I have to pick up Owen at Helen's before work.
Yeah, I get it.
You know, um, last night was... it was really great.
Yeah, it was.
I don't think I've seen this one before.
[gentle instrumental music]
That was our last deployment together.
Jeff looks so young.
Hey, we're good, right?
This is what I always carried in the field: gear for fluid resuscitation, hemorrhage control, airway management, basic meds, including OTCs.
Always have lots of Pepto.
Oh, and tape.
Can never have too much tape.
[chuckles] Yes, sir.
It's a lot to take in.
I know. When do you deploy?
12 weeks, sir.
Look, nothing really prepares you for war.
But a day in Chicago, the number of gunshots we see, the navy sending corpsmen for a rotation in the ED is a pretty good primer.
What's that, sir?
Is it a quick reference guide?
Case notes from the field.
Things I thought I shouldn't forget.
Dr. Choi, we got a drive up and drop.
Corpsman, with me.
[gasping and wheezing]
[car horn blares, tires screech]
All right, I got you, buddy. I got you, okay?
Hey, what's your name? Cuál es Tu nombre?
Marco. Marco, okay. You stay with me.
We're gonna take care of you.
Single GSW. Left flank thoracoabdomen.
No exit wound.
Corpsman, cut his shirt off.
Hey, hey, corpsman.
What do you hear?
Come on. Hey.
I have weak breath sounds on the left side.
Means the lung is collapsed.
Air leaking out is pressurizing his chest.
He's got a tension pneumothorax.
Breath sounds unilateral and tachycardic, needle the chest.
Breath sounds improving.
Bring in a board.
Easy, easy, easy, easy.
All right, let's move him on my count.
One, two, three.
Jeff, let's get an AP chest X-ray and prep a chest tube.
He said, "I'm only 18."
Welcome to Chi-raq.
Alright, now try to stay off the hoverboard for at least a week, Hudson, okay?
Bye. Thank you.
Hey, Gayle. Taking your daily lap around our gorgeous grounds?
Anything to get out of the pediatric ICU for a minute.
I swear, if I hear another monitor beep, I'm gonna nosedive onto Michigan Avenue.
And how is little Timmy doing? Hey, cutie!
He's had a good month, thanks to Dr. Rhodes.
Hoped we'd finally get to go outside today.
Probably best we head back upstairs.
It was nice seeing you, Gayle.
Hi, I'm Dr. Manning.
Hi. My daughter, Alicia. She stopped nursing.
She's only three months old.
Okay, well, don't worry.
We'll figure out what's going on.
Why don't you follow me into the back?
I'll take the paperwork. You guys want to go in the back?
Okay, got a new favorite: Capgras Syndrome.
The belief a familiar person has been replaced with a duplicate.
That was an unenthusiastic response, even for you.
Sorry. It's the new pathology resident.
Mark. He's in my head.
What's going on?
He's pushing really hard to get drinks after work.
Hang out on the weekends. Be pals.
Why? Are you worried something bad will happen if you become friends?
What? No, it's just I'd rather be colleagues.
I got enough friends.
Is there a limit to the number of people you can let into your life?
What is all this?
Nothing. We're just talking.
I've gotta get back.
Are we still on for dinner?
She's gurgling a bit, but there's no obstruction in her throat.
She doesn't appear too dehydrated, and her membranes are moist.
When did she stop nursing?
I wasn't too worried at first.
My boys were both finicky eaters.
But when she wouldn't nurse at all today...
Any fever or vomiting?
She's been a bit cranky.
She's been napping longer than usual, but that's about it.
Mama, I'm thirsty.
Okay, baby, we will get you a drink as soon as we speak to the doctor, okay?
All right? No, no, no.
I'm so sorry.
We go to the park every day. They're exhausted.
My husband will be here to help any minute.
Don't worry about it.
Let's get a CBC, CMP, an abdominal ultrasound and a babygram.
An X-ray of her entire body.
So this could be serious.
There's no way to know for sure just yet, but I want to cover all our bases.
I should've brought her in sooner.
It's just with my husband at work...
Look, you are juggling three kids.
Okay, I get it.
I only have one and it's a handful.
I will fill you in as soon as we know anything.
No, Nina, I've ditched cable, cut up my credit cards, and have nothing left to sell on Craigslist.
Yet, I'm still in the hole each month when the vig is due.
Easy there, Vegas.
It's med school loans and malpractice insurance, not a note from a bookie.
Either way, I'm broke.
Had to post an ad for a roommate.
Here, look at this.
Come on, it'll make you feel better.
What is it?
It's a type of pox virus. It's a nasty one, actually.
Even so, stunning, right?
Like 10 pounds of raspberry rock candy pressed into a 5-pound bag.
Come on, you must have a day off, right?
It's summertime, the animals are really playful.
Elephants are my favorite. They're so soulful.
Okay, you sold me.
This Saturday, I'm at the Lincoln Park Zoo.
BP 126 over 82. Heart rate 74. Sats 100%.
Hi, Mr. McGregor, I'm Dr. Halstead.
I understand you fell, hurt both wrists.
Yeah, just a moment of clumsiness, you know.
They feel better already now.
Don't be modest. He's here. Let him help.
I put my hands out just trying to catch my fall, you know?
15 years on the street.
I guess I'm not as fast as I used to be.
AP and lateral X-rays of both wrists.
Have you fallen before, Mr. McGregor?
A few times. So much action in the city nowadays.
You stop paying attention for a second... bam!
You're a big guy, Dr. Halstead. Football?
Baseball. Just a fan now, though.
Cubs or Sox?
Southside pride. Sox all the way.
Ah, I'm a Cubs guy.
I won't hold it against you.
The way the ivy creeps along the outfield wall, the perfect stripes mowed right into the infield grass.
Do you stay near the ball park?
During the season. Sure, why not?
You know, it's fun seeing the players.
In person, they're larger than life.
Moises Alou. Sammy Sosa.
Oh, yeah? Wow.
Must be really exciting.
Mr. McGregor, after your X-rays, I want to run an EKG.
Determine if a cardiac event caused your fall.
All right, we'll see you soon.
You know, they haven't had elephants at the Lincoln Park Zoo for ages.
You think he really met those baseball players?
Alou and Sosa's last season with the Cubs was in '04.
So, I guess, maybe Mr. McGregor could have seen them outside the park...
Unfortunately, homelessness and mental illness often go hand in hand.
I'll page Dr. Charles for a consult.
How's Marco doing, sir?
Bullet looks to have lodged in the midline between the spine and heart.
May even be touching the aorta.
You get a lot like him?
Drive up and drops?
Easy way to get your boys patched up without having to answer any questions.
A trauma surgeon is gonna come see you.
She'll decide how best to proceed.
Will you cut me open?
If the bullet shifts inside you, it could do a lot of damage.
Lot of you guys come in here and don't make it out.
If you do, make it mean something.
I ain't afraid.
He's saying that...
Timothy Williams, eight months old.
Diagnosed with Hypoplastic Left Heart Syndrome.
Bryan, can you tell us what that is?
I know. It's a congenital heart defect.
Left side of the heart can't efficiently pump blood, so the right side has to pump it to the lungs and the rest of the body.
Tim is on the heart transplant list.
But he's developing fluid around his lungs, a pleural effusion.
He requires a thoracentesis to drain it.
The patient is sedated, and the ultrasound shows the fluid surrounding his right lung.
Lidocaine is injected just below the surface of the skin, forming a wheel.
We go through the wheel and into the pleural space.
Staying above the rib because the blood vessels are below.
Go too far, puncture the lung.
Once you're in, aspirate the fluid.
Give us a minute.
Gayle, John, I think it's best that Tim not leave the PICU going forward.
No more trips downstairs.
You mean keep him on the vent.
He's not oxygenating well. His lungs are very congested.
He's gonna get a heart soon.
Listen, everything's gonna be okay, you hear me?
I'm gonna check the transplant list.
See if there's been any movement.
My husband, Andre, took the boys to get some food.
He'll be back soon. Any news?
The blood tests and babygram were okay.
Nothing abnormal on the abdominal ultrasound either.
Oh, thank goodness.
May I take a look at her?
Do you have any family history of neuromuscular disease?
Her deep tendon reflexes are diminished.
She's floppy. Her muscles are losing tone.
What is it? What do you see?
A baby's natural position is to flex the legs.
When straightened, there should be some resistance.
Let's get a CT of her head.
I want to make sure that there's no swelling in her brain.
Swelling in her brain?
I don't know that's the case. But we just have to check.
If the CT comes back negative, then we'll do a lumbar puncture to test her spinal fluid.
That'll let us know if she has an infection.
My poor baby.
Just hang in there, okay?
We'll know more soon.
That is one sick baby.
What do you think's going on?
I have no idea.
Surgeon ordered chest CT. I'll let you know what's up.
Then what happened?
So they were all looking at me and clapping, right?
So I started dancing too. We partied all afternoon.
Sounds like a blast.
You know, there'll probably be another fiesta next week.
Families rent that restaurant for them all the time.
You should check it out.
All day party do me good.
What was he telling you about?
A quinceañera he attended last week.
Didn't miss a detail about the people he met, the clothes they wore, the venue.
I mean, he really thinks he was there.
But he wasn't.
I know the place he's talking about, or I knew it.
Closed 10, 11 years ago. It's a Starbucks now.
Some kind of delusional disorder.
I mean, he also admitted that he binge drinks sometimes.
Even though he's sober now, could be alcoholic hallucinosis.
I'm gonna order an antipsychotic, see if we can narrow this down.
Well, for being homeless the last 15 years, he seems pretty okay with it.
Everything okay there, Doc?
Money problems. Pretty embarrassing.
Kind of all-consuming, actually.
Buy you lunch?
I'd rather you write me a check.
Get in line there, amigo.
Her lips are turning blue! What's happening?
She is in respiratory distress, unable able to contract her diaphragm and chest muscles enough.
I need to intubate, now.
Mr. and Mrs. James, I'm gonna need you to step outside, please.
Sats are falling. Heart rate stable.
Pharynx is collapsing around the scope.
I need crich pressure!
Sats still falling. 40%.
Heart rate's dropping. It's at 60. Atropine?
It's been a minute.
[monitor beeping rapidly]
Heart rate 30. O2 sat is zero.
We're running out of time.
I got it! I'm in!
Give the atropine.
[monitor beeping slows]
Sats coming up.
Heart rate 130. Sats 99.
How long did it take to intubate?
Almost two minutes.
Pupils are fixed and dilated.
Call PICU for a bed.
Have to go talk to the family.
Want me to join you?
No, no, I got this.
But thank you.
Okay, well, how about Thursday?
I'm busy Thursday too.
Pretty busy week.
Run something by you, Dr. Charles?
I was speaking with a colleague this morning.
My age, intelligent, compassionate, a great person.
Not a loner per Se, but comfortable being alone.
Recently, he's been presented with an opportunity to expand his social circle.
He wants nothing to do with it.
So? What are you thinking?
His reaction, actually his overreaction, screams avoidant personality disorder.
Hm. This is a colleague?
A close one.
Probably why I never noticed that he meets four of the seven APD criteria outlined in the DCM.
The psych fits, doesn't it?
Clinically, yeah, I guess.
Well, I'm gonna have to talk to him about this, but I don't want him to feel criticized or rejected.
Excuse me, I've got some reading to do.
Do you think "cat lover" means "cat" or "cats"?
Does it matter?
Good point. Pass.
Yeah, okay, another pass.
The roommate search is not going well.
You're trolling the Internet. What'd you expect?
It's the hospital community page.
I don't know, someone like me.
Oh, you mean, like, a slightly a**l, overly stubborn, rule breaking, control freak?
Really? When I'm already down?
Mr. McGregor's EKG and troponin results are normal.
Cardiac event didn't cause his fall.
Maybe. Or a bleed.
Either way, could affect his balance.
Let's get a CT.
So what does that mean?
There could have been a brain injury due to lack of oxygen.
We're running a cerebral flow study to make sure that blood is reaching her brain.
This isn't happening.
Yesterday, I was... I was singing to her in the bathtub.
And now, she's hooked up to all these machines...
Get him off the vent and bag him!
.07 milligrams of epi.
He's in V-fib.
Charge to 15 joules.
We're back in sinus rhythm.
We have a pulse.
This is the floor where babies die.
He's fourth on the organ transplant list, but he doesn't have time.
If, by some chance, four hearts do become available, one still has to be an HLA match.
I know the odds seem bleak, but children under a year have to receive organs from similarly-aged donors.
The pool of recipients is smaller...
Yes, but so is the pool of donors.
Ms. Goodwin, I can't perform another thoracentesis.
His lungs are too weak.
Without a transplant, he's gonna die.
I'm contacting the other doctors on the donor list.
I'm pleading my case...
I have a contact at Gift of Hope, a friend of a friend.
I will do my best to get Timothy pushed to the top of the UNOS list, but you know how delicate these matters are.
Still no sparkly on the finger.
Does that mean you made a decision?
April, the guy proposed two months ago.
You owe him an answer.
I know. It's complicated.
He told me I could quit my job.
I'm worried that means he thinks I'm a housewife...
I'm not a housewife.
In his house, no less, the one he shared with his ex.
It's a huge decision. And it's all happened so fast.
And, of course, then there's the TB.
I mean, the whole thing just really makes me anxious.
What are you thinking?
Anxiety is a powerful emotion.
Would you say that you feel more nervous about the situation or fearful of the future?
I-I don't know.
Both, I guess.
How've you been sleeping?
Waking up at night? Earlier than you'd like?
Oh, my God.
You're shrinking me.
Three weeks in psych, and she's Freud.
She said "anxious" and "worried."
Those are emotions that convey distress.
Meigs Field is beautiful.
The sun reflects off the water with the blues and the greens, and the luminescence...
How you doing there, Mr. McGregor?
Hey, Dr. Charles, how are you?
Who you, um... who are you talking to?
It was the nurse, yeah.
She mentioned how she walks her dog along the lakefront.
Took off from there.
Let me tell you something, doctor.
There was a time I used to hate hospitals.
But that's before I noticed the details.
The staff floating through the halls like angels...
There! [stammers] Do you see that?
White light surrounding. Oh!
You know, I missed the beginning.
You were talking about your favorite spot.
Where was that?
South end of Meigs Field.
You excuse me one second?
Absolutely. I'm here if you need me.
Mr. McGregor get his antipsychotics yet?
Yes. 2 milligrams of Risperidone.
Little over three hours ago.
You'd think it'd be making a dent in his symptoms by now.
Not really happening.
Give me a shout when the CT results come in.
You got it.
Hey, can I talk to you for a second?
What? No! No! Absolutely not.
I'm still working on a diagnosis.
What you're asking me to do is premature and completely unethical.
You're running a cerebral blood flow test for Alicia.
You clearly think brain death is a possibility.
But I will not get those test results back for another few hours.
So all I'm asking is that you speak to Alicia's family about organ donation.
Look, just let me run an HLA test.
Just to see if she's a match, just in... Should the worst happen.
Okay, you know that if I do that, I'm insinuating to her parents that she's definitely gone.
You are putting me in a terrible position.
When Tim was born, he wasn't breathing.
I performed his first surgery.
When he came to, I was the first person he saw.
And he put his hand around my finger.
I-I can't lose this kid.
So, it's about 2:00 in the morning, pitch black out.
We start taking fire. Small arms.
Just a few bad guys.
One of our guys drops into a wadi for cover.
Wham. Gets hit right in the foot.
When I get to him he's writhing in agony.
I shine my light on his boot, see two tiny puncture wounds.
So what was going on?
Slowly, I light up the wadi, and right there, staring back at me, is a cobra.
Get the hell out.
Hood flared. Ready to strike again.
Man, that's insane.
We just heard. Our banger, Marco?
CT chest showed the bullet isn't in the midline or touching the aorta.
It's in the left paraspinal muscles.
Surgeon gonna go in and get it?
No. Says it's harmless.
Safer just to leave it there.
Should be as good as new in a few days.
And back on the street.
Snakes here too.
So Alicia's brain dead?
The test results have not come back yet.
Then why are you even here asking us to cut up our baby?
No, that's not what I'm saying.
Have you given up on her?
No, I swear, I'm doing everything in my power to diagnose your daughter.
I don't believe this!
Alicia's life is hanging in the balance, our baby girl!
She's saying there's no hope.
But there is. Alicia is still alive.
She's supposed to be our doctor.
Mr. James, please.
I know that this is difficult to process, but the reality is, we don't know what the test results are gonna say and right now there's a baby fighting to survive, a baby just like Alicia.
What would it require?
We already have Alicia's blood.
All I'm asking is that you allow us to test it.
Alicia's a match.
I know this wasn't easy.
You know, as a doctor, you want to do everything in your power to save your patient.
And I am.
But it's just now, if I save my patient, it means yours won't make it.
Mr. McGregor has a pituitary tumor.
A big one.
Appears to be pressing on the optic chiasm.
Which, if his vision is impaired, could explain why he fell.
How long do you think it's been there?
Based on the size, a decade. Maybe even longer.
Meigs Field was torn down in '03.
In '04, Sammy Sosa and Moises Alou were still fixtures at Wrigley.
The restaurant where the quinceañera took place was still open for business.
All the while, Mr. McGregor's tumor is likely growing.
Putting pressure on his optic chiasm.
He's still really congested.
Order a chest X-ray and give him 5 milligrams of Lasix to try and clear some of the fluid.
Dr. Rhodes, it seems like he's getting worse pretty quickly.
Is he gonna make it to the transplant?
Do you know what we did last month?
We bought a car seat.
We were so sure that we were gonna beat the PICU, finally take our baby boy home.
The fight is not over yet.
The important thing for you right now is to try and stay in the present.
What do we got?
Joy Billings, 44 year old female.
Triple zero. GSW to the chest.
18 Gauge IV in the right AC. No drugs given per protocol.
Roughly eight minutes.
Watching TV with her kids.
Rival gangs start blasting at each other outside.
Stray bullet ripped into the house.
All right, let's move her on my count.
Ready, one, two, three.
Call the blood bank.
Police get the shooters?
Buddies of the kid from this morning, Marco.
Breath sounds bilaterally.
She's lost a lot of blood.
Trigger the MTP. Hang blood on the rapid transfuser.
Maggie, need a trauma surgeon now.
She's in the OR. Three minutes.
That's too long. Chest tray.
You're gonna cut her open?
Corpsman, need you to take over so I can cross clamp her aorta.
Back and forth as if you were clapping.
Resume compressions. Milligram of epi.
Beat, damn it, beat. Come on.
[monitor turns off]
Time of death: 15:42.
And Marco is gonna go home.
Is there a donor in the hospital for Timmy?
We heard a rumor.
It's her child, isn't it?
Her little girl?
They're the only new patients on the floor.
We've been here for eight months; we know everybody else.
It has to be her.
I'm sorry, Gayle.
But HIPAA regulations won't allow me to discuss another patient.
The spinal tap was clean.
I've ruled out all the common causes.
We must be looking at something rare.
Have you had any foreign visitors?
Anyone outside of your normal social circle?
Has your house been sprayed with pesticides?
No, none of that. Nothing. No.
I'd like to reach out to toxicology...
Would you look at them over there, watching like vultures!
Why don't they show some damn respect!
My fault, son.
I shouldn't have shouted.
Mr. and Mrs. James, I'm so sorry you're going...
Those... those grass stains.
When you take the boys to the park, what do you do with Alicia?
I lay her down on her stomach for tummy time.
You know what?
I'd like to consult with infectious diseases.
Excuse me, please.
Pupils are reactive.
Mr. McGregor, can you follow the light with your eyes?
How 'bout now?
Mr. McGregor, how many fingers am I holding up?
Good job. I'll be right back.
He can detect sharp lights and block images, probably how he made out my size earlier.
But anything more than a few feet away is likely just a blur.
His pituitary tumor, is it operable?
I'll have neuro consult, but I suspect it's a prolactinoma.
If so, medication alone should shrink it enough to ease the pressure on the optic chiasm.
So he's gonna get some of his sight back.
15 years. Homeless, essentially blind.
I mean, that's a crap hand.
He should be pissed. Yet, he's happy as can be.
Crazy I got this patient today.
My experience, we get the patients we need.
You've created a monster, you know that?
Turns out, the English language is primarily comprised of buzzwords for borderline personality disorders.
Now that I know them, I can't have a conversation without immediately seeing the psych in people, which is clearly an impulsive reaction, which, by the way, could also suggest a borderline personality disorder.
I mean, I can't even not analyze myself.
Now I'm using double negatives.
You're a first year psych resident.
Compulsive diagnosing is par for the course.
My first year, I was convinced that a friend of mine had dissociative identity disorder because suddenly he would only listen to Euro-Disco.
My advice: think less, listen more.
You'll be just fine.
Sir, just wanted to thank you for today.
Not gonna be easy over there.
You'll get through it.
The medicine, sure.
The rest... well, I just hope can handle my emotions as well as you.
Botulism? Isn't that a food thing?
I'm still breastfeeding.
Most cases actually come from contaminated soil.
It can be absorbed through the skin.
The park. Tummy time.
Is it treatable?
We will start Alicia on an antitoxin that will provide antibodies to stop the disease's progress.
But what about the vent?
The neurotoxin from the bacteria is what caused the muscle weakness.
I believe she'll make a full recovery.
Thank you so much, doctor.
What's it this time?
Ah. May I?
What do you think?
An explosion of brilliant crystals like Hawaiian shave ice.
I know how you pathologists love food references.
Yes, we do.
Yeah, uh... okay.
No, I-I understand.
Thanks for your time, Dr. Laurel.
It's gonna come through.
How do you do it?
They're just babies.
Well... on rough days, I call Helen.
Ask her to watch Owen for a few extra hours while I do something to decompress.
A good meal, a long walk.
Just something to let my emotions settle.
I find a safe space.
See you tomorrow.
Hey. How'd the rest of your day go?
Not so sure I want to talk about work.
Yeah, I may have overstepped a little bit earlier.
So you were analyzing me?
I'll make it up to you with burgers at Au Cheval?
You can tell me all about how the Bears are doing.
But you know nothing about football.
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