- 1 day ago
Chicago Med - Season 11 - Episode 12: Spill Your Guts
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00:05Novak and Violet are ten minutes out.
00:07I can take it.
00:08I wonder why he's so eager.
00:10Could it have something to do with a certain paramedic?
00:12You want to go back to your place?
00:18Sharon, you're overseeing the nursing program?
00:21Yeah, that's right.
00:21My nephew, Colton.
00:24I got in?
00:25You went with another candidate?
00:27Yes, but...
00:28Nope, I understand your support.
00:30You're behind someone who would benefit from the same opportunities you were given.
00:34You know, I'm not gonna dignify that statement with a response.
00:43Good morning.
00:44This is a lot of hoopla just to go kiss the ring of our majority owner.
00:49Well, I'm hearing whispers this meeting isn't just a formality.
00:52Apparently, he's not happy with last year's profits.
00:55Well, if they want to cut costs, they could start by not chartering a jet to Jackson Hole.
00:59Yeah, well, maybe don't lead with that.
01:01I could talk to Miranda, see if we could go in with a unified plan.
01:05I don't have time to explain your mistake to your boss.
01:09I'm already late.
01:12It's like she's in a good mood.
01:17I should probably go to work.
01:23Your feet aren't moving.
01:24That's weird, right?
01:25Oh.
01:27You're probably coming down with something.
01:28You should call off work.
01:29Hmm, yeah, maybe.
01:32Hmm.
01:35Sorry, can I help you?
01:37You look like a doctor.
01:39Thanks.
01:40So do you.
01:41Well, I'm a med student.
01:42I'm looking for Dr. Charles.
01:44I'm supposed to meet him in the ED, but I keep getting turned around.
01:47All right.
01:48Yeah, I'm actually headed in so I could take you to him.
01:53Want to pick this up later?
01:54Yeah, I will text you with takeout options.
01:56Okay.
02:03She seems nice.
02:05She's great.
02:06Man, med students just keep getting younger every year.
02:09They look like they're in high school.
02:11They're first years.
02:13First years?
02:14What are they doing here?
02:16You, uh, you remember my friend Howie?
02:18Of course.
02:19Yeah, I'm sorry about his wife.
02:21I know how close you are.
02:22Yeah, well, thanks.
02:23Um, anyway, Howie is on the faculty of the med school at Porter University, right?
02:28As you might know, there's a shortage of mental health workers in this country.
02:32So Howie identified a few students who were interested in psych, asked me to come talk
02:35to him.
02:36Oh, but that wasn't good enough.
02:37No, it wasn't because I'm a lazy ass, so I made him come to me.
02:40Uh, Dr. Charles, uh, this is Mira.
02:42Mira, she's been looking for you.
02:44Mira, what a pleasure to meet you.
02:45I was just on the way to say hi to your friends.
02:48Oh, they're not my friends.
02:49I don't really have friends at school yet.
02:51Oh, no?
02:52Well, um, who knows?
02:53Maybe by the end of the day, that will have changed.
02:56How are we doing?
02:57Uh, not as good as you, judging by that lipstick on your neck.
03:01That explains why security keeps high-fiving me today.
03:04Okay.
03:05Sorry.
03:09Sorry, it's, uh, spam.
03:11What were you, uh, saying?
03:12Uh, just that it looks like it's getting hot and heavy with you and Nova.
03:16Yeah, it's, uh, definitely hot.
03:18Don't know about heavy.
03:19She's not super into talking about personal stuff.
03:25Thoughts?
03:27What is it with these men wanting emotional intimacy?
03:30Can you not just be happy that you're having sex in a parking lot?
03:33That's, that's oddly specific.
03:35Treatment three.
03:37Um.
03:38If we have specific questions about procedure, is it okay?
03:41Fire away anytime, Sabrina.
03:43Yo, TikTok.
03:44What's up?
03:44Stay with me, Quentin, okay?
03:46100%.
03:46I'm stoked, Voss.
03:48So do you use structure protocols for triage here, or are you more focused on rapid assessment for better crisis
03:53intervention?
03:53That's an excellent question.
03:54Should, should we all be taking notes?
03:56You know what, my only wish is at the end of the day, you guys have a much clearer idea
04:01of what this specialty is about.
04:03Somebody please help us!
04:04Our son was shot, please help him!
04:06Let's give him some room.
04:07Trauma three is open, it's over here.
04:09What happened?
04:10We were just walking to a speech therapy appointment.
04:12One wound under the right collarbone, second wound just below the tip of the scapula, subclavian trajectory.
04:17We're waiting at the light, then these two guys, one put out a gun, and we just heard a loud
04:21pop.
04:22Decreased right radial pulse, let's get blood in the room.
04:24Copy.
04:25Is he gonna be okay?
04:26Billy!
04:27Hey, Dr. Morgan, you guys need to wait outside.
04:29I promise we're gonna take good care of him, okay?
04:31I'll get the cortisone we need to intubate.
04:33Let's call the blood bank and move MTP to the OR.
04:36Copy.
04:36Billy!
04:37I got him, he's gonna be okay.
04:39Two grams of TXA, one gram of ANSEP, and let's get ready to x-ray.
04:41On it.
04:43Excuse me.
04:59Hey, Kiana, I'm Dr. Frost.
05:01I'm seeing here that you fainted today.
05:03Yep.
05:03I ate it walking to school, and I've been all ham-a-jing since I woke up.
05:07I'm sorry, ham-a-ham-a what?
05:09It's Hawaiian Pigeon.
05:10It's like, out of sorts.
05:12I'm Jean, Kiana's mom.
05:13It's nice to meet you both.
05:14All right, you're from Hawaii, huh?
05:16Kauai.
05:16We moved to Chicago this past summer.
05:18Yeah, we came because my mom is marrying Steve the dentist.
05:22Steve the dentist.
05:23Why does that sound familiar?
05:24Dude, his face is on, like, most of the city buses.
05:29Smiles for miles, right?
05:31All right.
05:32Can you look forward for me, Kiana?
05:35We met when he was visiting Lihue for a conference a couple years back.
05:38Did the long-distance thing until he proposed.
05:41Congratulations.
05:42And now we're here, freezing to death.
05:44Can I see your hands for a moment, Kiana?
05:46Are you feeling cold right now?
05:48A little.
05:49I've been achy since yesterday.
05:50I thought it was because my period came on pretty aggro this month.
05:53Kiana!
05:54And then earlier today, I got a little lightheaded and woke up on the ground.
05:58You know, I think I'm just allergic to the Midwest.
06:02I'm going to get some labs done, then loop an OB-GYN, see if it is menstrual-related.
06:06In the meantime, Nancy, can we get a bag of warm saline and a heated blanket?
06:11Yep.
06:14How are you, Miranda?
06:17I'm all right.
06:19What's up?
06:20I heard a rumor about this meeting.
06:22More budget cuts?
06:24I didn't come to argue.
06:27I came because we should talk about it.
06:29Make sure we're protecting what's important.
06:31I appreciate that offer, but why don't we just go in there and see what's what first.
06:36It may be good to highlight moves that cost Gaffney up front, but to protect us in the long term.
06:42Hiring better staff, getting better equipment means better outcomes, less lawsuits.
06:48Dr. Hayes' lawsuits cost us a fortune.
06:51So, I was supposed to sweep that under the rug?
06:55No, but I am getting tired of your sanctimonious attitude, Sharon.
06:58Like, you're somehow unimpeachable.
07:01The moral center of this hospital.
07:03I mean, you get to be that because I make the hard choices.
07:07I'm done with it.
07:11Oh, I see.
07:13I'm the budget cut, aren't I?
07:16You're trying to get rid of me.
07:18Hey, look, as I said, let's just talk at the meeting.
07:30Okay, nothing abnormal.
07:32I think that your period issues might just be regular cramps.
07:37Safe to come in?
07:38You may enter Steve the dentist.
07:40Hey, you.
07:41Hi.
07:43Where are the girls?
07:44I just dropped them off with their mom.
07:46Thought it might be nice to have a little quiet when Kiana comes home.
07:49Oh, that's thoughtful.
07:50It'll also allow me to absolutely own you in Super Smash Brothers.
07:55Oh.
07:56You think I'm going to go easy on you because you fainted?
07:58Yeah, think again.
07:59I pray on the weak.
08:01No.
08:01Hey, can I borrow you for a second?
08:03Yeah.
08:03Okay, we'll be back.
08:07So, the exam didn't suggest any gynecological causes for Kiana's symptoms.
08:11Well, we got our labs back.
08:16Hemoglobin's 8.6.
08:18She's anemic.
08:19Yeah, but what's causing it?
08:20Well, her iron levels, folate and B12, look all normal.
08:25Though it did take them two times running the blood because it was so thick.
08:30Her hands were blue when she came in, right?
08:33Yeah.
08:34And she has never experienced anything like this until she left Hawaii.
08:39You think this might be CAD?
08:41So, she might actually be allergic to the Midwest.
08:46What's CAD?
08:48I heard some doctors talking about it.
08:50Anybody know what they're referring to?
08:51Nope.
08:53Cold gluten disease.
08:54It's a rare autoimmune disorder.
08:56Very good.
08:57More specifically, it's when cold weather triggers your immune system to attack red blood cells,
09:01which in turn causes...
09:03Anemia.
09:04Excellent.
09:04Dr. Charles, two patients incoming, one in restraints.
09:08Why restraints?
09:08He attacked his brother with a large rocking pizza cutter.
09:11Okay.
09:12Maybe you guys hang back a bit on this one?
09:15His guts are coming out of him!
09:17His guts are coming out of him!
09:19Enzo Pagliano.
09:20You can't let him do this!
09:21You gotta stop him!
09:22Wait, where's the wound?
09:23I don't see a wound.
09:24It's not blood.
09:24It's pizza sauce.
09:25Pizza sauce?
09:26They're opening a restaurant.
09:28We're in the middle of a tasting when he's hacked.
09:29This guy behind us is the one in real trouble.
09:31Please don't let him do this!
09:33He's trying to cut me out!
09:34Five of how paranoid I am!
09:36Dante Pagliano, Enzo's brother.
09:38Prama 2.
09:39Tachycardic at 133.
09:40Blood pressure's dropping.
09:41Now 94 over 53.
09:43Lower abdominal injury.
09:45Unknown blood loss.
09:46Oh, my gosh.
09:46Lacerated bowel.
09:46On my count.
09:47One, two, three.
09:4950 of fentanyl.
09:50Let's get some white lab sponges.
09:54He's got an eviscerated small bowel and lacerated mesentery.
09:59We need to get him to an alarm.
09:59Are you going to call up?
10:00I brought it up.
10:01You didn't do anything, Dante.
10:03Your intestines are outside your body.
10:04We need to get them back.
10:05No, no, my brother.
10:05I brought a demon out of him.
10:07You can't let him do this.
10:09No!
10:11Let me go!
10:12I spilled his guts!
10:15Ah!
10:15Let me go!
10:17Let me go!
10:23Dante suffered an evisceration of his intestines,
10:26which will require an exploratory laparotomy
10:28and an abdominal wall reconstruction.
10:31As soon as we get an OR, we'll be moving him to surgery.
10:33Don't you usually refer to patients by their last name?
10:37What was that?
10:37It's usually patient preference,
10:39but given that they're brothers,
10:40probably better go with first names,
10:42because it'll be clear.
10:43Got it.
10:44Okay.
10:45Dante have any other ideas about why his brother
10:47might have had a psychotic break?
10:49Just that he thought he brought out the psychosis in him,
10:52and it was all his fault,
10:54but he'd lost a lot of blood.
10:55He also said it was a demon.
10:59Yeah.
11:00Oh.
11:00I would encourage him to speak up and ask questions.
11:03That's fun.
11:05How's Enzo now?
11:07Well, the haloperidol just kicked in,
11:09so we're hoping to have a conversation with him
11:11when he wakes up.
11:12All right.
11:13Keep me busted.
11:14Oh, excuse me, Dr. Lennox.
11:15Oh, good.
11:16More questions.
11:17Sorry.
11:18Um, I was just wondering if there was an update
11:20on the boy with the gunshot wound from earlier.
11:22Billy, I think.
11:23He had a subclavian artery injury.
11:26He's in the ICU.
11:27But is he going to be okay?
11:29I have a brother who's the same age.
11:32If he makes it through the next few hours,
11:34he'll have a chance.
11:38So she's had this CAD her whole life?
11:40She's just never been anywhere cold enough
11:42to feel the effects.
11:43But the good news is,
11:44rituximab infusions four times over the next month
11:47should resolve your symptoms.
11:48Like forever?
11:49Like ever-ever.
11:55Spam again?
11:55Yeah.
11:56It's, uh, probably got put on some list.
12:01Was my brother okay?
12:03Could be in surgery a few more hours,
12:05but as soon as we know anything,
12:07we'll let you know.
12:08Oh, God, I heard him.
12:10I heard him.
12:12Enzo, can you tell me,
12:13from your perspective,
12:15what happened today?
12:16That's the thing.
12:18I don't really know.
12:19It doesn't really make any sense.
12:21Well, how do you mean that?
12:22Well, Dante and I were working on the menu,
12:25and I started to get this suspicion.
12:27And then it came on so strong,
12:29like he was trying to cheat me.
12:31Had he done anything to make you think that?
12:33No.
12:35Dante, if you met him,
12:37he's the most honest,
12:39gentle guy in the whole world.
12:40You never do something like that.
12:42Right.
12:43But this morning,
12:44in that moment,
12:45I was sure of it.
12:47And it made me so angry.
12:51Has this ever happened before?
12:53Not like this exactly.
12:55But lately,
12:56yeah,
12:57sometimes I have these thoughts
12:59and don't feel like they're mine.
13:02Huh.
13:03Your brother seems to think
13:05that he's responsible
13:06for this reaction.
13:08Oh, yeah.
13:09Well,
13:10because a lot of times
13:11I have these thoughts.
13:12It's when we're together.
13:14Yeah.
13:15I don't know why.
13:16He didn't do anything
13:17to provoke you?
13:18This just,
13:19it just happened.
13:20No.
13:20I love my brother.
13:22He's everything to me.
13:23You gotta save him, Doc.
13:25You can't let him die.
13:29So what,
13:30she was just gonna ambush you
13:31at this meeting?
13:31Sounds like it.
13:33Why don't we go talk to them,
13:34see if I can smooth things over.
13:36Because they can't let
13:37personal issues
13:38from one board member
13:39dictate a decision
13:40of this magnitude.
13:40Yeah, actually,
13:42let me go over there.
13:44Sharon,
13:44don't make things worse.
13:46I'm good.
13:49I don't have any interest
13:51in going another round
13:52on this right now.
13:52I don't either.
13:53I just wanna know
13:54if you're feeling okay.
13:56I'm fine.
13:56Why wouldn't I be?
13:58You seem a little shaky.
14:00I,
14:00because I spilled a drink.
14:02Miranda,
14:03your hand's still shaking.
14:05Talk to me.
14:09I'm just a little shaken up
14:10from this morning.
14:11My driver got in
14:12a fender bender
14:13and I,
14:14I wasn't wearing
14:15my seatbelt.
14:16Did you hit your head?
14:17No,
14:17but I did get thrown
14:19into the back
14:19of the driver's seat
14:20pretty hard
14:21and my ribs feel
14:22a little sore
14:23and I'm sure the altitude
14:24is not helping my breathing.
14:26So you feel out of breath.
14:29Come.
14:30I want you to lay down here.
14:32Excuse us.
14:33Peter,
14:34can you get rid
14:34of these pills, please?
14:36Really?
14:37You don't need
14:37to make a fuss.
14:38I mean,
14:38the car wasn't even
14:39going that fast.
14:40Well,
14:41slow speed accidents
14:42can be just as dangerous
14:44as high speed ones.
14:47Your heart rate's
14:48in the 120s.
14:50That's high.
14:50Oh,
14:51excuse me,
14:51can you bring
14:52some blankets, please?
14:53Of course.
14:54I'm going to need you
14:55to lay back
14:57and take
14:57deep,
14:58slow breaths,
15:00okay?
15:03Hey,
15:04please stop calling me.
15:06you've been ignoring me
15:07all day.
15:08I'm at work
15:09right now,
15:09so...
15:10I know,
15:10I know,
15:11but I
15:12need to talk to you.
15:15You've put on weight.
15:24What are you doing here,
15:25Mom?
15:26I just want to talk.
15:28We really don't
15:29have anything
15:30to talk about.
15:31It's been 14 years.
15:33There's plenty
15:34to discuss.
15:35Like,
15:36I don't know
15:37how you bankrupted me.
15:39We were just
15:40trying to provide
15:41a better life
15:42for everyone.
15:44What do you want
15:44us to do,
15:45grovel?
15:46That could be
15:46a start.
15:48Look,
15:49we took the RV
15:50here,
15:51and
15:52there's a little
15:53hole-in-the-wall
15:54restaurant near us.
15:55Your father and I
15:55would like to see you.
15:56Really?
15:57So,
15:58where is he then?
16:00I'm sorry.
16:01Hey,
16:01we have a situation.
16:02It's Kiana.
16:06She was fine
16:07a minute ago.
16:07125 milligram
16:08solumetrol,
16:1050 of Benadryl.
16:11What's going on?
16:11She had an allergic
16:12reaction to the infusion.
16:14She started hyperventilating
16:15and then lost consciousness.
16:17I already gave her
16:170.3 epi.
16:19Kiana?
16:19Hey,
16:20BP's 80 over 55.
16:22Anaphylactic shock?
16:23Okay,
16:23let's get rid of the
16:23intubate.
16:24One more dose of epi.
16:25Oh my god,
16:26my baby!
16:26Come on,
16:27Kiana,
16:27stay with us.
16:28Intubating?
16:34She's resting now,
16:35but she'll be okay.
16:36So she has a rare disease,
16:38then a rare allergic
16:39reaction to the medicine
16:40that cures it?
16:41There is a second-line
16:43treatment.
16:43It would resolve the
16:44symptoms,
16:45but it would not cure
16:46the CID like the
16:47rituximab.
16:48It would also require
16:49infusions every other
16:51week.
16:51But only during
16:53cold weather months.
16:54But if we went back
16:56to Hawaii,
16:56presumably,
16:58she'd go back to
16:59being totally fine
17:00again?
17:02Presumably.
17:09Okay, CT clean,
17:11MRI clean.
17:12So, no trauma,
17:14nothing neuroplastic.
17:15What's going on here?
17:16Wide lens, guys.
17:17No bad ideas.
17:18Let's go.
17:19Quentin?
17:20Uh,
17:21let me think.
17:22I...
17:22Well,
17:23maybe a pre-existing
17:24mental health condition.
17:25Yeah.
17:26Bipolar,
17:27schizophrenia.
17:27I like it.
17:28Except,
17:29Enza's been a stable,
17:30high-functioning executive
17:31for a whole bunch of years
17:34with technically
17:35no family history.
17:37Oh, my God.
17:39Folia, duh.
17:40Huh?
17:42Go on.
17:44It's a phenomenon
17:46in which a dominant
17:48individual with a
17:49psychotic disorder
17:50imposes their delusions
17:51onto a close partner,
17:53inducing psychosis
17:54in someone who otherwise
17:55would have no mental health
17:56issues of their own.
17:57So,
17:57what you're suggesting
17:58is that perhaps
18:01Dante's actually
18:02the sick one.
18:03Yes.
18:04And that Enzo,
18:05just by nature of standing
18:06side by side
18:08with his brother
18:08for all those hours...
18:10Enzo got pulled
18:10into his delusions.
18:12Huh.
18:14You're a first year?
18:15I read ahead.
18:16Okay, well,
18:17honestly,
18:17that's a pretty
18:18impressive hypothesis.
18:20I think that maybe
18:21we should be, uh,
18:22looking into Dante's.
18:25history.
18:25What do you say?
18:29Hey, uh,
18:29Kiana's waking up.
18:30She was looking...
18:33Well,
18:33what's going on?
18:36What's best for my daughter
18:38is going to destroy
18:39my marriage.
18:41Not even my marriage,
18:42my impending marriage.
18:45Oh, well,
18:45that's tough.
18:46But, I mean,
18:46how are you so sure?
18:48Because Steve just told me.
18:50I mean,
18:50he was lovely about it.
18:51And he adores Kiana,
18:53but he doesn't want
18:54to do long distance anymore.
18:56He doesn't want
18:57to move to Hawaii.
18:58He would,
18:59in a heartbeat,
18:59if he could.
19:00But he has shared custody
19:01of his daughters,
19:02and his ex lives here,
19:03so...
19:04Yeah, it's a non-starter.
19:06I don't even blame him.
19:08We did the whole
19:09long distance thing
19:10for two years,
19:11and it was so hard.
19:12And it's four more
19:13until Kiana goes to college,
19:15so...
19:17I just don't know.
19:18You don't know what?
19:21How many times
19:22have you been in love?
19:26Yeah,
19:27it's hard to say.
19:29Well, for me,
19:30it was zero.
19:31That's crazy to say,
19:32but it's true.
19:33Even Kiana's father,
19:35I never felt that
19:36connection,
19:37that euphoria.
19:39I came to terms
19:40with the fact
19:41that I was just...
19:43broken.
19:46But then I met
19:47Steve,
19:47the dentist,
19:48and every awkward
19:49little edge of his
19:50fit every awkward
19:51little edge of mine,
19:52and for the first time,
19:54I was totally
19:54and completely
19:55head over heels.
19:59But what are the odds
20:00I'll ever find that again?
20:04I just don't know
20:05if I can give that up.
20:11Tough choice.
20:12I can't decide
20:13if I want sweet
20:14or salty.
20:15That's the age-old
20:15question, man.
20:20Just came out here
20:21to check up
20:22on how you're doing.
20:23You okay?
20:24Me?
20:25Yeah.
20:26I'm good.
20:27Just, uh,
20:28got the feeling,
20:29I don't know,
20:30you're not that engaged
20:31with what we're doing
20:32here today.
20:35Oh, uh...
20:38Like, I don't want
20:38to seem unappreciative.
20:40I think what you're
20:41doing here is really cool.
20:42It's just...
20:45What?
20:48I'm not really
20:48interested in ED psych.
20:51Oh.
20:52Figured that out
20:52already, did you?
20:55I guess I just want
20:56a good work-life balance.
20:58Yeah, both of my parents
20:59are immigrants.
21:00They had to work,
21:01still do,
21:03really hard.
21:05They pushed me
21:06so I don't have
21:07to kill myself
21:07like they do.
21:09I just think
21:10having a private practice
21:11is more my speed.
21:13Quentin,
21:14diagnostics are
21:15diagnostics, right?
21:16I mean, you're gonna
21:17run into this stuff
21:18no matter where
21:19you end up.
21:20I mean, what,
21:20you think because
21:21you got a cozy
21:22office set up,
21:23your patient's just
21:24gonna walk in
21:25and plop themselves
21:26down on the couch,
21:27tell you what's wrong
21:27with them and how
21:28to fix it?
21:29I'm not saying
21:29I don't want to do
21:30a good job, doctor.
21:32Look, work-life balance
21:33is important.
21:34I get it.
21:35Really, I do.
21:36It's just that this field,
21:38I don't know if you
21:39can really half-ass it.
21:41You know,
21:41you really gotta,
21:42you gotta get to know
21:43your patients.
21:44You gotta get in there
21:45so you can understand
21:46them, see the world
21:47the way they do,
21:48right?
21:49So you can
21:50understand their issues.
21:52I mean,
21:53if you don't want
21:53to do that,
21:54you don't want to
21:54put your whole soul
21:55into this,
21:57you might want
21:57to reconsider.
22:01Reconsider what?
22:03Being a doctor.
22:09Miss Goodwin,
22:09it's Dr. Howard.
22:10Can I help you
22:11with something?
22:11I hope so.
22:12I'm currently
22:13on a plane
22:13with a woman,
22:14a board member
22:15who seems to be
22:16in trouble.
22:16What's going on?
22:17Well, she was
22:18in a minor traffic
22:19accident that caused
22:20some sort of
22:21thoracic trauma.
22:22She didn't think
22:23much of it
22:24until she started
22:25experiencing weakness.
22:27Any idea
22:27of her vitals?
22:28Oh, yes.
22:29There's an emergency
22:30medical kit up here.
22:32Her breath sounds
22:32are good,
22:33but her BP
22:34is only 84
22:35over 42.
22:37Oh, okay.
22:38Um,
22:40then it's not
22:40a pneumothorax
22:41or hemothorax.
22:42Take a look
22:43at her neck.
22:43Is the jugular vein
22:44distended?
22:45Hold on.
22:52Yes.
22:54Okay, um,
22:55it sounds like
22:56pericardial tamponade.
22:57she's bleeding
22:58into the sack
22:58around her heart.
22:59How much time
23:00until you land?
23:01Uh, 30 minutes,
23:03maybe more.
23:05Oh, um,
23:07Dr. Howard,
23:07what is it?
23:10Ms. Goodwin,
23:10are there any
23:11surgical supplies
23:12in that medical kit?
23:19I've got lidocaine,
23:21some saline flushes,
23:23and a few needles.
23:25What size needles?
23:26A 16 gauge
23:26and a 22.
23:27Okay, good.
23:28You're going to use
23:28the 16 to remove
23:30the fluid built up
23:30around her heart.
23:31You'll angle it
23:32at a 15 degree angle,
23:34just under the breastbone,
23:36and you should push
23:37until the tip
23:38punctures the pericardium.
23:39Wait, how will I know
23:40when that happens?
23:41Usually, we'd have
23:42an ultrasound to guide us,
23:43but you're just going
23:44to have to take it slow,
23:45and you should feel
23:46a soft pop
23:48when it goes in.
23:48A soft pop.
23:51And what if I miss
23:52or go too far?
23:54You mean if you
23:55puncture the heart?
23:56Dr. Howard,
23:57I don't know.
23:57I don't feel comfortable
23:59going in blind like this.
24:01There is another option.
24:03Yes?
24:03But let me just start
24:04by saying it's not
24:05as scary as it sounds.
24:10You want to cut me open?
24:13It's a small incision,
24:15just so I can see
24:16where to put the needle.
24:17The needle you want
24:18to put in my heart?
24:19Not in your heart, Miranda.
24:22Into the sack
24:23around your heart.
24:25Have you done this before?
24:27I've seen it done.
24:28No way.
24:29We can wait.
24:30We can wait.
24:30We can wait until we land.
24:31Miranda, if we wait,
24:34you're not going to make it.
24:37I'm just going to be awake
24:39for this?
24:40Yes, but you shouldn't
24:42feel much, okay?
24:44We have lidocaine
24:45that will numb the area
24:46and we also,
24:47we also have these.
24:50What is that?
24:51A weed coming?
24:53It is provided
24:54by in-house counsel.
24:58I don't,
25:00I don't want to die.
25:03Miranda,
25:05I know we have had
25:07our issues,
25:08but I think
25:10you also know
25:11that I mean what I say.
25:13And I'm telling you,
25:16I will do everything
25:17I can
25:18to get you through this.
25:22Don't get me.
25:25Hey, where are your
25:26med school ducklings?
25:29Lunch.
25:29What?
25:30How are you preparing them
25:31for life as a doctor
25:32if you are letting them
25:33take a cold lunch?
25:34Easy to min.
25:36Except for that guy.
25:44Quentin,
25:45you can't talk to the patients
25:46without me there.
25:48Sorry.
25:49I,
25:49I was just
25:50thinking about
25:51what you were saying
25:52earlier about
25:53connecting with patients,
25:54seeing every angle
25:55of their condition.
25:58Okay.
25:59Well,
26:00um,
26:01what did you learn?
26:04Well,
26:05I,
26:05I know Sabrina
26:06has that theory
26:06about shared psychosis,
26:08but when I talked
26:09to Enzo about
26:09what he and his brother
26:10do together,
26:11he said all they
26:11really do is work.
26:13So I started to wonder
26:14if Dante being there
26:15when Enzo had an episode
26:16was more a coincidence
26:18rather than a cause.
26:19Maybe it's the restaurant
26:21itself causing it?
26:22So you're saying
26:23you think maybe
26:23it's environmental?
26:25Maybe.
26:26I know it's a long shot,
26:28but I remember
26:29reading somewhere
26:29that celiac disease
26:30can cause psychosis.
26:32Certainly true
26:33that in rare cases,
26:35right,
26:35that the inflammation
26:36can extend
26:38beyond the abdomen
26:39and up into the brain.
26:40And it can come on
26:41later on in life,
26:42right?
26:42Like,
26:43when you open
26:44a pizza restaurant
26:44with your brother
26:45and you're suddenly
26:46exposed to gluten
26:47in massive quantities.
26:48I'm just saying
26:49it would explain
26:49the weight loss,
26:51the vitamin deficiency issues.
26:53And why it only happens
26:55when they're together.
26:57Yeah.
26:59Trini,
26:59order a tissue
27:01transglutinase test.
27:03Yeah?
27:04Hell yeah.
27:06You can get it back
27:07in an hour or so.
27:07We'll see what's what.
27:08Nice work.
27:10All right.
27:13I'm going to go
27:13grab lunch now.
27:16Dr. Charles,
27:17I'm sorry,
27:18but you already asked us
27:19to test for celiac.
27:21I sent you the results.
27:22They came back positive.
27:23I know,
27:24but why rain
27:26on the guy's parade?
27:27He did good.
27:29Yeah.
27:31Did you hear the good news?
27:32Yeah, what's that?
27:33We're going back to Hawaii.
27:35Peace out, Chi-Town.
27:37Wow, I didn't realize
27:38you'd already made the decision.
27:40It wasn't really a decision.
27:41It's what's best for Kiana.
27:44Well, she's going to be transferred
27:45to the PICU in a bit,
27:46just to observe overnight,
27:47but she should be out tomorrow.
27:49Sounds good.
27:50Hey, can we get a place
27:51closer to Salt Palm Beach
27:53or a place with a game room
27:54so I can keep schooling
27:55Steve the dentist?
27:56Where is he, by the way?
27:58He, uh,
27:59had to run out
28:00for work.
28:02Poor guy.
28:03He's going to have to build up
28:03that base 10 again.
28:05On the other hand,
28:06maybe he'll finally learn
28:07how to surf.
28:09Yeah.
28:11Maybe.
28:16That's pretty tight.
28:17Well, we don't want
28:18any involuntary movement.
28:20That gummy help?
28:22I don't think so.
28:23Uh,
28:24all right.
28:25Can you feel that?
28:28No.
28:29Lidocaine's working.
28:30That's something.
28:31Dr. Howard,
28:32I think we're ready.
28:34Okay, good.
28:35So you're going to find
28:36the xiphoid process,
28:37the very tip of the sternum,
28:39about one finger width
28:40below that.
28:41You'll make your incision.
28:42Eight centimeters
28:43or about three inches vertically.
28:45Okay.
28:47Okay.
28:49You might not want
28:50to watch this.
28:51Oh, my God.
28:59I've made my incision, Goss.
29:01Good.
29:02Okay.
29:02Now, you're going to push
29:03the tissue laterally
29:04until you find the heart
29:06and the bulging sack around it
29:07filled with fluid.
29:11Get closer.
29:12I think I see it.
29:14Good.
29:15Her pulse is slowing down.
29:17It's okay.
29:17It's okay.
29:18When we get that fluid out,
29:19it'll take the strain
29:20off of the heart
29:20and that pulse
29:21is going to come
29:21right back up.
29:22Okay.
29:22What now?
29:24Okay.
29:25You're going to take
29:26your syringe
29:26and push it through
29:28the pericardium.
29:30Dr. Howard,
29:32the needle goes in
29:34at 15 degrees, correct?
29:3715 to 20 when it...
29:39Dr. Howard?
29:42Dr. Howard?
29:43We lost service.
29:45No, no, no, no, no.
29:46Do you know what to do?
29:48I'm not sure.
29:49Please, I can't breathe.
29:51Please, keep on my thought.
29:52I think she's dying.
29:54Okay, okay.
29:55We need to find
29:55another phone.
29:56Everyone stop talking!
30:02Okay.
30:04Go in at a shallow angle
30:07and then as the needle penetrates
30:13until you feel it pop,
30:19I think I feel it.
30:27That's it.
30:28I mean, that's good, right?
30:31Her pulse is coming back up.
30:44Right.
30:50Yeah, so Dr. Lennox
30:51had to do a pretty significant
30:53bowel resection
30:53and then repaired
30:55the initial laceration.
30:57But it looks like Dante's
30:59going to make a complete recovery.
31:00Hard to imagine
31:01that Dante and Enzo's
31:02relationship
31:02will recover that quickly.
31:04You're probably right about that.
31:10Wow.
31:11You're all still here.
31:12Yeah, we're just
31:13finishing up our day.
31:15Uh-huh.
31:15Well, I heard one of you
31:16cracked the case with Enzo.
31:18Gluten-induced psychosis.
31:20Undiagnosed celiac disease.
31:22As long as he stays away
31:23from gluten,
31:23you'll be fine, right?
31:24It sucks that they have
31:25a pizza place, though.
31:26I mean, I've had gluten-free pizza,
31:27so that's an option,
31:29but I feel like
31:30it's never as good, you know?
31:36That's the boy
31:36from this morning.
31:37Billy.
31:38Wait.
31:39Is he?
31:41Yes.
31:43I thought you said
31:44he was going to be okay.
31:45I said he had a chance,
31:48but the bleeding
31:48was too severe.
31:50He was in DIC.
31:50We couldn't get him
31:52to clot.
31:53Yeah.
31:54Unfortunately,
31:56subclavian injuries
31:57are really
31:58tough to survive.
32:02Shh.
32:09Shh.
32:10Shh.
32:10Shh.
32:11Shh.
32:12Shh.
32:13Shh.
32:21Please,
32:22talk it up.
32:25Jonathan Michael,
32:27I didn't think
32:28you would come.
32:29Neither did I.
32:33What's the thing?
32:36Excuse me?
32:38The thing
32:38you want?
32:40Because if it's money,
32:41I'm on a resident's salary
32:43and if it's a place to live
32:45and then
32:46while I'm sleeping
32:47at a friend's house.
32:49We didn't come here
32:50to get anything from you.
32:51You really think
32:52we're monsters,
32:53don't you?
32:56I watched a mom today
32:58blow up her
32:59entire life
33:01for her kid
33:04because she wanted to do it.
33:05because she wanted to put her health
33:06and then I watched that same mom
33:11put a smile on her face
33:12so her kid wouldn't feel bad.
33:16I don't understand.
33:17I know you don't.
33:20See,
33:20because, um,
33:23well,
33:24I witness
33:26things like that
33:27every day
33:28in my hospital.
33:29You know,
33:30parents that
33:31go to the end
33:32of the earth
33:33to protect
33:35their kids
33:36no matter what.
33:38I mean,
33:39you two.
33:45I'm just going to ask again.
33:48What do you want?
33:50We just want to see...
33:52I'm sick.
33:56Secondary progressive MS.
34:02How long have you known?
34:05A while.
34:06Maybe
34:07six months.
34:13That's why we're here.
34:15We want to reconnect
34:16with our son.
34:21No.
34:23Know what?
34:24No, I'm not doing this
34:25with you right now.
34:27Yeah.
34:39I'm not doing this
34:42with you right now.
34:45Hmm.
34:47Listen,
34:47great job today.
34:49Yeah,
34:49thanks.
34:50No,
34:51I mean it.
34:51I mean,
34:52that, um,
34:53that folie
34:54adieu
34:55idea you had
34:56about Enzo.
34:58I mean,
34:59it's a spectacular guess.
35:00Look,
35:00it might not have been
35:01the right one,
35:02but trust me,
35:02that kind of
35:04creativity,
35:05you know,
35:05lateral thinking
35:06is really important
35:07in this line of work.
35:08So.
35:10It's not that,
35:11though.
35:11I think I'm just
35:12kind of rethinking things.
35:15I don't know
35:15if this is for me.
35:18How so?
35:20I didn't know
35:21it would affect me
35:21so much.
35:22I mean,
35:23even with Dante
35:23and Enzo,
35:24even though that
35:25worked out,
35:25there was still
35:26so much.
35:28It just got to me.
35:30I don't know.
35:31There's a cost
35:33to having a job
35:34with meaning,
35:36right?
35:36I mean,
35:37we experience
35:37these brutal
35:41moments here.
35:43true despair.
35:45But trust me,
35:46there are also
35:47these moments
35:48of euphoria,
35:49of, like,
35:50extraordinary
35:51fulfillment
35:52because we
35:53change people's
35:54lives here.
35:55You know,
35:55if we're lucky,
35:56we actually save them.
35:58So for me,
35:59anyway,
36:00I mean,
36:01over time,
36:02the benefits
36:03definitely come to
36:04outweigh the costs.
36:06I know it might not
36:07feel like it right now,
36:08but if you are
36:09feeling things deeply,
36:10as far as I'm
36:11concerned,
36:12it just means that,
36:13you know,
36:13you're doing it right.
36:17Yeah.
36:19Maybe.
36:19I just think that,
36:22I don't know,
36:23maybe I like the puzzle
36:24piece and not all
36:25the pain.
36:27Yeah.
36:27Maybe I'll go
36:28into research.
36:29I don't know.
36:31Anyway.
36:32Anyway.
36:38Thank you anyway,
36:39Dr. Charles.
36:42Oh, thanks for coming.
36:44Thanks.
36:53You guys taking off?
36:54Oh, yeah.
36:55Yeah.
36:58Look,
37:00today was,
37:00it was a lot,
37:03right?
37:03Really glad you got
37:04to see what we actually
37:05do here,
37:05but just for the record,
37:06it was just
37:07extra intense,
37:08you know.
37:10Just hope it wasn't,
37:11I don't know,
37:12discouraging.
37:15Dr. Charles,
37:16today was
37:16the greatest day
37:17of my life.
37:20Really?
37:22Well,
37:22my life's pretty
37:23boring,
37:24but,
37:24yeah,
37:26really.
37:29Yeah,
37:29it was pretty dope.
37:36You're welcome.
37:38Yeah,
37:38thanks for coming.
37:40See you around.
37:41See ya.
37:51Come in.
37:54Hey.
37:55Hi.
37:56How's Miranda?
37:58Good.
37:59We were able
37:59to repair the laceration
38:00in her atrium
38:01without issue.
38:02Great.
38:03You know,
38:03all those years
38:04of watching,
38:05surgery,
38:06assisting,
38:07I never
38:09really understood
38:11the impact
38:12of that moment,
38:13of holding
38:16the knife
38:16and cutting
38:18into someone.
38:19Yeah.
38:21My first surgery
38:22was a foot amputation.
38:23I was so nervous,
38:25I thought I was
38:25going to puke,
38:26but my attending
38:27talked me through it
38:28and I got it done.
38:29Later,
38:30she got me a bracelet
38:31that had a little
38:32charm of a foot.
38:33She said it should
38:34be a reminder,
38:35even though these
38:36miraculous things
38:37we do have somehow
38:38become commonplace,
38:40we shouldn't ever
38:41forget they're
38:41extraordinary.
38:43Yeah.
38:51I heart Chicago.
38:53Yeah,
38:53because of what
38:54you do with Miranda's
38:55neck.
38:55Yeah, yeah, yeah.
38:55I'm sorry.
38:56It's the best
38:56that I could do
38:57on short notice.
38:58But anyway,
38:59welcome to the club.
39:03Mm-hmm.
39:10So what did you say?
39:13I said no.
39:15And, um,
39:18I mean,
39:19it hurts
39:21more than I
39:22want to admit,
39:23but
39:23it doesn't just
39:25erase how my dad
39:26is treating me
39:27my whole life.
39:30I wish I could
39:32just move past it,
39:33you know,
39:34but
39:35I can't.
39:36And
39:38it makes me feel
39:39like
39:40a bad person.
39:45I'm sorry.
39:46I know
39:48this is not
39:49the, uh,
39:50conversations
39:50we usually have.
39:51And
39:53I mean,
39:54well,
39:54you ordered
39:55takeout
39:55from just about
39:56every restaurant
39:57in Chicago.
39:59Well,
40:00you didn't answer
40:00my text,
40:01so I got
40:01a little bit
40:02of everything.
40:03Now I'm
40:04ruining it.
40:05No,
40:05you're not.
40:05Hey,
40:09trust me,
40:09I would never
40:10judge someone
40:11in a situation
40:12like this,
40:13let alone
40:15tell them
40:15what to do.
40:19I will just
40:20say,
40:20no matter
40:21how you
40:22are feeling
40:23right now,
40:24someday your
40:25parents will
40:26be gone.
40:26And whenever
40:28that happens,
40:29however you
40:30leave things,
40:33that's how
40:34it will stay
40:36forever.
40:39Sounds like
40:39you're speaking
40:40from personal
40:41experience.
40:41kids.
40:45We were
40:45talking about
40:46you here,
40:46pal.
40:49I know,
40:50but we
40:51don't always
40:51have to just
40:52be on me.
40:58Except I like
40:59being on you.
41:02That's not
41:02what I meant.
41:04doesn't make
41:04it any less
41:05true.
41:10Good talk.
41:11Great talk.
41:13Good talk.
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