A Pediatrician Reviews: Chicago Med S1E4

On today’s episode of Chicago Med, we encounter my least favorite type of storyline in all of medical television.

Plot Summary

A family with an adorable toddler in a bear hat is on their way in to the movie theater when shots ring out. In the ensuing stampede, mom and kiddo get trampled.

Dr. Rhodes is buying the ED staff lunch when the page comes through and the ambulances roll in. The shooting is a mass casualty event. We see a bunch of patients roll in, including our little family. Kiddo is unharmed, mom is in a bad state. After arriving in the trauma bay, she codes.

Sharon and Dr. Charles observe the full waiting room, and ruminate on the fact that both the supposed shooter and the man who shot him (a high school algebra teacher”) are on their way in to Chicago Med. Meanwhile Dad shows up looking for Mom and Kiddo, and Maggie takes him to see Kiddo while not mentioning the fact that his wife is currently arresting (not cool).

Manning is seeing a teenager who was dizzy and vomiting. Mom is a little overbearing about what she’s eating (definitely an “almond mom” as the kids say). Shooter comes in with multiple GSW to the abdomen and also codes…so they open up his belly bedside to clamp his aorta and roll him straight to the OR. Halstead keeps making snippy comments that imply they shouldn’t be helping this guy.

Some dude we’ve never met before (but who has “Neurosurgery” embroidered on his coat) is examining Mom Lucy. She has no response to pain, no corneal reflex, no gag, failed her apnea test…she’s brain dead. Her husband has given permission to donate her organs. Rhodes and the attending whose name I’ve already forgotten Dr. Zenetti are working on the shooter in the OR, with ongoing snarky commentary from others in the room. Rhodes makes a comment about how the bullets have caused so much damage to his hepatic vasculature that they’ll either have to sacrifice his liver or let him bleed to death (Oh shit, I see where this storyline is going and if I’m right it’s SO BAD).

Manning asks Dr. Charles for a consult on her teenager, who she suspects has anorexia. Dr. Charles mentions a “brand new FDA approved anti-nausea med” which he is going to give her so she can eat a burger (oh, I see where this is going too). Maggie and Sharon watch Lucy’s organs leaving the ER, and Maggie makes an astute observation: If there was a shooting at the movie theater, why have they only had one patient with GSW?

April is taking vitals on a pleasantly racist old lady who lied about being in the movie theater so she wouldn’t have to wait. She’s got headaches, has been coughing, and has a moderately elevated blood pressure. Halstead orders some basic labs, an EKG and a chest x-ray. She closes out the interaction by asking for Dr. Choi to take care of her because the “Orientals make the best doctors” (yikes).

Med student Sarah is suturing the forehead of the Algebra teacher who stopped the shooter, when Sharon comes by to say the detectives want to ask him a few questions. It’s some folks I vaguely recognize from Chicago PD. They suggest that maybe the shots he heard were coming from the movie…because the supposed shooter was a prankster who liked scaring people, and what he walked in with wasn’t an assault rifle, but a leafblower.

Oops.

Dr. Choi goes in to see racist old lady with Dr. Halstead playing his “assistant”. She has some enlarged lymph nodes in her chest and abnormal calcium levels, so they need to do a biopsy. Meanwhile, Rhodes talks to the prankster Peter’s parents, telling them that he needs a liver transplant to survive. They ask Rhodes to save their boy.

Teenage girl is absolutely demolishing a hamburger while her mom, Manning, and Dr. Charles watch…then she vomits (And suddenly the remains of the hamburger just disappear off the table to be replaced by a box of tissues, lol). Manning and Dr. Charles step out, and he reveals what he gave her was a tic-tac. Manning freaks out. Dr. Charles is much more concerned about the fact that Manning was allowing her personal history with anorexia (a college roommate who died) bias her toward a diagnosis that isn’t supported by the evidence. If the kid was anorexic, she wouldn’t have even tried to eat the hamburger.

Rhodes approaches Sharon about Lucy’s liver, which is supposedly on its way back since the intended recipient died pre-operation. Rhodes tries to convince her the organ should go to Peter; Sharon argues that there are other names ahead of him on the list and Rhodes fires back that none of them are in this hospital. Rhodes asks Sharon to ask the husband to direct donate the liver to Peter (W H A T THE ACTUAL F). She does. He says no – but then hands her the signed papers.

Dr. Charles sits down with the Algebra teacher guy to talk to him…but Sarah interrupts to let him know his CT is clear and he can go. He walks out of the hospital to get mobbed by reporters. Shortly after, he rolls back in as a trauma – he stepped in front of a car. After three rounds of epi Manning refuses to get off the chest so Choi can’t shock him…and he calls time of death after some intense dramatic staring.

Meanwhile teenage girl has normal abdominal X-rays and ultrasound. Mom is on her case about slouching, which relieves her abdominal pain. That gives Manning an idea, and she orders a CT, which shows SMA syndrome. She can either have a nasal feeding tube for a few months, or a surgery. Manning suspects they’ll opt for surgery since mom is so concerned with appearances. But the girl opts for the tube.

The Husband Man goes in to see the family of Peter, the prankster, and completely flips out on them (WOW WHO COULD HAVE PREDICTED THAT); he has to be muscled out of the room and then escorted out by security.

Racist lady doesn’t have cancer, the stuff on CT was “non-caseating granulomas”. Halstead tells her she has sarcoidosis, but because it’s usually seen in African-Americans, they ran genetic testing on her (!!!) and she is 12% African-American. (This is supposed to be some kind of satisfying “gotcha” but I’m genuinely horrified that they would present this as even remotely okay)

The episode closes with various people watching the news reporting on the liver donation and Algebra Man’s suicide – Rhodes is sleeping with his attending (spicy) and Sharon and Charles are at the bar.

Medical Notes

• “Walk-ins can wait” – I mean, not necessarily. That’s the whole point of triage!!
• When mom codes, Rhodes starts compressions and immediately calls for 1mg epi – this is all good, and consistent with the ACLS asystole/PEA algorithm. I’d like to see a little more going on though – they need to be cutting off her clothes, getting pads and backboard in place, getting access…
• Since Halstead’s needle decompression was successful in restoring Lucy’s pulse, we can surmise that she arrested due to a tension pneumothorax; this totally makes sense given her mechanism of injury and the vitals they threw out, so points for that
• Manning’s list of labs is not terrible to start with, but you have to ask before you do a Utox. She mentions food allergies as something to test for, but none of her labs will show that. Her history is also super incomplete – a syncope differential always includes cardiac arrythmias and seizures, but she didn’t ask anything that would help to rule in or rule out either – and tbh I’m not really sure why this girl is in an ER room right now given how many other traumas there are who are clearly higher acuity
• Okay also, why has no one spoken to this teenage girl alone? HEADSS exam please, people.
• But also like…unless this girl’s vitals are abnormal, no one is keeping her in the ER to work out if she has anorexia or not. Zofran, PO trial, discharge with Adolescent Medicine follow up. Even if she WAS diagnosed with anorexia, that is OUTPATIENT management unless she’s gotten to the point where its’s affecting her vital signs (which they don’t mention) or she’s at risk for refeeding syndrome (her labs are totally normal)
• HERE WE GO AGAIN. Organ donation. I have NEVER seen a medical show get this correct, and they usually get it wrong in ways that are both spectacularly bad and, I truly suspect, damaging to the public perception of the medical field. *Soapbox activates*
• Regarding racist old lady, just saying she was in the movie theater shouldn’t be enough to jump the line – triage! is! a thing! – but okay if she said she was there and had a headache I suppose they’d take her back to check her for a brain bleed.
• Lol Halsted no one says “C-X-R” out loud like that
• The EKG confuses me, but maybe this is an adult medicine thing? I wouldn’t have ordered one in this situation but almost none of my patients are at risk for heart attack so
• *Soapbox One*: BEING SUSPECTED OF A SHOOTING DOES NOT PUT YOU AT THE BOTTOM OF THE TRANSPLANT LIST?? Even being convicted of a crime is not an absolute contraindication to transplant. It would probably cause some amount of public outrage, but would not affect his listing status. In fact, the fact that he would die so soon without the liver would move him UP the transplant list.
• *Soapbox Two*: THEY DID IT AND I’M SO MAD. The liver would not come back to Chicago Med!! It would go to the next available recipient in the area that the original recipient was in (probably someone else at *that* hospital)!! Rhodes would not have known that Lucy and Peter were HLA matches!! Neither of them could know where exactly Peter is on the transplant list!!
• *Soapbox Three*: ASK THE HUSBAND??? ASK THE HUSBAND TO DIRECT DONATE THE LIVER?? THAT IS NOT HOW THIS WORKS WTFFFFFFF and it is SO inappropriate for anyone involved in either Lucy’s or Peter’s care to approach him about donation FOR THIS EXACT REASON. Which is why it does not happen! The organ donor network people are the only ones who discuss donation with the families!!!!!!
• Manning should really have called GI much earlier for a vomiting kid
• Why is the trauma surgeon doing a liver transplant?
• They lost all their resuscitation points again, because they were shocking a flatline (say it with me kids: YOU CAN’T SHOCK A FLATLINE). Shocking is for non-perfusing rhythms – it resets the heart. If there’s nothing to reset, then…no point
• *Soapbox Four*: No one would let these families meet, especially so soon. Jesus Christ.
• W h a t is this sarcoidosis storyline!! Yes, it’s true that its classically seen more often in African Americans…but that doesn’t mean a white person can’t have sarcoid. Also, you CANNOT run genetic testing on a patient without their consent. Not to mention that it has no medical relevance to her treatment…so how did he do it? No hospital lab is running ancestry tests. Also, genetic testing doesn’t result that quickly. But most importantly, the consent thing.
• LMAO Manning will “send a GI resident down” to put in an NG?? That’s a nursing task

Who’s Getting Fired Today?

There’s a lot of generally unethical commentary and behavior this week. Comments about the supposed shooter not deserving medical treatment are SUPER inappropriate and while I’m sure people do feel conflict and moral distress about situations like that, no one would actually suggest not giving him the same standard of care. The placebo trick is also morally questionable.

However, who is getting fired this week?

Sharon is getting fired.

Rhodes is also getting fired.

Oh my god and HALSTEAD IS GETTING THE MOST FIRED for running genetic testing without consent.

Guess we have made up for the last couple weeks!