1 00:00:01,838 --> 00:00:03,473 - Dr. Larsen had traffic accident, 2 00:00:03,473 --> 00:00:05,077 he doesn't remember the last eight years. 3 00:00:05,077 --> 00:00:06,479 Previously in the series Doc. 4 00:00:06,479 --> 00:00:08,383 - Let me run Internal Medicine. - Back to the roots. 5 00:00:08,383 --> 00:00:10,487 - When you need time yes settle things with Michael, 6 00:00:10,487 --> 00:00:12,826 I accept that, but when the situation is reversed... 7 00:00:12,826 --> 00:00:13,994 - When the situation is reversed, 8 00:00:13,994 --> 00:00:15,397 it's hard for you to tell me the truth. 9 00:00:15,397 --> 00:00:17,068 - Delayed decisions about his care 10 00:00:17,068 --> 00:00:18,469 they have been harming him for a long time. 11 00:00:18,469 --> 00:00:20,509 - You don't have to tell me that the system is broken. 12 00:00:20,509 --> 00:00:23,246 - How much prednisone do you need? to withstand the shift? 13 00:00:23,246 --> 00:00:25,050 You'll burn out in a few weeks. 14 00:00:25,050 --> 00:00:26,854 - It's time to you use your size 15 00:00:26,854 --> 00:00:28,858 to bring out the greatness from others. 16 00:00:28,858 --> 00:00:30,828 - I'll miss you. 17 00:00:43,086 --> 00:00:44,990 - Excuse me. This boy likes to sleep. 18 00:00:44,990 --> 00:00:48,664 - Oh, here he is. Hey, can I give you a hug? 19 00:00:49,799 --> 00:00:52,038 Oh my gosh, this is so cute. 20 00:00:52,038 --> 00:00:54,475 - Ethan is sorry he didn't see you, he had a very early meeting. 21 00:00:54,475 --> 00:00:56,647 - Well, it's Robbie the main star, right? 22 00:00:56,647 --> 00:00:59,987 For what a great holiday they are this time canceled school? 23 00:00:59,987 --> 00:01:01,155 - It's Lunar New Year. 24 00:01:01,155 --> 00:01:02,960 - Oh, well. 25 00:01:04,228 --> 00:01:05,532 Grandma was all over the world. 26 00:01:05,532 --> 00:01:07,970 You know, she probably could learn to say hello 27 00:01:07,970 --> 00:01:09,205 in 50 different languages. 28 00:01:09,205 --> 00:01:11,075 - 67, but who's counting? 29 00:01:11,075 --> 00:01:12,546 - I should be back around six. 30 00:01:12,546 --> 00:01:14,081 And thank you very much for doing this. 31 00:01:14,081 --> 00:01:16,086 - Are you kidding me? The more time I can spend 32 00:01:16,086 --> 00:01:17,121 with this little man, the better. 33 00:01:17,121 --> 00:01:18,891 Oh. I brought you donuts, 34 00:01:18,891 --> 00:01:20,427 your dad said that they are your favorite. 35 00:01:20,427 --> 00:01:22,230 Thanks, grandma. 36 00:01:28,009 --> 00:01:29,479 - Joan, are you okay? 37 00:01:31,482 --> 00:01:32,318 - I'm fine. 38 00:01:34,856 --> 00:01:36,861 Robbie, why don't you go upstairs? 39 00:01:36,861 --> 00:01:38,764 Oh, my God. 40 00:01:38,764 --> 00:01:40,802 - Grandma! - Joan? 41 00:01:40,802 --> 00:01:41,871 - Grandma! 42 00:02:07,355 --> 00:02:08,791 - Good morning everyone. 43 00:02:08,791 --> 00:02:10,194 Morning. 44 00:02:10,194 --> 00:02:12,832 - This will be adjustment for all of us. 45 00:02:12,832 --> 00:02:15,003 dr. Ridley certainly left a great void to be filled, 46 00:02:15,003 --> 00:02:18,409 and I know that all these changes in the lead last year 47 00:02:18,409 --> 00:02:21,182 were probably disturbing. 48 00:02:21,182 --> 00:02:24,021 There are many reasons why 49 00:02:24,021 --> 00:02:26,760 I wanted to practice again medicine, 50 00:02:26,760 --> 00:02:29,031 but I want to be very clear regarding the reason why I asked 51 00:02:29,031 --> 00:02:31,102 to sit in that chair. 52 00:02:31,102 --> 00:02:33,439 Last year as your Chief Medical Officer, 53 00:02:33,439 --> 00:02:35,077 I saw what every person is capable of 54 00:02:35,077 --> 00:02:37,047 which stands in this room. 55 00:02:37,047 --> 00:02:38,784 - Dr. Miller. 56 00:02:38,784 --> 00:02:40,588 Again and again, you were up to the task. 57 00:02:40,588 --> 00:02:42,793 We have a 62-year-old wife 58 00:02:42,793 --> 00:02:44,095 in respiratory failure. 59 00:02:44,095 --> 00:02:45,999 Complications due to chronic MDS. 60 00:02:45,999 --> 00:02:47,134 - I'm on my way. 61 00:02:47,134 --> 00:02:49,472 - I'm not here just to guide you, 62 00:02:49,472 --> 00:02:53,614 I want to join you and help you to do what you already do so well. 63 00:02:53,614 --> 00:02:57,254 Problem, difficulty, proposal, 64 00:02:57,254 --> 00:02:59,358 my door will always be open. 65 00:02:59,358 --> 00:03:03,066 Before we go, it's time for congratulations. 66 00:03:03,066 --> 00:03:05,270 In two weeks, Dr. Maitra 67 00:03:05,270 --> 00:03:07,843 and Dr. Larsen will succeed Dr. Heller 68 00:03:07,843 --> 00:03:08,778 as main specialists, 69 00:03:08,778 --> 00:03:12,118 while we welcome ours a new class of interns. 70 00:03:15,391 --> 00:03:16,893 Uh, now, if you both would 71 00:03:16,893 --> 00:03:18,997 could stay for a moment with Dr. Heller. 72 00:03:18,997 --> 00:03:21,435 The rest of you are doing a good job. 73 00:03:24,776 --> 00:03:27,749 I would like you to be our co-bosses follow 74 00:03:27,749 --> 00:03:29,953 before you start yours pediatric specialization. 75 00:03:29,953 --> 00:03:31,122 You can start with Dr. Maitra 76 00:03:31,122 --> 00:03:32,559 this morning and then take turns. 77 00:03:32,559 --> 00:03:34,863 - Yes. Sounds like a plan. - Excellent. 78 00:03:38,838 --> 00:03:40,407 - That's quite a move. 79 00:03:40,407 --> 00:03:42,377 - Well, it was either this 80 00:03:42,377 --> 00:03:43,981 or a leather jacket and a motorcycle. 81 00:03:50,895 --> 00:03:52,298 Joan is in the emergency room. 82 00:03:52,866 --> 00:03:55,403 - The paramedic said she was extremely panting, 83 00:03:55,403 --> 00:03:57,743 probably bilateral pleural effusions. 84 00:03:57,743 --> 00:03:59,412 - Is she hypoxic? 85 00:03:59,412 --> 00:04:02,719 - Oxygenation improved to masks, but is hypotensive. 86 00:04:02,719 --> 00:04:05,457 Let's give norepinephrine, target MAP above 65. 87 00:04:05,457 --> 00:04:07,161 - No, Richard, that won't work. 88 00:04:07,161 --> 00:04:08,730 - Please? - He's on prednisone. 89 00:04:08,730 --> 00:04:10,969 - 30 milligrams and reduces the dose, I read her card. 90 00:04:10,969 --> 00:04:13,774 - No, her card is wrong, it takes a lot more than that. 91 00:04:15,611 --> 00:04:18,817 - I used it to endure the operation. 92 00:04:19,786 --> 00:04:21,422 - Did you know about this? 93 00:04:22,592 --> 00:04:25,531 - How much did she take? 94 00:04:26,165 --> 00:04:27,502 - Twice as much. 95 00:04:30,273 --> 00:04:32,645 Triple to withstand ex... 96 00:04:32,645 --> 00:04:34,448 hello with Javi. 97 00:04:34,448 --> 00:04:38,924 My natural production cortisol must have been destroyed. 98 00:04:40,294 --> 00:04:43,199 - Okay. Lucy, 100 milligrams of hydrocortisone 99 00:04:43,199 --> 00:04:45,336 in bolus before vasopressor. 100 00:04:45,336 --> 00:04:47,407 And do a complete lab workup. 101 00:04:48,610 --> 00:04:51,081 - We're all here if you anything needed, Joan. 102 00:04:54,923 --> 00:04:55,991 - Should I call Ethan? 103 00:04:57,862 --> 00:04:58,964 - He's on his way. 104 00:04:58,964 --> 00:05:02,905 But Amy, I want you to remember, 105 00:05:02,905 --> 00:05:04,610 I have DNR. 106 00:05:04,610 --> 00:05:07,816 - Joan, no, we're not even close to that. 107 00:05:12,091 --> 00:05:13,827 Shh. 108 00:05:18,671 --> 00:05:20,641 - Good morning, Dr. Walker. 109 00:05:20,641 --> 00:05:24,015 - Good morning to you too, Walter. How is our rocket holding up? 110 00:05:24,015 --> 00:05:25,518 - I can't wait to launch it. 111 00:05:25,518 --> 00:05:26,820 You think I will though be able to leave today? 112 00:05:26,820 --> 00:05:29,258 - First I have to examine you, we can't let you out of here 113 00:05:29,258 --> 00:05:30,828 until we are sure that you are completely fine. 114 00:05:30,828 --> 00:05:33,133 - I really want to show the rocket 115 00:05:33,133 --> 00:05:34,703 children in the home. 116 00:05:34,703 --> 00:05:36,873 - I believe. Looks like that thing would could really reach space. 117 00:05:36,873 --> 00:05:39,078 - Do you ever launch rockets with your kids? 118 00:05:39,078 --> 00:05:41,617 - I have no children. - Really? 119 00:05:42,284 --> 00:05:44,254 - I was thinking about it when i was younger 120 00:05:44,254 --> 00:05:46,126 but I decided take another path. 121 00:05:46,126 --> 00:05:47,294 - What do you mean? 122 00:05:47,294 --> 00:05:48,664 - Well, being a parent is a big commitment. 123 00:05:48,664 --> 00:05:52,003 But it's also true and to be a friend, a sister, 124 00:05:52,003 --> 00:05:54,643 an aunt, and especially a doctor. 125 00:05:54,643 --> 00:05:57,548 In the end I understood yes if I do my best 126 00:05:57,548 --> 00:06:00,153 in all these other things, that will be enough for me. 127 00:06:00,153 --> 00:06:01,857 - You are a great doctor. - Hmm. 128 00:06:01,857 --> 00:06:05,565 - It sure is, my friend. Sorry I'm late, how is he? 129 00:06:05,565 --> 00:06:08,570 - Well, breathing is much better. Let's look at those knees. 130 00:06:11,075 --> 00:06:14,549 - Oh. How long do you have? does the leg move like that? 131 00:06:14,549 --> 00:06:16,687 - It happens all the time because of my rheumatoid arthritis. 132 00:06:16,687 --> 00:06:18,724 - You shouldn't now, with the medicines you take. 133 00:06:18,724 --> 00:06:20,527 - Yes, I will order a CT scan. - Well, that's bad. 134 00:06:20,527 --> 00:06:22,565 - We just have to see what is happening. 135 00:06:22,565 --> 00:06:24,168 But we'll work it out. 136 00:06:24,168 --> 00:06:26,171 - It's time to find your social worker. 137 00:06:26,171 --> 00:06:28,042 - Again? 138 00:06:28,844 --> 00:06:31,550 - Atlantoaxial instability of this the weights will progress quickly. 139 00:06:31,550 --> 00:06:33,086 We must operate immediately. 140 00:06:33,086 --> 00:06:34,989 - We don't have approval from his guardian. 141 00:06:34,989 --> 00:06:37,327 - Well, his C1 and C2 they are pressing on his spinal cord. 142 00:06:37,327 --> 00:06:38,865 What is everyone waiting for? 143 00:06:38,865 --> 00:06:41,002 - The social worker said he would sign whatever we decide 144 00:06:41,002 --> 00:06:43,540 but he doesn't want to get involved in detail. 145 00:06:43,540 --> 00:06:44,743 - Well, that complicates things, 146 00:06:44,743 --> 00:06:46,245 because we have two surgical options. 147 00:06:46,245 --> 00:06:49,452 High risk, high reward, open neck, expose the spine, 148 00:06:49,452 --> 00:06:51,021 set corrective hardware directly. 149 00:06:51,021 --> 00:06:53,292 - But you are worried about the arterial one trauma or spinal cord trauma? 150 00:06:53,292 --> 00:06:56,633 - Not to mention the stroke, infection, damage to the ventral cord. 151 00:06:56,633 --> 00:06:58,637 - Plus, he's still recovering from pneumonia. 152 00:06:58,637 --> 00:07:00,140 - Definitely worrying. 153 00:07:00,140 --> 00:07:02,879 - And there is another option minimally invasive fusion? 154 00:07:02,879 --> 00:07:04,616 - Much less trauma and easier recovery. 155 00:07:04,616 --> 00:07:06,486 - But wouldn't we rely on it on CT for navigation? 156 00:07:06,486 --> 00:07:08,724 Which means less precision with hardware? 157 00:07:08,724 --> 00:07:10,193 - Yes, it might be necessary operate again, 158 00:07:10,193 --> 00:07:11,596 in six months or a year. 159 00:07:11,596 --> 00:07:13,065 - And there is a big chance for misplacing the screw. 160 00:07:13,065 --> 00:07:15,571 At C1-C2 spinal cord, it could be serious. 161 00:07:16,372 --> 00:07:19,979 - Both have risks. It's your decision, Gina. 162 00:07:27,895 --> 00:07:30,234 - Do the minimum invasive fusion. 163 00:07:30,234 --> 00:07:31,836 I'm going to explain to Walter. 164 00:07:34,743 --> 00:07:36,680 - So... 165 00:07:37,748 --> 00:07:40,086 I have advanced leukemia. 166 00:07:41,122 --> 00:07:42,257 - Can I see? 167 00:07:45,631 --> 00:07:48,102 - My belief is that they are steroids 168 00:07:48,102 --> 00:07:50,040 artificially raised your white blood cell count, 169 00:07:50,040 --> 00:07:52,879 hiding degree bone marrow infiltration, 170 00:07:52,879 --> 00:07:55,952 and I spoke with Dr. Rose, and he agrees. 171 00:07:55,952 --> 00:07:59,626 If this is not controlled, deterioration will be rapid. 172 00:07:59,626 --> 00:08:01,797 So we'd like to get started induction chemotherapy, 173 00:08:01,797 --> 00:08:04,034 what it could buy you a few extra months. 174 00:08:04,034 --> 00:08:05,938 - This shows pancytopenic picture 175 00:08:05,938 --> 00:08:09,144 without any signs of leukocytosis. 176 00:08:09,144 --> 00:08:10,413 - Yes. As I just said, 177 00:08:10,413 --> 00:08:11,683 steroids complicate matters. 178 00:08:11,683 --> 00:08:14,556 Her leukemia has atypical presentation, 179 00:08:14,556 --> 00:08:17,327 but we must act quickly before progressing. 180 00:08:17,327 --> 00:08:18,698 - Or her presentation 181 00:08:18,698 --> 00:08:20,768 atypical because it is not leukemia. 182 00:08:20,768 --> 00:08:21,704 - Amy. 183 00:08:21,704 --> 00:08:23,306 - Her findings are falling 184 00:08:23,306 --> 00:08:24,976 in all lines. 185 00:08:24,976 --> 00:08:26,814 It looks like bone marrow failure, and not a bone marrow takeover. 186 00:08:26,814 --> 00:08:28,951 You attach too much importance to the number of blasts. 187 00:08:28,951 --> 00:08:31,222 - No, I'm looking the facts before us. 188 00:08:31,222 --> 00:08:34,261 - It doesn't show cancer on peripheral smear. 189 00:08:34,261 --> 00:08:36,800 If this is pancytopenia, we could give platelets 190 00:08:36,800 --> 00:08:37,969 and plasma to raise its levels. 191 00:08:37,969 --> 00:08:40,607 - Blast proliferation and dysplasia 192 00:08:40,607 --> 00:08:42,812 are school signs of leukemia. 193 00:08:42,812 --> 00:08:45,283 And delaying treatment because of empty desires 194 00:08:45,283 --> 00:08:47,855 it will cost you significant time. 195 00:08:47,855 --> 00:08:51,195 - Or, if he's wrong, chemotherapy will damage all your organs. 196 00:08:51,830 --> 00:08:54,067 - I believe this is it Joan's decision. 197 00:08:58,577 --> 00:09:00,046 - Start chemotherapy. 198 00:09:02,585 --> 00:09:04,622 - I will introduce orders. 199 00:09:09,566 --> 00:09:11,001 - You are brilliant, Amy, 200 00:09:11,001 --> 00:09:13,339 and i know you don't want to for this to be true. 201 00:09:14,642 --> 00:09:16,178 But I can't. 202 00:09:16,178 --> 00:09:19,819 I can't lose anymore time with your family. 203 00:09:22,825 --> 00:09:24,361 - Yes. 204 00:09:33,881 --> 00:09:36,052 - Mom, do you feel pain in the incision? 205 00:09:36,052 --> 00:09:38,657 - Oh, it was routine surgery, I'm fine. 206 00:09:38,657 --> 00:09:40,460 - Where's John? 207 00:09:40,460 --> 00:09:42,999 - He's here, smoking. 208 00:09:42,999 --> 00:09:45,036 - I'm surprised, yes you didn't go with him. 209 00:09:45,036 --> 00:09:47,340 - Believe me, I meant it that I can get away with it. 210 00:09:47,340 --> 00:09:48,677 - Not while I'm here. 211 00:09:48,677 --> 00:09:51,381 - Oh, I know, Dr. Larsen. 212 00:09:51,381 --> 00:09:53,218 - Not yet, mom. 213 00:09:53,218 --> 00:09:55,289 - Speaking of which, you should back to Minneapolis. 214 00:09:55,289 --> 00:09:58,062 - No, it's fine. dr. Ridley is away for a few weeks, 215 00:09:58,062 --> 00:10:00,567 so I finally have some room to breathe. 216 00:10:00,567 --> 00:10:01,937 - Who is that? 217 00:10:01,937 --> 00:10:03,941 - I mentioned her, I guess, six times. 218 00:10:03,941 --> 00:10:06,646 A genius surgeon, Doctors Without Borders, 219 00:10:06,646 --> 00:10:09,786 absolutely terrifying... - Okay. She. 220 00:10:09,786 --> 00:10:11,623 - Everyone wants her to be their mentor, 221 00:10:11,623 --> 00:10:13,359 but travels so much, 222 00:10:13,359 --> 00:10:15,531 I don't think it ever does slow down enough for that. 223 00:10:15,531 --> 00:10:17,300 - Why do you need a mentor anyway? 224 00:10:17,300 --> 00:10:19,104 If you want something, you get it. 225 00:10:19,104 --> 00:10:21,241 It's always been that way, I hardly needed to push you. 226 00:10:21,241 --> 00:10:23,880 - Well, there were times when we would a little push is welcome. 227 00:10:28,022 --> 00:10:29,425 - Amy. 228 00:10:29,425 --> 00:10:31,328 - Hey. - Hi. 229 00:10:31,328 --> 00:10:33,266 I got there as fast as I could. 230 00:10:33,266 --> 00:10:35,070 - She is now stable. 231 00:10:35,070 --> 00:10:38,275 She is quite sleepy from chemotherapy drugs. 232 00:10:38,275 --> 00:10:40,781 - Okay. Okay. 233 00:10:42,785 --> 00:10:46,926 - Amy, the findings have arrived coagulation for Joan. 234 00:10:48,029 --> 00:10:49,733 He has a DIK. 235 00:10:49,733 --> 00:10:51,469 That we gave platelets as you wanted 236 00:10:51,469 --> 00:10:54,742 uncontrolled clotting could cause a massive stroke. 237 00:10:55,978 --> 00:10:58,149 I know how hard this is for you, 238 00:10:58,149 --> 00:11:00,821 but you will have to let me go to do my job. 239 00:11:05,831 --> 00:11:08,537 Ethan. I'm Dr. Miller. 240 00:11:08,537 --> 00:11:10,339 - Hi. - I'm glad. 241 00:11:15,116 --> 00:11:17,353 - So, the visits are over. What's next? 242 00:11:17,353 --> 00:11:19,157 - Well, your partner in crime 243 00:11:19,157 --> 00:11:20,761 watches over her friend on Intensive. 244 00:11:20,761 --> 00:11:22,097 Did you check her? 245 00:11:22,097 --> 00:11:24,268 - I didn't want her to enter the space. 246 00:11:24,268 --> 00:11:26,840 - It's always better to lend a hand. 247 00:11:26,840 --> 00:11:28,744 Trust me, they'll let you know if this is undesirable. 248 00:11:28,744 --> 00:11:30,581 - Oh, I'm sure he will. 249 00:11:30,581 --> 00:11:32,150 - So, as the main specialist, 250 00:11:32,150 --> 00:11:33,854 you have to be able to work with everyone. 251 00:11:33,854 --> 00:11:36,158 Is there anyone else something you have to put an end to? 252 00:11:36,158 --> 00:11:38,295 - I don't know have you ever noticed 253 00:11:38,295 --> 00:11:40,166 but Liz kind of liked TJ. 254 00:11:40,166 --> 00:11:41,803 - Yes, not really was subtle about it. 255 00:11:41,803 --> 00:11:43,607 Why, what's the problem? 256 00:11:43,607 --> 00:11:45,176 - I... 257 00:11:46,211 --> 00:11:47,982 - So you and TJ? 258 00:11:49,318 --> 00:11:50,854 Wow, okay. 259 00:11:50,854 --> 00:11:52,892 I guess I missed that. How long does it take? 260 00:11:52,892 --> 00:11:55,998 - Not long, and you don't really have it the right to condemn. 261 00:11:55,998 --> 00:11:58,469 I'm just not sure how everyone else react. 262 00:11:58,469 --> 00:11:59,939 - Well, listen. 263 00:11:59,939 --> 00:12:02,043 I mean, you can't control how people feel for you, okay? 264 00:12:02,043 --> 00:12:04,414 All you can do is show everyone that you will be there for them 265 00:12:04,414 --> 00:12:07,020 when things get tough. 266 00:12:07,655 --> 00:12:10,059 - Ah, Dr. Hamda. Do you have a minute? 267 00:12:10,059 --> 00:12:12,030 - Of course, yes. Come in, sit down. 268 00:12:14,368 --> 00:12:18,610 - I know I should have say something earlier. 269 00:12:19,044 --> 00:12:21,784 I think I was just too scared 270 00:12:21,784 --> 00:12:23,085 that no one they won't take it seriously. 271 00:12:23,085 --> 00:12:26,258 - It's okay, Liz. What is it about? 272 00:12:28,362 --> 00:12:29,565 - Dr. Miller. 273 00:12:29,565 --> 00:12:30,968 What he did to me. 274 00:12:30,968 --> 00:12:33,673 Everyone is just pretending as if nothing happened 275 00:12:33,673 --> 00:12:35,877 but that was an abuse of power. 276 00:12:38,082 --> 00:12:42,958 - I appreciate your honesty, and i understand how you feel. 277 00:12:42,958 --> 00:12:46,298 - Not how I feel. That's what happened. 278 00:12:47,668 --> 00:12:50,674 - No one approves what Dr. Miller did, 279 00:12:50,674 --> 00:12:52,110 but an agreement was reached. 280 00:12:52,110 --> 00:12:54,816 - What kind of deal? - I'm afraid I can't discuss that. 281 00:12:54,816 --> 00:12:56,451 - So you won't tell me what happened? 282 00:12:58,857 --> 00:13:00,827 - It was her confidential settlement. 283 00:13:00,827 --> 00:13:03,433 I'm sorry, Liz. 284 00:13:04,101 --> 00:13:06,338 - I guess just this proves why you never 285 00:13:06,338 --> 00:13:09,144 I shouldn't have bothered to come forward. 286 00:13:17,628 --> 00:13:18,997 CT confirms the location, 287 00:13:18,997 --> 00:13:20,500 it is clean of vertebral arteries. 288 00:13:20,500 --> 00:13:22,572 Moving the cannula into position. 289 00:13:28,315 --> 00:13:29,418 - Hey, honey. 290 00:13:29,418 --> 00:13:32,758 - Okay. So, I almost had to sell your body for this 291 00:13:32,758 --> 00:13:35,564 but Spoon and Stable they finally called me. 292 00:13:35,564 --> 00:13:37,100 - They had a cancellation? 293 00:13:37,100 --> 00:13:39,605 - I told them it was ours anniversary, and they said 294 00:13:39,605 --> 00:13:41,442 that they can squeeze us into six. 295 00:13:41,442 --> 00:13:42,912 Can you pull it off? 296 00:13:42,912 --> 00:13:44,515 - Well, looks like I'll have to. 297 00:13:44,515 --> 00:13:46,151 There's no way we're going to miss it and oysters. 298 00:13:46,151 --> 00:13:49,759 So there is a chance that I will have to come back here. 299 00:13:49,759 --> 00:13:52,799 - Oh no. Is that the boy which one did you tell me about? 300 00:13:52,799 --> 00:13:55,070 - I found a rather serious one a problem with his spine, 301 00:13:55,070 --> 00:13:56,573 he is now undergoing surgery. 302 00:13:56,573 --> 00:13:58,877 - Oh honey, that's terrible. 303 00:13:58,877 --> 00:14:01,148 Are they social workers helpful? 304 00:14:01,148 --> 00:14:03,052 - Not really. I had to make a decision on your own 305 00:14:03,052 --> 00:14:04,588 about which operation should have. 306 00:14:04,588 --> 00:14:06,726 - Okay, I know it's not my area, 307 00:14:06,726 --> 00:14:09,999 and i love you for who you are a person who cares so much. 308 00:14:09,999 --> 00:14:12,672 But the last time you brought so much to the case... 309 00:14:12,672 --> 00:14:15,076 - He doesn't have anyone, Wendy. 310 00:14:15,076 --> 00:14:16,979 I have no choice. 311 00:14:19,084 --> 00:14:21,322 Well, she told me about prednisone, 312 00:14:21,322 --> 00:14:22,925 that it brought her here much earlier 313 00:14:22,925 --> 00:14:24,428 than it would otherwise. 314 00:14:25,029 --> 00:14:27,935 - Yes. She is strong-willed. 315 00:14:27,935 --> 00:14:30,139 That's why we love her. 316 00:14:30,808 --> 00:14:33,412 - She probably felt it as if there is no choice. 317 00:14:33,412 --> 00:14:36,653 You know, me, after I told her that I don't want to see her 318 00:14:36,653 --> 00:14:38,690 what else does she care other than work? 319 00:14:39,224 --> 00:14:41,830 And now, Robbie may never be they won't even meet. 320 00:14:42,598 --> 00:14:45,704 - She knew it was up to her to yes fix things with you. 321 00:14:45,704 --> 00:14:47,440 Not on you. 322 00:14:48,610 --> 00:14:51,381 All you can do now is be there for each other. 323 00:15:15,831 --> 00:15:18,302 - What did you do? 324 00:15:19,873 --> 00:15:23,412 She was fine. She was perfectly fine an hour ago. 325 00:15:23,412 --> 00:15:24,549 What did you do? 326 00:15:24,549 --> 00:15:26,519 - It's not their fault. She had a heart attack. 327 00:15:26,519 --> 00:15:29,157 No one could predict this. 328 00:15:34,000 --> 00:15:37,842 - Amy. Uh, how's Joan? 329 00:15:37,842 --> 00:15:41,716 - Um, for now she is stable. On chemotherapy. 330 00:15:42,618 --> 00:15:45,858 - I'm sure this is difficult for you. If I can at all... 331 00:15:45,858 --> 00:15:48,129 - Something is happening inside. 332 00:15:50,600 --> 00:15:52,104 - Her temperature is dropping. 333 00:15:52,104 --> 00:15:53,974 - Yes, body temperature can drop 334 00:15:53,974 --> 00:15:55,544 after starting chemotherapy, that's normal. 335 00:15:55,544 --> 00:15:57,982 - But it can also be a sign of sepsis. 336 00:15:57,982 --> 00:16:01,021 - No, all her cultures were negative. 337 00:16:01,021 --> 00:16:02,290 - Is that true? 338 00:16:02,290 --> 00:16:04,562 - Yes, of course it's true. 339 00:16:04,562 --> 00:16:08,002 And you should know that Dr. Larsen 340 00:16:08,002 --> 00:16:09,672 previously recommended course of treatment 341 00:16:09,672 --> 00:16:11,543 which could have been disastrous for your mother. 342 00:16:11,543 --> 00:16:14,982 Therefore, I think so not a good idea 343 00:16:14,982 --> 00:16:17,086 that friends heal each other. 344 00:16:20,259 --> 00:16:22,765 I admire your mother, but I can be objective, 345 00:16:22,765 --> 00:16:24,133 and that's what she needs. 346 00:16:27,006 --> 00:16:28,275 - He's right. 347 00:16:28,943 --> 00:16:30,780 Sorry, Ethan. 348 00:16:38,697 --> 00:16:39,865 - Hey. - Hey. 349 00:16:39,865 --> 00:16:41,836 - Do you have any more blood Joan Ridley? 350 00:16:41,836 --> 00:16:43,673 - Yes, we should have something extra. 351 00:16:43,673 --> 00:16:44,876 - Can you make beta-D-glucan? 352 00:16:44,876 --> 00:16:46,913 - All her cultures were negative. 353 00:16:46,913 --> 00:16:48,349 What are you looking for? 354 00:16:48,349 --> 00:16:50,921 - I want to turn it off invasive fungal infection. 355 00:16:50,921 --> 00:16:52,758 Something in the endothelial tissue. 356 00:16:52,758 --> 00:16:54,361 - It can. 357 00:16:54,361 --> 00:16:56,231 - And uh, when you're done, 358 00:16:56,231 --> 00:16:58,202 can you send me results directly? 359 00:16:58,202 --> 00:17:00,439 - It says Dr. Miller is in charge. 360 00:17:00,439 --> 00:17:01,709 - He is. 361 00:17:02,778 --> 00:17:06,285 I need this, Carin. Please. 362 00:17:06,285 --> 00:17:07,554 - Of course. 363 00:17:09,959 --> 00:17:11,494 - Hey, how's it going? 364 00:17:11,494 --> 00:17:15,770 - Hey. I'm at school looks like Mia got into a fight. 365 00:17:16,773 --> 00:17:18,075 - I'm guessing, with Logan? 366 00:17:18,075 --> 00:17:20,046 - I didn't have a chance talk to her about it 367 00:17:20,046 --> 00:17:21,114 but I thought we should do it together. 368 00:17:21,114 --> 00:17:22,952 Can I bring her to the hospital? 369 00:17:22,952 --> 00:17:24,254 It shouldn't take long. 370 00:17:24,254 --> 00:17:26,559 - Yes, yes, of course. Um, yes, I'm here. 371 00:17:33,005 --> 00:17:35,376 - She killed herself, Gina. 372 00:17:35,376 --> 00:17:38,149 All those years when I begged her to stop smoking. 373 00:17:38,149 --> 00:17:41,221 Her blood pressure was sky high, 374 00:17:41,221 --> 00:17:42,692 it was only a matter of time. 375 00:17:42,692 --> 00:17:44,094 - You can't fixate all the time 376 00:17:44,094 --> 00:17:45,664 to what could be different. All right? 377 00:17:45,664 --> 00:17:48,402 All you can do now is start process your pain. 378 00:17:48,402 --> 00:17:50,239 - What makes you think if I didn't? 379 00:17:50,239 --> 00:17:52,878 - It's been a week and a half. You still haven't cried. 380 00:17:52,878 --> 00:17:55,850 - Crying won't fix anything. 381 00:17:55,850 --> 00:17:58,222 - I'm not saying you're forcing yourself, okay? 382 00:17:58,222 --> 00:18:00,259 But just let yourself feel. 383 00:18:00,259 --> 00:18:02,096 - This will only get worse 384 00:18:02,096 --> 00:18:03,800 when you become real a psychiatrist, right? 385 00:18:03,800 --> 00:18:07,106 - It's a neuropsychiatrist, thank you very much. 386 00:18:08,109 --> 00:18:10,012 - I just need myself focus on school. 387 00:18:10,012 --> 00:18:13,854 And maybe the handsome one bartender from Stanton. 388 00:18:13,854 --> 00:18:15,289 - I'm serious, Amy. 389 00:18:15,289 --> 00:18:18,295 You are grieving and you are angry with your mother. 390 00:18:18,295 --> 00:18:19,732 You can't just suppress it all. 391 00:18:19,732 --> 00:18:21,168 - Why not? 392 00:18:21,168 --> 00:18:22,738 - Because when it comes to feelings, 393 00:18:22,738 --> 00:18:24,174 the bill must come due. 394 00:18:24,174 --> 00:18:26,111 One way or another. 395 00:18:34,729 --> 00:18:36,465 - Hey. 396 00:18:36,465 --> 00:18:38,870 - I'm just checking on you. Joan's pressure and oxygen saturation improve. 397 00:18:38,870 --> 00:18:40,573 Chemotherapy must work. 398 00:18:40,573 --> 00:18:43,478 - I guess Richard was right. In relation to leukemia. 399 00:18:43,478 --> 00:18:45,851 - At least we have a diagnosis. Where are you? 400 00:18:45,851 --> 00:18:49,290 - Uh, I'm in Radiology with another patient. 401 00:18:49,290 --> 00:18:51,696 I will be back soon. - Okay. 402 00:18:54,101 --> 00:18:56,572 - We won't be angry, honey. 403 00:18:56,572 --> 00:18:58,275 We just want us to you say what happened. 404 00:18:58,275 --> 00:19:00,513 - Logan was throwing markers on me. 405 00:19:01,147 --> 00:19:02,952 - I thought we said when do things like that 406 00:19:02,952 --> 00:19:04,454 that you will tell the teacher. 407 00:19:04,454 --> 00:19:06,424 - I did. But he didn't stop. 408 00:19:06,424 --> 00:19:09,799 So I took my chocolate pudding 409 00:19:09,799 --> 00:19:11,970 and shook it on his head. 410 00:19:13,940 --> 00:19:16,011 - Um, so what happened? 411 00:19:16,011 --> 00:19:18,115 You told the teacher and she did she didn't do anything? 412 00:19:18,115 --> 00:19:19,952 - She had to sit in a big chair. 413 00:19:19,952 --> 00:19:21,355 - What is a big chair? 414 00:19:21,355 --> 00:19:23,593 - It's a big, comfortable chair in the corner 415 00:19:23,593 --> 00:19:26,231 where you sit and think about what you did. 416 00:19:26,231 --> 00:19:27,935 - So, as a punishment. 417 00:19:27,935 --> 00:19:31,441 - Okay, but uh, last week, when you won the spelling bee, 418 00:19:31,441 --> 00:19:33,513 you said you could have sat in a big, comfortable chair. 419 00:19:33,513 --> 00:19:36,117 - Yes. You sit in it if you do something good. 420 00:19:36,117 --> 00:19:40,693 But then, sometimes, you sit in it if you do something bad. 421 00:19:43,633 --> 00:19:45,369 - I want to print it from that school, Rache. All right? 422 00:19:45,369 --> 00:19:47,339 There is a public school, there is a Hebrew school 423 00:19:47,339 --> 00:19:48,877 which we visited I don't care which one. 424 00:19:48,877 --> 00:19:50,980 I just think it needs to be somewhere 425 00:19:50,980 --> 00:19:52,250 with more boundaries and strength, 426 00:19:52,250 --> 00:19:54,420 and less consolation prizes and large chairs. 427 00:19:54,855 --> 00:19:56,291 - Okay. 428 00:19:56,291 --> 00:19:58,530 - Okay what? - Okay, you're right. 429 00:19:58,530 --> 00:20:01,401 I'm wrong. Let's switch it over. 430 00:20:01,401 --> 00:20:04,141 - Wait, did you just tell me? Am I right about something? 431 00:20:06,077 --> 00:20:07,948 - And if you play well your cards, 432 00:20:07,948 --> 00:20:09,885 maybe it will happen again. 433 00:20:11,856 --> 00:20:13,291 I'm taking her home? 434 00:20:13,291 --> 00:20:15,329 - Yes, yes. 435 00:20:24,414 --> 00:20:25,750 - Are you okay? 436 00:20:29,157 --> 00:20:30,593 - Yes. 437 00:20:31,963 --> 00:20:36,872 I just realize how much I have little power here. 438 00:20:40,980 --> 00:20:42,918 - What happened? 439 00:20:44,588 --> 00:20:46,893 - Nothing can be done do about it, Sonya. 440 00:20:47,427 --> 00:20:50,132 - No, no. I will be chief specialist, 441 00:20:50,132 --> 00:20:52,671 which means I can get busy. 442 00:21:01,322 --> 00:21:03,358 And this is unprofessional. 443 00:21:03,358 --> 00:21:05,329 - He would never test for this, Richard, 444 00:21:05,329 --> 00:21:06,331 and the finding is positive. 445 00:21:06,331 --> 00:21:07,601 He wouldn't listen to me. 446 00:21:07,601 --> 00:21:08,970 - Well, that was my decision... 447 00:21:08,970 --> 00:21:10,607 - Would you like to tell me? what's going on here? 448 00:21:10,607 --> 00:21:12,544 - She did the test behind my back. 449 00:21:12,544 --> 00:21:13,613 - It's hardly the main news here. 450 00:21:13,613 --> 00:21:16,050 Joan has an infection organs Candida, 451 00:21:16,050 --> 00:21:17,721 which he would not reveal. 452 00:21:17,721 --> 00:21:19,558 I assume you are interested in treating this, 453 00:21:19,558 --> 00:21:21,461 even though I was the one who discovered it. 454 00:21:21,461 --> 00:21:23,432 - Okay, okay. That's enough. 455 00:21:23,432 --> 00:21:25,604 It's obviously chemotherapy reduced her immune response, 456 00:21:25,604 --> 00:21:27,608 reduce the dose for now and treat the infection. 457 00:21:27,608 --> 00:21:29,845 But we still are on the right track. 458 00:21:32,751 --> 00:21:36,458 - You know, maybe I would be more inclined to listen to you, 459 00:21:36,458 --> 00:21:39,798 that you are not so busy putting me in my place. 460 00:21:42,504 --> 00:21:46,444 - He would never order that test. Out of spite. 461 00:21:46,444 --> 00:21:48,448 - If you needed support... - What's up with that, Michael? 462 00:21:48,448 --> 00:21:50,319 I should come to you because you want to help? 463 00:21:50,319 --> 00:21:52,389 Or I shouldn't come 464 00:21:52,389 --> 00:21:54,528 to you because I put you in a difficult situation, 465 00:21:54,528 --> 00:21:55,764 because I heard both versions. 466 00:21:55,764 --> 00:21:57,968 - I am now the head of your department. 467 00:21:57,968 --> 00:21:59,270 That's a lot different 468 00:21:59,270 --> 00:22:01,108 than run two floors up talk to the Chief Medical Officer. 469 00:22:01,108 --> 00:22:02,644 And by the way, you lied. 470 00:22:02,644 --> 00:22:03,780 You told me you were in Radiology, 471 00:22:03,780 --> 00:22:05,850 on our first day joint work. 472 00:22:10,259 --> 00:22:11,996 - You're right. I'm sorry. 473 00:22:13,866 --> 00:22:15,537 I'm, I'm uh... 474 00:22:15,537 --> 00:22:19,811 Every time I look at Joan in that bed, all i see is... 475 00:22:20,714 --> 00:22:21,983 - His mother. 476 00:22:26,391 --> 00:22:28,094 - I wish you were here for that. 477 00:22:28,094 --> 00:22:29,998 - I'm here now. 478 00:22:31,001 --> 00:22:32,403 - I know. 479 00:22:32,403 --> 00:22:34,608 - Try to stick to it. 480 00:22:39,552 --> 00:22:42,056 - Oh, I think he's waking up. - Walter, can you hear me? 481 00:22:42,056 --> 00:22:43,693 - It hurts. Please, it hurts. 482 00:22:43,693 --> 00:22:47,033 - Blood pressure rises. - Walter, try to breathe. 483 00:22:47,033 --> 00:22:48,468 - My neck hurts, it hurts so much! 484 00:22:48,468 --> 00:22:50,139 - Two milligrams IV morphine, immediately. 485 00:22:50,139 --> 00:22:51,408 - Where in the neck? 486 00:22:51,408 --> 00:22:53,212 - Why can't I move my arms? What's going on? 487 00:22:53,212 --> 00:22:56,017 - It's okay, Walter. That's it sometimes happens with swelling. 488 00:22:56,451 --> 00:22:58,756 He lost Babinski. 489 00:22:59,992 --> 00:23:01,596 - So, the spinal cord not sending a signal? 490 00:23:01,596 --> 00:23:02,964 - Costa is doing a CT scan to confirm, 491 00:23:02,964 --> 00:23:05,570 but it seems that the swelling of the spinal cord causes compression. 492 00:23:05,570 --> 00:23:07,439 He's on morphine for pain, 493 00:23:07,439 --> 00:23:09,277 but there are serious ones neurological deficits. 494 00:23:09,277 --> 00:23:10,714 No movement below the neck. 495 00:23:10,714 --> 00:23:12,817 - Let's get back as soon as possible and we operate, the better. 496 00:23:12,817 --> 00:23:15,255 - But his lungs are still inflamed from rheumatoid arthritis. 497 00:23:15,255 --> 00:23:17,594 He might not be able to handle it another round of anesthesia. 498 00:23:17,594 --> 00:23:19,565 - Dr. Costa has reserved the hall for early in the morning. 499 00:23:19,565 --> 00:23:21,001 Anything longer than that, 500 00:23:21,001 --> 00:23:23,005 and could have serious neurological problems permanently. 501 00:23:23,005 --> 00:23:24,441 - We should have been more aggressive. 502 00:23:24,441 --> 00:23:26,445 - We can't be generals after the battle. 503 00:23:26,445 --> 00:23:27,814 The surgeon gave you two choices. 504 00:23:27,814 --> 00:23:29,685 - I also chose the safer one, because I was worried 505 00:23:29,685 --> 00:23:31,354 that Walter has no long-term support 506 00:23:31,354 --> 00:23:32,958 to decide for what is was really necessary. 507 00:23:32,958 --> 00:23:34,829 - It was a coin toss, Gina. - No, it's not. 508 00:23:34,829 --> 00:23:36,732 You wanted to make up your mind for the second option. 509 00:23:36,732 --> 00:23:38,836 - So, Costa hesitated. That it shouldn't have been up to you. 510 00:23:38,836 --> 00:23:40,005 - No, it wasn't necessary. 511 00:23:40,005 --> 00:23:42,109 So let this now I take off your burden. 512 00:23:42,109 --> 00:23:43,980 Tell Costa I want Walter 513 00:23:43,980 --> 00:23:45,751 be in reverse Trendelenburg position during surgery, 514 00:23:45,751 --> 00:23:48,055 and to use pulmonary protective ventilation 515 00:23:48,055 --> 00:23:49,591 with low tidal volume. 516 00:23:52,631 --> 00:23:55,068 - Maybe he never will again walk, Michael. 517 00:23:58,241 --> 00:24:01,148 - Induction chemotherapy destroyed me. 518 00:24:01,148 --> 00:24:03,587 - Well, you've almost passed the first dose. 519 00:24:03,587 --> 00:24:06,091 But we found an invasive one fungal infection, 520 00:24:06,091 --> 00:24:07,360 we assume Candida. 521 00:24:07,360 --> 00:24:09,064 We are treating her, we treat it with antifungals. 522 00:24:09,064 --> 00:24:11,100 - Candida. 523 00:24:11,100 --> 00:24:13,507 It must have spread to my liver. 524 00:24:13,507 --> 00:24:15,810 - No, not on the liver. 525 00:24:15,810 --> 00:24:17,648 It is probably diffuse endothelial, 526 00:24:17,648 --> 00:24:19,818 considering the high beta-D-glucan level. 527 00:24:19,818 --> 00:24:22,023 - Have you finished your homework? 528 00:24:22,658 --> 00:24:25,262 Is your father is your father home yet? 529 00:24:25,262 --> 00:24:27,399 - Mom? - Joan? Look at me. 530 00:24:27,399 --> 00:24:29,971 - What's wrong with her? - Ethan, step back. 531 00:24:30,774 --> 00:24:32,276 What's going on? 532 00:24:32,276 --> 00:24:33,779 He's having a seizure. 533 00:24:33,779 --> 00:24:35,550 Oxygen per 10 liters. 534 00:24:35,550 --> 00:24:38,355 Altered mental state, it must be neurological. 535 00:24:38,355 --> 00:24:40,560 - Increased intracranial pressure, her brain swells. 536 00:24:40,560 --> 00:24:42,530 - That he has leukemia, this wouldn't happen. 537 00:24:42,530 --> 00:24:44,234 Not so fast. - You're right. 538 00:24:44,234 --> 00:24:46,237 We're missing something. 539 00:24:50,980 --> 00:24:52,684 - Look, I know that whatever decisions have been made 540 00:24:52,684 --> 00:24:55,188 about Dr. Miller's return they are far beyond my competence, 541 00:24:55,188 --> 00:24:57,660 but we can't just ask Liz to forget what happened 542 00:24:57,660 --> 00:24:59,665 because it will make life easier to everyone else. 543 00:24:59,665 --> 00:25:02,971 - I'll talk to Richard once Joan stabilizes. 544 00:25:02,971 --> 00:25:05,777 I'm sure he will be willing tell Liz. 545 00:25:05,777 --> 00:25:09,785 - His apology will be hollow and insignificant. 546 00:25:09,785 --> 00:25:11,789 And you should know, while Dr. Miller was the boss, 547 00:25:11,789 --> 00:25:15,296 he tried to use me to find out the mistakes Amy was making. 548 00:25:15,730 --> 00:25:19,170 - Look, I'm sorry that you finished in the middle of it. 549 00:25:19,170 --> 00:25:21,743 But uh, I know the board of directors. 550 00:25:21,743 --> 00:25:23,579 They'd rather find a way to get rid of Liz 551 00:25:23,579 --> 00:25:25,115 but to reopen this Pandora's box. 552 00:25:25,115 --> 00:25:27,954 - Well, I can try, but if Liz starts talking, 553 00:25:27,954 --> 00:25:29,859 will get resistance from nurses 554 00:25:29,859 --> 00:25:31,428 and potentially from unions. 555 00:25:31,428 --> 00:25:33,331 - Is, uh, is that a threat? 556 00:25:33,331 --> 00:25:34,902 - That's reality. 557 00:25:34,902 --> 00:25:37,708 I'm just trying to do the right thing for her, 558 00:25:37,708 --> 00:25:40,379 and protect the department, which is now part of my job. 559 00:25:40,379 --> 00:25:43,686 - She bears the responsibility for your own decisions, Sonya. 560 00:25:43,686 --> 00:25:45,757 As you said, there is very strong union 561 00:25:45,757 --> 00:25:47,727 whom she could turn to when all this happened. 562 00:25:47,727 --> 00:25:49,531 - I mean, maybe, you expect too much 563 00:25:49,531 --> 00:25:53,606 or you don't understand the dynamics between an older man with power 564 00:25:53,606 --> 00:25:56,512 and young women on beginning of career. 565 00:25:56,512 --> 00:25:58,115 It's victim blaming, 566 00:25:58,115 --> 00:25:59,885 and I don't think so that it will be appreciated. 567 00:25:59,885 --> 00:26:02,924 - I hear you. - Well, good. 568 00:26:04,060 --> 00:26:06,665 Because you started the day saying your door is open, 569 00:26:06,665 --> 00:26:09,571 but now it seems that them you close Liz. 570 00:26:16,251 --> 00:26:17,788 - MDS is in the late phase, 571 00:26:17,788 --> 00:26:20,927 but it is hidden high use of steroids. 572 00:26:20,927 --> 00:26:23,498 pancytopenia, pleural effusions, 573 00:26:23,498 --> 00:26:26,004 DIK, increased beta-D-glucan, 574 00:26:26,004 --> 00:26:29,344 and now cerebral edema, and her condition worsens. 575 00:26:29,344 --> 00:26:32,684 - Hey, I just checked on Joan. How are you holding up? 576 00:26:32,684 --> 00:26:35,657 - I fought all day with Richard, 577 00:26:35,657 --> 00:26:37,259 and now we are running out of time. 578 00:26:37,259 --> 00:26:38,529 - Who is this? 579 00:26:38,529 --> 00:26:39,931 - Um, he's a doctor from Madrid 580 00:26:39,931 --> 00:26:42,671 which has a case study which might be relevant, 581 00:26:42,671 --> 00:26:45,042 and this translation app constantly barking. 582 00:26:45,042 --> 00:26:47,413 - Um, I mean, i studied spanish 583 00:26:47,413 --> 00:26:48,983 we could see how rusty i am. 584 00:26:48,983 --> 00:26:50,085 - Okay. 585 00:27:25,523 --> 00:27:27,661 - Thank you. So what he says 586 00:27:27,661 --> 00:27:29,097 is that the symptoms were similar, 587 00:27:29,097 --> 00:27:31,234 but his patient had latent sarcoidosis, 588 00:27:31,234 --> 00:27:33,472 so that made it complicated clinical picture. 589 00:27:33,472 --> 00:27:35,009 But when they discovered it, 590 00:27:35,009 --> 00:27:36,110 everything else is sat in place. 591 00:27:36,110 --> 00:27:37,881 - So, patient with MDS as Joan 592 00:27:37,881 --> 00:27:39,250 had these symptoms 593 00:27:39,250 --> 00:27:41,588 due to another chronic problem. 594 00:27:41,588 --> 00:27:43,492 - And he stayed undiscovered for years. 595 00:27:43,492 --> 00:27:45,730 - Okay, okay. Thanks. 596 00:27:45,730 --> 00:27:47,700 - Just remember you have to find a way 597 00:27:47,700 --> 00:27:49,203 to work with Richard on this. 598 00:27:51,809 --> 00:27:53,679 - Your lumbar puncture is negative, 599 00:27:53,679 --> 00:27:55,148 and a complete neurological panel as well. 600 00:27:55,148 --> 00:27:57,587 - Well, procalcitonin for her is short, 601 00:27:57,587 --> 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 --> 00:28:02,964 C-reactive protein and complement levels. 604 00:28:02,964 --> 00:28:05,135 How fast can you do it? - 20 minutes. 605 00:28:05,135 --> 00:28:08,208 - And if the results can go me, being her doctor, 606 00:28:08,208 --> 00:28:09,811 I would be grateful. 607 00:28:11,882 --> 00:28:14,186 We have a tall one complement protein level, 608 00:28:14,186 --> 00:28:17,026 and she needed prednisone lower immune surveillance, 609 00:28:17,026 --> 00:28:19,898 which means we are looking for something that is already there. 610 00:28:19,898 --> 00:28:22,303 Possibly for years, as you said 611 00:28:22,303 --> 00:28:23,873 but it was hiding before our eyes. 612 00:28:23,873 --> 00:28:25,710 - When Joan woke up, 613 00:28:25,710 --> 00:28:27,146 and I told her about Candida, 614 00:28:27,146 --> 00:28:28,716 she asked if spread to her liver. 615 00:28:28,716 --> 00:28:30,587 - Well, that wouldn't be unusual. 616 00:28:30,587 --> 00:28:32,123 But beta-D-glucan is so high, 617 00:28:32,123 --> 00:28:33,626 fungal load would be too big 618 00:28:33,626 --> 00:28:35,162 to be isolated on her liver. 619 00:28:35,162 --> 00:28:37,867 - Okay. We assumed that are elevated liver enzymes 620 00:28:37,867 --> 00:28:41,474 caused by MDS and prednisone, 621 00:28:41,474 --> 00:28:44,480 but look at her findings since 2016 622 00:28:45,916 --> 00:28:47,420 Upper limit of normal. 623 00:28:47,420 --> 00:28:49,357 - But low enough to no one would notice. 624 00:28:49,357 --> 00:28:51,194 - 2016, 625 00:28:51,194 --> 00:28:54,535 that's a long time yes it carries something in itself. 626 00:28:55,202 --> 00:28:58,776 - Wait a minute. One of the last the memories i have of her 627 00:28:58,776 --> 00:29:00,345 In 2016, she was in Ecuador. 628 00:29:00,345 --> 00:29:04,420 And she got sick, and I said to her that she should come back. 629 00:29:04,420 --> 00:29:07,627 She made the diagnosis herself, 630 00:29:07,627 --> 00:29:09,330 she thought it was dysentery... 631 00:29:09,330 --> 00:29:11,434 - Which means she was drinking unfiltered water. 632 00:29:11,434 --> 00:29:13,606 - So, if it was a parasite, 633 00:29:13,606 --> 00:29:16,211 she could be sick as she digested it, 634 00:29:16,211 --> 00:29:19,484 but as he migrated in her liver, she was fine. 635 00:29:19,484 --> 00:29:21,822 - Then she could fight quietly with these years. 636 00:29:21,822 --> 00:29:23,593 - And she's on prednisone weakened immune system, 637 00:29:23,593 --> 00:29:25,462 and unleashed it on her. 638 00:29:27,800 --> 00:29:29,871 - I think we have a way now. 639 00:29:34,079 --> 00:29:35,917 It loses its sympathetic tone. 640 00:29:35,917 --> 00:29:38,723 - The operation is scheduled for 6 in the morning, can we increase steroids? 641 00:29:38,723 --> 00:29:40,192 - I worry too much about his blood pressure. 642 00:29:40,192 --> 00:29:41,829 I think we just have to stay the course 643 00:29:41,829 --> 00:29:43,899 and hope that it is enough strong to last. 644 00:29:45,970 --> 00:29:48,141 - I appreciate what you said before. 645 00:29:48,141 --> 00:29:50,178 Trying to exonerate me. 646 00:29:51,347 --> 00:29:52,851 - Are you religious? 647 00:29:52,851 --> 00:29:54,386 - From time to time, 648 00:29:54,386 --> 00:29:57,426 depending on how I feel about the world. 649 00:29:58,094 --> 00:30:00,266 - I remember that I was once on sermons. 650 00:30:00,266 --> 00:30:04,140 The priest spoke about to how it can be a form of arrogance 651 00:30:04,140 --> 00:30:05,977 think that we can control things 652 00:30:05,977 --> 00:30:08,314 which are beyond our control. 653 00:30:09,585 --> 00:30:11,989 - Because it's someone else's domain? 654 00:30:11,989 --> 00:30:13,593 Doesn't mean it is easy to accept it. 655 00:30:13,593 --> 00:30:16,097 But I think that's the idea, yes. 656 00:30:17,133 --> 00:30:19,838 - I'll look into it, Dr. Coleman. 657 00:30:19,838 --> 00:30:21,207 - Good. 658 00:30:25,482 --> 00:30:26,618 Your wife is here. 659 00:30:30,425 --> 00:30:32,262 - Today is my anniversary and I forgot. 660 00:30:32,262 --> 00:30:34,200 - You go. I will take care of everything, 661 00:30:34,200 --> 00:30:36,838 inspections every hour, i won't go home 662 00:30:42,382 --> 00:30:45,155 - I'm down on the 15th minute, I tried to call you. 663 00:30:45,155 --> 00:30:48,194 - I'm sorry. There were problems with Walter's operation, 664 00:30:48,194 --> 00:30:49,865 he needs another one tomorrow. 665 00:30:50,533 --> 00:30:52,804 - Why don't we have dinner in your office tonight? 666 00:30:52,804 --> 00:30:57,179 So if something happens, you are close 667 00:30:57,179 --> 00:30:59,283 - What did I do to deserve you? 668 00:30:59,283 --> 00:31:00,620 - I don't know. 669 00:31:00,620 --> 00:31:03,157 I'm sure you'll find a way to repay me. 670 00:31:04,493 --> 00:31:07,299 - I mean 400 milligrams of albendazole. 671 00:31:07,834 --> 00:31:09,804 - I would give 300, 672 00:31:09,804 --> 00:31:12,209 with respect to ALT/AST, 673 00:31:12,209 --> 00:31:14,648 and 20 amphotericin B to balance it. 674 00:31:14,648 --> 00:31:16,686 - And 100 milligrams of cimetidine 675 00:31:16,686 --> 00:31:18,254 to reduce renal toxicity. 676 00:31:19,525 --> 00:31:20,893 - It's a tightrope walk. 677 00:31:20,893 --> 00:31:22,797 - Do you have any idea where Liz is? 678 00:31:22,797 --> 00:31:24,100 - Uh, let me see. 679 00:31:24,100 --> 00:31:27,405 Code Plavo, Intensive. Code Plavo, Intensive. 680 00:31:27,405 --> 00:31:28,575 - Joan is coding. 681 00:31:29,309 --> 00:31:31,414 Code Plavo, Intensive. 682 00:31:31,414 --> 00:31:33,385 Code Plavo, Intensive. 683 00:31:34,588 --> 00:31:36,324 - No pulse. 684 00:31:36,324 --> 00:31:37,961 - It's in V-fib. Give one milligram of Epi. 685 00:31:37,961 --> 00:31:40,031 Bring a defibrillator. 686 00:31:48,414 --> 00:31:50,185 - Ready? 687 00:31:51,187 --> 00:31:53,024 Stand back. 688 00:31:55,964 --> 00:31:58,468 - I start the compressions again. 689 00:32:06,383 --> 00:32:09,490 - Danny, Danny. Somebody call 911. 690 00:32:10,860 --> 00:32:12,295 Recharge to 50. 691 00:32:13,465 --> 00:32:15,468 Stand back. 692 00:32:20,011 --> 00:32:22,550 - I give another milligram of adrenaline. 693 00:32:28,996 --> 00:32:31,267 - Nice V-fib, we're losing it. 694 00:32:31,267 --> 00:32:34,039 - I increase to 100. Give me the electrodes. 695 00:32:38,048 --> 00:32:40,218 - Ready. - Stand back. 696 00:32:49,872 --> 00:32:51,106 - It looks like a sinus. 697 00:32:51,106 --> 00:32:53,679 - We have a pulse. He came back. 698 00:32:53,679 --> 00:32:56,618 - Call Dr. Costa, we can't wait with the operation. 699 00:33:19,698 --> 00:33:21,334 - The spinal cord is decompressed. 700 00:33:21,334 --> 00:33:25,509 The screws are in place. Let's secure the bars. 701 00:33:26,010 --> 00:33:27,513 - Hey. 702 00:33:31,020 --> 00:33:34,126 It had to be really hard for you. 703 00:33:34,795 --> 00:33:36,397 - Yes. 704 00:33:37,232 --> 00:33:40,072 And a hell of a first day for Michael. 705 00:33:40,072 --> 00:33:42,777 - Oh, it hit him quite personal. 706 00:33:44,246 --> 00:33:45,950 How's it going inside? 707 00:33:45,950 --> 00:33:47,687 - The hardware is almost in place. 708 00:33:47,687 --> 00:33:49,958 But even if it succeeds, 709 00:33:49,958 --> 00:33:52,095 no one will ever adopt him. 710 00:33:52,095 --> 00:33:54,801 Not when he needs this kind of support. 711 00:33:57,741 --> 00:34:01,447 - You're not thinking I guess about something drastic? 712 00:34:02,817 --> 00:34:04,453 - Go and be with Joan. 713 00:34:05,055 --> 00:34:06,791 - Gina. 714 00:34:07,928 --> 00:34:09,698 - I care about him, 715 00:34:10,466 --> 00:34:13,572 but I know where the limits are. 716 00:34:13,972 --> 00:34:16,578 Now go, where you are needed. 717 00:34:30,371 --> 00:34:32,242 - But you have to stop smoking. 718 00:34:32,242 --> 00:34:34,179 - You know that never happens not gonna happen baby 719 00:34:38,354 --> 00:34:40,960 - I don't know how much longer we can do pump into it 720 00:34:40,960 --> 00:34:43,264 before it starts to go out. 721 00:34:43,264 --> 00:34:46,170 - Her body is so fragile. 722 00:34:47,439 --> 00:34:50,211 - Chemotherapy she didn't help with that. 723 00:34:50,880 --> 00:34:53,484 - She was only on it eight hours. 724 00:34:55,021 --> 00:34:56,692 The parasite causes this, 725 00:34:56,692 --> 00:35:00,131 that and prednisone, it's not your fault, Richard. 726 00:35:37,941 --> 00:35:39,777 - Hey. It's okay, my friend. 727 00:35:50,700 --> 00:35:52,803 - Can I see? 728 00:35:55,342 --> 00:35:57,947 Aww, she's going to love this. 729 00:36:01,053 --> 00:36:03,058 - Will he wake up soon? 730 00:36:03,058 --> 00:36:05,562 - I really hope so. 731 00:36:21,093 --> 00:36:22,096 - Please? 732 00:36:22,096 --> 00:36:23,933 Hi Amy. dr. It's Ridley. 733 00:36:23,933 --> 00:36:27,472 - Oh. Hi. 734 00:36:27,472 --> 00:36:29,276 - I hope it's not 2 in the morning there, 735 00:36:29,276 --> 00:36:31,515 I stopped following the differences in time zones a long time ago. 736 00:36:31,515 --> 00:36:34,621 - No, it's noon. Is there a problem? 737 00:36:34,621 --> 00:36:36,558 - I spoke with to Dr. Kelly this morning, 738 00:36:36,558 --> 00:36:37,993 he told me about your mother. 739 00:36:39,263 --> 00:36:41,701 I'm so sorry, Amy. 740 00:36:42,269 --> 00:36:44,974 - Thank you, Dr. Ridley. 741 00:36:44,974 --> 00:36:46,109 - And I respect your persistence, 742 00:36:46,109 --> 00:36:47,647 you're already back at the hospital, 743 00:36:47,647 --> 00:36:50,151 but I just wanted to check do you take care of yourself. 744 00:36:50,151 --> 00:36:52,990 - I think so. 745 00:36:54,995 --> 00:36:56,532 That's... 746 00:36:56,532 --> 00:36:59,538 It was difficult, obviously. 747 00:36:59,538 --> 00:37:02,142 Your world is moved on its axis. 748 00:37:02,142 --> 00:37:04,279 But you will come out on the other side. 749 00:37:04,279 --> 00:37:05,883 - Just... 750 00:37:07,051 --> 00:37:09,323 I didn't even think you liked me. 751 00:37:09,323 --> 00:37:11,427 Well, that's on purpose, my dear. 752 00:37:11,427 --> 00:37:13,297 And now you know the truth. 753 00:37:13,297 --> 00:37:16,971 Not only do I like you, i believe in you 754 00:37:19,276 --> 00:37:22,416 - Thank you very much. I... 755 00:37:22,416 --> 00:37:24,286 I know how much this hurts now, 756 00:37:24,286 --> 00:37:26,423 but the best way in which you can pay tribute to your mother 757 00:37:26,423 --> 00:37:27,993 is to live life with purpose. 758 00:37:27,993 --> 00:37:30,833 You have greatness in you, Amy. 759 00:37:30,833 --> 00:37:33,772 And I'll be there to help you find her. 760 00:37:44,093 --> 00:37:46,097 - Joan. 761 00:37:46,097 --> 00:37:48,501 Hey. can you hear me 762 00:37:49,103 --> 00:37:52,743 Can you bring her son? He just went to get coffee. 763 00:37:53,778 --> 00:37:56,785 Hey. It's okay. 764 00:37:57,185 --> 00:38:00,057 Just take it easy. Breathe. 765 00:38:02,429 --> 00:38:05,536 - What happened? - You had cerebral edema. 766 00:38:05,536 --> 00:38:06,971 - No. 767 00:38:06,971 --> 00:38:10,746 - It's not leukemia. Not yet. 768 00:38:10,746 --> 00:38:13,585 You had a parasite in your liver. 769 00:38:13,585 --> 00:38:17,091 From Ecuador. Do you remember that? 770 00:38:17,091 --> 00:38:18,962 You thought it was dysentery? 771 00:38:19,697 --> 00:38:21,233 - Oh, my God. 772 00:38:21,901 --> 00:38:25,977 Is that the only way in my life that I misdiagnosed? 773 00:38:33,057 --> 00:38:35,963 - You haven't taken care of yourself for a long time. 774 00:38:38,067 --> 00:38:39,369 - I know. 775 00:38:39,369 --> 00:38:41,875 - Promise me that it stops now. 776 00:38:41,875 --> 00:38:43,845 - Ah. 777 00:38:43,845 --> 00:38:45,716 - Mom. Hey. 778 00:38:45,716 --> 00:38:47,018 - Hey. 779 00:38:47,987 --> 00:38:49,891 Thank you so much, Amy. 780 00:38:51,528 --> 00:38:55,836 - I will order KKS and liver function tests. 781 00:38:58,642 --> 00:39:00,378 The fact that he is conscious... 782 00:39:00,378 --> 00:39:02,482 - Yes, we bought it for her a little more time. 783 00:39:03,417 --> 00:39:06,591 - I appreciate what you found way to trust me today. 784 00:39:08,494 --> 00:39:10,131 - Yes, it worked today. 785 00:39:10,799 --> 00:39:13,638 But I will never tell you to believe, Richard. 786 00:39:21,253 --> 00:39:24,259 - Hey, Walter. Welcome back. 787 00:39:24,259 --> 00:39:25,696 - Did you fix my spine? 788 00:39:25,696 --> 00:39:28,669 - We have to do some tests the next few days, 789 00:39:28,669 --> 00:39:30,639 but it seems we are. 790 00:39:30,639 --> 00:39:32,376 - And I will be able to walk again? 791 00:39:32,376 --> 00:39:33,812 It will be a long recovery, 792 00:39:33,812 --> 00:39:36,718 lots of physical therapy while your body adjusts 793 00:39:36,718 --> 00:39:38,889 hardware in your spine. 794 00:39:38,889 --> 00:39:40,993 But yes, you will. 795 00:39:44,433 --> 00:39:47,138 - And I'll have to miss it next adoption fair? 796 00:39:47,840 --> 00:39:51,180 - There will be many more. I promise. 797 00:39:51,180 --> 00:39:52,750 - Thank you, Dr. Walker. 798 00:39:52,750 --> 00:39:55,789 No one ever cared like you. 799 00:39:59,363 --> 00:40:01,467 I'm so sorry. 800 00:40:01,467 --> 00:40:04,607 - It's okay. We will postpone. 801 00:40:11,721 --> 00:40:14,961 Sometimes I wonder how you manage to leave everything 802 00:40:14,961 --> 00:40:16,831 here when you get home. 803 00:40:18,468 --> 00:40:20,906 - It can be very difficult. 804 00:40:21,373 --> 00:40:22,977 - Yes. 805 00:40:32,764 --> 00:40:35,268 Let's go for a drink, huh? 806 00:40:35,268 --> 00:40:36,704 - Yes. 807 00:40:45,355 --> 00:40:47,994 - Hey. So I talked to Liz, 808 00:40:47,994 --> 00:40:50,666 and told her that if she wanted appear in front of human resources, 809 00:40:50,666 --> 00:40:52,369 we would both support her. 810 00:40:52,904 --> 00:40:56,077 - Thank you. Oh, and I'm sorry if I was too… 811 00:40:56,077 --> 00:40:59,416 - Sonya, telling the truth it requires courage for the powerful. 812 00:40:59,416 --> 00:41:01,821 I should be thanking you. 813 00:41:02,790 --> 00:41:05,128 - Sorry, I didn't wanted to interrupt. 814 00:41:05,128 --> 00:41:06,665 - Oh no, I was just leaving. 815 00:41:06,665 --> 00:41:09,169 - Actually, I was hoping that I will talk to you. 816 00:41:12,208 --> 00:41:14,780 I just wanted to say thanks which you checked earlier. 817 00:41:14,780 --> 00:41:18,220 Joan is better. - I heard, that's great news. 818 00:41:19,791 --> 00:41:22,495 - So we're going to do this? Together? 819 00:41:22,495 --> 00:41:24,366 - Well, that's what she wants. 820 00:41:24,366 --> 00:41:26,303 - He usually gets what he wants. 821 00:41:26,303 --> 00:41:27,773 - Yes. 822 00:41:32,650 --> 00:41:35,689 - I saw Joan, she is fighting as always. 823 00:41:35,689 --> 00:41:38,060 - That lady can't be broken. 824 00:41:39,429 --> 00:41:41,568 - Amen. - Yes. 825 00:41:41,568 --> 00:41:44,707 - Good night, Jake. - Hey. Good night, man. 826 00:41:50,418 --> 00:41:53,157 - Hey, did you know for him and Sonya? 827 00:41:53,157 --> 00:41:55,394 - What about them? 828 00:41:55,394 --> 00:41:57,432 Not. - Yes. 829 00:41:59,169 --> 00:42:01,140 I guess we set a good example. 830 00:42:06,951 --> 00:42:09,289 - I heard that you have a family was here today. 831 00:42:09,289 --> 00:42:10,993 - Yes. Um... 832 00:42:10,993 --> 00:42:13,364 Mia, she fell into trouble at school, there were 833 00:42:13,364 --> 00:42:15,334 er, i don't know, it was funny. 834 00:42:16,704 --> 00:42:20,211 - Maybe you can tell me all about it on the way home? 835 00:42:21,681 --> 00:42:24,787 - Yes, of course, boss. I can do that. 836 00:42:25,689 --> 00:42:27,860 - Co-bosses. 837 00:42:27,860 --> 00:42:30,699 - Co-bosses. sorry, that's such a clumsy thing to say. 838 00:42:30,699 --> 00:42:33,371 - I know, tell me about it. 839 00:42:33,371 --> 00:42:35,008 Co-bosses.