Chicago Med (2015) s01e03 Episode Script

Fallback

1 Okay, let's bring it up a bit.
I love it.
My dad is gonna hit the roof when he gets the bill.
What's he gonna do, fire you? I wish he would.
You liar.
All right, it needs to go 6 inches lower.
The street level sight line.
Look out! Russel! You're okay.
Oh my God, you're okay.
No, don't.
Don't touch him.
Go call 911.
You're okay, you're okay.
No, no, no, look at me.
Look at me, honey.
Could someone please help over here? [gasping] - Trauma 4.
- Incoming.
45-year-old male, multiple penetrating injuries to the chest.
GCS 12, BP's 90 over palp.
Did you give him anything for pain? We've given him 4 morphine and 500 saline.
What happened? Chandelier fell from about 20 feet and landed right on him.
How long ago was this? Maybe 30 minutes.
- Did he lose consciousness? - No.
All right.
Let's get ready to move 'em.
Very gently on my count.
One, two, three.
Ah! All right, can you tell me your name? [shaky voice] Russel Rollins.
Russel? Connor, oh, thank God.
Help me.
All right, we're going to, bud.
All right, airway's in tact.
Get me a set of vitals.
Someone draw a gas and get a chest X ray.
- You know him? - Since I was a kid.
Russel, can you move your fingers and toes? I think.
- Where did this happen? - At the store.
Claire? Sat's 90.
Heart rate's 124.
All right, everybody, quiet.
Russel, take a deep breath for me, huh? [screams] I don't hear much on the left side.
We're gonna need a chest X ray.
It's not optimal, but we're gonna do it from here.
Am I going to die? Hey, Russel, listen to me.
No, you are not.
No, you are gonna be fine, Russel.
- You're gonna be fine.
- You have to wait over here.
All right, I'm gonna hold the plate from here.
You just shoot as head on as possible, okay? - You got it? - Here, Russ.
Listen to me.
You're doing great, buddy.
I just need you to keep as still as possible, please.
X-ray.
Everyone clear? Both: Clear.
[whirrs] [monitors beeping] Big hemopneumothorax with some shift.
He needs a chest tube.
I got it.
Who's the trauma attending on call? Dr.
Zanetti.
Page her.
Tell her we need her down here right now.
Got it.
I'm sorry, are you family? I'm I'm his employer.
Claire Rhodes from Dolan Rhodes.
- The department store? - Yeah.
- Dr.
Rhodes, is he - He's my brother.
[monitors beeping] What are we looking at? 45-year-old male.
Impaled glass in his left chest.
Arrived hypotensive, but responded to blood and fluids.
Left tension pneumo.
That's a cluster.
Oh, God.
Ma'am, let me show you where you can wait.
Got a chest tube in on the left side.
Pressure's improved.
Base deficit was 8.
We need to get this thing off to see what we're dealing with.
What did you sedate him with? Got two of versed with the chest tube.
Which one of you is in charge? That's me.
I need to remove it without allowing this piece to vibrate in the slightest, so I'm thinking cuts here, here, and here.
Yes, ma'am.
[elevator bell dings] Nat.
Guess who Connor is.
I'm not talking to you.
Oh, come on.
What was it you said? "Try thinking like a doctor, not a pregnant woman?" I was crazed, all right? I didn't mean it.
You meant it.
Look, I need to ask you about a patient.
You wrote that article review on vertigo, right? Yes, that and other pediatric vestibular disorders, why? Well, I got a 24-year-old in four who lost her balance and took a header.
I'd like a second opinion.
- Get that package yet? - What package? I sent you an olive branch.
Not a real olive branch obviously, although now that I'm thinking about that, maybe that was the way to go.
I'm trying to apologize.
What's the patient's name? Dylan.
Her name is Dylan.
Captain Trevor Jackson.
Ma'am.
- Army? - Ranger.
First Battalion.
- 75th Regiment.
- Cool.
- Follow my pen line.
- You served? Navy.
Reservist now.
You're a long way from Georgia.
What brings you in today? Fender bender.
It was my fault.
I got light-headed.
Thought I was gonna pass out.
Well, you been drinking, soldier? No, sir.
Blood work.
You two in town for business, pleasure? Visiting my family.
Lincoln Park.
I got to get back to duty.
Mother-in-law's cooking packing on the pounds.
- Kids? - Not yet.
One day, baby, one day.
I don't want her to have to raise kids alone while I'm still being deployed.
Captain Jackson, are you diabetic? No.
I'm afraid these numbers indicate differently.
- Your blood sugar's at 350.
- What? No.
There's no way I have diabetes.
Baby, listen to the doctor.
If I have diabetes, they won't deploy me, and that's it.
I'm done, and I can't be a soldier anymore.
You understand.
Well, it's true you don't have the classic risk factors Obesity, family history And your white blood count is elevated, so it's possible there's some underlying infection driving your blood glucose up.
Okay.
We'll run some more tests, see if that's the case.
Please.
All right, we'll be right back.
It's gonna be okay, honey.
Can you smile for me, Dylan? All right, now I'd like you to tilt your head to your left for me, all right? I tried an Epley already.
It didn't seem to help.
[tuning fork chimes] - Can you hear this? - Yes.
How about now? Not as well as the other.
- You a musician? - Mm-hmm.
Getting my master's at CCPA.
The Conservatory? Impressive.
Follow my finger for me, all right? I don't mean to scare you, but becoming a doctor was actually my fallback plan.
I wanted to be a musician; a violinist, in fact.
I don't have a fallback plan.
Music's all I ever wanted to do.
You see, that's what I was missing.
Here, can you squeeze my hands? Plus, Paganini's C minor Caprice broke my will.
You and just about everyone else.
- It's a bear.
- Yeah.
[both humming] I played snare in marching band freshman year.
What do you call the guy who hangs out with the band but isn't a musician? The drummer.
Thanks.
I've got my recital next month, all Bach program.
- Maybe you can come.
- Sure, I'd love to.
Dr.
Halstead.
She's got a slight nystagmus in her In her right eye, I know.
And the hearing loss in the left.
I'm thinking it could be syndromic.
Well, apparently you didn't need a consult.
Come on, I value your opinion.
How come you never told me you wanted to be a musician? You want an opinion? Call a neurosurgeon and send her for a stat head CT.
I want a CTA of his chest ASAP.
Figure out exactly what's bleeding.
Got to get him on his back before we get him upstairs.
- Oh, you're gonna use - Yes, he is.
Can you hold the patient steady please? Thank you.
All right, hang in there, Russ.
[saw buzzing] All right, we're gonna flip him over onto his back gently on my count.
One, two, three.
Okay.
All right, let's start to package him up.
Newbie, start a femoral line.
[monitor beeping] I got this.
Reese, get over here and help me splint the glass to keep it still.
One wrong move on the way, and he could have a massive hemorrhage.
- Maggie? - Yep.
Call the blood bank.
Tell them I want five more blood, five plasma, and six platelets typed and crossed.
Yes, ma'am.
All right, are we ready? Look, I wish I had more to tell you.
Russel's on his way to CAT scan right now, so we can figure out what's injured.
We think that it has something to do with the subclavian artery.
English? The one that supplies blood to the arm.
He's gonna need an operation.
We have to remove the glass and You haven't removed the glass? It's actually keeping him from bleeding to death.
We are trying to get good imaging so that when we operate, we're not going in blind.
So get it.
Is this how it's gonna be? What did you expect? I had to leave, okay? The way things were with Dad, there was no Right, you left him, Connor, but you left me too.
Just go take care of Russel.
Did you hear? He's that Rhodes.
Oh, a prince in disguise.
Your friend with the glass shards? Uh-huh.
These are them.
Unusual case.
Couldn't help myself.
Yeah, I get it.
Looks like this thing goes through the left subclavian.
There's just so much scatter with the leaded glass.
It's impossible to make out the details.
I think we're gonna have to go to interventional for an angiogram.
Want my opinion? Yeah, sure.
Try Surgical Theater's SNAP.
What's that? S-N-A-P? Surgical Navigation Advanced Platform? You ought to crack a journal once in a while.
Yeah, well SNAP three-dimensionalizes CT images.
Because it's 3-D, you see your surgical point from every angle.
Okay, well, where do I find this SNAP? There is one in the main OR neuro room.
Great, thank you.
Dolan Rhodes.
I bought some socks there once, the only thing I could afford.
If this works out, I'll get you a tie.
Dr.
Travis, you have a visitor in the main lobby.
Captain Jackson, Mrs.
Jackson, I'm Dr.
Manning, Natalie Manning.
Ma'am? I understand you're a Ranger.
- First Battalion? - Yes, ma'am.
My husband was in the First Battalion.
Captain Jeffrey Manning.
Was? He was killed in action six months ago, Kandahar Province.
I'm very sorry, ma'am.
I didn't know your husband.
Jeff always got so uncomfortable when people would say, "Thank you for your service.
" But I guess that's what I want to say.
Appreciate it.
And thank you for your sacrifice.
Nat? I thought I would pay my respects, but it was really about Jeff me looking for Jeff.
[indistinct chatter] - Dad.
- Doctor.
How's our patient doing? Russel's stabilized for now.
I have found something that could help us with the surgery.
It's an imaging system called Surgical Theatre SNAP.
Okay.
It's FDA approved, so insurance is gonna cover it, but Russel is going to be looking at a lengthy hospital stay afterwards, and I just want to make sure that That somebody covers the co-pay? - We will.
- Hang on there, Bernie Sanders.
Now, I love Russel as much as you do, but we have to be responsible to the company.
Are you prepared to do this for every one of our employees? We are talking about Russel here.
God, he's worked for us since he was 14 years old.
- He's family.
- Us? When did it become "us"? - That's your dad? - Yep.
Fathers like that keep me in business, baby.
Dr.
Charles, do you have a minute? Sit down.
Don't mind if I eat.
I missed breakfast.
Please.
It's my patient, Captain Jackson.
He's a physically fit active service army ranger, but his blood sugars indicate he has diabetes.
You run labs? Do a CT? His pancreas is healthy.
There are no signs of tumors.
His labs came back clear for infection and autoimmune disease.
I can't find a reason for his diabetes, but I did find this.
He fractured two thoracic vertebrae.
- Ouch.
- Exactly.
So why hasn't he said anything? Why do you think he hasn't said anything? Overseas, I saw a number of soldiers who were away from home a lot.
They were depressed.
Depressed patients tend to mask or hide pain.
Right.
The thing is, diabetes is a red flag for the military.
You test positive, you don't go back to combat.
So if you were depressed about overseas deployment You'd think he'd be happy to have diabetes.
He's home for good.
Well, that's not the case.
Jackson's extremely upset at the possibility of not going back to active service.
Something's going on with him.
Let's go say hello to Captain Jackson.
Thank you, sir.
Captain, this is Dr.
Charles.
He's a senior attending physician here.
I've asked him to consult, just to make sure we're covering all our bases.
- Yes, sir.
- Please, as you were.
- You're Mrs.
Jackson? - Yes.
It's nice to meet you.
I just wanted to make sure that I have your history straight.
So you've seen combat before? - Yes, sir.
- And this was your first tour? Seventh.
Seventh.
And What was in the test results? You have a couple fractured vertebrae that will heal on their own, but all your other tests failed to give us an answer.
We can't find a clinical reason for your high sugars.
Clinical? What does that mean? A physical cause.
I'm sorry, what kind of doctor are you? He's a psychiatrist.
A shrink? I don't need a shrink; I'm not crazy.
Nobody's saying that you are.
Honey, they're just trying to help you.
How is a shrink gonna help me? As I said, we're covering all our bases.
- You think I'm faking this? - No.
You can't fake blood sugar.
So what are you saying, huh? You think I did something to myself? You think I'm a coward? Not for a second is anybody saying you're - Trevor.
- Whoa, whoa, Mr.
Jackson.
- Captain.
- I'm out of here.
- Mr.
Jackson - Whoa, whoa, Captain.
Whoa, whoa.
[metal clattering] - Jackson! - Captain! Captain! - Nurse, please, a little help! - Come on, baby.
Watch your back.
Left.
Straight to surgery.
Thank you.
Hey, Maggie? Can you help me out? With what? With, you know, an IV.
The patient's veins are really small.
How many goes have you had? Three.
Oh, man.
Okay, I got a kid with a broken arm in two.
No needles.
- Think you can manage that? - Yes, ma'am.
I'm not sure you're aware, but Connor knows Russel Rollins, and it just didn't seem appropriate to me that my son be the one treating him.
Well, the degree of familiarity doesn't warrant taking Dr.
Rhodes off the case, and Mr.
Rollins, when he was lucid, did not request another physician.
Let me put it another way.
I would like Russel to receive the very best medical care, and I do not think my son can provide that.
Your son is a first-rate surgeon, otherwise I would not have hired him.
I want him off the case.
It's not your decision to make, sir.
Excuse me, but I'm the one writing checks here.
And while we appreciate that, this is my shop, and I will not be pulling Dr.
Rhodes from the case.
I want you to remember this conversation, because if anything happens to Russel, you will be repeating it in a courtroom.
I will remember.
And you, sir, have a nice day.
This may not be your shop for long.
- Dr.
Halstead.
- Yeah? Your violinist.
Radiology just sent the report.
Has anyone from neurosurgery seen these yet? They're talking about scheduling surgery as soon as possible.
Acoustic neuroma? Tumors, essentially, caused by a genetic condition called neurofibromatosis.
It disturbs nervous system cell growth.
So these neuromas are pressing against your inner ear, and that's why you've been experiencing the hearing loss and the dizziness.
We need to remove them and stop the internal bleeding.
- When? - As soon as possible.
What are the side effects? There's a good chance you'll lose your hearing.
My hearing? Yes.
[metal clattering] Dylan, I know it seems like your world is coming apart right now, but we got lucky here today.
Okay, that fall you took might've just saved your life.
I'm a musician.
This could've killed you, and you don't always get a warning sign.
I want to transfer you upstairs and admit you into the hospital proper.
Is that okay with you? No, I want to talk to the woman who was in here earlier The violinist.
Dr.
Manning? I'm not going anywhere until I talk to her.
Okay, I'll tell her.
- How's he doing? - Okay.
Don't think it'd be a very good idea for me to go back in there.
No.
Wow, seven tours.
That must be tough.
Well, I knew what I was signing up for.
- I'm proud of my husband.
- Of course.
I just I know you must miss him and worry about him.
Like every soldier's wife.
And I know the illness is a blow, but at least, you know, you have him home, and he's close, right? Thank you.
The chairman is here to see you Of the hospital.
- That's never good.
- Mm-hmm.
He's waiting in your office.
Okay.
- Barry.
- Sharon.
Nice surprise.
Well, I was on my way to the Art Institute for a preview.
- I thought I'd drop by.
- A little out of your way.
I got a call from Cornelius Rhodes.
He's friends with some members of the board golf buddies.
- Said he spoke with you today.
- He did.
Unfortunately, he feels his concerns were not addressed.
Oh, no, they were addressed.
He feels he was dismissed.
Good.
I'm glad he got the message.
Sharon, I would never tell you how to run this hospital.
And I appreciate your faith in me, Barry.
But the Rhodes are wealthy people.
Mm-hmm, and how much has Mr.
Rhodes given to this hospital? His mother's donated quite a bit.
No, no, how much has he donated? Mr.
Rhodes was talking about making a $200,000 gift.
Right.
Talking.
I don't think we can ignore the fact that the Rhodes Barry, listen.
I can understand the need to cultivate donors.
Mr.
Rhodes can make a $200 million gift, but I still will not let him dictate who performs surgery in this hospital, and I think going to war for that conniving S.
O.
B.
is not a good idea.
Incredible.
Wait till you get the headset on.
It's like I'm moving around inside of his body.
Okay, so tell me how this thing works.
It combines images from the CT angiogram and creates a three-dimensional model of the patient's anatomy.
With the HTC Vibe, you get virtual reality.
It allows us to better tailor our operation.
Are you having some concerns? No, no, no, just just curious.
Oh, by the way, Dr.
Rhodes, I met your father today.
Yeah? Did he charm you? Not exactly.
Hey, Dr.
Zanetti.
Take a look at the middle-left subclavian artery.
The glass is going straight through.
It's like a finger in a dike.
I can't believe there's still flow past the injury.
Rotate a little to the left.
There.
Looks like our dike sprung a leak.
- He's bleeding.
- Yeah.
I think we can get away with a collarbone incision.
Come on, let's go.
Claire, Dad, this is Dr.
Zanetti.
Russel is being prepped for surgery right now, and she and I will perform the operation.
Okay.
You must have a lot of faith in him.
I do.
Hmm, I never thought I'd see the day; my son saving lives.
Your father, is he as big a tube steak as he seems? That he is.
You leave him out there, Rhodes.
Don't bring him in here.
[saw buzzes] [monitors beeping] Okay.
All right.
- Ready to pull this out? - Ready.
Okay, take a deep breath, and whatever you do, do not break the glass.
Damn it.
You lacerated the subclavian vein.
I need suction.
We have 20 seconds before he bleeds out.
More suction.
Systolic's 90.
What's going on? Are you guys in trouble? Shut up, Marty, just give him blood.
4-0 Proline.
Suction there.
- Right there.
- No, that's not it.
Damn it, I can't see anything.
He's 34 degrees.
I can't see a thing.
More suction.
Dr.
Zanetti, let me.
I got this.
Let me.
You better not screw this up.
Gentle.
Okay, I got it.
That wasn't about your father, was it? I really hope you weren't trying to prove something.
The Captain has been gaining weight, seems to bruise easily.
That's totally consistent.
I just can't believe it.
Let me do this.
Mrs.
Jackson? I'm sorry, I don't want these to get cold.
I I won't keep you long.
In reviewing your husband's symptoms, I'm pretty sure I know what's causing his diabetes.
Hmm.
And, um And I think you do too.
What? What are you talking about? You don't lie a whole lot, don't you? I mean, you're certainly not very good at it, to your great credit.
To lie well, you have to loosen up.
You know, make eye contact, stuff like that.
I don't understand what you're saying.
I mean, lie? Lie about what? Somebody's got to go in there and tell your husband the truth.
I could do it.
Let me hold those for you.
Maggie, any word from Dr.
Rhodes on the surgery? Nope, he's still in the OR.
I'm afraid I've got some bad news.
Oh, please, I am having a terrible day.
It's about to get a little bit worse.
We have a case of domestic abuse on our hands.
You couldn't! Are you out of your mind? That woman has been poisoning her husband with prednisone.
Why would you do something like that? Oh, my God.
I read on the Internet that if I gave him some prednisone, it would look like diabetes.
I just wanted him home safe.
It's been ten years of worry, of nightmares.
You can understand why I did it, can't you? Well, whether I understand or not, it doesn't matter.
There's a doctor here.
Her husband was a ranger, and she lost him.
He's dead.
Isn't it better to be sick than dead? Why did you let it go so far? Why didn't you talk to someone? What good would talking do? I wanted him home.
Talking wouldn't bring him home.
Mrs.
Jackson, I'm sorry.
What you did is a crime, and I have to report it.
Am I going to go to jail? I don't know.
She's not gonna do the surgery, at least not until she's given the recital.
You told her those tumors might kill her first? Hearing and being heard it's how Dylan interacts with the world.
She can't imagine her life without that ability.
She needs more time to process all of this.
She doesn't have more time.
I don't know what to tell you.
It's not our decision to make.
I don't believe this.
I miss something with one patient, and it's too late to fix it, then I catch something like this early on, and I still can't fix it.
Nat, the medicine is clear.
The patient should not be making this decision.
I should.
So you became a doctor to tell people what to do? I became a doctor to save people's lives.
It's all I've ever wanted to do.
I don't have a fallback plan or some hidden passion.
This is it for me.
It's just no one ever told me there'd be this much loss involved.
I pulled this out of the deep depths of my closet.
I reached out to Anne-Sophie Mutter's people, but it seems she's on tour in China, so I'm guessing you know Bach's "Concerto in D minor" for two violins? - In my day, we all learned it.
- Sure.
Get out your violin, Dylan.
We're gonna have that recital.
Come on.
The tumor's that bad? Yes, but we're gonna get it out.
And my hearing? Let me explain something.
The memory is not just in the head.
We also have what's called kinesthetic memory, the body's memory.
It remembers movement, resistance, and the position of its parts.
So hearing or not, your body can still remember how to play.
Don't focus on the sound.
Concentrate on the feel, the vibrations.
Just close your eyes and remember.
[plays Bach's "Concerto in D minor"] We'll taper off the prednisone, and your system will purge it over the next few days.
The side effects will dissipate, and your blood sugars will return to normal.
Where are they taking her? She's turning herself in to the police.
Lauren! Captain, easy.
We'll get through this together.
Dr.
Rhodes, how's your patient? The surgery was successful, and he should be okay.
Oh, thank God.
Isn't that great news, Mr.
Rhodes? Yes, I had every faith in my son.
That's exactly what I told the Chairman of the Board when he dropped by to see me today.
Thank you.
Of course.
Well, looks like we can go.
Thank you very much.
Dolan Rhodes.
That's a big name in Chicago.
Growing up with that can give a person a skewed perspective, like whatever he wants, he ought to get.
My dad give you a hard time? [laughs] Nothing I couldn't handle.
My grandfather was the one who started the business.
- Oh? - Yeah.
Salt of the earth kind of guy.
He used to say to me, "You're gonna have to "work harder than everybody else," you know? "Be better than everybody else so that you don't turn out like everybody expects you to.
" Hmm.
"So that you don't turn out like your father.
" Took me a while to get that message.
Well, congratulations, Dr.
Rhodes.
Dr.
Halstead, messenger just left this for you.
Charvet.
Ooh, someone likes you.
Mm-hmm.
Yep.
Reese.
Treatment 1.
Where's the patient? - You play golf? - No.
Me neither.
Who's got the time? There's something that golfers get.
The "yips.
" Some kind of mental block.
They can't make the simplest putt.
Even really the golfers.
I'm not following this conversation.
You got the yips with needles, and I'm gonna help you get over it.
Let's get started.
- You want me on - Yep.
Jab me.
Let's go.
I don't have all night.
Mm-hmm.
Dr.
Rhodes.
Back in the OR? Pretty ballsy move, pushing an attending aside.
Someone with a fragile ego would've chopped your head off.
Sorry.
Don't apologize.
Never apologize.
How'd it go? They got everything.
She's gonna be fine.
And her hearing? I'm sorry.
So what was in that package you sent me? Three bars of chocolate: dark, milk, semisweet.
Wasn't sure which you'd prefer And a jar of olives.
Olives? Well, I know you've been craving brine these days, so An olive branch.
I've got a patient I got to check on in peds.
You're forgiven.