- Don Adams: A metabolic... disorder caused her death?
- 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.
- 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.
- Carol Adams: But Myra was a vegan.
- 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.
- Carol Adams: So, you mean she'd be alive right now if she'd just... eaten?
- Don Adams: If this disease is genetic, that means one of us gave it to her.
- Natalie Manning: Yes. Um, it is passed through the X chromosome, from mother to child, but...
- Ethan Choi: OTC sufferers exhibit totally normal liver function. That's why all of Myra's tests came back clean.
- 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.
- Ethan Choi: What happened back there... sometimes when people are grieving, they last out.
- Eric Adams: Yeah, no, that's... that's how my folks always are. Man, they-they-they think I'm, uh... I'm worthless. I don't know. May-maybe I am, but they think I want to be like this, and-and I really don't. Uh, you know, My-Myra, she was the only one who ever, like... like, really... like, like, saw me. You know?
- Ethan Choi: Yeah.
- Eric Adams: And now it's...
- Ethan Choi: What do you want, Eric?
- Eric Adams: I want to get clean. You know, I wanna, like, wake up and just feel clear.
- Ethan Choi: Okay. We'll set you up with a social worker, get you in a program.
- Eric Adams: Was... seriously?
- Ethan Choi: Yeah. You'll get the support you need, but it's up to you to come through.
- Eric Adams: Why are you doing this for me?
- Ethan Choi: I guess I'm seeing that there's a difference between a crutch and a helping hand.
- Peter Kalmick: Just a head's up: the board is gonna push you for more growth. The bottom line has them concerned.
- Sharon Goodwin: When hasn't it? Can set my watch over their money worries. I'll be fine.
- Peter Kalmick: It's different this time. C-Suite feels we can better recognize how medicine and business are one and the same.
- Sharon Goodwin: Ah, let me guess. Um, scale back on outreach, combine responsibilities, outsource. So, basically, sacrifice patient care? I won't do that, Peter.
- Peter Kalmick: Well, Sharon, you have to do something, because the ED is hemorrhaging cash, and if the bleeding doesn't stop, it is not gonna be good for anybody.
- Daniel Charles: So, what are you thinking?
- Sarah Reese: Schizophrenia.
- Daniel Charles: Yeah, that was my initial thought, but now I'm not so sure.
- Sarah Reese: Seriously? His, uh, paranoia that there's something living inside him, and his attempt to remove it, is literally a textbook definition of a somatic delusional disorder.
- Daniel Charles: I'm stuck on the level of premeditation. You know, sterilization with Betadine, the clean incision, doing it near a hospital... all that kind of forethought, it's just not consistent with schizophrenic psychosis.
- Sarah Reese: So he's a germaphobe with a steady hand. It doesn't mean he's not schizophrenic.
- Daniel Charles: Mm, could be true, too.
- Sarah Reese: So, um... start him on anti-psychotics and reassess when his mind's clear?
- Daniel Charles: I'm just not there yet. My gut tells me it's chemical. You know, like maybe a methamphetamine overdose. Before we go any further, let's run a tox screen, see if he's just... high.
- April Sexton: What's with you? You look half-dead.
- Noah Sexton: Yeah, these 90 hour weeks are killing a brother.
- April Sexton: Law says you can't do more than 80.
- Noah Sexton: When Dr. Stohl asks you to volunteer, you don't say no. The game is rigged.
- April Sexton: All part of being a big-shot doc.
- Noah Sexton: Big shot, right. Big shot, living off of ramen and cheeseburgers.
- April Sexton: What?
- Noah Sexton: Yeah, that's all I got time for.
- April Sexton: You are getting a steady paycheck now. Sign up for one of those meal delivery services. You're gonna need the fuel.
- Natalie Manning: Good news. Helen's gonna watch Owen tonight.
- Will Halstead: "Watch" as in all night?
- Natalie Manning: Mm-hmm.
- Will Halstead: Yes!
- Natalie Manning: Just one thing I ask.
- Will Halstead: Anything.
- Natalie Manning: That you shave.
- Will Halstead: You don't like the sandpaper feel, huh?
- Natalie Manning: Mm-mm.
- Will Halstead: You ask a lot.
- Natalie Manning: Mm.
- Will Halstead: But okay.
- Ava Bekker: I still would've landed the grafts more distal, but your way worked, too.
- Connor Rhodes: I'll take that as a "nice job".
- Ava Bekker: Didn't know my approval meant that much to you.
- Connor Rhodes: Always on, aren't you?
- Isidore Latham: [after Bekker leaves] "Always on." What does that mean?
- Connor Rhodes: Nothing. It's just, um... steel sharpening steel.
- Isidore Latham: Hmm. Can't say I'm any more enlightened.
- Ethan Choi: I'm gonna order an echo, check for heart vegetations.
- Natalie Manning: You're thinking sepsis, but her white blood cell count was totally normal.
- Ethan Choi: Everything was normal the last time she was here, too, but she's back, even worse than before.
- Natalie Manning: Ethan, these two ED visits could be totally unrelated.
- Ethan Choi: No, I think they missed something last time.
- Natalie Manning: Missed what?
- Ethan Choi: I don't know.
- 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.
- Natalie Manning: You're thinking that's what made her sick, too?
- Ethan Choi: Last month, when Myra was feeling confused, she was fasting while studying.
- 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?
- Ethan Choi: The fellowship.
- Natalie Manning: She probably wasn't eating again.
- Ethan Choi: I think this is OTC. A metabolic disorder fits.
- Natalie Manning: You were right. The visits were connected.
- Natalie Manning: [worn out at the end of shift] Day like today... mm.
- Will Halstead: [putting his arm around her] Tell me about it.
- Natalie Manning: You make a really nice pillow.