02x04 - Brother's Keeper

♪ Well ♪
♪ Well, my love ♪

You think this is a good spot?


Ah, I'll see you inside.

Remember, if you get any central lines today, I'm your man.

And if I don't?

♪ Now I'm trying to wake up from this ♪

Honey, you're still bleeding.

Mm, yeah, I think I'll be doing those central lines myself.

[chuckles] Give me a break.

See you.


[sighs] The coast is clear.

Save some lives today, Dr. Halstead.

I'll try, Dr. Shore, and you down in path, enjoy your day with the dead.

Always do.

[both laugh]

♪ We turn our backs to the wind ♪

Hey, you look cheerful today.

Well, you know, I like to see the ED as half-full.

Dr. Halstead, Dr. Manning.


So how you two doing?


You and Jeff.

What are you talking about?

Natalie, everyone knows.

It's good. It's... you know, you seem a lot happier lately.

It's nice.

Okay, but when you say everybody, wh...

ED staff, ambulance drivers, EMTs.


The crazy guy out front who thinks he's Jesus.

Okay, so about the same people who know about you and Nina.

Wait, seriously?

Incoming. Dr. Choi?

We're going to room two.

Edward Hall, 82, he passed out in his apartment, was awake when we got there, vitals stable.

Mr. Hall, how are you feeling?

Head hurts.

You got an Aspirin?

He's never done this before.

He was just walking to the bedroom, and he fell down.

We're gonna take care of you, Mr. Hall, okay?

On my count, one, two, three.

Okay, let's get an H and H.

[speaks indistinctly]

Get Dr. Rhodes.


Have you experienced any recent neck pain, trouble swallowing?


Your neck is swollen.

How long has it been like that?

I don't... swallowing?

He's in and out mentally, mostly out, but I take care of him.

Are you his daughter?

No, I'm his girlfriend.

It's okay, Eddie. You're gonna be all right.

What do we got?

Neck swelling with a bruit. I'm thinking there's a compressive mass in his chest, possibly a tumor.

Oh, my God, do you think he has cancer?

Could be.

If it's pressing on his heart or carotids, that would explain his passing out.

And if that's the case, we're gonna have to operate to remove it.

Well, just do whatever it takes, please.

Just take care of him.

Tell radiology we're on our way up for a neck and chest CT with contrast, then up to the OR.

Whoa, whoa, whoa, please stop. Don't take him anywhere.

Excuse me, sir, can I help you?

This is my father.

He doesn't want any of this.

And that bitch has no right to make any decisions about his health.

[dramatic music]

♪ ♪

Fact is my father doesn't want any extraordinary measures taken.

He never said that.

When his mind first started to go, he made his wishes clear to me.

Dr. Choi, what are Mr. Hall's options?

The scan suggests he has a thymoma.

If we treat supportively, he'll probably have four to six months, but if we excise the tumor, we can prolong his life significantly, as I'm sure our surgeons can attest.

Surgery's definitely an option.

Yes, uh, though surgery does come with risk, a successful operation could result in a total cure.

He's 82 and demented.

You want to put him through an operation? For what?

He just said he could live.

Yeah, and he could be left hooked up to wires and tubes for who knows how long?


You can't do this.

You can't just let him kill Eddie.

I am trying to honor my father's wishes.

All right, enough.

Look, we all understand this is a very sensitive issue, but what matters here is who has the legal authority to make Mr. Hall's decisions.

Well, as far as the hospital's concerned, with no advance directive in place the surrogate decision-making power goes to the next of kin, which, in this case, is Mr. Hall's son.


Thank you.

Ms. Goodwin, all due respect, but my job is to do whatever it takes to keep my patients alive.

Dr. Choi, you heard him.

Our hands are tied.

So that's it?

You're just gonna let Eddie die?

I'm sorry.

Hey, you got a bounce-back in three.

Hey, Haley. Back so soon?

I was afraid you'd miss me.

Always. You still throwing up?

No, that's all better.

Right after we saw you, what, three days ago?

She started getting a fever and chills.

We tried ibuprofen, but it didn't come down.

You did the right thing.

When'd you finish your last round of chemo?


Usually the chemo fevers don't last this long.


Or get this high, 103.

Do you think something's wrong?

Hard to say. The cancer meds do knock down her immune system, so I wouldn't be surprised if she got some sort of infection.

But probably nothing to worry about?

Probably not, but I would like to start her on some antibiotics and get labs and cultures just to be safe.

Looks like we'll be spending a little more time together.

I'll be back shortly.

Ready to head to the farm?

Nurse, can you please come here?

Sorry, I'm slammed.


The farm?

Uh-huh, you want to come?

Sure. What's the farm?

You'll see.

Please, I need to leave.


No, I got to go. Can you just take this tube out of my nose?

Mr. Jones...

Everything okay?

He wants to leave.

Bowel obstructions, even partial ones, can become life-threatening situations.

We can't discharge you until it's cleared.

It doesn't hurt anymore.

Look, I understand, but your output is still too high.

Let's see if I can feel any...

No! I just... I don't like to be touched.

How we doing in here?

Give the tube a little more time.

I promise we'll get you home as soon as possible.

He was found passed out on the street.

AB showed a massive stool in his bowel.

Wow. Passed out?


It must have been pretty bad.

It's starting to clear, but he's been combative, fearful ever since he got here.

You want a consult?

Sure. He won't talk to me.

Oh, look, there's somebody he might have an easier time relating to.

You call this the vent farm?

Dark humor keeps you sane if you're gonna spend some time here.

Hey, good to see you.

So this is where all our comatose patients go?


A lot of these people didn't have anyone.

They just got appointed a case worker who decided to keep them on life support.

Others have families that are still holding out hope.

Either way, they're just...

Nothing that can be done, right?

Nothing medically.

So what, we're here to check some culture results?


Pronounce someone dead?


So what are we doing?

We're here to paint some nails.

What's going on?

You remember my cancer patient, Haley Cline?

Sweet, young girl?


This just showed up in her cultures.

Oh, God, colistin-resistant Enterobacter.

She can barely fight off infection as it is.

Now she has an antibiotic-resistant super bug?

This is really bad news.

Natalie, it's worse than you think.

What do you mean?

This is Eric Tillman, just came in.

He has CRE too.

The same bug? Are you serious?

Labs just confirmed it.

[sighs] So we could be looking at an outbreak that might not have a cure.

♪ ♪

[dramatic music]

♪ ♪

Dr. Halstead, Dr. Manning, this is Robin Charles, the newest member of our epidemiology department.


Top of her class, DuPont Scholar, and she just happens to be Dr. Charles's daughter.

What can I say? Nepotism is alive and well.

So I hear we've got colistin-resistant Enterobacter?

In two patients.

Did they catch it in this hospital?

I don't think so.

There's no record my patient's ever been here.

Well, he's here now, which means every immunocompromised patient in this place is at risk.

Do we have final culture sensitivities yet?

We're still waiting.

I'll need to talk to every one of your patient's contacts, get detailed histories, find out what the connections between these people are.

I'll be in touch soon.

Actually, um, wait.

Uh, I think it's my fault.

Haley was here three days ago.

I missed the diagnosis.

You don't know that.

She could have just as easily contracted it after she left.

I saw her records. You treated her exactly how you should have.

Well, what if I sent her back into the city with an infection and she gave it to Eric and who knows how many others?

Natalie, it's a city of almost 3 million people.

This could all just be a coincidence.

Actually, I don't believe in coincidences.

Sorry. I'll be in touch.


Hey, honey. This is Jeff Clarke, fourth-year med student, little rough around the edges, but it's so hard to find good help these days. [laughs]



How do you know her?

She came into the ED late one night alone, burst an aneurysm, massive hemorrhage.

By the time we got her, we knew it was too late.

She kept on asking me to talk to her, so I did.

Thing is my mother had just passed...

And when she used to put me to sleep as a kid, she used to call me Maggie-Pie from a nursery rhyme about a bird, and I don't know, maybe Cindy had heard that rhyme before.

She must have seen my nametag, I...

'cause in her last moment she squeezed my hand...

And she called me Maggie-Pie too.

[light instrumental music]

♪ ♪

Anyway, CPD looked, but there was no family, no friends, no one to speak for her, so they brought her here.

Now I check in on her every week, tell her what's going on with my life.

I don't know.

I figure she's got one foot in this world and, uh, another in the next where Mom is.

♪ ♪


So why would a 19 year old have a bowel obstruction?

Good question. All his other tests are normal.

It could be stress, right?

Could be.

Stress can present a hundred different ways.

But you think it's something else?

Don't know. That's what you're gonna find out.


I'm, uh, Dr. Reese, Sarah. Can I come in?

I really want to leave.

I don't blame you, but it sounds like you're gonna be here a little bit longer, so maybe we could talk?

Or I could just sit here. Is that okay?


I don't know.

I just thought you might want some company.

Are you from Chicago?

I've been here five years.

I'm from Connecticut, and I still totally dread the winter.

I mean, I thought I knew what cold was, but this is, like, "National Geographic," "Frozen Planet" cold.

I carry around those hand warmer pads just in case my eyelids freeze shut.

I hate the cold.

Yeah? Where are you from?


Oh, okay.

I have a sister named Sarah.

No kidding.

Uh-huh, yes, and have Monica call every patient that's been to the infusion center since Monday.

Mm-hmm, yes, anyone with fever, chills, headaches, or nausea gets a blood draw.

Yeah, okay.

How you doing? How's it going?

You know, busy but good.

Nice people in that department, right?

Yeah, they seem great.


So you get my text?

When... when we having coffee?

We will, Dad. I promise.

Just got a lot on my plate, first couple weeks of work and all.

Of course you do.

You're sleeping though, right? Are you sleeping?

Dad, come on.

Hey, new job, new city, I'm sorry, you know, could be a little stressful.

I'm fine, Dad.

And really, you're not my therapist.

Oh. [blows raspberry]

I'm just... I'm glad you're here.


Proud of you.

[stammering weakly]

Mr. Hall?

Mr. Hall? We found a tumor that's compressing the large vessels in your chest.

We can remove it with an operation.

Are you a doctor?

Yes, I'm Dr. Choi.

I'm your doctor.

You're Chinese.

I saw the Great Wall.

Mr. Hall, I really believe that surgery is your best option.

Do you give us permission to perform the surgery?



Are you a doctor?

What's going on?

I'm just explaining to your father what's happening in his chest.


Looks to me like you're trying to coerce him into a procedure he doesn't want.

I'm sorry, but I'm gonna have to ask that you not speak to him alone again.

I'll check back with you soon.

Check back?

Echo to get a better idea of her cardiac output, and then we'll take it from there.

Dr. Latham, about Mr. Hall, the three of us need to approach his son as a united front.


Perhaps together we can convince him to let us save his father's life.

I don't understand.

Well, I think what Dr. Choi is suggesting is that if we explain the surgery again in more detail, then maybe...

Our job isn't to solve family problems.

Our job is to fix ailments, and until the Halls ask us to do that, there will be no surgery.

This is distracting.

[dramatic music]

♪ ♪

Cute shoes.

I could see my boyfriend in those.

They're okay, too tight in the toes.

[laughs] These are pretty comfortable, not the cutest.

I had to order, like, 50 pairs to find the right ones.


Are you okay?

I... I gotta go. I got to go.

Hey, it shouldn't be too much longer, but let me check with Dr. Choi.


Call Dr. Choi.

Okay, this might just be from the obstruction.

Is anything hurting?

He's tachycardic.

Abdomen's far less distended.

I... I'm gonna throw up again.

[vomiting, coughing]

No sign of infection, no fever.

Hey, has anything like this happened before?

I am just here to help, but I need you to tell me if there's something I should know.

Danny, I am on your side.

Heroin. Heroin.


Are you... are you on heroin?

He is in withdrawal. Give me 10 milligrams IM of methadone and one of Ativan.

Got it.

Hey, I am right here.

It is going to be okay.

♪ ♪

You know I couldn't stop thinking about Cindy.

No family, alone in that room month after month.


So I called a friend of mine in the state Bureau of Identification to look into it.

It turns out that Cindy has a sister in Spokane.



Gave her the number to the hospital. I don't know.

Maybe this means Cindy'll have another person in her life.

That'd be great.

It would, right?

Yes, of course.


[grunting, wailing]

O2 stats are dropping.

Arms are swelling.

He must be hemorrhaging into the tumor.

It's compressing his SVC.

[wailing, stammering]

[muffled] Save me.

He said, "Save me."


What's going on?

He said, "Save me."

Where's his son?

I don't know, but I heard him.

Let's bag him.


Let's go.

Sat's still dropping.

Okay, let's get him to the OR.

What are you doing?

The patient expressed his wishes, we're taking him to surgery.

Are you kidding? He's demented. He can't express his wishes.

I heard him.

Doctor, ready to go.

Okay, let's move.

You can't do this.

How is it having her back in town?

Oh, it's great.

It's great.


Yeah, haven't shared a zip code since she was in high school.

You been spending some time together?

Yeah. I mean, haven't really hung out yet.

You know, she's got a lot on her plate, It's like, new job, new apartment.

I mean, just getting cable installed, like, come on.

That's a bitch.

So after she's got cable?



Sharon, look, she's never gonna forgive me.

For divorcing her mother?

Yeah, that and I don't know, all the time I was there, wasn't really there, you know?

You remember.

Yeah, I remember, Dr. Charles?

But I'm sure she...

Oh, yes?

I am sorry. Are you available?

Could you excuse me? I'm sorry.

You were right. There is something going on with Danny.

Oh. Tell me.

He told me he's addicted to heroin.

He started going through withdrawal, he's stable now, on methadone and Ativan, and I... I know detox is a long road, but maybe we can help.

Could work.

Let's see what we got.



Hi, uh, I'm Dr. Reese.

And I'm Dr. Charles. It's nice to meet you.

I'm Tina, Danny's mother.

He just told me what's going on. I had no idea.

Well, it's a lot to take in.

How you feeling, Danny?

He's embarrassed, and he should be.

It's just so confusing why he would do this.

We've tried so hard to be good parents.

Well, fortunately, Dr. Reese has a good plan about how to move forward.

Please tell me what to do.

So as long as you continue to tolerate the methadone, I'm gonna switch you to orals.

Then we can talk about rehab, but first, how are you feeling?

I appreciate all this, but I know he wants to go home.

That's totally understandable, but Danny is gonna have to finish his IV first, and that's gonna take a couple of hours, so might want to go get a cup of coffee or...

He is still gonna be here for a while.

Right now I don't think Danny wants me to leave his side, do you, honey?

Okay, makes perfect sense.

Um, why don't we check back on you in a bit?

I don't know what happened. He's totally different.

Well, it's gonna be a little tense with Mom in there, right?

But it's like a switch was flipped.

He wouldn't even look me in the eye.

Something is a little off.

What... how long till he's discharged?

Well, his obstruction's cleared, and now that we know it was caused by the heroin, there's no reason to keep him once his IV's done.

Let's ask Dr. Choi to order a lactic level and an iron panel.

Why would we want those?

Buy us a little time.

We got to separate them, see if we can find out what's what.


This was the right thing to do.


The surgery.

Absolutely. Why?

Well, you seemed against it.

The son said no, so it was a no.

The patient said yes, so now it's a yes.

Is there more to it than that?

Guess not.

I'm not good with ambiguity, Dr. Rhodes.

I want you to watch how I elevate the caudal portion of the right inferior horn while still attached to the pericardial fat pad.

It's an easier method to divide and ligate it like that.

Mr. and Mrs. Cline?

I have some news.

The lab tested Haley's CRE culture against every antibiotic, and it turns out it's sensitive to just one, a drug called ceftazidime/avibactam.


So there's a cure? That's fantastic.

Yes, but the thing is the bug is sensitive at a very low rate, which means it works best for patients that we catch early.

So, um... so Haley?

We won't know anything until we try the medication.

I waited too long, didn't I?


No, I should have brought her in sooner.


Mrs. Cline...

I am usually so on top of this, but I just... I can't tell what's an emergency anymore.

She's always so sick.

You cannot blame yourself.

Please, this is not your fault.

I promise you, we are gonna do everything we can to help her.

Okay. Thank... thank you.

♪ ♪

How is he?

They're just getting in the chest.

When he was crashing, did you hear what he said?


We're here to save lives.

You're doing what you're supposed to do.



[alarm beeping]

Someone help!

She can't get a breath. I need to intubate.

Ma'am, please move.

Five of versed.

What's going on?

She could be in septic shock.

I don't know. Pressure's fine. Pulse is strong.



What's going on?

Please, come with me.


It's okay.

I can't get the tube in.

It's like something's blocking it.

Do she eat anything?


Damn it.

Sat's down to 50.

Doris, give me the ultrasound.

Got it.

I need a CricKit.


I need to make a hole in her trachea so she can breathe.

Oh, my God.


Wait, you're right.

Her airway is blocked.

It's an abscess.

The infection's spread to her pharynx.

I'll page ENT.

No, no time.

Give me a minor tray and a knife.

I got it.

It's okay, I can do it.

No, I got this.

Sat's down to 50.

Hold her arm, please.

[alarm beeping]

Nat, I have to Cric her.

Hang on.


I got it.



Oh, my God.

Dr. Manning, thank you so much.

Lungs clear.


♪ ♪

How's she doing?

She's stable for now but the abscess was caused by her infection.

It's only a matter of time before she gets more.

What's going on from your end?

Bad news, I'm afraid.

East Mercy just got a new CRE patient, intubated, can't get any info yet, but we're working on it.

And they're sure it's CRE?

That's three.

It's a pattern, not a coincidence.

Okay, but just because another person has it doesn't mean it's your fault.

Well, there's only one way to find out.

We need to extubate Eric.

No. It's too dangerous.

We've tried everything else, his social media, his contacts.

In order to find the source of the infection, we have to figure out how he is connected to Haley and this patient at East Mercy.

We need to talk to him.

Well, that's if you can extubate him.

He may not even tolerate it.

We will go as slowly and safely as possible.

That's not a decision you can make.

No, it's not, but he can.

♪ ♪


I'll turn down his propofol, and he should be awake in a few minutes.

[humming softly]

Make sure you separate out the recurrent laryngeal nerve.

Copy that. Do you see it?

Should be right... ah, here.

[continues humming]

Ah, pull harder.

You see "The Force Awakens"?

Got it... uh...

I'm sorry, did I... did I see what?

"The Force Awakens."

Uh... no.

When Rey defeats Kylo Ren, the glove falls off of his left hand, but when he sits up, it's on again.

These are professional filmmakers.

It's unbelievable to me. [chuckles]

[continues humming]

O2's in the high 80s. That's the best we can get.


Eric, I'm Dr. Manning.

You are in the hospital right now with a very bad infection, and we're concerned that other people might be getting this infection as well.

A lot of people.

If we don't find them soon, it may be too late, but in order to do that we're gonna need to ask you some questions.

The problem is if we take your tube out, we cannot guarantee you'll be able to breathe on your own.

And once it's out, we may not be able to put it back in.

What we are asking you to do won't help you directly, but it could save a lot of lives.

You don't have to do this.

Do you give us permission to take out your breathing tube?

[dramatic music]

♪ ♪

Thank you.



♪ ♪

[alarms beeping]

[inhaling sharply]



[deeply inhales, exhales]

He's still in the high 80s.

How are you feeling? Are you okay?

[softly] Yeah.

Yeah? Okay, okay, good.

Okay, now, Eric, we're gonna ask you some questions.

[softly] Okay.

Danny, I thought we could spend some time looking over a few rehab centers.

Thank you, but I made some calls.

We're already booked in a private facility for as soon as he's discharged, which should be any minute, right?

Are you sure you're feeling well enough to leave?

Uh, well, if you ever want to talk.

Thank you.


Danny, are you okay?


We should get going.

Uh... because bowel obstructions can lead to irritation in the diaphragm if they aren't fully resolved, I... I feel like I should keep you for some more observation.

You know, if it gets worse, we'll have it checked at rehab.

There are doctors there.


We should do a chest X-ray.

Yes, yes, we need a stat chest X-ray.

Could you take Danny over to radiology?

I'll get a wheelchair.

Really, I'm sure he'll be fine.

We're on a schedule.

Mrs. Jones, I see how concerned you are for your son, and I want to make sure he gets the best care.

I promise we're gonna make this quick.

So it turns out Eric's roommate was seen here up in GI three days ago for a bleed.

But Eric wasn't here with him?

No, but he's immunocompromised from rheumatoid arthritis meds, which means even if his roommate was just a carrier for CRE, Eric could easily catch it from him.

And the patient in the ED at East Mercy?

Was upstairs Monday to see his hematologist for chronic anemia.

So with Haley, that's three patients all within the last few days.

We're checking the hospital records line by line to see if they have anything in common, staff, location, food, supplies.

Think we're almost there.


Hey, what's going on?

The hospital just received a set of legal papers.

They're from Cindy's sister.


She got in touch?

I'm afraid so.

She's ordering us to withdraw support.

What? No.

I've already spoken to legal.

There's nothing we can do.

I am truly, truly sorry.


Maggie, I had no idea...

♪ ♪

You feeling a little better, sweetheart?

Well, it's still early, but it looks like her fever's breaking.

I think the antibiotics may be starting to work.

I'll be back in a bit to check in again.

Thank you, Doctor.

I think Haley's turning the corner.

Yeah, Eric's perking up a little bit too.

Extubating him was risky.

But it was a good call.

I found our link.

An endoscope?

Haley, Eric's roommate, the patient at East Mercy all had endoscopies here in the last week.

Okay, but we're always gowned and gloved, and everything gets sterilized.

So this crevice along the tip is just wide enough to harbor bacteria and small enough that even following the manufacturer's guidelines, it doesn't always clean that groove.

Well, we have to tell the FDA.

They know.

They're the ones that told us.



The FDA knows?


Our hospital has dozens of these.

There must be thousands in use across the country.

That's why the FDA hasn't pulled them.

They don't want to cause an endoscope shortage.

So the agency created to protect patients is...

Made a cost-benefit analysis.

I have to tell Haley's parents.

No, no, no, that's my job.

Thank you, all.

Thank you.


♪ ♪

They knew about it.


It really is.

But I was right about one thing. Told you it wasn't your fault.

[chuckles] It's great, what you two have.

I'm sorry?

You and Dr. Halstead, you're really good together.

♪ ♪

Straight edges, opaque. It looks manmade, like there was something under Danny on the table.

No, this is definitely inside of him.

I could be wrong, but I think this might be a tracking device.

A what?

A transponder.

Emits a homing signal. Would explain how that woman found him.

You mean his mom?

Yeah, is she, though?

I mean, think about it... The guarded behavior, heroin abuse.

Wait, you think he's a drug mule?

Resistance to examination by male doctors suggesting a history of abuse by other men.

I've seen this before.

I think that Danny might be a victim of s*x trafficking.

s*x trafficking?

So that woman...

Is his pimp.

[dramatic music]

Wait, Sarah.

Dr. Reese? Stop.

We can't just let her take him.

He is not a minor, so we have no right to intercede unless he explicitly asks us to.

But he wanted me to find the chip.

He wanted me to know.

Well, what did he say? What exactly did he say?

He didn't say anything, but he was...

See, Sarah, it's not enough.

Crazy as it sounds, we need to know that he's psychologically ready to be extricated.

We do this the wrong way, we call the police, could be very, very bad for him.

It's why we need to hear it from his own lips. Trust me.

Then I need to talk to him.


♪ ♪


Thanks for all your help.

♪ ♪

[engine turns over]

♪ ♪

What's gonna happen to him?

♪ ♪



Fellowship programs?

Yeah, I'm just wondering if staying here was a mistake.


Latham... the man is odd.

He says that he is not good with ambiguity.

That is an understatement.

He is from Mars.

I... I am constantly trying to figure out who the hell is this guy, and I don't know if I can handle working with him every day for the next two years.

Is he? I get why you'd feel that way.

I just think he takes some getting used to.

Did you just say, "Is he?"

Why don't you come meet us on the balcony tonight around 7:00?

[chuckles] Why should I do that?

Because I think there's more to him than meets the eye.

[laughs] Okay.


Mr. Hall.

You're awake.

You a doctor?


We were worried about you.

That girl.


[clears throat] Laurie.

You should know, through all of this, she was your strongest advocate.

I'm sure. [chuckles]


I'm her... what's that word?

Gravy train... Is that the word?


You can't take it with you.

[laughs, coughs]

How's he doing?

Surprisingly well.

You made the right decision, Dr. Choi.

Did I?

I don't know.

It could have gone either way.

Combat medicine was always so simple.

Just save whoever they put in front of you; never any questions, "Should I?"

Shouldn't I?"

Never really had to deal with that before.

♪ ♪

[beeping, breathing machine pumping]

Tell Mom I said hi.

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[droning beep]

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[upbeat jazzy music]

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[dramatic music]

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