Chicago Med (2015) s03e09 Episode Script
On Shaky Ground
1 Hey, guys, I need your help over here.
We're going to Treatment six.
Joanna Harris, 25-year-old female, 22 weeks pregnant, hemorrhaging vaginally.
What happened? Nothing.
I was working at my computer, and then the next thing I know, I'm bleeding.
Okay, let's get her transferred on my count.
- All right.
- One, two, three.
[GROANS.]
Are you cramping? Yes.
Maggie, CBC, type RH, coags, and get her - on the fetal monitor.
- Got it.
Heart tones look good, healthy placenta, no previa.
Do you want to know the sex of the baby? We already do.
It's a boy.
We're naming him Ian.
All right, I'm going to check your cervix now, okay? Okay.
She's one centimeter dilated, 50% effaced.
Looks like you're going into labor.
What? What? It's too early.
Yes.
Bolus a liter of LR and start her on 30 milligrams of nifedipine PO.
- [GROANS.]
- Got it Just try to breathe, okay? Breathe through it.
Breathe through it.
We're going to give you some medication to stop the contractions.
What if you can't stop labor? Unfortunately, we don't consider a fetus viable until 24 weeks.
And even if he did survive, he would probably have severe deficits.
Brain damage, paralysis Oh, my God! Oh, my God.
Oh, my God [CRYING.]
If the baby does come today, we will need you to decide if you would like us to perform all life-saving measures.
As opposed to what, just letting him die? We would provide comfort measures.
Want to make sure that the baby doesn't have any pain.
[MOURNFUL MUSIC.]
I don't I don't know.
I mean, are we just going to let our baby go? What kind of life would we be giving him? Think about it.
It'd be cruel.
If he's born today, please, just make him comfortable.
Yes.
Don't let my baby suffer.
We won't.
I promise.
[CRYING.]
[ALARM BUZZES.]
[METAL DETECTOR BEEPS.]
- Fred.
- Dr.
Charles.
[METAL DETECTOR BEEPS.]
Hey, doc.
How's it going? What's up, Conway? How's the baby? Still not sleeping through the night.
Have you ever, uh, tried chamomile tabs? You can get them at any health food store.
Hmm.
Thanks for the tip, doc.
Hey, Dr.
Charles.
Dr.
Reese, this is Officer Kowalski.
He will be our escort for the day.
- Hi.
- First time? - Mm-hmm.
- You'll be fine.
Just don't feed the animals.
Uh, sign the visitor waiver, please.
Waiver? Basically says that if we, um, get taken hostage, that the state won't negotiate our release.
Just standard procedure.
Hey, look.
Your determination to explore exposure therapy is nothing less than admirable, but it doesn't mean we have to do it here, so if you're having second thoughts, now would be the time to tell me.
You're absolutely sure you want to do this? Yes.
This is what I want.
[TENSE MUSIC.]
[DOOR BUZZES.]
[PRISONERS YELLING DISTANTLY.]
Ava! - Hello.
- Hello, Dr.
Jaffrey! - How great to see you.
- Your trip was all right? Well, as all right as an 18-hour flight can possibly be.
[LAUGHS.]
You already know Dr.
Latham.
- Course.
- This is Dr.
Rhodes, - another CT Fellow.
- Ah.
Great.
Dr.
Jaffrey's not only one of the world's greatest heart surgeons, but was also my mentor in Cape Town.
Taught me everything I know.
I have read your book, Dr.
Jaffrey.
It's an honor to meet you.
Oh, please.
I'm just another patient today.
There's a tumor on the upper lobe of Dr.
Jaffrey's right lung.
It's invaded his superior vena cava, obstructing blood flow to his head and upper extremities.
We'll need to remove a portion of the lung and resect the tumor.
And I want my star pupil to oversee the procedure.
Thank you for your confidence, Dr.
Jaffrey.
We're getting an OR prepped as we speak.
Ah, just one thing.
Um I don't tolerate anesthesia well.
Well, we can talk to the anesthesiologist about adjusting your cocktail.
Uh, no.
Uh, I think I have a better idea.
Place a high epidural and load me up with bupivacaine.
Hold on.
You would like to be awake for the surgery.
Well, strictly as an observer, of course.
No, it's just that we would be taking an unnecessary risk.
The epidural site could hemorrhage from the blood thinners alone You you could be paralyzed.
Not if we do it off-pump.
Right.
We can construct a temporary graft from the brachiocephalic vein to the right atrium, clamp the superior vena cava, and remove the tumor.
Certainly eliminate the need for a bypass.
- Exactly.
- Absolutely.
We'll do it that is, of course, if it's okay with Dr.
Latham.
- Good.
- I think Dr.
Jaffrey has alleviated my concerns.
I'll make the arrangements.
Thank you.
[DESOLATE MUSIC.]
Hmm.
I'll let Vorspan know about the high epidural.
Did we really just agree to allow a patient to be fully awake while we perform open-heart surgery? Dr.
Jaffrey is well aware of the risks and has given us his consent.
There's no way that we can guarantee we'll neutralize all of his pain, and even if we do, every time his lungs inflate, it'll obstruct our field.
I have faith in our anesthesiologists and Dr.
Bekker.
Awake surgery is extremely risky and should only be performed when medically necessary.
I understand your concern, Dr.
Rhodes, but I trust Dr.
Jaffrey's judgment and respect his desire to observe.
If I were in his situation, I certainly would.
Seeing my own beating heart.
[CHUCKLES.]
[SOMBER MUSIC.]
Debra McCormick, 14-year-old female, GCS 13.
Possible overdose.
Dr.
Choi, April, you're going to treatment four.
We got it.
Found her on Lower Wacker, passed out and freezing.
Probably homeless.
I'm not homeless, damn it! I live with my friends.
Okay, can you tell us what happened? Nothing.
I tripped and fell.
I'll be fine.
Let's transfer on my count.
Ready? One, two, three.
Let's get her started on IV fluids and order a tox screen, CBC, CMP, and a white count with differential.
Yes, Doctor.
Do you have a family member we can contact? No.
You sure? Call Child Services.
No, please don't do that.
They never help.
They just keep sending me back to my mom and her drunk boyfriend, and he hates me.
[BREATHING HEAVILY.]
For now, you just rest and get warm, okay? We'll run some tests and be back to check on you soon.
What do we do? She's a minor.
We have to call Child Services.
Not if they're just gonna put her back in an unsafe environment.
We don't even know she's telling us the truth.
Ethan, I've seen this too many times.
Child Services sends a girl home, she winds up right back here, beaten, raped.
There's a little dive on Roosevelt that's got the best dry rub north of Memphis.
Let me take you to dinner tonight.
I thought we discussed this.
We did, and I decided to back off, but then I changed my mind.
- Barry - Come on, just think about it.
Unless you're gonna help me with these charts, I've got work to do.
I'll take that as a "maybe.
" What good is calling Child Services? She's already been through the system.
She still ended up in the street.
So what's the answer? Just let her be homeless? - 14-year-old girl.
- Hm.
Looks like this young lady's in a tough spot.
Most potential foster parents are only interested in babies or young children.
It's nearly impossible to place a teen.
Does she have any extended family? Not that she's told us about.
Well, April's right.
In all likelihood, Child Services will just send her back to the abusive home she fled.
But they'll follow up, make sure she's safe.
In a perfect world, yes.
In reality, they don't have the resources.
Let me call some contacts in social services, see if there isn't a group home with a vacancy.
- Thank you, Ms.
Goodwin.
- Mm-hm.
Thank you.
[SCREAMS.]
Dr.
Manning, she's having contractions.
We need help here.
[YELLS.]
[DESOLATE MUSIC.]
What's happening? What's wrong? She's fully dilated.
No, you have to stop the labor! I'm sorry, but the nifedipine is not working.
Okay? There's nothing else we can do.
Need to move her to labor and delivery.
No time.
Maggie, get a preset pack, a warmer, and page OB and tell them this baby is coming now.
Got it.
Jackie, come with me.
I'm gonna need you to push for me, okay? All right, you ready? Push.
[GROANS.]
Good.
All right, can you push again? One more.
And push.
[GROANS.]
Doing great.
You're doing great.
All right.
Just one more big one.
Can you do that? Just one more big one.
Ready? Push.
Go, push.
Push.
[SOMBER MUSIC.]
[CRYING.]
The embryonic sac is still intact.
- [CRYING.]
- All right.
Stay with me.
Stay with me.
[SOBS.]
Wait.
Where are you taking him? Hey, hey, hey.
It's gonna be okay.
Relax.
It's okay.
[CRYING.]
Will.
He's alive.
And he's active.
Responsive.
Let's get this baby up to the NICU.
Who's first on your list? Hector Ramirez.
You're gonna have to wait.
Ramirez is a level three.
We gotta clear the floor and bring in additional officers to escort him out.
All right, gentlemen.
Let's take it to your cells.
[PRISONERS GRUMBLING.]
Any particular reason you tried to sabotage this? How about we're taking an unnecessary risk all so you can rack up a splashy surgery? Oh, so it's about the credit.
Jealous, maybe? No.
No, I am just worried about Dr.
Jaffrey dying on the table.
He knows what he's doing.
Plus, this "splashy surgery," as you call it, will be good for the hospital and the CT program.
How very selfless of you.
Dr.
Bekker, we're ready.
Coming, Dr.
Rhodes? That's my cousin, Kiki.
Hey.
Hey.
Your labs came back negative.
No sign of infection or any immune deficiencies.
Great.
Kiki's come to take me home.
N we can only release you with the permission of a parent or legal guardian.
Forget it.
I'm still going.
Kiki, would Deb! What what's happening to her? - She's seizing.
- Step back, step back.
- Deb! - Two milligrams Ativan.
[DRAMATIC MUSIC.]
Call radiology.
We need to get her upstairs for a head CT, now.
Ativan in.
You're okay, Deb.
You're okay.
[SOMBER MUSIC.]
- Ready? - Yep.
[HEART MONITOR BEEPING.]
[BABY CRIES WEAKLY.]
Parents were clear about their wishes? Yes.
They have decided not to perform any resuscitative measures.
Mm.
Is there any chance this baby could be viable? Unfortunately not.
His heartbeat's weak and his weight is under 500 grams.
Yeah, but at 490 grams, he's not that far off.
Natalie No, his coloring and muscle tone are good, and he's making a decent respiratory effort.
Doesn't that say something? Not enough.
This baby's not going to survive.
The best we can do is make him comfortable.
[SIGHS.]
[MACHINE WHIRRING.]
Eh, she's got a mass in her sinus, possibly a tumor.
We need a biopsy.
Yeah, but look at the cross-sections.
I don't understand.
Neither do we.
It's moving.
You feeling any pain, Deb? No, it just feels weird.
Stop moving.
What was that? I have a pretty good idea.
Forceps and speculum.
W-what's happening? Just stay still.
A cockroach.
What? Oh I want to take another look at that CT.
So, Hector Ramirez, you know, anxiety, depression, history of intermittent explosive disorder.
All clear, doc.
May I? - Dr.
Reese, I really think - Dr.
Charles.
Hello, Mr.
Ramirez.
I am Dr.
Reese.
I, um [CLEARS THROAT.]
Dosage.
Right, um, how have you been feeling since Dr.
Charles altered your dosage? [BARKING.]
[PRISONERS CLAMORING.]
Knock it off, Ramirez.
[BARKS.]
[LAUGHS.]
We gotta take a little break.
Let's get Ramirez back to his cell.
[LAUGHS.]
Look at me, look at me.
Take a deep breath.
Take a deep breath.
It'll pass, okay? It'll pass.
[PRISONERS LAUGHING AND YELLING.]
[LAUGHS.]
Okay, we need to take a little break.
Get Ramirez back in his cell.
Okay, please escort Dr.
Reese back outside.
It's okay.
I'll be there in a bit.
It's all right.
[LAUGHS.]
Whoo! Whoo! [HOWLS.]
Your vitals look good, but we would like to keep you a few more hours just for observation.
What about my baby? Did he Your baby was born just over one pound, below the threshold of what experts consider viable.
And you know that for sure? Defining viability is not an exact science.
Unfortunately, there's no way of knowing anything with certainty.
What do you mean? You you mean our baby could survive? The neonatologist says no.
But you Do you think he has a chance? It it's possible.
But highly unlikely.
Once again, even if he did survive, he'd be deprived of any real quality of life.
[SOMBER MUSIC.]
It's too much.
It's just - Too much.
- Okay, okay.
- [CRIES.]
- It's okay.
Hey, it's okay.
It's okay.
It's gonna be okay.
Come here.
Hey, what were you thinking in there? That this baby still might have a chance.
Well, Dr.
Grant, who deals with this every day, completely disagrees with your assessment.
Still, there's a slight chance with medical support, that he could pull through.
Natalie, if we were talking about any other terminally ill patient, would you be telling me - to prolong life at any cost? - Of course not.
We should be helping these parents get through this, not making it harder for them.
But how did a cockroach get up my nose? It crawled.
It was attracted to the glucose in your cerebrospinal fluid.
- It's sweet.
- Eww.
Where do you live? Uh, never mind.
I'm gonna go scrub for surgery.
Surgery? Your cerebrospinal fluid is leaking into your nasal cavity because of a small cranial fracture.
Have you had a recent head injury? [BREATHES RAGGEDLY.]
Did somebody hurt you? [MELANCHOLY PIANO MUSIC.]
You can tell us.
Look, I don't want to get involved with the police.
Just tell them, D.
My mom's boyfriend.
He hit me.
That's That's why I won't go back.
Still think Child Services is the right call? Barry Nothing has changed.
Hey, I'm here to drop this off for Deb.
14-year-old I brought in this morning.
Seemed like she could use a warmer coat.
Oh.
Client left this in the ambo a while back.
It's already been dry cleaned, so I'll make sure she gets it.
Thanks.
Dr.
Jaffrey? Still no discomfort? Uh, a little pulling.
Some pressure.
Yeah, I can believe that.
Ah, my ventricles.
Contractions still look strong.
No fatty deposits.
My coronary artery is pristine.
Very healthy heart, Dr.
Jaffrey.
You eat a lot of oatmeal, Dr.
Jaffrey? [LAUGHS.]
Good one.
[CHUCKLES.]
I'm ready for the scalpel.
Uh, what? Why a scalpel? I need to divide the azygos vein.
But shouldn't you do the entire dissection first? Save that till last? I I She's got a good angle on it now.
Yeah, but what happens if something goes wrong? I mean, good Lord, you won't have enough collateral blood flow to bypass the obstruction.
Dr.
Jaffrey, I want to remind you that you're awake to observe this operation, not conduct it.
Oh, sorry.
Force of habit.
Sorry.
Please proceed, Dr.
Bekker.
[HEART MONITOR BEEPS.]
I understand.
Thank you.
I got Deb on a couple of wait lists for group homes, but none of them have a room available.
So where does that leave us? I could speak to Child Services, make sure they know about the abusive boyfriend.
Even if the boyfriend leaves, odds are the mom's going to allow him to come back.
But when Deb gets out of surgery, she'll need a clean place to recover.
She's not gonna get that on the street.
Well, you both make good points, but as the physician on this case, Dr.
Choi, it's your call.
There was a cockroach in her nose.
[DESOLATE MUSIC.]
I'm sorry, April, but we have to call Child Services.
How's he doing? He's holding on.
Is he still alive? Mm-hmm.
Can I see him? Yes.
Please.
My God.
He's so small.
He Would you like to hold him? Natalie Yes.
His skin I can see right through it.
My poor baby.
[MONITORS BEEP RAPIDLY.]
What's happening? He's De-satting.
His lungs can't provide enough oxygen.
I'm sorry it's But it's what we expected.
He's dying? I'm afraid so.
[SOBS.]
You you have to help him.
Are you asking us to resuscitate? - Yes, please.
- Well, hold on.
M-Mrs.
Harris, I want to remind you that you and your husband made a decision already.
- You heard her.
Nurse! - Can you Just save my baby.
I need a .
5 French E tube and a laryngoscope.
Will, see if you can get us umbilical vein access.
Will, I need access! Come on, Ian.
His airway's too small.
God Oh, God [CRIES.]
There.
I'm in.
[MONITOR BEEPS.]
Sats are back up to 91%.
Does that mean he's gonna be okay? For now.
[THUNDER RUMBLING.]
You shouldn't feel bad.
Why not? I am the one who asked for this.
It was stupid.
Not stupid.
Ambitious.
I have no business trying to treat a patient like that.
I can't help him or myself.
You know, the irony is, that guy is so much more scared of you than you are of him.
I doubt that.
What, are you kidding me? Guy like Hector Not gonna let you in.
A shrink? He's utterly terrified of what you might find, you know, what he might have to face, you know, so he does the jailhouse thing.
What do you mean? Convicts survive by demonstrating dominance, by going straight to attack mode.
It's how they do it.
So he manipulated me.
These guys are experts at At spotting vulnerability.
You know? And Mr.
Ramirez exploited yours.
And so he got the response he was hoping for.
I want to go back in.
How are you feeling? Okay, I guess.
Dr.
Abrams said everything went great, and the paramedic who brought you in dropped this off for you.
Great.
Did you call Child Services? I'm sorry, Deb.
There was nothing I could do.
[SOMBER MUSIC.]
Oh, my God.
Is he in pain? He might be experiencing some discomfort from the ventilator and the leads.
But it's all necessary, right? To keep him alive? Yes.
Hope this was the right thing to do.
Honey, look, he's moving.
He's hearing your voice.
He can recognize it, right? From when he was in the womb? It's possible.
Put your hand inside.
Uh Is that okay? Yes, of course.
[BABY WHIMPERS.]
[SIGHS.]
Did you see that? He's touching my finger.
That's amazing.
What does that mean? It's likely just a reflex.
But it does show that your son has some motor function, which is a good thing.
Talk to him.
[LAUGHS.]
Hey, Ian.
It's me.
Daddy.
I'm coming around to the anterior edge, just about ready to take the last section.
Hand me the bipolar.
W surely you don't intend to use a cautery knife.
I thought it would help to It'll help her keep ahead of the bleeding while she cuts.
No, no, no.
You do not touch me with that torture device.
Did I fail to teach you proper surgical technique? [UNEASY PIANO MUSIC.]
You always said it's important to maintain hemostasis.
Yes, after the cutting and the tying of the vessels individually, not charring them with a bloody cautery knife.
There's a lot of cooks in this kitchen.
Yes, well, my well-being's at stake here.
I understand, Dr.
Jaffrey.
I'm fine.
Give me the Metz.
There.
I've got everything.
I'm ready to reconstruct the vena cava.
Give me a 20-millimeter Dacron graft and a 3-0 Prolene stitch.
What? No, no, no, no, no.
3-0 is far too heavy for a graft this size.
I-I thought the 3-0 was appropriate.
No.
All right, that's it.
You're out.
That's enough, Dr.
Jaffrey.
It's my heart, and I'll tell you when it's enough.
Rhodes.
Rhodes! You're in.
Take the instruments.
Now.
Dr.
Latham, I believe that it's time to put our esteemed patient under general anesthesia.
What? No! I think it's in his best interest.
No, wait a minute.
We had an agreement.
- Come on.
- Allen, if you would please.
No.
Allen, the you do not You wouldn't dare! You What No How about that? So quiet you can hear a heart beat.
Now, Dr.
Bekker, I believe you were about to sew in the graft with a 3-0 stitch.
Suture and DeBakey's.
I apologize for ending our session prematurely.
If you don't mind, I would like to continue.
[INMATES LAUGH.]
[CHUCKLES.]
May we proceed? [BARKS.]
[INMATES CHEERING.]
[VOICE RAISED.]
I'm here to help you, Hector, but I can't do that if you keep barking at me.
[GROWLS.]
[ALARM BUZZES.]
Calm down! You hear me? [CHUCKLING.]
Now, how's your new dosage of sertraline working out? Any drowsiness or changes in appetite? [CHUCKLES.]
How about nausea, diarrhea, problems sleeping? Feels I'm gonna puke sometimes.
Okay.
Okay, I can prescribe a medication called Zofran for that.
[GROWLS.]
Well, the surgery went well, but it's going to be a few days - before we can discharge her.
- Okay.
She has concerns about being placed back with her mother, whose boyfriend is abusive.
We need to find alternative housing.
Uh, first thing we'll do is try to create a plan with her immediate family.
Excuse me.
Her immediate family is the problem.
We'll do everything we can to to make the home safe for Amy.
Amy? Deb.
The patient's name's Deb McCormick.
Oh.
Really? Ah.
[LAUGHS.]
Here it is.
Debra McCormick.
Where to? So where is she? Call security.
[SOMBER MUSIC.]
April, did you help her run? No.
April.
Okay, she told me she was going to leave.
I didn't stop her.
I could write you up for this.
You saw.
That case worker is clueless.
He is not equipped to help Deb.
But if you want to write me up, be my guest.
[MONITORS BLARE.]
- Wha - What is that? [MONITORS BLARE.]
What's happening to him? - Help him! - He's bradycardic.
Page Dr.
Grant.
I'm gonna start chest compressions.
Push .
5 of epi, IV.
- Come on, come on.
- Please, I need you to stand back.
Don't hurt him.
[HEART MONITORS BEEPING.]
Blood pressure's falling.
- Epi in? - Yes, Doctor.
Hold compressions.
[HEART MONITOR FLATLINING.]
No pulse.
[SOBS.]
[QUIETLY.]
Natalie I am so sorry.
[DISTANT SIRENS WAILING.]
I shouldn't have pushed them.
Natalie, it was a very tough call.
You didn't think so.
I could've been wrong.
Barry? So, I'm not big into the Memphis dry rub, but if you were to offer me some decent seafood Yeah? What's gotten into you? I don't know.
Maybe I've lost my mind.
We were able to completely remove the tumor and reconstruct the superior vena cava.
Dr.
Jaffrey? You disappoint me.
[MELANCHOLY MUSIC.]
Dr.
Jaffrey, everything went perfectly, all according to Dr.
Bekker's plan.
You were right to put your trust in her.
She is a first-rate surgeon.
Get some rest, Dr.
Jaffrey.
I'll be back to check on you soon.
Connor I have to go put in my surgical notes.
April, that for Deb? You told me a couple of weeks ago about your own sister and her struggles.
If she came in here, needing help, would you hand her over to an agency that you knew would only make things worse? Um You did, um You did very well today.
Really.
Again, I'm very, very sorry.
Thank you.
I don't know what to say.
We got to hold our child.
I only hope that he was able to feel our love.
I'm sure he was.
Thank you.
That had to make you feel a little better.
It did.
But what are you gonna do next time? [PEOPLE CHATTING.]
What's he doing here? Don't worry.
He's here to help.
Where's Deb? This way.
I'm not going with Child Services.
I'm not here to take you away.
I brought you antibiotics.
Twice a day, with a meal.
Will you make sure she takes these? April's going to show your friends how to keep the wound clean.
Thanks.
Let me take a look at that dressing.
We're going to Treatment six.
Joanna Harris, 25-year-old female, 22 weeks pregnant, hemorrhaging vaginally.
What happened? Nothing.
I was working at my computer, and then the next thing I know, I'm bleeding.
Okay, let's get her transferred on my count.
- All right.
- One, two, three.
[GROANS.]
Are you cramping? Yes.
Maggie, CBC, type RH, coags, and get her - on the fetal monitor.
- Got it.
Heart tones look good, healthy placenta, no previa.
Do you want to know the sex of the baby? We already do.
It's a boy.
We're naming him Ian.
All right, I'm going to check your cervix now, okay? Okay.
She's one centimeter dilated, 50% effaced.
Looks like you're going into labor.
What? What? It's too early.
Yes.
Bolus a liter of LR and start her on 30 milligrams of nifedipine PO.
- [GROANS.]
- Got it Just try to breathe, okay? Breathe through it.
Breathe through it.
We're going to give you some medication to stop the contractions.
What if you can't stop labor? Unfortunately, we don't consider a fetus viable until 24 weeks.
And even if he did survive, he would probably have severe deficits.
Brain damage, paralysis Oh, my God! Oh, my God.
Oh, my God [CRYING.]
If the baby does come today, we will need you to decide if you would like us to perform all life-saving measures.
As opposed to what, just letting him die? We would provide comfort measures.
Want to make sure that the baby doesn't have any pain.
[MOURNFUL MUSIC.]
I don't I don't know.
I mean, are we just going to let our baby go? What kind of life would we be giving him? Think about it.
It'd be cruel.
If he's born today, please, just make him comfortable.
Yes.
Don't let my baby suffer.
We won't.
I promise.
[CRYING.]
[ALARM BUZZES.]
[METAL DETECTOR BEEPS.]
- Fred.
- Dr.
Charles.
[METAL DETECTOR BEEPS.]
Hey, doc.
How's it going? What's up, Conway? How's the baby? Still not sleeping through the night.
Have you ever, uh, tried chamomile tabs? You can get them at any health food store.
Hmm.
Thanks for the tip, doc.
Hey, Dr.
Charles.
Dr.
Reese, this is Officer Kowalski.
He will be our escort for the day.
- Hi.
- First time? - Mm-hmm.
- You'll be fine.
Just don't feed the animals.
Uh, sign the visitor waiver, please.
Waiver? Basically says that if we, um, get taken hostage, that the state won't negotiate our release.
Just standard procedure.
Hey, look.
Your determination to explore exposure therapy is nothing less than admirable, but it doesn't mean we have to do it here, so if you're having second thoughts, now would be the time to tell me.
You're absolutely sure you want to do this? Yes.
This is what I want.
[TENSE MUSIC.]
[DOOR BUZZES.]
[PRISONERS YELLING DISTANTLY.]
Ava! - Hello.
- Hello, Dr.
Jaffrey! - How great to see you.
- Your trip was all right? Well, as all right as an 18-hour flight can possibly be.
[LAUGHS.]
You already know Dr.
Latham.
- Course.
- This is Dr.
Rhodes, - another CT Fellow.
- Ah.
Great.
Dr.
Jaffrey's not only one of the world's greatest heart surgeons, but was also my mentor in Cape Town.
Taught me everything I know.
I have read your book, Dr.
Jaffrey.
It's an honor to meet you.
Oh, please.
I'm just another patient today.
There's a tumor on the upper lobe of Dr.
Jaffrey's right lung.
It's invaded his superior vena cava, obstructing blood flow to his head and upper extremities.
We'll need to remove a portion of the lung and resect the tumor.
And I want my star pupil to oversee the procedure.
Thank you for your confidence, Dr.
Jaffrey.
We're getting an OR prepped as we speak.
Ah, just one thing.
Um I don't tolerate anesthesia well.
Well, we can talk to the anesthesiologist about adjusting your cocktail.
Uh, no.
Uh, I think I have a better idea.
Place a high epidural and load me up with bupivacaine.
Hold on.
You would like to be awake for the surgery.
Well, strictly as an observer, of course.
No, it's just that we would be taking an unnecessary risk.
The epidural site could hemorrhage from the blood thinners alone You you could be paralyzed.
Not if we do it off-pump.
Right.
We can construct a temporary graft from the brachiocephalic vein to the right atrium, clamp the superior vena cava, and remove the tumor.
Certainly eliminate the need for a bypass.
- Exactly.
- Absolutely.
We'll do it that is, of course, if it's okay with Dr.
Latham.
- Good.
- I think Dr.
Jaffrey has alleviated my concerns.
I'll make the arrangements.
Thank you.
[DESOLATE MUSIC.]
Hmm.
I'll let Vorspan know about the high epidural.
Did we really just agree to allow a patient to be fully awake while we perform open-heart surgery? Dr.
Jaffrey is well aware of the risks and has given us his consent.
There's no way that we can guarantee we'll neutralize all of his pain, and even if we do, every time his lungs inflate, it'll obstruct our field.
I have faith in our anesthesiologists and Dr.
Bekker.
Awake surgery is extremely risky and should only be performed when medically necessary.
I understand your concern, Dr.
Rhodes, but I trust Dr.
Jaffrey's judgment and respect his desire to observe.
If I were in his situation, I certainly would.
Seeing my own beating heart.
[CHUCKLES.]
[SOMBER MUSIC.]
Debra McCormick, 14-year-old female, GCS 13.
Possible overdose.
Dr.
Choi, April, you're going to treatment four.
We got it.
Found her on Lower Wacker, passed out and freezing.
Probably homeless.
I'm not homeless, damn it! I live with my friends.
Okay, can you tell us what happened? Nothing.
I tripped and fell.
I'll be fine.
Let's transfer on my count.
Ready? One, two, three.
Let's get her started on IV fluids and order a tox screen, CBC, CMP, and a white count with differential.
Yes, Doctor.
Do you have a family member we can contact? No.
You sure? Call Child Services.
No, please don't do that.
They never help.
They just keep sending me back to my mom and her drunk boyfriend, and he hates me.
[BREATHING HEAVILY.]
For now, you just rest and get warm, okay? We'll run some tests and be back to check on you soon.
What do we do? She's a minor.
We have to call Child Services.
Not if they're just gonna put her back in an unsafe environment.
We don't even know she's telling us the truth.
Ethan, I've seen this too many times.
Child Services sends a girl home, she winds up right back here, beaten, raped.
There's a little dive on Roosevelt that's got the best dry rub north of Memphis.
Let me take you to dinner tonight.
I thought we discussed this.
We did, and I decided to back off, but then I changed my mind.
- Barry - Come on, just think about it.
Unless you're gonna help me with these charts, I've got work to do.
I'll take that as a "maybe.
" What good is calling Child Services? She's already been through the system.
She still ended up in the street.
So what's the answer? Just let her be homeless? - 14-year-old girl.
- Hm.
Looks like this young lady's in a tough spot.
Most potential foster parents are only interested in babies or young children.
It's nearly impossible to place a teen.
Does she have any extended family? Not that she's told us about.
Well, April's right.
In all likelihood, Child Services will just send her back to the abusive home she fled.
But they'll follow up, make sure she's safe.
In a perfect world, yes.
In reality, they don't have the resources.
Let me call some contacts in social services, see if there isn't a group home with a vacancy.
- Thank you, Ms.
Goodwin.
- Mm-hm.
Thank you.
[SCREAMS.]
Dr.
Manning, she's having contractions.
We need help here.
[YELLS.]
[DESOLATE MUSIC.]
What's happening? What's wrong? She's fully dilated.
No, you have to stop the labor! I'm sorry, but the nifedipine is not working.
Okay? There's nothing else we can do.
Need to move her to labor and delivery.
No time.
Maggie, get a preset pack, a warmer, and page OB and tell them this baby is coming now.
Got it.
Jackie, come with me.
I'm gonna need you to push for me, okay? All right, you ready? Push.
[GROANS.]
Good.
All right, can you push again? One more.
And push.
[GROANS.]
Doing great.
You're doing great.
All right.
Just one more big one.
Can you do that? Just one more big one.
Ready? Push.
Go, push.
Push.
[SOMBER MUSIC.]
[CRYING.]
The embryonic sac is still intact.
- [CRYING.]
- All right.
Stay with me.
Stay with me.
[SOBS.]
Wait.
Where are you taking him? Hey, hey, hey.
It's gonna be okay.
Relax.
It's okay.
[CRYING.]
Will.
He's alive.
And he's active.
Responsive.
Let's get this baby up to the NICU.
Who's first on your list? Hector Ramirez.
You're gonna have to wait.
Ramirez is a level three.
We gotta clear the floor and bring in additional officers to escort him out.
All right, gentlemen.
Let's take it to your cells.
[PRISONERS GRUMBLING.]
Any particular reason you tried to sabotage this? How about we're taking an unnecessary risk all so you can rack up a splashy surgery? Oh, so it's about the credit.
Jealous, maybe? No.
No, I am just worried about Dr.
Jaffrey dying on the table.
He knows what he's doing.
Plus, this "splashy surgery," as you call it, will be good for the hospital and the CT program.
How very selfless of you.
Dr.
Bekker, we're ready.
Coming, Dr.
Rhodes? That's my cousin, Kiki.
Hey.
Hey.
Your labs came back negative.
No sign of infection or any immune deficiencies.
Great.
Kiki's come to take me home.
N we can only release you with the permission of a parent or legal guardian.
Forget it.
I'm still going.
Kiki, would Deb! What what's happening to her? - She's seizing.
- Step back, step back.
- Deb! - Two milligrams Ativan.
[DRAMATIC MUSIC.]
Call radiology.
We need to get her upstairs for a head CT, now.
Ativan in.
You're okay, Deb.
You're okay.
[SOMBER MUSIC.]
- Ready? - Yep.
[HEART MONITOR BEEPING.]
[BABY CRIES WEAKLY.]
Parents were clear about their wishes? Yes.
They have decided not to perform any resuscitative measures.
Mm.
Is there any chance this baby could be viable? Unfortunately not.
His heartbeat's weak and his weight is under 500 grams.
Yeah, but at 490 grams, he's not that far off.
Natalie No, his coloring and muscle tone are good, and he's making a decent respiratory effort.
Doesn't that say something? Not enough.
This baby's not going to survive.
The best we can do is make him comfortable.
[SIGHS.]
[MACHINE WHIRRING.]
Eh, she's got a mass in her sinus, possibly a tumor.
We need a biopsy.
Yeah, but look at the cross-sections.
I don't understand.
Neither do we.
It's moving.
You feeling any pain, Deb? No, it just feels weird.
Stop moving.
What was that? I have a pretty good idea.
Forceps and speculum.
W-what's happening? Just stay still.
A cockroach.
What? Oh I want to take another look at that CT.
So, Hector Ramirez, you know, anxiety, depression, history of intermittent explosive disorder.
All clear, doc.
May I? - Dr.
Reese, I really think - Dr.
Charles.
Hello, Mr.
Ramirez.
I am Dr.
Reese.
I, um [CLEARS THROAT.]
Dosage.
Right, um, how have you been feeling since Dr.
Charles altered your dosage? [BARKING.]
[PRISONERS CLAMORING.]
Knock it off, Ramirez.
[BARKS.]
[LAUGHS.]
We gotta take a little break.
Let's get Ramirez back to his cell.
[LAUGHS.]
Look at me, look at me.
Take a deep breath.
Take a deep breath.
It'll pass, okay? It'll pass.
[PRISONERS LAUGHING AND YELLING.]
[LAUGHS.]
Okay, we need to take a little break.
Get Ramirez back in his cell.
Okay, please escort Dr.
Reese back outside.
It's okay.
I'll be there in a bit.
It's all right.
[LAUGHS.]
Whoo! Whoo! [HOWLS.]
Your vitals look good, but we would like to keep you a few more hours just for observation.
What about my baby? Did he Your baby was born just over one pound, below the threshold of what experts consider viable.
And you know that for sure? Defining viability is not an exact science.
Unfortunately, there's no way of knowing anything with certainty.
What do you mean? You you mean our baby could survive? The neonatologist says no.
But you Do you think he has a chance? It it's possible.
But highly unlikely.
Once again, even if he did survive, he'd be deprived of any real quality of life.
[SOMBER MUSIC.]
It's too much.
It's just - Too much.
- Okay, okay.
- [CRIES.]
- It's okay.
Hey, it's okay.
It's okay.
It's gonna be okay.
Come here.
Hey, what were you thinking in there? That this baby still might have a chance.
Well, Dr.
Grant, who deals with this every day, completely disagrees with your assessment.
Still, there's a slight chance with medical support, that he could pull through.
Natalie, if we were talking about any other terminally ill patient, would you be telling me - to prolong life at any cost? - Of course not.
We should be helping these parents get through this, not making it harder for them.
But how did a cockroach get up my nose? It crawled.
It was attracted to the glucose in your cerebrospinal fluid.
- It's sweet.
- Eww.
Where do you live? Uh, never mind.
I'm gonna go scrub for surgery.
Surgery? Your cerebrospinal fluid is leaking into your nasal cavity because of a small cranial fracture.
Have you had a recent head injury? [BREATHES RAGGEDLY.]
Did somebody hurt you? [MELANCHOLY PIANO MUSIC.]
You can tell us.
Look, I don't want to get involved with the police.
Just tell them, D.
My mom's boyfriend.
He hit me.
That's That's why I won't go back.
Still think Child Services is the right call? Barry Nothing has changed.
Hey, I'm here to drop this off for Deb.
14-year-old I brought in this morning.
Seemed like she could use a warmer coat.
Oh.
Client left this in the ambo a while back.
It's already been dry cleaned, so I'll make sure she gets it.
Thanks.
Dr.
Jaffrey? Still no discomfort? Uh, a little pulling.
Some pressure.
Yeah, I can believe that.
Ah, my ventricles.
Contractions still look strong.
No fatty deposits.
My coronary artery is pristine.
Very healthy heart, Dr.
Jaffrey.
You eat a lot of oatmeal, Dr.
Jaffrey? [LAUGHS.]
Good one.
[CHUCKLES.]
I'm ready for the scalpel.
Uh, what? Why a scalpel? I need to divide the azygos vein.
But shouldn't you do the entire dissection first? Save that till last? I I She's got a good angle on it now.
Yeah, but what happens if something goes wrong? I mean, good Lord, you won't have enough collateral blood flow to bypass the obstruction.
Dr.
Jaffrey, I want to remind you that you're awake to observe this operation, not conduct it.
Oh, sorry.
Force of habit.
Sorry.
Please proceed, Dr.
Bekker.
[HEART MONITOR BEEPS.]
I understand.
Thank you.
I got Deb on a couple of wait lists for group homes, but none of them have a room available.
So where does that leave us? I could speak to Child Services, make sure they know about the abusive boyfriend.
Even if the boyfriend leaves, odds are the mom's going to allow him to come back.
But when Deb gets out of surgery, she'll need a clean place to recover.
She's not gonna get that on the street.
Well, you both make good points, but as the physician on this case, Dr.
Choi, it's your call.
There was a cockroach in her nose.
[DESOLATE MUSIC.]
I'm sorry, April, but we have to call Child Services.
How's he doing? He's holding on.
Is he still alive? Mm-hmm.
Can I see him? Yes.
Please.
My God.
He's so small.
He Would you like to hold him? Natalie Yes.
His skin I can see right through it.
My poor baby.
[MONITORS BEEP RAPIDLY.]
What's happening? He's De-satting.
His lungs can't provide enough oxygen.
I'm sorry it's But it's what we expected.
He's dying? I'm afraid so.
[SOBS.]
You you have to help him.
Are you asking us to resuscitate? - Yes, please.
- Well, hold on.
M-Mrs.
Harris, I want to remind you that you and your husband made a decision already.
- You heard her.
Nurse! - Can you Just save my baby.
I need a .
5 French E tube and a laryngoscope.
Will, see if you can get us umbilical vein access.
Will, I need access! Come on, Ian.
His airway's too small.
God Oh, God [CRIES.]
There.
I'm in.
[MONITOR BEEPS.]
Sats are back up to 91%.
Does that mean he's gonna be okay? For now.
[THUNDER RUMBLING.]
You shouldn't feel bad.
Why not? I am the one who asked for this.
It was stupid.
Not stupid.
Ambitious.
I have no business trying to treat a patient like that.
I can't help him or myself.
You know, the irony is, that guy is so much more scared of you than you are of him.
I doubt that.
What, are you kidding me? Guy like Hector Not gonna let you in.
A shrink? He's utterly terrified of what you might find, you know, what he might have to face, you know, so he does the jailhouse thing.
What do you mean? Convicts survive by demonstrating dominance, by going straight to attack mode.
It's how they do it.
So he manipulated me.
These guys are experts at At spotting vulnerability.
You know? And Mr.
Ramirez exploited yours.
And so he got the response he was hoping for.
I want to go back in.
How are you feeling? Okay, I guess.
Dr.
Abrams said everything went great, and the paramedic who brought you in dropped this off for you.
Great.
Did you call Child Services? I'm sorry, Deb.
There was nothing I could do.
[SOMBER MUSIC.]
Oh, my God.
Is he in pain? He might be experiencing some discomfort from the ventilator and the leads.
But it's all necessary, right? To keep him alive? Yes.
Hope this was the right thing to do.
Honey, look, he's moving.
He's hearing your voice.
He can recognize it, right? From when he was in the womb? It's possible.
Put your hand inside.
Uh Is that okay? Yes, of course.
[BABY WHIMPERS.]
[SIGHS.]
Did you see that? He's touching my finger.
That's amazing.
What does that mean? It's likely just a reflex.
But it does show that your son has some motor function, which is a good thing.
Talk to him.
[LAUGHS.]
Hey, Ian.
It's me.
Daddy.
I'm coming around to the anterior edge, just about ready to take the last section.
Hand me the bipolar.
W surely you don't intend to use a cautery knife.
I thought it would help to It'll help her keep ahead of the bleeding while she cuts.
No, no, no.
You do not touch me with that torture device.
Did I fail to teach you proper surgical technique? [UNEASY PIANO MUSIC.]
You always said it's important to maintain hemostasis.
Yes, after the cutting and the tying of the vessels individually, not charring them with a bloody cautery knife.
There's a lot of cooks in this kitchen.
Yes, well, my well-being's at stake here.
I understand, Dr.
Jaffrey.
I'm fine.
Give me the Metz.
There.
I've got everything.
I'm ready to reconstruct the vena cava.
Give me a 20-millimeter Dacron graft and a 3-0 Prolene stitch.
What? No, no, no, no, no.
3-0 is far too heavy for a graft this size.
I-I thought the 3-0 was appropriate.
No.
All right, that's it.
You're out.
That's enough, Dr.
Jaffrey.
It's my heart, and I'll tell you when it's enough.
Rhodes.
Rhodes! You're in.
Take the instruments.
Now.
Dr.
Latham, I believe that it's time to put our esteemed patient under general anesthesia.
What? No! I think it's in his best interest.
No, wait a minute.
We had an agreement.
- Come on.
- Allen, if you would please.
No.
Allen, the you do not You wouldn't dare! You What No How about that? So quiet you can hear a heart beat.
Now, Dr.
Bekker, I believe you were about to sew in the graft with a 3-0 stitch.
Suture and DeBakey's.
I apologize for ending our session prematurely.
If you don't mind, I would like to continue.
[INMATES LAUGH.]
[CHUCKLES.]
May we proceed? [BARKS.]
[INMATES CHEERING.]
[VOICE RAISED.]
I'm here to help you, Hector, but I can't do that if you keep barking at me.
[GROWLS.]
[ALARM BUZZES.]
Calm down! You hear me? [CHUCKLING.]
Now, how's your new dosage of sertraline working out? Any drowsiness or changes in appetite? [CHUCKLES.]
How about nausea, diarrhea, problems sleeping? Feels I'm gonna puke sometimes.
Okay.
Okay, I can prescribe a medication called Zofran for that.
[GROWLS.]
Well, the surgery went well, but it's going to be a few days - before we can discharge her.
- Okay.
She has concerns about being placed back with her mother, whose boyfriend is abusive.
We need to find alternative housing.
Uh, first thing we'll do is try to create a plan with her immediate family.
Excuse me.
Her immediate family is the problem.
We'll do everything we can to to make the home safe for Amy.
Amy? Deb.
The patient's name's Deb McCormick.
Oh.
Really? Ah.
[LAUGHS.]
Here it is.
Debra McCormick.
Where to? So where is she? Call security.
[SOMBER MUSIC.]
April, did you help her run? No.
April.
Okay, she told me she was going to leave.
I didn't stop her.
I could write you up for this.
You saw.
That case worker is clueless.
He is not equipped to help Deb.
But if you want to write me up, be my guest.
[MONITORS BLARE.]
- Wha - What is that? [MONITORS BLARE.]
What's happening to him? - Help him! - He's bradycardic.
Page Dr.
Grant.
I'm gonna start chest compressions.
Push .
5 of epi, IV.
- Come on, come on.
- Please, I need you to stand back.
Don't hurt him.
[HEART MONITORS BEEPING.]
Blood pressure's falling.
- Epi in? - Yes, Doctor.
Hold compressions.
[HEART MONITOR FLATLINING.]
No pulse.
[SOBS.]
[QUIETLY.]
Natalie I am so sorry.
[DISTANT SIRENS WAILING.]
I shouldn't have pushed them.
Natalie, it was a very tough call.
You didn't think so.
I could've been wrong.
Barry? So, I'm not big into the Memphis dry rub, but if you were to offer me some decent seafood Yeah? What's gotten into you? I don't know.
Maybe I've lost my mind.
We were able to completely remove the tumor and reconstruct the superior vena cava.
Dr.
Jaffrey? You disappoint me.
[MELANCHOLY MUSIC.]
Dr.
Jaffrey, everything went perfectly, all according to Dr.
Bekker's plan.
You were right to put your trust in her.
She is a first-rate surgeon.
Get some rest, Dr.
Jaffrey.
I'll be back to check on you soon.
Connor I have to go put in my surgical notes.
April, that for Deb? You told me a couple of weeks ago about your own sister and her struggles.
If she came in here, needing help, would you hand her over to an agency that you knew would only make things worse? Um You did, um You did very well today.
Really.
Again, I'm very, very sorry.
Thank you.
I don't know what to say.
We got to hold our child.
I only hope that he was able to feel our love.
I'm sure he was.
Thank you.
That had to make you feel a little better.
It did.
But what are you gonna do next time? [PEOPLE CHATTING.]
What's he doing here? Don't worry.
He's here to help.
Where's Deb? This way.
I'm not going with Child Services.
I'm not here to take you away.
I brought you antibiotics.
Twice a day, with a meal.
Will you make sure she takes these? April's going to show your friends how to keep the wound clean.
Thanks.
Let me take a look at that dressing.