Chicago Med (2015) s02e15 Episode Script

Oh, so here we go.
What letter are we up to now? J's.
So, Jeremiah if it's a boy, or Jacinta if it's a girl.
Hmm Jeremiah Sexton-Jenkins.
- I like it.
- Oh, my God, it's a boy? Or Jacinta Sexton-Jenkins.
You're having fun torturing me by not telling me the gender of the baby, aren't you? A little, but hey, if I can wait 21 more weeks, so can you.
Dr.
Rhodes? Page me if you need me.
Case coming your way.
Window washer fell 33 stories.
Should be DOA, but still alive barely.
- 33? - Press will be all over this.
Hospital PR's gonna be involved.
Get ready for your close-up.
Okay, who's next? Damian Butler.
- Damian Butler? - That's me.
Oh, God.
Won't be much longer.
It's just I have the flu.
It's low priority.
I get it.
Sir? - Maggie, how many minutes out? - They're here.
- Baghdad's prepped.
- Thanks.
Justin Pepper, 23, long fall, axial load injury after his window washing platform gave out.
GCS, 3 BP, 70 over palp Heart rate, 135.
All right, that long a fall, we're looking at injuries to the brain, spine, chest, and abdomen, let alone long bone fractures.
Maggie, I need extra hands and an O.
R.
on alert.
Done.
- What's he got for IV access? - 16 gauge on both arms.
All right, very gently, everybody.
On my count, one, two, three.
- Good luck.
- Thanks.
All right, likely cavitary bleeding.
Wheeler, get a groin line.
Start the MTP.
Hang two units of O-neg on the rapid transfuser until we type and cross.
X-Rays I need chest, pelvis, and C-spine.
And let's get the ultrasound over here to fast his belly.
- Lungs are clear.
- All right.
I'm gonna start the groin line.
Help me reduce this leg fracture.
Come on, come on.
One, two, three - X-Ray.
- All right, step back.
Pelvis down.
- C-spine.
- On the box.
- Chest X-Ray is up.
- Tension hemopneumothorax.
Trachea shifted, venous return is down.
Give me a chest tube.
Show me the pelvis.
Got it.
Vertical shear of the left hemipelvis It needs traction.
Pull up the C-spine.
Up.
Multiple C-spine fractures.
- Wheeler, how's that groin line? - Done.
All right, chest tube's in too.
Let's move.
Justin didn't survive a 330-foot fall just to die in my trauma bay.
- Let's go, let's go! - Go.
- Witnesses report that Mr.
Pepper clung to the window washing platform as it fell, almost riding it like a surfboard.
Physicists surmise this likely created wind resistance that not only slowed his plummet, but also absorbed some of the force from impact.
That might explain how he survived such a horrific fall.
I'm running the bowel.
Feeling tears.
Hemostat.
Pelvic hematoma and mesenteric bleeders are tied off.
Let's resect the bowel quickly and move on.
GIA 80 stapler with a reload.
50% of people who fall four to five stories die.
Ten or 11 it's almost 100%, so this is a first.
There's an exception to every rule.
All right, got some more spaces next.
Laura Pastino.
Laura Pastino? No, Melody Sayers.
Okay, uh, Treatment 3.
I'll be right there.
- I'm sorry.
- No, this one's on me.
I thought I could sneak in and see a doctor on my lunch break.
It's bad planning.
Okay, I'm April.
Can I get you anything? Water? Snack from the meal cart? No thanks.
Not much of an appetite.
If I need something, I'll just Melody? Are you okay? Yeah, sorry.
You just zoned out.
That ever happen before? Probably.
I'm a first-year associate.
My law firm's specialty.
60-hour weeks.
Can I see your wrist? Yeah.
Pulse is really weak.
I'm just exhausted.
I'm gonna go home and sleep.
I'll come back tomorrow.
Your feet hurt? Yeah, I've just been sitting for awhile.
Do you mind if I take a look? Sure.
Ankles are swollen.
Pitting edema.
Do me a favor.
Stick around for a little longer.
I'm gonna get you in.
Okay.
- Americano.
- Thank you.
Wow, all this for Connor's trauma? If it bleeds, it leads.
Help! I need help! My husband! - What happened? - He called me at work.
He said he wasn't feeling well.
But then But when I came home for lunch, I-I found him like this.
Hey, hey, can you hear me? Thready pulse, diaphoretic.
He's burning up.
He take any drugs? Could it be an overdose? No, never.
Septic shock? I think so.
We gotta get him inside.
All right, I'm gonna get techs to bring out a gurney, and set up for central access if we need one.
I'm gonna help you out of the car, okay? No, get back.
I can do it myself.
No, Nick, let him help you.
Don't let him, please.
- Easy.
- Nick, please, no Julia Julia - I need your help.
- I know, baby, I-I I'm sorry.
Okay, okay.
My legs don't work.
It's okay, Nick.
I got you.
Here.
All right.
Let's go.
Dr.
Choi, you're going to Treatment 5.
- Dr.
Manning's already there.
- Thanks, Mags.
Dr.
Reese? - Oh, my - This woman needs aid.
Dr.
Wheeler! I saw her fall crossing the street.
When I got to her, she was unable to speak.
- Think she's having a stroke.
- Treatment 2.
Weak pulse right side of the face is droopy.
- Right side body, limp.
- What do we got? Possible stroke.
Okay.
Thanks, Super-dude.
You're safe now, ma'am.
Oh, Lord.
We need a stretcher! Right now, your son is in shock.
There is massive blood loss from extensive injuries to his liver, his pelvis, his intestines.
We've packed his abdomen to control the bleeding and removed a portion of his bowel.
He's still open.
That's what we call a negative pressure dressing.
It helps to temporize the abdomen Is Justin going to survive? When he arrived in the E.
D.
, he was minute to minute.
Right now, he is hour to hour, and that is a very good first step.
This is Dr.
Rhodes.
Who is this and how did you get this number? No, my patient is very much alive, thank you.
Sounds like the press got to you before we did.
Dr.
Connor Rhodes, this is Evelyn Kumer, public affairs rep for the hospital.
She'll be coordinating all media platforms.
So, reporters got your number? Yeah, they wanted to know if Justin had died on the operating table.
Where do they get this crap? Who knows? But the rumor mill is grinding.
And you're in the spotlight.
A man falls 33 stories and is still alive? People are gonna want to know, is this a miracle or a setup for tragedy? Excuse me.
Until we know for sure how this is gonna turn out, let's stick with "no comment.
" 102.
7.
BP, 80 over 55.
Whoa, that's really low.
Uh, Melody, I hear a crackling in your chest.
This means fluid is building up in the lungs.
A symptom of the flu? - I don't think so.
- The exhaustion, swelling in your legs, low blood pressure are possible indicators of a cardiac problem.
My heart? Oh, my God.
We're gonna take a look and see what's going on, okay? Okay.
That just That doesn't make any sense.
I'm only 25 years old.
I walk to work instead of taking the train.
Eat salads take spin classes.
Okay, dilated left ventricle, poor wall motion.
April, let's get her on the monitor.
Your heart is pumping very poorly.
Uh, I'll need an echo, but if I had to say, I'd guess it's working at 20, 25%.
My heart is failing? It's unusual for a young woman.
Could be a thyroid imbalance, a kidney issue, virus.
We'll figure it out.
Before you know it, you'll be back at spin class.
I'm gonna hold you to that.
Melody Melody? No pulse or breathing.
V fib get on her chest.
Charge to 200.
Charged.
Hold CPR.
Clear.
200 again.
Hold CPR.
Clear.
I got a pulse.
It's weak but steady.
She's breathing.
Let's get her to the cath lab.
Great catch, April.
Had she gone home, no way help would've gotten to her in time.
- So it's an infection? - Fever, elevated white cells, inflammatory markers, and lacate.
- I'd say so.
- Most likely UTI.
It's common in paraplegics.
Been down that road a few times.
Life with a catheter, right? We made to need to replace it.
Suprapubic? T-boned by a drunk driver who didn't stop for a red light.
He walked away with a few stitches.
That was then.
We're moving on.
Brighter days ahead.
Area around the catheter looks clean.
No obvious abscess or skin infection.
Answer's in the pee then.
We'll get this and blood cultures up to the lab, find out what we're dealing with.
Sorry about lashing out earlier.
I sometimes forget I'm half a man.
No, you're not.
I'm with her.
Yeah, well, she's one of a kind.
Not letting her get away.
Good plan.
Hey K If it's a boy, Kalani.
If it's a girl, Kiersleigh.
What do you think? - Pass.
- Ulch.
Any word from the cath lab about Melody? No, but I should hear something soon.
Okay, I have an OB appointment.
Should be fast, though 20 minutes, tops.
I can push it.
Or I can text you if I hear something.
Because of the TB, Dr.
Lee likes to see me every two weeks.
- You'll text me about Melody? - Mm-hmm.
Now go, don't be late for your appointment.
We haven't officially met.
I'm Dr.
Reese.
Hi.
Edward Thompson.
That was quite an entrance, Edward.
Yeah, I could imagine.
The suit, elderly woman in my arms.
- Yeah.
- How is she? - Uh, doing well - Oh.
Thanks to you getting her here so quickly.
Oh, that's great.
How are you? How are you feeling? Okay, I think.
But I never passed out before.
What uh, what happened? Uh, your labs and EKG are normal, so I think you were just so excited in the moment that when it was over, you fainted.
And where are my clothes? A nurse said she'd get 'em, but she never came back.
Unfortunately, we had to cut off the costume, so that we could examine you.
Cut it off? You mean it's destroyed? Uh, yes.
Oh, God.
You had no right.
I I need it.
Edward, breathe.
Breathe.
All right, nice and s-all right, here.
Hey, look at me, look at me.
Just like this.
Two seconds in.
Four seconds out.
Two seconds in.
Four seconds out.
I need it.
33 stories.
God.
Massive subdural hemorrhage.
Significant left shift.
Big mass effect is crushing his brain inside of his skull.
Well, he did fall off a building.
Craniotomy, right? To what end? He's coagulopathic.
I go in and take out the clot, it'll just re-accumulate.
No, I don't think so.
I'm actively giving him plasma, platelets, and cryo.
Which improve his overall chances of survival from 1% to 2.
I'm not opening up his skull.
I question whether he's even strong enough for this CT, but that was your call.
If the pressure in his brain isn't relieved, it's over.
That's 100%.
I got him this far.
He'll get through surgery.
All the king's horses and all the king's men guess they should've gone to you.
- Full costume? - Cape and all.
When Edward learned it had been destroyed, he was so distraught, he could hardly even breathe.
That's a pretty extreme reaction, but, you know, wardrobe and self-esteem can be deeply intertwined.
The costume Ultimately, it's just a symbol that represent something crucially important to Edward.
Our job's to figure out what.
The inciting incident that made it necessary The origin story.
You know, because we're talking about a superhero.
- Uh-huh.
- Like like when Tony Stark became Iron Man.
Why did Billy Batson become Captain Marvel? Nice.
Pickle.
Urinalysis is clean, so your infection isn't from a UTI.
Clear.
Not pneumonia.
- Meds? - Aspirin, midodrine, tramadol.
No steroids, immunosuppressants.
No red flags.
I'll check the D-dimer.
It could be a DVT.
- Yeah.
- Deep vein thrombosis? D-dimer's negative.
No clots.
Abscess then.
The hot spot would be the sacrum.
- I-I can't - Yeah, I got you.
Nothing dermal.
It must be hiding deep down.
The, uh, scar I'm thinking of getting a tattoo to cover it He and she stick figures riding POPS.
It's a surf spot in Waikiki.
We took a lesson on our honeymoon.
We stood up on our first wave.
Did you feel something? Um, I don't know.
Maybe.
Let's get a CT chest, pelvis and abdomen.
Infection may be abdominal or in a deep space.
Yeah.
Hang tight.
- We're getting closer.
- We'll be back.
You felt that? - Good hemostasis.
- No new bleeds.
He tolerated the surgery well.
Appears luck's on your side today.
If that's how you wanna put it.
There's no heartbeat.
No.
No, no, please, look again.
I'm so sorry.
No.
- Wh - You'll need a D&C.
If there's a room available, I can do it now.
Okay.
I need to get back to work.
April, no one would expect you to I have to.
I There's a a patient I'm worried about.
Are you sure? Okay.
Well, you know the nurses up there.
You just give them a call when you're ready.
The sooner the better though.
End of the day.
Tomorrow at the latest.
Hey, April.
Cardiology make a diagnosis? Viral myocarditis.
She's only in the E.
D.
until a bed opens up in the CCU.
She needs cardiopulmonary support.
Infection's that bad? Well, the hope is partial bypass will rest her heart enough to let the antiviral meds get the upper hand.
That's doing most of my heart's job now.
I know.
It's hard to keep your mind from racing to that dark place.
Is there anyone I can call? Uh, family? My parents are divorced.
Mom's in Idaho.
Dad's in New Hampshire.
I'm not ready to deal with all that yet.
But I don't want to be alone.
Will you sit with me? As long as you need.
Thank you.
What was her name? Rachel.
Way out of my league.
I've always been the quite one.
She was the opposite.
Hm.
I rode her coattails, yet she still loved me.
And then it was over.
My wife was gone.
When did Rachel pass? Last year Ovarian cancer.
It took her so fast.
I couldn't help her.
I couldn't ease her pain.
I could only watch.
I was useless, weak.
- And the suit? - Stumbled across it online.
I don't know why I ordered it.
But when it came, I tried it on, and I felt different, stronger.
I just want to be useful.
I just wanna be able to help.
I understand.
Uh we'll come up with a plan.
Let me talk to my supervisor.
Hey, how was your ultrasound? It was fine.
I was just thinking about Melody.
She thought she only had the flu.
Yeah.
Okay.
- Hey, walk with me.
- The CPS working? A-line pulsatility is decreasing.
Heart's beating less and less on its own.
But it's only been a few hours.
The meds need awhile to build in her system.
And we can't speed up the process? We can? IVIG and plasmapheresis.
It's method to block Melody's immune system from attacking heart muscle as it tries to clear the infection.
- Well, why aren't we doing it? - The science is unproven.
The unknowns worry me.
The risk of anaphylaxis, additional infections, - inflammatory side effects.
- Well, she already coded.
Another one could be right around the corner.
Isn't it worth trying anything? Not if it does more harm than good.
Yes, and the suit was how Edward dealt with his wife's death.
See, I'm concerned that if he leaves, he's just gonna go get another one, and that will lead him right back here.
Some knucklehead will see him in that costume, and pick a fight.
"Let's see how tough you are, Super-guy.
" Hm, it's possible, but is he having any suicidal thoughts? No.
And he's certainly not a danger to others.
He literally presented saving a woman's life.
I mean, he just doesn't meet the criteria for a psychiatric hold.
Okay.
- There you go.
- Thank you.
Dr.
Rhodes? Dr.
Rhodes, wait.
Can you tell us about the miracle patient, Justin Pepper? - I - Please, anything.
The people want to know.
Well the craniotomy we performed was successful.
His blood pressure is steady.
The bleeding in his chest and belly has slowed, so, fortunately, we've been able to back off of the transfusions.
Is he gonna pull through? Well, it is still too early to tell, but we are fighting the good fight.
Now, if all continues to go well, Ortho will be able to start treating his bone fractures tomorrow.
Now, if you'll excuse me, I've got to get back to my patient.
What the hell was that? My patient's doing well.
I didn't see why the press shouldn't know.
Any interaction with the media goes through me.
I wouldn't have let you come out here and grandstand like that.
What if the patient dies? You gonna hold a press conference then? - Hey.
- Hey.
Thoracic hardware's stabilizing the spine on the T4 fracture.
Otherwise, everything looks normal.
Colon has descended.
It could be a colonic pseudo-obstruction.
They are common in paraplegics.
Yeah, but I don't see any free air or fluid.
Hm, the infection's gotta be hiding somewhere.
Let's try a white blood cell scan.
Tag some of his own infection-fighting cells with a tracer dye, and see where they go.
Let his immune system show us where the hot spot is.
Good idea.
I'll get on it.
- Hey, Nat.
- Yeah? Uh, when I pressed on Nick's abdomen, I was below a sensory loss level.
He shouldn't have felt anything.
His abdominal wall is inflamed.
When you applied pressure, it fired off a signal.
If anything, Nick felt nausea, but nothing tactile.
He couldn't have.
Yeah, I guess not.
It's gone up.
What about my heart? Improvement? Unfortunately, it's not responding the way I'd hoped.
I Googled myocarditis.
Severe cases, people needed heart transplants.
Am I one of them? Possibly.
But we're not there yet.
There is another procedure we can try IVIG and plasmapheresis But I have to warn you, there are some risks.
What do you think? If your heart stops beating again, it may never come back.
This procedure is it an operation? No, an infusion.
It can be done right here in the treatment room.
I'll be with you the whole time.
Okay.
Okay.
Gram-negative bacteria? What is that? It's a common germ found in water, soil, plants, the digestive tract Sometimes the skin.
They don't always lead to illness, but when they invade somewhere they are not endemic to, you can get pretty sick.
So what did these germs get into? The muscles surrounding your spine.
There's an abscess at the T4 vertebrae.
- Is it treatable? - Yes.
A surgeon will make an incision in your back, and drain it.
The hardware may need to come out as well.
Do it today, you'll likely feel better immediately.
We're good, babe.
We're all good.
There is something else, though.
In addition to the bacteria, the biopsy showed a cluster of cells that are not native to the paraspinal muscles.
The lab is still trying to figure out exactly what these cells are, but they shouldn't be there, nor do they They come from my body.
So, what are you guys not telling us? They're stem cells.
We've been going to Mexico to get injections to reverse the paralysis.
I'm gonna walk again.
I know that look.
You think we're crazy.
Abandon a state-of-the-art hospital for a clinic in Veracruz, but what Nick needs, we can't find here.
And between the FDA and constantly changing politics - and social taboos, we just - But leaving the country? There is no oversight.
The bacteria that caused your abscess likely came from a treatment.
To ditch the wheelchair, it's worth it.
You touched Nick's abdomen, and he felt it.
He felt it.
I'm gonna walk again.
And Julia and I are gonna get back to the life that we dreamed of The one that she deserves.
Okay.
We'll set up the surgery to have the abscess drained, then go from there.
Okay.
Sir, is everything okay? Nurse? Somebody? Oh, my God.
Uh, breathe, sir, breathe.
Breathe.
Look at me, look at me.
Two seconds in, four seconds out.
Slowly.
I need some help! Here, here, here.
What happened? Uh, he he suddenly grabbed his chest - and was short of breath.
- All right, possible MI.
- Uh - We gotta move.
Thank you.
Edward, are you okay? Yeah, I think.
Uh, he needed help.
Okay, well, I saw.
You saved him.
And look, in a hospital gown, no less.
Let me let me help you back to bed.
What's happening? Asystole.
Crash cart and a chest tray.
Got it.
Take over compressions.
Scalpels? You're operating here? There's no electrical activity in the heart, so I can't shock it back.
Internal CPR is my only option.
Oh, my God.
All right.
Come on, beat.
Amp of epi.
One amp.
Come on.
Come on.
All right, we've got a rhythm.
He's back.
He's back.
Uh, quite a turnaround.
I know, right? I was worried I wouldn't be able to pull it off as smoothly as you, but it worked out.
It's a new world for Edward.
Is it? Deception breaks doctor-patient trust.
We don't manipulate.
We guide.
Your ruse provided Edward with a moment of revelation, not the framework to build his future on.
I mean, trust me, the costume is not yet a thing of his past.
Okay, discharge papers for Edward.
I'm gonna need a little more time.
Oh, okay.
He feels cold.
His blood pressure is very low.
We're pushing meds, but his heart is really struggling to circulate blood through his body.
Justin is a climber.
He always has been.
Wow.
Uh, a few years ago, he realized that rock faces weren't enough.
Oh, he loved his life.
It's not over.
But his heart will fail again, won't it? If it does, I'll restart it.
I'll keep restarting it.
That last resuscitation was so violent.
Your son still has a chance.
Does he? Please no more heroics.
Dr.
Rhodes, I admit, I wanted you to be the hero today.
And I know you did too.
But maybe it's time to stop.
- Hey.
- Hey.
Got an update from the neurosurgical floor.
They just got started on Nick.
These foreign clinics $30,000 a treatment, sometimes more.
The stem cells are shipped in from all over the world.
There's no way to prove they're even authentic, and the success rates on their websites - Totally unverifiable.
- Scary, I know.
But still, stem cell research is making huge leaps.
Yeah, maybe for neurodegenerative diseases.
But spinal cord injuries like Nick's? That tech is years away.
Yeah.
Just give me a second.
Will Will, I need you in here.
All right, I gotta go.
Melody's A-line pulsatility is fluctuating.
- This just start? - A couple minutes ago.
Is my heart getting worse? Uh, no, better.
101.
Your temp's gone down.
It means your body's starting to fight back.
I'm gonna be okay? Well, we'll get another blood test, and if your white cell count has improved as well, and your heart continues to strengthen, then I'll dial down the support.
Oh, my God.
Oh, God, I thought for sure Thank you, April.
You saved my life.
Whew.
Oh, God, I was so scared.
You're good.
I should call my parents.
Of course.
Yeah, I gotta say, I did not expect IVIG and plasmapheresis to be so effective, let alone that quickly.
You know, maybe coupling it with the CPS or perhaps, you know, maybe the meds just finally worked on their own.
You know what? Who cares.
- It worked.
- Yeah.
- Yeah? - We got the win.
Yeah - You don't seem excited.
- No, I am.
It's just a long day.
Yeah, but a good one.
Nice job.
Neurosurgeon said everything went well.
I feel much better.
It's like night and day.
Mind if I take a look? All good back there? Yeah.
No surprises.
Great.
Ready to put today behind me No pun intended.
Nick, when I was examining your abdomen, you thought you felt something.
You didn't, did you? Just my wife's eyes desperately wishing I could.
These treatments you're getting in Mexico They're not working.
And given your injury, the chances of paralysis being reversed is almost zero.
I can't give up.
Stem cells can turn into any part of the body.
Instead of curing you, they could form a mass or a tumor.
Please, don't get anymore injections.
I have to.
I love Julia more than anything, but there are intimacies that I can't provide.
Our bond is built on hope.
It's what holds us together.
So it doesn't matter if you believe the treatments won't work.
Julia does.
- That's enough for me.
- But you're risking your life.
She is my life.
I don't want you to share your concerns with her.
Okay.
Good luck.
Good luck? Ethan, are you kidding? Nat, I've met combat vets who have been paralyzed.
The feelings of inferiority can be overwhelming.
If you told them a bottle of snake oil might help them walk again, they'd drink it every time.
So you agree with what Nick's doing? I understand it, Nat.
It wasn't real.
The situation was staged, but your response was absolutely real.
But I shouldn't have tricked you.
I thought building you up from the inside would help you connect to your true self, but I realize now you've always known exactly who you are.
The real goal is making sure others can see that.
- What's that? - A hospital volunteer vest.
I know it's not as flashy as your other outfit, but around here, there are a lot of people in need.
Seeing you in this, they'll know you're someone they can depend on Someone who can help them.
Think about it.
Hey.
Surgery? I have Procedure Room 3 open.
I'll schedule you in.
Come on up.
April? April I saw your name on the list for a D&C.
It was my ultrasound.
There wa there wasn't I-I don't I don't know when.
I-I don't I don't know why My baby's heart it stopped It's okay.
It stopped beating.
Hey.