Chicago Med (2015) s03e19 Episode Script
Crisis of Confidence
1 All right, here we go.
Next bucket wins.
Check.
All right, hold on.
I gotta tie my shoe.
So, how are you and Natalie doing? I see what you're doing.
It's not gonna work.
Seriously.
I just wanted to see if you two are getting along.
Seriously, things have never been better.
I'm a lucky guy.
Now quit stalling.
Well, I'm glad you didn't screw things up.
'cause you can be a real knucklehead.
What's that supposed to mean? Yes! [HIP-HOP MUSIC PLAYING.]
Ethan, this way.
What the hell happened? Uh, this guy, I think he OD'd.
- You should've called 911.
- Look around.
Last thing I wanna do is get anyone in trouble.
Em, it's 7:00 a.
m.
What are you even doing here? I was out dancing with my friends.
- Got invited over here after.
- Don't you have work today? Ethan, don't worry, I'll be there.
- [GAGGING.]
- Over here.
His name's Jeremy.
Jeremy? Hey, Jeremy what did you take, huh? Does anyone know what he took? [GAGGING.]
Heroin.
He's choking.
Oh, God.
[TENSE MUSIC.]
I can't clear it.
- Em, see if you can find a pen.
- What? Why? He's not breathing.
He needs a surgical airway.
[INDISTINCT MURMURING.]
- Hey! - Here, got one.
Unscrew the top.
[GROANS.]
I'm in.
[GASPS.]
He's breathing.
- Unfortunately, I have to bring up last week's mass casualty incident, because in the chaos, it seems 40 pills of Percocet disappeared from the medication dispensary.
That's a street value of $2,500.
Someone took advantage of that situation.
So, we will be implementing new protocols to prevent that from happening in the future.
Keep your eye out for a memo in the next few days.
Any questions? Good.
Back to work.
[KEYS JANGLING.]
[SOLEMN MUSIC.]
[DOOR BEEPS.]
- Go to Four.
- [BREATHING HEAVILY.]
Tracy Herman, 25-year-old female.
21 weeks pregnant.
GCS, 14, dyspneic.
This is her mother, Pam.
- Is my baby okay? - We're gonna take a look.
All right, Tracy, I'm Dr.
Manning.
- Can you tell me what happened? - I don't know.
We were having breakfast and she just collapsed.
All right, let's transfer her and put her on the monitors.
On my count, ready, one, two, three.
[GASPS.]
Any pain or discomfort? No.
Breath sounds are clear and present bilaterally, but I am hearing a systolic murmur.
What does that mean? It's probably the pregnancy putting a strain on your heart.
- Have you had any bleeding? - Uh, just some spotting, - but my OB said it's normal.
- It can be.
Uh, Doris, let's get a fetal ultrasound, uh, chest X-ray, and call up to Cardiology for an ECHO, okay? All right, Tracy, just try to relax.
All right, we're gonna do everything we can to figure this out, all right? - Thank you.
- Yeah.
Oh, goodie.
Lime flavor today.
I, uh, just checked with the charge nurse.
Your last set of labs look good.
If everything holds for the next 24 hours, they'll put you back on solid foods.
Whoo.
Wonderful news.
I also told her about your nausea.
She'll be over in a few minutes with some ondansetron.
Sarah? I know I haven't said it enough, but thank you.
I can't tell you how grateful I am for all you've done for me since the transplant.
No, just, uh, one more thing.
It looks like I'll still be in rehab for a while.
Uh, I haven't checked my mail since all this happened.
I'm sure the bills are piling up.
You want me to run to your apartment? Unfortunately, I have no one else to ask.
All right, but it'll have to wait a few hours.
Dr.
Charles and I have rounds at Cohn County.
The jail? Ooh, sounds fascinating.
[GROANS.]
All right.
Now, this certainly can wait till after.
It's this key right here.
I made a short list of things I need.
If you don't mind.
"No clues to mystery surrounding "missing college co-eds Search for Indiana girl goes on.
" This poor young lady, Olivia Coveny, seems to have disappeared from the Madison campus, what, about ten years ago? "Wisconsin girl missing.
" What am I looking at? Seems like somebody is trying to make a case that Robert Haywood is a very bad guy.
- Sarah Reese's father? - Yeah.
Well, I mean, apparently, he was a visiting lecturer at all of these colleges at the same time that these women disappeared.
And you don't know who sent you this? Nope.
Somebody slipped it under my door.
Apparently, somebody knows that I'm working with Robert Haywood.
I think if you think there's something there, you should turn it over to the police.
Turn what over to the police? It's all completely circumstantial.
There's nothing in here that connects him to any one of these women.
And if you read the articles, every single one of these cases has been thoroughly investigated by the police.
You haven't shared this with Dr.
Reese yet, have you? Absolutely not.
[TENSE MUSIC.]
[DOOR BEEPS.]
We set up Baghdad as soon as you called.
- How's he doing? - Got an ET tube in on the right, but held off on the naloxone.
They don't want him waking up with a tube in his neck.
But he needs a better airway.
Get me a number eight trach tube.
You ready to get him on the monitors? All right, we're gonna transfer him on my count.
Everybody ready? One, two, three.
I'm in.
Bag him.
BP's dropping.
88 over 50.
All right, he's still intoxicated.
We need to reverse him.
Push 2 milligrams of naloxone IV.
How's Jeremy? It's gonna take time for the drugs to clear from his system, but he should be okay.
[EXHALES.]
I'm gonna go home and change.
I'll be back for work in a couple of hours.
Heroin? What was she thinking, going to that party? I'm not sure she was thinking.
[SIGHS.]
Hey.
How was the game? I'm filing a protest with the league commissioner.
So you lost? - Dr.
Manning? - [LAUGHS.]
Yes? Imaging results from your pregnant patient in Treatment Four.
- You better page CT surgery.
- Yeah.
- Maggie? - Yeah? Okay.
Now, the access to the atria of both hearts.
We're ready to clamp.
Left is clamped.
[SOLEMN MUSIC.]
And the right Dr.
Bekker will now perform the separation.
Scalpel.
Josh, have peeds surgery ready.
[ALARM BEEPING.]
- What's happening? - Heart rate's diving.
- The twins are bradying down.
- Dr.
Bekker? I don't know, my incision was superficial.
- Step aside.
- Heart rate's down to 44.
There's no bleeding.
We haven't cut near any major vessels.
We need to push atropine.
No, it's too late.
[ELECTRICITY DRONES.]
Congratulations, Dr.
Latham.
According to the computer simulation, your team just killed both twins.
- Yes, we did.
- I don't know what happened.
That's why we conduct these exercises, Dr.
Bekker, so that we can predict all outcomes and make the necessary adjustments on game day.
Dr.
Frisch, my team will evaluate our approach and determine what went wrong.
We'll gather again this afternoon and resume the procedure.
I'd like all possible scenarios on my desk before lunch.
Yes, Dr.
Latham.
Keep your chin up.
You'll figure it out.
You know, you don't have to do that.
What? Act like you don't enjoy seeing me on the hot seat.
Go ahead and buy it.
If I were in your position, I would.
Dr.
Rhodes, Dr.
Bekker, they need you in the ED.
Okay.
You're saying I have damage to my heart? Uh, to be specific, it's your mitrovalve.
Uh, when it's not functioning properly, the body doesn't get enough oxygen.
Which is why you've been feeling so weak and short of breath.
But she's never had any problems with her heart before.
In all likelihood, Tracy was born with a defect, and it just didn't show any symptoms until now.
Um, the baby has apparently added strain to your heart, which has caused it to present itself.
We'll need surgery to replace the defective valve.
Oh Okay.
There are potential complications.
Complications? [DISQUIETING MUSIC.]
Due to your pregnancy, the medication needed to conduct the surgery could cause a life threatening vaginal bleed, and given that your fetus hasn't reached viability Wh what are you saying? We think it's best for your health if you terminate before undergoing surgery.
What? No.
You don't understand.
Her husband, Roy we lost him in a car accident three months ago.
[SOBBING.]
We had just got the news that I was pregnant.
He was so excited.
He wanted this so bad.
Tracy, trust me, I understand what you're going through, but without this surgery, neither you nor your baby will survive.
Honey, please listen to the doctors.
No.
No! This baby is all I have left.
I won't let you take it from me.
The patient understands that, without surgery, - condition could be fatal? - Yeah, we explained the risks.
Well, so, your concerns are certainly justified.
We need blood thinners to keep the bypass pump for clotting.
Hm.
Have you considered a minimally invasive valvuloplasty? Yes, but due to the level of stenosis and the presence of regurgitation, we don't feel that she's a candidate.
We have to open her chest.
What if there is another option? What? If we lower the dose of the blood thinners and use a heparin-coated bypass tube, there is a chance that we could save both mom and baby.
According to Dr.
Manning, Tracy's Level Two ultrasound showed placenta previa, which puts her at an even greater risk of developing a serious bleed.
Ava, you heard what she said.
This baby is all she has left of her dead husband.
Don't we have an obligation to honor the patient's wishes? So, we should let the patient's emotional involvement impact our medical decisions? I think we owe it to her to give it a shot, yes.
With close monitoring, it is possible to stay ahead of any bleeding.
Dr.
Rhodes, if you believe that this is the best course of action, - please proceed.
- Thank you.
[SOLEMN MUSIC.]
Well good luck.
Are you taking her up to surgery? Yeah.
I'm worried about her.
Connor's taking a big risk.
Hey, you two, Treatment Six.
Okay.
Hi.
- You must be Cody.
- [COUGHING.]
- What's his temp? - 102.
He's been like this for over a week.
Uh, I've had him on Tamiflu, bed rest, fluids.
We've tried everything.
He he just keeps getting worse.
It's been an an extremely harsh flu season.
Is anyone else in your household sick? No, it's just the two of us.
I've been spared so far, I-I assume 'cause I was vaccinated.
And what about Cody? Uh, unfortunately not.
No, I-I know what you're thinking.
It's not like that.
Uh, Cody has a A long list of allergies.
Last year, he had a severe reaction to the vaccine.
I-I didn't wanna put him through that again, you know? I understand, all right.
It makes sense why you didn't wanna get him vaccinated.
Let's get a CBC, CMP, and a chest X-ray, okay? I promise we're gonna do everything we can to take care of your son, okay? We'll be back soon.
All right couple of more seconds and I'll have the valve free.
[MUMBLES.]
No evidence of bleeding.
Good.
There.
Got it.
All right, let's get a sizing tool.
I'm gonna measure the opening, determine what size valve we need.
Let's start with a 21.
Yep.
Let's open a 21-millimeter porcine valve.
Manufacturer had some production delays with that size valve.
It's on backorder.
But I have a mechanical.
Can we get one from another supplier? Sure, but it'll take an hour or more - for a rep to get here.
- Marty? With any other patient, maybe, but every minute this woman's on pump reduces her chances of maintaining this pregnancy.
[SIGHS.]
Okay, then let's open the mechanical valve.
Mechanical valve means she'll need heparin post-operatively.
She'll be more likely to bleed.
- We need to wait for a porcine.
- You heard what Marty said.
This baby doesn't have an hour.
We don't have a choice.
Thank you again for stopping.
It saves me so much time.
Right on the way back from Cohn County.
Pretty easy.
I'll only be a couple of minutes.
You know, it's a pretty hefty list your dad left for you.
Are you sure you don't want some help? Do you mind? In case I can't fit it all in one box? - [LAUGHS.]
- Not at all.
[DOOR CLOSES.]
I'll go pack some clothes.
He said he wanted a book or two? Yeah, I think his office is down the hall.
[DISQUIETING MUSIC.]
- Dr.
Charles, you ready? - Yeah.
Do you have a book? Right over here.
You made it on time.
[SCOFFS.]
Don't act so surprised.
How's he doing? Stable for the moment.
Uh listen, about this morning thanks for being there.
- Yeah.
- Guess I better get to work.
I'll check in later.
You hear about the missing Percocet? Yeah, I'm not surprised.
It was a chaotic day.
You know, I hate to even mention this, but you don't think Emily could've had something to do with it, do you? What? She was working that day, she had access, and now her friend OD's at a party? And how'd she afford those new Louboutins? - Lou Loubout what? - The shoes she had on.
Do you know how expensive they are? April, you're the one that keeps telling me to give her a chance.
Did Emily show poor judgment this morning? Absolutely.
But this kid OD'd on heroin, not Percocet.
Is there something else about Emily I'm missing? No, uh I'm sorry.
Forget I mentioned it.
Okay.
So, get this, it turns out that Robert Haywood did know one of those co-eds that disappeared: - Olivia Coveny.
- Oh, yeah? The one from Madison, yeah, was his student.
And I saw a picture of 'em together this morning at his apartment.
Wait a minute, you you went to his apartment? Sarah and I were doing rounds at the jail this morning, and she needed to pick up some of this stuff, and so we just stopped on the way back.
But what happened to, "We're gonna forget all about it"? She asked for my help.
What am I supposed to do, sit in the car? And I couldn't help, seeing the picture was right there.
And, by the way, part of me says, "So they knew each other.
So what? Student, you know, teacher.
" But the thing is is that in the picture, he had his arm around her.
Well, have you considered calling t-he Madison Police Department? No, I did.
The detective I talked to, I don't know, he just didn't seem that interested.
You know, ten years ago, it was a cold case.
Mm.
If I only had, like, two more minutes in that apartment.
- Daniel - What? Be careful.
[MACHINE BEEPING.]
- Sats are dropping.
- What's happening? - Respiratory failure.
- Bag him.
20 of etomidate, 100 of sux.
We need to intubate now.
[WHEEZING.]
Sats are down to 87.
[TENSE MUSIC.]
- Nat - I'm almost there.
- Oh, God - 82.
- I'm in.
- [EXHALES.]
Now, let's get 10 parts per million of inhaled nitric oxide.
Let's get a chest X-ray for tube placement.
Dad? Oh, Sarah.
She's even lovelier than you said.
[SOFT MUSIC.]
Thank you.
I should probably get going, but, um thank you, Robert.
This has meant so much to me.
As to me.
What was that all about? That was the widow of my heart donor.
She had asked to meet me.
I admit I was reticent about the whole thing, but, surprisingly it felt good.
- Sats are still in the tank.
- Nitric oxide didn't work.
Neither did low volume ventilation.
Where's the mom? She went to grab a cup of coffee.
We should get him up to the PICU.
I called already.
They don't have an isolation room available.
This flu epidemic is wreaking havoc.
It's time to consider ECMO.
Yeah.
Hey, uh, what do you think of this? - A rash? - Mm-hmm.
It's not abnormal.
I'll call the ICU, see if they have an extra iso room.
Thanks.
Dr.
Choi, we need you.
[TENSE MUSIC.]
- He's having a seizure.
- Push 2 of Ativan.
All right, take it easy, take it easy.
His eyes are icteric.
There's something wrong with his liver.
From the heroin? Not likely.
Did we get his labs back? I think they came in a few minutes ago.
Okay.
Positive for acetaminophen.
That's in Percocet.
Uh, let's also start a NAC, 140 milligrams per kilogram.
Okay.
[SOLEMN MUSIC.]
April, what you said about the missing drugs Oh, forget it, I shouldn't have gone there.
Actually, you should've.
I thought this kid OD'd on heroin, but his labs came back positive for both opioids and acetaminophen.
I can't tell it's exactly what he took, but the most likely source is Percocet, our missing drug.
You thought from the beginning this could be a possibility.
- Why? - I don't know.
Maybe what you've told me about her history.
April, what aren't you telling me? Remember that first day Emily came to stay with you? Yeah.
She cleaned up and cooked dinner.
She also had some people over.
I found an ash tray full of cigarette butts in the bathroom.
You didn't think I should know? I just I wanted you two to get off on the right foot.
She begged me not to say anything.
I'm sorry.
I should've told you.
Yeah.
I'm gonna go talk to her.
Maybe she'll come clean to me.
No.
She's my sister.
I'll do it.
- [MURMURS.]
- [LAUGHS.]
Dr.
Charles, what a pleasant surprise.
Dr.
Haywood, just wanted to To stop by, see how you're doing.
Well, I won't be running a marathon any time soon, but I'm getting along much better.
You know, Sarah told me you spent some time up in Madison.
- I had no idea.
- Yeah.
I spent a few semesters.
You know, they keep on bugging me to come up there and do a forensic psychiatry seminar.
I don't know, worth my time? Worth the trip? I found Madison to be a bit, uh, claustrophobic.
Good to know.
Good to know.
- Could you do me a favor? - Course.
Would you mind getting me a book from that box? Yeah.
[BROODING MUSIC.]
Ha, Grisham.
Well, Sarah doesn't know me very well.
All right, Dr.
Haywood, time for your exercises.
Sorry to cut this short, Dr.
Charles.
I hope you'll stop by again soon.
You can count on it.
[INTRIGUING MUSIC.]
The surgery was a success.
We managed to replace your valve and stave off any bleeding.
And the baby? The baby pulled through just fine.
Thank you, Dr.
Rhodes.
Thank you.
I'll be back to check in on you soon, see how you're doing, okay? Dr.
Rhodes, good work.
Things broke our way this time.
Nonetheless, well done.
Hey, I was wondering, uh, has there been any progress on the conjoined twins simulation? Uh, Dr.
Bekker and I suspect it was the placement of the clamps that caused the problem, but we've already confirmed that the coronary vessels and vagus nerve were not affected.
What about the sinoatrial node? We hadn't considered that, given its location.
Well, the anatomy of these hearts is highly irregular, so it's possible that we clamped the SA node and it cut off the heart's electrical activity.
So are you suggesting moving the L.
A.
clamp laterally? - Worth a shot.
- Ah Dr.
Rhodes, why don't we test your theory before the next simulation? Meet me in the lab in an hour.
Okay.
I take it that means good news for Tracy and her baby? You know what they say, right? Fortune favors the bold.
Catheter's in good position.
Let's double-check circuit tubing, and set goal flow at 35 to 40 ccs per kilogram per minute.
I was lucky there was an ECMO available.
I was afraid they'd all be taken.
Um, you I don't think we should put him on ECMO.
Why not? The rash on Cody's IV site, given his history of intense allergic reactions? I think he may have undiagnosed systemic mastocytosis.
You're jumping to that from a rash? Kids with mastocytosis generally produce an overabundance of histamine.
If Cody has it, passing his blood through the machine could send him into anaphylactic shock.
Given the state his lungs are in, he would not survive that.
Mastocytosis is extremely rare, Natalie, and we don't have time for a biopsy to confirm it.
Dr.
Halstead, we're ready.
All right.
- What about PLV? - Partial liquid ventilation? I thought that was reserved for preemies.
There have been some clinical trials with encouraging results.
PLV's a good idea, in theory.
I I'm not sure we should be risking a kid's life by using a treatment that's unproven.
Will, I know we've had our disagreements, but I really think this could work.
Your patient, your call.
[SOFT MUSIC.]
Stop.
We're not putting him on ECMO.
Wait a minute, you you're saying you wanna drown my son? I assure you, Karen, Cody will not drown.
But you you you're gonna fill his lungs with fluid.
It's called Perflubron.
It has unique properties, including the ability to hold large amounts of oxygen.
Yeah, at this point, Cody's lungs are too damaged to absorb oxygen through the air, so our hope is that this treatment helps oxygen penetrate Cody's lungs and restore his breathing.
- Have you done this before? - Um This procedure is performed quite often with neonates.
We feel strongly it's the best chance we have at saving your son's life.
- Okay.
- Go ahead.
Maggie, I'm gonna be out of pocket for a little bit.
- For how long? - Uh, three or four hours.
If anybody needs me, just redirect them to Dr.
Kwon.
- You got it.
- Daniel Where are you going? Robert Haywood still has a storage locker in Madison, Wisconsin that he rented before Olivia Coveny disappeared.
Okay? Okay, so I'm going up there to check it out.
Come on, Daniel, let the proper authorities handle it.
The proper authorities, they're just not that interested right now.
- I have a limited window.
- Stop.
Look, I know you're trying to protect Dr.
Reese, but no matter what you find, you are really putting your relationship with her at risk.
Sharon, if there's even a remote chance that any of this stuff is true And, trust me, I don't want it to be It's a risk I'm willing to take.
[SOLEMN MUSIC.]
Hear you might have found a solution.
Fingers crossed.
Looks like it's all coming up roses for you today.
- You two, join me.
- Yes, sir.
I mean, I'm still hoping it's me who gets to do the surgery.
No surprise there.
If we move the two clamps to the center of the bridge, between the two atria, that could solve our problem.
I'll let Dr.
Frisch know that we're ready - to run another simulation.
- Okay.
Dr.
Rhodes, Dr.
Bekker, they need you back in the ICU.
[TENSE MUSIC.]
[MACHINE BEEPING.]
What's going on? Her BP just started plummeting.
Bag her.
What's going on with my daughter? - Uh, ma'am - She's hemorrhaging.
Uh all right.
All right, hang 2 units of O-neg on a pressure bag.
Give me the ultrasound.
We need to check her fetus and take a look at her placenta.
Placenta's marginally separating, - causing her to bleed.
- Fetal heart tones are strong.
We'll reverse the blood thinners.
Hopefully, the placenta will tamponade itself.
If we reverse the thinners, her new valve could clot off.
We'll lose mom and baby.
We have to get her to the O.
R.
Look, we can still save this pregnancy.
It's too late for that.
If we have any hope of getting control of this bleed, she needs an emergency hysterectomy.
Stop the heparin drip.
Bolus a gram of TXA.
We're not gonna lose either of them.
[SIGHS.]
- He still hasn't woken up.
- No.
How well do you know Jeremy? Not that well.
I mean, just from around.
I had no idea he was using heroin.
I don't think that's what Jeremy OD'd on.
- No? - No.
Pretty sure it was Percocet, which, coincidentally, is the same drug that went missing from the dispensary last week.
So? [CHUCKLES.]
What, are you suggesting that I took them? - Did you? - You know how easy it is to score pharmaceuticals on the street? Jeremy could've gotten them from anyone.
But he was at the party with you.
Ethan, I swear, I didn't take those drugs.
So where'd you get the money for the Louboutins? [SCOFFS.]
Louboutins? What do you even know about Louboutins? She put you up to this, didn't she? Your uptight narc of a girlfriend.
You know, all the two of you have done since I moved in is hover around, waiting for me to make a mistake.
That's not true.
Yeah, all my life it's been like this.
- You know, I've had it.
- Emily No, I'm not working some place - that thinks I'm a criminal.
- Em - Emily - Happy? You got him all to yourself now.
[SOLEMN MUSIC.]
How's she doing? She's passing an old clot, but there's no more active bleeding.
Placenta looks like it tamponaded itself.
Fetal heart tones are steady.
[RELIEVED SIGH.]
We've got a problem.
- Pressure's down.
- Heart rate's spiking.
She's clotting off that valve.
We need to get her to the O.
R.
and replace the valve.
Let's go, come on! [TENSE MUSIC.]
What's happening? Stop! No pulse.
She must be in V-fib.
Let's get a crash cart! Come on.
Come on, Tracy.
Come on.
- Stay with us.
- Charge to 200.
- [PADDLES WHIR.]
- Clear! [DEVICE TRILLING.]
No pulse.
Milligram of epi.
Please save her! Please! - Hold compressions.
- Come on.
Clear! - Still no pulse.
- Charge again.
- Charge! - [PADDLES WHIRRING.]
- Clear! - [DEVICE TRILLING.]
Another milligram of epi.
Connor she's gone.
Oh, God, no! [SOBBING.]
No, no, no! [SOBBING.]
No [SOMBER MUSIC.]
Time of death, 17:23.
[SOFT, SOLEMN MUSIC.]
If you want, I can help the mother with the paperwork.
No.
This is my responsibility.
Ms.
Barker, I am so sorry for your loss.
You talked my daughter into this, and now she's gone forever.
You did this.
This is all your fault! It's all your fault! [SOBBING.]
Dr.
Manning Cody's temp's back up to 103.
7.
- What are his sats? - 83%.
83? He's getting worse.
Okay.
- Hey, how's he doing? - PLV's not working.
- I made a huge mistake, Will.
- Natalie No, I should've just put him on ECMO, but I got carried away, and I might've just put his life in jeopardy.
Why didn't I just listen to you? Good thing you didn't.
- You were right.
- What? Cody tested positive for mastocytosis.
[SURPRISED CHUCKLE.]
If you had put Cody on ECMO, he could've gone into anaphylactic shock.
You may have just saved his life.
No, I haven't not yet.
Guess things got out of hand last night.
Yeah, you're lucky Emily called us.
According to your blood work, you had a high concentration of opioids in your system, along with toxic levels of acetaminophen.
Most likely due to the Percocet.
Yeah.
So where'd you get those pills? - Do you have a prescription? - No I mean my dad does.
He had back surgery a few weeks ago.
I swept some from his medicine cabinet.
I feel like an idiot.
Get some rest.
We'll check on you soon.
[DISQUIETING MUSIC.]
You think he's telling the truth? No reason to doubt him.
When it comes to my sister, I'm so used to assuming the worst.
I never should've accused her of stealing those drugs.
Have Noah work up Jeremy's discharge.
I need to find Emily, make things right.
Dr.
Manning? Yes? [SOFT HEARTFELT MUSIC.]
Cody's sats are back above 90.
Looks like he's out of the woods.
Thank you for saving my boy.
Of course.
I just found out myself.
Neurology's in there now, doing a quick exam.
You know what, we did good today.
Yeah, we did, didn't we? I mean, together.
Dr.
Rhodes, good.
We're just about to get started.
You coming? Dr.
Latham, with your permission, I would like to remove myself from the team.
[SOLEMN MUSIC.]
Why? I think it would be best for the patients and for everyone involved.
A surgery with this level of difficulty and in that environment I don't know that I can trust my judgment.
Are you sure about this? Yes.
Mm.
Very well.
So, your dad had back surgery? Yeah.
Awfully convenient.
Well, I told you, that's where I got them.
Mm-hmm.
According to your tox screen, the Percocet you took were hospital grade.
That means they didn't come from your dad's medicine cabinet.
Possessing a Schedule Two narcotic with that level of potency is a felony offense.
Now, I'm not gonna report you, but I need you to tell me.
Emily.
She sold them to me.
Emily? Em? [SUSPENSEFUL MUSIC.]
[KNOCKING ON DOOR.]
What's up? - You want a rematch? - [LAUGHS.]
I was just wondering, are you still holding onto Mom's wedding ring? Yeah, of course.
Why wouldn't I? [SOFT HOPEFUL MUSIC.]
Oh Just trying not to be a knucklehead.
Okay, uh, well, come on in, and I'll go get it.
Next bucket wins.
Check.
All right, hold on.
I gotta tie my shoe.
So, how are you and Natalie doing? I see what you're doing.
It's not gonna work.
Seriously.
I just wanted to see if you two are getting along.
Seriously, things have never been better.
I'm a lucky guy.
Now quit stalling.
Well, I'm glad you didn't screw things up.
'cause you can be a real knucklehead.
What's that supposed to mean? Yes! [HIP-HOP MUSIC PLAYING.]
Ethan, this way.
What the hell happened? Uh, this guy, I think he OD'd.
- You should've called 911.
- Look around.
Last thing I wanna do is get anyone in trouble.
Em, it's 7:00 a.
m.
What are you even doing here? I was out dancing with my friends.
- Got invited over here after.
- Don't you have work today? Ethan, don't worry, I'll be there.
- [GAGGING.]
- Over here.
His name's Jeremy.
Jeremy? Hey, Jeremy what did you take, huh? Does anyone know what he took? [GAGGING.]
Heroin.
He's choking.
Oh, God.
[TENSE MUSIC.]
I can't clear it.
- Em, see if you can find a pen.
- What? Why? He's not breathing.
He needs a surgical airway.
[INDISTINCT MURMURING.]
- Hey! - Here, got one.
Unscrew the top.
[GROANS.]
I'm in.
[GASPS.]
He's breathing.
- Unfortunately, I have to bring up last week's mass casualty incident, because in the chaos, it seems 40 pills of Percocet disappeared from the medication dispensary.
That's a street value of $2,500.
Someone took advantage of that situation.
So, we will be implementing new protocols to prevent that from happening in the future.
Keep your eye out for a memo in the next few days.
Any questions? Good.
Back to work.
[KEYS JANGLING.]
[SOLEMN MUSIC.]
[DOOR BEEPS.]
- Go to Four.
- [BREATHING HEAVILY.]
Tracy Herman, 25-year-old female.
21 weeks pregnant.
GCS, 14, dyspneic.
This is her mother, Pam.
- Is my baby okay? - We're gonna take a look.
All right, Tracy, I'm Dr.
Manning.
- Can you tell me what happened? - I don't know.
We were having breakfast and she just collapsed.
All right, let's transfer her and put her on the monitors.
On my count, ready, one, two, three.
[GASPS.]
Any pain or discomfort? No.
Breath sounds are clear and present bilaterally, but I am hearing a systolic murmur.
What does that mean? It's probably the pregnancy putting a strain on your heart.
- Have you had any bleeding? - Uh, just some spotting, - but my OB said it's normal.
- It can be.
Uh, Doris, let's get a fetal ultrasound, uh, chest X-ray, and call up to Cardiology for an ECHO, okay? All right, Tracy, just try to relax.
All right, we're gonna do everything we can to figure this out, all right? - Thank you.
- Yeah.
Oh, goodie.
Lime flavor today.
I, uh, just checked with the charge nurse.
Your last set of labs look good.
If everything holds for the next 24 hours, they'll put you back on solid foods.
Whoo.
Wonderful news.
I also told her about your nausea.
She'll be over in a few minutes with some ondansetron.
Sarah? I know I haven't said it enough, but thank you.
I can't tell you how grateful I am for all you've done for me since the transplant.
No, just, uh, one more thing.
It looks like I'll still be in rehab for a while.
Uh, I haven't checked my mail since all this happened.
I'm sure the bills are piling up.
You want me to run to your apartment? Unfortunately, I have no one else to ask.
All right, but it'll have to wait a few hours.
Dr.
Charles and I have rounds at Cohn County.
The jail? Ooh, sounds fascinating.
[GROANS.]
All right.
Now, this certainly can wait till after.
It's this key right here.
I made a short list of things I need.
If you don't mind.
"No clues to mystery surrounding "missing college co-eds Search for Indiana girl goes on.
" This poor young lady, Olivia Coveny, seems to have disappeared from the Madison campus, what, about ten years ago? "Wisconsin girl missing.
" What am I looking at? Seems like somebody is trying to make a case that Robert Haywood is a very bad guy.
- Sarah Reese's father? - Yeah.
Well, I mean, apparently, he was a visiting lecturer at all of these colleges at the same time that these women disappeared.
And you don't know who sent you this? Nope.
Somebody slipped it under my door.
Apparently, somebody knows that I'm working with Robert Haywood.
I think if you think there's something there, you should turn it over to the police.
Turn what over to the police? It's all completely circumstantial.
There's nothing in here that connects him to any one of these women.
And if you read the articles, every single one of these cases has been thoroughly investigated by the police.
You haven't shared this with Dr.
Reese yet, have you? Absolutely not.
[TENSE MUSIC.]
[DOOR BEEPS.]
We set up Baghdad as soon as you called.
- How's he doing? - Got an ET tube in on the right, but held off on the naloxone.
They don't want him waking up with a tube in his neck.
But he needs a better airway.
Get me a number eight trach tube.
You ready to get him on the monitors? All right, we're gonna transfer him on my count.
Everybody ready? One, two, three.
I'm in.
Bag him.
BP's dropping.
88 over 50.
All right, he's still intoxicated.
We need to reverse him.
Push 2 milligrams of naloxone IV.
How's Jeremy? It's gonna take time for the drugs to clear from his system, but he should be okay.
[EXHALES.]
I'm gonna go home and change.
I'll be back for work in a couple of hours.
Heroin? What was she thinking, going to that party? I'm not sure she was thinking.
[SIGHS.]
Hey.
How was the game? I'm filing a protest with the league commissioner.
So you lost? - Dr.
Manning? - [LAUGHS.]
Yes? Imaging results from your pregnant patient in Treatment Four.
- You better page CT surgery.
- Yeah.
- Maggie? - Yeah? Okay.
Now, the access to the atria of both hearts.
We're ready to clamp.
Left is clamped.
[SOLEMN MUSIC.]
And the right Dr.
Bekker will now perform the separation.
Scalpel.
Josh, have peeds surgery ready.
[ALARM BEEPING.]
- What's happening? - Heart rate's diving.
- The twins are bradying down.
- Dr.
Bekker? I don't know, my incision was superficial.
- Step aside.
- Heart rate's down to 44.
There's no bleeding.
We haven't cut near any major vessels.
We need to push atropine.
No, it's too late.
[ELECTRICITY DRONES.]
Congratulations, Dr.
Latham.
According to the computer simulation, your team just killed both twins.
- Yes, we did.
- I don't know what happened.
That's why we conduct these exercises, Dr.
Bekker, so that we can predict all outcomes and make the necessary adjustments on game day.
Dr.
Frisch, my team will evaluate our approach and determine what went wrong.
We'll gather again this afternoon and resume the procedure.
I'd like all possible scenarios on my desk before lunch.
Yes, Dr.
Latham.
Keep your chin up.
You'll figure it out.
You know, you don't have to do that.
What? Act like you don't enjoy seeing me on the hot seat.
Go ahead and buy it.
If I were in your position, I would.
Dr.
Rhodes, Dr.
Bekker, they need you in the ED.
Okay.
You're saying I have damage to my heart? Uh, to be specific, it's your mitrovalve.
Uh, when it's not functioning properly, the body doesn't get enough oxygen.
Which is why you've been feeling so weak and short of breath.
But she's never had any problems with her heart before.
In all likelihood, Tracy was born with a defect, and it just didn't show any symptoms until now.
Um, the baby has apparently added strain to your heart, which has caused it to present itself.
We'll need surgery to replace the defective valve.
Oh Okay.
There are potential complications.
Complications? [DISQUIETING MUSIC.]
Due to your pregnancy, the medication needed to conduct the surgery could cause a life threatening vaginal bleed, and given that your fetus hasn't reached viability Wh what are you saying? We think it's best for your health if you terminate before undergoing surgery.
What? No.
You don't understand.
Her husband, Roy we lost him in a car accident three months ago.
[SOBBING.]
We had just got the news that I was pregnant.
He was so excited.
He wanted this so bad.
Tracy, trust me, I understand what you're going through, but without this surgery, neither you nor your baby will survive.
Honey, please listen to the doctors.
No.
No! This baby is all I have left.
I won't let you take it from me.
The patient understands that, without surgery, - condition could be fatal? - Yeah, we explained the risks.
Well, so, your concerns are certainly justified.
We need blood thinners to keep the bypass pump for clotting.
Hm.
Have you considered a minimally invasive valvuloplasty? Yes, but due to the level of stenosis and the presence of regurgitation, we don't feel that she's a candidate.
We have to open her chest.
What if there is another option? What? If we lower the dose of the blood thinners and use a heparin-coated bypass tube, there is a chance that we could save both mom and baby.
According to Dr.
Manning, Tracy's Level Two ultrasound showed placenta previa, which puts her at an even greater risk of developing a serious bleed.
Ava, you heard what she said.
This baby is all she has left of her dead husband.
Don't we have an obligation to honor the patient's wishes? So, we should let the patient's emotional involvement impact our medical decisions? I think we owe it to her to give it a shot, yes.
With close monitoring, it is possible to stay ahead of any bleeding.
Dr.
Rhodes, if you believe that this is the best course of action, - please proceed.
- Thank you.
[SOLEMN MUSIC.]
Well good luck.
Are you taking her up to surgery? Yeah.
I'm worried about her.
Connor's taking a big risk.
Hey, you two, Treatment Six.
Okay.
Hi.
- You must be Cody.
- [COUGHING.]
- What's his temp? - 102.
He's been like this for over a week.
Uh, I've had him on Tamiflu, bed rest, fluids.
We've tried everything.
He he just keeps getting worse.
It's been an an extremely harsh flu season.
Is anyone else in your household sick? No, it's just the two of us.
I've been spared so far, I-I assume 'cause I was vaccinated.
And what about Cody? Uh, unfortunately not.
No, I-I know what you're thinking.
It's not like that.
Uh, Cody has a A long list of allergies.
Last year, he had a severe reaction to the vaccine.
I-I didn't wanna put him through that again, you know? I understand, all right.
It makes sense why you didn't wanna get him vaccinated.
Let's get a CBC, CMP, and a chest X-ray, okay? I promise we're gonna do everything we can to take care of your son, okay? We'll be back soon.
All right couple of more seconds and I'll have the valve free.
[MUMBLES.]
No evidence of bleeding.
Good.
There.
Got it.
All right, let's get a sizing tool.
I'm gonna measure the opening, determine what size valve we need.
Let's start with a 21.
Yep.
Let's open a 21-millimeter porcine valve.
Manufacturer had some production delays with that size valve.
It's on backorder.
But I have a mechanical.
Can we get one from another supplier? Sure, but it'll take an hour or more - for a rep to get here.
- Marty? With any other patient, maybe, but every minute this woman's on pump reduces her chances of maintaining this pregnancy.
[SIGHS.]
Okay, then let's open the mechanical valve.
Mechanical valve means she'll need heparin post-operatively.
She'll be more likely to bleed.
- We need to wait for a porcine.
- You heard what Marty said.
This baby doesn't have an hour.
We don't have a choice.
Thank you again for stopping.
It saves me so much time.
Right on the way back from Cohn County.
Pretty easy.
I'll only be a couple of minutes.
You know, it's a pretty hefty list your dad left for you.
Are you sure you don't want some help? Do you mind? In case I can't fit it all in one box? - [LAUGHS.]
- Not at all.
[DOOR CLOSES.]
I'll go pack some clothes.
He said he wanted a book or two? Yeah, I think his office is down the hall.
[DISQUIETING MUSIC.]
- Dr.
Charles, you ready? - Yeah.
Do you have a book? Right over here.
You made it on time.
[SCOFFS.]
Don't act so surprised.
How's he doing? Stable for the moment.
Uh listen, about this morning thanks for being there.
- Yeah.
- Guess I better get to work.
I'll check in later.
You hear about the missing Percocet? Yeah, I'm not surprised.
It was a chaotic day.
You know, I hate to even mention this, but you don't think Emily could've had something to do with it, do you? What? She was working that day, she had access, and now her friend OD's at a party? And how'd she afford those new Louboutins? - Lou Loubout what? - The shoes she had on.
Do you know how expensive they are? April, you're the one that keeps telling me to give her a chance.
Did Emily show poor judgment this morning? Absolutely.
But this kid OD'd on heroin, not Percocet.
Is there something else about Emily I'm missing? No, uh I'm sorry.
Forget I mentioned it.
Okay.
So, get this, it turns out that Robert Haywood did know one of those co-eds that disappeared: - Olivia Coveny.
- Oh, yeah? The one from Madison, yeah, was his student.
And I saw a picture of 'em together this morning at his apartment.
Wait a minute, you you went to his apartment? Sarah and I were doing rounds at the jail this morning, and she needed to pick up some of this stuff, and so we just stopped on the way back.
But what happened to, "We're gonna forget all about it"? She asked for my help.
What am I supposed to do, sit in the car? And I couldn't help, seeing the picture was right there.
And, by the way, part of me says, "So they knew each other.
So what? Student, you know, teacher.
" But the thing is is that in the picture, he had his arm around her.
Well, have you considered calling t-he Madison Police Department? No, I did.
The detective I talked to, I don't know, he just didn't seem that interested.
You know, ten years ago, it was a cold case.
Mm.
If I only had, like, two more minutes in that apartment.
- Daniel - What? Be careful.
[MACHINE BEEPING.]
- Sats are dropping.
- What's happening? - Respiratory failure.
- Bag him.
20 of etomidate, 100 of sux.
We need to intubate now.
[WHEEZING.]
Sats are down to 87.
[TENSE MUSIC.]
- Nat - I'm almost there.
- Oh, God - 82.
- I'm in.
- [EXHALES.]
Now, let's get 10 parts per million of inhaled nitric oxide.
Let's get a chest X-ray for tube placement.
Dad? Oh, Sarah.
She's even lovelier than you said.
[SOFT MUSIC.]
Thank you.
I should probably get going, but, um thank you, Robert.
This has meant so much to me.
As to me.
What was that all about? That was the widow of my heart donor.
She had asked to meet me.
I admit I was reticent about the whole thing, but, surprisingly it felt good.
- Sats are still in the tank.
- Nitric oxide didn't work.
Neither did low volume ventilation.
Where's the mom? She went to grab a cup of coffee.
We should get him up to the PICU.
I called already.
They don't have an isolation room available.
This flu epidemic is wreaking havoc.
It's time to consider ECMO.
Yeah.
Hey, uh, what do you think of this? - A rash? - Mm-hmm.
It's not abnormal.
I'll call the ICU, see if they have an extra iso room.
Thanks.
Dr.
Choi, we need you.
[TENSE MUSIC.]
- He's having a seizure.
- Push 2 of Ativan.
All right, take it easy, take it easy.
His eyes are icteric.
There's something wrong with his liver.
From the heroin? Not likely.
Did we get his labs back? I think they came in a few minutes ago.
Okay.
Positive for acetaminophen.
That's in Percocet.
Uh, let's also start a NAC, 140 milligrams per kilogram.
Okay.
[SOLEMN MUSIC.]
April, what you said about the missing drugs Oh, forget it, I shouldn't have gone there.
Actually, you should've.
I thought this kid OD'd on heroin, but his labs came back positive for both opioids and acetaminophen.
I can't tell it's exactly what he took, but the most likely source is Percocet, our missing drug.
You thought from the beginning this could be a possibility.
- Why? - I don't know.
Maybe what you've told me about her history.
April, what aren't you telling me? Remember that first day Emily came to stay with you? Yeah.
She cleaned up and cooked dinner.
She also had some people over.
I found an ash tray full of cigarette butts in the bathroom.
You didn't think I should know? I just I wanted you two to get off on the right foot.
She begged me not to say anything.
I'm sorry.
I should've told you.
Yeah.
I'm gonna go talk to her.
Maybe she'll come clean to me.
No.
She's my sister.
I'll do it.
- [MURMURS.]
- [LAUGHS.]
Dr.
Charles, what a pleasant surprise.
Dr.
Haywood, just wanted to To stop by, see how you're doing.
Well, I won't be running a marathon any time soon, but I'm getting along much better.
You know, Sarah told me you spent some time up in Madison.
- I had no idea.
- Yeah.
I spent a few semesters.
You know, they keep on bugging me to come up there and do a forensic psychiatry seminar.
I don't know, worth my time? Worth the trip? I found Madison to be a bit, uh, claustrophobic.
Good to know.
Good to know.
- Could you do me a favor? - Course.
Would you mind getting me a book from that box? Yeah.
[BROODING MUSIC.]
Ha, Grisham.
Well, Sarah doesn't know me very well.
All right, Dr.
Haywood, time for your exercises.
Sorry to cut this short, Dr.
Charles.
I hope you'll stop by again soon.
You can count on it.
[INTRIGUING MUSIC.]
The surgery was a success.
We managed to replace your valve and stave off any bleeding.
And the baby? The baby pulled through just fine.
Thank you, Dr.
Rhodes.
Thank you.
I'll be back to check in on you soon, see how you're doing, okay? Dr.
Rhodes, good work.
Things broke our way this time.
Nonetheless, well done.
Hey, I was wondering, uh, has there been any progress on the conjoined twins simulation? Uh, Dr.
Bekker and I suspect it was the placement of the clamps that caused the problem, but we've already confirmed that the coronary vessels and vagus nerve were not affected.
What about the sinoatrial node? We hadn't considered that, given its location.
Well, the anatomy of these hearts is highly irregular, so it's possible that we clamped the SA node and it cut off the heart's electrical activity.
So are you suggesting moving the L.
A.
clamp laterally? - Worth a shot.
- Ah Dr.
Rhodes, why don't we test your theory before the next simulation? Meet me in the lab in an hour.
Okay.
I take it that means good news for Tracy and her baby? You know what they say, right? Fortune favors the bold.
Catheter's in good position.
Let's double-check circuit tubing, and set goal flow at 35 to 40 ccs per kilogram per minute.
I was lucky there was an ECMO available.
I was afraid they'd all be taken.
Um, you I don't think we should put him on ECMO.
Why not? The rash on Cody's IV site, given his history of intense allergic reactions? I think he may have undiagnosed systemic mastocytosis.
You're jumping to that from a rash? Kids with mastocytosis generally produce an overabundance of histamine.
If Cody has it, passing his blood through the machine could send him into anaphylactic shock.
Given the state his lungs are in, he would not survive that.
Mastocytosis is extremely rare, Natalie, and we don't have time for a biopsy to confirm it.
Dr.
Halstead, we're ready.
All right.
- What about PLV? - Partial liquid ventilation? I thought that was reserved for preemies.
There have been some clinical trials with encouraging results.
PLV's a good idea, in theory.
I I'm not sure we should be risking a kid's life by using a treatment that's unproven.
Will, I know we've had our disagreements, but I really think this could work.
Your patient, your call.
[SOFT MUSIC.]
Stop.
We're not putting him on ECMO.
Wait a minute, you you're saying you wanna drown my son? I assure you, Karen, Cody will not drown.
But you you you're gonna fill his lungs with fluid.
It's called Perflubron.
It has unique properties, including the ability to hold large amounts of oxygen.
Yeah, at this point, Cody's lungs are too damaged to absorb oxygen through the air, so our hope is that this treatment helps oxygen penetrate Cody's lungs and restore his breathing.
- Have you done this before? - Um This procedure is performed quite often with neonates.
We feel strongly it's the best chance we have at saving your son's life.
- Okay.
- Go ahead.
Maggie, I'm gonna be out of pocket for a little bit.
- For how long? - Uh, three or four hours.
If anybody needs me, just redirect them to Dr.
Kwon.
- You got it.
- Daniel Where are you going? Robert Haywood still has a storage locker in Madison, Wisconsin that he rented before Olivia Coveny disappeared.
Okay? Okay, so I'm going up there to check it out.
Come on, Daniel, let the proper authorities handle it.
The proper authorities, they're just not that interested right now.
- I have a limited window.
- Stop.
Look, I know you're trying to protect Dr.
Reese, but no matter what you find, you are really putting your relationship with her at risk.
Sharon, if there's even a remote chance that any of this stuff is true And, trust me, I don't want it to be It's a risk I'm willing to take.
[SOLEMN MUSIC.]
Hear you might have found a solution.
Fingers crossed.
Looks like it's all coming up roses for you today.
- You two, join me.
- Yes, sir.
I mean, I'm still hoping it's me who gets to do the surgery.
No surprise there.
If we move the two clamps to the center of the bridge, between the two atria, that could solve our problem.
I'll let Dr.
Frisch know that we're ready - to run another simulation.
- Okay.
Dr.
Rhodes, Dr.
Bekker, they need you back in the ICU.
[TENSE MUSIC.]
[MACHINE BEEPING.]
What's going on? Her BP just started plummeting.
Bag her.
What's going on with my daughter? - Uh, ma'am - She's hemorrhaging.
Uh all right.
All right, hang 2 units of O-neg on a pressure bag.
Give me the ultrasound.
We need to check her fetus and take a look at her placenta.
Placenta's marginally separating, - causing her to bleed.
- Fetal heart tones are strong.
We'll reverse the blood thinners.
Hopefully, the placenta will tamponade itself.
If we reverse the thinners, her new valve could clot off.
We'll lose mom and baby.
We have to get her to the O.
R.
Look, we can still save this pregnancy.
It's too late for that.
If we have any hope of getting control of this bleed, she needs an emergency hysterectomy.
Stop the heparin drip.
Bolus a gram of TXA.
We're not gonna lose either of them.
[SIGHS.]
- He still hasn't woken up.
- No.
How well do you know Jeremy? Not that well.
I mean, just from around.
I had no idea he was using heroin.
I don't think that's what Jeremy OD'd on.
- No? - No.
Pretty sure it was Percocet, which, coincidentally, is the same drug that went missing from the dispensary last week.
So? [CHUCKLES.]
What, are you suggesting that I took them? - Did you? - You know how easy it is to score pharmaceuticals on the street? Jeremy could've gotten them from anyone.
But he was at the party with you.
Ethan, I swear, I didn't take those drugs.
So where'd you get the money for the Louboutins? [SCOFFS.]
Louboutins? What do you even know about Louboutins? She put you up to this, didn't she? Your uptight narc of a girlfriend.
You know, all the two of you have done since I moved in is hover around, waiting for me to make a mistake.
That's not true.
Yeah, all my life it's been like this.
- You know, I've had it.
- Emily No, I'm not working some place - that thinks I'm a criminal.
- Em - Emily - Happy? You got him all to yourself now.
[SOLEMN MUSIC.]
How's she doing? She's passing an old clot, but there's no more active bleeding.
Placenta looks like it tamponaded itself.
Fetal heart tones are steady.
[RELIEVED SIGH.]
We've got a problem.
- Pressure's down.
- Heart rate's spiking.
She's clotting off that valve.
We need to get her to the O.
R.
and replace the valve.
Let's go, come on! [TENSE MUSIC.]
What's happening? Stop! No pulse.
She must be in V-fib.
Let's get a crash cart! Come on.
Come on, Tracy.
Come on.
- Stay with us.
- Charge to 200.
- [PADDLES WHIR.]
- Clear! [DEVICE TRILLING.]
No pulse.
Milligram of epi.
Please save her! Please! - Hold compressions.
- Come on.
Clear! - Still no pulse.
- Charge again.
- Charge! - [PADDLES WHIRRING.]
- Clear! - [DEVICE TRILLING.]
Another milligram of epi.
Connor she's gone.
Oh, God, no! [SOBBING.]
No, no, no! [SOBBING.]
No [SOMBER MUSIC.]
Time of death, 17:23.
[SOFT, SOLEMN MUSIC.]
If you want, I can help the mother with the paperwork.
No.
This is my responsibility.
Ms.
Barker, I am so sorry for your loss.
You talked my daughter into this, and now she's gone forever.
You did this.
This is all your fault! It's all your fault! [SOBBING.]
Dr.
Manning Cody's temp's back up to 103.
7.
- What are his sats? - 83%.
83? He's getting worse.
Okay.
- Hey, how's he doing? - PLV's not working.
- I made a huge mistake, Will.
- Natalie No, I should've just put him on ECMO, but I got carried away, and I might've just put his life in jeopardy.
Why didn't I just listen to you? Good thing you didn't.
- You were right.
- What? Cody tested positive for mastocytosis.
[SURPRISED CHUCKLE.]
If you had put Cody on ECMO, he could've gone into anaphylactic shock.
You may have just saved his life.
No, I haven't not yet.
Guess things got out of hand last night.
Yeah, you're lucky Emily called us.
According to your blood work, you had a high concentration of opioids in your system, along with toxic levels of acetaminophen.
Most likely due to the Percocet.
Yeah.
So where'd you get those pills? - Do you have a prescription? - No I mean my dad does.
He had back surgery a few weeks ago.
I swept some from his medicine cabinet.
I feel like an idiot.
Get some rest.
We'll check on you soon.
[DISQUIETING MUSIC.]
You think he's telling the truth? No reason to doubt him.
When it comes to my sister, I'm so used to assuming the worst.
I never should've accused her of stealing those drugs.
Have Noah work up Jeremy's discharge.
I need to find Emily, make things right.
Dr.
Manning? Yes? [SOFT HEARTFELT MUSIC.]
Cody's sats are back above 90.
Looks like he's out of the woods.
Thank you for saving my boy.
Of course.
I just found out myself.
Neurology's in there now, doing a quick exam.
You know what, we did good today.
Yeah, we did, didn't we? I mean, together.
Dr.
Rhodes, good.
We're just about to get started.
You coming? Dr.
Latham, with your permission, I would like to remove myself from the team.
[SOLEMN MUSIC.]
Why? I think it would be best for the patients and for everyone involved.
A surgery with this level of difficulty and in that environment I don't know that I can trust my judgment.
Are you sure about this? Yes.
Mm.
Very well.
So, your dad had back surgery? Yeah.
Awfully convenient.
Well, I told you, that's where I got them.
Mm-hmm.
According to your tox screen, the Percocet you took were hospital grade.
That means they didn't come from your dad's medicine cabinet.
Possessing a Schedule Two narcotic with that level of potency is a felony offense.
Now, I'm not gonna report you, but I need you to tell me.
Emily.
She sold them to me.
Emily? Em? [SUSPENSEFUL MUSIC.]
[KNOCKING ON DOOR.]
What's up? - You want a rematch? - [LAUGHS.]
I was just wondering, are you still holding onto Mom's wedding ring? Yeah, of course.
Why wouldn't I? [SOFT HOPEFUL MUSIC.]
Oh Just trying not to be a knucklehead.
Okay, uh, well, come on in, and I'll go get it.