Original subtitles

- Night, Ned.

- Night, James. Keep an eye on bed three for me.

- Will do.

Hey.

Hey, Bart. - What's up, James?

- Is there an order in here for bed six?

Dr. Groff said it might land between shifts.

- There you go. - You the man.

Thanks. - No problem.

- I'll be a second, all right? - Okay.

- Thanks, man. - Yeah, no problem.

See you, James. - All right.

Looks like you're breathing okay on your own.

How you feeling?

- Fine.

- I found that poem that you remember.

You sure it's what you wanted?

- I'm sure.

- Okay.

Remember seeing erotic stuff they had there.

Okay.

Someone leans near

and sees the salt your eyes have shed.

You wait-

- Lord, please.

- Longing to hear.

- No.

No. Please.

- Code Blue in 305.

Code Blue in 305.

- Please!

You're killing me! - Code Blue in 305.

- Sorry, just finished up some dictations.

It's good to see you standing up.

It's been a few weeks.

- Two months.

- We've missed you on the floor.

That's a lot of energy today.

- Haven't run yet.

I've thought about it

and I need this.

- You have barely started counseling.

You're a brilliant resident, James.

You made a mistake.

Greenville's a different world.

They just don't have the resources we have here,

or the cases.

We're more...

Well, you don't strike me as a country mouse.

I think you just need time.

- I do.

I need this.

I don't know what'll happen if I can't move on.

If not here, then Greenville, anywhere.

What would you tell me if I was one of your patients?

"Get back on your feet, buddy.

Soon enough, you'll be as good as new."

- Patient floor is upstairs

and my office is downstairs.

- Huh.

- So very happy to have you here.

Sure, I know it's uncommon

for people to start their second year here,

but we're such a flexible program, you know?

Take all sorts and make fine, fine doctors out of them.

It's a strength, you know? The ability to make an impact.

- Yes, sir.

- I was very impressed with the letter

I received from Dr. Groff.

- He should've explained everything.

- Oh, mm, he did, he did.

Sounds like you're looking to make a fresh start.

You know, more of a rural inpatient experience.

I think you'll find Greenville a bit more than you expect.

Mm.

It has a real ability to make an impact out here.

I said that already.

- Yes, sir.

- All right, honey. Come on, right through here.

Now, my husband and I are upstairs if you need anything.

This was my son's room.

He used to complain, you know,

about us renting it out, but I liked to say,

"I didn't have to keep all your stuff in here, at all."

Made for a strange office, these trophies.

- He visit often?

- He's been dead a few years.

He was struggling with depression for a long time.

Now, the water pressure's better with the heater on.

Don't ask me why, but yeah. And no pets.

- CPR.

Let's say it together.

Patient pulses, start compressions.

What are we thinking about next? Can we shock this person?

Remember, occasional gasping does not equate to breathing.

- Provider feels the patient is becoming unstable

for any reason, oxygen saturation dropping,

tachycardia, bradycardia, you name it,

they can call a rapid response.

Obviously, if you're imminently worried

about respiratory or cardiac failure, then call the code.

Our codes are resident-run here,

but you'll have a ton of support from nursing as well...

- So the thing to remember, if you change in here,

you're right next to the OR, so you're gonna get a lot of,

"Oh, I thought this was Anesthesia."

Bullshit, obviously. Surgeons are assholes.

- Thanks. - I heard they had trouble

with your patient down the hall last week.

- Oh, god, it was not a good situation.

- Restraints? - Yeah, from day one.

All right, here. Put your username, password.

- Was the medical team helpful?

- What do you think?

Honestly, how hard is it just to prescribe-

- Here you go. - All right.

Welcome to Greenville, Doctor.

Hey, Marcus,

does that kid of yours still bake?

- Hey, thanks. I'm Carol.

- Hey. James.

- Nice to meet you. Guess we're housemates.

I'm an intern at Greenville.

Ooh.

I'm sorry. I don't know if anybody told you.

But if you need anything...

Man. Is there any beer in here?

You know, it's a dry county.

Had to carry my stuff.

Should've worn a scarf.

- Shit, I haven't seen this guy since middle school.

- What are you doing here?

- My dad and I came out here after the divorce.

Holy shit, man.

It's good to see you. - Can we go in?

Or you're gonna stay out here talking all night?

- Heard you've been having a tough time.

- I'm fine.

- Yeah.

No, no.

Yeah. Okay.

Oh, yeah, what did they say?

And what did they say?

No, I can hold, yeah.

No, I'm not doing anything.

- Blood pressure medication has shown

to have mortality benefits.

- So ACEs and ARBs.

- Mm, James, do you want to help them with the class

and the adverse effects?

- It's a potassium-sparing diuretic.

Well, it's used as a diuretic,

but it has a mortality benefit

and there's gynecomastia. - Gives you tits.

Just like my old man.

- Excuse me, hi. - Yeah?

- Can you help me understand what he meant by "aggressive"?

- Um, yeah.

He was referring to your daughter's fluid status,

so, basically, how much water we either need to give her

or have her pee out. - We're rounding.

Let's keep rounding.

- Uh.

- Basically, our kidney numbers show us

that she's holding on to too much water.

It's impacting how well her heart can pump,

so we're gonna try harder to get that water off today.

Does that make sense?

- Thanks. Yeah, cool.

It does. Thank you.

- We don't try harder, we'll try something else.

- Huh?

- We're already trying our hardest,

so instead of saying "we'll try harder,"

"we'll do our best next time."

- We'll try something else. - Got it.

- James. We talked about Mr. Jones's metastatic spread.

Would you feel comfortable breaking the news?

- Yeah.

- This is your patient. This is your conversation to lead.

I'll be here if need be, but I think you have it.

- Okay.

- The kindest thing to do is to be direct and humane.

- Hi.

- Hi there.

- Hi there, sir. I'm James.

Dr. Hayman.

We got the pathology results back this morning and

you do have lung cancer that's Stage IV.

It's spread to your lymph nodes.

The genetic panel shows that,

well, it's a little more aggressive,

so life expectancy is three to six months

rather than a year.

- I have cancer?

- Yes, as I said,

lymph node positive for adenocarcinoma of the lung.

That's Stage IV.

- Am I gonna die?

- It's, uh, it's a little more aggressive

than what the genetic panel shows us, so yes.

I mean, yes, life expectancy,

like I said, is three to six months.

- Three months?

- Rather than years.

- Three months? Oh, god.

Oh, god.

Oh, god.

Oh, god. Oh, god.

Oh, god.

Oh, god.

- I could present treatment options,

but an oncologist would better-

- Who the fuck is this guy?!

Is there someone else I can talk to?!

- Treatment options I could get into,

but, as I said, an oncologist would better elucidate-

- Fuck is wrong with you?!

Is this your job?!

- You're new.

But, I mean, I know you're not new,

but you've been away from it for a while.

And people forget.

We're learning every day, right?

So much of rural medicine is about the patient,

the relationship with the patient.

But if you lose that relationship, you've lost everything.

This is how I talk to my patients.

I'm at their level,

unless they're standing up.

A lot of the people around here,

it's hard enough to get them to go to

the doctor in the first place.

Folks just don't go.

They show up here with the cancer the size of a watermelon

and they wonder how it got so bad.

- I can be more personable.

- Good.

- Also for Mr. Jones,

I can maybe hold off on the amitriptyline.

- In this program, this, the patient,

this is what's important to us.

Hmm?

I know you get that,

and I know that it'll get easier for you.

I promise I ask all residents to attend.

- Am I in trouble?

- You see Greenville as some sort of opportunity to advance.

It's an opportunity to learn.

That starts here.

- Thanks.

- Vocal technique is a physical-based acting method

that, in this context,

is designed to improve your communication skills.

At its core, this practice facilitates finding ground

and then finding truth.

Your patient can tell when you're actually listening.

They know when you're offering something

of yourselves to them in those five minutes

they get to spend with the doc.

By being honest with them,

you're asking them to do the same.

It's the stuff of a robust therapeutic relationship.

I want to be clear,

I'm not going to be asking you

to plumb the depths of your childhood.

- How's the meal plan going?

Yeah, well, who doesn't like milkshakes?

Dad around?

He isn't here? I'm here.

- Hey.

- Can you hear me?

- I can hear you.

How's the garden?

- It's beautiful.

The weather's been perfect.

I think I'm gonna leave the sunflowers out

till the last possible moment.

How's the new program?

- Well, it's not how I imagine ending my residency,

but still think I can make some out of it, you know?

- Don't get crazy.

- That's not very nice.

- But you know what I mean, baby.

- I know.

I'm fine. - You're not there

to run a marathon.

It's not about making your best time, honey.

You're there to finish.

And then you can go wherever you want.

Maybe start a family.

Definitely move into a house of your own.

- I'm in the house now, Mom.

- Think I can't hear

your roommate talking to himself?

Not a doctor yet.

- He's an intern.

He goes through a stack of "New England Journal"

back issues every day.

Apparently, his family gets a new disease every week.

- Shouldn't you go to sleep?

- Yeah, night starts soon.

Yeah, I should probably get to it.

Goodnight, Mom.

- Did you get your cross fixed, baby?

- Yeah, yeah. I'm wearing it right now.

Love you.

- I love you, baby.

- Goodnight.

Yeah.

Yeah, we're turning in over here.

- So what is the mechanism

of action for cefepime?

- Bacteriostatic? - Ooh, strong and wrong.

Anyone?

Please tell me somebody knows the answer to this,

or we leave this poor woman to die.

- This is Helen Adso, 19-year-old female.

Has history of severe asthma.

Admitted last night with asthma exacerbation.

- I know her better than I'd like to.

- You talking about me out there?

- Evening, Karen.

- Hey, Emil.

- Uh, Miss Adso presented to the emergency room

in respiratory failure due to an asthma attack,

thought to be triggered by strong smells.

She was intubated last night.

Um, is this blood gas figure correct?

- I expect so. Mac?

- Uh, yeah, that's right.

I was on call when she came in.

- I don't understand why she was intubated

when her blood figure was almost normal.

- She was in respiratory distress.

Dr. Owens was worried that she would crash.

She went ahead and intubated her.

What do we do in cases of severe asthma exacerbation, Kayla,

in addition to intubating the patient if necessary?

- Respiratory mechanics, normal.

The ventilator pressure curve shows

no obstruction this morning either.

- That's a reversed obstruction.

It means she's doing better.

- Get that much better overnight?

- Are we really reviewing this now?

- I'm still here.

- I'm sorry.

- James, your patient.

I warn you, though, he's a bit of a gunner.

- Dr. Harrison tells me all your nicknames.

I think a gunner is a good thing? It means you're vicious.

- It's not always a very nice word, I don't think.

- Well- - Well, we're gonna

get you better.

- Oh, really? You're gonna do that?

You promise?

- Yes.

- Awesome.

- Well, let's move along.

At this rate, we'll be rounding till dinner.

Hear they got fishcakes.

- I'm Karen.

- I'm James Hayman. You can call me James.

I'm sure I'll be seeing you both around.

- Well, we hope not.

- Cirrhotic presenting gastrointestinal bleed.

COPD.

Kidney disease.

Oh, um.

Hmm.

Florid heart...

- I had a page last night.

17-year-old overdosed on acetaminophen.

- Huh.

- His boyfriend broke up with him.

Psych told me they even made up.

I don't know if anybody's told him his liver's dead.

Disaster.

- All right.

- I don't know if I'm even cut out for this, honestly.

You had a hard time, right, at your last program?

That's why you came to Greenville, right?

Somebody in housing said you had like

a breakdown or something.

Just hoping it gets easier is all.

But you're pretty chill compared

to the other residents, so...

- Thanks.

- I'm glad you're here

because I've been waiting, I've been asking for you.

- Ms. Geraldine, I'm here for you.

- Patient's upset. Wants to talk to an MD.

- Thanks, Diane.

Mr. Rogers, how do you feel?

- With my hands. I'm in pain.

- Scale of one to 10?

- 11.

- Hey, you said we could talk about

- why we're giving fluids to Mr. - Jones on top of.

Do you mind just going over that with me

before rounds tomorrow? - Later, okay?

Dr. Hayman?

I need you to order for cefepime, bed 16.

- I put it in.

- You didn't. - I did.

- I think my wife was trying to kill me.

She's putting rat poison in the biscuits!

- Wow, okay. What are your symptoms?

- I'm so sorry, ma'am.

Dr. Hayman, you didn't book them.

I need you to put it in again. - Can I have five minutes?

- Now.

- Move!

Helen Adso, 19-year-old with a history of asthma,

admitted in respiratory distress.

Intubated for presumed severe asthma exacerbation.

There's some evidence for asthma.

Been diagnosed with it for 10 years,

but nothing like this until recently.

Two admissions in the last month,

five over the last six months, and six in the last year.

We need to figure out what the patient needs,

not what we think she needs.

Can asthma just run off like this?

- Hey, your alarm went off like an hour ago.

I didn't want to wake you.

Don't know if you're the type of person

that sleeps through the first one

and gets up on the second one. - I don't have a second one.

- I don't know if you watch sports at all,

but I've been checking out the Olympic trials.

And I had a really long on call yesterday,

so I was watching all this weird shit.

And the History Channel had this whole program

all devoted to weird Olympic stuff.

And the weirdest one, they decided the weirdest one...

Number one in the lineup, right?

This was, I don't know,

this was the very end of the program, right?

This is what you're waiting for.

I like watching sports, but I've never been an athlete.

The weirdest sport they've decided was pole climbing.

Can you believe that?

- No, I can't.

How do you even compete?

Hey, you're gonna break

a button there.

- Was that six or 12? - I don't know.

- False alarm, false alarm.

Everything's under control.

- You okay, buddy?

- I'm fine.

Bed 35, she's gone?

- Yeah, the night team discharged her

right after- - She's my patient.

- Yeah, I know. I paged you, you didn't answer.

- Let me see your chart.

- You can look that up all by yourself.

- I'm having trouble logging into the EMR.

- Last time I log you in.

- Thank you.

There's something off.

This is her sixth admission this year.

- Are you eating?

- I had something at home.

- Look, I know her lung doctor. She's a good doctor.

She goes to see a family in India a few times a year.

And when she does, we cover for her.

She has asthma.

There is some disparity in what the testing show

and how severe it presented,

but she's not a textbook, James.

What are you doing?

This isn't hospital medicine, it's primary care medicine.

Follow up at the clinic.

Are you a lung specialist?

- No, sir, but I've always been told when you hear hooves-

- "Think horse, not zebra." I've heard it too.

Getting a page. You should be getting the same one.

Come on. Sounds like a horse to me.

- I paged you. Four times.

- Sorry.

- I need Mr. Henderson's Seroquel order.

- Hey, we got a 48-year-old male.

History of cirrhosis and varices.

He started coughing up blood five minutes ago.

We lost the pulse.

We've been doing compressions for about two minutes.

Come on, we need an MD here.

- Please! - I don't think it's a given.

- James, that's a little deep.

- Whose patient is this? - I was about to.

- James- - Well, we hope not.

- James? - James?

- James, step out!

And for fuck's sake, clean yourself up.

- Three, four, five, six, seven, eight, nine, 10.

- What do we got, Nan?

- Hey.

You got a little blood.

James.

You okay?

- James?

- What happened to you?

- Thought you were getting cleaned up?

- I was passing by, saw Miss Adso,

and I thought I'd see how she's doing.

- She can probably tell you better than me.

How you feeling, Helen?

- Oh, just swell.

- Swell, we haven't been able to get

any fresh batteries in here

and the TV's stuck on Turner Classic Movies.

- So what's new?

- Well, she's been on a severe asthma regimen for years now.

Mom tells me that they're really good

about the inhalers, every day.

And they even had her on oral steroids at the college.

- Yeah, she's done all of them.

She's done the , the prednisone, the nebulizer.

She's maintained them even through college. It's been hard.

- Huh. That's still not keeping up with it?

- No, obviously.

- Well, she's stronger than you think.

- Mrs. Adso, I'm not saying Helen doesn't have asthma,

I just don't think asthma alone is causing these episodes.

It just doesn't quite add up.

- Is that right?

- Dr. Hayman is exactly right.

That's why we're thinking that Helen might have CF,

what with the bronchiectasis from her CT.

- Cystic fibrosis at her age?

I mean, you don't just get it.

Why don't we do some PFTs-

- PFTs? She's had two dozen-

- Before we go and do something rash.

If they come back normal and her lungs are healthy,

then we know we're not looking at something like CF.

We need to trust the story Helen's telling us,

right here, not the one we're telling ourselves.

We're gonna see how healthy those lungs are.

- Well, she's having a lung transplant.

- Excuse me?

- Hold on, James! - And where'd that

pick lie come from? - Her mom insisted

that she would cry every time that we drew blood.

Oh, James!

Holy shit.

Hey, James, wait up.

I wouldn't walk on that if I were you.

- I'm fine.

Fine.

- We're really excited

about the new long-lasting-

- The train's left the station, James.

- When her lung specialist is on vacation,

it's not the time to jump ahead on the transplant list.

- Nobody plans these things.

- Let's just get the PFTs.

Her last dozen, range of normal.

Normal. There's something weird going on.

- Excuse me, can I just...

I think you're missing the big picture here. She's sick.

She's fucking sick.

She's very, very sick.

And, you said yourself,

she's come in multiple times over the last year.

What we're doing is obviously not sufficient.

- I just can't believe I'm still talking about the Adsos.

- "Folks just don't go to the doctor in the first place."

That's what you told me. Well, she's here.

Shouldn't we do everything we can while she's in our care?

- This case shouldn't be cracked by the hospital team.

Get your test. You have my permission.

- Thank you.

- James.

- But we have had these tests done over two dozen times,

so we just, we want to go home.

Right, hon?

- You and I gonna get you healthy as quickly as possible

and follow up with Dr. Chakrabarti.

Maybe get you some higher level care.

- Higher level care?

- I made a call to UK in the city.

There's a specialist there.

Said your symptoms sounded familiar.

- Wait, are you saying that my girl's

not gonna get her transplant?

- Wouldn't it be better if she didn't need it?

- Excuse me?

- Mrs. Adso, wouldn't you prefer

your daughter not need invasive surgery?

- Mom?

- Yes, sweetie?

- Could you get me an iced tea from the cafeteria? Please?

- Sure.

- Thanks for helping me.

I think you might actually do me some good.

I know what it's like.

When Dr. C's out of town,

it's, you know, the luck of the draw

whoever gets stuck with me.

- We're all happy to help. I know I am.

- So why'd you become a doctor?

- My mother.

- She must be proud of you.

- She is.

- I normally don't look like this, though. I promise.

You know, I bet we'd be friends out in the real world.

- I bet you're right.

Get some sleep.

- Uncle Gary. Yeah.

Yeah. No, it's probably not a.

No.

I mean, I'd have to see it, but my guess is that it's not.

Well...

Mm-hmm. Mm-hmm.

Mm-hmm. Yeah, you can go down the aisle.

Do self-checkout.

Mm-hmm.

No, a pharmacist is not a doctor, but you can trust them.

Mm-hmm. Mm-hmm.

No, no. Don't do that.

No. No, no.

Yeah, that would hurt me too if I did that.

- Revisiting Helen Adso.

19-year-old female with a history

of 10 admissions in the past year

due to respiratory distress.

Five requiring escalation to ICU care and intubation.

Episodes growing more frequent.

Discharged?

Initially felt to be due to asthma.

New diagnosis of cystic fibrosis. Genetic panel pending.

New diffuse scarring in the lungs on the CT scan.

Numerous negative bronchioles,

lung transplant candidate, given CF diagnosis.

Patient's mother is very involved.

Something's not right.

- Hey, you okay?

You okay?

- I'm good.

My ankle just gave out.

- What'd you get into this weekend?

- What?

- I said, what did you get into over the weekend?

- It's Friday morning.

- It's Monday night.

- Right.

- You're taking the asthma case too far.

- It's not asthma.

- You are taking it too far.

- You told me to be more invested.

- My first year of residency,

we had a very wealthy horse breeder in town.

Came in vomiting up blood.

Turns out, he had cancer of the stomach.

Had a life-threatening bleed.

He bled a lot.

But he had to get chemo for the cancer to shrink it down.

Side effect of chemo, though, was vomiting.

And the concern was he could bleed to death.

This man, a benefactor of the university,

paid for a wing in the hospital.

Nobody wanted to touch it, take responsibility.

I remember watching "Bonanza" with the man

on television every night.

He was a down-to-earth guy.

So I told them I would take the responsibility.

I handled the chemo as a junior resident.

And he bled to death.

What mattered was I gave him care.

Are you at least sleeping?

- I'm sleeping.

Plenty of doctors don't sleep.

- You need to take a step back. Take some time off.

How are the classes going?

- I think it's safe for me to guess,

you are all here for various reasons.

Some of you may be here to improve your bedside manner.

Others still may be here simply because the promise

of betterment appeals to a thing

that made you doctors to begin with.

Doctor, what is your name again, please?

- James.

- James. Why are you here?

- I was required to be here.

- Do you mind standing up just for a moment?

What do you see as the purpose of this class?

- You're gonna teach us how to act.

- What's wrong with that?

- We're doctors.

Feels a little dishonest.

- Don't your patients lie sometimes?

- They might. Their bodies usually don't.

- That's exactly right.

Now, tell me you're happy to be here.

- I'm happy to be here.

- And yet your body tells me a different story.

Ground yourself. Drop your shoulders.

Breathe. Look at me.

Tell me you're happy to be here.

- I'm happy to be here.

- Good.

Now, now, tell me something you do believe.

- I have better things to do than this.

- Thank you.

And you may well, for all I know.

Your honesty offers control.

Control in the clinical space,

control allows you to prioritize things

that will be helpful to the patients.

Your patient doesn't need to be able to see, on your face,

that you don't know when you're gonna be able to eat next

or what your wife texted you that morning.

That doesn't mean letting go of any part of ourselves,

but it may require leaving some things at the door.

Your truth may be, "I'm tired, I'm frustrated.

Why won't this fucking thing stop beeping?"

But I know, because your doctors,

your truth is also, "I want to help."

It's important we figure this out.

I want to take care of you.

- Hello?

Hello?

- Hello. - Who's this?

- Hi. Karen, this is James.

Dr. Hayman.

How's she doing?

- Uh, well, we are just...

We're waiting to hear from Dr. Chakrabarti

about the possibility of a lung transplant.

- Oh, yes.

- You worried us.

- I didn't mean to.

Transplant is a serious thing.

Where's Helen now? Is she with you?

Hello?

- Hello? James?

My mom said he wanted to talk to me?

- Just checking in.

How are you feeling about everything?

- I want to get better, you know?

- I just want to know what it's like

to have control over my life,

control over my body, you know?

- Listen, it's been a long day,

so I think if we have any other questions,

we'll just address them with Dr. Harrison.

- Oh, there's no need.

- Yeah, he does know that you're calling?

- I don't think I'll need to check in with Helen again. Bye.

Mm-hmm.

Mm-hmm.

No, I don't need a stool sample.

- Yes, Helen Adso's doctor at Greenville.

Uh-huh.

Thanks.

Uh, can you fax it?

Hi, I'm James Hayman.

I'm calling from Greenville Hospital.

I'm calling to get some records for Helen Adso.

She was an inpatient at your facility.

Yeah, fax would be great.

- I have been asked as I was emerging

from a 24-hour operation with a tube in every orifice,

"How are you feeling today?"

I am waiting for the moment

when someone asks me this question and I am dead.

- James. Eyes up here.

- Sorry.

- It's your turn, James.

- I didn't think we had time for everyone to go.

- We don't, but I would like a volunteer,

and your hand was raised.

- I didn't.

- Must've been dreaming about chasing a taxi, then.

There's a reason why you're here.

I think there's value in this.

- I'm not an actor.

- You're a doctor.

You tell people the truth for a living, isn't that right?

All right, then. Read it.

- I've been asked, "How are you feeling today?"

while I was throwing up into a plastic wash basin.

I've been asked as I was emerging from a four-hour operation

with a tube in every orifice, "How are you feeling today?"

Okay.

Again.

- Come on.

I've been asked, "How are you feeling today?"

while I was throwing up into a plastic wash basin.

I've been asked as I was emerging from a four-hour operation

with a tube in every orifice, "How are you feeling today?"

I'm waiting for the moment

when someone asks me this question and I am dead.

- Hey, take your chin up. Eyes forward.

Support from your-

- Look, I don't want to do this again.

- You have to be here. We've established that.

Perhaps that has to do with

the way you've interacted with some patients.

And we've established that you're so disappointed

that you have to be here.

But I would rather see you be honest

and read it and be tired and overworked and silly,

then have you read it and not be engaged.

- I've been asked- - Read it, please.

- "How are you feeling today?" while I was throwing up

into plastic wash basin.

I've been asked as I was emerging from a four-hour operation

with a tube in every orifice,

"How are you feeling- - You can be lazy

in your rounds, but please do not be lazy here.

- Look, I'm exhausted, all right?

- Then use it.

That's the first honest thing I've seen today.

Go on.

- You cannot imagine how time can be so still.

It hangs. It weighs, and there's so little of it.

- Okay. Slow down.

Hear it.

Talk to us like we're human beings

and you're trying to communicate something to us.

- I've been asked, "How are you feeling today?"

while I was throwing up into a plastic wash basin.

I've been asked as I was emerging from a four-hour operation

with a tube in every orifice, "How are you feeling today?"

I am waiting for the moment

when someone asks me this question and I am dead.

You cannot imagine how time can be so still.

It hangs.

It weighs,

and yet there is so little of it.

- Holy shit, wow.

- CF patient with a negative genetic PENS.

It isn't right. Her PFTs are consistently known.

Doesn't add up.

- So far, this all sounds like

something worth talking to Dr. Harrison about.

- She's 19, and her mother-

- What about her mother? - Her mother doesn't need

to be around as much as she is.

It's like Helen's her hobby. I don't know.

- That's right, you don't know.

And it would be a very terrible thing to accuse someone

of something that you couldn't even substantiate.

That being said, has she had a psych eval?

- Why?

- Could be Munchausen's.

I don't know anything about it.

I mean, you'd have to talk to somebody in psych

and this type of thing doesn't happen all the time.

You know, like, you see it more in movies

than in real life, right?

Man, this whole...

This type of thing really freaks me out.

How long you been working on this?

Something really bad must've happened to you.

- Something bad is happening right now.

- James? Honey, I'm just checking in.

Tried calling you yesterday too and I'm worried about you.

Call your mom back. Love you.

Remember, I was there when you lost the thread, baby.

You worked, you woke up,

you slept it off, but I was there.

Talk to me.

- To listen to the message again, press 1.

- It's not called Munchausen anymore.

It's fictitious disorder.

- Sam.

- In this case, it would be

fictitious disorder imposed on another.

- The mother to the daughter.

- Mm.

Multiple scarred abdomen of a woman

with Munchausen's syndrome.

This shows the woman's abdomen

after she had undergone 42 unwarranted operations.

43rd operation, they discovered her very real colon cancer.

- When did you see her?

- Too late. They switch hospitals, medical providers.

Many are, or have been, nurses or medical professionals,

so they know how to do it.

I had a patient once,

former nurse who would cut between her toenails,

drink the blood, and when she pooped it out,

she would rush to the hospital to get scoped.

She was scoped 18 times in three months.

No one would've found out

and she would've never been referred to psych

if the doctor simply hadn't glanced over her purse

and seen a jar of congealed blood.

- What happened then?

- Doctors aren't detectives.

She simply wrote it out on her chart

and referred her to Psych.

My question here would be, "How?"

Is it possible she just simply has

a complex bundle of lung issues?

- It's possible.

- You're smart, though. You see it differently.

- It's an interesting case.

I just wanted you to see if...

Am I crazy?

- Are you crazy?

Not a nice word.

- Am I crazy to be worried about this?

- Doesn't Greenville have

its own Psych department to consult?

It's funny, you know, seeing you here suddenly, James.

It's a little scary.

Are you okay?

Last time we saw each other, you weren't.

- I'm doing okay.

It's a fine hospital.

There's a real ability for me to make an impact there.

Thanks for your help, Sam.

- Call me if you need anything. Seriously.

Just to talk, even.

- I'm on call tonight.

- I'm worried.

- You're my doctor. Of course you're worried.

- How often have you been back?

- Twice this month.

- Every time, it's the same thing.

They tube you, you get better.

You know better than anyone if something wasn't right.

- When someone's taking care of you,

doesn't it always feel right?

Mom really wants me to get the transplant.

She says it's gonna make everything better.

- Do you know what a transplant is like?

First, they cut into your chest and break your ribs.

Then, they cut your lungs out one at a time

and give you someone else's.

The bones- - You're scaring me.

- Maybe for months. Maybe for years.

And maybe it doesn't work.

You might take a breath in and nothing comes out.

- Excuse me. Doctor.

- Karen.

It's good to see you.

- What are you doing here?

- I have family buried out here.

My mother. You?

- Huh?

- What are you doing here?

- I wanted us to be buried together, here on the hill.

- Is it really that bad?

- I'm gonna leave you to go to your mother.

- Could I say hello to her?

- Helen, she's in PT. All morning.

- The patient's getting sick and I don't know why.

Imaging is nonspecific. Labs aren't leading us anywhere.

Numerous scopes have added nothing.

Patient's mother is openly hostile

and evades direct questions by medical staff.

There's something off here, something slipping by.

Whatever care she needs, she's not getting it.

Might be necessary to consider a different approach.

- Hey, hey, look who's here.

- Thanks, Dr. Harrison.

- You sound a little hoarse.

- Well, I've been having nightmares.

- Ah, you've been sleeping. That's good.

I'm sure you heard about Helen Adso.

- Excuse me? - Had the transplant.

Transferred here for rehab this morning.

Should be getting her tube out now.

Would you believe it?

New set of lungs and she's doing just fine.

- I'd like to see her.

- Can't do that, James.

- Why not?

- Her mother filed a complaint against you.

Little red flag by your name.

- No, I need to see her.

Dr. Harrison, I...

- I know you came here for a fresh start.

There's no Greenville after Greenville. You know that.

- I think her life is at stake.

- She's sick.

It's a hospital. Everyone's life is at stake.

There's a New Year's Eve party in the doctors' lounge.

Nan bought cake.

- Just like we talked about.

Coming off. Okay, now.

Hold that big cough. Good job.

What is he doing here?

- Can somebody get him outta here?

- This is totally

against protocol, James. - No, I'm fine, I'm fine.

- Terribly sorry for the intrusion.

My office! - Just need some air!

- Keep an eye on him. - All right, deep breaths.

- Hey, James.

Heard, they got cake in the nurses' lounge.

- Yeah, be there in a second.

- Okay.

You good?

- Yeah. I'll see you.

- You're not really supposed to be here.

- I just left my coat.

It's cold out there.

Thanks.

- Did you hear the nurses have cake?

- Yeah. Mm-hmm.

Hey, I'm new here.

Do you know how to direct me to the lab?

- Mm. Yeah, sure.

- Thanks.

- 24. The patient is Thompson.

John Randall.

Medical record 2734458.

Specimen received in formalin-

And then labeled as

a left transbronchial lung biopsy.

Yeah?

- Could you check something out for me?

- Now?

- Please?

- Where'd you say you found this?

- Yeah. Trash can in a patient's room.

What?

- You sure it wasn't a landfill?

- What are you talking about?

- Whoever used this needle should be dead.

- What is this?

- Stool. And dirt.

Looks like a saline solution.

This your patient?

- Code Blue, ICU. Code Blue, ICU.

- Can I get back to her, please?

- What's going on here?

- We were weaning her off sedation

off the vent this morning

and she just to the high 70s

and systolics fell to the 50s.

- Okay, let's make sure we have two peripherals.

Nan, we got a pulse?

- We have a pulse.

- Let's sedate. - Yeah.

Sedation on, vent is on.

- Kayla, start compressions.

- One, two, three, four.

- Can somebody put pads on?

Use the paddles.

- Bagging. - 16, 17, 18, 19, 20, 21.

- Someone leans near-

- James? - Sees the salt-

- I got paddles. - When someone's taking

care of you, doesn't it always feel right?

- All clear. - Get him outta here.

- Shocking.

- Don't get crazy.

- Good to see you up.

- How long was I out?

- Three hours.

- Happy New Year, James.

- I called your attending and the admin at UK.

At first, they said the same thing they said before.

"Model resident, top of the class.

So sorry to see you go. Smart kid."

Then, I told them a bit about

what we've been seeing here at Greenville.

That sparked their interest.

And the story they told me was familiar and sad.

Let me see if I can remember.

Promising junior resident.

Had a great rapport with your patients, the nurses

Eager and communicative, but not a gunner.

No one resented you, your knowledge,

or anything you had to offer the hospital.

You were beloved.

Then, Vivian Spurlock was admitted late March of last year.

74.

Right so far?

- Yes, she had complaints of pain that led to a CT scan,

which led to a diagnosis, lung cancer.

- As a show of good faith

and the confidence they had in you,

your attending assigned her to you.

- I asked for her.

My interest was end of life at the time.

It made sense.

- You were the right doctor for the care she needed.

The cancer was aggressive.

She had no family.

And after a few months,

it seemed like the only person she had in her life

that gave her any support at all was you, her doctor.

- She did have family.

Just...

They're trash people.

They didn't care about what she wanted.

- She had a heart attack.

You had a nervous breakdown.

I was a little angry they didn't put that

in their recommendation, James.

Am I right so far?

- Not quite.

Can I see her?

- Who?

- Helen Adso.

- 19-Year-old in for asthma.

- Case like this, I knew an autopsy

would answer a lot of questions.

Limited autopsy, heart and lungs.

Asked her mother for one.

- She refused.

- She said, "Of course."

- You can see here, she had lung abscesses

and foreign bodies, material, in her lungs.

Sand, dirt, fecal matter, vegetable matter.

Loaded with bacteria, type you see in the GI tract.

It's a big deal for us.

We don't get anything like this in Greenville.

- She injected her with all of this.

- The patient injected herself.

Apparently, she'd been doing it for years.

- This is the transplanted lung.

Quick work.

- Why does somebody do something like that?

- How many times did she have a scope

down her throat in the past three months?

- 16.

- Well, most people wouldn't like that.

Maybe she did.

You said, "Not quite."

- Huh?

- When I asked if I got it right about your former patient,

you said, "Not quite."

- A few months before her heart attack,

she started having suicidal thoughts.

Sister came out of the woodwork

and insisted she be put on life support.

She was losing a desire to live.

After a month or so, that was replaced by a desire to die.

Someone leans near...

She asked me directly to let her die.

Her sister wouldn't want to pay for an autopsy anyway.

And besides, wouldn't have mattered much.

Another old lady's dead from a heart attack.

It wasn't hard.

Is there an order in here for bed six?

Dr. Groff said it might land between shifts.

- I don't think so. Want to take a look, though?

- Yeah, but it's a badge room.

- Ah.

There you go. - You the man.

I knew that a large dose

of potassium chloride would cause cardiac arrest.

In the end...

You sure it's what you wanted?

- I'm sure.

- Someone leans near-

She didn't want to die.

- I don't want to go.

Oh, James, you're killing me!

- Mom. Mom.

She went by her maiden name.

- Don't get crazy.

- You okay?

- So why'd you become a doctor?

- Don't get crazy.

- My mother.

Am I crazy?

- Vivian Spurlock was your mother.

- I just wanted to help.

- It's part of our job to care.

I think we all, sometimes,

feel like we're losing our minds a bit.

A lesson for me.

When you smell horseshit,

it might be something else entirely.

It might be a monster.

- 10, nine, eight, seven, six,

five, four, three, two, one!

- Happy New Year, James.

- Happy New Year, Dr. Harrison.