We are three weeks into IVF.
You know what they say?
You blink and the kids are grown.
Dr. Hannah Asher. Gynecology.
You shouldn't even be working.
You OD'd. For all I know,
you're... You're high right now.
How about you and I keep our distance from one another?
Just as soon as you stop treating patients
and seek treatment for your addiction.
If I go down, so do you.
So does the site.
Dr. Asher.
Could you say that any louder?
Not sure everybody heard you.
Sorry.
I wasn't trying to blow your spot.
Yeah, well, remember.
You tell on me, I tell on you.
Thanks for the reminder.
Hmm.
Why are you here?
Hey, hey. Wait.
Let's start over.
Okay, can we talk?
About options to get clean?
Yeah, like I appreciate you wanting to help,
but I'm not really in the mood for a lecture right now.
Hannah. You're a doctor.
You know what you're doing to your body.
Yeah, so, I know that this can't last forever.
Then why don't you want to do something about it?
I can get you an intake at a rehab facility.
I can't just go to rehab.
Okay? I have a job. I have responsibilities.
Okay, Narcotics Anonymous then.
You can drop in and out.
There's a meeting at the church
right around the corner from the hospital.
8:00 a.m. tomorrow. One hour of your time.
You won't even be late to work.
- Okay. - Yeah?
I'll go.
All right.
Thank you.
- Hey. - Hi.
So,
wonder if it's gonna snow today.
Crockett, it's okay.
What happened is in the past.
Can't remember what it was.
Desmond, what do we got?
Rick Tyler, 40, passenger in a motor vehicle collision.
Intubated in the field.
BP 88/57, heart rate 70, GCS 6.
- What happened? - Wife was driving the car
and ran a red light. She's in the ambo behind us.
CFD had to use the jaws of life
to pry them from the wreckage.
Ouch. Need a hand? - Yep.
All right, we're gonna transfer on my count.
Ready? One, two, three.
Need an X-ray in here.
Right leg's badly mangled. Lost a lot of blood.
Hang 2 units O-O-neg. Trigger the MTP.
Breath sounds are clear. Chest and pelvis.
BP's low. We need to fast him.
- X-ray's ready. - Everyone stand back.
Chest is clear.
There's blood in the belly.
- Dr. Manning. - Yeah.
His wife's coming into Trauma 2.
I got him. You get the missus.
Okay.
Hey, Mike. Shoot the pelvis.
Then we're taking him to the O.R.
All right, let's transfer on my count.
Ready? One, two, three.
Her name's Kim.
BP 115/75.
Heart rate's 90. GCS 15.
Hi, Kim. I'm Dr. Manning.
I didn't see the light change.
All I care about is your well-being.
All right, I'm gonna check your neck, okay?
Okay.
All right, let's see.
Okay, can you touch your chin to your chest?
How does that feel? Any pain?
- I'm okay. - All right.
Help me roll her over so I can check her spine.
We're gonna do it on my count.
All right, one, two, three.
You're doing great.
All right. Let's see.
Kim, were you in an accident prior to this one?
You have significant bruises all down your lower back.
Must be from the crash.
It couldn't be from the crash.
Bruises take a while to turn yellow like this.
Yeah, I fell last week.
On the stairs. I forgot.
All right.
Kim? I have to ask.
Did someone do this to you? No.
- Because if someone did... - No, I fell.
Okay.
But there's a goose-egg on her forehead.
I'd like to get a head CT.
My husband Rick...
He's headed into surgery now.
Okay.
- Dr. Manning? - Yeah.
Those bruises...
She was abused, right?
*CHICAGO MED* Season 05 Episode 14
*CHICAGO MED* Episode Title: "It May Not Be Forever"
Come on, everyone. Meeting's starting.
Hey. You free for an intake?
Yeah. Your sister called.
Vincent's transitioning to a toddler bed,
and she asked if we want his crib.
He's getting so big.
And it's kind of early for that,
but we're gonna need a crib at some point, right?
I mean, yeah.
It is one less thing to worry about.
I can pick it up tonight.
Hey.
I'm Dr. Choi. This is Nurse Sexton.
Hi.
Nina. This is Harlan, my husband.
Aw, I love it when you call me that.
- Mmm. - Newlyweds?
A month ago.
But we're still working our way through the cake.
- Oh, but it's delicious. - Mmm.
So, what brings you in?
This awful rash.
It goes all the way up my neck.
It's all over my legs.
My gynecologist prescribed me fluconazole last week
for a yeast infection.
Could that be related? Maybe.
What about something in my apartment, maybe?
Nina just moved in.
Hadn't been cleaned since 2015.
Okay.
Well, you're definitely allergic to something.
We're gonna order some labs,
and get an antihistamine for you,
then come back for a full allergen history.
We'll get this rash under control.
Aw, but I love you all red and puffy.
Come here, you.
No, you come here.
Missed you at the meeting.
So, you're stalking me now.
Do you do this with all the women
that leave the injection site, or am I special?
I'm just concerned.
Yeah, okay, if I had known going to a safe injection site
would result in you hounding me,
I never would've gone in the first place.
Hi, I'm Dr. Lanik, this is Ms. Curry,
fourth year medical student.
Hi, I'm Vanessa, Xavier's mom.
And this is my boyfriend, Alvin.
So, I see Xavier was diagnosed
as being in a persistent vegetative state
at Norris memorial after a bike accident?
Yeah, about five months ago, he hit his head.
So, what brings you in today?
I was changing Xavier's clothes this morning,
and I noticed a sore on his hip.
Maybe I left him on his side too long?
I'm just worried it's infected.
- Let's roll him. - Okay.
We call that a pressure ulcer.
Yeah, it does look infected.
Have you been managing Xavier's care at home?
Since he was discharged from the hospital
about four months ago.
See the granulation in the center?
We'll go ahead and clean and dress the wound.
Okay.
So, it should never get to this point.
We try to turn him regularly.
There's actually an air mattress
that can help with that.
We'll send you home today with some antibiotics,
but why don't you come with me,
and we can go over a handout about how to prevent bed sores?
Keep this from happening again.
Talk to me, Marty.
BP's better. He's gotten a lot of blood.
Packed his liver crack pretty well.
Bleeding should no longer be an issue.
I'm worried.
There's only 10 cc's of urine in his foley.
Dark and brown. I sent a sample for labs.
Could mean he's in rhabdo.
Let's remove the drape please.
Nice and easy.
Yeah. Leg's not looking good.
Muscle is dying and dumping off into the bloodstream.
Lab report? CPK levels are high.
25,000. Whoa.
That does indicate rhabdo.
Leg's gotta come off or it's gonna kill him.
Gotta talk to his wife.
So, based on your scans and neuro exam,
we can safely rule out a traumatic brain injury.
But I do want to ask you again about the bruising...
I told you. I fell.
Hi, Mrs. Tyler?
I'm Dr. Marcel.
I'm the surgeon who operated on your husband, Rick.
How is he?
He had a bad liver injury and he's still pretty sick.
So, is he going to live?
Well, we got the bleeding under control,
but my main concern is his right leg.
The muscle is dying, and it's poisoning his blood,
which in turn is hurting his kidneys,
putting him in renal failure... W-what does all that mean?
Rick's leg is making him very sick.
It will kill him.
And I need your consent to amputate.
He has to lose a leg?
I... isn't there something else you can do?
I'm sorry.
He'll be so upset.
Kim, I know this is a lot to deal with.
I...
I'm not...
I'm not sure what Rick would want.
He might rather be dead than have only one leg, he...
You sure there's nothing else you can do?
- Not that I'd advise. - Please, tell me.
We could move him to the ICU
and do the best we can to keep him alive.
That might give us some time for him to wake up
and make the decision himself.
Okay.
Let's do that.
Every second we wait increases the risk
of him dying of multi-organ failure.
I understand, but...
he should be the one to decide.
Okay.
I'll be back in a moment.
- Hey. - Yeah?
I am not comfortable with this.
That woman was abused by her husband.
- You sure about that? - Yes.
And in my opinion, she should not be making this decision.
What are the chances Mr. Tyler
doto make this call? own
Slim.
Rick needs to have his leg amputated.
And I don't think it's right to have Kim decide
if he's been abusing her.
- Why not? - Because
it's a life or death call.
And she's not in the right frame of mind to make it.
She's too vulnerable, and it's a decision
she'll have to live with for the rest of her life.
So, let me get this straight.
We're gonna take away the legal rights of an abuse victim
because she was abused.
No, it's more complex than that.
I mean, considering the emotional
and psychological burden that Kim's been under,
I really feel like the hospital should step in.
She's his wife.
She's entitled to make this decision.
Then, you're in favor of him not having the surgery?
I'm in favor of respecting the rights
of the next of kin to decide...
Even if it goes against what's best surgically.
All right, I'll convene an ethics committee.
Until then, do everything you can to keep Mr. Tyler alive.
Strange, isn't it?
Mm-hmm.
Is this consistent with a vegetative state?
No, it is not.
You know what? Send me his chart.
Okay? As soon as you can.
Okay.
What was Dr. Charles doing in here?
Um, I... I thought he might have some insights
into Xavier's condition.
Have you guys noticed that his legs can stay up like this?
We thought that was part of his condition.
Ms. Curry? A word.
Excuse me.
Ms. Curry, you had no right to consult another department
without clearing it with me first.
You were busy and I had a concern.
I mean, how do you explain Xavier's leg
staying up on its own?
Probably just spasticity,
which is common in a vegetative state.
Well, I've never heard of muscle stiffness
causing that presentation.
Look, this kid was brought in for a pressure ulcer,
so that is what we're treating him for.
Okay.
Nina, you ready for a scratch test?
I will give you two a minute.
The couple in Treatment 3
is having sex.
I don't get it.
The E.D. is about the last place I ever wanna have sex.
I know.
You know what?
God bless the couple that can't keep their hands off each other
even in this place.
Yeah.
What's going on?
Dr. Lanik is sending them home.
Oh.
I'm Dr. Charles with psychiatry.
I had been reviewing Xavier's medical records.
And I think that there's a very good chance
that he was misdiagnosed there.
Misdiagnosed?
Yeah, I... I don't think your son is in a vegetative state.
Do you know how his joints,
they stay in the same position after they've been moved?
Mm-hmm.
That's something called waxy flexibility.
It is indicative of only one condition.
Catatonia.
Catatonia?
Yeah, it's a... it's a neuropsychiatric disorder
that can lead to paralysis, but it's treatable.
And this was caused by the head injury?
I'm suggesting that this has nothing to do
with your son hitting his head.
What's going on?
He's saying our son might be catatonic.
Xavier was fully evaluated
before being diagnosed as being in a PVS.
Catatonia's a pretty rare condition,
so without a psychiatrist weighing in,
it's possible that the doctors at Norris
weren't even looking for it.
Yeah, but Xavier fell off his bike.
He hit his head.
Yeah, but the scans were inconclusive,
meaning that there was no clear brain injury.
Look.
I think that I can help your son.
But in order for me to do that, he needs to stay here.
Look, I'm just trying to spare you a bunch of tests
your son doesn't need,
so you don't wind up right back where you are.
Wait.
Yeah.
We're staying.
All right, well, he is discharged from my service,
so, Dan, if you wanna admit him to yours,
be my guest.
Put him back in his room please.
Somebody help!
Please!
No, no, no. Wake up.
Her rash suddenly just flared up and she just passed out.
Nina? Nina, can you hear me?
- She's not moving any air. - Pulse is thready.
Code blue, Treatment 3!
What's happening?
She's in anaphylactic shock. We need to intubate.
Bolus her a liter of NS,
and 0.3 milligrams of epi IM, stat.
Nina? Nina!
Heart rate's in the 40s.
BP 70/33.
Atropine?
Yeah, push a mil IV.
Baby, baby, come on, come on. No, no, no, no, no.
I'm in.
Stats are coming up. Pressure's still soft.
All right, keep the fluids running.
50 of Benadryl IV, start racemic epi,
and give her another dose of epinephrine IM.
What caused this?
Catatonia only freezes the voluntary muscle groups,
not the involuntary ones
like those that help us breathe.
So if I'm right, and Xavier is indeed catatonic,
he does not need the ventilator to breathe,
and we can disconnect it. Wait.
But isn't that dangerous?
The doctor said he'd die without it.
They said he wasn't, uh...
What's the expression?
Protecting his airway.
He has a trach...
Which means that we can always
reconnect the vent if needs it.
Do, uh, do we have your permission?
Yes.
Okay. Ms. Curry?
Kay, SATS are dropping. 92.
90. Isn't that bad?
Not necessarily. As carbon dioxide builds up,
it should kick his respiratory system into drive.
85.
Dr. Charles.
He's not breathing.
Wait, wait, wait.
Oh, my God.
Xavier?
My little boy!
What does this mean? What do we do now?
Well,
probably not a bad idea to try and figure out
what put him into a catatonic state in the first place.
So the first doctor to explain catatonia
Dr. Kahlbaum, rs ago,
described it as,
"immobility induced by severe mental shock,"
like an emotional trauma.
Well, I mean it's like a...
Like a deer caught in the headlights.
But instead of bounding into the forest,
they stay there, frozen.
What, like PTSD?
I'm a cop. I've... I've seen PTSD.
It doesn't look anything like this.
And there's been no trauma.
Xavier was always a happy kid.
Okay, you mind telling me a little bit more about...
About your home life?
It was good...
Before this happened.
I mean, there have been some rough patches.
My ex, Xavier's father, left us high and dry
when Xavier was a little boy,
but... we got through it.
And then Alvin came into the picture.
Yeah, we started dating five years ago.
We've been living together for the past three years.
How about school?
Xavier's always been a good student.
Loved reading.
- Friends? - Lots.
I used to take them all to White Sox games.
He did watch this movie "Poltergeist"...
Which gave him nightmares.
But that was a few years ago.
Unlikely that one movie's gonna induce catatonia.
I have to take this.
I'm working a task force with the DEA.
Sorry.
- Alvin here. - Yeah.
How did Xavier feel about, uh, about Alvin's work?
Alvin's always been good about
not bringing it home with him.
He took all the precautions. Keeps his gun in a safe.
But still, did he ever talk to you
about how he felt about
the fact that Alvin was a police officer?
Xavier's a 10-year-old boy.
Alvin being a cop is like
having a superhero sleeping down the hall.
Mm.
Why would you ask that?
Just trying to get some background.
Alvin's the best father figure Xavier could ever have.
You don't have to worry about that.
Hey, why did you stop?
It seemed like you were on to something.
I think we're getting to a sensitive area here.
So I just like to, you know, take a pause
before we push forward,
but Alvin's work life
is absolutely something we want to look into.
Nina's stable for now.
It doesn't make sense. The antihistamine was working.
So she must have been re-exposed to the allergen.
I guess we can move her to a clean room.
But she had the rash before she even came to the hospital.
Yeah, I just wish we could've gotten that scratch test.
I tried, but they were indisposed.
Before I could get back in there, she crashed.
Indisposed?
What do you mean, "indisposed?"
Were they having sex?
Yeah.
We need to talk to Harlan.
Harlan, I'm not here to judge you,
but I gather you and Nina had sex in the hospital.
Um, I'm sorry you had to walk in on that.
- Did you finish? - Jeez, man.
It's pertinent, Harlan. We need to know.
Did you ejaculate?
I did, yes.
I'm gonna write an order. You need to go to the lab.
- Maggie. - Yeah.
What's the story with the patient in five?
Uh, second trimester with preeclampsia.
Dr. Asher's seeing her now.
You all right?
Yeah, just have to do something I don't want to do.
Well, in my experience, better to not hesitate.
Just rip the band-aid off.
Thanks.
So after reviewing the details of Rick Tyler's case,
the ethics committee has decided to take away
decision-making rights from Kim.
Wow.
Kim's choice to wait on amputating Rick's leg
puts his life at unnecessary risk,
and the committee believes that Kim,
whatever her circumstances,
doesn't appreciate that risk.
Okay.
So you can take Mr. Tyler to surgery.
All right.
I have to go tell Kim now.
Why don't I come with you?
Thanks.
Yeah?
- Dr. Charles? - Come on in.
I called over to CPD.
And I found out some
pretty interesting things about Detective James.
Without asking him?
Why?
Because you said you didn't want to bother them?
Until they were ready to talk again.
What about their privacy, Elsa?
Alvin's not the patient.
I mean, it's not like I violated anyone's HIPAA rights.
Well, that is, in fact, debatable,
but you definitely violated their trust.
This family's in a very delicate place, Elsa.
They... they need to feel like we're on their side,
or they could just walk out the door.
Okay.
Do you wanna see what I found out, or... or not?
What's going on?
This is Sharon Goodwin.
She's the Executive Director of Patient Services.
What's going on? We're moving forward
with your husband's amputation.
But I said I wanted to wait!
The hospital believes it's in your husband's best interest
to take control of his medical decisions.
Why?
Kim, I saw signs of abuse.
We don't think you should have to be responsible
for someone who might be hurting you.
Kim? Hey, Kim.
Whatever your situation is,
it does not have to stay that way.
You can talk to us.
When he wakes up,
and he remembers I was driving the car...
It is my fault he lost his leg!
There are shelters that can provide you a safe haven.
You'll be taken to a secret location
where no visitors are allowed.
Please, Kim. Let us help you.
Okay.
I'll think about it.
Detective James, I want to apologize.
To ask about you.
My thought was that I might learn something
that could be helpful, but I...
I overstepped, and I'm sorry.
Xavier's your patient.
Why would you be checking up on me?
Ms. Curry made a mistake...
A serious mistake.
I just hope that you'd appreciate that
what she was trying to do was gain a better understanding
of Xavier's situation so that
we can give him the best possible care.
And I hope she learned what a good man...
What a good cop... Alvin is.
Matter of fact, she did.
You have an outstanding record, Detective.
You took out the Southside Ministers gang
on your own?
Eh, I had a lot of help.
Hmm. Sounds intense.
I mean, they put a hit out on you.
They blew up your car.
What does this have to do with anything?
Well, it just sounds like a pretty monumental event.
Do you think that there's any chance that
Xavier could've been aware of it?
I don't think so.
The car was parked around the corner.
So, he didn't witness any of it?
I mean, he may have seen the wreckage towed away.
There's no way he could've understood what happened.
But I'm sure you were probably pretty upset, Vanessa.
You think that he could've picked up on that?
Alvin moved out after that.
He stayed away while there was an active threat against him.
Mmm.
Just out of curiosity, when did he move back in?
Uh, it was about a week before Xavier became catatonic.
Alvin would never let anything happen to us.
He didn't do anything wrong.
I'm not suggesting that he did.
Then what are you suggesting?
I'm suggesting that Alvin works in a very scary world
and that, on some level,
Xavier very much understands that.
And his fear about the possible consequences
could very well have triggered his catatonic state.
So what does this mean? That Alvin needs to leave us?
Look, honey, it's just...
No, you are the best thing
that's ever happened to me and Xavier.
We've heard enough.
- Hey, Sean. - Will.
I have you on schedule for tomorrow night.
Right. Thing is...
It's not such a good idea for me to be involved
with the site right now.
Wait, we're really starting
to make a difference with these people,
in large part 'cause of you.
Appreciate that.
But I want what's best for the site,
and that means I have to go.
I'm sorry.
Are we at risk here?
I think my leaving will protect you.
Thanks.
Think you're ready to have this out.
Take a deep breath.
All right, hard exhale.
There we go.
What happened?
You had another allergic reaction.
Yeah, I'm, uh...
I'm the problem, honey.
It's me.
What are you talking about?
We ran tests on Harlan's semen,
and it turns out you're allergic to it.
What?
No...
It was never an issue before because you used condoms,
which you stopped once you started trying to get pregnant.
His semen?
Come on. Th...
Oh, my God. So what are you saying?
We can't have sex anymore?
- Yeah, what about kids? - There are options.
We'll get you to a fertility specialist.
There are multiple procedures you could do.
We'll also set you up with an allergist.
There might be some methods
to help you build up a tolerance.
With treatment, your sensitivity may lessen.
Meanwhile, you can go back to having sex with condoms.
Hey, you two obviously love one another.
You'll work this out.
Just keep an EpiPen on your nightstand.
You know, walking in on them like that
got me thinking, um...
Ever since we started IVF,
I feel like the only time you touch me
is when you're injecting me with hormones.
You're right.
How about we have a date tonight?
And stay home?
I'd like that.
Come in.
I'm sorry. I didn't mean to intrude.
- You got a minute? - Of course.
Um...
You were right.
My job.
I do bring my work home with me
whether I want to or not.
And Xavier knows that.
"Do the bad guys know where we live?"
He asked me that once.
And I told him that they didn't.
But the fact that he had to ask...
I mean, kind of says it all?
Doesn't it?
Yeah.
My job is to protect people.
And if I can protect my...
my son
just by stepping aside, then that's what I'm gonna do.
Look. Alvin.
If you feel you need to get a little space
while Xavier's coming out of this,
while he's recovering his faculties,
maybe that's not a bad idea.
But,
as soon as he's ready to start the therapy
that he needs to process his fear,
you need to be right there next to him
so you can heal together.
And... and move forward.
Like as a family.
Yeah.
Is he going to wake up now?
Well, after the surgery, and all the drugs,
it'll be a while before he does.
Okay.
This might sound crazy, but...
I think he really does love me.
That's not crazy.
A social worker will be by shortly
to talk to you about your options.
Thanks, Dr. Manning.
Dr. Manning.
You remember our social worker, Arlene Baker?
Yes, hi.
How's Ms. Tyler doing?
She's anxious.
Understandable.
I think I can allay some of her fears.
No pulse. He's in PEA.
Starting compressions.
Milligram of epi.
Why's his ventilator off? I did it.
How is this happening so fast?
He's in multi-system organ failure.
He had no reserve.
Still no pulse. Another milligram of epi.
Asystole.
Time of death.
18:08.
I don't understand.
She had options.
Oh, I imagine she couldn't stomach the idea
of looking over her shoulder the rest of her life
waiting for her husband to get even.
I thought we'd reached her.
Oh, considering what just happened,
Kim might have run that red light
this morning on purpose.
And if she was willing to sacrifice herself
to stop her husband's abuse?
I doubt there was any way to reach her.
Dr. Charles!
Look, he's moving.
Xavier, honey? Can you hear me?
What do you want, baby?
You thirsty?
Um, I can go get him some ice chips.
Mommy's here.
I'm here, baby.
Mommy's here.
Did he wake up?
Yeah.
Looks like he's coming out of it.
That's my boy.
Um...
Will you send Vanessa out here
when the time is right?
Absolutely.
Hey, you good? I heard what happened.
It was awful.
A lot of fine surgical work went to waste.
Really? That's all you have to say?
No, actually, I'd like to add
that if we just let it be, he would've died on his own.
Hey, you can't kill someone who's already dead.
Can't even be tempted.
Is that why you were so adamant
about having Kim decide?
Let me put it like this.
A victim of abuse is being hauled off to jail.
And in my opinion, that's a lousy outcome.
I'll see you tomorrow, Natalie.
That was a good catch today, Ms. Curry.
Yeah, right.
Yeah, right? Look, if it wasn't for you,
Xavier might be back home
on a vent for who knows how long.
Really good thing that you piped up when you did.
Good work. Well done.
Asking a junkie to meet you in a bar.
Not exactly sensitive.
I guess not.
Uh, just a water for me.
Sit.
Look, I'm sorry about this morning.
I may have overreacted a bit.
That's okay.
Hannah,
I can't let this go on.
Hmm?
If you won't turn yourself in...
Look, I thought we had an understanding.
I quit the injection site.
I thought that it meant so much to you?
Not more than this.
I never would've turned you in.
I just... I got...
Desperate and scared.
But you can't...
You can't possibly know what it's like.
Every day I say I'm gonna quit and yet...
Hannah.
You don't have to do this alone.
I'll be there. I'll help you.
What?
You care
about me.
I do.
I do care.
I will turn myself in.
First thing in the morning.
- I can go with you. - Yeah.
Yeah.
Yeah, I'd like that.
Okay.
Come to my place?
Hey.
Check it out.
Looks good.
Now we just have to set up the nursery.
But in the meantime...
How about that date?
Hey.
Everything okay?
Yes.
Come here.