Chicago Med (2015) s04e07 Episode Script

The Poison Inside Us

I'm sorry, Nat, I just gotta do something quick for Jay.
I'm gonna be a few minutes late.
Thanks.
Hey, why didn't you call 911? We called you.
Hi, Ray.
So what made you fall? I took one look at that carburetor Can you tell me how old you are? - What month is it? - Come on, Will.
Ray, what month is it? It's It's, uh I can't remember.
Your eye movement's a little sluggish.
I need to get you to the hospital for an MRI.
Happy to do it, first thing tomorrow.
Ray.
So he's got a bridge game today with some friends that Hasn't seen in a while.
Look at your father.
He could be having a stroke right now.
If he is and we don't get him to the hospital, he could die.
I'll get you in and out in an hour.
Really? An hour? Promise.
Fine, get my stuff.
- All right, come on.
- Okay.
- All right, there we are.
- Okay.
An hour.
Em, you sure you should be going to Vegas? I mean, you did meet in AA.
Ethan, Bernie has a lead on a really good job.
I mean, we're gonna buy a house.
Look, I know you're worried about me, but everything's gonna be okay.
Em, he has pancreatitis.
You have to keep his drain clean.
Check his glucose every four hours.
It's a lot of work.
I know.
Well, if we're gonna get to Omaha by dinner, we gotta hit the road.
Drive safely, okay? We will.
- And, Bernie - Don't worry, Doc.
I'll be checking my glucose.
Thanks for everything.
Call when you get there? I will.
- Thanks for your help.
- Yeah, of course.
See you at work.
Yeah.
Hey, haven't seen your big, red shadow today.
Yeah, he's running a little late.
- Oh, hey, um - Yeah? Have you noticed Will acting a little weird lately? He is getting married in a month.
Makes most men act a little weird.
Yeah, I guess.
Heard Emily left.
Oh, yeah.
So? So? So now what? Nothing.
- Really? - Yeah.
Emily was the only thing keeping you two apart.
She actually just made our problems more obvious.
Really, there's nothing left between me and Ethan.
If you say so.
Dr.
Choi, there's a patient in Treatment Four that's insisting to see you.
You know him? Don't think so, but I'll check him out.
All right, then.
Mr.
Patrick, hey, I'm Dr.
Choi.
What brings you in today? I was looking for Dr.
Ethan Choi.
- Is that you? - Yeah.
And why are you looking for me specifically? Do you recall seeing my wife here a year ago? Megan Patrick? I'm sorry, not off the top of my head.
Why? 'Cause you're the doctor that killed her.
- I don't care what you remember.
Just give me the facts.
I understand but first, I just want you to know that I realize you've been through something truly awful Sit down.
Just tell me what happened.
Okay, Mr.
Patrick, but I have to look up her chart.
Go go ahead.
Man, those vanilla lattes never get old, do they? Why do people think drinking black coffee makes them cool? We don't, we are cool, so we drink black coffee.
Is that my dad? - I do have one final question.
- Yes? How you feeling? Second trimester, and a lot better.
Thank you.
- You look fantastic.
- Hey, Dad.
- Thank you.
- Connor, hello.
Hello, Dr.
Bekker.
You are a little far from your office, aren't you? Didn't you hear? I have a seat on the board now.
I guess we'll be seeing more of each other.
Great.
Hey, Ms.
Garrett.
Yes? Can you tell me why my father has a seat on the hospital board? Well, it's the least we can do after he donated all that money.
The money for Wait Is he the principal donor for the Hybrid OR? Nice having a rich dad.
Unbelievable.
He is always trying to undercut me, trying to have some kind of power over me.
Oh Wait a second, did you know? You knew and you didn't tell me.
So instead, you lie to me, to my face for weeks? I didn't lie.
I just didn't mention it.
No, Ava, that is a lie.
That's great.
Thank you very much.
Your wife was admitted to the ED at 7:12 a.
m.
Her blood pressure was 104/62, heart rate 87.
Dr.
Manning, you're going to Treatment Three.
Monique, go with her.
Claire Burton, ran her bike into a car on Michigan Avenue.
Vitals stable.
Can't get any answers out of her, but she definitely looks pregnant.
Claire, I'm Dr.
Manning, do you remember me? - I used to eat a lot of carrots - Dr.
Charles.
But, you know, they don't really help your eyes I don't really need them anyway - She manic? - Yes, bipolar.
I treated her a few months ago for morning sickness.
All right, let's move her on my count.
Ready, one, two, three.
Anybody we should call? As far as I know, boyfriend's out of the picture.
Oh, my gosh.
Sometimes, if I look at something for too long, I feel like all that energy is gonna turn into a laser and just burn a hole right though whatever it is that I'm looking at.
I heal a lot faster than others Claire, does it hurt anywhere? Two Haldol, please.
A lot of times I try not to look at anything but myself.
Claire, Claire, can you tell me if anything hurts? Every single molecule on my skin is something She'll calm down in a couple minutes.
- I'm right outside.
- Okay, thank you.
And I just heal.
Does anybody know what happened to my bike? This it's just a little bit of a cut.
Maybe I could just get my bike and go.
What are you doing? Ray's gonna be here any minute.
Our tail has him seven minutes out.
You need to call off the MRI.
What are you talking about? That bridge game is the summit between Ray and his crew that we've been waiting for.
This is where he's going to incriminate himself.
So I'll do one test and send him home.
Listen, you work for us and I am telling you to call it off.
I work for the hospital, and he needs an MRI, so he's gonna get one.
We can make your life very hard.
Make sure you get him home for that meeting.
What's going on? I just got a weird vibe from Dr.
Choi's patient.
- I'll check it out.
- Yeah.
O2 sats, 86%.
You need my help? No.
We're fine in here, thanks.
All right.
Yeah, something's up.
Ethan wouldn't even let me in the room.
Okay, I'll call security and have them keep an eye on them.
Derek Glenn, 35 MVC, BP 110/60, heart rate's 120, left upper quadrant pain.
Why the hell is he in my OR? It's not a treatment room.
I was told to park him here because all the other rooms are full.
All right.
Let's get an ultrasound.
Hey there, Derek, can you tell me where it hurts? - Right here.
- All right.
Is there anyone you need us to call? Already called my wife.
Good.
Well, it looks like you've got some free fluid around your spleen.
That usually indicates a small tear, which we do sometimes see with blunt trauma.
Now, the good news is 90% of these bleeds stop on their own.
So for now I'd just like to get a scan to confirm, and then we'll keep a close eye on you to make sure that you're stable.
- That sound okay? - Yeah, sure.
Good.
Let's get him a CBC, CMP, coag panel, type and cross four units of blood, and set him up for a CT.
We will get you all set up, and then I'll be back to check in on you soon, okay? - Look, about this morning.
- I don't want to hear it.
So what if your father's the main donor? This hybrid room has been a godsend.
That's not the point.
You're saving lives with it.
Who cares where the money came from? I do, and you should know me well enough to know that I don't want to be beholden to my father.
- Connor - You should have told me.
How many more damn papers do I got to sign? That's it.
We're gonna get this done right now.
About time.
Let's get this done fast, okay? It's a head MRI.
It takes as long as it takes.
Let's lay you down.
Ray, I got to see some more patients, but I'll be back before you're done.
Yeah.
What was her normal dose of Quetiapine? It was 800 milligrams, but I cut it in half to be safe for the baby.
Huh, that might explain the onset of the mania.
Well, the standard of care is to cut the dose in half.
There's actually been some new research, a couple of new papers, both suggesting Dr.
Charles, I can't keep up with every psychiatric journal.
Course you can't.
I didn't have a choice.
I did what I had to do.
Dr.
Manning.
What's wrong? Your placenta must have abrupted from the accident.
Call OB, we need to get her upstairs for a delivery.
Delivery did something happen to my baby? Is he gonna be okay? What's wrong with my baby? Everything's gonna be fine.
Let's get you upstairs, and then we'll figure out what happens next, okay? Are you sure I didn't hurt the baby? Are you sure? What if I hurt it? Your wife was given anti-histamine, steroids, and epinephrine, but progressed to cardiac arrest.
I performed CPR with ACLS for 35 minutes, but she never regained circulation and at 9:17, she was pronounced dead.
Mr.
Patrick.
I assure you, we did everything we could.
No.
I can only imagine the pain you felt.
She couldn't breathe.
Do you know what's that like? I want you to know how it feels.
- This is your - Mr.
Patrick! There's a toxic spill.
Evacuate the ED now! Code Orange! Everyone, out, right now.
Get your patients out right now! Code Orange! Get out! Everybody, out! Go, move! This is Maggie Lockwood.
Toxic exposure in the ED.
I repeat, toxic exposure in the ED.
Get the hospital on bypass right now.
Start the internal disaster protocol.
Everyone, out now! Move, move! Dr.
Rhodes.
Eva, get me a gurney.
They're all in use.
- What's going on? - Toxic spill.
We need to get you out of here.
No, that's too dangerous.
What are you doing? This room has positive pressure ventilation.
We're safe as long as we stay in here.
What happened? Why did we stop? What's going on? I don't know.
Move! Move! Move! Everybody, out! Moving out the truck! Head trauma, GCS nine, we just got her so she needs a full trauma workup when you land.
35% TBSA second- and third-degree burns.
Take 'em straight to the burn center.
- Maggie.
- Yeah? - Have you seen Natalie? - Don't worry.
I saw her take a patient upstairs before the spill.
Dr.
Choi.
- You need to sit down.
- I'm okay.
But we have more patients in ambulances, so we need to triage in the red, yellow, and green and get the sickest ones off in the first wave.
Make sure everyone's showered and deconned.
You got it.
How long till you can detox my ED? Depends on the floor plan, ventilation, size of spill.
I'm sending Squad in now.
Soon as they get us the samples, we'll take them down to the lab and try and ID the toxin.
And what about Mr.
Patrick? We're looking into him now.
Background, employment, family, anything that'll give us a lead.
We already have 12 hospital staff and patients in respiratory distress.
We need to figure this out and fast.
Got it.
Easy, easy, easy.
- You okay? - Yeah.
Why are we here? What is this place? Orthopedics.
They're renovating the rehab floor.
I'm supposed to have my baby.
You you said I was bleeding.
Emergency exits are locked.
I was thinking maybe a Code Orange.
Would explain why the elevators when down.
Oh, there's a lot more blood.
A lot more blood.
Her bleeding's much worse.
Call Labor and Delivery.
Worse? What does that mean? Is my baby dying? No, we need to lay you down, okay? - Come on.
- He's dying, isn't he? - My baby's dying.
- No, he's not.
Come on, let's lay you down.
Just lay down right here.
You're all right.
There you go.
Dr.
Charles.
There's no signal.
I can't find a signal.
Oh, my God.
I killed him.
Just stay right there, okay? We have to figure out a way to break open these doors.
We need to get her upstairs.
Natalie, we're not getting through those door.
We're gonna have to do a c-section.
This is all my fault.
I killed my baby.
His pressure's dropping.
Derek, are you feeling dizzy? A little.
What does that mean? That means you're still bleeding.
The tear in your spleen isn't clotting like I'd hoped.
He's got a lot more free fluid.
Hey, hey! Cruz! I need to get this patient upstairs.
Sorry, doc, I can't open these doors until we get the place clear.
Just to get a couple units from the blood bank.
Even if I wanted to, all of the stairs are locked down so the gas can't spread.
Emergency exits, everything.
We'll get you out as soon as possible.
All right.
We need to keep his pressure up until they get us out of here.
I'll hang a bag of saline.
I got it.
April, we need more oxygen masks.
Fire brought out everything they could find.
All right, see how many nasal cannulas we have.
The worst patients can always double up.
Ethan, you need to sit down.
I'm okay.
I'm fine.
I'll be okay.
Okay, you let this nurse know if you feel any nausea, dizziness, or problems with your vision, okay? Hey, Will! Where's our dad? He's safe.
He's still upstairs.
Then go and get him out of there.
I can't.
They've locked down the entire hospital.
You're a doctor.
You go find whoever's got the key and you get him the hell out.
Look, guys, I'm sorry, but it just doesn't work like that.
Will, you said it'll only take an hour.
Yeah, and it should have, but we're having an emergency.
Dr.
Halstead! - Guys, I got to go.
- Ethan! Ethan, breathe.
Ethan? Talk to me, Ethan.
- Talk to me.
- Get him on O2! - Mask! - Here you go.
Ethan.
- Ethan.
- Hang in there, Ethan.
How's he doing? Not good.
We'll get him through this.
He was trying to keep me safe.
Back there in the ED.
That's that's why he didn't let me in the room.
Yeah.
I've never done a c-section.
I haven't even seen one in years.
We're gonna figure it out.
But we don't have any instruments or emergency supplies or pain meds.
There's got to still be some supplies on this floor.
What if we just held pressure? I mean, whatever's happening in the hospital right now can't last forever.
We have to do this now.
We don't have a choice.
Listen, whatever doubts you may or may not have about your previous treatment of this patient I led her to believe that she could go through with this pregnancy.
She can't take care of a baby.
She can't even take care of herself.
Then you were in a very difficult situation If I operate on her in this hallway and she dies, that's my fault.
Okay.
Okay, look.
I'm going to find a signal and get an OBGY on the phone.
But no one can get down here.
No, no, so she can talk us through it on the phone.
Together.
Okay? Please tell me you found something.
Jacob Patrick is an engineer at a textile factory.
He has access to numerous industrial toxins.
We're hoping to have it narrowed down soon.
- Please keep me posted.
- I will.
You can't be serious! Until an ambulance shows up with more, there's nothing we can do.
What's going on? Ethan and Mr.
Patrick and both in bronchospasm and in need of racemic epi.
The problem is there's only one dose left.
Which, obviously, we should give to Ethan.
Who's doing worse? That's the thing.
Mr.
Patrick is.
You're not really thinking of giving it to him.
I'm following protocol, April.
Whichever patient has the greatest need gets treated first.
He came here on a suicide mission.
I'm sorry.
Give Mr.
Patrick the epi.
This is wrong.
What's happening? The bleed isn't stopping.
I'll hang some Ringer's.
- I'm gonna embolize it.
- What? We're just putting a wire into his groin.
It's a simple procedure.
Not without nurses or techs, let alone anesthesia.
No, we can twilight him with Versed.
Look, we don't have a choice.
We need to close off the vessel, and frankly, I'm not interested in your opinion.
All right, hey, guys inside checked.
They can't find any more doses of racemic epi.
We have to do something.
His airway's almost closed.
I mean, we could try methylprednisolone.
It's not great, but it's better than nothing.
Okay, where can I find it? In the respiratory therapist carts.
All right, what does that cart look like? We're wasting time.
- April! - Hey, you can't go in there! Give it to him now.
That was incredibly stupid.
Let's hope this works.
All right, come on.
Let's get you decontaminated.
Do you have reception? I've got one bar.
It's ringing.
I'm not cutting until you get someone.
Cutting melon, cutting chicken, cutting me, cut the baby.
No one's gonna hurt the baby, Claire.
Her Haldol's wearing off.
Is someone answering? Yes, this is Dr.
Charles.
I need an OB immediately to talk me through an emergency C-section.
They're getting Dr.
Grant.
Come here and put her on speaker.
I-I-I can't.
I'll lose the call.
I'll drop the call.
Dr.
Grant, thank God.
I have a woman, 36 weeks, abrupted placenta, already lost a couple units of blood.
Some lidocaine which we've administered.
A scalpel and a few clamps.
Okay, okay, here we go.
Dr.
Grant says to start the incision three centimeters below the umbilicus.
Okay, here we go.
Come on.
Come on.
Damn it.
The pressure's still dropping.
I can't get the wire in there.
The anatomy's too challenging.
Hang 500 of albumin.
We'll hold pressure until we can get him out of here.
He won't make it that long.
There's nothing else we can do.
We can remove his spleen.
We can't open him up.
He'll lose too much blood, and we don't have any to give him.
I'm a universal donor.
That's insane.
The surgery will take too long.
Well, then do it faster.
Ava, what are you trying to prove? I'm trying to save his life.
If you do this, you both are gonna bleed out before I'm done.
Unless you have a better idea, I suggest you stop making excuses and get started.
How's your breathing? Good? All right.
Will.
Be right back.
Congratulations.
They called off Ray's meeting.
You screwed it up.
He was sick.
What was I supposed to do? What I told you to do.
Stay out of the way.
I didn't know there was gonna be a toxic spill, Jay.
This is why we don't take chances, and you needed to listen.
He could have had a stroke.
I wasn't gonna let him die.
I took an oath.
PD's narrowed down the possible toxins.
We hope to have an answer soon.
Look, I understand you're upset, April.
Ethan is dying, and you didn't fight for him.
I did what I was obligated to do, and Dr.
Choi would have done the same thing.
Can you seen the splenic artery? Not yet.
I'm still getting through the mesenteric fat.
Just keep going.
Ava, you've probably given a pint by now.
I'm doing fine.
You're gonna run out of blood before we even get there.
If I stop transfusing now, he'll die.
This is crazy.
Okay, tell Dr.
Grant I'm through the uterine wall and ready to deliver.
Through the wall.
It's a baby.
Through the wall.
Yeah, she's through the uterine wall.
Hold on.
The placenta's in the way.
I can't see the head.
Ask Dr.
Grant if I should extend the incision or reach through the placenta.
Well, can you reach around it? - Is there any room? - Ask Dr.
Grant.
Yes, Dr.
Grant, Dr.
Manning wants to know if she should extend the incision or go through the placenta.
Dr.
Grant says that That she totally trusts you to make that call.
No, she needs to tell me which way to go.
Make the call, Manning.
Manning, make the call.
Dr.
Grant says that without being there to assess the position of the placenta, there's no way that she can make that determination.
You need to decide.
I'm going through the placenta.
Hold on, it's too high.
I need you to come over here and push down on it.
- Here? - Yeah, I think so.
Okay, I'm sorry, but you're gonna feel this.
Get out of me! Help! Get out of me.
Did you get the baby? No.
Maybe I should do the incision.
Stop! Get off me! Stop! Okay, okay, Hold on.
How about now? Yeah, okay I think yeah, there it is.
Okay, push again.
Push again.
Get off me! I got it.
The baby Push.
Push.
I got it.
- Keep pushing.
- How's the baby? I got it.
How's the baby? He's not breathing.
His trachea's blocked with secretions.
- What do you need? - An aspirator.
Something to get the secretions out.
All I got is this IV tubing.
Give it to me.
He's okay.
You did it.
Yeah.
Baby greens, baby carrots, baby teeth Baby single parents, baby teeth, baby blankets, warm blankets, fuzzy blankets.
The artery's almost impossible to get to.
You okay? Yeah.
Ava.
You need to sit down before you pass out.
I'm okay.
Hey! Hey.
Hey.
I'm not taking out the tube till you're done.
All right, stay with me just a little bit longer, okay? Hold on for me.
Stay with me.
And All right.
And All right.
We did it.
Ava? Ava! Ava.
Hey, Ava-whoa.
Okay.
Okay.
Hold on here.
Okay, there we go.
There we go.
Did we do it? Yeah.
Yeah, we did it.
Coming through.
Any changes? Nothing.
All right, keep him going.
Word is we should have an ID on the toxin soon.
He's in v-fib.
April, start compressions.
I need these cuffs off.
Monique, charge to 200.
Bag.
Clear.
Continue compressions.
Charge again.
Clear.
Still no pulse.
Charge again.
Clear.
- Continue compressions - No, he's gone.
Time of death, 12:12.
They identified the toxin.
It's cyanide.
Oh, God.
Ethan.
Okay, let's go everyone.
Let's go.
We got the all clear.
Let's get everyone inside.
hot.
All affected staff, go to Trauma Two and Three and we'll triage from there.
Let's go.
Give a dose to everyone who's affected.
- What is it? - Hydroxocobalamin.
It helps counteract the cyanide.
I got the hydroxocobalamin.
Think it'll work? As you know, there's no antidote to cyanide.
But it's the best chance we got.
Dr.
Grant, how's Claire doing? She and the baby are both stable.
You did a nice job.
Well, I couldn't have done it without you.
I don't follow.
The phone call with Dr.
Charles.
Thank you for getting me through the c-section.
I wasn't on any phone call.
Dr.
Charles, you lied to me.
Yes, I did.
You tricked me into doing a surgery that endangered both Claire and her baby.
What you did was reckless and unprofessional.
You had no right to manipulate me.
Can I show you something? She looks good.
Yeah.
Meds kicked in.
Listen, you were trying to solve a very tricky problem, and most doctors would have tried to talk her out of this pregnancy But you you saw the woman, not the mental illness.
You have excellent instincts, Nat.
Just gotta trust 'em.
We've got a room for him in ICU.
We're moving him upstairs.
I'll make sure they call if anything changes.
Thank you.
Ms.
Goodwin, you were right.
He would have done the same thing.
His pressure's going up.
I think the medicine's working.
All right, get him upstairs.
Two units of PRBC are up.
What happened? The surgery got a little complicated, but you're gonna be fine.
In fact, your wife is waiting for you in the ICU.
They're gonna get you up to her, and I'll be there to meet you in just a minute.
Here you go.
You know I hate peanuts.
Well, as long as you're not allergic, right? What you did back there you were incredible.
Derek's alive because of you So thank you.
Wait.
About your father.
No, forget it, Ava.
I-I had no right to get upset with you like that.
- I'm sorry - No, Connor.
It was me.
I was the one who asked your father to donate to the Hybrid Room.
What you? You were taking that job at the Mayo Clinic.
I didn't want to lose you.
Will, are you all right? That's blood.
Were you exposed to the cyanide? Maybe.
Let's get you back inside.
Come on.
Let's go.
April, the ICU just called.
Dr.
Choi's improving.
Oh, thank God.
Go on, go up there.
I'll cover your patients.
Okay.
Hey, you know, what I said earlier about there being nothing left between us.
- I was wrong.
- I knew that.
Hey, you're up.
Yeah.
So it turns out it's not cyanide.
It's an ulcer.
Huh.
Did you know this was happening? I had no idea.
What is going on, Will? Are you stressed? - No.
- Really? Because I have to say you've not been yourself lately.
Natalie, most ulcers are bacterial.
- They're not stress-related - I know that.
With the way you've been acting, it is not There's nothing going on.
I'll go get your antibiotics.
- Thanks.
- Yeah.
Is there something you're not telling me? No.
Everything's fine.
Okay.
Vicki.
Hey.
I got a call from the hospital.
Apparently you haven't updated your emergency contact.
Are you okay? I will be.
Are you back in town? Couple months now.
I'm back at the VA.
- I should have called - It's okay.
Glad to see you.
So how was Germany? It was good.
I've had enough bratwurst to last me a lifetime, but my skiing has vastly improved, so That's good.
I see you're still funny even when you're laid up in a hospital bed.