Chicago Med (2015) s05e12 Episode Script

Leave the Choice to Solomon

1 From the looks of that rock, I'm guessing you didn't tell Ethan.
No, I didn't, and I would appreciate it if you didn't mention it again.
Mention what? I want us to try to get pregnant again.
I'm proposing opening a safe injection site at the hospital.
Preventing deaths would save the hospital money in the long run.
Allow drug use on our premises? A PR nightmare is how I put it.
- There's another way.
- An unsanctioned site? But they're illegal.
You could lose your license.
- You in? - I'm in.
Did you get any sleep? Nah, got busy around midnight and never let up.
I did a lot of counseling, though, - and set up that rehab consult.
- Great.
And I just heard back from our new hookup on clean needles.
Get me a Narcan inhaler.
She OD'd.
Hang in there.
It's okay.
You're okay.
What You overdosed.
But you're gonna be all right.
Overdosed Oh, my God.
Oh, my God, oh, my God.
What's your name? - Val.
- Okay, Val.
Let's get you into a bed, and, you know, maybe later, we can have a talk.
All right.
This is why we're here.
You realize I could do this myself, right? True, but Dr.
Patchefsky did say IVF is a team effort.
So any negative effects from the hormones? Headaches, mood swings? Are we counting the growing urge to pump my teammate full of hormones? I hope not.
- I'm doing great, babe.
- Good.
Maggie, good morning.
- I guess.
- What's the matter? My oncologist.
She says I'm not responding to the radiation the way she'd hoped.
We have to add a course of hormone therapy.
Oh, Maggie.
It's fine.
I guess that's how it goes.
Well, I'll call someone in.
You take the day off.
No, really, I'm fine.
It's only one day.
There'll be others.
Yeah Oh, no.
What's up? - We've got a school bus crash.
- How bad? They need doctors over there right now.
Marcel, Dr.
Manning, I need you to hop on an ambo and get to mass cas MVC school bus.
- How many passengers? - 30 to 35.
I'll get the packs.
Guess I'm gonna be here for a while.
- Keep me posted.
- Will do.
Natalie, hey! I need you over here, guys.
What happened? We got two kids in the front seat.
It's gonna be tricky getting them out.
Why? What's wrong? A bunch of rebar flew off this truck, went through the windows.
Luckily, most of the kids were in the back.
Help us.
Help us! Please, help! Okay, hang on, bud.
We're coming.
- Oh, my God.
- Help us, p‐please.
Get us out.
- Getting cold.
- I know.
We're gonna get you out of here right now.
- Are we good? - Yeah.
You're doing great.
I'll be right back, okay? Hang in there.
Lieutenant, a word please.
Henry's got good pulses in his neck, but Kate's bleeding into her belly, fast.
Normally, I'd cut the bar in between, but they're pinned together pretty tight.
So what do we do now? Slide her down a couple inches, make some space? No, she's already shocky from blood loss.
Moving her could shear the vessel wide open.
Just let me know what works for you.
- We'll make it happen.
- Can you give us a moment? He's right, there is no other way to move them.
Yes, there is.
We get more blood to up their reserves, - then we cut 'em out together.
- What? But we don't know where the rebar is in Henry's neck.
One wrong move and we could tear into a vessel.
Maybe, but if we slide Kate, we'll lose her for sure.
Look, you are gambling a kid's life on a Hail Mary.
Natalie, we got two kids here.
If there's any chance of saving them both, I'm taking it.
All right.
Someone you should take a look at.
Oh, I gotta get to work.
All right.
What's wrong? He's got a fever, pale, short of breath.
- I'm a doctor.
- Uh, Mike.
How long have you had a fever, Mike? I don't know.
A few days? You've got a pretty significant heart murmur.
It's very likely you could have something called endocarditis.
Give me a break, man.
- Have you had it before? - Yeah, I've had it.
I got my valve replaced last year.
I need to take you to the hospital.
I'll just end up back here.
We can find a way to treat your addiction.
Oh, forget it.
Nothing helps.
We have resources to help you.
Mike, you know better than anyone.
If we don't fix your heart valve, it'll kill you.
Let me take you in.
All right, first wave of kids are coming in.
- Dr.
Choi, you're up.
- On it.
Alice Winston, 12‐year‐old with shortness of breath and chest trauma, respirations at 24, heart rate 83, sats 92%.
Hey, Alice, I'm Dr.
You're gonna be okay.
We're gonna take good care of you, okay? All right, let's transfer her on my count.
All right, nice and easy.
Ready? One, two, three.
Oh, that sounds like it hurts.
Hey, Alice? Any dizziness, nausea, blurry vision? - No.
- Good, that's good.
- Any pain anywhere else? - Uh-uh.
Alice, sweetie, are you okay? I have a feeling she has some broken ribs.
Is it bad? We'll get some X-rays right now, but other than a little heavy breathing from the stress, she looks good.
- Okay, okay.
- Oh, thank God.
Hey, Alice.
I'm gonna give you a little more medicine for the pain.
Does that sound okay? You're a champ.
I'll be back in just a bit.
April, Dr.
Marcel is bringing in two traumas.
Stand by.
Marcel? Can someone else do it? April.
Please, I I'm really messed up.
I don't want to, but I can't stop thinking about him.
Okay, but whatever you're feeling, you've got to get over it.
- You hear me? - I know.
Thank you.
- Thought I recognized you.
- Maggie, right? Mm-hmm.
Taxotere, adriamycin, and Cytoxan, right? Yeah! My old chemo regimen.
We know each other from the infusion center.
So what's going on? If I remember, you were having trouble finding a match for your bone marrow transplant.
Took eight months, but we got one.
A woman, scheduled for next week.
That's great! So what happened today? He passed out.
You have severe anemia from the leukemia, and it's giving you intermittent dysrhythmias.
I'm gonna get you some blood, and then we're gonna see how you respond.
Thank you.
Excuse me, Dr.
So, how bad is it? We need to move the transplant up as soon as possible.
Okay, I'll call the donor.
See if we can get her in today.
I'd see if we can get her in in the next hour.
I have assessed your endocarditis patient, and I've decided not to perform the valve replacement.
But he has plus-four aortic regurgitation.
He won't survive without a new one.
But he's already infected and destroyed two healthy heart valves.
Every indication is that he will do so again.
Not if he stops using.
I don't see any evidence that he will, and heart valves are quite costly both in time and resources.
And there are too many children from the bus crash who require my attention.
Latham, I think beneath the addiction, Mike may be depressed.
So if we can treat that, it might push him in the right direction so that eventually we can get him off drugs.
Then the new valve would be safe.
Halstead has a patient who is a heroin addict.
I'd like you to evaluate him for surgery.
Oh, be happy to meet him.
Thank you.
If Dr.
Charles clears your patient, then I will schedule the procedure.
Thank you.
Hey, um, you wouldn't have happened to have come across this patient at your friend's safe injection site, would you? I did, and I know you think it's a bad idea.
It's illegal, buddy.
We're doing a lot of good there.
Yeah, well, you're not gonna be doing any good anywhere if you lose your license and go to jail.
We can talk about that later.
Please, just go talk to Mike.
Blood's in.
Stay with me, okay? Just hang in there.
Do you need civilian vehicles to get out of the way? There's still time to change our minds.
We're doing this.
You ready? - Yeah? - Yeah.
Okay, we have to keep these kids perfectly still.
There's no movement, shifts, nothing, all right? All right.
You're doing great.
- Let's get 'em out.
- Okay, easy, guys.
You ready? Nice and easy.
Here we go.
You all right? Okay.
We're gonna get you out, okay? - Ready? - Yeah.
I hope you're right about this.
Open the Hybrid Room.
We're coming straight in.
Need an extra gurney.
- How do they look? - Boy's stable.
Girl got 3 units in the field, GCS 11, BP's 80 over palp.
All right, start her on the MTP, 4 plasma, 4 blood.
- Right away.
- Let's get two FAST scans.
You're okay, bud.
You're all right.
What are you doing? Just taking a quick look, okay, bud? I can't get a window.
Must be in the kidney.
Oh, she's got a ton of free fluid in there.
- What about him? - Rebar got the jugular.
- You gotta be kidding.
- How bad is it? We won't know until we lift him off.
Hell of a move, bringing him in like a shish kebab.
We need some Betadine and a lot of Kerlex.
Kate? Hey, Kate, stay with me.
- Is she okay? - She's unconscious.
- We need to move 'em.
- All right, buddy.
It's time to get you off this thing.
- You ready? - Am I gonna die? No, hey, no.
No, you've got a whole hospital of people who just want to take care of you, okay? - Okay.
- Okay.
All right.
My count.
One, two, go.
Oh, that hurts.
You're doing great, Henry.
Keep him steady.
You're okay, buddy.
You're okay.
- Little more.
- Okay, he's off.
Get me some gauze.
Okay, yep, he's still bleeding.
All right, let's get him up to CT, see how bad it is.
All right, if it's just the vein, he could be okay.
It's gonna be okay.
All right? Okay.
All right, Dr.
Marcel, let's scrub in.
We've got a lot of work ahead of us.
Hey, Doc.
What do you think? Well, it's tricky, you know, because active addiction tends to mask whatever underlying pathology might be present.
I mean, he could very well be self-medicating, but what? Is it depression, is it bipolar, or, you know Yeah, understood.
And we can figure that out later, but right now, a diagnosis is what's gonna save his life.
It's not quite that simple, though.
You understand his heart is a ticking time bomb.
Every minute we let go by increases the chances he's gonna die right here in front of us.
I wanna help him too, but in order for the surgery to be successful, he's gotta be willing to get clean, and right now, I'm just not seeing a whole lot of evidence that he wants to do that.
We're doing everything we can.
The doctors are still examining the victims.
Any word on our son, Henry Chase? We heard they brought him in with Kate Lawson.
Oh, she's our daughter.
They're best friends.
Henry is being evaluated in radiology.
And Kate is still in the OR.
They're still operating? Oh, my God.
Could you just let us know when they're out? - We just wanna see them.
- Yes, of course.
I'll let you know as soon as I hear something.
Thank you.
Did you schedule the transplant? Oh, Gary's donor has the flu.
Her temp is 100.
But that shouldn't affect her bone marrow.
The cutoff is 99.
But Gary has a rare HLA type.
No one else in the system is a match.
Well, hopefully the donor will get better soon.
The longer we wait, the more unstable his rhythm gets.
It's only half a degree.
Can't we just make an exception? I'm sorry, but no.
We can't.
Maggie, we got two more coming in from the bus.
Hey, what's wrong? The girl with the broken ribs, Alice.
Her pain's under control, but her breathing just keeps getting worse.
Anything abnormal in our labs? No.
X-rays showed a few mild opacities, but nothing that should be causing this.
Yeah, hi.
Has Alice had a fever recently? Runny nose, sore throat? No.
Any history of asthma or pneumonia? - No, nothing.
- No.
Sats are down at 87.
Want me to put on a mask? Yeah, and call for a nebulizer treatment too, just in case.
Anything that could cause any sort of breathing trouble at all? Family history, asbestos exposure, mold? Um, she did smoke cigarettes last year.
But only for a little while.
We caught her and made her quit.
Is that true? Yeah.
Either way, this really isn't what we normally see from a smoking related illness.
So we need to keep looking.
If that was our daughter, her smoking history's the first thing I'd be telling the doctor.
I'm sure they're just embarrassed.
I mean, they probably feel like they've got it under control.
Yeah, I guess.
It just makes me wonder if there's anything else they're not telling us.
- He's tachycardic in A-fib.
- Doc, my chest is killing me.
- Want me to push Cardizem? - His pressure's dropping.
Milligram of morphine and Versed, synchronize and charge paddles to 50.
Mike, tear on your valve must be extending in to the electrical system of your heart.
I need to reset your rhythm.
Okay, let's go.
Charged to 50.
Rhythm's back.
Start him on an esmolol drip.
- They giving me a new valve? - I'm working on it.
It's just taking some time.
Hey, doc.
Whatever it takes.
I don't want to live like this anymore.
Hey, you seeing this? He is running out of time and needs our help.
And believe me, Will.
I wanna help.
- Then do it.
- Do what? You want me to just, like, make something up? Look, I appreciate the clock is ticking here.
So if you want me to try and talk to Dr.
Latham And tell him what? You know what? Forget it.
All right.
Kidney's free.
Oh, man.
Got the lateral cortex, and 3 centimeters into the hilum.
Maybe we should salvage.
Ah, nah, there's too much damage.
We're gonna have to take out the whole thing.
Sure hope we're not wasting our time here.
Marcel, there's an emergency in the CT scanner.
It's your other patient from the bus.
I'll handle the box kidney, okay? Go check on the boy.
Sats are down at 81.
His hematoma's expanding.
He must've started to bleed.
It's compressing his airway, so let's get a tube in fast.
Get etomidate and sux.
Getting a lot of resistance.
His sats are down to 72.
It's not going through.
68, give me a crich kit.
No, we're not gonna put another hole in his neck.
Got it.
He's still actively bleeding.
Damn it.
I'll call the OR.
- I'm puzzled by this order.
- Yeah? Your patient was written for antidepressants, but it's not from psychiatry, it's from you.
Yeah, right, I totally forgot to tell you, Dr.
Charles was gonna write it, but he got pulled off on an emergency.
Yeah, with the bus crash it's been just crazy down here.
Ah, of course.
Very well, then.
I'll let the OR know that Mr.
Monroe will be coming up immediately.
Thank you, Dr.
- Hey, Maggie.
- Hey.
Can I get you something? I just forgot to ask if you're still with that guy.
Vincristine Leucovorin Ben.
- And yes, I am.
- Seems like a good guy.
Anyway, I just wanted to say thanks.
I know you've been fighting for me.
Well, you can thank me after the transplant.
- I'm not done yet.
- I'm sure you're not.
But you know how this goes.
One day your numbers are bad, and you're crushed.
Then they get good again, and you can just beat the world.
Up and down, over and over.
But this time, it feels different.
I don't know if I've got another "up" left in me.
You don't talk like that.
You may not know this about me, but when I put my mind to something, I get it done.
So you just stick with me.
Where am I gonna go? That's right.
- Doris.
- Hmm? How do Gary's labs look? - Lower than when he got here.
- Huh.
- Come here.
- What? - I'm gonna draw your blood.
- What? - She can't breathe! - Sats are down to 74.
We need to intubate.
15 of etomidate, 70 of sux.
Alice, sweetie, I'm gonna have to sedate you so we can put a tube in to help you breathe, okay? Wait, wait, wait, you mean the machine is gonna breathe for her? She can't do it anymore on her own.
- We don't have a choice.
- Meds are in.
- There you go.
- Alice? I'm in.
Sats up to 83.
- Why is this happening? - I don't know.
Order a new round of tests.
We're gonna figure this out.
I need to get some air.
How'd she do? The surgery went well, but then again, eight units of blood, so she may end up with deficits, or not even wake up at all.
Just gotta wait and see.
I assure you, as soon as we know any answers, - I will let you know.
- Is that Dr.
Marcel? Why didn't you separate Henry and Kate - before bringing them in? - My brother's a doctor.
He says you never move people together like that.
Kate was in bad shape.
We didn't have a choice.
What do you mean? Well, keeping 'em together was the only way to save her.
She was gonna die.
Wait, so you endangered our son? - How could you? - I didn't have a choice.
Not if they both could have a chance to live.
No, you did have a choice.
And you have no right to make it.
I understand.
I do.
And I'll speak with you after your son's surgery.
Okay? If you'll excuse me.
- I tried to keep them calm.
- Yeah.
No, they're right.
I'll come back to answer their questions as soon as Henry's carotid is tied off.
What? You're gonna tie it off? But he wouldn't have normal blood flow to his brain for the rest of his life.
Why not reconstruct? Reconstruction is long and risky.
He's already lost a lot of blood.
- So? - So it makes him a poor candidate for prolonged anesthesia.
Well, I know what it means.
I just don't understand why you're suddenly trying to play it safe.
Because I've already done enough damage today.
I'm not gonna do any more.
That boy deserves to come out of this with the best outcome possible.
So you need to go in there and do everything that you can to make sure that happens.
Okay? What's going on here? I'm checking the staff to see if there's a donor for Gary.
Maggie, we've got an ED full of injured children.
- Our staff is needed in there.
- I know.
And that's why I'm going as fast as I can.
Maggie, we can't have this.
But if we If we don't find a donor for him today, he's gonna die.
After battling cancer for a year, every day, and then to have a cure right there, right in his hands, and then to have it taken away? I've got a hospital full of patients who need care.
Back to work.
Excuse me.
My little boy's in there.
He was on the school bus.
And I hope someone would do this for him.
Where do you want me? Right here.
What the hell is wrong with you? What did you do? Dr.
Charles, I already lost an addict that I helped get hooked on opioids.
I'm not about to lose another.
You let this get way too personal, Will.
Never a good idea.
For God's sakes, isn't it personal? You lost a brother to drugs.
What's that got to do with anything? You've been there.
Okay, you should know that we can't endlessly deliberate over every patient.
Enough! You have a lot of nerve bringing up my little brother.
But since you have, not a day goes by when I don't miss him or wonder what I could have done differently, but what I never do is bring that to work and let it affect my professional judgment.
Kay, how we doing? Carotid's mobilized.
Ready to tie.
Okay, silk tie on a pass.
Open a patch.
We're switching to reconstruction.
You sure? He's pretty coagulopathic.
I'm sure.
Adjusting the upper clamp.
He's bradying down.
Give me a 3-inch shunt.
Marcel, if we just tie the carotid off Give me the shunt.
Come on, come on.
Rate's down to 42.
I'm in.
Rate's back up, 63.
Let's get started on this patch.
Walker, there's no vaping allowed in the hospital.
Oh, sorry.
I didn't know.
Let me ask you something.
Does your daughter vape? What? No.
Well, I mean, she did, but just to get her off the cigarettes.
You know.
Doctor? - What's going on? - She's been vaping.
- Mind if I look at this? - Sure? I don't think you're gonna find anything.
She stopped vaping six months ago.
She's 12 years old.
Do you have any idea how dangerous that is? It's better than smoking.
That causes cancer.
She only did it for three weeks.
- She did it long enough to quit.
- I mean, it's totally safe.
Vaping's not addictive like cigarettes are.
Oh, my God.
Are these yours? No.
She must've gotten them from school or from her friends.
We had no idea.
Oh, my God.
Let's wait and see what the last few tests show.
We'll be back in a little bit.
Ronnie? Any luck? No.
You do realize you found almost 40 potential donors? We usually don't get that many in a month.
It's a match.
We got a match.
- Are you sure? - Maggie, this is the one.
Oh, my God.
Thank you so much, Ronnie.
- We've got a match! - Clear.
Oh, my God.
Gary? Doris, I'll take over.
Come on, Gary.
- Charging to 200.
- Come on, Gary.
- We'll get you through this.
- Clear.
Come on.
Let's go! Charge to 200! Come on, Gary.
- I'm sorry, Maggie.
- Charge it! - Maggie.
- No.
Time of death is 17:36.
Marcel, I'm sorry about before.
Thanks for saving our son.
Yeah, of course.
How's Kate? We don't know yet.
Kate's waking up.
Kate, sweetie, do you remember where you first saw me? Th-the bus? Yeah, good.
Really good.
Can you wiggle your toes for me, sweetheart? That's good.
That's good.
Can you squeeze my finger? Tight.
Like that? Yeah, just like that.
Did you get the other tests back? I'm afraid they were all negative.
So it was the vaping.
We call it EVALI.
E-cigarette or vaping associated lung injury.
She must've already had it, but the bus accident pushed her over the edge.
Um, so how long till she gets better? I wish I could tell you, but we don't know if she will.
What do you mean? This condition is so new, we're still figuring it out.
Your daughter may begin to breathe again on her own, but she may not.
Never? It's possible.
But the truth is, some people don't survive.
Oh, my God.
I'm very sorry.
Those poor parents.
And Alice.
All day long, I just I had a feeling I wasn't being told the truth.
Hey, I'm sorry about today.
And for bringing up your brother.
But you know what? It was all for this.
Just, um, caught his girlfriend trying to pass that to him.
Right now? Here? Yeah.
What oh, my God.
It's a long road, Will.
No shortcuts.
- Hey.
- Hey.
- Quite a day.
- Yep.
Risky call.
But you did it.
Yeah, well, didn't do it alone.
You were so adamant this morning on the bus.
I've never seen you like that before.
What was going on? Nothing.
It was a choice.
A choice no one else would've made.
Why did you? Because no one should have to lose a child.
No, of course not, but it was still I'll see you in the morning, Dr.
- Hey, Maggie? - Oh, hey.
I heard about Gary.
I'm I'm so sorry.
And I'm sorry for making a difficult day worse.
Oh, I've got something I want to show you.
Come with me.
What's this? We were able to match some of the donors you found with other patients waiting on the transplant list.
All these people? Yeah.
And there are more on the way.
You saved a lot of lives today, Maggie.
Ready to do it again? Listen, Sean, I'm sorry, but I don't think I can do this anymore.
Whoa, what's going on? Just not cut out for it.
Will, we have all had these moments.
Doctor, there's someone here to see you.
- Hi.
- I met you this morning.
When I was foaming on the ground.
Yeah, I remember.
Um I'm new here, and This place is a godsend.
Anyway, I just wanted to say thanks for saving my life.
I'm gonna try to turn things around.
I'm glad to hear that.
Hey, Uncle Dan.
Practice always end this late? When do you do your homework, man? I'm a psych major.
You can basically make it all up as you go.
That's funny.
You, uh, you hungry? Is that a question? Come with me.
All right.
So, you checking up on me? Uh, no.
Not really.
I don't know.
All right, don't worry.
I'm still clean.
The team checks my pee every month.
I loved my dad, but I'm not gonna end up like him.
You know how proud I am of you, right? - Yeah.
- Do you? - Yeah.
- Good.

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