1 00:00:00,383 --> 00:00:02,327 With the suggestion from Dr. Cooper 2 00:00:02,412 --> 00:00:04,578 I could've sabotaged Archer's CVP monitor 3 00:00:04,663 --> 00:00:06,476 so that the Vas-COM could save the day. 4 00:00:06,561 --> 00:00:07,961 And I came close to doing it. 5 00:00:08,046 --> 00:00:10,242 If this ever gets to be too much for you, 6 00:00:10,327 --> 00:00:11,937 I'll put a stop to the whole thing. 7 00:00:13,146 --> 00:00:14,242 I'll take it from here. 8 00:00:14,327 --> 00:00:15,766 I assumed I'd perform the surgery. 9 00:00:15,851 --> 00:00:16,976 You're free to watch. 10 00:00:17,429 --> 00:00:20,070 - Best by the powers that be. - I'm sorry. 11 00:00:20,623 --> 00:00:22,992 I made a fool of myself with Dr. Marcel. 12 00:00:23,144 --> 00:00:25,320 I'm crushing on my advisor. 13 00:00:26,088 --> 00:00:27,353 How long you been doing this? 14 00:00:27,438 --> 00:00:29,187 - 35 years. - How? 15 00:00:29,325 --> 00:00:31,243 You got to hang on to those good days. 16 00:00:31,328 --> 00:00:32,938 You got to hang on to those wins. 17 00:00:38,606 --> 00:00:41,699 - Really, Dad? - What? It's fine. 18 00:00:41,870 --> 00:00:44,351 It's a red zone. It's for emergencies only. 19 00:00:46,832 --> 00:00:48,015 - No... - See? 20 00:00:48,100 --> 00:00:49,742 Now, it's an emergency. 21 00:00:49,835 --> 00:00:52,250 Oh, you know what? I wanna check this out. 22 00:00:53,273 --> 00:00:54,539 New PDT system. 23 00:00:54,624 --> 00:00:56,703 I can check all of my units in real time. 24 00:00:57,578 --> 00:00:58,846 But, look, can I check it out later? 25 00:00:58,930 --> 00:01:00,335 I really do have to go. I'm late. 26 00:01:00,490 --> 00:01:03,164 - Everything okay here? - Oh, yeah, we all good. 27 00:01:03,659 --> 00:01:04,726 Just a little ride-along. 28 00:01:04,811 --> 00:01:07,121 Letting a civilian see what a real job looks like. 29 00:01:07,482 --> 00:01:09,476 - Yeah, thanks. - Yeah. 30 00:01:10,242 --> 00:01:11,817 Am I embarrassing you? 31 00:01:12,377 --> 00:01:13,726 - I'll see you later. - Okay. 32 00:01:15,687 --> 00:01:16,654 Come on, Dad. 33 00:01:20,058 --> 00:01:21,492 Okay, I'm gone. 34 00:01:26,306 --> 00:01:28,648 Hey, what's up? 35 00:01:28,961 --> 00:01:29,961 Do you remember how when we were 36 00:01:30,045 --> 00:01:32,732 in physical exam class, when we did breast exams, 37 00:01:32,817 --> 00:01:34,133 they would tell us to make small talk 38 00:01:34,217 --> 00:01:35,221 with the patient actors? 39 00:01:35,306 --> 00:01:36,415 Yeah, to help put them at ease. 40 00:01:36,499 --> 00:01:38,678 Yeah and there was that one guy, Mandelbrot. 41 00:01:39,117 --> 00:01:40,992 Super awkward. Caught hell for asking 42 00:01:41,077 --> 00:01:42,821 one of them what she was doing that weekend. 43 00:01:42,974 --> 00:01:45,204 - Oh. - He is a panelist 44 00:01:45,289 --> 00:01:47,812 at the next summit for female physicians. 45 00:01:49,617 --> 00:01:52,085 Wait, that... wasn't Mandelbrot. 46 00:01:52,170 --> 00:01:53,174 It was Richardson. 47 00:01:53,259 --> 00:01:55,032 No, pretty sure it was Mandelbrot. 48 00:01:55,117 --> 00:01:58,851 - No, it was Richardson. - You haven't changed a bit. 49 00:01:59,043 --> 00:02:01,531 - Always got to one-up me. - I'm not trying to one-up you. 50 00:02:01,616 --> 00:02:04,071 Two shots for Dr. Hammer. Three for Dr. Halstead. 51 00:02:06,490 --> 00:02:07,632 Thank you. 52 00:02:08,662 --> 00:02:11,092 - Have a good day. - You too. Thanks, Carly. 53 00:02:11,177 --> 00:02:13,039 - Morning. - Good morning. 54 00:02:14,392 --> 00:02:17,311 Dr. Halstead, how are things with Dr. Cooper? 55 00:02:17,396 --> 00:02:20,358 - Uh, pretty well, I think. - Oh, yeah? 56 00:02:20,443 --> 00:02:23,104 I mean, he hasn't said anything otherwise. 57 00:02:23,189 --> 00:02:24,933 Good morning, Ms. Goodwin, Will. 58 00:02:25,109 --> 00:02:26,335 Matt. 59 00:02:26,420 --> 00:02:27,367 Just the man I was looking for. 60 00:02:27,452 --> 00:02:28,239 I want to tell you about the conference 61 00:02:28,324 --> 00:02:29,289 coming up in a few weeks. 62 00:02:29,374 --> 00:02:31,640 National Critical Care Society annual meeting. 63 00:02:31,725 --> 00:02:33,767 It's here in Chicago. You should go. 64 00:02:33,852 --> 00:02:35,843 Vasik's gonna be a platinum sponsor. 65 00:02:35,928 --> 00:02:37,789 They're gonna have a corner booth. 66 00:02:37,929 --> 00:02:39,281 It's gonna be the perfect chance 67 00:02:39,366 --> 00:02:41,166 for you to meet some of the upper-level execs. 68 00:02:42,953 --> 00:02:45,992 Oh, do you think that you could spare him for the day? 69 00:02:46,077 --> 00:02:48,165 It's always good when our doctors 70 00:02:48,250 --> 00:02:49,784 broaden their expertise. 71 00:02:49,868 --> 00:02:51,786 - I'll be there. - Okay, great. 72 00:02:51,913 --> 00:02:54,663 I'll get you the details. Um, Ms. Goodwin. 73 00:02:54,748 --> 00:02:56,265 - Mm-hmm. - See you. 74 00:02:56,756 --> 00:02:58,093 This might be good. 75 00:02:58,621 --> 00:03:02,323 And maybe I can get them to offer me a deal like Cooper's. 76 00:03:03,709 --> 00:03:08,187 Geez, I got to get this, but, uh, you're on the right track. 77 00:03:11,351 --> 00:03:14,062 Thank you, La'Shawn. Morning, Alim. 78 00:03:14,147 --> 00:03:15,282 - Hey. - Hey. 79 00:03:15,367 --> 00:03:16,458 What time did you get in? 80 00:03:16,543 --> 00:03:18,722 Uh, I don't know. Like, around four. 81 00:03:19,008 --> 00:03:20,665 Why so early? 82 00:03:20,750 --> 00:03:22,310 Always try to get a leg up on the day. 83 00:03:23,379 --> 00:03:25,297 Two hours before your shift? 84 00:03:25,554 --> 00:03:27,118 Well, if I'm meeting with my patients earlier, 85 00:03:27,202 --> 00:03:28,376 then I can read up on their conditions. 86 00:03:28,460 --> 00:03:30,188 That way, I'm running rounds, I'll have all the answers. 87 00:03:30,272 --> 00:03:31,532 Plus, if I'm here a little early, 88 00:03:31,616 --> 00:03:32,843 I can study for my boards. 89 00:03:33,342 --> 00:03:35,289 Sleep ever a factor in this equation? 90 00:03:35,374 --> 00:03:37,466 Life of an intern. What can I tell ya? 91 00:03:37,648 --> 00:03:38,826 - Dr. Marcel. - Yeah. 92 00:03:38,911 --> 00:03:40,968 Treatment three incoming. 93 00:03:41,653 --> 00:03:42,657 What do we got? 94 00:03:42,788 --> 00:03:44,445 Avery Quinn, 28-year-old female. 95 00:03:44,530 --> 00:03:47,531 Pedestrian versus auto. BP 80/45. 96 00:03:47,616 --> 00:03:49,665 Heart rate 114, satting at 88. 97 00:03:49,750 --> 00:03:51,015 Okay, Avery, I'm Dr. Marcel. 98 00:03:51,100 --> 00:03:52,368 We're gonna take good care of you, okay? 99 00:03:52,452 --> 00:03:53,898 It hurts so much. 100 00:03:54,020 --> 00:03:56,208 Trigger the MTP, give her 50 of fentanyl. 101 00:03:57,334 --> 00:03:59,419 Here we go, guys. Transfer on my count. 102 00:03:59,504 --> 00:04:01,272 One, two, three. 103 00:04:02,940 --> 00:04:04,607 There it is. All right, let's roll her. 104 00:04:05,615 --> 00:04:08,273 You're okay, we got you. The board... 105 00:04:13,249 --> 00:04:15,012 All right, we're good. 106 00:04:16,106 --> 00:04:18,247 Avery, can you put your arms by your side for me? 107 00:04:18,332 --> 00:04:20,252 You're gonna feel a little bit of pressure, okay? 108 00:04:22,911 --> 00:04:24,490 - O2 sats down to 82. - Avery, 109 00:04:24,575 --> 00:04:27,287 Avery. Avery... she's out. 110 00:04:27,541 --> 00:04:29,807 We need to intubate. 20 of etomidate, 100 of sux. 111 00:04:29,922 --> 00:04:32,669 Get a CBC, CMP, type and cross four units. 112 00:04:32,887 --> 00:04:35,023 Let's get a fastscan and have them prep OR 12. 113 00:04:35,108 --> 00:04:37,708 - No, she's going to OR seven. - Excuse me? 114 00:04:37,976 --> 00:04:39,325 Yeah, I'll take it from here. 115 00:04:39,466 --> 00:04:41,654 And let's add a coag panel and LFTs. 116 00:04:41,739 --> 00:04:43,288 Dr. Blake, I think you're mistaken. 117 00:04:43,372 --> 00:04:45,224 This is a trauma, not a transplant surgery. 118 00:04:45,309 --> 00:04:47,184 Yeah, I can see that. 119 00:04:47,269 --> 00:04:49,666 She's got free fluid, and she's in shock. 120 00:04:49,751 --> 00:04:51,208 Her liver's ruptured but repairable. 121 00:04:51,293 --> 00:04:54,200 - We got to get her up now. - I'm in. Bag her. 122 00:04:54,583 --> 00:04:57,928 All do respect, Dr. Blake, you're a transplant surgeon. 123 00:04:58,029 --> 00:04:59,942 - I got this. - Thank you, Dr. Marcel, 124 00:05:00,027 --> 00:05:01,287 but I'll be taking over the case now. 125 00:05:01,371 --> 00:05:03,090 I'm sorry, I can't let you do that. 126 00:05:03,175 --> 00:05:03,966 This is my patient. 127 00:05:04,051 --> 00:05:06,091 And I understand that, but she's also my daughter. 128 00:05:07,797 --> 00:05:09,149 Now, I'm gonna need you to move. 129 00:05:09,660 --> 00:05:10,966 Let's go. 130 00:05:18,103 --> 00:05:19,825 You got a transplant patient? 131 00:05:19,910 --> 00:05:21,482 No, I don't. 132 00:05:22,237 --> 00:05:23,851 But we have a problem. 133 00:05:30,333 --> 00:05:32,044 *CHICAGO MED* 00:05:34,128 Episode Title: "Change Is a Tough Pill to Swallow" 135 00:05:34,212 --> 00:05:35,310 Aired on: October 20, 2021. 136 00:05:36,865 --> 00:05:38,232 Subtitles Synchronized by srjanapala 137 00:05:38,392 --> 00:05:40,154 Hey, Alex, I'm Dr. Scott. 138 00:05:40,317 --> 00:05:42,091 I'm Susan. This is Todd. 139 00:05:42,176 --> 00:05:44,958 And this is Ry... Ryan, come on. 140 00:05:45,043 --> 00:05:46,974 Hey, Ryan, can I get a couple of those? 141 00:05:49,183 --> 00:05:51,872 Ryan, enough with the gloves, okay? 142 00:05:51,957 --> 00:05:52,853 Thanks. 143 00:05:54,292 --> 00:05:57,820 Alex, says here that you 144 00:05:57,905 --> 00:05:59,435 got hit in the head with a Nerf gun. 145 00:05:59,909 --> 00:06:02,747 - Yeah. - Oof, I bet that hurt. 146 00:06:02,911 --> 00:06:05,961 The thing is, you're supposed to get hit with the foam dart, 147 00:06:06,046 --> 00:06:07,763 not the actual gun. 148 00:06:07,902 --> 00:06:09,090 Stop it. 149 00:06:09,432 --> 00:06:11,825 It was an accident. The boys were playing. 150 00:06:12,458 --> 00:06:14,177 - Mom, it wasn't a Nerf gun. - Okay. 151 00:06:14,262 --> 00:06:15,832 I... I didn't even see it happen. I... okay. 152 00:06:15,916 --> 00:06:16,825 - Ryan. - Mom... mom. 153 00:06:16,910 --> 00:06:18,002 - Hey, just a minute. - Mom... 154 00:06:18,086 --> 00:06:19,483 - They were down in the basement and... - It wasn't a Nerf gun. 155 00:06:19,567 --> 00:06:20,404 Ryan, okay. 156 00:06:20,489 --> 00:06:22,103 Hey, hey, hey, Ryan. 157 00:06:22,329 --> 00:06:23,898 What's up, buddy? Talk to me. 158 00:06:24,122 --> 00:06:26,419 - It was an Ultra Blaster. - Oh, yeah? 159 00:06:26,504 --> 00:06:28,465 Triple action with the slam-fire? 160 00:06:29,008 --> 00:06:31,615 - Uh-huh. - Sweet. Yeah. 161 00:06:31,852 --> 00:06:33,388 "I'm sorry, Doctor"? 162 00:06:34,082 --> 00:06:35,701 Todd, you want to take him for a walk to the truck? 163 00:06:35,785 --> 00:06:37,747 Give him his meds. Okay, go with Dad. Go. 164 00:06:42,179 --> 00:06:45,229 Oh, man. Tough day, huh, bro? 165 00:06:45,314 --> 00:06:46,802 He has ADHD. 166 00:06:47,016 --> 00:06:48,529 Yeah, we have him on Adderall, 167 00:06:48,630 --> 00:06:50,622 but we keep upping the dose, 168 00:06:50,707 --> 00:06:52,661 and some days are just a little tough. 169 00:06:52,746 --> 00:06:54,263 I know. It's okay. 170 00:06:55,191 --> 00:06:57,672 What about you? How you doing? 171 00:06:58,674 --> 00:06:59,895 I'm fine. 172 00:07:00,526 --> 00:07:01,716 You sure? 173 00:07:03,175 --> 00:07:04,875 Okay then. 174 00:07:04,975 --> 00:07:06,763 For now, we're gonna keep applying pressure 175 00:07:06,863 --> 00:07:08,997 and get you all stitched up. Shouldn't be too long. 176 00:07:15,311 --> 00:07:18,154 Hey, Mags, I need somebody to throw stitches in six. 177 00:07:18,239 --> 00:07:19,243 I'm on it. 178 00:07:19,328 --> 00:07:20,592 You already have two patients up. 179 00:07:20,676 --> 00:07:21,724 - You sure you have time? - Don't worry. 180 00:07:21,808 --> 00:07:23,027 I got it. 181 00:07:31,679 --> 00:07:33,521 - Rough morning, huh? - Yeah. 182 00:07:33,606 --> 00:07:35,044 It's a tricky family dynamic. 183 00:07:35,129 --> 00:07:36,661 I'm treating a 10-year-old named Alex. 184 00:07:36,746 --> 00:07:37,794 His brother has ADHD. 185 00:07:37,879 --> 00:07:39,419 Seems like it's pretty tough on them. 186 00:07:39,504 --> 00:07:40,154 Yeah. 187 00:07:40,239 --> 00:07:41,704 Takes up a lot of the family's energy. 188 00:07:41,788 --> 00:07:43,097 Oh, yeah. 189 00:07:43,182 --> 00:07:45,756 Parents so focused on... on the kid with the illness 190 00:07:45,841 --> 00:07:47,755 that they see right through the other one. 191 00:07:47,844 --> 00:07:49,763 Yeah, unfortunately not at all uncommon. 192 00:07:49,848 --> 00:07:51,767 There's even a name for it. It's called... it's called 193 00:07:51,851 --> 00:07:53,310 glass child syndrome. 194 00:07:53,395 --> 00:07:55,574 Oh, that sounds like exactly what's happening. 195 00:07:55,659 --> 00:07:57,925 Yeah, happy to provide you with a couple referrals 196 00:07:58,010 --> 00:07:59,407 for a therapist for the... for the kid 197 00:07:59,491 --> 00:08:00,931 if you think the parents'll be open to it. 198 00:08:01,015 --> 00:08:02,107 I think that'd be great. Thanks. 199 00:08:02,191 --> 00:08:03,802 Oh. 200 00:08:03,988 --> 00:08:05,162 Dr. Choi, I've been bugging him 201 00:08:05,246 --> 00:08:07,022 for an update on his rehab. I better take this. 202 00:08:07,106 --> 00:08:09,226 Go ahead, man, and tell him I look forward to meeting. 203 00:08:09,427 --> 00:08:10,427 Will do. 204 00:08:11,882 --> 00:08:13,607 I understand this must be hard for you, 205 00:08:13,692 --> 00:08:15,611 but that's the very reason I can't let you go in there. 206 00:08:15,695 --> 00:08:17,613 I appreciate your concern, but I'm fine. 207 00:08:17,803 --> 00:08:19,590 - Dr. Blake. - Ms. Goodwin. 208 00:08:19,675 --> 00:08:22,255 You know very well it's against hospital policy 209 00:08:22,340 --> 00:08:23,771 to operate on a family member. 210 00:08:23,856 --> 00:08:25,905 I am perfectly qualified to perform this surgery. 211 00:08:26,262 --> 00:08:28,232 Pamela, you are a transplant surgeon. 212 00:08:28,317 --> 00:08:29,931 Dr. Archer and I see these cases every day. 213 00:08:30,015 --> 00:08:31,677 And I make more money for this hospital 214 00:08:31,762 --> 00:08:34,943 - than any other doctor here. - That is not the point. 215 00:08:35,830 --> 00:08:38,950 Dr. Archer is a top trauma surgeon. 216 00:08:39,475 --> 00:08:42,568 He will do an excellent job. 217 00:08:43,332 --> 00:08:45,724 I will, and if you're so inclined, 218 00:08:45,809 --> 00:08:47,683 I'd be happy to have you observe. 219 00:09:00,693 --> 00:09:02,372 - Ryan. - Ryan... 220 00:09:02,457 --> 00:09:04,466 Can you sit still for just one minute? 221 00:09:05,309 --> 00:09:06,922 I'm gonna go get some air. 222 00:09:07,320 --> 00:09:08,615 Yeah. 223 00:09:13,391 --> 00:09:15,353 Will, can I get your opinion on something? 224 00:09:15,632 --> 00:09:17,810 Sure. What's going on? 225 00:09:17,895 --> 00:09:19,575 I've got a 71-year-old woman 226 00:09:19,702 --> 00:09:21,513 who's hypotensive and tachycardic. 227 00:09:21,598 --> 00:09:23,211 Passed out this morning at home. 228 00:09:23,352 --> 00:09:25,646 No medical history other than asthma. 229 00:09:25,731 --> 00:09:27,458 She could use some cardiac monitoring, 230 00:09:27,543 --> 00:09:29,183 and I know that you're big on the Vas-COM. 231 00:09:29,341 --> 00:09:30,650 Well, I mean, there are a number 232 00:09:30,735 --> 00:09:33,708 of good cardiac output monitors. 233 00:09:34,098 --> 00:09:36,325 But the Vas-COM is a terrific device. 234 00:09:36,555 --> 00:09:38,517 You mind if I, uh, have a look at her? 235 00:09:38,664 --> 00:09:40,704 - See if she's a good candidate? - Yeah, yeah, sure. 236 00:09:44,184 --> 00:09:45,974 Eleanor, Ron, this is Dr. Halstead. 237 00:09:46,059 --> 00:09:47,013 Hi. 238 00:09:47,110 --> 00:09:48,538 He's just going to ask you a few questions. 239 00:09:48,622 --> 00:09:50,599 - Nice to meet you. - You have to help her. 240 00:09:50,684 --> 00:09:51,661 Ellie, tell him, 241 00:09:51,746 --> 00:09:53,404 you've never been sick a day in your life. 242 00:09:53,497 --> 00:09:56,294 - Ron... - No, no, that's good to hear. 243 00:09:56,619 --> 00:09:58,520 - You mind if I? - Mm-hm. 244 00:09:58,605 --> 00:09:59,954 Make a fist. 245 00:10:01,104 --> 00:10:03,066 And release. 246 00:10:03,407 --> 00:10:04,474 Good. 247 00:10:04,625 --> 00:10:06,196 Does she have any sensitivities or allergies? 248 00:10:06,280 --> 00:10:08,099 Recent injuries, meds that would interfere 249 00:10:08,184 --> 00:10:10,538 - with an arterial line? - Just seasonal allergies. 250 00:10:10,718 --> 00:10:13,105 Okay. Eleanor, do you ever have any trouble 251 00:10:13,190 --> 00:10:15,804 - when you get your blood drawn? - I don't think so. 252 00:10:16,388 --> 00:10:19,847 What about leg swelling? Long car rides, trips? 253 00:10:20,150 --> 00:10:22,160 No, not that I can remember. 254 00:10:24,076 --> 00:10:25,211 That's good. 255 00:10:25,687 --> 00:10:27,808 All right, it was nice to meet you. 256 00:10:27,893 --> 00:10:29,886 I'll have a chat with Dr. Hammer. 257 00:10:29,971 --> 00:10:31,146 We'll be right back. 258 00:10:33,484 --> 00:10:35,344 What do you think? She look good for the Vas-COM? 259 00:10:35,428 --> 00:10:36,650 Uh, maybe. 260 00:10:36,735 --> 00:10:38,392 She was a little vague in her answers. 261 00:10:38,477 --> 00:10:39,526 But she definitely should have 262 00:10:39,610 --> 00:10:41,092 her cardiac output monitored? 263 00:10:41,177 --> 00:10:42,777 Dr. Hammer, if you're interested, 264 00:10:42,862 --> 00:10:44,128 I could give you copies 265 00:10:44,213 --> 00:10:47,590 of the Vas-COM's FDA-approved usage criteria? 266 00:10:47,875 --> 00:10:49,808 You know, that... that won't be necessary. 267 00:10:49,893 --> 00:10:51,988 I think Eleanor would be a great candidate. 268 00:10:52,073 --> 00:10:54,340 Okay, good. I'll get it set up. 269 00:11:01,199 --> 00:11:02,894 - Dr. Scott. - Alex? 270 00:11:02,979 --> 00:11:04,549 - Dr. Taylor. - Buddy? What? 271 00:11:04,634 --> 00:11:06,421 - Alex. - Bud... 272 00:11:06,506 --> 00:11:09,402 - Excuse me. - Honey, honey? 273 00:11:09,489 --> 00:11:11,652 - What... what's happening? - He's having a seizure. 274 00:11:11,768 --> 00:11:14,382 Give him 12 liters of O2 and .five of Ativan. 275 00:11:14,467 --> 00:11:16,342 Wait, seizure? Why is he having a seizure? 276 00:11:16,427 --> 00:11:17,562 I'm not sure yet. 277 00:11:17,647 --> 00:11:18,777 Come on. 278 00:11:19,503 --> 00:11:22,230 Come on, come on, come on, come on. 279 00:11:30,667 --> 00:11:33,238 Hey, Alex, you with me? 280 00:11:33,323 --> 00:11:34,849 Uh-huh. 281 00:11:35,064 --> 00:11:36,677 Okay. 282 00:11:42,510 --> 00:11:44,582 We're gonna figure this out as soon as we can. 283 00:11:44,667 --> 00:11:46,058 Dr. Taylor. 284 00:11:48,606 --> 00:11:51,176 Hi, hi, okay. It's okay. 285 00:11:51,261 --> 00:11:53,093 Has that cut been bleeding like that the whole time? 286 00:11:53,177 --> 00:11:54,922 I tried holding pressure, but it didn't work. 287 00:11:55,006 --> 00:11:56,316 And if I would've tried to stitch too soon, 288 00:11:56,400 --> 00:11:57,355 he would've got a hematoma. 289 00:11:57,440 --> 00:11:58,401 He could have a bleeding disorder. 290 00:11:58,486 --> 00:11:59,636 Did you order coags? 291 00:11:59,721 --> 00:12:02,715 - Um, well, no. I... - Get a coag panel, Maggie. 292 00:12:02,800 --> 00:12:04,631 And let CT know we're on our way. 293 00:12:04,880 --> 00:12:07,254 Wait, do you think he could have a subdural hematoma? 294 00:12:07,339 --> 00:12:09,457 Yes, and if he does have a bleeding disorder, 295 00:12:09,542 --> 00:12:11,026 then the trauma from getting hit in the head 296 00:12:11,110 --> 00:12:12,223 could've caused a bleed in the skull, 297 00:12:12,307 --> 00:12:14,160 which means he could herniate at any moment. 298 00:12:14,253 --> 00:12:15,926 All right, now. Let's go. 299 00:12:19,278 --> 00:12:20,808 Oh, my God. 300 00:12:24,472 --> 00:12:26,769 Okay, ready to release the pringle. 301 00:12:26,856 --> 00:12:29,770 Hold on, I didn't get a good look at the duodenum. 302 00:12:29,855 --> 00:12:32,059 - It's clear. - Okay. 303 00:12:32,144 --> 00:12:33,622 All right, pulling back on the lap. 304 00:12:35,443 --> 00:12:36,504 Looks good. 305 00:12:37,870 --> 00:12:39,372 What's her pH and temp? 306 00:12:39,457 --> 00:12:41,708 7.34 and 36.9. 307 00:12:41,793 --> 00:12:43,700 All right, looks like you're good to close. 308 00:12:43,785 --> 00:12:47,315 Uh, actually, we're just gonna pack and leave her open. 309 00:12:47,956 --> 00:12:49,473 No, her bleeding's under control. 310 00:12:49,558 --> 00:12:51,614 - Packing her isn't necessary. - I disagree. 311 00:12:51,699 --> 00:12:53,333 She's got a grade four liver laceration. 312 00:12:53,418 --> 00:12:54,919 The risk of re-bleeding is too high. 313 00:12:55,004 --> 00:12:56,614 She's a healthy 28-year-old. 314 00:12:56,699 --> 00:12:58,263 Leaving her open puts her at increased risk 315 00:12:58,347 --> 00:13:01,114 for infection, coagulopathy, hypothermia, and acidosis. 316 00:13:01,199 --> 00:13:03,027 - Dr. Blake, I... - Close her up, doctor. 317 00:13:03,111 --> 00:13:05,903 - I understand your concerns. - No, no, point well taken. 318 00:13:05,988 --> 00:13:07,989 I see the merit in what Dr. Blake is saying. 319 00:13:08,074 --> 00:13:09,326 - Dr. Archer... - All right, hold off 320 00:13:09,410 --> 00:13:11,544 on the lap. I need Celox, Gelfoam, 321 00:13:11,629 --> 00:13:14,341 and get an O Max and suture for Dr. Marcel. 322 00:13:14,426 --> 00:13:16,722 - Dr. Archer, you... - Dr. Marcel. 323 00:13:20,924 --> 00:13:23,104 Mr. and Mrs. Miller, I'm Dr. Charles. 324 00:13:23,189 --> 00:13:25,089 I had been consulting 325 00:13:25,174 --> 00:13:27,635 with... with Dr. Scott on Alex's case. 326 00:13:27,720 --> 00:13:29,964 - Psychiatry? - Head injury. 327 00:13:30,049 --> 00:13:31,901 You know, can't be too careful. 328 00:13:31,986 --> 00:13:34,229 Anyway, Dr. Scott wanted me to let you know that 329 00:13:34,314 --> 00:13:36,854 Alex's scans are almost ready. And in the meantime, 330 00:13:36,939 --> 00:13:38,043 is there anything I can get you? 331 00:13:38,127 --> 00:13:39,676 - A bottle of water? - Thank you, but we're fine. 332 00:13:39,760 --> 00:13:40,455 Yeah. 333 00:13:40,539 --> 00:13:42,370 Oh, sorry. This is work. 334 00:13:42,455 --> 00:13:43,970 Um, don't forget to text my parents. 335 00:13:44,055 --> 00:13:45,572 - Excuse me. - Oh, okay. Yep. 336 00:13:46,458 --> 00:13:48,432 Ryan? Is it Ryan? How about you, buddy? 337 00:13:48,517 --> 00:13:50,768 - Can I get you something? - Do you mind if I... 338 00:13:50,853 --> 00:13:52,035 - No, not at all. - Okay, I'll be right back. 339 00:13:52,119 --> 00:13:53,767 Not at all. 340 00:13:54,564 --> 00:13:58,213 Would you, uh, like a sandwich or something? 341 00:13:59,970 --> 00:14:02,216 No? Bag of chips? 342 00:14:02,595 --> 00:14:05,182 Soda? Anything at all? 343 00:14:05,267 --> 00:14:07,744 No! You interrupted me. 344 00:14:07,845 --> 00:14:10,815 - Oh, I'm sorry. - I, uh, I... I didn't mean to. 345 00:14:10,900 --> 00:14:13,369 Now I have to start all over again. 346 00:14:13,791 --> 00:14:16,964 Oh, you were counting. Huh? 347 00:14:17,049 --> 00:14:20,033 Okay, well, I'm... again, I'm very sorry. 348 00:14:20,181 --> 00:14:22,135 You... you get back to that. All right? 349 00:14:23,760 --> 00:14:28,464 Mr. and Mrs. Miller, we just got Alex's test results back. 350 00:14:28,549 --> 00:14:30,534 Alex is stable right now, 351 00:14:30,619 --> 00:14:34,447 but the scan did confirm that he is bleeding into his brain. 352 00:14:35,333 --> 00:14:37,417 And the intracranial pressure is great enough 353 00:14:37,502 --> 00:14:40,596 that he needs immediate surgical evacuation. 354 00:14:40,681 --> 00:14:41,768 Oh, my God. 355 00:14:41,853 --> 00:14:43,257 Wait, wait, wait. How'd this happen? 356 00:14:43,341 --> 00:14:45,854 Well, his test results came back positive 357 00:14:45,939 --> 00:14:49,174 for a bleeding disorder called Von Willebrand disease. 358 00:14:49,353 --> 00:14:52,378 So the impact from a small toy could've caused a bleed 359 00:14:52,463 --> 00:14:55,025 that his body just wasn't able to stop. 360 00:14:55,799 --> 00:14:56,966 I... I know this is a lot, 361 00:14:57,050 --> 00:14:58,968 but Dr. Abrams will be doing the surgery, 362 00:14:59,052 --> 00:15:00,448 and he's our very best. 363 00:15:00,674 --> 00:15:02,146 The procedure shouldn't be that long. 364 00:15:02,230 --> 00:15:04,551 I'll be here for status updates or if you have any questions. 365 00:15:04,635 --> 00:15:07,112 And if we have your consent, 366 00:15:07,197 --> 00:15:08,464 we could get started right away. 367 00:15:08,549 --> 00:15:09,667 - Sure. - Yeah, of course. 368 00:15:09,752 --> 00:15:10,885 - Whatever you need. - Okay. 369 00:15:10,970 --> 00:15:12,207 So why don't I take you somewhere 370 00:15:12,291 --> 00:15:13,418 that's more comfortable to wait? 371 00:15:13,502 --> 00:15:15,675 Um, Ryan. Hey, buddy. 372 00:15:15,760 --> 00:15:16,918 Come on, buddy. We're gonna take 373 00:15:17,002 --> 00:15:18,162 a little walk, all right? 374 00:15:33,172 --> 00:15:34,870 Hey, I saw Eleanor's oxygenation 375 00:15:34,955 --> 00:15:36,393 and cardiac output are down. 376 00:15:36,478 --> 00:15:37,652 Have you gotten her labs back yet? 377 00:15:37,736 --> 00:15:39,521 Yeah; they don't show much. Mild infiltrates 378 00:15:39,606 --> 00:15:41,675 on her chest X-ray and some eosinophilia. 379 00:15:41,760 --> 00:15:43,439 Still don't know what's going on. 380 00:15:43,758 --> 00:15:45,128 I'm a little concerned. 381 00:15:45,213 --> 00:15:47,066 One of her fingers and two of her toes are going cold. 382 00:15:47,150 --> 00:15:48,767 Oh, could just be a vasospasm. 383 00:15:48,931 --> 00:15:50,642 That could be, but... 384 00:15:50,834 --> 00:15:53,073 Look, the major drawback to any arterial line, 385 00:15:53,158 --> 00:15:54,917 including the Vas-COM, is the potential 386 00:15:55,002 --> 00:15:56,112 for thrombus formation. 387 00:15:56,197 --> 00:15:57,371 So I-I think we should pull it out. 388 00:15:57,455 --> 00:15:58,650 Pull it out? 389 00:15:59,061 --> 00:16:01,393 I mean, thromboembolization in arterial lines 390 00:16:01,478 --> 00:16:03,207 is extremely rare, and it almost never occurs 391 00:16:03,291 --> 00:16:05,330 - this quickly. - I understand. 392 00:16:05,533 --> 00:16:07,650 I just think we should err on the side of safety. 393 00:16:08,635 --> 00:16:10,074 What? 394 00:16:10,392 --> 00:16:13,860 Is something going on? It's getting us great numbers. 395 00:16:13,985 --> 00:16:15,557 Keeping Eleanor's meds titrated 396 00:16:15,642 --> 00:16:17,560 and her pressure and heart rate optimized. 397 00:16:17,644 --> 00:16:19,355 Without it, we'd just be shooting in the dark. 398 00:16:19,439 --> 00:16:20,862 I know. I just want to make sure 399 00:16:20,947 --> 00:16:23,696 - we're using it appropriately. - I think we are. 400 00:16:23,907 --> 00:16:25,556 Let's just give it a little more time. 401 00:16:31,830 --> 00:16:33,760 - Dr. Archer. - Yeah. 402 00:16:33,845 --> 00:16:35,502 What the hell happened back there? 403 00:16:35,662 --> 00:16:36,666 What? 404 00:16:36,750 --> 00:16:38,621 Giving in to Dr. Blake like that. 405 00:16:39,840 --> 00:16:42,498 The surgery was a success, and if you'll excuse me, 406 00:16:42,582 --> 00:16:44,021 I have an ED to run. 407 00:16:44,353 --> 00:16:45,892 Hold on, Dean. 408 00:16:46,283 --> 00:16:47,800 You know, with that kind of injury, 409 00:16:47,885 --> 00:16:49,432 keeping her open is the right thing to do. 410 00:16:49,516 --> 00:16:52,237 Dr. Blake's reasoning was medically sound. 411 00:16:52,322 --> 00:16:53,947 I mean, I could argue it either way. 412 00:16:54,032 --> 00:16:55,602 - Oh, come on! - Crockett... 413 00:16:55,812 --> 00:16:58,601 hospital politics is a lot like the military. 414 00:16:59,072 --> 00:17:00,893 You put in your time. You do as your told. 415 00:17:00,978 --> 00:17:04,119 And eventually you can rise up to become a Dr. Blake, too. 416 00:17:11,283 --> 00:17:13,746 Hey, buddy. This is my friend, Dr. Charles. 417 00:17:13,830 --> 00:17:15,142 Hey, Alex. 418 00:17:15,227 --> 00:17:16,910 We just came to check in on you before your surgery, 419 00:17:16,994 --> 00:17:18,443 see if you had any questions. 420 00:17:19,335 --> 00:17:21,503 - Is this gonna hurt? - No, no. 421 00:17:21,588 --> 00:17:22,652 They're gonna give you some medicine. 422 00:17:22,736 --> 00:17:23,626 It's gonna put you right to sleep. 423 00:17:23,710 --> 00:17:24,736 You won't feel a thing. 424 00:17:25,650 --> 00:17:27,760 Even when they open my head? 425 00:17:28,564 --> 00:17:30,216 Next thing you know, you're just gonna 426 00:17:30,438 --> 00:17:32,747 wake up in recovery. We promise. 427 00:17:33,357 --> 00:17:34,622 Okay. 428 00:17:36,926 --> 00:17:38,427 Anything else on your mind? 429 00:17:39,146 --> 00:17:40,465 No. 430 00:17:45,427 --> 00:17:48,810 It's just, when they look inside my head, 431 00:17:48,943 --> 00:17:50,824 will they see my secrets? 432 00:17:52,801 --> 00:17:55,044 Uh, I don't think so. 433 00:17:55,224 --> 00:17:58,232 But if there is something on your mind, 434 00:17:58,348 --> 00:18:01,798 a lot of kids tell me that it's just better to get it out. 435 00:18:03,750 --> 00:18:05,404 This wasn't Ryan's fault. 436 00:18:05,520 --> 00:18:08,170 Oh, don't worry about that. Ryan's not in any trouble. 437 00:18:08,255 --> 00:18:09,669 No, I made him do it. 438 00:18:11,599 --> 00:18:14,295 I made fun of him, and I know if I did it enough, 439 00:18:14,380 --> 00:18:17,005 then he'd get really mad and hit me. 440 00:18:18,756 --> 00:18:19,958 Yeah? 441 00:18:20,636 --> 00:18:22,271 Why would you want him to hit you? 442 00:18:23,592 --> 00:18:24,911 Because... 443 00:18:26,997 --> 00:18:28,357 Because? 444 00:18:30,161 --> 00:18:31,868 If you got hurt, maybe 445 00:18:32,302 --> 00:18:34,302 Mom and Dad pay a little more attention to you? 446 00:18:37,380 --> 00:18:39,326 It was stupid. I shouldn't have done it. 447 00:18:39,411 --> 00:18:41,098 Hey, it's okay. 448 00:18:43,572 --> 00:18:46,357 Let's get you taken care of. All right? 449 00:18:47,837 --> 00:18:50,365 Alex, it's gonna be okay, buddy. 450 00:18:50,666 --> 00:18:52,929 You're gonna be fine. We'll see you in a bit. 451 00:18:55,818 --> 00:18:58,373 Man, listen, I deal with a lot of sick kids, 452 00:18:58,458 --> 00:18:59,722 but what do you do for this? 453 00:18:59,818 --> 00:19:03,217 So... kid with ADHD, control issues, right? 454 00:19:03,302 --> 00:19:05,631 - Random outbursts. - True. 455 00:19:05,716 --> 00:19:09,514 Yeah, but Alex knew he could only get Ryan to lash out 456 00:19:09,598 --> 00:19:11,734 if he backed him into a corner. That's not random. 457 00:19:11,818 --> 00:19:14,365 So, what are we looking at if this isn't ADHD? 458 00:19:14,513 --> 00:19:16,434 I think maybe an anxiety disorder. 459 00:19:16,518 --> 00:19:18,873 Oh, another misdiagnosis. Second in a week. 460 00:19:18,958 --> 00:19:20,748 And if I'm right, that misdiagnosis 461 00:19:20,833 --> 00:19:22,849 is causing this family a lot of problems. 462 00:19:26,202 --> 00:19:27,623 You have to come quick. 463 00:19:27,707 --> 00:19:29,471 Something's wrong with Ellie. 464 00:19:34,101 --> 00:19:36,568 - Eleanor, can you hear me? - Yeah. 465 00:19:36,678 --> 00:19:39,896 - Okay. - Squeeze my hand. 466 00:19:45,442 --> 00:19:47,812 What's happening? Why's she like this? 467 00:19:47,897 --> 00:19:49,772 She had a TIA, a mini-stroke. 468 00:19:49,935 --> 00:19:51,795 Start her on aspirin and clopidogrel 469 00:19:51,880 --> 00:19:53,147 and call for an MRI of her head. 470 00:19:53,232 --> 00:19:54,777 A stroke? What... what? Why? 471 00:19:54,861 --> 00:19:56,779 'Cause she's forming thrombi. They're blood clots 472 00:19:56,863 --> 00:19:58,695 in her vessels, and one's travelled to her brain. 473 00:19:58,779 --> 00:19:59,869 Oh, my God. 474 00:20:02,694 --> 00:20:04,787 Get a suture kit. We have to pull the Vas out. 475 00:20:04,871 --> 00:20:06,789 I'll call Dr. Hammer. Excuse me, Mr. Halt. 476 00:20:06,943 --> 00:20:08,428 - She's up in radiology. - No, no, no. 477 00:20:08,513 --> 00:20:09,269 Every minute that passes 478 00:20:09,353 --> 00:20:10,793 increases her risk of a major stroke. 479 00:20:10,877 --> 00:20:12,388 We have to pull it right now. 480 00:20:21,838 --> 00:20:23,915