A Gifted Man s01e12 Episode Script
In Case of Blind Spots
Why am I slipping? Maybe it's something you haven't faced yet a part of your past - coming back to haunt you.
- Is that why the other docs call you E-Mo you go straight to the touchy-feely? I am double-boarded Neurology and psychiatry.
How would you like to consult for Holt Neuro? I can come by later.
Do that.
Let's get shaking, girls.
It's too early to be tired.
We got a big game tonight! Watch your passing lanes, ladies! All right! Good steal.
Good steal.
Take it all the way.
All right.
All right.
Go ahead, girls.
Go ahead.
All done.
There you go.
And don't forget to do the calf stretches that I gave you, all right? And keep it elevated after practice.
- Thanks, Dr.
Kate.
- Yeah, no problem.
All right, let's go! Come on, Shari! You can hit that shot with your eyes closed.
- Sorry, coach.
- It's all right.
You'll get it next time.
Don't be so hard on her.
- All right, take it.
- Go, Shari.
- Take it.
Take it.
- All right! Shari! Oh, my God.
You all right? Uh, yeah, I think.
Okay, I'm just going to check out your spine.
Oh.
Ow.
Ow.
She needs an X-Ray.
Kate, I'm okay.
See? She can wait till after practice.
Yeah, but I'm the team doctor.
Unofficial title.
And with point tenderness over her thoracic vertebrae, she's getting an X-Ray.
Still a pain, just like when you went to school here.
Go on, take her.
Everyone else, let's go.
Back to practice! Good news no fracture.
So I can play.
Well, you still have a pretty bad spinal contusion.
In other words, a bruise.
Oh, I see you're getting too smart for my fancy medical terms.
Listen, even bruises take time to heal, so I'm going to write you a note for coach You can sit out for a couple of days.
Kate, I have a big game today.
Please don't make me ride the bench.
I'll take it easy, I swear.
Please? All right, but you will come back here after school so I can check you out before the game.
I promise.
Hector, will you schedule Ms.
Jackson for my last appointment this afternoon, please? - No problem, Dr.
Kate.
- Thank you.
Uh, come here for a second.
Guys I want to introduce you to my little sister, Shari.
This is Dr.
Holt, Dr.
Barnes.
- Hi, Shari.
- Hello.
I always took you for an only child.
Kate grew up in my neighborhood.
She came to my middle school on mentor day, and we hit it off.
Luckiest day of my life.
Same here.
Shari's an all-star point guard.
Means, come fall, she's going to play basketball for whichever university is lucky enough to snag her.
Don't believe the hype.
I work with several NBA and WNBA teams, so if you ever want courtside seats for the Knicks or Liberty, just, uh, let me know.
Okay.
Thanks.
Back to school with you.
- Come back in the afternoon, yeah? - Okay already.
What's the deal there? She was abandoned by her mom when she was ten.
Yeah, when I first met her, she wouldn't even raise her voice above a whisper.
She just needed more than her foster parents could give her.
- So you took her under your wing.
- She's great.
Anyone would have.
Kate Sykora-- big sister, clinic director, snappy dresser.
Where do you find the time? When do you have time for your husband? Oh, five minutes here, five minutes there, but only 'cause Harrison's even busier than I am.
Ah.
Although we do make time for date night sometimes, like tonight.
Oh, yeah? I got a date with my running shoes right now before my first consult at Holt.
All right, well, don't freeze to death.
And I'll see you back here at 5:30.
Uh, what am I coming back here for? You are coming back here for the clinic's staff meeting.
That's funny.
It's mandatory for all employees, whether you work here ten hours a week or 24-7 like the rest of us.
Get here early.
I made lemon squares.
That sounds fantastic.
Help! Help, I need help! I'm a doctor, are you okay? It's not me.
It's him; Um, I was painting when he When he stumbled out of nowhere and fell into the water, and I can't get 911.
Try again.
Oh, God, is he dead? I don't know.
Oh, no pulse.
How long was he in the water? About ten minutes.
I still can't get through to 911.
All right, forget the hospital.
I got better rewarming equipment at my practice.
Where? Right there.
And you're gonna drive me.
- How long's he been down? - At least 15, 20 minutes.
Well, no one's dead until they're warm and dead.
He's still cold as ice.
I can't feel his pulse.
What's his temp? Only 79 degrees.
Hooking up the et tube.
I'll ventilate him with warm humidified air.
Somebody get the damn bair hugger or not? Coming right in.
What about the heated saline? Just starting it.
Two lines running wide open.
Checking his rhythm.
He's still got electrical activity.
Looks like fine v-fib.
His heart may still have a chance.
Give me the paddles.
Clear.
Everybody clear.
Still nothing.
Damn it, he's still in v-fib.
Heart's still too cold to shock him into regular rhythm.
It's only come up two degrees.
He'll come up faster if you warm him up from the inside.
Get me a scalpel and a chest tube.
Pleural lavage, that's good thinking.
Cutting the skin.
I'm in the pleura.
And the Kelly.
I'm in.
Okay, start the lavage.
Heated saline going in.
Temp's up to 84.
Try shocking again.
Give me the paddles.
All right, clear.
Temp's up to 94 degrees.
The cold water kept his heart alive.
All right, going it again.
Clear.
That did it.
All right, I got a pulse.
Pressure is 70.
All right, give me suture.
Guy falls in the drink and you run by? Gotta say he's pretty damn lucky.
Only if that freezing water kept his brain cells from dying.
How's our newest member of the polar bear club? Hemodynamically stable, normal brainstem reflexes, still unconscious.
I'm not asking about him.
What? You still got all your fingers and toes? I'm, uh, thawing out nicely.
Michael, we don't need you out there rescuing the city's downtrodden.
Our waiting list is a mile long.
Well, that wasn't my plan, and he's not downtrodden.
He came in wearing a nice designer suit, expensive watch.
What about a wallet? It must've fallen in the river.
We're not gonna know who he is till he wakes up.
Alert the police; Tell them we've got a John Doe.
- In the meantime - Yeah? What the hell is going on with E-Mo? What do you mean? He just missed a VIP consult first thing this morning.
- Did you call him? - About ten times.
I also reminded him last night, and I just got a call from two pharmacies saying he forgot to sign prescriptions.
It probably just slipped his mind.
Last week, your birthday party slipped his mind after I told him about that.
Rita, don't worry.
Everyone has a brain freeze once in a while, even brilliant neuroshrinks.
Then why are you looking so worried, Michael? Apologize to the VIP and put him on my schedule.
Already did.
He'll be in Monday at 2:00.
You're a lifesaver.
Without even getting wet.
Okay, what are you not you telling Rita about E-Mo? E-Mo forgetting stuff might not be an accident.
He may have Huntington's disease.
- Oh, that's terrible.
- Yeah.
Obviously, I can't tell Rita.
But both his father and his brother had it.
What does his test say? He hasn't been tested.
- Why not? - What good would it do? There's no cure.
Well, but if he's already exhibiting symptoms What would you do if you thought you may have Huntington's disease, and there's not a damn thing you could do except suffer miserably, lose all your faculties and die? Would you get tested? I don't know.
Yeah, me either.
Now if you'll excuse me, I have to attend a staff meeting at the clinica.
Oh, I miss those.
I mean, I hated them when I was alive.
But now they sound kind of nice.
Yeah? Sit in for me and report back.
It's a win-win.
I developed this file folder color-coding system.
Yellow for the nurse to see, blue for the docs to see, red when there are doctor's orders.
Any questions? Hector, have you ever thought about, uh, electronic medical records? Great.
Everyone fill out your feedback forms, and have a lemon square.
Is that it? Think I caught a nap there in hour two.
Call me, Shari; I'm starting to worry.
Little sister never showed? Can't even get her on the phone.
Maybe she's feeling better.
Or she's avoiding me.
I doubt that.
The girl adores you.
Yeah, well, exactly.
That's why I'm worried something's wrong.
- Here you are.
- Hi.
- Good to see you, Harrison.
- You too, Michael.
Good, you're ready to go.
- I'm so sorry, honey, I can't.
- What? You have no idea how many favors I called in - to get these tickets.
- I know, but Shari never came back this afternoon.
- So, I have to go look for her.
- Kate, c'mon, she's a responsible kid, thanks to you.
If there were a problem, she'd call.
And isn't this why we decided not to have kids? So we wouldn't have to run after them all the time? She's my responsibility.
You want to go see War Horse? Love to but, uh, I got a patient back at Holt.
So, you're either ignoring my calls or you're the only teenager in America who doesn't check her phone a hundred times a day.
Kate, what are you doing here? I came to see why you broke your promise.
I was gonna come back, I swear.
But coach told me there are college scouts coming to see me play tonight.
I got to bring my "A" game.
You are clearly in pain.
No, my back feels fine.
Not from what I just saw.
Listen, when I was a junior, I pulled a hamstring.
Tried to play through the pain for the big game.
I was out for over a month.
But you won, right? No, we got creamed.
It was a dumb decision.
My back still hurts.
A little.
Anything else? Um My toes feel kinda tingly.
Okay, it's all right.
Look, I'm gonna take you - to get an MRI right away.
- Let's go! It's time to head for the bus.
Coach, Shari can't play tonight.
What do you mean? She told me her X-Ray this morning was fine.
Was she lying? No, but she's also Then let her play, doc.
Tonight's the chance you always wanted for her.
Look, I can get her an MRI with a top neurosurgeon in the city.
While she misses her shot at having college scouts see her play.
There'll be other games.
The big ones are coming tonight.
She can get an MRI after we win.
She could have a spinal injury.
Half my girls are playing with injuries that could be something worse.
You haven't benched any of them.
Shari, it's up to you.
I'll be fine.
I'll pop some ibuprofen after the game and call you.
Coach just wants what you want; For me to get into college.
Shari! Oh, my God! Call an ambulance! Don't move a muscle.
Kate, I can't feel my legs.
She was running up the bleachers, her legs just buckled.
Right, but the X-Ray from this morning's tumble was negative? I thought so, but could I have missed something, a fracture or a spinal injury? Let's wait for the scan.
- Coming up now.
- Good, good.
Okay.
All right, spinal cord's intact, so that's good.
It's very good.
There's a fluid collection in the epidural space between T-12 and L-1, which certainly would not have shown up in the X-Ray.
Probably a bruise on her spine, right? It would explain why her legs gave out.
Must be the blood compressing on her spinal cord.
It's all right.
I'll drain it.
With a little rehab, she'll be sinking three-pointers before you know it.
What's wrong with my legs? That bruise you got earlier? It caused bleeding around your spinal cord.
You're gonna be fine once I operate.
I need surgery? Hold on.
Don't worry.
Dr.
Holt is the best.
A few weeks of physical therapy, and you'll be back on the court.
So for now, you'll have to make due with about 500 cable channels.
- I'll manage.
- Good.
Okay, I'm gonna go scrub up.
Call her foster parents for consent.
Shari's a ward of the state.
I'll have to get permission from ACS.
Well, how long is that gonna take? Uh, look, as soon as I get the go-ahead, I'll let you know.
Okay.
Thank you, Michael.
For what? For letting me bring Shari here, for operating on her.
For everything.
Don't worry about it.
Good night.
Well That was interesting.
Our new patient is Means the world to her.
- Uh-huh.
- Just make sure Ms.
Jackson has everything she wants, okay? What about your other patient, the wet one? You want me to corral him? What the hell? Hey! Where am I? Okay, uh, you're at Holt Neuro.
Here, you need to get back in your room.
So what's your name? Darren Halloran.
All right, I'm Dr.
Holt.
Here, let me help you into bed.
- Oh, thanks.
- Mmm-hmm.
How'd I get here? I pulled you out of the East River.
Really? Really.
Why's my throat hurt so much? Had to put a tube down your throat to get you breathing again.
I'm surprised you could get out of bed.
- Oh, my God.
- Yeah.
I was dead? Pretty damn close.
I woke up a few minutes ago so hungry.
I thought there was food on that cart.
We got a chef that'll get you whatever you want.
Do you remember how you ended up in the water? No.
Do you drink? Do drugs? I spend so much time at the office, I never even get a chance to go out for a beer.
Oh, yeah? Where do you work? Investment firm on Wall Street Loffredo & Kohn.
Wait.
I had lunch with my sister.
We ate at a place by the river.
What did you do afterwards? I put her in a cab.
I must have waited half an hour for another one.
I finally gave up and started for the subway.
That's when someone came up behind me, and I got hit over the head.
- You got mugged? - Yeah! I don't remember seeing any, uh, head trauma when we brought you in.
Let's take a look.
I felt the wallet get yanked out of my pocket.
Then everything went black.
Next thing I remember was feeling cold, so cold.
And then I woke up here.
Well, you could've, uh, had a seizure or fainted, which would have caused you to fall into the river.
But I don't know.
I'd like to keep you here overnight, get you a head CT and some blood work.
You got anybody I can call for you? Your sister, maybe? - Uh, yes, her name's Ella.
- All right.
Same last name? Yeah.
She's probably worried sick about me.
Yeah.
That's so weird.
What? Well, people talk about good Samaritans.
I thought they didn't exist.
Just get some sleep, and we'll, uh, check on your sister, track her down.
Dr.
Holt, this is Ella Halloran.
Thanks, Rita.
Michael Holt.
Thanks for coming.
Please have a seat.
Did my brother ask you to contact me? Uh, is that a surprise? Uh, he and I aren't exactly close.
He said you guys had lunch yesterday.
I haven't seen Darren since June.
Why is he here? Um, well, I found him floating in the East River, freezing, in cardiac arrest.
What?! Yeah, he's doing much better now.
He said he was mugged on his way back to work.
Darren hasn't had a job in six months, since he got fired from his firm for erratic behavior.
He missed days of work, never called in.
His boss called me looking for him.
When I pulled him out, he was wearing a business suit.
Well, that's what's so crazy about it.
He lost his job, his fiancée, his loft, but last I saw him, he was still getting up every morning, putting on his suit and going to work.
Where was he off to? I don't know.
He wouldn't talk about it.
He was living with me for a while.
I tried to get him to see a psychiatrist.
Get these off of me.
I'm leaving! Just let me call Dr.
Holt.
Sulla, I got this.
- Mr.
Halloran, calm down, calm down.
- Yeah, Darren.
- Relax.
- What is that bitch doing here? - You asked me to call her.
- Why the hell would I do that, and where are my clothes? Isn't it time you admitted - you're sick? - I'm sick? What kind of sister kicks her own brother out onto the street? One who is tired of being lied to! - You're the liar.
Just like always.
- No.
I never should have come here.
- Good.
Go to hell! - Wait.
I'm leaving, too.
Where's my suit? I had to cut it off you in order to treat you.
What? That cost me $2,000 bucks! Where's my watch? Did you steal that, too? Oh, knock it off; Nobody's trying to steal anything.
I'm trying to help you.
I have to get to work.
Your sister said you were fired months ago.
Yes, I lost my job, and then I got a new one a couple of weeks later.
Well, you can't go to your new one until I read your CT and your labs and make sure you don't drop dead before you walk out of here.
Now, keep the IV in, get back in bed and calm down! Fine but then I'm leaving.
I got a huge market analysis report due.
And don't forget my watch! It's a Rolex! Family reunion didn't go as planned? Sparky's intent on leaving, so gather his belongings and find him something to wear home, wherever that is.
Will do.
By the way, E-Mo just called.
He'll be here in five minutes.
Hmm.
Hey.
Beautiful morning, huh? Ah, speak for yourself.
Well, I guess I'm just still floating on air after doing it literally.
You're gonna have to help me out here.
Had a consult with a sky-diver yesterday.
The guy suddenly developed jitters after years of not thinking twice.
So, I'm not getting through to him.
I'm wondering, maybe it's because I've never done it before, so I did.
- You went sky-diving? - Yup.
- 10,000 feet, right out the door.
- So, now, you're jumping out of planes at the drop of a hat, huh? Hey, whoa, whoa, whoa, whoa.
What? So, you think I'm getting loopy because I might have Huntington's? I think a lot of people facing death develop extreme risk-taking behavior and forget things.
You got to help me out now.
- You missed a VIP intake yesterday.
- No, I didn't.
- That's today.
- No, it was yesterday.
And you sent several prescriptions to the pharmacy without signing them.
Listen, you need to get tested, just so you'll know, one way or another.
Michael, it was an honest mistake.
A scheduling screw-up.
How can I make it up to you? Well, you can assess whether a patient of mine is competent enough to refuse care.
Male drowning victim, status post cardiac arrest.
He was lucid and friendly, and now the guy is delusional and agitated and wants to leave.
I pulled him out of the East River yesterday.
You pull a guy out of the river, and you give me grief over jumping out of a plane? At least I had a parachute.
I'd love to take another couple days off, but there are a million other guys out there gunning for my job.
- Here's your stupid form.
- Mr.
Halloran, are you sure there's no one else we can call to pick you up? I'll be fine.
And you'll be getting a bill for ruining my suit.
So, that's it? Just letting him go? Labs and CT were clear.
You sure he's competent to refuse care? Guy's definitely weird.
He probably has a narcissistic personality disorder, but he's not suicidal, and he could verbalize the risks of leaving.
Guess I'm just surprised you could assess him so quickly.
Hey, do I come into the OR and backseat-drive when you're resecting a tumor? All right, relax.
If you say he's fine, okay.
Hey, you want to go grab an early lunch? Why? So you can eyeball me for Huntington's symptoms? Yeah, I just want to make sure you can read the menu.
The Sushi spot right up here Best unagi you've ever tasted, so, uh Is that Darren? (Horns honking, indistinct shouting) Darren! What the hell is your problem? You must really want to get hit.
Hey, hey, hey, back off, back off! Darren, what are you doing? Dr.
Holt? Yeah.
What? Help me.
I I can't see anything.
Why can't I see? Optic discs are normal.
So did the blindness come on suddenly or in the past few days? Oh, it came out of nowhere.
I started to cross the street, then everything went black.
Is there pain in either eye? Headache? - No.
Please, you gotta help me! - All right, we will.
Just try and relax.
His vision loss is so acute.
He could see just Well, we may be able to save his eyesight.
His head CT was normal, so that rules out trauma.
But he could have a tumor pushing on his optic chiasm or an occipital lobe infarct which would show up on MRI.
No masses, edema, demyelination It's totally clear.
This could be a delayed traumatic retinal detachment.
Ultrasound will show us the back of the eye.
No, that's not it either.
Retina's intact.
Maybe his blindness is hysterical.
Losing his job, his fiancée, causing a psychotic break.
If it is psychological, his eyes should still respond to the spinning pattern on the optokinetic drum.
No.
No nystagmus.
All right, so back to square one.
I'll take a run at the literature.
See if there's a cause for acute blindness we're missing.
Michael! Kate Sykora.
Ed Morris.
She's from my other job.
Oh, E-Mo.
Yeah.
Hi.
I've heard good things.
Oh, well, not as many as I've heard about you.
- I'll catch you later.
- Yeah.
- Good meeting you.
- Yeah.
- So you got a consent for Shari's surgery? - Yeah.
After a mountain of red tape and just about every runaround in the book.
Good.
I'll get her prepped right away.
- Michael? - Mm-hmm.
This girl's been dealt a terrible hand in life.
Basketball is pretty much her only chance of getting into college and a real future.
Then why don't you stick around, and you can keep an eye on me.
Make sure her systolic stays above 120.
Pressure's been stable.
Uh, hanging a second bag now.
I've finished with the laminotomy.
I have access to the epidural space, and I'm going to suction out the hematoma.
What if she starts bleeding again? Worry wart.
Cauterize it on the spot.
Suction.
Whoa, what the hell? What's going on? Temp's just spiked to 103.
Michael.
The fluid collection isn't blood, it's pus.
She's got a raging infection.
Epidural abscess? Yeah.
Is it in the bone? Doesn't look like it.
Put her on broad spectrum antibiotics.
And give her a gram of vancomycin to cover for MRSA.
You heard the doctor.
Let's get this cleaned up.
Well, that was a nasty surprise, huh? Why would a young, healthy athlete have an abscess on her spine? Usually there's a blood infection that seeds the spot.
She have any recent dental work or UTIs? No.
No, and I would know.
I'm pretty obsessive about her health.
No, really? Help me check for Janeway lesions.
You thinking infective endocarditis? Well, septic vegetation on the heart valves can certainly cause epidural abscesses.
I don't see anything.
Well, unless it's something else entirely.
Look, behind her knee.
Track marks? Injecting herself with dirty needles would explain how bacteria got into her blood.
Michael, she's not getting high.
I have known her half her life.
We talk about drugs.
She's a top student, a star basketball player.
She's chasing a scholarship.
All right, so maybe steroids.
She thinks she needs a competitive edge.
No way.
I'm gonna add a steroid panel to her blood work, and you can figure out how she would get 'em.
How'd the game go without Shari? Hey.
We lost by ten, and the scouts had to go home without seeing our star player.
How's she doing? You tell me.
I think you've been practicing sports medicine yourself.
What are you talking about, Sykora? Shari was almost paralyzed by a bad spinal infection The kind that can be caused from steroid use.
- What? - Don't act - so surprised.
- If Shari's doping, she sure as hell didn't get it from me.
Isn't that what the coaches always say? Look, I know how hard you work to get these girls into college.
I saw it when I went to school here.
You bend the rules here and there.
You get bad grades changed.
How far did you go, coach?! Who do you think you are, accusing me?! In 30 years I've never as much as thought about giving a player steroids.
Well, I don't give a damn what you think.
Kate.
Excuse me.
Can we talk? Must be really important for you to come and find me here.
I, uh, I got her lab work back.
And? So she's on steroids, right? The labs were negative for those But positive for opiates.
What? No, that has to be a mistake.
My lab doesn't make mistakes.
How did I miss this? Maybe you weren't looking.
No, I am looking out for her.
A parent's love can blind them to the truth about their kids.
A parent's love? You're supposed to be her mentor, Kate, not her mother.
You know what? I think it's time you just mind your own business.
Yeah, and you should probably just have kids of your own.
Kate.
If I wanted to talk to a shrink, I certainly would not come looking for a neurosurgeon.
- Morning.
- Morning.
So I heard you had to give Kate some bad news about her little sister.
How'd she take it? Wonderfully.
So where are we with Darren? Any new ideas of why he went blind? No, not yet.
You know look Maybe it's just the shrink in me, but I still think there's a psych component.
We should get his sister back in here, plumb through his past I don't know, I don't want to get him all riled up again.
Get 'em off, get 'em off me! Spiders are all over me, biting.
Get 'em off me! Darren, Darren, listen to me, there are no spiders on you.
- Calm down.
- You put them on me! Give me ten milligrams of haloperidol - and hard restraints.
- Darren! They're trying to kill me! There's nothing on you.
Spiders on his skin? What is going on with this guy? I saw a woman in residency She had severe tactile hallucinations after a cocaine overdose, but his tox screen was negative, as was his blood alcohol.
So tactile hallucinations, tremulousness, tachycardia.
Maybe his problem is lack of alcohol.
Delirium tremens? I thought he claimed not to drink.
He also said he's got a terrific job and gets along great with his sister.
D.
T.
's means he's a closet alcoholic and being stuck in here without booze put him into severe withdrawal.
I'll start him on fomepizole and midazolam drip.
Okay, but that still doesn't explain his blindness, though.
Draw a repeat metabolic panel and a blood gas.
Where are you going? Going to pick through trash.
Hey.
I I'm just here to see Shari.
Kate! My legs feel almost normal again.
I already got up twice to go to the bathroom.
I know about the drugs, Shari.
What? No.
I saw the track marks.
Your blood work confirms it.
What I don't understand is why? You have every opportunity in front of you right now.
I've been practicing really hard this year.
Remember when I dislocated my finger and then I sprained my wrist? There was a bunch of other stuff I didn't tell you about.
You were self-medicating? A kid at school sold me some oxycodone.
At first, I swallowed the pills.
Then I crushed 'em up and snorted 'em.
And then one day he ran out of the pills, but he said he had some other stuff.
Heroin.
He gave me the needles, too.
I know I should have told him no, but I was only taking it for pain between games.
Okay, you can't put this all on yourself.
Look, coach has been pushing you too hard.
No, Kate, I've been pushing myself for you.
For me? Kate, you do everything for me.
You come to all my basketball games, you paid for me to go to basketball camp.
You saved me.
I just want to be like you.
I want to go to college on a scholarship, like you.
I'm sorry, I can't let you down.
I don't care about basketball.
I care about you.
But I missed the game, and now I'm not gonna go to college.
There will be other games, there will be other scouts.
The only thing that matters is you getting better.
And I think that the best way for that to happen is for you to go to rehab and for me to take a step back.
No.
Shari, I need to let you go a little.
But that's what I didn't want to happen.
I didn't want to disappoint you and I don't want to lose you.
You are not ever going to lose me.
I just need to give you some space, so you can make your own decisions.
Live the life you want to live.
I will.
I promise.
Welcome back, Darren.
Oh, you're that shrink I spoke to.
Well, if you can see me, then you're doing a lot better.
Think it's time you told the truth, Darren.
Excuse me? You're an alcoholic.
Denying it almost cost you your life.
Dr.
Holt checked my blood.
There was no booze in it.
That's because we were looking for the wrong kind.
You've been guzzling methanol.
You're out of your mind.
Hmm a lot of end-stage alkies like, say, one who's lost his job, his loft, all of his money They can't afford real booze, so they start drinking anything they can get their hands on Rubbing alcohol, even stuff like this.
You think I've been drinking paint thinner? Mm.
Kept you boozed up long enough to keep the lie going; that you had a job, that you and your sister were close.
That's why you had us call her.
In the morning, you were irritated because you needed another drink.
That's why you left.
Problem with methanol is it doesn't metabolize the same as alcohol.
The chemical byproducts attacks the optic nerve, especially when you chug a half can.
That's why you went blind.
All right, get the hell out of here.
You had us stumped there for a while.
Until Dr.
Holt remembered finding you standing in the hallway after you woke up.
Next to a cleaning cart.
You tossed this in the trash.
You thought you got rid of it until he dug it out.
How do you turn this thing off, huh? - Darren.
Cut it out.
- Turn it off! - Unhook all this crap from me! - Darren, Darren, cut it out! Don't you see what denial has already cost you? Your career, your fiancée, your sister.
Nah, I'm good, I swear.
Every I don't drink.
- Everything's fine.
- Darren.
Darren If you don't start facing the truth right now, you're gonna die.
My life was great.
I had it all under control.
And then one day my fiancée came home and said she was leaving, out of nowhere.
Wedding was off.
She just didn't love me anymore.
She was my whole world.
And the booze was the only thing to make the pain go away.
I don't want to die.
I really don't.
Please, can you help me? You've already taken the hardest step.
E-Mo work his magic again? He's good at what he does.
When he's not forgetting more stuff.
Darren's labs - you asked E-Mo for earlier today? - Mm-hmm? He never sent them.
Michael, what aren't you telling me? I can't say.
If you're pulling privilege, it must be medical And bad.
What are you gonna do? Get some air.
You're here.
Good.
Well, that's a first.
I just watched E-Mo knock through a patient's denial like a wrecking ball, but the guy is oblivious to his own.
No one wants to be sick.
Well, I can't let him put patients in danger.
So what's next? Well, if he refuses to get tested, then I have to fire him.
But what? Well, what if he has the disease? - What if he really starts getting sick? - Oh, you mean who'll take care of him? Yeah, well, he's not married; both his parents are dead.
When his brother found out that he had Huntington's, he killed himself.
So E-Mo is all alone.
This is gonna be really tough if he's become a friend.
Nice work.
With Darren.
Really impressive.
Yeah, well, still a long road ahead.
Well, he couldn't have gotten past his denial without your help.
Maybe I can do the same for you.
You think I'm in denial? I think you need to face what you're afraid of.
I could say the same for you.
Well, this isn't about me.
I saw it the first day you hired me, remember? Something in your life you're too scared to face.
Okay, so, Michael, what is it? What-what secret are you hiding? I am not putting my patients in danger.
- You get tested, or you're gone.
- First of all, - I would never put a patient in danger.
- Not knowingly.
But this disease could be taking over day by day, diminishing your skills, warping your judgment.
E-Mo, if you have it, I'll do whatever I can to help you.
I'll adjust your schedule, hire an assistant.
- Look, Michael - But I can't just ignore what's happening and hope for the best.
I already got tested.
When? Yesterday.
When I saw what denial was doing to Darren, I went straight to a guy that I know that runs a genetics lab.
And? I don't know.
I haven't opened it yet.
It's negative for Huntington's.
Great.
Oh, man.
See? That's a hell of a lot easier than jumping out of an airplane.
I-I guess maybe I've been messing up so much because I've been stressed out.
Okay.
Well, it's all behind you now.
I thought I was gonna have to fire you.
Wow.
You know what? I quit.
- What? - A-at least for a while.
You know, Michael I've spent my whole life running.
Afraid.
Too scared to even make friends, because I didn't want them to have to watch my mind just rot away.
I've never even been in love, because I I feel like the darkest cloud in the world just got lifted.
I need to go out and see what it's like to finally live.
All right, well, just take a few days No, no, hold on, hold on, don't worry.
I'll still be on the court next week kicking your ass in basketball.
Hi.
Uh, small coffee to go.
What are the odds in a city of eight million people? Well, weirder things have happened to me.
Do you have a minute? Can you sit? Sure.
- So, I finally got to meet E-Mo.
- Yes, you did.
Just in time.
He quit.
Really? Why? Long story.
Thank you.
So, your, uh your little sister seems to be doing better.
Yeah.
Yeah, no, Shari's gonna be great.
She's got everything she needs to get back on track.
Look, Michael, I owe you an apology.
Nah.
It's all good.
No, you were right I was mothering her.
Harrison and I decided not to have kids when we got married, and, uh you know, it felt right at the time.
Now it's not.
What about you? You want kids? Uh Anna and I, um It wasn't in the cards for us, so I'm sorry.
Uh, excuse me.
Uh, Harrison's out front.
- He is? - Yeah, he managed to change our War Horse tickets to tonight.
I have to go.
Um But I will, uh, see you at the clinic in the morning.
- Bright and early.
- Okay.
Good night.
- Is that why the other docs call you E-Mo you go straight to the touchy-feely? I am double-boarded Neurology and psychiatry.
How would you like to consult for Holt Neuro? I can come by later.
Do that.
Let's get shaking, girls.
It's too early to be tired.
We got a big game tonight! Watch your passing lanes, ladies! All right! Good steal.
Good steal.
Take it all the way.
All right.
All right.
Go ahead, girls.
Go ahead.
All done.
There you go.
And don't forget to do the calf stretches that I gave you, all right? And keep it elevated after practice.
- Thanks, Dr.
Kate.
- Yeah, no problem.
All right, let's go! Come on, Shari! You can hit that shot with your eyes closed.
- Sorry, coach.
- It's all right.
You'll get it next time.
Don't be so hard on her.
- All right, take it.
- Go, Shari.
- Take it.
Take it.
- All right! Shari! Oh, my God.
You all right? Uh, yeah, I think.
Okay, I'm just going to check out your spine.
Oh.
Ow.
Ow.
She needs an X-Ray.
Kate, I'm okay.
See? She can wait till after practice.
Yeah, but I'm the team doctor.
Unofficial title.
And with point tenderness over her thoracic vertebrae, she's getting an X-Ray.
Still a pain, just like when you went to school here.
Go on, take her.
Everyone else, let's go.
Back to practice! Good news no fracture.
So I can play.
Well, you still have a pretty bad spinal contusion.
In other words, a bruise.
Oh, I see you're getting too smart for my fancy medical terms.
Listen, even bruises take time to heal, so I'm going to write you a note for coach You can sit out for a couple of days.
Kate, I have a big game today.
Please don't make me ride the bench.
I'll take it easy, I swear.
Please? All right, but you will come back here after school so I can check you out before the game.
I promise.
Hector, will you schedule Ms.
Jackson for my last appointment this afternoon, please? - No problem, Dr.
Kate.
- Thank you.
Uh, come here for a second.
Guys I want to introduce you to my little sister, Shari.
This is Dr.
Holt, Dr.
Barnes.
- Hi, Shari.
- Hello.
I always took you for an only child.
Kate grew up in my neighborhood.
She came to my middle school on mentor day, and we hit it off.
Luckiest day of my life.
Same here.
Shari's an all-star point guard.
Means, come fall, she's going to play basketball for whichever university is lucky enough to snag her.
Don't believe the hype.
I work with several NBA and WNBA teams, so if you ever want courtside seats for the Knicks or Liberty, just, uh, let me know.
Okay.
Thanks.
Back to school with you.
- Come back in the afternoon, yeah? - Okay already.
What's the deal there? She was abandoned by her mom when she was ten.
Yeah, when I first met her, she wouldn't even raise her voice above a whisper.
She just needed more than her foster parents could give her.
- So you took her under your wing.
- She's great.
Anyone would have.
Kate Sykora-- big sister, clinic director, snappy dresser.
Where do you find the time? When do you have time for your husband? Oh, five minutes here, five minutes there, but only 'cause Harrison's even busier than I am.
Ah.
Although we do make time for date night sometimes, like tonight.
Oh, yeah? I got a date with my running shoes right now before my first consult at Holt.
All right, well, don't freeze to death.
And I'll see you back here at 5:30.
Uh, what am I coming back here for? You are coming back here for the clinic's staff meeting.
That's funny.
It's mandatory for all employees, whether you work here ten hours a week or 24-7 like the rest of us.
Get here early.
I made lemon squares.
That sounds fantastic.
Help! Help, I need help! I'm a doctor, are you okay? It's not me.
It's him; Um, I was painting when he When he stumbled out of nowhere and fell into the water, and I can't get 911.
Try again.
Oh, God, is he dead? I don't know.
Oh, no pulse.
How long was he in the water? About ten minutes.
I still can't get through to 911.
All right, forget the hospital.
I got better rewarming equipment at my practice.
Where? Right there.
And you're gonna drive me.
- How long's he been down? - At least 15, 20 minutes.
Well, no one's dead until they're warm and dead.
He's still cold as ice.
I can't feel his pulse.
What's his temp? Only 79 degrees.
Hooking up the et tube.
I'll ventilate him with warm humidified air.
Somebody get the damn bair hugger or not? Coming right in.
What about the heated saline? Just starting it.
Two lines running wide open.
Checking his rhythm.
He's still got electrical activity.
Looks like fine v-fib.
His heart may still have a chance.
Give me the paddles.
Clear.
Everybody clear.
Still nothing.
Damn it, he's still in v-fib.
Heart's still too cold to shock him into regular rhythm.
It's only come up two degrees.
He'll come up faster if you warm him up from the inside.
Get me a scalpel and a chest tube.
Pleural lavage, that's good thinking.
Cutting the skin.
I'm in the pleura.
And the Kelly.
I'm in.
Okay, start the lavage.
Heated saline going in.
Temp's up to 84.
Try shocking again.
Give me the paddles.
All right, clear.
Temp's up to 94 degrees.
The cold water kept his heart alive.
All right, going it again.
Clear.
That did it.
All right, I got a pulse.
Pressure is 70.
All right, give me suture.
Guy falls in the drink and you run by? Gotta say he's pretty damn lucky.
Only if that freezing water kept his brain cells from dying.
How's our newest member of the polar bear club? Hemodynamically stable, normal brainstem reflexes, still unconscious.
I'm not asking about him.
What? You still got all your fingers and toes? I'm, uh, thawing out nicely.
Michael, we don't need you out there rescuing the city's downtrodden.
Our waiting list is a mile long.
Well, that wasn't my plan, and he's not downtrodden.
He came in wearing a nice designer suit, expensive watch.
What about a wallet? It must've fallen in the river.
We're not gonna know who he is till he wakes up.
Alert the police; Tell them we've got a John Doe.
- In the meantime - Yeah? What the hell is going on with E-Mo? What do you mean? He just missed a VIP consult first thing this morning.
- Did you call him? - About ten times.
I also reminded him last night, and I just got a call from two pharmacies saying he forgot to sign prescriptions.
It probably just slipped his mind.
Last week, your birthday party slipped his mind after I told him about that.
Rita, don't worry.
Everyone has a brain freeze once in a while, even brilliant neuroshrinks.
Then why are you looking so worried, Michael? Apologize to the VIP and put him on my schedule.
Already did.
He'll be in Monday at 2:00.
You're a lifesaver.
Without even getting wet.
Okay, what are you not you telling Rita about E-Mo? E-Mo forgetting stuff might not be an accident.
He may have Huntington's disease.
- Oh, that's terrible.
- Yeah.
Obviously, I can't tell Rita.
But both his father and his brother had it.
What does his test say? He hasn't been tested.
- Why not? - What good would it do? There's no cure.
Well, but if he's already exhibiting symptoms What would you do if you thought you may have Huntington's disease, and there's not a damn thing you could do except suffer miserably, lose all your faculties and die? Would you get tested? I don't know.
Yeah, me either.
Now if you'll excuse me, I have to attend a staff meeting at the clinica.
Oh, I miss those.
I mean, I hated them when I was alive.
But now they sound kind of nice.
Yeah? Sit in for me and report back.
It's a win-win.
I developed this file folder color-coding system.
Yellow for the nurse to see, blue for the docs to see, red when there are doctor's orders.
Any questions? Hector, have you ever thought about, uh, electronic medical records? Great.
Everyone fill out your feedback forms, and have a lemon square.
Is that it? Think I caught a nap there in hour two.
Call me, Shari; I'm starting to worry.
Little sister never showed? Can't even get her on the phone.
Maybe she's feeling better.
Or she's avoiding me.
I doubt that.
The girl adores you.
Yeah, well, exactly.
That's why I'm worried something's wrong.
- Here you are.
- Hi.
- Good to see you, Harrison.
- You too, Michael.
Good, you're ready to go.
- I'm so sorry, honey, I can't.
- What? You have no idea how many favors I called in - to get these tickets.
- I know, but Shari never came back this afternoon.
- So, I have to go look for her.
- Kate, c'mon, she's a responsible kid, thanks to you.
If there were a problem, she'd call.
And isn't this why we decided not to have kids? So we wouldn't have to run after them all the time? She's my responsibility.
You want to go see War Horse? Love to but, uh, I got a patient back at Holt.
So, you're either ignoring my calls or you're the only teenager in America who doesn't check her phone a hundred times a day.
Kate, what are you doing here? I came to see why you broke your promise.
I was gonna come back, I swear.
But coach told me there are college scouts coming to see me play tonight.
I got to bring my "A" game.
You are clearly in pain.
No, my back feels fine.
Not from what I just saw.
Listen, when I was a junior, I pulled a hamstring.
Tried to play through the pain for the big game.
I was out for over a month.
But you won, right? No, we got creamed.
It was a dumb decision.
My back still hurts.
A little.
Anything else? Um My toes feel kinda tingly.
Okay, it's all right.
Look, I'm gonna take you - to get an MRI right away.
- Let's go! It's time to head for the bus.
Coach, Shari can't play tonight.
What do you mean? She told me her X-Ray this morning was fine.
Was she lying? No, but she's also Then let her play, doc.
Tonight's the chance you always wanted for her.
Look, I can get her an MRI with a top neurosurgeon in the city.
While she misses her shot at having college scouts see her play.
There'll be other games.
The big ones are coming tonight.
She can get an MRI after we win.
She could have a spinal injury.
Half my girls are playing with injuries that could be something worse.
You haven't benched any of them.
Shari, it's up to you.
I'll be fine.
I'll pop some ibuprofen after the game and call you.
Coach just wants what you want; For me to get into college.
Shari! Oh, my God! Call an ambulance! Don't move a muscle.
Kate, I can't feel my legs.
She was running up the bleachers, her legs just buckled.
Right, but the X-Ray from this morning's tumble was negative? I thought so, but could I have missed something, a fracture or a spinal injury? Let's wait for the scan.
- Coming up now.
- Good, good.
Okay.
All right, spinal cord's intact, so that's good.
It's very good.
There's a fluid collection in the epidural space between T-12 and L-1, which certainly would not have shown up in the X-Ray.
Probably a bruise on her spine, right? It would explain why her legs gave out.
Must be the blood compressing on her spinal cord.
It's all right.
I'll drain it.
With a little rehab, she'll be sinking three-pointers before you know it.
What's wrong with my legs? That bruise you got earlier? It caused bleeding around your spinal cord.
You're gonna be fine once I operate.
I need surgery? Hold on.
Don't worry.
Dr.
Holt is the best.
A few weeks of physical therapy, and you'll be back on the court.
So for now, you'll have to make due with about 500 cable channels.
- I'll manage.
- Good.
Okay, I'm gonna go scrub up.
Call her foster parents for consent.
Shari's a ward of the state.
I'll have to get permission from ACS.
Well, how long is that gonna take? Uh, look, as soon as I get the go-ahead, I'll let you know.
Okay.
Thank you, Michael.
For what? For letting me bring Shari here, for operating on her.
For everything.
Don't worry about it.
Good night.
Well That was interesting.
Our new patient is Means the world to her.
- Uh-huh.
- Just make sure Ms.
Jackson has everything she wants, okay? What about your other patient, the wet one? You want me to corral him? What the hell? Hey! Where am I? Okay, uh, you're at Holt Neuro.
Here, you need to get back in your room.
So what's your name? Darren Halloran.
All right, I'm Dr.
Holt.
Here, let me help you into bed.
- Oh, thanks.
- Mmm-hmm.
How'd I get here? I pulled you out of the East River.
Really? Really.
Why's my throat hurt so much? Had to put a tube down your throat to get you breathing again.
I'm surprised you could get out of bed.
- Oh, my God.
- Yeah.
I was dead? Pretty damn close.
I woke up a few minutes ago so hungry.
I thought there was food on that cart.
We got a chef that'll get you whatever you want.
Do you remember how you ended up in the water? No.
Do you drink? Do drugs? I spend so much time at the office, I never even get a chance to go out for a beer.
Oh, yeah? Where do you work? Investment firm on Wall Street Loffredo & Kohn.
Wait.
I had lunch with my sister.
We ate at a place by the river.
What did you do afterwards? I put her in a cab.
I must have waited half an hour for another one.
I finally gave up and started for the subway.
That's when someone came up behind me, and I got hit over the head.
- You got mugged? - Yeah! I don't remember seeing any, uh, head trauma when we brought you in.
Let's take a look.
I felt the wallet get yanked out of my pocket.
Then everything went black.
Next thing I remember was feeling cold, so cold.
And then I woke up here.
Well, you could've, uh, had a seizure or fainted, which would have caused you to fall into the river.
But I don't know.
I'd like to keep you here overnight, get you a head CT and some blood work.
You got anybody I can call for you? Your sister, maybe? - Uh, yes, her name's Ella.
- All right.
Same last name? Yeah.
She's probably worried sick about me.
Yeah.
That's so weird.
What? Well, people talk about good Samaritans.
I thought they didn't exist.
Just get some sleep, and we'll, uh, check on your sister, track her down.
Dr.
Holt, this is Ella Halloran.
Thanks, Rita.
Michael Holt.
Thanks for coming.
Please have a seat.
Did my brother ask you to contact me? Uh, is that a surprise? Uh, he and I aren't exactly close.
He said you guys had lunch yesterday.
I haven't seen Darren since June.
Why is he here? Um, well, I found him floating in the East River, freezing, in cardiac arrest.
What?! Yeah, he's doing much better now.
He said he was mugged on his way back to work.
Darren hasn't had a job in six months, since he got fired from his firm for erratic behavior.
He missed days of work, never called in.
His boss called me looking for him.
When I pulled him out, he was wearing a business suit.
Well, that's what's so crazy about it.
He lost his job, his fiancée, his loft, but last I saw him, he was still getting up every morning, putting on his suit and going to work.
Where was he off to? I don't know.
He wouldn't talk about it.
He was living with me for a while.
I tried to get him to see a psychiatrist.
Get these off of me.
I'm leaving! Just let me call Dr.
Holt.
Sulla, I got this.
- Mr.
Halloran, calm down, calm down.
- Yeah, Darren.
- Relax.
- What is that bitch doing here? - You asked me to call her.
- Why the hell would I do that, and where are my clothes? Isn't it time you admitted - you're sick? - I'm sick? What kind of sister kicks her own brother out onto the street? One who is tired of being lied to! - You're the liar.
Just like always.
- No.
I never should have come here.
- Good.
Go to hell! - Wait.
I'm leaving, too.
Where's my suit? I had to cut it off you in order to treat you.
What? That cost me $2,000 bucks! Where's my watch? Did you steal that, too? Oh, knock it off; Nobody's trying to steal anything.
I'm trying to help you.
I have to get to work.
Your sister said you were fired months ago.
Yes, I lost my job, and then I got a new one a couple of weeks later.
Well, you can't go to your new one until I read your CT and your labs and make sure you don't drop dead before you walk out of here.
Now, keep the IV in, get back in bed and calm down! Fine but then I'm leaving.
I got a huge market analysis report due.
And don't forget my watch! It's a Rolex! Family reunion didn't go as planned? Sparky's intent on leaving, so gather his belongings and find him something to wear home, wherever that is.
Will do.
By the way, E-Mo just called.
He'll be here in five minutes.
Hmm.
Hey.
Beautiful morning, huh? Ah, speak for yourself.
Well, I guess I'm just still floating on air after doing it literally.
You're gonna have to help me out here.
Had a consult with a sky-diver yesterday.
The guy suddenly developed jitters after years of not thinking twice.
So, I'm not getting through to him.
I'm wondering, maybe it's because I've never done it before, so I did.
- You went sky-diving? - Yup.
- 10,000 feet, right out the door.
- So, now, you're jumping out of planes at the drop of a hat, huh? Hey, whoa, whoa, whoa, whoa.
What? So, you think I'm getting loopy because I might have Huntington's? I think a lot of people facing death develop extreme risk-taking behavior and forget things.
You got to help me out now.
- You missed a VIP intake yesterday.
- No, I didn't.
- That's today.
- No, it was yesterday.
And you sent several prescriptions to the pharmacy without signing them.
Listen, you need to get tested, just so you'll know, one way or another.
Michael, it was an honest mistake.
A scheduling screw-up.
How can I make it up to you? Well, you can assess whether a patient of mine is competent enough to refuse care.
Male drowning victim, status post cardiac arrest.
He was lucid and friendly, and now the guy is delusional and agitated and wants to leave.
I pulled him out of the East River yesterday.
You pull a guy out of the river, and you give me grief over jumping out of a plane? At least I had a parachute.
I'd love to take another couple days off, but there are a million other guys out there gunning for my job.
- Here's your stupid form.
- Mr.
Halloran, are you sure there's no one else we can call to pick you up? I'll be fine.
And you'll be getting a bill for ruining my suit.
So, that's it? Just letting him go? Labs and CT were clear.
You sure he's competent to refuse care? Guy's definitely weird.
He probably has a narcissistic personality disorder, but he's not suicidal, and he could verbalize the risks of leaving.
Guess I'm just surprised you could assess him so quickly.
Hey, do I come into the OR and backseat-drive when you're resecting a tumor? All right, relax.
If you say he's fine, okay.
Hey, you want to go grab an early lunch? Why? So you can eyeball me for Huntington's symptoms? Yeah, I just want to make sure you can read the menu.
The Sushi spot right up here Best unagi you've ever tasted, so, uh Is that Darren? (Horns honking, indistinct shouting) Darren! What the hell is your problem? You must really want to get hit.
Hey, hey, hey, back off, back off! Darren, what are you doing? Dr.
Holt? Yeah.
What? Help me.
I I can't see anything.
Why can't I see? Optic discs are normal.
So did the blindness come on suddenly or in the past few days? Oh, it came out of nowhere.
I started to cross the street, then everything went black.
Is there pain in either eye? Headache? - No.
Please, you gotta help me! - All right, we will.
Just try and relax.
His vision loss is so acute.
He could see just Well, we may be able to save his eyesight.
His head CT was normal, so that rules out trauma.
But he could have a tumor pushing on his optic chiasm or an occipital lobe infarct which would show up on MRI.
No masses, edema, demyelination It's totally clear.
This could be a delayed traumatic retinal detachment.
Ultrasound will show us the back of the eye.
No, that's not it either.
Retina's intact.
Maybe his blindness is hysterical.
Losing his job, his fiancée, causing a psychotic break.
If it is psychological, his eyes should still respond to the spinning pattern on the optokinetic drum.
No.
No nystagmus.
All right, so back to square one.
I'll take a run at the literature.
See if there's a cause for acute blindness we're missing.
Michael! Kate Sykora.
Ed Morris.
She's from my other job.
Oh, E-Mo.
Yeah.
Hi.
I've heard good things.
Oh, well, not as many as I've heard about you.
- I'll catch you later.
- Yeah.
- Good meeting you.
- Yeah.
- So you got a consent for Shari's surgery? - Yeah.
After a mountain of red tape and just about every runaround in the book.
Good.
I'll get her prepped right away.
- Michael? - Mm-hmm.
This girl's been dealt a terrible hand in life.
Basketball is pretty much her only chance of getting into college and a real future.
Then why don't you stick around, and you can keep an eye on me.
Make sure her systolic stays above 120.
Pressure's been stable.
Uh, hanging a second bag now.
I've finished with the laminotomy.
I have access to the epidural space, and I'm going to suction out the hematoma.
What if she starts bleeding again? Worry wart.
Cauterize it on the spot.
Suction.
Whoa, what the hell? What's going on? Temp's just spiked to 103.
Michael.
The fluid collection isn't blood, it's pus.
She's got a raging infection.
Epidural abscess? Yeah.
Is it in the bone? Doesn't look like it.
Put her on broad spectrum antibiotics.
And give her a gram of vancomycin to cover for MRSA.
You heard the doctor.
Let's get this cleaned up.
Well, that was a nasty surprise, huh? Why would a young, healthy athlete have an abscess on her spine? Usually there's a blood infection that seeds the spot.
She have any recent dental work or UTIs? No.
No, and I would know.
I'm pretty obsessive about her health.
No, really? Help me check for Janeway lesions.
You thinking infective endocarditis? Well, septic vegetation on the heart valves can certainly cause epidural abscesses.
I don't see anything.
Well, unless it's something else entirely.
Look, behind her knee.
Track marks? Injecting herself with dirty needles would explain how bacteria got into her blood.
Michael, she's not getting high.
I have known her half her life.
We talk about drugs.
She's a top student, a star basketball player.
She's chasing a scholarship.
All right, so maybe steroids.
She thinks she needs a competitive edge.
No way.
I'm gonna add a steroid panel to her blood work, and you can figure out how she would get 'em.
How'd the game go without Shari? Hey.
We lost by ten, and the scouts had to go home without seeing our star player.
How's she doing? You tell me.
I think you've been practicing sports medicine yourself.
What are you talking about, Sykora? Shari was almost paralyzed by a bad spinal infection The kind that can be caused from steroid use.
- What? - Don't act - so surprised.
- If Shari's doping, she sure as hell didn't get it from me.
Isn't that what the coaches always say? Look, I know how hard you work to get these girls into college.
I saw it when I went to school here.
You bend the rules here and there.
You get bad grades changed.
How far did you go, coach?! Who do you think you are, accusing me?! In 30 years I've never as much as thought about giving a player steroids.
Well, I don't give a damn what you think.
Kate.
Excuse me.
Can we talk? Must be really important for you to come and find me here.
I, uh, I got her lab work back.
And? So she's on steroids, right? The labs were negative for those But positive for opiates.
What? No, that has to be a mistake.
My lab doesn't make mistakes.
How did I miss this? Maybe you weren't looking.
No, I am looking out for her.
A parent's love can blind them to the truth about their kids.
A parent's love? You're supposed to be her mentor, Kate, not her mother.
You know what? I think it's time you just mind your own business.
Yeah, and you should probably just have kids of your own.
Kate.
If I wanted to talk to a shrink, I certainly would not come looking for a neurosurgeon.
- Morning.
- Morning.
So I heard you had to give Kate some bad news about her little sister.
How'd she take it? Wonderfully.
So where are we with Darren? Any new ideas of why he went blind? No, not yet.
You know look Maybe it's just the shrink in me, but I still think there's a psych component.
We should get his sister back in here, plumb through his past I don't know, I don't want to get him all riled up again.
Get 'em off, get 'em off me! Spiders are all over me, biting.
Get 'em off me! Darren, Darren, listen to me, there are no spiders on you.
- Calm down.
- You put them on me! Give me ten milligrams of haloperidol - and hard restraints.
- Darren! They're trying to kill me! There's nothing on you.
Spiders on his skin? What is going on with this guy? I saw a woman in residency She had severe tactile hallucinations after a cocaine overdose, but his tox screen was negative, as was his blood alcohol.
So tactile hallucinations, tremulousness, tachycardia.
Maybe his problem is lack of alcohol.
Delirium tremens? I thought he claimed not to drink.
He also said he's got a terrific job and gets along great with his sister.
D.
T.
's means he's a closet alcoholic and being stuck in here without booze put him into severe withdrawal.
I'll start him on fomepizole and midazolam drip.
Okay, but that still doesn't explain his blindness, though.
Draw a repeat metabolic panel and a blood gas.
Where are you going? Going to pick through trash.
Hey.
I I'm just here to see Shari.
Kate! My legs feel almost normal again.
I already got up twice to go to the bathroom.
I know about the drugs, Shari.
What? No.
I saw the track marks.
Your blood work confirms it.
What I don't understand is why? You have every opportunity in front of you right now.
I've been practicing really hard this year.
Remember when I dislocated my finger and then I sprained my wrist? There was a bunch of other stuff I didn't tell you about.
You were self-medicating? A kid at school sold me some oxycodone.
At first, I swallowed the pills.
Then I crushed 'em up and snorted 'em.
And then one day he ran out of the pills, but he said he had some other stuff.
Heroin.
He gave me the needles, too.
I know I should have told him no, but I was only taking it for pain between games.
Okay, you can't put this all on yourself.
Look, coach has been pushing you too hard.
No, Kate, I've been pushing myself for you.
For me? Kate, you do everything for me.
You come to all my basketball games, you paid for me to go to basketball camp.
You saved me.
I just want to be like you.
I want to go to college on a scholarship, like you.
I'm sorry, I can't let you down.
I don't care about basketball.
I care about you.
But I missed the game, and now I'm not gonna go to college.
There will be other games, there will be other scouts.
The only thing that matters is you getting better.
And I think that the best way for that to happen is for you to go to rehab and for me to take a step back.
No.
Shari, I need to let you go a little.
But that's what I didn't want to happen.
I didn't want to disappoint you and I don't want to lose you.
You are not ever going to lose me.
I just need to give you some space, so you can make your own decisions.
Live the life you want to live.
I will.
I promise.
Welcome back, Darren.
Oh, you're that shrink I spoke to.
Well, if you can see me, then you're doing a lot better.
Think it's time you told the truth, Darren.
Excuse me? You're an alcoholic.
Denying it almost cost you your life.
Dr.
Holt checked my blood.
There was no booze in it.
That's because we were looking for the wrong kind.
You've been guzzling methanol.
You're out of your mind.
Hmm a lot of end-stage alkies like, say, one who's lost his job, his loft, all of his money They can't afford real booze, so they start drinking anything they can get their hands on Rubbing alcohol, even stuff like this.
You think I've been drinking paint thinner? Mm.
Kept you boozed up long enough to keep the lie going; that you had a job, that you and your sister were close.
That's why you had us call her.
In the morning, you were irritated because you needed another drink.
That's why you left.
Problem with methanol is it doesn't metabolize the same as alcohol.
The chemical byproducts attacks the optic nerve, especially when you chug a half can.
That's why you went blind.
All right, get the hell out of here.
You had us stumped there for a while.
Until Dr.
Holt remembered finding you standing in the hallway after you woke up.
Next to a cleaning cart.
You tossed this in the trash.
You thought you got rid of it until he dug it out.
How do you turn this thing off, huh? - Darren.
Cut it out.
- Turn it off! - Unhook all this crap from me! - Darren, Darren, cut it out! Don't you see what denial has already cost you? Your career, your fiancée, your sister.
Nah, I'm good, I swear.
Every I don't drink.
- Everything's fine.
- Darren.
Darren If you don't start facing the truth right now, you're gonna die.
My life was great.
I had it all under control.
And then one day my fiancée came home and said she was leaving, out of nowhere.
Wedding was off.
She just didn't love me anymore.
She was my whole world.
And the booze was the only thing to make the pain go away.
I don't want to die.
I really don't.
Please, can you help me? You've already taken the hardest step.
E-Mo work his magic again? He's good at what he does.
When he's not forgetting more stuff.
Darren's labs - you asked E-Mo for earlier today? - Mm-hmm? He never sent them.
Michael, what aren't you telling me? I can't say.
If you're pulling privilege, it must be medical And bad.
What are you gonna do? Get some air.
You're here.
Good.
Well, that's a first.
I just watched E-Mo knock through a patient's denial like a wrecking ball, but the guy is oblivious to his own.
No one wants to be sick.
Well, I can't let him put patients in danger.
So what's next? Well, if he refuses to get tested, then I have to fire him.
But what? Well, what if he has the disease? - What if he really starts getting sick? - Oh, you mean who'll take care of him? Yeah, well, he's not married; both his parents are dead.
When his brother found out that he had Huntington's, he killed himself.
So E-Mo is all alone.
This is gonna be really tough if he's become a friend.
Nice work.
With Darren.
Really impressive.
Yeah, well, still a long road ahead.
Well, he couldn't have gotten past his denial without your help.
Maybe I can do the same for you.
You think I'm in denial? I think you need to face what you're afraid of.
I could say the same for you.
Well, this isn't about me.
I saw it the first day you hired me, remember? Something in your life you're too scared to face.
Okay, so, Michael, what is it? What-what secret are you hiding? I am not putting my patients in danger.
- You get tested, or you're gone.
- First of all, - I would never put a patient in danger.
- Not knowingly.
But this disease could be taking over day by day, diminishing your skills, warping your judgment.
E-Mo, if you have it, I'll do whatever I can to help you.
I'll adjust your schedule, hire an assistant.
- Look, Michael - But I can't just ignore what's happening and hope for the best.
I already got tested.
When? Yesterday.
When I saw what denial was doing to Darren, I went straight to a guy that I know that runs a genetics lab.
And? I don't know.
I haven't opened it yet.
It's negative for Huntington's.
Great.
Oh, man.
See? That's a hell of a lot easier than jumping out of an airplane.
I-I guess maybe I've been messing up so much because I've been stressed out.
Okay.
Well, it's all behind you now.
I thought I was gonna have to fire you.
Wow.
You know what? I quit.
- What? - A-at least for a while.
You know, Michael I've spent my whole life running.
Afraid.
Too scared to even make friends, because I didn't want them to have to watch my mind just rot away.
I've never even been in love, because I I feel like the darkest cloud in the world just got lifted.
I need to go out and see what it's like to finally live.
All right, well, just take a few days No, no, hold on, hold on, don't worry.
I'll still be on the court next week kicking your ass in basketball.
Hi.
Uh, small coffee to go.
What are the odds in a city of eight million people? Well, weirder things have happened to me.
Do you have a minute? Can you sit? Sure.
- So, I finally got to meet E-Mo.
- Yes, you did.
Just in time.
He quit.
Really? Why? Long story.
Thank you.
So, your, uh your little sister seems to be doing better.
Yeah.
Yeah, no, Shari's gonna be great.
She's got everything she needs to get back on track.
Look, Michael, I owe you an apology.
Nah.
It's all good.
No, you were right I was mothering her.
Harrison and I decided not to have kids when we got married, and, uh you know, it felt right at the time.
Now it's not.
What about you? You want kids? Uh Anna and I, um It wasn't in the cards for us, so I'm sorry.
Uh, excuse me.
Uh, Harrison's out front.
- He is? - Yeah, he managed to change our War Horse tickets to tonight.
I have to go.
Um But I will, uh, see you at the clinic in the morning.
- Bright and early.
- Okay.
Good night.