Chicago Med (2015) s03e20 Episode Script

The Tipping Point

The conjoint twins Dot and Lily Cronin spent an uneventful night in our Pediatric Intensive Unit.
They will be evaluated this morning, and if they remain stable, the surgical team, under the supervision of Dr.
Frisch and Dr.
Latham, will attempt to separate them.
Lungs sound clear.
The latest chest X-rays are good.
No infiltrates.
Vitals and saturation are stable.
The girls are healthy.
In my opinion, they're strong enough for surgery.
- Dr.
Rhodes? - I agree with Dr.
Bekker.
Actually, Dr.
Rhodes will not be in the operating room.
Dr.
Latham and I will be performing the cardiothoracic portion of the separation.
What? You've been so involved since the beginning.
What if we spoke to Dr.
Frisch? Believe me, Dot and Lily have the finest surgeons in the hospital.
We'll be back soon to take the babies to the O.
R.
Excuse me.
Connor why aren't you on the team? He pulled himself out.
Why? Because we lost a patient? I lost her and her baby, because of my poor judgment.
I made the wrong call on her treatment.
But the Cronins are counting on you.
They're counting on the team.
She's right.
Look, I can understand if you're having second thoughts.
Yeah.
- I'm worried about my sister.
Why? She told you she was going to Las Vegas.
Yeah, but she's not returning my calls or texts.
She's ashamed she stole those drugs and lied about it.
I still think we could've handled it better.
Handled it better? Emily committed a crime.
She's lucky she wasn't arrested.
As soon as she wants something, I'm sure you'll hear from her.
- Morning.
- Good morning.
- What? - Dr.
Halstead, incoming.
- Hey, after work - Mm-hmm? You wanna meet me on the balcony? - Okay.
- All right.
Monique, with us.
Cesar? Bert Goodwin, 60-year-old male.
Goodwin? Trauma One.
Neighbors found him unconscious in the garage.
Motor running.
Intubated in the field.
Carbon monoxide poisoning.
Tachycardic at 120.
BP, 145 over 95.
EKG shows slight ST depressions.
Sats at 92%.
Okay, on my count, one, two, three.
Monique, 12-lead EKG.
We need a carboxyhemoglobin level.
CBC, BMP, coags, lactate, troponins, and a chest X-ray.
- Got it.
- Maggie, call the ICU.
Have them set up a hyperbaric chamber.
Copy.
And page Ms.
Goodwin.
Let her know.
- Is this her husband? - Ex-husband.
How's the position of the twins? Good for peds surgery.
- CT? - Bit of a shadow in my field.
Can we adjust the light? Good.
Has everyone got room to work? No, bypass is in my way.
What if you move the machine to the foot of the bed? You could run the tubing along the sides.
That way, you won't cross with anesthesia.
Ah.
Good idea.
Tell me again why you're not in there.
So, are we good to go? All right, it's show time.
The pressure in the chamber unbinds carbon monoxide from hemoglobin.
It allows oxygen to bind.
Now, we've already seen a significant improvement.
Bert's carbon monoxide levels are down from 55% to 15.
Now, at 10%, we can take him out of the chamber and lighten the sedation.
He could've pulled into the garage and fallen asleep.
Maybe he had a mild stroke.
We'll test for that.
His girlfriend died, Dr.
Halstead.
He tried to kill himself.
Dr.
Choi, that homeless girl that you treated a couple months ago, she's back with her friend.
They're asking for you.
Hey, Nat - Yeah? - You free? Kiki, Deb, you remember Dr.
Manning.
- Hi.
- What's going on? Oh, she's really sick.
BP's 102 over 68.
Heart rate, 112.
Temp, 100.
My stomach hurts.
Headaches.
You are running a fever, so let's take a look and see what's going on, all right? Hey, Deb, you're looking a little under the weather too.
I'm just tired.
Still living on the streets? It's okay.
Not so cold.
Her liver is slightly enlarged.
- I'm gonna be sick.
- Okay.
We can help you with the nausea.
4 milligrams of Zofran.
We'll run some tests.
Let's get a CBC, BMP, LFT, hepatitis panel.
Whoa, whoa, whoa, whoa.
Ah.
Let's get Deb into a room, take a look at her.
Okay.
Come on, I got ya.
Better run the same labs for Deb too.
Yeah.
Mr.
Goodwin, do you remember me? I'm Dr.
Halstead.
- Mr.
Goodwin - I remember.
Good.
Can you follow my finger? Okay.
How 'bout this? Can you touch your right forefinger to your nose? Mr.
Goodwin, can you try to touch your right forefinger to your nose or Why didn't you just let me die? We're gonna get you through this.
I'll be back to check on you soon.
I think he'll be okay.
Damn, Bert.
How could you do this? Can't you think of anyone else but yourself? Sharon, come on.
It it's selfish and pathetic.
Not helping right now.
Attempted suicide is an automatic five-day psych hold.
Fine.
Sharon, do you have a minute? The board wants to meet with you.
Wha what is it? More complaining about the money we're spending? - I have to go.
- Sharon Look, I I have a situation to deal with.
Tell them I'll get back to them.
This facility, Holly Oaks, has a good staff-to-resident ratio.
They also have a nice package of supplemental services: art, music, pet therapy.
It's still a nursing home.
It's a cardiac rehab facility.
Why can't I go back to my apartment? No.
You just got a new heart.
You have to be monitored very closely, particularly for the first three months.
I don't deserve you.
Can we just focus on finding you a place to live? You're about to be discharged.
But it's true, Sarah I don't deserve you.
Dr.
Haywood, time to get you in the cardiac chair.
- Can't it wait? - No.
No, you have to change position to prevent pneumonia.
Find a place you like.
We have a public health issue.
Liver panels came back.
Both Kiki and Deb tested positive for Hep A.
Oh, no.
We need to admit them to the PICU.
Yeah, but then what? It'll only be for a couple days.
Then they'll wanna go back out on the streets, and they'll be They'll be contagious.
- Highly contagious.
- We have to report this.
I I understand they live in some kind of encampment? Yeah, with a bunch of other kids in close quarters.
It's got to be cleared out.
DCFS will have to find homes for these kids.
Meanwhile, let's get a team over there to see who else is infected, and immunize everybody who's been exposed.
Natalie and I should go.
We've treated them.
They know us, April too.
Okay, I'll stay and look after Kiki and Deb.
All right.
Please, can we have just one more minute? Yeah.
Guys, hold on.
We love you so much.
Are we doing the right thing taking this risk? Yes.
Look after them, Dr.
Rhodes.
Don't let my babies die.
- Thomas.
- Hey, Dr.
Choi.
Hey.
You know April.
Not sure if you met Dr.
Manning, but she was here with me a couple months ago.
Thomas, we need to examine everybody, but first we need to see anyone who's not feeling well.
The most sick first.
- Laura.
- Laura? Is she the one who had the baby? - Yeah.
- Where is she? Laura? Dr.
Manning? Have you seen my baby? No, but I know she was adopted by a good family.
Temp's 101.
When was the last time you had anything to eat or drink? Significantly jaundiced and dehydrated.
Liver's enlarged.
We need to get her to the hospital.
- No.
- Laura, you have to.
You have hepatitis.
You could die.
Call an ambulance.
Thomas, who else is sick? Over here.
Excuse me.
Hey, I'm Dr.
Choi.
Hey.
- Emily - Ethan? Emily, what are you doing here? Nowhere to go.
It's all right, okay? I messed up.
Have you been able to eat or drink anything? No, it makes me throw up.
Don't worry, you're gonna be okay.
I'm gonna take care of you.
Ambulances are on their way.
Oh, my God.
Take it easy, Em, I got you.
What's up, Jay? Gunshot victim just waiting to get a statement.
What'd Natalie say? I'll tell you tonight.
You didn't ask her yet? You've had Mom's ring a week.
It's gotta be perfect.
Do you have any idea what real French champagne costs? More than you can afford.
Don't I know it.
Hello? Yes, he's right here.
Dr.
Charles, it's for you.
Dr.
Charles? Yes, this is Mr.
and Mrs.
Coveny.
Uh, Detective Miller in Madison, uh, he said that you called him, that you're interested in the case of our daughter, Olivia.
She disappeared ten years ago.
Mr.
Coveny, um - Why did you call? - Well, I'm a, um I'm a I'm a forensic psychiatrist here in Chicago, and I'm interested in your daughter's case purely in a clinical point of view.
Come visit us.
We'll tell you about Olivia.
She was really remarkable.
Dr.
Charles, if you find out something, call us, please.
Uh, of course.
Let me give you my number.
Clamps are on.
A lot of bigwigs here: Hopkins, Mayo, Duke.
Dot's inferior vena cava is more anterior lateral than anticipated.
We'll have to reconstruct the atrium to get it closed.
What does that mean? They need to continue the surgery on bypass.
I'm afraid we're gonna have to put the twins on bypass.
You were right.
Thanks, Kelly.
Hey, Bert.
You mind if I sit? Just for the record, I'm not here on official business.
I just Came to say hi to an old pal.
Leave me alone, Daniel.
The other day, I heard these two residents talking about this ten-day master cleanse.
You ever heard of that? Reminded me of the time that you and I went on that grapefruit diet.
You know, something about the enzymes in the grape Please You're wasting your time.
Just go away.
Your fever's gone down.
Heart rate and blood pressure have improved.
All good signs.
Uh, what about Kiki? She's doing better too.
Maggie, if Deb and Kiki are both stable, we can send them up to the PICU.
We got more coming in.
Dr.
Manning? You're going to Treatment Two.
16-year-old female, suspect Hep A.
Febrile and hypotensive.
My stomach hurts.
We're gonna help you with that, all right? Emily? Possibly Hep A also.
You're going to Treatment Four.
Febrile and tachycardic.
Call Radiology.
We need an ultrasound of her liver, right upper quadrant.
Got it.
Transfer her on my count.
- Ready? - Yep.
One, two, three.
Let's get a CBC, BMP, LFTs, hepatitis panel, and a chest X-ray.
Got it.
She hates me.
She doesn't hate you.
I don't blame her.
Just get some rest.
I'm not going anywhere.
Laura is emaciated, lethargic, and profoundly jaundiced.
Incubation time should be similar, but she's presenting so much worse than the others.
I know you delivered this girl's baby.
I'm sorry, Natalie.
Both hearts on bypass.
We're ready to go.
One more echo to confirm positioning.
I'm seeing a pretty large muscular ventricular septal defect in Dot's heart.
Why didn't we see this on previous imaging? Doesn't matter.
We'll have to correct it before we can proceed.
Is this a big problem? Patching a hole of unknown size near the heart's apex, a difficult spot to reach, yeah, it's a very big problem.
To get access, we need to make a ventriculotomy.
No, in this case, with the abnormal anatomy of the heart, by cutting into the ventricle, we can disrupt the heart's conducting system.
The heart might never beat again.
We lose one girl, we lose them both.
Excuse me.
I think we should patch the hole using the sandwich method: two pieces of Gore-Tex on either side.
More incisions in her tiny, fragile heart.
No, too risky.
Use a transcatheter VSD closure device.
That's a cath lab procedure.
We never do it on an open heart case.
It's the only way to reach the VSD and not damage Dot's heart.
No incision.
We snake the patch in through the atrium.
- Dr.
Latham - No, he's right.
It's our only option.
I will take full responsibility for the outcome.
Indeed you will.
Dr.
Rhodes will perform the procedure.
Go scrub in.
Yes, sir.
- Connor - I have to do this.
You realize if those babies don't pull through, your career is over? Yeah.
I do.
- Sharon? - Hm? Can I just talk to you for a second? Yeah.
So Bert isn't talking to Dr.
Chapman, he isn't talking to Dr.
Reese, not even talking to me.
You two were married for 30 years.
30 years.
Oh, I'm sorry, I'm just Please, I'm asking you, could you Could you talk to him? Just try and open him up.
So, you think that because of all those good years, I owe him something now? I'm just saying that, coming from you, it might make a difference, that's all.
Well, let me ask you this, Daniel, what did Bert owe me when he walked out? You suspected a comorbid illness.
You were right.
Laura? Your HIV antibody tests came back as negative.
However, you did test positive for both hepatitis A and hepatitis C.
I am very sorry.
Hep A is recent, but the Hep C, we think you've had for a long time.
It's damaged your kidneys and your liver.
My baby did I give it to her? We don't know.
We'll have to contact her parents and have them bring her in, so that we can test her as well.
My little girl.
Now, luckily, if she is infected, at this early stage, we can treat her.
When she comes, can I see her? We'll see if that's possible.
Have you decided on a rehab facility? Oh, you pick one.
I'm not gonna be living there, you are.
Sarah, I'm sure you'll find the best one, or at least the lesser of all the evils.
You know I suddenly love choral music Just like my heart donor.
It's good to see you.
The nurses aren't very good company.
I hardly ever see them.
What do you mean? They're supposed to be walking you.
- Haven't you been outside today? - Nope.
Nurses put me in this chair and left me.
I imagine she's very busy.
Hey, uh, this transplant patient's supposed to walk every three hours.
We are short-staffed today.
I'll get to it when I can.
Never mind, I'll do it.
Come on, Dad, we're gonna go for a walk.
Oh, I'd like that.
So far, we have five Hep A patients: one adult and four adolescents.
One of the patients also has hepatitis C.
She gave birth to a baby a few months back, - put her up for adoption.
- Hm.
The adoptive parents are here to get the baby tested.
Please keep me informed if those numbers change.
Oh, and another thing, Peter Kalmick called.
They're asking for you upstairs in the board room.
Yeah, I know.
I I'll get to them.
Oh, and have you been up to see Bert? No.
I can't see her field of positioning as much as I had hoped.
Can you get the device in place? Give me a second.
Okay.
Snaking the catheter into position.
Pulling the first half of the patch into the left ventricle.
But if you can't see or feel the alignment, you can't be sure of deploying the second half correctly.
So we'll have to open the heart even more to make the repair, which is exactly - what we're trying to avoid.
- Maybe not.
Let's try a flexible pharyngoscope.
Maybe we can see where the patch is lying before we deploy.
Beth? Here.
Dr.
Rhodes Well? Uh Yeah, I see it.
All right, aligning the patch.
And deploying.
The VSD's repaired.
Now we can proceed.
I got some fluids in you.
Should be feeling better.
Heart rate and blood pressure look good.
Em, I, uh I I'm just I'm so sorry for what I did.
I lied to you.
I'm so sorry.
Don't worry about that.
Hey, I'll be right back, okay? - We can send Emily upstairs.
- Good.
And when she gets well, you should talk to Dr.
Charles.
We'll see.
He knows places, group homes that could take her in.
So, you want me to send her away? She needs professional help.
Let her be somebody else's problem? Ethan That's how I've always dealt with Emily.
I can't do that anymore.
Oh, Dr.
Charles.
- Hello.
- Bob.
And Dr.
Reese.
Sarah was taking me for a walk.
As soon as I get him back, I'll finish rounds.
Dr.
Charles, why don't you see me the rest of the way? Let Sarah get back to her real job.
Uh sure.
Thank you, Dr.
Reese.
You know, Sarah told me that a woman in her support group says her husband came away from his heart transplant - a changed man.
- Really? Yeah, I did a little Googling.
It turns out that there's a lot of anecdotal evidence that transplant patients experience profound personality changes.
Yes, uh, "anecdotal" being the key word there.
Oh, no, actually there's a A name for it.
It's called cell memory phenomenon: the theory that memory is stored in the neurons of donated organs.
I mean, it would certainly explain why recipients develop the tastes and preferences and habits, even dreams of their heart's donors.
What are you doing, Bob? Your antisocial personality disorder isn't gonna be affected by a transplant.
The issue is your brain, not your heart.
Glenda, could you escort Dr.
Haywood back to his room? He has had a nice, long walk.
- Sure.
- Yeah.
Well, Sarah seems open to the possibility, or do you think she's just another young, gullible woman, Daniel? Uh, yes, hi, uh, Mr.
Coveny? It's, uh, it's Dr.
Charles from Chicago Med.
I so appreciate your invitation to come up and visit.
It's very helpful for my research to get a A complete picture of everyone involved.
Seems like the world's forgotten about Olivia.
We're just so grateful to talk to someone who hasn't.
Left her room just the way it was the day Olivia disappeared.
That was taken the summer between her freshman and sophomore year in college.
She was a science major at Madison, right? And she minored in astronomy? Did you get to know any of her professors? No, she never mentioned any of her professors.
The police interviewed everyone.
No one knew anything.
Olivia loved monkeys.
Where's the third one? Oh, yeah, when we picked her things up from the dorm, it wasn't there; we don't know what happened to it.
Laura? I have some good news.
Your baby's okay.
Look.
My baby.
What's her name? Anna.
Anna.
I promise we'll take good care of her.
This way.
- Thank you.
- Of course.
So, the baby tested negative.
Yeah, and Laura got to see her.
- That's great.
- Yeah.
- Good omen.
- What? - No pulse.
- I'll bag her.
Milligram of epi.
Come on.
The girl with Hep C.
Hold compressions.
Another milligram of epi.
Come on.
Come on.
Hold compressions.
- Asystole.
- No.
No.
Laura, come on.
She's gone.
Time of death, 15:25.
Have you been able to reach her family? Not yet.
You know, the last time you brought Lyla here Just before she passed away, as sick as she was, she had the presence of mind to ask me to look after you when she was gone.
Sharon, I I I'm sorry for the pain I caused you.
You know, I don't need or want an apology from you, Bert, but I'm not gonna sit here and lie to you either.
It was hard, the way you left me our life.
But what's done is done, and I'm a big girl.
I'm working it out.
But we can be proud of this.
We have raised three wonderful children.
Don't do this to them, Bert.
Don't you dare do this to them.
And you let these people help you.
I just told you.
I can't let you in The without his permission.
It's just that Dr.
Haywood is entering this rehab facility on very short notice, and it's just important that I get him a few personal items: uh, you know, toothbrush, toothpaste Have him call me.
- Liver separation is complete.
- Both hearts as well.
- Already off bypass.
- Decannulated as well.
Pacing wires are in.
Patch is holding.
Both hearts look good.
So, what's included in your massive transfusion protocol? Well And how responsive is the blood bank? They'll come in with a cooler stocked with 4 units of reds and 2 plasma.
Well, can I see the data and your process improvement indicators? - Well - Excuse me.
Can I help you? Ms.
Goodwin, this is our new division chief of trauma, James Lanik.
Jimmy.
New chief of trauma? Ms.
Goodwin is our Executive Director of Patient and Medical Services.
Looks like you weren't expecting me.
News to me.
I just got the memo.
Well, it's nice to meet you, Dr.
Lanik.
Hospital intrigue.
Yeah, you'll see.
Sharon, congratulations on the twins.
Come join us for champagne.
How is it we have a new chief of trauma and I wasn't consulted? I've been trying to get you to meet with us all day.
But we should've given you a heads-up, and I'm sorry.
The position needed to be filled, and I know Dr.
Lanik personally.
He is first-rate.
Sharon, this is Gwen Garrett, our new C.
O.
O.
New? We never had an old C.
O.
O.
Well, it's a recently created position.
Help run the hospital a little more efficiently.
Efficiently or economically? Uh, both.
Ms.
Garret's done a wonderful job minimizing red ink at several large pharmaceuticals.
I look forward to working with you, Ms.
Goodwin.
As do I, Ms.
Garrett.
It's amazing.
Excuse me, Dr.
Rhodes, Ralph Ballard.
Have you got a minute? Yeah.
I gotta run to my locker.
I'll meet you on the balcony? Sure.
Will, care to come celebrate with me? Uh, no thanks.
- Natalie - It was her? Yes, but Please.
Told Emily when she gets out, she can stay with us.
Ethan, you can't trust her.
Look you know how hard she's been trying, how how great she was with patients.
Yeah, until she quit without notice.
Look, I I I know she said some awful things to you and - No, it's not about that.
- Then what is it? You're the one who always told me how important family is.
Yes, and I treated Emily like family.
I stood up for her, I told you to give her another chance, and how did she thank you? Thank me? She stole drugs.
She lied to us.
Ethan, she's damaged.
You can't fix her.
I gotta try.
She's just gonna bring her mess into our lives.
April I'm sorry, but she's coming home with us.
No, Ethan she's going home with you.
Natalie! Hey I wanted this to be so special: uh, a view of the city, champagne.
Not like this, not in a parking lot, but I'm not gonna let you go Not without asking.
Will- - Just wait.
Will you marry me? Will you marry me? So, tell me, did you orchestrate this whole thing? Reluctant hero comes in and saves the day? You give me too much credit.
Do I? Your ambition strikes me as boundless.
Wait a second, do you really think that? I don't know what to think.
Yes, you helped keep those babies alive, but I'm sure you also secured yourself an attending position.
Uh, God, Ava, I What? You bastard.
You got an offer tonight, didn't you? That guy in the PICU? Mayo Clinic.
You got an offer at the Mayo Clinic? I can't believe it.
And of course you're going to take it.
Would you? Yes.
Absolutely.
Great.
Oh, Dr.
Charles.
- Come to say good-bye.
- I did.
You all set to, uh, head off to rehab? Well, actually, Sarah has asked me to live with her while I complete my recovery.
- Really? - Mm-hmm.
Sarah's taking you home with her? - Mm-hmm.
- Huh.
Well, I guess she certainly turned out to be the, uh The devoted daughter you were looking for.
I'm a very lucky man.
So, guess what, I, uh I decided I'm gonna head up to Madison and give that forensic psychiatry seminar.
- Oh, you decided to do it? - Yeah.
It turns out that they got a bit of a dark history up there at the university, you know, some homegrown crime of their own.
- Oh? - Yeah, around ten years ago, I think around the time that you were teaching there, the, um the Olivia Coveny case? You remember? No, doesn't ring a bell.
Her parents are convinced she was murdered.
Murdered? Well, just because a girl is missing doesn't mean she was murdered.
Oh, uh, so you do remember? Hm? What? Sorry? Well, I I didn't say that she was missing.
Oh, well, guess I just assumed.
Yeah, I was kinda surprised when you said you didn't remember, because she was a, um She was an astronomy student, actually, one of yours.
Ah, so, this is where this is going, this little dance of yours.
You're suggesting I'm a murderer.
Really? You know what's the most fascinating thing about serial killers? Even the most brilliant ones, they all have this weakness, where they can't seem to resist taking a personal item from their victims, you know, like, uh Like a trophy.
Trophy? Yeah, in this case, I think it's a - little stuffed monkey.
- Oh, please.
Why don't you just admit you lost? I'm going home with my daughter, and you can't do anything about it.
Give it up.
You appreciate the irony, don't you? That you've got this new heart, this new life, and you spend the rest of it in jail? Bob? Bob? Dad?