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Time to get up already?

Mm, for me. Early department meeting.

You should stay in bed a while longer.

So should you.

Mm.

How about I put a call in to Rosalia's,

breakfast burrito, latte for pickup.

20 minutes saved.

If I get back in that bed,

it's gonna be for more than 20 minutes.

Oh.

I can be late.

I told you to put on a jacket.

And I told you I'd be fine.

Are you fine?

No. I'm freezing.

It's San Jose.

"Winter" is a relative term.

Eh.

- Thanks. - Mm-hmm.

Weren't you wearing that yesterday?

I crashed at her place.

We were working on a research project and finished late,

and he slept on the couch.

Didn't you have a date?

I rescheduled it.

I gotta get inside and shower or I'll be late for my call.

See you.

- All right. - See ya.

- He's bread crumbing you. - Excuse me?

He's flirtatious, non-committal.

He's giving you just enough attention to keep you on the hook.

He's dropping crumbs. You'll never get the full slice.

We're just friends.

I'm fine with that.

Hm. Or maybe you're settling for whatever he'll give you.

When did the stomach pain begin?

A couple weeks ago.

I'm on my tenth day of Lupron, so it could be the side effects.

We're hoping for an embryo transfer at the end of the month.

Gotta take care of this mama.

Other than the pain, any other...

Emesis, fever, sweats.

Some tenderness and distension.

A scar on the right lower quadrant.

That's a first date souvenir.

Unofficial first date.

A McBurney's incision.

You had an open appendectomy.

She had a ruptured appendix.

I'm an RN.

Oh, it was a medical meet-cute.

I'm okay.

You are not.

There is an irregularly shaped mass

in the right-side pelvic region.

You need a CT, stat.

Can I help you?

Are you okay?

Um, I fell and hit my head.

Come here.

Possible head trauma.

Can you give me your name and date of birth?

Um, Toni Rhodes,

Aug... August 7, 1995.

Slowly reactive pupils.

Any drugs or alcohol use?

No. No.

Uh, yes.

I... I had a couple drinks last night.

How did I get here?

And we need a head CT to check for brain bleed or skull fractures.

Oh, my stomach is...

How did you get this?

Okay, her abdomen is rigid and distended.

Significant intraperitoneal hemorrhage

at left upper quadrant.

You're bleeding from your spleen.

We need to get you into surgery.

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

I reviewed your patient's ultrasound.

The appearance of that mixed-echogenic mass is unusual.

Yes.

- We... - Keep me posted.

Ooh, you went to Rosalia's?

The breakfast burrito with the spicy chorizo...

Try molten chorizo.

Totally worth the ulcer I'm probably getting.

Hard Stan.

I have never been to Rosalia's.

I recommend it.

Your images are ready, Dr. Murphy.

There is the mass.

There's a ton of free fluid surrounding the lesion.

Possible active bleeding and invasion into adjacent organs.

She needs surgery immediately for resection of the lesion.

How long have you had these?

My monster horns?

A few years.

But now they're making it hard for my glasses to stay on.

I keep them hidden with my hair.

You are beautiful, and you have nothing to hide.

But those glasses do need to stay put,

so I think we should remove these growths.

Without shaving my hair or leaving big scars?

Those are the only options other doctors have given me.

Those doctors don't know my technique.

I'll make a tiny incision here.

It minimizes scars, and it'll leave your hair intact.

- Okay. - Okay?

Put Gwendolyn on my schedule in the morning.

Thank you, Dr. Andrews.

Yes.

Toni's CT came back clean.

No fractures or intracranial bleeding,

so she's clear for surgery.

Hm.

We need to finish our research for tomorrow?

I'll spring for pizza.

Have you ever heard of bread crumbing?

Does it involve pigeons?

No.

It's when two people hang out a lot.

One wants to be more than friends,

and the other isn't clear.

Question is, what should the first person do...

be patient or move on?

Asking for a friend.

I'd say real personal connection can be rare, invaluable,

whether the context is romantic or platonic.

I'll see you inside.

There are tentacles of scar tissue

reaching into every organ.

Multiple abscesses and infection burden.

We will need several drains.

100 cc already. This infection is crazy.

So, things with you and Lim are still sorta awkward?

Dr. Lim and I have a professional relationship

centered on medicine.

The mass is adherent to the pelvic wall,

colon, bladder, uterus.

But you guys used to be closer. Do you miss that?

Cutting through more tissue.

Dr. Lim is Chief of Surgery,

I am an attending.

A medical focus is logical and productive.

We've reached the mass.

Cutting into the capsule.

Wait.

Oh, my God, is that...

A surgical towel.

Have my special ex lap tray ready.

Transfuse two units and stay two ahead.

Place a Foley catheter now.

Her hematocrit's in the toilet.

A fall shouldn't have caused this much damage.

She was high when she came in.

No telling what could've happened.

How about we hold that judgment till her tox results come back?

Placing arterial line now.

Sluggish pupils, memory loss, confusion... she's using.

Not judgment, just recognize certain behavior when I see it.

She's hemodynamically unstable. Debate later.

Right now, we need to stop this bleed.

Dr. Allen, why aren't you placing the catheter?

There's severe bruising and signs of major trauma

in her pelvic region.

I think she was raped.

We were able to save your spleen,

but you bled a lot during the surgery

for reasons we don't understand yet.

We need to run more tests.

When we were placing your catheter,

we discovered some bruising and signs of trauma

in your pelvic region.

We're worried you may have been sexually assaulted.

No, that's... just not possible.

Your urine testing also came back positive for Rohypnol.

It's often associated with date rape.

No, I-I...

I went out for drinks with my friend.

We were celebrating his new job.

I watched the bartender mix my drinks.

I was tipsy, but I wasn't drunk.

The bruises must be from when I tripped.

I would remember if what you're saying happened.

Rohypnol can cause short-term amnesia.

I'm sure this information is a shock.

We're here to support you.

The best way to gather evidence

as to what happened is to do a rape kit.

No, I... I don't need that.

I was with my friend.

He wouldn't let anything happen to me.

You don't have to decide right now.

Get some rest.

We'll let you know when your latest labs come back.

A retained surgical item?

It's a towel that was left in you after a procedure.

It is adherent to several vital organs.

We could not remove it without irreversibly damaging...

Left behind by who? My doctor?

Let's focus on getting it out first, and then we can...

Who performed my appendectomy?

Broder, I think. But...

The count of sponges and other items

inside the surgical cavity is done by the lead scrub nurse.

But you may discuss this later.

Okay. So who was the lead scrub nurse?

Gomez, maybe, or Kraus.

I really don't remember.

But you were definitely there.

Are you blaming this on me?

You were one of the nurses. I mean, shouldn't you have noticed?

I was circulating, not scrub.

No way I was the one who did this.

A minute ago you can't remember,

but now you're sure you didn't do it.

- Maybe we should move on to... - Why are you attacking me?

I just found out I have an infected towel in my gut

that will require major surgery,

and you're making this about you.

You're acting like this was my fault.

It doesn't matter whose fault it was.

We will approach the towel like a sarcoma...

perform an en bloc resection,

bypass any intertwined vital arterial structures,

and finish with a thorough debridement.

I think that's a reasonable option.

Well, right now, your opinion doesn't mean a lot.

I just need a minute.

I'll be out in the hall.

She's... not conscious.

She's syncopal.

She fainted?

- Naveen. - BP spiking.

- Oh, my God. - Heart rate's up.

Possible bleed or septic shock.

Crash airway tray!

An additional abscess cavity in the towel may have ruptured.

We need to get her back to the O.R.

- You wanted to see me? - Hey.

Yeah, I'm double booked tomorrow.

You'll be scrubbing in with Dr. Annanian for Gwendolyn's surgery.

But she was so impressed with you.

She's really excited to have you as her surgeon.

Well, it's a meeting I can't miss.

But Dr. Annanian has my surgical plan.

I'll check in afterwards.

The rupture caused widespread peritonitis.

This infection is way worse than before.

Aggressively irrigate, debride, and suction.

We need to control the infection.

Send tissue and fluid to the micro lab

so we can focus her antibiotics.

Big drop in BP.

Heart rate spiking.

She isn't tolerating surgery.

We need to close her again. Sutures.

Wait, what about the towel?

We can't operate until her BP and O2 sats are under control.

She'll need to remain sedated and intubated until she stabilizes.

And we need to find a new approach to removing the towel.

Once she's closed, I can dive into research.

I will consult with Dr. Lim.

I would like a surgical consult.

The Mukherjee case?

The mass on the CT was a retained surgical towel.

And is acutely infected and adherent to vital organs.

The patient blames her wife, who was a surgical nurse

during the appendectomy... circulating, not scrub.

If we could stick to the medical...

The patient didn't understand

the count was not her wife's responsibility.

They argued quite a...

The most pressing issue is the towel poisoning her from the inside.

What is your plan to remove it?

That...

is what I am here to discuss.

You are an attending, Dr. Murphy.

And your patient has a few hours

before she's stable enough for any procedure.

Research RSIs and brainstorm possible solutions with your team.

Then, if you still need a consult, my door is open.

How's Toni's platelet count?

Still dropping.

Did you do an anti-platelet antibody?

Waiting on results.

Order another PRBC transfusion to get her hematocrit up.

Any progress on the rape kit?

She doesn't want to talk about it.

I can't blame her.

It's an invasive process that only serves to prove

something horrible happened that she doesn't remember.

Her brain may not be able to remember, but her body does.

And chances are, eventually, it will all come back.

Shouldn't we respect her wishes?

I mean, we don't want her to feel like

she's being assaulted all over again.

Denying what happened doesn't change the fact that it happened.

It's Toni... Code Gray.

No, please, please, stop!

She woke up screaming, and she pulled out her IV.

Just stay away from me!

We just want to help you.

Toni, you're okay.

We're here with you.

It's not real.

Can you breathe with me?

You're okay.

You're not in danger anymore.

I...

had a nightmare.

Her gown.

I need to take a look at that.

Okay?

The spleen repair didn't work.

Over the course of your long career,

you have removed five retained sponges.

That is statistically higher than any surgeon in the region.

Special skill on my resume right under juggling.

My patient has a retained towel

that has caused sepsis with multi-organ involvement.

I would like a surgical consult.

Perfect request for your department head.

Dr. Lim said I should tackle the problem on my own.

Well, that's interesting.

She is right. I am an attending.

But your RSI experience would be very helpful on this case.

All right, I'll take a look.

Thank you.

Nurse Villanueva,

why is Gwen's surgery still on my schedule?

She panicked when I told her it'd be another surgeon.

- She really wants you. - Assure the patient

she's in great hands with Dr. Annanian,

and take her off my rotation.

No.

You told her you'd do the surgery.

You can tell her that you're not going to do it.

What about a minimally invasive surgery...

cutting up the towel, removing it piece by piece through a single port?

That won't work.

Where it's stitched to the organs,

the infected tissue puts her at high risk.

An aggressive gross total resection of all organs invaded

by the towel plus all infected and necrotic tissue

is the best option for long-term survival.

That procedure risks major bleeds,

and we'd have to remove her uterus.

They're planning a family, and Naveen is supposed to carry the baby.

That will also be impossible if she is dead.

That's elegantly put.

The wife of the patient is here, right?

Explain the options to her,

and see how she wants us to proceed.

They had an argument before her last surgery.

She will not be pleased with her wife making that decision.

Just go talk to her.

We figured out why you've been bleeding.

You have a condition known as ITP.

Your immune system is destroying your platelets.

Can you fix it?

There is medication that can help.

And we need to remove your spleen.

Why didn't you just do that during my earlier surgery?

We weren't aware of your ITP.

It's a condition that can be triggered by trauma.

The ITP complicates our approach.

Usually, we'd remove your spleen through your abdomen,

but that risks a catastrophic bleed.

We can remove your spleen vaginally with minimal incisions.

There's less risk of bleeding.

Okay, let's do it.

I'm hoping you'll let us do a rape kit before the procedure.

I already told you, no.

The transvaginal approach will destroy

all evidence of the sexual assault.

No.

I don't care.

Without the kit, you'll have no proof.

You're right.

I believe that something terrible happened to me.

But that is true whether or not I go chase down the boogeyman.

But it could help.

Nothing will help.

Don't let whoever did this to you get away with it.

He already has.

Doing a rape kit is not going to unrape me.

Go ahead with the surgery.

We need your decision.

Is there any way to do the total resection

without removing Naveen's uterus?

No.

She's dreamed of being pregnant her whole life.

I can't choose this for her.

You can.

We understand how difficult this is.

- She'll never forgive me. - She will.

I mean, it's obvious Naveen loves you.

She already blames me for what's happening.

If I'm the one that takes away her chance to carry a child...

You are right.

If you choose the gross resection

and your wife loses her uterus,

it is likely she will never forgive you.

But that is irrelevant.

This is your decision.

You have to make it.

Whatever happens next.

Do the total resection.

I haven't seen you around here for a while, huh?

Forgot how relationships can eat into discretionary time.

Doesn't exactly sound like a complaint.

It's not.

Shaun came to me with a surgical consult.

Your RSI record. Smart.

He did it because you sent him away.

Well, part of the Chief's job

is to empower their attendings to find their own solutions.

Sounds like Shaun did.

A lot of ways to empower an attending.

And I chose one.

Because you're still angry with Shaun?

- Okay. - How long are you gonna keep that up?

How about as long as I want?

Okay, you be as mad at Shaun for as long as you need to be.

Thanks for the permission.

Just so you know, it's toxic.

And not just for Shaun.

Spare me.

You're not concerned for anyone other than Shaun.

I have to get back to work.

Dr. Andrews.

I rescheduled my finance meeting.

But in the future,

I'm requesting a scrub nurse who respects my role

as surgeon and hospital president.

When I was in the hospital, you sat at my bedside.

You helped me recover when I wasn't sure I wanted to.

That meant a lot.

Personal attention with patients is important

even when you're president.

The laparoscopic splenectomy

is a great alternative to the transvaginal...

Toni's surgery is already scheduled for this evening.

And she asked that you be removed from her case.

She may regret not taking action on this for the rest of her life.

That's her decision, not yours.

I got your message, Shaun.

What's so urgent?

I have added you to Naveen's surgical team.

Please get ready to scrub in in 30 minutes.

You have a surgical plan in place, Shaun.

You're perfectly capable of executing that plan.

It is my responsibility as attending

to create the conditions most likely to result

- in a positive outcome. - Which you've done.

Which include the presence of a surgeon with RSI experience.

Shaun, you're... you've always been confident in... in the O.R.

What is this about?

Having a surgeon with relevant experience present

in case I need advice.

- Well, what if I'm busy? - You're not.

What exactly about this case is so concerning...

You have more RSI experience

than any surgeon in this hospital.

That is why I would like you in this surgery.

Please?

All right, fine. I'll be there.

Please get changed.

I can't reach the highest point from here.

Best way to hide the scars is to go in above her hair line.

We'll need to shave some of her hair.

Maybe not.

Someone get me a comb.

Moving on to the hysterectomy.

Please clamp the uterine horns.

Grasping round ligament, midway to the inter... internal inguinal...

Infection of the muscular layer

of the uterine wall has reduced.

Maybe we can save her uterus.

Shaun?

Come on.

Shaun.

Stick to the plan.

You cannot save the uterus.

Okay.

You are right.

Necrosis is too advanced.

Transfixion sutures and hemoclip.

Hey.

I wanted to see how you're doing.

Naveen is recovering well.

The surgery turned out as expected.

You hesitated in the O.R. What was that about?

I wanted to save her uterus.

Why'd you get stuck on not doing the hysterectomy?

The patient wants to carry a child.

Well, that's very empathetic.

I guess you... you developed a personal connection?

Luna made the right decision

even if her wife will never forgive her.

Are you worried that this will hurt their marriage?

It doesn't matter, okay? It doesn't matter.

What matters is that she is alive.

We saved her life.

Well, that is one thing that matters.

So is losing a personal connection...

No, the medicine is...

Shaun, is this about Lim?

What... What about her?

I don't know. I just... It's...

Lim is still up... upset with you.

She's still mad at you. D-Does that bother you?

Dr. Lim and I have a professional relationship...

No. No, you don't.

And you need to fix that.

The two of you need to sort that out.

I don't know what you want me to do.

I want you and Lim to talk to each other.

She does not want to talk to me.

That depends on what you have to say.

I have nothing to say.

Shaun, Lim is hurting, okay?

You are hurting.

Tell her that.

I mean, maybe... maybe she'll forgive you.

Maybe... Maybe she won't.

I don't know.

But the two of you have to resolve this

for both of your sakes and mine.

Dr. Lim and I have a professional relationship.

I do not need to talk to her.

I have to finish my op note now.

I've never done a splenectomy that way either.

Cool surgery, not the coolest circumstances.

Our patient went through something terrible

and my initial reaction was to judge her...

same way people judge me.

Don't beat yourself up. You didn't know.

You're a good friend.

I know.

But...

I've been waiting to be more than that,

and I don't think I should do that anymore.

I'm gonna take a rain check on research

and reschedule my date.

I think that's good.

You deserve to be happy.

I have to go prep Toni.

I owe you an apology for pressuring you.

I didn't do a rape kit.

And I've always regretted it.

And I didn't want you to feel the same.

I was in medical school.

He was a friend of a friend.

Somewhere along the way, he became a stalker.

One night he showed up at a bar I was at.

He followed me home.

I hated the idea of being seen as a victim...

...so I never told anyone.

I let that creep go.

And now I'll never know how many other women he hurt.

But that's my regret.

And it's not fair to put that on you.

I knew he liked me.

I should have made sure

that he knew it wasn't a date.

I shouldn't have had a drink. I...

I don't even know

if I told him to stop.

What if I didn't?

It is not your fault.

He took away your choice.

And now you have to do what's best for you,

whatever that is.

Toni, time for surgery.

Not yet.

There's still a little swelling,

but you'll have minimal scarring.

They're gone.

Now those glasses will stay put.

Nice job with my braids.

Wasn't me.

Always wanted a daughter, so I learned to braid.

Well, you might've found a nice side hustle.

Thank you, Dr. Andrews.

You're welcome.

Are you okay to continue?

Yes.

Are you okay to continue?

Yes.

Are you okay to continue?

Are you okay to continue?

Are you okay to continue?

Are you okay to continue?

Naveen, in the process of removing the towel,

we also had to take your uterus.

We're so sorry.

There was no other way?

Yes, but I told them...

I told them to do it.

I needed you to survive.

Because you mean everything to me.

And I failed at my most important job...

keeping you safe.

I failed you five years ago in the O.R.

and again yesterday.

I was so focused on defending myself,

I wasn't thinking about what you were going through,

how scared you were. And I'm so, so sorry.

Whatever you need, if... if you want me here

every step of the way, or...

out of the picture completely...

You better be here every step of the way...

...because I love you more than anything, too.

I'm sorry.

How's she doing?

Surgery went well.

Her platelet count is turning in the right direction.

Good.

And beyond the physical?

Too early to tell.

Recovery's a process.

All that time we were together,

why didn't you tell me?

Because I don't need anyone's pity,

yours included.

It's in the past.

What you did for Toni, that was really brave.

I'm here if you ever need someone to be brave for you.

Thank you.

I need to talk to you about your surgery.

I can't change what happened,

and I do not owe you an apology.

Dr. Murphy.

But I am sorry for other things.

In my RSI surgery today, the medical choice was clear,

but I did not want to proceed

because I knew what the consequences would be.

In your surgery, the medical choice was clear,

and I did proceed,

but I did not know what the consequences would be.

I saved your life,

but my decision also caused you harm.

When I saw you hurt and bleeding...

I saw my brother Steve, when he died.

When I thought I might lose you

the way I lost him, I did not like that.

I am sorry...

this...

has been very hard for you.

A medicine-only relationship is... is not easy.

I...

It is not what I want.

I have missed your friendship.

I have missed you.

This has been...

really hard.

And my life is in a good place now.

I'm happy.

But

still angry sometimes.

It may take a while to let that go.

But...

I've missed you, too, Shaun.

Hey.

You know, I love being the boss, but connecting with patients

is the reason I got into medicine in the first place.

And you made me remember that.

Thank you.

You're welcome.

Could I buy you a drink

as an apology for being a pompous ass?

No.

Unless you throw in some wings and fries.

Tough negotiator.

You know it.

Shaun came to see me.

We talked.

Thank you.

You're welcome.

Join me?

I'm sure we can find some cucumber water

around here somewhere.

Late dinner with Clay.

Good night.

- Hey. - Hey.

Good night.

What was that?

I don't know.

- You're back. - Yes.

You told me I was isolating myself in my other office.

Shaun, there's something you should know.

Lim, when she was in her chair and adjusted her position,

there was flexion and rotation in the psoas and in the glutes.

There was movement.

She could walk again.

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