Original subtitles

If you think choosing a college major is hard,

wait until you have to choose your medical specialty.

How late were you up researching treatments for that patient?

- Late. - You need sleep.

I'll get right on that.

You have no idea how many emails you get

until you come back from a three-month sabbatical.

Delete all.

Wait. What if some of those are important?

I'm practicing healthy boundaries.

If they need me, they can pick up the phone.

It's not just what medicine you'll practice,

it's your whole life.

Hey, should I pull the drains on Mr. Sherwood before we round?

Uh, no, Adams can do that.

Um, Toni Wright is down a resident,

so I took the liberty of moving you to her service.

I hope that's okay.

-Dr. Toni Wright? -Yeah.

NIH grant recipient for research on myofibroblasts for wound healing,

- pioneer in lymphedema, Dr. Toni Wright? - Oh.

Yes.

- Okay, yeah. - I may have read up on her.

- Play it cool. - Yeah, I gotta go prep.

- Ben Warren? - Hey, hey, hey. Come on. I...

Look, I was born cool.

Uh, okay.

Oh, my God.

I'm playing. I'm playing.

Who you'll work with,

whether you'll be home in time for dinner or never see your kids.

I love how they think we have time to go to the doctor.

Last year, I had a dental student pull one of my teeth in the cath lab.

Have you considered egg freezing?

Have I considered giving myself a series of shots and screwing up my hormones

and then going through an uncomfortable procedure

and then paying forever to store my eggs in a freezer

on the chance that I might want kids?

You could have just said, "No."

I might do it. I wanna keep my options open.

Why do they need to know when your mom had her first period?

Oh. I hope they don't,

- 'cause I have no idea and no way to ask. - Oh, smoothies.

The choice is yours, and so are the consequences.

-Hey. -Hey.

Hey, so my lawyer wanted to check in.

I still haven't received any papers to sign.

Yeah, I still have them.

Your lawyer mentioned wanting to file before the end of the month.

I-I just... I-I've been slammed with work.

If we don't do it soon, they're gonna make us pay additional retainers.

I am aware. I'm... I'm sorry.

I-I have a consult, but I will... I will get to them as soon as I can.

Okay.

Dr. Morales to the ICU. Dr. Martha Morales to the ICU.

-Dr. Wright, Ben Warren. -Hey.

-Thrilled to be on your service. -Nice to meet you.

Benson, back on my service again?

Yeah, I can't get enough, and people call me Blue.

-After the Joni Mitchell album? -No.

Oh. Well, that's too bad. It's one of the all-time greats.

I applied to three colleges in California solely because I thought it'd be cool

to sing that line about coming home there and literally mean it.

Do either of you play guitar?

-Um, not really. -A little.

- Well... - Um...

Uh, listen, um, feel free to push me. You know, I like to work hard,

and I'm actually applying for a plastics fellowship.

Good for you.

You should have told her you play guitar.

Five minutes to answer a page? Patient could have died in that time.

-Did somebody die? -That's irrelevant.

-What do we got? -Randall Lutton, 62.

He has scrotal swelling and severe pain after blunt trauma.

BP is slightly elevated. Gave two of morphine en route.

Oh, God, it hurts like hell.

Yeah, we're gonna get you more inside, okay?

I got up to use the bathroom in the middle of the night

and walked right into the dresser.

I'm gonna need an ultrasound and some gel.

Are you a doctor?

Urologist.

No need to comment on the irony.

- Okay. Let's get him to trauma one.

Hey, Corban, just double-checking you're getting your IV antibiotics

before rounds with Dr. Altman.

Um, do you think you could slip me the staff Wi-Fi password?

I know the guest Wi-Fi is spotty,

but ours is used for things like imaging and staff messaging,

so they're pretty strict about it.

Well, could you make an exception?

I just... I really want to see my cousin get married in Big Sur today.

Second cousin, second marriage, and he's not that great.

You didn't get it from me.

Thank you.

Somehow, I am always in the hospital for my friends' and family's big life events.

This is his second aortic graft to get infected in a year.

No offense to Dr. Altman,

but if this one doesn't take, we need a second opinion.

Well, Dr. Altman's extremely skilled.

She's even kind of famous now. She invented a new surgery.

Yeah, but like a difficult one?

Don't look at me like that.

I already know I'm becoming Mom.

- Surgery's incredibly complicated.

She's on a podcast. You can look it up.

Told you. I just have bad luck.

Well, hopefully the new TEVAR gives your aorta a break

so the antibiotics can do their job.

That's what you said last time.

I'll be back soon.

Dr. Miley Tokugawa to the ER.

Welcome back, Dr. Shepherd.

Have you met our new plastics attending, Dr. Toni Wright?

Relatively new. Nice to meet you.

We should get started. It's a LeFort fracture.

I'm sure there will be questions.

-Did you see that? -Uh, yes. Um, yeah, I don't know.

I don't think she remembers me.

Should she?

We went to med school together. We were in the same study group.

She hated me.

Oh, well, maybe it's better she doesn't remember.

Teresa Daniels, 49, post-op day five from a hemicraniectomy for subdural hematoma

after auto versus pedestrian.

Concomitant LeFort I fractures.

Please say you're fixing my mom's face today.

Well, that's up to Dr. Shepherd.

She'll tell us if your mom's head bleed has healed enough for us to proceed.

I'll do a neuro exam on her now and make sure the EVD's working.

So, uh, what are you studying?

Uh, data science.

I was going to major in it, but the intro course is hard.

I'm a freshman at UC Davis.

Do you have a study group?

-I haven't found the right people. -Oh.

- Does make a big difference. - -My mom says to stick with it.

I was complaining to her about it on the phone

when she got hit by that idiot driver.

That's awful. I'm so sorry.

She'll be happy to see you when she wakes up.

ICP is 12 and subdural is stable.

Great. So we're good to go.

Let's order a CT max/face before bringing her to the OR.

Hey. Sorry I'm late.

How was Cousin Frank's wedding? Were you able to stream it?

Still no contractions?

Don't jinx it.

-Okay. -Uh, Dr. Meade.

Corban Gregory, 28-year-old male.

Status, post-coarctation repair when he was two.

He subsequently had two graft repairs, both became infected.

Has now developed a pseudoaneurysm

and is here today for his second TEVAR.

You made somebody a new aorta?

He's stalking you online. I told him it was weird.

And it said that the patient had two repeat graft infections too.

-Can I get this? -A TEVAR is still a solution for you.

It's less invasive and less risky.

For me or for you?

Corban, the patient that you're reading about was much sicker.

I don't want another Band-Aid if there's a permanent fix.

I don't want to diminish what you're going through, but--

You think you know what I'm going through?

My favorite thing is running,

but I can't remember the last time I had a runner's high.

I won't be able to lift my baby nephew.

I can't travel. I can't visit my friends.

I have spent more time in the CCU than my own house in the last year.

Is that not sick enough for you?

What, you just don't care?

That's not true.

Then why won't you fix me?

I wish there was an easy fix.

Just get out.

Get out!

Okay.

It's a larger patient load than usual,

but with two of you...

Adams, please tell me that you were at the benefits fair

or rounding or anything but late.

Sorry, I was on the phone with Boise General.

They don't have Katie Rogers's immunotherapy either.

Well, the government cut off funding. You're not going to find it.

Okay, what about cytoreduction surgery with HIPEC?

What about it?

Well, could Katie be a candidate for it?

- I-I emailed you the case report.

Okay, no. I appreciate your initiative, and I will look at it.

But right now, I need you to focus on patients

-that are currently admitted to the hospital. -Okay.

We're down two residents due to illness and a family wedding,

so I need you and Spencer to get started on the floor, okay?

Ms. Hayes needs a Dobhoff tube for tube feeds.

Ooh. Well, I've never inserted an NG tube on a real person

o-or a fake one, so...

Well, um, Adams will help you.

- Don't forget to check your email. - I...

Just keep taking deep breaths.

New pain medication should kick in any second.

Can I take a look?

Yeah.

Wow, that looks painful.

Last I checked, it measured 20 centimeters.

I suspect a bleeding testicular artery. Do you see anything?

I, uh... It looks like it's expanding.

Let's get an ultrasound and page urology.

Was the dresser sharp? I mean, I do see a couple of small lesions.

I-I must have just snagged a drawer pull.

Oh, okay. Well, let's get him some more fluids and a full set of labs.

Okay.

Well, the testicles are intact and they're in the correct position...

-Okay. -...but I do see some free fluid in the scrotum.

Oh, my God, Randall.

Is it his heart?

Uh, no, no. My heart's just fine.

Doctors, this is my wife Kimmy.

-Hey. -Hi.

Is that one of your...

Yeah, I walked into the dresser.

Probably just a hematoma.

Is this gonna jack your fertility? I ovulate next week.

We're going to give you some privacy.

Dr. Neil, dial radiology.

Oh.

You've been back three hours

and you've already requested a new 3D microscope with AR tech?

Why are you reading emails when you are supposed to be on leave?

Catherine finally left the house.

If that woman makes me take one more nap, I'm going to lose my mind.

Um...

When did you hire Toni Wright?

A few months ago.

I was surprised we got her.

Jackson says she's the go-to for facial reconstruction.

Well... Jackson is the go-to for facial reconstruction.

Is there a problem?

I just... I just spent the last few months getting to a really good place.

I took Scout camping.

I went to the grocery store during normal hours. I slept--

You need to get to the point.

Wright and I have a history, in that...

in that, historically, she pushes my buttons.

If I hired people based on whose buttons they pushed,

no one could work at this damn hospital.

And your request for a microscope is denied.

Oh.

You know, I, uh...

I read that you won the Goldstein Award for excellence in teaching.

-Mmm? -Um...

No.

So, you know, you must be an excellent teacher.

That's the name of the award.

-She is all set. -Okay.

Oh. Yeah.

Oh, her nasofrontal and ZF sutures are broken.

Good. What else?

Her zygomatic arch is comminuted.

And it's a LeFort III, not a LeFort I.

Yeah. This just got a lot more complicated.

Yeah.

Should I call the OR? Let them know that we're gonna push the surgery?

Her daughter's going to be crushed.

No, we're not pushing anything.

Every day that she's intubated, it makes it tougher for her to recover.

We're just going to have to come up with a new plan, quickly.

Dr. Traversa to radiology. Dr. Valentina Traversa...

Is he asleep?

Just resting.

Did you get my scans back?

Everything looks stable, so you're all set for the TEVAR.

Corban.

He was hoping you'd say that he got worse, so he could get that new aorta business.

The TEVAR really might work.

A new aorta would definitely work.

If you survive it.

I want to talk to the other guy,

the doctor that did the new surgery with Dr. Altman.

-Dr. Ndugu? -He could give me a second opinion, right?

Dr. Altman should be in shortly. You can ask her any questions,

-or you can-- -I'm asking for Ndugu.

This is my life. I'm not gonna ask permission to hear about all my options.

Would you?

Just give me ten minutes with him, please.

I'll talk to him. No promises.

Catherine, I didn't know you were here today.

Oh. I had to get out of that house.

For ten days, I've been taking care of my husband.

I don't know how these nurses do it.

All right, where's my consult?

Randall?

Randall, what are you doing here?

Good to see ya.

Oh. We missed you at the last AUA conference.

- We were on our honeymoon. - Oh, that's right.

So what... what brings you in?

Uh, you... you have more important things to do.

I can see a resident.

Nonsense. I am here.

Dr. Hunt, what we got?

Blunt trauma. Now experiencing severe scrotal swelling.

-Hmm. -It's the size of a coconut.

Thank you, Dr. Millin, for that wonderful assessment.

Randall, may I?

Uh...

You don't have to be here for this.

Why don't you just go eat? I'm sure you're starving after Pilates.

- I'm not leaving your side.

How does it look?

Well, for a blunt trauma, it doesn't seem to follow the typical injury pattern.

Will this mess up his sperm count?

Yes, it will.

From walking into a dresser? How is it this bad?

I'll let Dr. Lutton answer that.

I didn't walk into anything.

Okay, please don't hate me.

I gave myself a vasectomy last night.

Oh.

While I was at book club?

-What the hell? -I will page psych.

Mm-hmm. Yeah.

-Keep swallowing. -Mmm, mmm.

- It pushes the tube down your esophagus... - -Mmm.

- ...to your intestine. - Okay.

- Does that look right? - Yeah.

Keep going until you hit the mark we measured on the tube.

- You sure you know what you're doing? - Uh...

She does. Keep sipping.

-Chin down. -Is-Is that mine?

My catsitter's supposed to be calling.

Uh, excuse me.

Hi, this is Dr. Adams.

Uh, yeah. Uh, actually, I'm with a patient right now.

Can I call you back?

Okay, I'm done.

All right, looks good.

All right, pull out the stylet, secure the tube and start trickle tube feeds.

Then we gotta do research for Dr. Bailey.

She didn't mention anything about research.

-It's for her patient. -Oh.

Well, she's in luck. I'm really good at research.

- In med school, I-I presented a poster-- - Great.

Finish up here and, uh, I'm gonna get started.

Where you going?

I'll text you.

I'll text him.

Hey. How's it going with Wright?

I have no idea.

- Did you change services? - No, I-I'm just getting zero vibe.

Because you're over-vibing?

No, no, no, no, no. Okay, I've been cool.

No excessive praise, no impulsive moves.

Well, just give it time.

Hey, if it makes you feel better,

I hear your residency director is very impressed.

It does.

- What were you even thinking? -Psych is on their way.

That man doesn't need a psychiatrist. He needs a marriage counselor.

You think he was successful doing it on himself?

We'll find out.

I gotta get him in an OR and evacuate that hematoma.

Can I scrub in? I've never operated on a DIY vasectomy before.

It'll be my second.

Wait, you know somebody else who tried to do their own vasectomy?

Another urologist. Said he was embarrassed.

I don't know why these boys don't just pick up the phone and call me.

It's just a hollow tube filled with sperm.

In fact, if you ever want one--

I-I'm good down here.

Go scrub in.

Uh, wait.

Just let Kimmy get in another few rounds, then go prep him.

...laughingstock, and you'll be to blame.

Can't even count how many fractures she has.

Yeah, the number doesn't matter.

Okay, so how-how do we plate her zygomatic arch?

It's like tempered glass. There's nothing solid to screw into.

Warren, any ideas?

Uh, create a scaffold of cadaveric bone paste and BMP.

You've studied this.

No, I saw it once, years ago. I...

I was an anesthesiologist before I went into surgery. Mmm.

Interesting.

Okay, so our first step is gonna be to wire her jaw

with her bite in the proper place.

We won't be able to have her orally intubated for anesthesia.

Warren, trach or submental intubation?

Oh, trach. It's a straight shot into the airway,

less risky than going through the chin into the mouth.

Spoken like an anesthesiologist.

A plastic surgeon thinks it'll take her three months to heal from a trach.

A submental incision will heal in a week.

Kwan, what are the steps of a submental intubation?

You make an incision under the chin and...

Honestly, I-I don't know.

Of course not. You're a gen surge resident.

- You'll learn today. - Cool.

It is. Take a look at this.

So we would create a large segment of aorta with a synthetic graft,

rerouting it from your chest to your abdomen,

and then we would staple off the infected piece here

and remove it at a later time.

So then no more TEVAR procedures?

If the surgery's successful, yes. That's the idea.

And you really think this could be a success for me?

I'd need to further study your case before I could answer that.

So shoot me his latest imaging, and I want to do another echo. Before we--

Dr. Ndugu? Excuse me, may I have a word, please?

Sure. Yeah. Excuse us.

Someone talk fast.

- Corban asked for a second-- - Not you.

You're talking to my patient behind my back

about a procedure that I've already said no to.

Okay, I assumed you were aware.

Don't do that. Don't put it on the resident

to have the uncomfortable conversation with her attending.

Your patient asked if he was a good candidate for a ventral aorta.

I simply explained what it was.

No, you got his hopes up.

And if you had come to me first,

I would have explained that, unlike Nora,

Corban has major scarring from a previous esophageal reconstruction.

He is a bad candidate for it.

How do we know who's a good candidate? We've done this once.

And that might be all we ever do if we kill Corban with it.

Nora hasn't even hit the six-month mark.

We need more time to see how she does.

Okay. All right.

Dr. Altman, I'm sorry. I wasn't sure--

How did Corban even know about the ventral aorta in the first place?

If you shut me out again, you are off this case.

I'm her boss.

Didn't she make you chief while she was chief?

Okay, well... Okay, so what? Now I owe her?

If I made someone chief,

and they gave my patient a second opinion behind my back,

I would blow my stack too.

Okay, yeah, yeah...

...that part was bad, but I'm not wrong.

This surgery could cure all kinds of aortic disease, you know?

Wait, Toni Wright just gave me the cold shoulder again.

It's okay. I was pretty much done.

Okay, she can do a supermicrosurgery in a 30x magnified field,

- but she can't say hi to me? - Oh. Amelia, don't...

I can't watch this. Nope.

-Hi. -Hi.

We went to med school together. You hated me.

No. I didn't hate you.

So you do remember me?

Yeah.

Wow. I should have thought this through.

I don't really know what happens next.

Why did you think I hated you?

You ran out of your own birthday party when I showed up uninvited.

- Oh, my God. - You changed study groups

and actively avoided me in labs.

Because I liked you.

- What? - I tried to kiss you

in The Mission during orientation.

No, you were drunk. I thought... I thought you stumbled into... into me.

No, I had a huge crush on you.

I mean, I thought you were queer, but then I wasn't sure,

so I didn't want to get burned, so I kept my distance.

But you have nothing to worry about.

This is all way in the past, and, um, frankly, you're not my type.

My OR is ready.

For some reason, I froze when I saw you earlier.

I'm glad we cleared the air.

I'm pretty sure Altman hates me.

If she didn't kick you off the case, you're probably fine.

Let's talk about something else.

Uh, my patient tried to give himself a vasectomy.

- Wow, we will always have jobs. - -Mm-hmm.

Everyone thinks they can do anything themselves

if they watch enough videos on social media.

He's a board-certified urologist.

You know, that actually seems doable with some lidocaine and a mirror.

OR's ready. I'm out.

How come women in their 20s have to shell out big bucks

to preserve their fertility,

but men in their 60s are so worried about pregnancy,

they are giving themselves vasectomies?

Evolution failed us.

Do it with me. Our future and less fertile selves will thank us.

So we can both be hormonal at the same time?

It's a hard pass, but I will do your shots.

I am very good at giving injections.

Don't ask why.

You can have the other half of my sandwich if you're hungry.

-I brought it from home. -Yeah, I'm good.

Did you email me the results

for the immunotherapy study from San Francisco?

I included it in the Chicago study, at the bottom.

-Okay. -I like to cook.

Do you? It-It makes me happy following directions and--

I wonder if we could file a compassionate use application for her meds.

Or maybe we could get it off-label directly from the manufacturer.

Why is this particular patient's research so important?

I just meant, weren't there others in the trial?

What about them?

Look, I-I-I care about all the patients. I do. I just...

I don't know. Katie... She's in her late twenties just like us.

She feels like a classmate or more like a friend.

We've just spent a lot of time together, so she is now kind of a friend.

I get it.

It's like when you meet someone and you feel like you've already met them before,

like they're supposed to be in your life.

Oh, no, it's-it's Wendy.

Hey, may I come in?

She wanted me to apologize.

Unbelievable.

It's okay.

Can we have a minute?

Sure.

Don't say anything stupid.

You're stressing me and the baby out enough.

If you want Dr. Ndugu to replace your aorta,

I won't stand in your way, but I do need you to hear me out first.

Okay, talk.

Okay.

We have done this once on a person with very, very different anatomy

who could have a complication at any moment.

So it's not just a risk, it's a complete unknown.

There is no way to know what will happen if we staple your aorta shut.

And it is irreversible.

If the staples don't hold and you hemorrhage, you'll die.

I don't want to do this surgery on you because I want you to be able

to meet your nephew and see your sister become a mom

and go running again and visit your friends.

And I know the idea of going through this again is infuriating,

but at least... at least you'll still be alive.

I'll give you more time.

Thanks.

Oh. Nice. You didn't skive at all.

And now I will lift the scalp flap to expose the face.

- Hold up. What have you got there? - A beaver blade.

What, are you trying to keep us here all day?

Plastic surgeons use this to make delicate incisions.

Yeah, sure, if we're working on a cleft lip

or somewhere where every millimeter counts.

The scalp's robust. Get him the 15 blade.

Make sure to stay in the same plane.

Good.

Oh, there's some fluid.

Give me a specimen tube.

Paper towel?

- It's a halo sign. - -Damn it, she's leaking CSF.

We need neuro, now.

What happened?

She was fine. I started the trickle feeds and her sats dropped.

What's wrong?

Hold on, we're gonna find out. Just don't move.

The tube is in her lung. Wait, you didn't see that on the X-ray?

-What X-ray? -Let me see.

Look, you have to get an X-ray after you insert a Dobhoff

and most importantly, before you start feeds.

- Okay, let's pull it out, quickly now.

I'm s-sorry, this is my first one. I-I didn't know.

It's okay, and we can fix this.

Uh, prepare for a bronchoscopy to suction the feeds out.

Okay.

- Suction. - Okay.

Is it... Is it weird operating on your friend's scrotum?

My dear, you've seen one testicle, you've seen them all.

But ask me if I think the man has a screw loose, ooh, mmm.

He must really not want kids.

Of course not, he's a grandfather. That's when all the fun starts.

Raising a child is hard,

this coming from the chairwoman of a national hospital system.

I don't know how you did it.

Me neither, but I will tell you this.

As proud as I am of all my accomplishments,

the best job I've ever had is being Jackson's mom.

And the biggest surprise, I didn't think I wanted to be a parent.

I... I just never had that pull.

But life is full of surprises.

Yeah, just ask Kimmy.

Oh. She better make sure that lawyer's looking over that prenup.

Okay, let us finish this vasectomy in the right way.

I've palpated the vas deferens and isolated it. Now, what is next?

Exteriorize, ligate both ends, then divide and send path.

Mm-hmm.

After you.

Uh, 4-0 VICRYL.

All right, what happened? - She has a CSF leak.

Can you show me where the fluid's coming from?

Do you think it's from the cranial base?

I can't see. Let's light it up. Dilute fluorescein, please.

Inject it into the EVD and clamp it.

Injecting now.

All right, now we wait. Lights please.

For what?

The drain is in her ventricle which is filled with CSF.

If this is a leak, we should see... Oh.

Yeah, the fluorescence is coming from the location of the dural tear.

Is it weird that I think that's beautiful?

Not at all.

All right, let's sew this up. 5-0 nylon.

Actually, the dura is friable. It's not gonna hold a stitch.

And the pericranium is too scarred to harvest for a patch.

You want some fascia lata?

I think that might be our only option. Prep the thigh.

Not the only option.

Instead of another incision, I can harvest fascia from the existing field.

You think it'll have enough bite to hold the dura?

Give me three minutes, I'll show you.

- Mm-hmm. - Scalpel.

Okay, Mom. Whatever.

I'll let you know when I know what he's decided.

Hey. Everything okay?

Everything's fine. I'm just a terrible person.

I have a hard time believing that.

You're spending your third trimester with your brother in the CCU.

My mom's a wreck because her son is having another big surgery

- while she's recovering from pneumonia.

And I just yelled at her because she didn't have an opinion

on the paint color for the nursery.

Hey, you want your mom's help. That doesn't make you terrible.

I'm just overwhelmed.

Yeah. Of course you are. There's a lot going on.

It's so stupid.

I am 36 years old. I'm about to have a kid...

but I still just want my mom.

I know the feeling.

I should call her and apologize.

I'll see you up there.

Hey, Corban made his decision. He wants a TEVAR.

Okay.

I'd page someone else, but we're down residents today.

I'm good.

Do you need a minute?

Not at all. I'll go prep him.

Okay.

Dr. Bailey, I am so sorry.

I take full responsibility.

I should have told Spencer to check the KUB before starting feeds--

Yeah. Damn right. And you better have a good reason you didn't.

Yeah, a pharmaceutical company called with a lead on Katie's infusion. So I just--

No, the last time I checked, I asked you to focus on your patients

admitted in the hospital.

I only picked up long enough to let them know that I was serious.

Wendy could have died of chemical pneumonitis or pneumonia.

She didn't, and Katie could die if we don't fight for her.

I know. I am fighting for her too.

Are you?

Because what options have you found? What research have you done?

Have you exhausted your contact list? Because it feels like you've given up.

Oh, so you think after Katie sobbed in my arms,

I shrugged and said, "Good luck"?

That I gave her a goody bag and sent her on her way?

-She's dying, okay? We-- -And I think about it every single day.

And I also think about my 65-year-old with decompensated cirrhosis,

who's treatment resistant

and-and the 17-year-old that's septic and I can't figure out why.

Don't forget about John Doe in the ICU whose abdomen I had to leave open.

Yeah, he's also keeping me up at night.

And now I guess you can add Wendy to my list.

See, I haven't given up on Katie,

but I also haven't given up on the rest of my patients,

and that is where you and I are different.

Get it together.

Dr. Brooks to oncology. Dr. Brooks to oncology.

Hi. Randall did great.

He is recovering now, and they will call you when he's ready for visitors.

Is it bad if I don't answer?

No one would hold it against you.

I really do love him.

That's what makes this hurt so much.

I mean, it's his body and he can do whatever he wants.

But if I want to stay married to him,

I don't get a say in whether I have a baby.

Well, you could always ask him to reverse it.

What's the point?

He obviously doesn't want to have kids with me.

Uh...

Well, can you get a puppy?

I'm allergic.

That's unfortunate.

Yeah.

Hey.

Hey.

I did Corban's TEVAR. He did great.

His numbers are improving.

Okay.

I'm-I'm sorry if I came across as harsh earlier.

I-I still maintain that the ventral aorta

wasn't the right call for this patient.

What about the next one?

You were more than happy to talk about this surgery on podcasts

and publish abstracts, present it.

You were the one who came up with it.

What's the point if you never do it again?

It's a break-the-glass- in-case-of-emergency surgery.

But does it have to be?

Think of the number of people suffering from aortic disease with no options.

We might have something that could help them.

Why don't you want to use it?

She looks terrible.

She'll look more like herself when the swelling goes down.

And we'll keep monitoring her brain function to see what's intact.

Her intracranial pressure is stable

and she's not re-leaking any fluid from her nose.

And that's good.

I think I have to drop out of school.

I can't leave her like this. It's always been me and her.

Have you thought about contacting the school?

Maybe take a leave of absence? Or do your coursework remotely.

You think they'd do that?

Yeah, you've worked really hard.

And if you stop now, then it's gonna be a lot harder to start back up again.

Never hurts to ask.

Um, excuse me.

Uh, Dr. Wright, uh, I ordered Teresa's post-op imaging,

but it probably won't happen overnight,

so I'll make sure it's done for first thing tomorrow.

Good, thank you.

Uh, all due respect, uh, I don't want to be just good.

I want you to see me as excellent. So I'm asking, what would that take?

Tell me what you need me to do, and I will do it.

There's your problem.

That I'm not anticipating you well enough?

You're trying to anticipate me

when you should be trying to anticipate the medicine.

Look, over the years I've found that the most successful residents

focus on patient care and surgical technique.

-Mm-hmm. -They're confident in who they are,

which translates into them being confident in what they do.

And that is what leads to excellence in plastics.

I didn't see that from you today.

Maybe next time.

Hey. Did you update, uh, Ms. Cahill's output for Baxter?

He's on tonight.

You okay?

Super.

Look, Bailey was mad at me, not you, and she was way out of line.

Bailey?

Bailey wasn't the problem.

Spencer.

I thought you were going to apologize to me.

For what?

Look, you might have taken the heat because you're the second year,

but I fed the tube into Wendy's lungs.

And if you had told me to get a KUB,

I would have taken a damn X-ray and not initiated feeds.

-Okay, but we managed it. She's fine. -She had food in her lungs!

Uh, okay. Thank you.

Thank you.

I wasn't cool.

Oh, you're being hard on yourself.

Oh, she said in no uncertain terms

that she did not see excellence in me today.

I'm sorry.

You know what makes it worse?

She wasn't even mean about it. She just said it like it was a fact.

Huh.

What, you think it's a fact?

Oh, no, no, no. I was... ...thinking about how I yelled at Adams.

Oh. What did he do now?

Well, his concern for one patient got in the way of his care for other patients.

-Katie Rogers. -Yeah.

I mean, truth is, if she was our only patient,

his dedication would be admirable.

-Mmm. -I hope I wasn't too hard on him.

Um, I guess we got to have thick skin if we're going to do this thing.

Want to go home?

Mmm, let's go home.

Hey.

Everything okay?

I haven't signed the papers yet.

But getting a divorce was your idea.

I know.

I know.

Are you having second thoughts?

No.

I keep taking the papers out to sign and then I don't do it

and now they're just sitting in my bag with crumbs and crayon marks on them.

Just because it was my idea doesn't mean that I'm not scared.

- What are you scared of? - I don't know.

That everything will just explode and-and fall apart.

But hasn't that happened already?

You don't have to do them right now.

I mean, I'll-I'll-I'll take out another retainer. We don't have to rush this.

I have to do it sometime.

Okay.

My sixth-grade teacher said,

"Your actions plus your choices equals your life."

This is mostly true.

I can do a whole vasectomy, start to finish.

-It's pretty straightforward. -Why you looking at me?

What? You changed your mind?

Yeah, today, looking at questions about my mom,

thinking about being a mom just brought up a lot of old feelings

I don't have time to deal with. I need to focus on work.

What if I did it with you?

I don't have to be here for this, right?

No.

Thought you didn't want kids.

I don't think I do.

But I also don't want to wake up one day and my eggs are all shriveled and dusty

and realize that I do, and it's too late.

And then if we... if we do it together, I...

I could be there for you if you think about your mom.

-You'd do that? -Yeah, yeah.

And then I can tell you about my mom, which would make you feel better.

Fertility friends.

Don't call it that.

No, no.

But what it doesn't account for is luck.

-What is going on? -Leticia, you have to wait outside.

-Someone tell me what's going on. -Get her out, please.

-It's gonna be okay. It's gonna be okay. -No.

-No, please. -What happened?

I got him back after one round of epi,

but he's still hypotensive with a narrow pulse pressure.

-Did you get an X-ray? -Uh, right here.

Good work.

Mediastinal widening. The leak is expanding.

Page Altman.

We need to get him back to the angio suite.

Let's move.

Sometimes we encounter unexpected twists of fate.

- Hey. - Hey.

Thanks for today.

You're the only neurosurgeon that's ever responded to my page in under an hour.

Yeah, well, it was my first day back, so I didn't have a lot going on.

Not... Not to say that I'm not always prompt.

Right.

You need me again, I will come just as fast.

Okay.

Uh...

-I... I made it weird. -No.

I swear to you, the crush is all in the past.

I've had many crushes since then,

succeeded at several,

changed programs when others have failed.

You used to laugh more.

I also had a crush on you.

I mean, I didn't understand what I was feeling, but,

you know, I wish I had known.

Sorry, that-that is... this is...

I'm not hitting on you in the attending's lounge.

Right.

This is work.

Do you wanna go somewhere, get a coffee?

And the best things in life fall out of thin air.

All you have to do is catch it.