1 00:00:00,933 --> 00:00:02,433 Dr. Larsen was in a car accident, 2 00:00:02,458 --> 00:00:04,569 she has no recollection of the last eight years. 3 00:00:04,593 --> 00:00:06,088 Previously on Doc. 4 00:00:06,112 --> 00:00:08,717 - Let me run Internal Medicine. - Back to your roots. 5 00:00:08,741 --> 00:00:10,463 When you need time to work out things with Michael, 6 00:00:10,487 --> 00:00:12,802 I accept it, but when the shoe's on the other foot... 7 00:00:12,826 --> 00:00:13,970 When the shoe's on the other foot, 8 00:00:13,994 --> 00:00:15,373 you have a hard time telling me the truth. 9 00:00:15,397 --> 00:00:17,044 Delayed decisions on his care 10 00:00:17,068 --> 00:00:18,445 have been hurting him a long time. 11 00:00:18,469 --> 00:00:20,485 You don't have to tell me the system's broken. 12 00:00:20,509 --> 00:00:23,222 How much prednisone does it take to get you through a shift? 13 00:00:23,246 --> 00:00:25,026 You will flame out in weeks. 14 00:00:25,050 --> 00:00:26,830 It's time for you to use your greatness 15 00:00:26,854 --> 00:00:28,834 to pull the greatness out of others. 16 00:00:28,858 --> 00:00:30,828 I'm going to miss you. 17 00:00:42,478 --> 00:00:44,966 Sorry. This guy loves his sleep. 18 00:00:44,990 --> 00:00:48,782 Oh, there he is. Hey, can I have a hug? 19 00:00:49,799 --> 00:00:52,398 Oh my goodness, this is yummy. 20 00:00:52,422 --> 00:00:54,720 Ethan was sorry to miss you, he had a really early meeting. 21 00:00:54,744 --> 00:00:56,623 Well, Robbie's the main event, right? 22 00:00:56,647 --> 00:00:59,963 What fabulous holiday have they cancelled school for this time? 23 00:00:59,987 --> 00:01:01,509 It's Lunar New Year. 24 00:01:01,533 --> 00:01:02,936 Oh, well. 25 00:01:04,228 --> 00:01:05,833 Grandma's been all over the world. 26 00:01:05,857 --> 00:01:07,946 You know, she could probably teach you to say hello 27 00:01:07,970 --> 00:01:09,181 in 50 different languages. 28 00:01:09,205 --> 00:01:11,051 67, but who's counting? 29 00:01:11,324 --> 00:01:12,771 I should be back around six. 30 00:01:12,795 --> 00:01:14,306 And thanks so much for doing this. 31 00:01:14,330 --> 00:01:16,311 Are you kidding? The more time I get to spend 32 00:01:16,335 --> 00:01:17,562 with this little man, the better. 33 00:01:17,586 --> 00:01:19,116 Oh. Brought you donuts, 34 00:01:19,140 --> 00:01:20,652 your dad said they're your favorite. 35 00:01:20,676 --> 00:01:22,082 Thanks, Grandma. 36 00:01:28,258 --> 00:01:29,704 Joan, you okay? 37 00:01:30,961 --> 00:01:32,093 I'm fine. 38 00:01:35,105 --> 00:01:37,086 Robbie, why don't you go upstairs? 39 00:01:37,110 --> 00:01:38,989 Oh my God. 40 00:01:39,013 --> 00:01:41,027 - Grandma! - Joan? 41 00:01:41,051 --> 00:01:42,096 Grandma! 42 00:01:44,223 --> 00:01:52,223 Synced and corrected by -robtor- www.addic7ed.com 43 00:02:07,604 --> 00:02:09,016 Good morning, everyone. 44 00:02:09,040 --> 00:02:10,419 Morning. 45 00:02:10,443 --> 00:02:13,057 This is going to be an adjustment for all of us. 46 00:02:13,081 --> 00:02:15,228 Dr. Ridley certainly left some big shoes to fill, 47 00:02:15,252 --> 00:02:18,634 and I know all these leadership changes the past year 48 00:02:18,658 --> 00:02:21,407 have probably been unsteadying. 49 00:02:21,431 --> 00:02:24,246 There are a lot of reasons why 50 00:02:24,270 --> 00:02:26,985 I wanted to practice medicine again, 51 00:02:27,009 --> 00:02:29,256 but I want to be very clear about the reason I asked 52 00:02:29,280 --> 00:02:31,327 to sit in that chair. 53 00:02:31,351 --> 00:02:33,664 The past year as your CMO, 54 00:02:33,688 --> 00:02:35,302 I have seen what every person 55 00:02:35,326 --> 00:02:37,272 standing in this room is capable of. 56 00:02:37,296 --> 00:02:38,473 Dr. Miller. 57 00:02:38,497 --> 00:02:40,813 Time and again, you have risen to the occasion. 58 00:02:40,837 --> 00:02:43,018 We have a sixty-two year old female 59 00:02:43,042 --> 00:02:46,224 in respiratory failure. Complications from chronic MDS. 60 00:02:46,248 --> 00:02:47,359 I'm on my way down. 61 00:02:47,383 --> 00:02:49,697 I'm not here just to lead you, 62 00:02:49,721 --> 00:02:53,839 I want to join you, and help you do what you already do so well. 63 00:02:53,863 --> 00:02:57,479 An issue, a problem, a suggestion, 64 00:02:57,503 --> 00:02:59,583 my door will always be open. 65 00:02:59,955 --> 00:03:03,291 Before we go, some congratulations are in order. 66 00:03:03,315 --> 00:03:05,778 In two weeks, Dr. Maitra 67 00:03:05,802 --> 00:03:08,068 and Dr. Larsen will succeed Dr. Heller 68 00:03:08,092 --> 00:03:09,491 as Chief Residents, 69 00:03:09,515 --> 00:03:12,343 as we welcome our new class of interns. 70 00:03:15,640 --> 00:03:17,118 Uh, now, if you both 71 00:03:17,142 --> 00:03:19,222 could hang back for a moment with Dr. Heller. 72 00:03:19,246 --> 00:03:21,684 The rest of you, do good work. 73 00:03:25,025 --> 00:03:27,974 I'd like our co-chiefs to shadow you 74 00:03:27,998 --> 00:03:30,178 before you start your pediatric fellowship. 75 00:03:30,202 --> 00:03:32,784 You can begin with Dr. Maitra this morning, and then alternate days. 76 00:03:32,808 --> 00:03:35,112 - Yeah. Sounds like a plan. - Great. 77 00:03:39,087 --> 00:03:40,632 It's quite a move. 78 00:03:40,656 --> 00:03:42,602 Well, it was either this 79 00:03:42,626 --> 00:03:44,333 or a leather jacket and a motorcycle. 80 00:03:51,144 --> 00:03:52,674 Joan's in the ER. 81 00:03:53,115 --> 00:03:55,628 Paramedic said she was extremely short of breath, 82 00:03:55,652 --> 00:03:57,968 likely bilateral pleural effusions. 83 00:03:57,992 --> 00:03:59,637 So is she hypoxic? 84 00:03:59,661 --> 00:04:02,944 Oxygenations improved on the mask, but she's hypotensive. 85 00:04:02,968 --> 00:04:05,682 Let's push Norepi MAP goal above 65. 86 00:04:05,706 --> 00:04:07,386 No, Richard, that's not gonna work. 87 00:04:07,410 --> 00:04:08,955 - I'm sorry? - She's on prednisone. 88 00:04:08,979 --> 00:04:11,194 30 milligrams and she's tapered off, I read her chart. 89 00:04:11,218 --> 00:04:14,023 No, her chart's wrong, she's on way more than that. 90 00:04:15,860 --> 00:04:19,201 I've been using it to get through the surgery. 91 00:04:20,035 --> 00:04:21,671 You knew about this? 92 00:04:22,841 --> 00:04:25,082 How much has she been taking? 93 00:04:26,687 --> 00:04:28,024 Double that. 94 00:04:30,522 --> 00:04:32,870 Triple to get through the ex... 95 00:04:32,894 --> 00:04:34,673 vivo with Javi. 96 00:04:34,697 --> 00:04:39,173 My natural cortisol production's gotta be shot. 97 00:04:40,543 --> 00:04:43,424 Okay. Lucy, 100 milligram bolus 98 00:04:43,448 --> 00:04:45,284 of hydrocortisone before pressors. 99 00:04:45,308 --> 00:04:47,656 And run a complete lab workup. 100 00:04:48,859 --> 00:04:51,330 We're all here if you need anything, Joan. 101 00:04:55,172 --> 00:04:56,405 Should I call Ethan? 102 00:04:58,111 --> 00:04:59,489 He's on his way. 103 00:04:59,513 --> 00:05:03,130 But Amy, I need you to remember, 104 00:05:03,154 --> 00:05:05,092 I have a DNR. 105 00:05:05,116 --> 00:05:08,041 Joan, no, we're nowhere near that. 106 00:05:12,340 --> 00:05:14,076 Shh. 107 00:05:18,920 --> 00:05:20,866 Good morning, Dr. Walker. 108 00:05:20,890 --> 00:05:24,240 Good morning to you, Walter. How's our rocket holding up? 109 00:05:24,264 --> 00:05:25,743 Can't wait to launch it. 110 00:05:25,767 --> 00:05:27,045 You think I can still leave today? 111 00:05:27,069 --> 00:05:29,483 Gotta examine you first, can't let you out of here 112 00:05:29,507 --> 00:05:31,053 till we're sure you're all better. 113 00:05:31,623 --> 00:05:34,494 I really want to show the rocket to the kids at the house. 114 00:05:34,518 --> 00:05:37,312 I bet. Looks like that thing might actually make it to space. 115 00:05:37,336 --> 00:05:39,303 Do you ever launch rockets with your kids? 116 00:05:39,327 --> 00:05:41,866 - I don't have any. - Really? 117 00:05:42,533 --> 00:05:44,479 I thought about it when I was younger, 118 00:05:44,503 --> 00:05:46,351 but decided to take a different path. 119 00:05:46,375 --> 00:05:47,519 What do you mean? 120 00:05:47,543 --> 00:05:48,889 Well, being a parent's a big commitment. 121 00:05:48,913 --> 00:05:52,228 But that's also true for being a friend, a sister, 122 00:05:52,252 --> 00:05:54,868 an aunt, especially a doctor. 123 00:05:54,892 --> 00:05:57,773 Eventually, I figured if I gave my best 124 00:05:57,797 --> 00:06:00,378 to all those other things, that'd be enough for me. 125 00:06:00,402 --> 00:06:02,082 - You're a great doctor. - Hmm. 126 00:06:02,106 --> 00:06:05,790 That she is, buddy. Sorry I'm late, how's he doing? 127 00:06:05,814 --> 00:06:08,819 Well, breathing's much better. Let's look at those knees. 128 00:06:11,324 --> 00:06:14,774 Oh. How long has your leg been moving like that? 129 00:06:14,798 --> 00:06:16,912 Happens all the time with my RA. 130 00:06:16,936 --> 00:06:18,949 It shouldn't be now, with the medication you're on. 131 00:06:18,973 --> 00:06:20,752 - Yeah, I'll order a CT. - Well, that's bad. 132 00:06:20,776 --> 00:06:23,533 Just need to see what's going on. We'll get it sorted out, though. 133 00:06:24,417 --> 00:06:26,396 Time to find your social worker. 134 00:06:26,420 --> 00:06:28,291 Again? 135 00:06:28,873 --> 00:06:31,775 Atlantoaxial instability this severe will progress fast. 136 00:06:31,799 --> 00:06:33,311 We have to operate now. 137 00:06:33,335 --> 00:06:34,765 We don't have the go ahead from his proxy. 138 00:06:34,789 --> 00:06:37,180 Well, his C1 and C2 are compressing his spinal cord. 139 00:06:37,204 --> 00:06:38,755 What's everybody waiting for? 140 00:06:38,779 --> 00:06:41,227 The social worker said he'd sign off on whatever we decide, 141 00:06:41,251 --> 00:06:43,436 but he doesn't want to get in the weeds. 142 00:06:43,460 --> 00:06:46,470 Well, that makes things tricky, cause we have two surgical routes. 143 00:06:46,494 --> 00:06:49,677 High risk, high reward, open the neck, expose the vertebra, 144 00:06:49,701 --> 00:06:51,246 place the corrective hardware directly. 145 00:06:51,270 --> 00:06:53,517 But you're concerned about arterial or spinal cord trauma? 146 00:06:53,541 --> 00:06:56,858 Not to mention stroke, infection, ventral cord damage. 147 00:06:56,882 --> 00:06:59,180 Plus, he's still recovering from lung inflammation. 148 00:06:59,204 --> 00:07:00,365 Definitely a concern. 149 00:07:00,389 --> 00:07:02,775 And the second option is minimally invasive fusion? 150 00:07:02,799 --> 00:07:04,659 Far less trauma and easier recovery. 151 00:07:04,683 --> 00:07:06,711 But wouldn't we be relying on CT for navigation? 152 00:07:06,735 --> 00:07:08,644 Which means less precision with the hardware? 153 00:07:08,668 --> 00:07:11,474 Yeah, it may require going back in, in six months or a year. 154 00:07:11,498 --> 00:07:13,290 And there's a high chance for a screw misplacement. 155 00:07:13,314 --> 00:07:15,820 At the C1-C2 spinal cord, that could be severe. 156 00:07:16,621 --> 00:07:20,228 Both have risks. It's your call, Gina. 157 00:07:28,144 --> 00:07:30,459 Do the minimally invasive fusion. 158 00:07:30,483 --> 00:07:32,085 I'll go explain to Walter. 159 00:07:34,992 --> 00:07:36,929 So... 160 00:07:37,997 --> 00:07:40,485 I've got full-blown leukemia. 161 00:07:41,371 --> 00:07:42,506 May I see? 162 00:07:45,880 --> 00:07:48,327 My belief is that the steroids 163 00:07:48,351 --> 00:07:50,265 artificially raised your white blood cell count, 164 00:07:50,289 --> 00:07:53,104 hiding the degree of marrow infiltration, 165 00:07:53,128 --> 00:07:56,177 and I spoke to Dr. Rose, and he agrees. 166 00:07:56,201 --> 00:07:59,851 Now, if this goes unchecked, decline will be rapid. 167 00:07:59,875 --> 00:08:02,022 So, we'd like to start induction chemotherapy, 168 00:08:02,046 --> 00:08:04,259 which could buy you a few extra months. 169 00:08:04,283 --> 00:08:06,163 This shows a pancytopenic picture 170 00:08:06,187 --> 00:08:08,900 without any sign of leukocytosis. 171 00:08:08,924 --> 00:08:11,908 Yes. As I just said, the steroids are complicating things. 172 00:08:11,932 --> 00:08:14,781 Her leukemia has an atypical presentation, 173 00:08:14,805 --> 00:08:17,552 but we need to act fast before it progresses. 174 00:08:17,576 --> 00:08:20,814 Or her presentation is atypical because it's not leukemia. 175 00:08:20,838 --> 00:08:21,929 Amy. 176 00:08:21,953 --> 00:08:24,404 Her counts are dropping across every line. 177 00:08:24,428 --> 00:08:27,039 That looks like marrow failure, not marrow takeover. 178 00:08:27,063 --> 00:08:28,921 You're reading too much into the blast count. 179 00:08:28,945 --> 00:08:31,447 No, I'm looking at the facts in front of us. 180 00:08:31,471 --> 00:08:34,486 She doesn't show cancer on a peripheral smear. 181 00:08:34,510 --> 00:08:36,676 If this is pancytopenia, we could give platelets 182 00:08:36,700 --> 00:08:38,369 and plasma to raise her levels. 183 00:08:38,393 --> 00:08:40,832 Blast proliferation and dysplasia 184 00:08:40,856 --> 00:08:42,727 are textbook signs of leukemia. 185 00:08:42,751 --> 00:08:45,508 And delaying treatment because of wishful thinking 186 00:08:45,532 --> 00:08:47,813 will cost you significant time. 187 00:08:47,837 --> 00:08:51,598 Or, if he's wrong, the chemo will damage all your organs. 188 00:08:52,079 --> 00:08:54,316 I believe this is Joan's decision. 189 00:08:59,046 --> 00:09:00,515 Start the chemo. 190 00:09:02,834 --> 00:09:04,871 I'll put the orders in. 191 00:09:09,815 --> 00:09:11,226 You're brilliant, Amy, 192 00:09:11,250 --> 00:09:13,588 and I know you don't want this to be true. 193 00:09:14,891 --> 00:09:16,403 But I can't. 194 00:09:16,427 --> 00:09:20,068 I can't lose any more time with my family. 195 00:09:23,074 --> 00:09:24,610 Yeah. 196 00:09:34,130 --> 00:09:36,277 Mom, any soreness in the incision? 197 00:09:36,301 --> 00:09:38,882 Oh, it was routine surgery, I'm fine. 198 00:09:38,906 --> 00:09:40,685 Where's John? 199 00:09:40,709 --> 00:09:43,224 He's here, having a smoke. 200 00:09:43,248 --> 00:09:45,261 Surprised you didn't go with him. 201 00:09:45,285 --> 00:09:47,565 Believe me, if I thought I could get away with it. 202 00:09:47,589 --> 00:09:48,902 Not on my watch. 203 00:09:48,926 --> 00:09:51,606 Oh, I know, Dr. Larsen. 204 00:09:51,630 --> 00:09:53,443 Not yet, Mom. 205 00:09:53,467 --> 00:09:55,514 Speaking of which, you should get back to Minneapolis. 206 00:09:55,538 --> 00:09:58,287 No, it's fine. Dr. Ridley is away for a couple of weeks, 207 00:09:58,311 --> 00:10:00,792 so I finally get a little bit of breathing room. 208 00:10:00,816 --> 00:10:02,162 Who's that? 209 00:10:02,186 --> 00:10:04,166 I've mentioned her, like, six times. 210 00:10:04,190 --> 00:10:06,871 Genius surgeon, Doctors Without Borders, 211 00:10:06,895 --> 00:10:10,011 - utterly terrifying... - Alright. Her. 212 00:10:10,035 --> 00:10:11,848 Everybody wants her to be their mentor 213 00:10:11,872 --> 00:10:13,584 but she travels around so much, 214 00:10:13,608 --> 00:10:15,756 I don't think she ever slows down enough to do that. 215 00:10:15,780 --> 00:10:17,525 What do you even need a mentor for? 216 00:10:17,549 --> 00:10:19,329 You want something, you get it. 217 00:10:19,353 --> 00:10:21,466 Always been that way, barely even needed to push you. 218 00:10:21,490 --> 00:10:24,129 Well, there were times I could have used some pushing. 219 00:10:28,271 --> 00:10:29,650 Amy. 220 00:10:29,674 --> 00:10:31,553 - Hey. - Hi. 221 00:10:31,577 --> 00:10:33,491 I got here as fast as I could. 222 00:10:33,515 --> 00:10:35,295 She's stable now. 223 00:10:35,319 --> 00:10:38,500 She's pretty drowsy from the chemo meds. 224 00:10:38,524 --> 00:10:41,030 Right. Okay. 225 00:10:43,193 --> 00:10:47,334 Amy, Joan's co-ag panels came back. 226 00:10:48,278 --> 00:10:49,958 She has DIC. 227 00:10:49,982 --> 00:10:51,694 If we had pushed platelets like you wanted, 228 00:10:51,718 --> 00:10:54,991 the runaway clotting could have caused a massive stroke. 229 00:10:56,227 --> 00:10:58,374 I know how hard this is for you, 230 00:10:58,398 --> 00:11:01,070 but you're gonna have to let me do my job. 231 00:11:06,080 --> 00:11:08,762 Ethan. I'm Dr. Miller. 232 00:11:08,786 --> 00:11:10,588 - Hi. - It's good to meet you. 233 00:11:15,365 --> 00:11:17,578 So, rounds are done. What's next? 234 00:11:17,602 --> 00:11:19,382 Well, your partner in crime's 235 00:11:19,406 --> 00:11:20,986 sitting vigil for a friend in the ICU. 236 00:11:21,010 --> 00:11:22,618 Have you checked in on her? 237 00:11:22,642 --> 00:11:24,493 I didn't want to invade her space. 238 00:11:24,517 --> 00:11:27,065 It's always better to extend yourself. 239 00:11:27,089 --> 00:11:28,969 Trust me, she's gonna let you know if it's unwanted. 240 00:11:28,993 --> 00:11:30,806 Oh, I'm sure she will. 241 00:11:30,830 --> 00:11:32,375 So, as Chief Resident, 242 00:11:32,399 --> 00:11:34,079 you've gotta be able to work with anyone. 243 00:11:34,103 --> 00:11:36,383 Is there anybody else, anything you gotta get ahead of? 244 00:11:36,407 --> 00:11:38,520 I don't know if you ever noticed, 245 00:11:38,544 --> 00:11:40,391 but Liz kind of had a thing for TJ. 246 00:11:40,415 --> 00:11:43,832 Yeah, she wasn't exactly subtle about it. Why, what's the problem? 247 00:11:43,856 --> 00:11:45,425 I... 248 00:11:46,460 --> 00:11:48,358 So, you and TJ? 249 00:11:49,567 --> 00:11:51,079 Wow, okay. 250 00:11:51,103 --> 00:11:53,117 I guess I missed that. How long has that been going on? 251 00:11:53,141 --> 00:11:56,223 Not very, and you of all people don't get to judge. 252 00:11:56,247 --> 00:11:58,694 I'm just not sure how everyone else will react. 253 00:11:58,718 --> 00:12:00,164 Well, listen. 254 00:12:00,188 --> 00:12:02,268 I mean, you can't control how people feel about you, okay? 255 00:12:02,292 --> 00:12:04,639 All you can do is show everyone that you're gonna be there 256 00:12:04,663 --> 00:12:06,334 for them when things get tough. 257 00:12:07,904 --> 00:12:10,284 Ah, Dr. Hamda. Do you have a minute? 258 00:12:10,308 --> 00:12:12,279 Of course, yeah. Come in, have a seat. 259 00:12:14,926 --> 00:12:18,859 I know I should have said something sooner. 260 00:12:19,293 --> 00:12:22,009 I think I was just too afraid 261 00:12:22,033 --> 00:12:23,310 that no one was gonna take me seriously. 262 00:12:23,334 --> 00:12:26,507 It's okay, Liz. What is it? 263 00:12:28,611 --> 00:12:29,790 Dr. Miller. 264 00:12:29,814 --> 00:12:31,193 What he did to me. 265 00:12:31,217 --> 00:12:33,898 Everyone's just pretending like nothing happened, 266 00:12:33,922 --> 00:12:36,126 but it was an abuse of power. 267 00:12:38,331 --> 00:12:42,834 I appreciate your honesty, and I understand how you feel. 268 00:12:42,858 --> 00:12:46,547 Not how I feel. It's what happened. 269 00:12:47,917 --> 00:12:50,899 Nobody condones what Dr. Miller did, 270 00:12:50,923 --> 00:12:52,335 but an agreement was reached. 271 00:12:52,359 --> 00:12:55,041 - What agreement? - I'm afraid I can't discuss it. 272 00:12:55,065 --> 00:12:56,700 So you won't tell me what happened? 273 00:12:59,106 --> 00:13:01,052 It was a confidential settlement. 274 00:13:01,893 --> 00:13:03,682 I'm sorry, Liz. 275 00:13:04,767 --> 00:13:06,563 I guess this just proves why I never 276 00:13:06,587 --> 00:13:09,393 should have bothered coming forward in the first place. 277 00:13:17,877 --> 00:13:20,725 CT confirms location, we're clear of the vertebral artery. 278 00:13:20,749 --> 00:13:22,797 Advancing cannula into position. 279 00:13:28,564 --> 00:13:29,643 Hey, babe. 280 00:13:29,667 --> 00:13:32,983 Okay. So, I nearly had to sell my body for it, 281 00:13:33,007 --> 00:13:35,789 but Spoon and Stable finally called me back. 282 00:13:35,813 --> 00:13:37,325 They had a cancellation? 283 00:13:37,349 --> 00:13:39,830 I told them it was our anniversary, and they said 284 00:13:39,854 --> 00:13:41,667 they could squeeze us in at six. 285 00:13:41,691 --> 00:13:43,137 Can you make that work? 286 00:13:43,161 --> 00:13:44,740 Well, looks like I'm gonna have to. 287 00:13:44,764 --> 00:13:46,376 No way we're missing out on those oysters. 288 00:13:46,400 --> 00:13:49,984 So, there's a chance I may need to swing back here. 289 00:13:50,008 --> 00:13:53,024 Oh no. Is it that boy you told me about? 290 00:13:53,048 --> 00:13:55,295 Found a pretty serious issue with his spine, 291 00:13:55,319 --> 00:13:56,798 he's in surgery now. 292 00:13:56,822 --> 00:13:58,898 Oh honey, that's terrible. 293 00:13:58,922 --> 00:14:00,838 Are the social workers being helpful? 294 00:14:00,862 --> 00:14:03,277 Not really. I had to make the decision myself 295 00:14:03,301 --> 00:14:04,813 about what surgery he should have. 296 00:14:05,203 --> 00:14:06,951 Okay, I know it's not my lane, 297 00:14:06,975 --> 00:14:10,224 and I love you for being the person who cares this much. 298 00:14:10,248 --> 00:14:12,897 But the last time you got this invested in a case... 299 00:14:12,921 --> 00:14:15,301 He has no one, Wendy. 300 00:14:15,638 --> 00:14:17,541 I have no choice. 301 00:14:19,333 --> 00:14:21,547 Well, she told me about the prednisone, 302 00:14:21,571 --> 00:14:24,677 that it landed her here a lot sooner than she would have otherwise. 303 00:14:25,278 --> 00:14:28,160 Yeah. She is strong-willed. 304 00:14:28,643 --> 00:14:30,388 That's what we love about her. 305 00:14:31,057 --> 00:14:33,637 She probably felt like she had no choice. 306 00:14:33,661 --> 00:14:36,878 You know, I, after I told her I didn't want to see her, 307 00:14:36,902 --> 00:14:39,112 what else did she have besides work? 308 00:14:39,599 --> 00:14:42,205 And now, Robbie may never even get to know her. 309 00:14:42,847 --> 00:14:45,929 She knew that making things right with you was on her. 310 00:14:46,386 --> 00:14:48,122 Not you. 311 00:14:48,859 --> 00:14:51,630 All you can do now is be there for each other. 312 00:15:16,080 --> 00:15:18,551 What did you do? 313 00:15:20,122 --> 00:15:23,637 She was fine. She was just fine an hour ago. 314 00:15:23,661 --> 00:15:24,774 What did you do? 315 00:15:24,798 --> 00:15:26,744 It's not their fault. She had a heart attack. 316 00:15:26,768 --> 00:15:29,406 Nobody could have seen this coming. 317 00:15:34,249 --> 00:15:38,067 Amy. Uh, how is Joan doing? 318 00:15:38,091 --> 00:15:41,965 Um, she's stable for now. On chemo. 319 00:15:42,867 --> 00:15:46,083 I'm sure this must be hard for you. If there's anything I can... 320 00:15:46,107 --> 00:15:48,354 Something's escalating in there. 321 00:15:50,849 --> 00:15:52,329 Her temperature's dropping. 322 00:15:52,353 --> 00:15:54,199 Yeah, core temp can drop 323 00:15:54,223 --> 00:15:55,769 after starting chemotherapy, it's normal. 324 00:15:55,793 --> 00:15:58,207 But it can also be a sign of sepsis. 325 00:15:58,231 --> 00:16:01,246 No, all of her cultures were negative. 326 00:16:01,270 --> 00:16:03,206 Is that true? 327 00:16:03,230 --> 00:16:04,787 Yes, of course that's true. 328 00:16:04,811 --> 00:16:08,227 And you should know that Dr. Larsen 329 00:16:08,251 --> 00:16:09,897 recommended a course of treatment earlier 330 00:16:09,921 --> 00:16:11,768 that could have been catastrophic for your mother. 331 00:16:11,792 --> 00:16:15,207 So, I don't think that it is a good idea 332 00:16:15,231 --> 00:16:17,335 for friends to treat each other. 333 00:16:20,508 --> 00:16:22,990 I admire your mom, but I can be objective, 334 00:16:23,014 --> 00:16:24,509 and that's what she needs. 335 00:16:27,255 --> 00:16:28,524 He's right. 336 00:16:29,192 --> 00:16:31,029 Sorry, Ethan. 337 00:16:38,946 --> 00:16:40,090 - Hey. - Hey. 338 00:16:40,114 --> 00:16:42,061 Do you have any of Joan Ridley's blood left over? 339 00:16:42,085 --> 00:16:43,656 Yeah, we should have some extra. 340 00:16:43,680 --> 00:16:45,101 Can you run a beta-D-glucan? 341 00:16:45,125 --> 00:16:47,138 All her cultures came back negative. 342 00:16:47,162 --> 00:16:48,328 What are you looking for? 343 00:16:48,352 --> 00:16:51,146 I want to rule out an invasive fungal infection. 344 00:16:51,170 --> 00:16:52,983 Something in the endothelial tissue. 345 00:16:53,007 --> 00:16:54,586 You got it. 346 00:16:54,610 --> 00:16:56,137 And uh, when you're done, 347 00:16:56,161 --> 00:16:58,427 can you get me the results directly? 348 00:16:58,451 --> 00:17:00,664 Says Dr. Miller's assigned. 349 00:17:00,688 --> 00:17:01,958 He is. 350 00:17:03,027 --> 00:17:06,510 I need this, Carin. Please. 351 00:17:07,044 --> 00:17:08,313 Sure. 352 00:17:10,208 --> 00:17:11,719 Hey, how's it going? 353 00:17:11,743 --> 00:17:16,019 Hey. I'm at the school, apparently Mia got into a fight. 354 00:17:17,022 --> 00:17:18,300 Let me guess, with Logan? 355 00:17:18,324 --> 00:17:20,271 I haven't had a chance to talk to her about it, 356 00:17:20,295 --> 00:17:21,643 but figured we should do it together. 357 00:17:21,667 --> 00:17:23,177 Can I bring her by the hospital? 358 00:17:23,201 --> 00:17:24,479 Shouldn't take too long. 359 00:17:24,503 --> 00:17:26,808 Yeah, yeah, of course. Um, yeah, I'm here. 360 00:17:33,254 --> 00:17:35,601 She killed herself, Gina. 361 00:17:35,625 --> 00:17:38,374 All those times I begged her to quit smoking. 362 00:17:38,398 --> 00:17:41,446 Her blood pressure was through the roof, 363 00:17:41,470 --> 00:17:42,917 it was only a matter of time. 364 00:17:42,941 --> 00:17:46,351 You can't keep fixating on what could have gone differently. Okay? 365 00:17:46,375 --> 00:17:48,627 All you can do now is start to process your pain. 366 00:17:48,651 --> 00:17:50,174 What makes you think I haven't? 367 00:17:50,198 --> 00:17:53,103 It's been a week and a half. You still haven't cried. 368 00:17:53,127 --> 00:17:56,075 Crying won't fix anything. 369 00:17:56,099 --> 00:17:58,085 I'm not saying force it, okay? 370 00:17:58,109 --> 00:18:00,484 But just let yourself feel. 371 00:18:00,508 --> 00:18:02,321 This is only gonna get worse 372 00:18:02,345 --> 00:18:04,286 once you're an actual shrink, isn't it? 373 00:18:04,310 --> 00:18:07,355 That's neuropsychiatrist, thank you very much. 374 00:18:08,358 --> 00:18:10,237 I just need to focus on school. 375 00:18:10,261 --> 00:18:14,079 And maybe that hot bartender from Stanton. 376 00:18:14,103 --> 00:18:15,514 I'm serious, Amy. 377 00:18:15,538 --> 00:18:18,520 You're in grief and mad at your mom. 378 00:18:18,544 --> 00:18:19,957 You can't just push all that away. 379 00:18:19,981 --> 00:18:22,836 - Why not? - Cause when it comes to feelings, 380 00:18:22,862 --> 00:18:24,399 the piper has to get paid. 381 00:18:24,423 --> 00:18:26,360 One way or another. 382 00:18:34,757 --> 00:18:35,807 Hey. 383 00:18:35,831 --> 00:18:39,095 Just checking on you. Joan's BP and O2 SATs are improving. 384 00:18:39,119 --> 00:18:40,798 Chemo must be having an effect. 385 00:18:40,822 --> 00:18:43,703 I guess Richard was right. About the leukemia. 386 00:18:43,727 --> 00:18:46,076 At least we have a diagnosis. Where are you? 387 00:18:46,817 --> 00:18:49,515 Uh, I'm in Radiology with another patient. 388 00:18:49,539 --> 00:18:51,945 - I'll be back soon. - Okay. 389 00:18:54,350 --> 00:18:56,304 We won't be mad, honey. 390 00:18:56,328 --> 00:18:58,500 We just want you to tell us what happened. 391 00:18:58,524 --> 00:19:00,762 Logan was throwing markers at me. 392 00:19:01,396 --> 00:19:03,177 I thought we said when he did stuff like that, 393 00:19:03,201 --> 00:19:04,679 you would tell the teacher. 394 00:19:04,703 --> 00:19:06,649 I did. But he didn't stop. 395 00:19:06,673 --> 00:19:10,024 So I took my chocolate pudding 396 00:19:10,048 --> 00:19:12,195 and I dumped it on his head. 397 00:19:14,189 --> 00:19:16,672 Um, so, what happened? 398 00:19:16,696 --> 00:19:18,340 You told the teacher and they didn't do anything about it? 399 00:19:18,364 --> 00:19:20,177 They had him sit in the big chair. 400 00:19:20,201 --> 00:19:21,580 What's the big chair? 401 00:19:21,604 --> 00:19:23,818 It's a big, comfy chair in the corner, 402 00:19:23,842 --> 00:19:26,456 where you sit and think about what you did. 403 00:19:26,480 --> 00:19:28,160 So, like a timeout. 404 00:19:28,184 --> 00:19:31,666 Okay, but uh, last week, when you won the spelling bee, 405 00:19:31,690 --> 00:19:33,738 you said you got to sit in a big, comfy chair. 406 00:19:33,762 --> 00:19:36,342 Yeah. You sit in it if you do something good. 407 00:19:36,366 --> 00:19:40,942 But then, sometimes, you sit in it if you do something bad. 408 00:19:43,882 --> 00:19:45,594 I want her out of that school, Rache. Okay? 409 00:19:45,618 --> 00:19:47,564 There's the public school, there's the Hebrew school 410 00:19:47,588 --> 00:19:49,102 we toured, I don't care which one. 411 00:19:49,126 --> 00:19:50,775 I just think that she needs to be somewhere 412 00:19:50,799 --> 00:19:52,475 with more boundaries and grit, 413 00:19:52,499 --> 00:19:54,669 and fewer participation trophies and big chairs. 414 00:19:55,104 --> 00:19:56,516 Okay. 415 00:19:56,540 --> 00:19:58,755 - Okay what? - Okay, you're right. 416 00:19:58,779 --> 00:20:01,626 I'm wrong. Let's move her. 417 00:20:01,650 --> 00:20:04,366 Hold it, did you just tell me I was right about something? 418 00:20:06,326 --> 00:20:08,173 And if you play your cards right, 419 00:20:08,629 --> 00:20:10,566 it might even happen again. 420 00:20:12,531 --> 00:20:13,942 I'll take her home? 421 00:20:13,986 --> 00:20:16,024 Yeah, yeah. 422 00:20:24,816 --> 00:20:26,152 Are you alright? 423 00:20:29,838 --> 00:20:31,274 Yeah. 424 00:20:32,444 --> 00:20:37,353 I'm just realizing how little power I have here. 425 00:20:41,229 --> 00:20:43,167 What happened? 426 00:20:44,837 --> 00:20:47,142 There's nothing to be done about it, Sonya. 427 00:20:47,676 --> 00:20:50,357 No, no. I'm gonna be Chief Resident, 428 00:20:50,381 --> 00:20:52,920 which means I can advocate. 429 00:21:01,571 --> 00:21:02,923 And this is unprofessional. 430 00:21:02,947 --> 00:21:05,554 You were never going to test for this, Richard, 431 00:21:05,578 --> 00:21:06,556 and it's positive. 432 00:21:06,580 --> 00:21:07,826 You were not gonna listen to me. 433 00:21:07,850 --> 00:21:09,195 Well, that was my call to make... 434 00:21:09,219 --> 00:21:10,688 Do you wanna tell me what's going on here? 435 00:21:10,712 --> 00:21:12,105 She ran a test behind my back. 436 00:21:12,129 --> 00:21:14,052 That is hardly the headline here. 437 00:21:14,076 --> 00:21:16,275 Joan has a Candida organ infection, 438 00:21:16,299 --> 00:21:17,946 which he wouldn't have caught. 439 00:21:17,970 --> 00:21:19,783 I'm assuming you're interested in treating this, 440 00:21:19,807 --> 00:21:21,686 even though I was the one who found it. 441 00:21:21,710 --> 00:21:23,657 Alright, alright. That's enough. 442 00:21:23,681 --> 00:21:25,829 Clearly, the chemo lowered her immune response, 443 00:21:25,853 --> 00:21:27,833 decrease the dosage for now and treat the infection. 444 00:21:27,857 --> 00:21:30,094 But we are still on the right path here. 445 00:21:33,401 --> 00:21:36,683 You know, I might be more inclined to hear you, 446 00:21:36,707 --> 00:21:40,047 if you weren't so concerned with putting me in my place. 447 00:21:42,753 --> 00:21:46,669 He was never gonna order the panel. Out of spite. 448 00:21:46,693 --> 00:21:48,673 - If you needed backup... - Which is it, Michael? 449 00:21:48,697 --> 00:21:50,544 I'm supposed to come to you because you want to help? 450 00:21:50,568 --> 00:21:52,614 Or I'm not supposed to come to 451 00:21:52,638 --> 00:21:54,753 you because I put you in a tough position, 452 00:21:54,777 --> 00:21:55,989 because I've heard it both ways. 453 00:21:56,013 --> 00:21:58,193 I am Chief now, of your department. 454 00:21:58,217 --> 00:22:01,333 That's a lot different than running two floors up to talk to the CMO. 455 00:22:01,357 --> 00:22:02,869 And by the way, you lied. 456 00:22:02,893 --> 00:22:04,241 Told me you were in Radiology, 457 00:22:04,265 --> 00:22:06,099 on our first day working together. 458 00:22:10,508 --> 00:22:12,245 You're right. I'm sorry. 459 00:22:13,987 --> 00:22:15,634 I'm, I'm uh... 460 00:22:16,066 --> 00:22:20,340 Every time I look at Joan in that bed, all I see is... 461 00:22:21,182 --> 00:22:22,427 Your mom. 462 00:22:26,640 --> 00:22:28,319 I wish you'd been here for that. 463 00:22:28,862 --> 00:22:30,766 I'm here now. 464 00:22:31,250 --> 00:22:32,628 I know. 465 00:22:32,898 --> 00:22:35,103 Try to hold on to that. 466 00:22:39,801 --> 00:22:41,981 - Oh, I think he's waking up. - Walter, can you hear me? 467 00:22:42,005 --> 00:22:44,222 It hurts. Please, it hurts. 468 00:22:44,246 --> 00:22:47,092 - Blood pressure's spiking. - Walter, try to breathe. 469 00:22:47,148 --> 00:22:48,287 My neck, it hurts so bad! 470 00:22:48,312 --> 00:22:49,827 Two milligrams IV morphine, stat. 471 00:22:49,852 --> 00:22:51,053 Where in the neck? 472 00:22:51,078 --> 00:22:53,306 Why can't I move my hands? What's happening? 473 00:22:53,331 --> 00:22:56,136 It's okay, Walter. That can sometimes happen with swelling. 474 00:22:57,140 --> 00:22:59,445 He lost his Babinski. 475 00:23:00,241 --> 00:23:01,821 So, the spinal cord's not sending a signal? 476 00:23:01,845 --> 00:23:03,614 Costa's running a CT to confirm, 477 00:23:03,638 --> 00:23:05,795 but it seems the cord swelling is causing compression. 478 00:23:05,819 --> 00:23:07,664 He's on morphine for the pain, 479 00:23:07,688 --> 00:23:09,502 but he's got serious neurological deficits. 480 00:23:09,526 --> 00:23:10,939 No movement below the neck. 481 00:23:10,963 --> 00:23:13,042 The sooner we can get back in and operate, the better. 482 00:23:13,066 --> 00:23:15,480 But his lungs are still inflamed from the RA. 483 00:23:15,504 --> 00:23:17,819 He may not be able to take another round of anesthesia. 484 00:23:17,843 --> 00:23:19,790 Dr. Costa's booked an OR for first thing in the morning. 485 00:23:19,814 --> 00:23:21,226 Anything longer than that, 486 00:23:21,250 --> 00:23:23,230 then he could have serious neurological issues permanently. 487 00:23:23,254 --> 00:23:24,666 We should have been more aggressive. 488 00:23:24,690 --> 00:23:26,670 We can't Monday morning quarterback. 489 00:23:26,694 --> 00:23:28,039 The surgeon gave you two choices. 490 00:23:28,063 --> 00:23:29,622 And I picked the safer one, because I was worried 491 00:23:29,646 --> 00:23:31,579 Walter doesn't have the long term support 492 00:23:31,603 --> 00:23:33,183 to go for what was really needed. 493 00:23:33,207 --> 00:23:35,054 - It was a coin toss, Gina. - No, it wasn't. 494 00:23:35,078 --> 00:23:36,686 You wanted to go for the other option. 495 00:23:36,710 --> 00:23:39,061 So Costa waffled. It should not have been up to you. 496 00:23:39,085 --> 00:23:40,230 No, it shouldn't have been. 497 00:23:40,254 --> 00:23:42,334 So let me take this off your plate now. 498 00:23:42,358 --> 00:23:43,931 Tell Costa I want Walter 499 00:23:43,955 --> 00:23:45,976 in reverse Trendelenburg during the operation, 500 00:23:46,000 --> 00:23:49,840 and to use lung protective ventilation with low tidal volume. 501 00:23:52,973 --> 00:23:55,410 He may never walk again, Michael. 502 00:23:58,490 --> 00:24:01,926 Induction chemo did a number on me. 503 00:24:01,950 --> 00:24:03,812 Well, you're almost through the first dose. 504 00:24:03,836 --> 00:24:06,316 But we found an invasive fungal infection, 505 00:24:06,340 --> 00:24:07,585 presumptive Candida. 506 00:24:07,609 --> 00:24:09,289 We're, we're treating it with antifungals. 507 00:24:09,313 --> 00:24:11,325 Candida. 508 00:24:11,725 --> 00:24:13,732 Must have seeded in my liver. 509 00:24:13,756 --> 00:24:16,035 No, not the liver. 510 00:24:16,059 --> 00:24:17,873 It's likely diffused endothelial, 511 00:24:17,897 --> 00:24:20,043 given the high beta-D-glucan level. 512 00:24:20,067 --> 00:24:22,272 Did you finish your homework? 513 00:24:22,907 --> 00:24:25,487 Is your father, is your father home yet? 514 00:24:25,511 --> 00:24:27,624 - Mom? - Joan? Look at me. 515 00:24:27,648 --> 00:24:30,220 - What's wrong with her? - Ethan, step back. 516 00:24:31,023 --> 00:24:32,501 What's happening? 517 00:24:32,525 --> 00:24:34,004 She's seizing. 518 00:24:34,028 --> 00:24:35,775 Oxygen at 10 liters. 519 00:24:35,799 --> 00:24:38,580 Altered mental status, it's gotta be neurological. 520 00:24:38,604 --> 00:24:40,785 Increased ICP, her brain's swelling. 521 00:24:40,809 --> 00:24:42,755 If she had leukemia, this wouldn't be happening. 522 00:24:42,779 --> 00:24:44,459 - Not this fast. - You're right. 523 00:24:44,483 --> 00:24:46,486 We're missing something. 524 00:24:50,629 --> 00:24:52,909 Look, I know whatever decisions were made 525 00:24:52,933 --> 00:24:55,413 about bringing Dr. Miller back are way above my pay grade, 526 00:24:55,437 --> 00:24:57,885 but we can't just ask Liz to forget what happened 527 00:24:57,909 --> 00:24:59,890 cause it'll make life easier for everyone else. 528 00:24:59,914 --> 00:25:03,196 I'm going to talk to Richard once Joan is stabilized. 529 00:25:03,220 --> 00:25:06,002 I'm sure he'll be willing to apologize to Liz. 530 00:25:06,026 --> 00:25:10,010 His apology is gonna be hollow and meaningless. 531 00:25:10,034 --> 00:25:12,014 And you should know, when Dr. Miller was Chief, 532 00:25:12,038 --> 00:25:15,545 he tried to use me to find out mistakes Amy was making. 533 00:25:15,979 --> 00:25:19,395 Look, I'm sorry you ended up in the middle of that. 534 00:25:19,419 --> 00:25:21,968 But um, I know the board. 535 00:25:21,992 --> 00:25:23,804 They'd rather find a way to get rid of Liz 536 00:25:23,828 --> 00:25:25,340 than reopen this can of worms. 537 00:25:25,364 --> 00:25:28,179 Well, they can try, but if Liz starts talking, 538 00:25:28,203 --> 00:25:30,084 they're gonna get blowback from the nurses 539 00:25:30,108 --> 00:25:31,653 and potentially the union. 540 00:25:31,677 --> 00:25:33,556 Is uh, is that a threat? 541 00:25:33,580 --> 00:25:35,127 It's a reality. 542 00:25:35,151 --> 00:25:37,933 I'm just trying to do the right thing for her, 543 00:25:37,957 --> 00:25:40,604 and protect the department, which is part of my job now. 544 00:25:40,628 --> 00:25:43,911 She bears responsibility for her own decisions, Sonya. 545 00:25:43,935 --> 00:25:45,982 As you said, she has a very strong union 546 00:25:46,006 --> 00:25:47,952 she could have gone to when all this happened. 547 00:25:47,976 --> 00:25:49,756 I think, maybe, you're expecting too much, 548 00:25:49,780 --> 00:25:53,831 or not understanding the dynamic between an older man with power 549 00:25:53,855 --> 00:25:56,737 and a young woman at the start of her career. 550 00:25:56,761 --> 00:26:00,110 It's blaming the victim, and I don't think it'll be appreciated. 551 00:26:00,306 --> 00:26:03,345 - I do hear you. - Well, good. 552 00:26:04,309 --> 00:26:06,890 Because you started the day by saying your door was open, 553 00:26:06,914 --> 00:26:09,820 but now it seems like you're closing it on Liz. 554 00:26:15,931 --> 00:26:18,013 The MDS is late-stage, 555 00:26:18,037 --> 00:26:21,152 but it's obscured by high steroid usage. 556 00:26:21,176 --> 00:26:23,723 Pancytopenia, pleural effusions, 557 00:26:23,747 --> 00:26:26,229 DIC, elevated beta-D-glucan, 558 00:26:26,253 --> 00:26:29,569 and now cerebral edema, and she's getting worse. 559 00:26:29,593 --> 00:26:32,909 Hey, just checked in on Joan. How you holding up? 560 00:26:32,933 --> 00:26:35,882 I've been going toe to toe with Richard all day, 561 00:26:35,906 --> 00:26:37,484 and now we're running out of time. 562 00:26:37,508 --> 00:26:38,754 Who's this? 563 00:26:38,778 --> 00:26:40,156 Um, he's a doctor in Madrid 564 00:26:40,180 --> 00:26:42,896 who has a case study that might be relevant 565 00:26:42,920 --> 00:26:45,267 and this translation app keeps glitching. 566 00:26:45,291 --> 00:26:47,638 Um, I mean, I minored in Spanish, 567 00:26:47,662 --> 00:26:49,208 we could see how rusty I am. 568 00:26:49,232 --> 00:26:50,334 Okay. 569 00:27:25,772 --> 00:27:27,886 Gracias. So, what he's saying 570 00:27:27,910 --> 00:27:29,322 is that the symptoms were similar, 571 00:27:29,346 --> 00:27:31,459 but his patient had dormant sarcoidosis, 572 00:27:31,483 --> 00:27:33,697 so that was complicating the clinical picture. 573 00:27:33,721 --> 00:27:35,772 But once they found that, everything else just fell into place. 574 00:27:35,796 --> 00:27:37,618 So a patient with MDS like Joan 575 00:27:37,642 --> 00:27:39,475 presented with these symptoms 576 00:27:39,499 --> 00:27:41,813 because of a different chronic issue. 577 00:27:41,837 --> 00:27:43,717 And it went undetected for years. 578 00:27:43,741 --> 00:27:45,955 Okay, okay. Thanks. 579 00:27:45,979 --> 00:27:49,452 Just remember you gotta find a way to work with Richard on this. 580 00:27:52,058 --> 00:27:53,904 Your spinal tap came back negative 581 00:27:53,928 --> 00:27:55,373 and a full neuro panel too. 582 00:27:55,397 --> 00:27:57,812 Well, her procalcitonin is low, 583 00:27:57,836 --> 00:27:59,515 even though she just had an infection. 584 00:27:59,539 --> 00:28:00,985 I need total protein, 585 00:28:01,009 --> 00:28:03,189 C-reactive protein and complement levels. 586 00:28:03,213 --> 00:28:05,360 - How fast can you do that? - 20 minutes. 587 00:28:05,384 --> 00:28:08,433 And if the results can go to me, since I'm her doctor, 588 00:28:08,457 --> 00:28:10,060 that'd be appreciated. 589 00:28:12,131 --> 00:28:14,411 We've got a high complement protein level, 590 00:28:14,435 --> 00:28:17,251 and the prednisone must have dropped her immune surveillance, 591 00:28:17,275 --> 00:28:20,123 which means that we're looking for something that's been there. 592 00:28:20,147 --> 00:28:22,528 Possibly for years, like you said, 593 00:28:22,552 --> 00:28:24,098 but that's been hiding in plain sight. 594 00:28:24,122 --> 00:28:25,935 When Joan woke up, 595 00:28:25,959 --> 00:28:27,371 and I told her about the Candida, 596 00:28:27,395 --> 00:28:28,941 she asked if it seeded in her liver. 597 00:28:28,965 --> 00:28:30,309 Well, that wouldn't be uncommon. 598 00:28:30,333 --> 00:28:32,348 But the beta-D-glucan is so high, 599 00:28:32,372 --> 00:28:35,387 the fungal load would be too large to be isolated to her liver. 600 00:28:35,411 --> 00:28:38,092 Okay. We've been assuming that the elevated liver enzymes 601 00:28:38,116 --> 00:28:41,699 are caused by the MDS and the prednisone, 602 00:28:41,723 --> 00:28:44,729 but look at her blood work going back to 2016. 603 00:28:46,165 --> 00:28:47,645 Higher range of normal. 604 00:28:47,669 --> 00:28:49,582 But low enough that nobody would flag it. 605 00:28:49,606 --> 00:28:51,419 2016, 606 00:28:52,005 --> 00:28:54,784 that's a long time for her to be carrying something. 607 00:28:55,451 --> 00:28:59,001 Wait a minute. One of the last memories I have of her, 608 00:28:59,025 --> 00:29:00,570 2016, she was in Ecuador. 609 00:29:00,594 --> 00:29:04,645 And she got sick, and I told her that she should come back. 610 00:29:04,669 --> 00:29:07,852 And she self-diagnosed, 611 00:29:07,876 --> 00:29:09,555 she thought it was dysentery... 612 00:29:09,579 --> 00:29:11,659 Which means she was drinking unfiltered water. 613 00:29:11,683 --> 00:29:13,831 So, if it was a parasite, 614 00:29:13,855 --> 00:29:16,436 she could have been sick while she was digesting it, 615 00:29:16,460 --> 00:29:19,709 but by the time it migrated to her liver, she was fine. 616 00:29:19,733 --> 00:29:21,729 Then she could have been fighting this quietly for years. 617 00:29:21,753 --> 00:29:24,196 And the prednisone weakened her immune system, 618 00:29:24,221 --> 00:29:26,090 and unleashed it on her. 619 00:29:28,049 --> 00:29:30,120 I think we have a path now. 620 00:29:34,187 --> 00:29:36,001 He's losing sympathetic tone. 621 00:29:36,026 --> 00:29:38,942 Surgery's set for 6:00 AM, can we up the steroids? 622 00:29:39,243 --> 00:29:40,688 Too worried about his blood pressure. 623 00:29:40,713 --> 00:29:42,326 Think we just have to stay the course 624 00:29:42,351 --> 00:29:44,421 and hope that he's strong enough to hold on. 625 00:29:46,219 --> 00:29:48,366 I appreciate what you said before. 626 00:29:48,556 --> 00:29:50,593 Trying to let me off the hook. 627 00:29:51,596 --> 00:29:53,076 You religious at all? 628 00:29:53,100 --> 00:29:54,611 From time to time, 629 00:29:54,635 --> 00:29:57,675 depending on how I'm feeling about the world. 630 00:29:58,343 --> 00:30:00,491 I remember going to this sermon once. 631 00:30:00,515 --> 00:30:04,365 The minister was talking about how it can be a form of hubris 632 00:30:04,389 --> 00:30:06,202 to think that we can control things 633 00:30:06,452 --> 00:30:08,789 that are out of our control. 634 00:30:09,958 --> 00:30:12,338 Cause that's somebody else's domain? 635 00:30:12,363 --> 00:30:13,943 Doesn't mean it's easy to accept it. 636 00:30:13,968 --> 00:30:16,472 But I think that's the idea, yeah. 637 00:30:17,621 --> 00:30:20,302 I'll take that under advisement, Dr. Coleman. 638 00:30:20,327 --> 00:30:21,696 Good. 639 00:30:25,957 --> 00:30:27,093 Your wife's here. 640 00:30:30,674 --> 00:30:32,487 It's my anniversary and I forgot. 641 00:30:32,511 --> 00:30:34,425 You go. I am all over this, 642 00:30:34,449 --> 00:30:37,087 hourly exams, I will not go home. 643 00:30:42,631 --> 00:30:45,380 I've been downstairs 15 minutes, tried calling you. 644 00:30:45,404 --> 00:30:48,419 I'm sorry. There were problems with Walter's surgery, 645 00:30:48,443 --> 00:30:50,249 he needs another one tomorrow. 646 00:30:50,782 --> 00:30:53,029 Why don't we have dinner in your office tonight? 647 00:30:53,053 --> 00:30:57,404 That way, if anything happens, you're close. 648 00:30:57,428 --> 00:30:59,508 What did I do to deserve you? 649 00:30:59,532 --> 00:31:00,845 I don't know. 650 00:31:00,869 --> 00:31:03,406 I'm sure you'll find a way to make it up to me. 651 00:31:04,908 --> 00:31:07,714 I'm thinking 400 milligrams albendazole. 652 00:31:08,083 --> 00:31:10,029 I'd go 300, 653 00:31:10,053 --> 00:31:12,178 given the ALT/AST, 654 00:31:12,202 --> 00:31:14,873 and 20 of Ampho B to balance it out. 655 00:31:14,897 --> 00:31:16,911 And 100 milligrams of cimetidine 656 00:31:16,935 --> 00:31:18,503 to cut the renal toxicity. 657 00:31:19,774 --> 00:31:21,118 It's a tightrope. 658 00:31:21,142 --> 00:31:23,022 Any idea where Liz is? 659 00:31:23,046 --> 00:31:24,325 Uh, let's see. 660 00:31:24,349 --> 00:31:27,630 Code Blue, ICU. Code Blue, ICU. 661 00:31:27,654 --> 00:31:28,824 Joan's coding. 662 00:31:29,558 --> 00:31:31,639 Code Blue, ICU. 663 00:31:31,663 --> 00:31:33,610 Code Blue, ICU. 664 00:31:34,837 --> 00:31:36,549 No pulse. 665 00:31:36,573 --> 00:31:38,186 He's in V-fib. Push one milligram Epi. 666 00:31:38,210 --> 00:31:40,280 Get the defibrillator. 667 00:31:48,663 --> 00:31:50,434 Ready? 668 00:31:51,436 --> 00:31:53,273 Clear. 669 00:31:56,572 --> 00:31:59,076 Restarting compressions. 670 00:32:06,632 --> 00:32:09,739 Danny, Danny. Someone call 911. 671 00:32:11,109 --> 00:32:12,544 Charge to 50. 672 00:32:13,714 --> 00:32:15,717 Clear. 673 00:32:20,506 --> 00:32:23,045 Pushing another milligram of Epi. 674 00:32:29,245 --> 00:32:31,492 Fine V-fib, we're losing him. 675 00:32:31,516 --> 00:32:34,288 Going up to 100. Give me the paddles. 676 00:32:38,297 --> 00:32:40,467 - Ready. - Clear. 677 00:32:50,121 --> 00:32:51,331 Looks like Sinus. 678 00:32:51,355 --> 00:32:53,904 We have a pulse. He's back. 679 00:32:54,140 --> 00:32:57,079 Page Dr. Costa, we can't wait on the surgery. 680 00:33:20,200 --> 00:33:21,812 Cord is decompressed. 681 00:33:21,843 --> 00:33:26,018 Screws are seated. Let's secure the rods. 682 00:33:26,419 --> 00:33:27,922 Hey. 683 00:33:31,269 --> 00:33:34,375 That must have been really difficult for you. 684 00:33:35,044 --> 00:33:36,646 Yeah. 685 00:33:37,481 --> 00:33:40,297 And a hell of a first day for Michael. 686 00:33:40,593 --> 00:33:43,298 Oh, it hit pretty close to home. 687 00:33:44,495 --> 00:33:46,175 How's it going in there? 688 00:33:46,199 --> 00:33:47,912 Hardware's almost in place. 689 00:33:47,936 --> 00:33:50,183 But even if it works, 690 00:33:50,207 --> 00:33:52,320 no one's ever gonna adopt him. 691 00:33:52,344 --> 00:33:55,050 Not when he needs this kind of support. 692 00:33:58,163 --> 00:34:01,869 You're not thinking of doing something drastic? 693 00:34:03,066 --> 00:34:04,702 Go and be with Joan. 694 00:34:05,304 --> 00:34:07,040 Gina. 695 00:34:08,177 --> 00:34:09,947 I care about him, 696 00:34:10,715 --> 00:34:13,821 but I know what the boundaries are. 697 00:34:14,221 --> 00:34:16,827 Now go, where you're needed. 698 00:34:30,620 --> 00:34:32,467 But you've gotta quit smoking. 699 00:34:32,491 --> 00:34:34,428 You know that's never gonna happen, honey. 700 00:34:38,603 --> 00:34:41,185 I don't know how much more we can pump into her 701 00:34:41,280 --> 00:34:43,747 before she starts shutting down. 702 00:34:43,772 --> 00:34:46,678 Her body's so fragile. 703 00:34:48,278 --> 00:34:50,460 The chemo didn't help with that. 704 00:34:51,129 --> 00:34:53,733 She was only on it for eight hours. 705 00:34:55,270 --> 00:34:56,917 The parasite is causing this, 706 00:34:56,941 --> 00:35:00,380 that and the prednisone, it's not on you, Richard. 707 00:35:37,888 --> 00:35:39,913 Hey. It's okay, buddy. 708 00:35:50,949 --> 00:35:53,052 Can I see? 709 00:35:55,591 --> 00:35:58,557 Aww, she's gonna love this. 710 00:36:01,302 --> 00:36:03,283 Is she gonna wake up soon? 711 00:36:03,733 --> 00:36:06,237 I really hope so. 712 00:36:21,342 --> 00:36:22,535 Hello? 713 00:36:22,559 --> 00:36:24,463 Hi, Amy. It's Dr. Ridley. 714 00:36:24,487 --> 00:36:27,697 Oh. Hi. 715 00:36:27,721 --> 00:36:29,501 I hope it's not 2:00 AM there, 716 00:36:29,525 --> 00:36:31,740 I stopped tracking time zone differences ages ago. 717 00:36:31,764 --> 00:36:34,846 No, it's noon. Is there a problem? 718 00:36:34,870 --> 00:36:36,783 I spoke with Dr. Kelly this morning, 719 00:36:36,807 --> 00:36:38,242 he told me about your mother. 720 00:36:39,678 --> 00:36:42,116 I'm just so sorry, Amy. 721 00:36:42,518 --> 00:36:45,199 Thank you, Dr. Ridley. 722 00:36:45,223 --> 00:36:47,872 And I respect your tenacity, already being back in the hospital, 723 00:36:47,896 --> 00:36:50,376 but I just wanted to make sure you're taking care of yourself. 724 00:36:50,906 --> 00:36:53,745 I think so. 725 00:36:55,244 --> 00:36:56,757 It's... 726 00:36:56,781 --> 00:37:00,255 It's been hard, obviously. 727 00:37:00,279 --> 00:37:02,367 Your world shifted on its axis. 728 00:37:02,391 --> 00:37:04,504 But you will come out the other side. 729 00:37:04,940 --> 00:37:06,544 I just... 730 00:37:07,300 --> 00:37:09,548 didn't even think you liked me. 731 00:37:09,572 --> 00:37:11,652 Well, that's by design, my dear. 732 00:37:11,676 --> 00:37:13,522 And now you know the truth. 733 00:37:13,965 --> 00:37:17,220 Not only do I like you, I believe in you. 734 00:37:19,525 --> 00:37:22,641 Thank you so much. I... 735 00:37:22,665 --> 00:37:24,511 I know how bad this hurts right now, 736 00:37:24,535 --> 00:37:26,648 but the best way that you can honor your mother 737 00:37:26,672 --> 00:37:28,218 is to live a life with purpose. 738 00:37:28,242 --> 00:37:31,058 You have greatness in you, Amy. 739 00:37:31,082 --> 00:37:34,021 And I'll be there to help you find it. 740 00:37:44,667 --> 00:37:46,647 Joan. 741 00:37:46,672 --> 00:37:49,076 Hey. Can you hear me? 742 00:37:49,664 --> 00:37:53,304 Can you get her son? He just went to get coffee. 743 00:37:54,027 --> 00:37:57,034 Hey. It's okay. 744 00:37:57,434 --> 00:38:00,306 Just go slow. Breathe. 745 00:38:02,678 --> 00:38:05,761 - What happened? - You had cerebral edema. 746 00:38:05,785 --> 00:38:07,196 No. 747 00:38:07,220 --> 00:38:10,971 It's not leukemia. Not yet. 748 00:38:10,995 --> 00:38:13,810 You had a parasite in your liver. 749 00:38:13,834 --> 00:38:17,316 From Ecuador. Do you remember that? 750 00:38:17,340 --> 00:38:19,211 You thought it was dysentery? 751 00:38:19,946 --> 00:38:21,482 Oh my God. 752 00:38:22,150 --> 00:38:26,202 Is that the one time in my life I misdiagnosed? 753 00:38:33,306 --> 00:38:36,212 You haven't looked after yourself for a long time. 754 00:38:38,316 --> 00:38:39,594 I know. 755 00:38:39,618 --> 00:38:42,100 Promise me that stops now. 756 00:38:42,124 --> 00:38:43,637 Ah. 757 00:38:43,661 --> 00:38:45,941 Mom. Hey. 758 00:38:45,965 --> 00:38:47,267 Hey. 759 00:38:48,236 --> 00:38:50,140 Thanks so much, Amy. 760 00:38:51,777 --> 00:38:56,085 I'll order CBC and liver function tests. 761 00:38:58,891 --> 00:39:00,603 The fact that she's conscious... 762 00:39:00,627 --> 00:39:02,731 Yeah, we got her some more time. 763 00:39:03,919 --> 00:39:07,093 I appreciate you finding a way to trust me today. 764 00:39:08,743 --> 00:39:10,380 Yeah, it worked out today. 765 00:39:11,374 --> 00:39:14,213 But I'm never gonna trust you, Richard. 766 00:39:21,502 --> 00:39:24,484 Hey, Walter. Welcome back. 767 00:39:24,508 --> 00:39:26,343 Did you fix my spine? 768 00:39:26,367 --> 00:39:28,629 We need to run some tests over the next few days, 769 00:39:28,653 --> 00:39:30,864 but it seems that way. 770 00:39:30,888 --> 00:39:32,601 And I'll be able to walk again? 771 00:39:32,625 --> 00:39:34,037 It's gonna be a long recovery, 772 00:39:34,061 --> 00:39:36,943 lots of physical therapy as your body adjusts 773 00:39:36,967 --> 00:39:38,732 to the hardware in your spine. 774 00:39:38,756 --> 00:39:41,242 But yes, you will. 775 00:39:44,795 --> 00:39:47,500 And I'll have to miss the next adoption fair? 776 00:39:48,089 --> 00:39:51,405 There'll be lots more. I promise. 777 00:39:51,429 --> 00:39:52,975 Thank you, Dr. Walker. 778 00:39:52,999 --> 00:39:56,038 Nobody ever cared the way you do. 779 00:39:59,612 --> 00:40:01,692 I am so sorry. 780 00:40:01,988 --> 00:40:05,128 It's okay. We'll do a raincheck. 781 00:40:11,970 --> 00:40:15,186 Sometimes, I wonder how you manage to leave it all 782 00:40:15,210 --> 00:40:17,080 here when you come home. 783 00:40:18,869 --> 00:40:21,307 It can be really hard. 784 00:40:21,622 --> 00:40:23,226 Yeah. 785 00:40:33,013 --> 00:40:35,493 Let's go get a drink, huh? 786 00:40:35,517 --> 00:40:36,953 Yeah. 787 00:40:45,604 --> 00:40:48,219 Hey. So, I spoke to Liz, 788 00:40:48,243 --> 00:40:51,140 and told her if she wants to come forward to HR, 789 00:40:51,164 --> 00:40:52,618 we would both have her back. 790 00:40:53,153 --> 00:40:56,302 Thank you. Oh, and I'm sorry if I was too... 791 00:40:56,326 --> 00:40:59,641 Sonya, speaking truth to power takes courage. 792 00:40:59,984 --> 00:41:02,389 I should be thanking you. 793 00:41:03,039 --> 00:41:04,913 Sorry, I didn't mean to interrupt. 794 00:41:04,937 --> 00:41:06,697 Oh no, I was just leaving. 795 00:41:06,721 --> 00:41:09,418 Actually, I was hoping to speak to you. 796 00:41:12,457 --> 00:41:15,005 I just wanted to thank you for checking in earlier. 797 00:41:15,029 --> 00:41:18,469 - Joan's improving. - I heard, that's great news. 798 00:41:20,040 --> 00:41:22,720 So we're gonna do this thing? Together? 799 00:41:22,744 --> 00:41:24,591 Well, it's what she wants. 800 00:41:24,615 --> 00:41:26,528 She tends to get what she wants. 801 00:41:26,552 --> 00:41:28,022 Yeah. 802 00:41:32,899 --> 00:41:35,914 I saw Joan, she's spunky as ever. 803 00:41:35,938 --> 00:41:38,309 Can't keep that lady down. 804 00:41:39,678 --> 00:41:41,793 - Amen to that. - Yeah. 805 00:41:41,817 --> 00:41:44,956 - Goodnight, Jake. - Hey. Goodnight, man. 806 00:41:51,034 --> 00:41:53,382 Hey, did you know about him and Sonya? 807 00:41:53,620 --> 00:41:55,619 What about them? 808 00:41:55,643 --> 00:41:57,657 - No. - Yeah. 809 00:41:59,418 --> 00:42:01,365 I guess we set a good example. 810 00:42:07,200 --> 00:42:09,514 I heard your family was here today. 811 00:42:09,538 --> 00:42:11,218 Yeah. Um... 812 00:42:11,242 --> 00:42:13,589 Mia, she got in trouble at school, it was, 813 00:42:13,613 --> 00:42:15,583 er, I don't know, it was ridiculous. 814 00:42:17,139 --> 00:42:20,646 Maybe you can tell me all about it on the way home? 815 00:42:21,930 --> 00:42:25,036 Yeah, sure thing, Chief. I can do that. 816 00:42:25,938 --> 00:42:27,595 It's Co-Chief. 817 00:42:27,619 --> 00:42:30,664 Co-Chief. I'm sorry, that's just so awkward to say. 818 00:42:30,688 --> 00:42:33,596 I know, tell me about it. 819 00:42:33,620 --> 00:42:35,233 Co-Chief.