Chicago Med (2015) s02e14 Episode Script
Cold Front
1 [whirring.]
[indistinct chatter.]
Hey, we're going in 152 - On the right.
- Got it.
[sirens wailing, indistinct shouting.]
Okay, Craig, you take over bagging.
Got it.
Lacerated forehead, possible crushed airway.
Jeff, dispatch said mass casualty.
Only been on site a few minutes, but it's at least a dozen vehicles maybe more.
- [whimpering.]
- We need help over here! Sir - [shouts indistinctly.]
- Come here, come here.
- I've lost my teeth! - Gauze! Here you go.
Okay, bite down, bite down.
Hold the pressure.
All right, here.
Let's move over here.
There you go.
Lay down.
Casey has just radioed in.
They're popping the windshield on a minivan Need medical on site.
Red, thirty yards in, eye of the pileup.
- We're on it.
- Go.
- Jeff.
- I'm with ya.
- Go back that strip in, got it? - Got it.
Choi, got a family of four trapped inside.
Lot of intrusion on the vehicle.
All polytrauma.
All right, we're on it.
Adam - [grunts.]
- Got it.
My son save him.
My son.
We're gonna get you all out of here, all right? Help the boys.
Please.
- Help them please.
- Bleeding head lac Transected his temporal artery.
Give me two hemostats.
I've gotta clamp it off.
- Copy.
- [whirring.]
All right, I'm on the boys.
[grunting.]
Hang in there, guys.
[all whimpering.]
Almost there, guys.
Help my my boys, please.
Help help my Hey, Adam, need a C-collar.
You're gonna be okay.
- Jeff, what do you got? - I got some serious leg damage, - possible abdominal injuries.
- Let's give them some morphine.
Can you get a read on body weight? I don't know 60, 65 pounds each.
- Push 4 milligrams IM.
- I got it.
All right, take it easy.
Just take it easy.
Just take it easy.
- [groans.]
- It's okay.
Bleeding's under control.
Let's get him out of here.
Okay, you hang in there, guys.
I'm gonna give you something to make you feel better, all right? Place two 16-gauges on the right, and let them know he's red-tagged.
[people screaming.]
Jeff, stay with the kids.
[indistinct radio chatter.]
[indistinct shouting.]
I got you! [screaming.]
- Clear! Clear! - Back up! All right.
- [coughs.]
- He needs oxygen! Need a backboard! All right, sir, we're gonna get you out of here.
Sir, can you hear me? Try to stay calm, okay? Two, three - [grunting.]
- Pick him up.
[indistinct chatter.]
Oh, God.
[grunts.]
Hey! I need a little help over here! Pregnant woman! Hey, you there? Huh? Hey! A little help over here! Hey! Okay, everyone, listen up.
- Glad you made it in.
- [sighs.]
It wasn't easy.
We've got a predawn pileup Multiple traumas en route.
White-out conditions Staff snowed in at home No supplies coming in.
We need to make do with who and what we've got on hand.
All right, Dr.
Manning and Halstead, let's decompress the ED.
Anybody who's stable kicks back into the waiting area.
Copy.
- Dr.
Wheeler, be ready to glove up.
- Got it.
April, we need every room we've got.
Let's clear the hallways, supply room Anywhere we can fit a bed.
Let's go, people.
On it.
Doris, put out a hospital-wide alert, - and page the triage team.
- Okay.
Back to the waiting room? I've already waited an hour.
Uh, I apologize, Mr.
Kellogg, but we'll get to you as soon as we can, all right? What is the only indication for AVR in an asymptomatic patient with severe stenosis? Left ventricular systolic dysfunction.
Correct, Dr.
Bardovi.
This patient is stable.
Close his incision.
Why? We are expecting an influx of trauma patients.
Per emergency protocol, you and I will be in charge of triage.
We need to ensure that operating rooms are available to the most critical patients.
This man is not one of them.
- Close him up.
- Yes, Doctor.
All right, look alive.
Here we go.
Incoming.
38-year-old male pulled from his minivan.
Mom and two kids are on the way.
Here's the triage team.
GCS 12, hypotensive.
Clamped his temporal artery Belly's distended.
All right, he's surgical.
Stabilize him, and get him up to the O.
R.
- Dr.
Manning? - Got it.
All right.
Dr.
Choi 40-year-old male GCS 15 Satting 90% on a face mask.
- Dr.
Halstead? - Got it.
No, I got this one.
Severe burn make him warm, comfortable, and move on.
There's nothing more you can do.
- Naima? - 63-year-old female Went through the windshield.
Triple zeros Down for nearly 20 minutes.
Stand down.
Thrown from a vehicle with a high deceleration injury.
- Most likely a torn aorta.
- We can't be sure.
Regardless, asystole for 20 minutes.
This is not a survivable injury.
Hold compressions.
- Wait, let's warm her up first.
- Dr.
Rhodes, understand that today we need to focus our efforts on patients with the best chance of survival.
[whimpering.]
Please.
I need Helene, my wife.
Mr.
Winter, we'll find her.
Just try to relax.
He needs an IO.
Mr.
Winter, I'm gonna have trouble finding a vein.
I need to put an IV in your leg.
It'll only take a second.
[drill whirring.]
- Dr.
Choi, what are you doing? - Putting in an IO.
- Can I speak with you? - Hang on, one second.
- Almost - Now.
I'm in.
He's 95% TBSA.
Calculate his fluid based on Parkland, and run everything through the warmer.
Copy.
I thought I told you to make him comfortable and move on.
Dr.
Latham, standing by while a patient dies is not in my job description.
He has full thickness burns over 90% of his body.
There's no chance of recovery.
He's awake, talking, lucid, not in any pain.
As you well know, he's not in pain because his cutaneous nerves have been destroyed by the burn.
Very soon, his organs will began to shut down.
He is going to die.
And treating him will only take resources away from patients who have a chance of survival.
[sighs.]
- Maggie! - Jeffrey.
26-year-old female found passed out in the snow.
35 weeks pregnant Vitals stable.
Dr.
Wheeler, you're going to Treatment 2.
- Got it.
- Stop.
Green is not the proper designation.
An expectant mother always takes priority.
- Is my baby gonna be okay? - Don't worry.
We're gonna make sure both of you are taken care of.
[indistinct chatter.]
I'll get some blankets.
On my count, one, two, three.
They said you lost consciousness.
- Do you know what happened? - I don't remember.
It all happened so fast.
I saw a cut on my arm, and I went for help.
Next thing I know, they're bringing me here.
Well, your vitals look good.
- What about my baby? - I'm checking now.
- Baby's heartbeat is strong.
- Dr.
Wheeler Traumas are coming in hot.
You done here? Uh, let's get her undressed, and put her on a fetal monitor.
Everything looks good.
I'll be back soon.
Pulled from the minivan This is mom Susan, 38 years old, GCS 15.
Right arm fracture Complaining of back pain.
Son and nephew are coming in behind us.
My husband, Blake How is he? We've sent him up to the O.
R.
already.
Belly's clear.
Get her CT for head and TLS spine.
Make sure there are no vertebral fractures.
- Take care of the boys.
- We will.
9-year-old nephew, Josh GCS 15 vitals stable.
Got pinned in the backseat.
Bilateral femoral fractures One open.
His parents are traveling abroad.
He's been staying with his aunt and uncle.
- All right, Dr.
Manning? - Yep.
Hi, I'm Dr.
Manning.
I'm gonna take good care of you, okay? I'm gonna give her a hand.
All right, you're going to Treatment 5.
- Yep.
- Talk to me.
Benjamin 10-year-old son GCS 15.
Abdominal pain Mildly hypotensive from possible blood loss.
Systolic 100 over palp.
Dr.
Halstead, red tag.
- April.
- You're going to Treatment 4.
[groaning.]
My hips! My hips! Hang in there, champ.
We're gonna get you fixed up.
4, here.
Okay.
Okay, on my count, one, two, three.
[groaning.]
- Thank you, gentlemen.
- Yep.
[coughs and groans.]
[whimpers.]
Breath sounds clear and present bilaterally.
Hang another liter of saline on the level one.
Yep.
How'd you get to be so strong? You're doing great.
Chest and belly clear.
Okay, honey.
BP 86 over 47.
Heart rate 135.
- [screams.]
- I know, I know, I know.
Okay, okay, that's it, just breathe.
Unstable pelvis and hypotensive.
Close it down to stop the bleeding? Yeah, grab a sheet.
I need some help in here! What do you need? This might hurt.
Give him 25 mics of Fentanyl.
Copy.
Okay, honey.
Okay.
All right, all right.
[distressed breathing.]
Okay, make sure it's tight.
[grunts.]
Heart rate's coming down.
Bleeding's temporized for now.
Let's get X-rays Chest and pelvis.
Let me know the second there's an opening in interventional radiology.
We need to embolize the bleeding.
Got it.
[groaning.]
Chest and abdomen are clear.
Cold foot I can't get a pulse on this leg.
Fractures probably kinking the femoral artery.
- We've gotta reduce this now.
- Let's push two milligrams of versed and 25 mics of Fentanyl.
Okay, Josh, we're gonna have to do something right now, and I need you to be so brave for me.
- Can you do that? - Okay.
Yeah? Yeah? Are you ready? All right, one, two, three.
- [loud groans.]
- It's all done.
That's it.
It's over.
Great job.
All right, get a post-mold splint on him.
Page ortho.
He's gonna need surgery to wash out and ex-fix that fracture as soon as we can get an O.
R.
- [whimpers.]
- Are you all right? Okay, can you keep being brave like that? Dr.
Rhodes You are so brave So brave.
- What happened? - I I I don't know.
She was alert and talking a few minutes ago.
- No pulse.
- All right, Clarke, intubator.
April, a milligram of epi.
Wheeler, get on her chest now.
[grunts.]
- She's hemorrhaging.
- Abruption from the trauma? That might explain just a vaginal bleed, but not this.
She's bleeding around her IV.
- [grunts.]
- Dr.
Rhodes All right, likely an amniotic fluid embolism.
Impact from the accident forced amniotic fluid into her bloodstream Disrupted her clotting factors.
Trigger the MTP.
We need to get this baby out now.
- Page OB? - No, there's no time.
We've got about four minutes to deliver, or we're gonna lose her and the baby.
- Tubes in.
- Take over bagging.
Okay, splash prep her abdomen.
Give me the knife.
[alarm blaring.]
[dramatic music.]
Clarke, pull.
[grunting.]
There we go.
It's a girl.
April, cut the cord.
Clarke, start packing her abdomen.
On it.
There we go.
Okay.
The baby looks good.
April, let's get her up to the NICU.
- On my way.
- Okay.
All right, Wheeler, hold compressions.
She's in v-fib.
Paddles.
- Charge to 200.
- Charge.
- No.
- Charge again.
- Charge.
- Clear.
Sinus tach.
BP 70 over 33, heart rate 130, oxygen rate 95%.
All right, set up a Neo drip at a 100 mics.
100 mics.
She looks like she's lost about three liters.
How much have we given her? Two packed red blood cells, one FFP, two cryo.
Second patch is on its way with more blood and cryo.
All right.
She's still bleeding.
Tell the blood bank to keep sending us O-Neg.
We'll finish packing her here, and then we'll send her up to OB, so they can close her.
Right.
Hey, Mr.
Winter.
How are you feeling? Cold.
That's to be expected.
The damage to your skin caused you to lose heat.
We have another warmer coming in for you.
Mr.
Winter You're in burn shock.
Your organs are gonna shut down soon.
I'm I'm dying? Yes.
Keep me alive till my wife gets here.
I wanna say goodbye.
We'll do everything we can.
[coughing.]
Mr.
Winter, your airways are starting to swell.
We need to intubate you, and put you on a ventilator.
But I won't be able to talk.
When your wife gets here, I'll remove the tube, and you'll be ab [sniffles.]
And you'll be able to say goodbye.
20 of etomidate and 15 rocuronium.
[coughs.]
All right, now for waiting room drama.
His name is Jack Kellogg.
Came in for a Xanax refill.
How long you have to wait around here? Got bumped from his treatment room.
Doesn't seem like an emergency to me.
- Might just be hunting for drugs.
- He's fine, he's fine But if you think differently, I'll send him upstairs.
Did he threaten to hurt anybody or himself? No.
He's just a pain in the ass.
- I'll talk to him.
- All right.
Mr.
Kellogg? I'm Dr.
Charles.
I've been waiting for over two hours.
Nobody cares.
I'm just a number.
I'm very sorry.
We have a major pileup on the highway, and we're in a triage situation It's not my problem.
Okay, well, what seems to be the trouble? Cut the crap, all right? Blah, blah, blah.
- I'm out of my meds.
- Did you call your doctor? He's out.
Why else would I be here? How hard is it for you to write me a prescription? Well, we wanna make sure you get the right medication, - the proper dosage.
- Dr.
Charles - Could you hold on a second? - I'm sorry, but there's an emergency in the psych ward.
A patient attacked a nurse.
They need you.
Mr.
Kellogg, I'm very sorry.
We are gonna take excellent care of you, but you're gonna have to wait a little bit longer.
- Oh, for God's sake.
- I will be right back, and I'm gonna make you one of our first priorities.
First priority.
Yeah, sure.
Look at me! I'm a human being.
I'm a human being! A human being! Should we put him on a psych hold? No, he's not dangerous, just pissed off.
Daniel? We're slammed and short personnel.
I need to pull Dr.
Reese off your service, and put her to work here.
Go to it.
- Reese, with me.
- Okay.
Heart rate's 150.
BP 70 over 40.
What are his injuries? Femoral fractures in both legs - Lots of soft tissue injuries.
- [groans.]
Looks like bilateral thigh hematomas.
So blood's accumulating in his legs.
We need to transfuse him.
Yes, but first let's get a liter of lactated ringers Dopamine at 10 Titrate to systolic BP of 90.
[groaning.]
Maggie, need some help in here! Coming! Blood pressure's coming up 80 over 50.
- 90 over 60.
- He's stable for now.
Call up to the blood bank, and tell him we need two units of O-Negative for this boy.
I need the same for his cousin in the next room.
Okay, hold on.
[sighs.]
You're both gonna have to talk to Ms.
Goodwin about this.
Because of emergency surgeries, and a pregnant mother's serious bleeding disorder, we have used almost all of our O-Negative.
We can either treat Benjamin or Josh, but not both.
Benjamin needs an angio embolization more urgently than Josh needs surgery.
How can you say that? Josh isn't compensating for his blood loss as well.
He's in worst shape.
I understand you're trying to protect your patient, but you're being emotional.
"Emotional"? And what are you being? Our recommendation needs to be based solely on clinical criteria.
So I'm handing it over to the triage team.
Dr.
Rhodes, your opinion? I have to agree with Dr.
Halstead that Benjamin needs angio embolization more urgently than Josh needs surgery.
Not the issue.
We're here to decide who has the best chance of survival, so Unfortunately, even if Benjamin gets the embolization, there's only a 15% chance that the bleeding in his pelvis will stop.
Exactly.
Whereas with Dr.
Manning's patient, as the pressure in his thighs builds, the bleeding will eventually slow.
Worst case, Josh loses a leg, but there is no question he has the best chance of survival.
- I don't understand.
- We're very sorry, but it's up to you to decide which of the boys gets the blood.
Decide who gets the blood? The doctors have their opinion, but it is a decision you and your husband should make, and he's still in surgery.
But, without blood, is one of them gonna die? It is a possibility, but we are gonna do whatever we can to prevent that.
And you want me to decide between my son and my sister's? But how? Our recommendation is to give the blood to your nephew, Josh.
Josh? Why? Because he has the greater chance of survival.
- That means Ben - We are gonna do our best to keep him alive until we have more blood.
How can you make me do this? [sobbing.]
I can't.
- I can't.
- If you'd prefer, we can make the decision on your behalf.
Mrs.
Porter, I assure you, we will do what's medically and ethically correct.
[sobbing.]
You'll be all right.
No, no, just stay still Dr.
Rhodes, I hear we're running out of O-Neg.
No, we have run out of O-Neg.
Wait Is this because of the woman with the amniotic fluid embolism? - Partly, yes.
- Dr.
Rhodes! She didn't present with any of the symptoms No hypotension, shortness of breath, chills Wheeler, nobody's blaming you.
I understand.
We're going to do all we can.
Leah, there was a fella out here before - A Mr.
Kellogg? - That guy Yeah, did you see what happened to him? Stormed out Said he was tired of waiting.
You should've heard the language.
I don't appreciate being talked to like that.
Yeah.
His color's already improving.
Heart rate's down to 119.
BP's up, 118 over 84.
Albumin and platelets aren't gonna cut it.
- That kid needs blood.
- I know.
Hey.
We've contacted Mr.
Winter's wife.
She's doing her best to get here.
Mr.
Winter, did you hear that? BP's down to 80 over 40.
Hey.
Hey.
Hang in there.
- Hey.
- Hey.
How's Mr.
Winter? I'm sorry.
Yeah.
And I'm sorry to have to tell you this, but we're out of ventilators.
- No.
- We've got emergency cases, who are coming out of surgery, who need 'em.
The the only choice we've got is to take 'em from our terminal patients.
I can't.
That ventilator's not gonna save his life, Ethan.
You know that.
All he wants is to stay alive long enough to say goodbye to his wife.
She's trying to get here.
- Man, I understand - Look, in the field, so many times, a wounded soldier will call out for a loved one A mother, a wife.
There's nothing I can do.
Come on, man.
Let's give this man his dying wish.
I'm sorry, man.
I can do it for you.
I can take him off the ventilator myself.
No He's my patient.
I will.
Mr.
Winter As you know, your condition is going to continue to deteriorate.
I'm sorry, but the hospital is in an emergency situation, and I've just been informed that I need to disconnect you from this ventilator.
It's needed for other patients who have a better chance of surviving.
I know.
Here's what I can do.
I can help you breathe manually, until your wife gets here, all right? April, pull the ventilator.
I'll bag him myself.
[muffled breathing.]
Thank you, Doris.
I just told Dr.
Choi to take his patient off the ventilator.
Hm, right.
Dr.
Latham, don't you feel anything? Do you mean, am I empathetic? Do I feel what others feel? Dr.
Rhodes, one can lack empathy, but still feel compassion.
Sarah You liking psychiatry? Uh, parts of it.
Yeah, I'm thinking about psychiatry.
I'm not sure the E.
D.
is the best fit.
Uh, let me ask you something.
Day's got me a little stressed.
Could you write me a prescription for Klonopin? Um don't you have your own doctor? Actually, no.
I I never felt the need.
I only want a few pills You know, take the edge off.
Jason, I'm sorry, but I'd have to ask Dr.
Charles.
Really? Hey, you know what, never mind.
I didn't mean to put you on the spot.
It's no big deal.
- You sure? - Yeah, I'll be fine.
Forget I asked.
Uh-huh.
Uh-huh, wait, do you wanna talk to his resident? Wait, he's right here.
Dr.
Charles, the brother of that patient that you saw in the waiting room The one who left.
- Oh, Jack Kellogg, great.
- Mm-hmm.
This is Dr.
Charles.
Please tell your brother that I'm What? I'm I'm so, uh, very s Uh, I-is there anything that we can Hello? Jack Kellogg shot himself.
He's dead.
Dr.
Charles? I changed lanes.
Next thing I know, we were hit.
Truck came out of nowhere.
I'm just glad you're okay.
What about the boys? They're both at the hospital and receiving treatment.
[sighs.]
Thank God.
Josh broke his legs, and Benjamin suffered a pelvic fracture.
Pelvis? You can fix that, right? I'm afraid it's a bit more complicated than that, Mr.
Porter.
Both boys lost a lot of blood, and both needed transfusions.
However, the accident, uh, combined with the storm created a shortage.
We only had enough for one.
For one? Honey, please, it was an impossible choice.
I don't understand.
What are you saying? You gave the blood to Josh? She didn't.
We did.
We decided that Josh had the best chance of survival.
Survival? What what about Benny? We are doing everything that we can, - but he needs blood.
- Okay, I'll donate.
I'm sorry, sir, but neither you nor your wife are a match.
- You must've approved this.
- I I can't believe it.
You should've made them give the blood to Ben.
Josh, he's my sister's son.
How could I just So you're okay with letting our own son die? What kind of mother are you? I cannot imagine the difficulty this must be for the two of you, but again, we are doing everything that we can.
Excuse me.
I'm sorry.
Sixteen critical, 24 stable, seven treated and released.
All remaining have been accounted for and assigned - their proper designation.
- Thank you, Dr.
Latham.
Ms.
Goodwin, if Benjamin doesn't get blood soon, he's not gonna make it.
Dr.
Manning, we discussed this.
I know, but I have an idea.
So let's adjust her Ativan to Q2-hours, and with Q4-hour vitals.
- See if that doesn't calm her down.
- Yes Doctor.
Dr.
Charles um, about what happened with that patient Yeah, that was unfortunate.
No, what I mean, um, is there was no way you could've known.
It's emergency medicine, Dr.
Reese.
We make these evaluations very quickly, and these kind of things happen.
Of course.
I I was just concerned, because of your history.
Oh.
Look, I have lost patients to suicide before, and I undoubtedly will again.
I, uh I appreciate your concern, but it's just the It's the cost of doing business.
Oh.
Okay.
Okay.
Thank you.
Good.
Okay.
- Hey.
- Hey.
Came as soon as I could.
Yeah.
Replenishing the bank, and hoping to find a match for your patient.
Dr.
Halstead jumps to the front of the line.
- Done.
- Thank you.
- Thank you, Maggie.
- Don't thank me.
Thank her.
It was her idea.
Paramedics just brought in a hemothorax.
Dr.
Rhodes needs you to put in a chest tube.
What about his wife? Have we heard anything? She's stuck in the storm Still trying to get here.
Then ask Dr.
Rhodes to have one of the other residents do it.
Dr.
Choi He just needs a little more time.
[muffled breathing.]
[beeping slows.]
[rapid beeping.]
[flatlining.]
[whispers.]
I'm so sorry.
Time of death, 15:37.
BP's down.
Heart rate's up to 152.
- We can add another pressor.
- He's peri-arrest.
His heart's working to compensate.
We've tried every stopgap we have.
Without oxygen-rich-red-blood-cells I'm afraid there's nothing more we can do for him.
Ms.
Goodwin, we typed a few universal donors in the doctors' lounge.
What is taking so long? Everything has to go through the lab.
If we transfuse blood that hasn't been screened for HIV and hepatitis, we are in direct violation of FDA guidelines.
We'll just have to wait.
Now hold on, I'm O-Negative.
I'm screened routinely by the Navy.
I don't know if military testing meets our standards.
Please.
If this could save my boy - Heart rate's up to 160.
- Connect me to a bag now.
We can push whole blood directly through the rapid transfuser.
Ms.
Goodwin Okay, do it.
I put him in room PCHEN.
Earl, I got your text.
What's the emergency? I found this guy holed up in a patient room Not even registered.
Had his feet up, watching TV like he owns the place.
Said he was Dr.
Charles' patient, so I brought him here.
But your brother called and said It wasn't my brother.
It was me.
Dr.
Charles thought you were dead.
Well, maybe I finally got through to him.
Think he'll see me now? Mr.
Kellogg I am so grateful that you're still alive, and that I get to treat you.
- I just want my meds.
- Yeah.
It doesn't really work that way.
You see, your behavior indicates a pretty profound personality disorder.
Off the cuff, among other things, I'd say you're probably a malignant narcissist with overt sadistic impulses.
You've got no right to talk to me - Shut your mouth.
- Dr.
Charles - Maybe I should just go.
- No, no, no, no.
I'm so sorry, but I gotta put you on a 72-hour psychiatric hold For your own good.
What? Seventy-two hours? You wanted my attention, and now you have it.
[sighs.]
BP's coming up.
Heart rate's going down.
Thank you, Ethan.
Of course.
Good news, we should be able to get him up to interventional radiology soon.
[sobbing.]
Susan? His father was right.
I was willing to let him die.
No.
No, we made the decision to give Josh the blood, but that doesn't mean we ever gave up on your son.
I'm his mother.
I should've fought for him.
What will he think when he finds out? Hi, uh, I'm looking for my husband.
They said he was burned in the accident.
His name is Rod Winter.
Oh, his doctor is not available right now, but if you can wait in the waiting room Mrs.
Winter, uh, hi, I'm Dr.
Rhodes.
Uh, I can speak with you about your husband.
Please.
Blood finally arrived.
Good.
Hey, I'm sorry for calling you "emotional" earlier.
You know, you spend a lot of time apologizing to me.
Well there are very few people I care more about.
Good night, Will.
Night, Natalie.
Snow's letting up.
Supplies coming in finally.
Rough day.
I was glad to be back in the E.
D.
You can fix peoples' bodies, but their minds [sighs.]
Whoo.
[no audible dialogue.]
[baby crying.]
[sobbing.]
I envied you today Making those decisions clinically, not letting your emotions interfere.
Dr.
Rhodes, are you saying you envy my autism? A little bit, yeah.
[indistinct chatter.]
Hey, we're going in 152 - On the right.
- Got it.
[sirens wailing, indistinct shouting.]
Okay, Craig, you take over bagging.
Got it.
Lacerated forehead, possible crushed airway.
Jeff, dispatch said mass casualty.
Only been on site a few minutes, but it's at least a dozen vehicles maybe more.
- [whimpering.]
- We need help over here! Sir - [shouts indistinctly.]
- Come here, come here.
- I've lost my teeth! - Gauze! Here you go.
Okay, bite down, bite down.
Hold the pressure.
All right, here.
Let's move over here.
There you go.
Lay down.
Casey has just radioed in.
They're popping the windshield on a minivan Need medical on site.
Red, thirty yards in, eye of the pileup.
- We're on it.
- Go.
- Jeff.
- I'm with ya.
- Go back that strip in, got it? - Got it.
Choi, got a family of four trapped inside.
Lot of intrusion on the vehicle.
All polytrauma.
All right, we're on it.
Adam - [grunts.]
- Got it.
My son save him.
My son.
We're gonna get you all out of here, all right? Help the boys.
Please.
- Help them please.
- Bleeding head lac Transected his temporal artery.
Give me two hemostats.
I've gotta clamp it off.
- Copy.
- [whirring.]
All right, I'm on the boys.
[grunting.]
Hang in there, guys.
[all whimpering.]
Almost there, guys.
Help my my boys, please.
Help help my Hey, Adam, need a C-collar.
You're gonna be okay.
- Jeff, what do you got? - I got some serious leg damage, - possible abdominal injuries.
- Let's give them some morphine.
Can you get a read on body weight? I don't know 60, 65 pounds each.
- Push 4 milligrams IM.
- I got it.
All right, take it easy.
Just take it easy.
Just take it easy.
- [groans.]
- It's okay.
Bleeding's under control.
Let's get him out of here.
Okay, you hang in there, guys.
I'm gonna give you something to make you feel better, all right? Place two 16-gauges on the right, and let them know he's red-tagged.
[people screaming.]
Jeff, stay with the kids.
[indistinct radio chatter.]
[indistinct shouting.]
I got you! [screaming.]
- Clear! Clear! - Back up! All right.
- [coughs.]
- He needs oxygen! Need a backboard! All right, sir, we're gonna get you out of here.
Sir, can you hear me? Try to stay calm, okay? Two, three - [grunting.]
- Pick him up.
[indistinct chatter.]
Oh, God.
[grunts.]
Hey! I need a little help over here! Pregnant woman! Hey, you there? Huh? Hey! A little help over here! Hey! Okay, everyone, listen up.
- Glad you made it in.
- [sighs.]
It wasn't easy.
We've got a predawn pileup Multiple traumas en route.
White-out conditions Staff snowed in at home No supplies coming in.
We need to make do with who and what we've got on hand.
All right, Dr.
Manning and Halstead, let's decompress the ED.
Anybody who's stable kicks back into the waiting area.
Copy.
- Dr.
Wheeler, be ready to glove up.
- Got it.
April, we need every room we've got.
Let's clear the hallways, supply room Anywhere we can fit a bed.
Let's go, people.
On it.
Doris, put out a hospital-wide alert, - and page the triage team.
- Okay.
Back to the waiting room? I've already waited an hour.
Uh, I apologize, Mr.
Kellogg, but we'll get to you as soon as we can, all right? What is the only indication for AVR in an asymptomatic patient with severe stenosis? Left ventricular systolic dysfunction.
Correct, Dr.
Bardovi.
This patient is stable.
Close his incision.
Why? We are expecting an influx of trauma patients.
Per emergency protocol, you and I will be in charge of triage.
We need to ensure that operating rooms are available to the most critical patients.
This man is not one of them.
- Close him up.
- Yes, Doctor.
All right, look alive.
Here we go.
Incoming.
38-year-old male pulled from his minivan.
Mom and two kids are on the way.
Here's the triage team.
GCS 12, hypotensive.
Clamped his temporal artery Belly's distended.
All right, he's surgical.
Stabilize him, and get him up to the O.
R.
- Dr.
Manning? - Got it.
All right.
Dr.
Choi 40-year-old male GCS 15 Satting 90% on a face mask.
- Dr.
Halstead? - Got it.
No, I got this one.
Severe burn make him warm, comfortable, and move on.
There's nothing more you can do.
- Naima? - 63-year-old female Went through the windshield.
Triple zeros Down for nearly 20 minutes.
Stand down.
Thrown from a vehicle with a high deceleration injury.
- Most likely a torn aorta.
- We can't be sure.
Regardless, asystole for 20 minutes.
This is not a survivable injury.
Hold compressions.
- Wait, let's warm her up first.
- Dr.
Rhodes, understand that today we need to focus our efforts on patients with the best chance of survival.
[whimpering.]
Please.
I need Helene, my wife.
Mr.
Winter, we'll find her.
Just try to relax.
He needs an IO.
Mr.
Winter, I'm gonna have trouble finding a vein.
I need to put an IV in your leg.
It'll only take a second.
[drill whirring.]
- Dr.
Choi, what are you doing? - Putting in an IO.
- Can I speak with you? - Hang on, one second.
- Almost - Now.
I'm in.
He's 95% TBSA.
Calculate his fluid based on Parkland, and run everything through the warmer.
Copy.
I thought I told you to make him comfortable and move on.
Dr.
Latham, standing by while a patient dies is not in my job description.
He has full thickness burns over 90% of his body.
There's no chance of recovery.
He's awake, talking, lucid, not in any pain.
As you well know, he's not in pain because his cutaneous nerves have been destroyed by the burn.
Very soon, his organs will began to shut down.
He is going to die.
And treating him will only take resources away from patients who have a chance of survival.
[sighs.]
- Maggie! - Jeffrey.
26-year-old female found passed out in the snow.
35 weeks pregnant Vitals stable.
Dr.
Wheeler, you're going to Treatment 2.
- Got it.
- Stop.
Green is not the proper designation.
An expectant mother always takes priority.
- Is my baby gonna be okay? - Don't worry.
We're gonna make sure both of you are taken care of.
[indistinct chatter.]
I'll get some blankets.
On my count, one, two, three.
They said you lost consciousness.
- Do you know what happened? - I don't remember.
It all happened so fast.
I saw a cut on my arm, and I went for help.
Next thing I know, they're bringing me here.
Well, your vitals look good.
- What about my baby? - I'm checking now.
- Baby's heartbeat is strong.
- Dr.
Wheeler Traumas are coming in hot.
You done here? Uh, let's get her undressed, and put her on a fetal monitor.
Everything looks good.
I'll be back soon.
Pulled from the minivan This is mom Susan, 38 years old, GCS 15.
Right arm fracture Complaining of back pain.
Son and nephew are coming in behind us.
My husband, Blake How is he? We've sent him up to the O.
R.
already.
Belly's clear.
Get her CT for head and TLS spine.
Make sure there are no vertebral fractures.
- Take care of the boys.
- We will.
9-year-old nephew, Josh GCS 15 vitals stable.
Got pinned in the backseat.
Bilateral femoral fractures One open.
His parents are traveling abroad.
He's been staying with his aunt and uncle.
- All right, Dr.
Manning? - Yep.
Hi, I'm Dr.
Manning.
I'm gonna take good care of you, okay? I'm gonna give her a hand.
All right, you're going to Treatment 5.
- Yep.
- Talk to me.
Benjamin 10-year-old son GCS 15.
Abdominal pain Mildly hypotensive from possible blood loss.
Systolic 100 over palp.
Dr.
Halstead, red tag.
- April.
- You're going to Treatment 4.
[groaning.]
My hips! My hips! Hang in there, champ.
We're gonna get you fixed up.
4, here.
Okay.
Okay, on my count, one, two, three.
[groaning.]
- Thank you, gentlemen.
- Yep.
[coughs and groans.]
[whimpers.]
Breath sounds clear and present bilaterally.
Hang another liter of saline on the level one.
Yep.
How'd you get to be so strong? You're doing great.
Chest and belly clear.
Okay, honey.
BP 86 over 47.
Heart rate 135.
- [screams.]
- I know, I know, I know.
Okay, okay, that's it, just breathe.
Unstable pelvis and hypotensive.
Close it down to stop the bleeding? Yeah, grab a sheet.
I need some help in here! What do you need? This might hurt.
Give him 25 mics of Fentanyl.
Copy.
Okay, honey.
Okay.
All right, all right.
[distressed breathing.]
Okay, make sure it's tight.
[grunts.]
Heart rate's coming down.
Bleeding's temporized for now.
Let's get X-rays Chest and pelvis.
Let me know the second there's an opening in interventional radiology.
We need to embolize the bleeding.
Got it.
[groaning.]
Chest and abdomen are clear.
Cold foot I can't get a pulse on this leg.
Fractures probably kinking the femoral artery.
- We've gotta reduce this now.
- Let's push two milligrams of versed and 25 mics of Fentanyl.
Okay, Josh, we're gonna have to do something right now, and I need you to be so brave for me.
- Can you do that? - Okay.
Yeah? Yeah? Are you ready? All right, one, two, three.
- [loud groans.]
- It's all done.
That's it.
It's over.
Great job.
All right, get a post-mold splint on him.
Page ortho.
He's gonna need surgery to wash out and ex-fix that fracture as soon as we can get an O.
R.
- [whimpers.]
- Are you all right? Okay, can you keep being brave like that? Dr.
Rhodes You are so brave So brave.
- What happened? - I I I don't know.
She was alert and talking a few minutes ago.
- No pulse.
- All right, Clarke, intubator.
April, a milligram of epi.
Wheeler, get on her chest now.
[grunts.]
- She's hemorrhaging.
- Abruption from the trauma? That might explain just a vaginal bleed, but not this.
She's bleeding around her IV.
- [grunts.]
- Dr.
Rhodes All right, likely an amniotic fluid embolism.
Impact from the accident forced amniotic fluid into her bloodstream Disrupted her clotting factors.
Trigger the MTP.
We need to get this baby out now.
- Page OB? - No, there's no time.
We've got about four minutes to deliver, or we're gonna lose her and the baby.
- Tubes in.
- Take over bagging.
Okay, splash prep her abdomen.
Give me the knife.
[alarm blaring.]
[dramatic music.]
Clarke, pull.
[grunting.]
There we go.
It's a girl.
April, cut the cord.
Clarke, start packing her abdomen.
On it.
There we go.
Okay.
The baby looks good.
April, let's get her up to the NICU.
- On my way.
- Okay.
All right, Wheeler, hold compressions.
She's in v-fib.
Paddles.
- Charge to 200.
- Charge.
- No.
- Charge again.
- Charge.
- Clear.
Sinus tach.
BP 70 over 33, heart rate 130, oxygen rate 95%.
All right, set up a Neo drip at a 100 mics.
100 mics.
She looks like she's lost about three liters.
How much have we given her? Two packed red blood cells, one FFP, two cryo.
Second patch is on its way with more blood and cryo.
All right.
She's still bleeding.
Tell the blood bank to keep sending us O-Neg.
We'll finish packing her here, and then we'll send her up to OB, so they can close her.
Right.
Hey, Mr.
Winter.
How are you feeling? Cold.
That's to be expected.
The damage to your skin caused you to lose heat.
We have another warmer coming in for you.
Mr.
Winter You're in burn shock.
Your organs are gonna shut down soon.
I'm I'm dying? Yes.
Keep me alive till my wife gets here.
I wanna say goodbye.
We'll do everything we can.
[coughing.]
Mr.
Winter, your airways are starting to swell.
We need to intubate you, and put you on a ventilator.
But I won't be able to talk.
When your wife gets here, I'll remove the tube, and you'll be ab [sniffles.]
And you'll be able to say goodbye.
20 of etomidate and 15 rocuronium.
[coughs.]
All right, now for waiting room drama.
His name is Jack Kellogg.
Came in for a Xanax refill.
How long you have to wait around here? Got bumped from his treatment room.
Doesn't seem like an emergency to me.
- Might just be hunting for drugs.
- He's fine, he's fine But if you think differently, I'll send him upstairs.
Did he threaten to hurt anybody or himself? No.
He's just a pain in the ass.
- I'll talk to him.
- All right.
Mr.
Kellogg? I'm Dr.
Charles.
I've been waiting for over two hours.
Nobody cares.
I'm just a number.
I'm very sorry.
We have a major pileup on the highway, and we're in a triage situation It's not my problem.
Okay, well, what seems to be the trouble? Cut the crap, all right? Blah, blah, blah.
- I'm out of my meds.
- Did you call your doctor? He's out.
Why else would I be here? How hard is it for you to write me a prescription? Well, we wanna make sure you get the right medication, - the proper dosage.
- Dr.
Charles - Could you hold on a second? - I'm sorry, but there's an emergency in the psych ward.
A patient attacked a nurse.
They need you.
Mr.
Kellogg, I'm very sorry.
We are gonna take excellent care of you, but you're gonna have to wait a little bit longer.
- Oh, for God's sake.
- I will be right back, and I'm gonna make you one of our first priorities.
First priority.
Yeah, sure.
Look at me! I'm a human being.
I'm a human being! A human being! Should we put him on a psych hold? No, he's not dangerous, just pissed off.
Daniel? We're slammed and short personnel.
I need to pull Dr.
Reese off your service, and put her to work here.
Go to it.
- Reese, with me.
- Okay.
Heart rate's 150.
BP 70 over 40.
What are his injuries? Femoral fractures in both legs - Lots of soft tissue injuries.
- [groans.]
Looks like bilateral thigh hematomas.
So blood's accumulating in his legs.
We need to transfuse him.
Yes, but first let's get a liter of lactated ringers Dopamine at 10 Titrate to systolic BP of 90.
[groaning.]
Maggie, need some help in here! Coming! Blood pressure's coming up 80 over 50.
- 90 over 60.
- He's stable for now.
Call up to the blood bank, and tell him we need two units of O-Negative for this boy.
I need the same for his cousin in the next room.
Okay, hold on.
[sighs.]
You're both gonna have to talk to Ms.
Goodwin about this.
Because of emergency surgeries, and a pregnant mother's serious bleeding disorder, we have used almost all of our O-Negative.
We can either treat Benjamin or Josh, but not both.
Benjamin needs an angio embolization more urgently than Josh needs surgery.
How can you say that? Josh isn't compensating for his blood loss as well.
He's in worst shape.
I understand you're trying to protect your patient, but you're being emotional.
"Emotional"? And what are you being? Our recommendation needs to be based solely on clinical criteria.
So I'm handing it over to the triage team.
Dr.
Rhodes, your opinion? I have to agree with Dr.
Halstead that Benjamin needs angio embolization more urgently than Josh needs surgery.
Not the issue.
We're here to decide who has the best chance of survival, so Unfortunately, even if Benjamin gets the embolization, there's only a 15% chance that the bleeding in his pelvis will stop.
Exactly.
Whereas with Dr.
Manning's patient, as the pressure in his thighs builds, the bleeding will eventually slow.
Worst case, Josh loses a leg, but there is no question he has the best chance of survival.
- I don't understand.
- We're very sorry, but it's up to you to decide which of the boys gets the blood.
Decide who gets the blood? The doctors have their opinion, but it is a decision you and your husband should make, and he's still in surgery.
But, without blood, is one of them gonna die? It is a possibility, but we are gonna do whatever we can to prevent that.
And you want me to decide between my son and my sister's? But how? Our recommendation is to give the blood to your nephew, Josh.
Josh? Why? Because he has the greater chance of survival.
- That means Ben - We are gonna do our best to keep him alive until we have more blood.
How can you make me do this? [sobbing.]
I can't.
- I can't.
- If you'd prefer, we can make the decision on your behalf.
Mrs.
Porter, I assure you, we will do what's medically and ethically correct.
[sobbing.]
You'll be all right.
No, no, just stay still Dr.
Rhodes, I hear we're running out of O-Neg.
No, we have run out of O-Neg.
Wait Is this because of the woman with the amniotic fluid embolism? - Partly, yes.
- Dr.
Rhodes! She didn't present with any of the symptoms No hypotension, shortness of breath, chills Wheeler, nobody's blaming you.
I understand.
We're going to do all we can.
Leah, there was a fella out here before - A Mr.
Kellogg? - That guy Yeah, did you see what happened to him? Stormed out Said he was tired of waiting.
You should've heard the language.
I don't appreciate being talked to like that.
Yeah.
His color's already improving.
Heart rate's down to 119.
BP's up, 118 over 84.
Albumin and platelets aren't gonna cut it.
- That kid needs blood.
- I know.
Hey.
We've contacted Mr.
Winter's wife.
She's doing her best to get here.
Mr.
Winter, did you hear that? BP's down to 80 over 40.
Hey.
Hey.
Hang in there.
- Hey.
- Hey.
How's Mr.
Winter? I'm sorry.
Yeah.
And I'm sorry to have to tell you this, but we're out of ventilators.
- No.
- We've got emergency cases, who are coming out of surgery, who need 'em.
The the only choice we've got is to take 'em from our terminal patients.
I can't.
That ventilator's not gonna save his life, Ethan.
You know that.
All he wants is to stay alive long enough to say goodbye to his wife.
She's trying to get here.
- Man, I understand - Look, in the field, so many times, a wounded soldier will call out for a loved one A mother, a wife.
There's nothing I can do.
Come on, man.
Let's give this man his dying wish.
I'm sorry, man.
I can do it for you.
I can take him off the ventilator myself.
No He's my patient.
I will.
Mr.
Winter As you know, your condition is going to continue to deteriorate.
I'm sorry, but the hospital is in an emergency situation, and I've just been informed that I need to disconnect you from this ventilator.
It's needed for other patients who have a better chance of surviving.
I know.
Here's what I can do.
I can help you breathe manually, until your wife gets here, all right? April, pull the ventilator.
I'll bag him myself.
[muffled breathing.]
Thank you, Doris.
I just told Dr.
Choi to take his patient off the ventilator.
Hm, right.
Dr.
Latham, don't you feel anything? Do you mean, am I empathetic? Do I feel what others feel? Dr.
Rhodes, one can lack empathy, but still feel compassion.
Sarah You liking psychiatry? Uh, parts of it.
Yeah, I'm thinking about psychiatry.
I'm not sure the E.
D.
is the best fit.
Uh, let me ask you something.
Day's got me a little stressed.
Could you write me a prescription for Klonopin? Um don't you have your own doctor? Actually, no.
I I never felt the need.
I only want a few pills You know, take the edge off.
Jason, I'm sorry, but I'd have to ask Dr.
Charles.
Really? Hey, you know what, never mind.
I didn't mean to put you on the spot.
It's no big deal.
- You sure? - Yeah, I'll be fine.
Forget I asked.
Uh-huh.
Uh-huh, wait, do you wanna talk to his resident? Wait, he's right here.
Dr.
Charles, the brother of that patient that you saw in the waiting room The one who left.
- Oh, Jack Kellogg, great.
- Mm-hmm.
This is Dr.
Charles.
Please tell your brother that I'm What? I'm I'm so, uh, very s Uh, I-is there anything that we can Hello? Jack Kellogg shot himself.
He's dead.
Dr.
Charles? I changed lanes.
Next thing I know, we were hit.
Truck came out of nowhere.
I'm just glad you're okay.
What about the boys? They're both at the hospital and receiving treatment.
[sighs.]
Thank God.
Josh broke his legs, and Benjamin suffered a pelvic fracture.
Pelvis? You can fix that, right? I'm afraid it's a bit more complicated than that, Mr.
Porter.
Both boys lost a lot of blood, and both needed transfusions.
However, the accident, uh, combined with the storm created a shortage.
We only had enough for one.
For one? Honey, please, it was an impossible choice.
I don't understand.
What are you saying? You gave the blood to Josh? She didn't.
We did.
We decided that Josh had the best chance of survival.
Survival? What what about Benny? We are doing everything that we can, - but he needs blood.
- Okay, I'll donate.
I'm sorry, sir, but neither you nor your wife are a match.
- You must've approved this.
- I I can't believe it.
You should've made them give the blood to Ben.
Josh, he's my sister's son.
How could I just So you're okay with letting our own son die? What kind of mother are you? I cannot imagine the difficulty this must be for the two of you, but again, we are doing everything that we can.
Excuse me.
I'm sorry.
Sixteen critical, 24 stable, seven treated and released.
All remaining have been accounted for and assigned - their proper designation.
- Thank you, Dr.
Latham.
Ms.
Goodwin, if Benjamin doesn't get blood soon, he's not gonna make it.
Dr.
Manning, we discussed this.
I know, but I have an idea.
So let's adjust her Ativan to Q2-hours, and with Q4-hour vitals.
- See if that doesn't calm her down.
- Yes Doctor.
Dr.
Charles um, about what happened with that patient Yeah, that was unfortunate.
No, what I mean, um, is there was no way you could've known.
It's emergency medicine, Dr.
Reese.
We make these evaluations very quickly, and these kind of things happen.
Of course.
I I was just concerned, because of your history.
Oh.
Look, I have lost patients to suicide before, and I undoubtedly will again.
I, uh I appreciate your concern, but it's just the It's the cost of doing business.
Oh.
Okay.
Okay.
Thank you.
Good.
Okay.
- Hey.
- Hey.
Came as soon as I could.
Yeah.
Replenishing the bank, and hoping to find a match for your patient.
Dr.
Halstead jumps to the front of the line.
- Done.
- Thank you.
- Thank you, Maggie.
- Don't thank me.
Thank her.
It was her idea.
Paramedics just brought in a hemothorax.
Dr.
Rhodes needs you to put in a chest tube.
What about his wife? Have we heard anything? She's stuck in the storm Still trying to get here.
Then ask Dr.
Rhodes to have one of the other residents do it.
Dr.
Choi He just needs a little more time.
[muffled breathing.]
[beeping slows.]
[rapid beeping.]
[flatlining.]
[whispers.]
I'm so sorry.
Time of death, 15:37.
BP's down.
Heart rate's up to 152.
- We can add another pressor.
- He's peri-arrest.
His heart's working to compensate.
We've tried every stopgap we have.
Without oxygen-rich-red-blood-cells I'm afraid there's nothing more we can do for him.
Ms.
Goodwin, we typed a few universal donors in the doctors' lounge.
What is taking so long? Everything has to go through the lab.
If we transfuse blood that hasn't been screened for HIV and hepatitis, we are in direct violation of FDA guidelines.
We'll just have to wait.
Now hold on, I'm O-Negative.
I'm screened routinely by the Navy.
I don't know if military testing meets our standards.
Please.
If this could save my boy - Heart rate's up to 160.
- Connect me to a bag now.
We can push whole blood directly through the rapid transfuser.
Ms.
Goodwin Okay, do it.
I put him in room PCHEN.
Earl, I got your text.
What's the emergency? I found this guy holed up in a patient room Not even registered.
Had his feet up, watching TV like he owns the place.
Said he was Dr.
Charles' patient, so I brought him here.
But your brother called and said It wasn't my brother.
It was me.
Dr.
Charles thought you were dead.
Well, maybe I finally got through to him.
Think he'll see me now? Mr.
Kellogg I am so grateful that you're still alive, and that I get to treat you.
- I just want my meds.
- Yeah.
It doesn't really work that way.
You see, your behavior indicates a pretty profound personality disorder.
Off the cuff, among other things, I'd say you're probably a malignant narcissist with overt sadistic impulses.
You've got no right to talk to me - Shut your mouth.
- Dr.
Charles - Maybe I should just go.
- No, no, no, no.
I'm so sorry, but I gotta put you on a 72-hour psychiatric hold For your own good.
What? Seventy-two hours? You wanted my attention, and now you have it.
[sighs.]
BP's coming up.
Heart rate's going down.
Thank you, Ethan.
Of course.
Good news, we should be able to get him up to interventional radiology soon.
[sobbing.]
Susan? His father was right.
I was willing to let him die.
No.
No, we made the decision to give Josh the blood, but that doesn't mean we ever gave up on your son.
I'm his mother.
I should've fought for him.
What will he think when he finds out? Hi, uh, I'm looking for my husband.
They said he was burned in the accident.
His name is Rod Winter.
Oh, his doctor is not available right now, but if you can wait in the waiting room Mrs.
Winter, uh, hi, I'm Dr.
Rhodes.
Uh, I can speak with you about your husband.
Please.
Blood finally arrived.
Good.
Hey, I'm sorry for calling you "emotional" earlier.
You know, you spend a lot of time apologizing to me.
Well there are very few people I care more about.
Good night, Will.
Night, Natalie.
Snow's letting up.
Supplies coming in finally.
Rough day.
I was glad to be back in the E.
D.
You can fix peoples' bodies, but their minds [sighs.]
Whoo.
[no audible dialogue.]
[baby crying.]
[sobbing.]
I envied you today Making those decisions clinically, not letting your emotions interfere.
Dr.
Rhodes, are you saying you envy my autism? A little bit, yeah.