Chicago Med (2015) s08e16 Episode Script

1
He's putting me on a renal diet.
And if that doesn't turn
things around, then
Dialysis? I'm so sorry.
I don't advertise my immigration status,
but I'm undocumented.
My future always feels precarious.
ALL: [CHANTING]
More money in our checks!
We are essential!
- You're striking?
- It's very important
that Liliana feels like I have her back.
I'm going with my friends to celebrate.
- Come!
- Oh, no
You have to come. You're my boyfriend.
Lil.
Daniel.
Oh, the time.
I didn't realize.
I I'm almost finished.
I'm usually done before you arrive.
- I'm sorry.
- Oh, no.
No, let me get that. Let me get that.
I'm the one who should be apologizing.
No. No, I had the interns in
for pizza last night.
Then they dragged me out for a drink,
and and we just left.
It's OK. I've got it.
I apologize for the mess. Really, I do.
It's OK. Compared to other
offices, it's not that bad.
- Oh!
- [LAUGHS]
Daniel, have a good day.
You too.
[GROANS]
Ah.
I think this belongs to you.
Indeed, it does. Where did you find it?
This time? Waiting room.
- Top of the vending machine.
- Mm.
You know, maybe I should just put it
in a little red-and-white striped shirt,
put a bobble hat on it, black glasses,
and call it my "Where's Waldo?"
water bottle, huh?
You get it?
I get it.
You have to stay hydrated.
Thanks, Mom.
Dr. Cuevas.
- Ms. Goodwin, good morning.
- Good morning.
Do you have a moment
to discuss your DACA renewal?
Oh. Um, now?
Well, the paperwork's
not due for a few months,
but I want to make sure
we get everything filed early,
just in case there's
an unexpected policy change.
Right, of course. I appreciate that.
I just was about to dig
into these overnight charts.
Understood.
How about we meet up
at the end of the day?
Yeah. Sure, that works.
[QUICKLY] I will I'll see you then.
- Dr. Asher.
- Mm-hmm?
- Need you.
- Oh, yeah.
Come this way.
Hi, I'm Dr. Asher.
Leah, what's going on?
Parents and their daughter.
Came in a few minutes ago.
They're terrified.
- Even scared me.
- Going to two.
I didn't get a history.
Just came for you.
Excuse me, Doctor. We need your help.
- Our daughter.
- All right.
Hi, I'm Dr. Halstead. What's your name?
- [STAMMERING]
- Maria.
Her name is Maria. Very sick!
Listen. [SPEAKING SPANISH]
I'm sorry. I don't speak Spanish.
Get Dr. Cuevas.
I'm just gonna feel your neck, OK?
[INHALES SHARPLY]
Does that hurt?
¿Malo? Bad?
[CONVERSING IN SPANISH]
What are they saying?
They're saying
that she has the sickness,
and if we don't help her, she will die.
[TENSE MUSIC]
[CONVERSING IN SPANISH]
Thank you.
Hey. How's Maria doing?
Still a bit groggy,
but responding to questions in English.
Whatever this is,
it seems to be sporadic.
- Any guesses?
- I don't know.
Maybe infectious encephalitis,
but her vitals were normal.
I'm hoping labs shed some light.
What did Mom and Dad have to say?
The sickness that they're referring to
has to do with her older brother, Hugo.
About a month ago,
he came down with an illness,
was admitted
to Oakview Community Hospital,
- and then died a few days later.
- Oh, man.
Yeah, and even worse,
Oakview couldn't make a diagnosis.
Well, explains why
they're beating down our doors.
They're afraid whatever ravaged
Hugo is now attacking Maria.
But a death in the family, no answers,
plus the fear that she might
have the same illness?
Since nothing's jumping out,
I think it's possible
that her emotions could be
manifesting physically.
I want to talk to her,
see if there could be
- a psych explanation.
- OK.
Meantime, I'll reach out to Oakview,
get Hugo's records and autopsy results.
If Maria does have the same illness,
- there could be a clue in there.
- OK.
OK, Layla, you're 7 centimeters dilated,
100% effaced.
How long ago did your water break?
About an hour, hour and a
[GROANS]
7:02 a.m., I think.
This baby is coming out sideways.
No, it just feels like that.
Your fetus is OP,
meaning it's facing up instead of down.
- Something's wrong?
- No.
Baby's just moving around,
letting us know
that it is time to come out.
I'll have a nurse let L&D know.
Oh, my God.
Quentin, our son is coming.
I'm gonna be a mom today.
You know, I can't remember
if I turned off the oven
before we left the house.
Quentin, we haven't cooked in days.
The oven is off.
I'm just gonna go home and check.
Quentin, no!
- Mr. Bell, please don't go.
- You know what?
Maybe you can have a neighbor
check on it,
or maybe it's just nervous energy
that's making you think
that you left it on.
Yeah, I just don't feel like myself.
I get it. It's a big day.
You know, a lot of new experiences
all happening at once.
But, Quentin, this is not new for me.
I have been here many, many times,
and I know exactly how to help
you and Layla get through this.
Thank you.
Sorry, Lay.
I just lost my mind for a minute.
[CHUCKLES]
- Nice save.
- Mm-hmm.
[CHUCKLES]
Hey, Sam. This is Dr. Tanaka-Reed.
He's gonna be scrubbing in
with me today.
He's one of my surgical residents.
Uh, technically I'm a resident
but definitely not a beginner.
OK.
Anyway, like we discussed,
it's a straight appendix removal.
You're gonna be a bit sore afterwards,
but in a week or two, you'll
be back to full strength.
Mm, perfect,
because I've been itching
to get back in the gym.
Rugged Maniac is this summer.
Rugged Maniac? The adventure race?
- You know it?
- Yeah, sort of.
A couple of guys from the community
are putting a team together.
Community? You mean other doctors?
[LAUGHS] No, CrossFit.
From my Kalsu group. Kalsu's a workout.
We do burpees and thrusters for time.
Anyway, back to the task at hand.
If you're ready, we're ready.
- Let's do this.
- Great.
Nurse Trisha will be in
to get the prep started.
- Anesthesia after that.
- Sounds good, Doc.
See you on the other side, all right?
Appendix removal Pretty basic.
Well, sorry Sam's
not sick enough for you.
Oh, you know what I mean.
OR 2.0 is a Ferrari Sexy surgery.
But a lap appy? That's a minivan.
Well, not even in that today.
Sam had a sigmoid colon
resection 18 months ago.
Likely adhesions in his pelvis,
so we're gonna do this appy open
Right lower quadrant incision.
- OK?
- Old school.
Gee, hope I'm up to the challenge.
For a resident,
guy sure is full of himself.
I'm not a fan.
Hugo's gone.
I'm oldest now. I need to be strong.
For my other brothers and sisters.
For my parents.
They've been a wreck since Hugo died.
They can't sleep.
They can't eat.
Now I'm putting them through it again.
- I have it too.
- No.
Hey, we don't know that.
All of the labs Dr. Halstead
ran came back normal.
Then what's wrong with me?
In some cases, it's possible
for grief and fear
to lead to physical symptoms.
No, I'm not imagining this.
No, you're not.
Your symptoms are very real.
You suffered
a devastating loss, a trauma.
Hugo's tests were normal too.
And then he died.
I don't think we're looking
at a psych condition.
In conversion disorder, it's rare
that patients can express their
emotions the way Maria is.
But her awareness of the situation,
her acknowledgment of the fear,
it doesn't fit.
There's definitely
something physical going on.
I wish I knew what.
Medical examiner said
Hugo died of brain swelling
but don't know what caused it.
And here's the kicker:
it was only three days
from when Hugo was admitted
to the time he died.
OK, so whatever it is,
it moved really fast.
[GROANS] I think he's stuck.
No, just a big head.
- That's all.
- [GROANING]
Oh, my God.
- Is he gonna fit?
- Yes, he will.
We just need to open up
the birth canal a bit wider.
- McRoberts?
- Yes.
Call the OB resident on call.
Layla, we're gonna adjust you
to a new position, OK?
It makes it easier
for the baby to come out.
OK.
- I'm right here.
- All right, Quentin.
Why don't you let him
take over for you, OK?
- And I can use some pressure.
- Yep.
I'm right here.
OK, now on your next contraction,
I want you to give me
everything you've got.
- Everything.
- OK.
- OK.
- I can do this.
- Yes, you can.
- You got this.
- You got this. You got this.
- OK.
Oh.
[YELLING]
I've got the head.
Shoulder.
[GROANS] [BABY CRYING]
I've got him.
I got him. He's here.
He's here.
- He's here.
- Oh, my God.
Oh, my God.
I'm a mom.
Our baby, he's beautiful.
He's perfect.
Hey, Dad, do you want
to cut the umbilical cord?
[LAUGHS NERVOUSLY] Yeah.
OK. Just right here in the middle, OK?
I want to hold him.
That's not my son.
What?
Layla, who's the father?
You are, Quentin.
You are. That's our baby.
No, you're lying! You're lying!
Hey, Quentin, it's OK.
We'll figure this out, all right?
- That's not my son.
- That's our baby.
- Of course it is!
- No, get back!
Of course it is! Of course it is!
- I got to get out of here.
- Hey, deep breaths, OK?
Quentin, breathe with me.
Breathe with me, Quentin. Deep breaths.
- I got to get out of here!
- Stay! Baby, stay!
- Hey, call security.
- Help!
Oh, my God. What's happening?
Hey! Hey, stop!
Hey, guards! Quentin, stop!
[ALARM BLARING]
Why are you chasing me?
Just leave me leave me alone!
- Hey, Quentin
- Stay back! Stay back!
It's OK. It's OK.
Deep breath. Please, just breathe.
I just got to get out of here.
- I just got to get out of here!
- No, no, no, no, no!
All right, Quentin.
It's OK.
[LABORED BREATHING]
Oh, my God, the scissors,
they're pulsating.
They're penetrating the carotid artery.
I'll get someone
to turn off the machine.
No, the magnet
is holding everything in place,
including the scissors.
If gravity takes over,
it'll shift everything,
and we'll have maybe 20 seconds
before he bleeds out.
OK, we need help. Call Dr. Archer.
- Dr. Charles too.
- Yeah.
Do not touch the scissors, OK?
We got you.
Everything's gonna be OK.
Coming through. Excuse me.
Thank you guys for coming.
Absolutely.
- Hey, fellas.
- Doctor.
He's conscious and calm but out of it.
He's not being crushed.
He's able to breathe.
- He's got to be in pain, though.
- OK.
So let's give him
50 mics of fentanyl IM.
Syringe is plastic
and the needle nonferrous,
so it should be MRI safe.
OK, I'll get it.
Dr. Asher went back
to be with his wife, Layla.
- She's still in L&D.
- OK.
It's a rescue situation.
I just don't really know where to start.
All of our tools have metal.
So nothing is usable as long
as the MRI machine is running.
All right, well, let's say
we did turn the machine off.
Everything falls to the floor.
Bed alone is a couple hundred pounds.
I can put two of my guys
in there to try and catch it,
then get it out of the way
so you can get to Quentin.
Scissors in his neck are magnetic too.
Cut the MRI's power, they're gonna move.
Quentin will bleed out fast.
If you could go in there
with clamps and stem the flow,
- would that buy us some time?
- Not enough.
Odds of survival are less than 1%.
I'm running outcome
probabilities on our options,
and turning off the machine
cold turkey is the worst.
So what's the best?
If CFD can secure Quentin
and ensure the bed won't displace him
and Dr. Archer can
stabilize the neck wound
all before turning off the MRI machine,
then the odds of survival
are roughly 61%.
OK, we've got a plan. Can it be done?
Well, safest way to secure the patient
would be to do a webbing harness.
We can throw the ropes
over the MRI machine,
and then two of my guys
can hold it on the other side.
OK, the magnet's off, the bed falls.
How do we ensure that
Quentin doesn't go with it?
We can create a buffer zone
between him and the bed
using wooden cribbing,
wedges, and airbags.
We can run some hoses and inflate them
from a tank here in the hallway.
All right, we're halfway there.
- Dr. Archer?
- Yeah.
I just need to clamp the artery
in order to control the bleeding.
Then I could take the scissors out.
But the issue is
the tools needed to do it.
I can make them plastic. 3D printers.
There are four in the robotics lab.
All right. Get on it.
And get a few
of the 2.0 engineers to help.
- We'll get started too.
- Good.
OK, you're doing great.
Gonna give you a little injection.
Some pain meds, all right?
To just make you
a little more comfortable, OK?
Little pinch.
OK.
Daniel?
I'm just gonna step away for a second,
have a little chat with my colleague.
I'm not going anywhere, OK?
How's he doing?
Well, you know, I mean, he's
pinned to an MRI machine, so
Do you have any theories
on what sparked the break?
I've been really focusing
on trying to keep him calm.
But how's the plan
to get him off the thing going?
Well, we've got one.
But it's a possibility
that it won't work, Daniel,
so I've asked Dr. Asher to
bring Quentin's wife down here
to see him
'cause it may be the last time.
OK, thank you.
OK, making the incision.
OK.
OK, nice and easy.
Lab cut.
Yep.
Definitely feeling some adhesions.
Point taken.
Open surgery was the right call.
Go ahead, say it. "I told you so."
Yeah, maybe later.
For now, why don't you get
some practice old-school style?
Come around.
OK. You got it?
- Yeah.
- All right.
Babcock.
[STOMACH GURGLES]
[GRUNTS]
You OK?
Yeah, it's just a little heartburn.
I'm fine.
Oh, uh [FARTS]
Uh, God, excuse me. I'm sorry.
- [LAUGHS]
- Stop it.
Stop.
It's no big deal.
It happens, OK? Just focus on the field.
Stay focused.
[STOMACH GURGLES]
Uh-oh, here comes another one.
- [GROANS]
- Kai?
- [GROANING]
- Kai, talk to me.
Hey, buddy! Hey!
Angel. Angel, check him.
- Got a pulse.
- All right.
Give me the babcock, please.
- Maria!
- Need some help in here!
Maria!
I was helping her to the bathroom,
and she started seizing.
OK, 4 milligrams of Ativan.
[SPEAKING SPANISH]
Please help her. Please.
[SPEAKING SPANISH]
Ativan's in.
OK, she's gonna be
postictal for a while.
Put her on a foley.
I don't want her getting out of the bed,
not even for the bathroom.
A seizure expands
our differential tenfold.
We got to widen our net CT panscan,
MRI brain, sed rate, autoimmune labs.
- Let's rope in neurology.
- Guys.
Ms. Goodwin just called.
She said stand down. No more treatment.
What? What are you talking about?
She's in the MRI suite.
Be here as soon as she can, OK?
- Hey, you OK?
- This is overkill.
I probably just had some bad oatmeal.
Well, bad oatmeal doesn't drop you
in the middle of surgery.
So how about you let me check you out?
How's Sam? Appendectomy go OK?
Yeah, all good.
Dr. Graham is finishing up.
At least it's just an appendectomy.
Not missing much.
[GROANING]
[MACHINERY BEEPING RAPIDLY]
Oh, my chest. Pressure.
[FARTS]
Oh, God. I'm sorry.
That was weird.
Your heart rate plummeted,
but as soon as you passed gas,
it came back.
Will you sit up for me?
Take a deep breath.
[BREATHES DEEPLY]
All right. Lean back for me.
Hey, Mike. Let's get an X-ray in here.
What, did you hear a murmur?
Honestly, I'm not sure what I heard.
You're joking, right? Come on.
Has heartburn
been an issue before today?
I mean, I get it.
Even when I was a kid, it
would flare up here and there.
But it's never been an issue.
X-ray up. Clear.
[MACHINE WHIRRING]
What the hell? That's my colon.
It shouldn't be in my chest.
No, it should not.
Her brother. Hugo, was
a patient treated at Oakview.
So was Maria.
She was admitted yesterday
via ambulance,
but this morning,
her family just walked her out.
They just left absconded.
Well, her brother died at Oakview,
and they didn't get any answers.
You see how scared they are.
It's no wonder
that they didn't want to stay.
Look, I agree, but walking out
is the same as leaving
against medical advice.
It's triggered an insurance nightmare
with the family's HMO.
They won't pay for any more treatment
until Maria is placed back
with their preferred network
provider, Oakview.
Are you kidding me?
They're a community hospital.
They don't have the resources
to run the tests she needs.
Well, I've already reached out
to the director
of patient services at Oakview,
and she assured me
they'll do the best they can.
The best they can?
Ms. Goodwin, can't you reason
with the insurance company?
Hector and Gloria aren't trying
to take advantage of them.
They're trying
to save their daughter's life.
Look, I know, and I share
in your frustration, but they're
No. No, I don't care what
the insurance company says.
I'm not sending Maria back to
Oakview until I get a guarantee
she gets the treatment
she needs in time.
Dr. Halstead, the tests that you ordered
will cost tens of thousands of dollars,
and I know that's not
coming out your pocket.
The family has to decide how to proceed.
OK, Quentin, so listen,
we're gonna secure you to the machine
while it's still running with a harness.
So then, Dr. Archer,
who is an excellent surgeon,
is gonna come in here
and clamp your artery,
stabilize your neck wound,
and make it safer when
they pull out the scissors.
All right? Then we turn off the machine.
The idea is, bed falls to the side,
you're held firmly in place
by the harness, OK?
Still with me?
- Mm-hmm.
Great. Last thing.
Lower you onto a gurney,
shoot you off the ER,
and finish fixing up your neck.
- How's that sound?
- Mm-hmm.
[GRUNTS] Am I gonna die?
Look, this is a complicated situation.
But some really skilled people
have come up with this plan,
and it's the best option we got.
All you got to do: breathe in and out,
stay as still as you possibly can, OK?
All right.
Take all the time you need.
Hey, hold the work. Everybody, out.
You're my everything.
From our first date,
I knew that I was in love.
And now we're parents.
Uh
The nurse took a picture of him.
I named him Trevor, after your dad.
I think he'd like that.
Tell Trevor I love him.
You're gonna tell him yourself.
You're gonna be a great mother.
I love you, Quentin.
I will see you again, you hear me?
I will see you again.
[SOBBING]
Sorry.
I didn't know what to say.
How do you put into words when
You can't.
But we could feel
your love for each other.
I just don't understand,
because Quentin is my rock,
and I don't even recognize
the man that's in there.
He just snapped.
How does that happen all of a sudden?
I mean, usually
there are signs, you know?
Extreme expressions
of emotional frustration,
anger, confusion, outbursts.
You noticed anything like that
in Quentin recently?
- I don't think so.
- How about physical changes?
I noticed he had some lumps
on the back of his neck.
Have you Do you know what those are?
Lumps? I don't know.
I just wanted to get to today
and to have the baby.
I've been so consumed by the pregnancy
that I haven't noticed anything else.
Oh, Quentin.
Uh, give it to Spellman.
Thanks, Lori.
Mystery solved. Your chest CT.
- Hiatal hernia.
- No, diaphragmatic.
Big enough that your colon
migrated into your chest.
So the gas moving through it,
it puts pressure on the vagus
nerve, drops your heartbeat.
Breaking wind releases the pressure.
- Heart returns to a normal rate.
- Yeah.
You said you had heartburn
since you were a kid.
Probably this: undiagnosed
asymptomatic congenital
diaphragmatic hernia.
I've never passed out before, though.
Well, my guess is it's been
slowly expanding over time.
But you do CrossFit now, so the
thrusters, burpees, other workouts
Safe bet that they've
exacerbated the condition.
- Led to today.
- Yeah, well, I'll own that.
But I can't resist
dropping in the OR again,
- so let's fix this hernia.
- OK.
Well, you've got a few surgical options.
- Open.
- No.
That's a huge incision.
Lots of digging around.
I'll be laid up in the ICU for weeks.
Laparoscopic, then.
Be more incisions
for the scope and tools,
- but less invasive
- No old-school approaches.
Robotic assist in OR 2.0.
Shortest recovery time.
I just want this to be over with.
OK, I'm gonna scrub in.
I'll see you after, OK?
Holy cow. Look at this place.
It's like you guys are living
in 2050 up here.
So don't break anything.
How's it going with the surgical tools?
Almost there. Scalpel's printed.
Two of the three angled peripheral
vascular clamps are printed as well.
One Weitlaner retractor printed.
- One to go.
- Oh, it's like the real thing.
It is the real thing, just plastic.
These tools, I think they can work.
They'll have to.
They're all we got.
[SPEAKING SPANISH]
They never wanted to go to Oakview,
but the ambulance
took them there anyway.
Because Maria
didn't require specialty care,
paramedics took her to
the nearest hospital instead.
[SPEAKING SPANISH]
[SPEAKING SPANISH]
I'm so sorry that you've
been put in this situation.
We can continue to treat Maria,
but your insurance
won't cover the costs.
[SPEAKING SPANISH]
[BOTH SPEAKING SPANISH]
He said he'll sell the car.
He can get a second job.
His oldest son can get a job as well.
No. Papa, no.
No.
[SPEAKING SPANISH] I'll go back.
No. [SPEAKING SPANISH]
- Maria
- [SPEAKING SPANISH]
Maria.
[SPEAKING SPANISH]
[SIGHS]
[SPEAKING SPANISH]
You know, maybe Oakview
will figure it out.
All right.
Um, I'll set up the transfer.
What was Maria saying?
If she lets her parents
bankrupt the family
paying for her medical care,
then all of the opportunities
they've worked so hard to give
their children will be lost.
She is risking her life.
No.
No, she's sacrificing it.
And it's awful,
but I get it.
Ready to inflate?
Up on blue.
[TANK HISSING]
Hold.
Up on red.
[TANK HISSING]
Hold.
How's, uh How's Layla doing?
She's in shock, full of grief,
and a first-time mom
all at the same time.
It's a lot, but
a psych resident is with her.
Mm. And how about you?
How are you doing?
Honestly, I didn't see this coming.
I just thought Quentin
was a nervous first-time dad,
like the ones I see every single day.
Never suspected mental illness.
You know, I'm not sure it is, per se.
You know those lumps
on the back of his neck?
I have a very strong hunch
that they're indicative
of a physical issue that could very well
be causing a sudden psychosis.
It's physical, not psychological?
Yeah, I'm leaning that way.
I mean, can't be sure
until we run some tests.
[LABORED BREATHING]
Maria, this is a thumb drive
with all the work we did here,
along with our notes.
You give this to the doctors
as soon as you get there.
Thank you.
All right. Empty her foley.
It's OK, Mama.
[SNIFFS] Wait.
Will?
You smell that?
[SPEAKING SPANISH]
We have to run one more test.
I'll pay for it myself, if I have to.
[BOTH SPEAKING SPANISH]
I'm scared.
Well, you'll be less
frightened if you can't see it,
so I'm gonna drape your face, OK?
[GRUNTS] Yeah.
All right.
Here we go. Careful.
That's right. All right.
All right.
10cc's of lidocaine, please.
OK.
All right.
OK.
Scalpel.
All right. Grab hold of those scissors.
I don't want them flopping
after I make the incisions.
Here we go.
[GRUNTS]
OK.
All right.
Wheaties.
All right.
All right. Watch your fingers there.
That's it. That's it.
Don't move it. Don't move it.
Clamp.
All right.
All right.
Carotid clamps in place. CFD, you're up.
All right. Spread out around the bed.
When it falls down, we pull it
away from the MRI machine.
All right. And no slack
at all, you understand?
If there's any movement,
his clamps could pop off,
and then we'll have a problem
we might not be able to fix.
All right.
On three, you're gonna
cut the power to the MRI.
We ready? Everybody, ready?
Ready.
One, two, three.
[CLATTERING]
All right. Clamps are holding.
I'm gonna remove the scissors now.
All right.
All right, we're clear. OK, bed.
Let's lower Quentin.
- Lower him slowly.
- One, two, three.
Slack!
All right.
OK, ropes are free.
All right.
Incredible, Doc. Freaking incredible.
Thanks. Can someone get me
a bottle of water, please?
Dr. Archer, you did it.
- Dean, you all right?
- Yeah.
I got to get to the OR, so
Whoa, whoa, whoa, whoa, whoa.
Page Dr. Lanik
to take over with Quentin.
I'm just feeling a little dizzy.
That's all.
Hernia fixed?
I'd say you're as good as new.
Yeah, not quite.
I'm the fart doctor now.
- A punchline.
- No.
What happened today was a result
of a medical ailment, OK?
Like anyone's gonna care about that.
All they're gonna remember is the fart.
Oh, come on. It'll blow over.
Sorry. Poor choice of words,
but it will.
[LAUGHS] I doubt it.
All right, look.
I'll check on you a little later, OK?
All right.
- So his neck is fixed, then?
- Yeah.
The artery repair went very well.
What about his mind? Because before
Well, I gave him a very small dose
of an antipsychotic called risperidone,
and he does seem
to be thinking more clearly.
And you think he'll stay that way?
I don't think that what happened today
is the result of mental illness.
You know, tests are still pending,
but all indications are
is that Quentin has
a genetic disease called
neurofibromatosis type 2.
- Is it curable?
- It's not.
But there are a lot of
effective treatments out there.
And the good news is
that with a little luck,
Quentin is gonna be
the man you know again.
Genetic means he's had it forever.
Why'd it suddenly go berserk today?
NF is thought to be
an inflammatory ailment, right?
So possibly triggered
by changes in environment,
you know, lifestyle,
possibly diet, medication.
Diet.
Oh, my God.
The minute I got pregnant,
my hormones went crazy.
Smells were intense,
and Quentin's breath was the worst.
Everything he ate made me throw up.
So he gave up his entire diet.
No more fruits, vegetables, fish.
For the past nine months,
he's been eating nothing
but bland, processed crap for me.
Mrs. Bell, Quentin's asking to see you.
[GRUNTS]
Hi, honey.
Layla
I don't entirely understand
what happened or why,
but I know I put you in danger.
I'm sorry.
No, Quentin.
I was so tied up in the pregnancy,
I was oblivious
to what was going on with you.
I should've seen the signs. Forgive me.
Oh, honey, there's nothing to forgive.
I love you.
I love you too.
Someone's been missing you guys.
Hi.
Here you go.
Hi, sweetheart. Look who's here.
Hi.
I'm your dad.
I love you.
- Shh, sweetheart.
- Hi.
- A metabolic condition?
- Yeah.
It's called maple syrup urine disease,
and it's a rare condition
that makes it difficult
for the body to break down
certain amino acids.
The trademark symptom is
a distinct maple syrup smell
that shows up in urine.
It usually presents in childhood,
and it's almost unheard of
to discover it in someone your age,
or Hugo's.
It's likely that he had it too.
And I suspect this is why
Oakview couldn't diagnose him in time.
He didn't have a seizure
or a foley catheter.
It made his doctors' jobs even harder.
Wait, this disease killed Hugo.
Does that mean
No, you're gonna be OK.
You have an intermittent form
of the disease,
which can be managed by closely
monitoring protein levels.
We've already reached out to nephrology
to discuss treatment options.
Maria. [SPEAKING SPANISH]
[SPEAKING SPANISH]
[SPEAKING SPANISH]
Gracias.
- Hello, Daniel.
- Ooh!
Hey, you're, uh
You're a little early.
Oh, I couldn't wait to see you.
What's this? You cleaned your office?
No, I didn't.
I'm tidying up a little bit.
Why?
I was very embarrassed
by what happened this morning.
And um, you know, I just, uh
I don't ever want you to feel that I
I take for granted
the job that you do, or
Or that I'm oblivious
to how hard you work.
I really don't want that to happen.
You're very sweet.
I care about you too, Daniel.
A lot.
- Yeah?
- Mm-hmm.
Huh.
- Hey.
- Hey.
Ah!
- Where'd you find it?
- Nurses' station.
Oh, makes sense.
That's where I was when
the call about Quentin came in.
Yeah, I totally get it.
I would have run off
and left it behind too.
But my kidneys can handle
some mild dehydration.
- Yours can't.
- Yeah, yeah.
Yeah, pretty sure there will
be another emergency tomorrow,
and the day after that,
so I'm gonna give you something.
- It is a tracking device.
- Ah.
App connects it to your phone.
And I haven't lost my keys
since I put it on, so
Well, keep it. I'm past water bottles.
Nephrologist just left.
Uh, my kidneys are getting worse.
Dialysis?
That was a big win today.
You saved that family.
Yeah.
I suppose it's time
to talk about my DACA renewal.
I know I've been dragging my feet.
It's been a long day.
We can speak in the morning.
No. No, I'm ready.
Yeah? All right.
Truth is, I've been
thinking about leaving Med.
Really?
I've always been in school
or protected by my residency,
so my immigration status
has always been stable.
But my parents, despite
them always having jobs,
could never solidify theirs,
so they moved to Canada.
Hmm.
But they can't enter
the country to come visit me.
And if I leave to go see them,
I might be denied reentry.
So
I haven't hugged my parents in a decade.
Ugh.
That's that's heartbreaking.
But Maria today, her bravery,
what she was willing
to sacrifice for her family,
reminded me that
"no one puts their child in a boat
unless the water is safer
than the land."
Warsan Shire.
Oh, that's a beautiful poem.
So
my parents' sacrifice to get me here
put me in this boat,
which is why I have to stay.
And Dr. Cuevas,
I believe that you will find a way
to see your parents again.
But until that day,
know that you have family here
in us at Med.
Thank you.