Chicago Med (2015) s11e12 Episode Script
Spill Your Guts
1
Novak and Violet are ten minutes out.
I can take it.
Mm, I wonder why he's so eager.
Could it have something to do
with a certain paramedic?
You want to go back to your place?
[DRAMATIC MUSIC]
Sharon, you're overseeing
the nursing program?
- Yeah, that's right.
- My nephew, Colton.
♪
- I got in?
- [LAUGHS]
You went with another candidate.
Yes, but
No, I understand your support
behind someone who
would benefit from the same
opportunities you were given.
You know, I'm not gonna
dignify that statement
with a response.
♪
Thank you.
Good morning.
This is a lot of hoopla
just to go kiss the ring
of our majority owner.
Well, I'm hearing whispers
this meeting isn't just a formality.
Apparently, he's not happy
with last year's profits.
Well, if they want to cut costs,
they can start by not chartering a jet
to Jackson Hole.
Yeah, well, maybe don't lead with that.
I could talk to Miranda,
see if we could go in
with a unified plan.
I don't have time to explain
your mistake to your boss.
I'm already late.
Looks like she's in a good mood.
[AIRPLANE ENGINE ROARING OVERHEAD]
I should probably go to work.
- Your feet aren't moving.
- It's weird, right?
[CHUCKLES]
You're probably coming down
with something.
- You should call off work.
- Mm, yeah, maybe.
Mm. [CHUCKLES SOFTLY]
Sorry, can I help you?
- You look like a doctor.
- Thanks. So do you.
Oh, I'm a med student.
I'm looking for Dr. Charles.
I'm supposed to meet him in the ED,
but I keep getting turned around.
All right, yeah.
I'm actually headed in,
so I could take you to him.
- Want to pick this up later?
- Yeah.
I will text you with takeout options.
- Okay.
- [CHUCKLES]
[SOFT MUSIC]
- She seems nice.
- She's great.
Man, med students just keep
getting younger every year.
They look like they're in high school.
- They're first-years.
- [CHUCKLING] First-years?
What are they doing here?
You, uh you remember my friend Howie?
Of course. Yeah, I'm
I'm sorry about his wife.
- I know how close you were.
- Yeah, well, thanks.
Um, anyway, Howie is on
the faculty of the med school
at Porter University, right?
As you might know, there's a shortage
of mental-health workers
in this country.
So Howie identified a few students
who were interested in psych.
He asked me to come talk to them.
Oh, but that wasn't good enough.
No, it wasn't, because I'm a lazy ass,
so I made 'em come to me.
Dr. Charles, this is, uh, Amira.
She's been looking for you.
Amira, what a pleasure to meet you.
I was just on the way
to say hi to your friends.
Oh, they're not my friends.
I don't really have friends
at school yet.
Oh, no? Well, um, who knows?
Maybe by the end of the day,
that will have changed.
How are we doing?
Uh, not as good as you,
judging by that lipstick on your neck.
That explains why security
keeps high-fiving me today.
Okay. Sorry. [CELL PHONE VIBRATING]
Sorry, it's, uh, spam.
What were you, uh, saying?
Uh, just that it looks like
it's getting hot and heavy
with you and Novak.
Yeah, it's definitely hot.
Don't know about heavy.
She's not super into talking
about personal stuff.
[FILE THUDS ON DESK]
- [CLEARS THROAT]
- Thoughts?
What is it with these men
wanting emotional intimacy?
Can you not just be happy
that you're having sex in a parking lot?
That's that's oddly specific.
- Treatment three.
- Um
If we have specific questions
about procedures, is it okay
Fire away anytime, Sabrina.
Yo, TikTok, what's up?
Stay with me, Quentin, okay?
100%. I'm stoked, boss.
So do you use structure
protocols for triage here?
Or are you more focused
on rapid assessment
- for better crisis intervention?
- That's an excellent question.
Uh, should
should we all be taking notes?
You know what? My only wish is,
at the end of the day, you guys
have a much clearer idea
of what this specialty is about.
Somebody please help us!
Our son was shot! Please help him!
Let's give 'em some room.
Trauma 3 is open. It's over here.
What happened?
We were just walking to his
speech therapy appointment.
One wound under the right collarbone,
second wound just below the tip
of the scapula
subclavian trajectory.
We were waiting at the light.
There was two guys.
One pulled out a gun,
and we just heard a loud pop.
Decreased biradial pulse.
Let's get blood in the room.
- Copy.
- Is he gonna be okay?
- Billy!
- Page Dr. Morgan.
You guys need to wait outside.
I promise we're gonna take
good care of him, okay?
I'll get the cordis in.
We need to intubate.
Let's call the blood bank
and move MTP to the OR.
- Copy.
- [CRYING] Billy.
They got him. He's gonna be okay.
2 grams of TXA, 1 gram of Ancef,
- and let's get ready to X-ray.
- On it.
Excuse me.
[DRAMATIC MUSIC]
♪
- Hey, Kiana.
I'm Dr. Frost.
I'm seeing here that you fainted today.
Yep, ate it walking to school,
and I've been all hammajang
since I woke up.
I'm sorry. Hamma hamma what?
It's Hawaiian Pidgin.
It's like "out of sorts."
- I'm Jean, Kiana's mom.
- It's nice to meet you both.
All right, you're from Hawaii, huh?
Kauai. We moved to Chicago
this past summer.
Yeah, we came because my mom
is marrying Steve the Dentist.
Steve the Dentist
why does that sound familiar?
Dude, his face is on,
like, most of the city buses.
"Smiles for miles," right?
All right.
Can you look forward for me, Kiana?
We met when he was visiting Lihue
for a conference a couple years back.
Did the long-distance thing
until he proposed.
Congratulations.
And now we're here freezing to death.
Can I see your hands
for a moment, Kiana?
- Are you feeling cold right now?
- A little.
I've been achy since yesterday.
I thought it was because
my period came on pretty aggro
- this month.
- Kiana.
And then earlier today,
I got a little lightheaded
and woke up on the ground.
You know, I think I'm just
allergic to the Midwest.
[CHUCKLES] I'm gonna get some labs done
and then loop in OB/GYN,
see if it is menstrual-related.
Uh, in the meantime, Nancy,
can we get a, uh, bag of warm
saline and a heated blanket?
Yep.
How are you, Miranda?
I'm all right.
[SIGHS] What's up?
I heard a rumor about this meeting.
- More budget cuts?
- [SIGHS]
I didn't come to argue.
I came because we should talk about it,
make sure we're protecting
what's important.
I appreciate that offer, but
why don't we just go in there
and see what's what first?
You know, it may be good to highlight
moves that cost Gaffney up front
but protect us in the long-term.
Hiring better staff,
getting better equipment
means better outcomes, less lawsuits.
Dr. Hayes's lawsuits cost us a fortune.
So I was supposed to sweep
that under the rug?
No, but I am getting tired
of your sanctimonious attitude, Sharon,
like you're somehow unimpeachable.
The moral center of this hospital
I mean, you get to be that
because I make the hard choices.
I'm done with it.
Oh, I see.
I'm the budget cut, aren't I?
- You're trying to get rid of me.
- Look, as I said
[OBJECTS CLATTER] [GASPS] Damn!
Let's just talk at the meeting.
[TENSE MUSIC]
♪
[SCOFFS]
Okay, nothing abnormal.
I think that your period issues
might just be regular cramps.
- [KNOCKING ON DOOR]
- Safe to come in?
You may enter, Steve the Dentist.
Hey, you!
Hi. [BOTH SMOOCH]
Where are the girls?
I just dropped them off with their mom.
Thought it might be nice
to have a little quiet
- when Kiana comes home.
- Oh, that's thoughtful.
It'll also allow me
to absolutely own you
in "Super Smash Bros."
Oh, you think I'm gonna go
easy on you 'cause you fainted?
Yeah, think again. I prey on the weak.
- [LAUGHTER]
- Oh.
Hey, can I borrow you for a second?
Yeah. We'll be back.
So the exam didn't suggest
any gynecological causes
for Kiana's symptoms.
Well, we got her labs back.
Hemoglobin's 8.6. She's anemic.
Yeah, but what's causing it?
Well, her iron levels, folate, and B12
look all normal.
Though it did take them
two times running the blood
because it was so thick.
Her hands were blue
when she came in, right?
Yeah.
And she has never
experienced anything like this
until she left Hawaii.
You think this might be CAD.
So she might actually be
allergic to the Midwest?
[SCOFFS]
What's CAD?
I heard some doctors talking about it.
Anybody know
what they were referring to?
- Nope.
- Cold agglutinin disease.
It's a rare autoimmune disorder.
Very good.
Uh, more specifically,
it's when cold weather
triggers your immune system
to attack red blood cells,
which, in turn, causes
- Anemia.
- Excellent.
Dr. Charles, two patients
incoming one in restraints.
Why restraints?
He attacked his brother with
a large rocking pizza cutter.
Okay.
Maybe you guys hang back
a bit on this one.
His guts are coming out of him!
- His guts are coming out of him!
- Enzo Pagliano.
- You can't let him do this!
You got to stop him!
Wait, where's the wound?
I don't see a wound.
It's not blood. It's pizza sauce.
"Pizza sauce"?
They're opening a restaurant,
were in the middle of a tasting
when he attacked.
Guy behind us is the one
in real trouble.
Please don't let him do this!
He's trying to cut me out!
5 of haloperidol IM.
Dante Pagliano, Enzo's brother.
- Trauma 2.
- Tachycardic at 133.
Blood pressure's dropping,
now 94 over 53.
Lower-abdominal injury
unknown blood loss, eviscerated bowel.
On my count. One, two, three.
50 of fentanyl, and let's get
some wet lap sponges.
- Listen to me, please.
- [GROANING IN PAIN]
He's got an eviscerated small bowel
and lacerated mesentery.
- We need to get him to an OR.
- Right, I'll call up.
I brought it out.
You didn't do anything, Dante.
Your intestines are outside your body.
We need to get them back in.
No, no, my brother
I brought a demon out of him.
You can't let him do this!
No! Let me go!
I spilled his guts!
Aah! Let me go!
Dante suffered an
evisceration of his intestines,
which will require
an exploratory laparotomy
and an abdominal-wall reconstruction.
As soon as we get an OR,
we'll be moving him to surgery.
Don't you usually refer
to patients by their last name?
What was that?
It's, uh, usually patient preference,
but given that they're brothers,
it's probably better
to go with first names
- because it'll be clearer.
- Got it. Okay.
Did Dante have any other ideas
about why his brother might
have had a psychotic break?
Just that he thought
he brought out the psychosis in him
and it was all his fault.
- But he'd lost a lot of blood.
- He also said it was a demon.
- Yeah.
- Oh.
I've encouraged them
to speak up and ask questions.
That's fun.
How's Enzo now?
Well, the haloperidol just kicked in,
so we're hoping to have
a conversation with him
- when he wakes up.
- All right, keep me posted.
- Oh, excuse me, Dr. Lenox.
- Oh, good, more questions.
Sorry, um, I was just wondering
if there was an update on the boy
with the gunshot wound from earlier?
Billy, I think.
Mm, he had a subclavian-artery injury.
He's in the ICU.
Oh, but is he gonna be okay?
I have a brother who's the same age.
If he makes it through the next
few hours, he'll have a chance.
So she's had this CAD her whole life?
She's just never been
anywhere cold enough
- to feel the effects.
- But the good news is
rituximab infusions four times
over the next month
should resolve your symptoms.
- Like, forever?
- Like, foreva, eva.
[CELL PHONE VIBRATING]
- [CLEARS THROAT]
- Spam again?
Yeah, just, uh, probably
got put on some list.
Is my brother okay?
Could be in surgery a few more hours,
but as soon as we know anything,
- we'll let you know.
- Oh, God, I hurt him.
I hurt him.
Enzo, can you tell me
from your perspective
what happened today?
That's the thing. I don't really know.
It doesn't really make any sense.
Well, how do you mean that?
Well, Dante and I
were working on the menu,
and I started to get this suspicion.
And then it came on so strong,
like he was trying to cheat me.
Had he done anything
to make you think that?
No. [CHUCKLES]
Dante? If you met him,
he's the most honest,
gentle guy in the whole world.
He'd never do something like that.
Right.
But this morning, in that moment,
I was sure of it.
And it made me so angry.
Has this ever happened before?
Not like this exactly.
But, lately, yeah.
Sometimes I have these thoughts.
They don't feel like they're mine.
Huh.
Your brother seems to think
that he's responsible for this reaction.
Oh, yeah, well
'cause a lot of times
I have these thoughts,
it's when we're together.
And I don't know why.
He didn't do anything to provoke you?
This just it just happened?
No. [LAUGHS]
I love my brother.
He's everything to me.
You got to save him, Doc.
You can't let him die.
So, what, she was just gonna
ambush you at this meeting?
Sounds like it.
Let me go talk to them, see
if I can smooth things over.
They can't let personal issues
from one board member
dictate a decision of this magnitude.
You know, actually,
let me go over there.
Sharon, don't make things worse.
I'm good.
I don't have any interest
in going another round
on this right now.
I don't either.
I just want to know
if you're feeling okay.
I'm fine. Why wouldn't I be?
You seem a little shaky.
I because I spilled a drink?
Miranda, your hand's still shaking.
Talk to me.
I'm just a little shaken up
from this morning.
My driver got in a fender bender,
and I I wasn't wearing my seat belt.
- Did you hit your head?
- No.
But I did get thrown into the back
of the driver's seat pretty hard,
and my ribs feel a little sore,
and I'm sure the altitude
is not helping my breathing.
So you feel out of breath?
Come.
I want you to lay down here.
Excuse us?
Peter, can you get rid
of these pillows, please?
Really, you don't need to make a fuss.
I mean, the car
wasn't even going that fast.
Yeah, well, slow-speed accidents
can be just as dangerous
as high-speed ones.
Your heart rate's in the 120s.
- That's high.
- Uh, excuse me.
Can you bring some blankets, please?
Of course.
I'm gonna need you to lay back
and take deep, slow breaths, okay?
- [CELL PHONE VIBRATING]
- [SIGHS]
Hey, please stop calling me.
You've been ignoring me all day.
I'm at work right now, so
I know, I know,
but I need to talk to you.
- [SCOFFS]
- You've put on weight.
[CHUCKLES]
- What are you doing here, Mom?
- I just want to talk.
We really don't have
anything to talk about.
- It's been 14 years.
There's plenty to discuss.
Like, I don't know
how you bankrupted me?
We were just trying to provide
a better life for everyone.
What do you want us to do, grovel?
That could be a start.
Look, we took the RV here,
and there's a little
hole-in-the-wall restaurant near us.
Your father and I would like to see you.
Really? So where is he, then?
I I'm sorry.
Hey, we have a situation. It's Kiana.
She was fine a minute ago.
[ALARM BLARING]
125 milligrams SOLU-MEDROL,
50 of Benadryl.
What's going on?
She had an allergic reaction
to the infusion.
She started hyperventilating
and then lost consciousness.
I already gave her 0.3 epi.
Kiana? Hey!
- BP's 80/55.
- Anaphylactic shock.
Okay, let's get ready to intubate.
One more dose of epi.
- Oh, my God, my baby!
- Come on, Kiana, stay with us.
She's resting now, but she'll be okay.
So she has a rare disease,
then a rare allergic reaction
to the medicine that cures it?
There is a second-line treatment.
It would resolve the symptoms,
but it would not cure
the CAD like the rituximab.
It would also require infusions
every other week.
But only during cold-weather months.
But if we went back
to Hawaii, presumably,
she'd go back to being
totally fine again?
Presumably.
[DRAMATIC MUSIC]
♪
Okay, CT clean, MRI clean.
So no trauma, nothing neuroplastic.
What's going on here? Wide lens, guys.
No bad ideas. Let's go. Quentin.
Uh [EXHALES DEEPLY]
Let me think. I
Oh, uh, maybe preexisting
mental-health conditions.
- Yeah.
- Bipolar, schizophrenia.
I like it,
except Enzo's been a stable,
high-functioning executive
for a whole bunch of years
with, technically, no family history.
Oh, my God.
Folie à deux.
Huh?
Go on.
It's a phenomenon
in which a dominant individual
with a psychotic disorder
imposes their delusions
onto a close partner,
inducing psychosis in someone
who otherwise would have
no mental-health issues
of their own.
So what you're suggesting
is that perhaps
- Dante's actually the sick one?
- Yes.
And that Enzo,
just by nature of standing
side by side with his brother
for all those hours
Enzo got pulled into his delusions.
Huh.
- You're a first-year?
- I read ahead.
Okay, well, honestly, that's
a pretty impressive hypothesis.
I think that maybe
we should be, uh, looking
into Dante's history.
What do you say?
Hey, uh, Kiana's waking up.
She was looking
Whoa. What's going on?
[CRYING] What's best for my daughter
is going to destroy my marriage
not even my marriage,
my impending marriage.
That's tough, but, I mean,
how are you so sure?
[SNIFFLES] Because Steve just told me.
I mean, he was lovely about it,
and he adores Kiana,
but he doesn't want to do
long distance anymore.
He doesn't want to move to Hawaii?
He would in a heartbeat, if he could,
but he has shared custody
of his daughters,
- and his ex lives here, so
- Yeah, it's a nonstarter.
I don't even blame him.
We did the whole long-distance
thing for two years,
and it was so hard.
And it's four more till Kiana
goes to college, so
I just don't know.
You don't know what?
How many times have you been in love?
[CHUCKLES SOFTLY]
Yeah, that's, uh, hard to say.
Well, for me, it was zero.
That's crazy to say, but it's true.
Even Kiana's father
I never felt that connection,
that euphoria.
I came to terms with the fact
that I was just
broken.
But then I met Steve the Dentist.
And every awkward little edge of his
fit every awkward little edge of mine.
And for the first time,
I was totally and completely
head over heels.
But what are the odds
I'll ever find that again?
♪
I just don't know if I can give that up.
♪
Tough choice.
I can't decide if I want sweet or salty.
It's the age-old question, man.
Just came out here to
check up on how you're doing.
You okay?
Me? I'm good.
Just, uh, got the feeling
I don't know
you're not that engaged
with what we're doing here today.
Oh, uh [SIGHS]
Like, I don't want
to seem unappreciative.
I think what you're doing here
is really cool.
It's just
What?
I'm not really interested in ED psych.
Oh.
Figured that out already, did you?
[CHUCKLES]
I guess I just want
a good work-life balance.
Both of my parents are immigrants.
They had to work still do
really hard.
And they pushed me
so I don't have
to kill myself like they do.
I just think having a private
practice is more my speed.
Quentin, diagnostics
are diagnostics, right?
I mean, you're gonna run into this stuff
no matter where you end up.
I mean, what, you think because
you got a cozy office setup,
your patients are just gonna walk in
and plop themselves down on the couch,
tell you what's wrong with them
and how to fix it?
I'm not saying I don't want
to do a good job, Doctor.
I
Look, work-life balance is important.
I get it. Really, I do.
It's just that this field
I don't know
if you can really half-ass it.
You know, you really got to
you got to get to know your patients.
You got to get in there
so you can understand them,
see the world the way they do, right?
So you can understand their issues.
I mean, if you don't want to do that,
you don't want to put
your whole soul into this,
you might want to reconsider.
Reconsider what?
Being a doctor.
Ms. Goodwin, it's Dr. Howard.
- Can I help you with something?
- I hope so.
I'm currently on a plane
with a woman, a board member,
- who seems to be in trouble.
- What's going on?
Well, she was
in a minor traffic accident
that caused some sort
of thoracic trauma.
She didn't think much of it
until she started experiencing weakness.
- Any idea of her vitals?
- Oh, yes.
There is an emergency
medical kit up here.
Her breath sounds are good,
but her BP is only 84 over 42.
Oh, okay, um
then it's not a pneumothorax
or hemothorax.
Uh, take a look at her neck.
Is the jugular vein distended?
Hold on.
Yes.
Okay, um, it sounds like
pericardial tamponade.
She's bleeding into the sac
around her heart.
How much time until you land?
Uh, 30 minutes, maybe more?
Oh, um
Dr. Howard, what is it?
Ms. Goodwin, are there any
surgical supplies in that medical kit?
I've got lidocaine, some saline flushes,
and a few needles.
- What size needles?
- 16 gauge and a 22.
Okay, good. You're going to use the 16
to remove the fluid built up
around her heart.
You'll angle it at a 15-degree angle
just under the breastbone,
and you should push
until the tip punctures the pericardium.
Wait, how will I know when that happens?
Usually, we'd have
an ultrasound to guide us,
but you're just gonna have
to take it slow.
And you should feel a
a soft pop when it goes in.
A soft pop.
And and what if I miss
or or go too far?
You mean if you puncture the heart?
Dr. Howard, I don't know.
I don't feel comfortable
going in blind like this.
- There is another option.
- Yes?
But let me just start by saying,
it's not as scary as it sounds.
[DRAMATIC MUSIC]
You want to cut me open?
It's a small incision,
just so I can see
where to put the needle.
The needle you want to put in my heart?
Not in your heart, Miranda,
into the sac around your heart.
Have you done this before?
I've seen it done.
No way. We can wait. We can wait.
We can wait until we land.
Miranda, if we wait
you're not going to make it.
♪
Am I just gonna be awake for this?
Yes, but you shouldn't feel much, okay?
We have lidocaine
that will numb the area,
and we also we also have these.
What is that? A weed gummy?
It is, provided by in-house counsel.
♪
[CRYING] I don't
I don't I don't want to die.
Miranda
I know we have had our issues,
but I think you also know
that I mean what I say.
And I'm telling you,
I will do everything I can
to get you through this.
Okay.
Hey, where are your, uh,
med-school ducklings?
- Lunch.
- What?
How are you preparing them
for life as a doctor
if you are letting them
take a full lunch?
- Easing them in.
- Except for that guy.
Quentin.
You can't talk to the patients
without me there.
Sorry.
I I was just thinking about
what you were saying earlier
about connecting with patients,
seeing every angle of their condition.
Okay.
Well, um
what did you learn?
Well, I I know Sabrina
has that theory
about shared psychosis,
but when I talked to Enzo
about what he and his brother
do together,
he said all they really do is work.
So I started to wonder
if Dante being there
when Enzo had an episode
was more a coincidence
rather than a cause.
Maybe it's the restaurant
itself causing it.
So you're saying you think
maybe it's environmental?
Maybe.
Now, I know it's a long shot,
but I remember reading somewhere
that celiac disease can cause psychosis.
It's certainly true
that, uh, in rare cases, right,
that the inflammation
can extend beyond the abdomen
and up into the brain, yep.
And it can come on later on
in life, right?
Like, when you open a pizza
restaurant with your brother,
and you're suddenly exposed to
gluten in massive quantities.
I'm just saying, it would explain the
the weight loss,
the vitamin-deficiency issues
And why it only happens
when they're together.
Yeah.
Trini
order a, uh,
tissue transglutaminase test.
- Yeah?
- Hell, yeah.
Get it back in an hour or so.
We'll see what's what.
Nice work.
All right!
I'm gonna go grab lunch now.
Uh, Dr. Charles, I I'm sorry,
but you already asked us
to test for celiac.
I sent you the results.
They came back positive.
I know, but, like,
why rain on the guy's parade?
He did good.
Yeah. [CHUCKLES]
- Did you hear the good news?
- Yeah, what's that?
We're going back to Hawaii.
Peace out, Chi-town.
Wow, I I didn't realize
you'd, uh, already made the decision.
Wasn't really a decision.
It's what's best for Kiana.
Well, she's going to be transferred
to the PICU in a bit
just to observe overnight,
but she should be out tomorrow.
Sounds good. Thank you.
Hey, can we get a place
closer to Salt Pond Beach
or a place with a game room
so I can keep schooling
Steve the Dentist?
Where is he, by the way?
Uh, he, uh, had to run out for work.
Poor guy.
He's gonna have to build up
that base tan again.
On the other hand, maybe he'll
finally learn how to surf.
[CHUCKLES SOFTLY] Yeah.
Maybe.
♪
That's pretty tight.
Well, we don't want
any involuntary movement.
- That gummy help?
- I don't think so.
Uh, all right.
- Can you feel that?
- No.
Lidocaine's working. That's something.
Dr. Howard, I think we're ready.
Okay, good.
So you're gonna find
the xiphoid process,
the very tip of the sternum.
About one finger width below that,
you'll make your incision
8 centimeters
or about 3 inches vertically.
Okay. Okay.
You might not want to watch this.
Oh, my God.
Okay.
I've made my incision.
- Gauze.
- Good.
Okay, now, you're gonna
push the tissue laterally
until you find the heart
and the bulging sac
around it filled with fluid.
Get closer.
- I think I see it.
- Good.
Her pulse is slowing down now.
I-it's okay. It's okay.
When we get that fluid out,
it'll take the strain off of the heart,
and that pulse is gonna
come right back up.
Okay, what now? [GASPS]
Okay, you're gonna take your syringe
and push it through the pericardium.
When you start needle penetrate
Dr. Howard, the needle goes in
at 15 degrees, correct?
15 to 20 when it gets to the pericard
- [STATIC WHIRS]
- Dr. Howard?
Dr. Howard?
- Oh, no, we lost service.
- No, no, no, no, no.
- Do you know what to do?
- Uh, I'm not sure.
Please, I I can't breathe.
Oh, my God. I think she's dying!
Okay, st Okay.
We need to find another phone.
Everyone, stop talking!
♪
Okay, go in
at a shallow angle,
and then as the
needle penetrates
until you feel the pop.
[GASPS] I think
I feel it.
♪
Oh.
That's it. I mean, that's good, right?
Her pulse is coming back up.
[SIGHS]
♪
[EXHALES DEEPLY]
♪
So Dr. Lenox had to do
a pretty significant bowel resection
and then repair the initial laceration,
but it looks like Dante's gonna
make a complete recovery.
Hard to imagine that Dante
and Enzo's relationship
will recover that quickly.
You're probably right about that.
Ah. You're all still here.
Yeah, we're just finishing up our day.
Uh-huh. Well, I heard one of you
cracked the case with Enzo
gluten-induced psychosis.
Yeah, undiagnosed celiac disease.
As long as he stays away from gluten,
he should be fine, right?
Sucks that they have
a pizza place, though.
I mean, I've had gluten-free
pizza, so that's an option,
but I feel like it's never
as good, you know?
[SOBBING] Oh, no, no!
That's the boy from this morning.
- Billy.
- Wait. Is he
Yes.
I thought you said he was gonna be okay.
I said he had a chance.
But the bleeding was too severe.
He was in DIC.
We couldn't get him to clot.
Yeah.
Unfortunately, subclavian injuries
are really tough to survive.
[SOMBER MUSIC]
♪
- [GASPS]
- Please don't get up.
Jonathan Michael.
I didn't think you would come.
Neither did I.
What's the thing?
Excuse me?
The thing you want?
If it's money, I'm
I'm on a resident's salary.
And if it's a place to live,
then, well, I'm sleeping
at a friend's house.
We didn't come here
to get anything from you.
You really think
we're monsters, don't you?
I watched a mom today
blow up her entire life
for her kid
because she wanted to put
her health first.
And then I watched that same mom
put a smile on her face so
her kid wouldn't feel bad.
- I don't understand.
- I know you don't.
See? 'Cause, um
well, I I witness things like that
every day in my hospital
you know, parents that go
to the end of the Earth
to protect their kids, no matter what.
And, I mean
you two
[SCOFFS, SNIFFLES]
I'm just gonna ask again.
What do you want?
- We just want to see
- I'm sick.
Secondary progressive MS.
♪
How long have you known?
A while, maybe six months.
♪
That's why we're here.
We want to reconnect with our son.
♪
- No.
- No what?
No, I'm not doing this
With you right now.
Okay, I
[SCOFFS]
♪
[BREATHING SHAKILY, SNIFFLES]
♪
Mm.
Listen, great job today.
- Yeah, thanks.
- No, no, I mean it.
I mean, that, um that
"folie à deux" idea you had
about Enzo [SCOFFS]
That was a spectacular guess.
Look, it might not have been
the right one,
but trust me, that kind of creativity,
you know, lateral thinking
is really important
in this line of work, so
It's not that, though.
I think I'm just
kind of rethinking things.
Huh.
I don't know if this is for me.
Oh, how so?
[SIGHS]
I didn't know
it would affect me so much.
I mean, even with Dante and Enzo,
even though that worked out,
there was still so much
It just got to me. I don't know.
There's a cost
to having a job with meaning, right?
I mean, we experience these
[EXHALES SHARPLY]
Brutal
moments here, like
true despair.
But trust me, there are also
these moments of euphoria,
of, like, extraordinary fulfillment,
because we change people's lives here.
And if we're lucky,
we actually save them.
So, for me, anyway, I mean, over time,
the benefits definitely
come to outweigh the costs.
I know it might not feel
like it right now,
but if you are feeling things deeply,
as far as I'm concerned,
it just means that, you know,
you're doing it right.
Yeah maybe.
I-I just think that
[SIGHS] I don't know.
Maybe I like the puzzle piece
and not all the pain.
Yeah, maybe I'll go into research.
I don't know.
Anyway.
[SOFT MUSIC]
♪
Thank you anyway, Dr. Charles.
♪
Oh, thanks for coming. Thanks.
♪
You guys taking off?
- Oh, yeah.
- Yeah.
Look, today was, uh
it was a lot, right?
Really glad you got to see
what we we actually do here.
But, you know, just for the record,
it was just extra intense, you know?
I just hope it wasn't
I don't know discouraging.
[SCOFFS]
Dr. Charles, today was
the greatest day of my life.
Really?
Well, my life's pretty boring,
but, yeah [CHUCKLES]
Really.
Yeah, it was pretty dope. Thank you.
♪
You're welcome.
Thank you. Yeah, thanks for coming.
- See you around.
- See ya.
♪
Huh.
♪
[KNOCKING ON DOOR]
Come in.
- Hey.
- Hi.
- How's Miranda?
- Good.
We were able to repair
the laceration in her atrium
- without issue.
- Great.
You know, all those years
of watching surgery,
assisting, I never really understood
the impact of that moment,
of holding the knife and
and cutting into someone.
Yeah.
My first surgery was a foot amputation.
I was so nervous,
I thought I was gonna puke.
But my attending talked me
through it, and I got it done.
Later, she got me a bracelet
that had a little charm of a foot.
She said it should be a reminder
even though
these miraculous things we do
have somehow become commonplace,
we shouldn't ever forget
they're extraordinary.
Yeah.
[LAUGHS]
"I heart Chicago."
Yeah, because of what you did
with Miranda's heart.
- Yeah, yeah, yeah.
- I'm sorry.
It's the best that I could do
on short notice.
But, anyway, um, welcome to the club.
- Thank you.
- Mm-hmm.
♪
[CHUCKLES]
So what did you say?
I said no.
And, um
I mean, it it hurts
more than I want to admit.
But it doesn't just erase
how my dad has treated me my whole life.
I I wish I could just move
past it, you know?
But I can't.
And
it makes me feel like a bad person.
I'm sorry. I know
this is not the, uh,
conversations we usually have.
And
I mean, well, you ordered takeout
from just about
every restaurant in Chicago.
[CHUCKLES]
Well, you didn't answer my texts,
so I I got a little bit
of everything.
Now I'm ruining it.
No, you're not. Hey.
Trust me, I would never judge
someone in a situation like this,
let alone tell them what to do.
I will just say, no matter
how you are feeling right now,
someday your parents will be gone.
And whenever that happens,
however you leave things
That's how it will stay
forever.
Sounds like you're speaking
from personal experience.
[SOFT MUSIC]
We're talking about you here, pal.
[CHUCKLES] I know, but
we don't always have to just be on me.
♪
Except I like being on you.
- That's not what I meant.
- [CHUCKLES]
Doesn't make it any less true.
♪
- Good talk.
- Great talk.
[CHUCKLES]
♪
Novak and Violet are ten minutes out.
I can take it.
Mm, I wonder why he's so eager.
Could it have something to do
with a certain paramedic?
You want to go back to your place?
[DRAMATIC MUSIC]
Sharon, you're overseeing
the nursing program?
- Yeah, that's right.
- My nephew, Colton.
♪
- I got in?
- [LAUGHS]
You went with another candidate.
Yes, but
No, I understand your support
behind someone who
would benefit from the same
opportunities you were given.
You know, I'm not gonna
dignify that statement
with a response.
♪
Thank you.
Good morning.
This is a lot of hoopla
just to go kiss the ring
of our majority owner.
Well, I'm hearing whispers
this meeting isn't just a formality.
Apparently, he's not happy
with last year's profits.
Well, if they want to cut costs,
they can start by not chartering a jet
to Jackson Hole.
Yeah, well, maybe don't lead with that.
I could talk to Miranda,
see if we could go in
with a unified plan.
I don't have time to explain
your mistake to your boss.
I'm already late.
Looks like she's in a good mood.
[AIRPLANE ENGINE ROARING OVERHEAD]
I should probably go to work.
- Your feet aren't moving.
- It's weird, right?
[CHUCKLES]
You're probably coming down
with something.
- You should call off work.
- Mm, yeah, maybe.
Mm. [CHUCKLES SOFTLY]
Sorry, can I help you?
- You look like a doctor.
- Thanks. So do you.
Oh, I'm a med student.
I'm looking for Dr. Charles.
I'm supposed to meet him in the ED,
but I keep getting turned around.
All right, yeah.
I'm actually headed in,
so I could take you to him.
- Want to pick this up later?
- Yeah.
I will text you with takeout options.
- Okay.
- [CHUCKLES]
[SOFT MUSIC]
- She seems nice.
- She's great.
Man, med students just keep
getting younger every year.
They look like they're in high school.
- They're first-years.
- [CHUCKLING] First-years?
What are they doing here?
You, uh you remember my friend Howie?
Of course. Yeah, I'm
I'm sorry about his wife.
- I know how close you were.
- Yeah, well, thanks.
Um, anyway, Howie is on
the faculty of the med school
at Porter University, right?
As you might know, there's a shortage
of mental-health workers
in this country.
So Howie identified a few students
who were interested in psych.
He asked me to come talk to them.
Oh, but that wasn't good enough.
No, it wasn't, because I'm a lazy ass,
so I made 'em come to me.
Dr. Charles, this is, uh, Amira.
She's been looking for you.
Amira, what a pleasure to meet you.
I was just on the way
to say hi to your friends.
Oh, they're not my friends.
I don't really have friends
at school yet.
Oh, no? Well, um, who knows?
Maybe by the end of the day,
that will have changed.
How are we doing?
Uh, not as good as you,
judging by that lipstick on your neck.
That explains why security
keeps high-fiving me today.
Okay. Sorry. [CELL PHONE VIBRATING]
Sorry, it's, uh, spam.
What were you, uh, saying?
Uh, just that it looks like
it's getting hot and heavy
with you and Novak.
Yeah, it's definitely hot.
Don't know about heavy.
She's not super into talking
about personal stuff.
[FILE THUDS ON DESK]
- [CLEARS THROAT]
- Thoughts?
What is it with these men
wanting emotional intimacy?
Can you not just be happy
that you're having sex in a parking lot?
That's that's oddly specific.
- Treatment three.
- Um
If we have specific questions
about procedures, is it okay
Fire away anytime, Sabrina.
Yo, TikTok, what's up?
Stay with me, Quentin, okay?
100%. I'm stoked, boss.
So do you use structure
protocols for triage here?
Or are you more focused
on rapid assessment
- for better crisis intervention?
- That's an excellent question.
Uh, should
should we all be taking notes?
You know what? My only wish is,
at the end of the day, you guys
have a much clearer idea
of what this specialty is about.
Somebody please help us!
Our son was shot! Please help him!
Let's give 'em some room.
Trauma 3 is open. It's over here.
What happened?
We were just walking to his
speech therapy appointment.
One wound under the right collarbone,
second wound just below the tip
of the scapula
subclavian trajectory.
We were waiting at the light.
There was two guys.
One pulled out a gun,
and we just heard a loud pop.
Decreased biradial pulse.
Let's get blood in the room.
- Copy.
- Is he gonna be okay?
- Billy!
- Page Dr. Morgan.
You guys need to wait outside.
I promise we're gonna take
good care of him, okay?
I'll get the cordis in.
We need to intubate.
Let's call the blood bank
and move MTP to the OR.
- Copy.
- [CRYING] Billy.
They got him. He's gonna be okay.
2 grams of TXA, 1 gram of Ancef,
- and let's get ready to X-ray.
- On it.
Excuse me.
[DRAMATIC MUSIC]
♪
- Hey, Kiana.
I'm Dr. Frost.
I'm seeing here that you fainted today.
Yep, ate it walking to school,
and I've been all hammajang
since I woke up.
I'm sorry. Hamma hamma what?
It's Hawaiian Pidgin.
It's like "out of sorts."
- I'm Jean, Kiana's mom.
- It's nice to meet you both.
All right, you're from Hawaii, huh?
Kauai. We moved to Chicago
this past summer.
Yeah, we came because my mom
is marrying Steve the Dentist.
Steve the Dentist
why does that sound familiar?
Dude, his face is on,
like, most of the city buses.
"Smiles for miles," right?
All right.
Can you look forward for me, Kiana?
We met when he was visiting Lihue
for a conference a couple years back.
Did the long-distance thing
until he proposed.
Congratulations.
And now we're here freezing to death.
Can I see your hands
for a moment, Kiana?
- Are you feeling cold right now?
- A little.
I've been achy since yesterday.
I thought it was because
my period came on pretty aggro
- this month.
- Kiana.
And then earlier today,
I got a little lightheaded
and woke up on the ground.
You know, I think I'm just
allergic to the Midwest.
[CHUCKLES] I'm gonna get some labs done
and then loop in OB/GYN,
see if it is menstrual-related.
Uh, in the meantime, Nancy,
can we get a, uh, bag of warm
saline and a heated blanket?
Yep.
How are you, Miranda?
I'm all right.
[SIGHS] What's up?
I heard a rumor about this meeting.
- More budget cuts?
- [SIGHS]
I didn't come to argue.
I came because we should talk about it,
make sure we're protecting
what's important.
I appreciate that offer, but
why don't we just go in there
and see what's what first?
You know, it may be good to highlight
moves that cost Gaffney up front
but protect us in the long-term.
Hiring better staff,
getting better equipment
means better outcomes, less lawsuits.
Dr. Hayes's lawsuits cost us a fortune.
So I was supposed to sweep
that under the rug?
No, but I am getting tired
of your sanctimonious attitude, Sharon,
like you're somehow unimpeachable.
The moral center of this hospital
I mean, you get to be that
because I make the hard choices.
I'm done with it.
Oh, I see.
I'm the budget cut, aren't I?
- You're trying to get rid of me.
- Look, as I said
[OBJECTS CLATTER] [GASPS] Damn!
Let's just talk at the meeting.
[TENSE MUSIC]
♪
[SCOFFS]
Okay, nothing abnormal.
I think that your period issues
might just be regular cramps.
- [KNOCKING ON DOOR]
- Safe to come in?
You may enter, Steve the Dentist.
Hey, you!
Hi. [BOTH SMOOCH]
Where are the girls?
I just dropped them off with their mom.
Thought it might be nice
to have a little quiet
- when Kiana comes home.
- Oh, that's thoughtful.
It'll also allow me
to absolutely own you
in "Super Smash Bros."
Oh, you think I'm gonna go
easy on you 'cause you fainted?
Yeah, think again. I prey on the weak.
- [LAUGHTER]
- Oh.
Hey, can I borrow you for a second?
Yeah. We'll be back.
So the exam didn't suggest
any gynecological causes
for Kiana's symptoms.
Well, we got her labs back.
Hemoglobin's 8.6. She's anemic.
Yeah, but what's causing it?
Well, her iron levels, folate, and B12
look all normal.
Though it did take them
two times running the blood
because it was so thick.
Her hands were blue
when she came in, right?
Yeah.
And she has never
experienced anything like this
until she left Hawaii.
You think this might be CAD.
So she might actually be
allergic to the Midwest?
[SCOFFS]
What's CAD?
I heard some doctors talking about it.
Anybody know
what they were referring to?
- Nope.
- Cold agglutinin disease.
It's a rare autoimmune disorder.
Very good.
Uh, more specifically,
it's when cold weather
triggers your immune system
to attack red blood cells,
which, in turn, causes
- Anemia.
- Excellent.
Dr. Charles, two patients
incoming one in restraints.
Why restraints?
He attacked his brother with
a large rocking pizza cutter.
Okay.
Maybe you guys hang back
a bit on this one.
His guts are coming out of him!
- His guts are coming out of him!
- Enzo Pagliano.
- You can't let him do this!
You got to stop him!
Wait, where's the wound?
I don't see a wound.
It's not blood. It's pizza sauce.
"Pizza sauce"?
They're opening a restaurant,
were in the middle of a tasting
when he attacked.
Guy behind us is the one
in real trouble.
Please don't let him do this!
He's trying to cut me out!
5 of haloperidol IM.
Dante Pagliano, Enzo's brother.
- Trauma 2.
- Tachycardic at 133.
Blood pressure's dropping,
now 94 over 53.
Lower-abdominal injury
unknown blood loss, eviscerated bowel.
On my count. One, two, three.
50 of fentanyl, and let's get
some wet lap sponges.
- Listen to me, please.
- [GROANING IN PAIN]
He's got an eviscerated small bowel
and lacerated mesentery.
- We need to get him to an OR.
- Right, I'll call up.
I brought it out.
You didn't do anything, Dante.
Your intestines are outside your body.
We need to get them back in.
No, no, my brother
I brought a demon out of him.
You can't let him do this!
No! Let me go!
I spilled his guts!
Aah! Let me go!
Dante suffered an
evisceration of his intestines,
which will require
an exploratory laparotomy
and an abdominal-wall reconstruction.
As soon as we get an OR,
we'll be moving him to surgery.
Don't you usually refer
to patients by their last name?
What was that?
It's, uh, usually patient preference,
but given that they're brothers,
it's probably better
to go with first names
- because it'll be clearer.
- Got it. Okay.
Did Dante have any other ideas
about why his brother might
have had a psychotic break?
Just that he thought
he brought out the psychosis in him
and it was all his fault.
- But he'd lost a lot of blood.
- He also said it was a demon.
- Yeah.
- Oh.
I've encouraged them
to speak up and ask questions.
That's fun.
How's Enzo now?
Well, the haloperidol just kicked in,
so we're hoping to have
a conversation with him
- when he wakes up.
- All right, keep me posted.
- Oh, excuse me, Dr. Lenox.
- Oh, good, more questions.
Sorry, um, I was just wondering
if there was an update on the boy
with the gunshot wound from earlier?
Billy, I think.
Mm, he had a subclavian-artery injury.
He's in the ICU.
Oh, but is he gonna be okay?
I have a brother who's the same age.
If he makes it through the next
few hours, he'll have a chance.
So she's had this CAD her whole life?
She's just never been
anywhere cold enough
- to feel the effects.
- But the good news is
rituximab infusions four times
over the next month
should resolve your symptoms.
- Like, forever?
- Like, foreva, eva.
[CELL PHONE VIBRATING]
- [CLEARS THROAT]
- Spam again?
Yeah, just, uh, probably
got put on some list.
Is my brother okay?
Could be in surgery a few more hours,
but as soon as we know anything,
- we'll let you know.
- Oh, God, I hurt him.
I hurt him.
Enzo, can you tell me
from your perspective
what happened today?
That's the thing. I don't really know.
It doesn't really make any sense.
Well, how do you mean that?
Well, Dante and I
were working on the menu,
and I started to get this suspicion.
And then it came on so strong,
like he was trying to cheat me.
Had he done anything
to make you think that?
No. [CHUCKLES]
Dante? If you met him,
he's the most honest,
gentle guy in the whole world.
He'd never do something like that.
Right.
But this morning, in that moment,
I was sure of it.
And it made me so angry.
Has this ever happened before?
Not like this exactly.
But, lately, yeah.
Sometimes I have these thoughts.
They don't feel like they're mine.
Huh.
Your brother seems to think
that he's responsible for this reaction.
Oh, yeah, well
'cause a lot of times
I have these thoughts,
it's when we're together.
And I don't know why.
He didn't do anything to provoke you?
This just it just happened?
No. [LAUGHS]
I love my brother.
He's everything to me.
You got to save him, Doc.
You can't let him die.
So, what, she was just gonna
ambush you at this meeting?
Sounds like it.
Let me go talk to them, see
if I can smooth things over.
They can't let personal issues
from one board member
dictate a decision of this magnitude.
You know, actually,
let me go over there.
Sharon, don't make things worse.
I'm good.
I don't have any interest
in going another round
on this right now.
I don't either.
I just want to know
if you're feeling okay.
I'm fine. Why wouldn't I be?
You seem a little shaky.
I because I spilled a drink?
Miranda, your hand's still shaking.
Talk to me.
I'm just a little shaken up
from this morning.
My driver got in a fender bender,
and I I wasn't wearing my seat belt.
- Did you hit your head?
- No.
But I did get thrown into the back
of the driver's seat pretty hard,
and my ribs feel a little sore,
and I'm sure the altitude
is not helping my breathing.
So you feel out of breath?
Come.
I want you to lay down here.
Excuse us?
Peter, can you get rid
of these pillows, please?
Really, you don't need to make a fuss.
I mean, the car
wasn't even going that fast.
Yeah, well, slow-speed accidents
can be just as dangerous
as high-speed ones.
Your heart rate's in the 120s.
- That's high.
- Uh, excuse me.
Can you bring some blankets, please?
Of course.
I'm gonna need you to lay back
and take deep, slow breaths, okay?
- [CELL PHONE VIBRATING]
- [SIGHS]
Hey, please stop calling me.
You've been ignoring me all day.
I'm at work right now, so
I know, I know,
but I need to talk to you.
- [SCOFFS]
- You've put on weight.
[CHUCKLES]
- What are you doing here, Mom?
- I just want to talk.
We really don't have
anything to talk about.
- It's been 14 years.
There's plenty to discuss.
Like, I don't know
how you bankrupted me?
We were just trying to provide
a better life for everyone.
What do you want us to do, grovel?
That could be a start.
Look, we took the RV here,
and there's a little
hole-in-the-wall restaurant near us.
Your father and I would like to see you.
Really? So where is he, then?
I I'm sorry.
Hey, we have a situation. It's Kiana.
She was fine a minute ago.
[ALARM BLARING]
125 milligrams SOLU-MEDROL,
50 of Benadryl.
What's going on?
She had an allergic reaction
to the infusion.
She started hyperventilating
and then lost consciousness.
I already gave her 0.3 epi.
Kiana? Hey!
- BP's 80/55.
- Anaphylactic shock.
Okay, let's get ready to intubate.
One more dose of epi.
- Oh, my God, my baby!
- Come on, Kiana, stay with us.
She's resting now, but she'll be okay.
So she has a rare disease,
then a rare allergic reaction
to the medicine that cures it?
There is a second-line treatment.
It would resolve the symptoms,
but it would not cure
the CAD like the rituximab.
It would also require infusions
every other week.
But only during cold-weather months.
But if we went back
to Hawaii, presumably,
she'd go back to being
totally fine again?
Presumably.
[DRAMATIC MUSIC]
♪
Okay, CT clean, MRI clean.
So no trauma, nothing neuroplastic.
What's going on here? Wide lens, guys.
No bad ideas. Let's go. Quentin.
Uh [EXHALES DEEPLY]
Let me think. I
Oh, uh, maybe preexisting
mental-health conditions.
- Yeah.
- Bipolar, schizophrenia.
I like it,
except Enzo's been a stable,
high-functioning executive
for a whole bunch of years
with, technically, no family history.
Oh, my God.
Folie à deux.
Huh?
Go on.
It's a phenomenon
in which a dominant individual
with a psychotic disorder
imposes their delusions
onto a close partner,
inducing psychosis in someone
who otherwise would have
no mental-health issues
of their own.
So what you're suggesting
is that perhaps
- Dante's actually the sick one?
- Yes.
And that Enzo,
just by nature of standing
side by side with his brother
for all those hours
Enzo got pulled into his delusions.
Huh.
- You're a first-year?
- I read ahead.
Okay, well, honestly, that's
a pretty impressive hypothesis.
I think that maybe
we should be, uh, looking
into Dante's history.
What do you say?
Hey, uh, Kiana's waking up.
She was looking
Whoa. What's going on?
[CRYING] What's best for my daughter
is going to destroy my marriage
not even my marriage,
my impending marriage.
That's tough, but, I mean,
how are you so sure?
[SNIFFLES] Because Steve just told me.
I mean, he was lovely about it,
and he adores Kiana,
but he doesn't want to do
long distance anymore.
He doesn't want to move to Hawaii?
He would in a heartbeat, if he could,
but he has shared custody
of his daughters,
- and his ex lives here, so
- Yeah, it's a nonstarter.
I don't even blame him.
We did the whole long-distance
thing for two years,
and it was so hard.
And it's four more till Kiana
goes to college, so
I just don't know.
You don't know what?
How many times have you been in love?
[CHUCKLES SOFTLY]
Yeah, that's, uh, hard to say.
Well, for me, it was zero.
That's crazy to say, but it's true.
Even Kiana's father
I never felt that connection,
that euphoria.
I came to terms with the fact
that I was just
broken.
But then I met Steve the Dentist.
And every awkward little edge of his
fit every awkward little edge of mine.
And for the first time,
I was totally and completely
head over heels.
But what are the odds
I'll ever find that again?
♪
I just don't know if I can give that up.
♪
Tough choice.
I can't decide if I want sweet or salty.
It's the age-old question, man.
Just came out here to
check up on how you're doing.
You okay?
Me? I'm good.
Just, uh, got the feeling
I don't know
you're not that engaged
with what we're doing here today.
Oh, uh [SIGHS]
Like, I don't want
to seem unappreciative.
I think what you're doing here
is really cool.
It's just
What?
I'm not really interested in ED psych.
Oh.
Figured that out already, did you?
[CHUCKLES]
I guess I just want
a good work-life balance.
Both of my parents are immigrants.
They had to work still do
really hard.
And they pushed me
so I don't have
to kill myself like they do.
I just think having a private
practice is more my speed.
Quentin, diagnostics
are diagnostics, right?
I mean, you're gonna run into this stuff
no matter where you end up.
I mean, what, you think because
you got a cozy office setup,
your patients are just gonna walk in
and plop themselves down on the couch,
tell you what's wrong with them
and how to fix it?
I'm not saying I don't want
to do a good job, Doctor.
I
Look, work-life balance is important.
I get it. Really, I do.
It's just that this field
I don't know
if you can really half-ass it.
You know, you really got to
you got to get to know your patients.
You got to get in there
so you can understand them,
see the world the way they do, right?
So you can understand their issues.
I mean, if you don't want to do that,
you don't want to put
your whole soul into this,
you might want to reconsider.
Reconsider what?
Being a doctor.
Ms. Goodwin, it's Dr. Howard.
- Can I help you with something?
- I hope so.
I'm currently on a plane
with a woman, a board member,
- who seems to be in trouble.
- What's going on?
Well, she was
in a minor traffic accident
that caused some sort
of thoracic trauma.
She didn't think much of it
until she started experiencing weakness.
- Any idea of her vitals?
- Oh, yes.
There is an emergency
medical kit up here.
Her breath sounds are good,
but her BP is only 84 over 42.
Oh, okay, um
then it's not a pneumothorax
or hemothorax.
Uh, take a look at her neck.
Is the jugular vein distended?
Hold on.
Yes.
Okay, um, it sounds like
pericardial tamponade.
She's bleeding into the sac
around her heart.
How much time until you land?
Uh, 30 minutes, maybe more?
Oh, um
Dr. Howard, what is it?
Ms. Goodwin, are there any
surgical supplies in that medical kit?
I've got lidocaine, some saline flushes,
and a few needles.
- What size needles?
- 16 gauge and a 22.
Okay, good. You're going to use the 16
to remove the fluid built up
around her heart.
You'll angle it at a 15-degree angle
just under the breastbone,
and you should push
until the tip punctures the pericardium.
Wait, how will I know when that happens?
Usually, we'd have
an ultrasound to guide us,
but you're just gonna have
to take it slow.
And you should feel a
a soft pop when it goes in.
A soft pop.
And and what if I miss
or or go too far?
You mean if you puncture the heart?
Dr. Howard, I don't know.
I don't feel comfortable
going in blind like this.
- There is another option.
- Yes?
But let me just start by saying,
it's not as scary as it sounds.
[DRAMATIC MUSIC]
You want to cut me open?
It's a small incision,
just so I can see
where to put the needle.
The needle you want to put in my heart?
Not in your heart, Miranda,
into the sac around your heart.
Have you done this before?
I've seen it done.
No way. We can wait. We can wait.
We can wait until we land.
Miranda, if we wait
you're not going to make it.
♪
Am I just gonna be awake for this?
Yes, but you shouldn't feel much, okay?
We have lidocaine
that will numb the area,
and we also we also have these.
What is that? A weed gummy?
It is, provided by in-house counsel.
♪
[CRYING] I don't
I don't I don't want to die.
Miranda
I know we have had our issues,
but I think you also know
that I mean what I say.
And I'm telling you,
I will do everything I can
to get you through this.
Okay.
Hey, where are your, uh,
med-school ducklings?
- Lunch.
- What?
How are you preparing them
for life as a doctor
if you are letting them
take a full lunch?
- Easing them in.
- Except for that guy.
Quentin.
You can't talk to the patients
without me there.
Sorry.
I I was just thinking about
what you were saying earlier
about connecting with patients,
seeing every angle of their condition.
Okay.
Well, um
what did you learn?
Well, I I know Sabrina
has that theory
about shared psychosis,
but when I talked to Enzo
about what he and his brother
do together,
he said all they really do is work.
So I started to wonder
if Dante being there
when Enzo had an episode
was more a coincidence
rather than a cause.
Maybe it's the restaurant
itself causing it.
So you're saying you think
maybe it's environmental?
Maybe.
Now, I know it's a long shot,
but I remember reading somewhere
that celiac disease can cause psychosis.
It's certainly true
that, uh, in rare cases, right,
that the inflammation
can extend beyond the abdomen
and up into the brain, yep.
And it can come on later on
in life, right?
Like, when you open a pizza
restaurant with your brother,
and you're suddenly exposed to
gluten in massive quantities.
I'm just saying, it would explain the
the weight loss,
the vitamin-deficiency issues
And why it only happens
when they're together.
Yeah.
Trini
order a, uh,
tissue transglutaminase test.
- Yeah?
- Hell, yeah.
Get it back in an hour or so.
We'll see what's what.
Nice work.
All right!
I'm gonna go grab lunch now.
Uh, Dr. Charles, I I'm sorry,
but you already asked us
to test for celiac.
I sent you the results.
They came back positive.
I know, but, like,
why rain on the guy's parade?
He did good.
Yeah. [CHUCKLES]
- Did you hear the good news?
- Yeah, what's that?
We're going back to Hawaii.
Peace out, Chi-town.
Wow, I I didn't realize
you'd, uh, already made the decision.
Wasn't really a decision.
It's what's best for Kiana.
Well, she's going to be transferred
to the PICU in a bit
just to observe overnight,
but she should be out tomorrow.
Sounds good. Thank you.
Hey, can we get a place
closer to Salt Pond Beach
or a place with a game room
so I can keep schooling
Steve the Dentist?
Where is he, by the way?
Uh, he, uh, had to run out for work.
Poor guy.
He's gonna have to build up
that base tan again.
On the other hand, maybe he'll
finally learn how to surf.
[CHUCKLES SOFTLY] Yeah.
Maybe.
♪
That's pretty tight.
Well, we don't want
any involuntary movement.
- That gummy help?
- I don't think so.
Uh, all right.
- Can you feel that?
- No.
Lidocaine's working. That's something.
Dr. Howard, I think we're ready.
Okay, good.
So you're gonna find
the xiphoid process,
the very tip of the sternum.
About one finger width below that,
you'll make your incision
8 centimeters
or about 3 inches vertically.
Okay. Okay.
You might not want to watch this.
Oh, my God.
Okay.
I've made my incision.
- Gauze.
- Good.
Okay, now, you're gonna
push the tissue laterally
until you find the heart
and the bulging sac
around it filled with fluid.
Get closer.
- I think I see it.
- Good.
Her pulse is slowing down now.
I-it's okay. It's okay.
When we get that fluid out,
it'll take the strain off of the heart,
and that pulse is gonna
come right back up.
Okay, what now? [GASPS]
Okay, you're gonna take your syringe
and push it through the pericardium.
When you start needle penetrate
Dr. Howard, the needle goes in
at 15 degrees, correct?
15 to 20 when it gets to the pericard
- [STATIC WHIRS]
- Dr. Howard?
Dr. Howard?
- Oh, no, we lost service.
- No, no, no, no, no.
- Do you know what to do?
- Uh, I'm not sure.
Please, I I can't breathe.
Oh, my God. I think she's dying!
Okay, st Okay.
We need to find another phone.
Everyone, stop talking!
♪
Okay, go in
at a shallow angle,
and then as the
needle penetrates
until you feel the pop.
[GASPS] I think
I feel it.
♪
Oh.
That's it. I mean, that's good, right?
Her pulse is coming back up.
[SIGHS]
♪
[EXHALES DEEPLY]
♪
So Dr. Lenox had to do
a pretty significant bowel resection
and then repair the initial laceration,
but it looks like Dante's gonna
make a complete recovery.
Hard to imagine that Dante
and Enzo's relationship
will recover that quickly.
You're probably right about that.
Ah. You're all still here.
Yeah, we're just finishing up our day.
Uh-huh. Well, I heard one of you
cracked the case with Enzo
gluten-induced psychosis.
Yeah, undiagnosed celiac disease.
As long as he stays away from gluten,
he should be fine, right?
Sucks that they have
a pizza place, though.
I mean, I've had gluten-free
pizza, so that's an option,
but I feel like it's never
as good, you know?
[SOBBING] Oh, no, no!
That's the boy from this morning.
- Billy.
- Wait. Is he
Yes.
I thought you said he was gonna be okay.
I said he had a chance.
But the bleeding was too severe.
He was in DIC.
We couldn't get him to clot.
Yeah.
Unfortunately, subclavian injuries
are really tough to survive.
[SOMBER MUSIC]
♪
- [GASPS]
- Please don't get up.
Jonathan Michael.
I didn't think you would come.
Neither did I.
What's the thing?
Excuse me?
The thing you want?
If it's money, I'm
I'm on a resident's salary.
And if it's a place to live,
then, well, I'm sleeping
at a friend's house.
We didn't come here
to get anything from you.
You really think
we're monsters, don't you?
I watched a mom today
blow up her entire life
for her kid
because she wanted to put
her health first.
And then I watched that same mom
put a smile on her face so
her kid wouldn't feel bad.
- I don't understand.
- I know you don't.
See? 'Cause, um
well, I I witness things like that
every day in my hospital
you know, parents that go
to the end of the Earth
to protect their kids, no matter what.
And, I mean
you two
[SCOFFS, SNIFFLES]
I'm just gonna ask again.
What do you want?
- We just want to see
- I'm sick.
Secondary progressive MS.
♪
How long have you known?
A while, maybe six months.
♪
That's why we're here.
We want to reconnect with our son.
♪
- No.
- No what?
No, I'm not doing this
With you right now.
Okay, I
[SCOFFS]
♪
[BREATHING SHAKILY, SNIFFLES]
♪
Mm.
Listen, great job today.
- Yeah, thanks.
- No, no, I mean it.
I mean, that, um that
"folie à deux" idea you had
about Enzo [SCOFFS]
That was a spectacular guess.
Look, it might not have been
the right one,
but trust me, that kind of creativity,
you know, lateral thinking
is really important
in this line of work, so
It's not that, though.
I think I'm just
kind of rethinking things.
Huh.
I don't know if this is for me.
Oh, how so?
[SIGHS]
I didn't know
it would affect me so much.
I mean, even with Dante and Enzo,
even though that worked out,
there was still so much
It just got to me. I don't know.
There's a cost
to having a job with meaning, right?
I mean, we experience these
[EXHALES SHARPLY]
Brutal
moments here, like
true despair.
But trust me, there are also
these moments of euphoria,
of, like, extraordinary fulfillment,
because we change people's lives here.
And if we're lucky,
we actually save them.
So, for me, anyway, I mean, over time,
the benefits definitely
come to outweigh the costs.
I know it might not feel
like it right now,
but if you are feeling things deeply,
as far as I'm concerned,
it just means that, you know,
you're doing it right.
Yeah maybe.
I-I just think that
[SIGHS] I don't know.
Maybe I like the puzzle piece
and not all the pain.
Yeah, maybe I'll go into research.
I don't know.
Anyway.
[SOFT MUSIC]
♪
Thank you anyway, Dr. Charles.
♪
Oh, thanks for coming. Thanks.
♪
You guys taking off?
- Oh, yeah.
- Yeah.
Look, today was, uh
it was a lot, right?
Really glad you got to see
what we we actually do here.
But, you know, just for the record,
it was just extra intense, you know?
I just hope it wasn't
I don't know discouraging.
[SCOFFS]
Dr. Charles, today was
the greatest day of my life.
Really?
Well, my life's pretty boring,
but, yeah [CHUCKLES]
Really.
Yeah, it was pretty dope. Thank you.
♪
You're welcome.
Thank you. Yeah, thanks for coming.
- See you around.
- See ya.
♪
Huh.
♪
[KNOCKING ON DOOR]
Come in.
- Hey.
- Hi.
- How's Miranda?
- Good.
We were able to repair
the laceration in her atrium
- without issue.
- Great.
You know, all those years
of watching surgery,
assisting, I never really understood
the impact of that moment,
of holding the knife and
and cutting into someone.
Yeah.
My first surgery was a foot amputation.
I was so nervous,
I thought I was gonna puke.
But my attending talked me
through it, and I got it done.
Later, she got me a bracelet
that had a little charm of a foot.
She said it should be a reminder
even though
these miraculous things we do
have somehow become commonplace,
we shouldn't ever forget
they're extraordinary.
Yeah.
[LAUGHS]
"I heart Chicago."
Yeah, because of what you did
with Miranda's heart.
- Yeah, yeah, yeah.
- I'm sorry.
It's the best that I could do
on short notice.
But, anyway, um, welcome to the club.
- Thank you.
- Mm-hmm.
♪
[CHUCKLES]
So what did you say?
I said no.
And, um
I mean, it it hurts
more than I want to admit.
But it doesn't just erase
how my dad has treated me my whole life.
I I wish I could just move
past it, you know?
But I can't.
And
it makes me feel like a bad person.
I'm sorry. I know
this is not the, uh,
conversations we usually have.
And
I mean, well, you ordered takeout
from just about
every restaurant in Chicago.
[CHUCKLES]
Well, you didn't answer my texts,
so I I got a little bit
of everything.
Now I'm ruining it.
No, you're not. Hey.
Trust me, I would never judge
someone in a situation like this,
let alone tell them what to do.
I will just say, no matter
how you are feeling right now,
someday your parents will be gone.
And whenever that happens,
however you leave things
That's how it will stay
forever.
Sounds like you're speaking
from personal experience.
[SOFT MUSIC]
We're talking about you here, pal.
[CHUCKLES] I know, but
we don't always have to just be on me.
♪
Except I like being on you.
- That's not what I meant.
- [CHUCKLES]
Doesn't make it any less true.
♪
- Good talk.
- Great talk.
[CHUCKLES]
♪