Original subtitles

Previously on "New Amsterdam"...

Somebody reported that you have a problem with Adderall.

You're asking me if I've ever risked a patient's life

because I'm stoned.

Yeah, and you haven't answered the question.

What do you think would happen

if you stopped helping people? Who would they see?

They would see a corny, nerdy,

fat, worthless nothing.

All right, since you all prescribe 79% of our opioids,

I am giving you one year

to prescribe 79% less,

and anyone who doesn't will be fired.

I think they're clean.

The damage to his heart was extensive.

The virus also ravaged the surrounding heart muscle.

How bad?

Even if you found the best heart surgeon in the world,

I'm not sure it'd be enough.

- Hey. - Yeah?

Dr. Reynolds.

I used to work here.

Hospital ID?

No, but I should be in the system.

Oh, thank you.

So?

I can't operate.

Synced & corrected by -robtor- www.addic7ed.com

Here's Vijay's cardiac echo.

What do you mean "can't operate"?

His mitral valve, it's greater than 60% regurgitation.

That's secondary to a ruptured papillary muscle.

I didn't fly you out here to not operate.

Listen, his EF is under 20%.

These numbers aren't even compatible with life.

Right, which is exactly why you need to fix the valve.

I can't fix it because the virus has damaged

the heart muscle around the valve.

There's nothing to sew a new valve into.

Doing nothing isn't an option.

I didn't say I was doing nothing.

- Look, I'm gonna use a catheter. - TAVR?

- All right, I'm gonna place a clip... - A clip?

Into the mitral's weakened area... that should fix it.

He's dying, Floyd. He needs surgery.

Okay, look, you brought me here because of my expertise,

and because you trust me.

Right now my expertise is saying this.

I gotta go.

What happened to "How can I help?"

- The virus hit us hard. - Nothing's the same.

My hospital had three.

Three what?

Only three deaths.

I feel guilty just saying it.

Don't. You were spared.

I wish we were.

Especially Lauren.

It hit her the worst.

- Candelario's on! - Dr. Bloom, it's Gladys.

- Get Candelario! - It's about Iggy.

I'm on my way out.

He's sweaty, wobbly on his feet.

Did he take a COVID test?

PCR came back negative,

but he can hardly stand.

Ig?

- Hey. - Hey.

What brings you down to the... Ooh.

- Aw, God, Gladys was right. - You gotta go home.

No, I just... I stood up too fast.

- I got a head rush. - You're valor is noted,

but if you've got the flu, you gotta go.

I don't have the flu, I'm just... I'm tired.

You're color's not great.

Lauren, if I feel anything flu-y, I'll, uh...

Hey.

- I'll page you. - Hey, hey, hey, hey, hey.

Hey, come on, come on. Sit down.

- Sit down. - No, no, I'm fine.

I just... I haven't eaten.

Since when?

Hey. How many meals?

How many days?

Two.

Maybe three.

Hi.

I thought you might enjoy a full-bodied Ethiopian roast,

carefully wrapped for contactless delivery,

- as an apology. - None needed.

I'll take the coffee, but keep the apology.

Um, look, all of this, um,

being close bodies and trusting, normal,

it's kinda like I don't remember

how to do any of it anymore.

I get it, if that's what it is.

What do you mean?

I mean, there's no reason

to force something that's not there anymore.

No, it's not... that's not it.

Are you sure?

It's okay, Helen.

COVID took away a lot of things.

We focus here on the lives lost,

but there were other casualties.

See you around.

It's all I know right now. I'm sorry.

I know, but Dr. Kapoor

was supposed to be in the OR hours ago.

So that can't be good, right?

I know it's hard to wait.

As soon as I have an update, I will let you know.

Hi, Ella, I'm Dr. Sharpe,

one of Vijay's colleagues.

Of course, Double French Roast with a splash of agave.

Yep.

I'm sorry I'm not standing.

I just... I'm worried that if I get out of this chair,

Vijay's gonna die during surgery.

I have OCD,

and my irrational thoughts won this round.

It happens.

Ah, I wish it hadn't

because sitting is making my leg cramps worse.

I stretch, but they just keep coming back.

How long has that been going on?

Um, an hour or two?

I woke up breathing better for the first time in months,

but my back gets hot and now this.

Although my pregnancy podcast

said I was going to start feeling confident and sexy.

Ella, it sounds like you're in labor.

I got your page.

We caught the guy who's been pinching Oxy

- from the dispensary. - An orderly?

- My name is Paul. - Paul Argento.

Been working here for 13 months

and stealing from you just as long.

You mind telling me why?

Look, if we're using, we can get you tre...

They're not for me.

Well, if you're selling them...

The... they're for my mom.

She got diagnosed with osteosarcoma a year ago.

She used to be happy,

but now the pain's killing her.

She can't even walk her dog.

The Oxy was helping, but that idiot doctor of hers...

He's been giving me less and less for my pain.

Told me I had to be weaned off.

And what is he giving you as an alternative?

Nothing.

That's awful.

Whoever was treating you stops today.

You're a patient at New Amsterdam now.

But my doctor is at New Amsterdam.

Brenna Argento.

- I know her well. - Stage three bone cancer.

She can barely walk, and yet you pulled her Oxy. Why?

Because received a letter from a Dr. Max Goodwin

saying that if I didn't, I'd be fired.

No, for overprescribing, needlessly, recklessly,

- but Brenna... - Who wasn't the type

of patient you pictured when you wrote it.

This is what happens when you needlessly and recklessly

make a blanket policy without a regard to individual patients.

She is suffering.

Of course she's suffering, but not because of me.

Because of you.

Don't hang up!

Because I want whoever that is to know

that I'm person who killed you

for reversing this hospital's policy

on limiting opiate prescriptions.

I am unmoved.

- Wow, okay, I gotta go. - Yeah, Daddy's in trouble.

Love you. Bye.

Opioid prescriptions at New Amsterdam are down 38%.

We've won awards. We're a national model.

The Nyler family's rightfully drowning

in class-action lawsuits.

And yet, deaths from narcotic overdoses

are skyrocketing. Know by how much?

240%. So mission accomplished?

You instituted that policy.

Yeah, to save lives, but that policy was a blunt instrument

that put paper over people.

So you're denouncing your own hugely successful policy?

- Well, that's just it. - It wasn't successful.

Our books were clean, but at the cost of hurting people

who needed our help. We have to do better.

By returning to the halcyon days

when doled out highly addictive drugs like Halloween candy?

Karen, do you know what it feels like to have bone cancer?

- Oh, Max. - It's like being stabbed

over and over again

all day long with a serrated knife,

and the only, the only thing,

that is gonna ease that excruciating pain

is opioids.

Those aren't my words.

They're Brenna Argento's,

a patient that we...

that I let down.

You don't convince me opioids work.

That was never the issue. This was always about abuse.

About ensuring the drugs we send into the world

aren't getting our patients hooked or being sold

or ending up in the wrong hands.

You're absolutely right.

I don't like it when we're fighting,

- and you agree with me. - No, you're right.

We can get opioids to the people who need them

and in quantities that are in safe...

Karen, yes!

Sorry, forgot this was my office.

Uh, would you excuse me?

Contractions are organized and four minutes apart.

It's official.

What's official?

Ella, you're gonna have a baby today.

Oh, no, that's impossible

'cause my due date's in three weeks.

On a Friday. And today's Tuesday.

And Dr. Richardson was gonna delivery my baby.

Well, looks like someone wants to crash this party early.

I'll be covering for Dr. Richardson all day,

so I think we'll be seeing a lot of each other.

I'll be back in a bit to check on your progress.

Thank you.

This is not OCD. This is a relaxation exercise.

Good, you know, good. Relaxing is good.

How is this happening?

I am not ready for this.

Is there someone that you would like me to call?

- Family, friends? - No, there's only Vijay,

and he promised he'd be here for this.

Um, okay, uh...

Who... uh. You could try my doula,

but I think she's in Portland this weekend

for her great-aunt's birthday, so that feels like a dead end.

I know a great doula here at New Amsterdam.

Has she been working with me for the last 26 weeks

on ways to manage my OCD for this specific moment?

Uh, no.

- I had a plan. - I had such a perfect plan.

Oh.

Surgical suite prep to OR seven.

Uh, Leela, hi.

Can you clear my afternoon please?

No pagers, no patients. Nothing.

What are you doing?

I'm kicking off a new plan.

Okay.

Well, your concern is duly noted,

but I don't need your help. But thank you.

You know your staff's noticed?

I mean, even I can tell you're weak on your feet,

and you just admitted to caloric restrictions

spanning over 72 hours.

It's a cleanse, Lauren.

Really, I'm fine.

You know you sound like every first-timer

who's just been dragged to rehab.

Whatever it is that you think this is,

it isn't, and I don't appreciate the accusation.

Do you hide food?

Lauren...

Sometimes people starve themselves after a binge,

and not for health reasons, but because they feel ashamed.

Well, it's not like that.

Must be hard to hide your stash at home

what with Martin and the kids, so where do you keep it?

- Nowhere, I don't have a... - Here in this office?

No.

Lauren, don't. Don't.

Oh, Iggy.

- Hey. - It's...

The left atrium's barely moving.

COVID really did a number on his heart.

Vijay said he got it here at New Amsterdam?

- He's not the only one. - Approaching the left atrium.

You too?

It was in the early days.

I wore the same mask day and night for two weeks straight.

Then I was intubating a patient,

got a focused blast of exhaled air

right in my face.

I just felt the virus coming through the mask.

Sure enough, three days later, cough, fever, headaches.

Yeah. Vijay.

Why was he even here, you know?

I mean, his age, knowing the risk, why even come in?

- How could he not? - Vitals are stable.

We all felt a sense of duty,

of pride even.

What's that? You can't...

Ah, sorry about that.

Hi, again.

There are quite a few of you on this call,

and, well, you all have something in common,

and that's that you are all victims

of New Amsterdam's opioid policy that kept pain meds

from the people who need them the most.

We failed you

in the most fundamental way

a hospital can.

You came to us in pain,

you asked for our help, and we said no.

And what's worse,

is we shamed you for asking.

So I'm here to apologize

and to tell you that that cruel policy

ends now.

Yes!

Finally.

It's about damn time.

Yeah, all patients will get

the prescribed opioids they need

based on their pain levels,

and all have you to do is swing by New Amsterdam

once a week to pick up your pills.

Easy as pie.

Wait, what?

- I can't do that. - No, no.

We're gonna make it very, very simple.

We're gonna establish a special clinic.

What the hell's a special clinic?

I live in Long Island.

It's a three-hour trip if I'm lucky.

Excuse me, I have four kids and a job,

and you expect me to spend my one day off

with you every week?

Okay, I'm hearing some concerns

about the policy that we were

all just very excited about.

But I'll just be honest.

The hospital has some concerns

about portion control.

Portion control? Like I'm five?

No, no, no.

It's just that these pills are highly addictive,

and we do need to make sure that nobody is using

or distributing these pills inappropriately.

So now you think I'm dealing?

- No. - You just said

the shaming of chronic pain treatment was over.

And it is, but...

- Are you serious, Max? - Come on.

- That's not gonna work. - No way.

Um...

- What a joke. - I'm outta here.

- Come on, Max. - This is ridiculous.

- Thanks for nothing. - I'm closing this window.

Thank you all for responding to my multiple app requests.

I have some deliveries for you.

Addresses are grouped together for maximum efficiency.

- Those burritos? - They are not.

Are your items heat sensitive?

- No, we're good. - So if you wanna grab your bag...

Are dealing with breakable items like figurines?

- Are they insured? - Are we liable here?

I... no, it's very simple.

Some of our patients are having a hard time

getting to the hospital to pick up their prescriptions,

so I am hiring all of you

to solve that problem.

So we're delivering drugs.

Technically, yes?

But uh...

did I mention there's a 25% tip?

All right.

Yo, how many are we allowed to take?

Okay, okay.

That was smooth.

That was the alcohol swipe.

Getting started now.

Oh, my God. Distract me.

Uh, distract you?

Say something. Anything.

Um, okay.

Did you know that women blink nearly twice as much as men?

Nope, something interesting.

Fine, fine. Okay.

Aah, it feels like a sword!

Like I'm literally being stabbed by a sword!

All right, okay. Um...

there's this gorgeous man,

this doctor that I was seeing.

- Yes, good. - Am seeing.

- Well, mmm, was seeing. - I don't know.

I don't know.

But we started dating just when the pandemic hit,

and I thought about him for months during the lockdown.

I fantasized about him.

But then, the other day,

when he reached out to touch me, I pulled away.

I recoiled like I was physically repelled by him...

And I don't know. I don't know. Is it me?

Am I that scared to be touched by someone,

or is it him?

Did what we have,

did it just sort of...

No, keep going.

But fast forward to the interesting part.

Did he dump you? Are you sad?

Aah!

Was that a contraction?

Mm-hmm. Mmm!

What? The epidural seems to be

- taking its sweet time. - Yeah, it should've

kicked in by now. Unfortunately,

I think the catheter's tip is in the sub-dural space.

It didn't work?

It didn't work?

Uh, can we try again the epidural?

- It's too late, sweetheart. - You're too far along.

Ella, you're gonna have to do this on your own.

No. No.

No, no, no, no, no, no.

All right, I know how this looks.

I do. Believe me.

But these are my dad's words.

They're his words,

and growing up, I had to hear them practically every day.

My father struggled with his weight his entire life,

and he didn't want me to suffer the same fate.

So at an early age,

he took an interest in my weight.

An interest?

Mm-hmm, yeah.

It started around the third grade.

I filled out a little bit, and, uh,

he would make me go on crash diets

out of the blue,

skip meals, take meal replacement bars to school.

As a nine-year-old?

Mm-hmm.

Yeah, and...

he would make me take my shirt off

so he could take pictures of my body

to, um, put up on the wall in the basement

next to the makeshift gym that he'd built for me

to track my process.

There was a body progress chart.

And if I would ever walk by him,

he would smack my gut and say,

"Jesus, look at that thing."

"Got a lot of work left to do, don't we, buddy?"

And what's worse is,

if I ever had a good weigh-in, which was not very often,

I, uh, I would be over the moon

because it would make me feel loved.

Then... this one time,

I guess I would've been in middle school by this point,

I just... I...

I hated everything about myself.

So I tried to hang myself.

What?

Jesus, Iggy.

No, it's okay.

It didn't work, obviously.

Ironically, I was too fat

for the rod in the basement closet

to hold me up, and it crashed down on my head,

and my mom heard the sound and came to help me.

What? What did your dad say?

Oh.

My dad, um, well,

that night at my weigh-in,

he just snapped another polaroid for the wall

and acted like nothing ever happened.

That's my dad for you.

These are his words,

but they don't control me anymore.

They do not.

They serve as a reminder of all of the things

that I have conquered, which is a lot,

and sometimes I look at these words,

and they remind that I'm not that kid anymore

and that I'm making better decisions.

I'm making healthy decisions in my life.

And that I no longer need to stand around with my shirt off

- and let others judge me. - What?

You know that's not what I was doing, right?

I'm fine.

I am more than fine.

You can rest easy.

Now if you'll excuse me, I have patients to see.

No, I'm... I'm being careful.

Yeah.

Ma, I'm gonna see you soon.

Okay, yeah. I love you too.

All right.

Heard you pulled off one hell of a TAVR.

Just this side of genius.

I accept your apology, Max.

You need anything else while you're here?

Aw, no, just catching up with some folks.

You know, I missed my favorite scrub nurse in OR today, JJ.

- Devlin. - Yeah.

He passed away a few months ago.

COVID.

That's too bad.

Everything's changed.

- Dr. Max Goodwin. - That's me.

- You're under arrest. - Whoa, what's going on?

For what?

For writing 700 Oxycodone prescriptions,

each one over 100 milligrams,

and distributing them with bike messengers.

Oh, that.

It's nice to see some things haven't changed.

BP's 80/40 and falling.

Push epi, I'm coming in.

I need an echo over here.

What happened?

- The clip didn't hold. - His heart is failing.

The DA only agreed to not press charges for narcotics trafficking

because you're an essential worker.

- Huh. - Congratulations.

You're one of the select few to benefit from COVID-19.

Thanks for getting me out.

I have half a mind to leave you in there.

You know, pharmacies mail opioids all the time.

Bike messengers are almost the same.

I wonder if you've ever considered how exhausting it is

to be your boss.

All your wonderful ideas

that come with such chaos, every single one.

It's funny.

The thing you're best at is the part of my job I hate the most.

- You ignore reality. - That's not fair.

Says the man who just sent 70,000 milligrams of Oxy

out into the street via bike messenger.

I know it seems like a good idea.

Hell, it might even be a good idea,

but it's my job to deal with the reality of your ideas,

in this case criminal reality. Optics matter.

Patients matter.

I'm glad you're helping people, Max, truly.

But your plan has no accountability.

You don't know where these drugs are going.

You just don't.

And opioids, the potential for abuse,

it's a very emotional issue.

To many people, opioids aren't pain medicine.

They're what killed someone they loved.

Wait. Iggy.

Iggy, I wasn't judging you.

You could've fooled me.

It was just... people die from what you're doing.

What did she say?

In here. In here.

Ig.

Ig, look, I'm sorry for making a scene.

You should be.

It's just

I've seen people in my ED with eating disorders.

I mean, I've known people with eating disorders.

Some of them...

they're not here anymore.

Mm-hmm.

Look.

I know as well anyone

that the truth is really difficult.

I'm sorry. What are you doing?

Are you comparing your issues to mine right now?

Let me just mirror that back for you

so you can hear it out loud.

I'm on the Jimmy Kimmel diet,

and you almost killed a patient because you are a drug addict.

- Not the same. - That was way out of line.

I'm outta line? It's not hard, Lauren.

This is a hospital.

There's only one line that matters.

You were hurting patients. I am not.

Plain and simple!

Patients aren't the only people you can hurt.

Oh, yeah? Well, I think the janitors

- are safe from my eating too. - Yeah? What about your kids?

- Excuse me? - You're starving yourself.

You think they don't notice that?

- You stop talking. - How many meals have you had with them

- where you haven't eaten anything? - Stop!

How many have you skipped altogether?

I mean, what kind of screwed up issues

are your kids gonna have with food because of you?

Occupied!

It's a bad time, Gladys.

It's Dr. Kapoor.

The clip failed,

tore right through the valve leaflets.

I'm gonna have to crack open his chest

and put in an artificial valve.

That's a big surgery.

I thought you said you couldn't sew into the muscle.

- What changed? - Nothing. Not a damn thing.

But he'll make it through the surgery, right?

That's why I thought you should see him now,

and have one more moment with him

in case...

I'm gonna go prep.

You're fully effaced and dilated,

but the baby's still at minus three position.

Ella, the delivery isn't progressing as I had hoped.

What does that mean?

When your contraction comes, you need to push real hard.

Oh, my God, this is a disaster.

Maybe you could hold her hand.

E-Ella.

Look. Look.

Count them out with me, okay?

Here we go.

Give me the biggest push you got.

You can do this. Come on, come on.

No, I can't! Stop, I don't want to!

What if the baby's not okay? What if I hurt it?

What I ate undercooked meat and didn't know it?

And seven weeks ago I took a bath

right after the tub was cleaned,

and the water probably had bleach in it.

What kind of mom is that careless?

You are not careless.

You have disorder that sends your pregnancy into overdrive,

but you fought it, and you've made it this far.

I cheated. I got scans all the time.

Sometimes two days in a row

in case something happened while I was sleeping.

But then everything shut down,

and Vijay got sick, and I don't know why,

but I just convinced myself

that the baby was going to be okay as long as he was okay.

What if Vijay's not okay?

Ella! Everything on that monitor

says that your baby is going to be okay,

but you have to deliver it...

No! Oh.

- Contractions peaking. - Aah!

You can do it.

Your baby needs you to push now.

Aah.

Eh?

Yeah, yeah, buddy? What is it?

Hit me.

You're such a good dad.

Aw, I don't know. I...

If this doesn't work out...

Will you look after

Ella and the baby?

You've got this.

You can do it.

Hey.

And I am dying...

- What are you talking about? - Don't be silly.

You are going to be annoying her

for the rest of your life, okay?

Please.

If something happens, I...

Yes.

Obviously.

Good.

Listen, Iggy.

- Lauren, I'm fine. - No.

I never should've dragged your kids into this.

I'm really sorry.

A couple nights ago, I was, uh,

I was wearing this nice new sweater

that Martin gave me, and, um...

Harper told me that I looked handsome in it.

Then I immediately grabbed my stomach,

and I told her that she was wrong.

It just popped out of mouth.

I say things like that all the time.

And Vijay thinks that I'm a great father?

I'm teaching my kids

that someone who looks like me doesn't deserve to be loved.

That is the same lesson that my dad taught me.

Aw, man.

He just used different words.

Iggy.

These aren't your dad's words.

You wrote this.

I know.

These are your words. You're calling yourself this,

and you're keep suffering until you stop.

If I can't stop,

this note, that voice...

It's the thing about myself that feels the most true.

How do you stop believing that?

Well, you could try talking to a therapist.

Hey, I did.

He saved my life.

Come here.

- Thank you. - Yeah.

? Come on, Johnny, please

? Won't you speak to me?

Ready to restart the heart.

Everything's solid.

Charging. Clear.

Suctioning.

Quarter's ready.

We did it.

Good job, everyone.

Ooh.

All right, let's close him up.

BP is dropping.

What?

- Heart valve's not holding. - It's slipping.

Give me a 3-0 proline on the needle driver.

Times two.

You work the septum, I'll work the free wall.

I'm gonna have to get him back on bypass.

We can't reestablish aortic cannulation.

As a backup, yes.

- My stitches aren't holding. - Neither are mine.

- Trying 5-0. - Suction needs to be higher.

I'm not getting any purchase.

Another bag.

Come on. Hold, damn it.

Flash sterilized.

Ansuya.

Ansuya.

Ansuya.

Vijay.

Eat this.

I don't need it.

All I need is you.

It will give you strength

for our granddaughter.

Granddaughter?

She needs her Dadaji.

Vijay?

He's waking up.

Oh, thank God. Vijay.

Welcome back, Dr. Kapoor.

Happy birthday, little one.

Uh, K-Karen!

- Are the cops chasing you now? - Uh, I don't know,

but I did come up with a solve for our opioid issue,

and I think you're really gonna like it.

And here I thought we knew each other better.

Watermarking.

So every single opioid that New Amsterdam sends out

into the world will be watermarked

with invisible, fluorescent fibers.

Every patient will have access

to the medicine they need and without shame.

And they'll be able to manage their pain,

and they'll be able to live functional lives.

But if those pills ever do end up in the street,

or in the wrong hands, we'll know.

There will be no drug trafficking,

and there will be accountability.

Oh, and I almost forgot the best part.

The Nylers are gonna pay for it.

Why would they do that?

They kinda have to.

Part of their settlement includes

donating millions of dollars to public hospitals,

just like ours.

I don't know what to say.

It sounds like a well-thought-out

and realistic plan.

I know. Weird, right?

Karen.

Thank you for keeping me accountable.

That's my job.

And every once and a while, it's worth it.

I'm not ready.

Okay.

I mean, I'm not ready to call it.

I should've been here.

Well, you're here now.