Transplant (2020) s02e07 Episode Script
Control
1
I'm going through a split.
Any interest in a part-time resident practice? Who better than someone who knows what it's like to be a cardiac? I don't think so.
It's not fair, how you see me.
You're a fighter June, I get that.
What are you telling me to do here? I'm not, I'm just pointing out the landmines.
- Are you free tonight? - You're asking me on a date? You had two major health incidents.
They're pushing you out? I'm not done, Claire.
Welcome Brothers.
Couple of quick announcements.
Unfortunately we begin by offering our condolences to brother Karif Shahid, who recently lost his father.
So we pray that Allah grants him mercy and gives him the highest place in paradise.
In times of isolation, we look towards our community for peace.
Hey, those stitches still need to come out.
Maybe tomorrow after school, you stop by the hospital? Rania's coming to get some things.
We're friends, Amira.
She's still in both of our lives.
What time is it? It's late or early, depending on your point of view.
You're working? Yeah, I'm unwinding.
Unwinding.
With Electro Cardiography Interpretation? Okay, unless you can show me how to sleep like a stress-free toddler, yes, that is - I have stress! I stress! - Mm-hmm.
But I also just had a really good stress reliever.
Okay.
- Is that you? - Mm-hmm.
What stresses do you have? Well, still trying to impress Dr.
Hunter, that's one.
- Really? - Yeah.
You never seemed to worry about that.
It's future Jake's problem.
Current Jake is worried about how he's gonna sleep with the light on.
Unless you want me to go? It's okay, I can go.
Try and get some sleep, weirdo.
Hey.
Oh, do you need your office back? This isn't my office this morning.
Actually, I'm not even here.
- Soap me.
- Excuse me? Mnemonic device for rapid sequence intubation.
Suction, O2, Airways, Positioning.
Medication and Equipment.
- That's it.
- The exam's at noon? Yes.
Oh, I called in for supplementals, but somebody had to cancel, so I told Rhoda if she needs anything, just text.
We'll be fine, Claire.
Go kill it.
32-year-old found down, incoming.
- You paged me Rhoda? - Sorry.
By mistake, it's not a pedes trauma.
I'm filling in for Claire and we're just already swamped.
I have a window if you need help.
We're good.
Fall from a ladder, multiple contusions! BP's 100 over 80, rate's 130.
GCS 10.
- You're a doctor? - Yes, Kelsey's my daughter! I found her on the floor of the bar she owns.
She closed it to renovate.
I did a quick neurological exam, but she'll need a CT.
I don't know how long she's been there.
Two large bore IVs! E-FAST.
Start with her chest? Ray Grisholm.
Internist at Midcrest.
I would've got her there, but it's a 20-minute ride.
This is Dr.
Bishop, Chief of our emerg I saw you at the Trauma Association conference a few years ago.
Is there any free fluid? Your daughter is in very good hands, sir.
Fast positive.
Belly full of blood.
We'll give her a gram of TXA and activate MTP! - I'm calling the blood bank! - No, no.
She's AB negative, same as me! You can use mine now! That's not something that we do.
Well, she's not hemodynamically stable! Have either one of you ever done a direct transfusion? - I have.
- I've got a donor card in my wallet if you need to confirm.
Set up for a direct transfusion.
Let's take every step we can, Dr.
Grisholm.
Thank you.
Thank you.
Guy brought his wife in after a car accident.
He's dazed, a little bit cut up and she's Well Displaced leg fracture and when's the last time you delivered a baby? Is she okay? And after you answer that, please, tell me I can still get the epidural! Fetal heart rate's 140.
I paged OB, but It's okay, I'm on it.
Contractions are how far apart? Not very! Ben was supposed to time them, but It's really happening now? I just thought the accident might What, push it back in, Ben? Go find someone who can get me an epidural! You two got in an accident on your way to have a baby? - Ben ran a red - You were yelling at me! - Oh.
- I'm trying here, Tess.
Jake, ultrasound.
- Oh - Her stomach's bleeding.
- Tess, oh! - Ben! Remember, we took those classes about how your one job is to stay calm? Yeah? I need you to do your job, Ben! My baby's gonna be okay, right? It's not deep, just oozing.
Grab me a pair of forceps and a vacuum just in case, Arnold.
- Got it.
- Okay.
Baby's heartrate looks good, but it is sunny-side-up.
- Which is what Jake? - Occiput posterior position.
- Is that bad? - For the baby, no.
For mom, it could mean a tougher delivery, but to answer your question, Tessa, I have to get you in position to push, there's no time for an epidural, this baby is on its way now! You're ready? And one, two, three! Sorry about the heavy hand before.
I had a boss who used to say, "What this situation needs is two of me and none of you.
" I maybe followed a little too closely - in his footsteps.
- Pelvic fracture wrapped.
You're both what year? - I'm emerg PGY-two.
- I'm PGY-one.
But this is his second residency.
He was a trauma surgeon in Syria.
Oh so you're ahead of your peers, but also behind them? It's a good thing Kelsey isn't awake to see this.
She hates it when I insert myself in her life.
I'm guessing this is one time she'd make an exception.
You know, I told her that the bar would be the death of her, I meant it was a money pit, not this.
You said you didn't know how long she was alone? I knew she was trying to get the place ready to re-open and we hadn't talked in a few days.
She used to always call her mom, but We buried her a month ago.
Ovarian cancer.
I'm sorry.
When it happens, you're distracted.
Then everybody goes.
We're still figuring out not having her mom as our bridge.
Temp's 39.
I'd feel a lot better if her temp wasn't so high.
It could be an inflammatory response due to the trauma.
We'll get Kelsey up to interventional radiology for an angio-embolization to stop the pelvic bleed, and after that, just let her rest.
Okay, the baby's crowning, mom.
I just need a couple more pushes, okay? - Hang in there, Tess.
- Shut up.
I thought I was supposed to No, no, no, don't speak, don't move, don't even look at me! Okay, Tessa, let's try one more big push! I can't, I can't, I just can't anymore! It hurts too much.
Please, can you just cut it out of me.
My stomach's already bleeding, you could use that opening.
The delivery I remember the most was my youngest.
My wife was up all night with our oldest who was sick with a stomach flu.
She called me to tell me she was in labour, but she couldn't leave Abby home alone to come to the hospital.
So I drove like a maniac and got there just in time to deliver Grace on our kitchen floor.
It was insane, just like this.
- Yeah? - Okay.
When we look back on it now, we laugh.
You two will have the same kind of story! - I don't know - Yes, you will.
But Tessa, believe me.
You've got this.
I need you to push.
Okay? Come on, you can do this.
Push.
Here she is, she's coming.
She's coming, she's coming.
Here she is.
Here she is.
Here she is.
That's a man down.
- Seriously? - We'll check him out.
You did it.
Okay.
Congratulations! I already gave her the head laceration.
The fractured wrist went to imaging, back pain's on deck, Bash has a found down in two and Have you been able to find Peter? Still looking, love.
Dementia.
Doesn't know Peter's last name, or how to reach him.
Okay.
I'll get him back to his room.
Sir? Hey.
If you guys are swamped, I can grab a patient.
Nausea in D? Already been there awhile.
York emergency! Shouldn't be too long.
Ms.
Crawford? Hi, I'm Dr.
Curtis.
I heard you're feeling nauseated.
Nothing'll stay down.
Even water.
I was trying to ride it out.
She refused to go to the doctor.
But then the cramping started, and my sister strong-armed me.
Sometimes severe food poisoning can cause dehydration.
Actually, I had a gastric bypass three months ago.
I've been sick on and off ever since.
Before you ask, yes, I stick to the diet plan.
Yes, I exercise, no, I don't have high blood pressure, diabetes, or heart problems.
So about this bypass, did you have that done here? Yes.
Dr.
Evelyn Roche.
Okay, well, sometimes, after a bypass, our stomach will react by rapidly emptying food in a way that can make you feel sick.
Dumping syndrome.
I'm aware.
That's only supposed to happen if you reintroduce food too fast, but I've been following the eye-dropper meal plan like a zealot.
Did you let them know that in your postop visit? All Roche said was my system will only adjust when I commit to the lifestyle.
Didn't even run a single test.
Right.
Well, Dr.
Roche is a renowned surgeon.
She's also a jerk, who has a problem with fat people.
- Maya! - What can I say.
The woman contains multitudes.
I'm gonna order a CT.
- You will? - I can't rule out rapid gastric emptying, but we should consider other post-surgical complications, like a bowel obstruction, or another acute digestive problem.
In the meantime, I'm gonna get you some fluids and an anti-nauseant.
You'll need to change into a gown.
I'll need a second one to wrap around the back.
I'll get you one, hon.
You shouldn't have done that.
- Excuse me? - Given her false hope.
So you wanted me to tell her to exercise and eat right? Because it seems like she's already doing that.
Maya needs to hear this is normal and that she just needs to get through the worst of it.
But when you don't find something, I'll have to pick her up and get her back on track.
Is there anything else? Yes.
Who can I ask for a gown? - Here, this desk.
- Okay.
At the end of your message, press 1.
I know you're screening me, Mel.
We need to talk about you wanting sole custody.
We only speak now through lawyers, and every time I go for pick up or drop off your mom's there just glaring at me.
I don't understand why you're treating me like this.
What is it, Jake? Ben Lyons is still complaining about left upper quadrant pain.
Chest X-ray for pneumothorax and broken ribs came back normal.
Okay? You said to rule those two things out.
Yes, I did.
Can you think of any other organs in that quadrant which might be affected by blunt trauma? Kidney, spleen, pancreas.
But you didn't say to rule those out.
Ultrasound? - CT with contrast.
- CT with contrast.
So what this situation calls for is two of you and none of him? - You're defending him? - No, I mean You know, you could've walked him through your thinking.
I have, Mags.
More than once.
He's gotta start showing up for work, which means coming to me with answers instead of questions.
- Kelsey Grisholm? - Her bleed's under control, - but her temp's still high.
- We're waiting on labs.
And her father? Still insistent about being looped-in.
I want you both to stay on this.
Ray's pretty senior at Midcrest and eh, easier for all of us if he's managed.
Bash? About the thing that we're not About the elevator and like That had nothing to do with you.
Okay? The person in there wasn't even me really.
Who was it? Someone who'd had a messed up day and a messed up few months.
You're not alone there.
Listen, I I don't want it to get between us either so Let's just pretend it never happened.
Exactly what I was gonna say.
You really gave me a scare, kid.
What happened? I was painting the crown moulding.
I told you to call the contractor.
I told you I wanted to do it myself.
How are you feeling now? Ah headache, neck's a bit stiff, but I guess that's what happens when you lie on the concrete for a few hours.
We did a CT, no intracranial injury.
So, you just fell? Dad.
The world is an imperfect place.
People fall.
There's, uh concern because you're maintaining a high fever, and we'd like to know why.
Were you feeling unwell before this? Any dizziness? She's always run down.
Barely eats, works until 2:00 AM, pouring all her energy into slinging drinks.
I'm not bartending, I'm running a business.
Look, that lifestyle was fine in your 20s, but it's time to grow up! - We can give you a minute - No, it's fine.
You may as well all hear this.
I have ALS.
That's why I fell.
I found out near the end with Mom.
No, that can't be right, because Wait a minute, you're not showing any of the signs.
I've been covering.
I noticed I was having a hard time gripping things.
I ignored it at first, but Then I started having weakness in my legs.
Do you know how advanced it is? The neurologist said that I should expect more trouble with mobility and eating as I enter the mid-stage And the average survival rate is two to five years.
So I guess that's where we are.
Which neurologist? What's his name? Dr.
Vedder.
She's been great.
Never heard of her.
Joe Yoshida is a great neurologist.
I'll call him and get a second opinion.
Dr.
Vedder's done weeks of tests.
She's sure.
Honey, you gotta trust me here.
I can help us get to the bottom of this.
Dad.
Okay, this is why I haven't told you for so long.
I have doctors.
Just help me by being my dad.
Let me get Yoshida on the phone.
Did you discharge the guy in three? The new dad? No, actually, I was going to explain his imaging results.
I found this in his room.
I called OB, - and he's not there either.
- We lost him? Are you guys doing okay in there? We didn't lose him, he left.
And yes, we're having a small staffing issue, but we're managing just fine.
I got it! Peter's not here yet, sir.
Let's wait in your room, okay? Did you start her on the antibiotics? Let me call you back.
Broad spectrum, until we figure out the cause of her fever.
Well, that was the neurologist I like.
He advises we run a few exams to rule out ALS.
Spinal tap and EMG.
Kelsey was pretty firm on not wanting to re-test.
She's febrile with a headache and soar neck.
An LP will rule out meningitis, would it not? Yes, and while meningitis is plausible, there are less invasive ways of narrowing down a fever.
My daughter runs on emotion, Dr.
Hamed.
She'll make the right choice if we lead her to it.
Your boss said to do everything we can.
If you want to sign-off, he's right over there, talking to the co-head of emerg at UHN of all people.
I've got three minutes before a consult if you need me.
Uh, yeah.
Actually, I just caught this patient in emerg.
She's 12 weeks post-op from a gastric bypass, has nausea and vomiting.
But her imaging's clear.
She's aware of dumping syndrome? She is, but it could be something else right, like a peptic ulcer, an obstruction or Crohn's or What are you asking me to approve, June? A C-scope and a G-scope.
Okay, but you could have ordered those anyway.
Right, but not everybody would, based on her symptoms so Okay, you're the one who's always telling me to watch out for landmines.
Statistically, you know it's unlikely this is anything other than side effects from her bypass.
What I know is that I've made the mistake in the past of listening to statistics over patients.
Keep me in the loop.
Keep you in the loop.
We're monitoring Kelsey Grisholm closely.
Her father's a handful, but we're on top of it.
Let me know if you need any input.
Hey, I meant to ask, how's your sister? Since her head laceration.
Oh, uh she's healing fine.
I doubt it'll scar.
Good.
The woman she came in with, I'm told that's your fiancé? She was.
Uh Now, she's the reason Amira won't talk to me.
Sorry to hear that.
Amira, she takes everything on and I think she learned that from me.
You're not alone, Bashir.
Sir, that doctor that you were speaking with earlier, are you hiring a co-chief? No.
I've been asked to meet candidates and lead the transition to a new chief.
You're being pushed out? Well, let's just keep this between us for now.
It's not something I wanted, and to be frank, I don't know where it goes.
There must be something that we can do.
Let me handle, okay.
I'll find a way to get the board on side again.
I know you think you're only here because of me, but you're not.
You're here because of you.
Do you understand? Can we put her oxygen up to eight litres and find out where her chest X-ray is? Any nausea? Cold extremities at all? Just a bit short of breath.
I assumed it was a touch of the flu.
Which could be more dangerous for ALS patients.
You sound like my dad.
He's not a bad guy.
I know how badly he wants to fix me.
Fix this.
But when it comes to relating to me? That's all he's ever known.
And what about you? What do you want? To somehow meet this on my own terms? Buying that bar was a dream come true and I want to run it for as long as I can.
Her temp's up again.
Um I was wondering if you would consider letting us do a lumbar puncture? It would help us rule out meningitis, source your fever and Re-confirm my ALS diagnosis? My father ask you to float that? Yes, he did.
Resistance is futile with Ray.
Is that true about my fever? Wait, you're in control here.
Nothing's gonna happen without your consent.
- Okay? - Okay.
The maternity ward's the other way.
I can't go up there.
So you Uh, you're just You're leaving? But then, I remembered I totalled our car.
I just finished paying it off last month too, after nine years.
I don't even have a job right now.
Ben, why don't you come with me? I didn't want a baby, Dr.
Hunter.
It kinda just happened.
I thought if I cut my losses now, I'd be doing that kid a favour.
I can see you judging me.
Look I would never say running out on a new-born baby is a good idea, but that's not why I'm here.
You spleen is ruptured.
You need surgery.
What? - So I guess - Yeah.
Oh, okay.
Imaging's up.
Guys, what's happening? Just tell me, I can take it.
I'm hearing crackles in your lungs.
Crackles? From what? Based on your chest X-rays, it's likely pneumonia.
Wouldn't I be coughing? ALS makes it hard to cough due to the degeneration of the airway.
Then you accept my diagnosis? Until we get the results back from the lumbar puncture, - we have to assume - She's not doing a lumbar puncture, Dr.
Grisholm.
Stop trying to work him, Dad.
I've done the tests.
- I've come to terms - Let me talk next steps.
Well, we'll continue O2 therapy, target the pneumonia with macrolide antibiotics and monitor her levels carefully.
Also, we should consider mechanical ventilation.
What does that mean? Is that intubation? Yes.
You're not coughing due to the ALS, which means that without help your body might not be able to clear the secretions caused by pneumonia.
Dr.
Hamed's right.
It's aggressive, but it's the best way to prevent hypoxia.
Yes, but it's not your only option here, Kelsey.
We can try BIPAP for supplemental O2.
There's also postural drainage and percussion Which might not be enough to keep dangerous amounts of fluids from building.
But there's a chance I could still recover on my own, right? Yes.
This is your choice.
And intubation is the right one.
I've done my homework.
If I'm intubated, I may never come off the ventilator, right? That's what happens with ALS, right? No, this is an end-stage, Kel.
It'll only help you breathe until you fight off the pneumonia, then they extubate you in a day or two.
- No.
- Come on, Kel.
I said no.
I don't want to be intubated.
Dammit, Kelsey! You need a plan to deal with this! This is what I do! Why can't you trust me? Because you're not hearing me! Just stop and listen for once! You are doing exactly what you did with Mom.
And not just when she was sick, her whole life.
Your voice is always the loudest.
If I'm intubated, then you get to call all the shots.
You get to make all my choices and I can't give that kind of power to someone who's never listened to me.
Oh, apparently, he wandered into an exam room while a patient was getting changed? Not intentionally.
He's just confused about We should've located his people by now.
What's the hold up, Arnold? We're trying.
The reason I put both of you on Kelsey Grisholm was to make sure things went smoothly.
Well, I know it took a while to catch the pneumonia, but that's because she didn't show the regular signs No, I understand the diagnosis.
What I don't understand is why people I report to are telling me that my resident is standing in the way of a patient getting the care she needs.
Ray has friends in high places.
No, that's not at all how it happened.
He was steamrolling his daughter into intubating I recommended mechanical ventilation because I think Kelsey should consider it.
Dr.
Grisholm agreed and made a strong case for it.
- By ignoring hers.
- We are never going to intubate a patient against their will, Mags, you know that, but there's no law against giving an opinion and Ray feels that you weren't legitimately considering all the options.
Fine.
Fine, I'll tread more carefully.
Can you handle this on your own? What? You're taking me off? I'm ensuring there are no more calls from upstairs.
- Doctor Bishop, that is not - Mags! Don't push it.
Since when does Bishop let politics get in the way of a patient? That's not what he's doing.
- Dr.
Roche.
- Dr.
Curtis.
Why is one of my post-op patients in the endoscopy suite? Maya Crawford presented in emerg with significant discomfort, thought it warranted investigation, so I Decided to waste time and resources? Ms.
Crawford was here two weeks ago.
Her issue was diet.
She's my patient and I'm telling you this procedure isn't necessary.
With respect, Dr.
Roche, Maya's following her diet.
With respect, they all say that.
And when you've been doing this as long as I have, you learn to see the patterns, right? She's not a pattern, she's a person.
Doesn't she warrant the same investigation as any other patient? Put her back on a liquid diet.
If there's no change, I'll be happy to see her again - in four to six weeks.
- She doesn't want to see you.
You're out of line, June.
It's fine, Aajay.
Let's see what she turns up.
Awn, she looks peaceful.
Now, she does.
We just fought over my boob for an hour.
She refuses to latch, even though I know she's starving.
You want them to be fighters.
Well, you've met her parents.
Speaking of, there was an ER nurse that came looking for Ben earlier.
Have you seen him? He's in surgery.
- What? - He had a ruptured spleen, but he's gonna be fine.
Why didn't he tell me? Or respond to my texts? I know we're that couple.
You know, that breaks up a thousand times and gets married to try to save the relationship, and then when that doesn't work The nurse that was looking for him didn't know where he was.
He was gonna leave, wasn't he? I'm sorry.
That's probably because I didn't exactly let Ben in on my decision to forget taking the pill.
But I'm 36 and I wanted a baby.
So you planned to get pregnant? I know, I'm the worst.
Money's tight, things have been hard.
I know I should probably end things, but every time I think about doing this on my own, I just chicken out.
Time for round two.
Let me help.
Oh, yes.
Arnold.
Her BP dropped so I came to check.
She'd vomited bright red blood.
Hematemesis.
I'll ultrasound! A bleed from pneumonia? - What's happening? - Possible esophageal bleed.
- From what? - Blunt force trauma can cause portal vein thrombosis.
Could she have genetic varices? It's possible.
Talk to me! She's going into hemorrhagic shock.
- We need to stop the bleed.
- Rhythm's erratic.
Give her her own fluids and activate MTP.
Unstable V-tach, we need to cardiovert! Stay with me, kid.
Stay with me.
Charging up to 100 J.
Clear! Charge it to 200, try again.
- Her rhythm's going nowhere.
- Charging.
Clear! We're losing her! We have to do something! - I could do a Blakemore.
- It's risky, considering the ALS.
Could damage her airway.
We don't even train for that anymore! No, I know how and we need to stop the bleed.
You do it.
It has to be Dr.
Hamed.
Please.
Save my little girl.
Give us room to work, Dr.
Grisholm.
I'll prep the Blakemore kit.
I'll need a laryngoscope and portable X-ray to confirm placement! And have 50 mics of octreotide and a gram of ceftriaxone ready.
On it! - Mags.
- What? - You almost done? - There's other terminals.
What's up? I think I hate everybody we work with.
Except you, obviously.
Well, give it time.
If there's one thing that I've learned, it's that everyone disappoints you eventually.
Dr.
Grisholm? The surgeons will update us as soon as they know more, but we stopped the bleed long enough to get Kelsey to the OR.
Thank you.
Thank you, Dr.
Hamed.
My daughter didn't even want to tell me she had this horrible disease.
She needs to know I'm listening now.
Why would Mel play my voice mail for her lawyer? So he could play it for yours, before we all have to hear it in front of a judge.
All you're doing is making this worse, Theo.
It's her lawyers that are making this worse! They're acting like nothing good ever happened between us! Suddenly, I'm this villain who isn't worthy of parenting his own kids! Theo.
You chose to take a job in a different city from your family.
You can't erase that.
Of course, she was going to ask for custody.
And as your lawyer, I'm telling you that if you don't stop being so stubborn then you could lose everything.
Dr.
Curtis! Maya's having some kind of episode! She said her heart's racing, she's shaking like a leaf, so I'm putting her on a monitor.
Can you do a bedside glucose? What's wrong with her? She's tachycardic.
Maya, if you can hear me, can you say something? Something.
So there is a problem? The testing.
What did you find? - Nothing.
- Yeah.
There's no blockage.
No polyps.
No ulcer.
Glucose is 3,4.
Alright, she gonna need one amp of D-50, then could you just give us a second? What does that mean? The glucose? Well, rapid emptying can cause acute episodes of hypoglycemia.
It's hard to keep your sugars stable when your body rejects everything you put in it.
So, we're back where we started, with you telling me to eat less.
No, Maya.
It's not what I'm saying.
You haven't done anything wrong.
Then why is this happening? I don't know if Dr.
Roche made this clear, but gastric bypass is a complex surgery that can have various outcomes.
And mine varied into hell.
You had an extreme reaction and it's gonna take some time for your stomach to recover so you can intake normally.
I didn't even want the damn surgery in the first place.
If I'd know it would be this bad There's nothing else you can do? Well, there are some medications we can try.
They slow the emptying from the stomach into the intestine.
And I can find a nutritionist who's committed to something called Health at Any Size, and they help you manage meals and side effects.
What if I never adjust? I just live like this? You come back here when things get bad again and bypass reversal is an option.
Reversal.
You mean more surgery.
If you're serious about wanting another choice, then yeah.
Could that make things worse? It's an open surgery, so it can have complications, I would talk it over carefully with your surgeon.
But I can refer you to someone who is not Dr.
Roche.
Think about it, Maya.
I'm here if you need me.
The surgeons have managed to repair your spleen.
A couple more days and you'll be up and around.
Ben, I didn't mean to judge you before I thought we could call her Crash? Dr.
Hunter, do you mind bringing her over to her daddy? Of course.
Hello, there.
Oh my God, hi.
Welcome to the world.
She has your eyes.
I love you, Tess.
I love you too.
We can make it work, I know it.
Here.
Uh It's a beat-up 2013 Sedan, but she's got some good miles left in her and there's an old car seat in the trunk.
You're giving us your car? Dr.
Hunter, I mean, thanks, but You're gonna need one.
That is so generous, but we can't accept.
You have to.
I I need to purge a few things.
And I'll start jogging to work, so I mean, really, you're doing me a favour.
We don't know what to say.
Just say you'll give that kid a great life.
They stopped the bleed, but apparently, the Blakemore tube damaged the airway.
They had to do a tracheotomy.
I was careful with the inflation.
I know.
And the surgeons agree, if you hadn't acted, she would have died.
But her body's weak and couldn't take the pressure.
Kelsey will live, but she'll be attached to a ventilator for the rest of her life and unable to speak.
Oh, my God This is exactly what she didn't want to happen.
I'm sorry, Bash.
We made the call together.
A lot of doctors would've been paralyzed, you stopped the bleed.
And then, ruined this woman's life.
It could've easily rolled the other way.
But it didn't.
You wanted to see me? You're called into a meeting.
Roche isn't happy about your little dispute over Maya Crawford and she's making it known to the division heads.
I came to you for advice.
You just let me walk right into that.
I didn't tell you to go toe-to-toe with the head of GI.
But you stood there and watched it happen.
I just I thought you had my back.
You made an enemy of the wrong person today.
Maybe stop at one.
This is my last coin.
Sir, we need to talk.
You're never wrong to fight for your patients, Mags.
Thank you.
Although, I'm not sure that actually counts as an apology.
Ray was out of line, as was I.
Why do I get the impression you're here to register another complaint? Cardiology.
I told you I wanted to explore it.
But you didn't hear me.
You also told me emerg was the only thing you ever wanted.
- What's changed? - I don't know.
I don't know.
I just know that I can't get it out of my head and you need to let me explore my future.
Even if I mess it up.
Okay, well, I'm hearing you now.
I don't like the idea of sharing you with another department, but if it's what you want I'll talk to Dr.
Fisher.
Appreciate that.
You should really watch your sugar intake.
His eyes are green, actually they're sometimes blue.
And he's funny.
- I'm sorry.
Sir - No, this is important.
He gets very frightened when he's on his own.
- Gilbert? - Claire! Where've you been all day? When did I get to the hospital? This morning, sir.
Ah, right.
I'm looking for Peter.
We've lost him again.
Your cat lives with your son in Belleville.
Andre takes very good care of him.
- Peter's a cat? - Mm-hmm.
You never mentioned that.
You never asked.
I think I have your son's number in my phone, - should I give him a ring? - Never leave again.
Also, Bishop needs to see you in his office.
How about you tell me more about your cat? Okay.
Oh, wow! - Ta-da! - What? Congratulations, Claire.
You're going to feel really bad if I failed.
Oh, thank you.
I had a chance to fix things.
To get to know her the way I should have.
Now, I never will.
I'm very sorry that it went this way.
After what you took from us Sorry won't be good enough, Dr.
Hamed.
This is your fault.
Any interest in a part-time resident practice? Who better than someone who knows what it's like to be a cardiac? I don't think so.
It's not fair, how you see me.
You're a fighter June, I get that.
What are you telling me to do here? I'm not, I'm just pointing out the landmines.
- Are you free tonight? - You're asking me on a date? You had two major health incidents.
They're pushing you out? I'm not done, Claire.
Welcome Brothers.
Couple of quick announcements.
Unfortunately we begin by offering our condolences to brother Karif Shahid, who recently lost his father.
So we pray that Allah grants him mercy and gives him the highest place in paradise.
In times of isolation, we look towards our community for peace.
Hey, those stitches still need to come out.
Maybe tomorrow after school, you stop by the hospital? Rania's coming to get some things.
We're friends, Amira.
She's still in both of our lives.
What time is it? It's late or early, depending on your point of view.
You're working? Yeah, I'm unwinding.
Unwinding.
With Electro Cardiography Interpretation? Okay, unless you can show me how to sleep like a stress-free toddler, yes, that is - I have stress! I stress! - Mm-hmm.
But I also just had a really good stress reliever.
Okay.
- Is that you? - Mm-hmm.
What stresses do you have? Well, still trying to impress Dr.
Hunter, that's one.
- Really? - Yeah.
You never seemed to worry about that.
It's future Jake's problem.
Current Jake is worried about how he's gonna sleep with the light on.
Unless you want me to go? It's okay, I can go.
Try and get some sleep, weirdo.
Hey.
Oh, do you need your office back? This isn't my office this morning.
Actually, I'm not even here.
- Soap me.
- Excuse me? Mnemonic device for rapid sequence intubation.
Suction, O2, Airways, Positioning.
Medication and Equipment.
- That's it.
- The exam's at noon? Yes.
Oh, I called in for supplementals, but somebody had to cancel, so I told Rhoda if she needs anything, just text.
We'll be fine, Claire.
Go kill it.
32-year-old found down, incoming.
- You paged me Rhoda? - Sorry.
By mistake, it's not a pedes trauma.
I'm filling in for Claire and we're just already swamped.
I have a window if you need help.
We're good.
Fall from a ladder, multiple contusions! BP's 100 over 80, rate's 130.
GCS 10.
- You're a doctor? - Yes, Kelsey's my daughter! I found her on the floor of the bar she owns.
She closed it to renovate.
I did a quick neurological exam, but she'll need a CT.
I don't know how long she's been there.
Two large bore IVs! E-FAST.
Start with her chest? Ray Grisholm.
Internist at Midcrest.
I would've got her there, but it's a 20-minute ride.
This is Dr.
Bishop, Chief of our emerg I saw you at the Trauma Association conference a few years ago.
Is there any free fluid? Your daughter is in very good hands, sir.
Fast positive.
Belly full of blood.
We'll give her a gram of TXA and activate MTP! - I'm calling the blood bank! - No, no.
She's AB negative, same as me! You can use mine now! That's not something that we do.
Well, she's not hemodynamically stable! Have either one of you ever done a direct transfusion? - I have.
- I've got a donor card in my wallet if you need to confirm.
Set up for a direct transfusion.
Let's take every step we can, Dr.
Grisholm.
Thank you.
Thank you.
Guy brought his wife in after a car accident.
He's dazed, a little bit cut up and she's Well Displaced leg fracture and when's the last time you delivered a baby? Is she okay? And after you answer that, please, tell me I can still get the epidural! Fetal heart rate's 140.
I paged OB, but It's okay, I'm on it.
Contractions are how far apart? Not very! Ben was supposed to time them, but It's really happening now? I just thought the accident might What, push it back in, Ben? Go find someone who can get me an epidural! You two got in an accident on your way to have a baby? - Ben ran a red - You were yelling at me! - Oh.
- I'm trying here, Tess.
Jake, ultrasound.
- Oh - Her stomach's bleeding.
- Tess, oh! - Ben! Remember, we took those classes about how your one job is to stay calm? Yeah? I need you to do your job, Ben! My baby's gonna be okay, right? It's not deep, just oozing.
Grab me a pair of forceps and a vacuum just in case, Arnold.
- Got it.
- Okay.
Baby's heartrate looks good, but it is sunny-side-up.
- Which is what Jake? - Occiput posterior position.
- Is that bad? - For the baby, no.
For mom, it could mean a tougher delivery, but to answer your question, Tessa, I have to get you in position to push, there's no time for an epidural, this baby is on its way now! You're ready? And one, two, three! Sorry about the heavy hand before.
I had a boss who used to say, "What this situation needs is two of me and none of you.
" I maybe followed a little too closely - in his footsteps.
- Pelvic fracture wrapped.
You're both what year? - I'm emerg PGY-two.
- I'm PGY-one.
But this is his second residency.
He was a trauma surgeon in Syria.
Oh so you're ahead of your peers, but also behind them? It's a good thing Kelsey isn't awake to see this.
She hates it when I insert myself in her life.
I'm guessing this is one time she'd make an exception.
You know, I told her that the bar would be the death of her, I meant it was a money pit, not this.
You said you didn't know how long she was alone? I knew she was trying to get the place ready to re-open and we hadn't talked in a few days.
She used to always call her mom, but We buried her a month ago.
Ovarian cancer.
I'm sorry.
When it happens, you're distracted.
Then everybody goes.
We're still figuring out not having her mom as our bridge.
Temp's 39.
I'd feel a lot better if her temp wasn't so high.
It could be an inflammatory response due to the trauma.
We'll get Kelsey up to interventional radiology for an angio-embolization to stop the pelvic bleed, and after that, just let her rest.
Okay, the baby's crowning, mom.
I just need a couple more pushes, okay? - Hang in there, Tess.
- Shut up.
I thought I was supposed to No, no, no, don't speak, don't move, don't even look at me! Okay, Tessa, let's try one more big push! I can't, I can't, I just can't anymore! It hurts too much.
Please, can you just cut it out of me.
My stomach's already bleeding, you could use that opening.
The delivery I remember the most was my youngest.
My wife was up all night with our oldest who was sick with a stomach flu.
She called me to tell me she was in labour, but she couldn't leave Abby home alone to come to the hospital.
So I drove like a maniac and got there just in time to deliver Grace on our kitchen floor.
It was insane, just like this.
- Yeah? - Okay.
When we look back on it now, we laugh.
You two will have the same kind of story! - I don't know - Yes, you will.
But Tessa, believe me.
You've got this.
I need you to push.
Okay? Come on, you can do this.
Push.
Here she is, she's coming.
She's coming, she's coming.
Here she is.
Here she is.
Here she is.
That's a man down.
- Seriously? - We'll check him out.
You did it.
Okay.
Congratulations! I already gave her the head laceration.
The fractured wrist went to imaging, back pain's on deck, Bash has a found down in two and Have you been able to find Peter? Still looking, love.
Dementia.
Doesn't know Peter's last name, or how to reach him.
Okay.
I'll get him back to his room.
Sir? Hey.
If you guys are swamped, I can grab a patient.
Nausea in D? Already been there awhile.
York emergency! Shouldn't be too long.
Ms.
Crawford? Hi, I'm Dr.
Curtis.
I heard you're feeling nauseated.
Nothing'll stay down.
Even water.
I was trying to ride it out.
She refused to go to the doctor.
But then the cramping started, and my sister strong-armed me.
Sometimes severe food poisoning can cause dehydration.
Actually, I had a gastric bypass three months ago.
I've been sick on and off ever since.
Before you ask, yes, I stick to the diet plan.
Yes, I exercise, no, I don't have high blood pressure, diabetes, or heart problems.
So about this bypass, did you have that done here? Yes.
Dr.
Evelyn Roche.
Okay, well, sometimes, after a bypass, our stomach will react by rapidly emptying food in a way that can make you feel sick.
Dumping syndrome.
I'm aware.
That's only supposed to happen if you reintroduce food too fast, but I've been following the eye-dropper meal plan like a zealot.
Did you let them know that in your postop visit? All Roche said was my system will only adjust when I commit to the lifestyle.
Didn't even run a single test.
Right.
Well, Dr.
Roche is a renowned surgeon.
She's also a jerk, who has a problem with fat people.
- Maya! - What can I say.
The woman contains multitudes.
I'm gonna order a CT.
- You will? - I can't rule out rapid gastric emptying, but we should consider other post-surgical complications, like a bowel obstruction, or another acute digestive problem.
In the meantime, I'm gonna get you some fluids and an anti-nauseant.
You'll need to change into a gown.
I'll need a second one to wrap around the back.
I'll get you one, hon.
You shouldn't have done that.
- Excuse me? - Given her false hope.
So you wanted me to tell her to exercise and eat right? Because it seems like she's already doing that.
Maya needs to hear this is normal and that she just needs to get through the worst of it.
But when you don't find something, I'll have to pick her up and get her back on track.
Is there anything else? Yes.
Who can I ask for a gown? - Here, this desk.
- Okay.
At the end of your message, press 1.
I know you're screening me, Mel.
We need to talk about you wanting sole custody.
We only speak now through lawyers, and every time I go for pick up or drop off your mom's there just glaring at me.
I don't understand why you're treating me like this.
What is it, Jake? Ben Lyons is still complaining about left upper quadrant pain.
Chest X-ray for pneumothorax and broken ribs came back normal.
Okay? You said to rule those two things out.
Yes, I did.
Can you think of any other organs in that quadrant which might be affected by blunt trauma? Kidney, spleen, pancreas.
But you didn't say to rule those out.
Ultrasound? - CT with contrast.
- CT with contrast.
So what this situation calls for is two of you and none of him? - You're defending him? - No, I mean You know, you could've walked him through your thinking.
I have, Mags.
More than once.
He's gotta start showing up for work, which means coming to me with answers instead of questions.
- Kelsey Grisholm? - Her bleed's under control, - but her temp's still high.
- We're waiting on labs.
And her father? Still insistent about being looped-in.
I want you both to stay on this.
Ray's pretty senior at Midcrest and eh, easier for all of us if he's managed.
Bash? About the thing that we're not About the elevator and like That had nothing to do with you.
Okay? The person in there wasn't even me really.
Who was it? Someone who'd had a messed up day and a messed up few months.
You're not alone there.
Listen, I I don't want it to get between us either so Let's just pretend it never happened.
Exactly what I was gonna say.
You really gave me a scare, kid.
What happened? I was painting the crown moulding.
I told you to call the contractor.
I told you I wanted to do it myself.
How are you feeling now? Ah headache, neck's a bit stiff, but I guess that's what happens when you lie on the concrete for a few hours.
We did a CT, no intracranial injury.
So, you just fell? Dad.
The world is an imperfect place.
People fall.
There's, uh concern because you're maintaining a high fever, and we'd like to know why.
Were you feeling unwell before this? Any dizziness? She's always run down.
Barely eats, works until 2:00 AM, pouring all her energy into slinging drinks.
I'm not bartending, I'm running a business.
Look, that lifestyle was fine in your 20s, but it's time to grow up! - We can give you a minute - No, it's fine.
You may as well all hear this.
I have ALS.
That's why I fell.
I found out near the end with Mom.
No, that can't be right, because Wait a minute, you're not showing any of the signs.
I've been covering.
I noticed I was having a hard time gripping things.
I ignored it at first, but Then I started having weakness in my legs.
Do you know how advanced it is? The neurologist said that I should expect more trouble with mobility and eating as I enter the mid-stage And the average survival rate is two to five years.
So I guess that's where we are.
Which neurologist? What's his name? Dr.
Vedder.
She's been great.
Never heard of her.
Joe Yoshida is a great neurologist.
I'll call him and get a second opinion.
Dr.
Vedder's done weeks of tests.
She's sure.
Honey, you gotta trust me here.
I can help us get to the bottom of this.
Dad.
Okay, this is why I haven't told you for so long.
I have doctors.
Just help me by being my dad.
Let me get Yoshida on the phone.
Did you discharge the guy in three? The new dad? No, actually, I was going to explain his imaging results.
I found this in his room.
I called OB, - and he's not there either.
- We lost him? Are you guys doing okay in there? We didn't lose him, he left.
And yes, we're having a small staffing issue, but we're managing just fine.
I got it! Peter's not here yet, sir.
Let's wait in your room, okay? Did you start her on the antibiotics? Let me call you back.
Broad spectrum, until we figure out the cause of her fever.
Well, that was the neurologist I like.
He advises we run a few exams to rule out ALS.
Spinal tap and EMG.
Kelsey was pretty firm on not wanting to re-test.
She's febrile with a headache and soar neck.
An LP will rule out meningitis, would it not? Yes, and while meningitis is plausible, there are less invasive ways of narrowing down a fever.
My daughter runs on emotion, Dr.
Hamed.
She'll make the right choice if we lead her to it.
Your boss said to do everything we can.
If you want to sign-off, he's right over there, talking to the co-head of emerg at UHN of all people.
I've got three minutes before a consult if you need me.
Uh, yeah.
Actually, I just caught this patient in emerg.
She's 12 weeks post-op from a gastric bypass, has nausea and vomiting.
But her imaging's clear.
She's aware of dumping syndrome? She is, but it could be something else right, like a peptic ulcer, an obstruction or Crohn's or What are you asking me to approve, June? A C-scope and a G-scope.
Okay, but you could have ordered those anyway.
Right, but not everybody would, based on her symptoms so Okay, you're the one who's always telling me to watch out for landmines.
Statistically, you know it's unlikely this is anything other than side effects from her bypass.
What I know is that I've made the mistake in the past of listening to statistics over patients.
Keep me in the loop.
Keep you in the loop.
We're monitoring Kelsey Grisholm closely.
Her father's a handful, but we're on top of it.
Let me know if you need any input.
Hey, I meant to ask, how's your sister? Since her head laceration.
Oh, uh she's healing fine.
I doubt it'll scar.
Good.
The woman she came in with, I'm told that's your fiancé? She was.
Uh Now, she's the reason Amira won't talk to me.
Sorry to hear that.
Amira, she takes everything on and I think she learned that from me.
You're not alone, Bashir.
Sir, that doctor that you were speaking with earlier, are you hiring a co-chief? No.
I've been asked to meet candidates and lead the transition to a new chief.
You're being pushed out? Well, let's just keep this between us for now.
It's not something I wanted, and to be frank, I don't know where it goes.
There must be something that we can do.
Let me handle, okay.
I'll find a way to get the board on side again.
I know you think you're only here because of me, but you're not.
You're here because of you.
Do you understand? Can we put her oxygen up to eight litres and find out where her chest X-ray is? Any nausea? Cold extremities at all? Just a bit short of breath.
I assumed it was a touch of the flu.
Which could be more dangerous for ALS patients.
You sound like my dad.
He's not a bad guy.
I know how badly he wants to fix me.
Fix this.
But when it comes to relating to me? That's all he's ever known.
And what about you? What do you want? To somehow meet this on my own terms? Buying that bar was a dream come true and I want to run it for as long as I can.
Her temp's up again.
Um I was wondering if you would consider letting us do a lumbar puncture? It would help us rule out meningitis, source your fever and Re-confirm my ALS diagnosis? My father ask you to float that? Yes, he did.
Resistance is futile with Ray.
Is that true about my fever? Wait, you're in control here.
Nothing's gonna happen without your consent.
- Okay? - Okay.
The maternity ward's the other way.
I can't go up there.
So you Uh, you're just You're leaving? But then, I remembered I totalled our car.
I just finished paying it off last month too, after nine years.
I don't even have a job right now.
Ben, why don't you come with me? I didn't want a baby, Dr.
Hunter.
It kinda just happened.
I thought if I cut my losses now, I'd be doing that kid a favour.
I can see you judging me.
Look I would never say running out on a new-born baby is a good idea, but that's not why I'm here.
You spleen is ruptured.
You need surgery.
What? - So I guess - Yeah.
Oh, okay.
Imaging's up.
Guys, what's happening? Just tell me, I can take it.
I'm hearing crackles in your lungs.
Crackles? From what? Based on your chest X-rays, it's likely pneumonia.
Wouldn't I be coughing? ALS makes it hard to cough due to the degeneration of the airway.
Then you accept my diagnosis? Until we get the results back from the lumbar puncture, - we have to assume - She's not doing a lumbar puncture, Dr.
Grisholm.
Stop trying to work him, Dad.
I've done the tests.
- I've come to terms - Let me talk next steps.
Well, we'll continue O2 therapy, target the pneumonia with macrolide antibiotics and monitor her levels carefully.
Also, we should consider mechanical ventilation.
What does that mean? Is that intubation? Yes.
You're not coughing due to the ALS, which means that without help your body might not be able to clear the secretions caused by pneumonia.
Dr.
Hamed's right.
It's aggressive, but it's the best way to prevent hypoxia.
Yes, but it's not your only option here, Kelsey.
We can try BIPAP for supplemental O2.
There's also postural drainage and percussion Which might not be enough to keep dangerous amounts of fluids from building.
But there's a chance I could still recover on my own, right? Yes.
This is your choice.
And intubation is the right one.
I've done my homework.
If I'm intubated, I may never come off the ventilator, right? That's what happens with ALS, right? No, this is an end-stage, Kel.
It'll only help you breathe until you fight off the pneumonia, then they extubate you in a day or two.
- No.
- Come on, Kel.
I said no.
I don't want to be intubated.
Dammit, Kelsey! You need a plan to deal with this! This is what I do! Why can't you trust me? Because you're not hearing me! Just stop and listen for once! You are doing exactly what you did with Mom.
And not just when she was sick, her whole life.
Your voice is always the loudest.
If I'm intubated, then you get to call all the shots.
You get to make all my choices and I can't give that kind of power to someone who's never listened to me.
Oh, apparently, he wandered into an exam room while a patient was getting changed? Not intentionally.
He's just confused about We should've located his people by now.
What's the hold up, Arnold? We're trying.
The reason I put both of you on Kelsey Grisholm was to make sure things went smoothly.
Well, I know it took a while to catch the pneumonia, but that's because she didn't show the regular signs No, I understand the diagnosis.
What I don't understand is why people I report to are telling me that my resident is standing in the way of a patient getting the care she needs.
Ray has friends in high places.
No, that's not at all how it happened.
He was steamrolling his daughter into intubating I recommended mechanical ventilation because I think Kelsey should consider it.
Dr.
Grisholm agreed and made a strong case for it.
- By ignoring hers.
- We are never going to intubate a patient against their will, Mags, you know that, but there's no law against giving an opinion and Ray feels that you weren't legitimately considering all the options.
Fine.
Fine, I'll tread more carefully.
Can you handle this on your own? What? You're taking me off? I'm ensuring there are no more calls from upstairs.
- Doctor Bishop, that is not - Mags! Don't push it.
Since when does Bishop let politics get in the way of a patient? That's not what he's doing.
- Dr.
Roche.
- Dr.
Curtis.
Why is one of my post-op patients in the endoscopy suite? Maya Crawford presented in emerg with significant discomfort, thought it warranted investigation, so I Decided to waste time and resources? Ms.
Crawford was here two weeks ago.
Her issue was diet.
She's my patient and I'm telling you this procedure isn't necessary.
With respect, Dr.
Roche, Maya's following her diet.
With respect, they all say that.
And when you've been doing this as long as I have, you learn to see the patterns, right? She's not a pattern, she's a person.
Doesn't she warrant the same investigation as any other patient? Put her back on a liquid diet.
If there's no change, I'll be happy to see her again - in four to six weeks.
- She doesn't want to see you.
You're out of line, June.
It's fine, Aajay.
Let's see what she turns up.
Awn, she looks peaceful.
Now, she does.
We just fought over my boob for an hour.
She refuses to latch, even though I know she's starving.
You want them to be fighters.
Well, you've met her parents.
Speaking of, there was an ER nurse that came looking for Ben earlier.
Have you seen him? He's in surgery.
- What? - He had a ruptured spleen, but he's gonna be fine.
Why didn't he tell me? Or respond to my texts? I know we're that couple.
You know, that breaks up a thousand times and gets married to try to save the relationship, and then when that doesn't work The nurse that was looking for him didn't know where he was.
He was gonna leave, wasn't he? I'm sorry.
That's probably because I didn't exactly let Ben in on my decision to forget taking the pill.
But I'm 36 and I wanted a baby.
So you planned to get pregnant? I know, I'm the worst.
Money's tight, things have been hard.
I know I should probably end things, but every time I think about doing this on my own, I just chicken out.
Time for round two.
Let me help.
Oh, yes.
Arnold.
Her BP dropped so I came to check.
She'd vomited bright red blood.
Hematemesis.
I'll ultrasound! A bleed from pneumonia? - What's happening? - Possible esophageal bleed.
- From what? - Blunt force trauma can cause portal vein thrombosis.
Could she have genetic varices? It's possible.
Talk to me! She's going into hemorrhagic shock.
- We need to stop the bleed.
- Rhythm's erratic.
Give her her own fluids and activate MTP.
Unstable V-tach, we need to cardiovert! Stay with me, kid.
Stay with me.
Charging up to 100 J.
Clear! Charge it to 200, try again.
- Her rhythm's going nowhere.
- Charging.
Clear! We're losing her! We have to do something! - I could do a Blakemore.
- It's risky, considering the ALS.
Could damage her airway.
We don't even train for that anymore! No, I know how and we need to stop the bleed.
You do it.
It has to be Dr.
Hamed.
Please.
Save my little girl.
Give us room to work, Dr.
Grisholm.
I'll prep the Blakemore kit.
I'll need a laryngoscope and portable X-ray to confirm placement! And have 50 mics of octreotide and a gram of ceftriaxone ready.
On it! - Mags.
- What? - You almost done? - There's other terminals.
What's up? I think I hate everybody we work with.
Except you, obviously.
Well, give it time.
If there's one thing that I've learned, it's that everyone disappoints you eventually.
Dr.
Grisholm? The surgeons will update us as soon as they know more, but we stopped the bleed long enough to get Kelsey to the OR.
Thank you.
Thank you, Dr.
Hamed.
My daughter didn't even want to tell me she had this horrible disease.
She needs to know I'm listening now.
Why would Mel play my voice mail for her lawyer? So he could play it for yours, before we all have to hear it in front of a judge.
All you're doing is making this worse, Theo.
It's her lawyers that are making this worse! They're acting like nothing good ever happened between us! Suddenly, I'm this villain who isn't worthy of parenting his own kids! Theo.
You chose to take a job in a different city from your family.
You can't erase that.
Of course, she was going to ask for custody.
And as your lawyer, I'm telling you that if you don't stop being so stubborn then you could lose everything.
Dr.
Curtis! Maya's having some kind of episode! She said her heart's racing, she's shaking like a leaf, so I'm putting her on a monitor.
Can you do a bedside glucose? What's wrong with her? She's tachycardic.
Maya, if you can hear me, can you say something? Something.
So there is a problem? The testing.
What did you find? - Nothing.
- Yeah.
There's no blockage.
No polyps.
No ulcer.
Glucose is 3,4.
Alright, she gonna need one amp of D-50, then could you just give us a second? What does that mean? The glucose? Well, rapid emptying can cause acute episodes of hypoglycemia.
It's hard to keep your sugars stable when your body rejects everything you put in it.
So, we're back where we started, with you telling me to eat less.
No, Maya.
It's not what I'm saying.
You haven't done anything wrong.
Then why is this happening? I don't know if Dr.
Roche made this clear, but gastric bypass is a complex surgery that can have various outcomes.
And mine varied into hell.
You had an extreme reaction and it's gonna take some time for your stomach to recover so you can intake normally.
I didn't even want the damn surgery in the first place.
If I'd know it would be this bad There's nothing else you can do? Well, there are some medications we can try.
They slow the emptying from the stomach into the intestine.
And I can find a nutritionist who's committed to something called Health at Any Size, and they help you manage meals and side effects.
What if I never adjust? I just live like this? You come back here when things get bad again and bypass reversal is an option.
Reversal.
You mean more surgery.
If you're serious about wanting another choice, then yeah.
Could that make things worse? It's an open surgery, so it can have complications, I would talk it over carefully with your surgeon.
But I can refer you to someone who is not Dr.
Roche.
Think about it, Maya.
I'm here if you need me.
The surgeons have managed to repair your spleen.
A couple more days and you'll be up and around.
Ben, I didn't mean to judge you before I thought we could call her Crash? Dr.
Hunter, do you mind bringing her over to her daddy? Of course.
Hello, there.
Oh my God, hi.
Welcome to the world.
She has your eyes.
I love you, Tess.
I love you too.
We can make it work, I know it.
Here.
Uh It's a beat-up 2013 Sedan, but she's got some good miles left in her and there's an old car seat in the trunk.
You're giving us your car? Dr.
Hunter, I mean, thanks, but You're gonna need one.
That is so generous, but we can't accept.
You have to.
I I need to purge a few things.
And I'll start jogging to work, so I mean, really, you're doing me a favour.
We don't know what to say.
Just say you'll give that kid a great life.
They stopped the bleed, but apparently, the Blakemore tube damaged the airway.
They had to do a tracheotomy.
I was careful with the inflation.
I know.
And the surgeons agree, if you hadn't acted, she would have died.
But her body's weak and couldn't take the pressure.
Kelsey will live, but she'll be attached to a ventilator for the rest of her life and unable to speak.
Oh, my God This is exactly what she didn't want to happen.
I'm sorry, Bash.
We made the call together.
A lot of doctors would've been paralyzed, you stopped the bleed.
And then, ruined this woman's life.
It could've easily rolled the other way.
But it didn't.
You wanted to see me? You're called into a meeting.
Roche isn't happy about your little dispute over Maya Crawford and she's making it known to the division heads.
I came to you for advice.
You just let me walk right into that.
I didn't tell you to go toe-to-toe with the head of GI.
But you stood there and watched it happen.
I just I thought you had my back.
You made an enemy of the wrong person today.
Maybe stop at one.
This is my last coin.
Sir, we need to talk.
You're never wrong to fight for your patients, Mags.
Thank you.
Although, I'm not sure that actually counts as an apology.
Ray was out of line, as was I.
Why do I get the impression you're here to register another complaint? Cardiology.
I told you I wanted to explore it.
But you didn't hear me.
You also told me emerg was the only thing you ever wanted.
- What's changed? - I don't know.
I don't know.
I just know that I can't get it out of my head and you need to let me explore my future.
Even if I mess it up.
Okay, well, I'm hearing you now.
I don't like the idea of sharing you with another department, but if it's what you want I'll talk to Dr.
Fisher.
Appreciate that.
You should really watch your sugar intake.
His eyes are green, actually they're sometimes blue.
And he's funny.
- I'm sorry.
Sir - No, this is important.
He gets very frightened when he's on his own.
- Gilbert? - Claire! Where've you been all day? When did I get to the hospital? This morning, sir.
Ah, right.
I'm looking for Peter.
We've lost him again.
Your cat lives with your son in Belleville.
Andre takes very good care of him.
- Peter's a cat? - Mm-hmm.
You never mentioned that.
You never asked.
I think I have your son's number in my phone, - should I give him a ring? - Never leave again.
Also, Bishop needs to see you in his office.
How about you tell me more about your cat? Okay.
Oh, wow! - Ta-da! - What? Congratulations, Claire.
You're going to feel really bad if I failed.
Oh, thank you.
I had a chance to fix things.
To get to know her the way I should have.
Now, I never will.
I'm very sorry that it went this way.
After what you took from us Sorry won't be good enough, Dr.
Hamed.
This is your fault.