04x02 - When to Let Go

[bunniefuu]

Truck 81, Squad 3, I need search teams.

It's a long way down. Can't we take the elevator?

Hey, you're in the way.

She's alive!

Casey, what's it looking like up there?

Mr. Halstead is in rough shape.

I need a hand.

Dad.

Mayday, mayday!

It's Stella... Kidd.

She took in a lot of smoke.

She was trying to save you.

♪ Got another wave of patients coming in.

Let's look alive! Monique, what do we have?

I triggered the mass casualty protocol.

Everyone's prepped and ready to go.

All right, let's continue to decompress the ED.

Get all non-critical admitted or discharged.

On it. All right, Doris, talk to me.

I'm getting real-time updates from the Office of Emergency Management.

All right, I want to know how many are still down at the scene and how many we've got coming.

Copy. All right, Dr. Manning.

Status on your burn patient?

I need to get her up to the OR to have her burns excised.

Have you been able to reach her parents?

We're still trying to track them down.

Poor kid.

Maggie.

You page Dr. Rhodes for my dad?

He's coming down in five.

Hey, how are you guys doing?

Choi kicked us out.

Yeah, he needs room to work, Kelly.

Try to be patient.

Get her on the vent and make sure she's 100% oxygenated.

Right.

She's waking up.

Push 4 milligrams of midazolam.

Whoa, easy, easy.

Easy, easy.

All right. - Easy, Stella.

BP and heart rate are stable. She's settling down.

Draw a blood gas with carboxyhemoglobin.

Yes, Doctor.

Hey... what's happening?

Her vitals are holding, but she's in pretty bad shape.

We're running some tests and should know more soon.

Blood pressure and sats are dropping.

All right, she's bleeding in her airway.

Hang a unit on the rapid transfuser, suction her ET tube, and get a chest X-ray.

Yep.

♪

Pop tried to play hero.

He forgot he was in his 60s with a bum ticker.

Yeah, well.

This is your fault to begin with.

Yeah.

Stick me in that fire trap. Pop, stop talking.

You said you liked the place.

Just about.

Easy.

Paramedics said you were complaining of chest pain.

Did you forget you had a quadruple bypass a few weeks ago? Come on, stay still.

Hey, if it isn't my favorite patient.

How you doing, Mr. Halstead? Fine.

So you felt some tightness in your chest, huh?

It's nothing. Well, you might be right.

I don't see any ST elevation or depression.

No left access deviation.

Looks like a strong and healthy heart to me.

Nope, not yet.

You still have a pretty nasty inhalation injury.

Can I get a CBC, CMP, and a carboxyhemoglobin?

And add a full cardiac workup.

Dr. Choi needs a consult.

Yeah. Mr. Halstead, a pleasure as always.

Thank you, Connor.

I don't need all this.

Calm down, you're getting yourself worked up.

You're no doctor.

Pop. - Forget it.

You had no right to sell my house.

You want to talk about this again?

It was a wreck. You couldn't take care of the place.

You just wanted my money. Hey.

You don't have any money, you thankless old prick.

Whatever. - Jay.

♪ Blood's coming too fast.

Every time I suction the tube, it fills back up again.

Hang another unit and just do your best to keep up.

Here you go.

She's got a massive hemorrhage in her right lung.

It's impossible to say where it's coming from.

All right, call the blood bank, trigger the MTP.

First I've gotta find it.

Let's set up for a bronchoscopy.

Okay.

We're already maxed out on ventilators, and even if I brought more down, all my rooms are occupied.

I have nowhere to put these patients.

And Rhodes' pet project has us down a room.

This hybrid OR was a terrible idea.

I told you. Maggie, call Respiratory.

Tell them to send down as many vents as they've got.

Dr. Lanik, open up the doctors' lounge and the cafeteria and get them equipped for the overflow.

Maggie.

I need a nurse to help with some dressings.

Take Doris with you. She's with a patient.

She is too.

All right. Go down the phone tree again and get us more nurses.

Meanwhile, I'll give you a hand, Dr. Manning.

Thank you.

As soon as an operating room becomes available, your husband's gonna go into surgery.

Can I get you a bottle of water?

Yes, thank you. - Okay. Okay.

Damn it.

♪ Yeah. Yeah, yeah, fine.

♪ Happens when I don't eat. It's, uh...

Low blood sugar.

Of course.

♪ Dad's stable.

Why don't you go in and talk to him?

You know, make up? Well, he started it.

And thanks a lot.

We agreed that we were gonna sell that place and you just stood there. You didn't say anything.

What's the point in arguing with him?

He's old. He's sick. Just let it go.

That's fine for you to say. You're not the bad guy here.

Jay, come on. - No, seriously.

All those times you were away, and all those times you said that you couldn't leave the hospital, who took care of Dad?

Me.

I did plenty for Dad. I still do.

Who goes and checks on him?

Keeps him on his meds? Yeah, all right.

Tell you what. When he gets out of here, you find him his next apartment.

This is Leslie and Ryan Scott.

Blair's parents.

I'm Ms. Goodwin. This is Dr. Manning.

Hey. - We were both at work.

Heard there was a fire at the apartment, but... never expected this.

No.

We've given her medication to make sure she's comfortable.

You've got to save her.

We're going to do everything we can for her.

I've reviewed the imaging.

This is Dr. Bekker. She's a cardio thoracic surgeon we asked to consult.

One of your daughter's injuries is to her right carotid artery.

The artery is damaged.

It's blocking blood flow. Don't worry, I can repair it while her burns are being excised.

Is Blair going to... - No.

Blair's burns cover almost 80% of her body.

Once her blood pressure is stable enough, we will take her up to the OR to begin excision of her burn tissue.

I am afraid she will need to remain in the ICU for several months.

While the doctors continue to excise and graft her burns.

Yes, however, your daughter is going to need physical and occupational therapy to regain her ability to walk, talk, eat, even dress herself.

No...

We understand there are many challenges ahead, but with proper treatment and patience, Blair can recover.

♪ Oh, my baby.

Oh...

Hey, it's...

Take this one.

Got one more for you.

Hey, Maggie. This one... yeah.

I'm gonna get some air. You just, uh... you page me if there's anything happening with Stella, okay?

Will do.

Yeah.

Otis, you okay?

Get over here, Curly! Get me a gurney.

Ooh, let's take you down.

Easy, easy, easy.

Go get the gurney.

Yeah, I got this. I got it.

Stay with me.

Stay with me.

Stay with me. Stay with me.

I understand Otis had some kind of episode?

Yeah, looks like an inhalation injury.

I'm giving him a neb treatment.

Took blood to run an ABG.

He's doing much better, but he needs an extensive physical exam.

Dr. Choi, I need you.

You go ahead. I'll take a look at him.

Like to keep my chops up. Thanks.

We've got another burn victim coming in.

Desmond! Talk to me.

Early 20s, female, found down at the scene, unconscious due to smoke asphyxiation.

Intubated on the ride.

Mags, let's get her in a room.

Afraid it's the doctors' lounge.

Unless you want to go to the cafeteria.

Doctors' lounge. - Okay.

We were taking her to East Mercy, but they went on bypass.

No ID or identifying marks, so we're treating her as a Jane Doe.

Right here, right here. - Yep.

Let's transfer her on my count.

Everybody ready?

One, two, three.

Start a second IV and get her on the monitors.

Right away.

No gross deformities, but she's got some pretty nasty burns, including a full thickness, near circumferential on her lower left arm.

We need to get fluids in her.

Pull us 500 of ringers at 200 per hour. - Got it.

Wait, shouldn't we use Parkland?

Calculate fluid input based on percentage of burn area.

First 24 hours are critical.

We should start with a higher volume of fluid.

That's not standard procedure.

I've had experience with burns in the m*llitary.

We can always titrate down based on urine output.

Your party.

Thanks for that. - All right.

I really feel fine now.

You're a little tachycardic.

Can you feel your heart racing?

Yeah, it usually happens when I get a physical.

You know, what do they call it, white coat syndrome?

You know, doctors, needles... I hear you.

Probably why your blood pressure's a little high too.

You ever experience this before?

Yeah, a couple times.

Nothing serious.

You know. Smoke.

Right.

Ever happen when you're off duty?

I'm just going to, uh, make sure that you don't have a retinal burn, all right?

You don't have to go to all the trouble.

Just checking all the boxes, bud.

Will you close your eyes for me?

Doc Charles, my eyes feel good.

Just humor me.

Colors No.

Nothing.

Okay.

Okay.

Just sorry you had, uh... such a tough day at the office.

I heard there were a lot of victims.

We've got 16 critical patients, 24 stable, and a dozen more treated and released.

We've got the doctors' lounge and the cafeteria open and running for the overflow.

We've taken three down to the morgue.

We have two DOAs and one more that we weren't able to resuscitate.

Good work keeping the trains running.

Let me know if anything changes.

Will do.

Mags.

The burn patient we just brought in.

Early 20s, Latina, no ID, and no family.

Can we make some calls on a Jane Doe?

Yeah, I'll put out a bulletin and see what I can find out.

Thanks.

Dad!

He was talking just a minute ago.

No pulse. Bag him.

Wait, he's your dad.

Shouldn't another doctor run the code?

He's in V-fib.

Charge to 200 and give me the paddles.

Clear.

Still no pulse. Push a milligram of epi.

Got it.

♪ Charge to 200. - Charging.

Clear. - Clear.

Nothing. Another milligram of epi.

Yep.

♪

Hi.

Good news. An operating room has opened up.

We'll be able to take your daughter upstairs for burn surgery.

And to repair her carotid artery.

No. Please stop.

No treatments, no surgeries.

We don't want any surgeries.

I don't understand.

But if we don't take Blair up to the OR now, she won't survive.

My wife and I have talked about it.

Blair wouldn't want this.

But with proper treatment, she could still have a life.

Look at her.

What kind of life?

These last few years have been so hard for Blair.

She struggled with body issues, bullying.

Just recently, she was able to lose weight, change schools, and...

She finally felt good about herself.

And now this.

Everything she's been through...

We can't do this to her.

But... people react differently to trauma.

You don't know.

Surviving this might actually make your daughter more resilient.

We know our little girl.

Mr. and Mrs. Scott... - No.

We have to let her go.

♪ Dr. Manning should be clear about the parents' wishes before calling me in to consult.

It was a waste of my time.

They're withholding treatment.

How long before you restored sinus rhythm?

He was down around five minutes.

Well, that's consistent with what I'm seeing.

Almost no EEG waveforms.

Are we not seeing some brain activity?

Artifacts.

Distortion, interference. Dust on the window.

Okay, I am... I'm not following.

Your father's brain-dead.

♪ So he's just not coming back?

Like, you... you're saying that there's... there's no chance?

If I had to calculate the odds, I'd say 1,000 to 1 against.

This vent could be put to better use.

Are you serious? - Jay.

The hell is wrong with you, man?

Are you kidding me? We'll talk about it.

Thanks, Sam.

♪

She's lost a significant amount of blood.

Unfortunately, the only way we can be sure to completely stop her bleed is to remove her entire lung.

Yeah.

Kelly, it's the best chance we have of saving Stella's life.

She can't be a firefighter if she only has one lung.

There's gotta be something else you can do.

April?

It would rest her lung so we have enough time to locate the bleed... - No.

We'd have to give her anticoagulants to keep the lines open.

It would make her bleed even worse.

She's too unstable.

Believe me, Kelly, this is the best course of action.

Sounds to me like you've thrown in the towel before you even tried to save her lung.

Being a firefighter is the only thing Stella cares about.

I'm not gonna let you do it.

I'm sorry.

But it's not up to you.

We haven't been able to reach her family, so it's our decision.

Get her upstairs.

I won't let you do this. Kelly, please.

No. No. Kelly, you have to let me...

No! No. - Get off! Hey!

Security!

No!

Kelly... - Come on!

Ethan...

Please escort this man out. Ethan.

Sir, come with us. Don't... don't touch me.

I'm sorry, Kelly.

Don't do this.

Please, sir.

♪

Excuse me.

I was at the fire and, uh, I thought I was fine, but, um...

I have a headache now and I'm feeling a little dizzy.

Fill this out and we'll get to you as soon as we can.

I appreciate it.

Thank you.

Hey, Mags.

Any luck on ID'ing my Jane Doe?

Nothing yet.

I don't like that guy, man.

I want a second opinion.

He's our top neurosurgeon.

So all your degrees, all that money, all those years in school, this is the best you can do?

Jay, Dad almost d*ed two years ago.

He's been living on borrowed time.

Abrams didn't say Dad had no chance.

1,000 to 1 is no chance.

I'm trying to be realistic.

I've seen a lot of patients in his condition.

There goes that doctor voice.

I'm sorry, but I am a doctor.

Yeah, don't worry, we got that message.

And Dad knew you thought you were better than us.

We always came in second, you weren't there, and now you want to decide what happens?

That is not true, Jay.

There you are.

Ms. Garrett, this is my brother, Jay.

Yes. I'm the hospital's COO.

I heard about your father.

I'm very sorry.

Thank you.

I want you both to know that there's no hurry in making any decisions about Mr. Halstead.

You have the full support of this hospital.

And we will provide your father with any and all resources.

I appreciate that.

We take care of our own.

This... is my cell phone.

You call me if you need anything.

♪ It's decided.

We're not giving up.

♪ Dr. Manning.

I have the consent form.

They're gonna let her die.

I don't think it's that simple.

You ready?

♪

Mr. and Mrs. Scott, per your request, this form gives the hospital consent to remove Blair from the ventilator.

I need you to sign it in my presence.

♪

♪

We'll leave you with your daughter.

♪

Kelly.

They shouldn't have done that to you, man.

All I care about is Stella.

She's lucky to have you.

She loves what she does, April.

It's her life. They can't take out her lung.

I get it.

But since we can't reach her family, it's up to the doctors to make the decision.

But they don't know her.

There's nothing we can do?

Hey. There you are.

I just heard about your dad.

Are you okay?

Just hard to believe.

He was such a force.

Not good.

They're a lot alike.

Stubborn. Gwen didn't help.

I mean, she said she would use the hospital's resources to keep Dad alive.

That doesn't sound like her.

Yeah, it surprised me too.

I love you.

Let me know if there's anything I can do, okay?

Here are the ABG results for Brian Zvonecek.

Thank you. - You're welcome.

Doc Charles.

Mr. Zvonecek.

See, here's the thing.

Your blood gas shows low CO2, low carboxyhemoglobin, and normal oxygen.

Well, what it means is that you didn't have an inhalation injury.

More than likely, you passed out because you were hyperventilating.

Huh.

All the same, I'm not sick.

Okay, but... why were you hyperventilating?

You know, when we can't find a physical reason, more often than not, it's... you know, due to an emotional reaction to some sort of... Wait, wait, wait, wait.

Where you going?

What, PTSD? I didn't use that label.

I'm just saying it would explain... the tachycardia, the elevated blood pressure...

No. No way.

Full disclosure, I noticed a little hand tremor earlier today.

But I told you, that was my blood sugar.

Otis.

You were sh*t earlier this year.

I mean, that alone, it's gonna precipitate a little post-traumatic stress.

And that I can tell you from personal experience.

And after what you went through today, I mean, why don't you let me take you upstairs for a quick evaluation? - No.

I get it.

You're a shrink, so everybody you see has got to have some sort of mental problem, right?

But not me.

I feel great.

I'm trying to help you. There's just been...

Dr. Rhodes.

Sorry, guys, I gotta get scrubbed.

We just want to talk to you about Stella.

Really, April?

Just hear them out.

We don't want you to remove her lung.

There has to be another option.

Look, guys, I understand your concerns.

But as her doctors, we've decided on the best course of treatment, and only Stella's family can override that decision.

Dr. Rhodes.

We are her family.

That's true.

She'd tell you the same thing, Doc.

♪

Another walk-away.

♪

There's another way.

The majority of lung bleeds originate in the lower lobes, right?

So what if I clamp at the base of the pulmonary artery?

Connor, you made the right call.

We have a good surgical plan.

But what if we resect the lower lobe first?

If the bleeding stops, we won't have to remove the entire lung.

No, it's too risky.

If it doesn't work, we can still remove the lung.

After wasting precious time.

Have you forgotten we're trying to save her life?

I think we can do that and give her the life that she wants.

She's a young woman. She can find another career.

I have to try.

I owe it to her. I owe it to them.

Connor, being a firefighter isn't gonna mean a damn thing if Stella dies on the table.

♪ I can do it. Don't... Connor!

♪

Time, Dr. Rhodes. Where are we?

I'm almost there, but every time the lung inflates, it obstructs my view.

Marty, can we deflate the lung any further?

No way. I'm barely keeping her oxygenated as it is.

Take it down another 20%.

It's too risky.

I only need to reach the lower lobe.

I'll find the bleed and make my resection before you know it.

Make it fast.

You're quite the patient advocate today.

Did you do it for Stella or for Kelly?

I've known him since we were kids.

You didn't answer the question.

I did it because it was the right thing to do.

BP's down to 88 systolic.

I'm close.

Let's hope so.

You are not going to make it.

We have to open her up and remove the lung.

BP's at 82. - Up her pressers.

Can't, I'm already maxed out. Connor, please.

Just give me a second.

Sats are at 78. That's all she can tolerate.

I'm reinflating the lung.

No, wait. There.

That's it. That's the bleed.

You found it, but do you have time to fix it?

Her hand's ice-cold. I can't get a pulse.

The forearm's tight. She's got compartment syndrome.

Get Maggie. - Yeah, on it.

I told you to use the Parkland formula.

You gave her too much fluid. No.

I've been monitoring her urine output.

Everything's been normal.

Then what's your explanation for this?

Find us an OR.

This woman needs an emergency fasciotomy.

I'll tell you right now all the ORs are occupied.

You're gonna have to wait.

We can't.

20 minutes, she'll end up with an amputation.

Get me a soft tissue tray and a scalpel.

We'll relieve the pressure now.

Right here.

Prep the patient.

Come in.

Ms. Goodwin.

Oh, Dr. Halstead.

I'm very sorry about your father.

Gwen Garrett made a special point of telling me and Jay that there was no hurry in taking my dad off the vent.

My dad's chart. His bypass surgery was 29 days ago.

29 days ago.

I see.

I can't believe the hospital would do this.

Not to me.

Not to my family.

♪

Hey, Jay.

We gotta take Dad off the vent.

No, no, no. He...

I've been sitting with him, and he blinks his eyes.

And I grabbed his hand, and he squeezed my hand.

He squeezed my hand.

Those are just reflexes.

They don't mean anything.

I'm telling you, man, he knows that I'm here.

He doesn't.

He can't.

We can't. He's...

He's gotta come back, man, 'cause... that can't be the last conversation I ever have with him.

Look, whatever regrets you have, you're not gonna resolve them here.

You just gotta accept that.

Don't tell me what I got to accept.

Jay, the reason Gwen encouraged us to take our time with Dad?

His bypass was 29 days ago.

If he dies before 30 days are up, regardless of why, it's a fatality for the hospital.

So Gwen's just trying to keep Dad alive for one more day so the hospital doesn't take the hit.

I get it. You feel betrayed.

I don't care. I care about Dad.

And you think he'd want to be kept alive to buff some numbers?

You need to get out. You got to get out, man.

They're using him.

That's your problem.

Jay, he's gone.

♪

Gotta be honest, I'm just not comfortable signing off on you going back to work yet.

You're gonna keep me from working.

Look, I'll make you a deal.

Commit to some therapy.

Twice a week. Once a week.

You don't get it.

I can't be a firefighter if I have PTSD.

What, you can't be a firefighter and have feelings?

Look, I have no problem keeping this out of your chart if that'll make you feel better.

If I see a shrink, people are gonna find out.

I can't have that.

Tell me something.

When I asked you to close your eyes earlier today, what did you see?

What'd you really see?

Otis, you can tell me.

Okay.

I had to get a mom and a baby out of the building.

I lost contact.

Told her not to get in the elevator.

She got in the elevator.

The elevator got stuck.

When we finally got the doors open...

There they were.

b*rned alive.

Their faces were gone, but I knew it was them.

I can't get it out of my head.

♪ It's called an intrusive memory.

I can help you with that.

Doc Charles...

It means life's not a... stroll across a meadow.

These things I see... they're part of the job.

Every firefighter sees them.

We cope.

♪ I'm out of here.

You want to destroy my life, write whatever you want in your chart.

♪

Yes. - We need you.

Veronica.

She's still breathing on her own.

Yes. Her oxygen levels are good.

It's been hours.

Her heart rhythm is strong.

She's holding on.

She wants to live.

My little girl, she wants to live.

And we were gonna let her go.

How can we help her?

She needs to go to surgery right now.

Do it. Help her.

Tell the OR we're coming up.

♪

♪ Scissors.

♪ Okay, pressure's been relieved, but that's not fluid.

It's blood.

Her ulna's broken.

That's what caused the bleeding.

Compartment syndrome was caused by a fracture hematoma, not fluid.

It wasn't your fault, Dr. Choi.

They found her just outside the room where the fire started, so how would she have broken her arm?

There's also extensive bruising around her ribs and pelvis.

This woman wasn't just b*rned.

She was beaten.

♪

You guys put me in a terrible position.

But... we were able to isolate the bleed, and we only had to take out a portion of her lung.

It was a thoracoscopic procedure, minimally invasive.

That's all to say that... she should be back to work in no time.

Oh, thank God. Hey... Dr. Rhodes... you're the man.

Yeah, you guys are okay too.

Thanks.

Why don't you bring Kelly back in?

Thanks, Doc. You got it, bud.

You were extremely lucky, you know that?

Extremely.

♪ Kelly.

She's awake.

Wants to see you.

♪

Stop.

I'm so glad you're back.

Of course.

♪

♪ Hey.

You okay?

I could have been a better son.

Could have been a better brother.

Oh, Will... your dad knew you loved him.

And so does Jay.

♪

Oh, no.

I got it.

Here you go. - Thank you.

♪

My uncle was in the building with the fire?

I thought they might have brought him here.

Okay, sir, so I'm gonna need you to go back into the waiting room and give the nurse your uncle's name.

She'll let you know if your uncle was admitted.

All right. - Thank you.

Thank you.

Yeah.

♪

Told you you were going home, huh?

No, I did.

Yeah.

He's in pretty good hands.

For now.

I'm sorry, Jay.

For everything.

For not being there for you and Dad.

And for not giving you space to grieve.

We'll keep him on the vent as long as you want.

I know he's not coming back.

♪ Let him go.

Just let him go.

♪

Take these too.

Yeah.

What happened to our Jane Doe?

♪ She turned off the monitors.

She has serious internal injuries.

If we don't find her soon, she's gonna die.

♪