Chicago Med (2015) s06e14 Episode Script
A Red Pill, a Blue Pill
1
I can't find the artery.
I can't find Dean, you can do this.
Dr.
Charles helped me, and he can help you, too.
PTSD just doesn't go away, Dean.
I don't need therapy.
I have a daughter, Vanessa.
I found out that she was in medical school.
So you don't intend to see her again? Of course I want to.
What was your impression of her? Good candidate.
It'd be great to get her.
Medication was supposed to be sent back to Kender.
Package for Kender.
Someone already picked that up.
Is it even that big of a deal though? I'm gonna have to find them one way or another.
[DRAMATIC MUSIC.]
Welcome and congratulations.
You've all done well enough to get this far.
But this ED only accepts one med student a year from this audition, so these next few weeks are your one and only opportunity to impress.
No pressure.
Now, you're new, so I'm expecting some mistakes, but I'm also expecting you to display the confidence to push through those mistakes.
And if some of the nurses take a liking to you, that wouldn't hurt either.
- So which one of them are you so keen on? - Huh? The student application that you asked me to move to the top of the pile, Vanessa Taylor? That's her right there.
Ah, how do you know her, friend of the family? No, residency fair.
She just stood out.
Maggie, hi! I'm not sure if you remember me or not, but Of course I do.
You led me to Beecher Hall.
And you played the Scarecrow in middle school.
- Scarecrow? - Good memory.
- Vanessa Taylor, this is - Sharon Goodwin.
I was up last night doing research because I couldn't sleep.
I'm a bit excited if you can't tell.
Pleased to meet you, Ms.
Taylor.
Yeah, I should get back to the group, but thank you both for this opportunity.
- She's a go-getter.
- [CHUCKLES.]
[SOFT MUSIC.]
- Good morning.
- Morning.
Oh, hey, Dean.
You wanna grab lunch today? Wednesday is Reuben day.
This wouldn't happen to be your subtle attempt to sit me down for one of your casual check-ins, would it? - Busted.
- Yeah.
Well, tell you what, you have my full permission to tell Dr.
Choi that we spoke if it gets him off your back.
Everybody who works here has got to do this, including Dr.
Choi, but it's no big deal.
It'll take five minutes.
We can talk about gardening if you want.
I just gotta cross you off my list.
Thing is, I've found that what works best for me is when I steal away for some quiet personal time every day.
Unfortunately, I found that the only time I have for that is my lunch hour.
You understand.
Look, I am gonna have to pin you down eventually - [ALARM BLARES.]
- Or Goodwin's gonna get mad at me.
Yeah, they're playing my song.
Treatment 4.
Neil Dietrich, 24, collapsed at the park with severe abdominal pains.
Wouldn't let us take his vitals, but we were able to get a saliva swab, COVID negative.
What's going on, Neil? It's just a stomachache, okay? Whatever's wrong with me, probably go away on its own.
I don't know, I think maybe you should give us professionals a shot.
- One, two, three.
- [GROANS.]
- Okay.
- This isn't necessary! [TENSE MUSIC.]
- Stop, leave me alone! - 100.
9.
You have a fever, Neil, your body's way of telling us something's wrong.
Yeah, I'll be fine.
And that pain you're experiencing, I can make that go away easy.
Little morphine will have you feeling like it's a day at the spa.
No, please, leave me alone! Okay, well, if you won't let us treat you, maybe there's something else we can do to help? No, nothing you can do will matter.
How could you possibly believe that nothing we do will matter, nothing? - Because - Because? Come on, Neil, level with me.
I can take it.
Because none of this is real, okay? It's just a computer simulation.
[DRAMATIC MUSIC.]
It's obvious.
Every facet of our lives has been preprogrammed.
The richest 1% of the world owns 99% of basically everything.
- How's that possible? - Excellent question.
- Where does it hurt, Neil? - I'll be fine.
It's possible because the game is rigged.
All right, and who exactly is playing the game? All real people are players.
They have no choice.
I mean, obviously, there's some form of higher intelligence that created the simulation for a reason.
Which is? That's what I'm trying to find out, but clearly, some part of it is to keep real people compliant.
Are you are you a real person? The real question is, are you a real person, or are you an NPC? What's that? A non-player character a computer construct to maintain order of the simulation.
Well, despite our different beliefs, I think we can all agree that with the fever and the intermittent stabbing pain that you are unwell, and perhaps now's a good time to do something about that.
No, I'm sorry, I'm not gonna change my mind on this.
Neil, let's say you're right.
What I'd understand is that your pain is obviously very real to you.
And all we're trying to do is figure out what's causing it.
You don't want to let us do that? No, 'cause you could reverse the effects of the red pill.
The red pill? There's this red pill you take that initiates the process of waking you up outside of the simulation.
So you took one of these red pills? Yeah, thankfully.
Whatever you ingested might be making you sick.
See, that's exactly what an NPC would say.
But you know what? You're right.
Whatever I'm feeling right now, it's probably just the red pill starting to work, and if that's what it takes to wake up in the real world, so be it.
[DRAMATIC MUSIC.]
How much longer do I have to stay here? Give Dr.
Archer and I a couple minutes, and we'll be right back.
Well, if he hasn't poisoned himself with whatever he took, - he probably has appendicitis.
- Yeah.
Look, I mean, there's always a psych hold, but it'll just antagonize him, and we'll never find out what he took.
- Slow roll the paperwork a bit.
- Yeah, all right.
I wanna study up on this whole simulation thing a bit, see if I can get in better sync with his logic.
Logic? He thinks we're living in a computer game.
Hopefully, we will dispel him of that notion.
It's called the emergency room for a reason.
Working fast is key but not at the expense of working smart.
If you could do both, that's what we're looking for.
Good morning, Ms.
Royko.
Patient here is 62 years old.
She's experiencing a persistent headache, some blurry vision, and has a known history of diabetes.
All right, what's your differential? I suspect hypertension.
Do we know her BP yet? 226 over 115.
That would certainly qualify as hypertension, and what would your course of treatment be? - I'd push 10 of hydralazine.
- Well done.
Doris, push 10 of hydralazine, as recommended by student doctor Mims here.
Excuse us.
Moving on.
Vanessa, hey.
I couldn't help but notice, it seemed like you had the answer yourself.
Obviously, she has hypertension.
I raised my hand.
I just didn't get called on.
And frankly, I think Cardizem would be better than hydralazine.
If I may, word of advice: It wouldn't hurt to assert yourself a little bit more.
Student doctor Taylor.
You with us or not? [WHEEZING.]
Maggie, we need a room! What's going on with your mom? She's been passing out intermittently, started before breakfast.
What's Maggie doing here? What? Carol, we're gonna take good care of you Herbert! Okay, I'm gonna call the cardiologist and tell them to come down.
No, no, no, Nat, I'm gonna page Dr.
Young.
You go be with your mom.
Will, what are you doing in here? What do you mean? I'm up, and it's your mother.
She's having syncopal episodes? Yeah, I think it, um might have something to do with the LVAD? Okay, well, her lungs are clear, so that's a good sign.
But your extremities are super cold, Carol.
- I know.
- Let's do an EKG.
Thank you for stepping in, but I've paged Dr.
Young, and, um I think that we can manage until they come down.
Please, don't go.
I'm really scared, Will.
Could you stay, please? I'm not going anywhere, Carol.
I promise.
We'll just get some preliminary tests going, - give Dr.
Young a head start.
- All right.
I'll run a panel.
Remind me again what medications she's on? What? I assume she's on a beta blocker.
Yes, uh Metoprolol 25 milligrams twice daily, plus Lasix the same, and rosuvastatin, I believe 10 milligrams once a day.
Okay.
And don't forget about that new pill you gave me.
The one that's supposed to help my heart pump.
New one? Yes, I put her on a fish oil supplement, - that's all.
- No, it's a little blue pill.
I'll show it to you.
It's in my bag.
No, no, no, Mom, Mom.
Your bag is in the car.
- Well, I'll just go get it.
- No, Mom, you don't need it.
I need the stuff that's in there.
Okay, okay, Mom, Mom, Mom, I have to go move the car.
I will bring it in.
I'll be right back, okay? - All right.
- Okay.
You're each gonna be working one-on-one with the attendings.
Dr.
Driskell here will have your assignments.
Follow him.
- Taylor.
- Yes, sir? You start with me.
[GAGGING AND COUGHING.]
You can't go on like this, Neil.
I have to.
It's the only way to see what real life is.
Oh, good, no red pill.
Neil, are you familiar with the butterfly dream? You know, the Chinese philosopher who dreamt he was a butterfly? Yeah, only he woke up only to question whether or not he was the butterfly or the man.
Right.
You're not gonna convince me I'm wrong just 'cause there have been other philosophies about hypothetical simulations.
Well, but what struck me is that he did wake up, right? And then was able to acknowledge that one of those experiences was reality, right? You're making my point, okay? I'm trying to wake up.
That's my goal.
- I know what I'm doing.
- I've heard that before.
So a few years back in Afghanistan, I was working alongside this joint task force hunting down Taliban extremists.
Let me tell you, we saw some pretty gnarly stuff that you would not believe.
These soldiers, they didn't come any tougher.
When they had a mission, that was all that mattered.
Even with the worst injuries, they would not be deterred.
- I get that.
- I know you do.
But sometimes those same injuries that they ignored ended up killing them.
These were preventable deaths, and I do not want to see that happening to you, Neil.
You don't seem to understand, okay.
I can handle death.
I have to die to live.
Having witnessed that firsthand, that is patently untrue.
Look, well it's just, whatever you think you saw over there, none of that actually happened.
- You just think that it did.
- Okay.
It's part of the game.
All right.
[GROANS.]
- I-I told you not to touch me! - Hey.
No, no, I'm sorry, sorry.
I just wanted to find out where you're most sensitive, - that's all.
- [GROANS.]
Dr.
Charles, a word, please? He's guarding his lower right quadrant.
He has appendicitis.
I've seen this a hundred times.
All right, if we don't do anything about it, his appendix will rupture, and, if that happens, his whole life is gonna be in jeopardy.
I'm aware of what a ruptured appendix means, but why did you palpate him? He wouldn't let me come near him otherwise, right? I needed to get a read on him.
He's not even gonna get a scan.
I completely get how upsetting it must be to hear your military experience characterized that way, but, Dean, that guy's delusional.
I think you misread the moment, Dr.
Charles.
Right, I don't blame you for thinking that's what you saw, okay, but I was honestly trying to make a diagnosis, and now that I have, I think it's time for you to get a court order, so we can force treatment.
You know, if and when I determine that the patient lacks decisional capacity, I will absolutely reach out to a judge.
"If"? Are you kidding me? This guy's a box of loose screws.
Well, no, actually, he's a patient.
[DRAMATIC MUSIC.]
- Where are they taking me? - To get an echo, Carol.
A transthoracic echocardiogram will show us exactly how your heart pumps.
And this could be because of the LVAD, right? We'll see.
Mom, it's a really simple procedure.
I'll be right here when you get out.
Okay? I love you.
- Hey.
- Hey.
Sorry, didn't mean to startle you.
No, it's okay, I, um been a little on edge today.
Yeah, saw your mom was here.
Yeah, Dr.
Young still doesn't know what's going on, but something's affecting her circulation enough to cause her to pass out.
Oh, I'm sorry to hear that.
She's up for an echo now, so we should know more soon.
Well, hope the echo brings some good news.
- Thank you.
- See you.
See ya.
Hey, Doris.
What's going on in there? We got a drug addict in there whose veins are shot to hell.
Can't get a peripheral in.
- Ethan's asking for a - Triple lumen kit? - Here you go.
- Thanks.
Listen, I'm feeling a little restless just directing traffic.
I got an itch to slip on the gloves.
How 'bout you and me swap places for the day? I get to hold the brick? Thank you.
Here you go, Dr.
Choi.
- What happened to Doris? - You got me instead.
- You disappointed? - Never.
So you ever insert a central line? Plenty of times in med school, yes, sir.
Show me what you got then.
All right, Shawn.
I'm gonna get you prepped for this.
Pull down your gown.
Lidocaine? Yes, of course.
Thank you, Maggie.
Ethan? Goodwin's requesting your presence at the 2:30 budget meeting.
All right, I'll be right there.
Taylor.
You think you can handle this yourself? Yes, of course, Dr.
Choi.
I'm confident I can do this on my own.
I've assisted a million.
I've got her back.
Great.
Any problems, you notify an attending.
I'll be back in a bit.
- Crockett.
- Yeah? - You're up.
- Okay.
- Cesar, Baghdad.
- What do we got? Edgar Fuentes, 25, took a GSW to the leg in a drive-by.
Vitals are stable.
Applied a pressure dressing en route.
Bleeding's controlled.
Okay, Mr.
Fuentes, I'm Dr.
Marcel.
I'll be taking care of you.
Okay? - This hurts like hell.
- Yeah.
He was working on the car out front.
- He wasn't even doing anything.
- Right.
My wife Rosa, our baby Ada.
Well, I'm sorry we all had to meet this way.
Okay, folks, on me.
- Ready, set, lift.
- [GROANS.]
Nice and easy, you're okay.
Can you wiggle your toes for me? Yeah, but hurts.
We got two wounds, lateral thigh.
Nowhere near the blood vessel.
Probably through and through, but let's get an x-ray just to prove it.
50 fentanyl, please.
You're gonna be okay, Mr.
Fuentes.
Come here, come here.
All right.
Look, he's gonna be okay.
It's just a flesh wound.
- All right? - It looks so much worse.
We're gonna get an x-ray just to be sure.
Oh, my God.
Is she okay? - Huh? - Your baby, is she okay? - Ada? - May I? What? What? Hey, sweetheart.
- What is that? - Your baby's been shot.
- What? - I need help in here! Oh, my God! No! [SOBBING.]
No! Yep, there's the bullet.
[EXHALING HEAVILY.]
- Pressure's still low.
- Want me to hang another unit? No, let's do it up in the OR.
Let's move now.
I heard the gunfire, but I didn't hear a window break.
It could have come through the wall.
- I've seen it before.
- She was bundled up.
She seemed fine she wasn't bleeding or anything.
Pressure from the swaddle probably stopped the flow of blood.
- How could I not have noticed? - You didn't do anything wrong.
Look, I'm gonna do everything in my power to save your baby's life.
All right, let's go.
Put back pressure on the syringe, and walk the needle down the clavicle until you hit the vein.
- I lost the vacuum.
- It's just filled with air.
- I must have hit the lung.
- Worry about that later.
We still have a line to put in.
Now pull the needle back, and eject the air.
Now try again until you find the vein.
Wait a minute.
What's going on? It's okay, Shawn.
We're working on it.
Go ahead.
All right.
I'm drawing blood.
Perfect.
- Well done.
- What about the lung? I should go tell Dr.
Choi.
Let's just finish the procedure, okay? So physically there is something very wrong with you.
By all indications, your appendix is about to burst.
So what I'm asking is if you would please just let us do a scan.
I'm not getting a scan.
No matter what it would show, it's just the simulation's explanation of what the red pill is doing.
Neil, I respect your point of view.
But you need to understand that my reality is that I'm a doctor, and I can't just let you die, which is why I'm seriously considering going to talk to a judge this afternoon about taking away your ability to make your own medical decisions.
What, because you think I'm delusional? Of course you would think that.
That's actually not what I said.
Can I ask you something? Why is it that my belief is the one being questioned? Hey, I'm sorry to pull you out of your meeting, - but it's important.
- What's going on? So I have an appendicitis patient who's refusing treatment because he believes that we're living in a computer simulation.
- A what? - Yeah, I know, it's he's nuts.
Just page Dr.
Charles.
Well, no, see, Dr.
Charles is the problem.
He's dragging his heels on forcing the treatment that the guy needs.
- Is it emergent? - I believe it is, yeah.
- All right, what can I do? - Well, I want you to weigh in.
With another sensible voice in the room, maybe the two of ours can drown his out.
I'll take a look, but I can't imagine double doc-ing Dr.
Charles on a decisional capacity ruling.
Uh-huh.
You know what? Forget it.
I'm not interested in having a courtesy consult.
Dean, I know how frustrating it is to be in your position.
I've butted heads with Dr.
Charles on the same issue in the past.
Oh, yet now you sit on your hands? Watch it, Dean.
You're right, you're right.
I was I was over the line.
All clear.
Just like I thought.
There's a pneumothorax.
This happens all the time, even to the most seasoned doctors.
It happened to Ethan last week.
Don't beat yourself up.
I'll go find Dr.
Choi.
Or you can fix it yourself.
Insert a chest tube? Mm-hmm, you're comfortable doing that, right? - Sure, but I - Listen, Vanessa.
Everyone makes mistakes, but this way you can show Dr.
Choi that you know how to correct yours on your own.
I don't know.
If you want to win a permanent spot in this ED, this is how you do it.
All right.
Yeah, let's do it.
Hey, Shawn? It appears that when we did the procedure, we hit your lung.
It's nothing serious, but in order to fix the problem, we're gonna have to put a tube in your chest, and we need your consent.
Is it necessary? Unfortunately, it is, but we're gonna numb you up, we're gonna give you a little bit more sedation, and you'll hardly feel anything.
- Okay.
- All right.
You lay back and relax.
How'd it go? - No luck.
- No CT, okay.
Nurse Sexton! Yes? He's not protecting his airway.
I need to intubate him.
Get a line.
Order a CT.
Call the OR.
Make sure they have a room open in case we need to bring him up to surgery.
Wait, didn't Neil say that he didn't want to be treated? He did, but now he's unconscious.
So you're just gonna disregard what he wanted? When a patient is no longer able to make medical decisions, and there's no one to stand up for them, the hospital assumes power of attorney.
20 of etomidate, 100 of sux.
Should I not intubate him? He doesn't have a DNI.
Tell me! I have to admit, when your mother came in this morning, I assumed it was because her heart was on the brink of failure, but that's not what the echo is showing.
Looks like her heart is beating more effectively.
I mean, when you have the kind of underlying disease Carol does, the heart can behave inconsistently, but rarely does it show this kind of improvement.
Yeah, that is odd.
So why does my mom keep passing out? It's a phenomenon called "suck down".
The heart's contracting so hard that the ventricle wall is getting sucked into the LVAD, too.
The poor blood circulation is leading to a lack of cerebral perfusion.
Well, what do we do now? I'm going to consult with Dr.
Latham as soon as he gets out of surgery.
There's a chance he'll want to sew the left ventricle shut to help the LVAD work effectively.
Well, I mean, this is good news, right? I hesitate to call it good news until we figure out exactly what's going on.
- Thank you, Dr.
Young.
- Thank you.
Wow.
That's not something you see every day.
Yeah.
Must be the fish oil she's taking.
What are you doing? Will, why are you going through my mom's bag what are you doing? Let's see what these magical supplements look like.
God, this is so Will! Nope, that's the beta blocker.
Stop.
That's the statin, and those two are Lasix.
- Where'd they go, Natalie? - What are you talking about? The trial drugs that went missing? The blue pills.
I know you took them.
What'd you do with them? I can't believe you're accusing me of this.
The improved function in your mom's left ventricle.
Your sudden interest in the drug's side effects last week.
Come to think of it, you never did tell me the name of that trial patient with the dry cough.
- I wonder who it is.
- Please, come on.
This is ridiculous! You are dosing your mother with an untested clinical trial drug, Natalie, without supervision or monitoring.
We don't know how the drug interacts with an LVAD.
It could kill her.
You need to come clean right now.
Will - Will, I - Just give me that.
No, Will, wait, wait.
Wait! You heard the cardiologist.
Mom's heart is pumping harder.
The drugs could be working.
We don't know that for sure.
Please, I am desperate, and everything you said about the drug was good.
I didn't think I was putting Mom in any danger.
This is really bad, Nat.
Will, please.
Please.
Please [KNOCKING.]
- Am I interrupting? - Not at all.
I was just talking to a judge, trying to get a court order so we could treat Neil, but without definitive proof of his medical condition, he couldn't help us.
Well, it doesn't matter because Dr.
Archer took Neil up to surgery and is removing his appendix right now.
Wait, Neil agreed to that? No, but he went into respiratory distress and needed to be intubated.
Leaving Dean to make medical decisions on his behalf? Yeah.
I saw how frustrated Dr.
Archer was with Neil before.
Definitely.
It got me thinking, could he have could he have overmedicated Neil to knock him unconscious? Oh, God.
[SOFT DRAMATIC MUSIC.]
- - Will.
Sabeena.
[LAPTOP SHUTS.]
I didn't know you were coming in today.
Just passing through.
Thought I'd see how you were doing.
I have a meeting with the head lab technician.
Yeah, no, everything's all good here.
Just taking a break.
Okay.
Hey, the drug we're testing, any idea how it might affect a patient with an LVAD? The drug's an inotrope essentially, a chemical LVAD.
Why would anyone do that? Just a hypothetical.
I can't imagine why it would ever be prescribed in that situation.
But listen, we're a few months out from seeking FDA approval.
If there's a patient suffering any adverse reaction, - it needs to be reported.
- No.
Nothing like that.
[DRAMATIC MUSIC.]
The baby's still hypotensive.
I don't know if she's gonna survive this.
Trying to find the source of the bleed.
What do you want me to do? Just keep giving her more blood.
Okay.
Come on.
Hey, Shawn, how you doing? - Much better, thank you.
- Let's check your work.
Line placement looks good As does this chest tube, though I don't remember our patient requiring one.
Well, sir, when I made my first attempt at placing the central line, I noticed air coming out of the syringe, so I So she ordered an x-ray to see if there was a pneumo.
- And there was, so she - Yeah, I understand.
Student doctor Taylor, can I have a word with you outside? We'll be right back, Shawn.
Placing a chest tube is considered a surgical procedure that requires prior consent from the patient.
We okayed it with the patient.
- "We"? - Maggie and myself.
Consent for the procedure can only be obtained by a licensed physician.
Neither you nor Nurse Lockwood qualify.
I'm sorry, I didn't realize You acted recklessly.
By not notifying your supervisor, you put me and the ED at risk.
Don't worry, I'll fix this.
Ethan.
Listen, Vanessa was just following my instructions She's gonna be a doctor.
What happens in that treatment room is her decision.
But this is my fault.
She's a top-notch student.
She's head of her class.
What are you talking about? Student doctor Vanessa Taylor, I was assisting her.
I gave her some bad advice, but she solved the problem herself.
Mags, why are you going so far out of your way to help this student? Please, Ethan, give her a second chance.
She shouldn't have to pay for my mistake.
I'll give it some consideration.
Thank you.
Why were you assisting her? Doris and I just switched places for a bit.
I have to relieve her now.
So I understand that we have an update on our patient? Unfortunately, we waited so long his appendix perforated, so I removed it, washed his belly out, and he's recovering in the ICU.
How did that happen exactly? Well, he stopped protecting his airway, so I had to intubate him.
Which then gave you the authority to make medical decisions for him? Whoa, hey, if I hadn't come upon Neil when I did, oh, he'd be dead.
He'd stopped breathing.
- From appendicitis? - Mm-hmm.
You know that'd be a first, right? He was septic.
His appendix ruptured.
And why the hell am I getting the third degree? You're the one who was about to almost let a crazy person kill themselves! - Dean, stop! - No, no, no.
Remember, at the end of the day, it's my word versus Neil's the guy who thinks this whole thing is a game of Tetris! Enough.
Dean, take a walk.
Someone want to tell me what's going on? Mr.
and Mrs.
Fuentes.
Is my Ada okay? She's currently on a breathing machine up in the PICU.
Now, we're not out of the woods yet, but I was able to stop the bleeding.
She's alive.
Thank you, Dr.
Marcel.
Yeah, my pleasure.
I don't know what I would have done if we'd lost her.
She's gonna be all right.
[SOFT MUSIC.]
Well, hopefully, we'll get her extubated tomorrow.
In the meantime, Nurse Trini here, she's gonna escort you up to the PICU here in a bit.
You can see her, okay? - Thank you.
- Yeah, my pleasure.
Thanks.
- Hey.
- Hey.
- You been in surgery? - Yeah.
Seven-month-old baby with a GSW.
She's gonna be okay though.
Are you? Yeah.
Yeah, I'm gonna be fine.
Thanks.
Listen, I wanted to talk to you about something, but I was a little nervous about how you might take it, which I know is out of my control, so Natalie, you got a minute? It's about your mom.
Oh.
Yeah.
- Go ahead.
- Sorry.
I feel incredible.
Your hands are warm, and your color is starting to come back.
Oh! [GASPS.]
I want a pastry.
- I am famished.
- [LAUGHS.]
Okay, well, I will get you one.
- Go and take a seat.
- I will get it myself.
Let me feel like a normal human being again.
Okay, well, we'll be right over there.
Okay.
This is amazing.
What changed? I tried a little experiment before the surgeons weighed in.
I turned her LVAD as low as it could go to see what would happen.
And? Her heart's functioning fine with barely any assist.
In fact, now the LVAD's just getting in the way.
Does that mean the It appears as if the drug is working.
We should keep her overnight, monitor her, but looks good.
I wish I could go back in time, just insist that my mom signed up for the trial meds.
We can't ask Kender for a compassionate use exemption, and who knows what they'll do when they find out.
[SOFT MUSIC.]
Maybe they don't need to find out.
Here.
How many pills do you have left? Maybe a week's worth.
I'll try to secure more before she runs out.
Will, I do not want to put you in this position.
Let me worry about that.
In the meantime, I think we should talk to Dr.
Young about removing her LVAD altogether.
We want to try our chances on the transplant list.
- Are you sure? - Yes.
Natalie, if we can keep from getting caught, your mom may not ever need a transplant.
I don't even know what to say.
No one else can find out about this.
- You understand? - Yeah.
Neil, how you doing? Neil, this is my colleague, Dr.
Choi.
Hey, Neil.
I'd like to discuss what happened today.
It was working, the red pill.
I was finally gonna be able to experience reality, a world that's not constantly trying to manipulate me, and then you so-called doctors, you took that away.
Can you tell us more about that? Like you don't already know.
Well, you know, we're actually trying to get a better picture of what happened this afternoon when Dr.
Archer checked in on you.
Can you walk us through that what you remember, anyway? He cut me open and rewired my circuitry, so that I'll never be able to unplug from the simulation.
Even if I could get another red pill, it doesn't matter, okay? I'm stuck here forever! [SOBBING.]
Buddy, we're gonna get you out of here as soon as possible, okay? Not necessarily the most reliable witness, poor guy.
- No, but at least he's alive.
- Yeah.
In any case, I'm gonna go have a talk with Dean.
Oh, my goodness.
- Be right back.
- Hey, Carol.
Hi.
Hey, so I saw on the surgery schedule that they're removing Carol's LVAD? It was actually causing her problems, but they lowered it, and she got better.
Wow, with her level of heart disease, never seen that.
Is this what you wanted to tell me? Yeah, I just I was afraid of how you'd take it, you know? I didn't want you to feel responsible or anything.
No, I get it.
Good.
Well, I should get back in there, but I'll see you tomorrow, okay? Sure.
Vanessa, hey.
Good news, I spoke to Dr.
Choi.
He realizes now that what happened was entirely my fault.
In fact, he told me that he admired your handiwork.
Said that your chest tube was placed spot-on.
So trust me, if nothing else, he's gonna remember who you are now.
Hey, you should feel good about today.
Look, I'd really appreciate it if you didn't tell me how I should feel about being humiliated.
I'm sorry, that wasn't my intention.
I was just trying to help.
You know what? While I'm here these next few weeks, I'd just prefer if you left me alone.
- Vanessa, I - Maggie.
Everything okay? Yes, I was just talking to student doctor Vanessa Taylor, and You know, I should've known when I saw her this morning.
She's your daughter.
She doesn't know, does she? No, and I don't intend to tell her, so Oh, Maggie.
What happens if these three weeks turn into something more permanent? What if she's accepted? I'll manage it.
I'm telling you, this is not gonna be a problem.
Looks to me like it already is.
Sorry.
My character was being called into question, and I overreacted, and I let my emotions get the best of me.
Did you snow him to force him into surgery? Why would I do that? No, no, really, why would I risk my job and my career for that? - Why would I do that? - I don't know, Dean.
But given the circumstances that happened today, I it certainly seems plausible.
What do you want me to say? You want me to tell you that I can't sleep nights, and I'm always looking over my shoulder.
That's the way it's been for years.
- Is that what you want to hear? - Of course not.
I want you to be okay.
The idea of looking at what happened over there, putting that under a microscope no way.
I'm not doing that.
That scares the hell out of me.
That's why I keep pushing you to talk to a psychiatric professional if not Dr.
Charles, then someone else.
- Yeah, I will, I will.
- I'm serious, man.
I promise you, I will.
Promise.
Dean, if you want to keep working here, you have to deal with your issues.
I can't find Dean, you can do this.
Dr.
Charles helped me, and he can help you, too.
PTSD just doesn't go away, Dean.
I don't need therapy.
I have a daughter, Vanessa.
I found out that she was in medical school.
So you don't intend to see her again? Of course I want to.
What was your impression of her? Good candidate.
It'd be great to get her.
Medication was supposed to be sent back to Kender.
Package for Kender.
Someone already picked that up.
Is it even that big of a deal though? I'm gonna have to find them one way or another.
[DRAMATIC MUSIC.]
Welcome and congratulations.
You've all done well enough to get this far.
But this ED only accepts one med student a year from this audition, so these next few weeks are your one and only opportunity to impress.
No pressure.
Now, you're new, so I'm expecting some mistakes, but I'm also expecting you to display the confidence to push through those mistakes.
And if some of the nurses take a liking to you, that wouldn't hurt either.
- So which one of them are you so keen on? - Huh? The student application that you asked me to move to the top of the pile, Vanessa Taylor? That's her right there.
Ah, how do you know her, friend of the family? No, residency fair.
She just stood out.
Maggie, hi! I'm not sure if you remember me or not, but Of course I do.
You led me to Beecher Hall.
And you played the Scarecrow in middle school.
- Scarecrow? - Good memory.
- Vanessa Taylor, this is - Sharon Goodwin.
I was up last night doing research because I couldn't sleep.
I'm a bit excited if you can't tell.
Pleased to meet you, Ms.
Taylor.
Yeah, I should get back to the group, but thank you both for this opportunity.
- She's a go-getter.
- [CHUCKLES.]
[SOFT MUSIC.]
- Good morning.
- Morning.
Oh, hey, Dean.
You wanna grab lunch today? Wednesday is Reuben day.
This wouldn't happen to be your subtle attempt to sit me down for one of your casual check-ins, would it? - Busted.
- Yeah.
Well, tell you what, you have my full permission to tell Dr.
Choi that we spoke if it gets him off your back.
Everybody who works here has got to do this, including Dr.
Choi, but it's no big deal.
It'll take five minutes.
We can talk about gardening if you want.
I just gotta cross you off my list.
Thing is, I've found that what works best for me is when I steal away for some quiet personal time every day.
Unfortunately, I found that the only time I have for that is my lunch hour.
You understand.
Look, I am gonna have to pin you down eventually - [ALARM BLARES.]
- Or Goodwin's gonna get mad at me.
Yeah, they're playing my song.
Treatment 4.
Neil Dietrich, 24, collapsed at the park with severe abdominal pains.
Wouldn't let us take his vitals, but we were able to get a saliva swab, COVID negative.
What's going on, Neil? It's just a stomachache, okay? Whatever's wrong with me, probably go away on its own.
I don't know, I think maybe you should give us professionals a shot.
- One, two, three.
- [GROANS.]
- Okay.
- This isn't necessary! [TENSE MUSIC.]
- Stop, leave me alone! - 100.
9.
You have a fever, Neil, your body's way of telling us something's wrong.
Yeah, I'll be fine.
And that pain you're experiencing, I can make that go away easy.
Little morphine will have you feeling like it's a day at the spa.
No, please, leave me alone! Okay, well, if you won't let us treat you, maybe there's something else we can do to help? No, nothing you can do will matter.
How could you possibly believe that nothing we do will matter, nothing? - Because - Because? Come on, Neil, level with me.
I can take it.
Because none of this is real, okay? It's just a computer simulation.
[DRAMATIC MUSIC.]
It's obvious.
Every facet of our lives has been preprogrammed.
The richest 1% of the world owns 99% of basically everything.
- How's that possible? - Excellent question.
- Where does it hurt, Neil? - I'll be fine.
It's possible because the game is rigged.
All right, and who exactly is playing the game? All real people are players.
They have no choice.
I mean, obviously, there's some form of higher intelligence that created the simulation for a reason.
Which is? That's what I'm trying to find out, but clearly, some part of it is to keep real people compliant.
Are you are you a real person? The real question is, are you a real person, or are you an NPC? What's that? A non-player character a computer construct to maintain order of the simulation.
Well, despite our different beliefs, I think we can all agree that with the fever and the intermittent stabbing pain that you are unwell, and perhaps now's a good time to do something about that.
No, I'm sorry, I'm not gonna change my mind on this.
Neil, let's say you're right.
What I'd understand is that your pain is obviously very real to you.
And all we're trying to do is figure out what's causing it.
You don't want to let us do that? No, 'cause you could reverse the effects of the red pill.
The red pill? There's this red pill you take that initiates the process of waking you up outside of the simulation.
So you took one of these red pills? Yeah, thankfully.
Whatever you ingested might be making you sick.
See, that's exactly what an NPC would say.
But you know what? You're right.
Whatever I'm feeling right now, it's probably just the red pill starting to work, and if that's what it takes to wake up in the real world, so be it.
[DRAMATIC MUSIC.]
How much longer do I have to stay here? Give Dr.
Archer and I a couple minutes, and we'll be right back.
Well, if he hasn't poisoned himself with whatever he took, - he probably has appendicitis.
- Yeah.
Look, I mean, there's always a psych hold, but it'll just antagonize him, and we'll never find out what he took.
- Slow roll the paperwork a bit.
- Yeah, all right.
I wanna study up on this whole simulation thing a bit, see if I can get in better sync with his logic.
Logic? He thinks we're living in a computer game.
Hopefully, we will dispel him of that notion.
It's called the emergency room for a reason.
Working fast is key but not at the expense of working smart.
If you could do both, that's what we're looking for.
Good morning, Ms.
Royko.
Patient here is 62 years old.
She's experiencing a persistent headache, some blurry vision, and has a known history of diabetes.
All right, what's your differential? I suspect hypertension.
Do we know her BP yet? 226 over 115.
That would certainly qualify as hypertension, and what would your course of treatment be? - I'd push 10 of hydralazine.
- Well done.
Doris, push 10 of hydralazine, as recommended by student doctor Mims here.
Excuse us.
Moving on.
Vanessa, hey.
I couldn't help but notice, it seemed like you had the answer yourself.
Obviously, she has hypertension.
I raised my hand.
I just didn't get called on.
And frankly, I think Cardizem would be better than hydralazine.
If I may, word of advice: It wouldn't hurt to assert yourself a little bit more.
Student doctor Taylor.
You with us or not? [WHEEZING.]
Maggie, we need a room! What's going on with your mom? She's been passing out intermittently, started before breakfast.
What's Maggie doing here? What? Carol, we're gonna take good care of you Herbert! Okay, I'm gonna call the cardiologist and tell them to come down.
No, no, no, Nat, I'm gonna page Dr.
Young.
You go be with your mom.
Will, what are you doing in here? What do you mean? I'm up, and it's your mother.
She's having syncopal episodes? Yeah, I think it, um might have something to do with the LVAD? Okay, well, her lungs are clear, so that's a good sign.
But your extremities are super cold, Carol.
- I know.
- Let's do an EKG.
Thank you for stepping in, but I've paged Dr.
Young, and, um I think that we can manage until they come down.
Please, don't go.
I'm really scared, Will.
Could you stay, please? I'm not going anywhere, Carol.
I promise.
We'll just get some preliminary tests going, - give Dr.
Young a head start.
- All right.
I'll run a panel.
Remind me again what medications she's on? What? I assume she's on a beta blocker.
Yes, uh Metoprolol 25 milligrams twice daily, plus Lasix the same, and rosuvastatin, I believe 10 milligrams once a day.
Okay.
And don't forget about that new pill you gave me.
The one that's supposed to help my heart pump.
New one? Yes, I put her on a fish oil supplement, - that's all.
- No, it's a little blue pill.
I'll show it to you.
It's in my bag.
No, no, no, Mom, Mom.
Your bag is in the car.
- Well, I'll just go get it.
- No, Mom, you don't need it.
I need the stuff that's in there.
Okay, okay, Mom, Mom, Mom, I have to go move the car.
I will bring it in.
I'll be right back, okay? - All right.
- Okay.
You're each gonna be working one-on-one with the attendings.
Dr.
Driskell here will have your assignments.
Follow him.
- Taylor.
- Yes, sir? You start with me.
[GAGGING AND COUGHING.]
You can't go on like this, Neil.
I have to.
It's the only way to see what real life is.
Oh, good, no red pill.
Neil, are you familiar with the butterfly dream? You know, the Chinese philosopher who dreamt he was a butterfly? Yeah, only he woke up only to question whether or not he was the butterfly or the man.
Right.
You're not gonna convince me I'm wrong just 'cause there have been other philosophies about hypothetical simulations.
Well, but what struck me is that he did wake up, right? And then was able to acknowledge that one of those experiences was reality, right? You're making my point, okay? I'm trying to wake up.
That's my goal.
- I know what I'm doing.
- I've heard that before.
So a few years back in Afghanistan, I was working alongside this joint task force hunting down Taliban extremists.
Let me tell you, we saw some pretty gnarly stuff that you would not believe.
These soldiers, they didn't come any tougher.
When they had a mission, that was all that mattered.
Even with the worst injuries, they would not be deterred.
- I get that.
- I know you do.
But sometimes those same injuries that they ignored ended up killing them.
These were preventable deaths, and I do not want to see that happening to you, Neil.
You don't seem to understand, okay.
I can handle death.
I have to die to live.
Having witnessed that firsthand, that is patently untrue.
Look, well it's just, whatever you think you saw over there, none of that actually happened.
- You just think that it did.
- Okay.
It's part of the game.
All right.
[GROANS.]
- I-I told you not to touch me! - Hey.
No, no, I'm sorry, sorry.
I just wanted to find out where you're most sensitive, - that's all.
- [GROANS.]
Dr.
Charles, a word, please? He's guarding his lower right quadrant.
He has appendicitis.
I've seen this a hundred times.
All right, if we don't do anything about it, his appendix will rupture, and, if that happens, his whole life is gonna be in jeopardy.
I'm aware of what a ruptured appendix means, but why did you palpate him? He wouldn't let me come near him otherwise, right? I needed to get a read on him.
He's not even gonna get a scan.
I completely get how upsetting it must be to hear your military experience characterized that way, but, Dean, that guy's delusional.
I think you misread the moment, Dr.
Charles.
Right, I don't blame you for thinking that's what you saw, okay, but I was honestly trying to make a diagnosis, and now that I have, I think it's time for you to get a court order, so we can force treatment.
You know, if and when I determine that the patient lacks decisional capacity, I will absolutely reach out to a judge.
"If"? Are you kidding me? This guy's a box of loose screws.
Well, no, actually, he's a patient.
[DRAMATIC MUSIC.]
- Where are they taking me? - To get an echo, Carol.
A transthoracic echocardiogram will show us exactly how your heart pumps.
And this could be because of the LVAD, right? We'll see.
Mom, it's a really simple procedure.
I'll be right here when you get out.
Okay? I love you.
- Hey.
- Hey.
Sorry, didn't mean to startle you.
No, it's okay, I, um been a little on edge today.
Yeah, saw your mom was here.
Yeah, Dr.
Young still doesn't know what's going on, but something's affecting her circulation enough to cause her to pass out.
Oh, I'm sorry to hear that.
She's up for an echo now, so we should know more soon.
Well, hope the echo brings some good news.
- Thank you.
- See you.
See ya.
Hey, Doris.
What's going on in there? We got a drug addict in there whose veins are shot to hell.
Can't get a peripheral in.
- Ethan's asking for a - Triple lumen kit? - Here you go.
- Thanks.
Listen, I'm feeling a little restless just directing traffic.
I got an itch to slip on the gloves.
How 'bout you and me swap places for the day? I get to hold the brick? Thank you.
Here you go, Dr.
Choi.
- What happened to Doris? - You got me instead.
- You disappointed? - Never.
So you ever insert a central line? Plenty of times in med school, yes, sir.
Show me what you got then.
All right, Shawn.
I'm gonna get you prepped for this.
Pull down your gown.
Lidocaine? Yes, of course.
Thank you, Maggie.
Ethan? Goodwin's requesting your presence at the 2:30 budget meeting.
All right, I'll be right there.
Taylor.
You think you can handle this yourself? Yes, of course, Dr.
Choi.
I'm confident I can do this on my own.
I've assisted a million.
I've got her back.
Great.
Any problems, you notify an attending.
I'll be back in a bit.
- Crockett.
- Yeah? - You're up.
- Okay.
- Cesar, Baghdad.
- What do we got? Edgar Fuentes, 25, took a GSW to the leg in a drive-by.
Vitals are stable.
Applied a pressure dressing en route.
Bleeding's controlled.
Okay, Mr.
Fuentes, I'm Dr.
Marcel.
I'll be taking care of you.
Okay? - This hurts like hell.
- Yeah.
He was working on the car out front.
- He wasn't even doing anything.
- Right.
My wife Rosa, our baby Ada.
Well, I'm sorry we all had to meet this way.
Okay, folks, on me.
- Ready, set, lift.
- [GROANS.]
Nice and easy, you're okay.
Can you wiggle your toes for me? Yeah, but hurts.
We got two wounds, lateral thigh.
Nowhere near the blood vessel.
Probably through and through, but let's get an x-ray just to prove it.
50 fentanyl, please.
You're gonna be okay, Mr.
Fuentes.
Come here, come here.
All right.
Look, he's gonna be okay.
It's just a flesh wound.
- All right? - It looks so much worse.
We're gonna get an x-ray just to be sure.
Oh, my God.
Is she okay? - Huh? - Your baby, is she okay? - Ada? - May I? What? What? Hey, sweetheart.
- What is that? - Your baby's been shot.
- What? - I need help in here! Oh, my God! No! [SOBBING.]
No! Yep, there's the bullet.
[EXHALING HEAVILY.]
- Pressure's still low.
- Want me to hang another unit? No, let's do it up in the OR.
Let's move now.
I heard the gunfire, but I didn't hear a window break.
It could have come through the wall.
- I've seen it before.
- She was bundled up.
She seemed fine she wasn't bleeding or anything.
Pressure from the swaddle probably stopped the flow of blood.
- How could I not have noticed? - You didn't do anything wrong.
Look, I'm gonna do everything in my power to save your baby's life.
All right, let's go.
Put back pressure on the syringe, and walk the needle down the clavicle until you hit the vein.
- I lost the vacuum.
- It's just filled with air.
- I must have hit the lung.
- Worry about that later.
We still have a line to put in.
Now pull the needle back, and eject the air.
Now try again until you find the vein.
Wait a minute.
What's going on? It's okay, Shawn.
We're working on it.
Go ahead.
All right.
I'm drawing blood.
Perfect.
- Well done.
- What about the lung? I should go tell Dr.
Choi.
Let's just finish the procedure, okay? So physically there is something very wrong with you.
By all indications, your appendix is about to burst.
So what I'm asking is if you would please just let us do a scan.
I'm not getting a scan.
No matter what it would show, it's just the simulation's explanation of what the red pill is doing.
Neil, I respect your point of view.
But you need to understand that my reality is that I'm a doctor, and I can't just let you die, which is why I'm seriously considering going to talk to a judge this afternoon about taking away your ability to make your own medical decisions.
What, because you think I'm delusional? Of course you would think that.
That's actually not what I said.
Can I ask you something? Why is it that my belief is the one being questioned? Hey, I'm sorry to pull you out of your meeting, - but it's important.
- What's going on? So I have an appendicitis patient who's refusing treatment because he believes that we're living in a computer simulation.
- A what? - Yeah, I know, it's he's nuts.
Just page Dr.
Charles.
Well, no, see, Dr.
Charles is the problem.
He's dragging his heels on forcing the treatment that the guy needs.
- Is it emergent? - I believe it is, yeah.
- All right, what can I do? - Well, I want you to weigh in.
With another sensible voice in the room, maybe the two of ours can drown his out.
I'll take a look, but I can't imagine double doc-ing Dr.
Charles on a decisional capacity ruling.
Uh-huh.
You know what? Forget it.
I'm not interested in having a courtesy consult.
Dean, I know how frustrating it is to be in your position.
I've butted heads with Dr.
Charles on the same issue in the past.
Oh, yet now you sit on your hands? Watch it, Dean.
You're right, you're right.
I was I was over the line.
All clear.
Just like I thought.
There's a pneumothorax.
This happens all the time, even to the most seasoned doctors.
It happened to Ethan last week.
Don't beat yourself up.
I'll go find Dr.
Choi.
Or you can fix it yourself.
Insert a chest tube? Mm-hmm, you're comfortable doing that, right? - Sure, but I - Listen, Vanessa.
Everyone makes mistakes, but this way you can show Dr.
Choi that you know how to correct yours on your own.
I don't know.
If you want to win a permanent spot in this ED, this is how you do it.
All right.
Yeah, let's do it.
Hey, Shawn? It appears that when we did the procedure, we hit your lung.
It's nothing serious, but in order to fix the problem, we're gonna have to put a tube in your chest, and we need your consent.
Is it necessary? Unfortunately, it is, but we're gonna numb you up, we're gonna give you a little bit more sedation, and you'll hardly feel anything.
- Okay.
- All right.
You lay back and relax.
How'd it go? - No luck.
- No CT, okay.
Nurse Sexton! Yes? He's not protecting his airway.
I need to intubate him.
Get a line.
Order a CT.
Call the OR.
Make sure they have a room open in case we need to bring him up to surgery.
Wait, didn't Neil say that he didn't want to be treated? He did, but now he's unconscious.
So you're just gonna disregard what he wanted? When a patient is no longer able to make medical decisions, and there's no one to stand up for them, the hospital assumes power of attorney.
20 of etomidate, 100 of sux.
Should I not intubate him? He doesn't have a DNI.
Tell me! I have to admit, when your mother came in this morning, I assumed it was because her heart was on the brink of failure, but that's not what the echo is showing.
Looks like her heart is beating more effectively.
I mean, when you have the kind of underlying disease Carol does, the heart can behave inconsistently, but rarely does it show this kind of improvement.
Yeah, that is odd.
So why does my mom keep passing out? It's a phenomenon called "suck down".
The heart's contracting so hard that the ventricle wall is getting sucked into the LVAD, too.
The poor blood circulation is leading to a lack of cerebral perfusion.
Well, what do we do now? I'm going to consult with Dr.
Latham as soon as he gets out of surgery.
There's a chance he'll want to sew the left ventricle shut to help the LVAD work effectively.
Well, I mean, this is good news, right? I hesitate to call it good news until we figure out exactly what's going on.
- Thank you, Dr.
Young.
- Thank you.
Wow.
That's not something you see every day.
Yeah.
Must be the fish oil she's taking.
What are you doing? Will, why are you going through my mom's bag what are you doing? Let's see what these magical supplements look like.
God, this is so Will! Nope, that's the beta blocker.
Stop.
That's the statin, and those two are Lasix.
- Where'd they go, Natalie? - What are you talking about? The trial drugs that went missing? The blue pills.
I know you took them.
What'd you do with them? I can't believe you're accusing me of this.
The improved function in your mom's left ventricle.
Your sudden interest in the drug's side effects last week.
Come to think of it, you never did tell me the name of that trial patient with the dry cough.
- I wonder who it is.
- Please, come on.
This is ridiculous! You are dosing your mother with an untested clinical trial drug, Natalie, without supervision or monitoring.
We don't know how the drug interacts with an LVAD.
It could kill her.
You need to come clean right now.
Will - Will, I - Just give me that.
No, Will, wait, wait.
Wait! You heard the cardiologist.
Mom's heart is pumping harder.
The drugs could be working.
We don't know that for sure.
Please, I am desperate, and everything you said about the drug was good.
I didn't think I was putting Mom in any danger.
This is really bad, Nat.
Will, please.
Please.
Please [KNOCKING.]
- Am I interrupting? - Not at all.
I was just talking to a judge, trying to get a court order so we could treat Neil, but without definitive proof of his medical condition, he couldn't help us.
Well, it doesn't matter because Dr.
Archer took Neil up to surgery and is removing his appendix right now.
Wait, Neil agreed to that? No, but he went into respiratory distress and needed to be intubated.
Leaving Dean to make medical decisions on his behalf? Yeah.
I saw how frustrated Dr.
Archer was with Neil before.
Definitely.
It got me thinking, could he have could he have overmedicated Neil to knock him unconscious? Oh, God.
[SOFT DRAMATIC MUSIC.]
- - Will.
Sabeena.
[LAPTOP SHUTS.]
I didn't know you were coming in today.
Just passing through.
Thought I'd see how you were doing.
I have a meeting with the head lab technician.
Yeah, no, everything's all good here.
Just taking a break.
Okay.
Hey, the drug we're testing, any idea how it might affect a patient with an LVAD? The drug's an inotrope essentially, a chemical LVAD.
Why would anyone do that? Just a hypothetical.
I can't imagine why it would ever be prescribed in that situation.
But listen, we're a few months out from seeking FDA approval.
If there's a patient suffering any adverse reaction, - it needs to be reported.
- No.
Nothing like that.
[DRAMATIC MUSIC.]
The baby's still hypotensive.
I don't know if she's gonna survive this.
Trying to find the source of the bleed.
What do you want me to do? Just keep giving her more blood.
Okay.
Come on.
Hey, Shawn, how you doing? - Much better, thank you.
- Let's check your work.
Line placement looks good As does this chest tube, though I don't remember our patient requiring one.
Well, sir, when I made my first attempt at placing the central line, I noticed air coming out of the syringe, so I So she ordered an x-ray to see if there was a pneumo.
- And there was, so she - Yeah, I understand.
Student doctor Taylor, can I have a word with you outside? We'll be right back, Shawn.
Placing a chest tube is considered a surgical procedure that requires prior consent from the patient.
We okayed it with the patient.
- "We"? - Maggie and myself.
Consent for the procedure can only be obtained by a licensed physician.
Neither you nor Nurse Lockwood qualify.
I'm sorry, I didn't realize You acted recklessly.
By not notifying your supervisor, you put me and the ED at risk.
Don't worry, I'll fix this.
Ethan.
Listen, Vanessa was just following my instructions She's gonna be a doctor.
What happens in that treatment room is her decision.
But this is my fault.
She's a top-notch student.
She's head of her class.
What are you talking about? Student doctor Vanessa Taylor, I was assisting her.
I gave her some bad advice, but she solved the problem herself.
Mags, why are you going so far out of your way to help this student? Please, Ethan, give her a second chance.
She shouldn't have to pay for my mistake.
I'll give it some consideration.
Thank you.
Why were you assisting her? Doris and I just switched places for a bit.
I have to relieve her now.
So I understand that we have an update on our patient? Unfortunately, we waited so long his appendix perforated, so I removed it, washed his belly out, and he's recovering in the ICU.
How did that happen exactly? Well, he stopped protecting his airway, so I had to intubate him.
Which then gave you the authority to make medical decisions for him? Whoa, hey, if I hadn't come upon Neil when I did, oh, he'd be dead.
He'd stopped breathing.
- From appendicitis? - Mm-hmm.
You know that'd be a first, right? He was septic.
His appendix ruptured.
And why the hell am I getting the third degree? You're the one who was about to almost let a crazy person kill themselves! - Dean, stop! - No, no, no.
Remember, at the end of the day, it's my word versus Neil's the guy who thinks this whole thing is a game of Tetris! Enough.
Dean, take a walk.
Someone want to tell me what's going on? Mr.
and Mrs.
Fuentes.
Is my Ada okay? She's currently on a breathing machine up in the PICU.
Now, we're not out of the woods yet, but I was able to stop the bleeding.
She's alive.
Thank you, Dr.
Marcel.
Yeah, my pleasure.
I don't know what I would have done if we'd lost her.
She's gonna be all right.
[SOFT MUSIC.]
Well, hopefully, we'll get her extubated tomorrow.
In the meantime, Nurse Trini here, she's gonna escort you up to the PICU here in a bit.
You can see her, okay? - Thank you.
- Yeah, my pleasure.
Thanks.
- Hey.
- Hey.
- You been in surgery? - Yeah.
Seven-month-old baby with a GSW.
She's gonna be okay though.
Are you? Yeah.
Yeah, I'm gonna be fine.
Thanks.
Listen, I wanted to talk to you about something, but I was a little nervous about how you might take it, which I know is out of my control, so Natalie, you got a minute? It's about your mom.
Oh.
Yeah.
- Go ahead.
- Sorry.
I feel incredible.
Your hands are warm, and your color is starting to come back.
Oh! [GASPS.]
I want a pastry.
- I am famished.
- [LAUGHS.]
Okay, well, I will get you one.
- Go and take a seat.
- I will get it myself.
Let me feel like a normal human being again.
Okay, well, we'll be right over there.
Okay.
This is amazing.
What changed? I tried a little experiment before the surgeons weighed in.
I turned her LVAD as low as it could go to see what would happen.
And? Her heart's functioning fine with barely any assist.
In fact, now the LVAD's just getting in the way.
Does that mean the It appears as if the drug is working.
We should keep her overnight, monitor her, but looks good.
I wish I could go back in time, just insist that my mom signed up for the trial meds.
We can't ask Kender for a compassionate use exemption, and who knows what they'll do when they find out.
[SOFT MUSIC.]
Maybe they don't need to find out.
Here.
How many pills do you have left? Maybe a week's worth.
I'll try to secure more before she runs out.
Will, I do not want to put you in this position.
Let me worry about that.
In the meantime, I think we should talk to Dr.
Young about removing her LVAD altogether.
We want to try our chances on the transplant list.
- Are you sure? - Yes.
Natalie, if we can keep from getting caught, your mom may not ever need a transplant.
I don't even know what to say.
No one else can find out about this.
- You understand? - Yeah.
Neil, how you doing? Neil, this is my colleague, Dr.
Choi.
Hey, Neil.
I'd like to discuss what happened today.
It was working, the red pill.
I was finally gonna be able to experience reality, a world that's not constantly trying to manipulate me, and then you so-called doctors, you took that away.
Can you tell us more about that? Like you don't already know.
Well, you know, we're actually trying to get a better picture of what happened this afternoon when Dr.
Archer checked in on you.
Can you walk us through that what you remember, anyway? He cut me open and rewired my circuitry, so that I'll never be able to unplug from the simulation.
Even if I could get another red pill, it doesn't matter, okay? I'm stuck here forever! [SOBBING.]
Buddy, we're gonna get you out of here as soon as possible, okay? Not necessarily the most reliable witness, poor guy.
- No, but at least he's alive.
- Yeah.
In any case, I'm gonna go have a talk with Dean.
Oh, my goodness.
- Be right back.
- Hey, Carol.
Hi.
Hey, so I saw on the surgery schedule that they're removing Carol's LVAD? It was actually causing her problems, but they lowered it, and she got better.
Wow, with her level of heart disease, never seen that.
Is this what you wanted to tell me? Yeah, I just I was afraid of how you'd take it, you know? I didn't want you to feel responsible or anything.
No, I get it.
Good.
Well, I should get back in there, but I'll see you tomorrow, okay? Sure.
Vanessa, hey.
Good news, I spoke to Dr.
Choi.
He realizes now that what happened was entirely my fault.
In fact, he told me that he admired your handiwork.
Said that your chest tube was placed spot-on.
So trust me, if nothing else, he's gonna remember who you are now.
Hey, you should feel good about today.
Look, I'd really appreciate it if you didn't tell me how I should feel about being humiliated.
I'm sorry, that wasn't my intention.
I was just trying to help.
You know what? While I'm here these next few weeks, I'd just prefer if you left me alone.
- Vanessa, I - Maggie.
Everything okay? Yes, I was just talking to student doctor Vanessa Taylor, and You know, I should've known when I saw her this morning.
She's your daughter.
She doesn't know, does she? No, and I don't intend to tell her, so Oh, Maggie.
What happens if these three weeks turn into something more permanent? What if she's accepted? I'll manage it.
I'm telling you, this is not gonna be a problem.
Looks to me like it already is.
Sorry.
My character was being called into question, and I overreacted, and I let my emotions get the best of me.
Did you snow him to force him into surgery? Why would I do that? No, no, really, why would I risk my job and my career for that? - Why would I do that? - I don't know, Dean.
But given the circumstances that happened today, I it certainly seems plausible.
What do you want me to say? You want me to tell you that I can't sleep nights, and I'm always looking over my shoulder.
That's the way it's been for years.
- Is that what you want to hear? - Of course not.
I want you to be okay.
The idea of looking at what happened over there, putting that under a microscope no way.
I'm not doing that.
That scares the hell out of me.
That's why I keep pushing you to talk to a psychiatric professional if not Dr.
Charles, then someone else.
- Yeah, I will, I will.
- I'm serious, man.
I promise you, I will.
Promise.
Dean, if you want to keep working here, you have to deal with your issues.