Chicago Med (2015) s09e11 Episode Script
I Think There Is Something You're Not Telling Me
1
Pavel's suing you for malpractice.
Guy's a frickin' menace!
Never been one to
walk away from a fight.
[DRAMATIC MUSIC]
Maggie, I need you to brace yourself.
Oh, my God!
You're bleeding into your chest.
You know, I kept waiting
for this right moment to ask you out.
I shouldn't have waited.
Sully has lung cancer,
but he's refusing further testing.
Why won't he listen to me?
Maybe he's just looking for his friend.
If you need anything, I got you.
Wow. Oh, my goodness.
Look at you.
Never would've pictured
you being a chubby baby.
- Okay. Don't make fun.
- I'm not.
It's just it's an observation.
Well, what about you?
Let's see baby Ripley.
Ooh. Uh. [FLUTTERS LIPS]
I think I think those photos
all got lost in the, uh,
Great Chicago Fire of 1871.
- Oh. Pity.
- Yeah.
Well, uh, what about you as a kid?
Same sad story.
- Dr. Ripley. A word?
- Yeah.
Your sparring partner, Sully? He's back.
Do you want me to call security?
Uh, no need.
I got this.
- Excuse me.
- Yeah.
Thank God you're here.
That nurse was giving me the side-eye.
Can you blame her after
what happened last time?
Hey, you you were
no Boy Scout, either.
So what's going on?
You, uh, back to get
your lungs checked out?
Dude, chill.
Lynne?
No way.
- [LAUGHS]
- You gotta be kidding me.
Well, I know my belly got big,
but I'd like to think my
face hasn't changed too much.
20 years hasn't changed you at all.
God, you look the same too.
[COUGHS]
Oh, no, don't tell me
Yep. Yeah, I know.
Come on. Get it all out of your system.
I had such high hopes for you.
You got straight A's all
the way through high school
just to wind up with the loser
from the back of the class?
Mm-hmm.
Well, it took him a while,
but he finally wore me down.
Yeah, well, Sully always
did have a crush on you.
Oh, save it.
But enough about me.
I told Lynne how we ran into each other
at a bar a few weeks back.
Grabbed a drink.
That's right. We we
caught that Bulls game.
So what seems to be the issue?
She's in pain.
I've I've been
experiencing some cramping.
My OB's out of town
for the next few weeks,
and Sully said you worked here.
So I hope that's not a problem.
Not at all. I'm glad you came.
Uh, follow me.
[SOFT MUSIC]
Thank you for the coffee.
- How much do I owe you?
- It's on me.
Least I can do, seeing
as you saved my life.
Ooh, well, if you're gonna
be paying me in coffee,
- it's gonna take a while.
- That's true.
Mm.
So that was quite the
experience in the woods.
Yeah.
Anything you wanna talk about?
No.
You?
No.
Maybe not.
It's good to see you
back on your feet, though.
Yeah, those days off
actually did me some good.
Gave me a chance to brush
up for the trauma fellowship.
You were supposed to be taking a break.
I know, but I'm a restless soul.
- What can I say?
- [TIRES SCREECHING]
- [LOUD CRASH]
- Oh, my God.
[HORN BEEPING]
I'll call 911.
Yeah.
Hey.
[TENSE MUSIC]
- You okay?
- Help me, please.
You're gonna be okay. My
name is Loren. I'm a doctor.
We're gonna get you
out of here, all right?
Hi, I need a bus on the corner of
[GRUNTS]
Could you unlock your doors?
Hey, I need you to stay with me.
Stay with me.
CFD is on their way.
ETA five minutes out.
Yeah, I don't know if we
have that kind of time.
- She's losing consciousness?
- Yeah, she looks shocky.
You know, must've hit her
head, or she's bleeding out.
[CREAKING] But either way
We gotta get her out of there.
- Okay, ma'am?
- Ma'am?
- Look at us!
- Ma'am!
Hey, stay with us, okay?
Right here. Stay with us.
♪
Okay, she's barely holding on.
Here. Look at me, ma'am. Look at me.
I need you to stay
with me. Stay with me.
Keep your eyes open.
Do not go to sleep!
Do not close your eyes!
Hey, if you can hear me,
I need you to look away.
Ma'am, lean over here.
Lean towards the window.
Lean over.
[TENSE MUSIC]
[GRUNTS]
You got it?
[GRUNTING]
- Hey, can you hear me?
- I can't feel my legs.
[METAL GROANING]
- Anything else hurt?
- [DEBRIS CLANGING]
Look, we're running out of time.
Well, we can't move her,
not without a backboard.
Pulse is thready. Look,
just keep her talking.
[SIRENS WAILING]
- Can you tell me your name?
- Whitney.
- Whitney Poole.
- Hi, Whitney.
I'm Maggie Lockwood.
I'm a nurse.
We're gonna help you, okay?
Nothing's obstructing her legs.
[GROANS] Am I gonna die?
No. No. Okay, just focus on me.
- Right here.
- Court!
Maggie, what do we got?
Whitney Poole, restrained
MVC, no sensation in her legs.
Copy. Let's get her on the board.
Whitney, I'm gonna
lower your seat, okay?
All right, on my count.
[GRUNTS] One, two, three.
[WHIMPERS]
Okay. There you go.
Just gonna slide this here.
There you go.
Collar's on.
[GRUNTS]
I got her head. I got her head.
- [GRUNTS]
- You're doing great, Whitney.
We'll see you at the hospital.
Let's get out of here.
[DEBRIS CLANGING]
[BOTH BREATHING HEAVILY]
- Okay, enough. Enough already.
- Sit back
- Just trying to make you
- Go sit over there.
Trying to make you comfortable.
No, you're trying to
show off in front of Rip
and this beautiful doctor.
- Oh. [LAUGHS]
- This is Dr. Asher,
and she's a great OB.
It's very nice to meet you, Lynne.
So I hear you're experiencing cramping?
Yeah, and a little burning
when I use the bathroom.
Okay, well, how many
weeks along are you?
And are there any complications
I should know about?
I am 29 weeks, and I got that thing
where they sew your cervix
shut so the baby stays in.
A cerclage.
Cerclage, yeah.
I had that a few months ago.
Was pretty painful.
[COUGHING]
I would love to inspect
your cervix and the cerclage,
if that's okay?
Yeah. Yeah.
You know, the real pain has been
trying to get my boyfriend to
take me to these appointments.
Hey, your OB is the one who's been MIA,
so I made something out of nothing.
I'm your man.
Oh, yeah, apple of my eye.
And don't get me started on that cough.
It's just a cold.
It'll clear up. Tell her, Rip.
You're on your own, pal.
I know better than to
get on Lynne's bad side.
I will be outside.
No, no, no, stay.
Just keep on this side of the curtain.
Okay.
All right, Lynne, you're going to feel
a little bit of pressure.
Okay.
So the cerclage is intact.
The cervix is closed.
You're not having
contractions on the monitor.
Okay, my guess is, you
are experiencing a UTI.
So I'd like to order
some labs just to confirm,
and we'll get you started on
antibiotics if that's the case.
Shouldn't take too long.
Thank you, Dr. Asher.
Mm-hmm.
You are the best, Doc.
Don't mention it. [LAUGHS]
- We'll be back.
- Thanks.
Well, that was fun to meet
some people from your past.
You three haven't skipped a beat.
Yeah. Yeah, it's been 20 years.
And you guys must
have some crazy stories
from back in the day.
Uh, it was a pretty normal childhood.
Nothing too crazy.
I should, uh yeah.
Ready? One, two, three.
[SUSPENSEFUL MUSIC]
Dr. Johnson and Maggie
are right behind us.
They assisted in the extrication.
Thanks.
My legs.
You're doing great.
Need X-ray in here!
You're the new med student, yeah?
Uh, yes. Naomi Howard.
BP's soft. 87/58. Rate's 122.
All right, give her 2 and
2 on the rapid transfuser.
It's on its way. Hey, Kayla!
Mike.
Chest and pelvis.
Come on, Howard. In or out.
It it's my first day.
I didn't know where I should go.
Sats are dropping. 85.
- We need to intubate her.
- Yeah.
- I'm on it.
- Oh! So sorry.
Hey, Whitney. It's Loren. Remember?
We're gonna give you
something to put you to sleep,
insert a tube to help you breathe.
Too late, kid.
- But I just
- You're out.
♪
Come on. What's happening here?
Okay, I'm in.
Let's bag her.
X-ray. Clear.
[DEVICE BEEPS]
[EXHALES] Yeah, multiple rib fractures.
Sats are coming up. At 94.
Mike, get the pelvis
too. We get a FAST yet?
Yeah, that's next on the agenda.
- Doris, please?
- X-ray. Clear.
[DEVICE BEEPS]
Pelvis looks good too.
♪
All right, negative FAST.
No free fluid.
BP's transiently improving.
Too unstable for a CT, but
let's keep transfusing her.
At least we can spare
her the OR for now.
I do appreciate the validation.
I got this.
[EXHALES]
It's almost like seems
like everywhere we go,
calamity follows.
Yeah, at least no one can
accuse us of being boring.
Dr. Johnson, a minute, please.
I understand you applied
to our trauma fellowship?
Yes, sir.
Okay, well, give me the Cliff
Notes of your experience.
Um, med school and gen
surgery residency at Emory.
Before that, eight years 67J
aeromedical evacuation officer.
Two tours, Iraq and Afghanistan.
So why trauma?
You looking for adrenaline?
Well, I'd be lying if I said I wasn't.
I mean, I love the ED, the energy.
Something new every day.
All right, well, then
today's your interview.
And Whitney is your
patient, door to discharge.
That is, assuming you're all healed up
from last week's adventure?
Ready to serve.
All right.
Get changed.
This deposition is under oath.
So please, just tell the truth.
When you respond, don't talk too fast.
And by all means, remain
polite and professional,
even if Pawel's lawyer isn't.
Don't fall for the bait. Got it.
And remember, Dr. Ripley,
we are completely behind you
during this process.
Med will bear the brunt of this lawsuit.
Yes, it never falls on employees.
Just the institution.
Good to know.
And, uh, speaking of suits,
wouldn't hurt you to wear one.
First impressions matter.
I got one in my locker.
Well, I better get back to work.
Excuse me.
Student Doctor Howard?
- Uh, Naomi.
- Yes, Naomi.
I'm Maggie Lockwood, charge nurse.
I'm sorry about earlier.
- I should've jumped in.
- No, no, no. You're fine.
How about we ease you into something?
Okay.
Come on.
[CLEARS THROAT]
How long is this gonna take?
- I wanna get out of here.
- Not long.
Likely a sprain, but we will need X-rays
before we splint it.
Why don't you lean back, Jay?
Uh, no, no, no. I'm good.
It's my ankle that's the problem.
This is just a precaution, Jay.
Standard procedure.
So how did this happen?
I fell off the ladder in my studio.
Probably 'cause I haven't
been sleeping much.
I'm sorry to hear that.
I'm just trying to get
these pieces done, you know?
I'm in the groove. I
don't wanna waste it.
You're an artist? That's cool.
Yeah, I've just been
painting since I was a kid.
Ms. Howard, don't you think
we should hang some fluids?
Uh, right.
Uh, Jay, we're going to
give you a liter of fluid
to make sure you don't get dehydrated.
- [SIGHS]
- And some blood work.
Mm-hmm.
I really gotta get back to work.
You got a pen and paper?
Might as well sketch
while I'm stuck in here.
No problem.
Give us a minute, okay?
Okay.
Okay.
Thoughts?
Whoa.
I'm thinking the ankle
isn't his main problem.
Mm-hmm.
I mean, this is an unusual presentation
for someone who's just drunk, right?
Mm-hmm.
Do you think he could be on
something other than alcohol?
Maybe an amphetamine?
Possibly.
Why don't you add a tox
screen to the blood work?
And just to cover our bases,
let's page Dr. Charles.
- Okay.
- Good job.
[COUGHING]
[SOFT TENSE MUSIC]
Hey.
Sully.
- Hey, I was just
- Stop.
I've already said what I needed
to say about your smoking.
How you doing?
- You good?
- Yeah.
If you're really not
gonna treat your cancer,
you gotta let Lynne know
what's going on, man.
She's got enough on her
plate with the pregnancy.
I don't wanna give her
anything else to worry about.
Come on.
You and I both know
you're not telling her
'cause she's gonna force
you to get treatment.
Look, I'm handling it, okay?
Just keep this to yourself.
♪
Jay, this is Dr. Charles.
Jay, how are you doing?
You, uh you drawing something?
Still working it out.
Look, I don't need a psychiatrist.
Okay.
You're just gonna tell
me what I already know,
that I have depression.
So you've had a formal diagnosis?
Yeah. Six eight months ago.
Okay, and were you prescribed anything?
They put me on an SSRI.
Fluoxe something.
- Fluoxetine, right?
- Yeah.
- Yep.
- And it works.
It works great.
Oh, good. I'm glad to hear that.
Listen, Dr. Charles, I
gotta get out of here, okay?
I'm just starting to gel as an artist,
and people are starting
to finally notice.
I mean, this is a big week in my career.
I've got a meeting with
a very important gallery.
They wanna lock down a show.
So just tell me what I
gotta do to get out of here.
Okay? What do I gotta sign?
I hear you.
Only thing I need is
an X-ray of that ankle
to make sure it's not broken.
Once we get that, you're on your way.
So why don't I get that rolling?
And, um and I'll check back with you.
Yeah, okay.
I'm sorry.
He didn't report his depression earlier.
- Should I have asked?
- Oh, don't worry about it.
Would have been very difficult to spot
given the state that he's in.
Jay's test results are in.
And we also contacted his father.
Should be here in 30.
Huh.
Blood alcohol, 0.04.
I mean, that's, you know,
technically impaired,
but nothing extreme.
Mixing alcohol with his meds
should have a sedating effect.
- Correct.
- Not the opposite.
And his tox screen is clear.
No cocaine.
No amphetamines.
I don't get it.
Can't really say his behavior is in line
- with a depressive disorder.
- Yeah.
Pretty sure that depression
is not the only thing
we're looking at here.
Mags, page me when Dad gets here.
Yes, of course.
Howard, with me.
Hey, good luck with the deposition.
Let me know how it goes.
Yeah. Sure thing.
Hey, Lynne?
So I can confirm that it is a UTI.
I've called in some Macrobid for you.
You'll take that twice daily
with meals till it runs out.
Nothing too taxing for you or Sully.
Oh, yeah.
Last thing I'd want is to make
anything too taxing for him.
Yeah, some guys can shy away
from this kind of
stuff in the beginning.
He's probably just nervous.
Yeah, maybe.
But Sully is so tight-lipped.
And Rip. Just like the old neighborhood.
Can never let 'em see weakness.
Mitch doesn't ever really
talk about where he's from.
Yeah, him and Sully went
through a lot growing up.
Really? What do you mean?
It's probably not my place.
But I am really proud of Rip.
Yeah, he's overcome a lot.
[DEVICE BEEPS]
Thanks, Mike.
Hey, Mike.
You X-rayed yourself?
Look, Archer's pulled
me in for trauma today,
so I just, you know, wanted
to give myself a once-over.
Loren, I've been where you are.
So has Dr. Archer.
He'll understand if you're not ready
for trauma services just yet.
Look, I have flown through
rougher skies than this.
Oh, remind me how the last flight went?
Look, Archer called my number.
I just I wanna deliver.
- Yeah.
- Johnson, let's get moving.
[CLEARS THROAT]
- I'm good.
- Mm-hmm.
So where are we at?
Well, I just gave Whitney
another 2 of blood and plasma.
Base deficit's 11.
Mile marker one.
Excuse me?
Trauma is all about
knowing your mile markers,
all right, when to resuscitate or go
to surgery, when to keep stitching
or to pack and bail out.
Whitney's had all that volume,
but she's still got an oxygen
debt and is hypotensive.
So what's that tell you?
That she's probably
still bleeding somewhere.
BP's back to the 80s, and she's tachy.
Okay.
[SUSPENSEFUL MUSIC]
FAST is still negative.
I don't get it.
Her X-rays are okay.
She's not bleeding into her belly.
But vitals say she's shocky.
Well, don't discount the
retroperitoneal structures,
but it could be something else.
Well, her skin's flush, warm.
Neurogenic shock. Her cord injury.
A loss of vascular tone
dropped her pressure.
Just like an active bleed would.
Now you're thinking
like a trauma surgeon.
You know, I should have seen it.
She wasn't moving her legs at the scene.
Shock's always hemorrhagic
until proven otherwise,
and we just proved otherwise.
Start her on neo, get her MAP to 65,
and we gotta get her to CT stat.
[GROANS]
Mr. Keene?
I'm Dr. Charles. This is Ms. Howard.
She's a student doctor who helped
with Jay's intake this morning.
How's he doing?
He's stable, resting
comfortably just inside there.
We'd like to have a little chat with you
before we take you to see him,
though, if that's all right.
Do you mind if we sit?
Okay.
Psychiatry?
Is this about his depression?
His drinking?
Is that something he's been
struggling with for a while,
- his drinking?
- No.
It started a few months
ago, not long after
he was diagnosed with depression.
Is there any family history
of substance abuse or mental illness?
No not on my side or his
mother's, as far as I know.
We're divorced.
After he was diagnosed and
he started taking his meds,
right, did you notice any
any changes in his behavior?
I mean, other than the drinking.
At first, the meds were a godsend,
helped him focus, be productive,
like it brought him back to life.
But then it was as if the
dial got turned up to 11.
How do you mean?
He'd stay up all night
working, call me at all hours,
sleeping only when he drank
enough to knock himself out.
I tried getting him to quit,
but he wouldn't listen to me.
Yeah.
I'm at a loss.
These details are actually very helpful.
And I think I know what's
going on with your son.
Hey. Hey! Something's happening in here.
I think her water just broke.
Um
♪
Okay, I'd like to check you out again.
Okay. Okay.
This isn't supposed
to be happening, right?
No, no, no. It's too early.
I can't I can't deliver the baby.
- It's too early.
- You're okay.
- You're gonna be okay.
- Take a deep breath for me, all right?
[BREATHES DEEPLY]
All right, I'm seeing excess fluid.
Nitrazine swab?
What's she doing?
It's a test to indicate if
Lynne's water has broken.
Okay, test is positive.
No, no, no. I'm only 29 weeks.
That's why I'd like to do an
ultrasound, just to be sure.
Mitch?
Okay.
[INHALES SHARPLY]
What? What's wrong?
The ultrasound is showing normal levels
of amniotic fluid, which
is surprising to see
if your water ruptured.
So what is all this?
Could be discharge from your cerclage.
But we'll need to do a different
swab, an AmniSure, to confirm.
All these swabs and tests [COUGHING]
Hey, you okay?
I got him. Let's step outside.
Okay. Okay, take a seat.
Just try to just try to breathe
through your nose, okay?
Breathe through your nose, okay?
[COUGHING]
[CLEARS THROAT]
- Well, that's not good.
- Okay.
Okay, let's get you into bed, Sully.
- [GROANS]
- Hey.
Hey, hey. Hey, Sully?
Okay. Okay.
Come on.
Sully? Sully, stay with me, okay?
I need a hand in here!
Sully.
Sully, you with me?
♪
Hey, bud.
Where's Lynne? Is she
okay? She's in labor?
- She's fine.
- [EXHALES]
I'm more worried about you.
Got an X-ray while you were out.
All that coughing has torn
the lining of your throat.
We gotta get you upstairs so
pulmonary can get a look at.
[EXHALES] If they can
stop the pain, let's do it.
- [GROANS]
- Yeah. Okay.
[COUGHING]
We'll talk about how to
knock it off my bill later.
Right, bud?
Hey.
What happened with him?
Uh
Uh, significant lesion on the lungs.
Do you think it's cancerous?
Pretty certain.
I tried to get him worked
up and into treatment
a few weeks back, and let's
just say it didn't go well.
[EXHALES] I'm surprised
Lynne didn't mention anything.
Wait. She doesn't know?
Sully doesn't wanna say anything.
I I told him to tell
her, but he kept dodging,
so I I backed off.
So let me get this straight.
He's your old friend,
but you can't sit down
and have an honest
conversation with him?
Hannah, what else can
I do? He's my patient.
I have to honor his wishes.
Look, I gotta get him upstairs.
Yeah. Go.
[MACHINE WHIRRING]
Right there.
It's a burst fracture at the T3
and a cord hematoma ascending to T11.
That's what dropped her pressure.
You're missing the main attraction.
Check out the left kidney.
Grade 3 renal lac and a pneumatosis
around the abutting colon.
That'd be another mile marker.
Better get her to the OR.
Yep.
[GROANS SOFTLY]
What are you saying? I'm not depressed?
I think there's a really good
chance that you're suffering
from bipolar disorder.
Isn't that the same thing?
It's not.
Bipolar is a mood disorder
that makes people vulnerable
to extreme swings in mood,
cycling between depressive
states and manic states.
Manic?
What does that even mean?
Well, the beginning of a manic state
is characterized by intense
energy, confidence, creativity.
Problem is, they're
invariably accompanied, also,
by severely impaired judgment,
which can even evolve into delusion.
And that's when they
become really dangerous.
So you're saying my doctor got it wrong.
I think that what happened is
that your doctor diagnosed you
when you were in a manic state
and thought that that was just
the extent of the problem.
So, uh, what?
My meds, the fluoxetine, they
don't they don't do anything?
Quite the opposite, right?
The problem with SSRIs is
when they are misprescribed
to a patient with
bipolar, they can induce,
enhance, increase the
frequency of manic episodes.
Yeah, Dr. Charles was telling
me it's not uncommon for people
to self-medicate with alcohol.
I told you, it was just
to take the edge off.
I understand it feels
like a short-term fix.
The problem is, alcohol exacerbates
not only manic episodes but
depressive states as well.
Son, listen.
Dr. Charles says this is treatable.
By doing what?
Well, what we do is, we would slowly
titrate you off your SSRI
and switch you onto a mood stabilizer.
Well, then what about my art?
What do you mean?
I'm actually selling now.
Whatever's going on
with me, it's working.
I won't let you take that away from me.
Jay, your health is what's
important, not the art.
Of course you'd say that!
Because you didn't
support me as an artist.
That's not fair.
I only wanted what's best for you.
No, you wanted what you thought was best
because you didn't think I'd succeed!
Jay, look at me. Look at me.
We're gonna figure this out.
You've been given a lot of information.
I'm gonna give you time to process it.
I don't need to process.
I don't need other drugs.
I just need to leave.
I hear you.
And I sincerely apologize for
how backed up ortho is today.
- Just tell them to hurry up.
- Okay.
Well, let me go see if I can
shake somebody loose, okay?
In the meantime, I want you to
try and stay calm, all right?
Oh, my God.
You know, I would really encourage you
to try not to take anything you
heard in there too personally.
You know, he's still
in a manic state, and
But he's right.
I never really supported
him as an artist.
I'm an actuary, a numbers guy.
But art, I thought it was
a reckless career choice.
I tried talking him out of it, but
what if he's putting himself
through all this misery
just to prove me wrong?
[APPREHENSIVE MUSIC]
Is it my fault?
Mr. Keene, your son has a disease,
and that is absolutely not your fault.
I should call his mother,
let her know what's going on.
I can give ortho a call.
Okay. But you know what?
Don't rush it.
I wanna give Jay a little
time to maybe cool down a bit
before I have another chat with him.
Okay.
Um, okay, but, um, how are
you gonna get him to comply?
Honestly, I don't know yet.
Okay.
Did you pull in this specific direction
when you reduced Mr.
Wapniarski's shoulder?
Yes.
Exactly like that picture.
And how many shoulder reductions
have you actually done, Dr. Ripley?
Uh, too many to remember.
Can you give us a ballpark figure?
Hundreds.
Without any issues.
Dr. Ripley, where were you born?
Chicago.
I see you graduated from
Columbia on a full ride.
That's very impressive.
I did notice, however, a
huge gap in your education.
Your last two years of high
school are unaccounted for.
And no record to explain the absence.
So?
Well, in my experience, Dr. Ripley,
a complete lack of educational records
typically only leads down a few roads
one of those being incarceration
and the other, institutionalization.
Given that both of your parents
were out of the picture
Objection.
I'm not hearing a
question here, counselor.
None of this has any
relevance to the case.
I'll move on.
[TRASH CAN CLATTERING]
♪
Heard the, uh,
deposition was a little rocky.
It was fine.
It was, um the lawyer
The lawyer started getting personal.
Personal? How do you mean?
Trying to use my past against me.
I'm sorry to hear that.
Look, forget it.
I'm I'm I'm actually good.
Look, I know you know exactly
what you're doing here, but
I don't know maybe, um
maybe settling isn't the
worst idea in the world.
Listen, I'm [LAUGHS]
[SNIFFS]
I'm not gonna let some
shyster lawyer get in my head.
I'm good.
♪
All right, what's the game plan?
Get eyes on the left colon,
take down the flexure,
and decide if the kidney stays or goes.
Scissors.
[BREATHES SHARPLY]
[CLEARS THROAT]
Ribs are holding up?
Yeah, I'm good.
You know, the colon's avulsed
with a big mesentery gap.
Doesn't look salvageable.
But the kidney is okay.
Hemostatic. Hey, Marty, what's our temp?
35.5 Celsius.
Well, then quit chatting.
Get that colon resected.
[SOFT TENSE MUSIC]
Well, I've seen worse depositions.
Well, it sounds like
the plaintiff's attorney
is going for character assassination.
[KNOCK AT DOOR]
Yeah?
- Daniel?
- I'm sorry to interrupt.
Sharon, can I just grab
you for a quick sidebar?
Sure.
Peter, give us a minute?
Of course. I got some calls to roll.
- Thank you, Peter.
- Sure.
What's going on?
I was wondering if you wouldn't mind
talking to Dr. Ripley
about settling the lawsuit.
Why? What's changed?
Well, I'm the one, you know,
who brought Pawel in
here in the first place,
asked Mitch to look at him.
I kind of feel responsible
the way the whole thing's shaken out.
Well, you know it's not
your fault, right, Daniel?
I mean, Pawel was going
to sue the next hospital
he walked into, even
if he stubbed his toe.
But what I do have to
ask is, why is it you
bringing this to me and not Dr. Ripley?
It's complicated between us,
and I'd rather not go into it.
Complicated?
Look, here's what I
know about Mitch, okay?
At his core, he's a fighter.
And the thing about fighters is that
they don't always
know when to back down.
I actually think it's
the best idea if you just
make the decision for him.
Okay.
But why do I sense
there's more to this story?
Where's Sully? Is he okay?
Uh, Dr. Ripley's
taking good care of him.
But I want to talk next steps for you.
So the AmniSure swab came back negative,
but because I'm still
seeing excess fluid,
I want to do an even more
conclusive test to confirm
that your water's not broken.
Well, if this test is conclusive,
why didn't we do it in the first place?
Because unfortunately,
it is more invasive.
I'll need to inject blue
dye into the amniotic fluid
- around your baby may I?
- Yeah.
While you wear a tampon.
Now, if your membrane is still intact,
then the fluid can't pass through,
and the tampon does not change color.
But if your water is broken,
then the dye will pass through
and change the tampon blue.
Are you really not gonna
tell me anything about Sully?
It is more serious
than a cold, isn't it?
I can't share his private
health information.
Well, he's the father of my child!
I know.
I knew that he was
hiding something from me.
Every time I told him to
get this cold checked out,
he just brushed me off, and I knew it.
Why can't a man ever
just be straight with you?
How long? How long?
I promise you, ortho is on the way.
That's what you said 20 minutes ago!
- Jay, please.
- No, I'm out of here.
No, please. Just give me,
like, five more minutes.
- Stop. I'm done! I'm leaving.
- Just five.
- [GROANS]
- So you can get back to work?
I gotta keep grinding,
keep pushing through.
Yeah, see, that's what worries me.
What do you know about
art? This is my process!
Yeah, well, your process landed
you right here in the hospital.
I mean, how long do you
think you can keep this up?
As long as I have to,
until I get a gallery,
until I prove to my
dad that I can do this.
I mean, look at look at history.
All the great artists, they
suffered for their work.
Look, this idea that
great art can only be born
from emotional chaos and
misery, it's just not true.
People like Renoir, Vermeer, Hockney
by all accounts just, you know,
relatively well-adjusted people
whose names we know because
they were really talented
- and they worked really hard.
- What about Van Gogh?
Van Gogh was a brilliant
painter, right, who, um,
by all accounts, sadly,
very likely suffered from
bipolar disorder well
before it was understood,
self-medicated with alcohol
until it didn't work anymore,
and blew his head off
when he was 37 years old.
Look, I really get how scary
this idea of changing up
your meds is right now to you.
But you gotta trust me, man.
It's, like, these these SSRIs,
they're not what's gonna
make you a successful artist.
It's your talent.
And I'm just really worried
that if you don't make this change,
you're not going to
be around to share it.
[TENSE MUSIC]
Kidney just started bleeding heavily.
Lac's bigger than the CT showed.
Damn it. Kidney's gotta go now.
Hey, Marty, where are we at?
Given six units and
she's maxed on pressors.
Temp is down to 34.5.
We're in damage control now.
Let's get this kidney out.
I'm on it. [GROANS]
If you need me to step in
Almost got it.
Don't have time for almost.
Metz.
- [GROANS]
- Come on.
Get a tie on it. Let's go.
[GRUNTING]
- Hey.
- Hey.
Okay, now you're taking this
pretty boy thing too far.
[LAUGHTER]
Yeah, not my usual threads.
I had to give a deposition.
- Yeah?
- Yeah.
Some some guy trying to sue me
to make a quick buck
off of the hospital.
Sue you?
You want me to straighten him out?
Nothing a phone call won't solve.
Dude, chill.
It's not that deep.
Besides, you can't be
doing anything stupid.
You're about to be a dad, remember?
[APPREHENSIVE MUSIC]
So how long do you plan to avoid Lynne?
[SIGHS]
Rip, I'm serious, not with this again.
Look where you are right now, man.
How the hell do you plan
on explaining this to her?
♪
You remember my old man?
When he went off to the pen,
it was the happiest day of my life.
All his drinking and staying out late.
Now look at me.
Maybe Lynne and the kid
would be better off
- Stop.
- [LAUGHS] Without me.
You are so much better than your dad.
Hell, both of ours.
You're here, aren't you?
So what?
I get a gold star for attendance?
What's wrong with that?
I know you wanna be
there for your kid too.
That's why.
That's why you gotta get treatment.
♪
I don't know, but it sounds to me
like Jay could be open to
changing his medications.
- Really?
- Mm-hmm.
Well, that's encouraging.
Honestly, I can kind of relate to him,
not wanting to let your parents down.
Huh.
Well, I'm I'm sure a
lot of people feel that way.
I think you're probably
right about that.
Glad to see Lynne's doing better.
Yeah.
It turns out her water
didn't break after all.
The excess fluid was from the cerclage,
and baby and mom are doing fine.
That's great to hear.
Mm-hmm.
Looks like he told her about the cancer.
He did.
[GENTLE MUSIC]
You know, Lynne told me a
few things about you too.
- Oh, yeah?
- Mm-hmm.
Like what?
Well, mainly that you had
questionable hair as a kid.
[LAUGHTER]
Hopefully, one day, you'll
tell me a little more.
♪
I gotta get Sully up to oncology.
Hey, um
thank you for today.
No problem, Rip.
[LAUGHS]
♪
[SIGHS]
Oh, hey.
I just saw Whitney.
She's got sensation
returning to both of her legs.
Cord injury is incomplete. That's good.
Yeah, we should be able
to close her up tomorrow,
and then neurosurgery
can work up her spine.
Mm-hmm.
Well, I'm gonna complete
Whitney's surgery tomorrow.
You're off the case.
Whatever happened to door to discharge?
All right, sit down.
Sit down before you keel over
in front of everybody, all right?
Okay.
I know I may have overdone
it just a little bit.
But I never put my patient at risk.
Oh, well, that's a comfort, yeah.
She's alive and stable.
I mean, that's the job, isn't it?
No the job is to be
there for your patient
throughout their care.
You're the first one
they see when you get here
and the last when they go home.
That's trauma.
You saw all of your
patient's mile markers,
but you ignored your
own, and because of that,
you can't be there for her tomorrow.
Okay, but I was just trying
to do right by Whitney.
All right, look, I've
been where you are.
Yeah, the same instincts, push through.
But this job, I mean, you
gotta know your limits.
All right, you're
you're a competent surgeon.
May even be a good one.
But you want back on my service,
you get those ribs plated.
[GRUNTS]
[BREATHING HEAVILY]
♪
I, uh
I heard that Sully got admitted.
He, uh he all right?
Yeah. Yeah.
He's, uh he's good.
He's stable.
I'm waiting for him to get out of
Dr. Washington's office, actually.
Oh, excellent. That's a relief.
Yeah.
So I just got done
talking with Ms. Goodwin.
Yeah?
She now seems to think that
the best option for everyone
is to settle the lawsuit
and not go to trial.
Huh.
Does she know about my past our past?
No, nothing.
But you said something to her,
didn't you, about settling?
♪
You didn't have to do that.
I would've fought this case.
I know.
I just think that your
history belongs to you.
You know, I mean, that
is your story to tell.
And if you ever decide
that you wanna do that,
I would just hope that it
would be on your own terms.
That's all.
♪
[DRAMATIC MUSIC]
♪
[WOLF HOWLS]
Pavel's suing you for malpractice.
Guy's a frickin' menace!
Never been one to
walk away from a fight.
[DRAMATIC MUSIC]
Maggie, I need you to brace yourself.
Oh, my God!
You're bleeding into your chest.
You know, I kept waiting
for this right moment to ask you out.
I shouldn't have waited.
Sully has lung cancer,
but he's refusing further testing.
Why won't he listen to me?
Maybe he's just looking for his friend.
If you need anything, I got you.
Wow. Oh, my goodness.
Look at you.
Never would've pictured
you being a chubby baby.
- Okay. Don't make fun.
- I'm not.
It's just it's an observation.
Well, what about you?
Let's see baby Ripley.
Ooh. Uh. [FLUTTERS LIPS]
I think I think those photos
all got lost in the, uh,
Great Chicago Fire of 1871.
- Oh. Pity.
- Yeah.
Well, uh, what about you as a kid?
Same sad story.
- Dr. Ripley. A word?
- Yeah.
Your sparring partner, Sully? He's back.
Do you want me to call security?
Uh, no need.
I got this.
- Excuse me.
- Yeah.
Thank God you're here.
That nurse was giving me the side-eye.
Can you blame her after
what happened last time?
Hey, you you were
no Boy Scout, either.
So what's going on?
You, uh, back to get
your lungs checked out?
Dude, chill.
Lynne?
No way.
- [LAUGHS]
- You gotta be kidding me.
Well, I know my belly got big,
but I'd like to think my
face hasn't changed too much.
20 years hasn't changed you at all.
God, you look the same too.
[COUGHS]
Oh, no, don't tell me
Yep. Yeah, I know.
Come on. Get it all out of your system.
I had such high hopes for you.
You got straight A's all
the way through high school
just to wind up with the loser
from the back of the class?
Mm-hmm.
Well, it took him a while,
but he finally wore me down.
Yeah, well, Sully always
did have a crush on you.
Oh, save it.
But enough about me.
I told Lynne how we ran into each other
at a bar a few weeks back.
Grabbed a drink.
That's right. We we
caught that Bulls game.
So what seems to be the issue?
She's in pain.
I've I've been
experiencing some cramping.
My OB's out of town
for the next few weeks,
and Sully said you worked here.
So I hope that's not a problem.
Not at all. I'm glad you came.
Uh, follow me.
[SOFT MUSIC]
Thank you for the coffee.
- How much do I owe you?
- It's on me.
Least I can do, seeing
as you saved my life.
Ooh, well, if you're gonna
be paying me in coffee,
- it's gonna take a while.
- That's true.
Mm.
So that was quite the
experience in the woods.
Yeah.
Anything you wanna talk about?
No.
You?
No.
Maybe not.
It's good to see you
back on your feet, though.
Yeah, those days off
actually did me some good.
Gave me a chance to brush
up for the trauma fellowship.
You were supposed to be taking a break.
I know, but I'm a restless soul.
- What can I say?
- [TIRES SCREECHING]
- [LOUD CRASH]
- Oh, my God.
[HORN BEEPING]
I'll call 911.
Yeah.
Hey.
[TENSE MUSIC]
- You okay?
- Help me, please.
You're gonna be okay. My
name is Loren. I'm a doctor.
We're gonna get you
out of here, all right?
Hi, I need a bus on the corner of
[GRUNTS]
Could you unlock your doors?
Hey, I need you to stay with me.
Stay with me.
CFD is on their way.
ETA five minutes out.
Yeah, I don't know if we
have that kind of time.
- She's losing consciousness?
- Yeah, she looks shocky.
You know, must've hit her
head, or she's bleeding out.
[CREAKING] But either way
We gotta get her out of there.
- Okay, ma'am?
- Ma'am?
- Look at us!
- Ma'am!
Hey, stay with us, okay?
Right here. Stay with us.
♪
Okay, she's barely holding on.
Here. Look at me, ma'am. Look at me.
I need you to stay
with me. Stay with me.
Keep your eyes open.
Do not go to sleep!
Do not close your eyes!
Hey, if you can hear me,
I need you to look away.
Ma'am, lean over here.
Lean towards the window.
Lean over.
[TENSE MUSIC]
[GRUNTS]
You got it?
[GRUNTING]
- Hey, can you hear me?
- I can't feel my legs.
[METAL GROANING]
- Anything else hurt?
- [DEBRIS CLANGING]
Look, we're running out of time.
Well, we can't move her,
not without a backboard.
Pulse is thready. Look,
just keep her talking.
[SIRENS WAILING]
- Can you tell me your name?
- Whitney.
- Whitney Poole.
- Hi, Whitney.
I'm Maggie Lockwood.
I'm a nurse.
We're gonna help you, okay?
Nothing's obstructing her legs.
[GROANS] Am I gonna die?
No. No. Okay, just focus on me.
- Right here.
- Court!
Maggie, what do we got?
Whitney Poole, restrained
MVC, no sensation in her legs.
Copy. Let's get her on the board.
Whitney, I'm gonna
lower your seat, okay?
All right, on my count.
[GRUNTS] One, two, three.
[WHIMPERS]
Okay. There you go.
Just gonna slide this here.
There you go.
Collar's on.
[GRUNTS]
I got her head. I got her head.
- [GRUNTS]
- You're doing great, Whitney.
We'll see you at the hospital.
Let's get out of here.
[DEBRIS CLANGING]
[BOTH BREATHING HEAVILY]
- Okay, enough. Enough already.
- Sit back
- Just trying to make you
- Go sit over there.
Trying to make you comfortable.
No, you're trying to
show off in front of Rip
and this beautiful doctor.
- Oh. [LAUGHS]
- This is Dr. Asher,
and she's a great OB.
It's very nice to meet you, Lynne.
So I hear you're experiencing cramping?
Yeah, and a little burning
when I use the bathroom.
Okay, well, how many
weeks along are you?
And are there any complications
I should know about?
I am 29 weeks, and I got that thing
where they sew your cervix
shut so the baby stays in.
A cerclage.
Cerclage, yeah.
I had that a few months ago.
Was pretty painful.
[COUGHING]
I would love to inspect
your cervix and the cerclage,
if that's okay?
Yeah. Yeah.
You know, the real pain has been
trying to get my boyfriend to
take me to these appointments.
Hey, your OB is the one who's been MIA,
so I made something out of nothing.
I'm your man.
Oh, yeah, apple of my eye.
And don't get me started on that cough.
It's just a cold.
It'll clear up. Tell her, Rip.
You're on your own, pal.
I know better than to
get on Lynne's bad side.
I will be outside.
No, no, no, stay.
Just keep on this side of the curtain.
Okay.
All right, Lynne, you're going to feel
a little bit of pressure.
Okay.
So the cerclage is intact.
The cervix is closed.
You're not having
contractions on the monitor.
Okay, my guess is, you
are experiencing a UTI.
So I'd like to order
some labs just to confirm,
and we'll get you started on
antibiotics if that's the case.
Shouldn't take too long.
Thank you, Dr. Asher.
Mm-hmm.
You are the best, Doc.
Don't mention it. [LAUGHS]
- We'll be back.
- Thanks.
Well, that was fun to meet
some people from your past.
You three haven't skipped a beat.
Yeah. Yeah, it's been 20 years.
And you guys must
have some crazy stories
from back in the day.
Uh, it was a pretty normal childhood.
Nothing too crazy.
I should, uh yeah.
Ready? One, two, three.
[SUSPENSEFUL MUSIC]
Dr. Johnson and Maggie
are right behind us.
They assisted in the extrication.
Thanks.
My legs.
You're doing great.
Need X-ray in here!
You're the new med student, yeah?
Uh, yes. Naomi Howard.
BP's soft. 87/58. Rate's 122.
All right, give her 2 and
2 on the rapid transfuser.
It's on its way. Hey, Kayla!
Mike.
Chest and pelvis.
Come on, Howard. In or out.
It it's my first day.
I didn't know where I should go.
Sats are dropping. 85.
- We need to intubate her.
- Yeah.
- I'm on it.
- Oh! So sorry.
Hey, Whitney. It's Loren. Remember?
We're gonna give you
something to put you to sleep,
insert a tube to help you breathe.
Too late, kid.
- But I just
- You're out.
♪
Come on. What's happening here?
Okay, I'm in.
Let's bag her.
X-ray. Clear.
[DEVICE BEEPS]
[EXHALES] Yeah, multiple rib fractures.
Sats are coming up. At 94.
Mike, get the pelvis
too. We get a FAST yet?
Yeah, that's next on the agenda.
- Doris, please?
- X-ray. Clear.
[DEVICE BEEPS]
Pelvis looks good too.
♪
All right, negative FAST.
No free fluid.
BP's transiently improving.
Too unstable for a CT, but
let's keep transfusing her.
At least we can spare
her the OR for now.
I do appreciate the validation.
I got this.
[EXHALES]
It's almost like seems
like everywhere we go,
calamity follows.
Yeah, at least no one can
accuse us of being boring.
Dr. Johnson, a minute, please.
I understand you applied
to our trauma fellowship?
Yes, sir.
Okay, well, give me the Cliff
Notes of your experience.
Um, med school and gen
surgery residency at Emory.
Before that, eight years 67J
aeromedical evacuation officer.
Two tours, Iraq and Afghanistan.
So why trauma?
You looking for adrenaline?
Well, I'd be lying if I said I wasn't.
I mean, I love the ED, the energy.
Something new every day.
All right, well, then
today's your interview.
And Whitney is your
patient, door to discharge.
That is, assuming you're all healed up
from last week's adventure?
Ready to serve.
All right.
Get changed.
This deposition is under oath.
So please, just tell the truth.
When you respond, don't talk too fast.
And by all means, remain
polite and professional,
even if Pawel's lawyer isn't.
Don't fall for the bait. Got it.
And remember, Dr. Ripley,
we are completely behind you
during this process.
Med will bear the brunt of this lawsuit.
Yes, it never falls on employees.
Just the institution.
Good to know.
And, uh, speaking of suits,
wouldn't hurt you to wear one.
First impressions matter.
I got one in my locker.
Well, I better get back to work.
Excuse me.
Student Doctor Howard?
- Uh, Naomi.
- Yes, Naomi.
I'm Maggie Lockwood, charge nurse.
I'm sorry about earlier.
- I should've jumped in.
- No, no, no. You're fine.
How about we ease you into something?
Okay.
Come on.
[CLEARS THROAT]
How long is this gonna take?
- I wanna get out of here.
- Not long.
Likely a sprain, but we will need X-rays
before we splint it.
Why don't you lean back, Jay?
Uh, no, no, no. I'm good.
It's my ankle that's the problem.
This is just a precaution, Jay.
Standard procedure.
So how did this happen?
I fell off the ladder in my studio.
Probably 'cause I haven't
been sleeping much.
I'm sorry to hear that.
I'm just trying to get
these pieces done, you know?
I'm in the groove. I
don't wanna waste it.
You're an artist? That's cool.
Yeah, I've just been
painting since I was a kid.
Ms. Howard, don't you think
we should hang some fluids?
Uh, right.
Uh, Jay, we're going to
give you a liter of fluid
to make sure you don't get dehydrated.
- [SIGHS]
- And some blood work.
Mm-hmm.
I really gotta get back to work.
You got a pen and paper?
Might as well sketch
while I'm stuck in here.
No problem.
Give us a minute, okay?
Okay.
Okay.
Thoughts?
Whoa.
I'm thinking the ankle
isn't his main problem.
Mm-hmm.
I mean, this is an unusual presentation
for someone who's just drunk, right?
Mm-hmm.
Do you think he could be on
something other than alcohol?
Maybe an amphetamine?
Possibly.
Why don't you add a tox
screen to the blood work?
And just to cover our bases,
let's page Dr. Charles.
- Okay.
- Good job.
[COUGHING]
[SOFT TENSE MUSIC]
Hey.
Sully.
- Hey, I was just
- Stop.
I've already said what I needed
to say about your smoking.
How you doing?
- You good?
- Yeah.
If you're really not
gonna treat your cancer,
you gotta let Lynne know
what's going on, man.
She's got enough on her
plate with the pregnancy.
I don't wanna give her
anything else to worry about.
Come on.
You and I both know
you're not telling her
'cause she's gonna force
you to get treatment.
Look, I'm handling it, okay?
Just keep this to yourself.
♪
Jay, this is Dr. Charles.
Jay, how are you doing?
You, uh you drawing something?
Still working it out.
Look, I don't need a psychiatrist.
Okay.
You're just gonna tell
me what I already know,
that I have depression.
So you've had a formal diagnosis?
Yeah. Six eight months ago.
Okay, and were you prescribed anything?
They put me on an SSRI.
Fluoxe something.
- Fluoxetine, right?
- Yeah.
- Yep.
- And it works.
It works great.
Oh, good. I'm glad to hear that.
Listen, Dr. Charles, I
gotta get out of here, okay?
I'm just starting to gel as an artist,
and people are starting
to finally notice.
I mean, this is a big week in my career.
I've got a meeting with
a very important gallery.
They wanna lock down a show.
So just tell me what I
gotta do to get out of here.
Okay? What do I gotta sign?
I hear you.
Only thing I need is
an X-ray of that ankle
to make sure it's not broken.
Once we get that, you're on your way.
So why don't I get that rolling?
And, um and I'll check back with you.
Yeah, okay.
I'm sorry.
He didn't report his depression earlier.
- Should I have asked?
- Oh, don't worry about it.
Would have been very difficult to spot
given the state that he's in.
Jay's test results are in.
And we also contacted his father.
Should be here in 30.
Huh.
Blood alcohol, 0.04.
I mean, that's, you know,
technically impaired,
but nothing extreme.
Mixing alcohol with his meds
should have a sedating effect.
- Correct.
- Not the opposite.
And his tox screen is clear.
No cocaine.
No amphetamines.
I don't get it.
Can't really say his behavior is in line
- with a depressive disorder.
- Yeah.
Pretty sure that depression
is not the only thing
we're looking at here.
Mags, page me when Dad gets here.
Yes, of course.
Howard, with me.
Hey, good luck with the deposition.
Let me know how it goes.
Yeah. Sure thing.
Hey, Lynne?
So I can confirm that it is a UTI.
I've called in some Macrobid for you.
You'll take that twice daily
with meals till it runs out.
Nothing too taxing for you or Sully.
Oh, yeah.
Last thing I'd want is to make
anything too taxing for him.
Yeah, some guys can shy away
from this kind of
stuff in the beginning.
He's probably just nervous.
Yeah, maybe.
But Sully is so tight-lipped.
And Rip. Just like the old neighborhood.
Can never let 'em see weakness.
Mitch doesn't ever really
talk about where he's from.
Yeah, him and Sully went
through a lot growing up.
Really? What do you mean?
It's probably not my place.
But I am really proud of Rip.
Yeah, he's overcome a lot.
[DEVICE BEEPS]
Thanks, Mike.
Hey, Mike.
You X-rayed yourself?
Look, Archer's pulled
me in for trauma today,
so I just, you know, wanted
to give myself a once-over.
Loren, I've been where you are.
So has Dr. Archer.
He'll understand if you're not ready
for trauma services just yet.
Look, I have flown through
rougher skies than this.
Oh, remind me how the last flight went?
Look, Archer called my number.
I just I wanna deliver.
- Yeah.
- Johnson, let's get moving.
[CLEARS THROAT]
- I'm good.
- Mm-hmm.
So where are we at?
Well, I just gave Whitney
another 2 of blood and plasma.
Base deficit's 11.
Mile marker one.
Excuse me?
Trauma is all about
knowing your mile markers,
all right, when to resuscitate or go
to surgery, when to keep stitching
or to pack and bail out.
Whitney's had all that volume,
but she's still got an oxygen
debt and is hypotensive.
So what's that tell you?
That she's probably
still bleeding somewhere.
BP's back to the 80s, and she's tachy.
Okay.
[SUSPENSEFUL MUSIC]
FAST is still negative.
I don't get it.
Her X-rays are okay.
She's not bleeding into her belly.
But vitals say she's shocky.
Well, don't discount the
retroperitoneal structures,
but it could be something else.
Well, her skin's flush, warm.
Neurogenic shock. Her cord injury.
A loss of vascular tone
dropped her pressure.
Just like an active bleed would.
Now you're thinking
like a trauma surgeon.
You know, I should have seen it.
She wasn't moving her legs at the scene.
Shock's always hemorrhagic
until proven otherwise,
and we just proved otherwise.
Start her on neo, get her MAP to 65,
and we gotta get her to CT stat.
[GROANS]
Mr. Keene?
I'm Dr. Charles. This is Ms. Howard.
She's a student doctor who helped
with Jay's intake this morning.
How's he doing?
He's stable, resting
comfortably just inside there.
We'd like to have a little chat with you
before we take you to see him,
though, if that's all right.
Do you mind if we sit?
Okay.
Psychiatry?
Is this about his depression?
His drinking?
Is that something he's been
struggling with for a while,
- his drinking?
- No.
It started a few months
ago, not long after
he was diagnosed with depression.
Is there any family history
of substance abuse or mental illness?
No not on my side or his
mother's, as far as I know.
We're divorced.
After he was diagnosed and
he started taking his meds,
right, did you notice any
any changes in his behavior?
I mean, other than the drinking.
At first, the meds were a godsend,
helped him focus, be productive,
like it brought him back to life.
But then it was as if the
dial got turned up to 11.
How do you mean?
He'd stay up all night
working, call me at all hours,
sleeping only when he drank
enough to knock himself out.
I tried getting him to quit,
but he wouldn't listen to me.
Yeah.
I'm at a loss.
These details are actually very helpful.
And I think I know what's
going on with your son.
Hey. Hey! Something's happening in here.
I think her water just broke.
Um
♪
Okay, I'd like to check you out again.
Okay. Okay.
This isn't supposed
to be happening, right?
No, no, no. It's too early.
I can't I can't deliver the baby.
- It's too early.
- You're okay.
- You're gonna be okay.
- Take a deep breath for me, all right?
[BREATHES DEEPLY]
All right, I'm seeing excess fluid.
Nitrazine swab?
What's she doing?
It's a test to indicate if
Lynne's water has broken.
Okay, test is positive.
No, no, no. I'm only 29 weeks.
That's why I'd like to do an
ultrasound, just to be sure.
Mitch?
Okay.
[INHALES SHARPLY]
What? What's wrong?
The ultrasound is showing normal levels
of amniotic fluid, which
is surprising to see
if your water ruptured.
So what is all this?
Could be discharge from your cerclage.
But we'll need to do a different
swab, an AmniSure, to confirm.
All these swabs and tests [COUGHING]
Hey, you okay?
I got him. Let's step outside.
Okay. Okay, take a seat.
Just try to just try to breathe
through your nose, okay?
Breathe through your nose, okay?
[COUGHING]
[CLEARS THROAT]
- Well, that's not good.
- Okay.
Okay, let's get you into bed, Sully.
- [GROANS]
- Hey.
Hey, hey. Hey, Sully?
Okay. Okay.
Come on.
Sully? Sully, stay with me, okay?
I need a hand in here!
Sully.
Sully, you with me?
♪
Hey, bud.
Where's Lynne? Is she
okay? She's in labor?
- She's fine.
- [EXHALES]
I'm more worried about you.
Got an X-ray while you were out.
All that coughing has torn
the lining of your throat.
We gotta get you upstairs so
pulmonary can get a look at.
[EXHALES] If they can
stop the pain, let's do it.
- [GROANS]
- Yeah. Okay.
[COUGHING]
We'll talk about how to
knock it off my bill later.
Right, bud?
Hey.
What happened with him?
Uh
Uh, significant lesion on the lungs.
Do you think it's cancerous?
Pretty certain.
I tried to get him worked
up and into treatment
a few weeks back, and let's
just say it didn't go well.
[EXHALES] I'm surprised
Lynne didn't mention anything.
Wait. She doesn't know?
Sully doesn't wanna say anything.
I I told him to tell
her, but he kept dodging,
so I I backed off.
So let me get this straight.
He's your old friend,
but you can't sit down
and have an honest
conversation with him?
Hannah, what else can
I do? He's my patient.
I have to honor his wishes.
Look, I gotta get him upstairs.
Yeah. Go.
[MACHINE WHIRRING]
Right there.
It's a burst fracture at the T3
and a cord hematoma ascending to T11.
That's what dropped her pressure.
You're missing the main attraction.
Check out the left kidney.
Grade 3 renal lac and a pneumatosis
around the abutting colon.
That'd be another mile marker.
Better get her to the OR.
Yep.
[GROANS SOFTLY]
What are you saying? I'm not depressed?
I think there's a really good
chance that you're suffering
from bipolar disorder.
Isn't that the same thing?
It's not.
Bipolar is a mood disorder
that makes people vulnerable
to extreme swings in mood,
cycling between depressive
states and manic states.
Manic?
What does that even mean?
Well, the beginning of a manic state
is characterized by intense
energy, confidence, creativity.
Problem is, they're
invariably accompanied, also,
by severely impaired judgment,
which can even evolve into delusion.
And that's when they
become really dangerous.
So you're saying my doctor got it wrong.
I think that what happened is
that your doctor diagnosed you
when you were in a manic state
and thought that that was just
the extent of the problem.
So, uh, what?
My meds, the fluoxetine, they
don't they don't do anything?
Quite the opposite, right?
The problem with SSRIs is
when they are misprescribed
to a patient with
bipolar, they can induce,
enhance, increase the
frequency of manic episodes.
Yeah, Dr. Charles was telling
me it's not uncommon for people
to self-medicate with alcohol.
I told you, it was just
to take the edge off.
I understand it feels
like a short-term fix.
The problem is, alcohol exacerbates
not only manic episodes but
depressive states as well.
Son, listen.
Dr. Charles says this is treatable.
By doing what?
Well, what we do is, we would slowly
titrate you off your SSRI
and switch you onto a mood stabilizer.
Well, then what about my art?
What do you mean?
I'm actually selling now.
Whatever's going on
with me, it's working.
I won't let you take that away from me.
Jay, your health is what's
important, not the art.
Of course you'd say that!
Because you didn't
support me as an artist.
That's not fair.
I only wanted what's best for you.
No, you wanted what you thought was best
because you didn't think I'd succeed!
Jay, look at me. Look at me.
We're gonna figure this out.
You've been given a lot of information.
I'm gonna give you time to process it.
I don't need to process.
I don't need other drugs.
I just need to leave.
I hear you.
And I sincerely apologize for
how backed up ortho is today.
- Just tell them to hurry up.
- Okay.
Well, let me go see if I can
shake somebody loose, okay?
In the meantime, I want you to
try and stay calm, all right?
Oh, my God.
You know, I would really encourage you
to try not to take anything you
heard in there too personally.
You know, he's still
in a manic state, and
But he's right.
I never really supported
him as an artist.
I'm an actuary, a numbers guy.
But art, I thought it was
a reckless career choice.
I tried talking him out of it, but
what if he's putting himself
through all this misery
just to prove me wrong?
[APPREHENSIVE MUSIC]
Is it my fault?
Mr. Keene, your son has a disease,
and that is absolutely not your fault.
I should call his mother,
let her know what's going on.
I can give ortho a call.
Okay. But you know what?
Don't rush it.
I wanna give Jay a little
time to maybe cool down a bit
before I have another chat with him.
Okay.
Um, okay, but, um, how are
you gonna get him to comply?
Honestly, I don't know yet.
Okay.
Did you pull in this specific direction
when you reduced Mr.
Wapniarski's shoulder?
Yes.
Exactly like that picture.
And how many shoulder reductions
have you actually done, Dr. Ripley?
Uh, too many to remember.
Can you give us a ballpark figure?
Hundreds.
Without any issues.
Dr. Ripley, where were you born?
Chicago.
I see you graduated from
Columbia on a full ride.
That's very impressive.
I did notice, however, a
huge gap in your education.
Your last two years of high
school are unaccounted for.
And no record to explain the absence.
So?
Well, in my experience, Dr. Ripley,
a complete lack of educational records
typically only leads down a few roads
one of those being incarceration
and the other, institutionalization.
Given that both of your parents
were out of the picture
Objection.
I'm not hearing a
question here, counselor.
None of this has any
relevance to the case.
I'll move on.
[TRASH CAN CLATTERING]
♪
Heard the, uh,
deposition was a little rocky.
It was fine.
It was, um the lawyer
The lawyer started getting personal.
Personal? How do you mean?
Trying to use my past against me.
I'm sorry to hear that.
Look, forget it.
I'm I'm I'm actually good.
Look, I know you know exactly
what you're doing here, but
I don't know maybe, um
maybe settling isn't the
worst idea in the world.
Listen, I'm [LAUGHS]
[SNIFFS]
I'm not gonna let some
shyster lawyer get in my head.
I'm good.
♪
All right, what's the game plan?
Get eyes on the left colon,
take down the flexure,
and decide if the kidney stays or goes.
Scissors.
[BREATHES SHARPLY]
[CLEARS THROAT]
Ribs are holding up?
Yeah, I'm good.
You know, the colon's avulsed
with a big mesentery gap.
Doesn't look salvageable.
But the kidney is okay.
Hemostatic. Hey, Marty, what's our temp?
35.5 Celsius.
Well, then quit chatting.
Get that colon resected.
[SOFT TENSE MUSIC]
Well, I've seen worse depositions.
Well, it sounds like
the plaintiff's attorney
is going for character assassination.
[KNOCK AT DOOR]
Yeah?
- Daniel?
- I'm sorry to interrupt.
Sharon, can I just grab
you for a quick sidebar?
Sure.
Peter, give us a minute?
Of course. I got some calls to roll.
- Thank you, Peter.
- Sure.
What's going on?
I was wondering if you wouldn't mind
talking to Dr. Ripley
about settling the lawsuit.
Why? What's changed?
Well, I'm the one, you know,
who brought Pawel in
here in the first place,
asked Mitch to look at him.
I kind of feel responsible
the way the whole thing's shaken out.
Well, you know it's not
your fault, right, Daniel?
I mean, Pawel was going
to sue the next hospital
he walked into, even
if he stubbed his toe.
But what I do have to
ask is, why is it you
bringing this to me and not Dr. Ripley?
It's complicated between us,
and I'd rather not go into it.
Complicated?
Look, here's what I
know about Mitch, okay?
At his core, he's a fighter.
And the thing about fighters is that
they don't always
know when to back down.
I actually think it's
the best idea if you just
make the decision for him.
Okay.
But why do I sense
there's more to this story?
Where's Sully? Is he okay?
Uh, Dr. Ripley's
taking good care of him.
But I want to talk next steps for you.
So the AmniSure swab came back negative,
but because I'm still
seeing excess fluid,
I want to do an even more
conclusive test to confirm
that your water's not broken.
Well, if this test is conclusive,
why didn't we do it in the first place?
Because unfortunately,
it is more invasive.
I'll need to inject blue
dye into the amniotic fluid
- around your baby may I?
- Yeah.
While you wear a tampon.
Now, if your membrane is still intact,
then the fluid can't pass through,
and the tampon does not change color.
But if your water is broken,
then the dye will pass through
and change the tampon blue.
Are you really not gonna
tell me anything about Sully?
It is more serious
than a cold, isn't it?
I can't share his private
health information.
Well, he's the father of my child!
I know.
I knew that he was
hiding something from me.
Every time I told him to
get this cold checked out,
he just brushed me off, and I knew it.
Why can't a man ever
just be straight with you?
How long? How long?
I promise you, ortho is on the way.
That's what you said 20 minutes ago!
- Jay, please.
- No, I'm out of here.
No, please. Just give me,
like, five more minutes.
- Stop. I'm done! I'm leaving.
- Just five.
- [GROANS]
- So you can get back to work?
I gotta keep grinding,
keep pushing through.
Yeah, see, that's what worries me.
What do you know about
art? This is my process!
Yeah, well, your process landed
you right here in the hospital.
I mean, how long do you
think you can keep this up?
As long as I have to,
until I get a gallery,
until I prove to my
dad that I can do this.
I mean, look at look at history.
All the great artists, they
suffered for their work.
Look, this idea that
great art can only be born
from emotional chaos and
misery, it's just not true.
People like Renoir, Vermeer, Hockney
by all accounts just, you know,
relatively well-adjusted people
whose names we know because
they were really talented
- and they worked really hard.
- What about Van Gogh?
Van Gogh was a brilliant
painter, right, who, um,
by all accounts, sadly,
very likely suffered from
bipolar disorder well
before it was understood,
self-medicated with alcohol
until it didn't work anymore,
and blew his head off
when he was 37 years old.
Look, I really get how scary
this idea of changing up
your meds is right now to you.
But you gotta trust me, man.
It's, like, these these SSRIs,
they're not what's gonna
make you a successful artist.
It's your talent.
And I'm just really worried
that if you don't make this change,
you're not going to
be around to share it.
[TENSE MUSIC]
Kidney just started bleeding heavily.
Lac's bigger than the CT showed.
Damn it. Kidney's gotta go now.
Hey, Marty, where are we at?
Given six units and
she's maxed on pressors.
Temp is down to 34.5.
We're in damage control now.
Let's get this kidney out.
I'm on it. [GROANS]
If you need me to step in
Almost got it.
Don't have time for almost.
Metz.
- [GROANS]
- Come on.
Get a tie on it. Let's go.
[GRUNTING]
- Hey.
- Hey.
Okay, now you're taking this
pretty boy thing too far.
[LAUGHTER]
Yeah, not my usual threads.
I had to give a deposition.
- Yeah?
- Yeah.
Some some guy trying to sue me
to make a quick buck
off of the hospital.
Sue you?
You want me to straighten him out?
Nothing a phone call won't solve.
Dude, chill.
It's not that deep.
Besides, you can't be
doing anything stupid.
You're about to be a dad, remember?
[APPREHENSIVE MUSIC]
So how long do you plan to avoid Lynne?
[SIGHS]
Rip, I'm serious, not with this again.
Look where you are right now, man.
How the hell do you plan
on explaining this to her?
♪
You remember my old man?
When he went off to the pen,
it was the happiest day of my life.
All his drinking and staying out late.
Now look at me.
Maybe Lynne and the kid
would be better off
- Stop.
- [LAUGHS] Without me.
You are so much better than your dad.
Hell, both of ours.
You're here, aren't you?
So what?
I get a gold star for attendance?
What's wrong with that?
I know you wanna be
there for your kid too.
That's why.
That's why you gotta get treatment.
♪
I don't know, but it sounds to me
like Jay could be open to
changing his medications.
- Really?
- Mm-hmm.
Well, that's encouraging.
Honestly, I can kind of relate to him,
not wanting to let your parents down.
Huh.
Well, I'm I'm sure a
lot of people feel that way.
I think you're probably
right about that.
Glad to see Lynne's doing better.
Yeah.
It turns out her water
didn't break after all.
The excess fluid was from the cerclage,
and baby and mom are doing fine.
That's great to hear.
Mm-hmm.
Looks like he told her about the cancer.
He did.
[GENTLE MUSIC]
You know, Lynne told me a
few things about you too.
- Oh, yeah?
- Mm-hmm.
Like what?
Well, mainly that you had
questionable hair as a kid.
[LAUGHTER]
Hopefully, one day, you'll
tell me a little more.
♪
I gotta get Sully up to oncology.
Hey, um
thank you for today.
No problem, Rip.
[LAUGHS]
♪
[SIGHS]
Oh, hey.
I just saw Whitney.
She's got sensation
returning to both of her legs.
Cord injury is incomplete. That's good.
Yeah, we should be able
to close her up tomorrow,
and then neurosurgery
can work up her spine.
Mm-hmm.
Well, I'm gonna complete
Whitney's surgery tomorrow.
You're off the case.
Whatever happened to door to discharge?
All right, sit down.
Sit down before you keel over
in front of everybody, all right?
Okay.
I know I may have overdone
it just a little bit.
But I never put my patient at risk.
Oh, well, that's a comfort, yeah.
She's alive and stable.
I mean, that's the job, isn't it?
No the job is to be
there for your patient
throughout their care.
You're the first one
they see when you get here
and the last when they go home.
That's trauma.
You saw all of your
patient's mile markers,
but you ignored your
own, and because of that,
you can't be there for her tomorrow.
Okay, but I was just trying
to do right by Whitney.
All right, look, I've
been where you are.
Yeah, the same instincts, push through.
But this job, I mean, you
gotta know your limits.
All right, you're
you're a competent surgeon.
May even be a good one.
But you want back on my service,
you get those ribs plated.
[GRUNTS]
[BREATHING HEAVILY]
♪
I, uh
I heard that Sully got admitted.
He, uh he all right?
Yeah. Yeah.
He's, uh he's good.
He's stable.
I'm waiting for him to get out of
Dr. Washington's office, actually.
Oh, excellent. That's a relief.
Yeah.
So I just got done
talking with Ms. Goodwin.
Yeah?
She now seems to think that
the best option for everyone
is to settle the lawsuit
and not go to trial.
Huh.
Does she know about my past our past?
No, nothing.
But you said something to her,
didn't you, about settling?
♪
You didn't have to do that.
I would've fought this case.
I know.
I just think that your
history belongs to you.
You know, I mean, that
is your story to tell.
And if you ever decide
that you wanna do that,
I would just hope that it
would be on your own terms.
That's all.
♪
[DRAMATIC MUSIC]
♪
[WOLF HOWLS]