1 00:00:00,001 --> 00:00:02,827 [Michael] Dr. Larsen was in a car accident, 2 00:00:02,828 --> 00:00:04,742 she has no recollection of the last eight years. 3 00:00:04,743 --> 00:00:06,136 [Amy] Previously onDoc. 4 00:00:06,180 --> 00:00:08,834 - Let me run Internal Medicine. - Back to your roots. 5 00:00:08,835 --> 00:00:10,748 When you need time to work out things with Michael, 6 00:00:10,749 --> 00:00:12,533 I accept it, but when the shoe's on the other foot- 7 00:00:12,534 --> 00:00:13,751 When the shoe's on the other foot, 8 00:00:13,752 --> 00:00:15,318 you have a hard time telling me the truth. 9 00:00:15,319 --> 00:00:16,667 Delayed decisions on his care 10 00:00:16,668 --> 00:00:18,714 have been hurting him a long time. 11 00:00:18,715 --> 00:00:21,020 You don't have to tell me the system's broken. 12 00:00:21,021 --> 00:00:23,761 How much prednisone does it take to get you through a shift? 13 00:00:23,762 --> 00:00:25,373 You will flame out in weeks. 14 00:00:25,374 --> 00:00:27,200 [Joan] It's time for you to use your greatness 15 00:00:27,201 --> 00:00:29,159 to pull the greatness out of others. 16 00:00:29,203 --> 00:00:30,253 I'm going to miss you. 17 00:00:39,735 --> 00:00:41,563 [coughing] 18 00:00:42,781 --> 00:00:45,349 Sorry. This guy loves his sleep. 19 00:00:45,393 --> 00:00:50,050 Oh, there he is. Hey, can I have a hug? 20 00:00:50,093 --> 00:00:52,748 Oh my goodness, this is yummy. 21 00:00:52,749 --> 00:00:54,966 Ethan was sorry to miss you, he had a really early meeting. 22 00:00:54,967 --> 00:00:57,231 Well, Robbie's the main event, right? 23 00:00:57,232 --> 00:01:00,407 What fabulous holiday have they cancelled school for this time? 24 00:01:00,408 --> 00:01:01,496 It's Lunar New Year. 25 00:01:01,539 --> 00:01:03,324 Oh, well. 26 00:01:03,367 --> 00:01:04,934 [speaking Mandarin] 27 00:01:04,935 --> 00:01:07,022 [Samantha in English] Grandma's been all over the world. 28 00:01:07,023 --> 00:01:09,329 You know, she could probably teach you to say hello in 50 different languages. 29 00:01:09,330 --> 00:01:11,506 Sixty-seven, but who's counting? 30 00:01:11,549 --> 00:01:13,116 I should be back around 6:00. 31 00:01:13,117 --> 00:01:14,551 And thanks so much for doing this. 32 00:01:14,552 --> 00:01:16,423 Are you kidding? The more time I get to spend 33 00:01:16,424 --> 00:01:17,511 with this little man, the better. 34 00:01:17,512 --> 00:01:19,296 Oh. Brought you donuts, 35 00:01:19,297 --> 00:01:20,905 your dad said they're your favorite. 36 00:01:20,906 --> 00:01:22,256 [Robbie] Thanks, Grandma. 37 00:01:25,998 --> 00:01:27,130 [coughing] 38 00:01:28,349 --> 00:01:29,654 Joan, you okay? 39 00:01:29,698 --> 00:01:31,656 [coughing] I'm fine. 40 00:01:32,788 --> 00:01:35,486 [coughing and wheezing] 41 00:01:35,487 --> 00:01:37,139 [Samantha] Robbie, why don't you go upstairs? 42 00:01:37,140 --> 00:01:38,968 Oh my God. 43 00:01:39,011 --> 00:01:41,057 - Grandma! - Joan? 44 00:01:41,101 --> 00:01:42,151 - Joan? - Grandma! 45 00:01:42,189 --> 00:01:44,278 [coughing] 46 00:01:44,321 --> 00:01:47,237 [theme music playing] 47 00:01:56,159 --> 00:01:57,599 [chattering indistinctly] 48 00:02:02,774 --> 00:02:06,735 [tense music playing] 49 00:02:07,866 --> 00:02:09,066 Good morning, everyone. 50 00:02:09,085 --> 00:02:10,565 [all] Morning. 51 00:02:10,608 --> 00:02:13,350 This is going to be an adjustment for all of us. 52 00:02:13,351 --> 00:02:15,612 Dr. Ridley certainly left some big shoes to fill, 53 00:02:15,613 --> 00:02:18,921 and I know all these leadership changes the past year 54 00:02:18,964 --> 00:02:21,576 have probably been unsteadying. 55 00:02:21,619 --> 00:02:24,318 There are a lot of reasons why 56 00:02:24,361 --> 00:02:27,321 I wanted to practice medicine again, 57 00:02:27,322 --> 00:02:29,365 but I want to be very clear about the reason I asked 58 00:02:29,366 --> 00:02:31,455 to sit in that chair. 59 00:02:31,499 --> 00:02:33,849 The past year as your CMO, 60 00:02:33,850 --> 00:02:35,458 - I have seen what every person... - [cell phone buzzes] 61 00:02:35,459 --> 00:02:37,331 ...standing in this room is capable of. 62 00:02:37,374 --> 00:02:38,854 Dr. Miller. 63 00:02:38,855 --> 00:02:41,072 [Michael] Time and again, you have risen to the occasion. 64 00:02:41,073 --> 00:02:43,118 [man on phone] We have a 62 year old female 65 00:02:43,119 --> 00:02:44,468 in respiratory failure. 66 00:02:44,512 --> 00:02:46,209 Complications from chronic MDS. 67 00:02:46,253 --> 00:02:47,471 I'm on my way down. 68 00:02:47,515 --> 00:02:49,952 I'm not here just to lead you, 69 00:02:49,995 --> 00:02:54,130 I want to join you, and help you do what you already do so well. 70 00:02:54,174 --> 00:02:57,742 An issue, a problem, a suggestion, 71 00:02:57,786 --> 00:02:59,744 my door will always be open. 72 00:02:59,788 --> 00:03:03,357 Before we go, some congratulations are in order. 73 00:03:03,400 --> 00:03:05,663 In two weeks, Dr. Maitra 74 00:03:05,707 --> 00:03:08,100 and Dr. Larsen will succeed Dr. Heller 75 00:03:08,144 --> 00:03:09,493 as Chief Residents, 76 00:03:09,537 --> 00:03:12,409 - as we welcome our new class of interns. - Whoo! 77 00:03:12,453 --> 00:03:15,760 [applauding] 78 00:03:15,804 --> 00:03:17,371 Uh, now, if you both 79 00:03:17,372 --> 00:03:19,285 could hang back for a moment with Dr. Heller. 80 00:03:19,286 --> 00:03:21,505 The rest of you, do good work. 81 00:03:25,422 --> 00:03:28,338 I'd like our co-chiefs to shadow you 82 00:03:28,339 --> 00:03:30,252 before you start your pediatric fellowship. 83 00:03:30,253 --> 00:03:31,471 You can begin with Dr. Maitra 84 00:03:31,472 --> 00:03:33,081 this morning, and then alternate days. 85 00:03:33,082 --> 00:03:35,171 - Yeah. Sounds like a plan. - Great. 86 00:03:39,088 --> 00:03:40,785 It's quite a move. 87 00:03:40,829 --> 00:03:42,831 Well, it was either this 88 00:03:42,874 --> 00:03:44,744 or a leather jacket and a motorcycle. 89 00:03:46,443 --> 00:03:47,966 [cell phone message chimes] 90 00:03:51,231 --> 00:03:53,494 Joan's in the ER. 91 00:03:53,495 --> 00:03:55,973 Paramedic said she was extremely short of breath, 92 00:03:55,974 --> 00:03:57,976 likely bilateral pleural effusions. 93 00:03:58,020 --> 00:03:59,891 So is she hypoxic? 94 00:03:59,935 --> 00:04:03,286 Oxygenations improved on the mask, but she's hypotensive. 95 00:04:03,330 --> 00:04:05,897 Let's push Norepi MAP goal above 65. 96 00:04:05,898 --> 00:04:07,550 No, Richard, that's not gonna work. 97 00:04:07,551 --> 00:04:09,291 - I'm sorry? - She's on prednisone. 98 00:04:09,292 --> 00:04:11,641 Thirty milligrams and she's tapered off, I read her chart. 99 00:04:11,642 --> 00:04:14,172 No, her chart's wrong, she's on way more than that. 100 00:04:16,125 --> 00:04:18,955 [raspily] I've been using it to get through the surgery. 101 00:04:20,042 --> 00:04:21,435 You knew about this? 102 00:04:23,088 --> 00:04:25,526 How much has she been taking? 103 00:04:26,570 --> 00:04:27,620 Double that. 104 00:04:30,661 --> 00:04:32,924 Triple to get through the ex... 105 00:04:32,968 --> 00:04:35,753 vivo with Javi. 106 00:04:35,797 --> 00:04:39,104 My natural cortisol production's gotta be shot. 107 00:04:40,758 --> 00:04:43,631 Okay. Lucy, 100 milligram bolus 108 00:04:43,674 --> 00:04:45,676 of hydrocortisone before pressors. 109 00:04:45,720 --> 00:04:47,591 And run a complete lab workup. 110 00:04:49,201 --> 00:04:51,311 We're all here if you need anything, Joan. 111 00:04:55,120 --> 00:04:56,170 Should I call Ethan? 112 00:04:58,036 --> 00:04:59,211 He's on his way. 113 00:04:59,255 --> 00:05:03,128 But, Amy, I need you to remember, 114 00:05:03,172 --> 00:05:05,087 I have a DNR. 115 00:05:05,130 --> 00:05:08,003 Joan, no, we're nowhere near that. 116 00:05:08,046 --> 00:05:10,048 [wheezing] 117 00:05:12,529 --> 00:05:14,139 Shh. 118 00:05:19,144 --> 00:05:21,190 Good morning, Dr. Walker. 119 00:05:21,233 --> 00:05:24,280 Good morning to you, Walter. How's our rocket holding up? 120 00:05:24,324 --> 00:05:25,977 Can't wait to launch it. 121 00:05:25,978 --> 00:05:27,456 You think I can still leave today? 122 00:05:27,457 --> 00:05:29,328 Gotta examine you first, can't let you out of here 123 00:05:29,329 --> 00:05:31,722 till we're sure you're all better. 124 00:05:31,766 --> 00:05:34,536 I really want to show the rocket to the kids at the house. 125 00:05:34,537 --> 00:05:37,423 I bet. Looks like that thing might actually make it to space. 126 00:05:37,424 --> 00:05:39,948 Do you ever launch rockets with your kids? 127 00:05:39,991 --> 00:05:42,733 - I don't have any. - Really? 128 00:05:42,734 --> 00:05:44,691 I thought about it when I was younger, 129 00:05:44,692 --> 00:05:46,519 but decided to take a different path. 130 00:05:46,520 --> 00:05:49,130 - What do you mean? - Well, being a parent's a big commitment. 131 00:05:49,131 --> 00:05:52,308 But that's also true for being a friend, a sister, 132 00:05:52,352 --> 00:05:55,050 an aunt, especially a doctor. 133 00:05:55,093 --> 00:05:58,053 Eventually, I figured if I gave my best 134 00:05:58,054 --> 00:06:00,489 to all those other things, that'd be enough for me. 135 00:06:00,490 --> 00:06:02,449 - You're a great doctor. - Hmm. 136 00:06:02,492 --> 00:06:06,017 That she is, buddy. Sorry I'm late, how's he doing? 137 00:06:06,061 --> 00:06:08,951 Well, breathing's much better. Let's look at those knees. 138 00:06:11,675 --> 00:06:15,070 Oh. How long has your leg been moving like that? 139 00:06:15,113 --> 00:06:17,159 Happens all the time with my RA. 140 00:06:17,160 --> 00:06:18,681 It shouldn't be now, with the medication you're on. 141 00:06:18,682 --> 00:06:20,945 - Yeah, I'll order a CT. - Well, that's bad. 142 00:06:20,946 --> 00:06:22,337 Just need to see what's going on. 143 00:06:22,338 --> 00:06:24,384 We'll get it sorted out, though. 144 00:06:24,427 --> 00:06:26,516 Time to find your social worker. 145 00:06:26,560 --> 00:06:29,301 Again? 146 00:06:29,302 --> 00:06:32,042 Atlantoaxial instability this severe will progress fast. 147 00:06:32,043 --> 00:06:33,567 We have to operate now. 148 00:06:33,610 --> 00:06:35,743 We don't have the go ahead from his proxy. 149 00:06:35,744 --> 00:06:38,440 Well, his C1 and C2 are compressing his spinal cord. What's everybody waiting for? 150 00:06:38,441 --> 00:06:41,575 The social worker said he'd sign off on whatever we decide, 151 00:06:41,618 --> 00:06:43,968 but he doesn't want to get in the weeds. 152 00:06:43,969 --> 00:06:46,796 Well, that makes things tricky, 'cause we have two surgical routes. 153 00:06:46,797 --> 00:06:49,887 High risk, high reward, open the neck, expose the vertebra, 154 00:06:49,888 --> 00:06:51,714 place the corrective hardware directly. 155 00:06:51,715 --> 00:06:54,021 But you're concerned about arterial or spinal cord trauma? 156 00:06:54,022 --> 00:06:57,155 Not to mention stroke, infection, ventral cord damage. 157 00:06:57,156 --> 00:06:59,069 Plus, he's still recovering from lung inflammation. 158 00:06:59,070 --> 00:07:00,724 Definitely a concern. 159 00:07:00,725 --> 00:07:03,422 And the second option is minimally invasive fusion? 160 00:07:03,423 --> 00:07:05,162 Far less trauma and easier recovery. 161 00:07:05,163 --> 00:07:06,903 But wouldn't we be relying on CT for navigation? 162 00:07:06,904 --> 00:07:09,166 Which means less precision with the hardware? 163 00:07:09,167 --> 00:07:11,995 Yeah, it may require going back in, in six months or a year. 164 00:07:11,996 --> 00:07:13,693 [TJ] And there's a high chance for a screw misplacement. 165 00:07:13,694 --> 00:07:15,738 At the C1-C2 spinal cord, that could be severe. 166 00:07:15,739 --> 00:07:18,699 - [sighs] - Both have risks. 167 00:07:19,351 --> 00:07:20,527 It's your call, Gina. 168 00:07:22,442 --> 00:07:25,270 [soft music playing] 169 00:07:28,448 --> 00:07:30,580 Do the minimally invasive fusion. 170 00:07:30,624 --> 00:07:31,886 I'll go explain to Walter. 171 00:07:34,932 --> 00:07:36,847 So... 172 00:07:38,283 --> 00:07:40,198 I've got full-blown leukemia. 173 00:07:41,373 --> 00:07:42,462 May I see? 174 00:07:46,117 --> 00:07:48,729 My belief is that the steroids 175 00:07:48,730 --> 00:07:50,643 artificially raised your white blood cell count, 176 00:07:50,644 --> 00:07:53,429 hiding the degree of marrow infiltration, 177 00:07:53,473 --> 00:07:56,476 and I spoke to Dr. Rose, and he agrees. 178 00:07:56,519 --> 00:08:00,088 Now, if this goes unchecked, your decline will be rapid. 179 00:08:00,089 --> 00:08:02,263 So, we'd like to start induction chemotherapy, 180 00:08:02,264 --> 00:08:04,484 which could buy you a few extra months. 181 00:08:04,527 --> 00:08:06,398 This shows a pancytopenic picture 182 00:08:06,442 --> 00:08:09,314 without any sign of leukocytosis. 183 00:08:09,315 --> 00:08:12,142 Yes. As I just said, the steroids are complicating things. 184 00:08:12,143 --> 00:08:15,016 Her leukemia has an atypical presentation, 185 00:08:15,059 --> 00:08:17,758 but we need to act fast before it progresses. 186 00:08:17,801 --> 00:08:20,891 Or her presentation is atypical because it's not leukemia. 187 00:08:20,935 --> 00:08:22,110 Amy. 188 00:08:22,153 --> 00:08:24,852 Her counts are dropping across every line. 189 00:08:24,853 --> 00:08:27,418 That looks like marrow failure, not marrow takeover. 190 00:08:27,419 --> 00:08:29,508 You're reading too much into the blast count. 191 00:08:29,509 --> 00:08:31,815 No, I'm looking at the facts in front of us. 192 00:08:31,859 --> 00:08:34,949 She doesn't show cancer on a peripheral smear. 193 00:08:34,950 --> 00:08:38,473 If this is pancytopenia, we could give platelets and plasma to raise her levels. 194 00:08:38,474 --> 00:08:41,085 Blast proliferation and dysplasia 195 00:08:41,129 --> 00:08:43,218 are textbook signs of leukemia. 196 00:08:43,219 --> 00:08:45,567 And delaying treatment because of wishful thinking 197 00:08:45,568 --> 00:08:48,266 will cost you significant time. 198 00:08:48,310 --> 00:08:52,227 Or, if he's wrong, the chemo will damage all your organs. 199 00:08:52,270 --> 00:08:54,142 I believe this is Joan's decision. 200 00:08:59,060 --> 00:09:00,191 Start the chemo. 201 00:09:03,064 --> 00:09:04,761 I'll put the orders in. 202 00:09:10,027 --> 00:09:11,463 You're brilliant, Amy, 203 00:09:11,464 --> 00:09:13,029 and I know you don't want this to be true, 204 00:09:13,030 --> 00:09:16,773 but I can't... 205 00:09:16,817 --> 00:09:20,037 I can't lose any more time with my family. 206 00:09:22,953 --> 00:09:24,651 Yeah. 207 00:09:34,486 --> 00:09:36,619 Mom, any soreness in the incision? 208 00:09:36,663 --> 00:09:39,013 Oh, it was routine surgery, I'm fine. 209 00:09:39,056 --> 00:09:40,754 Where's John? 210 00:09:40,797 --> 00:09:43,539 [sighs] He's here, having a smoke. 211 00:09:43,583 --> 00:09:45,541 Surprised you didn't go with him. 212 00:09:45,542 --> 00:09:47,629 Believe me, if I thought I could get away with it. 213 00:09:47,630 --> 00:09:49,153 Not on my watch. 214 00:09:49,197 --> 00:09:51,678 Oh, I know, Dr. Larsen. 215 00:09:51,721 --> 00:09:53,854 Not yet, Mom. 216 00:09:53,855 --> 00:09:55,942 Speaking of which, you should get back to Minneapolis. 217 00:09:55,943 --> 00:09:58,593 No, it's fine. Dr. Ridley is away for a couple of weeks, 218 00:09:58,598 --> 00:10:01,668 - so I finally get a little bit of breathing room. - Who's that? 219 00:10:01,688 --> 00:10:04,429 I've mentioned her, like, six times. 220 00:10:04,473 --> 00:10:06,997 Genius surgeon, Doctors Without Borders, 221 00:10:07,041 --> 00:10:10,174 - utterly terrifying- - Alright. Her. 222 00:10:10,175 --> 00:10:12,088 Everybody wants her to be their mentor 223 00:10:12,089 --> 00:10:13,961 but she travels around so much, 224 00:10:13,962 --> 00:10:15,918 I don't think she ever slows down enough to do that. 225 00:10:15,919 --> 00:10:17,616 What do you even need a mentor for? 226 00:10:17,617 --> 00:10:19,706 You want something, you get it. 227 00:10:19,707 --> 00:10:21,837 Always been that way, barely even needed to push you. 228 00:10:21,838 --> 00:10:24,548 Well, there were times I could have used some pushing. 229 00:10:28,192 --> 00:10:29,672 Amy. 230 00:10:29,716 --> 00:10:31,674 - Hey. - Hi. 231 00:10:31,718 --> 00:10:33,458 I got here as fast as I could. 232 00:10:33,502 --> 00:10:35,591 - She's stable now. - Phew! 233 00:10:35,635 --> 00:10:38,638 She's pretty drowsy from the chemo meds. 234 00:10:38,681 --> 00:10:40,988 Right. Okay. 235 00:10:43,294 --> 00:10:47,516 - Amy, Joan's co-ag panels came back. - Mmm-hmm. 236 00:10:48,343 --> 00:10:50,127 She has DIC. 237 00:10:50,128 --> 00:10:52,085 If we had pushed platelets like you wanted, 238 00:10:52,086 --> 00:10:54,976 the runaway clotting could have caused a massive stroke. 239 00:10:56,568 --> 00:10:58,701 I know how hard this is for you, 240 00:10:58,745 --> 00:11:01,008 but you're gonna have to let me do my job. 241 00:11:06,230 --> 00:11:08,842 Ethan. I'm Dr. Miller. 242 00:11:08,885 --> 00:11:10,670 - Hi. - It's good to meet you. 243 00:11:15,631 --> 00:11:17,720 So, rounds are done. What's next? 244 00:11:17,764 --> 00:11:19,722 Well, your partner in crime's 245 00:11:19,723 --> 00:11:21,462 sitting vigil for a friend in the ICU. 246 00:11:21,463 --> 00:11:22,593 Have you checked in on her? 247 00:11:22,594 --> 00:11:24,814 I didn't want to invade her space. 248 00:11:24,858 --> 00:11:27,295 It's always better to extend yourself. 249 00:11:27,296 --> 00:11:29,209 Trust me, she's gonna let you know if it's unwanted. 250 00:11:29,210 --> 00:11:30,951 Oh, I'm sure she will. 251 00:11:30,994 --> 00:11:32,735 So, as Chief Resident, 252 00:11:32,736 --> 00:11:34,344 you've gotta be able to work with anyone. 253 00:11:34,345 --> 00:11:36,738 Is there anybody else, anything you gotta get ahead of? 254 00:11:36,739 --> 00:11:38,698 I don't know if you ever noticed, 255 00:11:38,741 --> 00:11:40,700 but Liz kind of had a thing for TJ. 256 00:11:40,701 --> 00:11:44,050 Yeah, she wasn't exactly subtle about it. Why, what's the problem? 257 00:11:44,051 --> 00:11:45,269 I... 258 00:11:46,531 --> 00:11:48,055 So, you and TJ? 259 00:11:49,578 --> 00:11:51,319 Wow, okay. 260 00:11:51,320 --> 00:11:53,363 I guess I missed that. How long has that been going on? 261 00:11:53,364 --> 00:11:56,411 Not very, and you of all people don't get to judge. 262 00:11:56,412 --> 00:11:58,760 I'm just not sure how everyone else will react. 263 00:11:58,761 --> 00:12:00,458 Well, listen. 264 00:12:00,459 --> 00:12:02,808 I mean, you can't control how people feel about you, okay? 265 00:12:02,809 --> 00:12:08,031 All you can do is show everyone that you're gonna be there for them when things get tough. 266 00:12:08,075 --> 00:12:10,555 Ah, Dr. Hamda. Do you have a minute? 267 00:12:10,599 --> 00:12:12,409 Of course, yeah. Come in, have a seat. 268 00:12:15,038 --> 00:12:16,605 Um... 269 00:12:16,648 --> 00:12:19,521 I know I should have said something sooner. 270 00:12:19,564 --> 00:12:22,219 I think I was just too afraid 271 00:12:22,220 --> 00:12:23,567 that no one was gonna take me seriously. 272 00:12:23,568 --> 00:12:26,397 It's okay, Liz. What is it? 273 00:12:28,704 --> 00:12:29,966 Dr. Miller. 274 00:12:30,010 --> 00:12:31,402 What he did to me. 275 00:12:31,403 --> 00:12:34,013 Everyone's just pretending like nothing happened, 276 00:12:34,014 --> 00:12:35,885 but it was an abuse of power. 277 00:12:38,670 --> 00:12:43,327 I appreciate your honesty, and I understand how you feel. 278 00:12:43,371 --> 00:12:46,417 Not how I feel. It's what happened. 279 00:12:48,071 --> 00:12:51,031 Nobody condones what Dr. Miller did, 280 00:12:51,074 --> 00:12:52,684 but an agreement was reached. 281 00:12:52,728 --> 00:12:55,209 - What agreement? - I'm afraid I can't discuss it. 282 00:12:55,252 --> 00:12:57,062 So you won't tell me what happened? 283 00:12:59,387 --> 00:13:01,137 It was a confidential settlement. 284 00:13:02,172 --> 00:13:03,783 I'm sorry, Liz. 285 00:13:05,132 --> 00:13:06,916 I guess this just proves why 286 00:13:06,960 --> 00:13:10,150 I never should have bothered coming forward in the first place. 287 00:13:17,971 --> 00:13:19,407 [TJ] CT confirms location, 288 00:13:19,408 --> 00:13:21,016 we're clear of the vertebral artery. 289 00:13:21,017 --> 00:13:22,888 [Dr. Costa] Advancing cannula into position. 290 00:13:22,889 --> 00:13:24,804 [cell phone buzzing] 291 00:13:28,677 --> 00:13:30,026 Hey, babe. 292 00:13:30,070 --> 00:13:33,203 Okay. So, I nearly had to sell my body for it, 293 00:13:33,247 --> 00:13:35,858 but Spoon and Stable finally called me back. 294 00:13:35,859 --> 00:13:39,078 - They had a cancellation? - I told them it was our anniversary, 295 00:13:39,079 --> 00:13:41,646 and they said they could squeeze us in at 6:00. 296 00:13:41,690 --> 00:13:43,387 Can you make that work? 297 00:13:43,388 --> 00:13:45,127 Well, looks like I'm gonna have to. 298 00:13:45,128 --> 00:13:46,607 No way we're missing out on those oysters. 299 00:13:46,608 --> 00:13:50,177 So, there's a chance I may need to swing back here. 300 00:13:50,220 --> 00:13:53,223 Oh no. Is it that boy you told me about? 301 00:13:53,224 --> 00:13:55,529 Found a pretty serious issue with his spine, 302 00:13:55,530 --> 00:13:58,663 - he's in surgery now. - Oh honey, that's terrible. 303 00:13:58,707 --> 00:14:01,623 Are the social workers being helpful? 304 00:14:01,624 --> 00:14:03,624 Not really. I had to make the decision myself 305 00:14:03,625 --> 00:14:04,886 about what surgery he should have. 306 00:14:04,887 --> 00:14:07,411 Okay, I know it's not my lane, 307 00:14:07,455 --> 00:14:10,371 and I love you for being the person who cares this much. 308 00:14:10,414 --> 00:14:12,982 But the last time you got this invested in a case- 309 00:14:13,026 --> 00:14:15,550 He has no one, Wendy. 310 00:14:15,593 --> 00:14:17,117 I have no choice. 311 00:14:17,118 --> 00:14:21,860 [Ethan] Well, she told me about the prednisone, 312 00:14:21,861 --> 00:14:25,171 said it landed her here a lot sooner than she would have otherwise. 313 00:14:25,516 --> 00:14:28,345 Yeah. She is strong-willed. 314 00:14:28,389 --> 00:14:31,261 That's what we love about her. 315 00:14:31,305 --> 00:14:33,916 She probably felt like she had no choice. 316 00:14:33,960 --> 00:14:37,006 You know, after I told her I didn't want to see her, 317 00:14:37,050 --> 00:14:39,791 what else did she have besides work? 318 00:14:39,835 --> 00:14:43,230 And now, Robbie may never even get to know her. 319 00:14:43,273 --> 00:14:45,928 She knew that making things right with you was on her. 320 00:14:46,755 --> 00:14:47,805 Not you. 321 00:14:49,279 --> 00:14:51,629 All you can do now is be there for each other. 322 00:14:56,286 --> 00:14:57,635 [door opening] 323 00:15:08,995 --> 00:15:12,215 [ominous music playing] 324 00:15:16,219 --> 00:15:18,352 What did you do? 325 00:15:20,267 --> 00:15:23,661 She was fine. She was just fine an hour ago. 326 00:15:23,705 --> 00:15:25,098 What did you do? 327 00:15:25,099 --> 00:15:27,055 It's not their fault. She had a heart attack. 328 00:15:27,056 --> 00:15:29,319 Nobody could have seen this coming. 329 00:15:34,498 --> 00:15:38,241 Amy. Uh, how is Joan doing? 330 00:15:38,285 --> 00:15:43,246 Um, she's stable for now. On chemo. 331 00:15:43,247 --> 00:15:46,292 I'm sure this must be hard for you. If there's anything I can- 332 00:15:46,293 --> 00:15:48,512 Something's escalating in there. 333 00:15:48,556 --> 00:15:50,819 [equipment beeping] 334 00:15:50,862 --> 00:15:52,603 Her temperature's dropping. 335 00:15:52,604 --> 00:15:56,041 Yeah, core temp can drop after starting chemotherapy, it's normal. 336 00:15:56,042 --> 00:15:58,392 But it can also be a sign of sepsis. 337 00:15:58,435 --> 00:16:01,264 No, all of her cultures were negative. 338 00:16:02,048 --> 00:16:03,527 Is that true? 339 00:16:03,571 --> 00:16:05,616 Yes, of course that's true. 340 00:16:05,660 --> 00:16:08,315 And you should know that Dr. Larsen 341 00:16:08,316 --> 00:16:10,272 recommended a course of treatment earlier 342 00:16:10,273 --> 00:16:12,144 that could have been catastrophic for your mother. 343 00:16:12,145 --> 00:16:15,409 So, I don't think that it is a good idea 344 00:16:15,452 --> 00:16:17,082 for friends to treat each other. 345 00:16:20,805 --> 00:16:24,175 I admire your mom, but I can be objective, and that's what she needs. 346 00:16:27,247 --> 00:16:28,335 He's right. 347 00:16:29,336 --> 00:16:30,990 Sorry, Ethan. 348 00:16:39,085 --> 00:16:40,477 - Hey. - Hey. 349 00:16:40,478 --> 00:16:42,174 Do you have any of Joan Ridley's blood left over? 350 00:16:42,175 --> 00:16:43,959 Yeah, we should have some extra. 351 00:16:43,960 --> 00:16:45,220 Can you run a beta-D-glucan? 352 00:16:45,221 --> 00:16:47,354 All her cultures came back negative. 353 00:16:47,397 --> 00:16:48,833 What are you looking for? 354 00:16:48,877 --> 00:16:51,358 I want to rule out an invasive fungal infection. 355 00:16:51,359 --> 00:16:53,141 Something in the endothelial tissue. 356 00:16:53,142 --> 00:16:54,926 You got it. 357 00:16:54,970 --> 00:16:58,582 And uh, when you're done, can you get me the results directly? 358 00:16:58,626 --> 00:17:00,628 Says Dr. Miller's assigned. 359 00:17:00,671 --> 00:17:01,890 He is. 360 00:17:03,065 --> 00:17:06,329 I need this, Carin. Please. 361 00:17:07,330 --> 00:17:08,380 Sure. 362 00:17:08,381 --> 00:17:12,073 - [cell phone vibrates] - Hey, how's it going? 363 00:17:12,074 --> 00:17:15,947 Hey. I'm at the school, apparently Mia got into a fight. 364 00:17:17,166 --> 00:17:18,559 Let me guess, with Logan? 365 00:17:18,560 --> 00:17:20,342 I haven't had a chance to talk to her about it, 366 00:17:20,343 --> 00:17:21,561 but figured we should do it together. 367 00:17:21,562 --> 00:17:23,346 Can I bring her by the hospital? 368 00:17:23,390 --> 00:17:24,652 Shouldn't take too long. 369 00:17:24,695 --> 00:17:26,745 Yeah, yeah, of course. Um, yeah, I'm here. 370 00:17:33,400 --> 00:17:35,837 [young Amy] She killed herself, Gina. 371 00:17:35,880 --> 00:17:38,622 All those times I begged her to quit smoking. 372 00:17:38,666 --> 00:17:41,669 Her blood pressure was through the roof, 373 00:17:41,712 --> 00:17:43,453 it was only a matter of time. 374 00:17:43,454 --> 00:17:46,716 You can't keep fixating on what could have gone differently. Okay? 375 00:17:46,717 --> 00:17:48,892 All you can do now is start to process your pain. 376 00:17:48,893 --> 00:17:50,678 What makes you think I haven't? 377 00:17:50,679 --> 00:17:53,245 It's been a week and a half. You still haven't cried. 378 00:17:53,246 --> 00:17:56,162 Crying won't fix anything. 379 00:17:56,205 --> 00:17:58,686 I'm not saying force it, okay? 380 00:17:58,729 --> 00:18:00,688 But just let yourself feel. 381 00:18:00,731 --> 00:18:04,344 This is only gonna get worse once you're an actual shrink, isn't it? 382 00:18:04,387 --> 00:18:07,086 That's neuropsychiatrist, thank you very much. 383 00:18:08,565 --> 00:18:10,306 I just need to focus on school. 384 00:18:10,350 --> 00:18:14,180 And maybe that hot bartender from Stanton. 385 00:18:14,223 --> 00:18:15,703 I'm serious, Amy. 386 00:18:15,746 --> 00:18:18,662 You're in grief and mad at your mom. 387 00:18:18,663 --> 00:18:20,010 You can't just push all that away. 388 00:18:20,011 --> 00:18:23,058 - Why not? - 'Cause when it comes to feelings, 389 00:18:23,102 --> 00:18:24,668 the piper has to get paid. 390 00:18:24,712 --> 00:18:26,105 One way or another. 391 00:18:30,326 --> 00:18:32,937 [cell phone vibrating] 392 00:18:35,070 --> 00:18:36,941 Hey. 393 00:18:36,942 --> 00:18:39,160 Just checking on you. Joan's BP and O2 SATs are improving. 394 00:18:39,161 --> 00:18:41,163 Chemo must be having an effect. 395 00:18:41,207 --> 00:18:43,948 I guess Richard was right. About the leukemia. 396 00:18:43,992 --> 00:18:46,342 At least we have a diagnosis. Where are you? 397 00:18:46,386 --> 00:18:49,650 Uh, I'm in Radiology with another patient. 398 00:18:49,693 --> 00:18:51,826 - I'll be back soon. - Okay. 399 00:18:54,481 --> 00:18:56,178 We won't be mad, honey. 400 00:18:56,222 --> 00:18:58,659 We just want you to tell us what happened. 401 00:18:58,702 --> 00:19:01,618 Logan was throwing markers at me. 402 00:19:01,619 --> 00:19:04,359 I thought we said when he did stuff like that, you would tell the teacher. 403 00:19:04,360 --> 00:19:06,841 I did. But he didn't stop. 404 00:19:06,884 --> 00:19:10,105 So I took my chocolate pudding 405 00:19:10,149 --> 00:19:12,281 and I dumped it on his head. 406 00:19:12,325 --> 00:19:14,283 [giggling] 407 00:19:14,327 --> 00:19:16,677 Um, so, what happened? 408 00:19:16,678 --> 00:19:18,504 You told the teacher and they didn't do anything about it? 409 00:19:18,505 --> 00:19:20,202 They had him sit in the big chair. 410 00:19:20,246 --> 00:19:21,812 What's the big chair? 411 00:19:21,856 --> 00:19:24,119 It's a big, comfy chair in the corner, 412 00:19:24,163 --> 00:19:26,556 where you sit and think about what you did. 413 00:19:26,600 --> 00:19:28,558 So, like a timeout. 414 00:19:28,602 --> 00:19:31,953 Okay, but, uh, last week, when you won the spelling bee, 415 00:19:31,954 --> 00:19:34,128 you said you got to sit in a big, comfy chair. 416 00:19:34,129 --> 00:19:36,784 Yeah. You sit in it if you do something good. 417 00:19:36,827 --> 00:19:40,831 But then, sometimes, you sit in it if you do something bad. 418 00:19:42,074 --> 00:19:45,792 I want her out of that school, Rache. Okay? 419 00:19:45,793 --> 00:19:47,750 There's the public school, there's the Hebrew school 420 00:19:47,751 --> 00:19:49,710 we toured, I don't care which one. 421 00:19:49,711 --> 00:19:52,320 I just think that she needs to be somewhere with more boundaries and grit, 422 00:19:52,321 --> 00:19:54,851 and fewer participation trophies and big chairs. 423 00:19:55,194 --> 00:19:56,673 Okay. 424 00:19:56,717 --> 00:19:58,980 - Okay what? - Okay, you're right. 425 00:19:59,023 --> 00:20:01,896 I'm wrong. Let's move her. 426 00:20:01,897 --> 00:20:04,550 Hold it, did you just tell me I was right about something? 427 00:20:04,551 --> 00:20:06,466 [laughing] 428 00:20:06,509 --> 00:20:08,207 And if you play your cards right, 429 00:20:08,250 --> 00:20:10,078 it might even happen again. 430 00:20:12,689 --> 00:20:13,739 I'll take her home? 431 00:20:14,300 --> 00:20:15,518 Yeah, yeah. 432 00:20:24,875 --> 00:20:25,925 Are you alright? 433 00:20:27,574 --> 00:20:29,053 [sobbing] 434 00:20:29,097 --> 00:20:30,620 Uh... Yeah. 435 00:20:32,535 --> 00:20:37,018 I'm just realizing how little power I have here. 436 00:20:41,588 --> 00:20:43,111 What happened? 437 00:20:45,113 --> 00:20:47,942 There's nothing to be done about it, Sonya. 438 00:20:47,985 --> 00:20:50,510 No, no. I'm gonna be Chief Resident, 439 00:20:50,553 --> 00:20:52,773 which means I can advocate. 440 00:21:00,259 --> 00:21:01,651 [sighs] 441 00:21:01,695 --> 00:21:03,784 [Richard] And this is unprofessional. 442 00:21:03,785 --> 00:21:06,742 You were never going to test for this, Richard, and it's positive. 443 00:21:06,743 --> 00:21:08,091 You were not gonna listen to me. 444 00:21:08,092 --> 00:21:09,571 Well, that was my call to make- 445 00:21:09,572 --> 00:21:11,399 Do you wanna tell me what's going on here? 446 00:21:11,400 --> 00:21:14,141 - She ran a test behind my back. - That is hardly the headline here. 447 00:21:14,142 --> 00:21:16,362 Joan has a Candida organ infection, 448 00:21:16,363 --> 00:21:17,753 which he wouldn't have caught. 449 00:21:17,754 --> 00:21:20,103 I'm assuming you're interested in treating this, 450 00:21:20,104 --> 00:21:21,931 even though I was the one who found it. 451 00:21:21,932 --> 00:21:23,891 Alright, alright. That's enough. 452 00:21:23,892 --> 00:21:26,109 Clearly, the chemo lowered her immune response, 453 00:21:26,110 --> 00:21:28,111 decrease the dosage for now and treat the infection. 454 00:21:28,112 --> 00:21:30,042 But we are still on the right path here. 455 00:21:33,248 --> 00:21:36,904 You know, I might be more inclined to hear you, 456 00:21:36,947 --> 00:21:39,863 if you weren't so concerned with putting me in my place. 457 00:21:42,953 --> 00:21:46,914 He was never gonna order the panel. Out of spite. 458 00:21:46,915 --> 00:21:48,958 - If you needed backup- - Which is it, Michael? 459 00:21:48,959 --> 00:21:50,699 I'm supposed to come to you because you want to help? 460 00:21:50,700 --> 00:21:52,876 Or I'm not supposed to come to 461 00:21:52,920 --> 00:21:55,052 you because I put you in a tough position, 462 00:21:55,053 --> 00:21:56,357 because I've heard it both ways. 463 00:21:56,358 --> 00:21:58,273 I am Chief now, of your department. 464 00:21:58,274 --> 00:22:01,449 That's a lot different than running two floors up to talk to the CMO. 465 00:22:01,450 --> 00:22:03,104 And by the way, you lied. 466 00:22:03,105 --> 00:22:04,278 Told me you were in Radiology, 467 00:22:04,279 --> 00:22:06,150 on our first day working together. 468 00:22:10,677 --> 00:22:12,113 You're right. I'm sorry. 469 00:22:13,897 --> 00:22:15,899 I'm, I'm uh... 470 00:22:15,943 --> 00:22:20,077 Every time I look at Joan in that bed, all I see is... 471 00:22:20,904 --> 00:22:22,210 Your mom. 472 00:22:22,253 --> 00:22:23,864 [sighs] 473 00:22:26,910 --> 00:22:28,540 I wish you'd been there for that. 474 00:22:28,956 --> 00:22:30,174 I'm here now. 475 00:22:31,350 --> 00:22:32,742 I know. 476 00:22:32,786 --> 00:22:34,657 Try to hold on to that. 477 00:22:38,400 --> 00:22:40,054 [moaning] 478 00:22:40,055 --> 00:22:42,360 - Oh, I think he's waking up. - Walter, can you hear me? 479 00:22:42,361 --> 00:22:44,101 It hurts. Please, it hurts. 480 00:22:44,145 --> 00:22:47,278 - Blood pressure's spiking. - Walter, try to breathe. 481 00:22:47,279 --> 00:22:49,541 - My neck, it hurts so bad! - Two milligrams IV morphine, stat. 482 00:22:49,542 --> 00:22:51,195 Where in the neck? 483 00:22:51,196 --> 00:22:53,371 Why can't I move my hands? What's happening? 484 00:22:53,372 --> 00:22:56,382 It's okay, Walter. That can sometimes happen with swelling. 485 00:22:57,376 --> 00:22:58,812 He lost his Babinski. 486 00:22:58,813 --> 00:23:02,162 So, the spinal cord's not sending a signal? 487 00:23:02,163 --> 00:23:03,685 [TJ] Costa's running a CT to confirm, 488 00:23:03,686 --> 00:23:05,992 but it seems the cord swelling is causing compression. 489 00:23:05,993 --> 00:23:07,777 He's on morphine for the pain, 490 00:23:07,778 --> 00:23:09,604 but he's got serious neurological deficits. 491 00:23:09,605 --> 00:23:11,172 No movement below the neck. 492 00:23:11,173 --> 00:23:13,391 The sooner we can get back in and operate, the better. 493 00:23:13,392 --> 00:23:15,872 But his lungs are still inflamed from the RA. 494 00:23:15,873 --> 00:23:18,091 He may not be able to take another round of anesthesia. 495 00:23:18,092 --> 00:23:20,049 Dr. Costa's booked an OR for first thing in the morning. 496 00:23:20,050 --> 00:23:21,661 Anything longer than that, 497 00:23:21,662 --> 00:23:23,618 then he could have serious neurological issues permanently. 498 00:23:23,619 --> 00:23:24,967 We should have been more aggressive. 499 00:23:24,968 --> 00:23:26,898 We can't Monday morning quarterback. 500 00:23:26,899 --> 00:23:28,318 The surgeon gave you two choices. 501 00:23:28,319 --> 00:23:30,233 And I picked the safer one, because I was worried 502 00:23:30,234 --> 00:23:31,844 Walter doesn't have the long term support 503 00:23:31,845 --> 00:23:33,542 to go for what was really needed. 504 00:23:33,543 --> 00:23:35,325 - It was a coin toss, Gina. - No, it wasn't. 505 00:23:35,326 --> 00:23:37,196 You wanted to go for the other option. 506 00:23:37,197 --> 00:23:39,373 So Costa waffled. It should not have been up to you. 507 00:23:39,374 --> 00:23:40,548 No, it shouldn't have been. 508 00:23:40,549 --> 00:23:42,419 So let me take this off your plate now. 509 00:23:42,421 --> 00:23:44,466 Tell Costa I want Walter 510 00:23:44,467 --> 00:23:46,249 in reverse Trendelenburg during the operation, 511 00:23:46,250 --> 00:23:48,295 and to use lung protective ventilation 512 00:23:48,296 --> 00:23:49,776 with low tidal volume. 513 00:23:53,170 --> 00:23:55,172 He may never walk again, Michael. 514 00:23:58,611 --> 00:24:01,657 Induction chemo did a number on me. 515 00:24:01,701 --> 00:24:03,964 Well, you're almost through the first dose. 516 00:24:04,007 --> 00:24:06,357 But we found an invasive fungal infection, 517 00:24:06,401 --> 00:24:07,794 presumptive Candida. 518 00:24:07,795 --> 00:24:09,838 We're, we're treating it with antifungals. 519 00:24:09,839 --> 00:24:11,972 Candida. 520 00:24:12,015 --> 00:24:13,930 Must have seeded in my liver. 521 00:24:13,974 --> 00:24:16,367 No, not the liver. 522 00:24:16,368 --> 00:24:18,194 It's likely diffused endothelial, 523 00:24:18,195 --> 00:24:20,241 given the high beta-D-glucan level. 524 00:24:20,284 --> 00:24:23,157 Did you finish your homework? 525 00:24:23,200 --> 00:24:25,638 Is your father... Is your father home yet? 526 00:24:25,681 --> 00:24:27,727 - [Ethan] Mom? - Joan? Look at me. 527 00:24:27,770 --> 00:24:30,360 - [Ethan] What's wrong with her? - Ethan, step back. 528 00:24:30,361 --> 00:24:32,644 - [groaning] - [Ethan] What's happening? 529 00:24:32,645 --> 00:24:34,255 [Amy] She's seizing. 530 00:24:34,298 --> 00:24:35,952 [Richard] Oxygen at 10 liters. 531 00:24:35,996 --> 00:24:38,651 Altered mental status, it's gotta be neurological. 532 00:24:38,694 --> 00:24:40,957 Increased ICP, her brain's swelling. 533 00:24:40,958 --> 00:24:43,045 If she had leukemia, this wouldn't be happening. 534 00:24:43,046 --> 00:24:44,570 - Not this fast. - You're right. 535 00:24:44,613 --> 00:24:45,873 We're missing something. 536 00:24:50,750 --> 00:24:52,926 Look, I know whatever decisions were made 537 00:24:52,927 --> 00:24:55,754 about bringing Dr. Miller back are way above my pay grade, 538 00:24:55,755 --> 00:24:58,060 but we can't just ask Liz to forget what happened 539 00:24:58,061 --> 00:25:00,062 'cause it'll make life easier for everyone else. 540 00:25:00,063 --> 00:25:03,414 I'm going to talk to Richard once Joan is stabilized. 541 00:25:03,458 --> 00:25:06,200 I'm sure he'll be willing to apologize to Liz. 542 00:25:06,243 --> 00:25:10,204 His apology is gonna be hollow and meaningless. 543 00:25:10,205 --> 00:25:12,248 And you should know, when Dr. Miller was Chief, 544 00:25:12,249 --> 00:25:16,253 he tried to use me to find out mistakes Amy was making. 545 00:25:16,297 --> 00:25:19,474 Look, I'm sorry you ended up in the middle of that. 546 00:25:19,518 --> 00:25:22,172 But, um, I know the board. 547 00:25:22,173 --> 00:25:23,956 They'd rather find a way to get rid of Liz 548 00:25:23,957 --> 00:25:25,654 than reopen this can of worms. 549 00:25:25,698 --> 00:25:28,483 Well, they can try, but if Liz starts talking, 550 00:25:28,484 --> 00:25:30,397 they're gonna get blowback from the nurses 551 00:25:30,398 --> 00:25:31,718 and potentially the union. 552 00:25:31,747 --> 00:25:33,619 Is, uh... Is that a threat? 553 00:25:33,662 --> 00:25:35,359 It's a reality. 554 00:25:35,403 --> 00:25:38,145 I'm just trying to do the right thing for her, 555 00:25:38,188 --> 00:25:41,017 and protect the department, which is part of my job now. 556 00:25:41,061 --> 00:25:44,151 She bears responsibility for her own decisions, Sonya. 557 00:25:44,194 --> 00:25:46,283 As you said, she has a very strong union 558 00:25:46,284 --> 00:25:48,241 she could have gone to when all this happened. 559 00:25:48,242 --> 00:25:50,286 I think, maybe, you're expecting too much, 560 00:25:50,287 --> 00:25:54,074 or not understanding the dynamic between an older man with power 561 00:25:54,117 --> 00:25:56,903 and a young woman at the start of her career. 562 00:25:56,946 --> 00:26:00,384 It's blaming the victim, and I don't think it'll be appreciated. 563 00:26:00,428 --> 00:26:02,952 - I do hear you. - Well, good. 564 00:26:02,953 --> 00:26:07,086 Because you started the day by saying your door was open, 565 00:26:07,087 --> 00:26:09,568 but now it seems like you're closing it on Liz. 566 00:26:13,528 --> 00:26:16,618 [man speaking Spanish over laptop] 567 00:26:16,662 --> 00:26:18,315 The MDS is late-stage, 568 00:26:18,359 --> 00:26:21,492 but it's obscured by high steroid usage. 569 00:26:21,536 --> 00:26:23,886 Pancytopenia, pleural effusions, 570 00:26:23,930 --> 00:26:26,454 DIC, elevated beta-D-glucan, 571 00:26:26,497 --> 00:26:29,979 and now cerebral edema, and she's getting worse. 572 00:26:30,023 --> 00:26:33,069 Hey, just checked in on Joan. How you holding up? 573 00:26:33,113 --> 00:26:35,985 I've been going toe to toe with Richard all day, 574 00:26:35,986 --> 00:26:37,551 and now we're running out of time. 575 00:26:37,552 --> 00:26:38,901 Who's this? 576 00:26:38,945 --> 00:26:40,381 Um, he's a doctor in Madrid 577 00:26:40,424 --> 00:26:42,992 who has a case study that might be relevant 578 00:26:43,036 --> 00:26:45,560 and this translation app keeps glitching. 579 00:26:45,604 --> 00:26:47,736 Um, I mean, I minored in Spanish, 580 00:26:47,780 --> 00:26:50,173 - we could see how rusty I am. - Okay. 581 00:26:52,480 --> 00:26:56,092 [speaking Spanish] 582 00:27:25,861 --> 00:27:27,994 Gracias.So, what he's saying 583 00:27:27,995 --> 00:27:29,603 is that the symptoms were similar, 584 00:27:29,604 --> 00:27:31,774 but his patient had dormant sarcoidosis, 585 00:27:31,775 --> 00:27:33,868 so that was complicating the clinical picture. 586 00:27:33,869 --> 00:27:36,610 But once they found that, everything else just fell into place. 587 00:27:36,611 --> 00:27:39,395 So a patient with MDS like Joan presented with these symptoms 588 00:27:39,396 --> 00:27:41,921 because of a different chronic issue. 589 00:27:41,964 --> 00:27:43,792 And it went undetected for years. 590 00:27:43,836 --> 00:27:46,055 Okay, okay. Thanks. 591 00:27:46,099 --> 00:27:48,101 Just remember you gotta find a way 592 00:27:48,144 --> 00:27:49,537 to work with Richard on this. 593 00:27:52,235 --> 00:27:54,107 Your spinal tap came back negative 594 00:27:54,150 --> 00:27:55,717 and a full neuro panel too. 595 00:27:55,761 --> 00:27:58,024 Well, her procalcitonin is low, 596 00:27:58,025 --> 00:27:59,546 even though she just had an infection. 597 00:27:59,547 --> 00:28:01,244 I need total protein, 598 00:28:01,245 --> 00:28:03,419 C-reactive protein and complement levels. 599 00:28:03,420 --> 00:28:05,684 - How fast can you do that? - 20 minutes. 600 00:28:05,727 --> 00:28:08,469 And if the results can go to me, since I'm her doctor, 601 00:28:08,512 --> 00:28:09,775 that'd be appreciated. 602 00:28:12,342 --> 00:28:14,693 We've got a high complement protein level, 603 00:28:14,694 --> 00:28:17,607 and the prednisone must have dropped her immune surveillance, 604 00:28:17,608 --> 00:28:20,306 which means that we're looking for something that's been there, 605 00:28:20,307 --> 00:28:22,744 possibly for years, like you said, 606 00:28:22,745 --> 00:28:24,266 but that's been hiding in plain sight. 607 00:28:24,267 --> 00:28:26,139 When Joan woke up, 608 00:28:26,140 --> 00:28:27,487 and I told her about the Candida, 609 00:28:27,488 --> 00:28:28,923 she asked if it seeded in her liver. 610 00:28:28,924 --> 00:28:30,446 [Richard] Well, that wouldn't be uncommon. 611 00:28:30,447 --> 00:28:32,580 But the beta-D-glucan is so high, 612 00:28:32,581 --> 00:28:34,102 the fungal load would be too large 613 00:28:34,103 --> 00:28:35,714 to be isolated to her liver. 614 00:28:35,715 --> 00:28:38,367 Okay. We've been assuming that the elevated liver enzymes 615 00:28:38,368 --> 00:28:42,024 are caused by the MDS and the prednisone, 616 00:28:42,068 --> 00:28:44,635 but look at her blood work going back to 2016. 617 00:28:44,636 --> 00:28:48,029 [Richard] Higher range than normal. 618 00:28:48,030 --> 00:28:49,596 But low enough that nobody would flag it. 619 00:28:49,597 --> 00:28:51,773 2016, 620 00:28:51,817 --> 00:28:55,646 that's a long time for her to be carrying something. 621 00:28:55,690 --> 00:28:59,128 Wait a minute. One of the last memories I have of her, 622 00:28:59,172 --> 00:29:00,913 2016, she was in Ecuador. 623 00:29:00,956 --> 00:29:04,786 And she got sick, and I told her that she should come back. 624 00:29:04,830 --> 00:29:08,007 And she self-diagnosed, 625 00:29:08,050 --> 00:29:09,922 she thought it was dysentery- 626 00:29:09,923 --> 00:29:11,836 Which means she was drinking unfiltered water. 627 00:29:11,837 --> 00:29:14,274 So, if it was a parasite, 628 00:29:14,275 --> 00:29:16,754 she could have been sick while she was digesting it, 629 00:29:16,755 --> 00:29:20,019 but by the time it migrated to her liver, she was fine. 630 00:29:20,020 --> 00:29:22,237 Then she could have been fighting this quietly for years. 631 00:29:22,238 --> 00:29:23,935 And the prednisone weakened her immune system, 632 00:29:23,936 --> 00:29:25,633 and unleashed it on her. 633 00:29:28,157 --> 00:29:30,072 I think we have a path now. 634 00:29:32,485 --> 00:29:35,773 [TJ] He's losing sympathetic tone. 635 00:29:35,774 --> 00:29:39,081 Surgery's set for 6:00 a.m, can we up the steroids? 636 00:29:39,082 --> 00:29:40,690 Too worried about his blood pressure. 637 00:29:40,691 --> 00:29:42,214 Think we just have to stay the course 638 00:29:42,215 --> 00:29:44,385 and hope that he's strong enough to hold on. 639 00:29:46,262 --> 00:29:48,482 I appreciate what you said before. 640 00:29:48,525 --> 00:29:50,223 Trying to let me off the hook. 641 00:29:51,485 --> 00:29:53,313 You religious at all? 642 00:29:53,356 --> 00:29:54,967 From time to time, 643 00:29:55,010 --> 00:29:58,405 depending on how I'm feeling about the world. 644 00:29:58,448 --> 00:30:00,842 I remember going to this sermon once. 645 00:30:00,886 --> 00:30:04,715 The minister was talking about how it can be a form of hubris 646 00:30:04,716 --> 00:30:06,412 to think that we can control things 647 00:30:06,413 --> 00:30:08,415 that are out of our control. 648 00:30:09,982 --> 00:30:12,462 'Cause that's somebody else's domain? 649 00:30:12,463 --> 00:30:14,376 [TJ] Doesn't mean it's easy to accept it. 650 00:30:14,377 --> 00:30:16,162 But I think that's the idea, yeah. 651 00:30:17,859 --> 00:30:20,149 I'll take that under advisement, Dr. Coleman. 652 00:30:20,166 --> 00:30:21,254 Good. 653 00:30:25,780 --> 00:30:26,830 Your wife's here. 654 00:30:29,131 --> 00:30:30,959 [gasps] 655 00:30:31,003 --> 00:30:32,693 It's my anniversary and I forgot. 656 00:30:32,700 --> 00:30:34,745 You go. I am all over this, 657 00:30:34,789 --> 00:30:36,835 hourly exams, I will not go home. 658 00:30:43,015 --> 00:30:45,713 I've been downstairs 15 minutes, tried calling you. 659 00:30:45,756 --> 00:30:48,585 I'm sorry. There were problems with Walter's surgery, 660 00:30:48,629 --> 00:30:51,110 he needs another one tomorrow. 661 00:30:51,111 --> 00:30:53,241 Why don't we have dinner in your office tonight? 662 00:30:53,242 --> 00:30:57,638 - [sighs] - That way, if anything happens, you're close. 663 00:30:57,681 --> 00:30:59,466 What did I do to deserve you? 664 00:30:59,509 --> 00:31:01,250 I don't know. 665 00:31:01,294 --> 00:31:03,464 I'm sure you'll find a way to make it up to me. 666 00:31:05,037 --> 00:31:07,561 I'm thinking 400 milligrams albendazole. 667 00:31:08,301 --> 00:31:10,172 I'd go 300, 668 00:31:10,216 --> 00:31:12,783 given the ALT/AST, 669 00:31:12,827 --> 00:31:15,047 and 20 of Ampho B to balance it out. 670 00:31:15,090 --> 00:31:17,092 And 100 milligrams of cimetidine 671 00:31:17,136 --> 00:31:18,396 to cut the renal toxicity. 672 00:31:19,878 --> 00:31:21,227 It's a tightrope. 673 00:31:21,270 --> 00:31:23,185 Any idea where Liz is? 674 00:31:23,229 --> 00:31:24,621 Uh, let's see. 675 00:31:24,665 --> 00:31:26,536 [woman over PA] Code Blue, ICU. 676 00:31:27,668 --> 00:31:28,756 Joan's coding. 677 00:31:29,844 --> 00:31:32,281 Code Blue, ICU. 678 00:31:32,325 --> 00:31:33,587 Code Blue, ICU. 679 00:31:33,630 --> 00:31:36,764 - [equipment beeping] - No pulse. 680 00:31:36,807 --> 00:31:39,817 He's in V-fib. Push one milligram Epi. Get the defibrillator. 681 00:31:45,729 --> 00:31:47,109 [defibrillator charging] 682 00:31:48,689 --> 00:31:50,439 - [defibrillator beeps] - Ready? 683 00:31:51,474 --> 00:31:52,998 Clear. 684 00:31:54,303 --> 00:31:56,871 [equipment beeping] 685 00:31:56,915 --> 00:31:58,786 Restarting compressions. 686 00:32:06,837 --> 00:32:09,623 Danny, Danny. Someone call 911. 687 00:32:11,190 --> 00:32:12,321 [Gina] Charge to 50. 688 00:32:13,975 --> 00:32:15,585 Clear. 689 00:32:18,153 --> 00:32:20,416 [ECG long beep] 690 00:32:20,460 --> 00:32:22,853 Pushing another milligram of Epi. 691 00:32:29,512 --> 00:32:31,688 Fine V-fib, we're losing him. 692 00:32:31,732 --> 00:32:33,995 Going up to 100. Give me the paddles. 693 00:32:38,478 --> 00:32:40,262 - Ready. - Clear. 694 00:32:47,617 --> 00:32:50,229 [equipment beeping] 695 00:32:50,272 --> 00:32:51,491 Looks like Sinus. 696 00:32:51,534 --> 00:32:54,233 We have a pulse. He's back. 697 00:32:54,276 --> 00:32:56,931 Page Dr. Costa, we can't wait on the surgery. 698 00:33:01,805 --> 00:33:06,332 [soft music playing] 699 00:33:19,998 --> 00:33:21,782 [Dr. Costa] Cord is decompressed. 700 00:33:21,825 --> 00:33:25,612 Screws are seated. Let's secure the rods. 701 00:33:26,439 --> 00:33:27,831 Hey. 702 00:33:31,487 --> 00:33:34,099 That must have been really difficult for you. 703 00:33:35,187 --> 00:33:36,492 Yeah. 704 00:33:37,798 --> 00:33:40,453 And a hell of a first day for Michael. 705 00:33:40,496 --> 00:33:43,064 Oh, it hit pretty close to home. 706 00:33:44,935 --> 00:33:46,372 How's it going in there? 707 00:33:46,415 --> 00:33:47,895 Hardware's almost in place. 708 00:33:47,938 --> 00:33:50,376 But even if it works, 709 00:33:50,419 --> 00:33:52,552 no one's ever gonna adopt him. 710 00:33:52,595 --> 00:33:54,945 Not when he needs this kind of support. 711 00:33:56,991 --> 00:33:58,297 [sighs] 712 00:33:58,340 --> 00:34:01,561 You're not thinking of doing something drastic? 713 00:34:03,215 --> 00:34:04,564 Go and be with Joan. 714 00:34:05,478 --> 00:34:06,957 Gina. 715 00:34:08,350 --> 00:34:11,005 I care about him, 716 00:34:11,049 --> 00:34:14,313 but I know what the boundaries are. 717 00:34:14,356 --> 00:34:16,880 Now go, where you're needed. 718 00:34:19,840 --> 00:34:23,757 [equipment beeping] 719 00:34:28,725 --> 00:34:32,808 - But you've gotta quit smoking. - [scoffs] 720 00:34:32,809 --> 00:34:34,979 You know that's never gonna happen, honey. 721 00:34:38,902 --> 00:34:41,340 I don't know how much more we can pump into her 722 00:34:41,383 --> 00:34:43,690 before she starts shutting down. 723 00:34:43,733 --> 00:34:46,127 Her body's so fragile. 724 00:34:48,521 --> 00:34:51,263 The chemo didn't help with that. 725 00:34:51,306 --> 00:34:53,569 She was only on it for eight hours. 726 00:34:55,441 --> 00:34:57,182 The parasite is causing this, 727 00:34:57,225 --> 00:35:00,098 that and the prednisone, it's not on you, Richard. 728 00:35:02,752 --> 00:35:05,320 [somber music playing] 729 00:35:11,196 --> 00:35:12,371 [sighs] 730 00:35:19,813 --> 00:35:21,771 [imperceptible] 731 00:35:38,310 --> 00:35:40,094 Hey. It's okay, buddy. 732 00:35:50,974 --> 00:35:52,933 Can I see? 733 00:35:55,762 --> 00:35:58,112 Aw, she's gonna love this. 734 00:36:01,463 --> 00:36:03,335 Is she gonna wake up soon? 735 00:36:03,378 --> 00:36:05,772 I really hope so. 736 00:36:12,474 --> 00:36:15,260 [equipment beeping slowly] 737 00:36:17,871 --> 00:36:20,090 [cell phone ringing] 738 00:36:21,527 --> 00:36:22,702 Hello? 739 00:36:22,745 --> 00:36:24,255 [Joan] Hi, Amy. It's Dr. Ridley. 740 00:36:25,139 --> 00:36:27,881 Oh. Hi. 741 00:36:27,924 --> 00:36:29,752 I hope it's not 2:00 a.m. there, 742 00:36:29,753 --> 00:36:31,971 I stopped tracking time zone differences ages ago. 743 00:36:31,972 --> 00:36:35,149 No, it's noon. Is there a problem? 744 00:36:35,193 --> 00:36:38,383 I spoke with Dr. Kelly this morning, he told me about your mother. 745 00:36:39,675 --> 00:36:42,678 I'm just so sorry, Amy. 746 00:36:42,722 --> 00:36:46,421 - Thank you, Dr. Ridley. - And I respect your tenacity, 747 00:36:46,422 --> 00:36:48,292 already being back in the hospital, 748 00:36:48,293 --> 00:36:51,251 but I just wanted to make sure you're taking care of yourself. 749 00:36:51,252 --> 00:36:53,298 I think so. 750 00:36:55,343 --> 00:36:56,997 It's... 751 00:36:57,040 --> 00:37:00,087 It's been hard, obviously. 752 00:37:00,130 --> 00:37:02,437 [Joan] Your world shifted on its axis. 753 00:37:02,481 --> 00:37:04,570 But you will come out the other side. 754 00:37:04,613 --> 00:37:06,180 I just... 755 00:37:07,486 --> 00:37:09,792 didn't even think you liked me. 756 00:37:09,836 --> 00:37:11,826 [Joan] Well, that's by design, my dear. 757 00:37:11,838 --> 00:37:14,057 And now you know the truth. 758 00:37:14,101 --> 00:37:17,626 Not only do I like you, I believe in you. 759 00:37:19,715 --> 00:37:22,892 Thank you so much. I- 760 00:37:22,893 --> 00:37:25,024 [Joan] I know how bad this hurts right now, 761 00:37:25,025 --> 00:37:28,288 but the best way that you can honor your mother is to live a life with purpose. 762 00:37:28,289 --> 00:37:31,336 You have greatness in you, Amy. 763 00:37:31,379 --> 00:37:33,860 And I'll be there to help you find it. 764 00:37:41,737 --> 00:37:44,305 [murmuring indistinctly] 765 00:37:44,871 --> 00:37:46,394 Joan. 766 00:37:46,438 --> 00:37:49,702 Hey. Can you hear me? 767 00:37:49,745 --> 00:37:53,009 Can you get her son? He just went to get coffee. 768 00:37:54,446 --> 00:37:57,536 Hey. It's okay. 769 00:37:57,579 --> 00:38:00,234 Just go slow. Breathe. 770 00:38:02,932 --> 00:38:05,631 - What happened? - You had cerebral edema. 771 00:38:05,674 --> 00:38:07,241 No. 772 00:38:07,285 --> 00:38:10,026 It's not leukemia. 773 00:38:10,070 --> 00:38:11,550 Not yet. 774 00:38:11,593 --> 00:38:14,074 You had a parasite in your liver. 775 00:38:14,117 --> 00:38:17,338 From Ecuador. Do you remember that? 776 00:38:17,382 --> 00:38:19,297 You thought it was dysentery? 777 00:38:19,949 --> 00:38:22,430 Oh my God. 778 00:38:22,474 --> 00:38:26,260 Is that the one time in my life I misdiagnosed? 779 00:38:26,304 --> 00:38:28,262 [laughing] 780 00:38:33,746 --> 00:38:36,276 You haven't looked after yourself for a long time. 781 00:38:38,446 --> 00:38:39,752 I know. 782 00:38:39,795 --> 00:38:42,102 Promise me that stops now. 783 00:38:42,145 --> 00:38:44,017 Ah. 784 00:38:44,060 --> 00:38:47,325 - Mom. Hey. - Hey. 785 00:38:48,282 --> 00:38:50,197 [Ethan] Thanks so much, Amy. 786 00:38:52,025 --> 00:38:55,898 I'll order CBC and liver function tests. 787 00:38:59,162 --> 00:39:00,816 The fact that she's conscious- 788 00:39:00,860 --> 00:39:03,906 Yeah, we got her some more time. 789 00:39:03,950 --> 00:39:06,779 I appreciate you finding a way to trust me today. 790 00:39:08,998 --> 00:39:11,305 Yeah, it worked out today. 791 00:39:11,349 --> 00:39:13,873 But I'm never gonna trust you, Richard. 792 00:39:21,576 --> 00:39:24,623 Hey, Walter. Welcome back. 793 00:39:24,666 --> 00:39:26,146 Did you fix my spine? 794 00:39:26,189 --> 00:39:29,018 We need to run some tests over the next few days, 795 00:39:29,062 --> 00:39:31,064 but it seems that way. 796 00:39:31,107 --> 00:39:32,805 And I'll be able to walk again? 797 00:39:32,806 --> 00:39:34,371 [Gina] It's gonna be a long recovery, 798 00:39:34,372 --> 00:39:37,157 lots of physical therapy as your body adjusts 799 00:39:37,200 --> 00:39:39,072 to the hardware in your spine. 800 00:39:39,115 --> 00:39:41,117 But yes, you will. 801 00:39:44,904 --> 00:39:47,297 And I'll have to miss the next adoption fair? 802 00:39:48,429 --> 00:39:51,563 There'll be lots more. I promise. 803 00:39:51,606 --> 00:39:53,303 Thank you, Dr. Walker. 804 00:39:53,347 --> 00:39:55,828 Nobody ever cared the way you do. 805 00:39:59,745 --> 00:40:01,834 [Gina] I am so sorry. 806 00:40:01,877 --> 00:40:04,619 It's okay. We'll do a raincheck. 807 00:40:08,754 --> 00:40:10,451 [sighs] 808 00:40:12,279 --> 00:40:15,195 Sometimes, I wonder how you manage to leave it all here 809 00:40:15,238 --> 00:40:17,110 when you come home. 810 00:40:19,242 --> 00:40:21,070 It can be really hard. 811 00:40:22,071 --> 00:40:23,121 Yeah. 812 00:40:27,773 --> 00:40:29,122 [sighs] 813 00:40:33,169 --> 00:40:35,650 Let's go get a drink, huh? 814 00:40:35,694 --> 00:40:36,956 Yeah. 815 00:40:41,351 --> 00:40:43,223 [sighs] 816 00:40:45,704 --> 00:40:48,576 Hey. So, I spoke to Liz, 817 00:40:48,620 --> 00:40:51,187 and told her if she wants to come forward to HR, 818 00:40:51,231 --> 00:40:53,451 we would both have her back. 819 00:40:53,494 --> 00:40:56,671 Thank you. Oh, and I'm sorry if I was too- 820 00:40:56,715 --> 00:40:59,848 Sonya, speaking truth to power takes courage. 821 00:40:59,892 --> 00:41:01,850 I should be thanking you. 822 00:41:03,069 --> 00:41:05,332 Sorry, I didn't mean to interrupt. 823 00:41:05,375 --> 00:41:07,029 Oh no, I was just leaving. 824 00:41:07,073 --> 00:41:09,336 Actually, I was hoping to speak to you. 825 00:41:10,376 --> 00:41:15,254 I just wanted to thank you for checking in earlier. 826 00:41:15,255 --> 00:41:18,388 - Joan's improving. - I heard, that's great news. 827 00:41:20,347 --> 00:41:22,915 So we're gonna do this thing? Together? 828 00:41:22,958 --> 00:41:24,656 Well, it's what she wants. 829 00:41:24,699 --> 00:41:26,614 She tends to get what she wants. 830 00:41:26,658 --> 00:41:28,007 Yeah. 831 00:41:33,055 --> 00:41:36,058 I saw Joan, she's spunky as ever. 832 00:41:36,102 --> 00:41:38,365 Can't keep that lady down. 833 00:41:39,932 --> 00:41:41,934 - Amen to that. - Yeah. 834 00:41:41,977 --> 00:41:44,893 - [TJ] Goodnight, Jake. - Hey. Goodnight, man. 835 00:41:50,812 --> 00:41:53,467 Hey, did you know about him and Sonya? 836 00:41:53,511 --> 00:41:54,642 What about them? 837 00:41:55,730 --> 00:41:57,819 - No. - Yeah. 838 00:41:57,863 --> 00:41:59,517 [chuckling] 839 00:41:59,560 --> 00:42:01,431 I guess we set a good example. 840 00:42:01,475 --> 00:42:03,085 [chuckling] 841 00:42:07,525 --> 00:42:09,614 I heard your family was here today. 842 00:42:09,657 --> 00:42:11,441 Yeah. Um... 843 00:42:11,485 --> 00:42:13,748 Mia, she got in trouble at school, it was, 844 00:42:13,792 --> 00:42:15,542 uh, I don't know... It was ridiculous. 845 00:42:17,099 --> 00:42:20,407 Maybe you can tell me all about it on the way home? 846 00:42:22,191 --> 00:42:24,977 Yeah, sure thing, Chief. I can do that. 847 00:42:26,065 --> 00:42:28,328 It's Co-Chief. 848 00:42:28,371 --> 00:42:31,157 Co-Chief. I'm sorry, that's just so awkward to say. 849 00:42:31,200 --> 00:42:33,768 [chuckles] I know, tell me about it. 850 00:42:33,812 --> 00:42:35,422 Co-Chief. 851 00:42:35,465 --> 00:42:39,557 ["Take Me Home" playing] 852 00:42:39,600 --> 00:42:43,343 ? Did that fancy college Art school let you in? ? 853 00:42:44,997 --> 00:42:47,565 ? Well damn it they'd be crazy ? 854 00:42:47,608 --> 00:42:50,132 ? If they never saw in you ? 855 00:42:50,176 --> 00:42:53,353 ? What I failed to see at 17 ? 856 00:42:53,396 --> 00:42:55,790 ? I must've missed it too ? 857 00:42:55,834 --> 00:42:58,227 ? Oh, kiss me ? 858 00:42:58,271 --> 00:43:00,839 ? Kiss me slowly ? 859 00:43:00,882 --> 00:43:05,583 ? Like you did When we were young ? 860 00:43:07,149 --> 00:43:11,545 ? And hold me Like you know me ? 861 00:43:11,589 --> 00:43:14,069 ? Like the old days ? 862 00:43:14,113 --> 00:43:18,813 ? Take me home ? 863 00:43:22,295 --> 00:43:26,125 [theme music playing] 864 00:43:26,175 --> 00:43:30,725 Repair and Synchronization by Easy Subtitles Synchronizer 1.0.0.0