Chicago Med (2015) s02e21 Episode Script

Deliver Us

Sure you don't want me to wait with you? Connor, I'm fine.
I'm not saying that you're not.
I just know that waiting rooms can be awfully boring.
All those old issues of "People" magazine.
Anyone else gets a little anxiety, they get a massage.
Daughter of a psychiatrist A full-blown psych eval.
Look, we both know that you haven't exactly been yourself lately.
So let's just do this right.
We'll get you back on your feet, okay? Fine.
Robin Charles? [phone ringing] Dr.
Kwon just told me Robin's coming in to be evaluated.
I'm so sorry to hear that.
Yeah, thanks.
Just, um, I'm hoping for the best.
He chose me as the resident to do her initial evaluation.
Really? Yeah, he said you spoke very highly of me.
- Thank you.
- Well, didn't tell him anything that wasn't true.
I imagine it must be hard to have to stay at arm's length from your daughter's treatment, but And this goes without saying, but I'm just want to say it anyway Dr.
Kwon and I will do everything we can to make sure Robin gets the best possible care.
Reese, I have complete confidence in you.
And if there's anything I can do to help, you just let me know.
I will.
There you are.
- What's up? - A buddy of mine had to pawn off two Blackhawks tickets for tonight.
- You in? - Only if I can feel the chill coming off the ice.
27 rows up, you're gonna feel it coming off your beer.
Pick you up at seven? See you at seven.
All right.
Rhodes! Possible collapsed lung coming in.
We're going to Treatment 3.
- I'm on it.
- Courtney? Talk to me.
Gayle Parks.
21 weeks pregnant.
Fell getting out of bed.
Baby's stable, but mom's short of breath and satting at 92, bradycardic and hypotensive.
- Doris! - Can you tell me what happened? She miscarried her last pregnancy, so we've kept her on bed rest just to be safe, but when she got up to go to the bathroom, she fell.
All right, thank you, sir.
All right.
Let's move her on my count.
One, two, three.
All right, let's get it out.
[shallow breathing] Nice, easy breaths for me.
[monitor beeping] Got breaths sounds bilaterally, but they're faint with crackles.
Let's get a stat AP chest x-ray.
Nothing that could harm the baby.
Parks, I promise the radiation will be minimal, and the fetus will be shielded by a lead apron.
We understand, - but if there's any other way - I'm sorry, sir, but your wife is having a lot of trouble breathing.
- We need to figure out why.
- I said don't do it.
[breathes sharply] This baby is a perfect match for my daughter.
I'm not taking any risks.
I'm sorry, excuse me? I have leukemia.
My mom's having this baby to save me.
[sharp breaths] [monitor beeping] - Imagine that baby being responsible for keeping its sister alive.
Serial bone marrow donation.
Maybe a kidney one day.
Part of its liver.
- Not gonna be easy.
- No.
But if your kid had advanced leukemia, what would you do? - Whatever it takes.
- Mm-hmm.
EKG confirmed a right inferior STEMI.
He's feeling better after aspirin.
Gave him a dose of beta blockers, spoke with cardiology, put him on the list for a cath, but he's currently stable and I think we're gonna be in good shape.
- Sounds like it.
- Mm-hmm.
All right, Mr.
You're in good hands with Dr.
And those hands couldn't be prettier.
Thank you, sweetheart.
Why is it that older men always think they can call you sweetheart? I can't say it happens much to me anymore.
Oh, maybe you should be sweeter then? And blow this rugged, tough guy thing I got? - [chuckles] - It's my meal ticket.
- Hi.
- Hey.
Don't even know why I'm bringing you this, Mr.
Well, that's because you're so thoughtful and lovely.
That's true.
I better get back to work.
I'll see you.
Have a good day.
Is it Match List day already? Uh-huh.
Stohl's yearly power trip.
Marching those poor med students around, telling them that he's turning in his list tonight.
So if they want a residency spot, here's your last chance to impress me.
Remind me of a drill instructor I had in boot camp.
- Nice guy? - Sweetheart.
[chuckling] Follow me.
We'll start over here.
First, I would like to hear about what's been happening lately.
After that, I'm gonna send you down to phlebotomy so we can run a few standard tests.
Then later, we can meet up again and see if we can figure out what's going on.
Sounds like a plan.
Um, so can you tell me in your own words why you're here today? To find out if I'm crazy.
Do you think that's a possibility? - No.
- Okay.
[exhales] Though you did agree to meet with me.
How come? [sighs] I don't know.
I mean, there is a history of psychiatric issues in my family.
I see.
Um, you want to tell me about what's been happening in the last few weeks? I started hearing rats in the walls of my apartment.
[sighs] [shallow breathing] - [knocking] - Mrs.
You breathing any better? - A little.
- Good.
Are you okay? Yeah.
Leah just finished a round of chemo.
She's been a little nauseous.
Got it.
Why don't you and Sam go get a little fresh air, huh? - I'll go with you.
- Okay.
[shallow breathing] Thanks, Doris.
So your tests show that you do not have a collapsed lung, but I'm seeing something more concerning.
You're in heart failure.
Um, uh, she had a peripartum cardiomyopathy during her last pregnancy.
So you understand the danger you're in? [exhales sharply] I had no choice.
Our son, Sam [shallow breathing] Wasn't a donor match for Leah.
This is the only way that I can save her.
We're well aware of the risks, but we discussed this at length and we, uh We're willing to take the risks.
I realize that this is difficult to hear, but the safest choice in cases like this is to Take the load off of your system and terminate the pregnancy.
My daughter can't make it without getting a marrow transplant in the next year.
If I lose this pregnancy, it'll be too late.
Three weeks, Dr.
That's all we need.
Can you help us do that? Yes.
[shallow breathing] I'm gonna put you on some medicine that will help to strengthen your heart.
We will get your pressure back up, and hopefully, you'll be breathing easier again soon.
- Oh, thank you.
- Thank you.
Of course.
Thanks for the help with Robin.
Of course.
Hey, Daniel? I understand Dr.
Reese is the resident evaluating Robin.
Yeah, well, it makes sense.
She's very good with patients in her own peer group.
Yes, she is, but she's also your student.
One of my very best, and I, uh I have the utmost confidence in her.
Well, I'm sure you do, Daniel.
I know this is complicated, but I sincerely hope you're not using Dr.
Reese as your surrogate.
Sharon, look.
Of course I'm a big fan of Sarah's, but Dr.
Kwon's running the show on this one.
My only job is to be a good dad, and stay out of the way.
[alarm beeping] He's in unstable V-tach.
Barely got a pulse.
A little help in here! He's peri-arrest Must be another heart attack.
Will, start bagging.
April, charge the paddles to 100.
- On it.
- What did his angio look like? Stented two small lesions in the cath lab.
[whirring intensifies] Charged to 100.
- Both: Clear.
- [paddles thump] No pulse.
I'm starting compressions.
Have a milligram of epi.
- Charge to 200.
- [paddles whirring] How were his vitals? He was fine.
He was totally stable.
- 200.
- Clear! - Clear.
- [paddles thump] He's gone into V-fib! Another milligram of epi.
300 amiodarone.
Keep up compressions and charge to 200.
[paddles whirring] Then he must have had a worse disease than we thought.
- Charge to 200.
- Clear! - Clear.
- [paddles thump] [monitor flatlining] Asystolic.
[paddles clang] [exhales] Time of death 10:32.
[sharp breathing] How did this happen? And now, for our final case Mr.
Dayne passed out this morning from a cardiac arrhythmia.
He's stable now, though still in A-fib.
Dayne, do you have any idea how long ago your irregular heartbeat began? Nope.
Thank you.
We'll be back.
So, if the A-fib started less than 48 hours ago, we Uh, shock him back into rhythm? Correct.
But if it's been longer than 48 hours, that same shock could throw a dangerous embolus to his brain.
So, my bright, young minds, one of you needs to come up with the answer.
Uh, Dr.
Stohl? How are we supposed to do that? Impress me.
[phone ringing] [exhales] - Dr.
Reese, what's up? - Hey.
Robin is down in phlebotomy now.
[clicks tongue] Oh.
Well, sounds like you're on top of it.
How's it, um How's it going? I'm starting to put together a clinical picture.
Good stuff.
Once again, you know, if you need any family history, any background For instance, she's been talking about her apartment a lot.
Has that come up at all? I really can't discuss this.
Of course you can't.
I'm sorry.
- [chuckles] - I just meant purely from a clinical standpoint, you know, the home is a reflection of the mind and all that.
It couldn't hurt exploring, but you're absolutely right.
Keep up the good work.
Doing a great job.
- Dr.
Manning? - Mm-hmm? I think you might want to have a look at this.
Oh, God.
What? My patient's autopsy report I made a mistake.
[phone ringing] Mr.
Walker didn't die of an MI.
Massive pulmonary embolism.
I can't believe it.
[stammers] I totally missed it.
Oh, come on.
Even if we knew, there's nothing we could've done differently.
It happened so fast.
We didn't have time to get heparin on board, let alone send him upstairs.
I know, but still [stammering] Wait.
How did you get this so fast? These reports usually take at least three to four hours.
Nina brought it up to me.
She came upstairs and gave it to you? Yeah.
[stammers] I'm gonna go back over the chart.
See if there were some clues.
Nat, listen.
You did everything you could for that man so don't get down on yourself over it.
Hey, you're too good a doctor.
Thanks, Will.
[keyboard clacking] Stohl's A-fib case.
Guy's holding a residency spot over our heads with this.
What's the case? 40-year-old male.
No records, no history, and Stohl expects us to figure out when it started.
Where are you at? I mean, there's no previous records.
No previous episodes.
[stammers] No family history.
I I'm getting killed on this.
You got any thoughts? Any recent caffeine or alcohol use? New onset irritability, perspiration, hand tremors? To assess for acute thyrotoxicosis.
Hey, that is good.
You got anything else? You applied here for residency, right? - Yeah.
- Well, you're not gonna get it by half-assing it through your cases.
Get back in there and start asking some questions.
And don't come out till you've done a thorough and complete history and physical.
- You understand? - Yeah.
- [alarm beeping] - Help! My wife can't breathe! - Please, please, we need help! - Mom! [alarm beeping] [shallow breathing] She's profoundly bradycardic.
Let's get 5 liters of O-2.
Let's get the external pads on to capture, and then we'll set up for a central line.
- Let me help! - Yep.
Mom, what's happening? [gasping] It's okay, Angel.
What are you gonna do? This is gonna fire electricity through your skin 60 times a minute to keep your heart beating until I can get an internal pacer on.
[gasping] It won't affect the baby? No, but it is gonna hurt.
[gasping] Okay.
- Set to 60 beats a minute.
- Got it.
Pacer's set.
[monitor beeping] Not capturing.
Mom! [hyperventilating] - Leah? Leah! - Leah! Leah! I got her! - Leah, baby? - She's not getting enough air! I need oxygen now! Nat, she's got stage four leukemia.
Just had chemo.
[both gasping] Save my daughter.
Try to stay calm, okay? How are you feeling? - I'm a lot better.
- Good.
20 more minutes of oxygen, and then she'll be free to go.
- I'll let her mom know.
- Great.
I love you.
Can I ask you something? Of course.
What's happening to my mom? [inhales] [exhales] I think that's something you should talk to your parents about.
They just tell me everything's fine.
When you're pregnant, your heart is pumping for two.
And right now, your mom is having trouble keeping up.
Is she gonna die? Dr.
Rhodes is the best heart doctor in the hospital.
He's gonna take the very best care of her.
She's doing this 'cause of me.
She's your mother.
She wants to do everything she can for you.
What about Sam? Your little brother? Sometimes, it's like Mom and Dad hardly notice him.
Like, he's not even there.
Why should I get all the attention? Your parents are worried about you because you're sick.
I'm sure they love your brother just as much.
What about the baby? What's it gonna be like for him? I don't want everyone sad 'cause of me.
I want us to be a regular family.
Have you told your mom how you feel? I think she'd want to know.
- Nina? - Hey.
Why did you give that report to Natalie? I'm sorry? Why did you come up to the E.
and give it to her? She missed a diagnosis.
I thought she'd want to know.
You file the report in the chart, and put an alert in the doctor's mailbox.
That's how you usually do it.
You have it in for Natalie? What? Are you trying to make her feel bad because you think there was or is something between us? Really, Will? That's what you think of me? Just explain this.
Why would you go out of your way to make sure Natalie knew about a diagnosis she couldn't possibly have done anything about? I told you.
She made a mistake.
And you know what? Anyone who refuses to learn from their mistakes is gonna repeat them.
Reese, how's everything going with Robin? I kind of have a problem.
Charles logged into her medical records.
I see.
I haven't posted any notes yet, so there's nothing much to see, but still Hmm.
Well, I'll go talk with Dr.
In the meantime, hold off on posting those notes.
- Ms.
Goodwin? - Yes? I can't help but wonder Did Dr.
Charles have me assigned to Robin's case just so he could get access to her treatment? 'Cause I get the feeling he's just using me to be his I don't know, his patsy.
Listen, Dr.
The only thing I can say is that this is a very difficult situation for him.
Try not to take it personally.
Hey, there you are.
Showing Dr.
Stohl what you're made of? Yeah.
I guess.
Actually, problem is, Dr.
Choi's been riding me really hard.
Well, that's his style.
It's just You're his friend, right? You think maybe you could ask him just to dial it back - just a little bit? - What do You know, just get him off my case.
He doesn't hassle the other med school students like this.
I'm not doing that.
I guess I'll just get back to work then.
How's Leah's mom doing? Even with the pacer, she's experiencing a dangerous number of premature ventricular contractions.
She could have a lethal decompensation any minute.
And if she does, I'm afraid we won't be able to get her back.
How's the breathing? [whispers] Okay.
[harsh breaths] Let me see the EKG.
What? What's wrong? Your heart function is deteriorating rapidly.
We need to surgically place a device called an LVAD to pump your heart for you.
How risky is it for the baby? Surgery on bypass does carry significant risks for the baby, but if we don't do surgery, we'll be forced to intubate you and put you on ECMO You won't get off the ventilator.
You'll remain in a persistent vegetative state.
[gasping] I am very sorry.
We'll get you ready to go upstairs soon.
Will my baby survive? If I were like that [gasping] in a coma? It's possible, but the chances are not very good.
- Honey - But it is possible? Mrs.
Parks, maybe we're not making ourselves clear, but No, I understand.
But I have the cure to my daughter's cancer inside me.
Maybe the two of you should take some time - to talk it over? - Yes, yes.
[gasping] We already discussed every possibility.
- Not this.
- Yeah.
We said we would do anything.
[gasping] If the time comes [shallow breathing] intubate me.
Hopefully, it won't come to that.
We obviously can't let her go through with this.
What choice do we have? We can't force her to have surgery.
We're talking about letting her kill herself.
[stammers] It's not that simple.
She doesn't see it as suicide.
She sees it as saving her daughter.
At what cost? She'd be leaving a three-year-old and an infant behind with no mother to care for them.
And Leah would survive leukemia.
I offered the surgery.
She declined it.
Wait! You said doing the surgery on bypass came with some risks.
What about doing it off bypass? A lot more dangerous.
I wouldn't be able to see through the blood.
I'd lose them both.
But what if we could save them both? I mean, brain-death shouldn't be an option.
That family needs a mother.
Hey, there! - Oh, hey.
- You, um You mind if I join you? Go right ahead.
- How's it going? - Fine.
Are you back in your place yet? Everyone says I don't have rats so I am back at my place.
So no more rats? Everything's good.
Got it all under control.
And Dr.
Reese seems comfortable with where I'm at, so I think one more session later on today and I'll be done.
- That's a relief.
- [chuckles] Hon, you must be exhausted.
You want me to bring some sushi by tonight? - Maybe we watch a movie or - No.
- No.
- How about I just - drop off some sushi? - Dad, I just I really want to get some rest.
Of course.
Um, hon, my knee has been acting up.
Can you do your old man a favor? Just grab me another creamer, please? Or two? Okay.
- Hazelnut.
- Mm-hmm.
[keys jangling] - Thank you.
- You're welcome.
[overlapping chatter] Hey, um, I know you're helping my brother with his case, and I really appreciate it, but could you maybe go a little easier on him? - What do you mean? - You know, just lay off the gas a little? Where's this coming from? Did Noah ask you to talk to me? April, there's a good doctor inside Noah.
But he has a way of getting people to make things easier for him.
And as long as they keep doing that, he's never gonna reach his full potential.
I won't coddle him.
Who said anything about coddling? You just asked me to give him a pass on a patient.
Not a pass.
Just stop being such a hard-ass.
Well, maybe if he had more hard-asses in his life, he wouldn't have to leave Med to do his residency.
You know what? You don't know anything about me, or my brother.
You know, truth is, I can't say I'm surprised that you and that guy didn't work out.
What? Well, yeah, I just mean a doctor and a lab tech He just can't understand you.
You know? The pressures we face.
Having someone's life in our hand.
It's Noah? Noah? Yeah? Have you solved Dr.
Stohl's case yet? - No, but - You can't keep having other people carry your water for you.
You have to commit.
Let them see that you're gonna kill it every day - and get the job done.
- I know, but I No, but nothing! Go back to Dr.
Listen to every word he says until you get the case solved.
You got that? Yeah.
I got it.
[sighs] I got your page.
BP's 80 over 40.
Stats are down to 60.
Gayle, your heart is no longer able to function on its own.
Please, let me do the surgery.
Otherwise, we're gonna have to intubate you now.
Honey, I know we've come so far, and we're so close, but I don't want you to do this.
- I do.
- No! It's okay.
You're gonna have a beautiful life.
No, not without you.
We don't want you to go.
Even if the baby saves me.
We love you.
We need you.
Pressure's down to 70.
Gayle, if you don't tell Dr.
Rhodes to do the surgery, we are going to need to intubate you now.
No! Don't! Please, Mommy! We could try the surgery off bypass.
What does that mean? Instead of diverting blood from her heart, I'll let it keep pumping.
It is an extremely difficult surgery, but I could avoid using the anti-coagulant that would harm the baby.
You could save us both? The odds are very low, and if we get into trouble, I have to tell you I will try to save you.
I won't be able to save the baby.
Mom, please! - Gayle - [shallow breathing] - Okay.
- All right, tell the O.
we're on our way up.
Let's get her ready to move now! Okay.
- Yep.
Good? - Let's go.
I'm sorry.
I shouldn't have brought Natalie into this But you were right.
I am jealous.
I just miss you, Will.
I don't want us to grow apart.
Neither do I.
I'll apologize to Natalie.
No, no.
I'll talk to her.
Infections can cause heart problems.
Have you had any recent illnesses? No.
Any past issues with blood pressure? No, I'm usually around 110 over 80.
And your cholesterol is good, too.
I watch what I eat.
I exercise a lot.
I'm a runner.
Do you track your vitals with, like, a Fitbit or an app? Yeah.
Yeah, that's how I know what my BP is.
I've got it on my phone.
Can I take a look? Yeah.
There is going to be more blood in the next two minutes than you've ever seen.
I'll get the LVAD into the ventricle while Dr.
Harper cannulates the aorta.
Keep the suction coming.
Steady hands.
Once we make the cut, the clock starts.
- Are you ready? - Yes.
[monitor beeping] Okay.
Ready? Go! I can't see anything.
[monitor beeping] Connor, baby's rate is at 120.
More suction.
Mom's pressure is dropping.
I need 45 seconds.
Baby's rate's at 98.
- You there? - Not yet.
Mom's not responding.
We're gonna lose her.
[monitor beeping] All right, I'm in.
Baby's rate is at 65 and dropping.
Mom can't handle this.
We need to deliver the fetus and get the load off her heart.
There's too much blood.
You can still save the mom.
- We have to deliver now.
- No! Dr.
I'm almost there.
Baby's rate is at 40.
Rhodes, what do you want to do? [keys jangling] [door creaking] Hey, honey.
Where are you off to? Uh, home.
Do you mind Could we just have a little chat? I really have a lot of things to do.
Sweetie, look.
[stammering] Honey, I'm sorry.
I'm just really very worried about you, and I just want to make sure that we're getting you the proper treatment.
Yeah, that's being taken care of.
No, darling.
Can we just talk about this for a second? Robin, stop.
I need to talk to you about - Not now, Dad.
- Robin! Robin! Excuse me, I need to get through.
I'm so sorry, honey.
I can't let you do that.
What? Get away from me! - What are you doing? - Just need you to stay here a little while longer.
We need to keep you here a little while longer so we can get you the help that you need.
- No.
No, I'm not staying.
- I'm worried that you're gonna hurt yourself.
I don't want you to hurt yourself.
Who are you to decide who's gonna hurt themselves? Get off of me.
Get off of me.
Get off of me! What are you doing? I hate you! I swear I'm never gonna speak to you again! [monitor beeping] Mrs.
Parks? Mrs.
Parks? Gayle? Hey.
You're okay.
The baby? Even with the transfusions, the blood loss was too great.
[exhales] Your heart couldn't keep up with it.
We tried.
There was no way to save both of you.
- I'm so sorry.
- No, Mom.
Oh, I'm sorry I failed you.
No, you didn't.
- No.
I love you.
- [whimpering] [sobbing] [sniffling] That girl has an impossible battle ahead of her.
At least she'll be able to face it with her mother.
Based on our patient's fitness app, the resourceful Mr.
Sexton believes he has determined when the arrhythmia began, and he proposes electrocardioversion.
If he's right, shocking the patient will return him to a sinus rhythm.
If he's wrong, we may soon see the effects of an embolic stroke.
Sexton? Charge to 75.
[paddles whirring] - Clear.
- [thumps] Sinus rhythm.
Well done, Mr.
I'm impressed.
Supposed you're looking for a thank you? Nah.
Just as long as I get to say I told you so.
How dare you admit Robin behind my back? She is my patient.
You didn't examine her.
You didn't treat her.
- You didn't see her apartment.
- I don't care what you saw! You should've come to me first.
I didn't have time, Dr.
- She was leaving the hospital.
- Yes, because I gave her the night to think about it.
I know she needs to be admitted! I thought I thought that she was masking it from you.
No! We were making progress.
I was trying to get her to admit herself voluntarily.
To take ownership of the idea so she'd be in the best state of mind to accept treatment.
I needed to earn her trust for that, and now that chance is gone.
You have to run around sticking your nose in everything instead of letting me do my job.
[door slams] Natalie, I'm sorry about Nina bringing that autopsy report to your attention.
What do you mean? She feels jealous.
We haven't spent a lot of time together lately, and you working here all day alongside me Anyway, you shouldn't have gotten dragged into our issues.
If I'm being honest If I saw my boyfriend working with another woman the way we work together, I'd be concerned, too.
Why? We work well together.
There's nothing wrong with that.
We don't just work well together.
The way we laugh, the way we talk It's special.
Well, we're good friends.
Are we, Will? Are we just good friends? Yes.
That's exactly what we are.
- Natalie! - No, you're right.
We're good friends.
Night, Will.
Reese! Hey.
Robin hasn't been answering my texts.
- Have you seen her? - I was about to call you.
I'm afraid I have some bad news.
[phone ringing] All right.
Let's do this.
Ah, man.
I'm sorry, but I'm gonna spend a little quality time with Nina tonight.
- We need that.
- Dude.
I know.
It's on me.
I promise I'll get us tickets for next week.
All right? I gotta go.
I will.
[exhales] Hey, Nat.
Do you like hockey? Oh, uh, not tonight, but thank you.
My brother just ditched me, and the ticket's gonna go to waste.
I guess Owen is already asleep at his grandma's, and I could use a hockey game? Right? Cold beer.
Grown men on skates.
What's not to love? Okay.
Thank you.
[sighs] Tough day.
Hope you're not here to lecture me.
Well, it's a little late for that.
[exhales] I had her back and I lost her.
[exhales sharply]