Chicago Med (2015) s08e03 Episode Script

Move the CR!
Stay with me.
So this is how it's gonna be?
All day long, you've been
talking down to me.
I should have given you credit.
I was very impressed with the way
you nearly killed our patient.
We are running low
on a number of key supplies.
No, no, no, no, no!
Stop! Stop! I need that dye.
We can't have one patient
depleting our supplies.
So call into the hospital.
We're all in the same boat.
Dr. Cuevas and I have a strong hunch
that David is developing
schizoaffective disorder.
No! My boy isn't crazy.
Stay away from us.
How is that boy
supposed to get any help?
It is a real pleasure
to finally meet you, Dr. Hawthorne.
My colleague at Med, David Kwan,
he sings your praises highly.
Oh, I'm not the doctor.
I'm her assistant, Katherine.
Okay.
Sign and date these forms, please.
Just wherever you see a highlight.
While you're finishing up with that,
I'll go over our
policies and procedures.
Everything you discuss
with Dr. Hawthorne
is confidential,
except in the event she feels
- you're a danger to yourself.
- You know what, Katherine?
I'm I'm actually a
practicing psychiatrist myself,
so, I mean, if you'd like,
you can skip that part.
I totally get it,
but Dr. Hawthorne,
who you'll meet next week,
requires we go through
the policies together.
If the doctor feels that you're
a danger to yourself or others,
- she's required to report
- You know what, Katherine?
I appreciate you're just
trying to do your job.
But, um, maybe you could tell
Dr. Hawthorne
to give me a call when she has a chance
to meet me herself in person, okay?
Um, you know what?
On second thought,
maybe tell her not to bother.
Yeah.
It's been a long time since
you had to hunt for a therapist.
Want me to shoot you some names?
I got a small stockpile of referrals.
I gotta be honest, Sharon,
after these last two experiences,
my interest in the process
might be waning.
I mean, this morning in particular
actually had me questioning
the state of psychiatry.
Well, that assembly-line mentality
is plaguing much of medicine these days,
not just psychiatry.
But don't worry,
you'll find your person.
- See you later.
- No coffee?
Ugh, no. I don't have any time.
We're implementing a new
drug shortage protocol,
so I'll be in the ED all
morning walking the staff
through the new guidelines.
You couldn't get the enforcer,
otherwise known
as Maggie Lockwood on that?
She's in Paris.
She and Ben never took their honeymoon,
and she was gonna
lose her vacation days.
- Wow.
- Yeah.
Well, still, not a great time
to be short-staffed, though, right?
There's never a good time.
- Yep, you got that right.
- See you later.
Get these off me!
David Sullivan, 17-year-old male.
Oh, we've met.
David, it's me, Dr. Archer.
- Do you remember me?
- I can't stay here.
They're gonna find me.
I have to keep moving.
- I can't stay in one place!
- It's okay, honey.
- You're safe. You're safe.
- He ran naked into the street.
Dad managed to grab him
before he got hit by a car.
No visible injuries that I can see.
Gave him 0.5 of lorazepam en route.
Hello, again, Mrs. Sullivan.
Is your husband all right?
He's fine, yeah.
He's just a bit shaken up.
He drove behind us,
should be here any minute.
- Doris, would you
- Page psych. I'm on it.
Okay, finish my sentences
for me, why don't you?
Okay, David, we're gonna
loosen your restraints now
and move you to the bed.
I need you to stay still.
Keep your hands by your side, all right?
Okay, ready, everybody?
On my count, one, two, three.
Good. Okay.
Very good, okay.
- Oh, no, no, no, no, no!
- It's all right.
- It's all right.
- David, please.
Just let the doctor
look at you, okay, honey?
They came inside the light.
They're trying to steal
my DNA so they can clone me.
Okay, so what do you think
could have triggered this?
We were at a stoplight,
and David became fixated
on this billboard.
It was just some random man
selling car insurance.
He's not random. He works for them.
- There's a whole network.
- I don't know.
He started taking
his clothes off and telling us
that they were they were
bugged with recording devices.
And then right when the light
turned green, he bolted.
He ran across four lanes
of oncoming traffic.
There was
There was a pickup truck
that was coming right at him.
- And he
- Eric.
- Sir, are you all right?
- Oh, my God, Eric!
All right, let's get him to the ground.
- Eric! Eric!
- Come on.
- What's going on with him?
- It was meant for me.
- They're gonna kill us all!
- It's okay, honey.
Mom, we gotta get out of here now.
- Let's get a gurney over here!
- It's okay.
- Come on!
- Oh, my God.
No, no, no! No, no!
Your husband's CT angiogram
showed an aortic dissection.
That's essentially a tear
in the wall of his aorta.
So Eric didn't have a heart attack?
Well, a dissection can often mimic
heart attacks in presentation.
This particular tear
is very close to his heart,
which is why we need to get him
to surgery as soon as possible
in order to repair it.
- Open heart surgery?
- Mm-hmm, yes.
Dr. Morris, one of our
cardiothoracic surgeons,
will be performing the operation.
He's on his way here now.
Oh.
Okay, can I see Eric
before he goes under?
Yes, of course.
Once we get him to pre-op,
I'll have a nurse come get you.
How about we go somewhere
and chat for a bit?
Thank you.
Okay.
I don't understand.
Why would David think that
this man on a billboard
was after him?
It's what we call
a delusion of persecution.
Yeah, one becomes convinced
that some individual,
you know, or group is
conspiring to harm them
or the people that they love.
And these delusions,
that's something that
you see with schizophrenia?
It is, yeah.
I know Eric and I
weren't exactly receptive
the last time we all spoke.
We completely understand.
It's it's a lot to take in.
I Just thought that David was going
through some kind of phase,
growing pains, you know?
But in these last couple
of days, it's like he's
He's lost all touch with reality.
It's just like,
I feel him slipping away.
Mrs. Sullivan, I promise you,
David is still there.
Yeah, and with treatment,
these episodes will become
less severe and less frequent.
And with proper management,
they can even go away.
What do you mean, medication?
That's a crucial component, yeah.
David thinks people
are trying to poison him.
How am I going to convince him
to take pills?
There are actually injectable versions
of many antipsychotics.
Though we don't generally start there.
Those are usually held in reserve
for non-compliant patients.
Of course.
I'm just saying, if he refuses
or becomes non-cooperative,
- they're an option.
- Right.
But we'll cross that bridge
if and when we get there.
In the long run, it's just much better
if we can get David on board
with taking medication.
Okay.
Ms. Martin, I'm Doctor
Liza.
Sorry, you were saying?
Uh, I'm Dr. Choi.
I understand you haven't
been feeling well.
Yeah I can't keep anything down.
And you're 12 weeks along.
Uh, that's just an estimate.
I only just recently
found out I was pregnant.
I haven't gotten around
to see a doctor just yet.
Well, in that case, we'll go
ahead and run an ultrasound.
Doris, will you mind grabbing Dr. Asher?
- Sure thing.
- Thanks.
So when did the vomiting
and diarrhea start?
Just last night.
And you haven't taken any medication?
No, nothing.
I don't want to take anything
while I'm pregnant.
Well, you know there are
some nausea medications
that are safe for pregnancy.
Still, I just
I would rather not.
I'll be fine.
I just really came in here
to make sure the baby's okay.
Understood.
Mind if I press on your belly?
I just want to see
if anything feels tender.
Mm-hmm.
No, no, no. No, no, no.
I don't want her.
You'll have to get me another doctor.
Dr. Asher?
Hannah Asher, right?
Yeah. She's an excellent physician.
She's an addict.
You get me another doctor,
or I'm leaving.
Whoa, whoa, whoa. Okay, okay, okay.
Just hold on a moment.
Hey, Hannah, sorry,
I jumped the gun, actually.
We're all good.
Oh, okay.
Well, in that case,
I'm grabbing breakfast
if anybody's looking for me.
Dr. Tanaka-Reed, hold up a minute.
Can you have them update that for me?
Thank you.
Look, I I wanted to clear the air.
The other day, I may have come
off a little condescending.
I appreciate the
acknowledgment, Dr. Marcel.
Of course, and if there's
anything you'd like to say
No, don't think so.
We're all good.
What, you didn't have time to grab him
flowers from the gift shop?
Huh?
I mean, I expect the other docs
to go soft on the residents.
I thought you had grit.
Well, no man's an island, right?
Aha.
You know, island life's
really not so bad.
Maybe you just don't
have the stomach for it.
Dr. Marcel, you've got
a trauma incoming.
Well, thanks for that pep talk, coach.
Any time.
What do we got?
Marcus Walker, 50-year-old
male, fall from standing.
Gave him a 500 liter bolus en route.
Pressure's hanging around 100, systolic.
Heart rate's 120.
Yeah, I've never seen him
in this much pain.
It hasn't let up since
he hit the pavement.
This is his sister, Janet.
Did you witness the fall, Janet?
He lost his balance
stepping off the sidewalk.
It didn't look that bad,
but then he couldn't get up.
Okay, we'll give him
something for the pain.
We just got to find
the source of it first.
Any medications we should know about?
Dialysis.
Oh, and he takes ramipril
for his blood pressure.
Okay, here we go, guys.
Nice and easy on my count, okay?
One, two, three.
I'm sorry, Marcus.
I'm right here, Marcus. I'm right here.
Janet, let's give the doctor
some room to work, okay?
We're gonna take care of him,
Janet, we got this.
Let's hang a unit of whole blood.
Pressure it in, Ron.
Hey, Marcus, put your arms
by your side for me.
There you go, bud. Deep breaths.
Okay, lungs are clear.
- He's still shocking.
- Yeah.
He's bleeding from somewhere.
Let's fast him, Dr. Taylor.
Belly's negative.
Really?
Yeah.
All right, let's get him on his side.
Herbert, come over, please.
All right, here we go.
Nice and easy, all right?
One, two, three.
There you go. You're doing great.
You're doing great, Marcus.
What is it?
Oh.
An abscess.
Looks like it. Pus under pressure.
It's gotta be the source of the pain.
All right, let's drain it.
Scalpel.
Hematoma.
Yep.
Hold pressure and pack it in.
- You got it?
- Yeah.
- Okay.
- Got it.
All right, give me
another unit of whole blood.
Start DDAVP and a unit
of platelets, stat.
Come on, let's move, folks.
Ms. Arya, hello again.
Indrani, please.
Indrani, I got the results
back on your culture.
Unfortunately, you tested positive
for an infection called MRSA.
From an ingrown toenail?
MRSA is really hard to treat, isn't it?
While it is resistant
to many antibiotics,
luckily, there are a couple
that still work for it.
How long do I have to be on antibiotics?
- About seven to ten days.
- Oh.
See, I told you you wouldn't
have to cancel your trip.
Oh, yeah? Where are you headed?
Well, I'm going to Scotland
in a few weeks
to hike the West Highland Way.
It's a 96-mile trail
through the Scottish Highlands.
96 miles?
I've been training for the last year.
I may be pushing 60,
but I don't feel it.
Let's start with vancomycin.
No, I can't take vancomycin.
I'm allergic.
Aha, I see that.
I had a terrible reaction
when I was a kid.
My throat closed up.
Then we will steer clear. Nancy?
- Linezolid? On it.
- Mm-hmm.
We'll get you in tip top
shape for Scotland, Indrani.
I've been wanting
to do this a long time.
Um, Dr. Halstead, the pharmacy
won't release the medication.
What?
Is there a problem?
No, just probably a system glitch.
Sit tight, and I'll be right back.
Look, per the new protocol,
you're gonna have to go through
Infectious Disease first.
And they're going to want
to try incising
and draining the infected tissue
before they approve giving linezolid.
Incising and draining?
So source control.
That is not gonna cut it, Ms. Goodwin.
She needs linezolid.
I mean, can't we just say that, um,
you know, Infectious Disease
already signed off?
No, we cannot, Dr. Halstead.
Linezolid is on the restricted list
due to extremely low inventory.
There's a region-wide shortage.
And we are dealing
with a systemic MRSA infection.
You're looking at the patient
in front of you.
But the Oversight Committee
designed the guidelines
to ration these drugs
to the most severe cases.
I have seen early
source control work wonders.
Give it a shot.
Dr. Marcel.
- Yeah?
- I got Marcus' CAT scans.
Uh-huh.
Two very severe lumbar burst fractures.
All from a spill on the sidewalk?
Take a look.
Oof.
Renal disease definitely
sped up his bone loss.
He's gonna need spinal
stabilization surgery.
Yeah, agreed, only option
to get him walking again.
Given his co-morbidities, without it,
he's just gonna circle the drain.
All right, let's
Let's go talk to neurosurgery.
And David, this voice
that you're hearing,
is it male or female?
I don't know.
It's more like it has its own language,
its own way of communicating.
And then my brain translates messages
- so I can understand them.
- Mm.
Are you getting any messages right now?
That you're writing down everything
I say because you work for them.
You're one of their spies, aren't you?
No, I'm not a spy.
Then give me your notebook.
I'm not gonna give you
my notebook, David.
Give it to me.
David, I need you to listen to me.
I'm a doctor.
I'm writing things down so I can
better understand what's going
Get out of here!
Out, now!
David, David, how about Dr. Cuevas
puts her notebook away for now.
Would that make you feel better?
And I notice you've been
checking out this vent.
There's a camera in there.
Huh.
They're always watching me.
There isn't a camera in there, David.
Yeah, I'm pretty sure that there isn't.
But, you know, we're
We're happy to cover it up if it'll
make you more comfortable.
Okay, good.
So why don't I go see
what I can scrounge up.
And I have another couple of patients
I need to check in on,
but in the meantime,
is there anything else I can get you?
Can I have a Coke?
Absolutely.
Okay, so back in a bit.
And Dr. Cuevas, can I just
get a quick word, please?
So with patients experiencing paranoia,
I've found that it's probably
not the best idea to push back
too hard on their version of events,
you know, especially at the outset.
There's actually evidence-based research
suggesting the opposite,
that you shouldn't reinforce
a patient's delusion.
Instead, you should
try to explain to them
why they're experiencing
things differently.
I hear you, except that that's
pretty much impossible if you haven't
first established trust.
But very glad to hear that you are
keeping up on the literature.
Way to go.
Ooh, got Choi as your advisor.
Luck really isn't on your side.
Why?
He's been really cool with me.
Yeah, well, I wouldn't
get too comfortable.
Word is, he's a real hard-ass.
Got his last resident fired.
Olga, what are you doing down here?
I was gonna ask you the same thing.
- I assumed you were out today.
- Why's that?
Oh, well, Dr. Choi asked me to
ultrasound his pregnant patient.
I don't understand.
Why would he ask you?
I cover the ED.
So do you have a question
about my qualifications
- or something?
- Of course not, Hannah.
Then why would you
ask another obstetrician
to do an ultrasound
in the ED when I'm here?
Obviously, you don't trust me.
It's not that.
I
The patient requested another doctor.
She she knew about your past.
What? How?
Does she know me personally?
She didn't volunteer that information,
- so I didn't press it.
- Fine.
- Forget it.
- Hannah.
I'm just so sick of this
following me everywhere I go.
No matter how much progress I make,
everyone's still judging me
for who I used to be.
Nope.
Medically, it's just too risky.
Chronic hypertension,
end-stage renal disease
The list goes on and on
with this patient.
The real kicker is that platelet count.
I'm not touching anyone whose
platelet count's below 100k.
Listen, we know that he's
not an ideal candidate.
Oh, wait, I almost forgot.
You guys also hacked
his back open in the ED,
making a posterior approach impossible.
Should I go on?
Look, I can give you
great anterior exposure.
All you have to do
is stabilize his spine.
I'll take care of everything else.
Oh, you'd be assisting me on this one?
Wow, way to save your
strongest argument for last.
Maybe you're just worried
about your stats, Sam.
Send him up to interventional radiology.
Have them inject cement
into his fractures.
That'll at least get him sitting up.
But that won't get him walking.
And lack of movement is dangerous
in Marcus's condition.
He can develop pressure sores,
blood clots, pneumonia.
All preferable to him
bleeding out on my table.
We just need
to get his platelet count up.
Yeah, it's the only way to get Marcus
healthy enough for surgery
and Abrams on board.
All right, I'll
I'll order a couple of units
of platelets, all right?
Patty, any updates on your husband?
Oh, he just went into surgery.
Dr. Archer said it will be a while
before there's any updates.
Okay, well, he's in very good hands.
You can trust me on that.
David, got that Coke you asked for
and some stuff for the vent.
Do you think you might
be up for chatting a bit?
You all right, pal?
Trini gave him something
just to calm him down.
Huh.
Okay, back in a second.
What did you give him?
6 of risperidone.
What?
Who the hell ordered that?
I did.
He became extremely agitated
and was resisting restraints.
Lorazepam worked this morning.
You didn't see how upset he was.
Haldol then.
He was going to tear out his IV.
His mom was freaking out,
begging me to do
Well, you cannot let a family member
pressure you into making
a rushed treatment call.
It wasn't rushed. It was necessary.
And besides, the meds
will clear his system
by tomorrow morning at the latest.
At which point,
we'll be back at square one
with David, if we're lucky, all right?
Any trust established, down the drain.
How about this, in the future,
maybe at least page me
before administering a very
high dose of antipsychotics
to a patient we're still evaluating?
With all due respect, Dr. Charles,
I am not a trainee.
And 6 milligrams is well within
the standard of care, I
Standard of care, whatever that is,
is not some blanket template you follow
without any regard
for the person in front of you
you're supposed to be helping!
Hey, Janet.
I just want to let you know,
the nurse will be by soon
to start Marcus'
platelet transfusion, okay?
I know it's been a rough day.
More like a rough year.
Lost my husband in January.
I'm so sorry.
Marcus came out from
California for the funeral
and just never went home,
moved in with me.
You must really get on.
Never had a choice in the matter.
We're twins, actually.
Marcus was born 45 seconds before me,
but you'd think he was
years older, the way he acts.
Seeing him here like this, so fragile
It's really hard.
I want you to know that, uh,
we're gonna do everything
we can for Marcus, I promise.
Okay.
What is it?
I was just looking back
in Marcus's history.
His platelets have always been low.
Huh.
Do you think this is chronic?
Some kind of undiagnosed
blood disorder, or?
- ITP would be my guess.
- Oh, man.
And if that's the case,
a transfusion is not gonna do much.
I mean, his body would just
keep chewing up
any new platelets we give him.
Well, unless
Unless what?
Um, forget it, actually.
I thought I had something.
But let's just hope the transfusion
moves the needle a little, okay?
Podiatry incised and drained the toe.
They had to cut the nail out.
I'm not a doctor, but it looks like
it's getting worse to me.
Don't worry. I'm on it.
We're gonna get you
the medicine you need.
Dr. Halstead, can I
speak with you outside?
What's wrong?
Just give us a moment.
We're now completely out of linezolid.
You've gotta be kidding me.
I knew it. I knew source
control wasn't gonna cut it.
How soon are we expecting
to get it back in stock?
Tomorrow morning, at the earliest.
Order vancomycin.
She's allergic.
I know, all right, but I've got an idea.
Hey, Liza.
So got your labs back,
and they look good.
Your white blood count
is slightly elevated,
but that's pretty common in pregnancy.
I think we're just looking
at a stomach bug.
Makes sense. I can go home then?
Yeah, Dr. Patchefsky sent down a list
of OB-GYN referrals,
as well as some
genetic testing counselors.
We'll just add those to your discharge.
Genetic testing?
I thought she said the
The baby looked healthy
on the ultrasound.
Genetic testing for hereditary
conditions is completely optional.
But the baby's healthy, right?
Yeah.
Hey, listen, if
Liza, my dear.
I have your discharge paperwork.
I'm not sure I'm following you.
You want to give me a drug
I told you almost killed me?
And we'll do everything
we can to mitigate the chances
- of another adverse reaction.
- How, exactly?
Through a process called desensitizing.
We'll pre-medicate you with
steroids and antihistamines
and then administer the
vancomycin via a slow IV drip.
And can you promise me that my throat
won't close up again?
I can't promise that, no.
But if you do go into anaphylaxis,
we'll have epinephrine at the ready.
Worst case scenario,
we might need to intubate,
but that would only be temporary.
Intubate me? No, no.
I'll go to another hospital.
Well, we've called everywhere.
The earliest anyone has
linezolid is tomorrow.
So I'll wait.
As you're seeing, MRSA moves fast.
I am afraid if we wait until tomorrow,
it will have already spread to the bone.
You could lose your leg, Indrani.
Give me the vancomycin.
Okay.
Marcus' platelet count rose
from 50,000 to 105,000.
- Can you believe it?
- That's great.
It's fantastic.
He must not have ITP after all.
Do me a favor.
Show Abrams these updated labs.
I think he'll be more receptive
if you deliver them solo.
How could he possibly
refuse to operate now?
It's Abrams.
I'll get him on board.
Dr. Choi? We've got a problem.
Liza?
I thought she had left.
I came in to turn over the room,
and I found her passed out.
Let's get her back in the bed
and up on the monitors. Ready?
One, two, three.
All right. All right.
Liza? Liza, can you hear me?
All right, let's re-start
her IV and get a Foley in her.
- Grab OB.
- Patchefsky, right?
No, no, no. No time.
- Grab Asher.
- Okay.
She's hypotensive. BP 85/43.
Maybe she vasovagaled?
Her white count was more
significant than I thought.
Liza.
- You know her?
- Yeah, Doris filled me in.
How long had she been experiencing
symptoms when she came in?
Less than 24 hours.
And that's self-reported
from the patient?
Yeah, why?
Bolus a liter of normal saline.
Hannah, we've been giving her fluids.
Could this be sepsis?
We could start a broad
spectrum antibiotic.
Let's just see what this does first.
I don't think we're looking at sepsis.
I think she's hypovolemic
from massive volume depletion.
I suspect she's been sick
a lot longer than she reported.
BP's starting to come up.
Appreciate you stepping up
to the plate on this one, Sam.
His platelets sure turned
around fast, didn't they?
Marcus is a fighter.
All right, this is my show.
Once we get to the spine,
you follow my lead, understood?
Fair enough.
Mia, start my playlist.
All right, after you.
Scalpel.
Where are we at?
I gave 125 of the methylprednisolone
and 50 of diphenhydramine.
All right, we're ready
to start the vancomycin.
Now, we're gonna take it slowly,
gradually increase the dose over time.
Are you ready?
As I'll ever be.
Something doesn't feel right.
- Okay.
- Oh, my God.
Oh, my God.
My throat I can't swallow.
Okay, we got you. Nancy, 0.3 of Epi.
I can't
It takes time to work.
Just stay calm. Keep your eyes on me.
Another 0.3 of Epi and another
50 of diphenhydramine.
Mask.
There you go.
Get ready to intubate.
Just a precaution.
I think it's working.
Slow, deep breaths. In through
the nose, out through the mouth.
That's it.
So how long have you actually been sick?
This is day six.
Ever since I stopped using.
Did you know that these
symptoms are a result of withdrawal?
I figured.
Dr. Asher, if I outed you
to your colleagues
No.
No, you didn't.
Everyone here knows
that I'm in recovery.
And you don't have to call me Dr. Asher.
It does feel kind of weird
calling you by your last name.
I won't tell anyone in group.
Thank you.
I don't even know if the drugs
have cleared my system yet.
I couldn't risk you
running a drug test on me,
given everything you know about me.
I just I don't want
anyone taking my baby away.
Well, I commend you for quitting, Liza.
Going cold turkey is really hard.
There are some medications
like Suboxone and methadone
that can help curb the cravings.
Those are opiates, right?
Yes.
But when you're medically supervised,
you are allowed to be
on them while you're pregnant.
The risk to the fetus is minimal
No.
If there are any risks, then no.
I probably shot up,
like, a half dozen times
during my first trimester.
And still, by some miracle,
the baby seems to be okay.
I can't do anything to jeopardize that.
I won't.
Come in.
I was going to check with Mrs. Sullivan
to see if she would agree
to David spending
a couple of nights in the psych ward.
I figure we can talk to him more,
begin to find the correct
medication and dosage.
Well, that sounds good, Dr. Cuevas.
Thank you.
Oh, and his father is out of surgery.
No complications.
Well, good stuff.
I'm glad to glad to hear too.
I should have spoken to you
first before medicating David.
Look, you know it was
a chaotic situation,
and I understand that you felt
the need to act swiftly.
I do.
I probably did jump
to medication too quickly,
if I'm being honest.
I know I rely heavily on the literature
and the standard of care,
but I just don't always feel
like I can trust my own instincts.
I mean, it took me years, years.
And still, I have
I have my days when you know?
But this, I can promise you,
you will get there.
You will. There's not a
shred of doubt in my mind.
Trust me on that.
Hey, Janet.
Marcus did great.
I can't thank you both enough.
No need. He's got a long road ahead,
but with physical therapy, I'm confident
he'll be back on his feet.
Can can I see him?
Of course. I'll take you to recovery.
Now, he's just waking up, so he
might be a bit groggy, okay?
This way.
Dr. Abrams, I heard the good news.
I really appreciate
Yeah, you two ever pull
a stunt like that again,
I won't keep it to myself.
I'll go straight to Goodwin.
Excuse me?
I don't appreciate
being conned into surgery
- under false pretenses.
- Wait.
I'm sorry, Dr. Abrams.
What are you talking about?
My antenna went up
when Marcus's platelets
corrected so quickly.
So I had the lab run
an anti-platelet antibody test
while we were in surgery.
You might be interested in the results.
- Marcus has ITP.
- Mm-hmm.
But this doesn't make any sense.
If Marcus has ITP, the transfusion
- shouldn't have worked.
- Correct.
Unless someone gave him
a little assistance.
You gave Marcus steroids, didn't you?
And that's why
his platelet count went up.
I know steroids can be controversial
- in the surgical settings
- To put it lightly.
You put him at greater risk
of post-op infection.
Vanessa, believe me when I tell you,
this was our only play.
Our only play?
I was left in the dark.
Look, I didn't want you
catching any heat
if things went south, okay?
I have more cover as an attending.
I was trying to protect you.
I do not need your protection.
I need your respect.
Vanessa, of course I respect you.
It does not feel that way right now.
Looking much better, Indrani.
Some techs will be back soon
to move you upstairs.
We're gonna keep you on IV
vancomycin for a few days
and then switch you over
to the oral version.
Dr. Halstead, I can't thank you enough.
I'm just sorry we had to
put you through all that.
Oh, it was worth it, believe me.
That's where I'm going to be next month.
I'm adding it to my bucket list.
Would you excuse me for a moment?
Of course.
Ms. Goodwin.
Stop by my office
before you leave tonight.
I'd like a word.
Will do.
Dr. Choi,
uh, this is for you.
I saw you were staying on
for the night shift,
so I figured you might
need a caffeine boost.
Oh, and these are also for you.
It's my CV, in-progress research papers,
and all my case logs to date.
For our first advisor meeting tomorrow.
Ah, well, you are really prepared, Zach.
Will you excuse me?
Yeah, of course.
See you tomorrow.
See you tomorrow.
- Hey.
- Hey.
Liza agreed to be admitted
overnight for observation.
Good.
She's in withdrawal, I take it.
Don't worry, I won't say anything.
I appreciate that, Ethan.
And while I suspect that the drugs
have already cleared her system,
she's terrified someone
might report her.
The last thing she needs is to be
penalized for seeking care.
Look, you were
absolutely right, by the way,
to bring in Dr. Patchefsky.
I never should have
given you flack for that.
Look, I know how frustrating it is
to always feel like you're being held
to some former version of yourself.
But on the flip side,
because of who you were
and what you went through,
you were able to connect to Liza
in a way no one else could.
Yeah.
I guess that's true.
Maybe it's not always such a bad thing,
having your reputation precede you.
Great work today, Sam.
Goodnight, Dr. Taylor.
Ooh, ouch.
Why, I see you've got yourself
quite the fan club.
You know, maybe I was wrong about you.
You might be cut out
for island life after all.
So let me get this straight.
You gave the patient an antibiotic
you knew she was allergic to
Only after I advised her
of the potential risks
and with her full consent.
Which, trust me,
wouldn't hold up in court
if this thing had gone sideways.
Well, Ms. Goodwin,
it wasn't my first choice.
I understand the new protocols got off
to a bit of a rocky start today, but
They're not working.
I have no doubt they were designed
with the best of intentions,
but as your boots on the ground,
I have to give it to you straight.
Let me give it to you straight.
These supply chain issues are
not gonna resolve anytime soon,
and not for lack of trying on my part.
So as imperfect as these
new protocols may be,
we need some sort of semblance
of order in the ED.
I can't have it turning
into the Wild West!
Honestly, Ms. Goodwin,
I think we're already there.