Chicago Med (2015) s03e07 Episode Script

Over Troubled Water

1 [ALARM RINGING] Is Owen asleep? Yep, coast is clear.
See you in the morning.
See you in the morning.
So I bought a ticket for Minneapolis.
I'm heading out tonight.
Really? We'll see what she has to say face-to-face.
Connor, you sure that you don't want to I don't know, just, uh, think about let letting it go? I'm sorry, Dr.
I love your daughter.
I'm not going to lose her.
[ALARM BEEPS] Get it away from me! Dr.
Choi, Dr.
Manning! You're going to 3.
I got LeAnn Crawford, 22, found attached to her newborn on the sidewalk in a pool of blood.
Combative in the field.
I couldn't cut the cord.
- Drugs? - Wouldn't surprise me.
- Get it away from me! - Ma'am, this is your baby.
Oh, no, it's a it's a monster.
She may be in withdrawal.
I need 4 milligrams of Versed, IV.
- On it.
- Not until we cut the cord.
Please get this thing away from me! Let's get her in restraints! Ma'am, I need you to listen to me.
Get it away! Whoa, she tore the cord! [BABY CRIES] All right, let's transfer on my count.
Ready? One, two, three.
Give her the Versed.
She's bleeding out.
We've got to deliver this placenta now.
No, it's a it's a monster! Kill kill it.
Baby's temp is 94.
I need more blankets! - Versed's in! - Let's start an IV.
Get two units of O neg on the rapid transfuser and start the MTP.
Vitals at 86.
Turn the O2 up to ten liters.
I got the placenta.
Heart rate's down.
Pressure's stable.
Baby's starting to pink up.
Hey, listen to me.
You just had a baby.
That's your baby.
Baby? [BABY CRIES] Call Child and Family Services.
No way she's taking this baby home.
Baby? Baby? [SOMBER MUSIC] - [DEVICE BEEPS] - Okay.
Temperature's back to 98.
I'll be back to check on him in a little bit.
Poor thing.
Let me know if anything changes.
[SIGHS] Hey, how's the mom? Better, apparently, after a little methadone.
I'm gonna talk to her about detox.
Tox screen showed heroin.
Odds are the baby's going to have the same result.
Eh, never know.
Might be a high-stress user.
Baby could be fine.
Crawford? I'm Dr.
Uh glad to see you're doing a little better.
Anything we can get you? Something to drink? I just want to go.
I don't blame you, but we do need to make sure that you're stable first.
So, you do understand that the DCFS is on the way to arrange a custodian for your child? Yeah.
I was looking at your tox screen and I'm just curious.
How long have you been using for? Roughly? The reason I ask is that we do have a number of programs here at the hospital that are that are available to you.
One particular, um I-I said I-I just want to go.
I understand that, but this would be an opportunity Dr.
Charles, can I talk to you for a second? [TENSE MUSIC] Yeah.
Uh, get some rest.
I'll, uh, check in with you later.
You're wasting your time.
You do understand that we have an obligation to try to get addicts into a program - before they leave the hospital? - Yeah, but clearly, - she doesn't want our help.
- We don't know that.
We almost never get through on the first shot.
She won't even talk to you, Dr.
Ethan, somebody puts up a wall like that they're usually trying to protect something.
That's often worth chipping away at.
Can you not see that I'm working? I'm just trying to get a closer look.
Observing the charge nurse in her natural habitat.
Aren't the paramedics supposed to drop off their patients and leave? Not paramedics with an agenda.
Have dinner with me tonight.
My answer's the same as it was last time: no.
Why not? We went out for drinks.
Right, drinks.
That's not a date.
Having dinner is dating, and we are not having dinner.
Well, not yet.
It's not even lunchtime.
[TAPS DESK] Hey, Miss Dempsey.
- Dr.
- Haven't seen you in a while.
- What's going on? - Still no cure for supranuclear palsy, as you can see.
But we do therapy three times a week and try to get around the block every night after dinner.
That's good.
Let's get you onto the bed here.
[COUGHS] I see they keep making these things higher and higher.
Yeah, it's completely unacceptable.
I'll look into it immediately.
[LAUGHS] [COUGHS] How long have you had that cough? [SIGHS] A few days now.
- [DEVICE BEEPS] - Temp's 103.
Has the palsy been making it harder to swallow? Uh, yeah, in the last couple of months.
Bert keeps making me smoothies, but I sneak in a granola bar every now and then.
Lean forward for me, would you? Sure.
Yeah, you're pretty clogged up.
Wouldn't surprise me if something went down the wrong tube and turned into a pneumonia.
Well, you can treat that, can't you? Yes.
I'm gonna start you on some antibiotics while we wait for the culture results, but for right now, you do nothing, and I'll be back soon.
I can do that.
Halstead? I know she has a degenerative disease, and that I won't have her forever, but, uh, her mind's all there.
I want to be able to take her home.
I promise I'm gonna do everything I can.
Thank you.
[SOLEMN MUSIC] - Hey, dinner tonight? - Can't.
Going to watch Noah's hockey game.
I know that stuff's not a big deal to you, but it's important to me.
"That stuff"? You mean adult rec league sports? I mean family.
Why do you think family's not a big deal to me? I don't know.
You never talk about them.
There's nothing to talk about.
Hey, Ava.
Can you cover for me tomorrow? Sure.
Are you getting sick? No, I'm headed to Minneapolis.
That sounds even worse.
Why are you going there? Oh, is that where Robin moved to? Yeah, it is.
So, this is what, a misguided attempt to win her back? - Forget I asked.
- No, I'm happy to do it, mostly because I find your gift for self-flagellation fascinating.
What is that supposed to mean? Just that, from what I gather, this sounds like a fool's errand.
CT's own Dr.
Phil? Thank you.
who? Dr.
Rhodes, CFD just called.
They've got a man trapped in a collapsed building and need a surgeon.
You're on trauma today? - I am.
- Good.
Ambo's waiting to take you there right now, and take Dr.
Bekker, too.
You could use a second pair of hands.
She is CT.
How about one of the other trauma surgeons? I'm already losing you.
I can't afford to lose another.
I'll let Dr.
Latham know where you are.
Let's move it.
- [KNOCKS] - You wanted to see me? Yeah, uh, what's the status on Dr.
Reese's probation? Well, she's been doing daily individualized therapy and a course in hospital safety, so she should be in good shape to start back up.
Uh, good.
I'd like you to give me a detailed progress report once she returns to work.
Well, actually, I'm not going to be supervising her anymore.
She's going to be working under Dr.
Why? Under my supervision, Dr.
Reese assaulted a patient with pepper spray.
You know, and I don't know.
My clinical approach might have had something to do with it, so I just think for now, Dr.
Chapman might be a better fit.
Whatever you think is best.
Uh, Sharon, I heard that that Bert's back in the hospital today.
Yeah, I heard that, too.
- What's going on? - He's inconsolable.
I've tried rocking him, swaddling him, singing.
Nothing I do calms him down.
[SOFTLY] Oh, hi.
Heart rate's in the 190s.
O2 sats have been dropping.
Has he been feeding? No, nothing.
Is it possible he's still in shock from the cold? I don't think so.
I'll go see if his labs are back.
That won't be necessary.
He's addicted to heroin.
[BABY CRIES] He's going through withdrawal.
I heard about the baby.
Neonatal abstinence syndrome.
That's a that's a rough road.
Yeah, I'm giving him fluids, Ativan, and aspiration precautions, but his numbers aren't getting any better.
How's the mom? Just wants to get out and get her next fix.
Why? Studies show that babies who are not thriving actually do significantly better when they have physical contact with their biological mothers.
- So? - So I think we should have LeAnn hold him for a little bit.
You can't be serious.
She tried to kill him.
She would be supervised.
Even hearing the mother's heartbeat can lower cortisol levels and stress.
LeAnn had nine months to do right by her baby.
She lost that chance.
- Dr.
Charles - Well, I appreciate your concern for your for your patient, Dr.
Manning, but I'm also concerned for mine, and here's the problem.
That baby's going home with somebody else.
We let LeAnn bond with him, and then just rip him away? Any chance we have of helping her pretty much gone for good.
Charles, we're talking about an infant's life.
I'm aware of that, but I just think that we should take a beat and look at all sides of this.
Excuse me, Dr.
DCFS is on their way.
They've got some foster parents that might be interested in caring for your patient.
Um, just have them give me a little bit of time.
Okay? Um, the baby's not stable yet.
- I'll do my best.
- Thank you.
Oh, hey, Sharon.
Hello, Bert.
Uh, how's Miss Dempsey doing? Well, hopefully, we'll be out of here soon.
Halstead's on top of it.
Well, that's good.
And how are you doing? Me? I'm, you know, the same: hanging in there, trying to help as best I can.
Well, I'm sure it isn't easy.
No, it isn't.
Watching her get a little worse every day and struggling with the things that were easy just a few weeks ago and Ah.
Anyhow, I I should get back.
Once you return to work, we'll round twice a day, do a chart review every morning, and you'll observe group therapy every afternoon.
By "observe," do you mean I will be sitting in? No, we have a one-way mirror.
I don't believe in using house staff as cheap labor.
You first.
Residency is a time to watch and absorb.
Um, okay.
Uh, though, speaking about therapy, I've been reading up on Erikson's theories uh, for strategic interaction, and it's an interesting take, focusing on a patient's, uh, personal strengths, rather than their pathologies.
Yes, interactional therapy is interesting, but you should spend the rest of your suspension learning these.
What are they? Treatment algorithms for the seven most common conditions we see.
But these are flow charts.
How do you individualize the therapy? Step three.
Is the patient responding to medication? Yes, no.
Thursday afternoons, we do journal club.
You're welcome to listen in.
- What happened? - Building's condemned.
Supposed to be empty, but we thought we heard somebody inside.
Turned out to be a squatter.
Guy's name is Gary.
He's got a big chunk of concrete compressing his left leg and a piece of rebar straight up through his groin.
We got pressure on it, but he's bleeding pretty bad.
If we stop the bleed, can we get him out? - Hard to say.
- Hey, Lieutenant! - Yeah? - Uh, the concrete's a bear.
We can't use the bags on it, but we might be able to break it up with the air chisel.
Be careful.
We haven't been able to clear a path yet, so we're gonna have to sneak through.
- Watch your heads.
- Yeah.
Ah, here we go, Gary.
We got Dr.
Rhodes and Dr.
Now, Gary, we're gonna take good care of you, all right? All right.
Hey, you're okay.
All right, draw up another round of labs, - and hang a gram of vanco.
- Yep.
Hey, Ms.
The antibiotics aren't working, are they? No, they're not, and it's possible the bacteria has spread from your lungs into your blood.
I've been reading.
Now, I'm hoping this new antibiotic we're starting will turn things around, but, as you know, the supranuclear palsy makes your immune system less effective, so there's also a chance before we get there your lungs will start to give out.
Now, if it comes to that, I am gonna have to intubate you.
And put me on a ventilator? Yes.
But hopefully, it's only temporary, until we can clear the infection.
[SOMBER MUSIC] Okay? Hang in there.
I'll be back to check on you in a few minutes.
Halstead? I don't want that ventilator.
I understand this sounds daunting, but like I said, if it comes to that, we may very well be able to get you off it again soon.
Or you may not.
I know how this all ends.
Lyla, if your lungs fail and I don't intubate, you'll die.
I know.
Crawford? I told you, I don't want to talk.
Uh, I'm not here to discuss detox.
I want to talk to you about your baby.
What about it? He's a boy, and he's withdrawing from heroin.
He's, um, not eating, not sleeping.
Breathing and heartbeat aren't quite as regular as we'd like.
So give him some medicine.
Well, we have been, but it is not quite that simple.
Um So? LeAnn, adults have years to develop the coping mechanisms that helps us get through life's trouble spots.
Uh, a newborn doesn't have any.
You know, for him, his mother is the only thing in the world that makes him feel safe.
Being held by her, you know, feeling her skin You want me to hold him? Well, it might be the best medicine we've got.
I-I-I don't I don't know how to hold a baby.
Well, we can show you.
We can teach you how to do that.
But this baby's sick 'cause of me, right? There's there's no way that more of me is gonna help it.
Well [WHISPERED] I said no.
Please leave me alone.
Dempsey? You wanted to see me? What can I do for you? I'm sure I'm the last person you want to talk to.
I know Bert didn't do right by you, but he's a good man.
He shouldn't be alone.
Well, he was fortunate to have found you.
Thank you.
But he won't have me for long.
I signed a do-not-resuscitate order.
I see.
So when my time does come, would you look after him? You don't have to answer now.
Just please think about it.
Let's see what we got here, all right? [FLESH SQUELCHING] Wait, hold pressure, hold pressure.
- All right.
- There.
- Yep.
- Move your hands.
Just a bit.
Can you see it? No, can't clamp the artery.
Rebar's in the way.
Herrmann, any chance of getting him out of here? We're gonna try the air chisels, but it don't look good.
All right, we're gonna have to do a REBOA.
What? Gary? An ER-REBOA is a catheter with a balloon at the tip that I can thread into your aorta.
Once I inflate the balloon, it'll keep you from bleeding.
One moment.
- Ready.
- Keep pressure there.
Got it.
Yep, hang on.
Watch it.
Hang on, bud.
Connor, we can't do that.
Once you inflate the balloon, we'll only have 30 minutes to get him out of here.
He's lost too much blood already.
It's gonna take a lot of movement to get him out of here, and we won't be able to maintain pressure.
So you're going to risk prolonged loss of circulation instead? I realize it can necessitate amputation, but I promise you, if we don't place a REBOA, he's going to bleed out right in front of us.
- Yeah? - Hey, what's going on? Nothing, Gary.
We're gonna get you out of here as fast as we can.
Just breathe, buddy.
Hang in there.
All right, here we go.
[KNOCKING] Come in.
How'd it go with Dr.
Chapman? Uh, it was fine.
She's fine.
Is there an issue? I prefer to come back to your service.
I understand, really, I do, but I-I think it's very important that you explore a different clinical approach.
Yeah, well, Dr.
Charles, I'm not an idiot.
Um, I know you think my anxiety, my PTSD, if you will, stems directly from your being shot, that our working together is negatively affecting my mental health [SOLEMN MUSIC] But first of all, um, these are my issues, and I'm working on them, and second of all, you chose to bring me into psychiatry So I'm not about to let you pawn me off onto that Dr.
Chapman When you're the psychiatrist I want to be.
Um I mean, I-I almost lost you once.
I-I don't want to lose you again.
I I very much appreciate what you're saying, but as a as a clinician, - and as a - Dr.
Charles And as a teacher, I just think that this is the best course of action that we stick with Dr.
Bert, stop.
Sweetheart, this isn't right.
Goodwin, it's not up to me.
Bert, please How can you not do anything? I explained all her options.
But you're her doctor.
Tell her what's best.
She made her wishes very clear.
There's nothing else I can do.
So you're just going to stand around and let her die? What the hell kind of hospital is this? - Bert, Bert - Bert.
She needs another doctor, one who will do something if she gets worse.
Bert, this is her choice.
She's got a fever.
She doesn't know what she wants.
This is hard, I know, but Dr.
Halstead is doing everything he can within the scope of Lyla's wishes.
The best thing you can do right now is go back in that room and be with her.
How are you feeling? Fine.
You don't think I should go see my baby, do you? That's up to you.
They say he's sick.
Yeah, he is.
I never planned on getting pregnant.
You know? Whatever.
You think I'm terrible.
I just wish things had worked out differently for you and your baby.
But I guess where you're from, things work out great for everybody.
Why would you understand? Actually, I understand a lot better than you think.
- [KNOCKS] - Oh.
Getting hungry yet? I know you think this is charming, but it's not.
Hey, you remember our first date? Mm-hmm.
Mexican food - at the mall.
- No, I mean afterwards.
We were throwing pennies into the pond where people made wishes.
You know what mine was? A second date with the pretty woman sitting next to me.
That's a sweet story.
Too bad it ends with you cheating on her.
- I've changed, Maggie.
- So you say.
But this time, I'm smart enough to draw the line.
- Maggie, just - Barry [SIGHS] Okay.
Keep going.
This place is unstable.
Another shift like that, and the whole thing's going to come down, Rhodes.
Guys, you gotta do something.
We could try coming from another angle, but it'll take 20 minutes.
[TENSE MUSIC] His leg's already cold.
All it's doing now is preventing us from getting him to hospital.
Gary listen to me.
Your leg is trapped and we need to get you out of here.
I'm afraid that the only way to do that is to amputate.
What? No.
Gary, I'm very sorry, but your leg has gone without blood for too long.
Is that 'cause of that thing you put in me? That balloon? We had to do that so you wouldn't lose even more blood, but now that it's in, every minute puts you in more danger.
- No.
- Gary - Dr.
Rhodes - Get away! Gary, listen to me.
I do not want you to die.
We have to get you to hospital.
Do you understand? You are not taking my leg.
I wish we didn't have to, but you've lost a lot of blood and you are in grave danger.
[SNIFFLES] You can't.
There's gotta be another way.
I'm sorry, there isn't.
And I know how terrible this seems, but you have a lot of years to live and a lot of life to experience, and I don't want you to miss out on that, but you will unless you let us help you right now.
But it's my leg.
I can't You can.
Now, Dr.
Rhodes is going to numb you up.
After that, you won't feel anything.
Just keep looking at me, Gary.
I've got you.
- What's happening? - He's having a seizure.
Give him a bolus of Ativan.
O2 sats are down to 72.
He can't get any air.
Bolus is in.
He could suffer an anoxic brain injury.
Give him 0.
1 milligrams of morphine.
He can't go much longer.
Give him another 0.
He's breathing.
Get a pediatric intubation kit.
Is this happens again, we're going to have to put him on a vent.
You have a very expressive face.
Easy to read.
I'm not sure that's a good thing.
When I told Bert that I was terminally ill, my greatest fear was that he would leave me.
We had only been dating a couple of months.
[COUGHS] But he didn't.
He stuck with me through thick and thin.
He doesn't deserve to have me leave him now.
So if you need to take extreme measures to keep me alive, do it.
Are you sure? Yes.
And you understand that means I may need to intubate you very soon? I promise, this is my decision [GASPS] Not his.
[COUGHS] Okay.
I'll go change the order.
[COUGHS] And he's gonna die.
He could, yeah.
And you you really think that having me hold him is gonna help? I know it's a lot to ask, and I-I just wouldn't be doing it if the situation wasn't so dire, but you're his mother, and and the baby needs you, and I if there's any chance at all that your holding him might help him get better, I think we should try.
[SOMBER MUSIC] This was my my fault.
I did this to him.
[BABY CRYING] He's so small.
Go ahead.
Hold him close, now.
Against your skin.
Don't cry.
Hi, yeah? - [LABORED BREATHING] - Dr.
Halstead? [ALARMS BEEPING] She's in SVT.
20 of etomidate, 50 of cisatracurium.
Grab the intubation kit and charge the paddles to 25.
What's happening? The infection's overwhelming her system.
She rescinded her DNR, so I have to shock her heart back into rhythm and intubate.
Goodwin, I need you to step back.
She's doing this for me, isn't she? She she doesn't want this.
Lyla, this is a shockable rhythm.
I can try to resuscitate you.
Do you want me to do that? [LABORED BREATHING] No.
You heard her.
You heard her.
Don't do this.
I love you.
All right, Karen, tell the OR we're on our way up as soon as this rebar's out.
100 milligrams of ketamine.
Get me a cut-down kit.
And hang two units of O neg on the rapid transfuser.
[TENSE MUSIC] On my count.
One, two, three.
All right.
Thanks, guys.
Is that a REBOA? Couldn't get it down in the ambo.
Pressure tanked every time I tried.
Of course it does.
A REBOA in the field is a problem waiting to happen.
- Whose idea was this? - Mine.
- Dr.
Rhodes, do you realize - It was the right call.
There was no other way to get him out of there alive.
All right, wound looks good.
Taking down the REBOA.
Watch the pressure.
Pressure's holding.
Vitals are stable.
All right, let's get this thing out and get him up to the OR.
Ready? - Yep.
- One, two, three.
[WINCES] No bleeding.
Let's go.
Nice job, Dr.
[DISTANT SIREN WAILING] - Yes, that's it.
- Right there.
Oh, excuse me.
Can I just have a quick word with with Ms.
Crawford first? Okay.
Oh, wow, he looks great.
A lot better, huh? He is great.
So, um, we have finally made some room for him in the intensive care unit, so we're gonna we're gonna take him up there now.
Oh, do I carry him up, or do we take him up in the warmer? Well, um Actually, LeAnn, there is a there's a there's a foster couple up there who is gonna be looking after him from here on out.
But he likes me so much.
I know.
And he is doing so well.
So so I should just keep holding him.
I really wish you could.
Really, I do.
But you said that he needs me.
I know.
I know I did.
I know how difficult this is.
I really do.
I'm sorry, but we need to take the baby now.
No! I'm his mother! I'm I'm his mother.
Doctor Dr.
Charles, please - I'm sorry.
- You know.
You know.
Charles, please, can you help me? Please! - I'm sorry.
- Please, can you help me? Please explain.
That is my baby.
Charles, please.
Please, can you just Dr.
Charles, can you please I saw Bert.
He's taking it pretty hard.
Yeah, I'm gonna send the kids over to check on him.
What? Sharon, do you think people can change? [INDISTINCT CHATTER] Maggie, I don't know.
Go call my kids.
LeAnn you lost a lot of blood today.
I'd really rather you stay.
Listen, it may not feel like it, but you did the right thing today.
You were there for your baby.
It's unfortunate that you can't take him home, but there's a methadone clinic right upstairs.
We can help you get cleaned up, and if you can get back on your feet, that's the crucial first step in getting him back.
I'm tired.
You know, I'm I'm just gonna go.
LeAnn LeAnn.
[SOMBER MUSIC] We had no choice.
We had to do - what's right for the baby.
- Oh, yeah, of course.
It's just, you know It's sad.
It's unlikely either of them ever really be whole again.
[SIGHS] Ah, the old Chapman flow charts.
Oh, yeah.
Number seven.
That there's a doozy.
Step seven? Dr.
Reese, the truth is, I feel responsible for letting your situation get out of hand the way it did.
It was my job to, well, guide you and teach you and make you a better doctor, and I I let you down.
- Dr.
Charles - But ultimately, some relationships are just better kept intact, which is why, if you'd still like to, when you return, I would very much welcome back on my service.
Really? Really.
Hey, Gary.
How you doing? It's weird.
I can feel it, like it's still there.
Yeah, it's called phantom limb pain.
Uh takes some time, but it will fade.
Listen, Gary, I am I am very sorry about your leg.
[SCOFFS] At least I'm still alive.
I'll find a way to move on.
[SOLEMN MUSIC] All right, bud.
I'll check on you soon.
I didn't want to believe that it was over, but you were right.
I need to let Robin go.
April? Hmm? Who's that? It's my sister.
What? Emily.
I should've told you.
I never talk about her.
It's painful.
My parents adopted Emily when she was four.
She had a hard life before she even came to us.
Still does.
She makes bad decisions, acts out, then blows up when I try to help her, and I swore the last time that I wouldn't let myself get involved again.
When was that? It was four years ago.
Maybe I should give her a call.
Thank you for today.
Uh, you were great.
I did feel a bit like Bonnie Henna out there.
Who? South African action hero.
Have a good night.
Oh, and no need to cover for me tomorrow.
I'll be here.
You're not going to Minneapolis? Nope.
Good evening, sir.
Can I help you? I'm looking for a change.
What model is this? The 911 4S.
Beautiful car.
Yes, it is.
You got the keys? I'm sorry, but we're actually done doing test drives for the night.
I don't want to test drive.
I want to buy it.
Oh, of course.
Just give me a moment.
- I'll see you in the morning.
- Mm.
You should stay.
- Yeah? - Mm-hmm.
What about Owen? Mm.
He's got to find out sometime.
Are you sure? Mm-hmm.
I'm sure.
This is so much better than scraping ice off my windshield.