Season 1, Episode 1
Air date November 17, 2015
Story by Andrew Dettmann
Teleplay by Andrew Dettmann and Diane Frolov & Andrew Schneider
Directed by Michael Waxman
Runtime 42 minutes
Episode Guide

"Derailed" is the first episode of Season 1 of Chicago Med.

Note: The official pilot episode of Chicago Med is "I Am The Apocalypse", a backdoor pilot episode of Chicago Fire. For more information on that episode, click here.


The grand opening of Chicago Med's emergency department is interrupted by victims of an elevated train crash, pushing the staff to their limits.


Main Cast

Crossover Cast

Guest Cast

  • Brennan Brown as Dr. Sam Abrams
  • Gregory Abbey as Joe Donahue
  • Marika Engelhardt as Beth Donahue
  • Audrey Francis as Margie Cavanaugh
  • Maria Rivera as Mariana Acosta
  • Adam Farabee as Jamie Delson
  • Marc Grapey as Peter Kalmick
  • Mayor Rahm Emanuel as Himself
  • Sasha Rossof as Rachel Lewis
  • Tonray Ho as Nurse Leah
  • Alex Weisman as Paramedic Allen Chout
  • Lorena Diaz as Nurse Doris
  • Kristie Berger as Linda Dilson
  • Jon Bradford as David Lewis
  • Stephanie Diaz as Yolanda Cruz
  • Amy J. Carle as Doctor Patchefsky
  • Audrey Morgan as Mary
  • Stephanie Monday as Anesthesiologist
  • Nick Mayer as Paramedic
  • Desmond Gray as Paramedic Desmond
  • Cesar Jaime as Paramedic Cesar
  • Miriam Lee as Paramedic
  • Amanda Marcheschi as Nurse Dina
  • Devin Demby as Orderly
  • W. Matt Daniels as Gunshot Victim
  • Brian Rife as Paramedic


The first episode begins with Connor tipping a busker and getting on the "L" train while the grand opening of Chicago Med's new emergency department (presumably redone after the explosion in "I Am The Apocalypse") occurs, attended by Chicago Mayor Rahm Emanuel (guest star) and Chicago Med's doctors and nurses. Almost immediately after the ribbon-cutting ceremony, the train derailment happens, interrupting the grand opening. Sharon triggers the all-hazard disaster plan and the ceremony abruptly ends, launching the emergency department into overdrive.

At the site of the derailment, Connor performs first aid and attends to the victims, riding to the hospital in an ambulance with a patient as he performs CPR. Upon arrival at the hospital, Will tries to take over the treatment, but Connor overrides his orders as the new trauma fellow, causing Will to instantly dislike him. He moves on to the next patient, and Sarah, a fourth-year medical student, joins in to help Connor. However, as it is her first day on ED rotation, she struggles to perform procedures, much to her dismay. They are able to stabilize the patient, but he was without oxygen for too long and is declared brain-dead. His girlfriend arrives and is clearly devastated by the news, breaking down by his bedside. After a while, Hermann arrives at the hospital carrying a box of victims' belongings and singing to Maggie, in which Maggie finds a ring in the brain-dead patient's jacket. She brings it to Mariana, the brain-dead patient's girlfriend, and tells her that she's no longer his girlfriend but his fiancée, giving her legal power over his treatment.

Meanwhile, A heavily pregnant Natalie, assisted by April, treats a little girl who was separated from her father during the crash. The girl, Rachel, has a severely broken leg and is panicking; however, Natalie and April manage to calm her down and sedate her; Maggie promises Rachel that she'll find her father for her. After Maggie tracks him down, Sarah tells Rachel's mother, explaining that her husband is in emergency surgery but doing well; their conversation is interrupted when Rachel suddenly collapses with no pulse. Sarah calls a code and starts to perform CPR, but Ethan tells her that she isn't compressing hard enough. Sarah protests, pointing out how small the girl is, but complies. She revives her, but is clearly shaken by the incident as Rachel is taken to the ICU. Ethan comforts Sarah, who is horrified that she broke Rachel's ribs. He corrects her, telling her that her actions saved Rachel's life.

Ethan and Will treat Gina, woman who sustained a traumatic head injury in the train crash with a GCS of 3, indicating brain death as the lowest score on the scale. They discover that Gina is pregnant and carrying the baby of another couple as a surrogate mother; the couple, Mr. and Mrs. Donahue, are deeply concerned about Gina, telling the doctors that they're all the family she has. However, when Will informs them that Gina requires an operation to reduce the swelling on her brain, the couple are more concerned with the baby's health than with Gina's, refusing to consent. Ethan and Will appeal to Sharon; they speak to the hospital's legal counsel, who advises them that Gina's surrogacy contract is binding and overriding it means the hospital will almost certainly be sued. Ethan and Will, furious at how callous the legal counsel is being about Gina's life, storm out of the room. Meanwhile, Connor sutures his own wound from the train crash, assisted by April. He tells her that he spent time working in Riyadh and was "paid not to leave scars"; Sharon and Maggie, watching them through the window, comment that Connor is going to "light up some estrogen receptors around here".


Jamie, 20-year-old student at Northwestern with cystic fibrosis, is admitted to the ED after developing a cold. As he is frequently hospitalized due to his condition, he is close with the doctors, especially Daniel, who Jamie has known since he was eight. Sharon assigns Jamie to Connor, who runs tests and becomes increasingly worried that Jamie's cold will progress into pneumonia. Daniel tells Connor that as his father abandoned them and his mother is an alcoholic, the staff at Chicago Med is basically his family. Jamie comments that Daniel taught him how to play chess, and Daniel adds that he "beats me every time. Not kidding."

After explaining to Sharon what happened with Rachel, Natalie makes her way to the nurse's station and asks Maggie for more patients saying that exercise is good for pregnant women. April then joins the conversation, telling her that Maggie and her are going to throw Natalie a crib party to help put the baby crib together and help with all the baby stuff. They assure Natalie that she won't have to do the "single mom thing" alone, and Natalie thanks them.


Jamie and Daniel are talking about the Fast and Furious movies, of which Daniel has never seen a single one. Connor then comes in and tells Jamie that as his test results aren't good, he needs to be intubated and put on a ventilator. Jamie doesn't consent, saying that he's been intubated eight times and he'd "rather skip it this time". Connor pulls Daniel aside, telling him that he knows Connor's right, but Daniel defends him, claiming that based on all Jamie's been through he has a right to say no. Connor reminds him that the intubation will happen anyway when Jamie loses consciousness, but by then, it may already be too late. Daniel speaks to Jamie and manages to convince him to do it for him; he is later seen watching Fast and Furious on an iPad while sitting at an intubated Jamie's bedside. Connor discovers that his brain-dead patient is a match for a lung transplant for Jamie; however, his girlfriend - now fiancée - refuses to consent. Desperate, Connor and Daniel bring her to see Jamie, and she finally consents, allowing his lungs to be transplanted into Jamie.

Sharon tracks down Mrs. Donahue, the mother of the surrogate child. She sits down outside with her and tells her that she sympathizes with her situation and thinks she and her husband are not monsters, but people "facing a very tough decision". Mrs. Donahue asks her what she would do, and Sharon replies that she'd ask herself what she can live with. The couple decides to go through with the surgery; although the baby goes into distress midway through, they are able to stabilize its vitals. Both Gina and the baby come through fine, and Gina is seen waking up at the end of the episode with the Donahues by her bedside.

Natalie finds Connor at her hiding spot, the hospital's roof. They officially meet each other and chat, and he asks her if her husband is a doctor too. Natalie says he isn't, but doesn't elaborate; she is then called away by a page before they can discuss it more. Sarah practices central line with a doll. Connor finds her and shares that he also struggled at first to deal with live patients and all it took was practice, comforting her. Before leaving for the day, Natalie goes to her locker and looks at a photo of her husband in his Army uniform; it is revealed that he was killed in action several months before the start of the series. Connor meets Daniel at Molly's, where Connor tells him that the lung transplant is halfway over and going well. Daniel shows Connor a card Jamie made for him when he was eight, telling Connor that while he was brought in to help Jamie cope with his condition, Jamie was really the one that taught him how to cope. He leaves, telling Connor he'd like to be there when Jamie wakes up.
As Rachel leaves the hospital in a wheelchair with her mother, she waves at Sarah, who happily waves back. At the end of the episode, Daniel is seen watching a Fast and Furious movie on an iPad while sitting at Jamie's bedside, while April, Maggie, and Natalie attempt to put the crib together, laughing happily.
Community content is available under CC-BY-SA unless otherwise noted.

Fandom may earn an affiliate commission on sales made from links on this page.

Stream the best stories.

Fandom may earn an affiliate commission on sales made from links on this page.

Get Disney+