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Chicago Med - Winning the Battle, but Still Losing the War – Review

Once again we have a wonderful win for Chi-hards and the Wolf Writers are again demonstrating their intelligence and understanding of the realities in healthcare following our pandemic with this well-written episode. We also explore how our past may affect but does not need to define our future and how sometimes it can help a health professional to better treat a patient.

Daniel and Sharon

Again this week, Dr. Charles tried out another new therapist, and yet again it was a no go. The doctor herself did not even meet with him and did not plan to meet with him at all for the first appointment. He leaves and later we see him speaking with Sharon about the experience. You cannot help but love the friendship between these two characters, and it is wonderful how Sharon cares about him and continues to encourage him to continue to find the help he needs. It also is very interesting with how much difficulty he is having finding someone to connect with, that he seems so passionate about teaching his Psych Fellow the importance of developing a relationship and rapport with a patient first.

Dr. Archer, Dr. Charles, Dr. Cuevas and the Sullivans

David Sullivan returns by ambulance after he ran out into traffic. He was in his parent’s car and became accurately paranoid about a billboard and took off his clothes and jumped out the moving car into traffic. The ambulance gave him some lorazepam and had to restrain him to the stretcher. They move him over to the stretcher and Dr. Archer asks for them to call Dr. Charles. David’s parents, Patty and Eric, come in and as they are explaining what happens, Eric grabs his chest and collapses on the floor.

Dr. Archer is treating Eric and after some investigation, he tells Patty that he has an Aortic dissection and will have to have surgery to repair it. He has called the cardio-thoracic surgeon, Dr. Morris, and they will be taking Eric for surgery soon. Patty asks to see him before he goes.

Dr. Charles and Dr. Cuevas are treating David and they speak with Patty about what happened today, and what has been happening since they were discharged last time. They then go to interview David. David is acutely paranoid and agitated and he is not reacting well to Dr. Cuevas for challenging his delusions. Dr. Charles speaks with him and is able to get him to settle down, and he asks to speak to Dr. Cuevas outside. They argue over best way to treat him and Dr. Charles says not to push back so hard with a patient’s delusions if you have not first established trust, but Dr. Cuevas says that according to the current research this is an acceptable approach. It is so tactful in this scene how Daniel tells her it is great that she is keeping up to date on the literature, but sometimes how things work with some patients does not follow that recipe.

Dr. Charles returns as he promised but and David is very sleepy and mom says Trini gave him something to calm him down. He finds out it was 6mg of Risperidone, and Daniel is upset. Nellie tries to defend herself and says she is not a trainee and it is in standard of care to give that dose of that medication. Daniel says that the standard of care is not a template where you do not consider the person in front of you, and how careless it is to give a large dose of antipsychotics to someone they are still assessing. It poses the question that perhaps Daniel’s search to connect with a therapist recently might be making him that much more sensitive to the importance of a strong personal connection when treating someone.

Later Dr. Charles and Dr. Cuevas talk it out in his office when she gives him an update on David and his father. She says she relies heavily on literature and standard of care and is worried about relying on her own instincts. He tells her she will get there and that learning to trust your judgement takes years. This was a lovely ending to this storyline, as we know Dr. Charles is a wonderful mentor and as we watch him work to find a connection that works for himself, it will be great for him to continue to encourage Dr. Cuevas to make meaningful connections with patients.

Dr. Taylor and Dr. Marcel and Marcus Walker

As we open on Dr. Marcel, we see him apologize to Dr. Tanaka-Reid if he came off as condescending. He then asks Dr. Tanaka-Reid if he has anything he wants to say and he says no. Dr. Archer overhears and has to get in a sarcastic comment about the situation. Leave it to Archer to always take the opportunity for a dig. It seems that Will used to be his main target but now it is Crockett.

Marcus is suddenly brought in by ambulance. He had a fall on the sidewalk and is having severe back pain. Dr. Taylor comes in to help Dr. Marcel to treat him. His sister fills them in on his medical history and that he is on dialysis with end-stage kidney disease. He has a huge swelling on his back that is a hematoma, and Dr. Marcel decides to open and drain it to see if they can ge t the patient some pain relief but it does not help, so they send him for a scan of his back.

Dr. Taylor comes to find Dr. Marcel. Marcus has burst fractures in his spine and they go to see Dr. Abrams about operating. Dr. Abrams thinks Marcus is too risky of a candidate as he would have to do an anterior approach because of them opening the hematoma in the ED, and his lab work is terrible and his platelets are to low. It is also clear Dr. Abrams is still holding hard feelings toward Dr. Marcel with what happened with Dr. Blake, as he is clearly not happy at the idea of working in the OR with him also.

Dr. Marcel speaks to Marcus’s sister, Janet, and learns he is her twin and has been helping her since her husband died. They order an infusion of platelets for him to hopefully make him a better surgical candidate. Vanessa tells Crockett that she sees his platelets have always been low and wonders if he has TTP, and wants to test him. Crockett tells her to hold off testing him and see what the infusion will do. Surprisingly, the transfusion brings his platelets up and Dr. Abrams agrees to do the surgery with Dr. Marcel.

Dr. Abrams is angry after the surgery and speaks to Dr. Taylor, saying that he will out them to Goodwin next time if they pull a stunt like that on him again. Dr. Taylor says she does not know what he is talking about. Sam shows her the lab reports as he was suspicious when the platelets responded the way they did and he does have TTP. He says that Marcus would not have improved that way without someone providing “help”. Dr. Taylor confronts Dr. Marcel about giving him Prednisone. She says he does not respect her by not telling her, but Dr. Marcel tries to defend himself by saying that he did not tell her so she would not take a hit if the outcome was bad. However she does not see it that way.

As they are leaving, Dr. Marcel tries to tell both of them good work today, but Dr. Taylor and Dr. Abrams are both mad at him, and do not reply. Dr. Archer makes snide comment about his fan club. It would seem that Dr. Marcel has been taking lessons from the Halstead play book, and it will be interesting to see if the tension between Dr. Marcel and Dr. Abrams continues or if we will be able to work it out.

Dr. Choi and Dr. Asher and Liza Martin

We see Dr. Tanaka-Reid talking to Dr. Hudgins and says bad luck about getting Dr. Choi as advisor. Dr. Hudgins says that he has been very nice to him so far, but Kai tells him about his reputation and that he got a resident fired. Unknown to them, Ethan is nearby and overhears the conversation.

A pregnant patient, Liza, comes in vomiting, and tells Dr. Choi she is 12 weeks pregnant and says that that is a guess based on dates as she has not had any prenatal care. Dr. Choi asks for Dr. Asher to come do an ultrasound but the patient sees her and refuses and asks for another doctor. She says she knows she is an addict.

Later, Hannah runs into another OB in the department, who said she figured that Hannah was off today as she was called to ultrasound Dr. Choi’s patient. Dr. Asher gets upset with Dr. Choi and he explains she refused her as knew about her past, and she asks if she knew her personally and he says he did not inquire and she gets upset because she says she is tired of being judged for who she was and not who she is now.

Liza passes out and they have to bring in Dr. Asher as it is now emergent. She asks Dr. Choi how long the patient reported she had been vomiting, and she feels that she may have been sicker longer than she reported and has massive volume depletion. They bolus saline and she wakes up.

Dr. Asher talks to her. Liza says she has been throwing up for 6 days since she stopped using drugs, that some of her and was afraid that if they tested her for drugs, someone would take her baby away. She is terrified because she has shot up heroine 6 times in her first trimester and the baby is somehow still ok and she will not risk taking anything to help her quit. They discuss that cold turkey is a tough way to quit, and she agrees to be admitted.

Dr. Hudgins brings Dr. Choi a coffee since he is staying on for the night shift and brings him a lot of stuff for him to review before their advisor meetings. It seems clear to Ethan that he is nervous about having him as an advisor for his rotation after what he overheard Kai saying earlier.

Dr. Choi and Dr. Asher discuss how difficult it is to be held to a former version of yourself and that it is not always a bad thing to have your reputation proceed you. This was a very sweet way for this storyline to develop as we know that we have seen major changes in Dr. Choi since his accident, and he really is quite a different person from that strict rule following man we met in Season 1, and Hannah is definitely a different version of the doctor we met who was fighting addiction, so I really like this pairing and think it works well.

Dr. Halstead and Andrani Aria

Speaking of the Halstead playbook, drug shortages cause Will to also carve a new page in this book. Andrani has come in with a foot infection from an ingrown toenail. She has MRSA and she is allergic to vancomycin. Will cannot get her the antibiotics she needs without Infectious Disease approval due to a shortage and he is not happy about having to jump through hoops to get her the medication due to the shortages. Will tries to get her medication without following the new guidelines and Goodwin says to follow protocol.

While Will is waiting for Infectious Disease to drain the area, the infection looks like it is spreading and the hospital runs out of medication, and will not have any in stock until tomorrow. Will is concerned if she waits, it will spread into her bone.

Will decides to try a risky option and give Andrani the medication she is allergic to while giving her steroids and antihistamines. Will gets her the consent for desensitizing process, and runs vancomycin slowly after pretreating her with steroids and antihistamines. She has a reaction while they start the infusion, but they give her more medication and epinephrine, and they work her through it.

Goodwin stops by the ED and asks him to come see her. She found out what he did and says despite the fact that he had the patient’s consent, if it had to gone sideways, it would have been an issue. Will says the new protocols are not working and Goodwin says the supply issues and the protocols will not be going away any time soon and she cannot have the ED turning into the wild west. Will says he believes they are already there. This storyline was so well crafted, because it truly blended together the reality of supply chain issues with the risk taking to get the end result he wants cowboy tactics of Will Halstead, and the mesh was perfect.

Overall this episode was another great job by the One Chicago team, and it seems like tension will be heating up this season on Med, whether with administration, protocols or team dynamics and personal relationships…perhaps it is a good thing that it airs so close to Chicago Fire in case one of these situations goes up in smoke.

What did you think of this episode of Chicago Med? Share your thoughts in the comments below.

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