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06x01 - When Did We Begin To Change

Posted: 11/12/20 20:21
by bunniefuu
Hang on, Hannah, okay?

I love you.

Will...

Dr. Halstead.

Doris.

Any symptoms?

Headache, dry cough?

Nope.

98.5.

Good.

Ope.

Let's get you tested.

I was just tested this morning.

You went home.

Nobody goes back in the E.D. without getting tested.

Come on.

Come up.

Open up.

Jim, a word?

Let's take it inside.

I need a break.

Hey.

This is April's third straight week in the COVID ward.

We're short-staffed.

April volunteered.

Protocol is one week on, one week off.

She's putting herself at risk.

I don't know what to tell you.

April feels this is her mission.

Jim, you're the chief of the E.D.

You've gotta protect your staff.

She knows what she's doing.

What's it to you?

I thought you guys broke up.

Has nothing to do with it.

Ethan, I need her.

Okay?

Check your iPad.

You got five patients.

You know the drill.

Monitor them from outside the room.

Leave it to the nurses inside to treat them.

Dr. Halstead.

COVID test was negative.

You're good to go.

Hannah's sats dropped and we couldn't recover 'em, so we intubated.

Figured you'd have to.

Now it looks she has a chemical pneumonitis...

Aspirated some vomit.

So I put an OG tube down to decompress her stomach, okay?

Hey, Will.

She's gonna be okay.

Yeah.

Thanks.

Crockett, I'm glad you're taking care of her.

You got it.

Hey.

I just got a text.

Hannah was brought in?

Yeah.

Well, she's in here.

So it can't be COVID.

Um...

I found her unconscious in her bathroom, syringe in her arm.

She OD'd.

Good.

Fine.

Got your energy back?

Sharon, I am ready to go back to work.

Trust me.

Well, good.

You've been missed.

How you been doing?

Well, the board still doesn't want me coming back because of my diabetes.

So all of my meetings are virtual.

Look...

Zooming with, like, ten people, all in their little box.

It's driving me crazy.

I can't read the room.

I don't know if people are, like, actually paying attention or just looking down at their phones.

Yeah, there's already a name for that.

They're calling it "Zoom fatigue." I've already read, like, three psych papers on it.

Hey, and speaking of psych, I need you to carve out time for the staff.

There's... there's just been no let-up with the workload.

And so many fatalities.

And then you add to that all the social trauma they've been dealing with.

I'm sending out a memo now.

Great.

Good.

And is Anna with you?

Yeah.

Yeah.

We decided that, you know, it was safe for her to come back.

Well, say hi for me, okay?

Will do.

Okay.

Take care of yourself.

Take care.

Good morning.

Uh, Sharon Goodwin says hi.

So, I-I'm going to work.

Uh...

You're pretty much gonna stay put.

Dad, I'm not gonna go out.

That's good.

Because, I mean, it's a...

I know.

Okay.

I'll...

I'll see you later.

Bye.

Whoa!

Sorry.

Sorry, Crockett.

Whoa, Manning.

Eyes on the road.

Sorry.

Oh, hey.

Yeah?

I heard you moved into Club Med.

The Pavilion.

Yes.

Yes, I am.

Oh.

Well, watch yourself.

I hear it gets pretty rowdy in there.

Lot of questionable behavior.

Mm.

Okay.

Nat?

Yes.

Check your iPad.

You're going to Treatment Four.

Got it.

See you, Crockett.

All right.

Mr.

Lieu?

Hi.

I'm Dr. Manning.

And you must be Kellie.

Hi.

Hi.

I see Kellie's been dealing with myelogenous leukemia?

For a couple years.

She's immunocompromised, so I didn't want to bring her into the hospital if I didn't need to.

But she was in remission, but her leukemia came back.

So we had to do chemo all over.

Just finished the last round eight weeks ago.

Just hope she won't have to do it again.

Let me see.

You're having difficulty breathing, aren't you?

It's okay.

I'm used to it.

Well, we're gonna help you feel better, okay?

Let's get a CBC, a BMP, an ECG, an echo, and a BNP, okay?

You got it.

You mind if I talk to your dad for a moment?

Okay.

So, I am hearing an S3 gallop in her heart which means it's struggling.

Also, her neck veins are distended.

And I am seeing some swelling in her legs and ankles.

Those are symptoms of heart failure, aren't they?

Her oncologist warned us about that.

It's most likely a result of the chemo medication.

Unfortunately, some are cardiotoxic.

They can damage the heart muscle.

The good news is I think we can reverse it if we change her medication.

So let's get the test results back, and then I will loop in your oncologist, okay?

Okay.

All right.

Thank you.

Mm-hmm.

Clear.

Mr. Booker?

I'm afraid your x-ray looks wet.

That means that you still have fluid in your lungs.

The proning hasn't helped.

So what now?

I suggest we intubate and put you on a ventilator.

A ventilator?

You would be sedated.

I don't feel that bad.

I know, but the thing that makes people feel bad...

A rise in CO2...

Doesn't happen with COVID.

But you're still not getting enough oxygen.

If we put you on a ventilator, it'll allow you to rest.

Please.

Can't you wait a little longer?

Make sure I really need it?

If we wait and you go into cardiac arrest, we can't resuscitate you.

I know it's terrible.

But we can't run a code in here.

Chest compressions release so much virus.

Please, Alvin.

Let us help you.

Okay.

Okay.

20 of etomidate, 100 of roc?

And start a propofol infusion.

I need to suit up.

I gotta go in to intubate.

Dr. Marcel, look alive.

Incoming GSW.

20-year-old male, COVID negative, g*nsh*t wound to the upper right thigh, GCS 15, BP 100/77.

It hurts.

Gonna take care of that, bud.

50 of Fentanyl.

X-rays, meet us inside.

g*nsh*t wound?

Second one today.

COVID or no COVID, some things never change.

How are we ever gonna heal this city?

I know what you're gonna say.

"I told you so." Why would I say that?

You said drug addicts can replace dr*gs with romance.

Ring a bell?

Well, I mean, it happens.

Well, not with us.

We love each other.

Okay?

Yeah, uh, sure.

There's stress because of the pandemic.

But everybody's feeling that.

And maybe 'cause of the quarantine, we moved in sooner than we would've.

Totally understandable.

I mean, trust me.

You are not the only ones.

But we're making it work.

What happened last night was a lapse.

That's all.

Will, look.

I'm not here to confront you, buddy.

I mean, these sessions are about one thing and one thing only, and that is lowering your stress levels in a time when practicing emergency medicine can... can be overwhelming.

You know?

And that's it.

Does that sound okay?

I'm sorry.

I haven't even asked how you're doing.

I understand you had a pretty bad time with it.

Yeah, you know, this COVID thing ain't no joke.

But you know what?

I'm fine.

And, look, I really appreciate your asking but I really wanna use this time if it's okay to talk about you, you know, and how you're doing.

I'm managing, I guess.

I mean, we finally have enough PPE.

And the safety protocols seem to be working.

Okay.

Good.

I just...

What?

I thought we'd be over it by now.

Three weeks straight.

Don't start, Ethan.

You're putting yourself at risk.

Look around.

So many of these patients...

I see the people I grew up with.

They're dying at twice the rate.

I know.

I know.

They've been discriminated against their entire lives.

Poverty, terrible healthcare.

And now they're here with this.

Yeah.

Wait.

I'm just worried about you.

The two men I'm treating, they are sick.

They are frightened.

And they are alone.

I'm not abandoning them.

Ms.

Palmer, hi.

I'm Dr. Halstead.

Hiya.

Call me Anita.

Okay.

Mm.

This is her husband, Brad.

Hey, Brad.

Sorry you can't be here.

We're limiting visitors for safety.

No, I understand.

Okay.

Thank you.

Is it true redheads like spicy food?

Uh, I haven't heard that one.

So, Anita, you had a fall today, huh?

Yeah.

In the kitchen after breakfast.

Okay.

You hurt your arm?

Mm-hmm.

Yeah.

Did you lose consciousness?

No.

Oh.

What happened here?

Oh.

That was a couple of days ago.

She's actually fallen three times in the last week.

Any history of low blood pressure, fainting, or seizures?

Mm-mm.

You on any new medications?

No.

I don't take anything.

I think this country is overmedicated.

I see you're an air traffic controller.

Mm-hmm.

Pretty stressful work.

No, I've been doing it for five years.

I know where all those little planes are going.

Impressive.

Brad, can you think of anything else?

She hasn't gone to the gym since the pandemic, and she stopped her paleo diet a few weeks ago.

Yeah, I'm not seeing anything that concerns me.

But we will get an EKG, labs, and an x-ray of your arm.

See if we can't find out why you've been unsteady lately.

Okey dokey.

Hang in there.

She seem a little high to you?

Yeah, maybe.

You know, some people get a little loopy in the E.D.

Mm-hmm.

Add a tox screen to her bloodwork.

Yeah.

Blood alcohol?

Yeah.

Okay.

Got any change?

Not yet.

Dr. Halstead.

Sabeena Virani.

Ah...

I'm sorry, Dr. Virani.

We were supposed to meet in the cardiology clinic.

If this isn't a good time...

No, it's just... someone I know.

I'm sorry.

I'll catch you another time.

Wait.

You said you work for Kender Pharma?

R&D.

We're running a trial at Med for an oral heart failure medication.

Dr. Ramsey is principal investigator.

He thought it'd be good to have an E.D. doc as co-P.I.

Recommended you.

Thanks.

Another time, I might be interested.

Just...

I got a lot going on right now.

I understand.

I hope everything works out.

Dina, status on Mr. Booker.

Sats are stable.

Keep me posted.

Ethan?

Coming to you.

Mr. MacNeal, his sats are 85.

I think you better talk to his wife.

Mrs. MacNeal?

Hi, I'm Dr. Choi.

I've been treating your husband today.

Please.

How is he?

I'm sorry to say he's not doing well.

His oxygen saturation level is still only 85, a good ten points under what it should be.

Oh, my God.

We've done everything we can with the ventilator...

Inhaled nitrous oxide, 100% oxygen...

And unfortunately, nothing's worked.

So if the ventilator hasn't helped, what else can we...

There is one more thing we could try.

It's called ECMO...

It's a life support system that takes the place of the lungs.

Life support?

That sounds so...

It is.

It is, ma'am.

I don't wanna minimize the seriousness of your husband's condition.

At this point, I believe ECMO is his only option.

Do we have your permission?

Yes.

Of course.

Uh, please.

Save my Freddie.

I'll do my best, ma'am.

Oh, hey.

Hi, sweetie!

Hey.

How's the arm?

The x-ray is negative.

Her arm is not broken.

Yay!

It's not broken.

But there is one thing.

So your labs show you have a blood alcohol level of 0.14.

A what?

It indicates that you had alcohol today.

No, I didn't.

No.

No way.

So I'm just wondering maybe if that's the reason you've been falling lately.

No.

No.

I haven't had any alcohol today.

What about last night?

No!

I don't drink.

I don't like the taste.

Yuck.

I'll tell you what.

Why don't we get some more fluids in your system and we'll be back to check on you in a bit?

Okay?

Okay.

She's drunk.

Well, something's going on.

I think she has a serious problem.

Hey, might be a one-time event, you know, set off by some stressor.

The woman's fallen three times in the last week.

Wouldn't you call that a pattern?

Hey, her husband said she doesn't drink.

She doesn't drink.

So, let's monitor her BAC, and when she comes down, we'll check, okay?

Wh...

Hey.

Kellie Lieu... my peds patient with leukemia?

Yeah.

Labs and history just came in.

Oh, perfect.

Not good, huh?

No.

I need a surgical consult.

All right.

I'll ask Crockett.

You know what?

Wait.

Don't page Crockett.

Just page whoever's on call.

Whoa.

Make sure he gets that.

Why not Crockett?

Oh, it's nothing.

I just...

I need a consult.

And so I was gonna page the call person.

Why do that?

I'm free.

Okay.

Okay.

Uh, the patient is Kellie Lieu.

She's 12.

She's been battling leukemia.

She presented today with chemo-induced heart failure.

Is that why you didn't wanna bring me in?

Kid with leukemia.

'Cause I lost my little girl?

I just thought maybe it was a little too close to home.

Thank you.

Tell me about the patient.

BNPs 2500, ejection fraction 15%.

Bad numbers.

And it just gets worse.

Her latest blood smear shows an increase in elevated cells in her bone marrow.

So the cancer's coming back?

Yeah.

Okay.

Well, send me the chart.

And what you just did, that's why I don't tell people about my past.

The leukemia's gonna come back?

Yes.

It seems like it is.

I'm so sorry, Mr. Lieu.

So...

we have to start chemo again.

Eventually, yes.

But right now, Kellie's heart's too damaged for more chemo.

Getting her heart in shape has to be her first priority.

Yes.

Okay.

How do we do that?

Well, there are two options.

The first we talked about...

Replace Kellie's current regimen with one that's less toxic, but in addition, we add Milrinone to ease the strain on her heart.

But we don't know how long that would take to work.

And if the cancer comes back before her heart is healthy for chemo, we'd have no way to fight it.

You said there's a second option.

Surgery.

Implant an LVAD...

An assist device that will take the pressure off Kellie's heart so it can recover faster.

Surgery.

That would be my recommendation.

But you have to know, it comes with risks.

Okay, Kellie is immunocompromised.

That increases the chance of post-op infection.

And with COVID, the danger is even greater.

So you don't advise surgery?

Well, we've learned how to mitigate those risks.

Still, LVADs are rarely used in pediatric cases because they are tailored to fit adults.

That's because there aren't many kids with Kellie's level of heart disease.

If you two don't agree, how can I make this decision?

Mr. Lieu, I know h...

We know how difficult this is but I...

I don't think you do.

I lost my wife two years ago.

She's not here to help me.

The world is upside down.

Yesterday, a woman in the parking lot pointed at us and screamed, "You brought COVID here.

It's your fault.

Go back where you're from!" I have to worry about my daughter's leukemia, the pandemic.

And now that we could get att*cked...

Who do I trust?

I'm sorry this is happening to you.

All I wanna do is what's best for Kellie.

The safest thing.

And that doesn't sound like surgery.

We'll try the medication?

All right.

I'll call your oncologist, and we'll get started.

Thank you.

Hey.

Yeah?

What's going on with you?

When did you get so hyper-conservative?

I thought he should have all the facts.

Let me tell you something.

You talked that man out of an operation his little girl needs.

Thank you.

What are you doing?

Dr. Lanik cancelled Mr. MacNeal's ECMO.

Why did you cancel it?

Look... he shouldn't have ordered it in the first place.

Excuse me.

He's my patient.

And I'm chief of the E.D.

I have to allocate resources.

We only have four ECMOs for the entire ward... four.

Three are already in use.

Which leaves one for Mr. MacNeal.

April, I can't tie up my last circuit on him.

Especially when we know Mr. Booker, who still has a chance, is gonna need it.

You don't know he's gonna need it for sure.

And ECMO's the only thing that could possibly save Mr. MacNeal's life.

The man is gonna go into multi-organ failure.

Over the last six months, how many times have we seen this?

ECMO is not gonna change the outcome.

You can't say that for sure.

You're just gonna give up?

We've done everything we could.

Look, you wanna make me the bad guy?

Get in line.

Hey, Crockett.

Yeah?

Oh, yeah.

She's doing fine.


Aced her spontaneous breathing trial.

I just extubated her.

You can head in.

All right.

Hey.

I'm so sorry.

It's all right, Hannah.

It's all right.

No.

No, you trusted me, and I let you down.

Hey, the most important thing is you're okay.

And you will come back from this.

When they were taking me out of the ambulance, as messed up as I was, I could still hear you.

You said "I love you." I do.

I swear I will make this up to you.

When I get out of here, I will go straight into rehab.

I wanna be so good.

Dr. Halstead.

They need you.

You rest.

I don't want it.

Okay.

Sweetie, these are electrolytes.

No.

You need them.

No, let me alone.

I wanna go home.

Whoa, whoa, whoa.

Hold on, hold on.

Anita, I'm sorry.

Get security in here.

Anita, I'm sorry.

I can't let you leave in this condition.

What condition?

There's no condition!

You're intoxicated.

No, you're...

Stay down!

No, I'm not!

Okay. Earl.

Let go!

Let go of me!

Hold on to her.

50 of Benadryl. Got it.

Earl, come up here please. No!

Thank you. No!

You can't. Okay, hold on, sweetie.

I wanna go home.

I wanna go...

Okay. Sorry.

You were right.

When am I gonna learn?

Dr. Halstead.

Ms. Goodwin, I have a patient an air traffic controller...

Who has a drinking problem.

Both she and her husband refuse to admit it, so I am going to inform the FAA.

I wanted to make you aware.

And you're certain about this?

Yes.

Uh, I didn't wanna believe it at first.

She's very convincing.

But it has been going on for some time.

And, clearly, both she and her husband are in denial.

I see.

Well, she's your patient.

It's your call.

I heard about Dr. Asher. I'm sorry.

How's she doing?

Yeah, better.

Thanks for asking.

Well, you know, I have no choice but to report Dr. Asher.

I know.

And as to your patient, I would encourage you to make sure there are no extenuating circumstances that you're not aware of.

Because once you make the call to FAA, this woman's career is very likely over.

Mrs. MacNeal?

Um...

This is bad, isn't it?

The doctors have reconsidered your husband's treatment.

They don't feel ECMO will change the course of his illness.

Does that mean... I'm afraid yes.

You have to prepare yourself.

Can I be with him?

Or hold his hand?

No.

It would put you at too much risk.

We've been married for 40 years.

And now he's going to die without me by his side.

I wish I could change that.

But I can't.

But he won't die alone.

I will be there.

I promise you.

Oh.

I want you to give him something.

I just found this.

It was our first date.

I'll make sure he gets this.

Deep breaths. Deeper, thanks.

Help. Somebody help.

She can't breathe.

Kellie? Kellie?

Hey, sweetheart. Look at me.

Look at me. All right?

I know you're scared, all right?

I just need you to take slow, deep breaths, okay?

Okay? There you go.

S Gallop is worse.

Let's get another echo and chest x-ray.

What? What's happening?

Kellie's heart failure is getting worse.

If we don't act now, she may not be around to fight the leukemia.

Oh, God.

It's that bad?

You wanna operate?

Put in that LVAD? That's right.

Dr. Manning, you were against it before.

I have to agree with Dr. Marcel now.

It's what's best for Kellie.

All right.

Do the surgery.

All right, let's get this girl upstairs.

All right, Trini.

You page Dr. Latham.

Tell him to meet me in the O.R.

Yeah?

You got a minute?

Yes. Sure.

Have a seat.

I wasn't being honest earlier.

Things haven't been good with Hannah.

In fact, they've been kind of a hell.

These last months, if she was having a hard day or we had a fight, I was always afraid she'd start using again.

I was just constantly on eggshells, and, uh, she could tell.

She blamed me for not trusting her.

And I see now that I-I blamed her for being an addict.

Blame, resentment, tricky stuff, you know?

Hard to... hard to let go of.

You were right...

What you said about addicts and romance, that, if the romance goes south, they'll likely turn to dr*gs.

You think that that's maybe what happened here?

Hannah and I got into a huge fight yesterday.

I stormed out of the condo.

The next thing I know, she's, uh... OD'd.

Oh, buddy. I'm sorry.

Yeah.

That's not the worst of it.

See...

I think I've been waiting for it to happen.

Where are we at?

She's sobering up.

You wanna talk to her?

Not yet.

This case got too personal for me.

I need to do some research and look into this more.

Hey.

Hey.

I just heard.

Kellie Lieu's surgery went well.

Congratulations.

Yeah, yeah.

I was being overly cautious.

I should've agreed with the LVAD way sooner.

Well, not necessarily.

It was a risky procedure.

Could've easily gone the other way.

You know, yesterday, I...

I moved out of my house.

I said goodbye to my son.

I have been thinking about him all day, wondering if I did the right thing, if he'll be okay.

I think those feelings clouded my judgement today.

You weren't wrong about me and kids with leukemia.

Every time I see one, I think about my little girl.

You know, we try to protect them as much as we can.

Until that last moment when we, uh, we can't.

Uh, all I'm saying is you're doing the right thing.

Yeah.

Owen'll be okay. I'll see you tomorrow.

See you tomorrow.

Now what?

I did some research and ordered one last test.

I owe you an apology.

We now know you have not been drinking.

Finally.

I gotta be honest with you. This is a first for me.

You have a condition called auto-brewery syndrome.

And because of it, the yeast in your gut turns certain carbohydrates into alcohol.

You never even have to take a drink.

Really?

Yes.

Why would this happen all of a sudden?

So you said Anita was on a paleo diet.

Very low carbs but she stopped.

Yeah, I was hungry all the time.

We're not sure why some people react this way, but that's probably what triggered it.

If you cut out simple carbs from your diet, you should be fine.

So Maggie's gonna discharge ya so you can get out of here. Okay.

And again...

I'm sorry.

Hey.

Hey.

Look... um...

You know, I've been thinking.

When I get out of rehab, I...

I wanna go somewhere...

Away from here. Get a fresh start.

You wanna leave Med?

Here, I'm just the addict doctor.

I always will be.

I was thinking L.A.

Decent weather for a change.

I want you to come with me.

Hannah...

I'm not gonna do that.

You don't have to decide right away, so.

No, I'm not coming with you.

I was afraid you'd say that.

See, the thing is, Will...

Without you...

I'm worried that...

I'm worried that I'll start using again.

I love you.

But I can't be the reason you stay sober.

It's not good for you and it's not good for me.

Who's gonna cut your hair?

Who knows?

Maybe in a year or so, you'll wanna come visit Disneyland.

Yeah. Maybe I will.

What?

Hey, I picked up a little Thai.

You, uh... you hungry?

I hadn't been out of the house in months.

I was going crazy.

I just wanted to see some friends.

None of them were sick.

Honey, I get it. I totally understand.

Jennifer had no idea that she had it.

She felt completely fine.

You know, sweetie. It's okay to feel bad.

It's okay. I'm really glad that...

Dad, of course I feel bad. I gave you COVID.

That's why you're mad at me.

I'm not mad at you.

Yes, you are!

You've been walking around the house acting like everything's fine, using that phony, calm voice but, clearly, it's not fine.

Why aren't you yelling at me right now?

Why would I yell at you?

Because I screwed up! I could've k*lled you.

I'm so sorry.

Can you forgive me?

Oh, sweetie. Of course I forgive you.

Of course I do.

And you know what?

I mean, I think you're right.

I think I have been angry.

And you know what? Maybe I...

Maybe I should have told you, but... but I know you didn't do it on purpose.

I didn't wanna make you feel any worse.

Here's the thing about your dad.

I can be pretty good with other people's emotions, but...

sometimes not so much when dealing with my own.

So I need you around to keep me honest.

Pad thai's probably getting cold by now.

So you know I'm not coming home tonight, right?

Yeah, I know. You're helping people.

But I miss you and I love you very much.

I love you too.

Nana and I are making cookies.

Oh, yeah? What kind of cookies?

Chocolate chip.

Mmm.

So you're having fun with Nana?

Yeah. Good.

I'm glad to hear that.

I'm gonna go now.

Oh, okay.

Bye, Mom.

Bye, sweetheart. Mwah.

BP 55/38. Sats at 60.

Maxed on pressors.

He's in multi-organ failure.

We've exhausted our options, April.

Turn up his morphine?

Yeah. And contact his wife.

April?

Hi, um...

I'm afraid it's his time.

Let me see him.

Fred?

Freddie?

I love you, honey.

And I'll miss you every day for the rest of my life.

But then... I'll see you again.

And we'll be together.

Forever.

I'm so sorry.

No.

Another week.

We remember those gone.

Let's share their names.

Helen-Mae Samuels, 85.

Her kids say she was a great cook.

Malcolm Grazer, 44.

Coached his son's little league team.

Maria Lopez, 58.

Dedicated, life-long school teacher.

Frederick MacNeal.

62, avid stamp collector, scout master, and beloved husband of Beverly for 40 years.