Chicago Med (2015) s03e02 Episode Script
Nothing to Fear
1 Damn it! What's going on? I put too much damn salt on the rub.
I got to get it out.
Honey, it's 4:30 in the morning.
Yeah, and if the meat loses its juices, it's gonna be all dry and burnt.
Sweetie, I I I feel like this might be one of those anxiety attacks that Dr.
Reese said you might have.
It's not because of my condition.
It's because I put too much damn salt Whoa! Okay, okay, okay.
[SIGHS.]
Let me help you.
[BREATHES DEEPLY.]
Why don't you start measuring out another rub? Excuse me.
Yeah ah, whoa.
Excuse me.
Okay.
Excuse me.
Dr.
Rhodes, you're late.
I know.
I am sorry.
I understand you're under additional stress at home lately, but please try not to make this a habit.
I assure you I will not.
Dr.
Rhodes, your CT patient's here.
- [ALARM BLARING.]
- You're going to 1.
[DOOR OPENS.]
Jerry Willis, 54, called 911 with shortness of breath and tachycardia.
BP 110 over 60, rate 120, satting at 89% on five liters 0-2.
Mr.
Willis, what are you doing back here so soon? I've been having trouble breathing.
It started a few days after I left.
What trouble are we talking about? Coughing.
He's wheezing.
It's been getting worse.
All right, let's move him on my count.
All right.
And one, two, three.
[GROANS.]
I replaced his aortic valve two weeks ago.
Any intraoperative difficulties? - None.
- Cardiac comorbidities? Nothing notable, no.
Austin Flint murmur.
The valve is leaking.
That's impossible.
Maybe you're hearing tricuspid stenosis or a subclinical MI.
Is it possible you misoriented the valve? Obstructed one of the leaflets? No.
I remember it very clearly.
Surgery went off without a hitch.
[WHEEZING.]
- We should order an echo? - What? What's wrong? Aortic insufficiency.
The valve is definitely leaking.
But you just replaced it.
How could it leak? I don't know.
It doesn't make any sense.
I Maybe Dr.
Rhodes made a mistake.
- Morning.
- Good morning.
Hi.
Whoa.
Is that what you're planning on wearing tonight? It's a brand-new Chiara Boni.
I mean nah, I mean it's probably fine.
I mean if you think it's fancy enough for the corner table at Alinea.
Are you kidding? That's like the toughest reservation in town.
"GQ" says 97% of relationships are decided on the first date.
Oh, now you're getting your dating advice from "GQ"? Natalie, these are hard numbers.
- Mm.
- I'm just citing the research.
[LAUGHS.]
I honestly don't know what happened.
Go back over your notes.
Try to learn from your error.
I will, and I'll get him preop'd for a re-do.
That will not be necessary.
Between the adhesions and further procedural stress, reopening his heart is simply too risky.
We'll manage him with medications instead.
But if we don't fix the valve, his quality of life is gonna suffer.
I understand, but at this point, it's our best option.
[BREATHING HEAVILY.]
Any plans tonight? Still got that chili.
- You want to join? - No way.
Is the sushi place on the corner still open? Why can't you just be nice? Oh, I can be nice.
[PAGER BEEPING.]
[BOTH GROAN.]
Hold that thought.
[EXHALES.]
Daniel.
You're looking more rested.
Doing my best.
What's the word? The board is deciding whether to put metal detectors at all the hospital entrances.
So I have to go prepare my recommendation.
Which way you leaning? [SIGHS.]
Toward yes.
Really? Doesn't that kind of fly in the face of being a trusted community institution? You know, putting up barriers between us and the people that we're trying to help? One of those people shot you in the gut, Daniel.
Yeah, outside the hospital.
What kind of detector's gonna stop that? - Dr.
Reese.
- Dr.
Charles.
So, Nurse Sexton, - who do we got next? - Henry Lee.
He's a sweetheart, comes in every month for his heart failure meds.
Mr.
Lee, I'm Dr.
Choi.
How are you doing today? A lot better now that my girl's here.
She does have that effect on people.
Any new complaints? Nope.
Just got to get my meds.
Take a deep breath.
[BREATHES DEEPLY.]
One more.
How much Lasix does he usually get? - 40 IV.
- That sounds good.
But I'm also hearing some dullness near your lung base.
I'd like to send you for an X-ray.
Thanks, Doc, but if it's all the same, I'd rather just get my meds and go.
Mr.
Lee, I hear what you're saying, but I prefer to be thorough.
Nah, let's just stick to the usual.
Hey, can you do the IV in my left hand today? I got a good puffy one.
[CHUCKLES.]
- She never misses.
- You got it.
I really would like that X-ray.
I bet he'd listen to you.
Why? You think there's something else going on? I don't know.
Probably not, but it's impossible to say.
Okay, I'll try.
Thank you.
So I've got a 43-year-old woman who passed out at a Starbucks from hypoglycemia.
- Mm-hmm.
- Now, that's normal, right? But then her blood came back showing insulin with a high C-peptide count.
So she gave herself too much insulin.
Right, but here's the thing: she is not diabetic.
Wait so wait a minute.
She somehow got her hands on insulin, then injected it into herself? Why would she do that? I don't know.
That's why I called you.
- Okay, I'll try to find out.
- All right, cool, thank you.
Oh, actually, um Okay, so you know how I've been hounding you about getting a drink one night after work? - I'm familiar with it, yes.
- Okay, well, I promise it's all going to stop.
Right after you get a drink with me tonight.
Oh, come on, Noah, couldn't we just stick to being colleagues? Sure.
A drink as colleagues.
Okay.
[LIGHT KNOCK ON DOOR.]
Ms.
Lake, I'm Dr.
Reese from Psychiatry.
Of course you are.
- It's nice to meet you.
- Nice to meet you.
I understand that you may have injected yourself with insulin today.
I did.
Can you tell me why? Today's the court hearing.
For my divorce.
Oh.
It just snuck up on me.
I mean, I've been dreading it for months, but when I woke up today and realized that this is it Did you try to harm yourself? Oh, no, no, no.
I don't want to die.
I just couldn't face the day.
So let me understand.
You made yourself pass out on purpose? I panicked.
I did something stupid.
And now I'm wasting your time.
I'm sorry.
Speaking of which, could you write a note for the judge? Just something saying I had a medical emergency.
Ah, I am sorry, but I can't do that.
It doesn't have to be anything big.
Handwritten on a letterhead is fine.
The thing is, you didn't have an emergency.
You caused it.
So it would be disingenuous for me to say otherwise.
I'd like to speak with your supervisor.
Excuse me? I'm seeing a doctor, now I need a doctor's note.
And if you can't do that, then get me your supervisor.
[TENSE MUSIC.]
Um.
Okay.
You look like you need this more than I do.
I'm fine.
Sure.
Hair's a mess, bags under your eyes.
You look great.
Don't be so hard on yourself.
You work our schedule then go home to a girlfriend who's basically your patient too.
Something like this was bound to happen.
Really? Is that so? At least it hasn't affected your sunny disposition.
Keep up the good work.
- [ALARM BLARING.]
- Dr.
Halstead, You're going to 3.
Doris.
Talk to me, Chout.
Julie Dutra, 34, pregnant, para one gravita zero, fainted in a yoga class, in A-fib at 150, BP 90 over 60.
Hi, Julie, I'm Dr.
Manning.
This is Dr.
Halstead.
I told them I don't want to be here.
Hopefully this won't take long.
On my count.
One, two, three.
[SUSPENSEFUL MUSIC.]
Julie.
Are you okay? - I'm fine, just call Mira.
- Our midwife.
I think Julie would be more comfortable at home with her.
Uh, sir, your wife's in a dangerous arrhythmia.
We can't let her go until we get it under control.
Do you have any history of heart disease? No, I don't eat red meat, and I keep a high antioxidant profile to minimize inflammation.
Okay, good.
Let's get an EKG, cardiac labs, CBC, CMP, coags and a U/A, and let's start 5 of verapamil IV, okay? No, no medications.
This one's safe for pregnancy.
If we don't control your arrhythmia it could - put the baby in danger.
- Is that true? - Scott.
- What? We don't want anything bad to happen.
[COUGHING.]
[INHALES DEEPLY.]
Okay, fine, but then we're leaving.
Thank you.
All right.
Let me ask you a few more questions.
- Wait, what are you doing? - Just a quick fetal - ultrasound.
- No, get that thing off me.
Acoustic radiation impairs neurodevelopment.
That's not actually true.
Note that the fetus measures normal size and weight for five months.
Wait, what did you say? That this looks like a normal five-month pregnancy.
Measure it again.
I'm sure of the numbers.
Well, you're wrong.
Measure it again.
See? Totally normal for five months.
Except I'm not five months pregnant.
I'm eight.
Julie's labs.
Anemia, vitamin deficiencies, all the signs of early kidney failure.
And no family history of troubled pregnancies or genetic conditions.
Maybe a malabsorption syndrome? - [KNOCKS ON DOOR.]
- Ms.
Dutra.
Have you ever had any gastrointestinal issues? Crohn's, ulcerative colitis? I used to have leaky gut.
At first we thought it was just lactose, but of course it was more complicated than that.
I see, and were you seeing someone for this? My nutritionist.
She got me off lecithin and phytic acid.
It helped some, but then once I got pregnant I had to give up all GMOs and anything that wasn't locally sourced, too.
So what do you eat? Certain strains of Swiss chard, broccoli.
Sometimes I'll have a cup of adzuki beans.
But she supplements a lot.
Selenium, coenzyme Q.
You eat three meals a day? More? Less? I do portion control to manage the baby's glucose.
700 to 800 calories a day.
Why? We suspect the difficulties with this pregnancy are being caused by your diet.
That can't be.
I only eat organic.
But you're not getting enough protein or iron.
And we're seeing the effects it's having on your baby.
We need to start aggressive IV nutrition to help it grow as much as possible before you deliver.
If we admit you to Obstetrics now we No.
I understand that you don't want to be here, but at this point it is No.
You're not giving me IV food.
Your baby is severely malnourished.
No, my baby is getting healthy farm-to-table nutrients.
You're not gonna pump him full of toxins and chemicals.
- Ms.
Dutra - I said no.
Your arrhythmia hasn't resolved yet.
We'll be back in a minute to check on you.
She's starving that baby to death.
We need to talk to Goodwin.
Mr.
Lee, we got your X-ray results back.
Great.
So I can get out of here? Actually, they show bilateral pleural effusions, fluid surrounding your lungs.
- Is that bad? - It's hard to say.
It could just be from your heart failure.
Either way, it's not making your breathing any easier.
I'd like to have Radiology remove it with a needle aspiration.
You want to stick a needle in my lung? - Yes.
- But I'm breathing fine now.
- I'd rather just go.
- I understand, but doing this will let you go longer between treatments.
I think it's a good idea.
Don't you agree? I don't know.
Um The effusions are pretty small.
True, but it also wouldn't hurt to send the fluid out for analysis, just to be sure, right? I suppose.
So, Henry, what do you say? You really think this is a good idea? Okay.
We'll get you over there right away.
Are you sure you want to be this aggressive? I want to cover all the bases, yeah.
Henry's not a very healthy man.
He doesn't do so well with procedures.
I hear you, but medically, it's the best course of action.
I don't think it is.
I'm sorry you feel that way.
What you should be sorry about is thinking that I would agree with you in there just because we're sleeping together.
That has nothing to do with it.
I thought you'd agree because that's my medical opinion.
Well, you were wrong.
The next time you want to put me on the spot in front of my patient, think again.
Hey.
April.
You want to feed a patient against her will.
A pregnant mother who's killing her baby.
We believe she has something called orthorexia, an obsession with healthy living that has limited her diet so severely that it's become dangerous.
And has led to a pathologic distrust of the entire medical system.
She won't let us do anything.
Well, is she delusional? Can she make decisions on her own? No, she's very clear about what she wants and what she does not want.
Well, then we can't prove incompetence, and we can't force her to do anything to her body she doesn't want.
The law sides with her.
But there are two patients here.
Yeah, one of whom has no control over what's being done to it.
This is child abuse.
Well, I can convene an emergency ethics committee.
It's possible they may find grounds to override her decision.
And in the meantime? See if you can find a way to help her trust us.
Dr.
Latham.
We should do the surgery.
- Dr.
Rhodes - No, I I looked over all my notes.
Okay? Mr.
Willis' anatomy is good.
We owe him a chance to get this right.
We owe him our best clinical judgement.
Yes, I was inside of his heart.
He's got more than enough healthy muscle and vasculature.
I'm telling you he can handle it.
Have you had more than four hours' sleep this last several weeks? I am a cardiothoracic fellow.
Sleep deprivation is part of the job.
I understand that.
But you have a lot on your plate.
Dr.
Bekker and I will take the case from here.
No, Dr.
Latham, that's not necessary [KNOCKING ON DOOR.]
Dr.
Rhodes, you have a phone call.
Tell them I'll call them back.
I'm sorry.
It's your landlord.
He says it's an emergency.
[DOOR CLOSES.]
[INDISTINCT CHATTER.]
[SIRENS WAILING.]
Excuse me.
Hey.
Thank you.
Excuse me.
Robin.
Robin.
Hey, are you okay? I forgot the brisket in the oven when I went to the store, and then all the alarms went off.
- I'm just such an idiot.
- Come here, come here.
- Come here.
- Hey, Otis, when are we gonna get that thing shut down? - [MOUTHING.]
She okay? - Yeah.
Thank you.
[SIRENS CONTINUE WAILING.]
Don't worry.
It could happen to anybody.
Shouldn't be more than a half hour.
I'm sorry you had to deal with that.
- No need to be sorry.
- You know what I mean.
The more time you spend with her, the less we have to see people who actually need our help.
I don't know.
I'm not quite sure we're We're done with Ms.
Lake yet.
Why? She just wants to use us to game the system.
Well, so do a lot of patients.
We're not gonna let her.
But the question is, why is she doing it? Wait, you still think this is a psych case? Why wouldn't I? I mean, she exhibited some pretty extreme behavior - this morning, didn't she? - To get out of a court date.
Well, perhaps, but until we figure out what's behind the behavior, we haven't really done our job, have we? - I guess.
- Good.
Keep me in the loop.
Your heart isn't responding to the meds.
If things keep going in this direction, we may need to consider an emergency C-section to take the extra load off your heart.
Drug me up then cut me open? No way.
That's not what we want either, but we do need to protect you and your baby.
That's why in the meantime, if you allow us to give you - some IV nutrition - No way.
Those bags off-gas BPAs.
Look, you don't get it.
This baby is being formed from every single molecule that enters my body.
It is my job to keep it absolutely pure.
That is how I'm protecting it.
- They understand that.
- No, they don't.
Uh, excuse us.
[TENSE MUSIC.]
Please tell me you have some good news.
I'm afraid not.
The committee ruled that we can't intervene against her wishes, not even for the sake of the baby.
So that's it? We just have to watch as she lets the baby die? If that's what she chooses to do.
But that's not what she wants.
She wants to help her baby.
She's just confused about how to do it.
I'm sorry.
Our hands are tied.
[ALARM BEEPING RAPIDLY.]
What happened? Satts are at 78 and dropping.
[WHEEZING.]
He's in pulmonary edema.
Get him on BiPAP and 40 of Lasix.
He's my patient.
Sublingual nitro, IV nitroprusside and ready an intra-aortic balloon pump.
- What's happening? - The leak in your valve is causing fluid to back up into your lungs.
BiPAP's at 100%.
Balloon pump is here.
What's that? It's a pump that we can implant directly into his aorta to take the strain off of his heart.
Meds are in.
Still satting at 78.
So, then he's hooked up to a machine forever? Possibly if his heart doesn't respond to the medications.
- Oh, my God.
- Betadine.
- Hold on.
- Dr.
Rhodes Give the meds a minute to work.
We may not have a minute.
Look.
Your sats are coming up.
We'll hold off for now.
Give him 1.
25 of enalapril IV and another 40 of Lasix.
Mr.
Dutra.
Hi.
I need you to talk to your wife.
She won't listen to me.
But you do understand this has gotten out of hand.
Of course I do.
I mean, all she thinks about is how uric acid and compromised soil are infecting everything we eat.
What do I say to that? Well, how did you handle it in the past? It wasn't this bad before.
I mean, she's always struggled with anxiety and control issues.
Even when she got pregnant, it's like she turned the dial straight to 11.
Nothing's pure enough anymore.
Everything looks like baby poison.
But there has to be something you can say to get her to let us help.
I am so scared my wife and my baby are gonna die.
Can't you do something? So you think I avoid conflict to protect myself? I think it is a possibility.
And you think that's a pattern.
Yes, a destructive one from the sounds of it.
I can't believe I didn't see it.
I will get your discharge paperwork started.
Looks like you had a little breakthrough.
I I think she sees that she has some issues and that it will be worthwhile for her to seek some long-term therapy.
Sounds like a good start.
I, um I was wrong about her, Dr.
Charles.
Thank you for making me stick with her.
[ALARM BEEPING.]
Dr.
Choi.
Pulse ox is down to 82.
[GASPING SLOWLY.]
[INTENSE MUSIC.]
No breath sounds on the left.
He's got pneumothorax.
Get a chest tube, 26 French.
I can't breathe.
I'm afraid your lung's collapsed.
Radiology must've nicked it during the tap.
You're kidding me.
I'm so sorry, Henry.
I need to insert a tube between your ribs to reinflate your lung.
Do you understand, Mr.
Lee? Lidocaine.
Henry, I'm just gonna lift your arm.
You're gonna feel a sting.
[GROANS.]
Just breathe.
It's okay.
We're gonna get you through this.
All I wanted was my damn medicine.
I know.
Then why'd you let him do this to me? I was fine.
[GROANS LOUDLY.]
Oh, God.
It feels like your stabbing me with a knife.
Breathe.
[GROANING.]
Put him on suction, get a portable chest X-ray, gram of cefazolin, a milligram of morphine and dress it with xeroform.
At this point I'm gonna have to admit you, Mr.
Lee.
Probably for several days.
I'm very sorry.
I'll check back on him soon.
I'm sorry.
What the hell are you trying to do me? Please, Ms.
Dutra, let me explai - I told you no food! - Just one second.
- What's going on? - I need you to calm down, - okay? Please.
- She put this in my IV - behind my back.
- Ms.
Dutra, wait.
Glucose, amino acids.
You did this? - Ms.
Dutra.
- Julie.
- Ms.
Dutra, just relax.
- Julie! Ms.
Dutra, we need to get you back into bed.
Get her away from me.
Get her away from me! I need some help here.
- [CRYING.]
- All right, easy.
Relax, I have her.
Let's get her back up.
[TENSE MUSIC.]
Dr.
Reese.
Your patient in 1's waiting for his prescription.
Okay.
Hey, have you seen my pad? Uh-uh.
Huh.
Have you seen my prescription pad? - No.
- No? I couldn't have lost it.
I always put it back in my pocket, always Hey, do you still need that note for the judge? Oh, no, it's fine, my lawyer actually took care of it.
Oh, good.
Could you please open your purse? - I'm sorry? - I can't find my prescription pad.
I want to check your purse.
I don't know why you think it'd be in there.
Because you decided to forge the judge a note and you took it from my pocket when you hugged me.
[QUIETLY CHUCKLES.]
I have no idea what you're talking about.
Hey! Give me that! So what's this? You have no right.
You're gonna pay for this! - Ma'am! - I am gonna make you pay! - Hey! Hey.
- Ma'am, step away now! She assaulted me.
She she put that in my purse.
Okay, everybody calm down.
[SNIFFLING.]
Dr.
Reese.
What happened in there? She stole my pad.
That's a felony.
She has been lying to us from the start.
Of course she has.
Lying, manipulating.
Behaving recklessly with no regard for herself or others.
- Exactly.
- No.
Not exactly.
[GROANS.]
Look, off the top of my head, probably a sociopath, but that makes your job exploring that and trying to help her.
Not punishing her.
But all she did from the moment she got here was try to manipulate us and waste our time.
Because she's mentally ill.
No.
No, it's because people like you let her.
- People like me? - Yes.
Yes, you enable and you make excuses and you give out psychiatric diagnoses so that no one has to be held accountable for their actions just like you did with the guy that shot you.
[TENSE MUSIC.]
[LIGHT TAPPING ON GLASS.]
You feeling any better? A little bit.
Good.
If there's anything that you need, Dr.
Latham and Dr.
Bekker are gonna be taking care of you from here on out, okay? Dr.
Rhodes.
Am I gonna be like this forever? Things will get better once they optimize your meds.
But I'll always be coming back here for something, right? [SOFT SOMBER MUSIC.]
There's no way to go back to how I was? It is possible to redo your valve surgery.
It comes with significant risks.
You could end up with an even worse leak than before.
You could even die.
But it could work.
I could go back to normal? Dr.
Latham is the best this hospital's got.
I promise he's gonna take great care of you.
This is why I didn't want to do the lung test.
- Still the right call.
- No, you don't know that.
- You don't know him - But I know what heart failure looks like, and this just - seems like something else.
- I've been treating Henry for years.
This is what he looks like.
I'm not asking for a second opinion.
You don't want my opinion.
Just because I don't have an MD after my name doesn't mean I don't know what's best for my patient.
April, as the doctor, I'm responsible.
I have to do what I think is right.
Both of you, in there.
Now.
[TENSE MUSIC.]
This has to stop.
Do you need another nurse on your case, Dr.
Choi? - No.
- Uh, excuse me.
Why didn't you ask me if I need a new doctor? - April.
- He's just as much my patient as he is Dr.
Choi's.
I don't know what's going on between the two of you, but if you don't stop disturbing my E.
D.
, I'm gonna separate you for good.
Do you understand? Clear.
Good.
Carry on.
You're very lucky her husband convinced her not to pursue action against you or the hospital.
Ms.
Goodwin, I'm sorry.
I expect better from you, Dr.
Manning.
Nat, wait.
Hi.
I'm sorry.
I'm really not interested.
I understand.
You didn't trust us before.
You certainly have no reason to trust us now.
Then we finally agree on something.
Julie.
Fearing for your baby's safety is the most natural thing in the world.
When I was pregnant, I lost my husband.
I was afraid of a lot of things.
And then one day, after I had my son, I was up in a high-rise building on the balcony and suddenly had this vivid image of myself falling over the railing.
And my first thought was, what would happen to my son if I wasn't here for him? And the craziest part is, my favorite thing in the world had always been Ferris wheels and roller coasters and being up in the air.
But from that day on, I had this totally irrational fear of heights.
It is really scary being solely responsible for that tiny, defenseless person inside of you.
But you are letting your fear win.
And it's gonna end badly.
Anyway I am sorry.
[SOMBER MUSIC.]
[KEYS CLACKING.]
I just got the analysis of Henry's lung tap.
Non-small-cell lung cancer? You were right to do the tap.
That's not important.
What matters now is that he needs to be told, and I think it would be best if he hears it from you.
You've treated him longer than anyone here.
You know him better than anyone here.
Why is Mr.
Willis insisting on surgery? Despite my explicit recommendations - to the contrary? - Dr.
Latham, I Did you go behind my back? No, he asked if he had options.
So I told him.
I, in no way, suggested [GROANS AND GROWLS.]
You've shown extremely poor decision-making today.
From this point on, you are not to step foot in the O.
R.
until I deem you ready to return.
- Do you understand? - You're benching me? For the foreseeable future.
Yes.
[ALARM BEEPING.]
Dr.
Halstead.
[TENSE MUSIC.]
Her heart rate's too high and her pressure's dropping.
Baby's heart rate's down to 90.
My chest hurts.
Your arrhythmia is escalating out of control.
Push 10 milligrams of diltiazem stat and up her 0-2 to 6 liters.
We need to do a C-section.
We have to get the baby out.
No.
Julie, I know you don't trust me, but your baby is in real danger.
- 84.
- Julie, let them do it.
I can't.
Julie, if you don't let us do this, your baby is going to die.
[SNIFFLES.]
- Okay, do it.
- Thank you.
Call O.
B.
and tell them we're coming up for a crash C-section, now! You heard her.
Let's move.
I'm not seeing any cause for the leak.
- Pickups.
- Pickups.
Are any of the leaflets impinged in the ventricle? No, they're opening freely, and the orientation is correct.
- So what do we do? - Re-suture the valve.
Won't give us much room to work, but I don't see where we have a choice.
It's the valve.
It's the valve.
Dr.
Rhodes, no one asked for your opinion.
It's a brand-new valve.
That's ridiculous.
The leaflets must be asymmetrical.
That would cause a large enough opening for the blood to keep leaking back through.
It does seem that they're not closing properly.
Really? They gave us a bad valve? It appears so.
Dr.
Rhodes, go change your clothes.
I'd like you to scrub in for the remainder of the surgery.
- How are you feeling? - I'm okay.
What are they putting in him? Proteins, carbohydrates, fats.
He needs them to grow.
[KNOCK ON DOOR.]
[DOOR OPENS.]
You paged about a consult? Yeah.
Yeah.
Um 50-something guy, post-op after getting shot by a patient.
Is this a joke? No.
I'm serious.
Give me your clinical evaluation of my recovery.
No residual anger or fear.
Mm-hmm.
Normal intellectual and emotional functioning.
You seem like you have moved on.
Yeah.
And you should too.
Excuse me? I'm just wondering if today was less about your patient and more about lingering fears for our safety.
It is certainly true that a very few patients can be dangerous.
But the overwhelming majority are harmless and in fact very grateful for our help.
Only they can't get that help if you come to work scared.
I'm not scared.
This is not an accusation, Doctor.
I just want you to know that every psychiatrist goes through this at some point or another.
And then it passes.
And it'll pass for you, too.
[PENSIVE MUSIC.]
Seems the hospital changed valve manufacturers several weeks ago.
This particular company didn't bother to conduct any human testing.
And they can do that? All they have to do is prove that it performs the same function as a previous device.
[SIGHS.]
Unbelievable.
Well Good night, Dr.
Latham.
When surgeons burn out, it always starts with stress.
Then a call goes the wrong way, an unlucky result.
And they get in their own heads, and that's when the hesitation starts, the unsteady hands.
And once you're there, it's a very hard road back.
Are you okay, Dr.
Rhodes? Yes.
I am.
Then you continue to have my full confidence.
Good night.
Good night.
I'm sorry.
Me too.
This isn't gonna be easy, is it? No, it's not.
Though, you know what would help? - Big pot of chili.
- Sushi? [BOTH CHUCKLE.]
- I'll see you later.
- Yeah.
- Hey.
- Hey.
How'd that metal detector thing turn out? I changed my mind.
- Really? - Yeah.
I saw a woman today who almost killed her baby because she didn't trust us.
And I thought, "How can we encourage people to trust us more if we don't show them trust first?" Couldn't agree more.
- Well, uh, good night.
- All right, see you tomorrow.
Dr.
Reese, Dr.
Sexton.
Check it out.
Someone slashed her tires.
You still think patients are harmless? She did this.
Yes, I'm still here.
I'm sorry you don't even get a real meal after the day you have had.
Oh, a little vegetarian living never hurt anybody.
Well, I'm sorry that you have to put up with all of this.
I promise it will be better soon.
I know.
[GENTLE MUSIC.]
[GROANS.]
It's almost 9:00.
Aren't we gonna miss our reservation? Maybe.
So then what are we doing here? What? No.
No, no, no.
No way.
Mm-mm.
Hey, you're not gonna let fear win, are you? Uh, yes.
Yes, I am.
Aw, come on.
Just one ride.
Oh, Will, no.
Natalie, I'm gonna be next to you the whole time.
Trust me.
[GIGGLES.]
I got to get it out.
Honey, it's 4:30 in the morning.
Yeah, and if the meat loses its juices, it's gonna be all dry and burnt.
Sweetie, I I I feel like this might be one of those anxiety attacks that Dr.
Reese said you might have.
It's not because of my condition.
It's because I put too much damn salt Whoa! Okay, okay, okay.
[SIGHS.]
Let me help you.
[BREATHES DEEPLY.]
Why don't you start measuring out another rub? Excuse me.
Yeah ah, whoa.
Excuse me.
Okay.
Excuse me.
Dr.
Rhodes, you're late.
I know.
I am sorry.
I understand you're under additional stress at home lately, but please try not to make this a habit.
I assure you I will not.
Dr.
Rhodes, your CT patient's here.
- [ALARM BLARING.]
- You're going to 1.
[DOOR OPENS.]
Jerry Willis, 54, called 911 with shortness of breath and tachycardia.
BP 110 over 60, rate 120, satting at 89% on five liters 0-2.
Mr.
Willis, what are you doing back here so soon? I've been having trouble breathing.
It started a few days after I left.
What trouble are we talking about? Coughing.
He's wheezing.
It's been getting worse.
All right, let's move him on my count.
All right.
And one, two, three.
[GROANS.]
I replaced his aortic valve two weeks ago.
Any intraoperative difficulties? - None.
- Cardiac comorbidities? Nothing notable, no.
Austin Flint murmur.
The valve is leaking.
That's impossible.
Maybe you're hearing tricuspid stenosis or a subclinical MI.
Is it possible you misoriented the valve? Obstructed one of the leaflets? No.
I remember it very clearly.
Surgery went off without a hitch.
[WHEEZING.]
- We should order an echo? - What? What's wrong? Aortic insufficiency.
The valve is definitely leaking.
But you just replaced it.
How could it leak? I don't know.
It doesn't make any sense.
I Maybe Dr.
Rhodes made a mistake.
- Morning.
- Good morning.
Hi.
Whoa.
Is that what you're planning on wearing tonight? It's a brand-new Chiara Boni.
I mean nah, I mean it's probably fine.
I mean if you think it's fancy enough for the corner table at Alinea.
Are you kidding? That's like the toughest reservation in town.
"GQ" says 97% of relationships are decided on the first date.
Oh, now you're getting your dating advice from "GQ"? Natalie, these are hard numbers.
- Mm.
- I'm just citing the research.
[LAUGHS.]
I honestly don't know what happened.
Go back over your notes.
Try to learn from your error.
I will, and I'll get him preop'd for a re-do.
That will not be necessary.
Between the adhesions and further procedural stress, reopening his heart is simply too risky.
We'll manage him with medications instead.
But if we don't fix the valve, his quality of life is gonna suffer.
I understand, but at this point, it's our best option.
[BREATHING HEAVILY.]
Any plans tonight? Still got that chili.
- You want to join? - No way.
Is the sushi place on the corner still open? Why can't you just be nice? Oh, I can be nice.
[PAGER BEEPING.]
[BOTH GROAN.]
Hold that thought.
[EXHALES.]
Daniel.
You're looking more rested.
Doing my best.
What's the word? The board is deciding whether to put metal detectors at all the hospital entrances.
So I have to go prepare my recommendation.
Which way you leaning? [SIGHS.]
Toward yes.
Really? Doesn't that kind of fly in the face of being a trusted community institution? You know, putting up barriers between us and the people that we're trying to help? One of those people shot you in the gut, Daniel.
Yeah, outside the hospital.
What kind of detector's gonna stop that? - Dr.
Reese.
- Dr.
Charles.
So, Nurse Sexton, - who do we got next? - Henry Lee.
He's a sweetheart, comes in every month for his heart failure meds.
Mr.
Lee, I'm Dr.
Choi.
How are you doing today? A lot better now that my girl's here.
She does have that effect on people.
Any new complaints? Nope.
Just got to get my meds.
Take a deep breath.
[BREATHES DEEPLY.]
One more.
How much Lasix does he usually get? - 40 IV.
- That sounds good.
But I'm also hearing some dullness near your lung base.
I'd like to send you for an X-ray.
Thanks, Doc, but if it's all the same, I'd rather just get my meds and go.
Mr.
Lee, I hear what you're saying, but I prefer to be thorough.
Nah, let's just stick to the usual.
Hey, can you do the IV in my left hand today? I got a good puffy one.
[CHUCKLES.]
- She never misses.
- You got it.
I really would like that X-ray.
I bet he'd listen to you.
Why? You think there's something else going on? I don't know.
Probably not, but it's impossible to say.
Okay, I'll try.
Thank you.
So I've got a 43-year-old woman who passed out at a Starbucks from hypoglycemia.
- Mm-hmm.
- Now, that's normal, right? But then her blood came back showing insulin with a high C-peptide count.
So she gave herself too much insulin.
Right, but here's the thing: she is not diabetic.
Wait so wait a minute.
She somehow got her hands on insulin, then injected it into herself? Why would she do that? I don't know.
That's why I called you.
- Okay, I'll try to find out.
- All right, cool, thank you.
Oh, actually, um Okay, so you know how I've been hounding you about getting a drink one night after work? - I'm familiar with it, yes.
- Okay, well, I promise it's all going to stop.
Right after you get a drink with me tonight.
Oh, come on, Noah, couldn't we just stick to being colleagues? Sure.
A drink as colleagues.
Okay.
[LIGHT KNOCK ON DOOR.]
Ms.
Lake, I'm Dr.
Reese from Psychiatry.
Of course you are.
- It's nice to meet you.
- Nice to meet you.
I understand that you may have injected yourself with insulin today.
I did.
Can you tell me why? Today's the court hearing.
For my divorce.
Oh.
It just snuck up on me.
I mean, I've been dreading it for months, but when I woke up today and realized that this is it Did you try to harm yourself? Oh, no, no, no.
I don't want to die.
I just couldn't face the day.
So let me understand.
You made yourself pass out on purpose? I panicked.
I did something stupid.
And now I'm wasting your time.
I'm sorry.
Speaking of which, could you write a note for the judge? Just something saying I had a medical emergency.
Ah, I am sorry, but I can't do that.
It doesn't have to be anything big.
Handwritten on a letterhead is fine.
The thing is, you didn't have an emergency.
You caused it.
So it would be disingenuous for me to say otherwise.
I'd like to speak with your supervisor.
Excuse me? I'm seeing a doctor, now I need a doctor's note.
And if you can't do that, then get me your supervisor.
[TENSE MUSIC.]
Um.
Okay.
You look like you need this more than I do.
I'm fine.
Sure.
Hair's a mess, bags under your eyes.
You look great.
Don't be so hard on yourself.
You work our schedule then go home to a girlfriend who's basically your patient too.
Something like this was bound to happen.
Really? Is that so? At least it hasn't affected your sunny disposition.
Keep up the good work.
- [ALARM BLARING.]
- Dr.
Halstead, You're going to 3.
Doris.
Talk to me, Chout.
Julie Dutra, 34, pregnant, para one gravita zero, fainted in a yoga class, in A-fib at 150, BP 90 over 60.
Hi, Julie, I'm Dr.
Manning.
This is Dr.
Halstead.
I told them I don't want to be here.
Hopefully this won't take long.
On my count.
One, two, three.
[SUSPENSEFUL MUSIC.]
Julie.
Are you okay? - I'm fine, just call Mira.
- Our midwife.
I think Julie would be more comfortable at home with her.
Uh, sir, your wife's in a dangerous arrhythmia.
We can't let her go until we get it under control.
Do you have any history of heart disease? No, I don't eat red meat, and I keep a high antioxidant profile to minimize inflammation.
Okay, good.
Let's get an EKG, cardiac labs, CBC, CMP, coags and a U/A, and let's start 5 of verapamil IV, okay? No, no medications.
This one's safe for pregnancy.
If we don't control your arrhythmia it could - put the baby in danger.
- Is that true? - Scott.
- What? We don't want anything bad to happen.
[COUGHING.]
[INHALES DEEPLY.]
Okay, fine, but then we're leaving.
Thank you.
All right.
Let me ask you a few more questions.
- Wait, what are you doing? - Just a quick fetal - ultrasound.
- No, get that thing off me.
Acoustic radiation impairs neurodevelopment.
That's not actually true.
Note that the fetus measures normal size and weight for five months.
Wait, what did you say? That this looks like a normal five-month pregnancy.
Measure it again.
I'm sure of the numbers.
Well, you're wrong.
Measure it again.
See? Totally normal for five months.
Except I'm not five months pregnant.
I'm eight.
Julie's labs.
Anemia, vitamin deficiencies, all the signs of early kidney failure.
And no family history of troubled pregnancies or genetic conditions.
Maybe a malabsorption syndrome? - [KNOCKS ON DOOR.]
- Ms.
Dutra.
Have you ever had any gastrointestinal issues? Crohn's, ulcerative colitis? I used to have leaky gut.
At first we thought it was just lactose, but of course it was more complicated than that.
I see, and were you seeing someone for this? My nutritionist.
She got me off lecithin and phytic acid.
It helped some, but then once I got pregnant I had to give up all GMOs and anything that wasn't locally sourced, too.
So what do you eat? Certain strains of Swiss chard, broccoli.
Sometimes I'll have a cup of adzuki beans.
But she supplements a lot.
Selenium, coenzyme Q.
You eat three meals a day? More? Less? I do portion control to manage the baby's glucose.
700 to 800 calories a day.
Why? We suspect the difficulties with this pregnancy are being caused by your diet.
That can't be.
I only eat organic.
But you're not getting enough protein or iron.
And we're seeing the effects it's having on your baby.
We need to start aggressive IV nutrition to help it grow as much as possible before you deliver.
If we admit you to Obstetrics now we No.
I understand that you don't want to be here, but at this point it is No.
You're not giving me IV food.
Your baby is severely malnourished.
No, my baby is getting healthy farm-to-table nutrients.
You're not gonna pump him full of toxins and chemicals.
- Ms.
Dutra - I said no.
Your arrhythmia hasn't resolved yet.
We'll be back in a minute to check on you.
She's starving that baby to death.
We need to talk to Goodwin.
Mr.
Lee, we got your X-ray results back.
Great.
So I can get out of here? Actually, they show bilateral pleural effusions, fluid surrounding your lungs.
- Is that bad? - It's hard to say.
It could just be from your heart failure.
Either way, it's not making your breathing any easier.
I'd like to have Radiology remove it with a needle aspiration.
You want to stick a needle in my lung? - Yes.
- But I'm breathing fine now.
- I'd rather just go.
- I understand, but doing this will let you go longer between treatments.
I think it's a good idea.
Don't you agree? I don't know.
Um The effusions are pretty small.
True, but it also wouldn't hurt to send the fluid out for analysis, just to be sure, right? I suppose.
So, Henry, what do you say? You really think this is a good idea? Okay.
We'll get you over there right away.
Are you sure you want to be this aggressive? I want to cover all the bases, yeah.
Henry's not a very healthy man.
He doesn't do so well with procedures.
I hear you, but medically, it's the best course of action.
I don't think it is.
I'm sorry you feel that way.
What you should be sorry about is thinking that I would agree with you in there just because we're sleeping together.
That has nothing to do with it.
I thought you'd agree because that's my medical opinion.
Well, you were wrong.
The next time you want to put me on the spot in front of my patient, think again.
Hey.
April.
You want to feed a patient against her will.
A pregnant mother who's killing her baby.
We believe she has something called orthorexia, an obsession with healthy living that has limited her diet so severely that it's become dangerous.
And has led to a pathologic distrust of the entire medical system.
She won't let us do anything.
Well, is she delusional? Can she make decisions on her own? No, she's very clear about what she wants and what she does not want.
Well, then we can't prove incompetence, and we can't force her to do anything to her body she doesn't want.
The law sides with her.
But there are two patients here.
Yeah, one of whom has no control over what's being done to it.
This is child abuse.
Well, I can convene an emergency ethics committee.
It's possible they may find grounds to override her decision.
And in the meantime? See if you can find a way to help her trust us.
Dr.
Latham.
We should do the surgery.
- Dr.
Rhodes - No, I I looked over all my notes.
Okay? Mr.
Willis' anatomy is good.
We owe him a chance to get this right.
We owe him our best clinical judgement.
Yes, I was inside of his heart.
He's got more than enough healthy muscle and vasculature.
I'm telling you he can handle it.
Have you had more than four hours' sleep this last several weeks? I am a cardiothoracic fellow.
Sleep deprivation is part of the job.
I understand that.
But you have a lot on your plate.
Dr.
Bekker and I will take the case from here.
No, Dr.
Latham, that's not necessary [KNOCKING ON DOOR.]
Dr.
Rhodes, you have a phone call.
Tell them I'll call them back.
I'm sorry.
It's your landlord.
He says it's an emergency.
[DOOR CLOSES.]
[INDISTINCT CHATTER.]
[SIRENS WAILING.]
Excuse me.
Hey.
Thank you.
Excuse me.
Robin.
Robin.
Hey, are you okay? I forgot the brisket in the oven when I went to the store, and then all the alarms went off.
- I'm just such an idiot.
- Come here, come here.
- Come here.
- Hey, Otis, when are we gonna get that thing shut down? - [MOUTHING.]
She okay? - Yeah.
Thank you.
[SIRENS CONTINUE WAILING.]
Don't worry.
It could happen to anybody.
Shouldn't be more than a half hour.
I'm sorry you had to deal with that.
- No need to be sorry.
- You know what I mean.
The more time you spend with her, the less we have to see people who actually need our help.
I don't know.
I'm not quite sure we're We're done with Ms.
Lake yet.
Why? She just wants to use us to game the system.
Well, so do a lot of patients.
We're not gonna let her.
But the question is, why is she doing it? Wait, you still think this is a psych case? Why wouldn't I? I mean, she exhibited some pretty extreme behavior - this morning, didn't she? - To get out of a court date.
Well, perhaps, but until we figure out what's behind the behavior, we haven't really done our job, have we? - I guess.
- Good.
Keep me in the loop.
Your heart isn't responding to the meds.
If things keep going in this direction, we may need to consider an emergency C-section to take the extra load off your heart.
Drug me up then cut me open? No way.
That's not what we want either, but we do need to protect you and your baby.
That's why in the meantime, if you allow us to give you - some IV nutrition - No way.
Those bags off-gas BPAs.
Look, you don't get it.
This baby is being formed from every single molecule that enters my body.
It is my job to keep it absolutely pure.
That is how I'm protecting it.
- They understand that.
- No, they don't.
Uh, excuse us.
[TENSE MUSIC.]
Please tell me you have some good news.
I'm afraid not.
The committee ruled that we can't intervene against her wishes, not even for the sake of the baby.
So that's it? We just have to watch as she lets the baby die? If that's what she chooses to do.
But that's not what she wants.
She wants to help her baby.
She's just confused about how to do it.
I'm sorry.
Our hands are tied.
[ALARM BEEPING RAPIDLY.]
What happened? Satts are at 78 and dropping.
[WHEEZING.]
He's in pulmonary edema.
Get him on BiPAP and 40 of Lasix.
He's my patient.
Sublingual nitro, IV nitroprusside and ready an intra-aortic balloon pump.
- What's happening? - The leak in your valve is causing fluid to back up into your lungs.
BiPAP's at 100%.
Balloon pump is here.
What's that? It's a pump that we can implant directly into his aorta to take the strain off of his heart.
Meds are in.
Still satting at 78.
So, then he's hooked up to a machine forever? Possibly if his heart doesn't respond to the medications.
- Oh, my God.
- Betadine.
- Hold on.
- Dr.
Rhodes Give the meds a minute to work.
We may not have a minute.
Look.
Your sats are coming up.
We'll hold off for now.
Give him 1.
25 of enalapril IV and another 40 of Lasix.
Mr.
Dutra.
Hi.
I need you to talk to your wife.
She won't listen to me.
But you do understand this has gotten out of hand.
Of course I do.
I mean, all she thinks about is how uric acid and compromised soil are infecting everything we eat.
What do I say to that? Well, how did you handle it in the past? It wasn't this bad before.
I mean, she's always struggled with anxiety and control issues.
Even when she got pregnant, it's like she turned the dial straight to 11.
Nothing's pure enough anymore.
Everything looks like baby poison.
But there has to be something you can say to get her to let us help.
I am so scared my wife and my baby are gonna die.
Can't you do something? So you think I avoid conflict to protect myself? I think it is a possibility.
And you think that's a pattern.
Yes, a destructive one from the sounds of it.
I can't believe I didn't see it.
I will get your discharge paperwork started.
Looks like you had a little breakthrough.
I I think she sees that she has some issues and that it will be worthwhile for her to seek some long-term therapy.
Sounds like a good start.
I, um I was wrong about her, Dr.
Charles.
Thank you for making me stick with her.
[ALARM BEEPING.]
Dr.
Choi.
Pulse ox is down to 82.
[GASPING SLOWLY.]
[INTENSE MUSIC.]
No breath sounds on the left.
He's got pneumothorax.
Get a chest tube, 26 French.
I can't breathe.
I'm afraid your lung's collapsed.
Radiology must've nicked it during the tap.
You're kidding me.
I'm so sorry, Henry.
I need to insert a tube between your ribs to reinflate your lung.
Do you understand, Mr.
Lee? Lidocaine.
Henry, I'm just gonna lift your arm.
You're gonna feel a sting.
[GROANS.]
Just breathe.
It's okay.
We're gonna get you through this.
All I wanted was my damn medicine.
I know.
Then why'd you let him do this to me? I was fine.
[GROANS LOUDLY.]
Oh, God.
It feels like your stabbing me with a knife.
Breathe.
[GROANING.]
Put him on suction, get a portable chest X-ray, gram of cefazolin, a milligram of morphine and dress it with xeroform.
At this point I'm gonna have to admit you, Mr.
Lee.
Probably for several days.
I'm very sorry.
I'll check back on him soon.
I'm sorry.
What the hell are you trying to do me? Please, Ms.
Dutra, let me explai - I told you no food! - Just one second.
- What's going on? - I need you to calm down, - okay? Please.
- She put this in my IV - behind my back.
- Ms.
Dutra, wait.
Glucose, amino acids.
You did this? - Ms.
Dutra.
- Julie.
- Ms.
Dutra, just relax.
- Julie! Ms.
Dutra, we need to get you back into bed.
Get her away from me.
Get her away from me! I need some help here.
- [CRYING.]
- All right, easy.
Relax, I have her.
Let's get her back up.
[TENSE MUSIC.]
Dr.
Reese.
Your patient in 1's waiting for his prescription.
Okay.
Hey, have you seen my pad? Uh-uh.
Huh.
Have you seen my prescription pad? - No.
- No? I couldn't have lost it.
I always put it back in my pocket, always Hey, do you still need that note for the judge? Oh, no, it's fine, my lawyer actually took care of it.
Oh, good.
Could you please open your purse? - I'm sorry? - I can't find my prescription pad.
I want to check your purse.
I don't know why you think it'd be in there.
Because you decided to forge the judge a note and you took it from my pocket when you hugged me.
[QUIETLY CHUCKLES.]
I have no idea what you're talking about.
Hey! Give me that! So what's this? You have no right.
You're gonna pay for this! - Ma'am! - I am gonna make you pay! - Hey! Hey.
- Ma'am, step away now! She assaulted me.
She she put that in my purse.
Okay, everybody calm down.
[SNIFFLING.]
Dr.
Reese.
What happened in there? She stole my pad.
That's a felony.
She has been lying to us from the start.
Of course she has.
Lying, manipulating.
Behaving recklessly with no regard for herself or others.
- Exactly.
- No.
Not exactly.
[GROANS.]
Look, off the top of my head, probably a sociopath, but that makes your job exploring that and trying to help her.
Not punishing her.
But all she did from the moment she got here was try to manipulate us and waste our time.
Because she's mentally ill.
No.
No, it's because people like you let her.
- People like me? - Yes.
Yes, you enable and you make excuses and you give out psychiatric diagnoses so that no one has to be held accountable for their actions just like you did with the guy that shot you.
[TENSE MUSIC.]
[LIGHT TAPPING ON GLASS.]
You feeling any better? A little bit.
Good.
If there's anything that you need, Dr.
Latham and Dr.
Bekker are gonna be taking care of you from here on out, okay? Dr.
Rhodes.
Am I gonna be like this forever? Things will get better once they optimize your meds.
But I'll always be coming back here for something, right? [SOFT SOMBER MUSIC.]
There's no way to go back to how I was? It is possible to redo your valve surgery.
It comes with significant risks.
You could end up with an even worse leak than before.
You could even die.
But it could work.
I could go back to normal? Dr.
Latham is the best this hospital's got.
I promise he's gonna take great care of you.
This is why I didn't want to do the lung test.
- Still the right call.
- No, you don't know that.
- You don't know him - But I know what heart failure looks like, and this just - seems like something else.
- I've been treating Henry for years.
This is what he looks like.
I'm not asking for a second opinion.
You don't want my opinion.
Just because I don't have an MD after my name doesn't mean I don't know what's best for my patient.
April, as the doctor, I'm responsible.
I have to do what I think is right.
Both of you, in there.
Now.
[TENSE MUSIC.]
This has to stop.
Do you need another nurse on your case, Dr.
Choi? - No.
- Uh, excuse me.
Why didn't you ask me if I need a new doctor? - April.
- He's just as much my patient as he is Dr.
Choi's.
I don't know what's going on between the two of you, but if you don't stop disturbing my E.
D.
, I'm gonna separate you for good.
Do you understand? Clear.
Good.
Carry on.
You're very lucky her husband convinced her not to pursue action against you or the hospital.
Ms.
Goodwin, I'm sorry.
I expect better from you, Dr.
Manning.
Nat, wait.
Hi.
I'm sorry.
I'm really not interested.
I understand.
You didn't trust us before.
You certainly have no reason to trust us now.
Then we finally agree on something.
Julie.
Fearing for your baby's safety is the most natural thing in the world.
When I was pregnant, I lost my husband.
I was afraid of a lot of things.
And then one day, after I had my son, I was up in a high-rise building on the balcony and suddenly had this vivid image of myself falling over the railing.
And my first thought was, what would happen to my son if I wasn't here for him? And the craziest part is, my favorite thing in the world had always been Ferris wheels and roller coasters and being up in the air.
But from that day on, I had this totally irrational fear of heights.
It is really scary being solely responsible for that tiny, defenseless person inside of you.
But you are letting your fear win.
And it's gonna end badly.
Anyway I am sorry.
[SOMBER MUSIC.]
[KEYS CLACKING.]
I just got the analysis of Henry's lung tap.
Non-small-cell lung cancer? You were right to do the tap.
That's not important.
What matters now is that he needs to be told, and I think it would be best if he hears it from you.
You've treated him longer than anyone here.
You know him better than anyone here.
Why is Mr.
Willis insisting on surgery? Despite my explicit recommendations - to the contrary? - Dr.
Latham, I Did you go behind my back? No, he asked if he had options.
So I told him.
I, in no way, suggested [GROANS AND GROWLS.]
You've shown extremely poor decision-making today.
From this point on, you are not to step foot in the O.
R.
until I deem you ready to return.
- Do you understand? - You're benching me? For the foreseeable future.
Yes.
[ALARM BEEPING.]
Dr.
Halstead.
[TENSE MUSIC.]
Her heart rate's too high and her pressure's dropping.
Baby's heart rate's down to 90.
My chest hurts.
Your arrhythmia is escalating out of control.
Push 10 milligrams of diltiazem stat and up her 0-2 to 6 liters.
We need to do a C-section.
We have to get the baby out.
No.
Julie, I know you don't trust me, but your baby is in real danger.
- 84.
- Julie, let them do it.
I can't.
Julie, if you don't let us do this, your baby is going to die.
[SNIFFLES.]
- Okay, do it.
- Thank you.
Call O.
B.
and tell them we're coming up for a crash C-section, now! You heard her.
Let's move.
I'm not seeing any cause for the leak.
- Pickups.
- Pickups.
Are any of the leaflets impinged in the ventricle? No, they're opening freely, and the orientation is correct.
- So what do we do? - Re-suture the valve.
Won't give us much room to work, but I don't see where we have a choice.
It's the valve.
It's the valve.
Dr.
Rhodes, no one asked for your opinion.
It's a brand-new valve.
That's ridiculous.
The leaflets must be asymmetrical.
That would cause a large enough opening for the blood to keep leaking back through.
It does seem that they're not closing properly.
Really? They gave us a bad valve? It appears so.
Dr.
Rhodes, go change your clothes.
I'd like you to scrub in for the remainder of the surgery.
- How are you feeling? - I'm okay.
What are they putting in him? Proteins, carbohydrates, fats.
He needs them to grow.
[KNOCK ON DOOR.]
[DOOR OPENS.]
You paged about a consult? Yeah.
Yeah.
Um 50-something guy, post-op after getting shot by a patient.
Is this a joke? No.
I'm serious.
Give me your clinical evaluation of my recovery.
No residual anger or fear.
Mm-hmm.
Normal intellectual and emotional functioning.
You seem like you have moved on.
Yeah.
And you should too.
Excuse me? I'm just wondering if today was less about your patient and more about lingering fears for our safety.
It is certainly true that a very few patients can be dangerous.
But the overwhelming majority are harmless and in fact very grateful for our help.
Only they can't get that help if you come to work scared.
I'm not scared.
This is not an accusation, Doctor.
I just want you to know that every psychiatrist goes through this at some point or another.
And then it passes.
And it'll pass for you, too.
[PENSIVE MUSIC.]
Seems the hospital changed valve manufacturers several weeks ago.
This particular company didn't bother to conduct any human testing.
And they can do that? All they have to do is prove that it performs the same function as a previous device.
[SIGHS.]
Unbelievable.
Well Good night, Dr.
Latham.
When surgeons burn out, it always starts with stress.
Then a call goes the wrong way, an unlucky result.
And they get in their own heads, and that's when the hesitation starts, the unsteady hands.
And once you're there, it's a very hard road back.
Are you okay, Dr.
Rhodes? Yes.
I am.
Then you continue to have my full confidence.
Good night.
Good night.
I'm sorry.
Me too.
This isn't gonna be easy, is it? No, it's not.
Though, you know what would help? - Big pot of chili.
- Sushi? [BOTH CHUCKLE.]
- I'll see you later.
- Yeah.
- Hey.
- Hey.
How'd that metal detector thing turn out? I changed my mind.
- Really? - Yeah.
I saw a woman today who almost killed her baby because she didn't trust us.
And I thought, "How can we encourage people to trust us more if we don't show them trust first?" Couldn't agree more.
- Well, uh, good night.
- All right, see you tomorrow.
Dr.
Reese, Dr.
Sexton.
Check it out.
Someone slashed her tires.
You still think patients are harmless? She did this.
Yes, I'm still here.
I'm sorry you don't even get a real meal after the day you have had.
Oh, a little vegetarian living never hurt anybody.
Well, I'm sorry that you have to put up with all of this.
I promise it will be better soon.
I know.
[GENTLE MUSIC.]
[GROANS.]
It's almost 9:00.
Aren't we gonna miss our reservation? Maybe.
So then what are we doing here? What? No.
No, no, no.
No way.
Mm-mm.
Hey, you're not gonna let fear win, are you? Uh, yes.
Yes, I am.
Aw, come on.
Just one ride.
Oh, Will, no.
Natalie, I'm gonna be next to you the whole time.
Trust me.
[GIGGLES.]