A Pediatrician Reviews: Chicago Med S1E2

And we’re back for round 2! On today’s episode of Chicago Med, my eyes have rolled completely out of my head.

Plot Summary

Manning and Halstead arrive at work together. Maggie invites Manning to girl’s night, saying her pregnancy hormones will “lure all the guys in” (ew).

Meanwhile Choi has gone out to his car because he forgot his badge, only to be handed a bleeding young woman. The dude who brought her to the ER says he found her on the ground a few blocks away. They work on stabilizing her – only to realize she just delivered a baby and the baby is nowhere to be seen. Trauma Fellow Man runs down the street to look for the baby and finds it (the fakest looking doll I’ve ever seen) in a backpack.

We come back from commercial break to find Choi insisting he can deliver a placenta because “he’s done it before” and OB is in a delivery. Manning dramatically says “I’m on the baby” which…I’d hope so, because she’s supposed to be the pediatrician (where’s the NICU fellow, is what I want to know).

Maggie assigns a patient with a sprained wrist to our baby med student Sarah Reese. The patient, an older lady, starts asking her about going to the beach. Sarah calls in Dr. Charles, who finds a bracelet on her wrist with contact info for her family. He kind of sasses Sarah for not recognizing the patient might have dementia based on the name she gave (“Connie Francis”, who was a singer, and yes I had to look it up).

Oh, turns out the girls’ night was a ruse – Maggie is conspiring with Manning’s MIL to throw her a baby shower!

Erica’s awake, and she’s 14. She breaks down crying and says she’s glad they found the baby. Manning is discussing the case with Trauma Man (I truly have forgotten his name) and Choi, who is annoyingly sanctimonious about the 14 year old panicking and says people have to be held accountable for their actions (which like…regardless of how you feel about this situation, is not the job of the medical system??).

Halstead is taking care of a seemingly hypochondriac man who thinks he’s having a heart attack. He tells him he’s had two normal EKGs, troponins, chest X-ray. The wife has a little snit about it being “all in his head” and strides out. Halstead gives him a cardiology referral for a stress test and sends him home.

There’s a pretty pharma rep wandering around the ER, and she zeroes in on Halstead as a target. They awkwardly flirt a bit and she asks them out to dinner. Manning then asks him to come to her baby shower but he’s now unavailable (I sense a love triangle brewing).

Maggie tells Rhodes (Trauma Man’s real name! I have been reminded) that his father called and wants him to call back. Hmm, mysterious.

Wrist injury lady’s (Carol’s) husband arrives to take her home – but Dr. Charles flags them down and has her walk. She’s got a “magnetic” gait and perfectly recalls what happened to injure her wrist, which they say isn’t consistent with Alzheimer’s and they want to run some tests.

Erica hemorrhages, and they take her up to the OR. Manning walks in there to watch (…what). Meanwhile the social worker tells Goodwin that Erica has been in the system for a while and she’s something of a problem child. They call Manning in, who says she’s reached the older sister who’s coming up. Rhodes dresses Choi down for doing the procedure himself instead of getting OB, and accuses him of letting his dislike for the patient impair his performance.

Halstead’s hypochondriac from earlier comes back in cardiac arrest. He’s in Vfib and they shock him back into sinus and start pressors. Halstead orders another 12-lead EKG. He wants to start nitric oxide to reduce afterload and buy time until the cath lab is ready.

Manning gets paged (to the PICU? Not the NICU? What is wrong with this hospital) where baby boy is getting a chest tube for his pneumothorax. They want to start nitric oxide because his oxygen is low and Manning goes to get a tank.

Halstead and Manning literally GET INTO A FIGHT OVER THE FUCKING iNO TANK. He tells her to “start thinking like a doctor, and not a pregnant woman.” Halstead pulls it out of her arms and walks away with it. Because he’s a huge dick. He continues to resuscitate his patient, who has lost pulses again, and gets ROSC again with sinus brady. They start amiodarone (…listen I don’t really remember ACLS but this all seems a little off to me) and go to cath lab.

The surgeon? interventional cardiologist? tells Halstead he stented two arteries, and that Halstead should have let his patient go. He tells the wife there are likely going to be deficits, and she has a little freakout at Halstead that he’s “turned her husband into a vegetable” (and…hits him).

In the PICU, because Halstead stole the iNO, they put the baby on ECMO. Then Erica’s sister arrives. She doesn’t seem excited about Manning’s plan to have them play happy family. After she talks to Erica she says she’s “come too far to get sucked back in”, and Manning’s outraged. She gets another chance to be outraged when Goodwin tells her the police are coming to talk to Erica. Choi goes in and tells Erica to emphasize to the police that she wanted her baby to live – and Erica runs away.

Rhodes’ dad shows up in the back of a limo and they have a tense conversation. Dad makes reference to him “working through his issues”. He wants to start over. Rhodes is emotional but not into it.

Carol gets a lumbar puncture because Charles thinks she might have hydrocephalus, and if she improves they’ll put a shunt in. When she wakes up, she knows her name and that she’s in the hospital. She also recognizes her husband! They dance together and it’s cute.

Halstead is staring at his dude’s chest X ray wondering what he missed…and he’s forgotten about his hot date. He calls her to cancel.

Montage: Sarah rides the bus home while listening to Connie Francis. Choi and Rhodes stare moodily at the baby’s isolette. Manning has her baby shower. The end.

Medical Notes

• Our trauma: I’m not seeing any primary survey or secondary survey, friends. REading off the vitals doesn’t count. Trauma Fellow Man orders an “istat ABG” and type and cross which…is not a bad start for a trauma found down.
• Please do not fucking put oxygen on the baby
• Sarah gets a “consult” by flagging down Dr. Charles in the ED. Mind you, she has not staffed this patient with anyone with a medical degree…and also this is not remotely how consults work
• Manning asks the NICU people to page her if anything changes with the baby…truly, truly not how any of this works. Maybe every once in a while you get invested and chart stalk someone afterward? But most ED attendings have strong professional boundaries and are focused on their patients in the ED, and after they leave don’t worry about them anymore (which is part of the appeal for many). Doesn’t make dramatic TV though.
• William Halstead, that is NOT how you pronounce “troponin”
• So it seems like maybe Choi is also a resident? Interesting. He seems old, but I guess he was a military dude so perhaps that explains it.
• FYI, ER doctors do not waltz into ORs to watch surgeries
• WHAT ARE THOSE COMPRESSIONS??? Those are so fake. Wow. Pathetic. Also, slow.
• Okay, let’s talk about this nitric oxide plot point. First of all, this is such an artificial scenario. Second of all, for infants/preemies it’s usually used for pulmonary hypertension, and there’s no indication that’s what’s happening here (Some searching suggests maybe it’s also used for other types of hypoxemic respiratory failure, although I’ve never personally seen that). And Halstead’s suggestion that they put the baby on ECMO also seems premature – have we maxed out the vent? Can’t say anything about the accuracy of using it in cardiac arrest, as I don’t know anything about adults, but a quick google suggests it might be a thing.
• Magnetic gait is a real sign of normal pressure hydrocephalus! Points for that one.
• …you can’t see a heart attack on a chest x ray. Take all the points away again.

Who’s Getting Fired Today?

Surprisingly, no one is getting fired! Halstead is definitely going to HR for that “pregnant woman” comment though. Also probably Manning for her comment to Choi.