All language subtitles for Chicago Med - 07x05 - Change Is a Tough Pill to Swallow.SYNCOPY.English.C.updated.Addic7ed.com

With the suggestion from Dr. Cooper

I could've sabotaged
Archer's CVP monitor

so that the Vas-COM could save the day.

And I came close to doing it.

If this ever gets
to be too much for you,

I'll put a stop to the whole thing.

I'll take it from here.

I assumed I'd perform the surgery.

You're free to watch.

- Best by the powers that be.
- I'm sorry.

I made a fool of myself with Dr. Marcel.

I'm crushing on my advisor.

How long you been doing this?

- 35 years.
- How?

You got to hang on to those good days.

You got to hang on to those wins.

- Really, Dad?
- What? It's fine.

It's a red zone.
It's for emergencies only.

- No...
- See?

Now, it's an emergency.

Oh, you know what?
I wanna check this out.

New PDT system.

I can check all
of my units in real time.

But, look, can I check it out later?

I really do have to go. I'm late.

- Everything okay here?
- Oh, yeah, we all good.

Just a little ride-along.

Letting a civilian see
what a real job looks like.

- Yeah, thanks.
- Yeah.

Am I embarrassing you?

- I'll see you later.
- Okay.

Come on, Dad.

Okay, I'm gone.

Hey, what's up?

Do you remember how when we were

in physical exam class,
when we did breast exams,

they would tell us to make small talk

with the patient actors?

Yeah, to help put them at ease.

Yeah and there was
that one guy, Mandelbrot.

Super awkward. Caught hell for asking

one of them what
she was doing that weekend.

- Oh.
- He is a panelist

at the next summit
for female physicians.

Wait, that wasn't Mandelbrot.

It was Richardson.

No, pretty sure it was Mandelbrot.

- No, it was Richardson.
- You haven't changed a bit.

- Always got to one-up me.
- I'm not trying to one-up you.

Two shots for Dr. Hammer.
Three for Dr. Halstead.

Thank you.

- Have a good day.
- You too. Thanks, Carly.

- Morning.
- Good morning.

Dr. Halstead, how are things
with Dr. Cooper?

- Uh, pretty well, I think.
- Oh, yeah?

I mean, he hasn't said
anything otherwise.

Good morning, Ms. Goodwin, Will.

Matt.

Just the man I was looking for.

I want to tell you about the conference
coming up in a few weeks.

National Critical Care
Society annual meeting.

It's here in Chicago. You should go.

Vasik's gonna be a platinum sponsor.

They're gonna have a corner booth.

It's gonna be the perfect chance

for you to meet
some of the upper-level execs.

Oh, do you think that you could
spare him for the day?

It's always good when our doctors

broaden their expertise.

- I'll be there.
- Okay, great.

I'll get you the details.
Um, Ms. Goodwin.

- Mm-hmm.
- See ya.

This might be good.

And maybe I can get them to
offer me a deal like Cooper's.

Geez, I got to get this, but,
uh, you're on the right track.

Thank you, La'Shawn. Morning, Alim.

- Hey.
- Hey.

What time did you get in?

Uh, I don't know. Like, around four.

Why so early?

Always try to get a leg up on the day.

Two hours before your shift?

Well, if I'm meeting
with my patients earlier,

then I can read up on their conditions.

That way, I'm running rounds,
I'll have all the answers.

Plus, if I'm here a little early,

I can study for my boards.

Sleep ever a factor in this equation?

Life of an intern. What can I tell ya?

- Dr. Marcel.
- Yeah.

Treatment three incoming.

What do we got?

Avery Quinn, 28-year-old female.

Pedestrian versus auto. BP 80/45.

Heart rate 114, satting at 88.

Okay, Avery, I'm Dr. Marcel.

We're gonna take good care of you, okay?

It hurts so much.

Trigger the MTP,
give her 50 of fentanyl.

Here we go, guys. Transfer on my count.

One, two, three.

There it is. All right, let's roll her.

You're okay, we got you. The board...

All right, we're good.

Avery, can you put
your arms by your side for me?

You're gonna feel
a little bit of pressure, okay?

O2 sats down to 82.

Avery, Avery. Avery... she's out.

We need to intubate.
20 of etomidate, 100 of sux.

Get a CBC, CMP,
type and cross four units.

Let's get a fastscan
and have them prep OR 12.

- No, she's going to OR seven.
- Excuse me?

Yeah, I'll take it from here.

And let's add a coag panel and LFTs.

Dr. Blake, I think you're mistaken.

This is a trauma,
not a transplant surgery.

Yeah, I can see that.

She's got free fluid,
and she's in shock.

Her liver's ruptured but repairable.

- We got to get her up now.
- I'm in. Bag her.

All do respect, Dr. Blake,
you're a transplant surgeon.

- I got this.
- Thank you, Dr. Marcel,

but I'll be taking over the case now.

I'm sorry, I can't let you do that.

This is my patient.

And I understand that,
but she's also my daughter.

Now, I'm gonna need you to move.

Let's go.

You got a transplant patient?

No, I don't.

But we have a problem.

- Synced and corrected by Firefly -
- www.addic7ed.com -

Hey, Alex, I'm Dr. Scott.

I'm Susan. This is Todd.

And this is Ry... Ryan, come on.

Hey, Ryan, can I get a couple of those?

Ryan, enough with the gloves, okay?

Thanks.

Alex, says here that you

got hit in the head with a Nerf gun.

- Yeah.
- Oof, I bet that hurt.

The thing is, you're supposed
to get hit with the foam dart,

not the actual gun.

Stop it.

It was an accident.
The boys were playing.

- Mom, it wasn't a Nerf gun.
- Okay.

I... I didn't even see it happen.
I... okay.

- Ryan.
- Mom... Mom.

- Hey, just a minute.
- Mom...

They were down in the basement and...

- It wasn't a Nerf gun.
- Ryan, okay.

Hey, hey, hey, Ryan.

What's up, buddy? Talk to me.

- It was an Ultra Blaster.
- Oh, yeah?

Triple action with the slam-fire?

- Uh-huh.
- Sweet. Yeah.

"I'm sorry, Doctor"?

Todd, you want to take him
for a walk to the truck?

Give him his meds.
Okay, go with Dad. Go.

Oh, man. Tough day, huh, bro?

He has ADHD.

Yeah, we have him on Adderall,

but we keep upping the dose,

and some days are just a little tough.

I know. It's okay.

What about you? How you doing?

I'm fine.

You sure?

Okay then.

For now, we're gonna keep
applying pressure

and get you all stitched up.
Shouldn't be too long.

- Thank you.
- Welcome.

Hey, Mags, I need somebody
to throw stitches in six.

I'm on it.

You already have two patients up.

- You sure you have time?
- Don't worry. I got it.

- Rough morning, huh?
- Yeah.

It's a tricky family dynamic.

I'm treating a 10-year-old named Alex.

His brother has ADHD.

- Seems like it's pretty tough on them.
- Yeah.

Takes up a lot of the family's energy.

Oh, yeah.

Parents so focused on...
on the kid with the illness

that they see right through
the other one.

Yeah, unfortunately not at all uncommon.

There's even a name for it.
It's called... it's called

glass child syndrome.

Oh, that sounds like
exactly what's happening.

Yeah, happy to provide you
with a couple referrals

for a therapist for the... for the kid

if you think the parents'll
be open to it.

I think that'd be great. Thanks.

Oh.

Dr. Choi, I've been bugging him

for an update on his rehab.
I better take this.

Go ahead, man, and tell him
I look forward to meeting.

Will do.

I understand this must be hard for you,

but that's the very reason
I can't let you go in there.

I appreciate your concern, but I'm fine.

- Dr. Blake.
- Ms. Goodwin.

You know very well
it's against hospital policy

to operate on a family member.

I am perfectly qualified
to perform this surgery.

Pamela, you are a transplant surgeon.

Dr. Archer and I
see these cases every day.

And I make more money for this hospital

- than any other doctor here.
- That is not the point.

Dr. Archer is a top trauma surgeon.

He will do an excellent job.

I will, and if you're so inclined,

I'd be happy to have you observe.

- Ryan.
- Ryan...

can you sit still for just one minute?

I'm gonna go get some air.

Yeah.

Will, can I get
your opinion on something?

Sure. What's going on?

I've got a 71-year-old woman

who's hypotensive and tachycardic.

Passed out this morning at home.

No medical history other than asthma.

She could use some cardiac monitoring,

and I know that
you're big on the Vas-COM.

Well, I mean, there are a number

of good cardiac output monitors.

But the Vas-COM is a terrific device.

You mind if I, uh, have a look at her?

- See if she's a good candidate?
- Yeah, yeah, sure.

- Eleanor, Ron, this is Dr. Halstead.
- Hi.

He's just going to ask you
a few questions.

- Nice to meet you.
- You have to help her.

Ellie, tell him,

you've never been sick
a day in your life.

- Ron...
- No, no, that's good to hear.

- You mind if I?
- Mm-hm.

Make a fist.

And release.

Good.

Does she have
any sensitivities or allergies?

Recent injuries,
meds that would interfere

- with an arterial line?
- Just seasonal allergies.

Okay. Eleanor, do you
ever have any trouble

- when you get your blood drawn?
- I don't think so.

What about leg swelling?
Long car rides, trips?

No, not that I can remember.

That's good.

All right, it was nice to meet you.

I'll have a chat with Dr. Hammer.

We'll be right back.

What do you think?
She look good for the Vas-COM?

Uh, maybe.

She was a little vague in her answers.

But she definitely should have

her cardiac output monitored?

Dr. Hammer, if you're interested,

I could give you copies

of the Vas-COM's FDA-approved
usage criteria?

You know, that... that
won't be necessary.

I think Eleanor would be
a great candidate.

Okay, good. I'll get it set up.

- Dr. Scott.
- Alex?

- Dr. Taylor.
- Buddy? What?

- Alex.
- Bud...

- Excuse me.
- Honey, honey?

- What... what's happening?
- He's having a seizure.

Give him 12 liters of O2
and .five of Ativan.

Wait, seizure?
Why is he having a seizure?

I'm not sure yet.

Come on.

Come on, come on, come on, come on.

Hey, Alex, you with me?

Uh-huh.

Okay.

We're gonna figure this out
as soon as we can.

Dr. Taylor.

Hi, hi, okay. It's okay.

Has that cut been bleeding
like that the whole time?

I tried holding pressure,
but it didn't work.

And if I would've tried
to stitch too soon,

he would've got a hematoma.

He could have a bleeding disorder.
Did you order coags?

- Um, well, no. I...
- Get a coag panel, Maggie.

And let CT know we're on our way.

Wait, do you think he could
have a subdural hematoma?

Yes, and if he does have
a bleeding disorder,

then the trauma from
getting hit in the head

could've caused a bleed in the skull,

which means he could herniate
at any moment.

All right, now. Let's go.

Oh, my God.

Okay, ready to release the pringle.

Hold on, I didn't get
a good look at the duodenum.

- It's clear.
- Okay.

All right, pulling back on the lap.

Looks good.

What's her pH and temp?

7.34 and 36.9.

All right, looks like
you're good to close.

Uh, actually, we're just
gonna pack and leave her open.

No, her bleeding's under control.

- Packing her isn't necessary.
- I disagree.

She's got a grade four liver laceration.

The risk of re-bleeding is too high.

She's a healthy 28-year-old.

Leaving her open puts her
at increased risk

for infection, coagulopathy,
hypothermia, and acidosis.

- Dr. Blake, I...
- Close her up, doctor.

- I understand your concerns.
- No, no, point well taken.

I see the merit
in what Dr. Blake is saying.

- Dr. Archer...
- All right, hold off on the lap.

I need Celox, Gelfoam,

and get an O Max
and suture for Dr. Marcel.

- Dr. Archer, you...
- Dr. Marcel.

Mr. and Mrs. Miller, I'm Dr. Charles.

I had been consulting

with... with Dr. Scott on Alex's case.

- Psychiatry?
- Head injury.

You know, can't be too careful.

Anyway, Dr. Scott wanted me
to let you know that

Alex's scans are almost ready.
And in the meantime,

is there anything I can get you?

- A bottle of water?
- Thank you, but we're fine.

Yeah.

Oh, sorry. This is work.

Um, don't forget to text my parents.

- Excuse me.
- Oh, okay. Yep.

Ryan? Is it Ryan? How about you, buddy?

- Can I get you something?
- Do you mind if I...

- No, not at all.
- Okay, I'll be right back.

Not at all.

Would you, uh, like a
sandwich or something?

No? Bag of chips?

Soda? Anything at all?

No! You interrupted me.

Oh, I'm sorry.
I, uh, I... I didn't mean to.

Now I have to start all over again.

Oh, you were counting. Huh?

Okay, well, I'm... again,
I'm very sorry.

You... you get back to that. All right?

Mr. and Mrs. Miller, we just
got Alex's test results back.

Alex is stable right now,

but the scan did confirm that
he is bleeding into his brain.

And the intracranial pressure
is great enough

that he needs immediate
surgical evacuation.

Oh, my God.

Wait, wait, wait. How'd this happen?

Well, his test results
came back positive

for a bleeding disorder called
Von Willebrand disease.

So the impact from a small toy
could've caused a bleed

that his body just wasn't able to stop.

I... I know this is a lot,

but Dr. Abrams will
be doing the surgery,

and he's our very best.

The procedure shouldn't be that long.

I'll be here for status updates
or if you have any questions.

And if we have your consent,

we could get started right away.

- Sure.
- Yeah, of course.

- Whatever you need.
- Okay.

So why don't I take you somewhere

that's more comfortable to wait?

Um, Ryan. Hey, buddy.

Come on, buddy. We're gonna
take a little walk, all right?

Hey, I saw Eleanor's oxygenation

and cardiac output are down.

Have you gotten her labs back yet?

Yeah; they don't show much.
Mild infiltrates

on her chest X-ray
and some eosinophilia.

Still don't know what's going on.

I'm a little concerned.

One of her fingers and two
of her toes are going cold.

Oh, could just be a vasospasm.

That could be, but...

look, the major drawback
to any arterial line,

including the Vas-COM, is the potential

for thrombus formation.

So I think we should pull it out.

Pull it out?

I mean, thromboembolization
in arterial lines

is extremely rare,
and it almost never occurs

- this quickly.
- I understand.

I just think we should err
on the side of safety.

What?

Is something going on?
It's getting us great numbers.

Keeping Eleanor's meds titrated

and her pressure
and heart rate optimized.

Without it, we'd just be
shooting in the dark.

I know. I just want to make sure

- we're using it appropriately.
- I think we are.

Let's just give it a little more time.

- Dr. Archer.
- Yeah.

What the hell happened back there?

What?

Giving in to Dr. Blake like that.

The surgery was a success,
and if you'll excuse me,

I have an ED to run.

Hold on, Dean.

You know, with that kind of injury,

keeping her open
is the right thing to do.

Dr. Blake's reasoning
was medically sound.

I mean, I could argue it either way.

- Oh, come on!
- Crockett...

hospital politics
is a lot like the military.

You put in your time.
You do as your told.

And eventually you can rise up
to become a Dr. Blake, too.

Hey, buddy.
This is my friend, Dr. Charles.

Hey, Alex.

We just came to check in
on you before your surgery,

see if you had any questions.

- Is this gonna hurt?
- No, no.

They're gonna give you some medicine.

It's gonna put you right to sleep.

You won't feel a thing.

Even when they open my head?

Next thing you know, you're just gonna

wake up in recovery. We promise.

Okay.

Anything else on your mind?

No.

It's just, when they
look inside my head,

will they see my secrets?

Uh, I don't think so.

But if there is something on your mind,

a lot of kids tell me that
it's just better to get it out.

This wasn't Ryan's fault.

Oh, don't worry about that.
Ryan's not in any trouble.

No, I made him do it.

I made fun of him,
and I know if I did it enough,

then he'd get really mad and hit me.

Yeah?

Why would you want him to hit you?

Because...

Because?

If you got hurt, maybe

Mom and Dad pay
a little more attention to you?

It was stupid. I shouldn't have done it.

Hey, it's okay.

Let's get you taken care of. All right?

Alex, it's gonna be okay, buddy.

You're gonna be fine.
We'll see you in a bit.

Man, listen, I deal
with a lot of sick kids,

but what do you do for this?

So... kid with ADHD,
they've control issues, right?

- Random outbursts.
- True.

Yeah, but Alex knew he could
only get Ryan to lash out

if he backed him into a corner.
That's not random.

So, what are we looking at
if this isn't ADHD?

I think maybe an anxiety disorder.

Oh, another misdiagnosis.
Second in a week.

And if I'm right, that misdiagnosis

is causing this family
a lot of problems.

You have to come quick.

Something's wrong with Ellie.

- Eleanor, can you hear me?
- Yeah.

- Okay.
- Squeeze my hand.

What's happening? Why's she like this?

She had a TIA, a mini-stroke.

Start her on aspirin and clopidogrel

and call for an MRI of her head.

A stroke? What... what? Why?

'Cause she's forming thrombi.
They're blood clots

in her vessels, and one's
travelled to her brain.

Oh, my God.

Get a suture kit.
We have to pull the Vas-COM.

I'll call Dr. Hammer.
Excuse me, Mr. Halt.

- She's up in radiology.
- No, no, no.

Every minute that passes

increases her risk of a major stroke.

We have to pull it right now.

No, that one too. Yeah.

Hey, you okay?

No. I screwed everything up today.

I saw Alex's notes.

Von Willebrand disease?
You couldn't have known.

I could've ordered those labs earlier.

But it doesn't matter.

The outcome still
would've been the same.

Look, you're always gonna wish
that you could've done

something earlier.

It's part of being a good doctor.

Alex is in surgery, Maggie.

He's bleeding into his brain.

Which isn't your fault.

You pulled my patient's Vas-COM?

She had a TIA.

The Vas-COM was most likely the source.

You don't know that.
Could've been lupus,

endocarditis, even leukemia.

And now we have no way to monitor her.

She could've had
another stroke at any minute.

What... what was I supposed to do?

She's my patient, Will.

You at least should've asked me.

By the time you got down here...

- I'm not taking that chance.
- No, you were afraid

that I would disagree
and that I'd stop you.

- No.
- It's the same old Will from med school,

always thinking that you know better.

Stevie, that's not what this was about.

You tell yourself that.

Hi.

I don't know if you remember me
from this morning.

I'm the surgeon on your case,
Dr. Marcel.

How you feeling?

Like I got hit by a car.

Well, you did just have major surgery,

but, uh, it went well,

and I imagine you will feel
a little better each day.

Here you go.

- Dr. Blake said to go slow.
- Thanks, Dina.

Ice chips. My mom is in love with them.

Frankly, I think they're just as much

- an aspiration risk as liquids.
- Aspiration risk?

What, are you a... you a doctor, too?

Made it halfway through
a third year of med school.

Oh, okay.

Realized I was doing it
for my mom, not for me.

Oh.

I'm assuming you've met her by now?

Made her acquaintance, yeah.

She try to scrub in?

How'd you guess?

I know my mom.

She didn't talk to me for six months

- after I quit med school.
- Wow, that's rough.

No.

The day I took control of my life?

Best move I ever made.

Anyway, I should let you get some rest.

Um, enjoy your ice chips,
and I'll check back later.

So wait, what did you end
up doing after med school?

- A malpractice lawyer.
- Medical?

Your mom must be very proud.

Mr. and Mrs. Miller,
I have an update for you.

Be right back, buddy.

So, look, they're... they're
just finishing up

in surgery now.

All indications are that
the procedure was a success.

And Alex is doing great.

Oh, my God, really? Thank you so much.

Listen, Dr. Scott and I talked to Alex

before the procedure today.

And I understand that you have
a lot on your plate right now,

but I... I also think
it's important that I share

this conversation with you.

Okay.

So... so what he told us is that

he provoked Ryan
into this outburst today.

He feels terrible.

I think he is looking
for some attention.

But where Ryan's concerned...
what this means to me

is that it wasn't an impulsive outburst.

It wasn't... it wasn't random.

And that and a couple other
things I've observed today

are leading me to believe
it's very possible

that... that your son has
been misdiagnosed with ADHD

and that we were probably looking

at some kind
of anxiety disorder instead.

Wait, what are you talking about?

Look at him. He can't sit still.

But Mr. Miller,
it's... it's the counting, right?

The tapping.

I think that he's self-soothing

to help him cope
with these feelings of anxiety.

And when that stops working,

I think he feels backed into a corner,

and then you have
a fight-or-flight situation.

Well, what about the Adderall?

His doctor said that would help.

If he actually had ADHD,
it would be working.

But it's not, right?
I think that in Ryan's case,

it's actually working against him

and serving to only intensify
these feelings of anxiety

to the point where they're often,

frankly, unbearable.

Dr. Charles, man, look I... I...

we appreciate everything you're doing.

Really, but please,
our son's in surgery.

I am sorry. This is
just not an ideal time

to have this conversation.
But I just wouldn't

be doing my job if I didn't tell you

how important I think
it would be to reassess Ryan

and make sure that you are
looking at the right diagnosis

for him, for his brother,
for all of you,

- for your whole family.
- No, Dr. Charles, it's just...

- it's just been a long day.
- Of course.

Listen, I am going
to check back with you

when Alex wakes up, okay?

- Yeah, yeah.
- Okay.

I should've consulted you
before pulling the Vas-COM.

It wasn't my place. I'm sorry.

And besides, you were right.

She's getting worse and
still having embolic events.

So it wasn't the Vas-COM after all.

Clearly, but I've gone through

every clotting disorder,
and none of it fits.

Is it possible
we're looking at this wrong?

That she doesn't even have
a clotting disorder?

Of course. It's just so little to go on.

I mean, history of asthma, eosinophils,

and left-sided lung infiltrates.

Left?

I thought they were on the right.

- Seriously, Will?
- No, no, wait.

The X-ray from this morning
had them on the left.

But look...

The one from this afternoon
shows they moved to the right.

Migratory infiltrates.

Could this be vasculitis? Churg-Strauss?

I mean maybe. She could've moved

from the asthmatic stage
into the vascular stage today.

It's a long shot, but it's possible.

If we're right, her organs could start

to shut down at any moment.

I'll start her on prednisone
and azathioprine

and set her up
for a diagnostic lung biopsy.

Dr. Hammer, Dr. Halstead,
you need to come.

Eleanor's getting worse.

I don't like these QRS complexes.

Eleanor, do you feel any pain
in your chest or arm?

- It feels tight.
- Oh, God, Ellie.

Why don't you come here?

- She's going into v-tach.
- I'll get the paddles.

- No, no, Ellie.
- Wait.

If this is Churg-Strauss,
this could be a tamponade.

We need to aspirate the fluid.

I know, but if we're wrong,

we won't have time to cardiovert.

I think we're right about this.

I do, too.

- 18 gauge on a syringe.
- 18 gauge.

Ron, there's fluid
around Eleanor's heart.

They need to drain it.

Nothing.

Got it.

Sinus rhythm.

Eleanor, can you hear me?

- Uh-huh.
- Oh, thank God.

Call IR. Tell them we're coming up

- for a drain and a lung biopsy.
- You got it.

Good job.

Hey. How you feeling?

- Okay.
- Good.

Surgery went well.

In fact, the neurosurgeon said

that you had the best-looking brain

he's seen in quite a while.

- Yeah?
- Yeah.

Told your parents,
but they weren't surprised.

Said they always knew
you had a great brain.

They said that?

Yeah, they did.

You know, Alex,
kids with great brains...

they don't always get
the most attention,

but... people notice.

What's going on?

O2 sats are 91. BP's down to 83/50.

Drains are full.

Belly's firm.

Okay, etomidate and sux, then transduce

to a bladder pressure. Let's go.

Hey, Avery, look at me.

You're re-bleeding into your abdomen.

I need to intubate and take you
back to the OR, okay?

What happened?

Abdominal compartment syndrome.

- We're going back to the OR.
- No, no need.

You can use a cordis catheter
and decompress here.

There's too much blood.
We don't have enough time.

I'm in. Bag her.

And if you open her up,
there'll be too much swelling,

and you'll never be able to close.

Get the cordis.

Dr. Marcel, bladder pressure's 35.

It's too high.

We need to open her up
to release the pressure.

- Get me a 10 blade.
- Dr. Marcel, I already told you...

Back off, Dr. Blake. Here we go. Ready?

Sats are up to 96 and BP's 112/83.

She's stable.

All right, get her up to the OR.

Make sure you get her swelling down.

You're gonna need to close
her up as soon as possible.

How is Alex?

Um, his surgery just ended.

He's doing really well.

Alex probably hates me.

I want to tell him
I'm really, really sorry.

You'll be able to see him soon.

- And then you can tell him.
- Can I see him now?

I'm not supposed to let you
until he's in his room.

Please?

Okay, maybe we could
just take a quick peek.

If it's okay with your parents.

Mom, can I go with the doctor?

Yeah, honey.

Okey doke, let's go.

So he's still a little sleepy,

so we're just gonna give him
a quick wave hi, okay?

That's not Alex.

It's okay.

He's just a little
bandaged from surgery.

- I didn't do that.
- No, of course you didn't.

I didn't mean to. No, I'm sorry.

- I'm sorry.
- Hey, hey, Ryan,

Ryan, Ryan, it's okay. Listen
to me. Listen to me. Ryan, look,

- you didn't do anything wrong.
- Stop it.

Ryan!

Ryan! Ryan!

I'm so sorry. This is all my fault.

The security camera picked him up.

We're okay.

Still, I just can't apologize enough.

Maybe I should talk to his parents or...

You know what?

I think it's probably better
if I handle this.

Listen, Vanessa, not your fault. Okay?

You were trying to help.

Ryan, your brother just had surgery.

That's why he looks like that.
He's gonna be fine, buddy.

Now, can you please come out?

Please, Ryan?

- Mind if I give it a try?
- Yes.

Hey, Ryan.

You know what?

I don't think that you wanted
to hurt your brother today.

I think the only reason
you threw that toy today

was because you didn't know
what else to do.

I got so mad.

'Cause those feelings, they just...

They just keep building and building.

Uh-huh. I can't stop them.

And I'm always getting in trouble.

What if I told you
that I didn't think that

- that was your fault?
- That's not what people say.

They're always telling me to reset.

Well, you know what?
I don't think it's your fault.

Not only that, you know
those... those feeling you get?

I get them, too.

- You do?
- Oh, yeah.

Everybody does.

And one of the things that
really helps me when I get them

is, actually, to talk about them.

You know, there's this weird
magic that happens when you...

when you get them out.

They just... they just don't
seem to bother you as much.

- Really?
- Yeah.

And I guarantee you,
whatever feeling you're having

there are people in your life...

they want to hear about it.
I mean, your mom and dad...

They would really want
to hear about them.

- They would?
- Of course we would, honey.

And you won't think that I'm bad?

Ryan, we never think you're bad.

I got you.

You really don't think this is ADHD?

I don't think it is.

So this Adderall isn't helping?

I think it's actually making it worse.

Hey, I just saw
Eleanor's biopsy results.

Churg-Strauss.

Hey, maybe we work well
together after all.

Maybe we do.

- I'll see you tomorrow.
- See you tomorrow.

Oh, I made a few calls.

It was definitely Mandelbrot.

Bye.

Bye.

Will, I just met Eleanor.

Churg-Strauss, one in a million.

Yeah.

Though I did see you had
to pull her Vas-COM.

Yeah, I hated to do it.

Uh, but she was throwing emboli,

had some cold fingers and toes...

Hey, hey, Will, you
absolutely did the right thing.

The last thing we need
is for the Vas-COM

to be used inappropriately
and then it gets a bad rap.

That... that's what I thought, too.

Now that she's stable,
however, it did seem

medically warranted to get
her on better monitoring again,

so I just put in another Vas-COM.

Okay.

Anyway, I'm glad you're
coming to the conference.

Yeah, same here.

Hey, maybe, um, if you get there
early, we could have a drink?

Sure.

So what do you think?

What do I think?

Um, I think that they have made
a crucial breakthrough.

And now they got some work to do.

Yeah, you know, it's something...

how easy it is, even in a loving family,

to feel so unseen.

Huh?

I guess I didn't always
appreciate how good I had it.

Your numbers look good.
And your drains are clear.

So, if you get thirsty,

you can just ask the nurses
for some ice chips.

Ice chips.

Finally going to get some sleep?

Boards aren't going to study
for themselves.

Believe me, a nap wouldn't hurt.

Anyway, I'm going to run
this boy's Adderall

over to the pharmacy,
then I'm out of here.

All right, well, um, see you tomorrow.

Hey, Vanessa,

I know how tough internship can be.

But everyone here already sees
what a good doctor you are.

Thanks, Maggie.

Yeah.

- Hey, Mike.
- Hey, Phil.

Hey, Dad.

Hey, Dylan, what are you doing here?

- Oh, you know, stopping by.
- Okay.

Italian beef?

Is that Al's? Oh, come on.

- It's been a long time.
- I know.

Ever since you used to bring them

to me every day at medical school.

Really, that was just so
I could get one, too.

- Here you go.
- Thank you.

- Mmm, mmm, mmm.
- Yeah.

You know, um,

just wanted to say thank you, Dad.

For what? Bringing you sandwiches?

No, no.

For everything.

Okay, you know what, boy?

How many times I got to tell you

you got to ask for
extra giardiniera over there?

Dr. Marcel, this is Enid,
from Dr. Blake's service.

Dr. Blake has a kidney transplant

that she would like you to scrub in on.

Uh, please be here in half an hour.

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