01x11 - Intervention

Alicia, we can't agree to this.

This is too much.

Then we'll go to mediation, and if you still think it's too much, we'll go to court.

I'm very confident in our chances.

Can't we find a compromise?

I'm sure everyone here would like nothing more than to put this behind us.

Easy for you, but since Dr. Halstead resuscitated Mrs. Baker against her wishes, she's been confined to this hospital, fed through a tube, and hooked up to a series of wires, tanks, and catheters with no end in sight.

This is not something she'll ever be able to put behind her.

I never wanted any of that.

I did what I did to give you time so...

Dr. Halstead.

Dr. Halstead.

Ms. Goodwin, you have our terms.

Okay, so it's my first surgery, and I'm holding this thing called a "Bovie."

For cauterizing blood vessels.

Yeah, yeah, so the surgeon, he tells me to buzz.

He's talking about the Bovie, but I have no idea, so finally I just look at him, and I say, "Bzz."

You did not.



Don't you have patients to see?

Yeah, I'm on my way.

It's just another kid with a earache.

And we've got 20 more in the waiting room.

You drinking baby formula?

Oh, yes.

It's all they had in the back.

The vanilla's actually pretty good.


35-year-old male found down in his kitchen.

Hypotensive at 80 over 40, rate 134, only responsive to pain.

All right, you're going to Treatment Four.

Dr. Rhodes, can you get this, please? We're slammed.

I'm on it. Reese, come with me.

Ready? One, two, three.

All right, let's get him hooked up.

Prep a saline line.

We're gonna need another one wide open.

O2 sats are 85 and dropping.

What's happening to me?

We're gonna find that out. We're gonna intubate.

Give me a 7.5 ET tube, 20 of Etomidate, and 1 milligram per kilo of ROC.

Septic shock?

Maybe, but we need to find a source.

Your respiratory muscles are weak.

I'm gonna intubate you so that they can rest.

Give him 3 grams Unasyn.

Send for a CBC, CMP, coags, and lactate.

Give me a blood gas and blood and urine for culture.

On it.

There's no bleeding or deformity in his legs.

We're almost ready.

Heartrate is erratic. Watch his pressure.

All right, I am in.

Dr. Rhodes.

O2 sats are 98 and he's stable.


We need to get him up to the OR now.

I have a feeling we're already too late.

Patient's spouse is here. He's very anxious.

Any updates I can give him?

Tell him his husband's got necrotizing fasciitis and we're debriding the muscle to try and stop the infection.

Dr. Rhodes, is that okay?

Uh, yeah. That's fine.

Did a med student seriously just go over my head to you?



You know that woman that you helped me get into the clinical trial?

Jennifer Baker?

Could you find out how she's doing?

You know, side effects, tumor burden.

Isn't she still suing you?

I just want to know if she's at least showing some improvement.

Will, it's a Phase III study.

All that information is confidential.

I'll see what I can do.

Thank you.


[indistinct P.A. chatter]



So how are you doing?

I'm good.

That's good.

We should, you know, talk.

Yeah, but not here.

Yeah. No.




You're gonna be fine.

Hi. I'm Dr. Manning.

This is Dr. Halstead.

You must be Shiloh.

I heard you had a bit of a headache, huh?

It started yesterday.

She's also had a 103 fever since last night.

Did you try Tylenol or ibuprofen?

Tylenol usually works, but this time it didn't touch her.

That's why we're here.

You mind if I take a look?

How about any nausea or vomiting?

She threw up once. That definitely concerned me.

But there hasn't been any purulent discharge, so I doubt it's bacterial.

Well, we can't rule anything out yet.

So you're going to do cultures, right?

Well, first things first.

Anyone you know have similar symptoms?

No, not that I know of.

Do you feel stiff or achy back here?

Yeah. When I move my head.

Wait. Are you thinking meningitis?

Well, with fever, headache, and neck stiffness, it's definitely possible.

Possible or probable?

Because she hasn't shown increased drowsiness or experienced any photophobia.

Are you MDs?

No. Engineers.

Well, like we said, meningitis is a possibility, so the next step is to do some tests.

What kind of tests?

Well, we're gonna do two pokes in your arm and one poke in your back so we can figure out what's going on and get rid of this headache.

Is that okay with you?

Yeah? Okay.

All right, well, we'll be back in.

Thank you.

Professor told me hardest part of pediatrics... never the kids.


Who sent you those?

Not mine.

Goodwin's anniversary. 32 years.

Dr. Choi, incoming.

Got it.

Treatment Six.

Ken Gallagher. 57-year-old male with an LVAD.

Called 911 with severe abdominal pain and epigastric tenderness. Vitals are stable.

Mr. Gallagher, on a scale of one to ten, how bad is your pain?

A zillion.

All right, let's move him.

On my count. One, two, three.

High dose antibiotics set up please.

That's a left ventricle assist device, right? An LVAD?

Unfortunately, yes.

No guarding or rebound tenderness.

Has this happened before?

There's a hole in my stomach. It never stops.

You've been diagnosed with an ulcer?

Diagnosed, scoped, transfused, scoped again.

Doesn't sound like you've had an easy time.

Okay, you're gonna feel a little p...

Feel a little pressure. Like I said, not my first rodeo.

All right. You on any ulcer meds?

Three of 'em. What is it this time?

Abscess? Breakthrough bleeding?

May be a trace of blood in there.

Get me an NG tube, and call GI for an endoscopy.

I want a better look.

No, no. Can't I just show you my last six endoscopies?

It's still the same stomach.

Well, I'll give you something for the pain, but we have to try and figure out how to get this ulcer under better control.

I'll tell you how. Get rid of this thing.

Not a good idea. That thing, the LVAD, is pumping your blood for you.

Yeah, and all my problems started right after I got it.

I understand, but it's better you follow up on that with your cardiologist.

My cardiologist is an arrogant SOB.

Come on.


I'll have cardiothoracic down to take a look.

Thank you.

Man, do I hate that stuff.

It's a lot worse without it.


I have a feeling you know the drill.


Hey, Dan.

I haven't seen you in a while.

Oh, it'd be more often if you'd show up at poker now and again.

Maybe I'd show up more often if you didn't keep taking my money.

Yeah, I'd stop taking your money if you didn't touch your chin whenever you bluffed.


I have a tell? Really?


Anyway, I try to stay out of here.

Private practice doc in a hospital is never good news.

Patient of yours get admitted?

Necrotizing fasciitis.

Oh, man. That is a bear.

Been seeing me for ten years.

Good guy. I'll see you, Dan.

Take it easy.

Nat, the little girl with the fever, Shiloh Kane.

Her lab results. They said it was urgent.

April, get the patient from two into isolation and order a chest X-Ray and CT head, and put the rest of the family in another room for culture times three, and no matter what, do not let anyone leave.


What's going on?

Get me on the phone with the CDC.


How dangerous is this?

It depends.

Haemophilus influenza B can often be contained with the antibiotics we're giving her now, but not always.

And if it's not contained?

It can cause hearing loss, brain injury... even death.

Well, I've never even heard of it.

How'd she get it?

Well, that is the question.

It's part of the standard vaccination regimen.

Is Shiloh vaccinated?


Are any of them?

Type B is transmitted by saliva, which makes incidental contacts like Dr. Halstead and I not at risk, but any of her long-term close contacts are.

We'll notify the school, but in the meantime, you'll each need to be immunized.

I'm not sure we want that.

Mr. Kane, I think it's very...

Your children are at serious risk.

We feel vaccinations pose a serious risk as well.

That is not true.

Doctors are about intervention. I get it.

But left alone, the body has a perfectly good immune system, and once you start injecting it with foreign proteins and preservatives, you can't help but change that.

Right now, all our other children seem to be fine, and Shiloh's in there all alone.

Can we just go be with her?

Of course you can.

We'll send someone in to watch your other children.

Thank you.

So what?

You're just gonna let them off the hook?

They're scared to death right now.

It is not the time to push.

I will talk to them again later, okay?

His coloring is pristine.

The LVAD is working perfectly.

I just don't see what else we can do at this time.

This is not pristine.

I understand.

Unfortunately, GI ulcers are not uncommon with these devices.

Yeah, apparently neither is torture.

I can't live like this.

Well, fortunately, the LVAD is temporary.

Just a bridge until you can get a heart transplant.

Come on, do you know where I am on the list?

Your heart will fail before I get one.

That's not true. There are a lot of factors.

You're a surgeon, right?


Take it out.

Excuse me?

Take the damn thing out.

Mr. Gallagher, I'm... I'm... I'm... I'm sure you understand.

Your heart is too weak to pump on its own.

The device is doing it for you.

I don't care, and I don't have a family.

It's my heart. I want it out.

That's not possible, because if we take it out, you will die.

I'm sorry.

Is Dr. Unger coming back?

Dr. Unger? I don't know. Was he...

He was starting to explain things, but his office kept paging him, so he had to go.


But it sounded bad.

Necrotizing fasciitis is what people call "flesh-eating bacteria," but that's a misnomer.

It doesn't actually eat. It just spreads very quickly.

Even with surgery and antibiotics, once it starts moving, we hardly ever catch up.

That's what Dr. Unger was saying.

Is he Elias's regular doctor?


I mean, not regular.

He hardly ever went.

Monday was the first time he'd been in, like... two years.

He saw Dr. Unger two days ago?


He had a pimple on his arm that was bugging him.

And what did Dr. Unger do?

He didn't think it was anything to worry about.

I mean, it was just a pimple.

It hurt him more yesterday, so we called, but we never heard back.

I-I guess it wasn't just a pimple.


Jennifer's nurses say she's tolerating the trial really well.

No nausea or vomiting. No muscle pain.

No cognitive dysfunction.

It's as good as a report as you could ask for.

Thank you.

I really appreciate this.

Hey. Sweet, sweet man, your husband.

If you want, I'll have someone take them to your office.

No. Keep 'em here for now.

They brighten up the place.

Works for me. What are you guys doing tonight?

Same as every year. Gibson's.

Bert orders the T-bone, and I get the sea bass.

Best steak house in Chicago and you get the fish?

It's delicious.

Do you know a doctor in private practice named Unger?


Is he reputable?


He missed a diagnosis, and now that patient's probably going to die.

Truthfully, he's missed a few in the last few months.

Can you pull up a list of his patients who've been here recently?

April. [sighs]

Okay. Just keep my name out of it.


You didn't get this from me.

[alarm chiming] Code blue.

He's in respiratory distress.

What happened?

Get the crash cart.

Let's get him flat.

He's unresponsive.

Prep a tray.

BP's not registering.

He's wet as a sponge. We're gonna intubate.

I can't find the pulse.

He won't have one.

LVAD's the pump. It bypasses the heart.

His device must have failed.

His heart's too weak to pump blood on its own.

That's why his lungs are soaked.

Prepping now.

I got a 14 and a 16 standing by.


The LVAD battery. He did this to himself.

What do we got?

Respiratory distress and acute heart failure.

I'll start a subclavian.

He take that out himself?

Looks that way.

Suicide mission. Not today, buddy.

And I'm in.

Vent setting's AC 16, tidal volume 500, peep of 5, and O2 at 100%.

Battery's back in.

Pushing pressors.

[electronic beeping]

He's pinking up.

BP is 100 over 65 and climbing.

He's stable.

Nice save.

I'll call upstairs.

He's gonna need to be admitted.

Dr. Halstead, I need a word with you.

Why were you poking around the clinical trial wing?

I didn't talk to her.

I instructed you not to go anywhere near Jennifer Baker.

But I heard good news.

Jennifer hasn't had any of the usual side effects.

She's doing great in her treatment.

That's beside the point.

You blatantly disregard the one thing I asked you not to do.

This could mean she's on the road to remission, and then I'm sure they'll drop the lawsuit.

You don't know that.

You know, I have tried to be supportive of you, but one more misstep and I will suspend you.

You will be barred from this hospital until the lawsuit is settled, and when it is, I will recommend to the board that you be terminated.

I'm done.

Excuse me, Ms. Goodwin.

What is it?

Um, what exactly is the protocol for reporting medical misconduct?

Nurse? Doctor? Who?


Dr. Unger.

Let's take this up to my office.

Over the past two years, Dr. Unger has increasingly missed routine diagnoses.

In the past three months alone there have been four separate incidents.

A UTI that led to pyelonephritis, abdominal pain that turned into a ruptured appendix, a leg rash that turned out to be a DVT, and now an infected pimple that's led to necrotizing fasciitis.

You know this guy. What are your thoughts?

We went to medical school together, and he's a caring, thorough physician.

Been my personal doctor for years.

Never missed a thing.

He missed those, and they're only the ones that came in here.

Thank you, Reese. We'll look into it.

In the meantime, don't share your concerns with anyone else.

I worry about his patients.

Dr. Unger should lose his license.

At the very least, his hospital privileges.

That's not your call to make.

Thank you.

So why'd you really ask me in here?

I'm starting an investigation.

I didn't want you blindsided.

This could get ugly.

Hey there.

Where are your parents?

My dad took my brother and sister home.

My mom's in the bathroom.

She'll be right back.

Well, that's okay. I just came in to check on you.

Why do you have to wear the mask?

Because the bacteria that's making you sick is contagious, which means other people can get it, and I have to be particularly careful because I have a newborn baby, and I wouldn't want to get him sick.

People always going to have to wear masks around me?

No, because this medicine that we're giving you, it's gonna make you all better.

You let me know if there's anything that you need, okay?

Even strawberry Jell-O?


[knocking at door]


Dr. Downey, you mind?


What's that?

"Ka Hana No'eau I Ka Hulu."

The art of the feather.


I am a rank amateur, but it's good for the hands.

What's on your mind?

I have a patient.

He's had an LVAD for four months.

Been experiencing unremitting pain, fatigue.

He has little to no control over his bodily functions.

That happens, unfortunately.

It's been rough, and he is not a candidate for a artificial heart.

Where is he on the transplant list?

Pretty far down.

Chances of being moved up are slim to none.

And he wants you to take it out.


Do it.

But he'll die.

I am a cardiothoracic surgeon.

The patient has asked you to remove it, yes?

In no uncertain terms.

Then honor his wishes.

I hope when my time comes to be so lucky as to have someone extend me the same consideration.

Bad news?

Well, Goodwin took the paddle to me.

I'm okay.

My shift's over in a little, and I was gonna go to Shiloh's school to help give out booster shots.

Why don't you come with us?


All right.

Van will be outside in ten.


Hey. You have a second?

What's up?

Did you give Keflex to the kid with the ear infection in three?

No, why?

Because he was supposed to get Azithro.

He's allergic to Keflex.

What happened?

I mean, nothing terrible.

He's okay.

But it could have been lethal.

Who else was on that side?



No, she was on a break, and he was with other patients.

I'll keep asking around.

You man your desk. I'll find out.

Yeah? Okay, thanks.

Come on, girl, just...


Where's Mr. Gallagher?

Dr. Rhodes just took him to surgery.


To remove his LVAD.

You're removing the LVAD? You didn't consult me.

The only person I needed to consult was the patient.

I thought we were on the same page with this.

What you're doing is assisted suicide.

The patient understands the consequences.

He made an informed decision.

What about you?

You're killing him.

It is what the patient wants.

It's ethical, and it's legal.

I can't let you do it.

Are you really gonna try and stop me, Dr. Choi?




The kid with the ear infection.

You were supposed to give him azithro.

I did.

No, you gave him Keflex instead.

Really? Are you sure?

Oh, my God.

The kid is allergic to Keflex.

O-okay. D-did he... did he go into anaphylactic shock?

No, luckily, they caught it in time.

[sighs] Okay.

Okay? It's not okay.

This could have been really serious.

But it wasn't.

Don't you understand what you did?

I made a mistake, but nobody died.

Anybody could have done what I did.

Who sets up the pharmacy bin?

[both speaking foreign language]

Don't look for someone else to blame.

I'm just saying...

Wait, wait, are you... Are you gonna write me up?

I don't know.

April, you'd do that to me?

If this happens Ag...

If anything like this happens again...

Look, it won't. It won't. I will be really careful.


Don't worry.

It's all good.

It's all good.


Hi, I'm the principal.

We're lining the kids up in the auditorium.

Here are the consent forms.

Thank you.

[alarm chiming] Code blue, ICU.

Excuse me, sir.

Excuse me.

There's no pulse.

What... what's happening?

He's unresponsive.

He's in V-tach.

Cardiac arrest.

What? Elias!

Give me the paddles. Charge to 200.

Charging to 200.

[electroning whining]




Nothing. Stand by.

All right, 1 milligram of EPI.

Got it, milligram of EPI.

1 of EPI.

Elias, come on.


Again. Clear.


Please, please, save him. Please, please.

Come on. Save him.

Again. Clear.


Another milligram of EPI.


Oh, my God, no.

Time of death 15:22.

[sobbing] No! No!


I'm sorry, Jim.

Don't touch me.

What changed your mind?


Right, you and Downey, the Dynamic Duo.

Oh, that wasn't fair.

I still don't agree with your call, but I can see why you made it.

Awful day today.

So what happened with this... with this patient?

It presented as a superficial skin infection.

Elias didn't have any fever, no nausea.

He certainly didn't manifest any risk factors for necrotizing fasciitis.

He was nondiabetic, not in renal failure.

So I gave him an oral Doxy, and I sent him on his way.

I misdiagnosed him.

I feel like hell.

Hey, everybody makes mistakes, but tell me if I'm wrong.

Maybe you didn't used to make so many?

Our own little morbidity immortality, huh?

Dan, I see upwards of 50 patients a day now.

I can't cut back.

Between the lousy reimbursements and my overhead, I need that many just to stay afloat, and then there's the paperwork.

I had to hire two people just to deal with it.

Health care bureaucracy.

I mean, it's tough on both the patient and the doc.

You know, when a young person comes and they ask me, "Should I go into medicine?" you know what I tell them?

No way.

Go get an MBA and enjoy your life.

That didn't hurt, did it?

Oh, you are so brave.

Was that the shot?


That's just the alcohol to make sure your arm is clean.

Is that the shot?


I'm gonna give it to you on the count of three, okay?

One, two...

Where's three?

That's it. You got the shot.

Mrs. Schroeder's not feeling well.

Have your teacher call 911, and tell the other doctor I need him.

Can you breathe?


Epiglottitis. Airway's blocked.

Mouth-to-mouth isn't working. Get me something.


Help me hold her hands down.


Natalie, here.

I know it's hard, but try slow even breaths, okay?

Mouth-to-mouth? She's type B, Natalie.

What were you thinking?

I had to do something.

[sirens wailing]

The ambulance is on its way. You're gonna be okay.

Theresa Schroeder. Haemophilus influenza B.

Criched her in the field.

The ENT is waiting for you in trauma three.

All right.

Terry? Shiloh's teacher?

This is what happens when you don't vaccinate.

You don't know that this was Shiloh's fault.

That lady almost died, and she may have infected my friend, who has a newborn baby.

Terry's probably sick because her immune system is shot from a lifetime of vaccinations.

That's ridiculous.

You docs, you think you know it all.

How... how many times you been wrong?

Urine therapy? Radium for diarrhea?

How many approved drugs need to be pulled every year 'cause they're killing people?

Fen-phen or Vioxx, Raptiva.

There's no evidence the HIB vaccine has any negative side effects.

How can you be sure?

Kids get the vaccine when they're babies.

Who knows what the long-term effects will be?

For Shiloh's long-term health and happiness, we'll risk a treatable childhood illness.

So no child should be vaccinated, right?

You want your kids in a school where no one's protected from polio, smallpox.

Will, enough.


You trot out this pseudoscience, but what you really want is for every other kid to be vaccinated so yours can be safe.

He has no right to speak to us like that.

You're right, he shouldn't have spoken to you that way.

I'm very sorry.


You know they're never gonna vaccinate their other kids after that, right?

I know.

I know.

I shouldn't have shot my mouth off.

It was because of me, wasn't it?

Because I was exposed.

I think it was very gallant.

You do?

Maybe we should talk about that kiss.

You asked why I treat you so badly, why I say things I wouldn't say to anybody else.

I'm like a little kid with a crush on a girl, so what does he do?

He pulls her pigtails.

Look, I understand if you don't feel the same way.

No. Listen, pl... please.

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

But there is just so much in my life that I haven't figured out yet.

You don't have to explain, Natalie; I... I... I get it.

No, I don't... I don't think you do.

I am not trying to let you down gently or put you off.

I'm just not in that place yet.


I'm gonna go check on the teacher.

You should get a booster.


[electronic beeping]

[sustained beep]

I'm sorry, Dr. Unger. I didn't have a choice.

I'll need your hospital ID.


It's not hard to make a still. It's basic chem.



I just wanted you to know that I am gonna file an incident report.

What's going on? Is someone making you do this?

No, no. It's my decision.



Hey, hey, look, look.

I get it. I screwed up.

But you're supposed to be here for me, not dime me out.


You know what? You... you're just pissed because I'm the doctor and you're not.

Noah, you are my brother, and I love you...


But you need to grow up.

Look at me. If you're gonna be a doctor, I want you to be a good one.

Dr. Halstead, what are you doing?

Agh, car wouldn't start. Waiting on a tow.

Ah, always a perfect way to end the day.



Ms. Goodwin?

I'm sorry I've been so much trouble.

Yes, Dr. Halstead.

You have been a monumental pain in the ass.

I know.


Oh, and congratulations on your anniversary.

Thank you.

I heard you've been married a long time.

I have.

How do you do that?

Stay out of each other's way and never forget an anniversary.

Good night.

Good night.

That was...


It was a rough day.

I have something to show you.


Johns Hopkins, huh?

Head of trauma.

That's quite an offer.

Yeah, it is.

I hope you let them down gently.

You know, Baltimore gets very cold too.

I know.

Looks like we had the same kind of day.

Sweet and strong, please.

I had a patient who wanted his LVAD removed.

He got what he wanted.

Now he's dead.


I guess I took out an LVAD myself today.

How do we ever know what we're doing is right?

It's tricky.

I mean, the first part of the Hippocratic Oath is clear, right?

"Do no harm."

Then it goes on to say, "I will remember that there is art to medicine as well as science."

So it's tricky.

It ever get any easier?

Hope so.

[glasses clink]