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1
00:00:01,830 --> 00:00:03,470
Dr. Larsen was in
a car accident,
2
00:00:03,470 --> 00:00:05,070
she has no recollection
of the last eight years.
3
00:00:05,070 --> 00:00:06,470
Previously on Doc.
4
00:00:06,470 --> 00:00:08,380
- Let me run Internal Medicine.
- Back to your roots.
5
00:00:08,380 --> 00:00:10,480
When you need time to
work out things with Michael,
6
00:00:10,480 --> 00:00:12,820
I accept it, but when the shoe's
on the other foot...
7
00:00:12,820 --> 00:00:13,990
When the shoe's on
the other foot,
8
00:00:13,990 --> 00:00:15,390
you have a hard time
telling me the truth.
9
00:00:15,390 --> 00:00:17,060
Delayed decisions on his care
10
00:00:17,060 --> 00:00:18,460
have been hurting
him a long time.
11
00:00:18,460 --> 00:00:20,500
You don't have to tell me
the system's broken.
12
00:00:20,500 --> 00:00:23,240
How much prednisone does it
take to get you through a shift?
13
00:00:23,240 --> 00:00:25,050
You will flame out in weeks.
14
00:00:25,050 --> 00:00:26,850
It's time for you
to use your greatness
15
00:00:26,850 --> 00:00:28,850
to pull the greatness
out of others.
16
00:00:28,850 --> 00:00:30,820
I'm going to miss you.
17
00:00:43,080 --> 00:00:44,990
- Sorry.
This guy loves his sleep.
18
00:00:44,990 --> 00:00:48,660
- Oh, there he is.
Hey, can I have a hug?
19
00:00:49,790 --> 00:00:52,030
Oh my goodness, this is yummy.
20
00:00:52,030 --> 00:00:54,470
Ethan was sorry to miss you,
he had a really early meeting.
21
00:00:54,470 --> 00:00:56,640
Well, Robbie's
the main event, right?
22
00:00:56,640 --> 00:00:59,980
What fabulous holiday have they
cancelled school for this time?
23
00:00:59,980 --> 00:01:01,150
It's Lunar New Year.
24
00:01:01,150 --> 00:01:02,960
Oh, well.
25
00:01:04,220 --> 00:01:05,530
Grandma's been
all over the world.
26
00:01:05,530 --> 00:01:07,970
You know, she could probably
teach you to say hello
27
00:01:07,970 --> 00:01:09,200
in 50 different languages.
28
00:01:09,200 --> 00:01:11,070
67, but who's counting?
29
00:01:11,070 --> 00:01:12,540
I should be back around six.
30
00:01:12,540 --> 00:01:14,080
And thanks so much
for doing this.
31
00:01:14,080 --> 00:01:16,080
- Are you kidding?
The more time I get to spend
32
00:01:16,080 --> 00:01:17,120
with this little man,
the better.
33
00:01:17,120 --> 00:01:18,890
Oh. Brought you donuts,
34
00:01:18,890 --> 00:01:20,420
your dad said
they're your favorite.
35
00:01:20,420 --> 00:01:22,230
Thanks, Grandma.
36
00:01:28,000 --> 00:01:29,470
Joan, you okay?
37
00:01:31,480 --> 00:01:32,310
I'm fine.
38
00:01:34,850 --> 00:01:36,860
Robbie,
why don't you go upstairs?
39
00:01:36,860 --> 00:01:38,760
Oh my God.
40
00:01:38,760 --> 00:01:40,800
- Grandma!
- Joan?
41
00:01:40,800 --> 00:01:41,870
Grandma!
42
00:02:07,350 --> 00:02:08,790
Good morning, everyone.
43
00:02:08,790 --> 00:02:10,190
Morning.
44
00:02:10,190 --> 00:02:12,830
This is going to be
an adjustment for all of us.
45
00:02:12,830 --> 00:02:15,000
Dr. Ridley certainly left
some big shoes to fill,
46
00:02:15,000 --> 00:02:18,400
and I know all these leadership
changes the past year
47
00:02:18,400 --> 00:02:21,180
have probably been unsteadying.
48
00:02:21,180 --> 00:02:24,020
There are a lot of reasons why
49
00:02:24,020 --> 00:02:26,760
I wanted to practice
medicine again,
50
00:02:26,760 --> 00:02:29,030
but I want to be very clear
about the reason I asked
51
00:02:29,030 --> 00:02:31,100
to sit in that chair.
52
00:02:31,100 --> 00:02:33,430
The past year as your CMO,
53
00:02:33,430 --> 00:02:35,070
I have seen what every person
54
00:02:35,070 --> 00:02:37,040
standing in this room
is capable of.
55
00:02:37,040 --> 00:02:38,780
Dr. Miller.
56
00:02:38,780 --> 00:02:40,580
Time and again,
you have risen to the occasion.
57
00:02:40,580 --> 00:02:42,790
We have
a sixty-two year old female
58
00:02:42,790 --> 00:02:44,090
in respiratory failure.
59
00:02:44,090 --> 00:02:45,990
Complications from chronic MDS.
60
00:02:45,990 --> 00:02:47,130
I'm on my way down.
61
00:02:47,130 --> 00:02:49,470
I'm not here just to lead you,
62
00:02:49,470 --> 00:02:53,610
I want to join you, and help you
do what you already do so well.
63
00:02:53,610 --> 00:02:57,250
An issue, a problem,
a suggestion,
64
00:02:57,250 --> 00:02:59,350
my door will always be open.
65
00:02:59,350 --> 00:03:03,060
Before we go, some
congratulations are in order.
66
00:03:03,060 --> 00:03:05,270
In two weeks, Dr. Maitra
67
00:03:05,270 --> 00:03:07,840
and Dr. Larsen
will succeed Dr. Heller
68
00:03:07,840 --> 00:03:08,770
as Chief Residents,
69
00:03:08,770 --> 00:03:12,110
as we welcome our
new class of interns.
70
00:03:15,390 --> 00:03:16,890
Uh, now, if you both
71
00:03:16,890 --> 00:03:18,990
could hang back for a moment
with Dr. Heller.
72
00:03:18,990 --> 00:03:21,430
The rest of you, do good work.
73
00:03:24,770 --> 00:03:27,740
I'd like our co-chiefs
to shadow you
74
00:03:27,740 --> 00:03:29,950
before you start your
pediatric fellowship.
75
00:03:29,950 --> 00:03:31,120
You can begin with Dr. Maitra
76
00:03:31,120 --> 00:03:32,550
this morning,
and then alternate days.
77
00:03:32,550 --> 00:03:34,860
- Yeah. Sounds like a plan.
- Great.
78
00:03:38,830 --> 00:03:40,400
It's quite a move.
79
00:03:40,400 --> 00:03:42,370
Well, it was either this
80
00:03:42,370 --> 00:03:43,980
or a leather jacket
and a motorcycle.
81
00:03:50,890 --> 00:03:52,290
Joan's in the ER.
82
00:03:52,860 --> 00:03:55,400
Paramedic said she was
extremely short of breath,
83
00:03:55,400 --> 00:03:57,740
likely bilateral
pleural effusions.
84
00:03:57,740 --> 00:03:59,410
So is she hypoxic?
85
00:03:59,410 --> 00:04:02,710
Oxygenations improved on
the mask, but she's hypotensive.
86
00:04:02,710 --> 00:04:05,450
Let's push Norepi MAP
goal above 65.
87
00:04:05,450 --> 00:04:07,160
No, Richard,
that's not gonna work.
88
00:04:07,160 --> 00:04:08,730
- I'm sorry?
- She's on prednisone.
89
00:04:08,730 --> 00:04:10,960
30 milligrams and she's
tapered off, I read her chart.
90
00:04:10,960 --> 00:04:13,770
No, her chart's wrong,
she's on way more than that.
91
00:04:15,610 --> 00:04:18,810
I've been using it
to get through the surgery.
92
00:04:19,780 --> 00:04:21,420
You knew about this?
93
00:04:22,590 --> 00:04:25,530
How much has she been taking?
94
00:04:26,160 --> 00:04:27,500
Double that.
95
00:04:30,270 --> 00:04:32,640
Triple to get through the ex...
96
00:04:32,640 --> 00:04:34,440
vivo with Javi.
97
00:04:34,440 --> 00:04:38,920
My natural cortisol
production's gotta be shot.
98
00:04:40,290 --> 00:04:43,190
Okay. Lucy,
100 milligram bolus
99
00:04:43,190 --> 00:04:45,330
of hydrocortisone
before pressors.
100
00:04:45,330 --> 00:04:47,400
And run a complete lab workup.
101
00:04:48,610 --> 00:04:51,080
We're all here if you
need anything, Joan.
102
00:04:54,920 --> 00:04:55,990
Should I call Ethan?
103
00:04:57,860 --> 00:04:58,960
He's on his way.
104
00:04:58,960 --> 00:05:02,900
But Amy, I need you to remember,
105
00:05:02,900 --> 00:05:04,610
I have a DNR.
106
00:05:04,610 --> 00:05:07,810
Joan, no, we're
nowhere near that.
107
00:05:12,090 --> 00:05:13,820
Shh.
108
00:05:18,670 --> 00:05:20,640
Good morning, Dr. Walker.
109
00:05:20,640 --> 00:05:24,010
- Good morning to you, Walter.
How's our rocket holding up?
110
00:05:24,010 --> 00:05:25,510
Can't wait to launch it.
111
00:05:25,510 --> 00:05:26,820
You think I can
still leave today?
112
00:05:26,820 --> 00:05:29,250
Gotta examine you first,
can't let you out of here
113
00:05:29,250 --> 00:05:30,820
till we're sure
you're all better.
114
00:05:30,820 --> 00:05:33,130
I really want to show the rocket
115
00:05:33,130 --> 00:05:34,700
to the kids at the house.
116
00:05:34,700 --> 00:05:36,870
I bet. Looks like that thing
might actually make it to space.
117
00:05:36,870 --> 00:05:39,070
Do you ever launch
rockets with your kids?
118
00:05:39,070 --> 00:05:41,610
- I don't have any.
- Really?
119
00:05:42,280 --> 00:05:44,250
I thought about it
when I was younger,
120
00:05:44,250 --> 00:05:46,120
but decided to take
a different path.
121
00:05:46,120 --> 00:05:47,290
What do you mean?
122
00:05:47,290 --> 00:05:48,660
Well, being a parent's
a big commitment.
123
00:05:48,660 --> 00:05:52,000
But that's also true
for being a friend, a sister,
124
00:05:52,000 --> 00:05:54,640
an aunt, especially a doctor.
125
00:05:54,640 --> 00:05:57,540
Eventually, I figured
if I gave my best
126
00:05:57,540 --> 00:06:00,150
to all those other things,
that'd be enough for me.
127
00:06:00,150 --> 00:06:01,850
- You're a great doctor.
- Hmm.
128
00:06:01,850 --> 00:06:05,560
- That she is, buddy.
Sorry I'm late, how's he doing?
129
00:06:05,560 --> 00:06:08,570
- Well, breathing's much better.
Let's look at those knees.
130
00:06:11,070 --> 00:06:14,540
Oh. How long has your leg
been moving like that?
131
00:06:14,540 --> 00:06:16,680
Happens all the time with my RA.
132
00:06:16,680 --> 00:06:18,720
It shouldn't be now,
with the medication you're on.
133
00:06:18,720 --> 00:06:20,520
- Yeah, I'll order a CT.
- Well, that's bad.
134
00:06:20,520 --> 00:06:22,560
Just need to see
what's going on.
135
00:06:22,560 --> 00:06:24,160
We'll get it sorted out, though.
136
00:06:24,160 --> 00:06:26,170
Time to find your social worker.
137
00:06:26,170 --> 00:06:28,040
Again?
138
00:06:28,840 --> 00:06:31,550
Atlantoaxial instability this
severe will progress fast.
139
00:06:31,550 --> 00:06:33,080
We have to operate now.
140
00:06:33,080 --> 00:06:34,980
We don't have the go
ahead from his proxy.
141
00:06:34,980 --> 00:06:37,320
Well, his C1 and C2 are
compressing his spinal cord.
142
00:06:37,320 --> 00:06:38,860
What's everybody waiting for?
143
00:06:38,860 --> 00:06:41,000
The social worker said he'd
sign off on whatever we decide,
144
00:06:41,000 --> 00:06:43,540
but he doesn't want
to get in the weeds.
145
00:06:43,540 --> 00:06:44,740
Well, that makes things tricky,
146
00:06:44,740 --> 00:06:46,240
cause we have two
surgical routes.
147
00:06:46,240 --> 00:06:49,450
High risk, high reward, open
the neck, expose the vertebra,
148
00:06:49,450 --> 00:06:51,020
place the corrective
hardware directly.
149
00:06:51,020 --> 00:06:53,290
But you're concerned about
arterial or spinal cord trauma?
150
00:06:53,290 --> 00:06:56,630
Not to mention stroke,
infection, ventral cord damage.
151
00:06:56,630 --> 00:06:58,630
Plus, he's still recovering
from lung inflammation.
152
00:06:58,630 --> 00:07:00,140
Definitely a concern.
153
00:07:00,140 --> 00:07:02,870
And the second option is
minimally invasive fusion?
154
00:07:02,870 --> 00:07:04,610
Far less trauma
and easier recovery.
155
00:07:04,610 --> 00:07:06,480
But wouldn't we be relying
on CT for navigation?
156
00:07:06,480 --> 00:07:08,720
Which means less precision
with the hardware?
157
00:07:08,720 --> 00:07:10,190
Yeah, it may require
going back in,
158
00:07:10,190 --> 00:07:11,590
in six months or a year.
159
00:07:11,590 --> 00:07:13,060
And there's a high chance
for a screw misplacement.
160
00:07:13,060 --> 00:07:15,570
At the C1-C2 spinal cord,
that could be severe.
161
00:07:16,370 --> 00:07:19,970
- Both have risks.
It's your call, Gina.
162
00:07:27,890 --> 00:07:30,230
Do the minimally
invasive fusion.
163
00:07:30,230 --> 00:07:31,830
I'll go explain to Walter.
164
00:07:34,740 --> 00:07:36,680
So...
165
00:07:37,740 --> 00:07:40,080
I've got full-blown leukemia.
166
00:07:41,120 --> 00:07:42,250
May I see?
167
00:07:45,630 --> 00:07:48,100
My belief is that the steroids
168
00:07:48,100 --> 00:07:50,040
artificially raised
your white blood cell count,
169
00:07:50,040 --> 00:07:52,870
hiding the degree
of marrow infiltration,
170
00:07:52,870 --> 00:07:55,950
and I spoke to Dr. Rose,
and he agrees.
171
00:07:55,950 --> 00:07:59,620
Now, if this goes unchecked,
decline will be rapid.
172
00:07:59,620 --> 00:08:01,790
So, we'd like to start
induction chemotherapy,
173
00:08:01,790 --> 00:08:04,030
which could buy you
a few extra months.
174
00:08:04,030 --> 00:08:05,930
This shows
a pancytopenic picture
175
00:08:05,930 --> 00:08:09,140
without any sign
of leukocytosis.
176
00:08:09,140 --> 00:08:10,410
Yes. As I just said,
177
00:08:10,410 --> 00:08:11,680
the steroids are
complicating things.
178
00:08:11,680 --> 00:08:14,550
Her leukemia has an
atypical presentation,
179
00:08:14,550 --> 00:08:17,320
but we need to act fast
before it progresses.
180
00:08:17,320 --> 00:08:18,690
Or her presentation
181
00:08:18,690 --> 00:08:20,760
is atypical because
it's not leukemia.
182
00:08:20,760 --> 00:08:21,700
Amy.
183
00:08:21,700 --> 00:08:23,300
Her counts are dropping
184
00:08:23,300 --> 00:08:24,970
across every line.
185
00:08:24,970 --> 00:08:26,810
That looks like marrow failure,
not marrow takeover.
186
00:08:26,810 --> 00:08:28,950
You're reading too much
into the blast count.
187
00:08:28,950 --> 00:08:31,220
No, I'm looking at
the facts in front of us.
188
00:08:31,220 --> 00:08:34,260
She doesn't show cancer
on a peripheral smear.
189
00:08:34,260 --> 00:08:36,800
If this is pancytopenia,
we could give platelets
190
00:08:36,800 --> 00:08:37,960
and plasma to raise her levels.
191
00:08:37,960 --> 00:08:40,600
Blast proliferation
and dysplasia
192
00:08:40,600 --> 00:08:42,810
are textbook signs of leukemia.
193
00:08:42,810 --> 00:08:45,280
And delaying treatment
because of wishful thinking
194
00:08:45,280 --> 00:08:47,850
will cost you significant time.
195
00:08:47,850 --> 00:08:51,190
Or, if he's wrong, the chemo
will damage all your organs.
196
00:08:51,830 --> 00:08:54,060
I believe this is
Joan's decision.
197
00:08:58,570 --> 00:09:00,040
Start the chemo.
198
00:09:02,580 --> 00:09:04,620
I'll put the orders in.
199
00:09:09,560 --> 00:09:11,000
You're brilliant, Amy,
200
00:09:11,000 --> 00:09:13,330
and I know you don't
want this to be true.
201
00:09:14,640 --> 00:09:16,170
But I can't.
202
00:09:16,170 --> 00:09:19,810
I can't lose any more
time with my family.
203
00:09:22,820 --> 00:09:24,360
Yeah.
204
00:09:33,880 --> 00:09:36,050
Mom, any soreness
in the incision?
205
00:09:36,050 --> 00:09:38,650
Oh, it was routine
surgery, I'm fine.
206
00:09:38,650 --> 00:09:40,460
Where's John?
207
00:09:40,460 --> 00:09:42,990
He's here, having a smoke.
208
00:09:42,990 --> 00:09:45,030
Surprised you
didn't go with him.
209
00:09:45,030 --> 00:09:47,340
Believe me, if I thought
I could get away with it.
210
00:09:47,340 --> 00:09:48,670
Not on my watch.
211
00:09:48,670 --> 00:09:51,380
Oh, I know, Dr. Larsen.
212
00:09:51,380 --> 00:09:53,210
Not yet, Mom.
213
00:09:53,210 --> 00:09:55,280
Speaking of which, you should
get back to Minneapolis.
214
00:09:55,280 --> 00:09:58,060
No, it's fine. Dr. Ridley
is away for a couple of weeks,
215
00:09:58,060 --> 00:10:00,560
so I finally get a little
bit of breathing room.
216
00:10:00,560 --> 00:10:01,930
Who's that?
217
00:10:01,930 --> 00:10:03,940
I've mentioned her,
like, six times.
218
00:10:03,940 --> 00:10:06,640
Genius surgeon,
Doctors Without Borders,
219
00:10:06,640 --> 00:10:09,780
utterly terrifying...
- Alright. Her.
220
00:10:09,780 --> 00:10:11,620
Everybody wants her
to be their mentor
221
00:10:11,620 --> 00:10:13,350
but she travels around so much,
222
00:10:13,350 --> 00:10:15,530
I don't think she ever
slows down enough to do that.
223
00:10:15,530 --> 00:10:17,300
What do you even
need a mentor for?
224
00:10:17,300 --> 00:10:19,100
You want something, you get it.
225
00:10:19,100 --> 00:10:21,240
Always been that way,
barely even needed to push you.
226
00:10:21,240 --> 00:10:23,880
Well, there were times I could
have used some pushing.
227
00:10:28,020 --> 00:10:29,420
Amy.
228
00:10:29,420 --> 00:10:31,320
- Hey.
- Hi.
229
00:10:31,320 --> 00:10:33,260
I got here as fast as I could.
230
00:10:33,260 --> 00:10:35,070
She's stable now.
231
00:10:35,070 --> 00:10:38,270
She's pretty drowsy
from the chemo meds.
232
00:10:38,270 --> 00:10:40,780
Right. Okay.
233
00:10:42,780 --> 00:10:46,920
Amy, Joan's co-ag
panels came back.
234
00:10:48,020 --> 00:10:49,730
She has DIC.
235
00:10:49,730 --> 00:10:51,460
If we had pushed platelets
like you wanted,
236
00:10:51,460 --> 00:10:54,740
the runaway clotting could
have caused a massive stroke.
237
00:10:55,970 --> 00:10:58,140
I know how hard this is for you,
238
00:10:58,140 --> 00:11:00,820
but you're gonna have to
let me do my job.
239
00:11:05,830 --> 00:11:08,530
Ethan. I'm Dr. Miller.
240
00:11:08,530 --> 00:11:10,330
- Hi.
- It's good to meet you.
241
00:11:15,110 --> 00:11:17,350
- So, rounds are done.
What's next?
242
00:11:17,350 --> 00:11:19,150
Well, your partner in crime's
243
00:11:19,150 --> 00:11:20,760
sitting vigil for
a friend in the ICU.
244
00:11:20,760 --> 00:11:22,090
Have you checked in on her?
245
00:11:22,090 --> 00:11:24,260
I didn't want to
invade her space.
246
00:11:24,260 --> 00:11:26,840
It's always better
to extend yourself.
247
00:11:26,840 --> 00:11:28,740
Trust me, she's gonna
let you know if it's unwanted.
248
00:11:28,740 --> 00:11:30,580
Oh, I'm sure she will.
249
00:11:30,580 --> 00:11:32,150
So, as Chief Resident,
250
00:11:32,150 --> 00:11:33,850
you've gotta be
able to work with anyone.
251
00:11:33,850 --> 00:11:36,150
Is there anybody else,
anything you gotta get ahead of?
252
00:11:36,150 --> 00:11:38,290
I don't know
if you ever noticed,
253
00:11:38,290 --> 00:11:40,160
but Liz kind of had
a thing for TJ.
254
00:11:40,160 --> 00:11:41,800
Yeah, she wasn't
exactly subtle about it.
255
00:11:41,800 --> 00:11:43,600
Why, what's the problem?
256
00:11:43,600 --> 00:11:45,170
I...
257
00:11:46,210 --> 00:11:47,980
So, you and TJ?
258
00:11:49,310 --> 00:11:50,850
Wow, okay.
259
00:11:50,850 --> 00:11:52,890
I guess I missed that.
How long has that been going on?
260
00:11:52,890 --> 00:11:55,990
Not very, and you of all
people don't get to judge.
261
00:11:55,990 --> 00:11:58,460
I'm just not sure how
everyone else will react.
262
00:11:58,460 --> 00:11:59,930
Well, listen.
263
00:11:59,930 --> 00:12:02,040
I mean, you can't control how
people feel about you, okay?
264
00:12:02,040 --> 00:12:04,410
All you can do is show everyone
that you're gonna be there
265
00:12:04,410 --> 00:12:07,020
for them when things get tough.
266
00:12:07,650 --> 00:12:10,050
- Ah, Dr. Hamda.
Do you have a minute?
267
00:12:10,050 --> 00:12:12,030
- Of course, yeah.
Come in, have a seat.
268
00:12:14,360 --> 00:12:18,610
I know I should have
said something sooner.
269
00:12:19,040 --> 00:12:21,780
I think I was just too afraid
270
00:12:21,780 --> 00:12:23,080
that no one was
gonna take me seriously.
271
00:12:23,080 --> 00:12:26,250
It's okay, Liz. What is it?
272
00:12:28,360 --> 00:12:29,560
Dr. Miller.
273
00:12:29,560 --> 00:12:30,960
What he did to me.
274
00:12:30,960 --> 00:12:33,670
Everyone's just pretending
like nothing happened,
275
00:12:33,670 --> 00:12:35,870
but it was an abuse of power.
276
00:12:38,080 --> 00:12:42,950
I appreciate your honesty,
and I understand how you feel.
277
00:12:42,950 --> 00:12:46,290
- Not how I feel.
It's what happened.
278
00:12:47,660 --> 00:12:50,670
Nobody condones
what Dr. Miller did,
279
00:12:50,670 --> 00:12:52,110
but an agreement was reached.
280
00:12:52,110 --> 00:12:54,810
- What agreement?
- I'm afraid I can't discuss it.
281
00:12:54,810 --> 00:12:56,450
So you won't tell
me what happened?
282
00:12:58,850 --> 00:13:00,820
It was
a confidential settlement.
283
00:13:00,820 --> 00:13:03,430
I'm sorry, Liz.
284
00:13:04,100 --> 00:13:06,330
I guess this just
proves why I never
285
00:13:06,330 --> 00:13:09,140
should have bothered coming
forward in the first place.
286
00:13:17,620 --> 00:13:18,990
CT confirms location,
287
00:13:18,990 --> 00:13:20,500
we're clear of
the vertebral artery.
288
00:13:20,500 --> 00:13:22,570
Advancing cannula into position.
289
00:13:28,310 --> 00:13:29,410
Hey, babe.
290
00:13:29,410 --> 00:13:32,750
Okay. So, I nearly had
to sell my body for it,
291
00:13:32,750 --> 00:13:35,560
but Spoon and Stable
finally called me back.
292
00:13:35,560 --> 00:13:37,100
They had a cancellation?
293
00:13:37,100 --> 00:13:39,600
I told them it was our
anniversary, and they said
294
00:13:39,600 --> 00:13:41,440
they could squeeze us in at six.
295
00:13:41,440 --> 00:13:42,910
Can you make that work?
296
00:13:42,910 --> 00:13:44,510
Well, looks like
I'm gonna have to.
297
00:13:44,510 --> 00:13:46,150
No way we're missing
out on those oysters.
298
00:13:46,150 --> 00:13:49,750
So, there's a chance I may
need to swing back here.
299
00:13:49,750 --> 00:13:52,790
Oh no. Is it that boy
you told me about?
300
00:13:52,790 --> 00:13:55,070
Found a pretty serious
issue with his spine,
301
00:13:55,070 --> 00:13:56,570
he's in surgery now.
302
00:13:56,570 --> 00:13:58,870
Oh honey, that's terrible.
303
00:13:58,870 --> 00:14:01,140
Are the social workers
being helpful?
304
00:14:01,140 --> 00:14:03,050
Not really. I had to make
the decision myself
305
00:14:03,050 --> 00:14:04,580
about what surgery
he should have.
306
00:14:04,580 --> 00:14:06,720
Okay, I know it's not my lane,
307
00:14:06,720 --> 00:14:09,990
and I love you for being
the person who cares this much.
308
00:14:09,990 --> 00:14:12,670
But the last time you got
this invested in a case...
309
00:14:12,670 --> 00:14:15,070
He has no one, Wendy.
310
00:14:15,070 --> 00:14:16,970
I have no choice.
311
00:14:19,080 --> 00:14:21,320
Well, she told me
about the prednisone,
312
00:14:21,320 --> 00:14:22,920
that it landed her
here a lot sooner
313
00:14:22,920 --> 00:14:24,420
than she would have otherwise.
314
00:14:25,020 --> 00:14:27,930
Yeah. She is strong-willed.
315
00:14:27,930 --> 00:14:30,130
That's what we love about her.
316
00:14:30,800 --> 00:14:33,410
She probably felt
like she had no choice.
317
00:14:33,410 --> 00:14:36,650
You know, I, after I told her
I didn't want to see her,
318
00:14:36,650 --> 00:14:38,690
what else did she
have besides work?
319
00:14:39,220 --> 00:14:41,830
And now, Robbie may never
even get to know her.
320
00:14:42,590 --> 00:14:45,700
She knew that making things
right with you was on her.
321
00:14:45,700 --> 00:14:47,440
Not you.
322
00:14:48,610 --> 00:14:51,380
All you can do now is be
there for each other.
323
00:15:15,830 --> 00:15:18,300
What did you do?
324
00:15:19,870 --> 00:15:23,410
She was fine.
She was just fine an hour ago.
325
00:15:23,410 --> 00:15:24,540
What did you do?
326
00:15:24,540 --> 00:15:26,510
- It's not their fault.
She had a heart attack.
327
00:15:26,510 --> 00:15:29,150
Nobody could have
seen this coming.
328
00:15:34,000 --> 00:15:37,840
Amy. Uh, how is Joan doing?
329
00:15:37,840 --> 00:15:41,710
- Um, she's stable for now.
On chemo.
330
00:15:42,610 --> 00:15:45,850
I'm sure this must be hard for
you. If there's anything I can...
331
00:15:45,850 --> 00:15:48,120
Something's escalating in there.
332
00:15:50,600 --> 00:15:52,100
Her temperature's dropping.
333
00:15:52,100 --> 00:15:53,970
Yeah, core temp can drop
334
00:15:53,970 --> 00:15:55,540
after starting chemotherapy,
it's normal.
335
00:15:55,540 --> 00:15:57,980
But it can also be
a sign of sepsis.
336
00:15:57,980 --> 00:16:01,020
No, all of her cultures
were negative.
337
00:16:01,020 --> 00:16:02,290
Is that true?
338
00:16:02,290 --> 00:16:04,560
Yes, of course that's true.
339
00:16:04,560 --> 00:16:08,000
And you should know
that Dr. Larsen
340
00:16:08,000 --> 00:16:09,670
recommended a course
of treatment earlier
341
00:16:09,670 --> 00:16:11,540
that could have been
catastrophic for your mother.
342
00:16:11,540 --> 00:16:14,980
So, I don't think that
it is a good idea
343
00:16:14,980 --> 00:16:17,080
for friends to treat each other.
344
00:16:20,250 --> 00:16:22,760
I admire your mom,
but I can be objective,
345
00:16:22,760 --> 00:16:24,130
and that's what she needs.
346
00:16:27,000 --> 00:16:28,270
He's right.
347
00:16:28,940 --> 00:16:30,780
Sorry, Ethan.
348
00:16:38,690 --> 00:16:39,860
- Hey.
- Hey.
349
00:16:39,860 --> 00:16:41,830
Do you have any of Joan
Ridley's blood left over?
350
00:16:41,830 --> 00:16:43,670
Yeah, we should have some extra.
351
00:16:43,670 --> 00:16:44,870
Can you run a beta-D-glucan?
352
00:16:44,870 --> 00:16:46,910
All her cultures
came back negative.
353
00:16:46,910 --> 00:16:48,340
What are you looking for?
354
00:16:48,340 --> 00:16:50,920
I want to rule out
an invasive fungal infection.
355
00:16:50,920 --> 00:16:52,750
Something in
the endothelial tissue.
356
00:16:52,750 --> 00:16:54,360
You got it.
357
00:16:54,360 --> 00:16:56,230
And uh, when you're done,
358
00:16:56,230 --> 00:16:58,200
can you get me
the results directly?
359
00:16:58,200 --> 00:17:00,430
Says Dr. Miller's assigned.
360
00:17:00,430 --> 00:17:01,700
He is.
361
00:17:02,770 --> 00:17:06,280
I need this, Carin. Please.
362
00:17:06,280 --> 00:17:07,550
Sure.
363
00:17:09,950 --> 00:17:11,490
Hey, how's it going?
364
00:17:11,490 --> 00:17:15,770
Hey. I'm at the school,
apparently Mia got into a fight.
365
00:17:16,770 --> 00:17:18,070
Let me guess, with Logan?
366
00:17:18,070 --> 00:17:20,040
I haven't had a chance
to talk to her about it,
367
00:17:20,040 --> 00:17:21,110
but figured we should
do it together.
368
00:17:21,110 --> 00:17:22,950
Can I bring her by the hospital?
369
00:17:22,950 --> 00:17:24,250
Shouldn't take too long.
370
00:17:24,250 --> 00:17:26,550
- Yeah, yeah, of course.
Um, yeah, I'm here.
371
00:17:33,000 --> 00:17:35,370
She killed herself, Gina.
372
00:17:35,370 --> 00:17:38,140
All those times I begged
her to quit smoking.
373
00:17:38,140 --> 00:17:41,220
Her blood pressure
was through the roof,
374
00:17:41,220 --> 00:17:42,690
it was only a matter of time.
375
00:17:42,690 --> 00:17:44,090
You can't keep fixating
376
00:17:44,090 --> 00:17:45,660
on what could have
gone differently. Okay?
377
00:17:45,660 --> 00:17:48,400
All you can do now is start
to process your pain.
378
00:17:48,400 --> 00:17:50,230
What makes you think I haven't?
379
00:17:50,230 --> 00:17:52,870
- It's been a week and a half.
You still haven't cried.
380
00:17:52,870 --> 00:17:55,850
Crying won't fix anything.
381
00:17:55,850 --> 00:17:58,220
I'm not saying force it, okay?
382
00:17:58,220 --> 00:18:00,250
But just let yourself feel.
383
00:18:00,250 --> 00:18:02,090
This is only gonna get worse
384
00:18:02,090 --> 00:18:03,800
once you're an actual
shrink, isn't it?
385
00:18:03,800 --> 00:18:07,100
That's neuropsychiatrist,
thank you very much.
386
00:18:08,100 --> 00:18:10,010
I just need to focus on school.
387
00:18:10,010 --> 00:18:13,850
And maybe that hot
bartender from Stanton.
388
00:18:13,850 --> 00:18:15,280
I'm serious, Amy.
389
00:18:15,280 --> 00:18:18,290
You're in grief
and mad at your mom.
390
00:18:18,290 --> 00:18:19,730
You can't just
push all that away.
391
00:18:19,730 --> 00:18:21,160
Why not?
392
00:18:21,160 --> 00:18:22,730
Cause when it comes to feelings,
393
00:18:22,730 --> 00:18:24,170
the piper has to get paid.
394
00:18:24,170 --> 00:18:26,110
One way or another.
395
00:18:34,720 --> 00:18:36,460
Hey.
396
00:18:36,460 --> 00:18:38,870
Just checking on you. Joan's
BP and O2 SATs are improving.
397
00:18:38,870 --> 00:18:40,570
Chemo must be having an effect.
398
00:18:40,570 --> 00:18:43,470
- I guess Richard was right.
About the leukemia.
399
00:18:43,470 --> 00:18:45,850
- At least we have a diagnosis.
Where are you?
400
00:18:45,850 --> 00:18:49,290
Uh, I'm in Radiology
with another patient.
401
00:18:49,290 --> 00:18:51,690
I'll be back soon.
- Okay.
402
00:18:54,100 --> 00:18:56,570
We won't be mad, honey.
403
00:18:56,570 --> 00:18:58,270
We just want you to
tell us what happened.
404
00:18:58,270 --> 00:19:00,510
Logan was throwing
markers at me.
405
00:19:01,140 --> 00:19:02,950
I thought we said when
he did stuff like that,
406
00:19:02,950 --> 00:19:04,450
you would tell the teacher.
407
00:19:04,450 --> 00:19:06,420
I did. But he didn't stop.
408
00:19:06,420 --> 00:19:09,790
So I took my chocolate pudding
409
00:19:09,790 --> 00:19:11,970
and I dumped it on his head.
410
00:19:13,940 --> 00:19:16,010
Um, so, what happened?
411
00:19:16,010 --> 00:19:18,110
You told the teacher and they
didn't do anything about it?
412
00:19:18,110 --> 00:19:19,950
They had him sit
in the big chair.
413
00:19:19,950 --> 00:19:21,350
What's the big chair?
414
00:19:21,350 --> 00:19:23,590
It's a big, comfy chair
in the corner,
415
00:19:23,590 --> 00:19:26,230
where you sit and think
about what you did.
416
00:19:26,230 --> 00:19:27,930
So, like a timeout.
417
00:19:27,930 --> 00:19:31,440
Okay, but uh, last week,
when you won the spelling bee,
418
00:19:31,440 --> 00:19:33,510
you said you got to sit
in a big, comfy chair.
419
00:19:33,510 --> 00:19:36,110
Yeah. You sit in it
if you do something good.
420
00:19:36,110 --> 00:19:40,690
But then, sometimes, you sit
in it if you do something bad.
421
00:19:43,630 --> 00:19:45,360
I want her out of
that school, Rache. Okay?
422
00:19:45,360 --> 00:19:47,330
There's the public school,
there's the Hebrew school
423
00:19:47,330 --> 00:19:48,870
we toured,
I don't care which one.
424
00:19:48,870 --> 00:19:50,980
I just think that she
needs to be somewhere
425
00:19:50,980 --> 00:19:52,250
with more boundaries and grit,
426
00:19:52,250 --> 00:19:54,420
and fewer participation trophies
and big chairs.
427
00:19:54,850 --> 00:19:56,290
Okay.
428
00:19:56,290 --> 00:19:58,530
- Okay what?
- Okay, you're right.
429
00:19:58,530 --> 00:20:01,400
I'm wrong. Let's move her.
430
00:20:01,400 --> 00:20:04,140
Hold it, did you just tell me
I was right about something?
431
00:20:06,070 --> 00:20:07,940
And if you play
your cards right,
432
00:20:07,940 --> 00:20:09,880
it might even happen again.
433
00:20:11,850 --> 00:20:13,290
I'll take her home?
434
00:20:13,290 --> 00:20:15,320
Yeah, yeah.
435
00:20:24,410 --> 00:20:25,750
Are you alright?
436
00:20:29,150 --> 00:20:30,590
Yeah.
437
00:20:31,960 --> 00:20:36,870
I'm just realizing how
little power I have here.
438
00:20:40,980 --> 00:20:42,910
What happened?
439
00:20:44,580 --> 00:20:46,890
There's nothing to
be done about it, Sonya.
440
00:20:47,420 --> 00:20:50,130
No, no. I'm gonna be
Chief Resident,
441
00:20:50,130 --> 00:20:52,670
which means I can advocate.
442
00:21:01,320 --> 00:21:03,350
And this is unprofessional.
443
00:21:03,350 --> 00:21:05,320
You were never going to
test for this, Richard,
444
00:21:05,320 --> 00:21:06,330
and it's positive.
445
00:21:06,330 --> 00:21:07,600
You were not gonna listen to me.
446
00:21:07,600 --> 00:21:08,970
Well, that was my
call to make...
447
00:21:08,970 --> 00:21:10,600
Do you wanna tell me
what's going on here?
448
00:21:10,600 --> 00:21:12,540
She ran a test behind my back.
449
00:21:12,540 --> 00:21:13,610
That is hardly
the headline here.
450
00:21:13,610 --> 00:21:16,050
Joan has a Candida
organ infection,
451
00:21:16,050 --> 00:21:17,720
which he wouldn't have caught.
452
00:21:17,720 --> 00:21:19,550
I'm assuming you're
interested in treating this,
453
00:21:19,550 --> 00:21:21,460
even though I was
the one who found it.
454
00:21:21,460 --> 00:21:23,430
- Alright, alright.
That's enough.
455
00:21:23,430 --> 00:21:25,600
Clearly, the chemo
lowered her immune response,
456
00:21:25,600 --> 00:21:27,600
decrease the dosage for now
and treat the infection.
457
00:21:27,600 --> 00:21:29,840
But we are still on
the right path here.
458
00:21:32,750 --> 00:21:36,450
You know, I might be
more inclined to hear you,
459
00:21:36,450 --> 00:21:39,790
if you weren't so concerned
with putting me in my place.
460
00:21:42,500 --> 00:21:46,440
He was never gonna order
the panel. Out of spite.
461
00:21:46,440 --> 00:21:48,440
- If you needed backup...
- Which is it, Michael?
462
00:21:48,440 --> 00:21:50,310
I'm supposed to come to you
because you want to help?
463
00:21:50,310 --> 00:21:52,380
Or I'm not supposed to come to
464
00:21:52,380 --> 00:21:54,520
you because I put you
in a tough position,
465
00:21:54,520 --> 00:21:55,760
because I've heard it both ways.
466
00:21:55,760 --> 00:21:57,960
I am Chief now,
of your department.
467
00:21:57,960 --> 00:21:59,270
That's a lot different
468
00:21:59,270 --> 00:22:01,100
than running two floors
up to talk to the CMO.
469
00:22:01,100 --> 00:22:02,640
And by the way, you lied.
470
00:22:02,640 --> 00:22:03,780
Told me you were in Radiology,
471
00:22:03,780 --> 00:22:05,850
on our first day
working together.
472
00:22:10,250 --> 00:22:11,990
You're right. I'm sorry.
473
00:22:13,860 --> 00:22:15,530
I'm, I'm uh...
474
00:22:15,530 --> 00:22:19,810
Every time I look at Joan
in that bed, all I see is...
475
00:22:20,710 --> 00:22:21,980
Your mom.
476
00:22:26,390 --> 00:22:28,090
I wish you'd been here for that.
477
00:22:28,090 --> 00:22:29,990
I'm here now.
478
00:22:31,000 --> 00:22:32,400
I know.
479
00:22:32,400 --> 00:22:34,600
Try to hold on to that.
480
00:22:39,550 --> 00:22:42,050
- Oh, I think he's waking up.
- Walter, can you hear me?
481
00:22:42,050 --> 00:22:43,690
It hurts. Please, it hurts.
482
00:22:43,690 --> 00:22:47,030
- Blood pressure's spiking.
- Walter, try to breathe.
483
00:22:47,030 --> 00:22:48,460
My neck, it hurts so bad!
484
00:22:48,460 --> 00:22:50,130
Two milligrams
IV morphine, stat.
485
00:22:50,130 --> 00:22:51,400
Where in the neck?
486
00:22:51,400 --> 00:22:53,210
- Why can't I move my hands?
What's happening?
487
00:22:53,210 --> 00:22:56,010
It's okay, Walter. That can
sometimes happen with swelling.
488
00:22:56,450 --> 00:22:58,750
He lost his Babinski.
489
00:22:59,990 --> 00:23:01,590
So, the spinal cord's
not sending a signal?
490
00:23:01,590 --> 00:23:02,960
Costa's running a CT to confirm,
491
00:23:02,960 --> 00:23:05,570
but it seems the cord
swelling is causing compression.
492
00:23:05,570 --> 00:23:07,430
He's on morphine for the pain,
493
00:23:07,430 --> 00:23:09,270
but he's got serious
neurological deficits.
494
00:23:09,270 --> 00:23:10,710
No movement below the neck.
495
00:23:10,710 --> 00:23:12,810
The sooner we can get back
in and operate, the better.
496
00:23:12,810 --> 00:23:15,250
But his lungs are
still inflamed from the RA.
497
00:23:15,250 --> 00:23:17,590
He may not be able to take
another round of anesthesia.
498
00:23:17,590 --> 00:23:19,560
Dr. Costa's booked an OR for
first thing in the morning.
499
00:23:19,560 --> 00:23:21,000
Anything longer than that,
500
00:23:21,000 --> 00:23:23,000
then he could have serious
neurological issues permanently.
501
00:23:23,000 --> 00:23:24,440
We should have been
more aggressive.
502
00:23:24,440 --> 00:23:26,440
We can't Monday morning
quarterback.
503
00:23:26,440 --> 00:23:27,810
The surgeon gave
you two choices.
504
00:23:27,810 --> 00:23:29,680
And I picked the safer one,
because I was worried
505
00:23:29,680 --> 00:23:31,350
Walter doesn't have
the long term support
506
00:23:31,350 --> 00:23:32,950
to go for what was
really needed.
507
00:23:32,950 --> 00:23:34,820
- It was a coin toss, Gina.
- No, it wasn't.
508
00:23:34,820 --> 00:23:36,730
You wanted to go
for the other option.
509
00:23:36,730 --> 00:23:38,830
So Costa waffled. It should
not have been up to you.
510
00:23:38,830 --> 00:23:40,000
No, it shouldn't have been.
511
00:23:40,000 --> 00:23:42,100
So let me take this
off your plate now.
512
00:23:42,100 --> 00:23:43,980
Tell Costa I want Walter
513
00:23:43,980 --> 00:23:45,750
in reverse Trendelenburg
during the operation,
514
00:23:45,750 --> 00:23:48,050
and to use lung
protective ventilation
515
00:23:48,050 --> 00:23:49,590
with low tidal volume.
516
00:23:52,630 --> 00:23:55,060
He may never
walk again, Michael.
517
00:23:58,240 --> 00:24:01,140
Induction chemo
did a number on me.
518
00:24:01,140 --> 00:24:03,580
Well, you're almost
through the first dose.
519
00:24:03,580 --> 00:24:06,090
But we found an invasive
fungal infection,
520
00:24:06,090 --> 00:24:07,360
presumptive Candida.
521
00:24:07,360 --> 00:24:09,060
We're, we're treating it
with antifungals.
522
00:24:09,060 --> 00:24:11,100
Candida.
523
00:24:11,100 --> 00:24:13,500
Must have seeded in my liver.
524
00:24:13,500 --> 00:24:15,810
No, not the liver.
525
00:24:15,810 --> 00:24:17,640
It's likely diffused
endothelial,
526
00:24:17,640 --> 00:24:19,810
given the high
beta-D-glucan level.
527
00:24:19,810 --> 00:24:22,020
Did you finish your homework?
528
00:24:22,650 --> 00:24:25,260
Is your father,
is your father home yet?
529
00:24:25,260 --> 00:24:27,390
- Mom?
- Joan? Look at me.
530
00:24:27,390 --> 00:24:29,970
- What's wrong with her?
- Ethan, step back.
531
00:24:30,770 --> 00:24:32,270
What's happening?
532
00:24:32,270 --> 00:24:33,770
She's seizing.
533
00:24:33,770 --> 00:24:35,550
Oxygen at 10 liters.
534
00:24:35,550 --> 00:24:38,350
Altered mental status,
it's gotta be neurological.
535
00:24:38,350 --> 00:24:40,560
Increased ICP,
her brain's swelling.
536
00:24:40,560 --> 00:24:42,530
If she had leukemia,
this wouldn't be happening.
537
00:24:42,530 --> 00:24:44,230
Not this fast.
- You're right.
538
00:24:44,230 --> 00:24:46,230
We're missing something.
539
00:24:50,980 --> 00:24:52,680
Look, I know whatever
decisions were made
540
00:24:52,680 --> 00:24:55,180
about bringing Dr. Miller back
are way above my pay grade,
541
00:24:55,180 --> 00:24:57,660
but we can't just ask Liz
to forget what happened
542
00:24:57,660 --> 00:24:59,660
cause it'll make life
easier for everyone else.
543
00:24:59,660 --> 00:25:02,970
I'm going to talk to Richard
once Joan is stabilized.
544
00:25:02,970 --> 00:25:05,770
I'm sure he'll be willing
to apologize to Liz.
545
00:25:05,770 --> 00:25:09,780
His apology is gonna be
hollow and meaningless.
546
00:25:09,780 --> 00:25:11,780
And you should know,
when Dr. Miller was Chief,
547
00:25:11,780 --> 00:25:15,290
he tried to use me to find out
mistakes Amy was making.
548
00:25:15,730 --> 00:25:19,170
Look, I'm sorry you ended up
in the middle of that.
549
00:25:19,170 --> 00:25:21,740
But um, I know the board.
550
00:25:21,740 --> 00:25:23,570
They'd rather find a way
to get rid of Liz
551
00:25:23,570 --> 00:25:25,110
than reopen this can of worms.
552
00:25:25,110 --> 00:25:27,950
Well, they can try,
but if Liz starts talking,
553
00:25:27,950 --> 00:25:29,850
they're gonna get blowback
from the nurses
554
00:25:29,850 --> 00:25:31,420
and potentially the union.
555
00:25:31,420 --> 00:25:33,330
Is uh, is that a threat?
556
00:25:33,330 --> 00:25:34,900
It's a reality.
557
00:25:34,900 --> 00:25:37,700
I'm just trying to do
the right thing for her,
558
00:25:37,700 --> 00:25:40,370
and protect the department,
which is part of my job now.
559
00:25:40,370 --> 00:25:43,680
She bears responsibility
for her own decisions, Sonya.
560
00:25:43,680 --> 00:25:45,750
As you said, she has
a very strong union
561
00:25:45,750 --> 00:25:47,720
she could have gone to
when all this happened.
562
00:25:47,720 --> 00:25:49,530
I think, maybe,
you're expecting too much,
563
00:25:49,530 --> 00:25:53,600
or not understanding the dynamic
between an older man with power
564
00:25:53,600 --> 00:25:56,510
and a young woman at
the start of her career.
565
00:25:56,510 --> 00:25:58,110
It's blaming the victim,
566
00:25:58,110 --> 00:25:59,880
and I don't think
it'll be appreciated.
567
00:25:59,880 --> 00:26:02,920
- I do hear you.
- Well, good.
568
00:26:04,060 --> 00:26:06,660
Because you started the day
by saying your door was open,
569
00:26:06,660 --> 00:26:09,570
but now it seems like
you're closing it on Liz.
570
00:26:16,250 --> 00:26:17,780
The MDS is late-stage,
571
00:26:17,780 --> 00:26:20,920
but it's obscured
by high steroid usage.
572
00:26:20,920 --> 00:26:23,490
Pancytopenia, pleural effusions,
573
00:26:23,490 --> 00:26:26,000
DIC, elevated beta-D-glucan,
574
00:26:26,000 --> 00:26:29,340
and now cerebral edema,
and she's getting worse.
575
00:26:29,340 --> 00:26:32,680
- Hey, just checked in on Joan.
How you holding up?
576
00:26:32,680 --> 00:26:35,650
I've been going toe to toe
with Richard all day,
577
00:26:35,650 --> 00:26:37,250
and now we're
running out of time.
578
00:26:37,250 --> 00:26:38,520
Who's this?
579
00:26:38,520 --> 00:26:39,930
Um, he's a doctor in Madrid
580
00:26:39,930 --> 00:26:42,670
who has a case study
that might be relevant
581
00:26:42,670 --> 00:26:45,040
and this translation app
keeps glitching.
582
00:26:45,040 --> 00:26:47,410
Um, I mean,
I minored in Spanish,
583
00:26:47,410 --> 00:26:48,980
we could see how rusty I am.
584
00:26:48,980 --> 00:26:50,080
Okay.
585
00:27:25,520 --> 00:27:27,660
Gracias. So, what he's saying
586
00:27:27,660 --> 00:27:29,090
is that the symptoms
were similar,
587
00:27:29,090 --> 00:27:31,230
but his patient had
dormant sarcoidosis,
588
00:27:31,230 --> 00:27:33,470
so that was complicating
the clinical picture.
589
00:27:33,470 --> 00:27:35,000
But once they found that,
590
00:27:35,000 --> 00:27:36,110
everything else just
fell into place.
591
00:27:36,110 --> 00:27:37,880
So a patient with MDS like Joan
592
00:27:37,880 --> 00:27:39,250
presented with these symptoms
593
00:27:39,250 --> 00:27:41,580
because of a different
chronic issue.
594
00:27:41,580 --> 00:27:43,490
And it went
undetected for years.
595
00:27:43,490 --> 00:27:45,730
Okay, okay. Thanks.
596
00:27:45,730 --> 00:27:47,700
Just remember
you gotta find a way
597
00:27:47,700 --> 00:27:49,200
to work with Richard on this.
598
00:27:51,800 --> 00:27:53,670
Your spinal tap
came back negative
599
00:27:53,670 --> 00:27:55,140
and a full neuro panel too.
600
00:27:55,140 --> 00:27:57,580
Well, her procalcitonin is low,
601
00:27:57,580 --> 00:27:59,290
even though she just
had an infection.
602
00:27:59,290 --> 00:28:00,760
I need total protein,
603
00:28:00,760 --> 00:28:02,960
C-reactive protein
and complement levels.
604
00:28:02,960 --> 00:28:05,130
How fast can you do that?
- 20 minutes.
605
00:28:05,130 --> 00:28:08,200
And if the results can go
to me, since I'm her doctor,
606
00:28:08,200 --> 00:28:09,810
that'd be appreciated.
607
00:28:11,880 --> 00:28:14,180
We've got a high
complement protein level,
608
00:28:14,180 --> 00:28:17,020
and the prednisone must have
dropped her immune surveillance,
609
00:28:17,020 --> 00:28:19,890
which means that we're looking
for something that's been there.
610
00:28:19,890 --> 00:28:22,300
Possibly for years,
like you said,
611
00:28:22,300 --> 00:28:23,870
but that's been hiding
in plain sight.
612
00:28:23,870 --> 00:28:25,710
When Joan woke up,
613
00:28:25,710 --> 00:28:27,140
and I told her
about the Candida,
614
00:28:27,140 --> 00:28:28,710
she asked if it
seeded in her liver.
615
00:28:28,710 --> 00:28:30,580
Well, that wouldn't be uncommon.
616
00:28:30,580 --> 00:28:32,120
But the beta-D-glucan
is so high,
617
00:28:32,120 --> 00:28:33,620
the fungal load
would be too large
618
00:28:33,620 --> 00:28:35,160
to be isolated to her liver.
619
00:28:35,160 --> 00:28:37,860
Okay. We've been assuming that
the elevated liver enzymes
620
00:28:37,860 --> 00:28:41,470
are caused by the MDS
and the prednisone,
621
00:28:41,470 --> 00:28:44,480
but look at her blood work
going back to 2016.
622
00:28:45,910 --> 00:28:47,420
Higher range of normal.
623
00:28:47,420 --> 00:28:49,350
But low enough that
nobody would flag it.
624
00:28:49,350 --> 00:28:51,190
2016,
625
00:28:51,190 --> 00:28:54,530
that's a long time for her
to be carrying something.
626
00:28:55,200 --> 00:28:58,770
Wait a minute. One of the last
memories I have of her,
627
00:28:58,770 --> 00:29:00,340
2016, she was in Ecuador.
628
00:29:00,340 --> 00:29:04,420
And she got sick, and I told
her that she should come back.
629
00:29:04,420 --> 00:29:07,620
And she self-diagnosed,
630
00:29:07,620 --> 00:29:09,330
she thought it was dysentery...
631
00:29:09,330 --> 00:29:11,430
Which means she was
drinking unfiltered water.
632
00:29:11,430 --> 00:29:13,600
So, if it was a parasite,
633
00:29:13,600 --> 00:29:16,210
she could have been sick
while she was digesting it,
634
00:29:16,210 --> 00:29:19,480
but by the time it migrated
to her liver, she was fine.
635
00:29:19,480 --> 00:29:21,820
Then she could have been
fighting this quietly for years.
636
00:29:21,820 --> 00:29:23,590
And the prednisone
weakened her immune system,
637
00:29:23,590 --> 00:29:25,460
and unleashed it on her.
638
00:29:27,800 --> 00:29:29,870
I think we have a path now.
639
00:29:34,070 --> 00:29:35,910
He's losing sympathetic tone.
640
00:29:35,910 --> 00:29:38,720
Surgery's set for 6:00 AM,
can we up the steroids?
641
00:29:38,720 --> 00:29:40,190
Too worried about
his blood pressure.
642
00:29:40,190 --> 00:29:41,820
Think we just have
to stay the course
643
00:29:41,820 --> 00:29:43,890
and hope that he's strong
enough to hold on.
644
00:29:45,970 --> 00:29:48,140
I appreciate what
you said before.
645
00:29:48,140 --> 00:29:50,170
Trying to let me off the hook.
646
00:29:51,340 --> 00:29:52,850
You religious at all?
647
00:29:52,850 --> 00:29:54,380
From time to time,
648
00:29:54,380 --> 00:29:57,420
depending on how I'm
feeling about the world.
649
00:29:58,090 --> 00:30:00,260
I remember going to
this sermon once.
650
00:30:00,260 --> 00:30:04,140
The minister was talking about
how it can be a form of hubris
651
00:30:04,140 --> 00:30:05,970
to think that
we can control things
652
00:30:05,970 --> 00:30:08,310
that are out of our control.
653
00:30:09,580 --> 00:30:11,980
Cause that's somebody
else's domain?
654
00:30:11,980 --> 00:30:13,590
Doesn't mean
it's easy to accept it.
655
00:30:13,590 --> 00:30:16,090
But I think that's
the idea, yeah.
656
00:30:17,130 --> 00:30:19,830
I'll take that under
advisement, Dr. Coleman.
657
00:30:19,830 --> 00:30:21,200
Good.
658
00:30:25,480 --> 00:30:26,610
Your wife's here.
659
00:30:30,420 --> 00:30:32,260
It's my anniversary
and I forgot.
660
00:30:32,260 --> 00:30:34,200
You go. I am all over this,
661
00:30:34,200 --> 00:30:36,830
hourly exams,
I will not go home.
662
00:30:42,380 --> 00:30:45,150
I've been downstairs 15
minutes, tried calling you.
663
00:30:45,150 --> 00:30:48,190
I'm sorry. There were problems
with Walter's surgery,
664
00:30:48,190 --> 00:30:49,860
he needs another one tomorrow.
665
00:30:50,530 --> 00:30:52,800
Why don't we have dinner
in your office tonight?
666
00:30:52,800 --> 00:30:57,170
That way, if anything happens,
you're close.
667
00:30:57,170 --> 00:30:59,280
What did I do to deserve you?
668
00:30:59,280 --> 00:31:00,620
I don't know.
669
00:31:00,620 --> 00:31:03,150
I'm sure you'll find a way
to make it up to me.
670
00:31:04,490 --> 00:31:07,290
I'm thinking 400
milligrams albendazole.
671
00:31:07,830 --> 00:31:09,800
I'd go 300,
672
00:31:09,800 --> 00:31:12,200
given the ALT/AST,
673
00:31:12,200 --> 00:31:14,640
and 20 of Ampho B
to balance it out.
674
00:31:14,640 --> 00:31:16,680
And 100 milligrams of cimetidine
675
00:31:16,680 --> 00:31:18,250
to cut the renal toxicity.
676
00:31:19,520 --> 00:31:20,890
It's a tightrope.
677
00:31:20,890 --> 00:31:22,790
Any idea where Liz is?
678
00:31:22,790 --> 00:31:24,100
Uh, let's see.
679
00:31:24,100 --> 00:31:27,400
Code Blue, ICU.
Code Blue, ICU.
680
00:31:27,400 --> 00:31:28,570
Joan's coding.
681
00:31:29,300 --> 00:31:31,410
Code Blue, ICU.
682
00:31:31,410 --> 00:31:33,380
Code Blue, ICU.
683
00:31:34,580 --> 00:31:36,320
No pulse.
684
00:31:36,320 --> 00:31:37,960
- He's in V-fib.
Push one milligram Epi.
685
00:31:37,960 --> 00:31:40,030
Get the defibrillator.
686
00:31:48,410 --> 00:31:50,180
Ready?
687
00:31:51,180 --> 00:31:53,020
Clear.
688
00:31:55,960 --> 00:31:58,460
Restarting compressions.
689
00:32:06,380 --> 00:32:09,490
- Danny, Danny.
Someone call 911.
690
00:32:10,860 --> 00:32:12,290
Charge to 50.
691
00:32:13,460 --> 00:32:15,460
Clear.
692
00:32:20,010 --> 00:32:22,550
Pushing another
milligram of Epi.
693
00:32:28,990 --> 00:32:31,260
Fine V-fib, we're losing him.
694
00:32:31,260 --> 00:32:34,030
- Going up to 100.
Give me the paddles.
695
00:32:38,040 --> 00:32:40,210
- Ready.
- Clear.
696
00:32:49,870 --> 00:32:51,100
Looks like Sinus.
697
00:32:51,100 --> 00:32:53,670
We have a pulse. He's back.
698
00:32:53,670 --> 00:32:56,610
Page Dr. Costa,
we can't wait on the surgery.
699
00:33:19,690 --> 00:33:21,330
Cord is decompressed.
700
00:33:21,330 --> 00:33:25,500
Screws are seated.
Let's secure the rods.
701
00:33:26,010 --> 00:33:27,510
Hey.
702
00:33:31,020 --> 00:33:34,120
That must have been
really difficult for you.
703
00:33:34,790 --> 00:33:36,390
Yeah.
704
00:33:37,230 --> 00:33:40,070
And a hell of a first day
for Michael.
705
00:33:40,070 --> 00:33:42,770
Oh, it hit pretty close to home.
706
00:33:44,240 --> 00:33:45,950
How's it going in there?
707
00:33:45,950 --> 00:33:47,680
Hardware's almost in place.
708
00:33:47,680 --> 00:33:49,950
But even if it works,
709
00:33:49,950 --> 00:33:52,090
no one's ever gonna adopt him.
710
00:33:52,090 --> 00:33:54,800
Not when he needs
this kind of support.
711
00:33:57,740 --> 00:34:01,440
You're not thinking
of doing something drastic?
712
00:34:02,810 --> 00:34:04,450
Go and be with Joan.
713
00:34:05,050 --> 00:34:06,790
Gina.
714
00:34:07,920 --> 00:34:09,690
I care about him,
715
00:34:10,460 --> 00:34:13,570
but I know what
the boundaries are.
716
00:34:13,970 --> 00:34:16,570
Now go, where you're needed.
717
00:34:30,370 --> 00:34:32,240
But you've gotta quit smoking.
718
00:34:32,240 --> 00:34:34,170
You know that's never
gonna happen, honey.
719
00:34:38,350 --> 00:34:40,960
I don't know how much more
we can pump into her
720
00:34:40,960 --> 00:34:43,260
before she starts shutting down.
721
00:34:43,260 --> 00:34:46,170
Her body's so fragile.
722
00:34:47,430 --> 00:34:50,210
The chemo didn't help with that.
723
00:34:50,880 --> 00:34:53,480
She was only on it
for eight hours.
724
00:34:55,020 --> 00:34:56,690
The parasite is causing this,
725
00:34:56,690 --> 00:35:00,130
that and the prednisone,
it's not on you, Richard.
726
00:35:37,940 --> 00:35:39,770
Hey. It's okay, buddy.
727
00:35:50,700 --> 00:35:52,800
Can I see?
728
00:35:55,340 --> 00:35:57,940
Aww, she's gonna love this.
729
00:36:01,050 --> 00:36:03,050
Is she gonna wake up soon?
730
00:36:03,050 --> 00:36:05,560
I really hope so.
731
00:36:21,090 --> 00:36:22,090
Hello?
732
00:36:22,090 --> 00:36:23,930
Hi, Amy.
It's Dr. Ridley.
733
00:36:23,930 --> 00:36:27,470
Oh. Hi.
734
00:36:27,470 --> 00:36:29,270
I hope it's not 2:00 AM there,
735
00:36:29,270 --> 00:36:31,510
I stopped tracking time zone
differences ages ago.
736
00:36:31,510 --> 00:36:34,620
- No, it's noon.
Is there a problem?
737
00:36:34,620 --> 00:36:36,550
I spoke with
Dr. Kelly this morning,
738
00:36:36,550 --> 00:36:37,990
he told me about your mother.
739
00:36:39,260 --> 00:36:41,700
I'm just so sorry, Amy.
740
00:36:42,260 --> 00:36:44,970
Thank you, Dr. Ridley.
741
00:36:44,970 --> 00:36:46,100
And I respect your tenacity,
742
00:36:46,100 --> 00:36:47,640
already being back
in the hospital,
743
00:36:47,640 --> 00:36:50,150
but I just wanted to make sure
you're taking care of yourself.
744
00:36:50,150 --> 00:36:52,990
I think so.
745
00:36:54,990 --> 00:36:56,530
It's...
746
00:36:56,530 --> 00:36:59,530
It's been hard, obviously.
747
00:36:59,530 --> 00:37:02,140
Your world shifted on its axis.
748
00:37:02,140 --> 00:37:04,270
But you will come out
the other side.
749
00:37:04,270 --> 00:37:05,880
I just...
750
00:37:07,050 --> 00:37:09,320
didn't even think you liked me.
751
00:37:09,320 --> 00:37:11,420
Well, that's by design, my dear.
752
00:37:11,420 --> 00:37:13,290
And now you know the truth.
753
00:37:13,290 --> 00:37:16,970
Not only do I like you,
I believe in you.
754
00:37:19,270 --> 00:37:22,410
Thank you so much. I...
755
00:37:22,410 --> 00:37:24,280
I know how bad
this hurts right now,
756
00:37:24,280 --> 00:37:26,420
but the best way that
you can honor your mother
757
00:37:26,420 --> 00:37:27,990
is to live a life with purpose.
758
00:37:27,990 --> 00:37:30,830
You have greatness in you, Amy.
759
00:37:30,830 --> 00:37:33,770
And I'll be there
to help you find it.
760
00:37:44,090 --> 00:37:46,090
Joan.
761
00:37:46,090 --> 00:37:48,500
Hey. Can you hear me?
762
00:37:49,100 --> 00:37:52,740
Can you get her son?
He just went to get coffee.
763
00:37:53,770 --> 00:37:56,780
Hey. It's okay.
764
00:37:57,180 --> 00:38:00,050
Just go slow. Breathe.
765
00:38:02,420 --> 00:38:05,530
- What happened?
- You had cerebral edema.
766
00:38:05,530 --> 00:38:06,970
No.
767
00:38:06,970 --> 00:38:10,740
It's not leukemia. Not yet.
768
00:38:10,740 --> 00:38:13,580
You had a parasite
in your liver.
769
00:38:13,580 --> 00:38:17,090
From Ecuador.
Do you remember that?
770
00:38:17,090 --> 00:38:18,960
You thought it was dysentery?
771
00:38:19,690 --> 00:38:21,230
Oh my God.
772
00:38:21,900 --> 00:38:25,970
Is that the one time
in my life I misdiagnosed?
773
00:38:33,050 --> 00:38:35,960
You haven't looked after
yourself for a long time.
774
00:38:38,060 --> 00:38:39,360
I know.
775
00:38:39,360 --> 00:38:41,870
Promise me that stops now.
776
00:38:41,870 --> 00:38:43,840
Ah.
777
00:38:43,840 --> 00:38:45,710
Mom. Hey.
778
00:38:45,710 --> 00:38:47,010
Hey.
779
00:38:47,980 --> 00:38:49,890
Thanks so much, Amy.
780
00:38:51,520 --> 00:38:55,830
I'll order CBC
and liver function tests.
781
00:38:58,640 --> 00:39:00,370
The fact that she's conscious...
782
00:39:00,370 --> 00:39:02,480
Yeah, we got her some more time.
783
00:39:03,410 --> 00:39:06,590
I appreciate you finding
a way to trust me today.
784
00:39:08,490 --> 00:39:10,130
Yeah, it worked out today.
785
00:39:10,790 --> 00:39:13,630
But I'm never gonna
trust you, Richard.
786
00:39:21,250 --> 00:39:24,250
Hey, Walter. Welcome back.
787
00:39:24,250 --> 00:39:25,690
Did you fix my spine?
788
00:39:25,690 --> 00:39:28,660
We need to run some tests
over the next few days,
789
00:39:28,660 --> 00:39:30,630
but it seems that way.
790
00:39:30,630 --> 00:39:32,370
And I'll be able to walk again?
791
00:39:32,370 --> 00:39:33,810
It's gonna be a long recovery,
792
00:39:33,810 --> 00:39:36,710
lots of physical therapy
as your body adjusts
793
00:39:36,710 --> 00:39:38,880
to the hardware in your spine.
794
00:39:38,880 --> 00:39:40,990
But yes, you will.
795
00:39:44,430 --> 00:39:47,130
And I'll have to miss
the next adoption fair?
796
00:39:47,840 --> 00:39:51,180
- There'll be lots more.
I promise.
797
00:39:51,180 --> 00:39:52,750
Thank you, Dr. Walker.
798
00:39:52,750 --> 00:39:55,780
Nobody ever cared
the way you do.
799
00:39:59,360 --> 00:40:01,460
I am so sorry.
800
00:40:01,460 --> 00:40:04,600
- It's okay.
We'll do a raincheck.
801
00:40:11,720 --> 00:40:14,960
Sometimes, I wonder how you
manage to leave it all
802
00:40:14,960 --> 00:40:16,830
here when you come home.
803
00:40:18,460 --> 00:40:20,900
It can be really hard.
804
00:40:21,370 --> 00:40:22,970
Yeah.
805
00:40:32,760 --> 00:40:35,260
Let's go get a drink, huh?
806
00:40:35,260 --> 00:40:36,700
Yeah.
807
00:40:45,350 --> 00:40:47,990
Hey. So, I spoke to Liz,
808
00:40:47,990 --> 00:40:50,660
and told her if she wants
to come forward to HR,
809
00:40:50,660 --> 00:40:52,360
we would both have her back.
810
00:40:52,900 --> 00:40:56,070
- Thank you.
Oh, and I'm sorry if I was too...
811
00:40:56,070 --> 00:40:59,410
Sonya, speaking truth
to power takes courage.
812
00:40:59,410 --> 00:41:01,820
I should be thanking you.
813
00:41:02,790 --> 00:41:05,120
Sorry, I didn't
mean to interrupt.
814
00:41:05,120 --> 00:41:06,660
Oh no, I was just leaving.
815
00:41:06,660 --> 00:41:09,160
Actually, I was
hoping to speak to you.
816
00:41:12,200 --> 00:41:14,780
I just wanted to thank you
for checking in earlier.
817
00:41:14,780 --> 00:41:18,220
Joan's improving.
- I heard, that's great news.
818
00:41:19,790 --> 00:41:22,490
- So we're gonna do this thing?
Together?
819
00:41:22,490 --> 00:41:24,360
Well, it's what she wants.
820
00:41:24,360 --> 00:41:26,300
She tends to get what she wants.
821
00:41:26,300 --> 00:41:27,770
Yeah.
822
00:41:32,650 --> 00:41:35,680
I saw Joan,
she's spunky as ever.
823
00:41:35,680 --> 00:41:38,060
Can't keep that lady down.
824
00:41:39,420 --> 00:41:41,560
- Amen to that.
- Yeah.
825
00:41:41,560 --> 00:41:44,700
- Goodnight, Jake.
- Hey. Goodnight, man.
826
00:41:50,410 --> 00:41:53,150
Hey, did you know
about him and Sonya?
827
00:41:53,150 --> 00:41:55,390
What about them?
828
00:41:55,390 --> 00:41:57,430
No.
- Yeah.
829
00:41:59,160 --> 00:42:01,140
I guess we set a good example.
830
00:42:06,950 --> 00:42:09,280
I heard your family
was here today.
831
00:42:09,280 --> 00:42:10,990
Yeah. Um...
832
00:42:10,990 --> 00:42:13,360
Mia, she got in
trouble at school, it was,
833
00:42:13,360 --> 00:42:15,330
er, I don't know,
it was ridiculous.
834
00:42:16,700 --> 00:42:20,210
Maybe you can tell me
all about it on the way home?
835
00:42:21,680 --> 00:42:24,780
- Yeah, sure thing, Chief.
I can do that.
836
00:42:25,680 --> 00:42:27,860
It's Co-Chief.
837
00:42:27,860 --> 00:42:30,690
Co-Chief. I'm sorry,
that's just so awkward to say.
838
00:42:30,690 --> 00:42:33,370
I know, tell me about it.
839
00:42:33,370 --> 00:42:35,000
Co-Chief.
58156
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