Transplant (2020) s02e10 Episode Script

My parents were a disaster when it was me.
An intense man, wasn't he? - Your Cardiologist? - Yeah.
Sad to hear about his lung cancer.
The death of a baby, it takes a toll on any doctor.
Dad's dying, Junie! The guy's oncologist changed his prognosis from four months to ten days.
I need you, so I'm asking.
Claire, stay.
This is the sort of things you want us to be able to handle, right? Not you, not with this lawsuit hanging over you.
Sorry, Dr.
Mitchell, I don't think you can help me.
They're offering us a deal? If there's a settlement on the table, then we should take it.
Except that Grisholm wants all costs, and an admission of responsibility for what happened to his daughter.
Uh, I thought we agreed we did nothing wrong.
But we have to be smart.
Limit our exposure.
Taking into account Dr.
Bishop's stroke and Dr.
Hamed's unorthodox beginnings with our hospital, I have to say I agree.
And this could all just go away if we settle? If you take the deal.
And we stay out of court.
Again? Second dropped call today.
Rolling black outs from the heat.
I know admitting error leaves a bad taste, Jed, but it may be our least objectionable choice.
We need to think very carefully before rushing into a decision.
Hello, sir.
Hey! So what did the X-ray say? Well, nothing.
Your lungs are clear, there's no sign of emphysema or pneumonia.
That's good, right? It is, we just don't know why your blood oxygen levels are still low, so Thing is, I've got movers coming and my ex-girlfriend, she's uh she's threatened to set my stuff on fire if I don't take it today.
You think you could, uh, prescribe something for me to help me through the move? Are you anxious? Because that can cause shortness of breath.
I've got lorazepam, but I know you're not supposed to take those every day.
So you're wondering about antidepressants.
- Have you talked to your GP? - I don't have one.
But the drummer in my band, he swears by this SSRI he's on, you know.
I play double-bass.
I'll look into it.
Thanks! Hey! I thought you were done.
Yeah, I am.
Can you get Mr.
Jennings a psych consult? And also he needs bloods, ABG-BNP and hematocrit, just to be safe.
Uh, sorry, Mags, but before you go the coroner's office called again.
They're still waiting for Oliver Campbell's chart notes.
Yeah.
I haven't transcribed them yet.
Do you need help? I'm basically a chart whisperer when it comes to other people's messy handwriting Can you both please back off, seriously? I will be back tonight, and I will do it then.
- Okay.
- Urgency.
Mags! Mags, hold on, incoming trauma.
Page if they need me.
Level P-three, spot 42.
Their flight lands in 30, so, I'll be right back.
Couldn't they just take a cab? I haven't seen my husband or son in a month, June.
- I'd like to pick them up.
- I'm surprised you're even letting Cle be here for this.
He wants to say bye to his grandad and that's how he feels, I don't want to shield him from it.
Besides, I didn't even think they were gonna make it in time and then Dad asked for the ventilator.
So that's what he's holding on for? An audience? I gave the nurse your phone number.
Relax, it's just for emergencies.
- Thank you for the car.
- Yeah.
Mags.
Why weren't you in the boardroom earlier? The meeting with the lawyers? I figured they'd told you.
They dropped me from the suit.
Yousef Ahmad.
22-year-old pedestrian impaled by a BBQ skewer.
Whoa.
Okay.
GCS 15.
BP's 110 over 80.
Can you describe how you're feeling, sir? I think okay.
The paramedics loaded me up with morphine so Yeah, I'd hope so.
Get him a blanket and start warmed saline.
How did this happen? All four lights went out at this intersection at the same time.
One of those junk collection trucks slammed on its brakes and lost some cargo.
I felt something hit me, but it wasn't until I looked down that I realized that Okay, we need to keep you still while we assess.
Are you gonna be able to get this thing out of me? We will, but first, we need to see what kind of damage it has done.
- Claire, page an attending? - Yeah.
I see fluid.
Chest and abdo.
Possible organ injury.
I don't feel alright.
Yousef? Can you open your eyes? Yousef? Temp's up, and he's clammy.
Mean arterial pressure is stable.
If it has perforated his bowel, he could be in sepsis.
No, it's too soon for that.
Possible pneumothorax.
- Claire, prep a chest tube.
- No, O-two sats are fine.
We need to get him to an X-ray first, get him antibiotics and a tetanus shot.
Chest tube or imaging, which call are we making? Neither.
At least, not down here.
Singh heard this was coming and cleared the way so we can image upstairs, walk him straight into OR and handle anything else that comes up.
Alright.
I guess we do nothing.
Mr.
Sullivan? Sully.
Sorry, man.
I was going stir crazy.
Small spaces aren't my thing.
I see that you have dislocated your knee cap? Yeah.
Yesterday.
But it popped right back in, I've been able to put weight on it, but your triage guy insisted I take the chair.
- How did it happen? - I'm a rock climber.
Free solo, mostly.
No ropes.
That sounds like an intense hobby.
Yeah.
Religion for me, man.
I was at Capreol near Sudbury, and I fell.
I don't know what happened.
I've done that route a hundred times.
Anyway, I thought I was dead until a ridge came out of nowhere and broke my fall.
Sounds like you're a lucky man.
Yeah.
I stitched the worst of it myself.
And your head? Smacked it, just not hard enough for a concussion.
But once I got back into the city, my foot started feeling weird.
You feel that? Hey, listen, the tingling, that's not gonna be permanent will it? We'll do imaging to rule out any blood flow complications, but I do feel a pulse in your foot which is a good sign.
You do have a bit of a fever.
Do you feel fluish, ill? Yeah, but I sweat those out pretty quickly.
I'll be back once you've been to radiology, okay? Perry! I've been trying to get you for days.
I know, bud.
My crew's stuck on this other job.
Okay, well, it's just that you finally got my water hook back up in the house, only to demo my kitchen and rip out half my wiring.
Look, I have no AC.
I can't wash my clothes, I'm using a cooler for my food.
Like I said, we'll be back soon, hopefully sometime this month.
- Look, I gotta go.
- No, Perry! Perry! Excuse me, ma'am? Is he doing okay? Your son.
Is he alright? You're deaf.
Okay, well, I'm a doctor, and he doesn't look very well.
May I? It's just, he's very flushed.
Hey! I'm Theo.
Can you tell me how you feel? He's deaf too? Okay.
We need to get him some We need to get him some water.
We gotta get his temperature down.
My work is just a couple blocks that way.
We can take him.
Hold on.
He's really burning up and with the heat today Okay? Okay.
I hear you, I'm coming.
Hold on a goddamn minute already.
Dr.
Mann? Who the hell are you? I'm Magalie, Magalie Leblanc.
Is that name supposed to mean something to me? Yes, I was Well, you were my cardiac surgeon when I was a kid.
Around 2004.
Look, if you get some kind of problem, - I don't practice anymore.
- No, I know.
I just heard about your lung cancer and I wanted to come and see you.
For what? To thank you, I guess? Yeah, I'm a doctor now too.
My condolences.
What did you say your name was? Magalie Leblanc.
I had like a rare kind of congenital heart block? Doesn't ring a bell.
If there's nothing else.
I hear you're officially a nurse practitioner now.
Any exciting interventions yet? Claire, triage is asking if we ordered more gloves this time.
And Mr.
Vessi needs his dressings changed, but he won't let anyone near him but you.
Hm.
Well, you know.
At least the scrubs are new.
Mr.
Sullivan's X-ray, CT keeps having to reboot, so nothing there.
- Curtain 6, your patient? - No.
Dr.
Leblanc ordered the psych consult.
But sir, about our last session You're certainly not the first patient to break up with their psychiatrist, Dr.
Hamed.
But my door is always open.
- I'm sorry, Dr.
Mitchell.
- Go.
Hey, Sully.
Is it hurting now? It is, yeah.
Did you figure out what's happening, doc? Your leg is showing signs of an infection called clostridial myonecrosis, or gas gangrene.
- From what? - A combination of soft tissue damage and bacteria from an external source that can enter the body through abrasion.
We need to get you upstairs to surgery right now.
Gangrene.
Does that mean They're not gonna take my leg, right? If they can debride only the infected tissue, no, but - It's possible.
- Look, the infection in your leg is very aggressive, okay? It can be life-threatening in a matter of hours.
The OR is waiting.
If there anyone you want us to call to be here with you? Yeah, yeah.
My girlfriend, Greta.
What's going on? I'll find out.
The porters are on their way with the gurney.
Okay, we'll be sure to call Greta.
Yeah.
We'll get that skewer out and then manage his bleeding.
Looks like bits of rust everywhere, they'll need to come out.
I can help guide the camera if you want? Hal and I are exclusive.
Oh, damn it.
Something sprung a leak.
Dr.
Curtis, locate and control.
Got it! Good.
Next step.
What's happening? What the hell? Should we extract the trocars and the camera? Camera, yes, let's hold on the trocars for when the power comes back on.
Removing them blind might cause more harm than good.
- The CO2 stopped pumping! - Stay calm.
Take him off the vent and bag.
Get the propofol out of the pump and drip it by gravity in case he wakes up and moves.
Lily, get some lights until backup power kicks in.
- Okay.
I'm on it.
- Oh, damn it.
Yeah, yeah.
Here too.
The generator should've kicked in.
We're doing a bed count now.
Let us know if there's anything we can send to ICU - to keep you functional.
- Doctor Atwater? - Yeah? - I've got a gangrenous leg that requires immediate surgical intervention.
- Is the OR running? - The elevators are down.
The OR has no backup power, the whole building is dark.
It didn't look like that before.
Because it's necrotizing.
The power's not coming back on, is it? They're trying to figure out what went wrong, but it might take some time.
You said I needed to get to surgery now or this could kill me.
Does that mean I can't get there? Unfortunately, yes.
Then you need to help me here.
In emergency.
With how quickly this is spreading, even if you could get to OR, the only option left is amputation.
Then what are we waiting for? I need to be sure you understand what you're asking us Yeah! I understand it's a choice, between life and death.
Do it! I couldn't find the ice packs.
Got maintenance to unlock the vending machine and thankfully, these are still cold.
If it is heatstroke, we have to watch for cardiac complications.
Your son needs an ECG to check his heart, but without power, we can't.
We can take blood, but we can't run labs yet.
I'm the babysitter.
It's my first week with Cohen.
The parents are where? About to be very pissed at me.
We were supposed to be at home, but I was taking him to a roller-coaster.
It's not your fault the subway got stuck between stations.
Except now I've got their sick kid in a place you can't help him.
Do we have any battery-powered fans? You'd have to ask maintenance.
Dr.
Atwater's on her way.
The kid in 3, he has heat stroke.
He needs an IV and someone in there every five minutes with cold water.
- We'll do our best.
- Rhoda! He's been there 20 minutes and no one's gone in there to see him.
And where's the ASL interpreter I ask you for? I put in the request, I mean, it's chaos.
- They'll get here when they - Why don't you do your job Dr.
Hunter! No turning on each other.
We stay focused while this gets sorted, understood? Right! All we're hearing is that the generator system is experiencing cascading failure.
Maintenance is on it, but they don't know why or how or for how long, but it is hospital-wide, which means there's no access to labs, medical records, or imaging.
Where the critically ill can be moved to other hospitals, we will.
When patients are acute, we rely on clinical observation and response.
Resources are obviously low, so we need to conserve where possible.
Alright, let's get to it! What's going on? When I came to check in, he passed out.
His blood oxygen is still low.
What is it with these machines, they give you 20 minutes of battery power? Rhoda, start bagging.
Eddie Jennings.
He came in with shortness of breath.
Bloods are not back and I guess they won't be.
Dr.
Mitchell did a consult.
Is that his chart? - Mm-hmm.
- Psychiatrist scrawl.
- Does that say "god"? - I think it's an A.
Generalized anxiety disorder? Doesn't explain his resp rate, but we're sending all our ventilators up to ICU.
Mr.
Kazinsky in E and Ms.
Olivier in 1, they both just came off theirs, so I thought we could I'm gonna need nurses to bag in shifts.
I pulled three phlebotomists to help since nobody's going to be going for blood right now.
I'll take the first shift, boss.
Thank you.
Dr.
Hamed? 33-year-old male with a gangrenous limb.
I've watched his tissue degrade by the minute and there's no way around it.
We have to amputate.
I gave him a spinal block and a sedative.
And since the power went out, his foot and ankle have gone from bronze to reddish purple.
Let me get this straight.
You want to perform an amputation in my trauma bay in the dark? I'm the only doctor in this department with the experience to do it.
I'm not going to let him die.
Arnold, we'll need a tourniquet, warmed saline.
And as much light as you can get.
Copy that.
My TV went out, we might as well get this over with.
- Arnold, suction.
- Yep.
You need to tie off the anterior tibial artery.
Hemostat.
Arnold! I'm trying, I can't keep up with the blood.
BP's still dropping.
Tighten the tourniquet.
- Dr.
Bishop, I need your hands! - Bashir, you know I can't.
I need your help to find the bleed and clamp it.
You're the only other doctor in the room and this patient is dying! Please.
Alright.
There's inflammation and necrosis everywhere.
Then we'd better get to work.
Tell me when you have it, sir.
Sir? There's the bleeder, got it.
Let's get ready to cut.
- Arnold? - Suctioning.
Tibial artery tied off.
Scissors? If you keep the distal end of the muscle and attach it to the periosteum of the tibial bone, it stabilizes for prosthetic fitting.
His colour's off.
Battery's dead.
I'm putting pressure on his nail bed to check capillary refill time.
Six seconds.
He's lost too much blood.
Two more bags of blood product.
That's our last bag.
I sent Janie 10 minutes ago, - but she hasn't come back yet.
- It's chaos upstairs.
- I'm A-neg.
- O positive.
Has to be O-neg.
That's me, but You've got to cut.
Six flights of stairs, but we have blood units.
Gigli saw.
Steady on, Dr.
Hamed.
Cutting now.
Alright, our biggest risk here is hemorrhagic shock.
We're gonna need manual BP and blood pressure every minute until we're back up.
Any news on the generator when you were out there? We're literally in the dark.
But Dr.
Curtis, they asked to pass along a message to you.
You didn't mention your father's here.
Yeah.
Uh, my brother's with him.
Apparently not.
And with the power failure, they had to take him off his vent.
Did he come off? Yes, but, they don't know for how long.
I, uh I'm gonna help you here with the trocars.
It is mayhem out there, you're gonna have a very hard time - finding another resident.
- June.
Lily, Richie and I, we'll be fine.
I really need to make sure that this guy is stable first.
- Here, let me - Oh no, no, no.
Leave it.
Leave it.
Only half-full, but it'll do.
You really shouldn't be smoking.
Yeah, and you really shouldn't be lying to me.
My ass, you're here to thank me.
I've treated hundreds of patients.
You know how many show up at my house to offload unsolicited gratitude? Just you.
A baby died on me last week.
Heart defect.
We treated him, we thought he was okay, and then he was just gone.
You want me to say something that'll make you feel better, but nothing can.
Which I think you know.
Put your glass in the sink on your way out.
I'm not leaving.
Look, have I not made myself clear? I can't help you.
Well, I can't leave a sick old man alone with half a tank of oxygen in the middle of a blackout! No, thank you.
Relax, it probably won't explode.
Sir, if we settle the lawsuit, we move on with our lives.
If you accept the blame when you didn't do anything wrong, that mark will follow you for every job you want the rest of your life.
Since when did you not want to fight? Sir, they're not wrong about me.
- My transcripts? - Let me worry about those.
This hospital is the only chance I have and they want me to settle.
Look how they've treated me here, Bashir.
There's no real loyalty anymore.
Just the choices you've made.
Mr.
Friedman is complaining of chest pain.
And lethargy.
His BP is low.
Well, there's no ECG on the menu, but we can do a clinical exam the way we used to.
Hi there.
Is there an oscillation point? Posterior to the sterno-mastoid.
Seven centimetres above the sternal angle.
What does that mean? Am I having a heart attack? No.
Your jugular venous pressure tells us that the muscle is under strain.
We'll start a medication called beta blockers and we watch you closely.
Yeah? Stellar job keeping us afloat today, Wendy, through all the chaos.
I need to ask, Jed.
With all the candidates you've been interviewing for the chief position.
Why haven't you been asked? I feel I merit consideration.
No doubt, no doubt, Wendy.
But the truth is these interviews are lip service.
I have no intention of being replaced.
Sully.
What happened? I fell.
Maybe because you were hanging off a mountain with no rope.
I know every inch of that rock, Greta.
There was no reason for that to happen.
You talk all the time about the variables out of your control.
A broken rock, a gust of wind.
Those are the risks.
It wasn't that.
I need to know why.
How soon can I get out of here? You're still fighting off the infection, Sully.
And you've lost a great deal of blood.
I need to get back out there and understand what happened, okay? Sully, how? It still feels like it's there.
That's not uncommon.
But normally, that feeling does go away.
I should've died on that mountain.
What kind of medicine did you say you practice? I didn't.
Emergency.
Also, I'm doing a resident practice in cardiology.
You're wasting your time with those.
They've been stuck shut longer than you've been alive.
I was just trying to give you a breeze.
Why are you hell bent on fixing me? I thought you were here for my help.
Were you always this rude and I just don't remember or? Finally, she says something interesting.
Look, just because you think I saved you as a kid doesn't mean that I can save you now.
- Okay, you made your point.
- I don't even know you.
It's okay! I get it! I'm gonna go.
But I do remember you.
You needed a heart-lung bypass.
Your parents were terrified and useless.
But you You were notably stubborn.
Which is apparently a quality you've not lost.
You told me if I fought, you would fight for me too.
And you did.
I didn't hold up my end.
You still needed the damn pacemaker, Mags.
You were the first person to ever call me that.
I didn't save you.
I failed you.
But what was I supposed to do? Quit? - He wants his parents.
- Where are they? Out with friends, a couple hours out of town.
But they're almost back.
Your fever's lower.
Which is good news.
Your belly is still swollen.
Can you tell me how you feel? Can you squeeze my finger? He doesn't like it here.
Guys, heat stroke can cause kidney failure.
His swelling is cause for concern, but I can't do an ultrasound right now, so I need to know what he's feeling.
He says he's scared and your face is making it worse.
My face? Yeah.
He reads it to understand tone.
So he's telling me to calm down.
Yeah.
Hey, Cohen.
Do you feel like this? No? Okay, it's good.
What about confusion? Do you know where you are? Uh In a room with a weirdo? Good, so no confusion.
What are you feeling? He hasn't gone to the bathroom in six days.
So he's got to poop! But he can't? Constipation can be exacerbated by extreme heat which we've been having and that would explain the distention.
We'll try a glycerin suppository and we'll know in 15 minutes.
This is something we can fix, buddy.
What's the sign for good job? Good job.
Okay.
- Did you send him for tests? - No, why? He asked me to get him water.
When I came back he wasn't here.
He got himself out of bed? - The way he was talking before.
- What do you mean? He never tells me before he goes climbing.
So that I don't have to say goodbye if he doesn't come back.
Look, he just had a major surgery, it would be pretty hard for him to get very far.
You don't know Sully.
Please, find him.
Hey, Charlie.
It's It's me.
I'm here with him and they They had to make a call on who to bag for breathing and His DNR means no life-saving measures, so if you could just hurry up and get here.
You stubborn bastard.
Well, Marcus You win.
Whatever it is you've been holding on for, now's your chance.
Here I am.
Dad? Dad.
Hello, sir.
Quite the day.
Have you managed all your patients? - We got through it okay.
- Good.
I've been meaning to speak to you about your attitude.
You've been short-tempered and dismissive lately, and it's been noticed.
- Did someone say something? - No, that's not the point.
And I know the toll a divorce can take.
But when I offered you this job, it's like you were a different person.
Maybe I was.
You should focus on getting yourself together, otherwise, this becomes a bigger conversation.
Sully! Greta figure out where I was? She said you always find a way to go up.
She's checking the other wing of the building.
And you want to know if I'm gonna jump? I just thought you shouldn't be up here alone.
I let you take my leg because my instincts are always to survive, but Sitting here now, man, God, I really wished they weren't.
Do we know what's wrong with Eddie yet? Waiting on labs now that the power's back.
Any news on new vents? With patients decompensating both in ICU and in the middle of aborted surgeries, they're all still spoken for.
30 years I've never seen that happen.
What's that redness on his arms? Scratch marks? We didn't notice that before and then it went dark.
The guy has been itchy.
There's no hives, so it's not topical.
That could correspond to any number of underlying conditions.
How about side effects? He was asking for antidepressants, said he was taking lorazepam and those can give rashes, but don't depress respiratory rate.
But opioids can.
Maybe he tried another little pick-me-up and Benzos can enhance the effects of painkillers.
And if our friend here accidentally overdosed Naloxone? There you are.
Claire, 4 needs rush labs and the gentlemen in B needs his urinary bag changed.
She's with a patient.
Can Arnold deal with that? It's still chaos out here, Dr.
Bishop.
No problem, Dr.
Atwater.
I'm on it.
Thank you.
It'll just take time.
They'll always see me as a nurse, Jed.
Welcome back, Dr.
Curtis.
- How is he doing? - Miraculously stable.
And you, June? Fine.
So what's the plan? Now that he's open, we don't have much choice, even with the power back on.
We'll have to remove all the remaining fragments by hand before we lavage.
Thought I'd show you how I learned.
Old school.
If you're up for it.
I am, thanks.
The power had to come back on just so I could get up here.
I can understand how that might make you feel.
I bet you do.
You cut my leg off in the dark.
Is it killing you now just standing there? Not being able to help me? You sit down, if you want.
Actually I'm I'm afraid of heights.
I've never told anyone that.
But you're not, really.
No one is.
You're just afraid of the fall.
You know even if I don't jump, I'm still going to feel like this tomorrow.
Maybe.
But maybe not the day after that.
Is it helping? Sitting this close? I'm fighting through it.
Um We should go.
Greta will worry.
- Hey.
You're back? - Yeah.
Guess I'm a glutton for punishment.
Hey, Mags, I'm really glad they're not suing you anymore.
Thank you.
Eddie? Eddie can you hear me? Pulseless V-tach.
Do you know him? Yeah, I saw him this morning for shortness of breath.
Turns out he'd accidentally OD'd on benzos.
Jesus.
This guy's had a day.
The naloxone they gave him, it's rare, but it can cause cardiac arrhythmias.
I'll get a crash cart.
Dude! Did you just punch me? It's called a precordial thump.
He just reset your heart rhythm.
He just saved your life.
You'll be okay now.
Thanks.
Do you normally take opioids, Eddie? No, no.
It's just been a stressful time, you know? Our psychiatrist made a referral.
You're gonna follow up? - Yeah.
- I know you were worried about leaving and getting your things but She probably torched them all already.
But I guess I don't have to move, huh? Eddie, glad you're back with us! Arnold will give you more fluids and an ECG to check your rhythm.
I'll get you all set up, Eddie, don't you worry.
What about you? What are you gonna do with their offer? We're not going to take the deal.
We're going to fight this.
Hey, Perry? Theo Hunter.
I want a timeline on when my work will be done.
Geez, bud.
I already told you, that's not happening.
Then I need you to give me back my deposit.
Or what? You're gonna do what? Sue me? Fire me? Because then you'd be eating the money.
Look, just We'll get to your place when we get there, okay? Perry? Ow! What the hell? - I'm so sorry, you - Get the hell away from me! - Hey! - Hey! I figured you guys would still be here.
Alright, we have two with pineapple, and one without.
You're an angel.
Good to know you're spending that fancy raise in the right place.
Here you go.
Oh, thanks.
You guys killed it today.
Cheers.
- Hey.
- Hey.
Listen.
You were being really nice this morning - and I was a jerk.
- You were? About what? Transcribing Oliver's chart.
Okay.
It's fine.
Water? I guess I'm still like Still messed up about losing him.
And the past few months have been The worst? The worst! My Dad died.
Here.
Earlier today.
I was alone with him.
June! Are you I mean How long has he been sick? Well, we didn't really I don't know I'm sorry.
Theo? I think I broke it.
What happened? I messed up, Bash.
Everything is messed up.