S01.E17: Withdrawal

[WendyCR72]

April and Dr. Halstead handle an alcoholic homeless man with a broken leg, but they don't see eye to eye on how to best treat his illness. Still grieving the death of her late husband, Dr. Manning experiences a medical event after realizing her wedding ring has gone missing. Dr. Charles and Sarah treat two elderly women with the exact same symptoms, but uncover a surprise that links the two cases together. Dr. Downey and Dr. Rhodes operate on a patient refusing their recommended treatment due to religious reasons. Meanwhile, a frustrated Dr. Halstead considers a job offer in California.

[Sandman]

"No, I'm a doctor! It's not my job to listen. It's my job to decide what's best for him."

Uh-oh! So much for Red Halstead learning his lesson.

[LittleIggy]

Why do people come up with such nonsense in the name of religion? Perversely, I was hoping that the JW guy would stick to his dogma and shun the wife who saved his stupid life.

Was that Howard Hessman as the nursing home Casanova?

[Artsda]

Halstead was right if he broke the rules and gave the patient alcohol he'd be in trouble, but it's ok for others to break the rules when they want and see fit.

[bourbon]

The difference to me was that in breaking the rules, Halstead substituted his own judgment and wishes for the patients. When Goodwin and April did it, they were doing what the patient wanted. Halstead has become almost irredeemable as a character for me. It becomes very hard to root for a character or a romance with Natalie when he is so smug. 

[starri]

I kind of agreed with Halstead on this one.

[Texasmom1970]

Damn you show for making me agree with Halstead! Did not think that would ever happen!

[candall]

Nice illustration of a problem I've noticed--that one of the many indignities associated with getting older is that doctors keep getting farther away from my own age and the greater the gap, the more condescending they are.

Silly, but I'd like Choi to check with wherever hoarder guy ended up and see if he could keep his parrot there.  Those things are intelligent and become very attached.  Be good for both of them.

Dr. Halsted, you need to learn to count to ten.  Okay, how about three?  Every time you chuff 'n charge, it's a mistake.

[LittleIggy]

I think the parrot is in love with Choi. Smart bird!

[Artsda]

7 hours ago, bourbon said:

The difference to me was that in breaking the rules, Halstead substituted his own judgment and wishes for the patients. When Goodwin and April did it, they were doing what the patient wanted. Halstead has become almost irredeemable as a character for me. It becomes very hard to root for a character or a romance with Natalie when he is so smug. 

So if the patient wanted them to kill him, for example assisted suicide then Halstead should do that now because it's what the patient wanted? Because based on Goodwin's logic now Halstead should do that. 

Breaking the rules is breaking the rules. It shouldn't be ok for their logic and not ok for Halstead's logic.

Edited May 11, 2016 by Artsda

[Lady Calypso]

I was also partially on Halstead's side this episode. Although Goodwin brought up a couple of good points in why she chose to give the drink to the patient (the patient needs to want to quit, or else he'll go back to drinking anyway, and the lack of drinking him was killing him this instance), Halstead has the right to call April and Goodwin out on double standards. He's now following protocol because of actions that he caused by going against patients' wishes and doing things that make him feel better; he even says in this episode that as a doctor, he doesn't need to listen to patients, but do what he thinks is best for them. He's slowly learning, even though he says stupid shit like this. Actually, he might not be fully learning, but he definitely has a point. Unfortunately, he's still not totally right in this situation, because the patient would never quit drinking, regardless of Halstead successfully detoxing him. He absolutely would have gone back to drinking the moment he left the hospital. So as much as I support Halstead in wanting to help this patient stop drinking, it's clear that he never would and he will most likely die of alcoholism. I mean, he was severely detoxing after not drinking for less than three days. That's bad. 

I sympathize with the JW patient and his need to stick to his faith, but....dude, you would have died and left your wife if she didn't make the call. It sucks, but at least you're alive. Either way, I appreciate that Connor and Choi got permission from the wife to do it. If this was Halstead, there's a good chance he would have done the bypass regardless of the wife's consent. 

I couldn't fully buy Manning's Broken Heart Syndrome plot because, despite wearing the wedding ring, we've seen very little of her grief, besides one or two subplots. In seventeen episodes, I forgot about her dead husband. I just wish there was more build up. I know wearing the wedding ring was significant, but there was just nothing to make me believe that she's been in this much grief over her husband's death that it would turn to a medical issue the moment she loses her ring. 

Choi and the parrot! I love that parrot! I also love Choi's girlfriend. 

For once, the Reese/Charles story was kind of dull. I didn't have much interest in it. 

[Xantar]

There is a genuine medical dilemma here, and I think both Halstead and Goodwin were right in their own ways.

Halstead was right to stick to the regulations. And he was right to be pissed that Goodwin broke the rules and left him in a bind. 

But Goodwin was right that people can only kick a habit if they want to. If the alcoholic had survived the detox, he probably would have gone out drinking again within a few weeks and landed back in the ER. What would all of Halstead's efforts have come to then?

I'm not a medical ethicist, but I'll bet this is an issue that they discuss quite a bit.

Similarly with the Jehovah's Witnesses, you could make an argument that Rhodes didn't really respect their expressed wishes. After all, he brought the wife into the room, showed her husband's heart to her in his hands, and essentially told her to make the decision to either let her husband live or die. That's incredibly manipulative. But then again, it did save his life, and in Rhodes' position I would probably have done the same thing. I think the episode actually did a decent job of presenting the situation as a very difficult and without a right answer.

[oucellogal]

10 minutes ago, Lady Calypso said:

I couldn't fully buy Manning's Broken Heart Syndrome plot because, despite wearing the wedding ring, we've seen very little of her grief, besides one or two subplots. In seventeen episodes, I forgot about her dead husband. I just wish there was more build up. I know wearing the wedding ring was significant, but there was just nothing to make me believe that she's been in this much grief over her husband's death that it would turn to a medical issue the moment she loses her ring. 

Choi and the parrot! I love that parrot! I also love Choi's girlfriend. 

Choi + Parrot = OTP.

Also agree with you about Natalie's Broken Heart Syndrome. While it's entirely possible that she has been stuffing away her grief in the interest of being both a good doctor and a good mom, the show hasn't given us any indication that this is the case. For this episode to have truly been effective, there needed to have been some hints along the way, particularly the last few eps, that she wasn't as over it as she seemed. (And not being willing to jump into a relationship with Halstead doesn't count, show! Sure, she might not be ready to date yet, but she also just might not want to date HIM. Smart girl, IMO.)

All that said, the last scene with her laying the wedding ring on Jeff's grave? *tears*

[starri]

1 minute ago, tvaddict44 said:

I guess I'm totally morally corrupt because I would have told the religious couple we did it the no-blood way and gone ahead and done it properly when they ran into trouble in order to save his life. 

That's not even a question of being morally corrupt, it's medical battery.  There are two exceptions to Jehovah's Witnesses and their (pardon this) frankly stupid blood donation policy:  an emergency where the patient doesn't have capacity to refuse, and under no circumstances can a parent refuse it for a minor child.  What makes it even more ridiculous is that in cases--this has more to do with Christian Scientists--where a child needs a procedure done, you convene a judge to come in and act in loco parentis.  Nine times out of ten, the parents wanted the kid to have the procedure, but they have to put up nominal resistance.  I think the JW blood policy is dumb--especially because they can still receive fractionated blood products (like hemophiliacs get), just not whole blood, packed red cells, white cells, platelets or plasma.

[juliet73]

I've only watched a small portion of the ep so far. I had to turn it off when it was announced that EVERYONE had to basically stop tending to their patients and look for Dr. Manning's ring. I know she was freaking out, and I would too, but wouldn't you call EVS to come down and go through the trash instead of the doctors and nurses?  

[Ariah]

I imagine Manning's Broken Heart occured now, because she was fully hit with the weight of her loss the moment she realized she lost the ring.

The ring turned into her husband substitute in her mind, and there she was, losing him again. This time of her own negligence. It's entirely normal not to grieve at all, and then to be flooded with grief in one instance that you colapse totally. Speaking from eperience. You just need the right trigger.

(but yes, Maggie telling everyone to look for a ring? Quite annoying. My dad lost a mobile phone in a hospital once - actually, it must have been stolen - and just one nurse helped me look for it, even though nothing was happening at that moment and it wasn't in the ER)

I second those who say they kind of agreed with Halstead this time. I think he was right, he just appeared as a jerk, because that's how he rolls.

Every medical drama needs to have their JW story. And each time the no-blood rule is brought up I think it's utterly impractical. 

[CoyoteBlue]

I missed the part where Halstead explained why it was necessary to put him through detox. Like, there's such a thing as AMA if a patient doesn't want treatment. And fixing the immediate danger didn't require detox, did it? So I would have liked more about why the patient HAD to submit to the treatment. (I'm actually a little surprised he didn't try to make a run for it since he wasn't restrained.)

As far as the JWs go, I think he should have let the guy die. The couple has all the facts and it's their choice. It's not like it was a case of him trying to impose his religion on someone else - it was his body, his choice, his morals. They aren't euthanizing him, they're just abiding by his medical wishes. Didn't they just give Halstead crap for not obeying a DNR? Same diff.

Edited May 11, 2016 by CoyoteBlue

[starri]

5 minutes ago, CoyoteBlue said:

I missed the part where Halstead explained why it was necessary to put him through detox. Like, there's such a thing as AMA if a patient doesn't want treatment. And fixing the immediate danger didn't require detox, did it? So I would have liked more about why the patient HAD to submit to the treatment. (I'm actually a little surprised he didn't try to make a run for it since he wasn't restrained.)

In all the laundry list of things that you can get addicted to, there are only two, alcohol and benzodiazepines that will kill you if you withdraw from them.  Ironically, you use the latter to withdraw from the former.  Drunko came in because he'd broken his leg, not because he was in withdrawal.  That only started once he'd been there for a while without a drink.  Once he started with the DTs, he was a danger to himself, and that puts him into involuntary commitment territory.  If Dr. Charles and Reese hadn't been off in the geriatric harem, this is where we'd probably have seen him this week.

I wonder if he was a heroin addict, would Sharon have been as quick to pass him a needle?

[CoyoteBlue]

3 minutes ago, starri said:

Drunko came in because he'd broken his leg, not because he was in withdrawal.  That only started once he'd been there for a while without a drink.  Once he started with the DTs, he was a danger to himself, and that puts him into involuntary commitment territory.

Daaang, that's fast! How does he get through the night without getting the DTs? :)

[starri]

It happened at the speed of drama.

[Netfoot]

JW:  We can not accept any treatment that involves blood transfusions!

Me: Then we can't help you, and you'll be dead by morning.  Please exit through the gift-shop!

[Sandman]

19 hours ago, LittleIggy said:

Was that Howard Hessman as the nursing home Casanova?

Yes, it was.

Which means Magda (and her sisters in the geriatric harem, ((tm) starri, hee!) had Johnny Fever! Er, more or less literally.

14 hours ago, bourbon said:

The difference to me was that in breaking the rules, Halstead substituted his own judgment and wishes for the patients. When Goodwin and April did it, they were doing what the patient wanted.

I have more trouble with the idea of complying with the patient's wishes when it's doing something that actively harms the patient, such as giving alcohol to an addicted patient, as opposed to refraining from doing something that the patient does not want, such as invasive surgery or use of life-saving transfusion technology. Maybe it's an arbitrary distinction, but giving a guy who's already at the DT stage more alcohol just seems like poisoning him to me. And the fact that heroin is an illegal drug and can't be purchased or prescribed legally (as far as I know) makes it even less likely that Goodwin, awesome though she normally is, would have handed Drunko (poor Frank Whaley!) a nice little needle.

Both Halstead and Rhodes arguably committed medical battery by not respecting their patients' wishes. I just have a hard time accepting that acting on a patient's express wish to harm himself is within the doctor's or nurse's range of duties. But I guess that's where we are next episode, too, with Rhodes and Doctor Tommy Bahama. 

How many times can the show go to the well of "Doctor substitutes own judgment for that of patient"? They're relying on this dilemma almost every week, it seems.

Edited May 12, 2016 by Sandman

[MakeMeLaugh]

I really hated the whole alcoholic storyline, starting with the sleazy surreptitious little half-pint bottle April was procuring from what, her pusher? Wouldn't the hospital pharmacy have medical grade stuff if say, a doctor prescribed it? Did Goodwin (not a doctor, right?, not apparently a nurse-practitioner or other pro who would be able to prescribe) note the dose of alcohol in the chart? No potential contraindications with other meds being administered pre- and during surgery to set that badly broken leg that would have put her hospital and her job in jeopardy? And hello, this detox situation would seem to actually fall within Dr Charles' area--wouldn't he be the go-to doc?

[izabella]

6 hours ago, starri said:

 I think the JW blood policy is dumb--especially because they can still receive fractionated blood products (like hemophiliacs get), just not whole blood, packed red cells, white cells, platelets or plasma.

I have heard of this, but have no idea what the reasoning is.  Can anyone explain?

55 minutes ago, Sandman said:

I have more trouble with the idea of complying with the patient's wishes when it's doing something that actively harms the patient, such as giving alcohol to an addicted patient, as opposed to refraining from doing something that the patient does not want, such as invasive surgery or use of life-saving transfusion technology. Maybe it's a arbitrary distinction, but giving a guy who's already at the DT stage more alcohol just seems like poisoning him to me. And the fact that heroin is an illegal drug and can't be purchased or prescribed legally (as far as I know) makes it even less likely that Goodwin, awesome though she normally is, would have handed Drunko (poor Frank Whaley!) a nice little needle.

In this patient's case, the alcohol actually would help him since that is what his body craves.  What was hurting him, making him throw up and seize and cough up stuff, was the withdrawal from the alcohol.  They said the withdrawal could kill him.  So forcing him to continue detox could have led to his death, which qualifies as actively harming him, I think.

As for heroin addicts, doctors give them methadone.  Some enlightened places dole it out regularly to heroin addicts, so they can stay alive instead of OD'ing, don't pass around dirty needles and spread diseases, and don't die or hurt others in their attempts to get heroin.  Other places give heroin addicts free needles. 

Edited May 12, 2016 by izabella

[Sandman]

I understand that the alcohol would shut down the DTs, but answering the body's craving for alcohol is a short-term solution only. Fatalities from detox occur mostly where it's not managed, right? I think the ED could have ensured -- was ensuring -- that he didn't die of withdrawal. As I say, I don't have a good answer, but some life-saving procedures are miserable and painful -- chemo, for one. It seems to me giving him alcohol only postpones (and potentially worsens) his eventual death.

Edited May 12, 2016 by Sandman

[starri]

Just now, izabella said:

In this patient's case, the alcohol actually would help him since that is what his body craves.  What was hurting him, making him throw up and seize and cough up stuff, was the withdrawal from the alcohol.  They said the withdrawal could kill him.  So forcing him to continue detox could have led to his death, which qualifies as actively harming him, I think.

Cold-turkey withdrawal is often fatal.  With an Ativan or Librium detox protocol (which he was getting), the worst side effects are avoided.  What he was experiencing was unpleasant, but it wasn't going to kill him.  Now, the bleeding varices and everything else that was wrong with him would have.  Halstead even said that he looked like he'd just walked out of a textbook.

[Sandman]

Would the bleeding varices or other problems have been eased or worsened by giving him booze? That part I didn't get.

If Mr. Gleason had been a heroin addict, I don't think anybody would have blinked at managing his withdrawal with methadone, or given a second thought to his preference for getting a fix of heroin. But that's not nearly as dramatic.

[starri]

3 minutes ago, Sandman said:

Would the bleeding varices or other problems have been eased or worsened by giving him booze? That part I didn't get.

Neither.  But he'd been out on the street and ruptured a varix, he'd either have bled to death, or choked on his own vomit.

8 minutes ago, Sandman said:

If Mr. Gleason had been a heroin addict, I don't think anybody would have blinked at managing his withdrawal with methadone, or given a second thought to his preference for getting a fix of heroin. But that's not nearly as dramatic.

We'd also just done heroin with the girl with porphyria and her addict father.  Also, opiate detox is not fun, but going through it on your own won't kill you.

[statsgirl]

I've heard that in some cases where the detoxing is bad, a little alcohol is given to make it less awful.

But what chiefly struck me is that Halstead, the attending doctor, gave orders that no alcohol was to be given to the patient and Goodwin, a nurse and administrator, countermanded the orders when she had no legal right.  Wouldn't this give Halstead leverage if he wanted to stay in Chicago?

I loved the old ladies and their diagnosis, and the whole plot with Charles going "yeah" and Reese so opposed to sex without commitment.  The group STDs are fastest growing in right now is the elderly so yay realism. Also, I can just see myself as one of those old ladies, will to get what I can in the retirement home.

[Xantar]

7 hours ago, CoyoteBlue said:

Daaang, that's fast! How does he get through the night without getting the DTs? :)

I believe the paramedics who wheeled him in stated that he had been lying at the bottom of the stairs with a broken leg overnight. He also stated that he had last had a drink about three days ago. He probably would have had one sooner if he hadn't been stuck where he was with a broken leg.

[Lillybee]

I do hope that Dr. Halsted accepts the job in California. He is the only character on this show that I dislike.

The JW storyline sturck me as being timely with Prince's death. He was a JW in constant pain because of a hip injury and refused surgery because he might have needed blood.

[WendyCR72]

1 hour ago, Lillybee said:

He was a JW in constant pain because of a hip injury and refused surgery because he might have needed blood.

By the by, other reports said Prince did have the surgery but was still in pain. Who knows.

[tvfanatic13]

Can someone please remind me what happened to Dr. Lulu Spencer.

[Artsda]

Didn't she get an offer from some other hospital and left?

[Diana Berry]

What was going with the mentor surgeon at the end?  They started laughing but I was lost about why?

[kassygreene]

Green bandages.

[statsgirl]

On 5/12/2016 at 2:37 PM, tvfanatic13 said:

Can someone please remind me what happened to Dr. Lulu Spencer.

She got an offer from Johns Hopkins I think to run her own department.  And left because she wasn't the sort of person to turn down a promotion so she could stay with a man.

[Chas411]

Kind of getting sick of the constant shade Halstead gets by each character (nurses especially). I get why Sampath did what sh did but I don't think she needed to be so condescending. I also think the line about Manning was a harsh dig as I think he backed off a few episodes ago and is now trying to just be a friend. I think the lines are always going to be blurred because they're both aware that he has feelings for her.

aprils smug once a nurse line to Halstead bugged as well.

Rhodes disregarded a patients wishes as well as railroading his terrified wife into making a decision she may not have made. It all works out though because he's Rhodes.