Pre-Existing Conditions

Season 1, Episode 3

Mario and Angus disagree over a patient.

**Pre-Existing Conditions** is the third episode of the first season of **Code Black**.

## Short Summary

Amid the chaos and exhaustion of working 36 consecutive hours in Code Black, the doctors must deal with Margaret O'Brien (Gail O’Grady), the distraught mother of two sons who are in a devastating car accident. Also, Mario bullies Angus into performing an unnecessary operation but lets Angus take the blame when Leanne finds out.

## Full Summary

**Code: Black Hour 36**

Leanne stands in the ER, looking off into the distance and drinking coffee. Flashes of chaotic ER scenes come through. Taylor starts talking to Leanne and takes a moment to get her attention. He asks if she smells burnt toast, to rule out an aneurysm. He then tells her they're bringing in two brothers who were in an accident and dispatch needs her because they can't get an airway in one of them. Taylor says they're in the 36th hours of a code black and he has to send the residents into extra innings. She says he's never worried about that before, but he says he has to pretend to be worried. She's sure they'll be fine. He asks about her. She's worked thirteen days in a row, to which she tells him he's welcome. Leanne talks to dispatch and helps them before going to meet the ambulance.

Angus examines Stanley, who fell off a truck ramp. He has hip and back pain and chest contusions. He's breathing normally, so Rollie tells him to send Stanley for a blunt-trauma workup. He also tells Angus good morning and Angus is surprised that it's morning.

Malaya tells Christa about a patient that needs transport with the rig on the way. Christa asks if she has time to use the bathroom. Malaya tells her to wear an adult diaper. That's what she does. After a moment, she tells Christa she was kidding.

Angus is still with Stanley. He's just getting worse. Angus orders labs and scans. Mario comes in and tells him to use a pelvic binder. As they argue about his treatment, Angus sends Risa Park to get blood. Angus thinks the pelvic bleeding is the problem, but Mario thinks it's in Stanley's chest.

Neal and Leanne meet the two brothers coming out of the ambulances. As they take Kevin O'Brien in, he begs them to save his brother, Patrick.

In the ER, they intubate Patrick, who is pulseless. Kevin continues to ask about Patrick as they treat him. Because of his seat belt sign, they suspect internal organ damage.

Angus and Mario are with Stanley, who is still getting worse. Angus can't find bleeding in the abdomen, but an ultrasound wouldn't necessarily detect that kind of bleeding. Stanley flatlines and Mario tells Angus he needs to act now. A nurse brings in two units of blood, which is all they had. He starts transfusing it. Mario says it's more likely there's cardiac trauma. He wants Angus to do a thoracotomy. Angus resists, but eventually says he'll do it.

They're still trying to get Patrick into a shockable rhythm. Leanne asks Neal if Kevin is ready for CT, signaling to him that Patrick's not going to make it. Neal takes Kevin out of the ER over his objections. After he's gone, Leanne tells Malaya to stop compressions. She asks for other suggestions. When no one has any, she pronounced Kevin dead. She then tells everyone to get back to work.

Once Stanley's chest is open, they notice it's beating normally. They shouldn't have cracked his chest. Rollie comes in and is shocked by what he sees.

Rollie is explaining what happened to Taylor and Leanne. Leanne says now their patient needs an orthopedic surgeon for his pelvis, plus a thoracic surgeon for his chest. Taylor adds that they need a lawyer to give them all a colonoscopy. Leanne scolds Angus and Angus tries to explain what happened. Mario stays quiet as Angus takes the blame. Transfusing the blood stabilized him because the pelvic fracture was causing the bleeding. Leanne says they can't waste more time on this. She sends Mario back to Trauma One and Angus to the waiting room to decompress it. After she walks away, Taylor tells Angus that he once removed the wrong testicle, if that makes him feel any better.

Jesse gives Malaya a piece of paper with Kevin and Patrick's mother's number on it. He coaches her, saying she can't give any news over the phone, so she just needs to tell her to get down to the hospital. Malaya makes the call and tells her to come down to the hospital. Margaret O'Brien is upset that Malaya can't give her more information over the phone.

In the bathroom in stalls next to each other, Christa and Malaya talks to each other about their patients. Christa turns over Kevin to Malaya, who's glad for the chance to get one of them home alive.

Neal and Leanne talk about the thoracotomy. Leanne says Mario just let Angus take all the heat. Neal realizes Leanne doesn't like Mario, which she says is because he's a gunner who doesn't play well with others and likes it that way. Neal says no one's unteachable. Leanne says she's not a teacher. She's a filter. No one gets through her who doesn't deserve it.

Taylor tells them to hide their jewelry as there's a jail bus coming in. Neal says he'll get it. He and Christa meet the ambulance bringing in Dylan Michael Ross. Neal's familiar with the case. He's had a kidney transplant in jail. Christa asked what he did and Neal tells her not to worry about it, but he's never getting out, so she doesn't have to worry about that either. His potassium is very high, so they immediately worked to get it lowered. Risa says she can't find a vein and Neal notes that he's a former IV drug user. He needs dialysis. Christa places a catheter to get access. Neal tells Christa she doesn't want to know what Dylan did and not to look up his past as it's an ethical violation. Mario comes by after Neal's gone and tells Christa to let him know if the convict gives her any grief and she asks if he'll come to her rescue. She heard what happened with Angus.

In the waiting room, Angus listens as Mrs. Curtis lists the symptoms she's having. TJ calls that he needs help and Angus tells him to wait. It's allergies. Her prescription ran out, which is why she's there. Angus says he has to do a full physical and history before he and prescribe anything. Tiffany interrupts, saying she fell off the pole. He notes that she's a stripper, but she quips that she's a preschool teacher. Donald then says his head hurts really bad. He got attacked by some ISIS people and they hit him with a golf club. But he's gotten really good at making it not hurt anymore. He's a soldier. He served in Desert Storm. Mrs. Curtis says Donald comes in all the time and he's nuts. She knows that Angus is new. That's why they put him out there with them.

Malaya explains to Leanne what she told Margaret O'Brien. Leanne says it's better to give the news face to face. Kevin doesn't know yet that his brother's dead. Leanne enters the family room, where Margaret is waiting. She tells her that Kevin is stable, waiting for a CT, and Patrick died in the ER. Margaret starts to cry.

Leanne takes Margaret to see Kevin. She tells Kevin he should have died and he killed his brother. She told him not to drive. Jesse pulls Margaret out of the room. Malaya asks if she should sedated Kevin, but Leanne tells her just to makes sure he doesn't hurt himself, because this is grief and she just needs to let it be.

Leanne gets something out of the vending machine. Jesse comes in and sarcastically says that went well. Leanne says one of her sons is dead and the other killed him. Jesse says he didn't do it deliberately. They don't have the tox screen back. Leanne goes to go back to work, but he says she can take a minute with Mama. It's allowed. Leanne talks about drunk drivers and what should happen to them, but then quickly changes to subject to the snack she just got, saying it tastes like drywall. Jesse says he's told her there's no real food in vending machines. The kitchen's out of food and he's not really in a position to be giving out advice on food. He says he could have been a movie star with his face. She's more worried about his breasts. He says at least their his. She says they need to get back to work and says her breasts are all hers.

Mario offers Malaya an energy drink, which she declines. The kitchen's out of food, so Taylor ordered a taco truck. Malaya tells Mario he completely sold Angus out. Everybody's talking about it. Malaya says they're all going to be there together for three more years. He says it's emergency medicine, not high school. He didn't get this far taken responsibility when he didn't have to. After she walks away, Mario tells Risa Malaya's into him. She asks if he's sure about that and he is.

As Mario bandages Tiffany's ankle, she makes conversation, talking about the taco truck. He gives her post-care instructions and says she's all finished. She says she hates stripping and she'd love to be out of commission. He tells her to follow up with her primary care doctor in a few days. She can't follow up with him because he's an ER physician and doesn't take appointments. She says it must be nice to be someone like him.

Medics bring in Zoe Fuller, whose temp was too high to read on the rig. Her friends deny drug use, but when pressed, say she took MDMA. Mario interrupts and talks about what MDMA does to the body. Leanne silences him. Zoe has a temp of 108°. She has non-exertional heatstroke. They need to get her temp down or she'll die. They don't have arctic sun blankets available, so they use ice and misters. Leanne also tells Mario that he didn't get away with anything that morning. She says the further he goes, the more he's going to need the people he started out with.

Malaya shows Leanne Kevin's tox screen. They have to tell the police. It's a crime now, not an accident.

The swelling in Dylan's body has gone down. Neal tells Christa to keep monitoring him. He's still pretty sick. Neal leaves and Dylan says his transplant failed. Christa tells him sometimes they come back. His mother used to say that about her boyfriends. He could have done without those, unlike his kidneys. Dylan says he's been throwing up and having diarrhea. He talks to Christa casually for a few minutes, then says he used to love this part, the soft part. Once he figured out how nice they were, he tried to keep them alive as long as possible. He liked it, watching them suffer. Dylan starts coding and Christa holds the syringe in her hand and hesitates for a moment before injecting it. He immediately stabilizes. Christa leaves to throw up.

Taylor finds Leanne. He doesn't want to be that guy, but Margaret O'Brien is still sitting with her son's body. It's been over three hours and they're overbooked. Jesse says they should leave her be, but Leanne says Trauma One is for the living.

Leanne tells Margaret that Kevin will be getting his CT soon. They'll know more after that. Margaret says she only has one son now and he died. Leanne says she can only imagine how angry she is. Leanne admits that Kevin was drunk when asked. Patrick worshipped Kevin and would have done anything for him, including letting him drive drunk. Their father died ten years ago, so now she's all alone. She doesn't think Leanne can imagine how she feels. Leanne says she'll leave her alone.

Zoe is still unresponsive. Her temp's down to 105. She suddenly stands up out of her bed and has blood dripping from her eyes and nose. He rushes her into Center Stage. Neal quizzes him about blood's reaction to heat. She has a blood clot in her lungs. They could use blood thinners, but that could killer her with the bleeding. He chooses to do it, because if he doesn't, she had no chance, and this gives her some chance. He gives her the blood thinners and she stabilizes. Neal says he could be a good doctor, but he has to stop keeping score. He tells them to take Zoe up to ICU.

Angus retrieves food from the taco truck, while complaining to Rollie about how he's waiting tables after going to medical school. Rollie says he needs to go. They're down to Code: Red, which is like saying it's just his arm that's on fire. Angus says he didn't want to do it, but Mario kept pushing him. Rollie figured that. Angus did it because he doesn't trust himself. Rollie says he needs to find his voice and let it sing. Angus tells a story of a boy who used to beat him up. One day, other kids brought him to Angus and told him to hit the kid. But Angus couldn't do it. Rollie says Angus is the hero of that story.

Kevin has started declining. Malaya examines him and asks Risa about a CT. The machine's back up, but he's not stable enough. Malaya talks to him, saying they're going to help. He says he doesn't want their help. Leanne comes in and immediately starts a central line. They transfer his fluids to that line. Leanne says that if an assessment tool is down, you improvise. She takes a sample of his blood. It's musty red, meaning he's hemorrhaging somewhere. He needs an exploratory laparotomy. Kevin repeats that he wants to die, but Leanne says they only save lives there.

Christa tells Neal that she can't treat Dylan anymore. He understands, but Dylan is her patient. Neal says, like his mother used to tell him, sometimes the way to be brave is to pretend to be brave.

Angus examines TJ's foot. It's just toenail fungus. He sees Donald coughing and struggling to breathe, so he goes to check. He's confused about what happened to his head and other details. The cough just started. Angus says he needs a chest x-ray. He can't remember if he actually served in the military. Angus sees a medal around his neck and tells him it happened. Donald grabs his chest and says it's tight. He sees the a wrapper. Mrs. Curtis gave him an energy bar because the taco truck left before he could get food. Hannah rushes in with a crash cart. Angus asks Donald if he's allergic to peanuts. Angus tabs epinephrine and injects it. Then he gets Donald onto a gurney and into the ER.

In the ER, they start an epi drip. Angus is anxious, so Leanne asks him what the first thing he checks is. His own pulse. She talks to him calmly as he tries to intubate. Remembering Rollie's advice, he starts singing Walk on the Wild Side to himself. When he gets to a line about colored girls, he nervously looks at Isabel, but she just starts singing along with him. The others join in as he finishes the intubation successfully and starts ventilating Donald.

Christa checks on Dylan. He says the nice ones always wanted to help him, which is why they opened the door or got in the car. He could smell the fear and he loved the smell. He smells it now with her in the room. Christa tells him she's not afraid of him.

Malaya tells Leanne that Kevin just got out of the OR. He had a serious laceration to his spleen. It'll be days in the ICU before they know. His mother is still by Patrick's bedside. She hasn't moved. It's like she can't say goodbye. Leanne suggests that Patrick's not the one she can't say goodbye to.

Leanne tells Margaret she knows how hard it is to forgive Kevin. She says she can't. But she must want to, Leanne says, because she hasn't left yet. Leanne tells her about the car accident that killed her whole family. Kevin wants to die, like any decent person would in his circumstances. The only thing she holds onto is that death isn't the answer to anything. If she didn't know that, she wouldn't be here and certainly wouldn't be a doctor. The only time machine we have is the one we're born in and it only goes forward. Kevin needs a reason to live. She advises Margaret not to lose him, too.

Mario talks to his grandma on the phone. He says he's making friends. When he hears Angus coming in, he quickly ends the call. Mario then tells Angus that they should talk about it if he's mad. Angus says Mario's the last person on his mind right now.

Angus asks Christa how long they've been there. Christa says she doesn't remember being anywhere else. Tiffany limps toward them and Angus says she's there for him. Christa leaves them alone. Tiffany says her name's not really Tiffany. She tries to give Angus her phone number. She doesn't think it'll happen unless she makes it happen between them. He says there are policies against them fraternizing. She says she's not a patient anymore, but he looks at her eyes and sees nystagmus, a sign of a bad concussion. He says she needs a scan. He leads her to go get it.

Outside the hospital, Christa sees Malaya, who is waiting for her ride. She asks about Kevin and Malaya says they don't know if he'll make it. Eva pulls up and honks. Neal walks up and waves to her. Malaya gets in the car, they kiss, and she drives off. Christa comments that at least someone has a life.

Leanne takes Margaret to see Kevin. When she rubs his head, he starts to cry about what happened with Patrick. She climbs into his bed and holds him and says he's her baby boy and she loves him.

Leanne is finally going home, finally. Taylor tells her goodbye. Jesse tells her she looks like she could use a walker. She counters that he looks like he could use a wheelchair. He says she could use a gurney. She says he looks dead.

## Cast

* Leanne Rorish
* Neal Hudson
* Christa Lorenson
* Malaya Pineda
* Rollie Guthrie
* Angus Leighton
* Mario Savetti
* Jesse Sallander
* Margaret O'Brien
* Dylan Michael Ross
* Kevin O'Brien
* Tiffany
* Donald
* Mark Taylor
* Stanley
* Isabel Mendez
* Risa Park
* Hannah Reynolds
* Zoe Fuller
* Mrs. Curtis
* Eva
* TJ
* EMT
* Friend One
* Friend Two
* Medic #2 (left)
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### 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

* Gail O'Grady as Margaret O'Brien
* Matthew John Armstrong as Dylan Michael Ross
* Aaron Christian Howles as Kevin O'Brien
* Shanti Lowry as Tiffany
* Dan Martin as Donald
* Kevin Dunn as Dr. Mark Taylor

### Co-Starring

* JF Davis as Stanley
* Ellia English as Isabel Mendez
* Angela Relucio as Risa Park
* Emily Nelson as Hannah Reynolds
* Lonny Aufrie as Zoe Fuller
* Amy Tolsky as Mrs. Curtis
* Jelly Howie as Eva
* Diego Rodriquez as TJ
* Aris Mendoza as EMT
* Grace Van Dien as Friend One
* Megan Neutze as Friend Two
* Kelly Michaels as Medic #1 (voice only)
* Andres Perez-Molina as Medic #2

## Medical Notes

### Patrick O'Brien

* **Diagnosis:**
	+ Abdominal bleeding

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Malaya Pineda *(ER resident)*

* **Treatment:**
	+ Attempted resuscitation

Patrick and his brother, Kevin, were in a car accident after Kevin drove drunk. Patrick suffered severe trauma. At the hospital, he was intubated and they continued CPR. Despite their efforts, he never regained a shockable rhythm and he was pronounced dead in the ER at 7:01 AM.

### Kevin O'Brien

* **Diagnosis:**
	+ Chest contusions
	+ Impact bruising
	+ Internal bleeding
	+ Splenic laceration

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Neal Hudson *(ER physician)*
	+ Christa Lorenson *(ER resident)*
	+ Malaya Pineda *(ER resident)*

* **Treatment:**
	+ Central line
	+ Exploratory laparotomy

Kevin, 21, and his brother, Patrick, were in a car accident after Kevin drove drunk. The paramedics had trouble intubating Kevin, so Leanne talked to them over the radio and talked them through using an LMA. He coded and they started compressions. Upon arrival at the hospital, he was conscious. He was given morphine for the pain. He had a seat belt mark on his chest, which made them suspect internal organ injury. They took him for a CT. After learning that his brother had died, his condition declined. He declared that he wanted to die. They put in a central line and drew blood from it, which was musty red, meaning he was bleeding internally. He was sent for an exploratory laparotomy. They found a laceration on his spleen and knew he'd have a long recovery.

### Stanley

* **Diagnosis:**
	+ Rib fractures
	+ Chest fractures
	+ Pelvic fracture

* **Doctors:**
	+ Rollie Guthrie *(ER physician)*
	+ Angus Leighton *(ER resident)*
	+ Mario Savetti *(ER resident)*

* **Treatment:**
	+ Thoracotomy

Stanley, 45, fell off a truck ramp and had hip and back pain along with chest contusions. His pelvis and ribs were broken. He was sent for a blunt-trauma assessment. He quickly got worse. Angus and Mario put him in a pelvic binder for that fracture, but his pressure continued to drop. When he flatlined, they started compressions. Angus believed it was due to blood loss and the transfusion would help, but Mario thought it was something more. They did a thoracotomy and were shocked to find his heart beating again. It was due to his pelvic fracture bleeding and the transfusion resolved it.

### Dylan Michael Ross

* **Diagnosis:**
	+ Renal failure
	+ Edema

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

* **Treatment:**
	+ Dialysis

Dylan, 38, came into the ER unconscious. Neal recognized him as a kidney recipient. He was in kidney failure. His potassium was high. He also had edema. They started dialysis. After dialysis, the swelling had gone down. They kept him to monitor him in the aftermath. He crashed shortly afterward, but they were able to bring him back.

### Mrs. Curtis

* **Diagnosis:**
	+ Allergies

* **Doctors:**
	+ Angus Leighton *(ER resident)*

* **Treatment:**

Mrs. Curtis was in the ER because she had allergies and her prescription ran out. Angus told her he'd need to do a full history and physical before prescribing anything and mentioned that the hospital was busy.

### Tiffany

* **Diagnosis:**
	+ Bruised ankle
	+ Nystagmus

* **Doctors:**
	+ Angus Leighton *(ER resident)*

* **Treatment:**
	+ Bandaging

Tiffany fell of a pole at work and hurt her ankle. Angus wrapped her ankle up and told her to keep weight off it for a few days. He also said to follow up with her primary care physician. Tiffany later came and found Angus. She tried to ask him out, but he said he saw nystagmus, a sign of a concussion. He said she needed a scan.

### TJ

* **Diagnosis:**
	+ Foot fungus

* **Doctors:**
	+ Angus Leighton *(ER resident)*

* **Treatment:**

TJ came into the ER with a foot problem. Angus examined him in the waiting room and diagnosed foot fungus.

### Donald

* **Diagnosis:**
	+ Anaphylactic shock

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Angus Leighton *(ER resident)*

* **Treatment:**
	+ Epinephrine

Donald was in the ER waiting room saying his head hurt really badly. He was also confused about details, saying he was attacked by ISIS people with a golf club. Angus later saw him coughing and struggling to breathe. He went to Donald, who was confused. Angus saw the wrapper of an energy bar and determined that Donald was having an allergic reaction. They took him into the ER after giving him epinephrine. In the ER, Angus intubated him with some difficulty, restoring the flow of oxygen.

### Zoe Fuller

* **Diagnosis:**
	+ Non-exertional heatstroke

* **Doctors:**
	+ Leanne Rorish *(ER physician)*
	+ Neal Hudson *(ER physician)*
	+ Mario Savetti *(ER resident)*

* **Treatment:**
	+ Cooling
	+ Heparin

Zoe, 19, came in with a temperature of 108° after ingesting MDMA. She had non-exertional heat stroke, so they used ice, fans, and misters to cool her down as quickly as possible. They got her down to 105° when she regained consciousness and started bleeding from her eyes. The heat had denatured her blood. She went into cardiac arrest and they found a clot in her lung. They pushed a clot-buster to resolve that clot and she regained sinus rhythm. She was sent to ICU for a heparin drip.

## Notes and Trivia

* This episode scored 6.96 million viewers.