Transplant (2020) s04e04 Episode Script

1
Strategies for revealing your scars,
- visible and invisible.
- Sometimes
I hurt myself, but we
don't have to talk about it.
I'm on a transplant list.
A heart may come tomorrow or never.
You should both know
you won't be in limbo
for much longer about
the fellowship spot.
I'm deciding by the end of the month.
Every time I think I'Ve built
something, that feeling fades
and I run.
(GENTLE MUSIC)
Okay
Oh, my God! Oh, my God!
Oh! No!
No
- Did you see that?
- Yup.
- Morning.
- Thank you.
(INDISTINCT)
(OPENING THEME)
- Morning, Dr. Hunter.
- Hi, hi.
Um I was just
looking at the schedule.
Nights, weekends are the
least popular shifts, I know.
- You're filling gaps for now.
- No problem. Totally get it.
Dr. Devi, I just, I
I appreciate your faith in
me and I plan to earn it.
Let Dr. Bergeron know
if you have any questions
about shifts or patient assignments.
Sure thing.
Am I only back because
Dr. Olsen strong-armed her?
Because in my parole
meeting, that was the vibe.
I better
Good luck with all that.
- June?
- What's wrong?
Why does something have to be wrong?
We run a department together.
I merely want to discuss it.
Uh-huh. Let me guess,
it's about the rotating
surgery residents that
are cycling through. Oh!
By the way, this is Ryan. He's
first year general surgery.
Hi, Ryan. Why would I
be concerned about Ryan
and his inexperienced ilk
getting in the way of us
doing our jobs just so that you
can feed your benevolent leader?
We are a teaching hospital.
And you were CC'd on a least
a dozen emails about justifying
the budget by training residents.
Nature abhors a vacuum, Ryan.
Look, if you're not going
to engage in the process,
you don't get to be
pissy about the results.
Ah, June's been practicing
her mantras, Ryan.
Perhaps she'll teach them
to you if you ask nicely,
or you could do your actual
job and help save our incoming
patient flattened by a forklift, ETA 10.
- You okay?
- Yeah, why?
- Let's go get set up.
- Alright.
- Hi!
- Hi.
Stupid thing's supposed
to be waterproof.
Did you want to talk about it?
Because it's been a couple of days.
Oh, Devi said end of the month.
That's technically today, right?
- Devi?
- Yeah, about the fellowship.
I thought that's
what you were talking about.
No, I was talking about
Since, you know
How is your brain not
fixated on the fellowship job?
I mean, it is, but did
you want to talk about it?
- About us?
- Yeah.
Well do you?
Unless you want to
wait until today's over.
- No, that's not what I
- Mags.
- I've been texting you.
- Dead phone.
Oh, okay. Well, we
need help in curtains.
- Okay.
- Yeah, we'll just
This is Dominic. He came in unconscious.
Central line's in.
Ryan did the foley cath,
and now he's helping me to debride.
- How long was he crushed for?
- EMS says two hours.
Apparently, a forklift knocked
a palette of bricks onto him,
so it took a while to get him out.
You have an open femur fracture.
BP's still soft, heart rate's erratic.
- Ryan, right here.
- Yup.
And you checked to see that
his urine isn't dark, Ryan?
- He did, I already asked.
- But he has a voice of his own.
- Doesn't he, Ryan?
- Yeah, I checked.
Good, and what's the mainstay of
treatment for a crush syndrome, Ryan?
Aggressive fluid recitation
to reverse metabolic acidosis.
Track progress over the next few hours,
treat rhabdomyolysis,
and prevent renal failure.
He still has a pulse in his lower leg,
so as long as ortho agrees, we
will debride and clean for now.
Okay. Sounds like I'm dismissed.
- What do you think, Ryan?
- Um
(BEEPING)
His BP's dropping.
His urine output is dark.
Ryan, did you check that or not?
After the foley
catheter, remember I told
you to tell me if his
urine was discoloured.
And then I asked you again, you said
you checked it and that it was fine.
- It was. I think that it was.
- Was it or wasn't it?
You said renal failure was a risk, Ryan,
but was that just kneejerk
memorization because
when proteins get released
into the bloodstream
after crush injury,
they damage the kidney.
Which you have allowed to happen.
He's in V-tach, set up the cardiovert.
Push 20mg fentanyl, 2 of midazolam.
- What can I do?
- Out of the way, Ryan.
- Charging.
- (BEEPING)
- Clear.
- Shock advised.
How long have you had
the headaches, Yuri?
A few weeks. Then I
started getting pain here.
And these waves of tired where
I can barely keep my eyes open.
- Any loss of appetite?
- Yeah.
Has your son gotten sick? We're seeing a
stomach bug going through the daycares.
Alexei's not in daycare.
I'm starting my own
contracting business.
Most of the time, he
comes along. He loves it.
When the job is too messy,
the neighbor watches him.
It's just the two of you?
His mother died when he was a baby.
I think there's something
in the water in our building.
Lead maybe.
I told the building manager
that the pipes have corroded.
Even offered to fix them, but
they're too cheap to pay or even test.
Which is illegal, not
that that stops them.
I stopped giving Alexei tap
water but bottle is expensive.
So I boil for me. But if it is lead
Boiling won't help.
The city does have a
program aimed at identifying
and responding to environmental
hazards in older buildings.
You mean low-rent ones.
Well, you could qualify
for extensive testing.
But healthcare is free here, no?
You can just do the tests I need.
Yes, but this program
allows us a wider scope.
It moves you to the front
of the line, not to mention
it outs the landlords
that tend to cut corners.
But I would have to criticize
the country that gave my asylum.
No, it's completely anonymous.
Look, all I want to do is help you and
Alexei through this as fast as possible.
He's stable for now, but in
trouble with kidney failure.
Amp of bicarb, give mannitol
and get his potassium STAT.
No, no. You have to think
like a field surgeon, June.
First priority is to flush.
Right, then react with dialysis.
Okay, I'll intubate.
Should I do something?
You've done enough.
Look, Ryan, we'll debrief later
about what went wrong, okay?
Why wait? Start it with
the abysmal judgment
of whoever matched Ryan to this hospital
bringing us to his
astounding incompetence today.
But since we're debriefing,
when your tiny brain
can't remember if you've
done something or not,
don't lie and say that you haven't.
Unless you want to kill someone.
- Dr. Novak
- I'm sorry, look, I just thought
Another mistake! Because what
you think means nothing in here.
And if you're going
to insist on thinking,
then why don't you think long and hard
about whether this is the
right profession for you?
Dr. Novak, I think you made your point!
Look, you made a mistake
in the heat of the moment.
These things happen, alright?
(HEAVY BREATHING)
He's having a panic attack.
Can someone get him one of
those kidney bases between
- (RETCHING)
- No, no, no!
Did any get inside? Alright, I'm
going to need to irrigate, alright?
Just push as much prophylactic
antibiotics as humanly possible.
Hey, hey Are you okay?
Look, what Novak said,
that was about him, alright?
Just don't make it about you.
Alright. Let's keep irrigating, guys.
This is unacceptable.
I'm reporting both of you for
creating an unsafe work environment.
Two months ago, after it happened,
Claire said it was a sprain.
And now you can't move it at all.
Are you on anything for the pain?
Well, that's the thing. I'm on
something for my blood pressure.
This one. And, um
Water pills.
And you can't take those
with aspirin apparently.
Yeah, with NSAIDs, depending
on what your pressure is at
Oh, I think that's a restaurant receipt.
Um, also, on this.
And also, this for high cholesterol.
But there was some other thing
that interacts with those.
Okay, let me just, um
- You don't have a GP?
- Not for years.
Claire's been helping me manage.
I try not to overburden her,
but I'm a bit of a handful.
150 over 92.
My wife used to keep
track of things, but she
Anyway.
- Donald, I'm really sorry.
- Oh, she's not dead.
She just had enough of me, I guess.
Claire said I could text her
if I needed to be looked at.
I tripped over an
extension cord at work.
Claire said she'd book an X-ray for me.
But when I didn't hear
anything back, I figured,
well, she's not worried, I shouldn't be.
Only it's gotten to the
point where I can't work.
I do plaster, you know,
so I need my wrists.
"Technician's committee, I've
known Arnold for seven years."
- Actually, it's five years.
- Wow, it feels so much longer than that.
Can you please stop
reading over my shoulder?
It's very annoying.
"I can confidently say he
possesses all the qualities
that are essential for
success in a medical field."
- Oh, that's so sweet.
- Hey, I just caught one
of Claire's frequent
flyers. Is she running late?
- Guys?
- We don't know, Mags, okay?
Dr. Leblanc. Can we
talk in my office in 20?
Yes! I mean, yes.
Okay, just let me know when she gets in.
Hey, Dr. Devi.
So I started sharing blind data
with Toronto public
health regarding certain
- environmental hazards.
- In low-income housing
after that patient of yours died
from carbon monoxide exposure?
Well, turns out over the last year,
they've been piloting
an action designated
to help patients before
that kind of thing happens.
Rentsafe. I'm on an email list.
I was wondering if that's something
that we could incorporate to ED?
A man came in this
morning who qualifies.
A suspected lead poisoning. I'd
also like long bone radiography
to check density for chronic exposure.
If we push him forward
and they agree, then
It cuts through a ton of red tape.
You'd need his consent first.
Well, he's with his young son,
so moving faster is great incentive.
- The kid's fine, thankfully.
- Do I need that?
It's nice to see you engaging in this.
I know you went to Lebanon
to do relief work, but
I wasn't sure if it was
personal or professional.
Um
I think it was both.
Marrying your vocation
with your avocation,
good for you, Bashir.
- Let me know how else I can support.
- Thank you.
(P.A. ANNOUNCEMENT)
Hi..
Hi, I'm sorry, the door was open.
I'm not sure if you wanted me to
- Definitely. Sit.
- Okay.
Just give me a minute here.
Thanks for bearing with
me through this process.
Yeah, for sure.
So you're my first meeting,
Mags, because this is
good news. Congratulations.
Congratulations, you mean
Like, "I got the job" congratulations?
You did. In a few months,
when your residency ends,
we'd like you to stay on as
our emergency department fellow.
- (LAUGHING)
- Financial's in here.
All the logistics. I
hope you know, Mags,
that you are the essential fit for what
I'm trying to do in this department.
You're patient-focused,
you lead with empathy.
You put all of yourself
into everything that you do.
And I know your residency
hasn't been exactly linear
and you've been dealt with
some health challenges,
but getting to know
you over this last year,
I have no doubt that you belong here.
Now, obviously, this is a big commitment
and a major decision,
so if you need some time
or you have any doubts or concerns
No, no. No, no doubts. No.
- Okay.
- Yes. Yes, I want it.
- Yes, absolutely.
- Good.
Would it be weird if we hugged?
(LAUGHING)
Thank you.
I just ask that you not tell anyone
until I've had a chance to
let your colleagues know.
- Should be by the end of the day.
- Okay.
(CHUCKLING)
Where are we, June?
I'm using negative
pressure wound therapy.
- I'm just getting the foam ready.
- Is he still hyperkalemic?
And his BP's way too low.
Actually, the only good news
is that I debrided twice so
the wound looks fantastic.
Free from Ryan's vomit, you mean.
I'm wounding it back with insulation
because the last thing
we need is sepsis.
Aside from that, just wait and
see how his kidneys recover.
Which the kid is blaming us for.
Olsen requested an audience.
Entitled little troll. I told
you, residents were a bad idea.
Just lay it around the film.
But my opinion is irrelevant here.
What is up with you? Don't compress!
I know what I'm doing.
Look, I know things
between us have been tricky,
but it seems like there's more
bothering you than me having power.
If you can't handle a friendly
sparring, June, then that's on you.
The way we work in here, edge
of the knife, I need that.
Okay, as weird as that is for me to say.
But not everyone can handle it.
Can you respond at least?
Are you going to play
nice with the Ryan thing?
- I'm cutting the hole.
- Mark.
Don't put your stability on me,
June, I never asked for that.
We're all sucking it up today.
It's a scaphoid fracture.
If you would've done
the X-ray two months ago,
we would have put it in a
cast to avoid this situation.
Then, it's been broken the whole time?
I'm sorry to say so, yes.
When this happens, the
pieces don't properly fuse.
- It's called "non-union".
- You seem happy
- that this is happening to me.
- No. No, no. I'm just
No, I'm glad that
we're on top of it now.
- So now what?
- A surgeon might need
a bone stimulator or maybe even graft
An operation? And then, how
many more weeks off of work?
Donald, I just saw your text.
My wrist has been broken
for two months, Claire.
You were supposed to
call me about that X-ray.
I did.
I bet somewhere in your bag there,
you will find the requisition.
You're right. Odds are it was me.
I didn't mean to accuse you, Claire.
Let's get Doctor Leblanc back to
her regular scheduled programming.
And you and I can talk to a
surgeon about the next steps?
I'll just get changed and call upstairs.
Yeah, I'll write up a few
hydromorphone for his pain.
- He should tolerate them fine.
- Okay, thanks.
Chelation therapy should
counteract the toxicity.
Over the next days of infusion,
it will bind with the lead
in your bloodstream
and form a compound that
can be excreted from
your body through urine.
Then Alexei will stay, too.
He won't be any trouble.
You'll be hooked up to monitors and IVs.
There's no way to run
after an energetic toddler.
And as much as we'd love to,
we just don't have the
staff to look out for him.
Well, excuse me.
- Hey.
- Would you care to fill me in,
- Dr. Hamed?
- That's Yuri Zeilinger.
He came in with symptoms
of lead poisoning.
And yet you sent a bone scan and an MRI,
that seems like an expensive
way to get somewhere
that basic bloods would have taken us.
If you're concerned about resources,
I believe it falls under
the public health budget.
So I heard, but I don't remember
approving any
patient-sharing initiatives.
Dr. Devi did. I asked her to.
I have experience working in refugee
camps in Turkey, Syria, Lebanon.
If we had programs like this available,
we would have saved a lot more lives.
Smart. Not everyone has the
personal experience to leverage.
Makes it harder for us to
say no to that kind of pitch.
These programs are good
in theory, Dr. Hamed.
But I doubt we'll ever see
a dime from public health,
which means that we will
be eating the extra costs.
Are you asking me to pull Yuri?
Bad optics, too late.
We have a wrinkle.
Did he just accuse me
of using my life story to get ahead?
He did. I'm not saying
it isn't offensive.
But he's not wrong about
public funding being unreliable.
If he okays programs like this one,
he risks losing money we need elsewhere.
And if he doesn't, then he
looks like an uncaring racist.
Dr. Devi made it seem like I
was on the exact right page,
but Olsen thinks the
same idea makes me look
like I have no clue
how things work here.
The gulf between those
two is above our paygrade.
You said we had a wrinkle?
Yuri won't let me place Alexei with
a family while he's in treatment.
I get it, I'm a stranger.
But the kid can't stay here.
I don't blame him. I wouldn't
trust us either in his shoes.
But you do now, right?
You see yourself in Yuri?
Help him get to where you are.
Liz says exam two's up.
- Are you sure about that, Arnold?
- Yep!
Okay.
Hi, I'm Theo Hunter.
Theo Hunter. The Theo Hunter. Okay.
You're Jonathan, right?
Liz's live-in ex. This is Ash.
Hi. You know, if you'd
like, I can go get Liz.
She never sees us herself when we come.
"Protocol", she says.
Also, we've already been waiting an hour
and Ash is straining for air.
You're asthmatic, aren't you, Ash?
Yeah. It's been pretty bad today.
Ash texted from school saying
they could barely breathe.
Alright, let's get a big
breath in and out, okay?
(WHEEZING)
Any triggers? Exercise, allergens?
- What meds are you on?
- Big Bad Purple every morning.
- Little Boy Blue for attacks.
- Salmeterol and salbutamol.
Oh. And Little Boy Blue
hasn't done anything
- to help with the wheezing today?
- They lost it.
And are aware that since
insurance only covers so many,
the next one's coming
out of their allowance.
Okay.
We'll be able to
get your breathing sorted,
but I would like to do a
chest X-ray just to be sure.
X-ray's not necessary.
Nebulizer's normally enough.
Ash, you okay?
John, are you sure this was DEFCON
enough to take them out of school?
You could've answered one of my
30 calls and decided yourself.
Your boyfriend thinks
it's serious enough
if he wants me getting an X-ray.
Okay, well, I'm going to
go run down that nebulizer
and I'll let you guys talk.
Be right back.
Well, first meeting could
have gone worse, right?
A week ago, you wouldn't even
let me in the car for a pick-up.
Now you're assigning them to
me without even a heads-up?
Okay, fine, But I can't treat them,
and you're a person I trust.
And yet you're overruling an X-ray.
Look, Ash does this.
You know, when they came to us a
few years ago, they were always sick.
We settled in and it got better.
But now that John and I
Trust me, all Ash needs
is to hear they're fine.
Alright, nebulizer it is, boss.
Thank you.
Over there is where we're
going to fix you Dad.
- Dr. Hamed.
- Hi.
- Who's this?
- This is Alexei.
His father had to make a call to
arrange child care so we are on a tour.
Hi, Alexei. I'm Neeta.
I got your note about Olsen.
Let me worry about him.
But when you have a moment,
- I do want to speak in my office.
- Okay. Great.
(INDISTINCT CHATTER)
Hey, Donald, has the
surgeon not been in?
Not since you left before.
I have been through every paper
and I can't find that
X-ray requisition.
And no missed calls or
texts from Claire either.
I don't want to make things
worse and I know I'm scattered.
But I don't think this was my fault.
And Claire tried to say it was.
Okay, well, um
Maybe there was a system glitch
or some kind of human error.
- Let me just go check
- And maybe give me something
for the pain because I'm
still waiting for that, too.
Thanks for meeting.
Anything to assuage hurt feelings.
Poor guy even know where he is?
No, he came in unconscious
and we had to intubate.
He's a family member who's driving down,
but still about a day away.
I heard about the resident's complaint.
As this came to me through surgical
channels, Dr. Devi, I'm on it.
Maybe so, but the incident
happened in my department,
- so my purview.
- Incident?
- Seriously?
- The young man feels
that a gentler language
could have been used.
He lied. About
vital information, twice.
You're going to back
me up on this, June?
Uh He did. Yes.
Ryan claims that an environment
of fear incited his mistake.
That's crap. (SCOFFS)
Patient's life was in danger.
He's going to have to face way
more intense situations than that.
And if he crumbles, what good is he?
Even so, that justification
has fallen out of favour, Mark.
Okay, let's coddle them.
Because that'll work out so well
- for people who've been crushed by forklifts.
- (CHUCKLING)
What is that even supposed to mean?
That it is used to be permissible to
berate residents into panic attacks?
It was practically a
sport for my attendees.
Radical thought, but it might
be nice for new residents
to come up without being
repeatedly traumatized.
It's hard to disagree with that.
Then again, Mark makes a
fair point about coddling.
Like saying yes to ill-advised
public health initiatives
to keep from offending a resident.
That was about encouraging
a valid, holistic interest.
Hamed's enthusiasm is not going
to pay for unnecessary diagnostics.
Which, as you'll recall, is my purview.
(BEEPING)
He needs increased pressor doses.
It could be worsening
sepsis, but it's hard to tell.
This mess is not a
good look for Trauma OR.
So whatever your personal
feelings, I need the two of you
to make sure that Ryan feels supported
- and the patient is stabilized.
- In that order?
In that case, you can have the future.
June, say whatever you
want to Ryan, I am out.
Godspeed, Dr. Curtis.
June, you do not need to
hold it back for Novak.
- I know he's great in Trauma OR.
- He is Trauma OR.
Someone's got to do it. Anyways, I
That was spirited.
You should know I have
chosen Magalie Leblanc
for the emerg fellowship.
Why don't you walk me
through your thinking?
I've already told her.
It was my decision so I made it.
Once I tell the others, we can announce.
Sounds good.
Yuri, it's only for two
nights. You said you'd try.
I did. Neighbor who watches him
when I can't take him on jobs
has her brother this week.
And he's been in and out
of jail. Not an option.
- That's only one person.
- There's nobody else.
Yes, there is. Lucy would not put him
- with someone who isn't safe.
- If I can't keep him with me,
then there's nothing left to say.
- But you need treatment!
- You keep saying that,
but beyond the stomach
pain and headaches,
- which I can handle, I'm fine.
- No, you're not.
Your blood pressure is through the roof.
You could have a stroke, then
what would happen to Alexei, hmm?
When I first got here, I
would have said no, too.
I would have taken it all on myself
and it would have been a mistake.
But I've made so many mistakes.
Then take him. If you watch Alexei,
I'll know he's safe and
stay here for treatment.
I would, Yuri. I would,
but they don't allow that.
I could lose my job, I'm sorry.
Then let us go.
We're survivors him
and me, we will manage.
Mags, um
Did you ask the social worker
to help keep Donald organized?
Because I was on that.
Yeah, just 'cause you just
started full time again and I
What? So you can go
above and beyond with
every patient, but I'm in over my head?
No, that's not what I
You didn't order the X-ray.
And there's no record of a
requisition or any follow-up.
Donald's in pain.
I can fit him in tonight. He's
gonna need ORIF and a bone graft.
How long until he goes back to work?
Eight weeks and it'll
be a while tonight,
so stay on top of his pain
management. He's in discomfort.
Oh, and Dr. Leblanc,
I understand that
congratulations are in order.
The emergency medicine fellowship.
Yeah, I wasn't aware that
that was out. Yeah, thank you.
Mags, that's amazing. Way to go.
Now I have to suck up
to you more intensely?
- Yeah, you better.
- Congrats.
Happy for you, Mags.
That's a nice feeling being
at the beginning of something.
Thank you. I do think that
you and I have that in common.
The way that we prioritize this place.
And I'm living proof that
you can both work here
and manage your health issues.
But I'm not doing it alone.
- I'm fine.
- Claire, I Claire!
Okay, I made one mistake.
I will apologize to Donald,
but I will not advertise my
health problem for sympathy
just because it worked for you.
So you do your job and
let me do mine, please.
Hey, first day back, how'd it go?
Awkward. Yours, too, I hear.
- Buy you a drink later?
- Sure, only why?
Just, I know how much
you wanted that job.
You know, great for Mags,
but still, sorry, man.
Ah, wait, you knew already, right?
Yeah, I'll let you know
later about that drink, okay?
(PHONE CHIMING)
(PHONE CHIMING)
Ash.
I told Jonathan that you two could go
when the nebulizer ran through.
- Somebody should've came and got you.
- Um John had a work thing.
Liz is driving me
home when she finishes.
Is there something you
want to say to me, Ash?
Are you the reason
she and John split up?
It's more complicated than that.
And something you should
probably talk to her about.
Liz is the only mom I have.
So If you hurt her,
you're going to regret it.
Fair enough.
Feel better?
Ash? Hey, Ash, whoa.
Alright, c'mon.
Alright. Okay.
Hey, Ash. Ash!
You're having a reaction to one
of the drugs in the nebulizer.
Ash! Hey! Hey! What'd you call it?
"Little Boy Blue?" You had a
reaction to Little Boy Blue before?
- I need to know, Ash.
- I lied.
I ran out of it because
I take extra sometimes.
Did you do that today?
Hey, extra meaning what?
More than two or four puffs?
More like 40.
- I like the way it feels.
- Combined with the nebulizer,
that is way too much salbutamol.
It's making your heart
work way too hard, okay?
Can somebody get me a wheelchair?
Are you hungry, Alexei?
- You want some apples?
- Apples.
He's so cute.
Who did you say he belongs to?
Just a friend in a bind.
Yeah, you don't have any friends
with kids who aren't Theo.
Well, you haven't met all of my friends.
Because this was actually a patient's?
Okay, look, his dad needed treatment,
so I picked Alexei up and now we're
babysitting for two nights, hmm?
Bashir, are you even allowed to do that?
Why don't you and Alexei
sit on the new couch?
Yeah, right. Then him or
probably me spills food
and you freak out
because you're not able
to return it if you don't get that job.
(SIGHING)
I didn't.
I found out today.
- So what does that mean?
- Nothing.
There's almost six months
left of my residency,
so I'm still employed.
But you can't stay where you are after.
You like it there.
Are you okay?
- Are we okay?
- Amira, we're fine.
Starting over is nothing new for us.
Well, I'm staying on
the floor just in case.
Just sit on the couch.
- Rhoda prep adenosine.
- Veins are flat.
Find me the IO, I'll get
access to the left tibia.
No, hold on. I found an entry in
the hand, I can make this work.
- Rhoda, we don't have time.
- Can you just trust me, please?
- What happened?
- SVT from an overdose of salbutamol.
How is that possible? Did
you dose the nebulizer wrong?
No. Ash told me, and
I've seen this before,
they get a body stone if they
hit the inhaler enough times.
- Why would they do that?
- Adenosine's prepped.
- You want to stop their heart?
- Line's in, ready to push.
Liz, we need to get the heart rate
under control and we
have to do it now. Okay?
Okay.
Pushing.
(BEEPING)
C'mon, c'mon, c'mon.
Ash
Nice stick.
Try to have faith next time, son.
You okay?
It's been hard since my promotion.
Being everything to
everyone at home, too.
Should've trusted your instincts.
- Don't worry about it.
- Ash likes you.
Which is kind of a big
deal. Very picky kid.
Good to know.
Especially after the talk
I got about not hurting you.
You should come to the house.
For dinner with all of us this weekend.
"In addition, Arnold
has a natural curiosity
about the human body and its functions,
and his passion for
learning is evident."
Does natural curiosity about the
human body sound really sexual?
Yeah, try "anatomy" instead.
We're off the clock.
Boss, you told Arnold
you would write him
a reference letter for
med school weeks ago.
- It's due tomorrow.
- It is?
Arnold, why didn't you say anything?
We were just writing
a draft and I figured
maybe you could read it and sign off?
You haven't been easy to talk to.
You're right, sorry. Um, yeah, send it.
- I'll get to it before I go.
- Thanks.
(GENTLE MUSIC)
Bleeding gums after
lower-body crush injury.
Really want the poor
guy to pull through.
And if he doesn't, you're under
scrutiny because of the resident.
All I needed was for Novak to just
He couldn't just admit that the
kid didn't need to be demeaned.
Yeah, did Ryan really lie
about checking his urine?
Because no doctor I've ever
worked for would take that lightly.
Okay, look, I remember
when I was in first year,
we hid a file behind a surgical desk.
Days without humiliation.
The number always hovered
around two, now I guess
- I'm back down to zero.
- Same.
I think the bar's close
enough for us to walk.
- No, you don't have to buy me a drink.
- Yeah, I do.
You just beat out a
tough crew for that job.
Yeah, including my ex-boyfriend
who's probably now spiralling into a pit
of existential despair about
he's eternally unemployable
and will never be
able to give his sister
the life that she deserves.
I think we might be on the wrong block.
Yeah, I'm not supposed
to be drinking anyway.
Why can't you just let us celebrate?
Because you feel guilty about Bash?
Claire told me I only
got the job because
Devi pities me for my health issues.
What? No, Mags, you got the
job because you deserve it.
You should've seen her today. Claire.
First, she was late, then
she missed a patient's X-ray.
And now he needs surgical intervention.
One minute she's her sweet old self,
and then I offered to help
and she just blew off on me.
Yeah, it's like with Bash.
You know the myth about
the five stages being linear
when in reality you
either experience them
all at the same time or
just completely out of order?
- What, I can't evolve?
- Okay.
Except I ordered her patient pain meds
and I don't think they ever got to him.
You think Claire took his pain meds?
I guess if she has something to hide,
that would explain her pushing you away.
What are you going to do? Novak.
I need him, so what I always do.
Just suck it up and
apologize on his behalf.
Tomorrow's 50 days of no cutting, too.
So that means we're not
only celebrating you
June! Ugh. How you feeling?
- Proud.
- Yeah.
I think I'm scared.
Like, what's going to
happen without the cutting?
My ability to handle things,
my endless capacity for
pain and suffering, my
Maybe you don't deserve
endless pain and suffering.
And I don't think that you
won't be able to handle things.
You're right about evolving.
Wait, did you say your
patient's gums were bleeding?
- Yeah, why?
- Because damaged tissue
after crush injury can
pump cellular debris
into the bloodstream and send his
clotting system into overdrive.
- DIC.
- If it's consuming
clotting factors and platelets
faster than they can be replaced
Go, if you need to take care of it.
Thanks! Congratulations, seriously.
(PHONE RINGING)
Hello?
Forgive me if I don't
apologize for waking you.
I drove out to Branson last night
only to scare the hell
out of Yuri's neighbor
who had no idea why I
was checking on a child
who wasn't staying with her.
And then, I drove all the way
back for Yuri to tell
me that you took Alexei.
- Yeah, only for a night or two.
- Except it won't be.
Yuri crashed, started
seizing from hypocalcaemia.
But we can regulate that.
He might just need slower dosage.
They moved him into ICU.
They're saying he'll need to
stay in-patient two weeks now.
Okay, well then, let me keep him.
You said to reach Yuri,
this is how I'm doing it.
I told you to get him to trust us.
But all you've done
is prove that he can't.
And now I have to place
his son with strangers
without the father's buy-in.
You're right, you're right.
I'll I'll come in. I'm sorry.
It's not me you should
be apologizing to.
(SIRENS WAILING)
Mr. Cassavetes.
Suffered an industrial accident
and crush injury yesterday.
He has fought through kidney failure
and cascading complications.
- How are you feeling, Dom?
- Lucky to be alive, Dr. Curtis.
Thank you.
Ryan, can you please
walk us through the clotting disorder
that this patient was treated for?
I hadn't had a chance
to review the chart.
Oh.
Let's move on to patient room C.
Ryan, can you walk with me this way?
Yeah.
Look, the way you were treated
the other day was unacceptable.
And I apologize.
Shouldn't Dr. Novak
be here for this, too?
You had the right to make a complaint
- and this is us addressing it.
- Okay.
I thought there was going to
be more of a formal meeting.
I'm a little blindsided.
Okay, you feel blindsided
because I'm apologizing to you?
Or because I called you
out for being unprepared
- for your rounds, Ryan?
- I asked my supervising doctor
if I could be excused from that
patient because of how it affected me.
That's not exactly how this
works, Ryan. You don't get
to pick and choose so that you
can hide from your mistakes.
It was your mistake, not mine.
And now you're giving me a fake
apology and trying to retraumatize me.
You need to shut up, you
entitled little troll.
You know, Ryan, if you knew
anything about real trauma,
you would get it together, face
your mess and do the damn work.
Claire?
I know doctors aren't
supposed to be in here,
but I just wanted to see
if Donald had his surgery.
Yeah, he came through fine.
And he told me about
our social worker's plan to get
his health care under control.
Yeah, that was the right move, Mags.
How long do you think that'll stick?
Knowing Donald, I have a feeling
he'll still need help from time to time.
Yeah, we all do.
Hydromorphone.
- Mags, what is this?
- If you have pain, Claire,
that pain should be managed.
We both know the harm
prevention protocols
when it comes to opioid
use tend to shut out people
who need them and know how
to use them responsibly.
Based on my actions lately,
are you sure that's the
word you want to use?
Yeah.
I know you, Claire.
There is physical pain, yeah. But
Every patient I see I think, "Is
this the person who stabbed me?"
I never saw their
face and I am so angry!
(SNIFFLING)
And I hear myself being
terrible to people.
It's just, I can't stop it, I
How do I know which pain I'm medicating?
We're going to make an accountability
plan for the painkillers.
So that they stay under control.
And find you a counselor.
You're not alone with this.
Claire
Thank you.
(SIGHING)
Sorry you found out about
the job the way you did.
That was unprofessional.
- I tried to find you, but
- Yeah, I had to
Rush off with a patient's
child and prove Olsen's point
about using your background
and public health to work us.
I didn't mean to make things
more complicated for you.
Well, you did. And while you're
a skilled doctor in so many ways,
this is an example of why
you didn't get the fellowship.
This instinct to leap blindly.
You just can't seem to shake it.
What happens now?
You try not to abscond
with any more children,
and hopefully, leave here
with a glowing recommendation.
They live close.
They promised to bring Alexei
by to see me every day I'm here.
I want to believe them, but
I'm so sorry about all of this, Yuri.
But if Lucy trusts this
family then we can, too.
I know you may not be
able to see it now, but
eventually, all of
this will be behind you.
You should've seen Ryan's face.
He's just so smug.
Feel myself simmering.
And then you just lost it on him.
Yeah, but it did help me
get to the end of day 50.
(CHUCKLING)
Did you want white or red?
Um, actually, before you open that
This dinner is going to have
her ex-husband and her two kids.
- June
- (DOOR CLOSING)
It's hard not to feel like
I'm being collected, you know?
- Yeah, sounds complicated.
- Hi.
- Hey!
- Congrats.
No, you didn't have to do that.
Yeah, he did.
Guys, it's not ornamental.
You want to maybe
No, yeah, I got it.
- (PHONE VIBRATING)
- Is that you?
Nope.
Oh, that's my phone.
My screen's garbled, but
- Hello?
- Hello?
- Magalie, is that you?
- Yes.
Mags, this is Connie
from your transplant team.
- I've been trying to reach you.
- Yeah, I'm sorry.
My phone died. Is everything alright?
There's a heart waiting
and it's a perfect match.
If you decide to take it, we need
you at the hospital now basically.
Mags? I need you to confirm.
Are you accepting this heart?
- (BOTTLE POPPING)
- (LAUGHING)
(INDISTINCT CHATTER)
(♪♪)