Transplant (2020) s02e08 Episode Script
Scars
You're being pushed out?
I'll find a way to get the board
back on-side again.
Dad's dying, Junie.
I don't know what it changes, so That's cold, even for you.
Cardiology.
I told you I wanted to explore it, but you didn't hear me.
Yeah, well, I'm hearing you now.
- Here.
- You're giving us your car? I need to purge a few things.
There's a detention order against me.
It's been two weeks.
You said Khaled would only be in detention one day.
He could be deported.
Sorry won't be good enough, Doctor Hamed.
This is your fault.
Mr.
Jackson, I have your results from Shh.
You'll scare him.
- You see him too, right? - I do.
Good.
Then it's not the mushrooms.
I'll be right back.
The house I bought in Leslieville.
Quick jog to the hospital.
Needs a little work Actually, needs a lot of work.
You wouldn't happen to know a contractor, would you? Well, my brother-in-law.
He's honest, but he's also kind of a moron.
I'll pa There you are.
Try not to move So Mr.
Lee definitely has gout but doesn't want to admit it while Mrs.
Watson thinks she has everything but actually just has dyspepsia and you missed.
If you're gonna practice, pay attention.
- Sorry? - She means me.
The vein.
The trick is to get him to accept a corticosteroid before he gets a kidney stone.
Arnold, you with me? Yeah.
Right.
Corticosteroid.
Why don't you try tapping the vein, Jake? - Tapping it? - Yeah, tapping it.
Like this.
- See? - Oh, yeah.
She needs antacids and a bland diet for a few days.
- You got it! - Hey! That was exhausting.
No kidding.
Lightweights, both of you.
So I got your text about lunch, but my sister's actually coming to meet me.
She is? Can I meet her? Sure, okay.
But if you thought learning how to put an IV was tough, I mean It flew that way.
Okay, I gotta go.
How did it even get in there? - Oh, hey! What's going on? - Hunting party.
We need something to coax it down.
Coax what down? The model's an acute care surgical response team.
It would decrease patient waiting times and expand the scope of procedures that we can do in emergency.
Do I want to know what's going on here? It's a bird.
We had it, then lost it.
- Shouldn't you be on rounds? - What? I was on my way.
We were just trying to catch it.
For patient safety.
And for our own amusement.
Okay, fun's over.
Get maintenance to handle it.
Sorry about the wait.
Landing on a wrist to break a fall usually means a fracture, but in your case it's just a sprain.
Doc, he looked me right into the eyes.
And I swear it felt like he could see through my soul.
Who, the bird? We tried freeing him but it seems he's trapped in here.
Or maybe we are.
That might be the mushrooms.
Six-month-old with complex CHD choppered in from Timmins.
Did they say what kind of congenital heart defect? No and things can happen fast with infants, Jake, so if we ask you for something, do it no questions asked, okay? Oliver Campbell, tacky at 280.
Stabilized at the regional hospital but thought it best to fly him down considering his heart history.
Second SVT episode started as we were landing.
- We lost his line in transit.
- I'm Dr.
Hunter, this is Dr.
Leblanc and Jake Cooper.
What's his previous heart status? He was born with tricuspid atresia.
We adopted him at 2 months when he was still in the NICU.
TA means the tricuspid valve is missing or malformed and blood doesn't flow correctly.
Any episodes of supraventricular tachycardia before today? - Nothing like this.
- Most TA patients need a shunt put in early on, - has that happened? - Four months ago.
They did it here.
They hoped that it would hold him over until he gets big enough for the more invasive surgery in a few years.
His little heart's been through so much already.
- It's okay.
- We'll bring his rate down, try to isolate the cause.
One, two, three.
Malik Lawson, 17 years old, type 1 diabetes and severe hypoglycemia.
Blood glucose is 3 millimoles per litre.
Had a glucagon shot en route.
He started slurring his words then passed out! I couldn't get him to eat or drink anything even though I know it's what I'm supposed to do! Did you get a hold of Mom and Dad? We're not related, I'm his girlfriend.
And he's emancipated.
We both are.
No, we need you to stay outside, young lady.
Rhoda, push 0.
7 milligrams of adenosine.
You have to shock him? It's just a precaution in case the meds don't work.
Veins are flat! Can't get a line.
- Intraosseus infusion then! - 15 mm/15 gauge needle.
Run that down, Jake.
Use the medullary cavity in the tibia as a "non-collapsible vein" when the patient is critical.
- But even in a baby this small? - Yeah, when we can't wait.
- Will it hurt him? - He may feel it.
But we're gonna make it as quick as we can.
- I can't watch.
- Baby, just go.
I'll stay with him.
Dr.
Hunter.
Rate's 300! - Syncope.
Non-responsive.
- Jake, get on bagging.
Smaller breaths.
Thumb and two fingers.
Squeeze on one, release on two-three, got it? - Yes.
- And eyes on me.
Locating the tibial tuberosity, then 1 cm below, 1 cm medial I'm in! Decreased air entry on his right side.
That's because of his kidneys? Large pleural effusion.
He needs the fluid out now.
60 cc syringe and a spinal needle! Malik has chronic kidney disease caused by his diabetes.
- We told you to wait outside.
- And I told you he needs me.
- Joanie, can you please? - No, I need to stay with him! It's okay.
What's your name? - Ruby Evans.
- Okay Ruby Evans, I'm Dr.
Hamed.
I'm going to use this needle now to drain the fluids from his lungs.
If you're going to stay, I need you to take a deep breath and help him by remaining calm.
Malik, I'm gonna move your arm above your head.
One millimetre to the left Can someone please explain what's happening? We are giving medication to Oliver to help reset his heart rhythm.
Okay.
One, two.
No change.
1.
4 milligrams more, Rhoda.
We thought we were done after we adopted our third, but uh, when we heard about Oli we just - We knew that he needed us.
- It's really admirable, taking on a baby with such a complex heart status.
It's been really hard for Gary.
He worries so much.
But our little guy is a fighter, right? One, two.
Give him a second.
Heart rate's stabilizing.
We'll get him up to CICU.
Mags will take you.
Okay? Actually, I'll be your resident there too.
We're gonna run some tests and sort out what happened, sir.
Bruce.
Thank you, all of you.
- Thank you.
- Of course.
Good job, little man.
You did it, huh? There you are, yes.
Getting fluid now.
We'll do some blood tests and get a urine sample to check his kidneys, then assess and make a plan.
We already have one.
I'm giving him one of my kidneys.
That's very generous of you but there are multiple complex tests you'd have to do to conf We did them already.
As soon as we learned he had CKD.
Have we seen you here before Ruby? Not here.
We did blood and tissue typing, and serum too.
The doctors said there's no way I'd be a match but they were wrong.
Mal and I are meant to be.
We won't let anything come between us.
Elevated heart rate and a slight fever.
Mr.
Garcia, I'm Dr.
Curtis.
Yeah, we've met before.
My fiancee brought me in a couple weeks ago.
That's right, you had that great story about the - the jellyfish, right? - In Miami.
I got stung and the first thing I said was, "Hi, I'm Sam, can you pee on my leg?" Oh, yeah.
You just need to rub sand on it to mitigate the sting.
That's what you said last time.
What brings you here, Mr.
Garcia? The stomach pains came back yesterday and then the nausea really hit during our groomsmen photos this morning.
I remember.
You had acute pancreatitis.
It's very rare for a 28-year-old.
We put you on fluids and kept you under observation for a couple hours.
At least your organs made an impression, Sam? Can you just do what you did last time and then get me out of here for my ceremony? It's supposed to be sunset at Cherry Beach.
Let's see what your pancreas has to say before I make you any promises.
So he's gonna need a cbc, chem, lft's, lipase, bbg.
- And CT abdo.
- Got it.
You really don't remember him? I see a lot of patients for a short period of time.
I'm supposed to remember all their stories? Okay, what major life event happened to me last week? You got promoted? I turned 30.
You ate one of the cupcakes.
Marnie Jensen's asthma symptoms aren't relieving with her inhaler.
She's been fighting a cold, her chest is congested.
Did a peak-flow test and she's in the red.
Hi Marnie, I'm Theo.
We're gonna take care of you, okay? - Action plan, Jake? - Nebulize with albuterol? He just gets to guess? This is a teaching hospital and he's a student.
But how is she with nebulizer, Mom? Unless you popped out of my uterus seven years ago, maybe call me Shelley? And the bronchodilator that works is ipratropium.
- Albuterol gives her headaches.
- That's good to know.
Jake will set that up for you right away.
Thank you.
Mr.
Kline, it's Bashir Hamed again.
It's been two months since Khaled was in immigration hold.
There must be some way I can help.
Please call me back.
You're renovating a house? Did you manage to sell your place in Sudbury? No, not yet.
And you still have your rental for when you go back home? I know what I'm doing, Bash.
You know you can kick Malik back to peds.
No, he's 17, I'll stay on.
Hey guys, so I kept thinking I knew Ruby, maybe she'd been here before.
This has been running on the local news.
Her mother is a school board trustee in Etobicoke.
And she reported her missing three days ago.
So much for being emancipated.
Does that mean Malik isn't either? Iris checked.
He is.
Do we call it in? She's not a patient so there's no confidentiality issue.
She's been pretty clear she doesn't want that.
She's a minor who's been reported missing.
I think we have a duty to let her mother know she's safe.
Keep me in the loop, Bash.
Bishop wants to see you.
So this isn't good news.
Ray Grisholm has filed a malpractice suit for the events which led to his daughter having to be mechanically ventilated for the rest of her life.
What, is he I mean, is he suing the hospital? Or us? All of the above, unfortunately.
He's been given power of attorney and he's running with it.
I know you weren't there when it happened, Mags, but the suit names all doctors who were involved in Kelsey's treatment.
We took a necessary action to save her life.
- I took the action.
- All our options were tragic.
I stand by the choice we made.
This is happening because a father needs somewhere to put his anger.
What do we do now? Contact your insurer, get them to arrange for a lawyer.
Otherwise, your jobs.
Do not let this get into your heads.
Sir, I know this is the last thing you need right now.
With you fighting to keep your position.
Don't worry about me, Bashir.
Tell me what I can do to manage this? You can play it safe.
Toe the line.
Toe the line.
Everything you do is going to be scrutinized.
I know it's unfair, but you already have to be better than everyone else.
Starting now, you need to go out of your way to follow protocol.
No more pushing the boundaries, no unnecessary risks.
Don't give them any ammunition.
Do you hear me? Hey, Gary.
Well, he's looking better.
Is Bruce checking in at home? Did you figure out what's wrong? Well, Oli has a condition called Wolff-Parkinson-White syndrome.
It's an extra electrical pathway that can cause dangerously high heart rate like you saw earlier today.
You mean it wasn't just his heart defect? He has a new thing? He does, yes.
Can what happened today happen again? Potentially regularly.
Or never.
Or somewhere in between All of this is so much harder than we realized.
What do we do now? You digest the information.
I'm gonna talk to Dr.
Fisher and get back to you.
How long did it take you to feel settled here? Should that have happened by now? I can't imagine It's just been so long since I've had to start new anywhere.
For your nurse practitioner clinical hours, will you be leaving us? Who called about my daughter Ruby? That was me, Ms.
Evans.
I'm Bashir Hamed.
They're actually just down this hallway Ah okay.
Thought you weren't going to call.
Social worker was asking me about my parents, then suggested a group home.
You're not going back to a place like that.
You're not alone, babe, you have me.
Ruby Josephine Evans, you step away from that boy right this minute! Don't upset him! He's sick.
What are you even doing here?! How can you ask me that? Ruby, you ran off.
- I was afraid you were dead! - Well, I'm not! I can handle myself! And this doctor tells me you said you were emancipated and you want to give away an organ? Over my dead body! It's my body, it's my kidney and I can do what I want with it! Explain to her I'm the only one who can help him! He knows that you can't make that choice on your own.
Why do you think he called me? Parental consent is required for a minor to donate an organ.
But he could die! You don't know him or what he's been through! I love him and I wanna do this for him! Spend three weeks with him without a roof over your head then tell me you love him.
This is foolish! Just because you got knocked up by the first guy who looked at you doesn't mean what Malik and I have isn't real! You're coming with me, we're phoning the police and you're gonna apologize for this mess that you created.
If he dies, it's your fault.
She's still struggling to breathe.
I know for a fact ipratropium works for her asthma.
Which made us think maybe it's not asthma.
How long has Marnie been fighting a cold for? Two weeks.
It was maybe four days after she got back.
- Back from where? - Bali.
With her father.
Would you give us a second? You always ask about international travel with a respiratory illness.
What Sometimes, it's okay if I don't know things because you haven't told me.
But other times it's not.
You keep moving the goal posts on me.
There's also the question of you making it sound like we don't know what's going on with her kid.
Does that mean that we do? Marnie's X-ray shows some indication of TB.
But that is news that you have to dole out carefully to avoid panic.
Do I look like I'm panicking? TB as in tuberculosis? It can mimic asthma, and with Marnie's travel history, it's something we need to consider.
Okay.
What happens now? We'll move her to a negative pressure isolation room while we work to rule it out.
- Your husband, has he been ill? - We're divorced.
I'll call him.
Ask about his boys too.
Jake, can you ask Rhoda to set up the room? This is just a precaution Do you get a disproportionate amount of panicky moms, or are you just not a good listener? I don't need to be bubble-wrapped.
I'll I'll let you know when I hear from the lab.
My hero.
How's the SVT baby? Ugh.
He's so tiny and he's been through so much already.
How do you deal with that kind of thing? Apparently by irritating people with aggressive emotional support.
Mags, are you dating my student? I mean it's not like I'm wearing his varsity jacket or anything.
- Why, is that a problem? - It's a bit weird, but whatever.
I already said yes, Charles.
CT results for Sam Garcia.
Pancreatic abscess.
It's not uncommon after acute pancreatitis.
He's gonna need the OR for drainage.
So, I guess that means no sunset wedding? Is he a candidate for percutaneous drainage? Possibly.
But either way, I can't get him in before tonight, so.
Unless we did an endoscopic ultrasound-guided drainage in emerg? That's not something we would normally do, is it? Not traditionally.
But we could if we had an acute care surgical response team.
So you want to send less patients up to OR? Well, patients who have been surgically diagnosed spend hours waiting for an OR slot.
Often in real pain.
Appendectomies, splenectomies, scopes.
All things that we can handle in a trauma OR.
Your groom would be a compelling example.
So do I tell him that there's a chance he's getting married today? I have to get a radiologist to agree to do guidance first and of course, Dr.
Singh's sign off.
Interrogate and let me know.
Where's Ruby? She's with her mother.
I know the plan was to give you a kidney but I don't care about that! I just want her to be okay.
Malik, we tested your renal function.
And you've lost 90%.
- Okay.
- I'll start you on fluids.
And we'll get you on a transplant list, but realistically that could take five years.
So until then I just survive.
You'll start dialysis and it will become a regular part of your life.
Where have you been staying? Friends' couches.
After that, Ruby rented a room with her savings.
I tried saying no but Ruby.
If I were her mom, I'd hate me too.
Look, it must be difficult trying to maintain your diet and blood sugar levels, moving around so much.
I keep up with my insulin.
I know, but our social worker has resources I tried that when I left home.
It was just as bad.
- Malik, you can't do this - I don't have to talk to you about this! Look, I get you just wanna help but there's nothing you can do about this.
Oliver Campbell has Wolff-Parkinson-White Syndrome on top of his heart defect? And this was the first onset of it.
Will they have a decision today? I assume you gave the parents the surgical option.
Radio frequency ablation? I Not yet, I didn't think I should raise it without asking you.
It's either that or wait and see.
Well, ablation is risky.
He could have a stroke, or sustain damage that could hurt his chances of open heart surgery later.
A surgery he might not make it to if SVT events like the one he had today lead to sudden cardiac death.
Then you think they should ablate? I think they need to know all their options to make an informed choice.
They're going to ask me what to do.
And you should answer them.
Mags, you lived their reality.
Tricuspid atresia wasn't my issue.
But you know what that little boy is going through.
What all of them are.
Sam Garcia meets the criteria for endoscopic drainage.
Taking a liberal view, maybe.
He's still at risk for sepsis, and necrotizing pancreatitis always needs multidisciplinary management.
His wedding's today.
And iif we did it in emerg, maybe he'd make it? And maybe Bishop told you he wants to start operating in trauma and you saw a chance to step up? I'd be getting in on cutting-edge procedures.
And diverting patients and therefore funding from OR.
You have to be smart.
I know I do, that's why I'm here.
Except this is becoming a bad habit.
You come to me before you walk into something.
I flag the risks and you do it anyway.
If you don't trust my advice, don't waste my time.
Hey, about what Bishop said earlier.
Yeah, well I called my insurer and they put me in touch with a lawyer.
Do they think we could lose our license? Well, she did say to prepare for it to take a minute.
And that it's a rite of passage.
But, most doctors come through fine.
I know you're not most doctors.
Look, it's unfair you're wrapped up in all of this.
Well, I am.
I am.
And I'm trying to follow Bishop's advice and stay focused on the job.
You should too.
The bird, he's in the ducts.
- Ruby? - I think I cut too deep.
He's young.
He's only two years younger than me.
But still a student? I took a couple years to travel.
Nothing wrong with some real world experience.
Oh.
She's defending you.
She likes you.
Don't get too excited.
She once carried a sock around for months telling us it was her soulmate.
I was four! I was four! And it was a really cute sock, okay? You already have to go? It's just an update.
Is it the patient this morning? You should've seen her.
She saved a baby's life.
Yes, she's a force of nature and always has been.
- Okay, you can go now.
- Oh my God, Cam! What? You'll have to run off, and I can't talk about him if he's here.
Okay, that's fine.
Very nice to meet you, Camille.
I look forward to hearing if I'm good enough for your sister.
But nobody is.
You can't honestly tell me you see yourself with him.
He's sweet.
He's funny.
He's smart.
And he will do anything you want to make you happy.
At least he's in keeping with your pattern.
No, he's not! What pattern? What are you talking about? It's either someone who withholds validation or someone who worships you.
You honestly don't see that? Look I get it.
You've had a terrible few months.
But letting this boy fall in love with you so you can feel better about yourself, it's the wrong answer, Mag.
Just once I wish you could tell me what I want to hear.
Do we have a patient with bedsores? Because I'm an expert, if you want advice.
Did you need me for something, Arnold? Sam's pain's is at an 8.
And not just because he finally told his fiancee he can't make their wedding.
Give him another 10 milligrams of morphine.
It's gonna be a few hours before his surgery.
How do you know so much about bedsores? Before I came to emerg, I was a hospice nurse.
Hard to avoid them in that field.
Why? - Oh, baby - Don't, okay? I already know what you're thinking.
Baby, I was afraid to ask if this was starting up again.
You have experience with this? When I was little, it was just pinching and scratching.
Then it got worse.
Seeing a psychologist has helped.
Yeah, once you accepted I needed to.
I wasn't raised to reach out for help with problems like these.
Many people aren't.
She's given me some good tools, but sometimes it's I don't know.
A hard pattern to break? This is why Malik's bad for you, honey.
- He's too unstable.
- You're wrong, Mom.
Sharing our burdens makes us stronger.
I know his and he knows mine.
And, look No fresh cuts, just old scars.
Today was the first time in months.
He helps me, you need to let me help him back.
Those are the only options? Do this ablation procedure or wait and see if the SVT recurs? There's medication that we can try to prevent future episodes, but there's no guarantee.
No.
No surgery.
You heard her.
These episodes could keep happening if we don't do it.
It could.
Not will.
The medication might help.
We should wait.
You wanted to wait to chopper him here, - but if we hadn't brought him - He's just a baby, Bruce! How much more can we ask him to go through? What about you? What would you do if he was yours? I don't know.
Because both options are terrible! I'm sorry.
Do we Do we need to decide this second? No.
And if you do choose the ablation, it won't be today.
So Take your time, think about it.
What's happened to Malik? We were about to start dialysis when his breathing worsened.
- What's going on? - Fluid in his lungs again.
- Claire? - On it.
What do you need, Bash? Help with thoracentesis.
Guide placement.
Puncturing now.
About to enter pleural cavity.
Good.
- O2 sats aren't really moving.
- This is the second time this has happened to him, he's in kidney failure.
The fluid's gonna continue to accumulate.
He needs the OR VATS pleurodesis.
- What does that mean? - It's a surgical procedure that seals up the space between his chest and his lungs, or this will keep happening.
Thoracics can't take him for at least another 8 hours.
- Excuse me.
- Can he wait that long? He'll have to.
I'll put a drain in, and we'll monitor him until they have time.
Unless we do a chemical pleurodesis here.
- That's a risk in emerg.
- It's talc in a chest tube.
It'll expedite dialysis.
We know he needs it.
It makes sense, Bash.
Call an attending? You guys should wait outside.
- I wanna stay.
Please! - Baby.
Let's let them work.
We need talc, 10 grams in a 250 ml sterile isotonic sodium chloride solution.
I'll start on the tube, you wanna prep the agent? - Bash? - What's happening? He needs a chemical pleurodesis.
Are you sure you don't want in on this? You guys have it.
I need a 28 French and two guarded clamps.
So, scale of one to Titanic? You were fine.
Cam is insane.
- Because if I said anything - No.
Marnie is negative for TB.
That's a relief.
Although I guess it means that we're back to not knowing.
Did you want me to work up a differential? Sure, but respirology will have to weigh in.
And this is complex so you're aware of the expectations.
You know certain fungal infections can mimic TB.
I'd look into any environmental exposures if I were you.
She did say that she was playing on a compost pile with her brothers.
You're incredible.
Why are you still here? Go, go cross-reference with her symptoms.
The wedding came to him? We didn't think Sam was a good candidate for draining in trauma.
Hmm.
Not to mention Dr.
Singh detested my idea of an acute care surgical response team.
Yeah, passionately.
And the kidney failure patient? The ED pleurodesis? What will he make of that? I haven't mentioned it yet but That patient was a candidate, and I'll defend it to any surgeons that wants to take issue.
How are you doing, June? Being Chief Resident, caught between the egos and the politics It's just hard to know whose interests you're serving, you know, who you can trust.
All I know is patient first is our true north.
Keep an open mind about what I'm proposing.
If you find a candidate that fits the bill, I'll have your back.
Khaled appealed his asylum case because you said he had a chance.
Now he's stuck in jail! I've been trying to argue for his conditional release.
- Beyond that - Don't say there's nothing I can do.
I'm sorry doctor, but it is the case.
Listen, I'll call if anything changes.
Dr.
Hamed, how long do these sessions usually take? His dialysis.
Three hours, four times a week.
Well, I feel for him, but he's gonna have to learn to make health his priority.
What alone? Without any support? - She's just a child! - Your daughter got him to do what apparently no one else can, confide in her.
And like it or not, she trusts him too.
This is none of your damn business.
She got sick from my compost pile? I'll have Jake here explain it since we have him to thank for the revelation.
Yeah, well, Marnie likely has "allergic bronchopulmonary aspergillosis".
It's an infection from a fungus commonly found in compost bins.
And the effects resemble asthma, or TB.
But the good new is, it's not contagious and totally treatable.
Wow.
Okay.
So what are the next steps? Well, we'll swab to confirm, but Marnie will be on the mend for a few days.
Shall I go fix you boys some cocktails while you finish chatting? Wow, the second a man's in the room.
Stand down, soldier.
I have a magnetic presence.
- It's why you fell for me.
- And why I left you.
Have you been doing this all day? Stop terrifying the doctors.
You're not scared of me, are you, Dr.
Hunter? It's happening again! He was awake and smiling and then Let's give him 0.
7 milligrams of adenosine, Nelly.
Okay.
One, two.
- Why isn't it working? - He's still at 300 bpm.
We need to cardiovert.
3.
5 joules.
On my mark.
Ready, and clear! Again.
7 joules.
Ready, and clear! Give him a minute.
Come on, come on, Oli.
Okay, he's stabilizing.
This isn't going to stop, is it? I think you should do the ablation.
- You said it could kill him! - There are risks either way.
But your son is a fighter, and it gives him the best chance.
Okay.
It'll take a few days to schedule and Dr.
Fisher will do the procedure, but I promise that I'll be with you every step of the way.
You didn't mention me that you treated Ruby for cutting herself.
I'm just going over today's patient intakes.
It was right before Malik crashed again.
I'm sorry.
It's not that.
It's just, you realize that with her history of self-harm, it's unlikely she'll be able to donate a kidney.
Even if she keeps it under control? Still a tough sell.
Donors often experience depression post-op.
There's pretty strict rules on mental health.
Then it's a death sentence for this kid, Theo.
Look, man, I heard about the lawsuit.
I know what it's like.
- You've been sued? - I'm being sued.
For custody.
- Theo, I - Just You have to tell them.
Ruby and Malik.
They need to know what they're facing.
Since when did you start drinking fancy apricot beer, anyways? You're free to buy your own.
I feel like I'm 16 again and you're bootlegging for me.
I did that one time.
You ended up throwing up all over Taneesha's car.
Which she made me pay to have it cleaned.
You're the one who insisted I go camping with you guys.
- Remember? - I had no choice.
What do you mean, you had no choice? Dad took out a second mortgage on the house without telling Mom.
I came home, she's screaming, packing up all his stuff.
So I had to get you out of the house for the weekend.
When we got back, she was fine.
And Dad was "on the road" for a month.
Yeah, but he was a management consultant! He always travelled for That one wasn't for work.
She threw him out and he wormed his way back in.
Again.
What else am I remembering wrong? I'm sorry that you had to build those walls, June.
I have enough bad memories, you know.
I just wanted you to have good ones.
Well, you're off the hook.
It's time for Dad's night meds.
You should change his mattress.
Gel or foam will help the bedsores.
Isn't that kind of helpful advice against the rules? I'm giving you advice, not him.
And trusting you not to tell me whether or not you take it.
Thanks, Junie.
Yeah.
Is that your secret identity? Yeah I keep the cape in the bag.
You know, in case I see a cat in a tree on my way home.
So, Marnie's in respirology now with a much less accommodating doctor.
Justin's gonna spend the night with her since I took the day.
So? Wow, you're really going to make me ask you, huh? Ask what? If you wanna come home with me.
To be clear, if you wanna have sex with me.
Yeah.
Um - What about your husband? - Ex-husband.
Though I'm sure he'd be delighted if you felt compelled to ask him for his blessing.
- You know, I'm your daughter's doctor.
- Ex-doctor.
What else you got? - I thought you hated me.
- Don't overthink it.
I'm sorry.
I know this isn't what you wanted to hear.
There must be something you can do! There isn't.
- It's okay, babe.
- No! We'll make dialysis work until you get a kidney.
I'll find us a place to live, get a part-time job.
I'll go to one of the group homes if the social worker's still around.
I can reach out if you think you're ready.
- Mal, you don't want that! - Ruby, it's better this way.
I'm not dragging you down with me.
Stop this foolishness, both of you.
He'll come and live with us.
He can stay in our guest room.
I'll make sure he gets to dialysis.
No, Ms.
Evans, I couldn't do that.
You deserve a fair chance to fight this off.
I'm not taking no for an answer.
If I can't convince you, I know Ruby can.
You don't know how much this means to me.
We'll find a way to get through.
It's a good thing you're doing.
What choice did I have? Turn my back and lose my daughter? I don't like this thing between them.
But I can't stop it.
All I can do now is let it happen.
Dad's dying, Junie.
I don't know what it changes, so That's cold, even for you.
Cardiology.
I told you I wanted to explore it, but you didn't hear me.
Yeah, well, I'm hearing you now.
- Here.
- You're giving us your car? I need to purge a few things.
There's a detention order against me.
It's been two weeks.
You said Khaled would only be in detention one day.
He could be deported.
Sorry won't be good enough, Doctor Hamed.
This is your fault.
Mr.
Jackson, I have your results from Shh.
You'll scare him.
- You see him too, right? - I do.
Good.
Then it's not the mushrooms.
I'll be right back.
The house I bought in Leslieville.
Quick jog to the hospital.
Needs a little work Actually, needs a lot of work.
You wouldn't happen to know a contractor, would you? Well, my brother-in-law.
He's honest, but he's also kind of a moron.
I'll pa There you are.
Try not to move So Mr.
Lee definitely has gout but doesn't want to admit it while Mrs.
Watson thinks she has everything but actually just has dyspepsia and you missed.
If you're gonna practice, pay attention.
- Sorry? - She means me.
The vein.
The trick is to get him to accept a corticosteroid before he gets a kidney stone.
Arnold, you with me? Yeah.
Right.
Corticosteroid.
Why don't you try tapping the vein, Jake? - Tapping it? - Yeah, tapping it.
Like this.
- See? - Oh, yeah.
She needs antacids and a bland diet for a few days.
- You got it! - Hey! That was exhausting.
No kidding.
Lightweights, both of you.
So I got your text about lunch, but my sister's actually coming to meet me.
She is? Can I meet her? Sure, okay.
But if you thought learning how to put an IV was tough, I mean It flew that way.
Okay, I gotta go.
How did it even get in there? - Oh, hey! What's going on? - Hunting party.
We need something to coax it down.
Coax what down? The model's an acute care surgical response team.
It would decrease patient waiting times and expand the scope of procedures that we can do in emergency.
Do I want to know what's going on here? It's a bird.
We had it, then lost it.
- Shouldn't you be on rounds? - What? I was on my way.
We were just trying to catch it.
For patient safety.
And for our own amusement.
Okay, fun's over.
Get maintenance to handle it.
Sorry about the wait.
Landing on a wrist to break a fall usually means a fracture, but in your case it's just a sprain.
Doc, he looked me right into the eyes.
And I swear it felt like he could see through my soul.
Who, the bird? We tried freeing him but it seems he's trapped in here.
Or maybe we are.
That might be the mushrooms.
Six-month-old with complex CHD choppered in from Timmins.
Did they say what kind of congenital heart defect? No and things can happen fast with infants, Jake, so if we ask you for something, do it no questions asked, okay? Oliver Campbell, tacky at 280.
Stabilized at the regional hospital but thought it best to fly him down considering his heart history.
Second SVT episode started as we were landing.
- We lost his line in transit.
- I'm Dr.
Hunter, this is Dr.
Leblanc and Jake Cooper.
What's his previous heart status? He was born with tricuspid atresia.
We adopted him at 2 months when he was still in the NICU.
TA means the tricuspid valve is missing or malformed and blood doesn't flow correctly.
Any episodes of supraventricular tachycardia before today? - Nothing like this.
- Most TA patients need a shunt put in early on, - has that happened? - Four months ago.
They did it here.
They hoped that it would hold him over until he gets big enough for the more invasive surgery in a few years.
His little heart's been through so much already.
- It's okay.
- We'll bring his rate down, try to isolate the cause.
One, two, three.
Malik Lawson, 17 years old, type 1 diabetes and severe hypoglycemia.
Blood glucose is 3 millimoles per litre.
Had a glucagon shot en route.
He started slurring his words then passed out! I couldn't get him to eat or drink anything even though I know it's what I'm supposed to do! Did you get a hold of Mom and Dad? We're not related, I'm his girlfriend.
And he's emancipated.
We both are.
No, we need you to stay outside, young lady.
Rhoda, push 0.
7 milligrams of adenosine.
You have to shock him? It's just a precaution in case the meds don't work.
Veins are flat! Can't get a line.
- Intraosseus infusion then! - 15 mm/15 gauge needle.
Run that down, Jake.
Use the medullary cavity in the tibia as a "non-collapsible vein" when the patient is critical.
- But even in a baby this small? - Yeah, when we can't wait.
- Will it hurt him? - He may feel it.
But we're gonna make it as quick as we can.
- I can't watch.
- Baby, just go.
I'll stay with him.
Dr.
Hunter.
Rate's 300! - Syncope.
Non-responsive.
- Jake, get on bagging.
Smaller breaths.
Thumb and two fingers.
Squeeze on one, release on two-three, got it? - Yes.
- And eyes on me.
Locating the tibial tuberosity, then 1 cm below, 1 cm medial I'm in! Decreased air entry on his right side.
That's because of his kidneys? Large pleural effusion.
He needs the fluid out now.
60 cc syringe and a spinal needle! Malik has chronic kidney disease caused by his diabetes.
- We told you to wait outside.
- And I told you he needs me.
- Joanie, can you please? - No, I need to stay with him! It's okay.
What's your name? - Ruby Evans.
- Okay Ruby Evans, I'm Dr.
Hamed.
I'm going to use this needle now to drain the fluids from his lungs.
If you're going to stay, I need you to take a deep breath and help him by remaining calm.
Malik, I'm gonna move your arm above your head.
One millimetre to the left Can someone please explain what's happening? We are giving medication to Oliver to help reset his heart rhythm.
Okay.
One, two.
No change.
1.
4 milligrams more, Rhoda.
We thought we were done after we adopted our third, but uh, when we heard about Oli we just - We knew that he needed us.
- It's really admirable, taking on a baby with such a complex heart status.
It's been really hard for Gary.
He worries so much.
But our little guy is a fighter, right? One, two.
Give him a second.
Heart rate's stabilizing.
We'll get him up to CICU.
Mags will take you.
Okay? Actually, I'll be your resident there too.
We're gonna run some tests and sort out what happened, sir.
Bruce.
Thank you, all of you.
- Thank you.
- Of course.
Good job, little man.
You did it, huh? There you are, yes.
Getting fluid now.
We'll do some blood tests and get a urine sample to check his kidneys, then assess and make a plan.
We already have one.
I'm giving him one of my kidneys.
That's very generous of you but there are multiple complex tests you'd have to do to conf We did them already.
As soon as we learned he had CKD.
Have we seen you here before Ruby? Not here.
We did blood and tissue typing, and serum too.
The doctors said there's no way I'd be a match but they were wrong.
Mal and I are meant to be.
We won't let anything come between us.
Elevated heart rate and a slight fever.
Mr.
Garcia, I'm Dr.
Curtis.
Yeah, we've met before.
My fiancee brought me in a couple weeks ago.
That's right, you had that great story about the - the jellyfish, right? - In Miami.
I got stung and the first thing I said was, "Hi, I'm Sam, can you pee on my leg?" Oh, yeah.
You just need to rub sand on it to mitigate the sting.
That's what you said last time.
What brings you here, Mr.
Garcia? The stomach pains came back yesterday and then the nausea really hit during our groomsmen photos this morning.
I remember.
You had acute pancreatitis.
It's very rare for a 28-year-old.
We put you on fluids and kept you under observation for a couple hours.
At least your organs made an impression, Sam? Can you just do what you did last time and then get me out of here for my ceremony? It's supposed to be sunset at Cherry Beach.
Let's see what your pancreas has to say before I make you any promises.
So he's gonna need a cbc, chem, lft's, lipase, bbg.
- And CT abdo.
- Got it.
You really don't remember him? I see a lot of patients for a short period of time.
I'm supposed to remember all their stories? Okay, what major life event happened to me last week? You got promoted? I turned 30.
You ate one of the cupcakes.
Marnie Jensen's asthma symptoms aren't relieving with her inhaler.
She's been fighting a cold, her chest is congested.
Did a peak-flow test and she's in the red.
Hi Marnie, I'm Theo.
We're gonna take care of you, okay? - Action plan, Jake? - Nebulize with albuterol? He just gets to guess? This is a teaching hospital and he's a student.
But how is she with nebulizer, Mom? Unless you popped out of my uterus seven years ago, maybe call me Shelley? And the bronchodilator that works is ipratropium.
- Albuterol gives her headaches.
- That's good to know.
Jake will set that up for you right away.
Thank you.
Mr.
Kline, it's Bashir Hamed again.
It's been two months since Khaled was in immigration hold.
There must be some way I can help.
Please call me back.
You're renovating a house? Did you manage to sell your place in Sudbury? No, not yet.
And you still have your rental for when you go back home? I know what I'm doing, Bash.
You know you can kick Malik back to peds.
No, he's 17, I'll stay on.
Hey guys, so I kept thinking I knew Ruby, maybe she'd been here before.
This has been running on the local news.
Her mother is a school board trustee in Etobicoke.
And she reported her missing three days ago.
So much for being emancipated.
Does that mean Malik isn't either? Iris checked.
He is.
Do we call it in? She's not a patient so there's no confidentiality issue.
She's been pretty clear she doesn't want that.
She's a minor who's been reported missing.
I think we have a duty to let her mother know she's safe.
Keep me in the loop, Bash.
Bishop wants to see you.
So this isn't good news.
Ray Grisholm has filed a malpractice suit for the events which led to his daughter having to be mechanically ventilated for the rest of her life.
What, is he I mean, is he suing the hospital? Or us? All of the above, unfortunately.
He's been given power of attorney and he's running with it.
I know you weren't there when it happened, Mags, but the suit names all doctors who were involved in Kelsey's treatment.
We took a necessary action to save her life.
- I took the action.
- All our options were tragic.
I stand by the choice we made.
This is happening because a father needs somewhere to put his anger.
What do we do now? Contact your insurer, get them to arrange for a lawyer.
Otherwise, your jobs.
Do not let this get into your heads.
Sir, I know this is the last thing you need right now.
With you fighting to keep your position.
Don't worry about me, Bashir.
Tell me what I can do to manage this? You can play it safe.
Toe the line.
Toe the line.
Everything you do is going to be scrutinized.
I know it's unfair, but you already have to be better than everyone else.
Starting now, you need to go out of your way to follow protocol.
No more pushing the boundaries, no unnecessary risks.
Don't give them any ammunition.
Do you hear me? Hey, Gary.
Well, he's looking better.
Is Bruce checking in at home? Did you figure out what's wrong? Well, Oli has a condition called Wolff-Parkinson-White syndrome.
It's an extra electrical pathway that can cause dangerously high heart rate like you saw earlier today.
You mean it wasn't just his heart defect? He has a new thing? He does, yes.
Can what happened today happen again? Potentially regularly.
Or never.
Or somewhere in between All of this is so much harder than we realized.
What do we do now? You digest the information.
I'm gonna talk to Dr.
Fisher and get back to you.
How long did it take you to feel settled here? Should that have happened by now? I can't imagine It's just been so long since I've had to start new anywhere.
For your nurse practitioner clinical hours, will you be leaving us? Who called about my daughter Ruby? That was me, Ms.
Evans.
I'm Bashir Hamed.
They're actually just down this hallway Ah okay.
Thought you weren't going to call.
Social worker was asking me about my parents, then suggested a group home.
You're not going back to a place like that.
You're not alone, babe, you have me.
Ruby Josephine Evans, you step away from that boy right this minute! Don't upset him! He's sick.
What are you even doing here?! How can you ask me that? Ruby, you ran off.
- I was afraid you were dead! - Well, I'm not! I can handle myself! And this doctor tells me you said you were emancipated and you want to give away an organ? Over my dead body! It's my body, it's my kidney and I can do what I want with it! Explain to her I'm the only one who can help him! He knows that you can't make that choice on your own.
Why do you think he called me? Parental consent is required for a minor to donate an organ.
But he could die! You don't know him or what he's been through! I love him and I wanna do this for him! Spend three weeks with him without a roof over your head then tell me you love him.
This is foolish! Just because you got knocked up by the first guy who looked at you doesn't mean what Malik and I have isn't real! You're coming with me, we're phoning the police and you're gonna apologize for this mess that you created.
If he dies, it's your fault.
She's still struggling to breathe.
I know for a fact ipratropium works for her asthma.
Which made us think maybe it's not asthma.
How long has Marnie been fighting a cold for? Two weeks.
It was maybe four days after she got back.
- Back from where? - Bali.
With her father.
Would you give us a second? You always ask about international travel with a respiratory illness.
What Sometimes, it's okay if I don't know things because you haven't told me.
But other times it's not.
You keep moving the goal posts on me.
There's also the question of you making it sound like we don't know what's going on with her kid.
Does that mean that we do? Marnie's X-ray shows some indication of TB.
But that is news that you have to dole out carefully to avoid panic.
Do I look like I'm panicking? TB as in tuberculosis? It can mimic asthma, and with Marnie's travel history, it's something we need to consider.
Okay.
What happens now? We'll move her to a negative pressure isolation room while we work to rule it out.
- Your husband, has he been ill? - We're divorced.
I'll call him.
Ask about his boys too.
Jake, can you ask Rhoda to set up the room? This is just a precaution Do you get a disproportionate amount of panicky moms, or are you just not a good listener? I don't need to be bubble-wrapped.
I'll I'll let you know when I hear from the lab.
My hero.
How's the SVT baby? Ugh.
He's so tiny and he's been through so much already.
How do you deal with that kind of thing? Apparently by irritating people with aggressive emotional support.
Mags, are you dating my student? I mean it's not like I'm wearing his varsity jacket or anything.
- Why, is that a problem? - It's a bit weird, but whatever.
I already said yes, Charles.
CT results for Sam Garcia.
Pancreatic abscess.
It's not uncommon after acute pancreatitis.
He's gonna need the OR for drainage.
So, I guess that means no sunset wedding? Is he a candidate for percutaneous drainage? Possibly.
But either way, I can't get him in before tonight, so.
Unless we did an endoscopic ultrasound-guided drainage in emerg? That's not something we would normally do, is it? Not traditionally.
But we could if we had an acute care surgical response team.
So you want to send less patients up to OR? Well, patients who have been surgically diagnosed spend hours waiting for an OR slot.
Often in real pain.
Appendectomies, splenectomies, scopes.
All things that we can handle in a trauma OR.
Your groom would be a compelling example.
So do I tell him that there's a chance he's getting married today? I have to get a radiologist to agree to do guidance first and of course, Dr.
Singh's sign off.
Interrogate and let me know.
Where's Ruby? She's with her mother.
I know the plan was to give you a kidney but I don't care about that! I just want her to be okay.
Malik, we tested your renal function.
And you've lost 90%.
- Okay.
- I'll start you on fluids.
And we'll get you on a transplant list, but realistically that could take five years.
So until then I just survive.
You'll start dialysis and it will become a regular part of your life.
Where have you been staying? Friends' couches.
After that, Ruby rented a room with her savings.
I tried saying no but Ruby.
If I were her mom, I'd hate me too.
Look, it must be difficult trying to maintain your diet and blood sugar levels, moving around so much.
I keep up with my insulin.
I know, but our social worker has resources I tried that when I left home.
It was just as bad.
- Malik, you can't do this - I don't have to talk to you about this! Look, I get you just wanna help but there's nothing you can do about this.
Oliver Campbell has Wolff-Parkinson-White Syndrome on top of his heart defect? And this was the first onset of it.
Will they have a decision today? I assume you gave the parents the surgical option.
Radio frequency ablation? I Not yet, I didn't think I should raise it without asking you.
It's either that or wait and see.
Well, ablation is risky.
He could have a stroke, or sustain damage that could hurt his chances of open heart surgery later.
A surgery he might not make it to if SVT events like the one he had today lead to sudden cardiac death.
Then you think they should ablate? I think they need to know all their options to make an informed choice.
They're going to ask me what to do.
And you should answer them.
Mags, you lived their reality.
Tricuspid atresia wasn't my issue.
But you know what that little boy is going through.
What all of them are.
Sam Garcia meets the criteria for endoscopic drainage.
Taking a liberal view, maybe.
He's still at risk for sepsis, and necrotizing pancreatitis always needs multidisciplinary management.
His wedding's today.
And iif we did it in emerg, maybe he'd make it? And maybe Bishop told you he wants to start operating in trauma and you saw a chance to step up? I'd be getting in on cutting-edge procedures.
And diverting patients and therefore funding from OR.
You have to be smart.
I know I do, that's why I'm here.
Except this is becoming a bad habit.
You come to me before you walk into something.
I flag the risks and you do it anyway.
If you don't trust my advice, don't waste my time.
Hey, about what Bishop said earlier.
Yeah, well I called my insurer and they put me in touch with a lawyer.
Do they think we could lose our license? Well, she did say to prepare for it to take a minute.
And that it's a rite of passage.
But, most doctors come through fine.
I know you're not most doctors.
Look, it's unfair you're wrapped up in all of this.
Well, I am.
I am.
And I'm trying to follow Bishop's advice and stay focused on the job.
You should too.
The bird, he's in the ducts.
- Ruby? - I think I cut too deep.
He's young.
He's only two years younger than me.
But still a student? I took a couple years to travel.
Nothing wrong with some real world experience.
Oh.
She's defending you.
She likes you.
Don't get too excited.
She once carried a sock around for months telling us it was her soulmate.
I was four! I was four! And it was a really cute sock, okay? You already have to go? It's just an update.
Is it the patient this morning? You should've seen her.
She saved a baby's life.
Yes, she's a force of nature and always has been.
- Okay, you can go now.
- Oh my God, Cam! What? You'll have to run off, and I can't talk about him if he's here.
Okay, that's fine.
Very nice to meet you, Camille.
I look forward to hearing if I'm good enough for your sister.
But nobody is.
You can't honestly tell me you see yourself with him.
He's sweet.
He's funny.
He's smart.
And he will do anything you want to make you happy.
At least he's in keeping with your pattern.
No, he's not! What pattern? What are you talking about? It's either someone who withholds validation or someone who worships you.
You honestly don't see that? Look I get it.
You've had a terrible few months.
But letting this boy fall in love with you so you can feel better about yourself, it's the wrong answer, Mag.
Just once I wish you could tell me what I want to hear.
Do we have a patient with bedsores? Because I'm an expert, if you want advice.
Did you need me for something, Arnold? Sam's pain's is at an 8.
And not just because he finally told his fiancee he can't make their wedding.
Give him another 10 milligrams of morphine.
It's gonna be a few hours before his surgery.
How do you know so much about bedsores? Before I came to emerg, I was a hospice nurse.
Hard to avoid them in that field.
Why? - Oh, baby - Don't, okay? I already know what you're thinking.
Baby, I was afraid to ask if this was starting up again.
You have experience with this? When I was little, it was just pinching and scratching.
Then it got worse.
Seeing a psychologist has helped.
Yeah, once you accepted I needed to.
I wasn't raised to reach out for help with problems like these.
Many people aren't.
She's given me some good tools, but sometimes it's I don't know.
A hard pattern to break? This is why Malik's bad for you, honey.
- He's too unstable.
- You're wrong, Mom.
Sharing our burdens makes us stronger.
I know his and he knows mine.
And, look No fresh cuts, just old scars.
Today was the first time in months.
He helps me, you need to let me help him back.
Those are the only options? Do this ablation procedure or wait and see if the SVT recurs? There's medication that we can try to prevent future episodes, but there's no guarantee.
No.
No surgery.
You heard her.
These episodes could keep happening if we don't do it.
It could.
Not will.
The medication might help.
We should wait.
You wanted to wait to chopper him here, - but if we hadn't brought him - He's just a baby, Bruce! How much more can we ask him to go through? What about you? What would you do if he was yours? I don't know.
Because both options are terrible! I'm sorry.
Do we Do we need to decide this second? No.
And if you do choose the ablation, it won't be today.
So Take your time, think about it.
What's happened to Malik? We were about to start dialysis when his breathing worsened.
- What's going on? - Fluid in his lungs again.
- Claire? - On it.
What do you need, Bash? Help with thoracentesis.
Guide placement.
Puncturing now.
About to enter pleural cavity.
Good.
- O2 sats aren't really moving.
- This is the second time this has happened to him, he's in kidney failure.
The fluid's gonna continue to accumulate.
He needs the OR VATS pleurodesis.
- What does that mean? - It's a surgical procedure that seals up the space between his chest and his lungs, or this will keep happening.
Thoracics can't take him for at least another 8 hours.
- Excuse me.
- Can he wait that long? He'll have to.
I'll put a drain in, and we'll monitor him until they have time.
Unless we do a chemical pleurodesis here.
- That's a risk in emerg.
- It's talc in a chest tube.
It'll expedite dialysis.
We know he needs it.
It makes sense, Bash.
Call an attending? You guys should wait outside.
- I wanna stay.
Please! - Baby.
Let's let them work.
We need talc, 10 grams in a 250 ml sterile isotonic sodium chloride solution.
I'll start on the tube, you wanna prep the agent? - Bash? - What's happening? He needs a chemical pleurodesis.
Are you sure you don't want in on this? You guys have it.
I need a 28 French and two guarded clamps.
So, scale of one to Titanic? You were fine.
Cam is insane.
- Because if I said anything - No.
Marnie is negative for TB.
That's a relief.
Although I guess it means that we're back to not knowing.
Did you want me to work up a differential? Sure, but respirology will have to weigh in.
And this is complex so you're aware of the expectations.
You know certain fungal infections can mimic TB.
I'd look into any environmental exposures if I were you.
She did say that she was playing on a compost pile with her brothers.
You're incredible.
Why are you still here? Go, go cross-reference with her symptoms.
The wedding came to him? We didn't think Sam was a good candidate for draining in trauma.
Hmm.
Not to mention Dr.
Singh detested my idea of an acute care surgical response team.
Yeah, passionately.
And the kidney failure patient? The ED pleurodesis? What will he make of that? I haven't mentioned it yet but That patient was a candidate, and I'll defend it to any surgeons that wants to take issue.
How are you doing, June? Being Chief Resident, caught between the egos and the politics It's just hard to know whose interests you're serving, you know, who you can trust.
All I know is patient first is our true north.
Keep an open mind about what I'm proposing.
If you find a candidate that fits the bill, I'll have your back.
Khaled appealed his asylum case because you said he had a chance.
Now he's stuck in jail! I've been trying to argue for his conditional release.
- Beyond that - Don't say there's nothing I can do.
I'm sorry doctor, but it is the case.
Listen, I'll call if anything changes.
Dr.
Hamed, how long do these sessions usually take? His dialysis.
Three hours, four times a week.
Well, I feel for him, but he's gonna have to learn to make health his priority.
What alone? Without any support? - She's just a child! - Your daughter got him to do what apparently no one else can, confide in her.
And like it or not, she trusts him too.
This is none of your damn business.
She got sick from my compost pile? I'll have Jake here explain it since we have him to thank for the revelation.
Yeah, well, Marnie likely has "allergic bronchopulmonary aspergillosis".
It's an infection from a fungus commonly found in compost bins.
And the effects resemble asthma, or TB.
But the good new is, it's not contagious and totally treatable.
Wow.
Okay.
So what are the next steps? Well, we'll swab to confirm, but Marnie will be on the mend for a few days.
Shall I go fix you boys some cocktails while you finish chatting? Wow, the second a man's in the room.
Stand down, soldier.
I have a magnetic presence.
- It's why you fell for me.
- And why I left you.
Have you been doing this all day? Stop terrifying the doctors.
You're not scared of me, are you, Dr.
Hunter? It's happening again! He was awake and smiling and then Let's give him 0.
7 milligrams of adenosine, Nelly.
Okay.
One, two.
- Why isn't it working? - He's still at 300 bpm.
We need to cardiovert.
3.
5 joules.
On my mark.
Ready, and clear! Again.
7 joules.
Ready, and clear! Give him a minute.
Come on, come on, Oli.
Okay, he's stabilizing.
This isn't going to stop, is it? I think you should do the ablation.
- You said it could kill him! - There are risks either way.
But your son is a fighter, and it gives him the best chance.
Okay.
It'll take a few days to schedule and Dr.
Fisher will do the procedure, but I promise that I'll be with you every step of the way.
You didn't mention me that you treated Ruby for cutting herself.
I'm just going over today's patient intakes.
It was right before Malik crashed again.
I'm sorry.
It's not that.
It's just, you realize that with her history of self-harm, it's unlikely she'll be able to donate a kidney.
Even if she keeps it under control? Still a tough sell.
Donors often experience depression post-op.
There's pretty strict rules on mental health.
Then it's a death sentence for this kid, Theo.
Look, man, I heard about the lawsuit.
I know what it's like.
- You've been sued? - I'm being sued.
For custody.
- Theo, I - Just You have to tell them.
Ruby and Malik.
They need to know what they're facing.
Since when did you start drinking fancy apricot beer, anyways? You're free to buy your own.
I feel like I'm 16 again and you're bootlegging for me.
I did that one time.
You ended up throwing up all over Taneesha's car.
Which she made me pay to have it cleaned.
You're the one who insisted I go camping with you guys.
- Remember? - I had no choice.
What do you mean, you had no choice? Dad took out a second mortgage on the house without telling Mom.
I came home, she's screaming, packing up all his stuff.
So I had to get you out of the house for the weekend.
When we got back, she was fine.
And Dad was "on the road" for a month.
Yeah, but he was a management consultant! He always travelled for That one wasn't for work.
She threw him out and he wormed his way back in.
Again.
What else am I remembering wrong? I'm sorry that you had to build those walls, June.
I have enough bad memories, you know.
I just wanted you to have good ones.
Well, you're off the hook.
It's time for Dad's night meds.
You should change his mattress.
Gel or foam will help the bedsores.
Isn't that kind of helpful advice against the rules? I'm giving you advice, not him.
And trusting you not to tell me whether or not you take it.
Thanks, Junie.
Yeah.
Is that your secret identity? Yeah I keep the cape in the bag.
You know, in case I see a cat in a tree on my way home.
So, Marnie's in respirology now with a much less accommodating doctor.
Justin's gonna spend the night with her since I took the day.
So? Wow, you're really going to make me ask you, huh? Ask what? If you wanna come home with me.
To be clear, if you wanna have sex with me.
Yeah.
Um - What about your husband? - Ex-husband.
Though I'm sure he'd be delighted if you felt compelled to ask him for his blessing.
- You know, I'm your daughter's doctor.
- Ex-doctor.
What else you got? - I thought you hated me.
- Don't overthink it.
I'm sorry.
I know this isn't what you wanted to hear.
There must be something you can do! There isn't.
- It's okay, babe.
- No! We'll make dialysis work until you get a kidney.
I'll find us a place to live, get a part-time job.
I'll go to one of the group homes if the social worker's still around.
I can reach out if you think you're ready.
- Mal, you don't want that! - Ruby, it's better this way.
I'm not dragging you down with me.
Stop this foolishness, both of you.
He'll come and live with us.
He can stay in our guest room.
I'll make sure he gets to dialysis.
No, Ms.
Evans, I couldn't do that.
You deserve a fair chance to fight this off.
I'm not taking no for an answer.
If I can't convince you, I know Ruby can.
You don't know how much this means to me.
We'll find a way to get through.
It's a good thing you're doing.
What choice did I have? Turn my back and lose my daughter? I don't like this thing between them.
But I can't stop it.
All I can do now is let it happen.