It Happened One Night
By Nancy Kiu, Director of Medical Research

They say it never rains in LA. Except, as I am writing this blog, it is actually raining. (Seriously, it is!) So "they", whoever they are, are wrong. "They've" never been to Los Angeles. Just because it rains infrequently doesn't mean it doesn't rain at all - there's even a rainy season! And when it does rain, all hell tends to break loose. It's not just because nobody in LA can drive in the rain (although there's a reason for that – roads are covered with a thin layer of water, oil, grease, lubricants, etc, which accumulate on the road until they are washed away. When it hasn't rained in a long time, the first rain makes for extra slippery roads, due to the fact that the water loosens the greasy materials and creates an oily, slick surface that can be dangerous to drive on.), but the rain washes away some of the shiny gloss of Los Angeles and brings out the unexpected. In this episode, the unexpected just happens to all accumulate in an ER overflowing with cases and patients. So much for the sleepy little Santa Monica ER that Charlotte promised James!

This episode was an opportunity to do a medical-heavy story set in the ER, and return to the show's signature ethical debates. This time though, instead of surrounding the debate around one main case, small debates were formed around each individual story, then tied together through the introduction of Dr. James Peterson! If you recall in episode 603, Charlotte makes the decision to finally hire someone to fill the void that Pete left, and what better way to introduce James to our doctors than by having him weigh in on all the separate cases that come through his ER.

James may be young, but he's a great doctor. One of the first rules of being a great doctor is to never make assumptions – one wrong assumption could mean the difference between life and death for a patient. Doctors are supposed to try to gather all the facts as presented and make an informed decision about each case, because every action has a consequence.

Take Ron and Dana Nelson, and their daughter Sarah. When Cooper's patient Sarah comes into the ER with a wrist fracture, James examines her past history and realizes that she's had multiple injuries in a short amount of time, which is cause for concern. Per protocol, James should report this to the Department of Children and Family Services to let them examine the situation and determine whether this was child abuse, neglect, or just the case of an overactive child with a penchant for getting into trouble. Cooper argues that he knows the family and there's no way that Sarah's the victim of abuse. To report the incident would only cause more stress and arguments in a family already rife with discord. This begs the question: what constitutes neglect? Was James just doing his job, or was he over-reacting? Should he have trusted Cooper, who knows the family's history, or is Cooper too close to the family to be objective?

Cooper decides to take matters into his own hands, and calls in Violet to mediate instead of DCFS. As Violet points out to Ron and Dana, when they fight, it makes Sarah feel as though it's not safe for her to love both parents equally. Ron and Dana have to stop fighting in front of her, but is it too late? Every action has a consequence, and Ron and Dana's fighting has not only driven a wedge in their marriage, but, as Sarah admits to Violet, it's made her want to run away. This confession becomes especially alarming when Sarah vanishes from the ER. Did Sarah run away? Or did Sheldon's pedophile patient Nick have something to do with her disappearance?

Sheldon (Doesn't he look very debonair in a tux? What's the story behind that?...) gets paged to the ER because his patient Nick (episode 602) is having an adverse reaction to hormone meds that are supposed to help reduce his sexual urges. According to Nick, the meds have been helping, and he wants to stay on this treatment, with Sheldon's help. James believes that Nick can't be cured and wants Nick out of his ER so that a bed can be freed up for someone who might really need it. Sheldon argues that while pedophilia can't be cured, it can be treated, but James has put enough doubt in Sheldon's mind that when Sarah goes missing amidst the chaos in the ER, Sheldon can't help but suspect Nick. Should we as a society assume that someone with Nick's problem is guilty until proven innocent? Would you have done the same thing? In this case, Sheldon may have been wrong about Nick, and his actions may come with a price – he has broken his trust with his patient, and where Nick had hope before, now he has none.

As an IVF specialist, Jake's job is to give his patients hope without selling false dreams. Trying to make a baby through IVF is an emotional and hormonal time. IVF is a numbers game, both in terms of how many eggs to implant and how many times you try. There is a point of diminishing returns, where the emotional damage of trying and failing multiple times outweighs the potential positive of finally having a baby. Addison has experienced the emotional devastation that comes with failed IVF attempts firsthand, and in her case, she knew her own limits enough to step away before it became too much. She advises Jake to be cautious with his patient, Megan, whose fourth IVF attempt just resulted in another miscarriage. Jake feels guilty because he promised to help Megan, who moved to LA for the sole purpose of getting treated by Jake, but is that guilt causing Jake to push his patient too far? How much responsibility do doctors have for their patients? Is it a doctor's responsibility to tell their patient when to stop, or to continue to give them as much information as possible and allow them to make their own informed decision? When is it enough?

Sam and Stephanie are going at it hot and heavy, but remember when Sam chose not to open up about his history with Addison to Stephanie? That decision came at a price when Addison's patients, Pam and Todd spill the beans about Addison and Sam's prior relationship to Stephanie. Sam is forced to own his past, and even though he's "a heart surgeon who looks like Sam and is a truly kind man with a wonderful spirit," it's still not enough for Stephanie, who feels that she deserves better. Even amazing guys make mistakes, and Sam may have made a huge one with Stephanie.

Amelia, on the other hand, has no qualms about owning her past. The past year has transformed her so significantly that it defines who she is now. James, riding the adrenaline of a successful and hectic first day on the job, takes action - he assumes that he and Amelia are similar, and that maybe she'd want to go for a drink or three, but he's wrong – they're not as similar as he thought. His invitation prompts a huge reveal about who Amelia is – she some who's lived a lifetime of pain, and nothing can wash that away.

James is left to ponder his first night at St. Ambrose – he may have proven himself and stood toe-to-toe with all the doctors, but it wasn't without casualties. He had some heroic saves, but it's safe to say that what he'll remember most about this night is the devastation of losing a patient – not one on the OR table, but a little girl in the ER.

When it rains in LA, all bets are off.