Chicago Med (2015) s04e14 Episode Script

Can't Unring That Bell

1 Can I confess something? Course you can.
So I picked a coffee shop for our first date in case I needed to make a quick getaway.
In case I was a dud? Smart.
Very smart.
I get it, trust me.
But I'm going to guess that, because you're letting me walk you home, maybe not a dud? You guessed right.
Yeah, I've been here about nine years now.
Love Lakeview.
Wrigley's right there.
Britt, what are you doing out here? I'm sorry.
I went to the store, wanted some chocolate milk, but I forgot my keys.
And your jacket? This is my daughter, Britt.
She's supposed to be staying inside the apartment.
Please, Mom.
Can you just let me in? Yes, yes, come on.
Um, Britt has a problem.
She's been clean a few weeks now and doing great.
It's just the withdrawal symptoms are hard.
[GROANS] Whoa, whoa, whoa, whoa, whoa.
You okay? My chest, it hurts when I breathe.
Okay, um, we need to get her to a hospital.
What? No.
I'll let 'em know we're coming.
[PHONE CLICKS] [PAGER BEEPING] Incoming.
- Take Baghdad.
- Yep.
Cesar? Gabriel Park, 16, single GSW to the abdomen.
GCS 15, BP 98/66, heart rate 118, sats 100%.
I can't move my leg.
Gabriel, I'm Dr.
Rhodes.
You hang in there.
What happened? Gunman held up the family store.
We were in the back, stocking the freezer.
And Gabriel was working the register.
Mr.
and Mrs.
Park, why don't you come with me - and let Dr.
Rhodes work, okay? - All right.
On my count.
One, two, three.
[DRAMATIC MUSIC] Single bullet hole, interior abdomen.
Let's get a chest x-ray and log roll.
On my count, one, two, three.
There we go.
[WHIMPERING] No exit wound.
All right, back down.
Let's find out where this bullet is.
Everybody clear.
[GRUNTING] We're gonna take care of you, Gabe.
X-ray's up.
There it is.
All right, trans abdominal trajectory.
He needs surgery.
Please, my left leg, I can't feel it.
Gabriel, I'm going to do everything I can to fix your leg, but right now I need to look inside your belly and make sure that everything is okay.
You understand me? Good.
Call for blood.
Let's move him over to the hybrid OR.
Page my team.
Let's go.
Will.
What's up, Jay? They just brought that kid in.
He was shot in a convenience store.
Okay.
So we caught the guy, and we got the gun that he used.
Good.
Why are you telling me? CPD ran the serial number on it, and it's your gun The one that was stolen.
- Hey.
Any word on the boy? I heard it was your gun.
Don't say it, okay? The last thing I need right now is a lecture.
I wasn't going to.
It's not like I put the gun in the shooter's hand.
It was stolen from me.
I know that.
Look, I know this is a terrible situation.
I just hope you're talking to someone.
Your therapist or Why do you even care? You said we were done, remember? Hey, any update on Britt Mills? Other than learning from her mom you two were on your first date? [EXHALES] It had to be awkward to find her daughter like that.
Yeah.
Britt's echocardiogram is showing endocarditis.
It happens sometimes with intravenous drug users.
I bet bacteria from a needle worked its way to the heart.
What's cardiology saying? They advise against surgery.
I think we should treat with a six week course of antibiotics, so we need to put in a PICC line.
PICC line? I don't know.
I mean she's only been clean a few weeks.
Leaving a catheter in her arm? That's almost an invitation to relapse.
But if we don't, she'll have to come into the hospital twice a day for infusions.
Got to be another way.
- Dr.
Rhodes.
- Thanks.
Connor, is the kid gonna be okay? Yeah, he'll definitely live.
We repaired a bunch of small bowel where the bullet tore through, but it's still lodged in his spinal canal.
How bad is it? Too soon to tell, but, when he came in, he said he lost feeling in his left leg.
We're sending him up to CT, get a better idea of what's going on.
Neurology's gonna take a look at him.
We got it.
[ALARM BLARING] Maggie, female mid-30s, syncopal episode in the field.
Down maybe 30 seconds before roused by bystanders.
Sydney? - Hey, Maggie.
- Hey.
Dr.
Lanik, you're going to treatment 3.
Went from GCS 12 to 14 with a sternal rub, supplemental oxygen, and 250 mils normal saline.
- Monitor showing multiple PVCs.
- I fainted.
Yes, and we're going to take very good care of you.
BP's a little low, 100/66, and heart rate, 78.
But I'm not sure if she's beta blocked.
Okay, transfer on my count.
One, two, three.
She's got a tunneled cath in the left upper chest.
That's for dialysis.
She's on the list for a kidney.
- Hey, order a 12-lead EKG.
- All right.
- Am I gonna be okay? - Yes, you are.
Where's that x-ray? [DRAMATIC MUSIC] Okay, clear.
Ms.
Curry? Ooh, mild fluid overload.
- So? - Cardiac enzymes, BMP, CBC, blood cultures times two.
Yeah, give her a dose of Vanc.
25 milligrams per kilogram.
On it.
Repeat her vitals and let me know when her labs are back.
Okay.
Okay.
- You know this patient? - She grew up near me.
Came in a couple weeks ago with sepsis.
I should have seen her immediately.
Feels like somebody sitting on my chest and my back at the same time ever since we got back from that cross country ski trip two days ago.
I never felt anything like this.
This isn't like him.
Patrick's always so healthy, even if he sort of let himself go the last few years.
Really, Alice? It's your medical history.
It's relevant, isn't it? Uh, yeah.
Does the pain extend down your arm or up to your jaw? - No.
- Does this hurt? Out of ten, ten being the most painful.
Mm, I guess a five.
Okay, let's get a CBC, CMP, troponins, and set Mr.
Novak up for an EKG.
- Patrick? - [MACHINE BEEPING] [TENSE MUSIC] - No pulse.
- What? - He's not breathing, bag him.
- Got it.
But he's got normal sinus rhythm.
There's no pulse.
He's in PEA.
Call a code.
- Patrick? - We need help in here! - Need an airway! - Look.
He just opened his eyes.
He's breathing on his own.
Oh, thank God.
Honey, are you okay? - Patrick? - Asystole.
- Milligram of epi, now.
- Wha - Intubate him.
- [GROANS] Hold off.
Patient's breathing on his own.
Can someone tell me what is happening? Your husband is in cardiac arrest, but as long as I'm doing compressions, he's getting oxygen to his brain.
We'll keep at it until his heart takes over.
Honey, Patrick.
I'm right here.
[KISSES] [SOMBER MUSIC] You're saying it's not just the withdrawal? I have a heart infection? Symptoms of endocarditis usually come on slowly and they're often mistaken for heroin withdrawal.
The chest pains you were feeling this morning.
We can treat endocarditis with long-term antibiotics, which normally involve leaving a catheter in the arm.
A PICC line.
It's okay, I'm used to needles.
Britt, we really get how tricky early sobriety can be and we just want to put you in the best possible position to succeed.
So if we're gonna give you this PICC line, there's something else we'd also like you to consider.
- What? - Well, it's a drug called Naltrexone that blocks the effects of opioids on the brain's limbic system, essentially making it impossible to get high.
There's a drug that'll stop me from getting high? Let's do that.
Listen, Naltrexone is by no means a magic bullet, and it comes with certain very real risks.
The thing is, Britt, you can't take it unless you've been opioid free for at least 14 days.
If there are any opioids in your system, the Naltrexone could trigger severe side effects.
- I'm clean.
- For over two weeks.
Okay, well, it's also crucial for you to understand, if you were to use, it could very well lead to an overdose.
I'm not going to.
Ever.
She's been trying so hard.
[SOFT MUSIC] Okay, well, we just need to do a urine test to be safe and, uh and we're set.
- Okay.
- This is great, I mean [SOBS] [HOPEFUL MUSIC] - Ava.
- Hello, Connor.
Um how's the hand? Ah, it's much better.
It was my fault.
I should have gotten my hand out of the way.
Well, maybe I could have been a little more careful.
Look, I am sorry that I haven't been able - to come by to check on you.
- It's okay.
I know we're not in the best of places right now.
- Yeah.
- Dr.
Rhodes.
Once again, you are doing your best to ruin my day.
- Maybe I should go.
- No, no, you stay, Dr.
Bekker.
This concerns you, too.
Two months ago, you operated on a gunshot victim, Shawn Corcoran? - Yeah? - And you assisted? He died, and someone is alleging that you brought him to the ICU with his abdomen left open when you should have closed him.
And then, you lightened his anesthesia prematurely while contributing to his death.
Who made these allegations? It was an anonymous complaint.
Unfortunately, the hospital oversight committee is obliged to do a root cause analysis into the case.
- You'll both be interviewed.
- And then what? Well, if the committee finds that the charges have merit, you, Dr.
Rhodes, will be brought before a peer review board.
But hopefully that does not happen.
Your hybrid OR has cost this hospital a fortune, but it has made for some good PR.
The last thing I need is a scandal involving its chief.
[TENSE MUSIC] Connor, peer review? You could lose your license.
Yeah.
Mr.
Davis, you're back.
Yeah, it's starting to feel like we live here.
But I'm just a little bit worried about Sophie.
- What's the matter with her? - She's not eating like she should, and she's sleeping more than usual.
All right, well, why don't you lay her down right here and I'll take a look, okay? Okay.
You're okay.
[FUSSING] - Just right here.
- Hey.
[COOING] You're all right.
- 100.
1.
- She is running a fever.
[CRYING] [CRYING] I'm not seeing anything unexpected.
Okay.
Don't worry, we'll figure this out.
Put in an IV and check the patency of the g-tube.
It could just be she's not getting her fluids and nutrition in.
- Right.
- This have anything to do - with her heart condition? - I don't know yet.
Um, it could just be that, right now, she's not getting the nourishment she needs.
But let's just check the tube first, and then, we'll go from there, okay? - Okay.
- All right.
Ms.
Hawkins, your tests show potassium 9.
2, chloride 115, BUN 105, and creatinine 6.
- What that mean? - It means your dialysis hasn't been working.
When was the last time that you went to the center? A few days ago.
Why? And did they mention any problems with your flow rates? Because your catheter is clotted.
Maybe told you to come to the hospital and get it replaced? Oh, something like that, maybe, yeah.
But then I got too sick.
That's okay, we'll get it all fixed up, and get you emergency dialysis.
Mm-hmm, meanwhile, we need to lower your potassium.
Let's give her an amp of bicarbonate, ten units regular insulin, an amp of D50, and then, 8.
4 grams of patiromer.
Got it.
[MACHINE BEEPING] All of that? It's really bad, isn't it? Mm-hmm.
You need a new kidney.
I'm gonna see if I can get you moved up on the transplant list.
Maggie You're taking such good care of me.
[SOMBER MUSIC] Thank you.
No more ski trips, I promise.
I know you didn't want to go.
Dr.
Halstead, should we get him on ECMO? We can't put a patient on ECMO unless we have a plan to get him off it.
- Then what can we do? - This is it.
There's nothing else.
I'm not gonna stop until his pulse comes back.
You need a break.
Let me take over for a while.
All right.
Switch.
Hey, you good? I'll be right back.
Based on my experience, it's definitely the best course of action.
Okay.
Hey, Sam.
What's the report on the GSW victim? Since when is he your patient? Come on, Sam.
Bullet lodged in his cord at T12, hematoma surrounding the cord.
Kid's hemiplegic on his left side, right leg still works.
Wait, so there's a chance he'll regain feeling in his left leg when you pull the bullet out? No, we're leaving it in.
Removing the bullet risks substantial bleeding along with more potential damage to the spinal cord, which could result in the kid being paraplegic.
Well, isn't that worth the risk if it means he might gain full function back? Well, I'd rather have one good leg than two bad ones.
Wait, look, we're talking about a kid, here.
Okay, with his whole life ahead of him.
Halstead, no one asked for your uninformed opinion, and the family's made their decision.
Go back to the ED and put a Band-Aid on someone.
Good news, the urine tox screen came back clean.
I wasn't worried.
Monique, let's administer the first dose of Naltrexone, then send her up to the IR for a PICC line.
Could you turn on your side, please? - Mm-hmm.
- Honey Are you are you sure about this? This is a really big step.
Yes, Mom.
I'm sure.
- Just a little pinch, okay? - Mm-hmm.
- That's it.
- Thank you, both.
I understand what she does for a living, but she's been responsible with her health.
No She's not high risk.
Yes.
I understand.
That about Sydney? Yeah, she's on the bottom of the transplant list because she's a sex worker.
[PHONE CLACKING] When she came in, I kept her waiting.
I didn't take her seriously.
I didn't realize that she was septic.
[SIGHS] Maybe if I hadn't kept her waiting, this wouldn't have happened.
Maggie, you don't know that.
You know, we grew up a couple blocks from each other.
Huge difference, those couple blocks.
[somber music[ April? I want you to do a blood draw on me.
A blood draw? Maggie, you cannot be serious.
Treatment 4's open.
Let's go.
[MACHINE BEEPING] - She's not breathing.
- Sats are down to 60%.
- Start bagging.
- Sats are coming back up.
- 88, 93.
- Need to intubate.
[TENSE MUSIC] I'm in.
Bag her.
Call for a vent and get a chest x-ray.
- She's stable for now.
- What's wrong with her? I don't know yet, but we're gonna get to the bottom of it.
Come back, Patrick.
Please? Just come back.
[SOBBING] Dr.
Halstead, it's been ten minutes.
No.
Stay with me please, baby.
[SOBS] Excuse me.
Will, I need a word.
[SOBBING] Gabriel and his parents are now saying they want the surgery to remove the bullet.
Glad to hear it.
You had no right interfering with my patient.
Hey, all I did was make sure they knew their options.
No, you went in there and advocated for a surgery that they had decided against.
Connor, this kid shouldn't have to live the rest of his life with only one good leg.
No, he shouldn't, but what happened happened, and we can't change that.
Well, maybe we can.
Maybe he can go back to the way he was.
Will, I get it, man.
It was your gun.
You might have some messed up idea that this was somehow your fault, but pushing for that surgery, the kid could wind up in a wheelchair.
Or he could be made whole again.
I have a patient to attend to.
[OMINOUS MUSIC] Help, help! Somebody help my daughter! - Excuse me.
- Need noodle.
- Not noodle, uh - She's seizing, 5 milligrams of Ativan.
[MACHINE BEEPING] Okay, meds are in.
Dan, help her, help her, help her! [MACHINE BEEPING] BP 154 over 94.
Heart rate 118.
Sats 92%.
She's stable.
[DRAMATIC MUSIC] How did that happen? Was it the injection? No, only if Britt had drugs in her system.
Hm, but but she didn't.
Did she? Maggie, come with me.
We need the room.
[CLEARS THROAT] I'm on the transplant committee.
I am notified about every HLA match.
Did you really think I wouldn't find out that you planned to donate a kidney? Well, I hoped you wouldn't, because I didn't want to have this discussion with you.
Maggie, undergoing surgery for a patient, an irreversible procedure, is a violation of professional boundaries.
I'm sorry, but I don't care.
So who are you doing it for? For her or for you? - For me? - Well, look.
I've gone through Sydney's records.
She was already in septic shock when she came in, Maggie.
We did everything we could for her.
So if this is coming out of some misplaced sense of guilt She's at the bottom of the transplant list.
She's never gonna get a kidney, and she's gonna die if I don't give her mine.
But have you stopped to consider your own health? - Wha - Donating puts you at risk, Maggie, for infection, hypertension, intestinal obstruction Those are very rare side effects.
Okay, but what if your remaining kidney fails? People who donate kidneys do just fine, and you know that.
[TENSE MUSIC] It is still an ethical violation and I can't I just I can't let you do this.
Sharon, there's nothing that you can do that's gonna stop me.
Actually, there is.
You're out of paid sick leave days.
You can't take the time off to recover Not without jeopardizing your employment.
Lose my job? You would do that? Maggie, yes, I would.
[DRAMATIC MUSIC] She could have died.
My baby could have died.
I'm just stumped as to how How she passed the urine test.
[MACHINE BEEPING] I don't know.
[SOMBER MUSIC] Jackie.
It was mine.
It was my urine.
She swore that she was clean, and then, when you said she was gonna have to do a drug test, she told me.
She told me she'd shot up a week ago.
And you went ahead anyway? She she said that it wasn't that much.
That it wouldn't matter.
You have to understand, this has been going on for such a long time.
I've tried everything.
I got her a therapist.
I-I got her a job.
I hardly ever leave her alone.
And still, every morning, I wake up and I find that she's figured out some other way to get high.
The Naltrexone gave me hope that it would save her.
Also could've killed her.
[WHIMPERING] Jackie, I cannot even imagine how brutal this must be.
But I'm gonna be very honest with you.
As a parent, I understand the need to protect your child, and as long as you keep doing that, she's never going to get better.
[SNIFFLING] The committee's running a little behind.
Ava, you are blameless in all of this.
I made every decision in the OR.
Dr.
Bekker, they're ready for you.
[KNOCKING] - Hi.
- Hi.
Sophie's MRI shows an abscess an area of swelling in the right frontal lobe of her brain.
It's an infection.
How why It can happen in children with congenital heart disease.
Bacteria originating from the heart - travels up to their brain.
- Mm-hmm.
So the neurosurgeons would like to take her up to the operating room to have a catheter placed and the abscess drained.
A catheter in her head? The good news is, is that the abscess is small enough so that she won't need a craniotomy surgery.
When my wife found out she had a brain aneurysm.
The doctors said it was small enough that she didn't need to have surgery, and then it killed her.
[SOMBER MUSIC] I can't make you any promises, but I can tell you that this is an entirely different situation.
I'm hopeful.
You should be, too.
Okay.
Let me check for a pulse.
[MACHINE FLATLINING] - Move.
- Patrick, come back! Oh, no.
No, you hang on, Patrick.
Please.
Oh, you hang on, Patrick.
- Dr.
Halstead.
- Oh, God.
No [MACHINE FLATLINING] I'm sorry.
[SOMBER MUSIC] It's my fault.
[SNIFFLES] I did this to him.
Okay, we are ready to start your dialysis.
Huh? [MACHINE BEEPING RAPIDLY] - Sydney? - She's in V-Fib.
Ugh, it's her potassium.
Call a code.
Code blue! Get Lanik in here.
[TENSE MUSIC] Start bagging.
Still in V-fib.
Paddles.
Charge to 200.
Charged.
Clear.
[THUMPING] Still in V-fib.
Milligram of epi.
- Epi is in.
- Charge again.
- Charged.
- Clear.
[THUMPING] Back in sinus rhythm.
Another round of insulin, glucose, - and two amps of bicarb.
- Got it.
Sydney, I'm right here.
- Sam, don't do the surgery.
- Are you on drugs? You're the one who pushed for this.
I was wrong.
It wasn't a clinical decision.
It was emotional.
Yeah, well, it's too late.
- Please, talk to the family.
- I already have.
You made such a compelling case for surgery that they're determined to go through with it.
Well, tell them you refuse to do the surgery.
I did.
They said they'd get another surgeon.
At least if I do it, there's a decent chance of success.
[SOMBER MUSIC] [KNOCK AT DOOR] Come in.
Maggie? I'm applying for the Family Medical Leave Act to get the time off I'll need for recovery from surgery.
You're determined to do this no matter what I say? Yes.
Why, Maggie? Why is this patient so different from any other? She isn't.
I see so much suffering every day Day after day and there's nothing I can do about it.
But this time I can, this one time.
I can.
[SOMBER MUSIC] It's just impossible to think that I would stand by and let her do this to herself.
Well, it's completely counterintuitive.
I mean, as parents, we're programmed to fix our children's problems, right? Dr.
Charles, did you release Britt? - She's gone.
- Britt? [DRAMATIC MUSIC] Britt! Britt! She took her clothes, too.
Where's she gonna go with a PICC line? She went to get high.
Let's just hope she doesn't OD.
Hey.
You were right.
I felt guilty.
Hoped I could turn back the clock.
Make it like the whole thing never happened.
Yeah.
If he wakes up worse than before, I'll never forgive myself.
Let's just hope for the best.
Connor.
I heard you're facing the oversight committee.
What's that all about? Old case, pro forma.
It's no big deal.
[SIGHS] [WHIMPERING] She's not answering any of my texts.
I knew I shouldn't have taken my eyes off her.
Jackie You don't understand.
I'm her mother.
I have to find her.
And how many times have you done that already? Dr.
Rhodes? Dr.
Rhodes, please.
Dr.
Latham, I want it to be clear that I bear full responsibility for Mr.
Corcoran's surgery and its outcome.
Be that as it may, we didn't call you in to hear your statement.
We called you in to apologize.
- Apologize? - Dr.
Bekker made it eminently clear that all of your decisions were sound both medically and ethically.
I reviewed Mr.
Corcoran's chart and, given the severity of his injuries, find no reason to disagree.
I'm not sure that Dr.
Bekker knows the details of the case.
Dr.
Rhodes, the committee has determined that you are not at fault for Mr.
Corcoran's death.
[TENSE MUSIC] You may go.
You told them that I did everything in the patient's best interest? Yeah.
You and I both know that some of my actions were questionable.
We have no way of knowing if they had any effect on the outcome.
Still, the oversight committee should have heard Why, so you can face peer review and lose your license? Connor, I did it for you.
I'd do anything for you.
Sam? I was able to remove the bullet without causing any more trauma.
So? He'll be fine.
Thank you.
You know, your behavior today has been erratic, irrational, and impulsive: hardly qualities one wants to see in a physician.
You need to get your head out of your ass.
[TENSE MUSIC] There's nothing you can do right now.
We just have to wait and see how Sophie responds to the antibiotics.
Why don't you go home and get some sleep? Okay.
[KNOCKING] Come in.
Mrs.
Goodwin, um I'm not entirely comfortable with how things were left with the oversight committee.
I am.
I just don't think that Mr.
Corcoran's case was accurately presented.
I'm guessing you're talking about when you lightened his sedation so Detective Halstead could interview him.
- Yes.
- And wasn't that done in an attempt to save Will Halstead's life? I assume when you made that decision you hoped Mr.
Corcoran would survive.
Mrs.
Goodwin, lightening Mr.
Corcoran's sedation might have contributed to his death.
Might have.
There's no way to know.
He was gravely injured when he was brought in.
You know, I was reminded today, in our effort to help people that we sometimes find ourselves in situations where what's right and what's wrong isn't entirely clear.
And we can only hope that the decisions we do make are coming from the right place.
Go home, Dr.
Rhodes.
- Hey.
- Gabriel pulled through.
He's gonna be fine.
Glad to hear it.
For both of you.
Yeah.
Sam Abrams told me to get my head out of my ass.
He's right.
Don't be too hard on yourself.
It was a tough call.
I get it.
- I gotta find Nat.
- Night.
Congratulations, Connor.
Heard you got a pass.
And I'm sure you thought I was the snitch.
You know, the thought crossed my mind.
I wish I could take credit, but your patient croaked in the ICU and I didn't even know about it, so I guess the question is, who was the snitch? Why now? Months after the fact.
Got an enemy out there.
So you'll be in tomorrow? Yeah, I'll see you in the morning.
- Dr.
Manning? - You can call me Natalie.
Natalie.
If it weren't for you, I don't know how I would get through this.
- So thank you.
- Yeah.
- Have a good night.
- You too.
- Natalie.
- Yeah? What's going on? What? I came to apologize and tell you I wanna start taking therapy seriously.
That's great.
But I find you hugging this guy.
- Will, I - No, tell me something.
Was it all really about me having a gun or was it about another guy and you just couldn't tell me? I don't even know what to say to that.
That man just lost his wife.
His baby could die.
He is all alone.
He needs someone to be there for him.
So do I, Natalie.
So do I.
[SOMBER MUSIC] What are you doing out here? Aren't you going home? I've been thinking who was in the hybrid OR who knew about my decision who had the expertise to judge it.
You think it was Marty? Or Sofia? No, if they'd had a problem they would have raised it at the time.
I think it was you.
What? I-I defended you.
[SCOFFS] Exactly.
You're You're like a pyromaniac that sets a fire just to put it out.
Why in God's name would I do that? For the same reason you slept with my father and put your hand where you knew I would cut it.
- What? - To keep me tied to you.
Risk my health? Like you said, you'd do anything, right? This is insane.
My God, can you hear yourself? Ava, I think you got a problem and I think you need to get some help.
I've done nothing but support you and help you.
You're the one with the problem, Connor.
You're the one who should get some help.
[SOMBER MUSIC]