Chicago Med (2015) s02e01 Episode Script
Soul Care
1 Chicago Med, we're inbound with a 24-year-old female, Cheryl Martin, high-speed collision on Route 30, T-boned on the passenger side.
34 weeks pregnant, chest and belly pain.
Heart rate 124, BP 102 over 80.
Got it.
We'll be waiting.
- Dr.
Halstead? - Maggie? Incoming helo, ten minutes out.
[tense music.]
Double cappuccino.
What are you doing with my phone? I'm posting this.
My little girl please Baghdad.
- Page OB.
- Got it.
- Maggie.
- Yep.
- Dad? - I'm here, honey.
- You need an assistant? - Sure.
- Coming through.
- Need x-rays, chest and pelvis.
- Got it.
- Sir, what is your name? Ray.
Why don't you come with me and let the doctors do their work, okay? This way.
- Dad, Dad, please.
- Stay right here.
He'll be right here, sweetie.
On my count, one, two, three.
I need the ultrasound.
Should I start a femoral line? - I'll do that.
- Okay, get a triple Excuse me.
Lungs are wet.
Belly's soft but tender.
Get a CBC, type and screen, KB and coags.
If she's RH negative, give RhoGAM.
Got good heart tones and fetal movement.
Baby and placenta look okay.
I'm in.
Clear! Natalie.
Left hemothorax.
She's bleeding.
Put in a chest tube and give her back all the blood you get out.
We're going to put a tube in your chest, okay? - My baby? - Won't hurt the baby.
- Betadyne, Lidocaine.
- I got it.
[whimpers.]
[breathing heavily.]
I'm in.
Secure the tube and let's get her over to CT.
[panting.]
We're taking your daughter up for a CAT scan; you can come.
Okay.
- Dr.
Rhodes.
Welcome to CT surgery.
Dr.
Latham, thank you.
I'll be supervising your fellowship.
I look forward to it.
Dr.
Downey thought very highly of you.
I'm curious.
There are rumors.
Did you kill him? I'm sorry? Did you? Well, yes, I killed him and several other patients as well.
You're being sarcastic.
Yes, Dr.
Latham.
I am being sarcastic.
I can see why you might have found that inappropriate.
Oh, I should tell you You weren't my first choice for this fellowship.
I preferred a young woman from Groote Schuur, but I was out-voted.
Hmm.
Such is life.
That being said, I hope we will work well together.
Sputum test was negative.
Chest is clear.
Night sweats? - No.
- Good.
TB's still latent.
For now.
No reason it shouldn't stay that way.
Anything I need to know? I worry about Tate and his son.
They've been tested, April, They're negative.
And you're not contagious.
I know, I know, but What? I just don't feel clean.
New residents settling in? Yeah.
Now I just got to keep 'em from killing people.
July 1st is not a good day to need a hospital.
[chuckles.]
And how are you doing? Cleaned out Bert's desk this morning.
Thought it would make me feel better.
- It didn't.
- Mm.
- Good morning.
- Dr.
Choi.
Our new Chief Resident will need this.
- E.
D.
staff contact list.
- Thank you.
Oh, and one more thing.
I know I got the Chief Resident's gavel here somewhere.
- [chuckles.]
- [laughing.]
Funny.
By the way, Maggie, I've got some ideas to improve patient flow.
Oh.
Can't wait to hear about them.
I hate killing their dreams.
No, you like to let them hang themselves.
Morning.
Hey.
Here are my scheduling sheets.
Last Chief Res gave them to me.
Thanks, but I've got my own system.
How we ran sick bay on the carrier.
Hey, Dr.
Choi, I'm taking off.
I texted you I'm switching shifts with Elise Baker.
Right, yeah.
And she also she called.
She said she's going to be a little late.
She has to take her kid in for shots.
No problem, thanks.
Sure you don't want these sheets? No, I got it.
Dr.
Choi, we need you.
Chout, talk to me.
Emmie Miles, 15-year-old girl.
Found unconscious, suspected opioid overdose.
She appeared to have smoked a Fentanyl patch.
Okay, we're going to treatment Six.
I got it, Maggie.
- All right.
- You give her NARCAN? Five times.
She responded in the ambo.
Just slid back into overdose.
All right, let's move her.
On my count.
Ready? One, two, three.
April, let's give her another two milligrams NARCAN - and hang a drip.
- Got it.
Bring her down slowly, don't want to precipitate withdrawal.
Chout, Fentanyl patch.
This girl try to kill herself? No idea, Doc.
Grande quad half-caf nonfat no whip mocha.
Not half-caf.
Three shots regular, one shot decaf.
Okay.
So what happened to your knee? I'm embarrassed to say, I tripped over a suitcase.
Missed my conference in Lyon.
At least I got to practice French with an orthopedic nurse from Montreal.
So, Dr.
Reese, the reason why I'm here, uh, aside from the coffee, of course, is that Med has a residency opening for you.
- I'll take it.
- On my service.
- Psychiatry? - Enough foam, enough foam.
Okay.
Um Dr.
Charles, thank you, but I've never considered psychiatry.
I don't think I'm equipped.
I think you have all the tools.
You're a problem solver.
You pay attention.
And look at how beautiful you're making my coffee despite all my meddling.
But I don't know how to talk to people.
It's actually more about listening than talking.
Grande quad 3/4-caf nonfat no whip mocha.
I tell you what.
How about you come and spend the day with me, and then see what you think.
She has a contained rupture of the aorta.
A pseudoaneurysm.
That's how we read it.
It's leaking.
Let's get her up to the cath lab, fix it.
Cheryl's 34 weeks pregnant.
Wouldn't that irradiate the baby? Well, it's not ideal, but it's very little radiation.
- What about surgery? - That's the other option.
We'd have to put her on bypass.
We can't protect the baby's heart rate.
So let's give her a c-section.
Take the baby out of the equation.
No.
She could still carry this baby to term.
Natalie, you are very concerned about the baby, but what about the mother? She is lying there with an aortic injury.
[breathing heavily.]
- Honey.
- Dad.
Your daughter has some damage to her aorta.
It's what we call a pseudoaneurysm.
And it caused a leak in the vessel wall.
Sometimes a leak like this will stop on its own.
If that's the case, then Cheryl will be able to carry the baby to term.
So at this point, we're just going to wait and watch.
We're going to take her up to the ICU where we can keep a close eye on her.
Whatever you think is best.
Oh, my chest.
Oh! - Mr.
Buckner? - Daddy! - He's having an M.
I.
- Dad? - Oh, oh.
- Daddy, what's happening? No pulse.
Code blue! Radiology hallway! We need a crash cart.
- Yes, Doctor.
- Daddy! We're going to take care of him; just lie still.
Just stay here.
- Nat, get a quick look.
- [crying.]
He's in v-fib.
Charge to 200.
Hold compressions.
Clear! Clear.
Still in v-fib.
Clear! Clear.
- Daddy.
- Sinus rhythm.
- We got a pulse.
- He's back.
Let's get him up to the cath lab now.
- On my count.
One, two three.
- Daddy.
Daddy! Daddy! All right, let's go.
- Huge ST changes.
- Yeah, it's a bad one.
- Morning, Dr.
Choi.
- Morning.
- This your Fentanyl OD? - Yes.
Sarah, are you back? I've invited Dr.
Reese to become a psych resident.
- That's great.
- You think so? Absolutely.
I'm a great believer in psychiatry.
Huh, interesting.
Dr.
Charles, this is the patient's mother, Mrs.
Miles.
Nice to meet you, Mrs.
Miles.
This is my colleague, Dr.
Reese.
I don't understand this.
Emmie doesn't use drugs.
A Fentanyl patch is a very high dose of a very strong opioid.
This is a difficult question, but I have to ask it.
Do you think there's any chance that your daughter could have been trying to take her own life? No, absolutely not.
She's very popular.
She has hundreds of friends.
She has no reason to kill herself.
Do you have any idea how she might have gotten hold of the patch? My mother has cancer.
She's prescribed Fentanyl patches for pain.
I suppose she could Would you mind if we talk with her for a bit? Please.
Go ahead.
Thank you.
Honey, I'll be back in a couple of minutes, hmm? Hi, Emmie, how are you feeling? I'm Dr.
Charles.
And I'm Dr.
Reese.
Can you tell us what happened today? Leave me alone.
We're concerned about you, Emmie.
And we need to understand what happened so that we can take care of you.
We just want to help.
You know what? Why don't we come back later.
And maybe you'll feel like talking then.
You know who the most unhappy people in the world are? - Hmm? - 15-year-old girls.
I remember.
Mom said Emmie had hundreds of friends.
- Hyperbole? - Maybe not.
She could have hundreds of friends.
Oh, like that.
Girls her age share everything.
They judge everything.
Maybe Emmie was shamed, and that led to a suicide attempt.
- Let me know what you find.
- Mm-hmm.
Nice bunch of newbies.
[chuckles.]
Maybe even the Ice Princess will finally find somebody.
The "Ice Princess"? Yeah, Dr.
Manning, who else? Just a princess? Why not the Ice Queen? It was a joke.
[whispering.]
It was a joke.
Dr.
Halstead.
HR informed me that you still haven't supplied them with current malpractice insurance.
Well, I'm trying to find a carrier that will write me a policy.
I'm guessing that's because of the lawsuit.
Doesn't make sense.
The suit was dropped.
But to an insurance company, you still look like a bad risk.
Attending physicians must provide their own malpractice insurance.
Now, the hospital could give you a grace period of two weeks, - but after that - I understand.
Look, I know you and I have had our ups and downs, but I don't want to lose you.
So I'll make a few calls.
Thank you.
You may not want to thank me.
I guarantee, your insurance will not come cheap.
- Courtney? - 33-year-old male, peds versus auto, GCS 15.
Bruising to the right orbit, no loss of consciousness.
All right, wait a second.
Dr.
Choi.
Got a GSW in Baghdad.
Where's Baker? Took her kid in for shots, remember? - I'll take it.
- What room, Dr.
Choi? - Trauma 3.
- You heard your Chief Resident.
- Let's go.
- It's it's occupied.
Dr.
Choi.
Go to Trauma 2.
Rotate.
Patient told me he's HIV positive.
- That's right, be careful.
- No problem.
On my count.
One, two, three.
Get out.
Can you tell me your name, sir? Greg Allen.
Can you tell me how this happened? Crossing the street.
Wasn't looking.
Will somebody please call my wife? - The number's in my wallet.
- I will.
Lungs are clear.
- I'll take it from here.
- I got it.
I'll take it.
- Thank you.
- I'm HIV positive.
Okay.
Follow my finger.
All right, retractor's in.
Looks good.
Let's harvest.
Check the LIMA pulse.
The LIMA looks small.
How about the saphenous vein? No.
The left internal mammary artery is always the first and best option.
I understand.
It's just Dr.
Downey preferred the saphenous vein to a small LIMA.
LIMA pulse is good.
Let's start freeing it up.
If you're sure.
Ben Zona! Al ta'atzben otti! I know what I'm doing and I don't like to be contradicted by a fellow while I am operating! [exhales sharply.]
Give me the Bovie.
And Emmie does have hundreds of friends.
623 to be exact.
She's on a lot of social media platforms.
623 friends? Yikes.
Who do you invite to the birthday party? Mm-hmm.
She isn't always very nice to the other girls.
Not very nice? She wasn't shamed.
She's the shamer.
Interesting.
Well, so what do you think? Maybe Emmie realized she really hurt someone, and she felt guilty.
Guilty enough to kill herself? Hmm, I don't know.
You know what? We got to get Emmie to open up.
Next time Mom takes a break, jump in there, give it another shot.
Uh, Dr.
Charles, wait.
Where are you going? Well, I just thought Emmie might be more comfortable talking to a woman and somebody her own age.
But I don't know what to say or what to ask.
I think that once you get in there, you'll discover that you do.
Thank you.
It's just I hate standing around.
I mean, I've had a lot of experience, and this guy won't let me do anything.
I know he's your friend and I'm sure he's a really good doctor, but Mm-hmm.
I don't know.
Jeff, can I Can I ask you something? Yeah.
Do I seem like a An ice princess? A what? A nurse called me that today.
Do I come across as rigid or uptight? Really? Come on.
Do you remember back when the four of us were hanging out? You were the one who always kept the party going.
Do you remember that one time we were at a Greek restaurant? There was a wedding party next to us, and they were breaking plates.
So you got us to start breaking plates, and the next thing you know, you're standing on the table, and you were waving your arms and you were yelling, like, "Opa! Opa!" You were crazy.
- Oh, my God, yes.
- You remember that? The bouzouki player wanted me to join the band.
- That's right.
That was great.
- Mm-hmm, yeah.
- [laughing.]
- Yeah, it really was.
Mmm.
See, I told you.
Everything's gonna be okay.
I still have to be on antibiotics for another five months.
Hey, we we'll be all clear by New Year's.
So, tonight, you're gonna come over.
I'll cook dinner.
I'll see how I feel after work.
Okay.
All right.
You're not contagious, honey.
Doesn't hurt to be careful.
Okay.
Hey.
How are you feeling? Your, um, your blood pressure looks good.
- And your heart rate - Are you a shrink? Uh, no.
I'm barely a doctor.
I just graduated medical school.
I was, uh, checking out your Instagram photos.
[chuckles.]
And you look really beautiful.
I always hate the way I look in photos.
Yeah.
You need to take a lot.
You do? I took about 100 to get that one.
Oh.
I have to look perfect or I won't send it.
You've been reading my tweets too? Mm-hmm.
You must think I'm a horrible person.
Why would I think that? 'Cause of what I say about other girls.
No.
No, I, um I just think you're under a lot of pressure to be perfect.
Oh, God.
- Emmie? - I'm not I'm not perfect.
Emmie, nobody is.
You don't understand.
Look.
It's vitiligo.
I Googled it.
You can't cure it.
It's gonna spread all over my body.
Every everybody's gonna make fun of me.
My life is ruined.
[sobbing.]
Emmie, did you try to kill yourself? I don't know.
You don't know? I just I just wanted it all to go away.
[sobbing.]
I'm gonna take a skin scraping; is that okay? He extubated easily, and the graft is in.
You were right about using the LIMA.
True, but he's hemolyzing.
His urine output is marginal and pink.
Neither's uncommon after being on pump.
Nothing to suggest he won't make a full recovery.
There's also nothing to suggest he will.
Dr.
Latham.
Um I realize, like every doctor who teaches here, you have your own methods.
But, I assume, if I have an opinion, you'd like to hear it.
Well, of course.
Why? Well, it's just that you seemed very upset in the O.
R.
Did I? Yes.
I'm not upset.
I can't see! Help me! Mr.
Allen? I can see out of my right eye.
Dr.
Wheeler! I can't see out of my right eye! The CT showed a hematoma.
Check the intraocular pressure.
- Where's my wife? - She's on her way.
Pressure's high.
He's got a retrobulbar hemorrhage.
He needs a lateral canthotomy.
The patient is HIV positive.
Now, or he'll lose the eye.
[whimpering.]
Help me.
- Clamp.
- [whimpering.]
Here.
- Surgical scissors.
- Here.
[whimpering.]
[moaning.]
[breathing heavily.]
Your vision will return in a little while.
Thank you.
Thank you.
Did Dr.
Wheeler tell you to perform that procedure? It was an emergency.
The patient could have gone blind in that eye.
Then why didn't Dr.
Wheeler perform it? You'll have to ask Dr.
Wheeler.
You're a medical student.
You're not allowed to do an invasive procedure unless ordered to do so by a doctor.
I've done a lateral canthotomy the third year on optho.
You're not on optho.
You're in the E.
D.
, and there are rules.
And unless you figure that out, you're gonna get yourself kicked out of here and med school.
You understand? I hear you.
Do you want me to write him up? No.
It's for his own good.
I know what happens when you don't follow protocol.
It's not personal.
Why didn't you tell me that you were coming back to Med? I didn't know until this morning.
So you'll be back in the E.
D.
? Uh, not exactly.
Dr.
Charles wants me to be a psych resident.
You? Is that such a shock? I just didn't realize that you had an interest in that.
I didn't.
I don't.
I I don't know.
What do you see? I wish people wouldn't diagnose themselves.
- They always screw it up.
- Hmm.
Your patient doesn't have vitiligo.
She has tinea veriscolor.
- A yeast infection? - Yeah.
That's wonderful.
You know, I'm gonna miss the smell of coffee on you.
It's a little early to tell, but my initial assessment is that your father is doing well post-op.
- Thank you.
- Mm-hmm.
Dr.
Rhodes.
Excuse us.
You can see.
The leak from her pseudoaneurysm is increasing.
I still think we should watch it.
Natalie, if she goes into labor, it could rupture and kill her.
We gotta take care of this now.
We'll take Cheryl to the Hybrid Room.
I'll shield the baby with a lead blanket and stent her.
We'll have OB standing by.
If anything goes wrong, they can perform an emergency c-section.
Nat, we've got to deal with this.
I'll page OB.
[door opens, closes.]
[footsteps approaching.]
Doctor? I was with his daughter when he crashed.
How is he? Mr.
Buckner is in and out of non-sustained v-tach.
Heart rate spikes to 180.
How long has it been going on? 15 minutes.
We've started an amiodarone infusion.
Should suppress his arrhythmia.
Your lips to God's ear.
Ready to cannulate.
Seeing decels on the fetal heart rate down to 110.
In position to place the stent.
Dr.
Manning's right.
I don't like that tracing.
Just a little bit longer.
- Heart rate's down to 100.
- [electronic beeping.]
No time.
The baby's in distress.
- We have to get her out now.
- Okay.
[indistinct chatter.]
Last heart rate was 85.
Cut the cord.
Dr.
Manning.
She's all yours, Dr.
Rhodes.
Okay, fluoro on.
Let's go.
I'm not hearing anything.
How's the baby? First APGAR 6 but already improving.
- How's mom? - Hanging in there.
Placing the stent now.
And deploy.
It's in.
Well-seated.
[crying.]
His creatinine levels hit 2.
5.
Is he responding to diuretics? - No.
- [exhales sharply.]
I'm not sure why his kidneys aren't working.
Possibly post CPR and pump.
Call renal, see what the nephrologists suggest.
Yes, Dr.
Latham.
Your little girl is doing just fine.
Oh, look at you.
Oh, thank you.
Cheryl.
I'm afraid your father is not doing very well.
What do you mean? I'm gonna go check on him.
I'll let you know.
Please take me to him.
Cheryl, you just had an emergency c-section.
Take me and my baby.
- I can't do that.
- Please.
My dad.
Pressure's dropping.
- No pulse.
- Call a code.
Will, start compressions.
Epi, one milligram.
- Charge to 200.
- Code blue.
All right, hold compressions.
- Clear.
- Clear.
Fine v-fib.
- 200 again.
- Charging 200.
Hold.
- Clear.
- Clear.
Let me do it.
He's asystole.
He's gone, Connor.
- Vasopressin 40.
Now.
- [sustained beep.]
Dr.
Rhodes, the patient is dead.
Time of death, 15:20.
[machine beeps.]
[machine beeps.]
Connor.
[machine beeps.]
[machine beeps.]
[machine beeps.]
Daddy.
Look.
It's your granddaughter.
[exhaling slowly.]
Daddy? Oh, no.
[crying.]
I've never seen anything like that.
Oh, no.
Baruch Dayan emet.
[muffled crying.]
Dr.
Reese, how's our patient? I gave her ketoconazole cream.
Her fungal infection should be gone in a week.
- Excellent.
- Mm-hmm.
Dr.
Charles, I've decided I will take that residency in psychiatry.
I see now that by combining my clinical knowledge with psychology, maybe I really can help people.
I am so glad to hear that.
You're not talking about Emmie though, are you? - Um - Listen, you very skillfully treated a superficial skin infection.
Unfortunately, neither of us have done anything to address the profound underlying psychological issues that she suffers from.
I'm just saying, you know, our patient has a long way to go.
Oh.
Yes.
Anybody ever tell you the etymology of the word "psychiatry"? The medical treatment of the soul.
Isn't that marvelous? So, worry not, Dr.
Reese.
We all all of us have a long way to go in healing our souls.
- Dr.
Choi.
- Yes? My patient waited 2 1/2 hours for a treatment room, but I understand Treatment 1 has been free all day.
- Yeah.
- Wonderful.
I'd sure like to know where Noah Sexton disappeared to.
35 grand a year.
- Huh? - What my malpractice is going to cost.
And that's on top of my student loans, which now because I'm an attending, I have to start paying off.
How's your "sick bay" system working? [chuckles.]
I will take those scheduling sheets after all.
You can have 'em.
Well, you know, the thing I learned early on, the nurses, they run everything anyway.
Yeah.
You know, I saw a dead man come back to life today.
Makes all this other stuff seem kinda small.
Do you think she's on pre-exposure prophylaxis? Pretty standard with HIV.
Why? Doesn't look like he's afraid he'll infect her.
Well, there's very little risk, April.
Learn to deal with things, April.
Life's not perfect.
But it is pretty great.
- Hey, Dad.
- Hi, sweetie.
Let me check your phone.
I want to see how many "likes" we got.
- "Likes"? - The selfie we took.
22.
Hey, you know what we should do? What? We should take one in front of Dylan's Candy Bar.
That'll make everybody jealous.
Yeah, you know what we should do? We should go live in a cave with no electricity until you're about 35 years old.
That's what we should do.
- Daddy.
- What? April.
Hey.
[thunder rumbling.]
So so how are we feeling after work? Good.
Then dinner tonight? You you like my raviolis, right? I tolerate your ravioli.
[chuckles.]
Are you sure you're okay with everything? Me, the whole package? Baby, I'm sure.
- I'll make the garlic bread.
- [chuckles.]
- Come on.
- [both laughing.]
Oh.
[chuckles.]
Mm.
I got these.
- Thanks.
- [sighs.]
- I'll get 'em next time.
- Okay.
You know, I didn't expect to see you here.
My mother-in-law insisted on taking Owen for the night.
She says I need a life.
[laughing.]
[both laughing.]
- Ah.
- Ahem.
My car is, um, is over there.
- Okay, I'll walk you to it.
- No, no.
You don't have to do that.
Okay.
My apartment is just around the block anyway, so Okay.
Well good night.
You want to come by for a night cap? Yeah.
Yeah, I do.
34 weeks pregnant, chest and belly pain.
Heart rate 124, BP 102 over 80.
Got it.
We'll be waiting.
- Dr.
Halstead? - Maggie? Incoming helo, ten minutes out.
[tense music.]
Double cappuccino.
What are you doing with my phone? I'm posting this.
My little girl please Baghdad.
- Page OB.
- Got it.
- Maggie.
- Yep.
- Dad? - I'm here, honey.
- You need an assistant? - Sure.
- Coming through.
- Need x-rays, chest and pelvis.
- Got it.
- Sir, what is your name? Ray.
Why don't you come with me and let the doctors do their work, okay? This way.
- Dad, Dad, please.
- Stay right here.
He'll be right here, sweetie.
On my count, one, two, three.
I need the ultrasound.
Should I start a femoral line? - I'll do that.
- Okay, get a triple Excuse me.
Lungs are wet.
Belly's soft but tender.
Get a CBC, type and screen, KB and coags.
If she's RH negative, give RhoGAM.
Got good heart tones and fetal movement.
Baby and placenta look okay.
I'm in.
Clear! Natalie.
Left hemothorax.
She's bleeding.
Put in a chest tube and give her back all the blood you get out.
We're going to put a tube in your chest, okay? - My baby? - Won't hurt the baby.
- Betadyne, Lidocaine.
- I got it.
[whimpers.]
[breathing heavily.]
I'm in.
Secure the tube and let's get her over to CT.
[panting.]
We're taking your daughter up for a CAT scan; you can come.
Okay.
- Dr.
Rhodes.
Welcome to CT surgery.
Dr.
Latham, thank you.
I'll be supervising your fellowship.
I look forward to it.
Dr.
Downey thought very highly of you.
I'm curious.
There are rumors.
Did you kill him? I'm sorry? Did you? Well, yes, I killed him and several other patients as well.
You're being sarcastic.
Yes, Dr.
Latham.
I am being sarcastic.
I can see why you might have found that inappropriate.
Oh, I should tell you You weren't my first choice for this fellowship.
I preferred a young woman from Groote Schuur, but I was out-voted.
Hmm.
Such is life.
That being said, I hope we will work well together.
Sputum test was negative.
Chest is clear.
Night sweats? - No.
- Good.
TB's still latent.
For now.
No reason it shouldn't stay that way.
Anything I need to know? I worry about Tate and his son.
They've been tested, April, They're negative.
And you're not contagious.
I know, I know, but What? I just don't feel clean.
New residents settling in? Yeah.
Now I just got to keep 'em from killing people.
July 1st is not a good day to need a hospital.
[chuckles.]
And how are you doing? Cleaned out Bert's desk this morning.
Thought it would make me feel better.
- It didn't.
- Mm.
- Good morning.
- Dr.
Choi.
Our new Chief Resident will need this.
- E.
D.
staff contact list.
- Thank you.
Oh, and one more thing.
I know I got the Chief Resident's gavel here somewhere.
- [chuckles.]
- [laughing.]
Funny.
By the way, Maggie, I've got some ideas to improve patient flow.
Oh.
Can't wait to hear about them.
I hate killing their dreams.
No, you like to let them hang themselves.
Morning.
Hey.
Here are my scheduling sheets.
Last Chief Res gave them to me.
Thanks, but I've got my own system.
How we ran sick bay on the carrier.
Hey, Dr.
Choi, I'm taking off.
I texted you I'm switching shifts with Elise Baker.
Right, yeah.
And she also she called.
She said she's going to be a little late.
She has to take her kid in for shots.
No problem, thanks.
Sure you don't want these sheets? No, I got it.
Dr.
Choi, we need you.
Chout, talk to me.
Emmie Miles, 15-year-old girl.
Found unconscious, suspected opioid overdose.
She appeared to have smoked a Fentanyl patch.
Okay, we're going to treatment Six.
I got it, Maggie.
- All right.
- You give her NARCAN? Five times.
She responded in the ambo.
Just slid back into overdose.
All right, let's move her.
On my count.
Ready? One, two, three.
April, let's give her another two milligrams NARCAN - and hang a drip.
- Got it.
Bring her down slowly, don't want to precipitate withdrawal.
Chout, Fentanyl patch.
This girl try to kill herself? No idea, Doc.
Grande quad half-caf nonfat no whip mocha.
Not half-caf.
Three shots regular, one shot decaf.
Okay.
So what happened to your knee? I'm embarrassed to say, I tripped over a suitcase.
Missed my conference in Lyon.
At least I got to practice French with an orthopedic nurse from Montreal.
So, Dr.
Reese, the reason why I'm here, uh, aside from the coffee, of course, is that Med has a residency opening for you.
- I'll take it.
- On my service.
- Psychiatry? - Enough foam, enough foam.
Okay.
Um Dr.
Charles, thank you, but I've never considered psychiatry.
I don't think I'm equipped.
I think you have all the tools.
You're a problem solver.
You pay attention.
And look at how beautiful you're making my coffee despite all my meddling.
But I don't know how to talk to people.
It's actually more about listening than talking.
Grande quad 3/4-caf nonfat no whip mocha.
I tell you what.
How about you come and spend the day with me, and then see what you think.
She has a contained rupture of the aorta.
A pseudoaneurysm.
That's how we read it.
It's leaking.
Let's get her up to the cath lab, fix it.
Cheryl's 34 weeks pregnant.
Wouldn't that irradiate the baby? Well, it's not ideal, but it's very little radiation.
- What about surgery? - That's the other option.
We'd have to put her on bypass.
We can't protect the baby's heart rate.
So let's give her a c-section.
Take the baby out of the equation.
No.
She could still carry this baby to term.
Natalie, you are very concerned about the baby, but what about the mother? She is lying there with an aortic injury.
[breathing heavily.]
- Honey.
- Dad.
Your daughter has some damage to her aorta.
It's what we call a pseudoaneurysm.
And it caused a leak in the vessel wall.
Sometimes a leak like this will stop on its own.
If that's the case, then Cheryl will be able to carry the baby to term.
So at this point, we're just going to wait and watch.
We're going to take her up to the ICU where we can keep a close eye on her.
Whatever you think is best.
Oh, my chest.
Oh! - Mr.
Buckner? - Daddy! - He's having an M.
I.
- Dad? - Oh, oh.
- Daddy, what's happening? No pulse.
Code blue! Radiology hallway! We need a crash cart.
- Yes, Doctor.
- Daddy! We're going to take care of him; just lie still.
Just stay here.
- Nat, get a quick look.
- [crying.]
He's in v-fib.
Charge to 200.
Hold compressions.
Clear! Clear.
Still in v-fib.
Clear! Clear.
- Daddy.
- Sinus rhythm.
- We got a pulse.
- He's back.
Let's get him up to the cath lab now.
- On my count.
One, two three.
- Daddy.
Daddy! Daddy! All right, let's go.
- Huge ST changes.
- Yeah, it's a bad one.
- Morning, Dr.
Choi.
- Morning.
- This your Fentanyl OD? - Yes.
Sarah, are you back? I've invited Dr.
Reese to become a psych resident.
- That's great.
- You think so? Absolutely.
I'm a great believer in psychiatry.
Huh, interesting.
Dr.
Charles, this is the patient's mother, Mrs.
Miles.
Nice to meet you, Mrs.
Miles.
This is my colleague, Dr.
Reese.
I don't understand this.
Emmie doesn't use drugs.
A Fentanyl patch is a very high dose of a very strong opioid.
This is a difficult question, but I have to ask it.
Do you think there's any chance that your daughter could have been trying to take her own life? No, absolutely not.
She's very popular.
She has hundreds of friends.
She has no reason to kill herself.
Do you have any idea how she might have gotten hold of the patch? My mother has cancer.
She's prescribed Fentanyl patches for pain.
I suppose she could Would you mind if we talk with her for a bit? Please.
Go ahead.
Thank you.
Honey, I'll be back in a couple of minutes, hmm? Hi, Emmie, how are you feeling? I'm Dr.
Charles.
And I'm Dr.
Reese.
Can you tell us what happened today? Leave me alone.
We're concerned about you, Emmie.
And we need to understand what happened so that we can take care of you.
We just want to help.
You know what? Why don't we come back later.
And maybe you'll feel like talking then.
You know who the most unhappy people in the world are? - Hmm? - 15-year-old girls.
I remember.
Mom said Emmie had hundreds of friends.
- Hyperbole? - Maybe not.
She could have hundreds of friends.
Oh, like that.
Girls her age share everything.
They judge everything.
Maybe Emmie was shamed, and that led to a suicide attempt.
- Let me know what you find.
- Mm-hmm.
Nice bunch of newbies.
[chuckles.]
Maybe even the Ice Princess will finally find somebody.
The "Ice Princess"? Yeah, Dr.
Manning, who else? Just a princess? Why not the Ice Queen? It was a joke.
[whispering.]
It was a joke.
Dr.
Halstead.
HR informed me that you still haven't supplied them with current malpractice insurance.
Well, I'm trying to find a carrier that will write me a policy.
I'm guessing that's because of the lawsuit.
Doesn't make sense.
The suit was dropped.
But to an insurance company, you still look like a bad risk.
Attending physicians must provide their own malpractice insurance.
Now, the hospital could give you a grace period of two weeks, - but after that - I understand.
Look, I know you and I have had our ups and downs, but I don't want to lose you.
So I'll make a few calls.
Thank you.
You may not want to thank me.
I guarantee, your insurance will not come cheap.
- Courtney? - 33-year-old male, peds versus auto, GCS 15.
Bruising to the right orbit, no loss of consciousness.
All right, wait a second.
Dr.
Choi.
Got a GSW in Baghdad.
Where's Baker? Took her kid in for shots, remember? - I'll take it.
- What room, Dr.
Choi? - Trauma 3.
- You heard your Chief Resident.
- Let's go.
- It's it's occupied.
Dr.
Choi.
Go to Trauma 2.
Rotate.
Patient told me he's HIV positive.
- That's right, be careful.
- No problem.
On my count.
One, two, three.
Get out.
Can you tell me your name, sir? Greg Allen.
Can you tell me how this happened? Crossing the street.
Wasn't looking.
Will somebody please call my wife? - The number's in my wallet.
- I will.
Lungs are clear.
- I'll take it from here.
- I got it.
I'll take it.
- Thank you.
- I'm HIV positive.
Okay.
Follow my finger.
All right, retractor's in.
Looks good.
Let's harvest.
Check the LIMA pulse.
The LIMA looks small.
How about the saphenous vein? No.
The left internal mammary artery is always the first and best option.
I understand.
It's just Dr.
Downey preferred the saphenous vein to a small LIMA.
LIMA pulse is good.
Let's start freeing it up.
If you're sure.
Ben Zona! Al ta'atzben otti! I know what I'm doing and I don't like to be contradicted by a fellow while I am operating! [exhales sharply.]
Give me the Bovie.
And Emmie does have hundreds of friends.
623 to be exact.
She's on a lot of social media platforms.
623 friends? Yikes.
Who do you invite to the birthday party? Mm-hmm.
She isn't always very nice to the other girls.
Not very nice? She wasn't shamed.
She's the shamer.
Interesting.
Well, so what do you think? Maybe Emmie realized she really hurt someone, and she felt guilty.
Guilty enough to kill herself? Hmm, I don't know.
You know what? We got to get Emmie to open up.
Next time Mom takes a break, jump in there, give it another shot.
Uh, Dr.
Charles, wait.
Where are you going? Well, I just thought Emmie might be more comfortable talking to a woman and somebody her own age.
But I don't know what to say or what to ask.
I think that once you get in there, you'll discover that you do.
Thank you.
It's just I hate standing around.
I mean, I've had a lot of experience, and this guy won't let me do anything.
I know he's your friend and I'm sure he's a really good doctor, but Mm-hmm.
I don't know.
Jeff, can I Can I ask you something? Yeah.
Do I seem like a An ice princess? A what? A nurse called me that today.
Do I come across as rigid or uptight? Really? Come on.
Do you remember back when the four of us were hanging out? You were the one who always kept the party going.
Do you remember that one time we were at a Greek restaurant? There was a wedding party next to us, and they were breaking plates.
So you got us to start breaking plates, and the next thing you know, you're standing on the table, and you were waving your arms and you were yelling, like, "Opa! Opa!" You were crazy.
- Oh, my God, yes.
- You remember that? The bouzouki player wanted me to join the band.
- That's right.
That was great.
- Mm-hmm, yeah.
- [laughing.]
- Yeah, it really was.
Mmm.
See, I told you.
Everything's gonna be okay.
I still have to be on antibiotics for another five months.
Hey, we we'll be all clear by New Year's.
So, tonight, you're gonna come over.
I'll cook dinner.
I'll see how I feel after work.
Okay.
All right.
You're not contagious, honey.
Doesn't hurt to be careful.
Okay.
Hey.
How are you feeling? Your, um, your blood pressure looks good.
- And your heart rate - Are you a shrink? Uh, no.
I'm barely a doctor.
I just graduated medical school.
I was, uh, checking out your Instagram photos.
[chuckles.]
And you look really beautiful.
I always hate the way I look in photos.
Yeah.
You need to take a lot.
You do? I took about 100 to get that one.
Oh.
I have to look perfect or I won't send it.
You've been reading my tweets too? Mm-hmm.
You must think I'm a horrible person.
Why would I think that? 'Cause of what I say about other girls.
No.
No, I, um I just think you're under a lot of pressure to be perfect.
Oh, God.
- Emmie? - I'm not I'm not perfect.
Emmie, nobody is.
You don't understand.
Look.
It's vitiligo.
I Googled it.
You can't cure it.
It's gonna spread all over my body.
Every everybody's gonna make fun of me.
My life is ruined.
[sobbing.]
Emmie, did you try to kill yourself? I don't know.
You don't know? I just I just wanted it all to go away.
[sobbing.]
I'm gonna take a skin scraping; is that okay? He extubated easily, and the graft is in.
You were right about using the LIMA.
True, but he's hemolyzing.
His urine output is marginal and pink.
Neither's uncommon after being on pump.
Nothing to suggest he won't make a full recovery.
There's also nothing to suggest he will.
Dr.
Latham.
Um I realize, like every doctor who teaches here, you have your own methods.
But, I assume, if I have an opinion, you'd like to hear it.
Well, of course.
Why? Well, it's just that you seemed very upset in the O.
R.
Did I? Yes.
I'm not upset.
I can't see! Help me! Mr.
Allen? I can see out of my right eye.
Dr.
Wheeler! I can't see out of my right eye! The CT showed a hematoma.
Check the intraocular pressure.
- Where's my wife? - She's on her way.
Pressure's high.
He's got a retrobulbar hemorrhage.
He needs a lateral canthotomy.
The patient is HIV positive.
Now, or he'll lose the eye.
[whimpering.]
Help me.
- Clamp.
- [whimpering.]
Here.
- Surgical scissors.
- Here.
[whimpering.]
[moaning.]
[breathing heavily.]
Your vision will return in a little while.
Thank you.
Thank you.
Did Dr.
Wheeler tell you to perform that procedure? It was an emergency.
The patient could have gone blind in that eye.
Then why didn't Dr.
Wheeler perform it? You'll have to ask Dr.
Wheeler.
You're a medical student.
You're not allowed to do an invasive procedure unless ordered to do so by a doctor.
I've done a lateral canthotomy the third year on optho.
You're not on optho.
You're in the E.
D.
, and there are rules.
And unless you figure that out, you're gonna get yourself kicked out of here and med school.
You understand? I hear you.
Do you want me to write him up? No.
It's for his own good.
I know what happens when you don't follow protocol.
It's not personal.
Why didn't you tell me that you were coming back to Med? I didn't know until this morning.
So you'll be back in the E.
D.
? Uh, not exactly.
Dr.
Charles wants me to be a psych resident.
You? Is that such a shock? I just didn't realize that you had an interest in that.
I didn't.
I don't.
I I don't know.
What do you see? I wish people wouldn't diagnose themselves.
- They always screw it up.
- Hmm.
Your patient doesn't have vitiligo.
She has tinea veriscolor.
- A yeast infection? - Yeah.
That's wonderful.
You know, I'm gonna miss the smell of coffee on you.
It's a little early to tell, but my initial assessment is that your father is doing well post-op.
- Thank you.
- Mm-hmm.
Dr.
Rhodes.
Excuse us.
You can see.
The leak from her pseudoaneurysm is increasing.
I still think we should watch it.
Natalie, if she goes into labor, it could rupture and kill her.
We gotta take care of this now.
We'll take Cheryl to the Hybrid Room.
I'll shield the baby with a lead blanket and stent her.
We'll have OB standing by.
If anything goes wrong, they can perform an emergency c-section.
Nat, we've got to deal with this.
I'll page OB.
[door opens, closes.]
[footsteps approaching.]
Doctor? I was with his daughter when he crashed.
How is he? Mr.
Buckner is in and out of non-sustained v-tach.
Heart rate spikes to 180.
How long has it been going on? 15 minutes.
We've started an amiodarone infusion.
Should suppress his arrhythmia.
Your lips to God's ear.
Ready to cannulate.
Seeing decels on the fetal heart rate down to 110.
In position to place the stent.
Dr.
Manning's right.
I don't like that tracing.
Just a little bit longer.
- Heart rate's down to 100.
- [electronic beeping.]
No time.
The baby's in distress.
- We have to get her out now.
- Okay.
[indistinct chatter.]
Last heart rate was 85.
Cut the cord.
Dr.
Manning.
She's all yours, Dr.
Rhodes.
Okay, fluoro on.
Let's go.
I'm not hearing anything.
How's the baby? First APGAR 6 but already improving.
- How's mom? - Hanging in there.
Placing the stent now.
And deploy.
It's in.
Well-seated.
[crying.]
His creatinine levels hit 2.
5.
Is he responding to diuretics? - No.
- [exhales sharply.]
I'm not sure why his kidneys aren't working.
Possibly post CPR and pump.
Call renal, see what the nephrologists suggest.
Yes, Dr.
Latham.
Your little girl is doing just fine.
Oh, look at you.
Oh, thank you.
Cheryl.
I'm afraid your father is not doing very well.
What do you mean? I'm gonna go check on him.
I'll let you know.
Please take me to him.
Cheryl, you just had an emergency c-section.
Take me and my baby.
- I can't do that.
- Please.
My dad.
Pressure's dropping.
- No pulse.
- Call a code.
Will, start compressions.
Epi, one milligram.
- Charge to 200.
- Code blue.
All right, hold compressions.
- Clear.
- Clear.
Fine v-fib.
- 200 again.
- Charging 200.
Hold.
- Clear.
- Clear.
Let me do it.
He's asystole.
He's gone, Connor.
- Vasopressin 40.
Now.
- [sustained beep.]
Dr.
Rhodes, the patient is dead.
Time of death, 15:20.
[machine beeps.]
[machine beeps.]
Connor.
[machine beeps.]
[machine beeps.]
[machine beeps.]
Daddy.
Look.
It's your granddaughter.
[exhaling slowly.]
Daddy? Oh, no.
[crying.]
I've never seen anything like that.
Oh, no.
Baruch Dayan emet.
[muffled crying.]
Dr.
Reese, how's our patient? I gave her ketoconazole cream.
Her fungal infection should be gone in a week.
- Excellent.
- Mm-hmm.
Dr.
Charles, I've decided I will take that residency in psychiatry.
I see now that by combining my clinical knowledge with psychology, maybe I really can help people.
I am so glad to hear that.
You're not talking about Emmie though, are you? - Um - Listen, you very skillfully treated a superficial skin infection.
Unfortunately, neither of us have done anything to address the profound underlying psychological issues that she suffers from.
I'm just saying, you know, our patient has a long way to go.
Oh.
Yes.
Anybody ever tell you the etymology of the word "psychiatry"? The medical treatment of the soul.
Isn't that marvelous? So, worry not, Dr.
Reese.
We all all of us have a long way to go in healing our souls.
- Dr.
Choi.
- Yes? My patient waited 2 1/2 hours for a treatment room, but I understand Treatment 1 has been free all day.
- Yeah.
- Wonderful.
I'd sure like to know where Noah Sexton disappeared to.
35 grand a year.
- Huh? - What my malpractice is going to cost.
And that's on top of my student loans, which now because I'm an attending, I have to start paying off.
How's your "sick bay" system working? [chuckles.]
I will take those scheduling sheets after all.
You can have 'em.
Well, you know, the thing I learned early on, the nurses, they run everything anyway.
Yeah.
You know, I saw a dead man come back to life today.
Makes all this other stuff seem kinda small.
Do you think she's on pre-exposure prophylaxis? Pretty standard with HIV.
Why? Doesn't look like he's afraid he'll infect her.
Well, there's very little risk, April.
Learn to deal with things, April.
Life's not perfect.
But it is pretty great.
- Hey, Dad.
- Hi, sweetie.
Let me check your phone.
I want to see how many "likes" we got.
- "Likes"? - The selfie we took.
22.
Hey, you know what we should do? What? We should take one in front of Dylan's Candy Bar.
That'll make everybody jealous.
Yeah, you know what we should do? We should go live in a cave with no electricity until you're about 35 years old.
That's what we should do.
- Daddy.
- What? April.
Hey.
[thunder rumbling.]
So so how are we feeling after work? Good.
Then dinner tonight? You you like my raviolis, right? I tolerate your ravioli.
[chuckles.]
Are you sure you're okay with everything? Me, the whole package? Baby, I'm sure.
- I'll make the garlic bread.
- [chuckles.]
- Come on.
- [both laughing.]
Oh.
[chuckles.]
Mm.
I got these.
- Thanks.
- [sighs.]
- I'll get 'em next time.
- Okay.
You know, I didn't expect to see you here.
My mother-in-law insisted on taking Owen for the night.
She says I need a life.
[laughing.]
[both laughing.]
- Ah.
- Ahem.
My car is, um, is over there.
- Okay, I'll walk you to it.
- No, no.
You don't have to do that.
Okay.
My apartment is just around the block anyway, so Okay.
Well good night.
You want to come by for a night cap? Yeah.
Yeah, I do.