New Amsterdam (2018) s02e14 Episode Script
Sabbath
1 Okay, so basically you want Bobbi to stay up for you? She could at least try.
Just for a few good night kisses.
- Right.
- And then go to sleep super easy with no bouncing, white noise, or tiptoeing required.
Very realistic plan.
I have been using the five Ss by the way.
- Thank you for that.
- Yeah.
Really knocks Luna out.
Lifesaver.
The real lifesaver is you can take Luna to work.
Sadly, Bobbi's not into the whole music scene.
Not what she told me.
Is everything okay? Yeah, I got impossible-to-get tickets for me and a friend to see Carol Churchill's play.
- Oh, I'm dying to see that.
- And my friend just bailed.
Oh.
- You should come.
- Um, yeah no, uh If you want, I mean.
No pressure.
No, I mean if you want.
I don't wanna If you don't, that's cool.
I'm into it.
Yes.
- Okay.
- Okay, so - Great.
- Great.
Yeah.
I'm sorry.
Sorry! Sorry, I'm late.
I hate being the last one here uh, Sergeant Todd.
- Sir.
- Uh, are we very early or very late? There's no meeting, Dr.
Goodwin.
No meeting? Why do I suddenly get the feeling I'm being ambushed? No, no.
If this were an ambush I would've placed myself against that wall, allowing the open door to obscure me as you entered the room.
I'm here to deliver a message from the board that they were too afraid to deliver.
Which is? You have to cut $2 million from the budget by the end of tomorrow.
And may I send a specifically worded message back with you? As soon as we've picked what goes.
Now, it appears in your tenure at New Amsterdam, you have created more than 200 very successful programs.
Thank you, Todd.
That have absolutely no funding.
Most never did.
This one here, CF56Z, costs exactly 2 million.
We could get this done right now.
Great, CF56Z, that would be hmm.
"Postnatal Care for Undocumented Mothers.
" - That's unfortunate.
- It is, Todd.
I'm not here to argue which of these programs deserves to stay.
I'm here to make sure that 2 million dollars' worth of them goes.
And if I refuse? Then New Amsterdam will not make payroll.
And tomorrow every one of your employees will be sent home without a dime.
Notice anything different about me? And don't say my hair because I chopped it off last year, and I will punch you.
- Good morning.
- What? Good morning.
That's what people say when they first interact for in day.
Yeah, well, it was implied.
Hey now All I'm saying is that every time I'm in the hallway people are jumping out at me mid-conversation.
It's rude.
There is always time for manners.
Outside of nuclear submarines, this is literally the place with the least amount of time for manners.
Now, you know what? I'm just gonna tell you.
It's my leg.
I'm finally better.
No more braces, no more crutches Lauren.
Oh, we really need to work on your manners.
Hey, we need help! - Yes, sir? - Yes, please, please.
- Somebody help my wife! - You don't have to shout.
Just please tell me what happened.
- She fell, hit her head - No, no.
- She was unconscious.
- I bumped my head.
- It's not a big deal.
- Yes, it is a big deal! - I just slipped for a second.
- This is serious.
Please, don't make a drama out of it.
- Hi, I'm Dr.
Bloom.
- Hi.
We're gonna figure out just how big a deal this is, okay? I promise you, it looks worse than it is.
- Let's go to bay 27.
- I slipped on our way to Shul, - in front everyone we know.
- Okay, Dr.
Walsh! Please, can you come stitch up a lac And let's get, um - Steph Goldman.
- Mrs.
Goldman a CT scan.
But it's the Sabbath.
- No electricity.
- It's not a big deal.
If mom hit her head, it could be dangerous.
HaShem makes exceptions to save a life.
Uh, if you could just go with Casey, and I'm gonna bring your mom right back, okay? Mom.
Mom, wait.
Can I stay with her? Ah How did I get so lucky? Is it okay if she stays? Uh, sure.
Yeah.
Thank you.
Come here, sweetheart.
I am fine.
It looks worse than it is.
Your mother's a klutz.
It's just a little blood.
Right? Oh, you must be my new mentee, Dawn.
Uh Today must be very exciting for you.
I still remember my first day working in a hospital.
Oh.
Thank you, but I'm I'm actually Now, before you join me on my rounds, I've compiled these books you must read to give you a proper framework on Neurology at New Amsterdam.
Dr.
Kapoor.
I'm not Dawn.
I'm Dr.
Gibbs, the lead programmer.
Programmer? Yes.
This is D.
A.
W.
N.
The Diagnostic Assessment Wellness Network.
I don't understand.
- You want me to mentor an iPad? - Dawn is a prototype for what we hope will become the most advanced Artificial Intelligence program in medical diagnosing.
But, wh I'm no, no, no, no You'll take D.
A.
W.
N.
with you on rounds, so it can improve its algorithms, and these textbooks, I'll just upload them.
Upload? It took me years to read those books.
Well, D.
A.
W.
N.
's connected to the hospital's medical network.
So you'll have instant access to patient files, radiology scans, MRIs, lab data.
With your help, D.
A.
W.
N.
will become the future of medicine.
Nice to meet you, Dr.
Kay-poor.
Mm.
It's Kapoor! I refuse.
Okay, Todd, here's the deal.
Since we are not gonna cut anything major from this budget, we're gonna make a lot of small cuts to each department.
My commanding officer would call that the Fabian Strategy.
That's the one.
You have no idea what that is, do you? - No, I do not.
- Max, you got a sec? - Yeah.
- It's about my future.
Great, I wanna talk to you about your future as well.
- You do? - Yeah.
You have, uh, seven dual-chamber pacemaker surgeries - on the books for tomorrow? - That's right.
Yeah, so those pacemakers are made in Mexico, but the American inventors charge three times as much, so we're gonna cancel the order, place it directly with the manufacturer in Mexico city.
It's gonna save us 50,000, but it's gonna, uh, have to push your surgeries.
Why not save money on shipping and just have me do the surgeries in Mexico? No, that that was sarcasm.
That was genius.
Mexico's opening tons of new clinics in response to our skyrocketing medical costs.
We could pay for you and your patients to fly to Mexico, it's gonna save them in co-pays, and us, like, 50 $100,000.
So my patients are supposed to just go to Mexico tomorrow? Yeah.
Only if they're content with getting the same surgery, with the same surgeon for less money and a better view.
100,000 down.
You happy? Sure.
Why wouldn't I be happy about outsourcing American jobs? That also both: Sarcasm.
Yeah.
I don't know what Ralph and Piggy thought when they found it, I think both the conch shell and the boar's head symbolize power, just different types.
Knock knock.
I hate to interrupt the creative process, but I have the results of your biopsy.
The mass in your stomach turned out to be a Primitive Neuroectodermal Tumor.
- Tumor? - The good news is, it's benign.
Surgeons should be able to remove it, and Cephas will make a full recovery.
What caused it? Tumors are very sensitive to hormone levels inside the body, and in Cephas' case, he had an excessive amount of cortisol, which is one of the body's main stress hormones.
How does a 13-year-old get a tumor from stress? That's what I'd like to find out.
Dr.
Sharpe didn't say anything about the tumor being in my brain.
No, no, no, no.
Um that's a little misleading.
Psych is not just about what's going on in your head.
Because what is going on up there can affect your entire body, right? In your case, excessive cortisol levels caused a tumor, but cortisol is triggered by PTSD, stress, anxiety But, I don't have any of those things.
PTSD? My life was pretty boring until I came here.
Okay.
Do you have any stressors in your life? I'm good.
Home's good.
School's good.
My biggest stressor is the school librarian.
The librarian? All right.
What's happening there? Tell me about that.
She refuses to let me check out some books because they're reserved for gifted students even though I've been reading them for years.
That's it.
- But that upset you.
- Yeah.
But they're just books.
Who cares? Well, yeah, but they're not just books, are they? And I think that you care.
I think you care very much.
Tell me why.
Because I'm smart too.
Yeah.
Does anyone else in your life make you feel that way? Less than? Diminished? I'm 13, so, like everybody.
You know what? Let's, uh, let's try something different here.
Yes.
All right, Cephas, I'm going to read a few remarks, and you simply have to reply one through ten.
One meaning almost never, ten meaning almost always.
Okay? Piece of cake.
Here we go.
What you think doesn't count very much.
Ten.
Ten? Really? Yeah, ten.
Ten it is.
You feel excluded, isolated.
Ten.
The rich get richer while the poor get poorer.
Absolutely ten.
When I walk into a store, I am followed or closely watched.
Ten.
These questions are easy.
You feel threatened, harassed, even if you can't articulate why.
Ten.
Make yourself comfortable, there's a couch over there.
Hey.
Is he okay? Yeah, yeah, he's, um he's okay.
I had Cephas answer some questions from a Harvard test known as "Unrest.
" It is designed to, um, measure someone's level of social resistance.
Social resistance? When people like us oppose the values and policies - of the dominant culture.
- That's right.
And what does that have to do with Your son, he feels threatened on a daily basis.
Like everything he's earned can just be taken away.
He's disenfranchised.
But because his life is seemingly free from all this, because he can't name it, he's internalizing it.
Name what? Racism.
I think your son's tumor was caused by racism.
Good to see you, Mrs.
Holland.
Dr.
Reynolds, this place no offence, but it's so much nicer than New Amsterdam.
I'm glad you approve.
I'll see you in there.
Wow, this is quite the operation.
We're pretty proud of it.
For people who can't afford American healthcare or a nice safe alternative.
And you only do pacemakers here? Focusing one procedure makes us hyper efficient.
How efficient? Well, we can usually knock out about 11 a day.
Ah that's pretty efficient.
It may not be as fancy as your cardio wing, but It definitely is.
It's nice! How long have you been Chair? Uh, for about a year, but I'm leaving.
Oh, I hear you.
Public hospitals are what sent me packing for Mexico.
Oh, I actually love New Amsterdam.
Then why? I love my fiancée more.
Max! Max, I need to talk to you.
Yeah, what's up? She keeps coming back.
Should I be made aware of any suspicious activity? Just stand down, Todd.
She wants to teach a computer to replace me.
After all the personal sacrifices I've made, just to have an iPad steal my knowledge it is not "artificial" intelligence, it is my intelligence.
- Max we're due in dermatology.
- I know.
Vijay, since I have no idea what you're talking about, I'm gonna trust you to make the right decision.
Thank you.
I won't do it.
No matter how much her company is paying the hospital.
Come again? How much are they paying the hospital? - They are - $160,000.
Really? That's, uh Vijay, my friend, I think that you and the iPad might've gotten off on the wrong foot.
My body's been sore, and my girl saw this crazy rash.
I have a couple of theories.
The first one I think Diagnosis confirmed.
Lyme disease.
An email is being sent to your account with detailed treatment information.
Yes, something to do with your I'm sorry, but let me see I I What happens next? We wait for the results from your CT scan.
Unfortunately, it can take a couple hours to arrive from, uh, Radiology because CT scan results have arrived.
- Diagnosis ACA aneurysm.
- What? - What? Where? - What? - What, what? - Aneurysm is located on the anterior clinoid segment Nobody likes a show-off, so just shut up, okay? I-I have to go.
I need that back please.
Okay.
You keep it.
Every day, 9:30-9:45 Sandra Fall from billing! Hi.
How goes it? It doesn't go good because you can't code for racism.
And yet, I did, so No, you hand-wrote a non-option in the margin like a Bern Bro during the 2016 General Election.
Yes, I did, because there isn't a code for my actual diagnosis.
Okay, then change your diagnosis to an approved ICD-10 code because that's how we bill insurance companies.
No.
No, I'm sorry, I'm not gonna change my diagnosis, Sandra Fall from billing not this time.
Many, many times I've played it fast and loose with insurance codes to help patients.
- Please, don't tell me that! - Many times.
But this time it will actually hurt patients.
Like, specifically the 13-year-old boy who is lying in our OR with a tumor.
He's proof that racism can cause life-threatening medical issues, and no one is doing anything about it because no one is tracking the data to prove it.
And do you know why no one is tracking the data to prove it? Because the ICD-10 doesn't have a diagnostic code for it? - Exactly.
- Dr.
Frome, go ahead, change the world, but not until you change the ICD codes.
That's Clamp.
Cephas' tumor's nestled up against the inferior mesenteric.
I can definitely get in there.
Forceps.
NR BP 55.
Dr.
Ayton, look at this.
Right next to the duodenum.
Another tumor.
Patient is hemodynamically stable.
And looks like another two right at the celiac junction.
Four total? Surgery's gonna take a bit longer.
I'll go tell his mother.
Helen, from what I can tell, these tumors are just going to keep recurring.
And next time they might not be benign.
Stand by with pylorus clamp.
Okay, give it to me straight, Todd.
- 100,000 from cardiothoracic - Yep.
- 160k from neurology - Yep.
45,000 from dermatology.
Come on, admit it.
This skimming thing is kind of working, right? So long as everyone does their part and sacrifices for the greater good.
- Exactly.
- Like Communism.
- Max! - Yeah? Notice anything different about me? Actually, I have been noticing a lot of your patients are being admitted before they need to be.
Uh, ACS, pre-crisis diabetics The thing is, if they don't actually end up in crisis, then we can't bill for it.
It's my leg.
Um, finally better.
- No biggie.
- That's great.
So, it would save this hospital a lot of money if you could keep these patients in the ED for observation until a crisis diagnosis can be confirmed.
If you don't mind hiring 20 more nurses, a dozen more orderlies, and increasing the number of residents, and adding, like, 30 beds, then sure.
Excuse me! Excuse me! This area is off limits! You can't just keep coming back here like this! Who the hell do you think you are? Uh So ultimately, I don't think it's going to save you any money.
She seems fun.
Yeah, I'll figure out whatever, uh, that was, but right now I need a new strategy.
We could always revisit cutting CF56Z.
You mean "Postnatal Care for Undocumented Mothers.
" I mean to save this hospital.
From your own good intentions.
I need some help here! Grab me an orderly and a non-rebreather mask! Hey, what happened? She just started walking and collapsed.
Okay, well, let's get her back on her feet.
I-I can't feel my legs.
Where? What part? All over.
Everywhere.
- What do her CTs say? - Nothing.
They were all clear.
- Do we need a collar? - Please, I - I can't I can't feel my legs.
- Mom? - Are you okay? - I can't feel my legs.
What's going on? - Please! - She didn't hit her head.
She just fell down.
- Sir.
- Sir.
- Hi there.
- Ma'am.
Um, thank you for agreeing to meet us here.
We thought neutral territory would be best for what Dr.
Goodwin has to say.
- Yeah.
- Max, I think I can save New Amsterdam and the city of New York hundreds of millions of dollars.
Oh, then you should definitely go first.
There's a 13-year-old boy in surgery right now having multiple tumors removed caused by racism.
I know I know how that sounds, trust me, I do, but yesterday, I treated two patients with PTSD from the exact same thing.
Our ED, at least three times a week, treats victims of hate crimes.
The city is spending hundreds of millions of dollars managing medical repercussions of racism, and it doesn't even know it because the ICD-10 does not have a code for it.
This is not gonna save us money.
How can I help? A campaign to make the ICD-10 add racism to their diagnostic index.
All I need is a little bit of money for a small team of researchers and lobbyists No.
What? Say that again? No.
That's I've never heard you say that word before.
In order to balance the budget, Max has no choice but to cut personnel.
How awful.
Did you guys have anyone in mind? Back away slowly.
Go, go, slower.
Okay, break.
Break break for it.
Four tumors, all being removed it's just going to take a little bit more time.
Why is this happening to my son? Uh Cephas let me read his essay on "Lord of the Flies, and it's clear just how open he is.
To the world.
And while that openness lets in a lot of beauty, it also lets in darker things.
God, I really thought that I shielded him from everything that I have to deal with.
I jumped through hoops to get him into a progressive school with a uniform policy.
I got him into group sports with diverse coaches.
His friends are amazing.
I I thought I was doing a good job, I really You you are doing more than a good job.
That boy is extraordinary because of you.
Even here, in this progressive hospital, I deal with microaggressions every day.
From people who mean well.
From people who should know better.
That's the world that we live in.
So, then what can I do to keep my son from ending up here next year? Next month? Have you been out of country recently? No.
Been bitten by an animal or a rodent? Uh, just the occasional mosquito bite.
Started any new diets? We keep kosher.
Nothing trendy.
Swam in any natural bodies of water? No.
Do you have any idea what's happening to me? Will you excuse us for a second? Okay.
Any theories? Guillain-Barre syndrome and Zika are both known to cause leg paralysis, but her tests came back normal.
And her CT came back negative except for some swelling around the spine.
The only viable option right now is to treat her symptoms, push steroids to reduce her spinal swelling, unless D.
A.
W.
N.
has a different diagnosis to humiliate me.
D.
A.
W.
N.
-ji? This is bad.
This is my favorite achievement since coming here.
Free daycare for all employees.
I don't see how getting rid of a few daycare employees is gonna put a dent in the budget.
Well, we contract out the daycare service.
It's a luxury, I mean, it's not essential, and if we close it, we might break even.
You're closing the daycare? Now, Mariana, I wouldn't even consider this unless I absolutely had to.
I mean, I need the daycare too.
So do a lot of the nurses and residents.
- I hear you, but - I don't think you do.
Do you know how expensive regular daycare is? Not to mention, they're only open ten hours, and most of us work 12-hour shifts.
Are you gonna cut our hours and pay us more too? I need to cut costs just to make payroll.
Well, you can keep my paycheck because if we have to pay for daycare, a lot of us will need new jobs.
We're not gonna cut daycare, are we? At the aortic arch.
Anterior wall of the left atrium looks prime for placement of the first lead.
All right, advancing now.
Just as good as at New Amsterdam? I'm not gonna lie to you, I'm pretty proud of what we accomplished.
I mean, that's what makes leaving so hard, you know? Whoa.
Is that from a lung? - Did I hit something? - No, it's from her stomach.
Massive hematemesis.
Maybe it's a bleeding ulcer or a Mallory Weiss Tear.
It looks like variceal bleeding.
Her cirrhotic liver decompensated.
The blood is backing up behind it.
We need to make a new pathway so the blood can bypass the liver.
Heart rate's up to 130.
All right, transfuse 2 units of packed red cells.
We don't have a blood bank.
We're not a hospital.
I'm calling an ambulance.
Her blood pressure's dropping.
We don't have time.
We're working on her now.
I told you, we're only equipped for cardiac emergencies.
Then we have to treat Grace's liver like a heart.
She's never there anymore.
She's only about her trial these days.
my plan would work.
Uh, can I run something by you? Sure, but where's your bodyguard? Oh, I gave him the slip.
- Really? - No, that's impossible.
He's at lunch.
I'm having a bit of a budget crisis, and I finally figured out a way to, uh, close the gap.
- You ready? - As ready as I'll ever be.
Okay, I want to eliminate all over-testing.
- That's a great idea.
- Really? Oh, my God, you're the first person who has not wanted to strangle me, or you know, slam the door in my face.
What test did you have in mind? I wanna cut yearly mammograms.
- Sorry? - I know how that sounds, okay, but the US Preventative Task Force says they're unnecessary for women under 50 unless of course they fall into a high-risk group.
Yeah, the American Cancer Society says 45.
A woman's individual doctor might say 40.
These tests aren't one-size fits all.
I'm not saying they are.
All I am saying is women under 50 are more likely to get false positive and therefore be over-diagnosed and over-treated for something that may ultimately be benign.
Someone may want that peace of mind.
Well, but should New Amsterdam be paying for it? - Fine, cut yearly mammograms.
- Really? - Sure.
- Thank you.
Except those mammograms are actually money-makers for this hospital.
I walked right into this, didn't I? If you cut mammograms paid for by insurance, I'm fairly certain it's gonna make your budget shortfall even worse.
What about mammograms not covered by insurance? So you're suggesting two standards of care, one for women with insurance and one for women without? No, because that would be - Draconian.
- Yeah.
And I would be ashamed to even be having this conversation.
Don't be, because I'm sure Castro will cut whatever you want.
Mm.
Glad I was at lunch for that one.
These cardiac stents are too small.
They're made to open a tiny artery, not make a large conduit for bypassing the liver.
If I can just get this last stent in place, the portal vein and the hepatic vein will flow as one.
Switch ultrasound to Doppler mode.
I don't see anything.
There's no flow.
You missed the connection.
We must have gone too distal.
BP's dropping again.
Hang a bag of Dobutamine.
Titrate to 3 micrograms.
I'm gonna try to pass the wire.
See if you can grab it, all right? That'll help us make the connection.
Little further.
A little further.
- Now.
- Got it.
Muy bien.
Looks like flow.
I can't believe it.
Gauze.
Forgot how much I missed real medicine.
My baby.
Okay, but the W.
H.
O.
needs a sponsor, and I can't I can't get a sponsor until the W.
H.
O Right exactly.
- Yes.
- Iggy! Yes, I'll be there.
Thank you very much.
Iggy, where have you been? Every day patients come in with so many stressors that I have no idea what the problem is.
With Cephas, I know exactly what the problem is, but I can't to do anything about it, which is just crazy-maker, you know? So I just managed to get a meeting with a member the World Health Organization so I can lobby Okay, Iggy, I love you, and I mean this in the best possible way Uh-oh.
Forget about trying to save the world and focus on trying to save our patient, 'cause no one else is going to.
Help.
Help, please, help.
Okay, deep breaths for me, Steph, okay? - Deep breaths.
- Now I can't move my arms.
Okay, let's get her on 100% non-rebreather and a stat EKG.
Squeeze my hands.
Come on, as hard as you can.
I can't.
Steph! Okay, let's get her on 2 milligrams of Ativan.
2 milligrams of Ativan! Oh, Mommy I need that Ativan! Mommy, please stop.
Ascending paralysis.
Soon she won't be able to breathe.
It could be Neuro-Bechet's Disease.
Diagnostic accuracy below 1%.
A tumor can cause paraneoplastic syndrome.
Diagnostic accuracy less than 1%.
D.
A.
W.
N.
if you do not have any actual ideas, please shut up.
Advise patient be placed in phenobarbital coma until diagnosis can be reached.
Tell me we're not doing that.
If we do not reach diagnosis today We'll have to.
I really thought we could do it.
We knew this would be painful.
Why do you think Brantley sent me? I could chip away at it, but every cut just makes this hospital worse.
Which is why I still think you should pick one big ticket item.
Will it make the hospital worse? Unfortunately, yes.
But will it compromise every single one of your departments? No.
Yeah.
You know, we were the first hospital in the country to cover postnatal care for undocumented mothers.
We were trying to be pioneers.
Now I can make payroll.
Max.
You did the right thing.
Well, it looks like Klinger's missed 11 games this year, and he's been battling this injury all season.
Oh, missed the second free throw.
Miller with the rebound.
Are we winning? - He's got seven assists - Oh, I'm sorry.
Please, please, don't tell my dad.
Ah, the Sabbath.
No electricity.
It's just a really big game.
Your secret is safe with me.
Nets fans have suffered enough.
May I? You must miss many games because of the Sabbath.
Well, I kind of make an exception for the Nets.
We haven't won a championship game in my whole life, but we're doing really well this year.
- Hm.
- Mm-hmm.
So do you break any other Sabbath rules? No way.
Never.
Shirley this is question is a matter of life and death.
I believe you have kept the Sabbath, but have you kept kosher? Vijay, you paged? - Hot dog! - What are we talking about? Shirley secretly ate a street vendor's hot dog.
Shirley got a tapeworm? And passed its eggs unknowingly to her mother with a kiss.
Neurocysticercosis.
Did D.
A.
W.
N.
confirm? I turned D.
A.
W.
N.
off.
Two tablets each, and they will be cleared up.
I I don't understand.
Did I hurt my mom? No, Shirley.
You saved her life.
Hey, there, kiddo.
How you doing? Better.
Better is good.
Very good.
So listen, I have I have one question that was not on my list from earlier.
You feel up to answering it? Why wouldn't the librarian let you take out those books? I don't know.
Well, I think you do know.
I think you know it so well that it is eating you up inside, and it is causing you to be sick.
Why wouldn't the librarian let you take out those books? Because of the color of my skin.
But she's not racist.
Yeah, I don't doubt that for a second.
But, you know, racism is so deeply ingrained in our society that people, myself included, we often don't realize that we're perpetuating it.
So, like when people give me nicknames I don't want 'cause my name is different? Yes, that is a microaggression because of the color of your skin.
What about when adults tell me I speak really good English? It's because of the color of your skin.
Or when people assume I only got into my school 'cause I'm diverse? Yes.
When the teacher tells me to lower my voice, even though I'm not the only one talking? Or she makes me answer all the Latino questions 'cause I'm the only one in the room? Yes.
I just thought I didn't deserve to be there.
I wasn't good enough.
I was a mistake.
No, Cephas, listen to me.
All of this, everything you're talking about has nothing to do with you, and everything to do with the world around you.
You walking around with all of this shame and confusion and stress inside your body, I can see that you don't want to feel this right now.
But I'm telling you, your body is definitely feeling it, and that is what is making you sick.
So How are you gonna fix the world? I'm not.
I can't.
But I can help you process.
Because if we can name it, we can treat it.
You win.
What do you want, Mom? Dinner.
May, how long has Fatima been like this? - All day.
- You should've paged me.
She's listed as Castro's patient.
Fatima, sweetheart, can I help you get back? I'm fine.
Fine, fine, fine.
Okay.
Have you seen Dr.
Castro? Dr.
Castro said my numbers are good.
I'm good.
Better than good.
She said her trial's helping.
Yeah.
Max, I got some bad news.
I'm already there, so just hit me.
Mexico is not the answer to your budget crisis.
You know, we shouldn't be sending our patients 2,000 miles away.
It erodes our hospital.
And American hospitals are eroded enough.
And, Max, the other thing I gotta tell you, it can't wait anymore, all right? Floyd, you're the best.
I gotta go.
Hey, wait! Excuse me.
Todd.
Wait, buddy, hold up.
Hey.
Listen, I found a way to make payroll, save $2 million, and not cut a single program.
How? Add a program.
Todd, there are two ways to meet the budget, right? We were trying to cut costs, but what if we tried to add revenue? Okay, what we need isn't less programs, it's more patients.
I think you've got all the sick people you can handle.
Exactly.
And so does every other hospital.
New Amsterdam has every specialist under the sun.
Right? But other hospitals can't even afford to keep one specialist on staff full time.
America is full of people who have specific medical needs that their local hospitals can't meet, but we can.
So instead of outsourcing our patients, we're gonna outsource our doctors.
Okay, yeah, I'm gonna call it something better, but I have commitments already from Bridgeport Medical in Alabama, Mount Ida Memorial in Arkansas, Townsend Hospital Center in Delaware.
Look, we can fill America's healthcare gaps, we can get fairly compensated, and most importantly, we can we can balance the budget.
What? Am I too late? The budget's already in? I threw it away.
- You what? - Your budget.
Threw it away.
Threw it away? Why? I knew you'd come up with something.
Huh.
Hi.
You look really nice.
- So do you.
- Thanks.
Here you go.
Right.
Yeah.
Um I'm sorry.
I don't think I can do this.
Thank God.
Me, neither.
Really? Yeah, I feel incredibly guilty just being here.
And I know I shouldn't, but I Yeah, no, it just sneaks up on you, right? My husband was a musician.
He took his own life.
Sorry.
I don't talk about that much.
- Yeah, no - Ever.
But the moment I start to feel happiness, a wave of panic just Yeah.
Is that crazy to be triggered by happiness? No.
Sorry I ruined the evening.
No, I mean you you didn't.
You didn't ruin anything.
Um Yeah, this is Max.
Sorry, I thought I'd get your voicemail.
No, that's okay.
Who is this? My name's Nolene George, and I heard there was an opening at New Amsterdam.
I'd love to be considered for the position.
Sorry, what position? Chair of cardiothoracic surgery.
Since Dr.
Reynolds is leaving.
Damn
Just for a few good night kisses.
- Right.
- And then go to sleep super easy with no bouncing, white noise, or tiptoeing required.
Very realistic plan.
I have been using the five Ss by the way.
- Thank you for that.
- Yeah.
Really knocks Luna out.
Lifesaver.
The real lifesaver is you can take Luna to work.
Sadly, Bobbi's not into the whole music scene.
Not what she told me.
Is everything okay? Yeah, I got impossible-to-get tickets for me and a friend to see Carol Churchill's play.
- Oh, I'm dying to see that.
- And my friend just bailed.
Oh.
- You should come.
- Um, yeah no, uh If you want, I mean.
No pressure.
No, I mean if you want.
I don't wanna If you don't, that's cool.
I'm into it.
Yes.
- Okay.
- Okay, so - Great.
- Great.
Yeah.
I'm sorry.
Sorry! Sorry, I'm late.
I hate being the last one here uh, Sergeant Todd.
- Sir.
- Uh, are we very early or very late? There's no meeting, Dr.
Goodwin.
No meeting? Why do I suddenly get the feeling I'm being ambushed? No, no.
If this were an ambush I would've placed myself against that wall, allowing the open door to obscure me as you entered the room.
I'm here to deliver a message from the board that they were too afraid to deliver.
Which is? You have to cut $2 million from the budget by the end of tomorrow.
And may I send a specifically worded message back with you? As soon as we've picked what goes.
Now, it appears in your tenure at New Amsterdam, you have created more than 200 very successful programs.
Thank you, Todd.
That have absolutely no funding.
Most never did.
This one here, CF56Z, costs exactly 2 million.
We could get this done right now.
Great, CF56Z, that would be hmm.
"Postnatal Care for Undocumented Mothers.
" - That's unfortunate.
- It is, Todd.
I'm not here to argue which of these programs deserves to stay.
I'm here to make sure that 2 million dollars' worth of them goes.
And if I refuse? Then New Amsterdam will not make payroll.
And tomorrow every one of your employees will be sent home without a dime.
Notice anything different about me? And don't say my hair because I chopped it off last year, and I will punch you.
- Good morning.
- What? Good morning.
That's what people say when they first interact for in day.
Yeah, well, it was implied.
Hey now All I'm saying is that every time I'm in the hallway people are jumping out at me mid-conversation.
It's rude.
There is always time for manners.
Outside of nuclear submarines, this is literally the place with the least amount of time for manners.
Now, you know what? I'm just gonna tell you.
It's my leg.
I'm finally better.
No more braces, no more crutches Lauren.
Oh, we really need to work on your manners.
Hey, we need help! - Yes, sir? - Yes, please, please.
- Somebody help my wife! - You don't have to shout.
Just please tell me what happened.
- She fell, hit her head - No, no.
- She was unconscious.
- I bumped my head.
- It's not a big deal.
- Yes, it is a big deal! - I just slipped for a second.
- This is serious.
Please, don't make a drama out of it.
- Hi, I'm Dr.
Bloom.
- Hi.
We're gonna figure out just how big a deal this is, okay? I promise you, it looks worse than it is.
- Let's go to bay 27.
- I slipped on our way to Shul, - in front everyone we know.
- Okay, Dr.
Walsh! Please, can you come stitch up a lac And let's get, um - Steph Goldman.
- Mrs.
Goldman a CT scan.
But it's the Sabbath.
- No electricity.
- It's not a big deal.
If mom hit her head, it could be dangerous.
HaShem makes exceptions to save a life.
Uh, if you could just go with Casey, and I'm gonna bring your mom right back, okay? Mom.
Mom, wait.
Can I stay with her? Ah How did I get so lucky? Is it okay if she stays? Uh, sure.
Yeah.
Thank you.
Come here, sweetheart.
I am fine.
It looks worse than it is.
Your mother's a klutz.
It's just a little blood.
Right? Oh, you must be my new mentee, Dawn.
Uh Today must be very exciting for you.
I still remember my first day working in a hospital.
Oh.
Thank you, but I'm I'm actually Now, before you join me on my rounds, I've compiled these books you must read to give you a proper framework on Neurology at New Amsterdam.
Dr.
Kapoor.
I'm not Dawn.
I'm Dr.
Gibbs, the lead programmer.
Programmer? Yes.
This is D.
A.
W.
N.
The Diagnostic Assessment Wellness Network.
I don't understand.
- You want me to mentor an iPad? - Dawn is a prototype for what we hope will become the most advanced Artificial Intelligence program in medical diagnosing.
But, wh I'm no, no, no, no You'll take D.
A.
W.
N.
with you on rounds, so it can improve its algorithms, and these textbooks, I'll just upload them.
Upload? It took me years to read those books.
Well, D.
A.
W.
N.
's connected to the hospital's medical network.
So you'll have instant access to patient files, radiology scans, MRIs, lab data.
With your help, D.
A.
W.
N.
will become the future of medicine.
Nice to meet you, Dr.
Kay-poor.
Mm.
It's Kapoor! I refuse.
Okay, Todd, here's the deal.
Since we are not gonna cut anything major from this budget, we're gonna make a lot of small cuts to each department.
My commanding officer would call that the Fabian Strategy.
That's the one.
You have no idea what that is, do you? - No, I do not.
- Max, you got a sec? - Yeah.
- It's about my future.
Great, I wanna talk to you about your future as well.
- You do? - Yeah.
You have, uh, seven dual-chamber pacemaker surgeries - on the books for tomorrow? - That's right.
Yeah, so those pacemakers are made in Mexico, but the American inventors charge three times as much, so we're gonna cancel the order, place it directly with the manufacturer in Mexico city.
It's gonna save us 50,000, but it's gonna, uh, have to push your surgeries.
Why not save money on shipping and just have me do the surgeries in Mexico? No, that that was sarcasm.
That was genius.
Mexico's opening tons of new clinics in response to our skyrocketing medical costs.
We could pay for you and your patients to fly to Mexico, it's gonna save them in co-pays, and us, like, 50 $100,000.
So my patients are supposed to just go to Mexico tomorrow? Yeah.
Only if they're content with getting the same surgery, with the same surgeon for less money and a better view.
100,000 down.
You happy? Sure.
Why wouldn't I be happy about outsourcing American jobs? That also both: Sarcasm.
Yeah.
I don't know what Ralph and Piggy thought when they found it, I think both the conch shell and the boar's head symbolize power, just different types.
Knock knock.
I hate to interrupt the creative process, but I have the results of your biopsy.
The mass in your stomach turned out to be a Primitive Neuroectodermal Tumor.
- Tumor? - The good news is, it's benign.
Surgeons should be able to remove it, and Cephas will make a full recovery.
What caused it? Tumors are very sensitive to hormone levels inside the body, and in Cephas' case, he had an excessive amount of cortisol, which is one of the body's main stress hormones.
How does a 13-year-old get a tumor from stress? That's what I'd like to find out.
Dr.
Sharpe didn't say anything about the tumor being in my brain.
No, no, no, no.
Um that's a little misleading.
Psych is not just about what's going on in your head.
Because what is going on up there can affect your entire body, right? In your case, excessive cortisol levels caused a tumor, but cortisol is triggered by PTSD, stress, anxiety But, I don't have any of those things.
PTSD? My life was pretty boring until I came here.
Okay.
Do you have any stressors in your life? I'm good.
Home's good.
School's good.
My biggest stressor is the school librarian.
The librarian? All right.
What's happening there? Tell me about that.
She refuses to let me check out some books because they're reserved for gifted students even though I've been reading them for years.
That's it.
- But that upset you.
- Yeah.
But they're just books.
Who cares? Well, yeah, but they're not just books, are they? And I think that you care.
I think you care very much.
Tell me why.
Because I'm smart too.
Yeah.
Does anyone else in your life make you feel that way? Less than? Diminished? I'm 13, so, like everybody.
You know what? Let's, uh, let's try something different here.
Yes.
All right, Cephas, I'm going to read a few remarks, and you simply have to reply one through ten.
One meaning almost never, ten meaning almost always.
Okay? Piece of cake.
Here we go.
What you think doesn't count very much.
Ten.
Ten? Really? Yeah, ten.
Ten it is.
You feel excluded, isolated.
Ten.
The rich get richer while the poor get poorer.
Absolutely ten.
When I walk into a store, I am followed or closely watched.
Ten.
These questions are easy.
You feel threatened, harassed, even if you can't articulate why.
Ten.
Make yourself comfortable, there's a couch over there.
Hey.
Is he okay? Yeah, yeah, he's, um he's okay.
I had Cephas answer some questions from a Harvard test known as "Unrest.
" It is designed to, um, measure someone's level of social resistance.
Social resistance? When people like us oppose the values and policies - of the dominant culture.
- That's right.
And what does that have to do with Your son, he feels threatened on a daily basis.
Like everything he's earned can just be taken away.
He's disenfranchised.
But because his life is seemingly free from all this, because he can't name it, he's internalizing it.
Name what? Racism.
I think your son's tumor was caused by racism.
Good to see you, Mrs.
Holland.
Dr.
Reynolds, this place no offence, but it's so much nicer than New Amsterdam.
I'm glad you approve.
I'll see you in there.
Wow, this is quite the operation.
We're pretty proud of it.
For people who can't afford American healthcare or a nice safe alternative.
And you only do pacemakers here? Focusing one procedure makes us hyper efficient.
How efficient? Well, we can usually knock out about 11 a day.
Ah that's pretty efficient.
It may not be as fancy as your cardio wing, but It definitely is.
It's nice! How long have you been Chair? Uh, for about a year, but I'm leaving.
Oh, I hear you.
Public hospitals are what sent me packing for Mexico.
Oh, I actually love New Amsterdam.
Then why? I love my fiancée more.
Max! Max, I need to talk to you.
Yeah, what's up? She keeps coming back.
Should I be made aware of any suspicious activity? Just stand down, Todd.
She wants to teach a computer to replace me.
After all the personal sacrifices I've made, just to have an iPad steal my knowledge it is not "artificial" intelligence, it is my intelligence.
- Max we're due in dermatology.
- I know.
Vijay, since I have no idea what you're talking about, I'm gonna trust you to make the right decision.
Thank you.
I won't do it.
No matter how much her company is paying the hospital.
Come again? How much are they paying the hospital? - They are - $160,000.
Really? That's, uh Vijay, my friend, I think that you and the iPad might've gotten off on the wrong foot.
My body's been sore, and my girl saw this crazy rash.
I have a couple of theories.
The first one I think Diagnosis confirmed.
Lyme disease.
An email is being sent to your account with detailed treatment information.
Yes, something to do with your I'm sorry, but let me see I I What happens next? We wait for the results from your CT scan.
Unfortunately, it can take a couple hours to arrive from, uh, Radiology because CT scan results have arrived.
- Diagnosis ACA aneurysm.
- What? - What? Where? - What? - What, what? - Aneurysm is located on the anterior clinoid segment Nobody likes a show-off, so just shut up, okay? I-I have to go.
I need that back please.
Okay.
You keep it.
Every day, 9:30-9:45 Sandra Fall from billing! Hi.
How goes it? It doesn't go good because you can't code for racism.
And yet, I did, so No, you hand-wrote a non-option in the margin like a Bern Bro during the 2016 General Election.
Yes, I did, because there isn't a code for my actual diagnosis.
Okay, then change your diagnosis to an approved ICD-10 code because that's how we bill insurance companies.
No.
No, I'm sorry, I'm not gonna change my diagnosis, Sandra Fall from billing not this time.
Many, many times I've played it fast and loose with insurance codes to help patients.
- Please, don't tell me that! - Many times.
But this time it will actually hurt patients.
Like, specifically the 13-year-old boy who is lying in our OR with a tumor.
He's proof that racism can cause life-threatening medical issues, and no one is doing anything about it because no one is tracking the data to prove it.
And do you know why no one is tracking the data to prove it? Because the ICD-10 doesn't have a diagnostic code for it? - Exactly.
- Dr.
Frome, go ahead, change the world, but not until you change the ICD codes.
That's Clamp.
Cephas' tumor's nestled up against the inferior mesenteric.
I can definitely get in there.
Forceps.
NR BP 55.
Dr.
Ayton, look at this.
Right next to the duodenum.
Another tumor.
Patient is hemodynamically stable.
And looks like another two right at the celiac junction.
Four total? Surgery's gonna take a bit longer.
I'll go tell his mother.
Helen, from what I can tell, these tumors are just going to keep recurring.
And next time they might not be benign.
Stand by with pylorus clamp.
Okay, give it to me straight, Todd.
- 100,000 from cardiothoracic - Yep.
- 160k from neurology - Yep.
45,000 from dermatology.
Come on, admit it.
This skimming thing is kind of working, right? So long as everyone does their part and sacrifices for the greater good.
- Exactly.
- Like Communism.
- Max! - Yeah? Notice anything different about me? Actually, I have been noticing a lot of your patients are being admitted before they need to be.
Uh, ACS, pre-crisis diabetics The thing is, if they don't actually end up in crisis, then we can't bill for it.
It's my leg.
Um, finally better.
- No biggie.
- That's great.
So, it would save this hospital a lot of money if you could keep these patients in the ED for observation until a crisis diagnosis can be confirmed.
If you don't mind hiring 20 more nurses, a dozen more orderlies, and increasing the number of residents, and adding, like, 30 beds, then sure.
Excuse me! Excuse me! This area is off limits! You can't just keep coming back here like this! Who the hell do you think you are? Uh So ultimately, I don't think it's going to save you any money.
She seems fun.
Yeah, I'll figure out whatever, uh, that was, but right now I need a new strategy.
We could always revisit cutting CF56Z.
You mean "Postnatal Care for Undocumented Mothers.
" I mean to save this hospital.
From your own good intentions.
I need some help here! Grab me an orderly and a non-rebreather mask! Hey, what happened? She just started walking and collapsed.
Okay, well, let's get her back on her feet.
I-I can't feel my legs.
Where? What part? All over.
Everywhere.
- What do her CTs say? - Nothing.
They were all clear.
- Do we need a collar? - Please, I - I can't I can't feel my legs.
- Mom? - Are you okay? - I can't feel my legs.
What's going on? - Please! - She didn't hit her head.
She just fell down.
- Sir.
- Sir.
- Hi there.
- Ma'am.
Um, thank you for agreeing to meet us here.
We thought neutral territory would be best for what Dr.
Goodwin has to say.
- Yeah.
- Max, I think I can save New Amsterdam and the city of New York hundreds of millions of dollars.
Oh, then you should definitely go first.
There's a 13-year-old boy in surgery right now having multiple tumors removed caused by racism.
I know I know how that sounds, trust me, I do, but yesterday, I treated two patients with PTSD from the exact same thing.
Our ED, at least three times a week, treats victims of hate crimes.
The city is spending hundreds of millions of dollars managing medical repercussions of racism, and it doesn't even know it because the ICD-10 does not have a code for it.
This is not gonna save us money.
How can I help? A campaign to make the ICD-10 add racism to their diagnostic index.
All I need is a little bit of money for a small team of researchers and lobbyists No.
What? Say that again? No.
That's I've never heard you say that word before.
In order to balance the budget, Max has no choice but to cut personnel.
How awful.
Did you guys have anyone in mind? Back away slowly.
Go, go, slower.
Okay, break.
Break break for it.
Four tumors, all being removed it's just going to take a little bit more time.
Why is this happening to my son? Uh Cephas let me read his essay on "Lord of the Flies, and it's clear just how open he is.
To the world.
And while that openness lets in a lot of beauty, it also lets in darker things.
God, I really thought that I shielded him from everything that I have to deal with.
I jumped through hoops to get him into a progressive school with a uniform policy.
I got him into group sports with diverse coaches.
His friends are amazing.
I I thought I was doing a good job, I really You you are doing more than a good job.
That boy is extraordinary because of you.
Even here, in this progressive hospital, I deal with microaggressions every day.
From people who mean well.
From people who should know better.
That's the world that we live in.
So, then what can I do to keep my son from ending up here next year? Next month? Have you been out of country recently? No.
Been bitten by an animal or a rodent? Uh, just the occasional mosquito bite.
Started any new diets? We keep kosher.
Nothing trendy.
Swam in any natural bodies of water? No.
Do you have any idea what's happening to me? Will you excuse us for a second? Okay.
Any theories? Guillain-Barre syndrome and Zika are both known to cause leg paralysis, but her tests came back normal.
And her CT came back negative except for some swelling around the spine.
The only viable option right now is to treat her symptoms, push steroids to reduce her spinal swelling, unless D.
A.
W.
N.
has a different diagnosis to humiliate me.
D.
A.
W.
N.
-ji? This is bad.
This is my favorite achievement since coming here.
Free daycare for all employees.
I don't see how getting rid of a few daycare employees is gonna put a dent in the budget.
Well, we contract out the daycare service.
It's a luxury, I mean, it's not essential, and if we close it, we might break even.
You're closing the daycare? Now, Mariana, I wouldn't even consider this unless I absolutely had to.
I mean, I need the daycare too.
So do a lot of the nurses and residents.
- I hear you, but - I don't think you do.
Do you know how expensive regular daycare is? Not to mention, they're only open ten hours, and most of us work 12-hour shifts.
Are you gonna cut our hours and pay us more too? I need to cut costs just to make payroll.
Well, you can keep my paycheck because if we have to pay for daycare, a lot of us will need new jobs.
We're not gonna cut daycare, are we? At the aortic arch.
Anterior wall of the left atrium looks prime for placement of the first lead.
All right, advancing now.
Just as good as at New Amsterdam? I'm not gonna lie to you, I'm pretty proud of what we accomplished.
I mean, that's what makes leaving so hard, you know? Whoa.
Is that from a lung? - Did I hit something? - No, it's from her stomach.
Massive hematemesis.
Maybe it's a bleeding ulcer or a Mallory Weiss Tear.
It looks like variceal bleeding.
Her cirrhotic liver decompensated.
The blood is backing up behind it.
We need to make a new pathway so the blood can bypass the liver.
Heart rate's up to 130.
All right, transfuse 2 units of packed red cells.
We don't have a blood bank.
We're not a hospital.
I'm calling an ambulance.
Her blood pressure's dropping.
We don't have time.
We're working on her now.
I told you, we're only equipped for cardiac emergencies.
Then we have to treat Grace's liver like a heart.
She's never there anymore.
She's only about her trial these days.
my plan would work.
Uh, can I run something by you? Sure, but where's your bodyguard? Oh, I gave him the slip.
- Really? - No, that's impossible.
He's at lunch.
I'm having a bit of a budget crisis, and I finally figured out a way to, uh, close the gap.
- You ready? - As ready as I'll ever be.
Okay, I want to eliminate all over-testing.
- That's a great idea.
- Really? Oh, my God, you're the first person who has not wanted to strangle me, or you know, slam the door in my face.
What test did you have in mind? I wanna cut yearly mammograms.
- Sorry? - I know how that sounds, okay, but the US Preventative Task Force says they're unnecessary for women under 50 unless of course they fall into a high-risk group.
Yeah, the American Cancer Society says 45.
A woman's individual doctor might say 40.
These tests aren't one-size fits all.
I'm not saying they are.
All I am saying is women under 50 are more likely to get false positive and therefore be over-diagnosed and over-treated for something that may ultimately be benign.
Someone may want that peace of mind.
Well, but should New Amsterdam be paying for it? - Fine, cut yearly mammograms.
- Really? - Sure.
- Thank you.
Except those mammograms are actually money-makers for this hospital.
I walked right into this, didn't I? If you cut mammograms paid for by insurance, I'm fairly certain it's gonna make your budget shortfall even worse.
What about mammograms not covered by insurance? So you're suggesting two standards of care, one for women with insurance and one for women without? No, because that would be - Draconian.
- Yeah.
And I would be ashamed to even be having this conversation.
Don't be, because I'm sure Castro will cut whatever you want.
Mm.
Glad I was at lunch for that one.
These cardiac stents are too small.
They're made to open a tiny artery, not make a large conduit for bypassing the liver.
If I can just get this last stent in place, the portal vein and the hepatic vein will flow as one.
Switch ultrasound to Doppler mode.
I don't see anything.
There's no flow.
You missed the connection.
We must have gone too distal.
BP's dropping again.
Hang a bag of Dobutamine.
Titrate to 3 micrograms.
I'm gonna try to pass the wire.
See if you can grab it, all right? That'll help us make the connection.
Little further.
A little further.
- Now.
- Got it.
Muy bien.
Looks like flow.
I can't believe it.
Gauze.
Forgot how much I missed real medicine.
My baby.
Okay, but the W.
H.
O.
needs a sponsor, and I can't I can't get a sponsor until the W.
H.
O Right exactly.
- Yes.
- Iggy! Yes, I'll be there.
Thank you very much.
Iggy, where have you been? Every day patients come in with so many stressors that I have no idea what the problem is.
With Cephas, I know exactly what the problem is, but I can't to do anything about it, which is just crazy-maker, you know? So I just managed to get a meeting with a member the World Health Organization so I can lobby Okay, Iggy, I love you, and I mean this in the best possible way Uh-oh.
Forget about trying to save the world and focus on trying to save our patient, 'cause no one else is going to.
Help.
Help, please, help.
Okay, deep breaths for me, Steph, okay? - Deep breaths.
- Now I can't move my arms.
Okay, let's get her on 100% non-rebreather and a stat EKG.
Squeeze my hands.
Come on, as hard as you can.
I can't.
Steph! Okay, let's get her on 2 milligrams of Ativan.
2 milligrams of Ativan! Oh, Mommy I need that Ativan! Mommy, please stop.
Ascending paralysis.
Soon she won't be able to breathe.
It could be Neuro-Bechet's Disease.
Diagnostic accuracy below 1%.
A tumor can cause paraneoplastic syndrome.
Diagnostic accuracy less than 1%.
D.
A.
W.
N.
if you do not have any actual ideas, please shut up.
Advise patient be placed in phenobarbital coma until diagnosis can be reached.
Tell me we're not doing that.
If we do not reach diagnosis today We'll have to.
I really thought we could do it.
We knew this would be painful.
Why do you think Brantley sent me? I could chip away at it, but every cut just makes this hospital worse.
Which is why I still think you should pick one big ticket item.
Will it make the hospital worse? Unfortunately, yes.
But will it compromise every single one of your departments? No.
Yeah.
You know, we were the first hospital in the country to cover postnatal care for undocumented mothers.
We were trying to be pioneers.
Now I can make payroll.
Max.
You did the right thing.
Well, it looks like Klinger's missed 11 games this year, and he's been battling this injury all season.
Oh, missed the second free throw.
Miller with the rebound.
Are we winning? - He's got seven assists - Oh, I'm sorry.
Please, please, don't tell my dad.
Ah, the Sabbath.
No electricity.
It's just a really big game.
Your secret is safe with me.
Nets fans have suffered enough.
May I? You must miss many games because of the Sabbath.
Well, I kind of make an exception for the Nets.
We haven't won a championship game in my whole life, but we're doing really well this year.
- Hm.
- Mm-hmm.
So do you break any other Sabbath rules? No way.
Never.
Shirley this is question is a matter of life and death.
I believe you have kept the Sabbath, but have you kept kosher? Vijay, you paged? - Hot dog! - What are we talking about? Shirley secretly ate a street vendor's hot dog.
Shirley got a tapeworm? And passed its eggs unknowingly to her mother with a kiss.
Neurocysticercosis.
Did D.
A.
W.
N.
confirm? I turned D.
A.
W.
N.
off.
Two tablets each, and they will be cleared up.
I I don't understand.
Did I hurt my mom? No, Shirley.
You saved her life.
Hey, there, kiddo.
How you doing? Better.
Better is good.
Very good.
So listen, I have I have one question that was not on my list from earlier.
You feel up to answering it? Why wouldn't the librarian let you take out those books? I don't know.
Well, I think you do know.
I think you know it so well that it is eating you up inside, and it is causing you to be sick.
Why wouldn't the librarian let you take out those books? Because of the color of my skin.
But she's not racist.
Yeah, I don't doubt that for a second.
But, you know, racism is so deeply ingrained in our society that people, myself included, we often don't realize that we're perpetuating it.
So, like when people give me nicknames I don't want 'cause my name is different? Yes, that is a microaggression because of the color of your skin.
What about when adults tell me I speak really good English? It's because of the color of your skin.
Or when people assume I only got into my school 'cause I'm diverse? Yes.
When the teacher tells me to lower my voice, even though I'm not the only one talking? Or she makes me answer all the Latino questions 'cause I'm the only one in the room? Yes.
I just thought I didn't deserve to be there.
I wasn't good enough.
I was a mistake.
No, Cephas, listen to me.
All of this, everything you're talking about has nothing to do with you, and everything to do with the world around you.
You walking around with all of this shame and confusion and stress inside your body, I can see that you don't want to feel this right now.
But I'm telling you, your body is definitely feeling it, and that is what is making you sick.
So How are you gonna fix the world? I'm not.
I can't.
But I can help you process.
Because if we can name it, we can treat it.
You win.
What do you want, Mom? Dinner.
May, how long has Fatima been like this? - All day.
- You should've paged me.
She's listed as Castro's patient.
Fatima, sweetheart, can I help you get back? I'm fine.
Fine, fine, fine.
Okay.
Have you seen Dr.
Castro? Dr.
Castro said my numbers are good.
I'm good.
Better than good.
She said her trial's helping.
Yeah.
Max, I got some bad news.
I'm already there, so just hit me.
Mexico is not the answer to your budget crisis.
You know, we shouldn't be sending our patients 2,000 miles away.
It erodes our hospital.
And American hospitals are eroded enough.
And, Max, the other thing I gotta tell you, it can't wait anymore, all right? Floyd, you're the best.
I gotta go.
Hey, wait! Excuse me.
Todd.
Wait, buddy, hold up.
Hey.
Listen, I found a way to make payroll, save $2 million, and not cut a single program.
How? Add a program.
Todd, there are two ways to meet the budget, right? We were trying to cut costs, but what if we tried to add revenue? Okay, what we need isn't less programs, it's more patients.
I think you've got all the sick people you can handle.
Exactly.
And so does every other hospital.
New Amsterdam has every specialist under the sun.
Right? But other hospitals can't even afford to keep one specialist on staff full time.
America is full of people who have specific medical needs that their local hospitals can't meet, but we can.
So instead of outsourcing our patients, we're gonna outsource our doctors.
Okay, yeah, I'm gonna call it something better, but I have commitments already from Bridgeport Medical in Alabama, Mount Ida Memorial in Arkansas, Townsend Hospital Center in Delaware.
Look, we can fill America's healthcare gaps, we can get fairly compensated, and most importantly, we can we can balance the budget.
What? Am I too late? The budget's already in? I threw it away.
- You what? - Your budget.
Threw it away.
Threw it away? Why? I knew you'd come up with something.
Huh.
Hi.
You look really nice.
- So do you.
- Thanks.
Here you go.
Right.
Yeah.
Um I'm sorry.
I don't think I can do this.
Thank God.
Me, neither.
Really? Yeah, I feel incredibly guilty just being here.
And I know I shouldn't, but I Yeah, no, it just sneaks up on you, right? My husband was a musician.
He took his own life.
Sorry.
I don't talk about that much.
- Yeah, no - Ever.
But the moment I start to feel happiness, a wave of panic just Yeah.
Is that crazy to be triggered by happiness? No.
Sorry I ruined the evening.
No, I mean you you didn't.
You didn't ruin anything.
Um Yeah, this is Max.
Sorry, I thought I'd get your voicemail.
No, that's okay.
Who is this? My name's Nolene George, and I heard there was an opening at New Amsterdam.
I'd love to be considered for the position.
Sorry, what position? Chair of cardiothoracic surgery.
Since Dr.
Reynolds is leaving.
Damn