Transplant (2020) s02e03 Episode Script
Sever
I already bought my flight pass,
so I'll be able to go back and forth for
even five times a week.
I want you to know, we don't have to jump into anything.
- What? - Placement was wrong, I think I perforated an organ.
Call for blood! Does this man speak to you? Sometimes.
Are you comfortable discussing why you were arrested? Doctors who treat rebels, the the Regime doesn't like that.
Has there been some kind of change or reminder that provoked these memories? We've spoken before about triggers.
And when they happen, you want to fix things.
I have seen enough to know that.
And your way of doing that is by running into burning buildings trying to save someone else.
It makes you feel in control.
The thing is, post-traumatic stress is like a faucet.
Once open, it keeps on flowing, Bash, whether you like it or not.
Are you saying I can't stop it? You can find healthy ways to live with it.
Like letting yourself feel the memories and talking about it instead of shouldering it alone.
Hey, this is progress.
All we're doing here is learning to recognize your triggers so you can control how to react to them.
Hmm.
Are you looking at apartments? I told you, man, you can stay with me as long as you want.
It's not for me, it's for Rania.
She's still having a hard time finding something.
I didn't see you come home last night.
I was in my room, I was on a very important task.
Mel was wiped, so I covered homework and bedtime All on video call? Yeah, we made a game out of it.
I was Robot dad.
And it went over really well with Mel.
She's flying in tonight and we're gonna out for dinner.
- That's good.
- Did Rania ever find a job? Not yet.
The government helps out for the first year, but she needs to find a place and a lot of landlords are hesitant about newcomers.
- Long night? - Yeah.
Are you finished soon? Another hour.
Remember Sonja Jessup? You know, when Bishop misread the ultrasound? And I punctured her spleen.
Hard to forget that one.
Well, her case is up at the Morbidity and Mortality rounds today.
I've sat in on a few M&Ms rounds, but never one of my own patients.
Then you know they're purely educational and anonymous.
You have nothing to worry about, Bash.
Does Bishop? Good morning.
Incoming trauma.
- I'm on it.
- Ah, you look tired, Leblanc.
Doctor Hamed, get changed, meet me outside.
ETA one minute.
Um, Doctor Novak, assuming I have time between patients, I'd like to attend the M&M rounds today.
- The case in question is mine - Oh.
No spoilers.
The whole point is an impartial review of adverse outcomes and I'm the one leading it.
But by all means join us.
We'll figure out what went wrong.
A guy sliced his femoral apparently.
It's gonna be bloody.
Please don't let him die! You need to wait out here.
Heart rate's 135, BP's crashing! Checking his artery.
Her skate sliced through his femoral, I can clamp it but IVC's flat.
He's hypovolemic.
That doesn't bode well for what's happening below the knee.
It's bad news for a figure skater.
He's exsanguinating! Activate MTP, I need two large bore IV's.
Four units, O-neg.
Rhoda, page vascular! Might not be enough.
Ever do an intravascular shunt back home? Yes, but they don't do it here, as a rule.
Then we make a new rule.
The shunt increases the odds when it comes to saving a limb.
Hemorrhagic shock.
Pulseless Vfib Start bagging and compressing.
Rhoda, one shot epi! If we can save this kid and his leg, why wouldn't we? Make do with what you can find.
Don't stop compressions, Claire.
Rhoda, prepare to defibrillate.
200 joules.
Be ready on my mark.
Doctor Hamed's going to build us a bridge, delivering blood from above Vince's injury to below it.
Here? Without vascular? Exciting, right? - Charged! - Clear! - Sinus rhythm.
- Let's hope it flows Beautiful.
Good job, everybody.
I haven't thrown up this much since university.
Should have brought a toothbrush.
We've got some mouthwash once you're done.
Don't hold your breath.
It's been non-stop for two hours.
Anything to eat or drink this morning beforehand? I've been trying to drink more milk, for the calcium.
I was on my phone so I wasn't paying attention when I poured it.
- It had already expired.
- No, but something else had.
Is that a mouse? A very dead mouse.
In the milk.
That I drank.
- You seem remarkably calm.
- Trust me, I wasn't.
Screamed so loud that my cute neighbour came to check on me.
Which is when the puking started.
Well, it's essentially food poisoning.
Your body's natural reaction of expelling what you've ingested.
We'll run some blood work and get you rehydrated.
Thank you so much! Hey, I'm not on the board.
Because the board is yours.
Congratulations, Doctor Curtis.
- I got Chief Resident? - It wasn't unanimous, but your surgical record swayed a few holdouts.
That internal decapitation you caught, the team you put together for that aggressive abdominal tumour, those were things people noticed.
One year term, first review in three months.
You'll lead morning rounds today.
Get a sense of who's got what on their plate, make assignments and any patient that's coming through emerg is your responsibility whether you're covering it or not.
- Oh, I start now? - Best way to learn.
Also you should know that the competition was stiff and will be unhappy.
Welcome to the deep end.
It doesn't matter where I took him, Matt.
Well, you gave up the right to know how he is.
No.
He I'm hanging up now! I'm sorry, I didn't, ah You're the mother? That room was empty.
He was finally asleep.
I've been trying to get the school to stop calling his father when he's absent, but they keep forgetting to take him off the damn list even though he doesn't have custody.
- When did his fever start? - A couple days ago.
It keeps coming back when the Tylenol wears off.
At first I thought he was just tired, but then, he didn't sleep at all last night.
We went to two walk-ins this morning and they said the wait was gonna be hours - and I'm supposed to be at work.
- He shouldn't be at school with a temperature over 38 anyway.
You also said to our triage nurse something about a toothache? Yeah.
He had a cold and then he said one of his bottom teeth was bugging him.
He stopped mentioning it, but I figured I should tell them.
What did his dentist say? Well, I switched jobs, and my benefits don't kick in for another month Matt, Eamon's father, he has better dental, but We can't use that anymore.
Eamon? I'm Theo.
Mind if I take a quick peek in your mouth there? Yeah? Roll over for me.
Perfect, alright, open wide.
Good.
Okay.
I'm gonna go talk to your mom for a second, okay? We'll have to check his white blood cell count and have a dentist weigh in, but it could be that an abscess led to an infection.
I figured it was just a cavity that could wait a couple weeks.
He needed a new winter coat, so Did I screw up? We have an oral surgeon on call.
She'll take a look.
If she has to drain the abscess, it'll be covered under provincial health care.
Doctor Bishop.
How are you feeling? Fine, gathering strength.
I wasn't sure you'd make it in today, I'm glad you did.
I'm not here for the M&M if that's what you mean.
I'm here as a patient.
You know, Doctor Novak, he's running the session.
And he's Yes, yes, we've established.
Wants my job.
He's picked a good case to take up, plenty to learn from what happened.
So, how come you won't If I'm there, others won't feel free to speak openly.
But if you're not, then Novak might malign my good name? My name can take it.
It's not your fight, Doctor Hamed.
- Congrats, June.
- Thanks, Erica.
- Hopefully, we can work together.
- Don't we already? And hey, I asked Alex to show me his system on consults and OR assignments in case I got the job but I don't mind walking you through it.
I'll figure it out, but thank you.
What the hell is that? I'm asking Public Health to test it.
Patient found it in a bag of milk.
Like, after they drank from it? - Mm-hmm.
- Argh - Oh, my God! June! - What? You got the job! Chief Resident! - Oh, my God! It's amazing! - Thank you.
Any blowback from the other applicants? If there is I'll just have to tune it out and do the work.
Something I feel like you might know all about? Is he still keeping you out of traumas? Or telling me I'm doing them wrong.
Anyway as soon as Public Health is on board, my shift's over.
You should know Mr.
Conor in three needs a scope.
- Possible ulcer.
- Oh, okay.
- I'm so happy for you, June - Are you gonna hug me again? Boundaries, please.
Trish? How's Vincent? He's doing well, he's stable and about to go into surgery.
Nothing like this has ever happened to us before.
How long have you two been Together? Ten years.
People always ask if we're a couple but we basically grew up on the ice, so more like siblings, partners.
It's hard to explain.
One of the nurses recognized your names.
You skate for the country? I'm sorry, I'm not familiar with the sport.
It's not like we're famous.
You need to be ranked 25th or better in the world to make it on the National team and qualify for the Olympics.
Right now we're 42nd.
That's still very impressive.
Vincent's been asking for you.
He looks so pale That's normal for someone who lost so much blood.
It's okay.
Are you okay? Are you seriously asking me that? - My blade almost killed you.
- Because I dropped you! - What went wrong, T? - I don't know.
But I've been running it through in my head so when we get back out there - Trish.
- Coming into that turn, if my freeside's forward and yours is out Trish.
Doctor Hamed's saying this operation could put me out for six months.
Six months? The blade sliced very deep, severing tissue and muscle, and our vascular surgeons might have to take more to permanently repair Vincent's artery.
We won't know the extent until they go in.
But everything we've worked for.
This was our shot.
And if we miss the whole season This can't be happening.
I'll get it right this time Get what right? Roland says we should be extensions of each other so I need to keep practicing.
What? He was our first coach, when we were kids.
- We haven't seen him in years.
- Trish? I need help in here! What's wrong with her? She may have fallen on her head.
We need to get her to CT, check for signs of concussion or skull fracture.
Find us a stretcher.
- Doctor Hamed, wait.
- What is it, Vincent? She's been taking something.
She doesn't know that I know.
- Doctor Curtis? - Yeah? Mr.
Conor was asking about us sending him home when this happened.
Did your stomach pain get worse? - Yeah.
- Okay.
Based on your history, it's probably a bleeding ulcer or gastritis.
Hey, I called for a scope for him like an hour ago.
Any idea why no one came to get him? A resident needs to be assigned for that.
I'm gonna take you up myself.
And I will ask Erica Harris to cover me in emerg.
Can you get us a chair? We'll give your wife a call, let her know what's going on, okay? Heard you were looking for me? He started breathing heavy a few minutes ago - and saying his head hurts? - Okay.
Eamon, could you sit up for me? Okay, good.
Take some big breaths, buddy.
Okay.
You can sit back down.
Perfect.
I heard from the oral surgeon.
She says there was a ruptured abscess which likely led to the infection.
How long's he had these marks? I don't know.
I've never noticed them.
Arnold? EKG.
Page cardio stat.
Copy that.
Eamon, I need you to take a big breath and hold it for me, okay? What's happening to him? Good job.
Those marks on his hands and feet are called Janeway lesions.
What that tells me is that Eamon's heart is throwing out tiny little blood clots.
And I heard a murmur when I listened.
In his heart?! What does that have to do with a toothache? Mommy, I'm scared.
That's okay, baby.
What do we do when we feel afraid? Huh? Take a deep breath, we put our scariest face and we say Go away fear! Okay, that's good.
Eamon may have something called endocarditis, it's an infection in one or more of the valves of the heart.
Sometimes, oral infections can travel to other parts of the body when left unchecked.
- When left unchecked.
- We'll do X-rays to confirm and an echo to see if or how it affected his heart function.
And if it has, how do you fix it? That depends on how far it's progressed.
Cardiology will tell us if he needs surgery or if it can be managed with medication.
Hi.
Arnold here is going to put some stickers on your chest, okay, Eamon? I promise you, it won't hurt one bit.
But it might tickle a little bit.
You think I'm a bad mom for leaving it so long.
- I never meant to imply - Maybe not.
But you did.
Look, Eamon's dad was abusive.
And about six months ago, it got real bad, so we got out.
And I don't want him to know where we are.
Ever.
But that also means not taking his money, so that means Eamon has to live with less because I can't give him everything he needs.
And now my little boy's heart Please help him.
Hey, Cam! I'm sorry! I know you only have 45 minutes, I'm sorry! I lied.
I have 90.
- You ordered anyway? - I was starving, sorry.
And you're actually earlier than I thought.
Oh, my God, this woman drank an entire bag of milk before she realized there was a dead mouse in it.
I had to stay and fill out paperwork and it just took me way longer to convince Public Health to get it tested for hantavirus, just forever.
Well, there's my appetite.
My sister, Magalie, James.
And that's on the low end of weird for her.
Just a coffee for now, James, thank you.
This is for you.
Their war against clutter continues.
Doctor Mann.
Twelve.
It's just, you know, when like the entire essence of your being offends someone? It's kind of hard not to start believing it.
You can't just tell him off? No! No, that would really make things worse for me.
Are you gonna eat that? You're not gonna eat that.
More labs on Trish Albrecht.
Head CT's normal.
Her transaminase levels are way too high.
There's something in her system.
Maybe what her partner said might explain that.
But I can't just come out and accuse her.
M&M rounds today.
You heard about what's being discussed? I tried to tell him.
There is a toxin in your body, Trish.
It's damaging your liver.
We need to know if there's anything you've taken or ingested.
Even too much acetaminophen can lead to this.
We won't know if we can reverse or stop the damage if we can't isolate the cause.
Supplements.
They're supposed to be natural.
Supplements from a pharmacy? One of the trainers at our club gets them online.
Do you know what's in them? Muscle proteins, beta-alines.
Nothing illegal.
- Performance enhancers? - No! No HGH.
Nothing banned that would show up on a drug test.
Vincent doesn't know.
How long have you been taking these? A few months.
After I fell and hurt my knee.
But I'm gonna be okay, right? The IV fluids are flushing your system.
Now that we know the cause, we'll look for a way to stop the damage.
And if you can't? Let's take it one step at a time.
We'll see how you respond to treatment and we'll take it from there.
We're 22.
And I know that sounds young but There's always stronger skaters coming up behind you.
And if we don't make it this season I did this to us.
34-year-old patient with multiple undiagnosed AVMs.
Pleural effusion required a chest tube.
The attending physician guided placement via ultrasound while the Resident managed insertion, after which there was a sudden withdrawal of frank blood, indicative of splenic laceration.
Our agenda with these rounds is to examine what happened and to invite discussion about how to prevent similar outcomes in the future.
Seems simple enough.
The Attending misread the ultrasound.
Thanks, Doctor Singh.
Yes.
There was a lapse in vision caused by a medical condition Keep going.
After which the Resident misplaced the tube.
That's addressed in the chart, and the case notes.
Human fallibility.
So, in other words, it's pretty dull from a clinical perspective.
Why then, Doctor Novak, did you want us taking up this case today? You're asking the right question, Wendy.
We know how it happened, but not why.
And when you tug that particular thread, things get interesting.
Systemic failure of leadership led to this entirely preventable incident.
How'd I do, Sunita? You know the drill when it comes to the Motor Assessment Scale, Doctor Bishop.
You get your score at the end.
Now, this next one's timed.
What I'd like you to do now is pinch between your thumb and forefinger, then middle, ring, and little finger, as fast as you can.
Okay.
Are you ready to start? As fast as you can, Doctor Bishop.
Then change hands, please.
That's fine, you can rest.
This shouldn't have happened.
It's on record that the Attending suffered a significant brain injury months earlier.
Doctor Novak, as you acknowledged, the Attending physician admitted that his medical condition led to the error.
Acute vision loss.
Unless you're saying his vision loss wasn't just "in the moment"? No, I think since you're asking that question, it's worth exploring.
Is that for all my hard work? Now with your right arm, take a jellybean from one cup, and place it in the next.
Now with your left.
Bugger.
I can't We'll try this one again next time.
You're suggesting the Attending was aware of his deficiencies and risked patients anyway? That's a hell of an allegation.
And not the point of this forum.
Logging my failures? In this room, we call them opportunities.
Not sure a trauma patient needing treatment would see it that way.
There's still work to do, sir, but it's nothing to be afraid of.
What are the odds that this was the first time he presented the symptom? And yet no one on his team raised any objection to him practicing? I mean, we're not a shy bunch.
Why not speak up? Did people fear repercussions? Was there a culture of fear in our emergency department? That's not what happened.
The Attending, and everyone knows you mean Doctor Bishop, fosters an environment of open communication.
And as the aforementioned Resident in this case, I can confirm that he invites us to push back.
Then why didn't you? How was it that a staff of fully trained physicians, who diagnose patients that they've just met every day, couldn't spot even the tiniest indication that something was wrong with him? Because he was hiding it.
He knew he wasn't recovering properly from his head injury though he did know how bad it was.
But that lack of judgment was his.
No one else's.
What the hell, June.
I was just in surgery.
Scoping some bloody ulcers.
The guy's fine.
GI's in there, sealing them up now.
Just got to keep him overnight.
A patient I know nothing about.
Okay, I thought I was responsible for assigning the residents to OR's? So you assigned yourself? Without finding anyone to cover emerg? I know it's your first day but, man! Harris said she was on it.
Doctor Harris is in OR seven on a whipple.
I can't be micromanaging you like this, June.
You've been given a team, use it.
Hey.
Everything okay? With me, yes.
But you sound upset.
- What's wrong? - Just a busy day I'm fine.
Uh, the place I found.
Did you go see it? But they said they'd take care of the references.
Okay, well, let me call them back.
Actually I have found something else.
A Syrian friend from class has an extra room.
Near Keele and Lawrence.
And the people you'll be living with? I just met them.
Three women and two men.
One of whom may or may not already want to marry me.
I'm kidding.
What, about him wanting to marry you? Or that you'll be living with people you don't know? Bashir, I can take care of myself.
I know.
It's just Yes.
Of course.
Ah, yes.
Singing and crude jokes.
You'll love it.
Ah, Rania, I have to go.
She's in and out, still confused.
Her sats are low and her blood ammonia level came back high.
Hypotensive, tachycardic.
AST, ALT, bilirubin all spiking.
She's in acute liver failure.
Encephalopathy grade 3, that's the threshold for intubation, right? Otherwise she's at risk of not protecting her airway? Yes.
I'll sedate her, and you call RT for intubation and insert an OG tube for lactulose.
Claire? What you said in there Did Doctor Bishop ask you to do that? I'll let you know when she's intubated.
- How are you feeling, Vincent? - Can I see Trish? She's not awake.
We're doing our best to look after her.
Was it her head? - No.
- Then I was right.
What did those things do to her? Trish is in acute liver failure.
No, don't tell me that.
I didn't say anything.
I could have stopped her from taking them.
But she was getting stronger and we were having our best year.
Can you help her? We're doing everything we can, but if we don't slow the toxicity down soon She could die? I'm sorry, Vincent.
It's a possibility.
She's always had to work harder physically But we joke that she's the artist and I keep us tethered to reality.
And I let her fall.
You got an early flight? The girls've probably already talked your folks into buying them an armload of candy.
- I'm sure they have.
- I know I said I could duck out early, but it's been busy today.
I did, however, snag us a 9PM table.
You could go early, sit with a glass of wine.
Mel, what's wrong? It's not working, Theo.
Since when? I've been trying so hard to make this work for us.
I know you have.
I do.
But it's not enough.
It'll get better.
I promise.
Once I settle in, I'll be less scattered.
We'll have more time to figure this all out.
I'm not happy, Theo.
No.
Mel.
I can fix that, I know I can.
You can't.
Because when you chose this, you didn't choose me.
Okay.
Okay, so Then I un-choose it.
I'll come home and we'll go back to the original plan.
Please don't try telling me you want to come home.
It's too late for that.
The past month, you doing this job, it's the happiest I've seen you for so long.
You can still be a great dad to your daughters.
I'm sorry.
Me too.
I'm going to go.
Where have you been, Doctor Curtis? We can't be left scrambling for surgical consults - when you're not here.
- I know, I'm sorry.
We managed, you'll learn.
It's good to see you coming up in the world, Doctor Curtis.
Did he really say all that stuff about Bishop? I just hate that man.
Doctor Curtis to ICU.
Doctor Curtis, ICU.
Go.
Better hurry.
Okay.
She needs mannitol and hypertonic saline.
She just started convulsing.
A decorticate posturing.
You're thinking cerebral edema? - Mm-hmm.
- Well I mean, it is a statistical complication of liver injury.
I'll get a CT to confirm.
But if we're right, she'll need a craniotomy to drain the fluid from her brain.
Okay.
I'll prime a neurosurgeon.
What the hell, Erica? I thought I asked you to cover for emerg.
A senior oncologist needed me in surgery.
I was supposed to say no? You could have asked somebody else, you could've paged me! You told me you didn't need help learning the system.
You know you need backups for your backups, right? Is that the emergency craniotomy? Who's assisting? I assigned another resident.
But you can be the backup.
Hey! Heard about the other figure skater.
Quite the pair, those two.
Listen, I'm glad you punched back earlier.
It's how those sessions are supposed to be.
Lively.
Illuminating.
You look up to Bishop.
I get that.
He's a brilliant guy.
He took a chance on me.
Now you feel like your survival here depends on him.
I know what it's like to need his approval.
It's like his residents are starving, and he controls the food supply.
That may have been your experience with him, it's not mine.
Doctors from your country, it's not easy to get your credentials out.
I looked into your file.
There's no medical transcripts there.
There's just a sworn statement from Bishop saying he swears they exist.
They do.
What are you saying? Just that I know how it feels when his approval doesn't come.
If you need anybody else in your corner, I'm there.
Remember that, Doctor Hamed.
Hey, hey! - You're back.
- And you're still here.
Why does it feel like the last 12 hours since I've seen you have been one minute? Does that mean it was a good first day? More like an ongoing ordeal of just disappointing everyone? - June.
- Oh, yeah.
It's Doctor Singh.
I wonder what else I messed up.
It will be okay.
This came back for you.
But Public Health is supposed to be testing it.
I spent an hour on hold and I talked to two people.
When did you have the time to do that? This morning after my shift.
And I know, I know.
You think it was a waste of energy.
And the person who makes the final decision at Public Health agrees.
Unless the patient's symptomatic for hantavirus, which yours was not, they're not gonna test the mouse because she isn't at risk.
Okay, then why are you giving it back to me? Oh, I thought, knowing you, you might want to dissect it and test it yourself? Or at least give it a proper burial.
Listeria outbreak in a U of T dorm.
Curtains are starting to line up.
Sorry, Mags.
Have a fun night.
I spoke with the cardiologist again.
Everyone's confident that he'll be able to fight off the infection without surgery and avoid any damage to his heart.
Um, they said he could be here on IV antibiotics for weeks.
Is there someone else who can help you manage? Grandparents or? No, we're alone together, him and me.
You didn't do anything wrong, Christie.
He needed a dentist and I bought him a coat.
And I'm supposed to know what's best for him, but, every decision has consequences.
We don't know what they are when we make them.
You're an amazing mom.
What was the last thing that he said after asking about your transcripts.
That if I needed an ally and you weren't around, I could turn to him.
Why do you think I sent Claire in there today? I was protecting my team, taking responsibility.
All you did by getting involved was make things worse.
- For both of us! - But you were not defending yourself! I told you this was not your fight! I know.
It's yours.
So why won't you fight it? Trish.
They said you came through okay.
- I did this to us, Vin.
- And I let you.
I knew what you were doing, and I didn't say anything.
How did we get so out of sync? Fear? I know I was afraid of all of this being for nothing.
I had to find a way to keep going for us.
You know, I've been sitting here, Trish, hoping you'd survive and thinking.
We've been picking each other up since we were kids, we can get up from this too.
Where does this leave us? Vincent's surgeons said 12 weeks, and I could try to give you a specific timeframe, but You two have been beating the odds all day.
Hey.
Doctor Harris told me about you losing your temper.
Of course she did.
Is that why you paged me? She wasn't wrong to leave emerg.
Someone with more weight needed her.
One of the things you learn as a boss, even in middle management, is how to live with people not liking you.
Uh, yeah, I'm fine with people not liking me.
You're the one who keeps telling me that I need to politick, and delegate and what was it? Yeah, trust them.
I didn't say it would be easy.
Anyway.
This is why I paged you.
Two please.
Actually, I have to get back, Doctor Singh.
Oh, come on, it's a rite of passage.
And the dinner of overworked doctors everywhere.
Today's mistakes are over.
Got any onions? So, this would be the first place I rented in this city with two bedrooms.
Since now.
But Theo's was always going to be temporary.
Actually, I was thinking you could move in here, with me and Amira.
The bedroom.
I'll take the couch.
You just finished telling me this is the first place you've rented with two bedrooms and you're already back to sleeping on the couch? I don't mind.
Rania, I'm serious.
You don't think it's a little fast? Fast.
We've already lost so much time.
I don't need to be saved, Bashir.
Maybe I do.
I want you to know, we don't have to jump into anything.
- What? - Placement was wrong, I think I perforated an organ.
Call for blood! Does this man speak to you? Sometimes.
Are you comfortable discussing why you were arrested? Doctors who treat rebels, the the Regime doesn't like that.
Has there been some kind of change or reminder that provoked these memories? We've spoken before about triggers.
And when they happen, you want to fix things.
I have seen enough to know that.
And your way of doing that is by running into burning buildings trying to save someone else.
It makes you feel in control.
The thing is, post-traumatic stress is like a faucet.
Once open, it keeps on flowing, Bash, whether you like it or not.
Are you saying I can't stop it? You can find healthy ways to live with it.
Like letting yourself feel the memories and talking about it instead of shouldering it alone.
Hey, this is progress.
All we're doing here is learning to recognize your triggers so you can control how to react to them.
Hmm.
Are you looking at apartments? I told you, man, you can stay with me as long as you want.
It's not for me, it's for Rania.
She's still having a hard time finding something.
I didn't see you come home last night.
I was in my room, I was on a very important task.
Mel was wiped, so I covered homework and bedtime All on video call? Yeah, we made a game out of it.
I was Robot dad.
And it went over really well with Mel.
She's flying in tonight and we're gonna out for dinner.
- That's good.
- Did Rania ever find a job? Not yet.
The government helps out for the first year, but she needs to find a place and a lot of landlords are hesitant about newcomers.
- Long night? - Yeah.
Are you finished soon? Another hour.
Remember Sonja Jessup? You know, when Bishop misread the ultrasound? And I punctured her spleen.
Hard to forget that one.
Well, her case is up at the Morbidity and Mortality rounds today.
I've sat in on a few M&Ms rounds, but never one of my own patients.
Then you know they're purely educational and anonymous.
You have nothing to worry about, Bash.
Does Bishop? Good morning.
Incoming trauma.
- I'm on it.
- Ah, you look tired, Leblanc.
Doctor Hamed, get changed, meet me outside.
ETA one minute.
Um, Doctor Novak, assuming I have time between patients, I'd like to attend the M&M rounds today.
- The case in question is mine - Oh.
No spoilers.
The whole point is an impartial review of adverse outcomes and I'm the one leading it.
But by all means join us.
We'll figure out what went wrong.
A guy sliced his femoral apparently.
It's gonna be bloody.
Please don't let him die! You need to wait out here.
Heart rate's 135, BP's crashing! Checking his artery.
Her skate sliced through his femoral, I can clamp it but IVC's flat.
He's hypovolemic.
That doesn't bode well for what's happening below the knee.
It's bad news for a figure skater.
He's exsanguinating! Activate MTP, I need two large bore IV's.
Four units, O-neg.
Rhoda, page vascular! Might not be enough.
Ever do an intravascular shunt back home? Yes, but they don't do it here, as a rule.
Then we make a new rule.
The shunt increases the odds when it comes to saving a limb.
Hemorrhagic shock.
Pulseless Vfib Start bagging and compressing.
Rhoda, one shot epi! If we can save this kid and his leg, why wouldn't we? Make do with what you can find.
Don't stop compressions, Claire.
Rhoda, prepare to defibrillate.
200 joules.
Be ready on my mark.
Doctor Hamed's going to build us a bridge, delivering blood from above Vince's injury to below it.
Here? Without vascular? Exciting, right? - Charged! - Clear! - Sinus rhythm.
- Let's hope it flows Beautiful.
Good job, everybody.
I haven't thrown up this much since university.
Should have brought a toothbrush.
We've got some mouthwash once you're done.
Don't hold your breath.
It's been non-stop for two hours.
Anything to eat or drink this morning beforehand? I've been trying to drink more milk, for the calcium.
I was on my phone so I wasn't paying attention when I poured it.
- It had already expired.
- No, but something else had.
Is that a mouse? A very dead mouse.
In the milk.
That I drank.
- You seem remarkably calm.
- Trust me, I wasn't.
Screamed so loud that my cute neighbour came to check on me.
Which is when the puking started.
Well, it's essentially food poisoning.
Your body's natural reaction of expelling what you've ingested.
We'll run some blood work and get you rehydrated.
Thank you so much! Hey, I'm not on the board.
Because the board is yours.
Congratulations, Doctor Curtis.
- I got Chief Resident? - It wasn't unanimous, but your surgical record swayed a few holdouts.
That internal decapitation you caught, the team you put together for that aggressive abdominal tumour, those were things people noticed.
One year term, first review in three months.
You'll lead morning rounds today.
Get a sense of who's got what on their plate, make assignments and any patient that's coming through emerg is your responsibility whether you're covering it or not.
- Oh, I start now? - Best way to learn.
Also you should know that the competition was stiff and will be unhappy.
Welcome to the deep end.
It doesn't matter where I took him, Matt.
Well, you gave up the right to know how he is.
No.
He I'm hanging up now! I'm sorry, I didn't, ah You're the mother? That room was empty.
He was finally asleep.
I've been trying to get the school to stop calling his father when he's absent, but they keep forgetting to take him off the damn list even though he doesn't have custody.
- When did his fever start? - A couple days ago.
It keeps coming back when the Tylenol wears off.
At first I thought he was just tired, but then, he didn't sleep at all last night.
We went to two walk-ins this morning and they said the wait was gonna be hours - and I'm supposed to be at work.
- He shouldn't be at school with a temperature over 38 anyway.
You also said to our triage nurse something about a toothache? Yeah.
He had a cold and then he said one of his bottom teeth was bugging him.
He stopped mentioning it, but I figured I should tell them.
What did his dentist say? Well, I switched jobs, and my benefits don't kick in for another month Matt, Eamon's father, he has better dental, but We can't use that anymore.
Eamon? I'm Theo.
Mind if I take a quick peek in your mouth there? Yeah? Roll over for me.
Perfect, alright, open wide.
Good.
Okay.
I'm gonna go talk to your mom for a second, okay? We'll have to check his white blood cell count and have a dentist weigh in, but it could be that an abscess led to an infection.
I figured it was just a cavity that could wait a couple weeks.
He needed a new winter coat, so Did I screw up? We have an oral surgeon on call.
She'll take a look.
If she has to drain the abscess, it'll be covered under provincial health care.
Doctor Bishop.
How are you feeling? Fine, gathering strength.
I wasn't sure you'd make it in today, I'm glad you did.
I'm not here for the M&M if that's what you mean.
I'm here as a patient.
You know, Doctor Novak, he's running the session.
And he's Yes, yes, we've established.
Wants my job.
He's picked a good case to take up, plenty to learn from what happened.
So, how come you won't If I'm there, others won't feel free to speak openly.
But if you're not, then Novak might malign my good name? My name can take it.
It's not your fight, Doctor Hamed.
- Congrats, June.
- Thanks, Erica.
- Hopefully, we can work together.
- Don't we already? And hey, I asked Alex to show me his system on consults and OR assignments in case I got the job but I don't mind walking you through it.
I'll figure it out, but thank you.
What the hell is that? I'm asking Public Health to test it.
Patient found it in a bag of milk.
Like, after they drank from it? - Mm-hmm.
- Argh - Oh, my God! June! - What? You got the job! Chief Resident! - Oh, my God! It's amazing! - Thank you.
Any blowback from the other applicants? If there is I'll just have to tune it out and do the work.
Something I feel like you might know all about? Is he still keeping you out of traumas? Or telling me I'm doing them wrong.
Anyway as soon as Public Health is on board, my shift's over.
You should know Mr.
Conor in three needs a scope.
- Possible ulcer.
- Oh, okay.
- I'm so happy for you, June - Are you gonna hug me again? Boundaries, please.
Trish? How's Vincent? He's doing well, he's stable and about to go into surgery.
Nothing like this has ever happened to us before.
How long have you two been Together? Ten years.
People always ask if we're a couple but we basically grew up on the ice, so more like siblings, partners.
It's hard to explain.
One of the nurses recognized your names.
You skate for the country? I'm sorry, I'm not familiar with the sport.
It's not like we're famous.
You need to be ranked 25th or better in the world to make it on the National team and qualify for the Olympics.
Right now we're 42nd.
That's still very impressive.
Vincent's been asking for you.
He looks so pale That's normal for someone who lost so much blood.
It's okay.
Are you okay? Are you seriously asking me that? - My blade almost killed you.
- Because I dropped you! - What went wrong, T? - I don't know.
But I've been running it through in my head so when we get back out there - Trish.
- Coming into that turn, if my freeside's forward and yours is out Trish.
Doctor Hamed's saying this operation could put me out for six months.
Six months? The blade sliced very deep, severing tissue and muscle, and our vascular surgeons might have to take more to permanently repair Vincent's artery.
We won't know the extent until they go in.
But everything we've worked for.
This was our shot.
And if we miss the whole season This can't be happening.
I'll get it right this time Get what right? Roland says we should be extensions of each other so I need to keep practicing.
What? He was our first coach, when we were kids.
- We haven't seen him in years.
- Trish? I need help in here! What's wrong with her? She may have fallen on her head.
We need to get her to CT, check for signs of concussion or skull fracture.
Find us a stretcher.
- Doctor Hamed, wait.
- What is it, Vincent? She's been taking something.
She doesn't know that I know.
- Doctor Curtis? - Yeah? Mr.
Conor was asking about us sending him home when this happened.
Did your stomach pain get worse? - Yeah.
- Okay.
Based on your history, it's probably a bleeding ulcer or gastritis.
Hey, I called for a scope for him like an hour ago.
Any idea why no one came to get him? A resident needs to be assigned for that.
I'm gonna take you up myself.
And I will ask Erica Harris to cover me in emerg.
Can you get us a chair? We'll give your wife a call, let her know what's going on, okay? Heard you were looking for me? He started breathing heavy a few minutes ago - and saying his head hurts? - Okay.
Eamon, could you sit up for me? Okay, good.
Take some big breaths, buddy.
Okay.
You can sit back down.
Perfect.
I heard from the oral surgeon.
She says there was a ruptured abscess which likely led to the infection.
How long's he had these marks? I don't know.
I've never noticed them.
Arnold? EKG.
Page cardio stat.
Copy that.
Eamon, I need you to take a big breath and hold it for me, okay? What's happening to him? Good job.
Those marks on his hands and feet are called Janeway lesions.
What that tells me is that Eamon's heart is throwing out tiny little blood clots.
And I heard a murmur when I listened.
In his heart?! What does that have to do with a toothache? Mommy, I'm scared.
That's okay, baby.
What do we do when we feel afraid? Huh? Take a deep breath, we put our scariest face and we say Go away fear! Okay, that's good.
Eamon may have something called endocarditis, it's an infection in one or more of the valves of the heart.
Sometimes, oral infections can travel to other parts of the body when left unchecked.
- When left unchecked.
- We'll do X-rays to confirm and an echo to see if or how it affected his heart function.
And if it has, how do you fix it? That depends on how far it's progressed.
Cardiology will tell us if he needs surgery or if it can be managed with medication.
Hi.
Arnold here is going to put some stickers on your chest, okay, Eamon? I promise you, it won't hurt one bit.
But it might tickle a little bit.
You think I'm a bad mom for leaving it so long.
- I never meant to imply - Maybe not.
But you did.
Look, Eamon's dad was abusive.
And about six months ago, it got real bad, so we got out.
And I don't want him to know where we are.
Ever.
But that also means not taking his money, so that means Eamon has to live with less because I can't give him everything he needs.
And now my little boy's heart Please help him.
Hey, Cam! I'm sorry! I know you only have 45 minutes, I'm sorry! I lied.
I have 90.
- You ordered anyway? - I was starving, sorry.
And you're actually earlier than I thought.
Oh, my God, this woman drank an entire bag of milk before she realized there was a dead mouse in it.
I had to stay and fill out paperwork and it just took me way longer to convince Public Health to get it tested for hantavirus, just forever.
Well, there's my appetite.
My sister, Magalie, James.
And that's on the low end of weird for her.
Just a coffee for now, James, thank you.
This is for you.
Their war against clutter continues.
Doctor Mann.
Twelve.
It's just, you know, when like the entire essence of your being offends someone? It's kind of hard not to start believing it.
You can't just tell him off? No! No, that would really make things worse for me.
Are you gonna eat that? You're not gonna eat that.
More labs on Trish Albrecht.
Head CT's normal.
Her transaminase levels are way too high.
There's something in her system.
Maybe what her partner said might explain that.
But I can't just come out and accuse her.
M&M rounds today.
You heard about what's being discussed? I tried to tell him.
There is a toxin in your body, Trish.
It's damaging your liver.
We need to know if there's anything you've taken or ingested.
Even too much acetaminophen can lead to this.
We won't know if we can reverse or stop the damage if we can't isolate the cause.
Supplements.
They're supposed to be natural.
Supplements from a pharmacy? One of the trainers at our club gets them online.
Do you know what's in them? Muscle proteins, beta-alines.
Nothing illegal.
- Performance enhancers? - No! No HGH.
Nothing banned that would show up on a drug test.
Vincent doesn't know.
How long have you been taking these? A few months.
After I fell and hurt my knee.
But I'm gonna be okay, right? The IV fluids are flushing your system.
Now that we know the cause, we'll look for a way to stop the damage.
And if you can't? Let's take it one step at a time.
We'll see how you respond to treatment and we'll take it from there.
We're 22.
And I know that sounds young but There's always stronger skaters coming up behind you.
And if we don't make it this season I did this to us.
34-year-old patient with multiple undiagnosed AVMs.
Pleural effusion required a chest tube.
The attending physician guided placement via ultrasound while the Resident managed insertion, after which there was a sudden withdrawal of frank blood, indicative of splenic laceration.
Our agenda with these rounds is to examine what happened and to invite discussion about how to prevent similar outcomes in the future.
Seems simple enough.
The Attending misread the ultrasound.
Thanks, Doctor Singh.
Yes.
There was a lapse in vision caused by a medical condition Keep going.
After which the Resident misplaced the tube.
That's addressed in the chart, and the case notes.
Human fallibility.
So, in other words, it's pretty dull from a clinical perspective.
Why then, Doctor Novak, did you want us taking up this case today? You're asking the right question, Wendy.
We know how it happened, but not why.
And when you tug that particular thread, things get interesting.
Systemic failure of leadership led to this entirely preventable incident.
How'd I do, Sunita? You know the drill when it comes to the Motor Assessment Scale, Doctor Bishop.
You get your score at the end.
Now, this next one's timed.
What I'd like you to do now is pinch between your thumb and forefinger, then middle, ring, and little finger, as fast as you can.
Okay.
Are you ready to start? As fast as you can, Doctor Bishop.
Then change hands, please.
That's fine, you can rest.
This shouldn't have happened.
It's on record that the Attending suffered a significant brain injury months earlier.
Doctor Novak, as you acknowledged, the Attending physician admitted that his medical condition led to the error.
Acute vision loss.
Unless you're saying his vision loss wasn't just "in the moment"? No, I think since you're asking that question, it's worth exploring.
Is that for all my hard work? Now with your right arm, take a jellybean from one cup, and place it in the next.
Now with your left.
Bugger.
I can't We'll try this one again next time.
You're suggesting the Attending was aware of his deficiencies and risked patients anyway? That's a hell of an allegation.
And not the point of this forum.
Logging my failures? In this room, we call them opportunities.
Not sure a trauma patient needing treatment would see it that way.
There's still work to do, sir, but it's nothing to be afraid of.
What are the odds that this was the first time he presented the symptom? And yet no one on his team raised any objection to him practicing? I mean, we're not a shy bunch.
Why not speak up? Did people fear repercussions? Was there a culture of fear in our emergency department? That's not what happened.
The Attending, and everyone knows you mean Doctor Bishop, fosters an environment of open communication.
And as the aforementioned Resident in this case, I can confirm that he invites us to push back.
Then why didn't you? How was it that a staff of fully trained physicians, who diagnose patients that they've just met every day, couldn't spot even the tiniest indication that something was wrong with him? Because he was hiding it.
He knew he wasn't recovering properly from his head injury though he did know how bad it was.
But that lack of judgment was his.
No one else's.
What the hell, June.
I was just in surgery.
Scoping some bloody ulcers.
The guy's fine.
GI's in there, sealing them up now.
Just got to keep him overnight.
A patient I know nothing about.
Okay, I thought I was responsible for assigning the residents to OR's? So you assigned yourself? Without finding anyone to cover emerg? I know it's your first day but, man! Harris said she was on it.
Doctor Harris is in OR seven on a whipple.
I can't be micromanaging you like this, June.
You've been given a team, use it.
Hey.
Everything okay? With me, yes.
But you sound upset.
- What's wrong? - Just a busy day I'm fine.
Uh, the place I found.
Did you go see it? But they said they'd take care of the references.
Okay, well, let me call them back.
Actually I have found something else.
A Syrian friend from class has an extra room.
Near Keele and Lawrence.
And the people you'll be living with? I just met them.
Three women and two men.
One of whom may or may not already want to marry me.
I'm kidding.
What, about him wanting to marry you? Or that you'll be living with people you don't know? Bashir, I can take care of myself.
I know.
It's just Yes.
Of course.
Ah, yes.
Singing and crude jokes.
You'll love it.
Ah, Rania, I have to go.
She's in and out, still confused.
Her sats are low and her blood ammonia level came back high.
Hypotensive, tachycardic.
AST, ALT, bilirubin all spiking.
She's in acute liver failure.
Encephalopathy grade 3, that's the threshold for intubation, right? Otherwise she's at risk of not protecting her airway? Yes.
I'll sedate her, and you call RT for intubation and insert an OG tube for lactulose.
Claire? What you said in there Did Doctor Bishop ask you to do that? I'll let you know when she's intubated.
- How are you feeling, Vincent? - Can I see Trish? She's not awake.
We're doing our best to look after her.
Was it her head? - No.
- Then I was right.
What did those things do to her? Trish is in acute liver failure.
No, don't tell me that.
I didn't say anything.
I could have stopped her from taking them.
But she was getting stronger and we were having our best year.
Can you help her? We're doing everything we can, but if we don't slow the toxicity down soon She could die? I'm sorry, Vincent.
It's a possibility.
She's always had to work harder physically But we joke that she's the artist and I keep us tethered to reality.
And I let her fall.
You got an early flight? The girls've probably already talked your folks into buying them an armload of candy.
- I'm sure they have.
- I know I said I could duck out early, but it's been busy today.
I did, however, snag us a 9PM table.
You could go early, sit with a glass of wine.
Mel, what's wrong? It's not working, Theo.
Since when? I've been trying so hard to make this work for us.
I know you have.
I do.
But it's not enough.
It'll get better.
I promise.
Once I settle in, I'll be less scattered.
We'll have more time to figure this all out.
I'm not happy, Theo.
No.
Mel.
I can fix that, I know I can.
You can't.
Because when you chose this, you didn't choose me.
Okay.
Okay, so Then I un-choose it.
I'll come home and we'll go back to the original plan.
Please don't try telling me you want to come home.
It's too late for that.
The past month, you doing this job, it's the happiest I've seen you for so long.
You can still be a great dad to your daughters.
I'm sorry.
Me too.
I'm going to go.
Where have you been, Doctor Curtis? We can't be left scrambling for surgical consults - when you're not here.
- I know, I'm sorry.
We managed, you'll learn.
It's good to see you coming up in the world, Doctor Curtis.
Did he really say all that stuff about Bishop? I just hate that man.
Doctor Curtis to ICU.
Doctor Curtis, ICU.
Go.
Better hurry.
Okay.
She needs mannitol and hypertonic saline.
She just started convulsing.
A decorticate posturing.
You're thinking cerebral edema? - Mm-hmm.
- Well I mean, it is a statistical complication of liver injury.
I'll get a CT to confirm.
But if we're right, she'll need a craniotomy to drain the fluid from her brain.
Okay.
I'll prime a neurosurgeon.
What the hell, Erica? I thought I asked you to cover for emerg.
A senior oncologist needed me in surgery.
I was supposed to say no? You could have asked somebody else, you could've paged me! You told me you didn't need help learning the system.
You know you need backups for your backups, right? Is that the emergency craniotomy? Who's assisting? I assigned another resident.
But you can be the backup.
Hey! Heard about the other figure skater.
Quite the pair, those two.
Listen, I'm glad you punched back earlier.
It's how those sessions are supposed to be.
Lively.
Illuminating.
You look up to Bishop.
I get that.
He's a brilliant guy.
He took a chance on me.
Now you feel like your survival here depends on him.
I know what it's like to need his approval.
It's like his residents are starving, and he controls the food supply.
That may have been your experience with him, it's not mine.
Doctors from your country, it's not easy to get your credentials out.
I looked into your file.
There's no medical transcripts there.
There's just a sworn statement from Bishop saying he swears they exist.
They do.
What are you saying? Just that I know how it feels when his approval doesn't come.
If you need anybody else in your corner, I'm there.
Remember that, Doctor Hamed.
Hey, hey! - You're back.
- And you're still here.
Why does it feel like the last 12 hours since I've seen you have been one minute? Does that mean it was a good first day? More like an ongoing ordeal of just disappointing everyone? - June.
- Oh, yeah.
It's Doctor Singh.
I wonder what else I messed up.
It will be okay.
This came back for you.
But Public Health is supposed to be testing it.
I spent an hour on hold and I talked to two people.
When did you have the time to do that? This morning after my shift.
And I know, I know.
You think it was a waste of energy.
And the person who makes the final decision at Public Health agrees.
Unless the patient's symptomatic for hantavirus, which yours was not, they're not gonna test the mouse because she isn't at risk.
Okay, then why are you giving it back to me? Oh, I thought, knowing you, you might want to dissect it and test it yourself? Or at least give it a proper burial.
Listeria outbreak in a U of T dorm.
Curtains are starting to line up.
Sorry, Mags.
Have a fun night.
I spoke with the cardiologist again.
Everyone's confident that he'll be able to fight off the infection without surgery and avoid any damage to his heart.
Um, they said he could be here on IV antibiotics for weeks.
Is there someone else who can help you manage? Grandparents or? No, we're alone together, him and me.
You didn't do anything wrong, Christie.
He needed a dentist and I bought him a coat.
And I'm supposed to know what's best for him, but, every decision has consequences.
We don't know what they are when we make them.
You're an amazing mom.
What was the last thing that he said after asking about your transcripts.
That if I needed an ally and you weren't around, I could turn to him.
Why do you think I sent Claire in there today? I was protecting my team, taking responsibility.
All you did by getting involved was make things worse.
- For both of us! - But you were not defending yourself! I told you this was not your fight! I know.
It's yours.
So why won't you fight it? Trish.
They said you came through okay.
- I did this to us, Vin.
- And I let you.
I knew what you were doing, and I didn't say anything.
How did we get so out of sync? Fear? I know I was afraid of all of this being for nothing.
I had to find a way to keep going for us.
You know, I've been sitting here, Trish, hoping you'd survive and thinking.
We've been picking each other up since we were kids, we can get up from this too.
Where does this leave us? Vincent's surgeons said 12 weeks, and I could try to give you a specific timeframe, but You two have been beating the odds all day.
Hey.
Doctor Harris told me about you losing your temper.
Of course she did.
Is that why you paged me? She wasn't wrong to leave emerg.
Someone with more weight needed her.
One of the things you learn as a boss, even in middle management, is how to live with people not liking you.
Uh, yeah, I'm fine with people not liking me.
You're the one who keeps telling me that I need to politick, and delegate and what was it? Yeah, trust them.
I didn't say it would be easy.
Anyway.
This is why I paged you.
Two please.
Actually, I have to get back, Doctor Singh.
Oh, come on, it's a rite of passage.
And the dinner of overworked doctors everywhere.
Today's mistakes are over.
Got any onions? So, this would be the first place I rented in this city with two bedrooms.
Since now.
But Theo's was always going to be temporary.
Actually, I was thinking you could move in here, with me and Amira.
The bedroom.
I'll take the couch.
You just finished telling me this is the first place you've rented with two bedrooms and you're already back to sleeping on the couch? I don't mind.
Rania, I'm serious.
You don't think it's a little fast? Fast.
We've already lost so much time.
I don't need to be saved, Bashir.
Maybe I do.