"It does not go well": Allen MacDonald drops teasers from the highly anticipated Chicago Med Season 10 finale; addresses a key character's fate

The drama is intensifying at Gaffney Chicago Medical Center, and this time, there is more than just a patient in danger. The Chicago Med Season 10 finale is on its way, and showrunner Allen MacDonald has indicated that audiences need to prepare themselves for an emotionally charged, morally complex series finale.

While the show is no stranger to cliffhangers and character reveals, this finale is something different—darker, more perilous, and full of irreparable decisions.

In a recent interview on TV Insider, MacDonald inadvertently spilled a revealing line that immediately got people talking. He said,

"I don’t think she’s happy or unhappy. I think she’s stunned. I think she’s shocked. She wasn’t expecting this and she’s having to process the information and on top of she’s got to tell the father and she’s got to tell her sister who she’s supposed to carry a child for, and this is going to throw the wrench in that."

He added,

"And I think I’m not spoiling much to say that when she does tell Lizzie near the top of the episode, it does not go well."

Ominous-sounding though the quote was, the line was applied to the fate of Dr. Mitch Ripley, portrayed by Luke Mitchell. Although MacDonald would not confirm the exact fate, it can be inferred that Ripley's life will come to a make-or-break juncture in the season finale. At the center is Walter, a patient whose care has posed ethical and procedural questions that could change everything for one of the ED's most beleaguered doctors.

Allen MacDonald reveals a high-stakes finale of Chicago Med Season

Allen MacDonald has been measured but deliberate when speaking about what fans can expect. For him, the finale goes deep into complex emotional and moral quandaries that don't yield easy answers. According to Collider, he said,

"Sam Trammell’s character Walter is in an extremely charged and emotional and grief-stricken state of mind, and I think he feels like he’s been lied to. I think he feels like he’s been misled. I think he correctly feels that his son was cheated out of a lifesaving organ and he’s not thinking rationally."

While Chicago Med has dealt with high-stakes medical drama before, this episode will focus as much on internal conflict and institutional stress as it will on the ER cases.

In particular, MacDonald reported that the drama surrounding Walter will escalate, placing Dr. Mitch Ripley in a crisis that tests his boundaries—both professionally and personally. Walter's treatment raises questions of protocol, personal preference, and peer-to-peer trust. Those tensions have been bubbling beneath the surface all season, but are sure to blow their top during the season finale.

Dr. Mitch Ripley's career—and life—may be on the line in Chicago Med Season

Since joining us at the start of this season, Dr. Mitch Ripley has been an enigmatic figure—quietly competent but demonstrably distressed. Viewers have become familiar with his stained past, including a history he has struggled to escape. Season 10 has incrementally opened up the psychological scars that continue to influence his practice.

Now, that history collides with his current situation. The Walter case puts Ripley into troubled waters, not just medically but also institutionally. His method, while done out of genuine concern for his patient, may be in contravention of hospital protocol or professional ethics. As MacDonald hinted, "it does not go well," and that very much suggests harsh consequences await, perhaps legal, professional, or even personal.

The Crockett-Ripley conflict hits a boiling point in Chicago Med

One of the main relationships that has been strained is that of Ripley and Dr. Crockett Marcel. Their tension has been escalating all season, based on opposed philosophies and ongoing personal grievances. In the series finale, their conflict seemingly reaches new levels, most probably based on how Walter's treatment is handled and who is willing to be responsible.

MacDonald's comments imply that this disagreement is more than a subplot—perhaps it's key to the end of the season. Neither character is written up as all right or all wrong, yet what they do in the moment can carry long-term consequences for their careers and reputations. This might have a ripple effect on the overall hospital dynamic, leaving other characters morally conflicted.

No classic cliffhanger—but no instant resolution either

One notable shift this year is the series' avoidance of the classic finale cliffhanger. MacDonald promised that although the ending will not leave audiences hanging in a classic cliffhanger fashion, it will not offer complete closure, either. Instead, the finale is about repercussions—about how decisions made under duress have lasting repercussions long after the fact.

The Season 10 finale is set to make a lasting impact, turning the story direction into Season 11. The audience might not get a clear "who lives, who dies" type of ending, but they will definitely depart with some extremely serious questions about what is to come with Ripley and the rest of the players involved in the case.

What's coming next on Chicago Med?

Even though NBC has already renewed Chicago Med up to Season 11, the Season 10 finale is positioned as a major cliffhanger. MacDonald hinted at the coming season, working with the fallout of what has been decided during this season's finale. That means potential changes in team dynamics, leadership roles, and even cast members, depending on how they choose to go.

Most importantly, the episode is not merely being written to shock, but to force the viewer to consider how medical personnel navigate compassion, policy, and duty in high-stakes cases. And for those invested in Ripley's redemption arc, the season finale can close the door on it or fling the door open even wider—just not the way anyone will expect.

In short, Allen MacDonald's enigmatic but insightful teaser—"it does not go well"—sets up a finale replete with emotional consequences and character-defining choices.

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As Walter's future hangs in the balance and Dr. Ripley faces a possible reckoning, the Chicago Med Season 10 finale hangs the threat of leaving a lasting mark, one that will be felt deep into next season.

Also read: Chicago Med Season 10 Episode 22: Release date news, time, streaming details and more

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