02x23 - Love Hurts

[bunniefuu]

Get them off!

Get them off of me, please!

Get them off of me!

They're on me!

Get them off of me!

Get them off of me!

Robin Charles, early 30s.

Delusional and combative.

Lacerations on the soles of her feet.

- Treatment 6.

- She's on 4 milligrams of risperidone...

Nothing given in the field.

- Vitals?

- No.

Too agitated.

Couldn't get her hooked up.

Get them off of me!

Are we set?

On my count.

One, two, three.

Gentle.

Robin, do you know where you are?

Do you know who I am?

- Help me!

Help me, please!

- We need to sedate her.

5 of olanzapine, 50 of Benadryl.

Shh.

2 of Ativan.

2 of Ativan!

No!

No!

Dr.

Rhodes?

So, you, um...

You starting to figure out why I didn't want her leaving the hospital?

She was rational.

She was lucid.

- I warned you.

- Robin was fine, okay?

Suddenly she just...

Suddenly, look at her now!

This is on you.

You did this.

I gave her 5 milligrams of olanzapine, and she responded well, so we're gonna titrate up to 10 a day.

Past that, Med isn't the place for her.

Robin belongs in a long-term locked facility.

Dr.

Latham.

Go, Dr.

Rhodes.

We'll text you if there's any change.

Go.

Okay.

Thank you.

Daniel...

You should go home and get some rest.

You have to take care of yourself.

Are you taking your meds?

Well, at least go up to your office and lie down.

You see this?

Mandatory penis examinations.

Under Illinois state law, all male emergency department workers are required to have a yearly penis exam, to be administered by Dr.

Stohl.

Please contact him directly.

Want me to prep you a treatment room?

Graduation week.

Childish pranks, not to mention the binge drinking and the stunts!

Every year, we have an ED full of morons.

Youth, Dr.

Stohl.

Yeah.

No.

No, there are no exams.

It's a practical joke!

Dr.

Shore, Dr.

Halstead, don't forget...

Keoni's Luau tonight, my grad party.

- We'll be there.

- Absolutely.

Great.

Mai Tais and poke.

Piña colada for me.

- See you later.

- Hey.

- You and Nina look happy.

- Yeah.

Hey, you two need to know that...

Robin Charles is in 6.

What happened?

- Psychotic break.

- My God.

You're up.

Incoming.

Poly trauma.

Go, go, go, go, go.

22-year-old male, peds versus auto.

GCS 12, BP 100/70, heart rate 125.

Got a student ID.

Kid's name is Marwan Haddad.

Hit-and-run.

The car dragged him, like, half a block.

- Sexton, fast his belly.

- On it.

Chest and pelvis.

And left lower leg.

Probably a tib-fib fracture.

Let's move him.

One, two, three.

Poor breath sounds on the left side.

- Christina.

- It's okay.

It's okay.

I'm Dr.

Manning.

This is Dr.

Halstead.

We're gonna take really good care of you, okay?

Christina.

Easy.

Easy.

Belly's clear.

He's shocky.

I'm intubating.

Bilateral rib fractures.

Bilateral pulmonary contusions.

And hemothorax on the left.

Sexton, chest tube.

Doris, hang two units of O-neg on the level one.

- Got it.

- We got a medical history?

No.

I spoke to his roommate.

Marwan's a Syrian refugee.

He's here to go to school.

That's about all the guy knows.

His parents are on a plane.

They're flying in from Germany - to go to his graduation.

- Poor guy.

- Chest tube's in.

- Good work.

Can you imagine?

The kid survives cluster bombs in Aleppo just to come to Chicago and get hit by a car.

Let me know when he wakes up, all right?

I want to get a statement, figure out who did this.

- Absolutely.

- Thanks, Jay.

Dr.

Rhodes, I have news for you.

I should say "good morning." - Good morning, Dr.

Latham.

- If I'm not mistaken, you don't seem to be your usual self.

- Tired?

- No.

I'm all right.

Thanks.

- Okay.

Good.

- Did you page me?

Yes.

You remember when I told you that you weren't my first choice for this fellowship?

- Yeah.

- It was a South African woman from Groote Schuur.

Well, the hospital has allowed for another second-year CT fellow, so she's here, joining our team.

Dr.

Rhodes, meet Dr.

Bekker.

- Ava.

- Connor.

I'm sure you two will enjoy working together.

I'll leave you two to get acquainted.

He's very odd.

Asperger's?

Dr.

Latham is a great surgeon, teacher, and friend.

Loyal.

That's sweet.

You know what, Dr.

Bekker?

I'm not sure we will enjoy working together.

Leah?

Okay.

Mr.

Kellogg, I'm the charge nurse.

Is Dr.

Charles ready to see me?

I texted him I was coming.

He may not be checking his messages.

He had a family emergency.

He told me that I could see him any time.

He promised.

I'm sorry.

But I can have one of his residents see you.

I'm not talking to some underling.

Is Dr.

Charles here?

Yes, but I don't think he's going to be available.

You tell him that I'm not gonna be treated this way.

I'm gonna stay right here and wait until he comes out.

Okay.

Hey, get me a cup of coffee.

The vending machine's right there.

April, about last night...

No.

It's just as much my fault.

It never happened.

Dr.

Choi, April, you're up.

Cesar?

Don Crocker, 47-year-old male, shortness of breath, chest pains.

You're going to Treatment 4.

Passed out on the stairs.

Neighbor found him.

Lucky.

Heart rate's at 110.

12 lead in the ambo.

All right, Mr.

Crocker, I'm Dr.

Choi.

We're gonna take good care of you, all right?

Okay.

Let's transfer on my count.

Ready?

One, two, three.

12 lead shows a stemi.

Activate the team.

Mr.

Crocker, you're having a heart att*ck.

- Aspirin?

- Yeah.

81 milligrams and 4 of morphine.

Mr.

Crocker, is there anyone we should call?

Friends?

Family?

- No.

- Someone at work?

Work from home.

Most days don't even leave the apartment.

- So, no one?

- No.

All right, Mr.

Crocker, you've got fluid backing up into your heart and lungs...

That's why you're having difficulty breathing.

April, let's give him 10 milligrams of Lasix and place a Foley...

We're gonna get the excess water out of your system.

Okay.

- Mr.

Crocker?

- He's lost consciousness.

All right, I've got a pulse.

Take him up to the Cath Lab.

I'll intubate him there.

Page Cardiology.

- Ready?

- Yep.

Why'd she do it?

Cut her hair.

A woman changes her hair like that, it's a big deal, right?

It means something.

Absolutely.

Yeah.

So?

Well, don't ask me.

My God.

What?

Are you coming to my party tonight?

I don't know.

I haven't thought about it.

Okay.

Well, it won't be the same without you.

All right.

Look, I'm busy, okay?

Okay.

But you are...

coming to my party.

Hey.

Glad you took my advice.

She's sleeping.

At least let me buy you some breakfast.

Cup of coffee, maybe.

Dr.

Charles?

I have been reviewing Robin's history just to make sure we haven't missed anything, and, well, some of her symptoms...

They're not consistent with a psychiatric disorder.

- Dr.

Reese...

- Let her finish.

Two days ago when Robin came to the hospital, she was running a mild fever, 100.2, and her BP was elevated.

Now, at the time, we didn't think anything of it...

That's 'cause it's a very mild fever.

And of course her BP was elevated.

She was on a forced hold.

She was agitated.

But when Robin was brought in today, it seemed she was experiencing visual hallucinations.

Now, auditory hallucinations indicate a mental disorder, but visual hallucinations should be considered organic until proven otherwise.

I think we all wish that Robin had a treatable physical condition rather than...

I want to check her ceruloplasmin levels and run an FTA-ABS as well as an MRI and EEG to rule out scelerosis and epilepsy.

Of course.

Do it.

What's the matter with you?

She's trying to make me feel better.

And bless her, but she's grasping at straws.

Come on.

Are you so blinded by your fear that Robin inherited her problems from you that you won't even entertain an alternative?

False hope, Sharon.

Come on.

I don't need any.

You don't know that.

Where's the Daniel who leaves no stone unturned when diagnosing a patient?

Where's the Daniel who never gives up?

Don't you think your own daughter deserves that much?

Thanks.

- Hey, what are we looking at?

- He needs a new valve.

Ava Bekker, CT fellow, Ethan Choi, Chief Resident of the ED.

So, we cr*ck his chest, replace the valve.

Well, we don't need to cr*ck his chest.

Mr.

Crocker's been assessed as intermediate risk, and transcatheter aortic valve replacement, TAVR, is now FDA approved for patients at that level.

We get excellent results with open aortic valve replacement.

With TAVR, you're just inviting complications.

I don't agree.

Why put the patient through a long operation and a long pump run?

He can have a functional heart again in under two hours.

- The less invasive, the better.

- Exactly.

Excuse me.

You're an emergency medicine resident.

- Why are you even talking?

- Excuse you?

Because I value Dr.

Choi's opinion.

And I think you'll find that Dr.

Latham will back me on the TAVR.

Fine.

I'm sorry you got brought into this.

I didn't know about Robin.

I'm sure you want to be with her.

Yeah, I'm all right, but thanks.

This won't take long.

I'll let you know how he does.

Thanks, man.

- What level of oxygen is he on?

- 100%.

Left upper lobe is segmentally collapsed.

Probably plugged up from a clot in his airway.

Yeah.

Let's get a bronchoscopy.

Yeah, clear out any obstructions.

Hey, I never asked, why'd you decide to cut your hair?

Time for a change.

I'm looking for Marwan Haddad.

- Are you family?

- We go to school together.

Well, he's being treated right now.

Why don't you wait in the lobby, and I'll tell you when you can see him, okay?

Dr.

Choi, take a look at this girl in 2.

Probable distal radial fracture and concussion.

This young genius tied a rope around a rafter and tried to swing across the school cafeteria.

- What?

- You'll see.

By the way, I'm missing my coffee mug.

Yeah, some cretin obviously thought it would be amusing to steal it.

I'll make sure to look out for it, Dr.

Stohl.

Thank you.

Closed distal radius fracture.

Monkey suit.

Of course.

Swinging from the rafters, - got to have a monkey suit.

- So stupid.

No.

You should've seen people's faces when they saw you.

It was so clutch.

Senior prank.

We're graduating from high school.

We'll need the Ortho resident to see her.

I'm afraid we're gonna have to cut this suit to set your arm.

- No!

It's a rental.

- I'm sorry.

Your friend lost consciousness when she fell?

Yeah.

I was kind of worried.

Concussion is always a concern.

I want to get a CAT scan, head and neck, just to be sure.

Don't worry.

You'll be out of here in no time.

I'll call Ortho.

Dr.

Choi, you're coming to my party tonight, right?

Thanks, but I'm not gonna be able to make it.

Early call tomorrow.

You sure?

One Mai Tai.

Sorry.

Okay.

The valve is in position and open.

- Injecting dye now to check it.

- Fluoro.

Left coronary artery looks good, but I'm not seeing the right.

Could be occluded.

Can you get the wire in?

Let me try and cannulate the right coronary artery.

Can't, the lumen's blocked.

There's no flow on the right side.

Seeing right side ST changes.

Calcium deposit must have broken off from the old valve and occluded the RCA.

His heart is dying.

We've got to open him up now.

What we should have done in the first place.

And we're already making calls to find her another bed.

We'll keep Robin here until we can get her transferred to a long-term facility.

We'll take good care of her.

I've dialed back on her sedation.

Robin?

Honey?

Get away from me.

Get away.

Get away from me.

Get away from me!

Make him go!

Dan, Dan, Dan, we got this.

You were right.

The tests I ran...

There's no indication of any organic medical condition...

I'm sorry.

Robin's showing dyskinesia.

Did you notice that before?

The jerky movements?

Yeah, I assumed it's from the antipsychotics.

Yeah.

It could be.

Did you order a paraneoplastic panel?

For auto-antibodies?

Why?

- Could we just run one?

- Of course.

Graft is in place.

Let's get him off of bypass.

Unclamping the aorta.

Let's get his heart b*ating on its own.

Defibrillate.

Clear.

Sinus rhythm.

Cut to 2 liters.

Hold on.

His right heart is ballooning.

Back on full support.

Marty, what's he on?

Dobutamine at 8, dopamine at 5.

Give him a milrinone loading dose, epinephrine bolus of 50 micrograms, and start inhaled nitric.

That's not gonna cut it.

His heart isn't coming back.

He's not leaving this room without ECMO.

Won't that just set him up for complications later?

Why do all the residents in this hospital think they can offer their opinions?

No ECMO.

His heart is strong enough to come back on its own.

I disagree.

Noted, but this is my case.

All right, cut to 2 liters.

The heart's coming back.

Septum is midline, SVR acceptable.

- Pressure's holding.

- Good call, Dr.

Rhodes.

Yeah.

Let's decannulate.

His sats are down to 80.

There's his latest X-ray.

No improvement.

How much vent support are we giving him?

- Maxed out.

- He's on bronchodilators, and he's still not getting enough oxygen.

75%.

If we don't correct his hypoxia, we're looking at anoxic brain injury.

Let's get him up to the ICU and put him on cardiopulmonary support.

Right.

Your patient has a friend here.

Girlfriend, maybe.

- Good.

I'll go talk to her.

- Okay.

Thanks, Nat.

How long you been waiting?

I don't know...

About an hour.

Typical.

They lie to you here.

Stand up for your rights.

Hi.

Are you Marwan's girlfriend?

Is your name Christina?

Yes.

How do you know my name?

When he first came in, he called out for you.

Do you know anything that may help me treat him?

Any medical history?

Medications?

We haven't known each other that long.

Okay.

We're taking Marwan up to the Intensive Care Unit.

If you want, you can come wait up there.

All right.

I'll have someone come grab you, okay?

Dr.

Stohl, I...

I found your mug.

Where?

Thank you.

I'll, um, call maintenance to get it down.

Hello?

It's a joke.

There are no inspections!

It's a joke!

Get me maintenance.

Here's the paraneoplastic panel.

Wow.

Look at that.

You were right, Dr.

Reese.

It is objective.

It's physical.

Well done.

Where's the tumor?

There.

It's so tiny.

And all that.

Page Dr.

Latham.

Good news.

Your CT was negative.

You're gonna be fine.

See?

I told you!

It isn't that.

She never does anything wrong.

Straight As, all honors.

She got into Harvard.

Well, we'll start the discharge paperwork.

Parents on their way?

Yes.

The school had trouble getting ahold of them, but yeah.

Hey.

So, what's with you and Dr.

Choi?

Nothing.

What are you talking about?

Come on, April.

I'm your brother.

No.

There's nothing with me and Dr.

Choi.

I...

Noah!

I just broke up with Tate.

You think I'm gonna jump into another relationship?

Maybe Dr.

Choi is no All-Pro football player, but he is one hell of a doc...

with decent earning potential...

I'm just saying.

- Maggie, where's Robin?

- Let me call you back.

They took her upstairs.

She's getting a scan.

Doctor...

I saw Robin's scheduled for surgery.

She has anti-NMDA Receptor Encephalitis.

It's very rare.

Dr.

Charles had the idea to test for it.

It's some autoimmune response?

Gone awry.

Robin has a mediastinal teratoma...

A benign one, but her body's attacking the tumor, and it's also attacking the brain.

Yeah, and the resulting inflammation is what's caused her psychiatric symptoms.

So, when the tumor's removed?

Hopefully the psychosis should resolve itself.

Wait.

What's going on?

Come on in.

I'll remove the teratoma via mediastinoscopy, a minimally invasive procedure.

Shouldn't take more than 90 minutes.

You're gonna be okay.

I love you.

Dr.

Latham, I would like to assist.

Absolutely not.

Given your relationship to the patient, it would be inappropriate and ill-advised.

I do not want you in my OR.

It would still be your surgery.

I just want to be there.

Dr.

Rhodes, my understanding of human behavior may be limited, but you are not acting in the professional manner that I am accustomed to.

Like any other friend or family member, you will sit in the waiting room.

Dr.

Bekker will assist.

As soon as your parents get here, you can go.

How can I explain what I did?

I don't even understand it myself.

I do.

You got into Harvard.

Sometimes we work so hard, hold ourselves so tight, when we finally reach our goal, we go a little crazy, swing from the rafters.

I don't know.

Listen to me.

You're gonna go to a fantastic school, get a great job, and ten years from now, you'll just think of this as a happy memory.

Noah says you're not coming to his party?

I'd really like it if you did.

Should be done soon.

I was wrong to take Robin out of the hospital.

I'm sorry.

Well, I have certainly been wrong too.

Seeing the whole thing through the prism of my own fears.

Since I was a kid, I always wondered if there was something I could've done to stop my mom from k*lling herself.

I obviously couldn't save my mom, but I was sure as hell gonna try and save Robin.

You know, at one point I considered bringing that up.

Decided it probably wouldn't have been helpful.

Yeah, probably not.

Well, she's not gonna want to have anything to do with me after this is all over...

That's for sure.

Any word?

No, not yet.

Everything okay?

- Yeah.

- Yeah.

She did well.

The tumor's out.

Now we just have to rid Robin's body of the antibodies with plasmapheresis.

Should take two hours, and hopefully she'll be okay.

Hey, Reese, been looking for you.

I thought you might want this back.

It was a gift.

Why would I want it back?

You know, when people break up, you give stuff back.

It's a Rubik's cube, Joey.

Not a diamond ring.

Keep it.

One more thing.

I'm dating Valerie.

I just thought you should know.

I'm glad you found someone.

Thanks.

Christina?

How are you doing?

We are doing everything we can for Marwan.

I'm pregnant.

We didn't mean it to happen.

We thought we were being careful.

We were going to get married after graduation.

Nobody knows.

You haven't told your families?

We were going to tell his parents tonight.

I am so sorry you both have to suffer like this.

Dr.

Choi?

Mr.

Crocker.

They did have to open your chest, but you came through just fine.

- Thank you.

- Sure.

For...

for caring.

- Hey.

- Hey.

How's Robin?

She's good.

Thanks.

You saw Mr.

Crocker?

Yeah.

Pretty young to have that kind of heart trouble.

Could be genetics, or...

He said he's alone, right?

He's not married.

No friends.

No family.

- No.

- Loneliness puts you at risk for heart disease.

That for real?

Yeah.

I think we all know that love can hurt, right?

But loneliness...

That'll k*ll you.

What is it, Natalie?

Look at his X-rays.

Diffuse airway disease.

Even with CPS, his lungs are getting worse.

Fast.

This poor kid.

What, his parents just flying here to bury him?

Why can we not figure out what's wrong with him?

We've been so focused on his injuries.

Maybe there's an underlying condition not related to the accident that we don't know about.

When Marwan got his bronchoscopy, his tidal volume dipped...

It shouldn't have.

Right.

The paralytics should've relaxed his chest wall, so why are his airways still so constricted?

Why can't he breathe?

What if it's as simple as Marwan's got asthma?

That would make sense.

He needs steroids.

Natalie, if we're wrong, that'll put him at risk for infection and myopathy, and that could wind up k*lling him.

Well, we are out of options.

If we don't do something now, he will die.

Candace, 125 milligrams of Solu-Medrol IV.

Dr.

Halstead, Dr.

Manning?

The patient's parents are here.

They just arrived.

Great.

- Hi.

- Hello.

Thank you for taking care of him.

How is he?

He was seriously injured, and our main focus right now is his lung function.

Is Marwan by any chance asthmatic?

Yes, yes, since he was a child.

It comes and goes.

- His X-ray is ready.

- Please, come with us.

My God.

Bilateral consolidation's markedly improved.

His airway pressures are coming down.

- What does that mean?

- It means we think your son's gonna be all right.

Thank you.

Candace, let's start weaning him off cardiopulmonary support.

You can stay with your son.

Marwan's recovering.

You should go introduce yourself.

I don't know.

They should know who you are.

Are you good?

Yeah.

Some days, I really love my job.

Asthma.

Astute diagnosis, doc.

Hey, don't give me all the credit.

I wouldn't have gotten there if it wasn't for you.

You're the genius.

Marwan's awake.

I got a statement from him.

- Great.

I'll go check on him.

- Thanks, Nat.

So, it's Noah's graduation party tonight.

- Yeah.

Should be fun.

- Yeah.

Natalie asked me to go with her.

You mind?

No.

Of course not.

You sure?

Yeah.

All right, you know, I'll tell her I pass.

You need to get your act together.

- Hey.

- Is it time to go?

Nina?

I haven't been fair to you.

You deserve someone as committed to you as you are to him, and I haven't been that person.

This is about Natalie, isn't it?

You lied to me.

You said there was nothing between you.

I don't know if she has feelings for me, but I have feelings for her, and I can't go on pretending.

All this time?

Pretending?

Nina, I care about you...

Get out of here, Will.

Go!

I'll get my stuff out of your apartment.

Sooner the better.

There are balloons in my office.

Hundreds of them.

I can't get in.

I'll call housekeeping.

Maggie...

Do people hate me?

No, Dr.

Stohl.

It's quite the reverse.

Then why?

You know the saying: "You only hurt the ones you love." A tumor?

Yeah.

Reaction to your antibodies caused your psychiatric symptoms.

So, I was crazy, but I wasn't crazy?

Yeah, something like that.

Okay.

You should know something.

It was your dad that came up with the diagnosis.

Robin, he's hardly left your side.

You should talk to him.

Hi, sweetie.

Honey.

Robin, I...

I...

So, I think we can call today a draw.

Didn't realize we were in a competition.

Come on.

You know, you're quite the gossip magnet.

Your mother committed su1c1de, you drove your girlfriend crazy, and you m*rder*d your attending, Dr.

Downey.

Well, then, you'd better watch yourself, hadn't you?

I like dangerous men.

I want you.

Come on.

April.

Dr.

Choi.

Ethan.

- You're still here?

- Five minutes, and I'm gone.

It's so good to hear about Robin.

Yeah.

Well, we made it through another year, Daniel.

Gonna get a new bunch of residents to drive us crazy.

Le plus ca change, baby.

Le plus ca change.

Good night, Sharon.

Good night.

Dr.

Charles.

Mr.

Kellogg?

I've been waiting here all day.

You haven't answered any of my messages.

I'm very sorry.

I've had a...

An unusual day.

Is there any way we could talk first thing in the morning?

Liar!