01x01 - Derailed

[bunniefuu]

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[jazzy tune]

♪ ♪

[applause]

Thank you.

We owe a great debt of gratitude to one man in particular.

He championed us, supported us, and happily, along the way, befriended us.

Without his help, this incredible new emergency department would never have become a reality.

Our Mayor, Rahm Emanuel.

[applause]

Thank you.

On behalf of all the people of the City of Chicago, all the families, all the parents who will be bringing their kids and their family members here in dire need of care, I want to thank you ahead of schedule for what you do every day to making sure that everybody counts in the City of Chicago.

Thank you.

[applause]

[crash]

[overlapping shouting]

Sir, you okay?

You all right? Everybody okay?

Sir, can I see that for a second?

Can I see that for a second?

All right, it doesn't look too bad.

You're gonna be all right.

Call out if you need some help!

Miss, are you calling 911?

Yeah.

It's all gonna be all right.

[indistinct cries]

Take a look at that for a second?

All right, you're okay. Miss, is he doing all right?

All: Whoo!

[applause]

[cell phone rings]

[pager beeps]

[cell phones ringing]

[beeping]

[cell phones beeping]

[low chatter]

[cell phones ring]

[sirens wailing]

CFD Plan 2, mass cas.

Multiple trauma patients minutes away.

Let's go!

[sirens wailing]

[indistinct radio chatter]

What do we have?

45-year-old male, left leg amputation.

Treatment Two!

Train motorman. GCS 3. BP of 90 by palp.

Maggie, where we going?

Go to Trauma 4.

Maggie, I need the X-ray here.

I got you.

Crossing.

Whoa, whoa, hold it, hold it.

Watch out!

Katrina, how are all these walk-ins making it through?

Let's set a perimeter.

Let's get her into Treatment 2.

[siren wailing]

[groans]

He keeps biting down. I can't get the blade in.

Look, you bag him. I'll do CPR.

[grunting]

Come on. We're almost there.

It's not time yet.

[grunts]

Trigger all-hazard disaster plan.

Yes, ma'am.

Page to Phone Tree.

Right away.

28-year-old male, crush injuries, severed artery, massive blood loss.

Trauma Three just opened.

Got a tourniquet on his right leg.

Tried to intubate but couldn't get his jaw open.

He lost his pulse on the ride.

Put him on our monitor and rapid transfuser.

Grab 4 units of O-neg, and start with a round of Epi.

Already hit him with the Epi times two.

Still no pulse. He's in fib.

Let's get him in the bay. I got it from here, man.

Nope, he's mine.

Okay, who the hell is this guy?

Says he's a doc.

Get off the gurney, Doc. I'm Senior Resident in this ER.

Yeah? Well, I'm your new trauma fellow.

Dr. Halstead!

Female, early 20s, head trauma.

GCS 3, unresponsive in the field.

Trauma 2 just opened.

Still GCS 3.

We got to change that king airway to a formal ET tube.

I'll get a line in the groin.

[girl cries]

Where's your line?

Left AC, obvious femur fracture.

Good distal pulse. It's blown.

Sweetheart, we're going to take good care of you.

You have to go back for my daddy!

I love my daddy!

You know anything about that?

Pretty sure her father was loaded.

Must've been sent to Sinai or County.

Okay, sweetie, look, you see this lady right here?

Uh-huh.

Her name is Maggie.

She can find anybody, anywhere, okay?

I promise she'll find your daddy for you.

Better believe I will, hon.

Hold compressions.

[flatline tone]

You are?

Sarah Reese, fourth year med student.

Can you do a cordis in the groin?

Mm-hmm.

Get a left femoral in there.

Yes, sir.

There, you're sterilized. Now stick it.

He's a patient, not a pin cushion.

I can't find a vein.

All right. Shock to 120.

[power up whine]

Clear.

No pulse.

Again. 200.

Clear.

[heart monitor beeps]

I have a pulse. Sinus tach at 112.

And... he's back.

Get a BP and keep giving him blood.

Send a rainbow of tubes and a type and cross.

Get his blood gas and get him to the OR.

Did you find my dad yet?

We will, sweetheart. Don't you worry.

All right, now we're gonna put something in your arm to give you medicine. It's just gonna be be a little pinch, okay?

No, no, no!

Make a fist for me, honey.

Squeeze my hand.

Look at me. Squeeze my hand. gonna count to three.

Look at me.

One, two, three.

Ow.

All done. Good job!

Excellent.

There you go.

Excellent.

Let's get X-ray in here.

Yeah.

[machine beeps]

No gag reflex. Didn't even need sedation.

Not good.

We got another problem.

This woman's pregnant.

Dr. Rhodes, welcome. Oh, are you all right?

Yeah, I'm fine.

Sharon Goodwin.

Pleasure to meet you. Is every day like this?

Some days we're busy.

20-year-old male, cystic fibrosis.

Complaining of chills, labored breathing.

Temp's 98.

Jamie, is that you?

Hi, Maggie.

Back so soon?

I missed you guys.

Respiratory rate is 26.

Let's take him to Treatment 6.

All our ER docs are busy.

Can you take care of our friend?

No problem.

Maggie?

Yes.

Let Dr. Charles know that Jamie's down here.

Sure thing.

Deep breath.

[Jamie inhales, coughs]

Hey, Jamie.

Maybe today... wasn't such... a good day to drop in.

Oh, we always got time for you.

Let's get a CBC, a CMP, Coags, a chest X-ray, and an ABG.

Now, Mr. Dilson, I see that you're use inhaled antibiotics, Tobramycin, Albuterol.

You wear a vibration jacket at night and use a humidifier.

Yeah.

That's all good.

I caught... a cold.

A whopper.

Well, we got to make sure that it doesn't turn into pneumonia.

You've had a few episodes.

A few means... three.

[labored breathing] I've had... more.

Well, we're going to take good care of you here, okay?

You're at Northwestern?

Yeah.

Well, we better get you out of here quick so you don't miss those mid-terms.

Make a fist.

Hey, who's my next patient?

The Red Tags have all been handled.

Why don't you sit down for a minute?

You know, exercise is good for pregnant women.

Come on. Next patient.

All right. Treatment 1.

Thank you.

Crib party Sunday.

Crib party?

Maggie and I are gonna come by, help you put the baby's crib together.

I'll bring the Allen wrenches and deep dish from Kitchen 17.

You guys do not have to do that.

Not if you think that you're gonna do the single-mom thing all by yourself, not with us around.

Takes a village.

Thanks, guys.

I don't know what I'd do without you.

Why am I putting in this bolt?

Where's my good-for-nothing resident?

Put in her 12 hours. Had to knock off.

These new rules... ridiculous, and bad for medicine.

"Oh, I'm so tired. Oh, I can't work."

Everybody's so damn spoiled, the whole generation.

Gina? Gina! Oh, my God.

Mrs. Donahue...

What happened to her?

Dr. Abrams, Dr. Halstead, this is Mrs. Donahue, the baby's mother.

Thanks, Maggie.

You're the baby's mother?

Biological mother.

My husband Joel and I, he's... he's at work.

He's on his way here. We're the parents.

Gina's our surrogate.

Opening pressure's 18. I'm done.

Look at her. [sniffs]

Is she going to be okay... and the baby?

Baby checks out fine.

[gasps] Oh!

Healthy heartbeat.

Amniotic sac and placenta are intact.

Gina, though, I'm afraid, suffered a traumatic head injury and so far, she's unresponsive.

We need to contact her family, if you have any information.

My husband and I are pretty much her family.

She... she's been living with us since before the embryo was implanted.

Okay.

She's gonna get better, isn't she?

She's gonna be okay?

I can't promise anything.

[cries]

No, I can't believe this.

What about the baby?

It's too soon to deliver, isn't it?

She's only 24 weeks.

Yes, the baby needs more time.

What does that mean?

Are we gonna lose our child, too?

Oh, my God.

No, Mrs. Donahue.

I'm not saying that, and I'm not giving up on Gina, but if the worst did happen, it might be possible to keep her on life support long enough for the fetus to become viable.

So... so what, Gina just becomes... a human incubator?

We're not there yet.

Dr. Rhodes, I thought you could use these.

Thank you.

How'd that happen?

Must have snagged it on the wreckage.

You know, we do have a couple of doctors around here.

I could hook you up.

I don't need one, but I could use a nurse though.

Come be my other hand.

Oh, nice.

You closed that like a plastic surgeon.

Where'd you pick that up?

Riyadh.

Spent a year there after my residency.

Saudis paid me well not to leave unsightly scars.

Could you pinch those two sides together?

There we go.

What about a tetanus sh*t?

No, I am current, April, uh...

April Sexton.

English? Irish?

My family's from Brazil.

Our real last name is Sanguessuga, but my parents thought Sexton sounded more American, and people could actually pronounce it.

Where're you from?

Chicago.

Born and bred.

Been away for a while.

Welcome home.

Two and four. Three is headed to the OR.

All righty.

Who's young Rambo over there?

Hmm?

Oh, that's Connor Rhodes, the new trauma fellow.

Mm-hmm.

He's gonna light up some estrogen receptors around here.

I'll say. He lit mine.

Well, that's all I need.

Where's Jamie again?

Treatment 5.

[murmurs] a dream.

Your daughter's stable.

She has a pretty serious leg fracture, but she's okay, just a little shaken up.

The orthopedic resident is on his way to put a cast on her.

And what about my husband? I can't get any information...

We made some calls.

Your husband's down the road at Sinai.

They were able to stabilize him, but his injuries are serious.

The last word I had, he was headed into surgery.

How is this happening?

They were just going on a father-daughter day trip.

She wanted to go to the zoo. What...

Ms. Lewis, the best thing you can do right now is just be there for your daughter.

We'll keep checking on your husband, okay?

All right.

[machines beep]

There. You can see her feet and a hand.

Everything looks good, Mr. and Mrs. Donahue.

Oh, thank you for doing this. We just needed to see her again.

She... she just squeezed my hand.

I swear, I felt it.

Her reflexes are still intact.

Movement can occur, but it's not purposeful.

No, she... she just did it again, right when you wiped her stomach.

She responded.

Tell me that wasn't purposeful.

Dr. Troy, let's get a repeat CAT scan.

You haven't seen... even one?

Hand to God, J, I swear I keep meaning to.

I just...

You need another blanket here, buddy.

How many "Fast and Furious" movies are there anyway?

I mean, seriously.

Seven.

Yeah?

Yeah.

I got a lot of catching up to do.

Well, the last one's the best.

How about this?

I'm gonna start with the last and move back... deal?

[knock at door]

Okay.

Dr. Rhodes, dressed.

I'm Dr. Charles, Head of Psychiatry.

Welcome to Chicago Med.

Pleasure. Thank you.

You two know each other?

Old pals.

Known Jamie since he was... eight?

He taught me... how to play chess.

Big mistake. Beats me every time.

Not kidding.

[all chuckle]

Jamie, I've got your test results back.

I wish they were a little more encouraging.

You're pancytopenic, which means that your cell counts are low.

You've got a blood pH of 7.14, which means that you...

I know.

I'd like to intubate you, put you to sleep, get you on a ventilator.

You're getting fatigued.

This would just allow you to rest so that the antibiotics can do their job.

I've been intubated eight times.

I think I'll skip it.

All right. I'll check back in later, huh?

Hey.

Well, there's something I don't often see...

Will Halstead looking stumped.

Why is it brain injuries are never like you read in the textbooks?

My pregnant TBI patient, bilateral contusions.

She was a GCS 3. And now, all of a sudden, she's exhibiting movement, and she's improved to a 6.

Well, that's good news.

Yeah.

The baby's parents will be happy.

Oh, she's a... she's a surrogate.

Oh. Wow.

I don't know how they do that.

Carry a baby and then give it up?

I mean, I know it brings a lot of joy to other people, but still...

Thanks.

Yeah.

[groans]

You meet the new guy yet, Rhodes?

You could say that.

Likes to throw his weight around.

I don't know, strikes me as a little arrogant.

Hey, I am not arrogant.

No, no. Not at all.

You just happen to know more than anybody else.

Dr. Rhodes, this is Ms. Acosta.

She's the girlfriend of your patient, Jorge Melendez.

El Dr. Rhodes es el medio de Jor.

Ms. Acosta.

Your boyfriend has suffered severe injuries.

[speaking Spanish]

Esta en coma, pero estable.

[gasps] Coma?

Does he have any family that we could contact, familia?

No.

I am all he has.

El no tiene nadie.

[speaks Spanish]

[whispers] He speaks Spanish?

♪ But to me, you're as fair as you were, Maggie ♪
♪ When you and I were young ♪

Hey, Herrmann.

Hey, Herrmann.

[Herrmann giggles]

You boys hanging in there?

Well, you know, it's a train wreck.

Hm.

You?

Same.

Is that from the crash site?

Yeah, it's the first load.

Cell phones, shoes, wallets, purses.

Thank you.

You're welcome.

Jorge. [sobs]

We're keeping him cool to prevent fever.

Come on.

Oh, Jorge.

[sobs] Jorge.

[cries]

Jorge.

"Still, he was determined to make it. With an extra shovel of coal, he started up the hill. The little train had never faced such a long uphill climb before. He was glad that he was red and that none of the other trains could see him there."

Mrs. Donahue?

This is my colleague, Dr. Manning.

Hi.

We, uh, we read to the baby every night so she'll recognize our voices.

I do that, too.

Sherry?

Dr. Halstead?

Need to blow down her CO2, take her off the vent and bag her, give her a dose of Mannitol, and increase her Dopamine drip to 12.

Right away.

Doctor?

Gina's intracranial pressure is rising.

What does that mean?

You said that she was getting better.

Well, she is, in that her function was improving, but the swelling of her brain is getting worse.

We're gonna try to control it with medication.

And what if the medication doesn't work?

Then she'll require surgery.

The procedure's called a "decompressive craniectomy."

Would that be dangerous to the baby?

There is always a risk for the fetus, and for the mother as well, so, yes.

That's why we hope the medication does the trick.

[speaking softly]

Dr. Charles, Jamie has pneumonia, and if there's any hope of b*ating it, I need to get him on a ventilator now.

You heard what he said. He doesn't want that.

Well, we're past what Jamie wants.

No, you know what, Doctor?

We're actually not past what Jamie wants.

Kid has been so brutalized his entire life.

He has a right to say no.

Intubating Jamie is the only hope we have of keeping him alive.

What's that gonna give him? A week? Ten days?

It could be six months, a year, more, and in that time, anything could happen.

New treatments are coming along every day.

Now, is he on the list?

Right at the top, but a match is highly unlikely.

He has HLA antibodies from an islet cell transplant.

Well, have you spoken to his next of kin?

Have they weighed in on this?

There isn't anybody. Dad took off years ago.

His mom's an alcoholic, bounces in and out.

Look, Dr. Charles, you know what's gonna happen.

Jamie will lose consciousness, and as his doctor, I'm gonna put him on a ventilator, but by then it may be too late, and there won't be any more choices no matter what anybody wants.

I'm Sarah Reese.

I'm a fourth year medical student.

Um, Dr. Manning sent me in to check on Rachel before we sign her out.

This is for you.

Oh, thanks. What's his name?

Why don't you give him a name?

I need to... talk to your mom.

So, about your husband...

What?

No, no. He's okay. He's still in surgery.

The OR nurse says it's going well.

As soon as we hear something, I'll let you know.

Rachel?

Rachel, can you hear me? What is wrong?

What's happening?

I can't find a pulse.

Oh, my God.

Code Blue, Treatment 3.

Code Blue, Treatment 3.

Code... a little help here!

Code Blue, Treatment 3.

Code Blue, Treatment 3. Code Blue.

You're not compressing the heart, Sarah.

You gotta go harder.

But she's so small.

I don't want to...

Harder! Do it, let's go!

Come on, Sarah! Harder!

Hold!

There we go. Back in sinus. Get a BP.

What happened?

She arrested. We got her back.

I can't get an IV.

Hand me a drill. I'll get an IO line.

[saw whirs]

I got a line.

All right, let's get her a CT/PE study and up to PICU.

Mom, you can come with us.

Good job.

I-I just...

I just broke a little girl's ribs.

Reese, you saved the girl's life.

Jamie.

Huh?

You know more about CF than most doctors.

I'm an expert.

So you know what will happen if we don't put you on a ventilator.

[coughs]

Dr. Charles... it's okay.

[wheezy inhale] I've had a good life.

Whoa, whoa, whoa! [laughs]

What movie is that from?

[Jamie coughs]

No, no, no. Jamie, look at me.

It's me, your corner man.

You got a lot of fight left in you.

I'm not ready to throw in the towel.

One more round.

For you?

Yeah. For me.

Yeah, okay. Okay.

Mariana?

Hi. I'm Maggie.

This... this is Jorge's.

Entiendes?

Yes.

Inside... I found this.

"From J.M. to M.A."

You're not his girlfriend.

You're his fiancée.

Prometida.

Prometida.

Jorge.

[elevator bell rings]

Natalie, what happened with the little girl?

She had a cardiac contusion.

Bruising caused her to arrest.

She's good now, but it was a real scare.

Thank you.

Yeah.

Your comatose guy... seems like you'd want to put him on the hypothermic protocol and protect his brain.

Well, I just gave him 20 units of blood.

His pH is only 7.2, and he's too cold to make a clot, so I didn't see how the hypothermic protocol would help him.

Hey, you're the fellow. I'm just a resident.

Heard you're local. Me, too.

Where'd you grow up?

Lake Shore Drive.

[whistles] Nice.

Well, I doubt we have any friends in common.

Canaryville. Oh.

Where'd you go to med school? Johns Hopkins? Stanford?

No. I went to UAG.

Where's that?

Guadalajara.

Didn't see that coming. [phone beeps]

Got to go.

Her ICP is unresponsive?

Her CPP is 40.

Sherry, get me Dr. Abrams.

You... you're planning to do the surgery?

What about our baby?

The meds we've been giving Gina haven't been effective.

Her intracranial pressure, the brain swelling, is getting to a dangerous level, and we shouldn't wait any longer.

I'm not sure we can consent to that.

It's not really a matter of consent.

Well, actually, Doctor, it is.

We have a surrogacy contract with Gina.

A rider to that is a Medical Power of Attorney, giving us the right to make decisions on Gina's behalf.

I don't see how we can sign off on a procedure knowing it will endanger our child.

Mr. and Mrs. Donahue, Gina needs this surgery.

It's her only hope.

But it's not a guarantee she's gonna recover.

No, but without the surgery, I can guarantee she won't.

You would just allow her condition to worsen?

This is our child!

What would you do to save your child?

Code Blue, ICU. Code Blue, ICU.

Code Blue, ICU.

Jorge! [cries]

I'll take over!

Ma'am, I'm sorry, we need some more room.

[sobbing]

Hold compressions.

No pulse.

Sinus tach.

He's profoundly hypotensive.

Amp of Epi, max of Dopamine, max of Vaso.

You're gonna max him on pressors.

Don't have a choice. Pads.

That contract's obscene.

I mean, the Donahues control everything, what Gina can eat, drink, how much she sleeps, even what she wears.

We have to perform this operation.

Well, I'd advise against that because this is really comprehensive, and nicely drawn up, I might add.

The lady probably didn't even know what she was signing.

We can't prove that.

We can't just stand by and let her die.

I guarantee if we perform this operation, regardless of the outcome, we'll be sued, and they'll likely win, and millions.

And that's how we make our decisions?

By how much it's gonna cost us?

All right, get off the high horse, Dr. Halstead.

How about we call the Ethics Committee?

Be faster to call a judge, but I'm not gonna burn a favor on this.

This is ridiculous!

Why aren't you trying to help us?

He is, and you need to back off!

So much easier to run a hospital without doctors.

Please.

Jorge's brain was without oxygen for too long.

Paso much tiempo sin oxigeno.

Dead?

Si.

Su corazon sigue latiendo, pero el...

no esta aqui.

I'm so sorry.

[footsteps approach]

Mariana.

Mariana, this is Ms. Goodwin, our hospital administrator, and Yolanda Cruz from Gift of Hope.

They would like to speak to you.

Thank you, Dr. Rhodes.

Senorita Acosta, [speaking Spanish]

Let's get Mr. Melendez typed for organ donation just in case.

Keep him on the ventilator.

Okay.

Your first day, you already found my hiding spot.

I'm Nat.

Connor.

I don't suppose you keep a bottle stashed up here, do you?

Not in my condition.

I heard about your patient.

Tough one.

Yeah.

I just keep wondering...

If there was anything else you could've done?

I know.

Is your husband a doc, too?

No.

[cell phone beeps]

Excuse me.

[knocks]

Hi. I have some good news.

Somebody would like to say hello to you.

Oh, God. David!

Judy.

I'm fine. How's Rachel?

She's good. She's sleeping.

The doctors said her tests are good.

They just want to keep her here a day or two.

David, I didn't know where you were.

I don't know what I would do if I lost you.

Ms. Donahue, I'm Sharon Goodwin, Chief of Services.

I know about your situation.

And you think we're monsters.

No, no.

I think that you and your husband are faced with a very difficult decision.

We just wanted to have a baby.

That's all.

It's supposed to be so simple, so natural, and instead...

I understand.

We love Gina, but this is our last chance to have a child.

There's no more embryos, no more eggs.

What are we supposed to do?

You have to ask yourself what you can live with.

How are you gonna feel a week from now?

A month or a few years?

Gina handed over her life to you in that contract.

She trusted you to make the right decision.

What would you do if you were me?

I'd want to live up to that trust.

[sighs/sobs]

Removing cranial flap now.

Swelling's pretty pronounced.

If we waited any longer, she would have herniated.

Fetal heartbeat steady.

[heart monitor beeps]

I don't recall inviting you into my OR.

Give me suction here.

Yes, Doctor.

All right, as soon as I cauterize this, we can get into the Dura.

[beep alarm]

Fetal heart rate is dropping.

I haven't opened the Dura yet.

Patient's BP is falling.

110.

Well, I'm almost there.

100.

Tracings look like crap.

That strip doesn't correct in 30 seconds, we're crash-sectioning her.

Give me suction here.

Give me suction right now. More.

[engine revving]

Here we go.

[engine revving]

Dr. Charles?

A crash victim I'd been treating has d*ed.

He's a match for Jamie.

Let's get him some lungs.

Only thing, his fiancée won't give consent.

Where is she?

[clears throat]

It was a difficult surgery, but it went well.

Dr. Abrams was able to relieve the pressure on Gina's brain.

Both Gina and the baby came through just fine, so far.

Dr. Abrams will be out to speak to you shortly.

Thank you.

[both laugh]

He's 20 years old.

Without new lungs, he will die.

[speaking Spanish]

Your fiancé...

Su prometida...

The man you love...

El hombre que amabas...

The man who loved you...

El hombre que te amaba...

Can save his life.

Puede salvar su vida.

[speaking Spanish]

Wait.

Si. [speaks Spanish]

Yes.

Thank you.

I'll alert the transplant team.

Central line.

I can't tell you how many times I missed before I finally got it.

I know how to do it. I just couldn't do it in there.

It takes practice, that's all.

I'm fine with him. I never miss.

Yeah, he's the ideal patient.

You can't hurt him, and his life's not hanging in the balance.

If this rotation weren't a requirement, I wouldn't be here.

Where would you be?

I'm a lab person.

Pathology?

Maybe.

Every med student, once they start dealing with patients, thinks they'd do better in Pathology.

I did.

[sentimental music]

♪ ♪

Nat?

You okay?

The first few months after Jeff d*ed...

[sniffs]

I still kept waiting for him to walk through the door.

I don't anymore.

[sobs]

Come here.

[background chatter]

"Death, vicious death, leave a green branch for love."

You do speak Spanish.

Nope.

But you know Lorca.

Third wife was from Spain. Loved Lorca.

Came in handy when we were courting.

[chuckles]

They got the first lung in.

Halfway there.

Jamie made that for me when he was eight.

You know, I was brought in to help him cope with his condition and all the things he wouldn't be able to do.

Did not need my help.

I mean, this kid did more things than most kids his age ever do.

He went out for the swim team in high school.

A kid with CF taught me how to cope.

Going back to the hospital?

Yeah.

Wouldn't mind being there when he wakes up.

Can I come?

Sure.

[gentle music]

♪ ♪