A Pediatrician Reviews: Chicago Med S1E5

On today’s episode of Chicago Med, none of these doctors went to medical school.

Plot Summary

We open on the team dramatically rolling a patient into the OR as a group of family? Friends? watches in horror. As they start to move him to the OR table, we see that it’s one of the firefighters from Chicago Fire (#crossover). Rhodes says he’s bleeding too much and needs to open him up. The anesthesiologist is struggling to intubate so Rhodes says he’ll thread a wire up through the neck to guide him (huh?? what about, like, a CMAC or fiberoptic??) and he’s successfully intubated. Rhodes starts packing the abdomen.

Zanetti comes in. Rhodes tells her firefighter man has gotten 4 units of blood and 4 of plasma and they’re going to send 6 more to angio (angiography). Zanetti makes some snide comments about “if there’s any left” because he’s type AB, and how she bets Rhodes is kicking himself for not taking him to angio when he first came in (uh, girl, you’re the attending, you could have overridden him). Rhodes finishes repairing the diaphragm and they pack up for angio. Cut to the title sequence.

Sarah Reese is getting coffee on the roof (why is the coffee station on the roof) and some weird dude makes an issue of her taking the Splenda. Meanwhile Choi is taking care of Jessica Pope, found by the fire department “with a bag over her head” and currently intubated on a vent “in a coma”. She had a bone marrow biopsy (uh, why?) that looks like it was “blasted by chemo”.

Sharon asks Dr. Charles to look through Jessica’s personal effects (brought in by the firefighters). Chicago PD lady comes in (#crossoversquared) and says the evidence is pointing toward suicide, as only her prints were at the scene. Halstead’s brother (also a cop) asks him he would have waited so long to take Hermann (the firefighter) to the OR and Halstead totally throws Rhodes under the bus.

Manning is going to see an 80 year old lady. Cop!Halsted makes a comment about her being a pediatrician – Maggie interrupts to say she did a combined peds-ER residency (not a thing) so she sees “everybody” (friends, that’s called Family Medicine. Or…just regular emergency medicine). Manning’s old lady is lying in the bed completely unresponsive to questioning and no one is worried about this – including her useless son who says he “doesn’t know” if she has dementia and that last he heard she was being treated for mouth cancer. Manning looks in her mouth (that’s your whole exam? Girl your dual residency failed you) and says she is going to start her on antibiotics and run some tests.

April introduces her baby brother med student to Maggie and the other nurses. They pawn him off on Sarah Reese for a tour. Sarah starts asking Choi about running more tests to investigate the cause of Jessica’s bone marrow depletion (it’s the focus of her research) and he’s not interested in hearing it so basically says “do whatever you want”. Meanwhile Dr. Charles is unconvinced Jessica committed suicide because she has an upcoming round trip ticket to Paris. He asks Halstead if his policeman brother would do him a favor.

Sarah takes Jessica’s samples to the lab for a “STAT mass spec” (lol) and…the tech is the weird dude from the roof. They have an awkward little moment but he says he’ll run the test.

The firefighters have taken Halstead’s comment that he would have gone in sooner to heart and head firefighter man goes to confront Rhodes, which he does in the most aggressive way possible. Rhodes is a dick about it, and firefighter man is a dick right back. So then Rhodes goes and is sad about it, and Zanetti comes to comfort him – he asks if she said something to them about mishandling Hermann’s case and she gets suuuuper offended and says maybe she needs to “reassess” their relationship.

Rhodes sees the Halstead brothers talking (Halstead asking Cop!Halstead to “take another look” at Jessica’s case due to Dr. Charles’ hunch) and his suspicions are raised about who might have actually said something to Fire.

Meanwhile Choi grabs Noah (April’s brother) to see a GSW rolling in. Choi does the laziest primary and secondary surveys and asks for X rays. There’s blood in the rectum so he thinks the bullet exited from there. He orders 5 of morphine. Kid wakes up and says he was doing a drug deal and ran when the guy pulled a gun and his leg hurts. Choi adds leg films – the bullet’s in the knee. No pulse in the extremity so they’re going to CT for an angiogram.

Manning walks in to the old lady’s room and the nurse tells her her fever is up, pressure is down, and “now she’s not responding” (Um, she wasn’t responding earlier either??). Manning says it could be the sedation (what sedation?? why on earth would this woman be sedated?) but she’s also “uremic, acidotic, and her BUN is through the roof” (please see below). She tells the nurse to take out the PICC line (…please see below) and broaden her to Zosyn. The son comes in to ask what’s happening and Manning says the woman has a urinary tract infection but more importantly her kidneys are shutting down and “we don’t know why” (um.. because she’s septic and hypoperfusing her kidneys??).

Awkward boy comes back with the results and is sad to have missed Reese, who is in radiology (aw, he’s got a crush) – but Noah takes them. Angry firefighter is flirting with April…and then kisses her in the elevator. He convinces her to have dinner with him tonight. Noah gives Dr. Choi the mass spec results, and takes credit for the idea. Reese overhears and is not happy.

Cop!Halstead brings in a restored document from her apartment – it’s a suicide note. Jessica didn’t kill herself because of the cancer, though – it’s something else, but the restoration is incomplete (“can’t live with the betrayal”. Maybe a lover. Choi finds that odd, because she’s dying of an overdose of chemo and never had cancer in the first place.

Maggie and Manning are touring the L&D floor and Manning is being snarky about it; the tour lady makes some passive aggressive comments back, and Maggie shuts it down.

Rhodes pages Zanetti to tell her he has trust issues and that’s why he accused her before. They make up. Rhodes gets stat paged to the ED for a woman who had a seizure in the street and then got hit by a car. Also, she has a chemo port (I see where this is going). Halstead says the actual dumbest thing I’ve heard in my life (see below), and he and Rhodes argue about what to CT (Halstead says head only, Rhodes says whole body). Halstead admits to sharing his opinions with angry fireman (Jay). While they are arguing, the woman goes into VTach and codes. They aren’t able to get her back.

Reese confronts Noah about taking credit for her idea to order the mass spec. Noah tries some “you know how med school is” BS but (unconvincingly) agrees to come clean to Choi. He asks Sarah not to tell April. (Messy, messy, messy).

Meanwhile Manning is telling Halstead about her mystery patient, implying that the chemo regimen she’s on should not have affected her kidneys to that degree (..again, not sure why sepsis isn’t reason enough to have kidney failure – I’ve certainly seen it). Halstead tries to get Manning to talk to the dead girl’s pregnant girlfriend because she’s gone through the same thing, and Manning is snarky about it, but does.

Dr. Charles and Sharon tell Rhodes they want to expedite Dani’s (dead girl) autopsy, because they suspect that her case may be related to that of Jessica Pope. Meanwhile, Halstead tells Cop!Halstead not to ask him any more hypothetical questions because he had said what he said to him in confidence.

Old lady is on dialysis in the ER (instead of the ICU), her pressure is dropping, and Manning freaks out because she “won’t arouse, she’s not protecting her airway” (Oh, NOW you’re concerned?). She calls for a crash cart and intubates. Dr. Charles brings up the suggestion that…maybe Old lay (carol) never had cancer in the first place and maybe Manning should run some biomarkers.

April and Noah have a little moment and he convinces her to let him order a pizza and study with her tonight (oops, did she forget about her date??).

Hermann codes (and we get to see a closeup with the worst NGT tube tape job I’ve ever seen him my life). Rhodes thinks he has a tension pneumo and snaps when Jay questions him. He does a needle decompression and then realizes the chest tube is clotted off. Jay realizes Rhodes is not an idiot after all.

Rhodes and Halstead get paged to the autopsy suite (not a thing) where Dr. Charles tells them Dani OD’d on chemo, and never had cancer. After a commercial break, they’re in Sharon’s office trying to figure out the connection between all their fake cancer patients; she’s going to look into it.

April tries to postpone her date with Jay, and he gets heated – he thinks she’s always putting Noah ahead of herself, and that she should be the one going to medical school. April isn’t happy.

Lab boy tells Sarah he just delivered another mass spec, and that she must be “some kind of hero” – which, no, because Noah took the credit. Seems like Sarah may think he’s cute too based on how she (almost) asks him out for a cup of coffee.

Old lady Carole opens her eyes. But plot twist – her biomarkers showed she never had cancer. She was also overdosed on chemo. Dr. Charles thinks someone is doing this deliberately, and Sharon has called the police. Cut to black.

Medical Notes

• This opening sequence is mostly fine. Using a guidewire for intubation is an actual technique called retrograde intubation, but I’m not sure about jumping straight to that before trying a bougie, a fiberoptic, etc. The patient also doesn’t really have a reason to have a difficult airway so I think the writers just wanted to show something cool and dramatic.
• Ok first of all, why would the trauma patient found down at the scene get, of all things, a BONE MARROW BIOPSY?? That’s not something we run just for kicks. It’s also not something that comes back this quickly – the impression I got is that we are currently later the same day from the fire.
• This show really has no understanding of how medical training or specialties work. Again, there is no such thing as a combined pediatrics-ER residency. Pediatric emergency medicine is fellowship that you can reach from either a pediatrics residency or emergency medicine residency, but you don’t need it to see kids in most ERs (only for children’s hospitals, generally).
• I’m so confused about why we aren’t more concerned about a completely nonresponsive old lady who as far as everyone is aware is usually alert and oriented??? Manning calls her “disoriented” but that’s not disoriented, that’s fucking obtunded. True that UTIs can classically cause disorientation/dementia-like symptoms in old people (half a point for that), but minus one million points for the shittiest most incomplete exam I’ve ever seen and not getting a STAT head CT.
• Points for the very consistent vital signs on the screen – Rhodes says Hermann’s pressure his low and we appropriately see 90s/40s on the screen (normal for a kid, low for an adult).
• Choi says “ABCs intact” which means airway/breathing/circulation and is not something you could tell from looking at someone for two seconds – you need to listen to breath sounds with a stethoscope and check pulses/perfusion, at a minimum. The X rays are reasonable for a trauma, but where are the labs?? Also, the lack of pulse in the leg should have been picked up on the primary survey and means the C (circulation) is NOT intact, Choi.
• WHY would an old lady with a suspected infection be sedated??? What??
• Oh god, where do I start. So first of all, BUN = blood urea nitrogen, so saying she’s “uremic” and “her BUN’s through the roof” is in fact saying the same thing twice. I will give Manning the benefit of the doubt and assume there was some urine testing done off screen that allows her to say so conclusively that old lady has a UTI, but the fact that this woman has a CENTRAL LINE and our first thought with fever wasn’t CLABSI is wild. Did she even get a blood culture? I hope so. Broadening antibiotics is good though.
• No idea how a mass spec would tell you that someone “never had cancer”. In fact, that would be pretty difficult to prove after treatment because how could you’ tell “never had cancer” from “successful treatment”? You’d have to look at the initial pathology.
• “This isn’t a trauma, she went down before she was hit” OK BUT SHE STILL GOT HIT?? SO YES IT IS A TRAUMA?? AND *ALSO* YOU HAVE TO WORK UP THE SEIZURE?? Halstead what are you smoking.
• The argument between Halstead and Rhodes is so idiotic. First of all, Halstead is just flat wrong. Yes, you need to figure out the seizure….but first you need to know if BEING HIT BY A CAR caused immediately life threatening injuries. Also CT scans take seconds, so the difference between CTH only and CTH/C/A/P is minimal. Also-also, Rhodes is the fellow, so as the person with more training he gets to make the decision! Residents can and absolutely should share their thoughts and opinions but there’s a reason medicine isn’t a democracy.
• A code! Let’s discuss: Halstead’s compressions are too fast. This is a rhythm you can shock, so points for that. It’s two minutes between shocks though, but I will concede we need to speed things up for TV.
• Med students don’t order labs, by the way. But regardless, Noah is what we would classify as a “gunner” – someone who gets ahead by making other students look bad. There’s a spectrum from just not quite being a team player (e.g., answering a question directed at another student when they don’t know the answer) to deliberate backstabbing. This is somewhere toward the middle of the scale, but knowing what I know about how Noah’s storyline ends, I’m not surprised to see him already starting on the wrong foot.
• Not bad on that on that intubation, but NEGATIVE ONE BILLION POINTS FOR NOT SECURING YOUR FUCKING TUBE before walking away.
• Does oral cancer have a biomarker that would be specific? Genuine question…I kind of suspect not, but could be wrong.
• April isn’t wrong that most of medicine is about logic/clinical reasoning over rote memorization, but Noah is talking about “when to shock”, doses, joules, which are all part of the ACLS algorithms and do, in fact, need to be memorized.
• HAHAHA April literally says you can’t shock a flatline here and yet…they continue to do it.

Who’s Getting Fired Today?

No one from our main cast, more’s the pity. Whoever is deliberately misdiagosing healthy people and then overdosing them on chemo is both getting fired and losing their license, but I don’t know if we’ll get to see the resolution of that storyline since I suspect it’s shown on a Chicago PD episode (much like this is the continuation of a Chicago Fire storyline) and I can only handle one dumb show at a time.