Chicago Med (2015) s06e15 Episode Script

This patient harms herself to get attention.
I'm not available to give the kind of care you need.
But I want you.
Where's Ramona? Check the front.
Tell security.
Did you snow him to force him into surgery? Why would I do that? I think you're suffering from PTSD.
That's why I keep pushing you to talk to Dr.
Charles.
What's going on? Something's off.
I don't have the bandwidth to worry about anyone else.
I need some space.
The drug we're testing, any idea how it might affect a patient with an LVAD? If there's a patient suffering any adverse reaction, it needs to be reported.
If we can keep from getting caught, your mom may not ever need a transplant.
Well, I do not want to put you in this position.
Then let me worry about that.
Hey, Sabeena.
Haven't seen you around the E.
D.
lately.
Haven't seen you around the trial office.
Though, I don't blame you.
I have been a little hard on you lately.
- Well, I had it coming.
- It's true.
Last round of follow-ups going okay? Everything looks good.
A few more left to go, and we're done.
That's great.
You know what that means, right? Kender starts the first stage of data analysis.
Wait.
Is there still a chance, you and me? Just a slight chance.
Well In that case, you better get to work.
Come on, get upstairs.
Move it.
Course guide.
You going back to school? Got my interview for Med's Nurse Practitioner program today.
I squeezed in under the deadline.
Well, I'm sure you'll do great.
Are you okay? You haven't seemed yourself lately.
No, I just, been, uh, working some late nights.
You know how it goes.
Okay.
Great.
Thanks.
Will, I need a little help.
Where should we go? Treatment #5.
What's going on? I think Mom's in liver failure.
Do you think this is from the trial meds? I don't know.
Hey, Carol.
Does your belly hurt? Yes, it does.
Okay, let's get you in the bed.
- Okay.
- Come on, Mom.
Hey, Carol.
- Hi.
- How you doing? - Thank you.
- Come on.
- Okay.
- There you go.
Thanks, guys.
Oh.
Jaundice, edema.
I think you're right.
Liver failure? How's her cardiac function been? You know, pretty good.
- Yeah? - Yeah.
On just the standard meds? Why? Shouldn't it be? Well, it's just you hadn't been responding before, but it looks like they're working well.
We'll need to do a full workup.
Okay, I'll get a liver panel, CBC, CMP, and coags.
- Thanks.
- And we'll need a list - of her medications as well.
- Okay.
Okay.
This could be a drug interaction.
- We have to rule everything out.
- Yeah, you're right.
But this doesn't look surgical.
I'll take it from here.
Well, you never know.
It could be an obstruction, gallstones.
I better stay on just to be safe.
- Um - Yeah? I really appreciate everything you're doing to help, and I promise as soon as this becomes surgical, I will call you, okay? Whatever you want.
I'll see you, Carol.
Thank you.
Bye.
- Hey, Maggie.
- Morning, Sharon.
- How's it going? - Okay.
She said tomorrow's Vanessa's last day here.
I didn't handle things right.
Well, it's not an easy situation.
I know, but I'm thinking maybe if I told her the truth I just don't like leaving things the way that they are with the two of us at odds.
I don't know, Maggie.
Once you take that step I know.
- Morning, Dean.
- Hey.
So, uh, I have to ask, have you sat down with Dr.
Charles yet? Mmm.
Actually, he referred me to a veterans' therapy group.
I went last night.
- Really? - Yeah, yeah.
It was something, man.
The stories you hear, the things people have been through is a There's a deep well of pain out there, man.
I can imagine.
I bet you had some stories too.
Ah, well, nothing worth saying compared to what I heard last night.
And I wanna thank you for, uh, leaning on me.
Last night was inspiring.
I'm sorry.
Am I interrupting? No, ma'am.
We have an 18-year-old in Treatment 6.
And a few weeks ago, she was diagnosed with a cranial hemangioblastoma.
At 18? That's tough.
Yeah.
Do you two mind taking a look? - Of course.
- Thank you.
Mindy, is this the first time you've passed out since your diagnosis? I just got dizzy for a second.
- It's not a big deal.
- Yes, it is.
When they diagnosed her last month, they said the tumor was small.
Does this mean it's growing? Well, possibly.
Or it could mean there's a bleed.
Either would be a reason to recommend surgery to remove it.
I'm not doing that.
- But sweetie, if it's getting worse - No! No one's digging through my brain.
She's spent the last month glued to her computer reading horror stories about brain surgery.
They're not just stories, Dad.
People come out changed.
They stutter, they have seizures, they forget everybody's names.
I play the piano.
What if I can't do that anymore? Uh-uh, no way.
Okay, before we go any further, why don't we get a CT to see what we're dealing with? Then we can talk again and come up with a plan.
- Yeah.
- Uh, we'll be right back.
Excuse us.
Her oncologist wanted to remove the tumor back when she was first diagnosed.
But you can see, there's no talking to her.
Is there any way that Can we make her do it? Uh, I'm sorry, but no.
She's 18 years old.
She has a right to make her own decisions.
But she's still a kid.
She doesn't understand the consequences.
We're at our wit's end.
We don't know what else to do.
Look, I see how distressing this is, and understandably so, but there is one thing, as parents, you can do.
Tell us.
You can apply for temporary power of attorney.
This will give you the ability to make medical decisions should she become unconscious.
You can do it with her consent, but using it to get a procedure she doesn't want would be still be circumventing your daughter's stated wishes.
With the goal of saving her life.
- Okay, can we discuss it? - Of course.
In the meantime, I'll order a CT.
Mom's going up for her echo now.
Are those her labs? Yeah.
It is acute liver failure.
Oh, God.
And look at this.
Hepatitis C? She must've been carrying it a long time asymptomatically, which means something happened to push her over the edge.
Do you think it's a drug interaction? I'm not sure what else it could be.
Well, we have to take her off the trial medication.
That's our only choice.
Oh, God.
I know.
I'll put her back on her old cardiac meds until we can get her liver failure under control.
- And then what? - I'll find something.
Thanks.
Yeah.
I found her sitting on a bench.
She said that she wanted to talk to you.
Wow.
Thanks, Mags.
Yeah.
Hi, Dr.
Charles.
Ramona, how you doing? Good.
Very good.
You know, you gave me a real scare running out of here like you did last time.
- I'm glad to see you're okay.
- I'm sorry.
There's no reason for you to worry.
So, um, what's going on? What can I do for you? Actually I just wanted you to know that I'm fine.
Oh, you know, that's great.
And you know what? I really appreciate you letting me know, I do.
Yeah, I just got a new apartment, and I'm working.
I mean, I'm just temping now, but I think they'll keep me on full time.
Wow, things are, uh, really looking up.
They are.
So I thought if you had a little free time, maybe we could get a cup of coffee? You know what, I'm in the middle of my workday.
But I really would like to hear about what's going on with you.
So, um, so what do you say, I don't know, let's make an appointment, you know, meet in my office and have a proper chat? I just thought we could hang out.
Probably better that we make an appointment.
I tell you what.
Call me anytime, okay? I mean it.
If you don't get me, leave a message.
I'll call you right back, okay? - Okay.
- Great.
Really good to see you, Ramona.
Really.
It's good to see you too.
Dr.
Marcel, incoming.
What do we got? Baghdad.
26-year-old male in respiratory distress, status-post double lung transplant eight days ago.
- James.
- You know him? Yeah, I was his surgeon.
Hillary, hey.
What happened? He started having trouble breathing the day after we got home.
His pulmonologist said to continue taking his meds, but he just kept getting worse until today he got a fever.
Yeah, okay.
All right.
James, we're gonna take good care of you, bud, okay? On my count.
One, two, three.
There we go.
James, on a scale of one to ten, how hard is it to breathe? Eight.
Maybe a nine.
O2 stats 85 on 12 liters, and he's tachycardic at 106.
Deep breaths for me, James.
Yeah, major consolidation in both the lungs.
Let's order cultures, lytes, CBC with diff, cyclosporine level and get him up for a chest CT, stat.
- Got it.
- Let me see your hands, bud.
Is he rejecting the lungs? No, he's immunosuppressed, so he shouldn't be, but he definitely got a bilateral pneumonia.
The question is why.
James, I want to get you on a BIPAP machine to help you breathe.
Is that okay? Okay, you hang in there for me, okay? I'll check back soon, all right? So soon after surgery.
What do you think happened? Yeah, I'm not sure yet.
But I do know when it goes this bad this fast, surgeon error's always at the top of the list.
You find anything yet? There's not a single case of liver failure in the entire trial.
Well, if it is a contra-indication, then Kender needs to know.
Yeah.
I guess I should go find Dr.
Virani.
- Uh - I need to let her know.
No.
She's not in yet.
Don't worry.
I'll handle it.
No.
I stole the pills.
I gave them to my mom illegally.
I need to be the one to tell her myself.
Sure.
How are you, James? Hillary.
Dr.
Marcel.
Have you figured out what's going on? So I've looked all the labs, the scans, and the only reason I can come up with for getting a pneumonia this fast was that something must have gone wrong during the transplant surgery.
Wrong? What do you mean? Well, the lungs could've mismatched.
A stitch could've come loose.
I'm really not sure.
So what do we do now? How do we fix this? Honestly, the options are not good.
As you can see, the pneumonia has already caused significant damage to both lungs.
At this point, we need to put you on ECMO, a machine that oxygenates your blood for you.
For how long? It's hard to say, but if we end up having to search for a new pair of lungs, it could be several more months.
Wait.
Are you saying that these lungs can't be saved? I'm not saying that, but it is possible.
I'm so sorry this happened.
Look, I promise you, I'm gonna do everything that I Uh, I'll give you some space.
James's new x-ray.
Lungs are just getting worse.
Damn it.
When I was in the COVID Ward, I saw a lot of films that looked just like that.
Is it possible he's infected? No.
The donor was negative.
James tested negative when he came in today.
I understand, but maybe it's worth retesting him.
No, the truth is, you were right.
My head has been completely out of the game lately.
And because of that, I may have cost this man his life.
If there is any donor tissue, we could check just in case.
April, I appreciate everything you're doing.
I do.
Now please, call the ECMO team and let's get this man hooked up before his lungs completely fail.
- Hey, Emma.
- Hey.
Can you look up the records of an organ donor? I need to know if there's any lung tissue you can test for COVID.
Sure, I'll check for you, April.
No.
No lung tissue.
Okay, thanks.
But we do have some deep washings.
- Can you test that? - Sure.
But I'd need a doctor's order.
- Here.
- Really, April? Come on, you're gonna make me go back upstairs? Okay, "Dr.
Marcel".
- I'll call you when it's ready.
- Thank you.
All right.
Anyway, it's wonderful that you're doing so well.
Really.
I guess what I'm curious about is what happened in the last four weeks? Oh, the self-harming, I mean, the poison.
It all seems like a bad dream now.
I realize stuff like that was crazy.
Wow.
That is great.
That's a huge step, really.
Any insights into why you were doing that stuff? - What do you mean? - Well, as I recall, we were talking a lot about your family, right? And in particular, your dad, and how you thought that your relationship changed as you got older.
Dr.
Charles, you always come back to that.
My father I mean, I thought we were just gonna hang out and catch up.
I mean, isn't that kinda what we're doing? Okay.
My father molested me when I was little a lot, I wished every day that it wouldn't happen, but it would, and there was nothing I could do about it.
Ramona, I'm so sorry to hear that.
It's okay.
You know it's not okay.
I mean, I can't imagine how difficult, how awful that must've been - for you to go through that.
- It was.
But it's all in the past now.
You know, in my experience, recognizing that something like that happened, as crucial as it is, and then processing it are actually two different things.
Okay, well, no.
I have processed it.
That's what I'm trying to tell you.
- I completely understand - No, okay, see? We don't need to talk about this.
You and I can just be friends, regular friends.
Ramona, I am absolutely 100% here for you as your doctor.
Okay, stop, I don't need a psychiatrist.
- Ramona, sit down.
- Why won't you listen to me? - I am fine! - Ramona.
Okay.
Yeah.
Bye.
Maggie, I've got some orders for treatment two.
- Okay, sure.
- Mm-hmm.
Oh, wait.
Can we meet up at the end of the day? Did I make a mistake? Uh, no, it's just, um, we use some different abbreviations here, and the doctors are sticklers on it, so I thought we could just meet up and go over them.
Yeah.
Yeah, sure.
All right.
Yeah.
Right.
Nat, your mom's EKG.
She developed a long QT interval? Exactly, but there's an upside to that.
She's now a candidate for biventricular pacing.
The cath lab? But she's still in acute liver failure.
Yeah, but it's a heart issue.
Nothing to do with the liver.
It's a major procedure, and she's extremely sick.
Yeah, if we don't try something, she could go into a dangerous arrhythmia at any moment.
But it's not a cure.
I mean, she still needs a heart transplant.
That's right, and this is our best shot at keeping her alive until she gets one.
I don't know, Will.
There's so many potential complications.
This is your mom.
I'm not leaving any stone unturned.
Okay.
Let's give it a try.
I'll set it up.
Lead's in the coronary sinus.
Just putting in the wire.
These veins are extremely torturous.
I'm getting a lot of resistance.
How about a venography balloon to anchor you in? That'd be great.
Susie? I'm on it.
Carol, how you doing? I'm great.
Good.
Shouldn't be much longer.
We're just grabbing an extra piece of equipment.
Okay, well, just take your Carol? Her pressure's dropping.
Heart rate's up to 180.
What's happening? She's in SVT.
Bag her.
Carol? Carol? She's unresponsive.
It looks like tamponade.
The wire must have perforated her heart.
60cc syringe.
Mom? Mom! Syringe.
She's gonna arrest if you don't get in there now.
I think I'm in.
No, nothing.
Angle it deeper.
Charge to 200.
Hold up.
I've got blood.
- Rhythm's back.
- Heart rate's down.
Pulse is strong.
Set up for continuous drainage.
Hey.
Vanessa brought her parents in and wants them to meet everyone.
- Oh.
- And this is our charge nurse, Maggie.
She keeps the place running.
Maggie, these are my parents, Kent and Bea.
- Hi.
- Hello.
Nice to meet you.
Your daughter is great.
She just loves working here.
She can't stop talking about the patients, - how much she's learning - Okay, Mom.
What? You do.
Ah, parents, such an embarrassment.
Ugh, come on, let me show you where the ambulances come in.
- So nice to meet you.
- Likewise.
Dr.
Choi! Dr.
Archer! She's not waking up.
- Mindy? - What's going on? The bleeding must've gotten much worse - faster than we expected.
- What can we do? You can use your power of attorney.
Say the word, and we'll take her right up to surgery.
But I'm sure we'd all rather have Mindy make this decision.
- How? - We can drill a hole in her skull right here to release the pressure.
Then when she wakes up, we can explain the situation, get her consent.
Let her make the choice.
- Okay.
- Dr.
Choi, a minute, please.
Nancy, get the drill, high flow O2, elevate her head.
We both know she needs this surgery.
- This is our chance.
What? - Did you do this? Sedate her to override her wishes? I am trying to save this girl's life.
I'm about to drill a hole in her head.
Am I gonna see blood? Drill the hole, Doctor.
Nancy.
Okay.
- Keep her still.
- Yep.
- I can't.
- Ready? Yeah.
Okay.
She's waking up.
Mindy, you're okay.
You want me to set up a drain for the rest of the blood? Yeah.
Hey, Mindy.
Hey, you're okay.
Ramona, it's Dr.
Charles again.
I don't know if you got my last message, but I just think it would be a really good idea for us to continue our conversation.
So I hope you call me back, at least to let me know that you're doing okay.
Okay.
Come in.
Hey.
Hello.
Almost done, huh? Yes.
Good.
We never ended up looking at interactions with Hepatitis C, did we? Of course not.
You know we screen all Hep-positive patients out.
Right.
Though, if we knew there was a definite contraindication with Hep C, that would be good to know, right? I suppose.
Why are you bringing this up? There is a patient who's on the drug who was not screened.
Did they slip through protocols? No, it's not that she slipped through, it's that she's not part of the trial.
Are you telling me our drug went to an outside patient? Will, this is a massive breach of protocol.
- Who did this? - Well, what's important - is that a very sick woman - Dr.
Halstead, who gave an unauthorized patient our trial drug? Me.
I did.
Why I can't believe you.
You swore you would never do anything like this again.
Sabeena, the patient was out of options Stop making excuses! I trusted you.
And you betray me like this.
Who is the patient? She's Natalie's mother.
That explains it all, doesn't it? You realize you have quite possibly compromised the trial Not to mention your career.
You can leave.
Okay.
Thank you so much.
Why isn't Mr.
Barton on ECMO? I ordered a culture of the lung donor's washings and told the ECMO tech to hold off just That man in there is dying, and every moment counts.
I know, but I just heard back from the lab April, for you to ignore me because of something you think you saw in an x-ray is absolutely inexcusable.
Dr.
Marcel, it's positive.
They were traces of COVID DNA in the lungs.
I have COVID? No, you do not have COVID.
The lungs you were given had been infected with COVID.
Even though the donor tested negative? He must've already recovered but not before the virus caused widespread microscopic damage to his lungs.
None of which was visible at the time of the transplant.
But it made them very susceptible to pneumonia.
So this wasn't anybody's fault.
Just bad luck.
It was, but the good news is Dr.
Marcel might be able to save one of the lungs.
But this will be a very risky surgery, and even then, I won't know until I'm in there whether you'll have enough functional lung left to survive.
I could die? Yes, you could.
So if you'd rather me not perform the surgery, I can get you on ECMO, and we can start looking for a new set of lungs.
Hey, it's okay.
James I trust you.
Okay.
Then we're gonna get you up there right now.
All right? Right now the drain is keeping the pressure from building up, but she can only stay on like this for so long.
Well, are we talking days, weeks? Depends on several factors, whether the tumor continues to grow, or whether the bleed breaks through the clot.
But she will eventually need the surgery.
- So I - Give me a minute with her, okay? Hey.
I don't need another lecture right now.
I know you think I'm being stupid.
Aw, come on.
You kidding me? Sometimes being scared is just about the smartest thing a person can be.
Listen, I was a doctor in Iraq, all right? And uh, we were in a town that was considered friendly.
All right, I'm just standing there in the middle of the street, and all of a sudden we start taking fire.
It seemed it was coming from every direction.
And right off the bat, I'm hit, all right? Left thigh, blood pouring out of everywhere.
And so I hightailed it to some stairwell.
All right? It was hidden, it was relatively quiet, and all I wanted to do was just sit there and wait for the shooting to stop.
I couldn't stop the bleeding.
Tried, couldn't stop it.
After a while, I start feeling woozy, started getting cold.
And I knew That I was gonna die right there.
All I could hear on the other side of that wall was shooting, right? So somehow, I just force myself to run out of there, run right through the middle of that firefight.
I'm running and running and Somehow, by some miracle, I made it.
Leaving that stairwell was the hardest thing I ever had to do.
But it was what I needed to do to save my life.
Do you understand? So as scary as this is If I'm there with you the whole time during this surgery, will you take that chance too? It's really my only chance? Yeah, it is.
Okay.
Okay.
Okay.
Okay? Looks like you may have picked the right man for this job.
Yeah.
Ramona, I'm so glad that you Okay, Ramona.
Don't do anything.
Don't move.
I'll be right there.
I'm on my way.
Hey, Ramona.
Any way I could get you to, um, to step back onto onto the balcony so we could, uh, so we could chat a bit? I keep wondering Would it make any difference if I jumped? Oh, it would make a great difference to me.
I can tell you that.
Hey, easy, easy, easy, easy.
Ramona, it's okay.
I just want to talk.
When I came to see you this morning, I just I just wanted to talk to someone like a normal person, just have a conversation.
Yeah.
Okay.
I just want a normal life.
Yeah.
You so, Ramona, a normal life, what does that look like for you? It looks like Not feeling like a freak.
Like, not being totally alone all the time.
Yeah.
It looks like having maybe someone - Who - Who you could trust.
Yeah.
Somebody who always had your back, no matter what.
Yes.
Ramona, look at me.
Look at me.
You can trust me.
I absolutely have your back.
And not just me.
There's so much help for you out there.
- I'm scared.
- Of course you're scared.
I mean, you've been through something awful.
To really look at that, I mean, it's gotta be scary as hell.
But you know what? I know that you are brave enough to do that.
You do? I do, and I also know about a safe place where that could happen.
What kind of safe place? It's a place where there are women who have been through the same kind of thing that you have.
What would you think about maybe letting me take you there? I gotcha, I gotcha.
It's okay, it's okay, it's okay.
I gotcha.
You're gonna be okay.
He opened his eyes.
Does that mean he's gonna be okay? It means he's waking up from anesthesia.
What matters is if he's able to follow commands.
Hey, James.
Hey.
Squeeze my hand.
Give it a good squeeze.
Come on.
Give it everything you got.
There it is.
That's good, right? Oh, my God.
Thank you both so much.
Hey, April.
Look, I'm sorry about getting upset before.
I shouldn't have.
You saved his life.
I'm just glad it worked out.
Yeah.
Hey, I never asked.
How'd your interview go? Oh, my God.
Hey.
So the pacer's not gonna be enough.
Gift of Hope's got her at the top of the transplant list, okay? Hopefully a new heart will come up soon.
Oh, um, you know, I never did get to talk to Dr.
Virani today.
You know what? She never came in.
Oh.
Yeah, so maybe you can track her down tomorrow.
Okay, I just, I really hope you don't get into any trouble.
I wouldn't worry about that.
Thank you for everything you did today.
Sure.
Yeah.
She looks good.
Yeah, I think it's gonna be a quick recovery.
Dean, that story in Iraq, I had no idea you went through anything like that.
Yeah, well, didn't we all? Not like that.
I didn't.
Yeah, okay.
Wait.
That story, did you make it up? No, I did not make it up.
Uh, actually I heard it from one of the guys in my vet's group.
I mean, it's not exactly the same story, but it's close.
Anyway, that reminds me, my group's about to start, so I better get a move on.
I got your page.
- Hey.
- Hi.
Hey, uh, look, Natalie, if you and Will are getting back together, just tell me.
This not knowing is driving me crazy.
No, Will and I are not getting back together.
Okay, then what? I mean, you been keeping secrets, shutting me out.
I mean, something's going on.
What? I I stole meds from Will's trial.
My mom was so sick, and nothing was working.
I was desperate.
I wanted to tell you, but I felt so guilty and so afraid.
And now my mom is dying in there, and she needs a new heart, and I don't know what to do.
Oh, honey, come here.
Oh, I'm so sorry.
It's okay, Nat.
It's okay.
Okay.
It's okay.
Okay.
Yeah.
Here you go.
Thank you.
Hey, you wanted to talk to me about abbreviations? I'll call you right back.
Yes.
I wrote them down for you.
Cool.
Your parents, they seem like really nice people.
Yeah, they're great.
You know, parents.
- Sure.
- Yes, I get this.
Anything else, Maggie? No.
That's it.
Okay.
Yeah, well, I'll see you tomorrow.
See you tomorrow.
It looks nice.
I think you're gonna find it's a pretty special place.
Hey, Daniel.
Ramona, this is Dr.
Garner.
Oh, please.
Call me Anne.
It's nice to meet you, Ramona.
Your room is ready.
And there's breakfast in the kitchen if you're hungry.
So would you like to come in and meet everyone? - Mm-hmm.
- Okay.