07x06 - When You're a Hammer Everything's a Nail

[bunniefuu]

- She's out.
- I'll take it from here.

Dr. Blake. You're a transplant surgeon.

- I got this.
- She tried to scrub in.

- How'd you guess?
- I know my mom.

You need a roof over your head, heat,

- running water.
- You just wanna call the sh*ts.

- You owe me $ , .
- Do what you want with it, Mom.

I screwed up everything today.

I know how tough internship can be.

Boards aren't gonna
study for themselves.

You pulled my patient's Vas-COM?

I just think we should err
on the side of safety.

It did seem medically warranted
to get her on better monitoring.

So I just put in another Vas-COM.

Is something going on?

Dr. Halstead tells me
you're progressing well.

I have excellent doctors
to thank for that.

And we're very impressed
with your staff.

Well, Dr. Halstead is one of our finest.

Don't forget Dr. Cooper.

Hey, there, what'd I miss?

We were just discussing
Eleanor's marked improvement.

How she looks much less edematous.

Yeah, right, it's terrific.

I've been able to strategically
manage her fluids

using the Vas-COM.

Sorry, I didn't mean to interrupt.

I just came in to take a quick
peak at her cardiac output.

It's all right. I have to go anyway.

- I have a meeting.
- I'll walk you out, Miss Goodwin.

You two take care.

Still can't believe Cooper
put in another Vas-COM.

I thought it was confirmed that Vas-COM

didn't contribute to her embolic events.

It didn't, but with Eleanor's
clotting issues, it's risky.

[APPREHENSIVE MUSIC]

♪

I heard you were here late last night.

I had a difficult septic patient.

I didn't wanna just leave
him for the night shift.

They can handle a septic patient.

I wanted to see it through.

Did you get any sleep?

Didn't we just have this
conversation a week ago?

And I'm allowed to ask you if
you're taking care of yourself.

Mom, you know you're
parked in a red zone.

Oh, no one cares.

You wanna see what I've done?

- Sure.
- Uh...

I found those pillows off a couch
someone left on the sidewalk.

And look what I pulled out of a dumpster

behind Merchandise Mart.

It's silk. Feel it.

Wow.

And back... back there,
I... I hung up a prism.

Remember that one when you were little?

- All the Rainbows?
- Yeah, I remember.

And I see you have a cooler.

I brought some groceries with me,

some fresh fruits and vegetables.

What's with your arm?

Oh... oh, no, it's not...
it's not a big deal.

Mom, let me see.

Oh, what did you do?

I was working on the van
and I... I knocked aside

that stick thingy that
holds the hood up.

It got me pretty good.

Oh, you're burning up.

I'm wearing layers.

Oh, Mom. Oh, man. This is infected.

- No, I washed... I washed it.
- Yeah.

No, we gotta get you to the hospital.

- No, no, no, no, it's fine.
- Mom.

- I can take care of myself.
- Mom...

Mom? Mom, Mom. No,
I'm calling an ambulance.

Mom?

[TENSE MUSIC]

I don't care if it's your hospital.

- I don't wanna be here.
- I can hear you fine, Mom.

But you won't listen to me.

Hey, Maggie, can we get a room,

and is Vanessa available?

Sure, Vanessa, you're
going to treatment .

♪

Hey, this is my mom, Terri.
She cut her arm pretty badly.

Hi, Terri, I'm Dr. Taylor.

- Good for you.
- Mom, please.

I don't like hospitals.

What?

All right, on three.

♪

The IV's for fluids.
You're dehydrated, Mom.

So get me a glass of water.

You happen to catch them
when they came in?

I did, yeah.

Not at all what I imagined.

In med school, Stevie was the
one who had it all together.

Head of the class, full scholarship.

I just figured she was raised
by some genius scientists

- who made her in a lab.
- Huh.

I thought scholarships
are usually for students

in need of financial aid.

Your bilirubin levels are high,

but they seem to have
plateaued at the moment.

How are you feeling, Sheldon?

Like every second could be my last.

A real thrill.

I know how difficult this has been.

I want you to meet Dr. Marcel.

He's taken an interest
in transplant surgery,

- and he's been shadowing me.
- Hey, Sheldon.

Dr. Marcel, are you
going to get me a liver?

Oh, well, uh, we're working on it.

You're at the top of
the transplant list.

So there's a good chance that
the next one that matches

- has your name on it.
- Okay,

I'll try not to die in the meantime.

You do that.

Bye.

[PENSIVE MUSIC]

He got his humor. That's a good sign.

I'm not sure if it's really humor

or his hepatic encephalopathy.

How long has he been waiting?

Eight months.

Wow.

Kinda makes you feel helpless.

It's definitely not the ED.

Someone lands here, and you
can't just get right to work

resetting a bone.

In transplant surgery, unfortunately,

it's all about waiting.

Dr. Scott, you're up.

You're going to treatment .

And by the way, we're
short-staffed today,

so I'm gonna be assisting you.

Oh, let's do it.

Who's the patient?

-year-old Siobhan Murphy.

She fell down a flight of stairs.

Those her parents?

- Yeah, Kate and Brandon.
- Ah. That guy looks familiar.

Mr. and Mrs. Murphy. I'm Dr. Scott.

This is our charge nurse, Maggie,

and you must be Siobhan.

Uh-oh, I know that look.

We're pretty sure Siobhan broke her arm.

She fell down the stairs
of our apartment complex.

Oh.

Do I know you?

Oh, I don't think so.

All right, Siobhan, what happened?

I guess I tripped.

She's never been the world's
most coordinated person.

So just a normal run-of-the-mill trip?

Nothing in front of you,
but your own two feet?

I don't really remember much.
When I fell, I hit my head.

Since then,

- it's all been a little foggy.
- Oh.

So we need to get a head CT to
check on that brain fog, yeah?

- Okay.
- May I look at your arm?

Let me see.

Ow.

Okay. Get an X-ray on the arm.

Uh-huh.

Okay, Siobhan, so we are gonna
take a few pictures of your arm

and the inside of your head.

Sound like a plan?

Okay.

I will be right back with
an X-ray technician.

[APPREHENSIVE MUSIC]

Hey, what was that
between you and the dad?

I realized how I know him.

I arrested him for as*ault
and battery years ago.

Really? Hey, is that gonna be an issue?

Are you sure you should be on this case?

I can call peds and get somebody else.

Oh, no, no, no. It's fine. I'm good.

♪

I'm sorry, you're missing
a whole column over here.

You need to re-do this. Okay, I'm sorry.

- Dr. Marcel, you made it.
- Hey, sorry I'm late.

I got caught up with
a patient in the ICU.

Remember, there's a
reason why it's called

- the Emergency Department, yeah?
- Dr. Archer, Dr. Marcel,

we have trauma incoming.

Nancy, you're good? Lacey, talk to me.

John Doe, age unknown,

most likely a long-distance swimmer.

Crew team found him floating in
Lake Michigan, fished him out

- and performed CPR.
- CFD defibrillated him once,

got a rhythm, and
intubated in the field.

Why are you still doing compressing him?

I lost pulse about secs ago.
Gave him a milligram of epi.

Okay, here we go. Nice and easy, okay?

All right, we're gonna
transfer on my count.

One, two, three.

Continuing compressions.

[TENSE MUSIC]

Pulse?

- No pulse.
- Continue CPR.

[SUSTAINED HIGH-PITCHED TONE]

He's in V-fib.

Give me the paddles, charge to .

Charging.

Okay, clear.

[MACHINERY BEEPING]

We got a pulse.

- Sinus rhythm.
- All right, he's hypothermic.

Can we get some warm blankets, please?

♪

All right, pupils are fixed and dilated.

That brain's been without
oxygen for a while.

Nancy, CT for a panscan, please.

And also, let's call CPD up in here.

They can run his prints.
Maybe they can identify him.

Hey.

I just wanted to say I'm
sorry about your mom.

- You're surprised.
- Surprised?

She looks like a street person, right?

You weren't expecting that.

If you need any help...

Thank you. It's nice of you,

but I've been dealing
with this a long time.

Just forwarded your mom's labs.

Yeah, it's about what I expected.

Are you sure you don't want
an attending instead of me?

This way I can stay on top of her case.

Okay, well, how do
you wanna handle this?

You take the lead.

She's more likely to
listen to you anyway.

Terri, you definitely have
an infection in your arm

that has spread to your bloodstream.

We have to treat it like MRSA
until your cultures come back.

We already knew it was infected.

Yes, Mom, but this
particular type of infection

is resistant to most
forms of antibiotics.

I thought she was my doctor.

We can still treat it, Terri.

We'd like to put in a PICC line.

It's a catheter we'll leave in your arm.

Because if you do have MRSA...

It's a minimum of six weeks
of intravenous antibiotics.

- Out of the question.
- It's not really optional.

You can't force me to take
some medicine I don't want.

We have no intention
of forcing anything.

But if the infection goes untreated,

then it could spread
to your heart valves

and turn into endocarditis.

Which could k*ll you.

Six weeks I have to keep coming
back to the hospital? No.

We could also make arrangements
for a home health nurse

- to come to your house.
- Or wherever you're staying.

She's ashamed of me
because I live in a van.

Once the infection is
cleared, then we can...

No, no, I'm not letting you
put some thing in my arm

so you can reel me back like
a fish whenever you want.

How long has this been going on, Gordon?

- Just a few days...
- A week.

Marielle's been nagging
me to get this looked at,

but sure it's just a cold.

What kind of cold makes
it hard to breathe?

It's called a chest cold, hon.

COVID PCR test came back negative.

Let's get a CBC, BMP, ABG,
blood and sputum cultures

- and chest X-ray.
- You got it.

We're gonna get to the
bottom of this, Gordon.

You sit tight.

Don't worry. I won't
let him go anywhere.

She's a tyrant, Doc.

Wouldn't even let me get a motorcycle.

years, he still talks about that.

Just my two cents.

But you should keep listening to her.

- [CHUCKLES]
- Thank you.

And here is your large green tea

with extra honey, Dr. Charles.

Thank you, Olivia.

Dr. Charles, do you have a minute?

Yeah, of course.

What's going on?

Uh, my, uh, my mom came in earlier.

- I think you saw.
- Yeah, I did.

Yeah, I was hoping that
you might talk to her.

She has a MRSA infection,

but she won't get treatment for it.

Oh, boy.

Yeah, she's always been this way.

I can't even get her to commit

to taking her blood pressure medication,

much less intravenous antibiotics.

Frustrating, right?

Yeah.

She and I kinda speak
a different language.

It's kinda why I was hoping
that you might have

a better chance of changing her mind.

Happy to give it a sh*t. Um...

Anything else you think
that I should know?

You'll see pretty quickly
what you're up against.

Okay, it's just, you know,

don't wanna be flying blind, that's all.

It's complicated, my mom and I.

My dad left before I
could even remember.

We spent my childhood bouncing
from apartment to apartment.

Sometimes leaving in
the middle of the night

to avoid paying the last month's rent.

Pretty chaotic.

Yeah, at the time I
thought it was normal.

It was all I knew.

And she wanted to make a home for us.

She really tried.

She just couldn't get
out of her own way.

How... how do you mean?

She couldn't hold down a job.

She'd mouth off to a boss, get fired.

- Right.
- She started drinking.

Started using.

We wound up on the street.

Oh, man.

I'm pretty sure she has some
undiagnosed mental illness.

- Right.
- Yeah, you'll see.

I thoroughly appreciate
how absolutely brutal

this must be for you.

And I also get how it might
really simplify your ability

to treat your mom

if I were to declare her incompetent.

If that's what it takes.

But you also know that in
order for me to take away

a patient's decisional
capabilities, it's...

they just have to meet a very
specific set of criteria.

I just... I just don't want you
to get your hopes up, okay?

But I'm only too happy
to speak to your mom,

and I... I really appreciate all
the detail you give me, okay?

- Thank you.
- You bet.

[PENSIVE MUSIC]

♪

It's an isolated fracture of the ulna,

but it should heal up just fine

after about a month
and a half in a cast.

The good news is, Siobhan,
you get to pick the color.

- What's your favorite color?
- Purple.

You know, I always forget
what two colors make purple.

I know it's blue and...

Red.

Ah, okay. We got a purple expert, y'all.

[CHUCKLES] It seems like
the brain fog has lifted.

- So there's no problem there.
- Thank God.

I did wanna ask about Siobhan's history.

I saw in the electronic medical records

that she landed at East
Mercy's emergency room

- about a year ago.
- Yeah.

That was another terrible accident.

Siobhan just doesn't pay
attention sometimes.

- Her head's in the clouds.
- We'd come inside from the grocery store.

It had been raining, and I
was unloading the groceries,

and I... I left my umbrella
on the kitchen tile.

And when I finally went
to pick it back up again,

there was this puddle of
water underneath and...

That's all we can think of.

I... I thought that I cleaned it up,

but I guess I must have
missed some and...

Yeah, she had a head CT then too.

Yeah, she... she fell and hit...
hit the back of her head

on the kitchen counter.

It took four staples to...

But like we said, Siobhan's
always been kind of clumsy.

[APPREHENSIVE MUSIC]

And what do you think, Siobhan?

Are you clumsy?

I guess I do fall down a lot.

We'll have an orthopedic
resident coming soon

and cast Siobhan's arm.

And, uh, we'll go make sure he
brings his purple casting tape.

All right.

Call DCFS.

Wait, what are you talking about?

There's a pattern of
suspicious injuries.

Yes, but they explained what happened

- and... and Siobhan confirmed it.
- Yeah.

What do you think she's gonna say, huh?

If there's one thing I learned
from my days at CPD,

is that the more convoluted
the story sounds,

the more likely it is not true.

Yes, but to call DCFS on
that with what little we saw?

Do you know what it could
do to those parents?

- Hey, if you won't call them, I will.
- No, I...

[SIGHS]

So your mom is... she's depressed.

She... she's definitely anxious.

I wouldn't be surprised if
a proper clinical evaluation

would yield a bipolar diagnosis.

But right now she has capacity.

Even if she refuses to
take care of herself?

It doesn't disqualify her from
making her own medical decisions.

What if it kills her this time?

She seems to be aware of the risk.

I didn't wanna suggest this
before running it by you first,

but there is a pill form of antibiotics

that's had some success with MRSA.

Linezolid, I know, but she'll
never stick to the regimen.

You know, could be different this time.

- Why?
- Well, for instance,

with her blood pressure medication,
right, that she won't take,

we don't experience high
blood pressure physically.

But your mom, she has a high fever.

Her arm is swollen.
She's in a lot of pain.

It's possible that her physical symptoms

could compel her to act.

And if they don't?

Unfortunately, it's
her decision to make.

I'll talk to her.
I'll see what I can do.

- Thank you.
- Of course.

♪

So how's our John Doe?

Well, head CT is really tight,

brain is very swollen,
bad anoxic injury.

I mean, the prognosis is not good.

Any word from CPD?

Only that his prints didn't
turn up any records.

Oh.

So what now?

There's gotta be somebody out
there looking for this poor man.

Let's give 'em a chance to
come out of the woodwork.

Right.

- Just the man we're looking for.
- Oh, there she is.

Heard you're being discharged today.

How you feeling?

I'd feel better if I were walking
out of here on my own two feet.

But my mother is taking me home
and insisting on the wheelchair.

- Ah.
- A little overly concerned about adhering

to hospital policy, if you ask me.

I am afraid you'd sue the
hospital if given the chance.

Uh-oh.

I wanted to thank you again, Dr. Marcel.

Yeah, it was my pleasure.
Just happy it all worked out.

Is that the John Doe that I heard about?

- Yeah.
- How's he doing?

Not good.

He suffered major oxygen deprivation
for an extended period of time.

So likely looking at irreversible
brain damage at this point.

Avery, I'm gonna call you an Uber.

A minute ago you're insisting
I stay in the wheelchair.

I'm sorry, sweetie. I just remembered
I have some charting to do.

I'm gonna circle back.

I'm interested in seeing what
happens with this patient.

♪

What's going on, Mags?

DCFS. Suspicion of child abuse.

Yeah, that is always hard.

I just hate seeing
families go through this.

- [ALARM BLARING]
- Somebody help!

- Something's wrong.
- Give us some space.

Sats down to , not responsive.

Start bagging. We have to intubate.

What's happening to him?

He's not protecting his airway.

- He can't breathe.
- Why... why?

I don't know yet. of
etomidate, of sux.

Oh, God. You've got to save him.

Hey, I promise.

- I'll do everything I can.
- Gordon is all I have, please.

[MACHINES BEEPING]

Vanessa, come here.

You remember how I said my
mom won't take her pills?

- Mm-hmm.
- Check this out.

What am I looking at?

New technology called a nanodrug.

It's a smart drug that works
with the digital feedback system.

I don't understand.

It's for patients that forget
to take their medicine.

Their caregivers can track
the exact date and time

that a patient ingest their
pills on a phone app.

- How?
- Watch.

Each pill is embedded with
a microscopic nanosensor.

When it dissolves in the stomach acid,

the sensor then sends a signal

to a patch on the patient's body.

- And that patch tells the phone app.
- _

I could track whether my
mom's taking them or not.

But her antibiotics
don't have nanosensors.

Well, researchers at Med are
working on their version of this.

They said they can add
nanosensors to any pills.

So when my mom's are ready at
the pharmacy, let me know, okay?

It's... it's cool, I admit it.

But how are you gonna get
her to sign off on this?

I mean, does she have to know?

[APPREHENSIVE MUSIC]

What is it? What's wrong?

I'm having trouble oxygenating him.

Hi, there. I'm Dr. Cooper.

Matt, there must've been a mistake.

I asked for the pulmonologist on call.

Your request came to my unit,

and as the critical care
doctor on call, you got me.

Excuse me. Are you the patient's wife?

Marielle.

Marielle, this is what I do. Okay.

I'm... I'm confident I can address
your husband's issues.

All right.

Yeah. Gordon came in with
a bad case of pneumonia.

I had to intubate him.

But I'm having difficulty achieving
adequate gas exchange.

I thought he was
fighting the ventilator,

so I sedated him with propofol,

but his airway pressures are still up.

Not... not exactly sure
what the problem is.

I think an early ARDS.

Already started him on
the ARDS net protocol.

ARDS?

Acute Respiratory Distress Syndrome.

There are tiny elastic sacs
at the base of the lungs.

It seems Gordon's are not
properly exchanging oxygen.

So to improve his gas exchange,
we need to sedate him more deeply

and then paralyze him.

- Paralyze him?
- Yeah, I know that sounds extreme.

In this case, it's necessary

to reduce the pressures
inside his chest.

And to do that, you
need to paralyze him?

Hey, can I talk to you
outside for a second?

Sure, yeah.

Marielle, we'll... we'll be right back.

Paralyzing people in this context

often leads to increased
morbidity and mortality.

I mean, there must be
something else we can do.

Believe me, Will, I wish
there were another way.

But unless we paralyze him and
get him oxygenated, he'll die.

Put him on an atracurium drip.

Use dexmedetomidine instead of propofol

and, uh, I'll be back
in a little bit, okay?

♪

[ALARM BLARING]

- What do we got?
- Heart rate's . Dropping.

Milligram of Atropine. Let's go.

I don't feel a pulse.

Are you in?

- Atropine's in.
- Okay.

- Okay, we got a pulse.
- Heart rate's .

.

- Holding at .
- Good, good.

Nice work.

You know, I can see from his labs

that his bilirubin levels are good.

That's good news for his liver.

You should check his blood type.

- Nancy.
- Yeah.

Look, I'm not so sure about that.

Crockett, we gotta think about Sheldon.

Dr. Blake, you know, unless this patient

has a relatively legal representative

to speak on his behalf,
his organs are off-limits.

Which is why we got to
track down a relative

or a legal representative.

Pamela, I don't believe
this is your patient.

He isn't, Dean. I'm just passing by.

Oh, in that case, I'd
prefer you keep passing

as Dr. Marcel is very busy
keeping this man alive.

I'll be in touch, Crockett.

Boy, I had no idea you and
the renowned Dr. Blake

were so chummy.

I've been assisting her on some cases.

Oh, right. Is that why you
were late this morning?

I'm considering applying for a
fellowship in transplant surgery.

That's good for you.

But when you're down here,
you represent the ED,

and these patients deserve
just as much care

and concern as any patient upstairs.

[TENSE MUSIC]

♪

Kate, Ms. Gastern's ready for you.

Brandon would do anything for Siobhan.

He's a great dad.

Oh, it's not for me to decide.

It was one bar fight.

It was the wrong place
at the wrong time.

He hasn't even had a drink
since Siobhan was born.

So Brandon recognized
Dr. Scott this morning?

It was the only crime that
Brandon ever committed.

Of course he would recognize
the officer who arrested him.

And... and that's why
we were on eggshells

when Dr. Scott was asking
us all those questions.

- I understand.
- If we lose our little girl,

I don't know what we'll do.

I've known Madeline
Gastern for a long time.

She'll give you a fair shake.

Okay.

Dylan, I have to ask you.

Is your relationship with Brandon Murphy

affecting your perception of this case?

Listen, all the evidence we found
today points to child abuse.

It's all right here in
Siobhan's medical files.

Dylan, all I'm asking
is that you take a look

at everything that's gone down today.

Are you absolutely sure
there's no other explanation?

♪

How can you stand it here?

The smell, and... and it's freezing.

Will you please just let me go?

We were waiting on your
prescription to be filled,

but good news, it's ready.

Your antibiotics. Twice a day with food.

This is a day supply,

and you need to refill
your prescription twice.

- I'll take care of the refills, Mom.
- I can do it.

If you could just lift your gown
a couple of inches for me, Terri,

I'm gonna place this patch.

What... what do I need a patch for?

- It helps track your meds.
- Tracking?

What are you talking about?
Who's tracking them?

You?

Get that away from me and these too.

Stop telling me what to do.

- I'm just trying to help you!
- I'm not taking your pills,

and I'm not staying in your hospital.

Get me out of here now.

♪

Yeah, paralyzed him as you suggested,

but I'm not seeing any improvement.

Oxygenation is still extremely poor.

Okay, let's try some vent changes.

I'll do a recruitment maneuver.

What's that?

So I'm going to expand Gordon's lungs

to allow for a better exchange
of oxygen for CO .

I'm... I'm sorry.

If you think of Gordon's
lungs like two balloons,

I'm going to blow them up so
they can take in more oxygen.

Is that safe?

You know, it's not a procedure
I've done before.

Look, Dr. Halstead is
an excellent doctor,

but he's not a lung specialist.

He doesn't have experience using
the ventilator in this manner.

We're all going to do this together.

All of us, okay?

Time me, Dr. Halstead. seconds.

[APPREHENSIVE MUSIC]

♪

[KNOCK AT DOOR]

You saw that, right?

I did.

I don't know what to do anymore.

Say you... you've essentially
been parenting your mother

for most of your life, right?

I never thought of it
like that, but yes.

- It's hard work.
- Yeah.

And for what?

So stupid to think that I could
ever get her to change.

Obviously, that's not gonna happen.

Okay, now that you're not
asking me for my advice...

No, I am.

Okay, well then maybe it's
time for a different approach.

Something perhaps less parental?

Like what?

Let her just do whatever she wants?

Just walk away?

Well, you see the thing about
taking a step back, though,

is that it might benefit
the both of you.

Well, it seems pretty optimistic.

I don't know, I mean, at the very least,

you would be getting a
very much-deserved break.

And I think that might
be a really good thing.

In three, two, one.

[MACHINE BEEPS]

No change. Set the timer again.

Wait, sats are climbing.

, .

.

and holding.

- That's good, right?
- Yes.

[HEARTWARMING MUSIC]

- Yeah.
- You did it.

So is he okay?

He's much better than he was.
I'm hopeful that he will be.

Thank you so much, Dr. Cooper.

Yeah, I'm happy I could help.

All right.

♪

Here we are, Mr. Sussman.

Uh, what's all this?

Dr. Archer, this is Marc Sussman.

- And he's here because...
- That's him.

That's my cousin, Ricky.

Oh, man.

We'll give you guys some space.

How?

Did you see the scar along
Ricky Sussman's hip?

Yeah, I thought it might've
been from a hip replacement.

Yeah, it was.

When I looked back at the CT,

I saw his prosthesis had
an identification chip.

So I had it scanned,

called around several
device manufacturers

until one claimed the
chip's serial number.

That got you to his name.

From there, tracking down
his cousin was pretty easy.

I suppose if his cousin decides

to withdraw life support
and donate his organs,

then you and Dr. Blake might just
get what you've been hoping for.

[TENSE MUSIC]

Now, hold on.

We had a moral obligation
for Ricky's sake

to find his next of kin.

You tell yourself that.

♪

Hey, Maggie, can you get Brandon Murphy

and bring him into
the consultation room?

I think I might've figured out
what's been happening here,

and it's not child abuse.

Uh, should I step out?

Actually, if you don't mind,

I'd like Ms. Gastern to hear this,

as I believe Siobhan's medical
status might clear things up.

I went back and took
a look at her scans.

This is Siobhan's head CT
from East Mercy last year.

And this is the one
we took this morning.

They look exactly the same to me.

That's what I initially thought too.

But then I noticed this.

Siobhan's cerebellum has
shown some signs of atrophy

in this last year.

Atrophy?

Yeah. Meaning there's been
a loss of brain cells.

It's subtle, but if you
look really close,

you can see that this part of the brain

is somewhat smaller in appearance.

Might explain why she's
always been a little clumsy.

Has that gotten worse this year?

I... I suppose so. Yeah.

I believe that that is a result

of these changes in her cerebellum,

which is the part of the brain
that controls coordination.

Are you saying Siobhan
has a brain disorder?

Not exactly.

I believe she has an illness

which causes her to not
produce an important enzyme

called HEXA.

The name of the disease is Tay-Sachs.

Tay... Tay-Sachs?
I think I've heard of that.

With your permission,
I would like to test Siobhan

to see if she has it.

Yes.

Of course.

Anything to figure out
what's causing this.

I'm gonna help you figure this out.

[PENSIVE MUSIC]

♪

I hated having to put
my faith in Cooper,

but he did everything right.

And without him, I would
have lost my patient.

What if he's not the guy we think he is?

What if all our suspicions
around dubious consulting fees,

kickbacks, malpractice,
what if it's just projection?

Well, that's why we have
to be absolutely positive

before we make any public accusations.

I just hope we're doing
the right thing, that's all.

I hear the relative met with
Organ Donors of America.

Since the patient suffered
an irreversible brain injury,

cousin wants us to withdraw support

and pursue DCD organ donation.

All fingers crossed his liver
is a match for Sheldon's.

Mm-mm.

- It's not?
- Nope,

Organ Donors of America
will be transporting

the patient's liver to a
recipient in Milwaukee.

Well, I guess we'll just
have to keep on waiting.

You know, I have to say,

I'm not exactly comfortable
with what I did today.

[TENSE MUSIC]

Your patient had no chance of recovery.

And now thanks to his cousin,
both you and the hospital

are relieved of any ethical concerns

regarding his end-of-life
decision-making.

More importantly,

someone in Milwaukee gets a
chance to extend their life.

What's the problem?

Just not sure whose interests
I had at heart today.

Crockett, it's a sad fact,
but in this business,

only % of transplants
come from living donors.

For someone to live,
someone else has to die.

If you can't handle that, then
maybe you weren't cut out

for transplant surgery after all.

♪

Finishing up the discharge
paperwork for Siobhan.

Finally get them home.

How are they doing?

They're coping. But it's tough.

There is no cure for Tay-Sachs.

But the fact that it's
late-onset is a good thing.

The decline is much more gradual,

and Siobhan's symptoms
aren't really that severe.

You did good today, Dylan.

It was a nice catch.

Yeah, wouldn't have happened
if it wasn't for you.

Sometimes you gotta check yourself.

Thanks for reminding me.

I have officially filed your paperwork,

and you're free to leave.

Here are your clothes.

When you see Stevie, tell her I...

Actually, don't tell her anything.

Hey, listen, I might've been
a little abrupt this morning.

You? No.

You were in the right. I was being nosy.

No. It's... it's no big deal.

No, I was mothering you,
and I... I shouldn't.

I won't do it again.

I don't know.

Maybe you looking out for
me isn't such a bad thing.

[PENSIVE MUSIC]

In that case, get some sleep.

Okay.

♪

Dylan, I wonder if you can help me out.

- Yeah, what's up, Stevie?
- Do you know anyone I can call

to get an illegally parked van towed?

I'm not getting anywhere with the city.

Yeah, I know a dude

over at Department of
Streets and Sanitation

that could probably have it towed.

Texting you his number right now.

Great, thank you. I appreciate it.

♪

Hey, Stevie, how's your mom doing?

She's gonna be okay. Thank you.

- Good.
- You know what, I gotta run.

Yeah.

[PHONE DINGS]

- Time of death, : .
- No!

- I'm so sorry.
- No, no, Ellie!

Ellie, no, no.

[SOMBER MUSIC]

♪

Is there any chance the
Vas-COM caused this?

Eleanora was hypercoagulable.

If she had another embolic event,

it's certainly possible.

Then Dr. Cooper may have k*lled her.

♪

What are you doing here?

Waiting, like you.

I think I wanna do this.

Help people like him.

[APPREHENSIVE MUSIC]

♪

No, no, no!

- Mom?
- It's gone! They towed it!

What?

They said a tow truck came and took it!

Hey, it's okay.

Hey.

- So what are you gonna do?
- All my stuff was in there.

My tent, my blankets, everything.

Hey, hey, Mom, stay with
me tonight, okay? Please.

No, it's cold out here.
You can't stay out here.

Please, come on. Let's go.

[SOBBING]

Mom, please.

♪

Hey, I know how upsetting this is, okay?

But we'll figure it out, okay?

Just go.

And I'm... I'm sorry about before.

I never should have tried to trick you.

And I was coming here
to try to persuade you

one last time to take your antibiotics.

But here.

Mom, whatever you
decide, it's up to you.

♪

[DRAMATIC MUSIC]

♪

[WOLF HOWLS]