01x09 - Choices

[blows landing]

[Ethan grunting]

[indistinct radio transmission]

Come on!

[continuous grunting]

[heavy breathing]



You are really gonna love these.

New patient satisfaction forms.

Oh, damn.

"On a scale of zero to ten, did the nurses treat you with courtesy and respect? Did the doctors explain things in a way you could understand?"



Morning, Dr. Choi.

Every patient should be asked if they'd like to fill one out.

Just what we need, more paperwork.

[alarm dinging] Incoming!

What do we got?

Found her at a coffee shop unresponsive after a fainting episode.

Initial GCS of 5 improved to a 10 en route.

Let's go to Treatment 5.


94 over 60.

Heart rate 144.

A-fib with RVR on the monitor.

We gave her 5 milligrams of diltiazem three minutes ago.

A gross deformity to the left wrist and a pretty good lac on her forehead.

On me.

One, two, three.


Chemo patient?

Looks that way.

Let's get her on the monitors.

You got it.

EKG and labs.

CBC, CMP, and ABG.

Yes, Dr. Halstead.

She's got a broken wrist.

Colles' fracture.

Can you tell me how this happened?


She's still in rapid AFib April, 10 milligrams of dilt, stat.

Ma'am, can you hear me?

Can you tell me your name?


Start her on a drip.

Titrate it to get her heart rate down.

Dilt is in.

[monitor beeping]

Heart rate's coming down.

[monitor beeping]



[monitor beeping]

Do we have an ID?

Find any family?

Right here.

I'm her husband.

Sal Baker.

Any idea what happened to her?

No, I mean, Jen just went for a walk and said she was getting us all breakfast.

Is Mommy okay?

Yeah, yeah, she's fine.

Just wait right here, all right, Bailey?

Could we talk for a minute?


My wife has end-stage lymphoma.

All right.

I have power of attorney, so I need to instruct you that if she starts to die again, per her wishes, that you do not resuscitate her.


Mrs. Baker, I'm Dr. Halstead, and this is my colleague, Dr. Manning.

Hi, how are you feeling?


Your husband said you have non-Hodgkin's lymphoma.

Uh, yes, diagnosed four years ago now.

Okay, and your husband also said that you have a do not resuscitate in place?

That's right.

What course of treatment have you taken?


Actually, we've learned to keep her records with us.

Just in case.

Thank you.


Well, we'd like to admit you and to wean you off the IV meds that are controlling your heart rate.

I'm sorry, Dr. Halstead, but absolutely not.

I won't be admitted.

Well, just until you're stable.

You're still in AFib.

I know you mean well, but I'd rather go home with my family.

We understand, but we need to set your arm, close up that cut, and get your rhythm under control.


All right, but do it down here.

I feel like once I go upstairs, I'll never leave.


We'll do our best to keep you down here.

Thank you.

Talk to me.

14-year-old boy.

Three penetrating wounds.

Two in the chest. One in the abdomen.

GCS of 10.

Go to Trauma 3.

Hypotensive since we got him.

IO in his left leg.

500 mils of saline given, but his pressure's still crappy.

This kid get stabbed?


Jumped the fence at a construction site.

Impaled himself on some rebar.


All right.

Ready, on my count.

One, two, three.

All right, we got it from here.

Thank you. April, keep bagging.

Reese, put in a groin line.

Yes, sir.

Stat trauma labs and bring in the level-one transfuser.

Suture kit's ready.

All right, line's in.

Fast. Good job. We got to tube this kid quick.

Think you can do it?


Let's hang another liter.

[over PA] Dr. Choi to Treatment 1, stat.

What do we know?

Olivia Gray, math professor, found unconscious at her desk at work... Blood sugar normal.

Sinus tach on monitor.

No external signs of trauma.

Still unresponsive.

Looks like she's had a seizure.

Let's get an EKG, labs, trops, and ABG just in case.

Put her on oxygen.


Professor Gray, can you hear me?

[moaning, coughing]

Lungs are really coarse.

Grab the ultrasound.

Call cardio for an echo, order a CT head.

[monitor flatlines] Just lost the pulse.

Milligram of epi.

Chest tray. We're gonna open him up.

Reese, on it.


Do, I need scissors.

Still no pulse.


Here, Doctor.

Crash cart is charged.

[monitor beeps]

Ah, there's a hole in the right ventricle.

Skin stapler.


[monitor beeping]

All right, he's got a rhythm back.

We need a cardiothoracic surgeon to help with this.

Call the OR, tell them we're on our way up with an open chest. Let's go.

Got it.


Getting pretty good in there.

Queen of the groin line.

Hey, you two.

Come on.

Gather around, gather around!

New patient satisfaction forms.

You need to get every patient who's been treated to fill this out.

Wait for it. It gets better.

We have a P&P in isolation.

Oh, yeah!

What's a P&P?


Reese should do it.

All: Yeah!

She's got to learn.

Give it to Reese.

Let's go.



Pediculosis and phthiriasis.

Lice infestation.

Among other things.

Uh, what exactly do I do?

First, gown up.

You strip him, scrub him three times.

Then put permethrin over every millimeter of his body.

Welcome to my world.


Don't worry, I'll help.

Thank you.

Jennifer Baker, cancer patient.

Where are we at with her?

Her arm is set, and she's back in normal sinus rhythm.

I'm actually looking at her history right now.


And she's been through hell the past few years.

Yeah, but a DNR?

Is she considering her family?

At this point, she may think it's the best thing.

I don't know.


Dr. Halstead, good morning.

I know I was supposed to call you back.

I should've. I'm sorry.

I understand. You're busy.

Hey, S&B has an outstanding new asthma drug.

Would you care for some... few samples?

No, thanks.

Listen, I read a prospectus on a clinical trial you're doing for non-Hodgkin's lymphoma.

A radioimmunotherapy drug.

Veltarmomab, very promising.

That's the one.

Listen, I got this patient.

She's tried everything, nothing's worked.

I'm pretty sure she fits the profile for your study.

I'm sorry, but the trial's closed.

It's full.

Zoe, this woman is end-stage.

She's got a kid.

I'm looking for anything to give her more time.

I get it, but...

Just try.


Let me make a call to our medical director.

No promises, though.

All right.


Her labs are back.

Electrolytes are way off.

BUN and creatinine's sky high.

She's uremic.

Kidney failure?

Yeah, but it doesn't make sense.

A woman this young?

I don't get it.

Call the renal service.

She needs to be admitted to the MICU for dialysis.


[monitor beeping]

Staple across the hole in the stomach, and then we'll run the bowel.

TA 55 blue stapler.


Dr. Zanetti. Dr. Rhodes.

Dr. Downey, I thought they were sending a resident.

Had a window before my next surgery.

You don't mind?

No, this kid just caught some good luck.

Who butchered him?

He fell off some scaffolding.

I meant the cracked chest.

Yeah, that was me.

Hmm, can we get to work on the heart? How's the gut?

Just had to fix a hole in the stomach, but we're done.

Give the 5,000 heparin.

Yes, Dr. Downey.

Get a 6-0 prolene with pledgets loaded up.

Rhodes, change your gloves.

I want you to help me up here.

He's about to close the abdomen.

I'll assist.

You close.

Rhodes, I want you to fix the ventricle.

Well, Dr. Zanetti really has more experience.

You made this mess, you clean it up.

Unless you don't feel up to it.


[suction gurgling]

Uh, too deep with the needle.

Hit the AV node, you're gonna have to explain to the parents why their son needs a pacemaker for the rest of his life.

Let me see the repair.

That works.

Close up the chest when you're done with the abdomen, will you?

Yes, Dr. Downey.

You don't have any tremor.

Even for a young guy, that's pretty good.


Not that I'm jealous or anything, but you just received high praise from David Downey.

Why did he have me do the heart?

I'm asking myself the same question.

Sorry to cause you so much trouble.

That's all right, sir.

After you bag the clothes, take them in for analysis.

Guess I let things get out of hand.

Hard to keep clean.

Pants too, please.

Where do you live?

Lots of places.

In winter, Lower Wacker.

By the heat vents.

Well, why not a shelter?

Don't like them.

Too many rules.

What about my skivvies?

Those too.

Dr. Halstead.


I just spoke to the medical director.

He's going to let your patient into the trial.

Oh, that is great.

You might've just saved her life.

Thank you, Zoe.


[exhales sharply]

[nurse chuckles]

There you go.

Mrs. Baker, I have some very good news.

A pharmaceutical company is conducting a clinical trial that you qualify for.

A new cancer drug.

I was able to get you in.

Mrs. Baker?

Sal, can you take Bailey outside?


Yeah, sure, yeah.

Come on, honey, girl. Let's go find something to eat.

But I'm drawing.

All right, you can do that when we come back.


Oh, thank you.

The trial's oncologist is gonna need to examine you.

I'd like to set that up as soon as possible.

Sorry, no more trials.

Mrs. Baker...

You know how I feel.

But this is very promising.

A new radioimmunotherapy drug.

Very similar to Tositumomab, which you've done before, but this works by...

Dr. Halstead, you're not listening to me.

I'm done.

I've tried everything.


You have nothing to lose.

Yes, I do.

The drugs make me sick, and weak, and exhausted.

I throw up.

I'm in constant pain, and my family suffers as much as I do.

But you may react differently to this.

It could be a game changer.

That's what the last 1/2 dozen doctors said, and yet, here we are.

Dr. Manning?

I think we should let Mrs. Baker rest.

I know you're trying to help...

But I can't do this anymore.

I want to live out the rest of my life with the people I love, and not in a hospital.

We understand.

We'll check back later.

Dr. Halstead?

Thanks for the help in there.

What is with you?

Last time I checked, we're supposed to be saving lives.

She has made her wishes very clear.

She can't just give up.

My mother died of cancer. If she had access to a drug like this, she might still be alive.

Did you page me?

Yeah, I'd like you to assist.

The E.D. hasn't sent up any trauma patients in the last hour.

Isn't a trauma.

65-year-old woman.

Aortic valve replacement.

AV replacement... You want me to assist?

Work on your suturing technique.

You can move a little faster.

Dr. Downey, I'm a trauma surgeon, not a cardiothoracic surgeon.

Sewing is sewing.

I cleared this with Sharon.

Wash your hands. Meet me inside.

Put on something nice.

Mr. Baker.

Jen's feeling a little nauseous.

Pop usually makes her feel better.

That clinical trial I mentioned, it's really worth a shot.

Would you talk to her?


I know what she's gonna say.

All right, this is off the record, but I spoke to the pharmaceutical rep.

She told me they've had some remissions.

Total remissions.



You know, I would do anything to keep my wife alive, but she's... she's had so many false hopes.


Okay, you know, I'll try.

I'll try.

Shower felt good.

Hadn't had one since last summer.

This cream will kill anything we missed, including eggs.


I'm not itching now.

Arms up, please.

And that should do it.

An orderly will take you to a treatment room, and we'll go find you some clothes.

I'm afraid we had to burn your old ones.

[pager beeping]

[alarm blaring]

Your patient?

Yeah, what's happening?

Some kind of psychotic episode.

Get away! No!

Get away from me, I have to do this!

Get away!

Professor Gray, I'm Dr. Charles.

I'm here to help you.

I can't have these tubes.

Get 5 of Haldol.

They are trying to escape!

Who's trying to escape?

The numbers!

They're trying to get out!

So you're pulling out your catheter to keep the numbers inside?

They're trying to get out!

Okay, easy, easy.

I need the numbers! No!

Easy, easy.

No, no, no!

Give it to her!

No, you can't!

Grab her legs.

No! I need the numbers!

You can't! I'm gonna lose them!

[Olivia panting]

[crying] No!

[Olivia sobbing]

Olivia Gray has bipolar disorder.

Diagnosed when she was 18.

So we're dealing with more than a medical issue.

She's unstable.

All due respect, it's entirely a medical issue, and she's been dealing with her condition with lithium pretty well, for almost 20 years.

So when we put her on dialysis it allowed her kidneys to rest, but it also cleared the lithium from her system.

Right, and sent her into that manic state we witnessed.

Olivia can't go back on the lithium.

What are her options?

Hard to say, you know, each one of these cases is treated differently.

I mean, her records indicate she's tried... Wellbutrin, Prozac, Effexor.

Apparently, side effects were too severe, so she stuck with lithium.

Well, the side effects of lithium can kill her.

The very least, she'll need a new kidney.

You, uh, had much experience with, uh... with bipolar disorder, Ethan?


Look at this.

Woman gives us a zero because her gown didn't fit, and this guy bitches because he couldn't change the channel on the TV.

We ought to get a chance to grade them.

Threw up in the waiting room, zero.

Peed on the floor, zero.

Ms. Goodwin?

I mean...


Hey, uh, I just got out of the OR assisting Dr. Downey, and he said that you approved.

I did.


You'll have to ask him.

But you're fine with it?

It's Dr. Downey.

I'm fine with whatever he wants.

You have a problem?


Yeah, yeah.

I do, actually.

Excuse me.

Mr. Brennan.

I got some things I hope will fit you.

You look like a medium.

I think so.

All right, why don't you get dressed, and then we'll sign you out?

So clean.

Is it okay if I lie just a few more minutes?

I guess.

Oh, um, would you...

Would you mind filling out a patient satisfaction card?



I'll be back in a little while.

[Hawaiian music]

[knocking on door]


Dr. Downey?

Uh, maybe this isn't such a good time?

No, it's fine.


So look, I just spoke with Ms. Goodwin.


I am a trauma fellow.


So if I'm scrubbing in with you, I'm neglecting my other responsibilities.



Let me tell you why I love what I do.

The heart is not just a pump.


This couple, they were in their car and they're having a terrible fight.

In the midst of it, they get in an accident.

The husband's killed, and they transplant his heart into another man.

When the recipient of this heart wakes up, he's... he's very troubled.

As soon as he gets out of the hospital, he looks up the donor's wife and he finds himself apologizing that his last words were so angry to her.

He wants her to know he loves her.

That wasn't this man talking.

That was the heart.

I like that story.

I think I remember it from when I was in eighth grade.

Doesn't make it not true.

Dr. Downey, the thing is, I am really more comfortable in trauma.

Comfort is important.



I'll leave you where you are.

Thank you.

[alarm dinging]

[over PA] Code blue. Treatment 5.

Code blue. Treatment 5.

Mommy! Mommy!

It's okay, it's okay.

She's in a better place.

Did you ask her?

She wouldn't.

She's wrong.

Mr. Baker, let me resuscitate her.

Will, she's got a DNR.

She doesn't have to die.

I don't know.

You want her to live. You told me.

I don't know.

No, Will, don't.

Tell me to resuscitate.


I don't know.

Please, let me try.

No, no, no.

I don't know!

Please, help her!

Will, don't do this!

Get the cart in here.

Will, stop!

I have to. April, the cart.





What are you doing?


Please, help her!

One milligram of epi.


Mr. Baker, take your daughter out.

Okay, come on, honey.


Will, you can't do this.

Will, stop.

I'm tubing her.

Natalie, please take over compressions.

No, I won't. Don't do this!

Doris, you take over compressions.

No, Will, this is illegal.

I'll take responsibility.

Do it.


7.5 ET tube and 4 Mac laryngoscope.

Yes, Dr. Halstead.

She's still in v-fib.

I'm charging, 200.

Will, let her go.

[defibrillator whirring, beeping]



Will, stop.


I said clear.

Continue CPR.

Charging to 200.



[monitor beeping rapidly]

I've got a pulse.


Get an EKG and redraw labs.

CMP and trops.

What have you done?


Her heart rate is erratic.

Let's watch her O2 level.

She's going to thank me.

That's why I love fractals.

The perfect union of math and art.

Well, The Art Institute would certainly agree.

Did you see the Mandelbrot exhibit?

Hello, he's the only reason I studied motion.

Who wants to see another iteration of finite subdivisions?

Not me, baby.

[Olivia chuckling]

Professor Gray, I'm Dr. Choi.

I've been treating you.

Oh, hi... sorry.

I understand I've been a lot to handle.

I'm glad you're feeling better.

Dr. Charles, can I have a word?

Be right back.


Amazing turnaround.

What did you replace the lithium with?


Excuse me?

Well, Olivia and I talked and decided that for now, it's the best course of treatment.

But she can't tolerate it. It's destroying her kidneys.

Yeah, but that's a trade-off that she's willing to make.

She can't be who she wants to be, or live the life she wants to live without lithium.

Here's a novel idea.

How about she learns to cope with her condition?


Learns to control it.

Buck up. People can do that.

Dr. Choi, you saw what a full-blown manic episode looks like for her.

And how much of that is self-indulgence?

Look, I'm just saying, I don't think her dependence on this destructive drug is the answer.


[monitor beeping steadily]

How we doing?

Excuse me, Bailey.

Gonna check Mommy's heart.

She's still stable.

She's off all blood pressure drips.

We can start the process of getting her in the trial.

We just want to be left alone right now.


Dr. Halstead, Ms. Goodwin would like to see you in her office.

Did he tell you to resuscitate his wife?

Her husband wants her in the trial.

He agrees with me.

Yes or no.

Did he tell you to resuscitate his wife?


But he wanted me to.

And how exactly did you divine that?

I couldn't just let her die for no reason.

Well, there is a reason.

She has a legally binding document ordering you not to do so.

And don't I, as her doctor, have a moral responsibility that supersedes that document?

No, you do not, and you know that.

Ms. Goodwin, she was out of her mind from the pain and the illness.

She did not understand what this drug could do for her.

I did.

This is not about you.

It's about her and what she wanted.

You have put this hospital and yourself in an extremely dangerous position.

I hope you understand the gravity of your actions.

Get her out of the E.D. and up to the MICU.

Dr. Manning will be primary now.

I want you to stay away from Jennifer Baker and her family.

Are we clear on that?




This isn't a hotel.

You need to get Mr. Brennan out of Treatment 4.

Mr. Brennan, I'm afraid you have to go.

Mr. Brennan?

Mr. Brennan, can you hear me?


He dressed?

He's dead.

So Dr. Downey is a very strange guy.

[chuckling] Now what?

He got Goodwin to assign me to him on some kind of ongoing basis.


Yeah, it's crazy, right?

Dr. Downey asked you to assist him?



The premier cardiac surgeon in the country asks you to assist him and you pass?

I'm a trauma surgeon.


[laughing] What?

Now, come on, wh... what is so strange about me wanting to do what I was trained to do?

In fact, what I was brought here for.

That's your excuse?

It's not an excuse.


Oh, come on, what?

I can't stand cowards.


That's how you see me?

What are you afraid of? That you're not good enough?

That you'll fail?

Is this your dad thing again?

It's disgusting.

She still stable?


She's not your patient.

Look, you know I only did it because I care.

I told you not to resuscitate her.

Why do you dismiss me?


You say you respect me.

You say I'm your friend.

I don't dismiss you.

Yes, you do, and not just today... All the time.

Look, things can't always just be on your terms, Will.

I'm tired of this.

[alarm dinging]

[over PA] Trauma incoming.

All attending to the ED.

58-year-old male, restrained driver car crash.

Front end collision. GCS 12.

Vitals stable since we got to him.

Go to Trauma 4.

Anybody else hurt?

No, he crashed into a pylon.

Looks like he blacked out and lost control of the car.

It's Dr. Downey. Let Ms. Goodwin know.

Dr. Downey, can you hear me?

Dr. Downey?

All right, let's get him in here.

Let's get him unstrapped and get him on the bed.

On my count.

One, two, three.

All right, airway's intact.

Get IVs in and get X-ray in here.

On it.

IVs going in.

All right, breath sounds bilaterally.

His belly's soft. Vitals?

BP 124 over 78.

Heart rate 92. Sat's 100%.

Call oncology.

Yes, ma'am.

Oncology? This is trauma.

Maybe, but Dr. Downey has liver cancer.

How's he doing?

He's pretty banged up, but, uh, remarkably, no real injuries.

We're gonna keep him sedated for the moment so that he rests.

How long have you known?

Well, he was diagnosed six months ago.

He told me then.

He asked me to keep it confidential.

He's not gonna be happy about this.

What's his prognosis?

Not good.

Thought he was a pothead.

[chuckles] Right.

[breathing deeply]

It's not a coincidence, is it?


When he realized the seriousness of his condition, he decided to find someone he could teach.

Someone who had the ability to do what he does.

So what do I have that all the other surgeons in this place don't?

He saw something.

You'll have to ask him when he wakes up.

[phone dings]

Excuse me.

I just got word.

The Bakers are suing the hospital, and pressing charges against you.

It's called "wrongful life and battery."

Hospital counsel will get in touch tomorrow morning.

Am I suspended?

No. Not that I'm not tempted, but the hospital can't allow even a hint of possible wrongdoing.

So you will continue working, and we will support you, but depending on how this goes the board may well decide to terminate you.


I don't understand what happened.

He came here to die.


People do that sometimes.

They sense they're at the end and they just want to die in a clean bed.

Reese, Mr. Brennan filled out a patient satisfaction form.

You got a perfect score.

All tens.

Dr. Halstead.


I heard.

It's out there already?

I think it's awful. You did the right thing.

Well, at least somebody thinks so.

Once she starts the drug and feels better, she'll drop the suit. You'll see.

Let's hope.

Dr. Halstead?

Can I buy you a drink?


I'd like that.


[knocking on door]


Dr. Charles?

You got a minute?

Hey, man, what's up?


Have a seat.


A field hospital, Helmand Province.

We'd been up 48 hours straight treating casualty.


This woman came in.

She'd walked from her village ten miles away.

Had her daughter in her arms.

A three-year-old.

Little girl didn't have a scratch on her.

Looked like she was sleeping. This sleeping angel, but she was dead.

A blast wave from a mortar round burst her lungs.

I can't stop seeing her.

I try to cope, but I can't sleep.

[crying] I have nightmares.

I can't stop seeing her.

Glad you stopped by.

Dr. Rhodes.

Dr. Downey.

How are you feeling?

I guess the cat's out of the bag.

I'm sorry.

Can I get you anything?

Can I take your presence as a good sign?

Yes, sir.

[breathes deeply]

You know... [clears throat]

The Hawaiians have a deep reverence for the sea.

They believe it's the best medicine there is.

They think a swim in the ocean can cure anything.

Wouldn't a swim be nice right now?

[light chuckle]