What do you do when a broken health care system leaves a violent child without access to the treatment he needs?

That was the question Dr. Charles struggled with on Chicago Med Season 5 Episode 13, and his decision may have done more harm than good.

He wasn't the only one making difficult decisions, either, in a night full of ethical dilemmas, medical mysteries, and painful truths.

Chicago Med deserves credit for the most original story involving a child who is prone to violence.

Most of the time, a child like Jamie is presented as a stereotypical psychopath who lashes out when he doesn't get his way, has zero remorse, and uses his advanced manipulation skills to get adults to give him whatever he wants.

But not this time. Jamie was far more multidimensional and interesting than that.

He had angry outbursts and attacked people, but he was upset about it and hated that he kept losing control.

He was depicted as ill, not evil, and that was a refreshing change.

There were so many pieces of the puzzle that it would have been impossible for Dr. Charles -- or anyone -- to make a diagnosis and get Jamie on the right meds in just a few hours.

Jamie was adopted and could have inherited mental illness, and there was no information about what his birth mother's prenatal care was like, including her diet.

He was on a lot of medications, some of which may have been interacting and making his symptoms worse.

Father: I pulled over and I just hugged Jamie as tight as I could. When he gets like this, the bear hugs are the only things that bring him back.
Charles: Bring him back?
Father: From his dark place.

Permalink: From his dark place.

Some of his symptoms sounded like ADHD but could have been something else that everyone missed because they were fixated on the obvious diagnosis.

Who knows what his eventual diagnosis will be or if he can even get the help he needs. Dr. Charles was right that Jamie needed residential treatment, and Choi was right for once too: next time Jamie could kill Dylan.

Charles: There's room for Jamie at Meyer Brook, which is the only facility capable of handling his needs. Unfortunately, neither his private insurance nor state Medicaid is gonna cover the cost.
Choi: What about an individual care grant from the state?
Charles: We already looked into it. It's no help.
Goodwin: The grant's so underfunded it wouldn't come close to what's needed.
Choi: So what's Plan B?
Charles: Well, you know, I'm gonna just try to use the 5 day hold to normalize his meds as best as I can and I do know a brilliant guy who specializes in these kinds of disorders I want to refer him to.
Choi: Outpatient service? Jamie pummeled Dylan over an iPad. The kid's jaw's wired shut. He's only six years old. He's gonna invade his brother's space again and when that happens and Jamie loses his temper, I'm worried he could kill Dylan.
Charles: I don't like it either but we can't hold him forever.
Choi: I get it. But we have an obligation to protect Dylan. He needs our help as much as Jamie.

Permalink: I get it. But we have an obligation to protect Dylan. He needs our help as much as Jamie.

But was Charles' solution a good idea?

Nobody addressed what being "abandoned" might do to Jamie.

He knows he's adopted, which could be related to his problems, and he knows his parents talk about his behavior all the time. So could his belief, rightly or wrongly, that his parents gave him up impact him negatively?

It was worth the risk because Jamie couldn't live at home without hurting himself or someone else. But still.

The whole thing was a striking illustration of how broken health care is in the United States, though.

Jamie's parents were so desperate to get him care that their insurance company wouldn't cover and they couldn't provide on their own that they were willing to abandon their child to get him that help.

Charles: We just don't have enough psychiatric resources for kids.
Goodwin: And the Shaws won't be the last family to face a lock-out. But Jamie will get the help he needs. That's a good thing.

Permalink: And the Shaws won't be the last family to face a lock-out. But Jamie will get the help he...

And they'll have to 100% abandon him, too, because if they get caught visiting him or even sending him a letter, they could probably get in trouble for Medicaid fraud.

Also, there was a throwaway line in this situation that hopefully won't terrify April

Did anyone else catch Mrs. Shaw's comment that they decided to adopt Jamie after several miscarriages and failed rounds of IVF?

April saw Jamie's heartbreaking separation from his parents, and that might scare her too.

Even if the IVF takes, she won't know what problems her child might have until she begins raising the child.

I'm not a big fan of April/Ethan, but this might be an interesting path for them to go down.

Meanwhile, what was Dr. Marcel doing being sensitive and determined to at least find his patient's cause of death before he informed the parents?

I want so badly to hate him.

When he first joined Chicago Med, he seemed like a sleazeball, and that questionable kiss with April at the crawfish boil didn't help.

His butting into Natalie and Maggie's conversation reinforced how obnoxious he can be. But then he took it so hard that Lucy died on his watch and I couldn't help liking him... or at least not hating him anymore.

His insistence on at least finding answers probably had to do with the reveal on Chicago Med Season 5 Episode 12 that he once lost a child.

I want to know more about that, but for goodness sake, let's nip this Marcel/Natalie thing in the bud.

Nat appears to feel the same way about Marcel that I do.

She finds his irritating banter as annoying as it's intended to be but has empathy for him when he has a bad day.

Marcel is at his worst in relationships and viewers have already suffered through five years of Nat and Will's on-again-off-again thing.

So can we not go there with her and Marcel now?

Natalie's case was more interesting than her conversations with Marcel, though if you watch a lot of medical dramas, it wasn't that hard to figure out what was really wrong with the mother.

People who can't feel pain is a favorite medical drama malady, though that was a nice attempt at misdirection with the mother's symptoms appearing to point to Munchausen's Syndrome by Proxy.

She asked me to run more tests than necessary and then she insisted on a front row seat to her child's endoscopy. Don't you think that's a little weird?
Natalie

Permalink: She asked me to run more tests than necessary and then she insisted on a front row seat to...

Nobody but Natalie found the mother weird. Natalie was jumping to conclusions about her as usual, but at least this time she realized she got it all wrong.

That's more than can be said for Will, who stuck his nose in someone's business for a change, with disastrous results.

It was only a matter of time before Will's moonlighting gig at the safe injection site and his day job caused a massive conflict of interest.

Will's concern about the patient was understandable, but he got stuck on the idea that the doctor MUST be getting high before work and handled this whole thing stupidly.

First of all, he forgot the safe injection site was illegal and he could lose his license if he gets caught. That gives anyone from that site leverage over him, so threatening Dr. Asher was not smart.

He also forgot the point of the safe injection site in his zeal to stop Dr. Asher from operating.

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The safe injection site is supposed to give people an alternative to shooting up on the streets so that medical personnel can help them if they overdose.

But how is that going to work if one of the doctors working at the site turns a patient in after her OD is resolved?

Will acted like an idiot and word may get around that he's not trustworthy because of it.

Plus he made an enemy out of Dr. Asher, which is never a good thing.

There is no way this ends well. None whatsoever.