Transplant (2020) s01e04 Episode Script
Saleh
1
The state controls the universities.
And I am an enemy of the state.
There is no paper trail because of who I am.
My place later? You've got a second chance.
You should think about how you're gonna use it.
You're in Idlib? Kafr Halab.
The building collapsed this morning.
Bombs last night.
And we're looking for survivors.
How many of you on site, Saleh? We're small team.
Most are trainees like me.
And what sort of equipment do you have? The usual, basic first aid.
It's good you called.
You need to manage hemorrhagic shock so he's safe to transport.
Can someone find a a sheet or towel to wrap him? Place your hands on his pelvis and compress inwards.
Feel around for movement.
They found a regime flag.
Planes? Saleh, do you need to get out of there? Just passing over, I hope.
How is How is Zaynab? We will be getting married.
Good for you.
Poor her.
His radial is strong.
We need to keep looking.
More bodies might be trapped in rubble.
- Thank you, Bashir.
- Be safe, if you need - Oh.
Is everything okay? - Yes, thank you.
I'm gonna take it.
Wait, wait, wait.
I know what that means.
Dr.
Singh says if you're not early you're late, so Well, your boss got no joy in his life.
He's a surgeon.
We're not exactly known for joy.
Dinner later? Maybe.
Don't forget to hold for five.
Everything alright? A grade four student in your household, Abigail Hunter, was marked absent at morning attendance.
I call the school, it goes straight to voicemail.
Mel texted me after the drop off, so I know Abby's there, or should be.
I called Mel, but she's not picking up.
She has meetings all day, so she might have her phone off.
I'll cover your patients.
You do what you need to do.
Thank you.
Why would I get a message from them saying you drop her off? I don't know, the school didn't call me so this is the first time I'm hearing about this.
- Did you call back? - It went to voicemail.
Look.
When you dropped Abby off, you saw her go in? I left her in the yard with her friends five minutes before the bell, she's been begging for this for months.
If we're making a decision like that, shouldn't we have discussed it? Well you're not here.
So you don't get to tell me how to drop the kids off.
Look, I'm worried, okay? Because if you didn't watch her go in, doesn't that mean she could actually be gone? I'm worried too.
I'm already in the car.
I'll call you when I get there.
Messy hair, flushed cheeks, and almost smiling? I wonder who the guy is.
Maybe she just overslept? - No judgment.
- No.
Respect, actually.
It's basically impossible to make a relationship work - around this job.
- You don't date? I've I've had to accept the fact that the hospital is my current boyfriend.
You? I sleep on a sofa so my sister can have a bedroom.
MVC 3 minutes out.
Code trauma.
VSA.
Hit-and-run.
Victim's not identified.
Driver of the vehicle, head injury, GCS 6, massive blood loss, multiple lacs, resus on the field 8 minutes ago.
Passenger.
Airbag malfunctioned, didn't deploy.
Cyanosed, 02 sats at 80 percent.
Pulse 120, resp rate 35, BP 95 on 68.
Bed one.
Dr.
Hamed.
Dr.
Leblanc, bed two.
One, two, three.
It's all yours, doctors.
Arnold take compressions.
Activate MTP, and insert two large bore IVs.
ABCs, doctor.
Uh, I'll intubate and decompress the chest bilaterally.
One, two, three.
We need two units O-neg.
Mags, an eFAST, and I need an art line.
EMS radioed from dispatch, we have IDs.
Marie Tabeh, 46, Ana Tabeh, 20.
This is a mother-daughter? Pneumothorax.
We need a chest tube! Use a 28 French in case there's a hemothorax.
Let's sedate with ketamine, she needs 40mg, let's start her.
Still no pulse.
There's cardiac activity on the ultrasound, but her heart looks empty.
1mg epinephrine.
Epi won't help if there's no blood for the heart to pump.
PEA, narrow complex.
Not a shockable rhythm.
Restart compressions.
Let's focus on resuscitation using blood product.
Preparing for chest tube, making incision.
Test.
Get your finger in the pleural space.
- What are you feeling? - Smooth pleural Lung.
I think I'm good.
Chest tube.
Hemopneumo.
Left foot is cold.
No pulse.
Her knee looks pretty mangled.
This could be vascular injury.
Page vascular.
She's gonna need the OR.
Still no pulse! No cardiac or electrical activity.
Okay.
I think that's it.
You think? Or you know.
I know.
So you're confident.
Yes.
Asystole, no cardiac activity on ultrasound, prolonged downtime.
We managed the correctable causes of traumatic cardiac arrest.
3 units packed cells, bilateral chest decompression.
No pericardial effusion, and a stable pelvis.
I'm confident that after the massive head injuries suffered by this patient she had no chance.
Then call it.
Time of death, 10:14 AM.
Thank you, everyone.
Let's just take a moment to acknowledge the end of a life and the efforts of our team to save it.
Sir? About what just happened.
Being challenged? Consider it the new normal.
Are you talking about how I ran that trauma? I'm talking about you telling Legal that you can't get us your transcripts.
Do you know what a lawyer hears when you say enemy of the state? They hear liability, that puts the pressure on us to make certain that you are not.
I need you to be above reproach.
Sharper than everyone else.
Hi, Jasmine Weber, peds two.
- Thanks.
- Where's Doctor Hunter? I asked to take a couple extra patients.
Staying sharp.
Let's see.
Can you tell me what happened Mr.
Monroe? Kinda stupid.
My fault, really.
I've been trying to lose a few pounds so I hid the cookies up in the cupboard.
I got a craving, so I climbed up on a stool to get them, and bam! I didn't want to come all the way down here but the boss insisted when she got back from work.
Are you a nurse? Nurse's aide.
At a retirement home.
I work the night shift.
You're not supposed to call it the graveyard shift, there.
I get home and he's white as a sheet, can barely stand from the pain, but it's all, "No, no, I'm fine.
" She worries.
Only because she cares.
We should all be so lucky.
It's gonna be cold.
Okay, well, I'm seeing some fluid here, so this could be an indication of internal bleeding.
- You'll need a CT.
- If you say so, Doc.
We need to bring him to the resus room, stat! Then she lost control of her legs.
I needed the neighbour to help me get her to the car.
Should I have called an ambulance? No, the important thing is that you're here now.
How old are you, Jasmine? Thirteen.
And can you tell me when you started feeling this way? Earlier today.
It started with a little slurring, and then it got worse.
Did you take any drugs or alcohol? Any issues swallowing? Headaches? Can you do this for me? That's great.
Any indications leading to today? Cognitive or behavioural? Can I talk to you outside? I'm her foster mother.
I've only had Jasmine a few weeks.
Do you have any family medical history? Specifically, I'm looking for a history of heart disease or strokes.
You think she's having a stroke? With slurred speech and loss of motor function, that's the first thing to rule out.
Well, she's been in a series of group homes for the past two yes.
She ran away from the last one.
That's all the information the foster agency had.
I barely know her at all.
For labs, you want a CBC and electrolytes? Um Also venous gas, extended lytes, CK, liver panel, hemoglobin A1C.
And get her to CT as soon as possible.
Got it.
So.
, uh, we'll do imaging and send blood work to the lab and see what's going on.
In the meantime, just stay with her and keep her spirits up.
Where's the rest of your team? The building shifted again and they got stuck on a higher floor.
We need your help.
Remember after your accident, we talked about you having a second chance? I remember you talking about how I was coming out of a coma at the time, so I wasn't saying much.
Running down Bash like that in trauma for no reason? If that's you trying for a second chance, you're failing.
I had a very good reason.
I could take you through it.
Over dinner.
My place.
Yeah, I thought we finished with all that about five years ago.
Anyway, I don't recall you ever actually making me dinner.
I wanted to.
I guess we both wanted things that would not have worked.
What are you doing, Jed? I mean, why now? After all this time.
You're the one who keeps talking about second chances.
And you're the only one here who's not afraid to tell me to piss off.
So Dinner? What's your answer? Piss off.
How is her airway? Blood pressure? Before you move her, you need to tourniquet her leg.
See? You know your stuff, Saleh.
I guess you don't have any blood.
Saline will have to do.
Tourniquet, get to a clinic as soon as possible.
How much saline for a child like this? Keep your phone on Bashir, please! In a pediatric crush, uh, normal saline is 20, 20 ml per kg? We have a pediatric crush injury? You should've paged me right away No, no, it's just hypothetical.
- Something I came across in my reading.
- Uh, the saline dose is right.
Watch closely for hyperkalemia.
Thanks.
Uh, why did you order a CT for Jasmine Weber? The symptoms pointed to possible stroke because of the dysarthria.
Did you call for a bedside glucose test? - No.
- Claire? I had blood sent to the lab.
Hemoglobin A1C.
- Isn't that protocol? - DKA can mimic stroke symptoms.
Bedside glucose is the protocol here for pediatric patients She won't open her eyes! Guys! Jasmine? Jasmine? Come on, Jasmine.
Try and open your eyes for us.
Glucose is 25.
She's in DKA.
- DKA? What is that? - Diabetic ketoacidosis.
She's going to need insulin therapy.
I thought you said she was having a stroke.
The symptoms can be very similar.
- She didn't tell me.
- She probably didn't know.
Hello.
Um, the endoscopy showed enlarged veins in the esophagus which ruptured from your fall.
Subsequent tests, however, reveal cirrhosis and liver failure.
I'm sorry to tell you that with this amount of damage, the chances of the liver recovering on its own are pretty slim.
Is there anything we can do? We're starting medication now, but Walter will also need something called a variceal ligation, which means a surgeon uses rubber bands to stop the enlarged veins from bleeding.
Long term though, a liver transplant is your only option.
That's what a lifetime of drinking gets you.
It's probably what I deserve.
I'm sorry.
Excuse me, doctor? - Yes? - You mentioned a transplant.
Does it jeopardize that, him having been a drinker? Well, he would have to be sober for a minimum of six months.
He's four years sober.
I'm six.
We met in the program.
I'm sorry to bring you such bad news.
We've overcome a lot.
We'll get through this too.
Let me guess.
Jasmine Weber? Any luck? I called every contact number that I could find, pieced together that she lived with a grandmother until a few years ago when she passed.
Of what? Heart attack.
Apparently, in front of Jasmine.
Not sure that's something you get over.
It isn't.
Then she was abandoned by an uncle, who's now in jail.
Learned in the hard way not to trust anyone.
Any type 1 diabetes in the family? Medical records don't even start until she was put in foster care.
But she's one of the lucky ones.
Most of the older kids don't find someone conscientious like Liz to look out for them.
Think we could speed walk a variceal ligation into OR? What's his coag look like? Labs just came in.
Mmm Blood alcohol level 0.
09? I couldn't smell it on him Might've been vodka.
Is he cirrhotic? Yeah.
The seasoned ones know how to hide it.
No, his fiancée says he's been in recovery four years.
Guess he slipped.
They always do.
I was so focused on the cirrhosis I didn't question the X-ray.
Look.
Do you see anything? Fracture to the sternum, none to the extremities.
Trauma to the abdomen.
- Was there any circular bruising? - Yeah.
Does this look like a fall off a stool to you? That's a tough angle for a stool Could it be steering wheel trauma? My guess is that your drunk was driving.
And, by the looks of it, may've been in a serious accident.
The timeline tracks for that hit-and-run we got this morning.
The mother we lost.
The daughter, how's she doing? She'll pull through.
No thanks to that asshole.
Well, even if he was in an accident, doesn't make it a bad accident.
You sure about that? Okay.
Have a look.
Okay, her pupils are dilated.
She's losing consciousness? Yes, she is.
Okay.
So we manage pain and get Fatima on fluid resuscitation or she risks kidney injury.
She needs a field hospital.
You can't wait, Saleh.
You need to get her out yourself.
- I can't do this alone, Bashir.
- Yes, you can.
Your adrenaline will give you strength.
Lou! Hey! Hi.
Uh, I saw you were talk to the cop from the car accident before.
- Who, Desantos? - Yeah.
Yeah.
Our kids go to the same school.
Uh, quick question I got her leg out, but it's a mess.
I need you to tell me how to manage the bleeding.
Saleh.
Saleh! I'm sorry, okay? I know, I know you have a lot on your plate.
I know.
Fine.
Hey.
Hey.
I didn't mean to interrupt.
No, no.
Mel called.
The school's automated attendance software misfired.
Abby was there the whole time.
Good to know she's okay.
Mel had to cancel a meeting and drive halfway across town, but Anyway, Abby is fine.
What's going on with you today? That, uh That pediatric crush wound? It was a child in Syria.
They found her pinned in a bombed out building.
My friend Saleh he's a volunteer medic, only a year of med school.
He calls sometimes with consults.
Is she okay? We don't know yet.
You told me that was hypothetical.
- I didn't want to involve you.
- But you did! When you asked my advice.
If I'd have known there was a real child, I would have asked more questions.
Made sure I had all the details! What if something I said cost that child's life? I just needed guidance on fluid resuscitation.
Protocols change based on the scenarios.
You should know that.
Are you talking about the testing I ordered for Jasmine? I'm talking about you being honest with me instead of taking everything on yourself.
We put in a chest tube to drain the fluids, and we performed a surgery to repair a torn artery in your leg.
Both were successful.
We'll keep you for observation but you should make a full recovery.
We've called your dad.
He's on a flight now.
- So - Can I see my mom? I'm so sorry.
Lydia not here? She's gone to get some air.
Walter, do you drive a blue sedan? Why? Because your labs came back and there was alcohol in your bloodstream.
And the bruising on your abdomen, the placement of it, it suggests you could've hit a steering wheel.
I I started slipping.
Once or twice.
Then last night, with a buddy, I I don't remember what happened.
I woke up a few blocks from the house in a smashed car.
Lydia wasn't home from work yet so I left it in the lot.
And just hoped that what I hit was parked and empty.
A mother and a daughter came in this morning.
Hit by a blue sedan.
Oh Oh Are they okay? No, Walter.
They're not.
There were no complications and you're responding to medication well.
Are you feeling better? How long do I have to stay here? A little while longer.
We want to make sure that your blood sugar is under control.
And we have to show you how to use a glucose meter before you go.
It'll help you and Liz manage things easier when you get home.
That's not my home.
I never wanted to go there.
I know it's hard, adjusting to a new place.
Where I live isn't my home either.
Do you have to share it with someone you barely know? We'll try again later.
Do you have a minute? I've got a hypothetical.
Sure.
If a patient admits to a crime in confidence - Mm-hmm? - Would you tell the authorities? We can't.
We're bound by doctor-patient confidentiality.
I know, I know.
Unless it's to report a gunshot wound, the safety of a child, or intent to cause future harm.
I know.
And it isn't.
Then you'd be breaking your oath.
Yeah, I know that too.
I just I I can't help but think that you, you know, the rule-breaker, Doctor Instinct, would understand that someone might break the oath for a moral obligation you felt outweighed the needs of a patient.
There are consequences to drawing lines like that.
Then you've done it? During the war, I treated regime soldiers.
Only when they forced me.
Often, at gunpoint.
It's fine.
The point is, I chose sides.
And now I can't go home.
His nausea's getting worse.
I always know something's wrong when he gets quiet.
Liddy, could you go get me a glass of water, please? Sure.
No sign of new haemorrhaging.
We're just waiting to hear back from the OR on a scheduled time for your ligation.
You haven't told her? When are the cops coming for me? I haven't told them either.
But I hurt those people.
I have to pay for what I've done.
I agree.
But I have a duty to protect your confidentiality.
So if you want to tell the police, you'll have to them yourself.
What, what if, what if I If I can't bring myself to do it? Then you'll have your surgical procedure.
Lydia will take you home.
And I guess you try to live with what you've done.
The Mannitol is helping.
Jasmine's going to be okay.
Thank God.
So, was this my fault? Is it the food I'm making? - Was I making the wrong - No, type 1 is genetic.
There was nothing you could do to prevent this.
But you can help her control it.
I doubt she'll let me do that.
I thought I was doing a good thing, becoming a foster mom.
- But this? - I think you're very strong, doing something like this.
I'm not questioning my decision.
I just I feel like I'm messing it up.
Like I'm messing her up, and she's already been through so much already.
I'm sorry.
We all feel like that the minute we become parents.
But the highs outweigh the lows.
And all we can do is get up every day, committed to doing our very best.
Walter's ligation procedure.
When is that happening? Well, procedures are triaged according to urgency.
And because he stopped bleeding, it may not be for a few more hours.
When When he does get it, how much time will it buy him? Well, it only fixes the bleeding, not his liver.
- Oh - And there are no guarantees, but Without the transplant maybe a year? A year more than that young woman will have with her mother.
I'm so sorry, Lydia.
It won't be the life we planned, - but - But He did a terrible thing, but he's not a terrible person.
He'll never forgive himself for this.
What kind of a person would I be if I left him alone with that? You told the cops.
No, he did.
And she's sticking by him.
And you wouldn't? He killed somebody.
I would, yes, like to say that if I was in love with somebody, I would be able to get past that, but I People stay with people who hurt them all the time.
We're kind of stupid like that.
Well, if that cop arrests Walter before his procedure, there's no telling when he'll be able to get another one.
Let me see what I can do.
Bashir? Hello? Bashir? Alhamdulellah.
I was on the road.
The cell towers are still Are you driving her yourself? I had to.
Nobody was coming for us.
She's feverish.
She started vomiting 15 minutes ago.
Can you Can you feel air under the flesh? Press down on the tissue.
Yes, I feel air.
Crepitus.
Saleh, you have to amputate the leg.
On the side of the road? Now? - Alone? - If you don't, she'll die.
And you're not alone.
I'm here.
So there's a patient waiting in Emerg on a variceal ligation.
Let me guess, you want to scrub in? Yes, always.
But I was actually just checking to see if there was any wiggle room.
The patient needs the ligation before he's arrested.
You mean arrested? No.
Like, hauled off to jail.
He's a drunk driver who killed a woman this morning.
And you want to rush him into surgery so he doesn't lose his chance to get it? I didn't take you for someone who'd be affected by that.
I'm not.
You know the girl with the arterial injury we repaired earlier? - Mm-hmm.
- Well, her mom died because of him.
He should be healthy enough to serve whatever sentence they throw at him.
Well The candor's refreshing.
Anyway, he's in luck.
An elective case dropped off the board so I was about to move him up to this evening anyway.
It's the ICU.
It's the daughter.
Better go, then.
You paged me? Patient is a nine-year-old girl.
Crushed lower right extremity.
Saleh called with a few questions.
We really need your help.
What do I need to know? This is Saleh.
We worked together in Syria.
Hello, doctor.
Severe soft tissue injury progressed by a gangrenous limb.
He's pulled over on the side of the road and needs to perform an above the knee amputation right now.
With what tools? I have a scalpel, scissors, hemo The clips.
- Hemostatic clips.
- Yes, dressings.
- And a handsaw.
- Ketamine for sedation.
Uh, can you show me the girl again? She weighs maybe 20 kilograms, Dr.
Hunter.
Try 20 megs, if you have that.
Uh, 20 milligrams.
Done.
Okay, Saleh.
If the tourniquet is tight, make your incision.
Start by dividing the skin circumferentially.
Good.
Now cut through the subcutaneous tissue.
Okay.
You're doing great.
Code Blue.
Room 305.
- You've gotta go to that, Bash.
- I can't leave him.
Saleh? You think we can do this, just you and me? Okay.
Who knows, something might get lost in translation.
Bash.
We got this, okay? Go.
- Code blue, room 305.
- Thank you, Theo.
I finished the sewing.
There's blood everywhere.
Tighten the tourniquet, then apply the hemostats to the longitudinal structures that are likely to be the major blood vessels.
Hemostats to I'm sorry? The structures that look like So The leg The blood vessels.
Okay? Yes? The structures, the blood vessels.
- What happened? - Acute respiratory failure, we need a non-rebreather at 15 litres per minute, - and a stat portable chest.
- Chest tube's not working.
- O2 stats? - Uh, 66.
Resp is 40, tachy's at 144, BP's 84 60.
Prep a new tube.
If it's kinked, we'll have to re-insert.
The chest tube's definitely not working.
Tension pneumothorax.
Your colleagues were all here before you.
Sorry, I got held up.
If you can't get here on time, we don't need you.
Insert a new tube, she'll settle.
You sure? Just try again.
Keep at it.
Show me.
Here.
Do you see it? - Good.
- What do I do now? Okay now, keep the tourniquet - in the position, and - Okay.
Just examine for obvious blood vessels.
Then clamp with your hemostats.
- Okay.
- That was fast.
She's okay.
Dr.
Hunter, there's oozing.
That's normal, just keep an eye on it.
If it continues, you just need more pressure on the dressing.
Thank you.
Thank you both.
Well done, Saleh.
What the hell is going on in here? Uh nine-year-old, uh Syrian female, crushed lower extremities after a building collapse.
Rapid onset of GFM after tourniquet and rescue.
A volunteer medic just successfully performed a roadside amputation with almost no equipment.
Prognosis? Uh She's responsive and stable.
He He saved her life.
Good.
Find me before you leave.
Who was that? The big boss.
Call me when you get to the hospital, Saleh.
You do that kind of thing a lot? Not anymore.
Cops agreed to wait until he's out.
Thank you for pushing for the ligation.
Well, I didn't do it for him.
Dinner.
For one? I have to get back.
My dad's a drinker, and one time he almost ran the car off the road with me and my brother inside.
And the next day, he didn't even realize he'd done it.
We don't talk anymore.
Why are you telling me this? Because I want you to know.
And if I'm closed off sometimes, which I might be again, it's not because I don't want you around.
Well, you haven't driven me away just yet.
Good news.
You're almost ready to be discharged.
Only one thing left.
You need to be able to test your own blood sugar levels in order to leave.
Liz knows how.
You know, I helped treat a little girl today who lost her leg in an accident.
Her life is going to be different, and it will be hard at first.
It'll be hard forever.
I think that's up to her.
And I bet it won't be long before she gets good on crutches.
Maybe even learns to play soccer with them.
You said this isn't your home? My home is Syria.
Do you wish you were still there? Sometimes.
A lot of the time.
I wish my grandma was still here.
What helps me is to focus on the things I can control.
It makes everything I can't less scary.
What do you do? I do this.
This child was on the other side of the world.
To be a part of saving her Puts things in perspective? I'm sorry about earlier.
I just was upset that I couldn't do anything to help.
I know it's hard to be the one away.
I just I hate how much I'm missing.
You know, the good, the bad.
And I don't mean just with them.
With you, too.
In six months, you'll be back, and everything will be so much better.
Hey, I have tomorrow off.
I can fly home.
Surprise the girls.
Take them out of school? It's difficult when you come home for such a short time.
When you go, I'm picking up the pieces.
I know I didn't handle things well today.
But if If you're upset with me, or I'm not, I swear.
I'm just trying to be honest about what I need.
Gotta go.
I'll call you when I can.
Have a good night.
You too.
Hey, Mel? And the timeline of this? Okay, let's follow the progress for her.
Takes 24 hours, and then get back to me, let me know, how's the rest.
Alright, thanks, Mark.
How's the Syrian girl? They made it to the hospital.
Good.
Take a seat.
Look, I understand what you did.
It's why I hired you.
But you can't ever do it again.
Not from work, not with everything we're up against.
I need you to be better than everyone else.
That means when you're paged, you arrive first, and be present.
Yes, sir.
I spoke to the Dean's office at your med school today.
I didn't get the transcripts.
But they did assure me they exist, and confirmed your qualifications.
You They did? How is that possible? I told Legal I would swear whatever they need so we can put this thing to bed, once and for all.
Bashir, you need to learn to take yes for an answer.
We're in this together now.
Don't let me down.
And I am an enemy of the state.
There is no paper trail because of who I am.
My place later? You've got a second chance.
You should think about how you're gonna use it.
You're in Idlib? Kafr Halab.
The building collapsed this morning.
Bombs last night.
And we're looking for survivors.
How many of you on site, Saleh? We're small team.
Most are trainees like me.
And what sort of equipment do you have? The usual, basic first aid.
It's good you called.
You need to manage hemorrhagic shock so he's safe to transport.
Can someone find a a sheet or towel to wrap him? Place your hands on his pelvis and compress inwards.
Feel around for movement.
They found a regime flag.
Planes? Saleh, do you need to get out of there? Just passing over, I hope.
How is How is Zaynab? We will be getting married.
Good for you.
Poor her.
His radial is strong.
We need to keep looking.
More bodies might be trapped in rubble.
- Thank you, Bashir.
- Be safe, if you need - Oh.
Is everything okay? - Yes, thank you.
I'm gonna take it.
Wait, wait, wait.
I know what that means.
Dr.
Singh says if you're not early you're late, so Well, your boss got no joy in his life.
He's a surgeon.
We're not exactly known for joy.
Dinner later? Maybe.
Don't forget to hold for five.
Everything alright? A grade four student in your household, Abigail Hunter, was marked absent at morning attendance.
I call the school, it goes straight to voicemail.
Mel texted me after the drop off, so I know Abby's there, or should be.
I called Mel, but she's not picking up.
She has meetings all day, so she might have her phone off.
I'll cover your patients.
You do what you need to do.
Thank you.
Why would I get a message from them saying you drop her off? I don't know, the school didn't call me so this is the first time I'm hearing about this.
- Did you call back? - It went to voicemail.
Look.
When you dropped Abby off, you saw her go in? I left her in the yard with her friends five minutes before the bell, she's been begging for this for months.
If we're making a decision like that, shouldn't we have discussed it? Well you're not here.
So you don't get to tell me how to drop the kids off.
Look, I'm worried, okay? Because if you didn't watch her go in, doesn't that mean she could actually be gone? I'm worried too.
I'm already in the car.
I'll call you when I get there.
Messy hair, flushed cheeks, and almost smiling? I wonder who the guy is.
Maybe she just overslept? - No judgment.
- No.
Respect, actually.
It's basically impossible to make a relationship work - around this job.
- You don't date? I've I've had to accept the fact that the hospital is my current boyfriend.
You? I sleep on a sofa so my sister can have a bedroom.
MVC 3 minutes out.
Code trauma.
VSA.
Hit-and-run.
Victim's not identified.
Driver of the vehicle, head injury, GCS 6, massive blood loss, multiple lacs, resus on the field 8 minutes ago.
Passenger.
Airbag malfunctioned, didn't deploy.
Cyanosed, 02 sats at 80 percent.
Pulse 120, resp rate 35, BP 95 on 68.
Bed one.
Dr.
Hamed.
Dr.
Leblanc, bed two.
One, two, three.
It's all yours, doctors.
Arnold take compressions.
Activate MTP, and insert two large bore IVs.
ABCs, doctor.
Uh, I'll intubate and decompress the chest bilaterally.
One, two, three.
We need two units O-neg.
Mags, an eFAST, and I need an art line.
EMS radioed from dispatch, we have IDs.
Marie Tabeh, 46, Ana Tabeh, 20.
This is a mother-daughter? Pneumothorax.
We need a chest tube! Use a 28 French in case there's a hemothorax.
Let's sedate with ketamine, she needs 40mg, let's start her.
Still no pulse.
There's cardiac activity on the ultrasound, but her heart looks empty.
1mg epinephrine.
Epi won't help if there's no blood for the heart to pump.
PEA, narrow complex.
Not a shockable rhythm.
Restart compressions.
Let's focus on resuscitation using blood product.
Preparing for chest tube, making incision.
Test.
Get your finger in the pleural space.
- What are you feeling? - Smooth pleural Lung.
I think I'm good.
Chest tube.
Hemopneumo.
Left foot is cold.
No pulse.
Her knee looks pretty mangled.
This could be vascular injury.
Page vascular.
She's gonna need the OR.
Still no pulse! No cardiac or electrical activity.
Okay.
I think that's it.
You think? Or you know.
I know.
So you're confident.
Yes.
Asystole, no cardiac activity on ultrasound, prolonged downtime.
We managed the correctable causes of traumatic cardiac arrest.
3 units packed cells, bilateral chest decompression.
No pericardial effusion, and a stable pelvis.
I'm confident that after the massive head injuries suffered by this patient she had no chance.
Then call it.
Time of death, 10:14 AM.
Thank you, everyone.
Let's just take a moment to acknowledge the end of a life and the efforts of our team to save it.
Sir? About what just happened.
Being challenged? Consider it the new normal.
Are you talking about how I ran that trauma? I'm talking about you telling Legal that you can't get us your transcripts.
Do you know what a lawyer hears when you say enemy of the state? They hear liability, that puts the pressure on us to make certain that you are not.
I need you to be above reproach.
Sharper than everyone else.
Hi, Jasmine Weber, peds two.
- Thanks.
- Where's Doctor Hunter? I asked to take a couple extra patients.
Staying sharp.
Let's see.
Can you tell me what happened Mr.
Monroe? Kinda stupid.
My fault, really.
I've been trying to lose a few pounds so I hid the cookies up in the cupboard.
I got a craving, so I climbed up on a stool to get them, and bam! I didn't want to come all the way down here but the boss insisted when she got back from work.
Are you a nurse? Nurse's aide.
At a retirement home.
I work the night shift.
You're not supposed to call it the graveyard shift, there.
I get home and he's white as a sheet, can barely stand from the pain, but it's all, "No, no, I'm fine.
" She worries.
Only because she cares.
We should all be so lucky.
It's gonna be cold.
Okay, well, I'm seeing some fluid here, so this could be an indication of internal bleeding.
- You'll need a CT.
- If you say so, Doc.
We need to bring him to the resus room, stat! Then she lost control of her legs.
I needed the neighbour to help me get her to the car.
Should I have called an ambulance? No, the important thing is that you're here now.
How old are you, Jasmine? Thirteen.
And can you tell me when you started feeling this way? Earlier today.
It started with a little slurring, and then it got worse.
Did you take any drugs or alcohol? Any issues swallowing? Headaches? Can you do this for me? That's great.
Any indications leading to today? Cognitive or behavioural? Can I talk to you outside? I'm her foster mother.
I've only had Jasmine a few weeks.
Do you have any family medical history? Specifically, I'm looking for a history of heart disease or strokes.
You think she's having a stroke? With slurred speech and loss of motor function, that's the first thing to rule out.
Well, she's been in a series of group homes for the past two yes.
She ran away from the last one.
That's all the information the foster agency had.
I barely know her at all.
For labs, you want a CBC and electrolytes? Um Also venous gas, extended lytes, CK, liver panel, hemoglobin A1C.
And get her to CT as soon as possible.
Got it.
So.
, uh, we'll do imaging and send blood work to the lab and see what's going on.
In the meantime, just stay with her and keep her spirits up.
Where's the rest of your team? The building shifted again and they got stuck on a higher floor.
We need your help.
Remember after your accident, we talked about you having a second chance? I remember you talking about how I was coming out of a coma at the time, so I wasn't saying much.
Running down Bash like that in trauma for no reason? If that's you trying for a second chance, you're failing.
I had a very good reason.
I could take you through it.
Over dinner.
My place.
Yeah, I thought we finished with all that about five years ago.
Anyway, I don't recall you ever actually making me dinner.
I wanted to.
I guess we both wanted things that would not have worked.
What are you doing, Jed? I mean, why now? After all this time.
You're the one who keeps talking about second chances.
And you're the only one here who's not afraid to tell me to piss off.
So Dinner? What's your answer? Piss off.
How is her airway? Blood pressure? Before you move her, you need to tourniquet her leg.
See? You know your stuff, Saleh.
I guess you don't have any blood.
Saline will have to do.
Tourniquet, get to a clinic as soon as possible.
How much saline for a child like this? Keep your phone on Bashir, please! In a pediatric crush, uh, normal saline is 20, 20 ml per kg? We have a pediatric crush injury? You should've paged me right away No, no, it's just hypothetical.
- Something I came across in my reading.
- Uh, the saline dose is right.
Watch closely for hyperkalemia.
Thanks.
Uh, why did you order a CT for Jasmine Weber? The symptoms pointed to possible stroke because of the dysarthria.
Did you call for a bedside glucose test? - No.
- Claire? I had blood sent to the lab.
Hemoglobin A1C.
- Isn't that protocol? - DKA can mimic stroke symptoms.
Bedside glucose is the protocol here for pediatric patients She won't open her eyes! Guys! Jasmine? Jasmine? Come on, Jasmine.
Try and open your eyes for us.
Glucose is 25.
She's in DKA.
- DKA? What is that? - Diabetic ketoacidosis.
She's going to need insulin therapy.
I thought you said she was having a stroke.
The symptoms can be very similar.
- She didn't tell me.
- She probably didn't know.
Hello.
Um, the endoscopy showed enlarged veins in the esophagus which ruptured from your fall.
Subsequent tests, however, reveal cirrhosis and liver failure.
I'm sorry to tell you that with this amount of damage, the chances of the liver recovering on its own are pretty slim.
Is there anything we can do? We're starting medication now, but Walter will also need something called a variceal ligation, which means a surgeon uses rubber bands to stop the enlarged veins from bleeding.
Long term though, a liver transplant is your only option.
That's what a lifetime of drinking gets you.
It's probably what I deserve.
I'm sorry.
Excuse me, doctor? - Yes? - You mentioned a transplant.
Does it jeopardize that, him having been a drinker? Well, he would have to be sober for a minimum of six months.
He's four years sober.
I'm six.
We met in the program.
I'm sorry to bring you such bad news.
We've overcome a lot.
We'll get through this too.
Let me guess.
Jasmine Weber? Any luck? I called every contact number that I could find, pieced together that she lived with a grandmother until a few years ago when she passed.
Of what? Heart attack.
Apparently, in front of Jasmine.
Not sure that's something you get over.
It isn't.
Then she was abandoned by an uncle, who's now in jail.
Learned in the hard way not to trust anyone.
Any type 1 diabetes in the family? Medical records don't even start until she was put in foster care.
But she's one of the lucky ones.
Most of the older kids don't find someone conscientious like Liz to look out for them.
Think we could speed walk a variceal ligation into OR? What's his coag look like? Labs just came in.
Mmm Blood alcohol level 0.
09? I couldn't smell it on him Might've been vodka.
Is he cirrhotic? Yeah.
The seasoned ones know how to hide it.
No, his fiancée says he's been in recovery four years.
Guess he slipped.
They always do.
I was so focused on the cirrhosis I didn't question the X-ray.
Look.
Do you see anything? Fracture to the sternum, none to the extremities.
Trauma to the abdomen.
- Was there any circular bruising? - Yeah.
Does this look like a fall off a stool to you? That's a tough angle for a stool Could it be steering wheel trauma? My guess is that your drunk was driving.
And, by the looks of it, may've been in a serious accident.
The timeline tracks for that hit-and-run we got this morning.
The mother we lost.
The daughter, how's she doing? She'll pull through.
No thanks to that asshole.
Well, even if he was in an accident, doesn't make it a bad accident.
You sure about that? Okay.
Have a look.
Okay, her pupils are dilated.
She's losing consciousness? Yes, she is.
Okay.
So we manage pain and get Fatima on fluid resuscitation or she risks kidney injury.
She needs a field hospital.
You can't wait, Saleh.
You need to get her out yourself.
- I can't do this alone, Bashir.
- Yes, you can.
Your adrenaline will give you strength.
Lou! Hey! Hi.
Uh, I saw you were talk to the cop from the car accident before.
- Who, Desantos? - Yeah.
Yeah.
Our kids go to the same school.
Uh, quick question I got her leg out, but it's a mess.
I need you to tell me how to manage the bleeding.
Saleh.
Saleh! I'm sorry, okay? I know, I know you have a lot on your plate.
I know.
Fine.
Hey.
Hey.
I didn't mean to interrupt.
No, no.
Mel called.
The school's automated attendance software misfired.
Abby was there the whole time.
Good to know she's okay.
Mel had to cancel a meeting and drive halfway across town, but Anyway, Abby is fine.
What's going on with you today? That, uh That pediatric crush wound? It was a child in Syria.
They found her pinned in a bombed out building.
My friend Saleh he's a volunteer medic, only a year of med school.
He calls sometimes with consults.
Is she okay? We don't know yet.
You told me that was hypothetical.
- I didn't want to involve you.
- But you did! When you asked my advice.
If I'd have known there was a real child, I would have asked more questions.
Made sure I had all the details! What if something I said cost that child's life? I just needed guidance on fluid resuscitation.
Protocols change based on the scenarios.
You should know that.
Are you talking about the testing I ordered for Jasmine? I'm talking about you being honest with me instead of taking everything on yourself.
We put in a chest tube to drain the fluids, and we performed a surgery to repair a torn artery in your leg.
Both were successful.
We'll keep you for observation but you should make a full recovery.
We've called your dad.
He's on a flight now.
- So - Can I see my mom? I'm so sorry.
Lydia not here? She's gone to get some air.
Walter, do you drive a blue sedan? Why? Because your labs came back and there was alcohol in your bloodstream.
And the bruising on your abdomen, the placement of it, it suggests you could've hit a steering wheel.
I I started slipping.
Once or twice.
Then last night, with a buddy, I I don't remember what happened.
I woke up a few blocks from the house in a smashed car.
Lydia wasn't home from work yet so I left it in the lot.
And just hoped that what I hit was parked and empty.
A mother and a daughter came in this morning.
Hit by a blue sedan.
Oh Oh Are they okay? No, Walter.
They're not.
There were no complications and you're responding to medication well.
Are you feeling better? How long do I have to stay here? A little while longer.
We want to make sure that your blood sugar is under control.
And we have to show you how to use a glucose meter before you go.
It'll help you and Liz manage things easier when you get home.
That's not my home.
I never wanted to go there.
I know it's hard, adjusting to a new place.
Where I live isn't my home either.
Do you have to share it with someone you barely know? We'll try again later.
Do you have a minute? I've got a hypothetical.
Sure.
If a patient admits to a crime in confidence - Mm-hmm? - Would you tell the authorities? We can't.
We're bound by doctor-patient confidentiality.
I know, I know.
Unless it's to report a gunshot wound, the safety of a child, or intent to cause future harm.
I know.
And it isn't.
Then you'd be breaking your oath.
Yeah, I know that too.
I just I I can't help but think that you, you know, the rule-breaker, Doctor Instinct, would understand that someone might break the oath for a moral obligation you felt outweighed the needs of a patient.
There are consequences to drawing lines like that.
Then you've done it? During the war, I treated regime soldiers.
Only when they forced me.
Often, at gunpoint.
It's fine.
The point is, I chose sides.
And now I can't go home.
His nausea's getting worse.
I always know something's wrong when he gets quiet.
Liddy, could you go get me a glass of water, please? Sure.
No sign of new haemorrhaging.
We're just waiting to hear back from the OR on a scheduled time for your ligation.
You haven't told her? When are the cops coming for me? I haven't told them either.
But I hurt those people.
I have to pay for what I've done.
I agree.
But I have a duty to protect your confidentiality.
So if you want to tell the police, you'll have to them yourself.
What, what if, what if I If I can't bring myself to do it? Then you'll have your surgical procedure.
Lydia will take you home.
And I guess you try to live with what you've done.
The Mannitol is helping.
Jasmine's going to be okay.
Thank God.
So, was this my fault? Is it the food I'm making? - Was I making the wrong - No, type 1 is genetic.
There was nothing you could do to prevent this.
But you can help her control it.
I doubt she'll let me do that.
I thought I was doing a good thing, becoming a foster mom.
- But this? - I think you're very strong, doing something like this.
I'm not questioning my decision.
I just I feel like I'm messing it up.
Like I'm messing her up, and she's already been through so much already.
I'm sorry.
We all feel like that the minute we become parents.
But the highs outweigh the lows.
And all we can do is get up every day, committed to doing our very best.
Walter's ligation procedure.
When is that happening? Well, procedures are triaged according to urgency.
And because he stopped bleeding, it may not be for a few more hours.
When When he does get it, how much time will it buy him? Well, it only fixes the bleeding, not his liver.
- Oh - And there are no guarantees, but Without the transplant maybe a year? A year more than that young woman will have with her mother.
I'm so sorry, Lydia.
It won't be the life we planned, - but - But He did a terrible thing, but he's not a terrible person.
He'll never forgive himself for this.
What kind of a person would I be if I left him alone with that? You told the cops.
No, he did.
And she's sticking by him.
And you wouldn't? He killed somebody.
I would, yes, like to say that if I was in love with somebody, I would be able to get past that, but I People stay with people who hurt them all the time.
We're kind of stupid like that.
Well, if that cop arrests Walter before his procedure, there's no telling when he'll be able to get another one.
Let me see what I can do.
Bashir? Hello? Bashir? Alhamdulellah.
I was on the road.
The cell towers are still Are you driving her yourself? I had to.
Nobody was coming for us.
She's feverish.
She started vomiting 15 minutes ago.
Can you Can you feel air under the flesh? Press down on the tissue.
Yes, I feel air.
Crepitus.
Saleh, you have to amputate the leg.
On the side of the road? Now? - Alone? - If you don't, she'll die.
And you're not alone.
I'm here.
So there's a patient waiting in Emerg on a variceal ligation.
Let me guess, you want to scrub in? Yes, always.
But I was actually just checking to see if there was any wiggle room.
The patient needs the ligation before he's arrested.
You mean arrested? No.
Like, hauled off to jail.
He's a drunk driver who killed a woman this morning.
And you want to rush him into surgery so he doesn't lose his chance to get it? I didn't take you for someone who'd be affected by that.
I'm not.
You know the girl with the arterial injury we repaired earlier? - Mm-hmm.
- Well, her mom died because of him.
He should be healthy enough to serve whatever sentence they throw at him.
Well The candor's refreshing.
Anyway, he's in luck.
An elective case dropped off the board so I was about to move him up to this evening anyway.
It's the ICU.
It's the daughter.
Better go, then.
You paged me? Patient is a nine-year-old girl.
Crushed lower right extremity.
Saleh called with a few questions.
We really need your help.
What do I need to know? This is Saleh.
We worked together in Syria.
Hello, doctor.
Severe soft tissue injury progressed by a gangrenous limb.
He's pulled over on the side of the road and needs to perform an above the knee amputation right now.
With what tools? I have a scalpel, scissors, hemo The clips.
- Hemostatic clips.
- Yes, dressings.
- And a handsaw.
- Ketamine for sedation.
Uh, can you show me the girl again? She weighs maybe 20 kilograms, Dr.
Hunter.
Try 20 megs, if you have that.
Uh, 20 milligrams.
Done.
Okay, Saleh.
If the tourniquet is tight, make your incision.
Start by dividing the skin circumferentially.
Good.
Now cut through the subcutaneous tissue.
Okay.
You're doing great.
Code Blue.
Room 305.
- You've gotta go to that, Bash.
- I can't leave him.
Saleh? You think we can do this, just you and me? Okay.
Who knows, something might get lost in translation.
Bash.
We got this, okay? Go.
- Code blue, room 305.
- Thank you, Theo.
I finished the sewing.
There's blood everywhere.
Tighten the tourniquet, then apply the hemostats to the longitudinal structures that are likely to be the major blood vessels.
Hemostats to I'm sorry? The structures that look like So The leg The blood vessels.
Okay? Yes? The structures, the blood vessels.
- What happened? - Acute respiratory failure, we need a non-rebreather at 15 litres per minute, - and a stat portable chest.
- Chest tube's not working.
- O2 stats? - Uh, 66.
Resp is 40, tachy's at 144, BP's 84 60.
Prep a new tube.
If it's kinked, we'll have to re-insert.
The chest tube's definitely not working.
Tension pneumothorax.
Your colleagues were all here before you.
Sorry, I got held up.
If you can't get here on time, we don't need you.
Insert a new tube, she'll settle.
You sure? Just try again.
Keep at it.
Show me.
Here.
Do you see it? - Good.
- What do I do now? Okay now, keep the tourniquet - in the position, and - Okay.
Just examine for obvious blood vessels.
Then clamp with your hemostats.
- Okay.
- That was fast.
She's okay.
Dr.
Hunter, there's oozing.
That's normal, just keep an eye on it.
If it continues, you just need more pressure on the dressing.
Thank you.
Thank you both.
Well done, Saleh.
What the hell is going on in here? Uh nine-year-old, uh Syrian female, crushed lower extremities after a building collapse.
Rapid onset of GFM after tourniquet and rescue.
A volunteer medic just successfully performed a roadside amputation with almost no equipment.
Prognosis? Uh She's responsive and stable.
He He saved her life.
Good.
Find me before you leave.
Who was that? The big boss.
Call me when you get to the hospital, Saleh.
You do that kind of thing a lot? Not anymore.
Cops agreed to wait until he's out.
Thank you for pushing for the ligation.
Well, I didn't do it for him.
Dinner.
For one? I have to get back.
My dad's a drinker, and one time he almost ran the car off the road with me and my brother inside.
And the next day, he didn't even realize he'd done it.
We don't talk anymore.
Why are you telling me this? Because I want you to know.
And if I'm closed off sometimes, which I might be again, it's not because I don't want you around.
Well, you haven't driven me away just yet.
Good news.
You're almost ready to be discharged.
Only one thing left.
You need to be able to test your own blood sugar levels in order to leave.
Liz knows how.
You know, I helped treat a little girl today who lost her leg in an accident.
Her life is going to be different, and it will be hard at first.
It'll be hard forever.
I think that's up to her.
And I bet it won't be long before she gets good on crutches.
Maybe even learns to play soccer with them.
You said this isn't your home? My home is Syria.
Do you wish you were still there? Sometimes.
A lot of the time.
I wish my grandma was still here.
What helps me is to focus on the things I can control.
It makes everything I can't less scary.
What do you do? I do this.
This child was on the other side of the world.
To be a part of saving her Puts things in perspective? I'm sorry about earlier.
I just was upset that I couldn't do anything to help.
I know it's hard to be the one away.
I just I hate how much I'm missing.
You know, the good, the bad.
And I don't mean just with them.
With you, too.
In six months, you'll be back, and everything will be so much better.
Hey, I have tomorrow off.
I can fly home.
Surprise the girls.
Take them out of school? It's difficult when you come home for such a short time.
When you go, I'm picking up the pieces.
I know I didn't handle things well today.
But if If you're upset with me, or I'm not, I swear.
I'm just trying to be honest about what I need.
Gotta go.
I'll call you when I can.
Have a good night.
You too.
Hey, Mel? And the timeline of this? Okay, let's follow the progress for her.
Takes 24 hours, and then get back to me, let me know, how's the rest.
Alright, thanks, Mark.
How's the Syrian girl? They made it to the hospital.
Good.
Take a seat.
Look, I understand what you did.
It's why I hired you.
But you can't ever do it again.
Not from work, not with everything we're up against.
I need you to be better than everyone else.
That means when you're paged, you arrive first, and be present.
Yes, sir.
I spoke to the Dean's office at your med school today.
I didn't get the transcripts.
But they did assure me they exist, and confirmed your qualifications.
You They did? How is that possible? I told Legal I would swear whatever they need so we can put this thing to bed, once and for all.
Bashir, you need to learn to take yes for an answer.
We're in this together now.
Don't let me down.