Chicago Med (2015) s04e08 Episode Script
Play By My Rules
1 [INDISTINCT CHATTER.]
[SIREN WAILING.]
[SUSPENSEFUL MUSIC.]
I asked you to plant one bug then walk away.
But no, you couldn't do that.
Hell, you don't seem to get it.
As a physician, I have a responsibility I'm so tired of hearing that.
After the MRI fiasco, Ray Burke said he was done with you and still you called him.
Well, I need to speak to him about his MRI results.
I'm concerned.
Concerned how? There are some subdural hematomas and plaques in both his carotids.
It could mean he's at risk for a stroke.
Could? I can't make a diagnosis without more of a work-up.
That case, there's nothing to report to Ray about.
We could have nailed that scumbag a week ago if you hadn't screwed things up.
No more calls.
I can't just walk away.
You can and you will.
It's over, Dr.
Halstead.
Hey, you made this mess when you took Ray's kickback.
This is on you.
[DRAMATIC MUSIC.]
Will, who was that woman? Oh, just a drug rep.
They just won't leave me alone.
Really? I've never seen her before.
So, listen, the DJ texted me.
The wedding's only three weeks away.
We haven't given him a song list.
What was she pushing? The drug rep.
Oh, just some calcium channel blocker.
Uh, so about the DJ - It's Maggie.
- Yeah, me too.
[PA BEEPS.]
Father and daughter hit and run victims.
This is Abigail Jones, two years old.
GCS nine, blunt head trauma with lacerations.
IO line in the left leg.
Abigail, it's gonna be okay.
- Where's the father? - En route.
Other ambo was trying to get an airway when we rolled away from the scene.
They were in crosswalk.
They had the signal.
Car plowed right through them.
Let's transfer on my count: One, two, three.
Abigail? Abigail? She's unresponsive.
I need to intubate.
Broselow tape.
And a chest X-ray.
Just about 12 to 14 kilos.
Yellow drawer.
Four etomidate.
20 of sux.
BP 100 over 70.
Heart rate 136.
Sats 88.
X-rays in place.
Nat, tell us when.
All right, I'm in.
Go.
Clear.
Right side's whited out.
Chest tube.
Ultrasound.
[MACHINE BEEPING.]
Sats down to 80.
Fastscan's negative.
No blood in the belly.
Tubes in.
Sats coming back up.
100%.
BP and heart rate's stabilizing, as well.
Pupils are reactive but sluggish.
Heads up, paramedics are coming in with the father right now.
You go take him.
I'll finish this.
[PA BEEPS.]
Marc Jones, 32.
GCS 3, intubated in the field.
Suspect a C-spine injury.
There's a step off on the back of his neck.
All right.
Let's transfer him.
One two three.
- Thank you, Cesar.
- Yep.
Good breath sounds bilaterally.
BP 88 over 58.
Heart rate 120.
Should we start a neo bag? Yes, titrate to a pressure of 110.
Need a chest X-ray and an ultrasound.
Yep.
Oh, my God.
Dr.
Halstead.
Hold on.
[TENSE MUSIC.]
[MUFFLED PHONES RINGING.]
How's the little girl? Her vitals are stable and no long bone fractures.
But CT Head shows diffuse intraparenchymal bleeding.
And what did neuro say? I just got off the phone with them.
They put in a pressure monitor, and they agreed with me to treat with hyperventilation and mannitol to reduce the intracranial pressure.
And what about the father? Intubated but unresponsive without sedation.
- So, a brain injury? - I'm not sure.
Pupils are equal and reactive, so that's a good sign.
We're just waiting on scan results to see how bad the injuries are.
Look, Marc's stable now, but what if he goes downhill? He's wearing a lot of ink.
Is this "Do No Resuscitate" a legit advanced directive? The hospital's got a team of lawyers trying to figure that out.
What about his family? Do they know if he meant it or not? We're looking for them too.
It seems it's just Mr.
Jones and his daughter, Abigail, in the world.
He had on a wedding ring.
There's no wife? There was, Melinda.
Legal found an obituary.
She died last year.
Ovarian cancer.
If his wife had to be intubated and wasn't able to get off the vent, seeing her like that could be why he got that tattoo.
Yeah, maybe that's what he was feeling then, but what about now? He's all Abigail has.
I can't see him not wanting us to do everything in our power to keep him alive for her.
Well, the truth is, we don't know why Mr.
Jones got the tattoo or how he feels about it now.
So, let's not jump to conclusions until we have real facts.
And in the meantime? While the hospital does their due diligence, err on the side of life.
Thank you.
[DRAMATIC MUSIC.]
Keegan and I have been neighbors for a few months.
Since I moved back.
I'm only here 'cause Vicki talked me into it.
At this point, I've given up on doctors.
Whoa, no, no, no.
No more scratching.
I can't help it.
It's been three years.
Three years.
Never stops.
And it started with a MRSA infection? The antibiotics to treat it.
Linezolid.
Side effect was pruritus.
- Bad itch, huh? - Mm, the worst.
Everywhere.
And I mean everywhere.
But the reaction went away when she stopped taking the pills.
Except for right here, and it is killing me not to scratch it right now.
The itch never lets up? In the shower? When you're sleeping? Never.
I've used toothbrushes, pencils, even steel wool once.
Nothing stops the itch.
- Easy, Keegan.
Keegan.
- Stop.
Stop- - Stop.
- I know it's hard.
Just try not to scratch.
All right, I'm gonna clean it out and apply some steroid cream.
Should help calm it down.
That won't do anything.
I've tried creams and antihistamines, acupuncture.
I've seen dozens of doctors, dermatologists, allergists.
Nothing helps.
I I just can't stop.
[MOANS.]
D don't.
Don't.
Don't.
Don't.
- Doesn't that hurt? - All I feel is the itch.
It's all day, every day.
Please just find it and cut it out.
Okay.
Let's get a full set of labs and go from there.
I'll be back with the results.
No more scratching.
Thank you.
I've never seen anything like this.
She's down to the muscle.
And she was serious about trying everything.
I looked inside her medicine cabinet, it's like a pharmacy.
I tried to help her, but she didn't serve, so I can't bring her to the VA.
How much do you know about Keegan outside of the itch? Is she Crazy? I don't think so, but an itch for three years Yeah.
I'm gonna get psych involved.
Thanks for bringing her in.
Thanks.
Yeah.
So, Vicki's here.
She just brought in a patient.
This is the only hospital in Chicago? You trying to tell me something? No.
Okay.
April, I appreciate you covering for me every time I'm in the Hybrid OR.
Of course I don't expect you to know everything that I've learned, so I made a reference guide for you.
Well, I haven't had any problems.
Well, not yet, but it's good to be prepared.
"Obligations and Proficiencies of the Charge Nurse.
" People don't realize how complex the job can be.
How many pages is this thing? Is there a PowerPoint presentation to go with it? Is that gonna be a problem? No problem.
Vicki brought in the patient.
Vicki.
Your uh your friend, Vicki? Former friend.
Yeah.
Keegan.
I'm Dr.
Charles.
How you doing? [SCOFFS.]
Of course.
The shrink.
Look, this isn't because of feelings, and it's not OCD.
I don't have delusional parasitosis or a conversion disorder.
And the itching didn't start after my dad died or my boyfriend left me.
Look, I'm not insane.
My head just itches and I want it to stop.
Okay.
Well, let's try to make that happen.
Really? Usually docs are writing me a referral so I'll leave.
Well, you came to us for help, so we're gonna help ya.
Just for now though, do you think you can keep your hand away from the wound? I can't help it.
Okay.
So Dr.
Choi told me that you've tried OTC's, prescriptions, host of home remedies.
How 'bout bupivacaine? What's that? A local anesthetic.
Five mil should do it.
I'd like to apply a little bit to the area.
If it provides relief, it would suggest that the problem might lie in your cutaneous nerve endings.
And that would help suggest a treatment plan going forward.
Then stop talking and get to it.
You're gonna feel a pinch.
Do it.
Whoa.
Okay.
It feels different.
Different how? Better.
I mean, it tingles a little, but it itches less.
Hmm.
That's a good start.
Yeah.
We'll check on you in a bit.
So, anesthetic should provide relief for like, three or four hours.
Itch doesn't come back, then set her up with some topical patches to take home.
Sounds good.
Mannequins? Look, I was a department store latchkey kid.
So, I took what I could get.
Jenny was basically my first girlfriend.
Which is why I am such a good kisser.
I don't think I know how to feel about this.
On the one hand, it's very disturbing.
On the other, I should probably be thanking Jenny for those years of practice.
Hold on.
It wasn't years, okay? Dr.
Rhodes was looking for you.
I wanted to tell you before you got the memo.
The Hybrid Room will be used for general surgeries when needed.
General surgeries? Appendectomies, gall bladders So, everything but trauma, which is why we built it in the first place.
Look, the Hybrid Room was expensive.
It came in over budget.
Using it when we can will help balance the books.
You mean, pad them? Well, profit's not a bad thing.
Ms.
Goodwin, this is Chicago.
We get six traumas before lunch.
What are those patients supposed to do? I don't know, take a number? Well, your displeasure is noted, Dr.
Rhodes.
And overruled.
When does all this start? Today.
In fact, Dr.
Lanik will take the lead.
[DRAMATIC MUSIC.]
This is a terrible idea.
It's gotta be Gwen Garrett.
Let it go.
This isn't a hill to die on.
Damn it! [GRUNTING.]
Call Dr.
Charles.
[INTENSE MUSIC.]
Keegan, stop.
Don't scratch.
Oh, the itch is back and it's worse than before.
You have to stop scratching.
Oh, then you have to tie me down.
- Five milligrams of diazepam.
- On it.
[GROANS.]
I can't live like this anymore.
I'd rather be dead.
What happened? Oh, God.
She scratched through to her skull.
[MONITOR BEEPING.]
How's Abigail? Fighting.
How's the dad? Scans are back.
CT brain revealed no bleeding, and there's no obvious brain trauma.
Well, that's good news.
Yeah, except the CT C-spine revealed a subluxation at C3 on 4.
MRI confirmed? Complete spinal cord transection.
He's paralyzed from the neck down.
I'm sorry.
I just spoke with Jay.
PD caught the driver who hit them.
He blew through a red light because he was texting.
[BEEPING.]
BP's spiked, 146 over 94.
Heart rate's down, 54.
[SUSPENSEFUL MUSIC.]
Cushing's Reflex.
Her intracranial pressure is worsening.
She needs more hyperventilation.
Get her off the vent.
Heart rate's still dropping.
Two milligrams of atropine.
It's in.
Come on.
Come on.
Heart rate's coming back up.
49 51 Come on.
Come on.
Come on, Abigail.
[MELANCHOLY MUSIC.]
Dr.
Rhodes, you're gonna bag that.
Yep.
Talk to me.
James Brice, 24.
GCS 7.
Hypotensive.
Intubated en route.
Belly's distended.
What happened? He was putting in storm windows for the nursery.
He fell off the ladder.
At least 20 feet.
I was worried the baby would be cold this winter.
It's okay.
Don't worry.
It's not your fault.
Maggie? I got her.
Mrs.
Brice, why don't you come with me, and let the doctors work, okay? He keeps trying to die on us.
All right.
On my count.
One, two, three.
[DRAMATIC MUSIC.]
Good breath sounds on the left and the right.
Let's get a chest X-ray.
Field IV is blown.
We don't have access.
All right.
Ava, can you get a line in? Give me a kit.
X-ray's up.
Everybody clear.
Looks good.
Belly's hard as a rock.
Give me a Fastscan.
It's full of blood.
I need to get in there and find the bleed.
We'll use the Hybrid OR.
We can make it upstairs.
There are operating rooms available.
There's also one right across the ED.
- Much closer.
- Connor, Goodwin just to you I know what she said.
Find Maggie.
Have her page my team.
[PAGER BEEPS.]
It's probably CT looking for you.
I got this.
You're going to get yourself into trouble.
I can't worry about that now.
Get James ready to go.
Lanik.
I'm taking the Hybrid OR.
My patient is on the table.
His gall bladder can wait.
Bring him back next week.
I'm not your resident, Connor.
You can't order me around.
Is your patient about to die? Because mine sure is.
[CLANGING.]
Get Dr.
Lanik's patient out and re-prep the room for mine.
Natalie.
I just need a moment.
Yeah, of course.
[SOLEMN MUSIC.]
All right.
Thank you.
April, I'm getting pulled into surgery.
Okay, I'll hold it down out here.
Oh, and I've got a delivery of NG Tubes, Hep Locks, and ABD Pads coming in.
I called it in late last night.
I'll double check the order against the invoice, make sure it's all there.
All right.
Oh.
And it's payroll week, so it means that you have All the nurses need to sign off on their timecards.
Maggie, you're driving me crazy.
If anything happens, I'll handle it.
Okay, and you've got the reference guide that I wrote, so we're all good.
All good.
Good, good, good.
[INDISTINCT CHATTER.]
You want some company? I get it if you'd rather be alone.
No, I'm glad to see you.
How's Marc? No change.
Still unconscious.
Abigail was only two.
And now she's gone.
All because some guy couldn't look away from his phone.
[INHALES DEEPLY.]
But maybe something good could come from all of this.
I mean, all these kids waiting for transplants.
There are so few pediatric donors in comparison to the thousands of children in need.
Abigail could be an organ donor.
As a minor, you know, she's gotta get a parent or guardian to sign off before she can donate.
Yeah, I know that.
And if Goodwin can't track down any of her other family, then all that's left is her father.
Do you think Marc will wake up? I've seen patients in worse shape turn around.
[DRAMATIC MUSIC.]
Well, that's a new one.
Usually I have to cut them open myself to get to the brain.
So, what do you think? Well, for whatever reason, the cutaneous nerves in that part of her scalp went haywire.
Makes them always feel itchy, so she keep scratching.
There a fix? Yeah, surgery.
Sever the nerve.
No more feeling, no more itching.
And no more scratching.
Yeah, and possible serious, irreversible side effects.
Facial paralysis, blurred vision.
Worst case, she ends up in a wheelchair.
I'm not cutting her open in an alley, Daniel.
The risks you're describing are dwarfed by the reward.
- Yeah, we hope.
- What do you suggest? Twice a week counseling sessions? Of course, we'd have to put a cone around her neck to keep her from scratching.
Sam, all those years of scratching, those nerves are shot.
There's nothing left to go haywire.
Dr.
Charles, if that were the case, Keegan shouldn't feel anything.
Let alone an itch.
If those nerves were active, that anesthetic would have provided relief for hours.
- It didn't.
- You only used 5 mil.
- It wasn't enough.
- I agree.
The anesthetic didn't work for long, but it did work.
Proves the nerves are involved.
Great, we have a majority.
Not that I care.
- We done? - Sam? All I'm saying, I don't think operating is gonna do a damn thing.
[SIGHS.]
Thanks for you input.
But the last time I checked, I was the neurosurgeon.
Put her on the schedule.
Isn't surgery supposed to be the last option? Dr.
Charles, she scratched into her skull.
[MACHINES BEEPING.]
What happened? He suddenly went into V-fib.
Shocked him multiple times and then he went asystolic.
Another round of epi.
It's in.
Check for a pulse.
Nothing.
Come on, Marc.
Don't you give up.
[BEEPING.]
Pulse is back.
Sinus tach.
He's back.
All right.
Prep him to move.
I'll call ICU, tell them we're sending him up for cooling.
How long was he asystole? Almost ten minutes.
What's your boyfriend thinking? This guy's not waking up.
[INDISTINCT CHATTER.]
[GROANS.]
Hey, is your ulcer getting worse? Today's not helping.
Yeah.
So, I looked at the Paramedic's report from the accident scene.
Marc was down at least five minutes before help arrived.
And after this last code it was almost ten.
I mean, that's almost 15 minutes with no oxygen.
I know.
Increases the chances the brain function he has is now compromised.
But we won't know if that's the case until he wakes up.
You think he really will? After he coded? I don't know.
Maybe it's time to start thinking about honoring his advanced directive.
Advanced directive? Nat, it is a tattoo, not a legal document.
It might be a proxy to one.
And what if Marc does have the paperwork to back it up? I mean, it could be at home in a file or in a safety deposit box.
If something binding exists, the hospital's lawyers will find it, and I'll obey whatever it says.
But until then, it's just a tattoo, and one of many.
Will, Abigail's organs are still healthy.
But they won't be viable for long.
Without Marc or any family to consent, we can't donate them.
But if we honor his tattoo and we let him go, then the hospital can petition to become Abigail's legal guardian, and we can make the decision to donate her organs before they go to waste.
Natalie, you are asking me to let Marc die.
I can't do that.
Well, if by some miracle he does wake up, it'll be to brain damage, paralysis, and the loss of his daughter.
So, please help me understand why you won't even consider this.
I have a responsibility to my patients to do everything I can to save their lives.
Anything less, then I am failing them.
[DRAMATIC MUSIC.]
Okay.
He's losing blood faster than I can replace it.
Massive bleed from behind the liver.
There must be a hole in the vena cava.
Long Allis clamps.
Damn it, this isn't working.
I can't reach the tear without making it worse.
All right, Maggie, get your hands in here.
Push on these packs.
Press hard.
All right.
That'll buy us some time.
Call Dr.
Lanik, get him in here.
I don't care what he's doing.
Just make sure he's scrubbed up and ready to work.
Give me an 8 ET tube and a sternal saw.
Sternotomy? You're gonna open up his chest? I gotta get to the bleed somehow.
Hey, got your page.
Come on in.
Dr.
Abrams is in surgery right now.
As soon as he's done, Keegan's next.
Uh-huh.
- What's all this? - It's an experiment.
For what? Well, you don't think that Keegan can experience her itch without cutaneous nerves.
And I do.
I think I can prove it.
Have a seat.
Okay.
So, can you take your left arm and put it on the other side of the partition here? Thank you.
So, is this like a magic trick? Yeah, kinda.
Okay, so I'm gonna start to brush your real hand and the fake hand simultaneously.
But I just want you to look at the fake hand.
Okay? Whatever you say.
So, amputees sometimes still feel the missing limb, right? Yeah.
A phantom limb.
The nerves are transmitting confusing signals.
Or do amputees still feel missing limbs because the brain is just assuming that it's still there? 'Cause if that were the case, the nerves would be irrelevant.
Right? So, you're suggesting Keegan's got a phantom itch? Her brain is telling her it's there, even though it isn't? Yeah.
Just like amputees perceive a limb that used to be there.
Keegan still perceives an itch that she got three years ago from a drug reaction.
I mean, the brain's basically playing a trick on her.
Interesting theory.
Where are you going with all this? That's not your hand.
Right? But the more you stare at it, while feeling me brush your real hand, the more your brain might start to blend them together.
Well, I guess I can buy that.
Yeah.
Very powerful, the connection between what we see and what we feel.
But Dr.
Charles, I still know which one's my arm.
Huh.
Do ya? Ah.
Uh, for a second there You felt the hammer.
Yeah, I did.
Yeah.
Well, and we both know there aren't any nerve endings in this thing, right? Amazing the tricks the brain can play on us.
Keegan.
Keegan, wait.
I've changed my mind.
I don't think you should have surgery just yet.
Oh, here we go.
What crazy idea has Dr.
Charles talked you into? It may not be a nerve problem.
It could be a perception problem.
In fact, I'm not sure your itch is real.
Not real? Are you two serious? Look at me.
I have to be tied to the bed so I don't scratch a bigger hole in my head.
If surgery will work, I have to do it.
But what if it doesn't? What if you wake up and nothing's changed? It has to work.
Because I can't live like this anymore.
I want my life back.
Surgery will give it to you.
All right, let's go.
Wait, Keegan.
Wait, wait.
The brain can change.
It responds to experience.
It's called neuroplasticity.
Three years ago, a drug reaction created a chronic itch that you can't seem to satisfy, because it rewired your brain.
No surgery is gonna fix that.
Trust me.
Daniel.
Please.
Please, Keegan.
Let me try something before you go under the knife.
It's been three years.
What can you do for me that no other doctor has tried? A trick.
What the hell is going on? I was told you needed help with a liver bleed.
Retro-hepatic cava tear.
Can't fix anything until I control the bleed.
I'm gonna do that with an atrial caval shunt.
You gotta be kidding.
Nope, I'm gonna snake an ET tube down his heart and bypass the tear.
What, you couldn't think of a riskier move? Atrial caval shunts have an abysmal success rate.
Yep, I'm aware.
Then you also know that he's cold and coagulopathic.
So, if you don't pack him up, and get him up to the ICU to be warmed, he's gonna die here on this table.
At least this gives him a shot.
If we send him up to the ICU, he bleeds out and dies for sure.
Scissors and ET tube.
If you cut into that heart, there is no going back.
Yeah, I know.
Don't do it.
[DRAMATIC MUSIC.]
God damn it.
You kick me out of here only to force me to help you kill this guy.
You're a prick, Rhodes.
Yeah, maybe.
[MONITOR BEEPING.]
If her father doesn't wake up, what happens to Abigail's organs? They're no good to anyone.
Ms.
Goodwin, can I speak to you about something? Could've driven a truck through this hole.
He never would have survived in the ICU.
This is the right call.
Don't act like you didn't get lucky as hell.
Let's finish this up.
What do I do? I don't know how long I can go without scratching.
Okay.
I want you to look at your reflection and scratch the non-itchy side of your head.
In the mirror, the image is gonna be reversed.
It's gonna look like you're actually scratching the itchy side.
Oh, I see it.
But how is scratching this side of my head gonna make the itch go away on the other side? Keegan, trust me.
We know that you've been feeling this thing.
But I just want you to consider the possibility that maybe, just maybe that this itch isn't real.
And no amount of scratching is gonna satisfy it.
Well, then what the hell am I doing? Giving your brain new visual input to the override the experience you had three years ago, so it can begin to rewire itself.
Okay, you're losing me.
By feeling yourself scratch one side of your head while you're seeing yourself scratch the other, your brain will be tricked.
And realize something's not right.
Now, hopefully, that experience will force you to perceive a new reality.
A reality in which the itch doesn't exist.
So you say, but nothing's changing.
And I feel stupid.
The exercise is designed to confuse your brain, so don't worry about that.
Just keep scratching.
Like this? Harder? Softer? - Just like you're doing.
- Yes.
Be patient.
Give it a chance.
Keegan, we'll be just outside.
You're doing great.
[DRAMATIC MUSIC.]
How long are we gonna let her keep scratching? She's been dealing with this for what, three years? I mean, honestly Ethan, I don't know how long it might take.
If it takes.
The phantom itch theory makes sense, but it's still just a theory.
I just really don't wanna give her any false hope.
Dr.
Charles.
Something's definitely happening.
The itch, it's less.
Okay.
All right, I'll be back in five.
I'm gonna run these over to sterile processing.
Hey.
Have you seen April? - I wanted to check in on her.
- Nope.
She's probably putting out a fire somewhere.
That girl is on it.
So, things went well while I was in surgery? Yeah, didn't even realize you were gone.
Oh.
That's great.
Yeah.
Dr.
Halstead, could I have a moment? Of course.
An emergency ethics committee was formed to evaluate Marc Jones's current condition and future prognosis.
Wait, was formed? Who asked for that? Between his spinal cord injury and the high probability for irreparable brain damage, the committee concluded with reasonable medical certainty that he has no quality of life.
No.
Listen, the hospital will honor Mr.
Jones's tattoo as an advanced directive.
If he codes again, you will not resuscitate.
I cannot just walk away.
I'm sorry, but it's over, Dr.
Halstead.
I wanna talk to you.
An emergency ethics committee? What, I don't bow down to your decision on my patient, so you go over me to Goodwin and bench me? You forced my hand.
I tried talking to you.
You shut me down.
Because you'd already decided Marc should die.
He has a tattoo across his chest that says, "Do Not Resuscitate.
" We don't know that's how he feels.
We don't know he doesn't.
But what I do know is that if we don't act now, we will lose Abigail's organs.
Those are children's lives in our hands.
No, don't turn this on me.
Don't guilt me into thinking that I'm the bad guy.
You don't think I know the stakes of this case? I am sick of everyone telling me what I can and what I cannot do.
I am just trying to save my patients.
What are you talking about? Who is everyone? You betrayed me.
How can I ever trust you? How can I trust you? In the past, you have let patients go who you knew were hopeless.
But you know what? It is more than that.
No, look at me.
It is more than that.
You have been acting strange for weeks.
And this morning, that ridiculous story about a drug rep, really? Well then, here we are.
And about to get married.
- Maggie.
- Yep.
Thanks for approving my PTO for next month.
I didn't think there was a way to make it happen.
Oh, yeah.
Sure.
April.
Did you sign off on Monique's paid time off for next month? Yeah.
Saw her request had been siting there for three weeks.
I hate it when I put in for vacation times and nothing happens.
It takes a long time because someone's always asking for PTO.
Especially Monique.
She took eight days off last month.
Well, her sister is pregnant, on bed rest and needs help.
So, how could I say no? - What? - Lisa.
I'm talking to you.
I have a system for handling PTO's.
You can't take time off if you're out of vacation.
Monique was out.
Doris gave her some of hers.
Oh, my God.
You let them swap? Doris said she wasn't gonna use them.
No sense letting them gather dust.
You know what's gonna happen now? I'm gonna get hammered with requests from nurses who wanna swap days.
- Thanks a lot.
- You know what? You don't like the way I handle things when I'm doing you a favor A favor? This is a privilege.
Give your privilege to someone else.
[MONITORS BEEPING.]
[BEEPING CONTINUES.]
[SOLEMN MUSIC.]
Time of death, 19:22.
There, he's gone.
You won.
I was about to give up, but then there was this moment.
Look at me, I'm not scratching.
I am so happy for you.
Dr.
Choi, I can keep these mirrors, right? It's so much better.
Of course.
And keep it up.
Over time, they should fade away completely.
Excuse me.
Dr.
Charles, surgery would have been a mistake.
Good call steering her away.
Yeah, but, you know, I certainly understood her desperation for relief.
Do you know that scientifically, itching is ranked as one of the most distressing sensations a human being can experience? Really? You know what, Dr.
Charles, maybe it's not a good idea, but some itches you just have to scratch.
Vicki.
Hey.
What do you say we go for a run? Like old times? Sure.
Call me sometime.
My shift's over.
How 'bout now? [LAUGHS.]
Okay.
Let's do it.
[DRAMATIC MUSIC.]
Okay, look, my way isn't the only way.
You're doing a good job.
Thanks.
And I confess, it sucks when you realize that you can be replaced.
Yeah, I know.
Oh.
Wanna get a drink? Maybe two? Yeah.
Oh, Sam.
You'll be happy to hear that Keegan's feeling much better.
Oh, your smoke and mirrors? Temporary fix.
She'll be back here in six weeks to get that surgery.
Well, that's the way you see it, I, uh, I guess I see it a little differently.
Until next time, Daniel.
Good night.
An atrial caval shunt.
My cowboy.
Dr.
Rhodes.
Three operating rooms upstairs were open.
You could have treated your patient in any one of them.
Maybe, but I didn't want to risk him dying in transit.
That is why we have a Hybrid OR.
The gall bladder surgery you interrupted, I'm rescheduling it for tomorrow.
In the Hybrid OR.
Ms.
Goodwin, this idea to repurpose my room is misguided and reckless.
Your room? Well, the board is considering closing your room unless it starts proving its worth.
That's why I'm gonna make sure it is always earning money.
Great.
Then I'm gonna keep fighting back, because I'm not gonna let Gwen Garrett turn the Hybrid OR into an ATM.
Gwen Garrett has nothing to do with this.
I decided to put general surgeries in there.
So you pull this little stunt again, and I'll show you the door.
[DRAMATIC MUSIC.]
I don't care what she says.
I saved his life.
I'd do it again.
Come here.
[HEAVY BREATHING.]
We're a lot alike, you know.
You'd do anything to get what you want.
You're that bad, huh? I'm that bad.
[SOLEMN MUSIC.]
Abigail's organs are off to recipients.
That's good.
Maybe you want this back? No, I don't.
Natalie, I wanna marry you.
[SIREN WAILING.]
[SUSPENSEFUL MUSIC.]
I asked you to plant one bug then walk away.
But no, you couldn't do that.
Hell, you don't seem to get it.
As a physician, I have a responsibility I'm so tired of hearing that.
After the MRI fiasco, Ray Burke said he was done with you and still you called him.
Well, I need to speak to him about his MRI results.
I'm concerned.
Concerned how? There are some subdural hematomas and plaques in both his carotids.
It could mean he's at risk for a stroke.
Could? I can't make a diagnosis without more of a work-up.
That case, there's nothing to report to Ray about.
We could have nailed that scumbag a week ago if you hadn't screwed things up.
No more calls.
I can't just walk away.
You can and you will.
It's over, Dr.
Halstead.
Hey, you made this mess when you took Ray's kickback.
This is on you.
[DRAMATIC MUSIC.]
Will, who was that woman? Oh, just a drug rep.
They just won't leave me alone.
Really? I've never seen her before.
So, listen, the DJ texted me.
The wedding's only three weeks away.
We haven't given him a song list.
What was she pushing? The drug rep.
Oh, just some calcium channel blocker.
Uh, so about the DJ - It's Maggie.
- Yeah, me too.
[PA BEEPS.]
Father and daughter hit and run victims.
This is Abigail Jones, two years old.
GCS nine, blunt head trauma with lacerations.
IO line in the left leg.
Abigail, it's gonna be okay.
- Where's the father? - En route.
Other ambo was trying to get an airway when we rolled away from the scene.
They were in crosswalk.
They had the signal.
Car plowed right through them.
Let's transfer on my count: One, two, three.
Abigail? Abigail? She's unresponsive.
I need to intubate.
Broselow tape.
And a chest X-ray.
Just about 12 to 14 kilos.
Yellow drawer.
Four etomidate.
20 of sux.
BP 100 over 70.
Heart rate 136.
Sats 88.
X-rays in place.
Nat, tell us when.
All right, I'm in.
Go.
Clear.
Right side's whited out.
Chest tube.
Ultrasound.
[MACHINE BEEPING.]
Sats down to 80.
Fastscan's negative.
No blood in the belly.
Tubes in.
Sats coming back up.
100%.
BP and heart rate's stabilizing, as well.
Pupils are reactive but sluggish.
Heads up, paramedics are coming in with the father right now.
You go take him.
I'll finish this.
[PA BEEPS.]
Marc Jones, 32.
GCS 3, intubated in the field.
Suspect a C-spine injury.
There's a step off on the back of his neck.
All right.
Let's transfer him.
One two three.
- Thank you, Cesar.
- Yep.
Good breath sounds bilaterally.
BP 88 over 58.
Heart rate 120.
Should we start a neo bag? Yes, titrate to a pressure of 110.
Need a chest X-ray and an ultrasound.
Yep.
Oh, my God.
Dr.
Halstead.
Hold on.
[TENSE MUSIC.]
[MUFFLED PHONES RINGING.]
How's the little girl? Her vitals are stable and no long bone fractures.
But CT Head shows diffuse intraparenchymal bleeding.
And what did neuro say? I just got off the phone with them.
They put in a pressure monitor, and they agreed with me to treat with hyperventilation and mannitol to reduce the intracranial pressure.
And what about the father? Intubated but unresponsive without sedation.
- So, a brain injury? - I'm not sure.
Pupils are equal and reactive, so that's a good sign.
We're just waiting on scan results to see how bad the injuries are.
Look, Marc's stable now, but what if he goes downhill? He's wearing a lot of ink.
Is this "Do No Resuscitate" a legit advanced directive? The hospital's got a team of lawyers trying to figure that out.
What about his family? Do they know if he meant it or not? We're looking for them too.
It seems it's just Mr.
Jones and his daughter, Abigail, in the world.
He had on a wedding ring.
There's no wife? There was, Melinda.
Legal found an obituary.
She died last year.
Ovarian cancer.
If his wife had to be intubated and wasn't able to get off the vent, seeing her like that could be why he got that tattoo.
Yeah, maybe that's what he was feeling then, but what about now? He's all Abigail has.
I can't see him not wanting us to do everything in our power to keep him alive for her.
Well, the truth is, we don't know why Mr.
Jones got the tattoo or how he feels about it now.
So, let's not jump to conclusions until we have real facts.
And in the meantime? While the hospital does their due diligence, err on the side of life.
Thank you.
[DRAMATIC MUSIC.]
Keegan and I have been neighbors for a few months.
Since I moved back.
I'm only here 'cause Vicki talked me into it.
At this point, I've given up on doctors.
Whoa, no, no, no.
No more scratching.
I can't help it.
It's been three years.
Three years.
Never stops.
And it started with a MRSA infection? The antibiotics to treat it.
Linezolid.
Side effect was pruritus.
- Bad itch, huh? - Mm, the worst.
Everywhere.
And I mean everywhere.
But the reaction went away when she stopped taking the pills.
Except for right here, and it is killing me not to scratch it right now.
The itch never lets up? In the shower? When you're sleeping? Never.
I've used toothbrushes, pencils, even steel wool once.
Nothing stops the itch.
- Easy, Keegan.
Keegan.
- Stop.
Stop- - Stop.
- I know it's hard.
Just try not to scratch.
All right, I'm gonna clean it out and apply some steroid cream.
Should help calm it down.
That won't do anything.
I've tried creams and antihistamines, acupuncture.
I've seen dozens of doctors, dermatologists, allergists.
Nothing helps.
I I just can't stop.
[MOANS.]
D don't.
Don't.
Don't.
Don't.
- Doesn't that hurt? - All I feel is the itch.
It's all day, every day.
Please just find it and cut it out.
Okay.
Let's get a full set of labs and go from there.
I'll be back with the results.
No more scratching.
Thank you.
I've never seen anything like this.
She's down to the muscle.
And she was serious about trying everything.
I looked inside her medicine cabinet, it's like a pharmacy.
I tried to help her, but she didn't serve, so I can't bring her to the VA.
How much do you know about Keegan outside of the itch? Is she Crazy? I don't think so, but an itch for three years Yeah.
I'm gonna get psych involved.
Thanks for bringing her in.
Thanks.
Yeah.
So, Vicki's here.
She just brought in a patient.
This is the only hospital in Chicago? You trying to tell me something? No.
Okay.
April, I appreciate you covering for me every time I'm in the Hybrid OR.
Of course I don't expect you to know everything that I've learned, so I made a reference guide for you.
Well, I haven't had any problems.
Well, not yet, but it's good to be prepared.
"Obligations and Proficiencies of the Charge Nurse.
" People don't realize how complex the job can be.
How many pages is this thing? Is there a PowerPoint presentation to go with it? Is that gonna be a problem? No problem.
Vicki brought in the patient.
Vicki.
Your uh your friend, Vicki? Former friend.
Yeah.
Keegan.
I'm Dr.
Charles.
How you doing? [SCOFFS.]
Of course.
The shrink.
Look, this isn't because of feelings, and it's not OCD.
I don't have delusional parasitosis or a conversion disorder.
And the itching didn't start after my dad died or my boyfriend left me.
Look, I'm not insane.
My head just itches and I want it to stop.
Okay.
Well, let's try to make that happen.
Really? Usually docs are writing me a referral so I'll leave.
Well, you came to us for help, so we're gonna help ya.
Just for now though, do you think you can keep your hand away from the wound? I can't help it.
Okay.
So Dr.
Choi told me that you've tried OTC's, prescriptions, host of home remedies.
How 'bout bupivacaine? What's that? A local anesthetic.
Five mil should do it.
I'd like to apply a little bit to the area.
If it provides relief, it would suggest that the problem might lie in your cutaneous nerve endings.
And that would help suggest a treatment plan going forward.
Then stop talking and get to it.
You're gonna feel a pinch.
Do it.
Whoa.
Okay.
It feels different.
Different how? Better.
I mean, it tingles a little, but it itches less.
Hmm.
That's a good start.
Yeah.
We'll check on you in a bit.
So, anesthetic should provide relief for like, three or four hours.
Itch doesn't come back, then set her up with some topical patches to take home.
Sounds good.
Mannequins? Look, I was a department store latchkey kid.
So, I took what I could get.
Jenny was basically my first girlfriend.
Which is why I am such a good kisser.
I don't think I know how to feel about this.
On the one hand, it's very disturbing.
On the other, I should probably be thanking Jenny for those years of practice.
Hold on.
It wasn't years, okay? Dr.
Rhodes was looking for you.
I wanted to tell you before you got the memo.
The Hybrid Room will be used for general surgeries when needed.
General surgeries? Appendectomies, gall bladders So, everything but trauma, which is why we built it in the first place.
Look, the Hybrid Room was expensive.
It came in over budget.
Using it when we can will help balance the books.
You mean, pad them? Well, profit's not a bad thing.
Ms.
Goodwin, this is Chicago.
We get six traumas before lunch.
What are those patients supposed to do? I don't know, take a number? Well, your displeasure is noted, Dr.
Rhodes.
And overruled.
When does all this start? Today.
In fact, Dr.
Lanik will take the lead.
[DRAMATIC MUSIC.]
This is a terrible idea.
It's gotta be Gwen Garrett.
Let it go.
This isn't a hill to die on.
Damn it! [GRUNTING.]
Call Dr.
Charles.
[INTENSE MUSIC.]
Keegan, stop.
Don't scratch.
Oh, the itch is back and it's worse than before.
You have to stop scratching.
Oh, then you have to tie me down.
- Five milligrams of diazepam.
- On it.
[GROANS.]
I can't live like this anymore.
I'd rather be dead.
What happened? Oh, God.
She scratched through to her skull.
[MONITOR BEEPING.]
How's Abigail? Fighting.
How's the dad? Scans are back.
CT brain revealed no bleeding, and there's no obvious brain trauma.
Well, that's good news.
Yeah, except the CT C-spine revealed a subluxation at C3 on 4.
MRI confirmed? Complete spinal cord transection.
He's paralyzed from the neck down.
I'm sorry.
I just spoke with Jay.
PD caught the driver who hit them.
He blew through a red light because he was texting.
[BEEPING.]
BP's spiked, 146 over 94.
Heart rate's down, 54.
[SUSPENSEFUL MUSIC.]
Cushing's Reflex.
Her intracranial pressure is worsening.
She needs more hyperventilation.
Get her off the vent.
Heart rate's still dropping.
Two milligrams of atropine.
It's in.
Come on.
Come on.
Heart rate's coming back up.
49 51 Come on.
Come on.
Come on, Abigail.
[MELANCHOLY MUSIC.]
Dr.
Rhodes, you're gonna bag that.
Yep.
Talk to me.
James Brice, 24.
GCS 7.
Hypotensive.
Intubated en route.
Belly's distended.
What happened? He was putting in storm windows for the nursery.
He fell off the ladder.
At least 20 feet.
I was worried the baby would be cold this winter.
It's okay.
Don't worry.
It's not your fault.
Maggie? I got her.
Mrs.
Brice, why don't you come with me, and let the doctors work, okay? He keeps trying to die on us.
All right.
On my count.
One, two, three.
[DRAMATIC MUSIC.]
Good breath sounds on the left and the right.
Let's get a chest X-ray.
Field IV is blown.
We don't have access.
All right.
Ava, can you get a line in? Give me a kit.
X-ray's up.
Everybody clear.
Looks good.
Belly's hard as a rock.
Give me a Fastscan.
It's full of blood.
I need to get in there and find the bleed.
We'll use the Hybrid OR.
We can make it upstairs.
There are operating rooms available.
There's also one right across the ED.
- Much closer.
- Connor, Goodwin just to you I know what she said.
Find Maggie.
Have her page my team.
[PAGER BEEPS.]
It's probably CT looking for you.
I got this.
You're going to get yourself into trouble.
I can't worry about that now.
Get James ready to go.
Lanik.
I'm taking the Hybrid OR.
My patient is on the table.
His gall bladder can wait.
Bring him back next week.
I'm not your resident, Connor.
You can't order me around.
Is your patient about to die? Because mine sure is.
[CLANGING.]
Get Dr.
Lanik's patient out and re-prep the room for mine.
Natalie.
I just need a moment.
Yeah, of course.
[SOLEMN MUSIC.]
All right.
Thank you.
April, I'm getting pulled into surgery.
Okay, I'll hold it down out here.
Oh, and I've got a delivery of NG Tubes, Hep Locks, and ABD Pads coming in.
I called it in late last night.
I'll double check the order against the invoice, make sure it's all there.
All right.
Oh.
And it's payroll week, so it means that you have All the nurses need to sign off on their timecards.
Maggie, you're driving me crazy.
If anything happens, I'll handle it.
Okay, and you've got the reference guide that I wrote, so we're all good.
All good.
Good, good, good.
[INDISTINCT CHATTER.]
You want some company? I get it if you'd rather be alone.
No, I'm glad to see you.
How's Marc? No change.
Still unconscious.
Abigail was only two.
And now she's gone.
All because some guy couldn't look away from his phone.
[INHALES DEEPLY.]
But maybe something good could come from all of this.
I mean, all these kids waiting for transplants.
There are so few pediatric donors in comparison to the thousands of children in need.
Abigail could be an organ donor.
As a minor, you know, she's gotta get a parent or guardian to sign off before she can donate.
Yeah, I know that.
And if Goodwin can't track down any of her other family, then all that's left is her father.
Do you think Marc will wake up? I've seen patients in worse shape turn around.
[DRAMATIC MUSIC.]
Well, that's a new one.
Usually I have to cut them open myself to get to the brain.
So, what do you think? Well, for whatever reason, the cutaneous nerves in that part of her scalp went haywire.
Makes them always feel itchy, so she keep scratching.
There a fix? Yeah, surgery.
Sever the nerve.
No more feeling, no more itching.
And no more scratching.
Yeah, and possible serious, irreversible side effects.
Facial paralysis, blurred vision.
Worst case, she ends up in a wheelchair.
I'm not cutting her open in an alley, Daniel.
The risks you're describing are dwarfed by the reward.
- Yeah, we hope.
- What do you suggest? Twice a week counseling sessions? Of course, we'd have to put a cone around her neck to keep her from scratching.
Sam, all those years of scratching, those nerves are shot.
There's nothing left to go haywire.
Dr.
Charles, if that were the case, Keegan shouldn't feel anything.
Let alone an itch.
If those nerves were active, that anesthetic would have provided relief for hours.
- It didn't.
- You only used 5 mil.
- It wasn't enough.
- I agree.
The anesthetic didn't work for long, but it did work.
Proves the nerves are involved.
Great, we have a majority.
Not that I care.
- We done? - Sam? All I'm saying, I don't think operating is gonna do a damn thing.
[SIGHS.]
Thanks for you input.
But the last time I checked, I was the neurosurgeon.
Put her on the schedule.
Isn't surgery supposed to be the last option? Dr.
Charles, she scratched into her skull.
[MACHINES BEEPING.]
What happened? He suddenly went into V-fib.
Shocked him multiple times and then he went asystolic.
Another round of epi.
It's in.
Check for a pulse.
Nothing.
Come on, Marc.
Don't you give up.
[BEEPING.]
Pulse is back.
Sinus tach.
He's back.
All right.
Prep him to move.
I'll call ICU, tell them we're sending him up for cooling.
How long was he asystole? Almost ten minutes.
What's your boyfriend thinking? This guy's not waking up.
[INDISTINCT CHATTER.]
[GROANS.]
Hey, is your ulcer getting worse? Today's not helping.
Yeah.
So, I looked at the Paramedic's report from the accident scene.
Marc was down at least five minutes before help arrived.
And after this last code it was almost ten.
I mean, that's almost 15 minutes with no oxygen.
I know.
Increases the chances the brain function he has is now compromised.
But we won't know if that's the case until he wakes up.
You think he really will? After he coded? I don't know.
Maybe it's time to start thinking about honoring his advanced directive.
Advanced directive? Nat, it is a tattoo, not a legal document.
It might be a proxy to one.
And what if Marc does have the paperwork to back it up? I mean, it could be at home in a file or in a safety deposit box.
If something binding exists, the hospital's lawyers will find it, and I'll obey whatever it says.
But until then, it's just a tattoo, and one of many.
Will, Abigail's organs are still healthy.
But they won't be viable for long.
Without Marc or any family to consent, we can't donate them.
But if we honor his tattoo and we let him go, then the hospital can petition to become Abigail's legal guardian, and we can make the decision to donate her organs before they go to waste.
Natalie, you are asking me to let Marc die.
I can't do that.
Well, if by some miracle he does wake up, it'll be to brain damage, paralysis, and the loss of his daughter.
So, please help me understand why you won't even consider this.
I have a responsibility to my patients to do everything I can to save their lives.
Anything less, then I am failing them.
[DRAMATIC MUSIC.]
Okay.
He's losing blood faster than I can replace it.
Massive bleed from behind the liver.
There must be a hole in the vena cava.
Long Allis clamps.
Damn it, this isn't working.
I can't reach the tear without making it worse.
All right, Maggie, get your hands in here.
Push on these packs.
Press hard.
All right.
That'll buy us some time.
Call Dr.
Lanik, get him in here.
I don't care what he's doing.
Just make sure he's scrubbed up and ready to work.
Give me an 8 ET tube and a sternal saw.
Sternotomy? You're gonna open up his chest? I gotta get to the bleed somehow.
Hey, got your page.
Come on in.
Dr.
Abrams is in surgery right now.
As soon as he's done, Keegan's next.
Uh-huh.
- What's all this? - It's an experiment.
For what? Well, you don't think that Keegan can experience her itch without cutaneous nerves.
And I do.
I think I can prove it.
Have a seat.
Okay.
So, can you take your left arm and put it on the other side of the partition here? Thank you.
So, is this like a magic trick? Yeah, kinda.
Okay, so I'm gonna start to brush your real hand and the fake hand simultaneously.
But I just want you to look at the fake hand.
Okay? Whatever you say.
So, amputees sometimes still feel the missing limb, right? Yeah.
A phantom limb.
The nerves are transmitting confusing signals.
Or do amputees still feel missing limbs because the brain is just assuming that it's still there? 'Cause if that were the case, the nerves would be irrelevant.
Right? So, you're suggesting Keegan's got a phantom itch? Her brain is telling her it's there, even though it isn't? Yeah.
Just like amputees perceive a limb that used to be there.
Keegan still perceives an itch that she got three years ago from a drug reaction.
I mean, the brain's basically playing a trick on her.
Interesting theory.
Where are you going with all this? That's not your hand.
Right? But the more you stare at it, while feeling me brush your real hand, the more your brain might start to blend them together.
Well, I guess I can buy that.
Yeah.
Very powerful, the connection between what we see and what we feel.
But Dr.
Charles, I still know which one's my arm.
Huh.
Do ya? Ah.
Uh, for a second there You felt the hammer.
Yeah, I did.
Yeah.
Well, and we both know there aren't any nerve endings in this thing, right? Amazing the tricks the brain can play on us.
Keegan.
Keegan, wait.
I've changed my mind.
I don't think you should have surgery just yet.
Oh, here we go.
What crazy idea has Dr.
Charles talked you into? It may not be a nerve problem.
It could be a perception problem.
In fact, I'm not sure your itch is real.
Not real? Are you two serious? Look at me.
I have to be tied to the bed so I don't scratch a bigger hole in my head.
If surgery will work, I have to do it.
But what if it doesn't? What if you wake up and nothing's changed? It has to work.
Because I can't live like this anymore.
I want my life back.
Surgery will give it to you.
All right, let's go.
Wait, Keegan.
Wait, wait.
The brain can change.
It responds to experience.
It's called neuroplasticity.
Three years ago, a drug reaction created a chronic itch that you can't seem to satisfy, because it rewired your brain.
No surgery is gonna fix that.
Trust me.
Daniel.
Please.
Please, Keegan.
Let me try something before you go under the knife.
It's been three years.
What can you do for me that no other doctor has tried? A trick.
What the hell is going on? I was told you needed help with a liver bleed.
Retro-hepatic cava tear.
Can't fix anything until I control the bleed.
I'm gonna do that with an atrial caval shunt.
You gotta be kidding.
Nope, I'm gonna snake an ET tube down his heart and bypass the tear.
What, you couldn't think of a riskier move? Atrial caval shunts have an abysmal success rate.
Yep, I'm aware.
Then you also know that he's cold and coagulopathic.
So, if you don't pack him up, and get him up to the ICU to be warmed, he's gonna die here on this table.
At least this gives him a shot.
If we send him up to the ICU, he bleeds out and dies for sure.
Scissors and ET tube.
If you cut into that heart, there is no going back.
Yeah, I know.
Don't do it.
[DRAMATIC MUSIC.]
God damn it.
You kick me out of here only to force me to help you kill this guy.
You're a prick, Rhodes.
Yeah, maybe.
[MONITOR BEEPING.]
If her father doesn't wake up, what happens to Abigail's organs? They're no good to anyone.
Ms.
Goodwin, can I speak to you about something? Could've driven a truck through this hole.
He never would have survived in the ICU.
This is the right call.
Don't act like you didn't get lucky as hell.
Let's finish this up.
What do I do? I don't know how long I can go without scratching.
Okay.
I want you to look at your reflection and scratch the non-itchy side of your head.
In the mirror, the image is gonna be reversed.
It's gonna look like you're actually scratching the itchy side.
Oh, I see it.
But how is scratching this side of my head gonna make the itch go away on the other side? Keegan, trust me.
We know that you've been feeling this thing.
But I just want you to consider the possibility that maybe, just maybe that this itch isn't real.
And no amount of scratching is gonna satisfy it.
Well, then what the hell am I doing? Giving your brain new visual input to the override the experience you had three years ago, so it can begin to rewire itself.
Okay, you're losing me.
By feeling yourself scratch one side of your head while you're seeing yourself scratch the other, your brain will be tricked.
And realize something's not right.
Now, hopefully, that experience will force you to perceive a new reality.
A reality in which the itch doesn't exist.
So you say, but nothing's changing.
And I feel stupid.
The exercise is designed to confuse your brain, so don't worry about that.
Just keep scratching.
Like this? Harder? Softer? - Just like you're doing.
- Yes.
Be patient.
Give it a chance.
Keegan, we'll be just outside.
You're doing great.
[DRAMATIC MUSIC.]
How long are we gonna let her keep scratching? She's been dealing with this for what, three years? I mean, honestly Ethan, I don't know how long it might take.
If it takes.
The phantom itch theory makes sense, but it's still just a theory.
I just really don't wanna give her any false hope.
Dr.
Charles.
Something's definitely happening.
The itch, it's less.
Okay.
All right, I'll be back in five.
I'm gonna run these over to sterile processing.
Hey.
Have you seen April? - I wanted to check in on her.
- Nope.
She's probably putting out a fire somewhere.
That girl is on it.
So, things went well while I was in surgery? Yeah, didn't even realize you were gone.
Oh.
That's great.
Yeah.
Dr.
Halstead, could I have a moment? Of course.
An emergency ethics committee was formed to evaluate Marc Jones's current condition and future prognosis.
Wait, was formed? Who asked for that? Between his spinal cord injury and the high probability for irreparable brain damage, the committee concluded with reasonable medical certainty that he has no quality of life.
No.
Listen, the hospital will honor Mr.
Jones's tattoo as an advanced directive.
If he codes again, you will not resuscitate.
I cannot just walk away.
I'm sorry, but it's over, Dr.
Halstead.
I wanna talk to you.
An emergency ethics committee? What, I don't bow down to your decision on my patient, so you go over me to Goodwin and bench me? You forced my hand.
I tried talking to you.
You shut me down.
Because you'd already decided Marc should die.
He has a tattoo across his chest that says, "Do Not Resuscitate.
" We don't know that's how he feels.
We don't know he doesn't.
But what I do know is that if we don't act now, we will lose Abigail's organs.
Those are children's lives in our hands.
No, don't turn this on me.
Don't guilt me into thinking that I'm the bad guy.
You don't think I know the stakes of this case? I am sick of everyone telling me what I can and what I cannot do.
I am just trying to save my patients.
What are you talking about? Who is everyone? You betrayed me.
How can I ever trust you? How can I trust you? In the past, you have let patients go who you knew were hopeless.
But you know what? It is more than that.
No, look at me.
It is more than that.
You have been acting strange for weeks.
And this morning, that ridiculous story about a drug rep, really? Well then, here we are.
And about to get married.
- Maggie.
- Yep.
Thanks for approving my PTO for next month.
I didn't think there was a way to make it happen.
Oh, yeah.
Sure.
April.
Did you sign off on Monique's paid time off for next month? Yeah.
Saw her request had been siting there for three weeks.
I hate it when I put in for vacation times and nothing happens.
It takes a long time because someone's always asking for PTO.
Especially Monique.
She took eight days off last month.
Well, her sister is pregnant, on bed rest and needs help.
So, how could I say no? - What? - Lisa.
I'm talking to you.
I have a system for handling PTO's.
You can't take time off if you're out of vacation.
Monique was out.
Doris gave her some of hers.
Oh, my God.
You let them swap? Doris said she wasn't gonna use them.
No sense letting them gather dust.
You know what's gonna happen now? I'm gonna get hammered with requests from nurses who wanna swap days.
- Thanks a lot.
- You know what? You don't like the way I handle things when I'm doing you a favor A favor? This is a privilege.
Give your privilege to someone else.
[MONITORS BEEPING.]
[BEEPING CONTINUES.]
[SOLEMN MUSIC.]
Time of death, 19:22.
There, he's gone.
You won.
I was about to give up, but then there was this moment.
Look at me, I'm not scratching.
I am so happy for you.
Dr.
Choi, I can keep these mirrors, right? It's so much better.
Of course.
And keep it up.
Over time, they should fade away completely.
Excuse me.
Dr.
Charles, surgery would have been a mistake.
Good call steering her away.
Yeah, but, you know, I certainly understood her desperation for relief.
Do you know that scientifically, itching is ranked as one of the most distressing sensations a human being can experience? Really? You know what, Dr.
Charles, maybe it's not a good idea, but some itches you just have to scratch.
Vicki.
Hey.
What do you say we go for a run? Like old times? Sure.
Call me sometime.
My shift's over.
How 'bout now? [LAUGHS.]
Okay.
Let's do it.
[DRAMATIC MUSIC.]
Okay, look, my way isn't the only way.
You're doing a good job.
Thanks.
And I confess, it sucks when you realize that you can be replaced.
Yeah, I know.
Oh.
Wanna get a drink? Maybe two? Yeah.
Oh, Sam.
You'll be happy to hear that Keegan's feeling much better.
Oh, your smoke and mirrors? Temporary fix.
She'll be back here in six weeks to get that surgery.
Well, that's the way you see it, I, uh, I guess I see it a little differently.
Until next time, Daniel.
Good night.
An atrial caval shunt.
My cowboy.
Dr.
Rhodes.
Three operating rooms upstairs were open.
You could have treated your patient in any one of them.
Maybe, but I didn't want to risk him dying in transit.
That is why we have a Hybrid OR.
The gall bladder surgery you interrupted, I'm rescheduling it for tomorrow.
In the Hybrid OR.
Ms.
Goodwin, this idea to repurpose my room is misguided and reckless.
Your room? Well, the board is considering closing your room unless it starts proving its worth.
That's why I'm gonna make sure it is always earning money.
Great.
Then I'm gonna keep fighting back, because I'm not gonna let Gwen Garrett turn the Hybrid OR into an ATM.
Gwen Garrett has nothing to do with this.
I decided to put general surgeries in there.
So you pull this little stunt again, and I'll show you the door.
[DRAMATIC MUSIC.]
I don't care what she says.
I saved his life.
I'd do it again.
Come here.
[HEAVY BREATHING.]
We're a lot alike, you know.
You'd do anything to get what you want.
You're that bad, huh? I'm that bad.
[SOLEMN MUSIC.]
Abigail's organs are off to recipients.
That's good.
Maybe you want this back? No, I don't.
Natalie, I wanna marry you.