Original subtitles

You have an epidural hematoma.

Do you know whose head you drilled into?

I know who Doctor Bishop is.

We have met before, of course.

I interviewed you for a job, but then didn't hire you.

I think we need to do it again.

Have you eaten anything?!

I can't find my math book.

It's over by the window.

What if everything is different at the hospital?

Habibti, you're learning math in a whole new language.

I'll be fine.

I was waiting until I was a doctor again.

Sir, you need to get in line.

I'm not a patient, I'm...

We've got a trauma coming in!

Tim Stafford, 35 years old.

BP's 100 over 60. Pulse 150.

Page Atwater.

Construction site. Scaffolding collapse.

Fell 20 feet. Landed on a piece of rebar.

We cut it off at the scene.

Did he get anything for pain?

You can't be here.

If the rebar punctured his femoral artery,

- it could be potentially lethal. - Yeah. I know that.

- You got the hand? - Got it.

I got the leg. On three. One, two, three.

I need an X-ray plate.

You can't just show up here and volunteer as a doctor.

I'm not.

One, two, three.

One, two, three.

What the hell do you think you're doing?

His job. Did you page vascular?

They're on their way. OR needs five.

Sir, do you know where you are?

Please get that thing out of me!

Not here. First we have to stabilize you,

then we'll get you down to the OR.

100 mics fentanyl. IV push.

The rebar may have hit an important artery.

Believe me, you don't want it bleeding inside you.

Dr. Leblanc is going to tell us if it is.

- X-ray's up! - Femoral's great. Good pulses.

It's your lucky day, sir.

Not yet. He has a ruptured spleen.

I'll do a scan.

- He's right. - Good. And?

I'd do a splenectomy right now.

Maybe five years ago. Not now.

Dr. Curtis, tell him why.

Because it will be jump at the gun.

First we CT to find out what grade it is.

Dr. Leblanc? I can see you're dying to tell us

what happens pending that outcome?

ICU and monitor, after the rebar's out.

Get him to CT, stat!

There are thousands of pages of co-curricular reading

and you'll need to catch up.

And next time you come to work, get changed first

and find out where we actually want you to be.

You may remember Dr. Hamed from two weeks ago

when he drilled a hole in my head.

He's one of you now.

- Synced and corrected by martythecrazy - - www.addic7ed.com -

Welcome to the best Emerge in the country.

Triage nurses assign patients to acute,

intermediate or ambulatory.

Ambulatory's the busiest.

Big waits, small problems, but for them,

it's the worst day of their lives.

They get a headache, go online,

convince themselves they've got a tumour.

Acute's where the action is.

Traumas, MIs, GSWs,

stabbings, sepsis,

strokes, overdoses.

You were a trauma surgeon already, but that was in Syria.

In this teaching hospital, you'll start at the bottom.

Redo your residency,

learn our system from scratch.

- Questions so far? - No, sir.

I'm sure they'll have plenty for you.

Okay, see you soon.

Come on, then.

Did you know we are hiring him?

It's Dr. Bishop's prerogative.

But I want him shadowing you today.

And don't just do everything yourself, Mags.

I need to know what we're getting with this guy.

Dr. Wendy Atwater is your attending.

All the residents report to her, she reports to me.

It's not every day a patient from one week

becomes a doctor the next.

You'll get scrubs in the lounge,

an ID card's in your mailbox.

What happened in the trauma bay

is not how the rest of your day is going to go.

You're gonna stick with Dr. Leblanc, she's gonna teach you the rules.

Scripts, decisions, it all goes through her.

- Understood? - Mmm.

Maybe don't show him where we keep the power tools.

- Hi. - Who are you?

I mean, clearly you have experience and you did save Bishop's life.

This is us moving on.

Uh. Dr. Bishop...

As Chief, does he always oversee his patients like that?

Whenever he feels like it, yeah.

You're also an emergency resident?

Second year. The ruptured spleen.

How did you know without imaging?

From the way the patient was clenching his shoulder.

Right. You trained in war zones, I'm guessing.

Not a lot of equipment or resources.

Do you always just ask whatever's on your mind?

When I'm being asked to trust somebody with my patients? Yeah.

Practicing medicine in the dark, you learn to sharpen other skills.

Yeah, well here we always rely on imaging.

Oh. I'm sorry.

That one sticks.

Not everything we have here is state of the art.

Thanks.

- Theo Hunter. - Bashir Hamed.

Welcome aboard.

That looks like it has lived a life.

Was, uh...

Was that your family I saw you with?

Yeah. Saying goodbye for the week.

We live in Sudbury, I'm here doing my fellowship.

- Pediatric EM. - Uh. We have a patient waiting.

And those stitches should come out.

Mags here used to be a hall monitor.

And Theo here was almost a priest.

- Pastor! - A pastor.

It runs in the family.

I was on the bus.

They made me get off.

People don't like it when you throw up on the bus.

Um, my purse and phone.

I had them when I talked to that nurse.

- Did she put them somewhere? - We'll find them.

How long has this been going on?

Ms. Harper?

Irene?

The vomiting and the abdominal pain.

- When did it start? - Few days, I think.

Maybe this morning?

I didn't wanna miss my shift today.

I just... thought it was the flu.

But it's worse, right?

Put your hands out for me, Ms. Harper?

Okay, thank you.

My kid.

I'm supposed to pick her up from school later.

I need my phone so I can...

My husband doesn't know where I am.

It's okay, we'll take care of that.

Atwater wants me to let you weigh in first, so...

She's confused and disoriented.

Hypotensive and tachycardic. She's jaundiced.

I'd be concerned with liver injury.

Yeah, but those symptoms could also describe biliary colic?

But not the trembling hands.

The asterixis can mean acute liver failure.

We should do testing to confirm.

Given her level of consciousness,

I'd suggest an aggressive approach.

Intubation sooner rather than later.

She could go into multiple organ failure.

But you want to do testing first.

We need blood. CVC, LFT, all of it.

Okay.

Bashir Hamed?

- Uh, I'll catch up. - Okay.

Lavondra Kelly, HR. I have been looking for you.

- Human Resources? - Uh, yes.

Welcome to the team.

I'm still waiting for your transcripts.

Excuse me?

Your medical school transcripts from...

the University of Aleppo?

I... I sent the PDF.

I know. Didn't somebody follow up with you on that?

Legal still needs certified original copies of those transcripts.

Without them we won't be able to verify your credentials.

If I needed some time to coordinate that?

Last year the Infectious Disease unit brought in a Somali candidate.

A doctor who pioneered a leading approach to malaria in his country.

He couldn't get his documents in order either,

and now he does data entry at a university lab.

I see. So...

- The transcripts... - The originals.

Are essential.

If you want to work as a doctor, they are.

So, how long have you had this pain?

Two days. But it's getting worse every hour.

Any other symptoms I should know about? Fever, vomiting?

Does dry heaving count?

Have you ever experienced these symptoms before, Ms. Bennet?

Cassie.

I have endometriosis.

But this is way worse than normal.

Have you spoken to your OBGYN about these new symptoms?

Yes, I have,

and they can't see me until next week.

But last time I saw her, she just told me to get pregnant.

At least then, I'd have nine months of relief.

Right. Well, I heard that comes with its own side of side effects.

Look, the adhesions for endometriosis can cause severe pain.

Unfortunately, it's a chronic issue

and there's really not too much we can do for a flare-up

- here in the emergency department. - I know, I know.

Look, and I know what you're thinking, okay?

Woman with endo comes in suffering from a flare-up,

is afraid it's something worse, and it never is

and there's nothing you can do for her.

Look, I've been through this more times than I can count.

Alright? I've been told to go home,

and take pain meds, and sleep it off,

and I have done all that.

And I...

Are you here by yourself?

My boyfriend's out of town.

Look, you're just gonna have to trust me on this. Okay?

I know my body, and this pain is different.

Irene Harper, INR's 2.1, bili elevated.

Her liver's failing. You know the procedure?

Screen for hepatitis and acetaminophen.

- LOC? - Signs of hepatic encephalopathy.

Her O2 sats are borderline.

If she's unconscious, you need to intubate.

She could go into multiple organ failure.

We need to pre-oxygenate

then give her a hundred ketamine and a hundred succs.

- She's apneic. - Laryngoscope.

Endotracheal tube.

I can't visualize her cords.

- Airway edema? - No. Cords are anterior.

Let's back off and bag her for a second.

I should call Respiratory Therapy.

Do you have light wands in here?

Um, bottom shelf I think, yeah, why?

With the lighted stylet, you'll be able to guide it through the tube.

No, I don't have a view.

You will now.

When you said working in the dark, you meant literally?

Occasionally. Do you need suction?

No.

Could you just...

Okay.

Did you ever think all that would lead you here?

What led you here?

Everything okay?

Yeah. Tough airway. Just got it.

We don't intubate with light wands anymore.

I proposed it.

Next time, call RT.

Now let's figure out what's causing her liver to fail.

The bruising speaks to rapid deterioration.

She wanted her family. Do you know if they've been contacted?

No.

Update her chart, then see if the social worker did that.

I'm gonna run down the rest of her labs.

55-year-old man with adenocarcinoma of the pancreas.

He had radiation to reduce the tumour load.

He wants a Whipple? We'll have to see.

What's your story, Dr. Curtis? Quickly.

Emergency walk-in.

I'd like to do a lab to isolate the cause of her pain.

Endometriosis. We both know we don't do

elective procedures for chronic problems.

- Yes, but... - She's likely having a flare-up.

I did a transvaginal ultrasound and...

Nothing's conclusive on it.

There have been cases where imaging has missed

ovarian torsion, even a ruptured cyst.

Her abdomen's distended, she's in extreme pain,

and I'm concerned it could be more than endometriosis...

Are you?

Or are you fishing for OR time.

You know I want the operative time.

But that doesn't mean my patient is wrong

about her pain being acute.

Dr. Curtis...

Endo's tricky.

Women can feel one thing one day,

and something completely different the next.

The pathophysiology of uterine nerves...

They're complex.

And often don't correspond to what's happening internally.

And every time we go in there,

we run the risk of doing more harm than good.

Surgical intervention is not an option

in the absence of extremely clear evidence,

which you simply do not have here.

She should follow up with her OBGYN.

Send them the ultrasound.

Otherwise, give her Toradol and send her home to rest.

64-year-old female, arteriogram.

Aneurism at four centimeters.

Let's keep her under observation.

- It's okay, we're just gonna ask... - You can't do this again!

Mr. Harper, calm down. Layla...

- Don't you touch her! - Daddy!

Layla, the nurse just wants to ask you some questions.

I told you before to leave her alone!

- You have no right to do this! - Actually, I do!

And for your daughter's sake, why don't we calm down?

You tell me that my wife is sick,

and you take one look at me and decide what?

- That I am a threat to my family? - That's not what's happening, here!

You don't know me!

Is this Irene Harper's family?

I'm Dr. Hamed. She's my patient.

You're Irene's doctor?

Please tell me you can explain what is wrong with her.

He will. But first, I need to talk to your daughter

- and make sure that she's okay. - Daddy, I wanna stay with you!

Baby, it's okay.

Is everything okay here, sir?

Yeah, we're okay, alright?

- We're okay. - Lou, gimme a sec? Doctor.

Vivian Barnes, staff social worker.

Can you talk to me about the bruising on Irene?

I need to know what we're dealing with, here.

You wrote suspicious bruising on her chart. Why?

You think that the bruising was caused by her husband?

You don't?

Well, if she's suffering from liver failure,

possible kidney failure, either could cause bruising.

This family has a flag.

A history with Children's Aid Society.

There was an incident two years ago.

Layla fell down the stairs,

and CAS intervened for her protection.

I meant medically undetermined. Not intentional...

You wrote suspicious, so I have to investigate.

It's protocol.

And the father's behaviour isn't helping the situation.

- People act out when they get scared. - I know.

But Layla's safety is my priority.

I'll interview her, and we'll go from there.

What will happen to her?

If we have reason to believe that he's abusive,

- we can remove her. - Wait, no, I can change the wording!

It's too late for that now.

Layla, it's time to go, okay?

It's okay, baby girl, I'll see you soon.

I promise.

Ms. Bennett.

You're sending me home.

Uh, well your imaging didn't, uh...

didn't warrant further action.

But we will forward it to your OBGYN for a follow up.

In the meantime, I did...

I did give you some anti-inflammatories for the pain.

- So, if it gets any worse... - What, come back?

It's already worse.

Please, please don't be like the rest of them.

Don't do this.

You can take your time getting dressed.

How's my wife? How's Irene?

Well, she doesn't have hepatitis,

which means the differential is wider than we thought.

We're keeping her stable,

but we need to know if she's been exposed to any toxins

- which could be affecting her liver. - Does she drink?

- No more than anyone. - Any drug use?

You think she's on drugs? No!

What about something she ate?

She ate what we always eat.

Chicken... Salad, I don't know. Okay?

Irene takes care of herself. Of all of us.

Okay? No fast food, no junk.

What about her workplace. Is she employed?

Yes, she's employed. Okay? She cuts hair.

Hair dyes, chemicals?

- If we can narrow down the tox screen... - Can you help her?

First we need to determine why your wife is sick.

And I can't get my kid back until I prove that I didn't hurt Irene.

Because I didn't, and I never would.

Or Layla.

That fall two years ago was an accident.

Sir, the social worker is just following protocol here.

The last time this happened,

she thought she was going to lose us.

Then they kept coming back,

until they finally decide to leave us alone.

But Layla wouldn't sleep in her own bed for months.

And now it's happening again.

It wasn't my intention to suggest abuse.

I heard you.

Suspicious bruising, that's what you said.

So I'm losing my family because you don't know how to speak English?

Couldn't be worse than my last ones.

Saleh, Salaam alaikum.

W'alaikum Al-salaam, Bashir.

The many airstrikes targeted

homes hospitals and market

shattering the daily lives of the local population.

Hundreds of thousands of people fled north

to the overflowing Turkish border.

What started as a peaceful protest

against the Assad regime in the spring of 2011

has turned into one of the bloodiest...

Bash.

- Have you eaten? - No.

If there's any advice I can give you

about making it through your day here

is always remember to eat.

Come on!

Yeah, I gotta ask. That drill.

Was that standard operating procedure for you?

You should see what I can do with a hammer.

So were you already in medicine

- before the war broke out? - I was doing my residency.

My first residency.

- Mmm. Come here with family? - My sister. She's 12.

How's she handling everything?

She's adjusting.

You said your family lives in a different city?

Sudbury. Much smaller town.

We didn't want to displace the girls.

My father-in-law has a family practice

waiting for me when I'm done. So...

You must miss them.

Terribly.

I try not to let myself think that my absence

will be permanently scarring.

I, uh...

I have a patient who has a child here today, and, uh...

- This social worker intervened... - Layla Harper?

Yeah, Viv asked me to examine her.

No signs of physical abuse.

But her family's still being separated? Why?

It's hard to overcome a history like theirs.

Even if it's not true?

The father said he was cleared of all wrong-doing.

Yeah. Doesn't seem fair, but...

he'll always be seen with suspicion first.

Oh!

So much for my own advice! Gotta go!

My wife. Have you seen her?

I've been here six hours!

Unfortunately, your wife's condition hasn't changed but...

What I said to you before. I'm not racist.

That's not who I am. I'm just... just scared.

I know.

Mr. Harper, are you feeling okay? Do you need to sit down?

No, no, I'm fine, I'm fine. Listen.

When can I see my daughter?

Sir? Can you hear me?

Arnold!

What happened?

I got two blocks away and threw up.

You told me to come back if it got worse.

They just...

They just gave me the bucket and told me to wait here.

I was trying to make it to the bathroom, but I-I couldn't.

Come on.

I need someone to fight for me.

Just, uh...

Okay.

- You okay? - Yeah.

Alright. Let's go.

Doctor Singh?

Doctor Singh.

The endometriosis patient I brought you earlier...

I thought we sent her home.

We did, and she's back. In agony.

She's vomiting, she's hemorrhaging

which we both know are signs of a ruptured cyst

and not just chronic endo pain.

She needs surgery now.

Book an OR. Stat.

And I wanna stay on and see this patient through.

It's your call.

If it is ruptured, it's good we caught it when we did.

He was starting to look jaundiced,

and losing consciousness, like his wife.

And his airway is compromised.

We should resuscitate and intubate.

- 100 ketamine, 100 succs. - Heart rate's 110, BP's crashing.

I need two large bore IVs. Let's get this patient 2 liters of NS

stats, CPC, chem, coags, LFTs,

and cross-match four units red cells.

IVC's flat. He's hypovolemic but no signs of free fluid.

Hematemesis.

If he has genetic varices,

elevated INR will cause this kind of sudden bleeding.

Which would mean his liver's also failing?

And whatever caused Irene's problem is affecting them both.

Get Dr. Hunter to check on the daughter.

- On it. - Where is Atwater.

She's with a patient on six.

- I need a Blakemore kit. - What?

This man will bleed to death if we don't get a Blakemore now!

Okay. Got it.

We can't put in a Blakemore without an attending.

- Atwater's on her way. - His heart rate is through the roof!

Blakemores are incredibly risky, we don't use them except...

As a last resort?

And if we don't do something now this man is going to die.

- Have you ever seen one work? - Yes.

And if this one's going to, we don't have another second to waste.

Four units, O-negative!

No pulse. He's in cardiac arrest.

I need a board. On three.

One, two, three.

One, two, three.

1 amp epi, keep giving packed cells.

When I inflate it in his stomach,

it should stop the bleeding.

Okay, he's been down for 25 seconds!

What the hell's happening here?

Massive hematemesis and hemorrhagic shock.

He just lost his pulse.

- You sanctioned this? - He wasn't protecting his airway

- so I put in the Blakemore. - Okay.

Packed cells through the Level one.

Pass me the OG tube, and get out of the way.

He needs the proximal balloon up as well.

Dr. Leblanc, you stay.

- One gram TXA. - 50 mics of octreotide.

Go!

Is Robbie alive?

He's hanging on by a thread in ICU.

Dr. Hunter checked the daughter,

took blood, her vitals look good.

I couldn't let her lose both her parents.

Yeah. You didn't build consensus. You just did whatever you wanted

and those decisions have consequences.

If I'd asked you permission,

you would have said it's against the rules.

If you want me to trust you, I need to know who you are first.

If you're here long enough for that to happen.

Layla?

Where is Vivian?

You wanted to see your mom.

Is that hers?

- I can put it somewhere safe. - I don't want it to get lost.

Good idea.

Do you want to put a bandage on me?

I know I could use one, too.

You should still be at home, resting.

Relax. I've been cleared for work.

Mm.

There's only a bit nausea.

Four milligrams will be plenty.

- I'm not a chemo patient, Claire. - Mm.

Something tells me you haven't even told your neurosurgeon

about your nausea.

Are you still getting those headaches?

Normal symptoms after my surgery.

Yeah?

What about questionable decision-making?

Come on, are you sure hiring this guy was the right move, Jed?

Ugh.

Hey.

How's your son handling all this?

He's fine.

Have you even told him about the accident?

Mm, well, managing your concern is enough.

You're welcome.

We need to keep Layla overnight and monitor.

Otherwise they'll send her alone to strangers.

Well she can't go home

because there's obviously some kind of exposure.

But she's not symptomatic, so it can't be airborne or water, but...

Could it be food?

The father says they eat healthy.

Produce has pesticides?

Maybe. Although Layla is not sick.

What are you thinking?

She picked off all the vegetables on her pizza.

So what did they eat that she didn't?

- Let's find out. - No, no, no you can't.

After what you did, they want you in the suture room

for the rest of your shift.

Dr. Leblanc.

Layla's all alone.

She's afraid of losing everything,

so if you push too hard she'll shut down.

Everybody calls me Mags.

Hey, Layla.

I'm Dr. Leblanc.

Layla's feeling pretty quiet right now.

I need help narrowing down what her parents might've eaten.

Layla?

Could you answer a few more questions

about your mom and dad for Dr. Leblanc?

Can I colour with you?

I'll go get her some water.

That's a nice tree.

This hospital's really big and scary, huh?

Hm?

I want to go home.

I know.

When I was your age, I had to spend the night in the hospital too.

Lots of times, actually.

But you know what?

I found out hospitals are full of people that want to help.

So when I grew up, I...

I became one of the helpers.

And Layla there are maybe something that your parents like to eat

that you don't, and that's what's making them sick.

And if we can just find that one little thing,

maybe I could help them feel better.

Do you think you can help me do that?

Layla picked out vegetables with her father at a community garden.

Layla doesn't like mushrooms.

Her parents do.

It was a, uh...

It was a difficult surgery.

In addition to the extensive scarring from endometriosis,

you also had a...

hemorrhaging, ruptured cyst.

And...

as a result of the damage,

we had to remove one of your ovaries.

I lost an ovary?

Well, the good news is we got in in time to save the other one.

You...

You told us

that it was more serious all along,

and the system's just not good at dealing with chronic pain,

- so... - You don't know what it's like

to be dismissed and ignored.

Told what you feel isn't real.

Cassie, I just wanted you to hear someone say that you were right.

I know I was.

Didn't your shift end 20 minutes ago?

Yes. But I, um...

I was just...

Waiting for Bishop to tell you if you still work here?

He's gone.

Which means you get to spend all night dreaming up plan B.

Hmm.

This is my plan B.

You should go home.

How is it feeling? The arm?

- Much better, thanks to you. - Can you raise it?

Open.

Okay.

The sling can come off.

Favour your other side if you need to work.

I wish I could.

Not the kind of place willing to pay under the table.

Even for me, it's going to be difficult

getting them the papers they asked for.

- Which papers? - My university transcripts.

I have copies, they need the originals.

I got your sister a phone. Maybe I can get you these too.

Yeah, you mean forgeries, Khaled.

It would only prove who you already are.

No, there must be another way.

In case there isn't, I know a man who makes documents.

You say the word, I will ask him.

Amira!

Are you here?

How was your first day?

It was fine.

Baba used to let me listen to his heartbeat.

It always helped me fall asleep.

How was your first day, really?

I loved it.

Ah, you're supposed to find Bishop before changing.

Don't apologize, he hates that.

You wanted to see me, sir?

The Blakemore.

It better not have been the first time you pulled that move.

Dr. Leblanc thinks you saved that man's life.

You could just as easily have killed him.

Most emergent Blakemores end in the morgue.

I did say to find your place, here.

Dr. Bishop?

I've been asked to provide the original copies

of my medical school transcripts.

But I need you to know

my university might never release them.

But sir, I did earn my degree.

I am the doctor I told you I was.

Close the door on your way out.

We were able to confirm

that the toxin you and your wife ingested

came from wild mushrooms.

I picked those mushrooms.

This was all my fault.

Well, you're both responding to treatment well.

- It will take some time, but... - Maybe...

they were right to judge me.

No they weren't.

People can think what they want to think,

but you know who you are.

A man who loves his family.

Daddy!

Hey. There's my brave girl.

- Hey, baby. - Hi.

We're okay, now.

Mom's gonna be okay.

Can you believe it was the mushrooms?

You stayed with her all night?

Mushrooms, I know.

- I'm glad you're okay. - Your stitches should come out.

I love you guys. I love you guys so much.

Both my parents were doctors.

It was all I was ever going to be.

I lost them in the war.

And that's why I don't talk about it.

The scars will fade.

Dr. Hamed?

Detective Greggs.

I'm sorry to bother you at work.

- I know you have a lot on your plate. - Mm-hmm.

You were involved in a major vehicle incident a couple of weeks ago?

Mm-hmm.

I'd like to ask you a few questions about that.

Uh, but I already spoke to the police.

Uh, I'm here about your former colleague.

Khaled Abdullah.

Emergency personnel took his name,

but then lost track of him

when he fled the scene of the accident.

Do you know where he is?

Mr. Abdullah is wanted for an immigration violation.

I need to locate him, so...

if you see him, call me.

- Synced and corrected by martythecrazy - - www.addic7ed.com -