|Transcripts - Forever Dreaming
|02x05 - Extreme Measures
|Page 1 of 1|
|Author:||bunniefuu [ 10/21/16 13:20 ]|
|Post subject:||02x05 - Extreme Measures|
City runners, welcome...
Now, remember to stay hydrated out here to beat the heat.
Keep it up.
See? Taking a header at your first marathon is nothing.
Now, taking a header into a pool in your wedding dress?
Both: Epic fail.
No, that would be taking 20 minutes to put on a Band-Aid.
Sorry. Totally my fault.
No, no, not at all.
Take as long as you need. You, on the other hand, have a superhero with super intestinal discomfort who requires your immediate attention.
Almost halfway. You holding up?
I'm sure that runner's high is gonna kick in any second now.
That or heatstroke.
It's not the best day for a heat wave.
Yeah, I was thinking maybe later we can do something else.
What? Like collapse?
No. Maybe a bedroom activity.
Or kitchen table.
Let's go, Doc. Pick up the pace.
Now, try to keep it elevated, and remember: ice, not heat.
Oh, please don't mention heat. It's hot as balls out here.
We need help. A guy got run over.
Grab an aid kit.
Three. Two. One.
My brakes went out. You've got to help him.
We'll do all we can.
Where does it hurt, Ignacio?
Maggie, we got a bike versus auto.
Diminished breath sounds on the left side.
Sounds like it's full of fluid. I think his lung collapsed.
Marathon traffic and power outages from the heat have paramedics backed up.
We're on our own for a while.
Well, he doesn't have a while. He needs a chest tube now.
Not from you. You've never put one in.
Be my guest.
Neither of us is allowed to do it.
Then he's gonna die.
Maggie, I need Goodwin.
Sir, just hang on.
We're gonna do everything we can for you, okay?
We're gonna help you, okay?
Just hang on.
Sit tight, April. Dr. Halstead's on the way.
No, no, no. You let him make that call.
All right. You keep me posted.
How goes the battle?
Ugh, it's supposed to hit 105 today, so we've got a generator on standby just in case our grid goes dark.
Sharon, listen. Bert called me.
He wants to get together for drinks, and I just... I wanted to check in with you before I responded to him.
Daniel, you do whatever you like.
Hey, Peter... your husband is a divorce attorney, isn't he?
Best in the city.
Text me his number.
I can do this.
We don't even have a chest tube.
I got a suction tube.
You are not gonna Jerry-rig your way into this guy's chest.
He's got no chance unless I do.
Goodwin said to wait for Will.
How long is that gonna take?
Got a neck pulse, but it's thready.
I've got to relieve the pressure on his lung.
BP 82 over palp. Sat at 82%.
I'm doing this.
Pulse is coming up.
You did it.
Yeah, but the tube's not slowing down.
Damn. It's a bad bleed.
Okay. Come on.
He needs surgery.
We need to intubate and give him blood.
Where the hell is Will?
Eight-year-old girl with sudden onset deafness in treatment 2.
They said the heat wave's supposed to be worse than '95.
Hi. I'm Dr. Manning.
I understand Phoebe's experiencing some hearing loss?
Yeah... we were headed to cheer on the runners.
She was skipping ahead.
A semi started backing up.
I was screaming, and she couldn't hear me.
A few seconds later...
I don't want to think about it.
It's okay, sweetie.
Can you hear that, Phoebe?
How about now?
Okay, her hearing is diminished on the right side and nearly absent on the left.
Does she have any prior history of head trauma or hearing loss?
No. Not that I can think of.
I mean, there have been a few times where I've had to call her more than once within these last few months, but nothing like this.
Okay, well, I'd like to order a head CT just so we can figure out what's going on, okay?
Are you going to fix my ears?
I'm sure gonna try.
Be back shortly.
I-I can't get it in.
You have to capture the tongue.
Elevate the jaw.
What the hell are you doing?
I'm trying to intubate.
He had a massive hemothorax, and I had to put in a chest tube.
No, what you had to do was wait.
Dr. Halstead, this man would have died.
Yeah, judging by all the blood, if we don't get him into surgery in the next few minutes, he will anyway.
I'm in. Bag him.
Any ETA on transport?
Still saying it'll be a while.
We could open his chest. Try to address the bleed.
It might buy him enough time for the ambulance to show up.
Yeah, it might... there's no guarantee I could even find it.
The only guarantee is he'll die if we don't try.
No, I've been down this road before trying extreme measures.
It doesn't end well.
His pressure is down.
Trachea feels deviated to the right.
I need a scalpel.
We're going to treatment 5.
You got it, Maggie.
74, lives alone.
Complex cardiac history. Called EMS for dyspnea.
BP 82 over 44.
Chronic A-fib at rate 105. Tachypneic at 30.
Those are her meds.
I'll page Dr. Choi.
Mrs. Barlow, what happened today?
It's so hot out, I'm having a hard time catching my breath.
Do you have an air conditioner in the home?
Don't I wish?
Well, let's move her.
One, two, three.
There you go.
Pulse ox 89.
She's tachy up to 130.
I think we're looking at heat exhaustion.
Let's pack her axilla and groin in ice and send a CBC, CMP, LFTs, and urine.
And give her an amp of D50.
What's the story?
Non-exertional heat illness.
We're going to lower her core temp and keep her hydrated.
You check her meds?
Looks like she has pulmonary hypertension.
That's right. Jugular venous distention.
That means she's in volume overload.
This fluid you ordered could've sent her into heart failure.
Am I gonna be okay?
We're gonna take good care of you.
Let's get a chest film. AP and lateral.
ECG and stat formal echo.
Start epoprostenol at two. Dobutamine at three.
Is your arthritis causing you pain?
Yes, it's pretty bad.
That's a pretty good dose of oxycodone.
Let's give her one... no, two milligrams of hydromorphone.
She won't even notice one milligram.
You're gonna be feeling better soon.
Next time do a complete history and physical before making a diagnosis.
Great. There you go.
Ms. Goodwin, a word?
Problem, Dr. Rhodes?
I filled in for trauma last night.
I was double-booked going back and forth between ORs.
Well, a month ago you were complaining about not having enough to do.
Well, last night cured me of that.
The hospital is over-scheduling, Ms. Goodwin.
Well, maybe someone thought we needed the revenue.
I'll look into it.
Look, we're all having our problems today, Dr. Rhodes.
Go home. Get some sleep.
I can't, I've got a consult on a cold leg in IR that needs an aortalfemoral bypass.
Retract his ribs.
Nothing but clots.
I don't see it. I got to get behind the lungs.
Still has a carotid pulse.
Oh, man. Rib perforated the aorta.
Can you clamp it?
With what? My hand?
It'll buy us... Him 20 minutes?
Any longer there's a good chance he'll be paralyzed.
If you don't, he'll bleed out.
Yeah, it stopped.
Now he needs more blood... and a miracle.
Which could happen if we get him on portable bypass.
They've been doing it in France.
We have a unit in clinical trial at Med.
April, call Maggie.
We've got about 19 minutes to get Ignacio hooked up before he's paralyzed or worse.
Hey, I meant to ask you.
Are flowers too much for your mom tonight?
Roses tend to wilt in her presence, but hey.
Don't worry about it. She actually canceled her trip.
She's too busy.
This is her idea of an apology.
I wish my mom apologized like that.
She just bakes cookies.
It takes time to bake cookies.
This just took a call to her accountant.
Her tongue has relaxed, closing off her airway.
I'll do an oral airway.
I got it.
No, two milligrams of naloxone IV.
I think this is an overdose.
I don't understand.
She shouldn't have had this kind of reaction.
Respiration's at 8 per minute.
I know I was off on my original diagnosis, but that won't happen again. You can trust me.
Clark, you're here to learn.
You're gonna make mistakes, okay?
I need you to run this portable bypass, Satinsky clamps, and ten units of packed cells out to Dr. Halstead at the marathon aid station, okay?
You doing anything else?
[electricity hums, crackles]
This is gonna be great.
Sorry it's taking so...
I want to call Daddy.
I told you.
Is everything okay?
When can I call him?
He's traveling, Phoebes.
You know that.
I want to go home.
Hey, Phoebe, I promise the CT is not gonna hurt, okay?
It's just like getting your picture taken, but in the meantime, will you do me a favor?
Can you color a picture for the doctors' lounge?
Because of the marathon, the hospital's way busier than usual, but it shouldn't be too much longer.
And do you mind if we speak for a moment?
Hey. I'll be right outside, okay, sweetie?
So you indicated in Phoebe's chart that her father was deceased.
I'm wondering why she would want to call him?
David had a massive coronary and died a few months ago.
I haven't had the heart to tell her.
I am so sorry.
He was away on business.
I feel awful for lying, but I just know that she'll be crushed, and I don't know how to break it to her.
Yeah, well, you know, we have a really great doctor that may be able to help with that.
But in the meantime, just hang in there.
We'll get Phoebe up to CT soon, okay?
Okay, thank you.
Dr. Halstead has a patient in the field with a torn aorta.
He's putting him on a portable bypass.
Seriously? A portable bypass?
You can't regulate blood flow to the brain.
Well, you can debate the medicine with Dr. Halstead when he gets here.
Believe me, I will.
There's blood in the tube.
Must be a pulmonary laceration.
We got to pack his lung and get the blood out of that tube before he drowns.
You want to pack the chest, and I'll suction the tube?
With what free hand?
I'll suction the tube.
I'll pack the chest.
Give me the suction.
Noah, grab both sides, and try to keep 'em open.
My wrist is cramped up.
If you let go on the ribs, I'm done.
Come on, man, pull.
Hang in there.
It's closing on my wrist. I can't hold this.
Don't let go.
Come on, Noah, pull!
Don't let go! [grunting]
All right. I got most of the blood.
Sat's at 95%.
Ribs, ribs, grab the ribs.
Guys, guys, he's here.
Sorry it took so long.
I need two clamps. How long's it been?
Three to go. Hurry up.
You gave us a scare. How are you feeling?
Oh, I'm... I'm much better, Doctor, thank you.
Your reaction to the pain medication surprised us, because that dose shouldn't have been an issue for you.
Have you been taking everything as prescribed?
I didn't mention it before, because it's...
It's so embarrassing, but I accidentally spilled some pills into the toilet, so I haven't taken everything I was supposed to.
Mrs. Barlow, skipping doses is very dangerous.
You should have called your doctor.
Well, I certainly know better now.
I won't let it happen again.
There's one other thing.
I was reviewing your labs, and some of the numbers indicate that you haven't been eating as well as you should.
No one, except my late husband, has ever accused me of being a good cook.
Well, wait till you taste the hospital food.
Dr. Charles, I have a patient I'd like you to evaluate.
She's 74, lives alone, and for some reason hasn't been taking her meds.
Her blood work indicates she's undernourished.
It might be dementia or depression.
I'm just not sure.
I'll have a little chat.
Shoot me her chart?
Yeah, Olga Barlow.
Oh, great. Thank you.
Paramedics are close.
All right, we're good to go.
Let's get some more blood in him.
Come on, Ignacio.
And... it's up.
Time. How long has he been clamped?
Mrs. Barlow? I'm Dr. Charles.
How are we doing today?
Pleased to meet you, Dr. Charles.
Dr. Choi mentioned that you were having some trouble with your medication, and he asked me to look in on you.
Of course, but this is all just a big mistake.
Tell me, how did you end up here today?
I spilled some pills and didn't take all my medication.
It's so boring.
Charles. That's an English name isn't it?
Yes, it is.
My late husband Robert was English.
He had a Charles on his mother's side.
Have you been?
Not for a while.
Well, when I was quite a bit younger, Robert and I took the final voyage on the RMS "Queen Elizabeth" across the pond from New York.
That sounds like quite a trip.
Oh, it was.
There was a sense of design back then that you just don't see today.
Now it's... it's all screens, and technology, and people have forgotten the importance of style, haven't they?
Boy, you can say that again.
I'm sorry for running on like that.
Was there something else you wanted to ask me?
You know, I think that I'm all set.
Thank you. It was so nice to meet you.
It was really nice to meet you, Dr. Charles.
So in my opinion, Mrs. Barlow is competent and definitely a bit of a charmer.
One who's not taking her meds or eating properly.
Not depressed as far as I can tell.
I mean, what she is, is she's nostalgic for a more refined culture... which is a far cry from eating cat food.
She told you she was eating cat food?
Look at her blood work.
Raised taurine level. That's the telltale sign.
I thought she was lying about eating regularly, but cat food?
Mm-hmm, this happens when money's tight.
You know, elderly woman. Fixed income.
She'd be way too embarrassed to say anything.
What about dropping her pills in the toilet?
You think that's a lie too?
Oxycodone, sildenafil, benzos all have a very high street value, buddy.
You think this sweet old lady's selling them to get money?
Sweet old lady in need, man.
I've seen it before.
You know, and the sad part is, is, even selling her meds, she doesn't seem to be making ends meet.
25-year-old male. High-velocity impact.
Found with aortic and lung lacerations from a rib.
Aortic cross clamp in place. Bleeding controlled.
We've got eight units of packed cells in the field via a portable bypass in progress at three liters.
Portable bypass? That your call?
It was our only option.
I got it from here.
Sharon Goodwin, this is Lawrence.
Wonderful to meet you.
Sorry it's under such difficult circumstances.
I'm gonna leave you two alone.
I don't have much time.
It's a busy day for us.
Now, would you prefer that I call you Ms. Goodwin or Sharon?
Oh, Sharon is fine.
Sharon, before we go any further, are you sure that you don't want to try to reconcile?
While legal separation is not a divorce, it is a big step down that road.
We're past trying to reconcile.
I know we talked a little bit about this on the phone, but pending court approval, you and your spouse are agreeing to live independent of each other, both financially and physically.
Which we have been for months.
Illinois law allows a spouse who is without fault to receive reasonable support and maintenance while parties are living apart.
We would need to ask the court to determine that amount.
I don't want anything from him.
In that case, when you're ready, I just need you to sign at the bottom of both copies.
I'm Dr. Charles, and this is Dr. Reese.
Nice to meet you.
Dr. Manning mentioned that you were struggling with how to break the news of your husband's death to your daughter.
We were thinking that if we all sat down, we might be able to help you come up with a plan to... how to best discuss this with Phoebe.
You know, I really appreciate you're trying to help, but the timing is just all wrong.
Phoebe is scared enough just being here.
I can't add stress to her right now.
If you'll excuse me.
I think she's lying to us.
The pause before answering, throat clearing, and hand-to-face activity all point to her not being truthful.
Just so you know, all that behavioral cue stuff about how to spot liars: bunch of hooey.
Having said that...
I think you're absolutely right.
She's hiding something.
What do you think?
I think an ED doc opened him up in the field.
Can you repair it?
Well, it's not every day that you see a rib in the aorta, but I'm gonna try to repair it by graft.
Whether there is impaired brain activity or paralysis...
[faucet shuts off]
Well, that remains to be seen.
You must be one hell of a poker player.
Why is that?
It was a hell of a gamble.
What's the word?
We had to try.
Mrs. Barlow, there are some things about your case that are puzzling.
I was hoping I could ask you a few questions.
As I mentioned, your labs show you're a little undernourished.
I just want to make sure you're getting enough to eat.
I'm glad to hear that, because sometimes people skip meals when they're finding it hard to get by.
Well, when money's an issue.
We've seen some patients who felt they had no choice but to sell their medications.
Are you insinuating...
I'm just trying to understand these results.
I have no need to sell anything, and I resent the implication.
Mrs. Barlow, I just want you to know that there are resources available for you, if you need anything.
I already told you.
I just... I dropped my pills down the toilet.
That's all there is to it.
Olga Barlow, you gave me such a fright.
Ruth, my hair.
I look terrible.
You look fine.
I've just brought you your purse and wanted to see if there was anything you needed.
I'm sorry, Doctor. I'm her neighbor.
And you mustn't worry about Princess.
I fed her.
I'll give you two some privacy, Mrs. Barlow.
Now, what's going on?
She won't admit to it.
Well, I'm not surprised.
People think s*x is a touchy subject.
Believe me, money is a lot touchier.
I've been doing a little digging into Phoebe's mother, Michelle Kastpen.
I can't find anyone in or around Chicago with that name.
Hey. Phoebe's CT results are back.
Mom has clearly not given us a full history.
Ms. Kastpen, is there any other information, anything at all, about Phoebe's medical history that you'd like to share with us?
Not that I can think of.
The reason we ask is that Phoebe's CAT scans revealed several healed skull fractures.
These explain Phoebe's hearing loss.
They're also possible indicators of child abuse.
Wait, you think it was me?
I would never do anything to hurt Phoebe.
The way this works, Ms. Kastpen, is that unless you can shine some light on your daughter's injuries, we don't really have any choice but to contact the authorities.
I would never, never...
You have to understand how we're seeing it, from our perspective.
It wasn't me.
I lied. I'm divorced.
It was my ex.
Phoebe would get hurt when she was with him a lot.
A sprained ankle. A broken arm.
Too many things to be random.
Did you ever confront him?
I tried, but he has money.
He out-lawyered me.
Oh, so it sounds to me like your ex-husband's still alive.
I felt powerless, so I took her.
You kidnapped your daughter?
I had to.
You can't call the police.
Please. They'll just send Phoebe back, and I don't know what he's gonna do to her.
You have to protect my daughter.
This woman has given us a false name and admitted to kidnapping her daughter.
But I think she's finally being honest.
She is legitimately concerned for her daughter's safety.
Just because she thinks she's telling the truth, Doctor, doesn't necessarily mean that she is.
Yeah, but if she is, I'd hate to tear this child away from her mother.
It's not our job to figure out what the truth is.
If we suspect abuse, it's our duty to report it and let the proper authorities sort it out.
Hey. Any news?
I'm headed back up to check.
We found Ignacio's family.
They're in St. Louis.
Be here in four hours.
Let's hope it's a happy reunion.
Si, Si. In Chicago Med.
Oh, thank you.
Thank you, Doctor.
Ruth, wasn't it?
Those are beautiful earrings. Emerald?
Oh, yes. Thank you.
And nice bag. I noticed the one you brought Mrs. Barlow was a real beauty too.
Oh, well, we both have a weakness for nice things.
The thing... never mind.
What were you going to say?
It just doesn't fit.
How Mrs. Barlow can afford to spend so much on a purse.
I could be wrong, but I think she's economizing on food.
You think Olga has financial issues?
Well, what do you think?
I don't know, but now that you mention it...
I was over there for coffee last week, and when I went to get the sugar all she had were those little packets that you get in restaurants.
Is it possible Mrs. Barlow might feel pressure to keep up appearances with you?
Oh, dear. I...
I-I may have given Olga the wrong impression.
Actually, I don't have that much.
It's my son.
My son sends me nice things.
And you never told Mrs. Barlow that?
I see you care about her, and you want to help her.
Then please let her know the truth.
Hi. Can we speak for a moment?
You made the call.
Yes, it is our duty in these types of cases to alert the authorities.
Now may be a good time to have a conversation with Phoebe to prepare her.
Oh, I'll get that.
Well, that's a pretty drawing.
I used to color better.
Yeah? What changed?
I don't know.
Hey, Phoebe, you mind if I take a look at your hands?
All right, now, can you squeeze my fingers as hard as you can?
What are you doing?
Just making sure we haven't missed anything.
How about with this hand?
He hasn't woken up yet.
It could be a sign of impaired brain function.
It's too soon to make that call.
You do a Babinski?
It's your patient. I didn't want to overstep.
♪ ♪ ♪ ♪
What did I do to this guy?
Listen, Will, he's still got a good amount of paralytic in him.
He's also acidotic and cold.
You can't expect a good reaction just yet.
So after I observed the weakness in Phoebe's hand, I ran some tests on the blood work we took, and the results showed an explanation for her hearing loss.
She has a genetic condition called osteopetrosis.
It's a bone disease that can cause progressive hearing loss.
It also explains the carpal tunnel that's causing weakness in her wrists.
But I don't have it, and neither does her father.
It just means that you and her father are both genetic carriers.
Is she gonna be deaf?
We've had some success in treating the condition with bone marrow transplants.
What aren't you telling me?
Osteopetrosis makes bones abnormally dense and prone to breakage, which explains her skull fractures.
What I'm trying to say is, I don't think she was ever abused.
Oh, my God.
He didn't hurt her?
What have I done?
What have I done?
I'm Detective Olinski.
What have I done?
Still hasn't come to.
Dr. Halstead, we saved his life.
To lie like this on a ventilator for God knows how long?
We don't know that's the case.
He's been off sedation for an hour and a half.
He should be coming around.
Okay, so let's give him a little nudge.
Flumazenil 0.2 milligrams IV push.
Wait. We don't know his history.
If he's an alcoholic or on a benzo, he could seize.
That's not gonna happen. Please.
We need to know his mental status.
Mr. Garza, I'm Dr. Rhodes.
You're at Chicago Med.
You were in an accident.
You were hit by a car.
Do you need me to translate?
Oh, no. Thank you.
[continues in Spanish]
You got a good grip there.
Mr. Garza, I want you to push your foot down, like you're stepping on the gas pedal of a car.
Okay. How about this?
Mr. Garza, can you move your toes?
You're a rock star, Mr. Garza.
You did great.
Now we're gonna let you get some rest.
I'm so sorry.
No, it's okay.
Then why... ?
I'm just so relieved.
Good job getting the bypass out there.
It's okay, baby.
It's okay, baby.
No, don't go, Mommy! Don't go!
Baby, it's okay, it's okay.
Come back, Mom!
No! Come back, Mommy!
She thought she was doing the right thing.
She risked everything and lost everything to get her daughter out of harm's way, and we're sending her to jail.
I understand why she did it, but couldn't she have had a doctor evaluate Phoebe before going on the run?
She messed up so many lives.
Yeah, but... it still feels wrong.
So this was all just about keeping up with the Joneses.
It was a good catch, Dr. Choi.
A new one for me.
It can literally kill you.
I guess sometimes that's all we have left, right?
Ignacio is going to make it.
We did that.
Man, you really stepped up today.
You impressed me out there.
Hold up. Is... is that a compliment?
'Cause as I remember it, you were like, "Don't you even think about putting in that chest tube."
Yeah, you know what? I was proud of you, and now you're just being a dick.
I just wanted to say thanks for the check.
No, I-I appreciate it, Mom.
I appreciate everything.
All right, bye.
I thought you were pissed off at her.
Yeah, I was.
I mean, you know, she wasn't... She's wasn't a great mom, but she tried her best. I realize that.
Anyway, I've got all this money, so where do you want to eat?
I hear there's this great place uptown with a lobster mac to die for.
You could say that.
Wait. I thought you had a win today?
Only thing I did right today was double-time some heavy stuff across the city.
Same thing any grunt could do in basic.
Jeff... whatever you did it, it saved a life.
[knock at door]
Hey, I just thought you might like to know that Dr. Halstead's bypass patient, he's doing well.
So now you can finish your marathon shift.
Go home, Dr. Rhodes. Put your feet up.
Oh, actually I had something a little different in mind.
What about you?
Just gonna go home.
You know, this place I'm going, it's...
It's pretty fun.
Maybe you want to join me?
A few more feet, you can officially check marathon off your bucket list.
"Officially" is a bit of a stretch.
Hold that thought.
Doesn't get more official than this.
With a time of ten hours and six minutes, Dr. Nina Shore has just set a new marathon record.
[upbeat Hawaiian music playing]
There it is.
Now, this is different.
Dr. Downey loved this place.
He said it was as close as you could get to the real thing.
Oh, thank you.
Any friend of Connor's.
Mrs. Goodwin, this is Keoni. He owns this place.
It's a pleasure to meet you.
Pleasure's all mine, and it's good to see you, brah.
It's good to see you too.
Do you know what "aloha" means?
Isn't that what they say when you get off the plane?
I thought it meant "welcome."
"Aloha" actually means "to consciously manifest life joyously in the present."
Well, in that case... aloha.
Oh, there it is.
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