1 00:00:01,830 --> 00:00:03,470 Dr. Larsen was in a car accident, 2 00:00:03,470 --> 00:00:05,070 she has no recollection of the last eight years. 3 00:00:05,070 --> 00:00:06,470 Previously on Doc. 4 00:00:06,470 --> 00:00:08,380 - Let me run Internal Medicine. - Back to your roots. 5 00:00:08,380 --> 00:00:10,480 When you need time to work out things with Michael, 6 00:00:10,480 --> 00:00:12,820 I accept it, but when the shoe's on the other foot... 7 00:00:12,820 --> 00:00:13,990 When the shoe's on the other foot, 8 00:00:13,990 --> 00:00:15,390 you have a hard time telling me the truth. 9 00:00:15,390 --> 00:00:17,060 Delayed decisions on his care 10 00:00:17,060 --> 00:00:18,460 have been hurting him a long time. 11 00:00:18,460 --> 00:00:20,500 You don't have to tell me the system's broken. 12 00:00:20,500 --> 00:00:23,240 How much prednisone does it take to get you through a shift? 13 00:00:23,240 --> 00:00:25,050 You will flame out in weeks. 14 00:00:25,050 --> 00:00:26,850 It's time for you to use your greatness 15 00:00:26,850 --> 00:00:28,850 to pull the greatness out of others. 16 00:00:28,850 --> 00:00:30,820 I'm going to miss you. 17 00:00:43,080 --> 00:00:44,990 - Sorry. This guy loves his sleep. 18 00:00:44,990 --> 00:00:48,660 - Oh, there he is. Hey, can I have a hug? 19 00:00:49,790 --> 00:00:52,030 Oh my goodness, this is yummy. 20 00:00:52,030 --> 00:00:54,470 Ethan was sorry to miss you, he had a really early meeting. 21 00:00:54,470 --> 00:00:56,640 Well, Robbie's the main event, right? 22 00:00:56,640 --> 00:00:59,980 What fabulous holiday have they cancelled school for this time? 23 00:00:59,980 --> 00:01:01,150 It's Lunar New Year. 24 00:01:01,150 --> 00:01:02,960 Oh, well. 25 00:01:04,220 --> 00:01:05,530 Grandma's been all over the world. 26 00:01:05,530 --> 00:01:07,970 You know, she could probably teach you to say hello 27 00:01:07,970 --> 00:01:09,200 in 50 different languages. 28 00:01:09,200 --> 00:01:11,070 67, but who's counting? 29 00:01:11,070 --> 00:01:12,540 I should be back around six. 30 00:01:12,540 --> 00:01:14,080 And thanks so much for doing this. 31 00:01:14,080 --> 00:01:16,080 - Are you kidding? The more time I get to spend 32 00:01:16,080 --> 00:01:17,120 with this little man, the better. 33 00:01:17,120 --> 00:01:18,890 Oh. Brought you donuts, 34 00:01:18,890 --> 00:01:20,420 your dad said they're your favorite. 35 00:01:20,420 --> 00:01:22,230 Thanks, Grandma. 36 00:01:28,000 --> 00:01:29,470 Joan, you okay? 37 00:01:31,480 --> 00:01:32,310 I'm fine. 38 00:01:34,850 --> 00:01:36,860 Robbie, why don't you go upstairs? 39 00:01:36,860 --> 00:01:38,760 Oh my God. 40 00:01:38,760 --> 00:01:40,800 - Grandma! - Joan? 41 00:01:40,800 --> 00:01:41,870 Grandma! 42 00:02:07,350 --> 00:02:08,790 Good morning, everyone. 43 00:02:08,790 --> 00:02:10,190 Morning. 44 00:02:10,190 --> 00:02:12,830 This is going to be an adjustment for all of us. 45 00:02:12,830 --> 00:02:15,000 Dr. Ridley certainly left some big shoes to fill, 46 00:02:15,000 --> 00:02:18,400 and I know all these leadership changes the past year 47 00:02:18,400 --> 00:02:21,180 have probably been unsteadying. 48 00:02:21,180 --> 00:02:24,020 There are a lot of reasons why 49 00:02:24,020 --> 00:02:26,760 I wanted to practice medicine again, 50 00:02:26,760 --> 00:02:29,030 but I want to be very clear about the reason I asked 51 00:02:29,030 --> 00:02:31,100 to sit in that chair. 52 00:02:31,100 --> 00:02:33,430 The past year as your CMO, 53 00:02:33,430 --> 00:02:35,070 I have seen what every person 54 00:02:35,070 --> 00:02:37,040 standing in this room is capable of. 55 00:02:37,040 --> 00:02:38,780 Dr. Miller. 56 00:02:38,780 --> 00:02:40,580 Time and again, you have risen to the occasion. 57 00:02:40,580 --> 00:02:42,790 We have a sixty-two year old female 58 00:02:42,790 --> 00:02:44,090 in respiratory failure. 59 00:02:44,090 --> 00:02:45,990 Complications from chronic MDS. 60 00:02:45,990 --> 00:02:47,130 I'm on my way down. 61 00:02:47,130 --> 00:02:49,470 I'm not here just to lead you, 62 00:02:49,470 --> 00:02:53,610 I want to join you, and help you do what you already do so well. 63 00:02:53,610 --> 00:02:57,250 An issue, a problem, a suggestion, 64 00:02:57,250 --> 00:02:59,350 my door will always be open. 65 00:02:59,350 --> 00:03:03,060 Before we go, some congratulations are in order. 66 00:03:03,060 --> 00:03:05,270 In two weeks, Dr. Maitra 67 00:03:05,270 --> 00:03:07,840 and Dr. Larsen will succeed Dr. Heller 68 00:03:07,840 --> 00:03:08,770 as Chief Residents, 69 00:03:08,770 --> 00:03:12,110 as we welcome our new class of interns. 70 00:03:15,390 --> 00:03:16,890 Uh, now, if you both 71 00:03:16,890 --> 00:03:18,990 could hang back for a moment with Dr. Heller. 72 00:03:18,990 --> 00:03:21,430 The rest of you, do good work. 73 00:03:24,770 --> 00:03:27,740 I'd like our co-chiefs to shadow you 74 00:03:27,740 --> 00:03:29,950 before you start your pediatric fellowship. 75 00:03:29,950 --> 00:03:31,120 You can begin with Dr. Maitra 76 00:03:31,120 --> 00:03:32,550 this morning, and then alternate days. 77 00:03:32,550 --> 00:03:34,860 - Yeah. Sounds like a plan. - Great. 78 00:03:38,830 --> 00:03:40,400 It's quite a move. 79 00:03:40,400 --> 00:03:42,370 Well, it was either this 80 00:03:42,370 --> 00:03:43,980 or a leather jacket and a motorcycle. 81 00:03:50,890 --> 00:03:52,290 Joan's in the ER. 82 00:03:52,860 --> 00:03:55,400 Paramedic said she was extremely short of breath, 83 00:03:55,400 --> 00:03:57,740 likely bilateral pleural effusions. 84 00:03:57,740 --> 00:03:59,410 So is she hypoxic? 85 00:03:59,410 --> 00:04:02,710 Oxygenations improved on the mask, but she's hypotensive. 86 00:04:02,710 --> 00:04:05,450 Let's push Norepi MAP goal above 65. 87 00:04:05,450 --> 00:04:07,160 No, Richard, that's not gonna work. 88 00:04:07,160 --> 00:04:08,730 - I'm sorry? - She's on prednisone. 89 00:04:08,730 --> 00:04:10,960 30 milligrams and she's tapered off, I read her chart. 90 00:04:10,960 --> 00:04:13,770 No, her chart's wrong, she's on way more than that. 91 00:04:15,610 --> 00:04:18,810 I've been using it to get through the surgery. 92 00:04:19,780 --> 00:04:21,420 You knew about this? 93 00:04:22,590 --> 00:04:25,530 How much has she been taking? 94 00:04:26,160 --> 00:04:27,500 Double that. 95 00:04:30,270 --> 00:04:32,640 Triple to get through the ex... 96 00:04:32,640 --> 00:04:34,440 vivo with Javi. 97 00:04:34,440 --> 00:04:38,920 My natural cortisol production's gotta be shot. 98 00:04:40,290 --> 00:04:43,190 Okay. Lucy, 100 milligram bolus 99 00:04:43,190 --> 00:04:45,330 of hydrocortisone before pressors. 100 00:04:45,330 --> 00:04:47,400 And run a complete lab workup. 101 00:04:48,610 --> 00:04:51,080 We're all here if you need anything, Joan. 102 00:04:54,920 --> 00:04:55,990 Should I call Ethan? 103 00:04:57,860 --> 00:04:58,960 He's on his way. 104 00:04:58,960 --> 00:05:02,900 But Amy, I need you to remember, 105 00:05:02,900 --> 00:05:04,610 I have a DNR. 106 00:05:04,610 --> 00:05:07,810 Joan, no, we're nowhere near that. 107 00:05:12,090 --> 00:05:13,820 Shh. 108 00:05:18,670 --> 00:05:20,640 Good morning, Dr. Walker. 109 00:05:20,640 --> 00:05:24,010 - Good morning to you, Walter. How's our rocket holding up? 110 00:05:24,010 --> 00:05:25,510 Can't wait to launch it. 111 00:05:25,510 --> 00:05:26,820 You think I can still leave today? 112 00:05:26,820 --> 00:05:29,250 Gotta examine you first, can't let you out of here 113 00:05:29,250 --> 00:05:30,820 till we're sure you're all better. 114 00:05:30,820 --> 00:05:33,130 I really want to show the rocket 115 00:05:33,130 --> 00:05:34,700 to the kids at the house. 116 00:05:34,700 --> 00:05:36,870 I bet. Looks like that thing might actually make it to space. 117 00:05:36,870 --> 00:05:39,070 Do you ever launch rockets with your kids? 118 00:05:39,070 --> 00:05:41,610 - I don't have any. - Really? 119 00:05:42,280 --> 00:05:44,250 I thought about it when I was younger, 120 00:05:44,250 --> 00:05:46,120 but decided to take a different path. 121 00:05:46,120 --> 00:05:47,290 What do you mean? 122 00:05:47,290 --> 00:05:48,660 Well, being a parent's a big commitment. 123 00:05:48,660 --> 00:05:52,000 But that's also true for being a friend, a sister, 124 00:05:52,000 --> 00:05:54,640 an aunt, especially a doctor. 125 00:05:54,640 --> 00:05:57,540 Eventually, I figured if I gave my best 126 00:05:57,540 --> 00:06:00,150 to all those other things, that'd be enough for me. 127 00:06:00,150 --> 00:06:01,850 - You're a great doctor. - Hmm. 128 00:06:01,850 --> 00:06:05,560 - That she is, buddy. Sorry I'm late, how's he doing? 129 00:06:05,560 --> 00:06:08,570 - Well, breathing's much better. Let's look at those knees. 130 00:06:11,070 --> 00:06:14,540 Oh. How long has your leg been moving like that? 131 00:06:14,540 --> 00:06:16,680 Happens all the time with my RA. 132 00:06:16,680 --> 00:06:18,720 It shouldn't be now, with the medication you're on. 133 00:06:18,720 --> 00:06:20,520 - Yeah, I'll order a CT. - Well, that's bad. 134 00:06:20,520 --> 00:06:22,560 Just need to see what's going on. 135 00:06:22,560 --> 00:06:24,160 We'll get it sorted out, though. 136 00:06:24,160 --> 00:06:26,170 Time to find your social worker. 137 00:06:26,170 --> 00:06:28,040 Again? 138 00:06:28,840 --> 00:06:31,550 Atlantoaxial instability this severe will progress fast. 139 00:06:31,550 --> 00:06:33,080 We have to operate now. 140 00:06:33,080 --> 00:06:34,980 We don't have the go ahead from his proxy. 141 00:06:34,980 --> 00:06:37,320 Well, his C1 and C2 are compressing his spinal cord. 142 00:06:37,320 --> 00:06:38,860 What's everybody waiting for? 143 00:06:38,860 --> 00:06:41,000 The social worker said he'd sign off on whatever we decide, 144 00:06:41,000 --> 00:06:43,540 but he doesn't want to get in the weeds. 145 00:06:43,540 --> 00:06:44,740 Well, that makes things tricky, 146 00:06:44,740 --> 00:06:46,240 cause we have two surgical routes. 147 00:06:46,240 --> 00:06:49,450 High risk, high reward, open the neck, expose the vertebra, 148 00:06:49,450 --> 00:06:51,020 place the corrective hardware directly. 149 00:06:51,020 --> 00:06:53,290 But you're concerned about arterial or spinal cord trauma? 150 00:06:53,290 --> 00:06:56,630 Not to mention stroke, infection, ventral cord damage. 151 00:06:56,630 --> 00:06:58,630 Plus, he's still recovering from lung inflammation. 152 00:06:58,630 --> 00:07:00,140 Definitely a concern. 153 00:07:00,140 --> 00:07:02,870 And the second option is minimally invasive fusion? 154 00:07:02,870 --> 00:07:04,610 Far less trauma and easier recovery. 155 00:07:04,610 --> 00:07:06,480 But wouldn't we be relying on CT for navigation? 156 00:07:06,480 --> 00:07:08,720 Which means less precision with the hardware? 157 00:07:08,720 --> 00:07:10,190 Yeah, it may require going back in, 158 00:07:10,190 --> 00:07:11,590 in six months or a year. 159 00:07:11,590 --> 00:07:13,060 And there's a high chance for a screw misplacement. 160 00:07:13,060 --> 00:07:15,570 At the C1-C2 spinal cord, that could be severe. 161 00:07:16,370 --> 00:07:19,970 - Both have risks. It's your call, Gina. 162 00:07:27,890 --> 00:07:30,230 Do the minimally invasive fusion. 163 00:07:30,230 --> 00:07:31,830 I'll go explain to Walter. 164 00:07:34,740 --> 00:07:36,680 So... 165 00:07:37,740 --> 00:07:40,080 I've got full-blown leukemia. 166 00:07:41,120 --> 00:07:42,250 May I see? 167 00:07:45,630 --> 00:07:48,100 My belief is that the steroids 168 00:07:48,100 --> 00:07:50,040 artificially raised your white blood cell count, 169 00:07:50,040 --> 00:07:52,870 hiding the degree of marrow infiltration, 170 00:07:52,870 --> 00:07:55,950 and I spoke to Dr. Rose, and he agrees. 171 00:07:55,950 --> 00:07:59,620 Now, if this goes unchecked, decline will be rapid. 172 00:07:59,620 --> 00:08:01,790 So, we'd like to start induction chemotherapy, 173 00:08:01,790 --> 00:08:04,030 which could buy you a few extra months. 174 00:08:04,030 --> 00:08:05,930 This shows a pancytopenic picture 175 00:08:05,930 --> 00:08:09,140 without any sign of leukocytosis. 176 00:08:09,140 --> 00:08:10,410 Yes. As I just said, 177 00:08:10,410 --> 00:08:11,680 the steroids are complicating things. 178 00:08:11,680 --> 00:08:14,550 Her leukemia has an atypical presentation, 179 00:08:14,550 --> 00:08:17,320 but we need to act fast before it progresses. 180 00:08:17,320 --> 00:08:18,690 Or her presentation 181 00:08:18,690 --> 00:08:20,760 is atypical because it's not leukemia. 182 00:08:20,760 --> 00:08:21,700 Amy. 183 00:08:21,700 --> 00:08:23,300 Her counts are dropping 184 00:08:23,300 --> 00:08:24,970 across every line. 185 00:08:24,970 --> 00:08:26,810 That looks like marrow failure, not marrow takeover. 186 00:08:26,810 --> 00:08:28,950 You're reading too much into the blast count. 187 00:08:28,950 --> 00:08:31,220 No, I'm looking at the facts in front of us. 188 00:08:31,220 --> 00:08:34,260 She doesn't show cancer on a peripheral smear. 189 00:08:34,260 --> 00:08:36,800 If this is pancytopenia, we could give platelets 190 00:08:36,800 --> 00:08:37,960 and plasma to raise her levels. 191 00:08:37,960 --> 00:08:40,600 Blast proliferation and dysplasia 192 00:08:40,600 --> 00:08:42,810 are textbook signs of leukemia. 193 00:08:42,810 --> 00:08:45,280 And delaying treatment because of wishful thinking 194 00:08:45,280 --> 00:08:47,850 will cost you significant time. 195 00:08:47,850 --> 00:08:51,190 Or, if he's wrong, the chemo will damage all your organs. 196 00:08:51,830 --> 00:08:54,060 I believe this is Joan's decision. 197 00:08:58,570 --> 00:09:00,040 Start the chemo. 198 00:09:02,580 --> 00:09:04,620 I'll put the orders in. 199 00:09:09,560 --> 00:09:11,000 You're brilliant, Amy, 200 00:09:11,000 --> 00:09:13,330 and I know you don't want this to be true. 201 00:09:14,640 --> 00:09:16,170 But I can't. 202 00:09:16,170 --> 00:09:19,810 I can't lose any more time with my family. 203 00:09:22,820 --> 00:09:24,360 Yeah. 204 00:09:33,880 --> 00:09:36,050 Mom, any soreness in the incision? 205 00:09:36,050 --> 00:09:38,650 Oh, it was routine surgery, I'm fine. 206 00:09:38,650 --> 00:09:40,460 Where's John? 207 00:09:40,460 --> 00:09:42,990 He's here, having a smoke. 208 00:09:42,990 --> 00:09:45,030 Surprised you didn't go with him. 209 00:09:45,030 --> 00:09:47,340 Believe me, if I thought I could get away with it. 210 00:09:47,340 --> 00:09:48,670 Not on my watch. 211 00:09:48,670 --> 00:09:51,380 Oh, I know, Dr. Larsen. 212 00:09:51,380 --> 00:09:53,210 Not yet, Mom. 213 00:09:53,210 --> 00:09:55,280 Speaking of which, you should get back to Minneapolis. 214 00:09:55,280 --> 00:09:58,060 No, it's fine. Dr. Ridley is away for a couple of weeks, 215 00:09:58,060 --> 00:10:00,560 so I finally get a little bit of breathing room. 216 00:10:00,560 --> 00:10:01,930 Who's that? 217 00:10:01,930 --> 00:10:03,940 I've mentioned her, like, six times. 218 00:10:03,940 --> 00:10:06,640 Genius surgeon, Doctors Without Borders, 219 00:10:06,640 --> 00:10:09,780 utterly terrifying... - Alright. Her. 220 00:10:09,780 --> 00:10:11,620 Everybody wants her to be their mentor 221 00:10:11,620 --> 00:10:13,350 but she travels around so much, 222 00:10:13,350 --> 00:10:15,530 I don't think she ever slows down enough to do that. 223 00:10:15,530 --> 00:10:17,300 What do you even need a mentor for? 224 00:10:17,300 --> 00:10:19,100 You want something, you get it. 225 00:10:19,100 --> 00:10:21,240 Always been that way, barely even needed to push you. 226 00:10:21,240 --> 00:10:23,880 Well, there were times I could have used some pushing. 227 00:10:28,020 --> 00:10:29,420 Amy. 228 00:10:29,420 --> 00:10:31,320 - Hey. - Hi. 229 00:10:31,320 --> 00:10:33,260 I got here as fast as I could. 230 00:10:33,260 --> 00:10:35,070 She's stable now. 231 00:10:35,070 --> 00:10:38,270 She's pretty drowsy from the chemo meds. 232 00:10:38,270 --> 00:10:40,780 Right. Okay. 233 00:10:42,780 --> 00:10:46,920 Amy, Joan's co-ag panels came back. 234 00:10:48,020 --> 00:10:49,730 She has DIC. 235 00:10:49,730 --> 00:10:51,460 If we had pushed platelets like you wanted, 236 00:10:51,460 --> 00:10:54,740 the runaway clotting could have caused a massive stroke. 237 00:10:55,970 --> 00:10:58,140 I know how hard this is for you, 238 00:10:58,140 --> 00:11:00,820 but you're gonna have to let me do my job. 239 00:11:05,830 --> 00:11:08,530 Ethan. I'm Dr. Miller. 240 00:11:08,530 --> 00:11:10,330 - Hi. - It's good to meet you. 241 00:11:15,110 --> 00:11:17,350 - So, rounds are done. What's next? 242 00:11:17,350 --> 00:11:19,150 Well, your partner in crime's 243 00:11:19,150 --> 00:11:20,760 sitting vigil for a friend in the ICU. 244 00:11:20,760 --> 00:11:22,090 Have you checked in on her? 245 00:11:22,090 --> 00:11:24,260 I didn't want to invade her space. 246 00:11:24,260 --> 00:11:26,840 It's always better to extend yourself. 247 00:11:26,840 --> 00:11:28,740 Trust me, she's gonna let you know if it's unwanted. 248 00:11:28,740 --> 00:11:30,580 Oh, I'm sure she will. 249 00:11:30,580 --> 00:11:32,150 So, as Chief Resident, 250 00:11:32,150 --> 00:11:33,850 you've gotta be able to work with anyone. 251 00:11:33,850 --> 00:11:36,150 Is there anybody else, anything you gotta get ahead of? 252 00:11:36,150 --> 00:11:38,290 I don't know if you ever noticed, 253 00:11:38,290 --> 00:11:40,160 but Liz kind of had a thing for TJ. 254 00:11:40,160 --> 00:11:41,800 Yeah, she wasn't exactly subtle about it. 255 00:11:41,800 --> 00:11:43,600 Why, what's the problem? 256 00:11:43,600 --> 00:11:45,170 I... 257 00:11:46,210 --> 00:11:47,980 So, you and TJ? 258 00:11:49,310 --> 00:11:50,850 Wow, okay. 259 00:11:50,850 --> 00:11:52,890 I guess I missed that. How long has that been going on? 260 00:11:52,890 --> 00:11:55,990 Not very, and you of all people don't get to judge. 261 00:11:55,990 --> 00:11:58,460 I'm just not sure how everyone else will react. 262 00:11:58,460 --> 00:11:59,930 Well, listen. 263 00:11:59,930 --> 00:12:02,040 I mean, you can't control how people feel about you, okay? 264 00:12:02,040 --> 00:12:04,410 All you can do is show everyone that you're gonna be there 265 00:12:04,410 --> 00:12:07,020 for them when things get tough. 266 00:12:07,650 --> 00:12:10,050 - Ah, Dr. Hamda. Do you have a minute? 267 00:12:10,050 --> 00:12:12,030 - Of course, yeah. Come in, have a seat. 268 00:12:14,360 --> 00:12:18,610 I know I should have said something sooner. 269 00:12:19,040 --> 00:12:21,780 I think I was just too afraid 270 00:12:21,780 --> 00:12:23,080 that no one was gonna take me seriously. 271 00:12:23,080 --> 00:12:26,250 It's okay, Liz. What is it? 272 00:12:28,360 --> 00:12:29,560 Dr. Miller. 273 00:12:29,560 --> 00:12:30,960 What he did to me. 274 00:12:30,960 --> 00:12:33,670 Everyone's just pretending like nothing happened, 275 00:12:33,670 --> 00:12:35,870 but it was an abuse of power. 276 00:12:38,080 --> 00:12:42,950 I appreciate your honesty, and I understand how you feel. 277 00:12:42,950 --> 00:12:46,290 - Not how I feel. It's what happened. 278 00:12:47,660 --> 00:12:50,670 Nobody condones what Dr. Miller did, 279 00:12:50,670 --> 00:12:52,110 but an agreement was reached. 280 00:12:52,110 --> 00:12:54,810 - What agreement? - I'm afraid I can't discuss it. 281 00:12:54,810 --> 00:12:56,450 So you won't tell me what happened? 282 00:12:58,850 --> 00:13:00,820 It was a confidential settlement. 283 00:13:00,820 --> 00:13:03,430 I'm sorry, Liz. 284 00:13:04,100 --> 00:13:06,330 I guess this just proves why I never 285 00:13:06,330 --> 00:13:09,140 should have bothered coming forward in the first place. 286 00:13:17,620 --> 00:13:18,990 CT confirms location, 287 00:13:18,990 --> 00:13:20,500 we're clear of the vertebral artery. 288 00:13:20,500 --> 00:13:22,570 Advancing cannula into position. 289 00:13:28,310 --> 00:13:29,410 Hey, babe. 290 00:13:29,410 --> 00:13:32,750 Okay. So, I nearly had to sell my body for it, 291 00:13:32,750 --> 00:13:35,560 but Spoon and Stable finally called me back. 292 00:13:35,560 --> 00:13:37,100 They had a cancellation? 293 00:13:37,100 --> 00:13:39,600 I told them it was our anniversary, and they said 294 00:13:39,600 --> 00:13:41,440 they could squeeze us in at six. 295 00:13:41,440 --> 00:13:42,910 Can you make that work? 296 00:13:42,910 --> 00:13:44,510 Well, looks like I'm gonna have to. 297 00:13:44,510 --> 00:13:46,150 No way we're missing out on those oysters. 298 00:13:46,150 --> 00:13:49,750 So, there's a chance I may need to swing back here. 299 00:13:49,750 --> 00:13:52,790 Oh no. Is it that boy you told me about? 300 00:13:52,790 --> 00:13:55,070 Found a pretty serious issue with his spine, 301 00:13:55,070 --> 00:13:56,570 he's in surgery now. 302 00:13:56,570 --> 00:13:58,870 Oh honey, that's terrible. 303 00:13:58,870 --> 00:14:01,140 Are the social workers being helpful? 304 00:14:01,140 --> 00:14:03,050 Not really. I had to make the decision myself 305 00:14:03,050 --> 00:14:04,580 about what surgery he should have. 306 00:14:04,580 --> 00:14:06,720 Okay, I know it's not my lane, 307 00:14:06,720 --> 00:14:09,990 and I love you for being the person who cares this much. 308 00:14:09,990 --> 00:14:12,670 But the last time you got this invested in a case... 309 00:14:12,670 --> 00:14:15,070 He has no one, Wendy. 310 00:14:15,070 --> 00:14:16,970 I have no choice. 311 00:14:19,080 --> 00:14:21,320 Well, she told me about the prednisone, 312 00:14:21,320 --> 00:14:22,920 that it landed her here a lot sooner 313 00:14:22,920 --> 00:14:24,420 than she would have otherwise. 314 00:14:25,020 --> 00:14:27,930 Yeah. She is strong-willed. 315 00:14:27,930 --> 00:14:30,130 That's what we love about her. 316 00:14:30,800 --> 00:14:33,410 She probably felt like she had no choice. 317 00:14:33,410 --> 00:14:36,650 You know, I, after I told her I didn't want to see her, 318 00:14:36,650 --> 00:14:38,690 what else did she have besides work? 319 00:14:39,220 --> 00:14:41,830 And now, Robbie may never even get to know her. 320 00:14:42,590 --> 00:14:45,700 She knew that making things right with you was on her. 321 00:14:45,700 --> 00:14:47,440 Not you. 322 00:14:48,610 --> 00:14:51,380 All you can do now is be there for each other. 323 00:15:15,830 --> 00:15:18,300 What did you do? 324 00:15:19,870 --> 00:15:23,410 She was fine. She was just fine an hour ago. 325 00:15:23,410 --> 00:15:24,540 What did you do? 326 00:15:24,540 --> 00:15:26,510 - It's not their fault. She had a heart attack. 327 00:15:26,510 --> 00:15:29,150 Nobody could have seen this coming. 328 00:15:34,000 --> 00:15:37,840 Amy. Uh, how is Joan doing? 329 00:15:37,840 --> 00:15:41,710 - Um, she's stable for now. On chemo. 330 00:15:42,610 --> 00:15:45,850 I'm sure this must be hard for you. If there's anything I can... 331 00:15:45,850 --> 00:15:48,120 Something's escalating in there. 332 00:15:50,600 --> 00:15:52,100 Her temperature's dropping. 333 00:15:52,100 --> 00:15:53,970 Yeah, core temp can drop 334 00:15:53,970 --> 00:15:55,540 after starting chemotherapy, it's normal. 335 00:15:55,540 --> 00:15:57,980 But it can also be a sign of sepsis. 336 00:15:57,980 --> 00:16:01,020 No, all of her cultures were negative. 337 00:16:01,020 --> 00:16:02,290 Is that true? 338 00:16:02,290 --> 00:16:04,560 Yes, of course that's true. 339 00:16:04,560 --> 00:16:08,000 And you should know that Dr. Larsen 340 00:16:08,000 --> 00:16:09,670 recommended a course of treatment earlier 341 00:16:09,670 --> 00:16:11,540 that could have been catastrophic for your mother. 342 00:16:11,540 --> 00:16:14,980 So, I don't think that it is a good idea 343 00:16:14,980 --> 00:16:17,080 for friends to treat each other. 344 00:16:20,250 --> 00:16:22,760 I admire your mom, but I can be objective, 345 00:16:22,760 --> 00:16:24,130 and that's what she needs. 346 00:16:27,000 --> 00:16:28,270 He's right. 347 00:16:28,940 --> 00:16:30,780 Sorry, Ethan. 348 00:16:38,690 --> 00:16:39,860 - Hey. - Hey. 349 00:16:39,860 --> 00:16:41,830 Do you have any of Joan Ridley's blood left over? 350 00:16:41,830 --> 00:16:43,670 Yeah, we should have some extra. 351 00:16:43,670 --> 00:16:44,870 Can you run a beta-D-glucan? 352 00:16:44,870 --> 00:16:46,910 All her cultures came back negative. 353 00:16:46,910 --> 00:16:48,340 What are you looking for? 354 00:16:48,340 --> 00:16:50,920 I want to rule out an invasive fungal infection. 355 00:16:50,920 --> 00:16:52,750 Something in the endothelial tissue. 356 00:16:52,750 --> 00:16:54,360 You got it. 357 00:16:54,360 --> 00:16:56,230 And uh, when you're done, 358 00:16:56,230 --> 00:16:58,200 can you get me the results directly? 359 00:16:58,200 --> 00:17:00,430 Says Dr. Miller's assigned. 360 00:17:00,430 --> 00:17:01,700 He is. 361 00:17:02,770 --> 00:17:06,280 I need this, Carin. Please. 362 00:17:06,280 --> 00:17:07,550 Sure. 363 00:17:09,950 --> 00:17:11,490 Hey, how's it going? 364 00:17:11,490 --> 00:17:15,770 Hey. I'm at the school, apparently Mia got into a fight. 365 00:17:16,770 --> 00:17:18,070 Let me guess, with Logan? 366 00:17:18,070 --> 00:17:20,040 I haven't had a chance to talk to her about it, 367 00:17:20,040 --> 00:17:21,110 but figured we should do it together. 368 00:17:21,110 --> 00:17:22,950 Can I bring her by the hospital? 369 00:17:22,950 --> 00:17:24,250 Shouldn't take too long. 370 00:17:24,250 --> 00:17:26,550 - Yeah, yeah, of course. Um, yeah, I'm here. 371 00:17:33,000 --> 00:17:35,370 She killed herself, Gina. 372 00:17:35,370 --> 00:17:38,140 All those times I begged her to quit smoking. 373 00:17:38,140 --> 00:17:41,220 Her blood pressure was through the roof, 374 00:17:41,220 --> 00:17:42,690 it was only a matter of time. 375 00:17:42,690 --> 00:17:44,090 You can't keep fixating 376 00:17:44,090 --> 00:17:45,660 on what could have gone differently. Okay? 377 00:17:45,660 --> 00:17:48,400 All you can do now is start to process your pain. 378 00:17:48,400 --> 00:17:50,230 What makes you think I haven't? 379 00:17:50,230 --> 00:17:52,870 - It's been a week and a half. You still haven't cried. 380 00:17:52,870 --> 00:17:55,850 Crying won't fix anything. 381 00:17:55,850 --> 00:17:58,220 I'm not saying force it, okay? 382 00:17:58,220 --> 00:18:00,250 But just let yourself feel. 383 00:18:00,250 --> 00:18:02,090 This is only gonna get worse 384 00:18:02,090 --> 00:18:03,800 once you're an actual shrink, isn't it? 385 00:18:03,800 --> 00:18:07,100 That's neuropsychiatrist, thank you very much. 386 00:18:08,100 --> 00:18:10,010 I just need to focus on school. 387 00:18:10,010 --> 00:18:13,850 And maybe that hot bartender from Stanton. 388 00:18:13,850 --> 00:18:15,280 I'm serious, Amy. 389 00:18:15,280 --> 00:18:18,290 You're in grief and mad at your mom. 390 00:18:18,290 --> 00:18:19,730 You can't just push all that away. 391 00:18:19,730 --> 00:18:21,160 Why not? 392 00:18:21,160 --> 00:18:22,730 Cause when it comes to feelings, 393 00:18:22,730 --> 00:18:24,170 the piper has to get paid. 394 00:18:24,170 --> 00:18:26,110 One way or another. 395 00:18:34,720 --> 00:18:36,460 Hey. 396 00:18:36,460 --> 00:18:38,870 Just checking on you. Joan's BP and O2 SATs are improving. 397 00:18:38,870 --> 00:18:40,570 Chemo must be having an effect. 398 00:18:40,570 --> 00:18:43,470 - I guess Richard was right. About the leukemia. 399 00:18:43,470 --> 00:18:45,850 - At least we have a diagnosis. Where are you? 400 00:18:45,850 --> 00:18:49,290 Uh, I'm in Radiology with another patient. 401 00:18:49,290 --> 00:18:51,690 I'll be back soon. - Okay. 402 00:18:54,100 --> 00:18:56,570 We won't be mad, honey. 403 00:18:56,570 --> 00:18:58,270 We just want you to tell us what happened. 404 00:18:58,270 --> 00:19:00,510 Logan was throwing markers at me. 405 00:19:01,140 --> 00:19:02,950 I thought we said when he did stuff like that, 406 00:19:02,950 --> 00:19:04,450 you would tell the teacher. 407 00:19:04,450 --> 00:19:06,420 I did. But he didn't stop. 408 00:19:06,420 --> 00:19:09,790 So I took my chocolate pudding 409 00:19:09,790 --> 00:19:11,970 and I dumped it on his head. 410 00:19:13,940 --> 00:19:16,010 Um, so, what happened? 411 00:19:16,010 --> 00:19:18,110 You told the teacher and they didn't do anything about it? 412 00:19:18,110 --> 00:19:19,950 They had him sit in the big chair. 413 00:19:19,950 --> 00:19:21,350 What's the big chair? 414 00:19:21,350 --> 00:19:23,590 It's a big, comfy chair in the corner, 415 00:19:23,590 --> 00:19:26,230 where you sit and think about what you did. 416 00:19:26,230 --> 00:19:27,930 So, like a timeout. 417 00:19:27,930 --> 00:19:31,440 Okay, but uh, last week, when you won the spelling bee, 418 00:19:31,440 --> 00:19:33,510 you said you got to sit in a big, comfy chair. 419 00:19:33,510 --> 00:19:36,110 Yeah. You sit in it if you do something good. 420 00:19:36,110 --> 00:19:40,690 But then, sometimes, you sit in it if you do something bad. 421 00:19:43,630 --> 00:19:45,360 I want her out of that school, Rache. Okay? 422 00:19:45,360 --> 00:19:47,330 There's the public school, there's the Hebrew school 423 00:19:47,330 --> 00:19:48,870 we toured, I don't care which one. 424 00:19:48,870 --> 00:19:50,980 I just think that she needs to be somewhere 425 00:19:50,980 --> 00:19:52,250 with more boundaries and grit, 426 00:19:52,250 --> 00:19:54,420 and fewer participation trophies and big chairs. 427 00:19:54,850 --> 00:19:56,290 Okay. 428 00:19:56,290 --> 00:19:58,530 - Okay what? - Okay, you're right. 429 00:19:58,530 --> 00:20:01,400 I'm wrong. Let's move her. 430 00:20:01,400 --> 00:20:04,140 Hold it, did you just tell me I was right about something? 431 00:20:06,070 --> 00:20:07,940 And if you play your cards right, 432 00:20:07,940 --> 00:20:09,880 it might even happen again. 433 00:20:11,850 --> 00:20:13,290 I'll take her home? 434 00:20:13,290 --> 00:20:15,320 Yeah, yeah. 435 00:20:24,410 --> 00:20:25,750 Are you alright? 436 00:20:29,150 --> 00:20:30,590 Yeah. 437 00:20:31,960 --> 00:20:36,870 I'm just realizing how little power I have here. 438 00:20:40,980 --> 00:20:42,910 What happened? 439 00:20:44,580 --> 00:20:46,890 There's nothing to be done about it, Sonya. 440 00:20:47,420 --> 00:20:50,130 No, no. I'm gonna be Chief Resident, 441 00:20:50,130 --> 00:20:52,670 which means I can advocate. 442 00:21:01,320 --> 00:21:03,350 And this is unprofessional. 443 00:21:03,350 --> 00:21:05,320 You were never going to test for this, Richard, 444 00:21:05,320 --> 00:21:06,330 and it's positive. 445 00:21:06,330 --> 00:21:07,600 You were not gonna listen to me. 446 00:21:07,600 --> 00:21:08,970 Well, that was my call to make... 447 00:21:08,970 --> 00:21:10,600 Do you wanna tell me what's going on here? 448 00:21:10,600 --> 00:21:12,540 She ran a test behind my back. 449 00:21:12,540 --> 00:21:13,610 That is hardly the headline here. 450 00:21:13,610 --> 00:21:16,050 Joan has a Candida organ infection, 451 00:21:16,050 --> 00:21:17,720 which he wouldn't have caught. 452 00:21:17,720 --> 00:21:19,550 I'm assuming you're interested in treating this, 453 00:21:19,550 --> 00:21:21,460 even though I was the one who found it. 454 00:21:21,460 --> 00:21:23,430 - Alright, alright. That's enough. 455 00:21:23,430 --> 00:21:25,600 Clearly, the chemo lowered her immune response, 456 00:21:25,600 --> 00:21:27,600 decrease the dosage for now and treat the infection. 457 00:21:27,600 --> 00:21:29,840 But we are still on the right path here. 458 00:21:32,750 --> 00:21:36,450 You know, I might be more inclined to hear you, 459 00:21:36,450 --> 00:21:39,790 if you weren't so concerned with putting me in my place. 460 00:21:42,500 --> 00:21:46,440 He was never gonna order the panel. Out of spite. 461 00:21:46,440 --> 00:21:48,440 - If you needed backup... - Which is it, Michael? 462 00:21:48,440 --> 00:21:50,310 I'm supposed to come to you because you want to help? 463 00:21:50,310 --> 00:21:52,380 Or I'm not supposed to come to 464 00:21:52,380 --> 00:21:54,520 you because I put you in a tough position, 465 00:21:54,520 --> 00:21:55,760 because I've heard it both ways. 466 00:21:55,760 --> 00:21:57,960 I am Chief now, of your department. 467 00:21:57,960 --> 00:21:59,270 That's a lot different 468 00:21:59,270 --> 00:22:01,100 than running two floors up to talk to the CMO. 469 00:22:01,100 --> 00:22:02,640 And by the way, you lied. 470 00:22:02,640 --> 00:22:03,780 Told me you were in Radiology, 471 00:22:03,780 --> 00:22:05,850 on our first day working together. 472 00:22:10,250 --> 00:22:11,990 You're right. I'm sorry. 473 00:22:13,860 --> 00:22:15,530 I'm, I'm uh... 474 00:22:15,530 --> 00:22:19,810 Every time I look at Joan in that bed, all I see is... 475 00:22:20,710 --> 00:22:21,980 Your mom. 476 00:22:26,390 --> 00:22:28,090 I wish you'd been here for that. 477 00:22:28,090 --> 00:22:29,990 I'm here now. 478 00:22:31,000 --> 00:22:32,400 I know. 479 00:22:32,400 --> 00:22:34,600 Try to hold on to that. 480 00:22:39,550 --> 00:22:42,050 - Oh, I think he's waking up. - Walter, can you hear me? 481 00:22:42,050 --> 00:22:43,690 It hurts. Please, it hurts. 482 00:22:43,690 --> 00:22:47,030 - Blood pressure's spiking. - Walter, try to breathe. 483 00:22:47,030 --> 00:22:48,460 My neck, it hurts so bad! 484 00:22:48,460 --> 00:22:50,130 Two milligrams IV morphine, stat. 485 00:22:50,130 --> 00:22:51,400 Where in the neck? 486 00:22:51,400 --> 00:22:53,210 - Why can't I move my hands? What's happening? 487 00:22:53,210 --> 00:22:56,010 It's okay, Walter. That can sometimes happen with swelling. 488 00:22:56,450 --> 00:22:58,750 He lost his Babinski. 489 00:22:59,990 --> 00:23:01,590 So, the spinal cord's not sending a signal? 490 00:23:01,590 --> 00:23:02,960 Costa's running a CT to confirm, 491 00:23:02,960 --> 00:23:05,570 but it seems the cord swelling is causing compression. 492 00:23:05,570 --> 00:23:07,430 He's on morphine for the pain, 493 00:23:07,430 --> 00:23:09,270 but he's got serious neurological deficits. 494 00:23:09,270 --> 00:23:10,710 No movement below the neck. 495 00:23:10,710 --> 00:23:12,810 The sooner we can get back in and operate, the better. 496 00:23:12,810 --> 00:23:15,250 But his lungs are still inflamed from the RA. 497 00:23:15,250 --> 00:23:17,590 He may not be able to take another round of anesthesia. 498 00:23:17,590 --> 00:23:19,560 Dr. Costa's booked an OR for first thing in the morning. 499 00:23:19,560 --> 00:23:21,000 Anything longer than that, 500 00:23:21,000 --> 00:23:23,000 then he could have serious neurological issues permanently. 501 00:23:23,000 --> 00:23:24,440 We should have been more aggressive. 502 00:23:24,440 --> 00:23:26,440 We can't Monday morning quarterback. 503 00:23:26,440 --> 00:23:27,810 The surgeon gave you two choices. 504 00:23:27,810 --> 00:23:29,680 And I picked the safer one, because I was worried 505 00:23:29,680 --> 00:23:31,350 Walter doesn't have the long term support 506 00:23:31,350 --> 00:23:32,950 to go for what was really needed. 507 00:23:32,950 --> 00:23:34,820 - It was a coin toss, Gina. - No, it wasn't. 508 00:23:34,820 --> 00:23:36,730 You wanted to go for the other option. 509 00:23:36,730 --> 00:23:38,830 So Costa waffled. It should not have been up to you. 510 00:23:38,830 --> 00:23:40,000 No, it shouldn't have been. 511 00:23:40,000 --> 00:23:42,100 So let me take this off your plate now. 512 00:23:42,100 --> 00:23:43,980 Tell Costa I want Walter 513 00:23:43,980 --> 00:23:45,750 in reverse Trendelenburg during the operation, 514 00:23:45,750 --> 00:23:48,050 and to use lung protective ventilation 515 00:23:48,050 --> 00:23:49,590 with low tidal volume. 516 00:23:52,630 --> 00:23:55,060 He may never walk again, Michael. 517 00:23:58,240 --> 00:24:01,140 Induction chemo did a number on me. 518 00:24:01,140 --> 00:24:03,580 Well, you're almost through the first dose. 519 00:24:03,580 --> 00:24:06,090 But we found an invasive fungal infection, 520 00:24:06,090 --> 00:24:07,360 presumptive Candida. 521 00:24:07,360 --> 00:24:09,060 We're, we're treating it with antifungals. 522 00:24:09,060 --> 00:24:11,100 Candida. 523 00:24:11,100 --> 00:24:13,500 Must have seeded in my liver. 524 00:24:13,500 --> 00:24:15,810 No, not the liver. 525 00:24:15,810 --> 00:24:17,640 It's likely diffused endothelial, 526 00:24:17,640 --> 00:24:19,810 given the high beta-D-glucan level. 527 00:24:19,810 --> 00:24:22,020 Did you finish your homework? 528 00:24:22,650 --> 00:24:25,260 Is your father, is your father home yet? 529 00:24:25,260 --> 00:24:27,390 - Mom? - Joan? Look at me. 530 00:24:27,390 --> 00:24:29,970 - What's wrong with her? - Ethan, step back. 531 00:24:30,770 --> 00:24:32,270 What's happening? 532 00:24:32,270 --> 00:24:33,770 She's seizing. 533 00:24:33,770 --> 00:24:35,550 Oxygen at 10 liters. 534 00:24:35,550 --> 00:24:38,350 Altered mental status, it's gotta be neurological. 535 00:24:38,350 --> 00:24:40,560 Increased ICP, her brain's swelling. 536 00:24:40,560 --> 00:24:42,530 If she had leukemia, this wouldn't be happening. 537 00:24:42,530 --> 00:24:44,230 Not this fast. - You're right. 538 00:24:44,230 --> 00:24:46,230 We're missing something. 539 00:24:50,980 --> 00:24:52,680 Look, I know whatever decisions were made 540 00:24:52,680 --> 00:24:55,180 about bringing Dr. Miller back are way above my pay grade, 541 00:24:55,180 --> 00:24:57,660 but we can't just ask Liz to forget what happened 542 00:24:57,660 --> 00:24:59,660 cause it'll make life easier for everyone else. 543 00:24:59,660 --> 00:25:02,970 I'm going to talk to Richard once Joan is stabilized. 544 00:25:02,970 --> 00:25:05,770 I'm sure he'll be willing to apologize to Liz. 545 00:25:05,770 --> 00:25:09,780 His apology is gonna be hollow and meaningless. 546 00:25:09,780 --> 00:25:11,780 And you should know, when Dr. Miller was Chief, 547 00:25:11,780 --> 00:25:15,290 he tried to use me to find out mistakes Amy was making. 548 00:25:15,730 --> 00:25:19,170 Look, I'm sorry you ended up in the middle of that. 549 00:25:19,170 --> 00:25:21,740 But um, I know the board. 550 00:25:21,740 --> 00:25:23,570 They'd rather find a way to get rid of Liz 551 00:25:23,570 --> 00:25:25,110 than reopen this can of worms. 552 00:25:25,110 --> 00:25:27,950 Well, they can try, but if Liz starts talking, 553 00:25:27,950 --> 00:25:29,850 they're gonna get blowback from the nurses 554 00:25:29,850 --> 00:25:31,420 and potentially the union. 555 00:25:31,420 --> 00:25:33,330 Is uh, is that a threat? 556 00:25:33,330 --> 00:25:34,900 It's a reality. 557 00:25:34,900 --> 00:25:37,700 I'm just trying to do the right thing for her, 558 00:25:37,700 --> 00:25:40,370 and protect the department, which is part of my job now. 559 00:25:40,370 --> 00:25:43,680 She bears responsibility for her own decisions, Sonya. 560 00:25:43,680 --> 00:25:45,750 As you said, she has a very strong union 561 00:25:45,750 --> 00:25:47,720 she could have gone to when all this happened. 562 00:25:47,720 --> 00:25:49,530 I think, maybe, you're expecting too much, 563 00:25:49,530 --> 00:25:53,600 or not understanding the dynamic between an older man with power 564 00:25:53,600 --> 00:25:56,510 and a young woman at the start of her career. 565 00:25:56,510 --> 00:25:58,110 It's blaming the victim, 566 00:25:58,110 --> 00:25:59,880 and I don't think it'll be appreciated. 567 00:25:59,880 --> 00:26:02,920 - I do hear you. - Well, good. 568 00:26:04,060 --> 00:26:06,660 Because you started the day by saying your door was open, 569 00:26:06,660 --> 00:26:09,570 but now it seems like you're closing it on Liz. 570 00:26:16,250 --> 00:26:17,780 The MDS is late-stage, 571 00:26:17,780 --> 00:26:20,920 but it's obscured by high steroid usage. 572 00:26:20,920 --> 00:26:23,490 Pancytopenia, pleural effusions, 573 00:26:23,490 --> 00:26:26,000 DIC, elevated beta-D-glucan, 574 00:26:26,000 --> 00:26:29,340 and now cerebral edema, and she's getting worse. 575 00:26:29,340 --> 00:26:32,680 - Hey, just checked in on Joan. How you holding up? 576 00:26:32,680 --> 00:26:35,650 I've been going toe to toe with Richard all day, 577 00:26:35,650 --> 00:26:37,250 and now we're running out of time. 578 00:26:37,250 --> 00:26:38,520 Who's this? 579 00:26:38,520 --> 00:26:39,930 Um, he's a doctor in Madrid 580 00:26:39,930 --> 00:26:42,670 who has a case study that might be relevant 581 00:26:42,670 --> 00:26:45,040 and this translation app keeps glitching. 582 00:26:45,040 --> 00:26:47,410 Um, I mean, I minored in Spanish, 583 00:26:47,410 --> 00:26:48,980 we could see how rusty I am. 584 00:26:48,980 --> 00:26:50,080 Okay. 585 00:27:25,520 --> 00:27:27,660 Gracias. So, what he's saying 586 00:27:27,660 --> 00:27:29,090 is that the symptoms were similar, 587 00:27:29,090 --> 00:27:31,230 but his patient had dormant sarcoidosis, 588 00:27:31,230 --> 00:27:33,470 so that was complicating the clinical picture. 589 00:27:33,470 --> 00:27:35,000 But once they found that, 590 00:27:35,000 --> 00:27:36,110 everything else just fell into place. 591 00:27:36,110 --> 00:27:37,880 So a patient with MDS like Joan 592 00:27:37,880 --> 00:27:39,250 presented with these symptoms 593 00:27:39,250 --> 00:27:41,580 because of a different chronic issue. 594 00:27:41,580 --> 00:27:43,490 And it went undetected for years. 595 00:27:43,490 --> 00:27:45,730 Okay, okay. Thanks. 596 00:27:45,730 --> 00:27:47,700 Just remember you gotta find a way 597 00:27:47,700 --> 00:27:49,200 to work with Richard on this. 598 00:27:51,800 --> 00:27:53,670 Your spinal tap came back negative 599 00:27:53,670 --> 00:27:55,140 and a full neuro panel too. 600 00:27:55,140 --> 00:27:57,580 Well, her procalcitonin is low, 601 00:27:57,580 --> 00:27:59,290 even though she just had an infection. 602 00:27:59,290 --> 00:28:00,760 I need total protein, 603 00:28:00,760 --> 00:28:02,960 C-reactive protein and complement levels. 604 00:28:02,960 --> 00:28:05,130 How fast can you do that? - 20 minutes. 605 00:28:05,130 --> 00:28:08,200 And if the results can go to me, since I'm her doctor, 606 00:28:08,200 --> 00:28:09,810 that'd be appreciated. 607 00:28:11,880 --> 00:28:14,180 We've got a high complement protein level, 608 00:28:14,180 --> 00:28:17,020 and the prednisone must have dropped her immune surveillance, 609 00:28:17,020 --> 00:28:19,890 which means that we're looking for something that's been there. 610 00:28:19,890 --> 00:28:22,300 Possibly for years, like you said, 611 00:28:22,300 --> 00:28:23,870 but that's been hiding in plain sight. 612 00:28:23,870 --> 00:28:25,710 When Joan woke up, 613 00:28:25,710 --> 00:28:27,140 and I told her about the Candida, 614 00:28:27,140 --> 00:28:28,710 she asked if it seeded in her liver. 615 00:28:28,710 --> 00:28:30,580 Well, that wouldn't be uncommon. 616 00:28:30,580 --> 00:28:32,120 But the beta-D-glucan is so high, 617 00:28:32,120 --> 00:28:33,620 the fungal load would be too large 618 00:28:33,620 --> 00:28:35,160 to be isolated to her liver. 619 00:28:35,160 --> 00:28:37,860 Okay. We've been assuming that the elevated liver enzymes 620 00:28:37,860 --> 00:28:41,470 are caused by the MDS and the prednisone, 621 00:28:41,470 --> 00:28:44,480 but look at her blood work going back to 2016. 622 00:28:45,910 --> 00:28:47,420 Higher range of normal. 623 00:28:47,420 --> 00:28:49,350 But low enough that nobody would flag it. 624 00:28:49,350 --> 00:28:51,190 2016, 625 00:28:51,190 --> 00:28:54,530 that's a long time for her to be carrying something. 626 00:28:55,200 --> 00:28:58,770 Wait a minute. One of the last memories I have of her, 627 00:28:58,770 --> 00:29:00,340 2016, she was in Ecuador. 628 00:29:00,340 --> 00:29:04,420 And she got sick, and I told her that she should come back. 629 00:29:04,420 --> 00:29:07,620 And she self-diagnosed, 630 00:29:07,620 --> 00:29:09,330 she thought it was dysentery... 631 00:29:09,330 --> 00:29:11,430 Which means she was drinking unfiltered water. 632 00:29:11,430 --> 00:29:13,600 So, if it was a parasite, 633 00:29:13,600 --> 00:29:16,210 she could have been sick while she was digesting it, 634 00:29:16,210 --> 00:29:19,480 but by the time it migrated to her liver, she was fine. 635 00:29:19,480 --> 00:29:21,820 Then she could have been fighting this quietly for years. 636 00:29:21,820 --> 00:29:23,590 And the prednisone weakened her immune system, 637 00:29:23,590 --> 00:29:25,460 and unleashed it on her. 638 00:29:27,800 --> 00:29:29,870 I think we have a path now. 639 00:29:34,070 --> 00:29:35,910 He's losing sympathetic tone. 640 00:29:35,910 --> 00:29:38,720 Surgery's set for 6:00 AM, can we up the steroids? 641 00:29:38,720 --> 00:29:40,190 Too worried about his blood pressure. 642 00:29:40,190 --> 00:29:41,820 Think we just have to stay the course 643 00:29:41,820 --> 00:29:43,890 and hope that he's strong enough to hold on. 644 00:29:45,970 --> 00:29:48,140 I appreciate what you said before. 645 00:29:48,140 --> 00:29:50,170 Trying to let me off the hook. 646 00:29:51,340 --> 00:29:52,850 You religious at all? 647 00:29:52,850 --> 00:29:54,380 From time to time, 648 00:29:54,380 --> 00:29:57,420 depending on how I'm feeling about the world. 649 00:29:58,090 --> 00:30:00,260 I remember going to this sermon once. 650 00:30:00,260 --> 00:30:04,140 The minister was talking about how it can be a form of hubris 651 00:30:04,140 --> 00:30:05,970 to think that we can control things 652 00:30:05,970 --> 00:30:08,310 that are out of our control. 653 00:30:09,580 --> 00:30:11,980 Cause that's somebody else's domain? 654 00:30:11,980 --> 00:30:13,590 Doesn't mean it's easy to accept it. 655 00:30:13,590 --> 00:30:16,090 But I think that's the idea, yeah. 656 00:30:17,130 --> 00:30:19,830 I'll take that under advisement, Dr. Coleman. 657 00:30:19,830 --> 00:30:21,200 Good. 658 00:30:25,480 --> 00:30:26,610 Your wife's here. 659 00:30:30,420 --> 00:30:32,260 It's my anniversary and I forgot. 660 00:30:32,260 --> 00:30:34,200 You go. I am all over this, 661 00:30:34,200 --> 00:30:36,830 hourly exams, I will not go home. 662 00:30:42,380 --> 00:30:45,150 I've been downstairs 15 minutes, tried calling you. 663 00:30:45,150 --> 00:30:48,190 I'm sorry. There were problems with Walter's surgery, 664 00:30:48,190 --> 00:30:49,860 he needs another one tomorrow. 665 00:30:50,530 --> 00:30:52,800 Why don't we have dinner in your office tonight? 666 00:30:52,800 --> 00:30:57,170 That way, if anything happens, you're close. 667 00:30:57,170 --> 00:30:59,280 What did I do to deserve you? 668 00:30:59,280 --> 00:31:00,620 I don't know. 669 00:31:00,620 --> 00:31:03,150 I'm sure you'll find a way to make it up to me. 670 00:31:04,490 --> 00:31:07,290 I'm thinking 400 milligrams albendazole. 671 00:31:07,830 --> 00:31:09,800 I'd go 300, 672 00:31:09,800 --> 00:31:12,200 given the ALT/AST, 673 00:31:12,200 --> 00:31:14,640 and 20 of Ampho B to balance it out. 674 00:31:14,640 --> 00:31:16,680 And 100 milligrams of cimetidine 675 00:31:16,680 --> 00:31:18,250 to cut the renal toxicity. 676 00:31:19,520 --> 00:31:20,890 It's a tightrope. 677 00:31:20,890 --> 00:31:22,790 Any idea where Liz is? 678 00:31:22,790 --> 00:31:24,100 Uh, let's see. 679 00:31:24,100 --> 00:31:27,400 Code Blue, ICU. Code Blue, ICU. 680 00:31:27,400 --> 00:31:28,570 Joan's coding. 681 00:31:29,300 --> 00:31:31,410 Code Blue, ICU. 682 00:31:31,410 --> 00:31:33,380 Code Blue, ICU. 683 00:31:34,580 --> 00:31:36,320 No pulse. 684 00:31:36,320 --> 00:31:37,960 - He's in V-fib. Push one milligram Epi. 685 00:31:37,960 --> 00:31:40,030 Get the defibrillator. 686 00:31:48,410 --> 00:31:50,180 Ready? 687 00:31:51,180 --> 00:31:53,020 Clear. 688 00:31:55,960 --> 00:31:58,460 Restarting compressions. 689 00:32:06,380 --> 00:32:09,490 - Danny, Danny. Someone call 911. 690 00:32:10,860 --> 00:32:12,290 Charge to 50. 691 00:32:13,460 --> 00:32:15,460 Clear. 692 00:32:20,010 --> 00:32:22,550 Pushing another milligram of Epi. 693 00:32:28,990 --> 00:32:31,260 Fine V-fib, we're losing him. 694 00:32:31,260 --> 00:32:34,030 - Going up to 100. Give me the paddles. 695 00:32:38,040 --> 00:32:40,210 - Ready. - Clear. 696 00:32:49,870 --> 00:32:51,100 Looks like Sinus. 697 00:32:51,100 --> 00:32:53,670 We have a pulse. He's back. 698 00:32:53,670 --> 00:32:56,610 Page Dr. Costa, we can't wait on the surgery. 699 00:33:19,690 --> 00:33:21,330 Cord is decompressed. 700 00:33:21,330 --> 00:33:25,500 Screws are seated. Let's secure the rods. 701 00:33:26,010 --> 00:33:27,510 Hey. 702 00:33:31,020 --> 00:33:34,120 That must have been really difficult for you. 703 00:33:34,790 --> 00:33:36,390 Yeah. 704 00:33:37,230 --> 00:33:40,070 And a hell of a first day for Michael. 705 00:33:40,070 --> 00:33:42,770 Oh, it hit pretty close to home. 706 00:33:44,240 --> 00:33:45,950 How's it going in there? 707 00:33:45,950 --> 00:33:47,680 Hardware's almost in place. 708 00:33:47,680 --> 00:33:49,950 But even if it works, 709 00:33:49,950 --> 00:33:52,090 no one's ever gonna adopt him. 710 00:33:52,090 --> 00:33:54,800 Not when he needs this kind of support. 711 00:33:57,740 --> 00:34:01,440 You're not thinking of doing something drastic? 712 00:34:02,810 --> 00:34:04,450 Go and be with Joan. 713 00:34:05,050 --> 00:34:06,790 Gina. 714 00:34:07,920 --> 00:34:09,690 I care about him, 715 00:34:10,460 --> 00:34:13,570 but I know what the boundaries are. 716 00:34:13,970 --> 00:34:16,570 Now go, where you're needed. 717 00:34:30,370 --> 00:34:32,240 But you've gotta quit smoking. 718 00:34:32,240 --> 00:34:34,170 You know that's never gonna happen, honey. 719 00:34:38,350 --> 00:34:40,960 I don't know how much more we can pump into her 720 00:34:40,960 --> 00:34:43,260 before she starts shutting down. 721 00:34:43,260 --> 00:34:46,170 Her body's so fragile. 722 00:34:47,430 --> 00:34:50,210 The chemo didn't help with that. 723 00:34:50,880 --> 00:34:53,480 She was only on it for eight hours. 724 00:34:55,020 --> 00:34:56,690 The parasite is causing this, 725 00:34:56,690 --> 00:35:00,130 that and the prednisone, it's not on you, Richard. 726 00:35:37,940 --> 00:35:39,770 Hey. It's okay, buddy. 727 00:35:50,700 --> 00:35:52,800 Can I see? 728 00:35:55,340 --> 00:35:57,940 Aww, she's gonna love this. 729 00:36:01,050 --> 00:36:03,050 Is she gonna wake up soon? 730 00:36:03,050 --> 00:36:05,560 I really hope so. 731 00:36:21,090 --> 00:36:22,090 Hello? 732 00:36:22,090 --> 00:36:23,930 Hi, Amy. It's Dr. Ridley. 733 00:36:23,930 --> 00:36:27,470 Oh. Hi. 734 00:36:27,470 --> 00:36:29,270 I hope it's not 2:00 AM there, 735 00:36:29,270 --> 00:36:31,510 I stopped tracking time zone differences ages ago. 736 00:36:31,510 --> 00:36:34,620 - No, it's noon. Is there a problem? 737 00:36:34,620 --> 00:36:36,550 I spoke with Dr. Kelly this morning, 738 00:36:36,550 --> 00:36:37,990 he told me about your mother. 739 00:36:39,260 --> 00:36:41,700 I'm just so sorry, Amy. 740 00:36:42,260 --> 00:36:44,970 Thank you, Dr. Ridley. 741 00:36:44,970 --> 00:36:46,100 And I respect your tenacity, 742 00:36:46,100 --> 00:36:47,640 already being back in the hospital, 743 00:36:47,640 --> 00:36:50,150 but I just wanted to make sure you're taking care of yourself. 744 00:36:50,150 --> 00:36:52,990 I think so. 745 00:36:54,990 --> 00:36:56,530 It's... 746 00:36:56,530 --> 00:36:59,530 It's been hard, obviously. 747 00:36:59,530 --> 00:37:02,140 Your world shifted on its axis. 748 00:37:02,140 --> 00:37:04,270 But you will come out the other side. 749 00:37:04,270 --> 00:37:05,880 I just... 750 00:37:07,050 --> 00:37:09,320 didn't even think you liked me. 751 00:37:09,320 --> 00:37:11,420 Well, that's by design, my dear. 752 00:37:11,420 --> 00:37:13,290 And now you know the truth. 753 00:37:13,290 --> 00:37:16,970 Not only do I like you, I believe in you. 754 00:37:19,270 --> 00:37:22,410 Thank you so much. I... 755 00:37:22,410 --> 00:37:24,280 I know how bad this hurts right now, 756 00:37:24,280 --> 00:37:26,420 but the best way that you can honor your mother 757 00:37:26,420 --> 00:37:27,990 is to live a life with purpose. 758 00:37:27,990 --> 00:37:30,830 You have greatness in you, Amy. 759 00:37:30,830 --> 00:37:33,770 And I'll be there to help you find it. 760 00:37:44,090 --> 00:37:46,090 Joan. 761 00:37:46,090 --> 00:37:48,500 Hey. Can you hear me? 762 00:37:49,100 --> 00:37:52,740 Can you get her son? He just went to get coffee. 763 00:37:53,770 --> 00:37:56,780 Hey. It's okay. 764 00:37:57,180 --> 00:38:00,050 Just go slow. Breathe. 765 00:38:02,420 --> 00:38:05,530 - What happened? - You had cerebral edema. 766 00:38:05,530 --> 00:38:06,970 No. 767 00:38:06,970 --> 00:38:10,740 It's not leukemia. Not yet. 768 00:38:10,740 --> 00:38:13,580 You had a parasite in your liver. 769 00:38:13,580 --> 00:38:17,090 From Ecuador. Do you remember that? 770 00:38:17,090 --> 00:38:18,960 You thought it was dysentery? 771 00:38:19,690 --> 00:38:21,230 Oh my God. 772 00:38:21,900 --> 00:38:25,970 Is that the one time in my life I misdiagnosed? 773 00:38:33,050 --> 00:38:35,960 You haven't looked after yourself for a long time. 774 00:38:38,060 --> 00:38:39,360 I know. 775 00:38:39,360 --> 00:38:41,870 Promise me that stops now. 776 00:38:41,870 --> 00:38:43,840 Ah. 777 00:38:43,840 --> 00:38:45,710 Mom. Hey. 778 00:38:45,710 --> 00:38:47,010 Hey. 779 00:38:47,980 --> 00:38:49,890 Thanks so much, Amy. 780 00:38:51,520 --> 00:38:55,830 I'll order CBC and liver function tests. 781 00:38:58,640 --> 00:39:00,370 The fact that she's conscious... 782 00:39:00,370 --> 00:39:02,480 Yeah, we got her some more time. 783 00:39:03,410 --> 00:39:06,590 I appreciate you finding a way to trust me today. 784 00:39:08,490 --> 00:39:10,130 Yeah, it worked out today. 785 00:39:10,790 --> 00:39:13,630 But I'm never gonna trust you, Richard. 786 00:39:21,250 --> 00:39:24,250 Hey, Walter. Welcome back. 787 00:39:24,250 --> 00:39:25,690 Did you fix my spine? 788 00:39:25,690 --> 00:39:28,660 We need to run some tests over the next few days, 789 00:39:28,660 --> 00:39:30,630 but it seems that way. 790 00:39:30,630 --> 00:39:32,370 And I'll be able to walk again? 791 00:39:32,370 --> 00:39:33,810 It's gonna be a long recovery, 792 00:39:33,810 --> 00:39:36,710 lots of physical therapy as your body adjusts 793 00:39:36,710 --> 00:39:38,880 to the hardware in your spine. 794 00:39:38,880 --> 00:39:40,990 But yes, you will. 795 00:39:44,430 --> 00:39:47,130 And I'll have to miss the next adoption fair? 796 00:39:47,840 --> 00:39:51,180 - There'll be lots more. I promise. 797 00:39:51,180 --> 00:39:52,750 Thank you, Dr. Walker. 798 00:39:52,750 --> 00:39:55,780 Nobody ever cared the way you do. 799 00:39:59,360 --> 00:40:01,460 I am so sorry. 800 00:40:01,460 --> 00:40:04,600 - It's okay. We'll do a raincheck. 801 00:40:11,720 --> 00:40:14,960 Sometimes, I wonder how you manage to leave it all 802 00:40:14,960 --> 00:40:16,830 here when you come home. 803 00:40:18,460 --> 00:40:20,900 It can be really hard. 804 00:40:21,370 --> 00:40:22,970 Yeah. 805 00:40:32,760 --> 00:40:35,260 Let's go get a drink, huh? 806 00:40:35,260 --> 00:40:36,700 Yeah. 807 00:40:45,350 --> 00:40:47,990 Hey. So, I spoke to Liz, 808 00:40:47,990 --> 00:40:50,660 and told her if she wants to come forward to HR, 809 00:40:50,660 --> 00:40:52,360 we would both have her back. 810 00:40:52,900 --> 00:40:56,070 - Thank you. Oh, and I'm sorry if I was too... 811 00:40:56,070 --> 00:40:59,410 Sonya, speaking truth to power takes courage. 812 00:40:59,410 --> 00:41:01,820 I should be thanking you. 813 00:41:02,790 --> 00:41:05,120 Sorry, I didn't mean to interrupt. 814 00:41:05,120 --> 00:41:06,660 Oh no, I was just leaving. 815 00:41:06,660 --> 00:41:09,160 Actually, I was hoping to speak to you. 816 00:41:12,200 --> 00:41:14,780 I just wanted to thank you for checking in earlier. 817 00:41:14,780 --> 00:41:18,220 Joan's improving. - I heard, that's great news. 818 00:41:19,790 --> 00:41:22,490 - So we're gonna do this thing? Together? 819 00:41:22,490 --> 00:41:24,360 Well, it's what she wants. 820 00:41:24,360 --> 00:41:26,300 She tends to get what she wants. 821 00:41:26,300 --> 00:41:27,770 Yeah. 822 00:41:32,650 --> 00:41:35,680 I saw Joan, she's spunky as ever. 823 00:41:35,680 --> 00:41:38,060 Can't keep that lady down. 824 00:41:39,420 --> 00:41:41,560 - Amen to that. - Yeah. 825 00:41:41,560 --> 00:41:44,700 - Goodnight, Jake. - Hey. Goodnight, man. 826 00:41:50,410 --> 00:41:53,150 Hey, did you know about him and Sonya? 827 00:41:53,150 --> 00:41:55,390 What about them? 828 00:41:55,390 --> 00:41:57,430 No. - Yeah. 829 00:41:59,160 --> 00:42:01,140 I guess we set a good example. 830 00:42:06,950 --> 00:42:09,280 I heard your family was here today. 831 00:42:09,280 --> 00:42:10,990 Yeah. Um... 832 00:42:10,990 --> 00:42:13,360 Mia, she got in trouble at school, it was, 833 00:42:13,360 --> 00:42:15,330 er, I don't know, it was ridiculous. 834 00:42:16,700 --> 00:42:20,210 Maybe you can tell me all about it on the way home? 835 00:42:21,680 --> 00:42:24,780 - Yeah, sure thing, Chief. I can do that. 836 00:42:25,680 --> 00:42:27,860 It's Co-Chief. 837 00:42:27,860 --> 00:42:30,690 Co-Chief. I'm sorry, that's just so awkward to say. 838 00:42:30,690 --> 00:42:33,370 I know, tell me about it. 839 00:42:33,370 --> 00:42:35,000 Co-Chief.