Chicago Med (2015) s09e01 Episode Script
Row Row Row Your Boat on a Rocky Sea
1
OR 2.0 is the fruit
of years of development.
I know the tech.
I promise you, it won't let you down.
You know tech,
but you don't know surgery.
- Are you having an affair?
- No.
Never.
I don't know if Ben and I
are on a path to divorce.
Dayton has bought controlling interest
in the Gaffney Medical Group.
So I guess he's in charge now.
We will be livestreaming a surgery
for the entire world to watch.
This is not a simulation.
There's a human being on that table.
I know, and you're gonna save his life.
And what if I don't?
What if he dies?
I'm officially in
end stage renal disease.
Sean is your best possible donor match.
I'm not taking my son's kidney, Hannah.
- Warning, warning.
- [ALARM BLARING]
The platform is defective.
We gotta shut it down.
I'm ruined, Sharon.
I have to sell the hospital.
[DRAMATIC MUSIC]
Come on, Brice.
Brice, move your feet for me.
[MACHINE BEEPING]
Squeeze my fingers. Come on, buddy.
Squeeze 'em.
On extrication, he was
moving all his limbs.
- There's nothing now.
- Listen up, everybody.
Listen up.
Multi-vehicle crash on the interstate.
Mass casualties en route.
Ambos are about to land right now.
Hannah, I'm gonna need you
for more than OB today, okay?
- Yeah.
- Okay, thanks.
Need to secure his airway
before he crashes.
0.2 mgs per kg etomidate,
0.6 mgs per kg roc.
Got it.
- Tube.
- Ready.
I'm in.
Bag him.
Peter, I'm gonna have to cut this short.
Take care.
Thank you.
25-year-old male.
Heart rate 115. BP 75/50.
GCS 13. Arterial bleed.
Tourniquet placed in the field.
Ripley, with me in six.
You got it.
Dr. Marcel? ETA in five.
♪
Joshua, you got enough with this.
That's a red tag. You're good.
Tracy, I'll be right back.
Oh, I'm sorry, hold for a second.
That is a green tag.
Non-emergency for now, sir.
We're gonna have you wait
in the waiting room, okay?
Let's go back. You, too. I'm so sorry.
That is a green tag also.
Everyone with a green tag,
you have to wait in the waiting room.
Green tag in the waiting room.
Thank you.
Check his arm, please.
♪
Chest is clear.
What are you doing?
Making sure this is an arterial bleed.
Cuff works as a secondary tourniquet.
Release it slowly,
and if the bleeding has stopped
It's not an arterial bleed.
Not everybody knows that trick.
Very nice.
So I pass?
[HELICOPTER BLADES WHIRRING]
[SOBBING] Oh, God.
It all happened so fast.
I didn't mean it.
I tried not to hit them.
I couldn't stop.
- It wasn't your fault.
- Oh, my God.
- It's not your fault.
- Oh, my God.
Let's see if we can find
somebody to take a look at you.
We're doing our best
right now to get everyone.
All the information
Dolores Williams, is she here?
- Robbie.
Robbie Wilson.
Please, please, everyone,
go to the waiting room,
and someone will be out soon
to answer all your questions.
To the waiting room, please.
That's it. Cesar, talk to me.
Ivy Vance, 30s.
Hit her head against
the interior of her vehicle.
Complaining of headache, disoriented.
GCS 12.
You're going to treatment three.
I got no movement through the limbs.
- Got you.
- Coming in.
I've got it.
- Easy.
- Yep, yep.
Keep him steady.
All right, let's move. Ready?
Hey, Maggie, you need
an extra pair of hands,
I could put the gloves on.
I might take you up on that.
Maggie, need ortho in there.
Got it.
Oh, and you're going to treatment three.
Got it.
Zach, what do we got?
Ivy Vance.
Few lacerations, closed head injury.
Okay. Hi, Ivy.
I'm Dr. Asher.
I'm gonna ask you some questions, okay?
Okay.
So you hit your head.
Uh-huh.
Do you know where you are?
Hospital.
What day is today?
Um
Wednesday.
Okay, everything's good.
We just need to check that head
bump out, get a CT. Sound okay?
Transport.
What's that?
Hamster.
Came in with her.
- Yep. Maggie.
- Yeah?
- You're going to Baghdad.
- I got a ten-year-old boy.
Brice Morgan. GCS 7.
Vehicle was crushed under a semi.
Father died at the scene.
Mike, X-ray. Let's go.
Got it.
Jimmy, take over.
Mike, give me a cross-table C-spine.
Yep.
Clear.
The ligaments.
Is that even possible?
Yeah. He's internally decapitated.
The only thing holding
his head on is his skin.
♪
- Jack.
- Hey.
Eight-year-old boy with a head lac.
- He's my son.
- We'll take good care of him.
Keep that compress on his head.
You're going to treatment two.
- Thanks, Jack.
- Mm-hmm.
Dean. Hey.
You're getting a new kidney tomorrow.
- Take it easy.
- Yeah, I'm fine.
- Dr. Marcel.
- Yeah?
The boy's mother's here.
Okay.
Ms. Morgan, I'm Dr. Marcel.
I know you lost your husband.
I'm very sorry.
My son, Brice,
please just tell me he's alive.
He is.
But he has been critically injured.
Here.
[SOBS] Oh, my God.
No, no, no, no!
Look, I'm gonna do my
very best to help your son.
Okay, but I don't wanna
minimize the severity
of Brice's condition.
He suffered what's called
a bilateral
atlanto-occipital dislocation.
What that means is that
the ligaments from his skull
have separated from his spinal column.
Oh, no. No.
We're gonna do a CT and an MRI,
and that's gonna help us determine
how to proceed surgically, okay?
Surgically.
Yes.
It's necessary in order to stabilize
the head to the spine.
And let's page Dr. Abrams, please, okay?
Liz, Dr. Abrams is a great neurosurgeon.
Okay?
All right.
Why don't you come be with him?
Come on.
[SOMBER MUSIC]
Hey, baby.
It's okay, Mommy's here.
Mommy's here.
Maggie.
- Matt.
- Harris Shorr, 40s.
Injured in that accident.
His right arm is swollen and bruised.
Complained of dizziness on the scene.
GCS 15. Heart rate 110.
Respiratory rate 25 per minute.
All right, you're going
to treatment four.
I'll have a doctor in there
as soon as possible.
Are you done yet?
Almost.
Decision time, AJ.
We got two types of bandages.
We've got Wolverine or Spider-Man.
What's your poison?
- Poison? I don't want poison.
- [LAUGHS]
No, honey, he's asking
which one you want.
Oh. Spider-Man.
All right.
My friend here will fix you up.
I'll catch you later, AJ.
Dr. Asher, here's Ivy's CT.
I got in touch
with her emergency contact,
a woman she works with.
No family?
It doesn't seem like it.
The woman explained about the hamster.
She said it's probably a rescue.
She says Ivy likes
to find homes for things.
Aw.
Well, it looks like
she can continue to do so.
I'm just seeing a small contusion.
- Nothing serious.
- Yeah, that's what I thought.
Yeah, well, I will let her know.
Hey, Ivy.
How you feeling?
- Better.
- Good.
Well, good news, your CT didn't
show any concerning injuries,
so we're gonna give you a neuro check
every couple hours just to
make sure everything's okay.
Thank you.
Your work friend said that
you like to rescue animals.
They're family.
Yeah. I guess I can understand that.
I mean, we are all related,
from fish, to hamsters,
to us, so
And we all need a home.
That we do.
I was rescued.
[PENSIVE MUSIC]
I was in a very bad place,
and someone took care of me.
Yeah.
I can relate to that.
It is a good thing that people
like you are in the world.
♪
[SIGHS]
- Hey, Archer.
- Yeah.
Who is that?
That's the new ED attending.
Name's Ripley.
- Ripley?
- Yeah.
- Huh. Look so familiar to me.
- Yeah?
What do you, uh,
what do you know about him?
Ah, he's really smart.
Got a full ride to Columbia.
Got great references.
Hmm.
Dr. Ripley, help me
with a patient in four.
I just sent you the chart.
Mr. Shorr.
[BREATHLESS] Harris is fine.
This is my wife, Audrey.
I'm Dr. Ripley, and this is, um,
Maggie Lockwood, our charge nurse.
Mrs. Ben.
Excuse me?
Oh, our son Michael was
your husband's student.
We met last year
at parent-teacher night.
Oh.
So you two were in that pile-up?
Tried to avoid it.
Harris lost control of the car.
I don't know what happened.
I got dizzy.
Also, I think I broke my arm.
- X-ray.
- Yup.
Let's get AP and lateral views
of the right upper arm and forearm.
You say you got dizzy?
That's been happening a lot.
And you're short of breath?
A little bit.
Clear. [MACHINE BEEPS]
Non-displaced fracture
of the distal radius.
Afraid you do have a busted wing.
Get ortho down here to take a look?
Please.
Your blood pressure's high.
- Did you know that?
- No.
It says here you're on lithium
as well as quetiapine and lamotrigine.
Yeah, I'm bipolar.
He's been managing very well.
That's good.
But I am concerned about your breathing,
blood pressure, the dizziness.
I'd like to do more of a workup.
I wish you would.
I've been worried about him.
But you're okay, Audrey? Nothing hurts?
- No.
- Okay.
Please give our regards to Mr. Ben.
Let's start with standard blood work.
I'll come back soon and follow up.
Thanks, Doc.
Since Mr. Shorr is on mood stabilizers,
shouldn't we have psychiatry
take a look at him?
Dr. Charles is on call.
I don't wanna bother him just yet.
Let's just see what the labs show.
All right.
[PENSIVE MUSIC]
Oh. How's she doing?
Emotionally, she's a wreck.
Thinks it's all her fault.
Physically, I don't know yet.
I found a bruise on her scalp,
so I'm ordering a non-contrast C
to see if there's something there.
- Okay. Keep me posted.
- Sure.
[ALARM BEEPING]
She's in V-fib.
Set up the paddles. Start bagging.
On it.
Charge to 120.
[SUSPENSEFUL MUSIC]
Charging.
Clear.
No pulse. 1 epi milligram.
Coming.
What happened gotta be
the head trauma, right?
I mean, she doesn't even
she doesn't have any other injuries.
No, it shouldn't be happening.
Charge to 200.
Charging.
Clear.
Another 1 of epi.
200 again.
Charging.
Clear.
Okay, okay.
[MACHINE BEEPING]
I got a pulse.
♪
[SIGHS]
Her, um her pupils are blown.
No. No, no, no, no, no.
Watch out, watch out.
She's brain dead, isn't she?
Let's, um, let's intubate.
Put her on a vent until we confirm
and hear from her contact.
What, did I miss something?
Is there something else
I could have done?
I sincerely doubt that.
I'm OB/GYN. This isn't what I do.
Probably a pseudoaneurysm
the CT didn't pick up.
Or I didn't see it.
Hannah, nobody did.
All right?
This kind of thing happens.
Not your fault.
Really?
Hardly your area of expertise, either.
♪
It's true. I can perform
miracles. But this?
I mean, I've never seen such distraction
and dislocation of skull to spine
and still have the patient alive.
Yeah. I've been thinking.
It doesn't seem like
we could take the standard
posterior approach,
not with all the massive
- scalp and neck lacerations.
- Yeah.
And an occipital bone only
a few millimeters thick.
Yeah. So what do we do?
Go in through the mouth?
Yeah.
Transoral.
Are you serious?
It's the only option for anterior
atlanto-occipital screw fixation.
But it's not a good one.
Has it ever been done before?
Once or twice in cadaver studies.
Cadaver.
- Never on a live patient.
- That's correct.
And they were adult cadavers.
I have no idea if it
could work on a child.
[APPREHENSIVE MUSIC]
Survival rate for this
kind of injury is, what, 50%?
What do you give this kid?
5%, best.
We gotta increase those odds.
♪
Dennis, the ED is overwhelmed
and has got to clear rooms.
Every department needs
to find beds for more patients.
Well, double up the private
rooms if you have to.
[KNOCKING ON DOOR] Come in.
Ms. Goodwin.
We have a ten-year-old boy with
atlanto-occipital dislocation.
I'm sorry to hear that.
Yeah, well, the thing is,
we can't attempt
the standard surgical approach.
We have to try going in
through the mouth.
Whoa.
And why are you bringing this to me?
Because this has never
been done before on a child.
In fact, it's only been done
on adult cadavers.
I need you to authorize my using 2.0.
2.0? No.
Come on, it's a disaster.
It hallucinated data.
You can't use the hybrid OR?
Not up to the task.
And you've managed to
put up guardrails on 2.0?
- I think I have.
- Oh, you think?
I've run simulations,
and the platform's performed very well.
Yeah, but not with a real patient.
No, not since
It sent this hospital into bankruptcy.
Look, 2.0's tech is more advanced
than anything else in this hospital.
I believe in it.
And I believe it's that boy's only hope.
Sharon, come on.
I mean, the liability,
potential lawsuits
Peter.
If it's the boy's only hope,
what choice do we have?
You have my authorization.
Thank you.
- Dr. Marcel.
- Yeah?
Our new owners
they're business people.
The surgery goes south,
they're gonna want your head.
I hear you.
And they're gonna want your head too.
What else is new?
Dean, did you get Sean's text?
He was admitted to pre-op
for tomorrow's surgery.
Oh. No.
Hey, why don't you go up and see him?
We'll manage.
I'm sorry about your patient.
Are you gonna be okay?
You mean, am I gonna
head to the ladies room
- and shoot up?
- Oh, stop it.
Sorry. Sorry.
Yeah.
- All right.
- I'll be fine.
Okay.
Dr. Ripley.
I'm Dan Charles.
We've met before.
Haven't we? We know each other.
Good memory.
It was 20 years ago.
I looked a little different.
Dr. Ripley, take a look.
Mr. Shorr's labs are in.
Excuse me.
[KNOCKS ON WINDOW]
Harris, Audrey.
Hey, Doc.
So
your blood work shows
elevated glucose, LDL
inflammatory markers.
Have you experienced
unusual weight gain?
[SCOFFS] Uh, yeah.
Look at this gut.
These are all metabolic symptoms,
which can be associated with
the mood stabilizers you're on.
Is that serious?
It can be life threatening.
Oh, my God.
I knew something was wrong.
You think that his mood
stabilizers are the problem?
What I think is that your
husband is overmedicated.
Too many medications and at
unnecessarily high doses.
They're putting him at risk.
But his doctor prescribed them.
Doctors can be wrong, honey.
No offense.
[APPREHENSIVE MUSIC]
What do we do?
I wanna try taking you off
one of your meds, the quetiapine,
and see if your metabolic
symptoms improve.
Take him off?
Just while he's here in the hospital
where we can keep him under observation.
If there is a problem,
we can put him right back on.
[SIGHS]
Yeah, okay.
Let's do it.
Okay.
♪
Archer.
I just started the intake on a
little girl from the accident.
Maybe you wanna weigh in.
All right, Hannah.
You've had a tough loss,
and I have every faith that
I'm asking because she's
a recent kidney recipient.
Oh.
Hello, Kayla.
- I'm Dr. Archer.
- Hi.
- Hi.
- I'm her dad, Tom.
Yes. I understand you
got a new kidney, huh?
- Uh-huh.
- Yeah.
About three months ago.
We're waiting on labs,
but Kayla is not showing
any obvious signs of injury
from the accident.
But her X-rays were good.
I told you I was fine, Dad.
She didn't wanna come in,
but, you know, I worry about her.
Of course.
BP's a little soft.
She's tachy.
I don't feel bad, really.
All right, I'm gonna touch
your tummy, okay?
- This hurt?
- No.
No? How about here?
Uh-uh.
Here?
- Ow.
- Hmm.
- Uh, just hurts a little bit.
- Yeah?
Did this start today after the accident?
Maybe.
Were you wearing your seatbelt, Kayla?
Dad doesn't drive me if I don't.
What are you getting at?
When your car stopped abruptly,
if the seatbelt was riding high,
it might have pulled across her
abdomen instead of her hips.
So it could have damaged her kidney?
Well, possibly.
But let's not get ahead of ourselves.
We're gonna send Kayla
for a CT to check, okay?
It's okay. I'll be fine.
Her kidney's bleeding, isn't it?
She could lose it, yeah.
♪
Hey. Daniel.
We are swamped. I'm looking for beds.
Can you see if anyone qualifies
for early discharge
in the psych unit?
From yeah. Yep.
- Yeah?
- Yeah.
Hey.
What's the matter?
I ran into a patient of mine
well, actually, somebody who
was a patient of mine,
like, 20 years ago,
when they were a teenager.
And?
They were violent back then.
You know, put another kid
in the hospital.
I mean, they're seemed to
really turn their life around.
Fancy college, fancy fancy job.
I mean, it's actually
a great story is what it is.
- So so it's good?
- It's good.
- It's really good. Yeah. Good.
- Okay.
- Now you can help me out?
- Okay.
- Find me some beds?
- I'll look, yeah. I'll look.
Okay. Thank you.
Thanks, Dr. Cameron. Appreciate it.
- Hey.
- Hey.
Dr. Cameron says I'm good to go.
Oh, yeah?
Bloodwork, imaging, all perfect.
Congratulations.
Yeah.
Congratulations.
You don't have to do this, you know.
What are you talking about?
I want to do this.
I'm just sorry it
hasn't happened sooner.
I'm sorry about a lot of things.
You're sorry?
What are you sorry about?
'Cause if anybody's got
something to be sorry for,
- that's me.
- Dad, please stop.
Hey.
Do you remember that family
that lived next door?
The Barns?
- Yeah.
- Well, they had a daughter.
Sarah.
Just a couple years younger than me.
Anyway, she lost her cat.
And she was crying and everything.
Like, really upset.
So I went to look for it.
And weirdly enough,
I found it under our porch.
So I got it
and I brought it back to her.
And she was so
[CHUCKLES]
Happy.
And it was, like,
the best day of my life.
Best day of my life.
Till now.
[SENTIMENTAL MUSIC]
♪
[SUSPENSEFUL MUSIC]
I've often thought your
judgment was suspect,
but this, this might be your
most boneheaded idea yet.
You know 2.0 is Brice's best chance.
Of what, dying on the table?
So what you wanna do, Sam?
You want me to find
another neurosurgeon?
No.
I'm the only one who might be able
to save you from yourself.
But how in God's name are you
gonna be able to verify
what the AI is telling us?
Oh, I won't be alone.
I'll be working with the best
neurosurgeon on the planet, right?
♪
Tom, Kayla, this is Dr. Cameron.
He's our chief of kidney transplant.
Hello.
Dr. Archer shared
Kayla's CT and labs with me.
So, Kayla, your labs indicate
that even before the accident,
your kidney was not doing well.
And the CAT scan shows
what we call an active blush,
which means the kidney is bleeding.
It's well, it's not
working at all now.
Oh, God.
It failed?
Yes.
So it's back on dialysis, I guess.
I'm afraid so.
Yes, but first we need
to send you to IR.
That's Interventional Radiology
to embolize the kidney
to stop the bleeding.
- Okay.
- All right.
We need this done right away.
I'll go get things moving.
Thank you.
Dr. Cameron is gonna
take very good care of you.
Okay? He's the best.
And I know this because
he's my doctor too.
You have kidney disease?
Yes, I do.
I'm really sorry.
[SENTIMENTAL MUSIC]
Oh, thanks.
[DRAWS SHAKY BREATH]
Um, all right, there's somebody
gonna come, uh,
take you down to IR soon, okay?
♪
Hey, Mark.
By any chance, is Sean
a match for Kayla?
I'm sorry?
Could Sean, you know,
donate his kidney to Kayla?
Sean is donating his kidney to you.
Why would you even ask that?
No.
He's not a match.
Dean, can I talk to you?
- Yeah?
- What the hell?
You'd have Sean give
his kidney to Kayla?
Hey, it's not your business, Hannah.
[LAUGHING] Not my business.
Okay, that's pretty cold, even for you.
You've had a lousy day.
It's not my problem.
No. Hey, hey.
All this time, I thought
that you were worried
about Sean giving up his kidney.
But that's not it at all.
What really bothers you is
that he's giving it up to you.
Yeah, well, maybe because
there's a 13-year-old girl
out there who needs a kidney.
And you don't?
Look at you.
Listen, this is my son.
And he wants to sacrifice
a piece of himself for me.
Yeah, he does.
Look, I don't
I don't deserve it.
All right? I was a terrible father.
- Do you get that?
- I get it.
Do you get that?
[SOFTLY] I get it.
I get it. I get it. You feel unworthy.
Yeah.
I'm an addict. Okay, I no, I know.
I know what it feels like
to be unworthy.
So does Sean.
And he knows about loneliness
and about being cut off from everybody.
And take it from me,
drugs are a great way
- to fill that space.
- Hannah, please.
No, now you listen to me.
Your son doesn't want drugs anymore.
He wants connection.
And he wants it with his father
his father, whom he loves.
You feel unworthy.
But if you deny Sean this,
you will destroy him.
♪
[SIGHS]
[INDISTINCT YELLING]
I don't wanna be here. Let me go!
- What's going on?
- I don't know.
No, I'm gonna go.
You gotta let me get out of here, okay?
- Let me out of here!
- Security!
I said let me out of here!
Let me I'm getting out.
No! They're gonna kill me!
They're gonna kill me. No!
- Get me out of here!
- Okay, okay.
No! No, why did you bring me here?
I'm good.
There you go.
There you go.
I'm good, guys. Thank you.
Can I have a little quick
look at his chart, please?
Dr. Ripley, can I, um
could I get a quick word, please?
So you took Mr. Harris
off his quetiapine.
I'm just curious why you did that.
He's a bomb about to go off.
Did you look at his chart?
Dyspnea, high BP, blood sugar,
low HDL, central obesity.
I need to find out
if that's from his meds.
And it didn't occur to you to maybe
just call in psych for a little consult?
I mean, I've been here all day.
He's not your patient.
He's looking an awful lot
like a psych patient to me.
Not today.
Today, he's an ED patient
with metabolic syndrome.
Who just flipped out 'cause
you took him off his meds.
To keep him from having
a coronary or stroking out.
He is overmedicated.
You can't know that.
Quetiapine, lithium, lamotrigine?
All neurotransmitter modulators.
They overlap. They're redundant.
They are not redundant.
The two mood stabilizers
are actually complementary.
Okay? And quetiapine
Yeah, yeah. You guys love to medicate.
You can't just stop it.
I mean, honestly, Dr. Ripley, I
think what you did today was
a little reckless.
Reckless?
Reckless.
Well, come on, Dr. Charles.
Why don't you just say it?
"Impulse control disorder."
Isn't that what you called it back then?
Oh, so you took him off
his meds 'cause of me?
I took Mr. Shorr off one drug,
the one most likely to be causing
his metabolic symptoms, and I did so
in a controlled clinical setting.
Now, I'm an attending physician
at this hospital.
Do not treat me like the boy
you knew 20 years ago.
[SOFT TENSE MUSIC]
♪
[SIGHS]
Dissecting soft tissue to prepare
the anterior C1 ring for
the AO transarticular screws.
2.0, what is the ideal
screw entry point?
Ideal entry point is lower one third
of midline of C1 lateral mass,
just above C1-2 joint capsule.
Yeah, that's what the cadaver studies
in our simulation suggested.
Drill.
Okay.
Starting with the left side,
drilling laterally,
posteriorly, and upwardly.
The kid's end tidal CO2 just dipped.
2.0, assess.
Based on baseline and trending vitals,
there is high likelihood
of venous air embolism.
Is that really the case?
Slight dip could be bronchospasm,
poor tissue perfusion,
or nothing at all.
Yeah, 2.0, verify
venous air embolism, please.
Verified. There is a greater
than 75% chance of mortality
or catastrophic outcome.
Address immediately.
I don't know, maybe the damn
thing's hallucinating again.
Yeah.
BP's just a tad low. 85/49.
Hey, we need to finish this surgery.
- Get this kid off the table.
- No, hold on.
Lower his head. Place
a precordial doppler
and set up for a transesophageal echo.
Crockett.
An air embolism could kill him.
We have to know what we're dealing with.
[SUSPENSEFUL MUSIC]
[SOFT RUMBLING]
That sound from the doppler
it's air bubbles.
Yeah, I think when we
drilled into the bone,
it got sucked into the vascular system
directly to the heart. [MACHINE BEEPING]
BP is dropping more now.
65/33.
And heart rate, too, at 36.
There it is.
Significant air bubbles.
Yeah, they're embolizing
into the pulmonary artery,
causing right heart strain.
Yeah, 2.0 was correct.
Marty, give the kid 100% O2
and bag him up.
Coming.
But I'm having trouble
ventilating and oxygenating.
- 80% sat.
- Confirmed.
Critically significant hypoxia
and poor systemic perfusion.
We're gonna have to suction
the air out of the kid's heart.
Give me the Swan-Ganz catheter.
Seeing ST segment changes on EKG.
Got about a minute before
complete cardiac collapse.
We're gonna float the existing cordis
right into the pulmonary artery.
Vitals are tanking.
- Systolics in the 40s.
- Get a crash cart.
In the right ventricle. Balloon up.
Balloon's up. Go ahead.
Okay, advancing.
♪
Any day now, Crockett.
Almost.
Okay, I'm in the pulmonary artery.
- Syringe?
- On it.
[ALARM BEEPING, BLARING]
No air.
Barely seeing an arterial trace.
He's bradying down.
Cardiac arrest is imminent.
Push a milligram of atropine now.
Advancing further. Balloon down.
♪
Come on.
[ALARM STOPS] Got air.
BP, heart rate.
Pulmonary air embolism
successfully addressed.
Audrey?
- Thank you.
- You're welcome.
Poor Harris.
He works so hard to stay well.
It's a rough illness.
I wish more people saw it that way
and not as some kind of failing.
Your husband's one of the
rare ones who understands.
He was always so good to our son.
There was a time that Harris
had to be hospitalized.
Michael was so scared and upset,
and Mr. Ben really
helped him through it.
Made him see that people can
get sick in different ways.
And that his daddy was gonna be okay.
He will be, Audrey.
He will be.
That was nice
what she said about Ben.
Yeah, to tell you the truth, Doris,
I really don't wanna hear about Ben.
Okay.
Hey, Doris, what's happening
with the hamster?
No one wants it.
I called animal control.
Dean, I saw tomorrow's
surgical schedule.
Looks like you're getting
that transplant.
Yeah.
Dr. Charles.
Judith's CT showed an acute
subdural hematoma.
Her doctor has her on blood thinners,
so it could get worse.
- So she needs surgery?
- Yeah.
Thing is, she's refusing treatment.
Says she wants to die.
She's suicidal.
We could hold her?
Uh, we could.
But let me, um,
let me have a chat first.
Yeah.
Judith, I'm Dr. Charles.
We, uh, we met earlier today.
I don't know if you remember that.
I am being told that you don't want us
to treat your hematoma.
It's just important for me
that I know that you understand
that, if left untreated,
that it could kill you.
I don't deserve to live.
[CRYING]
Okay.
Can I ask you a question?
If somebody that you knew
and that you cared about
were in exactly the same situation,
is that what you'd say to them?
Would you say that
they didn't deserve to live?
I mean, I I don't think so.
I mean, you wouldn't, would you?
What you'd say to them, probably, is
"It wasn't your fault."
But this was my fault.
I hit the brakes, and the car
just started spinning,
and I crashed first,
and then all of the other cars
started to crash behind me.
If it hadn't been for me,
none of this would have happened.
You hit some black ice.
It was an accident.
You didn't hurt all
those people on purpose.
[APPREHENSIVE MUSIC]
One of the hardest moments in life
is when we figure out
how little control we actually have
over the things
that happen to us, right?
But but what we can control
is how we respond to them.
And I just know that with a little time,
clarity will come, you know?
And maybe, just maybe, you might even
get around to doing
one of the hardest things
that a human being can learn
how to do, which is
to forgive yourself.
But if you don't
let us help you, there's just no chance
that that's gonna happen.
♪
So would you let us help you?
Okay.
Okay, Brice, squeeze my hands for me.
Good. Good.
Can you wiggle your feet back and forth?
Okay, now stick your tongue
straight out.
Even the hypoglossal's working well.
I think your son's gonna be fine.
- Thank you.
- Okay.
Thank you.
We'll give you some time with your boy.
You're gonna be okay, okay?
[SOFT SENTIMENTAL MUSIC]
Did you hear? Ivy was an organ donor.
Oh?
Yeah. Dr. Archer had her typed.
Turns out she's a match
for a little girl here
who needs a kidney.
Archer?
No, I hadn't heard.
Just thought it might
make you feel a little better.
♪
Mags, grab your coat, and
I will walk you to your car.
[CHUCKLES] No.
Janine's running a couple hours late,
and I said that I'd cover
for her until she gets here.
No. You've been working nonstop all day.
- Have somebody else cover.
- That's okay. I don't mind.
No. You need to go home to Ben.
He's probably wondering
where his wife is.
Ben's just fine.
Mm, if I had a guy like
Ben waiting for me
Just stop.
[QUIETLY] Stop, okay?
Stop.
Everybody keeps on talking
about my wonderful Ben.
Well, my wonderful husband
wants a divorce.
No.
♪
Mitch.
If this is about Mr. Shorr,
he is rational again.
Back on his full panoply of meds.
We still need to address his
metabolic issues, and soon.
Of course.
But, um, you know,
what I really came up here
to tell you is how impressed I am
with how you turned your life around.
You know, truly. I mean, you've done
you've done so well.
Better than you expected?
Well, I mean, you had a lot to overcome.
Yeah.
Top of the list, maybe county juvenile.
My psych care, remember?
Haldol, Zyprexa
the whole candy store.
I do. I remember.
I remember that you were violent,
and you were aggressive.
It was a big place, a lot of kids.
You know, we had to protect them.
Chemical restraints.
They worked.
I couldn't move, couldn't sleep.
Couldn't pee, either.
It's fun times.
Look, we know a whole lot
more about those meds now
than we did then.
You know, we've gotten
much better at dosing.
I mean, frankly, you probably
were overmedicated.
You were.
And then you booked.
I booked?
You took off. You left.
Well, I mean, I imagine
that's because I had a
that my my rotation was probably
Okay.
[SOFT TENSE MUSIC]
♪
OR 2.0 is the fruit
of years of development.
I know the tech.
I promise you, it won't let you down.
You know tech,
but you don't know surgery.
- Are you having an affair?
- No.
Never.
I don't know if Ben and I
are on a path to divorce.
Dayton has bought controlling interest
in the Gaffney Medical Group.
So I guess he's in charge now.
We will be livestreaming a surgery
for the entire world to watch.
This is not a simulation.
There's a human being on that table.
I know, and you're gonna save his life.
And what if I don't?
What if he dies?
I'm officially in
end stage renal disease.
Sean is your best possible donor match.
I'm not taking my son's kidney, Hannah.
- Warning, warning.
- [ALARM BLARING]
The platform is defective.
We gotta shut it down.
I'm ruined, Sharon.
I have to sell the hospital.
[DRAMATIC MUSIC]
Come on, Brice.
Brice, move your feet for me.
[MACHINE BEEPING]
Squeeze my fingers. Come on, buddy.
Squeeze 'em.
On extrication, he was
moving all his limbs.
- There's nothing now.
- Listen up, everybody.
Listen up.
Multi-vehicle crash on the interstate.
Mass casualties en route.
Ambos are about to land right now.
Hannah, I'm gonna need you
for more than OB today, okay?
- Yeah.
- Okay, thanks.
Need to secure his airway
before he crashes.
0.2 mgs per kg etomidate,
0.6 mgs per kg roc.
Got it.
- Tube.
- Ready.
I'm in.
Bag him.
Peter, I'm gonna have to cut this short.
Take care.
Thank you.
25-year-old male.
Heart rate 115. BP 75/50.
GCS 13. Arterial bleed.
Tourniquet placed in the field.
Ripley, with me in six.
You got it.
Dr. Marcel? ETA in five.
♪
Joshua, you got enough with this.
That's a red tag. You're good.
Tracy, I'll be right back.
Oh, I'm sorry, hold for a second.
That is a green tag.
Non-emergency for now, sir.
We're gonna have you wait
in the waiting room, okay?
Let's go back. You, too. I'm so sorry.
That is a green tag also.
Everyone with a green tag,
you have to wait in the waiting room.
Green tag in the waiting room.
Thank you.
Check his arm, please.
♪
Chest is clear.
What are you doing?
Making sure this is an arterial bleed.
Cuff works as a secondary tourniquet.
Release it slowly,
and if the bleeding has stopped
It's not an arterial bleed.
Not everybody knows that trick.
Very nice.
So I pass?
[HELICOPTER BLADES WHIRRING]
[SOBBING] Oh, God.
It all happened so fast.
I didn't mean it.
I tried not to hit them.
I couldn't stop.
- It wasn't your fault.
- Oh, my God.
- It's not your fault.
- Oh, my God.
Let's see if we can find
somebody to take a look at you.
We're doing our best
right now to get everyone.
All the information
Dolores Williams, is she here?
- Robbie.
Robbie Wilson.
Please, please, everyone,
go to the waiting room,
and someone will be out soon
to answer all your questions.
To the waiting room, please.
That's it. Cesar, talk to me.
Ivy Vance, 30s.
Hit her head against
the interior of her vehicle.
Complaining of headache, disoriented.
GCS 12.
You're going to treatment three.
I got no movement through the limbs.
- Got you.
- Coming in.
I've got it.
- Easy.
- Yep, yep.
Keep him steady.
All right, let's move. Ready?
Hey, Maggie, you need
an extra pair of hands,
I could put the gloves on.
I might take you up on that.
Maggie, need ortho in there.
Got it.
Oh, and you're going to treatment three.
Got it.
Zach, what do we got?
Ivy Vance.
Few lacerations, closed head injury.
Okay. Hi, Ivy.
I'm Dr. Asher.
I'm gonna ask you some questions, okay?
Okay.
So you hit your head.
Uh-huh.
Do you know where you are?
Hospital.
What day is today?
Um
Wednesday.
Okay, everything's good.
We just need to check that head
bump out, get a CT. Sound okay?
Transport.
What's that?
Hamster.
Came in with her.
- Yep. Maggie.
- Yeah?
- You're going to Baghdad.
- I got a ten-year-old boy.
Brice Morgan. GCS 7.
Vehicle was crushed under a semi.
Father died at the scene.
Mike, X-ray. Let's go.
Got it.
Jimmy, take over.
Mike, give me a cross-table C-spine.
Yep.
Clear.
The ligaments.
Is that even possible?
Yeah. He's internally decapitated.
The only thing holding
his head on is his skin.
♪
- Jack.
- Hey.
Eight-year-old boy with a head lac.
- He's my son.
- We'll take good care of him.
Keep that compress on his head.
You're going to treatment two.
- Thanks, Jack.
- Mm-hmm.
Dean. Hey.
You're getting a new kidney tomorrow.
- Take it easy.
- Yeah, I'm fine.
- Dr. Marcel.
- Yeah?
The boy's mother's here.
Okay.
Ms. Morgan, I'm Dr. Marcel.
I know you lost your husband.
I'm very sorry.
My son, Brice,
please just tell me he's alive.
He is.
But he has been critically injured.
Here.
[SOBS] Oh, my God.
No, no, no, no!
Look, I'm gonna do my
very best to help your son.
Okay, but I don't wanna
minimize the severity
of Brice's condition.
He suffered what's called
a bilateral
atlanto-occipital dislocation.
What that means is that
the ligaments from his skull
have separated from his spinal column.
Oh, no. No.
We're gonna do a CT and an MRI,
and that's gonna help us determine
how to proceed surgically, okay?
Surgically.
Yes.
It's necessary in order to stabilize
the head to the spine.
And let's page Dr. Abrams, please, okay?
Liz, Dr. Abrams is a great neurosurgeon.
Okay?
All right.
Why don't you come be with him?
Come on.
[SOMBER MUSIC]
Hey, baby.
It's okay, Mommy's here.
Mommy's here.
Maggie.
- Matt.
- Harris Shorr, 40s.
Injured in that accident.
His right arm is swollen and bruised.
Complained of dizziness on the scene.
GCS 15. Heart rate 110.
Respiratory rate 25 per minute.
All right, you're going
to treatment four.
I'll have a doctor in there
as soon as possible.
Are you done yet?
Almost.
Decision time, AJ.
We got two types of bandages.
We've got Wolverine or Spider-Man.
What's your poison?
- Poison? I don't want poison.
- [LAUGHS]
No, honey, he's asking
which one you want.
Oh. Spider-Man.
All right.
My friend here will fix you up.
I'll catch you later, AJ.
Dr. Asher, here's Ivy's CT.
I got in touch
with her emergency contact,
a woman she works with.
No family?
It doesn't seem like it.
The woman explained about the hamster.
She said it's probably a rescue.
She says Ivy likes
to find homes for things.
Aw.
Well, it looks like
she can continue to do so.
I'm just seeing a small contusion.
- Nothing serious.
- Yeah, that's what I thought.
Yeah, well, I will let her know.
Hey, Ivy.
How you feeling?
- Better.
- Good.
Well, good news, your CT didn't
show any concerning injuries,
so we're gonna give you a neuro check
every couple hours just to
make sure everything's okay.
Thank you.
Your work friend said that
you like to rescue animals.
They're family.
Yeah. I guess I can understand that.
I mean, we are all related,
from fish, to hamsters,
to us, so
And we all need a home.
That we do.
I was rescued.
[PENSIVE MUSIC]
I was in a very bad place,
and someone took care of me.
Yeah.
I can relate to that.
It is a good thing that people
like you are in the world.
♪
[SIGHS]
- Hey, Archer.
- Yeah.
Who is that?
That's the new ED attending.
Name's Ripley.
- Ripley?
- Yeah.
- Huh. Look so familiar to me.
- Yeah?
What do you, uh,
what do you know about him?
Ah, he's really smart.
Got a full ride to Columbia.
Got great references.
Hmm.
Dr. Ripley, help me
with a patient in four.
I just sent you the chart.
Mr. Shorr.
[BREATHLESS] Harris is fine.
This is my wife, Audrey.
I'm Dr. Ripley, and this is, um,
Maggie Lockwood, our charge nurse.
Mrs. Ben.
Excuse me?
Oh, our son Michael was
your husband's student.
We met last year
at parent-teacher night.
Oh.
So you two were in that pile-up?
Tried to avoid it.
Harris lost control of the car.
I don't know what happened.
I got dizzy.
Also, I think I broke my arm.
- X-ray.
- Yup.
Let's get AP and lateral views
of the right upper arm and forearm.
You say you got dizzy?
That's been happening a lot.
And you're short of breath?
A little bit.
Clear. [MACHINE BEEPS]
Non-displaced fracture
of the distal radius.
Afraid you do have a busted wing.
Get ortho down here to take a look?
Please.
Your blood pressure's high.
- Did you know that?
- No.
It says here you're on lithium
as well as quetiapine and lamotrigine.
Yeah, I'm bipolar.
He's been managing very well.
That's good.
But I am concerned about your breathing,
blood pressure, the dizziness.
I'd like to do more of a workup.
I wish you would.
I've been worried about him.
But you're okay, Audrey? Nothing hurts?
- No.
- Okay.
Please give our regards to Mr. Ben.
Let's start with standard blood work.
I'll come back soon and follow up.
Thanks, Doc.
Since Mr. Shorr is on mood stabilizers,
shouldn't we have psychiatry
take a look at him?
Dr. Charles is on call.
I don't wanna bother him just yet.
Let's just see what the labs show.
All right.
[PENSIVE MUSIC]
Oh. How's she doing?
Emotionally, she's a wreck.
Thinks it's all her fault.
Physically, I don't know yet.
I found a bruise on her scalp,
so I'm ordering a non-contrast C
to see if there's something there.
- Okay. Keep me posted.
- Sure.
[ALARM BEEPING]
She's in V-fib.
Set up the paddles. Start bagging.
On it.
Charge to 120.
[SUSPENSEFUL MUSIC]
Charging.
Clear.
No pulse. 1 epi milligram.
Coming.
What happened gotta be
the head trauma, right?
I mean, she doesn't even
she doesn't have any other injuries.
No, it shouldn't be happening.
Charge to 200.
Charging.
Clear.
Another 1 of epi.
200 again.
Charging.
Clear.
Okay, okay.
[MACHINE BEEPING]
I got a pulse.
♪
[SIGHS]
Her, um her pupils are blown.
No. No, no, no, no, no.
Watch out, watch out.
She's brain dead, isn't she?
Let's, um, let's intubate.
Put her on a vent until we confirm
and hear from her contact.
What, did I miss something?
Is there something else
I could have done?
I sincerely doubt that.
I'm OB/GYN. This isn't what I do.
Probably a pseudoaneurysm
the CT didn't pick up.
Or I didn't see it.
Hannah, nobody did.
All right?
This kind of thing happens.
Not your fault.
Really?
Hardly your area of expertise, either.
♪
It's true. I can perform
miracles. But this?
I mean, I've never seen such distraction
and dislocation of skull to spine
and still have the patient alive.
Yeah. I've been thinking.
It doesn't seem like
we could take the standard
posterior approach,
not with all the massive
- scalp and neck lacerations.
- Yeah.
And an occipital bone only
a few millimeters thick.
Yeah. So what do we do?
Go in through the mouth?
Yeah.
Transoral.
Are you serious?
It's the only option for anterior
atlanto-occipital screw fixation.
But it's not a good one.
Has it ever been done before?
Once or twice in cadaver studies.
Cadaver.
- Never on a live patient.
- That's correct.
And they were adult cadavers.
I have no idea if it
could work on a child.
[APPREHENSIVE MUSIC]
Survival rate for this
kind of injury is, what, 50%?
What do you give this kid?
5%, best.
We gotta increase those odds.
♪
Dennis, the ED is overwhelmed
and has got to clear rooms.
Every department needs
to find beds for more patients.
Well, double up the private
rooms if you have to.
[KNOCKING ON DOOR] Come in.
Ms. Goodwin.
We have a ten-year-old boy with
atlanto-occipital dislocation.
I'm sorry to hear that.
Yeah, well, the thing is,
we can't attempt
the standard surgical approach.
We have to try going in
through the mouth.
Whoa.
And why are you bringing this to me?
Because this has never
been done before on a child.
In fact, it's only been done
on adult cadavers.
I need you to authorize my using 2.0.
2.0? No.
Come on, it's a disaster.
It hallucinated data.
You can't use the hybrid OR?
Not up to the task.
And you've managed to
put up guardrails on 2.0?
- I think I have.
- Oh, you think?
I've run simulations,
and the platform's performed very well.
Yeah, but not with a real patient.
No, not since
It sent this hospital into bankruptcy.
Look, 2.0's tech is more advanced
than anything else in this hospital.
I believe in it.
And I believe it's that boy's only hope.
Sharon, come on.
I mean, the liability,
potential lawsuits
Peter.
If it's the boy's only hope,
what choice do we have?
You have my authorization.
Thank you.
- Dr. Marcel.
- Yeah?
Our new owners
they're business people.
The surgery goes south,
they're gonna want your head.
I hear you.
And they're gonna want your head too.
What else is new?
Dean, did you get Sean's text?
He was admitted to pre-op
for tomorrow's surgery.
Oh. No.
Hey, why don't you go up and see him?
We'll manage.
I'm sorry about your patient.
Are you gonna be okay?
You mean, am I gonna
head to the ladies room
- and shoot up?
- Oh, stop it.
Sorry. Sorry.
Yeah.
- All right.
- I'll be fine.
Okay.
Dr. Ripley.
I'm Dan Charles.
We've met before.
Haven't we? We know each other.
Good memory.
It was 20 years ago.
I looked a little different.
Dr. Ripley, take a look.
Mr. Shorr's labs are in.
Excuse me.
[KNOCKS ON WINDOW]
Harris, Audrey.
Hey, Doc.
So
your blood work shows
elevated glucose, LDL
inflammatory markers.
Have you experienced
unusual weight gain?
[SCOFFS] Uh, yeah.
Look at this gut.
These are all metabolic symptoms,
which can be associated with
the mood stabilizers you're on.
Is that serious?
It can be life threatening.
Oh, my God.
I knew something was wrong.
You think that his mood
stabilizers are the problem?
What I think is that your
husband is overmedicated.
Too many medications and at
unnecessarily high doses.
They're putting him at risk.
But his doctor prescribed them.
Doctors can be wrong, honey.
No offense.
[APPREHENSIVE MUSIC]
What do we do?
I wanna try taking you off
one of your meds, the quetiapine,
and see if your metabolic
symptoms improve.
Take him off?
Just while he's here in the hospital
where we can keep him under observation.
If there is a problem,
we can put him right back on.
[SIGHS]
Yeah, okay.
Let's do it.
Okay.
♪
Archer.
I just started the intake on a
little girl from the accident.
Maybe you wanna weigh in.
All right, Hannah.
You've had a tough loss,
and I have every faith that
I'm asking because she's
a recent kidney recipient.
Oh.
Hello, Kayla.
- I'm Dr. Archer.
- Hi.
- Hi.
- I'm her dad, Tom.
Yes. I understand you
got a new kidney, huh?
- Uh-huh.
- Yeah.
About three months ago.
We're waiting on labs,
but Kayla is not showing
any obvious signs of injury
from the accident.
But her X-rays were good.
I told you I was fine, Dad.
She didn't wanna come in,
but, you know, I worry about her.
Of course.
BP's a little soft.
She's tachy.
I don't feel bad, really.
All right, I'm gonna touch
your tummy, okay?
- This hurt?
- No.
No? How about here?
Uh-uh.
Here?
- Ow.
- Hmm.
- Uh, just hurts a little bit.
- Yeah?
Did this start today after the accident?
Maybe.
Were you wearing your seatbelt, Kayla?
Dad doesn't drive me if I don't.
What are you getting at?
When your car stopped abruptly,
if the seatbelt was riding high,
it might have pulled across her
abdomen instead of her hips.
So it could have damaged her kidney?
Well, possibly.
But let's not get ahead of ourselves.
We're gonna send Kayla
for a CT to check, okay?
It's okay. I'll be fine.
Her kidney's bleeding, isn't it?
She could lose it, yeah.
♪
Hey. Daniel.
We are swamped. I'm looking for beds.
Can you see if anyone qualifies
for early discharge
in the psych unit?
From yeah. Yep.
- Yeah?
- Yeah.
Hey.
What's the matter?
I ran into a patient of mine
well, actually, somebody who
was a patient of mine,
like, 20 years ago,
when they were a teenager.
And?
They were violent back then.
You know, put another kid
in the hospital.
I mean, they're seemed to
really turn their life around.
Fancy college, fancy fancy job.
I mean, it's actually
a great story is what it is.
- So so it's good?
- It's good.
- It's really good. Yeah. Good.
- Okay.
- Now you can help me out?
- Okay.
- Find me some beds?
- I'll look, yeah. I'll look.
Okay. Thank you.
Thanks, Dr. Cameron. Appreciate it.
- Hey.
- Hey.
Dr. Cameron says I'm good to go.
Oh, yeah?
Bloodwork, imaging, all perfect.
Congratulations.
Yeah.
Congratulations.
You don't have to do this, you know.
What are you talking about?
I want to do this.
I'm just sorry it
hasn't happened sooner.
I'm sorry about a lot of things.
You're sorry?
What are you sorry about?
'Cause if anybody's got
something to be sorry for,
- that's me.
- Dad, please stop.
Hey.
Do you remember that family
that lived next door?
The Barns?
- Yeah.
- Well, they had a daughter.
Sarah.
Just a couple years younger than me.
Anyway, she lost her cat.
And she was crying and everything.
Like, really upset.
So I went to look for it.
And weirdly enough,
I found it under our porch.
So I got it
and I brought it back to her.
And she was so
[CHUCKLES]
Happy.
And it was, like,
the best day of my life.
Best day of my life.
Till now.
[SENTIMENTAL MUSIC]
♪
[SUSPENSEFUL MUSIC]
I've often thought your
judgment was suspect,
but this, this might be your
most boneheaded idea yet.
You know 2.0 is Brice's best chance.
Of what, dying on the table?
So what you wanna do, Sam?
You want me to find
another neurosurgeon?
No.
I'm the only one who might be able
to save you from yourself.
But how in God's name are you
gonna be able to verify
what the AI is telling us?
Oh, I won't be alone.
I'll be working with the best
neurosurgeon on the planet, right?
♪
Tom, Kayla, this is Dr. Cameron.
He's our chief of kidney transplant.
Hello.
Dr. Archer shared
Kayla's CT and labs with me.
So, Kayla, your labs indicate
that even before the accident,
your kidney was not doing well.
And the CAT scan shows
what we call an active blush,
which means the kidney is bleeding.
It's well, it's not
working at all now.
Oh, God.
It failed?
Yes.
So it's back on dialysis, I guess.
I'm afraid so.
Yes, but first we need
to send you to IR.
That's Interventional Radiology
to embolize the kidney
to stop the bleeding.
- Okay.
- All right.
We need this done right away.
I'll go get things moving.
Thank you.
Dr. Cameron is gonna
take very good care of you.
Okay? He's the best.
And I know this because
he's my doctor too.
You have kidney disease?
Yes, I do.
I'm really sorry.
[SENTIMENTAL MUSIC]
Oh, thanks.
[DRAWS SHAKY BREATH]
Um, all right, there's somebody
gonna come, uh,
take you down to IR soon, okay?
♪
Hey, Mark.
By any chance, is Sean
a match for Kayla?
I'm sorry?
Could Sean, you know,
donate his kidney to Kayla?
Sean is donating his kidney to you.
Why would you even ask that?
No.
He's not a match.
Dean, can I talk to you?
- Yeah?
- What the hell?
You'd have Sean give
his kidney to Kayla?
Hey, it's not your business, Hannah.
[LAUGHING] Not my business.
Okay, that's pretty cold, even for you.
You've had a lousy day.
It's not my problem.
No. Hey, hey.
All this time, I thought
that you were worried
about Sean giving up his kidney.
But that's not it at all.
What really bothers you is
that he's giving it up to you.
Yeah, well, maybe because
there's a 13-year-old girl
out there who needs a kidney.
And you don't?
Look at you.
Listen, this is my son.
And he wants to sacrifice
a piece of himself for me.
Yeah, he does.
Look, I don't
I don't deserve it.
All right? I was a terrible father.
- Do you get that?
- I get it.
Do you get that?
[SOFTLY] I get it.
I get it. I get it. You feel unworthy.
Yeah.
I'm an addict. Okay, I no, I know.
I know what it feels like
to be unworthy.
So does Sean.
And he knows about loneliness
and about being cut off from everybody.
And take it from me,
drugs are a great way
- to fill that space.
- Hannah, please.
No, now you listen to me.
Your son doesn't want drugs anymore.
He wants connection.
And he wants it with his father
his father, whom he loves.
You feel unworthy.
But if you deny Sean this,
you will destroy him.
♪
[SIGHS]
[INDISTINCT YELLING]
I don't wanna be here. Let me go!
- What's going on?
- I don't know.
No, I'm gonna go.
You gotta let me get out of here, okay?
- Let me out of here!
- Security!
I said let me out of here!
Let me I'm getting out.
No! They're gonna kill me!
They're gonna kill me. No!
- Get me out of here!
- Okay, okay.
No! No, why did you bring me here?
I'm good.
There you go.
There you go.
I'm good, guys. Thank you.
Can I have a little quick
look at his chart, please?
Dr. Ripley, can I, um
could I get a quick word, please?
So you took Mr. Harris
off his quetiapine.
I'm just curious why you did that.
He's a bomb about to go off.
Did you look at his chart?
Dyspnea, high BP, blood sugar,
low HDL, central obesity.
I need to find out
if that's from his meds.
And it didn't occur to you to maybe
just call in psych for a little consult?
I mean, I've been here all day.
He's not your patient.
He's looking an awful lot
like a psych patient to me.
Not today.
Today, he's an ED patient
with metabolic syndrome.
Who just flipped out 'cause
you took him off his meds.
To keep him from having
a coronary or stroking out.
He is overmedicated.
You can't know that.
Quetiapine, lithium, lamotrigine?
All neurotransmitter modulators.
They overlap. They're redundant.
They are not redundant.
The two mood stabilizers
are actually complementary.
Okay? And quetiapine
Yeah, yeah. You guys love to medicate.
You can't just stop it.
I mean, honestly, Dr. Ripley, I
think what you did today was
a little reckless.
Reckless?
Reckless.
Well, come on, Dr. Charles.
Why don't you just say it?
"Impulse control disorder."
Isn't that what you called it back then?
Oh, so you took him off
his meds 'cause of me?
I took Mr. Shorr off one drug,
the one most likely to be causing
his metabolic symptoms, and I did so
in a controlled clinical setting.
Now, I'm an attending physician
at this hospital.
Do not treat me like the boy
you knew 20 years ago.
[SOFT TENSE MUSIC]
♪
[SIGHS]
Dissecting soft tissue to prepare
the anterior C1 ring for
the AO transarticular screws.
2.0, what is the ideal
screw entry point?
Ideal entry point is lower one third
of midline of C1 lateral mass,
just above C1-2 joint capsule.
Yeah, that's what the cadaver studies
in our simulation suggested.
Drill.
Okay.
Starting with the left side,
drilling laterally,
posteriorly, and upwardly.
The kid's end tidal CO2 just dipped.
2.0, assess.
Based on baseline and trending vitals,
there is high likelihood
of venous air embolism.
Is that really the case?
Slight dip could be bronchospasm,
poor tissue perfusion,
or nothing at all.
Yeah, 2.0, verify
venous air embolism, please.
Verified. There is a greater
than 75% chance of mortality
or catastrophic outcome.
Address immediately.
I don't know, maybe the damn
thing's hallucinating again.
Yeah.
BP's just a tad low. 85/49.
Hey, we need to finish this surgery.
- Get this kid off the table.
- No, hold on.
Lower his head. Place
a precordial doppler
and set up for a transesophageal echo.
Crockett.
An air embolism could kill him.
We have to know what we're dealing with.
[SUSPENSEFUL MUSIC]
[SOFT RUMBLING]
That sound from the doppler
it's air bubbles.
Yeah, I think when we
drilled into the bone,
it got sucked into the vascular system
directly to the heart. [MACHINE BEEPING]
BP is dropping more now.
65/33.
And heart rate, too, at 36.
There it is.
Significant air bubbles.
Yeah, they're embolizing
into the pulmonary artery,
causing right heart strain.
Yeah, 2.0 was correct.
Marty, give the kid 100% O2
and bag him up.
Coming.
But I'm having trouble
ventilating and oxygenating.
- 80% sat.
- Confirmed.
Critically significant hypoxia
and poor systemic perfusion.
We're gonna have to suction
the air out of the kid's heart.
Give me the Swan-Ganz catheter.
Seeing ST segment changes on EKG.
Got about a minute before
complete cardiac collapse.
We're gonna float the existing cordis
right into the pulmonary artery.
Vitals are tanking.
- Systolics in the 40s.
- Get a crash cart.
In the right ventricle. Balloon up.
Balloon's up. Go ahead.
Okay, advancing.
♪
Any day now, Crockett.
Almost.
Okay, I'm in the pulmonary artery.
- Syringe?
- On it.
[ALARM BEEPING, BLARING]
No air.
Barely seeing an arterial trace.
He's bradying down.
Cardiac arrest is imminent.
Push a milligram of atropine now.
Advancing further. Balloon down.
♪
Come on.
[ALARM STOPS] Got air.
BP, heart rate.
Pulmonary air embolism
successfully addressed.
Audrey?
- Thank you.
- You're welcome.
Poor Harris.
He works so hard to stay well.
It's a rough illness.
I wish more people saw it that way
and not as some kind of failing.
Your husband's one of the
rare ones who understands.
He was always so good to our son.
There was a time that Harris
had to be hospitalized.
Michael was so scared and upset,
and Mr. Ben really
helped him through it.
Made him see that people can
get sick in different ways.
And that his daddy was gonna be okay.
He will be, Audrey.
He will be.
That was nice
what she said about Ben.
Yeah, to tell you the truth, Doris,
I really don't wanna hear about Ben.
Okay.
Hey, Doris, what's happening
with the hamster?
No one wants it.
I called animal control.
Dean, I saw tomorrow's
surgical schedule.
Looks like you're getting
that transplant.
Yeah.
Dr. Charles.
Judith's CT showed an acute
subdural hematoma.
Her doctor has her on blood thinners,
so it could get worse.
- So she needs surgery?
- Yeah.
Thing is, she's refusing treatment.
Says she wants to die.
She's suicidal.
We could hold her?
Uh, we could.
But let me, um,
let me have a chat first.
Yeah.
Judith, I'm Dr. Charles.
We, uh, we met earlier today.
I don't know if you remember that.
I am being told that you don't want us
to treat your hematoma.
It's just important for me
that I know that you understand
that, if left untreated,
that it could kill you.
I don't deserve to live.
[CRYING]
Okay.
Can I ask you a question?
If somebody that you knew
and that you cared about
were in exactly the same situation,
is that what you'd say to them?
Would you say that
they didn't deserve to live?
I mean, I I don't think so.
I mean, you wouldn't, would you?
What you'd say to them, probably, is
"It wasn't your fault."
But this was my fault.
I hit the brakes, and the car
just started spinning,
and I crashed first,
and then all of the other cars
started to crash behind me.
If it hadn't been for me,
none of this would have happened.
You hit some black ice.
It was an accident.
You didn't hurt all
those people on purpose.
[APPREHENSIVE MUSIC]
One of the hardest moments in life
is when we figure out
how little control we actually have
over the things
that happen to us, right?
But but what we can control
is how we respond to them.
And I just know that with a little time,
clarity will come, you know?
And maybe, just maybe, you might even
get around to doing
one of the hardest things
that a human being can learn
how to do, which is
to forgive yourself.
But if you don't
let us help you, there's just no chance
that that's gonna happen.
♪
So would you let us help you?
Okay.
Okay, Brice, squeeze my hands for me.
Good. Good.
Can you wiggle your feet back and forth?
Okay, now stick your tongue
straight out.
Even the hypoglossal's working well.
I think your son's gonna be fine.
- Thank you.
- Okay.
Thank you.
We'll give you some time with your boy.
You're gonna be okay, okay?
[SOFT SENTIMENTAL MUSIC]
Did you hear? Ivy was an organ donor.
Oh?
Yeah. Dr. Archer had her typed.
Turns out she's a match
for a little girl here
who needs a kidney.
Archer?
No, I hadn't heard.
Just thought it might
make you feel a little better.
♪
Mags, grab your coat, and
I will walk you to your car.
[CHUCKLES] No.
Janine's running a couple hours late,
and I said that I'd cover
for her until she gets here.
No. You've been working nonstop all day.
- Have somebody else cover.
- That's okay. I don't mind.
No. You need to go home to Ben.
He's probably wondering
where his wife is.
Ben's just fine.
Mm, if I had a guy like
Ben waiting for me
Just stop.
[QUIETLY] Stop, okay?
Stop.
Everybody keeps on talking
about my wonderful Ben.
Well, my wonderful husband
wants a divorce.
No.
♪
Mitch.
If this is about Mr. Shorr,
he is rational again.
Back on his full panoply of meds.
We still need to address his
metabolic issues, and soon.
Of course.
But, um, you know,
what I really came up here
to tell you is how impressed I am
with how you turned your life around.
You know, truly. I mean, you've done
you've done so well.
Better than you expected?
Well, I mean, you had a lot to overcome.
Yeah.
Top of the list, maybe county juvenile.
My psych care, remember?
Haldol, Zyprexa
the whole candy store.
I do. I remember.
I remember that you were violent,
and you were aggressive.
It was a big place, a lot of kids.
You know, we had to protect them.
Chemical restraints.
They worked.
I couldn't move, couldn't sleep.
Couldn't pee, either.
It's fun times.
Look, we know a whole lot
more about those meds now
than we did then.
You know, we've gotten
much better at dosing.
I mean, frankly, you probably
were overmedicated.
You were.
And then you booked.
I booked?
You took off. You left.
Well, I mean, I imagine
that's because I had a
that my my rotation was probably
Okay.
[SOFT TENSE MUSIC]
♪