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1
00:00:00,383 --> 00:00:02,327
With the suggestion
from Dr. Cooper
2
00:00:02,412 --> 00:00:04,578
I could've sabotaged
Archer's CVP monitor
3
00:00:04,663 --> 00:00:06,476
so that the Vas-COM
could save the day.
4
00:00:06,561 --> 00:00:07,961
And I came close to
doing it.
5
00:00:08,046 --> 00:00:10,242
If this ever gets
to be too much for you,
6
00:00:10,327 --> 00:00:11,937
I'll put a stop
to the whole thing.
7
00:00:13,146 --> 00:00:14,242
I'll take it from here.
8
00:00:14,327 --> 00:00:15,766
I assumed I'd perform
the surgery.
9
00:00:15,851 --> 00:00:16,976
You're free to watch.
10
00:00:17,429 --> 00:00:20,070
- Best by the powers that be.
- I'm sorry.
11
00:00:20,623 --> 00:00:22,992
I made a fool of myself
with Dr. Marcel.
12
00:00:23,144 --> 00:00:25,320
I'm crushing
on my advisor.
13
00:00:26,088 --> 00:00:27,353
How long
you been doing this?
14
00:00:27,438 --> 00:00:29,187
- 35 years.
- How?
15
00:00:29,325 --> 00:00:31,243
You got to hang on
to those good days.
16
00:00:31,328 --> 00:00:32,938
You got to hang on
to those wins.
17
00:00:38,606 --> 00:00:41,699
- Really, Dad?
- What? It's fine.
18
00:00:41,870 --> 00:00:44,351
It's a red zone.
It's for emergencies only.
19
00:00:46,832 --> 00:00:48,015
- No...
- See?
20
00:00:48,100 --> 00:00:49,742
Now, it's an emergency.
21
00:00:49,835 --> 00:00:52,250
Oh, you know what?
I wanna check this out.
22
00:00:53,273 --> 00:00:54,539
New PDT system.
23
00:00:54,624 --> 00:00:56,703
I can check all
of my units in real time.
24
00:00:57,578 --> 00:00:58,846
But, look,
can I check it out later?
25
00:00:58,930 --> 00:01:00,335
I really do have to go.
I'm late.
26
00:01:00,490 --> 00:01:03,164
- Everything okay here?
- Oh, yeah, we all good.
27
00:01:03,659 --> 00:01:04,726
Just a little ride-along.
28
00:01:04,811 --> 00:01:07,121
Letting a civilian see
what a real job looks like.
29
00:01:07,482 --> 00:01:09,476
- Yeah, thanks.
- Yeah.
30
00:01:10,242 --> 00:01:11,817
Am I embarrassing you?
31
00:01:12,377 --> 00:01:13,726
- I'll see you later.
- Okay.
32
00:01:15,687 --> 00:01:16,654
Come on, Dad.
33
00:01:20,058 --> 00:01:21,492
Okay, I'm gone.
34
00:01:26,306 --> 00:01:28,648
Hey,
what's up?
35
00:01:28,961 --> 00:01:29,961
Do you remember
how when we were
36
00:01:30,045 --> 00:01:32,732
in physical exam class,
when we did breast exams,
37
00:01:32,817 --> 00:01:34,133
they would tell us
to make small talk
38
00:01:34,217 --> 00:01:35,221
with the patient actors?
39
00:01:35,306 --> 00:01:36,415
Yeah, to help
put them at ease.
40
00:01:36,499 --> 00:01:38,678
Yeah and there was
that one guy, Mandelbrot.
41
00:01:39,117 --> 00:01:40,992
Super awkward.
Caught hell for asking
42
00:01:41,077 --> 00:01:42,821
one of them what
she was doing that weekend.
43
00:01:42,974 --> 00:01:45,204
- Oh.
- He is a panelist
44
00:01:45,289 --> 00:01:47,812
at the next summit
for female physicians.
45
00:01:49,617 --> 00:01:52,085
Wait,
that... wasn't Mandelbrot.
46
00:01:52,170 --> 00:01:53,174
It was Richardson.
47
00:01:53,259 --> 00:01:55,032
No, pretty sure
it was Mandelbrot.
48
00:01:55,117 --> 00:01:58,851
- No, it was Richardson.
- You haven't changed a bit.
49
00:01:59,043 --> 00:02:01,531
- Always got to one-up me.
- I'm not trying to one-up you.
50
00:02:01,616 --> 00:02:04,071
Two shots for Dr. Hammer.
Three for Dr. Halstead.
51
00:02:06,490 --> 00:02:07,632
Thank you.
52
00:02:08,662 --> 00:02:11,092
- Have a good day.
- You too. Thanks, Carly.
53
00:02:11,177 --> 00:02:13,039
- Morning.
- Good morning.
54
00:02:14,392 --> 00:02:17,311
Dr. Halstead, how are things
with Dr. Cooper?
55
00:02:17,396 --> 00:02:20,358
- Uh, pretty well, I think.
- Oh, yeah?
56
00:02:20,443 --> 00:02:23,104
I mean, he hasn't said
anything otherwise.
57
00:02:23,189 --> 00:02:24,933
Good morning,
Ms. Goodwin, Will.
58
00:02:25,109 --> 00:02:26,335
Matt.
59
00:02:26,420 --> 00:02:27,367
Just the man
I was looking for.
60
00:02:27,452 --> 00:02:28,239
I want to tell you about
the conference
61
00:02:28,324 --> 00:02:29,289
coming up in a few weeks.
62
00:02:29,374 --> 00:02:31,640
National Critical Care
Society annual meeting.
63
00:02:31,725 --> 00:02:33,767
It's here in Chicago.
You should go.
64
00:02:33,852 --> 00:02:35,843
Vasik's gonna be
a platinum sponsor.
65
00:02:35,928 --> 00:02:37,789
They're gonna have
a corner booth.
66
00:02:37,929 --> 00:02:39,281
It's gonna be
the perfect chance
67
00:02:39,366 --> 00:02:41,166
for you to meet
some of the upper-level execs.
68
00:02:42,953 --> 00:02:45,992
Oh, do you think that you could
spare him for the day?
69
00:02:46,077 --> 00:02:48,165
It's always good
when our doctors
70
00:02:48,250 --> 00:02:49,784
broaden their expertise.
71
00:02:49,868 --> 00:02:51,786
- I'll be there.
- Okay, great.
72
00:02:51,913 --> 00:02:54,663
I'll get you the details.
Um, Ms. Goodwin.
73
00:02:54,748 --> 00:02:56,265
- Mm-hmm.
- See you.
74
00:02:56,756 --> 00:02:58,093
This might be good.
75
00:02:58,621 --> 00:03:02,323
And maybe I can get them to
offer me a deal like Cooper's.
76
00:03:03,709 --> 00:03:08,187
Geez, I got to get this, but,
uh, you're on the right track.
77
00:03:11,351 --> 00:03:14,062
Thank you, La'Shawn.
Morning, Alim.
78
00:03:14,147 --> 00:03:15,282
- Hey.
- Hey.
79
00:03:15,367 --> 00:03:16,458
What time did you get in?
80
00:03:16,543 --> 00:03:18,722
Uh, I don't know.
Like, around four.
81
00:03:19,008 --> 00:03:20,665
Why so early?
82
00:03:20,750 --> 00:03:22,310
Always try to get
a leg up on the day.
83
00:03:23,379 --> 00:03:25,297
Two hours before your shift?
84
00:03:25,554 --> 00:03:27,118
Well, if I'm meeting
with my patients earlier,
85
00:03:27,202 --> 00:03:28,376
then I can read up
on their conditions.
86
00:03:28,460 --> 00:03:30,188
That way, I'm running rounds,
I'll have all the answers.
87
00:03:30,272 --> 00:03:31,532
Plus, if I'm here
a little early,
88
00:03:31,616 --> 00:03:32,843
I can study
for my boards.
89
00:03:33,342 --> 00:03:35,289
Sleep ever a factor
in this equation?
90
00:03:35,374 --> 00:03:37,466
Life of an intern.
What can I tell ya?
91
00:03:37,648 --> 00:03:38,826
- Dr. Marcel.
- Yeah.
92
00:03:38,911 --> 00:03:40,968
Treatment three incoming.
93
00:03:41,653 --> 00:03:42,657
What do we got?
94
00:03:42,788 --> 00:03:44,445
Avery Quinn,
28-year-old female.
95
00:03:44,530 --> 00:03:47,531
Pedestrian versus auto.
BP 80/45.
96
00:03:47,616 --> 00:03:49,665
Heart rate 114, satting at 88.
97
00:03:49,750 --> 00:03:51,015
Okay, Avery, I'm Dr. Marcel.
98
00:03:51,100 --> 00:03:52,368
We're gonna take
good care of you, okay?
99
00:03:52,452 --> 00:03:53,898
It hurts so much.
100
00:03:54,020 --> 00:03:56,208
Trigger the MTP,
give her 50 of fentanyl.
101
00:03:57,334 --> 00:03:59,419
Here we go, guys.
Transfer on my count.
102
00:03:59,504 --> 00:04:01,272
One, two, three.
103
00:04:02,940 --> 00:04:04,607
There it is.
All right, let's roll her.
104
00:04:05,615 --> 00:04:08,273
You're okay, we got you.
The board...
105
00:04:13,249 --> 00:04:15,012
All right, we're good.
106
00:04:16,106 --> 00:04:18,247
Avery, can you put
your arms by your side for me?
107
00:04:18,332 --> 00:04:20,252
You're gonna feel
a little bit of pressure, okay?
108
00:04:22,911 --> 00:04:24,490
- O2 sats down to 82.
- Avery,
109
00:04:24,575 --> 00:04:27,287
Avery.
Avery... she's out.
110
00:04:27,541 --> 00:04:29,807
We need to intubate.
20 of etomidate, 100 of sux.
111
00:04:29,922 --> 00:04:32,669
Get a CBC, CMP,
type and cross four units.
112
00:04:32,887 --> 00:04:35,023
Let's get a fastscan
and have them prep OR 12.
113
00:04:35,108 --> 00:04:37,708
- No, she's going to OR seven.
- Excuse me?
114
00:04:37,976 --> 00:04:39,325
Yeah, I'll take it from here.
115
00:04:39,466 --> 00:04:41,654
And let's add
a coag panel and LFTs.
116
00:04:41,739 --> 00:04:43,288
Dr. Blake,
I think you're mistaken.
117
00:04:43,372 --> 00:04:45,224
This is a trauma,
not a transplant surgery.
118
00:04:45,309 --> 00:04:47,184
Yeah, I can see that.
119
00:04:47,269 --> 00:04:49,666
She's got free fluid,
and she's in shock.
120
00:04:49,751 --> 00:04:51,208
Her liver's ruptured
but repairable.
121
00:04:51,293 --> 00:04:54,200
- We got to get her up now.
- I'm in. Bag her.
122
00:04:54,583 --> 00:04:57,928
All do respect, Dr. Blake,
you're a transplant surgeon.
123
00:04:58,029 --> 00:04:59,942
- I got this.
- Thank you, Dr. Marcel,
124
00:05:00,027 --> 00:05:01,287
but I'll be
taking over the case now.
125
00:05:01,371 --> 00:05:03,090
I'm sorry,
I can't let you do that.
126
00:05:03,175 --> 00:05:03,966
This is my patient.
127
00:05:04,051 --> 00:05:06,091
And I understand that,
but she's also my daughter.
128
00:05:07,797 --> 00:05:09,149
Now, I'm gonna need you
to move.
129
00:05:09,660 --> 00:05:10,966
Let's go.
130
00:05:18,103 --> 00:05:19,825
You got a transplant patient?
131
00:05:19,910 --> 00:05:21,482
No, I don't.
132
00:05:22,237 --> 00:05:23,851
But we have a problem.
133
00:05:30,333 --> 00:05:32,044
*CHICAGO MED*
Season 07 Episode 05
134
00:05:32,128 --> 00:05:34,128
Episode Title:
"Change Is a Tough Pill to Swallow"
135
00:05:34,212 --> 00:05:35,310
Aired on:
October 20, 2021.
136
00:05:36,865 --> 00:05:38,232
Subtitles
Synchronized by srjanapala
137
00:05:38,392 --> 00:05:40,154
Hey, Alex,
I'm Dr. Scott.
138
00:05:40,317 --> 00:05:42,091
I'm Susan.
This is Todd.
139
00:05:42,176 --> 00:05:44,958
And this is Ry... Ryan,
come on.
140
00:05:45,043 --> 00:05:46,974
Hey, Ryan,
can I get a couple of those?
141
00:05:49,183 --> 00:05:51,872
Ryan, enough with the gloves,
okay?
142
00:05:51,957 --> 00:05:52,853
Thanks.
143
00:05:54,292 --> 00:05:57,820
Alex, says here
that you
144
00:05:57,905 --> 00:05:59,435
got hit in the head
with a Nerf gun.
145
00:05:59,909 --> 00:06:02,747
- Yeah.
- Oof, I bet that hurt.
146
00:06:02,911 --> 00:06:05,961
The thing is, you're supposed
to get hit with the foam dart,
147
00:06:06,046 --> 00:06:07,763
not the actual gun.
148
00:06:07,902 --> 00:06:09,090
Stop it.
149
00:06:09,432 --> 00:06:11,825
It was an accident.
The boys were playing.
150
00:06:12,458 --> 00:06:14,177
- Mom, it wasn't a Nerf gun.
- Okay.
151
00:06:14,262 --> 00:06:15,832
I... I didn't even see it happen.
I... okay.
152
00:06:15,916 --> 00:06:16,825
- Ryan.
- Mom... mom.
153
00:06:16,910 --> 00:06:18,002
- Hey, just a minute.
- Mom...
154
00:06:18,086 --> 00:06:19,483
- They were down in the basement and...
- It wasn't a Nerf gun.
155
00:06:19,567 --> 00:06:20,404
Ryan, okay.
156
00:06:20,489 --> 00:06:22,103
Hey, hey, hey, Ryan.
157
00:06:22,329 --> 00:06:23,898
What's up, buddy?
Talk to me.
158
00:06:24,122 --> 00:06:26,419
- It was an Ultra Blaster.
- Oh, yeah?
159
00:06:26,504 --> 00:06:28,465
Triple action
with the slam-fire?
160
00:06:29,008 --> 00:06:31,615
- Uh-huh.
- Sweet. Yeah.
161
00:06:31,852 --> 00:06:33,388
"I'm sorry, Doctor"?
162
00:06:34,082 --> 00:06:35,701
Todd, you want to take him
for a walk to the truck?
163
00:06:35,785 --> 00:06:37,747
Give him his meds.
Okay, go with Dad. Go.
164
00:06:42,179 --> 00:06:45,229
Oh, man.
Tough day, huh, bro?
165
00:06:45,314 --> 00:06:46,802
He has ADHD.
166
00:06:47,016 --> 00:06:48,529
Yeah, we have him
on Adderall,
167
00:06:48,630 --> 00:06:50,622
but we keep upping the dose,
168
00:06:50,707 --> 00:06:52,661
and some days
are just a little tough.
169
00:06:52,746 --> 00:06:54,263
I know.
It's okay.
170
00:06:55,191 --> 00:06:57,672
What about you?
How you doing?
171
00:06:58,674 --> 00:06:59,895
I'm fine.
172
00:07:00,526 --> 00:07:01,716
You sure?
173
00:07:03,175 --> 00:07:04,875
Okay then.
174
00:07:04,975 --> 00:07:06,763
For now, we're gonna keep
applying pressure
175
00:07:06,863 --> 00:07:08,997
and get you all stitched up.
Shouldn't be too long.
176
00:07:15,311 --> 00:07:18,154
Hey, Mags, I need somebody
to throw stitches in six.
177
00:07:18,239 --> 00:07:19,243
I'm on it.
178
00:07:19,328 --> 00:07:20,592
You already have
two patients up.
179
00:07:20,676 --> 00:07:21,724
- You sure you have time?
- Don't worry.
180
00:07:21,808 --> 00:07:23,027
I got it.
181
00:07:31,679 --> 00:07:33,521
- Rough morning, huh?
- Yeah.
182
00:07:33,606 --> 00:07:35,044
It's a tricky family dynamic.
183
00:07:35,129 --> 00:07:36,661
I'm treating
a 10-year-old named Alex.
184
00:07:36,746 --> 00:07:37,794
His brother has ADHD.
185
00:07:37,879 --> 00:07:39,419
Seems like
it's pretty tough on them.
186
00:07:39,504 --> 00:07:40,154
Yeah.
187
00:07:40,239 --> 00:07:41,704
Takes up a lot
of the family's energy.
188
00:07:41,788 --> 00:07:43,097
Oh, yeah.
189
00:07:43,182 --> 00:07:45,756
Parents so focused
on... on the kid with the illness
190
00:07:45,841 --> 00:07:47,755
that they see right through
the other one.
191
00:07:47,844 --> 00:07:49,763
Yeah, unfortunately
not at all uncommon.
192
00:07:49,848 --> 00:07:51,767
There's even a name for it.
It's called... it's called
193
00:07:51,851 --> 00:07:53,310
glass child syndrome.
194
00:07:53,395 --> 00:07:55,574
Oh, that sounds like
exactly what's happening.
195
00:07:55,659 --> 00:07:57,925
Yeah, happy to provide you
with a couple referrals
196
00:07:58,010 --> 00:07:59,407
for a therapist
for the... for the kid
197
00:07:59,491 --> 00:08:00,931
if you think the parents'll
be open to it.
198
00:08:01,015 --> 00:08:02,107
I think that'd be great.
Thanks.
199
00:08:02,191 --> 00:08:03,802
Oh.
200
00:08:03,988 --> 00:08:05,162
Dr. Choi,
I've been bugging him
201
00:08:05,246 --> 00:08:07,022
for an update on his rehab.
I better take this.
202
00:08:07,106 --> 00:08:09,226
Go ahead, man, and tell him
I look forward to meeting.
203
00:08:09,427 --> 00:08:10,427
Will do.
204
00:08:11,882 --> 00:08:13,607
I understand
this must be hard for you,
205
00:08:13,692 --> 00:08:15,611
but that's the very reason
I can't let you go in there.
206
00:08:15,695 --> 00:08:17,613
I appreciate your concern,
but I'm fine.
207
00:08:17,803 --> 00:08:19,590
- Dr. Blake.
- Ms. Goodwin.
208
00:08:19,675 --> 00:08:22,255
You know very well
it's against hospital policy
209
00:08:22,340 --> 00:08:23,771
to operate
on a family member.
210
00:08:23,856 --> 00:08:25,905
I am perfectly qualified
to perform this surgery.
211
00:08:26,262 --> 00:08:28,232
Pamela, you are
a transplant surgeon.
212
00:08:28,317 --> 00:08:29,931
Dr. Archer and I
see these cases every day.
213
00:08:30,015 --> 00:08:31,677
And I make more money
for this hospital
214
00:08:31,762 --> 00:08:34,943
- than any other doctor here.
- That is not the point.
215
00:08:35,830 --> 00:08:38,950
Dr. Archer is
a top trauma surgeon.
216
00:08:39,475 --> 00:08:42,568
He will do
an excellent job.
217
00:08:43,332 --> 00:08:45,724
I will,
and if you're so inclined,
218
00:08:45,809 --> 00:08:47,683
I'd be happy
to have you observe.
219
00:09:00,693 --> 00:09:02,372
- Ryan.
- Ryan...
220
00:09:02,457 --> 00:09:04,466
Can you sit still
for just one minute?
221
00:09:05,309 --> 00:09:06,922
I'm gonna go
get some air.
222
00:09:07,320 --> 00:09:08,615
Yeah.
223
00:09:13,391 --> 00:09:15,353
Will, can I get
your opinion on something?
224
00:09:15,632 --> 00:09:17,810
Sure.
What's going on?
225
00:09:17,895 --> 00:09:19,575
I've got a 71-year-old woman
226
00:09:19,702 --> 00:09:21,513
who's hypotensive
and tachycardic.
227
00:09:21,598 --> 00:09:23,211
Passed out this morning
at home.
228
00:09:23,352 --> 00:09:25,646
No medical history
other than asthma.
229
00:09:25,731 --> 00:09:27,458
She could use
some cardiac monitoring,
230
00:09:27,543 --> 00:09:29,183
and I know that
you're big on the Vas-COM.
231
00:09:29,341 --> 00:09:30,650
Well, I mean, there are
a number
232
00:09:30,735 --> 00:09:33,708
of good cardiac output
monitors.
233
00:09:34,098 --> 00:09:36,325
But the Vas-COM
is a terrific device.
234
00:09:36,555 --> 00:09:38,517
You mind if I, uh,
have a look at her?
235
00:09:38,664 --> 00:09:40,704
- See if she's a good candidate?
- Yeah, yeah, sure.
236
00:09:44,184 --> 00:09:45,974
Eleanor, Ron,
this is Dr. Halstead.
237
00:09:46,059 --> 00:09:47,013
Hi.
238
00:09:47,110 --> 00:09:48,538
He's just going to ask you
a few questions.
239
00:09:48,622 --> 00:09:50,599
- Nice to meet you.
- You have to help her.
240
00:09:50,684 --> 00:09:51,661
Ellie, tell him,
241
00:09:51,746 --> 00:09:53,404
you've never been sick
a day in your life.
242
00:09:53,497 --> 00:09:56,294
- Ron...
- No, no, that's good to hear.
243
00:09:56,619 --> 00:09:58,520
- You mind if I?
- Mm-hm.
244
00:09:58,605 --> 00:09:59,954
Make a fist.
245
00:10:01,104 --> 00:10:03,066
And release.
246
00:10:03,407 --> 00:10:04,474
Good.
247
00:10:04,625 --> 00:10:06,196
Does she have
any sensitivities or allergies?
248
00:10:06,280 --> 00:10:08,099
Recent injuries,
meds that would interfere
249
00:10:08,184 --> 00:10:10,538
- with an arterial line?
- Just seasonal allergies.
250
00:10:10,718 --> 00:10:13,105
Okay. Eleanor, do you
ever have any trouble
251
00:10:13,190 --> 00:10:15,804
- when you get your blood drawn?
- I don't think so.
252
00:10:16,388 --> 00:10:19,847
What about leg swelling?
Long car rides, trips?
253
00:10:20,150 --> 00:10:22,160
No, not that I can remember.
254
00:10:24,076 --> 00:10:25,211
That's good.
255
00:10:25,687 --> 00:10:27,808
All right, it was nice
to meet you.
256
00:10:27,893 --> 00:10:29,886
I'll have a chat
with Dr. Hammer.
257
00:10:29,971 --> 00:10:31,146
We'll be right back.
258
00:10:33,484 --> 00:10:35,344
What do you think?
She look good for the Vas-COM?
259
00:10:35,428 --> 00:10:36,650
Uh, maybe.
260
00:10:36,735 --> 00:10:38,392
She was
a little vague in her answers.
261
00:10:38,477 --> 00:10:39,526
But she definitely
should have
262
00:10:39,610 --> 00:10:41,092
her cardiac output monitored?
263
00:10:41,177 --> 00:10:42,777
Dr. Hammer,
if you're interested,
264
00:10:42,862 --> 00:10:44,128
I could give you copies
265
00:10:44,213 --> 00:10:47,590
of the Vas-COM's FDA-approved
usage criteria?
266
00:10:47,875 --> 00:10:49,808
You know, that... that
won't be necessary.
267
00:10:49,893 --> 00:10:51,988
I think Eleanor would be
a great candidate.
268
00:10:52,073 --> 00:10:54,340
Okay, good.
I'll get it set up.
269
00:11:01,199 --> 00:11:02,894
- Dr. Scott.
- Alex?
270
00:11:02,979 --> 00:11:04,549
- Dr. Taylor.
- Buddy? What?
271
00:11:04,634 --> 00:11:06,421
- Alex.
- Bud...
272
00:11:06,506 --> 00:11:09,402
- Excuse me.
- Honey, honey?
273
00:11:09,489 --> 00:11:11,652
- What... what's happening?
- He's having a seizure.
274
00:11:11,768 --> 00:11:14,382
Give him 12 liters of O2
and .five of Ativan.
275
00:11:14,467 --> 00:11:16,342
Wait, seizure?
Why is he having a seizure?
276
00:11:16,427 --> 00:11:17,562
I'm not sure yet.
277
00:11:17,647 --> 00:11:18,777
Come on.
278
00:11:19,503 --> 00:11:22,230
Come on, come on,
come on, come on.
279
00:11:30,667 --> 00:11:33,238
Hey, Alex, you with me?
280
00:11:33,323 --> 00:11:34,849
Uh-huh.
281
00:11:35,064 --> 00:11:36,677
Okay.
282
00:11:42,510 --> 00:11:44,582
We're gonna figure this out
as soon as we can.
283
00:11:44,667 --> 00:11:46,058
Dr. Taylor.
284
00:11:48,606 --> 00:11:51,176
Hi, hi, okay.
It's okay.
285
00:11:51,261 --> 00:11:53,093
Has that cut been bleeding
like that the whole time?
286
00:11:53,177 --> 00:11:54,922
I tried holding pressure,
but it didn't work.
287
00:11:55,006 --> 00:11:56,316
And if I would've tried
to stitch too soon,
288
00:11:56,400 --> 00:11:57,355
he would've got a hematoma.
289
00:11:57,440 --> 00:11:58,401
He could have
a bleeding disorder.
290
00:11:58,486 --> 00:11:59,636
Did you order coags?
291
00:11:59,721 --> 00:12:02,715
- Um, well, no. I...
- Get a coag panel, Maggie.
292
00:12:02,800 --> 00:12:04,631
And let CT know
we're on our way.
293
00:12:04,880 --> 00:12:07,254
Wait, do you think he
could have a subdural hematoma?
294
00:12:07,339 --> 00:12:09,457
Yes, and if he does have
a bleeding disorder,
295
00:12:09,542 --> 00:12:11,026
then the trauma
from getting hit in the head
296
00:12:11,110 --> 00:12:12,223
could've caused
a bleed in the skull,
297
00:12:12,307 --> 00:12:14,160
which means he could herniate
at any moment.
298
00:12:14,253 --> 00:12:15,926
All right, now.
Let's go.
299
00:12:19,278 --> 00:12:20,808
Oh, my God.
300
00:12:24,472 --> 00:12:26,769
Okay, ready to release
the pringle.
301
00:12:26,856 --> 00:12:29,770
Hold on, I didn't get
a good look at the duodenum.
302
00:12:29,855 --> 00:12:32,059
- It's clear.
- Okay.
303
00:12:32,144 --> 00:12:33,622
All right, pulling back
on the lap.
304
00:12:35,443 --> 00:12:36,504
Looks good.
305
00:12:37,870 --> 00:12:39,372
What's her pH and temp?
306
00:12:39,457 --> 00:12:41,708
7.34 and 36.9.
307
00:12:41,793 --> 00:12:43,700
All right, looks like
you're good to close.
308
00:12:43,785 --> 00:12:47,315
Uh, actually, we're just
gonna pack and leave her open.
309
00:12:47,956 --> 00:12:49,473
No, her bleeding's
under control.
310
00:12:49,558 --> 00:12:51,614
- Packing her isn't necessary.
- I disagree.
311
00:12:51,699 --> 00:12:53,333
She's got a grade four
liver laceration.
312
00:12:53,418 --> 00:12:54,919
The risk of re-bleeding
is too high.
313
00:12:55,004 --> 00:12:56,614
She's a healthy 28-year-old.
314
00:12:56,699 --> 00:12:58,263
Leaving her open puts her
at increased risk
315
00:12:58,347 --> 00:13:01,114
for infection, coagulopathy,
hypothermia, and acidosis.
316
00:13:01,199 --> 00:13:03,027
- Dr. Blake, I...
- Close her up, doctor.
317
00:13:03,111 --> 00:13:05,903
- I understand your concerns.
- No, no, point well taken.
318
00:13:05,988 --> 00:13:07,989
I see the merit
in what Dr. Blake is saying.
319
00:13:08,074 --> 00:13:09,326
- Dr. Archer...
- All right, hold off
320
00:13:09,410 --> 00:13:11,544
on the lap.
I need Celox, Gelfoam,
321
00:13:11,629 --> 00:13:14,341
and get an O Max
and suture for Dr. Marcel.
322
00:13:14,426 --> 00:13:16,722
- Dr. Archer, you...
- Dr. Marcel.
323
00:13:20,924 --> 00:13:23,104
Mr. and Mrs. Miller,
I'm Dr. Charles.
324
00:13:23,189 --> 00:13:25,089
I had been consulting
325
00:13:25,174 --> 00:13:27,635
with... with Dr. Scott
on Alex's case.
326
00:13:27,720 --> 00:13:29,964
- Psychiatry?
- Head injury.
327
00:13:30,049 --> 00:13:31,901
You know, can't be too careful.
328
00:13:31,986 --> 00:13:34,229
Anyway, Dr. Scott wanted me
to let you know that
329
00:13:34,314 --> 00:13:36,854
Alex's scans are almost ready.
And in the meantime,
330
00:13:36,939 --> 00:13:38,043
is there anything
I can get you?
331
00:13:38,127 --> 00:13:39,676
- A bottle of water?
- Thank you, but we're fine.
332
00:13:39,760 --> 00:13:40,455
Yeah.
333
00:13:40,539 --> 00:13:42,370
Oh, sorry.
This is work.
334
00:13:42,455 --> 00:13:43,970
Um, don't forget
to text my parents.
335
00:13:44,055 --> 00:13:45,572
- Excuse me.
- Oh, okay. Yep.
336
00:13:46,458 --> 00:13:48,432
Ryan? Is it Ryan?
How about you, buddy?
337
00:13:48,517 --> 00:13:50,768
- Can I get you something?
- Do you mind if I...
338
00:13:50,853 --> 00:13:52,035
- No, not at all.
- Okay, I'll be right back.
339
00:13:52,119 --> 00:13:53,767
Not at all.
340
00:13:54,564 --> 00:13:58,213
Would you, uh,
like a sandwich or something?
341
00:13:59,970 --> 00:14:02,216
No? Bag of chips?
342
00:14:02,595 --> 00:14:05,182
Soda?
Anything at all?
343
00:14:05,267 --> 00:14:07,744
No!
You interrupted me.
344
00:14:07,845 --> 00:14:10,815
- Oh, I'm sorry.
- I, uh, I... I didn't mean to.
345
00:14:10,900 --> 00:14:13,369
Now I have to start
all over again.
346
00:14:13,791 --> 00:14:16,964
Oh, you were counting.
Huh?
347
00:14:17,049 --> 00:14:20,033
Okay, well, I'm... again,
I'm very sorry.
348
00:14:20,181 --> 00:14:22,135
You... you get back to that.
All right?
349
00:14:23,760 --> 00:14:28,464
Mr. and Mrs. Miller, we just
got Alex's test results back.
350
00:14:28,549 --> 00:14:30,534
Alex is stable right now,
351
00:14:30,619 --> 00:14:34,447
but the scan did confirm that
he is bleeding into his brain.
352
00:14:35,333 --> 00:14:37,417
And the intracranial pressure
is great enough
353
00:14:37,502 --> 00:14:40,596
that he needs
immediate surgical evacuation.
354
00:14:40,681 --> 00:14:41,768
Oh, my God.
355
00:14:41,853 --> 00:14:43,257
Wait, wait, wait.
How'd this happen?
356
00:14:43,341 --> 00:14:45,854
Well, his test results
came back positive
357
00:14:45,939 --> 00:14:49,174
for a bleeding disorder called
Von Willebrand disease.
358
00:14:49,353 --> 00:14:52,378
So the impact from a small toy
could've caused a bleed
359
00:14:52,463 --> 00:14:55,025
that his body
just wasn't able to stop.
360
00:14:55,799 --> 00:14:56,966
I... I know this is a lot,
361
00:14:57,050 --> 00:14:58,968
but Dr. Abrams
will be doing the surgery,
362
00:14:59,052 --> 00:15:00,448
and he's our very best.
363
00:15:00,674 --> 00:15:02,146
The procedure
shouldn't be that long.
364
00:15:02,230 --> 00:15:04,551
I'll be here for status updates
or if you have any questions.
365
00:15:04,635 --> 00:15:07,112
And if we have your consent,
366
00:15:07,197 --> 00:15:08,464
we could get started
right away.
367
00:15:08,549 --> 00:15:09,667
- Sure.
- Yeah, of course.
368
00:15:09,752 --> 00:15:10,885
- Whatever you need.
- Okay.
369
00:15:10,970 --> 00:15:12,207
So why don't I take you
somewhere
370
00:15:12,291 --> 00:15:13,418
that's more comfortable
to wait?
371
00:15:13,502 --> 00:15:15,675
Um, Ryan.
Hey, buddy.
372
00:15:15,760 --> 00:15:16,918
Come on, buddy.
We're gonna take
373
00:15:17,002 --> 00:15:18,162
a little walk, all right?
374
00:15:33,172 --> 00:15:34,870
Hey, I saw
Eleanor's oxygenation
375
00:15:34,955 --> 00:15:36,393
and cardiac output are down.
376
00:15:36,478 --> 00:15:37,652
Have you gotten her labs
back yet?
377
00:15:37,736 --> 00:15:39,521
Yeah; they don't show much.
Mild infiltrates
378
00:15:39,606 --> 00:15:41,675
on her chest X-ray
and some eosinophilia.
379
00:15:41,760 --> 00:15:43,439
Still don't know
what's going on.
380
00:15:43,758 --> 00:15:45,128
I'm a little concerned.
381
00:15:45,213 --> 00:15:47,066
One of her fingers and two
of her toes are going cold.
382
00:15:47,150 --> 00:15:48,767
Oh, could just be
a vasospasm.
383
00:15:48,931 --> 00:15:50,642
That could be, but...
384
00:15:50,834 --> 00:15:53,073
Look, the major drawback
to any arterial line,
385
00:15:53,158 --> 00:15:54,917
including the Vas-COM,
is the potential
386
00:15:55,002 --> 00:15:56,112
for thrombus formation.
387
00:15:56,197 --> 00:15:57,371
So I-I think we should
pull it out.
388
00:15:57,455 --> 00:15:58,650
Pull it out?
389
00:15:59,061 --> 00:16:01,393
I mean, thromboembolization
in arterial lines
390
00:16:01,478 --> 00:16:03,207
is extremely rare,
and it almost never occurs
391
00:16:03,291 --> 00:16:05,330
- this quickly.
- I understand.
392
00:16:05,533 --> 00:16:07,650
I just think we should err
on the side of safety.
393
00:16:08,635 --> 00:16:10,074
What?
394
00:16:10,392 --> 00:16:13,860
Is something going on?
It's getting us great numbers.
395
00:16:13,985 --> 00:16:15,557
Keeping Eleanor's meds titrated
396
00:16:15,642 --> 00:16:17,560
and her pressure
and heart rate optimized.
397
00:16:17,644 --> 00:16:19,355
Without it, we'd just be
shooting in the dark.
398
00:16:19,439 --> 00:16:20,862
I know.
I just want to make sure
399
00:16:20,947 --> 00:16:23,696
- we're using it appropriately.
- I think we are.
400
00:16:23,907 --> 00:16:25,556
Let's just give it
a little more time.
401
00:16:31,830 --> 00:16:33,760
- Dr. Archer.
- Yeah.
402
00:16:33,845 --> 00:16:35,502
What the hell
happened back there?
403
00:16:35,662 --> 00:16:36,666
What?
404
00:16:36,750 --> 00:16:38,621
Giving in to Dr. Blake
like that.
405
00:16:39,840 --> 00:16:42,498
The surgery was a success,
and if you'll excuse me,
406
00:16:42,582 --> 00:16:44,021
I have an ED to run.
407
00:16:44,353 --> 00:16:45,892
Hold on, Dean.
408
00:16:46,283 --> 00:16:47,800
You know,
with that kind of injury,
409
00:16:47,885 --> 00:16:49,432
keeping her open
is the right thing to do.
410
00:16:49,516 --> 00:16:52,237
Dr. Blake's reasoning
was medically sound.
411
00:16:52,322 --> 00:16:53,947
I mean, I could argue it
either way.
412
00:16:54,032 --> 00:16:55,602
- Oh, come on!
- Crockett...
413
00:16:55,812 --> 00:16:58,601
hospital politics
is a lot like the military.
414
00:16:59,072 --> 00:17:00,893
You put in your time.
You do as your told.
415
00:17:00,978 --> 00:17:04,119
And eventually you can rise up
to become a Dr. Blake, too.
416
00:17:11,283 --> 00:17:13,746
Hey, buddy.
This is my friend, Dr. Charles.
417
00:17:13,830 --> 00:17:15,142
Hey, Alex.
418
00:17:15,227 --> 00:17:16,910
We just came to check in
on you before your surgery,
419
00:17:16,994 --> 00:17:18,443
see if you had any questions.
420
00:17:19,335 --> 00:17:21,503
- Is this gonna hurt?
- No, no.
421
00:17:21,588 --> 00:17:22,652
They're gonna give you
some medicine.
422
00:17:22,736 --> 00:17:23,626
It's gonna put you
right to sleep.
423
00:17:23,710 --> 00:17:24,736
You won't feel a thing.
424
00:17:25,650 --> 00:17:27,760
Even when they open
my head?
425
00:17:28,564 --> 00:17:30,216
Next thing you know,
you're just gonna
426
00:17:30,438 --> 00:17:32,747
wake up in recovery.
We promise.
427
00:17:33,357 --> 00:17:34,622
Okay.
428
00:17:36,926 --> 00:17:38,427
Anything else on your mind?
429
00:17:39,146 --> 00:17:40,465
No.
430
00:17:45,427 --> 00:17:48,810
It's just,
when they look inside my head,
431
00:17:48,943 --> 00:17:50,824
will they see my secrets?
432
00:17:52,801 --> 00:17:55,044
Uh, I don't think so.
433
00:17:55,224 --> 00:17:58,232
But if there is something
on your mind,
434
00:17:58,348 --> 00:18:01,798
a lot of kids tell me that
it's just better to get it out.
435
00:18:03,750 --> 00:18:05,404
This wasn't Ryan's fault.
436
00:18:05,520 --> 00:18:08,170
Oh, don't worry about that.
Ryan's not in any trouble.
437
00:18:08,255 --> 00:18:09,669
No, I made him do it.
438
00:18:11,599 --> 00:18:14,295
I made fun of him,
and I know if I did it enough,
439
00:18:14,380 --> 00:18:17,005
then he'd get really mad
and hit me.
440
00:18:18,756 --> 00:18:19,958
Yeah?
441
00:18:20,636 --> 00:18:22,271
Why would you want him
to hit you?
442
00:18:23,592 --> 00:18:24,911
Because...
443
00:18:26,997 --> 00:18:28,357
Because?
444
00:18:30,161 --> 00:18:31,868
If you got hurt, maybe
445
00:18:32,302 --> 00:18:34,302
Mom and Dad pay
a little more attention to you?
446
00:18:37,380 --> 00:18:39,326
It was stupid.
I shouldn't have done it.
447
00:18:39,411 --> 00:18:41,098
Hey, it's okay.
448
00:18:43,572 --> 00:18:46,357
Let's get you taken care of.
All right?
449
00:18:47,837 --> 00:18:50,365
Alex, it's gonna be okay,
buddy.
450
00:18:50,666 --> 00:18:52,929
You're gonna be fine.
We'll see you in a bit.
451
00:18:55,818 --> 00:18:58,373
Man, listen,
I deal with a lot of sick kids,
452
00:18:58,458 --> 00:18:59,722
but what do you do for this?
453
00:18:59,818 --> 00:19:03,217
So... kid with ADHD,
control issues, right?
454
00:19:03,302 --> 00:19:05,631
- Random outbursts.
- True.
455
00:19:05,716 --> 00:19:09,514
Yeah, but Alex knew he could
only get Ryan to lash out
456
00:19:09,598 --> 00:19:11,734
if he backed him into a corner.
That's not random.
457
00:19:11,818 --> 00:19:14,365
So, what are we looking at
if this isn't ADHD?
458
00:19:14,513 --> 00:19:16,434
I think maybe
an anxiety disorder.
459
00:19:16,518 --> 00:19:18,873
Oh, another misdiagnosis.
Second in a week.
460
00:19:18,958 --> 00:19:20,748
And if I'm right,
that misdiagnosis
461
00:19:20,833 --> 00:19:22,849
is causing this family
a lot of problems.
462
00:19:26,202 --> 00:19:27,623
You have to come quick.
463
00:19:27,707 --> 00:19:29,471
Something's wrong with Ellie.
464
00:19:34,101 --> 00:19:36,568
- Eleanor, can you hear me?
- Yeah.
465
00:19:36,678 --> 00:19:39,896
- Okay.
- Squeeze my hand.
466
00:19:45,442 --> 00:19:47,812
What's happening?
Why's she like this?
467
00:19:47,897 --> 00:19:49,772
She had a TIA,
a mini-stroke.
468
00:19:49,935 --> 00:19:51,795
Start her on aspirin
and clopidogrel
469
00:19:51,880 --> 00:19:53,147
and call for an MRI
of her head.
470
00:19:53,232 --> 00:19:54,777
A stroke?
What... what? Why?
471
00:19:54,861 --> 00:19:56,779
'Cause she's forming thrombi.
They're blood clots
472
00:19:56,863 --> 00:19:58,695
in her vessels, and one's
travelled to her brain.
473
00:19:58,779 --> 00:19:59,869
Oh, my God.
474
00:20:02,694 --> 00:20:04,787
Get a suture kit.
We have to pull the Vas out.
475
00:20:04,871 --> 00:20:06,789
I'll call Dr. Hammer.
Excuse me, Mr. Halt.
476
00:20:06,943 --> 00:20:08,428
- She's up in radiology.
- No, no, no.
477
00:20:08,513 --> 00:20:09,269
Every minute that passes
478
00:20:09,353 --> 00:20:10,793
increases her risk
of a major stroke.
479
00:20:10,877 --> 00:20:12,388
We have to pull it right now.
480
00:20:21,838 --> 00:20:23,915
ADs --->
481
00:22:10,119 --> 00:22:12,119
<--- ADs
482
00:22:12,642 --> 00:22:14,439
- No. That I want to...
- No.
483
00:22:15,900 --> 00:22:18,595
Hey,
you okay?
484
00:22:20,462 --> 00:22:23,142
No.
I screwed everything up today.
485
00:22:25,822 --> 00:22:27,775
I saw Alex's notes.
486
00:22:28,158 --> 00:22:30,791
Von Willebrand disease?
You couldn't have known.
487
00:22:30,876 --> 00:22:32,525
I could've ordered
those labs earlier.
488
00:22:32,610 --> 00:22:33,508
But it doesn't matter.
489
00:22:33,592 --> 00:22:35,192
The outcome still
would've been the same.
490
00:22:36,556 --> 00:22:38,550
Look, you're always gonna wish
that you could've done
491
00:22:38,634 --> 00:22:39,819
something earlier.
492
00:22:39,903 --> 00:22:41,362
It's part
of being a good doctor.
493
00:22:41,447 --> 00:22:43,236
Alex is in surgery, Maggie.
494
00:22:43,572 --> 00:22:45,259
He's bleeding into his brain.
495
00:22:45,585 --> 00:22:47,456
Which isn't your fault.
496
00:22:58,846 --> 00:23:01,040
You pulled
my patient's Vas-COM?
497
00:23:06,625 --> 00:23:07,759
She had a TIA.
498
00:23:07,844 --> 00:23:09,151
The Vas-COM was
most likely the source.
499
00:23:09,235 --> 00:23:11,376
You don't know that.
Could've been lupus,
500
00:23:11,525 --> 00:23:13,510
endocarditis, even leukemia.
501
00:23:13,595 --> 00:23:15,353
And now we have no way
to monitor her.
502
00:23:15,470 --> 00:23:16,943
She could've had
another stroke at any minute.
503
00:23:17,027 --> 00:23:18,284
What... what was
I supposed to do?
504
00:23:18,368 --> 00:23:20,120
She's my patient, Will.
505
00:23:20,267 --> 00:23:21,752
You at least
should've asked me.
506
00:23:21,837 --> 00:23:23,190
By the time
you got down here...
507
00:23:23,275 --> 00:23:24,472
- I'm not taking that chance.
- No, you were afraid
508
00:23:24,556 --> 00:23:26,082
that I would disagree
and that I'd stop you.
509
00:23:26,166 --> 00:23:26,751
No.
510
00:23:26,836 --> 00:23:28,476
It's the same old Will
from med school,
511
00:23:28,626 --> 00:23:30,354
always thinking
that you know better.
512
00:23:30,439 --> 00:23:32,751
Stevie, that's not
what this was about.
513
00:23:33,181 --> 00:23:34,569
You tell yourself that.
514
00:23:41,368 --> 00:23:42,490
Hi.
515
00:23:42,574 --> 00:23:44,300
I don't know if you remember me
from this morning.
516
00:23:44,384 --> 00:23:46,233
I'm the surgeon on your case,
Dr. Marcel.
517
00:23:46,317 --> 00:23:47,451
How you feeling?
518
00:23:47,884 --> 00:23:49,767
Like I got hit by a car.
519
00:23:50,143 --> 00:23:52,105
Well, you did
just have major surgery,
520
00:23:52,236 --> 00:23:53,631
but, uh, it went well,
521
00:23:53,775 --> 00:23:57,113
and I imagine you will feel
a little better each day.
522
00:23:57,508 --> 00:23:59,114
Here you go.
523
00:23:59,199 --> 00:24:02,204
- Dr. Blake said to go slow.
- Thanks, Dina.
524
00:24:02,486 --> 00:24:05,868
Ice chips.
My mom is in love with them.
525
00:24:05,953 --> 00:24:07,341
Frankly, I think they're
just as much
526
00:24:07,425 --> 00:24:10,001
- an aspiration risk as liquids.
- Aspiration risk?
527
00:24:10,086 --> 00:24:12,471
What, are you
a... you a doctor, too?
528
00:24:12,556 --> 00:24:14,768
Made it halfway through
a third year of med school.
529
00:24:14,853 --> 00:24:15,958
Oh, okay.
530
00:24:16,243 --> 00:24:18,971
Realized I was doing it
for my mom, not for me.
531
00:24:19,056 --> 00:24:19,919
Oh.
532
00:24:20,034 --> 00:24:22,400
I'm assuming
you've met her by now?
533
00:24:23,415 --> 00:24:25,488
Made her acquaintance, yeah.
534
00:24:26,056 --> 00:24:27,578
She try to scrub in?
535
00:24:28,126 --> 00:24:29,599
How'd you guess?
536
00:24:29,751 --> 00:24:31,237
I know my mom.
537
00:24:31,322 --> 00:24:32,714
She didn't talk to me
for six months
538
00:24:32,798 --> 00:24:35,935
- after I quit med school.
- Wow, that's rough.
539
00:24:36,019 --> 00:24:37,204
No.
540
00:24:37,368 --> 00:24:39,618
The day I took control
of my life?
541
00:24:40,181 --> 00:24:41,938
Best move I ever made.
542
00:24:45,408 --> 00:24:47,268
Anyway, I should
let you get some rest.
543
00:24:47,353 --> 00:24:52,429
Um, enjoy your ice chips,
and I'll check back later.
544
00:24:52,865 --> 00:24:55,997
So wait, what did you
end up doing after med school?
545
00:24:56,170 --> 00:24:59,154
- A malpractice lawyer.
- Medical?
546
00:25:00,458 --> 00:25:03,264
Your mom must be very proud.
547
00:25:07,223 --> 00:25:09,412
Mr. and Mrs. Miller,
I have an update for you.
548
00:25:11,863 --> 00:25:13,029
Be right back, buddy.
549
00:25:15,685 --> 00:25:18,085
So, look, they're... they're
just finishing up
550
00:25:18,170 --> 00:25:19,241
in surgery now.
551
00:25:19,326 --> 00:25:21,981
All indications are that
the procedure was a success.
552
00:25:22,154 --> 00:25:23,873
And Alex is doing great.
553
00:25:24,068 --> 00:25:26,724
Oh, my God, really?
Thank you so much.
554
00:25:27,045 --> 00:25:29,843
Listen, Dr. Scott and I
talked to Alex
555
00:25:29,928 --> 00:25:31,490
before the procedure today.
556
00:25:31,631 --> 00:25:34,994
And I understand that you have
a lot on your plate right now,
557
00:25:35,078 --> 00:25:37,389
but I... I also think
it's important that I share
558
00:25:37,474 --> 00:25:38,865
this conversation with you.
559
00:25:39,037 --> 00:25:40,086
- Okay.
- Okay.
560
00:25:40,217 --> 00:25:42,732
So... so what
he told us is that
561
00:25:42,834 --> 00:25:45,221
he provoked Ryan
into this outburst today.
562
00:25:45,305 --> 00:25:46,483
He feels terrible.
563
00:25:46,567 --> 00:25:48,701
I think he is looking
for some attention.
564
00:25:48,787 --> 00:25:51,639
But where Ryan's concerned...
What this means to me
565
00:25:51,724 --> 00:25:54,327
is that it wasn't
an impulsive outburst.
566
00:25:54,412 --> 00:25:56,711
It wasn't... it wasn't random.
567
00:25:57,021 --> 00:26:01,020
And that and a couple other
things I've observed today
568
00:26:01,104 --> 00:26:03,239
are leading me to believe
it's very possible
569
00:26:03,323 --> 00:26:06,460
that... that your son has
been misdiagnosed with ADHD
570
00:26:06,545 --> 00:26:08,186
and that we were
probably looking
571
00:26:08,271 --> 00:26:10,246
at some kind
of anxiety disorder instead.
572
00:26:10,330 --> 00:26:11,835
Wait, what are you
talking about?
573
00:26:11,920 --> 00:26:13,304
Look at him.
He can't sit still.
574
00:26:13,389 --> 00:26:16,061
But Mr. Miller,
it's... it's the counting, right?
575
00:26:16,146 --> 00:26:17,264
The tapping.
576
00:26:17,396 --> 00:26:18,929
I think that
he's self-soothing
577
00:26:19,014 --> 00:26:21,257
to help him cope
with these feelings of anxiety.
578
00:26:21,513 --> 00:26:23,061
And when that stops working,
579
00:26:23,146 --> 00:26:24,695
I think he feels
backed into a corner,
580
00:26:24,967 --> 00:26:27,131
and then you have
a fight-or-flight situation.
581
00:26:27,717 --> 00:26:29,194
Well, what
about the Adderall?
582
00:26:29,279 --> 00:26:30,538
His doctor said
that would help.
583
00:26:30,623 --> 00:26:34,140
If he actually had ADHD,
it would be working.
584
00:26:34,318 --> 00:26:37,491
But it's not, right?
I think that in Ryan's case,
585
00:26:37,576 --> 00:26:38,694
it's actually working
against him
586
00:26:38,778 --> 00:26:41,175
and serving to only intensify
these feelings of anxiety
587
00:26:41,360 --> 00:26:42,799
to the point
where they're often,
588
00:26:42,884 --> 00:26:44,324
frankly, unbearable.
589
00:26:44,408 --> 00:26:46,282
Dr. Charles,
man, look I... I...
590
00:26:46,537 --> 00:26:48,067
We appreciate everything
you're doing.
591
00:26:48,151 --> 00:26:50,608
Really, but please,
our son's in surgery.
592
00:26:50,693 --> 00:26:53,764
I am sorry.
This is just not an ideal time
593
00:26:53,849 --> 00:26:55,702
to have this conversation.
But I just wouldn't
594
00:26:55,787 --> 00:26:57,296
be doing my job
if I didn't tell you
595
00:26:57,381 --> 00:26:59,671
how important I think
it would be to reassess Ryan
596
00:26:59,756 --> 00:27:02,081
and make sure that you are
looking at the right diagnosis
597
00:27:02,165 --> 00:27:04,944
for him, for his brother,
for all of you,
598
00:27:05,029 --> 00:27:07,477
- for your whole family.
- No, Dr. Charles, it's just...
599
00:27:07,752 --> 00:27:10,093
- It's just been a long day.
- Of course.
600
00:27:10,435 --> 00:27:12,327
Listen, I am going
to check back with you
601
00:27:12,412 --> 00:27:14,108
when Alex wakes up, okay?
602
00:27:14,193 --> 00:27:15,857
- Yeah, yeah.
- Okay.
603
00:27:21,037 --> 00:27:23,646
I should've consulted you
before pulling the Vas-COM.
604
00:27:23,748 --> 00:27:25,568
It wasn't my place.
I'm sorry.
605
00:27:26,529 --> 00:27:27,780
And besides, you were right.
606
00:27:27,865 --> 00:27:30,152
She's getting worse and
still having embolic events.
607
00:27:30,236 --> 00:27:31,632
So it wasn't
the Vas-COM after all.
608
00:27:31,857 --> 00:27:34,156
Clearly,
but I've gone through
609
00:27:34,240 --> 00:27:36,202
every clotting disorder,
and none of it fits.
610
00:27:36,912 --> 00:27:39,100
Is it possible
we're looking at this wrong?
611
00:27:39,185 --> 00:27:41,366
That she doesn't even have
a clotting disorder?
612
00:27:41,451 --> 00:27:45,224
Of course.
It's just so little to go on.
613
00:27:45,787 --> 00:27:48,358
I mean, history of asthma,
eosinophils,
614
00:27:48,443 --> 00:27:49,519
and left-sided
lung infiltrates.
615
00:27:49,603 --> 00:27:50,607
Left?
616
00:27:50,943 --> 00:27:52,223
I thought
they were on the right.
617
00:27:52,553 --> 00:27:55,090
- Seriously, Will?
- No, no, wait.
618
00:27:55,334 --> 00:27:57,421
The X-ray from this morning
had them on the left.
619
00:27:57,506 --> 00:27:58,876
But look...
620
00:27:58,960 --> 00:28:01,241
The one from this afternoon
shows they moved to the right.
621
00:28:03,433 --> 00:28:05,459
Migratory infiltrates.
622
00:28:07,935 --> 00:28:10,772
Could this be vasculitis?
Churg-Strauss?
623
00:28:10,857 --> 00:28:12,335
I mean maybe.
She could've moved
624
00:28:12,420 --> 00:28:14,725
from the asthmatic stage
into the vascular stage today.
625
00:28:14,810 --> 00:28:17,999
It's a long shot,
but it's possible.
626
00:28:18,084 --> 00:28:20,085
If we're right,
her organs could start
627
00:28:20,170 --> 00:28:21,396
to shut down
at any moment.
628
00:28:21,481 --> 00:28:23,155
I'll start her on prednisone
and azathioprine
629
00:28:23,239 --> 00:28:25,397
and set her up
for a diagnostic lung biopsy.
630
00:28:25,482 --> 00:28:27,459
Dr. Hammer, Dr. Halstead,
you need to come.
631
00:28:27,544 --> 00:28:29,053
Eleanor's getting worse.
632
00:28:34,857 --> 00:28:37,210
I don't like
these QRS complexes.
633
00:28:37,295 --> 00:28:39,699
Eleanor, do you feel any pain
in your chest or arm?
634
00:28:39,784 --> 00:28:42,224
- It feels tight.
- Oh, God, Ellie.
635
00:28:42,309 --> 00:28:43,466
Why don't you come here?
636
00:28:45,075 --> 00:28:46,428
- She's going into v-tach.
- I'll get the paddles.
637
00:28:46,512 --> 00:28:48,131
- No, no, Ellie.
- Wait.
638
00:28:49,185 --> 00:28:51,474
If this is Churg-Strauss,
this could be a tamponade.
639
00:28:51,793 --> 00:28:53,320
We need to aspirate the fluid.
640
00:28:53,412 --> 00:28:54,576
I know, but if we're wrong,
641
00:28:54,661 --> 00:28:56,139
we won't have time
to cardiovert.
642
00:28:56,822 --> 00:28:58,232
I think we're right
about this.
643
00:28:59,700 --> 00:29:00,889
I do, too.
644
00:29:00,974 --> 00:29:04,279
- 18 gauge on a syringe.
- 18 gauge.
645
00:29:06,579 --> 00:29:09,281
Ron, there's fluid
around Eleanor's heart.
646
00:29:09,466 --> 00:29:11,146
They need to drain it.
647
00:29:12,938 --> 00:29:14,287
Nothing.
648
00:29:20,868 --> 00:29:22,310
Got it.
649
00:29:23,537 --> 00:29:24,959
Sinus rhythm.
650
00:29:25,656 --> 00:29:28,209
Eleanor, can you hear me?
651
00:29:28,403 --> 00:29:30,365
- Uh-huh.
- Oh, thank God.
652
00:29:30,450 --> 00:29:31,802
Call IR.
Tell them we're coming up
653
00:29:31,887 --> 00:29:34,428
- for a drain and a lung biopsy.
- You got it.
654
00:29:35,570 --> 00:29:37,224
Good job.
655
00:29:43,567 --> 00:29:45,612
Hey. How you feeling?
656
00:29:46,619 --> 00:29:49,334
- Okay.
- Good.
657
00:29:51,269 --> 00:29:52,792
Surgery went well.
658
00:29:55,703 --> 00:29:58,361
In fact, the neurosurgeon said
659
00:29:58,446 --> 00:29:59,885
that you had
the best-looking brain
660
00:29:59,970 --> 00:30:01,724
he's seen in quite a while.
661
00:30:02,862 --> 00:30:05,128
- Yeah?
- Yeah.
662
00:30:05,658 --> 00:30:08,615
Told your parents,
but they weren't surprised.
663
00:30:08,931 --> 00:30:11,584
Said they always knew
you had a great brain.
664
00:30:13,001 --> 00:30:14,568
They said that?
665
00:30:16,897 --> 00:30:19,279
Yeah, they did.
666
00:30:23,372 --> 00:30:26,465
You know, Alex,
kids with great brains...
667
00:30:26,550 --> 00:30:27,905
They don't always get
the most attention,
668
00:30:27,989 --> 00:30:30,349
but... people notice.
669
00:30:37,377 --> 00:30:38,729
What's going on?
670
00:30:38,829 --> 00:30:41,922
O2 sats are 91.
BP's down to 83/50.
671
00:30:42,271 --> 00:30:43,881
Drains are full.
672
00:30:44,125 --> 00:30:46,248
Belly's firm.
673
00:30:46,333 --> 00:30:47,873
Okay, etomidate and sux,
then transduce
674
00:30:47,958 --> 00:30:49,137
to a bladder pressure.
Let's go.
675
00:30:49,221 --> 00:30:50,747
Hey, Avery, look at me.
676
00:30:50,863 --> 00:30:52,210
You're re-bleeding
into your abdomen.
677
00:30:52,294 --> 00:30:54,734
I need to intubate and take you
back to the OR, okay?
678
00:30:57,817 --> 00:30:58,952
What happened?
679
00:30:59,037 --> 00:31:00,346
Abdominal compartment
syndrome.
680
00:31:00,431 --> 00:31:02,116
- We're going back to the OR.
- No, no need.
681
00:31:02,200 --> 00:31:04,404
You can use a cordis catheter
and decompress here.
682
00:31:04,580 --> 00:31:06,417
There's too much blood.
We don't have enough time.
683
00:31:06,501 --> 00:31:07,940
I'm in. Bag her.
684
00:31:08,025 --> 00:31:09,862
And if you open her up,
there'll be too much swelling,
685
00:31:09,946 --> 00:31:11,265
and you'll never
be able to close.
686
00:31:11,349 --> 00:31:12,481
Get the cordis.
687
00:31:14,890 --> 00:31:16,895
Dr. Marcel,
bladder pressure's 35.
688
00:31:18,468 --> 00:31:20,490
It's too high.
689
00:31:20,708 --> 00:31:22,374
We need to open her up
to release the pressure.
690
00:31:22,458 --> 00:31:23,146
Get me a 10 blade.
691
00:31:23,231 --> 00:31:24,538
Dr. Marcel,
I already told you...
692
00:31:24,623 --> 00:31:27,737
Back off, Dr. Blake.
Here we go. Ready?
693
00:31:38,925 --> 00:31:42,975
Sats are up to 96
and BP's 112/83.
694
00:31:43,129 --> 00:31:44,482
She's stable.
695
00:31:44,811 --> 00:31:46,816
All right,
get her up to the OR.
696
00:31:48,608 --> 00:31:49,943
Make sure
you get her swelling down.
697
00:31:51,552 --> 00:31:53,615
You're gonna need to close
her up as soon as possible.
698
00:32:13,168 --> 00:32:14,670
How is Alex?
699
00:32:15,632 --> 00:32:18,595
Um, his surgery just ended.
700
00:32:18,742 --> 00:32:20,094
He's doing really well.
701
00:32:20,178 --> 00:32:22,060
Alex probably hates me.
702
00:32:22,145 --> 00:32:24,498
I want to tell him
I'm really, really sorry.
703
00:32:24,583 --> 00:32:25,848
You'll be able
to see him soon.
704
00:32:25,933 --> 00:32:28,806
- And then you can tell him.
- Can I see him now?
705
00:32:29,907 --> 00:32:32,565
I'm not supposed to let you
until he's in his room.
706
00:32:32,875 --> 00:32:34,271
Please?
707
00:32:36,671 --> 00:32:39,416
Okay, maybe we could
just take a quick peek.
708
00:32:39,501 --> 00:32:41,139
If it's okay with your parents.
709
00:32:41,490 --> 00:32:43,103
Mom, can I go
with the doctor?
710
00:32:43,258 --> 00:32:44,784
Yeah, honey.
711
00:32:45,256 --> 00:32:47,248
Okey doke, let's go.
712
00:32:51,432 --> 00:32:52,967
So he's still a little sleepy,
713
00:32:53,079 --> 00:32:55,334
so we're just gonna give him
a quick wave hi, okay?
714
00:33:00,695 --> 00:33:02,099
That's not Alex.
715
00:33:02,624 --> 00:33:03,654
It's okay.
716
00:33:03,739 --> 00:33:05,482
He's just
a little bandaged from surgery.
717
00:33:05,567 --> 00:33:07,881
- I didn't do that.
- No, of course you didn't.
718
00:33:07,966 --> 00:33:09,708
I didn't mean to.
No, I'm sorry.
719
00:33:09,793 --> 00:33:10,584
- I'm sorry.
- Hey, hey, Ryan,
720
00:33:10,669 --> 00:33:11,607
Ryan, Ryan, it's okay.
721
00:33:11,692 --> 00:33:12,958
Listen to me. Listen to me.
Ryan, look,
722
00:33:13,042 --> 00:33:14,540
- you didn't do anything wrong.
- Stop it.
723
00:33:14,624 --> 00:33:15,712
Ryan!
724
00:33:16,723 --> 00:33:19,164
Ryan! Ryan!
725
00:33:35,893 --> 00:33:37,811
I'm so sorry.
This is all my fault.
726
00:33:38,020 --> 00:33:39,112
The security camera
picked him up.
727
00:33:39,196 --> 00:33:40,331
We're okay.
728
00:33:40,416 --> 00:33:42,170
Still, I just
can't apologize enough.
729
00:33:42,321 --> 00:33:44,395
Maybe I should talk
to his parents or...
730
00:33:44,480 --> 00:33:45,389
You know what?
731
00:33:45,474 --> 00:33:46,740
I think it's probably better
if I handle this.
732
00:33:46,824 --> 00:33:49,051
Listen, Vanessa,
not your fault.
733
00:33:49,136 --> 00:33:50,131
Okay?
734
00:33:50,216 --> 00:33:51,916
You were trying to help.
735
00:33:54,654 --> 00:33:56,474
Ryan, your brother
just had surgery.
736
00:33:56,585 --> 00:34:00,201
That's why he looks like that.
He's gonna be fine, buddy.
737
00:34:00,465 --> 00:34:02,597
Now, can you please come out?
738
00:34:03,969 --> 00:34:05,334
Please, Ryan?
739
00:34:10,497 --> 00:34:12,740
- Mind if I give it a try?
- Yes.
740
00:34:14,725 --> 00:34:16,030
Hey, Ryan.
741
00:34:19,686 --> 00:34:20,861
You know what?
742
00:34:21,936 --> 00:34:24,852
I don't think that you wanted
to hurt your brother today.
743
00:34:27,292 --> 00:34:29,408
I think the only reason
you threw that toy today
744
00:34:29,493 --> 00:34:32,496
was because you didn't know
what else to do.
745
00:34:34,038 --> 00:34:35,561
I got so mad.
746
00:34:37,837 --> 00:34:39,908
'Cause those feelings,
they just...
747
00:34:40,171 --> 00:34:43,229
They just keep building
and building.
748
00:34:44,957 --> 00:34:46,788
Uh-huh.
I can't stop them.
749
00:34:46,927 --> 00:34:48,929
And I'm always
getting in trouble.
750
00:34:52,910 --> 00:34:55,057
What if I told you
that I didn't think that
751
00:34:55,159 --> 00:34:58,322
- that was your fault?
- That's not what people say.
752
00:34:58,459 --> 00:35:00,377
They're always telling me
to reset.
753
00:35:00,618 --> 00:35:02,794
Well, you know what?
I don't think it's your fault.
754
00:35:04,807 --> 00:35:08,158
Not only that, you know
those... those feeling you get?
755
00:35:09,395 --> 00:35:10,822
I get them, too.
756
00:35:11,309 --> 00:35:13,009
- You do?
- Oh, yeah.
757
00:35:13,304 --> 00:35:14,908
Everybody does.
758
00:35:15,476 --> 00:35:20,158
And one of the things that
really helps me when I get them
759
00:35:20,804 --> 00:35:22,806
is, actually,
to talk about them.
760
00:35:24,335 --> 00:35:26,893
You know, there's
this weird magic when you...
761
00:35:27,179 --> 00:35:28,768
When you get them out.
762
00:35:29,095 --> 00:35:32,901
They just... they just don't
seem to bother you as much.
763
00:35:33,960 --> 00:35:35,571
- Really?
- Yeah.
764
00:35:36,833 --> 00:35:40,260
And I guarantee you,
whatever feeling you're having
765
00:35:41,335 --> 00:35:43,041
there are people in your life...
766
00:35:43,604 --> 00:35:45,940
They want to hear about it.
I mean, your mom and dad...
767
00:35:47,103 --> 00:35:49,502
They would really want
to hear about them.
768
00:35:50,327 --> 00:35:53,199
- They would?
- Of course we would, honey.
769
00:35:55,376 --> 00:35:57,595
And you won't think
that I'm bad?
770
00:35:58,562 --> 00:36:01,229
Ryan,
we never think you're bad.
771
00:36:15,631 --> 00:36:17,049
I got you.
772
00:36:27,029 --> 00:36:29,205
You really don't think
this is ADHD?
773
00:36:29,926 --> 00:36:31,299
I don't think it is.
774
00:36:33,806 --> 00:36:37,088
So this Adderall
isn't helping?
775
00:36:37,452 --> 00:36:39,631
I think it's
actually making it worse.
776
00:36:54,807 --> 00:36:57,221
Hey, I just saw
Eleanor's biopsy results.
777
00:36:57,716 --> 00:36:59,338
Churg-Strauss.
778
00:37:00,078 --> 00:37:03,338
Hey, maybe we work well
together after all.
779
00:37:03,563 --> 00:37:04,869
Maybe we do.
780
00:37:05,676 --> 00:37:07,396
- I'll see you tomorrow.
- See you tomorrow.
781
00:37:07,675 --> 00:37:10,283
Oh, I made a few calls.
782
00:37:10,689 --> 00:37:13,838
It was definitely Mandelbrot.
783
00:37:15,439 --> 00:37:16,963
Bye.
784
00:37:17,850 --> 00:37:19,072
Bye.
785
00:37:19,180 --> 00:37:21,885
Will, I just met Eleanor.
786
00:37:22,285 --> 00:37:25,857
Churg-Strauss,
one in a million.
787
00:37:25,942 --> 00:37:27,354
Yeah.
788
00:37:27,439 --> 00:37:29,643
Though I did see you had
to pull her Vas-COM.
789
00:37:29,878 --> 00:37:31,291
Yeah, I hated to do it.
790
00:37:31,422 --> 00:37:32,948
Uh, but she
was throwing emboli,
791
00:37:33,033 --> 00:37:34,300
had some
cold fingers and toes...
792
00:37:34,384 --> 00:37:35,825
Hey, hey, Will, you
absolutely did the right thing.
793
00:37:35,909 --> 00:37:37,349
The last thing we need
is for the Vas-COM
794
00:37:37,433 --> 00:37:39,557
to be used inappropriately
and then it gets a bad rap.
795
00:37:40,106 --> 00:37:41,885
That... that's what I thought,
too.
796
00:37:41,970 --> 00:37:44,182
Now that she's stable,
however, it did seem
797
00:37:44,267 --> 00:37:46,186
medically warranted to get
her on better monitoring again,
798
00:37:46,270 --> 00:37:48,013
so I just put in
another Vas-COM.
799
00:37:49,753 --> 00:37:51,062
Okay.
800
00:37:51,163 --> 00:37:52,970
Anyway, I'm glad you're
coming to the conference.
801
00:37:53,054 --> 00:37:54,737
Yeah, same here.
802
00:37:55,443 --> 00:37:57,416
Hey, maybe, um,
if you get there early.
803
00:37:57,501 --> 00:37:58,556
We could have a drink?
804
00:37:59,198 --> 00:38:00,493
Sure.
805
00:38:17,216 --> 00:38:19,017
So what do you think?
806
00:38:21,348 --> 00:38:22,918
What do I think?
807
00:38:23,003 --> 00:38:27,134
Um, I think that they have made
a crucial breakthrough.
808
00:38:27,219 --> 00:38:29,150
And now they got
some work to do.
809
00:38:29,946 --> 00:38:32,486
Yeah, you know,
it's something...
810
00:38:32,571 --> 00:38:35,150
How easy it is,
even in a loving family,
811
00:38:35,235 --> 00:38:37,066
to feel so unseen.
812
00:38:37,656 --> 00:38:38,868
Huh?
813
00:38:40,607 --> 00:38:43,532
I guess I didn't always
appreciate how good I had it.
814
00:38:56,602 --> 00:39:00,329
Your numbers look good.
And your drains are clear.
815
00:39:07,304 --> 00:39:09,298
So, if you get thirsty,
816
00:39:09,383 --> 00:39:12,038
you can just ask the nurses
for some ice chips.
817
00:39:20,073 --> 00:39:21,683
Ice chips.
818
00:39:34,020 --> 00:39:36,373
Finally going to
get some sleep?
819
00:39:36,527 --> 00:39:39,008
Boards aren't going to study
for themselves.
820
00:39:39,236 --> 00:39:40,904
Believe me,
a nap wouldn't hurt.
821
00:39:43,231 --> 00:39:45,380
Anyway, I'm going to run
this boy's Adderall
822
00:39:45,465 --> 00:39:48,763
over to the pharmacy,
then I'm out of here.
823
00:39:52,537 --> 00:39:55,671
All right, well, um,
see you tomorrow.
824
00:39:56,621 --> 00:39:58,029
Hey, Vanessa,
825
00:39:58,810 --> 00:40:00,679
I know how tough
internship can be.
826
00:40:01,271 --> 00:40:03,722
But everyone here already sees
what a good doctor you are.
827
00:40:05,725 --> 00:40:07,161
Thanks, Maggie.
828
00:40:09,815 --> 00:40:11,208
Yeah.
829
00:40:12,796 --> 00:40:14,037
- Hey, Mike.
- Hey, Phil.
830
00:40:18,105 --> 00:40:19,327
Hey, Dad.
831
00:40:19,521 --> 00:40:21,478
Hey, Dylan,
what are you doing here?
832
00:40:21,563 --> 00:40:23,712
- Oh, you know, stopping by.
- Okay.
833
00:40:24,962 --> 00:40:26,093
Italian beef?
834
00:40:26,836 --> 00:40:29,973
Is that Al's?
Oh, come on.
835
00:40:30,058 --> 00:40:31,681
- It's been a long time.
- I know.
836
00:40:31,970 --> 00:40:33,018
Ever since you
used to bring them
837
00:40:33,102 --> 00:40:34,347
to me every day
at medical school.
838
00:40:36,415 --> 00:40:37,901
Really, that was just so
I could get one, too.
839
00:40:39,858 --> 00:40:42,037
- Here you go.
- Thank you.
840
00:40:42,272 --> 00:40:43,745
- Mmm, mmm, mmm.
- Yeah.
841
00:40:46,362 --> 00:40:47,635
You know, um,
842
00:40:48,614 --> 00:40:52,139
just wanted to say
thank you, Dad.
843
00:40:53,555 --> 00:40:56,079
For what?
Bringing you sandwiches?
844
00:40:56,620 --> 00:40:58,003
No, no.
845
00:40:59,865 --> 00:41:01,370
For everything.
846
00:41:16,248 --> 00:41:17,600
Okay, you know what, boy?
847
00:41:17,786 --> 00:41:19,181
How many times
I got to tell you
848
00:41:19,266 --> 00:41:21,146
you got to ask for
extra giardiniera over there?
849
00:41:36,936 --> 00:41:39,690
Dr. Marcel, this is Enid,
from Dr. Blake's service.
850
00:41:39,775 --> 00:41:41,606
Dr. Blake has
a kidney transplant
851
00:41:41,690 --> 00:41:43,596
that she would
like you to scrub in on.
852
00:41:43,681 --> 00:41:45,565
Uh, please be here
in half an hour.
853
00:42:59,581 --> 00:43:01,417
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