SPOILER ALERT: The following contains spoilers for Chicago Med Season 12, Episode 1.
The Chicago Med Season 12 premiere is a classic Chicago Med premiere. The NBC show typically begins and ends its seasons with a mass casualty event, wanting to make the biggest impression at the biggest times, and “Shots Fired” is no exception. It’s not the most chaotic episode fans have ever seen, but showrunner Allen MacDonald delivers plenty of potential for the rest of the season—and one scene that no one’s going to forget any time soon.
The case of the week is a mass shooting, in which a vengeful ex-boyfriend opens fire at his ex’s wedding. There are two primary stories: the wounded bride Tamar, who happens to be pregnant, and a young girl named Dakota who’s experiencing trauma-induced blindness. This isn’t the most complex or intense emergency to hit the ED, but there’s an effiency of storytelling that makes it work. The script allows the audience to focus on those two patients—and the show to put more time into developing their stories—instead of simply unleashing dramatic chaos. Viewers feel like they actually have a sense of the guest characters and an emotional investment in them, bolstered by a strong round of guest casting.
That’s Beverly Hills, 90210 alum Gabrielle Carteris as the abrasive mother-in-law Mrs. Sutherland, but the standout is Michael Alix as wedding guitar player and good Samaritan Bruno; viewers feel like he’s become everyone’s best friend, not just Dakota’s, before his tragic end. Plus, Luke Mitchell’s wife Rebecca Breeds appears as temporary hospital administrator Mallory Sloan; hopefully they’ll get more scenes together than Colin Donnell and Patti Murin did. It’s at least fun to see her butt heads with Steven Weber; they’re perfect contrasts to one another.
Plot-wise, the conflict between Tamar, her fiance Dexter and her future mother-in-law isn’t surprising, but it’s executed solidly. Dexter having missed the entire incident is an interesting added wrinkle. But that pales in comparison to the jaw-dropping twist of the shooter driving his car straight through the hospital’s front door and into Bruno—as well as Dr. Mitch Ripley’s reaction to it. Of course this isn’t the first terrible thing to happen inside the hospital, but the sight of the show’s most recognizable locations being plowed through is a visual statement in and of itself. It’s reminiscent of the Homicide: Life on the Street two-parter “Fallen Heroes,” in which Junior Bunk Mahoney opened fire in the homicide unit’s squad room; it seemed improbable that destruction would happen there. The same feeling occurs on Chicago Med. The hospital is essentially the show’s home, and Henry just wrecked the living room, ratcheting up the tone not only for this episode—but for the whole season, because fans know MacDonald is willing to take those kinds of big risks.
The more important gain from the scene, though, is the character development it provides for Ripley—not only now but again, in the future. Chicago Med Season 12 seems poised to be a good test for him. “Shots Fired” brings back shades of the old Ripley from his first season, the one who was living on a knife edge emotionally, but at the same time viewers see his growth in the way he’s able to have that burst of (completely understandable) anger and then pull back from it.
The development of him being the attending supervising new addition Dr. Annie Wu is a really smart move, both to professionally reward Ripley’s work over the last few seasons, and also how does he act when he’s in charge? It’s similar to how Chicago Fire is addressing how Kelly Severide has to make different choices now that he’s captain of Firehouse 51. Ripley will have to have his own different perspective as a supervisor, and he’s got a fourth-year resident who’s not going to help him at all.

The fourth-act scene between Ripley and Dr. Caitlin Lenox is one of their best scenes yet. Of course it re-establishes the status of their relationship, but it’s Ripley taking that anger and processing it. He’s also talking to the exact right person to help him process where it came from. If anyone is able to understand grappling with mortality, it’s Lenox—in her own caustic way, as her line about Ripley co-opting her “existential dread” is so absolutely perfect. The question is how long Lenox will be out of the country and thus actor Sarah Ramos will be limited in her screen time. Lenox’s three-month drug trial lines up with the amount of time jumped between seasons, so if she left not long after the Season 12 finale, she could be back immediately. But if this is another instance of the One Chicago franchise having to shuffle cast members around for budgetary reasons, at least this in-universe explanation not only makes sense but is actually constructive for both of the characters involved.
Elsewhere, MacDonald deserves a hat tip for also not sidelining Dr. Hannah Asher or Asher and Archer’s new baby. It would’ve been easy to leave it as Hannah being out on maternity leave. But instead, viewers not only get to see Hannah and Mabel, but Hannah has a plotline that’s got nothing to do with the baby or her relationship status. After Chicago Med tended to forget about Owen Manning fairly often, it’s much appreciated that Mabel doesn’t seem to be facing the same fate, and that Hannah’s arc won’t just be about the baby. Obviously Mabel isn’t going to be a fixture, since it’s not realistic to have the baby in the ED all the time, but MacDonald is making a concerted effort to not just dismiss Mabel and the confession of Archer’s feelings as stuff that happened last season.
Last but certainly not least, viewers get the expected resolution (ish) to the Sharon Goodwin cliffhanger. It was fairly obvious that Goodwin had to get off the hook for leaking Dr. Theo Rabari’s medical file, because Chicago Med needs S. Epatha Merkerson. As enjoyable as it is to have Rebecca Breeds filling in for her, Merkerson is part of the foundation of One Chicago. What is more of a surprise is who the real culprit is: Nurse Doris. That’s because Doris has become charge nurse since the departure of Maggie Lockwood, making her the most prominent nurse on the show. So if Doris gets in trouble for the leak (and she really has to), does Chicago Med just replace its charge nurse again? Aside from the strike storyline, the nurses haven’t been as prominent on the show in a while, so this might not be a hugely noticeable change. Yet actor Lorena Diaz has likewise been around a while, so it’s not a small development either. It was a big ask for anyone to fill Marlyne Barrett’s shoes, but Diaz was the best possible choice for that, and now she could be leaving as well.
On the whole, the Chicago Med Season 12 premiere is the most well-rounded of the three One Chicago premieres. It has the best sense of what’s going to happen to the whole show, rather than one or two specific characters. It delivers a plot that while on occasion predictable, is done very well and is incredibly cast, and the whole “let’s crash a car through the waiting room” bit is a bold statement to make right off the top. This is what a season premiere should look like—except for the gigantic mess of an ED waiting room somebody’s going to have to clean up.
Chicago Med airs Wednesdays at 8:00 p.m. ET/PT on NBC. Photo Credit: Courtesy of NBC.