Teenager With Life-Threatening Heart Disease Refuses Treatment | Chicago Med

DR. HOLSTEAD: Hi, Sophia. I'm Dr. Holstead. Are you her mom?
CINDY: Her swim coach, Cindy. Her dad should be here soon. He lives a few hours away. Sophia goes to St. Joseph Prep here in the city.
DR. HOLSTEAD: Oh, the boarding school, right?
CINDY: Mm-hmm.
DR. HOLSTEAD: Okay. So, what's going on, Sophia?
SOPHIA: I don't know, honestly. It's the weirdest thing.
CINDY: Sophia and her teammates were practicing their individual medley races, and right after Sophia made her last flip turn, she fell behind all the others. Then she stopped swimming altogether.
SOPHIA: I think I felt something in my chest, but then I passed out.
DR. HOLSTEAD: Okay, let me give a quick listen.
CINDY: Oh, it was terrifying. She was just floating there face down. One of the other coaches helped me get her out of the pool, and she was unconscious at first. Then after a few seconds, she came to. Thank goodness.
DR. HOLSTEAD: Anything like this ever happened before?
SOPHIA: No, never.
CINDY: Sophia is a fantastic swimmer. Broke the state record for the 200-meter breaststroke last year.
DR. HOLSTEAD: Wow. Impressive. All right, let's get a chest X-ray, CBC, CMP, EKG, and cardiac labs.
SOPHIA: Hey, um, is this the hospital Jack Dayton bought?
DR. HOLSTEAD: It is.
SOPHIA: Any chance I'll get to see him?
DR. HOLSTEAD: You're 16 and you keep up with Jack Dayton?
SOPHIA: When Jack Dayton was 16, he'd already created the beta version of what would become SapphireCash.com.
DR. HOLSTEAD: You know a lot about him.
SOPHIA: Of course. I'm a developer. It's hard not to look up to somebody like Jack Dayton.
DR. HOLSTEAD: Unfortunately, I doubt Jack will make an appearance today. He's a pretty busy guy. Sorry. But we'll get these tests and figure out what's going on. Sound good?
SOPHIA: Mm-hmm.
GLEN: You must be Sophia's dad. GLENny Smith. I'm sorry I'm late. I live out in Relle [unclear]. Got here as soon as I could.
DR. HOLSTEAD: I'm glad you made it. I'm Dr. Holstead. I have your lab results.
CINDY: I'll step outside.
SOPHIA: No, Coach, please stay.
GLEN: You're basically family. Cindy, she's been a wonderful influence in Sophia's life over the past few years, especially since I live so far away.
DR. HOLSTEAD: Okay. Well, the good news is your labs and EKG came back normal.
GLEN: Any idea what did cause this then?
DR. HOLSTEAD: Not yet, but I'd like to test Sophia for something called Brugada syndrome. It's a very rare disorder that causes arrhythmias, or irregular heartbeats, especially if someone who has it overexerts themselves like you did swimming today.
CINDY: That sounds serious.
DR. HOLSTEAD: In the very worst cases, it can cause the heart to stop altogether. But there are treatments that will prevent that from happening. That's why I'd like to do another EKG. But this time, I'd like to administer a medication called procainamide that will trigger an irregular EKG result if Sophia does, in fact, have Brugada syndrome.
GLEN: We got to do it, right? So we know either way.
SOPHIA: Yeah.
DR. HOLSTEAD: All right. I'll have a nurse get you set up right away.
DR. HOLSTEAD: Okay, we ready? Okay, all looks normal so far. Just like the first time. Push the procainamide. See the slope that gradually descends after each heartbeat?
SOPHIA: I don't feel any different.
DR. HOLSTEAD: You're not supposed to. The medication only changes the EKG reading if you have Brugada syndrome.
GLEN: So does this mean Sophia has it?
DR. HOLSTEAD: I'm afraid so. A cardiologist will walk you through it, but Sophia, you're going to need an implantable cardioverter defibrillator, an ICD.
SOPHIA: What's that?
DR. HOLSTEAD: It's a device that monitors your heartbeats. And if you were to ever have another heart-stopping arrhythmia, it will deliver a very small shock to your heart to restore a regular rhythm. It's a procedure typically done in a cath lab, and after four to six weeks, Sophia should be able to resume all normal activities, including swimming.
SOPHIA: Wait, you mean I can't swim at all until then?
DR. HOLSTEAD: You will need to take a break.
SOPHIA: That's going to be a problem for regionals. If Sophia doesn't compete in the upcoming meet in two weeks, she'll be ineligible for future events. That means I won't be able to compete at state. Can't we put this surgery off until later?
GLEN: That makes me a little nervous.
CINDY: I agree. It's best to take care of this right away.
GLEN: Okay, we'll do it.
SOPHIA: Dad—
GLEN: Dr. Holstead is saying your heart could stop beating.
SOPHIA: You don't understand, Dad. You're not around, and you hardly come to my meets. If I don't compete at state, that'll mess up my chances at going for the Olympics a year from now.
GLEN: I'm sorry, honey. It's just too risky. There'll be plenty more opportunities for you to compete in the future.
DR. HOLSTEAD: I will have someone from cardiology come speak with you.
SOPHIA: Yeah. It doesn't matter what I think.
[SCENE CHANGE]
STAFF MEMBER: We're very sorry, Mr. Eastman.
DR. EASTMAN: What's going on?
STAFF MEMBER: Sophie is refusing to stop swimming competitively. She's petitioned a judge to issue a stay on her ICD implantation.
DR. EASTMAN: Well, how's that possible? Her father signed off, and she's a minor.
STAFF MEMBER: She's filing for emancipation.
DR. EASTMAN: What? She's going to need her father's consent.
STAFF MEMBER: Well, in most cases, yes. But she's been living independently at her boarding school these last few years on a swimming scholarship, so the court may grant her emancipation regardless of what her father wants.
DR. EASTMAN: She has a heart disorder. You're telling me a judge is going to let her ignore it?
STAFF MEMBER: It's out of our hands now.
[SCENE CHANGE]
UNIDENTIFIED FRIEND/CONTACT: As long as we have an automated external defibrillator on standby, you are okay to compete.
DR. HOLSTEAD: That another doctor you were talking to?
CINDY: A friend who's in contact with the state's competitive committee.
DR. HOLSTEAD: Sophia, you do realize the more you exert yourself, the higher the chances this happens again.
SOPHIA: Which is why we're looking into precautionary measures that don't require surgery.
DR. HOLSTEAD: There aren't any. I've trained my whole life for this, and I'm not about to throw it all away just because I passed out once. Sophia, if another arrhythmia occurs, you may not get the chance to go to the Olympics.
CINDY: Dr. Holstead—
DR. HOLSTEAD: You could die.
DR. HOLSTEAD: May I have a word?
[PRIVATE CONVERSATION]
DR. HOLSTEAD: It's good when she's taking medical advice from the swim coach.
CINDY: You need to give this girl some space. I don't like it any more than you do, but it's time to step away.
[SCENE CHANGE]
DR. HOLSTEAD: Mr. Dayton, I'm Will Holstead, one of the ED doctors.
ASSISTANT: Sorry, Mr. Dayton's on a very tight schedule.
DR. HOLSTEAD: Oh, I understand, but I have a patient, a teenager, who has a heart condition. She needs a procedure, and she's refusing because it'll get in the way of her competitive swimming. But I think you might be able to change her mind.
JACK DAYTON: Why would she listen to me?
DR. HOLSTEAD: She's into computers. I mean, she idolizes you. I wouldn't be asking otherwise.
ASSISTANT: Mr. Dayton, you have to be in San Francisco by 8:00 p.m. I've got a very important meeting. It can't be rescheduled.
DR. HOLSTEAD: All I'm asking for is a few minutes convincing Sophia to get this procedure. It could save her life.
JACK DAYTON: I appreciate your concern for your patient, but I really do have a plane to catch.
DR. HOLSTEAD: Why'd you even buy a hospital if you don't care about the patients in it?
JACK DAYTON: Excuse me?
DR. HOLSTEAD: You know, when you took over Med, I hoped it might have something to do with a desire to help people, but clearly that was naive on my part. We're nothing to you. Just another toy to play with. Have a safe flight.
[SCENE CHANGE]
DR. HOLSTEAD: Sophia, your discharge paperwork is complete. You're free to go.
JACK DAYTON: Sorry. Hope this is the right room.
SOPHIA: You're Jack Dayton.
JACK DAYTON: You must be Sophia. Dr. Holstead here tells me you're quite the swimmer.
CINDY: She is.
JACK DAYTON: He also tells me you're a fan of mine.
SOPHIA: Oh, that's very kind of you.
JACK DAYTON: You know, one of the perks of owning my own hospital is getting to know the patients. So I thought I'd come by and say hello.
SOPHIA: Hi.
JACK DAYTON: Hi. Now, you love swimming, but I also hear that you have an interest in computers, right? Tell me about that. What are you developing?
[SCENE CHANGE]
DR. HOLSTEAD: I do appreciate you stepping in, Mr. Dayton.
JACK DAYTON: Smart girl. Sophia, glad you changed your mind about having the procedure.
DR. HOLSTEAD: Curious, sir. What'd you say to get through to her?
JACK DAYTON: Oh, well, turns out we have a lot in common. I told her how I used to be a bit of an athlete myself. Basketball was my thing. But I also loved computers. So when I messed up my back and couldn't play for a little bit, I still had this other passion. And, well, worked out well for me. I think it gave her a whole new perspective.
DR. HOLSTEAD: Hey, look, about what I said earlier—
JACK DAYTON: No one ever talks to me like that.
DR. HOLSTEAD: I'd like to apologize.
JACK DAYTON: Save it. I can respect a straight shooter, especially one so committed to his patients. Glad to know I have you on my team, Dr. Holstead. Now, if you'll excuse me, I have a plane to catch.