Transplant (2020) s02e04 Episode Script
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I've been trying so hard
to make this work for us.
When you chose this, you didn't choose me.
I know we've had our differences.
Why don't you just tell me why you spoke to my boss.
I have stomach cancer.
I was thinking you could move in here, with me and Amira.
[ALARM CLOCK RINGING.]
[GENTLE MUSIC.]
[INDISTINCT.]
[RHYTHMIC MUSIC PLAYING.]
[GIGGLING.]
No, you have to bend your knees.
Not that much! [INDISTINCT CHATTER.]
Your arms have to be looser.
[LAUGHING.]
Living in sin with me and praying in the morning, Bashir? We could fix that.
Call the Imam, get married.
You and Amira can do your dance at the party.
That may be my least romantic proposal since, uh, your first one.
I got a yes then, didn't I? [CHUCKLING.]
What will you do today? Amira's lending me her tech skills.
I don't mind paying the bills while you study English and figure out your qualifications.
I know that.
But I want to work.
And maybe we'll organize her room.
Put away some of the mess she moved in here with.
Yeah, she keeps anything with a story.
After everything over these years, I'm going to work on a Saturday, and I'm not worried about leaving her home alone.
[CITY HUBBUB.]
[KNOCKING.]
[GENTLE MUSIC.]
Didn't hear you get up.
Oh, I thought a walk would do me good.
Excited to reclaim your office? That's up to the committee.
Are you nervous? I'll update them on how I am doing, and they'll either agree that I'm ready to come back to work or - they won't.
- When you say update? The truth, Claire.
And what are you gonna say if they ask about what Novak said during the M&M rounds? That I instill a culture of fear? I'll tell them that Dr.
Novak had the unfortunate luck of working under me when I was less charming.
Had worse when I was a resident, though I never remember publicly flogging any of my bosses for it.
Is that okay? Yeah.
And on the subject of you ignoring your symptoms that led to your stroke? Well, let's hope 30 years here buy some clemency.
Are you sure you want this again, Jed? I should go up there.
[GENTLE MUSIC.]
- Mr.
Neal? - Hey.
Hi, I'm Dr.
Leblanc.
I heard you had a bit of fall today.
- Do you mind if I take a look? - Yeah.
Okay.
Yeah, this'll need sutures.
Can you tell me where else it hurts? Uh, well, my stomach got the worst of it.
Yeah.
Okay, lie down for me please? Here we go, let's see here.
[INHALES SHARPLY.]
Hmm.
Where did you fall exactly? Hum.
I didn't fall.
The truth is, yeah, I borrowed money from the wrong guy and I lost it in a card game.
He didn't take it so well.
Okay, so you're saying that he beat you up? Sometimes you eat the bear, sometimes the bear eats you? No, but we can call the police if you want to file a report.
Thanks.
I think I'm just gonna call this a lesson learned - and move on.
- Okay.
Did you lose consciousness or feel dizzy at all? - No.
- Any nausea? Vomiting? - Trouble with your eyesight? - No.
I mean, not from this.
- What do you mean? - Well, I get double vision sometimes, but you know, the larger problem is I don't know how to fight.
I'm gonna do an ultrasound on your abdomen.
Okay.
This might be cool.
I bet your boyfriend wouldn't get his ass handed to him like this.
[CHUCKLES.]
Unless you're single.
Which I will be, when my wife finds out how much money I lost.
[AWKWARD CHUCKLE.]
There's fluid around your spleen.
- Uh Is that a bad thing? - No, not necessarily, but we need to make sure there's no organ damage.
So we'll do imaging to be sure.
I'll be back soon to stitch the cut on your cheek.
- Thank you.
- 'Course.
Theo.
I keep forgetting to give these back.
Well, you may have moved on, but your things haven't.
Can you come by this week and get the rest of it? Well, I called the junk service.
They were supposed Well, they didn't.
You've been gone two weeks, your things are mixed in with mine and there's the Sudbury stuff and it's just - Theo, I'm - Forget it.
I'll deal with it.
Sending Mr.
Neal to CT, flagging a potential low-grade splenic injury.
He just admitted to being in a fight so I want to keep him until we get the full picture.
Couple hours monitoring will do, Leblanc.
Don't follow the poor guy home and cook him soup.
Multiple traumas incoming.
EMS reports a boy with hypothermia and a woman sliced by a boat propeller losing blood volume, both pulled from Lake Ontario.
Dr.
Hamed, we'll take the mom.
[DRAMATIC MUSIC.]
Let me go! Witnesses say they turned too sharp and capsized.
His core temp's down to 30.
Rate's 65, BP's 95 on 53.
Resp rate's 13, and no telling how much water he took in.
It's okay, okay.
Whoa, whoa, whoa Okay, on three.
One, two, three.
Don't! Everything's gonna be okay, Owen.
Arnold, heating blankets.
No! Stop! Okay, we need a line and warmed oxygen.
Warmed IV fluids too.
No! [WHIMPERING.]
Okay.
[HEAVY BREATHING.]
My husband, did he make it? We're looking for him, ma'am.
Two large-bore IVs, cross-match and give two units O-neg.
Get her on a monitor! Somebody, please My son.
He's here.
He has hypothermia, he's being warmed.
He has SPD.
- What's SPD? - Sensory Processing Disorder.
It's a kind of neurodivergence.
[LABOURED BREATHING.]
: Sounds, lights, touch.
They all set him off.
Rhoda, make sure Dr.
Hunter knows.
It's really important we get you warmed up.
Okay, pal? - Warmed O2's ready.
- No, Owen, I need you to stay down.
- Don't touch me! - Resp rate's falling.
Ketamine? Dr.
Hunter.
Okay, okay, we're not touching you, okay? GCS is seven.
Radial and ulnar pulses are absent.
Brachial artery is severed.
Okay, buddy, we know about your condition and we're here to help.
Owen, your temperature's too low, we need to bring it back up, okay? I know you don't like the feeling of the blanket, but even a few minutes will really help us.
I've never seen SPD before.
Is it the warming blankets? - It's everything.
- What do you want to do? - [SIGHS.]
- We don't have a choice.
We're gonna hold you down for just a second.
Okay, Owen? We're going to give you some medicine with a needle - to make you sleepy.
- No! Not nee no, no, no! [SCREAMING.]
No, no, no! [INDISTINCT CHATTER.]
[SCREAMING.]
It's done buddy, it's done, it's done.
It's okay, it's okay.
OR's on standby, guys.
She might not survive the trip up.
What's the call here, Dr.
Hamed? Protocol would be transfusions to stabilize her blood pressure.
And if that's not her best shot? Since when do you let protocol stand in your way? We fix the bleed here.
Brachial plexus block for anesthesia.
1% xylocaine, 10 cc syringe, 18 and 25 gauge needle with a catheter.
Let's go.
Now if I had made this call when I was a resident, I would've been called dangerous.
And if you'd made the other call? Waiting and risking her life? Short-sighted and irresponsible.
BP's 85.
Still no word on her husband? Sorry about the wait.
I'll do your sutures now.
Lot of action out there? Uh, it's just a normal Saturday for us.
At least you're never bored.
So imaging does show a rupture to your spleen.
But it's minor, a grade one, which means it'll heal by itself.
I can also refer you to an ophthalmologist.
Occasional double vision is normally related to dryness, but it wouldn't hurt to see a specialist.
I'm seeing fine now.
[NERVOUS LAUGHTER.]
Excuse me.
- Oh.
- Look straight.
This won't take long.
You smell good.
- Mr.
Neal.
- What? Come on - [GASPS.]
- Stop! Come on.
You've been flirting with me all morning.
[GRUNTS.]
[CRIES OUT.]
[CLATTERING.]
- [PANTING.]
- Hey, whoa! [CRIES OUT.]
Get off me, man! I didn't do anything! - Calm down.
- Come on! Ow! - [PANTING.]
- Mags? Calm down! Come with me.
It's okay.
- [GRUNTING, YELLING.]
- It's over.
Hey.
You okay? [PANTING.]
Is this the father from the boat? It took them longer to find him.
They had to resuscitate.
No pain response.
O2 sats are down to 90.
Let's get him on a 100 % oxygen.
Do we have a GCS? Three.
And no pupillary reflex.
He's showing every sign of brain death.
I'll confirm with EEG and, uh, tell the mom.
I'll go see the kid.
[SIRENS BLARING IN THE DISTANCE.]
Well, he made a couple comments, but I didn't think too much of it.
What happened next, Mags? Well, then he grabbed me, you know, and I pushed him to try to get loose.
Good.
Good for you.
And then that's when he got angry, and he shoved me, and then Lou came in and tried to grab him before he could, - you know - I just heard.
Mags? I'm fine.
Are you back? So it would seem.
- The police are here.
- I'll go talk to them.
Dr.
Atwater can handle it.
Find Mags when they need a statement.
I'll take over her patient as well.
Thanks, Wendy.
Let's keep things as they are for this morning, while I get my bearings.
We'll talk later about how my transition back will work.
Sir.
Hold on a minute, doctor.
- What? - Do you need to take the day? No.
No, I'd just really want to keep moving.
I'm gonna tell Dr.
Atwater that his splenic rupture makes sense, but he also complained of double vision, and I offered him a referral, but he he wasn't interested, so.
I've missed our differentials.
Me too.
How have you been, this last month? Hum Dr.
Novak has his own way of doing things, I guess, and I was just getting used to it.
I'm sorry this happened to you.
It shouldn't have.
I'm really happy you're back.
[INDISTINCT CHATTER.]
They told me you were up, Olivia.
And uh, the pain meds aren't helping? I can put in a catheter to get you on a continuous infusion of a local anesthetic.
Owen.
How is he? His temperature's rising.
We had to sedate him, but his doctors are aware of his condition.
[SIGHS.]
And Eli? A nurse said he's here, but won't say how he is.
Your husband, um He he was pulled out of the lake and resuscitated.
But he went without oxygen for too long and his brain is no longer functioning.
What? No.
That can't be.
He's on mechanical ventilator and it's it's the only thing keeping him alive.
- What? - Olivia.
Eli is not going to recover.
Oh, God No.
If there's anything we can do.
Well, you can save him.
Please.
[SOBBING.]
Oh, God.
I'm very sorry.
[SOFT MUSIC.]
You've been pretty brave today, pal.
I know we didn't get off to a great start.
I'm sorry about the needle.
I also know you don't like the way the blankets feel.
Your body isn't warming up on its own, so I need you to speak up if there's anything we're doing that makes you feel bad, or anything we can do to make things easier.
Good news is you get to see your mom soon.
I want to see my dad.
I'm fine.
Guys.
Okay, I'm okay.
Okay, so uh, the trops from the patient in four came back negative.
It's just a stable angina so I can discharge with No, no, I'll take it.
- Thank you.
- Yeah.
Dr.
Bishop, hi.
It's good to have you back, sir.
Alright, enough gawking.
Everybody back to work.
- Sir.
When did you decide to - The intensivist wants to know if Eli Rosenthal's family has made a decision yet.
Not yet.
I should check on his wife.
Sir.
Ibuprofen? Thank you.
- His wife's arrived.
- Hmm.
I knew he was a creep.
I knew it.
Just didn't follow my instincts, you know, completely You didn't cause this.
He did.
He made a decision and put you in a situation.
And now I have to live with it.
How's she doing? Somewhere between didn't happen and can't stop thinking about it.
[SIGHING.]
Mr.
Eldridge? - Can I have a look? - Sure.
[GROANS.]
[EXHALES SHARPLY.]
Hernia.
It was barely a bump two months ago.
My GP offered to refer a surgeon, but I said let's wait and see.
Look, if you're worried about the surgery, don't be, okay? We can do it laparoscopically, so it's through small incisions.
You'll be out of here by today or tomorrow.
And uh, if it's not laparo? Sir, if you can avoid the pain of open surgery.
I can take the pain.
Oh.
Well And, you can call my sister, tell her I need the support? She'll take it more seriously if it comes from you.
I explained all the benefits of laparo to Mr.
Eldridge, and he still wants open surgery.
First, I was thinking drug seeker.
Oh.
Even pain seeker.
I've seen those before too.
You said he didn't let his GP address the issue early on.
Yeah.
I think he just wants to milk this experience - for all it's worth.
- Hmm.
So your last follow-up with my father.
You know I can't discuss an on-going patient.
Yeah, he's just not great at relaying important details.
He seems like a guy trying his best to stay in good spirits.
Hmm.
We can get Mr.
Eldridge in today, but you need to document everything.
Get it in writing that he chose open surgery AMA.
Yeah, I think I just need one more shot to change his mind.
Dr.
Curtis, if he's got a legitimate fear of laparoscopy He doesn't.
Better be sure.
Eli The ventilator.
We can't leave him on it.
No one's rushing you to make that decision.
But Owen, he doesn't know.
Not until you want him to.
We moved to Ward's Island for him.
It's so quiet there.
Eli quit his job just to homeschool.
I wasn't patient enough with him.
Could you be with me when Owen hears? Of course.
Does your brother mind when you bother him at work? He says he'd say, "References available on request and hope they forgot they needed them once they met me.
" It beats homework.
Let's do something fun after.
We could paint your room? We just have to tidy a bit first.
Maybe unpack some boxes.
Hum, recent work experience.
Did you say you worked in your cousin's cafe in Amman? Hmm-mm.
We can make your room your own? Any colour you want.
I don't want to.
Right here, Owen.
Oh honey, I'm so glad you're okay.
Where's Dad? - Why won't they tell me? - Owen I need you to prepare yourself for some hard news.
Come here.
Um, when the boat went over, Dad was under for a long time.
The doctors examined him, and They found out that his brain isn't working anymore.
Then they need to fix it.
Sometimes when a person's brain is injured badly, we can't.
Right now we're using a machine to help his body breathe.
Then he's not dead.
I'm so sorry, baby.
He is.
I didn't want to believe it either.
They said he was breathing.
He's alive if he's breathing.
But he won't be able to without the machine.
- Once we turn it off.
- Then don't! Owen, they have to.
- Dad would want us to.
- You don't know that! You let them hurt me, now you're letting them kill Dad? I know this is a lot.
You can take some time to get used to what we're telling you.
No! You don't know us! Don't let them do this.
He could wake up.
- He could! - No.
He's gone, baby.
- You're wrong! I hate you! - You don't mean that.
- You never do.
- I always do! This is your fault! You do what you want.
You don't care what I want or what Dad wants, and you don't get to kill him! You think I wanted this? You got upset on that boat.
You couldn't calm down and Dad lost control.
That's why this happened! Owen, I [SOBBING.]
I wanted you both to hear this from me directly.
The committee agreed I'd resume my duties effective immediately, but that I won't be working hands-on with patients for the foreseeable future.
I'll still be teaching, and running the department.
This will put added responsibility onto you, Wendy.
Hum what about, hum, Dr.
Novak? I'm taking today to consider that.
Thank you both.
I know that wasn't easy.
Nothing else to say, Claire.
My cognitive tests are clear, but my fine motor skills are lacking.
Hello? Is everything okay? It's about Amira.
I just thought you should know.
She's moved around so much since leaving our parents.
I don't think she can trust anything as permanent.
You know, it's not just the apartment this time.
It's also us.
It's you and me.
She needs us to be real.
Does that scare you? What scares me is Is not knowing what you really feel.
Can you trust anything as permanent? I I know I'm happy.
I am too.
But are you happy because of what it means for her? Or because of what it means for us? Um I'll talk to you later tonight.
Bye.
Olivia? I could never soothe him when he was a baby.
Then he got older, and diagnosed.
But Eli, he knows how.
They have this language together.
Arnold? Yeah.
Let's get you back to your room.
Where's the bathroom? Down the hall to the right.
Okay, thanks.
Are you okay? [SIGHS.]
My husband.
They say he, uh And then there was something about his spleen, I don't know.
His spleen has a low-grade rupture.
With proper rest and medication, it'll be fine.
You were the doctor? The one he I'm so sorry.
He wasn't always like this.
A few months ago, he started to change, and when I'd confront him about it, he'd blame it on me, not come home.
I'm sorry, this isn't my place.
Uh, your husband.
Any recent headaches or changes in taste or smell? Why? Are you saying there's something medically wrong with him? If you'll excuse me.
- What happened? - As soon as we got her into bed, her heart rate went up, her BP dropped, she got confused.
Olivia, do you remember hitting your head? Could you have lost consciousness before? Olivia? I gave her a drink of water, she barely sipped it, she said it felt funny.
And then the vomiting started.
Felt funny, those were her words? - Yeah.
- She's seizing.
Push 60 milligram propofol! Thank you.
- Propofol's in! - Good.
Talk to me.
Dr.
Bishop.
She was seizing.
And we need to intubate her, but it could be tricky.
You need to paralyze her.
Page RT and get the first physician you can see.
Norm, prep 50 milligrams rocuronium.
You know I can only walk you through this? What happened? Uh, she was light-headed, and then vomiting and confusion with tachycardia and hypotension.
Followed by seizure.
Subdural hematoma from head injury? Stabilizing larynx.
We're in.
Well, let's get her up to imaging.
Looks more like local anesthetic systemic toxicity than a cranial bleed.
Last? That's highly unlikely.
She has no physical indication of a head injury.
Dr.
Hamed? She's your patient.
The catheter may have eroded a blood vessel, but statistically a hematoma's more probable.
And we prioritize according to probability.
Imaging first, then talk to me about toxicity.
- You agree with him? - He was pretty clear.
I'm asking what you think is most likely, given the facts.
She told Claire taking a sip felt a bit funny.
Mouth numbness is a common symptom of last.
And her heart rate's increasing.
I'm stopping administering painkiller.
I'm calling up to toxicology for a bag of lipid emulsion.
Imaging can wait.
Dr.
Hunter, it's Owen.
When did you notice he was gone? Right when I paged you.
He was there but ten minutes ago.
- We've all been - That's not good enough! That was uncalled for.
I just I can't get through to this kid.
Page security.
Make sure they don't touch him.
[SIGHING.]
Your OR slot is coming up and I just want to make sure that you understand.
What did Brenda say? She's not coming? The social worker called your sister and left a message and she has not gotten back to us.
I want you to call her this time.
Tell her all the stuff you told me about pain, and not lifting what's heavy.
Okay.
Huh, look.
The recurrence rate for open surgery is really high.
Which means that you could end up right back here.
I just wanna make sure that you're making this decision for the right reason.
My reasons are not your problem.
Relax, I can handle this.
Now, when you call Brenda, don't tell her about the lapro option.
Let her think this is all there is.
Yeah, uh If you want to lie to your sister, that's something you're gonna have to do yourself.
Mr.
Neal.
Hi.
Your head CT shows a tumour.
A sub-frontal meningioma and they're typically benign.
The tumour's in the lining of your brain - and relatively easy to remove.
- Hold on Side effects can include vision problems, neuro-dysfunction and personality changes.
Heightened aggression, impulse control, etcetera.
I'll update Dr.
Atwater and someone from neurosurgery will be down to answer any questions.
Wait.
Wait.
Wait! Dr.
Leblanc.
Please! Are you saying Shane's personality changes are because of a tumour? I didn't know him before today, so And if they remove it, does he go back to normal? Many patients do revert to their previous traits post surgery, yes.
All these months.
He made me feel like it was my fault.
That I did something to make him stop caring.
The surgeon will be down soon.
[PANTING.]
It was definitely systemic toxicity from the infusion.
Lipid emulsion worked.
BP's stable, rate's stable.
Does her injured arm look more pale than her left one now? When she got here we fixed the artery, and we ran every test in the book.
She was clear.
It's cool to the touch.
Earlier she was complaining about pain.
Plenty of patients do.
But we wouldn't know if the level of her pain was increasing in severity.
Because the local anesthetic Was masking the post-surgical compartment syndrome she was developing? We've barely got the toxicity under control, the last thing this patient needs is another complication.
Well, she may have one.
Soft tissue feels wooden.
I'll get her pressure checked, just to confirm.
Injecting saline.
40 millimeters of mercury.
If we don't relieve the pressure under her skin, she'll lose her arm.
Find bodies, now.
What's going on here? Preparing for an emergent fasciotomy.
Marking incisions.
I told you to image her head.
It wasn't a brain bleed before, it was toxicity, the lipid emulsion proved it.
- Could have gone either way.
- But I was right then.
And I am right now.
It's compartment syndrome.
It just presented.
Her arm feels wooden, high compression pressure, it all points to the same thing.
Then we need to resolve it.
Claire, doctors Atwater and Leblanc need help going up.
Is that it? You'd rather I do what, exactly? I would like you to tell me that I am right for once.
I agree with your diagnosis, Dr.
Novak.
Now let's get it done.
Dr.
Hamed, ready to incise.
Claire, would you administer the fentanyl, please.
Mags, retractors when you're ready.
Fentanyl in.
Excuse me.
Making incision.
- Retracting.
- Dr.
Novak? Fascia's yours.
Fascia is exposed.
Cutting.
Current literature says we need to open the skin a few more inches to inspect the carpal tunnel.
This isn't a research study, Leblanc.
Yeah, but she's not wrong.
Dr.
Leblanc, why don't you show us how it's done, release the volar compartment.
Leblanc have you ever done an ED fasciotomy before? I've done the reading.
She's not ready.
What are you doing? This is a teaching hospital, Mark.
I'm teaching.
Retracting.
Scissors? Good.
Release the next compartment.
Keep the motion smooth.
All compartments released.
That should do it.
Apply and secure wet dressing.
Welcome home.
Hi, Owen.
You're getting better, but you still need to stay warm.
So I went out and picked up this bad boy.
If you want it, grab it.
It's up to you.
He's really not waking up, is he? No, Owen.
He's not.
I almost love it.
Lie to your own damn sister, sir.
We should get t-shirts made with that on them.
Look, I know what I said was unprofessional, okay? But that guy was basically emotionally extorting his family.
I guess I'm off that surgery.
Why? Just because patients get sick doesn't mean we can't occasionally find them annoying.
I'm not condoning insulting them moments before an operation.
But we all lose our cool.
[GRUNTS.]
Medical record consent forms.
Get your father to sign them and you can access his chart.
Uh, about my dad.
I'm not up to date on his condition because we don't talk.
I'm his doctor, June.
And your boss.
I don't want that information.
I appreciate you pitching in this last month.
But my services will no longer be required? Mark.
I was too tough on you when you were a resident.
When I look back now.
I put you through hell.
Should have been a better mentor to you, and for that, I apologize.
Maybe it's how I was trained too, but that's no excuse for paying it forward.
For either of us.
So you're apologizing, but you're still saying I'm never gonna be good enough.
No, that's not what I'm saying.
There's no question you're a skilled doctor, Mark.
If you want to stay, work under Wendy, we could try again.
But I don't think you're ready, as a leader.
I'll pass, thanks.
Up to you.
Hamed, his transcripts.
If anyone else were to look under that rock.
They'll find me.
[SIGHS.]
You fixed her? Yes.
She's going to need a lot of rest, but she'll be okay.
The first time you ran away, you were only nine.
I was so scared.
Dad knew you were in the shed.
He said we should pretend we didn't know where you were.
You needed the independence and You always came back feeling better.
He hid snacks in there for me.
Yeah.
I know I'm not him, baby.
I know I'm gonna get a lot of stuff wrong.
But I promise you, I'm gonna try.
I love you so much.
[GENTLE MUSIC.]
Are you gonna fly home tonight? Seems like a good night to go hug the girls.
I can't.
Hey.
What's wrong? Mel and I split up.
I chose this and she wasn't okay with it.
Theo.
I'm so sorry.
I No, I just I guess I thought she'd change her mind.
That was stupid.
Hey, why don't you come to our place tonight, huh? We'll make some dinner.
I don't think I'd be great company, uh Well, Theo, if You know, I'm fine, Bash.
I'll see you later.
You know, it was some good work you did back there.
Anyway.
It hasn't been boring.
Are you leaving us? Back to ICU.
Guys like us, we might not fit into a place like this.
But don't let them turn you into something that you're not.
So he really has a brain tumour? A benign one, but yeah.
I really want to hate him, but it's sort of not his fault.
Screw that! You don't owe him any empathy, Mags.
Well, maybe it's not that easy for me! Ooh.
Okay.
It's cool.
Look, um If you need to yell at anyone, or whatever, just, I'm here, alright? Okay.
Okay.
Rania's teaching me to play tricks.
Hey.
We waited for you, for dinner.
I will heat it.
Thank you.
Where did you find playing cards? I didn't know we had any.
I saved them from the airplane.
Are we going to keep those old rocks too? I found them in the park, by the first place we had.
Rania tells me you're not ready to unpack.
You're the one who's still sleeping on the couch.
Amira.
We're still figuring out what this looks like.
But that doesn't mean we're going anywhere.
This is your home now.
You can get comfortable.
The rocks go in my closet.
Top shelf.
The rest of it, I'm still deciding.
[GENTLE MUSIC.]
[CUTLERY CLATTERING.]
When you chose this, you didn't choose me.
I know we've had our differences.
Why don't you just tell me why you spoke to my boss.
I have stomach cancer.
I was thinking you could move in here, with me and Amira.
[ALARM CLOCK RINGING.]
[GENTLE MUSIC.]
[INDISTINCT.]
[RHYTHMIC MUSIC PLAYING.]
[GIGGLING.]
No, you have to bend your knees.
Not that much! [INDISTINCT CHATTER.]
Your arms have to be looser.
[LAUGHING.]
Living in sin with me and praying in the morning, Bashir? We could fix that.
Call the Imam, get married.
You and Amira can do your dance at the party.
That may be my least romantic proposal since, uh, your first one.
I got a yes then, didn't I? [CHUCKLING.]
What will you do today? Amira's lending me her tech skills.
I don't mind paying the bills while you study English and figure out your qualifications.
I know that.
But I want to work.
And maybe we'll organize her room.
Put away some of the mess she moved in here with.
Yeah, she keeps anything with a story.
After everything over these years, I'm going to work on a Saturday, and I'm not worried about leaving her home alone.
[CITY HUBBUB.]
[KNOCKING.]
[GENTLE MUSIC.]
Didn't hear you get up.
Oh, I thought a walk would do me good.
Excited to reclaim your office? That's up to the committee.
Are you nervous? I'll update them on how I am doing, and they'll either agree that I'm ready to come back to work or - they won't.
- When you say update? The truth, Claire.
And what are you gonna say if they ask about what Novak said during the M&M rounds? That I instill a culture of fear? I'll tell them that Dr.
Novak had the unfortunate luck of working under me when I was less charming.
Had worse when I was a resident, though I never remember publicly flogging any of my bosses for it.
Is that okay? Yeah.
And on the subject of you ignoring your symptoms that led to your stroke? Well, let's hope 30 years here buy some clemency.
Are you sure you want this again, Jed? I should go up there.
[GENTLE MUSIC.]
- Mr.
Neal? - Hey.
Hi, I'm Dr.
Leblanc.
I heard you had a bit of fall today.
- Do you mind if I take a look? - Yeah.
Okay.
Yeah, this'll need sutures.
Can you tell me where else it hurts? Uh, well, my stomach got the worst of it.
Yeah.
Okay, lie down for me please? Here we go, let's see here.
[INHALES SHARPLY.]
Hmm.
Where did you fall exactly? Hum.
I didn't fall.
The truth is, yeah, I borrowed money from the wrong guy and I lost it in a card game.
He didn't take it so well.
Okay, so you're saying that he beat you up? Sometimes you eat the bear, sometimes the bear eats you? No, but we can call the police if you want to file a report.
Thanks.
I think I'm just gonna call this a lesson learned - and move on.
- Okay.
Did you lose consciousness or feel dizzy at all? - No.
- Any nausea? Vomiting? - Trouble with your eyesight? - No.
I mean, not from this.
- What do you mean? - Well, I get double vision sometimes, but you know, the larger problem is I don't know how to fight.
I'm gonna do an ultrasound on your abdomen.
Okay.
This might be cool.
I bet your boyfriend wouldn't get his ass handed to him like this.
[CHUCKLES.]
Unless you're single.
Which I will be, when my wife finds out how much money I lost.
[AWKWARD CHUCKLE.]
There's fluid around your spleen.
- Uh Is that a bad thing? - No, not necessarily, but we need to make sure there's no organ damage.
So we'll do imaging to be sure.
I'll be back soon to stitch the cut on your cheek.
- Thank you.
- 'Course.
Theo.
I keep forgetting to give these back.
Well, you may have moved on, but your things haven't.
Can you come by this week and get the rest of it? Well, I called the junk service.
They were supposed Well, they didn't.
You've been gone two weeks, your things are mixed in with mine and there's the Sudbury stuff and it's just - Theo, I'm - Forget it.
I'll deal with it.
Sending Mr.
Neal to CT, flagging a potential low-grade splenic injury.
He just admitted to being in a fight so I want to keep him until we get the full picture.
Couple hours monitoring will do, Leblanc.
Don't follow the poor guy home and cook him soup.
Multiple traumas incoming.
EMS reports a boy with hypothermia and a woman sliced by a boat propeller losing blood volume, both pulled from Lake Ontario.
Dr.
Hamed, we'll take the mom.
[DRAMATIC MUSIC.]
Let me go! Witnesses say they turned too sharp and capsized.
His core temp's down to 30.
Rate's 65, BP's 95 on 53.
Resp rate's 13, and no telling how much water he took in.
It's okay, okay.
Whoa, whoa, whoa Okay, on three.
One, two, three.
Don't! Everything's gonna be okay, Owen.
Arnold, heating blankets.
No! Stop! Okay, we need a line and warmed oxygen.
Warmed IV fluids too.
No! [WHIMPERING.]
Okay.
[HEAVY BREATHING.]
My husband, did he make it? We're looking for him, ma'am.
Two large-bore IVs, cross-match and give two units O-neg.
Get her on a monitor! Somebody, please My son.
He's here.
He has hypothermia, he's being warmed.
He has SPD.
- What's SPD? - Sensory Processing Disorder.
It's a kind of neurodivergence.
[LABOURED BREATHING.]
: Sounds, lights, touch.
They all set him off.
Rhoda, make sure Dr.
Hunter knows.
It's really important we get you warmed up.
Okay, pal? - Warmed O2's ready.
- No, Owen, I need you to stay down.
- Don't touch me! - Resp rate's falling.
Ketamine? Dr.
Hunter.
Okay, okay, we're not touching you, okay? GCS is seven.
Radial and ulnar pulses are absent.
Brachial artery is severed.
Okay, buddy, we know about your condition and we're here to help.
Owen, your temperature's too low, we need to bring it back up, okay? I know you don't like the feeling of the blanket, but even a few minutes will really help us.
I've never seen SPD before.
Is it the warming blankets? - It's everything.
- What do you want to do? - [SIGHS.]
- We don't have a choice.
We're gonna hold you down for just a second.
Okay, Owen? We're going to give you some medicine with a needle - to make you sleepy.
- No! Not nee no, no, no! [SCREAMING.]
No, no, no! [INDISTINCT CHATTER.]
[SCREAMING.]
It's done buddy, it's done, it's done.
It's okay, it's okay.
OR's on standby, guys.
She might not survive the trip up.
What's the call here, Dr.
Hamed? Protocol would be transfusions to stabilize her blood pressure.
And if that's not her best shot? Since when do you let protocol stand in your way? We fix the bleed here.
Brachial plexus block for anesthesia.
1% xylocaine, 10 cc syringe, 18 and 25 gauge needle with a catheter.
Let's go.
Now if I had made this call when I was a resident, I would've been called dangerous.
And if you'd made the other call? Waiting and risking her life? Short-sighted and irresponsible.
BP's 85.
Still no word on her husband? Sorry about the wait.
I'll do your sutures now.
Lot of action out there? Uh, it's just a normal Saturday for us.
At least you're never bored.
So imaging does show a rupture to your spleen.
But it's minor, a grade one, which means it'll heal by itself.
I can also refer you to an ophthalmologist.
Occasional double vision is normally related to dryness, but it wouldn't hurt to see a specialist.
I'm seeing fine now.
[NERVOUS LAUGHTER.]
Excuse me.
- Oh.
- Look straight.
This won't take long.
You smell good.
- Mr.
Neal.
- What? Come on - [GASPS.]
- Stop! Come on.
You've been flirting with me all morning.
[GRUNTS.]
[CRIES OUT.]
[CLATTERING.]
- [PANTING.]
- Hey, whoa! [CRIES OUT.]
Get off me, man! I didn't do anything! - Calm down.
- Come on! Ow! - [PANTING.]
- Mags? Calm down! Come with me.
It's okay.
- [GRUNTING, YELLING.]
- It's over.
Hey.
You okay? [PANTING.]
Is this the father from the boat? It took them longer to find him.
They had to resuscitate.
No pain response.
O2 sats are down to 90.
Let's get him on a 100 % oxygen.
Do we have a GCS? Three.
And no pupillary reflex.
He's showing every sign of brain death.
I'll confirm with EEG and, uh, tell the mom.
I'll go see the kid.
[SIRENS BLARING IN THE DISTANCE.]
Well, he made a couple comments, but I didn't think too much of it.
What happened next, Mags? Well, then he grabbed me, you know, and I pushed him to try to get loose.
Good.
Good for you.
And then that's when he got angry, and he shoved me, and then Lou came in and tried to grab him before he could, - you know - I just heard.
Mags? I'm fine.
Are you back? So it would seem.
- The police are here.
- I'll go talk to them.
Dr.
Atwater can handle it.
Find Mags when they need a statement.
I'll take over her patient as well.
Thanks, Wendy.
Let's keep things as they are for this morning, while I get my bearings.
We'll talk later about how my transition back will work.
Sir.
Hold on a minute, doctor.
- What? - Do you need to take the day? No.
No, I'd just really want to keep moving.
I'm gonna tell Dr.
Atwater that his splenic rupture makes sense, but he also complained of double vision, and I offered him a referral, but he he wasn't interested, so.
I've missed our differentials.
Me too.
How have you been, this last month? Hum Dr.
Novak has his own way of doing things, I guess, and I was just getting used to it.
I'm sorry this happened to you.
It shouldn't have.
I'm really happy you're back.
[INDISTINCT CHATTER.]
They told me you were up, Olivia.
And uh, the pain meds aren't helping? I can put in a catheter to get you on a continuous infusion of a local anesthetic.
Owen.
How is he? His temperature's rising.
We had to sedate him, but his doctors are aware of his condition.
[SIGHS.]
And Eli? A nurse said he's here, but won't say how he is.
Your husband, um He he was pulled out of the lake and resuscitated.
But he went without oxygen for too long and his brain is no longer functioning.
What? No.
That can't be.
He's on mechanical ventilator and it's it's the only thing keeping him alive.
- What? - Olivia.
Eli is not going to recover.
Oh, God No.
If there's anything we can do.
Well, you can save him.
Please.
[SOBBING.]
Oh, God.
I'm very sorry.
[SOFT MUSIC.]
You've been pretty brave today, pal.
I know we didn't get off to a great start.
I'm sorry about the needle.
I also know you don't like the way the blankets feel.
Your body isn't warming up on its own, so I need you to speak up if there's anything we're doing that makes you feel bad, or anything we can do to make things easier.
Good news is you get to see your mom soon.
I want to see my dad.
I'm fine.
Guys.
Okay, I'm okay.
Okay, so uh, the trops from the patient in four came back negative.
It's just a stable angina so I can discharge with No, no, I'll take it.
- Thank you.
- Yeah.
Dr.
Bishop, hi.
It's good to have you back, sir.
Alright, enough gawking.
Everybody back to work.
- Sir.
When did you decide to - The intensivist wants to know if Eli Rosenthal's family has made a decision yet.
Not yet.
I should check on his wife.
Sir.
Ibuprofen? Thank you.
- His wife's arrived.
- Hmm.
I knew he was a creep.
I knew it.
Just didn't follow my instincts, you know, completely You didn't cause this.
He did.
He made a decision and put you in a situation.
And now I have to live with it.
How's she doing? Somewhere between didn't happen and can't stop thinking about it.
[SIGHING.]
Mr.
Eldridge? - Can I have a look? - Sure.
[GROANS.]
[EXHALES SHARPLY.]
Hernia.
It was barely a bump two months ago.
My GP offered to refer a surgeon, but I said let's wait and see.
Look, if you're worried about the surgery, don't be, okay? We can do it laparoscopically, so it's through small incisions.
You'll be out of here by today or tomorrow.
And uh, if it's not laparo? Sir, if you can avoid the pain of open surgery.
I can take the pain.
Oh.
Well And, you can call my sister, tell her I need the support? She'll take it more seriously if it comes from you.
I explained all the benefits of laparo to Mr.
Eldridge, and he still wants open surgery.
First, I was thinking drug seeker.
Oh.
Even pain seeker.
I've seen those before too.
You said he didn't let his GP address the issue early on.
Yeah.
I think he just wants to milk this experience - for all it's worth.
- Hmm.
So your last follow-up with my father.
You know I can't discuss an on-going patient.
Yeah, he's just not great at relaying important details.
He seems like a guy trying his best to stay in good spirits.
Hmm.
We can get Mr.
Eldridge in today, but you need to document everything.
Get it in writing that he chose open surgery AMA.
Yeah, I think I just need one more shot to change his mind.
Dr.
Curtis, if he's got a legitimate fear of laparoscopy He doesn't.
Better be sure.
Eli The ventilator.
We can't leave him on it.
No one's rushing you to make that decision.
But Owen, he doesn't know.
Not until you want him to.
We moved to Ward's Island for him.
It's so quiet there.
Eli quit his job just to homeschool.
I wasn't patient enough with him.
Could you be with me when Owen hears? Of course.
Does your brother mind when you bother him at work? He says he'd say, "References available on request and hope they forgot they needed them once they met me.
" It beats homework.
Let's do something fun after.
We could paint your room? We just have to tidy a bit first.
Maybe unpack some boxes.
Hum, recent work experience.
Did you say you worked in your cousin's cafe in Amman? Hmm-mm.
We can make your room your own? Any colour you want.
I don't want to.
Right here, Owen.
Oh honey, I'm so glad you're okay.
Where's Dad? - Why won't they tell me? - Owen I need you to prepare yourself for some hard news.
Come here.
Um, when the boat went over, Dad was under for a long time.
The doctors examined him, and They found out that his brain isn't working anymore.
Then they need to fix it.
Sometimes when a person's brain is injured badly, we can't.
Right now we're using a machine to help his body breathe.
Then he's not dead.
I'm so sorry, baby.
He is.
I didn't want to believe it either.
They said he was breathing.
He's alive if he's breathing.
But he won't be able to without the machine.
- Once we turn it off.
- Then don't! Owen, they have to.
- Dad would want us to.
- You don't know that! You let them hurt me, now you're letting them kill Dad? I know this is a lot.
You can take some time to get used to what we're telling you.
No! You don't know us! Don't let them do this.
He could wake up.
- He could! - No.
He's gone, baby.
- You're wrong! I hate you! - You don't mean that.
- You never do.
- I always do! This is your fault! You do what you want.
You don't care what I want or what Dad wants, and you don't get to kill him! You think I wanted this? You got upset on that boat.
You couldn't calm down and Dad lost control.
That's why this happened! Owen, I [SOBBING.]
I wanted you both to hear this from me directly.
The committee agreed I'd resume my duties effective immediately, but that I won't be working hands-on with patients for the foreseeable future.
I'll still be teaching, and running the department.
This will put added responsibility onto you, Wendy.
Hum what about, hum, Dr.
Novak? I'm taking today to consider that.
Thank you both.
I know that wasn't easy.
Nothing else to say, Claire.
My cognitive tests are clear, but my fine motor skills are lacking.
Hello? Is everything okay? It's about Amira.
I just thought you should know.
She's moved around so much since leaving our parents.
I don't think she can trust anything as permanent.
You know, it's not just the apartment this time.
It's also us.
It's you and me.
She needs us to be real.
Does that scare you? What scares me is Is not knowing what you really feel.
Can you trust anything as permanent? I I know I'm happy.
I am too.
But are you happy because of what it means for her? Or because of what it means for us? Um I'll talk to you later tonight.
Bye.
Olivia? I could never soothe him when he was a baby.
Then he got older, and diagnosed.
But Eli, he knows how.
They have this language together.
Arnold? Yeah.
Let's get you back to your room.
Where's the bathroom? Down the hall to the right.
Okay, thanks.
Are you okay? [SIGHS.]
My husband.
They say he, uh And then there was something about his spleen, I don't know.
His spleen has a low-grade rupture.
With proper rest and medication, it'll be fine.
You were the doctor? The one he I'm so sorry.
He wasn't always like this.
A few months ago, he started to change, and when I'd confront him about it, he'd blame it on me, not come home.
I'm sorry, this isn't my place.
Uh, your husband.
Any recent headaches or changes in taste or smell? Why? Are you saying there's something medically wrong with him? If you'll excuse me.
- What happened? - As soon as we got her into bed, her heart rate went up, her BP dropped, she got confused.
Olivia, do you remember hitting your head? Could you have lost consciousness before? Olivia? I gave her a drink of water, she barely sipped it, she said it felt funny.
And then the vomiting started.
Felt funny, those were her words? - Yeah.
- She's seizing.
Push 60 milligram propofol! Thank you.
- Propofol's in! - Good.
Talk to me.
Dr.
Bishop.
She was seizing.
And we need to intubate her, but it could be tricky.
You need to paralyze her.
Page RT and get the first physician you can see.
Norm, prep 50 milligrams rocuronium.
You know I can only walk you through this? What happened? Uh, she was light-headed, and then vomiting and confusion with tachycardia and hypotension.
Followed by seizure.
Subdural hematoma from head injury? Stabilizing larynx.
We're in.
Well, let's get her up to imaging.
Looks more like local anesthetic systemic toxicity than a cranial bleed.
Last? That's highly unlikely.
She has no physical indication of a head injury.
Dr.
Hamed? She's your patient.
The catheter may have eroded a blood vessel, but statistically a hematoma's more probable.
And we prioritize according to probability.
Imaging first, then talk to me about toxicity.
- You agree with him? - He was pretty clear.
I'm asking what you think is most likely, given the facts.
She told Claire taking a sip felt a bit funny.
Mouth numbness is a common symptom of last.
And her heart rate's increasing.
I'm stopping administering painkiller.
I'm calling up to toxicology for a bag of lipid emulsion.
Imaging can wait.
Dr.
Hunter, it's Owen.
When did you notice he was gone? Right when I paged you.
He was there but ten minutes ago.
- We've all been - That's not good enough! That was uncalled for.
I just I can't get through to this kid.
Page security.
Make sure they don't touch him.
[SIGHING.]
Your OR slot is coming up and I just want to make sure that you understand.
What did Brenda say? She's not coming? The social worker called your sister and left a message and she has not gotten back to us.
I want you to call her this time.
Tell her all the stuff you told me about pain, and not lifting what's heavy.
Okay.
Huh, look.
The recurrence rate for open surgery is really high.
Which means that you could end up right back here.
I just wanna make sure that you're making this decision for the right reason.
My reasons are not your problem.
Relax, I can handle this.
Now, when you call Brenda, don't tell her about the lapro option.
Let her think this is all there is.
Yeah, uh If you want to lie to your sister, that's something you're gonna have to do yourself.
Mr.
Neal.
Hi.
Your head CT shows a tumour.
A sub-frontal meningioma and they're typically benign.
The tumour's in the lining of your brain - and relatively easy to remove.
- Hold on Side effects can include vision problems, neuro-dysfunction and personality changes.
Heightened aggression, impulse control, etcetera.
I'll update Dr.
Atwater and someone from neurosurgery will be down to answer any questions.
Wait.
Wait.
Wait! Dr.
Leblanc.
Please! Are you saying Shane's personality changes are because of a tumour? I didn't know him before today, so And if they remove it, does he go back to normal? Many patients do revert to their previous traits post surgery, yes.
All these months.
He made me feel like it was my fault.
That I did something to make him stop caring.
The surgeon will be down soon.
[PANTING.]
It was definitely systemic toxicity from the infusion.
Lipid emulsion worked.
BP's stable, rate's stable.
Does her injured arm look more pale than her left one now? When she got here we fixed the artery, and we ran every test in the book.
She was clear.
It's cool to the touch.
Earlier she was complaining about pain.
Plenty of patients do.
But we wouldn't know if the level of her pain was increasing in severity.
Because the local anesthetic Was masking the post-surgical compartment syndrome she was developing? We've barely got the toxicity under control, the last thing this patient needs is another complication.
Well, she may have one.
Soft tissue feels wooden.
I'll get her pressure checked, just to confirm.
Injecting saline.
40 millimeters of mercury.
If we don't relieve the pressure under her skin, she'll lose her arm.
Find bodies, now.
What's going on here? Preparing for an emergent fasciotomy.
Marking incisions.
I told you to image her head.
It wasn't a brain bleed before, it was toxicity, the lipid emulsion proved it.
- Could have gone either way.
- But I was right then.
And I am right now.
It's compartment syndrome.
It just presented.
Her arm feels wooden, high compression pressure, it all points to the same thing.
Then we need to resolve it.
Claire, doctors Atwater and Leblanc need help going up.
Is that it? You'd rather I do what, exactly? I would like you to tell me that I am right for once.
I agree with your diagnosis, Dr.
Novak.
Now let's get it done.
Dr.
Hamed, ready to incise.
Claire, would you administer the fentanyl, please.
Mags, retractors when you're ready.
Fentanyl in.
Excuse me.
Making incision.
- Retracting.
- Dr.
Novak? Fascia's yours.
Fascia is exposed.
Cutting.
Current literature says we need to open the skin a few more inches to inspect the carpal tunnel.
This isn't a research study, Leblanc.
Yeah, but she's not wrong.
Dr.
Leblanc, why don't you show us how it's done, release the volar compartment.
Leblanc have you ever done an ED fasciotomy before? I've done the reading.
She's not ready.
What are you doing? This is a teaching hospital, Mark.
I'm teaching.
Retracting.
Scissors? Good.
Release the next compartment.
Keep the motion smooth.
All compartments released.
That should do it.
Apply and secure wet dressing.
Welcome home.
Hi, Owen.
You're getting better, but you still need to stay warm.
So I went out and picked up this bad boy.
If you want it, grab it.
It's up to you.
He's really not waking up, is he? No, Owen.
He's not.
I almost love it.
Lie to your own damn sister, sir.
We should get t-shirts made with that on them.
Look, I know what I said was unprofessional, okay? But that guy was basically emotionally extorting his family.
I guess I'm off that surgery.
Why? Just because patients get sick doesn't mean we can't occasionally find them annoying.
I'm not condoning insulting them moments before an operation.
But we all lose our cool.
[GRUNTS.]
Medical record consent forms.
Get your father to sign them and you can access his chart.
Uh, about my dad.
I'm not up to date on his condition because we don't talk.
I'm his doctor, June.
And your boss.
I don't want that information.
I appreciate you pitching in this last month.
But my services will no longer be required? Mark.
I was too tough on you when you were a resident.
When I look back now.
I put you through hell.
Should have been a better mentor to you, and for that, I apologize.
Maybe it's how I was trained too, but that's no excuse for paying it forward.
For either of us.
So you're apologizing, but you're still saying I'm never gonna be good enough.
No, that's not what I'm saying.
There's no question you're a skilled doctor, Mark.
If you want to stay, work under Wendy, we could try again.
But I don't think you're ready, as a leader.
I'll pass, thanks.
Up to you.
Hamed, his transcripts.
If anyone else were to look under that rock.
They'll find me.
[SIGHS.]
You fixed her? Yes.
She's going to need a lot of rest, but she'll be okay.
The first time you ran away, you were only nine.
I was so scared.
Dad knew you were in the shed.
He said we should pretend we didn't know where you were.
You needed the independence and You always came back feeling better.
He hid snacks in there for me.
Yeah.
I know I'm not him, baby.
I know I'm gonna get a lot of stuff wrong.
But I promise you, I'm gonna try.
I love you so much.
[GENTLE MUSIC.]
Are you gonna fly home tonight? Seems like a good night to go hug the girls.
I can't.
Hey.
What's wrong? Mel and I split up.
I chose this and she wasn't okay with it.
Theo.
I'm so sorry.
I No, I just I guess I thought she'd change her mind.
That was stupid.
Hey, why don't you come to our place tonight, huh? We'll make some dinner.
I don't think I'd be great company, uh Well, Theo, if You know, I'm fine, Bash.
I'll see you later.
You know, it was some good work you did back there.
Anyway.
It hasn't been boring.
Are you leaving us? Back to ICU.
Guys like us, we might not fit into a place like this.
But don't let them turn you into something that you're not.
So he really has a brain tumour? A benign one, but yeah.
I really want to hate him, but it's sort of not his fault.
Screw that! You don't owe him any empathy, Mags.
Well, maybe it's not that easy for me! Ooh.
Okay.
It's cool.
Look, um If you need to yell at anyone, or whatever, just, I'm here, alright? Okay.
Okay.
Rania's teaching me to play tricks.
Hey.
We waited for you, for dinner.
I will heat it.
Thank you.
Where did you find playing cards? I didn't know we had any.
I saved them from the airplane.
Are we going to keep those old rocks too? I found them in the park, by the first place we had.
Rania tells me you're not ready to unpack.
You're the one who's still sleeping on the couch.
Amira.
We're still figuring out what this looks like.
But that doesn't mean we're going anywhere.
This is your home now.
You can get comfortable.
The rocks go in my closet.
Top shelf.
The rest of it, I'm still deciding.
[GENTLE MUSIC.]
[CUTLERY CLATTERING.]