ER
April Sexton: And easy on the CrossFit for a while, okay? Okay. Thank you. Just cleared Treatment 3. Just got to turn it over.
Maggie Lockwood: Sure.
April Sexton: Man, we're up again already?
Maggie Lockwood: Looks like it.
Sarah Reese: What's going on? Who are they?
Maggie Lockwood: Big brother. Hey.
April Sexton: Oh.
Maggie Lockwood: Up.
April Sexton: JCAHO.
Sharon Goodwin: Yeah, they're doing a surprise site survey.
Sarah Reese: Who's JCAHO?
Maggie Lockwood: The Joint Commission. They rate the performance standards of hospitals and certify them.
Sharon Goodwin: So far, JCAHO's reports have been positive. So let's keep it that way. Stick to protocols and with big smiles… Dr. Choi, we're gonna need some of your Navy-inspired discipline today.
Ethan Choi: Sorry, I'm with the paramedics today. Resident ride along.
Maggie Lockwood: Mm.
Ethan Choi: And discipline, that a nice way of saying I'm a tight ass?
Maggie Lockwood: Oh, yes. Tight.
Sharon Goodwin: I didn't say that.
Maggie Lockwood: And, uh, getting those docs in line, isn't that? the chief resident's job anyway?
Sharon Goodwin: Wonderful, the guy enforcing the rules is the one who's always breaking them.
Kendra Perrington: Yeah. Good luck with that.
Announcer: Code One team to the ED.
Connor Rhodes: What do we got?
Paramedic: Nathan Clay. 58-year-old male. "Peeds" versus auto. GCS 12. Vitals stable. Gross deformity to the left upper arm.
Treatment
Connor Rhodes: Right in here.
Nathan Clay: Ow.
Paramedic: He's complaining of chest and back pains.
Connor Rhodes: Mr. Clay, can you hear me? Mr. Clay? On my count. One, two, three. Central line and a CVC catheter. Right away. Airway's intact. Breath sounds clear bilaterally.
Nathan Clay: Ow!
Connor Rhodes: Tenderness in the left chest and thoracic spine. What happened here?
Sean Roman: He's walking with his wife on Michigan Avenue. Suddenly flips out, starts wailing on her. A couple of Samaritans jumped in to help out. He takes off right into traffic. Score one for, uh, karma.
Connor Rhodes: 12-lead EKGs, chest X-rays, CT of the chest, abdomen, and pelvis, with recons of the TLS spine.
April Sexton: On it.
ER
Laura Clay: Leave me... No. Leave me alone. I'm fine.
Paramedic: Laura Clay. 55-year-old female. GCS 15…
Laura Clay: I'm fine. I need to get to my husband.
Treatment
Connor Rhodes: Whoa, whoa, whoa. Ma'am, ma'am, ma'am. Okay.
Nurse: Heart rate's tachycardic.
Laura Clay: This is all my fault. Look, I blocked my fall with my hand, not my C spine. I'm neurologically intact.
Connor Rhodes: Technical. Are you a doctor?
Laura Clay: Yes, yes, I am.
Nathan Clay: Laura! Please...
Nurse: Dr. Rhodes!
Laura Clay: Honey, I'm here.
Connor Rhodes: Ma'am, stay right there.
Laura Clay: I'm right here.
Nathan Clay: There are too many of them!
Laura Clay: I'm here, my love!
Nathan Clay: Help me!
Connor Rhodes: 2... I need restraints. 2 of Versed and 5 of Haldol.
Nathan Clay: There are too many of th...
Laura Clay: No, not Haldol! Quetiapine. He's not abusive. He has Lewy Body Dementia.
Connor Rhodes: Wait, scratch the Haldol. 25 of quetiapine.
Nathan Clay: Laura!
Laura Clay: It's all right, my love.
Sean Roman: What the hell's Lewy Body?
Connor Rhodes: Debilitating form of dementia. Alzheimer's meets Parkinson's.
ER
Connor Rhodes: He took a pretty good whack. He's got a chest bruise, left first rib fracture, proximal humerus fracture.
Daniel Charles: How are his labs?
Connor Rhodes: It's all good. Calcium was elevated. I suspect he'll develop a kidney stone down the road, but it's likely he's had a few before.
Daniel Charles: Prior heart surgery?
Connor Rhodes: Says it was a quadruple bypass. Had it done at Northwestern five years ago.
Daniel Charles: He remembers the details?
Connor Rhodes: Yeah, he's lucid. Somewhat. All right, EKG is normal, but because of the prior heart surgery, I'm gonna repeat it every few hours. He's all yours.
Treatment
Daniel Charles: Mr. Clay? Mr. Clay, I'm Dr. Charles. How are you feeling?
Nathan Clay: My wife, Laura, where is she?
Daniel Charles: She's being treated right now, but will be in shortly.
Nathan Clay: I hurt her again, didn't I? This isn't the life she deserves.
Daniel Charles: Mr. Clay? Mr. Clay?
Street
Sylvie Brett: Damn, you got the online thing down, huh?
Ethan Choi: There was a time.
Desmond: Yeah, what's her name?
Sylvie Brett: Easy. She's taken.
Ethan Choi: Vicki. Doctor at the VA.
Sylvie Brett: Oh, man. There are so many female paramedics who are gonna be sorry to hear you're off the market. Couple guys, too.
Ethan Choi: Well, you let 'em down easy for me.
Sylvie Brett: All right. You sure you gonna be okay back here? 'Cause we can just throw Desmond in the back.
Ethan Choi: Eh, I'm fine. Ambo's like the Humvee. You sit where there's room. Comfort's not a factor.
Sylvie Brett: Well, good. This day's gonna go by quick then.
Radio: Ambo 61, 40-year-old male down in his home. 222 Bromley Avenue. Some kind of lower extremity insult. He's in severe pain, possibly trapped.
Desmond: Copy Main. Ambo 61 responding. All right, we're on!
Treatment
Tara: It doesn't make any sense. I've had Boomer since he was a puppy. He's super loyal. I leave the room for a second, he's looking for me.
Sarah Reese: I had a dog like that.
Tara: He might nip a little, but this was a full-on attack.
Natalie Manning: In my experience, dogs can be unpredictable. Even really friendly ones.
Sarah Reese: Sometimes if a dog's in pain, though, he... He wasn't.
Tara: We were playing tug of war, like we always do.
Sarah Reese: Dog bites shouldn't be stitched. They need to stay open so the wound doesn't become infected. Also, I'm gonna give you a tetanus shot and an antibiotic.
Tara: Boomer's healthy. He's had all his shots.
Natalie Manning: It's just a precaution.
Paul’s home
Neighbour: Paul's in trouble down there.
Sylvie Brett: Did you call 911?
Neighbour: Yes, I'm his neighbour.
Ethan Choi: Paul? It's the paramedics.
Desmond: Ooh. Ooh, that's ripe.
Ethan Choi: Man, look at this. He's a hoarder… What do you think?
Sylvie Brett: You good going in there?
Ethan Choi: I'm good.
Sylvie Brett: Okay. Uh, get the truck company here. Tell 'em they're gonna have to help dig us out, and grab me a second radio. And, uh, I'm gonna try and go in through the back door.
Desmond: You got it.
Ethan Choi: Paul! Everything okay?
Back door
Desmond: Third squad caught a high-rise fire. Dispatch is pulling a truck from up north to help us out. It'll be a while before they get here.
ER
Laura Clay: In the beginning, I wanted to think it would pass. Any wife would, but I'm also a neurologist, and I couldn't ignore his symptoms.
Daniel Charles: Oh, so you diagnosed the Lewy Body Dementia?
Laura Clay: Yes, but I got second and third opinions, and they both agreed it was LBD, and that was about four years ago.
Daniel Charles: Four years, really? You know, Nathan expressed deep regret to me about the pain that he's caused you. That kind of insight is rare for somebody who's been battling LBD for that long.
Laura Clay: Well, my husband was an engineer, and his brain is wired to solve problems. Last year, I retired early. I wanted to devote more time to his cognitive therapy.
Daniel Charles: Hmm, well, it's been working.
Laura Clay: There's moments when he's lucid. But more and more, it's this.
Connor Rhodes: Mrs. Clay, Nathan's latest EKG is still normal. I want to do another one in a few hours, but if it is good too, I'll discharge him.
Laura Clay: Thank you, doctor.
Connor Rhodes: Mm-hmm.
Laura Clay: I know that it would be better and safer for the both of us if Nathan went to a care facility, but if I do that, then it's over. And I'm not ready to give up our Sundays listening to opera. I know it's hard to imagine, but my Nathan is still in there. Last week he made me dinner, Florentine lasagna.
Daniel Charles: He can still cook?
Laura Clay: Well, meals take longer to prepare than they used to, but... He does it for me. He's fighting just as hard as I am… Hi, honey.
Treatment
Laura Clay: Everything's gonna be okay. Everything's okay.
Paul’s home
Sylvie Brett: How you doing, Ethan?
Ethan Choi: Fine, as long as I breathe through my mouth.
Sylvie Brett: Is it as tight in there as I think it is?
Ethan Choi: It's worse.
Sylvie Brett: Are you claustrophobic?
Ethan Choi: Didn't used to be.
Treatment
April Sexton: I mean, and Tate totally snores, but I don't mind. Oh, he does this thing where he shoots his dirty boxers into the hamper like a buzzer beater. Anyway, it's cute.
Maggie Lockwood: Oh, my God. You're in love.
Will Halstead: Whoa, whoa, whoa, whoa. What's that?
April Sexton: What's what?
Will Halstead: Used gloves go in the bio bin, not the trash.
April Sexton: Okay, those were actually clean though. They were on the floor.
Maggie Lockwood: Probably just got stuck to the pair that came out before them.
Will Halstead: Unless you're certain, it's bio. Come on, Maggie. You know the protocol.
Maggie Lockwood: I do. I've also been through this circus about a dozen times. JCAHO days are about patient care, not about a pair of latex gloves.
Will Halstead: Look, I'm already in the doghouse with Goodwin. If there's any chance of getting out, I want it. So by the book... By the book.
Maggie Lockwood: By the book.
Treatment
Laura Clay: Okay honey, eight across. It's five letters and the clue is rental agreement, and the first letter is L… I'm thinking the second is E.
Nathan Clay: L-E... Lease.
Laura Clay: Good. Good, honey. All right, next one. We're gonna do 23 down. Six letters. The clue is collects... With an S.
Connor Rhodes: What happened?
Laura Clay: I don't know. His blood pressure tanked.
Connor Rhodes: All right, bag and hang a liter bolus.
Nurse: Yes, doctor.
April Sexton: SATS are dropping. Intubate?
Connor Rhodes: Yep.
Nurse: Grab the bag and hook it up to the O2.
Connor Rhodes: All right, 20 of etomidate. 100 of sux. Let's bring in the FAST scan. April, give me some pressure.
April Sexton: Here, doctor.
Connor Rhodes: And I'm in.
April Sexton: Got it.
Connor Rhodes: Okay. Scan.
Nurse: Here you go. Heart rate 110.
Connor Rhodes: All right, belly's clean. Poor wall motion of the LV and a small effusion.
Laura Clay: He's bleeding internally?
Connor Rhodes: Dr. Charles.
Daniel Charles: Mrs. Clay, please, right over here.
April Sexton: SATS are back up. Oxygenation improving.
Connor Rhodes: It's not gonna matter if he goes into cardiac arrest. CT of the heart and great vessels. Let's get him ready to go.
ICU
Connor Rhodes: Laura? If we may? The blunt trauma from the car accident displaced one of Nathan's bypass grafts. His aorta is leaking blood.
Laura Clay: A pseudo-aneurysm.
Connor Rhodes: Mm-hmm.
Laura Clay: How bad?
Connor Rhodes: Right now it's just a slow drip. It hasn't ruptured yet.
Laura Clay: So there's still an opportunity to operate, repair the suture line, and plug the hole?
Connor Rhodes: Normally, yes.
Davis Downey: Your husband's prior heart bypass surgery significantly increases the difficulty of the operation. His odds of surviving the procedure plummet.
Laura Clay: So if surgery isn't a viable option, what is?
Connor Rhodes: Given the circumstances, we feel the safest choice is to make Nathan comfortable.
Laura Clay: How long?
Davis Downey: We can't be certain. A day, a week, maybe a few months until the aneurysm ruptures.
Connor Rhodes: We're very sorry.
Paul’s home
Paul: Help. I can't move.
Ethan Choi: I'm coming, Paul.
Parrot: Don't touch that!
Ethan Choi: What was that? Ah!
Sylvie Brett: Ethan, what happened?
Ethan Choi: Got bit by the lid of a tin can.
Sylvie Brett: Truck company is almost here. They're going to clear a path to get the stretcher through.
Paul: Please, hurry!
Ethan Choi: Hold on, Paul!
Treatment
Martin: Oh, thank God. I haven't been able to pee in over 16 hours. I thought I was gonna explode.
April Sexton: Brachytherapy for prostate cancer?
Martin: Two days ago. My urologist said it was the way to go.
April Sexton: Who's your urologist? I'll call and tell them you've experienced a blockage.
Martin: Dr. Mason, over at Advocate South. Uh, contact info's, uh, in my phone in my pants pocket… Oh, sorry.
April Sexton: Oh, whoa, whoa, whoa, whoa, whoa, whoa.
Maggie Lockwood: Everything okay?
April Sexton: Just a little spill. I got it.
Maggie Lockwood: Okay, hold on. I'll call environmental services and have them send a janitor.
April Sexton: It's just pee. I've cleaned it a thousand times.
Maggie Lockwood: Yeah, but not with JCAHO and Robocop Halstead on the prowl. By the book, remember?
April Sexton: Oh, man. I think the seed came out. It's radioactive, right?
Maggie Lockwood: Oh, it did. Okay, I'll call Urology instead.
Hallway
Daniel Charles: Cath lab for a cardio angiogram?
Connor Rhodes: Should give a better view of Nathan's pseudo-aneurysm and hopefully help me estimate a timeline for his wife.
Daniel Charles: You mind grabbing me an MRI of his head while you're up there?
Connor Rhodes: Brain scan? His injuries don't necessitate it.
Daniel Charles: It's not for him. It's for me.
Connor Rhodes: Uh, Dr. Charles.
Daniel Charles: Dr. Rhodes, his awareness and gross motor skills are just too strong for somebody who's been battling LBD as long as he has. No amount of cognitive therapy in the world is gonna outthink this disease to the degree that he appears to be.
Connor Rhodes: Laura and two other neurologists have all agreed on the Lewy Body diagnosis. You think they're wrong?
Daniel Charles: I don't know what to think. That's why I need the scan.
Connor Rhodes: I need the wife's consent.
Daniel Charles: Hasn't she been through enough? I'm just trying to spare her some false hope here. Um.
Man: Hello.
Daniel Charles: Gentlemen.
Man: Doctors.
Connor Rhodes: JCAHO day isn't exactly the time to be sneaking in unauthorized tests.
Daniel Charles: I don't know what to tell you.
Connor Rhodes: Okay.
Daniel Charles: Thanks, pal.
Connor Rhodes: Mm.
Street
Firefighter: What've we got?
Sylvie Brett: Hey, guys, start clearing out!
Paul’s home
Parrot: Don't touch that. Get away. Get away.
Ethan Choi: There's a second person. I'm hearing another victim.
Sylvie Brett: Ethan, the neighbours seem sure it's only Paul in there.
Parrot: Don't touch that!
Ethan Choi: There's someone else here.
ER
Will Halstead: Dr. Perrington, got a hemoptysis patient. Chest X-ray says it's a COPD, but I think he needs a bronch. You want to take a quick look?
Kendra Perrington: Really? The esteemed Dr. Halstead needs my help with a patient. I'm honoured.
Will Halstead: Look, I, uh... I'm sorry about what happened the other day.
Kendra Perrington: You want a consult, page my resident.
Treatment
Sarah Reese: Okay, no redness, no inflammation. Looks good.
Tara: So I can go?
Natalie Manning: The nurses are working on your discharge paperwork right now. Your wound should heal in about seven days or so. Until then, irrigate them and keep them covered. You all right?
Tara: Oh, just itchy and a little sweaty.
Natalie Manning: Mind if I take a look? No rash. Could be an allergic reaction to the antibiotics. You do feel warm though.
Sarah Reese: I'll get a temp.
Tara: Oh, my sister checking in. I left Boomer with her. She's not a dog person either. I get the impression they're not for you.
Natalie Manning: I've treated a lot of dog wounds, especially on kids.
Sarah Reese: It's 99.4. Was normal at intake. CBC and CMP?
Natalie Manning: Yeah.
Tara: I'm not out of here, am I?
Natalie Manning: Sorry. Itching and fever, even a low one, could be more than an allergic reaction.
Sarah Reese: Someone will be with you shortly.
Paul’s home
Ethan Choi: Paul, is there anyone else in the house?
Paul: No, no, it's just me. You've got to hurry!
Ethan Choi: Ah! Ah!
Street
Sylvie Brett: Ethan, what happened? Are you okay?
Paul’s home
Ethan Choi: Ahh!
Office
Natalie Manning: What's all this?
Will Halstead: Well, it's pretty clear an attending job at Med isn't gonna happen.
Natalie Manning: You don't know that.
Will Halstead: Just being realistic. Perrington's on the hiring committee. She hates me. Not to mention Goodwin.
Natalie Manning: But really, Miami, Will? I've seen you sunburn walking from the ED to your car.
Will Halstead: Hey, got to go where the jobs are. No coffee. JCAHO day.
Natalie Manning: Right.
Hallway
Laura Clay: I don't understand. There should be atrophy, heavy degeneration, tangled cells in the white matter. When was this taken?
Daniel Charles: About an hour ago. I'm sorry. I had a hunch. I rushed it. I really should have...
Laura Clay: That is a healthy brain. There's no disease. This means that...
Daniel Charles: Nathan doesn't have Lewy Body Dementia.
Laura Clay: He has the symptoms. Keeps getting worse. Practically a textbook case. How?
Daniel Charles: Take a look at this cross section we took during the MRI. Notice the adenoma, benign tumour, in the parathyroid gland.
Laura Clay: So you think this is all hormonal irregularity?
Daniel Charles: Elevated parathyroid hormone is consistent with increased calcium and cognitive impairment. Nathan has both.
Laura Clay: Yes, but he also has hallucinations, physical aggression. You don't see that in patients with hyperparathyroidism.
Daniel Charles: That's where his recent bypass surgery makes him unique, okay? The beta blocker he's been taking ever since causes increased levels of violent behaviour in a select amount of patients.
Laura Clay: Oh, my God… A hormonal imbalance with a medication side effect… Why didn't I see that? The clues were right in front of me.
Daniel Charles: Because they mimic the symptoms of Lewy Body Dementia to a T, and four years ago that adenoma would have been so small no scan could have caught it. Look, I'm just telling you that presented with the same evidence, I would have done exactly the same thing, reached exactly the same diagnosis. Anybody would have.
Laura Clay: You didn't. I did. And if I had caught the PTH four years ago, Nathan doesn't run into traffic, doesn't get hit by a car. Today never happens. He's dying and it's entirely my fault.
Paul’s home
Parrot: Don't touch that!
Paul: Help. Please, please anybody!
Parrot: I need help!
Street
Sylvie Brett: Ethan. Ethan, talk to me… Ethan, do you copy?
Desmond: Let's go.
Firefighter: Living room's clear.
Paul’s home
Paul: Thank God.
Ethan Choi: Paul?
Paul: Help me, please.
Ethan Choi: Paul, I'm Dr. Choi. Okay, your heart's racing. When's the last time you had any fluids?
Paul: My leg, burned it. Yeah.
Ethan Choi: I see that.
Parrot: Don't touch that.
Ethan Choi: How did this happen?
Paul: I was cooking. I tripped and spilled a frying pan, grease.
Ethan Choi: This didn't just happen. This burn is thick, leathery. 24 hours old?
Paul: I guess.
Ethan Choi: Why didn't you seek help sooner?
Paul: I didn't want anybody to see how I live.
Ethan Choi: Okay, I'm here now. Gonna take care of you.
Treatment
Dr. Harper: Brachytherapy seed. Yep, doesn't happen often, but it can get expelled in the urine.
Maggie Lockwood: So, um, how radioactive is it?
Dr. Harper: To us, harmless. Still, don't touch it with your bare hands.
Maggie Lockwood: Whoa. So you're not gonna dispose of it?
Dr. Harper: Not on JCAHO day. Sorry. Call the radiation safety officer.
Maggie Lockwood: Oh, man. Here we go.
ICU
Laura Clay: I get it. You didn't do Nathan's bypass surgery. You don't know what you're walking into. I can get you every angio he had. You will know exactly where the surgeon placed every suture.
David Downey: The bigger issues are the adhesions and scar tissue that have formed over the last five years. We can expose a healthy heart in 10 or 15 minutes. After a quadruple bypass surgery, it could take hours. An infinite number of complications can arise.
Laura Clay: When I decided to make Nathan comfortable, I believed he had a neurological death sentence. Now it's a whole new world. The dementia can be reversed.
David Downey: I understand, but the fact that he doesn't have LBD doesn't make the surgery any easier. Nathan's odds of dying in that operating room are just as high as they ever were. It's still my recommendation to not operate. I'm sorry.
Connor Rhodes: I'll do the surgery.
Laura Clay: Thank you. Thank you for giving us a second chance.
Connor Rhodes: Difficult is not impossible.
David Downey: Hmm.
Paul’s home
Ethan Choi: Brett, how close are you?
Sylvie Brett: Ugh, Ethan, finally. You okay?
Ethan Choi: I'm fine, but Paul's got a serious third degree burn that needs to be released in the ED. ETA?
Sylvie Brett: I think we're almost to the kitchen. We need more room for the gear.
Parrot: Don't touch that! Get away, get away.
Sylvie Brett: Who was that?
Ethan Choi: The other person I heard, a parrot. Look, you still have the hallway to deal with and Paul's foot's still swelling. No pulse in the instep or ankle.
Sylvie Brett: All right, uh, we're coming as fast as we can.
Paul: But not fast enough?
Ethan Choi: Okay, Paul, here's the deal. Your skin's so burned, blood can't get in or out of your foot. I'm gonna cut into your leg on both sides of the burn to release the pressure.
Paul: Here?
Ethan Choi: I wait any longer, you're gonna lose your foot.
Paul: But... Is it gonna hurt?
Ethan Choi: Already pushed morphine in your IV. That'll help.
Paul: But I'll feel it?
Ethan Choi: Focus on me, not my hands. It'll be over before you know it. Okay? Deep breath. Then exhale… Keep breathing, Paul. Keep breathing. Big breath. Bigger exhale… Done. Good job, Paul. Good job.
Treatment
Tara: A high white cell count, what does that mean?
Sarah Reese: You probably have an infection.
Tara: From Boomer?
Natalie Manning: It's possible. Have you felt sick recently?
Tara: No, not really. I mean, every now and then my throat aches a little. It doesn't really bother me though.
Sarah Reese: Hmm. Hmm, the lymph nodes are swollen, consistent with an upper respiratory infection.
Natalie Manning: Let's get a rapid strep test.
Sarah Reese: What kind of dog is Boomer?
Tara: Boxer bulldog mix. A rescue. When I went to the shelter, all the dogs swarmed me, but Boomer hung back. Not because he was shy. It was a move so he'd stand out. He was playing me.
Sarah Reese: Smart dog. I'm gonna swab the back of your throat… I'll get this to the lab.
OR
Connor Rhodes: I'm doing what I think is right. Nathan's mental impairment is due to a pea-sized tumour that is easily removable. A 45-minute operation will cure him.
David Downey: But first, he has to survive this monumentally difficult surgery.
CMed entrance
Nurse: I'm sorry, you can't bring your dog into the hospital.
Dana: It's my sister's dog. She's somewhere in the back not answering her texts.
Nurse: Only service dogs in the ED. I'm sorry.
Sarah Reese: Oh, is this Boomer?
Dana: How'd you know?
Sarah Reese: I've been taking care of Tara. She said he was a boxer bulldog mix.
Dana: I thought it was only gonna be one or two hours. It's been five. Is she okay?
Sarah Reese: She spiked a low fever. We're testing for strep.
Dana: Strep? That's nothing. Okay, good. Look, I have to go to work. There's no pets allowed in my building. He barks one time and I can get evicted. I'm sorry, there's nowhere else to take him.
Sarah Reese: Um, no, no, no. I can't take this... I know. It all happened really fast. What do I do?
Will Halstead: Get him out of here. Now.
Sarah Reese: But where do I take...
Will Halstead: Reese, I don't care where. Just out.
Earl: Hey, look at this guy.
Sarah Reese: Yeah, Earl, this is Boomer. Could you watch him for a minute? But don't get too close because...
Earl: Oh, come on, fella. Come on, guy. Let's go. Come on, big boy.
Sarah Reese: Hey. Okay. Okay.
Paul’s home
Paul: When I'm out, the city will condemn my home, won't they?
Ethan Choi: Fresh start, I guess.
Paul: Get away. Don't touch that.
Parrot: Don't touch that.
Firefighter: There they are. Ethan.
Ethan Choi: Hey, guys.
Sylvie Brett: Hey, you okay? For a second there, it sounded like...
Ethan Choi: Little hairy for a while, that's all.
Sylvie Brett: Escharotomy in the field. Damn, nice job.
Waiting room
Daniel Charles: One across. Six letters. Bread, milk, eggs. Thoughts?
Laura Clay: Staple.
Daniel Charles: Nice.
Paul’s home
Paul: Thank you.
Ethan Choi: Sure.
Sylvie Brett: All right, guys.
Firefighter: Got it, clear. Lift him up.
Parrot: Don't touch that.
ER
Sarah Reese: Dr. Manning, uh, Tara's rapid strep came back negative.
Natalie Manning: Okay, so we're back at square one. You know what, let's run a, uh...
Waiting room
Earl: Easy! Easy. I'm sorry. I am so sorry.
Sarah Reese: Hey, Earl, what's going on?
Earl: I don't know what happened. Twenty people petted this dog, and this patient is the only one he barked at. Come on, boy. Come on. Come on, Boomer. Come on, come on, Boomer.
Natalie Manning: Let's run an infused CT chest and abdomen on Tara.
Sarah Reese: Oh, I've heard stories.
Natalie Manning: Mm-hmm.
Sarah Reese: Yeah.
OR
David Downey: Easy. Snakes in the grass. Bypass grafts are buried in the scar tissue, tough to see. Soften your grip... An... And go slow.
Connor Rhodes: I see it.
David Downey: Mm-hmm.
Connor Rhodes: Proximal pseudo-aneurysm of the LAD bypass graft.
David Downey: Let's cannulate and get him on the pump so we can do the repair.
Connor Rhodes: No, I don't need the pump. It just needs a single repair stitch. I can do it on the beating heart. 8-0 suture.
Nurse: Suture.
Dr. Vorspan: EKG's ischemic. STs elevation.
David Downey: Pseudo-aneurysm's ruptured. He's bleeding. 8-0 suture to me.
Connor Rhodes: I've got the better angle.
David Downey: Dr. Rhodes.
Connor Rhodes: I pushed for the surgery. I can't lose him.
David Downey: I'll get you better exposure. There.
Connor Rhodes: Going to put a second stitch in now.
David Downey: Don't back-wall the graft.
Connor Rhodes: Bleeding has stopped.
Dr. Vorspan: EKG's improving. Pressure's good. We're out of the woods.
Connor Rhodes: Not yet. I want to check his other bypass grafts. Something goes wrong in the future, no surgeon's gonna open his chest a third time.
Treatment
Tara: Lymphoma. I have cancer?
Natalie Manning: The next step is a biopsy to determine exactly which kind.
Tara: But I'm only 26. I go to the gym every day. I don't smoke.
Natalie Manning: I know. It's not fair.
Tara: But I don't feel sick.
Sarah Reese: Well, that's because it was caught early.
Natalie Manning: You have time to get way ahead of this.
Sarah Reese: Mm-hmm.
Tara: The lymph nodes are around here, aren't they? Boomer's been nipping at me for a month. Always right there. Do you think he knew?
Natalie Manning: Maybe. It seems some dogs can smell cancers, even in the very early stages.
Sarah Reese: Yeah, he wasn't attacking you. He was trying to protect you.
ER
April Sexton: Maggie, what's going on with Treatment 4? We don't have the space for this...
Maggie Lockwood: I know, I know. It's been all day. Dr. Halstead, environmental services hasn't shown up yet. I can't even get an estimate as to when they will.
Will Halstead: I'll go see them in person. I'll drag someone down here if I have to.
Maggie Lockwood: Knock some heads. I need that room back.
ICU
Daniel Charles: How's he doing?
Laura Clay: Well.
Daniel Charles: Good. How are you doing?
Laura Clay: As a neurologist, Lewy Body Dementia was my worst nightmare. I'd seen so many cases, and I'm wondering if it influenced my diagnosis.
Daniel Charles: Hmm. Medicine, you know. Imperfect science. Practiced by human beings, no less.
Laura Clay: Four years we could have been doing CTs, but I had an answer, so there was no reason to continue radiating his brain. I robbed Nathan of his mind. I imprisoned him… I drained our savings. Squandered our time together, time that we can never get back. How am I gonna tell him what I've done? He's never gonna forgive me.
Daniel Charles: Your husband's gonna forgive you, Laura. I want you to trust me on that. Your struggle, if I may, is figuring out how you're gonna forgive yourself.
Connor Rhodes: Vitals are stable. EKG looks good.
David Downey: Cleveland Clinic has an axiom. Emergency surgery on a healthy heart? Yes.
Redo surgery for a repaired heart? Yes. Emergency surgery for a repaired heart? No, because overwhelmingly, those patients die on the table.
Connor Rhodes: I couldn't do nothing.
David Downey: I suspect it was ego more than altruism. Great surgeons know the balance. You're confident, not arrogant. I like that, Dr. Rhodes. Nice job today.
Street
Sarah Reese: You're good. You're good. Good boy. Good boy. Don't come from above. Come from the front so he can see you, and hold out the back of your hand first.
Natalie Manning: Okay.
Sarah Reese: Come on, buddy.
Natalie Manning: Yeah?
Sarah Reese: Yeah.
Natalie Manning: Hey, there. Did you ever hear that origin story about dogs? In Eden, humans and animals got along, even spoke the same language, but when Adam and Eve sinned and God drove them out, a great chasm opened up between people and animals. And as the chasm grew wider, at the very last moment, a dog leaped across it to be with us.
Sarah Reese: That's a great story.
Natalie Manning: Yeah.
Sharon Goodwin’s office
Sharon Goodwin: Come in.
Natalie Manning: Ms. Goodwin, can I talk to you for a moment?
Sharon Goodwin: Quickly, I'm on the homestretch with JCAHO, and I don't want to let up now.
Natalie Manning: I know my voice isn't official, but I'd like to put in a good word for Will regarding the open ED attending position.
Sharon Goodwin: Really?
Natalie Manning: It'd be a shame to lose him. He's a great doctor. He cares about this hospital.
Sharon Goodwin: Just a few weeks ago you asked to be taken off his shifts.
Natalie Manning: We don't always see eye to eye, but his heart is in the right place.
Sharon Goodwin: Well, Dr. Manning, I'm glad your opinion of Dr. Halstead has changed.
Natalie Manning: Okay.
ER
Maggie Lockwood: Dr. Halstead, environmental services are on their way?
Will Halstead: Nope. Turns out, every department in the hospital's calling ES to handle things they normally take care of themselves. Be tomorrow before a janitor shows up.
April Sexton: Ah, bureaucracy.
Treatment
Will Halstead: Whew. Mm… There. The room is yours again.
Maggie Lockwood: Against protocol?
Will Halstead: I won't tell if you won't.
April Sexton: Huh, guess that means I get to clean this up now the way I wanted to eight hours ago.
Will Halstead: You know, toss me a pair.
April Sexton: Oh?
Will Halstead: You know, the kind that, uh, stick to yours when you pull 'em out.
April Sexton: You want in?
Maggie Lockwood: Heck yeah. We've come this far. And they call you Robocop.
Will Halstead: Robocop?
ER
Sharon Goodwin: Katrina. Reese, come with me.
April Sexton: Uh-oh.
Maggie Lockwood: Yeah, I've seen that look.
Sharon Goodwin: Dr. Rhodes. Everyone. Look, we all know how important JCAHO site visits are. Yet, despite what I said about the rules, my team ordered tests on the sly, brought a dog into the ED, and handled radioactive material.
Daniel Charles: Sharon, you have every right to be upset. Really. But we can't really be ignoring the, uh, the second law of thermodynamics here. Now, can we?
Sharon Goodwin: How's that?
Daniel Charles: Well, systems do tend to degenerate into ever more disordered versions of themselves, right? I mean, look around you. All we're doing here, all day long, is battle the universe's desire to fall apart.
Ethan Choi: Yeah, should've seen the house I was in today.
Daniel Charles: I'm just saying, I love rules. We all do, but in bringing order to disorder, every now and then a couple gonna get bent.
Sharon Goodwin: Nice try, Daniel. But the good news is JCAHO didn't catch any of you, so we keep our top rating… I'll see you all tomorrow… Second law of thermodynamics. Please.
