Chicago Med (2015) s07e05 Episode Script

1 With the suggestion from Dr.
Cooper I could've sabotaged Archer's CVP monitor so that the Vas-COM could save the day.
And I came close to doing it.
If this ever gets to be too much for you, I'll put a stop to the whole thing.
I'll take it from here.
I assumed I'd perform the surgery.
You're free to watch.
- Best by the powers that be.
- I'm sorry.
I made a fool of myself with Dr.
Marcel.
I'm crushing on my advisor.
How long you been doing this? - 35 years.
- How? You got to hang on to those good days.
You got to hang on to those wins.
- Really, Dad? - What? It's fine.
It's a red zone.
It's for emergencies only.
- No - See? Now, it's an emergency.
Oh, you know what? I wanna check this out.
New PDT system.
I can check all of my units in real time.
But, look, can I check it out later? I really do have to go.
I'm late.
- Everything okay here? - Oh, yeah, we all good.
Just a little ride-along.
Letting a civilian see what a real job looks like.
- Yeah, thanks.
- Yeah.
Am I embarrassing you? - I'll see you later.
- Okay.
[SIREN BEEPS.]
- Come on, Dad.
- [LAUGHS.]
- [SIREN BEEPS.]
- Okay, I'm gone.
[LAUGHS.]
Hey, what's up? Do you remember how when we were in physical exam class, when we did breast exams, they would tell us to make small talk with the patient actors? Yeah, to help put them at ease.
Yeah and there was that one guy, Mandelbrot.
Super awkward.
Caught hell for asking one of them what she was doing that weekend.
- Oh.
- He is a panelist at the next summit for female physicians.
- [LAUGHS.]
- Wait, that wasn't Mandelbrot.
It was Richardson.
No, pretty sure it was Mandelbrot.
- No, it was Richardson.
- You haven't changed a bit.
- Always got to one-up me.
- I'm not trying to one-up you.
Two shots for Dr.
Hammer.
Three for Dr.
Halstead.
[LAUGHS.]
Thank you.
- Have a good day.
- You too.
Thanks, Carly.
- Morning.
- Good morning.
Dr.
Halstead, how are things with Dr.
Cooper? - Uh, pretty well, I think.
- Oh, yeah? I mean, he hasn't said anything otherwise.
Good morning, Ms.
Goodwin, Will.
Matt.
Just the man I was looking for.
I want to tell you about the conference coming up in a few weeks.
National Critical Care Society annual meeting.
It's here in Chicago.
You should go.
Vasik's gonna be a platinum sponsor.
They're gonna have a corner booth.
It's gonna be the perfect chance for you to meet some of the upper-level execs.
Oh, do you think that you could spare him for the day? It's always good when our doctors broaden their expertise.
- I'll be there.
- Okay, great.
I'll get you the details.
Um, Ms.
Goodwin.
- Mm-hmm.
- See ya.
This might be good.
And maybe I can get them to offer me a deal like Cooper's.
[PHONE BUZZES.]
Geez, I got to get this, but, uh, you're on the right track.
Thank you, La'Shawn.
Morning, Alim.
- Hey.
- Hey.
What time did you get in? Uh, I don't know.
Like, around four.
Why so early? Always try to get a leg up on the day.
Two hours before your shift? Well, if I'm meeting with my patients earlier, then I can read up on their conditions.
That way, I'm running rounds, I'll have all the answers.
Plus, if I'm here a little early, I can study for my boards.
Sleep ever a factor in this equation? Life of an intern.
What can I tell ya? - Dr.
Marcel.
- Yeah.
- Treatment three incoming.
- [BELL BEEPING.]
What do we got? Avery Quinn, 28-year-old female.
Pedestrian versus auto.
BP 80/45.
Heart rate 114, satting at 88.
Okay, Avery, I'm Dr.
Marcel.
We're gonna take good care of you, okay? It hurts so much.
Trigger the MTP, give her 50 of fentanyl.
Here we go, guys.
Transfer on my count.
- One, two, three.
- [GROANS.]
There it is.
All right, let's roll her.
You're okay, we got you.
The board [GROANS.]
All right, we're good.
Avery, can you put your arms by your side for me? You're gonna feel a little bit of pressure, okay? - [GROANS.]
- O2 sats down to 82.
Avery, Avery.
Avery she's out.
We need to intubate.
20 of etomidate, 100 of sux.
Get a CBC, CMP, type and cross four units.
Let's get a fastscan and have them prep OR 12.
- No, she's going to OR seven.
- Excuse me? Yeah, I'll take it from here.
And let's add a coag panel and LFTs.
Dr.
Blake, I think you're mistaken.
This is a trauma, not a transplant surgery.
Yeah, I can see that.
She's got free fluid, and she's in shock.
Her liver's ruptured but repairable.
- We got to get her up now.
- I'm in.
Bag her.
All do respect, Dr.
Blake, you're a transplant surgeon.
- I got this.
- Thank you, Dr.
Marcel, but I'll be taking over the case now.
I'm sorry, I can't let you do that.
This is my patient.
And I understand that, but she's also my daughter.
Now, I'm gonna need you to move.
Let's go.
[DRAMATIC MUSIC.]
You got a transplant patient? No, I don't.
But we have a problem.
Hey, Alex, I'm Dr.
Scott.
I'm Susan.
This is Todd.
And this is Ry Ryan, come on.
Hey, Ryan, can I get a couple of those? Ryan, enough with the gloves, okay? Thanks.
[LAUGHS.]
Alex, says here that you got hit in the head with a Nerf gun.
- Yeah.
- Oof, I bet that hurt.
The thing is, you're supposed to get hit with the foam dart, not the actual gun.
[CHUCKLES.]
Stop it.
It was an accident.
The boys were playing.
- Mom, it wasn't a Nerf gun.
- Okay.
I I didn't even see it happen.
I okay.
- Ryan.
- Mom Mom.
- Hey, just a minute.
- Mom They were down in the basement and - It wasn't a Nerf gun.
- Ryan, okay.
Hey, hey, hey, Ryan.
What's up, buddy? Talk to me.
- It was an Ultra Blaster.
- Oh, yeah? Triple action with the slam-fire? - Uh-huh.
- Sweet.
Yeah.
"I'm sorry, Doctor"? Todd, you want to take him for a walk to the truck? Give him his meds.
Okay, go with Dad.
Go.
Oh, man.
Tough day, huh, bro? He has ADHD.
Yeah, we have him on Adderall, but we keep upping the dose, and some days are just a little tough.
[WHISPERS.]
I know.
It's okay.
What about you? How you doing? [WHISPERS.]
I'm fine.
You sure? Okay then.
For now, we're gonna keep applying pressure and get you all stitched up.
Shouldn't be too long.
- Thank you.
- Welcome.
Hey, Mags, I need somebody to throw stitches in six.
I'm on it.
You already have two patients up.
- You sure you have time? - Don't worry.
I got it.
[SIGHS.]
- Rough morning, huh? - Yeah.
It's a tricky family dynamic.
I'm treating a 10-year-old named Alex.
His brother has ADHD.
- Seems like it's pretty tough on them.
- Yeah.
Takes up a lot of the family's energy.
Oh, yeah.
Parents so focused on on the kid with the illness that they see right through the other one.
Yeah, unfortunately not at all uncommon.
There's even a name for it.
It's called it's called glass child syndrome.
Oh, that sounds like exactly what's happening.
Yeah, happy to provide you with a couple referrals for a therapist for the for the kid if you think the parents'll be open to it.
I think that'd be great.
Thanks.
- [PHONE BUZZES.]
- Oh.
Dr.
Choi, I've been bugging him for an update on his rehab.
I better take this.
Go ahead, man, and tell him I look forward to meeting.
Will do.
I understand this must be hard for you, but that's the very reason I can't let you go in there.
I appreciate your concern, but I'm fine.
- Dr.
Blake.
- Ms.
Goodwin.
You know very well it's against hospital policy to operate on a family member.
I am perfectly qualified to perform this surgery.
Pamela, you are a transplant surgeon.
Dr.
Archer and I see these cases every day.
And I make more money for this hospital - than any other doctor here.
- That is not the point.
Dr.
Archer is a top trauma surgeon.
He will do an excellent job.
I will, and if you're so inclined, I'd be happy to have you observe.
- Ryan.
- Ryan can you sit still for just one minute? [SIGHS.]
I'm gonna go get some air.
Yeah.
Will, can I get your opinion on something? Sure.
What's going on? I've got a 71-year-old woman who's hypotensive and tachycardic.
Passed out this morning at home.
No medical history other than asthma.
She could use some cardiac monitoring, and I know that you're big on the Vas-COM.
Well, I mean, there are a number of good cardiac output monitors.
But the Vas-COM is a terrific device.
You mind if I, uh, have a look at her? - See if she's a good candidate? - Yeah, yeah, sure.
- Eleanor, Ron, this is Dr.
Halstead.
- Hi.
He's just going to ask you a few questions.
- Nice to meet you.
- You have to help her.
Ellie, tell him, you've never been sick a day in your life.
- Ron - No, no, that's good to hear.
- You mind if I? - Mm-hm.
Make a fist.
- And release.
- [SIGHS.]
Good.
Does she have any sensitivities or allergies? Recent injuries, meds that would interfere - with an arterial line? - Just seasonal allergies.
Okay.
Eleanor, do you ever have any trouble - when you get your blood drawn? - I don't think so.
What about leg swelling? Long car rides, trips? No, not that I can remember.
That's good.
All right, it was nice to meet you.
I'll have a chat with Dr.
Hammer.
We'll be right back.
What do you think? She look good for the Vas-COM? Uh, maybe.
She was a little vague in her answers.
But she definitely should have her cardiac output monitored? Dr.
Hammer, if you're interested, I could give you copies of the Vas-COM's FDA-approved usage criteria? You know, that that won't be necessary.
I think Eleanor would be a great candidate.
Okay, good.
I'll get it set up.
- Dr.
Scott.
- Alex? - Dr.
Taylor.
- Buddy? What? - Alex.
- Bud - Excuse me.
- Honey, honey? - What what's happening? - He's having a seizure.
Give him 12 liters of O2 and .
five of Ativan.
Wait, seizure? Why is he having a seizure? I'm not sure yet.
[WHISPERS.]
Come on.
Come on, come on, come on, come on.
Hey, Alex, you with me? Uh-huh.
[WHISPERS.]
Okay.
We're gonna figure this out as soon as we can.
Dr.
Taylor.
Hi, hi, okay.
It's okay.
Has that cut been bleeding like that the whole time? I tried holding pressure, but it didn't work.
And if I would've tried to stitch too soon, he would've got a hematoma.
He could have a bleeding disorder.
Did you order coags? - Um, well, no.
I - Get a coag panel, Maggie.
And let CT know we're on our way.
Wait, do you think he could have a subdural hematoma? Yes, and if he does have a bleeding disorder, then the trauma from getting hit in the head could've caused a bleed in the skull, which means he could herniate at any moment.
All right, now.
Let's go.
[WHISPERING.]
Oh, my God.
Okay, ready to release the pringle.
Hold on, I didn't get a good look at the duodenum.
- It's clear.
- Okay.
All right, pulling back on the lap.
[HEART MONITOR BEEPING.]
Looks good.
What's her pH and temp? 7.
34 and 36.
9.
All right, looks like you're good to close.
Uh, actually, we're just gonna pack and leave her open.
No, her bleeding's under control.
- Packing her isn't necessary.
- I disagree.
She's got a grade four liver laceration.
The risk of re-bleeding is too high.
She's a healthy 28-year-old.
Leaving her open puts her at increased risk for infection, coagulopathy, hypothermia, and acidosis.
- Dr.
Blake, I - Close her up, doctor.
- I understand your concerns.
- No, no, point well taken.
I see the merit in what Dr.
Blake is saying.
- Dr.
Archer - All right, hold off on the lap.
I need Celox, Gelfoam, and get an O Max and suture for Dr.
Marcel.
- Dr.
Archer, you - Dr.
Marcel.
[KNOCKING.]
Mr.
and Mrs.
Miller, I'm Dr.
Charles.
I had been consulting with with Dr.
Scott on Alex's case.
- Psychiatry? - Head injury.
You know, can't be too careful.
Anyway, Dr.
Scott wanted me to let you know that Alex's scans are almost ready.
And in the meantime, is there anything I can get you? - A bottle of water? - Thank you, but we're fine.
- Yeah.
- [CELL PHONE BUZZES.]
Oh, sorry.
This is work.
Um, don't forget to text my parents.
- Excuse me.
- Oh, okay.
Yep.
Ryan? Is it Ryan? How about you, buddy? - Can I get you something? - Do you mind if I - No, not at all.
- Okay, I'll be right back.
Not at all.
Would you, uh, like a sandwich or something? No? Bag of chips? Soda? Anything at all? No! You interrupted me.
Oh, I'm sorry.
I, uh, I I didn't mean to.
Now I have to start all over again.
Oh, you were counting.
Huh? Okay, well, I'm again, I'm very sorry.
You you get back to that.
All right? Mr.
and Mrs.
Miller, we just got Alex's test results back.
Alex is stable right now, but the scan did confirm that he is bleeding into his brain.
And the intracranial pressure is great enough that he needs immediate surgical evacuation.
Oh, my God.
Wait, wait, wait.
How'd this happen? Well, his test results came back positive for a bleeding disorder called Von Willebrand disease.
So the impact from a small toy could've caused a bleed that his body just wasn't able to stop.
I I know this is a lot, but Dr.
Abrams will be doing the surgery, and he's our very best.
The procedure shouldn't be that long.
I'll be here for status updates or if you have any questions.
And if we have your consent, we could get started right away.
- Sure.
- Yeah, of course.
- Whatever you need.
- Okay.
So why don't I take you somewhere that's more comfortable to wait? Um, Ryan.
Hey, buddy.
Come on, buddy.
We're gonna take a little walk, all right? [ALL TALKING BRIEFLY.]
Hey, I saw Eleanor's oxygenation and cardiac output are down.
Have you gotten her labs back yet? Yeah; they don't show much.
Mild infiltrates on her chest X-ray and some eosinophilia.
Still don't know what's going on.
I'm a little concerned.
One of her fingers and two of her toes are going cold.
Oh, could just be a vasospasm.
That could be, but look, the major drawback to any arterial line, including the Vas-COM, is the potential for thrombus formation.
So I think we should pull it out.
Pull it out? I mean, thromboembolization in arterial lines is extremely rare, and it almost never occurs - this quickly.
- I understand.
I just think we should err on the side of safety.
What? Is something going on? It's getting us great numbers.
Keeping Eleanor's meds titrated and her pressure and heart rate optimized.
Without it, we'd just be shooting in the dark.
I know.
I just want to make sure - we're using it appropriately.
- I think we are.
Let's just give it a little more time.
[UNEASY MUSIC.]
- Dr.
Archer.
- Yeah.
What the hell happened back there? What? Giving in to Dr.
Blake like that.
The surgery was a success, and if you'll excuse me, I have an ED to run.
Hold on, Dean.
You know, with that kind of injury, keeping her open is the right thing to do.
Dr.
Blake's reasoning was medically sound.
I mean, I could argue it either way.
- Oh, come on! - Crockett hospital politics is a lot like the military.
You put in your time.
You do as your told.
And eventually you can rise up to become a Dr.
Blake, too.
Hey, buddy.
This is my friend, Dr.
Charles.
Hey, Alex.
We just came to check in on you before your surgery, see if you had any questions.
- Is this gonna hurt? - No, no.
They're gonna give you some medicine.
It's gonna put you right to sleep.
You won't feel a thing.
Even when they open my head? Next thing you know, you're just gonna wake up in recovery.
We promise.
Okay.
Anything else on your mind? No.
It's just, when they look inside my head, will they see my secrets? Uh, I don't think so.
But if there is something on your mind, a lot of kids tell me that it's just better to get it out.
This wasn't Ryan's fault.
Oh, don't worry about that.
Ryan's not in any trouble.
No, I made him do it.
I made fun of him, and I know if I did it enough, then he'd get really mad and hit me.
Yeah? Why would you want him to hit you? Because Because? If you got hurt, maybe Mom and Dad pay a little more attention to you? It was stupid.
I shouldn't have done it.
Hey, it's okay.
Let's get you taken care of.
All right? Alex, it's gonna be okay, buddy.
You're gonna be fine.
We'll see you in a bit.
[SIGHS.]
Man, listen, I deal with a lot of sick kids, but what do you do for this? So kid with ADHD, they've control issues, right? - Random outbursts.
- True.
Yeah, but Alex knew he could only get Ryan to lash out if he backed him into a corner.
That's not random.
So, what are we looking at if this isn't ADHD? I think maybe an anxiety disorder.
Oh, another misdiagnosis.
Second in a week.
And if I'm right, that misdiagnosis is causing this family a lot of problems.
- [ALARM BEEPING.]
- You have to come quick.
Something's wrong with Ellie.
[DRAMATIC MUSIC.]
[MONITOR BEEPING.]
- Eleanor, can you hear me? - Yeah.
- Okay.
- Squeeze my hand.
What's happening? Why's she like this? She had a TIA, a mini-stroke.
Start her on aspirin and clopidogrel and call for an MRI of her head.
A stroke? What what? Why? 'Cause she's forming thrombi.
They're blood clots in her vessels, and one's travelled to her brain.
Oh, my God.
Get a suture kit.
We have to pull the Vas-COM.
I'll call Dr.
Hammer.
Excuse me, Mr.
Halt.
- She's up in radiology.
- No, no, no.
Every minute that passes increases her risk of a major stroke.
We have to pull it right now.
No, that one too.
Yeah.
Hey, you okay? No.
I screwed everything up today.
I saw Alex's notes.
Von Willebrand disease? You couldn't have known.
I could've ordered those labs earlier.
But it doesn't matter.
The outcome still would've been the same.
Look, you're always gonna wish that you could've done something earlier.
It's part of being a good doctor.
Alex is in surgery, Maggie.
He's bleeding into his brain.
Which isn't your fault.
You pulled my patient's Vas-COM? She had a TIA.
The Vas-COM was most likely the source.
You don't know that.
Could've been lupus, endocarditis, even leukemia.
And now we have no way to monitor her.
She could've had another stroke at any minute.
What what was I supposed to do? She's my patient, Will.
You at least should've asked me.
By the time you got down here - I'm not taking that chance.
- No, you were afraid that I would disagree and that I'd stop you.
- No.
- It's the same old Will from med school, always thinking that you know better.
Stevie, that's not what this was about.
You tell yourself that.
Hi.
I don't know if you remember me from this morning.
I'm the surgeon on your case, Dr.
Marcel.
How you feeling? Like I got hit by a car.
Well, you did just have major surgery, but, uh, it went well, and I imagine you will feel a little better each day.
Here you go.
- Dr.
Blake said to go slow.
- Thanks, Dina.
Ice chips.
My mom is in love with them.
Frankly, I think they're just as much - an aspiration risk as liquids.
- Aspiration risk? What, are you a you a doctor, too? Made it halfway through a third year of med school.
Oh, okay.
Realized I was doing it for my mom, not for me.
Oh.
I'm assuming you've met her by now? Made her acquaintance, yeah.
She try to scrub in? - How'd you guess? - [GROANS.]
- I know my mom.
- [LAUGHS.]
She didn't talk to me for six months - after I quit med school.
- Wow, that's rough.
No.
The day I took control of my life? Best move I ever made.
Anyway, I should let you get some rest.
Um, enjoy your ice chips, and I'll check back later.
So wait, what did you end up doing after med school? - A malpractice lawyer.
- Medical? - Your mom must be very proud.
- [LAUGHS.]
Mr.
and Mrs.
Miller, I have an update for you.
Be right back, buddy.
So, look, they're they're just finishing up in surgery now.
All indications are that the procedure was a success.
And Alex is doing great.
Oh, my God, really? Thank you so much.
Listen, Dr.
Scott and I talked to Alex before the procedure today.
And I understand that you have a lot on your plate right now, but I I also think it's important that I share this conversation with you.
BOTH: Okay.
So so what he told us is that he provoked Ryan into this outburst today.
He feels terrible.
I think he is looking for some attention.
But where Ryan's concerned what this means to me is that it wasn't an impulsive outburst.
It wasn't it wasn't random.
And that and a couple other things I've observed today are leading me to believe it's very possible that that your son has been misdiagnosed with ADHD and that we were probably looking at some kind of anxiety disorder instead.
Wait, what are you talking about? Look at him.
He can't sit still.
But Mr.
Miller, it's it's the counting, right? The tapping.
I think that he's self-soothing to help him cope with these feelings of anxiety.
And when that stops working, I think he feels backed into a corner, and then you have a fight-or-flight situation.
Well, what about the Adderall? His doctor said that would help.
If he actually had ADHD, it would be working.
But it's not, right? I think that in Ryan's case, it's actually working against him and serving to only intensify these feelings of anxiety to the point where they're often, frankly, unbearable.
Dr.
Charles, man, look I I we appreciate everything you're doing.
Really, but please, our son's in surgery.
I am sorry.
This is just not an ideal time to have this conversation.
But I just wouldn't be doing my job if I didn't tell you how important I think it would be to reassess Ryan and make sure that you are looking at the right diagnosis for him, for his brother, for all of you, - for your whole family.
- No, Dr.
Charles, it's just - it's just been a long day.
- Of course.
Listen, I am going to check back with you when Alex wakes up, okay? - Yeah, yeah.
- Okay.
I should've consulted you before pulling the Vas-COM.
It wasn't my place.
I'm sorry.
And besides, you were right.
She's getting worse and still having embolic events.
So it wasn't the Vas-COM after all.
Clearly, but I've gone through every clotting disorder, and none of it fits.
Is it possible we're looking at this wrong? That she doesn't even have a clotting disorder? Of course.
It's just so little to go on.
I mean, history of asthma, eosinophils, and left-sided lung infiltrates.
Left? I thought they were on the right.
- Seriously, Will? - No, no, wait.
The X-ray from this morning had them on the left.
But look The one from this afternoon shows they moved to the right.
Migratory infiltrates.
Could this be vasculitis? Churg-Strauss? I mean maybe.
She could've moved from the asthmatic stage into the vascular stage today.
It's a long shot, but it's possible.
If we're right, her organs could start to shut down at any moment.
I'll start her on prednisone and azathioprine and set her up for a diagnostic lung biopsy.
Dr.
Hammer, Dr.
Halstead, you need to come.
Eleanor's getting worse.
I don't like these QRS complexes.
Eleanor, do you feel any pain in your chest or arm? - It feels tight.
- Oh, God, Ellie.
Why don't you come here? [BEEPING.]
- She's going into v-tach.
- I'll get the paddles.
- No, no, Ellie.
- Wait.
If this is Churg-Strauss, this could be a tamponade.
We need to aspirate the fluid.
I know, but if we're wrong, we won't have time to cardiovert.
I think we're right about this.
I do, too.
- 18 gauge on a syringe.
- 18 gauge.
[BEEPING.]
Ron, there's fluid around Eleanor's heart.
They need to drain it.
[BEEPING.]
Nothing.
Got it.
Sinus rhythm.
Eleanor, can you hear me? - Uh-huh.
- Oh, thank God.
Call IR.
Tell them we're coming up - for a drain and a lung biopsy.
- You got it.
Good job.
Hey.
How you feeling? - Okay.
- Good.
Surgery went well.
In fact, the neurosurgeon said that you had the best-looking brain he's seen in quite a while.
- Yeah? - Yeah.
Told your parents, but they weren't surprised.
Said they always knew you had a great brain.
They said that? Yeah, they did.
You know, Alex, kids with great brains they don't always get the most attention, but people notice.
What's going on? O2 sats are 91.
BP's down to 83/50.
Drains are full.
- [GROANS.]
- Belly's firm.
Okay, etomidate and sux, then transduce to a bladder pressure.
Let's go.
Hey, Avery, look at me.
You're re-bleeding into your abdomen.
I need to intubate and take you back to the OR, okay? [GROANS.]
What happened? Abdominal compartment syndrome.
- We're going back to the OR.
- No, no need.
You can use a cordis catheter and decompress here.
There's too much blood.
We don't have enough time.
I'm in.
Bag her.
And if you open her up, there'll be too much swelling, and you'll never be able to close.
Get the cordis.
Dr.
Marcel, bladder pressure's 35.
- [BEEPING.]
- It's too high.
We need to open her up to release the pressure.
- Get me a 10 blade.
- Dr.
Marcel, I already told you Back off, Dr.
Blake.
Here we go.
Ready? [BEEPING.]
Sats are up to 96 and BP's 112/83.
She's stable.
All right, get her up to the OR.
Make sure you get her swelling down.
You're gonna need to close her up as soon as possible.
How is Alex? Um, his surgery just ended.
He's doing really well.
Alex probably hates me.
I want to tell him I'm really, really sorry.
You'll be able to see him soon.
- And then you can tell him.
- Can I see him now? I'm not supposed to let you until he's in his room.
Please? Okay, maybe we could just take a quick peek.
If it's okay with your parents.
Mom, can I go with the doctor? Yeah, honey.
Okey doke, let's go.
So he's still a little sleepy, so we're just gonna give him a quick wave hi, okay? That's not Alex.
It's okay.
He's just a little bandaged from surgery.
- I didn't do that.
- No, of course you didn't.
I didn't mean to.
No, I'm sorry.
- I'm sorry.
- Hey, hey, Ryan, Ryan, Ryan, it's okay.
Listen to me.
Listen to me.
Ryan, look, - you didn't do anything wrong.
- Stop it.
Ryan! Ryan! Ryan! I'm so sorry.
This is all my fault.
The security camera picked him up.
We're okay.
Still, I just can't apologize enough.
Maybe I should talk to his parents or You know what? I think it's probably better if I handle this.
Listen, Vanessa, not your fault.
Okay? You were trying to help.
Ryan, your brother just had surgery.
That's why he looks like that.
He's gonna be fine, buddy.
Now, can you please come out? Please, Ryan? - Mind if I give it a try? - Yes.
Hey, Ryan.
You know what? I don't think that you wanted to hurt your brother today.
I think the only reason you threw that toy today was because you didn't know what else to do.
I got so mad.
'Cause those feelings, they just They just keep building and building.
Uh-huh.
I can't stop them.
And I'm always getting in trouble.
What if I told you that I didn't think that - that was your fault? - That's not what people say.
They're always telling me to reset.
Well, you know what? I don't think it's your fault.
Not only that, you know those those feeling you get? I get them, too.
- You do? - Oh, yeah.
Everybody does.
And one of the things that really helps me when I get them is, actually, to talk about them.
You know, there's this weird magic that happens when you when you get them out.
They just they just don't seem to bother you as much.
- Really? - Yeah.
And I guarantee you, whatever feeling you're having there are people in your life they want to hear about it.
I mean, your mom and dad They would really want to hear about them.
- They would? - Of course we would, honey.
And you won't think that I'm bad? Ryan, we never think you're bad.
I got you.
You really don't think this is ADHD? I don't think it is.
So this Adderall isn't helping? I think it's actually making it worse.
Hey, I just saw Eleanor's biopsy results.
Churg-Strauss.
Hey, maybe we work well together after all.
Maybe we do.
- I'll see you tomorrow.
- See you tomorrow.
Oh, I made a few calls.
- It was definitely Mandelbrot.
- [LAUGHTER.]
Bye.
Bye.
Will, I just met Eleanor.
Churg-Strauss, one in a million.
Yeah.
Though I did see you had to pull her Vas-COM.
Yeah, I hated to do it.
Uh, but she was throwing emboli, had some cold fingers and toes Hey, hey, Will, you absolutely did the right thing.
The last thing we need is for the Vas-COM to be used inappropriately and then it gets a bad rap.
That that's what I thought, too.
Now that she's stable, however, it did seem medically warranted to get her on better monitoring again, so I just put in another Vas-COM.
Okay.
Anyway, I'm glad you're coming to the conference.
Yeah, same here.
Hey, maybe, um, if you get there early, we could have a drink? Sure.
[GROANS.]
So what do you think? What do I think? Um, I think that they have made a crucial breakthrough.
And now they got some work to do.
Yeah, you know, it's something how easy it is, even in a loving family, to feel so unseen.
Huh? I guess I didn't always appreciate how good I had it.
Your numbers look good.
And your drains are clear.
[GROANS.]
So, if you get thirsty, you can just ask the nurses for some ice chips.
Ice chips.
[LAUGHS.]
Finally going to get some sleep? Boards aren't going to study for themselves.
Believe me, a nap wouldn't hurt.
Anyway, I'm going to run this boy's Adderall over to the pharmacy, then I'm out of here.
All right, well, um, see you tomorrow.
Hey, Vanessa, I know how tough internship can be.
But everyone here already sees what a good doctor you are.
Thanks, Maggie.
Yeah.
- Hey, Mike.
- Hey, Phil.
Hey, Dad.
Hey, Dylan, what are you doing here? - Oh, you know, stopping by.
- Okay.
Italian beef? Is that Al's? Oh, come on.
- It's been a long time.
- I know.
Ever since you used to bring them to me every day at medical school.
[LAUGHS.]
Really, that was just so I could get one, too.
[LAUGHS.]
- Here you go.
- Thank you.
- Mmm, mmm, mmm.
- Yeah.
You know, um, just wanted to say thank you, Dad.
For what? Bringing you sandwiches? No, no.
For everything.
Okay, you know what, boy? How many times I got to tell you you got to ask for extra giardiniera over there? [PHONE DINGS.]
Dr.
Marcel, this is Enid, from Dr.
Blake's service.
Dr.
Blake has a kidney transplant that she would like you to scrub in on.
Uh, please be here in half an hour.
[SIGHS.]
[CLEARS THROAT.]
[WOLF HOWLS.]