All language subtitles for Rounding.2022.1080p.AMZN.W.1.H.264

- 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.