Chicago Med (2015) s05e19 Episode Script

That day, when I found out I couldn't have children You pushed me away and ran into another man's arms.
This is Auggie, one of my students.
I haven't been able to reach his foster mom.
It's too much, and I can't.
They don't want the sick kid.
DCFS is gonna start looking for a new foster placement tomorrow.
And we'll spend the night with Auggie.
You wanna come up? I just wonder if that's a good idea.
There's actually very little difference between drug addiction And romance addiction? Let's go up and discuss it.
Did you really use all of my floss? I told you, if we're gonna keep doing this, I need a toothbrush.
I don't know.
I feel like it gives a guy too great a sense of security.
Or does it just prevent cavities? No, that is a gateway toiletry.
And before I know it, you're gonna have your own curling iron here.
You'll have your own loofah.
You've clearly given this a great deal of thought.
Maybe a little bit.
It's been a really good couple of weeks.
Yeah, it has.
And not just us.
I mean, you been knocking it out of the park.
I mean, work, everything, rehab.
I'm really proud of you.
Just so you know, the more you kiss me, the more it makes me think I should get you that toothbrush.
- Oh, yeah? - Mm-hmm.
- Yeah.
- Hmm? So what's nice is, as we progress through the surgery, we can slide the retractor down.
There you go.
Go ahead and bring that blade down.
Now, you wanna keep the most tension on, - so go ahead and tighten it up.
- Hey, April.
Never mind.
Ethan! Ethan.
Hey.
He was just showing me some new equipment.
I'm sure he was.
I'm his Hybrid OR nurse.
You know that.
- Learning is part of the job.
- Right.
What is this? You're sleeping on the couch? You want nothing to do with me? Why do you care? - Dr.
Marcel, I'm sorry.
- No, it's all good.
I gotta deal with some inventory anyway.
We'll finish up later.
- Morning, Dr.
Manning.
- Morning, Crockett.
- How's your day? - Great.
You realize you say that every day? Every day is great.
We got two traumas coming in.
Dr.
Choi, you're going to two.
Dr.
Marcel, take her to Baghdad.
Copy.
What do we got? Zach Brand, 15.
Says he fell off an overpass.
Is that true? You fell? Fractured his left arm.
He's got a pretty good bruise on his head.
GCS 13, pressure and heart rate are good.
All right, Zach.
Any of this hurt? All right, he looks stable.
Let's get a chest X-ray and a pan scan just to be safe.
Let's get ready to transfer.
Oh, wait a second.
Zach, where did this glass come from? Zach? Hey, we'll figure this out.
All right, let's transfer on my count.
Ready? One, two, three.
I've got Terrie Cross, intubated in the field.
Status post MVC, car versus divider, GCS 3T, BP 95/60, heart rate 130s, satting at 86%.
Yeah, I'm not liking this rhythm.
Get me an EKG with tropes and trauma labs.
- Let's go.
- She's coding.
No pulse.
Get him up for those scans.
I'll check in as soon as you're back.
Here we go.
Come on, folks.
We know what this is.
- What's up? - She's in V-fib.
Let's go.
On my count.
One, two, three.
Give me the paddles.
Charge to 200.
This could be a blunt cardiac arrest.
Charged.
Open it up.
Clear.
I got a pulse.
- Sinus tach.
- For now.
- What happened? - Single-vehicle crash.
Any drugs or alcohol on board? Rapid tox was negative.
Why'd she hit the median? Stroke, seizure? Wait, wait, wait.
She's got glass shards on her.
So does the kid in Trauma 2.
It's from her windshield.
- How do you know? - He fell off an overpass.
And landed on her.
No breath sounds on the left.
- Let's set her up for a chest tube.
- What do you got? Some fluid on the right, but I can't find her spleen.
What do you mean can't find it? I mean it's not there.
It's gotta be in there somewhere.
Go back up.
Right there.
That's the tip.
Can't be.
It's too high.
That's right, 'cause it's in her chest.
All right, she must have ruptured her diaphragm.
- Chest tubes ready.
- No, she's hypotensive.
- We're going to the Hybrid OR now.
- No, no, no, no.
Stop.
If it's a tension pneumo, we can't move her till we decompress the lung.
There's no time.
I'll do it in the OR.
Let's go.
Come on.
Easy, easy.
We just wanted to come say a quick hello before we finished up the paperwork.
Of course.
Maggie, Madeline's found foster parents for Auggie.
That's great.
He can't wait to get out of the hospital.
So What a sweet kid.
He is.
Except when he doesn't get his Nutella for breakfast.
Oh, and he doesn't like anything but bubblegum toothpaste.
No fruit flavors and definitely not mint.
As you can see, Maggie has become quite attached in the past couple of weeks.
We know how it is.
We've been fostering for 12 years.
Auggie is going to a loving family.
So let's cross the Ts, dot the Is.
Hopefully, you'll be able to take him home tonight.
Who's winning? We both have 16 life points left.
But as soon as my Jace uses his Ultimate, he's toast.
I have no idea what's going on.
So what did you think of those people? - They're nice.
- Yeah? I'm sorry, you two, but I gotta get to school.
- Finish this later? - Wanna drag it out? Mm I'm good.
Okay, honey.
Keep an eye on this guy.
Oh, I will.
You mind if I take a look? - Okay.
- Yeah? Ooh.
- Your tummy hurt? - Mm-hmm.
You getting cold? You know what I'm gonna do? I'm gonna ask my friend Dr.
Manning to come and take a look at you, just to make sure everything's all right.
Okay.
Meanwhile, why don't you get some rest? And when Mr.
Campbell comes Don't go easy on him.
Hey, Zach.
So we got your scans back.
Good news.
It's just a simple fracture.
Okay.
And your parents are on their way.
Mind if I check your eyes? So how did you go over the edge of that overpass? The railing was kinda low, I guess.
Okay.
But, uh I mean, were you fooling around with your friends? You lose your balance? Could could we do this later? My my head really hurts.
Sure.
But I do wanna make sure that you're okay and that something like this doesn't happen again.
So I'll have another doctor come in and see you in a bit, okay? Maybe you'll feel up to talking then.
I have to ask.
Do I think he jumped? Yeah, I do.
We're out looking for witnesses now, but if he did jump, we'll have to arrest him for vehicular endangerment - and possibly manslaughter.
- Easy, Rosado.
If Zach attempted suicide, first thing that happens, we put him on a psych hold.
Hey, Trini.
Call Dr.
Charles.
Tell him we need a consult.
What do we got? Marcie Burton, 19 weeks pregnant with mild vaginal bleeding, vitals stable.
Okay, thanks.
I called the ambulance just to be safe.
Good.
Hi, Marcie.
I'm Dr.
Halstead.
This is student doctor Curry.
I'm not losing the baby, am I? We're gonna take a look right now.
When did the bleeding start? This morning.
It wasn't much, but it hasn't stopped.
This will be a little cold.
Is it moving? Is it okay? Well, the fetus is fine, but you do have placenta previa.
- Is that bad? - It depends.
It could be if the bleeding gets worse.
Then you need to stop it.
We are certainly gonna do everything we can I have brain cancer.
I'm sorry? Stage IV.
Which means this is my last chance to have a family.
How long ago were you diagnosed? Eight months.
Though her tumor's been stable lately, and the scans have been good.
Ron.
I don't have time to start another pregnancy.
And my baby will be viable in just a few more weeks.
So please, help me.
Okay.
Let me go over your chart and have obstetrics come down and take a look.
And we'll figure out where to go from there.
Thank you.
Call Dr.
Asher.
Dr.
Asher? What are you sure? Yeah.
She's the best.
He has a GI bleed and his liver's getting worse.
What are you gonna do? Send him for a TIPS procedure.
You think he needs something that invasive? Any more damage moving forward will be irreversible.
Sooner we can take the pressure off his vasculature, the better.
He was really hoping to go home with his new family today.
TIPS has a pretty quick recovery.
Maybe tomorrow? Yeah.
- I'm gonna call over to IR.
- Okay.
Thanks.
Rhythm's not great.
We gotta move.
I'm on it.
I need better exposure.
Okay, you remember how I showed you to insert the larger blade? Yes, I do.
No, slide it all the way.
Okay.
Loosen it up, loosen it up.
- Okay, got it.
- Okay, good.
Let's do this.
Nope, I need a better angle.
Okay.
How do I know Okay, hold on.
Switch with me.
She's not gonna hold out if you can't get this going soon.
Yeah, I gotcha, Marty.
Okay.
Here we go.
Don't let go.
- Sorry, Dr.
Marcel.
- Don't sweat it.
Just get a 2-0 ready for the diaphragm.
One, two, three.
- Dr.
Marcel.
- Yeah.
I think you should start training a new nurse for the hybrid room.
- What are you talking about? - I slowed you down today.
No, hey, it was a tough case with new equipment.
No, it was because of the whole thing with Ethan.
It got in the way.
And there's no excuse for that.
Look, April, you're my nurse.
And you're the best.
I'm not gonna train anyone else.
Okay? Okay.
Dr.
Choi, Zach's parents are here.
He fell off the overpass? How is he? - Is he all right? - Zach has a broken arm that he's getting cast right now.
But otherwise, just some scrapes and bruises.
Oh, thank God.
Mr.
and Mrs.
Brand, I'm Dr.
Charles.
I haven't actually met Zach yet, but I was looking forward to saying hello in a few minutes.
Psychiatry I don't understand.
I just wanna ask him a few questions, get a better sense of what happened.
What does that mean? Well, uh, just that.
Wait don't tell me you think he jumped.
Based on Dr.
Choi's assessment, it seems like there might be a possibility.
And so I just I wouldn't be doing my job if I didn't say a quick hello.
- Oh, my God.
- Honey, no, no.
That's ridiculous.
It's those kids he hangs out with.
They're wild.
They were probably goofing around and it went too far.
Mm, very possible.
But it's not so easy to accidentally fall off one of those things.
You know what? I bet he got pushed by that homeless guy.
- Yeah.
- Homeless guy? Yeah, there's this man who stands on that overpass screaming all day.
He's psychotic and dangerous.
Huh.
Okay.
Well, uh, I'm sure the police will look into that.
But in the meantime, we just wanna make sure we're not missing anything.
Zach could've died today, okay? The last thing he needs is to be interrogated by a shrink.
Now, which one's his room? Treatment 5.
Are we gonna have a hard time with them? The dad? Yeah.
The mom? Not so sure.
Hey, Mom.
Hey.
Okay.
Michael.
Tell me.
Meet the newest clinical device specialist for Kender Bio Systems! - You got the job.
- Yeah.
Joining the Kender team right here.
- Here at Med? - Mm-hmm.
Given the size of the contract, they need more people.
That's wonderful.
Mom, I know you always wanted me to be a doctor.
Michael, I just wanted you To be happy.
I know, but believe me.
Kender's training is like going to med school.
I'll know more about the devices than the docs.
And I'll be in the OR right alongside them.
I'm so proud of you.
Oh, I gotta hook up with my supervisor.
- Take you to lunch? - It's a date.
All right.
Zach, how you doing? I'm Dr.
Charles.
He's a psychiatrist.
Legally, we have to let him talk to you.
Harris.
I'm really just here to help, Zach, and was hoping to ask you a few quick questions about what happened today.
O-okay.
Okay, so this morning, you left your house.
And where were you headed? Nowhere, I was just taking a walk.
Okay.
By yourself? - Yeah.
- Okay.
Got it.
So you get to this overpass and and what happened then? Tell him about that homeless man, Zach.
Like you told us.
Yeah, there was There was this guy who was yelling and acting crazy.
Right.
And, uh, he started shoving me, and I tried to get out of the way, but he he wouldn't stop, and before I knew it, I I lost my balance.
All right.
Well, um you know, Zach's been through a lot today.
Has anybody asked him if he wants anything to eat? - No.
- No? Are you hungry, buddy? How about a sandwich? - Maybe maybe turkey.
- Okay.
Um, why don't we get going on that? And then when we get back, maybe we can talk a little bit more, okay? Nice to meet you, Zach.
Thank you.
You know his parents coached him to say that.
Are they worried he's gonna get arrested? Probably.
Look, even if Zach won't admit he jumped, we gotta put him on a psych hold for his own good.
Forced hold? Taking a minor away from his parents is a very high bar to clear, you know? More importantly, it doesn't really tend to work unless you get buy-in from the whole family.
We can't let a suicidal kid walk out of here.
I hear you.
Look, let's see what a turkey sandwich gets us, okay? Moms love to see their kids get fed.
Her cervix isn't handling the weight of the growing fetus and is starting to open up.
She's already dilated one centimeter.
Then she's going to lose the pregnancy.
Maybe not.
I'd like to try her on progesterone, see if we can stop her from dilating any farther.
Wait, is that safe? I mean, given her increased chance of infection and bleeding? This is a unique situation, due to her limited time frame.
This pregnancy is very important to her.
I'd like to try and save it.
Okay, then.
Thanks.
Dr.
Halstead, I've read the literature on cervical insufficiency with bleeding in high-risk patients, and trying to intervene is not the standard of care.
Dr.
Asher is the specialist.
I trust her.
She's had a drug problem.
That is irrelevant.
You're way out of line, Ms.
Curry.
He's cold.
And he's getting a little short of breath.
What's taking IR so long to get him down for his TIPS? They're always backed up.
I'll give them a call.
Wait, he's not even on the schedule.
What? I put the order in an hour ago.
Uh-uh, it says he's been denied by DCFS.
- Can they do that? - I don't know.
Come on.
Madeline If this is about Auggie, I'm sorry.
But until the Kramers get final approval, the state is still Auggie's legal guardian.
He's getting worse.
He needs this.
According to the Illinois health service protocols, TIPS is only indicated if two other previous treatments fail.
That's just a guideline.
Every patient is different.
Which is why I've already escalated this to a physician mediator appointed by the state.
That's gonna take days.
He needs this now! Look, he's at risk for encephalopathy, peritonitis I understand Madeline, he needs someone to advocate for him.
And I'm trying my best.
There's nothing else I can do.
Dr.
Lanik, do you remember Auggie Roberts? Foster kid.
Sure.
He's getting worse.
I was wondering, could you write a note saying that he'd do well to receive a TIPS procedure? Well, he's upstairs now.
Get his pediatrician to do it.
She did, but there's some red tape.
I thought if we had a double doc, we could convene an ethics committee and we could Oh, so my quick note is turning into an afternoon - in front of a committee? - Dr.
Lanik Maggie, I have patients to see.
And you have a waiting room full of them to process.
Three centimeters, you're still progressing.
So what do we do now? Well, we can try increasing the progesterone, give you a little more time to see if we can turn this around.
- I agree.
- Are you sure? The longer we wait, the greater the chance of a serious complication.
I don't believe we're there yet.
What do you think we should do? Terminate the pregnancy.
At this point, it's the safest option.
What? No.
Ms.
Curry is a medical student, not a doctor.
I need to have this baby! So my husband can have someone to love him as much as I do and someone he can love.
If I can have that then I'm okay to die.
We'll increase your meds and check back in a little bit.
You gonna get your nose out of that laptop? I'm sorry, Mom.
I just got so much prep to do.
Let me ask you, Dr.
Latham, CT surgeon You know if he's into anything, any hobbies? No, not really.
We don't socialize.
A lot of CT surgeons are into cars.
You know, vintage, racing? Yeah, that doesn't sound like Dr.
Latham.
How about Dr.
Abrams? I hear his wife makes some kind of power drink.
- Is he a gym rat? - Why are you asking this? Well, I'm gonna be working with these guys.
It'd be nice to have something to talk about.
Well, what about the medical devices they'll be using? Well, that's a given.
But you know how touchy these surgeons can be.
Since I'm gonna be coaching them, I want to establish a rapport.
Well, our surgeons are at the top of their game.
I doubt if they need any coaching.
Sure.
It's just, we have a lot of exciting new products I'll be introducing them to.
And, you know, business is all about relationships.
I'm sorry, Dr.
Charles, but the Brands' lawyer is here, and apparently you can't speak to Zach until legal gets it straightened out.
Mr.
and Mrs.
Brand, just wanna let you know the field officers have completed their investigation.
Did they find that homeless man? No.
In fact, we couldn't find any eyewitnesses at all.
So Zach can go? Well, hold on.
There's still one more witness, - the woman who was driving the car.
- Oh, for God's sake.
Are you just trying to get my son arrested? No, I'm trying to get him the help he needs.
Mr.
and Mrs.
Brand, if it turns out that Zach did in fact jump, then I would be able Hopefully with your blessing To put him on a hold and we can start to address this.
He would likely be charged.
But I will personally advocate for him and, under the circumstances, can practically guarantee he would not be prosecuted.
My son is not suicidal.
The driver's still unconscious.
If she wakes up, we'll question her then.
But in the meantime, I can't keep him here any longer.
I gotta let him go.
Thank you.
Rosado don't let them leave just yet.
I'll be right back.
Crockett, I need you to wake her up.
What? Why? The boy needs our help.
All right, she's our only chance.
If she confirms he jumped, we can give him the help he needs.
Yeah, I'm sorry.
She's not ready.
Why not? Huh? She's overbreathing the vent.
Her vitals are stable.
I just rebuilt her diaphragm and her belly's open.
- She's not there yet.
- Come on, man.
You're telling me you can't lighten her sedation for five minutes? If I wake her up now, she could still go into metabolic crisis.
And if you don't, there's a severely troubled kid who can't get the help he needs.
Well, I don't know what to tell you, man.
But I'm gonna do what's best for my patient.
If that boy tries to kill himself again That's on you.
His pressure's dropping.
We need more suction, blood, and drugs to intubate.
What happened? He was coughing, and then he just started throwing up blood.
Esophageal varices.
The pressure must've opened one up.
Auggie, I need you to calm down, okay? We're gonna take good care of you.
Auggie.
Auggie, listen to me.
- No! - Auggie.
- Drugs are in.
- I know this is scary.
But you're so brave.
I need you to be brave just a little bit longer.
Can you do that for me? - All right.
- He's out.
I'm in.
Bag him.
All right, let's get him up to the IR for a TIPS.
Let's go.
It's emergent now.
No need for consent.
- What do you think? - Dr.
Asher, Dr.
Halstead! Oh, oh, okay.
She's losing the pregnancy.
Marcie, I'm sorry, but we need to get the fetus out now.
- No, no! - Marcie.
It's okay.
It's okay.
Dr.
Halstead, please don't let my baby die.
Hannah.
Okay, we could try what's called a cerclage.
It's a procedure to tie your cervix closed.
But in your case, we would have to go - in through the abdomen.
- What? With the placement of her placenta and her bleeding, that would be extremely risky.
How risky? Well, the chances of catastrophic bleeding are high.
Not to mention the significant cardiac risks of anesthesia.
It's true.
There's no guarantee at all that you would survive this.
Hon, that sounds like a bad idea.
Do it.
Marcie, we can always try again.
No, we can't! You know that.
Do it! All right, let's go.
Come on.
Marcie, no! I love you.
That's why I have to do this.
- Come on.
- Elsa, call the OR.
Dr.
Halstead, this is crazy.
I'm sorry.
That woman is gonna die.
That's a risk she's willing to take.
What are you doing this because of your feelings for Dr.
Asher? Call the OR now.
Please, it is a mistake to send Zach home.
I believe your son is depressed.
Depressed? I hate that word.
It's just an excuse for weakness.
Our son is not weak.
Dr.
Charles.
I think that we have said everything there is to say, Dr.
Choi.
Unless, of course, there's something that either of you feel like you you might have left out.
Her vitals look good.
How's her rhythm been? Stable.
Dr.
Marcel was talking about lightening her sedation.
Yeah, I'll take care of it.
Don't try to talk.
You're intubated in the hospital.
You're safe.
I just need to know.
Did you see the boy who landed on your car? Okay.
Did he get pushed Or did he jump? Please.
Just think.
You were driving toward the bridge.
He was on it.
You saw him.
Did he jump? Okay.
Mr.
Brand, uh, we forgot to validate your parking.
Come with me.
I'll be right back.
Mrs.
Brand.
I think that your son needs help.
Now, I recognize that your family situation is complicated.
And I can't imagine how challenging that must be under the circumstances.
But listen.
Here's my card.
I hope you will call me anytime of the day or night.
All right? The only thing that you don't wanna do is let your son go through this alone.
Thank you.
Okay.
Oh, hey.
How's he doing? He finally got his procedure, no thanks to you.
Maggie.
You know that under the circumstances, I did everything I could.
Did you? Because it took him hemorrhaging for him to get this.
I can see the cervix.
Hold it gently so I can get it isolated.
Mm-hmm.
It's bleeding.
It's too vascular.
Laps to me.
Give her a gram of TXA.
Still bleeding.
More laps.
Pressure's dropping.
We may need to terminate the procedure.
Watch her rhythm.
She's throwing PVCs.
I think we need to call it.
Switch to a hysterotomy.
No, no, no.
Her water's still intact, and we've got plenty of blood in reserve.
- We can still do this.
- Are you sure? Yes.
Okay.
Talk me through it.
Release the laps so I can get some celox in there.
Lap? All right, it's working.
Bleeding's slowed.
Okay, hold it steady so I can get it packed.
We did it.
How's she look? BP is coming back up, but I still can't shake these irregular beats.
Okay, then we're not out of the woods yet.
Let's get ready to place the stitch.
Where is he? Where is he? You got a lot of nerve interfering with my patient! I had to.
The boy needed help.
The boy.
Don't kid yourself.
This wasn't about him.
It was about me.
The hell it was.
You've been pushing against me all day, man.
- Because you deserved it.
- Oh, come on! You know what this is about.
It's about April.
No, you don't wanna go there.
No, I wanna end this.
So what's it gonna take? You need to hit me? That it? Huh, big man? Go on.
Take your best shot! There it is.
There it is.
Okay, and snip.
Okay, cerclage is complete.
Ready to close.
Her pressure's dropping and she's got ectopy.
I don't see anything.
It's here.
She's hemorrhaging! - The placenta.
- We need to terminate the pregnancy.
Trigger the MTP and convert to a hysterotomy now.
- What do you need? - Cut the cerclage.
She's in V-fib.
Damn it, give me a scalpel! Start CPR! Starting compressions.
Charged.
- Placenta out.
- Charge to 200.
Get some blood in her.
Charged.
All right, clear.
Still in V-fib.
- No pulse.
- Charge to 200.
Give her an amp of epi! Charged.
Clear! Come on, give another amp of epi.
Charge to 200! Hannah.
What are you waiting for? Shock her! She bled out.
Time of death: 18:04.
Hannah.
Oh, boy.
You, uh you all right? Did Zach leave? Uh, yeah.
You know, I was finally able to talk to his mom alone.
Poor thing.
I don't know.
She did take my card.
I don't get it.
The boy's so deeply troubled, but the dad just doesn't wanna face it.
Well, you know, maybe it's just easier for him to focus his anxiety and anger elsewhere rather than face the pain of looking at the The real problem, you know? Anyway see you tomorrow.
Now the Amulet of Krogg.
What do I do with it? No, it's Kroog.
Kroog.
Okay.
I'll be right back.
And I'm gonna beat you.
Is he going to be okay? Now, at least.
Good.
But I'm afraid I've got some bad news.
The foster family backed out.
They felt he would just be too much to handle.
So he'll have to go back on the list? I'm afraid so.
I'm sorry.
Sharon.
Yeah? We'll do it.
We'll foster him.
Maggie, you don't have to do No.
We want to.
Are you sure? Okay.
I'll let DCFS know.
Mr.
Burton.
I'm so sorry.
My wife made it very clear what she wanted.
Thank you for honoring her wishes.
I always knew this day would come.
But still it's so hard.
Hey, Hannah.
Today was a tough one.
But you made the right decision.
Yeah, but doesn't make it any easier.
I need I need to go to an NA meeting.
Okay.
I'll drive you.
Hey, Mom.
I'll see you tomorrow.
Ah.
See you tomorrow.
Dr.
Lanik.
Hey, Michael.
Your son is a good salesman.
Yeah? Yeah, he somehow knew I was a scotch drinker.
Gave me this great bottle of single malt.
Your eye okay? Yeah, I'll live.
So you sure have been making a lot of new friends since coming over to the day shift.
Yeah.
That's what I do.
Make friends.
Are you okay, Crockett? Oh, yeah.
That lidocaine works fast.
- That's not what I meant.
- I know what you meant.
Let's just keep it at the lidocaine.
Really? You hit him? You know, the thing is, April It was so easy for me to see Crockett as the problem.
Yeah, and I told you.
Whatever happened between me and him in the past Yeah.
I know.
I get it now.
Because the real problem was always right here.
Between us.
April, whatever it is you want It isn't me.
Ethan, that's not true.
What are you Where are you going? What are the bags for? - I'm gonna find a hotel.
- No! Ethan, stop! Listen.
Just just take as long as you need to find a new place.
What? Ethan! Oh, God.