Transplant (2020) s01e10 Episode Script

Bishop offered to recommend me for a full-time spot at the hospital.
You're pushing yourself too hard.
Unless you can strike a balance, maybe the emergency department is not for you.
And with post-traumatic stress injuries, the only way out is through? - Amira.
Come on.
- Bye, Daneesha.
There's an apartment that sounds good not far from here.
Should we go see it? I know you don't want to move again, but we have to find our own place.
Daneesha asked me to go to a movie.
- You can go right after.
- Please? I really want to go.
Okay.
I'll check it out for the both of us.
Follow me.
Mr.
Orr is 55 years old.
Presumed venous thromboembolism, but the D-dimer was negative.
What's the next step? Dr.
Owens, go ahead.
You have the option of a family practice back home.
What made you decide to apply for this permanent position? The resources available at Memorial, and the range of what we're able to do for our patients here.
Could you be more specific? Why this job, Dr.
Hunter? What makes it worth changing all your plans? Next? Free the neck of the gallbladder.
Mm-hmm.
Nice technique, Dr.
Miller.
I'll go ahead and clip the cystic artery.
Why did you jump in like that? You hesitated.
I was waiting for the go-ahead.
Singh wants us showing confidence.
Hey! How's internal? You hate it.
I love emergency medicine.
I always have, and I always will.
And that's exactly what I should've said in my interview.
Was it really that bad? At least now I won't have to tell Melissa.
What was that? Was that an explosion? Auxiliary power Does that mean it was in the building? No, we would have felt the shock wave.
Then where is it coming from? Dispatch says a building up the street just blew up.
Power's down on the whole block.
Bash! We're still waiting for an ETA from the scene.
- In the meantime - What's he doing? Doctor Hamed! Running into the fire, apparently.
I think it was a gas leak, there are people trapped inside.
You got this? Get as far away as you can.
Help.
Can anybody hear me? Please, help! Are you hurt? I'm a doctor.
Not me.
Her.
We need all hands on deck.
We are implementing mass trauma protocol.
That means wristbands for triage.
Red for critical, yellow for intermediate and green can wait.
Residents will help with assessment and immediate action.
OR's are being cleared of anything noncritical.
Page myself and Dr.
Atwater for anything above your pay grade.
Nursing staff are crucial and will be the busiest today.
If you see a way to help them, do it.
Family members looking for patients, Ms.
Barnes and her staff are on that.
We're closest to the incident and best equipped for trauma.
But You to be prepared for any eventuality.
All right.
Ready? Let's go.
Dr.
Leblanc, Internal's gonna have to live without you today.
- We need all the help we can get.
- Yes, sir.
- No word from Bash? - Nothing.
What's your name? Julia.
Tell me how you're feeling, Julia.
Like a building fell on me? We're going to get you out of here as soon as help arrives.
Until then, we need to keep you hydrated and combat any blood loss.
Maybe I can find something to leverage this beam and dig her out.
Do you remember where you were when the explosion happened? Julia? My wife Naomi.
Did you see her? She has brown hair, red sneakers.
Did you see her when you came in? Tell me how you're feeling, Julia.
Fine.
I'm just a little light-headed.
It's all a blur.
We got blown back.
Tried to get out, then she got buried.
This thing's too heavy.
This place is unstable.
You need to leave.
No.
Please, you gotta let me help.
She's lost a lot of blood and I only have two bags of saline.
I'm going to stay with her.
There are rescue teams out there and inside the building.
Go tell them where we are.
Please! Okay.
They're still trying to get victims out the building.
Apparently, the whole place could come down any minute, and Bash is still in there.
Hey, guys, did you see any doctors in there? No, I'm sorry, I didn't.
- No pulse.
- She's in V-fib.
Charging to 100 joules.
Everyone clear? Defib arrest.
We have a pulse.
How long was she down? Paramedics found her alone so there's no telling.
We need a cooling blanket, and as many ice packs you can find.
You're starting targeted temperature management? I'm worried about potential brain damage.
There's a chance you could combat cellular decay from lack of blood flow.
As long as she wasn't down more than six minutes.
- Any word on mom or dad? - Nothing yet.
Alright, there's a cooling unit in ICU.
Let's get it up there.
Come on, let's go! You need blood.
So you're just gonna give me yours? I'm a universal donor.
I've done this before.
At the hospital up the street? In Syria, where I'm from.
During the war.
Lucky me.
I got the war vet.
I feel like I'm losing as fast as you're putting it in.
Help is on the way.
My wife and I had an argument.
I was so angry at her.
It seems so stupid now.
I'm sure she thinks so too.
She was late getting out of the house.
She's always late.
What if the last thing I said to her was over some dumb fight about how disorganized she is? Hey.
Just hold on, Julia.
We're gonna get you out of here.
Julia? Julia! Is there anybody here? Over here! This woman is in traumatic rhabdomyolysis.
We need to fluid overload before releasing pressure.
You should get out of here.
The building is unstable.
- I can't guarantee your safety.
- I'll risk it.
I'm not leaving her.
My wife My Has anyone seen I've been waiting forever, okay? I keep trying to ask people where she is.
Her name is Julia Baranski.
Please tell me that you know.
We're moving as quickly as we can, but right now, things are still backing up.
So come with me please.
Okay.
- What's your name? - Naomi.
But Julia, I need to find her.
I promise that we're gonna look for Julia.
But right now, I need to take care of you.
I tried to go back inside, but I couldn't get in.
You did the right thing not to go back in.
You have bruises and a number of wounds that need to be treated.
Do you have any intense pain anywhere in particular? My stomach.
Okay.
Lie down for me, please.
Okay.
I'm trying to find my boyfriend.
No one will tell me anything.
There's a list of people from the explosion, at registration.
No, no.
I asked them already and they don't A number of people came in without ID's.
Look, I know it's hard, but we've got a lot going on right now.
We just need you to stay patient while we sort it out.
All right? Okay Who is this? I need you to sign off on the on-calls I'm bringing in.
Our biggest problem is managing just the minor injuries and family coordination.
Triage nurses are doing great, but we're barely keeping up.
I'll tell EMS to divert the ambulances to St.
Jacobs.
- I already did.
- Oh, good.
Anything else you need, as you need it.
Yeah.
All right.
Excellent, thank you.
Claire.
Can anybody help me? - Are you looking for someone? - I'm looking for my daughter, she's not answering her phone.
She goes by that building on her way home from school.
- How old? - Twelve.
Blonde hair, plaid private school skirt, and a green sweater.
Her name is Gabriela.
She's in our intensive care unit.
Intensive care? - Is she okay? - Come with me.
Nurse.
Okay, Naomi, this is gonna be cold.
Let me know if I'm pressing too firmly.
Okay.
I'm gonna have to scan to confirm, but you're hemorrhaging inside, which means our first priority right now is to get you to surgery.
How Jules is gonna find me? Look, if she's here, our support staff are gonna find her and they're gonna tell her where you are, I'll ask them to myself.
But for now, I really need you to stay as still as possible.
Okay? Miss Petrakis.
Gabby.
What happened? Gabby suffered a traumatic impact, and she went into cardiac arrest.
Her heart stopped? Yes.
But we restarted it, and we're hoping to rule out any possible brain damage, but Brain damage? Can you do anything to help her? We're cooling down her system in order to decrease her brain function, so the lack of oxygen is less damaging.
After enough time, we can warm her back up, and her brain will reset itself to normal functioning.
When will we know if she's okay? Not until she wakes up.
But she will wake up? Julia Burrenski, 33 years old, open tip fib fractured, lost a lot of blood on the scene, possible smoke inhalation.
GCS 15.
Okay.
We've got this.
Welcome back, Dr.
Hamed.
Bash? Are you okay? Yeah.
What? Am I okay? Are you? What were you thinking? You could have been killed.
You can't just Show up and volunteer as a doctor? - You gave blood? - Yeah.
At the scene.
Let me check you out.
No.
This place is overflowing and I see one of my patients from the building.
I need to make sure he's okay.
You made it.
Because of you.
You found help.
- Julia? - She made it too.
Gav.
Has anyone looked at you? Just some bruised ribs.
Nothing I haven't done mountain biking.
Do buildings usually fall on you when you are mountain biking.
Breathe for me, okay? You said you were blown back during the blast? Yeah.
I think maybe I slammed into the wall.
Gavin, why didn't you tell anyone? Julia needed you more.
Dr.
Curtis? No.
Honestly, guys, you got bigger problems than Gavin.
You did your part to help, let us do ours.
- What do we have? - Impact trauma.
Tell me what you hear.
Bowel sounds Reduced air entry.
The porters are all backed up.
So I'm going to take you up to surgery myself.
- Did you find Julia? - Not yet.
It doesn't mean she's not here.
Won't be long.
Careful.
You think this is bad mountain biking? Oh, not even close.
Let's have a look.
There it is.
Free fluid.
Dr.
Hamed? Do you see the disruption at the left diaphragm? Is that the bowel? Stomach, I think, I'm just We'll need a CT to confirm.
Anyone want to explain? You may have torn your diaphragm when you were blown backwards.
These type of tears can cause your abdominal organs to protrude into your chest cavity.
If so, you will need surgery, but finding it early means it's treatable.
Good catch, Dr.
Hamed.
I'll get him to CT.
Um, Dr.
Curtis will take care of you from here.
Thank you for everything.
Dr.
Hamed.
Dr.
Hamed! Are you with us? I heard you gave blood at the scene today.
There were chemicals in that explosion.
We need to take care of those.
Anyone who was in there could be exposed.
What was that? Uh, it's Power grid kicking in.
We've been on generator since the explosion.
The elevator should start up again in a second.
Why isn't it? I don't know.
Naomi? Where does it hurt? My neck.
Can you describe it for me? It's tightening.
Almost like I'm being choked.
Okay.
We saw the hematoma earlier, but I do see increased swelling right now.
Likely residual effect from impact trauma.
What do we do? You're gonna be fine.
Okay? You're sure the burns are chemical? It must have been something I touched during the explosion, maybe even one of the patients had that substance on their skin.
And you didn't notice till now? There are a number of corrosives that don't take effect until much after contact.
The timeline varies depending on the chemical.
So there's no telling who or what you touched.
You've seen this kind of burns before? Regime chemical attacks were frequent.
Sometimes people would be exposed and not know it at first.
You need to monitor every patient from the explosion to make sure they haven't been affected.
We will.
But that includes you.
Sir, I'm fine.
My burns are minor.
They still need to be treated.
So do the people who might have been exposed.
We're busy.
They need my help.
And they will get it.
As soon as you finish irrigating your burns and do a pH assessment.
Understood? Good.
I'll send a nurse? Is there anyone else presenting with chemical burns? We've been screening, so far nothing.
Triage knows to alert us if they see any signs.
How's Bash? His burns are minor and we caught them in time.
You're worried about him? He's seen chemicals like this before, during the war.
Dr.
Bishop.
We've got a problem with one of the elevators.
Have you called Mechanical? Yes, but I think you need to come with me.
Hi.
Can I help you? I still can't find my boyfriend.
Did you check with triage? They have the most updated list from the explosion.
Yeah, I tried to tell the other nurse.
- He wasn't in the explosion.
- Okay.
- Tell me what happened.
- Uhm The paramedics brought him here because he He OD'd.
And I gave him naloxone, but I think that maybe it was too late.
And no one is telling me anything so What's your boyfriend's name? Chris Hewitt.
And yours? Alexia.
Alexia.
My name is Claire.
I'm going to figure out what happened to him.
That's what the other guy said and it's been forever.
It has been a bit of a madhouse here today.
And it might take me a bit of time, but I promise I'll find him, okay? Just have a seat over here and wait.
Sure you will.
I was prepping him for surgery when his burns started to develop.
Gavin, you said you were in the bike shop when the blast happened? It felt like the explosion was right under us.
What sort of chemicals do you use there? Lots of stuff.
Degreaser, mineral spirits, rust remover - Rust remover? - Yeah.
We use it all the time.
Hydrofluoric acid.
It's used to strip rust, among other things.
It can take some time to present.
It's easily neutralized with a solution of calcium gluconate.
If it was localized to the shop that will explain why we haven't see more burns.
I wasn't there alone, Dr.
Hamed.
Excuse me.
This just came on now? When I woke up.
You must have been in closer proximity than Gavin.
It's in my lungs? Aerosolized particles.
We can do a procedure called a lung lavage.
It flushes out the chemicals from your lungs.
Take slow breaths for me.
It's an internal hematoma which is now swelling quickly.
A blast injury? Arterial? A venous collection.
And it aggravated when the elevator stopped.
Dr.
Bishop, if it's pressing on her airway How long until somebody can get us out? When the power came back on, the surge blew part of our grid.
We've got two elevators down, but only yours was in use at the time.
Mechanical's working with fire and rescue, but you're between floors, so it's delicate.
Sir, if the swelling continues we lose our shot at intubating her.
You need to be prepared to act before that happens.
You mean, open an airway without imaging? Sir, even if I could approximate an incision point, I don't have the proper tools.
Well, let's hope it doesn't come to that.
How fast is the swelling accelerating? It's doubled in the last nine minutes.
Well, if it keeps accelerating at the same rate, you won't have another nine minutes.
If I don't make it, I need you to tell Jules If I knew this morning was gonna be the last time Please, tell her that I love her.
- No.
- What? I'm not gonna tell your wife you love her.
Because you will.
You will.
Do we have an ETA on doctor Singh? He's on OR4 with a thoracotomy.
He's going to be out for at least ten more minutes.
Who else is on? All the ORs are active right now.
We're it.
He's getting worse.
We're losing circulation to the herniated bowel.
We're gonna have to go in.
Without Singh? Dr.
Curtis If we lose blood flow, the bowel will become ischemic.
It could cause severe damage.
I have to go in.
Scalpel.
Please.
May I? So we're slowly bringing your daughter's temperature back up.
I can't stand this.
Not knowing.
It shouldn't be too much longer now.
There must be something you can tell me.
Chances? Statistics? I can't just sit here in the dark.
Gabby walks home from school on her own.
If I'd finished work early and come to pick her up Elena This is not your fault.
I had the option to work from home this year and I didn't take it.
And if you did pick her up? You could both be lying here.
I'm never letting her walk home again.
I bet you Gabby wouldn't be as keen on that idea as you are.
She's always been so stubborn.
I'll come get you as soon as there's news.
Okay? Thank you.
All I need to do is make an incision distally.
I'll quickly insert a tube.
Dr.
Leblanc.
Poor hemostatic technique can increase the risk Mags.
To be careful to apply pressure - Mags! - What? Where do you spend every waking moment of your day? In this hospital? Exactly.
And when you're not here, what are you doing? Reading.
Reading what? Medical textbooks.
I've read three studies on this procedure and I've watched every video available online.
You're the one always telling me not to overthink, but I'm ready for this because because of all the work I've done.
I agree.
You do? If I was stuck in an elevator with a hematoma, no imaging, and no tools, I'd be lucky to have you there to handle it.
I'm gonna do it now.
Slow and steady.
Come on.
Come on.
It's working.
It's working.
It's working! Her O2 sats are rising.
Hey.
Alexia? Did you find him? Is Chris okay? Is he Do you mind coming with me? No.
If he's, uh If this is what I think, please just tell me here.
I am so sorry to tell you, but the doctors weren't able to save Chris's life.
He died from the overdose.
I tried to help him.
I did.
I spoke with the paramedics and they said the exact same thing.
You did everything you could.
Is there anyone I can call to be here with you? No, there's, uh There's no one.
I know how hard this must be.
Do you? Really? The only person who ever gave a crap about me is dead.
You started without me? The patient's stomach was halfway into his chest cavity and beginning to necrotize.
I had no choice.
Let me take a look at what you've done.
You were able to re-assemble the edges without tension.
Yeah.
I used running silk and interrupted reinforcement sutures along with some mesh.
You can close up.
Lung isolation established.
You fully evaluated potential morbidity from the procedure? No risk for complications.
We don't tape the joints.
They can leak.
We did a lot of these in the field during the war.
Did you check for effective lung isolation? One lung needs to be ventilated while the other is being flushed.
Clamp the drainage tube, and introduce 1200 mL of lavage fluid.
Yes, sir.
Lavage fluid starting.
Clamping lavage tube.
Start percussion.
Starting percussion.
There's fluid leaking into the ventilated lung.
We need to stop.
It's not draining.
All right, let's get her to lie on the cubitus.
Lavage side down.
- Lift on three.
- One, two We need to aspirate.
Hyper-oxygenate the airway.
We need to move, Dr.
Hamed.
Momma Momma Bashir! Just do a scan, check for lung sliding.
I'll take over that.
I'll do it.
You got it? Okay.
No lung sliding.
Pneumothorax.
She's not getting enough oxygen.
Let's put a chest tube in.
Get me a scalpel and a 22 French? Double time.
Bash.
You're good? Alright.
What if she doesn't wake? Let's just give it a second.
Come on, Gabby.
Gabby? Do you know where you are? It's okay, baby.
You're in the hospital.
Everything's okay.
Hi, I'm Theo.
Gabby, I'm gonna ask you something, okay? Can you count backwards from ten for me? Why backwards? That's a very good sign.
Your mother told me you had a mind of your own.
It looks like she was right.
Welcome back, Gabby.
Oh, my baby.
Oh, you're okay.
She's okay.
She's okay.
Oh, baby.
That was just a split second.
It was long enough for me to take over the aspiration.
You said you did those procedures in the war.
It's understandable if this one got to you, given the events of the day.
It didn't.
I hesitated.
That's all.
I think we both know it was more than that.
You pull something like that again, you're off my team.
If I didn't intervene when I did, the patient would be on a feeding tube for the rest of his life.
I was minutes away.
You should have waited You would be saying the same thing if I was Dr.
Miller? You think I'm giving you a hard time because you're a woman? When I started here 25 years ago, I was the only brown face in the department.
I guess you found a way to pay that prejudice forward.
If that's what you want to believe Dr.
Curtis, fine.
But the truth is, you shouldn't perform that procedure alone for the same reason I didn't want Dr.
Miller to go ahead and divide that cystic artery this morning, which I explained to him after you left.
Because you're not ready.
A patient's gonna live a normal life because of what I did in there.
Your execution was sloppy.
You cut wider than necessary and you used twice the mesh that you needed.
He'll have a harder recovery because of it.
This isn't about your gender, or your sense of entitlement or the massive chip on your shoulder.
It's about the patients.
Consider that next time before you cut.
Oh my God, that's her.
You sure she's okay? Her lung lavage worked.
You'll both be home soon.
Thank you.
For everything.
You ready? Hi.
Took you long enough.
You know me.
Always late.
I promise never to complain about that again.
No, you don't.
I'm sorry.
Dr.
Bishop? Dr.
Bishop, I just I want you to know that you were wrong about me when you suggested that Internal would be a better fit because Emergency is where I belong and - I know.
- No, but what I'm saying is You showed me that today.
Welcome home, Dr.
Leblanc.
Hi.
Uh Sorry I missed your messages.
I'm coming home soon.
Uh, let's have dinner together tonight? Yeah, it's been a crazy day.
Hey.
Can Amira and I stay with you a little while longer? Bash, I don't know how many times I have to tell you, but I love having you two around.
Stay as long as you need to.
How'd you do today? I beat the odds.
That's what I should have said in the interview.
We beat the odds here.
That was a tough day.
I know you're all exhausted.
We weren't perfect, but we came through.
What we do here is about more than being perfect.
It's about showing up, no matter how we're tested, and leaving everything on the floor.
That's what we do every day.
And nothing makes me more proud than knowing that.
Now get back to work.
Hey.
Hey.
There's a Gift card for the grocery store down the street.
They have hot meals too.
There's also the name and address of a woman's shelter.
Our social worker called ahead, they have a bed waiting for you.
All you have to do is show up.
Why are you doing this? I ran away when I was fifteen.
It's never too late to start again.
I'm here most days.
You need anything, you come back.
I bet you do something like this every day and no one ever notices.
Look at you, so sentimental today.
How are you feeling, Gavin? I talked to the nurses.
Four people died in that explosion.
I was there.
You did everything you could.
Those people that didn't make it, you have to You have to try and let that go.
Yeah.