01x10 - Clarity



That wasn't the warm reception I was expecting.

Sorry. Just thinking about the day ahead.

Speaking of... dinner before the recruiting event tonight?

Oh, yeah.

Inspiring the hearts and minds of the next generation of Navy sailors.


Don't sound so excited.

Wish I could stay, but Du calls.

Hey, you okay?

You were tossing and turning like crazy last night.

Yeah, all good, and yes to dinner.

You're not hearing me, Dr. Halstead.

With the hospital being sued...

I'm under a microscope. I get it.

Doesn't make it fair.

You ignored your patient's wishes and put the hospital in jeopardy.

It's absolutely fair, and now you have to deal with the consequences.

You're in for interrogatories, depositions, mediation, and then possibly a civil trial, and that doesn't even include what you may have to go through with the state medical board.

Yeah. Okay.

Every move you make will be scrutinized by Jennifer Baker's attorneys.

Stick to the script.

Don't give them any more ammo.

Until the lawsuit is settled, you are the perfect doctor.

Are we clear?

Because your future at this hospital... depends on it.

Five, six, seven, eight...

Uh-uh, girlfriend. Go to Treatment 4, please.

You got it.

Thank you.

Right this way.

All right.

Reese, why so glum?

Residency Match picks.


They have to be in by end of day and I have no clue what to do.

I'm literally choosing where I'll spend the next four years of my life.

And probably the rest of your life after that.

Be nice.

[phone beeps]

Dr. Choi, incoming!

Where are we going, Maggie?

Trauma 2.


Bret Cooper, 17-year-old male, down on the ice after a hip check... GCS 10, improved to a 12.


Must have got his bell rung.

I'm his father. I was there.

He didn't get his bell rung. He barely got hit.

Bret, I'm Dr. Choi. Can you hear me?

Can you breathe?

Get me off of here!

All right, let's transfer him. Reese, on your count.

Okay, nice and easy. One, two, three.



Transfer the oxygen, leave him on the cannula, and let's get him up on the monitors.

On it.

Check his sat levels.


Okay. Pupils equal bilaterally and reactive.

He stayed on his skates the whole time.

Bret, I need you to focus on me... is there any pain?

Ah... there! Right where you're touching.

Your show, Reese.

He needs a CT head and spine, and I would get him a chest X-ray.

Come on, really?

We got this.

Oh, my God... is it a concussion... What happened, Jack?

He was battling for a puck along the boards... it's nothing.

Here we are in the emergency room, Jack.

Mr. and Mrs. Cooper, I'm gonna need you to step outside.

Bret had a bad concussion last month.

Honey, it's not a concussion.

Look, Doc, he's got a scholarship on the table for Boston College, okay?

Another concussion, they might rescind the offer.

My eyes... everything's blurry!

Bret, you have to stay still.

Please, Bret, you have to hold still... hold still, buddy.


Son, you okay?

Dad! Dad, I can't see!

Stay still, Bret.

I can't see!

Stay still, Bret. Stay still.

Wake up, Sleeping Beauty.

The cat nap's over.

Oh, yeah.

They're on their way in.

How long was I down?

About 20 minutes.

Oh, it felt like 20 seconds.

You know you're only supposed to work 12-hour shifts, right?

It's the law.

I know.

But Dr. Downey makes his own rules.

All right...

Half a minute more.

[whimpering] Come on.



Doc, hey. How is he?

What happened to his eyesight?

His vision's fine.

It was a transient impairment, probably caused by anxiety.

What about his head? Is it another concussion?

Can't say for sure yet.

We're doing a CT of his head and cervical spine to make sure there's no bleeding.

That might require surgery.

Surgery? Oh, God.

I'm not saying he needs surgery.

We just need to rule everything out.

Relax, hon, okay?

Let's not get worked up before the tests come back.

It's... it... it's... it's like... it's like I...

It's like I said before. It... it l-looks worse than it is.

Look, Doc, I played 18 seasons. I took a hit or two.

99% of the time, it was nothing.

I sat out a shift, got right back in.

Trust me, I get it.

Listen, as soon as we get the tests back, we'll figure out our next step.





It's gonna be fine.


Tired, Dr. Rhodes?

No, I feel great.

Sign for the lungs, and let's move.

All right.

How long was he waiting?

Half a minute.

Watch out, please.

Yes. Spoke with Dr. Bucchheit about Loratazone... Think it's gonna work out.

Hey, Greg, let me call you back.

Dr. Halstead... Will.

Zoe, how are you? Your hair's different.

I like it.


Yeah. Thank you.

Had a great time the other night.

You've officially converted me to a rye whiskey girl.

It cleanses the soul, or at least the memory.

Things any better?

Well, they haven't gotten worse.

Guess that's something.

Good. Cup half full... my kind of guy.

Round two soon?

I'm free tonight.

I'll call you when my shift's over.

Yeah. Okay.

Mr. Anderson, I'm Dr. Halstead.

Oh, please, call me Tim.

You got it, Tim.

So you're a diabetic?

Yeah, since after college. Lucky b*st*rd, I know.

I see you're on the blood-thinner Warfarin.

How's your INR?

Don't know.

I haven't had it checked in a few weeks.

Mm-hmm. Let's have a listen.


Yeah, you've also had a mitral valve replaced.

I can hear the clicking.

Yeah, two stent operations, an atherectomy, and a laser angioplasty.

And somehow still putting us all to shame.

You look like a Bergdorf's catalog.

Well, look good, feel good, Dr. Manning.

I was wondering if I would see you.

Dr. Halstead, you mind if I sit in?

You don't have to ask.

So what's going on today?

Last time you were in for a foot infection.

Any reoccurrence?

No, just a little shortness of breath.

I was cleaning out my attic, started feeling a little light-headed.

Nothing, really, to worry about, but, still, better safe than sorry.

Anything else?

My left leg's been aching a bit.

Mr. Anderson is in congestive heart failure.


It's mild.

At least, that's what my last doctor told me.

But you could still stand to lose some of that fluid.

All right, what we're gonna do... chest X-Ray, EKG, labs.

Have IR do an angiogram, check the flow of the leg.

Here I was, thinking I was gonna make it home for the Bulls game.

Don't worry, Tim, we'll get you the Wi-Fi password.

You can watch the game on your phone.



A little overboard. His leg wasn't cold.

A vascular ultrasound, maybe, but an angiogram's a bit much to start.

He's a decade-long vasculopath.

His blood vessels are shot.

He's not indicating.

I hardly think he needs another uncomfortable procedure.

There's no telling what he needs.

Look, I am not dismissing you, Nat, but I did the intake.

It's my call.

[tense music]

♪ ♪



Hoo, you look like crap.

[laughs] Thanks.

Downey boot camp.

Presume you're on the transplant?

Ex-vivo... have you ever seen one?

The lungs are perfused out...

Outside the body, yeah. I know the procedure.

Yeah, the patient was an NYFD first responder on 9/11.

He developed pulmonary fibrosis from debris exposure.

So no good deed, right?

[pager beeping]

I got to jet.

Your trauma pages are coming to me now.

Lunch later?

Page me.

So then I just break up the center and carry the puck into the zone myself?

Exactly. You catch the D-man in the neutral zone.

And I'll be left with a two-on-one.

Good read.

Hey, put that away now.

Good news. CT head and spine were clear.

No concussion?

No concussion.

So I'm out of here?

And off to Chestnut Hill. Go, Eagles.

Sweet! Thanks, Doc.


Sports aren't really my thing.

What'd I tell you, hon?

Nothing. The kid's a rock.

Like father, like son. Doc, thanks so much.

You got it.

Okay, so let's go tell those bad-news scouts that the nation's number-one recruit is good to go.

Dr. Choi, is it possible you missed something?

Bret complains of headaches. Mom.

He's had this one for two weeks.

Joan, enough!

Look, the scan came back clean, honey.

Stop looking for something that isn't there.


Headaches could be a symptom of meningitis.

An infection like that wouldn't show up on the CT.

Could explain why a minor hit caused such a big reaction earlier.

I think it's best we do a spinal tap.

Okay, but meningitis, that is treatable, right?

Hockey can wait for an hour, Jack.

Okay, Joan.

So, Bret, if you could lie on your side and pull your knees up to your chest, I'm gonna numb you with a local anesthetic.

Are you okay?

Feeling a little dizzy.


Bret? Bret!





Little help!

Anything hurt?

Not really.

Gonna be stiff tomorrow, though, aren't I?

Yeah, but pain builds character.

According to who, exactly?

[both chuckle]

Bret still needs an LP. You good?

Uh... fourth period, bottom of the 9th... Put me back in, Coach.

Butchered hockey, football, and baseball in one sentence... impressive.

Dr. Charles, thanks for coming down.

Quick favor? Shoot.

Uh, got a patient, 17-year-old hockey player.

I heard. Bret "Bear" Cooper.

Dad was a heavy.

Hear the kid's even better.

Wouldn't have taken you for a jock.

Oh, come on... sport's the oldest form of group therapy.

We yell. We scream.

Testosterone spikes.

Every now and then, we even get to believe in a miracle.

Your patient...

It's actually his father Jack that I needed the consult on.

He's exhibiting memory loss, hand tremors, agitation...

Could be Chronic Traumatic Encephalopathy, but I'd like to rule out anxiety and depression first.

CTE sounds right.

Get hit in the head that many times, it's bound to catch up with you.


Past always does.

Listen, sorry about the other day.

We got slammed. I get it.

E.D. never sleeps.

But if you keep skipping our sessions, buddy, I'm afraid you won't either.

So finally, as we reintroduce blood into your lungs, we will manually compress the pulmonary artery to avoid initial volume overload.

Hey, can I see those lungs again, please, Doc?

Yeah, of course.

Science fiction meets reality.

[both chuckle]

I just hope they work as well once they're in me.

Believe me, you couldn't be in better hands than Dr. Downey's.

We'll see you in the O.R., Mr. Mosconi.

Your lungs got a Chicago Fire escort like I have never seen.

Brothers in arms.

This is really happening.

It is. We'll see you on the other side.


Quite the presentation, Dr. Rhodes.

I wanted to be thorough.


Next time, in English.

Patient's already overwhelmed.


Start of the second, Bulls are looking strong...

What's the score?

Bulls are up by 4.


Dr. Manning, Tim's blood work came back.

INR's high.

Same thing happened the last time he came in.

All right, let's ease him off the blood thinners and give him 10mg of Vitamin K to level off his clotting factors.

Put in the order.


Oh, those tests that Dr. Halstead ordered?

All negative.

Put Tim through all that stress for nothing.

They won't listen. They're doing a lumbar puncture.

That is exactly what I was trying to tell them.

Okay, yeah. I'll keep you posted, Doc.


Mr. Cooper?

Dan Charles. Boy, what a pleasure.

That's quite a grip.

Good for stick handling. You ever played hockey?

Oh, a million years ago. Only Junior League goalie, but had one shut-out. Best day of my life.

Ha. I loved the Junior Leagues.

Played the game for no other reason than it was fun.

Don't read too much into that.

You are a shrink, right?

Oh, boy, what gave me away?

Well, the team always had a couple on the payroll.

Soft spoken, loved eye contact, and not to mention the sweater vest and the Rockports didn't help.

[laughs] Oh, geez. Well, then you know exactly what my next question's gonna be.

How am I feeling?


I mean, my son is in the E.D., so as a dad, I'm concerned.

But as a former player, knowing that leaving it out on the ice is what got us here, couldn't be more proud.

Sacrifice in the name of sport...

Wouldn't know anything about that.

I never played hockey.

You know, that's a shame.

I mean, you got great width, you know?

You never thought about playing goalie?

Mm... more of a bookworm than a bruiser.

[chuckles] Yeah, I got you.

The spinal tap's done.

We'll get it off to the lab and go from there.


Well, nice to meet you, Doc.

Real pleasure.

Short-term memory loss...

As of now, CTE's only diagnosable postmortem, but I'm afraid your instincts are correct.

You still at it?


Didn't your mom ever tell you you'd go blind staring at a screen that long?

My mother was a litigation attorney and worked 90-hour weeks. She didn't tell me much.

Well, guess it's on the nurses then.

All right, this hospital's too far from the city.

You wouldn't last a week in the boonies.

[laughs] Oh, and this one's way too vanilla.

You've been rolling with us. You got a little flavor now.

This one's Boston?

Winters are terrible.

All right, you got me on that one.

Maybe... we're angling for you to stay.

Chicago Med's definitely in the running.


It's my specialty I'm torn over.

I always thought I'd choose pathology, but the E.D.'s really... grown on me.

I can't believe I just said that.

Oh, that's okay, sweetie.

You're not the first lab geek that we've turned.

You shouldn't be the last one in.

Patient's ready, Dr. Downey.

Let's get this show on the road.

Propofol's going in.

[rapid beeping]

Pressure's tanking.

No pulse.

Rhodes, on his chest.

Allen, how much EPI has he gotten?

20 mics.

[flatline tone]

[flatline stops]

[steady beeping]

Got a pulse back.

Good waveform on the A Line.

He's in sinus rhythm.

Let's TEE.

All right.

Here you go, Doctor.

Thank you, Nurse.

Get in there.

Show me what I need to see.

Look at the aortic valve.

Valve area's .6.

Cardiologist said it was only mild to moderately stenotic.

I know, but this is critical.

He needs a new valve.

How long have the lungs been perfusing?

Including transport, at least six hours.

They're good for another five to six, but we can't transplant until we fix that valve.

Keep him deep... between his lungs and the blockage, he won't tolerate going under again.

You and I need to figure out a plan quickly.


Code blue, treatment 1.

Code blue, treatment 1.

What happened?

A second ago, he was perfectly stable.

We were talking.

Hold compressions.

[flatline tone]

No pulse.

What's going on?

I don't know.

No breath sounds.


Crash cart!

Charge to 200 Joules.



Everyone clear.

[beep beep]

Nat, back away.

No, just give me one more second.

I see the cords.

I'm almost in.

All right, tube's in. Let's go.

Everyone clear!

Nothing. Copy. O.R. on standby.

Round of EPI.

Got it.





[beep beep]


Still in fib.

Nat, you take over compressions.

Don't stop for anything. April, where's that EPI?

EPI's in.

Clear. Clear!

[beep beep]


[murmurs in background]

CPR. EPI again.

Follow it with an amp of bicarb.

Yes, Doctor.

Asystole... he's got no pulse.

I got it.


Will, he's gone.

[dramatic music]

♪ ♪

Time of death... 14:21.

Balloon valvuloplasty will stabilize the valve and allow us to do the transplant.

It's only a stopgap.

In a month we're back at square one needing to replace the valve, only now the patient's fresh off a transplant.

Then we open him up, replace the aortic valve, and do the transplant afterwards.

I don't want him open that long.

Invites a whole host of complications.


How about this?

We do the valve replacement and the lung transplant at the same time.

We'll do a trans-aortic valve replacement first...

Less invasive.

Cardiologist can go in through the groin via catheter to fix the valve.

Once they're done, we'll move on with the transplant.

Yes, sir.

A brain infection... Like meningitis?

You can treat this with antibiotics, can't you?

Possibly. We did catch this one early.

This is cerebritis, not meningitis, which is not only serious but stems from some underlying condition, one we have yet to find.

So... more tests?

Afraid so.


Third period, son. We got this.

Mr. Cooper... mind if I talk to you for a second?

Yeah, sure.

Hang tight.

We're gonna get to the bottom of this.



Look, I couldn't help but notice earlier...

The CTE.


Yeah, I know.

I know. I got it under control.

Mr. Cooper, the disease is progressive.

You think I don't know that?

I have a private physician, a team doctor from when I played, and he says it's not too bad.

And Bret?

Bret is fine. All right?

The game's changed, huh? Safer.

Better equipment, better penalty regulations...

Does he know?

Well, I don't really see how that's any of your damn business.

Bret deserves the truth. What kind of father keeps his kid in the dark?

Hey, you watch what you say to me!

Dr. Choi!

I apologize for my colleague, sincerely.

Why don't you, um, why don't you go check on your wife and son?

I'm very sorry about that.

Okay. Thanks.

He's keeping it from Bret.

And so you thought threatening him would make him more forthcoming?

That's my conversation anyway. Why didn't you page me?

Wouldn't have helped... Guy's in total denial.

Oh, he is?

Huh. [scoffs]

This is why you go to therapy and why you stick with it.

[whispers] Come on.

What the hell?

Can I talk to you for a minute?

Why did you administer vitamin K to my patient without consulting me?

His clotting was slow.

It's standard protocol, and I think you mean our patient.

Your protocol may have caused a pulmonary embolism.

You have no grounds to say that.

Any number of things could've happened.

He has been battling his vasculopathy for years.

Oh, so now he was a ticking time bomb?

That's not what I said, and if you had listened, you'd know that.

I heard you loud and clear.

You thought nothing was wrong, and where is Tim now?

He was stable when I left him.

You better think about what you're saying right now.

Nat, that vitamin K made him throw a clot.

You don't know that.

If you hadn't interfered, he'd still be here.

No, this is not about me.

This is about you and the mess that you made when you resuscitated Jennifer Baker against her DNR.

Well, blaming me for this is not gonna make that right.

[tense music]

♪ ♪

Hey, I paged you twice.

Shouldn't you be operating?

No, the patient arrested. Cardiologist is doing a TAVR, and I had a minute and figured we might grab a bite to eat.


I... you know, maybe I'm missing something.

I-I just... I pitched Downey at least four solutions, right?

Not one bullet hit its mark.

You know, half the time, I feel like I'm the chosen one.

The other half, I feel like I'm failing him.

I just can't get a read on the guy.

Mind if we talk about something else?

Is there something we should be talking about, 'cause I get the feeling...


Damn, uh... I gotta go.

Look, we'll pick this up later, okay?


Often, brain infections are caused by inflammation in the sinuses and in the ears.

Your ears look okay.

Always know you wanted to be a doctor?



And no.

As a kid, I was intrigued by anatomy, dissecting frogs and looking at their organs under the microscope.

But here I am in the E.D.

I never thought I'd be dealing with people in their most difficult times.

And you?


[both chuckle]

Hockey is... Well, it's so...


Well, yeah.

[laughs] Yeah.

I don't understand how someone could risk all of their teeth for a game.

[chuckles] My dad played pro, and I was skating before I could walk.

Even if I wanted a different career, nothing else would feel right on me.

Guess you can't escape who you are.

You've got a little dried blood in your nose, but it's probably just because of the fall.

Oh, no, I had a nosebleed this morning.

I get 'em all the time.

All the time?

Yeah, it's no big deal.

Can I take a look in your mouth, please?


[tense music]

♪ ♪

I'll be right back.

Ms. Goodwin?


My schedule... I would like to be on different shifts than Dr. Halstead.


I think it's in the best interest of our patients.

It's nothing personal.

It sounds personal. You two at odds?

That's putting it mildly.

Listen, I couldn't honor your request even if I wanted to.

With the hospital under scrutiny, any changes with Dr. Halstead could be interpreted as culpability.

It's status quo until the dust clears.

You know, when I'm faced with a snarling dog, I try to remind myself it's self-preservation that's making him show his teeth.

Sinuses and ears were clear of infection, but Bret gets frequent nosebleeds, has since he was a kid, and he's got dilated vessels on the inside of his mouth.

You're thinking HHT?

It's rare, but it fits the symptoms.

Okay, let's get a CT chest and belly and see what comes back.


Reese, good call.

No sign of foreign bodies.

No abnormalities in my external exam.

What's your theory?

Pulmonary embolism.

He came into the E.D. with mild CHF and was dead in a couple hours.

I'm gonna start with the chest then.

[saw buzzing]

[bones cracking]

A pulmonary embolism wouldn't manifest this much blood.

Give me some suction.

Definitely not a PE. Give me your hand.

You feel that?


You feel the hole?

Ruptured aortic aneurysm. He didn't stand a chance.

So I was wrong.

Nothing you or anyone else could've done.


[murmuring] Just go at him right there...

- [whistle blows]

[crowd noise]

[Bret continues murmuring]

Hey, Bret.

Mr. and Mrs. Cooper, Bret, we got our chest CT back.

Why don't we have a seat?



Bret has a condition called Hereditary Hemorrhagic Telangiectasia or HHT.

HHT? What's that?

Hey, hey, it's okay, son.

It causes the blood vessels in different parts of the body to form fragile bundles called arterial venous malformations.

These AVMs can sometimes allow bacteria to seep into the blood and spinal fluid and cause an infection.

Is it curable?

It's manageable.

The AVMs can be repaired, but they have a tendency to recur.

Okay, so what does it mean?

I can still play, right?

We'll try to monitor any AVMs that might develop, but if there's an AVM we don't know about, one wrong hit, and you could suffer a catastrophic bleed.

Look, I'm sorry, Bret, but it's my recommendation that you quit hockey.

Okay, listen, if he's had this his whole life, why is it only a problem now?


You know what? I am getting a second opinion.

Hey, it's gonna be okay, sweetie.

Mind if we have a minute?

I'll be right outside.

You said if I take the wrong hit, you're saying I could die?

That's what I'm saying.

Listen to me. I know what you're thinking.

"One in a million hit can't happen to me," but it can.

It can.

I know.

Think about it.

[pat pat]

You'll find another path...

And it'll feel right.

I'm sure of it.

I was so certain I was right.

I did everything I could, covered every single base...

I'm sure you did.

The worst part...

I attacked a colleague.

A friend.

You're under a lot of pressure.

Everyone knows that.

If you apologize, I'm Dr. Manning will understand.

It's her, right?

Why don't we rain-check dinner tonight?

It's okay.

Thanks, Zoe.

We are ready to transplant.

Not yet. You cut too shallow.

If the vessels are too long. They could thrombose.

Here, trim the atrial cuff.

Not too deep.

Not too quickly.

Don't want to damage the vessel.


All right, let's get the lungs in.

Maybe you should take over.

Let's get the lungs in.

Yes, sir.

The aortic cannula's loose.

[rapid beeping]

BP and sats falling.

Get him clamped now or he's gonna bleed out.

[beeping continues]

[tense music]

Got it. He's clamped.

And the pressure is improving.

Let's get the lungs in and get him off the pump.

Are you all right?

You're gonna have to take lead from here.

Okay, I'll cover you.

I'm ready for the lung.

Here, Doctor.

Bronchus first, followed by the left atrial cuff and the pulmonary artery.


Let's start sewing.

4-0 Prolene.

And that's the cerebellum.

[continues murmuring]

You see what Bret tweeted?

"Off my skates for a couple of days," but I'll be back at All Star Clinics, "stronger than ever. #Downbutnotout."


He's still gonna play?

I told him he could die.

Boys will always want to be better than their fathers, which is precisely what their fathers want.

Ready to go?

"What price glory," right?

Headed out? Made your decision?

Yep, just now.

Let me guess... E.D. strikes again.

No... pathology.


It's the patients.

They come in, and you want to help them.

You care about them, so you try to connect, and, just when you think you're getting through, they go back to what they were doing before.

And it's like you were never even there...

Like everything you did was for nothing.

I can't take a life of that.

I'll see you tomorrow.

I am in no mood, Will.

I get it.

Natalie, I'm sorry.

It wasn't the vitamin K. I was wrong.

You, wrong?



I've been an ass, not just today... Since last week...

Before that.

I should not have yelled at you.

Why do you always take things out on me?

You invite me in, and then you push me back.

You ask for my opinion, and then you completely ignore me.

It hurts, Will.

You wouldn't treat anyone else like this, so why me?

Don't you know?


Mr. Mosconi's gas exchange is good.

We'll rest him overnight, hopefully extubate him in the morning.

I thought maybe you'd be at home resting after that episode in the O.R.


You didn't need me to take over.

I've usually found, Dr. Rhodes, that when given responsibility, people rise to the occasion.

I know the last few weeks have been... challenging, and I'd be lying if I said the months to come will be any easier.

I have an impossible amount to teach you in a diminishing amount of time.

You don't have to show me how smart you are, and you don't have to please me.

Just learn.

He's breathing on his own.

Indeed he is.

Sorry about dinner.

Wasn't sure you were gonna show.


What is it?

I've been talking to Dr. Charles, the hospital psychiatrist.

Shared some things about my service... tough things.

You don't have to explain. I know.

I thought if I didn't think about it or talk about it...

I'm here.

My dad was Navy.

That why you enlisted?

It just always seemed like that was what I was gonna do.

There's a room full of kids in there who are gonna ask you about your service.

What are you gonna tell 'em?

That I'd do it again.

[pop music plays]

Scotch... rocks. Thanks.

Who's winning?

The Blackhawks by one.



We haven't exactly been the same since I started with Downey.

No, we haven't.

Sam, I know this can't be easy for you...

But if you're gonna make me choose between you and Downey...

It's gonna be Downey.


I'm not gonna make you choose.

[somber music]

♪ ♪