- Morning. - Morning.
Uh, do you want me to make you some coffee?
No, I always get one from the cart at work,
unless you're making some for yourself.
Uh, no, actually, the cart sounds good,
'cause I have no idea how to use this thing.
Um, so...
you wanna go straight to work,
or do you need to stop by atour place first or...
I think my fish will survive till I get home tonight.
Though I could go feed them now,
if you wanted to get a drink tonight after work.
Yeah, sure. Uh... uh...
What?
Uh, I actually have plans tonight.
- Plans? - But I can cancel them.
Nope.
Keep your plans. It's fine.
Smooth.
- Hey. - Hey.
- How was the night shift? - Only got puked on twice.
Then it was a good night.
Bye, guys. See you tomorrow.
- Bye. - Night.
Have you contacted your sister yet about meeting up?
Still working on it.
It might actually be better for her
if I keep a little distance.
Better for her or for you?
You know what would be good for me?
Is dinner with you tonight.
- Are you gonna shower first? - Depends on who's paying.
Then it's definitely on me.
- Later. - Bye.
And now she's shivering and... and throwing up,
and I-I don't know what to do.
Deb, what's going on?
Her homeless friend is nine months pregnant
and has a fever. She needs to come in.
- But she won't, right? - No.
Would you come out and help her, please?
Not when she's this far along.
She needs to be monitored and have emergency measures nearby.
Dr. Choi...
Let me get some supplies.
Hey, wait... hey...
you're just gonna go treat a pregnant girl on the streets?
I have met some of these kids.
They're underage. They know that if they come in,
- they'll get put in a system. - Yeah, but she's nine months.
She's gonna have to come in eventually to have her baby.
But she needs to be assessed now.
- Nat, I could use your help. - Seriously?
- Fine. - Thanks.
Text babysitter.
Cold pizza is Owen's favorite breakfast.
There's some in the fridge. Tell him I love him.
- Send. - I'll send your message.
She's over here.
Come on. Come on.
I wrapped her up, but she's still shivering.
Hey.
Laura, I'm Dr. Manning.
I'm gonna take your temperature, okay?
Let me take a look.
103.
You most likely have an infection.
It is very important that we treat it
before you go into labor.
Okay, but my... my water broke, what does that mean?
- When did your water break? - Two days ago.
- Synced and corrected by martythecrazy - - www.addic7ed.com -
- Dr. Reese...
How was your dinner with your dad?
It was good.
Uh, I mean, I'm glad we're talking again.
He's funny, smart.
You don't sound entirely convinced.
Well, it's just kinda hard to look past the last 20 years.
I know he wrote me those letters, but...
there were other ways to contact me if he wanted.
Makes me wonder.
Well, you know what, I've always been
immensely impressed with your instincts,
so... no reason to stop listening to them now.
Yeah, I guess so.
- Courtney? - I've got Luke Wallis.
Cystic fibrosis. No breath sounds on the right.
Tachycardic with BP 122 over 66.
- Satting at 86. - Oh, I know Luke.
- How you doing, buddy? - Been better.
He was just watching TV,
and then suddenly, he couldn't breathe.
Get a stat chest X-ray.
Make it a CT.
And get more information.
On my count, one, two, three.
There we go.
Has his lung function been getting worse?
He's been in the ICU three times in the last five months.
Yeah, Dr. Rhodes has him at the top of
the transplant list for lungs, but so far, nothing.
He's got a pneumothorax on the right,
significant rales on the left.
Set me up for a 16 French chest tube.
That's a little invasive. We can use a pigtail catheter.
His lungs are too stiff. He needs a tube.
Which will only cause additional trauma.
It's bad, isn't it?
The collapsed lung means that your lungs are so scarred
that they can't hold together, so...
Yeah, buddy, it's bad.
Look, as soon as we get your lung re-inflated,
I'm gonna sit down with you and your mom and your dad,
and we're gonna talk about what comes next, okay?
Chest tube, 16 French. Lidocaine?
All right, buddy, you're gonna feel a little pinch,
followed by some pressure, okay?
There you go, buddy.
You're okay, you're okay.
You're doing great, pal.
Mr. Thomas, I'm Dr. Halstead.
I heard you had an incident at work today.
Yeah, I guess I, uh, fell down.
The EMS report says they found you unconscious.
How long you been coughing up blood?
A few weeks.
Some wheezing and stridor. What's his weight?
138.
Doc, I appreciate your concern,
but I'd just as soon go rest up at home.
Yeah, I don't blame ya, but I fear if you go home,
you may have a far worse event
than whatever happened this morning.
That's okay.
Well, you're too dehydrated to walk out of here,
so why don't you let me give you some fluids,
we'll run some tests,
and I promise I'll be back soon?
All right.
Syncope, weight loss, hemoptysis.
He's got cancer, right?
A lot of people are more afraid of
getting the diagnosis than the actual treatment.
Let's get a CBC with diff, EKG,
chest X-ray, and CT.
And then we can try and talk to him again.
So, um, Robert Haywood is here
for a thoracic P.E.T. scan?
Uh, yeah, we're doing a full cardiac workup.
You think you could add a... a head study of that for me?
I just wanna make sure I'm not missing anything on my end.
- Sure, no problem. - Thank you.
Mm-hmm.
Laura...
your membranes ruptured prematurely,
allowing an infection in your uterus.
The longer we go without delivering this baby,
the greater the danger you're both in.
So deliver it then.
We need to do it at the hospital.
No, I told you, I'm not going.
I understand that you don't want to,
but this is a safety issue, okay?
You need to think about your baby.
I said no.
If there are complications, if anything goes wrong...
It's okay, we'll do it here.
You're not seriously thinking about inducing her
right here on the street?
Women deliver outside the hospital all the time.
Yeah, and some of them die.
Listen, I don't like this either, but you heard her.
She's gonna do this with or without us.
And then what? A newborn can't survive out here.
Nat, you don't have to do this, but I'm staying.
I have good news.
They found a pair of lungs in Kansas
that are a perfect match.
We're loading them onto a plane now.
- Oh, my God. - You hear that, Luke?
This is good news, buddy.
Uh, I am gonna have a conversation with Dr. Bekker,
and I'll be back in just a few minutes, okay?
I'll start the transplant protocol.
Hold on.
- We have to put him on ECMO. - What?
He's satting in the 80s and wearing down.
His respiratory muscles are going to give out.
But ECMO could introduce an infection.
It's a partial contraindication to surgery.
And Kansas is a two-hour flight.
We have to keep him oxygenated till the lungs get here.
Those lungs only last four hours.
If anything goes wrong before they get here,
and he's stuck on ECMO,
we may not be able to get him off.
He could die.
Then we make sure that nothing goes wrong.
Thank you.
Mr. Thomas...
We found a large growth in your larynx.
It's almost certainly cancer.
All right.
Now, the good news is,
we have an excellent oncology department,
so I'd like to arrange for a biopsy and a consultation,
so they can determine... It's okay.
I'm not interested.
Mr. Thomas, the sooner you begin treatment,
the better your chances of survival.
You don't understand. I'm...
I'm ready to die.
I know it's a lot of information,
and it can seem overwhelming, but I...
I said no.
Can you tell me why you're so resistant to treatment?
Because I've made it 56 years
without molesting a child,
and I can't stand it anymore.
I'm sorry?
I'm a pedophile...
and I wanna die.
Yeah?
Have you seen this yet?
A lawsuit?
An indigent man's claiming an ambulance driver
passed him over to bring in an insured patient instead.
Seems the extra wait time cost this guy his leg.
Oh, that's terrible.
But isn't that the fault of the ambulance company?
Apparently the ambulance driver was following
our hospital's instructions.
Now that's ridiculous.
I never told anyone to pass up uninsured patients.
No, but the claimant states
that an E.D. charge nurse named Maggie Lockwood did.
Give me some time to look into it.
Try to relax, all right?
Look at me, look at me, look at me. Take a deep breath.
104.
The antibiotics aren't working.
We need a couple bags of Flagyl.
- Ethan... - I need more drugs?
Laura, what you need is to go to the hospital, okay?
You're putting yourself and your baby at unnecessary risk.
She can't. They'll put her back into foster care.
I know it's not ideal, but this isn't just about you.
Your baby's gonna need food and a roof over its head.
Unless they keep 'em out in the yard,
feed 'em whatever the dogs don't want.
I'll talk to the social worker,
make sure you find a good home.
No one wants to adopt a 16-year-old.
Even if you do get a good home in foster care,
everyone keeps getting passed along,
until you finally end up some place
where they'd rather cash a check from the state
than feed you.
Yeah, they're the ones who keep you forever.
Nat, we really need those antibiotics.
Okay, I'll be back as soon as I can.
Yeah.
Okay, keep breathing, keep breathing.
Okay? Keep breathing.
- Just try to relax. - It's okay.
Dr. Rhodes?
What's wrong?
Luke's LFTs are rising.
What... what does that mean?
It indicates that he might be in early liver failure.
Unfortunately, if it progresses,
it could prevent him from getting the lungs.
Prevent him?
Fortunately, we can still get him off the ECMO,
while we try to reverse this trend.
However, if we take him off of ECMO now,
it decreases the odds that he survives
until the lungs get here.
I don't understand. Can't you agree on what to do?
It's not a black and white situation.
Uh, you've been treating him, Dr. Rhodes.
What should we do?
We should keep him on the ECMO.
It's still our best chance that he gets those lungs.
Okay.
Yes. That's what we'll do.
All right.
You're being completely irresponsible.
That kid is going to die if he doesn't get new lungs.
Only if your ECMO doesn't kill him first.
He's a snowball rolling down a hill,
and this is our last chance to stop it.
So what are we doing about Mr. Thomas?
Psych's in there right now.
As soon as they declare him incompetent,
I'm gonna call Oncology down here to get started.
Incompetent?
Who cares? The man is a pedophile, okay?
If he wants to die, why don't we just let him?
April, we're going to stop him from dying,
because he's our patient and because we can.
Did you put him on a psych hold?
Uh, I'm not ready to make that decision.
Why? He's suicidal.
He may want to die, but he is lucid
and understands the consequences of his choices.
He... he has a treatable condition.
How lucid can he be if he's not letting us treat it?
If he was depressed, you'd put him on a psych hold
and try and treat his depression.
You're not gonna do the same for pedophilia?
I just don't know that much about pedophilia.
Well, you better find out fast, because he's dying.
Department charge nurse Maggie Lockwood,
especially providing incentive.
- I don't believe this. - All right, take it easy.
What do you know about this patient?
I don't.
And I definitely never told any ambulance driver
to make decisions based on insurance coverage.
All right. This driver, John Gates,
- do you know him? - Yeah, he's a jerk.
Well, do me a favor: page me when he comes in.
I wanna talk to him.
Sure... if I don't kill him first.
- I need a doctor in here. - Help him!
- He's coagulopathic. - What does that mean?
The combination of his poor liver function
and the anticoagulants that we gave him
has disrupted his ability to clot.
Hang a bag of heparin.
We thinned his blood for the ECMO, we had to,
but his liver is failing more quickly than we expected.
You did this, so take him off that machine!
I am afraid that it is too late for that.
Too late?
Heparin's running.
We're gonna try and reverse the bleeding now.
Run the plasma now.
Hold on that.
Wait...
A transfusion is going to increase his antibody count.
His PRA's already at 50.
If it hits 80, we can't use those lungs.
You think I don't know that? We don't have a choice.
We wouldn't be in this situation
if you hadn't insisted on ECMO in the first place.
You keep pointing out problems.
What I need are solutions, so if you don't have any,
just... just get out of my way, okay?
Hang the bags.
Dr. Halstead has a point.
Is this man, this pedophile, really being rational?
Funny enough, it sounds to me like he is.
Uh, so we just have to, uh, stand by
- and watch him kill himself? - Not treating your cancer
is not the same thing as committing suicide.
I mean, it's his decision. He's allowed to make it.
More to the point, I think what he may be trying to do
is looking for a way to... escape his urges.
By dying.
Dr. Reese, have you ever seen a pedophile's P.E.T. scan?
The prefrontal cortex and the putamen,
they... they light up.
There's a very good chance that pedophilia
could be genetically hardwired into the brain.
There... there... there's nothing he can do about it?
Well, yes and no.
I mean, the thinking is, you can't change the hardware,
but the software is another question,
and it sounds to me like... Like that's what Mr. Thomas
has been trying to do.
If you look at it from his perspective,
the whole thing seems quite rational.
Hey, what are you doing here on your day off?
- Don't ask. - Don't ask?
I'm not crazy about what I'm doing,
and I will tell you the whole thing later,
but right now, I just need to get something and go.
- I'll talk to you later. - Okay.
Hey!
Everyone out, please.
You stay.
John Gates, this is Sharon Goodwin,
the Executive Director of Patient Services.
You might stand up.
Did you speak to anyone recently
regarding a lawsuit?
Yeah, lawyers asked me some questions.
And what did you say?
I said you guys only wanted patients with good insurance,
so I brought you what you wanted.
And where exactly did you get that idea?
Look around.
Excuse me?
The TV. The pizza?
Everyone knows this room's just a ploy
to get us to bring in paying customers.
Get out of here.
Sharon...
I never intended for him to leave people on the street.
He's not the problem.
Dr. Bekker...
You disagree with Dr. Rhodes' treatment, don't you?
It's a complicated situation.
Okay.
I know... how hard it must be
watching him go through this.
It is...
And it has been for 12 years.
We tried everything:
modulator therapies, clinical trials.
It's all we ever thought about, but nothing ever worked.
After a while, we just wanted to let Luke be a kid,
while he still had the chance.
But now, I'm...
Maybe there was more we could've done.
Did we just let our little boy die?
There are no right answers with cystic fibrosis.
It's relentless
and impervious to whatever we throw at it.
But every decision you made for your son,
you made out of love...
And I believe that whenever you do something out of love,
it can never really be wrong.
Dr. Halstead!
Sats are down to 78.
Did you eat this morning?
He might be obstructed. Laryngoscope on the gills.
Give him a sublingual nitro and an amp of glucagon.
The food must've gotten trapped by your tumor,
and it's starting to block your airway.
- I need to break it up. - Oh, please, don't.
What about his DNR?
I'm not tubing him, I'm just clearing his airway.
Mr. Thomas, I am legally obligated to do this.
It will only take a moment.
Forceps?
Almost there. Got it.
That's it, Mr. Thomas.
Take a few deep breaths...
Deep breaths.
God damn it.
Why won't you people just let me die?
Well, I don't see any tumors or signs of stroke.
Robert Haywood, is he one of your prison patients?
Um, no. Why?
He's a criminal, right?
Not that I know of.
Decreased activity in the lower frontal lobe,
significant reductions in the orbital prefrontal cortex,
which is the regulator of morality and aggression.
- Oh, psychopath. - Well, in my opinion,
the best thing you can do for this patient
is to put a pillow over his head.
How's he doing?
Not great.
His larynx is still partially obstructed,
and now I need ENT to come clear it out completely.
Are you putting him on a hold?
Dr. Charles believes he is rational. We can't.
So that's that?
- What, we just let him die? - Not necessarily.
Since he is rational,
maybe we can reason with him.
Fine, as soon as he's cleaned up.
Why are you fighting so hard for this guy?
Because it's not my job to judge him.
I just got the call. The lungs are ten minutes out.
His cardiac output is down, urine too.
He's in multi-organ failure.
BP's 90 over 50.
He's not going to be stable enough for surgery.
This doesn't make any sense.
Cystic fibrosis is a chronic disease.
This is all happening too fast.
Only since you put him on the ECMO.
These are symptoms of under-perfusion.
It shouldn't happen on ECMO.
Unless the problem is with the ECMO itself.
Let me see your readings.
The flow rate's too slow.
- How long's it been at 2.6? - Couple hours.
- Did you interrogate the line? - Yeah, it was clean.
You think it's the oxygenator?
Let's find out.
His sats are gonna drop. We gotta do this fast.
Turn the FiO2 up to 100.
- Shut down ECMO. - What? You're turning it off?
I thought it was keeping him alive.
Sats are down to 80.
We think there might be a clot in the oxygenator.
That would impede the blood flow enough
to cause his organs to fail.
75.
- Set. - Set.
Got it.
It must've happened when we hung the plasma.
ECMO back on.
Flow rate's at 4.
Sats are coming back up. 83...
85...
Is he gonna be okay?
He's getting oxygen back to his organs.
The failure should be reversible.
Oh, thank God.
Dr. Rhodes, Dr. Bekker... the lungs are here.
All right, let's get him upstairs. Come on.
You can still do the transplant?
Yes.
- Oh! - It's okay.
Come on!
All right, let's go.
You got this!
- Good job, Laura. Good job. - You're doing great.
Nat, we've been pushing for 30.
- Come on. - Keep pushing, keep pushing.
- I can't. - There you go.
You can do this, you can do this, okay?
Push, push, push, push, push, push, push, push...
Good job. There you go.
There you go.
All right, keep pushing, Laura.
- You're doing great. Keep going. - Okay, I see the head.
Push, push, push, push...
Okay, here it comes. Here it comes.
Is it out?
Nat...
- What's wrong? - Shoulder dystocia.
The head is through the birth canal,
but the shoulders are too big. It's stuck.
Stuck? What do you mean stuck?
Don't worry, we're gonna get it out,
- but we need to hurry. - Call an ambulance.
What? No, I'm not calling an ambulance.
- Call an ambulance. - What are you...
What are you doing? No, no, what's going on?
- You're okay. - What are you doing?
We're just gonna pick your leg up.
You're gonna be fine.
- What are those for? - An episiotomy.
I need to cut a wider hole for the baby to come out.
I'm sorry, but this is gonna hurt.
Can't you numb her?
Not with the head this close, not out here.
I'll push harder. I... I'll get it to come out!
Laura, we are past that right now, okay?
I need you to just be strong for your baby.
I can't... I can't...
Laura, I promise you it will be worth it.
Now, are you ready? Yes?
Okay.
All right, you got it.
You got it.
You did it!
You did it. Great job, Laura.
It's a beautiful girl.
Hi.
Pulmonary artery is cut.
- Left lung is free. - Yep.
Lungs are coming out.
Keep the heart elevated.
Okay.
All right.
Let's sew these new lungs in.
Dr. Bekker's gonna take the lead.
- Me? - Yes.
- But he's your patient. - You are the better choice.
Why would you say that?
You've been fighting me tooth and nail all day.
Your hands are smaller.
It'll be easier for you to work in the confined space.
I see.
And is that the only reason? The size of my hands?
Also, you are an excellent surgeon.
All right.
Stitch?
My apologies, Sharon. This is my fault.
The pizza room was my idea.
No, Maggie, I was in full support of it,
and never stopped to think about what we were encouraging.
How are you feeling?
Just let me go.
Mr. Thomas, I can't begin to imagine
what your life is like...
But one thing I know is that it can't get better
unless you let me help you.
Now, I've talked to the oncologist...
- Enough. - And we have a real chance
at getting you into remission.
Please, just take a few minutes to at least consider it.
Mr. Thomas, can I ask you a question?
You have a job, right?
Coworkers, do you get along with some of them?
Yeah. So?
How about interests?
Reading? Sports?
What's your point?
That you are not just a pedophile.
There is more to you than that.
And I understand that you have been
challenged by your thoughts your entire life,
but you have overcome them.
Maybe this cancer is just another challenge,
something that you can overcome as well,
so you can get back to
all of the parts of your life that you do like.
Doctor, I have an itch...
every second of every day.
To scratch it would feel so good,
but I don't, ever.
Not scratching that itch
is the worst hell that I can imagine,
and cancer is gonna get me out of that hell.
It isn't another challenge...
Cancer is my reward.
So, Bob, I know that we haven't
known each other very long at all,
but from what I've observed
and our conversations,
it's my opinion that you evident
some of the hallmark characteristics
of something known as
Antisocial Personality Disorder.
Huh. Interesting.
That could explain a lot about my life.
I mean, divorces,
- problems with colleagues. - Right, right.
Well, you should know that it's very manageable. I mean...
No, I... I've got things handled.
- I'm okay. - Are you, though?
Because, very honestly, from what I've seen,
that you aren't in fact always the best judge
of your own self-interest.
What do you mean?
Well, you have significant heart disease,
which, one way or the other, is gonna require
serious long-term care.
Your plan is to have your daughter provide that care,
a daughter whose father
has suddenly reappeared in her life after 20 years.
I mean, she's gonna have trust issues,
abandonment issues.
What I'm saying is if you want this
to work out with Sarah, it would be a really good idea
to discuss this personality disorder.
And why would that help me?
Well, first of all, I think she'd appreciate your candor.
She'd be comforted by your honesty.
More importantly, it would shed a huge amount of light
on... on her life,
on what transpired between the two of you.
I think, ultimately, she'd embrace your care,
she'd throw herself into it,
and that the time you spend together
would just be much richer for the both of you.
Or she could have the opposite reaction.
Antisocial Personality Disorder?
I mean, that's like saying I'm a psychopath.
I mean, when people hear that word,
they run in the opposite direction.
Labels, semantics can be toxic.
Whatever the case, all I'm saying is that
I think it would be very much in your best interest
to share this with your daughter.
She's so happy.
All she does is smile.
Laura...
we need to take you to the hospital.
You said I could stay here.
You could give birth out here,
but it's not a safe place to keep her.
It's too cold. She'll freeze.
But if we come in, we'll have to go to foster care.
She's too good for that. I won't let her.
Laura...
I'm sorry, but we don't have a choice.
- Take her without me. - What?
Babies with 16-year-old mothers go into foster care.
But babies on their own...
Get adopted into nice families.
Laura, this is your baby.
You'll never see her again.
I know.
You don't have to do this.
You're gonna have a good life.
Hey, thought you'd wanna know
we're settling that case out of court.
Yeah, I figured the hospital wouldn't want the bad press.
We'll move on. Hopefully, it's just an isolated incident.
It should be.
It turns out the pizza room was the source of the problem,
so I shut it down.
- Wait, what? - I shut down the pizza room.
No. No, no, no, the board's not gonna let you do that.
Why not? It was influencing the decision-making
of ambulance crews.
And it's making this hospital a lot of money.
The E.D. has shown a 14% increase in revenue
- since it opened. - Are you serious?
Sharon... the pizza room stays open.
His obstruction must be eroding into the mucosa.
Hang two units.
Vic, you're losing too much blood.
I need to cauterize the vessels.
No... you don't.
Hey, I'm sorry, but I don't have a choice.
Yes... you do.
Hanging the blood.
Get me a cautery.
- There's one in Trauma 3. - Okay.
It won't be long.
Time of death: 19:21.
Hey, hey.
How's it going, bud? How's it feel?
Sore, but good.
Good.
Well, don't go anywhere, okay?
I'm gonna be back to check on you in just a little bit.
I have to admit, your way worked.
- You got him to the finish line. - I think we both know
that I couldn't have done this without you.
Say, uh...
I cancelled my plans.
Um... what do you say we go get that drink?
No.
Last night was a mistake.
I was wrong about Laura.
I don't know if I could've done what she did.
Those kids surprised me too.
I just hate the thought of them out there,
having to take care of themselves.
Yeah.
Oh, there's DCFS.
- I got it. - Okay.
Hey, I am so sorry about earlier.
Oh, that's okay.
It's just, I had the most awful,
yet the most incredible day.
There is this girl who lives at...
Hey, Nat, I'm not really in the mood to talk right now.
Oh, okay. Are you all right?
Yeah, it's just... uh, don't ask.
Hey.
That patient...
I judged him.
I should've just... been his nurse.
Sometimes it's really hard not to judge.
I've been there.
You mind if we, uh,
take a rain check on dinner tonight?
Sure.
Hey there.
Everything okay?
No.
No, I, um... I just had a long talk with my dad,
and it turns out he has class III heart failure
from cardiomyopathy.
Oh, man. Very sorry to hear that.
Yeah, you know, he said he wasn't gonna tell me.
- Said he was afraid. - Afraid?
That he just came back into my life,
and now if he dies,
he doesn't know what it might do to me.
Said he worries he's giving me issues
with abandonment and trust.
Oh... wow, he said that, huh?
Yeah, as sick as he is, he... he didn't wanna tell me.
That is so... selfless.
You were right.
Maybe I need to look at things more from his perspective.
Dr. Reese, did your...
Did your father tell you anything else?
No. Why?
I'm just curious, you know.
Nothing else?
No.
- Ethan. - Hey.
Why are you here?
I just wanted to see how you're doing.
Oh.
Maybe, I should've called.
No, it's okay.
Your hair's longer.
Yeah.
Yours is...
Shorter.
Okay if I come in?
Yeah. Kay.
- Synced and corrected by martythecrazy - - www.addic7ed.com -