All language subtitles for Chicago.Med.S01E16.en

.

- And easy on the CrossFit
for a while, okay?

- Okay.
- Thank you.

Just cleared Treatment 3.
Just got to turn it over.

- Sure.
- Man, we're up again already?

- Looks like it.
- What's going on?

Who are they?
- Big brother.

Hey.
- Oh.

- Up.
- JCAHO.

- Yeah, they're doing
a surprise site survey.

- Who's JCAHO?
- The Joint Commission.

They rate
the performance standards

of hospitals
and certify them.

- So far, JCAHO's reports
have been positive.

So let's keep it that way.

Stick to protocols
and with big smiles.

Dr. Choi, we're gonna need

some of your Navy-inspired
discipline today.

- Sorry,
I'm with the paramedics today.

Resident ride along.
- Mm.

- And discipline, that a nice
way of saying I'm a tight ass?

- Oh, yes.
Tight.

- I didn't say that.
[laughs]

- And, uh, getting those docs
in line,

isn't that
the chief resident's job anyway?

- Wonderful, the guy
enforcing the rules

is the one
who's always breaking them.

- Yeah.

Good luck with that.
- [chuckles]

- Code One team to the ED.

- What do we got?
- Nathan Clay.

58-year-old male.
"Peeds" versus auto.

GCS 12.
Vitals stable.

Gross deformity
to the left upper arm.

- Right in here.
- Ow.

- He's complaining of chest
and back pains.

- Mr. Clay, can you hear me?
- [groaning]

- Mr. Clay?
On my count.

One, two, three.

- [grunts]

- Central line
and a CVC catheter.

- Right away.
- Airway's intact.

Breath sounds clear bilaterally.
- Ow!

- Tenderness in the left chest

and thoracic spine.
What happened here?

- He's walking with his wife
on Michigan Avenue.

Suddenly flips out,
starts wailing on her.

A couple of Samaritans
jumped in to help out.

He takes off right into traffic.

Score one for, uh, karma.

- 12-lead EKGs, chest x-rays,

CT of the chest,
abdomen, and pelvis,

with recons of the TLS spine.

- On it.
- Leave me--no.

Leave me alone.
I'm fine.

- Laura Clay.
55-year-old female.

GCS 15.
- I'm fine.

I need to get to my husband.

- Whoa, whoa, whoa.
Ma'am, ma'am, ma'am.

Okay.
- Heart rate's tachycardic.

- This is all my fault.

Look, I blocked my fall
with my hand, not my C spine.

I'm neurologically intact.

- Technical.
Are you a doctor?

- Yes, yes, I am.
- Laura! Please--

- Dr. Rhodes!
- Honey, I'm here.

- Ma'am, stay right there.
- I'm right here.

- There are too many of them!
[crying]

- I'm here, my love!
- Help me!

- 2--I need restraints.
2 of Versed and 5 of Haldol.

- There are too many of th--
- No, not Haldol!

Quetiapine.
He's not abusive.

He has Lewy Body Dementia.

- Wait, scratch the Haldol.
25 of quetiapine.

- Laura!
- It's all right, my love.

- What the hell's Lewy Body?

- Debilitating form of dementia.

.

- He took a pretty good whack.

He's got a chest bruise,
left first rib fracture,

proximal humerus fracture.

- How are his labs?
- It's all good.

Calcium was elevated.

I suspect he'll develop
a kidney stone down the road,

but it's likely
he's had a few before.

- Prior heart surgery?

- Says it was
a quadruple bypass.

Had it done
at Northwestern five years ago.

- He remembers the details?
- Yeah, he's lucid.

Somewhat.
All right, EKG is normal,

but because of
the prior heart surgery,

I'm gonna repeat it
every few hours.

He's all yours.

- Mr. Clay?

Mr. Clay, I'm Dr. Charles.
How are you feeling?

- My wife, Laura, where is she?

- She's being treated right now,
but will be in shortly.

- I hurt her again, didn't I?
[breathing heavily]

This isn't
the life she deserves.

- Mr. Clay?

Mr. Clay?

- Damn, you got
the online thing down, huh?

- There was a time.
- Yeah, what's her name?

- Easy.
She's taken.

- Vicki.
Doctor at the VA.

- Oh, man.

There are so many
female paramedics

who are gonna be sorry
to hear you're off the market.

Couple guys, too.

- Well, you let 'em down easy
for me.

- All right.

You sure you gonna
be okay back here?

'Cause we can just
throw Desmond in the back.

- Eh, I'm fine.

Ambo's like the Humvee.
You sit where there's room.

Comfort's not a factor.
- Well, good.

This day's gonna
go by quick then.

- Ambo 61, 40-year-old male
down in his home.

222 Bromley Avenue.

Some kind of
lower extremity insult.

He's in severe pain,
possibly trapped.

- Copy Main.
Ambo 61 responding.

All right, we're on!

[siren wailing]

- It doesn't make any sense.

I've had Boomer
since he was a puppy.

He's super loyal.
I leave the room for a second,

he's looking for me.

- I had a dog like that.

- He might nip a little,
but this was a full-on attack.

- In my experience,
dogs can be unpredictable.

Even really friendly ones.

- Sometimes if a dog's in pain,
though, he--

- He wasn't.

We were playing tug of war,
like we always do.

- Dog bites
shouldn't be stitched.

They need to stay open

so the wound doesn't
become infected.

Also, I'm gonna give you
a tetanus shot

and an antibiotic.

- Boomer's healthy.
He's had all his shots.

- It's just a precaution.

- [inhales sharply]

[indistinct radio chatter]

- Paul's in trouble down there.

- Did you call 911?
- Yes, I'm his neighbor.

- Paul?

It's the paramedics.

- Ooh.
- Ooh, that's ripe.

- Man, look at this.
He's a hoarder.

- [groans]

- What do you think?

- You good going in there?

- I'm good.
- Okay.

Uh, get the truck company here.

Tell 'em they're gonna have
to help dig us out,

and grab me a second radio.

And, uh, I'm gonna try
and go in through the back door.

- You got it.

- Paul!

Everything okay?

- [quietly]
Okay.

[grunting]

- Third squad caught
a high-rise fire.

Dispatch is pulling a truck
from up north to help us out.

It'll be a while
before they get here.

[grunts]

- In the beginning,
I wanted to think it would pass.

Any wife would,
but I'm also a neurologist,

and I couldn't
ignore his symptoms.

- Oh, so you diagnosed
the Lewy Body Dementia?

- Yes, but I got second
and third opinions,

and they both agreed it was LBD,

and that was
about four years ago.

- Four years, really?

You know, Nathan
expressed deep regret to me

about the pain
that he's caused you.

That kind of insight is rare

for somebody who's been
battling LBD for that long.

- Well, my husband
was an engineer,

and his brain is wired
to solve problems.

Last year, I retired early.

I wanted to devote more time
to his cognitive therapy.

- Hmm, well, it's been working.

- There's moments
when he's lucid.

But more and more, it's this.

- Mrs. Clay,

Nathan's latest EKG
is still normal.

I want to do another one
in a few hours,

but if it is good too,
I'll discharge him.

- Thank you, doctor.
- Mm-hmm.

- I know that it would be better
and safer for the both of us

if Nathan went
to a care facility,

but if I do that,
then it's over.

And I'm not ready
to give up our Sundays

listening to opera.

I know it's hard to imagine,
but my Nathan is still in there.

Last week he made me dinner,
Florentine lasagna.

- He can still cook?

- Well, meals take longer
to prepare than they used to,

but...

he does it for me.

He's fighting
just as hard as I am.

Hi, honey.

Everything's gonna be okay.

Everything's okay.

- How you doing, Ethan?

- Fine, as long
as I breathe through my mouth.

- Is it as tight
in there as I think it is?

- It's worse.
- [clears throat]

- Are you claustrophobic?

- Didn't used to be.

- I mean,
and Tate totally snores,

but I don't mind.

Oh, he does this thing
where he shoots his dirty boxers

into the hamper
like a buzzer beater.

Anyway, it's cute.

- Oh, my God.

You're in love.

- Whoa, whoa, whoa, whoa.
What's that?

- What's what?

- Used gloves go in the bio bin,
not the trash.

- Okay, those were actually
clean though.

- They were on the floor.
- Probably just got stuck

to the pair
that came out before them.

- Unless you're certain,
it's bio.

Come on, Maggie.
You know the protocol.

- I do.

I've also been
through this circus

about a dozen times.

JCAHO days are
about patient care,

not about a pair
of latex gloves.

- Look, I'm already
in the doghouse with Goodwin.

If there's any chance
of getting out, I want it.

So by the book--by the book.

- By the book.

[sighs]

- Okay honey, eight across.

It's five letters

and the clue
is rental agreement,

and the first letter is L.

I'm thinking the second is E.

- L-E...

Lease.

- Good.
Good, honey.

All right, next one.

We're gonna do 23 down.

Six letters.

The clue is collects...
[rapid beeping]

With an S.

[beeping continues]

- What happened?
- I don't know.

His blood pressure tanked.

- All right, bag
and hang a liter bolus.

- Yes, doctor.
- SATS are dropping.

Intubate?
- Yep.

- Grab the bag and hook it up
to the O2.

- All right, 20 of etomidate.
100 of sux.

Let's bring in the FAST scan.

April, give me some pressure.
- Here, doctor.

- And I'm in.

- Got it.
- Okay.

Scan.
- Here you go.

- Heart rate 110.

- All right, belly's clean.

Poor wall motion of the LV
and a small effusion.

- He's bleeding internally?

- Dr. Charles.

- Mrs. Clay, please,
right over here.

- SATS are back up.

Oxygenation improving.

- It's not gonna matter
if he goes into cardiac arrest.

CT of the heart
and great vessels.

.

- Laura?

If we may?

The blunt trauma
from the car accident

displaced one of
Nathan's bypass grafts.

His aorta is leaking blood.

- A pseudo-aneurysm.
- Mm-hmm.

- How bad?

- Right now
it's just a slow drip.

It hasn't ruptured yet.

- So there's still
an opportunity

to operate,
repair the suture line,

and plug the hole?

- Normally, yes.

- Your husband's
prior heart bypass surgery

significantly increases
the difficulty of the operation.

His odds of surviving
the procedure plummet.

- So if surgery isn't
a viable option, what is?

- Given the circumstances,

we feel the safest choice

is to make Nathan comfortable.

- How long?

- We can't be certain.

A day, a week,

maybe a few months

until the aneurysm ruptures.

- We're very sorry.

- Help.
I can't move.

- I'm coming, Paul.

- Don't touch that!

- What was that?

[exhales]

Ah!

[grunts]

- Ethan, what happened?

- Got bit by the lid
of a tin can.

- Truck company is almost here.

They're going to clear a path
to get the stretcher through.

- Please, hurry!

- Hold on, Paul!

- Oh, thank God.

I haven't been able
to pee in over 16 hours.

I thought I was gonna explode.

- Brachytherapy
for prostate cancer?

- Two days ago.

My urologist said
it was the way to go.

- Who's your urologist?

I'll call and tell them
you've experienced a blockage.

- Dr. Mason,
over at Advocate South.

Uh, contact info's,
uh, in my phone

in my pants pocket.

Oh, sorry.

- Oh, whoa, whoa,
whoa, whoa, whoa, whoa.

- Everything okay?

- Just a little spill.
I got it.

- Okay, hold on.

I'll call environmental services
and have them send a janitor.

- It's just pee.

I've cleaned it
a thousand times.

- Yeah, but not with JCAHO
and Robocop Halstead

on the prowl.

By the book, remember?

- Oh, man.

I think the seed came out.
It's radioactive, right?

- Oh, it did.

Okay, I'll call Urology instead.

- Cath lab
for a cardio angiogram?

- Should give a better view
of Nathan's pseudo-aneurysm

and hopefully help me estimate
a timeline for his wife.

- You mind grabbing me an MRI
of his head

while you're up there?

- Brain scan?

His injuries
don't necessitate it.

- It's not for him.
It's for me.

- Uh, Dr. Charles.

- Dr. Rhodes, his awareness
and gross motor skills

are just too strong

for somebody who's been
battling LBD as long as he has.

No amount of cognitive therapy
in the world is gonna outthink

this disease to the degree
that he appears to be.

- Laura
and two other neurologists

have all agreed
on the Lewy Body diagnosis.

You think they're wrong?
- I don't know what to think.

That's why I need the scan.

- I need the wife's consent.

- Hasn't she been
through enough?

I'm just trying to spare her
some false hope here.

- Um.
- Hello.

- Gentlemen.
- Doctors.

- JCAHO day isn't exactly
the time

to be sneaking in
unauthorized tests.

- I don't know what to tell you.

- Okay.
- Thanks, pal.

- Mm.

[siren beeps]

- What've we got?
[indistinct chatter]

- Hey, guys,
start clearing out!

[indistinct radio chatter]

- Don't touch that.

Get away.

Get away.
- There's a second person.

I'm hearing another victim.

- Ethan, the neighbors seem sure
it's only Paul in there.

- Don't touch that!

- There's someone else here.

- Dr. Perrington,

got a hemoptysis patient.

Chest x-ray says it's a COPD,
but I think he needs a bronch.

You want to take a quick look?

- Really?

The esteemed Dr. Halstead
needs my help with a patient.

I'm honored.

- Look, I, uh--I'm sorry about
what happened the other day.

- You want a consult,
page my resident.

- Okay, no redness,
no inflammation.

Looks good.

- So I can go?

- The nurses are working on your
discharge paperwork right now.

Your wound should heal
in about seven days or so.

Until then, irrigate them
and keep them covered.

You all right?
- Oh, just itchy

and a little sweaty.

- Mind if I take a look?

No rash.

Could be an allergic reaction
to the antibiotics.

You do feel warm though.
- I'll get a temp.

[phone vibrates and chimes]

- Oh, my sister checking in.

I left Boomer with her.

She's not a dog person either.
- [chuckles softly]

- I get the impression
they're not for you.

- I've treated
a lot of dog wounds,

especially on kids.

- It's 99.4.
Was normal at intake.

CBC and CMP?
- Yeah.

- I'm not out of here, am I?
- Sorry.

Itching and fever,
even a low one,

could be more
than an allergic reaction.

Someone will be
with you shortly.

- Paul, is there anyone else
in the house?

- No, no, it's just me.

You've got to hurry!

- Ah!
Ah!

- Ethan, what happened?

Are you okay?

- [grunting]

[plane flying overhead]

[explosion]

[gunfire]

[groaning]

Ahh!

[hyperventilating]

.

- What's all this?
- Well, it's pretty clear

an attending job at Med
isn't gonna happen.

- You don't know that.

- Just being realistic.

Perrington's on
the hiring committee.

She hates me.

Not to mention Goodwin.

- But really, Miami, Will?

I've seen you sunburn walking
from the ED to your car.

- Hey, got to go
where the jobs are.

No coffee.
JCAHO day.

- Right.

- I don't understand.

There should be atrophy,
heavy degeneration,

tangled cells
in the white matter.

When was this taken?

- About an hour ago.

I'm sorry.
I had a hunch.

I rushed it.
I really should have--

- That is a healthy brain.

There's no disease.
This means that--

- Nathan doesn't have
Lewy Body Dementia.

- He has the symptoms.

Keeps getting worse.
Practically a textbook case.

How?

- Take a look at this cross
section we took during the MRI.

Notice the adenoma,

benign tumor,
in the parathyroid gland.

- So you think this is
all hormonal irregularity?

- Elevated parathyroid hormone

is consistent
with increased calcium

and cognitive impairment.
Nathan has both.

- Yes, but he also has
hallucinations,

physical aggression.
You don't see that

in patients
with hyperparathyroidism.

- That's where his recent bypass
surgery makes him unique, okay?

The beta blocker
he's been taking ever since

causes increased levels
of violent behavior

in a select amount of patients.

- Oh, my God.

A hormonal imbalance

with a medication side effect.

[exhales]

Why didn't I see that?

The clues were right
in front of me.

- Because they mimic
the symptoms

of Lewy Body Dementia to a T,

and four years ago that adenoma
would have been so small

no scan could have caught it.

Look, I'm just telling you

that presented
with the same evidence,

I would have done
exactly the same thing,

reached exactly
the same diagnosis.

Anybody would have.

- You didn't.

I did.

And if I had caught the PTH
four years ago,

Nathan doesn't run into traffic,

doesn't get hit by a car.

Today never happens.

He's dying

and it's entirely my fault.

- [hyperventilating]
- Don't touch that!

- Help.
Please, please anybody!

- [straining]

- I need help!

[screaming]

- Ethan.

Ethan, talk to me.

Ethan, do you copy?

- Let's go.

- Living room's clear.

[tense music]

*

- Thank God.
- Paul?

- Help me, please.
- Paul, I'm Dr. Choi.

Okay, your heart's racing.
When's the last time

you had any fluids?
- [exhales]

My leg, burned it.
- Yeah.

- I see that.
- Don't touch that.

[cawing]

[cooing]

- How did this happen?
- I was cooking.

I tripped and spilled
a frying pan, grease.

[grunts]
- This didn't just happen.

This burn is thick, leathery.

24 hours old?
- I guess.

- Why didn't you
seek help sooner?

- I didn't want anybody
to see how I live.

- Okay, I'm here now.

Gonna take care of you.

- Brachytherapy seed.

Yep, doesn't happen often,

but it can get expelled
in the urine.

- So, um, how radioactive is it?

- To us, harmless.

Still, don't touch it
with your bare hands.

- Whoa.

So you're not
gonna dispose of it?

- Not on JCAHO day.

Sorry.

Call the radiation
safety officer.

- Oh, man.

Here we go.

- I get it.

You didn't do
Nathan's bypass surgery.

You don't know
what you're walking into.

I can get you
every angio he had.

You will know exactly where
the surgeon placed every suture.

- The bigger issues
are the adhesions

and scar tissue that have formed
over the last five years.

We can expose a healthy heart
in 10 or 15 minutes.

After a quadruple bypass
surgery,

it could take hours.

An infinite number
of complications can arise.

- When I decided
to make Nathan comfortable,

I believed he had
a neurological death sentence.

Now it's a whole new world.

The dementia can be reversed.

- I understand, but the fact
that he doesn't have LBD

doesn't make
the surgery any easier.

Nathan's odds of dying
in that operating room

are just as high
as they ever were.

It's still my recommendation
to not operate.

I'm sorry.

- I'll do the surgery.

- Thank you.

Thank you for giving us
a second chance.

- Difficult is not impossible.

- Hmm.

- Brett, how close are you?
- Ugh, Ethan, finally.

You okay?
- I'm fine, but Paul's got

a serious third degree burn
that needs to be released

in the ED.
ETA?

- I think we're almost
to the kitchen.

We need more room for the gear.

- Don't touch that!
Get away, get away.

- Who was that?

- The other person I heard,
a parrot.

Look, you still have
the hallway to deal with

and Paul's foot's
still swelling.

No pulse in the instep or ankle.

- All right, uh, we're coming
as fast as we can.

- [exhales]
But not fast enough?

- Okay, Paul, here's the deal.

Your skin's so burned,
blood can't get in

or out of your foot.
I'm gonna cut into your leg

on both sides of the burn
to release the pressure.

- Here?

- I wait any longer,
you're gonna lose your foot.

- But--is it gonna hurt?

- Already pushed morphine
in your IV.

That'll help.

- But I'll feel it?

- Focus on me, not my hands.

It'll be over
before you know it.

Okay?

Deep breath.
[inhales]

Then exhale.
[exhales]

- [exhales]
[groaning]

Keep breathing, Paul.
Keep breathing.

Big breath.
[inhales]

Bigger exhale.
[exhales]

Done.

Good job, Paul.

- [breathing heavy]

.

- A high white cell count,
what does that mean?

- You probably have
an infection.

- From Boomer?
- It's possible.

Have you felt sick recently?

- No, not really.

I mean, every now and then
my throat aches a little.

It doesn't really
bother me though.

- Hmm.

- Hmm, the lymph nodes
are swollen,

consistent with
an upper respiratory infection.

- Let's get a rapid strep test.

- What kind of dog is Boomer?

- Boxer bulldog mix.

A rescue.

When I went to the shelter,
all the dogs swarmed me,

but Boomer hung back.

Not because he was shy.

It was a move
so he'd stand out.

He was playing me.

- Smart dog.

I'm gonna swab
the back of your throat.

I'll get this to the lab.

- I'm doing
what I think is right.

Nathan's mental impairment
is due to a pea-sized tumor

that is easily removable.

A 45-minute operation
will cure him.

- But first,
he has to survive

this monumentally
difficult surgery.

- I'm sorry, you can't bring
your dog into the hospital.

- It's my sister's dog.

She's somewhere in the back
not answering her texts.

- Only service dogs in the ED.

I'm sorry.
- [sighs]

- Oh, is this Boomer?
- How'd you know?

- I've been taking care of Tara.

She said he was
a boxer bulldog mix.

- I thought it was only gonna
be one or two hours.

It's been five.
Is she okay?

- She spiked a low fever.

We're testing for strep.
- Strep?

That's nothing.
Okay, good.

Look, I have to go to work.

There's no pets
allowed in my building.

He barks one time
and I can get evicted.

I'm sorry, there's nowhere else
to take him.

- Um, no, no, no.
I can't take this--

I know.

It all happened really fast.

What do I do?

- Get him out of here.
Now.

- But where do I take--
- Reese, I don't care where.

Just out.

- [groans]

- Hey, look at this guy.

- Yeah, Earl, this is Boomer.

Could you watch him
for a minute?

But don't get
too close because--

- Oh, come on, fella.

Come on, guy.
Let's go.

Come on, big boy.

Hey.
- Okay.

Okay.

- When I'm out,

the city will condemn my home,

won't they?

- Fresh start, I guess.

- Get away.
Don't touch that.

- Don't touch that.

- There they are.
Ethan.

- Hey, guys.

- Hey, you okay?

For a second there,
it sounded like--

- Little hairy
for a while, that's all.

- Escharotomy in the field.

Damn, nice job.

- One across.
Six letters.

Bread, milk, eggs.

Thoughts?

- Staple.

- Nice.

- Thank you.

- Sure.

- All right, guys.

[indistinct radio chatter]

- Got it, clear.
- Lift him up.

- Don't touch that.

[bird squawks]

- Dr. Manning,

uh, Tara's rapid strep
came back negative.

- Okay, so we're back
at square one.

You know what, let's run a, uh--

[dog barking]

[snarling]
- Easy! Easy.

[growling]

- I'm sorry.
I am so sorry.

- Hey, Earl, what's going on?
- I don't know what happened.

Twenty people petted this dog,

and this patient is
the only one he barked at.

Come on, boy.
Come on.

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

- Let's run an infused CT chest
and abdomen on Tara.

- Oh, I've heard stories.

- Mm-hmm.
- Yeah.

- Easy.

Snakes in the grass.

Bypass grafts are buried
in the scar tissue,

tough to see.

Soften your grip...

an--and go slow.

- I see it.
- Mm-hmm.

- Proximal pseudo-aneurysm
of the LAD bypass graft.

- Let's cannulate
and get him on the pump

so we can do the repair.

- No, I don't need the pump.

It just needs a single
repair stitch.

I can do it
on the beating heart.

8-0 suture.
- Suture.

[monitor beeping]

- EKG's ischemic.
STs elevation.

- Pseudo-aneurysm's ruptured.

He's bleeding.
8-0 suture to me.

- I've got the better angle.
- Dr. Rhodes.

- I pushed for the surgery.
I can't lose him.

- I'll get you better exposure.

.

- Going to put
a second stitch in now.

- Don't back-wall the graft.

- Bleeding has stopped
and EKG's improving.

Pressure's good.

We're out of the woods.

- Not yet.

I want to check
his other bypass grafts.

Something goes wrong
in the future,

no surgeon's gonna
open his chest a third time.

- Lymphoma.

I have cancer?

- The next step is a biopsy
to determine exactly which kind.

- But I'm only 26.

I go to the gym every day.

I don't smoke.

- I know.

It's not fair.

- But I don't feel sick.

- Well, that's
because it was caught early.

- You have time
to get way ahead of this.

- Mm-hmm.

- The lymph nodes
are around here, aren't they?

Boomer's been nipping
at me for a month.

Always right there.

Do you think he knew?

- Maybe.

It seems some dogs
can smell cancers,

even in the very early stages.

- Yeah, he wasn't attacking you.
- [sighs]

- He was trying to protect you.

- [laughs softly]

- Maggie, what's going on
with Treatment 4?

We don't have
the space for this--

- I know, I know.
It's been all day.

Dr. Halstead, environmental
services hasn't shown up yet.

I can't even get an estimate
as to when they will.

- [sighs]
I'll go see them in person.

I'll drag someone down here
if I have to.

- Knock some heads.

I need that room back.

- How's he doing?

- Well.

- Good.

How are you doing?

- As a neurologist,

Lewy Body Dementia
was my worst nightmare.

I'd seen so many cases,

and I'm wondering

if it influenced my diagnosis.

- Hmm.

Medicine, you know.

Imperfect science.

Practiced by human beings,
no less.

- [sniffles]

Four years
we could have been doing CTs,

but I had an answer,
so there was no reason

to continue radiating his brain.

I robbed Nathan

of his mind.

I imprisoned him.

I drained our savings.

Squandered our time together,

time that we can never get back.

How am I gonna tell him
what I've done?

He's never gonna forgive me.

- Your husband's gonna
forgive you, Laura.

I want you to trust me on that.

Your struggle,

if I may,

is figuring out

how you're gonna
forgive yourself.

- Vitals are stable.

EKG looks good.

- Cleveland Clinic has an axiom.

Emergency surgery
on a healthy heart?

Yes.

Redo surgery
for a repaired heart?

Yes.

Emergency surgery
for a repaired heart?

No,

because overwhelmingly,

those patients die on the table.

- I couldn't do nothing.

- I suspect it was ego more
than altruism.

Great surgeons

know the balance.

You're confident,

not arrogant.

I like that, Dr. Rhodes.

Nice job today.

- You're good.
You're good.

Good boy.

Good boy.

Don't come from above.

Come from the front
so he can see you,

and hold out the back
of your hand first.

- Okay.
- Come on, buddy.

- Yeah?
- Yeah.

Hey, there.
- [laughs]

- Did you ever hear
that origin story about dogs?

In Eden,
humans and animals got along,

even spoke the same language,

but when Adam and Eve sinned
and God drove them out,

a great chasm opened up
between people and animals.

And as the chasm grew wider,
at the very last moment,

a dog leaped across it
to be with us.

[car trunk opening]

- That's a great story.

- Yeah.

[knocks on door]
- Come in.

- Ms. Goodwin,
can I talk to you for a moment?

- Quickly, I'm on
the homestretch with JCAHO,

and I don't want to let up now.

- I know my voice
isn't official,

but I'd like to put
in a good word

for Will regarding
the open ED attending position.

- Really?

- It'd be a shame to lose him.

He's a great doctor.

He cares about this hospital.

- Just a few weeks ago you asked
to be taken off his shifts.

- We don't always
see eye to eye,

but his heart is
in the right place.

- Well, Dr. Manning,

I'm glad your opinion
of Dr. Halstead has changed.

- Okay.

- [sighs]

- Dr. Halstead,
environmental services

are on their way?

- Nope.

Turns out, every department
in the hospital's calling ES

to handle things they normally
take care of themselves.

Be tomorrow
before a janitor shows up.

- Ah, bureaucracy.
- [chuckles]

- Whew.

Mm.

[exhales]

There.
The room is yours again.

- Against protocol?

- I won't tell if you won't.

- Huh, guess that means
I get to clean this up now

the way I wanted to
eight hours ago.

- [laughs]

- You know, toss me a pair.
- Oh?

- You know, the kind that,
uh, stick to yours

when you pull 'em out.

- You want in?
- Heck yeah.

We've come this far.

And they call you Robocop.

- [clears throat]
- Robocop?

[indistinct chatter]

- Katrina.

Reese, come with me.

- Uh-oh.

- Yeah, I've seen that look.

- Dr. Rhodes.

Everyone.

Look, we all know how important
JCAHO site visits are.

Yet, despite what I said
about the rules,

my team ordered tests
on the sly,

brought a dog into the ED,

and handled
radioactive material.

- Sharon, you have every right
to be upset.

Really.
But we can't really be ignoring

the, uh, the second law
of thermodynamics here.

Now, can we?

- How's that?

- Well, systems
do tend to degenerate

into ever more disordered
versions of themselves, right?

I mean, look around you.

All we're doing here,
all day long,

is battle the universe's desire
to fall apart.

- Yeah, should've seen
the house I was in today.

- I'm just saying,
I love rules.

We all do, but in
bringing order to disorder,

every now and then a couple
gonna get bent.

- Nice try, Daniel.

But the good news is JCAHO

didn't catch any of you,

so we keep our top rating.

I'll see you all tomorrow.

Second law of thermodynamics.

Please.