Good Sam (2022) s01e01 Episode Script
Pilot
1
(MOZART'S DIE ENTFÃHRUNG
AUS DEM SERAIL PLAYING)
Mr.
Ferguson! Mr.
Ferguson! Mr.
Ferguson! Mr.
Ferguson, stop! Mr.
Ferguson.
Stop! Mr.
Fergu son.
Mr.
Ferguson, stop! If you have a heart attack out here, I am not gonna save you.
Do you hear me? I'm sorry, Dr.
Sam.
(PANTING) I just can't go through with it.
(CRIES, PANTS) It's too risky, with my diabetes and my blood pressure.
We have talked about this.
The benefits outweigh the risks.
I could die on the table! You won't die on the table.
How can you be sure? Because Dr.
Griffith is your surgeon.
He is one of the best cardiothoracic surgeons in the country.
And I say "one of the best" because I'm quoting U.
S.
News & World Report.
But in my opinion, Dr.
Rob Griffith is the best.
He is incredibly detail-orientated.
Meticulous, really.
Sometimes to a degree that is hard to believe.
He's a genius.
And I know that you are scared, okay? I was, too.
You had heart surgery? Long time ago.
Wow.
But instead of thinking about dying on the table or what could go wrong, I thought about Crystal Lake.
My dad and I went fishing there every summer.
It's beautiful.
It's stocked with trout and coho salmon.
And I just I thought about the next trip we'd take.
Do you have a place you'd like to go? Uh my wife wants to do a cruise.
Oh, yeah? Where to? (SNORTS SOFTLY) Alaska.
Alaska? That's colder than Michigan! What happened to going - to the Bahamas? - (LAUGHING) You know, I don't think you can promise that I won't die.
Legally speaking.
I'll tell you what.
Have the surgery, and if you live, you can sue me.
- (LAUGHS) - Deal? - Deal.
- Okay.
(CHUCKLES) Oh.
(HANDS SCRUBBING) Well, Ferguson is prepped, and I got my cardio in.
Ha! Told you she'd get him back.
20 bucks says this guy celebrates his new valves with a yard of beer and a bloomin' onion.
(CHUCKLES) Caleb, does your mechanic care how you drive your car after a tune-up? Oh, I'm so over blood and guts.
Just give me some fake boobies - and call it a day.
- (CALEB CHUCKLES) - You are so superficial.
You know that? - Lex, you know that frowny face you make when you're judging people, - you're gonna need some Botox.
- (GASPING) - SAM: Joey.
- Don't expect a discount, honey.
- Ooh - Watch out.
Okay, guys, we're a team.
This is not a competition.
You all have strengths.
(CHUCKLES) I'm afraid I disagree.
From where I stand, I see a lot of weaknesses.
Pathologically arrogant.
Profoundly insecure.
Emotionally unpredictable.
And exceptionally vain.
I don't know if any of you have what it takes.
That's why you're here.
To earn your seat at the grown-up table by proving empirically that you are more valuable than the person next to you.
This is surgical residency, not a drum circle.
And you, you're supervising these doctors.
You're above them, in knowledge, rank and skill.
Act like it.
I been in the right place SAM: Patient suffers restenosis.
Dr.
Griffith is removing some of the failed stents before harvesting the left saphenous vein for bypass.
Actually, I've changed my mind.
I'm gonna use the internal thoracic arteries.
Why would we do that? Because some interventional cardiologist has run a full metal jacket down this artery, and now I have nowhere to put the anastomosis.
But the patient is diabetic.
Yeah.
We all read his file, Doctor.
I just mean that he's at higher risk for infection, and harvesting arteries close to the breastbone only increases that risk.
Maybe.
That also decreases the risk of him coming back next year with an occluded vein graft.
Clamps.
A sternal complication could kill him.
Good thing he's in the hands of a capable surgeon.
(ELEVATOR DINGS) (DOORS OPEN) Doctor.
Doctor.
(CHUCKLES SOFTLY) I Yeah, just let it out.
I am the cardiac fellow.
I'm second in command here, and he shows me no respect.
It-It's like undermining me - is a sport for him.
- If it makes you feel any better, he doesn't respect anybody.
It doesn't.
I I think I'm gonna take the Cleveland offer, Caleb.
You don't want to do that.
Are you saying I should stay? It's not about me.
You need to do what's best for your career.
- Yeah.
- (CHUCKLES) You know, I've told him before.
If he can't respect me, I can't work here.
End of story.
You need to tell the wife you did a different procedure.
(SCOFFS) Okay.
I'll tell her for you.
Tell her I said, "You're welcome.
" There's something else.
I've made a decision.
About my future.
- And - (PAGER BEEPING, BUZZING) (SIGHS) Ten-car pileup on I-94.
They're running triage.
One cardiac event.
(INDISTINCT CHATTER) - GRIFF: That's our code.
- Griff.
Doctor.
Please, my wife is in pain.
Oh, no, she's fine.
- DOCTOR: Hurry! - GRIFF: What do we got? Hang on.
Came in with chest pain.
Nitroglycerin? Already gave it to her.
All right.
(INDISTINCT WALKIE TRANSMISSION) LEX: Grab a crash cart.
- Uh, AED's closer.
- DOCTOR: One, two, three.
(EXHALES) No pulse.
Start CPR.
Hey! You can't walk away from me.
What kind of doctor are you? A bad one.
You don't want me.
Keep waiting.
- (GUNSHOT) - (GROANS) (SCREAMING) (GROANS) (GASPING) (WHEEZES) Dad! NEWSMAN: Breaking news out of Lakeshore Sentinel Hospital.
- There has been a shooting.
- NEWSWOMAN: Suspect taken into custody.
He apparently had no connection to the victim.
NEWSMAN: The victim is Dr.
Rob Griffith, a renowned surgeon at the very hospital where this random attack took place.
SAM: What happened to my father was a shock for our entire community.
As a community, we went on, as I know he'd want us to.
- Morning.
- Dr.
Griffith.
I was humbled to step in as interim chief in my father's absence.
- Hi.
- Good morning.
And I am humbled again today and grateful to the board for making my position permanent.
My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
I love it.
Huh.
And so would he.
I'm not so sure about that.
No.
Do not feel guilty.
- You've earned this.
- (GROANS SOFTLY) And I say that as your chief medical officer, not your mother.
LEX: It's perfect.
Really? It's not boring? No, it's definitely boring, but How can it be perfect and boring? I just mean it's a very appropriate speech for a room full of uptight rich donors.
Mm It's a compliment.
Okay, don't do your overthinking thing.
You're gonna break out in hives again, like you did when you spoke at that wellness retreat.
That was an allergic reaction.
Okay.
What you call overthinking, I call evaluating from all sides to make the most informed decision.
Hmm.
Is that how we're spinning it these days? Got to love therapy.
Good morning, all.
Morning, Dr.
Griffith.
Big day.
No kidding.
Atrial fib, hiatal hernia, ICD candidate? You know I mean your promotion.
I know.
- Shall we? - Mm-hmm.
A-fib.
What do we know? Patient has failed three anti-arrhythmia meds, - including amiodarone.
- ISAN: Yeah, probably needs an ablation, but I say we just cardiovert now.
Dr.
Shah, run point on that.
Dr.
Trulie and Dr.
Costa will take the ICD.
And when Dr.
Tucker catches up from being so very late for rounds, he'll take the hernia.
One last thing.
I couldn't have gotten through the last six months without you.
Tonight is as much a celebration of you as it is of me, and I hope to see you there.
That's the fifth hernia this month.
It's also, like, the fifth time you've been late.
It's not personal.
I'm pretty sure it is.
She's a professional.
You two didn't work, she moved on.
Uh, we did though.
I just I panicked, you know? I didn't want her to plan her whole life around me.
It was the Cleveland clinic.
Isan, what do you think I should do? Show up on time.
"My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
" - That's beautiful.
- Oh.
Hi.
Oh, I'm sorry.
I Thank you.
Just trying to keep it tight and play to the audience.
Mm.
Which is? Oh, you know, boring rich donors.
Ah.
(CHUCKLES) Well, at least there's an open bar.
(CHUCKLES) I plan on hitting that hard post-speech.
(CHUCKLES) I'm Sam, by the way.
Everyone knows who you are, Dr.
Griffith.
- Eh.
- I'm Malcolm.
Kingsley.
As in the Kingsley Family Foundation? Currently underwriting the expansion of our surgical wing? A.
K.
A.
boring rich donor.
(CHUCKLES) (CHUCKLES SOFTLY) (ELEVATOR CHIMES) Lovely to meet you.
Pleasure to meet you.
SAM: Well, this'll be an awkward little stroll.
Would you like to walk ahead of me? VIVIAN: Sam! Mom.
What is it? It's your father.
He's waking up.
Uh Hi, Dad.
- Griff.
- (GRUNTS) Oh, I can't believe it.
I mean, your MRIs and EEGs always showed high residual function, but A-And your brain stem was intact, which is why we decided to None of this matters right now.
You're awake.
(GRUNTS) Are you trying to say something? - Oh, here.
Give him some water.
- Oh.
Um Here.
(GRUNTS) (HOARSE): How long? H-How long have you been out? You were shot six months ago.
And how till I can work again? (CHUCKLES) Did you hear what Sam said? It's been six months.
Not to me.
It's a long time to be in a coma.
Long time with no chief.
Actually, the hospital named a new chief.
I've been replaced? I think "succeeded" is a better word.
Who-who is it? It's me, Dad.
Tonight was the reception.
I see.
So glad I wore my gown.
(LAUGHS SOFTLY) SAM: I can't believe it.
I know.
I come by here, every night wondering if he would ever open his eyes again.
And he finally does and all he wants to do is get back to work.
(CHUCKLES) Wait, every night? I-I don't know, I think I spent more time with him here than I did when we were married.
He didn't talk, so that helped.
(BOTH LAUGH) Oh, baby.
(PIANO INAUDIBLE) (KNOCKS ON WOOD) (GASPS) Hi.
Some pretty impressive playing.
Uh, you couldn't hear anything.
That is true.
But I witnessed some very powerful body language.
That is mortifying.
Uh (BOTH CHUCKLE) When I was a kid, I-I got it in my head that I should take the piano so that I'd make my fingers more agile.
They'd be faster in surgery.
And now it's my stress release.
I have dragged this thing everywhere with me.
Med school, residency.
To here.
Mm-hmm.
- Speaking of, what brings you here? - Mm.
I mean, I'm glad for another opportunity to apologize for insulting you - in the elevator, but - I-I work here.
What? Yeah, I am the new director of finance.
But your dad is one of our biggest donors.
(CHUCKLES) Well, he and I are very different people.
He didn't get me this job, by the way.
My dad didn't get me my job.
I didn't think that he did.
I didn't think yours did, either.
So we were both not thinking the same thing.
(LAUGHS SOFTLY) (BOTH CHUCKLE) How is he, by the way? - My dad? - Yeah.
He's doing really well.
Remarkably well.
Well, if you ever need to talk, I'm here.
Thanks.
GRIFF: I've made more progress in two weeks than most patients do in months.
VIVIAN: You almost died.
Don't you think you should use this time to, you know, take stock of your life? What? I did one to two procedures per day, five days per week, seven hours of median cut time, that's 35 hours a week.
140 hours a month, 840 hours in six months I've missed.
That's the stock I've been taking.
I meant more like "I've never seen Paris.
" We saw Paris.
Together.
I had a good time.
All right, the Parthenon, then.
What do I have to do to get back into surgery? You have to be proctored.
Oh, come on.
It's state law.
After a medical leave like this, you are months away from even picking up a scalpel.
Eh Sam.
No.
(GRUNTS): It has to be Sam.
It is her department now.
Her promotion was - Premature.
- unexpected.
But it was also well-deserved.
And if you are gonna ask her to proctor you, you have to respect that she's in charge.
I was thinking maybe you should ask her.
Oh I'll do it.
I'll supervise him.
- Sam.
- I'm the attending physician.
Have you forgotten how tense things were between you two? - You had one foot out the door.
- Exactly.
Six months ago Sam would not have been able to handle this.
I'm different.
I've changed.
- What if he hasn't? - It doesn't really matter.
I have the authority now and he will have to respect that.
He also has to undergo extensive evaluation.
- Clinical, technical, procedural.
- Yeah.
You'll have to file assessment reports for peer review.
And that's only after he regains his physical stamina.
It's gonna take a long time, Sam.
I can do this.
And I say that as your head of cardiothoracic surgery, not your daughter.
I thought I had the flu.
I don't know why my doctor sent me here.
Has anyone ever told you that you have a heart murmur? - No.
- That's why.
A new murmur can be cause for concern, especially with your recent dental work.
It could be endocarditis.
It's an infection that can spread from the teeth to the heart.
So we are gonna start you on some antibiotics and run a couple of tests.
Okay.
How long have you had the swollen lip? JULIO: I don't want to talk about it.
Okay.
We'll get those tests ordered.
(KNOCKING ON DOOR) (EXHALES SHARPLY) Huh? (DOOR CLOSES) Huh.
(CHUCKLES) What are you doing in here? This isn't your office anymore.
Uh, looking for my white coat.
I don't remember clearing you.
Your physical isn't for two more weeks.
Come on, we both know I'm ready.
Hey, feel that muscle.
I am not feeling your muscle.
Come on, just as a scientist.
It's like a rock.
It's like the statue of David.
Larry David.
Griff, the rules governing proctorship are serious, and if you disregard them, I have to answer to the licensing board.
We could put the whole hospital at risk.
You'll be able to take histories and talk to families.
You can also be in the OR, but if you so much as touch a patient, malpractice insurance will drop you and your bony ass will lose privileges at this hospital.
Bony? You didn't even touch it.
And for future reference, coats are in the locker room.
I don't deserve you as a wife.
Probably why I've been married elsewhere for eight years.
Lucky man.
Tell me something.
And be honest.
Yeah? When you look at him, do you ever think his eyebrows look like moustaches? Mr.
Vargas's symptoms are consistent with left-sided, native valve endocarditis, status: post-dental implant.
How did you lose the tooth? It got knocked out.
Trust me, he deserved it.
LEX: Blood cultures pending, we empirically started an antibiotic course.
But the fever persists.
Why? Maybe the infection is methicillin resistant? We could change to vanco? - Good.
Anything else? - ISAN: Could be a deep space abscess the antibiotics can't reach.
I'd get a soft-tissue CT scan.
I agree.
GRIFF: I'm afraid I disagree.
Who is that? Dr.
Griffith.
I thought you were Dr.
Griffith.
I am.
And he is.
We are Dr.
Griffith.
That's not confusing at all.
You didn't say he was starting today.
Your proctorship has not officially begun, Doctor.
Let's get Mr.
Vargas down to radiology.
It's not endocarditis.
Please don't interrupt me.
Fever hasn't gone down has it? SAM: Okay, let's go through the symptoms again.
Whoa, whoa, whoa.
What happened to my whiteboard? Oh.
We upgraded.
This can be updated in real time from any tablet on the network.
It promotes the sharing of information across departments.
Well, I like to doodle on my whiteboard.
Well, sorry for your loss.
What do we have? The constellation of symptoms and clinical presentation really suggest infective endocarditis.
GRIFF: Well, I would be inclined to agree.
Oh, is that what you were doing when you parachuted into the room just now? But not before ruling out noninfective endocarditis.
A.
K.
A.
Libman-Sacks endocarditis.
A.
K.
A Lupus.
Two diseases with almost identical symptoms.
But totally opposite treatment strategies.
If that's true, we've been giving him antibiotics when we should've been treating him with immunosuppressants.
(STAMMERS) What are you basing this on? Because Libman-Sacks is characterized by lesions on the aortic valves, and his transthoracic echo was clear.
Echo imaging is notoriously insensitive.
We all know that, right? Fine.
In the spirit of collaboration, I will order a coags and a D.
I.
C.
panel.
Already did.
- Hey! - Excuse me? Along with antinuclear antibodies and ESR.
You cannot order tests without my authorization.
Should we get him started on Solu-Medrol? If it is a lupus flare, we'll need to deal with the inflammation.
ISAN: That's a dangerous suggestion.
Suppressing Mr.
Vargas's immune system if he's actually fighting an infection would be catastrophic.
Exactly.
We wait for test results before we change course.
Well, looks like I got time to doodle.
(MARKER SQUEAKING) (DOOR OPENS) I thought I'd find you down here.
I was gonna ask how you're doing, but it looks like you're banging out a concerto, so I wanted this to be a fresh start.
But this all feels very familiar.
Uh, do not let this affect your confidence.
These are famously difficult conditions to differentiate.
I'm sure that's exactly what he'll say if he's right.
Don't worry about what he'll say.
That's easy to say when he's not your father.
No.
No, my father gambled away my college tuition.
So you are not the only one with daddy issues - around here, sweetheart.
- (CHUCKLES) When you put it that way TECH: Labs are ready.
Thank you.
He was right.
Damn it.
Thanks to Dr.
Griffith's diagnosis, we have started you on immunosuppressants and anticoagulants.
And we will keep you here to monitor your overall heart function.
I thought the other thing affected my heart.
This one can, too, but in a different way.
Thank you, Dr.
Griffith.
- You're welcome.
- You're welcome.
I think he was talking to me.
And yet, I was the one speaking.
Julio, I know that your wife is the one who knocked your tooth out.
Would you mind telling me why? It's a long story.
Well, if we only had the time.
I have time.
I got the thing.
(SIGHS) I'm listening.
What are you doing in here? Reading my eulogy.
It's terrible.
You hardly even mention me.
That's because it's not your eulogy, it was my acceptance speech.
Dad.
You cannot run out of the room when patients want to talk anymore.
It's not how I do things.
So, what, it's your way or the highway? It's my way because it works.
If you'd followed protocols and listened to Mr.
Vargas, you would know that That he cheated on his wife and she decked him.
I don't need your protocols to solve that particular mystery.
You do have a lot of experience to draw from, given what you did to Mom.
I have work to do, and this is my office, so if you could? (DOOR OPENS, CLOSES) Steroids are working.
Inflammatory markers are down everywhere.
Everywhere but the sore on his lip.
What could cause that? Dr.
Costa.
He's immune-suppressed from the treatment.
Could have left him susceptible to a herpetic outbreak.
But he came in with the sore.
It was less pronounced, but it preexisted treatment.
So he got it from cheating, and the immunosuppressants - made it worse.
- Agreed.
Give him an ice pack, some Valtrex.
Let's move on.
I am not ready to move on.
It is the one symptom that doesn't fit the diagnosis.
Dr.
Shah.
Could also be hereditary angioedema.
Oh, a man has an affair, turns up with a sore on his lip.
STD or a rare genetic disorder? Is this about the patient's lip, or needing to be right about something? CALEB: All I'm saying is, Rob Griffith is gonna get his job back.
Sam's just signing her own pink slip by helping him.
Mm.
You should tell her that.
It'll really help your getting back together cause.
LEX (LAUGHS): Getting back together? After he wouldn't commit? Please.
Separate issue.
- Really? - ISAN: Is it? Sam was your girlfriend.
You know better than anybody - how hard he was on her.
- Yeah, and I also know that she put up with it for the same reason we all did.
Griff was tough, okay? But he's also the best.
He makes us better.
You are really a black-belt ass-kisser.
You know that? He made me miserable.
Sam's made the whole place better.
We are all happier.
We get more sleep, we're more effective.
Okay, Isan, you have to have open-heart surgery tomorrow.
Which Dr.
Griffith do you choose? Anybody who opens my chest has to be a good person and a good doctor.
(ALL GROANING) JOEY: You know what? - You're in time-out.
- (LAUGHTER) (DOOR CLOSES) - Oh, hello.
- Hey.
You are officially the first administrative executive to ever set foot in this lab.
Look, I was thinking about asking you to dinner.
But I received a tip that you rarely leave the hospital for meals, and that if I wanted some alone time with you, I'd have to get it in the lab after hours.
My office is next to your mom's.
Ah.
Do you always prep your own lab work? Uh, just when the lab is backed up.
Makes sense.
Why wait? Hate waiting.
Speaking of, when were you gonna ask me to dinner? (BOTH LAUGH) - MAN (OVER P.
A.
): Code blue.
- Oh, no.
- It's your patient? - It's Julio.
He's coding.
He was responding to treatment, so why the cardiogenic shock? Ooh, ooh, miss.
If you say lesions on his valves Lesions on his valves.
Jinx.
Lactate and blood cultures were negative.
What are we missing? Preexisting malignancy, maybe? Or an undiagnosed thrombotic disorder? GRIFF: For months, I was here in this hospital, while you all carried on without me.
There was no evidence of me at all.
If you wanted to find me, you would have had to go looking.
Like with a transesophageal echo? No.
We just got him stabilized.
It would answer the question.
And it's relatively low-risk.
It is not low-risk.
His ejection fraction is at 35%.
(SCOFFS) Well, why don't we take a vote? All in favor of a diagnostic test An unnecessary diagnostic test.
a diagnostic test to find out what's actually going on? Slow down, Sam.
- Talk to me.
- No.
Since when do we vote on risky, invasive procedures? This is not a democracy.
I know, but No, I have to do a TEE on a patient now because the Almighty Griff can't fathom that he could possibly be wrong? He's not wrong.
Three sets of bacterial cultures were negative.
We are missing something, Lex.
- Sam.
- I know it.
I know it.
He was right.
And I know it's hard to not make this personal, but That's what you think I'm doing? I think that you are being very emotional, and it's possibly clouding your judgment.
Huh.
Yeah, maybe my judgment is off.
(EXHALES) Because I thought my best friend would have my back.
(EXHALES) We're looking in the wrong place.
Tricuspid valve appears intact.
CALEB: Same with the pulmonic.
Valves look fine.
Exactly.
There's nothing here.
So I'm here for you to say, "I told you so, Doctor" That is not why I agreed to this procedure, Doctor.
It's not the valves we need to see.
It's what's around them.
Like the failing ventricle.
What failing ventricle? Go transgastric? The myocardium's dead.
I-It's going after the muscle.
CALEB: Lupus doesn't attack heart muscle.
Which means we're missing something.
Exactly.
This has nothing to do with his valves, but unless we figure out what this is, he's gonna need a whole new heart.
(SIREN WAILING) Daisy, I relate to living next to someone you'd like to punch more than you can possibly imagine.
But Julio needs your help right now, and so do I.
Will you tell me the story? - Your version? - There's nothing to tell.
Julio came home from Rio with that sore on his lip.
- Mm-hmm.
- He tried to hide it, but I saw it.
By the time he confessed, I was so angry, I punched him.
Right in the mouth.
The business trip where Julio had the affair, where did you say it was? Rio de Janeiro saw a dramatic uptick in cases of Trypanosoma cruzi over the last decade.
Cruzi? Sounds like a girl I dated in college.
It's a parasite.
It's infected over six million people in Brazil.
Which is where Mr.
Vargas had his affair, which is where he was likely bitten by an insect carrying T.
Cruzi, which then likely entered his system through the insect's feces.
So it bites you and then it poops on you? - Uh-huh.
- JOEY: You definitely dated that girl.
The insect targets mucous membranes of the face, like the eyes and the lips.
It's actually nicknamed the kissing bug.
- Yes.
- That explains the lip.
Exactly.
The STD is actually an acute-phase symptom of Chagas disease.
Ah, so wait, the inflammation that we diagnosed as lupus w Was another symptom.
An immune response to the tissue-nested parasite.
I'll confirm with antibody tests.
- Start an antiparasitic.
- I'm on it.
GRIFF: It's too late.
The troponin levels are sky-high.
Massive myocyte necrosis.
Cell death.
So we put him on the transplant list.
Ventricular-assist device as a bridge.
- He's a young man - Never gonna happen in time.
The family needs to start saying goodbye.
SAM: Give us a minute? Okay (DOOR OPENS) (DOOR CLOSES) Why are you doing this? The heart is gone.
You have to be able to call it.
Not the case.
This.
You don't respect my authority, or my rules.
So why not work under someone else? Somewhere else? Because you need me.
It's actually the other way around.
"I can handle him," I said.
"He won't get under my skin.
" I can barely hold my team together.
Well, they're confused.
He was the boss for a long time, but he is not in charge.
Well, that's not what he thinks.
What do you think? (STAMMERS) I think that my entire management approach was naive.
I think that, ultimately, unfortunately, people respect tyrants and bullies more than kindness and decency.
That's not respect.
- It's fear.
- I thought that the whole almost dying thing would change him.
Not a lot, but a little.
Something in him is broken, Sam.
Since the accident I don't want to talk about the accident.
Okay? That can't be the excuse for everything forever.
He was speeding.
So what? What happened to me, my heart, that wasn't his fault.
And besides, if you feel badly for hurting someone, you don't push them away, you try to make it better.
You do that.
You try to make things better.
Sam.
What-what are you doing here? I'm sorry that I took my frustration out on you earlier.
And I brought you a peace offering.
What, do you have company? (CHUCKLES) Look, I wanted to tell you.
Tell me what? I-It started before the shooting.
And, look, I know it shouldn't have, but it did.
But it is over now.
It may not look that way.
It probably looks really bad.
We should've told you.
"We"? Yeah.
Uh I-I should have told you.
There is no we.
All right, look, if I may No.
You may not.
At least, not with me.
Find someone else to proctor you.
(DOOR CLOSES) What do you mean, there's nothing you can do? I have to uphold the chain of command the same as I did when you were attending.
I can't force Sam to proctor you.
You're insubordinate and disrespectful.
Please, Vivi.
Don't.
Surgery is the only time i-it's quiet in my head.
You know that.
- Then go somewhere else.
- Listen.
I I can make her stronger.
- Better.
- Really? A resident, Griff? Sam's best friend.
I know, I know.
What do I do? Just tell me what to do.
Make this right with your daughter.
Be her father.
Stop hiding behind your work.
This is how I'm her father.
I've always been like this.
No, not always.
Oh, no, not that again.
You need professional help.
You can't see how the accident affected your relationship with her.
You have blocked it out.
Stop.
What is this, a-a memory test? I remember, remember leaving the lake house, I was driving too fast around the bend, watching our daughter getting wheeled into surgery.
Heart surgery, which I think we both agree was, uh Yeah, it was traumatic.
I was gonna say ironic.
Give me your badge.
Come on.
(DOOR OPENS) My father and I disagree about a lot of things.
Including what we see in each of you.
So here's what I see.
Inspiring confidence.
Wisdom and compassion.
Commitment, courage and a complexion that I truly envy.
A brilliant doctor who I need on this team.
Right now, this patient is all there is.
So, if you are with me, let's get to work.
Lex, do a lit search on the most up-to-date treatments for Chagas, even experimental ones.
Joey, get him into the transplant network.
Isan and Caleb, start him on inotropes and get a Swan-Ganz cath into him right away.
This is not over.
Julio's in the transplant registry, status 1A.
And I ordered a CBC.
If we get a hit, we'll be ready.
Thank you, Caleb.
Second chances.
- Excuse me? - Just, your dad, and this patient.
You don't give up on people.
Which I'm hoping is also true in my case.
You caught me off guard back then.
And after everything that happened, I never got the chance to take it back.
Uh, what are you saying? (PAGER BEEPS, BUZZES) Mount Sinai Dearborn had a failed transplant.
Doesn't say what happened, but they saw our request.
- They're sending it.
- There's a heart.
- It's en route.
- What are we doing here? (HELICOPTER WHIRRING) LEX: Perfusing fluid.
Vessels are cold.
SAM: Dr.
Tucker, we're ready.
No.
That cannot be right.
I thought it was a match.
Blood type is, but the donor's BMI is, like, 16.
It's too small.
Bet that's why Mount Sinai didn't want it.
This heart's garbage.
No, it isn't.
We have to make it work.
(PHONE RINGING) Yeah? The heart's too small? SAM: If I abort and wait for the right heart, - he dies.
- I agree.
And if I transplant that heart, it'll fail - before I close up.
- Agree again.
Neither of these hearts can keep him alive.
Three in a row.
Why'd you call me? Because maybe both of them can.
A heterotopic transplant? That procedure's so rare it's almost a myth.
He's done it.
Y-You know I can't perform surgery.
So talk me through it.
The connection between atria is essential.
If it's not exact, he'll either embolize or bleed out.
Good thing he's in the hands of a capable surgeon.
Dad.
Clamp.
Little pericardial flap on the right side, above the diaphragm.
11 blade.
Transverse incision should be at the sternum, over the diaphragm To here.
GRIFF: Okay.
Ooh, slow slow down, slow down.
Okay, watch out for fragments.
There you go.
- All right.
- Ready for the graft.
GRIFF: Mm-hmm.
Start the anastomosis at the posterior portion of both left atria.
You want to terminate the sutures On the anterior edges.
You want as large a connection as possible.
Okay.
The atrial pathway should be clear.
Come on.
Come on, come on.
(SAM EXHALES) (SOFT LAUGHTER) (LAUGHS) (EXHALES) Lucky, lucky man.
Could easily have died.
I think what you're trying to say is "well done.
" (SCOFFS) Look, if I have been hard on you, it's only because you have tremendous potential.
I want to help you realize it.
I want to teach you how to realize it.
That's my job as a father.
No, that's your job as a surgeon.
Maybe I-I haven't always been there for you, the way you would've wanted Dad, you have never been there for me.
At least, not in a very long time.
But you were there for this.
Today.
And we saved a man's life.
Yeah.
Oh I've decided to continue proctoring you, if that's what you want.
Yes.
Please.
I want to be very clear.
I am making this decision as a doctor.
As your daughter? I'm calling it.
That'll be all, Doctor.
Ferguson! Mr.
Ferguson! Mr.
Ferguson! Mr.
Ferguson, stop! Mr.
Ferguson.
Stop! Mr.
Fergu son.
Mr.
Ferguson, stop! If you have a heart attack out here, I am not gonna save you.
Do you hear me? I'm sorry, Dr.
Sam.
(PANTING) I just can't go through with it.
(CRIES, PANTS) It's too risky, with my diabetes and my blood pressure.
We have talked about this.
The benefits outweigh the risks.
I could die on the table! You won't die on the table.
How can you be sure? Because Dr.
Griffith is your surgeon.
He is one of the best cardiothoracic surgeons in the country.
And I say "one of the best" because I'm quoting U.
S.
News & World Report.
But in my opinion, Dr.
Rob Griffith is the best.
He is incredibly detail-orientated.
Meticulous, really.
Sometimes to a degree that is hard to believe.
He's a genius.
And I know that you are scared, okay? I was, too.
You had heart surgery? Long time ago.
Wow.
But instead of thinking about dying on the table or what could go wrong, I thought about Crystal Lake.
My dad and I went fishing there every summer.
It's beautiful.
It's stocked with trout and coho salmon.
And I just I thought about the next trip we'd take.
Do you have a place you'd like to go? Uh my wife wants to do a cruise.
Oh, yeah? Where to? (SNORTS SOFTLY) Alaska.
Alaska? That's colder than Michigan! What happened to going - to the Bahamas? - (LAUGHING) You know, I don't think you can promise that I won't die.
Legally speaking.
I'll tell you what.
Have the surgery, and if you live, you can sue me.
- (LAUGHS) - Deal? - Deal.
- Okay.
(CHUCKLES) Oh.
(HANDS SCRUBBING) Well, Ferguson is prepped, and I got my cardio in.
Ha! Told you she'd get him back.
20 bucks says this guy celebrates his new valves with a yard of beer and a bloomin' onion.
(CHUCKLES) Caleb, does your mechanic care how you drive your car after a tune-up? Oh, I'm so over blood and guts.
Just give me some fake boobies - and call it a day.
- (CALEB CHUCKLES) - You are so superficial.
You know that? - Lex, you know that frowny face you make when you're judging people, - you're gonna need some Botox.
- (GASPING) - SAM: Joey.
- Don't expect a discount, honey.
- Ooh - Watch out.
Okay, guys, we're a team.
This is not a competition.
You all have strengths.
(CHUCKLES) I'm afraid I disagree.
From where I stand, I see a lot of weaknesses.
Pathologically arrogant.
Profoundly insecure.
Emotionally unpredictable.
And exceptionally vain.
I don't know if any of you have what it takes.
That's why you're here.
To earn your seat at the grown-up table by proving empirically that you are more valuable than the person next to you.
This is surgical residency, not a drum circle.
And you, you're supervising these doctors.
You're above them, in knowledge, rank and skill.
Act like it.
I been in the right place SAM: Patient suffers restenosis.
Dr.
Griffith is removing some of the failed stents before harvesting the left saphenous vein for bypass.
Actually, I've changed my mind.
I'm gonna use the internal thoracic arteries.
Why would we do that? Because some interventional cardiologist has run a full metal jacket down this artery, and now I have nowhere to put the anastomosis.
But the patient is diabetic.
Yeah.
We all read his file, Doctor.
I just mean that he's at higher risk for infection, and harvesting arteries close to the breastbone only increases that risk.
Maybe.
That also decreases the risk of him coming back next year with an occluded vein graft.
Clamps.
A sternal complication could kill him.
Good thing he's in the hands of a capable surgeon.
(ELEVATOR DINGS) (DOORS OPEN) Doctor.
Doctor.
(CHUCKLES SOFTLY) I Yeah, just let it out.
I am the cardiac fellow.
I'm second in command here, and he shows me no respect.
It-It's like undermining me - is a sport for him.
- If it makes you feel any better, he doesn't respect anybody.
It doesn't.
I I think I'm gonna take the Cleveland offer, Caleb.
You don't want to do that.
Are you saying I should stay? It's not about me.
You need to do what's best for your career.
- Yeah.
- (CHUCKLES) You know, I've told him before.
If he can't respect me, I can't work here.
End of story.
You need to tell the wife you did a different procedure.
(SCOFFS) Okay.
I'll tell her for you.
Tell her I said, "You're welcome.
" There's something else.
I've made a decision.
About my future.
- And - (PAGER BEEPING, BUZZING) (SIGHS) Ten-car pileup on I-94.
They're running triage.
One cardiac event.
(INDISTINCT CHATTER) - GRIFF: That's our code.
- Griff.
Doctor.
Please, my wife is in pain.
Oh, no, she's fine.
- DOCTOR: Hurry! - GRIFF: What do we got? Hang on.
Came in with chest pain.
Nitroglycerin? Already gave it to her.
All right.
(INDISTINCT WALKIE TRANSMISSION) LEX: Grab a crash cart.
- Uh, AED's closer.
- DOCTOR: One, two, three.
(EXHALES) No pulse.
Start CPR.
Hey! You can't walk away from me.
What kind of doctor are you? A bad one.
You don't want me.
Keep waiting.
- (GUNSHOT) - (GROANS) (SCREAMING) (GROANS) (GASPING) (WHEEZES) Dad! NEWSMAN: Breaking news out of Lakeshore Sentinel Hospital.
- There has been a shooting.
- NEWSWOMAN: Suspect taken into custody.
He apparently had no connection to the victim.
NEWSMAN: The victim is Dr.
Rob Griffith, a renowned surgeon at the very hospital where this random attack took place.
SAM: What happened to my father was a shock for our entire community.
As a community, we went on, as I know he'd want us to.
- Morning.
- Dr.
Griffith.
I was humbled to step in as interim chief in my father's absence.
- Hi.
- Good morning.
And I am humbled again today and grateful to the board for making my position permanent.
My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
I love it.
Huh.
And so would he.
I'm not so sure about that.
No.
Do not feel guilty.
- You've earned this.
- (GROANS SOFTLY) And I say that as your chief medical officer, not your mother.
LEX: It's perfect.
Really? It's not boring? No, it's definitely boring, but How can it be perfect and boring? I just mean it's a very appropriate speech for a room full of uptight rich donors.
Mm It's a compliment.
Okay, don't do your overthinking thing.
You're gonna break out in hives again, like you did when you spoke at that wellness retreat.
That was an allergic reaction.
Okay.
What you call overthinking, I call evaluating from all sides to make the most informed decision.
Hmm.
Is that how we're spinning it these days? Got to love therapy.
Good morning, all.
Morning, Dr.
Griffith.
Big day.
No kidding.
Atrial fib, hiatal hernia, ICD candidate? You know I mean your promotion.
I know.
- Shall we? - Mm-hmm.
A-fib.
What do we know? Patient has failed three anti-arrhythmia meds, - including amiodarone.
- ISAN: Yeah, probably needs an ablation, but I say we just cardiovert now.
Dr.
Shah, run point on that.
Dr.
Trulie and Dr.
Costa will take the ICD.
And when Dr.
Tucker catches up from being so very late for rounds, he'll take the hernia.
One last thing.
I couldn't have gotten through the last six months without you.
Tonight is as much a celebration of you as it is of me, and I hope to see you there.
That's the fifth hernia this month.
It's also, like, the fifth time you've been late.
It's not personal.
I'm pretty sure it is.
She's a professional.
You two didn't work, she moved on.
Uh, we did though.
I just I panicked, you know? I didn't want her to plan her whole life around me.
It was the Cleveland clinic.
Isan, what do you think I should do? Show up on time.
"My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
" - That's beautiful.
- Oh.
Hi.
Oh, I'm sorry.
I Thank you.
Just trying to keep it tight and play to the audience.
Mm.
Which is? Oh, you know, boring rich donors.
Ah.
(CHUCKLES) Well, at least there's an open bar.
(CHUCKLES) I plan on hitting that hard post-speech.
(CHUCKLES) I'm Sam, by the way.
Everyone knows who you are, Dr.
Griffith.
- Eh.
- I'm Malcolm.
Kingsley.
As in the Kingsley Family Foundation? Currently underwriting the expansion of our surgical wing? A.
K.
A.
boring rich donor.
(CHUCKLES) (CHUCKLES SOFTLY) (ELEVATOR CHIMES) Lovely to meet you.
Pleasure to meet you.
SAM: Well, this'll be an awkward little stroll.
Would you like to walk ahead of me? VIVIAN: Sam! Mom.
What is it? It's your father.
He's waking up.
Uh Hi, Dad.
- Griff.
- (GRUNTS) Oh, I can't believe it.
I mean, your MRIs and EEGs always showed high residual function, but A-And your brain stem was intact, which is why we decided to None of this matters right now.
You're awake.
(GRUNTS) Are you trying to say something? - Oh, here.
Give him some water.
- Oh.
Um Here.
(GRUNTS) (HOARSE): How long? H-How long have you been out? You were shot six months ago.
And how till I can work again? (CHUCKLES) Did you hear what Sam said? It's been six months.
Not to me.
It's a long time to be in a coma.
Long time with no chief.
Actually, the hospital named a new chief.
I've been replaced? I think "succeeded" is a better word.
Who-who is it? It's me, Dad.
Tonight was the reception.
I see.
So glad I wore my gown.
(LAUGHS SOFTLY) SAM: I can't believe it.
I know.
I come by here, every night wondering if he would ever open his eyes again.
And he finally does and all he wants to do is get back to work.
(CHUCKLES) Wait, every night? I-I don't know, I think I spent more time with him here than I did when we were married.
He didn't talk, so that helped.
(BOTH LAUGH) Oh, baby.
(PIANO INAUDIBLE) (KNOCKS ON WOOD) (GASPS) Hi.
Some pretty impressive playing.
Uh, you couldn't hear anything.
That is true.
But I witnessed some very powerful body language.
That is mortifying.
Uh (BOTH CHUCKLE) When I was a kid, I-I got it in my head that I should take the piano so that I'd make my fingers more agile.
They'd be faster in surgery.
And now it's my stress release.
I have dragged this thing everywhere with me.
Med school, residency.
To here.
Mm-hmm.
- Speaking of, what brings you here? - Mm.
I mean, I'm glad for another opportunity to apologize for insulting you - in the elevator, but - I-I work here.
What? Yeah, I am the new director of finance.
But your dad is one of our biggest donors.
(CHUCKLES) Well, he and I are very different people.
He didn't get me this job, by the way.
My dad didn't get me my job.
I didn't think that he did.
I didn't think yours did, either.
So we were both not thinking the same thing.
(LAUGHS SOFTLY) (BOTH CHUCKLE) How is he, by the way? - My dad? - Yeah.
He's doing really well.
Remarkably well.
Well, if you ever need to talk, I'm here.
Thanks.
GRIFF: I've made more progress in two weeks than most patients do in months.
VIVIAN: You almost died.
Don't you think you should use this time to, you know, take stock of your life? What? I did one to two procedures per day, five days per week, seven hours of median cut time, that's 35 hours a week.
140 hours a month, 840 hours in six months I've missed.
That's the stock I've been taking.
I meant more like "I've never seen Paris.
" We saw Paris.
Together.
I had a good time.
All right, the Parthenon, then.
What do I have to do to get back into surgery? You have to be proctored.
Oh, come on.
It's state law.
After a medical leave like this, you are months away from even picking up a scalpel.
Eh Sam.
No.
(GRUNTS): It has to be Sam.
It is her department now.
Her promotion was - Premature.
- unexpected.
But it was also well-deserved.
And if you are gonna ask her to proctor you, you have to respect that she's in charge.
I was thinking maybe you should ask her.
Oh I'll do it.
I'll supervise him.
- Sam.
- I'm the attending physician.
Have you forgotten how tense things were between you two? - You had one foot out the door.
- Exactly.
Six months ago Sam would not have been able to handle this.
I'm different.
I've changed.
- What if he hasn't? - It doesn't really matter.
I have the authority now and he will have to respect that.
He also has to undergo extensive evaluation.
- Clinical, technical, procedural.
- Yeah.
You'll have to file assessment reports for peer review.
And that's only after he regains his physical stamina.
It's gonna take a long time, Sam.
I can do this.
And I say that as your head of cardiothoracic surgery, not your daughter.
I thought I had the flu.
I don't know why my doctor sent me here.
Has anyone ever told you that you have a heart murmur? - No.
- That's why.
A new murmur can be cause for concern, especially with your recent dental work.
It could be endocarditis.
It's an infection that can spread from the teeth to the heart.
So we are gonna start you on some antibiotics and run a couple of tests.
Okay.
How long have you had the swollen lip? JULIO: I don't want to talk about it.
Okay.
We'll get those tests ordered.
(KNOCKING ON DOOR) (EXHALES SHARPLY) Huh? (DOOR CLOSES) Huh.
(CHUCKLES) What are you doing in here? This isn't your office anymore.
Uh, looking for my white coat.
I don't remember clearing you.
Your physical isn't for two more weeks.
Come on, we both know I'm ready.
Hey, feel that muscle.
I am not feeling your muscle.
Come on, just as a scientist.
It's like a rock.
It's like the statue of David.
Larry David.
Griff, the rules governing proctorship are serious, and if you disregard them, I have to answer to the licensing board.
We could put the whole hospital at risk.
You'll be able to take histories and talk to families.
You can also be in the OR, but if you so much as touch a patient, malpractice insurance will drop you and your bony ass will lose privileges at this hospital.
Bony? You didn't even touch it.
And for future reference, coats are in the locker room.
I don't deserve you as a wife.
Probably why I've been married elsewhere for eight years.
Lucky man.
Tell me something.
And be honest.
Yeah? When you look at him, do you ever think his eyebrows look like moustaches? Mr.
Vargas's symptoms are consistent with left-sided, native valve endocarditis, status: post-dental implant.
How did you lose the tooth? It got knocked out.
Trust me, he deserved it.
LEX: Blood cultures pending, we empirically started an antibiotic course.
But the fever persists.
Why? Maybe the infection is methicillin resistant? We could change to vanco? - Good.
Anything else? - ISAN: Could be a deep space abscess the antibiotics can't reach.
I'd get a soft-tissue CT scan.
I agree.
GRIFF: I'm afraid I disagree.
Who is that? Dr.
Griffith.
I thought you were Dr.
Griffith.
I am.
And he is.
We are Dr.
Griffith.
That's not confusing at all.
You didn't say he was starting today.
Your proctorship has not officially begun, Doctor.
Let's get Mr.
Vargas down to radiology.
It's not endocarditis.
Please don't interrupt me.
Fever hasn't gone down has it? SAM: Okay, let's go through the symptoms again.
Whoa, whoa, whoa.
What happened to my whiteboard? Oh.
We upgraded.
This can be updated in real time from any tablet on the network.
It promotes the sharing of information across departments.
Well, I like to doodle on my whiteboard.
Well, sorry for your loss.
What do we have? The constellation of symptoms and clinical presentation really suggest infective endocarditis.
GRIFF: Well, I would be inclined to agree.
Oh, is that what you were doing when you parachuted into the room just now? But not before ruling out noninfective endocarditis.
A.
K.
A.
Libman-Sacks endocarditis.
A.
K.
A Lupus.
Two diseases with almost identical symptoms.
But totally opposite treatment strategies.
If that's true, we've been giving him antibiotics when we should've been treating him with immunosuppressants.
(STAMMERS) What are you basing this on? Because Libman-Sacks is characterized by lesions on the aortic valves, and his transthoracic echo was clear.
Echo imaging is notoriously insensitive.
We all know that, right? Fine.
In the spirit of collaboration, I will order a coags and a D.
I.
C.
panel.
Already did.
- Hey! - Excuse me? Along with antinuclear antibodies and ESR.
You cannot order tests without my authorization.
Should we get him started on Solu-Medrol? If it is a lupus flare, we'll need to deal with the inflammation.
ISAN: That's a dangerous suggestion.
Suppressing Mr.
Vargas's immune system if he's actually fighting an infection would be catastrophic.
Exactly.
We wait for test results before we change course.
Well, looks like I got time to doodle.
(MARKER SQUEAKING) (DOOR OPENS) I thought I'd find you down here.
I was gonna ask how you're doing, but it looks like you're banging out a concerto, so I wanted this to be a fresh start.
But this all feels very familiar.
Uh, do not let this affect your confidence.
These are famously difficult conditions to differentiate.
I'm sure that's exactly what he'll say if he's right.
Don't worry about what he'll say.
That's easy to say when he's not your father.
No.
No, my father gambled away my college tuition.
So you are not the only one with daddy issues - around here, sweetheart.
- (CHUCKLES) When you put it that way TECH: Labs are ready.
Thank you.
He was right.
Damn it.
Thanks to Dr.
Griffith's diagnosis, we have started you on immunosuppressants and anticoagulants.
And we will keep you here to monitor your overall heart function.
I thought the other thing affected my heart.
This one can, too, but in a different way.
Thank you, Dr.
Griffith.
- You're welcome.
- You're welcome.
I think he was talking to me.
And yet, I was the one speaking.
Julio, I know that your wife is the one who knocked your tooth out.
Would you mind telling me why? It's a long story.
Well, if we only had the time.
I have time.
I got the thing.
(SIGHS) I'm listening.
What are you doing in here? Reading my eulogy.
It's terrible.
You hardly even mention me.
That's because it's not your eulogy, it was my acceptance speech.
Dad.
You cannot run out of the room when patients want to talk anymore.
It's not how I do things.
So, what, it's your way or the highway? It's my way because it works.
If you'd followed protocols and listened to Mr.
Vargas, you would know that That he cheated on his wife and she decked him.
I don't need your protocols to solve that particular mystery.
You do have a lot of experience to draw from, given what you did to Mom.
I have work to do, and this is my office, so if you could? (DOOR OPENS, CLOSES) Steroids are working.
Inflammatory markers are down everywhere.
Everywhere but the sore on his lip.
What could cause that? Dr.
Costa.
He's immune-suppressed from the treatment.
Could have left him susceptible to a herpetic outbreak.
But he came in with the sore.
It was less pronounced, but it preexisted treatment.
So he got it from cheating, and the immunosuppressants - made it worse.
- Agreed.
Give him an ice pack, some Valtrex.
Let's move on.
I am not ready to move on.
It is the one symptom that doesn't fit the diagnosis.
Dr.
Shah.
Could also be hereditary angioedema.
Oh, a man has an affair, turns up with a sore on his lip.
STD or a rare genetic disorder? Is this about the patient's lip, or needing to be right about something? CALEB: All I'm saying is, Rob Griffith is gonna get his job back.
Sam's just signing her own pink slip by helping him.
Mm.
You should tell her that.
It'll really help your getting back together cause.
LEX (LAUGHS): Getting back together? After he wouldn't commit? Please.
Separate issue.
- Really? - ISAN: Is it? Sam was your girlfriend.
You know better than anybody - how hard he was on her.
- Yeah, and I also know that she put up with it for the same reason we all did.
Griff was tough, okay? But he's also the best.
He makes us better.
You are really a black-belt ass-kisser.
You know that? He made me miserable.
Sam's made the whole place better.
We are all happier.
We get more sleep, we're more effective.
Okay, Isan, you have to have open-heart surgery tomorrow.
Which Dr.
Griffith do you choose? Anybody who opens my chest has to be a good person and a good doctor.
(ALL GROANING) JOEY: You know what? - You're in time-out.
- (LAUGHTER) (DOOR CLOSES) - Oh, hello.
- Hey.
You are officially the first administrative executive to ever set foot in this lab.
Look, I was thinking about asking you to dinner.
But I received a tip that you rarely leave the hospital for meals, and that if I wanted some alone time with you, I'd have to get it in the lab after hours.
My office is next to your mom's.
Ah.
Do you always prep your own lab work? Uh, just when the lab is backed up.
Makes sense.
Why wait? Hate waiting.
Speaking of, when were you gonna ask me to dinner? (BOTH LAUGH) - MAN (OVER P.
A.
): Code blue.
- Oh, no.
- It's your patient? - It's Julio.
He's coding.
He was responding to treatment, so why the cardiogenic shock? Ooh, ooh, miss.
If you say lesions on his valves Lesions on his valves.
Jinx.
Lactate and blood cultures were negative.
What are we missing? Preexisting malignancy, maybe? Or an undiagnosed thrombotic disorder? GRIFF: For months, I was here in this hospital, while you all carried on without me.
There was no evidence of me at all.
If you wanted to find me, you would have had to go looking.
Like with a transesophageal echo? No.
We just got him stabilized.
It would answer the question.
And it's relatively low-risk.
It is not low-risk.
His ejection fraction is at 35%.
(SCOFFS) Well, why don't we take a vote? All in favor of a diagnostic test An unnecessary diagnostic test.
a diagnostic test to find out what's actually going on? Slow down, Sam.
- Talk to me.
- No.
Since when do we vote on risky, invasive procedures? This is not a democracy.
I know, but No, I have to do a TEE on a patient now because the Almighty Griff can't fathom that he could possibly be wrong? He's not wrong.
Three sets of bacterial cultures were negative.
We are missing something, Lex.
- Sam.
- I know it.
I know it.
He was right.
And I know it's hard to not make this personal, but That's what you think I'm doing? I think that you are being very emotional, and it's possibly clouding your judgment.
Huh.
Yeah, maybe my judgment is off.
(EXHALES) Because I thought my best friend would have my back.
(EXHALES) We're looking in the wrong place.
Tricuspid valve appears intact.
CALEB: Same with the pulmonic.
Valves look fine.
Exactly.
There's nothing here.
So I'm here for you to say, "I told you so, Doctor" That is not why I agreed to this procedure, Doctor.
It's not the valves we need to see.
It's what's around them.
Like the failing ventricle.
What failing ventricle? Go transgastric? The myocardium's dead.
I-It's going after the muscle.
CALEB: Lupus doesn't attack heart muscle.
Which means we're missing something.
Exactly.
This has nothing to do with his valves, but unless we figure out what this is, he's gonna need a whole new heart.
(SIREN WAILING) Daisy, I relate to living next to someone you'd like to punch more than you can possibly imagine.
But Julio needs your help right now, and so do I.
Will you tell me the story? - Your version? - There's nothing to tell.
Julio came home from Rio with that sore on his lip.
- Mm-hmm.
- He tried to hide it, but I saw it.
By the time he confessed, I was so angry, I punched him.
Right in the mouth.
The business trip where Julio had the affair, where did you say it was? Rio de Janeiro saw a dramatic uptick in cases of Trypanosoma cruzi over the last decade.
Cruzi? Sounds like a girl I dated in college.
It's a parasite.
It's infected over six million people in Brazil.
Which is where Mr.
Vargas had his affair, which is where he was likely bitten by an insect carrying T.
Cruzi, which then likely entered his system through the insect's feces.
So it bites you and then it poops on you? - Uh-huh.
- JOEY: You definitely dated that girl.
The insect targets mucous membranes of the face, like the eyes and the lips.
It's actually nicknamed the kissing bug.
- Yes.
- That explains the lip.
Exactly.
The STD is actually an acute-phase symptom of Chagas disease.
Ah, so wait, the inflammation that we diagnosed as lupus w Was another symptom.
An immune response to the tissue-nested parasite.
I'll confirm with antibody tests.
- Start an antiparasitic.
- I'm on it.
GRIFF: It's too late.
The troponin levels are sky-high.
Massive myocyte necrosis.
Cell death.
So we put him on the transplant list.
Ventricular-assist device as a bridge.
- He's a young man - Never gonna happen in time.
The family needs to start saying goodbye.
SAM: Give us a minute? Okay (DOOR OPENS) (DOOR CLOSES) Why are you doing this? The heart is gone.
You have to be able to call it.
Not the case.
This.
You don't respect my authority, or my rules.
So why not work under someone else? Somewhere else? Because you need me.
It's actually the other way around.
"I can handle him," I said.
"He won't get under my skin.
" I can barely hold my team together.
Well, they're confused.
He was the boss for a long time, but he is not in charge.
Well, that's not what he thinks.
What do you think? (STAMMERS) I think that my entire management approach was naive.
I think that, ultimately, unfortunately, people respect tyrants and bullies more than kindness and decency.
That's not respect.
- It's fear.
- I thought that the whole almost dying thing would change him.
Not a lot, but a little.
Something in him is broken, Sam.
Since the accident I don't want to talk about the accident.
Okay? That can't be the excuse for everything forever.
He was speeding.
So what? What happened to me, my heart, that wasn't his fault.
And besides, if you feel badly for hurting someone, you don't push them away, you try to make it better.
You do that.
You try to make things better.
Sam.
What-what are you doing here? I'm sorry that I took my frustration out on you earlier.
And I brought you a peace offering.
What, do you have company? (CHUCKLES) Look, I wanted to tell you.
Tell me what? I-It started before the shooting.
And, look, I know it shouldn't have, but it did.
But it is over now.
It may not look that way.
It probably looks really bad.
We should've told you.
"We"? Yeah.
Uh I-I should have told you.
There is no we.
All right, look, if I may No.
You may not.
At least, not with me.
Find someone else to proctor you.
(DOOR CLOSES) What do you mean, there's nothing you can do? I have to uphold the chain of command the same as I did when you were attending.
I can't force Sam to proctor you.
You're insubordinate and disrespectful.
Please, Vivi.
Don't.
Surgery is the only time i-it's quiet in my head.
You know that.
- Then go somewhere else.
- Listen.
I I can make her stronger.
- Better.
- Really? A resident, Griff? Sam's best friend.
I know, I know.
What do I do? Just tell me what to do.
Make this right with your daughter.
Be her father.
Stop hiding behind your work.
This is how I'm her father.
I've always been like this.
No, not always.
Oh, no, not that again.
You need professional help.
You can't see how the accident affected your relationship with her.
You have blocked it out.
Stop.
What is this, a-a memory test? I remember, remember leaving the lake house, I was driving too fast around the bend, watching our daughter getting wheeled into surgery.
Heart surgery, which I think we both agree was, uh Yeah, it was traumatic.
I was gonna say ironic.
Give me your badge.
Come on.
(DOOR OPENS) My father and I disagree about a lot of things.
Including what we see in each of you.
So here's what I see.
Inspiring confidence.
Wisdom and compassion.
Commitment, courage and a complexion that I truly envy.
A brilliant doctor who I need on this team.
Right now, this patient is all there is.
So, if you are with me, let's get to work.
Lex, do a lit search on the most up-to-date treatments for Chagas, even experimental ones.
Joey, get him into the transplant network.
Isan and Caleb, start him on inotropes and get a Swan-Ganz cath into him right away.
This is not over.
Julio's in the transplant registry, status 1A.
And I ordered a CBC.
If we get a hit, we'll be ready.
Thank you, Caleb.
Second chances.
- Excuse me? - Just, your dad, and this patient.
You don't give up on people.
Which I'm hoping is also true in my case.
You caught me off guard back then.
And after everything that happened, I never got the chance to take it back.
Uh, what are you saying? (PAGER BEEPS, BUZZES) Mount Sinai Dearborn had a failed transplant.
Doesn't say what happened, but they saw our request.
- They're sending it.
- There's a heart.
- It's en route.
- What are we doing here? (HELICOPTER WHIRRING) LEX: Perfusing fluid.
Vessels are cold.
SAM: Dr.
Tucker, we're ready.
No.
That cannot be right.
I thought it was a match.
Blood type is, but the donor's BMI is, like, 16.
It's too small.
Bet that's why Mount Sinai didn't want it.
This heart's garbage.
No, it isn't.
We have to make it work.
(PHONE RINGING) Yeah? The heart's too small? SAM: If I abort and wait for the right heart, - he dies.
- I agree.
And if I transplant that heart, it'll fail - before I close up.
- Agree again.
Neither of these hearts can keep him alive.
Three in a row.
Why'd you call me? Because maybe both of them can.
A heterotopic transplant? That procedure's so rare it's almost a myth.
He's done it.
Y-You know I can't perform surgery.
So talk me through it.
The connection between atria is essential.
If it's not exact, he'll either embolize or bleed out.
Good thing he's in the hands of a capable surgeon.
Dad.
Clamp.
Little pericardial flap on the right side, above the diaphragm.
11 blade.
Transverse incision should be at the sternum, over the diaphragm To here.
GRIFF: Okay.
Ooh, slow slow down, slow down.
Okay, watch out for fragments.
There you go.
- All right.
- Ready for the graft.
GRIFF: Mm-hmm.
Start the anastomosis at the posterior portion of both left atria.
You want to terminate the sutures On the anterior edges.
You want as large a connection as possible.
Okay.
The atrial pathway should be clear.
Come on.
Come on, come on.
(SAM EXHALES) (SOFT LAUGHTER) (LAUGHS) (EXHALES) Lucky, lucky man.
Could easily have died.
I think what you're trying to say is "well done.
" (SCOFFS) Look, if I have been hard on you, it's only because you have tremendous potential.
I want to help you realize it.
I want to teach you how to realize it.
That's my job as a father.
No, that's your job as a surgeon.
Maybe I-I haven't always been there for you, the way you would've wanted Dad, you have never been there for me.
At least, not in a very long time.
But you were there for this.
Today.
And we saved a man's life.
Yeah.
Oh I've decided to continue proctoring you, if that's what you want.
Yes.
Please.
I want to be very clear.
I am making this decision as a doctor.
As your daughter? I'm calling it.
That'll be all, Doctor.