Good Sam (2022) s01e07 Episode Script
Chronic Insult
1
Previously on Good Sam
I have been trying to keep
up with you in a game
that you've had rigged the entire time.
I'm going to go and tell Sam everything.
I think I'm all caught up.
- Ambulance has just landed.
- Step back, Dr.
Trulie.
You don't need to worry about your best friend being with your dad because you and I are not friends.
It was me.
I called your mother.
Her vote could be the key.
This is not personal.
She is my mother! I told you I didn't even want to think about her! I have to end this war.
You ended something, all right.
I want you to know that you can talk to me.
I think I lost my way.
Morning.
Thank you for letting me sleep here last night and letting me talk your ear off.
Of course.
So, uh, how you feeling, other than tired? Uh Hmm.
I feel like a bulldozer ran over everyone and everything that I care about.
All around me, I see destruction.
And in the cold light of day, I realize that it was not a bulldozer that destroyed everything.
- It was me.
- Hmm.
I think you're being a little hard on yourself.
Nah.
You should've seen the look on Malcolm's face.
And what Lex said to me not that I blame her.
And my mother? I accused my own mother of not being on my side.
Because of what? This vote for chief? I am a human bulldozer.
You don't have to do that.
Uh - No, it's fine.
I want to.
- I just I didn't expect anyone, so it's a mess.
Compared to my life, this is nothing.
Hey, you remember the last thing you said last night? Uh, was it something along the lines of, "I've become a power-crazed monster who hurts the people she loves"? No.
It was, "I'm gonna make this right.
" And I said, "If anyone can do it, it's you.
" Did I happen to say how I was planning on doing that? No.
At that point, you started snoring like a baby rhino.
I do not snore.
Caleb! I do not snore! I'm gonna I'm gonna make this right.
I'm gonna try.
Well, uh, guess we better get to work.
Yeah.
Hey.
Oh.
I'm really glad you opened the door last night.
Yeah, well, glad you knocked.
- I'm gonna get dressed.
- I love you.
Yeah, get dressed.
Me, too.
I'm gonna brush my teeth, then I'm gonna Yup.
- Yeah.
- Sounds good.
I never should have called your mom.
Okay.
You told me that she was on the board, and all I could think about was her vote.
But all I should've been thinking about was you.
And how reaching out to her would make you feel.
I'm Damn it.
It's the ER.
You should go.
What do we have? Violet Stein.
18.
She fell at her high school track event.
- She was in first place, too.
- Okay, just gonna take a listen.
There's a lot of turbulence between atrioventricular valves.
Is that because of her broken rib? They said she has a broken rib.
Looks like this is the third bone you've broken at a track meet.
A lot of kids fall at these things.
Well, three fractures is unusual.
Are you getting enough vitamin D, calcium? We're very good about supplements.
You have to be, on a vegan diet.
Does this vegan diet include a lot of soy products? Yes.
Why? No air entry left side.
And vital signs are unstable.
Violet, can you breathe? Tension pneumothorax.
14 gauge needle.
Three and a quarter inch.
- Excuse me.
- Quickly, please! - What's happening? - It's all right.
Just hold on.
Her rib is stabbing into her lung, and we need to clear the air that's trapped in her chest cavity.
It's all right.
Try to relax.
It's okay.
Straight into the trauma bay.
Who's the patient? April Krane, 25, hypothermic.
I'm told her dry suit ripped while scuba diving.
Scuba diving? In the middle of winter? All the lakes are frozen.
They cut a hole in the ice, I guess.
Water under the surface is about 39 degrees.
She lost consciousness on the way over.
Okay, let's get these wet clothes off of her.
Breathing is shallow, pulse is weak.
All right.
We need to get her core temp up.
Bring a Bair Hugger in here, please.
We could warm up her IV fluids.
Good idea.
I'll grab a bag.
- Hi.
- Hey.
Still on trauma? - Is that because of me? - Not everything is about you.
I am sorry that I threw you off that patient.
I was out of line.
If you want to come off trauma, it will not happen again.
I like trauma.
Oh, if I broke that many bones running track, - I would take up chess.
- Mm.
We should also check her B12 levels.
Oh, it's not B12.
Cadmium is the problem.
- Cadmium? - Yeah, heavy metal, chemically similar to zinc and mercury.
- Yeah.
- Toxic levels linked to fragile bone syndrome - and often found in - In soy products.
Doesn't explain the mid-diastolic murmur you heard, but does address the fractures, at least.
Okay, I'll run the labs.
Dad, one more thing.
Hmm? I'm done fighting you for the chief job.
The job is yours.
Uh, the vote's not for 42 days.
They don't need to vote.
What are you? You quitting? Yeah.
I'm out.
Why? When you put so much into it? Too much, and that's the problem.
I'm I just want to focus on my patients, and I want to get you through your proctorship.
- Uh-huh.
- And speaking of which, we do have a double bypass on the schedule for later today.
- I'm aware.
- I am making you primary.
You've aced every step so far, and it's time you do your first solo surgery.
I'll see you in the OR.
How do you - accidentally say "I love you"? - It just slipped out.
I mean, I spent the whole night listening to her talk about making up with Malcolm.
And then, right at the end, I blew it.
Making up? Are they in a fight? I heard all about it right before dropping the "L" bomb on her.
I mean, who does that? And she didn't say anything? Maybe she didn't hear me.
Maybe she thought I said "I love the view," or, "I shove you.
" I just I've never said it before.
- Never to Sam? - Never to anyone.
You've never said "I love you" to someone? You don't tell your mother you love her? Okay, yeah.
My mom, sure, but Why? How many people have you said it to? - Hundreds.
- Hundreds? I'm very comfortable saying it.
It's easier than you think.
I love you, Caleb.
See? Now you say it to me.
- Oh.
No.
- Come on.
Tell me you love me.
You can do it, Dr.
Tucker.
I love balloon angioplasty.
And, look.
There's one now in, uh, room 2115.
So Everything okay, Dr.
Griffith? Yeah, fine.
I just, uh I just started thinking about my office.
Maybe the desk should go here, huh? Wait.
Your office? Yeah, well, it's not official till the vote, obviously, but, uh, now that I'm running unopposed, it's not exactly a nail biter.
What-what do you mean, you're running unopposed? What happened to Sam? Well, she wants me back in charge.
Back in surgery, back to normal.
S-So she dropped out? Did she say why? I think that ultimately, she realized I'm the leader this department needed, that my world-class reputation Well, I'm not saying it was easy, you two fighting all the time, but is dropping out the solution? Yes.
And ever since this whole battle started, I haven't been myself.
I haven't been there for you as a friend.
- Sure you have.
- What about your lawsuit? - The lawsuit settled.
- And I wasn't there for you.
Caleb sat up with me all night, just listening, and it made all the difference.
It made all the difference? Labs on your track star.
Thanks, Bernie.
Your dad was right about the cadmium.
The heavy metals, we can flush, but look at her troponin levels.
BNP's elevated, too.
Her cardiac enzymes are through the roof.
How does a teenage track star have the biomarkers of an 85-year-old in advanced heart failure? Hey, there.
You look a little lost.
Yeah, I'm looking for my son.
Apparently, he's in cardiothoracics.
Oh, well, that's where I'm headed.
Thank you, Doctor.
Sure.
Oh, if you want, I can look him up for you, tell you what room he's in.
Oh, no, no.
My son's not a patient.
He works here.
Hi.
Hey.
I didn't expect to see you here, not that you're here to see me.
I shouldn't make that assumption.
- Not everything is about me.
- I saw your dad earlier.
He-he was in your office.
Oh.
Well, was he measuring for drapes? So it is true.
You dropped out of the race.
Mm-hmm.
Hurting you was a wake-up call for me, Malcolm.
And I know that I can't undo the past, but I am not going to repeat it.
For what it's worth, I think you would've beat him.
With or without my mom.
To be honest, I'm just hoping we can put the stuff with your mom behind us.
Oh, it's definitely behind you.
Hello, Malcolm.
What are you doing here, Mom? Mom? Malcolm, please talk to me.
You shouldn't have come.
It wasn't my idea.
Dr.
Griffith called.
Yes, and I am very sorry that you came all this way, Mrs.
Kingsley.
But everything has been resolved.
My father will take over again soon.
Your father can't even perform surgery.
Why do you care? - This isn't your concern.
- Of course it is.
I mean, I don't do the day-to-day.
That's supposed to be your father's job.
But I do run this foundation.
And should this hospital fall into disarray, well, that would make my job much harder.
Everything is under control here.
If that were true, you never would have called me.
Dr.
Griffith, you know, bad leadership leads to chaos.
And chaos is bad for business yours and mine.
Order must be restored.
You look like you're feeling better, April.
I am.
Super glad I'm not dead.
Why were you diving down there in the first place? Are you kidding? The Great Lakes are full of shipwrecks.
There's so much to explore.
Why not explore in the summer when the risk of hypothermic death is just a little bit lower? The risk is why I do it.
The bigger the risk, the bigger the rush.
Hmm.
Adrenaline junkie.
You're like my fiancée.
What happened, exactly? I was inside one of the wrecks.
So awesome.
And But then my hand cramped, and I dropped my flashlight, snagged my suit going after it.
Wait.
Y-Your hand cramped so badly that you couldn't hold on to your flashlight? Has that ever happened before? Yeah.
All the time, actually.
That can be a, uh, sign of a neurological condition called "focal dystonia.
" Neurological? Is there something wrong with my brain? It's more like, um, the way that your brain and your muscles talk to each other.
We'll know more after the test.
Violet Stein.
That is one of the ugliest valves I've ever seen.
Mitral deterioration is very advanced.
There's no family history of heart disease? No.
She's a typical teenager with no preexisting conditions.
What about the cadmium toxicity? Well, explains the bones, but not the heart.
And she's had no symptoms of valve disease? No.
None.
We only caught it because she fell.
Although, the falling could be a symptom.
Cardiovascular syncope.
Blood flow to her brain is getting cut off during exertion.
Like during a track event.
She's broken multiple ribs.
Because she's fallen during multiple races.
She's gonna keep falling unless we replace this valve.
We can do it today after Dr.
Griffith's bypass.
Back-to-back surgeries.
- I love it.
- Yeah? Then why are you still standing here? Get to the OR, man your stations.
Let's go, people.
Byron.
You know, after all these years, I still don't like this tie.
What are you doing here, Tina? I was called, and now that I'm here, I have no intention of rubber-stamping the reinstatement of Rob Griffith as chief.
I had reservations about him the first time around.
You said you'd stay out of hospital business.
And you said you'd stay out of our son's business.
Yet, I see he's running around like your little clone.
- It was his decision to come here.
- It's not good for him to live in your shadow like this.
Don't talk to me about what's good for him.
You're the one who turned your back on this family.
Which makes you, what? The blameless victim? Is that how you remember it? It's how it went down.
Clearly, what our son thinks, too.
You turned him against me.
No.
No, Tina.
You did that all by yourself.
Well, here's hoping I can undo it.
See you at the next board meeting.
A mechanical valve? Yes.
They're strong, reliable.
It should last you the rest of your life.
How can she have heart disease? We're vegans.
Our diets are very healthy.
Your diet may not have caused your valve disease, but all of that soy and cadmium did contribute to your broken ribs.
Now, a new valve will help your heart get stronger, but you'll likely need to make some dietary changes to help your bones get stronger, too.
What kind of changes? Have you ever considered eating any fish or meat? - No.
- No.
Violet has never had so much as a glass of milk in her life.
We are diligent about supplements, and getting all the nutrients we need from non-animal sources.
If we need to cut back on soy, we will, but meat is not an option.
Why don't we get you started with a new valve, and we'll take the rest from there? Your EMG results are in.
Your motor unit recruitment is perfect.
- What does that mean? - It means whatever's causing the cramp is probably not neurological.
Oh.
Well, does that mean I can go? We still haven't found the cause of the cramp.
Hey, as long as my brain's okay, I can live with a few dropped flashlights and the occasional charley horse.
Charley horse.
Peripheral artery disease would explain the hand and the claudication in the lower extremities.
She needs a stress test.
You can't go just yet, April.
So Malcolm's mom is here.
Yes.
But you shouldn't feel guilty or anything.
It's not like you told her to come.
- And - Hmm.
I need to get my head in the game.
I blew it.
You didn't blow it.
It was one "I love you.
" No.
She's never gonna talk to me again.
She said talking to you made all the difference.
She said that? Mm-hmm.
All right, gentlemen, are you ready to be reminded how a bypass should be done? You have an audience.
It's good to be home.
Right this way, Dr.
Griffith.
I know where the patient's head is, Dr.
Shah.
Ah.
Let's see if we can get him to the heart.
Okay.
It's all for you, Dad.
Ten blade to me.
Hit it.
I'm back in the game I'm back in the saddle, here I go Back in I'm back in, back in the game Loupes? All right.
Back in the game Remove the clamp.
I'm back in the game I'm back in Aortic clamp is off.
Electrical activity is restored.
Perfect.
Not so fast.
There is excess tissue over the proximal anastomosis.
I'm back in charge, back in the mode Back in my flow, back in the show I'm back in the game Now it's perfect.
I'm back in Back in the game.
Well done, Dad.
Hey, is everything okay? Yeah.
Just, uh, the light was angled towards my eyes.
Let's watch that next time.
Close up, Dr.
Tucker.
Nice bypass, everyone.
We owe Violet a mechanical valve.
Next, back-to-back surgeries today.
- Back-to-backs.
- Back-to-backs.
Uh, I hate to miss out on all the fun, but I think I should probably go and dictate an operative report on that bypass, don't you? Sooner you can sign off on this step the better, right? - Yeah, sure.
- Okay.
One step closer, Dad.
One step closer.
What is all this? We think there's a blockage in your arteries restricting blood flow to your extremities.
This is gonna help us find it.
- I just start running? - Mm-hmm.
This IV has a radioactive tracer in it.
So we're gonna get your heart pumping and let the tracer lead us to the problem.
Take her to four.
How fast does it go? Most people get up to about a six.
- Take me to seven.
- You sure? Heart rate's at 140.
All right, her hand's cramping.
Are you okay, April? - It hurts.
- What hurts? - Everything.
- Take her down.
No! Take me higher.
- April - Please, you have to.
Going faster is - the only way to make it stop.
- Make what stop? - The pain! - All right, all right.
I'm pulling it.
All right, all right.
Mind telling me what happened in that bypass? What are you talking about? Your father dropped an instrument in the middle of surgery.
The surgery was over, and surgeons drop instruments all the time.
When was the last time he dropped one? I'm due in another surgery soon.
He was in a coma for six months.
Now he can't get through a routine surgery without incident.
- There was no incident.
- I know what I saw.
With all due respect, I am Dr.
Griffith's proctor.
I am the only person who is authorized to assess his progress, and I am telling you that there is no issue or concern regarding his performance.
Well, I guess that's all there is to say.
Stress test shows her arteries are clear.
We know her nerve and muscle function are normal.
So, what's with the hand cramp? It only happens during extreme activity.
My guess: involuntary response to stress hormones.
So, she stops the extreme sports and the hand cramp goes away.
- But she's not gonna stop.
- Why not? I see it with Tim, too.
He'll do anything for a rush.
Except with April, it's even more intense.
What if the hand cramp is actually a small price to pay for the upside of all of those stress hormones? The adrenaline, the cortisol, all of those endorphins that act as natural painkillers? She's not chasing a high.
She's self-medicating.
The hand cramp isn't the problem.
It's it's the solution to the problem, Which is chronic pain.
Okay, let's get an MRI.
Whatever's causing this pain, jumping out of a airplane can't be the only way to treat it.
- I'm on it.
- Thank you.
- Hey.
- Mm.
Hey.
You want some company? Sure.
I thought you were in the valve replacement.
Yeah, uh, so, Sam gave me the, uh, bypass surgery at the last minute.
You were primary? Oh, that's great.
How do you feel? Yeah, good.
I, uh, just need to, um, come down a bit from the adrenaline rush.
Mm.
All right.
Well, uh, you do that, and come find me later.
- Mm-hmm.
- All right.
- Hey, do me a favor.
- Hmm? Just slip that back in the charger, preferably when Donna's not looking.
What did you do? Did you drop it? No.
It was like that when I found it.
Liar.
And what if Donna thinks I broke it? You say it was like that when you found it.
What are you doing with the quarterly reports? Reading them.
I would have used your father's office, but I couldn't find it.
- Uh, he doesn't have one.
- Doesn't have one? What, does he do skulk around like Phantom of the Opera? I have work.
Whatever you're doing, can you do it somewhere else, please? We never talked about my leaving.
What is there to say? You left.
The end.
I left him.
I didn't leave you.
And I didn't leave because I wanted to.
I left because I had to.
- You had to? - There's only one way with your father.
If you can be what he wants you to be, if you can stay within those lines that he draws for you, then you're good.
But I couldn't do it, Malcolm.
I knew that if I chose to be myself, it would cost me the marriage.
But I never imagined it would cost me my son.
And I hope it's not too late to get him back.
How can I trust you after all this time? I I'm not asking for your trust.
I'm asking you to give me a chance to earn your trust.
I-I need to get to work.
Yeah.
Yeah, me too.
Um, you know, I know this hospital better than you think.
I could do some some good around here.
With your blessing, of course.
But, um, if you want me to leave, I I can be on the next flight.
- Ready for the valve, Dr.
Shah.
- Mm-hmm.
A new valve in healthy 18-year-old? You don't see that every day.
Hold on.
Something's not right here.
I need more light.
Look at this.
Annular calcification.
- But that didn't show up in the echo.
- No, it did not.
The annulus is supposed to be firm.
This is like Jell-O.
- Liquefactive necrosis.
- I can't attach the metal to this tissue.
It's too viscous.
I There's literally nothing for me to sew into.
You need something more pliable.
BP and O2 sats are trending down.
Call down for a bioprosthetic valve, stat.
Wh A pig valve? Well, it's not a vegan option, but it'll keep her alive.
Telling a vegan mother you put a pig valve in her vegan daughter's heart? Not the high point of my day.
Well, that valve is also keeping her alive.
Oh.
- Thanks, man.
I appreciate it.
- Mm-hmm.
And also I love you.
What? - Nothing.
- You did it! Good for you, Dr.
Tucker.
What? He accidentally said "I love you" to Sam.
We're trying to normalize it so it's not such a big deal.
That advice is why some of us are engaged and why others are going to die alone.
Look, I'm desperate, man, okay? I cannot let things get weird with me and Sam.
So, this is the not-weird solution? Just go with it.
Fine.
Say it again.
I love you.
You're not my type.
That stung a little.
Operative report dotted the I's, crossed the T's.
Does that report mention the scalpel that you dropped? Why would it? Because I've never seen you drop an instrument.
I told you, it was the lights.
I've also never heard you complain about the lights.
I'm worried that I put you in too soon, and I want to sign off on this, but I need to understand what happened in there.
A successful bypass is what happened.
Who cares about a scalpel? I'll tell you who cares.
Dad.
Tina Kingsley cares.
She's raising questions about your competency after what she saw.
- I told you she never liked me.
- I covered for you.
I said there was nothing to worry about.
Is that true? It was the lights.
I heard what happened with the scalpel.
Scrub nurses like to gossip.
And what, you think I'm being too hard on him? Because it was my idea to put him back in surgery.
- I know.
- This is just due diligence.
I want to clear him.
I don't think you should.
You don't think he's ready? I think he should be ready.
I think he thinks he's ready.
But? That scalpel's not the only thing he's dropped.
Her hands are ice-cold and she won't wake up.
Heart rate's 140.
Why is she so tachycardic? And hypotensive.
Blood pressure's 90/40 and dropping.
Maybe she's turning septic.
Have we gotten another H and H? There's no fever, she hasn't lost any blood volume.
Could she be rejecting the valve? No, acute and chronic rejection takes weeks to occur.
She's been out of surgery about an hour.
- Could be hyperacute.
- No.
Then we would've known before we closed up.
This is something else.
What's happening? Her heart is failing.
I need you to increase her Levophed, get another pressor.
We got to get her pressure up, and I want a cardiac MRI as soon as she is stable.
Her body hates this valve.
I want to know why.
Postoperative ultrasound confirmed the graft was seamless.
Well, installation's not the problem.
- Maybe it's a defect in the valve? - Well I'm gonna check the production lot for reported problems.
Look at the leaflets on the mitral valve.
- They're so stiff.
- Uh-huh.
And what are those spots? They look like goosebumps.
Or hives.
Can we see if there's inflammation, please? Ah.
Lit up like a Christmas tree.
That is an allergic reaction.
But to what? Anesthesia's out of her system.
The only thing she could be reacting to The valve itself.
She's allergic to meat? To animal protein, yes.
I've never heard of this.
What did you say it's called? Alpha-gal syndrome.
It's a reaction to the sugar molecule in most mammals.
It is a severe allergy, but because Violet's never eaten meat, she was never diagnosed.
She was fine.
She had a broken rib, but she was fine.
How did things get so bad so fast? I know that she seemed fine, but something has been damaging her heart.
But you don't know what it is.
The mechanical valve didn't work.
The pig valve isn't working.
Her heart is failing.
Which is why we need to give her a new one.
Your MRI shows that you have spinal stenosis.
It's the narrowing of your spinal cavity that's compressing your nerves and causing your chronic pain.
Well, can you fix it? Mm-hmm.
It's called a laminectomy.
We remove part of your vertebra to ease the pressure on your nerves.
Sounds complicated.
There are risks, but the bigger the risk, the bigger the rush, right? Look, April, I know you found a way to cope with your pain, but it's just temporary.
Problems like these do not go away on their own.
In fact, they usually get worse.
Lying down in the middle of a shift? This is another first, Dad.
It's low blood sugar.
Or post-exertional malaise.
Is that why you ducked out of the valve replacement surgery? I'll have some trail mix, I'll be fine.
I want to run a blood panel on you, a full workup.
Whoa! Why? Because I know about the headaches and the ringing in your ears, the photosensitivity.
And I hear you dropped a tablet in addition to that scalpel.
Et tu, Brute? I'm worried about you.
Ignoring this isn't gonna make it go away.
I can't clear you for surgery unless we address these symptoms.
Symptoms? It's nothing.
It's a little bit of anemia or something.
Maybe.
But the headaches could be a sentinel bleed, or a subarachnoid hemorrhage, or - Or a tumor.
- Mm.
I see no cause for alarm.
Neither did our patient until her heart started to fail.
You need bloodwork and scans.
I'm not having a scan.
Dad, this is serious.
So am I.
Word gets out Tina Kingsley finds out It's all over.
Forget it.
Okay, fine.
Just bloodwork for now.
I can get around Bernie.
Yeah, I think I prefer it when you two don't talk to each other.
- Uh - Going down? Uh, yeah, to the lab.
- Thanks.
- Yeah.
How are things going with your mom? Mm.
She wants a fresh start.
Not that she has any right to ask for that.
You're probably right.
But you could still give her one.
Sometimes people just need a second chance, you know, before it's too late.
I've got some bloodwork for you, Bernie.
Who's the patient? Um, I didn't put a name.
Say it's me? Is it you? How about we say yes and I'll owe you one.
You and everybody else.
It's death by a thousand cuts.
Hang on.
Bernie, can you run labs on something that isn't human? Why did you want to see all the supplements we take? So that our lab could test them.
Test them for what? We know Violet has alpha-gal.
- The meat allergy.
- Yes, which explains your reaction to the pig valve.
What it doesn't explain is the heart condition you came in with, because you are a lifelong vegan.
Whatever's been damaging Violet's heart, we assumed it had to be something other than meat.
But she has no other conditions, no other factors that could explain the damage to her heart.
It had to be the alpha-gal.
Which means you had to be consuming meat.
Your vitamin B-12 supplements are encased in a capsule derived from animal proteins.
Now, the amount in each capsule is too small to trigger an outward reaction.
But the chronic insult to your system damaged your heart over time.
- The label says they're vegan.
- Yes.
But supplements are not regulated by the FDA.
The-the labels, the ingredients They're not verified the way the prescription medications are.
So, I-I've been taking meat pills? The good news is that you are at the top of the transplant list, and it is not too late for a new start.
We're gonna get a nutritionist.
We'll make meal plans.
We're gonna be okay.
Stop saying "we.
" What? We're not the same person.
If it were up to me, maybe I wouldn't even be vegan.
I might have eaten a hamburger by now and found out about this sooner.
None of this would've happened if you had just let me make my own decisions.
Violet, I was just trying to do what I thought Well, you were wrong.
Donor match for Violet Stein.
We got a hit? Yeah.
She'll have a new heart by tomorrow.
I'll get her on the schedule.
Okay, great, and I'll notify the family.
Okay.
Oh.
Sorry.
You know what? Uh, after you.
- You go.
- I Okay, I'll go.
What was that? That was awkward.
Mm.
I accidentally said "I love you.
" I've been trying to undo it, but Why, because you don't love her? Everything okay? Yeah.
Uh Well, I can do this if you want to join Dr.
Griffith and tell the family about the transplant.
No.
I got to, uh, get to the lab, anyway, so Okay.
Dad says once you break trust, it's gone.
I know he'd say this is a mistake, but if you want to stay I won't stop you.
Thank you for this chance.
I hope I don't regret it.
All I want is to make things better for us and for this hospital.
Starting with the cardiothoracic department.
Hey.
Hey.
Look, I know you're out of the race, but I just want to let you know that my mom has some plans for your department.
What do you mean? Well, she's opening the position to outside candidates.
Thought your dad might like to know that he won't be running unopposed for too long.
Um I'll tell him.
Yeah.
So she's sticking around, then? Yeah.
Uh, I'm gonna try this whole second chance thing.
I'm still so sorry.
No, no, don't.
Hey, it's okay.
It's just, I-I got to figure out this stuff with my mom right now, and I get it.
You don't have to explain.
I will see you around.
I'll see you around.
Okay.
Hey.
How'd it go in there? Oh, yeah, she's stable.
Um, I just finished the paperwork for the transplant.
Her mom was just doing what she thought was best, wasn't she? She didn't know what her daughter needed.
This morning, what I said, um, is probably the last thing you need.
It was probably the worst possible time to say it, but I did, and I don't want to pretend like I didn't.
What did you say? I said "I love you.
" Which you clearly didn't hear.
Um, but that's-that's good, because it just slipped out.
It was an accident, and it shouldn't have happened.
At least, not like that.
What are you saying? I love you.
I love you.
Oh.
That's how it should've happened.
Because that's how I feel.
And now you know.
What are you doing in here? I always used to come down here before surgery and after.
Your mother would say, "He's in church.
" Me too.
Hmm.
Tina Kingsley is widening the search for chief.
She's not gonna make it easy for me, is she? You'll be fine.
Your history and relationships.
No one can compete with you.
I know one person who can.
I told you I'm out, Dad.
Well, maybe you should reconsider.
Better you than an outsider, right? What about you? You got your test results.
Not anemia.
Okay.
That doesn't mean it's a worst-case scenario.
Doesn't rule it out, either.
This race may be decided for me.
If it is, I would prefer you to be the one Stop.
We're not talking about work.
We're going to imaging.
No arguments.
Thanks for telling me about this.
Thanks for telling me about his symptoms.
I'm really glad you're here.
Me too.
Just want to remind you of a little thing called doctor-patient confidentiality.
A-And Sam? Don't worry.
I'm not gonna tell Mom.
I'm going to go and tell Sam everything.
I think I'm all caught up.
- Ambulance has just landed.
- Step back, Dr.
Trulie.
You don't need to worry about your best friend being with your dad because you and I are not friends.
It was me.
I called your mother.
Her vote could be the key.
This is not personal.
She is my mother! I told you I didn't even want to think about her! I have to end this war.
You ended something, all right.
I want you to know that you can talk to me.
I think I lost my way.
Morning.
Thank you for letting me sleep here last night and letting me talk your ear off.
Of course.
So, uh, how you feeling, other than tired? Uh Hmm.
I feel like a bulldozer ran over everyone and everything that I care about.
All around me, I see destruction.
And in the cold light of day, I realize that it was not a bulldozer that destroyed everything.
- It was me.
- Hmm.
I think you're being a little hard on yourself.
Nah.
You should've seen the look on Malcolm's face.
And what Lex said to me not that I blame her.
And my mother? I accused my own mother of not being on my side.
Because of what? This vote for chief? I am a human bulldozer.
You don't have to do that.
Uh - No, it's fine.
I want to.
- I just I didn't expect anyone, so it's a mess.
Compared to my life, this is nothing.
Hey, you remember the last thing you said last night? Uh, was it something along the lines of, "I've become a power-crazed monster who hurts the people she loves"? No.
It was, "I'm gonna make this right.
" And I said, "If anyone can do it, it's you.
" Did I happen to say how I was planning on doing that? No.
At that point, you started snoring like a baby rhino.
I do not snore.
Caleb! I do not snore! I'm gonna I'm gonna make this right.
I'm gonna try.
Well, uh, guess we better get to work.
Yeah.
Hey.
Oh.
I'm really glad you opened the door last night.
Yeah, well, glad you knocked.
- I'm gonna get dressed.
- I love you.
Yeah, get dressed.
Me, too.
I'm gonna brush my teeth, then I'm gonna Yup.
- Yeah.
- Sounds good.
I never should have called your mom.
Okay.
You told me that she was on the board, and all I could think about was her vote.
But all I should've been thinking about was you.
And how reaching out to her would make you feel.
I'm Damn it.
It's the ER.
You should go.
What do we have? Violet Stein.
18.
She fell at her high school track event.
- She was in first place, too.
- Okay, just gonna take a listen.
There's a lot of turbulence between atrioventricular valves.
Is that because of her broken rib? They said she has a broken rib.
Looks like this is the third bone you've broken at a track meet.
A lot of kids fall at these things.
Well, three fractures is unusual.
Are you getting enough vitamin D, calcium? We're very good about supplements.
You have to be, on a vegan diet.
Does this vegan diet include a lot of soy products? Yes.
Why? No air entry left side.
And vital signs are unstable.
Violet, can you breathe? Tension pneumothorax.
14 gauge needle.
Three and a quarter inch.
- Excuse me.
- Quickly, please! - What's happening? - It's all right.
Just hold on.
Her rib is stabbing into her lung, and we need to clear the air that's trapped in her chest cavity.
It's all right.
Try to relax.
It's okay.
Straight into the trauma bay.
Who's the patient? April Krane, 25, hypothermic.
I'm told her dry suit ripped while scuba diving.
Scuba diving? In the middle of winter? All the lakes are frozen.
They cut a hole in the ice, I guess.
Water under the surface is about 39 degrees.
She lost consciousness on the way over.
Okay, let's get these wet clothes off of her.
Breathing is shallow, pulse is weak.
All right.
We need to get her core temp up.
Bring a Bair Hugger in here, please.
We could warm up her IV fluids.
Good idea.
I'll grab a bag.
- Hi.
- Hey.
Still on trauma? - Is that because of me? - Not everything is about you.
I am sorry that I threw you off that patient.
I was out of line.
If you want to come off trauma, it will not happen again.
I like trauma.
Oh, if I broke that many bones running track, - I would take up chess.
- Mm.
We should also check her B12 levels.
Oh, it's not B12.
Cadmium is the problem.
- Cadmium? - Yeah, heavy metal, chemically similar to zinc and mercury.
- Yeah.
- Toxic levels linked to fragile bone syndrome - and often found in - In soy products.
Doesn't explain the mid-diastolic murmur you heard, but does address the fractures, at least.
Okay, I'll run the labs.
Dad, one more thing.
Hmm? I'm done fighting you for the chief job.
The job is yours.
Uh, the vote's not for 42 days.
They don't need to vote.
What are you? You quitting? Yeah.
I'm out.
Why? When you put so much into it? Too much, and that's the problem.
I'm I just want to focus on my patients, and I want to get you through your proctorship.
- Uh-huh.
- And speaking of which, we do have a double bypass on the schedule for later today.
- I'm aware.
- I am making you primary.
You've aced every step so far, and it's time you do your first solo surgery.
I'll see you in the OR.
How do you - accidentally say "I love you"? - It just slipped out.
I mean, I spent the whole night listening to her talk about making up with Malcolm.
And then, right at the end, I blew it.
Making up? Are they in a fight? I heard all about it right before dropping the "L" bomb on her.
I mean, who does that? And she didn't say anything? Maybe she didn't hear me.
Maybe she thought I said "I love the view," or, "I shove you.
" I just I've never said it before.
- Never to Sam? - Never to anyone.
You've never said "I love you" to someone? You don't tell your mother you love her? Okay, yeah.
My mom, sure, but Why? How many people have you said it to? - Hundreds.
- Hundreds? I'm very comfortable saying it.
It's easier than you think.
I love you, Caleb.
See? Now you say it to me.
- Oh.
No.
- Come on.
Tell me you love me.
You can do it, Dr.
Tucker.
I love balloon angioplasty.
And, look.
There's one now in, uh, room 2115.
So Everything okay, Dr.
Griffith? Yeah, fine.
I just, uh I just started thinking about my office.
Maybe the desk should go here, huh? Wait.
Your office? Yeah, well, it's not official till the vote, obviously, but, uh, now that I'm running unopposed, it's not exactly a nail biter.
What-what do you mean, you're running unopposed? What happened to Sam? Well, she wants me back in charge.
Back in surgery, back to normal.
S-So she dropped out? Did she say why? I think that ultimately, she realized I'm the leader this department needed, that my world-class reputation Well, I'm not saying it was easy, you two fighting all the time, but is dropping out the solution? Yes.
And ever since this whole battle started, I haven't been myself.
I haven't been there for you as a friend.
- Sure you have.
- What about your lawsuit? - The lawsuit settled.
- And I wasn't there for you.
Caleb sat up with me all night, just listening, and it made all the difference.
It made all the difference? Labs on your track star.
Thanks, Bernie.
Your dad was right about the cadmium.
The heavy metals, we can flush, but look at her troponin levels.
BNP's elevated, too.
Her cardiac enzymes are through the roof.
How does a teenage track star have the biomarkers of an 85-year-old in advanced heart failure? Hey, there.
You look a little lost.
Yeah, I'm looking for my son.
Apparently, he's in cardiothoracics.
Oh, well, that's where I'm headed.
Thank you, Doctor.
Sure.
Oh, if you want, I can look him up for you, tell you what room he's in.
Oh, no, no.
My son's not a patient.
He works here.
Hi.
Hey.
I didn't expect to see you here, not that you're here to see me.
I shouldn't make that assumption.
- Not everything is about me.
- I saw your dad earlier.
He-he was in your office.
Oh.
Well, was he measuring for drapes? So it is true.
You dropped out of the race.
Mm-hmm.
Hurting you was a wake-up call for me, Malcolm.
And I know that I can't undo the past, but I am not going to repeat it.
For what it's worth, I think you would've beat him.
With or without my mom.
To be honest, I'm just hoping we can put the stuff with your mom behind us.
Oh, it's definitely behind you.
Hello, Malcolm.
What are you doing here, Mom? Mom? Malcolm, please talk to me.
You shouldn't have come.
It wasn't my idea.
Dr.
Griffith called.
Yes, and I am very sorry that you came all this way, Mrs.
Kingsley.
But everything has been resolved.
My father will take over again soon.
Your father can't even perform surgery.
Why do you care? - This isn't your concern.
- Of course it is.
I mean, I don't do the day-to-day.
That's supposed to be your father's job.
But I do run this foundation.
And should this hospital fall into disarray, well, that would make my job much harder.
Everything is under control here.
If that were true, you never would have called me.
Dr.
Griffith, you know, bad leadership leads to chaos.
And chaos is bad for business yours and mine.
Order must be restored.
You look like you're feeling better, April.
I am.
Super glad I'm not dead.
Why were you diving down there in the first place? Are you kidding? The Great Lakes are full of shipwrecks.
There's so much to explore.
Why not explore in the summer when the risk of hypothermic death is just a little bit lower? The risk is why I do it.
The bigger the risk, the bigger the rush.
Hmm.
Adrenaline junkie.
You're like my fiancée.
What happened, exactly? I was inside one of the wrecks.
So awesome.
And But then my hand cramped, and I dropped my flashlight, snagged my suit going after it.
Wait.
Y-Your hand cramped so badly that you couldn't hold on to your flashlight? Has that ever happened before? Yeah.
All the time, actually.
That can be a, uh, sign of a neurological condition called "focal dystonia.
" Neurological? Is there something wrong with my brain? It's more like, um, the way that your brain and your muscles talk to each other.
We'll know more after the test.
Violet Stein.
That is one of the ugliest valves I've ever seen.
Mitral deterioration is very advanced.
There's no family history of heart disease? No.
She's a typical teenager with no preexisting conditions.
What about the cadmium toxicity? Well, explains the bones, but not the heart.
And she's had no symptoms of valve disease? No.
None.
We only caught it because she fell.
Although, the falling could be a symptom.
Cardiovascular syncope.
Blood flow to her brain is getting cut off during exertion.
Like during a track event.
She's broken multiple ribs.
Because she's fallen during multiple races.
She's gonna keep falling unless we replace this valve.
We can do it today after Dr.
Griffith's bypass.
Back-to-back surgeries.
- I love it.
- Yeah? Then why are you still standing here? Get to the OR, man your stations.
Let's go, people.
Byron.
You know, after all these years, I still don't like this tie.
What are you doing here, Tina? I was called, and now that I'm here, I have no intention of rubber-stamping the reinstatement of Rob Griffith as chief.
I had reservations about him the first time around.
You said you'd stay out of hospital business.
And you said you'd stay out of our son's business.
Yet, I see he's running around like your little clone.
- It was his decision to come here.
- It's not good for him to live in your shadow like this.
Don't talk to me about what's good for him.
You're the one who turned your back on this family.
Which makes you, what? The blameless victim? Is that how you remember it? It's how it went down.
Clearly, what our son thinks, too.
You turned him against me.
No.
No, Tina.
You did that all by yourself.
Well, here's hoping I can undo it.
See you at the next board meeting.
A mechanical valve? Yes.
They're strong, reliable.
It should last you the rest of your life.
How can she have heart disease? We're vegans.
Our diets are very healthy.
Your diet may not have caused your valve disease, but all of that soy and cadmium did contribute to your broken ribs.
Now, a new valve will help your heart get stronger, but you'll likely need to make some dietary changes to help your bones get stronger, too.
What kind of changes? Have you ever considered eating any fish or meat? - No.
- No.
Violet has never had so much as a glass of milk in her life.
We are diligent about supplements, and getting all the nutrients we need from non-animal sources.
If we need to cut back on soy, we will, but meat is not an option.
Why don't we get you started with a new valve, and we'll take the rest from there? Your EMG results are in.
Your motor unit recruitment is perfect.
- What does that mean? - It means whatever's causing the cramp is probably not neurological.
Oh.
Well, does that mean I can go? We still haven't found the cause of the cramp.
Hey, as long as my brain's okay, I can live with a few dropped flashlights and the occasional charley horse.
Charley horse.
Peripheral artery disease would explain the hand and the claudication in the lower extremities.
She needs a stress test.
You can't go just yet, April.
So Malcolm's mom is here.
Yes.
But you shouldn't feel guilty or anything.
It's not like you told her to come.
- And - Hmm.
I need to get my head in the game.
I blew it.
You didn't blow it.
It was one "I love you.
" No.
She's never gonna talk to me again.
She said talking to you made all the difference.
She said that? Mm-hmm.
All right, gentlemen, are you ready to be reminded how a bypass should be done? You have an audience.
It's good to be home.
Right this way, Dr.
Griffith.
I know where the patient's head is, Dr.
Shah.
Ah.
Let's see if we can get him to the heart.
Okay.
It's all for you, Dad.
Ten blade to me.
Hit it.
I'm back in the game I'm back in the saddle, here I go Back in I'm back in, back in the game Loupes? All right.
Back in the game Remove the clamp.
I'm back in the game I'm back in Aortic clamp is off.
Electrical activity is restored.
Perfect.
Not so fast.
There is excess tissue over the proximal anastomosis.
I'm back in charge, back in the mode Back in my flow, back in the show I'm back in the game Now it's perfect.
I'm back in Back in the game.
Well done, Dad.
Hey, is everything okay? Yeah.
Just, uh, the light was angled towards my eyes.
Let's watch that next time.
Close up, Dr.
Tucker.
Nice bypass, everyone.
We owe Violet a mechanical valve.
Next, back-to-back surgeries today.
- Back-to-backs.
- Back-to-backs.
Uh, I hate to miss out on all the fun, but I think I should probably go and dictate an operative report on that bypass, don't you? Sooner you can sign off on this step the better, right? - Yeah, sure.
- Okay.
One step closer, Dad.
One step closer.
What is all this? We think there's a blockage in your arteries restricting blood flow to your extremities.
This is gonna help us find it.
- I just start running? - Mm-hmm.
This IV has a radioactive tracer in it.
So we're gonna get your heart pumping and let the tracer lead us to the problem.
Take her to four.
How fast does it go? Most people get up to about a six.
- Take me to seven.
- You sure? Heart rate's at 140.
All right, her hand's cramping.
Are you okay, April? - It hurts.
- What hurts? - Everything.
- Take her down.
No! Take me higher.
- April - Please, you have to.
Going faster is - the only way to make it stop.
- Make what stop? - The pain! - All right, all right.
I'm pulling it.
All right, all right.
Mind telling me what happened in that bypass? What are you talking about? Your father dropped an instrument in the middle of surgery.
The surgery was over, and surgeons drop instruments all the time.
When was the last time he dropped one? I'm due in another surgery soon.
He was in a coma for six months.
Now he can't get through a routine surgery without incident.
- There was no incident.
- I know what I saw.
With all due respect, I am Dr.
Griffith's proctor.
I am the only person who is authorized to assess his progress, and I am telling you that there is no issue or concern regarding his performance.
Well, I guess that's all there is to say.
Stress test shows her arteries are clear.
We know her nerve and muscle function are normal.
So, what's with the hand cramp? It only happens during extreme activity.
My guess: involuntary response to stress hormones.
So, she stops the extreme sports and the hand cramp goes away.
- But she's not gonna stop.
- Why not? I see it with Tim, too.
He'll do anything for a rush.
Except with April, it's even more intense.
What if the hand cramp is actually a small price to pay for the upside of all of those stress hormones? The adrenaline, the cortisol, all of those endorphins that act as natural painkillers? She's not chasing a high.
She's self-medicating.
The hand cramp isn't the problem.
It's it's the solution to the problem, Which is chronic pain.
Okay, let's get an MRI.
Whatever's causing this pain, jumping out of a airplane can't be the only way to treat it.
- I'm on it.
- Thank you.
- Hey.
- Mm.
Hey.
You want some company? Sure.
I thought you were in the valve replacement.
Yeah, uh, so, Sam gave me the, uh, bypass surgery at the last minute.
You were primary? Oh, that's great.
How do you feel? Yeah, good.
I, uh, just need to, um, come down a bit from the adrenaline rush.
Mm.
All right.
Well, uh, you do that, and come find me later.
- Mm-hmm.
- All right.
- Hey, do me a favor.
- Hmm? Just slip that back in the charger, preferably when Donna's not looking.
What did you do? Did you drop it? No.
It was like that when I found it.
Liar.
And what if Donna thinks I broke it? You say it was like that when you found it.
What are you doing with the quarterly reports? Reading them.
I would have used your father's office, but I couldn't find it.
- Uh, he doesn't have one.
- Doesn't have one? What, does he do skulk around like Phantom of the Opera? I have work.
Whatever you're doing, can you do it somewhere else, please? We never talked about my leaving.
What is there to say? You left.
The end.
I left him.
I didn't leave you.
And I didn't leave because I wanted to.
I left because I had to.
- You had to? - There's only one way with your father.
If you can be what he wants you to be, if you can stay within those lines that he draws for you, then you're good.
But I couldn't do it, Malcolm.
I knew that if I chose to be myself, it would cost me the marriage.
But I never imagined it would cost me my son.
And I hope it's not too late to get him back.
How can I trust you after all this time? I I'm not asking for your trust.
I'm asking you to give me a chance to earn your trust.
I-I need to get to work.
Yeah.
Yeah, me too.
Um, you know, I know this hospital better than you think.
I could do some some good around here.
With your blessing, of course.
But, um, if you want me to leave, I I can be on the next flight.
- Ready for the valve, Dr.
Shah.
- Mm-hmm.
A new valve in healthy 18-year-old? You don't see that every day.
Hold on.
Something's not right here.
I need more light.
Look at this.
Annular calcification.
- But that didn't show up in the echo.
- No, it did not.
The annulus is supposed to be firm.
This is like Jell-O.
- Liquefactive necrosis.
- I can't attach the metal to this tissue.
It's too viscous.
I There's literally nothing for me to sew into.
You need something more pliable.
BP and O2 sats are trending down.
Call down for a bioprosthetic valve, stat.
Wh A pig valve? Well, it's not a vegan option, but it'll keep her alive.
Telling a vegan mother you put a pig valve in her vegan daughter's heart? Not the high point of my day.
Well, that valve is also keeping her alive.
Oh.
- Thanks, man.
I appreciate it.
- Mm-hmm.
And also I love you.
What? - Nothing.
- You did it! Good for you, Dr.
Tucker.
What? He accidentally said "I love you" to Sam.
We're trying to normalize it so it's not such a big deal.
That advice is why some of us are engaged and why others are going to die alone.
Look, I'm desperate, man, okay? I cannot let things get weird with me and Sam.
So, this is the not-weird solution? Just go with it.
Fine.
Say it again.
I love you.
You're not my type.
That stung a little.
Operative report dotted the I's, crossed the T's.
Does that report mention the scalpel that you dropped? Why would it? Because I've never seen you drop an instrument.
I told you, it was the lights.
I've also never heard you complain about the lights.
I'm worried that I put you in too soon, and I want to sign off on this, but I need to understand what happened in there.
A successful bypass is what happened.
Who cares about a scalpel? I'll tell you who cares.
Dad.
Tina Kingsley cares.
She's raising questions about your competency after what she saw.
- I told you she never liked me.
- I covered for you.
I said there was nothing to worry about.
Is that true? It was the lights.
I heard what happened with the scalpel.
Scrub nurses like to gossip.
And what, you think I'm being too hard on him? Because it was my idea to put him back in surgery.
- I know.
- This is just due diligence.
I want to clear him.
I don't think you should.
You don't think he's ready? I think he should be ready.
I think he thinks he's ready.
But? That scalpel's not the only thing he's dropped.
Her hands are ice-cold and she won't wake up.
Heart rate's 140.
Why is she so tachycardic? And hypotensive.
Blood pressure's 90/40 and dropping.
Maybe she's turning septic.
Have we gotten another H and H? There's no fever, she hasn't lost any blood volume.
Could she be rejecting the valve? No, acute and chronic rejection takes weeks to occur.
She's been out of surgery about an hour.
- Could be hyperacute.
- No.
Then we would've known before we closed up.
This is something else.
What's happening? Her heart is failing.
I need you to increase her Levophed, get another pressor.
We got to get her pressure up, and I want a cardiac MRI as soon as she is stable.
Her body hates this valve.
I want to know why.
Postoperative ultrasound confirmed the graft was seamless.
Well, installation's not the problem.
- Maybe it's a defect in the valve? - Well I'm gonna check the production lot for reported problems.
Look at the leaflets on the mitral valve.
- They're so stiff.
- Uh-huh.
And what are those spots? They look like goosebumps.
Or hives.
Can we see if there's inflammation, please? Ah.
Lit up like a Christmas tree.
That is an allergic reaction.
But to what? Anesthesia's out of her system.
The only thing she could be reacting to The valve itself.
She's allergic to meat? To animal protein, yes.
I've never heard of this.
What did you say it's called? Alpha-gal syndrome.
It's a reaction to the sugar molecule in most mammals.
It is a severe allergy, but because Violet's never eaten meat, she was never diagnosed.
She was fine.
She had a broken rib, but she was fine.
How did things get so bad so fast? I know that she seemed fine, but something has been damaging her heart.
But you don't know what it is.
The mechanical valve didn't work.
The pig valve isn't working.
Her heart is failing.
Which is why we need to give her a new one.
Your MRI shows that you have spinal stenosis.
It's the narrowing of your spinal cavity that's compressing your nerves and causing your chronic pain.
Well, can you fix it? Mm-hmm.
It's called a laminectomy.
We remove part of your vertebra to ease the pressure on your nerves.
Sounds complicated.
There are risks, but the bigger the risk, the bigger the rush, right? Look, April, I know you found a way to cope with your pain, but it's just temporary.
Problems like these do not go away on their own.
In fact, they usually get worse.
Lying down in the middle of a shift? This is another first, Dad.
It's low blood sugar.
Or post-exertional malaise.
Is that why you ducked out of the valve replacement surgery? I'll have some trail mix, I'll be fine.
I want to run a blood panel on you, a full workup.
Whoa! Why? Because I know about the headaches and the ringing in your ears, the photosensitivity.
And I hear you dropped a tablet in addition to that scalpel.
Et tu, Brute? I'm worried about you.
Ignoring this isn't gonna make it go away.
I can't clear you for surgery unless we address these symptoms.
Symptoms? It's nothing.
It's a little bit of anemia or something.
Maybe.
But the headaches could be a sentinel bleed, or a subarachnoid hemorrhage, or - Or a tumor.
- Mm.
I see no cause for alarm.
Neither did our patient until her heart started to fail.
You need bloodwork and scans.
I'm not having a scan.
Dad, this is serious.
So am I.
Word gets out Tina Kingsley finds out It's all over.
Forget it.
Okay, fine.
Just bloodwork for now.
I can get around Bernie.
Yeah, I think I prefer it when you two don't talk to each other.
- Uh - Going down? Uh, yeah, to the lab.
- Thanks.
- Yeah.
How are things going with your mom? Mm.
She wants a fresh start.
Not that she has any right to ask for that.
You're probably right.
But you could still give her one.
Sometimes people just need a second chance, you know, before it's too late.
I've got some bloodwork for you, Bernie.
Who's the patient? Um, I didn't put a name.
Say it's me? Is it you? How about we say yes and I'll owe you one.
You and everybody else.
It's death by a thousand cuts.
Hang on.
Bernie, can you run labs on something that isn't human? Why did you want to see all the supplements we take? So that our lab could test them.
Test them for what? We know Violet has alpha-gal.
- The meat allergy.
- Yes, which explains your reaction to the pig valve.
What it doesn't explain is the heart condition you came in with, because you are a lifelong vegan.
Whatever's been damaging Violet's heart, we assumed it had to be something other than meat.
But she has no other conditions, no other factors that could explain the damage to her heart.
It had to be the alpha-gal.
Which means you had to be consuming meat.
Your vitamin B-12 supplements are encased in a capsule derived from animal proteins.
Now, the amount in each capsule is too small to trigger an outward reaction.
But the chronic insult to your system damaged your heart over time.
- The label says they're vegan.
- Yes.
But supplements are not regulated by the FDA.
The-the labels, the ingredients They're not verified the way the prescription medications are.
So, I-I've been taking meat pills? The good news is that you are at the top of the transplant list, and it is not too late for a new start.
We're gonna get a nutritionist.
We'll make meal plans.
We're gonna be okay.
Stop saying "we.
" What? We're not the same person.
If it were up to me, maybe I wouldn't even be vegan.
I might have eaten a hamburger by now and found out about this sooner.
None of this would've happened if you had just let me make my own decisions.
Violet, I was just trying to do what I thought Well, you were wrong.
Donor match for Violet Stein.
We got a hit? Yeah.
She'll have a new heart by tomorrow.
I'll get her on the schedule.
Okay, great, and I'll notify the family.
Okay.
Oh.
Sorry.
You know what? Uh, after you.
- You go.
- I Okay, I'll go.
What was that? That was awkward.
Mm.
I accidentally said "I love you.
" I've been trying to undo it, but Why, because you don't love her? Everything okay? Yeah.
Uh Well, I can do this if you want to join Dr.
Griffith and tell the family about the transplant.
No.
I got to, uh, get to the lab, anyway, so Okay.
Dad says once you break trust, it's gone.
I know he'd say this is a mistake, but if you want to stay I won't stop you.
Thank you for this chance.
I hope I don't regret it.
All I want is to make things better for us and for this hospital.
Starting with the cardiothoracic department.
Hey.
Hey.
Look, I know you're out of the race, but I just want to let you know that my mom has some plans for your department.
What do you mean? Well, she's opening the position to outside candidates.
Thought your dad might like to know that he won't be running unopposed for too long.
Um I'll tell him.
Yeah.
So she's sticking around, then? Yeah.
Uh, I'm gonna try this whole second chance thing.
I'm still so sorry.
No, no, don't.
Hey, it's okay.
It's just, I-I got to figure out this stuff with my mom right now, and I get it.
You don't have to explain.
I will see you around.
I'll see you around.
Okay.
Hey.
How'd it go in there? Oh, yeah, she's stable.
Um, I just finished the paperwork for the transplant.
Her mom was just doing what she thought was best, wasn't she? She didn't know what her daughter needed.
This morning, what I said, um, is probably the last thing you need.
It was probably the worst possible time to say it, but I did, and I don't want to pretend like I didn't.
What did you say? I said "I love you.
" Which you clearly didn't hear.
Um, but that's-that's good, because it just slipped out.
It was an accident, and it shouldn't have happened.
At least, not like that.
What are you saying? I love you.
I love you.
Oh.
That's how it should've happened.
Because that's how I feel.
And now you know.
What are you doing in here? I always used to come down here before surgery and after.
Your mother would say, "He's in church.
" Me too.
Hmm.
Tina Kingsley is widening the search for chief.
She's not gonna make it easy for me, is she? You'll be fine.
Your history and relationships.
No one can compete with you.
I know one person who can.
I told you I'm out, Dad.
Well, maybe you should reconsider.
Better you than an outsider, right? What about you? You got your test results.
Not anemia.
Okay.
That doesn't mean it's a worst-case scenario.
Doesn't rule it out, either.
This race may be decided for me.
If it is, I would prefer you to be the one Stop.
We're not talking about work.
We're going to imaging.
No arguments.
Thanks for telling me about this.
Thanks for telling me about his symptoms.
I'm really glad you're here.
Me too.
Just want to remind you of a little thing called doctor-patient confidentiality.
A-And Sam? Don't worry.
I'm not gonna tell Mom.