So I get this specimen labeled "synovial fluid, left hip."
And I'm looking at it,
and it's not very viscous.
Obviously, I'm thinking maybe it's gout,
but there aren't any crystals under the microscope,
just cells, so I call the intern who drew it,
and he tells me he's trying to rule out cirrhosis,
which doesn't make any sense,
until I suddenly realize,
those weren't monocytes I was seeing, they were PMLs.
The guy had drawn it from the left hip,
but it was peritoneal fluid.
What is the matter with you?
Did you see someone following us when we got off the bus?
No.
I'm pretty sure I did.
- Who? - I don't know.
I just can't shake this feeling I'm being followed.
- Followed? - Mm-hmm.
Oh, I get it.
Don't worry, it's not real.
- What? - You're a first year
- psych resident. - But what does that mean?
You spend all day treating very disturbed people.
It's only natural that you'd start mirroring
some of their disorders. For example, paranoia.
I don't know.
That sounds kind of condescending.
Stacking up here, Maggie, you need to get these patients
to the medical force.
Oh, really? Sorry, Dr. Choi, I didn't notice.
Dr. Manning, Hayley Kline, incoming.
Adolescent female, on chemo for non-Hodgkin's lymphoma.
- No, no, no, Baghdad. - Oh, okay.
Dr. Manning, thank God you're here.
Stop the shoes. No shoes.
- Honey, I don't understand. - She's been talking nonsense.
GCS 10, altered mental status, mostly incoherent.
New onset of jaundice.
- April? - Got it.
Her eyes, they're... They're yellow.
Hayley, honey, it's Dr. Manning.
Do you remember me?
I can't find my...
- What's wrong with her? - We're gonna find out.
No rain. No. No.
Let's hang a liter of NS
and draw a CBC, BMP, LFT, and lytes.
On it.
When was her last dose of chemo?
Few days ago, I think.
A week, actually.
Oh! Sweetie, honey.
She could be in liver failure,
which could be causing her brain to swell.
Oh, no.
GCS is worsening. We need to intubate, protect her airway.
I got it.
Do what you gotta do.
10 of etomidate and a 75 of sux.
Yup.
Nine percent.
I'm in.
Let's get a head CT and belly, hyperventilate
and get labs now with an acetaminophen level.
- Got it. - Call 'em and tell 'em
we're on our way up, we don't have time.
You can come with us. Let's go.
Hang in there, Hayley.
- Synced and corrected by martythecrazy - - www.addic7ed.com -
- Can't you rush those discharges?
- I need those meds. - You paged?
Yeah. Yeah, yeah, yeah, yeah.
We're jammed and there's no beds upstairs.
I hate to say it, but maybe we should...
We're not diverting patients to other hospitals.
I'm just saying...
Maggie, we're not going on bypass.
If the medical floors are filled, call the ICUs,
put patients there until beds are available.
I'll try.
Sorry for the lack of privacy.
Oh, no problem. I just want to get outta here.
When did the pain start?
About a half hour ago.
- Mm-hmm. - I was gonna ignore it,
but my neighbor, he's a nurse,
and so he said I should get it checked out.
I don't like hospitals.
I hear ya. Where exactly is the pain?
Here. Uh, the belly button.
Dr. Halstead?
Mr. Logan, do you have a history of A-fib?
What's that?
An irregular heartbeat.
No. Is it serious?
Oh, very common, but something we should look into.
What about this? This hurt?
No.
- This? - Yeah, there.
Well, good news, your belly's soft and you're not guarding,
meaning you're not tensing when I touch you.
Oh, so it's probably nothing, right?
I mean, it's probably something I ate.
I hope so, but let's just... Let's just be safe.
Let's order a chest x-ray, KUB and lactate,
CBC, amylase lipase, check his basic chemistry.
Right.
How long is that all gonna take?
Uh, do you know, not long.
We'll get you outta here as soon as possible.
Tolerated the surgery well, Mr. Collins.
Your chest sounds good.
That's great.
Let me.
Mr. Collins, we're gonna have to redo
your aortic valve replacement.
- What? - Dr. Latham?
Apical systolic murmur.
I didn't hear it.
It's subtle.
I'm sorry, I still don't hear it.
Call the OR, have them set up
for an emergent aortic valve take back.
Right away.
You're gonna have to operate again, really?
Dr. Latham, if I may. Excuse us.
Ah.
We're gonna put him through it again?
Shouldn't we at least get an echo to confirm?
The valve will fail.
If you need to assuage your doubts,
we can do an echo on the table.
Meanwhile, I'm changing into my scrubs.
Here is the reason for your tummy ache, Shannon.
You have an obstruction in your stomach.
Oh, dear.
It's not a growth. It's clearly a foreign object.
What did you eat?
Nothing.
You must have swallowed something.
It's the only way it could've gotten there.
I don't know.
Honey, think. What could it be?
I had some of those little carrots.
No, a carrot wouldn't reflect x-rays.
This is dense.
It's metal or ceramic, maybe some kind of toy.
- Honey? - I don't know.
Won't it just come out eventually?
You know, peristalsis.
Well, whatever this is,
I don't want it moving through you.
It could cut the bowel, and that would be serious.
With your permission, I'd like Shannon the have an endoscopy.
We'll sedate her, put a scope down her esophagus,
and get the thing out.
It shouldn't be a problem.
- Oh, God. - Don't worry.
It'll be over before you know it.
All right.
Well, you were right, Diffuse cerebral edema
with effacement of the sulci and ventricles.
Yeah.
Get her up to PICU.
I'm sorry, but the CT shows that
there is significant swelling in Hayley's brain.
The cause is acute liver failure.
Acute?
There are things we can do for her.
We have her on medication that will help reduce the swelling.
This is Dr. Abrams, he's a neurosurgeon.
I've called him to consult.
I'm gonna put in a drain to relieve
the pressure on your daughter's brain.
With your permission, of course.
Are you talking about brain surgery?
I do it bedside. It's not a difficult procedure.
My baby.
My poor baby.
It's okay, honey.
We are gonna do everything that we can for her.
I...
Chicken salad, chicken wings, chicken tenders.
Don't you have anything without chicken?
Dude, can you read the sign?
We only do chicken, and we do it "clucking" well.
Next!
You don't eat chicken anymore?
Since I got my parrot, you know,
eating birds doesn't feel right.
Uh, can I get chicken tenders?
Dr. Reese?
Danny.
You've been following me.
I had to talk to you.
Well... Mmhmm.
You were nice to me.
We know what's going on. That woman with you
was not your mother and you're being sex trafficked.
They make me do things that I don't want to do.
We can help you, Danny.
No.
No, nobody can.
But you came to me. Why?
I can't take it anymore.
I want to kill myself.
I twisted arms, got a few beds, but we're still shy,
but I'm sure there's more up there.
You know how those ICU nurses are.
They always keep spares for emergency.
Yeah, right. We both played that game.
Go up there, light a fire.
If you get any push-back, call me.
Will do.
Danny said he'd get back in touch.
When he does, you should refer him to the psych clinic.
Well, he won't go. He's afraid to come
into the hospital or any clinic.
He's afraid the traffickers will find out
and he only wants to see me outside.
Bad idea.
Dr. Charles, he's suicidal.
So, let me get this straight.
You are gonna give him psychotherapy
in the parking lot once a week?
Dr. Reese, this patient... Any patient
has gotta be treated in the proper clinical setting.
He feels a connection to me.
Let me ask you something.
You feel like you're the only one who can help?
Only one who understands him?
No. No, it's just...
Just what?
I care about him.
Cut it off. You're too involved.
But I-I-I don't understand.
What happens if you don't get
the rosy outcome you're looking for?
I think I can deal with that.
No. Crucial part of my job
is protecting my staff.
You are headed down a dangerous path.
Step away.
We clear?
Good.
Mr. Logan's lab work.
Albumin's a little low, creatinine a little high.
Yeah, so's his lactate.
- Yeah, thanks, April. - Yeah.
Mr. Logan. How are you feeling?
Pretty good.
And the pain in your belly?
That's about the same. No worries.
I'd sure like to get outta here.
This is a... this is the last X-Ray of your abdomen.
It shows some vague dilation, not enough to be a real concern,
but your labs too, they're just slightly off the norm.
So?
So I'm not comfortable discharging you just yet,
till I know for sure what's going on.
I'd like to do a CT scan of your abdomen.
Really?
Humor me.
Fine. Whatever you say.
All right.
Sternum closing looks good.
Dr. Bardovi, any help with closing skin?
No, sir.
Amazing how effortlessly you throw 8-0 stitches.
You too, Dr. Rhodes.
Hey.
Oh, hey.
Your friend, Izzy Latham,
that guy hears heart sounds
that are practically undetectable.
It's the same when we play music.
He has an unbelievable ear.
I mean, my hearing is good,
but this patient today,
Latham caught a murmur, I didn't.
It just sounded fine to me.
Yeah, he's not Superman, you know?
I mean, knowing Izzy, he's worked very hard at it,
probably listened to a lot of hearts.
But you're a first-year fellow. You'll get it.
- Hey, Nat? - Yeah?
I pulled this out of the gut of a 14-year-old girl.
Any idea what it is?
I've never seen anything like it.
Me neither.
- Care to find out? - Yeah.
Shannon, Mrs. Fisher, this is Dr. Manning.
- Hi. - Hi.
We removed this foreign body from your stomach.
That was inside her?
What is it?
Shannon.
It's mine, I need it back.
Is that something you made in the basement?
You made that?
Tell them what it is.
It's a prototype.
For what?
- A robot. - A robot?
The idea is, you swallow it.
You swallowed that?
And it can clear blockages
or repair intestinal wall without surgery.
Excuse me, clear blockages? It caused a blockage.
Okay, so it needs work.
What exactly goes on in your basement?
Shannon and her friends, they call themselves bio-hackers.
I'm a body-hacker. Kyle and Jen are bio-hackers.
Bio-hackers, genetic engineering,
a bunch of kids?
They make things, the DIY generation,
turned our basement into a lab.
I can hardly get to the washing machine.
And I do not want you experimenting on yourself.
- I'll second that. - Yeah, seriously,
this was very dangerous.
You could have cost yourself an operation.
You listen to the doctors.
Can I have it back?
Please?
That's up to your mom.
Body hacking?
They could really hurt themselves.
Shouldn't we report this to someone?
Who? It's not illegal.
- It's just crazy. - Oh.
- Excuse me. - Kids, where do they
get these ideas?
Listen to me, I sound like my dad.
Your dad would be right.
Still, makes you wonder what goes on there.
- Mm. See ya. - Thanks.
I just came from 3 West.
They said they have a Mr. Isaac Johnson
who was just transferred from your ICU.
How can he still be listed there?
You should have a free bed.
We just didn't get around to clearing the computer,
but we already gave that bed to an ortho patient.
Yeah, yeah, yeah, yeah.
What about that room?
- Oh, that's the red room. - The red room?
That's what the docs call it.
They won't let us put their patients there.
Why?
They think it's bad luck.
Say what?
Three patients have died in there in the last two weeks.
- They think it's bad luck. - Doctors.
Nguyen won't operate without orange socks,
Bernstein's gotta play "Mandy" in every single surgery...
Drives the OR nurses nuts, and now this.
Dr. Rhodes.
I see you got a patient in the SICU.
Emergent redo aortic valve.
How do you feel about transferring him
into that room?
Given the choice, I'd rather not.
Really, Dr. Rhodes, you?
Why take a chance?
All right, let's fight fire with fire.
You know that Hawaiian guy that you talked to me about?
Yeah, Keoni?
Yeah, the one who owns the bar.
Yeah.
Can you put me in touch with him?
Yeah, sure.
Thank you.
Okay, so since you couldn't tolerate the oral contrast,
the images are non-specific... We can't tell much.
Luckily, there's no evidence of perforation or free fluid.
And you know what? That pain I was feeling,
it's gone.
- Really? - Yeah.
That doesn't hurt at all.
So, I can go home, right?
I'm sorry, no. I think you need an operation.
Surgery?
Immediately.
No, no, I told you, it doesn't hurt anymore.
Well, in this case, that's not a good sign.
When a section of the bowel dies,
at first you can't feel it.
We need to remove that section while there's still time,
otherwise it could be fatal.
Page Dr. Rhodes right now.
Mm-hmm.
How long has she been on chemo?
Multiple courses over the last year.
To get to this.
We're still in the Dark Ages.
Done.
Peds cases.
You can go in now.
How is she?
Um...
It's too soon to tell.
While we have her on dialysis,
that'll take over the function of her liver.
Is our daughter dying?
Uh, no.
No, she's not.
With dialysis she will stabilize and her labs should improve.
Unfortunately, the...
the damage to her liver could be permanent.
She may need a transplant.
Oh, my God, a liver transplant?
Another operation?
- I know... - She's been through so much.
I know. I know, but...
Hayley's a fighter.
I've seen these things turn around.
We're not giving up. She could pull out of this.
Thank you.
Little more. Toward me.
We're on borrowed time right now.
- We need to get him up there now. - No, look, I am looking
at the scan myself and I am telling you
I am not taking him up for surgery.
Connor, he's got an ischemic bowel.
So show me the scan.
- It's inconclusive. - Exactly.
So you are asking me to take him up for a laparoscopy...
Possibly an open laparotomy... On what, your hunch?
Okay, look, he was in A-fib when he came in.
- Uh-huh. - Made me think right off,
a clot had embolized to the gut.
Now his bowel sounds are gone and he's distended.
The differential for what you're describing
is a mile long... gastroenteritus to inflammatory bowel disease.
This man's bowel is dying.
I felt it with my hands.
Your hands?
Yes.
If it wasn't for what I just went through
with Latham today, I would say no.
Fine, but for both our sakes, I hope you're right.
Hey, Dr. Charles.
Do you have a second?
Of course.
I did something today that I shouldn't have.
I have a patient, an 11-year-old girl...
Non-Hodgkin's lymphoma.
I've been treating her for some time now.
Her name's Hayley.
She came back in today in acute liver failure
with acute cerebral edema.
- Sorry to hear it. - Yeah.
Dr. Abrams put in a ventricular drain.
We've got her on liver dialysis, waiting for a transplant.
Sounds about right.
This, on top of her lymphoma,
I mean, she is in very bad shape, Dr. Charles.
Like... and I told her parents that she could pull out of it,
that I've seen it happen before.
Haven't you?
Uh, I gave them hope and I don't think there is any.
Well, you really know that, though?
I didn't give them an honest assessment, though.
I let my feelings get in the way
because I so much want Hayley to pull through.
I didn't act professionally. I didn't prepare them for...
Nat, you can't torture yourself.
Really hard drawing these lines, you know?
When do we know we've become too involved?
At the very least, you can't fault yourself for caring.
You know? I don't think
Hayley's parents would want anything less.
Right?
Yeah.
Thank you.
Dr. Reese, got a second?
Years ago, I had a private practice.
I saw patients on a regular basis.
One of them was a musician,
young lady in her 20s,
talented, funny,
suffered from bouts of depression and anxiety,
but we were working through it.
You know, she's a brave lady.
Really liked her,
looked forward to our sessions together.
One night, I got a phone call.
3:00 a.m.
She had...
jumped off the roof of her building.
Left a note.
"Sorry, I'm done."
I couldn't understand why she killed herself.
You know. Went over my notes,
looking for cues, you know,
things I could've done differently...
Replayed our conversations over and over in my head,
wondering what I could've said or done.
Hm.
Never got over it.
Sold my practice, you know,
went into emergency psychiatry.
Swore I would never get that involved
in anyone's life again.
Look, Sarah, it was wrong of me
to dismiss your feelings for Danny.
You know, my issues are my issues, not yours.
Look, I really need you to trust me.
Seeing him outside a clinical setting
is a terrible idea,
especially given the people he's involved with.
But...
But if you insist on...
I do.
Well, then grab your coat,
'cause I want to introduce you to someone who can help,
the right way.
Inject the indocyanine green, please.
Going in.
Let's get the lights.
The area that's not lit up
is about a foot and a half of dead bowel.
Lights, please.
You were right.
Gotta open him up.
So this hypothetical patient... Female?
Male, hypothetically.
Okay.
And you say he was implanted with a tracking device?
Yes.
Innovative.
We... we usually see human trafficking victims
who've been branded or tattooed, but not this.
How old is he?
Um...
Oh, we don't have consent to get any more specific.
Sure.
You want to help this boy get out of the life.
It's complicated.
Traffickers control their victims in a number of ways...
Psychologically through fear and emotional abuse...
And physically.
Drugs.
Torture.
He's up against a lot.
I think it'll help him open up
if he feels like he can trust you.
Pretty sure he already does.
Great.
Once he tells you that he's ready to involve us,
just call me, and we'll start
looking at ways to extricate him,
but in the meantime,
you have to be really careful.
His fears are legitimate.
If these traffickers find out that he's trying to get out...
That he could potentially become a witness against them...
They'll kill him.
Dr. Abrams?
Tell me if you concur.
Her pupils are large, sluggish.
What does that mean?
No.
Wait. Wait.
What aren't you telling us?
Unfortunately, the swelling in your daughter's brain
is so severe that it's affecting the brain stem.
B.P.'s spiking.
200 over 100, heart rate's falling.
- She's crashing. - Call a code.
She's in v-fib! 1 milligram of epi,
charge to 200!
Now! Hold compressions.
Clear.
Still in v-fib.
Charge for 200, another milligram of epi.
Hold compressions.
Clear.
V-fib's... fine v-fib.
Asystole.
I'm so sorry. She's gone.
- Gone? - Are you... are you sure?
Yes. Yes. May we stop?
Stop?
I need your permission.
Yes, please, for God's sake, let her be.
No, no, no. No, no, no, come on.
Come on, baby, come on.
Baby, come on.
No! No! No!
I hope this isn't inconvenient.
I'm just concerned about what Shannon and her friends
are up to.
Believe me, they won't mind.
They love to show off their lab, little mad scientists.
But you're very supportive.
They get so excited. They think they can do anything.
Listen, I had to give Shannon back that gizmo.
She said she'd never speak to me if I didn't.
Shannon, look who's here.
What you're describing... The suicidal thoughts,
the, um, sense of hopelessness, lack of energy...
These are all signs of depression.
And I can prescribe you medications that could help,
but I think we need to address something more fundamental.
What do you mean?
Hey, Danny, when we...
When we examine a patient who's in prison,
we have to ask ourselves, "Is this person really depressed"
or are they just living in a situation that is so awful,
so inherently depressing,
that any person would have these feelings.
So what I'm saying...
Sorry, um...
If you were living in a better situation,
you might not be depressed.
You mean leave them?
Yes.
No. No, no, I-I can't.
These people, they'll hurt me.
We can protect you.
What about the heroin?
I need it, you know that. They give it to me.
We can get you off of heroin. You won't need it anymore.
They'll find me. They will, they always do.
Well, of course they do, they put a tracking device...
A chip in you, but we can take it out,
and then they won't be able to find you.
You don't know these people. They're too smart.
Okay, Danny, you don't have to make any decisions right now.
I just want you to know, things can be different.
This was a bad idea. I shouldn't have come.
- This was a bad idea. No! - No, Danny. Danny!
No!
I heard. I'm sorry.
Yeah.
We ran the code, all the time knowing it was hopeless.
- Yeah. - I failed her.
- You did everything you could. - No, I did everything I could,
and it wasn't enough.
I felt helpless, Ethan,
watching that little girl slip away.
How many more kids like Hayley are we gonna have to lose?
Nat, you know that patient of mine
you saw today, Shannon?
Yeah.
I was worried about her, so I went to see her lab.
Nat, you can't believe it... They're doing gene sequencing.
One kid's trying to make an affordable Hep C drug,
another's trying to bio-engineer chicken meat
so we never have to kill another chicken.
Okay.
These kids...
are doing stuff in a basement
that ten years ago you could only do
at a major university or hospital lab.
You should go.
It'll make you feel better.
Make me feel better?
Nat, when we find the cure for cancer,
it might just come out of a lab like that one.
Keoni.
- Howzit, brah? - Good, good.
- That's the room? - That's it.
Not a healing atmosphere.
Can you do anything?
Oh, yeah.
What?
You said he told you that certain abilities
ran in his family.
The shaman thing? Seriously?
Show some respect, Dr. Rhodes, the term is "kahuna."
And for a man who thinks a room can be unlucky,
you're one to judge.
Just calm down. It's okay, just calm down.
Dr. Choi, incoming. Trauma 2's open.
19-year-old male, found on the street
with a self-inflicted wound to the right flank.
- Hey, Sarah! - April, page Dr. Reese.
- Yeah. - GCS 15 but lethargic.
BP 110 over 60,
about 200 of blood loss at the scene.
I need Dr. Reese!
Looks superficial,
but there's still a lot of bleeding.
- Type and cross and hang a unit. - Right.
- And a liter of normal saline. - Yup.
Danny?
He cut himself.
Were you trying to kill yourself?
No, I-I tried to cut it out... The chip.
- The chip? - Oh...
I want... I want to live.
I want to get away from them. Help me.
Okay.
We're culturing gut bacteria over here.
Maybe we can re-program some E. coli Nissle
to boost the immune system.
But Nissle's not dangerous.
Still, what level of safety are you operating at?
BSL-1. Maybe 1 1/2.
What we're doing here doesn't need more than that.
And who's supervising all of this?
Ms. Herbert, our biology teacher.
But I don't think she really gets what we're doing.
She just tries to make sure we don't kill ourselves.
Oh! This is cool.
Kyle, show her the ear.
He took a slice of apple and implanted it with HeLa cells.
The cellulose in the apple is kinda like scaffolding
for the cells to grow on.
Wow.
That really looks like an ear.
Well, it's not.
I carved it to make it look like one.
But it's not apple anymore either.
Well, when I was your age, I was working
with hippocampal cultures, studying
the transduction pathways with short interfering DNA.
I know, big deal, so 1995.
- You were a science geek too? - Mm-hmm.
And I would've killed to have a place like this.
Let me ask you a question.
What do you know about non-Hodgkin's lymphoma?
Blood cancer.
Body produces a lot of abnormal lymphocytes.
How'd you like to give it a shot?
The room is clear.
- Clear? - For lack of a better word.
All right, now.
Everybody, you heard the man. The room is good now.
I'm sending patients up.
No argument.
Okay.
Mahalo.
Mahalo nui.
Come on, you don't actually think that there was
anything wrong with the room, right?
Oh, yeah. It's just physics.
Physics?
Vibrations from sound waves.
They create micro movements in things.
They imprint themselves.
So, stuff in a room... Tables, chairs, walls...
They get changed very slightly, but they get changed.
A lot of grief and anger in there...
Left its mark.
Not helpful to the ill.
So how do you fix that?
You can't erase things,
but you can write over them.
Big first step.
Remember, it's just the beginning.
What do you want to do with this?
I'll take it.
Hey, I just checked in on Mr. Logan, he's doing fine.
He said to say thank you,
and he would like to know when he's going home.
That was a tough diagnosis you made.
How could you be so sure?
When I was a fourth year, I did a rotation
with this amazing surgeon... Real old-school.
Unbelievable diagnostician.
Didn't need a scan.
She had such...
Great hands.
Just by touch she could tell if a patient had
cystic fibrosis, renal cysts.
They don't make 'em like that anymore.
I think I know one.
You know, it's a good thing I didn't know what I didn't know
before I became a doctor. I don't think that I would've.
Oh, who would?
- Good night. - Good night, Will.
Hey, looking good.
Hello, Dr. Rowan.
Hello.
- Here you go. - Oh.
How are you today?
Oh, fit as a fiddle.
Mom said we're going to take a train.
Perfect.
I love trains.
You know, Dr. Rowan,
you were my teacher.
Was I?
That's right.
You were a surgeon.
The best.
Oh, how about that?
Yeah.
And I wanted to tell you,
today, what you taught me
saved a man's life.
Oh.
Thank you.
Oh, you're welcome.
- Synced and corrected by martythecrazy - - www.addic7ed.com -