Dr. Natalie Manning quotes from Chicago Med

Dr. Natalie Manning

We are aware that your son was prescribed a new oral chemo, and that you have been withholding it.

I'm not withholding them.

Dr. Natalie Manning

I understand that you're a single father and that this must be incredibly hard for you...

It's not about me.

Dr. Natalie Manning

But if you are willingly keeping your son off of his meds, then we...

It's his decision.

Dr. Natalie Manning

Excuse me?

Gabe's. He's been through four courses of chemo. The nausea, the pain, the the drugs to treat the pain, it was awful.

Dr. Natalie Manning

That doesn't mean you can just stop trying.

He begged me all through the last course. But I wouldn't stop it. And it didn't help at all. None of them helped. So this time, I let him decide.

Dr. Natalie Manning

Well, he can't decide. He is eight years old, okay? His brain is literally not developed enough to process this. Life and death and forever are concepts that he cannot fully understand yet.

Gabe does understand.

Dr. Natalie Manning

I'm sorry, but we need to start your son on his new chemo.

No. I won't authorize that.

He's breathing so hard.

Dr. Natalie Manning

He's septic. We need to give the antibiotics time.

He'd scream out in his sleep when it first started, and get these pains. But he kept on fighting. I quit my job to take care of him.

Dr. Natalie Manning

Then help him keep fighting. Tell him that there's a chance this new chemo could work.

Look at him. He's not fighting anymore. He's done. And I will not flog him against his wishes. My boy deserves better than that.

Sharon Goodwin

Because of emergency surgeries, and a pregnant mother's serious bleeding disorder, we have used almost all of our O-negative. We can either treat Benjamin or Josh, but not both.

Dr. Will Halstead

Benjamin needs an angio emolization more urgently than Josh needs surgery.

Dr. Natalie Manning

How can you say that? Josh isn't compensating for his blood loss as well. He's in worse shape.

Dr. Will Halstead

I understand you're trying to protect your patient, but you're being emotional.

Dr. Natalie Manning

[insulted] Emotional? And what are you being?

Sharon Goodwin

Our recommendation needs to be based solely on clinical criteria. So I'm handing it over to the triage team.

Dr. Isidore Latham

Dr. Rhodes, your opinion?

Dr. Connor Rhodes

I have to agree with Dr. Halstead that Benjamin needs angio embolization more urgently than Josh needs surgery.

Dr. Isidore Latham

Not the issue. We're here to decide who has the best chance of survival, so...

Dr. Connor Rhodes

Unfortunately, even if Benjamin gets the embolization, there's only a 15% chance that the bleeding in his pelvis will stop.

Dr. Isidore Latham

Exactly. Whereas with Dr. Manning's patient, as the pressure in his thighs builds, the bleeding will eventually slow. Worst case, Josh loses a leg, but there is no question he has the best chance of survival.

Dr. Natalie Manning

Good luck? Ethan, are you kidding?

Dr. Ethan Choi

Nat, I've met combat vets who have been paralyzed. The feelings of inferiority can be overwhelming. If you told them a bottle of snake oil might help them walk again, they'd drink it every time.

Dr. Natalie Manning

So you agree with what Nick's doing?

Dr. Ethan Choi

I understand it, Nat.

Dr. Natalie Manning

[performing an ultrasound on a patient] No kidney stones. Let's look at the bladder. [noticing something unusual] How long did you say she was in a vegetative state for?

Maggie Lockwood

Five years.

Dr. Natalie Manning

We need to call the police. This woman is pregnant.

Erin Lindsay

Is this our victim?

Dr. Natalie Manning

Yeah. It's awful. You ever seen anything like this?

Erin Lindsay

I wish I could say I hadn't.

Maggie Lockwood

Okay, let's lift. One, two, three.

Dr. Natalie Manning

So helpless.

Erin Lindsay

We're looking into all of the employees at Teresa's facility. We're checking visitor logs, security footage. We'll find out who had access to her and to her floor.

Maggie Lockwood

But the rape kit's only supposed to reveal DNA for the past five days. How is this gonna help?

Erin Lindsay

I hate to say this, but the likelihood in a case like this is that the offender's been assaulting her regularly, maybe even daily.

Sharon Goodwin

In your daughter's condition, I have to tell you, taking this pregnancy to term would be extremely difficult.

Why? Her brain has been injured, but her body's healthy.

Dr. Natalie Manning

No. At five years in a persistent vegetative state, it's not. This is a high risk situation for pulmonary embolism, sepsis, colonic obstruction, respiratory failure.

But those are just risks, right? It could all work out.

Sharon Goodwin

They are extremely high risks.

Dr. Natalie Manning

If you have your daughter go through with this pregnancy, there is a chance that she will not survive.

She's hardly living as it is. If she dies giving birth, maybe that's a merciful outcome. Sometimes, I've wished for that.

Sharon Goodwin

There is another issue to consider. Given the abuse your daughter has undergone, do you believe that she would want to keep this pregnancy? In any case, you are Teresa's guardians, and therefore speak on her behalf. Your wishes will be honored.

I hardly slept last night. I just couldn't stop thinking. I mean, so many people coming in, horrible injuries.

April Sexton

And this isn't even a busy day.

I just hope I'm up to it.

Maggie Lockwood

Quick, nurses' credo?

Uh... cure sometimes, treat often, comfort always.

Maggie Lockwood

Uh-uh. Don't kill your patient.

Because that's the doctor's job.

Dr. Natalie Manning

[approaching] I heard that.

Dr. Natalie Manning

Mr. Walker didn't die of an MI.

Dr. Will Halstead

[reading the autopsy report] Massive pulmonary embolism.

Dr. Natalie Manning

I can't believe it. I totally missed it.

Dr. Will Halstead

Oh, come on. Even if we knew, there's nothing we could have done differently. It happened so fast. We didn't have time to get heparin on board, let alone send him upstairs.

Dr. Natalie Manning

No, I know, but still... I... I...

Dr. Will Halstead

Wait. How did you get this so fast? These reports usually take at least three to four hours.

Dr. Natalie Manning

Nina brought it up to me.

Dr. Will Halstead

She came upstairs and gave it to you?

Dr. Natalie Manning

Yeah. You know, I... I... I'm gonna go back over the chart. See if there were some clues.

Dr. Will Halstead

Nat, listen. You did everything you could for that man, so don't get down on yourself over it. Hey, you're too good a doctor.

Jay Halstead

I spoke to the parents together and independently.

Dr. Natalie Manning

And?

Jay Halstead

I don't like the stepdad for the guy. He offered to give a polygraph and submit his DNA. Offenders don't usually behave that way.

Dr. Will Halstead

Any other leads?

Jay Halstead

Allison's comprehensive tox screen detected trace amounts of triazolam in her blood. That's a benzo, right?

Dr. Natalie Manning

Yeah. A sedative hypnotic with amnestic properties.

Jay Halstead

The stepdad's an accountant. I don't see him getting his hands on that.

Dr. Natalie Manning

Unless maybe he was prescribed it. I mean, it is sometimes used for insomnia.

Dr. Will Halstead

Yeah, it definitely puts you out. The hospital uses it mostly to treat patient anxiety, usually before procedures, MRIs scans, things like that.

Jay Halstead

So she could have gotten it here. Did you give it her before the CT scan?

Dr. Natalie Manning

No.

Dr. Will Halstead

[checking his tablet] No.

Jay Halstead

Another doctor then, maybe. Did the mom mention any other recent medical issues?

Dr. Natalie Manning

No, nothing. Other than the symptoms that brought her in today. [remembering something] Braces. Allison did just get her braces on.

Dr. Will Halstead

Dentists also sometimes use triazolam.

The orthodontist? I was in the waiting room the whole time just checking my e-mails. When she came out, she smiled, showed me her braces, didn't seem any different.

Dr. Will Halstead

The police suspect instead of nitrous, he used triazolam. It knocked her out, ensured she had no memory of the assault.

Sick bastard.

Dr. Natalie Manning

I know this is a lot to process, but once Allison is stronger, the detective would like to come in and ask her a few questions.

Look, Ali just had a brush with death, and all she cares about is if she can still go to the junior high dance. She's so innocent. I don't want to take that from her. One day we'll have to, but not today.

Dr. Natalie Manning

We understand. We'll be back in the morning to check on her.

Sharon Goodwin

You want to feed a patient against her will.

Dr. Will Halstead

A pregnant mother who's killing her baby.

Dr. Natalie Manning

We believe she has something called orthorexia, an obsession with healthy living that has limited her diet so severly that it's become dangerous.

Dr. Will Halstead

And has led to a pathologic distrust of the entire medical system. She won't let us do anything.

Sharon Goodwin

Well, is she delusional? Can she make decisions on her own?

Dr. Natalie Manning

No, she is very clear about what she wants and what she does not want.

Sharon Goodwin

Well, then we can't prove incompetence, and we can't force her to do anything to her body she doesn't want. The law sides with her.

Dr. Will Halstead

But there are two patients here.

Dr. Natalie Manning

Yeah, one of whom has no control over what's being done to it.

Dr. Will Halstead

This is child abuse.

Sharon Goodwin

Well, I can convene an emergency ethics committee. It's possible they may find grounds to override her decision.

Dr. Natalie Manning

And in the meantime?

Sharon Goodwin

See if you can find a way to help her trust us.

Dr. Ethan Choi

Hey, Nat, I was speaking with Eric; the drugs, he's self-medicating. Since he was a kid, he's gotten sick after eating protein. Myra was a vegan; avoided protein.

Dr. Natalie Manning

You're thinking that's what made her sick, too?

Dr. Ethan Choi

Last month, when Myra was feeling confused, she was fasting while studying.

Dr. Natalie Manning

Ketosis. Her body was starving, so it started digesting muscle as fuel, which released protein into her blood. Okay, well, that explains what made her sick last month, but what about today?

Dr. Ethan Choi

The fellowship.

Dr. Natalie Manning

She probably wasn't eating again.

Dr. Ethan Choi

I think this is OTC. A metabolic disorder fits.

Dr. Natalie Manning

You were right. The visits were connected.

A metabolic... disorder caused her death?

Dr. Natalie Manning

The precise term is "ornthine transcarbamylase deficiency", or OTC. You see, Myra's liver was missing a vital enzyme that helps break down protein.

Dr. Ethan Choi

Something as simple as eating a burger could cause toxic levels of ammonia to build up in her blood and attack her nervous system.

But Myra was a vegan.

Dr. Natalie Manning

Which is how she was able to avoid symptoms for so long, but when she pushed herself and didn't eat - finals, the fellowship - her body started breaking down muscle, which released protein into her blood.

So, you mean she'd be alive right now if she'd just... eaten?

If this disease is genetic, that means one of us gave it to her.

Dr. Natalie Manning

Yes. Um, it is passed through the X chromosome, from mother to child, but...

Dr. Ethan Choi

OTC sufferers exhibit totally normal liver function. That's why all of Myra's tests came back clean.

Dr. Natalie Manning

Yeah. We were only able to diagnose her once Eric explained his lethargy and sickness after eating. We believe he has the defect, as well, and has been self-medicating with drugs.

Dr. Natalie Manning

But you have to tell me.

Dr. Will Halstead

And violate the sacred oath?

Dr. Natalie Manning

[laughing] It's not like you're guarding the Holy Grail. It's a holiday gift exchange.

Dr. Will Halstead

That we call "Secret Santa", because we're supposed to keep it a secret.

Dr. Natalie Manning

Okay, so who is it? Is it April?

Dr. Will Halstead

I'm not gonna tell you.

Dr. Natalie Manning

Fine. Don't tell me. But it's only a matter of time before you crack.

Dr. Will Halstead

Not a chance.