Chicago Med (2015) s06e11 Episode Script
Letting Go Only to Come Together
1
I came in with this patient.
I'd like to see it through.
I got a team.
Thanks.
Hey, April, you saved his life.
You're pretty good for a nurse.
Should've gone to med school.
We have to stick with the playbook.
Or we try something else.
We have something better in mind.
How do we sit here and not even try? - I'm with you.
- Charged.
Clear.
Okay, let's give it a minute.
Going behind my back, throwing up Hail Marys? You and I have a problem.
Dr.
Marcel? I've got this new device.
Promoting your products for unapproved uses? They could've worked.
This is far beyond the bounds of professional conduct.
I started seeing someone new.
Dr.
Marcel.
You haven't introduced him to Owen yet, have you? Where is all this coming from? It was pitch-black.
I couldn't see my hand in front of my face.
So here I am, moving slowly, cautious, skimming my flashlight across the water, when there he is.
You do remember that I have a heart condition? Oh, in that moment, I did too.
He was big.
Terrifying big, right? But I was gonna get him.
Oh, dear me.
You went in closer.
Oh, I had to.
All or nothing.
So I eased in, lined him up.
Then, pop! Got him.
Look at this.
- Oh, wow! That's amaz - Look at that.
No, it's like he's right there.
- Right? - Yeah.
Wow.
- Hey.
- Hey.
- Owen tucked in? - Yes.
Fell asleep before the door got closed.
What'd I miss? I asked Crockett about his hobbies, and he said photography.
Yes, I think we were about, what, five minutes into our first dinner before he pulled that story out and showed me the picture.
Yeah, I think it was his move to try and impress me.
- Mm-hmm.
- Busted.
But here we are, many dinners later.
Mission accomplished.
- So Crockett? - Mm-hmm? I know that you are a surgeon and have an eye for reptiles.
What else? Any siblings? - Yeah, a younger sister.
- Mm-hmm.
Lives in Baton Rouge.
And your parents? Yeah, Natalie tells me that they emigrated from Iran.
So does that mean that your family is Muslim? No, we're actually Zoroastrian.
"Zoroastrian"? I'm sorry.
I Yeah, it dates back to ancient Persia.
The three main pillars: good thoughts, good words, good deeds.
Hmm.
Not always so easy.
Hmm.
That's very interesting.
Yeah.
I had no idea.
- Does anyone want some coffee? - Yeah, I'll take some.
- Okay.
Mom, tea? - Yes, sweetheart.
- Thank you.
- Yeah.
I will be right back.
Hey.
Nice.
Is that a new suit? You want to tell me what's going on? Just got the new pharma rep rules.
Resterilization of proprietary equipment, in-house device review.
Lots of red tape.
Well, it's just some adjustments so all the reps are on the same page.
We need to make sure no one's overstepping.
This is about Dr.
Marcel and me last week, isn't it? Indirectly, Michael, yes.
Ma, I am not the only red hat who's pitched a device off-label.
I'm aware of that.
Then why does this feel personal? This wasn't intentional.
The updates are solely to protect the hospital.
It sounds like the company line.
Michael Michael.
- Uh-oh.
- Michael and I.
It's been rocky the last few weeks.
Parenthood.
Life sentence, right? Oh, you're telling me.
- Want to grab coffee? - Oh, I don't have time.
- Maybe later? - Yeah.
- Five courses? - Yeah.
Website says it'll send all the ingredients.
We just prepare it.
Okay.
I'm in.
This weekend? I know.
I know I'm late.
By 33 seconds.
Was just gonna say good morning.
But I guess you are late.
- Meet up for lunch? - Sounds good.
Still waiting to hear back on that invitation to play chess.
Beginning to think that you're dodging me.
No.
Long day.
It's the time my shift ends.
Don't have the brain power.
- Maybe play Will.
- Tried.
It didn't go well.
He's a checkers guy.
Anyway, offer's out there.
Dr.
Choi, incoming.
Treatment 3.
Courtney? Montez Price, 21.
Pro tennis player.
Hitting partner accidentally drilled him in the chest with a tennis ball.
Trainer said he was unresponsive and pulseless.
Grabbed an AED, and shocked him once.
When we got there, he was awake and in sinus rhythm.
Tested negative for COVID in the ambo.
Let's get ready to transfer, huh? Everybody ready? One, two, three.
Okay.
Vitals stable.
BP 120/82.
Heart rate's 78.
Heart is good.
Regular rate and rhythm.
Let's get a CBC, BMP, cardiac labs, 12-lead EKG, and a chest X-ray.
Hey, Montez.
I'm Dr.
Choi.
Can you hear me? My chest hurts.
- Did I have a heart attack? - No.
Your rhythm on monitor looks good.
It was likely an episode of what's called commotio cordis.
The blow from the ball disrupted your heart rhythm, caused it to stop beating.
- But it's all better now? - Yeah.
The impact caused it.
It's not your heart.
But it still feels funny.
Funny? Funny, how? Hey, Montez.
Montez! BP's dropping.
72/40.
Heart rate's spiking.
180.
He's in narrow complex v-tach.
Connect the pads to cardiovert.
- Synced.
- Clear.
Hit it.
BP's back up.
120/70.
But heart rate's still high.
110.
Bolus 150 milligrams of amio and hang a drip.
Before, his heart wasn't beating at all.
- Now it's beating too fast? - What's going on? Maybe you should check her chart first before you waste my time with this dumb question.
Morning, Dr.
Lanik.
Maggie said you requested me for the COVID ICU.
Yeah, one less person for me to micromanage.
Almost sounds like a compliment.
Anyway, thanks.
I've really missed Yeah, sure.
You good to go? Always.
Counting on you.
Go suit up.
- Dr.
Halstead, you're going to Baghdad.
- Yeah.
Liam McIntyre.
65-year-old male.
COVID negative.
GCS 15.
BP 100/70.
Rate 120.
Suspected left shoulder dislocation.
Okay.
Mr.
McIntyre? I'm Dr.
Halstead.
- You know where you are? - Hospital? All right.
Let's get ready to transfer.
On my count.
One, two, three.
Thank you.
Diminished breath sounds.
Left side.
Kathleen, we're gonna need an X-ray.
- Any pain where I touch? - No.
Okay, chin up.
Down.
Left, right.
Any pain? Good.
C-spine's clear.
Mr.
McIntyre? Liam, you with me? I'm fine.
I'm just a little rattled.
X-ray's up.
Everybody get back.
Have a small amount of fluid.
Left chest.
Left shoulder dislocated.
50 fentanyl, 2 of versed.
- Maggie, countertraction.
- Yep.
All right, Mr.
McIntyre.
We're gonna put this around your arm.
Okay.
This is gonna hurt.
- I'm gonna need you to breathe, okay? - Okay.
Mm-hmm.
Ah! All right.
Yep, all done.
Shoulder's in.
- So sorry.
- You're good, Liam.
You just rest for now.
- Okay? - Thanks.
Draw up trauma labs.
Yeah.
But did you catch how he keeps on looking at the corner of the room? Yeah, it's weird.
No evidence of head trauma, though.
He's doing it again.
Remember our trip to Tahoe? I was in a cast for weeks.
But there's no one else there.
Do me a favor.
Yeah, I'll contact Dr.
Charles.
- Mm-hmm.
- Done.
Thanks.
- Hey.
- Hey.
I wanted to apologize about last night.
- My mom - No.
No apology necessary.
Look, I grew up in the Bible Belt.
You're either Catholic, Methodist, or Southern Baptist.
Not different, you know? So I'm used to it.
Nat, Crockett, patient in treatment 4.
- Her name is Lisa Holtzman.
- Thanks, Mags.
- Okay.
- All right.
Hi, Lisa.
I'm Dr.
Manning.
- This is Dr.
Marcel.
- Hi.
Belly radiating.
"Radiating"? Not a lay term.
- You a doctor? - No.
Professional patient.
You mind if I lift your gown? Okay.
Those scars on your abdomen, laparoscopic ports? Appendix, gall bladder, all gone.
Okay.
I'm gonna Fullness in the pelvis.
All right, we're gonna do an ultrasound, okay? Okay.
Can't see anything.
Bladder's huge and in the way.
Lisa, when's the last time you urinated? I don't know.
Yesterday, I think? Well, pain could be coming from urinary retention.
Foley? We're gonna drain your bladder.
It should help ease the pain.
- Okay? - Okay.
And get you some med too, all right? My bag.
Grab what's inside.
What is all this? My medical records.
Hey, Montez.
How are you feeling? Exhausted.
And then there's all this Your heart's still beating irregularly.
Too fast I'm trying to get a read on why.
Your vitals are fine.
EKG and echo were both normal.
- So you're saying I'm healthy? - No.
The chart is, but it's wrong.
The heart of a 21-year-old pro athlete should not spontaneously go into A-fib.
This can't be it.
I'm too close.
My father loved tennis.
I was maybe four.
He tossed me balls.
Pretended it was the U.
S.
Open.
He'd say, "One day, Montez.
Arthur Ashe Stadium".
He died when I was seven.
I've been training for the Open ever since, and now, I'm inches away.
I need to play in that tournament.
I'll keep looking, figure this out.
Seriously? Damn it! Put pressure.
Lean your head forward.
Ice pack.
I got it.
I got it.
It happens when I'm stressed.
It'll stop.
- What the hell, Sharon? - Ms.
Goodwin, I'm so sorry.
That's all right, Cheryl.
I always have time for our COO.
Well, my phone has been ringing off the hook this morning.
Angry reps.
Your unilateral changes to our red hat protocols they're trouble.
I have to do what's best for the hospital, Gwen, which means reducing liabilities wherever they are.
Our relationship with pharma and biotech, they help keep the lights on.
If Med is suddenly difficult to work with, they move to East Mercy.
We lose funding.
This is our house.
They can play by our rules.
Not these.
I'm shutting them down.
Three.
Good.
Mind me asking where you were headed this morning - when you had your accident? - Nowhere really.
Four.
Right.
Just out running errands? Just driving.
Was cooped up for over a year.
But now that I'm finally vaccinated, I'll take any excuse I can to leave the house.
I hear that.
I mean, whoever thought we'd actually be looking forward to picking up our dry cleaning, right? No fingers yet? Now, I see it.
Two.
Okay.
Okay, good.
So, Liam, tell me, uh, what's in the corner? What? No one.
Wait, is it a person? It's my wife.
Terri.
Okay.
She died three weeks into lockdown.
Aneurysm.
Very sorry to hear that.
We were actually looking forward to being quarantined.
Cook all those recipes we never had time for.
Then she was just gone.
Look.
I know she's dead, but I swear, she's she's right there.
You know what? I believe you.
Tell me, how long roughly have you been seeing her? A few months.
I know my mind is playing tricks on me, but I don't care.
Losing Terri was devastating, so having her back, even like this, it's salvation.
You know, I, um I actually lost my wife not that long ago, so trust me, I get it.
Look, I'm going to have a quick chat with Dr.
Halstead, and then, I will I'll be back.
- All right? - Okay.
So what do you think? Dementia? No.
You know, he's lucid.
He's oriented.
His peripheral vision is virtually nonexistent on the right side in both eyes, all right? And that blind spot is exactly where he's seeing his dead wife.
So she's a visual hallucination.
Right, and I think we're looking at Charles Bonnet Syndrome, right? Where the brain responds to vision loss by filling in the blanks.
But here's the thing.
I'm not seeing any evidence of, you know, standard signs of vision loss, which makes me think that we're I don't know.
We might be looking at some deeper brain or eye issue.
I'll order an MRI.
- Thank you.
- Yep.
Lisa, hi.
So we got your initial lab results back, and it was normal all across the board.
I'm sorry.
Normal is usually good news.
I let myself get my hopes up.
I shouldn't have done that.
Volume seven of my 16-year war with abdominal pain.
All I know, it's not IBS.
Or endometriosis.
Or interstitial cystitis.
Kidney stones, pancreatitis, bowel obstruction.
It hurts the worst right here.
There has to be a reason.
But I have been poked, prodded, scanned, cut open, and no one ever finds anything! Lisa, I can't even imagine your frustration But I don't need sympathy.
I need you to fix me.
We'll do our best.
Unfortunately, that does require more pokes, prods, X-rays, scans.
Have at it.
Okay.
Hi.
Ms.
Caine? I'm April.
What happened to your cannula? Pulled it out.
Who knows what's really in it? And you don't need the space suit.
Hmm, one day.
But for now, it's a precaution we take in the COVID ICU.
- I don't have coronavirus.
- No? It's not real.
Big scam.
Okay.
But I can see you're having trouble breathing.
It's just the flu.
Get it every year.
Well, flu or not, a little extra oxygen might help you feel more comfortable.
What do you say? Want to give the cannula another shot? Fine.
Okay.
I saw him play a couple of months ago.
On TV, that is.
You're a tennis fan? I was that night.
Couldn't sleep.
His match was the only show that was on at 2:00 a.
m.
Hell of a player.
Is he gonna be okay? I'm not sure.
A-fib problem.
Don't know why.
Well, I'm a cardiologist.
Can I help? Thanks, but technically, you're limited to seeing patients who are part of your clinical trial.
Totally understand.
I cauterized the active bleeders.
Should help stem the tide.
Kid keeps asking me if his career is over.
I didn't know what to say.
Neither do I.
Thanks.
Dr.
Virani.
I reconsidered.
I'll send you the chart.
- Hey.
- Hey.
What's this? That is a Persian spice set.
- Gift from your mom.
- Oh.
Even comes with a, uh an array of popular recipes.
Oh, this is awkward.
I'm Iranian.
We love to cook.
It's a wonderful gift.
Thoughtful.
Never got a gesture like that from my ex in-laws.
What do you mean? You know, a Persian Zoroastrian son-in-law is not what they had in mind for their southern belle.
I mean, from the little I know about Claire, you two seem pretty different, so Opposites attract, I guess.
Didn't keep us together, though.
Uh, is that Lisa's latest test results? Yes.
The labs are all normal.
Same with the KUB and trans-vaginal ultrasound.
Next up is a CT.
I'll squeeze that into my locker.
I'll meet you upstairs.
Sharon.
- You know the E.
D.
's hurting for staffing.
- Mm-hmm.
But same time, with the pandemic, nursing and med school enrollments have surged.
- A silver lining.
- Mm-hmm.
I was thinking we expand the E.
D.
training programs to match demand.
Puts Med on the map, and we get helping hands.
- Win-win.
- I like it.
Write a proposal.
All right! What's up? I updated Med's protocols for the pharma reps, and Gwen's undoing them, playing hero in the process.
And now, all the reps owe her one.
No doubt she'll enjoy using that against me.
My smile convincing enough? - Very professional.
- Mm-hmm.
Grand Mal seizure.
- Five of Ativan.
- Yeah.
Mr.
McIntyre? You just had a seizure.
Terri? Terri? Terri, where are you? Terri? Oh! Oh, there you are.
Oh, there you are.
Thank God.
A tumor? In your brain's vision center.
The left occipital lobe.
It caused your seizure.
And it's safe to assume an earlier one led to your car accident.
Vision center? - That's also why - That's right.
The tumor created a blind spot, right? And in order to make sense of that void, your brain has been filling it in with images of your wife.
Now, Liam, I know a brain tumor can sound overwhelming, but yours is treatable.
- Surgery? - Right.
It'll eliminate the risk of another seizure, and it'll correct your peripheral vision loss.
But I'd lose my wife.
She she'd disappear.
Yeah, I mean, you would you would no longer see those images of her.
I don't want the operation.
Mr.
McIntyre, without the surgery, you will have more seizures.
And they'll be more severe.
I mean, you could even lose your eyesight entirely.
When Terri died, I was lost.
But now, it's it's like I've got her back again.
She she's everything to me.
You know that I understand how grateful you are to have Terri back in your life, but another seizure would probably put you into a coma.
I mean, it could kill you.
Since Terri died, I haven't really been living anyway.
I want to go home.
Mr.
McIntyre, I can't in good conscience discharge you without a treatment plan.
I'll sign whatever I have to.
I just want to be with my wife.
Uh, you know, we will, um we will get the paperwork going, okay? Thank you, Liam.
We're not letting him go home.
- I agree.
- Okay.
Psych hold, then? Will, he's not mentally ill.
He's grieving.
I mean, we're asking him to say goodbye to his wife.
You know, again.
So what's our play? Honestly, I don't know.
Can you buy me a little time? Yeah, I can slow-roll his AMA paperwork.
- Thank you.
- All right.
You brought Dr.
Virani in on your case.
I needed a consult.
Usually we call Cardiology for consults.
No one upstairs has London Heart Hospital on their résumé.
So I'm sure the resident Cardiology would've sent down will understand.
Dr.
Lanik? Gina Caine in 3 Oh.
Ms.
COVID is a Hoax? I upped her high flow O2 and RT is ready to convert to a BiPAP, but it's just delaying the inevitable.
She'll need to be intubated.
Yeah, but is she gonna give consent? It's been tough just keeping her on the cannula, so it's doubtful.
Well, you better change her mind.
It looks like there's mildly distended loops of small bowel.
- Could be a partial obstruction.
- I'm not sure.
If it were an obstruction, I'd expect the bowel to be a lot more dilated than it is.
So what? We just agree to disagree? - I mean, that doesn't help her.
- Damn it.
I know something's causing her pain, and if it's in there, we just don't know what it is.
Can't see it.
Uh, Kara, build the scan into a high-res 3D rendering.
Focus on the left flank, where her pain is the worst.
- Well, how about that? - Renal vein is compressed.
I mean, it looks like it's causing significant left-sided venous congestion.
That isn't just painful It's excruciating.
Same drill as before.
Set up to cardiovert, then 200 milligrams of amio followed by a drip.
A-fib with RVR.
Replay on his intake.
- Okay.
Synced.
- Clear.
Hit it.
BP's coming back up.
122/73.
Heart rate's settling.
140.
Still too high.
Add an esmolol drip.
It happened again? - My heart? - Yeah.
Doesn't make sense his heart's beating irregularly, but there's no evidence anything's actually wrong with him.
I looked at his chart.
The only other anomaly is the nosebleed.
And you think the nosebleed's connected then? Could be.
I once treated a guy who slipped in the shower and dislocated his shoulder.
Random accident, right? It turns out, he had undiagnosed celiac disease.
A poor B12 absorption leads to anemia Leads to weakness in his feet, leads to falling in the shower.
Nothing random about it.
Trini, repeat CBC, BMP, cardiac labs, echo.
Leave the EKG.
We're starting over.
This is the reason? The renal vein is being compressed? It's called nutcracker syndrome.
Because the pain feels like you're being squeezed by a nutcracker.
All this time.
Right there.
How'd all the other doctors miss it? It hides.
Only get to it by ruling out everything else first.
I'm relieved to finally have an answer, but my pain, it's more than a squeeze.
I'm being crushed by a car compactor.
Yes, we suspect a compounding issue, a second disorder affecting the ureter.
Loin pain hematuria syndrome.
So misery on top of agony.
- What's the fix? - Surgery.
There are two options.
First is a renal vein transposition.
It'll relieve the nutcracker syndrome, but unfortunately, it may not do anything for the loin pain.
Option two? Embolize the renal artery.
This will help with the loin pain, but may aggravate the nutcracker.
So let's do both.
The thing is, you can't do both.
Together, they would put too much stress on the kidney's blood supply.
The organ would fail.
Then, no.
To both options.
Neither ends my pain, so what's the point? Less pain could make a huge difference in your life.
Zero pain is something.
Everything else is just history repeating itself.
Procedure after procedure, all of them, colossal failures.
I can't take another one.
I will lose my mind.
I am always going to live in pain.
It's just time that I accept that.
Hey.
If you're busy, I could come back later.
Oh, hell no.
This case had me going in circles.
Thank you very much.
You're welcome.
- So? - Hmm? Your day going any better? No, in fact, it fell off a cliff.
It wouldn't have anything to do with these updated protocols I've been hearing so much about? The reps are angry with me.
DEFCON 1 with Gwen because I got the board involved.
And then, there's Michael, who thinks these protocols are solely because of him.
And you don't think there's even a tiny bit of truth to that? Really? You too? If it were any other rep at the center of this thing, you think it would have gotten quite this far? Probably not.
He's my son, Daniel.
When he started working here, I was so excited, but I just don't know how eventually that doesn't get complicated.
Hmm.
Yeah.
Ain't that the truth? Well I've got a hard decision to make.
I'm here if you need me.
Thanks.
Montez's repeat labs, all good.
Same for the repeat echo.
His heart's now beating normally.
He's back in sinus rhythm.
Yeah, but still no clue as to why it started beating irregularly or now why it stopped.
Dr.
Choi, Dr.
Virani, it's Montez.
- What's happening? - Coughing up blood.
That's not a nasal or a cardiac problem.
- It's a lung issue.
- Yeah.
They sound junky.
We need another chest X-ray.
I'm falling apart.
Hey, just hang in there, Montez.
X-ray up.
Bottom of the right lung is partially whited out.
Two prior chest x-rays, that wasn't there.
No, but it is now.
We need a CT.
- Hey.
- Hey.
I got your text.
All I've been hitting are dead ends.
- You got something? - Yeah, I think so.
Kidney's at the center of Lisa's pain problems, right? There's not enough space for the blood and urine to flow smoothly, so, what if I were to move it to a place where there is? That's a massive undertaking.
I mean, if you're willing to go that far, why not just remove the kidney altogether? - Less risk of complications.
- Possibly.
But there'd be a huge trade-off.
She'd be losing a perfectly healthy organ.
I mean, look, if there were a better option, I'd be all over it.
I'm just I'm not seeing one.
A kidney transplant? A kidney autotransplant.
It's more like a relocation.
The new positioning decompresses the renal vein so there's no more pressure on the ureter.
So it both addresses the nutcracker and the loin pain.
I've been let down so many times.
You're sure this will work? - The theory is sound.
- Look, I believe it will work.
Okay.
I'll hope.
Okay.
Ms.
Caine? You need to be intubated.
No tubes.
You put people on that machine, then never take them off.
It's part of the scam so they can bill you forever.
Just give me more oxygen.
No, that won't work.
COVID attacks your It's not COVID! Gina.
Okay, I'm not supposed to say this, but you're right.
COVID is a hoax.
It is.
I know it is.
About time you admit it.
I couldn't say anything before because I don't want to get fired.
Can't go against "the hospital machine".
Exactly.
Please, just agree to be intubated.
Let me help you get past this flu.
And then, we can talk about the truth.
Okay.
All right.
Dr.
Lanik? Intubation in 3.
- Let me suit up.
- Copy.
No, no, no.
No, no, no.
Gina? Gina? Dr.
Lanik, she's crashing.
No pulse.
What do we got? Dr.
Lanik? Bag her.
Come on.
- What happened? - She went into P.
E.
A.
All right.
Milligram of epi? Already in.
What? You pushed meds on your own? You weren't gonna make it in time.
You can't do that without a doctor's order.
Got a pulse.
Sinus rhythm.
Stats are still terrible, though.
Kit's ready.
Sux and etomidate? Give me the tube and the blade.
Paperwork's ready.
It's now or never.
I'm gonna leave.
You can't stop me.
Liam, I was just hoping that you'd indulge me with one more minute of your time before we sign you out.
Okay.
What is it? Well I told you about my wife, about about CeCe and how she recently passed away.
Um, whenever I had a big decision to make, I mean, she was just always there, right? And I she made me feel safe that way.
But, the same for you and Terri? Yeah.
So I guess my question is, how do you think that that Terri would feel? I mean, about the surgery? I mean, what do you think that she would want you to do? Liam, I can see the way that you're looking at her, and I'm guessing that she's looking back at you the same way? She loved me.
So Honor that.
Honor that love? She'd want me to have the surgery.
Yeah.
I-I think so too.
Look at that.
Bottom of the right lung.
You were right.
Everything's connected.
It's an arteriovenous malformation, AVM.
An abnormal tangle of blood vessels.
They tear easily.
Results in bleeding.
- The blood I was coughing up.
- Yeah.
And for some, AVMs are a symptom of a genetic disease called hereditary hemorrhagic telangiectasia, HHT.
A hallmark of HHT is frequent nosebleeds.
Also, recently research shows that HHT patients have a predilection for A-fib.
These initials AVM, HHT - could I die? - No.
The conditions are treatable.
Surgery, embolization, medication.
I'm gonna admit you, and we'll figure out what the best option is.
And my career? Can I still compete when I get out of here? Nosebleeds may continue to be an issue, but today should be the last time you see yourself in hospital.
Get you back on the court.
U.
S.
Open awaits.
April.
So Lanik just went on a rant.
He was so pissed, I could barely understand him, but I did manage to make out "super reckless" and a threat to fire you.
What happened? I pushed meds without his order.
What? What were you thinking? The patient was coding.
Lanik was still suiting up.
What was I supposed to do? Let her die? Of course not, but it doesn't He told me to solve the problem.
What would you have done? April, we are nurses.
Just because we know what to do, it doesn't mean we have the authority to do it.
Well, I did.
And I saved her life.
Hey, great work today.
Appreciate the help.
I really enjoyed the challenge.
Been a while since I've been on the detective side of a case.
If you ever need me again, I'm in.
Deal.
And, uh, next time, I won't hesitate.
Truth is, uh, I was actually deflecting.
I know you and Will are close.
Just didn't want to overstep.
If it helps, I find nothing untoward with me seeing Will and playing chess with you.
Good to know.
So now that that's settled, how much brain power do you have left today? Game on.
All right.
- Hey.
- Hey.
So Lisa's gonna be sore for a while from the procedure, but her pain no more.
That is fantastic.
Right? I was worried she was gonna have to add us to her list of failures.
Yeah, I was too.
But we pulled it off.
We're a good team.
I hope so.
Oh.
A wistful tone after a huge win? What's going on? No, I just, um you know, we broke Lisa's cycle of pain and put her on a new path.
And I guess I'm just wondering if you broke yours too.
I'm not following.
I mean, you said this afternoon that opposites attract, and they do.
They don't always stay together.
Yeah.
You know, Manning? The moment you came into my life, my history became just that history.
I love you, Natalie.
I love you too.
Liam.
Heard the surgery went really well.
How you doing? How you feeling? Lonely.
She's gone for good now.
You think so? I mean, for myself anyway, I feel CeCe's presence all the time.
Honestly, I I I don't know if they ever really leave us.
Michael.
Can we not, Mom? Son, let me talk to you.
Give me a minute.
Come here.
I just wanted to let you know the board is backing up my protocol changes.
There will be a new memo tomorrow.
And you were right.
Some of my motive was personal.
Okay.
You've got my attention.
Sit with me a minute? You know I always want you to succeed, but this hospital is my responsibility.
And when those two things don't line up, - that's a problem.
- I know.
And it's not all on you.
My ambitions, they're big.
I push.
So when management pushes back, it stings.
Yeah.
But you're also my mom.
- This hits closer to home.
- Yeah.
And that's why I've decided to leave Med.
Really? I've been thinking about it for a while.
You cast a long shadow.
Time I get out from under it.
I raised you right.
I think you're making the right decision.
I wanna stay in the city.
Kender has a presence at Northwestern.
That's what I've put up for.
Well, they'll be lucky to have you.
Oh, thanks, Mom.
And I'm gonna miss seeing you every day.
But I'm staying in Chicago.
I'd like to see it through.
I got a team.
Thanks.
Hey, April, you saved his life.
You're pretty good for a nurse.
Should've gone to med school.
We have to stick with the playbook.
Or we try something else.
We have something better in mind.
How do we sit here and not even try? - I'm with you.
- Charged.
Clear.
Okay, let's give it a minute.
Going behind my back, throwing up Hail Marys? You and I have a problem.
Dr.
Marcel? I've got this new device.
Promoting your products for unapproved uses? They could've worked.
This is far beyond the bounds of professional conduct.
I started seeing someone new.
Dr.
Marcel.
You haven't introduced him to Owen yet, have you? Where is all this coming from? It was pitch-black.
I couldn't see my hand in front of my face.
So here I am, moving slowly, cautious, skimming my flashlight across the water, when there he is.
You do remember that I have a heart condition? Oh, in that moment, I did too.
He was big.
Terrifying big, right? But I was gonna get him.
Oh, dear me.
You went in closer.
Oh, I had to.
All or nothing.
So I eased in, lined him up.
Then, pop! Got him.
Look at this.
- Oh, wow! That's amaz - Look at that.
No, it's like he's right there.
- Right? - Yeah.
Wow.
- Hey.
- Hey.
- Owen tucked in? - Yes.
Fell asleep before the door got closed.
What'd I miss? I asked Crockett about his hobbies, and he said photography.
Yes, I think we were about, what, five minutes into our first dinner before he pulled that story out and showed me the picture.
Yeah, I think it was his move to try and impress me.
- Mm-hmm.
- Busted.
But here we are, many dinners later.
Mission accomplished.
- So Crockett? - Mm-hmm? I know that you are a surgeon and have an eye for reptiles.
What else? Any siblings? - Yeah, a younger sister.
- Mm-hmm.
Lives in Baton Rouge.
And your parents? Yeah, Natalie tells me that they emigrated from Iran.
So does that mean that your family is Muslim? No, we're actually Zoroastrian.
"Zoroastrian"? I'm sorry.
I Yeah, it dates back to ancient Persia.
The three main pillars: good thoughts, good words, good deeds.
Hmm.
Not always so easy.
Hmm.
That's very interesting.
Yeah.
I had no idea.
- Does anyone want some coffee? - Yeah, I'll take some.
- Okay.
Mom, tea? - Yes, sweetheart.
- Thank you.
- Yeah.
I will be right back.
Hey.
Nice.
Is that a new suit? You want to tell me what's going on? Just got the new pharma rep rules.
Resterilization of proprietary equipment, in-house device review.
Lots of red tape.
Well, it's just some adjustments so all the reps are on the same page.
We need to make sure no one's overstepping.
This is about Dr.
Marcel and me last week, isn't it? Indirectly, Michael, yes.
Ma, I am not the only red hat who's pitched a device off-label.
I'm aware of that.
Then why does this feel personal? This wasn't intentional.
The updates are solely to protect the hospital.
It sounds like the company line.
Michael Michael.
- Uh-oh.
- Michael and I.
It's been rocky the last few weeks.
Parenthood.
Life sentence, right? Oh, you're telling me.
- Want to grab coffee? - Oh, I don't have time.
- Maybe later? - Yeah.
- Five courses? - Yeah.
Website says it'll send all the ingredients.
We just prepare it.
Okay.
I'm in.
This weekend? I know.
I know I'm late.
By 33 seconds.
Was just gonna say good morning.
But I guess you are late.
- Meet up for lunch? - Sounds good.
Still waiting to hear back on that invitation to play chess.
Beginning to think that you're dodging me.
No.
Long day.
It's the time my shift ends.
Don't have the brain power.
- Maybe play Will.
- Tried.
It didn't go well.
He's a checkers guy.
Anyway, offer's out there.
Dr.
Choi, incoming.
Treatment 3.
Courtney? Montez Price, 21.
Pro tennis player.
Hitting partner accidentally drilled him in the chest with a tennis ball.
Trainer said he was unresponsive and pulseless.
Grabbed an AED, and shocked him once.
When we got there, he was awake and in sinus rhythm.
Tested negative for COVID in the ambo.
Let's get ready to transfer, huh? Everybody ready? One, two, three.
Okay.
Vitals stable.
BP 120/82.
Heart rate's 78.
Heart is good.
Regular rate and rhythm.
Let's get a CBC, BMP, cardiac labs, 12-lead EKG, and a chest X-ray.
Hey, Montez.
I'm Dr.
Choi.
Can you hear me? My chest hurts.
- Did I have a heart attack? - No.
Your rhythm on monitor looks good.
It was likely an episode of what's called commotio cordis.
The blow from the ball disrupted your heart rhythm, caused it to stop beating.
- But it's all better now? - Yeah.
The impact caused it.
It's not your heart.
But it still feels funny.
Funny? Funny, how? Hey, Montez.
Montez! BP's dropping.
72/40.
Heart rate's spiking.
180.
He's in narrow complex v-tach.
Connect the pads to cardiovert.
- Synced.
- Clear.
Hit it.
BP's back up.
120/70.
But heart rate's still high.
110.
Bolus 150 milligrams of amio and hang a drip.
Before, his heart wasn't beating at all.
- Now it's beating too fast? - What's going on? Maybe you should check her chart first before you waste my time with this dumb question.
Morning, Dr.
Lanik.
Maggie said you requested me for the COVID ICU.
Yeah, one less person for me to micromanage.
Almost sounds like a compliment.
Anyway, thanks.
I've really missed Yeah, sure.
You good to go? Always.
Counting on you.
Go suit up.
- Dr.
Halstead, you're going to Baghdad.
- Yeah.
Liam McIntyre.
65-year-old male.
COVID negative.
GCS 15.
BP 100/70.
Rate 120.
Suspected left shoulder dislocation.
Okay.
Mr.
McIntyre? I'm Dr.
Halstead.
- You know where you are? - Hospital? All right.
Let's get ready to transfer.
On my count.
One, two, three.
Thank you.
Diminished breath sounds.
Left side.
Kathleen, we're gonna need an X-ray.
- Any pain where I touch? - No.
Okay, chin up.
Down.
Left, right.
Any pain? Good.
C-spine's clear.
Mr.
McIntyre? Liam, you with me? I'm fine.
I'm just a little rattled.
X-ray's up.
Everybody get back.
Have a small amount of fluid.
Left chest.
Left shoulder dislocated.
50 fentanyl, 2 of versed.
- Maggie, countertraction.
- Yep.
All right, Mr.
McIntyre.
We're gonna put this around your arm.
Okay.
This is gonna hurt.
- I'm gonna need you to breathe, okay? - Okay.
Mm-hmm.
Ah! All right.
Yep, all done.
Shoulder's in.
- So sorry.
- You're good, Liam.
You just rest for now.
- Okay? - Thanks.
Draw up trauma labs.
Yeah.
But did you catch how he keeps on looking at the corner of the room? Yeah, it's weird.
No evidence of head trauma, though.
He's doing it again.
Remember our trip to Tahoe? I was in a cast for weeks.
But there's no one else there.
Do me a favor.
Yeah, I'll contact Dr.
Charles.
- Mm-hmm.
- Done.
Thanks.
- Hey.
- Hey.
I wanted to apologize about last night.
- My mom - No.
No apology necessary.
Look, I grew up in the Bible Belt.
You're either Catholic, Methodist, or Southern Baptist.
Not different, you know? So I'm used to it.
Nat, Crockett, patient in treatment 4.
- Her name is Lisa Holtzman.
- Thanks, Mags.
- Okay.
- All right.
Hi, Lisa.
I'm Dr.
Manning.
- This is Dr.
Marcel.
- Hi.
Belly radiating.
"Radiating"? Not a lay term.
- You a doctor? - No.
Professional patient.
You mind if I lift your gown? Okay.
Those scars on your abdomen, laparoscopic ports? Appendix, gall bladder, all gone.
Okay.
I'm gonna Fullness in the pelvis.
All right, we're gonna do an ultrasound, okay? Okay.
Can't see anything.
Bladder's huge and in the way.
Lisa, when's the last time you urinated? I don't know.
Yesterday, I think? Well, pain could be coming from urinary retention.
Foley? We're gonna drain your bladder.
It should help ease the pain.
- Okay? - Okay.
And get you some med too, all right? My bag.
Grab what's inside.
What is all this? My medical records.
Hey, Montez.
How are you feeling? Exhausted.
And then there's all this Your heart's still beating irregularly.
Too fast I'm trying to get a read on why.
Your vitals are fine.
EKG and echo were both normal.
- So you're saying I'm healthy? - No.
The chart is, but it's wrong.
The heart of a 21-year-old pro athlete should not spontaneously go into A-fib.
This can't be it.
I'm too close.
My father loved tennis.
I was maybe four.
He tossed me balls.
Pretended it was the U.
S.
Open.
He'd say, "One day, Montez.
Arthur Ashe Stadium".
He died when I was seven.
I've been training for the Open ever since, and now, I'm inches away.
I need to play in that tournament.
I'll keep looking, figure this out.
Seriously? Damn it! Put pressure.
Lean your head forward.
Ice pack.
I got it.
I got it.
It happens when I'm stressed.
It'll stop.
- What the hell, Sharon? - Ms.
Goodwin, I'm so sorry.
That's all right, Cheryl.
I always have time for our COO.
Well, my phone has been ringing off the hook this morning.
Angry reps.
Your unilateral changes to our red hat protocols they're trouble.
I have to do what's best for the hospital, Gwen, which means reducing liabilities wherever they are.
Our relationship with pharma and biotech, they help keep the lights on.
If Med is suddenly difficult to work with, they move to East Mercy.
We lose funding.
This is our house.
They can play by our rules.
Not these.
I'm shutting them down.
Three.
Good.
Mind me asking where you were headed this morning - when you had your accident? - Nowhere really.
Four.
Right.
Just out running errands? Just driving.
Was cooped up for over a year.
But now that I'm finally vaccinated, I'll take any excuse I can to leave the house.
I hear that.
I mean, whoever thought we'd actually be looking forward to picking up our dry cleaning, right? No fingers yet? Now, I see it.
Two.
Okay.
Okay, good.
So, Liam, tell me, uh, what's in the corner? What? No one.
Wait, is it a person? It's my wife.
Terri.
Okay.
She died three weeks into lockdown.
Aneurysm.
Very sorry to hear that.
We were actually looking forward to being quarantined.
Cook all those recipes we never had time for.
Then she was just gone.
Look.
I know she's dead, but I swear, she's she's right there.
You know what? I believe you.
Tell me, how long roughly have you been seeing her? A few months.
I know my mind is playing tricks on me, but I don't care.
Losing Terri was devastating, so having her back, even like this, it's salvation.
You know, I, um I actually lost my wife not that long ago, so trust me, I get it.
Look, I'm going to have a quick chat with Dr.
Halstead, and then, I will I'll be back.
- All right? - Okay.
So what do you think? Dementia? No.
You know, he's lucid.
He's oriented.
His peripheral vision is virtually nonexistent on the right side in both eyes, all right? And that blind spot is exactly where he's seeing his dead wife.
So she's a visual hallucination.
Right, and I think we're looking at Charles Bonnet Syndrome, right? Where the brain responds to vision loss by filling in the blanks.
But here's the thing.
I'm not seeing any evidence of, you know, standard signs of vision loss, which makes me think that we're I don't know.
We might be looking at some deeper brain or eye issue.
I'll order an MRI.
- Thank you.
- Yep.
Lisa, hi.
So we got your initial lab results back, and it was normal all across the board.
I'm sorry.
Normal is usually good news.
I let myself get my hopes up.
I shouldn't have done that.
Volume seven of my 16-year war with abdominal pain.
All I know, it's not IBS.
Or endometriosis.
Or interstitial cystitis.
Kidney stones, pancreatitis, bowel obstruction.
It hurts the worst right here.
There has to be a reason.
But I have been poked, prodded, scanned, cut open, and no one ever finds anything! Lisa, I can't even imagine your frustration But I don't need sympathy.
I need you to fix me.
We'll do our best.
Unfortunately, that does require more pokes, prods, X-rays, scans.
Have at it.
Okay.
Hi.
Ms.
Caine? I'm April.
What happened to your cannula? Pulled it out.
Who knows what's really in it? And you don't need the space suit.
Hmm, one day.
But for now, it's a precaution we take in the COVID ICU.
- I don't have coronavirus.
- No? It's not real.
Big scam.
Okay.
But I can see you're having trouble breathing.
It's just the flu.
Get it every year.
Well, flu or not, a little extra oxygen might help you feel more comfortable.
What do you say? Want to give the cannula another shot? Fine.
Okay.
I saw him play a couple of months ago.
On TV, that is.
You're a tennis fan? I was that night.
Couldn't sleep.
His match was the only show that was on at 2:00 a.
m.
Hell of a player.
Is he gonna be okay? I'm not sure.
A-fib problem.
Don't know why.
Well, I'm a cardiologist.
Can I help? Thanks, but technically, you're limited to seeing patients who are part of your clinical trial.
Totally understand.
I cauterized the active bleeders.
Should help stem the tide.
Kid keeps asking me if his career is over.
I didn't know what to say.
Neither do I.
Thanks.
Dr.
Virani.
I reconsidered.
I'll send you the chart.
- Hey.
- Hey.
What's this? That is a Persian spice set.
- Gift from your mom.
- Oh.
Even comes with a, uh an array of popular recipes.
Oh, this is awkward.
I'm Iranian.
We love to cook.
It's a wonderful gift.
Thoughtful.
Never got a gesture like that from my ex in-laws.
What do you mean? You know, a Persian Zoroastrian son-in-law is not what they had in mind for their southern belle.
I mean, from the little I know about Claire, you two seem pretty different, so Opposites attract, I guess.
Didn't keep us together, though.
Uh, is that Lisa's latest test results? Yes.
The labs are all normal.
Same with the KUB and trans-vaginal ultrasound.
Next up is a CT.
I'll squeeze that into my locker.
I'll meet you upstairs.
Sharon.
- You know the E.
D.
's hurting for staffing.
- Mm-hmm.
But same time, with the pandemic, nursing and med school enrollments have surged.
- A silver lining.
- Mm-hmm.
I was thinking we expand the E.
D.
training programs to match demand.
Puts Med on the map, and we get helping hands.
- Win-win.
- I like it.
Write a proposal.
All right! What's up? I updated Med's protocols for the pharma reps, and Gwen's undoing them, playing hero in the process.
And now, all the reps owe her one.
No doubt she'll enjoy using that against me.
My smile convincing enough? - Very professional.
- Mm-hmm.
Grand Mal seizure.
- Five of Ativan.
- Yeah.
Mr.
McIntyre? You just had a seizure.
Terri? Terri? Terri, where are you? Terri? Oh! Oh, there you are.
Oh, there you are.
Thank God.
A tumor? In your brain's vision center.
The left occipital lobe.
It caused your seizure.
And it's safe to assume an earlier one led to your car accident.
Vision center? - That's also why - That's right.
The tumor created a blind spot, right? And in order to make sense of that void, your brain has been filling it in with images of your wife.
Now, Liam, I know a brain tumor can sound overwhelming, but yours is treatable.
- Surgery? - Right.
It'll eliminate the risk of another seizure, and it'll correct your peripheral vision loss.
But I'd lose my wife.
She she'd disappear.
Yeah, I mean, you would you would no longer see those images of her.
I don't want the operation.
Mr.
McIntyre, without the surgery, you will have more seizures.
And they'll be more severe.
I mean, you could even lose your eyesight entirely.
When Terri died, I was lost.
But now, it's it's like I've got her back again.
She she's everything to me.
You know that I understand how grateful you are to have Terri back in your life, but another seizure would probably put you into a coma.
I mean, it could kill you.
Since Terri died, I haven't really been living anyway.
I want to go home.
Mr.
McIntyre, I can't in good conscience discharge you without a treatment plan.
I'll sign whatever I have to.
I just want to be with my wife.
Uh, you know, we will, um we will get the paperwork going, okay? Thank you, Liam.
We're not letting him go home.
- I agree.
- Okay.
Psych hold, then? Will, he's not mentally ill.
He's grieving.
I mean, we're asking him to say goodbye to his wife.
You know, again.
So what's our play? Honestly, I don't know.
Can you buy me a little time? Yeah, I can slow-roll his AMA paperwork.
- Thank you.
- All right.
You brought Dr.
Virani in on your case.
I needed a consult.
Usually we call Cardiology for consults.
No one upstairs has London Heart Hospital on their résumé.
So I'm sure the resident Cardiology would've sent down will understand.
Dr.
Lanik? Gina Caine in 3 Oh.
Ms.
COVID is a Hoax? I upped her high flow O2 and RT is ready to convert to a BiPAP, but it's just delaying the inevitable.
She'll need to be intubated.
Yeah, but is she gonna give consent? It's been tough just keeping her on the cannula, so it's doubtful.
Well, you better change her mind.
It looks like there's mildly distended loops of small bowel.
- Could be a partial obstruction.
- I'm not sure.
If it were an obstruction, I'd expect the bowel to be a lot more dilated than it is.
So what? We just agree to disagree? - I mean, that doesn't help her.
- Damn it.
I know something's causing her pain, and if it's in there, we just don't know what it is.
Can't see it.
Uh, Kara, build the scan into a high-res 3D rendering.
Focus on the left flank, where her pain is the worst.
- Well, how about that? - Renal vein is compressed.
I mean, it looks like it's causing significant left-sided venous congestion.
That isn't just painful It's excruciating.
Same drill as before.
Set up to cardiovert, then 200 milligrams of amio followed by a drip.
A-fib with RVR.
Replay on his intake.
- Okay.
Synced.
- Clear.
Hit it.
BP's coming back up.
122/73.
Heart rate's settling.
140.
Still too high.
Add an esmolol drip.
It happened again? - My heart? - Yeah.
Doesn't make sense his heart's beating irregularly, but there's no evidence anything's actually wrong with him.
I looked at his chart.
The only other anomaly is the nosebleed.
And you think the nosebleed's connected then? Could be.
I once treated a guy who slipped in the shower and dislocated his shoulder.
Random accident, right? It turns out, he had undiagnosed celiac disease.
A poor B12 absorption leads to anemia Leads to weakness in his feet, leads to falling in the shower.
Nothing random about it.
Trini, repeat CBC, BMP, cardiac labs, echo.
Leave the EKG.
We're starting over.
This is the reason? The renal vein is being compressed? It's called nutcracker syndrome.
Because the pain feels like you're being squeezed by a nutcracker.
All this time.
Right there.
How'd all the other doctors miss it? It hides.
Only get to it by ruling out everything else first.
I'm relieved to finally have an answer, but my pain, it's more than a squeeze.
I'm being crushed by a car compactor.
Yes, we suspect a compounding issue, a second disorder affecting the ureter.
Loin pain hematuria syndrome.
So misery on top of agony.
- What's the fix? - Surgery.
There are two options.
First is a renal vein transposition.
It'll relieve the nutcracker syndrome, but unfortunately, it may not do anything for the loin pain.
Option two? Embolize the renal artery.
This will help with the loin pain, but may aggravate the nutcracker.
So let's do both.
The thing is, you can't do both.
Together, they would put too much stress on the kidney's blood supply.
The organ would fail.
Then, no.
To both options.
Neither ends my pain, so what's the point? Less pain could make a huge difference in your life.
Zero pain is something.
Everything else is just history repeating itself.
Procedure after procedure, all of them, colossal failures.
I can't take another one.
I will lose my mind.
I am always going to live in pain.
It's just time that I accept that.
Hey.
If you're busy, I could come back later.
Oh, hell no.
This case had me going in circles.
Thank you very much.
You're welcome.
- So? - Hmm? Your day going any better? No, in fact, it fell off a cliff.
It wouldn't have anything to do with these updated protocols I've been hearing so much about? The reps are angry with me.
DEFCON 1 with Gwen because I got the board involved.
And then, there's Michael, who thinks these protocols are solely because of him.
And you don't think there's even a tiny bit of truth to that? Really? You too? If it were any other rep at the center of this thing, you think it would have gotten quite this far? Probably not.
He's my son, Daniel.
When he started working here, I was so excited, but I just don't know how eventually that doesn't get complicated.
Hmm.
Yeah.
Ain't that the truth? Well I've got a hard decision to make.
I'm here if you need me.
Thanks.
Montez's repeat labs, all good.
Same for the repeat echo.
His heart's now beating normally.
He's back in sinus rhythm.
Yeah, but still no clue as to why it started beating irregularly or now why it stopped.
Dr.
Choi, Dr.
Virani, it's Montez.
- What's happening? - Coughing up blood.
That's not a nasal or a cardiac problem.
- It's a lung issue.
- Yeah.
They sound junky.
We need another chest X-ray.
I'm falling apart.
Hey, just hang in there, Montez.
X-ray up.
Bottom of the right lung is partially whited out.
Two prior chest x-rays, that wasn't there.
No, but it is now.
We need a CT.
- Hey.
- Hey.
I got your text.
All I've been hitting are dead ends.
- You got something? - Yeah, I think so.
Kidney's at the center of Lisa's pain problems, right? There's not enough space for the blood and urine to flow smoothly, so, what if I were to move it to a place where there is? That's a massive undertaking.
I mean, if you're willing to go that far, why not just remove the kidney altogether? - Less risk of complications.
- Possibly.
But there'd be a huge trade-off.
She'd be losing a perfectly healthy organ.
I mean, look, if there were a better option, I'd be all over it.
I'm just I'm not seeing one.
A kidney transplant? A kidney autotransplant.
It's more like a relocation.
The new positioning decompresses the renal vein so there's no more pressure on the ureter.
So it both addresses the nutcracker and the loin pain.
I've been let down so many times.
You're sure this will work? - The theory is sound.
- Look, I believe it will work.
Okay.
I'll hope.
Okay.
Ms.
Caine? You need to be intubated.
No tubes.
You put people on that machine, then never take them off.
It's part of the scam so they can bill you forever.
Just give me more oxygen.
No, that won't work.
COVID attacks your It's not COVID! Gina.
Okay, I'm not supposed to say this, but you're right.
COVID is a hoax.
It is.
I know it is.
About time you admit it.
I couldn't say anything before because I don't want to get fired.
Can't go against "the hospital machine".
Exactly.
Please, just agree to be intubated.
Let me help you get past this flu.
And then, we can talk about the truth.
Okay.
All right.
Dr.
Lanik? Intubation in 3.
- Let me suit up.
- Copy.
No, no, no.
No, no, no.
Gina? Gina? Dr.
Lanik, she's crashing.
No pulse.
What do we got? Dr.
Lanik? Bag her.
Come on.
- What happened? - She went into P.
E.
A.
All right.
Milligram of epi? Already in.
What? You pushed meds on your own? You weren't gonna make it in time.
You can't do that without a doctor's order.
Got a pulse.
Sinus rhythm.
Stats are still terrible, though.
Kit's ready.
Sux and etomidate? Give me the tube and the blade.
Paperwork's ready.
It's now or never.
I'm gonna leave.
You can't stop me.
Liam, I was just hoping that you'd indulge me with one more minute of your time before we sign you out.
Okay.
What is it? Well I told you about my wife, about about CeCe and how she recently passed away.
Um, whenever I had a big decision to make, I mean, she was just always there, right? And I she made me feel safe that way.
But, the same for you and Terri? Yeah.
So I guess my question is, how do you think that that Terri would feel? I mean, about the surgery? I mean, what do you think that she would want you to do? Liam, I can see the way that you're looking at her, and I'm guessing that she's looking back at you the same way? She loved me.
So Honor that.
Honor that love? She'd want me to have the surgery.
Yeah.
I-I think so too.
Look at that.
Bottom of the right lung.
You were right.
Everything's connected.
It's an arteriovenous malformation, AVM.
An abnormal tangle of blood vessels.
They tear easily.
Results in bleeding.
- The blood I was coughing up.
- Yeah.
And for some, AVMs are a symptom of a genetic disease called hereditary hemorrhagic telangiectasia, HHT.
A hallmark of HHT is frequent nosebleeds.
Also, recently research shows that HHT patients have a predilection for A-fib.
These initials AVM, HHT - could I die? - No.
The conditions are treatable.
Surgery, embolization, medication.
I'm gonna admit you, and we'll figure out what the best option is.
And my career? Can I still compete when I get out of here? Nosebleeds may continue to be an issue, but today should be the last time you see yourself in hospital.
Get you back on the court.
U.
S.
Open awaits.
April.
So Lanik just went on a rant.
He was so pissed, I could barely understand him, but I did manage to make out "super reckless" and a threat to fire you.
What happened? I pushed meds without his order.
What? What were you thinking? The patient was coding.
Lanik was still suiting up.
What was I supposed to do? Let her die? Of course not, but it doesn't He told me to solve the problem.
What would you have done? April, we are nurses.
Just because we know what to do, it doesn't mean we have the authority to do it.
Well, I did.
And I saved her life.
Hey, great work today.
Appreciate the help.
I really enjoyed the challenge.
Been a while since I've been on the detective side of a case.
If you ever need me again, I'm in.
Deal.
And, uh, next time, I won't hesitate.
Truth is, uh, I was actually deflecting.
I know you and Will are close.
Just didn't want to overstep.
If it helps, I find nothing untoward with me seeing Will and playing chess with you.
Good to know.
So now that that's settled, how much brain power do you have left today? Game on.
All right.
- Hey.
- Hey.
So Lisa's gonna be sore for a while from the procedure, but her pain no more.
That is fantastic.
Right? I was worried she was gonna have to add us to her list of failures.
Yeah, I was too.
But we pulled it off.
We're a good team.
I hope so.
Oh.
A wistful tone after a huge win? What's going on? No, I just, um you know, we broke Lisa's cycle of pain and put her on a new path.
And I guess I'm just wondering if you broke yours too.
I'm not following.
I mean, you said this afternoon that opposites attract, and they do.
They don't always stay together.
Yeah.
You know, Manning? The moment you came into my life, my history became just that history.
I love you, Natalie.
I love you too.
Liam.
Heard the surgery went really well.
How you doing? How you feeling? Lonely.
She's gone for good now.
You think so? I mean, for myself anyway, I feel CeCe's presence all the time.
Honestly, I I I don't know if they ever really leave us.
Michael.
Can we not, Mom? Son, let me talk to you.
Give me a minute.
Come here.
I just wanted to let you know the board is backing up my protocol changes.
There will be a new memo tomorrow.
And you were right.
Some of my motive was personal.
Okay.
You've got my attention.
Sit with me a minute? You know I always want you to succeed, but this hospital is my responsibility.
And when those two things don't line up, - that's a problem.
- I know.
And it's not all on you.
My ambitions, they're big.
I push.
So when management pushes back, it stings.
Yeah.
But you're also my mom.
- This hits closer to home.
- Yeah.
And that's why I've decided to leave Med.
Really? I've been thinking about it for a while.
You cast a long shadow.
Time I get out from under it.
I raised you right.
I think you're making the right decision.
I wanna stay in the city.
Kender has a presence at Northwestern.
That's what I've put up for.
Well, they'll be lucky to have you.
Oh, thanks, Mom.
And I'm gonna miss seeing you every day.
But I'm staying in Chicago.