Original subtitles

This is a teaching hospital.

I'm not a therapist.

I'm here to make her into a doctor.

Our job is to nurture,

not to cull the herd.

Said he'd been assaulted by a masked assailant.

He did this.

I've been advocating for you ever since you got here.

And you know what? I'm done.

How are things at home?

Honestly, it's a little strained.

The job is to be there for your patient

throughout their care.

It's a hard rotation for anyone,

but it's the burden we bear.

Yeah, me too.

I don't want to be sad anymore.

So I just want to be clear. You're saying you don't think

- there's any way that... - Goodbye, Daniel.

Everything OK?

She just got herself transferred

to another hospital.

A little extreme, don't you think?

Wow, I'm sorry you two couldn't work it out.

Don't know what to tell you, you know?

She still thinks that Ripley attacked Pawel,

and it infuriates her that I don't.

You miss her?

Been a little quiet around the house

since she moved out. Not gonna lie.

- Do I have to worry about you? - No.

You've got to get ready to address your troops.

I'm ready, I ...

don't know if they're ready to hear it.

- Good luck. - Yeah.

Hey, you up for a celebratory beer?

Oh, yeah. What are you celebrating?

I'm done with chemo.

I've got a good feeling about this PET scan.

Hopefully, I can start helping Lynne with the baby.

Well, I'm digging this new attitude,

but a beer and chemo is not a... not a great combo.

Maybe it's the perfect combo. Hey -

you hear anything more about our other situation

with, uh, Pawel?

It's been quiet.

You see? What'd I tell you?

Cops don't care about small time stuff.

- See you. - Yeah.

Excuse me.

Uh, you were a no-show last night

at Crockett's goodbye party.

He's sleeping it off on a plane to Boston about now.

Yeah, sorry. I, uh, got held up here.

- What's going on? - Oh, you haven't heard?

Ms. Goodman's about to make a very big announcement

to the entire ED.

Well, that can't be good.

Maybe we'll get a new hot tub in the staff lounge.

Did it just get colder in here?

We're on a break.

Like a Ross and Rachel break or a Brad and Angelina break?

I don't know, but I'm not gonna let it

ruin my good mood.

Have either of you seen the Brick?

- No. - No, I haven't.

It's just so strange.

The night nurse normally leaves it at my desk, and...

- So everyone's here? - Yeah.

Good morning, everyone.

I know that you've all heard that Jackson Monroe Hospital

is closing its doors next week.

Gaffney will absorb the overflow.

Daily patient numbers will double.

We need to rethink how this ED operates.

So changes are on the horizon,

and I just ask for your patience

as we navigate this thing together.

And thank you in advance.

Dr. Archer, we should talk.

Dr. Archer? Trauma 2 needs you.

Uh, let's talk later, OK?

Uh, don't be concerned about the ED.

I'm ready for whatever's coming.

Excuse me. Hi.

- Can I have that? - Yeah.

Thank you.

Oh, my God.

The commuter ship was struck by a smaller vessel.

Water flooded the hull,

and it capsized within minutes.

Rescue operations are underway.

That's right.

A mass casualty incident is en route for Gaffney ASAP.

70 or 80 victims, nearly half critical.

Most of them are coming to us.

Full MCI protocol. Yes.

What's the ETA for the first arrival?

Two minutes out.

Trauma suites have been cleared?

Treatment rooms too.

Have you locked down the walk-in entrance?

Done, the ambulance bay's

the only point of entry into the ED.

Chaos control.

Trigger the all hazards disaster plan.

Every on-call doctor, nurse, and otherwise

hightails it in here ASAP.

- All hands on deck. - Look at you.

That's why I keep my RN license active

for emergencies like this.

Take intake and triage.

- It's all set up. - Got it.

Thank you.

Thought it was gonna be a quiet morning.

That's when the universe gets you.

Coming in behind you!

Paramedics say she was impaled

by deck railing in a small explosion.

Please! Please save my baby girl.

All right, baby's 39 weeks. Let's make mom comfortable.

- 20 of Etomidate, 80 of roc... - Kelsey, I'm Dr. Asher.

We're gonna give you something

to help you go to sleep, OK?

Can someone find my husband?

Was he on the ship with you, Kelsey?

Yeah. Finn Gallicano.

What does he look like?

Etomidate and roc going in.

Thin, dark hair, lots of tattoos.

- Black. - We're gonna find him.

Is my baby gonna be OK?

She's in good hands.

Do you have a name for her yet?

It's Darby.

Darby. OK.

I'll let you know when I track down the husband.

She's under.

Intubating now.

All right, carry on.

OK, baby's in distress.

Fetal heart tones are slow.

The metal shard is penetrating the placenta.

The baby's unharmed, but the placenta is abrupting.

We need to deliver right now.

Whoa, whoa, whoa, whoa, whoa. Chest X-ray first.

- Mike? - You got her?

X-ray.

All right, ET placement confirmed.

Look, see? Free air.

Yeah, but no free fluid.

She likely perforated her bowel.

Who knows what else.

Mom could bleed to death all over the table.

How do you repair the damage if the baby is on the way?

The only option that we have...

Remove the debris and deliver the baby at the same time.

Pretty risky.

What other choice do we have?

Oh, we can't take any overflow from Jackson Monroe.

She's not overflow.

She's a patient of mine who needs an MRI.

Well, your hospital has its own MRI.

The hospital sold all of its radiology machines

because of the closure, so I was hoping that...

No, it's not gonna happen. Look around.

We're underwater, and more are coming.

I get that, OK?

But just because this kid wasn't on that ship

does not mean she isn't in danger.

Look, Maggie?

You're a capable, intelligent woman with a big heart.

I can tell.

Well, thank you for really seeing me, Dr. Frost.

I'm sure you can figure this out if you try.

Does this usually work?

Does what usually work?

The charm assault and the smile and the puppy dog eyes.

Uh, yeah, it does,

most of the time.

- OK. - This is Zoey.

- Hello, sweetie. - Hello.

How are...

are you?

Where are her parents?

She's been in the system since

she was four years old when her mom abandoned her.

She's never met her dad.

I'm sorry to hear that, but who gave you permission

to bring her here now?

Her DCFS rep. I have the paperwork.

Zoey's been in and out of my ED the past couple

weeks with headaches, and today,

she got roughed up by some older kids

because of her speech issues.

My hospital wants to discharge her

without any further assessment.

OK, I'll call upstairs and see if we can get her in.

You're an angel.

And you're trouble.

You know, it becomes endearing once you get to know me.

It becomes less annoying when you get to...

I'll just quit while I'm ahead. Yep.

Nice to meet you, Maggie.

Hey, Ellis.

How you doing?

Where's, um... where's Mom and Dad?

- Fighting, I think. - You know what?

Sometimes my parents would fight

when they were worried about me.

So I don't know.

I mean, a lot of stuff happened today.

You got hurt.

I think your parents are a little worried about you,

right? And your leg.

- My leg hurts. - Huh.

Let me take a quick look, OK?

OK. Um, you know what?

I think it's time for Dr. Johnson

to check up on you anyway, so I'm gonna go find him, OK?

Be right back.

OK, just try to stay off the leg

as much as possible for the next few weeks.

Dr. Ripley?

Hey, Rosado. How's it looking out there?

Still a lot of people missing inside that ship,

but I want to give you a heads up.

About what?

- The Pawel Wapniarski case. - OK.

A witness just came forward who puts you at the scene.

Claims he saw you at the bar where Wapniarski was beaten

moments after it happened.

Look, I appreciate the heads up,

but I got nothing to hide.

I'd get a lawyer.

An arrest is not out of the question.

Dr. Ripley, Code Blue, Trauma 2.

He's unresponsive.

One moment, he was fine, the next moment, not.

Mr. Harley? Mr. Harley, can you hear me?

Heart rate 140. Pulse ox 92.

Respiratory rate 30. Blood pressure 78 over 40.

Abdomen's distended.

He's in hemorrhagic shock and bleeding into the abdomen.

Could be a splenic laceration. Page Archer.

Surgery's slammed.

Hybrid OR is the only available option.

OK, he needs blood. Let's give him two by two.

Hang a liter of LR on a pressure bag while we wait.

- Let's move. - OK.

Ellis's leg has a tissue infection

called necrotizing fasciitis.

The bacteria's point of entry was the cut he sustained

during the accident, and then it quickly

spread through the fascia.

So this is like a flesh-eating bacteria?

What it also is is a scary name for

an often very treatable condition.

I... I'm sorry. I don't understand.

Was the bacteria in the water?

Maybe, or it was on the object

that he scraped his leg against,

but that is just a guess.

And it's spreading so quickly.

Jeanine, Ellis is gonna be OK.

Good news, we caught it fast, so,

- you know, we got options. - Right.

I'd recommend antibiotics and debridement.

We remove all the dead tissue, irrigate the wound,

and then we leave it open for a couple of days,

- clear out the infection. - Surgery?

What about his hemophilia?

It's totally manageable with meds.

My son almost bled out an hour ago.

Now you want to fillet his leg? No way!

What are the other options?

W... uh, well, we could try stronger antibiotics.

Great. Let's do that.

OK, but that's... that's a risk.

His infection's too severe for antibiotics alone.

You just said that we caught it early.

To save his life, not his leg.

If the antibiotics fail, I mean,

amputation's gonna be the only option.

We can't gamble his leg. Let's do the surgery on Ellis.

Enough.

Tell them what you did, Seth.

- Jeanine, please don't. - What?

What's the matter?

You don't want to talk about it now?

We were below deck when the ship capsized.

Water was rushing in faster than we could swim.

Ellis was trapped in a tangle of chairs

pressed against a wall, and he was screaming to us

- for help. - Please stop.

I turn around and Seth is gone.

So even though we almost drowned several times over,

I pulled Ellis out alone.

- You don't understand... - I understand perfectly, Seth.

You abandoned us.

You were gonna let our son die to save yourself.

So, no, you don't get a vote.

I'm sorry.

I'm so sorry...

Stay the hell away from us. No surgery, period.

- Ready? - Ready.

On three. One, two, three.

Ah, trigger the MTP.

- OK. - Bolus. Start pressors.

We're in trouble.

Baby's blue.

Let's go. She's apneic.

- Where's the neonatologist? - Yes, doctor?

OK, I'll resuscitate. Let's go.

Starting CPR.

We've got to get her heart rate up.

Come on.

Show me how strong you are, baby girl.

- Come on. - V-fib.

Ah, damn it. We need to shock.

Paddles.

Charge to 120. Clear.

Still in V-fib.

There you are!

All right. Again, 200 this time.

Clear!

Ah, Mom's back.

OK.

Strange timing.

It's almost like she heard her baby cry.

Or it's the electrical current.

Can I help, Ms. Howard?

No matter how tight I make the tourniquet,

the bleeding won't stop.

Well, it's hard to compress a blood vessel at the elbow,

so just slide the tourniquet above the elbow,

and then tighten it.

There you go.

This job is a lot of things, but boring isn't one of them.

Want to know a secret?

I miss the hell out of it.

Not the suffering, mind you, but being able to help

in an immediate way?

That adrenaline is a drug.

Don't let anyone tell you different.

Why'd you stop?

Being a clinical nurse, I mean.

I realized there are other ways of being of service.

So I went back to school, got my MBA.

Administration was a natural fit.

So it's a trade-off.

Yeah, like most things in life, Ms. Howard.

Dr. Archer?

Huh?

I have a second wave of ship accident victims

coming in, but I'm out of space.

Bypass them to Jackson Monroe.

Is that really necessary?

We're getting slammed, huh?

Soon we'll hit a tipping point where

we will be unable to maintain a proper level of care.

So why don't we pivot?

Find empty ICU beds and move the beds to...

- what's that room? - The consultation room?

That is a tremendous waste of space.

Your first day here and you...

you know everything, right?

Diverting patients could cost red tag victims

precious time that they can't afford to lose.

That also falls below a proper level of care.

You're military.

Army.

Well, I guess that counts.

You?

Navy.

OK.

This is fun, but I need a decision.

Yeah, what she said.

Isaac? Talk to me.

Late 20s adult female. Critical.

Heart rate 133.

BP 94 over 59.

Intubated at the scene.

Frontal scalp wound, bleeding controlled with dressing.

We've got an 18-gauge IV on the left AC.

Her name is Wendy. I'm her wife.

Please just help her.

Let's go to the consultation room.

Dr. Lenox, the room is not prepped.

Walk and chew gum at the same time.

Dr. Hudgins, you're with me.

Get ready to rotate. Let's go.

Let's go.

Let's flip this.

Put the bed here.

You OK?

Dr. Hudgins, you OK?

Yeah, I'll be fine.

Dr. Uh, Frost, I presume?

Dr. Abrams, pleasure to meet you.

Uh, I imagine so.

- Can we talk in private? - Yeah.

Be right back.

So I reviewed the MRI brain imaging,

and you're right.

Your patient has a large 6-by-4-centimeter

glioma tumor in her Broca's area.

Well, that explains the sudden onset of speech issues.

Yes, that's why I said you were right.

I can say it again if you like.

No, I'm good.

So, um, what happens now?

I get the kid on my table ASAP so I can remove the tumor

before it does any more damage,

but there are some significant risks.

What kind of risks?

Well, there's a chance that you could completely

lose your ability to speak.

How... for...

For how long?

Permanently.

And if I don't...

don't do the surgery?

Well, pediatric brain tumors are tricky to predict.

Your speech difficulties might keep getting worse,

or they might stay the same for a while.

But the tumor will likely continue to grow and eventually

start to affect other functions of the brain, like strength.

And by that time, it'll be harder to remove,

and it might even progress to Stage 4 brain cancer.

And by then, I'm afraid it'll be too late.

Will you do the surgery?

I wish I could, but I...

I'm not a brain surgeon.

Not smart enough?

Wow. That...

That was a good one.

Look, Dr. Abrams is the best

neurosurgeon in the country.

I mean, just ask him. He'll tell you himself.

Look, Zoey,

I want you in the world.

OK, it's a better world with you in it.

You're scared. I get that.

But if you can embrace that fear and move through it,

you will be shocked how much stronger

you are on the other side.

So what do you say?

Y... you talk too much.

Well, guess what?

So will you,

very, very soon.

We got this, right?

We got this? Yeah, come on.

We got it.

- Hey, Dale. - Hey.

John Does are in the back corner there.

OK. Thanks.

Damn it.

OK, looks like we're about done here.

Bleeding's stopped.

Spleen's in the bucket. Let's close.

Oh, what the hell is this?

He's seizing again, just like he did on his ship.

Whoa, ah!

Ah, damn it, I lacerated the liver.

Heart rate increasing to 180.

Don't your paralytics prevent seizures?

Yes, this shouldn't be happening.

He's eating through the paralytic.

I'll recheck my train of fours.

Get these seizures under control.

I can't repair his liver if he's bucking

like a damn bronco.

I've started an Ativan drip to break the seizure,

and I'll re-bolus so we can get out of here.

Now what?

Pressure dropping, 90 over 40.

He's bleeding all over the place.

Where the hell's his O-Neg?

He's not gonna make it without it.

I'll get it myself.

At a certain point, I think if Dr. Ripley's

- not here and I am... - What's holding up my O-Neg?

My patient's circling the drain.

We've got a situation, Dr. Ripley.

The MCI depleted our supply of O-Neg.

These are the last five units.

And my patient won't survive without it.

Yeah, neither will mine.

- You must be Dr. Lenox. - Correct.

Run down your patients for me, please.

28-year-old female, severe head trauma.

GCS is 6.

Intubated with right flank stab wound.

She's in hemorrhagic shock.

Probably a retroperitoneal bleed.

43-year-old male, chest and abdominal trauma.

Grade 5 splenic laceration.

Possible late onset of epilepsy.

But didn't he cause the whole accident?

No moral judgments.

We favor the patient who has a better chance

for a positive outcome, period.

Prognosis for recovery?

If he makes it through surgery, excellent.

He's bleeding out in the OR as we speak?

We removed the spleen.

We're working on a small liver lac now.

We just need blood.

My patient is only 28. She's younger and stronger.

But her GCS was only 6, right?

Does she have a bleed?

- Was she anoxic? - We don't know yet.

- No CT. - Mm-hmm.

She needs the blood and surgery first.

And what are the chances of all that working out?

Or is your only argument that my 43-year-old patient

- is too old? - All right, that's enough.

The blood goes to Dr. Ripley.

Thank you.

I'm sorry, Dr. Lenox.

I would have made the same call.

Protocol demands it.

Hannah? Hannah.

- Hey. - Hey.

Baby and mom are both doing great.

I heard.

That's wonderful. Um...

What's going on?

I have some sad news.

I found Kelsey's husband in the morgue.

Finn showed up about five minutes ago.

He was at another hospital.

Are you OK?

Yeah, uh,

guess I didn't realize

how much I needed good news today.

Me too.

Jeanine, there you are.

Oh, no, Ellis is fine.

I just wanted to let you know that the, um...

the antibiotics are going in, and fingers crossed.

Did my husband send you to convince me

to let Ellis have surgery?

No, I have not discussed the...

the surgery with your husband.

But you do think I said no to spite him.

I absolutely do not.

I don't think you'd ever do anything to hurt your child.

I mean, come on. You saved his life today.

Enough said.

I mean, look, you've had an unimaginably

horrible day today.

I... I mean...

I don't know why Seth did what he did.

That's Ellis's father, his hero.

He was our world.

I don't want to sound for a second

like I'm trying to minimize what he did or didn't do,

but human behavior, I mean, it's just endlessly mysterious.

And my sense, for what it's worth,

is that he was just as shocked

by what he did today as you were.

I keep replaying it in my head.

I was holding Ellis's hand with all the strength

that I have because I knew if I let it go,

the water would suck him right under.

And for two minutes, I felt the terror of losing him forever.

And I will never forget the way he looked at me.

I'm supposed to protect him, and I was failing.

I was so tired.

But I just kept thinking, "Do not let go of his hand.

Do not let go of his hand."

So maybe letting Ellis have the surgery

would be letting go of his hand?

Yes.

Am I making a mistake, Dr. Charles?

You know, that's not really for me to say.

But I think if it were me, I would just want to make sure

that this decision, whatever it might be,

wasn't being driven by my own fear

when it's my child who might be suffering

the consequences, right?

Still in V-tach.

No pulse.

Dr. Hudgins?

Dr. Hudgins!

120. Clear.

Oh, Dr. Hudgins, it's worse now.

V-fib.

Dr. Hudgins.

Dr. Hudgins!

Zach!

Come back here!

- Maggie? - Yes?

We need a doctor in here now!

I'll get someone.

200.

Clear.

You brought him back?

I'm certified in critical care.

It's been a while.

Where's Dr. Hudgins? This is his patient.

He walked.

He abandoned his patient and walked out on you?

I'm afraid he did.

No, no, no, no, no!

Wendy!

Oh, I am so sorry. Are you OK?

That was a close one!

Yep.

- That was weird. - People are weird.

How's Zoey's surgery going?

Oh, just got an update from the OR.

Abrams should be done within the hour.

Good. All right, that's good.

You really care about her.

Yeah, I do.

What are you gonna do when Jackson Monroe

- closes next week? - I don't know.

Beg someone to let me finish my residency?

You know what?

Maybe I'll find a sugar mama and retire.

Yeah.

I can spend my days drinking Pabst

and my savings getting bleacher seats to Cubs games.

Well, as a White Sox fan, I can't support that.

You like disappointment. OK.

I'm learning so much about you.

Admit it.

I am more endearing once you get to know me.

Uh-uh. Just slightly less annoying.

- Mm, OK. - Yeah.

Hey, that was a compliment, whether you know it or not.

Dr. Johnson says Ellis will be fine,

but the parents, not so much?

Mm, they got a lot of stuff to work through.

Do you think they've got a shot at staying together?

I don't know.

Sometimes you know, you, uh,

hit a point of no return.

How are you holding up?

Oh, you trying to get all up in my business, Ms. Goodwin?

All up in your business.

I learned from the master. So stop deflecting.

Breakups suck.

What are you gonna do?

I hear it helps to talk to your shrink.

Today's tragic events recall another sad day

in Chicago history when the SS "Eastland" capsized

109 years ago...

You almost died on the table today.

What?

You had a near fatal seizure,

which should not have been possible with

the paralytics given at the start of your surgery.

It didn't make sense until we tested

your blood for common seizure meds

and found Dilantin.

How long have you known you had epilepsy?

How long?

Six years.

You should not have been behind the wheel of that ship.

Not today, not ever.

If I told the company about my diagnosis,

I'd have lost my job. My family depends on me.

You had a responsibility to disclose your condition.

And I was responsible.

I did everything I could to manage it.

I took the medication, changed my diet,

I exercised, I avoided alcohol, and it worked for years...

Until today.

I thought if anyone ever found out,

I'd just get fired, and that'd be the end of it.

Never thought I might hurt anyone else.

It was just one little lie.

One little lie.

Yeah.

Hey, Zoey. You made it.

Hey, sweetie.

How are you feeling?

Hey, it's OK.

Just take a deep breath and try again, all right?

No rush.

Did my surgery go OK?

Um...

You rocked it, Zoey,

just like we knew you would.

Dr. Hudgins?

I know you just met me,

but I'm not usually like this.

I'm so sorry.

What happened in there?

The day, it just got to me.

You're a resident.

I'm sure you've seen your fair share of unpleasantness.

Not like today. So much blood.

I froze up,

and I knew the patient would be better off

if I wasn't there.

That's a normal human reaction.

But a doctor can't afford to be normal.

We take an oath to be more than that

so our patients can have faith in us.

I know. I'm sorry.

You don't belong here,

and I don't think there's any reason

for you to come back here tomorrow.

What?

You're fired, Zach.

- Hey. - Hey.

I was just coming down to see you.

I hear congratulations are in order.

You found me.

Sully called me that day to tell me that he and his boys

had followed Pawel to a bar in Lincoln Park.

He told me that they were about to give him a proper beatdown

on my behalf, and he was offering me

a chance to get my licks in.

I tried to talk him out of it, but no one talks Sully

out of anything once his mind is made up.

So I rushed over there to try and stop it.

I was too late.

I found Pawel lying unconscious in the alley,

just as Sully and his boys were walking away.

He assured me that Pawel couldn't ID any of them

because they all were wearing face masks.

Why are you telling me this now?

'Cause you don't always get a chance to apologize

to the people you hurt.

I shut you out, and I let that jeopardize what we had,

and what we had was really good.

And for that, I'm sorry.

You fired Dr. Hudgins?

I made a judgment call.

You made a jud...

listen, you just got here.

You don't have the right to make a judgment call.

You have no knowledge of the way this place operates

or the chain of command.

He walked away from a patient.

I'm aware of that, and I do not condone that,

but you should have consulted with me first.

I didn't see the need.

Goodwin signed off on Zach's termination.

Chain of command.

Are you worried I'm here because Goodwin's

lost confidence in your ability to lead alone?

What I'm worried about is your effect on morale

and making snap judgments without consulting me.

I've run this ED just fine before you came here.

Dr. Archer, your department nearly came apart today.

No plan for overflow, misuses of space,

blood shortages, and a doctor who walked away

and nearly cost a patient their life.

I wouldn't call any of that just fine.

We were in the middle of a mass casualty incident.

And in a few short days, Jackson Monroe will close

and nearly double the patients will come through those doors.

Today could become every day.

I'm here for a reason,

and it's not to keep the status quo.