Chicago Med (2015) s12e04 Episode Script
Tomorrow, and Tomorrow, and Tomorrow
1
We had a deal.
You are no longer employed here.
Did you really think
I was gonna sit home
while you undermine
the mission of this hospital?
I can't stop Sharon working here,
but I can control who runs the ED,
and that's no longer going to be you.
I'm assuming that Miranda's
not playing on the level.
I know she's not.
The problem is proving it.
Well, how would you like
a little help?
[DRAMATIC MUSIC]
[DOOR BANGS SHUT]
- Hey.
- [GASPS]
Oh. [CHUCKLES]
Why did you want to meet here?
Because I can't risk anyone
seeing us together, okay?
If Miranda finds out
I'm feeding you information
You'll also be looking
for a new line of work.
Yes, and unlike you,
I don't look good in scrubs.
You have information.
All right. Okay, here's the headline.
Miranda had a three-hour
closed-door meeting
last Wednesday, okay?
It didn't appear
on her official calendar.
There's no minutes, no memos.
Well, who was she meeting with?
No one seems to know.
Well, someone has to know.
Ask Felicia in Security for a list
of all the temporary badges
that were issued on Wednesday.
Look, if I start pulling
security records,
Miranda's gonna find out.
Peter, you're the hospital's counsel.
Come up with something attorney-like.
You know, the things I do for you
Yeah. And do me one more favor.
The next time, just walk up to me
like a normal person.
You almost gave me a heart attack.
Okay, then Mario and Luigi.
- Absolutely not.
- Come on.
I bet you look great
in a pair of overalls.
I do, but it's still a hard no.
[CHUCKLES]
Dr. Frost.
Just the person
I've been trying to reach.
Dr. Heart, hey. I'm sorry.
I have been meaning to email you back.
Well, attending positions
are opening very soon,
so we need to discuss your CV,
your references,
your interview strategy.
Absolutely. I'm all over it.
Just make sure we get
something on the calendar.
I want to make sure
you're set up for success.
- Great.
- All right.
Good morning, Dr. Ripley.
Morning.
You really should meet with Heart.
Job market's supposed to be
brutal this year.
Yeah, I'm not too worried about it.
Look, I know things typically
have a way of working out for you
Are you forgetting the fact
that Naomi kind of
just dumped me?
I thought that was mutual.
Look, if you want to stay at Gaffney,
you're gonna have competition.
There's only so many attending
spots to go around.
What should I be doing
that I am not already doing?
Taking initiative.
People aren't just gonna
hand you opportunities.
Mm. That's great advice.
See, I do better with specifics,
so maybe give me something
actionable, Dr. Yoda.
Take on a leadership role.
Okay, you're in your final year
of residency.
Put yourself up for chief resident.
Aren't those applications
due, like, today?
Then you still have time.
So there's family ideas,
but I wanted to focus on her.
And I have a few saved.
What do you think?
Oh, baby Elton John. No contest.
Mm, no, I say go classic,
like pea pod or pumpkin
or something cute.
Okay, I'll bite. What are we, uh
Uh, baby Mabel's
first Halloween costume.
Mabel, our four-month-old
who will have absolutely
no memory of what she wore?
- Mm.
- It's not for her, Dr. Archer.
It's so you have a picture
of your adorable baby
as a tiny pop icon.
That's the whole point of having kids.
- Yes.
- Side benefit down the line
blackmail material for the teen years.
- It's perfect.
- Excuse me.
If I could have your attention.
[INDISTINCT CHATTER]
Everybody listen up!
- Oh.
- Thank you.
Good morning.
I just have a brief
staffing announcement.
First, I would like
to thank Dr. Archer
for his excellent work
as interim ED chief.
He'll remain in the position
throughout the end of the week,
after which he will be stepping away
to focus on several key
departmental initiatives.
Can't wait to hear what those are.
So if everyone could please
thank Dr. Archer for his service.
[APPLAUSE]
Go, Dean!
And please, if you could
welcome Dr. Ripley,
who will assume the position
of interim ED chief,
effective Monday.
I I will?
Congratulations, Dr. Ripley.
My office will be in touch
regarding the transition.
Thank you.
Well, guess sometimes
you do get handed opportunities, huh?
Got the big dog ED chief,
chief resident.
We're gonna be running this place.
- Oh.
- God help us.
Dr. Archer, we need you
in Treatment 3.
Got Cynthia Peterson, 55,
advanced multiple sclerosis.
Presenting with fever, tachycardia,
and intermittent vomiting.
Her daughter, Lucy, called 911.
- Lucy Abrams.
- Sam's daughter.
Yep.
And is that his ex-wife?
Mm-hmm.
Are they on good terms?
Well, let's put it this way.
She tried bribing the ambulance driver
to take her to any other hospital.
[TENSE MUSIC]
We're going to Trauma 1.
Jessa Huntington, 36-year-old female,
37 weeks pregnant,
fell down a flight of stairs.
I was right behind her.
Uh, she missed a step.
I I couldn't catch her.
Struck her head
against the metal railing
before landing on her abdomen.
Had a witnessed seizure after
the fall and was postictal.
GCS 13. Heart rate's 115.
Initial pressure 80/40.
Improved to 95/53 with fluids.
Last fetal heart rate was 113.
We're gonna need a chest X-ray,
a FAST exam, and a head CT.
Uh, let's prepare to transfer, folks.
Hold on, hold on, hold on.
Baby's heart rate's in the 80s.
We need to deliver now.
Change of plans.
Everybody, we're headed upstairs.
- Let's go.
- Is the baby gonna be okay?
Kacy, call the OR.
- Emergency C-section.
- Go ahead. Go, go, go.
Tell them to activate
the neonatal team.
On it.
I I want to go with my wife.
Sorry, she's too unstable.
You can't be in the OR.
- Please.
- Doris will stay with you.
We'll update you as soon as we can.
Please.
Please! You you have to save them.
[DRAMATIC MUSIC]
♪
Your liver transplant is
scheduled for next week?
Thursday.
My brother's the donor.
Which is why we came straight in
when she woke up with abdominal pain.
We didn't want to take any chances.
Tumor is right where
the bile duct leaves my liver.
They can't resect it,
so transplant's my only option.
And really, it's a Hail Mary.
Hey, I thought we were
staying positive.
We are, it's just
this cancer has a very high
recurrence rate,
so it's but we're staying positive.
I'm not gonna let a little stomachache
keep us from Italy.
- Oh, you have a trip planned.
- Yeah.
A cruise for our ten-year anniversary.
As soon as I'm cleared to travel.
Let's get a full set of labs.
And a CT.
Nora, let the doctor
We both know
that's where this is headed.
We can skip ahead to the CT.
Given the upcoming transplant,
your surgeons are gonna want imaging.
With contrast.
If your kidney function allows it.
It does.
Nora.
Oh. Okay.
Okay, I'll back off.
You're the doctor.
Okay.
Uh, we'll loop in your oncologist
at Midwest Advocate and, uh,
get going on these labs.
Thank you, Dr. Ripley.
Yeah. You're welcome.
I'll take care of notifying
Nora's oncologist.
Dr. Ripley, you're about
to take over as chief.
You've got enough on your plate.
You don't need to lighten my load.
Just treat me like
any other nurse in the ED.
Uh, no, it's not that.
Nora's oncologist is,
uh, Dennis Washington.
Oh.
I didn't see that.
I heard he was at Midwest Advocate.
Actually, if you don't mind
making that call.
Consider it done.
Thank you.
All right, buddy, just
follow my finger for me, okay?
Just with your eyes.
Yeah, we got back
from Miami last night.
Caleb spent most of his time
in the pool or in the ocean.
Well, his skin's pretty red.
Was he wearing sunscreen?
Uh, yeah, yeah, but we were
chasing around his
two-year-old brother a lot.
We probably didn't reapply enough.
And plus, Caleb refused
to wear his rash guard.
Mom said I didn't have to
if I wore the floppy hat.
You should hear him
negotiate bedtimes.
All right, well,
a severe burn can blister.
And combined with dehydration,
that would explain the fainting.
It could.
But this blistering is
a bit more impressive
than we'd expect from a sunburn,
so we'll get some labs going
and start him on fluids.
Uh, great. Uh, thanks.
Yeah.
The neonatal team is still
responding to another code.
Backup's on the way, but we may
deliver before they get here.
Then we're the neonatal team
until they arrive.
Cutting.
Okay, I got the head.
- Kai, more fundal pressure.
- Yeah.
[BEEPING]
Come on.
Hi, baby girl.
Hi there.
Okay, clamp.
Hey there.
All right.
Here we go.
Okay.
Here we go.
[MONITOR BEEPING]
Dr. Asher, baby's in distress.
Okay, I'll be right there.
Deliver the placenta,
then start closing the uterus.
Got it.
[TENSE MUSIC]
Heart rate's 80.
Starting positive
pressure ventilation.
Mom's pressure's 60/30 and falling.
Call for blood.
Mom's hemorrhaging.
Heart rate's down to 50.
Okay, keep ventilating.
I'm starting compressions.
[MONITOR BEEPING RAPIDLY]
Kai, check her uterine tone.
Yeah.
It's firm. It's not atony.
- We've got her.
- All right.
Pack.
More laps.
[BEEPING CONTINUES]
[KNOCKING]
Oh, my God.
Is that Dan Charles?
How the heck are you?
Well, better now.
[CHUCKLES]
Oh.
You know, your father and I
used to double-date
with Dan and his wife, Susan.
How is Susan?
Oh, no. God.
You're divorced.
- Yeah.
- Sorry.
- It's okay.
- MS brain.
Uh, how's the new wife?
Uh, Linda.
Lucia.
Uh, you know what?
She took off too.
Quite a while ago now.
I know it's a pretty
damning pattern, isn't it?
At least I'm still, you know,
startlingly attractive.
Indeed, you are.
- Well, thank you.
- [LAUGHS]
- You know our daughter, Lucy.
- Of course.
You probably don't remember me, Lucy,
but I remember your dad carrying you
through these very halls
on his shoulders
when you were just a tot,
often wearing a sparkly tutu,
if memory serves, right?
Uh, yeah.
Yeah, I think I am.
I uh, Mom?
Okay, don't get mad, but I called Dad.
Mm.
He was gonna find out you're here.
Yeah, it's true.
You know, VIP shows up,
word travels fast in these parts.
Hey, Dad.
Hi.
Get it over with.
I look like crap.
You look thin, that's all.
You look puffy and tired.
Toddler keeping you up?
How high was her fever?
Uh, I just got here.
102, Dad.
They send urine and blood cultures?
No. Gosh.
Without you here, Sam,
the doctors have just been
sitting around guessing.
Uh[CLEARS THROAT]
- Any drop in urine output?
- Yeah.
My urine is none of your business.
I assure you,
this isn't personal curiosity.
No, it's just an opportunity
to remind everyone
you're the smartest person
in the room.
What, you above taking the bait?
You ever considered maybe I'm
just a better person than you?
No.
And I don't need your pity.
[WHISPERING] Hey, Lucy,
are you enjoying this as much as I am?
- [KNOCKING]
- You know it.
Hey, Cynthia. Got your results.
- Oh, phew.
- No, no.
You stay.
I like you.
You, I've seen enough of.
Bye now.
I'm afraid you've got
a kidney infection.
Long-term catheters are
a common source.
Who handles yours?
Uh, oh, I do.
Well, we'll have to have a nurse
review Foley care with you, so
I clean it exactly
the way I was taught.
I'm very thorough.
Okay, we're gonna start
IV antibiotics,
but because of the vomiting and fever,
I'd like to admit you
under observation
until the culture
sensitivities come back.
- [ALARMS BLARING]
- Mom's still hypertensive.
[TENSE MUSIC]
More. More.
Okay.
Looks like the blood is welling
up from behind the uterus.
I need more exposure.
Okay.
There.
She's got a posterior uterine rupture
extending to her cervix.
- See it.
- Allis.
O Vicryl.
♪
All right, get ready.
Scissors.
Pressure's coming up.
20 minutes.
Still no cardiac activity.
Time of death, 10:04.
[SUSTAINED TONE]
Sharon?
Dennis. Hello.
I had heard you stepped out
as executive director, but
Sharon Goodwin back in nursing scrubs
wasn't on your bingo card?
Not even close.
Well, I missed nursing.
After all those years behind a desk,
I missed being at the bedside.
Dr. Washington.
Thanks for coming over so fast.
Of course.
- You get Nora's CT back yet?
- Yeah.
Any indication
what's causing her pain?
A gallstone.
Well, that's a relief.
We can address that
during the transplant.
Well, unfortunately,
there is something else
you need to see on the scan.
So transplant's off the table?
Completely?
I'm sorry, Nora.
Your latest CT shows
the tumor has grown
past the 3-centimeter cutoff.
That puts you outside
of transplant protocol.
The only reason you know that
is because I came in today.
I should've muscled through the pain.
They would've discovered it
during the preoperative work.
There's no version
where this stayed hidden.
Guess Italy's off.
Hope the tickets are refundable.
Hey, we don't know that.
Yes, we do.
If the transplant's
no longer an option,
could we biopsy the tumor?
The doctor who diagnosed Nora
said that was too risky,
that the needle could
spread cancer cells?
She was right.
A core needle biopsy could
have seeded the tumor
in the needle track,
and that would've disqualified
Nora from from transplant.
Now I'm disqualified anyway, so
Yeah, but a biopsy will give us tissue
for genetic testing.
And if the tumor has
an actionable mutation,
we may be able to treat it
with a targeted drug.
Wait, treat it?
How? Like, cure it?
Well, no,
but we may be able
to slow down the progression.
Uh, for how long?
It's hard to know.
Months possibly a year,
if we find a mutation we can target.
Do the biopsy.
Hey, honey.
Hi.
Oh, uh
you're probably a little sore
from the breathing tube.
Um, you fell, Jessa.
You hit your head.
Um
the scans don't show any bleeding,
so you're gonna be okay.
[TENSE MUSIC]
The baby?
Jessa, we had to deliver her.
She didn't survive.
I am so sorry.
We did everything
everything that we could.
No.
I'm so sorry.
No!
[MONITOR BEEPING]
[SOBBING]
[SOMBER MUSIC]
♪
You saw her?
I did.
What did she look like?
She was beautiful.
♪
Would you like to hold your daughter?
We can bring her to you.
♪
You're right.
She's so beautiful.
[SOBBING]
I know. I I understand.
I, um you know what?
I will figure something out.
Everything okay?
Oh, yeah.
I'm just falling behind
on my dissertation,
and my advisor's starting
to lose patience.
Wow.
You're chasing a PhD
and caring for your mom?
That's gotta be tricky.
I can manage.
As long as my mom's okay, I'm okay.
That's all I care about.
Well, if there's anything
that I can do.
Uh, actually, that is why
I'm so confused about the infection.
I'm meticulous with my mom's catheter.
I clean it constantly.
I disconnect it
from its drainage tubing
several times a day so I can
clean the connection points.
And then I sanitize
everything thoroughly
before I put it back together, so
Lucy, do you mind
if I ask you something?
Oh. [SCOFFS]
- It's just a nervous habit.
- Oh, no, no.
I didn't mean to put you on the spot.
No, uh, I, uh
I should get back to my mom.
Hey, honey.
Lucy, you okay?
Yeah, all good.
What was that about?
Sam, look, I
I hope I'm not overstepping,
but I'm worried that
maybe Lucy might need
a little more support
in looking after Cynthia
you know, that maybe
this current setup is
I don't know, it's just not
optimal for either of them.
Well, I've tried.
I've offered to cover the costs,
but Cynthia's too damn stubborn
to accept my help.
Wait, what do you mean, not optimal?
Are you saying that
Lucy hasn't been taking
proper care of her mother?
No, quite the opposite.
She's so vigilant about
keeping the catheter clean,
she's breaking
the closed drainage system
several times a day to disinfect it.
I'm pretty sure that's where
this infection's coming from.
I'm just curious.
Have you ever noticed I don't know,
other behaviors like this before?
You know, sort of repetitive cleaning,
checking, needing to do things
in a certain sequence
Lucy's always been a perfectionist.
She sets high standards for herself.
- Okay.
- And look
aren't there rules
in your profession about,
you know, diagnosing people
in hallways?
Sam, I haven't diagnosed anyone.
I'm just I'm just concerned.
Well, maybe with
everything that happened
with Anna last year,
you're projecting, you know,
seeing warning signs
where there aren't any.
Lucy has enough on her plate as it is.
She's got a sick mother.
She's got a PhD program.
She doesn't need you giving her
one more thing to worry about.
♪
Caleb's labs are encouraging.
His electrolytes
and kidney function are normal.
All right.
Hemoglobin's a little low.
Yeah, mildly.
It's likely nutritional.
We'll have his pediatrician follow up.
All right.
He's just a sunburned,
dehydrated little kid.
After this bolus,
I think he's good to go.
Well, all right.
What you working on?
Uh, application for chief resident.
- Oh, cool.
- Yeah.
I had a little run-in
with our residency director
this morning, and then Ripley kind of
got into my head that I need
to take more initiative.
So but, I mean,
chief resident is basically
just all scheduling, right?
Yeah. Yeah, that's part of it.
Well, what else is there?
Um, I've I've heard
it's a ton of admin meetings
and committee work
and managing the call schedule.
And then, of course,
you're the one fielding
complaints from residents
and mediating disputes
between residents and attendings.
And I've just heard it's a lot,
but maybe that's your jam.
[CLEARS THROAT]
Hey.
Nora's biopsy's complete.
Pathology's expediting the results.
Thank you.
And if you need to go,
I can text you when they come in.
Uh, no, I'll stay.
All right.
Uh, Sharon?
Yeah?
I'll keep this short,
because after the way I behaved,
I wouldn't blame you for not
giving me the time of day.
I owe you an apology.
I demanded you let me into your life
while shutting you out of mine.
And then after you did
everything you could
to save my job, I blamed you
for not doing enough.
I was wrong.
I'm sorry.
Thank you, Dennis.
I appreciate that.
I really do wish I could've done more
to protect you from Miranda,
but you were, unfortunately,
collateral damage
in her campaign against me.
Well, leaving Med wasn't easy.
But I like it over
at Midwest Advocate.
I landed on my feet.
I'm glad.
The part I haven't
gotten over is losing you.
Ms. Goodwin,
incoming level 1, Trauma 1.
I'm sorry, I
I I've gotta go.
Of course, of course.
Go.
Feel free to take one for the road.
Hey, hey, Dr. Frost said one.
If your mom knew
you were having sugar
Caleb's not been very good
about brushing his teeth lately,
and they're getting brown.
So we are trying to limit his sweets.
I brush my teeth.
Well, you are not doing
a very good job.
Now, come on.
Hey.
Something wrong?
My chest feels kind of funny.
Funny how?
Like there's a bird flapping
its wings inside of it.
Okay.
Let's lay you back down, all right?
There we go.
Yeah, he's tachycardic.
Let's put him on the monitor.
Okay, sinus tach rate's 133.
That's pretty high, right?
It's higher than it should be.
He's probably still volume-depleted.
We'll put him on some fluids,
repeat the labs,
make sure nothing's changed,
all right?
Yeah, whatever you need to do.
Hey.
Heard about the baby.
Yeah.
So a few months after Sean was born,
I lost a little boy in the OR.
Eh
[SOMBER MUSIC]
I mean, we kept the code going
for almost an hour,
long after I knew that he
he wasn't coming back.
And all I kept thinking was,
what if that was Sean on the table?
Because before I was a parent,
you know, I could just
I could compartmentalize everything.
But afterwards, every kid was Sean.
Every kid.
Does that ever go away?
No, it doesn't.
You just get better at
handling it, that's all.
I was not very good
at handling it today.
Oh, when I told Jessa that her
that her baby was gone,
I couldn't hold it in.
It was so unprofessional.
She needed someone
to be strong for her,
and I made her pain about me.
But there's a difference between
making a patient's tragedy
about yourself
and letting them see
that it's affecting you too.
And on the worst moment of her life,
maybe that's exactly
what Jessa needed,
somebody to feel the pain with her.
Wait.
Sorry.
Uh, what gloves are you using?
Oh, the ones in the kit.
Shouldn't you change them?
Oh, that's not necessary.
But but you touched the swab.
Lucy, that
that's a sterile Foley kit.
Everything in that package is sterile.
I'd be happy to change them
if it would make you more comfortable.
That would be great.
Trini, you don't need
to change your gloves.
The swab was in the basin on the bed.
You picked it up. You put it back.
You touched the flush,
and the flush touched the basin.
So you need to start over.
New basin, new flush, new gloves.
Lucy, you're being irrational.
Honey, you have to calm down.
I can't calm down, Mom.
[INHALES DEEPLY]
What if bacteria gets
into your catheter again
and this time gets
into your bloodstream
and the antibiotics don't work
and your fever spikes?
- None of that's happening.
- Okay, but it could happen.
And she could get septic,
and she could die,
and I will have just stood here
and and let it happen.
I can't let that happen.
I cannot let that happen!
Lucy, nothing's happening.
Your mother's gonna be fine.
You don't know that!
Hey, hey, hey, you're catastrophizing.
You just need to calm down.
I can't breathe. I can't breathe.
[GASPING] I can't breathe.
- I can't I can't
- Lucy, Lucy, look at me.
Lucy, Lucy, you're having
a panic attack, okay?
- I know, I
- It feels really dangerous,
- but it's not.
- Something's wrong.
- Something's wrong.
- It's not dangerous,
and it's gonna pass
it's gonna pass.
You know what helps?
I want you to breathe
with me, all right?
- Breathe in through your nose.
- I can't.
- Look at me. Look at me.
- I can't.
Look at me. Okay, that's okay.
Don't fight it. Don't fight it.
Okay, look at Mom.
What color is Mom's blanket?
- It's it's blue.
- That's right.
It's blue. And how about Dad?
What's Dad wearing?
His gray coat.
That's right, his gray coat.
And so Dad's right there,
and he's okay.
And Mom's okay.
They're okay.
And you know what? You're okay too.
You're okay.
You're safe, Lucy, all right?
Okay. Come on.
Come sit down here with me.
There you go.
You're doing great.
[GASPING]
Oh, my God, I'm sorry.
[SOBBING] I'm so sorry.
I just I
I need to keep her safe.
[SOFT DRAMATIC MUSIC]
♪
I'm sorry, what?
You can't be serious.
Pathology triple-checked the results.
Uh, your biopsy shows
you don't have cholangiocarcinoma.
You have primary biliary lymphoma.
It grows much faster
than most bile duct cancers,
which explains how
the mass grew so dramatically
in such a short time.
So I I still have cancer?
Yes, but, um, this changes everything.
It's an aggressive lymphoma,
but also, it's highly
responsive to chemotherapy.
In the majority of cases,
it can be cured.
[BREATHES SHAKILY]
Well, Dr. Pitzer,
the doctor who diagnosed me,
was she wrong not to do a biopsy?
Because if we'd known sooner,
maybe we could've
No, she wasn't.
The location and the appearance
of the tumor were classic
for bile duct cancer.
Lymphoma presenting this way
is extraordinarily rare.
There was no reason to suspect it.
Before you came in,
I was planning my funeral
Making mental notes of everything
Eden would need to know
bank accounts, passwords.
Instead, we get to plan a future.
All I wanted was for you to be okay.
[SIGHS]
[SNIFFLES]
How is Lucy?
Dan gave her a small dose of Ativan.
She's resting in my office.
He thinks this is likely
obsessive compulsive disorder.
And given how severe
the symptoms have become,
he's recommending a 30-day
residential treatment program
at Northwestern.
Well, how do we get her in?
Getting her in isn't the issue.
Dan just makes a phone call.
It's getting her to go.
Lucy won't leave you alone.
Well, I'll I'll move
to a nursing facility.
I mean, whatever it takes.
Lucy's not gonna agree to that.
She's not gonna put you in a home.
No, you need to do
something very hard, Cynthia.
You need to let me help you.
[BREATHES DEEPLY]
All right.
What was that?
I said okay, Sam.
30 years,
and you finally do what I ask.
Are they sure you're not dying?
It was the first good idea
you've had in 30 years.
No, remember, the divorce was my idea.
Mm.
I assume your, uh, child bride
is more agreeable.
Michelle's nearly 40, you know.
[CHUCKLES] How near?
Hey.
Check out Caleb's hemoglobin.
It's dropped a point
since he got here.
Well, that could be dilution
from the fluids.
Except his bilirubin
and LDH are climbing.
He's hemolyzing.
I knew those blisters were
something worse than
just a bad sunburn.
Okay, so what could cause hemolysis
and make his skin react
that violently to sunlight?
His brown teeth.
Porphyrins.
If excess porphyrins are
building up in his teeth,
- his skin, his blood cells
- Exactly.
It explains everything.
The discoloration,
the anemia, the blistering.
Okay, we're gonna need
a quantitative urine
and plasma porphyrins
to start narrowing down
the list of possible blood disorders.
No, it's okay.
I have a faster way to see
if we're on the right track.
Just gotta visit my friend
in Dermatology.
You're sleeping with someone in Derm.
I don't think you can ask me that.
It was a statement, not a question.
Well, your statement is inaccurate.
Mm.
She's just giving me
a few chemical peels.
Uh-huh.
It was quite a day.
Oh.
Well, those don't look
like happy tears.
I'm I'm so incredibly happy
that Nora's gonna be okay.
I am, I just
I don't know what's gonna happen now.
Can I sit?
Yeah.
So what do you mean?
[SIGHS]
Before Nora got sick,
I was thinking of leaving her.
More than thinking about it.
I I started looking at apartments.
I consulted a divorce attorney.
Does Nora know that?
She knew I was unhappy.
I don't think she understood
how unhappy.
You got a small taste of it today.
The questions, the second-guessing,
telling everyone how to do their jobs.
[PENSIVE MUSIC]
Nora has to be in control.
And before she got sick,
it extended to everything
her home, our marriage.
But things changed after she got sick?
For the first time in years,
Nora was faced with something
that she couldn't control.
It made her vulnerable.
She had to lean on me,
let me take care of her.
We started to feel
like partners again.
I want her to be better.
That's all that I want.
But what if getting better means
Things go back to the way they were?
You know, what Nora's
gone through changes people
sometimes for a period,
but sometimes forever.
You don't know yet who
either of you are going to be
on the other side of this.
But
you don't have to decide today.
♪
How's she been?
Asleep, mostly.
That's not unusual.
Between the fall, the anesthesia,
all the pain medication
her body's been through a lot.
Hey, Jessa.
Mm.
Where am I?
We moved you to the ICU.
I'm sorry, who are you?
Um, honey, this is Dr. Asher.
Remember?
She's the doctor who operated.
What happened?
Oh, did I have the baby?
[SOFT TENSE MUSIC]
Please tell me where my baby is.
Neurology will speak
with you, but they believe that
Jessa has anterograde amnesia,
which is affecting
her ability to create
new memories post-accident.
Will will she get better?
Yes.
This is temporary.
Her memory should improve
over the next few days.
And until then
She'll continue to forget
what we've told her.
Jessa suffered two miscarriages
before this pregnancy.
She wanted this baby so badly.
We both did.
She's asking for you.
I'll help you tell her.
What's that?
This is called a Wood's lamp.
Dermatologists use it
to look for things on your skin
you can't see in normal light.
You ready?
Give me a big smile, Caleb.
Why do his teeth look like that?
Erythrodontia.
It happens when porphyrins
accumulate in the teeth.
I want to see.
His blisters, the anemia, his teeth,
they all point to a rare
metabolic disorder
called Gunther disease.
What do you think?
Whoa!
This is so cool.
How do you treat it?
With rigorous protection from sunlight
and blood transfusions
to control the anemia.
Is this something he's gonna
have for the rest of his life?
It's genetic, so yes.
But now that we know
what we're dealing with,
we can prevent him
from further damage.
We'll have Hematology down shortly
to talk you guys through everything.
Thank you so much.
Of course.
We'll see you in a bit, kid.
Um, Wood's lamp, right?
You don't see these
every day in the ED.
Just used it to diagnose a kid
with congenital
erythropoietic porphyria.
Oh.
That's, uh, quite the catch.
Well, his worsening anemia
didn't fit dehydration.
And then we noticed
a staining on his teeth,
and I remembered that
erythroderma fluoresces red
under a Wood's lamp.
Yeah I expect so little
from residents.
Nicely done.
Uh, what was that?
You kind of just made it sound
like it was all your idea.
Oh. Um, God, I'm I'm sorry.
I didn't even think about that.
I don't really pay attention
to who gets the credit,
but, um, my bad.
No, it's, uh forget it.
Are you sure?
I'm I'm sorry. Again
Totally, it's it's fine.
Okay.
So Northwestern can take Lucy
whenever she's ready.
Thanks.
She's agreed to go
once we have full-time care
- in place for her mother.
- Great.
I contacted an agency,
and they're gonna send
some caregivers over to me
with Cynthia on Monday.
I'm sure she'll reject
the first six on principle,
but we'll get there.
I don't doubt it for a second.
Dan, thank you for stepping
in with Lucy earlier.
Sam, come on.
My attempt to calm her down
had roughly the opposite effect.
Look, this situation is
a classic parental minefield, right?
You're damned if you open your mouth,
and you're damned if you don't.
They're moving her upstairs shortly.
I got her the VIP suite.
Thanks, Dad.
I dropped the ball, Lucy.
The signs have been there for years,
but I was too busy
fighting with your mother,
which I'm sure only exacerbated
Can we just skip this part?
What part?
The part where you blame yourself.
You have far less influence
over me than you think.
[SOFT MUSIC]
Dad, I
I need you to promise me
that you'll take care of Mom.
Lucy
you have my word.
Your mother's gonna be taken care of.
Your only job is
to take care of yourself.
♪
Congratulations are in order, Dr. Wu.
Or should I say Gaffney's next
emergency medicine chief resident?
Oh, even running unopposed,
I'm grateful for the opportunity.
Well, taking on a role this demanding
while finishing your residency
is quite admirable.
I know it'll be a lot of extra work,
but some opportunities are worth it.
You got this.
Dr. Heart.
I hope I'm not too late.
- Deadline said end of day, so
- Oh.
And the day is not over.
Frankly, I'm just pleased
to see you putting yourself
forward for a leadership
position, Dr. Frost.
And, uh, just so you know,
Dr. Wu has also declared her interest.
So since there are two candidates now,
the ED attendings will be
making the final decision.
Looks like we've got ourselves a race.
That was a hell of a catch.
Yeah.
We got lucky.
Uh, I guess
I probably should head out.
Be well, Dennis.
You too, Sharon.
[SOFT TENSE MUSIC]
♪
I found Miranda's mystery
visitors in the security logs.
Miranda met with the executive
search firm the board retained
after Quinley announced
his retirement.
Well, that's hardly a secret.
I mean, everyone knows that Gaffney is
looking for a new CEO.
Why would she need
to hide the fact that
she was advising them on the search?
Because she wasn't advising them.
I mean, at least that's not
what it looks like.
Look, in preparation for this meeting,
Miranda had her office
pull five years of
departmental financials,
charting the hospital's margins
from before and after her
arrival, a nice summary
of every cost-cutting
initiative she's implemented,
her five-year strategic plan
for Gaffney.
So Miranda isn't helping them
choose the next CEO.
She wants to be the next CEO.
Bingo.
[SIGHS]
What?
[SOFT MUSIC]
Oh.
♪
Ooh. Oof.
You got her down by 8:00?
No one's more surprised
than I am, believe me.
- Okay, so
- What is
Well, I'm gonna tell you.
So I figured that, you know, at
least one of these would work.
But you know what? The hell with it.
Let's just put all of them
on her and, I don't know,
have a photo shoot
and take Doris's advice.
You know, collect blackmail
for when she's 16 and hates us.
Do you want me to run you a bath?
You can just stay in there
as long as you want.
I'll take the first shift.
♪
I'd rather stay right here.
♪
sync & corrections awaqeded
[DRAMATIC MUSIC]
♪
[WOLF HOWLS]
We had a deal.
You are no longer employed here.
Did you really think
I was gonna sit home
while you undermine
the mission of this hospital?
I can't stop Sharon working here,
but I can control who runs the ED,
and that's no longer going to be you.
I'm assuming that Miranda's
not playing on the level.
I know she's not.
The problem is proving it.
Well, how would you like
a little help?
[DRAMATIC MUSIC]
[DOOR BANGS SHUT]
- Hey.
- [GASPS]
Oh. [CHUCKLES]
Why did you want to meet here?
Because I can't risk anyone
seeing us together, okay?
If Miranda finds out
I'm feeding you information
You'll also be looking
for a new line of work.
Yes, and unlike you,
I don't look good in scrubs.
You have information.
All right. Okay, here's the headline.
Miranda had a three-hour
closed-door meeting
last Wednesday, okay?
It didn't appear
on her official calendar.
There's no minutes, no memos.
Well, who was she meeting with?
No one seems to know.
Well, someone has to know.
Ask Felicia in Security for a list
of all the temporary badges
that were issued on Wednesday.
Look, if I start pulling
security records,
Miranda's gonna find out.
Peter, you're the hospital's counsel.
Come up with something attorney-like.
You know, the things I do for you
Yeah. And do me one more favor.
The next time, just walk up to me
like a normal person.
You almost gave me a heart attack.
Okay, then Mario and Luigi.
- Absolutely not.
- Come on.
I bet you look great
in a pair of overalls.
I do, but it's still a hard no.
[CHUCKLES]
Dr. Frost.
Just the person
I've been trying to reach.
Dr. Heart, hey. I'm sorry.
I have been meaning to email you back.
Well, attending positions
are opening very soon,
so we need to discuss your CV,
your references,
your interview strategy.
Absolutely. I'm all over it.
Just make sure we get
something on the calendar.
I want to make sure
you're set up for success.
- Great.
- All right.
Good morning, Dr. Ripley.
Morning.
You really should meet with Heart.
Job market's supposed to be
brutal this year.
Yeah, I'm not too worried about it.
Look, I know things typically
have a way of working out for you
Are you forgetting the fact
that Naomi kind of
just dumped me?
I thought that was mutual.
Look, if you want to stay at Gaffney,
you're gonna have competition.
There's only so many attending
spots to go around.
What should I be doing
that I am not already doing?
Taking initiative.
People aren't just gonna
hand you opportunities.
Mm. That's great advice.
See, I do better with specifics,
so maybe give me something
actionable, Dr. Yoda.
Take on a leadership role.
Okay, you're in your final year
of residency.
Put yourself up for chief resident.
Aren't those applications
due, like, today?
Then you still have time.
So there's family ideas,
but I wanted to focus on her.
And I have a few saved.
What do you think?
Oh, baby Elton John. No contest.
Mm, no, I say go classic,
like pea pod or pumpkin
or something cute.
Okay, I'll bite. What are we, uh
Uh, baby Mabel's
first Halloween costume.
Mabel, our four-month-old
who will have absolutely
no memory of what she wore?
- Mm.
- It's not for her, Dr. Archer.
It's so you have a picture
of your adorable baby
as a tiny pop icon.
That's the whole point of having kids.
- Yes.
- Side benefit down the line
blackmail material for the teen years.
- It's perfect.
- Excuse me.
If I could have your attention.
[INDISTINCT CHATTER]
Everybody listen up!
- Oh.
- Thank you.
Good morning.
I just have a brief
staffing announcement.
First, I would like
to thank Dr. Archer
for his excellent work
as interim ED chief.
He'll remain in the position
throughout the end of the week,
after which he will be stepping away
to focus on several key
departmental initiatives.
Can't wait to hear what those are.
So if everyone could please
thank Dr. Archer for his service.
[APPLAUSE]
Go, Dean!
And please, if you could
welcome Dr. Ripley,
who will assume the position
of interim ED chief,
effective Monday.
I I will?
Congratulations, Dr. Ripley.
My office will be in touch
regarding the transition.
Thank you.
Well, guess sometimes
you do get handed opportunities, huh?
Got the big dog ED chief,
chief resident.
We're gonna be running this place.
- Oh.
- God help us.
Dr. Archer, we need you
in Treatment 3.
Got Cynthia Peterson, 55,
advanced multiple sclerosis.
Presenting with fever, tachycardia,
and intermittent vomiting.
Her daughter, Lucy, called 911.
- Lucy Abrams.
- Sam's daughter.
Yep.
And is that his ex-wife?
Mm-hmm.
Are they on good terms?
Well, let's put it this way.
She tried bribing the ambulance driver
to take her to any other hospital.
[TENSE MUSIC]
We're going to Trauma 1.
Jessa Huntington, 36-year-old female,
37 weeks pregnant,
fell down a flight of stairs.
I was right behind her.
Uh, she missed a step.
I I couldn't catch her.
Struck her head
against the metal railing
before landing on her abdomen.
Had a witnessed seizure after
the fall and was postictal.
GCS 13. Heart rate's 115.
Initial pressure 80/40.
Improved to 95/53 with fluids.
Last fetal heart rate was 113.
We're gonna need a chest X-ray,
a FAST exam, and a head CT.
Uh, let's prepare to transfer, folks.
Hold on, hold on, hold on.
Baby's heart rate's in the 80s.
We need to deliver now.
Change of plans.
Everybody, we're headed upstairs.
- Let's go.
- Is the baby gonna be okay?
Kacy, call the OR.
- Emergency C-section.
- Go ahead. Go, go, go.
Tell them to activate
the neonatal team.
On it.
I I want to go with my wife.
Sorry, she's too unstable.
You can't be in the OR.
- Please.
- Doris will stay with you.
We'll update you as soon as we can.
Please.
Please! You you have to save them.
[DRAMATIC MUSIC]
♪
Your liver transplant is
scheduled for next week?
Thursday.
My brother's the donor.
Which is why we came straight in
when she woke up with abdominal pain.
We didn't want to take any chances.
Tumor is right where
the bile duct leaves my liver.
They can't resect it,
so transplant's my only option.
And really, it's a Hail Mary.
Hey, I thought we were
staying positive.
We are, it's just
this cancer has a very high
recurrence rate,
so it's but we're staying positive.
I'm not gonna let a little stomachache
keep us from Italy.
- Oh, you have a trip planned.
- Yeah.
A cruise for our ten-year anniversary.
As soon as I'm cleared to travel.
Let's get a full set of labs.
And a CT.
Nora, let the doctor
We both know
that's where this is headed.
We can skip ahead to the CT.
Given the upcoming transplant,
your surgeons are gonna want imaging.
With contrast.
If your kidney function allows it.
It does.
Nora.
Oh. Okay.
Okay, I'll back off.
You're the doctor.
Okay.
Uh, we'll loop in your oncologist
at Midwest Advocate and, uh,
get going on these labs.
Thank you, Dr. Ripley.
Yeah. You're welcome.
I'll take care of notifying
Nora's oncologist.
Dr. Ripley, you're about
to take over as chief.
You've got enough on your plate.
You don't need to lighten my load.
Just treat me like
any other nurse in the ED.
Uh, no, it's not that.
Nora's oncologist is,
uh, Dennis Washington.
Oh.
I didn't see that.
I heard he was at Midwest Advocate.
Actually, if you don't mind
making that call.
Consider it done.
Thank you.
All right, buddy, just
follow my finger for me, okay?
Just with your eyes.
Yeah, we got back
from Miami last night.
Caleb spent most of his time
in the pool or in the ocean.
Well, his skin's pretty red.
Was he wearing sunscreen?
Uh, yeah, yeah, but we were
chasing around his
two-year-old brother a lot.
We probably didn't reapply enough.
And plus, Caleb refused
to wear his rash guard.
Mom said I didn't have to
if I wore the floppy hat.
You should hear him
negotiate bedtimes.
All right, well,
a severe burn can blister.
And combined with dehydration,
that would explain the fainting.
It could.
But this blistering is
a bit more impressive
than we'd expect from a sunburn,
so we'll get some labs going
and start him on fluids.
Uh, great. Uh, thanks.
Yeah.
The neonatal team is still
responding to another code.
Backup's on the way, but we may
deliver before they get here.
Then we're the neonatal team
until they arrive.
Cutting.
Okay, I got the head.
- Kai, more fundal pressure.
- Yeah.
[BEEPING]
Come on.
Hi, baby girl.
Hi there.
Okay, clamp.
Hey there.
All right.
Here we go.
Okay.
Here we go.
[MONITOR BEEPING]
Dr. Asher, baby's in distress.
Okay, I'll be right there.
Deliver the placenta,
then start closing the uterus.
Got it.
[TENSE MUSIC]
Heart rate's 80.
Starting positive
pressure ventilation.
Mom's pressure's 60/30 and falling.
Call for blood.
Mom's hemorrhaging.
Heart rate's down to 50.
Okay, keep ventilating.
I'm starting compressions.
[MONITOR BEEPING RAPIDLY]
Kai, check her uterine tone.
Yeah.
It's firm. It's not atony.
- We've got her.
- All right.
Pack.
More laps.
[BEEPING CONTINUES]
[KNOCKING]
Oh, my God.
Is that Dan Charles?
How the heck are you?
Well, better now.
[CHUCKLES]
Oh.
You know, your father and I
used to double-date
with Dan and his wife, Susan.
How is Susan?
Oh, no. God.
You're divorced.
- Yeah.
- Sorry.
- It's okay.
- MS brain.
Uh, how's the new wife?
Uh, Linda.
Lucia.
Uh, you know what?
She took off too.
Quite a while ago now.
I know it's a pretty
damning pattern, isn't it?
At least I'm still, you know,
startlingly attractive.
Indeed, you are.
- Well, thank you.
- [LAUGHS]
- You know our daughter, Lucy.
- Of course.
You probably don't remember me, Lucy,
but I remember your dad carrying you
through these very halls
on his shoulders
when you were just a tot,
often wearing a sparkly tutu,
if memory serves, right?
Uh, yeah.
Yeah, I think I am.
I uh, Mom?
Okay, don't get mad, but I called Dad.
Mm.
He was gonna find out you're here.
Yeah, it's true.
You know, VIP shows up,
word travels fast in these parts.
Hey, Dad.
Hi.
Get it over with.
I look like crap.
You look thin, that's all.
You look puffy and tired.
Toddler keeping you up?
How high was her fever?
Uh, I just got here.
102, Dad.
They send urine and blood cultures?
No. Gosh.
Without you here, Sam,
the doctors have just been
sitting around guessing.
Uh[CLEARS THROAT]
- Any drop in urine output?
- Yeah.
My urine is none of your business.
I assure you,
this isn't personal curiosity.
No, it's just an opportunity
to remind everyone
you're the smartest person
in the room.
What, you above taking the bait?
You ever considered maybe I'm
just a better person than you?
No.
And I don't need your pity.
[WHISPERING] Hey, Lucy,
are you enjoying this as much as I am?
- [KNOCKING]
- You know it.
Hey, Cynthia. Got your results.
- Oh, phew.
- No, no.
You stay.
I like you.
You, I've seen enough of.
Bye now.
I'm afraid you've got
a kidney infection.
Long-term catheters are
a common source.
Who handles yours?
Uh, oh, I do.
Well, we'll have to have a nurse
review Foley care with you, so
I clean it exactly
the way I was taught.
I'm very thorough.
Okay, we're gonna start
IV antibiotics,
but because of the vomiting and fever,
I'd like to admit you
under observation
until the culture
sensitivities come back.
- [ALARMS BLARING]
- Mom's still hypertensive.
[TENSE MUSIC]
More. More.
Okay.
Looks like the blood is welling
up from behind the uterus.
I need more exposure.
Okay.
There.
She's got a posterior uterine rupture
extending to her cervix.
- See it.
- Allis.
O Vicryl.
♪
All right, get ready.
Scissors.
Pressure's coming up.
20 minutes.
Still no cardiac activity.
Time of death, 10:04.
[SUSTAINED TONE]
Sharon?
Dennis. Hello.
I had heard you stepped out
as executive director, but
Sharon Goodwin back in nursing scrubs
wasn't on your bingo card?
Not even close.
Well, I missed nursing.
After all those years behind a desk,
I missed being at the bedside.
Dr. Washington.
Thanks for coming over so fast.
Of course.
- You get Nora's CT back yet?
- Yeah.
Any indication
what's causing her pain?
A gallstone.
Well, that's a relief.
We can address that
during the transplant.
Well, unfortunately,
there is something else
you need to see on the scan.
So transplant's off the table?
Completely?
I'm sorry, Nora.
Your latest CT shows
the tumor has grown
past the 3-centimeter cutoff.
That puts you outside
of transplant protocol.
The only reason you know that
is because I came in today.
I should've muscled through the pain.
They would've discovered it
during the preoperative work.
There's no version
where this stayed hidden.
Guess Italy's off.
Hope the tickets are refundable.
Hey, we don't know that.
Yes, we do.
If the transplant's
no longer an option,
could we biopsy the tumor?
The doctor who diagnosed Nora
said that was too risky,
that the needle could
spread cancer cells?
She was right.
A core needle biopsy could
have seeded the tumor
in the needle track,
and that would've disqualified
Nora from from transplant.
Now I'm disqualified anyway, so
Yeah, but a biopsy will give us tissue
for genetic testing.
And if the tumor has
an actionable mutation,
we may be able to treat it
with a targeted drug.
Wait, treat it?
How? Like, cure it?
Well, no,
but we may be able
to slow down the progression.
Uh, for how long?
It's hard to know.
Months possibly a year,
if we find a mutation we can target.
Do the biopsy.
Hey, honey.
Hi.
Oh, uh
you're probably a little sore
from the breathing tube.
Um, you fell, Jessa.
You hit your head.
Um
the scans don't show any bleeding,
so you're gonna be okay.
[TENSE MUSIC]
The baby?
Jessa, we had to deliver her.
She didn't survive.
I am so sorry.
We did everything
everything that we could.
No.
I'm so sorry.
No!
[MONITOR BEEPING]
[SOBBING]
[SOMBER MUSIC]
♪
You saw her?
I did.
What did she look like?
She was beautiful.
♪
Would you like to hold your daughter?
We can bring her to you.
♪
You're right.
She's so beautiful.
[SOBBING]
I know. I I understand.
I, um you know what?
I will figure something out.
Everything okay?
Oh, yeah.
I'm just falling behind
on my dissertation,
and my advisor's starting
to lose patience.
Wow.
You're chasing a PhD
and caring for your mom?
That's gotta be tricky.
I can manage.
As long as my mom's okay, I'm okay.
That's all I care about.
Well, if there's anything
that I can do.
Uh, actually, that is why
I'm so confused about the infection.
I'm meticulous with my mom's catheter.
I clean it constantly.
I disconnect it
from its drainage tubing
several times a day so I can
clean the connection points.
And then I sanitize
everything thoroughly
before I put it back together, so
Lucy, do you mind
if I ask you something?
Oh. [SCOFFS]
- It's just a nervous habit.
- Oh, no, no.
I didn't mean to put you on the spot.
No, uh, I, uh
I should get back to my mom.
Hey, honey.
Lucy, you okay?
Yeah, all good.
What was that about?
Sam, look, I
I hope I'm not overstepping,
but I'm worried that
maybe Lucy might need
a little more support
in looking after Cynthia
you know, that maybe
this current setup is
I don't know, it's just not
optimal for either of them.
Well, I've tried.
I've offered to cover the costs,
but Cynthia's too damn stubborn
to accept my help.
Wait, what do you mean, not optimal?
Are you saying that
Lucy hasn't been taking
proper care of her mother?
No, quite the opposite.
She's so vigilant about
keeping the catheter clean,
she's breaking
the closed drainage system
several times a day to disinfect it.
I'm pretty sure that's where
this infection's coming from.
I'm just curious.
Have you ever noticed I don't know,
other behaviors like this before?
You know, sort of repetitive cleaning,
checking, needing to do things
in a certain sequence
Lucy's always been a perfectionist.
She sets high standards for herself.
- Okay.
- And look
aren't there rules
in your profession about,
you know, diagnosing people
in hallways?
Sam, I haven't diagnosed anyone.
I'm just I'm just concerned.
Well, maybe with
everything that happened
with Anna last year,
you're projecting, you know,
seeing warning signs
where there aren't any.
Lucy has enough on her plate as it is.
She's got a sick mother.
She's got a PhD program.
She doesn't need you giving her
one more thing to worry about.
♪
Caleb's labs are encouraging.
His electrolytes
and kidney function are normal.
All right.
Hemoglobin's a little low.
Yeah, mildly.
It's likely nutritional.
We'll have his pediatrician follow up.
All right.
He's just a sunburned,
dehydrated little kid.
After this bolus,
I think he's good to go.
Well, all right.
What you working on?
Uh, application for chief resident.
- Oh, cool.
- Yeah.
I had a little run-in
with our residency director
this morning, and then Ripley kind of
got into my head that I need
to take more initiative.
So but, I mean,
chief resident is basically
just all scheduling, right?
Yeah. Yeah, that's part of it.
Well, what else is there?
Um, I've I've heard
it's a ton of admin meetings
and committee work
and managing the call schedule.
And then, of course,
you're the one fielding
complaints from residents
and mediating disputes
between residents and attendings.
And I've just heard it's a lot,
but maybe that's your jam.
[CLEARS THROAT]
Hey.
Nora's biopsy's complete.
Pathology's expediting the results.
Thank you.
And if you need to go,
I can text you when they come in.
Uh, no, I'll stay.
All right.
Uh, Sharon?
Yeah?
I'll keep this short,
because after the way I behaved,
I wouldn't blame you for not
giving me the time of day.
I owe you an apology.
I demanded you let me into your life
while shutting you out of mine.
And then after you did
everything you could
to save my job, I blamed you
for not doing enough.
I was wrong.
I'm sorry.
Thank you, Dennis.
I appreciate that.
I really do wish I could've done more
to protect you from Miranda,
but you were, unfortunately,
collateral damage
in her campaign against me.
Well, leaving Med wasn't easy.
But I like it over
at Midwest Advocate.
I landed on my feet.
I'm glad.
The part I haven't
gotten over is losing you.
Ms. Goodwin,
incoming level 1, Trauma 1.
I'm sorry, I
I I've gotta go.
Of course, of course.
Go.
Feel free to take one for the road.
Hey, hey, Dr. Frost said one.
If your mom knew
you were having sugar
Caleb's not been very good
about brushing his teeth lately,
and they're getting brown.
So we are trying to limit his sweets.
I brush my teeth.
Well, you are not doing
a very good job.
Now, come on.
Hey.
Something wrong?
My chest feels kind of funny.
Funny how?
Like there's a bird flapping
its wings inside of it.
Okay.
Let's lay you back down, all right?
There we go.
Yeah, he's tachycardic.
Let's put him on the monitor.
Okay, sinus tach rate's 133.
That's pretty high, right?
It's higher than it should be.
He's probably still volume-depleted.
We'll put him on some fluids,
repeat the labs,
make sure nothing's changed,
all right?
Yeah, whatever you need to do.
Hey.
Heard about the baby.
Yeah.
So a few months after Sean was born,
I lost a little boy in the OR.
Eh
[SOMBER MUSIC]
I mean, we kept the code going
for almost an hour,
long after I knew that he
he wasn't coming back.
And all I kept thinking was,
what if that was Sean on the table?
Because before I was a parent,
you know, I could just
I could compartmentalize everything.
But afterwards, every kid was Sean.
Every kid.
Does that ever go away?
No, it doesn't.
You just get better at
handling it, that's all.
I was not very good
at handling it today.
Oh, when I told Jessa that her
that her baby was gone,
I couldn't hold it in.
It was so unprofessional.
She needed someone
to be strong for her,
and I made her pain about me.
But there's a difference between
making a patient's tragedy
about yourself
and letting them see
that it's affecting you too.
And on the worst moment of her life,
maybe that's exactly
what Jessa needed,
somebody to feel the pain with her.
Wait.
Sorry.
Uh, what gloves are you using?
Oh, the ones in the kit.
Shouldn't you change them?
Oh, that's not necessary.
But but you touched the swab.
Lucy, that
that's a sterile Foley kit.
Everything in that package is sterile.
I'd be happy to change them
if it would make you more comfortable.
That would be great.
Trini, you don't need
to change your gloves.
The swab was in the basin on the bed.
You picked it up. You put it back.
You touched the flush,
and the flush touched the basin.
So you need to start over.
New basin, new flush, new gloves.
Lucy, you're being irrational.
Honey, you have to calm down.
I can't calm down, Mom.
[INHALES DEEPLY]
What if bacteria gets
into your catheter again
and this time gets
into your bloodstream
and the antibiotics don't work
and your fever spikes?
- None of that's happening.
- Okay, but it could happen.
And she could get septic,
and she could die,
and I will have just stood here
and and let it happen.
I can't let that happen.
I cannot let that happen!
Lucy, nothing's happening.
Your mother's gonna be fine.
You don't know that!
Hey, hey, hey, you're catastrophizing.
You just need to calm down.
I can't breathe. I can't breathe.
[GASPING] I can't breathe.
- I can't I can't
- Lucy, Lucy, look at me.
Lucy, Lucy, you're having
a panic attack, okay?
- I know, I
- It feels really dangerous,
- but it's not.
- Something's wrong.
- Something's wrong.
- It's not dangerous,
and it's gonna pass
it's gonna pass.
You know what helps?
I want you to breathe
with me, all right?
- Breathe in through your nose.
- I can't.
- Look at me. Look at me.
- I can't.
Look at me. Okay, that's okay.
Don't fight it. Don't fight it.
Okay, look at Mom.
What color is Mom's blanket?
- It's it's blue.
- That's right.
It's blue. And how about Dad?
What's Dad wearing?
His gray coat.
That's right, his gray coat.
And so Dad's right there,
and he's okay.
And Mom's okay.
They're okay.
And you know what? You're okay too.
You're okay.
You're safe, Lucy, all right?
Okay. Come on.
Come sit down here with me.
There you go.
You're doing great.
[GASPING]
Oh, my God, I'm sorry.
[SOBBING] I'm so sorry.
I just I
I need to keep her safe.
[SOFT DRAMATIC MUSIC]
♪
I'm sorry, what?
You can't be serious.
Pathology triple-checked the results.
Uh, your biopsy shows
you don't have cholangiocarcinoma.
You have primary biliary lymphoma.
It grows much faster
than most bile duct cancers,
which explains how
the mass grew so dramatically
in such a short time.
So I I still have cancer?
Yes, but, um, this changes everything.
It's an aggressive lymphoma,
but also, it's highly
responsive to chemotherapy.
In the majority of cases,
it can be cured.
[BREATHES SHAKILY]
Well, Dr. Pitzer,
the doctor who diagnosed me,
was she wrong not to do a biopsy?
Because if we'd known sooner,
maybe we could've
No, she wasn't.
The location and the appearance
of the tumor were classic
for bile duct cancer.
Lymphoma presenting this way
is extraordinarily rare.
There was no reason to suspect it.
Before you came in,
I was planning my funeral
Making mental notes of everything
Eden would need to know
bank accounts, passwords.
Instead, we get to plan a future.
All I wanted was for you to be okay.
[SIGHS]
[SNIFFLES]
How is Lucy?
Dan gave her a small dose of Ativan.
She's resting in my office.
He thinks this is likely
obsessive compulsive disorder.
And given how severe
the symptoms have become,
he's recommending a 30-day
residential treatment program
at Northwestern.
Well, how do we get her in?
Getting her in isn't the issue.
Dan just makes a phone call.
It's getting her to go.
Lucy won't leave you alone.
Well, I'll I'll move
to a nursing facility.
I mean, whatever it takes.
Lucy's not gonna agree to that.
She's not gonna put you in a home.
No, you need to do
something very hard, Cynthia.
You need to let me help you.
[BREATHES DEEPLY]
All right.
What was that?
I said okay, Sam.
30 years,
and you finally do what I ask.
Are they sure you're not dying?
It was the first good idea
you've had in 30 years.
No, remember, the divorce was my idea.
Mm.
I assume your, uh, child bride
is more agreeable.
Michelle's nearly 40, you know.
[CHUCKLES] How near?
Hey.
Check out Caleb's hemoglobin.
It's dropped a point
since he got here.
Well, that could be dilution
from the fluids.
Except his bilirubin
and LDH are climbing.
He's hemolyzing.
I knew those blisters were
something worse than
just a bad sunburn.
Okay, so what could cause hemolysis
and make his skin react
that violently to sunlight?
His brown teeth.
Porphyrins.
If excess porphyrins are
building up in his teeth,
- his skin, his blood cells
- Exactly.
It explains everything.
The discoloration,
the anemia, the blistering.
Okay, we're gonna need
a quantitative urine
and plasma porphyrins
to start narrowing down
the list of possible blood disorders.
No, it's okay.
I have a faster way to see
if we're on the right track.
Just gotta visit my friend
in Dermatology.
You're sleeping with someone in Derm.
I don't think you can ask me that.
It was a statement, not a question.
Well, your statement is inaccurate.
Mm.
She's just giving me
a few chemical peels.
Uh-huh.
It was quite a day.
Oh.
Well, those don't look
like happy tears.
I'm I'm so incredibly happy
that Nora's gonna be okay.
I am, I just
I don't know what's gonna happen now.
Can I sit?
Yeah.
So what do you mean?
[SIGHS]
Before Nora got sick,
I was thinking of leaving her.
More than thinking about it.
I I started looking at apartments.
I consulted a divorce attorney.
Does Nora know that?
She knew I was unhappy.
I don't think she understood
how unhappy.
You got a small taste of it today.
The questions, the second-guessing,
telling everyone how to do their jobs.
[PENSIVE MUSIC]
Nora has to be in control.
And before she got sick,
it extended to everything
her home, our marriage.
But things changed after she got sick?
For the first time in years,
Nora was faced with something
that she couldn't control.
It made her vulnerable.
She had to lean on me,
let me take care of her.
We started to feel
like partners again.
I want her to be better.
That's all that I want.
But what if getting better means
Things go back to the way they were?
You know, what Nora's
gone through changes people
sometimes for a period,
but sometimes forever.
You don't know yet who
either of you are going to be
on the other side of this.
But
you don't have to decide today.
♪
How's she been?
Asleep, mostly.
That's not unusual.
Between the fall, the anesthesia,
all the pain medication
her body's been through a lot.
Hey, Jessa.
Mm.
Where am I?
We moved you to the ICU.
I'm sorry, who are you?
Um, honey, this is Dr. Asher.
Remember?
She's the doctor who operated.
What happened?
Oh, did I have the baby?
[SOFT TENSE MUSIC]
Please tell me where my baby is.
Neurology will speak
with you, but they believe that
Jessa has anterograde amnesia,
which is affecting
her ability to create
new memories post-accident.
Will will she get better?
Yes.
This is temporary.
Her memory should improve
over the next few days.
And until then
She'll continue to forget
what we've told her.
Jessa suffered two miscarriages
before this pregnancy.
She wanted this baby so badly.
We both did.
She's asking for you.
I'll help you tell her.
What's that?
This is called a Wood's lamp.
Dermatologists use it
to look for things on your skin
you can't see in normal light.
You ready?
Give me a big smile, Caleb.
Why do his teeth look like that?
Erythrodontia.
It happens when porphyrins
accumulate in the teeth.
I want to see.
His blisters, the anemia, his teeth,
they all point to a rare
metabolic disorder
called Gunther disease.
What do you think?
Whoa!
This is so cool.
How do you treat it?
With rigorous protection from sunlight
and blood transfusions
to control the anemia.
Is this something he's gonna
have for the rest of his life?
It's genetic, so yes.
But now that we know
what we're dealing with,
we can prevent him
from further damage.
We'll have Hematology down shortly
to talk you guys through everything.
Thank you so much.
Of course.
We'll see you in a bit, kid.
Um, Wood's lamp, right?
You don't see these
every day in the ED.
Just used it to diagnose a kid
with congenital
erythropoietic porphyria.
Oh.
That's, uh, quite the catch.
Well, his worsening anemia
didn't fit dehydration.
And then we noticed
a staining on his teeth,
and I remembered that
erythroderma fluoresces red
under a Wood's lamp.
Yeah I expect so little
from residents.
Nicely done.
Uh, what was that?
You kind of just made it sound
like it was all your idea.
Oh. Um, God, I'm I'm sorry.
I didn't even think about that.
I don't really pay attention
to who gets the credit,
but, um, my bad.
No, it's, uh forget it.
Are you sure?
I'm I'm sorry. Again
Totally, it's it's fine.
Okay.
So Northwestern can take Lucy
whenever she's ready.
Thanks.
She's agreed to go
once we have full-time care
- in place for her mother.
- Great.
I contacted an agency,
and they're gonna send
some caregivers over to me
with Cynthia on Monday.
I'm sure she'll reject
the first six on principle,
but we'll get there.
I don't doubt it for a second.
Dan, thank you for stepping
in with Lucy earlier.
Sam, come on.
My attempt to calm her down
had roughly the opposite effect.
Look, this situation is
a classic parental minefield, right?
You're damned if you open your mouth,
and you're damned if you don't.
They're moving her upstairs shortly.
I got her the VIP suite.
Thanks, Dad.
I dropped the ball, Lucy.
The signs have been there for years,
but I was too busy
fighting with your mother,
which I'm sure only exacerbated
Can we just skip this part?
What part?
The part where you blame yourself.
You have far less influence
over me than you think.
[SOFT MUSIC]
Dad, I
I need you to promise me
that you'll take care of Mom.
Lucy
you have my word.
Your mother's gonna be taken care of.
Your only job is
to take care of yourself.
♪
Congratulations are in order, Dr. Wu.
Or should I say Gaffney's next
emergency medicine chief resident?
Oh, even running unopposed,
I'm grateful for the opportunity.
Well, taking on a role this demanding
while finishing your residency
is quite admirable.
I know it'll be a lot of extra work,
but some opportunities are worth it.
You got this.
Dr. Heart.
I hope I'm not too late.
- Deadline said end of day, so
- Oh.
And the day is not over.
Frankly, I'm just pleased
to see you putting yourself
forward for a leadership
position, Dr. Frost.
And, uh, just so you know,
Dr. Wu has also declared her interest.
So since there are two candidates now,
the ED attendings will be
making the final decision.
Looks like we've got ourselves a race.
That was a hell of a catch.
Yeah.
We got lucky.
Uh, I guess
I probably should head out.
Be well, Dennis.
You too, Sharon.
[SOFT TENSE MUSIC]
♪
I found Miranda's mystery
visitors in the security logs.
Miranda met with the executive
search firm the board retained
after Quinley announced
his retirement.
Well, that's hardly a secret.
I mean, everyone knows that Gaffney is
looking for a new CEO.
Why would she need
to hide the fact that
she was advising them on the search?
Because she wasn't advising them.
I mean, at least that's not
what it looks like.
Look, in preparation for this meeting,
Miranda had her office
pull five years of
departmental financials,
charting the hospital's margins
from before and after her
arrival, a nice summary
of every cost-cutting
initiative she's implemented,
her five-year strategic plan
for Gaffney.
So Miranda isn't helping them
choose the next CEO.
She wants to be the next CEO.
Bingo.
[SIGHS]
What?
[SOFT MUSIC]
Oh.
♪
Ooh. Oof.
You got her down by 8:00?
No one's more surprised
than I am, believe me.
- Okay, so
- What is
Well, I'm gonna tell you.
So I figured that, you know, at
least one of these would work.
But you know what? The hell with it.
Let's just put all of them
on her and, I don't know,
have a photo shoot
and take Doris's advice.
You know, collect blackmail
for when she's 16 and hates us.
Do you want me to run you a bath?
You can just stay in there
as long as you want.
I'll take the first shift.
♪
I'd rather stay right here.
♪
sync & corrections awaqeded
[DRAMATIC MUSIC]
♪
[WOLF HOWLS]