Chicago Med (2015) s03e17 Episode Script
The Parent Trap
1 She still isn't answering.
She's probably not allowed to have her phone at the poker table.
She shouldn't be at the poker table at 7:00 a.
m.
She should be back with my car, so I can get to work.
Babe, it's your day off.
From the hospital.
Emily knows I check on the kids at the homeless encampment.
They count on me.
They'll understand if you're a few minutes late.
If Emily's gonna live here, she needs to get her act together, make a plan.
This isn't some vacation.
Come on, I'll give you a ride.
I've come to recognize your expressions pretty well.
This one's my least favorite.
I wish I had better news.
But look even though your cardiac output is decreasing, you are still highest status on the transplant list.
You're first in line.
I appreciate your optimism, Dr.
Rhodes, as always.
- Hang in there, Bob.
- Uh-huh.
You know, for my part, I'm just not seeing any organic causes.
Excuse me, I Sorry to interrupt.
Um Sarah, I've just been up to see your father.
His stroke volume, systolic arterial pressure, and pulse pressure have all decreased since yesterday.
I I I just can't keep the fluid off of his lungs.
I see.
I promise you, we're doing everything we can to find him a new heart, but if you wanna say good-bye, I would consider doing it today.
I'm very sorry.
Okay.
- How long have you had a fever? A few days now.
And are you always this short of breath? Lately, yeah.
Athena, stop! Hey, Dr.
Choi.
Hey, Deb.
Can I take a look at your legs? Yeah, sure.
How long have you been getting these spots? - Why? Are they bad? - I'm not sure but I'd like to prick your finger to check your blood.
Okay, yeah.
All right.
Ethan, I know, I'm sorry, I promised I'd be home, but I had half the table on tilt, and I just lost track of time.
Whatever.
Take the car.
I'll get a cab.
I'm not gonna just leave you here.
What can I do to help? I don't want your help.
Ethan, you don't have to be like that.
He doesn't have to be like that.
Hi.
Emily.
- Josh.
- Nice to meet you.
- Uh, cute dog.
- Thank you.
- What kinda tent do you use? - Uh, it's an old Coleman.
- Has a rain fly.
- Nice.
Hold on.
Josh I'm seeing some cells in your blood called lymphoblasts.
That plus your other symptoms make me concerned enough that I'd like to bring you into the hospital.
Why? What do you think it is? It could be all sorts of things but what I'm worried about is leukemia.
- Isn't that a kind of cancer? - It is.
Josh, this is important.
Look, I mean, Athena needs me out here.
And if I go back with you, you're gonna have to call my parents, the people that adopted me, and I don't think I want that.
- Did they mistreat you? - No, no, no, they're okay.
It's just, uh things didn't really work out with them, you know? You don't have to call his parents, right? Em Is that true? You're only 16.
Legally, they need to be notified.
I mean, if his life is on the line, you could make an exception.
I mean, if you could do that, I'm sure I could get Deb to watch Athena, if it's just for the afternoon.
We could run some tests first, make sure we know what's going on.
Hey, Deb, could I ask you a favor? You shouldn't have done that.
Eventually I'm gonna have to call his parents.
What are you busting on me for? Got him to come in, didn't I? Wow.
One of our patients is well loved.
Actually, they came for me.
- Really? - Mm.
The enchanting Dr.
Bekker.
What? Uh, seems they're from your father.
- My father? - Yeah.
Uh, you've been seeing him? Is, uh is that a problem? No, no, it's not a problem.
Just uh, he's just You know what, forget it.
Enjoy the flowers.
Are you two still at it? At what? I've barely seen you speak two words to each other in a week.
Whatever this is, you need to work it out.
- Everything's fine.
- Oh, everything's fine? - Mm-hmm.
- Good.
Dr.
Manning, Dr.
Halstead, you're up, Treatment Four.
- Hey.
- Hey.
Kevin Parks: He's ten years old.
He woke up with 8 out of 10 abdominal pain and a fever of 103.
We gave him Tylenol and a cool bath, - but nothing's worked.
- Okay.
All right, Kevin, let's get you up on the bed.
Ow, ow.
That hurts.
- That hurts? All right.
- All right, you got it.
- We're gonna figure out why.
- There you go.
Hi, Kevin, I'm Dr.
Manning.
This is Dr.
Halstead.
Can you show us where it hurts? - Right here? - Right there? Okay.
Has anything like this ever happened before? No, never.
Abdomen is tender but not rigid, with no rebound.
Bowel sounds are decreased.
I don't like it.
It could still be his appendix, Crohn's disease, ulcerative colitis.
Temp's up to 104.
Give Ibuprofen to start cooling measures.
Is there any other medical history we should be aware of? Yes, he's been diagnosed with PANDAS.
PANDAS? Uh, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection.
Kevin started getting tics and OCD after a strep infection two years ago.
Nobody else could figure out what it was, until finally Dr.
Kravitz diagnosed him.
Okay, we'll be sure to give him a call.
I've heard of Dr.
Kravitz.
He sees a lot of kids with PANDAS, right? He's one of the nation's top experts.
I'm guessing Dr.
Kravitz put Kevin on long-term prophylactic antibiotics to fight the residual strep? Yes, he did.
CBC, chem panel, blood cultures, abdominal CT, and hang a gram of vanco STAT.
We're gonna start him on some medications while we run some tests to try to figure out what's going on, okay? We'll be back to check on him shortly.
Thank you.
Hey, you've heard of this Dr.
Kravitz.
He labels every kid's neurological condition as PANDAS.
It's not even an officially recognized diagnosis.
Either way, right now, that child is in real pain with a real fever.
Right, because he's been on three different antibiotics for over 12 months, which we both know has wiped out all the healthy flora in his gut, causing a massive superinfection.
I mean, all because his parents shopped around for a doctor willing to blame Kevin's neurologic tics on strep, instead of admitting they most likely passed it on to him genetically.
Okay, but dismissing them isn't gonna help.
They are upset and worried.
And what they're doing to try and fix him might wind up killing him.
Dr.
Sexton, Treatment Six is open.
You're up.
We got Frank Larson: 74.
He was found unconscious in an abandoned warehouse.
Bradycardic at 45, BP's 90 over 60, respiration's 10, and satting at 91%.
Mr.
Larson, do you know where you are? Let's move him on one, two, three.
Dad? Dad, what happened? Is he is he all right? That's what we're trying to figure out.
Frank, can you hear me? Can you hear me Frank? He he he goes around feeding the stray cats, but he has dementia and he gets lost.
Does he have any other medical conditions? No.
You're the one examining him.
- What do you think it could be? - It's hard to say right now.
We need to let the doctor run some tests.
It looks like he doesn't have any injuries, but yes, I would like to run some more tests - to figure out what's going on.
- Okay.
- Okay? - Okay.
Dad, I'll be right here, okay? I'm right here.
I'm not going anywhere.
- Sorry.
Big sister moment.
- Yep.
Anyway, let's get an EKG, CBC, chem panels, troponins, tox screens, and a head CT.
We'll figure this out.
Dr.
Reese, I was just, um I was just heading up to To check on your dad.
Okay.
Listen, I, um I know you've had a very complicated relationship, and this is really none of my business, but I think that if he should die before you have a chance to speak to him, that that could very possibly be something you would come to regret.
My father Has clearly stated that he doesn't want me to be a part of his life, so, uh, whatever regrets I may have I just don't think any of them will be resolved by me talking to him.
Okay.
You, uh you accepting visitors? It depends.
Is it professional or is it personal? Uh personal? Then by all means.
I, um I heard about your situation.
Mm.
Really so sorry that it's come to this.
Yeah, what can I say? It's been kind of a chess game between the two of us, hasn't it? I regret that you see it that way.
Uh uh, I would hope that you would Ha.
It's ironic.
You made me cut Sarah out of my life to get a heart, and I end up with neither.
Robert, it was never my intention to have you cut Sarah out of your life.
Semantics.
Uh, in any case you play a good game.
Dr.
Bekker - You're looking lovely.
- Thank you.
And thank you for the flowers.
That was quite unnecessary.
Did you like them? They're beautiful.
Though, I must admit, the money would've been better spent as part of your donation to the department.
Speaking of which, I glanced at that information you gave me concerning Da Vinci robotic surgical system? Yes, that's, uh It was very impressive, but a little technical for a layman like myself.
Perhaps you could explain the details to me? - Of course.
- How 'bout tonight? Over dinner? Mr.
Rhodes the flowers? Dinner? Is it me or are you trying to make your son crazy? Dr.
Bekker you are an intelligent attractive, dynamic woman, and if this makes Connor crazy, then so be it.
Look, I and the entire cardiothoracic department truly appreciate your patronage, but you and I are going to keep our relationship on a professional level.
Oh all right.
I'll have the head of philanthropy services give you a call this afternoon.
Thank you.
- Dr.
Rhodes, Trauma Three.
- Yep.
All right, Brett, what do we got? David Gray: 50-year-old bystander in an attempted robbery.
He got shot in the head.
GCS, 6.
He's only responding to painful stimuli.
We couldn't intubate in the field.
All right, give me an intubation kit.
- 150 of mannitol, 500 of keppra.
- Got it.
All right, on my count, one, two, three.
Entry wound, left parietal skull, no exit.
Get a neurosurg down here ASAP.
- And get me a Cordis kit.
- Yep.
There we go.
No reactions to light.
All right, I'm in.
No corneal reflex either.
We're losing him.
Cordis kit.
Brainstem reflexes are completely absent, and his pupils are fixed and blown.
He was responding to pain in the ambo.
Dr.
Rhodes, he's GCS 3.
Dr.
Rhodes, he's braindead.
Is he a donor? Yeah.
Okay let's get an angio to confirm brain death, then get a cardiac echo.
I've got a patient who needs a heart.
You're wasting your time on this one, Dr.
Rhodes.
I heard significant mitral regurg on auscultation.
There's no way that heart is viable.
Maybe not now, but that doesn't mean I can't fix it.
Let's get him up to Radiology now.
- A drug overdose? - Opioids.
Your father's tox screen showed extremely high levels.
Bolus him with 2 of narcan, then start a drip.
It can't be.
My dad doesn't do drugs.
I mean, he he never has.
He he doesn't even drink.
- What about pain medication? - He doesn't take anything.
You need to run some more tests.
Ma'am, Dr.
Sexton has run all the appropriate Is there anything around the house? Um, Vicodin? Tylenol with codeine? No, I I cleaned all the medicine cabinets out.
We don't have anything.
Hmm, then he may have gotten it outside the house.
What? You think I'm letting him shoot up or something? - No, I'm just saying - Look, your test is wrong.
You need to redo it.
These tests, they are usually pretty accurate And I know my father.
Look, if you need to consult with another doctor, - then maybe - No.
I'll redo the test.
But in the meantime, I'm gonna give him some medicine to reverse the opioids, just so we can try and wake him up.
- Okay.
- Thanks.
Administer the narcan.
Hi.
So, Kevin's scans indicate toxic megacolon.
It's a dangerous intestinal infection caused by an overgrowth of opportunistic bacteria.
Which is most likely due to his long-term antibiotic use.
So the new medicine you're giving him should fix it? It's not that simple.
Kevin's bowel is so inflamed, it's become dangerously dilated.
And if it perforates, it's a life threatening situation, which is why we need to release the pressure from his colon to try and prevent that.
We appreciate your help, but we've spoken with Dr.
Kravitz, and he wants Kevin transferred over there.
Dr.
Kravitz says if we treat him incorrectly, it's only going to make Kevin's neurologic symptoms worse.
He wants to give him an infusion of IVlg to prevent that.
Kevin's tics are the least of his problems right now.
We need to focus on treating his infection.
We want that too, but Kevin's tics are a big problem.
They're odd, and the kids at school are starting to stare at him.
We just don't wanna do anything - to compromise his future.
- I understand, but We'll do the IVig here.
Natalie That would work.
Great, we'll get started right away.
- Thank you so much.
- Yeah.
Why are you indulging them like this? Indulging them? You know full well the IVlg will have exactly zero therapeutic benefit.
It's keeping Kevin in the hospital.
Why are you being so negative? I'm just being realistic.
The more you humor then, the less likely they'll ever be to seek out an actual effective therapy for what is most likely a genetic neurologic condition.
So what do you want me to do, Will? Have them sign out and leave? - Nah, you should just give them a placebo: IVlg.
If that's what's gonna allow us to do our job, then that's exactly what I'm gonna do.
Just a little bit longer.
I need to get back to Athena.
I'm still waiting on a few more tests, so please, don't go anywhere yet.
Dr.
Charles I've got a runaway kid with confirmed leukemia, but I can't get him to give me his parents' contact information, and Oncology won't begin treatment till they're sure he's not gonna be living in a tent on the streets during his recovery.
Figure his parents might have abused him? Apparently not.
He's adopted, but he says they're nice people.
It just wasn't a good fit.
And you're sure he understands the danger here? Cancer? Life or death? Says he does, but I don't know.
- Let me have a chat with him.
- Thanks.
There's too much retrograde flow.
The leaflet's totally eaten away.
Shame to have an otherwise perfectly good heart go to waste.
It's not gonna go to waste.
Excuse me? This heart is an HLA match for my patient.
I'm gonna do a valve repair.
You're joking.
Get him prepped for surgery, thanks.
You're going to do major surgery on this heart, which by itself contains significant morbidity and mortality, and then turn around and transplant it into someone else? Uh-huh.
You'll kill the recipient on the table.
So don't scrub in.
I'm sure with your active social life, there are things you'd rather be doing anyways.
Now, if you will excuse me, I am going to prep for my valve repair.
Ms.
Larson the retests once again show high levels of opioids.
I'm sorry.
Well, then why isn't he waking up? Should we be doing something else? Well, with overdoses that large, it can sometimes Dr.
Sexton Okay, um, we need to step out.
Let's clear the room.
- Wha what's going on? - Step out.
That white powder on his jacket, I'm guessing that's fentanyl.
- What's that? - A synthetic opiate.
Now, he could have either inhaled it or even just touched it, but it's 100 times stronger than heroin.
That could explain why the narcan's moving so slow.
But how did he get it? They smuggle it in from China and cut it in abandoned buildings.
All your dad had to do was brush up against some while he was feeding stray cats.
We're notifying CPD, CFD, anyone who might've come in contact, Now, um, you have to test it, but I think we have fentanyl.
Okay, I'll set up the decon protocol out in the ambulance bay, and I'll call Goodwin.
- Doris, door.
- Okay, got it.
We will get you back in the room, but please come.
You gotta strip.
I feel fine.
Come on, Maggie.
You come on.
Even absorbed through the skin, fentanyl can cause mental status changes and respiratory distress.
- Strip.
- She's right, Cesar.
Go get some clean clothes.
I don't like this at all, Maggie.
We got too many sick people in here to take any chances.
We need to scrub down the back half of the ED, and put us on bypass until we get the go-ahead from the decontamination team.
- Yes, ma'am.
- All right.
All finished.
You okay, Kevin? Can I have a word? Kevin's latest scans show increasing edema across the wall of his bowel, indicating lack of blood flow.
At this point, we need to consider surgical resection.
Surgery? Shouldn't we finish the IVig first to see if it helps? He can keep getting it, but we really need to move him upstairs.
We need to call Dr.
Kravitz.
Mr.
and Mrs.
Parks, your son is running out of time.
My wife works tirelessly to try to fix our son's problems, and if she has any hesitation at all, then we need to listen to her.
How 'bout I call Dr.
Kravitz and explain the situation to him, okay? - Could you do that? - Of course.
- Is there a bathroom nearby? - Right down the hall.
So, you're just gonna keep encouraging them to follow this quack? Now is not the time to start an argument with them.
You know, it must be nice always being right.
Sorry? From the moment we started this case, everything's been your way.
"We can't do this, we have to do that.
" What are you talking about? I'm talking about everything always being done your way: how we treat patients, what we can or can't tell them What? Whether you and I are together or split up or on a break.
Is that what this is about? You and me? Because it definitely wasn't my idea to go hook up with some woman in a bar.
I told you, it went nowhere.
Oh, and that's supposed to make me feel better? I made a mistake.
I'm not perfect.
But at least I admit it.
I don't think I'm perfect.
Okay, all I can say, Natalie, is that it's very hard for us mere mortals to measure up to you.
Thanks, Officer Burgess, I appreciate your help.
What are you still doing here? I wanted to see how Josh is doing.
He's not letting us treat him.
Luckily, PD's got a lead on his parents.
Wait, you said you weren't going to call his parents.
I said I'd end up calling them eventually.
Yeah, but you don't have to.
I mean, there are other ways to do this.
This is what Josh needs to stay alive.
You don't know what Josh needs.
And you do? Look, you're not adopted.
You don't know what it's like.
Josh needs a bone marrow transplant, and he won't get it if he's living on the streets.
So you're just gonna do whatever you want? Yeah, because you always know better than everyone.
No, I don't, but I do know that when his immune system is obliterated by chemo, he's gonna need to recover in a stable, clean environment, and if you're too irresponsible to understand that, then stay out of my way.
Mrs.
Parks? I'm sorry, I was just finishing up.
Are you all right? I'm just stressed.
- Does that help? - What? The handwashing.
It used to in high school, but I stopped for a long time, till Kevin got sick.
Having a child with uncontrollable tics must be so stressful.
That's why we've seen so many doctors.
My husband likes answers.
Does he know about this? He's already got enough that he didn't sign up for.
What would be the point? It might help you and Kevin.
I don't see how.
Kathy, you have OCD, like Kevin, and it's not caused by any bacterial infection.
It's genetic, something a child inherits from the parents.
I appreciate your concern, but please, just take care of Kevin's intestines.
I'll worry about the rest.
Excuse me, are you all right? Um, sorry, I'm I'm fine.
I'm Dr.
Reese from Psychiatry.
Can I help? Uh my dad ran into some trouble today.
He has dementia.
Oh, I'm sorry.
I know that's really hard.
It's completely normal to feel overwhelmed.
It's like he's a different person.
And sometimes, I wonder if maybe If maybe it would be better if he Does that make me a horrible person? No.
No, it doesn't make you horrible.
Almost anyone in your position would have these thoughts.
Talked to your patient.
Nice kid.
Is he still insisting on going back to the homeless encampment? He feels pretty strongly about it.
Is he suicidal? Nope, he definitely seems to wanna live.
Then he shouldn't object so much to me calling his parents.
I need to spend a little more time with him, but off the top of my head, I'd say that Josh is dealing with a classic case of attachment disorder.
Does that explain why he'd rather risk his life than live with his parents for a couple of months? I know it seems bizarre, but those two years that he was at the orphanage, it's that critical period when babies need parental affection the most.
And if they're in a facility where they don't get it, their brains actually become wired differently, leaving them poorly adapted to cope with the complexities of giving and receiving love, I mean, sometimes for the rest of their lives.
I hear what you're saying, Dr.
Charles But Josh has his whole life to live as far from his parents as he wants, if we treat his cancer.
- Scissors to Dr.
Bekker.
- Scissors.
So, what's the story with you and my friend with the flowers? I'm definitely picking up on some rancor.
How do I put this? Uh my father and I have always had an - unhealthy competition.
- Competition? You're a cardiothoracic surgeon.
What is there to compete over? Well next time you two get together, you can ask him about it.
Snip.
Let's take him off pump.
Paddles.
And clear.
No retrograde flow.
Congratulations, we have a working valve.
I'm gonna go let my patient know that he's about to get a new heart.
Okay, I'll let her know.
- Sharon? - Yeah? That was Peter Kalmick.
Apparently the board is refusing to let us go on bypass.
They're overriding my decision? They didn't find sufficient reason to take such drastic action.
There were enough opioids on that man's coat - to drop a herd of elephants.
- Yep.
You keep us on bypass.
I'll deal with the board.
I got you.
Mr.
and Mrs.
Logan? I'm Dr.
Choi.
I've been taking care of Josh.
Thank you so much for contacting us.
Of course.
Please.
Uh, he's run away before, but he'd always come back, and then this time We contacted the police.
We tried every way we could to find him.
I do have to warn you, calling you was my idea, not his, but he's very ill and he needs help, so please, no matter how this goes, try to understand and be patient.
Of course.
He's right over here.
April my patient in Two didn't go for anymore tests, did he? Doesn't look like it.
I'm sorry.
Just give me a minute.
Leah, did you see my patient? 16-year-old boy, tall, brown hair? Yeah, I think so.
Left with a young woman about 20 minutes ago.
Now, this shows distribution of aggregate hospital costs and stays by payer for our last fiscal year.
Excuse me I'm sorry to interrupt.
Ms.
Goodwin.
As Executive Director of Patient and Medical Services, the safety of our staff and patients is my responsibility.
There are few substances more dangerous and terrifying than fentanyl.
Even a minute amount inhaled or absorbed through the skin can cause an overdose and even death, and while I understand going on bypass costs this hospital money, if just one person goes into respiratory failure from coming in contact with this drug, I guarantee that the damage to this hospital's reputation will be far costlier.
So, I'm sure you'll all agree that keeping us on bypass is medically and fiscally the best course of action.
Well since you put it like that Thank you.
I'll be in my office if anyone has anymore questions.
Sharon You shouldn't have done that.
I don't see that I had a choice.
Listen, I'm up here with them, okay? I hear which way the wind is blowing, and lately, the board feels that you are not making decisions that are aligned with this hospital's interests.
Well, I'm sorry, Peter, but I thought this hospital's foremost interest was in treatment of patients.
You're not hearing me, and you keep taking an adversarial position vis-Ã -vis the board and they will fire you.
Hey, Dad.
Sarah So nice of you to come.
I just wanted to, um, see how you're doing.
Did you? - No ulterior motive? - What? Sure you didn't come here to make yourself feel better by doing the right thing? That this visit isn't all about you? Dad, n Maybe I'm not the only one with personality disorder.
Are you serious? Oh, don't be so sensitive.
Come now.
Let's see what I can do to leave you with a good memory.
Kay, this was clearly a mistake.
Should we sit and reminisce? Perhaps order some hot cocoa? Goodbye, Dad.
No, stay.
Let's focus on getting you some closure.
I found your dad a heart.
Thank you.
We're gonna take him to do the transplant now.
- Dr.
Choi? - Please wait here a second.
What do you think you're doing? He wanted to come back to Athena, - so I called us an Uber.
- Emma, I get it.
He needs his dog, and I don't wanna take that for him, but right now, he needs our help even more.
- This isn't a game.
- Like I don't know that? But you don't understand him.
I do.
I've been there.
What do you mean? You've been homeless? Yeah.
But that's not important.
What matters is that this dog is the only thing in the world Josh can relate to.
I think he needs her so much that if he had to go on without her, he'd rather die.
All right.
Tell Josh to pack his clothes, and we'll take the dog with us.
H help! Somebody! Uh, wh wh what's going on? Wh what's happening? His lungs are full of fluid.
He must've been coming to and inhaled against his glottis.
Sats down to 83.
He lost his IV.
Uh, do something! Save him! Just so you understand, with the lack of oxygen, there's no guarantee that he won't have new physical or neurological deficits.
Just save him, please.
Do you understand what Dr.
Sexton is saying? He's my father.
Please, don't let him die.
Okay, give 20 of Lasix, 20 of etomidate, 50 of sux.
Open an intubation kit and a central line kit, now.
- Can you intubate? - Yeah.
Sats at 65.
He's in PEA.
Bag him.
Give me a milligram of epinephrine.
I'll start CPR.
Epinephrine's in.
He's still in PEA.
Another milligram.
- Second milligram in.
- Come on, Dad.
Still in PEA.
Another milligram.
Third milligram's in.
What? No.
No, no, no, no.
I'm sorry.
Daddy! Time of death, 17:13.
I'm sorry.
His abdomen's more distended, and his pain is getting worse.
Like I was saying, we need to take him up to surgery.
Dale, maybe we should let them.
Are you sure that that's necessary? Did you even talk to Dr.
Kravitz? He says that general anesthesia will exacerbate Kevin's PANDAS.
You're not hearing me.
At the moment, that is not our biggest concern.
- But Dr.
Kravitz says - Forget about Dr.
Kravitz.
Kevin doesn't have PANDAS.
His tics are from me.
What are you talking about? He has OCD.
It's not from step; it's genetic.
He inherited it from me.
It's a far more likely explanation.
So the antibiotics, the all of it He never needed them.
It's it's my fault.
All my fault.
Why didn't you tell me you had OCD? I thought if you knew something was wrong with me, you wouldn't love me.
Do the surgery.
Dale, wait We'll get Kevin ready to go upstairs.
His temperature is 99.
6.
It could signal the onset of infection, which would be a contraindication for performing the transplant.
He won't get the heart? No, I'm sorry.
He always runs warm.
- What? - My dad, um his temperature always runs high.
It's normal for him, which would mean that this isn't an infection.
You're sure? Because if that's the case, then he could still get the heart.
Yes, I'm sure he's fine.
Let's get Dr.
Haywood up to the O.
R.
Yes, sir.
All right.
Ejection fraction looks good.
Normal rate and rhythm.
I think we did it.
- Well done, Dr.
Rhodes.
- You as well.
Dr.
Mehta, will you please close? - Yes, sir.
- Thank you.
I must admit, despite your overall surliness, your determination today in the face of great odds was admirable.
I will take that as a compliment.
You should.
I'm gonna go take my flowers home.
Ava It's not that it's my dad you're dating I wish that you weren't dating anybody at all.
As long as we're making confessions, I was never dating your father.
But you didn't mind me thinking so.
No, I didn't mind.
Oh, Josh.
- Hello, Josh.
- Hi.
Uh, Dr.
Choi told us about what's going on, and we're gonna get through this, honey, together.
I'm sorry I caused you so much trouble.
We're just glad to see you again, and that you're safe.
Josh will need to stay here for about two weeks, but after that, he's agreed to go home with you, if you let him bring his dog.
- Of course.
- Anything.
- What's its name? - Athena.
Well, we'll take care of Athena.
Please follow me.
Uh, we'll get Athena after we settle Josh in.
Of course.
He's never really gonna be able to love them back, is he? By our definition? Unlikely.
I don't know who to feel more sorry for, the parents or him.
Thanks.
Really? For what? You did good today.
Maybe we could use you around here.
Athena It'd be so hard to do that all alone.
What? It's just I know when mom and dad get old, at least we'll face it together.
Kevin's fever is coming down, and his numbers all look great.
- I think he's gonna be okay.
- Thank you, Dr.
Manning.
At least they can start getting Kevin - the help he needs.
- Yeah.
Hey, Will I'm not perfect.
I have got a million fears and insecurities about being a doctor, a mother, everything.
It's exhausting.
But yes, sometimes, I push it too far.
It's okay.
I understand.
Good.
It still doesn't mean you get a pass for the other night.
Looks like he's gonna live.
Yeah.
Now what?
She's probably not allowed to have her phone at the poker table.
She shouldn't be at the poker table at 7:00 a.
m.
She should be back with my car, so I can get to work.
Babe, it's your day off.
From the hospital.
Emily knows I check on the kids at the homeless encampment.
They count on me.
They'll understand if you're a few minutes late.
If Emily's gonna live here, she needs to get her act together, make a plan.
This isn't some vacation.
Come on, I'll give you a ride.
I've come to recognize your expressions pretty well.
This one's my least favorite.
I wish I had better news.
But look even though your cardiac output is decreasing, you are still highest status on the transplant list.
You're first in line.
I appreciate your optimism, Dr.
Rhodes, as always.
- Hang in there, Bob.
- Uh-huh.
You know, for my part, I'm just not seeing any organic causes.
Excuse me, I Sorry to interrupt.
Um Sarah, I've just been up to see your father.
His stroke volume, systolic arterial pressure, and pulse pressure have all decreased since yesterday.
I I I just can't keep the fluid off of his lungs.
I see.
I promise you, we're doing everything we can to find him a new heart, but if you wanna say good-bye, I would consider doing it today.
I'm very sorry.
Okay.
- How long have you had a fever? A few days now.
And are you always this short of breath? Lately, yeah.
Athena, stop! Hey, Dr.
Choi.
Hey, Deb.
Can I take a look at your legs? Yeah, sure.
How long have you been getting these spots? - Why? Are they bad? - I'm not sure but I'd like to prick your finger to check your blood.
Okay, yeah.
All right.
Ethan, I know, I'm sorry, I promised I'd be home, but I had half the table on tilt, and I just lost track of time.
Whatever.
Take the car.
I'll get a cab.
I'm not gonna just leave you here.
What can I do to help? I don't want your help.
Ethan, you don't have to be like that.
He doesn't have to be like that.
Hi.
Emily.
- Josh.
- Nice to meet you.
- Uh, cute dog.
- Thank you.
- What kinda tent do you use? - Uh, it's an old Coleman.
- Has a rain fly.
- Nice.
Hold on.
Josh I'm seeing some cells in your blood called lymphoblasts.
That plus your other symptoms make me concerned enough that I'd like to bring you into the hospital.
Why? What do you think it is? It could be all sorts of things but what I'm worried about is leukemia.
- Isn't that a kind of cancer? - It is.
Josh, this is important.
Look, I mean, Athena needs me out here.
And if I go back with you, you're gonna have to call my parents, the people that adopted me, and I don't think I want that.
- Did they mistreat you? - No, no, no, they're okay.
It's just, uh things didn't really work out with them, you know? You don't have to call his parents, right? Em Is that true? You're only 16.
Legally, they need to be notified.
I mean, if his life is on the line, you could make an exception.
I mean, if you could do that, I'm sure I could get Deb to watch Athena, if it's just for the afternoon.
We could run some tests first, make sure we know what's going on.
Hey, Deb, could I ask you a favor? You shouldn't have done that.
Eventually I'm gonna have to call his parents.
What are you busting on me for? Got him to come in, didn't I? Wow.
One of our patients is well loved.
Actually, they came for me.
- Really? - Mm.
The enchanting Dr.
Bekker.
What? Uh, seems they're from your father.
- My father? - Yeah.
Uh, you've been seeing him? Is, uh is that a problem? No, no, it's not a problem.
Just uh, he's just You know what, forget it.
Enjoy the flowers.
Are you two still at it? At what? I've barely seen you speak two words to each other in a week.
Whatever this is, you need to work it out.
- Everything's fine.
- Oh, everything's fine? - Mm-hmm.
- Good.
Dr.
Manning, Dr.
Halstead, you're up, Treatment Four.
- Hey.
- Hey.
Kevin Parks: He's ten years old.
He woke up with 8 out of 10 abdominal pain and a fever of 103.
We gave him Tylenol and a cool bath, - but nothing's worked.
- Okay.
All right, Kevin, let's get you up on the bed.
Ow, ow.
That hurts.
- That hurts? All right.
- All right, you got it.
- We're gonna figure out why.
- There you go.
Hi, Kevin, I'm Dr.
Manning.
This is Dr.
Halstead.
Can you show us where it hurts? - Right here? - Right there? Okay.
Has anything like this ever happened before? No, never.
Abdomen is tender but not rigid, with no rebound.
Bowel sounds are decreased.
I don't like it.
It could still be his appendix, Crohn's disease, ulcerative colitis.
Temp's up to 104.
Give Ibuprofen to start cooling measures.
Is there any other medical history we should be aware of? Yes, he's been diagnosed with PANDAS.
PANDAS? Uh, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection.
Kevin started getting tics and OCD after a strep infection two years ago.
Nobody else could figure out what it was, until finally Dr.
Kravitz diagnosed him.
Okay, we'll be sure to give him a call.
I've heard of Dr.
Kravitz.
He sees a lot of kids with PANDAS, right? He's one of the nation's top experts.
I'm guessing Dr.
Kravitz put Kevin on long-term prophylactic antibiotics to fight the residual strep? Yes, he did.
CBC, chem panel, blood cultures, abdominal CT, and hang a gram of vanco STAT.
We're gonna start him on some medications while we run some tests to try to figure out what's going on, okay? We'll be back to check on him shortly.
Thank you.
Hey, you've heard of this Dr.
Kravitz.
He labels every kid's neurological condition as PANDAS.
It's not even an officially recognized diagnosis.
Either way, right now, that child is in real pain with a real fever.
Right, because he's been on three different antibiotics for over 12 months, which we both know has wiped out all the healthy flora in his gut, causing a massive superinfection.
I mean, all because his parents shopped around for a doctor willing to blame Kevin's neurologic tics on strep, instead of admitting they most likely passed it on to him genetically.
Okay, but dismissing them isn't gonna help.
They are upset and worried.
And what they're doing to try and fix him might wind up killing him.
Dr.
Sexton, Treatment Six is open.
You're up.
We got Frank Larson: 74.
He was found unconscious in an abandoned warehouse.
Bradycardic at 45, BP's 90 over 60, respiration's 10, and satting at 91%.
Mr.
Larson, do you know where you are? Let's move him on one, two, three.
Dad? Dad, what happened? Is he is he all right? That's what we're trying to figure out.
Frank, can you hear me? Can you hear me Frank? He he he goes around feeding the stray cats, but he has dementia and he gets lost.
Does he have any other medical conditions? No.
You're the one examining him.
- What do you think it could be? - It's hard to say right now.
We need to let the doctor run some tests.
It looks like he doesn't have any injuries, but yes, I would like to run some more tests - to figure out what's going on.
- Okay.
- Okay? - Okay.
Dad, I'll be right here, okay? I'm right here.
I'm not going anywhere.
- Sorry.
Big sister moment.
- Yep.
Anyway, let's get an EKG, CBC, chem panels, troponins, tox screens, and a head CT.
We'll figure this out.
Dr.
Reese, I was just, um I was just heading up to To check on your dad.
Okay.
Listen, I, um I know you've had a very complicated relationship, and this is really none of my business, but I think that if he should die before you have a chance to speak to him, that that could very possibly be something you would come to regret.
My father Has clearly stated that he doesn't want me to be a part of his life, so, uh, whatever regrets I may have I just don't think any of them will be resolved by me talking to him.
Okay.
You, uh you accepting visitors? It depends.
Is it professional or is it personal? Uh personal? Then by all means.
I, um I heard about your situation.
Mm.
Really so sorry that it's come to this.
Yeah, what can I say? It's been kind of a chess game between the two of us, hasn't it? I regret that you see it that way.
Uh uh, I would hope that you would Ha.
It's ironic.
You made me cut Sarah out of my life to get a heart, and I end up with neither.
Robert, it was never my intention to have you cut Sarah out of your life.
Semantics.
Uh, in any case you play a good game.
Dr.
Bekker - You're looking lovely.
- Thank you.
And thank you for the flowers.
That was quite unnecessary.
Did you like them? They're beautiful.
Though, I must admit, the money would've been better spent as part of your donation to the department.
Speaking of which, I glanced at that information you gave me concerning Da Vinci robotic surgical system? Yes, that's, uh It was very impressive, but a little technical for a layman like myself.
Perhaps you could explain the details to me? - Of course.
- How 'bout tonight? Over dinner? Mr.
Rhodes the flowers? Dinner? Is it me or are you trying to make your son crazy? Dr.
Bekker you are an intelligent attractive, dynamic woman, and if this makes Connor crazy, then so be it.
Look, I and the entire cardiothoracic department truly appreciate your patronage, but you and I are going to keep our relationship on a professional level.
Oh all right.
I'll have the head of philanthropy services give you a call this afternoon.
Thank you.
- Dr.
Rhodes, Trauma Three.
- Yep.
All right, Brett, what do we got? David Gray: 50-year-old bystander in an attempted robbery.
He got shot in the head.
GCS, 6.
He's only responding to painful stimuli.
We couldn't intubate in the field.
All right, give me an intubation kit.
- 150 of mannitol, 500 of keppra.
- Got it.
All right, on my count, one, two, three.
Entry wound, left parietal skull, no exit.
Get a neurosurg down here ASAP.
- And get me a Cordis kit.
- Yep.
There we go.
No reactions to light.
All right, I'm in.
No corneal reflex either.
We're losing him.
Cordis kit.
Brainstem reflexes are completely absent, and his pupils are fixed and blown.
He was responding to pain in the ambo.
Dr.
Rhodes, he's GCS 3.
Dr.
Rhodes, he's braindead.
Is he a donor? Yeah.
Okay let's get an angio to confirm brain death, then get a cardiac echo.
I've got a patient who needs a heart.
You're wasting your time on this one, Dr.
Rhodes.
I heard significant mitral regurg on auscultation.
There's no way that heart is viable.
Maybe not now, but that doesn't mean I can't fix it.
Let's get him up to Radiology now.
- A drug overdose? - Opioids.
Your father's tox screen showed extremely high levels.
Bolus him with 2 of narcan, then start a drip.
It can't be.
My dad doesn't do drugs.
I mean, he he never has.
He he doesn't even drink.
- What about pain medication? - He doesn't take anything.
You need to run some more tests.
Ma'am, Dr.
Sexton has run all the appropriate Is there anything around the house? Um, Vicodin? Tylenol with codeine? No, I I cleaned all the medicine cabinets out.
We don't have anything.
Hmm, then he may have gotten it outside the house.
What? You think I'm letting him shoot up or something? - No, I'm just saying - Look, your test is wrong.
You need to redo it.
These tests, they are usually pretty accurate And I know my father.
Look, if you need to consult with another doctor, - then maybe - No.
I'll redo the test.
But in the meantime, I'm gonna give him some medicine to reverse the opioids, just so we can try and wake him up.
- Okay.
- Thanks.
Administer the narcan.
Hi.
So, Kevin's scans indicate toxic megacolon.
It's a dangerous intestinal infection caused by an overgrowth of opportunistic bacteria.
Which is most likely due to his long-term antibiotic use.
So the new medicine you're giving him should fix it? It's not that simple.
Kevin's bowel is so inflamed, it's become dangerously dilated.
And if it perforates, it's a life threatening situation, which is why we need to release the pressure from his colon to try and prevent that.
We appreciate your help, but we've spoken with Dr.
Kravitz, and he wants Kevin transferred over there.
Dr.
Kravitz says if we treat him incorrectly, it's only going to make Kevin's neurologic symptoms worse.
He wants to give him an infusion of IVlg to prevent that.
Kevin's tics are the least of his problems right now.
We need to focus on treating his infection.
We want that too, but Kevin's tics are a big problem.
They're odd, and the kids at school are starting to stare at him.
We just don't wanna do anything - to compromise his future.
- I understand, but We'll do the IVig here.
Natalie That would work.
Great, we'll get started right away.
- Thank you so much.
- Yeah.
Why are you indulging them like this? Indulging them? You know full well the IVlg will have exactly zero therapeutic benefit.
It's keeping Kevin in the hospital.
Why are you being so negative? I'm just being realistic.
The more you humor then, the less likely they'll ever be to seek out an actual effective therapy for what is most likely a genetic neurologic condition.
So what do you want me to do, Will? Have them sign out and leave? - Nah, you should just give them a placebo: IVlg.
If that's what's gonna allow us to do our job, then that's exactly what I'm gonna do.
Just a little bit longer.
I need to get back to Athena.
I'm still waiting on a few more tests, so please, don't go anywhere yet.
Dr.
Charles I've got a runaway kid with confirmed leukemia, but I can't get him to give me his parents' contact information, and Oncology won't begin treatment till they're sure he's not gonna be living in a tent on the streets during his recovery.
Figure his parents might have abused him? Apparently not.
He's adopted, but he says they're nice people.
It just wasn't a good fit.
And you're sure he understands the danger here? Cancer? Life or death? Says he does, but I don't know.
- Let me have a chat with him.
- Thanks.
There's too much retrograde flow.
The leaflet's totally eaten away.
Shame to have an otherwise perfectly good heart go to waste.
It's not gonna go to waste.
Excuse me? This heart is an HLA match for my patient.
I'm gonna do a valve repair.
You're joking.
Get him prepped for surgery, thanks.
You're going to do major surgery on this heart, which by itself contains significant morbidity and mortality, and then turn around and transplant it into someone else? Uh-huh.
You'll kill the recipient on the table.
So don't scrub in.
I'm sure with your active social life, there are things you'd rather be doing anyways.
Now, if you will excuse me, I am going to prep for my valve repair.
Ms.
Larson the retests once again show high levels of opioids.
I'm sorry.
Well, then why isn't he waking up? Should we be doing something else? Well, with overdoses that large, it can sometimes Dr.
Sexton Okay, um, we need to step out.
Let's clear the room.
- Wha what's going on? - Step out.
That white powder on his jacket, I'm guessing that's fentanyl.
- What's that? - A synthetic opiate.
Now, he could have either inhaled it or even just touched it, but it's 100 times stronger than heroin.
That could explain why the narcan's moving so slow.
But how did he get it? They smuggle it in from China and cut it in abandoned buildings.
All your dad had to do was brush up against some while he was feeding stray cats.
We're notifying CPD, CFD, anyone who might've come in contact, Now, um, you have to test it, but I think we have fentanyl.
Okay, I'll set up the decon protocol out in the ambulance bay, and I'll call Goodwin.
- Doris, door.
- Okay, got it.
We will get you back in the room, but please come.
You gotta strip.
I feel fine.
Come on, Maggie.
You come on.
Even absorbed through the skin, fentanyl can cause mental status changes and respiratory distress.
- Strip.
- She's right, Cesar.
Go get some clean clothes.
I don't like this at all, Maggie.
We got too many sick people in here to take any chances.
We need to scrub down the back half of the ED, and put us on bypass until we get the go-ahead from the decontamination team.
- Yes, ma'am.
- All right.
All finished.
You okay, Kevin? Can I have a word? Kevin's latest scans show increasing edema across the wall of his bowel, indicating lack of blood flow.
At this point, we need to consider surgical resection.
Surgery? Shouldn't we finish the IVig first to see if it helps? He can keep getting it, but we really need to move him upstairs.
We need to call Dr.
Kravitz.
Mr.
and Mrs.
Parks, your son is running out of time.
My wife works tirelessly to try to fix our son's problems, and if she has any hesitation at all, then we need to listen to her.
How 'bout I call Dr.
Kravitz and explain the situation to him, okay? - Could you do that? - Of course.
- Is there a bathroom nearby? - Right down the hall.
So, you're just gonna keep encouraging them to follow this quack? Now is not the time to start an argument with them.
You know, it must be nice always being right.
Sorry? From the moment we started this case, everything's been your way.
"We can't do this, we have to do that.
" What are you talking about? I'm talking about everything always being done your way: how we treat patients, what we can or can't tell them What? Whether you and I are together or split up or on a break.
Is that what this is about? You and me? Because it definitely wasn't my idea to go hook up with some woman in a bar.
I told you, it went nowhere.
Oh, and that's supposed to make me feel better? I made a mistake.
I'm not perfect.
But at least I admit it.
I don't think I'm perfect.
Okay, all I can say, Natalie, is that it's very hard for us mere mortals to measure up to you.
Thanks, Officer Burgess, I appreciate your help.
What are you still doing here? I wanted to see how Josh is doing.
He's not letting us treat him.
Luckily, PD's got a lead on his parents.
Wait, you said you weren't going to call his parents.
I said I'd end up calling them eventually.
Yeah, but you don't have to.
I mean, there are other ways to do this.
This is what Josh needs to stay alive.
You don't know what Josh needs.
And you do? Look, you're not adopted.
You don't know what it's like.
Josh needs a bone marrow transplant, and he won't get it if he's living on the streets.
So you're just gonna do whatever you want? Yeah, because you always know better than everyone.
No, I don't, but I do know that when his immune system is obliterated by chemo, he's gonna need to recover in a stable, clean environment, and if you're too irresponsible to understand that, then stay out of my way.
Mrs.
Parks? I'm sorry, I was just finishing up.
Are you all right? I'm just stressed.
- Does that help? - What? The handwashing.
It used to in high school, but I stopped for a long time, till Kevin got sick.
Having a child with uncontrollable tics must be so stressful.
That's why we've seen so many doctors.
My husband likes answers.
Does he know about this? He's already got enough that he didn't sign up for.
What would be the point? It might help you and Kevin.
I don't see how.
Kathy, you have OCD, like Kevin, and it's not caused by any bacterial infection.
It's genetic, something a child inherits from the parents.
I appreciate your concern, but please, just take care of Kevin's intestines.
I'll worry about the rest.
Excuse me, are you all right? Um, sorry, I'm I'm fine.
I'm Dr.
Reese from Psychiatry.
Can I help? Uh my dad ran into some trouble today.
He has dementia.
Oh, I'm sorry.
I know that's really hard.
It's completely normal to feel overwhelmed.
It's like he's a different person.
And sometimes, I wonder if maybe If maybe it would be better if he Does that make me a horrible person? No.
No, it doesn't make you horrible.
Almost anyone in your position would have these thoughts.
Talked to your patient.
Nice kid.
Is he still insisting on going back to the homeless encampment? He feels pretty strongly about it.
Is he suicidal? Nope, he definitely seems to wanna live.
Then he shouldn't object so much to me calling his parents.
I need to spend a little more time with him, but off the top of my head, I'd say that Josh is dealing with a classic case of attachment disorder.
Does that explain why he'd rather risk his life than live with his parents for a couple of months? I know it seems bizarre, but those two years that he was at the orphanage, it's that critical period when babies need parental affection the most.
And if they're in a facility where they don't get it, their brains actually become wired differently, leaving them poorly adapted to cope with the complexities of giving and receiving love, I mean, sometimes for the rest of their lives.
I hear what you're saying, Dr.
Charles But Josh has his whole life to live as far from his parents as he wants, if we treat his cancer.
- Scissors to Dr.
Bekker.
- Scissors.
So, what's the story with you and my friend with the flowers? I'm definitely picking up on some rancor.
How do I put this? Uh my father and I have always had an - unhealthy competition.
- Competition? You're a cardiothoracic surgeon.
What is there to compete over? Well next time you two get together, you can ask him about it.
Snip.
Let's take him off pump.
Paddles.
And clear.
No retrograde flow.
Congratulations, we have a working valve.
I'm gonna go let my patient know that he's about to get a new heart.
Okay, I'll let her know.
- Sharon? - Yeah? That was Peter Kalmick.
Apparently the board is refusing to let us go on bypass.
They're overriding my decision? They didn't find sufficient reason to take such drastic action.
There were enough opioids on that man's coat - to drop a herd of elephants.
- Yep.
You keep us on bypass.
I'll deal with the board.
I got you.
Mr.
and Mrs.
Logan? I'm Dr.
Choi.
I've been taking care of Josh.
Thank you so much for contacting us.
Of course.
Please.
Uh, he's run away before, but he'd always come back, and then this time We contacted the police.
We tried every way we could to find him.
I do have to warn you, calling you was my idea, not his, but he's very ill and he needs help, so please, no matter how this goes, try to understand and be patient.
Of course.
He's right over here.
April my patient in Two didn't go for anymore tests, did he? Doesn't look like it.
I'm sorry.
Just give me a minute.
Leah, did you see my patient? 16-year-old boy, tall, brown hair? Yeah, I think so.
Left with a young woman about 20 minutes ago.
Now, this shows distribution of aggregate hospital costs and stays by payer for our last fiscal year.
Excuse me I'm sorry to interrupt.
Ms.
Goodwin.
As Executive Director of Patient and Medical Services, the safety of our staff and patients is my responsibility.
There are few substances more dangerous and terrifying than fentanyl.
Even a minute amount inhaled or absorbed through the skin can cause an overdose and even death, and while I understand going on bypass costs this hospital money, if just one person goes into respiratory failure from coming in contact with this drug, I guarantee that the damage to this hospital's reputation will be far costlier.
So, I'm sure you'll all agree that keeping us on bypass is medically and fiscally the best course of action.
Well since you put it like that Thank you.
I'll be in my office if anyone has anymore questions.
Sharon You shouldn't have done that.
I don't see that I had a choice.
Listen, I'm up here with them, okay? I hear which way the wind is blowing, and lately, the board feels that you are not making decisions that are aligned with this hospital's interests.
Well, I'm sorry, Peter, but I thought this hospital's foremost interest was in treatment of patients.
You're not hearing me, and you keep taking an adversarial position vis-Ã -vis the board and they will fire you.
Hey, Dad.
Sarah So nice of you to come.
I just wanted to, um, see how you're doing.
Did you? - No ulterior motive? - What? Sure you didn't come here to make yourself feel better by doing the right thing? That this visit isn't all about you? Dad, n Maybe I'm not the only one with personality disorder.
Are you serious? Oh, don't be so sensitive.
Come now.
Let's see what I can do to leave you with a good memory.
Kay, this was clearly a mistake.
Should we sit and reminisce? Perhaps order some hot cocoa? Goodbye, Dad.
No, stay.
Let's focus on getting you some closure.
I found your dad a heart.
Thank you.
We're gonna take him to do the transplant now.
- Dr.
Choi? - Please wait here a second.
What do you think you're doing? He wanted to come back to Athena, - so I called us an Uber.
- Emma, I get it.
He needs his dog, and I don't wanna take that for him, but right now, he needs our help even more.
- This isn't a game.
- Like I don't know that? But you don't understand him.
I do.
I've been there.
What do you mean? You've been homeless? Yeah.
But that's not important.
What matters is that this dog is the only thing in the world Josh can relate to.
I think he needs her so much that if he had to go on without her, he'd rather die.
All right.
Tell Josh to pack his clothes, and we'll take the dog with us.
H help! Somebody! Uh, wh wh what's going on? Wh what's happening? His lungs are full of fluid.
He must've been coming to and inhaled against his glottis.
Sats down to 83.
He lost his IV.
Uh, do something! Save him! Just so you understand, with the lack of oxygen, there's no guarantee that he won't have new physical or neurological deficits.
Just save him, please.
Do you understand what Dr.
Sexton is saying? He's my father.
Please, don't let him die.
Okay, give 20 of Lasix, 20 of etomidate, 50 of sux.
Open an intubation kit and a central line kit, now.
- Can you intubate? - Yeah.
Sats at 65.
He's in PEA.
Bag him.
Give me a milligram of epinephrine.
I'll start CPR.
Epinephrine's in.
He's still in PEA.
Another milligram.
- Second milligram in.
- Come on, Dad.
Still in PEA.
Another milligram.
Third milligram's in.
What? No.
No, no, no, no.
I'm sorry.
Daddy! Time of death, 17:13.
I'm sorry.
His abdomen's more distended, and his pain is getting worse.
Like I was saying, we need to take him up to surgery.
Dale, maybe we should let them.
Are you sure that that's necessary? Did you even talk to Dr.
Kravitz? He says that general anesthesia will exacerbate Kevin's PANDAS.
You're not hearing me.
At the moment, that is not our biggest concern.
- But Dr.
Kravitz says - Forget about Dr.
Kravitz.
Kevin doesn't have PANDAS.
His tics are from me.
What are you talking about? He has OCD.
It's not from step; it's genetic.
He inherited it from me.
It's a far more likely explanation.
So the antibiotics, the all of it He never needed them.
It's it's my fault.
All my fault.
Why didn't you tell me you had OCD? I thought if you knew something was wrong with me, you wouldn't love me.
Do the surgery.
Dale, wait We'll get Kevin ready to go upstairs.
His temperature is 99.
6.
It could signal the onset of infection, which would be a contraindication for performing the transplant.
He won't get the heart? No, I'm sorry.
He always runs warm.
- What? - My dad, um his temperature always runs high.
It's normal for him, which would mean that this isn't an infection.
You're sure? Because if that's the case, then he could still get the heart.
Yes, I'm sure he's fine.
Let's get Dr.
Haywood up to the O.
R.
Yes, sir.
All right.
Ejection fraction looks good.
Normal rate and rhythm.
I think we did it.
- Well done, Dr.
Rhodes.
- You as well.
Dr.
Mehta, will you please close? - Yes, sir.
- Thank you.
I must admit, despite your overall surliness, your determination today in the face of great odds was admirable.
I will take that as a compliment.
You should.
I'm gonna go take my flowers home.
Ava It's not that it's my dad you're dating I wish that you weren't dating anybody at all.
As long as we're making confessions, I was never dating your father.
But you didn't mind me thinking so.
No, I didn't mind.
Oh, Josh.
- Hello, Josh.
- Hi.
Uh, Dr.
Choi told us about what's going on, and we're gonna get through this, honey, together.
I'm sorry I caused you so much trouble.
We're just glad to see you again, and that you're safe.
Josh will need to stay here for about two weeks, but after that, he's agreed to go home with you, if you let him bring his dog.
- Of course.
- Anything.
- What's its name? - Athena.
Well, we'll take care of Athena.
Please follow me.
Uh, we'll get Athena after we settle Josh in.
Of course.
He's never really gonna be able to love them back, is he? By our definition? Unlikely.
I don't know who to feel more sorry for, the parents or him.
Thanks.
Really? For what? You did good today.
Maybe we could use you around here.
Athena It'd be so hard to do that all alone.
What? It's just I know when mom and dad get old, at least we'll face it together.
Kevin's fever is coming down, and his numbers all look great.
- I think he's gonna be okay.
- Thank you, Dr.
Manning.
At least they can start getting Kevin - the help he needs.
- Yeah.
Hey, Will I'm not perfect.
I have got a million fears and insecurities about being a doctor, a mother, everything.
It's exhausting.
But yes, sometimes, I push it too far.
It's okay.
I understand.
Good.
It still doesn't mean you get a pass for the other night.
Looks like he's gonna live.
Yeah.
Now what?