1 00:00:01,469 --> 00:00:01,635 . 2 00:00:01,669 --> 00:00:02,170 - And why don't you check 3 00:00:03,304 --> 00:00:05,173 the drawer next to the pantry? 4 00:00:05,206 --> 00:00:06,507 I'm sorry, Robin, then I don't know 5 00:00:06,540 --> 00:00:08,209 where they are. I'll tell you what: 6 00:00:08,242 --> 00:00:10,078 I'll get another set made on my way home. 7 00:00:10,111 --> 00:00:12,012 - [clears throat] 8 00:00:13,181 --> 00:00:16,117 - [sighs] Look, babe, I really have to go. 9 00:00:16,150 --> 00:00:18,586 Yeah, sure, that's fine. 10 00:00:20,221 --> 00:00:21,622 Okay, I love you too. 11 00:00:21,655 --> 00:00:24,024 Bye-bye. 12 00:00:25,159 --> 00:00:26,494 My apologies. 13 00:00:26,527 --> 00:00:27,395 - Everything okay? 14 00:00:27,428 --> 00:00:29,430 - Yeah, Robin just couldn't find her keys. 15 00:00:29,463 --> 00:00:31,399 - Rough morning? Perhaps I should take over the pre-op? 16 00:00:31,432 --> 00:00:34,268 - That will not be necessary. 17 00:00:34,302 --> 00:00:35,503 Shall we? 18 00:00:35,536 --> 00:00:37,638 - Please. 19 00:00:37,671 --> 00:00:39,273 - Just a heads-up: 20 00:00:39,307 --> 00:00:41,275 the board is gonna push you for more growth. 21 00:00:41,309 --> 00:00:43,277 The bottom line has them concerned. 22 00:00:43,311 --> 00:00:44,778 - When hasn't it? Can set my watch 23 00:00:44,812 --> 00:00:46,114 over their money worries. 24 00:00:46,147 --> 00:00:47,281 I'll be fine. 25 00:00:47,315 --> 00:00:48,682 - It's different this time. 26 00:00:48,716 --> 00:00:50,551 C-Suite feels 27 00:00:50,584 --> 00:00:52,220 we can better recognize 28 00:00:52,253 --> 00:00:54,555 how medicine and business are one and the same. 29 00:00:54,588 --> 00:00:55,789 - Ah, let me guess: 30 00:00:55,823 --> 00:00:57,658 scale back on outreach, 31 00:00:57,691 --> 00:00:59,427 combine responsibilities, 32 00:00:59,460 --> 00:01:00,428 outsource? 33 00:01:00,461 --> 00:01:01,295 So basically, 34 00:01:01,329 --> 00:01:02,830 sacrifice patient care? 35 00:01:02,863 --> 00:01:04,565 I won't do that, Peter. 36 00:01:04,598 --> 00:01:06,300 - Well, Sharon, you have to do something, 37 00:01:06,334 --> 00:01:09,237 because the ED is hemorrhaging cash, 38 00:01:09,270 --> 00:01:10,471 and if the bleeding doesn't stop, 39 00:01:10,504 --> 00:01:12,306 it's not going to be good for anybody. 40 00:01:12,340 --> 00:01:14,242 - Mm. - Need I remind you 41 00:01:14,275 --> 00:01:18,146 Randall Memorial closed their ED? 42 00:01:19,880 --> 00:01:21,849 - Dr. Halstead, Doris, you're with me. 43 00:01:21,882 --> 00:01:23,551 - Copy that. - Barry? 44 00:01:23,584 --> 00:01:25,319 - [heavy breathing] - Alex Mayer, 23. 45 00:01:25,353 --> 00:01:27,255 Slash and stab. Large diagonal lacerations 46 00:01:27,288 --> 00:01:28,356 of the abdomen. 47 00:01:28,389 --> 00:01:29,790 He's a little tachy. GCS 15. 48 00:01:29,823 --> 00:01:30,791 - Get it out! 49 00:01:30,824 --> 00:01:31,825 - You're going Baghdad. 50 00:01:31,859 --> 00:01:32,860 - Get it out! 51 00:01:32,893 --> 00:01:34,328 - The weapon still in? 52 00:01:34,362 --> 00:01:35,396 - I don't know. Wasn't even a call. 53 00:01:35,429 --> 00:01:36,597 We were a few blocks away, 54 00:01:36,630 --> 00:01:38,199 I saw him on the street, bleeding, 55 00:01:38,232 --> 00:01:39,500 loaded him in the ambo and rolled. 56 00:01:39,533 --> 00:01:41,369 - I can feel it inside me! - Whoa, whoa! 57 00:01:41,402 --> 00:01:42,403 Alex, keep your hands down. 58 00:01:42,436 --> 00:01:43,904 - I got you, Dr. Halstead. 59 00:01:43,937 --> 00:01:45,339 Let's transfer. 60 00:01:45,373 --> 00:01:47,775 - On my count. One, two, three! 61 00:01:47,808 --> 00:01:48,776 - [screams] 62 00:01:48,809 --> 00:01:50,211 [groans] 63 00:01:50,244 --> 00:01:51,679 - Two of Versed to calm him down. 64 00:01:51,712 --> 00:01:53,514 Thank you, boys. 65 00:01:53,547 --> 00:01:56,250 - [sobbing] 66 00:01:56,284 --> 00:01:58,419 - How's that Versed coming? - On it, Doctor. 67 00:01:58,452 --> 00:02:00,288 - Gaping diagonal incision 68 00:02:00,321 --> 00:02:01,622 of the right upper quad. 69 00:02:01,655 --> 00:02:02,790 - Evidence of evisceration? 70 00:02:02,823 --> 00:02:04,358 - No, I can see the base. 71 00:02:04,392 --> 00:02:06,360 Abdomen's still intact. Just a flesh wound. 72 00:02:06,394 --> 00:02:07,761 It's really clean, though. 73 00:02:07,795 --> 00:02:08,929 - Wash it out and stitch it up. 74 00:02:08,962 --> 00:02:09,930 - Irrigation. 75 00:02:09,963 --> 00:02:11,499 - Sir, you're a lucky man. 76 00:02:11,532 --> 00:02:13,767 Whoever knifed you didn't do any serious damage. 77 00:02:13,801 --> 00:02:16,370 [suspenseful music] 78 00:02:16,404 --> 00:02:17,805 - Look at this. Betadine's smeared 79 00:02:17,838 --> 00:02:19,273 all over the abdomen. 80 00:02:19,307 --> 00:02:20,508 The skin was prepped before the cut. 81 00:02:20,541 --> 00:02:22,410 I'm telling you, that incision is precise. 82 00:02:22,443 --> 00:02:25,346 - Back-alley surgery gone wrong? 83 00:02:25,379 --> 00:02:26,847 - Alex, what happened? 84 00:02:26,880 --> 00:02:28,216 - I was desperate. 85 00:02:28,249 --> 00:02:29,650 - Dr. Halstead, his hand, 86 00:02:29,683 --> 00:02:31,252 under the blood. 87 00:02:31,285 --> 00:02:32,653 - More Betadine. 88 00:02:32,686 --> 00:02:34,688 - So he doused his own hands. 89 00:02:34,722 --> 00:02:36,457 - Alex, did you cut into yourself? 90 00:02:36,490 --> 00:02:38,292 - I had to! I had to get it out! 91 00:02:38,326 --> 00:02:39,460 - Get what out? 92 00:02:39,493 --> 00:02:41,929 - The person living inside me! 93 00:02:41,962 --> 00:02:49,337 * 94 00:02:54,475 --> 00:02:56,444 - [gasps] - Oh, I'm sorry. 95 00:02:56,477 --> 00:02:58,646 Are you all right? I was just trying to say "hi." 96 00:02:58,679 --> 00:03:00,748 - Um, it's Edith Lake. 97 00:03:00,781 --> 00:03:02,350 - Your insulin patient? 98 00:03:02,383 --> 00:03:04,552 - The woman who slashed my tires? 99 00:03:04,585 --> 00:03:07,321 - Oh, the woman you think slashed your tires. 100 00:03:07,355 --> 00:03:08,856 - Who else? 101 00:03:08,889 --> 00:03:10,324 I saw her yesterday, 102 00:03:10,358 --> 00:03:11,892 across the street from my apartment. 103 00:03:11,925 --> 00:03:15,263 - You really think it was her? 104 00:03:15,296 --> 00:03:17,298 - Looked like her. 105 00:03:17,331 --> 00:03:19,433 - Next. 106 00:03:23,471 --> 00:03:26,507 - Dr. Latham, this is Ray Preston, 53. 107 00:03:26,540 --> 00:03:28,309 Fell short of breath while jogging. 108 00:03:28,342 --> 00:03:29,710 - I was only two miles in. 109 00:03:29,743 --> 00:03:32,346 I'm always good for five before I start to get tired. 110 00:03:32,380 --> 00:03:33,714 - Ray lives in Galena. 111 00:03:33,747 --> 00:03:35,949 It's about 3 1/2 hours west of Chicago. 112 00:03:35,983 --> 00:03:38,018 His cardiologist performed an EKG, 113 00:03:38,051 --> 00:03:39,987 stress test, and cardiac cath. 114 00:03:40,020 --> 00:03:41,489 - Told me to skip the community hospital 115 00:03:41,522 --> 00:03:44,392 and come straight here. 116 00:03:44,425 --> 00:03:45,559 Dr. Rhodes, I know we're getting 117 00:03:45,593 --> 00:03:46,827 pretty close to show time here, 118 00:03:46,860 --> 00:03:47,828 but are you absolutely sure 119 00:03:47,861 --> 00:03:48,829 I need this surgery? 120 00:03:48,862 --> 00:03:50,698 - I'm positive. 121 00:03:50,731 --> 00:03:51,932 - But I'm not in any pain. 122 00:03:51,965 --> 00:03:53,801 - I know, that's the danger. 123 00:03:53,834 --> 00:03:55,803 - Severe three-vessel disease, complicated by-- 124 00:03:55,836 --> 00:03:59,006 - Heavy calcification and extremely poor targets. 125 00:03:59,039 --> 00:04:00,474 CABG is still doable, 126 00:04:00,508 --> 00:04:02,643 but it will be more challenging than normal. 127 00:04:02,676 --> 00:04:03,744 - Indeed. 128 00:04:03,777 --> 00:04:05,346 You're a lucky man, Mr. Preston. 129 00:04:05,379 --> 00:04:06,847 Keeping fit bought you the time 130 00:04:06,880 --> 00:04:08,015 to notice something was wrong. 131 00:04:08,048 --> 00:04:10,318 - Yeah. Well, Dr. Rhodes said 132 00:04:10,351 --> 00:04:11,885 people with arteries as damaged as mine 133 00:04:11,919 --> 00:04:13,053 usually just drop dead. 134 00:04:13,086 --> 00:04:16,457 - He's absolutely right. 135 00:04:16,490 --> 00:04:19,427 - Not to worry, Ray. We'll take great care of you. 136 00:04:20,060 --> 00:04:21,795 - To streamline costs, 137 00:04:21,829 --> 00:04:22,830 Dr. Stohl and I 138 00:04:22,863 --> 00:04:24,064 are implementing a system 139 00:04:24,097 --> 00:04:25,366 to track supplies 140 00:04:25,399 --> 00:04:26,967 to know exactly what we've used. 141 00:04:27,000 --> 00:04:28,902 Everything will be barcoded 142 00:04:28,936 --> 00:04:30,571 and logged into Pyxis. 143 00:04:30,604 --> 00:04:32,373 It will operate by finger scan, 144 00:04:32,406 --> 00:04:33,707 like we do for medications. 145 00:04:33,741 --> 00:04:36,444 - That's easy enough for minor treatments, 146 00:04:36,477 --> 00:04:37,778 but what about emergencies? 147 00:04:37,811 --> 00:04:40,013 Not a lot of time to stop down and scan your prints 148 00:04:40,047 --> 00:04:41,615 during a trauma. 149 00:04:41,649 --> 00:04:43,451 - A tech will take note of what was used in the moment 150 00:04:43,484 --> 00:04:45,853 and then scan after the fact. 151 00:04:45,886 --> 00:04:47,788 - "In the moment." They'll follow us 152 00:04:47,821 --> 00:04:49,557 into the trauma bay? 153 00:04:49,590 --> 00:04:51,992 Between nurses and equipment, we're already tight on space. 154 00:04:52,025 --> 00:04:52,993 Another body... 155 00:04:53,026 --> 00:04:54,027 - We'll find the room 156 00:04:54,061 --> 00:04:56,397 because we have to. 157 00:04:56,430 --> 00:04:58,666 Not to worry, Miss Goodwin. 158 00:04:58,699 --> 00:05:00,934 - All right, uh, let's get back to work. 159 00:05:00,968 --> 00:05:02,370 Thank you for your time. 160 00:05:02,403 --> 00:05:03,537 - Doctors, one more thing before you go, 161 00:05:03,571 --> 00:05:04,972 while I have you here, 162 00:05:05,005 --> 00:05:06,407 charting. 163 00:05:06,440 --> 00:05:07,675 When I was in Attending, 164 00:05:07,708 --> 00:05:09,677 it was pen, paper, and long-form. 165 00:05:09,710 --> 00:05:12,713 Today, it's--it's tablets and shorthand. 166 00:05:12,746 --> 00:05:13,981 I get it-- 167 00:05:14,014 --> 00:05:15,449 tech saves time-- 168 00:05:15,483 --> 00:05:17,485 but details get lost in translation, 169 00:05:17,518 --> 00:05:21,355 so please be explicit in procedure notes. 170 00:05:21,389 --> 00:05:23,424 Okay? Document everything. 171 00:05:23,457 --> 00:05:25,926 If you do it, write it down. 172 00:05:25,959 --> 00:05:26,927 Okay? 173 00:05:26,960 --> 00:05:29,930 [dramatic music] 174 00:05:29,963 --> 00:05:33,701 * 175 00:05:33,734 --> 00:05:35,536 - I clean up nice, don't I? 176 00:05:35,569 --> 00:05:36,804 - I haven't noticed. 177 00:05:36,837 --> 00:05:40,674 - I saw that. 178 00:05:40,708 --> 00:05:43,444 - Why don't you believe me? 179 00:05:43,477 --> 00:05:44,778 I'm not crazy. 180 00:05:44,812 --> 00:05:47,448 Something lives inside of me, right here. 181 00:05:47,481 --> 00:05:48,582 - I hear you. I understand. 182 00:05:48,616 --> 00:05:49,750 - Then get it out! 183 00:05:49,783 --> 00:05:51,819 [sobs] I feel it all the time! 184 00:05:51,852 --> 00:05:54,455 - Alex... 185 00:05:54,488 --> 00:05:56,757 we're gonna help you, I promise. 186 00:05:56,790 --> 00:05:58,692 Sedative? 187 00:05:58,726 --> 00:06:00,060 - No, no, no. Wait, wait, wait. 188 00:06:00,093 --> 00:06:01,995 I'm sorry, I'm sorry. 189 00:06:02,029 --> 00:06:03,597 I'm telling you the truth. 190 00:06:03,631 --> 00:06:05,132 I can feel it inside of me. 191 00:06:05,165 --> 00:06:07,067 Please. [breathes fearfully] 192 00:06:07,100 --> 00:06:10,971 [breathing slows] 193 00:06:11,004 --> 00:06:13,073 Please... 194 00:06:13,106 --> 00:06:18,879 * 195 00:06:18,912 --> 00:06:20,047 - What'd you give him? 196 00:06:20,080 --> 00:06:21,148 - Five of Versed. 197 00:06:21,181 --> 00:06:22,583 - Hm. 198 00:06:22,616 --> 00:06:25,018 Two probably would have sufficed. 199 00:06:25,052 --> 00:06:26,153 - He put hands on you. 200 00:06:26,186 --> 00:06:28,656 I was being cautious. 201 00:06:28,689 --> 00:06:30,057 - So what are you thinking? 202 00:06:30,090 --> 00:06:31,525 - Schizophrenia. 203 00:06:31,559 --> 00:06:32,926 - Yeah, that was my initial thought, 204 00:06:32,960 --> 00:06:34,061 but now I'm not so sure. 205 00:06:34,094 --> 00:06:36,597 - Seriously? His, uh, paranoia 206 00:06:36,630 --> 00:06:38,098 that there's something living inside him, 207 00:06:38,131 --> 00:06:39,533 and his attempt to remove it 208 00:06:39,567 --> 00:06:40,734 is literally a textbook definition 209 00:06:40,768 --> 00:06:43,170 of a somatic delusional disorder. 210 00:06:43,203 --> 00:06:45,506 - I'm stuck on the level of premeditation. 211 00:06:45,539 --> 00:06:47,508 You know, sterilization with Betadine, 212 00:06:47,541 --> 00:06:49,109 the clean incision, 213 00:06:49,142 --> 00:06:50,578 doing it near a hospital... 214 00:06:50,611 --> 00:06:52,045 All that kind of forethought-- 215 00:06:52,079 --> 00:06:54,615 it's just not consistent with schizophrenic psychosis. 216 00:06:54,648 --> 00:06:56,684 - So he's a germophobe with a steady hand. 217 00:06:56,717 --> 00:06:58,919 It doesn't mean he's not schizophrenic. 218 00:06:58,952 --> 00:07:00,888 - Mm, could be true, too. 219 00:07:00,921 --> 00:07:02,590 - So, um... 220 00:07:02,623 --> 00:07:03,791 start him on anti-psychotics 221 00:07:03,824 --> 00:07:05,459 and reassess when his mind's clear? 222 00:07:05,493 --> 00:07:07,060 - I'm just not there yet. 223 00:07:07,094 --> 00:07:08,662 My gut tells me it's chemical. 224 00:07:08,696 --> 00:07:11,565 You know, like maybe a methamphetamine overdose. 225 00:07:11,599 --> 00:07:13,567 Before we go any further, let's run a tox screen, 226 00:07:13,601 --> 00:07:15,969 see if he's just...high. 227 00:07:16,003 --> 00:07:21,675 * 228 00:07:26,714 --> 00:07:29,216 - What's with you? You look half-dead. 229 00:07:29,249 --> 00:07:31,952 - Yeah, these 90-hour weeks are killing a brother. 230 00:07:31,985 --> 00:07:33,921 - Law says you can't do more than 80. 231 00:07:33,954 --> 00:07:36,957 - [laughs] When Dr. Stohl asks you to volunteer, 232 00:07:36,990 --> 00:07:38,592 you don't say "no." 233 00:07:38,626 --> 00:07:40,794 Game is rigged. 234 00:07:40,828 --> 00:07:43,564 - All part of being a big-shot doc. 235 00:07:43,597 --> 00:07:45,132 - Big shot, right. 236 00:07:45,165 --> 00:07:48,869 Big shot, living off of ramen and cheeseburgers. 237 00:07:48,902 --> 00:07:50,270 - What? 238 00:07:50,303 --> 00:07:51,805 - Yeah, that's all I got time for. 239 00:07:51,839 --> 00:07:53,874 - You are getting a steady paycheck now. 240 00:07:53,907 --> 00:07:56,109 Sign up for one of those meal delivery services. 241 00:07:56,143 --> 00:07:58,045 You're gonna need the fuel. 242 00:07:58,078 --> 00:08:00,848 - That's not a bad idea. 243 00:08:00,881 --> 00:08:02,950 Hey, um... 244 00:08:02,983 --> 00:08:05,919 do you mind setting it up for me? 245 00:08:05,953 --> 00:08:06,987 What? You-- 246 00:08:07,020 --> 00:08:09,056 you always know what I like. 247 00:08:09,089 --> 00:08:10,090 - Sure. 248 00:08:10,123 --> 00:08:11,124 - Thank you. 249 00:08:11,158 --> 00:08:12,125 Thank you, thank you. 250 00:08:12,159 --> 00:08:13,727 I'ma try to get some Zs 251 00:08:13,761 --> 00:08:17,698 before the troll hawks me for more rounds. 252 00:08:21,034 --> 00:08:22,803 - Don't give me that look. 253 00:08:26,139 --> 00:08:28,742 - Mm-hmm. Okay. 254 00:08:28,776 --> 00:08:30,143 Thank you, Helen. 255 00:08:30,177 --> 00:08:31,545 Bye. 256 00:08:31,579 --> 00:08:32,646 Good news: 257 00:08:32,680 --> 00:08:35,148 Helen's gonna watch Owen tonight. 258 00:08:35,182 --> 00:08:36,249 - Watch as in all night? 259 00:08:36,283 --> 00:08:37,585 - Mm-hmm. - Yes. 260 00:08:37,618 --> 00:08:39,319 - [giggles] 261 00:08:39,352 --> 00:08:41,154 Just one thing I ask. 262 00:08:41,188 --> 00:08:42,155 - Anything. 263 00:08:42,189 --> 00:08:45,325 - That you shave. 264 00:08:45,358 --> 00:08:47,160 - You don't like the sandpaper feel, huh? 265 00:08:47,194 --> 00:08:48,929 - Uh-huh. 266 00:08:48,962 --> 00:08:50,030 - You ask a lot... 267 00:08:50,063 --> 00:08:51,231 - Mm. 268 00:08:51,264 --> 00:08:52,800 - But okay. 269 00:08:52,833 --> 00:08:55,803 - Thank you. - Yeah. 270 00:08:57,905 --> 00:09:00,641 - Proximal anastomosis is complete. 271 00:09:00,674 --> 00:09:01,709 - That looks good. 272 00:09:01,742 --> 00:09:02,910 Let's move on to the base. 273 00:09:02,943 --> 00:09:04,812 Do you have a suitable landing spot? 274 00:09:04,845 --> 00:09:05,913 - Yeah. 275 00:09:05,946 --> 00:09:07,948 Lighter calcification in this area. 276 00:09:07,981 --> 00:09:09,249 Potts, please. 277 00:09:09,282 --> 00:09:10,751 - I'd go more distal. 278 00:09:10,784 --> 00:09:12,920 Vessel's bigger. You'll get a cleaner target. 279 00:09:12,953 --> 00:09:15,689 - This area of vessel is perfect. 280 00:09:15,723 --> 00:09:18,659 - If you say so. 281 00:09:18,692 --> 00:09:19,927 - 8-0 Prolene. 282 00:09:19,960 --> 00:09:21,695 - The artery could probably handle the 7-0. 283 00:09:21,729 --> 00:09:23,230 - I prefer the 8-0. 284 00:09:23,263 --> 00:09:24,632 - Just thought the larger stitch 285 00:09:24,665 --> 00:09:25,833 might be easier for you to work with. 286 00:09:25,866 --> 00:09:27,067 - I don't understand the debate. 287 00:09:27,100 --> 00:09:28,836 The difference between vessel location, 288 00:09:28,869 --> 00:09:30,671 and now suture choice, is negligible. 289 00:09:30,704 --> 00:09:31,872 - Good point, Dr. Latham. 290 00:09:31,905 --> 00:09:33,206 Dr. Rhodes, you're lead surgeon. 291 00:09:33,240 --> 00:09:34,274 I'm only assisting. 292 00:09:34,307 --> 00:09:37,010 I defer to your preference. 293 00:09:37,044 --> 00:09:39,012 - Thank you, Doctor. 294 00:09:39,046 --> 00:09:41,081 Now, how about from here on out, 295 00:09:41,114 --> 00:09:44,151 we keep the background noise to a minimum? 296 00:09:44,184 --> 00:09:46,687 [tense music] 297 00:09:46,720 --> 00:09:48,689 [alarm beeps] 298 00:09:48,722 --> 00:09:49,990 - Myra Adams, 20. 299 00:09:50,023 --> 00:09:51,391 Passed out in her bathroom washing her face. 300 00:09:51,424 --> 00:09:52,993 Struck her head as she fell. 301 00:09:53,026 --> 00:09:53,894 - Chamber two. 302 00:09:53,927 --> 00:09:55,963 - GCS 6. BP 128 over 60, 303 00:09:55,996 --> 00:09:57,030 heart rate 102 304 00:09:57,064 --> 00:09:58,666 Her brother Eric's a step behind. 305 00:09:58,699 --> 00:10:00,200 Total wreck. - Hey, uh, what's-- 306 00:10:00,233 --> 00:10:01,735 what's wrong with her? 307 00:10:01,769 --> 00:10:02,936 - She's tensing up. Decorticate posturing. 308 00:10:02,970 --> 00:10:04,772 - Can you hear me? - Excuse us. 309 00:10:04,805 --> 00:10:05,773 - Can you tell me your name? 310 00:10:05,806 --> 00:10:07,140 Responds to pain. 311 00:10:07,174 --> 00:10:08,976 All right, we're gonna transfer on my count. 312 00:10:09,009 --> 00:10:10,210 One, two, three. 313 00:10:10,243 --> 00:10:11,812 - Uh, she was complaining 314 00:10:11,845 --> 00:10:12,913 about her stomach last night. 315 00:10:12,946 --> 00:10:14,247 I-I told her it was, like, 316 00:10:14,281 --> 00:10:15,816 uh, something that she ate. 317 00:10:15,849 --> 00:10:17,150 - It's okay. Please give the doctor 318 00:10:17,184 --> 00:10:18,251 some room to examine her. 319 00:10:18,285 --> 00:10:20,721 - Okay. 320 00:10:20,754 --> 00:10:22,289 - Clear breath sounds bilaterally. 321 00:10:22,322 --> 00:10:24,357 CBC, CMP, coags, and u-tox. 322 00:10:24,391 --> 00:10:25,826 - Nat, belly's soft. 323 00:10:25,859 --> 00:10:27,360 - All right, nasal airway and a head CT. 324 00:10:27,394 --> 00:10:28,862 And while we're there, let's scan 325 00:10:28,896 --> 00:10:30,130 her C spine and belly, okay? 326 00:10:30,163 --> 00:10:31,164 - We're on it. 327 00:10:31,198 --> 00:10:34,001 * 328 00:10:34,034 --> 00:10:35,669 - All right, let's move her. 329 00:10:35,703 --> 00:10:37,270 * 330 00:10:37,304 --> 00:10:40,741 - Look, I-I should have brought her in last night. 331 00:10:40,774 --> 00:10:42,876 Uh, why--why is this happening to her? 332 00:10:42,910 --> 00:10:44,277 - Look, we're gonna do everything we can 333 00:10:44,311 --> 00:10:45,746 to help your sister, okay? 334 00:10:45,779 --> 00:10:47,347 She's lucky you found her when you did. 335 00:10:47,380 --> 00:10:49,883 I-I gotta, uh, call my parents. 336 00:10:49,917 --> 00:10:51,084 - Sure. 337 00:10:51,118 --> 00:10:53,921 * 338 00:10:53,954 --> 00:10:55,122 - This level of posturing... 339 00:10:55,155 --> 00:10:56,724 - Has to be some sort of brain injury. 340 00:10:56,757 --> 00:10:58,191 - Yeah. 341 00:11:01,895 --> 00:11:02,062 . 342 00:11:02,095 --> 00:11:02,395 - Thank you. 343 00:11:03,931 --> 00:11:05,298 Uh, we're looking for our daughter, Myra Adams. 344 00:11:05,332 --> 00:11:07,067 - Our son called. Is she all right? 345 00:11:07,100 --> 00:11:08,068 - Come with me, please. 346 00:11:08,101 --> 00:11:09,770 Dr. Manning, Dr. Choi. 347 00:11:09,803 --> 00:11:11,171 These are Myra's parents. 348 00:11:11,204 --> 00:11:12,773 - What happened? 349 00:11:12,806 --> 00:11:14,041 We talked to her two days ago. She was fine. 350 00:11:14,074 --> 00:11:15,042 - Myra? 351 00:11:15,075 --> 00:11:16,276 Myra, honey! 352 00:11:16,309 --> 00:11:17,277 Oh, please, I'd like to see her. 353 00:11:17,310 --> 00:11:19,679 - Yes, of course, please. 354 00:11:24,985 --> 00:11:27,287 - What's going on? 355 00:11:27,320 --> 00:11:28,421 - I don't know. 356 00:11:28,455 --> 00:11:30,824 - You poor baby. 357 00:11:30,858 --> 00:11:32,259 Myra? 358 00:11:32,292 --> 00:11:33,426 Honey? 359 00:11:33,460 --> 00:11:34,427 We're here. 360 00:11:34,461 --> 00:11:35,462 - What's wrong with her? 361 00:11:35,495 --> 00:11:37,264 - We don't know yet. 362 00:11:37,297 --> 00:11:38,498 She collapsed in the bathroom 363 00:11:38,531 --> 00:11:40,200 and hasn't regained consciousness. 364 00:11:40,233 --> 00:11:41,401 - We don't think it's a brain injury. 365 00:11:41,434 --> 00:11:43,503 Myra's CT scans were clear. 366 00:11:43,536 --> 00:11:46,106 - Last month, her friends brought her in to the ED. 367 00:11:46,139 --> 00:11:48,041 Could that have something to do with this? 368 00:11:48,075 --> 00:11:50,343 - Honey, that doctor said she was just dehydrated. 369 00:11:50,377 --> 00:11:53,480 She, uh, got an IV. She was, uh... 370 00:11:53,513 --> 00:11:55,348 she was fine. 371 00:11:55,382 --> 00:11:56,917 - We checked her chart. 372 00:11:56,950 --> 00:11:58,451 Back then, Myra's tox screen and blood work 373 00:11:58,485 --> 00:12:00,921 was normal, except she was slightly anemic. 374 00:12:00,954 --> 00:12:02,956 Same as now. She vegetarian? 375 00:12:02,990 --> 00:12:03,824 - Vegan. 376 00:12:03,857 --> 00:12:05,092 As long as I can remember. 377 00:12:05,125 --> 00:12:06,927 - Never liked meat. [chuckles] 378 00:12:06,960 --> 00:12:08,328 - Well, that would explain the anemia. 379 00:12:08,361 --> 00:12:10,197 Is there anything else you can tell us? 380 00:12:10,230 --> 00:12:12,933 - Uh, she, um... 381 00:12:12,966 --> 00:12:14,902 - What? 382 00:12:14,935 --> 00:12:17,104 - No, it's just, uh, it was finals week, 383 00:12:17,137 --> 00:12:19,239 so she wasn't really, like, eating, 384 00:12:19,272 --> 00:12:20,774 or sleeping much at all. 385 00:12:20,808 --> 00:12:22,976 - She always worked so hard. 386 00:12:23,010 --> 00:12:25,478 I tell her all the time, she needs to rest. 387 00:12:25,512 --> 00:12:28,882 - How do you know all that? 388 00:12:28,916 --> 00:12:30,283 - I've been staying with her. 389 00:12:30,317 --> 00:12:31,952 - [scoffs] Since when? 390 00:12:31,985 --> 00:12:35,355 - [wheezing] [machine beeping] 391 00:12:35,388 --> 00:12:36,824 - Myra? 392 00:12:36,857 --> 00:12:38,025 - She's tachycardic and tachypneic. 393 00:12:38,058 --> 00:12:39,392 - That means her heart is racing 394 00:12:39,426 --> 00:12:40,393 and she's having trouble breathing. 395 00:12:40,427 --> 00:12:41,862 We need to intubate her. 396 00:12:41,895 --> 00:12:43,163 - Please let the doctors help her, okay? 397 00:12:43,196 --> 00:12:45,465 - My baby, no, oh, God. - Please, okay? 398 00:12:45,498 --> 00:12:47,167 - Let's get an EEG and LP, 399 00:12:47,200 --> 00:12:49,803 an antibiotics and antiviral, just in case. 400 00:12:49,837 --> 00:12:50,871 Gram of Ceftriaxone, 401 00:12:50,904 --> 00:12:52,539 500 milligrams Acyclovir. 402 00:12:52,572 --> 00:12:54,441 - Why is it happening? Why? 403 00:12:54,474 --> 00:12:57,444 [dramatic music] 404 00:12:57,477 --> 00:12:59,479 * 405 00:12:59,512 --> 00:13:01,581 - And lift. 406 00:13:01,614 --> 00:13:03,416 - I still would've landed the grafts 407 00:13:03,450 --> 00:13:04,417 more distal, 408 00:13:04,451 --> 00:13:07,054 but your way worked, too. 409 00:13:07,087 --> 00:13:09,222 - I'll take that as a "nice job." 410 00:13:09,256 --> 00:13:11,291 - Didn't know my approval meant so much to you. 411 00:13:11,324 --> 00:13:15,428 - Always on, aren't you? 412 00:13:15,462 --> 00:13:18,231 - "Always on." What does that mean? 413 00:13:18,265 --> 00:13:21,168 - Nothing. It's just, um... 414 00:13:21,201 --> 00:13:22,903 steel sharpening steel. 415 00:13:22,936 --> 00:13:25,572 - Hmm, can't say I'm any more enlightened. 416 00:13:25,605 --> 00:13:27,474 [heart monitor beeps rapidly] 417 00:13:27,507 --> 00:13:29,042 - BP's falling. We're in to the 80s. 418 00:13:29,076 --> 00:13:30,410 - Anterior lateral ST elevations. 419 00:13:30,443 --> 00:13:31,912 - Damn it. Cardiac ischemia. 420 00:13:31,945 --> 00:13:33,881 - One of your grafts must have went down. 421 00:13:33,914 --> 00:13:35,015 - All right, get him back on the table. 422 00:13:35,048 --> 00:13:36,516 I'll go back in to fix the graft. 423 00:13:36,549 --> 00:13:37,550 - No, we've already broken down the room. 424 00:13:37,584 --> 00:13:38,852 By the time we re-prep, 425 00:13:38,886 --> 00:13:39,853 we'll have lost too much time. 426 00:13:39,887 --> 00:13:41,254 IR's a better option. 427 00:13:41,288 --> 00:13:42,923 - What about the hybrid room? 428 00:13:42,956 --> 00:13:44,524 I have it booked for a stenotic dialysis arm graft. 429 00:13:44,557 --> 00:13:45,959 I'll bump it and cath Ray. 430 00:13:45,993 --> 00:13:47,394 If I can't fix the issue noninvasively, 431 00:13:47,427 --> 00:13:49,429 room's already prepped for us to re-open him up. 432 00:13:49,462 --> 00:13:51,431 - Dr. Rhodes? 433 00:13:51,464 --> 00:13:52,900 [dramatic music] 434 00:13:52,933 --> 00:13:54,134 - It's a good idea. 435 00:13:54,167 --> 00:13:55,568 - Okay, let's go. 436 00:13:55,602 --> 00:14:02,976 * 437 00:14:05,078 --> 00:14:07,247 - Myra's lumbar puncture was negative. 438 00:14:07,280 --> 00:14:08,448 There's no infection. 439 00:14:08,481 --> 00:14:09,649 However, her EEG 440 00:14:09,682 --> 00:14:11,651 was positive for seizures. 441 00:14:11,684 --> 00:14:13,086 We've put her on Ativan, 442 00:14:13,120 --> 00:14:15,088 but unfortunately, they haven't subsided. 443 00:14:15,122 --> 00:14:16,489 - Myra's always been so healthy. 444 00:14:16,523 --> 00:14:17,958 I just don't understand. 445 00:14:17,991 --> 00:14:19,927 - But the Ativan, it'll work, right? 446 00:14:19,960 --> 00:14:21,428 - Well, we're gonna do an MRI 447 00:14:21,461 --> 00:14:22,996 to get a closer look at her brain, 448 00:14:23,030 --> 00:14:25,665 see if there's something that the CT didn't pick up. 449 00:14:25,698 --> 00:14:26,967 - Oh, my God. - What--what's happening? 450 00:14:27,000 --> 00:14:28,468 - She's posturing again. 451 00:14:28,501 --> 00:14:31,371 I'm afraid whatever's going on in her brain is getting worse. 452 00:14:31,404 --> 00:14:33,040 - Her pupils are sluggish. 453 00:14:33,073 --> 00:14:34,407 Bolus another five milligrams 454 00:14:34,441 --> 00:14:35,575 of Ativan on top of the drip 455 00:14:35,608 --> 00:14:37,244 and get her up to MRI, quickly. 456 00:14:37,277 --> 00:14:38,545 - Hey, can I-- can I go with her? 457 00:14:38,578 --> 00:14:39,546 - Sure. 458 00:14:39,579 --> 00:14:41,548 - No, no. 459 00:14:41,581 --> 00:14:44,517 Eric, you stay with us. 460 00:14:44,551 --> 00:14:47,254 - I'm gonna order an echo, check for heart vegetations. 461 00:14:47,287 --> 00:14:48,621 - You're thinking sepsis, 462 00:14:48,655 --> 00:14:50,991 but her white blood cell count was totally normal. 463 00:14:51,024 --> 00:14:52,392 - Everything was normal the last time she was here, 464 00:14:52,425 --> 00:14:54,427 too, but she's back, even worse than before. 465 00:14:54,461 --> 00:14:55,996 - Ethan, these two ED visits 466 00:14:56,029 --> 00:14:57,330 could be totally unrelated. 467 00:14:57,364 --> 00:14:58,598 - No, I think they missed something last time. 468 00:14:58,631 --> 00:14:59,599 - Missed what? 469 00:14:59,632 --> 00:15:00,968 - I don't know. 470 00:15:01,001 --> 00:15:02,335 * 471 00:15:02,369 --> 00:15:05,005 - [sighs] 472 00:15:05,038 --> 00:15:06,373 - Don't beat yourself up, Connor. 473 00:15:06,406 --> 00:15:07,975 Grafts fail, 474 00:15:08,008 --> 00:15:09,676 often in patients with far less calcification 475 00:15:09,709 --> 00:15:10,677 than Ray. 476 00:15:10,710 --> 00:15:12,145 - Doesn't make any sense. 477 00:15:12,179 --> 00:15:14,181 I checked every graft before I closed. 478 00:15:14,214 --> 00:15:15,182 They were solid. 479 00:15:15,215 --> 00:15:16,049 - They still are. 480 00:15:16,083 --> 00:15:18,518 Good flow through all repaired vessels. 481 00:15:18,551 --> 00:15:20,020 One, two, three. 482 00:15:20,053 --> 00:15:21,421 The problem is here. 483 00:15:21,454 --> 00:15:23,723 - Clot of the left anterior descending artery. 484 00:15:23,756 --> 00:15:26,059 - Likely a bad reaction to the protamine 485 00:15:26,093 --> 00:15:27,694 administered during anesthesia. 486 00:15:27,727 --> 00:15:29,229 Recommendations on how to proceed? 487 00:15:29,262 --> 00:15:31,498 - Treat noninvasively with heparin. 488 00:15:31,531 --> 00:15:32,699 Thin the blood, let his heart 489 00:15:32,732 --> 00:15:34,267 clear the clot out on its own. 490 00:15:34,301 --> 00:15:35,635 - Too conservative. Clot's already stopped up 491 00:15:35,668 --> 00:15:37,304 the vessel. The LAD is the widow-maker. 492 00:15:37,337 --> 00:15:39,439 If it's down much longer, Ray's not coming back. 493 00:15:39,472 --> 00:15:41,641 We've got to suck it out. 494 00:15:41,674 --> 00:15:43,310 - I agree with Dr. Bekker. 495 00:15:43,343 --> 00:15:45,545 Thrombo-aspiration, though the riskier procedure, 496 00:15:45,578 --> 00:15:48,315 ensures complete removal of the blockage. 497 00:15:48,348 --> 00:15:49,482 - Excuse me, Dr. Rhodes. 498 00:15:49,516 --> 00:15:55,055 * 499 00:15:55,088 --> 00:15:58,158 - Alex's tox screen's negative for methamphetamine. 500 00:15:58,191 --> 00:15:59,726 Negative for all drugs, in fact--he's clean. 501 00:15:59,759 --> 00:16:01,594 - Yeah, I saw the report. 502 00:16:01,628 --> 00:16:03,696 - So now can we start him on a course of anti-psychotics? 503 00:16:03,730 --> 00:16:07,067 - I'm just still not convinced it's schizophrenia. 504 00:16:07,100 --> 00:16:08,468 - How? He's presented with 505 00:16:08,501 --> 00:16:10,403 more than enough evidence of a thought disorder 506 00:16:10,437 --> 00:16:11,638 to warrant the diagnosis. 507 00:16:11,671 --> 00:16:13,106 - Yeah, but even so, before today, 508 00:16:13,140 --> 00:16:14,474 I mean, his medical record's clean. 509 00:16:14,507 --> 00:16:16,743 History doesn't track with schizophrenia. 510 00:16:16,776 --> 00:16:18,311 - Or meth addiction. 511 00:16:18,345 --> 00:16:19,546 He doesn't fit the profile of a user, either. 512 00:16:19,579 --> 00:16:21,048 - Just 'cause he's clean today, 513 00:16:21,081 --> 00:16:23,316 doesn't mean he's free of the drug. 514 00:16:23,350 --> 00:16:24,784 - So that's what the fan is for? 515 00:16:24,817 --> 00:16:27,387 White noise, Dr. Charles? Really? 516 00:16:27,420 --> 00:16:28,455 - Yes, really. 517 00:16:28,488 --> 00:16:30,090 White noise has been proven 518 00:16:30,123 --> 00:16:32,459 to trigger auditory hallucinations 519 00:16:32,492 --> 00:16:34,227 in meth users. 520 00:16:34,261 --> 00:16:35,495 - How long have you been waiting 521 00:16:35,528 --> 00:16:36,529 for something to happen? 522 00:16:36,563 --> 00:16:37,764 - [sighs] 523 00:16:37,797 --> 00:16:39,199 Hm, seven or eight minutes. 524 00:16:39,232 --> 00:16:41,601 - How long does it usually take? 525 00:16:41,634 --> 00:16:44,537 - Two or three. 526 00:16:44,571 --> 00:16:45,772 Probably not meth. Go ahead, 527 00:16:45,805 --> 00:16:48,775 start anti-psychotics. 528 00:16:51,544 --> 00:16:54,281 - Two of Haldol... 529 00:16:55,815 --> 00:16:57,284 Dr. Charles... 530 00:16:57,317 --> 00:16:58,785 [dramatic music] 531 00:16:58,818 --> 00:17:00,253 - Oh, my God. 532 00:17:00,287 --> 00:17:01,654 Alex... get his hand, get his hand! 533 00:17:01,688 --> 00:17:05,592 - I needed it gone. Just see--wait! 534 00:17:05,625 --> 00:17:06,793 - Help! We need some help in here! 535 00:17:06,826 --> 00:17:09,729 - [breathing rapidly] 536 00:17:09,762 --> 00:17:11,231 - What happened? 537 00:17:11,264 --> 00:17:12,665 - He used a pen to pop the stitches 538 00:17:12,699 --> 00:17:13,700 and chisel through his abdominal wall. 539 00:17:13,733 --> 00:17:14,801 - Clearly. 540 00:17:14,834 --> 00:17:15,802 - All right, no time to re-pack. 541 00:17:15,835 --> 00:17:16,836 Got to scoop and move. 542 00:17:16,869 --> 00:17:18,171 - Okay, call OR. Tell them 543 00:17:18,205 --> 00:17:19,339 we're coming immediately. 544 00:17:19,372 --> 00:17:20,473 Let's go! 545 00:17:20,507 --> 00:17:21,808 - Okay, go, go, go! 546 00:17:21,841 --> 00:17:29,216 * 547 00:17:34,854 --> 00:17:35,222 . 548 00:17:35,255 --> 00:17:35,922 - Hmm, sweet potato or quinoa? 549 00:17:39,426 --> 00:17:41,261 Noah's menu. 550 00:17:41,294 --> 00:17:42,495 - Why don't you feed yourself 551 00:17:42,529 --> 00:17:44,331 before the next wave of orders coming down? 552 00:17:44,364 --> 00:17:45,832 You've been ripping and running all day. 553 00:17:45,865 --> 00:17:49,269 - Exactly why I need to get this done now. 554 00:17:51,238 --> 00:17:52,505 - Dr. Manning? - Yes. 555 00:17:52,539 --> 00:17:53,773 - We think we know what might have caused this. 556 00:17:53,806 --> 00:17:55,242 - Eric. 557 00:17:55,275 --> 00:17:56,509 Myra got sick while he was staying with her. 558 00:17:56,543 --> 00:17:57,844 - We never wanted him around our daughter. 559 00:17:57,877 --> 00:17:58,845 - He's a bad influence. 560 00:17:58,878 --> 00:18:00,613 He never applied himself. 561 00:18:00,647 --> 00:18:02,115 He's the opposite of Myra. 562 00:18:02,149 --> 00:18:03,516 - No job, hangs out with a bunch of deadbeats. 563 00:18:03,550 --> 00:18:05,552 - We kicked him out because he was stealing from us. 564 00:18:05,585 --> 00:18:07,454 He takes drugs. 565 00:18:07,487 --> 00:18:09,789 - I'm sorry. I'm--I'm not following. 566 00:18:09,822 --> 00:18:11,424 - He probably slipped her something. 567 00:18:11,458 --> 00:18:12,792 A drug of some sort. 568 00:18:12,825 --> 00:18:14,227 - There's no evidence of that. 569 00:18:14,261 --> 00:18:15,595 - Well, are you sure? Because if you knew 570 00:18:15,628 --> 00:18:16,596 what it was... 571 00:18:16,629 --> 00:18:17,697 - I understand that 572 00:18:17,730 --> 00:18:19,266 this is a very difficult time, 573 00:18:19,299 --> 00:18:20,900 but the best thing we can do right now 574 00:18:20,933 --> 00:18:22,502 is wait for the MRI to come back, 575 00:18:22,535 --> 00:18:25,172 and I promise, as soon as we hear anything, 576 00:18:25,205 --> 00:18:27,374 you will be the first to know. 577 00:18:27,407 --> 00:18:28,608 Okay? 578 00:18:28,641 --> 00:18:30,410 - [scoffs] - All right. 579 00:18:30,443 --> 00:18:32,145 - [scoffs] 580 00:18:32,179 --> 00:18:33,813 - They're blaming Eric for this? 581 00:18:33,846 --> 00:18:35,215 How is this his fault? 582 00:18:35,248 --> 00:18:36,349 - They're desperate, looking for answers, 583 00:18:36,383 --> 00:18:37,517 and we don't know the whole story. 584 00:18:37,550 --> 00:18:39,352 Family dynamics can be complicated. 585 00:18:39,386 --> 00:18:40,920 - Doesn't matter. It's family. 586 00:18:40,953 --> 00:18:42,789 It's blood. Time like this, 587 00:18:42,822 --> 00:18:44,291 they should be banding together, 588 00:18:44,324 --> 00:18:46,226 not ostracizing one of their own. 589 00:18:46,259 --> 00:18:49,429 - I'd expect you to say that. 590 00:18:49,462 --> 00:18:51,364 - This again? Really? 591 00:18:51,398 --> 00:18:52,565 [scoffs] 592 00:18:52,599 --> 00:18:54,167 Here we go. 593 00:18:54,201 --> 00:18:57,370 [somber music] 594 00:18:57,404 --> 00:18:59,272 - You've got a soft spot for family, 595 00:18:59,306 --> 00:19:01,241 sometimes at your own expense. 596 00:19:01,274 --> 00:19:02,442 Planning meals for Noah 597 00:19:02,475 --> 00:19:04,177 when you're slammed at work, for example. 598 00:19:04,211 --> 00:19:06,213 - Helping my brother when he's exhausted. 599 00:19:06,246 --> 00:19:07,847 That's a bad thing in your eyes? 600 00:19:07,880 --> 00:19:09,449 * 601 00:19:09,482 --> 00:19:12,319 - The day I turned 18, it was sink-or-swim. 602 00:19:12,352 --> 00:19:14,354 Noah's a grown man, April. 603 00:19:14,387 --> 00:19:15,822 You're not doing him any favors 604 00:19:15,855 --> 00:19:18,191 by constantly picking up his slack. 605 00:19:18,225 --> 00:19:19,559 Some point, we've all got to learn 606 00:19:19,592 --> 00:19:21,761 to go it alone. 607 00:19:21,794 --> 00:19:24,531 - I'd expect you to say that. 608 00:19:24,564 --> 00:19:28,735 * 609 00:19:28,768 --> 00:19:30,203 [sighs] 610 00:19:30,237 --> 00:19:35,942 * 611 00:19:35,975 --> 00:19:37,644 - All right, think we're there. 612 00:19:37,677 --> 00:19:40,447 * 613 00:19:40,480 --> 00:19:42,882 Vacuuming. 614 00:19:42,915 --> 00:19:44,284 Got it. 615 00:19:44,317 --> 00:19:46,286 * 616 00:19:46,319 --> 00:19:48,288 - Ah, blood flow's good. 617 00:19:48,321 --> 00:19:49,656 BP's holding. 618 00:19:49,689 --> 00:19:51,858 - Nice job. 619 00:19:51,891 --> 00:19:53,960 - Thanks. 620 00:19:53,993 --> 00:19:56,363 Look, I know I have a tendency to step on toes, 621 00:19:56,396 --> 00:19:57,797 Not personal. I just want to-- 622 00:19:57,830 --> 00:19:59,499 - Win? 623 00:19:59,532 --> 00:20:00,867 * 624 00:20:00,900 --> 00:20:02,001 [heart monitor beeping rapidly] 625 00:20:02,034 --> 00:20:03,970 - What happened? 626 00:20:04,003 --> 00:20:05,505 - Artery ruptured. 627 00:20:05,538 --> 00:20:07,407 Blood is pouring into his chest. 628 00:20:07,440 --> 00:20:09,376 Blood flow was blocked, and now it's out of control. 629 00:20:09,409 --> 00:20:10,677 - All right, help me stent the leak 630 00:20:10,710 --> 00:20:12,245 before he arrests. - Where's the rupture? 631 00:20:12,279 --> 00:20:13,913 - Distal LAD. - Are you kidding? 632 00:20:13,946 --> 00:20:15,382 That's not even where the clot was. 633 00:20:15,415 --> 00:20:16,883 It's an entirely different section of vessel. 634 00:20:16,916 --> 00:20:18,285 [dramatic music] 635 00:20:18,318 --> 00:20:21,321 - Murphy's Law. 636 00:20:30,297 --> 00:20:31,931 - How's he doing? 637 00:20:31,964 --> 00:20:33,433 - A few more feet to go, 638 00:20:33,466 --> 00:20:37,003 but no perforations to the bowel. 639 00:20:37,036 --> 00:20:39,038 - I was just standing there. 640 00:20:39,071 --> 00:20:40,507 Meanwhile, he was ripping himself open 641 00:20:40,540 --> 00:20:42,275 with a pen? Wait. 642 00:20:42,309 --> 00:20:45,011 The extra Versed. 643 00:20:45,044 --> 00:20:46,779 It completely tranqed him out. 644 00:20:46,813 --> 00:20:50,450 - But if I hadn't given it to him, who knows? 645 00:20:50,483 --> 00:20:52,485 I mean, Alex was intent on harming himself. 646 00:20:52,519 --> 00:20:54,053 He could have attacked one of us. 647 00:20:54,086 --> 00:20:56,556 * 648 00:20:56,589 --> 00:20:58,425 - What the hell? 649 00:20:58,458 --> 00:20:59,426 There's something embedded 650 00:20:59,459 --> 00:21:00,593 deep in his left gutter, 651 00:21:00,627 --> 00:21:01,794 next to the colon. 652 00:21:01,828 --> 00:21:06,733 * 653 00:21:06,766 --> 00:21:07,800 - What is it? 654 00:21:07,834 --> 00:21:09,702 - I have no idea. 655 00:21:09,736 --> 00:21:13,573 * 656 00:21:13,606 --> 00:21:15,975 - Did you see this? Myra's MRI. 657 00:21:16,008 --> 00:21:17,544 Global edema in the brain. 658 00:21:17,577 --> 00:21:19,446 Two hours ago, there was no sign of swelling. 659 00:21:19,479 --> 00:21:21,581 - Echo was clean, too. It's not sepsis. 660 00:21:21,614 --> 00:21:23,716 - Or encephalitis, meningitis, 661 00:21:23,750 --> 00:21:24,851 HSV, CMV. 662 00:21:24,884 --> 00:21:26,853 We need to brainstorm zebras. 663 00:21:26,886 --> 00:21:29,456 - Paraneoplastic syndrome? Usually presents with a fever, 664 00:21:29,489 --> 00:21:31,458 but there could be cancer cells in her spinal fluid. 665 00:21:31,491 --> 00:21:33,326 - Or another autoimmune, lupus, 666 00:21:33,360 --> 00:21:35,061 sarcoid, some kind of tumor... 667 00:21:35,094 --> 00:21:36,796 - What about FilmArray PCR tests? 668 00:21:36,829 --> 00:21:39,399 - I'll draw paraneoplastic and autoimmune panels. 669 00:21:39,432 --> 00:21:40,733 Have a lab put a rush on 'em. 670 00:21:40,767 --> 00:21:42,802 - I'll talk to hem-onc, get bone and PET scans. 671 00:21:42,835 --> 00:21:44,337 - Okay. 672 00:21:44,371 --> 00:21:46,339 Myra's mom says she's been busting her ass 673 00:21:46,373 --> 00:21:47,740 for this fellowship in New Zealand. 674 00:21:47,774 --> 00:21:50,009 She got it. 675 00:21:50,042 --> 00:21:52,044 She's just starting her life. 676 00:21:52,078 --> 00:21:54,981 - We keep testing till we find out what's wrong. 677 00:21:55,014 --> 00:21:56,716 - Yeah. 678 00:22:00,420 --> 00:22:01,488 - Dr. Halstead, 679 00:22:01,521 --> 00:22:02,689 I've been reviewing the write-up 680 00:22:02,722 --> 00:22:05,024 of our self-surgery patient, Alex. 681 00:22:05,057 --> 00:22:06,359 Not bad, but I think 682 00:22:06,393 --> 00:22:07,760 some small additions to the chart 683 00:22:07,794 --> 00:22:08,761 are in order. 684 00:22:08,795 --> 00:22:10,096 - Additions? 685 00:22:10,129 --> 00:22:11,864 - Perhaps "elaborations" is the better word. 686 00:22:11,898 --> 00:22:14,401 Regarding the initial intake, you noted, 687 00:22:14,434 --> 00:22:16,536 "Wound lavaged and closed." I was there. 688 00:22:16,569 --> 00:22:19,472 It was a little more than that. 689 00:22:19,506 --> 00:22:21,508 I think we should say, "We lavaged 690 00:22:21,541 --> 00:22:23,510 "and irrigated with chlorhexidine 691 00:22:23,543 --> 00:22:26,779 and two liters of normal saline," okay? 692 00:22:26,813 --> 00:22:29,148 "Six-inch lacerations repaired in two layers 693 00:22:29,181 --> 00:22:30,950 "with 60 interrupted 694 00:22:30,983 --> 00:22:32,819 2-0 nylon sutures." 695 00:22:32,852 --> 00:22:34,721 - You don't think that's overdoing it a little bit? 696 00:22:34,754 --> 00:22:37,390 - Absolutely not. This is exactly what we did. 697 00:22:37,424 --> 00:22:38,791 So you'll adjust? 698 00:22:38,825 --> 00:22:40,527 Yes? - Yes. 699 00:22:40,560 --> 00:22:42,094 - Residence charts, too. 700 00:22:42,128 --> 00:22:43,095 - Yes. 701 00:22:43,129 --> 00:22:45,565 - Good man. 702 00:22:48,868 --> 00:22:50,670 - The art of charting. 703 00:22:50,703 --> 00:22:52,872 The one thing I didn't learn in residency. 704 00:22:52,905 --> 00:22:55,074 - I'll look them over. 705 00:22:55,107 --> 00:22:57,744 - Thanks. 706 00:23:00,046 --> 00:23:01,681 - I...don't understand. 707 00:23:01,714 --> 00:23:04,050 What are you-- what are you saying? 708 00:23:04,083 --> 00:23:05,184 - We did what's called 709 00:23:05,217 --> 00:23:06,786 a nuclear blood flow study 710 00:23:06,819 --> 00:23:08,955 and it showed no circulation to her brain. 711 00:23:08,988 --> 00:23:11,090 - Well, there must be some other test you can run. 712 00:23:11,123 --> 00:23:14,060 - They've all been negative. 713 00:23:14,093 --> 00:23:16,028 - Something else you can do. 714 00:23:16,062 --> 00:23:17,096 - I'm sorry. 715 00:23:17,129 --> 00:23:18,598 There isn't. 716 00:23:18,631 --> 00:23:21,100 - [cries] 717 00:23:21,133 --> 00:23:23,503 - We've done everything we can, 718 00:23:23,536 --> 00:23:26,105 but unfortunately, your daughter is brain-dead. 719 00:23:26,138 --> 00:23:27,640 - [pants] 720 00:23:27,674 --> 00:23:28,841 - No... 721 00:23:28,875 --> 00:23:30,209 [sobbing] No... 722 00:23:30,242 --> 00:23:31,811 Okay. 723 00:23:31,844 --> 00:23:33,513 - Our little girl... - I'm so sorry-- 724 00:23:33,546 --> 00:23:34,847 - No, no, no, no, no. 725 00:23:34,881 --> 00:23:36,082 She's gonna wake up. She's gonna be fine. 726 00:23:36,115 --> 00:23:38,117 Myra? Myra... 727 00:23:38,150 --> 00:23:40,086 My baby. 728 00:23:40,119 --> 00:23:41,788 Myra. 729 00:23:41,821 --> 00:23:44,123 - She's gone, sweetie. 730 00:23:44,156 --> 00:23:46,225 Your little girl's gone. 731 00:23:46,258 --> 00:23:49,128 [somber music] 732 00:23:49,161 --> 00:23:50,797 - We'll give you some time with her. 733 00:23:50,830 --> 00:23:51,864 - No... 734 00:23:51,898 --> 00:23:53,800 - Our baby... 735 00:23:53,833 --> 00:23:55,735 [cries] 736 00:23:55,768 --> 00:23:58,605 Oh, baby... 737 00:23:58,638 --> 00:24:00,607 [cries] 738 00:24:00,640 --> 00:24:02,909 * 739 00:24:11,884 --> 00:24:12,051 . 740 00:24:12,084 --> 00:24:12,384 - Excuse me. 741 00:24:13,553 --> 00:24:14,954 - Mr. Adams. 742 00:24:14,987 --> 00:24:17,690 - Our daughter was always doing things for other people. 743 00:24:17,724 --> 00:24:19,926 She told us if anything ever happened to her, 744 00:24:19,959 --> 00:24:21,628 she, uh... 745 00:24:21,661 --> 00:24:23,996 wanted to donate her organs. 746 00:24:24,030 --> 00:24:25,231 - Of course. 747 00:24:25,264 --> 00:24:27,634 We'll get that started. 748 00:24:27,667 --> 00:24:30,136 We want her life to have meant something. 749 00:24:30,169 --> 00:24:31,638 - We understand. 750 00:24:31,671 --> 00:24:33,573 - [breathes raggedly] Thank you. 751 00:24:33,606 --> 00:24:34,841 - Of course. 752 00:24:34,874 --> 00:24:38,144 - You're high. Look at you! 753 00:24:38,177 --> 00:24:39,579 You're high. 754 00:24:39,612 --> 00:24:43,082 Your sister's dead and you're high! 755 00:24:43,115 --> 00:24:46,586 - Wait, Myra's, uh...de--? 756 00:24:46,619 --> 00:24:48,020 She's dead? 757 00:24:48,054 --> 00:24:49,155 - Ah... 758 00:24:49,188 --> 00:24:51,223 - This is your fault, isn't it? 759 00:24:51,257 --> 00:24:52,725 You did this. 760 00:24:52,759 --> 00:24:55,528 - See? I told you he is no good. 761 00:24:55,562 --> 00:24:58,064 He is a drug addict. 762 00:24:58,097 --> 00:25:00,199 - What did you give her? 763 00:25:00,232 --> 00:25:01,801 - Nothing. 764 00:25:01,834 --> 00:25:04,704 - We told you. Myra's tox screen was negative. 765 00:25:04,737 --> 00:25:07,239 - You worthless piece of.... 766 00:25:07,273 --> 00:25:08,775 - Oh. - Whoa. 767 00:25:08,808 --> 00:25:09,876 - Get out. 768 00:25:09,909 --> 00:25:12,044 [dramatic music] 769 00:25:12,078 --> 00:25:13,279 Get out! 770 00:25:13,312 --> 00:25:20,720 * 771 00:25:32,331 --> 00:25:34,166 - He's moving in the wrong direction. 772 00:25:34,200 --> 00:25:35,702 - He'll turn around. 773 00:25:35,735 --> 00:25:37,637 - Your optimism is enchanting. 774 00:25:37,670 --> 00:25:38,771 Reality, though: 775 00:25:38,805 --> 00:25:40,172 between the clot, then the bleed, 776 00:25:40,206 --> 00:25:41,674 his heart is dying. 777 00:25:41,708 --> 00:25:43,910 We should push for a transplant. 778 00:25:43,943 --> 00:25:45,344 - We're only a few hours post-op. 779 00:25:45,377 --> 00:25:47,279 We are miles away from that discussion. 780 00:25:47,313 --> 00:25:48,981 - Normally, yes, 781 00:25:49,015 --> 00:25:51,818 but a hit-and-run just died in surgery. 782 00:25:51,851 --> 00:25:53,620 His heart is an HLA match. 783 00:25:53,653 --> 00:25:54,921 - You already tested for compatibility? 784 00:25:54,954 --> 00:25:56,623 Ray's not even on the list. 785 00:25:56,656 --> 00:25:58,625 - Anything that could go wrong with Ray has. 786 00:25:58,658 --> 00:26:01,193 We fix one thing, something else breaks. 787 00:26:01,227 --> 00:26:02,829 A heart has fallen into our laps. 788 00:26:02,862 --> 00:26:04,697 Let's use it and steal a win. 789 00:26:04,731 --> 00:26:06,699 - Is that our priority? 790 00:26:06,733 --> 00:26:08,167 - You want his death on your record? 791 00:26:08,200 --> 00:26:10,369 - Dr. Bekker, you may have elbowed your way 792 00:26:10,402 --> 00:26:13,840 onto Ray's case, but he's still my patient. 793 00:26:13,873 --> 00:26:16,008 Transplant's not an option. 794 00:26:16,042 --> 00:26:17,744 - Then you're just wasting time, 795 00:26:17,777 --> 00:26:20,246 because the balloon pump he's on won't hold. 796 00:26:20,279 --> 00:26:21,681 He'll max out on pressors 797 00:26:21,714 --> 00:26:23,683 but he'll still need to go on VA-ECMO. 798 00:26:23,716 --> 00:26:24,917 Then it gets invasive: 799 00:26:24,951 --> 00:26:26,352 a procedure for a temporary LVAD. 800 00:26:26,385 --> 00:26:27,820 When that's not enough, 801 00:26:27,854 --> 00:26:29,188 a bigger procedure for a permanent one. 802 00:26:29,221 --> 00:26:31,090 You're going to put Ray through months of 803 00:26:31,123 --> 00:26:33,325 physical and emotional strain, only to get back to 804 00:26:33,359 --> 00:26:35,094 exactly where we are right now. 805 00:26:35,127 --> 00:26:37,396 - Ray's arteries were bad, not his heart. 806 00:26:37,429 --> 00:26:38,931 Now that the vessels are repaired, 807 00:26:38,965 --> 00:26:41,901 it will compensate for the clot and the bleed. 808 00:26:41,934 --> 00:26:43,302 It'll heal. 809 00:26:43,335 --> 00:26:45,638 - No, it won't. 810 00:26:45,672 --> 00:26:46,939 And when I'm right, 811 00:26:46,973 --> 00:26:50,109 I'll make sure the blame is on you, not me. 812 00:26:50,142 --> 00:26:53,946 [tense music] 813 00:26:53,980 --> 00:26:56,716 - Wow. 814 00:26:56,749 --> 00:26:58,785 I guess there was something 815 00:26:58,818 --> 00:27:01,888 living inside Alex. 816 00:27:01,921 --> 00:27:04,090 - I'm still not exactly sure what I'm looking at. 817 00:27:04,123 --> 00:27:05,958 Is it a tumor? 818 00:27:05,992 --> 00:27:06,826 - Possibly. 819 00:27:06,859 --> 00:27:09,996 Or it could be a fetus in fetu: 820 00:27:10,029 --> 00:27:13,132 a twin that her absorbed in utero. 821 00:27:13,165 --> 00:27:14,701 Either way, 822 00:27:14,734 --> 00:27:18,237 it's not a result of schizophrenia or meth. 823 00:27:18,270 --> 00:27:20,172 - How about that? 824 00:27:20,206 --> 00:27:21,741 - That's gotta be so rare. 825 00:27:21,774 --> 00:27:23,309 - To say the least. 826 00:27:23,342 --> 00:27:26,078 It's very cool. 827 00:27:26,112 --> 00:27:28,748 - Hm. 828 00:27:28,781 --> 00:27:30,349 But how did he... 829 00:27:30,382 --> 00:27:32,685 know, not only that there was something inside him, 830 00:27:32,719 --> 00:27:33,920 but exactly where it was? 831 00:27:33,953 --> 00:27:34,754 - Beats me. 832 00:27:34,787 --> 00:27:36,789 And after all the advances we've made, 833 00:27:36,823 --> 00:27:39,225 splicing the genome, reprogramming viruses, 834 00:27:39,258 --> 00:27:40,793 mapping the brain... 835 00:27:40,827 --> 00:27:43,062 in this case, you know, just completely trumped 836 00:27:43,095 --> 00:27:44,864 by human instinct. 837 00:27:44,897 --> 00:27:46,465 - Everything I've learned about human nature, 838 00:27:46,498 --> 00:27:50,169 I still can't see things coming. 839 00:27:50,202 --> 00:27:53,039 - He scared you? 840 00:27:53,072 --> 00:27:54,774 - There's risk in our work. 841 00:27:54,807 --> 00:27:56,442 - I guess I realized a long time ago, 842 00:27:56,475 --> 00:28:00,179 you--you choose to see the threat 843 00:28:00,212 --> 00:28:02,181 or the opportunity. 844 00:28:02,214 --> 00:28:05,184 [solemn music] 845 00:28:05,217 --> 00:28:12,258 * 846 00:28:15,527 --> 00:28:18,931 [distant siren wailing] 847 00:28:22,501 --> 00:28:24,503 - Hey, Eric. 848 00:28:24,536 --> 00:28:26,172 - Hey, uh, listen, 849 00:28:26,205 --> 00:28:27,907 the last thing that I need right now is a lecture. 850 00:28:27,940 --> 00:28:31,110 - Hey, I'm here for me as much as I am for you. 851 00:28:33,545 --> 00:28:35,815 What happened back there... 852 00:28:35,848 --> 00:28:37,216 sometimes, when people are grieving, 853 00:28:37,249 --> 00:28:38,317 they lash out. 854 00:28:38,350 --> 00:28:39,418 - Yeah, no, that's-- 855 00:28:39,451 --> 00:28:41,821 that's how my folks always are. 856 00:28:41,854 --> 00:28:43,455 Man, they think I'm, uh-- 857 00:28:43,489 --> 00:28:47,794 I'm worthless. 858 00:28:47,827 --> 00:28:50,196 I don't know. May--maybe I am, 859 00:28:50,229 --> 00:28:51,931 but they think I want to be like this, 860 00:28:51,964 --> 00:28:55,501 and--and I really don't. 861 00:28:55,534 --> 00:28:56,936 Uh, you know, My-Myra-- 862 00:28:56,969 --> 00:28:58,537 she was the only one who ever, like-- 863 00:28:58,570 --> 00:29:01,007 like, really, like--like, saw me. 864 00:29:01,040 --> 00:29:02,374 You know? 865 00:29:02,408 --> 00:29:04,811 - Yeah. 866 00:29:06,545 --> 00:29:09,248 - And now it's... 867 00:29:09,281 --> 00:29:11,951 [sighs] 868 00:29:13,986 --> 00:29:16,255 - What do you want, Eric? 869 00:29:16,288 --> 00:29:19,125 - I want to get clean. 870 00:29:19,158 --> 00:29:21,527 You know, I wanna, like, wake up 871 00:29:21,560 --> 00:29:23,262 and just feel clear. 872 00:29:23,295 --> 00:29:24,563 - Okay. 873 00:29:24,596 --> 00:29:25,865 We'll set you up with a social worker, 874 00:29:25,898 --> 00:29:27,533 get you in a program. 875 00:29:27,566 --> 00:29:30,502 - [laughs] Was--seriously? 876 00:29:30,536 --> 00:29:32,038 - Yeah. 877 00:29:32,071 --> 00:29:33,439 You'll get the support you need, 878 00:29:33,472 --> 00:29:36,042 but it's up to you to come through. 879 00:29:36,075 --> 00:29:38,144 - Why are you doing this for me? 880 00:29:38,177 --> 00:29:40,379 * 881 00:29:40,412 --> 00:29:42,081 - I guess I'm seeing that there's a difference 882 00:29:42,114 --> 00:29:44,550 between a crutch and a helping hand. 883 00:29:44,583 --> 00:29:47,153 * 884 00:29:47,186 --> 00:29:48,387 - Thank you. 885 00:29:48,420 --> 00:29:50,222 - Yeah. 886 00:29:50,256 --> 00:29:57,029 * 887 00:29:57,063 --> 00:29:59,065 - [laughs] 888 00:29:59,098 --> 00:30:00,532 - Let's get you something to eat first, huh? 889 00:30:00,566 --> 00:30:01,868 Help you come down. 890 00:30:01,901 --> 00:30:04,003 - No, no, I had a burger earlier. 891 00:30:04,036 --> 00:30:06,973 Uh, it made me, like, feel really sick. 892 00:30:07,006 --> 00:30:09,075 It's why I-- I had to get high. 893 00:30:09,108 --> 00:30:10,576 You know, not to-- not to feel it. 894 00:30:10,609 --> 00:30:13,412 - Maybe food poisoning? 895 00:30:13,445 --> 00:30:14,613 - Uh, no, I just-- 896 00:30:14,646 --> 00:30:17,216 I just felt crappy, 897 00:30:17,249 --> 00:30:18,517 like I always do. 898 00:30:18,550 --> 00:30:20,086 * 899 00:30:20,119 --> 00:30:22,621 - Always, or just after eating? 900 00:30:22,654 --> 00:30:28,928 * 901 00:30:31,297 --> 00:30:32,631 - Hey. 902 00:30:32,664 --> 00:30:34,300 - Oh, you again. 903 00:30:34,333 --> 00:30:36,102 - Yeah, last guy only had a hangnail. 904 00:30:36,135 --> 00:30:37,503 Brought him in anyway. 905 00:30:37,536 --> 00:30:39,005 - Okay. 906 00:30:39,038 --> 00:30:40,606 - Crew's meeting at Molly's tonight. 907 00:30:40,639 --> 00:30:44,076 Come and hang? 908 00:30:44,110 --> 00:30:46,145 - This sudden flirting-- 909 00:30:46,178 --> 00:30:47,213 what is it? 910 00:30:47,246 --> 00:30:50,349 - Have you seen you? 911 00:30:50,382 --> 00:30:51,417 You're still a catch. 912 00:30:51,450 --> 00:30:53,519 - I always have been. 913 00:30:53,552 --> 00:30:55,654 You should've thought about that before you cheated. 914 00:30:55,687 --> 00:30:58,490 - I'm not the same guy anymore. 915 00:30:58,524 --> 00:31:00,326 - Hm. 916 00:31:04,696 --> 00:31:06,298 - Barry up to something? 917 00:31:06,332 --> 00:31:07,633 - I'm not sure. 918 00:31:07,666 --> 00:31:10,436 - Yeah, right. This round two? 919 00:31:10,469 --> 00:31:11,637 - Too much baggage. 920 00:31:11,670 --> 00:31:13,339 - Mm-hmm. Make him work for it. 921 00:31:13,372 --> 00:31:14,340 - Mm. 922 00:31:14,373 --> 00:31:16,042 - [chuckles] 923 00:31:16,075 --> 00:31:17,309 - Can I help you with something? 924 00:31:17,343 --> 00:31:18,911 - No, I'm just giving today's charts 925 00:31:18,945 --> 00:31:20,146 a once-over. 926 00:31:20,179 --> 00:31:21,981 - Ugh, well, you better settle in. 927 00:31:22,014 --> 00:31:23,950 Some of them are a few chapters long. 928 00:31:23,983 --> 00:31:26,018 Stohl's five-minute knee aspiration 929 00:31:26,052 --> 00:31:28,220 reads like "War and Peace." 930 00:31:28,254 --> 00:31:30,256 - Hey, Nat, I was speaking with Eric 931 00:31:30,289 --> 00:31:31,690 The drugs-- he's self-medicating. 932 00:31:31,723 --> 00:31:33,125 Since he was a kid, 933 00:31:33,159 --> 00:31:35,194 he's gotten sick after eating protein. 934 00:31:35,227 --> 00:31:36,695 Myra was a vegan-- avoided protein. 935 00:31:36,728 --> 00:31:38,297 - You're thinking that's what made her sick, too? 936 00:31:38,330 --> 00:31:40,166 - Last month, when Myra was feeling confused, 937 00:31:40,199 --> 00:31:42,001 she was fasting while studying. 938 00:31:42,034 --> 00:31:43,970 - Ketosis. 939 00:31:44,003 --> 00:31:45,271 Her body was starving, 940 00:31:45,304 --> 00:31:47,039 so it started digesting muscle as fuel, 941 00:31:47,073 --> 00:31:49,308 which released protein into her blood. 942 00:31:49,341 --> 00:31:51,410 Okay, well, that explains what made her sick last month, 943 00:31:51,443 --> 00:31:52,411 but what about today? 944 00:31:52,444 --> 00:31:54,146 - The fellowship. 945 00:31:54,180 --> 00:31:55,514 - She probably wasn't eating again. 946 00:31:55,547 --> 00:31:57,383 - I think this is OTC-- a metabolic disorder fits. 947 00:31:57,416 --> 00:31:59,185 - You were right. The visits were connected. 948 00:31:59,218 --> 00:32:00,719 - Yeah. - Wait. 949 00:32:00,752 --> 00:32:03,055 Did they transplant the liver yet? 950 00:32:03,089 --> 00:32:04,723 - It's still up in the OR. They can't use it. 951 00:32:04,756 --> 00:32:06,692 [suspenseful music] 952 00:32:06,725 --> 00:32:08,127 - If Myra had OTC, 953 00:32:08,160 --> 00:32:09,361 she couldn't break down nitrogen. 954 00:32:09,395 --> 00:32:10,696 - So it built up in her body as ammonia 955 00:32:10,729 --> 00:32:12,164 and finally put her in a coma. 956 00:32:12,198 --> 00:32:13,432 - And if the liver gets transplanted... 957 00:32:13,465 --> 00:32:15,634 - Same thing will happen to the recipient. 958 00:32:15,667 --> 00:32:17,503 * 959 00:32:17,536 --> 00:32:18,670 - Is the transplant finished? 960 00:32:18,704 --> 00:32:20,672 - No, the last surgery ran late. 961 00:32:20,706 --> 00:32:23,009 They moved the transplant to OR 3. 962 00:32:23,042 --> 00:32:24,743 - Come on. 963 00:32:24,776 --> 00:32:29,748 * 964 00:32:29,781 --> 00:32:31,583 - Okay... 965 00:32:31,617 --> 00:32:33,419 - Stop! - What the hell? 966 00:32:33,452 --> 00:32:34,453 - Liver might not be good. 967 00:32:34,486 --> 00:32:35,487 - The biopsy was clean. 968 00:32:35,521 --> 00:32:36,622 - It's a genetic defect. 969 00:32:36,655 --> 00:32:38,090 It wouldn't show up on the biopsy. 970 00:32:38,124 --> 00:32:39,158 - I got my patient wide open, Choi. 971 00:32:39,191 --> 00:32:40,259 - You transplant that liver, 972 00:32:40,292 --> 00:32:41,560 he could be dead within hours. 973 00:32:41,593 --> 00:32:43,195 We need time to test the donor's blood, 974 00:32:43,229 --> 00:32:45,331 see if she had OTC. 975 00:32:45,364 --> 00:32:46,532 * 976 00:32:46,565 --> 00:32:48,100 - I'll pack and hold, 977 00:32:48,134 --> 00:32:49,601 but the donor's liver's only got four hours 978 00:32:49,635 --> 00:32:51,103 till it's shot, 979 00:32:51,137 --> 00:32:53,039 so move it. 980 00:32:53,072 --> 00:32:54,240 * 981 00:32:59,345 --> 00:32:59,645 . 982 00:32:59,678 --> 00:33:00,012 - A metabolic... 983 00:33:00,579 --> 00:33:02,748 disorder caused her death? 984 00:33:02,781 --> 00:33:04,216 - The precise term is 985 00:33:04,250 --> 00:33:06,552 "ornithine transcarbamylase deficiency," 986 00:33:06,585 --> 00:33:08,620 or OTC. 987 00:33:08,654 --> 00:33:11,623 You see, Myra's liver was missing a vital enzyme 988 00:33:11,657 --> 00:33:14,160 that helps break down protein. 989 00:33:14,193 --> 00:33:16,162 - Something as simple as eating a burger 990 00:33:16,195 --> 00:33:17,729 could cause toxic levels of ammonia 991 00:33:17,763 --> 00:33:20,466 to build up in her blood and attack her nervous system. 992 00:33:20,499 --> 00:33:22,234 - But Myra was a vegan. 993 00:33:22,268 --> 00:33:24,336 - Which is how she was able to avoid symptoms 994 00:33:24,370 --> 00:33:25,504 for so long, 995 00:33:25,537 --> 00:33:27,139 but when she pushed herself, 996 00:33:27,173 --> 00:33:28,274 and didn't eat-- 997 00:33:28,307 --> 00:33:29,741 finals, the fellowship-- 998 00:33:29,775 --> 00:33:32,111 her body started breaking down muscle, 999 00:33:32,144 --> 00:33:35,481 which released protein into her blood. 1000 00:33:35,514 --> 00:33:36,682 - So, you mean, 1001 00:33:36,715 --> 00:33:39,485 she'd be alive right now if she'd just... 1002 00:33:39,518 --> 00:33:42,288 eaten? 1003 00:33:42,321 --> 00:33:44,756 [solemn music] 1004 00:33:44,790 --> 00:33:48,060 - If this disease is genetic, 1005 00:33:48,094 --> 00:33:50,262 that means one of us gave it to her. 1006 00:33:50,296 --> 00:33:53,665 - Yes, um, it is passed through the X chromosome, 1007 00:33:53,699 --> 00:33:57,303 from mother to child, but... 1008 00:33:57,336 --> 00:34:00,406 * 1009 00:34:00,439 --> 00:34:03,742 - OTC sufferers exhibit totally normal liver function. 1010 00:34:03,775 --> 00:34:06,612 That's why all of Myra's tests came back clean. 1011 00:34:06,645 --> 00:34:08,180 - We were only able to diagnose her 1012 00:34:08,214 --> 00:34:09,281 once Eric explained 1013 00:34:09,315 --> 00:34:11,617 his lethargy and sickness after eating. 1014 00:34:11,650 --> 00:34:13,752 We believe he has the defect as well, 1015 00:34:13,785 --> 00:34:17,356 and he's been self-medicating with drugs. 1016 00:34:17,389 --> 00:34:18,557 - Wha--? 1017 00:34:18,590 --> 00:34:21,360 - Oh... 1018 00:34:21,393 --> 00:34:23,562 - Eric... 1019 00:34:23,595 --> 00:34:26,432 is this true? 1020 00:34:26,465 --> 00:34:28,367 - I'm so sorry. 1021 00:34:28,400 --> 00:34:30,602 - Oh, son... 1022 00:34:30,636 --> 00:34:32,704 - Forgive us? 1023 00:34:32,738 --> 00:34:34,706 Will you forgive us? 1024 00:34:34,740 --> 00:34:37,709 - We're so sorry. 1025 00:34:37,743 --> 00:34:39,711 Oh, Eric. [crying] 1026 00:34:39,745 --> 00:34:47,119 * 1027 00:34:49,688 --> 00:34:51,257 - So, how's our patient? 1028 00:34:51,290 --> 00:34:52,624 Heading for ECMO? 1029 00:34:52,658 --> 00:34:53,825 - Actually, no. 1030 00:34:53,859 --> 00:34:56,195 Uh, BP's risen and is holding, 1031 00:34:56,228 --> 00:34:57,463 vitals have stabilized as well, 1032 00:34:57,496 --> 00:34:59,331 so I'm going 1033 00:34:59,365 --> 00:35:00,632 to remove the balloon pump 1034 00:35:00,666 --> 00:35:04,203 and give his heart back its full load. 1035 00:35:05,537 --> 00:35:07,839 - What do you want, an "I was wrong"? 1036 00:35:07,873 --> 00:35:10,409 - I'm not holding my breath. 1037 00:35:12,178 --> 00:35:13,745 - Ah, I see our patient 1038 00:35:13,779 --> 00:35:14,880 is making a turn for the better. 1039 00:35:14,913 --> 00:35:16,515 - For a moment, there was concern 1040 00:35:16,548 --> 00:35:17,883 the damage was irreparable. 1041 00:35:17,916 --> 00:35:19,385 A transplant option presented itself, 1042 00:35:19,418 --> 00:35:21,553 but upon discussing the visual assessment 1043 00:35:21,587 --> 00:35:23,289 of the heart during surgery, 1044 00:35:23,322 --> 00:35:24,623 the decision was made to give it more time 1045 00:35:24,656 --> 00:35:26,358 to come back on its own. 1046 00:35:26,392 --> 00:35:27,726 It was a risk, 1047 00:35:27,759 --> 00:35:31,630 but it appears we made the right choice. 1048 00:35:31,663 --> 00:35:33,365 - Indeed. 1049 00:35:33,399 --> 00:35:35,367 Nice work, doctors. 1050 00:35:35,401 --> 00:35:36,768 - Thank you. 1051 00:35:36,802 --> 00:35:39,905 * 1052 00:35:39,938 --> 00:35:42,874 - You and Dr. Bekker... 1053 00:35:42,908 --> 00:35:45,311 your successes suggest a good pairing, 1054 00:35:45,344 --> 00:35:46,945 but your... 1055 00:35:46,978 --> 00:35:50,249 exchanges often convey the opposite. 1056 00:35:50,282 --> 00:35:54,420 What's peculiar is Dr. Bekker seems to enjoy this... 1057 00:35:54,453 --> 00:35:56,322 discordance. 1058 00:35:56,355 --> 00:35:58,457 Do you? 1059 00:35:58,490 --> 00:36:01,193 * 1060 00:36:01,227 --> 00:36:03,629 - Maybe I do. 1061 00:36:03,662 --> 00:36:10,736 * 1062 00:36:16,408 --> 00:36:18,610 - You okay? 1063 00:36:18,644 --> 00:36:21,680 - We turned this hospital upside-down chasing zebras, 1064 00:36:21,713 --> 00:36:23,249 but a simple ammonia test 1065 00:36:23,282 --> 00:36:24,683 would've given us everything we needed to know. 1066 00:36:24,716 --> 00:36:27,253 - There's no way you could've known. 1067 00:36:27,286 --> 00:36:28,754 Silver lining: 1068 00:36:28,787 --> 00:36:30,556 the liver transplant was stopped 1069 00:36:30,589 --> 00:36:31,857 before it was too late, 1070 00:36:31,890 --> 00:36:33,259 and thanks to you, 1071 00:36:33,292 --> 00:36:35,427 Eric's getting the help he needs. 1072 00:36:35,461 --> 00:36:36,962 * 1073 00:36:36,995 --> 00:36:40,299 I may coddle my family, 1074 00:36:40,332 --> 00:36:43,802 but seems I'm not the only one with a soft spot. 1075 00:36:43,835 --> 00:36:51,209 * 1076 00:36:55,347 --> 00:36:56,815 - Yes, yes, yes. 1077 00:36:56,848 --> 00:36:58,450 Wonderful, Dr. Halstead. 1078 00:36:58,484 --> 00:36:59,518 Above and beyond. 1079 00:36:59,551 --> 00:37:00,719 Excellent medicine, 1080 00:37:00,752 --> 00:37:02,454 and your writing for the ED. 1081 00:37:02,488 --> 00:37:04,556 It's been a good day. 1082 00:37:05,857 --> 00:37:09,027 We're gonna turn this place around. 1083 00:37:09,060 --> 00:37:13,365 - He more happy about the work, or the bill? 1084 00:37:13,399 --> 00:37:15,501 - So I guess the rumors are true. 1085 00:37:15,534 --> 00:37:16,868 This morning's board meeting 1086 00:37:16,902 --> 00:37:18,003 was basically an edict 1087 00:37:18,036 --> 00:37:19,671 to shake the old money tree? 1088 00:37:19,705 --> 00:37:22,441 - Ah, nothing that hasn't come down the pipe before. 1089 00:37:22,474 --> 00:37:23,675 I'm handling it. 1090 00:37:23,709 --> 00:37:24,943 - And these itemized charts 1091 00:37:24,976 --> 00:37:26,412 that Stohl's championing? 1092 00:37:26,445 --> 00:37:28,714 I mean, detail equals charges, right? 1093 00:37:28,747 --> 00:37:30,816 Basically a menu 1094 00:37:30,849 --> 00:37:33,385 for Billing to pad the invoices? 1095 00:37:33,419 --> 00:37:34,820 - Well, I've looked at every chart 1096 00:37:34,853 --> 00:37:36,622 coming out of the ED today. 1097 00:37:36,655 --> 00:37:37,823 Each one has been accurate 1098 00:37:37,856 --> 00:37:39,458 to the services provided. 1099 00:37:39,491 --> 00:37:41,360 - Well, I should hope he's not committing fraud. 1100 00:37:41,393 --> 00:37:44,363 I mean, the fact that you even had to check... 1101 00:37:44,396 --> 00:37:45,831 Look, Sharon. 1102 00:37:45,864 --> 00:37:47,533 You set the tone, 1103 00:37:47,566 --> 00:37:49,034 so if you're okay with it, 1104 00:37:49,067 --> 00:37:50,536 well, then, it must-- 1105 00:37:50,569 --> 00:37:52,338 - The numbers are clear. 1106 00:37:52,371 --> 00:37:53,739 If I don't improve the bottom line, 1107 00:37:53,772 --> 00:37:55,507 the board will start slashing. 1108 00:37:55,541 --> 00:37:58,544 Do you want to see the ED closed, or contracted out? 1109 00:37:58,577 --> 00:37:59,745 Because that's what'll happen. 1110 00:37:59,778 --> 00:38:01,079 - No, of course not, 1111 00:38:01,112 --> 00:38:02,314 but I also don't wanna see the bottom line 1112 00:38:02,348 --> 00:38:04,049 dictating patient care. 1113 00:38:04,082 --> 00:38:06,618 - Well, let me tell you something. 1114 00:38:06,652 --> 00:38:08,754 Psych is the biggest money-loser 1115 00:38:08,787 --> 00:38:10,556 in the ED. 1116 00:38:10,589 --> 00:38:11,857 You, Daniel, 1117 00:38:11,890 --> 00:38:13,859 are a major part of our problem, 1118 00:38:13,892 --> 00:38:17,295 so don't get on the soapbox with me. 1119 00:38:27,873 --> 00:38:28,940 - You seen Natalie? 1120 00:38:28,974 --> 00:38:30,576 - She's in the doctor's lounge. 1121 00:38:30,609 --> 00:38:31,843 Oh, she told me that you had 1122 00:38:31,877 --> 00:38:34,513 a hot date planned tonight. 1123 00:38:34,546 --> 00:38:35,881 - Uh-huh, 1124 00:38:35,914 --> 00:38:37,383 and I'm even gonna shave. 1125 00:38:37,416 --> 00:38:38,116 - No. 1126 00:38:38,149 --> 00:38:39,918 The things we do for love... 1127 00:38:39,951 --> 00:38:41,853 - [chuckles] 1128 00:38:41,887 --> 00:38:43,689 - [laughs softly] 1129 00:38:43,722 --> 00:38:46,692 [somber music] 1130 00:38:46,725 --> 00:38:53,932 * 1131 00:39:01,172 --> 00:39:02,741 - Hey. 1132 00:39:02,774 --> 00:39:05,744 - Day like today...mm. 1133 00:39:05,777 --> 00:39:07,679 - Tell me about it. 1134 00:39:07,713 --> 00:39:09,848 - You make a really nice pillow. 1135 00:39:09,881 --> 00:39:16,054 * 1136 00:39:20,592 --> 00:39:22,828 - Your hot date? 1137 00:39:22,861 --> 00:39:25,397 * 1138 00:39:25,431 --> 00:39:26,465 Nice. 1139 00:39:26,498 --> 00:39:33,505 * 1140 00:39:50,522 --> 00:39:51,857 Hi. 1141 00:39:51,890 --> 00:39:54,493 - Dirty Martini. 1142 00:39:54,526 --> 00:39:57,095 Extra olives. 1143 00:39:57,128 --> 00:39:59,030 - You remember the important things. 1144 00:39:59,064 --> 00:40:02,100 - Wasn't sure you'd show. 1145 00:40:02,133 --> 00:40:04,135 - Well, don't get ahead of yourself. 1146 00:40:04,169 --> 00:40:06,772 You say that you've changed. 1147 00:40:06,805 --> 00:40:08,607 We'll see. 1148 00:40:08,640 --> 00:40:10,942 * 1149 00:40:10,976 --> 00:40:12,644 Thank you. 1150 00:40:12,678 --> 00:40:19,685 * 1151 00:40:33,965 --> 00:40:37,135 [phone buzzing] 1152 00:40:38,637 --> 00:40:40,105 - April, 1153 00:40:40,138 --> 00:40:42,808 I'll be there in ten minutes. 1154 00:40:42,841 --> 00:40:44,910 Okay. 1155 00:40:44,943 --> 00:40:52,117 * 1156 00:41:31,723 --> 00:41:34,526 [wolf howling] 1157 00:41:34,560 --> 00:41:37,763 [Universal fanfare]