Chicago Med (2015) s02e16 Episode Script
Prisoner's Dilemma
1 Incoming, peds in respiratory distress.
- 30 seconds out.
- We got this.
Hey, love.
What are you doing here? Aren't you supposed to be home taking care of yourself? I don't wanna stay at home.
Just can't stop thinking about things.
I'd rather be here, busy.
You sure? Since we lost the baby, things with me and Tate are just different.
I need to work.
All right, well, you tell me if you need anything.
- Okay? You got this? - Mm-hmm.
You're going to Treatment 2.
Emergency landing at O'Hare.
7-year-old girl collapsed mid-flight.
Acute shortness of breath started on the plane.
One albuterol and one racemic epi given en route.
- Sats? - Uh, low 90s.
Meds didn't do much.
All right, gently.
One, two, three.
Mommy? [speaking Spanish.]
She's just telling her daughter to be calm.
We speak English.
Lungs sound congested rhonchi throughout.
Let's get a chest X-ray.
I'm Dr.
Choi.
I'm gonna be taking care of your daughter.
- Where are you traveling from? - Ecuador.
All right, has your daughter ingested any drugs? Alcohol? - Anything we should be aware of? - No.
Any medical issues we should be aware of? She can never get enough air.
Her lips are always blue.
Her whole life, the doctor in my village she says she can't help.
We were going to Minneapolis to see a heart doctor.
Definitely volume overloaded.
Let's get five milligrams of Lasix IV.
BP, 108 over 82.
- Heart rate, 110.
- Could be a pulmonary issue, or any number of congenital heart defects.
Let's get an EKG, and call CT.
We're gonna do everything we can for your daughter.
Thank you.
- Incoming.
Dr.
Manning? - Yep.
Teresa Azen, 25.
Persistent vegetative state.
Brought in by her long-term care facility after blood was discovered in her urine.
Now let's get vitals, a temp, CBC, CMP, UA with C&S.
Could just be a UTI, but let's look at her kidneys with an ultrasound - to rule out hydro from a stone.
- Got it.
All right, on my count, one, two, three.
- Brain injury? - Car crash.
Teresa, I'm Dr.
Manning.
I'm gonna take good care of you, okay? [clears throat.]
G-tube looks good.
Temp, 100.
6.
Unresponsive.
No kidney stones.
Let's look at the bladder.
How long did you say she was in a vegetative state for? Five years.
We need to call the police.
This woman is pregnant.
There's vaginal trauma, which explains the blood in the urine.
Thank you.
- Is this our victim? - Yeah.
It's awful.
You ever see anything like this? - I wish I could say I hadn't.
- Okay, let's lift.
One, two, three.
[grunting.]
So helpless.
We're looking into all of the employees at Teresa's facility.
We're checking visitor logs, security footage.
We'll find out who had access to her and to her floor.
But the rape kit's only supposed to reveal DNA for the past five days.
- How is this gonna help? - I hate to say this, but the likelihood in a case like this is that the offender's been assaulting her regularly, maybe even daily.
Hey, Teresa's parents are here.
Okay.
David and Angela Azen, this is Detective Lindsay and Dr.
Manning.
I am so sorry for what happened to your daughter.
How could someone do this to her? Are you gonna catch this monster? Yes, we've already opened an investigation, and finding whoever did this is a top priority for us.
I just want you to know, we are gonna give your daughter the best possible care.
Why don't you go spend some time with your daughter? We have 18 patients on this floor, all suffering from serious mental illnesses.
Since age 13, Henry has been battling anorexia nervosa coupled with borderline personality disorder.
Evelyn struggles with schizophrenia, auditory hallucinations, paranoia.
We have her on a new anti-psychotic, hoping that'll curb her violent tendencies.
Patients might be here anywhere from six weeks to six months.
You're not listening! You don't belong here.
Get out! - Get out! - That's enough, Tom.
Why don't we go work on your art project? Who are you? Uh, I'm Dr.
Reese.
I'm visiting from Chicago Med.
He's right.
I don't belong here.
All the doctors think I'm crazy, but I'm not.
Dr.
Reese, we're moving on.
She's the worst.
Hey, just so you know, "crazy" is a word I never use.
And we've got Ms.
Perreira post op day two.
We removed her chest tube and wires this morning.
She is tolerating a diet, and looking good.
She's on a solid dose of morphine.
Ah.
And what about consults? Uh, we have two in the MICU, one for an aortic valve, and the other for a potential bypass.
All right.
Let's go have a look, everybody.
Uh, just a moment.
Uh, one more thing more of a question, really.
What does a Jewish pirate say? I beg your pardon, Dr.
Latham? Ah, what does a Jewish pirate say? Ahoy vey.
Get it? Ahoy vey.
[all snicker.]
All right, that's a that is a good one, Dr.
Latham.
Jewish humor.
Long tradition.
[chuckles.]
Shall we move on to the MICU? So I take it that your TMS treatments are going well.
Yes, I've been picking up on all sorts of subtleties in the way people communicate.
For instance, it never dawned on me the profound purpose behind sharing a joke.
[chuckles.]
Oh, uh, well, what is it? Camaraderie, Dr.
Rhodes.
Camaraderie.
[chuckles.]
Hey, check out what I got you.
Mousse de Maracujá.
Your favorite.
When I was, like, eight.
Well, still, I thought it might make you feel better.
He's trying, April.
No one knows what to say.
There's nothing to say.
- How were rounds at the youth hospital? - Brutal.
I'm sure there's a more clinical term, but - I hear ya.
- [sighs.]
It's really hard to see so many teenagers suffering from psychological trauma.
Yeah, younger patients are the hardest.
Very tough to draw a line between an actual disorder and good old-fashioned adolescence.
How do you learn to make that call? Tourist asks a New Yorker, "How do you get to Carnegie Hall?" Practice.
Hi.
So Teresa is approximately ten weeks along in her pregnancy.
[sighs.]
Oh, God.
Fortunately, termination will be a painless procedure.
Wait, termination? We don't want that.
We wanna keep the baby.
I'm sorry.
I thought, given the circumstances Mr.
and Mrs.
Azen, nothing has to be decided today.
No, we've made up our mind.
It is terrible what happened to our daughter, but even if it came from a rape, the baby's still part of Teresa.
The only part we have left.
Yes, and I can understand that, but in your daughter's condition, I have to tell you, taking this pregnancy to term would be extremely difficult.
Why? Her brain has been injured, - but her body's healthy.
- No.
At five years in a persistent vegetative state, it's not.
This is a high risk situation for pulmonary embolism, sepsis, colonic obstruction, respiratory failure.
But those are just risks, right? It could all work out.
They are extremely high risks.
If you have your daughter go through with this pregnancy, there is a chance that she will not survive.
She's hardly living as it is.
If she dies giving birth, maybe that's a merciful outcome.
Sometimes, I've wished for that.
There is another issue to consider.
Given the abuse your daughter has undergone, do you believe that she would want to keep this pregnancy? In any case, you are Teresa's guardians, and therefore speak on her behalf.
Your wishes will be honored.
So based on the echo and the CT scans, your daughter is suffering from a congenital heart condition known as Tetralogy of Fallot.
It's a condition that puts a significant amount of stress on the heart, and it's something that needs to be addressed surgically.
I can pay.
I bought travel insurance.
It's an emergency surgery.
We would operate regardless.
We'll take your daughter to the pediatric ICU, and get her ready.
Are you all right? I know this is a lot.
- I'm fine.
- Mommy? [speaking Spanish.]
Whoa, whoa, whoa, whoa, whoa, you sure you're okay? - Maybe I should take a look at you.
- No, no.
I haven't had anything to eat no sleep.
I'll be okay.
Hey, April, so sorry to hear about the baby.
- How you holding up? - It's okay.
I'm okay.
[speaking Spanish.]
[speaking Spanish.]
[speaking Spanish.]
[alarm blares.]
T-2.
Talk to me, Cesar.
Suicide attempt.
15-year-old female from County Psych.
She swallowed bleach, sodium hydroxide, and some sort of rust remover.
Hydrofluoric acid.
Okay, call toxicology, get an NG tube in her, push an amp of calcium gluconate, and hang a magnesium drip.
Watch for V-tach, - and get a psych consult.
- Got it.
You have to get Dr.
Reese for me.
I need to talk to her.
I wasn't trying to commit suicide.
I was trying to see you.
Do you believe it's okay to hurt yourself? How else could I get to you? It's not like I can ask for a phone call.
Nancy, you you could have seriously hurt or even killed yourself.
You have to help me get out of there.
They locked me up after I got in a fight with my mom, but she's bipolar has been for years.
Hey, I'm sorry, but I'm I'm not your psychiatrist.
My mom came at me with a hammer while I was sleeping.
I was trying to defend myself.
That doesn't make me crazy.
No.
If that were the situation, it would be reasonable to defend yourself.
[sighs.]
See? You're the only one who said that.
All the other doctors think I'm psychotic, but my mom's the one who's crazy.
Dr.
Reese? Could I speak to you for a second? I'll be right back.
Yeah, could could you, uh could you fill me in? I understand that you ran into Nancy on - on rounds this morning? - Yes.
Uh-huh.
Could you have said anything to make her think it was a good idea to come over here and and see you? All I said was "crazy" isn't a word I ever use.
Huh.
Gotta be very careful the way we talk to younger psych patients.
You know, they're much more vulnerable to mixed messages.
She seems to think that you're some sort of ally.
I am.
Aren't we all? To get her the right treatment, of course, but this is a young woman who purposefully drank extremely toxic chemicals.
I mean, Nancy's been diagnosed with borderline personality disorder.
She has severe bouts of manic depression.
Uncontrollable hysteria, paranoid delusions.
People who suffer from these disorders can be very persuasive, very manipulative, and a danger to themselves, so we just we have to be careful.
We wouldn't wanna put her in a position where she wanted to harm herself again.
Ms.
Cespedes? Can I get your signature on this consent? This gives us permission to operate.
[panting.]
Ms.
Cespedes, you don't look well to me.
You could've picked up a virus while traveling.
- May I please check your pulse? - [gasps.]
- Is everything all right? - I told you I'm fine.
Please.
Let's go back to the Emergency Department, and let me take a look at you.
Just show me where the bathroom is, please.
Yeah.
Follow me.
Hey.
Her parents here? - No, making calls outside - [sighs.]
- Looking for a new care facility.
- Mm.
Did you hear they wanna keep the pregnancy? Mm-hmm.
When you can't talk, you don't get to say nothing.
Yeah, well, I don't think it's the right thing.
Mm.
Maggie? - Did you see that? - Mm-hmm.
I know PVS patients do that, and it's just a reflex, but didn't it seem like there was more going on? Ah, wishful thinking.
Teresa, can you hear me? If you can hear me, please open your eyes.
Teresa, if you can hear me, squeeze my hand.
In my time at the vent farm, I've seen this a lot blinking, spasms, sudden jerks of movement.
Never ends up meaning what you want it to.
[sighs.]
Let's get a CT brain.
- On a five-year coma patient? - Just in case.
[sighs.]
Hey, Sarah, you, uh you got a second? - Hm? - I heard that, uh, most of the psych residents get therapy.
Yeah.
- Have you tried it? - Uh-huh.
Um, I'm I'm sorry.
Can we talk later? Sure.
Yeah.
How's she doing? Well, we've flushed her pretty good.
She'll be medically cleared soon, and will have to go back to the psych hospital.
[sighs.]
- You buy her story? - I don't know.
She's on a six-month psych hold.
Does she seems like she requires that much time locked up? Don't ask me.
Psych's way too spongy.
In med school, my head-shrink professor took us to the mall, and asked us to point out people we thought were mentally ill.
- No one could agree.
- Hm.
That is when I knew I wanted to be an ED doc.
- Much clearer business.
- Yeah.
I wish there was a way to evaluate Nancy like an ED doc.
Well, maybe there is.
Like I tell my residents, always go back to the history.
Mommy? Mommy? Where's my mommy? Hey, Bruna, she's out in the waiting room right now.
I need her.
You're gonna be okay, sweetheart.
We're gonna take very good care of you.
Marty, uh, now might be a good time to start the sedation.
Please, I want my mommy.
Hold on, Marty.
I would want my mom too if I were in a new place with new people.
You know what? Everyone here has one job, and that is to make you feel better.
And by the time we're finished, you won't have trouble breathing.
You won't faint on airplanes.
You'll be a healthy little girl.
How does that sound to you? - You can really fix me? - Yes.
Now I need you to do something for me.
- Can you count to 100? - In Spanish? Mm-hmm.
And by the time you're finished, your mother will be right next to you.
I promise.
Uno dos tres - Hey, April.
- Is she still in there? Says she's okay, but keeps vomiting.
Won't open the door, so I called maintenance.
[knocking at door.]
Zulmira Zulmira, open the door, please.
Hold on.
I got this.
Just give me a minute.
Stay away.
It was the only way I could get her to America.
- April, what's going on? - I'll be fine.
[toilet flushes.]
She just needed a good hospital.
[sobbing.]
Okay, uh she's overdosing! - How do you know? - She's a drug mule.
Blood glucose is good, but tachycardic as hell.
BP's 150 over 110.
Heart rate, 150.
There's still two packets in your stomach.
One of them appears to be leaking.
We need to know.
Is it cocaine? Just so we can help you.
[speaking Spanish.]
Yes.
Okay, we need to get these out now before they burst.
Let's get an EGD scope and 70 milligrams of ketamine.
- You can't take it out.
- You'll die of an overdose if any more cocaine leaks into your intestine.
- Can you give me medicine? - No, we need to remove them.
Would you give it to the police? We'll explain the situation to them.
No, I can't go to prison in my country.
They'll kill me.
Bruna needs me.
She will starve without me.
Tell Goodwin we need a court order to remove the drug packets.
She'll be dead by the time it's approved.
Call PD.
Maybe they can bring a warrant in time.
Please, just leave me alone.
Zulmera, if you don't let us remove those packets, you will die.
[speaking Spanish.]
I-I can't go to prison.
Do you want Bruna to wake up from surgery and learn that her mother has died? You can't help her in any way if you're dead.
Let us keep you alive, please.
- Okay.
- All right, come on, let's go.
Yeah.
You think there's any chance of brain activity? I don't see how.
A lot of brain volume loss and atrophy.
This is not the healthy brain of a 25-year-old.
But even with some atrophy, couldn't there still be consciousness? What was her Glasgow Coma score? There was no response.
Yeah, this woman is in a persistent vegetative state my guess, for the rest of her life.
But I'm almost sure I saw something in her eyes, like she was aware of us talking about her or something.
Maybe you want that so much, you're projecting? I I don't know.
I do feel terrible for her.
She's pregnant.
She was sexually assaulted at her care facility, and her parents wanna keep the baby.
I just if I could somehow get through to Teresa, she might finally have a say in what happens to her.
I'm sorry, Natalie.
You know what, I want a neurology consult.
Have Abrams take a look.
Dr.
Charles, do you have a minute? I do.
[clears throat.]
In order to get a more complete history, I contacted the officer who arrested Nancy and her mother.
He sent me his report.
It said they often get called to Nancy's house on domestic disputes involving the mother.
She's been in and out of jail for assault.
In fact, she is at County right now.
Please take a look.
This could just mean that, you know, mental illness runs in in Nancy's family, and she and her mom suffer from the same disorder.
Or it could mean that Nancy was wrongfully committed by an unstable mother.
The one thing we know for sure it was her mother's testimony that got Nancy committed, and her mother's an unreliable witness.
We have a seven-year-old female, here for reconstruction of Tetralogy of Fallot.
Once we are in the chest and on bypass, we will relieve the right ventricular outflow tract stenosis.
Scalpel? I want you to observe as I start at the sternal notch and cut to the xiphoid.
Dr.
Latham? Dr.
Latham, is everything okay? Yes, yes, Dr.
Rhodes.
All right, I got it.
Okay, one left.
She'll be waking soon.
Dose her again with ketamine? No, let's just finish this.
- Okay.
- Go ahead, Jeff.
Almost there.
All right, I got it.
Okay, pulling it out.
I think it burst in her esophagus.
Give her 20 more of labetalol, and start an esmolol drip.
Jeff, get the crash cart ready, - and give me the nitro.
- Got it.
[speaking Spanish.]
Just lie back.
Stay calm.
- [speaking Spanish.]
- [gasps, groans.]
She's having a cocaine-induced heart attack.
[groaning.]
Giver her two of Versed IV.
Open your mouth, open your mouth.
I'm gonna spray nitroglycerin under your tongue.
It'll make you feel better.
[groaning.]
ST segments are improving.
Does your chest still hurt? No.
- Sats are good.
- Okay, heart rate, 120s.
- She's out and stable.
- [sighs.]
Okay, what's the call? We don't have a choice.
We got to report it.
Look, this was the only way she could get her daughter the operation she needed.
Why can't we destroy it? Who would that harm? Smuggling cocaine is a serious crime.
If she made it to her dealers, people would've been harmed, possibly kids.
She can't just get away with that.
She hasn't.
Look at her.
Five minutes ago, her heart wasn't beating.
- April - No.
She wasn't trying to deliver it.
She was trying to flush it.
To destroy evidence.
As of now, it's a victimless crime.
She is a good mother, who did the only thing she knew how to help her daughter.
If we destroy this packet, we'll be committing a crime.
We don't have a choice.
He's right.
Sorry.
[sighs.]
- Dr.
Manning.
- Yes.
Where are we with Teresa's treatment? I'd like to run a few more blood tests to rule out any potential infection, and I'd also like to look into physical therapy.
Are there any medical issues you're still treating? No, um, we've treated the vaginal bleeding.
Then it's time to discharge her.
Her parents have found a new care facility, and they're eager to get their daughter settled in.
How do we know Teresa will be safe? How do we know she won't get abused again? She has suffered so much.
I just Just what? What can you do? We all wish we could do more, but our job is to treat the ailment that brought the patient in, and that's all.
It's time to give her back to her parents.
We've finished the repair, and now coming off bypass.
We're off bypass.
At the end of any surgery, when the patient has been Pulmonary artery pressure is 50.
- Coming up to 70.
- And the left ventricular? Well, let's not get excited.
She'll ride it out.
It's dropping 80.
Should we put her back on bypass? Uh uh, we we I think we should - we we should, uh - She's throwing PVCs.
Pulmonary hypertension's getting worse.
Your graft has to be stenotic.
Bypass, Dr.
Latham.
We need to fix the graft.
We could try a, uh uh, pul-pulmonary vasodilator.
Vasodilator's not gonna do it.
We need to open her back up.
Blood pressure's dropping rapidly.
- We're losing her.
- Dr.
Latham - She's peri-arrest.
- Dr.
Latham Step away, Dr.
Latham.
Step away.
Marty, re-dose of heparin.
Let's get her back on bypass.
I'm reopening the heart.
There you are.
Hey, how 'bout we, um how 'bout we hang out after work? Yeah, maybe go get some of your favorite fries or something.
Noah, please.
I get it, but just give me some space, okay? So I understand that you believe that you've been wrongfully committed.
Is that right? - Yes, definitely.
- Mm-hmm.
Ever been hospitalized before, Nancy? Besides for the night my mom attacked me with a hammer? - No.
- Huh.
You wanna tell me a little bit about your mom? I would.
Finally.
Hi, Nancy.
How are you? Okay.
I'm Dr.
Baker, Nancy's psychiatrist.
Dan Charles.
Nice to meet you.
This is Dr.
Halstead, and I think you know Dr.
Reese.
Yes, I'm glad to see our girl here is in good hands.
- When will she be discharged? - Oh, she's clear.
We just need to remove the NG tube, and she'll be ready to go.
Good.
Do you mind? Could I get a quick word outside? Of course.
Are you aware that Nancy's mother has an extensive arrest record? No, I wasn't.
Why? Well, it seems that she might've been committed largely based on her mother's version of events.
Dr.
Charles, Nancy was committed because I deemed her a threat to herself and others.
I I was just wondering if you thought that there was any chance that, uh, your assessment might've been colored by a potentially unreliable history given by the mother.
My assessment was colored by 20 years of experience in adolescent psychiatry.
And quite frankly, I don't appreciate being second-guessed by a doctor who's only known my patient for one afternoon.
I just saw the potential for a biased narrative, and I wanted to make sure you had all the facts.
A biased narrative.
As Nancy's court-appointed doctor, I'd advise you to worry about your own patients, Dr.
Charles.
Hey, are you discharging her? I just finished the paperwork now.
[sighs.]
- Dr.
Manning.
- Yes.
Your coma patient given the abysmal treatment she received at that facility, I couldn't help but wonder what other ways they might've failed her, - so I reviewed her history.
- Did you find anything? I'm afraid not, but I do have one question.
What time of day did you perform that neuro exam? Morning.
Why? Well, sometimes, traumatic brain injuries result in a patient developing irregular sleep/wake circadian cycles, so it's possible Teresa's become nocturnal.
I suggest we try that test again.
Great.
Mr.
and Mrs.
Azen this is Dr.
Abrams, Chief of Neurosurgery.
Do you mind if we perform one more test on your daughter? Well, the EMTs from her new facility are on their way.
It should just take a moment.
Teresa, if you can hear me, please open your eyes.
I've asked her that a million times.
I know.
Just bear with me a moment.
Teresa, if you can hear me, please move your eyes side to side.
I'm sorry.
I finished Teresa's discharge.
As soon as her transportation arrives Hold on.
There's a condition called locked-in syndrome.
If your daughter has it, she'd be conscious, but she wouldn't be able to move her eyes side to side.
She could, however, move them well, let's see.
Teresa I need you to move your eyes up and down for me, please.
Up and down.
Did you see that? What was that? Teresa, if you can hear me, please move your eyes up and down again.
Oh, my God.
I don't understand.
How did you wake her from the coma? I didn't.
Uh, I don't believe she ever was in a coma.
What? We need more tests to be certain, but it's my opinion that her accident caused a stroke to the brain stem, which included the basilar artery.
What does that mean? The stroke left her completely paralyzed, but still conscious.
Locked-in syndrome she's awake, but locked in her body.
All these years? She's always been awake? Yes.
She heard everything we said I said.
And she was conscious while some monster assaulted her? Oh, my poor baby.
[sobbing.]
I know, it's so terrible.
I'm so sorry.
But at least you haven't lost her.
[clears throat.]
It's possible that some of her paralysis is the result of spasticity, and it's therefore treatable with muscle relaxants and physical therapy.
Wait, will she get better? She'll never be fully functional, but she should regain some movement.
We can also order an infrared eye-tracking device that'll allow Teresa to communicate through a computer.
- Communicate? - Yeah.
And she'll be able to put together words and sentences.
You'll be able to have a conversation with your daughter again.
A conversation? With my little girl? - Thank you.
- [relieved laughter.]
We'll give you time alone with your daughter now.
Thank you.
[distressed breathing.]
Sarah? Th-they're telling me to get dressed.
- They're sending me back.
- I know.
I'm sorry.
Sarah, please, - help me.
- I tried.
I did, but Dr.
Baker has conservatorship over you.
According to the courts, she has to be the one to change the diagnosis, and we couldn't change her mind.
[whimpering.]
Hey, I'm not giving up, and you can't either.
Stay strong.
We'll figure something else out.
Okay? Give me a second.
Dr.
Charles, I know I don't have any definitive proof, but she is sane.
I know it.
- We can't let her go back.
- Slow down, Dr.
Reese.
Dr.
Baker just doesn't want to admit that she misdiagnosed her.
You know what, I happen to agree with you.
I'm filing an appeal.
You you don't think she's mentally ill? Can't be positive, but either way, she should not be locked up on a long-term hold based solely on her mother's testimony.
- Need some help! - Treatment 1.
- What happened? - Give me some pressure.
Must've grabbed the scalpel from the cart.
Tourniquet her arm, and give me a hemostat.
- It's tied.
- I-I'm not crazy, Sarah.
I-I'm not.
Surgery turned out well today.
Thanks to you, Dr.
Rhodes.
It's been a long day, Dr.
Latham.
How 'bout a drink? Señorita Cespedes [speaking Spanish.]
Gracias.
We need to talk to Goodwin.
Trafficking of cocaine is a felony.
That means calling the DEA, Homeland, the whole nine yards.
All that over one packet? Well, if the evidence is just this one, that doesn't demonstrate intent to traffic and sell.
Were there more? No.
The one packet is all we found.
That's correct.
Dr.
Choi? Anything to add? Dr.
Choi No.
Then that's that.
Thank you, Dr.
Choi.
Do not put me in that position again either of you.
I don't know that I helped Zulmera.
She still has to deal with the people whose drugs she lost.
Ah, she is a resourceful woman.
- She's gonna do what she needs - to take care of that little girl.
I had to at least try to help her.
If I had a child, I would've done the same thing.
I know.
Thank you.
And thank you for earlier about the baby.
It's my fault.
Why'd you say that? I gave her false hope.
I told her I believed she was stable when she clearly isn't.
Uh, I'm not sure I agree.
I mean, just made her case a little tougher, but I'm still gonna file the appeal.
Why would you do that when she just tried to kill herself? Losing hope is not a sign of mental illness.
It's a sign of being human.
I mean, the poor girl she has a violent, unstable mother, and her fate is in the hands of this psychiatrist who doesn't believe a word she says.
I mean, given those odds, I can absolutely understand why she'd fall into despair.
Had to prove me wrong, didn't ya? Looks like you're gonna get your wish.
She will have a say in her future.
[chuckles.]
Dr.
Latham, you decide on that drink after all? Maimonides 12th century rabbi and physician.
He said that the risk of a wrong decision is preferable to the terror of indecision.
I have never had a moment like today before I started my TMS treatments.
I wouldn't worry.
I doubt it'll happen again.
Hm.
That girl was more than just a surgical challenge.
She became a human being to me.
I lost my detachment.
I cannot afford that.
I'm ending my treatments, at least for the time being.
Well, I'm sorry that you feel like you have to make that decision, but I trust your judgement.
Hm.
When you started your fellowship, I told you that you were not my first choice.
After working with you these last months, I would like to say that I cannot imagine a finer surgeon or person than you, Dr.
Rhodes.
Thank you.
- Well, let's leave it at that.
- Yeah.
I would like a drink.
Scotch for me neat.
And another for my friend.
Hey.
Look, I'm I'm sorry.
Okay, I I I don't know what to say.
I got no clue what you're going through, but I wish I could help.
[sobbing.]
- 30 seconds out.
- We got this.
Hey, love.
What are you doing here? Aren't you supposed to be home taking care of yourself? I don't wanna stay at home.
Just can't stop thinking about things.
I'd rather be here, busy.
You sure? Since we lost the baby, things with me and Tate are just different.
I need to work.
All right, well, you tell me if you need anything.
- Okay? You got this? - Mm-hmm.
You're going to Treatment 2.
Emergency landing at O'Hare.
7-year-old girl collapsed mid-flight.
Acute shortness of breath started on the plane.
One albuterol and one racemic epi given en route.
- Sats? - Uh, low 90s.
Meds didn't do much.
All right, gently.
One, two, three.
Mommy? [speaking Spanish.]
She's just telling her daughter to be calm.
We speak English.
Lungs sound congested rhonchi throughout.
Let's get a chest X-ray.
I'm Dr.
Choi.
I'm gonna be taking care of your daughter.
- Where are you traveling from? - Ecuador.
All right, has your daughter ingested any drugs? Alcohol? - Anything we should be aware of? - No.
Any medical issues we should be aware of? She can never get enough air.
Her lips are always blue.
Her whole life, the doctor in my village she says she can't help.
We were going to Minneapolis to see a heart doctor.
Definitely volume overloaded.
Let's get five milligrams of Lasix IV.
BP, 108 over 82.
- Heart rate, 110.
- Could be a pulmonary issue, or any number of congenital heart defects.
Let's get an EKG, and call CT.
We're gonna do everything we can for your daughter.
Thank you.
- Incoming.
Dr.
Manning? - Yep.
Teresa Azen, 25.
Persistent vegetative state.
Brought in by her long-term care facility after blood was discovered in her urine.
Now let's get vitals, a temp, CBC, CMP, UA with C&S.
Could just be a UTI, but let's look at her kidneys with an ultrasound - to rule out hydro from a stone.
- Got it.
All right, on my count, one, two, three.
- Brain injury? - Car crash.
Teresa, I'm Dr.
Manning.
I'm gonna take good care of you, okay? [clears throat.]
G-tube looks good.
Temp, 100.
6.
Unresponsive.
No kidney stones.
Let's look at the bladder.
How long did you say she was in a vegetative state for? Five years.
We need to call the police.
This woman is pregnant.
There's vaginal trauma, which explains the blood in the urine.
Thank you.
- Is this our victim? - Yeah.
It's awful.
You ever see anything like this? - I wish I could say I hadn't.
- Okay, let's lift.
One, two, three.
[grunting.]
So helpless.
We're looking into all of the employees at Teresa's facility.
We're checking visitor logs, security footage.
We'll find out who had access to her and to her floor.
But the rape kit's only supposed to reveal DNA for the past five days.
- How is this gonna help? - I hate to say this, but the likelihood in a case like this is that the offender's been assaulting her regularly, maybe even daily.
Hey, Teresa's parents are here.
Okay.
David and Angela Azen, this is Detective Lindsay and Dr.
Manning.
I am so sorry for what happened to your daughter.
How could someone do this to her? Are you gonna catch this monster? Yes, we've already opened an investigation, and finding whoever did this is a top priority for us.
I just want you to know, we are gonna give your daughter the best possible care.
Why don't you go spend some time with your daughter? We have 18 patients on this floor, all suffering from serious mental illnesses.
Since age 13, Henry has been battling anorexia nervosa coupled with borderline personality disorder.
Evelyn struggles with schizophrenia, auditory hallucinations, paranoia.
We have her on a new anti-psychotic, hoping that'll curb her violent tendencies.
Patients might be here anywhere from six weeks to six months.
You're not listening! You don't belong here.
Get out! - Get out! - That's enough, Tom.
Why don't we go work on your art project? Who are you? Uh, I'm Dr.
Reese.
I'm visiting from Chicago Med.
He's right.
I don't belong here.
All the doctors think I'm crazy, but I'm not.
Dr.
Reese, we're moving on.
She's the worst.
Hey, just so you know, "crazy" is a word I never use.
And we've got Ms.
Perreira post op day two.
We removed her chest tube and wires this morning.
She is tolerating a diet, and looking good.
She's on a solid dose of morphine.
Ah.
And what about consults? Uh, we have two in the MICU, one for an aortic valve, and the other for a potential bypass.
All right.
Let's go have a look, everybody.
Uh, just a moment.
Uh, one more thing more of a question, really.
What does a Jewish pirate say? I beg your pardon, Dr.
Latham? Ah, what does a Jewish pirate say? Ahoy vey.
Get it? Ahoy vey.
[all snicker.]
All right, that's a that is a good one, Dr.
Latham.
Jewish humor.
Long tradition.
[chuckles.]
Shall we move on to the MICU? So I take it that your TMS treatments are going well.
Yes, I've been picking up on all sorts of subtleties in the way people communicate.
For instance, it never dawned on me the profound purpose behind sharing a joke.
[chuckles.]
Oh, uh, well, what is it? Camaraderie, Dr.
Rhodes.
Camaraderie.
[chuckles.]
Hey, check out what I got you.
Mousse de Maracujá.
Your favorite.
When I was, like, eight.
Well, still, I thought it might make you feel better.
He's trying, April.
No one knows what to say.
There's nothing to say.
- How were rounds at the youth hospital? - Brutal.
I'm sure there's a more clinical term, but - I hear ya.
- [sighs.]
It's really hard to see so many teenagers suffering from psychological trauma.
Yeah, younger patients are the hardest.
Very tough to draw a line between an actual disorder and good old-fashioned adolescence.
How do you learn to make that call? Tourist asks a New Yorker, "How do you get to Carnegie Hall?" Practice.
Hi.
So Teresa is approximately ten weeks along in her pregnancy.
[sighs.]
Oh, God.
Fortunately, termination will be a painless procedure.
Wait, termination? We don't want that.
We wanna keep the baby.
I'm sorry.
I thought, given the circumstances Mr.
and Mrs.
Azen, nothing has to be decided today.
No, we've made up our mind.
It is terrible what happened to our daughter, but even if it came from a rape, the baby's still part of Teresa.
The only part we have left.
Yes, and I can understand that, but in your daughter's condition, I have to tell you, taking this pregnancy to term would be extremely difficult.
Why? Her brain has been injured, - but her body's healthy.
- No.
At five years in a persistent vegetative state, it's not.
This is a high risk situation for pulmonary embolism, sepsis, colonic obstruction, respiratory failure.
But those are just risks, right? It could all work out.
They are extremely high risks.
If you have your daughter go through with this pregnancy, there is a chance that she will not survive.
She's hardly living as it is.
If she dies giving birth, maybe that's a merciful outcome.
Sometimes, I've wished for that.
There is another issue to consider.
Given the abuse your daughter has undergone, do you believe that she would want to keep this pregnancy? In any case, you are Teresa's guardians, and therefore speak on her behalf.
Your wishes will be honored.
So based on the echo and the CT scans, your daughter is suffering from a congenital heart condition known as Tetralogy of Fallot.
It's a condition that puts a significant amount of stress on the heart, and it's something that needs to be addressed surgically.
I can pay.
I bought travel insurance.
It's an emergency surgery.
We would operate regardless.
We'll take your daughter to the pediatric ICU, and get her ready.
Are you all right? I know this is a lot.
- I'm fine.
- Mommy? [speaking Spanish.]
Whoa, whoa, whoa, whoa, whoa, you sure you're okay? - Maybe I should take a look at you.
- No, no.
I haven't had anything to eat no sleep.
I'll be okay.
Hey, April, so sorry to hear about the baby.
- How you holding up? - It's okay.
I'm okay.
[speaking Spanish.]
[speaking Spanish.]
[speaking Spanish.]
[alarm blares.]
T-2.
Talk to me, Cesar.
Suicide attempt.
15-year-old female from County Psych.
She swallowed bleach, sodium hydroxide, and some sort of rust remover.
Hydrofluoric acid.
Okay, call toxicology, get an NG tube in her, push an amp of calcium gluconate, and hang a magnesium drip.
Watch for V-tach, - and get a psych consult.
- Got it.
You have to get Dr.
Reese for me.
I need to talk to her.
I wasn't trying to commit suicide.
I was trying to see you.
Do you believe it's okay to hurt yourself? How else could I get to you? It's not like I can ask for a phone call.
Nancy, you you could have seriously hurt or even killed yourself.
You have to help me get out of there.
They locked me up after I got in a fight with my mom, but she's bipolar has been for years.
Hey, I'm sorry, but I'm I'm not your psychiatrist.
My mom came at me with a hammer while I was sleeping.
I was trying to defend myself.
That doesn't make me crazy.
No.
If that were the situation, it would be reasonable to defend yourself.
[sighs.]
See? You're the only one who said that.
All the other doctors think I'm psychotic, but my mom's the one who's crazy.
Dr.
Reese? Could I speak to you for a second? I'll be right back.
Yeah, could could you, uh could you fill me in? I understand that you ran into Nancy on - on rounds this morning? - Yes.
Uh-huh.
Could you have said anything to make her think it was a good idea to come over here and and see you? All I said was "crazy" isn't a word I ever use.
Huh.
Gotta be very careful the way we talk to younger psych patients.
You know, they're much more vulnerable to mixed messages.
She seems to think that you're some sort of ally.
I am.
Aren't we all? To get her the right treatment, of course, but this is a young woman who purposefully drank extremely toxic chemicals.
I mean, Nancy's been diagnosed with borderline personality disorder.
She has severe bouts of manic depression.
Uncontrollable hysteria, paranoid delusions.
People who suffer from these disorders can be very persuasive, very manipulative, and a danger to themselves, so we just we have to be careful.
We wouldn't wanna put her in a position where she wanted to harm herself again.
Ms.
Cespedes? Can I get your signature on this consent? This gives us permission to operate.
[panting.]
Ms.
Cespedes, you don't look well to me.
You could've picked up a virus while traveling.
- May I please check your pulse? - [gasps.]
- Is everything all right? - I told you I'm fine.
Please.
Let's go back to the Emergency Department, and let me take a look at you.
Just show me where the bathroom is, please.
Yeah.
Follow me.
Hey.
Her parents here? - No, making calls outside - [sighs.]
- Looking for a new care facility.
- Mm.
Did you hear they wanna keep the pregnancy? Mm-hmm.
When you can't talk, you don't get to say nothing.
Yeah, well, I don't think it's the right thing.
Mm.
Maggie? - Did you see that? - Mm-hmm.
I know PVS patients do that, and it's just a reflex, but didn't it seem like there was more going on? Ah, wishful thinking.
Teresa, can you hear me? If you can hear me, please open your eyes.
Teresa, if you can hear me, squeeze my hand.
In my time at the vent farm, I've seen this a lot blinking, spasms, sudden jerks of movement.
Never ends up meaning what you want it to.
[sighs.]
Let's get a CT brain.
- On a five-year coma patient? - Just in case.
[sighs.]
Hey, Sarah, you, uh you got a second? - Hm? - I heard that, uh, most of the psych residents get therapy.
Yeah.
- Have you tried it? - Uh-huh.
Um, I'm I'm sorry.
Can we talk later? Sure.
Yeah.
How's she doing? Well, we've flushed her pretty good.
She'll be medically cleared soon, and will have to go back to the psych hospital.
[sighs.]
- You buy her story? - I don't know.
She's on a six-month psych hold.
Does she seems like she requires that much time locked up? Don't ask me.
Psych's way too spongy.
In med school, my head-shrink professor took us to the mall, and asked us to point out people we thought were mentally ill.
- No one could agree.
- Hm.
That is when I knew I wanted to be an ED doc.
- Much clearer business.
- Yeah.
I wish there was a way to evaluate Nancy like an ED doc.
Well, maybe there is.
Like I tell my residents, always go back to the history.
Mommy? Mommy? Where's my mommy? Hey, Bruna, she's out in the waiting room right now.
I need her.
You're gonna be okay, sweetheart.
We're gonna take very good care of you.
Marty, uh, now might be a good time to start the sedation.
Please, I want my mommy.
Hold on, Marty.
I would want my mom too if I were in a new place with new people.
You know what? Everyone here has one job, and that is to make you feel better.
And by the time we're finished, you won't have trouble breathing.
You won't faint on airplanes.
You'll be a healthy little girl.
How does that sound to you? - You can really fix me? - Yes.
Now I need you to do something for me.
- Can you count to 100? - In Spanish? Mm-hmm.
And by the time you're finished, your mother will be right next to you.
I promise.
Uno dos tres - Hey, April.
- Is she still in there? Says she's okay, but keeps vomiting.
Won't open the door, so I called maintenance.
[knocking at door.]
Zulmira Zulmira, open the door, please.
Hold on.
I got this.
Just give me a minute.
Stay away.
It was the only way I could get her to America.
- April, what's going on? - I'll be fine.
[toilet flushes.]
She just needed a good hospital.
[sobbing.]
Okay, uh she's overdosing! - How do you know? - She's a drug mule.
Blood glucose is good, but tachycardic as hell.
BP's 150 over 110.
Heart rate, 150.
There's still two packets in your stomach.
One of them appears to be leaking.
We need to know.
Is it cocaine? Just so we can help you.
[speaking Spanish.]
Yes.
Okay, we need to get these out now before they burst.
Let's get an EGD scope and 70 milligrams of ketamine.
- You can't take it out.
- You'll die of an overdose if any more cocaine leaks into your intestine.
- Can you give me medicine? - No, we need to remove them.
Would you give it to the police? We'll explain the situation to them.
No, I can't go to prison in my country.
They'll kill me.
Bruna needs me.
She will starve without me.
Tell Goodwin we need a court order to remove the drug packets.
She'll be dead by the time it's approved.
Call PD.
Maybe they can bring a warrant in time.
Please, just leave me alone.
Zulmera, if you don't let us remove those packets, you will die.
[speaking Spanish.]
I-I can't go to prison.
Do you want Bruna to wake up from surgery and learn that her mother has died? You can't help her in any way if you're dead.
Let us keep you alive, please.
- Okay.
- All right, come on, let's go.
Yeah.
You think there's any chance of brain activity? I don't see how.
A lot of brain volume loss and atrophy.
This is not the healthy brain of a 25-year-old.
But even with some atrophy, couldn't there still be consciousness? What was her Glasgow Coma score? There was no response.
Yeah, this woman is in a persistent vegetative state my guess, for the rest of her life.
But I'm almost sure I saw something in her eyes, like she was aware of us talking about her or something.
Maybe you want that so much, you're projecting? I I don't know.
I do feel terrible for her.
She's pregnant.
She was sexually assaulted at her care facility, and her parents wanna keep the baby.
I just if I could somehow get through to Teresa, she might finally have a say in what happens to her.
I'm sorry, Natalie.
You know what, I want a neurology consult.
Have Abrams take a look.
Dr.
Charles, do you have a minute? I do.
[clears throat.]
In order to get a more complete history, I contacted the officer who arrested Nancy and her mother.
He sent me his report.
It said they often get called to Nancy's house on domestic disputes involving the mother.
She's been in and out of jail for assault.
In fact, she is at County right now.
Please take a look.
This could just mean that, you know, mental illness runs in in Nancy's family, and she and her mom suffer from the same disorder.
Or it could mean that Nancy was wrongfully committed by an unstable mother.
The one thing we know for sure it was her mother's testimony that got Nancy committed, and her mother's an unreliable witness.
We have a seven-year-old female, here for reconstruction of Tetralogy of Fallot.
Once we are in the chest and on bypass, we will relieve the right ventricular outflow tract stenosis.
Scalpel? I want you to observe as I start at the sternal notch and cut to the xiphoid.
Dr.
Latham? Dr.
Latham, is everything okay? Yes, yes, Dr.
Rhodes.
All right, I got it.
Okay, one left.
She'll be waking soon.
Dose her again with ketamine? No, let's just finish this.
- Okay.
- Go ahead, Jeff.
Almost there.
All right, I got it.
Okay, pulling it out.
I think it burst in her esophagus.
Give her 20 more of labetalol, and start an esmolol drip.
Jeff, get the crash cart ready, - and give me the nitro.
- Got it.
[speaking Spanish.]
Just lie back.
Stay calm.
- [speaking Spanish.]
- [gasps, groans.]
She's having a cocaine-induced heart attack.
[groaning.]
Giver her two of Versed IV.
Open your mouth, open your mouth.
I'm gonna spray nitroglycerin under your tongue.
It'll make you feel better.
[groaning.]
ST segments are improving.
Does your chest still hurt? No.
- Sats are good.
- Okay, heart rate, 120s.
- She's out and stable.
- [sighs.]
Okay, what's the call? We don't have a choice.
We got to report it.
Look, this was the only way she could get her daughter the operation she needed.
Why can't we destroy it? Who would that harm? Smuggling cocaine is a serious crime.
If she made it to her dealers, people would've been harmed, possibly kids.
She can't just get away with that.
She hasn't.
Look at her.
Five minutes ago, her heart wasn't beating.
- April - No.
She wasn't trying to deliver it.
She was trying to flush it.
To destroy evidence.
As of now, it's a victimless crime.
She is a good mother, who did the only thing she knew how to help her daughter.
If we destroy this packet, we'll be committing a crime.
We don't have a choice.
He's right.
Sorry.
[sighs.]
- Dr.
Manning.
- Yes.
Where are we with Teresa's treatment? I'd like to run a few more blood tests to rule out any potential infection, and I'd also like to look into physical therapy.
Are there any medical issues you're still treating? No, um, we've treated the vaginal bleeding.
Then it's time to discharge her.
Her parents have found a new care facility, and they're eager to get their daughter settled in.
How do we know Teresa will be safe? How do we know she won't get abused again? She has suffered so much.
I just Just what? What can you do? We all wish we could do more, but our job is to treat the ailment that brought the patient in, and that's all.
It's time to give her back to her parents.
We've finished the repair, and now coming off bypass.
We're off bypass.
At the end of any surgery, when the patient has been Pulmonary artery pressure is 50.
- Coming up to 70.
- And the left ventricular? Well, let's not get excited.
She'll ride it out.
It's dropping 80.
Should we put her back on bypass? Uh uh, we we I think we should - we we should, uh - She's throwing PVCs.
Pulmonary hypertension's getting worse.
Your graft has to be stenotic.
Bypass, Dr.
Latham.
We need to fix the graft.
We could try a, uh uh, pul-pulmonary vasodilator.
Vasodilator's not gonna do it.
We need to open her back up.
Blood pressure's dropping rapidly.
- We're losing her.
- Dr.
Latham - She's peri-arrest.
- Dr.
Latham Step away, Dr.
Latham.
Step away.
Marty, re-dose of heparin.
Let's get her back on bypass.
I'm reopening the heart.
There you are.
Hey, how 'bout we, um how 'bout we hang out after work? Yeah, maybe go get some of your favorite fries or something.
Noah, please.
I get it, but just give me some space, okay? So I understand that you believe that you've been wrongfully committed.
Is that right? - Yes, definitely.
- Mm-hmm.
Ever been hospitalized before, Nancy? Besides for the night my mom attacked me with a hammer? - No.
- Huh.
You wanna tell me a little bit about your mom? I would.
Finally.
Hi, Nancy.
How are you? Okay.
I'm Dr.
Baker, Nancy's psychiatrist.
Dan Charles.
Nice to meet you.
This is Dr.
Halstead, and I think you know Dr.
Reese.
Yes, I'm glad to see our girl here is in good hands.
- When will she be discharged? - Oh, she's clear.
We just need to remove the NG tube, and she'll be ready to go.
Good.
Do you mind? Could I get a quick word outside? Of course.
Are you aware that Nancy's mother has an extensive arrest record? No, I wasn't.
Why? Well, it seems that she might've been committed largely based on her mother's version of events.
Dr.
Charles, Nancy was committed because I deemed her a threat to herself and others.
I I was just wondering if you thought that there was any chance that, uh, your assessment might've been colored by a potentially unreliable history given by the mother.
My assessment was colored by 20 years of experience in adolescent psychiatry.
And quite frankly, I don't appreciate being second-guessed by a doctor who's only known my patient for one afternoon.
I just saw the potential for a biased narrative, and I wanted to make sure you had all the facts.
A biased narrative.
As Nancy's court-appointed doctor, I'd advise you to worry about your own patients, Dr.
Charles.
Hey, are you discharging her? I just finished the paperwork now.
[sighs.]
- Dr.
Manning.
- Yes.
Your coma patient given the abysmal treatment she received at that facility, I couldn't help but wonder what other ways they might've failed her, - so I reviewed her history.
- Did you find anything? I'm afraid not, but I do have one question.
What time of day did you perform that neuro exam? Morning.
Why? Well, sometimes, traumatic brain injuries result in a patient developing irregular sleep/wake circadian cycles, so it's possible Teresa's become nocturnal.
I suggest we try that test again.
Great.
Mr.
and Mrs.
Azen this is Dr.
Abrams, Chief of Neurosurgery.
Do you mind if we perform one more test on your daughter? Well, the EMTs from her new facility are on their way.
It should just take a moment.
Teresa, if you can hear me, please open your eyes.
I've asked her that a million times.
I know.
Just bear with me a moment.
Teresa, if you can hear me, please move your eyes side to side.
I'm sorry.
I finished Teresa's discharge.
As soon as her transportation arrives Hold on.
There's a condition called locked-in syndrome.
If your daughter has it, she'd be conscious, but she wouldn't be able to move her eyes side to side.
She could, however, move them well, let's see.
Teresa I need you to move your eyes up and down for me, please.
Up and down.
Did you see that? What was that? Teresa, if you can hear me, please move your eyes up and down again.
Oh, my God.
I don't understand.
How did you wake her from the coma? I didn't.
Uh, I don't believe she ever was in a coma.
What? We need more tests to be certain, but it's my opinion that her accident caused a stroke to the brain stem, which included the basilar artery.
What does that mean? The stroke left her completely paralyzed, but still conscious.
Locked-in syndrome she's awake, but locked in her body.
All these years? She's always been awake? Yes.
She heard everything we said I said.
And she was conscious while some monster assaulted her? Oh, my poor baby.
[sobbing.]
I know, it's so terrible.
I'm so sorry.
But at least you haven't lost her.
[clears throat.]
It's possible that some of her paralysis is the result of spasticity, and it's therefore treatable with muscle relaxants and physical therapy.
Wait, will she get better? She'll never be fully functional, but she should regain some movement.
We can also order an infrared eye-tracking device that'll allow Teresa to communicate through a computer.
- Communicate? - Yeah.
And she'll be able to put together words and sentences.
You'll be able to have a conversation with your daughter again.
A conversation? With my little girl? - Thank you.
- [relieved laughter.]
We'll give you time alone with your daughter now.
Thank you.
[distressed breathing.]
Sarah? Th-they're telling me to get dressed.
- They're sending me back.
- I know.
I'm sorry.
Sarah, please, - help me.
- I tried.
I did, but Dr.
Baker has conservatorship over you.
According to the courts, she has to be the one to change the diagnosis, and we couldn't change her mind.
[whimpering.]
Hey, I'm not giving up, and you can't either.
Stay strong.
We'll figure something else out.
Okay? Give me a second.
Dr.
Charles, I know I don't have any definitive proof, but she is sane.
I know it.
- We can't let her go back.
- Slow down, Dr.
Reese.
Dr.
Baker just doesn't want to admit that she misdiagnosed her.
You know what, I happen to agree with you.
I'm filing an appeal.
You you don't think she's mentally ill? Can't be positive, but either way, she should not be locked up on a long-term hold based solely on her mother's testimony.
- Need some help! - Treatment 1.
- What happened? - Give me some pressure.
Must've grabbed the scalpel from the cart.
Tourniquet her arm, and give me a hemostat.
- It's tied.
- I-I'm not crazy, Sarah.
I-I'm not.
Surgery turned out well today.
Thanks to you, Dr.
Rhodes.
It's been a long day, Dr.
Latham.
How 'bout a drink? Señorita Cespedes [speaking Spanish.]
Gracias.
We need to talk to Goodwin.
Trafficking of cocaine is a felony.
That means calling the DEA, Homeland, the whole nine yards.
All that over one packet? Well, if the evidence is just this one, that doesn't demonstrate intent to traffic and sell.
Were there more? No.
The one packet is all we found.
That's correct.
Dr.
Choi? Anything to add? Dr.
Choi No.
Then that's that.
Thank you, Dr.
Choi.
Do not put me in that position again either of you.
I don't know that I helped Zulmera.
She still has to deal with the people whose drugs she lost.
Ah, she is a resourceful woman.
- She's gonna do what she needs - to take care of that little girl.
I had to at least try to help her.
If I had a child, I would've done the same thing.
I know.
Thank you.
And thank you for earlier about the baby.
It's my fault.
Why'd you say that? I gave her false hope.
I told her I believed she was stable when she clearly isn't.
Uh, I'm not sure I agree.
I mean, just made her case a little tougher, but I'm still gonna file the appeal.
Why would you do that when she just tried to kill herself? Losing hope is not a sign of mental illness.
It's a sign of being human.
I mean, the poor girl she has a violent, unstable mother, and her fate is in the hands of this psychiatrist who doesn't believe a word she says.
I mean, given those odds, I can absolutely understand why she'd fall into despair.
Had to prove me wrong, didn't ya? Looks like you're gonna get your wish.
She will have a say in her future.
[chuckles.]
Dr.
Latham, you decide on that drink after all? Maimonides 12th century rabbi and physician.
He said that the risk of a wrong decision is preferable to the terror of indecision.
I have never had a moment like today before I started my TMS treatments.
I wouldn't worry.
I doubt it'll happen again.
Hm.
That girl was more than just a surgical challenge.
She became a human being to me.
I lost my detachment.
I cannot afford that.
I'm ending my treatments, at least for the time being.
Well, I'm sorry that you feel like you have to make that decision, but I trust your judgement.
Hm.
When you started your fellowship, I told you that you were not my first choice.
After working with you these last months, I would like to say that I cannot imagine a finer surgeon or person than you, Dr.
Rhodes.
Thank you.
- Well, let's leave it at that.
- Yeah.
I would like a drink.
Scotch for me neat.
And another for my friend.
Hey.
Look, I'm I'm sorry.
Okay, I I I don't know what to say.
I got no clue what you're going through, but I wish I could help.
[sobbing.]