In Extremis

Season 1, Episode 6

Leanne and Cole talk about work

**In Extremis** is the sixth episode of the first season of **Code Black**.

## Short Summary

Leanne must deal with the difficult decision of whether to save Tom Moreno (Michael Trucco), the police officer who helped her during her family's accident, or his shooter, who has more serious injuries. Also, when Malaya's pregnant ex-girlfriend, Carla Niven (Shiri Appleby), arrives at the hospital with pain in her arm, Malaya is shocked by her MRI results.

## Full Summary

Andres Cantu is drunk and sings loudly in the ER.

Mario prepares a needle, but Ethan Watney objects that he said no shots.

At the desk, Malaya, Christa, and Neal are watching. Malaya says Mario has no game with kids. Christa asks what everyone thinks about Cole Guthrie. Malaya says he's hot. Christa asks Neal if he's met him before. Neal says Rollie mentioned him a few times, but they'd never met before. They say he's a good surgeon though. The Guthries are a bit of a mystery.

Ethan is still resisting the shot. Mario says it'll be over quickly. Taylor sees what's happening and attempts a magic trick to impress him. He knows what Taylor did, though, and isn't swayed. Ethan then looks around, sees Christa, and says she can give him the shot, because, "That ass." His mother scolds him, but Christa goes over anyway to give him the shot.

Mario asks what's next. Neal asks him what happened with the kidney stone. Mario gave him morphine and discharged him. Neal asks if he called her a cab. He says he doesn't call cabs for people. He's not a bartender anymore. Jesse asks him if he was any good at bartending. Mario points at each person and names their drink. Christa comes up and says an 11 year old just tried to look down her shirt. Mario says it's hard being a guy because that's all they think about. He then names her drink and Neal's. Neal tells Mario to call the patient a cab.

Carla Niven walks into the ER and calls for Malaya. Jesse recognizes her and greets her happily. He then tells Malaya to take a deep breath. Malaya sees that Carla is pregnant.

Andres is still singing.

Malaya leads Carla into a room and sarcastically asks if the baby is hers. She asks Carla how it happened and why she's there. Carla says she had a sharp pain in her shoulder. She treated it, but it's still hurting. She wants an MRI. She couldn't go get a scan at her own hospital because of the gossip. She came because she thought Malaya could be a friend. Malaya reminds her that she didn't want to be friends. Carla starts to cry and says she just needs to know what it is. Malaya says okay.

Malaya and Christa hear sirens as they walk outside. Christa thought they weren't supposed to use sirens on the ramp and Malaya says they aren't. They then hear the doorbell ring and Christa asks if it's a homeboy drop-off. Not with sirens, though. Leanne comes up behind them and says it's red on blue.

Outside, she sees Tom Moreno. He says his partner's been hit. Neal goes to the partner while Leanne tells Tom he's been shot as well. Tom tells Leanne how a gangbanger just started shooting at them while Christa and Neal check out Scott Barnes' graze wound to the head. Tom says he knows he managed to shoot the shooter. Leanne says it's time for them to take care of him now. He tries to say he's fine, but they get him on a gurney and get him and Scott inside.

In the ER, Leanne orders scans for Tom. Jesse says he'll notify the sheriff so they can post security at the doors. Malaya tells Angus gangbangers have been known to come into the ER to finish the job. The bullet shattered Tom's femur. It also released endorphins which stopped him from feeling his injuries. Scott seems fine, but then his BP suddenly crashes. As they take Tom out of the ER, they hear a man screaming. Leanne tells Malaya to go check it out.

Steve Jasso comes in, carrying his son. He says his son shot himself. Rollie takes Victor out of Steve's arms and says they'll take care of him. He puts Victor on the gurney and has Risa page surgery.

In the ER, Malaya tries to intubate as Rollie examines Victor's injury. Cole comes in as the surgical consult. Rollie tells Jesse this isn't a good case for Cole to take. Despite this, he gives Cole a rundown on the case. Malaya can't intubate because the hematoma is expanding. Cole steps in to drain it. Steve comes into the ER asking about his son. Jesse directs him out, saying he can't be in there. Cole ends up having to open Victor up to drain the blood. Malaya intubates, but when Cole checks his reflexes, he gets no response. Victor is brain dead. Jesse tells them his father's in the family room.

As Rollie goes to tell Steve about Victor, Malaya offers to do it. She's called a parent before. Rollie says that's a completely different thing. Jesse says she has to do it sometimes and he'll go with her. Rollie tells her to keep her own emotions out of it. She nods.

Leanne gives Tom a shot. Tom talks about how strong Scott is and how great he is. Then he asks if they heard anything about the shooter. She hasn't, but he knows he hit the shooter. He must be dead by now. Neal comes up and says Scott nearly bled out, but they were able to stabilize him. Neal asks Leanne how she knows Tom and she says he's a family friend. She suggests that they bring Scott in next to Tom and Neal says he'll make it happen.

Jesse tells Malaya to hold her stethoscope so she has something to do with her hands. Look him until the eye until she's done speaking. Don't look at Jesse, because it'll make her seem unsure.

Malaya enters the family room. She tells Steve that Victor is brain dead. He starts to cry. Steve says Victor's mother is dead. He starts to scream and flips a table over. Jesse walks to him and gives him clean clothes to change into, then says they'll take him to his son.

Steve, now cleaned up, is by Victor's bedside. He asks what Victor did and starts to cry.

Rollie tells Malaya he'd like to tell her it gets easier, but it doesn't.

Rollie asks Cole if he's all right. Cole asks why. Rollie says he knows why. Cole says he wasn't there, so he doesn't get to talk about it. Rollie says it's been so many years and asks if Cole isn't tired of it. Cole says when you find your mother when her brains on the wall and a gun in her hand, it's never been so many years. It's always yesterday. Rollie says he can't change the past, but one day, this moment will be the past, too.

**10:30 PM**

**Code: Black**

Paramedics bring in James, who was shot in the chest, a stray bullet from the shooting Tom was involved in. James says he has a pacemaker and defibrillator. Mario finds what he thinks is an exit wound on the back, but Neal says it could be a second entry wound. Two fastest ways to kill your patient are what you don't know and what you think you know, but isn't so. His EKG is normal, so they send him for an x-ray.

A reporter on the TV is talking about the shooting. Taylor is bombarded by reporters who want a statement. He tries to get them to clear the area.

Angus asks Henry Pollen about his pain. It's an 11. He tells Angus he played tennis and got worked up, so he got acupuncture and believes Dr. Wu left a needle in him. Angus says he can't see or feel a needle in there, but Henry knows it's there and it's going to kill him. Angus says he won't let that happen.

Isabel tells Malaya Carla's scans are up. Malaya says she'll be right up. She sees someone with a hood walk into the ER. She follows him as he walks into the ER and stops at Victor's bed. She asks him what he's doing. Jamal turns around and says he did this, getting Steve's attention. Steve says he told Jamal to stay away and now Victor's dead. Jamal says he can't be dead because he's right there. Rollie tries to calm them down. Steve tells Jamal to leave.

The Code Black light turns off and Jesse smiles. Leanne walks up and it turns back on. He tells her in Spanish she's bad luck. He tells her why. She steps back and the light goes off again. She walks forward and it got back on. He says he'll bring some sage in. She tells him to do that and she'll tell him where to shove it. Risa comes up and says they need Leanne in sides.

Tom is getting worse. Leanne examines him. He says it's good to see her working again. He apologizes for not keeping in touch after the trial. Leanne ignores him and asks Christa what she sees. She says it could be atelectasis, but Leanne says his breath is too strong for that. Cole says there's not an OR opened because of an emergency. Cole examines Tom and they both hear bowel sounds in his chest. His diaphragm is ruptured and his bowel is herniated into his chest and kinked. Next OR is his. Cole tells Jesse to get zolfran IV, not pill. When Jesse just stares at him, he asks if there's a problem. Jesse says there isn't.

Walking away, Cole knows Jesse doesn't like him. Leanne says it's because he barks out orders like Jesse doesn't know. Jesse's been a nurse since Cole was in diapers. He wouldn't give a patient throwing up a pill. Leanne tells Cole to respect Jesse. She says he can help her by clearing an OR because Tom's condition is life-threatening.

Malaya sees Jamal in a hallway. He asks if Victor's going to wake up. She says she can't tell him and asks what he meant when he said he did this to Victor. He says he can't give her that information. She says she's not his enemy. He wasn't there when it happened. He explains that they were hanging out playing video games a few days ago. Victor started laughing at a dumb joke he had made. When he laughs, you have to laugh. Then Jamal kissed him. Best moment of his life. But he regretted it right away. Victor got scared. Jamal loved Victor and knew him in a way his father didn't. He was safe with Jamal or Jamal thought he was.

Christa shows Neal and Mario James's x-ray. The bullet hit his defibrillator. The device angled it away from his heart. Neal goes to tell James about it, but James is more worried about getting out of there because he had school in the morning. Neal says his device was damaged, but James says he can live without it. His arrhythmia is due to congenital dilated cardiomyopathy. He asks again when he can leave. His EKG is normal, so he says he needs to be out of there by the morning. He promises he'll check in with her cardiologist. He knows this is serious, but so is school. Christa asks if there's anyone they can call. He says his parents aren't around. They were bangers. He did everything he could to stay out of the path of the bullet, but the bullet found him anyway. Christa and Mario tell him he's lucky because his implant directed the bullet away from his heart. He tells Mario he's studying electrical engineering. It's a miracle he even got into the program and he can't afford to miss a day. Christa says he's going to be there a while since he was shot in the chest. He has at least two surgeries ahead, one to repair the damage and one to replace his implant. He's probably out for the semester. He asks them to give him a minute.

As they walk away, Christa tells Mario he was right to be honest. Mario says he took a bullet to the chest and all he wants is to get back to school. James is his people.

Angus shows Henry his x-ray, which is completely clear. Henry thinks the machine is broken and tells Angus to do something.

Malaya walks into the lounge to see Carla. Carla immediately knows she's there to deliver bad news. She has a lesion in her upper humerus and elevated white count. Carla looks at her own results as Malaya tells her she has leukemia. Malaya suggests treatment options, but Carla reminds her she's pregnant. Carla starts to cry and tells her to stop talking. Malaya says she's doing it all wrong and Carla asks if she's talking about being a doctor or being a human. She then walks out.

Scott asks Tom about the kid who was hit by the stray bullet, if it was one of their bullets. Tom says he was shooting in that direction. Tom says he hopes the guy he shot at is bleeding out somewhere. Jesse says they need to calm down and he's taking Scott to ICU. Scott asks if Tom is getting his OR. Tom asks Leanne if Scott's going to be okay. She says he is and the kid who came in is also stable. Leanne asks him how long he and Scott have been partners. It's only been a few weeks, which shocks Leanne. Tom defends himself again, saying the guy came out of nowhere and Tom never saw him. Jesse asks how he knew it was a gangbanger if he never saw him. Tom gets upset and Leanne pushes him back in the bed and calls Jesse away.

Out in the hallway, Leanne asks Jesse if he's a cop now. Tom pulled her entire family out of the wreck. She couldn't move because her whole body was broken. Jesse doesn't know because he wasn't there. No one was there except her and Tom. It was an eternity before help came. Tom did everything she said to try to save her family. When they finally got to the hospital, her family died one by one and Tom stayed with her. She was in the darkest place a person can be and Tom never left her side. She's not sure if she believes Tom's story. Jesse says she's the best diagnostician he knows and asks if she thinks she's getting the whole story.

Steve is still with Victor. He asks Rollie if Victor's ever going to wake up. Rollie says he isn't. Steve laments all the other things they'll never do again. He says he's ready to take Victor off the machines. Malaya says she spoke to Jamal, who would like to see Victor and say goodbye. Steve says no. Rollie calls Malaya out.

Outside, Rollie asks Malaya what she's doing. She tells Rollie what happened. Rollie says they don't know why Victor did what he did, but he knows how that man is feeling right now and he can't judge him for that and neither should Malaya.

Leanne asks Tom how he is. He says he doesn't mind the morphine. He asks her if he's going to make it. She says she'd do the surgery herself if she could, but it's beyond what they can do in the ER. That's not what he asks. She tells him he's going to make it, but he knows she's lying. She says she'll never forget what he did out there on the highway. He saw her at the lowest point in her life. She asks if she's seeing him at his. She asks him what really happened. He starts to repeat his story. Then he tries to defend himself again. Jesse comes up and asks for a second with Leanne. He tells her privately they found the shooter. Multiple gun shot wounds.

The shooter is pulled out of the ambulance. They take him into the ER. They transfuse blood and intubate. They page surgery for an exploratory laparotomy. Malaya struggles to intubate, so Leanne steps in. She then says it wasn't a difficult intubation and asks where Malaya's head is.

Tom leans up in his bed to try to see what's happening. Cole comes up and introduces himself. Tom asks about the shooter. He tries to get out of bed, but Cole tells him he can't stand and they're taking him to the OR.

The shooter needs surgery immediately. Leanne looks between the shooter and Tom. She asks for Neal.

James is writhing in bed. Amy tells Mario and Christa his device just shocked him twice in ten seconds. It's malfunctioning. James asks them to stop it before it happens again. It shocks him again and he flatlines. Mario starts compressions.

Neal arrives and Leanne tells him the shooter's injuries. She says Tom needs an OR as well, too. The shooter has five minutes and Tom has twenty. She says she can't make the call because her judgment is off, so Neal has to make the call. Cole asks what's going on and Malaya tells him it's the guy who shot the cops. Neal says the shooter is more emergent and tells Cole to take him up instead of Tom. Malaya is in awe of that, but Leanne says she's not needed and sends her away. Cole also objects, saying the shooter's not stable for transport. He believes he can't save him, but he could save Tom.

Just then, Mario and Christa come into Center Stage with James. Neal says he'll do the surgery himself. Tom, up on his feet, tells them to let the shooter die. He then collapses on the floor.

They open the shooter in the ER in a last-ditch effort to save him. Taylor comes in and says they have 50 photographers dying to get a picture of the white cop between two black men he shot. Malaya comes in to help. She apologizes for bringing her baggage into the ER, but Leanne says she's not the only one who did.

As he and Cole work, Neal tells Christa and Mario the need an ICD magnet to shut down James's device. Cardiology has both of them. Without it, they need to cut the wires to disable the device manually. They have to time it just right so they don't get electrocuted. Neal instructs Christa on how to do it.

Tom has a tension pneumothorax. Leanne receives the pressure and prepares to take him upstairs. Cole says to take him and he'll be right behind them. Christa prepares to start cutting the leads. She goes to cut, but the device triggers. She hesitates and James is shocked two more times. Mario tells her to do it and she cuts, but is jolted backward when she receives a shock from the device. Despite that, she's okay and James stabilizes.

Meanwhile, the shooter has flatlined. Neal asks for suggestions and then calls time of death. Neal says Cole was right and Cole says Neal's a good surgeon. Neal says Cole is as well, but Cole's actually a surgeon. Cole wonders why Neal is down in the ER.

Henry still believes he has a needle in him. He complains to Taylor about it and Angus says he's checked for needles and found nothing. Taylor goes into a drawer and tells a story about going to an acupuncturist for fertility. One needle in his scrotum and he had his very own millennial. Taylor then reaches down to where Henry's pain is an pulls out a needle. Henry says he didn't feel a thing and thanks Taylor. Aside, Taylor tells Angus he'll find two syringes without the needles in the drawer. Angus questions him and he says Henry's mind was playing tricks on him, so he played a trick on Henry's mind.

Rollie is turning off Victor's machines when Malaya asks him to wait a minute. She tells Steve Victor would have wanted Jamal there. She says the hardest thing for Victor would be disappointing his father. She had to tell her parents who she was. It took years and she had to take her girlfriend with her and her girlfriend did most of the talking. Steve says Victor wasn't unhappy. Malaya says Jamal made him very happy. He and Jamal are the same in loving Victor more than anything in the world. Jamal comes in, holds Victor's hand, and apologizes. Steve asks Jamal if Victor knew he loved him. Jamal says he thinks so.

Jesse finds Malaya, who asks him to explain the world to her. Jesse asks if she knows what a covenant. It's a sacred agreement. People come to the hospital at their very worst, so no matter what, they have to be at their best. No one said it was easy. That's the covenant.

Malaya finds Carla on the roof. She knows Carla had already diagnosed herself. She feels awful. She was trying to keep her emotions out of it, but she wasn't at her best. Malaya says this is where it all started. Malaya was scandalized because Carla was a senior resident and she was nervous. Carla says it was adorable. Carla didn't think anything could be worse than saying goodbye to Malaya. Malaya thinks this is worse, but Carla says not by much.

Tom is awake and asking about Scott. Leanne says he'll be okay. James will also make it. When Tom asks about the shooter, Leanne asks if he's worried about what he might say. Tom says whatever people are thinking, that's not it. Tom says he took money from a guy you don't take money from. He said he'd come for Tom and he did. Leanne tells him the shooter is dead, so it's up to Tom if he tells the truth or not. Leanne says the guilt never goes away. She goes to leave, but he stops her and asks what she has to feel guilty about. She feels guilty that she survived.

## Cast

* Leanne Rorish
* Neal Hudson
* Christa Lorenson
* Malaya Pineda
* Rollie Guthrie
* Angus Leighton
* Mario Savetti
* Jesse Sallander
* Cole Guthrie
* Tom Moreno
* Steve Jasso
* Jamal
* Henry Pollen
* James
* Carla Niven
* Mark Taylor
* Risa Park
* Isabel Mendez
* Amy Wolowitz
* Ethan Watney
* Scott Barnes
* Andres Cantu
* X-Ray Tech
* EMT
* News Anchor
1/25
### Main Cast

* Marcia Gay Harden as Dr. Leanne Rorish
* Raza Jaffrey as Dr. Neal Hudson
* Bonnie Somerville as Dr. Christa Lorenson
* Melanie Chandra as Dr. Malaya Pineda
* William Allen Young as Dr. Rollie Guthrie
* Harry Ford as Dr. Angus Leighton
* Benjamin Hollingsworth as Dr. Mario Savetti
* Luis Guzmán as Jesse Sallander

### Guest Starring

* Cress Williams as Dr. Cole Guthrie
* Michael Trucco as Tom Moreno
* Benito Martinez as Steve Jasso
* J. Mallory McCree as Jamal
* Steven Shaw as Henry Pollen
* Christopher Meyer as James
* Shiri Appleby as Dr. Carla Niven
* Kevin Dunn as Dr. Mark Taylor

### Co-Starring

* Angela Relucio as Risa Park
* Ellia English as Isabel Mendez
* Gabrielle Carteris as Amy Wolowitz
* Luke Donaldson as Ethan
* Casey Printers as Scott Barnes
* Sal Lopez as Andres Cantu
* Melissa Bickerton as X-Ray Tech
* Joshua Keller Katz as EMT
* Rick Garcia as News Anchor

## Medical Notes

### Ethan Watney

* **Diagnosis:**

* **Doctors:**
	+ Mark Taylor *(ER physician)*
	+ Mario Savetti *(ER resident)*
	+ Christa Lorenson *(ER resident)*

* **Treatment:**
	+ Shot

Ethan, 11, came into the ER and insisted he didn't want any needles. He refused to let Mario give him a shot. Taylor came up and used a magic trick to entice him, but Ethan saw through it and still refused. He then saw Christa and said she could give him the shot, so she did.

### Carla Niven

* **Diagnosis:**
	+ Pregnancy
	+ Acute lymphoblastic leukemia

* **Doctors:**
	+ Malaya Pineda *(ER resident)*

* **Treatment:**

Carla told Malaya she'd had a sharp pain in her shoulder a few weeks before. She put a bandage on it, but the pain didn't go away. She asked Malaya to give her an MRI to confirm that it was a break at the humeral head. Instead, the MRI and labs showed ALL. Malaya told her about treatment options, but she refused them because she was pregnant.

### Tom Moreno

* **Diagnosis:**
	+ Gun shot wound
	+ Perforated diaphragm
	+ Tension pneumothorax

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Cole Guthrie *(general surgeon)*
	+ Angus Leighton *(ER resident)*
	+ Malaya Pineda *(ER resident)*
	+ Christa Lorenson *(ER resident)*

* **Treatment:**
	+ Surgery

Tom, 42, was shot in the leg during an altercation. He tried to say he was okay because his partner was also injured, but they took him into the ER to be treated. They did x-rays, which showed a shattered femur where the bullet hit. He later started coughing up blood. His diaphragm was ruptured from the bullet ricochet and his bowel was through the hole and kinked. He tried to get up and walk, but he collapsed. He had a tension pneumothorax, so Leanne relieved the pressure with a needle and took him up to surgery. After his surgery, Leanne told him he'd be okay.

### Scott Barnes

* **Diagnosis:**
	+ Gun shot wound

* **Doctors:**
	+ Neal Hudson *(ER physician)*
	+ Christa Lorenson *(ER resident)*
	+ Mario Savetti *(ER resident)*

* **Treatment:**
	+ Stitches

Scott was shot at during an altercation. He had a head wound, but it was just a graze, so they sewed it up in the ER. He was then taken to the ICU.

### Victor Jasso

* **Diagnosis:**
	+ Gun shot wound

* **Doctors:**
	+ Rollie Guthrie *(ER physician)*
	+ Cole Guthrie *(general surgeon)*
	+ Malaya Pineda *(ER resident)*

* **Treatment:**
	+ Life support

Victor came in with a self-inflicted gun shot wound to the head. He had a hematoma on his neck which made it hard to intubate him. Cole tried to drain the hematoma, so they could intubate, but he ended up having to open Victor's neck in the ER with he pulled out arterial blood. Sadly, they tested his reflexes and found he was brain dead. Victor's father later decided he was ready to end life support.

### James

* **Diagnosis:**
	+ Congenital dilated cardiomyopathy
	+ Gun shot wound

* **Doctors:**
	+ Neal Hudson *(ER physician)*
	+ Mario Savetti *(ER resident)*
	+ Christa Lorenson *(ER resident)*

* **Treatment:**
	+ Disabling device

James, 18, came into the ER with a gun shot wound to the chest. He told them he had a pacemaker and internal defibrillator. They took him for x-ray and got a cardiology consult. The bullet had hit his defibrillator. They told him about that and he told them he could survive without it and wanted to leave the hospital. He promised to check in with his cardiologist. His damaged device started shocking him randomly and put him in asystole. They had to shut down his device, but the magnets to do so were unavailable, so they had to disconnect the leads manually. Once it was disconnected, they were able to save him. He was told he'd need at least two surgeries.

### Henry Pollen

* **Diagnosis:**
	+ Psychosomatic pain

* **Doctors:**
	+ Mark Taylor *(ER physician)*
	+ Angus Leighton *(ER resident)*

* **Treatment:**
	+ Sleight of hand

Henry came in after having acupuncture believing the acupuncturist left a needle in him. Angus said he didn't feel or see a needle, but Henry insisted it must be there, so Angus ordered an x-ray. Angus showed him the clear x-ray, but he wasn't convinced. Taylor then used sleight of hand to make him believe he'd pulled out a needle, which relieved Henry's pain.

### Shooter

* **Diagnosis:**
	+ Gun shot wound

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Neal Hudson *(ER physician)*
	+ Cole Guthrie *(general surgeon)*
	+ Malaya Pineda *(ER resident)*
	+ Angus Leighton *(ER resident)*

* **Treatment:**
	+ Exploratory laparotomy

The man who shot Tom and Scott came into the ER. They intubated him, but he needed an emergent exploratory laparotomy. Since he was so unstable, Neal helped Cole open him up in the ER. However, they were unable to save him and he was pronounced dead at 1:44 AM.

## Notes and Trivia

* This episode scored 6.44 million viewers.