Chicago Med (2015) s07e14 Episode Script
All the Things That Could Have Been
Oh, my God.
Is this why you ended things with me? Ended things with you? Did you go out with my daughter? - There are several tumors.
- Is it malignant? We'll send the tissue for pathology.
Is that your wedding ring? The Chief of ED at Andrew's hospital is retiring.
Andrew wants to put me up for the job.
It's been nice, you know, having my old rival back.
But, uh, you gotta do what's right for you.
Is my 5:30 Thursday still available? I'm trying to lighten my patient load.
I deserve a little more of an explanation.
After 20 years, I don't I don't make the cut? I have developed feelings for you, Daniel.
Thank you.
- Oh, hi.
- Hey, there.
- I was just on my - What are you doing? You go.
I'm on my way up to Medical Records.
Need to sign a few charts.
Nice to see you.
Have a good day.
Hey.
Hey, Lonnie? Look, I accept the fact that you can't treat me anymore, and I I respect that.
But, I it's also It's important for me to tell you that that the The work we did together? Um, you really helped me.
A lot.
And I wanted to thank you for it.
I appreciate that, Dan.
Okay, take care.
Hey.
- Daniel? - Hey.
You seeing her in person again, huh? No, you know, she, um she dumped me.
She's been your therapist for years.
What happened? She developed feelings for me.
- Feelings? - Yeah, romantic feelings, man.
She give you a referral? Well, sure, but I mean, you know, changing shrinks is not exactly like changing sneakers.
- You know? - True, true.
- Are you okay? - Yeah.
How're you doing? You know, I think I left my phone in the car.
Look, I'm going to be here all day, so if you want to talk some more I'm fine.
But thank you, and I'll see you around.
All right.
You're going to T2.
Thank you.
Hey, biopsy results come back yet? Not yet, but the lab promises that sometime today.
You know there's a good chance it's benign.
I'm not so sure.
- I had cancer before.
- Oh.
It's just You're afraid your cancer's come back.
Chest sounds good.
X-rays, a lot better.
As long as he continues to improve, I don't see any reason why we can't discharge him.
- Oh.
- It still hurts.
Yeah, well, pneumonia's no joke, D-man.
Look, I'ma give your mom some medicine to make you feel better, okay? Due to his pneumonia, it'll be a couple weeks before he can - go back on chemo.
- Okay.
Any word from Terrell? No.
And he's never stayed away this long.
This isn't like him.
- Thank you.
- Sure.
Morning, Ms.
Goodwin.
Dr.
Shentu.
Seems like the Med staff is adapting well to our new guidelines.
Your new guidelines.
And you really think so? In any case, I appreciate the cooperation.
My God, look out! - Please, help me! - We got you.
It's okay, it's okay.
I need a 911 and the emergency response team out front, main entrance.
Single vehicle crash, driver responsive.
The patient's car hit a concrete barrier.
The airbag deployed, but no visible signs of injury.
Heart rate's steady.
Having a lot of generalized pain.
Okay, everyone, let's get ready.
Got it? On my count.
One, two, three.
Okay, let's get a cannula and IV in.
Let's put her up on a monitor, draw trauma labs.
We need X-rays stat.
- Yup.
- Dr.
Shentu.
BP 95/65.
Heart rate and sats not picking up.
Cycle it again.
Clear.
Chest is okay.
No hemo or pneumothorax.
Mediastinum is normal.
Ultrasound? Thank you.
Fast is negative.
Got an ID.
Name's Gia Lindahl.
I can see if there's a history.
She's too distracted to clear her C-spine.
Let's keep the collar on for now.
Dr.
Shentu, pupils? Yeah.
Spare penlight? Pupils equal and reactive.
Little sluggish.
Ms.
Lindahl, can you hear me? Ms.
Lindahl? GCS 12.
She is a patient here.
One of the first we treated for COVID.
Been back a few times with long-haul symptoms.
Give her 50 mics of fentanyl.
Let's get a pelvis x-ray, and let's send her up to CT for a pan scan, and make sure we add a tox to her blood and urine.
Yep.
Dr.
Shentu, why don't you see this through? Uh, certainly.
And Dr.
Taylor, you run point.
Doris, let's get the doctor a pair of scrubs.
Okay.
Did you just assign the compliance officer to a medical case? He's a critical care doctor who's credentialed at Med.
He's a bureaucrat.
A suit.
Nevertheless, I know you'll be accommodating.
Yeah, do me a favor, keep me briefed on Dr.
Shentu's performance today.
Sure.
Oh, God.
Why does my body feel like it's on fire? Given everything we've seen, we think you have a condition called fibromyalgia.
Let's give her another 50 of fentanyl.
Fibromyalgia? We've seen it in long-haul COVID patients like yourself; there's even a name, "Fibro-COVID.
" What causes it? We think it's due to a problem in the way that the spinal cord and the brain process pain signals.
It's not life-threatening, but it is It's terrible.
We need a rheumatology consult, but for right now, we're giving you more pain meds so you can get some rest, all right? The good news, Gia? According to your scans, there were no serious injuries with your crash.
Oh, I'm so sorry.
I should have never driven myself.
Dr.
Taylor and I are just happy you're safe and getting the treatment you need.
- Fibromyalgia.
- That's tough.
Yeah.
So how are you thinking of treating her? There's data on patients responding very well - to Xyrem.
- Xyrem? As I recall, it's not FDA-approved for fibromyalgia.
- Right.
- Yeah, it's only approved for cataplexy and narcolepsy.
We'd be using it off-label.
And per your new mandates, our doctors can't prescribe off-label meds without the patient's consent.
And she's sedated now, so she can't.
Well, then as soon as she wakes, we'll, uh, explain the situation and ask for consent.
Yeah, seems like your only option.
Dr.
Scott! I understand we're doing a transplant - on a patient of yours.
- Yeah, yeah.
I was glad you and Dr.
Blake got the case, man.
Well, we're gonna take good care of her, all right? Thank you.
Dylan, I could use an extra set of hands in here.
30-something male.
GCS 10.
He was found passed out in the street, inebriated.
Right arm swollen and discolored.
- Terrell.
- You know him? Yeah, since we were kids.
His son's a patient upstairs.
Paramedics gave Narcan in the field, but zero response.
- Still hypothermic.
- Terrell, you hear me? Get away from me.
Look, I'm just trying to help, man.
Not you.
All right, he's rousable.
Let's get this board out of here.
All right, on three.
One, two, three.
Temp's 93.
All right, let's swap this out for one of our warmer blankets.
And get him a liter of NS on the warmer.
Right arm's pretty tight.
Hand's cold.
Can't feel distal, ulnar, or radial pulse.
Compartment syndrome.
Heart's a little tachy.
Foley output.
5cc's of dark urine.
Dead muscle's causing him to go into rhabdo.
Could be disaster for his kidneys.
He needs a fasciotomy.
Call Dr.
Archer.
On it.
Hey.
Any history you can share? Help us treat him? Terrell's kind of a mystery.
When we were kids, he was funny, smart.
Then he drops out, starts hanging with the wrong crowd.
After that, things went downhill.
It's tough to see a life fall apart.
He's been MIA for a while.
I'm gonna go tell his wife he's here.
- Yeah.
- All right, thanks.
Morning.
Hey.
Here you go.
I hear that Stevie's going back to Michigan to be with her husband? Yeah, so? Don't start with me.
Where is Trini? They're short-staffed at the ICU.
- She's covering.
- Well, I need her.
She's supposed to make a house call with me.
Oh.
I'll go.
Trini knows the patient, you don't.
What? Am I not the nurse with more experience than anyone else down here? Sorry, Nurse Lockwood.
I'm sure you've seen it all.
I'm grateful for your assistance.
Huh.
Charge Nurse Lockwood.
- You're in a good mood.
- So are you.
Mm-hmm.
Dr.
Hammer.
Good news, huh? - What's that? - Your mom.
I was just up in the Psych Ward.
I saw that they're discharging her.
Oh, right.
Yeah.
Kind of put them in their separate corners, - but other than that - My mother's here? Why didn't you tell me? - I couldn't.
- Why? Because she gave me express orders not to.
Well, this doesn't make any sense.
Did you commit her? I'm sorry, I can't discuss that with you.
She's my mother! Doesn't matter, Stevie.
She's a patient here, and she has rights.
Okay, where is she? - Stevie - This is ridiculous.
Come on.
Are you really gonna make me call security? Terri, good morning.
Um.
So Stevie found out that you're here.
How is she? She's a little confused.
Right? She's she's angry.
She's she's hurt.
But, um how would you like to handle this? What what would you like me to tell her? Wait here, please.
What's up? Nothing.
Nice.
Patient's a financial planner.
- He's, uh, done well.
- Mm.
- Dr.
Halstead.
- Hey, Lenny.
This is Maggie Lockwood, our charge nurse.
Hey.
Ellis is ready.
- Ellis, hi.
- Hey.
- Thank you for coming.
- Of course.
I want you to meet my friend, Maggie Lockwood.
My pleasure, Maggie.
Hi.
When I was bathing him this morning, he looked paler.
I normally have a healthy glow.
Okay.
Well, we're gonna need to open the box so I can take a look.
Can't be for long.
Polio paralyzed Ellis's diaphragm and intercostal muscles, so without the respirator, every breath requires conscious effort.
Polio.
Contracted it when he was five, a month before the vaccine came out.
Good timing, eh? Turning it off.
Those were my ward mates.
Ellis has been in the iron lung for 60 years.
63.
But who's counting? He's also instructed me more than once never to refer to him as a polio victim.
Life threw me a curveball, that's all.
I got lots to be thankful for.
Found some friends, work I enjoy, good docs like Halstead.
Hey, how's your love life, huh? Last time we talked, it wasn't so good.
Hasn't gotten any better.
Mm, I'm all ears.
Nothing to tell.
Ellis, I'm seeing peripheral cyanosis and you're skin is cold.
Maggie, pulse, please.
Bradycardia.
His HR's in the 50s.
We need an EKG.
I brought one.
You good for a few more minutes? Oh, yeah.
I need the exercise.
So, um, your mom has given me permission to share her medical history with you.
- Well, that's big of her.
- Have a seat, please.
I'm okay.
So you're mom admitted herself.
She was very depressed and, uh, was worried about self-harm.
Oh, my God.
She has been diagnosed with bipolar disorder.
All right? Which has, of course, been exacerbated by her alcohol abuse.
But admitting herself to the hospital, seeking help Really good sign.
And I have to say, with, uh With treatment, right? With therapy, with medication, she's I've been trying to reach her for weeks.
No answer.
She just hasn't returned any of my calls.
I'm, um I'm moving back to Michigan, but I didn't know if I should.
You know, Stevie, I'm so sorry that you've had to go through this.
Yet you were just fine keeping me in the dark.
Look, if it's any consolation, you're mom? She's doing very well.
Yeah, okay.
But did it have to mean cutting me out of her life? So Doc, am I gonna live? Well, our heart rate's hovering around 49, not quite the picture of heart health.
Any more good news? EKG also shows low voltage, and I wish your BP was higher.
However, these alone don't point to anything specific.
- Blood work? - Yeah.
So Ellis, we gotta place a line so we can collect your samples.
Unfortunately, you know, the only place we have access to is your neck.
Gets better and better.
Mr.
Turner, I'm gonna ask you to remain as still as possible.
Uh-huh.
And shut up.
I I get it.
And we're in.
I know a private lab nearby.
I'll have them run the tests.
We'll get a quick turnaround.
Should I be worried? Hey, whatever's causing your symptoms, - we'll deal with it.
- Okay.
Sorry about before.
I shouldn't have made that crack about your love life.
What's going on with you? I'll talk to you about it later.
You need to get to the lab.
We won't know the size of the recipient's abdominal cavity until we open her up.
So we'll resect the donor liver then according to the body weight ratio.
Right, get as close a match as possible.
Good morning.
How's everyone doing? We're all a little nervous.
- Her most of all.
- Yeah.
So how you feeling? Good.
Ready to go.
And how's our recipient? Stable, lightly sedated, but no reason not to proceed.
They're gonna make you all well, honey.
The techs are gonna be in shortly to take your daughter and you, Mr.
Byers, to pre-op.
I love you.
So we'll see you guys on the other side, yeah? You all right? All right, I'll see you.
Hey, Pamela? Pamela.
Hey, look, I spoke with Avery, and I made it clear you had no idea we'd gone out.
You mean, so she wouldn't think that her mom was snaking her boyfriend? - What a mess.
- I know, come on.
I want to make things right.
I want to make things right between you and me.
Look, I also told Avery I had I had feelings for you.
Okay, stop.
Stop, stop, stop.
I never should have let myself get involved.
You're a surgeon.
You're on my team.
That's all.
Dr.
Taylor, Dr.
Shentu, need you.
O2 started dropping.
I put her on a mask at 10 liters.
Need a chest x-ray.
I'm hearing a rub.
Okay, clear.
Her heart shadow looks a little fuzzy.
- Ultrasound? - Yeah.
It's gonna be okay, Gia.
Okay.
Pericardial effusion.
Why didn't your morning work up catch it? Wasn't on CT, but things change.
Could be a blunt cardiac injury from the crash.
We need to perform pericardiocentesis.
Dr.
Shentu, it's not indicated at this time.
She's not in tamponade.
She's protecting her airway, her condition is not emergent.
And with a non-emergent invasive procedure, we need Gia's permission before we can perform it.
Like the Xyrem? Yes.
Another new guideline.
Well, let's hope she regains consciousness soon.
Resected the left lateral segment.
Graft-to-recipient weight ratio is 4.
2%.
All right, resection complete.
Go ahead and put that on ice for Lily's transplant.
Let's get ready to close.
You're heart rate's not getting any better.
Same as your BP.
- What are you not telling him? - What? Halstead.
What are you not telling him? Come on, come on.
I'm in an iron lung.
I'm allowed to be nosy.
I had a biopsy.
Cancer, maybe? And why didn't you tell him? I don't want people worrying about me.
Yeah, I get that.
I'm not much for pity parties, myself.
No.
So what are you going to do if it's positive? I don't know.
Depends on how serious it is.
Chemo, radiation, surgery.
I'd have to stop working.
So how are you set for retirement? I don't know.
I haven't thought about that.
Yeah, but you should.
So you want me to take a look at your financials with you? - I can't ask you to do that.
- Why not? - Because you're my patient.
- Get your phone.
Pull up your accounts and email them to me, and we'll go over them together.
- Now? - Yeah.
I don't believe in putting things off.
Hi, Terrell.
Hi, I am Dr.
Archer, this is Dr.
Hammer.
I was the surgeon who performed a procedure on your forearm.
What happened? You were found near Washington Park.
You were passed out and laying on your arm, which lead to a condition which needed to be treated surgically.
You're lucky Dr.
Archer was able to operate so quickly.
It could have been very serious.
Does my wife know? Yeah, uh, she's here in the PICU with your son.
Yeah, she must be so mad.
Do you want me to have her come see you? No.
No, please.
Not like this.
Can I go home today? Well, I wouldn't recommend it, - but, uh, if you insist - I do.
And, um And then after I'm dressed, I'll I'll see her.
All right, well, you rest, and we'll make sure you get out of here.
Living arrangements all set.
And a van is on the way to pick you up.
Thank you, Dr.
Charles.
You know, Terri, there's something that I've been curious about.
Yeah? When you checked yourself into a hospital where you knew that Stevie worked, you had to think that eventually she was gonna find out that you were here.
I did.
I I wanted to be near her, and I thought eventually I would want to see her.
But The better I got, the more I felt I was turning my life around, the less I wanted to see her.
Does that sound terrible? No.
I love my daughter.
I I do, but she can be negative.
Even if she doesn't say it, Stevie always thinks I'll fail.
I know I've given her plenty of reasons to think that, but Not necessarily something you need right now.
No.
Ah, Dr.
Shentu.
You know, I heard about your inability to treat your patient.
But hey, you stand by your rules.
Somebody's gotta set an example.
Dr.
Shentu? Dr.
Taylor needs you.
I decided to scan her heart again just to be sure, and look.
You can see the beginning stages of Diastolic collapse of the right ventricle.
It's a sign of impending cardiac tamponade.
Congratulations, her condition is now emergent.
We can perform the pericardiocentesis without consent.
Doris, bolus fluids.
Add 125 milligrams of solumedrol, and set up a pericardial tap.
Heart rate 145, BP 88/48.
She's tanking.
What do you think? Maybe this could have been avoided? You mind? Come on in.
Um, my mom was, uh, was she bipolar her whole life? The disorder does tend to be genetic, but it doesn't usually present till late teens, early 20s.
And the drinking? The drugs? Most likely an attempt to self-medicate her condition.
You know, problem is, it just invariably makes it worse.
I used to get so angry at her.
I thought she was a drug addict.
Happens all the time.
You know, a, uh, a psychiatric illness goes undiagnosed, people just assume that it's an addiction issue.
I thought the drinking, drugs, were the cause, not the other way around.
I mean, situations like that, they can, in a strange way, turn into kind of a A self-fulfilling prophecy.
Yeah, I'm always just, uh, waiting for her to fall apart again.
Well, of course you are, because that's what she did over and over again your entire life.
Stevie, you gotta try and take it easy on yourself.
I think you should be giving yourself credit for Recognizing the importance of seeing somebody that you love in a new way.
Okay, um, so if you do have to stop working, you'll want a risk-averse portfolio.
So I'd I'd get you out of the mutual funds and put you in dividend stocks, and, uh, maybe an annuity.
It's my doctor.
Go ahead.
Hello? Yeah.
Thank you.
Your biopsy? Yeah.
Negative? Well, that's good news.
Why aren't you jumping up and down? This isn't my first go-around.
I've had cancer before.
And I guess the The possibility of it coming back, it just It will always be a worry.
Can I give you a little advice? Okay.
We all live on a razor's edge.
Everybody.
Just some of us know it more than others.
In a way, we're the lucky ones.
We have the good sense to Cherish every moment.
So it looks like we'll keep you in the mutual funds.
Okay.
All right, making the chevron incision.
Ready? So now you'll stay in the ICU for observation, and tomorrow you'll be transferred to Rheumatology.
There they'll work up a plan to address your fibromyalgia.
- Thank you, Dr.
Shentu.
- Okay.
Ms.
Goodwin, about the, uh, directives that I recently implemented, I think some of them might be too stringent, given the frenzied nature of an ED.
I will adjust them accordingly.
If you think that's best.
Ah, well played, Ms.
Goodwin.
Well played.
I'm assuming that was the precise outcome you were hoping for when you assigned Dr.
Shentu to the case? Dr.
Archer, you have a devious mind.
Maybe not as devious as yours.
What kind of person even becomes a compliance officer, anyway? He's a good guy.
And a good doctor.
Well.
Look at you.
Dr.
Shentu? Yes? I was wondering if you'd like to go to a concert with me tonight? Durand Jones.
I've got an extra ticket.
If you think it's appropriate.
Huh.
You mean, uh, within my guidelines? Um, yes.
I would love to go.
Wow, this is great.
I didn't think there was anywhere you could still make 5%.
Ellis? Ellis, talk to me.
Ellis? He just lost consciousness.
I got his labs back.
Thyroid function's in the toilet.
I'm hoping this levothyroxine will do the trick.
Poor guy, everything he's been through Hey, if anybody can beat this, it's Ellis.
- Terrell, how you feeling? - Uh, okay.
Now when can I get out of here? Well, your vitals are good.
I just need you to sign discharge forms.
- Where? - Oh, just your signature here.
And then just check the box that says that you agree to the terms and conditions.
There's two boxes? Oh, the one that says "I agree.
" Yeah, uh - That one.
- No, yeah, right.
Right, right, right, right.
You know, you're probably gonna be here for a bit.
Why don't you order yourself some food? Yeah, so what's good? Uh, nothing.
But, uh, if I was you, I'd probably get the roast beef.
Yeah, the roast beef Roast beef.
Yeah, roast beef.
Great.
I'll let the nurses know.
I'll get this in the works.
Hey.
Terrell.
I'm pretty sure he can't read.
Can't read? People can be really good at hiding it.
- You had no idea? - No.
He had trouble with the discharge forms.
He couldn't read the menu.
I mean, he dropped out of high school at 17, be he knew how to read by then.
Unless that's why he dropped out.
You know, come to think of it, he did always have trouble telling left from right.
We'd make jokes about it.
And he'd mix up words.
You know, I've seen kids like that.
Stevie, don't discharge him yet, all right? - Yeah.
- All right.
Damn, you again, huh? Since you lost consciousness, we need to do a brief neuro exam.
- Standard - Where's Dr.
Hammer? You know, I'm sorry, but she had an emergency.
Well, you're not doing it.
Aw, come on, T.
Just let me do this, and then you can get out of here.
All right.
All right, let's just get it over with.
Okay, so without moving your head, follow my finger.
Good.
All right.
Now, I'ma say four things to you, and I need you to repeat them back to me in the order that I say them, okay? - Whatever.
- All right.
Cow, pig, duck, horse.
Cow.
Pig.
Duck.
Horse.
Horse.
Pig, duck, cow.
All right.
Now, with your good hand, I need you to touch your nose, ear, and chin.
Come on, man, what was that? Nose, ear, chin.
All right, let's get you processed.
Hurry up.
Okay, all bile ducts reattached.
Finished up the hepatic artery.
Removing clamps.
Yeah, not hearing any systemic circulation.
Yeah, liver's not pinking up either.
Looks like hepatic artery thrombosis.
We're gonna need to remove that clot.
Get me a small Fogarty balloon and 500 units of heparin, Betty.
Reopening the hepatic arterial anastomosis.
Sats down to 91.
Inflate.
The balloon's too small.
Next size catheter, right? The patient's not even a year old.
Any wider and we risk perforating the vessel.
Well, I don't see as we have any other choice.
Reset.
One size up.
Oh, this one feels too tight.
I do not want to rupture this artery.
Sats are still lowering.
86.
84.
We might have to go back to the smaller catheter.
Why don't you let me try? I might have a better angle.
Here.
- Crockett.
- Give me a sec.
Now.
Here's the clot.
Sats climbing.
88, 93.
96 and holding.
Moment of truth.
Yeah.
Looks like an adequate flow.
A quick turnaround, Ellis.
I'm impressed.
Quality medical care.
I'm gonna send over an endocrinologist, make sure this doesn't happen again.
Thank you, Doc.
Hey, take care.
You gonna be okay? I should be asking you that.
Nice meeting you, Nurse Lockwood.
You too.
Bye.
Can I give you a kiss? Sure.
Here.
So you asked what was going on.
I had a biopsy.
Oh, Maggie.
No, no, no, no.
It's benign.
- I'm okay.
- That's great news.
Yeah, it is.
Well, long as we're coming clean, I wish Stevie was staying.
But like Ellis says, life can throw you a curveball.
Terrell, honey, let him speak.
It's important.
You need to be tested by a specialist, but I believe you have a neurological condition called dyslexia.
- Something you were born with.
- Dyslexia? It affects how the brain processes information.
You know how you've always had trouble with left and right, and how you mix up words.
Everybody does that.
It's, uh It's why you never learned to read.
- Dude, who says I can't read? - Terrell, come on.
Listen, it's not your fault.
And it doesn't mean that you're not smart.
No, no.
Not at all.
It's a learning disability.
It has nothing to do with intelligence.
You should have been diagnosed as a kid and helped, but, psh, let's face it, our school? They didn't have the funding for that kind of thing.
I thought I was stupid.
No.
No, baby.
No.
It's not too late to change things, bro.
Dyslexia is not all that uncommon, and there's plenty that can be done for you.
His life could have been so different if he'd known.
That was great work today, Dr.
Marcel.
Thank you.
You too.
- Okay, well, good night.
- Good night.
Oh, God, Crockett It's better this way.
Is it? Not the way I see it.
- Dan - Lonnie, just hear me out.
No, there's something I gotta say to you.
A colleague of mine had this pretty remarkable breakthrough today where they They were able see somebody who had been in their life for a long, long time, in a completely different light.
And it it kind of got me thinking, um, you know, I've been, um, I've kind of been at sea since you told me that you couldn't be my therapist anymore.
And I thought that that was because what I missed was the work that we did together.
But now what I'm thinking, is maybe Maybe what I really miss is you.
Hi, honey.
Come on in.
- Thanks for seeing me.
- Sure.
It's my own space.
I feel safe.
It's really nice, Mom.
There's a rec room, showers And we're self-governed.
No one tells us what to do.
Oh, honey, I wasn't talking about you.
It's okay, Mom.
Would you like some tea? Yeah, that'd be great.
Listen, Mom Are you gonna be okay with me leaving? I'll be fine, Stevie.
And I'm really going to make it this time.
I know you are.
I love you.
Is this why you ended things with me? Ended things with you? Did you go out with my daughter? - There are several tumors.
- Is it malignant? We'll send the tissue for pathology.
Is that your wedding ring? The Chief of ED at Andrew's hospital is retiring.
Andrew wants to put me up for the job.
It's been nice, you know, having my old rival back.
But, uh, you gotta do what's right for you.
Is my 5:30 Thursday still available? I'm trying to lighten my patient load.
I deserve a little more of an explanation.
After 20 years, I don't I don't make the cut? I have developed feelings for you, Daniel.
Thank you.
- Oh, hi.
- Hey, there.
- I was just on my - What are you doing? You go.
I'm on my way up to Medical Records.
Need to sign a few charts.
Nice to see you.
Have a good day.
Hey.
Hey, Lonnie? Look, I accept the fact that you can't treat me anymore, and I I respect that.
But, I it's also It's important for me to tell you that that the The work we did together? Um, you really helped me.
A lot.
And I wanted to thank you for it.
I appreciate that, Dan.
Okay, take care.
Hey.
- Daniel? - Hey.
You seeing her in person again, huh? No, you know, she, um she dumped me.
She's been your therapist for years.
What happened? She developed feelings for me.
- Feelings? - Yeah, romantic feelings, man.
She give you a referral? Well, sure, but I mean, you know, changing shrinks is not exactly like changing sneakers.
- You know? - True, true.
- Are you okay? - Yeah.
How're you doing? You know, I think I left my phone in the car.
Look, I'm going to be here all day, so if you want to talk some more I'm fine.
But thank you, and I'll see you around.
All right.
You're going to T2.
Thank you.
Hey, biopsy results come back yet? Not yet, but the lab promises that sometime today.
You know there's a good chance it's benign.
I'm not so sure.
- I had cancer before.
- Oh.
It's just You're afraid your cancer's come back.
Chest sounds good.
X-rays, a lot better.
As long as he continues to improve, I don't see any reason why we can't discharge him.
- Oh.
- It still hurts.
Yeah, well, pneumonia's no joke, D-man.
Look, I'ma give your mom some medicine to make you feel better, okay? Due to his pneumonia, it'll be a couple weeks before he can - go back on chemo.
- Okay.
Any word from Terrell? No.
And he's never stayed away this long.
This isn't like him.
- Thank you.
- Sure.
Morning, Ms.
Goodwin.
Dr.
Shentu.
Seems like the Med staff is adapting well to our new guidelines.
Your new guidelines.
And you really think so? In any case, I appreciate the cooperation.
My God, look out! - Please, help me! - We got you.
It's okay, it's okay.
I need a 911 and the emergency response team out front, main entrance.
Single vehicle crash, driver responsive.
The patient's car hit a concrete barrier.
The airbag deployed, but no visible signs of injury.
Heart rate's steady.
Having a lot of generalized pain.
Okay, everyone, let's get ready.
Got it? On my count.
One, two, three.
Okay, let's get a cannula and IV in.
Let's put her up on a monitor, draw trauma labs.
We need X-rays stat.
- Yup.
- Dr.
Shentu.
BP 95/65.
Heart rate and sats not picking up.
Cycle it again.
Clear.
Chest is okay.
No hemo or pneumothorax.
Mediastinum is normal.
Ultrasound? Thank you.
Fast is negative.
Got an ID.
Name's Gia Lindahl.
I can see if there's a history.
She's too distracted to clear her C-spine.
Let's keep the collar on for now.
Dr.
Shentu, pupils? Yeah.
Spare penlight? Pupils equal and reactive.
Little sluggish.
Ms.
Lindahl, can you hear me? Ms.
Lindahl? GCS 12.
She is a patient here.
One of the first we treated for COVID.
Been back a few times with long-haul symptoms.
Give her 50 mics of fentanyl.
Let's get a pelvis x-ray, and let's send her up to CT for a pan scan, and make sure we add a tox to her blood and urine.
Yep.
Dr.
Shentu, why don't you see this through? Uh, certainly.
And Dr.
Taylor, you run point.
Doris, let's get the doctor a pair of scrubs.
Okay.
Did you just assign the compliance officer to a medical case? He's a critical care doctor who's credentialed at Med.
He's a bureaucrat.
A suit.
Nevertheless, I know you'll be accommodating.
Yeah, do me a favor, keep me briefed on Dr.
Shentu's performance today.
Sure.
Oh, God.
Why does my body feel like it's on fire? Given everything we've seen, we think you have a condition called fibromyalgia.
Let's give her another 50 of fentanyl.
Fibromyalgia? We've seen it in long-haul COVID patients like yourself; there's even a name, "Fibro-COVID.
" What causes it? We think it's due to a problem in the way that the spinal cord and the brain process pain signals.
It's not life-threatening, but it is It's terrible.
We need a rheumatology consult, but for right now, we're giving you more pain meds so you can get some rest, all right? The good news, Gia? According to your scans, there were no serious injuries with your crash.
Oh, I'm so sorry.
I should have never driven myself.
Dr.
Taylor and I are just happy you're safe and getting the treatment you need.
- Fibromyalgia.
- That's tough.
Yeah.
So how are you thinking of treating her? There's data on patients responding very well - to Xyrem.
- Xyrem? As I recall, it's not FDA-approved for fibromyalgia.
- Right.
- Yeah, it's only approved for cataplexy and narcolepsy.
We'd be using it off-label.
And per your new mandates, our doctors can't prescribe off-label meds without the patient's consent.
And she's sedated now, so she can't.
Well, then as soon as she wakes, we'll, uh, explain the situation and ask for consent.
Yeah, seems like your only option.
Dr.
Scott! I understand we're doing a transplant - on a patient of yours.
- Yeah, yeah.
I was glad you and Dr.
Blake got the case, man.
Well, we're gonna take good care of her, all right? Thank you.
Dylan, I could use an extra set of hands in here.
30-something male.
GCS 10.
He was found passed out in the street, inebriated.
Right arm swollen and discolored.
- Terrell.
- You know him? Yeah, since we were kids.
His son's a patient upstairs.
Paramedics gave Narcan in the field, but zero response.
- Still hypothermic.
- Terrell, you hear me? Get away from me.
Look, I'm just trying to help, man.
Not you.
All right, he's rousable.
Let's get this board out of here.
All right, on three.
One, two, three.
Temp's 93.
All right, let's swap this out for one of our warmer blankets.
And get him a liter of NS on the warmer.
Right arm's pretty tight.
Hand's cold.
Can't feel distal, ulnar, or radial pulse.
Compartment syndrome.
Heart's a little tachy.
Foley output.
5cc's of dark urine.
Dead muscle's causing him to go into rhabdo.
Could be disaster for his kidneys.
He needs a fasciotomy.
Call Dr.
Archer.
On it.
Hey.
Any history you can share? Help us treat him? Terrell's kind of a mystery.
When we were kids, he was funny, smart.
Then he drops out, starts hanging with the wrong crowd.
After that, things went downhill.
It's tough to see a life fall apart.
He's been MIA for a while.
I'm gonna go tell his wife he's here.
- Yeah.
- All right, thanks.
Morning.
Hey.
Here you go.
I hear that Stevie's going back to Michigan to be with her husband? Yeah, so? Don't start with me.
Where is Trini? They're short-staffed at the ICU.
- She's covering.
- Well, I need her.
She's supposed to make a house call with me.
Oh.
I'll go.
Trini knows the patient, you don't.
What? Am I not the nurse with more experience than anyone else down here? Sorry, Nurse Lockwood.
I'm sure you've seen it all.
I'm grateful for your assistance.
Huh.
Charge Nurse Lockwood.
- You're in a good mood.
- So are you.
Mm-hmm.
Dr.
Hammer.
Good news, huh? - What's that? - Your mom.
I was just up in the Psych Ward.
I saw that they're discharging her.
Oh, right.
Yeah.
Kind of put them in their separate corners, - but other than that - My mother's here? Why didn't you tell me? - I couldn't.
- Why? Because she gave me express orders not to.
Well, this doesn't make any sense.
Did you commit her? I'm sorry, I can't discuss that with you.
She's my mother! Doesn't matter, Stevie.
She's a patient here, and she has rights.
Okay, where is she? - Stevie - This is ridiculous.
Come on.
Are you really gonna make me call security? Terri, good morning.
Um.
So Stevie found out that you're here.
How is she? She's a little confused.
Right? She's she's angry.
She's she's hurt.
But, um how would you like to handle this? What what would you like me to tell her? Wait here, please.
What's up? Nothing.
Nice.
Patient's a financial planner.
- He's, uh, done well.
- Mm.
- Dr.
Halstead.
- Hey, Lenny.
This is Maggie Lockwood, our charge nurse.
Hey.
Ellis is ready.
- Ellis, hi.
- Hey.
- Thank you for coming.
- Of course.
I want you to meet my friend, Maggie Lockwood.
My pleasure, Maggie.
Hi.
When I was bathing him this morning, he looked paler.
I normally have a healthy glow.
Okay.
Well, we're gonna need to open the box so I can take a look.
Can't be for long.
Polio paralyzed Ellis's diaphragm and intercostal muscles, so without the respirator, every breath requires conscious effort.
Polio.
Contracted it when he was five, a month before the vaccine came out.
Good timing, eh? Turning it off.
Those were my ward mates.
Ellis has been in the iron lung for 60 years.
63.
But who's counting? He's also instructed me more than once never to refer to him as a polio victim.
Life threw me a curveball, that's all.
I got lots to be thankful for.
Found some friends, work I enjoy, good docs like Halstead.
Hey, how's your love life, huh? Last time we talked, it wasn't so good.
Hasn't gotten any better.
Mm, I'm all ears.
Nothing to tell.
Ellis, I'm seeing peripheral cyanosis and you're skin is cold.
Maggie, pulse, please.
Bradycardia.
His HR's in the 50s.
We need an EKG.
I brought one.
You good for a few more minutes? Oh, yeah.
I need the exercise.
So, um, your mom has given me permission to share her medical history with you.
- Well, that's big of her.
- Have a seat, please.
I'm okay.
So you're mom admitted herself.
She was very depressed and, uh, was worried about self-harm.
Oh, my God.
She has been diagnosed with bipolar disorder.
All right? Which has, of course, been exacerbated by her alcohol abuse.
But admitting herself to the hospital, seeking help Really good sign.
And I have to say, with, uh With treatment, right? With therapy, with medication, she's I've been trying to reach her for weeks.
No answer.
She just hasn't returned any of my calls.
I'm, um I'm moving back to Michigan, but I didn't know if I should.
You know, Stevie, I'm so sorry that you've had to go through this.
Yet you were just fine keeping me in the dark.
Look, if it's any consolation, you're mom? She's doing very well.
Yeah, okay.
But did it have to mean cutting me out of her life? So Doc, am I gonna live? Well, our heart rate's hovering around 49, not quite the picture of heart health.
Any more good news? EKG also shows low voltage, and I wish your BP was higher.
However, these alone don't point to anything specific.
- Blood work? - Yeah.
So Ellis, we gotta place a line so we can collect your samples.
Unfortunately, you know, the only place we have access to is your neck.
Gets better and better.
Mr.
Turner, I'm gonna ask you to remain as still as possible.
Uh-huh.
And shut up.
I I get it.
And we're in.
I know a private lab nearby.
I'll have them run the tests.
We'll get a quick turnaround.
Should I be worried? Hey, whatever's causing your symptoms, - we'll deal with it.
- Okay.
Sorry about before.
I shouldn't have made that crack about your love life.
What's going on with you? I'll talk to you about it later.
You need to get to the lab.
We won't know the size of the recipient's abdominal cavity until we open her up.
So we'll resect the donor liver then according to the body weight ratio.
Right, get as close a match as possible.
Good morning.
How's everyone doing? We're all a little nervous.
- Her most of all.
- Yeah.
So how you feeling? Good.
Ready to go.
And how's our recipient? Stable, lightly sedated, but no reason not to proceed.
They're gonna make you all well, honey.
The techs are gonna be in shortly to take your daughter and you, Mr.
Byers, to pre-op.
I love you.
So we'll see you guys on the other side, yeah? You all right? All right, I'll see you.
Hey, Pamela? Pamela.
Hey, look, I spoke with Avery, and I made it clear you had no idea we'd gone out.
You mean, so she wouldn't think that her mom was snaking her boyfriend? - What a mess.
- I know, come on.
I want to make things right.
I want to make things right between you and me.
Look, I also told Avery I had I had feelings for you.
Okay, stop.
Stop, stop, stop.
I never should have let myself get involved.
You're a surgeon.
You're on my team.
That's all.
Dr.
Taylor, Dr.
Shentu, need you.
O2 started dropping.
I put her on a mask at 10 liters.
Need a chest x-ray.
I'm hearing a rub.
Okay, clear.
Her heart shadow looks a little fuzzy.
- Ultrasound? - Yeah.
It's gonna be okay, Gia.
Okay.
Pericardial effusion.
Why didn't your morning work up catch it? Wasn't on CT, but things change.
Could be a blunt cardiac injury from the crash.
We need to perform pericardiocentesis.
Dr.
Shentu, it's not indicated at this time.
She's not in tamponade.
She's protecting her airway, her condition is not emergent.
And with a non-emergent invasive procedure, we need Gia's permission before we can perform it.
Like the Xyrem? Yes.
Another new guideline.
Well, let's hope she regains consciousness soon.
Resected the left lateral segment.
Graft-to-recipient weight ratio is 4.
2%.
All right, resection complete.
Go ahead and put that on ice for Lily's transplant.
Let's get ready to close.
You're heart rate's not getting any better.
Same as your BP.
- What are you not telling him? - What? Halstead.
What are you not telling him? Come on, come on.
I'm in an iron lung.
I'm allowed to be nosy.
I had a biopsy.
Cancer, maybe? And why didn't you tell him? I don't want people worrying about me.
Yeah, I get that.
I'm not much for pity parties, myself.
No.
So what are you going to do if it's positive? I don't know.
Depends on how serious it is.
Chemo, radiation, surgery.
I'd have to stop working.
So how are you set for retirement? I don't know.
I haven't thought about that.
Yeah, but you should.
So you want me to take a look at your financials with you? - I can't ask you to do that.
- Why not? - Because you're my patient.
- Get your phone.
Pull up your accounts and email them to me, and we'll go over them together.
- Now? - Yeah.
I don't believe in putting things off.
Hi, Terrell.
Hi, I am Dr.
Archer, this is Dr.
Hammer.
I was the surgeon who performed a procedure on your forearm.
What happened? You were found near Washington Park.
You were passed out and laying on your arm, which lead to a condition which needed to be treated surgically.
You're lucky Dr.
Archer was able to operate so quickly.
It could have been very serious.
Does my wife know? Yeah, uh, she's here in the PICU with your son.
Yeah, she must be so mad.
Do you want me to have her come see you? No.
No, please.
Not like this.
Can I go home today? Well, I wouldn't recommend it, - but, uh, if you insist - I do.
And, um And then after I'm dressed, I'll I'll see her.
All right, well, you rest, and we'll make sure you get out of here.
Living arrangements all set.
And a van is on the way to pick you up.
Thank you, Dr.
Charles.
You know, Terri, there's something that I've been curious about.
Yeah? When you checked yourself into a hospital where you knew that Stevie worked, you had to think that eventually she was gonna find out that you were here.
I did.
I I wanted to be near her, and I thought eventually I would want to see her.
But The better I got, the more I felt I was turning my life around, the less I wanted to see her.
Does that sound terrible? No.
I love my daughter.
I I do, but she can be negative.
Even if she doesn't say it, Stevie always thinks I'll fail.
I know I've given her plenty of reasons to think that, but Not necessarily something you need right now.
No.
Ah, Dr.
Shentu.
You know, I heard about your inability to treat your patient.
But hey, you stand by your rules.
Somebody's gotta set an example.
Dr.
Shentu? Dr.
Taylor needs you.
I decided to scan her heart again just to be sure, and look.
You can see the beginning stages of Diastolic collapse of the right ventricle.
It's a sign of impending cardiac tamponade.
Congratulations, her condition is now emergent.
We can perform the pericardiocentesis without consent.
Doris, bolus fluids.
Add 125 milligrams of solumedrol, and set up a pericardial tap.
Heart rate 145, BP 88/48.
She's tanking.
What do you think? Maybe this could have been avoided? You mind? Come on in.
Um, my mom was, uh, was she bipolar her whole life? The disorder does tend to be genetic, but it doesn't usually present till late teens, early 20s.
And the drinking? The drugs? Most likely an attempt to self-medicate her condition.
You know, problem is, it just invariably makes it worse.
I used to get so angry at her.
I thought she was a drug addict.
Happens all the time.
You know, a, uh, a psychiatric illness goes undiagnosed, people just assume that it's an addiction issue.
I thought the drinking, drugs, were the cause, not the other way around.
I mean, situations like that, they can, in a strange way, turn into kind of a A self-fulfilling prophecy.
Yeah, I'm always just, uh, waiting for her to fall apart again.
Well, of course you are, because that's what she did over and over again your entire life.
Stevie, you gotta try and take it easy on yourself.
I think you should be giving yourself credit for Recognizing the importance of seeing somebody that you love in a new way.
Okay, um, so if you do have to stop working, you'll want a risk-averse portfolio.
So I'd I'd get you out of the mutual funds and put you in dividend stocks, and, uh, maybe an annuity.
It's my doctor.
Go ahead.
Hello? Yeah.
Thank you.
Your biopsy? Yeah.
Negative? Well, that's good news.
Why aren't you jumping up and down? This isn't my first go-around.
I've had cancer before.
And I guess the The possibility of it coming back, it just It will always be a worry.
Can I give you a little advice? Okay.
We all live on a razor's edge.
Everybody.
Just some of us know it more than others.
In a way, we're the lucky ones.
We have the good sense to Cherish every moment.
So it looks like we'll keep you in the mutual funds.
Okay.
All right, making the chevron incision.
Ready? So now you'll stay in the ICU for observation, and tomorrow you'll be transferred to Rheumatology.
There they'll work up a plan to address your fibromyalgia.
- Thank you, Dr.
Shentu.
- Okay.
Ms.
Goodwin, about the, uh, directives that I recently implemented, I think some of them might be too stringent, given the frenzied nature of an ED.
I will adjust them accordingly.
If you think that's best.
Ah, well played, Ms.
Goodwin.
Well played.
I'm assuming that was the precise outcome you were hoping for when you assigned Dr.
Shentu to the case? Dr.
Archer, you have a devious mind.
Maybe not as devious as yours.
What kind of person even becomes a compliance officer, anyway? He's a good guy.
And a good doctor.
Well.
Look at you.
Dr.
Shentu? Yes? I was wondering if you'd like to go to a concert with me tonight? Durand Jones.
I've got an extra ticket.
If you think it's appropriate.
Huh.
You mean, uh, within my guidelines? Um, yes.
I would love to go.
Wow, this is great.
I didn't think there was anywhere you could still make 5%.
Ellis? Ellis, talk to me.
Ellis? He just lost consciousness.
I got his labs back.
Thyroid function's in the toilet.
I'm hoping this levothyroxine will do the trick.
Poor guy, everything he's been through Hey, if anybody can beat this, it's Ellis.
- Terrell, how you feeling? - Uh, okay.
Now when can I get out of here? Well, your vitals are good.
I just need you to sign discharge forms.
- Where? - Oh, just your signature here.
And then just check the box that says that you agree to the terms and conditions.
There's two boxes? Oh, the one that says "I agree.
" Yeah, uh - That one.
- No, yeah, right.
Right, right, right, right.
You know, you're probably gonna be here for a bit.
Why don't you order yourself some food? Yeah, so what's good? Uh, nothing.
But, uh, if I was you, I'd probably get the roast beef.
Yeah, the roast beef Roast beef.
Yeah, roast beef.
Great.
I'll let the nurses know.
I'll get this in the works.
Hey.
Terrell.
I'm pretty sure he can't read.
Can't read? People can be really good at hiding it.
- You had no idea? - No.
He had trouble with the discharge forms.
He couldn't read the menu.
I mean, he dropped out of high school at 17, be he knew how to read by then.
Unless that's why he dropped out.
You know, come to think of it, he did always have trouble telling left from right.
We'd make jokes about it.
And he'd mix up words.
You know, I've seen kids like that.
Stevie, don't discharge him yet, all right? - Yeah.
- All right.
Damn, you again, huh? Since you lost consciousness, we need to do a brief neuro exam.
- Standard - Where's Dr.
Hammer? You know, I'm sorry, but she had an emergency.
Well, you're not doing it.
Aw, come on, T.
Just let me do this, and then you can get out of here.
All right.
All right, let's just get it over with.
Okay, so without moving your head, follow my finger.
Good.
All right.
Now, I'ma say four things to you, and I need you to repeat them back to me in the order that I say them, okay? - Whatever.
- All right.
Cow, pig, duck, horse.
Cow.
Pig.
Duck.
Horse.
Horse.
Pig, duck, cow.
All right.
Now, with your good hand, I need you to touch your nose, ear, and chin.
Come on, man, what was that? Nose, ear, chin.
All right, let's get you processed.
Hurry up.
Okay, all bile ducts reattached.
Finished up the hepatic artery.
Removing clamps.
Yeah, not hearing any systemic circulation.
Yeah, liver's not pinking up either.
Looks like hepatic artery thrombosis.
We're gonna need to remove that clot.
Get me a small Fogarty balloon and 500 units of heparin, Betty.
Reopening the hepatic arterial anastomosis.
Sats down to 91.
Inflate.
The balloon's too small.
Next size catheter, right? The patient's not even a year old.
Any wider and we risk perforating the vessel.
Well, I don't see as we have any other choice.
Reset.
One size up.
Oh, this one feels too tight.
I do not want to rupture this artery.
Sats are still lowering.
86.
84.
We might have to go back to the smaller catheter.
Why don't you let me try? I might have a better angle.
Here.
- Crockett.
- Give me a sec.
Now.
Here's the clot.
Sats climbing.
88, 93.
96 and holding.
Moment of truth.
Yeah.
Looks like an adequate flow.
A quick turnaround, Ellis.
I'm impressed.
Quality medical care.
I'm gonna send over an endocrinologist, make sure this doesn't happen again.
Thank you, Doc.
Hey, take care.
You gonna be okay? I should be asking you that.
Nice meeting you, Nurse Lockwood.
You too.
Bye.
Can I give you a kiss? Sure.
Here.
So you asked what was going on.
I had a biopsy.
Oh, Maggie.
No, no, no, no.
It's benign.
- I'm okay.
- That's great news.
Yeah, it is.
Well, long as we're coming clean, I wish Stevie was staying.
But like Ellis says, life can throw you a curveball.
Terrell, honey, let him speak.
It's important.
You need to be tested by a specialist, but I believe you have a neurological condition called dyslexia.
- Something you were born with.
- Dyslexia? It affects how the brain processes information.
You know how you've always had trouble with left and right, and how you mix up words.
Everybody does that.
It's, uh It's why you never learned to read.
- Dude, who says I can't read? - Terrell, come on.
Listen, it's not your fault.
And it doesn't mean that you're not smart.
No, no.
Not at all.
It's a learning disability.
It has nothing to do with intelligence.
You should have been diagnosed as a kid and helped, but, psh, let's face it, our school? They didn't have the funding for that kind of thing.
I thought I was stupid.
No.
No, baby.
No.
It's not too late to change things, bro.
Dyslexia is not all that uncommon, and there's plenty that can be done for you.
His life could have been so different if he'd known.
That was great work today, Dr.
Marcel.
Thank you.
You too.
- Okay, well, good night.
- Good night.
Oh, God, Crockett It's better this way.
Is it? Not the way I see it.
- Dan - Lonnie, just hear me out.
No, there's something I gotta say to you.
A colleague of mine had this pretty remarkable breakthrough today where they They were able see somebody who had been in their life for a long, long time, in a completely different light.
And it it kind of got me thinking, um, you know, I've been, um, I've kind of been at sea since you told me that you couldn't be my therapist anymore.
And I thought that that was because what I missed was the work that we did together.
But now what I'm thinking, is maybe Maybe what I really miss is you.
Hi, honey.
Come on in.
- Thanks for seeing me.
- Sure.
It's my own space.
I feel safe.
It's really nice, Mom.
There's a rec room, showers And we're self-governed.
No one tells us what to do.
Oh, honey, I wasn't talking about you.
It's okay, Mom.
Would you like some tea? Yeah, that'd be great.
Listen, Mom Are you gonna be okay with me leaving? I'll be fine, Stevie.
And I'm really going to make it this time.
I know you are.
I love you.