Transplant (2020) s02e12 Episode Script

Dad? My dad left me in charge of his estate.
Couple hours monitoring will do, Leblanc.
Don't follow the poor guy home and cook him soup.
Dr.
Novak has his way of doing things, I guess, I'm just getting used to it.
There's a detention order against me.
Khaled, you're telling me this now? Ray Grisholm has filed a malpractice suit, the suit names all doctors who were involved in Kelsey's treatment.
He's stuck in that cell they put him in when they took him away from you! Sorry about that, folks.
There's a bit of construction in front of us.
Sit tight, won't be long.
Nothing in this city works! Hey! I got somewhere to be! You got a problem with me expressing my opinion? Let me off this damn thing! Hey, you can't keep me hostage! This is a free country! The doors will open when we get to the next stop.
- Now please take a seat.
- You're not gonna let me off? Then I'll come up there and make you.
Get out of my way! And dress like a normal person! Hey, that's enough.
What did you say to me? I think you need to calm down and wait like everyone else.
Yeah or what? Or we're going to have a problem.
Who the hell do you think you are? Move! This is my country.
And my rights and my dignity don't matter anymore! I'm getting off! Let me off! Let me off! Sir please, get back! Call an ambulance! Dwayne Clark, 47, stepped off a bus into oncoming traffic.
BP's 100 over 80 and dropping, rate's 100, O-two sats 90! - Is that his blood on you? - I was on the bus.
Broken left femur and he's hemodynamically unstable from what I'm certain is a large internal bleed! - We need to intubate him ASAP.
- He needs the trauma OR.
Leblanc, find Dr.
Curtis.
Hamed, you're with me.
Good morning, everyone.
Dr.
Novak, are you prepping to open? E-FAST showed a massive internal hemorrhage.
So it's either an open lap or he dies on this table.
- Dr.
Curtis? - Ten blade.
Hang two more bags of O-neg! Dr.
Hamed, protract.
That's too much blood.
Dr.
Curtis, source that bleed.
One gram TXA.
Where's this coming from, people? - It's not clear yet.
- Ready with suction.
His liver.
It's his liver! - Pringle Manoever - Stop the blood inflow! Are you running this or am I, Dr.
Bishop? Page me if you need me.
Compressed, but it won't stop bleeding.
- Okay, 80 over 60 now.
- We're losing him, Dr.
Hamed.
I can see it! The hepatic vein's avulsed.
The only way to fix it is to ligate.
Stopping his liver from draining and killing it.
He can't live without a liver, but does anyone think - he's gonna survive this bleed? - No.
Then we do it.
Ligate the hepatic vein.
You clamp, I tie? Let's hope that he stabilizes, so we can extubate and make a plan.
Pressure's coming up.
Dr.
Curtis, you close.
Dr.
Hamed, you see if this guy's got any relatives with functioning livers they feel like sharing.
How is he? The guy you brought in? He's alive, for now.
We could've used you.
Bishop wasn't in there long, was he? I guess they're figuring out how to power share.
You don't have to be happy Novak is back.
Well, I can't let it get to me.
Because if he's gonna take over for Atwater, I need to figure out a way to make this work.
Which means never coming back into trauma? No, it means finding a way to make him realize that he wants me there.
I'll be home next weekend and I promise we can do whatever you want.
- Even Chuck E.
Cheese? - Sure, but I thought you were afraid of him.
Alright, say hi to your sister for me.
Pass me the phone, honey.
Hey! Thanks for rolling with the schedule change.
If they're happy, I'm happy.
I know this is not what you wanted, Theo, but you've been a real trooper lately.
- I'll see you next Friday.
- Okay, bye.
They say I may not be coming in today, Gloria.
I was in the van and then I had to get out.
When I asked what was happening, they said that they'd contact my caseworker who'd call you.
Because why tell me, the person this is actually happening to.
Hold on a minute.
Everything alright? I'm Theo, a doctor here.
Hey, Theo, a doctor here, I'm Siobhan, a patient here.
Or at least I was? According to those two guys over there, I'm in a bit of limbo? We can't just wash our hands of her.
Guys? Guys, that kid back there? Siobhan Carlyle, 14-year-old lupus patient, she's waiting on an experimental bone marrow transplant.
Yeah, she told me she was supposed to get transferred to Ottawa Gen because her foster mom had to move for a job? Transpo was double-booked.
Internal gave her bed away, they asked us to keep her, but we haven't a room to spare.
Except that's not your call to make, Mark.
I am capable of looking at the allotment and knowing what we have! Guys! I can handle this.
Siobhan may have to be a little flexible depending on who comes in, but I can find space for her.
I'll tell the foster mother.
Kid keeps getting infections.
They were waiting for Ottawa to place a PICC line, but given the delay You think you can manage? I'll figure something out.
Those don't look like surgical notes.
It's my father's estate, it is a mess.
You know, he inflated his wealth so that he could take out loans, and then deflated his wealth, so he could save on taxes.
Yeah, impressive.
Hello? Someone keeps calling and hanging up.
You know, probably someone he owes money to.
You probably don't wanna hear about any of this.
I used an accountant when my brother died.
I'll get you his number.
Just be sure he doesn't bill based on a percentage of the estate.
Hourly is cheaper.
Thanks.
Call it selfish, I need something in return.
I've got a Nissen Fundoplication booked on Mrs.
Sawatsky, and I'm being pulled for a debulking.
Sawatsky is the lady with reflux? Dr.
Roche is stepping in, and she asked for you personally.
It's impressive, you turned things around with her.
Did I? Because it kind of feels like every interaction is still a test.
I remember when you were nervous about having the skills for this job.
Yeah, I mean Terrible executor.
Surprisingly not so terrible Chief Resident.
Let me know how the Nissen goes.
You know, salt might help get that blood out.
Yeah, I know.
I think this is a lost cause.
- You saw that guy get hit? - I did.
I heard you saved him.
Our patient from the bus.
By sacrificing his liver.
I may have only delayed the inevitable.
If he's a fighter, he has a chance.
I did dress for our deposition.
Maybe not the best image to project while defending a malpractice claim.
Dr.
Bishop, I made a decision, and now we could lose everything.
We did the right thing with Kelsey Grisholm.
And this is where we start proving it.
I've got a spare shirt in my office.
Hi, Stacey? I'm Dr.
Leblanc.
I heard you had a spider encounter while camping? This wasn't camping.
There wasn't even a tent.
Haley's more outdoorsy.
Glamping was our compromise.
One of those vintage airstreams a couple hours outside town.
- Yeah.
- That's what happens when you insist on wearing short shorts.
- I tried to ride it out - Obsessively sending screenshots to Dad and poison control.
I freaked, okay? It turned blue, then became this open sore.
And they said to get it checked, so here we are.
Open your mouth.
- You two are sisters? - No, she's my mother.
Can't you tell from looking at us? I'm married to Haley's father.
This was supposed to be their trip, but he got called out of town, so I thought Forced bonding would be a good idea? I guess the spider disagreed.
- Did you see the spider? - No, but after it happened, the campground people said they saw some brown recluse around.
But then I checked online, it says they're almost never deadly.
Yeah that's true, but your heart rate is a bit elevated.
So we'll start antibiotics, get you a tetanus shot and run bloodwork, just to be safe, okay? Is she actually really sick? Her body just needs time for the venom to run its course.
The nurse will be back with some pain reliever.
Hey, Rhoda, do you mind starting E on antibiotics and getting a tetanus? Also did a delivery come for me? You need me to watch for something? It's just a parcel with some clothes, porch pirates have it in for my block, and I only get my packages when I'm home and - I'm never home.
- You're never home? - Not a post office, Leblanc.
- Oh, I know, it's just a one-time thing, I promise.
Here we go.
Brown recluse bite? Let me guess, you called in an entomologist just to be sure? No, I didn't have to.
The patient suspected and the bite mark confirmed.
Great.
So what's the catch? - I'm sorry? - Well, knowing you, you probably have about 47 different reasons for this elevated heart rate, which is not a spider bite symptom, so let's have them.
I think she's just anxious, so unless you think otherwise, I thought I'd treat the bite and move on? Alright.
Carry on, then.
Post-op glucose is still low.
Let's start the TGC protocol.
Can you prep the insulin I ordered? Yep.
Dwayne? Do you know where you are? You were hit by a car.
You're in York Memorial Hospital.
- Your liver was bleeding.
- Yeah.
You think you can tell me what to do? - Let me out of here! - No! Dr.
Hamed? I'm fine, Arnold, we need to sedate him.
Yeah.
Dwayne, you just had open surgery, - you need to lay still.
- You did this to me! So for the entire weekend, I was known as Uncle Claire.
My sister felt bad, but But you secretly loved it? Mm-hmm.
He'll only be four for so long.
How did you feel the trauma procedure went this morning? Did it run smoothly for you? Jed are you trying to dig up dirt on Mark's performance? No, no, no.
That's not what I meant.
I was I read the notes and I just wondered how the experience was for you, that's all.
Okay.
Sorry.
Hum, yeah, it was fine.
Uh-huh.
Are you doing homework? Haven't been to school in a month.
And I'm kinda in between schools at the moment.
Well, I am sorry about the decor, we're waiting on a better room.
Just need some pukers to clear out.
That's alright.
Falling through the cracks is kinda my super skill.
Well, we just want to make sure that these infections you've been having don't derail your chances for your surgery in a few weeks.
You've already met Anna.
You know what a PICC line is? First rule of supply room club: no boring lupus talk.
Okay, well, if isn't homework you're working on, what are you writing? Deep breath in.
Letters.
I write letters.
- Oh.
To who? - Anyone who deserves one.
The restaurant that gave Gloria food poisoning.
I wrote one to the dollar store company that pollutes oceans with cheap plastic.
Isn't that what Twitter is for? Well, you are pretty brave.
You know when people tell me that, they're usually trying to trick me into being okay with something I hate.
Well, we're almost done, okay? Chris Hadfield once said, "Things are never as good or as bad as they seem to be at the time.
" He's who I'm writing to now.
You've got a complaint for an astronaut? More of a question.
They say that in 10 years, civilians will be able to go to Mars.
And I wanna know if they'll let someone on who's had a bone marrow transplant.
Keeping your options open? I respect that.
Exactly.
Bash, hey.
Are you okay? You got a full dose of insulin.
Yeah, I took some glucose to counteract it, thanks, Arnold.
Okay, well, we should still keep an eye on it.
That stuff can mess you up.
Should security know what he did? I told them, it's under control.
It was just a surprising burst of adrenaline, he's leveled up now.
But let's keep our distance just in case.
Okay, uh, well, his son is here.
Mr.
Clark? DJ.
Are you my father's doctor? They said you wanted to talk to me about something.
Mm-hmm.
So, he's stable for now, but he suffered permanent liver damage.
It's no longer functioning.
Is there some kind of transplant list he can go on for that? There is, but the best option for him is a living donor.
Which means if there's a match, they could give him a part of their liver.
The organ regenerates, so it'll grow back.
Alright.
And by "they", you mean me.
We'd still need to see if there's a tissue match, if that's something you'd be willing to consider.
Me and my father.
You don't know what you're asking.
What happens if I say no? If a liver doesn't come through before his fails He could die? I've spent years trying to pretend this man never existed.
Now I'm his only shot at staying alive! - Hey.
- Uh, you said this would get better, but she's getting worse.
Yeah, the nurse tells me you've been vomiting? Can the venom cause complications? In rare cases, yes, but it would take a larger dose than one.
But how do you know for sure? What if this spider was just a jerk and bit her over and over again! I trapped the spider, and I put it in our airstream to scare her.
- Geez, Haley! - It was stupid, okay? It was a prank! I didn't mean to poison you! I don't think that's what happened, unless there's another bite mark? But can you lie back for me, please? - Ooh, ah! - Oh, sorry.
Any changes in health? Medication? Not that I can think of.
What about those diet pills you started taking? They're just over-the-counter.
And none of your business! I'm trying to help! Haley, would you mind getting Stacey a cup of ice water? Just down the hall.
Thanks.
Is she right about the pills? I mean, they can affect your liver, even your pancreas a week or two into using them, so we'll test to find out.
She was in a tough custody battle a few years back.
Haley had to stand up in court and pick her Dad.
Then I come along.
If I was her, I'd hate me too.
Sounds complicated.
I love her dad.
I'm not the villain she thinks I am.
Darren doesn't want more kids, so I just have to be patient and hope she comes around.
Okay.
- LES is wrapped.
- Esophagus is free.
Do I need to beg you to wrap the stomach Curtis? Or are you going to volunteer? No, sorry.
I would love to wrap the stomach.
Okay.
Move around, make sure it's loose.
Good, now wrap.
Okay, okay, that's tight enough, we're fixing acid reflux, not strangling this lady.
First suture.
- What do you want, June? - Sorry? Your career.
Chief Resident, trauma surgeon in the ED doing interesting work with Bishop.
- What's next? - Oh, I You should know the answer to that.
I don't know.
I think, huh.
.
I think I still have a lot to learn as a surgeon, you know.
I blame Singh for that.
He does this every few years.
Holds back a good resident.
You realize that's for his benefit, not yours.
I don't know, I don't think that's what he's doing.
Second suture.
Which is why he's succeeded.
Alright, take that through the esophagus.
Dammit! I just nicked her spleen.
I'm on it.
You can ligate, Dr.
Curtis? There it is.
Bleeding managed.
- I'm so sorry, Dr.
Roche.
- It happens.
I'll explain it to Mrs.
Sawatsky - and inform Dr.
Singh.
- We dealt with it.
It'll only panic the patient after the fact.
Dr.
Singh should be informed.
This is exactly what I'm talking about.
The narrative that you can only function if he's in the room.
It's up to you to change that.
I'll make a note to delay her post-op blood thinners so our bases are covered.
Kelsey made it clear she didn't want to be intubated, and yet that's exactly what you did, Dr.
Hamed.
She refused it as a preventative measure.
We didn't act until she decompensated.
- Did she verbally consent? - She was unconscious I'll remind you there was no DNR.
Dr.
Hamed, did you stop to consider how Ms.
Grisholm might feel about being mechanically ventilated for the rest of her life? It was a matter of life and death, we made a choice.
And Kelsey paid the price! Dr.
Grisholm, I'm sorry that was the outcome for your daughter.
I know how difficult this must be.
See? He knows exactly what he did! This guy's racked with guilt! Dr.
Grisholm, you were there.
You consented.
And you understand exercising judgement is part of the job.
Was that the same judgment which led you to hide concussive symptoms several months ago? Or misdiagnose a heart attack leading to a similar action in 2006? I have other examples for us to go through.
Is that all you've got? A fishing expedition full of specious speculations and ancient history? Anyone who has been in emergency medicine as long as me has the same list.
As for the concussion, it's public record.
Do your worst.
You're telling me I gotta wait for some stranger to die? You're four-F, the highest priority transplant candidate.
The entire country is on standby for a liver, so until then, I suggest you remain patient.
Or what? You're gonna hold me down again? You get off on hurting sick people? Well, look who bothered to care.
Where the hell have you been, Dwayne? DJ.
I've been living my life.
Wasting it, you mean.
- I'm not here to talk about me.
- Good.
Let's get on with this liver business then.
You say his could save me? We're not even certain DJ's open to it.
- He'd better be.
- Real nice, Dad.
- Real nice way of asking.
- What do you want, boy? You want a hug? You got your mother for that.
- How is she, anyway? - Don't talk about her.
Watch your tone! You haven't got the balls to let me die.
That's enough! Mr.
Clark, you are not entitled to anything here.
I came here to see if being alone all these years, or um, getting smoked by a car maybe had some kind of effect on you, but I don't know what I was thinking.
I'm sorry, Dr.
Hamed.
But I'm not doing this.
He's not going anywhere.
Mr.
Clark, your O-two saturation is low, so you'll need to be sedated and intubated before your surgery.
I'm not doing that operation.
I need you to understand the reality you're facing.
They told me the odds are 10 to one I don't make it.
Why would I agree to that when my son's got a perfectly good liver? DJ's made his choice, Dwayne.
Then change his mind! He'll listen to you, so convince him! No.
Someone will be in with consent forms.
Sign them, or don't.
Dr.
Hunter! I just fielded a call from Child and Family Services - you should know something about? - Siobhan? I spoke to her rheumatologist who okayed the trip.
Since the place isn't open to the public, there's no risk to her immune system.
And I spoke with her foster mom, who said she wishes she could see Siobhan looking at Mars through a telescope.
I didn't even know there was an observatory in this city.
Yeah, it's about an hour north.
It's the largest in the country.
A friend said a social worker and I could go with her, but it has to be today.
Someone's got time on their hands.
Well, they're gonna have to find another way of spending it, because CFS says she can't go.
Dr.
Bishop, this kid's got a pretty raw deal.
I'd like to give her some good news.
I understand, but they require 72 hours - to make the proper approvals.
- That's just red tape! I mean, if her foster mom and her medical team are okay with it, why should they have a problem? Because they do, which means we do.
Is that gonna be an issue, Dr.
Hunter? Thank you for letting me know.
Jed! Uh I know I wasn't an advocate for this trauma OR when you were pitching it, but when they asked me to head it up Well, it works with the right person in charge, Mark.
But? But I need to know that we can work together.
And you need to know that I don't plan on going anywhere.
- Up? - Yeah.
Do you remember the accident? On the 4-0-1 years ago? In the hail storm? We made some tough choices that day.
- I still lose sleep over that.
- Yeah.
If we'd had this program then, we'd have saved more lives.
To that end, there are some improvements I'd like us to consider.
Hey, yeah, you need to call me back ASAP.
I don't know if you knew about this kid, but we need to have a conversation.
Because I promised her I would think about the whole money thing, but Charlie, I think she really She loved him.
My IUD is trying to kill me? In rare cases, they can migrate.
And yours perforated your uterine wall and got lodged in your left ureter, so your kidney filled with fluid.
- Can you fix that? - A surgeon can.
So we're sending you for laparoscopic surgery.
They'll remove the IUD, and place a tube to drain your kidney.
What about my uterus? Well, it may heal fine.
But if the perforation is severe, it could affect your ability to have kids.
- Wait, were you and my Dad? - No.
It's just a lot to process.
I mean, maybe for the best? You can't even handle a spider.
Can you let your father know he should probably cut his trip short? I'm on it! - DJ! What are you doing? - Just walk away, Dr.
Hamed.
Just pretend you didn't see this.
- I can't do that.
- Stay back! - Or I'll rip this thing apart! - Hey! You'll go to jail.
I don't care.
I can't spend the rest of my life looking over my shoulder.
I will never be free as long as there's a chance that he is still alive! Look, DJ.
If you make this choice, and he dies because of you, it will haunt you for the rest of your life.
But if you walk away, you'll at least have a chance to be free.
Please! Hey! Hey! - It's okay, it's okay.
- I'm sorry.
It's alright, it's okay.
Okay? - Hey! - Hi.
- Are you coming from OR? - Yeah, the the trauma patient from the bus.
We got him stable enough for auto transplantation.
He was lucky he had you fighting for him.
I've spent my whole day asking myself why.
Because it's who you are.
And nobody else would.
A migrating IUD? Your patient suffered all day for the wrong reason? Well, she's in the OR now.
They'll remove it and unblock her kidney.
Oh, wow.
I guess you picked the wrong day to stop meddling in your patients' personal lives.
Here's a angina meets a headache.
If you want to try to redeem yourself.
No.
- Excuse me? - No.
The way you treat me? It's I keep thinking that the problem is me.
But the problem is you.
Easy, Leblanc, we're just having fun.
See, if you believe that, you're a terrible leader.
And it's Doctor Leblanc.
I hope you have everything, because you're not coming back to this room.
This place is like musical chairs.
You guys are lucky I'm so accommodating.
I got it from here.
Here we go.
Let me guess.
You found a broom closet in maternity? Better.
I found a way to get you to Ottawa.
It won't be like seeing Earth from Mars, but they did say they would go as high as possible.
Are you serious about this? Yeah, I tried getting you a seat on the Perseverance Rover, but apparently, that's still 10 years away.
You're definitely getting a thank you letter for this.
Just have a good time up there, okay? - What happened? - Mrs.
Sawatsky decompensated after an infusion of anti-coags! Why was she getting IV blood thinners? We said to hold off! She went into a-fib.
There was no extraneous bleeding during the Nissen so I assumed Roche was just being cautious.
Looks like her spleen? That doesn't make sense.
I nicked it during the surgery.
And didn't tell me? Roche and I fixed it at the time.
She said it would be fine.
That's why I put no blood thinners in her surgical notes.
That's useless without the why! Unstable v-tach.
Low hemoglobin can cause a cardiac event.
We're cardioverting.
Let's get her on a rebreather, Raya.
50 ketamine, IV push.
Charging.
All clear! Shocking.
Claire? Oh hell, you scared me.
Sorry.
I do realize this is sacred non-doctor ground.
Well, yes, but no it wasn't that.
I'm just working on this new mindfulness app again.
Should I leave? No, it's fine, I mean, who wants to be left alone with their thoughts anyway.
What's up? I have a question for you.
Hear the whole thing before reacting.
How would you feel about specializing as the dedicated trauma OR nurse practitioner? That way you would be involved in interventions and be able to see the patient through.
This isn't me giving you another leg up.
This came from Novak.
He saw a synergy with you this morning and asked me first, so as to not step on any toes.
Um, is it okay if I think about it? Yeah, yeah, sure.
Just let us know.
Claire? You You came in here walking on eggshells just to tell me that? Well, it's my fault.
When I asked you to stay when you wanted to leave, I I broke something between us.
So badly wish I could take that back.
It wasn't just you.
I could have said no.
I didn't.
Because, we really work best when I'm in your shadow.
Claire And, I mean that was enough.
But now, I I am really glad you're not letting them push you out of here.
But things can't go back to how they were.
I'm sorry.
I love you, Jed.
I just I have to move on from us.
I love you too.
- How is she? - Lucky to be alive.
You better hope they don't make a formal complaint.
I'll stay overnight in case something happens.
Dr.
Singh? Roche told me not to bother you about clipping the artery, that's why I didn't What else did she tell you? I trusted you, June.
Hey, I heard you sprung that kid on a transpo-chopper? Those things are for emergency only.
Well, pal was an old hockey buddy of mine, and heading up that way anyways.
If there is a fallout, I will wear it.
No, there's no complaints here.
I just thought it was bold.
Well, Siobhan deserved it.
She's got an adventurous spirit.
And you were right.
I have too much free time on my hands.
You know, I know of an organisation that matches specialists with communities up North and flies them up there.
And they're always looking for doctors.
You could squeeze in a few days here and there, places that have a real need.
- I don't know.
- Well, think about it.
In case you need another option for your own adventurous spirit.
Hey! I can get you a chair if you wanna go in.
- I'm good.
- Haley? It's okay, I'm just giving them a minute alone.
Hey, uh, about earlier.
However you wanna deal with that is your call.
Thank you.
And for the record, you weren't wrong either.
Where are you going looking all badass? I'm just going home.
See you tomorrow.
See you tomorrow.
He's still in surgery? And will be all night.
It'll take days to see if he pulls through or not.
What I did.
Tried to do It stays between us.
Thank you.
- Sir? - My lawyer just called.
Seems there's more to their case than came up this morning.
Ray's team have looked into your medical school transcripts.
I'm not sure how, but they know that we don't have the originals.
But the hospital accepted your statement that the originals exist.
I know.
What are they going to do with this information? Use it to convince a judge that neither of us are to be trusted.
The hospital won't want any of this going on the record, bad for their reputation.
Sir, when you told me you spoke to the Dean of my medical school - We'll figure this out, son.
- So that means you didn't? Just let me fix this! Dr.
Bashir? Khaled? They let you out? What? How? They accepted my claim.
I get to stay in the country.
- Really? - Yes.
- Seriously? - Yes.
Oh, Khaled! This is the best news I've heard in a really long time.
Yes.
I know how much you did to make this happen.
You never stopped fighting for me.
Thank you.