Chicago Med (2015) s01e17 Episode Script
Withdrawal
1 [bird squawks.]
Have you seen my coat? It's right here.
- Don't touch that.
Get away, get away.
- [laughs softly.]
It's really taking to you.
Ha, funny.
No, he really has.
It's because I'm the one with the food.
That's why I took to you.
Really? That mean if I feed you some seeds you'll forget about teaching this course? And miss two months in Bethesda? It's the vacation capital of Montgomery County.
[squawks.]
Get away, get away.
[laughs softly.]
Don't touch that.
Get away.
[laughter.]
[bird squawks.]
Hmm.
They charge you twice for your cable again? No, I got offered a job.
Yeah? That's great.
I guess.
It's in California.
Oh.
But I mean, that's okay, right? It's nice out there.
Yeah, definitely.
It's just just far.
Have you heard from Rush yet? Northwestern? Uh, still waiting.
Course, there's always a chance things could work out here.
Very slim chance.
Hey, you two.
Patients incoming.
You're going to Treatment 6.
April, you got this? - Yeah.
- Thank you.
Right here.
What do we got? Chuck Gleason, 42-year-old male.
Found at the bottom of some stairs on Lower Wacker with a fractured left tibia.
Okay, on my count.
One, two, three.
Oh.
He looks dehydrated.
Let's call ortho and start some fluids.
- Oh.
- On it.
Starter 1, let's get him set up.
Let's pull the board out.
You got a drink, April? Could really use a drink.
Are you guys friends? Frequent flier.
Alcohol.
And everything that goes with it.
How 'bout you, buddy? You got a drink? Unfortunately, this is a hospital, not a bar.
When did this happen? Yesterday.
Oh.
All right, let's get a chest X-ray and a UA.
- Okay.
- [groans.]
Okay, Mr.
Gleason, you broke your leg pretty bad.
We're gonna have to evaluate this and - He's seizing.
- Mr.
Gleason? All right, milligram of Ativan.
- On it.
- It's a grand mal seizure.
He ever had this before? Not that I've seen.
Milligram of Ativan.
He's withdrawing.
He's going into delirium tremens.
You know.
Never seen him get DTs before.
It's gonna be bad, isn't it? Is it ever good? [dramatic music.]
[sighs.]
- Hey.
Thanks for the bird.
Kids are gonna love it.
Definitely.
Glad he'll have a nice home.
Yeah.
Anything I need to know? Nope.
Just enjoy.
All right, you're a good man, Doc.
[chuckles.]
[siren wails in distance.]
Cirrhosis, hepatitis, cardiomyopathy, renal failure.
Reads like the index of "Harrison's Guide to Internal Medicine.
" [retches.]
[panting.]
Ah.
Ah! Mr.
Gleason, when was your last drink? Two nights ago, which is why I need to get the hell out of here.
Afraid I can't do that.
Talk to this guy, will you please? I'm sorry, Chuck, the doctor's in charge.
No, I'm in charge, okay? I'm in charge.
I know my rights.
I don't have to stay here if I don't want to stay here.
That's very true, but you're not going to get far on that leg without ortho taking care of it.
Okay, fine, man.
It's cool.
W-w-what are we talking about here, two hours? Mr.
Gleason, you're going through delirium tremens.
Your body is so used to the presence of alcohol that it's reacting violently to its absence.
Blah, blah, blah! We need to keep you here a day or so till you get through it.
Ain't gonna happen, man.
Okay? I seen what happens with the DTs.
I can't go through that, please.
We can't stop them, but we have given you a sedative to make it easier.
I'm sorry, but at this point, it's no longer safe for you to leave.
[whimpers.]
[vomits.]
Okay.
Okay.
[retches.]
Hey, Maggie, can you call ortho and see what's taking so long? Sure can.
Hey.
Where's your wedding ring? I-I don't know.
Um I had it on when I got here.
You didn't put it in your locker? No, I never take it off.
Well, where else have you been? Re-trace your steps.
I've been in and out of five rooms, washing my hands.
I mean, who knows how many gloves I've taken on and off? [tense music.]
Maggie.
All right, all right, I got this.
Everyone, listen up.
We're missing a gold wedding band, so take a room and search every inch of it.
From now on, nothing leaves the ED.
Every sheet, every gown, every piece of trash gets bagged and stored until I search it.
Got that? Hey, we're gonna find it, okay? I'm gonna check in the lounge.
- Okay.
- Thank you.
Okay.
So this is Rose Wechsler, 83.
Arrived from her nursing facility confused and agitated.
Ms.
Wechsler, good morning.
Baloney.
Are you here for the sink? You know, I'm not.
But it would help me out a great deal if you would tell me what year it was.
Check your damn calendar.
No wonder you people never show up on time.
That's completely my fault.
Do you mind if I just shine What are you, some kind of a maniac? Get the hell out of here! Thank you.
Out! Lovely to meet you.
What do you think? [sighs.]
Nursing home delirium.
Acute cognitive dysfunction from some combination of dehydration, stasis, over-medication, and a lack of human engagement.
Could be.
She's neurologically intact but her mucous membranes are dry.
If you're right, fluids will perk her up.
Mm, yeah, for now.
What? Well, I'm sorry, it's just that her records indicate she led a remarkable life.
Was one of the first female test pilots, trained at NASA.
Even if fluids work, it's sad seeing someone like that wind up like this.
Well Incoming! Dr.
Choi.
We're going to Baghdad.
- [alarm beeps.]
- [indistinct P.
A.
announcement.]
On it.
Talk to me.
Frank McCormick.
Here's his EKG.
42, lost his rhythm again in the van.
Shocked from v-fib in the field.
Hang in there, Frank, it's going to be okay.
Excuse us, ma'am.
Let's rotate.
[suspenseful music.]
All right, let's transfer him on my count.
One, two, three.
Transfer.
Dr.
Choi, what have you got? STEMI.
A big one.
[machines beeping.]
He flipped back into v-fib.
- On it.
- STATs are dropping.
- Frank.
- Paddles to Dr.
Choi.
Ma'am, ma'am, is this your husband? - Yes.
- He had a heart attack.
Please step outside.
- Oh, my God.
- Come with me and stand right there.
- Charge 200.
- Charging.
- Clear.
- Clear.
[machines beeping.]
[paddles shock.]
[machine flat-lining.]
Charging.
[paddles whirring.]
Clear.
[paddles shock.]
[machine beeping.]
Heart rate's back to 65.
Pressure's 115 over 60.
All right, let's get him up to the cath lab.
Based on his EKG, he's gonna need a bypass.
Okay, let's go.
Watch the lines.
Wait.
Did you say he needs a bypass? Yes, ma'am.
We got your husband's rhythm back, but he's still not out of the woods.
We need to find the blockage that caused his heart attack and most likely, we will graft new vessels on around it.
But that means going on a heart-lung machine, right? Yes, it does.
Then I'll have to refuse.
Refuse? What? My husband can't have any surgery that involves the administration of blood.
We're Jehovah's Witnesses.
Stop! Stop it! Get it off of me.
They're inside of this thing now.
Chuck, you're hallucinating again.
It's part of the DTs.
We're gonna increase your sedatives.
I don't want a sedative.
How many times do I got to tell you that? I don't need a sedative.
I don't need a sedative.
I need a drink.
You know I can't do that.
Then get the hell out of here! Hey, how long have I known you? Years.
Every time you come in here, you are sicker.
One of these times you're going to be too far gone.
Chuck, listen to me.
You're never gonna beat this if you give in now.
[crying.]
I'm never gonna beat this.
I ain't beating nothing.
Please help.
Make it stop.
Please, please, make it stop.
I'm trying to help you.
[vomits.]
[clears throat.]
[gags.]
I told you I told you how to help me, but you don't listen.
Going to increase your sedatives, and I'm going to get you a clean blanket.
I don't need a clean blanket.
I need a drink.
Youse are killing me with all your help! [dark music.]
Frank, we respect your beliefs, we do.
But the fact is, you're going to have another heart attack.
The only question is when.
You page me? This is Dr.
Downey, our top cardiothoracic surgeon.
I was just explaining to the McCormicks that unfortunately surgery is the only option that we have left.
And I was explaining that we need an alternative that doesn't involve the administration of blood.
It is his own blood.
It's re-circulated.
Blood contains the gift of life.
Once it leaves the body, it's contaminated forever.
I know you think we're being difficult, but this isn't just about the danger that Frank's body is in right now.
It's about he and I being able to spend eternity together.
We understand, but you have to What about bloodless surgery? What's that? It's where we do it off-pump.
Operate on the heart while it's still beating.
[tense music.]
You can do that? Yes.
Though it comes with significant risks.
For the McCormicks, the heart-lung machine is a risk.
Stopping the heart, removing the blood to oxygenate it, then putting it back violates their faith, so let's do it without the machine.
Excuse us for a moment.
He's got bad three vessel disease.
He's a terrible candidate.
It's too high of a risk.
Higher than not doing anything at all? Let's at least give them some time to see if they want to choose the safer option.
We don't want to wait.
We want to do the bloodless surgery.
Okay.
I'll inform the OR.
Please, it's a lot Please.
You need to up his benzos.
I already did, twice.
Then give him a milligram of Haldol, too.
[sighs.]
I'll tell you, when I was a clinical nurse I used to dread DT patients.
I know, such misery.
And most of the time they're back in two months to do it all over again.
Mm-hmm.
I lost my wedding ring recently, didn't find it for three days.
What did Bert say? You know, he didn't say anything, which was weird because he's usually so observant.
Huh.
Oh, excuse me.
Daniel.
What are you doing tonight? Mm, working, why? Well, an old friend of Bert's and mine has moved to town and I thought we could all go to dinner.
You know, sounds like a blast but I really am slammed.
Come on, Daniel.
Bert's been so grumpy lately, and he always cheers up when he talks to you.
What's going on? It's a long story, but you'd really be helping me out.
Besides, Maribel loves Scotch and ballroom dancing.
You haven't been out in a while.
You know, there's a reason for that.
There's this new study out, says dating can lead to marriage.
It's just a friendly dinner.
Yeah, and I'm still paying two and a half alimonies.
Those friendly dinners can get expensive.
Ooh, Ms.
Reese, any word on that nursing home patient? Actually, there is.
- Daniel.
- I got to go.
Thank you so much for the invite.
Best to Bert.
We'll do it next time.
So the good news is, Ms.
Wechsler's doing much better after some fluids.
She's awake and alert.
That is good news.
Yes, though she does still have a fever and is reporting lower abdominal pain.
Fluids and scans? All negative except for a slightly elevated white count, but I'm already doing an infectious workup now.
Sounds like a great plan.
What's the bad news? This is Wanda Stern.
In from the same nursing home.
She has a 101 fever and feels Nixon is just what this country needs to run out the commies.
Fluids and labs? Fluids and labs.
Hey.
Sorry about your ring.
It's so stupid.
I can't believe I lost it.
No, no, no.
Come on.
These things, they happen.
No, illnesses happen.
Bad weather happens.
This is on me.
Look, I'm on all your patients, so don't worry, okay? Just try to take it easy.
I feel so terrible.
Like, like I betrayed Jeff, like I didn't care enough.
Hey, April? April.
What's in the bag? Nothing, it's a personal item.
Is that a bottle of booze? [sighs.]
[dramatic music.]
You were going to give that to Mr.
Gleason? My nursing supervisor did it all the time.
April, it's against protocol.
Since when do you care about that? I care about getting our patient through this.
Does he look like he's getting through this? He needs a drink.
I didn't say it would be easy, but that? That's just a Band-Aid.
I come in here every day and I put Band-Aids on patients and most of them thank me for it.
And he may thank you, but you're not helping him.
And you are? Standing around while he dies in front of us? This man has a chance to get past his problem and make a new start.
He's telling us that he doesn't want that, and it's up to us to listen.
No, no, no, no.
It's not my job to listen.
I'm a doctor.
It's my job to decide what is best for him.
That is exactly why I'm a nurse.
Hey.
Uh, Frank McCormick is going into surgery.
I need you to load his angio into the system.
You doctor Rhodes? Uh, yep.
Should be up now.
[tense music.]
Yeah, thanks.
No luck yet, huh? Not yet, but we haven't even gone through the trash.
Are you okay? Yeah, uh [clears throat.]
My head is spinning.
I feel like I'm gonna throw up, but oh, Maggie.
Natalie, I'm gonna find your ring, but in the meantime, I want you to go in there, have a drink of water, and lie down.
Okay? Mmhmm.
All right.
Natalie? I don't know why you guys are ordering all these tests.
I'm anemic.
It was nothing.
That's not what the EKG's saying.
I'm seeing elevated ST segments in the anterior and lateral leads.
Where? Tell echo we're bringing her upstairs.
Echo? I have no cardiac history, no risk factors.
You guys are just being overly cautious because it's me.
Nat, that's darn right that's what we're doing.
Stop being stubborn and listen to the man, please? Let's go.
Ugh.
On Wednesdays, I go downstairs to the beauty shop.
My neighbor Sheila always does my hair.
Okay.
How about the card room? I play a lot of canasta.
- In the south lobby? - No, darling.
Uh, in the north.
Oh.
How we doing, ladies? Any luck? Wanda here is lovely, and though I appreciate your theory that our conditions may arise from the same source, I'm afraid the only thing we have in common is Sinai Gardens.
Ah.
Ms.
Reese, could I, um could I talk to you for a moment? Mm-hmm.
Keep at it.
[sighs.]
Their labs are all negative, but both are febrile with leukocytosis, and infections in the elderly can present quite differently than normal.
I think we need to start looking for zebras.
Rickettsia, leptospirosis Ms.
Stern had some redness in her left eye.
You notice that? Probably from the chlorine in the pool.
She likes to do water aerobics.
But consider the symptoms.
Acute delirium, severe dehydration, lower abdominal pain, one itchy red eye.
Like I said, in an 85-year-old, it could be anything.
If these women were closer to you in age, what might you suspect? [gasps.]
[tense music.]
No.
No, no, no, no, no.
Why not? No.
Because they're old ladies.
They can't have gonorrhea.
Are you trying to tell me that because they're old, they can no longer be sexually active? Well, come on, they barely have the energy to play canasta, whatever that is.
I say we keep digging.
Ahem.
There's a gentleman from the retirement home out there inquiring about the status of your two patients.
Says his name is Clyde.
Hmm.
Maybe they, um, have something in common after all.
We're gonna need some swabs.
Dr.
Halstead! What happened? He just started vomiting blood.
Must have ruptured an esophageal varix.
Prep a Minnesota tube and call for MTP.
I need to intubate.
[suspenseful music.]
It's from years of alcoholic cirrhosis.
The vessels get dilated and tortured.
But why's this all happening right now? Must have ruptured from all the vomiting.
Right, tube.
Got an airway.
Bag him.
Good breath sounds bilaterally.
We need to stop this bleeding.
- Minnesota tube.
- Yes, Doctor.
- What do you need? - Start a groin line.
Get a rapid transfuser, and give him two of blood, stat.
I need more suction.
I got it.
Send a runner to Central for the infuser, and call the blood bank.
I'm on it.
I can't see a damn thing.
All right, I'm gonna have to go in blind.
Line's in.
Start the MTP.
Pressure's down to 80 over 40.
He's bleeding out.
Come on.
Come on.
Got it! - Blood's going.
- Good.
Ready to inflate the internal balloons.
Syringe.
Want an X-ray for placement? No time.
As soon as the balloons are inflated, we'll know whether the pressure they're placing on the vessels is enough to staunch the bleeding.
Bleeding's stopped.
For now.
[tense music.]
Call GI to cauterize the vessels.
Okay.
I'm doing everything I can.
Dr.
Halstead? Dr.
Manning's results from echo.
Knock, knock.
Hey.
Did you get my echo results? Yeah, good news.
You definitely did not have a heart attack.
You see? That's what I've been saying.
But you did have a cardiac event.
Uh, takotsubo cardiomyopathy.
Let me see that.
Um, spasm on your coronary artery.
Would explain the shortness of breath and chest pain.
Scary for sure, but completely reversible.
Yeah, we should have you out of here in a day or two.
Losing my wedding ring.
That's what triggered this.
Hey, it's not always easy to pinpoint the cause of the stress.
You you just can't know.
Will, no, you don't have to sugar-coat it.
I know the colloquial term for this.
Broken heart syndrome.
[solemn music.]
This is about, uh This is about Jeff.
Chance of another episode is incredibly low.
You will get past this, I promise.
Yeah.
I came as soon as Maggie called me.
How is she? Hi, uh she's gonna be okay.
Oh.
Hi.
And LAD is finished.
Raising the heart ventrally to get at the RCA.
Uh-huh.
Two-thirds of the way there.
This is the big one.
Right there.
Scalpel and Gerald.
Scalpel.
[machines beeping.]
Blood pressure bottomed out.
You got to lower the heart back down.
Okay.
[suspenseful music.]
Okay.
Marty? It's not coming back.
He's in v-fib.
We got to put him on the pump.
No, we'll defibrillate him, continue as planned.
And then what? This is gonna happen again.
- Clear.
- Clear.
[instrument whirring.]
[machine beeping.]
Still v-fib.
We have to put him on the pump.
We don't have a choice.
Charge to 50.
Charging.
[instrument whirring.]
Clear.
This isn't working.
We need to get the perfusionist and the bypass team in here now.
That's not an option, Dr.
Rhodes.
Then we will get his wife in here and we will get her consent.
It's his ball game.
I don't understand.
Is Frank okay? Please, put this on.
[dramatic music.]
We're not getting the pressure back.
Frank, oh, my God.
Your husband is dying.
I'm pumping his heart with my hands.
Mrs.
McCormick.
If you don't authorize this right now, you'll never see him alive again.
Is there really no other way? No.
Do what you have to.
Forgive me, Jehovah.
Why don't you come with me outside? Right, let's hook him up and get to work.
This is the right thing to do.
Thank you.
Yeah.
That was Julia.
She needs me to relieve her.
I could bring Owen back here a little later.
Maybe later tonight.
Okay, all right, well, you just, uh you just call me and and let me know what you'd like, all right? Oh, uh, Helen, actually, I'm sorry.
One last thing.
Mmhmm.
Do you know where Jeff got my ring? Well, not right offhand, but I-I could look that up.
Please.
You're not thinking about replacing the ring, are you? Yes, I am.
Do you really think that's a good idea? Why wouldn't it be? Natalie, I know you loved Jeff.
Jeff loved you, but maybe losing the ring is a sign.
A sign? Natalie what do they call this? Broken heart syndrome.
[solemn music.]
Your grieving is so great that it has put you in a hospital bed and is keeping you from coming home to see your son.
So, maybe you just you need to let go a little bit.
How could you say that? I would never let go of Jeff.
I don't mean let go of him.
Just move forward.
[sobs.]
You just you call me and let me know if you need anything from home.
The clap? Yikes.
Have Rose and Wanda been told? How did they take it? You'd have to ask them.
Mr.
Glickman, partner notification is an important part of gonorrhea treatment, and while we really don't want to be intrusive A gentleman never tells.
But if there are others, they should be informed.
There's Cookie.
Beautiful blue eyes.
Cookie? Sylvia, marvelous sense of humor.
So you're sleeping with four different women? Ms.
Reese.
You make it sound tawdry.
It's not like that.
At our age, there are very few men left, and people need companionship.
I make them happy, they make me happy.
And I love them, all of them.
All of them.
I think of it as assisted loving.
We'll get you a shot of ceftriaxone and azithromycin.
The nurse will be with you shortly.
Don't touch that.
Get away.
Hey, Dr.
Choi.
Earl said to give this back to you.
What what do you mean? Made such a racket, wouldn't let him get any sleep.
Said he's going to get a gerbil.
Don't touch that.
Get away, get away.
Sorry, Maggie, I got to go.
Hey, what am I supposed to do with it? I don't know.
Put him in the doctors' lounge.
- [scoffs.]
- Get away, get away.
Come on.
[indistinct P.
A.
announcement.]
[laughs softly.]
Hm.
Oh, Frank, I was so scared.
Told you it'd be all right.
Jehovah lit the path.
It was His will.
These doctors, maybe you should do every surgery this way.
[chuckles softly.]
Mr.
McCormick, you should know that there were complications with the surgery.
What kind of complications? We had to use the bypass machine after all.
I thought we made our wishes clear.
Did they tell you they were doing this? They did.
And you gave them your permission? [tense music.]
How could you do this to me? I did it for you.
For us.
You weren't going to survive the surgery.
And now how am I supposed to survive eternity? Frank, I'm sorry.
- Get out.
- Please.
Get out.
[cries.]
You had no right.
You had no right.
That is why we don't disregard patients' wishes.
Have you read the fine print of what they believe in? They can accept all the fractions of blood but they can't accept them all together.
Does that make any sense to you? Doesn't have to make sense to us.
If he believed he would live longer if his wounds were dressed in green bandages, then we give him green bandages.
Not if the green bandages are going to kill him.
Yeah, even if it kills him.
David, do you really believe that? Or is this just because this is the day that your liver is going to be ablated? I saw your name on the board in IR.
The mass on my liver isn't shrinking.
We're going to try and reduce it again.
In fact, I should mosey down there.
You're a good surgeon, Dr.
Rhodes, but saving a life isn't always the answer, and you will never be a great surgeon until you understand that.
Hey, hey, hey.
Look what I found.
Where did you find it? In a linen bag, stuck to the hem of a fitted sheet.
[poignant music.]
That's why you quadruple check, right? Thank you, Maggie.
I thought it was gone for good.
Well, now it's back.
Mm.
We're gonna beat 'em to the finish line.
Here it comes.
Hold on tight.
- Up we go.
- Whoo! Thank you very much.
Thank you again for all your help.
Ms.
Wechsler, can I ask you something? Sure.
[sighs.]
You're a strong, successful woman.
You flew jets.
Aren't you angry with him? I tell you, Ms.
Reese, some men spend their whole lives with women but never bother to learn what pleases them.
Clyde learned.
Let's go, Rosebud, before this thing turns back into a pumpkin.
Thank you very much.
Going flying.
[sighs.]
He seems like a nice enough guy, but no one is worth lying, cheating, or disease.
Where are you getting lying and cheating? You heard what he said.
Didn't hear that.
This looks like more of an open relationship to me.
Well, you would think by their age they'd be past that.
Past wanting physical intimacy? If my boyfriend ever suggested an open relationship, I'd kill him.
Huh.
You might be surprised how things you once thought were so important become less so when you get older.
My life definitely become bigger, messier, far more interesting than I ever thought it could when I was younger.
And you know what? It hasn't always been such a bad thing.
Well, I'm not that young.
I'm almost 26.
[huffs.]
So you know, I was thinking, if you guys You know, your friend's still going out to dinner, I wouldn't be opposed.
Great, you changed your mind.
Yeah, got hungry.
Well, not too hungry I hope.
My friend's a vegan.
A vegan? And you're telling me now? That's curious.
Important thing is, it'll make Bert happy.
You know I live to serve.
T-shirt and a pair of jeans.
I paid for it.
How much? [laughter.]
Mr.
Gleason seems much improved.
Yeah.
When did his tremors subside? Uh, about 20 minutes ago.
And no more hallucinations? Mm-mmm.
Did we up his benzos? No, why? [tense music.]
Nurse Sexton.
Pretty miraculous turnaround for our frequent flier, don't you think? It looks like he'll pull through, yeah.
Did you give him a drink? No.
Well, someone did, so who was it? Goodwin? I guess once a nurse, always a nurse.
Excuse me, a word, please? Sure.
You gave Mr.
Gleason a drink? He was likely going to die without one.
I've seen it happen.
So it doesn't matter if that was against hospital policy, 'cause I'm pretty sure if that were me, I'd be raked over the coals right now by you.
Damned if you do and damned if you don't.
I admit, it's a bit of a double standard.
What can I say? This patient he had a chance to kick his addiction.
Now it's gone.
Dr.
Halstead, an addict doesn't just kick a habit.
He's got to want to quit, and right now he doesn't.
Listen, you can't force a person to move on from something if they're not ready.
You know they found Dr.
Manning's ring.
Want to come up with me to see her? I'll be up a little later.
Any shortness of breath? Mr.
McCormick, I am sorry.
We were just trying to deal with the circumstances The best you could.
I know.
Do you even think about God's will or just your own? You familiar with Peter 5:2? "Be a shepherd to the flock that is under your care.
"Watch over them.
"Not for what you'll get out of it, but because you are eager to serve God.
" You entrusted me to watch over not just your body but your soul.
You're alive .
because I couldn't imagine life without you.
I misplaced my faith.
Today, I didn't serve God.
But I have to believe that a god of love is also a god of forgiveness.
[solemn music.]
[chuckles.]
[sighs.]
Have you seen my coat? It's right here.
- Don't touch that.
Get away, get away.
- [laughs softly.]
It's really taking to you.
Ha, funny.
No, he really has.
It's because I'm the one with the food.
That's why I took to you.
Really? That mean if I feed you some seeds you'll forget about teaching this course? And miss two months in Bethesda? It's the vacation capital of Montgomery County.
[squawks.]
Get away, get away.
[laughs softly.]
Don't touch that.
Get away.
[laughter.]
[bird squawks.]
Hmm.
They charge you twice for your cable again? No, I got offered a job.
Yeah? That's great.
I guess.
It's in California.
Oh.
But I mean, that's okay, right? It's nice out there.
Yeah, definitely.
It's just just far.
Have you heard from Rush yet? Northwestern? Uh, still waiting.
Course, there's always a chance things could work out here.
Very slim chance.
Hey, you two.
Patients incoming.
You're going to Treatment 6.
April, you got this? - Yeah.
- Thank you.
Right here.
What do we got? Chuck Gleason, 42-year-old male.
Found at the bottom of some stairs on Lower Wacker with a fractured left tibia.
Okay, on my count.
One, two, three.
Oh.
He looks dehydrated.
Let's call ortho and start some fluids.
- Oh.
- On it.
Starter 1, let's get him set up.
Let's pull the board out.
You got a drink, April? Could really use a drink.
Are you guys friends? Frequent flier.
Alcohol.
And everything that goes with it.
How 'bout you, buddy? You got a drink? Unfortunately, this is a hospital, not a bar.
When did this happen? Yesterday.
Oh.
All right, let's get a chest X-ray and a UA.
- Okay.
- [groans.]
Okay, Mr.
Gleason, you broke your leg pretty bad.
We're gonna have to evaluate this and - He's seizing.
- Mr.
Gleason? All right, milligram of Ativan.
- On it.
- It's a grand mal seizure.
He ever had this before? Not that I've seen.
Milligram of Ativan.
He's withdrawing.
He's going into delirium tremens.
You know.
Never seen him get DTs before.
It's gonna be bad, isn't it? Is it ever good? [dramatic music.]
[sighs.]
- Hey.
Thanks for the bird.
Kids are gonna love it.
Definitely.
Glad he'll have a nice home.
Yeah.
Anything I need to know? Nope.
Just enjoy.
All right, you're a good man, Doc.
[chuckles.]
[siren wails in distance.]
Cirrhosis, hepatitis, cardiomyopathy, renal failure.
Reads like the index of "Harrison's Guide to Internal Medicine.
" [retches.]
[panting.]
Ah.
Ah! Mr.
Gleason, when was your last drink? Two nights ago, which is why I need to get the hell out of here.
Afraid I can't do that.
Talk to this guy, will you please? I'm sorry, Chuck, the doctor's in charge.
No, I'm in charge, okay? I'm in charge.
I know my rights.
I don't have to stay here if I don't want to stay here.
That's very true, but you're not going to get far on that leg without ortho taking care of it.
Okay, fine, man.
It's cool.
W-w-what are we talking about here, two hours? Mr.
Gleason, you're going through delirium tremens.
Your body is so used to the presence of alcohol that it's reacting violently to its absence.
Blah, blah, blah! We need to keep you here a day or so till you get through it.
Ain't gonna happen, man.
Okay? I seen what happens with the DTs.
I can't go through that, please.
We can't stop them, but we have given you a sedative to make it easier.
I'm sorry, but at this point, it's no longer safe for you to leave.
[whimpers.]
[vomits.]
Okay.
Okay.
[retches.]
Hey, Maggie, can you call ortho and see what's taking so long? Sure can.
Hey.
Where's your wedding ring? I-I don't know.
Um I had it on when I got here.
You didn't put it in your locker? No, I never take it off.
Well, where else have you been? Re-trace your steps.
I've been in and out of five rooms, washing my hands.
I mean, who knows how many gloves I've taken on and off? [tense music.]
Maggie.
All right, all right, I got this.
Everyone, listen up.
We're missing a gold wedding band, so take a room and search every inch of it.
From now on, nothing leaves the ED.
Every sheet, every gown, every piece of trash gets bagged and stored until I search it.
Got that? Hey, we're gonna find it, okay? I'm gonna check in the lounge.
- Okay.
- Thank you.
Okay.
So this is Rose Wechsler, 83.
Arrived from her nursing facility confused and agitated.
Ms.
Wechsler, good morning.
Baloney.
Are you here for the sink? You know, I'm not.
But it would help me out a great deal if you would tell me what year it was.
Check your damn calendar.
No wonder you people never show up on time.
That's completely my fault.
Do you mind if I just shine What are you, some kind of a maniac? Get the hell out of here! Thank you.
Out! Lovely to meet you.
What do you think? [sighs.]
Nursing home delirium.
Acute cognitive dysfunction from some combination of dehydration, stasis, over-medication, and a lack of human engagement.
Could be.
She's neurologically intact but her mucous membranes are dry.
If you're right, fluids will perk her up.
Mm, yeah, for now.
What? Well, I'm sorry, it's just that her records indicate she led a remarkable life.
Was one of the first female test pilots, trained at NASA.
Even if fluids work, it's sad seeing someone like that wind up like this.
Well Incoming! Dr.
Choi.
We're going to Baghdad.
- [alarm beeps.]
- [indistinct P.
A.
announcement.]
On it.
Talk to me.
Frank McCormick.
Here's his EKG.
42, lost his rhythm again in the van.
Shocked from v-fib in the field.
Hang in there, Frank, it's going to be okay.
Excuse us, ma'am.
Let's rotate.
[suspenseful music.]
All right, let's transfer him on my count.
One, two, three.
Transfer.
Dr.
Choi, what have you got? STEMI.
A big one.
[machines beeping.]
He flipped back into v-fib.
- On it.
- STATs are dropping.
- Frank.
- Paddles to Dr.
Choi.
Ma'am, ma'am, is this your husband? - Yes.
- He had a heart attack.
Please step outside.
- Oh, my God.
- Come with me and stand right there.
- Charge 200.
- Charging.
- Clear.
- Clear.
[machines beeping.]
[paddles shock.]
[machine flat-lining.]
Charging.
[paddles whirring.]
Clear.
[paddles shock.]
[machine beeping.]
Heart rate's back to 65.
Pressure's 115 over 60.
All right, let's get him up to the cath lab.
Based on his EKG, he's gonna need a bypass.
Okay, let's go.
Watch the lines.
Wait.
Did you say he needs a bypass? Yes, ma'am.
We got your husband's rhythm back, but he's still not out of the woods.
We need to find the blockage that caused his heart attack and most likely, we will graft new vessels on around it.
But that means going on a heart-lung machine, right? Yes, it does.
Then I'll have to refuse.
Refuse? What? My husband can't have any surgery that involves the administration of blood.
We're Jehovah's Witnesses.
Stop! Stop it! Get it off of me.
They're inside of this thing now.
Chuck, you're hallucinating again.
It's part of the DTs.
We're gonna increase your sedatives.
I don't want a sedative.
How many times do I got to tell you that? I don't need a sedative.
I don't need a sedative.
I need a drink.
You know I can't do that.
Then get the hell out of here! Hey, how long have I known you? Years.
Every time you come in here, you are sicker.
One of these times you're going to be too far gone.
Chuck, listen to me.
You're never gonna beat this if you give in now.
[crying.]
I'm never gonna beat this.
I ain't beating nothing.
Please help.
Make it stop.
Please, please, make it stop.
I'm trying to help you.
[vomits.]
[clears throat.]
[gags.]
I told you I told you how to help me, but you don't listen.
Going to increase your sedatives, and I'm going to get you a clean blanket.
I don't need a clean blanket.
I need a drink.
Youse are killing me with all your help! [dark music.]
Frank, we respect your beliefs, we do.
But the fact is, you're going to have another heart attack.
The only question is when.
You page me? This is Dr.
Downey, our top cardiothoracic surgeon.
I was just explaining to the McCormicks that unfortunately surgery is the only option that we have left.
And I was explaining that we need an alternative that doesn't involve the administration of blood.
It is his own blood.
It's re-circulated.
Blood contains the gift of life.
Once it leaves the body, it's contaminated forever.
I know you think we're being difficult, but this isn't just about the danger that Frank's body is in right now.
It's about he and I being able to spend eternity together.
We understand, but you have to What about bloodless surgery? What's that? It's where we do it off-pump.
Operate on the heart while it's still beating.
[tense music.]
You can do that? Yes.
Though it comes with significant risks.
For the McCormicks, the heart-lung machine is a risk.
Stopping the heart, removing the blood to oxygenate it, then putting it back violates their faith, so let's do it without the machine.
Excuse us for a moment.
He's got bad three vessel disease.
He's a terrible candidate.
It's too high of a risk.
Higher than not doing anything at all? Let's at least give them some time to see if they want to choose the safer option.
We don't want to wait.
We want to do the bloodless surgery.
Okay.
I'll inform the OR.
Please, it's a lot Please.
You need to up his benzos.
I already did, twice.
Then give him a milligram of Haldol, too.
[sighs.]
I'll tell you, when I was a clinical nurse I used to dread DT patients.
I know, such misery.
And most of the time they're back in two months to do it all over again.
Mm-hmm.
I lost my wedding ring recently, didn't find it for three days.
What did Bert say? You know, he didn't say anything, which was weird because he's usually so observant.
Huh.
Oh, excuse me.
Daniel.
What are you doing tonight? Mm, working, why? Well, an old friend of Bert's and mine has moved to town and I thought we could all go to dinner.
You know, sounds like a blast but I really am slammed.
Come on, Daniel.
Bert's been so grumpy lately, and he always cheers up when he talks to you.
What's going on? It's a long story, but you'd really be helping me out.
Besides, Maribel loves Scotch and ballroom dancing.
You haven't been out in a while.
You know, there's a reason for that.
There's this new study out, says dating can lead to marriage.
It's just a friendly dinner.
Yeah, and I'm still paying two and a half alimonies.
Those friendly dinners can get expensive.
Ooh, Ms.
Reese, any word on that nursing home patient? Actually, there is.
- Daniel.
- I got to go.
Thank you so much for the invite.
Best to Bert.
We'll do it next time.
So the good news is, Ms.
Wechsler's doing much better after some fluids.
She's awake and alert.
That is good news.
Yes, though she does still have a fever and is reporting lower abdominal pain.
Fluids and scans? All negative except for a slightly elevated white count, but I'm already doing an infectious workup now.
Sounds like a great plan.
What's the bad news? This is Wanda Stern.
In from the same nursing home.
She has a 101 fever and feels Nixon is just what this country needs to run out the commies.
Fluids and labs? Fluids and labs.
Hey.
Sorry about your ring.
It's so stupid.
I can't believe I lost it.
No, no, no.
Come on.
These things, they happen.
No, illnesses happen.
Bad weather happens.
This is on me.
Look, I'm on all your patients, so don't worry, okay? Just try to take it easy.
I feel so terrible.
Like, like I betrayed Jeff, like I didn't care enough.
Hey, April? April.
What's in the bag? Nothing, it's a personal item.
Is that a bottle of booze? [sighs.]
[dramatic music.]
You were going to give that to Mr.
Gleason? My nursing supervisor did it all the time.
April, it's against protocol.
Since when do you care about that? I care about getting our patient through this.
Does he look like he's getting through this? He needs a drink.
I didn't say it would be easy, but that? That's just a Band-Aid.
I come in here every day and I put Band-Aids on patients and most of them thank me for it.
And he may thank you, but you're not helping him.
And you are? Standing around while he dies in front of us? This man has a chance to get past his problem and make a new start.
He's telling us that he doesn't want that, and it's up to us to listen.
No, no, no, no.
It's not my job to listen.
I'm a doctor.
It's my job to decide what is best for him.
That is exactly why I'm a nurse.
Hey.
Uh, Frank McCormick is going into surgery.
I need you to load his angio into the system.
You doctor Rhodes? Uh, yep.
Should be up now.
[tense music.]
Yeah, thanks.
No luck yet, huh? Not yet, but we haven't even gone through the trash.
Are you okay? Yeah, uh [clears throat.]
My head is spinning.
I feel like I'm gonna throw up, but oh, Maggie.
Natalie, I'm gonna find your ring, but in the meantime, I want you to go in there, have a drink of water, and lie down.
Okay? Mmhmm.
All right.
Natalie? I don't know why you guys are ordering all these tests.
I'm anemic.
It was nothing.
That's not what the EKG's saying.
I'm seeing elevated ST segments in the anterior and lateral leads.
Where? Tell echo we're bringing her upstairs.
Echo? I have no cardiac history, no risk factors.
You guys are just being overly cautious because it's me.
Nat, that's darn right that's what we're doing.
Stop being stubborn and listen to the man, please? Let's go.
Ugh.
On Wednesdays, I go downstairs to the beauty shop.
My neighbor Sheila always does my hair.
Okay.
How about the card room? I play a lot of canasta.
- In the south lobby? - No, darling.
Uh, in the north.
Oh.
How we doing, ladies? Any luck? Wanda here is lovely, and though I appreciate your theory that our conditions may arise from the same source, I'm afraid the only thing we have in common is Sinai Gardens.
Ah.
Ms.
Reese, could I, um could I talk to you for a moment? Mm-hmm.
Keep at it.
[sighs.]
Their labs are all negative, but both are febrile with leukocytosis, and infections in the elderly can present quite differently than normal.
I think we need to start looking for zebras.
Rickettsia, leptospirosis Ms.
Stern had some redness in her left eye.
You notice that? Probably from the chlorine in the pool.
She likes to do water aerobics.
But consider the symptoms.
Acute delirium, severe dehydration, lower abdominal pain, one itchy red eye.
Like I said, in an 85-year-old, it could be anything.
If these women were closer to you in age, what might you suspect? [gasps.]
[tense music.]
No.
No, no, no, no, no.
Why not? No.
Because they're old ladies.
They can't have gonorrhea.
Are you trying to tell me that because they're old, they can no longer be sexually active? Well, come on, they barely have the energy to play canasta, whatever that is.
I say we keep digging.
Ahem.
There's a gentleman from the retirement home out there inquiring about the status of your two patients.
Says his name is Clyde.
Hmm.
Maybe they, um, have something in common after all.
We're gonna need some swabs.
Dr.
Halstead! What happened? He just started vomiting blood.
Must have ruptured an esophageal varix.
Prep a Minnesota tube and call for MTP.
I need to intubate.
[suspenseful music.]
It's from years of alcoholic cirrhosis.
The vessels get dilated and tortured.
But why's this all happening right now? Must have ruptured from all the vomiting.
Right, tube.
Got an airway.
Bag him.
Good breath sounds bilaterally.
We need to stop this bleeding.
- Minnesota tube.
- Yes, Doctor.
- What do you need? - Start a groin line.
Get a rapid transfuser, and give him two of blood, stat.
I need more suction.
I got it.
Send a runner to Central for the infuser, and call the blood bank.
I'm on it.
I can't see a damn thing.
All right, I'm gonna have to go in blind.
Line's in.
Start the MTP.
Pressure's down to 80 over 40.
He's bleeding out.
Come on.
Come on.
Got it! - Blood's going.
- Good.
Ready to inflate the internal balloons.
Syringe.
Want an X-ray for placement? No time.
As soon as the balloons are inflated, we'll know whether the pressure they're placing on the vessels is enough to staunch the bleeding.
Bleeding's stopped.
For now.
[tense music.]
Call GI to cauterize the vessels.
Okay.
I'm doing everything I can.
Dr.
Halstead? Dr.
Manning's results from echo.
Knock, knock.
Hey.
Did you get my echo results? Yeah, good news.
You definitely did not have a heart attack.
You see? That's what I've been saying.
But you did have a cardiac event.
Uh, takotsubo cardiomyopathy.
Let me see that.
Um, spasm on your coronary artery.
Would explain the shortness of breath and chest pain.
Scary for sure, but completely reversible.
Yeah, we should have you out of here in a day or two.
Losing my wedding ring.
That's what triggered this.
Hey, it's not always easy to pinpoint the cause of the stress.
You you just can't know.
Will, no, you don't have to sugar-coat it.
I know the colloquial term for this.
Broken heart syndrome.
[solemn music.]
This is about, uh This is about Jeff.
Chance of another episode is incredibly low.
You will get past this, I promise.
Yeah.
I came as soon as Maggie called me.
How is she? Hi, uh she's gonna be okay.
Oh.
Hi.
And LAD is finished.
Raising the heart ventrally to get at the RCA.
Uh-huh.
Two-thirds of the way there.
This is the big one.
Right there.
Scalpel and Gerald.
Scalpel.
[machines beeping.]
Blood pressure bottomed out.
You got to lower the heart back down.
Okay.
[suspenseful music.]
Okay.
Marty? It's not coming back.
He's in v-fib.
We got to put him on the pump.
No, we'll defibrillate him, continue as planned.
And then what? This is gonna happen again.
- Clear.
- Clear.
[instrument whirring.]
[machine beeping.]
Still v-fib.
We have to put him on the pump.
We don't have a choice.
Charge to 50.
Charging.
[instrument whirring.]
Clear.
This isn't working.
We need to get the perfusionist and the bypass team in here now.
That's not an option, Dr.
Rhodes.
Then we will get his wife in here and we will get her consent.
It's his ball game.
I don't understand.
Is Frank okay? Please, put this on.
[dramatic music.]
We're not getting the pressure back.
Frank, oh, my God.
Your husband is dying.
I'm pumping his heart with my hands.
Mrs.
McCormick.
If you don't authorize this right now, you'll never see him alive again.
Is there really no other way? No.
Do what you have to.
Forgive me, Jehovah.
Why don't you come with me outside? Right, let's hook him up and get to work.
This is the right thing to do.
Thank you.
Yeah.
That was Julia.
She needs me to relieve her.
I could bring Owen back here a little later.
Maybe later tonight.
Okay, all right, well, you just, uh you just call me and and let me know what you'd like, all right? Oh, uh, Helen, actually, I'm sorry.
One last thing.
Mmhmm.
Do you know where Jeff got my ring? Well, not right offhand, but I-I could look that up.
Please.
You're not thinking about replacing the ring, are you? Yes, I am.
Do you really think that's a good idea? Why wouldn't it be? Natalie, I know you loved Jeff.
Jeff loved you, but maybe losing the ring is a sign.
A sign? Natalie what do they call this? Broken heart syndrome.
[solemn music.]
Your grieving is so great that it has put you in a hospital bed and is keeping you from coming home to see your son.
So, maybe you just you need to let go a little bit.
How could you say that? I would never let go of Jeff.
I don't mean let go of him.
Just move forward.
[sobs.]
You just you call me and let me know if you need anything from home.
The clap? Yikes.
Have Rose and Wanda been told? How did they take it? You'd have to ask them.
Mr.
Glickman, partner notification is an important part of gonorrhea treatment, and while we really don't want to be intrusive A gentleman never tells.
But if there are others, they should be informed.
There's Cookie.
Beautiful blue eyes.
Cookie? Sylvia, marvelous sense of humor.
So you're sleeping with four different women? Ms.
Reese.
You make it sound tawdry.
It's not like that.
At our age, there are very few men left, and people need companionship.
I make them happy, they make me happy.
And I love them, all of them.
All of them.
I think of it as assisted loving.
We'll get you a shot of ceftriaxone and azithromycin.
The nurse will be with you shortly.
Don't touch that.
Get away.
Hey, Dr.
Choi.
Earl said to give this back to you.
What what do you mean? Made such a racket, wouldn't let him get any sleep.
Said he's going to get a gerbil.
Don't touch that.
Get away, get away.
Sorry, Maggie, I got to go.
Hey, what am I supposed to do with it? I don't know.
Put him in the doctors' lounge.
- [scoffs.]
- Get away, get away.
Come on.
[indistinct P.
A.
announcement.]
[laughs softly.]
Hm.
Oh, Frank, I was so scared.
Told you it'd be all right.
Jehovah lit the path.
It was His will.
These doctors, maybe you should do every surgery this way.
[chuckles softly.]
Mr.
McCormick, you should know that there were complications with the surgery.
What kind of complications? We had to use the bypass machine after all.
I thought we made our wishes clear.
Did they tell you they were doing this? They did.
And you gave them your permission? [tense music.]
How could you do this to me? I did it for you.
For us.
You weren't going to survive the surgery.
And now how am I supposed to survive eternity? Frank, I'm sorry.
- Get out.
- Please.
Get out.
[cries.]
You had no right.
You had no right.
That is why we don't disregard patients' wishes.
Have you read the fine print of what they believe in? They can accept all the fractions of blood but they can't accept them all together.
Does that make any sense to you? Doesn't have to make sense to us.
If he believed he would live longer if his wounds were dressed in green bandages, then we give him green bandages.
Not if the green bandages are going to kill him.
Yeah, even if it kills him.
David, do you really believe that? Or is this just because this is the day that your liver is going to be ablated? I saw your name on the board in IR.
The mass on my liver isn't shrinking.
We're going to try and reduce it again.
In fact, I should mosey down there.
You're a good surgeon, Dr.
Rhodes, but saving a life isn't always the answer, and you will never be a great surgeon until you understand that.
Hey, hey, hey.
Look what I found.
Where did you find it? In a linen bag, stuck to the hem of a fitted sheet.
[poignant music.]
That's why you quadruple check, right? Thank you, Maggie.
I thought it was gone for good.
Well, now it's back.
Mm.
We're gonna beat 'em to the finish line.
Here it comes.
Hold on tight.
- Up we go.
- Whoo! Thank you very much.
Thank you again for all your help.
Ms.
Wechsler, can I ask you something? Sure.
[sighs.]
You're a strong, successful woman.
You flew jets.
Aren't you angry with him? I tell you, Ms.
Reese, some men spend their whole lives with women but never bother to learn what pleases them.
Clyde learned.
Let's go, Rosebud, before this thing turns back into a pumpkin.
Thank you very much.
Going flying.
[sighs.]
He seems like a nice enough guy, but no one is worth lying, cheating, or disease.
Where are you getting lying and cheating? You heard what he said.
Didn't hear that.
This looks like more of an open relationship to me.
Well, you would think by their age they'd be past that.
Past wanting physical intimacy? If my boyfriend ever suggested an open relationship, I'd kill him.
Huh.
You might be surprised how things you once thought were so important become less so when you get older.
My life definitely become bigger, messier, far more interesting than I ever thought it could when I was younger.
And you know what? It hasn't always been such a bad thing.
Well, I'm not that young.
I'm almost 26.
[huffs.]
So you know, I was thinking, if you guys You know, your friend's still going out to dinner, I wouldn't be opposed.
Great, you changed your mind.
Yeah, got hungry.
Well, not too hungry I hope.
My friend's a vegan.
A vegan? And you're telling me now? That's curious.
Important thing is, it'll make Bert happy.
You know I live to serve.
T-shirt and a pair of jeans.
I paid for it.
How much? [laughter.]
Mr.
Gleason seems much improved.
Yeah.
When did his tremors subside? Uh, about 20 minutes ago.
And no more hallucinations? Mm-mmm.
Did we up his benzos? No, why? [tense music.]
Nurse Sexton.
Pretty miraculous turnaround for our frequent flier, don't you think? It looks like he'll pull through, yeah.
Did you give him a drink? No.
Well, someone did, so who was it? Goodwin? I guess once a nurse, always a nurse.
Excuse me, a word, please? Sure.
You gave Mr.
Gleason a drink? He was likely going to die without one.
I've seen it happen.
So it doesn't matter if that was against hospital policy, 'cause I'm pretty sure if that were me, I'd be raked over the coals right now by you.
Damned if you do and damned if you don't.
I admit, it's a bit of a double standard.
What can I say? This patient he had a chance to kick his addiction.
Now it's gone.
Dr.
Halstead, an addict doesn't just kick a habit.
He's got to want to quit, and right now he doesn't.
Listen, you can't force a person to move on from something if they're not ready.
You know they found Dr.
Manning's ring.
Want to come up with me to see her? I'll be up a little later.
Any shortness of breath? Mr.
McCormick, I am sorry.
We were just trying to deal with the circumstances The best you could.
I know.
Do you even think about God's will or just your own? You familiar with Peter 5:2? "Be a shepherd to the flock that is under your care.
"Watch over them.
"Not for what you'll get out of it, but because you are eager to serve God.
" You entrusted me to watch over not just your body but your soul.
You're alive .
because I couldn't imagine life without you.
I misplaced my faith.
Today, I didn't serve God.
But I have to believe that a god of love is also a god of forgiveness.
[solemn music.]
[chuckles.]
[sighs.]