|Transcripts - Forever Dreaming
|01x18 - Timing
|Page 1 of 1|
|Author:||bunniefuu [ 05/18/16 17:52 ]|
|Post subject:||01x18 - Timing|
Is your mom flying in for tonight?
No, she's got an early day tomorrow.
Doesn't want to red-eye back. She sent me a check.
Well, then after the ceremony, let's you and I go out and celebrate.
Depends on how late it is.
Reese, it's your graduation.
You've earned it.
Okay, well, I'll be the guy clapping the loudest.
I'll see you later.
Oh, no, don't tell me you lost it again.
Your wedding ring.
Oh, uh... no.
I decided it was time to take it off.
Can't get used to it not being there, though.
Six-month-old boy, Michael Thomas.
Suffering from diarrhea, vomiting.
You're going to Treatment Six.
Hi, I'm Dr. Manning.
Something's really wrong with him.
Hey, don't worry. We're gonna take good care of your baby.
Page Dr. Rhodes. Dr. Halstead, you're with me.
It's Dr. Downey.
Talk to me.
BP's 90 over 60.
Rate of 110. Respiration's at 38.
Okay, we're going to Trauma Three, Baghdad.
He was found at home.
He dialed 911 himself, but he was down by the time we got there.
Dr. Downey, can you hear me?
Are you in pain?
Get ready to rotate.
No breath sounds on the right. Need an X-ray.
Sharon, we need you in Baghdad.
On my count.
One... two... three.
Get it out.
There's fluid in his chest.
He just had an RFA yesterday.
His liver must be bleeding into it.
All right, hemopneumothorax on the right.
All right, we're gonna put in a chest tube to drain the blood.
2 of Versed. 5 of morphine.
Sorry about the shirt.
Pulse is thready.
All right, get a groin line in, will you?
Okay, I'm in.
How's he doing?
His liver is bleeding into his chest.
I need to open him up to stop it.
How close are we?
All right, I'm in.
Activate the MTP. Tell 'em to send all the blood they have and meet me in the O.R.
You gotta stop the bleeding. I'm barely keeping up.
Can't get to the diaphragm.
The right lung is in the way. Can you collapse it?
Give me some room?
Set up the Argon Plasma Coagulator.
Putting in a bronchial blocker right now.
It's coming. In a sec.
Okay, I see the bleed.
All set with DRB?
Bleeding's slowing. It's still pretty oozy.
How much product has he gotten?
Six platelets, one cryo.
We're gonna have to warm him up in the ICU and continue transfusions. Make sure he can form clots.
Want me to close?
No. My teacher.
So, insomnia, obsessive pacing, aggression?
Some of that.
And this is a parrot?
What else you know about the bird?
He was kept by a hoarder. Basically lived in a trash heap.
Yelled at a lot.
Look, I don't know what to do. I tried to give him away, but nobody'll take him.
How's he feel about you?
How should I know? He's a bird.
Will you do me a favor, and before you try and give him away again, can I come by and meet him?
You wanna meet the parrot?
Very much so.
How about lunch today? I'll bring sandwiches.
What's wrong with our baby?
He's probably just weak, right?
From the diarrhea?
We've given him fluids, so he's not dehydrated.
Was he born prematurely?
His liver's enlarged.
Oh, my God.
Was he exposed to any toxins in the house?
No, we're careful about that.
Anything else you can think of?
Only... he... he just started sitting up, but he hasn't been able to do that the last couple days.
Let's order a CBC, CMP, UA, and blood cultures, and let's start a 10cc bolus of albumin and page Dr. Grant.
What is all that?
We just need to run some further tests, and I'm bringing in a specialist to consult.
We're gonna find out what's going on with you.
Be back shortly.
You could have just dropped me off.
My mama told me, "Escort a lady to the door."
Well, here I am.
Safe and sound.
See you tonight.
Any word on Dr. Downey?
He's out of surgery and stable.
Oh, good. Good.
How's the renovation going? Bert's "man cave."
You know, I thought it would cheer him up, but he's not showing any interest at all.
I feel like I'm being punished for not retiring with him.
Rough at home, huh?
That's an understatement.
Morning, Ms. Goodman.
That woman... does not like me.
You haven't exactly made her life easy.
How's the job search going?
Hey, got an offer yesterday from Mount Sinai, Miami.
Plus Memorial West in California.
So, either way, looks like sunshine for me.
What about Med?
Should have heard by now.
Hey, you know, Dr. Manning...
She's not wearing her wedding ring anymore.
Why would you tell me that?
Timing, Dr. Halstead.
That's what it's all about.
His fault. Shouldn't have been wearing that shirt.
Oh, that seems like a pleasant one.
Take them to Treatment Three, please.
Oh, thank you.
April, you busy?
I'm with you.
All right, fellas, I'm Dr. Halstead.
Don't need this.
Just let 'em take a look.
All right, come on. Let's get you on this bed.
No, no, just... Just wanna go home.
Okay, what happened?
Went out to party after the game, he sees these Cards fans...
Douchebag's wearing a "Cubs suck" shirt.
Yet, we won. How could we suck, douchebag?
Sir, please stay on the bed.
Down... sit down.
Dan got the worst of it. Got kicked in the ribs.
Stay on the bed.
Let me go!
[grunts and gasps]
You, hold him!
Dan, what're you doing?
[gasping and coughing]
You all right, April?
You okay? Yeah, I'm okay.
Get this guy in restraints. 5 of Haldol.
You good... okay.
All right, let's go over here.
Michael's heart is enlarged.
What would cause that?
Given everything else, I'd say we're looking at a genetic disease.
How can that be? We're both fine.
You could each be carrying one faulty recessive gene which, when paired together, can express in Michael.
Dr. Manning, BP and sats are dropping.
He's not breathing.
Oh, my God.
Tube him now.
10 mics dopamine per kilo and 15 of fentanyl.
Sats are coming up.
All right, let's get him up to the PICU.
Okay, I'll go with him.
Where is he going? What's happening?
He's stable. We're taking him up to pediatric intensive care.
You can come with.
And then what?
There are many genetic diseases that could be causing this. We need to determine which one.
Chicago Med can do fast genetic sequencing.
We'll need blood samples from the three of you to analyze.
Hopefully we'll have a diagnosis in 26 hours.
But what if he keeps getting worse?
We're gonna do everything that we can.
Okay? Go ahead.
Didn't mean to hit her. I'm sorry.
Really, I'm fine.
Your lungs are clear.
So can I go back to work?
Just hold on.
Does this hurt?
On a scale of one to ten, how bad's the pain?
That means it's a seven or eight.
Hey, you're probably okay, but I'd like to get a chest X-ray just to be safe.
April, you have some pain and tenderness.
A broken rib could have punctured your liver or your lung.
I want to make sure you don't have pneumothorax.
I'm not short of breath.
We don't want to see you wheeled back in here on a gurney.
Ms. Goodwin, I appreciate that, but you are all overreacting.
I'm telling you, I'm fine.
He's been off the lorazepam for two hours, and he still hasn't woken up, and he's still completely reliant on the vent.
[sighs] So you needed me to tell you he should have come to by now?
No, I needed you to tell me why he hasn't.
Could it just be that his poor liver function is preventing him from metabolizing the lorazepam?
Dr. Rhodes, you called a neurosurgeon in to consult.
Obviously, you suspect something else.
I'm afraid he might have stroked on the table.
And you were hoping I'd tell you otherwise.
I can't. His pupils are sluggish.
We need a head CT.
You should have already ordered one.
Call me when he's done in radiology.
100 mics of epi.
Heart slowed to 40.
We need to give the epi through the tube.
Let's just hope this little guy makes it until we get those results back.
He won't fly. Just does this all day.
What else he do?
I know this sounds crazy, but I think he gets nightmares.
He'll suddenly cry out in his sleep.
It's not crazy.
It's actually consistent.
Don't touch that.
Post Traumatic Stress?
Come on. A parrot?
Parrots are highly intelligent, and very socially attuned.
There is, in fact, a program at the VA in San Francisco that matches vets with PTSD with similarly afflicted birds.
So he can help me?
Don't touch that.
What do I do?
Eh, take care of him.
Talk to him. Hang out with him.
For starters, teach him something else to say.
Don't touch that.
We've extracted DNA from the baby and both parents, and the DNA samples have been prepared, so that we can load it into the sequencer, which will give us the genetic code of each.
Once we have that, we can target specific parts of the baby's genome, based on the baby's symptoms, and give a gene-based diagnosis.
I mean, that's pretty amazing, don't you think?
Oh, you're thinking about your graduation?
I'm thinking about the baby.
He's so... little and helpless and in so much pain.
I know that you've had second thoughts, but it's actually a good thing you stuck with pathology.
You don't want to get so involved with patients.
What if... that poor little baby doesn't make it?
You're gonna feel terrible.
Yeah, I am.
I would too.
That's why I like it down here.
I'm... I'm not good with suffering.
It's just... too much up there.
From the hiring committee.
Didn't even have the balls to tell me in person.
"Dr. Halstead, we are pleased to offer you a full-time position as attending physician in emergency medicine at Gaffney Chicago Med."
Well, well, well. "Lost cause," huh?
I can't believe it.
I must have some, uh, mystery friend on the committee. Overruled Goodwin.
Nobody overrules Goodwin.
You wouldn't have gotten that without her say-so.
What do you see?
You want the good news or the bad?
Let me have it all, Sam.
David didn't have a stroke.
He's gonna wake up, but the problem is here in his temporal lobe.
It's a mass.
The cancer spread to his brain.
Metastic hepastatic carcinoma.
It's very bad news.
Is it operable?
Hold on just a second.
The core of the mass is centered over area 5, the superior parietal gyrus.
If I resect, he'll have asteriognosis.
You won't recognize objects by touch.
You won't know the meaning of sensations or be able to coordinate between your visual and tactile systems, and that would be a good outcome.
You can't be sure that's gonna be the case.
Without the surgery, what can I look forward to?
Already got that.
Loss of motor skills, bodily functions, uh, neuropathic pain, seizures, delusions...
Look, I'll give surgery a shot.
It's your call, David. You know my reservations.
All due respect, Dr. Abrams is not the only neurosurgeon in this hospital.
No, but he's the best.
Dr. Downey, we should at least get a second opinion.
I'm satisfied with Dr. Abrams' prognosis.
Thank you, Sam.
By the way, Sam...
I've always appreciated your bedside manner.
Come back later.
I may feel like some company.
I want to thank you.
I'm going to accept Med's offer.
My fear is, is you're gonna find a way to get yourself kicked off the staff.
I'm curious to see how long it'll take.
I'm headed home, Mag.
I'm just gonna make a big meal.
Bert always loves my cooking.
That should put him in a better mood.
I checked on the baby. He's stable.
Oh, I'm gonna go up and see him.
You're graduating tonight, right?
Well, why don't you just take off? We won't know anything until the morning.
I won't stay long.
Remember when you were a kid and you lost a tooth and you kept running your tongue over the gap?
Without my wedding ring, it's like the same thing.
Well, I don't know if it's any consolation, but what do they say?
"One door closes and another one opens."
I don't know about that, but thanks.
Hey, did you hear?
I got an offer from Med.
You're gonna take it, right?
Of course, yeah.
And I promise, from now on, I'll never argue with you.
You will be an attending, so you won't have to argue with me.
You can just boss me around.
That's a good point.
No, uh, I'll never do that either.
[gentle music playing]
Between the incision and my head, I'm not sure which hurts worse.
Well, those fentanyl boluses aren't doing much for you.
I'll order a morphine PCA.
I hate morphine.
Makes me loopy.
Turn that up a little, will you?
I'd hoped to make it to the islands one more time.
Flying's such a hassle these days.
As soon as we can, we'll get you out of the ICU and into a room... one with a view.
Hey, easy there.
You know what I'm facing.
I'd just as soon skip it.
If you know what I mean.
Check out a little early.
I'd need some help though.
You know I can't do that.
I guess we're all given our measure of suffering.
Parrot's are supposed to fly.
Don't you know that?
Maybe this'll help.
Like this. Flap your wings, come on.
Flap your wings.
Come on, fly.
Come on, like this.
Can you fly?
Flap your wings. Fly.
Come on, you can fly.
We're not making much progress here.
[both laughing softly]
Okay, good night, son.
And what you need to do is tell me who this guy is that popped you so I can have a little, uh, talk with him.
[chuckles] No, I do not want to see him back in the E.D. Thank you.
Anyway... it's not that bad.
I've taken worse shots.
So you been hit like this before?
Lots of times.
Nursing is a dangerous profession.
Maybe you should leave it.
What, quit my job?
And do what?
I want you to marry me, April.
You missed your graduation.
I fell asleep.
I was afraid to leave the baby.
I texted you. I-I called.
Did we get the results?
I need to call Dr. Manning.
"Have a nice day."
Can't you say that?
"Have a nice day."
Okay. I'll be back tonight.
Be back tonight.
Be back tonight.
Say that again?
Be back tonight.
Yeah, I will.
Really sorry to hear about David.
Can imagine that's gotta be very difficult for you.
He's given me so much.
How do I ever pay that back?
How do you know you haven't already?
Get out. What did you say?
I said I had to think about it.
He give you a ring?
No, it was a spur of the moment thing.
You even love him?
Yeah, I love him.
It seems you have a big decision to make.
You seen Goodwin?
She missed the budget meeting.
It's not like her.
No, it isn't.
Michael has a condition called Long-Chain Acyl CoA Dehydrogenase Deficiency, or LCADD.
I know it's a lot of words, but what it basically boils down to is he can't process fat.
When, uh, the body can't use fat for energy, it relies on glucose, but there's only a limited amount available.
Michael suffered a severe drop in blood sugar.
That's what caused him to stop breathing and-and his heart?
It doesn't have to happen again.
It can be managed.
We're giving him intravenous dextros...
Getting his blood sugar up. That will keep him stable.
So he's gonna be okay?
Michael will always have the condition, but by altering his diet, we can control it.
He'll be able to live a long and healthy life.
Oh, thank you. Thank you.
You're in pain.
It's no big deal.
April, you're getting that X-ray.
Really, I do not...
No, go to radiology now.
I'm putting in the order.
Bert, is that you?
No, it's me, Maggie.
Sharon, I've been calling you.
Is he all right?
What is it?
He said, uh, "I don't know how much time I have left", but I want to spend it happy."
No, he didn't.
I don't make him happy.
He's just being a fool, Sharon.
He's gonna be coming right back. You'll see.
[sniffles] He's gone.
I can't do this. I gotta get myself together.
I gotta go to work.
No, wait a minute, now...
I missed that budget meeting this morning.
It doesn't matter.
Come on, let's go. Let's go.
You sure you don't want to stay home?
You were supposed to get this last night.
What is it?
Open it and find out.
Oh, I gotta get back to the lab.
Um... enjoy that.
Pardon me, Dr. Reese.
[gentle music playing]
[hoarsely] Dr. Rhodes.
So you had mentioned wanting to get back to the islands.
So I thought...
There you go.
Hawaiian name... for this jasmine.
I thought you should know, I am starting my cardiothoracic fellowship.
So I haven't been wasting my time.
Not entirely, no.
[both chuckle softly]
I never asked. Do you have any family?
I had a sister.
If you're wondering...
I've left instructions.
Thank you... for everything.
It's been a good ride.
Yes, it has.
Yes, it has.
Dr. Downey's coding.
He has a DNR. Let him go.
We are thrilled to have you.
Hey, you wanna see one badass gastric carcinoma?
Dr. Shore, you've been really nice, and I appreciate your encouragement... but I have decided not to go into pathology.
Wh... what are you talking about?
I think I would do better treating patients.
But we're... We're counting on you.
I'm really sorry.
You realize, don't you, that pathology is your match?
If... if you don't take this, you won't have a job.
What're you going to do?
I don't know.
This is the E.D. you'll be rotating through.
On this side are the trauma bays, over there are the treatment rooms.
That is called Baghdad. You will learn why later.
I have schedules.
Uh, Jeff... Jeff Clarke. Welcome.
Our new fourth-year students.
It's time for my "Welcome to Chicago Med" speech.
How do I look?
My eyes that bad?
You can get through this.
Oh, my gosh.
You're in med school?
Yeah, um, I hurt my back on the job, so no more lugging fire hose.
I always liked the medical side of things.
Didn't realize bio-chem would be such a bitch, but...
[laughs] Hey, Maggie.
You see who's here?
Hey, I heard the rumors.
How you doing, Maggie?
It's good to see you, Jeff.
Good to see you.
So, clearly, I am the oldest one in my class.
Um, they call me "Pops."
Yeah, it's cute.
Hey, Will, you ever meet Jeff Clarke?
You were a firefighter, right?
Jeff and my Jeff were really good friends.
We used to call them the two Jeffs.
We had such a great time together.
Oh, I'm sorry.
Well, it's really great to have you here.
Good to be here.
Uh, excuse me.
It's good to see you, Jeff.
Uh, the blow didn't cause any significant damage.
It did show us something else.
Uh, there's a coin legion in the upper lobe of your lung.
Given your history, I think we can rule out lung cancer or lymphoma.
Then what is it?
Well, we'll need a bronchoscopy and an IGRA to confirm, but I'm pretty sure you have tuberculosis.
I've got TB?
Yeah, I'm afraid so.
Dr. Rhodes, we're so very sorry for your loss.
Um, Ms. Goodwin, I'm gonna need a few personal days, if that's all right.
Thinking about you, pal.
So, uh, how you doing?
What do you mean?
I don't know.
Haven't quite seemed yourself lately.
Eh, hasn't been a good day.
Sorry to hear it.
Oh, Dr. Reese.
I understand that congratulations are in order.
I just quit pathology.
Nice fricking move. Right on, sister.
I knew you were smart.
I don't have a job.
You're gonna be fine.
His vocabulary's improving.
He said "be back" to me this morning.
He knew I was leaving.
Come on, show Dr. Charles.
Say, "Be back."
"Be back tonight."
[whispers] Performance anxiety, man.
He did say it.
I heard him. He said it to me this morning.
I believe you.
Look at that.
More success than I have with most of my patients.
To the both of you.
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