Chicago Med (2015) s03e13 Episode Script
Best Laid Plans
1 [MACHINERY HISSING.]
[SOFT MUSIC.]
- Another "3-oh" Prolene.
- Here.
Homestretch, Peter.
Just finishing up the aortic connection.
Then we'll start you back up.
Talking to the patient while they're out, that's a new one.
- It's a nice touch.
- Actually, not new.
Just the first time you've noticed.
Thought I'd made more of an impression on you.
The way you can turn a compliment into a dig, it's quite the skill, Dr.
Bekker.
Don't be so sensitive, Dr.
Rhodes.
Okay, donor heart is fully attached.
- All right.
- Let's get the pacer leads on.
Yes, doctor.
- 100 beats per minute, Marty.
- We're set.
Okay then, turn it on.
[BEEPING.]
Excellent contractility in the left and right ventricles.
- No distension.
- Healthy color.
Take off bypass? Looks like this one's going to take, Peter.
There's no better sight, is there, Dr.
Bekker? Can't argue with that.
- No, no, no! - Losing color.
It's cyanotic.
Global contractility's way down.
Left and right ventricles severely distended.
Hyperacute rejection.
Donor heart's failing.
We need to get it out now.
Damn it.
Okay, back on bypass.
[TENSE MUSIC.]
Okay, Peter obviously goes back on the transplant list, but for right now, I only see two options: - ECMO or an artificial heart.
- ECMO's quick and easy.
Peter's on bypass, so the cannulas are already in place.
Downside, he'd be confined to the ICU and likely intubated.
- I'm leaning artificial.
- That is a huge surgery.
Peter's already been on the table for over four hours.
The risk of complications, especially stroke? But if all goes well, he could get out of bed, walk around, maybe even go home.
Peter waited a year for his first donor heart, two and a half for the one that just failed.
There's no telling how long the next will take.
Then I guess you really only have one option.
[SOLEMN MUSIC.]
It's Peter's wife, Jane.
Not the post-op conversation I was planning for.
Dr.
Rhodes, Dr.
Halstead called from the E.
D.
while you were in surgery, asked that you find him the moment you're free.
- Thank you.
- Mm.
It's Dan Kennet, my giant-cell myocarditis patient.
- He's back.
- Go.
I've got this.
All right.
April, this thing tonight, how big we talking? It's my little cousin's 15th birthday, okay? It's gonna be some of her friends, a few family members, low-key.
Yeah, right.
You always say that.
Then I get there and it's Carnival.
In Brazilian culture, fifteen's a huge birthday for a girl.
Baile De Debutante.
- Uh, did you Google that? - Yeah.
Okay, that's really cute.
Oh, you're gonna bring your sister? I wasn't planning on it.
Come on, you guys have been talking.
Things are going well, right? Yeah, but Emily's always been kind of a wild card.
I don't wanna spend the whole night worrying she'll do something to offend your family.
Plus, she probably has a poker game.
Lame.
All right, I'm not gonna push.
I'd really like to meet her, though.
You will one day.
He fainted? Yeah, getting out of the shower.
When I pressed for details, he confessed to being light-headed all week.
Labs? Yeah, troponin's way too high.
Left ventricular ejection fraction is 10%.
I've been treating Dan for six months.
Steroids, calcium channel blockers, ace inhibitors, beta blockers, no matter what I try, he just keeps getting worse.
Where is he on the transplant list? Way too low.
Don't let him give up.
- Aww.
[CHUCKLES.]
- [CHATTERS.]
Hey, Dan.
Hey, Sheila.
Hey.
We're back too soon.
Listen, Dan, your heart is failing, so I'm going to adjust the meds that you're already on and add IV dobutamine.
IV? Guess I'm not going home today, am I? Yeah, we've gotta get the inflammation of your heart muscle under control.
How long in the ICU? I'm not sure, I'm sorry.
Hey, little B.
- [CHUCKLES.]
- Hi.
The hospital has a daycare center.
- I can, uh, call - No, no.
Having them close keeps me keeps my spirits up.
Good.
That's what we want.
I'll see you guys soon, all right? All right.
Hey, take it from the old guy, ease up or you get a bunch of these.
What are you grinding on? My dad asked me to cosign on a loan.
Huh.
Northwestern offered him a tenure-track position.
He's gonna buy a place in Chicago.
- Isn't that great news? - Yeah.
I can get through the most arcane medical jargon, but legalese? Impossible.
I just wanna know what I'm signing.
- Is that too much to ask? - Not at all.
Cosigning a loan is a big deal.
- Mm.
- If the borrower defaults, you're on the hook for the money, right? Mm-hmm.
Another little piece of advice from the old guy: finances and family, they don't always mix.
Oh, no, Dr.
Charles, my dad is good for the money.
He just needs me to cosign because identity theft messed up his credit a few years ago.
Huh.
So when did your back start bothering you? Oh, it's been killing me since last night.
Listen, I probably overdid it in my spin class.
I've been working on my stamina.
We're off to Italy tonight, bike trip through Tuscany - Oh, yeah? - Our 30th anniversary.
- Congratulations.
- Thanks.
All right, so let me know if you feel anything tender - Okay.
- Okay? The spinning, is that a new activity to prep for the trip? Um, yeah.
And also, I've been trying to lose the Twenty-ish pounds I gained over the winter.
Obviously, it's not working.
But muscle weighs more than fat, isn't that right? Don't answer that.
Are you on any medications, Mrs.
Davis? Yeah, I'm on hormone replacement therapy.
I'm at high risk for osteoporosis, so I started the hormones after menopause.
- No midline abnormalities.
- Okay.
Is, uh do you have any burning with urination? Um, no, although lately, it does seem like I have to go every ten minutes.
Our granddaughter just got out of diapers.
I guess I'm on my way into them.
Well, looks like it's just a muscle strain.
Really? Yeah, a 10 of Flexeril and 800 of Ibuprofen.
And, uh, I'll check back in an hour, see how you're feeling.
- [CHUCKLES.]
Thanks.
- Yeah.
- Muscle strain.
- Mm.
- Maggie - Uh-huh? I need a doctor in the waiting room.
Got it.
Dr.
Choi, we're up.
LaShawn, hold onto this.
- Be quiet, please! - Are you okay? Clear out, clear out.
Here, here, here.
Sir, take this chair and move it, please, thank you.
She kept falling over onto the person next to her.
I can't wake her up.
Ma'am ma'am, can you hear me? She's snoring, so she's protecting her airway.
Able to breathe, good pulse.
Who is she? Patient here to be seen? No idea, she never checked in with me.
Anyone know who she is? Mags, see if there's an ID.
Yeah.
I got it.
Illinois driver's license.
Her name is Rachel Wexler.
30 years old, lives in Evanston.
- That's not close.
- No.
Don't know why she's here, but she's a patient now.
All right, get ready to clear out.
Move, people, move, move, move, move, move, move! Go, go, go, go, go, go, go, go! - Doris, Treatment Four.
- What do we got? Fell asleep, now won't wake up.
- OD? - That's my guess.
A drop and dash, or maybe a last fling, before coming in to get treatment.
- Doris, push 2 of Narcan.
- Yep.
[TENSE MUSIC.]
Mags, any more info from her purse? Wallet, keys, makeup, gum, birth control pills, and cigarettes, nothing helpful.
BP, 104 over 68, heartrate, 72, pulse ox, 99%, EKG, normal sinus rhythm.
Not exactly OD vitals, Dr.
Choi.
- No response to Narcan.
- I told you.
Narcan only counteracts opiates.
Must be a benzo.
Push .
4 of Flumazenil, and order a CBC, CMP, ammonia levels, arterial blood gas, BAC, and blood and urine tox screens.
Maggie, she's wearing a wedding ring.
Can you find a contact for a spouse? Would if I could, but no cell phone, but a charger, so I'm guessing she had one at some point.
If she stumbled in here high, who knows where she lost it.
Flumazenil's not working either.
Okay, OD's out.
Doris, add an HCG, a CT chest, spine, um, abdomen and pelvis to the test.
Got it.
Dr.
Stohl, you're thinking injury? All I'm seeing is a scar on her right cheek, but it's old, clearly healed.
Just because there's no bruising doesn't mean there's no trauma.
You should know that, Dr.
Choi.
So, I took a second look at your echo, and I wanna start you on dexamethasone.
It's another anti-inflammatory.
Whatever you think is best, do it.
- How'd it go? - Surgery went well.
Peter's artificial heart is in.
Let's hope it lasts until a donor heart becomes available.
Peter's Status One on the transplant list.
He's got a chance.
My patient, Dan, he's Status Two.
I am waiting for a call that's probably never gonna come.
GCM's brutal but not usually discovered until autopsy.
- You're way ahead of it.
- I was.
Now I'm just playing catch-up.
- [DOOR BEEPS.]
- 23-year-old male.
Went down on his motorcycle just outside Bloomington.
- Wasn't wearing a helmet.
- Massive brain hemorrhaging? Rural hospital's been working on him, but he's worse than they can handle.
GCS, 3, down six hours already.
Crap scans.
Doubt we can do much better.
You know what they call a motorcyclist riding without a helmet, don't you? One, two, three.
An organ donor.
Well, she's not catatonic.
Whatever knocked her out, it's not psychiatric.
- What'd her tox screens show? - Yeah, she's clean.
Blood alcohol, arterial gases, and all other labs too.
- Diabetic Ketoacidosis? - Blood sugar's normal.
- Liver failure? - Ammonia level's normal.
Tumor? Chest X-ray and all the CTs were clean.
- The scar on her cheek? - Plate from an old fracture.
No apparent connection to her unconsciousness.
Just got off the phone with PD.
Ruzek ran Rachel's name through the system.
She got busted a few times: DUI and possession.
And yet a clean tox and BAC.
Hmm, the plot thickens.
Good luck.
Hey.
Hi, Natalie.
Just getting here? Yeah, remember, it was my turn to be volunteer mom at Owen's daycare class.
Oh, right, yeah.
Three hours and 20 toddlers, do you have any idea how many boogers that is? Ha, I'll bet.
Okay not my best material, but not even a courtesy laugh? - Are you okay? - Yeah, I'm just tired.
- Are you sure? - No, yeah, I'm good.
Dr.
Manning, you're up.
You're going to Treatment Two.
Okay.
Hey, I'll catch you later? - Okay.
- [DOOR BEEPS.]
Sam Covington, 27-year-old male.
Hypotensive and tachypneic.
Long-term care patient following a TBI.
How long ago did he sustain the brain injury? Um, five years.
It was a surfing accident.
He was only 22.
Just graduated from UCSD, magna cum laude.
Mm, sorry, you don't need to know all that.
Mom, I take it? All right, let's transfer him on my count.
Ready, one, two, three.
[TENSE MUSIC.]
[STRAINED BREATHING.]
[GASPS.]
- Temp, 101.
6.
- Mm-kay.
[GASPS.]
Congested on both sides.
Mom, hey, I just got your message.
Sorry, I was in class.
What happened? Is-is Sam okay? Uh, your brother was breathing fast, and, um, he [STAMMERS.]
He looked like he was in pain.
Uh, let's get a CBC, CMP, ABG, a UA, and blood cultures, and begin sepsis protocol.
Excuse me, sorry.
- Start him on antibiotics.
- That's a lot of tests.
I understand, but since Sam can't tell us where it hurts, it's better to err on the side of caution.
Okay? [SOFT MUSIC.]
[DOOR OPENS, HOSPITAL BED RATTLING.]
Take as much time with your son as you need.
When you're ready, someone will come speak with you about organ donation.
- What happened? - Motorcycle accident.
Never had a chance.
Soon as the immunotyping results are in, find me.
Yeah, okay.
- So, how we feeling? - Ugh, my back is better, but now I'm feeling really queasy.
All of a sudden, it just hit her.
- A reaction to the Flexeril? - Yeah, maybe.
Um, can can I take a look? Okay, uh-huh [HURLS.]
Oh, gosh.
Mm.
- April, can I - Sorry.
Mm can I get, um, 4 milligrams of Zofran? Uh, and if you'll excuse me, I'll - I'll be right back.
- Sorry.
No, yes, it's, um It's no it's no problem.
Sorry.
- Oh, I'm so embarrassed.
- Oh, he's fine.
First-year resident, projectile vomit is a rite of passage.
- I'll get you a gown.
- Thank you.
- Oh, my God.
- Are you all right? [ELEVATOR DINGS.]
Daniel, there you are.
The next round of prospective transplant candidates.
No rest for the wicked.
Dr.
Reese's father, Robert Haywood, is in this stack: Class Three heart failure.
I hope he makes a strong candidate.
[CHUCKLES.]
You'll keep me in the loop? Uh, Daniel? Yes.
Yes, of course.
Could you excuse me? - [MACHINES BEEPING ERRATICALLY.]
- Dan? - Dan? - Daddy? Get the crash cart! Paddles now.
Come here.
[TENSE MUSIC.]
Come No pulse or breathing, He's in V-fib.
Get on his chest.
Charge to 200.
- Charged.
- [PADDLES WHIRRING.]
All right, hold compressions.
Clear! [MACHINE CHIRPING.]
Charge again.
Amp of epi.
Epi's in.
Charged.
All right, clear! [SOBBING.]
- He's hurting Daddy! - No, honey Charge again.
Amp of epi.
- He's just trying to help.
- Come on, Dan.
- Beat, damn it.
Come on.
- Meds are in.
- Charged.
- Hold compressions.
Clear.
[STEADY BEEPING.]
He's back.
[SOLEMN MUSIC.]
Thank you.
So, I'm not getting on the transplant list? I didn't say that.
I'm just making you aware that personality disorders can be a contraindication of transplant.
You believe I have Antisocial Personality Disorder, but another psychiatrist might not.
It's-it's a pretty gray area, wouldn't you say? Well, actually it isn't.
Uh, take a look at this.
This is a PET scan of your brain.
[FINGERS DRUM.]
Taken when Dr.
Rhodes was conducting his thoracic study? That's right.
[DESOLATE MUSIC.]
And this supports your diagnosis? - Mm.
- Well since you're bound by doctor-patient confidentiality, I just say we keep this to ourselves.
I'm afraid that's not an option.
Um, I am obliged to report my findings to the evaluation committee.
[DISQUIETING MUSIC.]
I didn't realize you had such influence on the process, Dr.
Charles.
[CLEARS THROAT.]
My heart meds.
Do you have any water? Of course.
Um, by the way, contraindication isn't absolute.
I mean, taking positive steps to manage your disorder can go a long way to mitigating concerns.
Well, I hope you have some suggestions.
Well, what the committee's looking for - is self-sufficiency - Mm-hmm? - Fiscal responsibility - Fiscal responsibility? You wouldn't by any chance be referring to the loan I asked Sarah to cosign? Anything you can do to establish independence Perhaps rescind the request.
Would certainly count in your favor.
I'm sorry, Bob, you know, they come up against us all the time.
There are simply too many people waiting for too few organs.
I really appreciate you giving me this advice.
- [KNOCKING ON DOOR.]
- Hi.
Dr.
Manning, this is my sister, Lizzie.
She just drove down from Racine.
Nice to meet you.
Uh, how long was I sleeping? Lizzie, whe when did you get here? Just now, Mom.
"Eddie would go"? Who's Eddie? Eddie Aikau: legendary big wave surfer and lifeguard at Waimea Bay.
He'd charge waves no one else would dare.
Sam's hero.
So we got the results back from Sam's labs and X-rays.
Um, I'm afraid he has pneumonia.
The antibiotics should knock it out.
Right now, we'd like to swap out Sam's trach tube so we can put him on the vent, you know, give his respiratory system a rest.
Okay? - [GRUNTS.]
- No, no, it's okay.
Honey, honey, it's okay.
Just she'll-she'll be gentle.
Okay [GRUNTING.]
Monique, pass me the new trach tube.
Hey, that's, um, Rachel's husband, Jacob.
- Where'd you find him? - He found us.
He kept on calling her voice mail and finally used a "find my phone" app, which led him to the waiting room.
Her phone was buried in the chair cushion.
- Thanks, Mags.
- Yeah.
- Mr.
Wexler - Hey.
I'm Dr.
Choi.
I've been treating your wife.
What's wrong with her? Well, we don't know yet.
All her tests have been negative, including the tox screen.
But given your wife's drug history - You think she overdosed? - She might have taken something that's beating the test, possibly a synthetic.
Rachel was in a car accident a few years ago.
Airbag broke her jaw and a bone in her cheek.
The injuries healed, but the pain pills After her last arrest, she promised that she'd stay clean.
Here we go again.
[SOFT MUSIC.]
[KNOCKING ON DOOR.]
[SOLEMN MUSIC.]
Meds alone aren't taking enough pressure off of Dan's heart, so I am going to put him on ECMO.
Full support, so that his heart doesn't have to shoulder any load.
When you first diagnosed the GCM, you said ECMO was a final option.
Mm-hmm.
I told myself To make a plan, to prepare for this moment, but I couldn't do it.
It felt like giving up.
I promise you that's not what's happening here.
Okay? - How's your TBI patient? - [SIGHS.]
Saw pneumonia on his chart.
Pretty sure he got it from his trach tube.
It was filthy.
His mom's his caregiver.
Looks like she hasn't been cleaning or suctioning it.
- What, neglect? - No, I don't think so.
All other areas, he was meticulously well-cared for.
His nails are trimmed, his teeth are brushed, - skin is moisturized.
- So Mom's burnt out.
The first thing to slip was the tube? Ever since Sam's injury, she has devoted her entire life to caring for him.
I'm not sure how to tell her that she may no longer be up to the task.
You want some backup? No, I don't want her to feel ganged up on.
I'll figure it out.
Agh! So, the the Zofran hasn't helped at all? No! And the cramps are unbearable.
- So is her gas.
- Hey! No fever, vitals are normal.
All right, let's hang another liter of, uh, normal saline, and order a CBC, CMP, amylase, and lipase levels.
Okay? Uh, this might be, uh, a stomach bug, - possibly kidney stones, okay? - Oh I'm just gonna I'm gonna p I'm gonna press on your stomach.
- Ah! Wait, I need a bathroom! - Okay.
- Oh, okay.
- I need a bathroom right now! - All right, come on, honey.
- Okay, hold on a second.
- We'll get you there.
- Ahh! - [URINE SPLATTERS.]
- Oh! - What? - Whoa.
- [SIGHS.]
Sorry.
- That's okay.
Honey, let's get you back into bed.
Oh, my God, no I still need to go! - Okay, I'm gonna help you.
- Really bad! - Come on.
Come on, let's go.
- Wait, wait, wait, no, no, no.
That's not urine.
Oh, okay.
Let's let's get you right back into bed.
- Come on.
- Wait, what what's going on? I don't know what's happening.
- Come on.
- What's going on? Oh! Oh! Ow! - Come on.
- Jeez.
[YELLS.]
What are you doing? - What's going on? - Oh.
- Yikes! - What is going on? - Really? Are you s whoa! - Oh.
- Okay, Mrs.
Davis - Yeah? You're gonna wanna push, but don't.
[WHIMPERS.]
There's no way.
No, no, no.
This this is not possible.
- Uh, what is going on? - Your wife is pregnant - [GROANS.]
- And in labor.
No, no, that c That can't be true.
I'm 55; I've been through menopause.
I know this might be a shock, but this is happening.
- I am positive.
Page OB.
- Okay.
- I'll be right back, okay? - Uh - Oh, my God! - Oh, my What the hell, Connor? Not here.
[BROODING MUSIC.]
That motorcyclist is an HLA match to my patient, Peter, but suddenly, your GCM patient is above him on the transplant list? How did he come in this morning at Status Two and suddenly jump to the highest priority? - I had to put him on ECMO.
- Before other meds? Milrinone? Monoclonal antibody therapy? They're just stop-gaps.
Oh, you sneaky son of a bitch.
ECMO trumps an artificial heart, puts your patient to the top of the list.
You manipulated the system.
I made an aggressive treatment decision.
You're taking a heart that doesn't belong to you! I am fighting for one that's available! This isn't right and it isn't over.
The hospital can connect you with respite services, as well as caregiver support groups.
You do not have to do this alone.
And we can help out more, Mom.
Catherine no one is blaming you.
You have done a tremendous job caring for Sam.
I wasn't trying to hurt him.
No, of course not.
I thought that he would go peacefully.
Uh, I wasn't prepared to see him in pain.
Mom, what are you talking about? Sam doesn't want this oblivion.
[SOLEMN MUSIC.]
I see it in his eyes every time he looks at me.
[SNIFFLES.]
The doctors say there is no meaning behind it [INHALES SHARPLY.]
that that he's not really looking at me.
[SNIFFLES.]
I know my son And he wants this over.
- He was begging me to help him.
- Mom, stop talking.
I should never have called 9-1-1.
I should have just let him go, like I planned, like he wanted.
I got scared.
I panicked.
Oh, my God, Mom, did you Mom, please, don't say anything else.
Sam, I'm sorry I let you down.
I am so sorry, honey.
We need to call a lawyer, now.
First, you're treating my father, and now you're blackmailing him? - What? - You heard me.
Look, I don't know what he told you He said you're jealous of our relationship, that you have some twisted paternal feelings for me, that you threatened him, and said if he didn't stay away from me, you'd sabotage his chances of getting on the list.
I threatened him? - Wh sabotage? - Yes.
I'm a shrink in a sweater vest, not a secret agent.
Is it true? I can't disclose details of our conversation, but I assure you, all I did was lay out the facts as they pertain to his condition.
What are you treating him for? I can't tell you that, Sarah.
- He's my patient.
- But he is my father.
Who suddenly reappears after two decades of avoiding parental responsibility and alienating everyone in his life, who now presents himself as a victim in order to create an alliance with you.
Think about what you know, Sarah.
If he was your patient, what would be on your differential? [SOLEMN MUSIC.]
[SCOFFS SOFTLY.]
What was that about? As you will read in my evaluation, her father, Dr.
Haywood, has a particularly malignant form of Antisocial Personality Disorder.
Are you serious? Is she in danger? Well, I haven't picked up any violent tendencies yet, but he's an extremely effective manipulator.
Dr.
Reese doesn't know? Well, I think she might be starting to figure it out on a clinical level, but emotionally, she's she's not there yet.
Ahh! Oh! This can't be real! This can't be real! - Where the hell is the OB? - They said five minutes.
We can't wait.
The baby's crowning.
- What? - Tessa - Yeah? - On three, - really big push, okay? - Okay.
- All right, one - Uh-huh? Two, three.
[GRUNTS LOUDLY.]
- [PANTING.]
- Yeah, good, good.
When did we go to Mark and Patti's cabin? - What? - Was that Fourth of July? What are you talking about? I'm just trying to figure out when this happened.
Oh, God, Greg, how does that matter now? Mr.
Davis, can you please help the nurse hold your wife's leg back? - All right, okay, yeah, yeah.
- Thank you.
Okay.
Tessa, Tessa, look at me.
Look at me, Tessa.
Okay, Tessa, one more push, all right? - Okay.
- You can do it, you can do it.
- Yeah! - You can do it.
- Ready? - Yeah! - Go.
- [GRUNTS LOUDLY.]
You're doing great.
You're almost there.
- All right, all right.
- Yes.
- Oh! - Whoa.
- Okay, okay - [BABY CRYING.]
This is crazy.
- Does he look okay? - Oh, my - It's a girl.
Congratulations.
- Oh! - Oh - Congratulations to you both.
Oh, my goodness.
[CHUCKLES.]
[BABY CRYING.]
Oh, my gosh.
Natalie, you can't sit on this.
If I report it, Catherine will likely be removed as Sam's guardian.
I wanna pull in social services.
This goes beyond family counseling.
It's a criminal matter.
She intentionally stopped trach care to cause her son's death.
To end his suffering.
You know, she looked into moving to a state where assisted suicide is legal? But because Sam isn't terminal ill and can't express his wishes, he didn't qualify.
Exactly, which means you can't be certain this is what he wants.
No one knows what Sam wants more than his mother.
Then she needs to go to court and make her case, petition a judge to get his feeding tube removed.
Look, Natalie, I'm not arguing she's wrong, but what she did is illegal.
You have to call the police.
No.
Then I will.
[DIAL PAD CLACKING.]
Decerebrate posturing: rigid limbs, pointed toes.
She's slipping deeper into unconsciousness.
Dr.
Stohl, Dr.
Choi, we got something.
Right after we discovered Rachel, I texted a pic of her license throughout the hospital.
I just got a call from my friend from HR.
She said she interviewed Rachel this morning for an admin job.
She said she was alert and engaging.
Alert and engaging? That doesn't sound like someone about to OD.
All right, but if it's not drugs, - what the hell knocked her out? - You missed something.
Recheck every test result, look for anything that might be mimicking something else.
Her MRI.
These two spots of diffusion restriction, radiology says they're from movement and mental artifact.
The plate in her cheek.
But what if that's wrong? This could be damage from a stroke, a clot that's knocked out the Reticular Activating System.
- I don't - Look, RES controls wake and sleep patterns.
Easy, Quincy, that would take a huge clot.
The damage would be far more extensive than this.
Normally, yes, because most people have two vessels that provide blood flow to the area, - but some only have one.
- The Artery of Percheron.
If Rachel has this variant, a small clot in just the right area would take out the RAS.
She's been out for about 4 1/2 hours.
We missed the window to use tPA to bust the clot.
Still may be able to reverse the damage - with local thrombolysis.
- Okay, so get on it.
This is not a debate, Dr.
Rhodes.
My patient's HLA is an ideal match to the donor.
But his antibody levels are not.
They're too high and suggest he'll reject the heart.
So it slides to the next person on the transplant list, Dr.
Bekker's, patient, Peter.
I'm sorry.
Without that heart, Dan doesn't stand a chance.
- Neither does Peter.
- No, actually, he does, because the artificial heart that you put in can last months, possibly even years.
Dan doesn't have that kinda time.
Peter, he's had two hearts already, and with each transplant, his chances of survival decrease.
It is not fair that he gets a third heart before Dan even gets his first.
There's no limit to the number of organs a person can receive, and it's impossible to compare patients in need.
That's why there's a list, to crunch numbers and break ties.
You're right.
It's all about the numbers.
Okay.
No, no, right, uh, I understand.
Okay, bye.
I canceled our trip.
They asked if I wanted to rebook for a later date.
I said, "Sure, in about 18 years.
" Uh, what's that saying? "When we plan, God laughs"? [SIGHS.]
Speaking of planning, we need diapers and a crib and a car seat and bottles and, uh, onesies and and and did I say diapers? - You did.
- I ate sushi.
I had the occasional glass of wine.
I am happy to report that you have a completely healthy baby girl.
- [LAUGHS.]
- Really? Aw.
- Amazing.
- Hey, you.
Yes! - Hello! God! - Oh.
Oh, holy cow, you weren't kidding.
- [CHUCKLES.]
No.
- This is our son, Martin, and our daughter-in-law, Amy, and Haley, come here and meet your, um aunt.
How 'bout that, huh? We'll give you all some time.
- Thanks.
- Thanks very much.
- I'll let you - Right this way, guys.
It's weird that Will was so adamant about calling the cops.
What do you mean? Well, last week's patient, Vic Thomas, he had advanced-stage cancer, and he was refusing treatment.
Will sent me out of the room to get a cautery, and when I came back, Vic was dead.
I can't be certain, but I think Will let him die.
What did you do? Oh, my God.
He's not hooked up.
I need some help here! Ma'am, I need you to step out.
Right now, ma'am! - I love you, Sam.
- Ma'am, please.
No pulse.
Bag him.
I need you to step back from here, please.
Step back, please.
- Quick look? - [PROLONGED BEEPING.]
- Asystole.
- Milligram of epi.
- Still no pulse.
- Another milligram of epi.
Please, don't hurt him.
Just let him go.
Time of death, 18:16.
It did not have to get this messy.
I had no choice, Natalie.
When someone commits a crime, you have to report it.
Except from when it's you? - What are you talking about? - Vic Thomas.
You let him die.
That's why you've been walking around like a ghost, right? [BROODING MUSIC.]
I don't know what April told you, but Vic Thomas explicitly and repeatedly expressed his wishes to me, and there is a monumental difference between allowing someone to die naturally and intentionally causing their death.
Well, if you did nothing wrong, then why keep it a secret? No, no, no, don't you dare compare what I did to what happened here today.
Natalie, they murdered him.
You backed them into a corner when you called the police.
You forced that family into a decision! These are the results of Dan Kennet's latest panel reactive antibody test.
His antibody levels were above 80, but now They're within transplant criteria.
Antibody levels don't just go down on their own that quickly.
Uh, you can see for yourself.
I had the lab run it twice.
- [STAMMERS.]
- I'm sorry, Dr.
Bekker.
It's not my decision.
Dan Kennet is at the top of the list.
Assemble the transplant team, and notify Mr.
Kennet and his family.
Emergency plasmapheresis and IVIG.
Didn't you? You made Dan look like a better candidate than he really is.
Soon as he's off the plasmapheresis and IVIG, his antibody levels will shoot back up.
Maybe, but the immunosuppressants that he's gonna be on post-transplant should ensure that his body doesn't reject the organ.
- You got it all covered, huh? - Hey, look, I did what I had to for my patient.
At the expense of mine! So do me a favor, okay, and save your self-righteous hero speech for someone else.
- Will she wake up? - I'm hopeful.
Interventional radiology was able to locate the clot and clear it.
But she's so young.
What caused the stroke? A DVT: deep vein blood clot.
Cigarettes and birth control pills were found in Rachel's purse.
Smoking on the pill can sometimes cause one.
But how'd it get into her brain? A PFO, a hole in the heart.
They're not uncommon.
Most people don't even know they have them.
Jacob? Oh, thank God, Rachel.
- Where am I? - The hospital.
Rachel I'm Dr.
Choi.
Do you know what day it is? Tuesday.
What's the last thing you remember? I sat down to wait for my cab.
I had a job interview.
The nurse told me.
That's where you've been going in the afternoons, isn't it? Looking for a job? Why didn't you tell me? I've messed up so many times before.
To surprise you, show you that I really changed.
So, it's really gonna happen today? Yes.
You are getting a new heart.
[EXHALES.]
Uh my antibody levels, like, I thought they were too high.
They were, but now they're not.
The emergency plasmapheresis and IVIG you're on now lowered your levels to within transplant criteria.
Techs are gonna be by to prep you for surgery soon.
Thank you, Dr.
Rhodes.
Of course.
Thank you.
[CHUCKLES.]
It's all just legal mumbo jumbo.
It's pretty boilerplate.
Ah Here.
- [CLEARS THROAT.]
- [PEN CLICKING.]
Um, Dad, I'm sorry, but I I I can't sign this.
[CHUCKLES SOFTLY.]
[LIVELY MUSIC PLAYING, MAN SINGING IN PORTUGUESE.]
Yeah! Muah.
Yeah! [LAUGHS.]
[CHILDREN LAUGHING.]
Yeah! [LAUGHS.]
Just some friends and family? You look so good in a suit.
I cannot wait to tear it off later.
April, this is my sister, Emily.
- Emily, my girlfriend, April.
- [BOTH CHUCKLE.]
- It's all good.
- [CHUCKLES.]
I am so happy to finally meet you.
Prazer em conhecê.
Oh, get Você falar Português? A little.
I spent a year in Rio.
[CHUCKLES.]
Wow Well, hello there.
I am Noah.
And you are? - Emily.
- [CHUCKLES.]
- Emily.
- Ethan's sister.
Right.
Oh, really? Really? Well, you know, how about that? Yeah? You wanna join me on the dance floor? Sure.
Think you can keep up? Oh, yeah? Oh, it's on.
Vamos lá.
Aww! [CHUCKLES.]
Aww, she seems fun.
I'm so glad you brought her.
With Emily, I always expect to be disappointed.
Thought I'd give her a chance to prove me wrong.
But you breathtaking.
Come on, join me on the dance floor.
- No.
[CHUCKLES.]
- Yes! - No! - Hey! No And then faster.
One, two, one, two.
[SOFT MUSIC.]
- Another "3-oh" Prolene.
- Here.
Homestretch, Peter.
Just finishing up the aortic connection.
Then we'll start you back up.
Talking to the patient while they're out, that's a new one.
- It's a nice touch.
- Actually, not new.
Just the first time you've noticed.
Thought I'd made more of an impression on you.
The way you can turn a compliment into a dig, it's quite the skill, Dr.
Bekker.
Don't be so sensitive, Dr.
Rhodes.
Okay, donor heart is fully attached.
- All right.
- Let's get the pacer leads on.
Yes, doctor.
- 100 beats per minute, Marty.
- We're set.
Okay then, turn it on.
[BEEPING.]
Excellent contractility in the left and right ventricles.
- No distension.
- Healthy color.
Take off bypass? Looks like this one's going to take, Peter.
There's no better sight, is there, Dr.
Bekker? Can't argue with that.
- No, no, no! - Losing color.
It's cyanotic.
Global contractility's way down.
Left and right ventricles severely distended.
Hyperacute rejection.
Donor heart's failing.
We need to get it out now.
Damn it.
Okay, back on bypass.
[TENSE MUSIC.]
Okay, Peter obviously goes back on the transplant list, but for right now, I only see two options: - ECMO or an artificial heart.
- ECMO's quick and easy.
Peter's on bypass, so the cannulas are already in place.
Downside, he'd be confined to the ICU and likely intubated.
- I'm leaning artificial.
- That is a huge surgery.
Peter's already been on the table for over four hours.
The risk of complications, especially stroke? But if all goes well, he could get out of bed, walk around, maybe even go home.
Peter waited a year for his first donor heart, two and a half for the one that just failed.
There's no telling how long the next will take.
Then I guess you really only have one option.
[SOLEMN MUSIC.]
It's Peter's wife, Jane.
Not the post-op conversation I was planning for.
Dr.
Rhodes, Dr.
Halstead called from the E.
D.
while you were in surgery, asked that you find him the moment you're free.
- Thank you.
- Mm.
It's Dan Kennet, my giant-cell myocarditis patient.
- He's back.
- Go.
I've got this.
All right.
April, this thing tonight, how big we talking? It's my little cousin's 15th birthday, okay? It's gonna be some of her friends, a few family members, low-key.
Yeah, right.
You always say that.
Then I get there and it's Carnival.
In Brazilian culture, fifteen's a huge birthday for a girl.
Baile De Debutante.
- Uh, did you Google that? - Yeah.
Okay, that's really cute.
Oh, you're gonna bring your sister? I wasn't planning on it.
Come on, you guys have been talking.
Things are going well, right? Yeah, but Emily's always been kind of a wild card.
I don't wanna spend the whole night worrying she'll do something to offend your family.
Plus, she probably has a poker game.
Lame.
All right, I'm not gonna push.
I'd really like to meet her, though.
You will one day.
He fainted? Yeah, getting out of the shower.
When I pressed for details, he confessed to being light-headed all week.
Labs? Yeah, troponin's way too high.
Left ventricular ejection fraction is 10%.
I've been treating Dan for six months.
Steroids, calcium channel blockers, ace inhibitors, beta blockers, no matter what I try, he just keeps getting worse.
Where is he on the transplant list? Way too low.
Don't let him give up.
- Aww.
[CHUCKLES.]
- [CHATTERS.]
Hey, Dan.
Hey, Sheila.
Hey.
We're back too soon.
Listen, Dan, your heart is failing, so I'm going to adjust the meds that you're already on and add IV dobutamine.
IV? Guess I'm not going home today, am I? Yeah, we've gotta get the inflammation of your heart muscle under control.
How long in the ICU? I'm not sure, I'm sorry.
Hey, little B.
- [CHUCKLES.]
- Hi.
The hospital has a daycare center.
- I can, uh, call - No, no.
Having them close keeps me keeps my spirits up.
Good.
That's what we want.
I'll see you guys soon, all right? All right.
Hey, take it from the old guy, ease up or you get a bunch of these.
What are you grinding on? My dad asked me to cosign on a loan.
Huh.
Northwestern offered him a tenure-track position.
He's gonna buy a place in Chicago.
- Isn't that great news? - Yeah.
I can get through the most arcane medical jargon, but legalese? Impossible.
I just wanna know what I'm signing.
- Is that too much to ask? - Not at all.
Cosigning a loan is a big deal.
- Mm.
- If the borrower defaults, you're on the hook for the money, right? Mm-hmm.
Another little piece of advice from the old guy: finances and family, they don't always mix.
Oh, no, Dr.
Charles, my dad is good for the money.
He just needs me to cosign because identity theft messed up his credit a few years ago.
Huh.
So when did your back start bothering you? Oh, it's been killing me since last night.
Listen, I probably overdid it in my spin class.
I've been working on my stamina.
We're off to Italy tonight, bike trip through Tuscany - Oh, yeah? - Our 30th anniversary.
- Congratulations.
- Thanks.
All right, so let me know if you feel anything tender - Okay.
- Okay? The spinning, is that a new activity to prep for the trip? Um, yeah.
And also, I've been trying to lose the Twenty-ish pounds I gained over the winter.
Obviously, it's not working.
But muscle weighs more than fat, isn't that right? Don't answer that.
Are you on any medications, Mrs.
Davis? Yeah, I'm on hormone replacement therapy.
I'm at high risk for osteoporosis, so I started the hormones after menopause.
- No midline abnormalities.
- Okay.
Is, uh do you have any burning with urination? Um, no, although lately, it does seem like I have to go every ten minutes.
Our granddaughter just got out of diapers.
I guess I'm on my way into them.
Well, looks like it's just a muscle strain.
Really? Yeah, a 10 of Flexeril and 800 of Ibuprofen.
And, uh, I'll check back in an hour, see how you're feeling.
- [CHUCKLES.]
Thanks.
- Yeah.
- Muscle strain.
- Mm.
- Maggie - Uh-huh? I need a doctor in the waiting room.
Got it.
Dr.
Choi, we're up.
LaShawn, hold onto this.
- Be quiet, please! - Are you okay? Clear out, clear out.
Here, here, here.
Sir, take this chair and move it, please, thank you.
She kept falling over onto the person next to her.
I can't wake her up.
Ma'am ma'am, can you hear me? She's snoring, so she's protecting her airway.
Able to breathe, good pulse.
Who is she? Patient here to be seen? No idea, she never checked in with me.
Anyone know who she is? Mags, see if there's an ID.
Yeah.
I got it.
Illinois driver's license.
Her name is Rachel Wexler.
30 years old, lives in Evanston.
- That's not close.
- No.
Don't know why she's here, but she's a patient now.
All right, get ready to clear out.
Move, people, move, move, move, move, move, move! Go, go, go, go, go, go, go, go! - Doris, Treatment Four.
- What do we got? Fell asleep, now won't wake up.
- OD? - That's my guess.
A drop and dash, or maybe a last fling, before coming in to get treatment.
- Doris, push 2 of Narcan.
- Yep.
[TENSE MUSIC.]
Mags, any more info from her purse? Wallet, keys, makeup, gum, birth control pills, and cigarettes, nothing helpful.
BP, 104 over 68, heartrate, 72, pulse ox, 99%, EKG, normal sinus rhythm.
Not exactly OD vitals, Dr.
Choi.
- No response to Narcan.
- I told you.
Narcan only counteracts opiates.
Must be a benzo.
Push .
4 of Flumazenil, and order a CBC, CMP, ammonia levels, arterial blood gas, BAC, and blood and urine tox screens.
Maggie, she's wearing a wedding ring.
Can you find a contact for a spouse? Would if I could, but no cell phone, but a charger, so I'm guessing she had one at some point.
If she stumbled in here high, who knows where she lost it.
Flumazenil's not working either.
Okay, OD's out.
Doris, add an HCG, a CT chest, spine, um, abdomen and pelvis to the test.
Got it.
Dr.
Stohl, you're thinking injury? All I'm seeing is a scar on her right cheek, but it's old, clearly healed.
Just because there's no bruising doesn't mean there's no trauma.
You should know that, Dr.
Choi.
So, I took a second look at your echo, and I wanna start you on dexamethasone.
It's another anti-inflammatory.
Whatever you think is best, do it.
- How'd it go? - Surgery went well.
Peter's artificial heart is in.
Let's hope it lasts until a donor heart becomes available.
Peter's Status One on the transplant list.
He's got a chance.
My patient, Dan, he's Status Two.
I am waiting for a call that's probably never gonna come.
GCM's brutal but not usually discovered until autopsy.
- You're way ahead of it.
- I was.
Now I'm just playing catch-up.
- [DOOR BEEPS.]
- 23-year-old male.
Went down on his motorcycle just outside Bloomington.
- Wasn't wearing a helmet.
- Massive brain hemorrhaging? Rural hospital's been working on him, but he's worse than they can handle.
GCS, 3, down six hours already.
Crap scans.
Doubt we can do much better.
You know what they call a motorcyclist riding without a helmet, don't you? One, two, three.
An organ donor.
Well, she's not catatonic.
Whatever knocked her out, it's not psychiatric.
- What'd her tox screens show? - Yeah, she's clean.
Blood alcohol, arterial gases, and all other labs too.
- Diabetic Ketoacidosis? - Blood sugar's normal.
- Liver failure? - Ammonia level's normal.
Tumor? Chest X-ray and all the CTs were clean.
- The scar on her cheek? - Plate from an old fracture.
No apparent connection to her unconsciousness.
Just got off the phone with PD.
Ruzek ran Rachel's name through the system.
She got busted a few times: DUI and possession.
And yet a clean tox and BAC.
Hmm, the plot thickens.
Good luck.
Hey.
Hi, Natalie.
Just getting here? Yeah, remember, it was my turn to be volunteer mom at Owen's daycare class.
Oh, right, yeah.
Three hours and 20 toddlers, do you have any idea how many boogers that is? Ha, I'll bet.
Okay not my best material, but not even a courtesy laugh? - Are you okay? - Yeah, I'm just tired.
- Are you sure? - No, yeah, I'm good.
Dr.
Manning, you're up.
You're going to Treatment Two.
Okay.
Hey, I'll catch you later? - Okay.
- [DOOR BEEPS.]
Sam Covington, 27-year-old male.
Hypotensive and tachypneic.
Long-term care patient following a TBI.
How long ago did he sustain the brain injury? Um, five years.
It was a surfing accident.
He was only 22.
Just graduated from UCSD, magna cum laude.
Mm, sorry, you don't need to know all that.
Mom, I take it? All right, let's transfer him on my count.
Ready, one, two, three.
[TENSE MUSIC.]
[STRAINED BREATHING.]
[GASPS.]
- Temp, 101.
6.
- Mm-kay.
[GASPS.]
Congested on both sides.
Mom, hey, I just got your message.
Sorry, I was in class.
What happened? Is-is Sam okay? Uh, your brother was breathing fast, and, um, he [STAMMERS.]
He looked like he was in pain.
Uh, let's get a CBC, CMP, ABG, a UA, and blood cultures, and begin sepsis protocol.
Excuse me, sorry.
- Start him on antibiotics.
- That's a lot of tests.
I understand, but since Sam can't tell us where it hurts, it's better to err on the side of caution.
Okay? [SOFT MUSIC.]
[DOOR OPENS, HOSPITAL BED RATTLING.]
Take as much time with your son as you need.
When you're ready, someone will come speak with you about organ donation.
- What happened? - Motorcycle accident.
Never had a chance.
Soon as the immunotyping results are in, find me.
Yeah, okay.
- So, how we feeling? - Ugh, my back is better, but now I'm feeling really queasy.
All of a sudden, it just hit her.
- A reaction to the Flexeril? - Yeah, maybe.
Um, can can I take a look? Okay, uh-huh [HURLS.]
Oh, gosh.
Mm.
- April, can I - Sorry.
Mm can I get, um, 4 milligrams of Zofran? Uh, and if you'll excuse me, I'll - I'll be right back.
- Sorry.
No, yes, it's, um It's no it's no problem.
Sorry.
- Oh, I'm so embarrassed.
- Oh, he's fine.
First-year resident, projectile vomit is a rite of passage.
- I'll get you a gown.
- Thank you.
- Oh, my God.
- Are you all right? [ELEVATOR DINGS.]
Daniel, there you are.
The next round of prospective transplant candidates.
No rest for the wicked.
Dr.
Reese's father, Robert Haywood, is in this stack: Class Three heart failure.
I hope he makes a strong candidate.
[CHUCKLES.]
You'll keep me in the loop? Uh, Daniel? Yes.
Yes, of course.
Could you excuse me? - [MACHINES BEEPING ERRATICALLY.]
- Dan? - Dan? - Daddy? Get the crash cart! Paddles now.
Come here.
[TENSE MUSIC.]
Come No pulse or breathing, He's in V-fib.
Get on his chest.
Charge to 200.
- Charged.
- [PADDLES WHIRRING.]
All right, hold compressions.
Clear! [MACHINE CHIRPING.]
Charge again.
Amp of epi.
Epi's in.
Charged.
All right, clear! [SOBBING.]
- He's hurting Daddy! - No, honey Charge again.
Amp of epi.
- He's just trying to help.
- Come on, Dan.
- Beat, damn it.
Come on.
- Meds are in.
- Charged.
- Hold compressions.
Clear.
[STEADY BEEPING.]
He's back.
[SOLEMN MUSIC.]
Thank you.
So, I'm not getting on the transplant list? I didn't say that.
I'm just making you aware that personality disorders can be a contraindication of transplant.
You believe I have Antisocial Personality Disorder, but another psychiatrist might not.
It's-it's a pretty gray area, wouldn't you say? Well, actually it isn't.
Uh, take a look at this.
This is a PET scan of your brain.
[FINGERS DRUM.]
Taken when Dr.
Rhodes was conducting his thoracic study? That's right.
[DESOLATE MUSIC.]
And this supports your diagnosis? - Mm.
- Well since you're bound by doctor-patient confidentiality, I just say we keep this to ourselves.
I'm afraid that's not an option.
Um, I am obliged to report my findings to the evaluation committee.
[DISQUIETING MUSIC.]
I didn't realize you had such influence on the process, Dr.
Charles.
[CLEARS THROAT.]
My heart meds.
Do you have any water? Of course.
Um, by the way, contraindication isn't absolute.
I mean, taking positive steps to manage your disorder can go a long way to mitigating concerns.
Well, I hope you have some suggestions.
Well, what the committee's looking for - is self-sufficiency - Mm-hmm? - Fiscal responsibility - Fiscal responsibility? You wouldn't by any chance be referring to the loan I asked Sarah to cosign? Anything you can do to establish independence Perhaps rescind the request.
Would certainly count in your favor.
I'm sorry, Bob, you know, they come up against us all the time.
There are simply too many people waiting for too few organs.
I really appreciate you giving me this advice.
- [KNOCKING ON DOOR.]
- Hi.
Dr.
Manning, this is my sister, Lizzie.
She just drove down from Racine.
Nice to meet you.
Uh, how long was I sleeping? Lizzie, whe when did you get here? Just now, Mom.
"Eddie would go"? Who's Eddie? Eddie Aikau: legendary big wave surfer and lifeguard at Waimea Bay.
He'd charge waves no one else would dare.
Sam's hero.
So we got the results back from Sam's labs and X-rays.
Um, I'm afraid he has pneumonia.
The antibiotics should knock it out.
Right now, we'd like to swap out Sam's trach tube so we can put him on the vent, you know, give his respiratory system a rest.
Okay? - [GRUNTS.]
- No, no, it's okay.
Honey, honey, it's okay.
Just she'll-she'll be gentle.
Okay [GRUNTING.]
Monique, pass me the new trach tube.
Hey, that's, um, Rachel's husband, Jacob.
- Where'd you find him? - He found us.
He kept on calling her voice mail and finally used a "find my phone" app, which led him to the waiting room.
Her phone was buried in the chair cushion.
- Thanks, Mags.
- Yeah.
- Mr.
Wexler - Hey.
I'm Dr.
Choi.
I've been treating your wife.
What's wrong with her? Well, we don't know yet.
All her tests have been negative, including the tox screen.
But given your wife's drug history - You think she overdosed? - She might have taken something that's beating the test, possibly a synthetic.
Rachel was in a car accident a few years ago.
Airbag broke her jaw and a bone in her cheek.
The injuries healed, but the pain pills After her last arrest, she promised that she'd stay clean.
Here we go again.
[SOFT MUSIC.]
[KNOCKING ON DOOR.]
[SOLEMN MUSIC.]
Meds alone aren't taking enough pressure off of Dan's heart, so I am going to put him on ECMO.
Full support, so that his heart doesn't have to shoulder any load.
When you first diagnosed the GCM, you said ECMO was a final option.
Mm-hmm.
I told myself To make a plan, to prepare for this moment, but I couldn't do it.
It felt like giving up.
I promise you that's not what's happening here.
Okay? - How's your TBI patient? - [SIGHS.]
Saw pneumonia on his chart.
Pretty sure he got it from his trach tube.
It was filthy.
His mom's his caregiver.
Looks like she hasn't been cleaning or suctioning it.
- What, neglect? - No, I don't think so.
All other areas, he was meticulously well-cared for.
His nails are trimmed, his teeth are brushed, - skin is moisturized.
- So Mom's burnt out.
The first thing to slip was the tube? Ever since Sam's injury, she has devoted her entire life to caring for him.
I'm not sure how to tell her that she may no longer be up to the task.
You want some backup? No, I don't want her to feel ganged up on.
I'll figure it out.
Agh! So, the the Zofran hasn't helped at all? No! And the cramps are unbearable.
- So is her gas.
- Hey! No fever, vitals are normal.
All right, let's hang another liter of, uh, normal saline, and order a CBC, CMP, amylase, and lipase levels.
Okay? Uh, this might be, uh, a stomach bug, - possibly kidney stones, okay? - Oh I'm just gonna I'm gonna p I'm gonna press on your stomach.
- Ah! Wait, I need a bathroom! - Okay.
- Oh, okay.
- I need a bathroom right now! - All right, come on, honey.
- Okay, hold on a second.
- We'll get you there.
- Ahh! - [URINE SPLATTERS.]
- Oh! - What? - Whoa.
- [SIGHS.]
Sorry.
- That's okay.
Honey, let's get you back into bed.
Oh, my God, no I still need to go! - Okay, I'm gonna help you.
- Really bad! - Come on.
Come on, let's go.
- Wait, wait, wait, no, no, no.
That's not urine.
Oh, okay.
Let's let's get you right back into bed.
- Come on.
- Wait, what what's going on? I don't know what's happening.
- Come on.
- What's going on? Oh! Oh! Ow! - Come on.
- Jeez.
[YELLS.]
What are you doing? - What's going on? - Oh.
- Yikes! - What is going on? - Really? Are you s whoa! - Oh.
- Okay, Mrs.
Davis - Yeah? You're gonna wanna push, but don't.
[WHIMPERS.]
There's no way.
No, no, no.
This this is not possible.
- Uh, what is going on? - Your wife is pregnant - [GROANS.]
- And in labor.
No, no, that c That can't be true.
I'm 55; I've been through menopause.
I know this might be a shock, but this is happening.
- I am positive.
Page OB.
- Okay.
- I'll be right back, okay? - Uh - Oh, my God! - Oh, my What the hell, Connor? Not here.
[BROODING MUSIC.]
That motorcyclist is an HLA match to my patient, Peter, but suddenly, your GCM patient is above him on the transplant list? How did he come in this morning at Status Two and suddenly jump to the highest priority? - I had to put him on ECMO.
- Before other meds? Milrinone? Monoclonal antibody therapy? They're just stop-gaps.
Oh, you sneaky son of a bitch.
ECMO trumps an artificial heart, puts your patient to the top of the list.
You manipulated the system.
I made an aggressive treatment decision.
You're taking a heart that doesn't belong to you! I am fighting for one that's available! This isn't right and it isn't over.
The hospital can connect you with respite services, as well as caregiver support groups.
You do not have to do this alone.
And we can help out more, Mom.
Catherine no one is blaming you.
You have done a tremendous job caring for Sam.
I wasn't trying to hurt him.
No, of course not.
I thought that he would go peacefully.
Uh, I wasn't prepared to see him in pain.
Mom, what are you talking about? Sam doesn't want this oblivion.
[SOLEMN MUSIC.]
I see it in his eyes every time he looks at me.
[SNIFFLES.]
The doctors say there is no meaning behind it [INHALES SHARPLY.]
that that he's not really looking at me.
[SNIFFLES.]
I know my son And he wants this over.
- He was begging me to help him.
- Mom, stop talking.
I should never have called 9-1-1.
I should have just let him go, like I planned, like he wanted.
I got scared.
I panicked.
Oh, my God, Mom, did you Mom, please, don't say anything else.
Sam, I'm sorry I let you down.
I am so sorry, honey.
We need to call a lawyer, now.
First, you're treating my father, and now you're blackmailing him? - What? - You heard me.
Look, I don't know what he told you He said you're jealous of our relationship, that you have some twisted paternal feelings for me, that you threatened him, and said if he didn't stay away from me, you'd sabotage his chances of getting on the list.
I threatened him? - Wh sabotage? - Yes.
I'm a shrink in a sweater vest, not a secret agent.
Is it true? I can't disclose details of our conversation, but I assure you, all I did was lay out the facts as they pertain to his condition.
What are you treating him for? I can't tell you that, Sarah.
- He's my patient.
- But he is my father.
Who suddenly reappears after two decades of avoiding parental responsibility and alienating everyone in his life, who now presents himself as a victim in order to create an alliance with you.
Think about what you know, Sarah.
If he was your patient, what would be on your differential? [SOLEMN MUSIC.]
[SCOFFS SOFTLY.]
What was that about? As you will read in my evaluation, her father, Dr.
Haywood, has a particularly malignant form of Antisocial Personality Disorder.
Are you serious? Is she in danger? Well, I haven't picked up any violent tendencies yet, but he's an extremely effective manipulator.
Dr.
Reese doesn't know? Well, I think she might be starting to figure it out on a clinical level, but emotionally, she's she's not there yet.
Ahh! Oh! This can't be real! This can't be real! - Where the hell is the OB? - They said five minutes.
We can't wait.
The baby's crowning.
- What? - Tessa - Yeah? - On three, - really big push, okay? - Okay.
- All right, one - Uh-huh? Two, three.
[GRUNTS LOUDLY.]
- [PANTING.]
- Yeah, good, good.
When did we go to Mark and Patti's cabin? - What? - Was that Fourth of July? What are you talking about? I'm just trying to figure out when this happened.
Oh, God, Greg, how does that matter now? Mr.
Davis, can you please help the nurse hold your wife's leg back? - All right, okay, yeah, yeah.
- Thank you.
Okay.
Tessa, Tessa, look at me.
Look at me, Tessa.
Okay, Tessa, one more push, all right? - Okay.
- You can do it, you can do it.
- Yeah! - You can do it.
- Ready? - Yeah! - Go.
- [GRUNTS LOUDLY.]
You're doing great.
You're almost there.
- All right, all right.
- Yes.
- Oh! - Whoa.
- Okay, okay - [BABY CRYING.]
This is crazy.
- Does he look okay? - Oh, my - It's a girl.
Congratulations.
- Oh! - Oh - Congratulations to you both.
Oh, my goodness.
[CHUCKLES.]
[BABY CRYING.]
Oh, my gosh.
Natalie, you can't sit on this.
If I report it, Catherine will likely be removed as Sam's guardian.
I wanna pull in social services.
This goes beyond family counseling.
It's a criminal matter.
She intentionally stopped trach care to cause her son's death.
To end his suffering.
You know, she looked into moving to a state where assisted suicide is legal? But because Sam isn't terminal ill and can't express his wishes, he didn't qualify.
Exactly, which means you can't be certain this is what he wants.
No one knows what Sam wants more than his mother.
Then she needs to go to court and make her case, petition a judge to get his feeding tube removed.
Look, Natalie, I'm not arguing she's wrong, but what she did is illegal.
You have to call the police.
No.
Then I will.
[DIAL PAD CLACKING.]
Decerebrate posturing: rigid limbs, pointed toes.
She's slipping deeper into unconsciousness.
Dr.
Stohl, Dr.
Choi, we got something.
Right after we discovered Rachel, I texted a pic of her license throughout the hospital.
I just got a call from my friend from HR.
She said she interviewed Rachel this morning for an admin job.
She said she was alert and engaging.
Alert and engaging? That doesn't sound like someone about to OD.
All right, but if it's not drugs, - what the hell knocked her out? - You missed something.
Recheck every test result, look for anything that might be mimicking something else.
Her MRI.
These two spots of diffusion restriction, radiology says they're from movement and mental artifact.
The plate in her cheek.
But what if that's wrong? This could be damage from a stroke, a clot that's knocked out the Reticular Activating System.
- I don't - Look, RES controls wake and sleep patterns.
Easy, Quincy, that would take a huge clot.
The damage would be far more extensive than this.
Normally, yes, because most people have two vessels that provide blood flow to the area, - but some only have one.
- The Artery of Percheron.
If Rachel has this variant, a small clot in just the right area would take out the RAS.
She's been out for about 4 1/2 hours.
We missed the window to use tPA to bust the clot.
Still may be able to reverse the damage - with local thrombolysis.
- Okay, so get on it.
This is not a debate, Dr.
Rhodes.
My patient's HLA is an ideal match to the donor.
But his antibody levels are not.
They're too high and suggest he'll reject the heart.
So it slides to the next person on the transplant list, Dr.
Bekker's, patient, Peter.
I'm sorry.
Without that heart, Dan doesn't stand a chance.
- Neither does Peter.
- No, actually, he does, because the artificial heart that you put in can last months, possibly even years.
Dan doesn't have that kinda time.
Peter, he's had two hearts already, and with each transplant, his chances of survival decrease.
It is not fair that he gets a third heart before Dan even gets his first.
There's no limit to the number of organs a person can receive, and it's impossible to compare patients in need.
That's why there's a list, to crunch numbers and break ties.
You're right.
It's all about the numbers.
Okay.
No, no, right, uh, I understand.
Okay, bye.
I canceled our trip.
They asked if I wanted to rebook for a later date.
I said, "Sure, in about 18 years.
" Uh, what's that saying? "When we plan, God laughs"? [SIGHS.]
Speaking of planning, we need diapers and a crib and a car seat and bottles and, uh, onesies and and and did I say diapers? - You did.
- I ate sushi.
I had the occasional glass of wine.
I am happy to report that you have a completely healthy baby girl.
- [LAUGHS.]
- Really? Aw.
- Amazing.
- Hey, you.
Yes! - Hello! God! - Oh.
Oh, holy cow, you weren't kidding.
- [CHUCKLES.]
No.
- This is our son, Martin, and our daughter-in-law, Amy, and Haley, come here and meet your, um aunt.
How 'bout that, huh? We'll give you all some time.
- Thanks.
- Thanks very much.
- I'll let you - Right this way, guys.
It's weird that Will was so adamant about calling the cops.
What do you mean? Well, last week's patient, Vic Thomas, he had advanced-stage cancer, and he was refusing treatment.
Will sent me out of the room to get a cautery, and when I came back, Vic was dead.
I can't be certain, but I think Will let him die.
What did you do? Oh, my God.
He's not hooked up.
I need some help here! Ma'am, I need you to step out.
Right now, ma'am! - I love you, Sam.
- Ma'am, please.
No pulse.
Bag him.
I need you to step back from here, please.
Step back, please.
- Quick look? - [PROLONGED BEEPING.]
- Asystole.
- Milligram of epi.
- Still no pulse.
- Another milligram of epi.
Please, don't hurt him.
Just let him go.
Time of death, 18:16.
It did not have to get this messy.
I had no choice, Natalie.
When someone commits a crime, you have to report it.
Except from when it's you? - What are you talking about? - Vic Thomas.
You let him die.
That's why you've been walking around like a ghost, right? [BROODING MUSIC.]
I don't know what April told you, but Vic Thomas explicitly and repeatedly expressed his wishes to me, and there is a monumental difference between allowing someone to die naturally and intentionally causing their death.
Well, if you did nothing wrong, then why keep it a secret? No, no, no, don't you dare compare what I did to what happened here today.
Natalie, they murdered him.
You backed them into a corner when you called the police.
You forced that family into a decision! These are the results of Dan Kennet's latest panel reactive antibody test.
His antibody levels were above 80, but now They're within transplant criteria.
Antibody levels don't just go down on their own that quickly.
Uh, you can see for yourself.
I had the lab run it twice.
- [STAMMERS.]
- I'm sorry, Dr.
Bekker.
It's not my decision.
Dan Kennet is at the top of the list.
Assemble the transplant team, and notify Mr.
Kennet and his family.
Emergency plasmapheresis and IVIG.
Didn't you? You made Dan look like a better candidate than he really is.
Soon as he's off the plasmapheresis and IVIG, his antibody levels will shoot back up.
Maybe, but the immunosuppressants that he's gonna be on post-transplant should ensure that his body doesn't reject the organ.
- You got it all covered, huh? - Hey, look, I did what I had to for my patient.
At the expense of mine! So do me a favor, okay, and save your self-righteous hero speech for someone else.
- Will she wake up? - I'm hopeful.
Interventional radiology was able to locate the clot and clear it.
But she's so young.
What caused the stroke? A DVT: deep vein blood clot.
Cigarettes and birth control pills were found in Rachel's purse.
Smoking on the pill can sometimes cause one.
But how'd it get into her brain? A PFO, a hole in the heart.
They're not uncommon.
Most people don't even know they have them.
Jacob? Oh, thank God, Rachel.
- Where am I? - The hospital.
Rachel I'm Dr.
Choi.
Do you know what day it is? Tuesday.
What's the last thing you remember? I sat down to wait for my cab.
I had a job interview.
The nurse told me.
That's where you've been going in the afternoons, isn't it? Looking for a job? Why didn't you tell me? I've messed up so many times before.
To surprise you, show you that I really changed.
So, it's really gonna happen today? Yes.
You are getting a new heart.
[EXHALES.]
Uh my antibody levels, like, I thought they were too high.
They were, but now they're not.
The emergency plasmapheresis and IVIG you're on now lowered your levels to within transplant criteria.
Techs are gonna be by to prep you for surgery soon.
Thank you, Dr.
Rhodes.
Of course.
Thank you.
[CHUCKLES.]
It's all just legal mumbo jumbo.
It's pretty boilerplate.
Ah Here.
- [CLEARS THROAT.]
- [PEN CLICKING.]
Um, Dad, I'm sorry, but I I I can't sign this.
[CHUCKLES SOFTLY.]
[LIVELY MUSIC PLAYING, MAN SINGING IN PORTUGUESE.]
Yeah! Muah.
Yeah! [LAUGHS.]
[CHILDREN LAUGHING.]
Yeah! [LAUGHS.]
Just some friends and family? You look so good in a suit.
I cannot wait to tear it off later.
April, this is my sister, Emily.
- Emily, my girlfriend, April.
- [BOTH CHUCKLE.]
- It's all good.
- [CHUCKLES.]
I am so happy to finally meet you.
Prazer em conhecê.
Oh, get Você falar Português? A little.
I spent a year in Rio.
[CHUCKLES.]
Wow Well, hello there.
I am Noah.
And you are? - Emily.
- [CHUCKLES.]
- Emily.
- Ethan's sister.
Right.
Oh, really? Really? Well, you know, how about that? Yeah? You wanna join me on the dance floor? Sure.
Think you can keep up? Oh, yeah? Oh, it's on.
Vamos lá.
Aww! [CHUCKLES.]
Aww, she seems fun.
I'm so glad you brought her.
With Emily, I always expect to be disappointed.
Thought I'd give her a chance to prove me wrong.
But you breathtaking.
Come on, join me on the dance floor.
- No.
[CHUCKLES.]
- Yes! - No! - Hey! No And then faster.
One, two, one, two.