Chicago Med (2015) s02e09 Episode Script
Uncharted Territory
1 - April.
- Huh? - Cutting board? - Corner cabinet by the lazy Susan.
- Yeah.
- And you still haven't weighed in on the paint choices that I asked you about.
Uh, what room is that for again? The den.
Come on, Tate.
I've been working on this remodel for weeks.
I know.
I know.
I'm sorry, babe.
I love that you're making my house our house.
I love that we set a date for the wedding.
- But I'm driving you crazy.
- Yep.
- [laughs.]
- You know what? Stuck in a house on TB leave I get it.
I mean, I've been trying to keep busy, 'cause when I'm not, I can't help but worry.
First ultrasound today.
Yeah.
It's gonna be perfect.
[chatter, sirens blaring.]
Are you crazy? Where's your jacket? Don't need it.
I love the crisp winter air.
Yeah, right.
I can see your goose bumps.
Oh, you mean my pilomotor reflex? Oh, good God.
[both laugh.]
Anyway, this weather is balmy.
Do you remember that February when you and Jeff and me and Lisa we rented that cabin at Lake Mendota? - Yes.
- And then we got hammered on that box of wine we found in the pantry.
Which led to the hot tub.
Which led to you sneaking a peek.
I did not! Did you? No.
Course not.
[both laugh.]
You're terrible.
Ugh! [shivers.]
Seems like a lifetime ago.
How'd we lose touch for so long? I'm not sure.
[sirens wailing.]
Life of a med student.
Lunch'll wait.
Ricky Wade, GCS 15, vitals stable.
You're going to Treatment 4, Dr.
Choi.
Trauma to the left ear with hematoma, multiple dislocated fingers, expanding hematoma of the anterior thigh.
Refused the board and collar.
I'm not a cripple.
I could'a walked.
I know.
MMA.
Feel no pain, right? Any loss of consciousness? Dizziness? Hell no.
That bitch barely connected.
Cage doc called the fight.
Said it was a freakin' bloodbath.
All right.
Let's get an IV in him, then a gram of Ancef.
- [alarm beeps.]
- The opponent? Yep.
You're going to Treatment 3.
- Thanks.
- Cyrus Hammad.
GCS 15.
Significant swelling to his left eye and bruising on the right flank.
No loss of consciousness, but the fight doc wanted to have him looked at anyway.
You're lucky that doc stopped the fight.
I would've pounded you into a living Hey! Not in the cage anymore, huh? Give it a rest.
History and physical and a detailed neuro exam.
Got it.
I'll shout if I need you.
Yeah.
- Excuse me.
- Yes? I'm looking for my brother, Cyrus Hammad.
Cheating-ass punks.
What did you do? Grease some palms? You know your bro was getting his ass beat.
I'm gonna need security in the ED.
- [grunts.]
- Dr.
Choi! Stop him! - Come on! Come on! Come on! - [all shouting at once.]
Chill out! Walk away.
You okay? Yeah.
It's swollen.
Let's get some ice on his thigh and hands.
Had that A-rab eating mat in the first round.
Should'a stomped him into oblivion.
You've got a lot of blood in your ear, Mr.
Wade.
I need to release the pressure around the cartilage or it will cauliflower.
Skip the lido.
Last thing I need's a mile-long hospital bill.
You're gonna feel it.
You sure? Suit yourself.
[yells.]
Damn it, that hurts like a mother.
[Ricky yelling.]
Bastard was all about cheap shots.
Towel head.
What do you expect? [grunting, breathing heavily.]
Gonna put a dressing on the ear and get a CT head and face.
Also some X-rays of the hands.
What have we got? Moderate swelling in his left orbit, probable fracture.
Inbreds.
Always go for the low-hanging fruit.
Elbow strike? Hammerfist.
Sounds bad.
I know.
But it was a legal shot.
[pained breathing.]
May have a couple fractured ribs.
CT orbits and facial bones to start, chest X-ray for the ribs? Thanks.
[indistinct.]
I should hit up Rasheed.
Get these jackasses in the parking lot, show them how the towel heads do it.
Aamir, let it go.
This is why you fight, Cyrus.
Not anymore.
You can't control ignorance, only how you react.
Surah Al shura verse 40.
[speaking Arabic.]
[speaking Arabic.]
[speaking Arabic.]
Scans may take a while.
Moving around's gonna hurt like hell.
How's a bit of morphine sound? Like heaven.
Findings showed that people with higher confidence tend to use open, expansive postures.
Sure.
Runner crosses the finish line, throw their hands up in victory.
Exactly.
Conversely, those who are timid or defensive make themselves small.
They'll slouch in their seats, cross their arms, their legs, and actually what is really cool is, um Hey.
How you guys doing? - Good, good.
- So far, so good.
You know, just another day.
Um, so, dinner tonight? Our usual spot? - You got it.
- Good.
Bye.
I will catch you guys later.
[clears throat loudly.]
Crossed arms.
- What? - Crossed arms.
Sorry.
Hey, Daniel? I need you to evaluate a potential organ recipient to see if she's a candidate for transplant.
Her name's Meghan Scott.
LVAD.
Still in SICU.
I know it's delicate, but if you could get it back to me by the end of the day? I will do my very best.
Thank you.
Yeah.
For two at 8:00 p.
m.
Great.
Thank you.
Look at you, all smiles.
Hot date? - Surprise date.
- Oh, shh.
I'm taking Nina to this French restaurant on Monroe, - Cochon Volant Brasserie.
- Nice.
Actually, it's Cochon Volant Brasserie.
Dr.
Stohl.
Personally, I prefer Alinea.
It's American molecular gastronomy at its finest.
Highly ranked on the S.
Pelligrino list.
Didn't realize you were back from your sabbatical already.
Or that you spoke French.
Enough to get by.
Something I can do for you, Dr.
Stohl? My "sabbatical" was a World Health Organization assignment.
I advised nongovernmental emergency medical teams on how best to respond and treat SODs.
Sudden Onset Disasters.
We should sit down and talk about it.
Sure.
Sounds great.
Who is that? The troll.
Our beloved Chief of Emergency Medicine.
Okay.
Talk about sudden onset disasters.
I've been sober almost three years.
It's it's not been easy.
Temptation never really goes away.
But you've done it, Mom.
Um, you been going to meetings? Alcoholics Anonymous? I tried, but the endless talk about hitting rock bottom I know it's supposed to be cathartic, but it just put me in a worse mental space.
So, no meetings, no therapy.
Um, any relapses? Wow.
Well, it's remarkable that you've been able to stay sober.
Congratulations.
Thank you.
I I started meditating and setting small, achievable goals, and of course, Bria.
The crew Mom used to hang with I helped her see they were bad influences.
She dropped them all.
No more bars, nightlife.
She's a homebody now.
It's senior year.
Must be nice to have Mom home more.
- Is college in the picture? - Yes.
But not right away.
We've agreed I'd take a year off before applying.
[coughing.]
I'm sorry.
A bit parched.
I just I just want this to be over.
It's just important that you understand that this would be a life-changing event, the surgery, and could really shake up your and Bria's routine, so it's very important that you you have a postsurgical plan in place.
I plan to keep doing what I've been doing.
Going solo has worked.
I need to make sure it keeps working.
What's the status with the room change, Maggie? These guys next-door to each other are like napalm.
I'm working on it, Dr.
Choi.
Thanks.
Hey, man.
Where you headed? [sighs.]
To grab a pop.
Vending machine's in the waiting room, that way.
So that's how it's gonna be? Whatever.
Hey, don't let those ass-wipes get to you.
Just trying to be tough guys.
No, Jeff.
It goes deeper.
Not many families with the last name Choi where I grew up.
Know the type all too well.
Dr.
Manning, you're going to Trauma 3.
- Got it.
- Ted Baylor.
21-year-old male.
Friends found him in his dorm room hooked up to the Xbox and unresponsive.
Gave him fluids and oxygen in the field.
- Glucose level? - Blood sugar's 800.
That's sky-high.
See the train kept rolling without me.
Yep.
Welcome back.
We missed you.
All right.
On my count.
One, two, three.
Mr.
Baylor? Mr.
Baylor? - He's out.
Sternal? - Yep.
There he is.
Mr.
Baylor, do you know where you are? Hospital.
Okay.
He's able to speak and protect his airway.
Good breath sounds.
Lungs are clear.
Maintaining oxygen saturation.
All right, let's keep him on the O2, bolus another liter of fluid, and start an insulin drip.
Labs? What do you think? Likely diabetic ketoacidosis, so, CBC, CMP, VBG, hemoglobin, A1-C, and another Accu-Chek.
For cardiac, troponin and an EKG.
Nice job.
- [alarm sounding.]
- Help! Help! Something's wrong! I got it.
What happened? [alarm sounding.]
What happened? He was talking, and then his eyes rolled back.
I I don't Get a [indistinct.]
right away.
Got a pulse, but he can't protect his airway.
We need to intubate.
Draw up meds.
20 of etomidate, 100 of sux.
- Is he gonna be okay? - We'll see.
[dramatic music.]
Hold the meds.
Don't need them.
No gag reflex.
I'm in.
Bag him.
Let's get an OG tube down to decompress his stomach.
[respirations.]
- Pupil's blown.
- Must have a head bleed.
Page neurosurgery.
We need a stat head CT.
Hi.
Dr.
Manning, I presume? - [chuckles.]
- I know.
Corny.
A little.
But making jokes? Feeling better? Compared to before? I mean, it still feels like I got hit by a truck.
What happened? Your body wasn't producing enough insulin to control your blood sugar, so it spiked and it knocked you out.
- Is it diabetes? - Yes.
Ugh.
But the crisis period is over.
Your blood sugar levels are improving.
[grunts.]
You okay? It's just a little tender.
Do you mind if I take a look? Oh! Pain scale, one to ten? Okay.
How long has your stomach been hurting? A few days.
I mean, it's winter break.
Just more cheap beer and pizza than usual.
I figured it was just indigestion.
Is it the diabetes? No.
Gallstones.
I would like to run some additional blood tests and get an MRCP, a more detailed scan of your stomach, okay? - Mm-hmm.
- Is there anyone I can call for you? No.
My dad's on his way.
All right.
He had them.
Gallstones.
They're a fat person's problem, aren't they? They are often tied to obesity.
Diabetes as well.
But, you know, with lifestyle changes, these things are manageable.
You mean like diet and exercise? You're only 21.
It'd be easier than you think.
I'll be back shortly.
[sighs.]
[saw buzzing.]
Massive hemorrhaging in his brain.
Trying to get the swelling under control.
Decompressive craniectomy.
Opening up the skull should relieve the pressure.
Yeah, but right before they put him under, he had a Cushing's reflex.
Dropped his heart rate, and his BP went through the roof.
Hang in, man.
[indistinct chatter.]
Mm-hmm.
Yeah.
All right, I'll check.
Sure.
Uh-huh.
Everything okay? Yeah.
Why wouldn't it be? So, uh so, Meghan Scott.
I got to say I have some reservations.
But she's three years sober and committed to staying clean.
Yeah.
Without a plan or strategy to avoid relapse.
Addiction is never conquered.
Only managed.
But she's got a support system in her daughter.
Bria's involved.
Maybe too involved.
I mean, by delaying college, she is valuating her mother's life over her own, and as admirable as that may seem, it just doesn't tend to last.
Meghan's sick.
It makes sense that she'd want to take care of her.
There's a very fine line between a healthy support system and an unhealthy dependence.
I mean, did you see during the evaluation Meghan needed her daughter's help to reach a glass of water that was literally right in front of her? Look, it's a gut-wrenching process, and we just have to remember that we give Meghan a heart, we could be denying one to somebody who is just as deserving and might have a better chance of success.
So Meghan's a no? No, I didn't say that.
I just I just want to sit with it a little longer.
Okay.
That gallbladder's really inflamed.
It's full of stones.
But it doesn't look like any have dropped into the common bile duct.
Oh, but it's only a matter of time before one does and causes a major obstruction.
Right.
Well, play it safe, remove the gallbladder? Yes, except his latest labs.
Calcium's low.
Amylase, lipase, white cells are all through the roof.
Gallstone pancreatitis.
Man.
The swelling is really bad.
[sighs.]
Right now I think we should up his IV fluids and start a course of IV nutrition.
Should buy him a few days, give his pancreas time to cool off.
Good idea.
Good.
What does this mean? His pupils are nonreactive? The bleeding in Cyrus's brain has caused significant injury.
Despite the surgeon's best efforts, Cyrus has slipped into a persistent vegetative state.
A coma? But he can wake up, no? It's possible? I'm sorry, but it's more likely he stays like this or devolves to brain death.
That referee he should've stopped the fight earlier.
Cyrus was dominant.
The crowd they cheered for blood.
They wanted to see the Muslim boy get killed.
[somber music.]
- Hey.
- Hey.
Oh! [laughs.]
All bundled up? You you realize your pilomotor reflex is the first step towards frostbite? Yeah.
Something like that.
So you know, I've been sitting on this for a while now, and, uh, it might sound silly, but I believe if couples are good travel partners, then they have what it takes to have a future.
So what do you think? New Orleans? Drinks, food, music.
I [clears throat.]
"I sometimes imagine it was the other way around: that Lisa was your wife and Natalie was mine.
" What are you talking about? I said that to Jeff.
That's why we all lost touch.
He didn't want us to hang out anymore.
I don't understand.
Right when Lisa and I started to go sideways, you and Jeff met me out at Twin Anchors for moral support.
Yeah.
I remember.
You were up at the bar ordering a round, and I was looking at you, and I just said it.
Why? 'Cause my marriage was falling apart and I was a little bit drunk, and right at that moment, it was true.
Jeff, of course, flipped out, and I mean, if you weren't there, it might've gotten ugly.
And you're just telling me this now? I know.
I should've told you this morning when you asked.
This morning? How about when you showed up as a med student? Or before we slept together, or before I let you into my life? Unbelievable.
Hi.
Setting up grocery delivery.
Farewell, supermarket temptations.
Well, that's a good first step.
- Mm-hmm.
- You know there's some great apps for tracking calories too.
That's way down the line.
I mean, after I get a handle on GMOs, gluten, organic versus farm-fresh.
I it's why I like fast food.
It's simple.
You know what? Why don't I page the hospital's nutritionist, have her come in for a consult? [takes deep breath.]
You okay? I've just been feeling a little bit short of breath, and Just come on now? A couple minutes ago.
Is it a reaction to all the meds, or No.
They're just sparking your immune system.
It shouldn't affect your breathing.
Sit up for me? Lungs are clear.
Is the extra oxygen helping? No, not really.
Will? Will, I need a hand.
Stat portable chest X-ray.
- What's going on? - Blood sugar's normal.
White cells, amylase, lipase they're all down.
Everything's good, except now he can't breathe.
What's happening? Your blood pressure and oxygen levels keep dropping, so we're gonna take a chest X-ray to try to figure out why.
Mass in the lung.
- [labored breathing.]
- I'm hearing a rub.
It wasn't there before.
All right.
Let's get an echo.
I can't breathe.
O2 keeps dropping.
Switching to a full face mask.
Pericardial effusion.
What does that mean? Keep this on.
There's fluid built up around your heart.
It's constricting it from beating.
Bolus another liter of fluid.
Get 125mg Solu-Medrol IV and a Levophed drip.
Yes, Doctor.
Page Dr.
Rhodes.
We need to tap this fluid off his heart.
Five minutes ago he was getting better, and now he's sicker than when he came in.
Okay.
So the fluid's from acute pericarditis.
Stemming from the mass in his lungs.
Drain's a temporary fix, but his heart is really struggling.
CT chest will show exactly what we're dealing with.
He presented with hyperglycemia and gallstone pancreatitis.
There was absolutely no evidence of a heart problem.
My time with Dr.
Downey, now Dr.
Latham the one constant: cardiac events can strike without warning.
Thought he was on the mend.
So did I.
Look.
About earlier - Dr.
Manning? - Yeah? Ted's father has arrived.
I can fill him in.
No.
I'll do it.
Hi.
Dr.
Manning.
[groaning.]
[squelching.]
[breathing heavily.]
Okay.
Hard part's done.
Big muscle bleeder down deep.
Stick tying it now.
[groaning.]
The A-rab, Cyrus.
You wheeled him out of here, but he never came back.
What happened? Turn for the worse.
He knew the risk when he stepped inside the cage.
It's the cost of doing business.
Shower and change the dressing every day.
It'll take at least two to three weeks to heal.
Pack the wound.
Get him out of here.
Bulky, swollen lymph nodes and a clear primary mass in the right lower lobe of the lung.
Non-small cell lung cancer? [sighs.]
The biopsy results are pending, but I'm almost certain they'll confirm it.
I'm gonna talk to Dr.
Latham about surgical options.
All right.
I'll consult with oncology, get their opinion as well.
Yeah.
Hey.
Sorry, Nat.
- Thank you.
- Yeah.
Hey, Dr.
Charles.
Um, speak with you a second? - What's up? - Yeah, so, my my heart patient Meghan Scott I hadn't heard anything, so is there something going on with the transplant eval? Well, I know you know that we're not supposed to be talking about this, but unofficially, her history of addiction makes her very high risk.
Wh I understand her history, but we're talking about her future here.
Well, her future's precisely the issue.
I'm sorry, Dr.
Rhodes, but the the clearance process it's unforgiving.
No, no, no, no.
Dr.
Charles, you spent what? All of an hour with her? I've known Meghan and her daughter Bria for months now.
You've known her within a controlled environment.
The invasive surgery, the powerful opiates for pain management, the rigorous medication schedule, the constant check-ups to make sure she's not rejecting the organ.
So you're gonna seal her fate with a checklist, then? She doesn't get a heart, she dies.
She's looking at six months, maybe a year.
Do you honestly think that I don't know that? Someone's got to make the tough decisions here, Dr.
Rhodes.
I'd thank you to let me do my job.
Amniotic fluid level looks okay.
Same with nuchal translucency.
Fetal heart rate is 180, nice and strong.
Aw, yeah, that's a boy.
What's up, little man? Already looking like a linebacker.
Um, she looks like a scientist to me.
Dr.
Lee? Something wrong? At 12 weeks, optimal crown chin length is 26 millimeters.
Your fetal measurement is 23.
Is that still within the normal range? Yes, but on the low end.
Something we need to keep an eye on.
Low measurement what does it mean? The main concern is anencephaly, a neural tube defect that can cause the brain to develop abnormally.
Is it because of my TB meds? Possibly.
We can't really know for sure.
[sighs.]
TShe said the TB meds could possibly be affecting the baby.
That doesn't mean I know.
But what if they are? You can't stop taking them.
So, where does that leave us? Look.
You're 12 weeks.
If we're considering We're not.
April, it's not what I want either, but if your health is in question, the quality of life of our baby is threatened, I we need to understand this gets riskier, more complicated after 14 weeks.
Tate, I am Catholic.
April, it's my baby too.
Don't I at least get to discuss this? We are not terminating this pregnancy.
So how long would I have to do chemo for? That's up to the oncologist.
Generally, it's given in cycles between one and four weeks long followed by a period of rest.
How many cycles? One average, four to six.
What about side effects? The Internet lists thousands.
It all depends on how Ted's body reacts.
But yes, the side effects can add up.
And because of the gallstone pancreatitis, they may even be exacerbated.
Well, all of this sounds awful.
Um, what am I looking at with surgery? Removal of the mass via thoracotomy.
I'll open your chest and peel away the growth from whatever it's attached to.
But my pancreatitis a few a few hours ago it was too dicey for gallbladder surgery.
How is it okay with all of this? Your cardiac function is compromised.
Preventing heart failure has to be our chief concern.
[crying.]
Dad, I don't know what I'm gonna do.
I feel like if I make the wrong decision right now I'm gonna I'm gonna die.
Do you need an answer right now? Ted, look, I understand this is all overwhelming, but you're very sick.
The sooner we start fighting back Emergency radiation.
Yeah, a single dose intended only to stabilize the mass in your lung.
It'll give the pancreatitis a few more days to heal, and it'll give you and your dad more time to decide on a treatment.
And if I still choose surgery after, it'll be safer, right? Theoretically, yes.
When can I do it? The radiation.
Today.
I will set it up with the radiation oncologist.
You gonna just stand there staring, or are you gonna come in? I can't get this frickin' coffee ring off of what's on your mind? I know you have reservations, but I've been reading about how others have managed addiction in unorthodox ways.
There's meditation.
Meghan already does that.
Predicting your weak spots.
She's cut off friends that were bad influences.
The problem with these techniques is that they're all solo endeavors.
What Meghan needs is the support of a sober community.
But she's been successful without one.
And she's got Bria, all the reason in the world to stay sober.
Won't be enough.
I've been treating addiction for over 20 years.
And trust me.
I know of what I speak.
My brother lost his battle with addiction about 14 years ago.
I am sorry.
I want Meghan to succeed just as badly as you do.
But I look at her, and I I see my little brother.
He tried to do it solo too.
It just doesn't work.
And I can't in good conscience recommend her to the Transplant Committee without one good, solid, clinical reason that might give her a chance to succeed.
I've been looking for it.
Just I just can't find it.
Okay.
Hey.
Okay to discharge the asthmatic in Treatment 2? Yeah.
Prednisone and albuterol scrips are with the clerk.
They've been going for the last several hours, trading places.
They believe prayer can bring him out.
What are you doing over here? I just, um I'm not sure.
You've been discharged.
Go home.
You're showing your face around here? [indistinct.]
.
Is he gonna wake up? Like you care.
You did this to him.
Murderer! It's not my fault.
We b we both wanted to win.
- Go home, Ricky.
- God will punish you.
You will burn in hell! Aamir! Enough.
Come.
Pray with us.
I'm s [voice breaks.]
[crying.]
I'm sorry.
[sniffles.]
[somber music.]
- Dr.
Halstead, a moment.
- Yeah? Dr.
Manning's patient Ted Baylor I understand surgery was proposed, but that radiation will be tried first.
As a short-term measure.
Yeah, well, it's the size of the mass that's killing him.
Radiation only stalls its growth.
It doesn't doesn't shrink it.
Well, Dr.
Manning's opinion and mine is that radiation is a much safer option right now.
Well, you're the attending.
Keep me posted.
Hey, Daniel, I haven't gotten your report on Meghan Scott.
How's it going? Still dotting the Is, crossing the Ts.
You know, I know these evaluations are difficult, but if you're looking for something and not finding it, maybe it's not there.
I said I'd have it for you before the end of the day, and I will.
Okay.
From now on, clean nutrition, lots of cardio, diet and exercise.
My dad, too.
That's the enthusiasm I was hoping to hear.
I'm getting a second chance.
I'm not wasting a day of it.
Good for you.
[sighs.]
Okay, let's do this.
Natalie, hey.
[exhales sharply.]
I am so sorry that I didn't say something sooner.
I was afraid I'd lose you.
Say something, please.
I was terrified to move on from Jeff.
Even more afraid to get involved with you, my husband's best friend.
And yet I thought there is no one Jeff would approve of me being in a relationship with more than you.
And you let me think that.
- [alarm sounds.]
- He's coding! I need help! - What happened? - He just dropped.
Take over compressions.
- Got it.
I got it.
I got it.
- No pulse.
V fib.
- Charge 200.
- Charging.
[electricity builds.]
Hold compressions.
Clear.
Resume compressions.
Another milligram epi.
Charge to 300.
- Charging.
- [electricity builds.]
Hold compressions.
Clear.
[monitor flatlining.]
Asystole.
[flatlining.]
You gonna call it? Time of death 17:32.
[dramatic music.]
[somber music.]
.
He was dead before the first alarm even went off.
C.
O.
D.
tumor lysis syndrome.
No way.
You know, the radiation was supposed to stabilize the mass.
Instead it caused it to burst.
I might as well have just given Ted a lethal injection, because that is essentially what happened.
Natalie, this is not on you.
There are no predictors for tumor lysis syndrome.
It is monumentally rare even more so in young people.
And the few times that it does occur, overwhelmingly, it's a reaction to chemo, not radiation.
It still feels like I missed something.
Well, you didn't.
No doctor sees gallstone pancreatitis with diabetes and thinks volatile cancerous chest mass.
And yet here it is.
[sighs.]
Ted's death is not your fault.
You just get good news or bad news? My coma patient this morning, he mentioned a Qur'an verse: Surah Al shura 40.
"The recompense of an evil deed "can only be an evil equal to it; "but whoever pardons and makes reconciliation, their reward is due from God.
" In the psych world, it's called complementarity.
You know, kindness begets kindness.
Hostility, hostility.
Yeah.
An hour ago, those two hated each other, but then his father extends a hand.
Dr.
Charles calls it "flipping the script.
" Don't know if I could've done it.
Yeah.
Not many people can.
[chatter.]
Okay, what is with you? No invitation to sit down? Usually I can't sneak past you.
I'm just a little preoccupied.
I I got to figure something out fast, and I'm at a roadblock, and I can't find my way around it.
Okay.
I I will leave you to it.
Hey, uh, if you're going through hell, keep going.
Isn't that what you always taught me? Well, technically it was Winston Churchill, but Well, still, it's never let me down.
Hm.
Good.
[soft dramatic music.]
[laughs softly.]
Mom.
[light music.]
You're recommending Meghan to the hospital's Transplant Committee.
- Uh-huh.
- Well, what happened? Well, if you must know, a member of my junior staff drew my attention to the fact that, um, I was so focused on her risk factors that I was blind to the one personality trait that my late brother did not have.
What? Grit.
One's ability to persevere in the face of obstacles a clean clinical reason.
I mean, the stressors are still there, as are significant future challenges, but I like to think that the determination that's kept her clean the past three years is gonna help her go the distance.
Mm-hmm.
Hey, what made you think of grit? Fatherhood.
Rough one today, huh? To say the least.
Well, not to pile on, but Dr.
Stohl just informed me that he'd like to use your case for the next Morbidity and Mortality Review, trace your steps.
An M&M? Oh, my God.
Well, it's not an inquisition.
It's just a learning tool for the medical staff.
You tell Dr.
Stohl that? [takes deep breath.]
Okay, night.
All righty.
Good night.
[soft dramatic music.]
What now? Can't kick me out of here too.
I'm not here to do that.
I was thinking we got off to a rough start.
Let me make it up to you.
Two beers.
My tab.
- Huh? - Cutting board? - Corner cabinet by the lazy Susan.
- Yeah.
- And you still haven't weighed in on the paint choices that I asked you about.
Uh, what room is that for again? The den.
Come on, Tate.
I've been working on this remodel for weeks.
I know.
I know.
I'm sorry, babe.
I love that you're making my house our house.
I love that we set a date for the wedding.
- But I'm driving you crazy.
- Yep.
- [laughs.]
- You know what? Stuck in a house on TB leave I get it.
I mean, I've been trying to keep busy, 'cause when I'm not, I can't help but worry.
First ultrasound today.
Yeah.
It's gonna be perfect.
[chatter, sirens blaring.]
Are you crazy? Where's your jacket? Don't need it.
I love the crisp winter air.
Yeah, right.
I can see your goose bumps.
Oh, you mean my pilomotor reflex? Oh, good God.
[both laugh.]
Anyway, this weather is balmy.
Do you remember that February when you and Jeff and me and Lisa we rented that cabin at Lake Mendota? - Yes.
- And then we got hammered on that box of wine we found in the pantry.
Which led to the hot tub.
Which led to you sneaking a peek.
I did not! Did you? No.
Course not.
[both laugh.]
You're terrible.
Ugh! [shivers.]
Seems like a lifetime ago.
How'd we lose touch for so long? I'm not sure.
[sirens wailing.]
Life of a med student.
Lunch'll wait.
Ricky Wade, GCS 15, vitals stable.
You're going to Treatment 4, Dr.
Choi.
Trauma to the left ear with hematoma, multiple dislocated fingers, expanding hematoma of the anterior thigh.
Refused the board and collar.
I'm not a cripple.
I could'a walked.
I know.
MMA.
Feel no pain, right? Any loss of consciousness? Dizziness? Hell no.
That bitch barely connected.
Cage doc called the fight.
Said it was a freakin' bloodbath.
All right.
Let's get an IV in him, then a gram of Ancef.
- [alarm beeps.]
- The opponent? Yep.
You're going to Treatment 3.
- Thanks.
- Cyrus Hammad.
GCS 15.
Significant swelling to his left eye and bruising on the right flank.
No loss of consciousness, but the fight doc wanted to have him looked at anyway.
You're lucky that doc stopped the fight.
I would've pounded you into a living Hey! Not in the cage anymore, huh? Give it a rest.
History and physical and a detailed neuro exam.
Got it.
I'll shout if I need you.
Yeah.
- Excuse me.
- Yes? I'm looking for my brother, Cyrus Hammad.
Cheating-ass punks.
What did you do? Grease some palms? You know your bro was getting his ass beat.
I'm gonna need security in the ED.
- [grunts.]
- Dr.
Choi! Stop him! - Come on! Come on! Come on! - [all shouting at once.]
Chill out! Walk away.
You okay? Yeah.
It's swollen.
Let's get some ice on his thigh and hands.
Had that A-rab eating mat in the first round.
Should'a stomped him into oblivion.
You've got a lot of blood in your ear, Mr.
Wade.
I need to release the pressure around the cartilage or it will cauliflower.
Skip the lido.
Last thing I need's a mile-long hospital bill.
You're gonna feel it.
You sure? Suit yourself.
[yells.]
Damn it, that hurts like a mother.
[Ricky yelling.]
Bastard was all about cheap shots.
Towel head.
What do you expect? [grunting, breathing heavily.]
Gonna put a dressing on the ear and get a CT head and face.
Also some X-rays of the hands.
What have we got? Moderate swelling in his left orbit, probable fracture.
Inbreds.
Always go for the low-hanging fruit.
Elbow strike? Hammerfist.
Sounds bad.
I know.
But it was a legal shot.
[pained breathing.]
May have a couple fractured ribs.
CT orbits and facial bones to start, chest X-ray for the ribs? Thanks.
[indistinct.]
I should hit up Rasheed.
Get these jackasses in the parking lot, show them how the towel heads do it.
Aamir, let it go.
This is why you fight, Cyrus.
Not anymore.
You can't control ignorance, only how you react.
Surah Al shura verse 40.
[speaking Arabic.]
[speaking Arabic.]
[speaking Arabic.]
Scans may take a while.
Moving around's gonna hurt like hell.
How's a bit of morphine sound? Like heaven.
Findings showed that people with higher confidence tend to use open, expansive postures.
Sure.
Runner crosses the finish line, throw their hands up in victory.
Exactly.
Conversely, those who are timid or defensive make themselves small.
They'll slouch in their seats, cross their arms, their legs, and actually what is really cool is, um Hey.
How you guys doing? - Good, good.
- So far, so good.
You know, just another day.
Um, so, dinner tonight? Our usual spot? - You got it.
- Good.
Bye.
I will catch you guys later.
[clears throat loudly.]
Crossed arms.
- What? - Crossed arms.
Sorry.
Hey, Daniel? I need you to evaluate a potential organ recipient to see if she's a candidate for transplant.
Her name's Meghan Scott.
LVAD.
Still in SICU.
I know it's delicate, but if you could get it back to me by the end of the day? I will do my very best.
Thank you.
Yeah.
For two at 8:00 p.
m.
Great.
Thank you.
Look at you, all smiles.
Hot date? - Surprise date.
- Oh, shh.
I'm taking Nina to this French restaurant on Monroe, - Cochon Volant Brasserie.
- Nice.
Actually, it's Cochon Volant Brasserie.
Dr.
Stohl.
Personally, I prefer Alinea.
It's American molecular gastronomy at its finest.
Highly ranked on the S.
Pelligrino list.
Didn't realize you were back from your sabbatical already.
Or that you spoke French.
Enough to get by.
Something I can do for you, Dr.
Stohl? My "sabbatical" was a World Health Organization assignment.
I advised nongovernmental emergency medical teams on how best to respond and treat SODs.
Sudden Onset Disasters.
We should sit down and talk about it.
Sure.
Sounds great.
Who is that? The troll.
Our beloved Chief of Emergency Medicine.
Okay.
Talk about sudden onset disasters.
I've been sober almost three years.
It's it's not been easy.
Temptation never really goes away.
But you've done it, Mom.
Um, you been going to meetings? Alcoholics Anonymous? I tried, but the endless talk about hitting rock bottom I know it's supposed to be cathartic, but it just put me in a worse mental space.
So, no meetings, no therapy.
Um, any relapses? Wow.
Well, it's remarkable that you've been able to stay sober.
Congratulations.
Thank you.
I I started meditating and setting small, achievable goals, and of course, Bria.
The crew Mom used to hang with I helped her see they were bad influences.
She dropped them all.
No more bars, nightlife.
She's a homebody now.
It's senior year.
Must be nice to have Mom home more.
- Is college in the picture? - Yes.
But not right away.
We've agreed I'd take a year off before applying.
[coughing.]
I'm sorry.
A bit parched.
I just I just want this to be over.
It's just important that you understand that this would be a life-changing event, the surgery, and could really shake up your and Bria's routine, so it's very important that you you have a postsurgical plan in place.
I plan to keep doing what I've been doing.
Going solo has worked.
I need to make sure it keeps working.
What's the status with the room change, Maggie? These guys next-door to each other are like napalm.
I'm working on it, Dr.
Choi.
Thanks.
Hey, man.
Where you headed? [sighs.]
To grab a pop.
Vending machine's in the waiting room, that way.
So that's how it's gonna be? Whatever.
Hey, don't let those ass-wipes get to you.
Just trying to be tough guys.
No, Jeff.
It goes deeper.
Not many families with the last name Choi where I grew up.
Know the type all too well.
Dr.
Manning, you're going to Trauma 3.
- Got it.
- Ted Baylor.
21-year-old male.
Friends found him in his dorm room hooked up to the Xbox and unresponsive.
Gave him fluids and oxygen in the field.
- Glucose level? - Blood sugar's 800.
That's sky-high.
See the train kept rolling without me.
Yep.
Welcome back.
We missed you.
All right.
On my count.
One, two, three.
Mr.
Baylor? Mr.
Baylor? - He's out.
Sternal? - Yep.
There he is.
Mr.
Baylor, do you know where you are? Hospital.
Okay.
He's able to speak and protect his airway.
Good breath sounds.
Lungs are clear.
Maintaining oxygen saturation.
All right, let's keep him on the O2, bolus another liter of fluid, and start an insulin drip.
Labs? What do you think? Likely diabetic ketoacidosis, so, CBC, CMP, VBG, hemoglobin, A1-C, and another Accu-Chek.
For cardiac, troponin and an EKG.
Nice job.
- [alarm sounding.]
- Help! Help! Something's wrong! I got it.
What happened? [alarm sounding.]
What happened? He was talking, and then his eyes rolled back.
I I don't Get a [indistinct.]
right away.
Got a pulse, but he can't protect his airway.
We need to intubate.
Draw up meds.
20 of etomidate, 100 of sux.
- Is he gonna be okay? - We'll see.
[dramatic music.]
Hold the meds.
Don't need them.
No gag reflex.
I'm in.
Bag him.
Let's get an OG tube down to decompress his stomach.
[respirations.]
- Pupil's blown.
- Must have a head bleed.
Page neurosurgery.
We need a stat head CT.
Hi.
Dr.
Manning, I presume? - [chuckles.]
- I know.
Corny.
A little.
But making jokes? Feeling better? Compared to before? I mean, it still feels like I got hit by a truck.
What happened? Your body wasn't producing enough insulin to control your blood sugar, so it spiked and it knocked you out.
- Is it diabetes? - Yes.
Ugh.
But the crisis period is over.
Your blood sugar levels are improving.
[grunts.]
You okay? It's just a little tender.
Do you mind if I take a look? Oh! Pain scale, one to ten? Okay.
How long has your stomach been hurting? A few days.
I mean, it's winter break.
Just more cheap beer and pizza than usual.
I figured it was just indigestion.
Is it the diabetes? No.
Gallstones.
I would like to run some additional blood tests and get an MRCP, a more detailed scan of your stomach, okay? - Mm-hmm.
- Is there anyone I can call for you? No.
My dad's on his way.
All right.
He had them.
Gallstones.
They're a fat person's problem, aren't they? They are often tied to obesity.
Diabetes as well.
But, you know, with lifestyle changes, these things are manageable.
You mean like diet and exercise? You're only 21.
It'd be easier than you think.
I'll be back shortly.
[sighs.]
[saw buzzing.]
Massive hemorrhaging in his brain.
Trying to get the swelling under control.
Decompressive craniectomy.
Opening up the skull should relieve the pressure.
Yeah, but right before they put him under, he had a Cushing's reflex.
Dropped his heart rate, and his BP went through the roof.
Hang in, man.
[indistinct chatter.]
Mm-hmm.
Yeah.
All right, I'll check.
Sure.
Uh-huh.
Everything okay? Yeah.
Why wouldn't it be? So, uh so, Meghan Scott.
I got to say I have some reservations.
But she's three years sober and committed to staying clean.
Yeah.
Without a plan or strategy to avoid relapse.
Addiction is never conquered.
Only managed.
But she's got a support system in her daughter.
Bria's involved.
Maybe too involved.
I mean, by delaying college, she is valuating her mother's life over her own, and as admirable as that may seem, it just doesn't tend to last.
Meghan's sick.
It makes sense that she'd want to take care of her.
There's a very fine line between a healthy support system and an unhealthy dependence.
I mean, did you see during the evaluation Meghan needed her daughter's help to reach a glass of water that was literally right in front of her? Look, it's a gut-wrenching process, and we just have to remember that we give Meghan a heart, we could be denying one to somebody who is just as deserving and might have a better chance of success.
So Meghan's a no? No, I didn't say that.
I just I just want to sit with it a little longer.
Okay.
That gallbladder's really inflamed.
It's full of stones.
But it doesn't look like any have dropped into the common bile duct.
Oh, but it's only a matter of time before one does and causes a major obstruction.
Right.
Well, play it safe, remove the gallbladder? Yes, except his latest labs.
Calcium's low.
Amylase, lipase, white cells are all through the roof.
Gallstone pancreatitis.
Man.
The swelling is really bad.
[sighs.]
Right now I think we should up his IV fluids and start a course of IV nutrition.
Should buy him a few days, give his pancreas time to cool off.
Good idea.
Good.
What does this mean? His pupils are nonreactive? The bleeding in Cyrus's brain has caused significant injury.
Despite the surgeon's best efforts, Cyrus has slipped into a persistent vegetative state.
A coma? But he can wake up, no? It's possible? I'm sorry, but it's more likely he stays like this or devolves to brain death.
That referee he should've stopped the fight earlier.
Cyrus was dominant.
The crowd they cheered for blood.
They wanted to see the Muslim boy get killed.
[somber music.]
- Hey.
- Hey.
Oh! [laughs.]
All bundled up? You you realize your pilomotor reflex is the first step towards frostbite? Yeah.
Something like that.
So you know, I've been sitting on this for a while now, and, uh, it might sound silly, but I believe if couples are good travel partners, then they have what it takes to have a future.
So what do you think? New Orleans? Drinks, food, music.
I [clears throat.]
"I sometimes imagine it was the other way around: that Lisa was your wife and Natalie was mine.
" What are you talking about? I said that to Jeff.
That's why we all lost touch.
He didn't want us to hang out anymore.
I don't understand.
Right when Lisa and I started to go sideways, you and Jeff met me out at Twin Anchors for moral support.
Yeah.
I remember.
You were up at the bar ordering a round, and I was looking at you, and I just said it.
Why? 'Cause my marriage was falling apart and I was a little bit drunk, and right at that moment, it was true.
Jeff, of course, flipped out, and I mean, if you weren't there, it might've gotten ugly.
And you're just telling me this now? I know.
I should've told you this morning when you asked.
This morning? How about when you showed up as a med student? Or before we slept together, or before I let you into my life? Unbelievable.
Hi.
Setting up grocery delivery.
Farewell, supermarket temptations.
Well, that's a good first step.
- Mm-hmm.
- You know there's some great apps for tracking calories too.
That's way down the line.
I mean, after I get a handle on GMOs, gluten, organic versus farm-fresh.
I it's why I like fast food.
It's simple.
You know what? Why don't I page the hospital's nutritionist, have her come in for a consult? [takes deep breath.]
You okay? I've just been feeling a little bit short of breath, and Just come on now? A couple minutes ago.
Is it a reaction to all the meds, or No.
They're just sparking your immune system.
It shouldn't affect your breathing.
Sit up for me? Lungs are clear.
Is the extra oxygen helping? No, not really.
Will? Will, I need a hand.
Stat portable chest X-ray.
- What's going on? - Blood sugar's normal.
White cells, amylase, lipase they're all down.
Everything's good, except now he can't breathe.
What's happening? Your blood pressure and oxygen levels keep dropping, so we're gonna take a chest X-ray to try to figure out why.
Mass in the lung.
- [labored breathing.]
- I'm hearing a rub.
It wasn't there before.
All right.
Let's get an echo.
I can't breathe.
O2 keeps dropping.
Switching to a full face mask.
Pericardial effusion.
What does that mean? Keep this on.
There's fluid built up around your heart.
It's constricting it from beating.
Bolus another liter of fluid.
Get 125mg Solu-Medrol IV and a Levophed drip.
Yes, Doctor.
Page Dr.
Rhodes.
We need to tap this fluid off his heart.
Five minutes ago he was getting better, and now he's sicker than when he came in.
Okay.
So the fluid's from acute pericarditis.
Stemming from the mass in his lungs.
Drain's a temporary fix, but his heart is really struggling.
CT chest will show exactly what we're dealing with.
He presented with hyperglycemia and gallstone pancreatitis.
There was absolutely no evidence of a heart problem.
My time with Dr.
Downey, now Dr.
Latham the one constant: cardiac events can strike without warning.
Thought he was on the mend.
So did I.
Look.
About earlier - Dr.
Manning? - Yeah? Ted's father has arrived.
I can fill him in.
No.
I'll do it.
Hi.
Dr.
Manning.
[groaning.]
[squelching.]
[breathing heavily.]
Okay.
Hard part's done.
Big muscle bleeder down deep.
Stick tying it now.
[groaning.]
The A-rab, Cyrus.
You wheeled him out of here, but he never came back.
What happened? Turn for the worse.
He knew the risk when he stepped inside the cage.
It's the cost of doing business.
Shower and change the dressing every day.
It'll take at least two to three weeks to heal.
Pack the wound.
Get him out of here.
Bulky, swollen lymph nodes and a clear primary mass in the right lower lobe of the lung.
Non-small cell lung cancer? [sighs.]
The biopsy results are pending, but I'm almost certain they'll confirm it.
I'm gonna talk to Dr.
Latham about surgical options.
All right.
I'll consult with oncology, get their opinion as well.
Yeah.
Hey.
Sorry, Nat.
- Thank you.
- Yeah.
Hey, Dr.
Charles.
Um, speak with you a second? - What's up? - Yeah, so, my my heart patient Meghan Scott I hadn't heard anything, so is there something going on with the transplant eval? Well, I know you know that we're not supposed to be talking about this, but unofficially, her history of addiction makes her very high risk.
Wh I understand her history, but we're talking about her future here.
Well, her future's precisely the issue.
I'm sorry, Dr.
Rhodes, but the the clearance process it's unforgiving.
No, no, no, no.
Dr.
Charles, you spent what? All of an hour with her? I've known Meghan and her daughter Bria for months now.
You've known her within a controlled environment.
The invasive surgery, the powerful opiates for pain management, the rigorous medication schedule, the constant check-ups to make sure she's not rejecting the organ.
So you're gonna seal her fate with a checklist, then? She doesn't get a heart, she dies.
She's looking at six months, maybe a year.
Do you honestly think that I don't know that? Someone's got to make the tough decisions here, Dr.
Rhodes.
I'd thank you to let me do my job.
Amniotic fluid level looks okay.
Same with nuchal translucency.
Fetal heart rate is 180, nice and strong.
Aw, yeah, that's a boy.
What's up, little man? Already looking like a linebacker.
Um, she looks like a scientist to me.
Dr.
Lee? Something wrong? At 12 weeks, optimal crown chin length is 26 millimeters.
Your fetal measurement is 23.
Is that still within the normal range? Yes, but on the low end.
Something we need to keep an eye on.
Low measurement what does it mean? The main concern is anencephaly, a neural tube defect that can cause the brain to develop abnormally.
Is it because of my TB meds? Possibly.
We can't really know for sure.
[sighs.]
TShe said the TB meds could possibly be affecting the baby.
That doesn't mean I know.
But what if they are? You can't stop taking them.
So, where does that leave us? Look.
You're 12 weeks.
If we're considering We're not.
April, it's not what I want either, but if your health is in question, the quality of life of our baby is threatened, I we need to understand this gets riskier, more complicated after 14 weeks.
Tate, I am Catholic.
April, it's my baby too.
Don't I at least get to discuss this? We are not terminating this pregnancy.
So how long would I have to do chemo for? That's up to the oncologist.
Generally, it's given in cycles between one and four weeks long followed by a period of rest.
How many cycles? One average, four to six.
What about side effects? The Internet lists thousands.
It all depends on how Ted's body reacts.
But yes, the side effects can add up.
And because of the gallstone pancreatitis, they may even be exacerbated.
Well, all of this sounds awful.
Um, what am I looking at with surgery? Removal of the mass via thoracotomy.
I'll open your chest and peel away the growth from whatever it's attached to.
But my pancreatitis a few a few hours ago it was too dicey for gallbladder surgery.
How is it okay with all of this? Your cardiac function is compromised.
Preventing heart failure has to be our chief concern.
[crying.]
Dad, I don't know what I'm gonna do.
I feel like if I make the wrong decision right now I'm gonna I'm gonna die.
Do you need an answer right now? Ted, look, I understand this is all overwhelming, but you're very sick.
The sooner we start fighting back Emergency radiation.
Yeah, a single dose intended only to stabilize the mass in your lung.
It'll give the pancreatitis a few more days to heal, and it'll give you and your dad more time to decide on a treatment.
And if I still choose surgery after, it'll be safer, right? Theoretically, yes.
When can I do it? The radiation.
Today.
I will set it up with the radiation oncologist.
You gonna just stand there staring, or are you gonna come in? I can't get this frickin' coffee ring off of what's on your mind? I know you have reservations, but I've been reading about how others have managed addiction in unorthodox ways.
There's meditation.
Meghan already does that.
Predicting your weak spots.
She's cut off friends that were bad influences.
The problem with these techniques is that they're all solo endeavors.
What Meghan needs is the support of a sober community.
But she's been successful without one.
And she's got Bria, all the reason in the world to stay sober.
Won't be enough.
I've been treating addiction for over 20 years.
And trust me.
I know of what I speak.
My brother lost his battle with addiction about 14 years ago.
I am sorry.
I want Meghan to succeed just as badly as you do.
But I look at her, and I I see my little brother.
He tried to do it solo too.
It just doesn't work.
And I can't in good conscience recommend her to the Transplant Committee without one good, solid, clinical reason that might give her a chance to succeed.
I've been looking for it.
Just I just can't find it.
Okay.
Hey.
Okay to discharge the asthmatic in Treatment 2? Yeah.
Prednisone and albuterol scrips are with the clerk.
They've been going for the last several hours, trading places.
They believe prayer can bring him out.
What are you doing over here? I just, um I'm not sure.
You've been discharged.
Go home.
You're showing your face around here? [indistinct.]
.
Is he gonna wake up? Like you care.
You did this to him.
Murderer! It's not my fault.
We b we both wanted to win.
- Go home, Ricky.
- God will punish you.
You will burn in hell! Aamir! Enough.
Come.
Pray with us.
I'm s [voice breaks.]
[crying.]
I'm sorry.
[sniffles.]
[somber music.]
- Dr.
Halstead, a moment.
- Yeah? Dr.
Manning's patient Ted Baylor I understand surgery was proposed, but that radiation will be tried first.
As a short-term measure.
Yeah, well, it's the size of the mass that's killing him.
Radiation only stalls its growth.
It doesn't doesn't shrink it.
Well, Dr.
Manning's opinion and mine is that radiation is a much safer option right now.
Well, you're the attending.
Keep me posted.
Hey, Daniel, I haven't gotten your report on Meghan Scott.
How's it going? Still dotting the Is, crossing the Ts.
You know, I know these evaluations are difficult, but if you're looking for something and not finding it, maybe it's not there.
I said I'd have it for you before the end of the day, and I will.
Okay.
From now on, clean nutrition, lots of cardio, diet and exercise.
My dad, too.
That's the enthusiasm I was hoping to hear.
I'm getting a second chance.
I'm not wasting a day of it.
Good for you.
[sighs.]
Okay, let's do this.
Natalie, hey.
[exhales sharply.]
I am so sorry that I didn't say something sooner.
I was afraid I'd lose you.
Say something, please.
I was terrified to move on from Jeff.
Even more afraid to get involved with you, my husband's best friend.
And yet I thought there is no one Jeff would approve of me being in a relationship with more than you.
And you let me think that.
- [alarm sounds.]
- He's coding! I need help! - What happened? - He just dropped.
Take over compressions.
- Got it.
I got it.
I got it.
- No pulse.
V fib.
- Charge 200.
- Charging.
[electricity builds.]
Hold compressions.
Clear.
Resume compressions.
Another milligram epi.
Charge to 300.
- Charging.
- [electricity builds.]
Hold compressions.
Clear.
[monitor flatlining.]
Asystole.
[flatlining.]
You gonna call it? Time of death 17:32.
[dramatic music.]
[somber music.]
.
He was dead before the first alarm even went off.
C.
O.
D.
tumor lysis syndrome.
No way.
You know, the radiation was supposed to stabilize the mass.
Instead it caused it to burst.
I might as well have just given Ted a lethal injection, because that is essentially what happened.
Natalie, this is not on you.
There are no predictors for tumor lysis syndrome.
It is monumentally rare even more so in young people.
And the few times that it does occur, overwhelmingly, it's a reaction to chemo, not radiation.
It still feels like I missed something.
Well, you didn't.
No doctor sees gallstone pancreatitis with diabetes and thinks volatile cancerous chest mass.
And yet here it is.
[sighs.]
Ted's death is not your fault.
You just get good news or bad news? My coma patient this morning, he mentioned a Qur'an verse: Surah Al shura 40.
"The recompense of an evil deed "can only be an evil equal to it; "but whoever pardons and makes reconciliation, their reward is due from God.
" In the psych world, it's called complementarity.
You know, kindness begets kindness.
Hostility, hostility.
Yeah.
An hour ago, those two hated each other, but then his father extends a hand.
Dr.
Charles calls it "flipping the script.
" Don't know if I could've done it.
Yeah.
Not many people can.
[chatter.]
Okay, what is with you? No invitation to sit down? Usually I can't sneak past you.
I'm just a little preoccupied.
I I got to figure something out fast, and I'm at a roadblock, and I can't find my way around it.
Okay.
I I will leave you to it.
Hey, uh, if you're going through hell, keep going.
Isn't that what you always taught me? Well, technically it was Winston Churchill, but Well, still, it's never let me down.
Hm.
Good.
[soft dramatic music.]
[laughs softly.]
Mom.
[light music.]
You're recommending Meghan to the hospital's Transplant Committee.
- Uh-huh.
- Well, what happened? Well, if you must know, a member of my junior staff drew my attention to the fact that, um, I was so focused on her risk factors that I was blind to the one personality trait that my late brother did not have.
What? Grit.
One's ability to persevere in the face of obstacles a clean clinical reason.
I mean, the stressors are still there, as are significant future challenges, but I like to think that the determination that's kept her clean the past three years is gonna help her go the distance.
Mm-hmm.
Hey, what made you think of grit? Fatherhood.
Rough one today, huh? To say the least.
Well, not to pile on, but Dr.
Stohl just informed me that he'd like to use your case for the next Morbidity and Mortality Review, trace your steps.
An M&M? Oh, my God.
Well, it's not an inquisition.
It's just a learning tool for the medical staff.
You tell Dr.
Stohl that? [takes deep breath.]
Okay, night.
All righty.
Good night.
[soft dramatic music.]
What now? Can't kick me out of here too.
I'm not here to do that.
I was thinking we got off to a rough start.
Let me make it up to you.
Two beers.
My tab.