|Transcripts - Forever Dreaming
|01x05 - Malignant
|Page 1 of 1|
|Author:||bunniefuu [ 01/06/16 14:24 ]|
|Post subject:||01x05 - Malignant|
Off his liver from the stab wound...
He's dumping blood.
Get him on the table.
Three, two, one, lift.
95 over 50, tachy at 140.
Hey, you're bleeding too much, okay?
I need to open you up.
He go unconscious, or was that you?
No way to know.
Sats are dropping.
Is he tubed yet?
Let's get more blood.
Two bags on the transfuser.
Damn it, I can't get it in.
I'm gonna thread a wire up to you through the neck, help guide the tube down. Central line kit?
Just give me a few seconds.
I don't have a few seconds.
Heart rate's falling.
Giving 1 of atropine.
I can't see it.
[rapid beeping continues]
Give me a knife.
Get Dr. Zanetti in here right now.
Heart rate 50.
Hang in there, Chris.
Great. Open more laps and keep 'em coming.
I'm gonna need around 20.
Keep up with me. If we don't pack him fast, he will bleed out and die.
Is he still bleeding?
How many units is that?
Four blood, four plasma.
Send six more to angio, we're coming soon.
If there's any left.
What? He's type AB. I'm just saying.
I don't blame you for kicking yourself right now.
For not taking him straight to angio when he first came in this morning.
He had a penetrating liver trauma with no collateral injury.
A wound like that usually stops bleeding on its own.
The chest tube was dry. I made the right call.
Maybe, but we'd sure have a lot more type AB in the bank if you'd made the wrong one.
Keep suturing, Dr. Rhodes.
That diaphragm's not gonna repair itself.
All right, let's get a vac on him.
Let me clip it.
Done. Get him to angio.
Whoa, did you just swipe my Splenda?
I mean, yes, but it's yours?
Only if you believe in being considerate to other people.
Oh, okay, well, here, you can have it.
No, that's okay.
Reese... I'm gonna remember that.
No, seriously, you can take it.
You don't have to...
She was found by Fire with a bag over her head.
Resuscitated at the scene.
In a coma ever since.
The thing is her bone marrow biopsy just came back.
No stem cells. Nothing.
Looks like it was blasted by chemo.
Might explain suicide.
Let me know if anything changes.
You got it.
How is she?
It turns out she was on chemo.
What do you guys know about her?
Not a lot at this time.
That's all that was salvaged from the scene.
That's her personal belongings...
A couple of books, receipts.
We processed them, didn't find anything useful.
Hey, Daniel, why don't you take a look at this?
Never know what you might find.
A lot of receipts.
Getting ready for tax season.
Forensics just came in.
They only found her prints at the scene.
There's no signs of foul play.
All the evidence is pointing to suicide.
Excuse me, guys.
Can I ask you a doctor question?
Sure, come on.
If he'd come in on your watch, would you have waited so long before doing anything?
That's a tough call.
It's been a while since my surgical residency.
And, you know, I wasn't there for the exam, so it's hard to say.
Yeah, just in general.
Yeah, I probably would have gone in.
But, uh, again, I wasn't there.
Hey, what you got?
Don't forget our date this afternoon.
We don't seriously have to do this.
You know, I did go to med school.
[groans] He's gonna be a kickboxer.
Nat, I'm your birthing buddy.
Which means I take you on every tour and watch you sign every form this hospital and the State of Illinois demands.
Wait a second.
You have an 80-year-old woman to go see in treatment 5.
I thought Will said you were a pediatrician?
Combined pediatrics and ER residency, which mean she sees everybody.
My birthing buddy.
So what else did Will tell you about me, huh?
I mean, nothing.
I'm Dr. Manning.
Hi, I'm Michael.
Mrs. Shepperd, how are you feeling?
Mrs. Shepperd, how long have you had this fever?
Are you her son?
But I don't live here. I just flew in this morning.
Does your mother have dementia?
Not that I know of.
When was the last time you spoke to her?
Uh, maybe three months ago?
Her birthday, I guess.
Honestly, I don't know much about what's going on with her.
They are treating her for mouth cancer.
Last I heard, it was going okay.
I don't see anything.
Although it's possible it's cleared.
Do you have the name of her doctor?
Well, we need to find the source of her fever.
Could be a simple urinary tract infection, which would also account for the disorientation.
I'll start her on antibiotics, but I want to run some tests.
Hopefully, we'll get her feeling better soon.
A nurse will be in shortly.
You're coming with me.
My baby brother.
Now he is here to learn, so don't go easy on him.
Always toughest on family.
Remember that last third-year that rotated here?
The one they admitted into psych because he was picking holes into his skin?
No, the one that hanged himself with his stethoscope.
You guys are funny.
No, they're serious.
I want her to show him around.
I don't know.
Oh, hey, Reese.
April's little brother needs a tour.
Does she have to call me that?
Hi. Be there in a minute.
No change in her labs yet.
Let's run another test in four hours.
I heard about the bone marrow depletion.
It's the focus of my research.
There are so many discrete causes and variations., I thought we could run a few extra tests to rule out any possible...
Whatever you think, Reese.
Titrate her nor epi to keep her MAP at 60.
We'll need to up the rate on her vent.
I'm not convinced.
Jessica Pope had a confirmation for a round-trip ticket from Paris six months from now, okay?
Presumably when she's in remission.
A person... a conservative, responsible person... with cancer?
They don't do that unless they have high hopes.
So she's sick, but she thinks she's getting better.
Why would she kill herself?
Did you just say "hinky"?
Women almost always leave suicide notes.
Where's the note?
Well, maybe it was destroyed in the fire.
Or maybe it wasn't a suicide.
Have you been binging on "Mannix" again?
You don't like it, stop sending me box sets for Christmas.
All right, okay.
Next year, it'll be "Sanford and Son."
Do you think that your policeman brother might do you a little favor?
This place is ginormous.
Good thing I got GPS.
Oh, it won't do you any good.
Radiology's right above us.
Between the MRI and the fluoroscope, there's no way you get an accurate signal around here.
Uh, here we go. Uh, excuse me.
I need a mass spectrometry right away on this sample.
A mass spec?
Yes, and if I could get that stat.
And you want it stat?
Yeah, see, we have this patient...
Got a request for a mass spec.
Oh, hey, Joey.
Um... about that Splenda thing...
We've got a woman who is in a coma, and I really need to figure out why.
So if you could just please do this for her...
Wait, really? You will?
Seriously, thank you so much.
And just to... just to reconfirm, we need that stat.
I heard you.
Jay got it from Will.
He said if it was him, that's what he would've done.
Well, so... does that mean none of this should've happened?
Sounds like it.
I'm gonna go find out.
How much blood is coming from the vac?
About 250 mils.
Pressure's still low.
You think it might've helped if you hadn't waited so long?
If you'd operated on him when we brought him in.
Are you talking to me about medicine right now?
I'm talking to you about my friend.
Look, I'm gonna say this once.
Because he is my friend too.
I did what was right.
Well, some of your fellow docs don't agree.
Odd that they would share that with you and not me.
Your patient, Herrmann, he's stable?
He's still on the vent, but, yeah.
In the O.R. when I said what I did... you know that I'm only hard on the good surgeons, right?
Is that right?
Yeah, I'm not gonna change because we're sleeping together.
If you've got some male power thing where you can't get it up unless I constantly applaud your surgical prowess...
Did you say something to Fire about me mishandling him?
You heard me.
You think that I would do something like that?
If you think for one second that I would undermine a colleague, no matter how I felt about his choices...
Maybe I need to reassess this.
Sorry to ask you this, but Dr. Charles, he's on a thing about that attempted suicide.
He's not buying it.
What's not to buy? You heard the report.
There's no signs of foul play.
But could you just take one more look?
Turn over a few rocks?
Ugh, come on.
All right, how about a pound of smoked trout from Calumet?
All right, two and you got a deal.
You're my hero.
Mass trauma incoming.
Dr. Choi, Baghdad incoming!
Baghdad. Noah, with me.
Dr. Choi, uh, what...
Get used to this. Gunshot.
The one thing you can always count on in Chicago.
What do we got?
22-year-old male, shot in the left lower back, no exit wound.
140 over 80, heart rate 60, minimal blood loss.
Okay, those are good numbers.
On my count.
One, two, three.
Get his clothes off and roll him over.
Chest and pelvis X-ray, KUB.
Get him dressed.
Yes, Dr. Choi. Here.
Get an H and H and let's dress.
You're gonna need to call for a rudder.
No exit wound.
So our first job is... ?
To find the bullet.
Minor shrapnel but no missile.
Blood in the rectum.
Where do you think the bullet is now?
In the rectum?
Remember the X-ray.
On the ground or in his underwear.
What's the problem with holes, Anthony?
Things come out of them, Dr. Choi.
Things come out of them.
Sir, are you still feeling any pain?
5 of morphine.
Whoa. Wait, hold the morphine.
Where does it hurt?
How did this happen?
Chump just shot me.
What were you doing when you got shot?
I'm doing business, but the buyer thought he could stiff me.
So I decked his ass.
Next thing I know he pulls a strap, so I bolted.
Thigh and leg films, now.
Now where's the bullet?
Got him while he was running, leg flexed all the way up.
Bullet could've lodged in the popliteal artery.
Let's get him to CT for an angiogram... go!
Hey, they gonna catch this guy?
Just be happy you'll live to sling another day.
I'm sorry, Dr. Choi.
I've been up reading about gunshot wounds, but it's just...
Not the last gunshot you'll see.
What's going on?
Fever's up, pressure's down, and now she's not responding.
Could be the sedation.
But she's also uremic, acidotic, and her BUN's through the roof.
Something's not right.
All right, let's get this PICC line out and broaden her to Zosyn.
What's going on?
She's got a urinary tract infection, okay?
But the antibiotics aren't touching it.
More importantly, her kidneys are shutting down and we don't know why.
What do you mean you don't know?
Mrs. Shepperd? Carol?
This is bad, right?
Can't you do something?
We're giving her fluids, antibiotics, and medication to increase her blood pressure.
Will that work?
Have you been able to find any recent history?
Any records we can check?
Anybody you've been able to talk to?
No, I told you, I don't know who to talk to.
I haven't been around.
Look, I'm not blaming you, okay?
But I just met your mother this morning, and I'm working without a history here.
Excuse me, sir.
Uh, got those tests on Jessica Pope that Reese wanted.
Have you seen her?
Man, that was fast.
I said I'd do it.
I did it.
Where is she?
Uh, in radiology.
Yeah, but I'll make sure she gets them.
How's Herrmann doing?
He's still unconscious.
Looks like hell.
Cindy must be out of her mind.
She's hanging in there.
Hey, by the way, there's a guy in here, I swe... dead ringer for your brother.
That's 'cause he is my brother.
They're really gonna let Noah become a doctor?
Does he know an ass from an elbow yet?
'Cause I swear I saw him flailing around back there.
All right, it's his first day.
He'll be fine.
Well, at least he's got a big sister to turn to when he needs someone to show him how it's done.
Yeah, he does.
Learned it from the Girl Scouts.
Meet up with me tonight.
[elevator bell rings]
The neupogen's not working.
Let's give her 80 of methylprednisolone.
Um, Dr. Choi?
Test results on this patient.
What is this?
A mass spectrometry.
To get a fingerprint of everything her body's absorbed over the last several days as well as some key biomarkers.
How'd you pull that off? Good idea, Noah.
I-I... yeah. Yeah, no problem, Dr. Choi.
Just wanted to help.
Turned over some rocks on the Jessica Pope case like you asked me to.
Had the documents lab restore some papers from her place.
And they found this.
[heart monitor beeping]
But she didn't do it because she was sick.
"My fault because I trusted him.
"I'm a fool.
I can't live with this betrayal."
Maybe a lover?
Is this the whole thing?
That's all they could restore.
What's going on?
Suicide after all.
Because I just got some very weird test results.
They confirm she's dying from an overdose of chemo.
What's weird about that?
The results also show that... she never had cancer.
Just a very weird case, you know?
Turns out Jessica Pope did try and commit suicide.
But that's not what's killing her.
It's an overdose of chemo for a cancer she does not have.
She was misdiagnosed?
Someone needs to have their license taken away.
At the very least.
Once you begin labor, a small monitor will be placed on your abdomen to assess the fetus's heart rate.
Which she just said five minutes ago.
In some cases, a small electrode will be placed on the fetus's scalp.
This might be a bit uncomfortable, and yet...
And yet you have flat-screen TVs and still use a pulse ox instead of capnography.
Can we go?
I know you medical professionals like to think you already know all this, and maybe you do, but it wouldn't hurt to let those who are here to learn have that chance.
How about showing them a little respect, okay?
We were just wondering if you knew that internal monitoring increases the risk of an infection without offering a comparable amount of clinical benefit.
Her mother was a midwife.
She grew up with this stuff.
We're also wondering why, if you really want to respect these women, you'd have them stand around for an hour while you talk about how the TV can play soothing sounds of nature.
Because if they stand around much longer, these babies are gonna start dropping out right in front of you.
Then you're gonna hear some sounds of nature.
You are so right.
We should keep this moving.
Let's go take a quick look at the maternity ward.
Let's get out of here.
I was paged?
Look... this isn't an excuse.
I am just trying to give you a little context here.
I have a father, whom you met, who's made it his life's mission to undermine me.
Maybe that's made me a little sensitive at times.
You have trust issues.
You could put it that way.
I can handle that.
How is he?
[cell phone beeps and vibrates]
I got to go.
Dr. Rhodes to the ED, stat.
What do we got?
25-year-old witnessed seizure in the street.
She was clipped by a swerving car.
GCS 3, intubated in the field, 102 over 60, tachy at 110.
Prep the table, let's get him on the monitor.
H and H also.
All right, on my count.
One, two, three.
Give me a laryngoscope to confirm the tube...
X-rays of the chest and pelvis, then to CT for a pan-scan.
This isn't a trauma.
She went down before she was hit.
But we don't know the damage.
She was hit by a car.
Because she had a seizure.
She's tachy. Sats are down.
500 milligrams of Keppra.
She's got a chemo port.
I'm telling you, the money's in the seizure.
We got to figure that out.
Get a CBC, CMP, HCG, and a tox screen.
Tell CT we're going for head only, not the whole body.
No, tell CT that we're going for the whole body.
Must be nice, having so many opinions.
I have opinions about how I handle incoming patients.
I don't like that QT on the monitor.
You by any chance share those opinions with your brother?
Look, Jay asked, so I told him.
Can you come this way, please?
Come this way with me.
[machine beeping erratically]
She's in V-tach.
70 over 30.
I can't get a pulse.
Give me the paddles, now.
We're losing her.
[heart monitor flatlining]
Charge to 200.
[heart monitor flatlining]
Milligram of epi.
1 of epi.
Stay with us, Dani!
For the baby!
[heart monitor flatlining]
[defibrillator powers up]
What's... what's that? What's going on?
Another milligram of epi. Now.
1 of epi.
Time of death, 16:21.
You take credit for the labs I ordered?
The mass spec was my idea.
Okay. Um, I'm sorry.
Look, it just came out. I don't know why.
I was just nervous and I just wanted him to like me.
What about me?
You know how med school is.
It's so competitive.
Okay, look, I'll do whatever it takes to make things right.
You'll tell Dr. Choi?
Look. Wait, wait, wait.
Don't tell my sister.
I heard about your patient.
25 years old.
Early ovarian cancer.
Girlfriend didn't know any details.
Said Dani didn't like to talk about it.
Yeah, it gets worse.
Whoa, what the...
What's that all about?
My patient's son.
He's gonna have questions.
And you don't have answers.
80 years old in renal failure, unknown cause.
Any other history?
She's being treated for an oral carcinoma, but standard chemo protocol should not box her kidneys.
So what are you gonna do?
And avoid him forever?
Look, you know who you could talk to?
Who you might really be able to help?
The pregnant one?
Who just lost her partner?
I'm supposed to understand and have some special piece of advice 'cause the same thing happened to me?
Where is she?
I'm Dr. Manning, Natalie.
I heard about what happened.
I am so sorry.
You wanted to see me?
Yes, come in.
The patient that was hit by a car...
Yeah, Dani Frank.
I'd like to expedite the autopsy.
Everything I did was by the book.
She was nonresponsive, and until I could rule out a bleed...
Not questioning your performance for a second.
Dr. Choi's patient, Jessica Pope.
She's dying from an overdose of chemo.
And we know Dani had a chemo port.
And she seized before she was hit by the car.
Could indicate an overdose.
Dr. Charles wants to make sure these two cases aren't related.
Yeah, I'll get pathology on it.
Did you tell Severide what I said to you in confidence?
You never said that was in confidence.
Great. In the future, do me a favor.
Don't ask me any more hypothetical questions.
Then don't ask me to bring you any more sensitive materials from police investigations.
Her pressure's been dropping since the dialysis started.
She might be too weak to handle it because of her fever.
Turn her levophed up to 10.
I should've been there for her.
Maybe this wouldn't have happened.
You don't know that.
Her pressure's bottoming out.
O2 sats 92... 89.
Turn her levophed up to 20 and stop the dialysis.
Hey, what's going on?
She won't arouse.
She's not protecting her airway. Someone get me a crash cart!
We need to intubate.
She's biting down.
Give me 20 of etomidate, 100 of rocuronium.
20 of etomidate.
100 of rocuronium.
O2 down to 87.
O2 down to 84.
Give me some cricoid pressure.
Can you see the cords?
Take over bagging. Hook her up on a vent.
Dr. Halstead tells me that your chemo patient, despite your continuing efforts, continues to decline.
Carol Shepperd. Yes.
Dr. Choi has a patient in similar circumstances, though it turns out that she never had cancer at all.
You know, now that you mention it, Carol has oral cancer, but I've never been able to find a tumor.
I thought maybe it had cleared.
I think it'd be a good idea to run some biomarkers, just confirm she had cancer in the first place.
You think there might be a connection between Ethan's patient and mine?
I hope not.
How'd it go today?
What, somebody say something?
No. I'm just asking.
It was fine.
Yeah, it's just, um, I'm trying to memorize these emergency protocols.
You know, all the flow charts and decision points.
I don't know when to shock, when to give meds, like, how many joules, what's the doses...
Look, it's not so much about memorization as just thinking logically.
We shock because electricity resets the current.
But in asystole, there's no current.
So we push meds instead.
See, you just have a way of putting things.
Okay, hey, um, how about I bring over pizza tonight, and you help me study?
Noah, you're gonna be fine.
No, I'm not.
I'm drowning here.
I need you.
Oh, thank you, thank you...
I love you too, April.
Any change on Herrmann yet?
Think you can get him off the vent?
We are waiting on the next round of labs before...
Hey, guys, get in here!
He was fine a second ago.
He's not ventilating.
Airway pressure's 40.
I don't hear great breath sounds on the right.
He's deviated to the left.
I think it's a tension pneumo.
But he's already got a chest tube.
Yeah, I know.
Give me a 3-inch 16-gauge angiocath.
You sure about this?
He has air in place of a collapsed lung.
It's squeezing the other lung shut.
Airway pressure's back down to 26.
Chest tube's clotted up.
Good call, Dr. Rhodes.
[cell phone rings]
Yeah, I'll be right there.
Set him up for another chest tube.
I'll be right back.
Look, I wasn't there when Herrmann came in.
It wasn't my place to say anything.
I shouldn't have.
Dani OD'ed on chemo.
That explains why she seized in the street.
That's not the troubling part.
Yeah, she was loaded up on chemo.
But this woman... never had cancer.
Two patients in one day overdose on chemo... and neither had cancer.
Which, I must admit, does seem suspicious.
Well, it could be a new oncologist in town making incorrect diagnoses.
Or even just mixing up a few charts.
Yeah, but even then, why the overdoses?
And on the same day?
What do we know about these women?
Jessica's note said she felt betrayed.
And Dani's girlfriend said Dani was upset about something, but wouldn't talk about it.
Something was going on with both of these women.
Yeah, but we don't have any medical records, no information that might link them.
I'm gonna to get in touch with some local oncologists, see if there have been any problems with their chemo or if they've had other patients in the same condition.
You're gloating, Daniel.
You know Mannix would never gloat.
Oh, yeah, he would.
I wouldn't, but he would.
Hey. Did you hear?
Herrmann woke up.
That man's a fighter.
He's gonna pull through.
Calls for champagne.
Maybe we can get into Morton's.
Can we do it another night?
I have to help Noah study.
How about tomorrow?
Never changes, does it?
April, you've been putting him ahead of you your whole life.
You should be the one with the stethoscope.
I have a stethoscope.
You know what I mean. I'm not...
You wanted to be a doctor. You're twice as smart as him.
You're just doing this to put him through med school.
You know my parents.
You think I had a choice?
It was always the boy who was gonna become a doctor.
And I get that. I understand.
But you're grown up now.
When does it stop?
You know what?
Thank you for your concern, but I'm fine, and I don't need your advice.
[soft dramatic music]
Two mass specs, one day.
Some kind of record.
I just delivered another one.
They made it sound like a really big deal.
You must be some kind of hero now.
Yeah, not exactly.
I know you got those results back to me way faster than humanly possible.
You said you needed them stat, like, 600 times.
Hey, tomorrow, can I buy you a cup... of coffee?
Hey, she opened her eyes.
That's good, right?
Can you hear me?
She is still in kidney failure.
And her infection hasn't cleared.
That's why we're still seeing the delirium.
But, yes, that is a good sign.
If she does get better, should I bring her to New York?
Or would she be too sick to travel?
I could consider staying here a while.
You can figure all that out later.
I want to do something.
Something to help her.
Just sit with her.
Be with her.
I'm here, Mom.
Carol Shepperd's biomarkers just came back.
She never had cancer.
So she is just like Ethan's patient.
And Dr. Rhodes' patient, Dani.
That's three today.
Oh, my God.
Three women all cancer-free overdosed on chemo.
Somebody's doing this on purpose.
Do you think a doctor's doing this?
Giving false diagnoses and overdosing?
It's a long way from "do no harm."
I've called the police.
They're on their way.
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