04x17 - The Space Between Us

[bunniefuu]

All right, Caroline, we'll have your infusion ready in just a minute.

If you feel nauseous just let us know and we'll get you some Zofran.

Okay.

Think maybe we could just give her some preemptively?

She... she got nauseous the first three infusions.

I'm fine.

Danny, I can ask for my own meds, thank you.

Of course you can, I'm just... I'm just trying to...

Wait, wait a second.

Don't start the infusion yet.

Heather? Heather, sorry.

Um, I'm just curious, is nausea a side-effect of the drug?

No, it... it's an effect of the infusion process in general.

Well, what kind of side effects are you seeing from patients who are getting the... the drug as opposed to those who are getting the placebo?

This is a blinded trial.

You know I can't disclose that kind of information.

Of course, of course you can't.

I mean, not that I'd ever tell her.

I just wanna be able to manage her expectations, that's all.

Dan, I'm not gonna tell you whether she's on drug or placebo.

♪ What are you doing?

Trying to take care of my wife... my ex-wife.

I know that you're worried about Cece, but this is exactly what got you into trouble when you were married.

Okay, look, I'm just gonna go get her a glass of water.

Hey, we got a patient in 2.

Cystic fibrosis, temp 103.

Third time he's been in the last month.

That doesn't sound good.

Uh, here.

Been meaning to give you that back.

Hi, Ben, I'm Dr. Halstead.

This is Dr. Manning. - Hi.

How long have you had the fever?

Started last night.

Do you know what antibiotics usually work for you?

Not many.

The last few times they went straight to Imipenem.

Okay.

500 of Imipenem, CBC, BMP, cultures times three, chest x-ray, PA, and a lateral.

I'm sorry, one second.

That's okay.

Hey.

I just parked.

I'm walking. I love you.

I love you, too.

It's my girlfriend. - Aww.

Lisa.

She can come in if she wants.

Actually, she can't.

Um, she has cystic fibrosis too.

Ah. Well, CF isn't contagious.

But CF patients carry many different strains of drug-resistant bacteria.

The fear is that by sharing the same air, they'll cross-infect each other.

So you've never been in the same room?

We met in an online support group.

Lots of video chatting.

Um, but that's all gonna change once we each get new lungs.

You have to tell them you're status 1A.

I'm status 1A.

This is why she makes me bring her everywhere.

Glad to hear you're 1A.

Three severe infections in a month, you're gonna need those lungs sooner than later.

All right, well, I'll call over to the transplant coordinator, and in the meantime hopefully the antibiotics will help get your fever down, okay?

♪ Poor kids.

So in love and they can't even be together.

♪ April, are you taking Mr. Lane in 6?

Going now. - Awesome.

Don? - Yeah?

I have some stretchers in the ambo bay.

Can you take care of that? Yeah, I'll get them.

Thank you so much.

Hey. - Hey.

Hey, Ava.

Robin.

So, I heard you rounded on my mom this morning.

How's her new valve doing? She is looking great.

I don't foresee any problems. Good.

Oh, and did you see the vertical farming exhibit at the Smart I told you about?

I'm telling you, the future is aeroponics.

We get 120 days of rain a year.

I don't see us running out of water.

It's not about the water.

It's about feeding 130 million new babies a year.

Okay. - Have you seen it?

Uh, no, but... but I'll make a point to.

Thank you.

Obviously, it is over some people's heads.

That's a vertical farming joke.

No. - Yeah.

Nope, nope, nope.

Anyway, I know my mom's scheduled for an echo tomorrow, so once you get the results...

Oh, my God, help me!

Please, help me! Get me out!

Help!

Hey, hey, hey, don't move! April, give me a hand!

Robin, go call Goodwin! Sir, sir?

Can you hear me, sir?

It's locked!

I got an idea!

Don! - Don?

Hang on, Don!

Use this! - Clear!

I'll go call CFD!

♪ k*ll the engine. Stay with him!

Got it.

What do we got? - Hey, hey.

It's okay, we got you. What hurts the most, Don?

My leg! He's bleeding really bad.

Yeah. - It's too much blood.

Am I gonna die? Don't talk like that.

We're gonna get you out of here.

Something cut his thigh.

It looks like it must have been the artery.

I can't reach it.

Hey, give me an 18-gaugue IV catheter with an EJ line and four units of O-neg on the rapid transfuser.

Got it. - April!

April, you can't go under there!

It's okay, I got it! It hurts so bad, it hurts!

Definitely arterial blood. Maybe femoral.

Can you get a tourniquet above it?

It's too high. It's too high to clamp, too.

If I can just pinch my fingers around it...

Okay, I got it.

I pinched it off.

Hey, hey, be careful up there!

Please, please.

Don't let anything happen to me.

April, you gotta get out of there.

I'm not letting his artery go.

She is the only thing that's keeping him alive right now.

CFD's gonna be here soon.

Hold on.

Sir?

Sir, can you tell me your name?

He's got a loud diastolic rumble.

It could be an embolic stroke.

Which would mean he passed out while driving.

We need to get him up to CT! Okay, let's move him!

Get the gurney in here!

Clear out, folks. - All right!

All right, let's move him! Come on!

On my count. One, two, three.

All right, all right, all right.

Let's go. There we go.

Ethan, page me when you're ready to move Don, okay?

Yeah!

All right, let's go, let's go!

Curry, we've got ambulances lining up outside of the lobby!

Go help them! - Absolutely.

♪ I got you.

♪ This is Sandy Glenn and her husband, Drew.

Passed out in her home this morning.

GCS 15, vitals stable.

I'm Elsa Curry, third-year medical student.

Uh, can you tell me what happened?

Uh, I was just making some tea, then suddenly I saw stars.

I found her on the floor.

Has this ever happened before?

No.

But she does have multiple sclerosis.

Uh, relapsing/remitting.

Could it be the start of a new episode?

Yeah, it's possible. Any other symptoms?

Visual disturbances, pain, incontinence?

Uh, no, nothing like that.

Okay, uh, transfer on my count.

One, two, three.

Okay, yeah, you've also got some dry skin, marked pallor, and some peripheral edema.

Have you been losing any weight?

Maybe a little, but not much.

All right, then my attending and I are gonna order a full set of labs and have neuro come down to take a look.

I'll be back in a little bit.

April! - Hey!

We got here as fast as we could.

Kelly? - April, you hit?

No, no, no, I'm fine. It's Don.

We gotta get him out of here.

Just hold tight. We got it.

Cruz, how's it look?

His leg's stuck in the wheel well.

Okay, but how long till we get him out?

Well, we have to stabilize the car with airbags and secure it with cribbing before we can even attempt to remove that leg.

We move too quick, whole thing will come down on top of him.

All right, keep me posted. Yeah.

Hey, Don? Hey, you hang in there, okay?

I'll try my best. - Good.

We're working on a way to get you out soon.

Hey, come on. I'll take over from here.

No, don't leave me. Don't leave me.

No, it's fine.

You're not gonna fit under here, anyways.

Look, April, I can squeeze my way in.

I said I'm fine.

♪ Dr. Choi.

♪ How's he doing? He's lost a lot of blood.

April's pinching off his femoral artery, but he's still bleeding into his pelvis.

We've got him on the rapid transfuser.

I'm gonna have Dr. Lanik take over from here.

What? Why? April's in danger.

We need someone in charge who's not as close to her.

Ms. Goodwin, I hear what you're saying, but April and I, we're just coworkers.

It's fine.

Okay.

♪

Mr. Nichols, I'm Dr. Rhodes.

This is Dr. Bekker.

How are you feeling?

Um, sore, but okay.

I'm so sorry about what happened.

I was getting so numb and dizzy, and I just wanted to get here, and...

You passed out while you were driving.

Mr. Nichols, your scans show that you have a tumor growing in your heart.

It's called a myxoma.

Now, it is most likely benign, which means that it won't spread to the rest of your body, but it is large enough that pieces are breaking off and causing you to have small strokes.

So how do you fix it?

Normally we'd remove it surgically, but yours has grown extremely large.

We would like to put you on the transplant list.

Find you a new, healthy heart.

Couldn't that take a while?

What if I have another stroke? I could die.

Removing the tumor is a very difficult procedure.

If we try and are unsuccessful, your body won't be able to tolerate a transplant later on.

But it's possible you could get it all.

It's possible.

Then let's do it.

Mr. Nichols, I appreciate how eager you are to take care of this, but I... and we... would really advise against that.

This thing almost k*lled me today.

Please, take it out.

♪ Well, the risks are significant, but if you'd prefer to take them, of course we'll do everything we can to fix this.

Yes.

Thank you.

All right, then.

Ava, you realize what we are committing ourselves to?

I do.

We get one sh*t at opening him up.

If we do it and we don't succeed, he's gonna die.

We can do it.

♪ Hi, Ben.

So, good news.

A new pair of lungs have become available.

Really?

Oh, my God, Ben! That's amazing!

Yeah, they're flying in now.

Should be here in a couple of hours.

So I'm getting them today?

I'll call surgery now.

Hey, you here for your check-up?

That we are. - Hi, Sophie.

Oh. Oh, I think she's waking up.

I hope the, um... the doctors will warm his fingers up.

Oh, I heard they charge extra for that.

But maybe I can put in a good word.

I'll call surgery for Ben.

Thanks. Why don't I take you guys up?

Great, yeah.

Everything's all right.

All right.

Dr. Choi!

Don needs you right now.

I can't breathe.

What happened?

He just started wheezing a minute or two ago.

It's just getting worse. I can't breathe.

I can't breathe.

He's having a transfusion reaction.

We gotta stop the blood.

Give me 50 milligrams of diphenhydramine, stat.

What's happening to me? Am I gonna be okay?

You're having an allergic reaction.

They're gonna have to stop the blood.

But I'm still bleeding, right?

All right.

Cruz! - Yeah?

How close are you?

Uh, leg's almost free, but there's a lot of jagged metal down here.

We gotta move this whole thing at least eight inches, stabilize it before we can move anybody.

It's gonna be a while.

I can't give him anymore blood.

How long is a while? What can I tell you?

We're working.

♪ April?

Just let me switch out with you.

Ethan, I am not leaving him.

♪

Okay, so, anemic, hypoglycemic.

Uh, low vitamin B12 and calcium.

EKG changes, hmm.

It ain't good, but it doesn't look like an exacerbation of her MS.

No, it looks like anorexia, but she's not underweight.

Which doesn't necessarily exclude the disorder.

Let's go say hi.

I'm Dr. Charles.

Ms. Curry wanted me to, uh... to say a quick hello.

Were my test results bad?

We're worried about your nutrition.

Have you been experiencing any digestive issues or decreased appetite?

No.

No? Okay, that's good.

Are you concerned about your weight at all, or...

Or even, say, your appearance in general?

I'm not anorexic.

I have a tapeworm.

A tapeworm?

Yes, I infected myself on purpose for my MS.

There's this thing called helminthic therapy...

Yeah, for autoimmune diseases.

It's... it's really cutting edge.

You've heard of it? - Yes.

Uh, basically, the hypothesis is that a worm infestation can activate your immune system to fight against certain conditions.

You know, there's actually quite a few centers that are doing clinical trials.

Oh, she couldn't get in to any of them.

Have you discussed this with your neurologist?

'Cause there are several new therapies for MS.

And, you know, modulators... Steroids, Cytoxan.

I've tried everything.

But since I started this, I haven't had an episode in three months.

Really?

Okay, what is your normal remission rate?

Because anything longer than two standard deviations and we could probably publish a case study.

Um, could you excuse us for a second?

Ms. Curry.

♪ Ms. Curry, I appreciate your enthusiasm, but these trials are held under strict medical supervision.

She's doing it on her own.

I know, but this is the front line of immunotherapy.

I mean, we could find a positive result.

That woman passed out today from malnourishment.

That's what we're treating here.

Or we can work with her.

We... we can modify her diet, we can... we can give her higher calorie foods...

The patient has a parasite, and it is clearly undermining her health.

Dr. Charles, I really...

Let's start with 400 milligrams of Albendazole and hang a liter of D5W.

Thanks. - Mm-hmm.

♪

Looks like things between you and Phillip are going well.

He's still having a tough time, but it's slowly getting better.

He's lucky to have you.

Dr. Halstead, Dr. Manning, Ben's sats are dropping.

Please, help him.

Sats are down to 82.

No breath sounds on the left.

It's likely a pneumothorax.

I'll get a chest tube kit. Wait.

Do you know how many chest tubes you've had before?

Four.

His lungs are likely scarred as-is.

Another chest tube will only jeopardize his ability to receive a transplant.

But the new lungs are still an hour out.

I don't think he'll make it like this.

I can make it.

We can give him steroids and put him on a mask.

It's worth a try.

Okay, let's give him 60 milligrams of methylprednisolone and up the O2 to ten liters.

Hang in there, Ben.

We're gonna send you up to prep for surgery soon.

♪ Hey, hey, hey, hey, hey. Ethan?

He is losing consciousness. We gotta get him out of here.

Hey, Don? Don, can you hear me?

I'm so tired. Stay with me, Don.

Kelly, you guys ready to go yet?

The back wheels are still too unstable.

We need a little bit more time. No, we don't have more time.

Don's lost too much blood.

We're not moving anyone until it's safe.

No, Ethan... I'm sorry, April.

Kelly!

He's dying. We have to move him now.

Dr. Choi, is that true?

How unstable is the car? It's not where we'd like it.

If we move now, can't promise you it won't collapse.

Kelly!

Do it!

You start pressors, I'll up his fluids.

Keep working. We're waiting till it's safe.

Ethan! - We're waiting.

♪

What's going on?

Turned into a tension pneumo. We have to needle it.

♪

♪ His sats aren't coming up. It's not working.

The new lungs are still 15 minutes away.

He's not gonna make it that long.

We have to do a chest tube.

If we do it, he may not be able to get a transplant.

We have to do this.

Get the chest tube kit. No, wait!

I'm sorry.

♪ Sats are down to 71.

What about his transplant?

We don't have a choice.

Okay, making the incision.

♪

I'm in.

Sats back up to 80.

83.

All right, tell radiology he needs a stat chest CT before he goes to the OR.

Mm-hmm.

♪

I can't get an angle on this.

Reflect the atrium.

That's as far back as it's gonna go.

I can't get around it.

Damn it.

The tumor's extended too far into the auricle.

And into the valve and the SA node.

I don't see how we're ever gonna get the margins clear.

We may have to close him back up.

But we can't close him back up.

He's never gonna survive another procedure.

We need to fix this today.

Let me try it from here.

Reflect the atrium. Yes, sir. Forceps.

Right here.

Dr. Rhodes?

They're ready to extract the patient from under the car.

Okay.

Keep dissecting.

It's the only option we have.

♪ Go grab a board. - Ethan.

Hey, team's in place.

Soon as he's out, Maggie and I will bind the pelvis while you clamp off the artery.

Whoa, why isn't he on the rapid transfuser?

He had a reaction to the blood.

We had to take him off.

And he's been down there this long?

Yeah.

He's lost too much blood and his pressure's in the toilet.

Even if we are perfect on this, it might not be enough.

I know.

Man, I know that this is delicate, but is Don an organ donor?

I don't know.

The driver.

He needs a new heart.

God.

Yeah.

Don, Don, it's time to get you out of here.

You have lost a lot of blood. I know.

Your condition is extremely serious, and you know that in cases like this, we'd like to have a plan.

You wanna know if I'm an organ donor.

You're a healthcare worker, Don, you understand.

You said you were gonna save me.

I know. We are, Don.

Don, we're gonna do everything that we possibly can...

I don't want to die.

Stop, guys, you're scaring him.

April, please. - Get me out.

Just get me out. - Don, Don?

Kelly, we gotta go now.

Let's move! - Ready?

Up on blue! - Copy that.

Up on blue.

Let's get it in.

♪ Okay, ready? - Yep.

One, two, three. There we go.

Gonna roll him! - Yep!

Roll! - Roll!

You're good.

Clamp? - Clamp!

All right, April. both: Yep!

Faster, let's go! He's gonna bleed out!

Clamps are on!

Heartrate's 140! Sats are dropping!

Let's go, let's move! All right, on my count!

One, two, three!

Let's go! Come on, let's move, people!

He's crashing!

All right, let's move! Move, move!

♪ Whoa, what's going on?

Dr. Latham called the transplant off.

What do you mean? The new lungs are ready to go.

The chest tube caused a hemothorax, and that's on top of the damage from all his previous procedures.

He'd bleed out before we even got the new lungs in.

Nothing we've tried has touched his infection.

If he doesn't get this transplant, he's going to die.

Dr. Latham says his lungs are completely fused to his chest wall.

It's just not possible.

I'm sorry.

♪ Oh, God!

Oh, God, here.

Oh, God.

Oh, God. - You okay?

Oh, God. Yeah, I'm okay.

Hang a bag of Zofran.

No, I don't want any Zofran.

Honey, you... you're nauseous.

It'll make you feel so much better.

Go get the Zofran. No, I don't want any Zofran.

I take the Zofran, I get tired.

When I get tired, I nap, and then I can't sleep at night.

I don't want any Zofran.

Okay, well, we can get you something to help you sleep.

Ask Dr. Singh to write an order for, um...

Will you stop it, please?

Okay, will you leave, please?

I want you to get out.

Okay, okay.

I'll be back in a little while...

20, 30 minutes... just to see if you're still feeling nauseous.

No!

Don't come back!

I want you out!

♪

How's Don?

His pelvis is completely shattered.

It's still touch and go.

What?

If he doesn't make it, that's a heart wasted.

He was terrified, Ethan.

It was wrong of you to ask him.

How could we not? He wanted us to save him.

And we are! We're doing everything we can!

You did not do everything you could.

You should have gotten Don out sooner.

That car could have collapsed.

I wanted to make sure he was safe.

No, you wanted to make sure I was safe!

But I wasn't your patient, Ethan.

He was.

♪

♪ Okay, so, um, if you email me the details, I'll follow up with you in a week and we can take it from there.

Ms. Curry? What are you doing?

She wanted to be discharged.

She's severely anemic.

She could pass out before she gets to the parking lot.

I mean, I scheduled a visit with a nutritionist and I'm gonna monitor her closely.

Ms. Glenn?

You're aware that this worm puts you at risk of pancreatitis, heart disease, arrhythmia...

I know, but it's the only thing that's helped my MS.

Trust me, correlation is not necessarily causation.

What does that mean?

He doesn't think that the absence of MS symptoms is related to the tapeworm.

Not what I said.

Whether it's helping you or not, the side effects are seriously endangering your health.

I don't agree.

I know how I feel, and I'm going home.

Well, then, I'm sorry, you leave me no choice but to put you on a psych hold.

What? You can't make her stay here!

I'm afraid I can.

Right now, your wife is a danger to herself.

My job is to protect her. Earl, back in 4.

No... Dr. Charles, what are you doing?

Come with me, ma'am. Let go of me!

Hey, what are you doing?

You can't keep me here! Dr. Charles!

You can't keep me here! Get off of her!

Oh, hey, uh, my mom, she was feeling some tightness in her chest before, so...

Yeah, of course.

I'll... I'll check on her as soon as I can.

Okay, thank... hey.

What's the matter? Uh, tough case.

We allowed this patient to talk us into removing his cardiac myxoma when we should have done a transplant and now, well, he's probably gonna die.

Why can't you remove it?

Well, it... it's too extensive.

We'd never get it all.

Could you get it all with an autotransplant?

You're talking about completely removing his heart from his body.

I mean, we could get at the whole tumor, but the damage is so extensive the odds of reimplantation are miniscule.

That might not be true.

The chief of CT back at my hospital?

He did a 12-patient trial on reimplantation after ice bath dissection.

He hasn't published yet but he got good results.

What kind of results? Greater than 50%.

"Greater than 50%"? You're sure?

Yeah, I can get you the details on the procedure.

Do it, fast.

I'm gonna be back in the OR.

Thank you. - Yeah.

Okay.

Mm-hmm.

I gotta go.

♪ Hey.

♪ Four months ago, we were getting married.

Today I gave her her house key back.

I know.

What do I do?

♪ Come on.

Let's get back to work.

♪

♪

Don's still in surgery. It's not going well.

If he dies, I accept full responsibility.

I looked at the notes, spoke with CFD.

Lieutenant Severide said you were faced with some tough decisions, especially regarding April.

You tried to warn me.

Being responsible for people's lives is never easy, Dr. Choi.

Let's all just hope that things work out for the best.

Yes, ma'am.

♪

The antibiotics aren't working, are they?

No, they're not.

Lisa.

I spoke with the transplant coordinator.

No one ahead of you on the list can get here before the donor lungs expire, which means you're up next.

♪ To get a transplant?

Yes.

♪

I can't.

Not if he's going to die.

He's septic.

He has a DNR.

There... there's nothing you can do.

I can be here with him.

I have to be here.

♪ He's amazing.

Never complains.

Most people born with something like this would say, "Why me?"

But Ben, he's always saying, "Why not me?"

He taught me to be grateful for what I have.

And I am.

I understand.

But you need these lungs, too.

♪ I still have time.

Another pair will come up. Lisa... - No.

I'm sorry.

No.

♪

Mind if I come in?

Not at all.

You okay?

What, you mean that whole thing down there?

I mean, I wish it hadn't come to that, but, uh, yeah, I'm fine.

Didn't look that way to me.

Now, we've worked together a long time, Daniel.

You usually empower your patients to make their own choices.

Putting that woman on a psych hold?

Sharon, I made a clinical decision for her own wellbeing.

Don't know what to tell you.

Look, I know watching Cece go through treatment has been very hard on you.

It's making you feel a little helpless.

But... bringing your emotions to work?

♪

♪

♪

I really don't like this.

You have a better idea?

You don't know how you're going to restart his heart.

Robin's on the phone right now.

She'll have answers for us soon.

Robin.

Not a cardiothoracic surgeon, not even an amiable country doctor.

I trust her.

♪

Why isn't Lisa in surgery?

You told her she was next up.

She won't leave Ben.

Not while he's still alive.

Lisa, you and Ben have never been able to be together.

But what if there was a way you could be?

Not through a pane of glass.

We could?

Yes.

It could only be for a minute, though, because you'd have to agree to take the new lungs.

No.

I can't.

Don't you think Ben would want you to have them?

I can't leave him now.

It wouldn't be leaving him.

It'd be giving him what you both have always wanted.

Lisa, this is the memory you'll have for the rest of your life.

The one moment you were truly together.

♪ Okay.

Okay.

♪

♪ Lisa, no.

It's okay.

It's okay. I promise, Ben.

♪

♪

♪

♪ Love you, Ben.

♪ I love you.

♪

It's outrageous, I...

What recourse do we have?

My husband's talking to our lawyer.

We're going to sue you.

That won't be necessary.

I'm releasing the psych hold. You can go home.

What?

I'm discharging you. You're free to go.

Okay.

Well, good luck. Hope you feel better.

Follow up with her neurologist.

Stay on top of those labs, and, um... keep me updated as to her progress.

Of course. - Thank you.

You know there's no published data on intracardiac pacemaker use in reimplanted hearts?

I am aware.

So do you have a plan for what to do if it doesn't catch?

No.

Great.

All right, here we go.

♪

♪ Well, will you look at that?

♪ All right, we still have a lot of work to do.

Let's get him off bypass. Yes, Doctor.

♪

♪ V-fib.

♪ He's DNR. Nothing more we can do.

♪ Time of death, 19:42.

♪

♪ They were able to set his pelvis.

They actually think he'll make a full recovery.

Are you all right?

I was worried about you today.

Did it clould my judgment?

Maybe.

But either way, there's no place for that here.

Thank you.

For caring.

♪ Lisa, I'm so sorry.

Ben has passed.

♪

♪

♪

Natalie! - Yeah?

♪ You and I... we have some good memories.

Don't we?

♪ Yes, we do.

♪

♪