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We're beginning our descent into LaGuardia Airport. Please stow your tray
in their upright and locked... You got any plans during the layover?
Catching up on sleep.
In the city, that never sleeps.
You single?
I am. Come on, young, beautiful, single girl like you should be out hitting the
town. That's not really my style.
That glitter on your cheek says otherwise.
I was at a concert last night, and I'm fine, I promise. It's all good.
I like to party, too.
Maybe we should party together.
Flight AM208, runways are backed up. Stacking all inbounds, descend to 5 ,000
and maintain.
Descend, maintain 5 ,000.
Eastern hold.
Take her off autopilot. Your plane.
My plane.
I gotta use the head. Is everything all right?
If we're stuck circling, I'm not gonna be able to hold it. It'll just be a
minute, unless you can't handle it.
I can.
It'll be our little secret. Just like that glitter on your cheek, tiger.
Occupied.
Leaving 2 ,000 for 3 ,000.
AM208, your transponder indicates you are descending.
Senator, we are experiencing significant visual disturbance.
Roger, AM208. Do you wish to declare an emergency?
What's happening?
Where's Captain Clark? I need him now. The turbulence knocked him unconscious,
but I was able to get instructions.
Get everyone belted in and in brief position.
Okay.
Load, load, load.
Flight AM208, do you copy?
Load, load, load.
Flight AM208, come in, please.
Flight AM208, you need to respond.
Senator, this is AM208. I'm attempting an emergency landing.
Your dedication is admirable, Ana.
Sensory and motor stimulation are crucial at this stage and exactly what
needs.
Si, pero three weeks.
Nothing. When will my son wake up? Every case is different. There is no precise
timeline. But Jorge is stable. We'll continue with the aggressive
rehabilitation, monitor him, and wait.
Dr. Wolf, Jorge hasn't shown meaningful neurologic recovery in weeks. I'm
worried about maintaining this level of hope given the current circumstances.
Trust the process, Dr. Porter. Does the process always include Bach and Ferns?
Yes, actually. Excuse me.
Hey, where are you off to so early? Oh, I got a call from the family of a former
patient. He was supposed to be discharged from Hudson Oak a week ago,
can't get straight in. That's why he's still there. And you're going there now?
If you let me. Carol, Hudson Oak, that's where that succubus with the brochures
is from.
She's always lurking around our hallways, poaching our psych patients.
I'm afraid if you go there, I may never see you again. Don't get my hopes up.
Was there something you actually wanted to talk to me about?
Just checking in.
The day seems pretty quiet.
What's up?
Checking my credit card statement.
The credit card you gave Sam, your unhoused patient with schizophrenia, how
did he spend? It's fine. He needs it.
Erica, can you cancel it right now?
Good morning, ladies. Happy mandatory drug test day.
What's happening now? Bronx General's policy mandates a drug test every six
months. It's been two years since Nero had one.
Hope you're all hydrated.
I'm getting fired.
We don't know that. I don't have a prescription for my benzo.
When was the last time you took one? Last week when I went down to the ED.
Okay.
Here's the plan.
No more benzos while we flush your system today. Avoid elevators, the ED,
anything that would trigger your anxiety.
And then we need to get a serious handle on this.
Scott, there was a plane crash. The patients are coming here. We need it
the ED.
All available personnel.
So scratch that plan.
Plane crash, multiple injuries, 40 patients en route.
Every time one of these boneheads loses their remote, I got to risk my life to
change the channel. We continue to bring you updates on this developing story as
more information comes in regarding injuries and any possible causality.
now, you're looking at pictures of Atlantic Meridian jetliner that went
into the Hudson River. You're lucky you didn't go swimming this morning, Dr.
Wolf.
Okay, people, let's divide and conquer. And to my neuro colleagues, not the day
to get all nerdy.
Treat and street. What he means is you'll be taking patients regardless of
whether they're neuro or not. And because it's an MCI, you'll be working
unsupervised. There's no time for attending presentations.
I've got your back if you need me.
Buckle up.
It's going to be a bumpy ride.
Oh, no. Not the walking wounded bus. Why does Bellevue always get the big
traumas? Get warm blankets.
Screen for hypothermia. There are lacerating kits in the cart. Upgrade
necessary. On it.
Right over here.
She insisted on being the last to be rescued, so she can't open her eyes.
Possible gestural exposure. Captain, I'm Dr. Wolf. These passengers are lucky to
have you. Oh, I failed them. My vision failed me. Something's seriously wrong.
I'm living in a nightmare.
Okay? You okay?
Yeah.
Can I examine your eyes?
Hey, look at me.
What do you see?
Everything's upside down.
It happened during the flight.
Your eyes look normal, but what you're describing is an incredibly rare
phenomenon called reverse visual metamorphopsia.
You need to run some tests right away.
This should help keep you warm.
I can't move my right side.
I can't move my right side.
There's no disturbance in your lateral weakness.
Call a cold stroke now!
I'm afraid you might be having a life -threatening stroke. I need you to lie
back to me right now, okay?
Let's go. She's declining fast. We need to get her to a scanner stat.
Everybody move!
Move! Move!
Excuse me.
Al? Your scans are inconclusive for a stroke, so we need to do more tests to
know for sure. In the meantime, if it is a stroke, I'm obliged to tell you that
there is a drug called TPA, which may restore your vision and your strength,
we'd have to give it now. It's less effective the longer we wait. Let's do
It's more complicated than that. If we're wrong, if you're not having a
then TPA could cause life -threatening bleeding, especially after trauma. If I
may. I've seen TPA work miracles. There are some very impressive studies to back
this up. Thank you, Dr. Porter.
Thorne and I are running this stroke code. You're here to document.
That means you write, not speak.
What's the call, Nero?
My instinct is not to give the TPA, Al. There are too many unknowns. I think we
should get an MRI so we have a clearer sense of the situation.
If your gut is wrong, could I be permanently impaired?
I'm asking you to trust me here.
Um... No. No, what? Why is it so difficult?
You've got to be kidding me.
You good, Kenny?
No. Thorne sent me to find 6 -0 switchers, and I can't find them
He means 6 -0 as in 6 -0.
Oh. Thank you.
No problem.
Hey, you're a former athlete.
Former? Silva is giving a drug test today, and I'm not accusing you, but you
must have had teammates who passed dirty.
Damn, Kenny, you still on the benzos?
I've seen it all. Donated urine, synthetic urine, adulterants. None of it
Don't even go there.
This is too much. I am spinning out.
I got you, 6 -0.
Come on.
Something's wrong down there.
Let us take a look, okay?
So your testicle got twisted up from the impact. Now we'll have to untwist it,
otherwise its blood supply will be cut off and you could lose it. This is what
get for letting that stupid bitch fly unsupervised.
I won't twist.
On my count? Actually, on my count.
Have a look at this. This will only hurt a little tiny bit.
Ready?
One.
Two. Just breathe.
Dr.
Pierce.
Carol, please.
Dr. Amelia Frederick, Director of Psychiatric Care. We met before at...
remember. It's nice to see you again, Amelia.
What a pleasant surprise.
I only wish I'd known you were coming. I'd love to give you a tour. Oh, I
wouldn't want to take up your time.
I wanted to ask about Hector Martinez. He's a patient of mine.
Yes, I know Hector. He's a lovely man. And he's making good progress.
Well, his family has been getting mixed messages about the timeline of his
discharge.
That's why I'm here. They wanted a second opinion.
Well, that's strange because we always include the family in discussing
discharge plans.
In any case, I'm happy to take you to see Hector. Great. He's right this way.
It's all over the news.
162 souls on the plane.
All accounted for.
Thank you.
Thank you for telling me.
How did you safely land a plane with everything upside down?
I trusted my instruments. That's what pilots are taught.
Interesting.
Because I got more breaking news for you.
MRI just came back.
It's normal.
Now, we've got to run some more tests to figure out these symptoms, but you
definitely do not have a stroke.
Your co -pilot was right about the TPA.
Co -pilot?
You mean Dr. Wolf?
One thing about Wolf, he's an odd bird, but the guy knows his stuff.
He's a walking medical instrument.
You can trust him.
Is this it?
Is he leaving me? Despite the fever, 102, and now he's hypotensive.
He's infected again. Let's bullet him a liter, get him a full set of cultures,
and start with Bank and Zosyn.
I
know
this is scary, but infections are common for people as sick as Jorge, especially
since he's been in the hospital for this long.
We can treat this.
Where is Dr.
Wolf? He's dealing with patients in the emergency department.
I am very familiar with your son's case.
You can trust me.
What the hell did you do?
You could have killed us all.
I could have lost him. Hey, back off. I am going to make sure.
You lose your license.
Hey, what's happening here?
Just trying to get some answers. No, you're getting strapped down if you
take it easy.
She at least owes all of you an explanation.
Come on.
Right?
You don't have to say anything.
Okay?
I... I dare... I dare to make a cheese ball.
Magneto jam?
I... Elle, look at me.
Where's the overshoot? The overshoot? You see? She's unstable.
She's unreliable. Let's get point -of -care glucose, okay?
Elle, can you tell me what today's date is? Fuck, I'm... I'm zero.
Hold out your arms toward me and resist the pressure, okay?
No focal deficit.
It's drugs.
Guaranteed. Tell them where you were last night.
Testing you for drugs, right? Next flight that you're going to be on is one
taking you to prison.
Agents Bellum and Cortez with the National Transportation Safety Board.
We need to speak with Al Parker.
Are you taking any medication, prescribed or otherwise?
I'm on lisopril for diet and hypertension
and melatonin for sleeping.
All FAA approved and neither of which caused any impairment. How long is this
going to take? You can see she's not well. Did you note any mechanical
malfunctions before takeoff?
No. When did you first communicate distress?
At approximately 7 .14 a .m.
before landing. Did First Officer Parker appear intoxicated upon arrival?
No. How do you explain the speech?
Aphasia can be multifactorial, but she urgently needs additional workup. You
need to let us get back to treating her. We want a copy of the toxicology report
as soon as it's available. Sure.
You can go now.
She stayed here.
We have more questions.
You two can leave.
She was speaking complete gibberish two hours ago, which would make more sense
if her stroke imaging wasn't normal.
There's no mask, no detection, her speech resolved, and she's not
like any typical toxic room I know of. I know drug users. She's not that.
We gotta figure this out before they draw their own conclusion.
Mrs. Torres?
Jorge's blood pressure is better after the fluids.
I'll tell you as soon as we have any more news.
The fact that he hasn't woken up yet is not good.
There is a real possibility that he won't return to anything like he was
I think it's time we start asking ourselves how much would Jorge be
go through.
There comes a time when doctors stop doing things for a patient and start
things to them.
He would not want to live this way.
As someone who has some personal experience with this, may I make a
recommendation?
We're treating Jorge's infection, and we hope he'll continue to get better.
But if he worsens...
We won't recommend any more invasive procedures.
We allow Jorge to pass with peace
and with dignity.
Gracias.
It's great to see you, Hector.
It's been, what, about a month since you got here?
It's been that long?
Yeah, you were supposed to be discharged a week ago.
What happened?
I'm not ready to leave.
As long as I'm here, I'm not the only crazy one.
We don't use that... We don't use that word, I know.
But other people still do.
People at my job.
The ones that saw me lose it, they all used that word.
How am I supposed to go back to them, my family, and act like everything's
normal?
It's going to be hard.
But you can do it.
Part of your commitment to treatment is to develop the tools to handle
adversity.
Mindfulness, hobbies, passions. Yes.
Heck, they're even the strongest people if they lose those tools.
They lose the ability to navigate obstacles.
And the key is to develop a diverse toolbox so you're always prepared.
And you have one of the best tools of all.
A family that loves you.
They reached out to me.
Yeah, they want you home.
They do?
Very much so.
We're treating the infection, but she agreed if Jorge continues to worsen, we
won't intervene with invasive measures.
That doesn't sound well -sanctioned. I'll talk to him.
But Mrs. Torres deserves to know what comes next.
He'll most likely exist in a painful, torturous loop until he dies and she's
bankrupt. Wow.
Good luck convincing Wolf of that. He never gives up on a patient, but a
that the chief has also investigated... Do you agree?
He's lost professional distance.
Wolf gets overly attached, yes.
But he also always tries to give hope to the hopeless.
Give him a fighting chance.
The only thing worse than no hope is false hope.
And the opposite of fighting isn't giving up, by the way. It's peace.
Sorry, but I gotta, um...
trying to understand how else sees the world.
What is this? A video surface. It's been making the rounds on circles. I give it
an hour before it's on the news.
This is what our co -pilot was doing 12 hours before he crash -landed into the
Hudson. Are her toxicology results back yet?
Preliminatives, but they don't catch all the new rave drugs.
You okay, Dr. Wolf?
Get Thorne and Ellen here right away.
I have an idea.
You know, for a long time, inpatient mental health care facilities meant
soulless, state -run institutions.
But then, well, those shut down.
And for decades, only the wealthiest patients have been able to stay.
Betty Ford or what have you for tens of thousands of months. We are trying to
make long -term inpatient care accessible to all.
I grew up without money and I was forced to watch my mother suffer because
affordable care was out of reach.
I had made it my mission that no one should ever have to endure that kind of
helplessness.
Well, clearly what you're doing here is working.
It's been very good for Hector.
I'm so pleased to hear you say that. Patient satisfaction is our top
metric.
My only concern is if he stays here, then he won't be able to keep up his
relationships with the outside world, which is why I think he's ready to be
discharged. I agree.
I will start the discharge process right away.
Oh, Carol, thank you so much for coming by. I really hope that we'll be able to
work together more.
Can I hug you?
Okay, bye!
I swear I'm not on drugs.
I've been sober for years.
Dancing is just how I reset.
I can disconnect from the world like when I'm up in the air.
The problem is this accident has opened your entire life to scrutiny. Tell me
something. Before your vision flipped, did you see anything else unusual?
The Manhattan skyline started having black dots all over the buildings.
I
want
you to write something for me.
What? Anything. Just a complete sentence.
What are we doing?
Those investigators will say that video is all the proof they need.
There are drugs that are undetectable and can cause patients to claim they're
seeing upside down when in fact they're just high.
So I need Elle to provide undeniable proof that her brain is actually wired.
Upside down.
L.
This proves that you're not seeing upside down. Your brain is processing
down.
And I know the cause.
The flip vision, the coma states, the disturbances in speech, the weakness,
they're all symptoms of one thing.
A rare, complex basilar migraine.
A migraine?
I've never even had a headache.
Well, typically complex migraines don't come with a headache, but rather
neurological disturbances called aura. And those black dots you saw were an
aura. A warning sign of a migraine. It's one of the most mysterious phenomena of
the human brain.
Can't migraines just come on at any time?
I'm never going to trust myself to fly again.
Let's just start you on meds, all right, before you ground yourself.
Medication can successfully stop migraine symptoms.
But to prevent them from happening altogether, we need to get underneath
triggering your migraines. And we have the perfect doctor here to help you with
that.
Yes, she is.
Wonderful.
While you were with the pilot, Jorge was febrile and hypotensive. I started him
on antibiotics, and his pressure improved with fluids. Good work.
And I talked to Mrs. Torres.
Together, we came up with a new plan for Jorge's treatment.
We're not going to escalate any further.
No pressers, no lines.
Dr. Wolf, Mrs. Torres is worried about her son's suffering, and I understand.
She's not unreasonable.
I am sorry I couldn't come by earlier, but I understand you're making some big
decisions today. I'd be happy to talk about them with you.
Jorge's not waking up.
I know, but as we keep saying he can still get better, I believe he will.
To stop now after everything... Dr. Charlie is wrong?
He's not wrong.
He's young.
Young doctors haven't seen as much. They may not have seen a patient as sick as
Jorge, who ultimately gets better, goes home.
You say one thing, Dr. Charlie says another.
Por favor, leave me with my Jorge.
As the medication kicked in?
Thankfully. Good.
I still don't understand.
I've never had a migraine before. Why now?
You probably have.
You just didn't recognize the symptoms.
Let's start with this morning.
Did you notice anything unusual?
It's a routine flight.
I was feeling fine until the approach.
Flying into New York City's airspace, that can be stressful, no?
It's actually the opposite.
Flying over the city gives me perspective.
From up there, everything down here is made small.
The people, buildings.
Problems.
Free from all of that.
And as the pilot, I'm in control.
Did you feel in control this morning?
I did.
Only if she was my captain, he was acting kind of inappropriate.
Inappropriate? How so?
Asking me about my personal life. It's not a big deal, but...
I ideally don't want to be trapped in a cockpit with someone who's hitting on
me. Well, has that ever happened before?
No.
Well, we do know that emotional triggers can cause migraines.
Could this event with your captain connect back to something else in your
I mean, even if there was, I don't see how one small interaction like this
be such a trigger. The dancing, the flying, that's where you feel free.
Was there a time where you felt trapped?
Like you couldn't escape?
Growing up, it was just my mom and me in Hartford.
We didn't have a lot.
Just... Well, I think she decided to marry him.
She thought she was giving me a better life, but I don't think she realized
always be in it, too.
Or whether he would decide to drink that night and take it out on my mom.
Or me.
That sounds terrible.
Is that why you became a pilot?
To escape that situation?
Did you know that on a wide -body 767 there are 463 pre -flight checkpoints?
And five distinct and critical phases of acceleration?
Two.
Pratt and Whitney engines to thrust up all the while we monitor no less than 1
,000 data points in real time. All this every time just to take off.
That sounds difficult.
No, it's the easy part.
When I had to walk out one single door, when I left home and my mom for good,
that was the most difficult thing I've ever had to do.
My mom reached out a few years ago to tell me he had died, but I still can't
back and I haven't forgiven her.
Well, a wound like this, it needs
to heal.
Even at 30 ,000 feet, our bodies remember to
keep score.
But with therapy and an understanding of the mechanics of your migraine, we can
treat the more debilitating symptoms.
Now we already know that you are an incredibly strong person. Not because
a pilot, but because you are a fighter and a survivor.
And that's not ever going to change.
Yeah. Right?
It's pretty incredible. They're waiting on that urine, Kitty.
I'm not sure if you heard, but there was a plane crash today, Silva.
I'm aware.
Urine?
What are you looking for?
Yeah, no, nothing really. Just, um, do you remember when my apartment building
collapsed? Yeah, afterwards I snuck a bunch of benzos from Dana to deal with
debilitating anxiety effects, and I have been taking them ever since. And I
have... Managed to keep it a secret until today's drug test.
What's that for? If I stick myself with this needle and I check myself into
occupational health, I can buy myself some time.
I know, I know, I know, but Sam, all my life, all I have ever wanted to do is be
a doctor. And if I take this test, I will fail, and I will get fired, and my
life will be ruined.
No, no, no, no way. You're not doing this.
There were moments where I felt you were scared or anxious, but I thought I must
be wrong. I'm so sorry for never checking in to see if you were okay.
and I both know the risks of taking ventros without supervision. So instead
continuing to hide, maybe just have a conversation with Silva.
We've diagnosed Elle with a treatable form of complex migraine.
As her neurologist, I can certify that with proper management, she will be fit
to fly again with some time.
And as her psychiatrist, I can assure you there was no history of substance
abuse. Elle fully cooperated and passed every drug test.
She was not at fault.
And we'd like to know if Ms. Parker has any final remarks.
Um, you always wonder how you'll act in a crisis.
Not only do I take full responsibility for my actions, but I'm proud of them.
I landed a plane while my vision was inverted with zero severe injuries.
This is my last flight. I can hold my head high.
Ms. Parker, while the investigation will take several more weeks, we are
inclined to agree with you.
Preliminary reports are your plane hit a recreational drone in restricted
airspace. Additionally, Captain Paul Clark's unprofessional photos led us to
concerning discovery.
He should have never left the cockpit while autopilot was disengaged.
While he's suspended, you are not.
I can't take the test today.
Can't say I was expecting this from you, but few things surprise me anymore.
Hey, I've seen it all.
It's out with it.
Coke, Molly, ketamine.
Benzos. It's not a big deal. I don't have a prescription.
Okay, that's a big deal.
Hey, I trust you to handle this.
As a doctor, you know the harms of self -treatment. You're jeopardizing your
health, not to mention breaking the law.
So never let it happen again.
Hear me?
Come see me in two weeks.
You
paid,
Dr. Wolfe?
Sit down.
Why didn't you call me before you changed Jorge's goals of care?
I knew you were busy.
I'm a second year. It's my responsibility to talk to families more,
meetings. Stop.
You made plans to move my patient toward hospice without consulting or
attending. There is no defense for that.
We're a team.
We need to come across as a team, which means we give one unified message. If
that message gets fractured, we lose the trust of our patients and their
families. Maybe Mrs. Torres didn't want the team this time. Maybe she wanted
another perspective. You don't speak to another family member without me
present. Dr. Wolfe, with all due respect, this reaction is irrational.
I offered a reasonable recommendation to Mrs. Torres based on the information
she gave me about her son.
And if you don't think that's true, maybe you should look into why you're so
hell -bent on treating a comatose man.
Could it be because he's also the chief's patient?
Dr. Porter, let me remind you that you came to this hospital to work for me.
Do not confuse me allowing you into this department as an actual seat at the
table. Your privileges here are by definition provisional. You are a
You are a journeyman.
This is not your home.
Do not for one minute confuse it as such.
Get out of my office.
Now! You want to talk about it?
There's not much to say. Charlie clearly wouldn't have stepped too far.
But so did I.
You didn't go far enough, in my opinion.
Charlie is an overstepper. Like the way he was pushing for Elle's TPA.
You can't help the team if you're too busy trying to put it on your back. I
agree.
In what we do, it's vital the team works together.
Like you two.
Yes, actually. Seriously,
though, Wolf.
I get that you were frustrated, but...
Yelling at residents?
Come on, that doesn't sound like you.
And you've been sleeping at your office? Your desk is a mess?
Yeah, I've been working really hard.
When was the last time you went for a swim in the Hudson?
Probably not since my dad left.
You paying for these sessions, Wolf?
Yes.
In friendship.
Sometimes courage means relinquishing control.
Letting someone else guide the way.
Dr. Pierce?
Dr. Kenny?
Can you recommend a good therapist?
Of course.
Is the therapist for you or for someone else?
For me.
I need help.
Other times it means seizing the wheel and charting your own course.
This is the first step to you gaining your confidence back and believing in
migraine treatment.
It's an honor to be your co -pilot.
Thank you.
How long is this flight?
To Hartford, it's just under an hour.
Hope you like soft -shell crab.
My mom's specialty.
Ultimately, it takes courage to trust.
My son.
You did it on purpose to him again.
Just wanted to let you know we started the discharge paperwork on Hector
Martinez. Thank you, Amelia.
You know, it wasn't my choice to put Hector in Hudson Oaks. His family saw
of your ads.
But now that I've been there in person, I see that your priorities are in the
right place.
That's so good to hear, Carol.
And I hope you'll think of us if you ever have someone in need.
Okay.
Have a good night.
Okay, you too. Bye -bye.
Sometimes it just takes seeing the world upside down for everything to make
sense.
Nobody wants to help you more than I do. I am your doctor and you're a very
thick man.
But how can I help you if you won't trust me? Everything you say is a lie.
It's your word against mine.
But I have witnesses to corroborate what I say.
Isn't that right, Hector?
We have a lot more work to do, Oliver.
So, get comfortable.
You're going to be with us for a while.
Greg, move your head.
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