Original subtitles

Previously on Doc...

Dr. Lars has no recollection of the last eight years.

- Babe, what's wrong? - We got divorced four years ago.

Are you married?

We were together, Amy and me.

The woman created a toxic work environment

You're the reason I became a doctor. I hope you come back.

The Board has decided against you coming back to work here.

I wanted to be a doctor my entire life.

Will you help me do that, Michael?

Where's Robert Buxton?!

- He's supposed to be in 628! - He was moved. He's in 617 now.

It should change on the telemetry!

Dr. Coleman!

You didn't notice the pressure drop on inspiration?

Or the jugular venous distension?

Because you were just about to place a line in it.

He has Beck's triad, caused by cardiac tamponade.

Emergent decompression.

You can use the central line needle.

It won't reach. I need a spinal needle.

Three inches, 18 gauge, and a 60 cc syringe!

You might want to make sure your patients are okay

before you go home.

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

As you all know,

today will be Dr. Larsen's first day back with us.

But it will obviously be

a very different situation than when she was Chief.

Not only is she missing the last eight years of her own life,

she will also be missing all of those years

of medical advancements and best practices.

Now, I'm told she's been getting up to speed,

but let me remind you all

as brilliant as Dr. Larsen was,

no one knows if she's going to be able to get that back.

So, you have to trust your own instincts

and resist the temptation to defer to hers.

Which is exactly why this is so dangerous.

I think we can all manage ourselves, Peter.

Can we, though? Can we?

Okay, I know... I know some of you are uncomfortable,

but the hospital is obligated

to make a reasonable accommodation

to any employee with a disability.

So here are the new protocols:

until she is recertified,

she will be assigned to trail a doctor in our department

on a rotating basis.

She can consult on patients, take histories,

and discuss diagnoses with us,

but she cannot prescribe medications,

do procedures on her own,

or discuss course of action with patients' families.

So, how's this gonna work?

We walk into a patient's room, and explain... what...?

She's brain-damaged but

we're letting her audit their cases anyway?

Brain-damaged?

Department heads have discussed this with everyone.

Dr. Larsen was a patient here so she's protected by HIPAA.

Share information about her, lose your job.

We clear?

Well, at least we're not being put in a compromising position.

We promised you a path

and this is what the Board and our legal department

feel comfortable with.

So I-I'm basically a med student now?

It would be malpractice, on everyone's part,

if we were to allow you full privileges

without assessing you for a few months.

To make sure there are no other effects from your brain injury.

And to give you time to pass the Boards.

I am retaking the Boards?

None of this would even be happening, and happening this fast,

if it weren't for your brilliant track record.

Right. I...

I guess I'm just having a hard time

wrapping my head around the details.

We're really sorry about that. The Board called a meeting last night

and some of this wasn't even finalized until this morning.

Tell me they're not just setting up

as many roadblocks as possible, hoping that I fail.

It's not you against the world, Amy.

Let's not go down that path again.

I understand.

And I'm grateful.

And I will do everything I can

not to make you look bad for fighting for me.

You don't need to worry about us.

I will take my leave then.

Wish me bon voyage.

You got this.

The theory is

the more time she spends in the environment where she lost her memories,

the better chance she has of recovering them.

And if she remembers, then what?

I thought the autopsy cleared you.

The pathologist didn't catch the problem

because she didn't have the whole context.

But if Dr. Larsen ever remembers...

She must already have access to her emails?

I can only assume.

It's been almost four weeks since her accident.

So if there was an alarming exchange

between her and the pathologist, you would've heard something.

This is like the sword of Damocles hanging over me.

Then make sure she fails.

First day back.

Yeah.

Kinda strange.

I understand Michael and Gina

have gone over the protocols with you.

They have and um, yeah, I'm ready to dive in.

Great.

So, these are for you for now.

A nurse's assistant will have some more for you

at the end of the day.

Right.

And where would you like me to go, Coach?

You'll be trailing Sonya today.

Perfect.

Look, I know that this is a strange situation for everyone.

And easier to support someone

when you actually believe it's the right thing to do,

so... thank you.

When you finish up today,

you've got some personal effects here.

Oh!

Uh, well, these will come in handy with the scrubs.

Uh, yeah, I'll come back at the end of the day

and get those out of your hair.

Hi.

I'm... uh, well, you know who I am.

And you're Liz, right?

- Yes. - Great.

Um, I'm looking for Dr. Maitra.

Why is that?

Hey, um, yeah,

Richard said she'd be overseeing me today.

I think that must have been a misunderstanding.

Happy to pinball, just don't tilt the machine.

Yeah, ah... Dr. Coleman... he's got more time for you today.

He's admitting Evan Reilly. Room 626.

Okay. Off I go then.

Hi, I'm Amy.

Amy Larsen. I'm... I'll be working

with Dr. Coleman.

Nice to meet you.

Evan's been suffering from abdominal pain.

He's been dizzy, light-headed, anemic

and vomiting blood-tinged material.

Checked himself into the E.R. last night

He drove himself here.

Which I'm not happy about.

I was already downtown. It was five minutes.

- You were coming from work? - Yeah, I work in Sales.

Over on Phillips.

Would've taken longer to call an ambulance.

And I told you, this is my acid reflux acting up.

I forgot to take my meds the last few days.

And when did your abdominal pain start?

Yesterday afternoon.

How long have you had those red marks?

I don't know, I didn't even see them.

I've been using a new soap the last week or so.

Lean forward, please.

Breathe deeply.

You know, I got a really important meeting this afternoon,

so whatever tests you're gonna be doing,

if I could just call in later for the results...

I think you're not understanding:

you've been admitted because we can't discharge you with your symptoms.

Well, uh, I'm not gonna let you miss the play.

Oh. Uh, I'm a third-grade teacher;

we're doing "Annie." I'm not going anywhere.

I-I already called the school.

Hello?

Right, so when can I expect those clotting panels?

Be right back.

We need to get the wife out of here.

Why?

Because to diagnose him, we need the truth

and every word out of his mouth is a lie.

The most common cause of cardiac syncope?

- Arrhythmia? - Right, and...

This must be Valerie Henderson?

Ah, yes. Uh, 62-year-old female,

um, two weeks of increasing fatigue and shortness of breath.

Syncopal episode last night, she fainted, broke her leg.

Morphine for pain, which is why she's so out of it.

Dr. Coleman, since you almost killed a patient

with similar cardiac issues yesterday,

maybe you want to step in here?

And?

Tachycardia. And a decreased S1 heart sound.

But no pericardial knock?

Um, I believe there may be...

It's a knock. It's loud.

Yes, I hear that now.

Which, in the presence of pulsus paradoxus makes you think...?

- A valve issue? - Wrong.

And did I ask you, Dr. Wilson?

Come on, Dr. Coleman.

A pericardial knock, friction rubbing, JVD?

Effusive constrictive pericarditis.

And since increased pericardial thickness

can be missed on an echo,

- how will we confirm? - You're gonna have to float a swan.

No. You're gonna have to float a swan.

And you better not let him screw it up.

So are you okay with that plan?

I don't want to overstep.

Yes, absolutely.

What?

Never saw you deferring to anyone before.

Well, fresh start. New rules.

That sounds like a tag line from a really bad sitcom.

Shall we do this?

You go first.

It's gonna take at least

four to six hours to get the test results back

so if, um... you wanna go and do your play...

Yes, please. Just go.

He's stable and in good hands.

We'll call you as soon as we get results.

- As soon as you know anything. - Of course.

Okay.

- I love you. - I love you too.

We need you to tell us what's really going on.

What do you mean?

You must know vomiting up blood doesn't happen because of acid reflux.

No, I actually didn't.

How many drinks do you have a week?

Ah, none.

Because those red marks indicate liver disease

usually caused by alcoholic hepatitis or cirrhosis.

Well, I'm a recovering alcoholic.

I haven't had a drink in six years, seven months,

and two days. So, that's not your answer.

Are these the clothes you were wearing yesterday?

At your office downtown?

I don't see what that has to do with anything.

You couldn't have been wearing these at your sales job.

Actually, I was!

And I don't get really get what's with the third degree here.

Look, you don't want your wife to know,

and we're not here to judge.

But it is much harder to treat you

when you keep things from us.

And whatever you tell us

is covered by doctor-patient confidentiality

I'm not lying.

I told you my symptoms,

now you got these fancy machines,

so why don't you just figure out what's wrong with me

so I can get out of here.

Will you stop with that?

You can't button this one.

It doesn't need to be buttoned.

Now would you keep your hands to yourself

and take your own pills! Like a candy store over there.

It's a wonder she's not the one in this bed.

So, 59 years, is it?

- Uh-huh. - Married 59.

Together 61 and a half.

Wow. Love the "and a half."

Mm-hmm. She still think we're teenagers.

Just tell me when I can take him out of this God-forsaken place.

You know she's gonna have to get rid of all her boyfriends...

...when I come home.

So, your bloodwork shows your kidneys, they are improving

but your red blood cell count's starting to drop so we just...

Oh, no. No, no, I'm not staying.

My stomach can't take one more meal in this place!

Are you having stomach pains now?

Of course. Of course.

You see that sad excuse for a piece of chicken?

He's always been sensitive to hospital food.

I'm sure it's nothing.

We just need to run a few more tests.

- It'll only be one more night. - It'll be okay.

I promise.

LFT's are through the roof.

But no alcohol on his tox screen.

Mm.

The liver failure's from chronic drinking.

He probably cut himself off a couple days ago

when he started feeling bad.

Just gonna be another minute here.

Apparently, Darrin is one of the few people

that liked the Old Me.

Well, at least that's what he's claiming now.

Ah, come on.

No, it's a very small but exclusive club.

- Right, Darrin? - No comment, Dr. Larsen.

Oh, you can't call me that anymore.

- Not yet. - I'm not gonna call you Amy.

Me neither.

Well, somebody's gonna have to figure out something to...

What's going on there?

I can't remember my old email password.

And this thing gives me five chances a day

and then it locks me out. And I'm starting to go a little batty.

Okay, here we go.

Okay.

What do we see?

Moderate hepatomegaly, definitely an acute hepatitis.

Impressive.

Enlarged liver could mean an infection.

Yeah, but AST's are elevated.

I just don't see much cirrhosis.

Yeah, but you see the heterogeneous echogenicity?

- Mm-hmm. - And the enlarged veins.

Lower right lobe.

Ultrasounds are quick and dirty.

We need an MRI to get more detail.

Why not just do a biopsy?

It's pretty invasive.

And risky given his platelets and clotting numbers.

I'll explain it to him.

I'd wait.

Let me tell you why.

Usually, you got one of the orderlies walking me down the hall.

Am I supposed to be worried?

It's just 'cause we love you, Dante.

You better watch yourself, young lady.

Watch herself?

She got Dr. Heller for that.

Oh, my God, come on!

Those two are as thick as thieves, aren't they, Rubes?

Yeah, but I sensed a little chill in the air this morning.

Little hanky-panky gone sideways?

I think you missed some of your pills today, Ruby.

Uh-huh.

Dante's getting a CT abdomen and FIT test.

I don't think it's a G.I. bleed.

- Extra-luminal? - Yeah, that's my hunch.

How's it going with Amy?

Ah, I have no idea. What do you mean?

She was supposed to be trailing you.

Um, that's news to me.

Maybe we should have the room.

Well, at least it's not already becoming a thing.

Chief Resident is customarily in charge of Intern assignments.

Which is your excuse for reversing my personnel decision.

I just wasn't sure why you'd pair 'em

when you knew there'd be conflict.

So you decided that handing her to

the lowest person on the food chain was the better call.

Everybody understands the protocols.

And Dr. Maitra is the one most inclined to follow them.

Which is why I wanted it that way.

I really hope that's true.

Otherwise, people might start to think

that you're going out of your way to make things more difficult for her.

Too fast.

You're not watching the EKG tracing.

Just... just stay calm, TJ.

- Don't force it. - I'm not.

But if you hit the inner wall again...

I'll cause an ectopy, I know.

- Do you want to take over? - No. He's got it.

Just go slowly, TJ.

You want to be gentle but firm.

Okay, catheter's in place. Well done, Dr. Coleman.

Absolutely.

Always better not to put the patient into arrhythmia.

I added a fourth year so I could oversee other residents.

It's kind of an honor. And I like teaching, so...

I told you he was one of the smartest.

Well, I don't know about that but I had some great teachers,

so, you know, it feels good to give back.

I was waiting for Dr. Maitra.

We have some news.

We know why you've been losing blood.

You have what's called a contained leaking abdominal aortic aneurysm.

"Contained" means you can fix it, right?

You're not a candidate for the stent, but there's a surgery.

Problem is, the risk that you don't survive it,

given your age and co-morbid conditions, is high.

I know what you're thinking.

I've had four surgeries in the past five years.

I'm not letting you give up. You hear me?

You can't leave me yet.

We don't have a choice.

Can I have a day...

to call our kids and grandkids?

And get some things in order?

Of course.

Thank you for doing this for me.

And how's it going with Dr. Larsen?

Good. Fine.

The patient's been a bit non-compliant,

so we're waiting on the MRI before we confront him

with all the evidence.

Explain that to me.

The liver failure's caused by chronic alcohol abuse.

We can treat it symptomatically

and get him well enough to go home,

but if he doesn't get himself into a treatment facility,

he'll end up back here in a month in even worse condition.

But you don't even know that this is alcohol-related.

Especially without evidence of cirrhosis.

Paging Dr. Coleman to Nurse Station Three.

Paging Dr. Coleman to Nurse Station Three.

Stat!

Dr. Coleman, it's Evan Reilly.

I tried to stop him from leaving

- He left?! When?! - Two minutes ago.

- I paged you right away. - Give me his number.

Mr. Reilly, it's Dr. Coleman.

You have acute liver failure.

It is very dangerous for you to not be in a hospital.

Come back or call us immediately!

When you have a patient who may be non-compliant,

you scare them the minute you have tangible information.

You don't hoard it,

looking to break them like you're on some cop show.

Now, I warned you about being overly influenced by her,

and this is precisely why.

Why don't you fill me in?

We have a patient with acute liver failure

who was not told their condition

and then left the hospital unaware of the danger they're in.

Amy advised Dr. Coleman to forgo a biopsy...

That was a judgment call.

...in favor of an MRI

because it suited her preconceived idea

that his condition was alcohol-related.

The MRI, as it turns out,

indicates some fibrosis but no end-stage cirrhosis.

And what's worse,

she and Dr. Coleman pushed the patient's wife to leave the hospital

so that they could cross-examine him without her present.

And, of course, if she'd been here,

she never would have let her husband leave.

So she was wrong in her diagnosis,

reckless in her approach with the patient,

and violated the protocols we laid out this morning.

Is that accurate?

It's obviously not

how I was thinking about any of it when we made our decisions...

but, uh, yes.

Yes.

And next time maybe don't second-guess my decisions.

Watch behind you!

- Coming through! - Excuse me!

They found him behind the dumpster in the parking lot.

He must have gone to take a leak, then fainted.

I'm sorry, TJ, I knew he was being resistant, but...

It is what it is. I should have been stronger.

Check his blood for LFT and ammonia, stat.

Turn up his oxygen and prep him for transfer.

I need all hands on deck.

Let me guess.

You want to discuss TJ?

Uh, no, I want to discuss our training methodology.

Oh?

We're not gonna get 'em where they need to be

with a drill-sergeant mentality.

You turned out just fine.

Not everyone responds to that type of pressure.

Well, they're gonna have to learn how.

And, believe me, TJ, he can take it.

I'm not worried about TJ.

But Bradley Wilson did quit today.

- He quit? - Mm-hmm.

From being exposed to my tyranny?

The term he used was "triggered."

We are not gonna get snowflakes

to turn into shards of hail, so just hire another intern.

Yeah, no, that's fine and I will.

But... you did make me Chief Resident for a reason.

The interns are my responsibility, so...

I need to ask you to give me a little bit of space.

Are you telling me to back off my own department?

I am. Yes.

Now I'm feeling triggered.

How is he?

He's hypoxic and in multi-organ failure.

And you still don't know why.

We're awaiting biopsy results, running every panel.

We don't figure this out, he's got what?

24 to 48 hours to live?

I know everyone thinks that I was acting like the Old Me.

Hubris and... and marking my territory.

But I wouldn't be that brazen, Michael.

Not on Day One.

We didn't have much of a choice but to go all-in on the steroids.

But if we're wrong, it's going to make him worse.

Let's just hope the biopsy gives us something.

It's late; everyone's fried.

I think it's better if you head home.

For good?

Nobody said that.

But you haven't made it any easier for yourself.

I have Amy Larsen on line two for you.

Yes?

Richard, I'm looking at the biopsy.

Do you see the increased mitotic activity,

plus the regenerative changes from injury?

Staring at all of that right now.

I think it could be an environmental exposure.

We tested for every known toxin, medication, virus.

- Blood cultures are negative. - Did you do bronch cultures?

Of course we did. Also negative.

And white blood count's stabilizing, no severe fevers

so we're not even sure it's an infection at this point.

I could be wrong, of course.

But if he regains consciousness,

somebody needs to talk to him and find out where he was last night.

Besides doing shots at Hooters?

He came in wearing jeans and work boots.

If it was an environmental exposure, that could be the answer.

So, please will you just try?

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112 minutes in the HOV lane at 5 AM

is not my idea of a good time, my dear.

I know, I know. I owe you one.

One?

Uh, 81.

That sound more accurate?

Absolutely.

What can I do for you ladies?

Evan started working here 'bout six weeks ago.

Said he was willing to do anything.

Even offered to take less than we were offering on that jobs website.

He came in extra early, um,

worked nights, weekends sometimes.

Doing what exactly?

Painting, any kind of maintenance,

cleaned the restrooms - Anything around chemicals?

Not unless you include turpentine for the paint

and cleaning products for the bathrooms.

Could I see where the waste gets disposed of?

That's a sewer system. There's nothing above ground.

Look, Frank, I'm not trying to get you in trouble.

I just want to help Evan and he is really sick right now.

I've told you everything.

What are those traps for? Mice or rats?

I wish mice.

Did you have Evan handling dead rats?

He charged me double but it was still less than the exterminator.

What's that got to do with anything?

We just put him on a ventilator.

Listen, you need to stop the steroids now!

It's leptospirosis.

He needs acetylcysteine and penicillin,

1.5 million units every six hours.

I'm on it.

You know, conjugal visits are strictly prohibited.

Dr. Maitra made an exception for us.

Didn't she, darling?

Sweetheart?

Ruby?

Ruby!

- Code Blue! - What's happening to her?

- I'm here. - Code Blue!

She's in cardiac arrest. We need to get him out of the bed.

Got it. Sir, we're gonna get you out of the bed

so we can help your wife, all right?

- Starting compressions. - Did she die?

Move over, please. We're gonna help your wife.

- Leads! - Ruby?

Sweetheart. Come on, Ruby.

Come on, darling.

Have someone ready to sub in for compressions.

Don't you go nowhere.

Still pulseless.

Asystole. Take over compressions.

Get an airway, start bagging.

Two minutes of compressions then we'll check rhythm.

Hey. Give a milligram of epi.

- Got it. - Ruby!

Don't you, Ruby. Don't you go.

I mean, we only came to Minneapolis for this new job of his.

We bought a house we couldn't quite afford.

And then he gets laid off

and he's more worried about the mortgage

than being honest with his wife.

'Cause he's so afraid that I'm gonna judge him and blame him.

And then he's vomiting up blood

and running out of the hospital to go to some damn job interview.

'Cause he... he thinks if he has a job,

then he can come home to me.

Come on, Hayley, don't do this to yourself.

No, it's true.

'Cause when we couldn't have a kid...

I resented him that we waited so long to try.

Instead of...

And now here we are,

and I just want another chance, you know? I just...

What's happening?! What's going on?!

What's happening? What's wrong?

What's happening?!

- It's okay. - Tell me what's happening!

Hey! Hey, it's a good thing.

It means he's trying to breathe on his own.

- Is he okay? - He just turned a corner.

- The medicine is working. - Oh, my God.

There we go. Breathe easy, Mr. Reilly.

- You're gonna be okay. - Thank you, thank you!

Oh, my God! Thank you!

You're pretty smooth with that intubation tube.

You should see me float a swan.

Oh, I didn't think you were on call tonight.

I swapped with Dr. Park.

Isn't it the first night of Passover?

Yeah. Shared-custody gods smiled on my ex-wife this year

and being home, it just makes it worse, so...

I didn't realize you'd split up.

I don't mention it too much.

Kind of makes me feel like a failure so...

My daughter can't even stand to be

in the same room with me right now, so...

Oh, so that's why you're here?

Uh, yeah.

And I wanted to make sure

Valerie Henderson came through surgery okay.

Yeah, I heard she's already out of... okay, come on.

Don't tell me that's your dinner.

- What? - A chocolate bar?

Where's that fall on the food pyramid?

Okay, why? What have you got?

Matzah and charoset.

- Charoset? - Mm-hmm.

Honey, apples, walnuts, little bit of kosher wine.

Here, try it.

It's not bad.

- Mm-hmm. - Yeah?

Here try it with a little bit of this.

Horseradish. Mm?

When life is sweet,

you remember that there's bitterness for others.

When life is bitter,

you're reminded that there's still sweetness underneath.

Gotta love a food metaphor.

You do know it totally defeats the purpose of having a password

if you post it where anyone can see it?

It's hard to remember the capital letters.

MOOcow2009?

It was my son's favorite stuffed animal.

Plus his birth year.

Okay, then I... kinda makes me a huge ass right now.

No.

No, you're actually very kind.

We have surgery scheduled with the vascular team for you.

I'm not doin' it, Dr. Heller.

There's just no point now.

Not with Ruby gone.

You sure?

You have a little bit of time to think about it.

Mm.

I've lived a full life.

And that's all anybody can ask for.

Yeah, I'm ready to meet her on the other side.

I heard about Ruby.

Yeah.

And now Dante doesn't want the surgery.

Oh. Well...

they had a great run.

Not everyone gets that.

The Reagans.

Newman and Woodward.

I thought it was Woodward and Bernstein.

Paul Newman? Joanne Woodward?

Oh, the guy with the tomato sauce.

Yeah, the guy with the tomato sauce.

I'm sorry, Jake.

And I'm sorry I haven't been a better friend.

I gotta say,

that was pretty extraordinary

for you to drive all the way out to that warehouse.

I don't think I've ever heard of a doctor doing that.

I just figured I'd try to make myself useful.

And thank you for even considering what I had to say.

Well, you have overwhelming support from Michael,

and your neuropsychiatrist is a very loyal friend,

so everyone understands we have to make accommodations.

Listen, Richard,

it's hard for me to answer for whatever it is I did to you

when I can't remember it,

but let me just say that we used to be friends,

so I am very, very sorry.

And I have absolutely no desire to become Chief again.

I appreciate the sentiment.

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_

Hey.

Why are you still here?

Trying to get into my old emails.

I thought, you know, eight years of information

might trigger some memories.

Or give me some insight at least.

Yeah, seems like a safe bet.

- You know the password? - Nope.

Try MOOcow2009.

"Moo" is capitalized.

Shut up.

You know, you weren't very careful

about keeping it a secret.

It was my son's favorite stuffed animal.

Plus his birth year.

That I didn't know.

Uh, yeah, I'm locked out for the rest of the day,

but I will definitely give it a try tomorrow.

Thank you.

Yeah.

Have a good night.

So, just like riding a bike?

Oh, yeah. Piece of cake.

Except for your Nancy Drew moment out at the warehouse.

Well, I did crack the case.

Hm, I'm gonna chalk it up to rookie enthusiasm.

As opposed to a deeply concerning episode of impulsivity

by a TBI patient who previously stormed into a board room

with a bandage on her head, demanding to go back to work?

Did you actually manage to say all that in a complete sentence?

Guess the brain's working just fine.

Oh, and now I get into my email.

You figured out your password?

Jake knew it. Somehow.