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.