Chicago Med left fans with a major cliffhanger in its previous episode as “The Book of Charles" concluded with Dr. Charles collapsing in his office after having a stroke. The twist left viewers fearing the worst, and the week between new episodes felt longer than ever as fans waited to see whether Charles would live or die.
Heading into season 11, episode 17, “Altered States,” we knew it would be an emotional episode, and that was certainly the case with the writers making us wait as long as possible to find out Charles’ fate!
As the episode opens we hear Lenox telling her patient to hold on through blurry eyes as she tells him they’re going to help him and that his daughter is on the way. The individual begins to lose consciousness as Lenox shouts for them to stay with her, and our assumption quickly jumps to this being Charles she’s treating; however, when the camera finally pans out, we learn this is not the case. The patient is a man who hit his head on concrete after falling when taking down Christmas lights. All signs point towards the man being brain dead, but Lenox orders a CT to confirm.
Out in the ED, Archer asks Goodwin if she’s heard from Charles, as he’s in need of a psych consult, and she theorizes that Charles is cooling off somewhere and encourages Archer to give him some space. She tells Archer about their argument and Archer is surprised, as it doesn’t sound like Charles.
We cut to Charles, who is lying on the floor of his office unconscious as we enter his subconscious, where he’s sitting with his mother in their old home, trying to figure out why he’s here. His mother brings up his call with Gio and notes that the boy had the terrible luck of working up the courage to call for help only to have Charles answer on the phone. Charles asks what happened to her that made her feel so small that the only way she could feel good about herself was to make someone else miserable. His mom quips back that he still doesn’t get why they’re here. She notes this is where it all started, where “it” happened as we cut to a doorway and see smoke coming through.
Just then, Charles sees Goodwin on the TV in the room as we cut to Goodwin in his office trying to awaken Charles. She calls Archer for help, suspecting that he’s had a stroke.
Charles sees the ghost of Ripley's past
Charles is raced down to the OR, but things aren’t looking promising. Anna arrives at the hospital after getting a call from Goodwin, who greets her and brings her up to speed. She doesn’t sugarcoat things but assures her they’re doing everything they can and will take it one step at a time.
As Abrams and Ripley work together to clear the clot, we return to Charles’ mind as he walks into a room where he finds a teenage boy who tells him he told Charles he didn’t want to see him again. The teen tells Charles to say what he’s going to say and get the hell out. Charles admits he thinks about things all the time and that he has some good news. This is when we learn the teen is a young Ripley, as Charles tells him how in 20 years they’ll meet again and work together.
Young Ripley is surprised to learn that he and Charles become friends as Charles calls seeing Ripley dealing with his stuff one of the proudest moments of his life. Teen Ripley points out how he always finds ways to take credit as he points out that this is a conversation with himself and Charles is playing the hits. In this case, he’s forcing Ripley to revisit his abandonment issues only to abandon him here himself as Charles notes his rotation ended.
As the camera pans around Charles, teen Ripley is replaced with present-day Ripley, who calls Charles a fraud as smoke begins streaming into the room from an air vent above.
In the real world, Ripley informs Anna that they performed a mechanical thrombectomy to manually remove the clot. It was a large clot, and they were able to remove some of it, but not all of it. They now have two options.
The first option is they can raise his blood pressure and wait and see, with the best-case scenario being he wakes completely fine while the worst case would be him needing a feeding tube and ventilator for the rest of his life. The other option is a direct bypass craniotomy, which would definitively restore blood flow; however, the tPA Archer and Ripley administered to break down the clot puts Charles at a higher risk for hemorrhagic complications during surgery.
Anna is overwhelmed as Goodwin notes that she’s still here because Archer took a risk on the operating table, but notes there are no guarantees. Anna mentions calling Robin to get her thoughts, which is when Abrams interjects to reveal that it’s Goodwin who must make the decision as Charles’ medical power of attorney, news that surprises Goodwin just as much as it surprises Anna.
Chicago Med introduces Hannah's replacement ahead of her maternity leave
Hannah arrives at Gaffney and asks Doris if she’s seen Archer, as she can’t seem to get through to him. Doris realizes that Hannah hasn’t heard about Charles and quickly fills her in. As Hannah tries to process the news, Lenox springs yet another piece of shocking news on her as she asks if Hannah is ready to onboard her substitute before she goes on maternity leave.
Hannah is surprised by Lenox’s actions as she points out that she was planning on working until close to her due date, which is still weeks away, and Lenox points out that she should know that babies don’t always abide by their due dates. Turns out the substitute Lenox has hired is Dr. Lovell, the same OB who Hannah had seen months earlier.
Goodwin and Anna sit down, and Goodwin notes she’s just as surprised as Anna that Charles gave her medical power of attorney. Goodwin replies that she would have said no if he had asked her, as that decision should belong to family as Anna points out that Goodwin is family; she’s always been Auntie Sharon to her and Robin, and she was friends with their dad years before she was born. She points out that there are only a few people her dad really trusts, and he certainly trusts Goodwin as she encourages them to make a decision together. Anna wants to do the surgery, and Goodwin agrees.
Anna senses there is something Goodwin isn’t telling her, and Goodwin admits to having an argument with Charles as well which was bad. Goodwin notes she went to his office to talk things out, and that’s when she found him.
Down in the ED, Hannah and Dr. Lovell team up, and it’s clear that Hannah is not a fan of Lovell’s approach to patient care. Among their patients is Summer, a woman who has come into the ED with stomach discomfort and painful intercourse. It seems she’s played internet doctor via TikTok, and Hannah encourages her to stay off the internet, which is full of incorrect information. As Hannah examines Summer, Lovell and Summer connect over a social media doctor, and Hannah cuts the conversation off. When Hannah goes to perform an exam, Summer requests Lovell perform the procedure instead as Hannah steps to the side.
In the OR, Charles is prepped for surgery, and we enter yet another memory. This time, we see Charles walk into the kitchen of his home, where he finds a young Robin eating breakfast at the table. She warns him he’s in big trouble as Charles’ ex-wife Caroline “Cece” Charles enters the room complaining about how Charles promised to be home in time to help get Robin to school, but then he decided to stick around at work and never bothered to call.
As Cece goes to leave, the backdrop of the memory changes as Anna’s mom, Sue Charles, enters the room, and we enter the memory of when Sue left him as nothing could compete with his fancy job. Charles assures her nothing was more important to him than her and Anna, but she points out how he would never let anyone else handle the next emergency, as that is who he is. That’s when a young Anna runs into the room crying as he embraces her and assures her she’ll see him all the time and they’ll have so much fun.
We again see the memory shift as Sue and Anna disappear and Charles is faced with the memory of a woman named Lucia. She reminds him how he said things would be different with them, but they never were. She points out that he didn’t need her as he doesn’t need anyone. Lucia seems to be Charles’ third wife, who had previously never appeared on the show or been mentioned by name.
Back in the ED, Lovell tries to clear the air with Hannah as she points out how it was clear she was pissed at her when treating Summer. Hannah points out how they shouldn’t be encouraging patients to seek medical advice on social media, to which Lovell points out that influencers are helping to break stigmas about seeking treatment. Hannah maintains that she felt Lovell sent mixed messages to Summer as Lovell quips she was simply trying to connect after Hannah dismissed her with her buzzkill energy. Summer’s results come through and Hannah asks if Lovell minds if she takes the lead in telling Summer, to which she replies that Hannah is the boss, at least until she takes over.
It turns out that Summer has PID, an infection of her reproductive organs. Hannah makes it clear that with some antibiotics they can easily treat this as she remarks about being glad she came in as Summer notes that she never was going to self-diagnose herself; she simply turned to social media for research. Summer inquires about how she caught the PID, and Hannah notes that it seems it might have come from her IUD insertion. Unrelated to the PID, they’ve also found that Summer has HPV. As Summer spirals, Lovell assures her that it’s nothing to be ashamed of and even admits that she has it as Hannah cuts the conversation off and Lovell excuses herself.
Frost comes to check on Ripley who is feeling a bit useless at the moment. Frost points out how there have been a few times when he’s been in a bad place and Charles helped bail him out; he always made him think to himself, “Why couldn’t my dad have been like that?”
Brenda Strong returns as Suzie as Charles inches closer to facing his biggest demon
In the OR, Abrams and Archer continue to work on Charles. We return to his memory this time as he sits in his cubicle at the suicide prevention center where the previous episode begins. He takes a call and hears the voice of Suzie Mankiewicz, his friend from school who passed away earlier this season.
Suzie and Charles discuss Gio and Charles admits while he was speaking with Gio he realized that this kid was completely and utterly alone, so he asked him to talk about his loss. She assures him any shrink would have done the same thing and that he’s clearly invested in beating himself up about all the people he thinks he’s let down. She reminds him about a subject he would never open up about, and she points out how anyone would be afraid of confronting this, hinting he needs to confront this demon of his past once and for all.
In the locker room, Lenox finds Ripley and asks how Charles is doing. He replies that he’s holding his own, as far as he recalls meeting Charles when he was 16. He recalls how he didn’t care what happened next, but before he finishes the thought, she pulls him in for a kiss. As Ripley pulls back, he points out that sex is not a cure-all. She remarks that she’s found that it is, as he points out, that it seems to be used to distract her from real conversations. Annoyed, she tells him she doesn’t do death, meaning she’s trying to meet him halfway, but he admits it’s not enough as she leaves the room.
Lenox attempts to get some air in the bathroom, but she encounters Hannah, who quickly encourages her to reconsider Lovell as her replacement. Hannah notes that Lovell is not a good fit, as she’s borderline unprofessional, as she points out the many issues she has with her approach to medicine, as Lenox points out that this seems to be more of a personal issue for Hannah. She makes it clear that this is not up for discussion as she exits. That’s when things get really awkward, as Hannah and Lenox were not alone in the room: Lovell was in the stall and overheard the entire conversation.
Hannah admits that she fears Lovell tries too hard to be young and hip. Lovell remarks that she is young and hip, as Hannah points out that she shared a personal medical fact with a patient, which is universally pretty frowned upon, which Lovell points out put the patient at ease. Hannah notes that she’s been doing this a long time, and much to her surprise, Lovell notes that she respects Hannah a lot and hopes to be as accomplished as her someday but notes that Hannah needs to be able to pivot at times. Hannah gets vulnerable as she notes that her body is not her own, her hormones are not, and it’s not fair that her career is being ripped out of her hands, and Lovell agrees as she assures her she’s going to figure it all out while on leave.
Ripley and Goodwin sit and wait as Ripley admits that his mind is doing all the things the mind will do when you’re worried you won’t see someone again. Goodwin reminds him that Charles has only ever held him in the highest regard as Ripley admits that sometimes he worries Charles thinks that he’s still holding onto some ancient history. He admits that Charles has had a profoundly positive impact on his life. Anna returns and updates the pair on Robin’s attempt to get there as we learn that Charles’ status hasn’t changed. To Ripley’s surprise, Lenox approaches and asks to join them.
In the OR, Abrams and Archer encounter some complications as we return to Charles’ memories. He’s in his childhood home as his mother returns and asks if he remembered the conversation they had the day she died in which he accused her of driving his dad and brother to early graves. She questions whether he misses her, and he admits he’s been haunted by the things he said to her. She replies how he’s always felt it was his job to make everything and everyone okay.
She admits her regret that he had to be there alone that day as we see smoke coming into the room. Daniel follows the smoke to the door. Before he enters it, his mother asks if he knows she always loved him, to which he gives her a subtle nod before walking through the door into the memory of the day he found his dad dead in the garage. As Charles confronts this memory, he flat-lines in the real world.
Dr. Charles pulls through surgery and lives to fight another day
In his mind, we see Charles break open the window and attempt to wake up his father. In his memory, he’s able to save his father, who he quickly embraces. Charles’ father admits he didn’t know he had gotten home from school and thanks him for saving him as he notes that it wasn’t his mother’s fault; the truth is he struggled long before meeting her.
Charles notes that it was depression as his dad apologizes and assures him they can get him the help he needs. That’s when the garage door closes and his dad tells him it’s best to let sleeping dogs lie as he turns the car back on and the exhaust fumes begin filling the car. His dad points out that he can stop this, but it’s important for him to know three things: it’s not his fault, he couldn’t have stopped this, and he loves him and always will.
His dad encourages him to come with him, but Charles fights to open the door. Just as it looks as though Charles isn’t going to make it, we see those who love Charles outside the car window working to break the glass: Anna, Ripley, and Goodwin. That’s when his pulse returns, and Abrams and Archer are able to finish the surgery.
As the episode draws to an end, Charles awakens in his hospital bed and finds Goodwin asleep in the chair by his bedside. Goodwin informs him she sent Anna home to get some rest as she’d been awake for almost 48 hours—suggesting a slight time jump. He begins mumbling, "Anna, Ripley, thank you," and talking about the extinguisher, which we know from the memory was what helped free him from the car.
Goodwin fears the worst, not understanding what he’s talking about, but he notes that he’s at Gaffney, the best damn hospital in the Midwest, and jokes about getting a sippy cup and no jello or balloons. He jokes about calling Howie and being down with this dump as she assures him she’s on it. It’s clear he has a long recovery ahead, but Charles survived and pulled through the surgery!