Original subtitles

If you're experiencing domestic violence, reach out. Ask for help. I'm

It was just a mix -up.

Thank you for saving her life. I know how much attention you paid to her.

I wish I could have done more.

I thought I built up a fluid in the abdomen.

You think I have stomach cancer?

We have a baby on the way!

We're gonna get through this.

John asked me out today. Why did you say no?

I should have let you.

I really like John.

There is a tremendous amount of potential in this tech. You want me to

machine tell me what's going on with my patient?

We might have gotten off on the wrong foot.

Maybe there is a place for you here at Gaffney.

Hannah!

You've lost too much time.

Bleeding out.

She's ever seen.

Jeremy Lockhart, 32 -year -old male with gastric adenocarcinoma.

Complaining of severe abdominal pain, persistent vomiting, and hematemesis.

Started a liter of normal saline in the ambo. Heart rate's 140.

BP's 115 .72.

This is his wife, Esme. When did he start to vomit? Around 2 a .m. I called

as soon as I saw blood. So you're under the care of Dr. Kingston, surgical

oncology, is that right? Yes, that's right.

All right, everybody.

On my count. Ready? One, two, three.

All right, let's start with four of Zofran and 50 of fentanyl. On it.

Jeremy's on a chemo regimen of 5 -fluorouracil and cisplatin. Just

last cycle on Friday.

Everything was going smoothly until last night. Yeah, I've actually tolerated

this combo way better than the last one. Last night?

Jeremy. Dr. Asher. You all know each other? Yeah, long story short, Dr.

been my own personal guardian angel.

How are you holding up?

I've been better, but so long as the chemo keeps doing its job, I can take

Let's get a full set of labs and type and cross two and two.

And an abdominal CT.

Thanks. I'll call Dr. Kingston. Let him know you're here.

Can I get you anything? Ask me a cup of tea?

I'm all right. Okay. I'll check back soon.

Thanks.

Dr. Charles?

Got a minute?

Yeah.

Patient in four.

Angelical arson.

She broke her ankle during a gymnastics competition.

In the middle of her beam routine, said she got dizzy, couldn't see straight.

I hate it when that happens. Yeah.

I ran a full workup of all the usual suspects.

Everything came back normal.

But you think there's a psych issue?

Angelica has been on this new anti -anxiety medication the past year. It's

Bomaline. Oh, I've heard of it. I mean, it's supposed to be a good drug, but

isn't it still in trials?

It is.

Angelica was a phase two participant.

And she was allowed to continue on the drug after her trial ended under the

supervision of one of the study's co -PIs, Dr.

Theo Rabari.

I know Theo. He's actually here at MED. He's doing some research. I invited him.

Yeah. Well, that's why her mom brought her into MED. They were concerned she

might be experiencing some new side effects.

Okay. I'll loop him in. Thanks.

Hey, Novak.

Wow. Really coming down out there, huh?

Must be nice to be holed up at Club Med on a day like this in your warm pajamas.

Can't lie, it is pretty snug.

You hit up a rave last night?

That is from one of my patients.

Yeah, she's a gymnast, so that apparently means a lot of sparkles.

Sure, sure.

Do I look like a raver to you? I mean, there was that rumor you're on meth,

so... What?

Nothing. Yeah, you'll be shocked to find that I'm not, so... Good.

Yeah, I'd hate to see you mess up those veneers.

Why do you think I have veneers? I don't know. I thought everyone in Hollywood

had them.

It's all natural now.

But my ass, on the other hand, that's BBL all the way.

Dr. Goodwork.

I should go. Can I maybe grab your number?

Do you have a pen?

Pen? It's very old school. I like it.

Go.

Didn't think it would be that easy, did you?

East Mercy's dealing with some flooding in their ED, and their ambulances are

going to be diverted to us and Lakeshore Memorial.

Fuck yeah.

Our latest shipment of IV fluids is delayed. We got one CT down, and

construction and treatment seven hit yet another snag.

Do you have any good news to share?

No, not really.

Have we resorted to medieval torture? What's going on in there? Some kind of

electrical injury?

What happened?

He was working on a downed power line and it tripped his defibrillator. Now it

keeps shocking him.

Dr. Ripley, the magnet isn't disabling the defibrillator. The eschar from the

burn is preventing it from working. His pressure is dropping.

Call cardiology. We need their CID programmer.

There's no time. His heart can't take much more of this. The next arrhythmia

could kill him. Who are you? Lena Martinez, third year medical student.

great. Please move.

Excuse me. Now, give me 10 cc's of 1 % lidocaine. What are you thinking?

Here's Lido.

Dr. Lennox?

And a scalpel.

You want to fill me in on... Whoa, whoa, whoa. What are you doing?

I got it.

Are you okay?

I'm fine.

Put pressure on the wound.

Now you can call cardiology.

Don't ever do that.

Hey, you okay?

Is your hand all right?

I'm awake now.

Don't need that second cup of coffee.

You know, I could have helped if you'd let me know what you were thinking.

Well, I didn't have time to stop and explain.

I thought that was obvious.

Is it just me, or does she seem like a completely different person lately?

I kind of dig it.

I can't believe I'm going to say this, but I kind of miss the old Lennox.

Hey, Betsy. This is Dr. Charles, our chief psychiatrist here at Gaffney.

Hi, Betsy. How are you feeling?

Did Dr. Asher bring you in to convince me to go back on my narcolepsy meds? She

did not. She just told me that you had recently found out that you were

and had some concerns.

I just feel like no one can tell me definitively if there's any medications

won't pose a risk to the baby, even Dr. Asher.

No offense.

None taken.

Unfortunately, there just haven't been enough narcolepsy studies on the

population to speak in absolutes.

Exactly. Which is why I would really like to refer you to a fabulous

of mine who specializes in sleep disorders and maternal health.

That would be amazing.

No one I've met with has much experience with both, and they don't

want to... Oh,

man.

I wish I could fall asleep like that.

Me too.

Well, you got the insomnia pregnancy thing happening?

Yeah. When I do finally fall asleep, it's not exactly

restful. I know. I can relate.

You are pregnant too?

Unfortunately not, but I swear to God, I feel like I've been tossing and turning

for years.

You know...

I thought you look a little... Like crap.

I was... That's okay.

A little tired.

Yo. Rip.

Hey. Just so you know, I'm checking out our new sublet tomorrow.

I might end up in a bag at the bottom of the Chicago River, but I'll be out of

your hair.

What's the hurry?

I just figured since you and Sadie called it quits, you might need your

back. No, I mean, there's really no rush.

The company's kind of nice, to be honest.

You sure about that?

Yeah. Oh, good. I was hoping you'd say that because that mattress in your guest

room, I have not slept this good in years. Thank you so much. Yeah.

How are you holding up?

I miss Sadie and Amelia a lot.

But Sadie was right to end things.

I'm starting to see that now. Dr. Ripley, you're up and both two minutes

On my way.

It wasn't even the most difficult part of my routine.

I was just doing a pivot turn into an arabesque when I fell off the beam.

This is going to set me back months.

So much for my big comeback.

Comeback? I insisted Angelica take a break from gymnastics for a while. Which

I'm struggling to make up for. It was taking a toll on her body, but actually

was more worried about her mind.

So the dizziness per vision, when did that start?

24 hours ago.

I guess it was more like a week.

Could this be a side effect of the bromelain?

What's possible? Highly unlikely.

Sorry to interrupt, Dr. Charles. We've just had very few documented side

with bromelain. Really just fatigue and dry mouth.

Have you been taking the medication at the same time every day?

I take it right after breakfast every morning.

Okay. Well, seems like you're right on top of it.

Well, forgive me.

Because I'm like Dr. Charles. I have very limited gymnastics knowledge.

But I wonder if this could be the same condition that Simone Biles had.

The twisties?

That happens more when you're midair doing things like flips and dismounts.

about before the competition?

You experience any nerves or anything?

Not really.

I was feeling pretty chill.

That's great, Angelica.

I know that wasn't always the case before Bonely. Well, look, this is all

helpful. Dr.

O 'Brien and I are going to go compare notes and then get back to you soon with

a plan, okay?

An MRI will rule out any neurological or vestibular causes.

We should absolutely do that.

But? But if it comes back clean, we should probably think about ramping her

off the bumblebee, right? See if her symptoms subside.

Buddy, look, I completely understand my mistake here. We don't want an emerging

negative side effect to blow back on your published finding.

Well, this isn't about what is best for me or the study. This is about what is

best for Angelica.

She's finally got her life back, and I would hate to do anything to disrupt

unless absolutely necessary.

Understood. How about this? How about we see what the MRI says and go from

there? Plan?

Sounds good.

Jeremy's CT scan shows that his tumor isn't responding to the new chemo.

Well, that doesn't sound good.

So he switches to a different chemo, right?

No, I'm afraid not.

What? Why?

Well, further chemo wouldn't yield any meaningful improvement.

What about a clinical trial or surgery?

Any aggressive treatment won't change the progression of your disease.

So this is it?

I'm so sorry, Jeremy.

How long do I have?

A matter of weeks, maybe a month?

That's not enough time to meet our baby.

It's okay, honey.

It's okay.

It's okay.

I

should

be the one comforting him right now. You just got the worst news of your life.

You were allowed to fall apart.

Is there any way I can be induced early without jeopardizing the baby's health?

I'll be 31 weeks on Friday. The earliest we could possibly induce you is 39

weeks.

Any sooner would pose risk to the baby and to you.

I know Dr. Kingston said further treatment was futile, but is there any

can buy Jeremy a little more time?

Being a family, even just for a moment, would mean everything to us.

Hey, Sean.

Hey. Hi. Good to see you. Thanks for coming by.

Of course, I always do when I'm in town.

Plus, you said you had some news, so I didn't want to miss that.

Oh, yeah? Why's that?

Well, since you always downplay everything as a rule, I figured it must

so out with it.

Are you sick? No, no, I'm fine.

Hannah and I are having a baby.

Are you serious?

Yeah.

And no, we're not dating. And yes, it's just a one -time thing. And yes, we're

going to be co -parenting.

More importantly, I just want you to know that I'm not going to let having

child get in the way of our relationship.

Dad, I'm 39 years old.

I don't feel threatened or replaced.

I'm just glad this is happening before I have kids.

Why is that?

Can you imagine having an aunt or an uncle younger than you?

Smart aleck.

Congratulations, Doug.

Thank you, son.

Theo!

Can I get a word, bud?

Yeah.

Angelica's IV site was occluded, so I flushed it. Buddy, it's all good. I just

never seen you.

I didn't know that you were interested in doing the hands -on stuff. That's

Yeah. I guess just being here has made me realize how much I miss the face time

of patients.

Look, anytime you want to shadow me here in the ED, you're more than welcome.

Oh, yeah?

That'd be great.

Yeah, man. Text me. We'll set it up. Okay.

Hey, Angelica's ready to head up her MRI.

Do you know where her mom is?

Uh, Terry went up to get a coffee.

Uh, I'll go see if we can find her and bring her up. Thanks.

Everything okay? Yeah.

Yeah, yeah, yeah.

Um, do me a favor.

You get that MRI back? Just call me first?

Sure. Thank you. Yeah.

Hey. I was visiting your cousin.

Boston was a blast.

We actually spent time outside in the dead of winter.

Yeah. Damn, that Chicago went you, huh?

Any tattoo?

I can't seem to get that number right, you know?

Novak wrote it when Dr. Frost asked for her number.

It was adorkable.

So the rumors are true.

Congrats. It's not like a thing.

Yet.

I didn't actually get her number, Casey.

Something tells me you will.

I think it's adorkable.

Well, well, well.

Looks like you're in a classic love triangle.

For the love of God, please stop.

If you ever decide to make that triangle a square, give me a call.

The procedure is called a cytoreduction with HIPEC. Once we remove all

visible signs of the tumor, we'd insert a catheter containing chemotherapy into

the abdominal cavity.

The catheter is attached to a perfusion machine, which heats the chemo. Why is

it heated?

Well, there's evidence that hot chemo increases its ability to penetrate and

kill cancer cells. It will immediately target any of the micrometastases that

can't see.

And this could buy me enough time to meet my daughter?

If you survive the surgery, potentially.

But as I said to Dr. Asher when she presented me with this idea, your PCI

and your significant comorbidities make this a tremendously risky proposition.

What are the chances he won't survive?

Doesn't matter.

Either way, I'm going to die.

But you need to understand that your post -surgery quality of life will be

at best. You'll be bedridden. You'll have a colostomy bag.

What would you do in my position?

If it meant I could meet my baby, I'd roll the dice and fight for more life.

That's all I want.

I don't know, Jeremy. I don't want you to be in pain. Hey, I can handle the

pain.

But this is one of those situations.

What do you always call it?

A nuclear submarine situation.

Takes two keys to launch.

Then let's do it.

Well, I don't have to tell you that time is of the essence, so...

I'd like to schedule your surgery for today.

I am ready when you are. All right, we'll book an OR and we'll get you

Dr. Lennox, your stores asked me to get a history on the John Doe in treatment

six.

Who are you?

We met this morning.

Elena Martinez, third year medical student.

Seriously? You asked me to move?

Right. Yes, sorry. Please continue.

So I tried to take a history, but the patient won't wake up.

Maybe he's dead.

I can tell when a patient is dead.

Are you sure?

Yeah, patients generally stop breathing after death.

This guy's still taking, just very intoxicated.

What's his blood alcohol?

0 .275.

No wonder he's passed out.

Who brought him in?

Paramedics. He's got a laceration along his left forearm and bruising on the

right knuckle.

They find him at the bar. He was actually at the drugstore.

Pharmacists noticed him stumbling and slurring his words.

Dr. Lennox?

His name is Devin Carter.

So you know him?

He and his wife, Faye, were in the ED last month.

Tell a nurse to hang a liter of saline and we'll deal with his injuries when he

sobers up. I can stitch him up. Don't touch him.

Just come find me when he's awake.

You okay?

Yeah.

Taking a moment before I send a patient off to surgery.

Tough case?

Yeah, it is.

Clearly the hormones are raging.

Hey.

Did you ever tell John how you feel?

Um, no.

Cold feet?

Epic bad timing.

He moved on to Novak pretty fast.

I'm sorry, wait, they're dating?

They're circling each other.

Okay, so make a move.

Make a move? He asked me out and I said I don't date co -workers. I don't want

to give the poor guy whiplash.

Okay, well, I mean, if John and Novak were an official couple, I'd agree with

you, but it doesn't sound like that's the case, so...

Tell John how you feel.

Just put it out there.

I'm not comfortable with that.

Okay.

Fair enough.

I just, I think that we need to do the things that make us happy while we still

have the time.

His blood alcohol is .275, and his injuries could be defensive wounds.

Maybe he got into a fae and she tried to fight back.

Which means she could be much worse off than him right now.

Okay.

Let me see what I can find out.

Hey, Angelica's MRI is completely normal.

Why am I completely unsurprised?

Why let Dr. Rabari know? And get this.

He asked me to order a serum retinol test.

What? How do you get from a clean MRI to a weight of an A test?

No clue.

Look, I hope I'm not speaking out of turn, but Dr. Mubari is reaching.

It's like he's trying to find any other cause for Angelica's symptoms other than

the momoline.

Tell me about it.

Wreck hockey, huh?

Yeah.

Guy came out of nowhere, checked me against the boards, and then I, uh...

I hit my head against the glass, went down, and then the moron skated over my

arm. Ouch.

On purpose?

No. Accidents happen.

I punched the ice.

Can you make a fist for me?

Now release and wiggle your fingers.

Okay. Well, I don't think anything's broken.

That's a relief.

So, uh...

When they brought you in, you were passed out.

What happened there?

I was hurting pretty bad after the game, and I thought I could drink it off. But

obviously I went a little too hard.

How'd you end up at a pharmacy?

I got it in my head that I could fix myself up with some Neosporin and an Ace

Bandage.

Right. Well, it's going to take a little more than that. You need stitches.

Sure. You want to give Faye a call?

memory uh you know she's actually out of town visiting her dad and i don't think

she'd be too happy about this so yeah yeah i hear you well uh just sit tight

uh i'll be back soon to stitch up and get you some pain meds okay he's lying

agreed but how do we prove it

what hall Hey.

It is a bad idea. Do you have a better one?

Yeah, we call CPD, ask them to do a welfare check.

Devin and Faye live in the burbs outside of CPD's jurisdiction, and with the

storm outside, the local police are going to be swamped, and this won't be a

priority.

Dr. Ripley, ambles two minutes out, single MVC, you're on deck. Hold on a

second. Just keep Devin here until I'm back.

Hey there.

Dr. Frost told me that you ordered a serum retinol test for Angelica.

I had a hunch.

Results are back.

Whoa. 240.

That is a toxic level of vitamin A. Explains the dizziness in the blurred

vision.

Seems like we found our culprit.

Yeah. And it wasn't bumbling after all. What do you know?

Is there a problem?

No. Not at all. I mean, good catch.

Vitamin A toxicity? Pretty rare.

I mean, certainly...

It wouldn't have been my first guess, I can tell you that much.

It wasn't my first guess either. It wouldn't have been my tenth guess.

How'd you get there?

When I saw Angelica with her hair down, I noticed it was a lot thinner than I

remembered. And she confirmed that it was falling out in the shower lately,

so... So you went into a room to flush her IV while her mom was... I was

coffee?

What are you getting at, Dr. Charles?

Well, just a little curious.

You know, you order a targeted lab for a very common substance that conveniently

covers all of Angelica's symptoms and exonerates Bowling for your trial in the

process? You can't be serious.

You think I would dose a patient to protect the results of a study?

Isn't the more likely explanation that Angelica or Terry are hiding something

from us?

You know what? I'd like to think I'm pretty good at detecting when people are

concealing things from me.

Is that right?

Yeah.

Look, we have the results. Let's just go and ask Terry and Angelica directly.

Fine by me.

Wait, wait.

I love you.

I love you, too.

Like anyone ever could.

I really outdid it with the man flu this time, didn't I?

We're a ridiculous pair, huh?

I wouldn't have it any other way.

That felt like goodbye.

You're just focused on bringing that little girl into the world.

Great.

Angelica uses a daily multivitamin, but she's been on it for years without an

issue. I showed Dr. Frost my food log.

Would you share with me? Nothing on the list would cause vitamin A toxicity.

Angelica, I know comebacks, you know, can be tough.

Take anything for a shortcut?

Shortcuts? Yeah.

Sometimes athletes take things to enhance their performance.

You mean steroids?

Of course not.

Angelica, you can't be loose with the truth here. Your health depends on it.

You think I'd do that? I think you feel a lot of pressure to catch back up with

the team.

Gymnasts get disqualified for taking steroids.

I would never do that, okay?

I believe you.

Glad somebody does.

The only thing I use to enhance my performance is glitter.

Which is totally allowed, by the way.

How often do you use glitter?

Mostly just on competition days.

Had a fair amount of those recently, haven't you?

She's had qualifying events every other day for the past month.

Right.

And do you mind me asking, what kind of products do you use to apply the

glitter? So much.

Hair gel, body butter, eye shadow, lip gloss.

Do you happen to have any of those with you today?

Yeah, in my bag.

Sodium hyaluronate, rosehip oil, shea butter, retinol, and tretinoin.

What's wrong?

Retinol is just another name for vitamin A, and tretinoin is actually the

strongest form of it. Not supposed to be available for over -the -counter use.

More than half the ingredients in these products contain forms of vitamin A.

It's unusual for your body to absorb enough vitamin A through the skin to

toxicity, but it can happen with prolonged use of high -dose topical

I've been literally poisoning myself with glitter. You have, but...

You stop using these products immediately, your body will clear the

vitamin A in a matter of weeks.

I'm sorry that I accused you.

I get it. I went overboard last year.

And you were right to make me take a break.

But I'm fine now, okay?

I promise.

Okay.

But your glitter days are over.

You shine plenty without it.

How did you figure out it was your glitter?

Oh, it was Dr.

Ravari's idea to order this here retinol test.

Just glad we got the bottom of it.

Hey. Hey.

I've been looking for you. Here I am.

I just wanted to apologize for Casey earlier.

She's... A lot.

I was going to say an acquired taste.

Yeah, Casey's going to be Casey.

Yeah, facts.

Were you good?

Yeah. Okay, good.

John? Yeah?

I should have said yes when you asked me out the other week.

Oh. Please, just listen.

I've had feelings for you for a long time.

I think you knew that from the start.

But I get in my head. I overthink things. I create obstacles and

rules that keep my life as simple and as uncomplicated as possible.

We missed our window, and I'm fine with that.

This isn't a declaration of love.

And Novak is pretty damn great.

Yeah.

Why say anything now, though?

Because I needed to.

Thanks.

This tumor's more involved than the CT alluded.

Give me a little more counter -attraction, I'm going to start to lyze

adhesions. I hope you don't feel bulldozed into presenting this surgery

law courts.

Bulldozed by two E .D. dwellers?

Please.

Typical boy.

What's typical?

You hot shots upstairs looking down at us emergency department plebs.

I gather from what you told Jeremy today, you have kids?

A son.

Sean, yeah.

You? Nope, never wanted him.

I don't hear regret in your voice.

It was the right choice for me.

Do I hear a but?

You hear an and.

I admire the bond between parents and their children.

It is powerful.

You still married?

Uh, no. It's not for a long time.

Same. You single?

I am.

Same.

How do you feel about music in the O .R., Dr. Archer?

Only if it's good music.

You know Cannonball Adderley?

One of the greats.

Hey, Kelly, start my mix.

Come in.

Hey, I got your text.

Theo, come on in.

Got a meeting in ten.

I'll be quick. I promise.

Look, I owe you an apology.

I thought you were overprotecting your bumbling study, and I was wrong.

And I'm sorry.

You questioned my integrity.

I know.

Is something going on with me?

I don't know. what it is i'm looking into it but it's like affecting my

you know and i just reached an unfair conclusion and again i apologize

if i'm being honest with myself maybe i was spinning the lack of side

effects with angelica and her mom a bit buddy i get it studies are really big

deal but dr charles i would never sacrifice a patient's health of course

wouldn't i know that not for nothing

Your vitamin A glitter glue connection?

That was pretty impressive.

I don't know, man.

Maybe, uh... Maybe we're a team.

Maybe.

Oh, hey.

You know that patient you asked me to keep an eye on?

Yeah. Just tried to leave.

He's getting antsy.

Okay, thanks.

Everything okay?

I thought you said you'd be right back.

Yeah, yeah, sorry. I'm just waiting on the log jam to clear upstairs so we can

get you to CT.

CT?

What is that?

Oh, um, computed tomography scan. It's an imaging test. It'll give me a better

idea of the extent of the injuries.

Oh, okay.

And we need that for a cut on my arm.

Well, you said you hit your head, right, on the glass before you went down?

Yeah.

But I didn't hit it that hard.

Well, still, it's concussion protocol.

I'd get in some pretty big trouble if it turned out you had a brain bleed.

Look, Doc, my head feels fine.

So, can you help a guy out and stitch me up so I can go home?

I'll tell you what.

As soon as you're back from CT, you'll be first on my list.

I promise.

Any type.

You got it.

The tumor has local extension into the splenic artery.

After that last unit, base deposit is zero. Vital stable.

Okay. Starting to separate the plane around the artery.

What the hell is that?

What happened?

I'm guessing the storm knocked the power out. What about Jeremy? How will

they... It's okay, it's okay. The hospital has backup generators.

They'll kick in any second now.

I'll start bagging. Get vitals manually.

We have to keep the graspers completely still.

The slightest shift could lacerate the splenic artery.

We're flying blind here.

What the hell are the generators?

The hospital should have switched over by now. Would you please find out what's

going on?

Blood pressure's down 80 over 40.

If you don't do something soon, Jeremy could die on the table.

Faye.

Oh, my God. Faye.

Are you okay?

I'm here.

I'm here.

I'm going to sit you up. I'll help you breathe.

It's going to hurt, but I'm going to do it really fast, okay?

One, two, three.

I'm gonna get you out of here.

Thank you.

Thank you.

One second.

I don't have service down here, so I have to go upstairs and call for help.

Please don't leave me.

I'm not leaving you. I promise.

I'll be right back.