]
142, say again?
Did you say on the ramp?
[ Radio crackling ]
142, this is angels base.
Do you copy?
[ Screams ]
142?
[ Sirens wailing ]
What do we have?
I don't know.
What's he doing?
Looks like he stalled.
Why isn't anyone getting out?
[ Thud ]
Christa, go get security.
[ Indistinct radio chatter ]
What the...
[ man groaning ]
Hell no.
- Jesse!
- Aah!
Hey, get back, get back!
- Drop it!
- Take it easy!
All right, get him down.
- Get him.
- [ Screams ]
Get that arm.
Ready?
Go!
- Hey, you all right?
- I'm okay.
Pupils reactive.
- Restraints!
- Hold still.
How is she?
Get a c-collar.
Angus: The hulk looks like
he has superficial injuries.
Minor abrasions
on his elbows and knees.
Minimally conscious.
Moving spontaneously.
- Positive battle signs.
- Dilated pupils.
He's obviously on something.
I think he's gonna need
a hefty dose of ativan.
Breath sounds bilaterally.
Minor abrasions everywhere.
Man: Get on his leg!
Keep him down!
All right, bite marks
on the shoulder and clavicle.
De-gloving of the left knee,
probably
from the oxygen tank valve.
Let's move her.
Count of three.
1, 2, 3.
That's it.
Great.
[ Groans ]
Careful.
Okay.
[ Screaming ]
- Let's go.
- [ Groans ]
Let's get him inside now.
[ Groaning ]
Let's bring it in bed one.
I'm sorry.
I can't hear you.
We have traumas coming in.
- [ Groans ]
Angus: Tighten the restraints
over there.
- [ Groans ]
- You okay, mama?
You went down pretty hard.
- You call that hard?
- [ Screams ]
- Okay, Jody.
Just try and breathe deeply
for me.
You're in center stage
at angels.
Risa, methylene blue, please.
Inject it into the capsule
through the skin.
My partner, Jeff.
How is he?
He's here.
We're working on him.
Do you know what happened?
We picked a guy
in pershing square, passed out.
We were on our way to angels
when we woke
and he just went crazy.
Hold on. I'm sorry.
Almost done, all right?
Hang in there.
- Joint looks intact.
Close it up, please,
and push eight of morphine.
- Do we know what he's on?
- No.
Never seen anything like it.
[ Groans ]
You got to stop.
You got to stop it.
Okay, you've give him
elephant-dose benzos.
- Yeah, with minimal effect.
- Suggestions, young squire?
Knock this zombie out
till whatever he took wears off.
- Let's get some propofol.
- [ Groans ]
Sir, we're gonna give you
a chemically-induced time out.
Amy, prep rsi, please.
[ Monitors beeping rapidly ]
Whoa, whoa, whoa.
What is this, Christa?
Uh, blood in the airway
caused by the trauma.
And how do we proceed?
We need to see if the bleeding's
coming from the left
or right lung.
I'll grab the bronchoscope.
Or we could use our instincts.
Deformity's on the right side
of the chest, correct?
Excuse me.
More than likely, the bleeding's
in the right lung.
Dr. Rorish.
Jesse, airway dl sux
and etomidate.
You're not attempting
a blind intubation, are you?
- Jesse, mask, please.
How will you see the bleeding
source without a scope?
Thank you.
There we go.
Okay, so bleeding is
on the right side,
so we need to intubate
on the left.
We should call pulm.
Leanne, do you hear me?
- It's hard not to.
We know how
to use a scope, Gina.
If I wait for the gear,
he'll die.
Tube, please.
[ Monitor beeping rapidly ]
I'm in.
[ Beeping steadies ]
We're running low
on nasal packing.
I'll go get some.
You want to take over here?
Thank you.
All right, Christa.
We'll need
a ct head/neck, please.
[ Key pad beeping ]
Let's go find you.
Ooh, man.
Where is it?
[ Coughing ]
[ Gasps, yelling ]
[ Thud ]
Oh!
¶¶
We was trying to help this guy
and this is what we get...
Nearly killed.
Leanne: The ct scan confirms
that he has
a basilar skull fracture,
but, Dr. Lorenson,
tell us why he's lucky.
It doesn't appear to be severe
enough to require surgery.
But you have to keep him
for a few days.
Yes.
The fracture exposed the brain
and spinal fluid.
We need to watch him
to make sure
it doesn't develop
into an infection.
Luckily, you'll both be back
on the rig before you know it.
Have you seen Jesse?
- Mnh-mnh.
Not since we were
in center stage.
Okay, Dr. Savetti has
some paperwork
for you to fill out
so he can discharge you.
I think I'll stick around
for a while.
Sleeping beauty may need me
to save his butt again.
Hey, that guy who attacked us...
What the hell was he on?
It was like he was possessed.
Angus: Negative.
You want him to put negative tox
screen on the report?
I ran the test twice.
They were both negative.
Young squire, how many times
do we tell you,
don't rely on tests?
Dr. Savetti.
Can you help your erstwhile
colleague here?
He's looking for clues into this
young man's drug of choice.
His pupils are dilated
so we know
it's either sympathomimetic
or anticholinergic.
So cocaine, meth, LSD,
angel dust...
Yeah, all covered
in the tox panel.
All right.
Wait.
His fingertips are yellow.
You knew.
I suspected
when I saw him earlier.
Dr. Leighton,
you missed that.
I must have overlooked it
when he was trying to kill me.
What is this?
- Looks like spice resin.
Spice resin?
Is he a chef?
Spice is a street name
for synthetic pot.
Dealers spray chemicals
on dried plants.
It doesn't show up
on a drug test.
- Idiots smoke this stuff?
- Yeah, it's a cheap high.
Well, not so cheap.
He's on his way up to icu.
If and when he awakens,
he probably won't remember
any of this.
See, out of nasal packing.
Jesse went for it
a half-hour ago.
[ Breathes deeply ]
Hello.
I'm Dr. Rorish.
What do you got?
15-year-old Aubrey shopping
with her mom...
We found her
on the dressing room floor.
My heart was suddenly racing.
And that's all I remember.
EKG showed atrial fibrillation,
normal rhythm restored
with metoprolol.
Any congenital heart issues?
Heart? No, no, no.
She's perfectly fine.
She was totally healthy.
She's only 15.
Actually, I've been feeling
a little run-down lately.
Sometimes
I can't catch my breath.
- For how long?
- Last few weeks.
- Babe, why didn't you tell me?
- You know how you get.
How do I get?
What, concerned?
- Controlling.
- I am not controlling.
Okay, look,
the ambulance brought us here,
but I need her to go
to our doctor in Beverly hills,
so can we expedite
the discharge paperwork?
I'd like to keep her here
for a while.
She's my daughter,
and I need her to be seen
by someone that I know
and that I trust.
I'm happy to call her doctor.
I mean, how old are you?
What, 26?
Excuse me, but I probably
just saved her life.
No offense, but we can't be
a part of someone's
learning curve.
- You're not controlling at all.
- Aubrey, not now.
Leanne:
Okay, okay, okay.
How about we all
just take a minute,
and then we'll call
her doctor together.
I'll explain what happened,
and you two can decide
together what's best.
Dr. Pineda.
- [ Sighs ]
¶¶
[ keypad beeps ]
Gina: Oh, crap.
[ Sighs ] Jesse.
Jesse.
[ Grunts ]
Jesse.
[ Sighs ]
Somebody, help!
I need help in here!
Come on.
You can't die
in my first week, Jesse, please.
Someone!
Somebody get help in here!
I need help in here!
Someone!
You've lost your cool like that
more than once recently.
I'm sorry.
I'm just tired.
I'm worried about Carla and she
won't even speak to me.
Somebody get help!
This program is
the second-hardest thing
you'll ever face.
Carla's illness is the first.
You may have to decide
if you can do both.
Somebody,
please help me in here now!
Excuse me, Dr. Pineda.
What do you have?
47-year-old male
clipped by incoming Metro train,
thrown back
against station wall.
Blunt trauma to chest, abdomen.
No loc, minimal ebl.
BP 80 over 50.
Man: Someone has to get Eli!
[ Screams ]
Mario: Center stage, please.
He's going to bed three.
Gina:
I need help in here!
Someone!
[ Keypad beeping ]
Oh, my God.
Get a gurney in here now!
- I need a chest X-Ray, please.
- Eli.
On me.
1, 2, 3.
[ Groans ]
Eli.
- Roll him, please.
- Ow!
Gently, gently.
Take it out slowly.
Is Eli your son?
- Yes.
- Okay.
David: [ Groaning ]
I was supposed to pick him up
he's at the bus stop at western
and third, waiting for me.
He has down syndrome.
Is there someone we can call?
No, he'll get scared
if I'm not there.
He could get lost.
- X-Ray ready.
Woman: Clear for X-Ray.
Clear.
[ Whirring, beeping ]
What do you see?
Multiple rib fractures,
vascular markings all the way
to the periphery.
No hemothorax.
Clavicular dislocation,
but not compressing the airway.
Good.
He needs ultrasound.
My son's afraid of the dark.
[ Groans ]
And that's pelvic free fluid.
Talk to me through it,
Dr. Savetti.
Most likely a leak
from the bladder.
Could have been blown open
by the impact of the train.
You're gonna need surgery,
David.
Ow. Wait, please.
There's a Yoda doll
in my coat pocket.
It's his.
You'll need it.
- Need it for what?
- When you go get him.
It's how he'll know you're safe.
All right,
the paramedics can pick him up.
We'll get him here.
- You promise?
Yeah, I promise.
- Clear a path.
- What is it?
- Oh, my God.
- We didn't get a call.
- Can you see who it is?
- Oh, no.
- I can't believe it.
- Hey, what's going on?
- What happened to him?
- Is he conscious?
- What's going on?
- Find Dr. Rorish.
Malaya: I need the cath team
activated now.
Holy...
Dr. Rorish, it's Jesse.
Gina: Get a crash cart
and a defibrillator.
Man:
Get an airway ready.
Let me in.
Jesse.
You are not leaving me.
I need someone
from cardiology down here now.
- Oh, my God.
- 12 lead, stat.
- Got it.
- Leanne, are you okay?
I can come and help.
- Yeah, stay with your patient.
Okay, Malaya, talk to him.
Hold his hand.
Angus, ultrasound.
What does it say?
Dr. Leighton!
If you can't be useful to me,
get out.
Fight, mama.
You hear me?
You have to fight!
Markedly reduced
ventricular function.
Ef is 20%, maybe 30%.
I don't see an embolus
or a rupture.
Let's get these on.
Leanne:
Okay, massive heart attack.
Diffuse s.T. Elevations
in ii, III, and avf.
Probably the inferior
right ventricle.
Christa, vitals?
BP borderline...
90s over 60s.
Heart rate 80s.
He's sat'ing well.
I activated a code stemi.
Take a look at this
EKG, and I want to know
the exact time this happened.
Malaya, what's
the single-most important thing
we can do to save
this patient's life?
He needs a cath lab.
The heart attack was caused
by a blockage
in one of his arteries.
He needs a stent to break it up.
- How long do we have?
90 minutes from door to stent.
Are we in the window?
Um, he hasn't q'ed out yet.
He still has
hyper-acute t-waves.
This probably happened
less than an hour ago.
He's conscious.
Jesse.
I know you're scared,
but I got you, mama.
You hear me?
Gina:
Cardiology's here.
Cath lab's ready for him.
I'm going with you.
[ Clears throat ]
Look, I get this is tough.
I know Jesse's daddy, but...
- mama.
Jesse's mama.
Mama.
Maybe I don't quite get it,
but I have an er to run.
I need you to say
something motivational,
get the people back to work.
I would, but coming from me,
it might seem like
I'm a cold, unfeeling bitch.
From you, they'll understand.
Okay?
[ Clears throat ]
Uh, hey, everyone.
Look, I know mama is
on all of our minds.
Let's give ourselves a moment
to say a prayer for him,
and then we have to get back
to our patients
and give them
the same care and attention
that we've just given to Jesse.
'Cause you all know
mama's number-one rule.
We're not allowed...
All: To kill
a guest in mama's house.
¶¶
- Dr. Guthrie?
- Yes.
She is here about a patient
that came in
just before shift change.
Kyle eldrich?
Yeah, he's my husband.
I'm Debbie.
Stabbing victim.
This young man
was taken up to the O.R.
Yeah, how is he?
Please.
His wounds are severe.
He's being prepped for surgery.
Okay, see, he has to be okay.
'Cause he just got back
from a tour in Afghanistan.
- Oh, he's active duty?
- Yeah.
68 whiskey.
68 whiskey?
I'll check on him.
Thank you.
Guthrie: Hey, son.
Your patient's wife
just got here.
She was asking about him.
Well, he's holding on.
I'll know more
when I get inside.
Well, I just wanted you to know
that this young man is army,
just like you and me.
Matter of fact,
same m.O.S. And unit as you.
- Yeah?
- Yeah.
- He's a whiskey?
- Yeah.
Boy, those medics
saved me more than once
when I was still in the service.
Let's repay the favor, huh?
Yeah.
Nothing I'd like more...
But you saw his chart.
Eight penetrating wounds,
ebl nearly a liter.
BP still 70s over 40s
after six units of o-neg.
That's why I'm glad he has you.
- No pressure.
- [ Chuckles ]
Hey.
You want to scrub up, soldier?
You sure?
Why not?
[ Pager beeps ]
Aw, man, they...
They're swamped down there.
But rain check?
I'll let you know how he does.
Yeah, yeah.
He's gonna pull through.
He has to.
I can't imagine this place
without Jesse.
So we'll keep her here
for a few hours,
I'll monitor her, and I'll
call you if anything changes.
Thank you.
Right now, she's stable.
I just want to make sure
she stays that way.
Okay, thank you,
and I'm sorry about before.
No, I'm the one who's sorry.
You're supposed to worry
about your daughter.
What the hell
is this doing here?
Isabel, did the paramedics
forget to take this with them?
They got called out and didn't
get a chance to go for the boy.
I'm waiting on a call back
from social services.
Are you kidding me?
That kid could be
out there somewhere alone.
He could be in trouble!
Yell at me again, I'm gonna
put you over my knee.
I'd like to see that.
- What's going on?
- Eli's still out there.
No one went to go find him.
I got to go get him.
Hey, hey!
We're all on edge.
Someone's got to get that kid.
I promised his father.
Well, you can't go...
Not now.
We're already down a doctor
and a nurse.
I'll be quick.
Dr. Savetti,
you're not going.
Call social services or ask
the police to get the boy.
- Okay, what is it?
- I need a favor.
I am not taking
that impacted bowel from you.
I need you guys to cover for me
while I go find
my patient's kid.
But Dr. Hudson said
to stay in-house.
We could all get into trouble,
I know.
I can't just leave
that kid out there.
I'm in.
It's a kid with down syndrome
alone out on the street.
[ Sighs ] Okay.
I'm in.
Guys, we could get suspended
or worse.
Okay, you better hurry.
I'm not a very good liar.
- One time, at summer camp...
- Angus.
Thanks, I'll be quick.
Malaya,
Aubrey Clark is crumping.
- Oh.
- I'll help.
She can't get enough air
and her monitor keeps screaming.
She's in sinus, but sats are
only in the 80s on four liters.
- Diffuse crackles throughout.
- Okay.
Okay, would you help her?
Please fix this!
I'm gonna raise
the bed so you can
breathe a little easier, okay?
I need a bipap
and an ultrasound.
Page respiratory, stat.
- Okay, wait a minute.
What are you doing?
Her heart isn't pushing
her blood forward effectively.
It's backing up into her lungs,
which is affecting
her breathing.
We're going to start
a device called bipap
that blows high-pressured air
into the lungs.
[ Gasping ]
Okay, start at 10 over 5.
40 of lasix.
- Yep.
Aubrey, this is gonna make you
feel better, okay?
Ultrasound.
That looks like a poor squeeze.
This is global hypokinesis.
[ Monitor beeping rapidly ]
Sats back in the 90s.
Okay, you see, this is why
she's got to get
out of here
because this is getting worse.
Based on this ultrasound,
this is early heart failure.
She's not going anywhere.
- What?
- [ Gasping ]
- Okay, wait a minute.
What is causing this,
and what can we do?
- Okay.
- Hey, hey, hey.
Absent family history
or congenital issues,
this condition could be caused
by cocaine or methamphetamine.
Is that possible?
- No, no.
No, my daughter's not a druggie.
Let's do a tox screen anyway.
No, we don't need
to do a tox screen.
You see, this is why
I need real doctor here!
Mrs. Clark, right now,
I'm all you've got,
so back off
and let me do my job.
- Malaya, easy.
- You said you were gonna help.
Tox screen, please.
- Okay, you got it.
¶¶
Heather:
It's a big blockage.
You're lucky to be alive.
Heather, aren't you
a surgical resident?
Yes, but we have to do
an interventional
cardiac rotation
as part of our residency.
I just started mine.
Well, I'm sure
you're quite capable,
but I'd prefer an attending.
Looks like
a great doctor to me.
Score.
I'm flattered and offended
at the same time.
Light sedation
feels pretty good to you, huh?
For sure, for sure.
Want to dance?
Jesse, stop talking.
Don't worry, Dr. Rorish.
I'm very good.
I scared you, huh?
Well, you're the one
shaking in his boots.
[ Laughs ]
You cried.
And it was an ugly cry, too.
You made a face like this.
[ Imitates crying, laughs ]
[ Sighs ]
Listen.
Before I'm dead,
there's something
I got to tell you.
Shut up.
You're not dead.
Neither are you.
What are you talking about?
You're alive.
I know that.
I don't think you do.
You're alive.
They're not.
Jesse, what are you doing?
What I'm telling you is
that if I die today,
my one wish would be
that you live.
Really live.
I'm pretty sure
that's their wish, too.
Dr. Rorish.
What?
The artery wall in this area
appears very thin.
I'm afraid I may rupture it
if I move too quickly.
We don't have time to wait.
I think I can get past it
without causing any damage.
All right.
We're through.
Okay, there's the blockage.
Now I just need
to move the stent in place.
And inflate it.
[ Sighs ]
You officially have
an unblocked artery.
- That's it?
- No.
Now you have to listen to me
when I say,
"take the salad.
Lay off the fries."
A man's got to live.
[ Indistinct conversations ]
Have you, uh...
Have you seen Dr. Savetti?
[ Coughs ]
- You okay, Dr. Leighton?
- Mm-hmm.
I'm good.
Gina got us this pizza.
Have you tried it?
Ooh, it is good.
No, maybe later.
Have you seen Dr. Savetti?
Me?
Yeah, you.
I believe he took a patient
for a ct scan.
Yeah, I hear
they're really backed up.
Mm-hmm.
If I, uh, run into Mario,
I'll send him your way.
You're not lying to cover
for Mario, are you?
Are you asking me
as an attending or as a friend?
What's the difference?
The answer is no.
I don't know where Mario is.
If I find out the residents
are lying to cover for Mario,
there will be a reprimand,
and I won't protect you.
I didn't ask you to.
[ Dogs barking ]
Eli?
I was looking for you
at your bus stop.
I see you found your way home.
My dad told me not
to talk to strangers.
Well, I'm Dr. Savetti.
Your dad sent me
to come get you.
He gave me this.
Can I tell you a secret?
Sure.
I like Yoda, too.
When I was a kid,
my dad, he, uh...
He wasn't a good guy like yours.
He'd go out a lot at night
and leave me alone.
Were you scared?
Hell, yeah.
But I had a star wars videotape
and I'd play it
and it made me feel safe.
What's a videotape?
You're messing with me, huh?
[ Laughs ]
All right, come on.
Let me call your dad
and see if I can tell him
you're all right.
Angels, trauma one,
risa speaking.
Hey, risa.
It's Mario.
Can you tell me if a patient,
David Jacobs, is in recovery?
Seatbelt.
- Sure, hold on.
Mario, he is still in surgery.
You want me to check on him...
Where are you?
And be careful how you answer.
I found David's son.
Get back to the hospital
immediately, Dr. Savetti.
I hear he's okay?
He seems to be.
Thanks to you.
Well, I needed to win
you over somehow.
I figured if I saved
Jesse's life, you might like me.
[ Chuckles ]
Good strategy.
Thank you.
Forget about it.
And I'm gonna need you
to work a regular schedule.
What?
Too soon?
[ Chuckles ]
Cole:
Your husband pulled through
a very difficult surgery,
but he is still
in critical condition.
Yeah, but he's gonna make it.
Well, we have to wait and see.
We found extensive internal
bleeding due to the damage
in his stomach and bowel,
but he's a whiskey.
I'm sure he's tough.
Yeah, he's gonna be fine.
I know it.
Has anyone looked at that arm?
Oh, it's fine.
Mrs. eldrich,
how did you know
that your husband was
in the hospital?
Were you there when it happened?
Is that a...
Virgin Mary there?
I went to catholic school.
I used to go to mass
every Sunday with my mom.
Debbie.
What happened to your arm?
Did Kyle try to hurt you?
- God, no.
No, he'd never.
Do you mind if I take a look?
Please.
Kyle's been trying to...
Get me quit my habit.
He's taking me to meetings
and all that.
I waited until he was asleep...
To go out and score tonight.
He must have been following me
because he knew where I was.
And I was... I was high
by the time he came in,
wanting to drag me home.
The people I was with
got spooked, and before...
Before I knew it,
some son of a bitch
had his knife out and...
And you just left him there.
Why the hell
was he following me?
I am his wife.
I'm not...
I'm not his daughter.
- Did you at least call 911?
- Yes, of course.
But I was... I was coming down
and I needed a fix.
I wasn't seeing straight.
- You just left him there.
Guthrie: Cole.
Your husband survived terrorists
and mortar attacks
but he couldn't survive you.
- Stop.
No, she needs to hear this.
You did this to him.
It should be you
in that damn icu, not him.
Cole, that's enough.
Oh, Jesus.
I'm so sorry.
[ Sighs ]
I'm so sorry.
You know, we have a command
hierarchy for a reason.
We allow the residents
to ignore it
and there are consequences
for the patients.
I knew you had a tough job,
but I didn't know how hard.
I'm confused.
About what?
You're the one who said
that every resident is a lock
and you just have to find
the right combination.
I still believe that.
Mario just did two things
he could have never done before.
He put himself at risk
for a patient
and he reached out for help.
He disobeyed you, yes.
But he also proved your point...
That they're all teachable.
So you
wouldn't discipline him?
Me? [ Scoffs ]
I'd throw him out of the program
if I knew he did this.
But...
I don't know a thing about it.
I got to go check on Jesse.
¶¶
So...
I'm sorry, I just...
I just came to check on him.
Maybe I'll just come back.
[ Door closes ]
[ Laughs ]
I heard you had to take
eldrich back into surgery.
He's dead.
Oh, man.
Three liters of blood
in the belly.
- [ Sighs ]
- The liver's shredded to pieces.
I tried,
but I couldn't save him.
Yeah, I'm sure you did
the best you could.
I'll go talk to his wife.
- No, he was my patient.
I don't think
that's a good idea, son.
You already said enough.
You don't get to make
that decision.
Wait a minute, Cole!
It's my responsibility.
- Yeah.
- Excuse me.
Have you seen
Kyle eldrich's wife?
- Ugh, I'm so sorry.
- What is it?
She overhead some
of the trauma nurses talking.
She knows her husband
didn't make it.
Well, where is she?
She said she was gonna go
clean up in the ladies' room.
¶¶
Debbie?
Debbie.
Debbie:
[ Crying ] I don't want this.
I don't want this.
I don't want this.
[ Toilet flushes ]
Help me.
- It's okay. It's okay.
- Help me.
It's okay.
Angus: We were able to wean your
daughter off bipap with lasix.
- Mm-hmm.
- That is the good news.
Her tox panel came back.
There's no meth
or cocaine in her system.
Yeah, I told you.
But her thyroid levels
are so high
they can't be measured
by our laboratory.
She's in a thyroid storm.
What...
What is a thyroid storm?
A side effect of thyroid meds
is weight loss.
Sometimes patients abuse
those meds to get thin,
but the excessive hormones
in the blood
can reach toxic levels.
It's called a thyroid storm.
It can cause heart failure
and abnormal rhythms.
Aubrey, we've noticed
from your medical records
that you've lost quite
a few pounds over the last year.
From diet and exercise.
You don't have a prescription
for thyroid medication,
but we've known some girls
to sneak their mom's pills.
Do you have a prescription,
Mrs. Clark?
Yes, I do.
Aubrey:
I've never taken my mom's pills.
The only thing I take
are my vitamins.
Mom, you believe me, right?
Yes, honey, of course I do.
Mrs. Clark, could you
step out with me, please?
You did this, didn't you?
What are you talking about?
She could die,
and you're still lying.
Who the hell do you think
you are, young lady?
My name is Dr. Pineda.
Are you gonna tell
the truth or not?
Leanne:
What's going on here?
She's giving her daughter
her thyroid medication
without her knowledge.
Am I right?
Malaya: Answer me!
Am I right?
Are you gonna let her talk
to me like this?
You bet your ass I am.
She could die if you
don't tell me the truth.
Did you give her
your medication... yes or no?
Yes. Yes, but I didn't think
that this was gonna hurt her.
You wanted her to lose weight
so you gave her
your medication and you
told her it was a vitamin.
Mom!
Is that true?
Honey, I never ever
meant to hurt you.
I just wanted... I wanted you
to like yourself, honey.
And it worked!
Didn't it?
It worked.
I wish there was a drug
to make you like me, mom.
[ Monitor beeping rapidly ]
Aubrey. Aubrey, honey!
- She's in vtac.
Angus, let's get her back
in bed.
Honey!
[ Coughing ]
[ Monitor beeping rapidly ]
- He's bleeding out again.
- He's been fine until now.
I thought Dr. Rorish fixed the
bleed with the breathing tube.
Me, too.
I need thoracic,
or I.R. Or...
Oh, he's starting to vomit.
The tube could come out.
Do something!
- [ Coughs ]
- Oh, my God.
- Should I page Dr. Rorish?
- No!
Hudson, we need a surgeon.
- How's my heart rate?
- 210.
It's fast, but it's
not irregularly irregular.
I don't think it's afib.
It's worse.
It's a paroxysmal svt.
Get me to center stage.
I need leanne.
[ Monitor beeping rapidly ]
Aubrey!
Leanne: Malaya, pads.
[ Defibrillator whirs ]
- Charging. Ready?
- Okay, clear.
And now.
[ Gasps ]
[ Sighs ]
[ Beeping steadies ]
Angus:
She's in sinus rhythm.
- Is she gonna be okay?
- She's gonna be okay.
She's gonna need
anti-thyroid medication.
Isabel, call the pharmacy.
- Mom?
- Oh, honey, I'm so sorry.
I... I'm so sorry.
Woman: Doctor.
- Coming through.
- What happened?
I missed you.
Heather, what is it?
Paroxysmal supraventricular
tachycardia.
Uh, Mario, get over here.
Heart rate in the 200s.
- What's his BP?
- High 100s over 60s.
Okay, post m.I.,
this kind of heart rate places
excessive demand on
already stressed cardiac tissue.
How do we proceed from here?
Jesse: Are you still
really teaching now?
I mean, this is me on the table.
Mario?
- Adenosine.
- That's right... a medication...
that will
literally stop your heart.
Why?
- Because it...
Heather. Why would we want
to stop his heart?
To restart it like a computer.
Exactly.
It should restore
normal heart rhythm.
What's the catch?
Jesse: I'll tell you
what the catch is.
You're gonna do it
while I'm still awake,
and it's gonna hurt like hell.
I'm sorry, mama.
Get it done already.
He was fine all shift
after we intubated him.
I've checked the BP twice.
It's still low.
Okay, this breathing tube
has to come out.
I need to take a look at
the bronchi to see the bleeding.
What, extubate him?
He could bleed out.
No, patients with bleeding lungs
don't die from losing blood.
They drown in it.
Hey.
Jesse, I'm gonna
tell you something.
I must be about to die because
you're gonna say
something touchy-feely.
You're not gonna die
because I need you.
Okay?
I need you.
I know.
I love you, too.
Risa, grab another airway.
Dr. Lorenson, tube out, now.
Be ready to re-intubate.
¶¶
Okay, I think I see the bleed.
It's in the left mainstem.
Oh, my God.
We intubated
the wrong mainstem earlier.
Nobody used the bronchoscope
the first time?
Dr. Rorish
intubated blind.
Okay.
Thread the new breathing tube
over my scope.
Risa:
Sat's in the 80s.
You ready?
I'm ready.
Okay, stand by.
Okay.
Sat 75%.
And I am in.
Dr. Lorenson,
inflate the tube, please.
Good breath sounds on the right,
not on the left...
Just what we want.
Let get some fluids in him,
please, and up to the I.R.
Sat's normalizing.
Dr. Rorish, we're ready.
Okay.
Jesse, you ready?
Save my life, daddy.
[ Sighs ]
All right.
[ Groaning ]
[ Flatline ]
[ Beeping steadies ]
- Sinus rhythm.
- Blood pressure's back.
He's good!
[ Cheers and applause ]
He's good.
Marion: Oh, my God.
Oh.
Okay, mama.
You're not going anywhere, okay?
- [ Sighs ]
- You're not going anywhere.
Oh, I love you.
Did you find an open bed
in the addiction clinic
for Mrs. eldrich?
The way you talked
to that woman, Cole,
in her state,
your temper almost killed her.
I told her
what she needed to hear.
No.
You told her what
you needed her to hear.
We both know what that temper
has cost you in the past, son.
I hoped
that you when you came here,
you'd have put all
of that behind you.
I don't need a father-and-son
talk from you.
This isn't
a father-and-son talk.
This is a senior faculty member
telling a new attending
that his behavior
is unacceptable.
[ Elevator dings ]
He'll wake up soon.
I'm here, dad.
My friend Mario
told me you're gonna be okay.
[ Chuckles ]
Eli?
Dad.
Don't worry, dad.
I'm gonna take care of you.
Do you have an explanation
for what you did today?
Not really.
Not really.
That's it?
That's an appropriate answer?
I was trying to be mayonnaise.
Mayonnaise?
Something Jesse said
from that movie,
"officer and a gentleman."
They called him mayonnaise
'cause he's white
and his name's Mayo.
I've seen the movie.
I'm talking about...
I was just trying
to do the right thing, man.
For Jesse.
All right.
What about the others?
Do they get a pass?
This time.
Thank you.
Thank you.
[ Sighs ]
There were, uh, complications
with your patient, Jeff,
the paramedic.
He's fine, but the bleed was
on the left side,
not on the right.
I intubated the wrong side?
I could have killed him.
Well, you didn't.
I corrected it, so...
don't do that, leanne.
Don't internalize this.
We all make mistakes.
Not like that one.
What is it Jesse says?
"Lean on each other.
That's what
siblings are for."
You think he's all you have,
but you're wrong, leanne.
You have me.
You have all of us.
Thank you.
¶¶
Cole:
What are you doing?
Living.