Disorder

Air date

May 3, 2016

Runtime

42 minutes

Production information

Directed by

Ami Mann

Written by

Eli Talbert

Teleplay by

Diane Frolov

Series information
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Disorder is the sixteenth episode of Season 1 of Chicago Med. It aired on May 3, 2016.

Summary[]

Dr. Charles and Dr. Rhodes misdiagnose a patient with mental and heart problems with dementia. Meanwhile, Dr. Manning and Reese treat a dog biting victim, Dr. Choi tags alongs with the paramedics and receives a call from a burn victim who lives like a hoarder. Also, Sharon warns everyone at the hospital to be on their professional behavior when the Joint Commission visits.

Cast[]

Main Cast[]

Crossover Cast[]

Kara Killmer as Sylvie Brett
Brian Geraghty as Sean Roman

Recurring Cast[]

Gregg Henry as Dr. David Downey
Karen Aldridge as Dr. Kendra Perrington
Tosin Morohunfola as Dr. Allen Vorspan
Cesar Jaime as Paramedic Cesar
Courtney Rioux as Paramedic Courtney
Desmond Gray as Paramedic Desmond
Tonray Ho as Nurse Leah
C. Anthony Jackson as Security Guard Earl

Guest Cast[]

Jayne Atkinson as Laura Clay
Francis Guinan as Nathan Clay
McKenzie Chinn as Tara
Ed Gass as Martin
Si Osborne as Paul
Hannaha Hall as Dana
Emjoy Gavino as Dr. Harper
Susan Fay as Mabel
Kevin Gilwa as Injured Cop

Plot[]

The episode begins with a surprise site survey at the hospital by JCAHO, the Joint Commission which evaluates hospitals for performance standards and certification. Sharon Goodwin tells Dr. Choi that the hospital could use some of his Naval discipline, but he excuses himself, as he is riding along with EMTs that day. Maggie Lockwood points out that the job of keeping the doctors in line belongs to the Chief Resident, Dr. Will Halstead. Sharon Goodwin says to her that this is wonderful, as "the guy responsible for enforcing the rules is always the one breaking them". Maggie wishes her good luck with that.

In the E.R. a patient, Nathan Clay is brought in with chest and back pains after an accident, with Dr. Connor Rhodes attending to him. Police officers tell Connor that Nathan Clay was walking on a road with his wife when he began to violently assault her, leading to people to intervene. Nathan's wife, Laura comes in, but when Connor attempts to attend to her, she tells him that she is fine, and that she is a doctor. She tells Connor that Nathan Clay is not abusive, but has Lewy Body Dementia, a particularly aggressive form of dementia which causes the violent outbursts, and that she has been working with him to keep it under control through therapy and medication. Dr. Charles comes in to speak with Nathan, who is very concerned about his wife, and is now lucid enough to recall that he hurt her. He tells Dr. Charles that his wife deserves better, but halfway through the conversation, faints. Dr. Charles talks to Dr. Laura Clay, who tells him she is a neurologist who diagnosed the dementia herself, while also having colleagues confirm the diagnosis. Dr. Charles doubts the diagnosis of dementia, pointing out that he seems to be more lucid than is common for the condition, being able to cook, and speak and think clearly. Dr. Clay tells him that while there are periods of lucidity, she is sure of the diagnosis, and insists on caring for him herself, being reluctant to give up the care of her husband to a facility despite the difficulties it causes to herself.

Later, Nathan Clay faints again. Dr. Connor Rhodes brings in Dr. David Downey to tell Dr. Laura Clay, that the accident apparently damaged one of a previous quadruple bypass graft that Nathan had in his heart, causing a pseudo-aneurysm. They tell her that operation is not an option to repair the bypass as his odds of survival are very low and that the best option is to make him comfortable, as he has at best a few months before the aneurysm ruptures. Dr. Daniel Charles asks them to also get a brain scan, and that he is concerned that the diagnosis of the Lewy Body Dementia may not be correct. Dr. Connor Rhodes points out that they need Dr. Laura Clay's consent, but Dr. Charles convinces him to go ahead and order the test without telling her. Dr. Connor Rhodes and Dr. Charles then talk to Dr. Laura Clay, and tell her that they suspect that Nathan has a problem with his thyroid, and not dementia, and that some of his symptoms could be explained by the heart medication he is also taking. Dr. Clay is angry with herself, wondering why she didn't catch this earlier. She attempts to convince Dr. David Downey and Dr. Connor Rhodes to operate, and while Dr. David Downey advises against it, Dr. Connor Rhodes agrees to do it, telling Dr. Downey that even if the surgery will be difficult, it isn't impossible. As they prep for surgery, Dr. Connor Rhodes insists to Dr. David Downey that he is making the right call by choosing to operate. While they operate, Dr. Connor Rhodes disagrees with Dr. David Downey's suggestions for a more cautious route, telling Downey that Rhodes pushed for the surgery, so he can't lose Nathan, and places repairing stitches on Nathan's beating heart instead of putting him on bypass. They repair the bypass graft, and Rhodes takes the opportunity to check on Nathan's other bypass grafts while he is in the room, as a third surgery is very unlikely if they develop issues.

After the surgery Dr. David Downey tells Dr. Connor Rhodes that the Cleveland Clinic advises against emergency surgery on a repaired heart, as the risks are too high and most patients will die on the table. When Dr. Connor Rhodes responds that he could not do nothing, Dr. Downey tells him his motivation was probably ego, and not altruism. Dr. Downey tells Rhodes that Rhodes is confident, not arrogant, and that Downey likes that, but that "Great surgeons know the balance," and that he did a nice job. During the surgery, Dr. Charles keeps Dr. Laura Clay company, doing crosswords with her, as he had observed her doing crosswords with her husband before. While they wait, Dr. Clay tells Dr. Charles that she blames herself for misdiagnosing her husband, wasting their savings, and their time together on a wrong treatment plan. She tells Dr. Charles that her husband won't forgive her for her mistake, and Dr. Charles tells her that her husband will forgive her, but she needs to figure out how to forgive herself.

Meanwhile, in the E.R., Dr. Will Halstead is stressed, telling April Sexton and Maggie Lockwood that he has already been in trouble with Sharon Goodwin before and wants everything to go well for the JCAHO inspection, scolding them for leaving gloves on the floor. Dr. Will Halstead also speaks with Dr. Perrington, asking for her advice with a patient. Dr. Perrington sarcastically tells him that she is honored and tells him to page her resident for consults, and ignores Dr. Halstead's attempt to apologize for going over her head previously when treating a patient who was one of his childhood friends. In response, Dr. Halstead starts looking for attending jobs at other hospitals, and tells Dr. Natalie Manning when she sees him doing so that he has to go where the jobs are, as he doesn't have a future at Gaffney Chicago Medical Center. Later, Dr. Natalie Manning goes to Sharon Goodwin and vouches for Will for the new attending position, telling her that while she doesn't always agree with Will, his heart is in the right place. Sharon Goodwin points out that it was only recently that Dr. Manning had disagreed with Dr. Will Halstead to the point of asking to be moved to another shift, and that she has noted that Dr. Manning's opinion of Dr. Will Halstead appears to have changed.

Sarah Reese and Dr. Natalie Manning attend to a 26 year old woman, Tara, who has been bitten unexpectedly by her pet dog, a boxer-bulldog mix called Boomer. Dr. Manning tells the patients that dogs can be risky pets, and that she has treated a lot of dog bites. As they are about to discharge her, Dr. Manning notices that the patient has a rash and instead sends her for tests. After tests, Reese and Manning tell the patient that she has an infection, which she may have contracted from her dog. Meanwhile, Tara's sister comes by the hospital and hands over Boomer to Reese, telling her that she can't take care of the dog, leaving Reese holding on to Boomer's leash in the E.R. Dr. Will Halstead tells Reese to get the dog out before the JHACO team notices, and Reese hands over the dog to a security guard, Earl, telling him to be careful of the dog. Tara's tests come back negative for strep, which is what they had suspected, and they notice that the dog, which has mostly ignored other people, barks at a cancer patient specifically. Tests results show that Tara has lymphoma, a form of cancer, and that they were luckily to have caught it early. Tara notes that Boomer bit her uncharacteristically near her lymph nodes, and Reese tells her that some dogs can smell cancer, and he might have been trying to protect Tara, not attack her. Later, outside the hospital, Reese shows Dr. Manning on how to safely approach a dog, and tells her a Biblical story about the origin of dogs.

While attending to a man who has had trouble urinating, after being treated for prostate cancer, April starts to clean up some urine fallen on the floor, instead of waiting for the hospital's janitors. While she is doing so, she and Maggie Cambell notice that a radioactive implant used to treat the man's prostate cancer has fallen out onto the floor. A consulting doctor from Urology tells them that the implant will have to be disposed of by special staff dealing with radioactive material, even though the risk is very low, because they have to do everything by the book during the JHACO visit. When they have trouble getting the cleaning services quickly, Dr. Will Halstead goes personally to get them to clean up the urine spill and implant. He is unsuccessful, because every department is demanding janitorial services according to protocol instead of cleaning up themselves, because of the JHACO inspection. He cleans up the radioactive implant himself, and then helps Maggie and April clean up the urine, joking about gloves to make up for scolding them about gloves earlier. During the episode, April Sexton talks to Maggie Lockwood about dating Tate Jenkins and Maggie tells April that it sounds like she is love with Tate.

Dr. Ethan Choi accompanies two paramedics, Desmond and Courtney, for a ride-along in the ambulance and they discuss dating, with Dr. Ethan Choi telling them he is now seeing Dr. Vicki Glass. He also tells them that riding an ambulance reminds him of being in a Humvee. They respond to a forty-year old man, Paul, whose neighbor called 911 after he had a fall. The man turns out to be a hoarder, which gives the paramedics and Dr. Ethan Choi some trouble accessing him inside the house filled with things. While trying to reach Paul, Dr. Ethan Choi notices a number of risky things in the house, including maggots, and then falls and cuts his arm. As he is treating his arm, he tells the paramedics waiting outside for additional help that he can hear another person inside with Paul. Dr. Ethan Choi manages to locate Paul, who is lying on his bed with an burn injury on leg. Dr. Ethan Choi asks Paul about the injury, and tells him that the injury is quite old, asking him why he didn't seek help earlier. Paul expresses hesitance about leaving his home, and Dr. Ethan Choi assures him he will help him. He contacts the paramedics, who are trying to break through the house's contents and reach them, and tells them the second voice he heard was Paul's pet parrot. The burn is preventing blood from reaching Paul's foot, and Dr. Ethan Choi makes a painful incision to resolve the problem. They are able to get Paul out of the house, to get treatment, and he thanks Choi and the paramedics. As Choi is leaving, he hears the parrot repeat the phrase "Don't touch that," and holds out a finger, letting the parrot climb on to his hand.

At the end of the episode, Sharon Goodwin gathers the hospital staff together and tells them that despite her warning about the JHACO inspection, today they ordered tests on the sly (referring to Dr. Charles and Dr. Rhodes), brought a dog into the E.R. (referring to Reese and Dr. Manning) and ignored protocol relating to radioactive material (referring to Dr. Halstead, April, and Maggie). Dr. Charles reminds her of the second law of thermodynamics, telling her that systems tend to degenerate, and that they are simply trying to bring order. Dr. Choi agrees, and while Goodwin does not agree with them, she tells them JHACO did not notice any of it, allowing them to keep their high rating. She leaves, muttering about the second law of thermodynamics as she goes.