- Dr. Daniel Charles: [Robin has been brought into Med after a psychotic break] So, you, um... you starting to figure out why I didn't want her leaving the hospital?
- Dr. Connor Rhodes: She was rational. She was lucid.
- Dr. Daniel Charles: I warned you.
- Dr. Connor Rhodes: Robin was fine, okay? Suddenly, she just...
- Dr. Daniel Charles: Suddenly, look at her now! This is on you. You did this.
- Dr. Sarah Reese: Here's the paraneoplastic panel.
- Dr. Daniel Charles: Wow. Look at that. You were right, Dr. Reese. It is objective. It's physical. Well done.
- Maggie Lockwood: Hey, you two need to know that... Robin Charles is in 6.
- Dr. Will Halstead: What happened?
- Maggie Lockwood: Psychotic break.
- Dr. Natalie Manning: Oh, my god.
- Paramedic Courtney: Twenty-two year old male, peds versus auto. GCS 12, BP 100/70, heart rate 125.
- Jay Halstead: Got a student ID. Kid's name is Marwan Haddad. Hit and run. Car dragged him, like, half a block.
- Dr. Will Halstead: Sexton, fast his belly.
- Noah Sexton: On it.
- Dr. Natalie Manning: Need x-rays, chest and pelvis.
- Dr. Will Halstead: And left lower leg. Probably a tib-fib fracture. Let's move him.
- Dr. Natalie Manning: Poor breath sounds on the left side.
- Marwan Haddad: [rasping] Christina.
- Dr. Natalie Manning: It's okay. It's okay. I'm Dr. Manning. This is Dr. Halstead. We're gonna take really good care of you, okay?
- Marwan Haddad: Christina.
- Dr. Will Halstead: Easy. Easy.
- Noah Sexton: Belly's clear.
- Dr. Will Halstead: He's shocky. I'm intubating.
- Dr. Natalie Manning: Bilateral rib fractures. Bilateral pulmonary contusions.
- Dr. Will Halstead: And hemothorax on the left. Sexton, chest tube.
- Noah Sexton: On it.
- Dr. Will Halstead: Doris, hang two levels of O-neg on the level one.
- Nurse Doris: Got it.
- Dr. Will Halstead: We got a medical history?
- Jay Halstead: No. I spoke to his roommate. Marwan's a Syrian refugee. He's here to go to school. That's about all the guy knows. His parents are on a plane. They're flying in from Germany to go to his graduation.
- Dr. Natalie Manning: Poor guy.
- Jay Halstead: Can you imagine? The kid survives cluster bombs in Aleppo just to come to Chicago and get hit by a car. Let me know when he wakes up, all right? I want to get a statement, figure out who did this.
- Dr. Will Halstead: Absolutely.
- Jay Halstead: Yeah.
- Dr. Will Halstead: Thanks, Jay.
- Dr. Sarah Reese: I have been reviewing Robin's history just to make sure we haven't missed anything, and... well, uh, some of her symptoms, they're not consistent with a psychiatric disorder.
- Dr. Daniel Charles: Dr. Reese...
- Sharon Goodwin: Let her finish.
- Dr. Sarah Reese: Two days ago when Robin came to the hospital, she was running a mild fever, 100.2, and her BP was elevated. Now, at the time, we didn't think anything of it...
- Dr. Daniel Charles: That's cause it's a very mild fever. And of course her BP was elevated. She was on a forced hold. She was agitated.
- Dr. Sarah Reese: But when Robin was brought in today, it seemed she was experiencing visual hallucinations. Now, auditory hallucinations indicate a mental disorder, but visual hallucinations should be considered organic until proven otherwise.
- Dr. Daniel Charles: I think we all wish that Robin had a treatable physical condition rather than...
- Dr. Sarah Reese: I want to check her ceruloplasmin levels and run an FTA-ABS, as well as an MRI and EEG to rule out scelerosis and epilepsy.
- Sharon Goodwin: Of course. Do it.
- Sharon Goodwin: What's the matter with you?
- Dr. Daniel Charles: She's trying to make me feel better. And bless her, but she's grasping at straws. Come on.
- Sharon Goodwin: Are you so blinded by your fear that Robin inherited her problems from you that you won't even entertain an alternative?
- Dr. Daniel Charles: False hope, Sharon. Come on. I don't need any.
- Sharon Goodwin: You don't know that. Where's the Daniel who leaves no stone unturned when diagnosing a patient? Where's the Daniel who never gives up? Don't you think your own daughter deserves that much?
- Dr. Ethan Choi: Hey, what are we looking at?
- Dr. Ava Bekker: He needs a new valve.
- Dr. Connor Rhodes: Ava Bekker, CT fellow, Ethan Choi, Chief Resident of the E.D.
- Dr. Ava Bekker: So we crack his chest, replace the valve.
- Dr. Connor Rhodes: Well, we don't need to crack his chest. Uh, Mr. Crocker's been assessed as intermediate risk, and transcatheter aortic valve replacement, TAVR, is now FDA approved for patients at that level.
- Dr. Ava Bekker: We get excellent results with open aortic valve replacement. With TAVR, you're just inviting complications.
- Dr. Connor Rhodes: I don't agree. Why put the patient through a long operation and a long pump run? He could have a functional heart in under two hours.
- Dr. Ethan Choi: The less invasive, the better.
- Dr. Connor Rhodes: Exactly.
- Dr. Ava Bekker: Excuse me. You're an emergency medicine resident. Why are we even talking?
- Dr. Ethan Choi: [insulted] Excuse you?
- Dr. Connor Rhodes: Because I value Dr. Choi's opinion. And I think you'll find that Dr. Latham will back me on the TAVR.
- Dr. Connor Rhodes: I was wrong to take Robin out of the hospital. I'm sorry.
- Dr. Daniel Charles: Well... I have certainly been wrong, too. Seeing the whole thing through the prism of my own fears.
- Dr. Connor Rhodes: Since I was a kid, I always wondered if there was something I could've done to stop my mom from killing herself. I obviously couldn't save my mom, but I was sure as hell gonna try and save Robin.
- Dr. Daniel Charles: You know, at one point, I considered bringing that up. Decided it probably wouldn't have been helpful.
- Dr. Connor Rhodes: [they share a snicker] Yeah, probably not.
- Dr. Daniel Charles: Well, she's not gonna want to have anything to do with me after all this is over, that's for sure.
- Dr. Connor Rhodes: You saw Mr. Crocker?
- Dr. Ethan Choi: Yeah. Pretty young to have that kind of heart trouble.
- Dr. Connor Rhodes: Well, could be genetics or... he said he's alone, right? He's not married. No friends. No family.
- Dr. Ethan Choi: None.
- Dr. Connor Rhodes: Loneliness puts you at risk for heart disease.
- Dr. Ethan Choi: That for real?
- Dr. Connor Rhodes: Yeah. I think we all know that love can hurt, right? But loneliness, that'll kill you.
- Dr. Robin Charles: A tumor?
- Dr. Connor Rhodes: Yeah. Reaction to your antibodies caused your psychiatric symptoms.
- Dr. Robin Charles: So I was crazy, but I wasn't crazy?
- Dr. Connor Rhodes: Yeah, something like that.
- Dr. Robin Charles: Okay.
- Dr. Connor Rhodes: You should know something. It was your dad that came up with the diagnosis. Robin, he's hardly left your side. You should talk to him.
- Sharon Goodwin: I saw Robin's scheduled for surgery.
- Dr. Sarah Reese: She has anti-NMDA Receptor Encephalitis. It's very rare. Dr. Charles had the idea to test for it.
- Sharon Goodwin: It's some autoimmune response?
- Dr. Daniel Charles: Gone awry. Robin has a mediastinal teratoma; a benign one, but her body's attacking the tumor, and it's also attacking her brain.
- Dr. Sarah Reese: Yeah, and the resulting inflammation is what's caused her psychiatric symptoms.
- Sharon Goodwin: So, when the tumor's removed?
- Dr. Daniel Charles: Hopefully the psychosis should resolve itself.
- Dr. Connor Rhodes: [entering] Wait. What's going on?
- Dr. Daniel Charles: [getting onto the elevtor] Come on in.
- Dr. Daniel Charles: Robin's showing dyskinesia. Did you notice that before? You know, the jerky movements?
- Dr. Sarah Reese: Yeah, I assumed it's from the anti-psychotics.
- Dr. Daniel Charles: Yeah. It could be. Did you order a paraneoplastic panel?
- Dr. Sarah Reese: For auto-antibodies? Why?
- Dr. Daniel Charles: Could we just run one?
- Dr. Sarah Reese: Of course.