04x11 - Who Can You Trust

[bunniefuu]

Next. - Yeah, can I get a...

Hey, there's a line. My shift starts in five.

You understand.

We've all got places to be, I'm next.

Cut me a break, all right?

Can I get a double espresso?

I said I was next. What is your problem, man?

No problem.

Will, can I talk to you a second?

What has gotten into you? Guy's a d*ck.

I'm concerned about you.

Why? Because I wouldn't let him cut in front of me?

No, because you're not acting like yourself.

Yeah, well, maybe I'm a little upset about you throwing me out. I didn't throw you out.

Right. The g*n, the g*n, the g*n.

Will, I think you should consider talking to someone.

I think you're having a hard time processing all of it.

Anybody would.

Nat, I don't want to process it.

I want to forget it ever happened and move on with my life.

Our life.

You were talking in your sleep last night.

Really? I haven't done that in a while.

Hmm. - What was I saying?

Your usual. Barking orders to subordinates.

Sounds like me.

Give me the box!

Hey, get back here, that's mine!

You don't want that!

Hey, you okay?

Get off me, man!

Stay down.

Ethan!

Get out of here.

What happened?

He might be having a heart att*ck.

His pulse is through the roof. I called an ambulance.

Here, here, here. Let me do it. Let me do it.

Take deep breaths. In and out. In and out.

Petechiaes all over his chest too.

Oh, my God.

Gangrene.

April, call general surgery for a consult.

He'll need to have his leg debrided.

Meantime, start him on fluids, hang a gram of vanc, 500 metronidazole, order a CBC, CMP, blood cultures, and chest X-ray.

Add a cardiac panel and EKG. Need to rule out his heart.

Dr. Choi, do you want a cardiac panel and EKG?

Yeah.

Mags, any luck finding ID?

Not yet, and there was nothing in his clothes.

I got some lock cutters.

Figured there might be something inside.

Let me try.

He's a veteran. - Yeah.

Marks. - Reginald Marks.

Oh.

Silver Star. Which one is that?

It's awarded for heroism during combat.

Ah, Dr. Choi, CFD's coming in with semi-conscious 26-year-old.

Uh, go. I'll make a call to the VA.

Find him a housing placement.

Thanks.

All right, I got this.

I'm sure it's just my asthma acting up.

It happened with the last pregnancy too.

Is this your second? - Yep.

Double the fun this time. Twins.

Congratulations. - Thanks.

But actually, they're not mine.

I'm a surrogate.

Usually, Nate and Stephanie, the twins' biological parents, come with me to all my doctor's visits, but I didn't want to panic them over nothing.

Yeah, I hear some scattered wheezes.

I think you're right.

Uterus is compressing the lungs, exacerbating your asthma.

Let's get a Med Neb and 40 mg of IV methylprednisolone.

Well, since you're here... Ultrasound?

This isn't your first rodeo.

Whoo. Baby boy is doing somersaults today.

Probably the salsa I had with my eggs.

Spicy foods always get 'em moving.

Sister on the other hand, hardly ever kicks.

Celine, have you had your anatomy ultrasound yet?

No, it's for next week.

Is something wrong?

The male fetus's amniotic fluid is elevated.

But that can happen with twins. I just...

I'd like to get a better picture of what's going on.

Well, should I call Nate and Stephanie?

I think that'd be a good idea.

Just take these three. - Yep.

Hey. - Hey.

Will still crashing at his brother's?

Mm-hmm.

How long?

He can come home whenever he wants.

Just not with that g*n.

He's been through hell. I get that.

He just needs time to get reacclimated to his old life.

I hope so. I just wish he'd let me in.

He'll come around.

Mr. Davis.

Hello.

Hey, Phillip. - Dr. Manning.

How's little Sophie doing?

She's good, she's good, um, they say that we can, uh...

That I can take her home soon.

I'm so glad to hear that. Me too.

I'm so sorry, Dr. Manning. Heads up.

Ambo is in, treatment 6. - Okay.

Sorry about that. I'm sorry, um...

It was good to see you. You too. Yeah.

Get the hell away from me!

Good Samaritan found her wandering, called 911.

Fran Mooney, 83-year-old female with Alzheimer's disease.

BP is 138 over 90. I said let me go!

She was able to tell you all that?

Medical alert bracelet.

Called the emergency contact on the back.

Daughter should be here any second.

Okay. Uh, Dr. Charles, can I grab you?

All right, let's sheet transfer on my count.

Ready. One, two, three.

Milty? Milty.

Tell these people to get the hell away from me!

I'm actually Dr. Charles, but... but could you tell me a little bit more about Milty?

Milton was her husband.

Who the hell are you? Lungs are clear.

Mom, it's me. It's Alana.

Don't touch me!

2.5 haloperidol IM.

Help calm her down a little bit.

I'm so sorry, this... this is the third time this month she's wandered.

I-I don't know how she keeps getting out.

I always lock the door.

You notice any other changes in her...

Her general disposition?

Uh, she's... she's more agitated than usual, and she's... she's lost some weight too.

All right, well, we'll run some labs and see if there's anything out of the ordinary, okay?

Okay.

Might just have to adjust her meds a bit.

Thank you.

Long night?

Exceptionally long.

Why don't you head over to my place?

The new mattress just got delivered this morning.

Ah. Don't you think that's something we ought to break in together?

I like where your head's at.

So listen, we haven't really, um, we haven't talked about what happened at the gala.

Connor... What Cornelius told people...

It was vintage my father.

He's spreading lies and using you to get under my skin.

Look, he's a prick.

Bekker. Good.

There was a huge pileup on the highway near East Mercy.

I had to send two surgeons over there to assist.

Do you mind sticking around the ED?

We could really use the extra hand.

So much for sleep. Sure.

You hold onto those.

You two a thing? What's it to you?

Well, give me a heads-up when she dumps you.

Rhodes, head vs. auto, trauma three.

You got it. Courtney?

Leslie Taylor, 37-year-old female.

Car struck her in the crosswalk.

GCS 12, heart rate 130.

BP 86 over palp.

Leslie, I'm Dr. Rhodes, do you know where you're at?

Uh, was there an accident?

You were hit by a car, but now you're in the hospital.

What happened? Was I in an accident?

She lose consciousness at any point?

Bystander said she was out for a few minutes after it happened.

Couldn't get anything coherent from her in the ambo.

All right. Let's get her over on my count.

One, two, three.

There we go.

Breath sounds clear and present bilaterally.

Was I in an accident? Maggie filled me in.

I'll clear the C-spine?

Can't. She's perseverating.

You gotta wait until she's lucid.

Let's do a fast scan.

She's jaundiced. - Yeah.

Maggie! - Yeah.

Check to see if the patient's in the system.

Look for anything that would account for the jaundice.

Just pulled up her records.

She's got a lot of blood in her belly.

All right, let's give her a liter of fluid, 2 units of plasma, 2 units of blood.

Once her pressure stabilizes, we're gonna move her to CT.

Yes, Doctor.

Jaundice is from liver disease.

She's on the list.

Was I in an accident? If her liver took the hit...

She doesn't have much time.

Yeah.

Dr. Halstead.

This is Nate and Stephanie Addison, the twins' parents.

Hi. - Hi there.

Hi.

I'm afraid I have some difficult news.

What's wrong?

The male fetus has something called a congenital diaphragmatic hernia.

His abdominal organs have migrated into his chest through a hole in his diaphragm.

Oh, my God. It's treatable, right?

There are surgical options post-birth, but... due to the severity of his case, his prognosis is poor.

And unfortunately, that is not all.

The increased fluid is compressing the female twin, jeopardizing her growth.

So you're saying she's in trouble too?

There has to be something you can do.

Yeah.

Selectively reducing the male fetus would give her the best chance of survival.

You mean... - Lose him.

I am so sorry.

Is there a chance things could stabilize on their own if we just wait?

It's possible, but in all likelihood, the fluid will continue to build, hindering her lung development.

Oh! Oh, no.

But the earlier we intervene, the better.

Dr. Charles. I got Fran Mooney's labs back.

Her TSH is really low, so I ran some more tests.

It's likely due to an overdose of her thyroid medication.

Huh. Yeah, so I'm gonna put her on beta blockers and start detoxing her with charcoal.

Let me... let me talk to the daughter, find out who's in charge of the meds.

Okay.

Your EKG and labs were negative.

You didn't have a heart att*ck.

Have you ever had chest pain like that before?

Yeah, I have.

Panic att*cks?

Yeah.

When I got back from my first tour, I started talking in my sleep.

Shouted out orders, mostly.

It was like every night, I went back to Afghanistan.

Army? - Navy.

Squid.

Reservist now. Vicki's active duty.

How long did you serve, Reginald?

Reggie, please.

I was 12 years in the Corps.

I made it all the way up to Gunny.

Hmm.

Three tours in Iraq, two in Afghanistan.

The last tour was the roughest.

I had an IED that took my leg.

Took three of my marines with it.

Sorry, man.

Sorry to interrupt. Dr. Choi, can I talk to you?

Yeah.

Be right back.

Got the rest of Reggie's labs back.

White count is 18,000. His platelets...

His platelets are what?

I'm sorry, I can't share test results with someone who's not on staff at the hospital.

Uh, you know, I'll, uh, I'll head back to the VA.

I'll pick you up at 6:00. Yeah.

Bye, April. - Bye.

His platelets are really low. 30,000.

He's got thrombocytopenia. Guy can't catch a break.

Puts him at risk for bleeding.

Page hematology for a consult.

Okay. - W-w-wait a second.

What's with the attitude? What do you mean?

Why are you giving Vicki a hard time?

I was just protecting patient confidentiality.

Following the rules.

Dr. Halstead?

We've decided that, um...

Celine will have the procedure.

We've tried for six years to have a child.

These are our last two embryos.

We just can't risk losing both of them.

I'll let obstetrics know.

I give my mom her pills, but I only give her one tablet every morning.

That's what the doctor prescribed.

You mind me asking, where... Where are the meds kept?

Are they locked away, or...

I came as soon as I could. Had to leave a client meeting.

This is my husband, Patrick.

Patrick, this is Dr., um, sorry, remind me?

Dr. Charles. Nice to meet ya.

They think Mom overdosed on her thyroid medication, but I don't see how.

Maybe Fran got into the pills?

No, of course not.

She can't even button her own shirt.

There's no way she could open a pill bottle herself.

She unlocked the front door.

You know... when Fran was first diagnosed, she begged Alana to euthanize her.

She couldn't stand the thought of deteriorating.

But she's not lucid enough to attempt su1c1de.

Is she?

Periods of lucidity aren't uncommon with Alzheimer's, and, you know, the increased agitation, the weight loss, I mean, those both, they could be signs of depression.

I told you.

Your mother shouldn't be living with us.

We are not having this conversation right now.

Why don't you two take a break?

Go grab a cup of coffee. Let me have a chat with Fran.

Okay? - You go ahead.

I have to respond to some client emails.

Celine, you all right? He just kicked.

I know it's him, he's always on the right.

Wait, wait. Stop. - What is it?

I can't do this. - What?

You heard Dr. Halstead. We don't have a choice.

He said there's a chance things could stabilize.

Celine, we can't risk losing both of our babies.

How about we talk this out...

I'm sorry, but I'm not willing to let him go.

I can't do the procedure. I just can't.

Okay, here's the clause in the surrogacy contract.

The parents have the right to request a selective reduction for any medical reason.

And the surrogate agreed to defer to their wishes?

She signed the contract.

But she has since, very emphatically, changed her mind.

Okay, well, that's the funny thing about contracts.

They don't really care if you change your mind.

Well, I don't care if she signed the thing in blood.

Celine is not a human incubator.

I won't force a procedure on her without her explicit consent.

You're not gonna do anything at all, Dr. Halstead.

This is a legal matter now. Let the lawyers hash it out.

Waiting room's jumping. What's going on?

Mass casualty over at East Mercy.

They went on bypass about an hour ago.

Started diverting patients here.

Hi.

Uh, I think my sister's here, Leslie Taylor.

She was hit by a car.

Yes, I'm the nurse who left the message but I'm taking that you're not Paul Taylor?

No, that's Leslie's husband. Ex-husband. He called me.

Okay, just give me a second. I'll get her doctor.

Okay.

Dr. Choi!

I need you.

BP's in the toilet. Heart rate's 130.

Must be an upper GI bleed. He's got thrombocytopenia.

He won't be able to make a clot.

He needs blood and platelets now.

Trigger the MTP, I'm gonna intubate.

20 etomidate, 100 of sux, and grab me an EGD scope.

Gotta find the source of the bleed.

The impact from the accident destroyed the right lobe of Leslie's liver.

We will be able to fix it for now, but she's gonna need a new liver urgently, and because of her condition, she's gonna move up the transplant list from her previous status.

Wait, previous status? What... what do you mean?

Leslie's already on the transplant list.

You didn't know?

Right, right. Of course I did.

I'm sorry. There's just a lot to take in.

You were saying?

So if Leslie doesn't get a new liver in the next few days...

Oh, God. There is another option.

A living donor.

Someone can donate a lobe of their liver.

Really?

I'll donate then. What do I need to do?

First of all, you should know that there can be complications for the donor that...

I don't care.

Is there anybody that you need to talk to about this?

No. There's no...

I need to do this for my sister, Dr. Rhodes.

Okay. We'll get you tested right away.

Fran, could you open this bottle, take out a pill, and hand it to me?

Could you do that?

You do it, Milty.

Just pull down the tab and press.

She's in A-fib with RVR.

Give me 10 of diltiazem.

Yes, ma'am.

Meds are in.

She's back in normal sinus rhythm.

It's odd that she flipped into A-fib.

We've already treated her hyperthyroidism.

I'm gonna order an echo, see what's going on.

Yeah, good idea.

But, um, I think we might be dealing with more than just an overdose here.

April, call the blood bank.

We're gonna need more platelets.

Give the second dose of TXA.

That's it.

That's where he's bleeding from.

Epinephrine injector.

Ready? - Mm-hmm.

There we go. I think we got it.

Dr. Choi.

Damn it. It's not clotting.

They won't allocate any more platelets for Reggie.

What? Why?

'Cause of the MCI at East Mercy.

There's a citywide shortage.

Blood bank's been mandated to dispense only to patients who will benefit.

Go down there in person and tell them the order's coming from me.

Do not take no for an answer.

We've given him multiple doses.

It is not working.

I didn't ask for your opinion.

Do it now, or I'll get someone who will.

There's more.

I want to make sure you understand you're in clear breach of contract.

I'm sorry but I think we should just wait and see if things stabilize on their own.

With all due respect, there is no we.

It's the Addisons' decision and theirs alone.

It's her body.

That doesn't give her the right to hold my clients' fetuses hostage.

That's not my intention. Listen.

I'd hate to have to bring this to trial because if I do, you'll be facing severe legal and financial ramifications.

Let's take it down a notch, okay?

You're not gonna force her hand with intimidation and scare tactics.

Why don't you stay in your lane, Doctor?

This doesn't concern you.

Oh, no, it does concern me, because you're upsetting my patient.

You need to leave.

Our lawyer is not going anywhere until we figure this out.

Celine, do you want her to leave?

Excuse me.

I'm Sharon Goodwin, Director of Patient Medical Services.

Is there anything I could help you sort out?

Yes.

We'd... we'd like a different doctor.

Dr. Halstead is clearly biased against us.

That's not up to you. I'm Celine's doctor.

Only she can make that decision.

Dr. Halstead, can I speak to you outside?

Ms. Goodwin... - Now.

You're wrong, Dr. Halstead.

You know who else can make that decision?

Me.

And if the Addisons aren't comfortable with you...

You're benching me? I'm reassigning the case.

Yes.

Unbelievable.

When was the prescription filled?

I-I don't remember.

I think Patrick picked up the last refill.

It was about a month ago.

No good?

A little sweeter than I like.

Can I get you another cup? No, no. It's fine.

Okay, so there's 20 pills left, and the quantity of the prescription was 90.

Sorry, I'm terrible at math. It's okay.

Um, there should be 60 pills remaining, which means there's 40 pills unaccounted for.

You think my mom took 40 pills?

No, no, if she took that many pills at once, she would be in a coma.

The overdosing has to be taking place over time, like, a little bit each day.

And based on my evaluation, your mom doesn't have the cognition to be able to carry out a repetitive, multistep task anyway.

Wait, you think someone's doing this to her?

Is there anybody who comes and goes from your home?

A part-time caregiver or...

There was for a bit, but she quit months ago.

And the only people with access to my mom's pills are me and... my husband.

What if... I don't get a liver in time?

Well, the good news is that we found you a donor already.

Really? - Mm-hmm.

We tested your sister. Turns out...

No, no. Wait, my sister?

Denise? - Yeah.

How did she know I was here?

Hi, Leslie.

What are you doing here?

Leslie, please.

No, I told you to stay away from me.

I-I just want to help you.

I don't want your help.

Leslie, hear me out. Get out!

Whoa, whoa, whoa, whoa.

Whoa, whoa, whoa, whoa. Here, let's step outside.

Um, take a deep breath.

Deep breath, that's it.

Look, Leslie, I don't know what happened between you and your sister, but she...

I'll tell you what happened.

She k*lled my little girl.

Mary was only three years old.

Denise... put her to bed.

Went downstairs, lit her bong, and smoked herself into oblivion.

When she woke up, the house was in flames.

She managed to get herself out, but she was too stoned to remember... that Mary...

My Mary...

Was still upstairs.

I won't accept anything from her.

I'd rather die.

That's all you can do.

I asked her to stick around, see if we can get Leslie to change her mind.

Denise doesn't think she'll budge.

Yeah, no, she was quite adamant.

I mean... I can understand.

Oh, Connor, she's cheating herself out of life to what?

Punish her sister?

Denise has already done that to herself.

Every day of her life, she has to reckon with what happened.

What do you mean, with what she did?

She's not shirking responsibility.

The opposite.

That's why she's so desperate to make amends.

Well, look, regardless, we can't force Leslie to accept Denise's liver.

No. We just have to stand by and watch her die.

We both know the likelihood of another liver coming through in time is slim.

She's got days at most.

I'm gonna reach out to the hospital's PR team, get them to put out an urgent public appeal for a donor.

What? - Nothing.

No, that's a good idea.

Where are the platelets? He's not getting any more.

They have to be conserved for patients who have an actual sh*t at survival.

He has a sh*t. Once the meds kick in, the platelets start holding, we can get him up to surgery.

We both know that is not gonna happen.

We take him up to the OR, he's gonna bleed out...

You have no right to deny him treatment.

Dr. Choi?

He's bleeding from his IV too.

He's in V-fib. No pulse.

April, charge to 200. Doris, start bagging.

Charging.

Charged. - Clear.

Dr. Choi. - Amp of epi.

Charging to 200.

Clear.

Doris?

He's asystolic. Another amp of epi.

Dr. Choi, enough! Another amp of epi!

Give him an amp of bicarb and an amp of calcium.

On it. - Come on.

Come on.

Time of death, 16:48.

The Addisons aren't speaking to me except through their lawyer.

I don't know what to do.

I can't afford to be in some long, drawn-out legal battle.

Maybe I should just respect their wishes.

But I know they don't want this either.

That's why I'm here. I may have found another way.

It's an investigational procedure called fetal tracheal occlusion.

If successful, it would allow the twins to reach viability.

I mean, it could even help improve the male fetus' lung function.

Hold on, though.

General anesthesia always carries risks.

And because of your asthma, the potential complications are increased.

You would be putting yourself on the line.

I know they're not mine.

And when it's time to hand them over, I'll be happy to, 'cause they know how loved and wanted they are.

But while they're still inside my body, while their lives depend on me, I have to do what I think is best.

I want to do it, Dr. Halstead.

This is absurd.

I can't believe that you think I would do something like this!

I don't know what to think.

I know you resented my mom moving in with us.

The imposition on our lives.

So you think I'm trying to k*ll her?

No one's accusing you of anything.

Yes, you are.

We're just trying to understand how this happened.

Too sweet? Your coffee. Is your coffee too sweet?

Yeah.

Why?

Alana, I'd like you to get an MRI.

April, that man risked his life for all of us.

We owed it to him to do everything we possibly could.

Yeah, but we did, Ethan.

The situation had become futile, you just couldn't see it.

So you had to go snitch to Lanik?

I was following the chain of command.

Funny, you're such a stickler for the rules when they align with your agenda.

My only agenda is the welfare of my patients.

Then you wouldn't have interfered when I was trying to save Reggie's life.

Did you go to Lanik to get back at me?

Get back at you?

You made it very clear you resent Vicki.

Are you serious?

You think I would jeopardize a patient to get even with you?

You two need to take this outside right now.

You're disturbing my ED.

Sorry, Maggie.

We're done.

Alana.

We have the results of your MRI, and we were just wondering if we could discuss...

Please, just... just tell me.

Your MRI shows atrophy to the hippocampus.

It's the area of your brain associated with memory.

Combined with some of the behaviors that we observed today...

Forgetting that you had already put sugar in your coffee, problems with simple math...

The findings are consistent with the...

With the initial stages of early-onset Alzheimer's.

Jesus.

Wait.

You mean I'm gonna end up like my mom?

There are certain medications that help slow the disease's progression.

Not to mention hundreds of new clinical trials, some of the results of which are promising, especially when started early.

What... wait, so it was me?

I was... I was overdosing her?

Accidentally.

You were forgetting that you had already given her the medication.

Oh, my God.

What... what have I done?

I'm so sorry.

I-I can't believe I suspected you.

Can you... can you ever forgive me?

Honey.

It's okay.

We'll give you both some time.

Thank you.

Hey. I have great news.

We found a donor for Leslie.

Someone answered the hospital's public plea.

Really? That fast?

It just went out a few hours ago.

I could hardly believe it myself.

Um, is it a living donor, or did the family of the deceased request it go to Leslie?

Uh... I don't know.

It's all anonymous, so... Right.

Her disease was staring her in the face.

But she was never gonna see it.

Well, that's the kicker, right?

I mean, a primary symptom of early Alzheimer's is anosognosia.

Anosognosia?

It's when you don't realize you have the disease.

You can't recognize anything's wrong.

Dr. Charles?

Can I talk to you about something?

Of course.

Dr. Halstead.

What part of "you are off the case" was unclear to you?

I felt I had an ethical obligation to present Celine with all the options.

While you had no qualms about leaving the Addisons out of the decision entirely.

You know, this is the kind of behavior that almost got you kicked out of residency.

You're an attending physician now.

You know better.

Dr. Halstead.

Are you still planning to observe?

We're about to start.

We're not done.

I'll deal with you after.

Dr. Choi.

I'm doing the nursing schedule for next month.

Wanted to let you know that I'm putting you and Nurse April on alternate shifts.

Did April request that?

No.

But until you two get your act together, I'm not gonna risk another spectacle.

That won't work for me, Mags.

Unfortunately, Dr. Choi, it's not your decision to make.

I understand.

Unless April objects, I want her on my shifts.

Excuse me.

April.

I'm leaving. - Please don't.

You know what, for the record, I would never let our personal history affect my decision-making when it comes to patients.

I know. I shouldn't have accused you.

I didn't report you to Lanik out of spite.

You left me no choice. I'm sorry.

And maybe I could be nicer to Vicki.

But it's hard.

Seeing you together is... It's hard, Ethan.

April.

Don't. No.

Hey.

You okay?

What?

Maggie told me about Reggie.

Sounds like you did everything you could.

I wish I could have done more.

Come on.

Let's go.

What the hell were you thinking?

If Leslie ever finds out... She won't.

That's why it's so perfect.

An anonymous, self-directed donation.

Denise's identity can never be revealed without her consent.

There is no justification for blatantly disregarding Leslie's wishes.

Listen, I tried to keep you out of it.

You kept me out of it because you knew I wouldn't be on board.

Okay, so go on. Tell her the truth.

I can take the hit, but her death, that'll be on you.

We're saving her life. The end justifies the means.

Oh, hey, Daniel.

You got a minute? For you? Maybe.

What's up?

It's about Will Halstead.

Popular topic of conversation today.

Is that right?

Did... did our babies make it?

Dr. Dennis will be out to speak with you both shortly, but the surgery was a success.

Yeah, both fetuses have strong heartbeats.

Is Celine okay? Yeah, she did just fine.

What, so I don't do what you want, and you force it on me?

What are you talking about?

Mandatory counseling, Goodwin's orders.

Or I could take a leave of absence, my choice.

Tell me this isn't your doing.

I spoke with Dr. Charles because I'm worried.

That's terrific.

You told the Head of Psychiatry I'm unstable.

You are the only one who doesn't see that there's a problem.

Will, please. This is not you.

Or maybe it's not the Will you want.

What does that mean?

I am done being everyone's puppet.

How can you put that on me?

I wasn't the one pulling the strings.

How could I?

You lied to me, you kept me in the dark.

You're still keeping me in the dark.

Well, well.

Young Oedipus.

Come to hit me again?

What happened between you and Ava?

Let me get you a drink first.