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1
00:00:01,031 --> 00:00:03,383
Then why don't you check
the *** next to the pantry?
2
00:00:04,476 --> 00:00:06,671
I'm sorry, Robert, but I...
I don't know where they are.
3
00:00:06,726 --> 00:00:09,334
I'll tell you what, I'll get another
set made on my way home.
4
00:00:09,358 --> 00:00:10,990
[clears throat]
5
00:00:12,479 --> 00:00:15,381
[sighs] Look, babe, I really have to go.
6
00:00:15,415 --> 00:00:17,850
Yeah, sure, that's fine.
7
00:00:19,519 --> 00:00:20,920
Okay, I love you too.
8
00:00:21,020 --> 00:00:22,955
Bye-bye.
9
00:00:24,424 --> 00:00:25,725
My apologies.
10
00:00:25,759 --> 00:00:27,093
Everything okay?
11
00:00:27,127 --> 00:00:28,895
Yeah, Robin just couldn't find her keys.
12
00:00:28,929 --> 00:00:30,796
Rough morning? Perhaps I
should take over the pre-op?
13
00:00:30,831 --> 00:00:33,399
That will not be necessary.
14
00:00:33,433 --> 00:00:34,734
Shall we?
15
00:00:34,768 --> 00:00:36,936
Please.
16
00:00:36,970 --> 00:00:38,638
Just a heads-up:
17
00:00:38,672 --> 00:00:40,640
the board is gonna push you
for more growth.
18
00:00:40,674 --> 00:00:42,642
The bottom line has them concerned.
19
00:00:42,676 --> 00:00:44,143
When hasn't it? Can set my watch
20
00:00:44,177 --> 00:00:45,344
over their money worries.
21
00:00:45,379 --> 00:00:46,646
I'll be fine.
22
00:00:46,680 --> 00:00:47,980
It's different this time.
23
00:00:48,015 --> 00:00:51,517
C-Suite feels we can better recognize
24
00:00:51,551 --> 00:00:53,819
how medicine and business
are one and the same.
25
00:00:53,854 --> 00:00:55,154
Ah, let me guess:
26
00:00:55,188 --> 00:00:56,956
scale back on outreach,
27
00:00:56,990 --> 00:00:59,592
combine responsibilities, outsource?
28
00:00:59,626 --> 00:01:02,261
So basically, sacrifice patient care?
29
00:01:02,296 --> 00:01:04,030
I won't do that, Peter.
30
00:01:04,064 --> 00:01:05,665
Well, Sharon, you have to do something,
31
00:01:05,699 --> 00:01:08,534
because the ED is hemorrhaging cash,
32
00:01:08,568 --> 00:01:09,936
and if the bleeding doesn't stop,
33
00:01:09,970 --> 00:01:11,637
it's not going to be good for anybody.
34
00:01:11,672 --> 00:01:13,539
- Mm.
- Need I remind you
35
00:01:13,573 --> 00:01:17,109
Randall Memorial closed their ED?
36
00:01:19,313 --> 00:01:21,280
Dr. Halstead, Doris, you're with me.
37
00:01:21,315 --> 00:01:23,015
- Copy that.
- Barry?
38
00:01:23,050 --> 00:01:24,684
- [heavy breathing]
- Alex Mayer, 23.
39
00:01:24,718 --> 00:01:26,552
Slash and stab.
Large diagonal lacerations
40
00:01:26,586 --> 00:01:27,720
of the abdomen.
41
00:01:27,754 --> 00:01:29,155
He's a little tachy. GCS 15.
42
00:01:29,189 --> 00:01:30,156
Get it out!
43
00:01:30,190 --> 00:01:31,190
You're going Baghdad.
44
00:01:31,224 --> 00:01:32,224
Get it out!
45
00:01:32,259 --> 00:01:33,659
The weapon still in?
46
00:01:33,694 --> 00:01:34,794
I don't know. Wasn't even a call.
47
00:01:34,828 --> 00:01:36,062
We were a few blocks away,
48
00:01:36,096 --> 00:01:37,463
I saw him on the street, bleeding,
49
00:01:37,497 --> 00:01:38,965
loaded him in the ambo and rolled.
50
00:01:38,999 --> 00:01:40,733
- I can feel it inside me!
- Whoa, whoa!
51
00:01:40,767 --> 00:01:41,801
Alex, keep your hands down.
52
00:01:41,835 --> 00:01:43,336
I got you, Dr. Halstead.
53
00:01:43,370 --> 00:01:44,670
Let's transfer.
54
00:01:44,705 --> 00:01:47,139
On my count. One, two, three!
55
00:01:47,174 --> 00:01:48,140
[screams]
56
00:01:48,175 --> 00:01:49,475
[groans]
57
00:01:49,509 --> 00:01:50,977
Two of Versed to calm him down.
58
00:01:51,011 --> 00:01:52,712
Thank you, boys.
59
00:01:52,746 --> 00:01:55,548
[sobbing]
60
00:01:55,582 --> 00:01:57,817
- How's that Versed coming?
- On it, Doctor.
61
00:01:57,851 --> 00:01:59,585
Gaping diagonal incision
62
00:01:59,619 --> 00:02:00,886
of the right upper quad.
63
00:02:00,921 --> 00:02:02,154
Evidence of evisceration?
64
00:02:02,189 --> 00:02:03,723
No, I can see the base.
65
00:02:03,757 --> 00:02:05,725
Abdomen's still intact.
Just a flesh wound.
66
00:02:05,759 --> 00:02:07,059
It's really clean, though.
67
00:02:07,094 --> 00:02:08,361
Wash it out and stitch it up.
68
00:02:08,395 --> 00:02:09,362
Irrigation.
69
00:02:09,396 --> 00:02:10,930
Sir, you're a lucky man.
70
00:02:10,964 --> 00:02:13,065
Whoever knifed you
didn't do any serious damage.
71
00:02:13,100 --> 00:02:15,735
[suspenseful music]
72
00:02:15,769 --> 00:02:17,169
Look at this. Betadine's smeared
73
00:02:17,204 --> 00:02:18,571
all over the abdomen.
74
00:02:18,605 --> 00:02:19,939
The skin was prepped before the cut.
75
00:02:19,973 --> 00:02:21,774
I'm telling you,
that incision is precise.
76
00:02:21,808 --> 00:02:24,677
Back-alley surgery gone wrong?
77
00:02:24,711 --> 00:02:26,212
Alex, what happened?
78
00:02:26,246 --> 00:02:27,446
I was desperate.
79
00:02:27,481 --> 00:02:30,549
Dr. Halstead, his hand, under the blood.
80
00:02:30,584 --> 00:02:31,917
More Betadine.
81
00:02:31,952 --> 00:02:34,220
So he doused his own hands.
82
00:02:34,254 --> 00:02:35,855
Alex, did you cut into yourself?
83
00:02:35,889 --> 00:02:37,590
I had to! I had to get it out!
84
00:02:37,624 --> 00:02:38,858
Get what out?
85
00:02:38,892 --> 00:02:41,293
The person living inside me!
86
00:02:41,359 --> 00:02:46,290
♪
87
00:02:46,892 --> 00:02:51,062
Synced & corrected by kinglouisxx
www.addic7ed.com
88
00:02:53,840 --> 00:02:55,808
- [gasps]
- Oh, I'm sorry.
89
00:02:55,842 --> 00:02:57,877
Are you all right?
I was just trying to say "hi."
90
00:02:57,911 --> 00:03:00,046
Um, it's Edith Lake.
91
00:03:00,080 --> 00:03:01,647
Your insulin patient?
92
00:03:01,681 --> 00:03:03,949
The woman who slashed my tires?
93
00:03:03,984 --> 00:03:06,619
Oh, the woman you think
slashed your tires.
94
00:03:06,653 --> 00:03:08,220
Who else?
95
00:03:08,255 --> 00:03:09,622
I saw her yesterday,
96
00:03:09,656 --> 00:03:11,257
across the street from my apartment.
97
00:03:11,291 --> 00:03:14,493
You really think it was her?
98
00:03:14,528 --> 00:03:16,562
Looked like her.
99
00:03:16,596 --> 00:03:18,464
Next.
100
00:03:22,803 --> 00:03:25,905
Dr. Latham, this is Ray Preston, 53.
101
00:03:25,939 --> 00:03:27,573
Fell short of breath while jogging.
102
00:03:27,607 --> 00:03:29,241
I was only two miles in.
103
00:03:29,276 --> 00:03:31,644
I'm always good for five
before I start to get tired.
104
00:03:31,678 --> 00:03:33,179
Ray lives in Galena.
105
00:03:33,213 --> 00:03:35,314
It's about 3 1/2 hours west of Chicago.
106
00:03:35,348 --> 00:03:37,450
His cardiologist performed an EKG,
107
00:03:37,484 --> 00:03:39,418
stress test, and cardiac cath.
108
00:03:39,453 --> 00:03:40,853
Told me to skip the community hospital
109
00:03:40,887 --> 00:03:43,689
and come straight here.
110
00:03:43,723 --> 00:03:44,957
Dr. Rhodes, I know we're getting
111
00:03:44,991 --> 00:03:46,125
pretty close to show time here,
112
00:03:46,159 --> 00:03:47,126
but are you absolutely sure
113
00:03:47,160 --> 00:03:48,127
I need this surgery?
114
00:03:48,161 --> 00:03:49,929
I'm positive.
115
00:03:49,963 --> 00:03:51,297
But I'm not in any pain.
116
00:03:51,331 --> 00:03:53,332
I know, that's the danger.
117
00:03:53,366 --> 00:03:55,334
Severe three-vessel disease,
complicated by...
118
00:03:55,368 --> 00:03:58,370
Heavy calcification
and extremely poor targets.
119
00:03:58,405 --> 00:03:59,805
CABG is still doable,
120
00:03:59,840 --> 00:04:01,841
but it will be more
challenging than normal.
121
00:04:01,875 --> 00:04:03,209
Indeed.
122
00:04:03,243 --> 00:04:04,610
You're a lucky man, Mr. Preston.
123
00:04:04,644 --> 00:04:06,145
Keeping fit bought you the time
124
00:04:06,179 --> 00:04:07,446
to notice something was wrong.
125
00:04:07,481 --> 00:04:09,548
Yeah. Well, Dr. Rhodes said
126
00:04:09,583 --> 00:04:11,183
people with arteries as damaged as mine
127
00:04:11,218 --> 00:04:12,485
usually just drop dead.
128
00:04:12,519 --> 00:04:15,788
He's absolutely right.
129
00:04:15,822 --> 00:04:18,457
Not to worry, Ray.
We'll take great care of you.
130
00:04:19,493 --> 00:04:22,128
To streamline costs, Dr. Stohl and I
131
00:04:22,162 --> 00:04:24,663
are implementing a
system to track supplies
132
00:04:24,698 --> 00:04:26,332
to know exactly what we've used.
133
00:04:26,366 --> 00:04:28,200
Everything will be barcoded
134
00:04:28,235 --> 00:04:29,969
and logged into Pyxis.
135
00:04:30,003 --> 00:04:31,637
It will operate by finger scan,
136
00:04:31,671 --> 00:04:33,172
like we do for medications.
137
00:04:33,206 --> 00:04:35,741
That's easy enough for minor treatments,
138
00:04:35,775 --> 00:04:37,309
but what about emergencies?
139
00:04:37,344 --> 00:04:40,237
Not a lot of time to stop down and
scan your prints during a trauma.
140
00:04:40,308 --> 00:04:42,748
A tech will take note
of what was used in the moment
141
00:04:42,782 --> 00:04:45,384
and then scan after the fact.
142
00:04:45,418 --> 00:04:47,019
"In the moment." They'll follow us
143
00:04:47,053 --> 00:04:48,921
into the trauma bay?
144
00:04:48,955 --> 00:04:51,357
Between nurses and equipment,
we're already tight on space.
145
00:04:51,391 --> 00:04:52,358
Another body...
146
00:04:52,392 --> 00:04:53,392
We'll find the room
147
00:04:53,426 --> 00:04:55,694
because we have to.
148
00:04:55,729 --> 00:04:58,063
Not to worry, Miss Goodwin.
149
00:04:58,098 --> 00:05:00,266
All right, uh, let's get back to work.
150
00:05:00,300 --> 00:05:01,600
Thank you for your time.
151
00:05:01,635 --> 00:05:02,902
Doctors, one more thing before you go,
152
00:05:02,936 --> 00:05:05,704
while I have you here, charting.
153
00:05:05,739 --> 00:05:07,106
When I was in Attending,
154
00:05:07,140 --> 00:05:09,108
it was pen, paper, and long-form.
155
00:05:09,142 --> 00:05:11,911
Today, it's... it's tablets
and shorthand.
156
00:05:11,945 --> 00:05:14,747
I get it... tech saves time...
157
00:05:14,781 --> 00:05:16,782
but details get lost in translation,
158
00:05:16,816 --> 00:05:20,586
so please be explicit
in procedure notes.
159
00:05:20,620 --> 00:05:22,688
Okay? Document everything.
160
00:05:22,722 --> 00:05:25,224
If you do it, write it down.
161
00:05:25,258 --> 00:05:26,225
Okay?
162
00:05:26,259 --> 00:05:29,228
[dramatic music]
163
00:05:29,262 --> 00:05:33,132
♪
164
00:05:33,166 --> 00:05:34,867
I clean up nice, don't I?
165
00:05:34,901 --> 00:05:36,035
I haven't noticed.
166
00:05:36,069 --> 00:05:40,072
I saw that.
167
00:05:40,106 --> 00:05:42,708
Why don't you believe me?
168
00:05:42,742 --> 00:05:44,243
I'm not crazy.
169
00:05:44,277 --> 00:05:46,712
Something lives inside of me,
right here.
170
00:05:46,746 --> 00:05:47,913
I hear you. I understand.
171
00:05:47,948 --> 00:05:49,215
Then get it out!
172
00:05:49,249 --> 00:05:51,050
[sobs] I feel it all the time!
173
00:05:51,084 --> 00:05:55,955
Alex... we're gonna help you, I promise.
174
00:05:55,989 --> 00:05:58,090
Sedative?
175
00:05:58,124 --> 00:05:59,425
No, no, no. Wait, wait, wait.
176
00:05:59,459 --> 00:06:01,293
I'm sorry, I'm sorry.
177
00:06:01,328 --> 00:06:02,928
I'm telling you the truth.
178
00:06:02,963 --> 00:06:04,563
I can feel it inside of me.
179
00:06:04,598 --> 00:06:06,432
Please. [breathes fearfully]
180
00:06:06,466 --> 00:06:10,269
[breathing slows]
181
00:06:10,303 --> 00:06:12,438
Please...
182
00:06:12,472 --> 00:06:18,110
♪
183
00:06:18,144 --> 00:06:19,411
What'd you give him?
184
00:06:19,446 --> 00:06:20,579
Five of Versed.
185
00:06:20,614 --> 00:06:21,914
Hm.
186
00:06:21,948 --> 00:06:24,316
Two probably would have sufficed.
187
00:06:24,351 --> 00:06:25,517
He put hands on you.
188
00:06:25,552 --> 00:06:28,020
I was being cautious.
189
00:06:28,054 --> 00:06:29,421
So what are you thinking?
190
00:06:29,456 --> 00:06:30,823
Schizophrenia.
191
00:06:30,857 --> 00:06:32,191
Yeah, that was my initial thought,
192
00:06:32,225 --> 00:06:33,425
but now I'm not so sure.
193
00:06:33,460 --> 00:06:35,928
Seriously? His, uh, paranoia
194
00:06:35,962 --> 00:06:37,463
that there's something
living inside him,
195
00:06:37,497 --> 00:06:38,831
and his attempt to remove it
196
00:06:38,865 --> 00:06:40,132
is literally a textbook definition
197
00:06:40,166 --> 00:06:42,534
of a somatic delusional disorder.
198
00:06:42,569 --> 00:06:44,803
I'm stuck on the level of premeditation.
199
00:06:44,838 --> 00:06:46,772
You know, sterilization with Betadine,
200
00:06:46,806 --> 00:06:48,474
the clean incision,
201
00:06:48,508 --> 00:06:49,875
doing it near a hospital...
202
00:06:49,909 --> 00:06:51,610
All that kind of forethought...
203
00:06:51,645 --> 00:06:53,946
it's just not consistent
with schizophrenic psychosis.
204
00:06:53,980 --> 00:06:56,048
So he's a germophobe with a steady hand.
205
00:06:56,082 --> 00:06:58,150
It doesn't mean he's not schizophrenic.
206
00:06:58,184 --> 00:07:00,119
Mm, could be true, too.
207
00:07:00,153 --> 00:07:03,222
So, um... start him on anti-psychotics
208
00:07:03,256 --> 00:07:04,690
and reassess when his mind's clear?
209
00:07:04,724 --> 00:07:06,392
I'm just not there yet.
210
00:07:06,426 --> 00:07:07,993
My gut tells me it's chemical.
211
00:07:08,028 --> 00:07:10,863
You know, like maybe
a methamphetamine overdose.
212
00:07:10,897 --> 00:07:12,865
Before we go any further,
let's run a tox screen,
213
00:07:12,899 --> 00:07:15,234
see if he's just... high.
214
00:07:15,268 --> 00:07:20,706
♪
215
00:07:26,079 --> 00:07:28,847
What's with you? You look half-dead.
216
00:07:28,882 --> 00:07:31,483
Yeah, these 90-hour weeks
are killing a brother.
217
00:07:31,518 --> 00:07:33,385
Law says you can't do more than 80.
218
00:07:33,420 --> 00:07:36,188
[laughs] When Dr. Stohl
asks you to volunteer,
219
00:07:36,222 --> 00:07:37,890
you don't say "no."
220
00:07:37,924 --> 00:07:40,192
Game is rigged.
221
00:07:40,226 --> 00:07:42,861
All part of being a big-shot doc.
222
00:07:42,896 --> 00:07:44,730
Big shot, right.
223
00:07:44,764 --> 00:07:48,067
Big shot, living off of
ramen and cheeseburgers.
224
00:07:48,101 --> 00:07:49,702
What?
225
00:07:49,736 --> 00:07:51,203
Yeah, that's all I got time for.
226
00:07:51,237 --> 00:07:53,339
You are getting a steady paycheck now.
227
00:07:53,373 --> 00:07:55,441
Sign up for one of
those meal delivery services.
228
00:07:55,475 --> 00:07:57,343
You're gonna need the fuel.
229
00:07:57,377 --> 00:08:00,012
That's not a bad idea.
230
00:08:00,046 --> 00:08:02,414
Hey, um...
231
00:08:02,449 --> 00:08:05,117
do you mind setting it up for me?
232
00:08:05,151 --> 00:08:06,218
What? You...
233
00:08:06,252 --> 00:08:08,354
you always know what I like.
234
00:08:08,388 --> 00:08:09,388
Sure.
235
00:08:09,422 --> 00:08:10,456
Thank you.
236
00:08:10,490 --> 00:08:11,457
Thank you, thank you.
237
00:08:11,491 --> 00:08:13,058
I'ma try to get some Zs
238
00:08:13,093 --> 00:08:16,729
before the troll hawks me
for more rounds.
239
00:08:20,300 --> 00:08:21,900
Don't give me that look.
240
00:08:25,438 --> 00:08:28,073
Mm-hmm. Okay.
241
00:08:28,108 --> 00:08:29,441
Thank you, Helen.
242
00:08:29,476 --> 00:08:30,776
Bye.
243
00:08:30,810 --> 00:08:31,944
Good news:
244
00:08:31,978 --> 00:08:34,446
Helen's gonna watch Owen tonight.
245
00:08:34,481 --> 00:08:35,614
Watch as in all night?
246
00:08:35,648 --> 00:08:36,815
- Mm-hmm.
- Yes.
247
00:08:36,850 --> 00:08:38,751
[giggles]
248
00:08:38,785 --> 00:08:40,486
Just one thing I ask.
249
00:08:40,520 --> 00:08:41,487
Anything.
250
00:08:41,521 --> 00:08:44,757
That you shave.
251
00:08:44,791 --> 00:08:46,458
You don't like the sandpaper feel, huh?
252
00:08:46,493 --> 00:08:48,127
Uh-huh.
253
00:08:48,161 --> 00:08:49,294
You ask a lot...
254
00:08:49,329 --> 00:08:50,596
Mm.
255
00:08:50,630 --> 00:08:52,164
But okay.
256
00:08:52,198 --> 00:08:54,867
- Thank you.
- Yeah.
257
00:08:57,303 --> 00:08:59,905
Proximal anastomosis is complete.
258
00:08:59,939 --> 00:09:00,939
That looks good.
259
00:09:00,974 --> 00:09:02,341
Let's move on to the base.
260
00:09:02,375 --> 00:09:03,942
Do you have a suitable landing spot?
261
00:09:03,977 --> 00:09:05,344
Yeah.
262
00:09:05,378 --> 00:09:07,146
Lighter calcification in this area.
263
00:09:07,180 --> 00:09:08,614
Potts, please.
264
00:09:08,648 --> 00:09:10,082
I'd go more distal.
265
00:09:10,116 --> 00:09:12,317
Vessel's bigger.
You'll get a cleaner target.
266
00:09:12,352 --> 00:09:14,987
This area of vessel is perfect.
267
00:09:15,021 --> 00:09:17,923
If you say so.
268
00:09:17,957 --> 00:09:19,324
8-0 Prolene.
269
00:09:19,359 --> 00:09:20,993
The artery could probably
handle the 7-0.
270
00:09:21,027 --> 00:09:22,594
I prefer the 8-0.
271
00:09:22,629 --> 00:09:23,862
Just thought the larger stitch
272
00:09:23,897 --> 00:09:25,197
might be easier for you to work with.
273
00:09:25,231 --> 00:09:26,598
I don't understand the debate.
274
00:09:26,633 --> 00:09:28,200
The difference between vessel location,
275
00:09:28,234 --> 00:09:29,935
and now suture choice, is negligible.
276
00:09:29,969 --> 00:09:31,270
Good point, Dr. Latham.
277
00:09:31,304 --> 00:09:32,538
Dr. Rhodes, you're lead surgeon.
278
00:09:32,572 --> 00:09:33,639
I'm only assisting.
279
00:09:33,673 --> 00:09:36,208
I defer to your preference.
280
00:09:36,242 --> 00:09:38,477
Thank you, Doctor.
281
00:09:38,511 --> 00:09:40,612
Now, how about from here on out,
282
00:09:40,647 --> 00:09:43,449
we keep the background noise
to a minimum?
283
00:09:43,483 --> 00:09:45,951
[tense music]
284
00:09:45,985 --> 00:09:47,953
[alarm beeps]
285
00:09:47,987 --> 00:09:49,455
Myra Adams, 20.
286
00:09:49,489 --> 00:09:50,823
Passed out in her bathroom
washing her face.
287
00:09:50,857 --> 00:09:52,191
Struck her head as she fell.
288
00:09:52,225 --> 00:09:53,292
Chamber two.
289
00:09:53,326 --> 00:09:56,495
GCS 6. BP 128 over 60, heart rate 102
290
00:09:56,529 --> 00:09:57,896
Her brother Eric's a step behind.
291
00:09:57,931 --> 00:09:59,498
- Total wreck.
- Hey, uh, what's...
292
00:09:59,532 --> 00:10:01,033
what's wrong with her?
293
00:10:01,067 --> 00:10:02,334
She's tensing up. Decorticate posturing.
294
00:10:02,368 --> 00:10:04,069
- Can you hear me?
- Excuse us.
295
00:10:04,103 --> 00:10:05,070
Can you tell me your name?
296
00:10:05,104 --> 00:10:06,672
Responds to pain.
297
00:10:06,706 --> 00:10:08,173
All right, we're gonna transfer
on my count.
298
00:10:08,208 --> 00:10:09,508
One, two, three.
299
00:10:09,542 --> 00:10:11,143
Uh, she was complaining
300
00:10:11,177 --> 00:10:12,311
about her stomach last night.
301
00:10:12,345 --> 00:10:13,579
I-I told her it was, like,
302
00:10:13,613 --> 00:10:15,147
uh, something that she ate.
303
00:10:15,181 --> 00:10:16,415
It's okay. Please give the doctor
304
00:10:16,449 --> 00:10:17,583
some room to examine her.
305
00:10:17,617 --> 00:10:20,018
Okay.
306
00:10:20,053 --> 00:10:21,653
Clear breath sounds bilaterally.
307
00:10:21,688 --> 00:10:23,722
CBC, CMP, coags, and u-tox.
308
00:10:23,756 --> 00:10:25,157
Nat, belly's soft.
309
00:10:25,191 --> 00:10:26,725
All right, nasal airway and a head CT.
310
00:10:26,759 --> 00:10:28,227
And while we're there, let's scan
311
00:10:28,261 --> 00:10:29,394
her C spine and belly, okay?
312
00:10:29,429 --> 00:10:30,429
We're on it.
313
00:10:30,463 --> 00:10:33,398
♪
314
00:10:33,433 --> 00:10:34,900
All right, let's move her.
315
00:10:34,934 --> 00:10:36,869
♪
316
00:10:36,903 --> 00:10:40,038
Look, I-I should have
brought her in last night.
317
00:10:40,073 --> 00:10:42,241
Uh, why... why is this happening to her?
318
00:10:42,275 --> 00:10:43,575
Look, we're gonna do everything we can
319
00:10:43,610 --> 00:10:45,010
to help your sister, okay?
320
00:10:45,044 --> 00:10:46,712
She's lucky you found her when you did.
321
00:10:46,746 --> 00:10:48,947
I-I gotta, uh, call my parents.
322
00:10:48,982 --> 00:10:50,282
Sure.
323
00:10:50,316 --> 00:10:53,285
♪
324
00:10:53,319 --> 00:10:54,586
This level of posturing...
325
00:10:54,621 --> 00:10:55,954
Has to be some sort of brain injury.
326
00:10:55,989 --> 00:10:57,422
Yeah.
327
00:10:59,799 --> 00:11:01,899
Thank you.
328
00:11:01,934 --> 00:11:03,611
Uh, we're looking for
our daughter, Myra Adams.
329
00:11:03,667 --> 00:11:05,268
Our son called. Is she all right?
330
00:11:05,302 --> 00:11:08,070
Come with me, please.
Dr. Manning, Dr. Choi.
331
00:11:08,105 --> 00:11:09,439
These are Myra's parents.
332
00:11:09,473 --> 00:11:10,516
What happened?
333
00:11:10,570 --> 00:11:12,241
We talked to her two days ago.
She was fine.
334
00:11:12,276 --> 00:11:13,242
Myra?
335
00:11:13,277 --> 00:11:14,321
Myra, honey!
336
00:11:14,346 --> 00:11:15,392
Oh, please, I'd like to see her.
337
00:11:15,417 --> 00:11:17,418
Yes, of course, please.
338
00:11:22,739 --> 00:11:24,544
- Honey.
- What's going on?
339
00:11:25,433 --> 00:11:26,600
I don't know.
340
00:11:26,635 --> 00:11:28,669
You poor baby.
341
00:11:28,703 --> 00:11:30,337
Myra?
342
00:11:30,372 --> 00:11:31,605
Honey?
343
00:11:31,640 --> 00:11:32,606
We're here.
344
00:11:32,641 --> 00:11:33,641
What's wrong with her?
345
00:11:33,675 --> 00:11:35,342
We don't know yet.
346
00:11:35,377 --> 00:11:36,744
She collapsed in the bathroom
347
00:11:36,778 --> 00:11:38,279
and hasn't regained consciousness.
348
00:11:38,313 --> 00:11:39,580
We don't think it's a brain injury.
349
00:11:39,614 --> 00:11:41,749
Myra's CT scans were clear.
350
00:11:41,783 --> 00:11:44,351
Last month, her friends
brought her in to the ED.
351
00:11:44,386 --> 00:11:46,253
Could that have something
to do with this?
352
00:11:46,288 --> 00:11:48,455
Honey, that doctor said
she was just dehydrated.
353
00:11:48,490 --> 00:11:51,659
She, uh, got an IV. She was, uh...
354
00:11:51,693 --> 00:11:53,494
she was fine.
355
00:11:53,528 --> 00:11:55,029
We checked her chart.
356
00:11:55,063 --> 00:11:56,630
Back then, Myra's tox screen
and blood work
357
00:11:56,665 --> 00:11:58,966
was normal,
except she was slightly anemic.
358
00:11:59,000 --> 00:12:00,834
Same as now. She vegetarian?
359
00:12:00,869 --> 00:12:01,869
Vegan.
360
00:12:01,903 --> 00:12:03,304
As long as I can remember.
361
00:12:03,338 --> 00:12:05,039
Never liked meat. [chuckles]
362
00:12:05,073 --> 00:12:06,635
Well, that would explain the anemia.
363
00:12:06,690 --> 00:12:08,424
Is there anything else you can tell us?
364
00:12:08,459 --> 00:12:11,027
Uh, she, um...
365
00:12:11,061 --> 00:12:13,229
What?
366
00:12:13,264 --> 00:12:15,565
No, it's just, uh, it was finals week,
367
00:12:15,599 --> 00:12:17,534
so she wasn't really, like, eating,
368
00:12:17,568 --> 00:12:19,035
or sleeping much at all.
369
00:12:19,069 --> 00:12:21,337
She always worked so hard.
370
00:12:21,372 --> 00:12:23,873
I tell her all the time,
she needs to rest.
371
00:12:23,908 --> 00:12:27,210
How do you know all that?
372
00:12:27,244 --> 00:12:28,578
I've been staying with her.
373
00:12:28,612 --> 00:12:30,280
[scoffs] Since when?
374
00:12:30,314 --> 00:12:33,683
- [wheezing]
- [machine beeping]
375
00:12:33,717 --> 00:12:35,084
Myra?
376
00:12:35,119 --> 00:12:36,419
She's tachycardic and tachypneic.
377
00:12:36,453 --> 00:12:37,720
That means her heart is racing
378
00:12:37,755 --> 00:12:38,721
and she's having trouble breathing.
379
00:12:38,756 --> 00:12:40,123
We need to intubate her.
380
00:12:40,157 --> 00:12:41,624
Please let the doctors help her, okay?
381
00:12:41,659 --> 00:12:43,860
- My baby, no, oh, God.
- Please, okay?
382
00:12:43,894 --> 00:12:45,628
Let's get an EEG and LP,
383
00:12:45,663 --> 00:12:48,064
an antibiotics and antiviral,
just in case.
384
00:12:48,098 --> 00:12:49,198
Gram of Ceftriaxone,
385
00:12:49,233 --> 00:12:50,967
500 milligrams Acyclovir.
386
00:12:51,001 --> 00:12:52,802
Why is it happening? Why?
387
00:12:52,836 --> 00:12:55,805
[dramatic music]
388
00:12:55,839 --> 00:12:57,874
♪
389
00:12:57,908 --> 00:13:00,043
And lift.
390
00:13:00,077 --> 00:13:01,744
I still would've landed the grafts
391
00:13:01,779 --> 00:13:05,448
more distal, but your way worked, too.
392
00:13:05,482 --> 00:13:07,717
I'll take that as a "nice job."
393
00:13:07,751 --> 00:13:09,552
Didn't know my approval
meant so much to you.
394
00:13:09,587 --> 00:13:13,790
Always on, aren't you?
395
00:13:13,824 --> 00:13:16,459
"Always on." What does that mean?
396
00:13:16,493 --> 00:13:19,329
Nothing. It's just, um...
397
00:13:19,363 --> 00:13:21,164
steel sharpening steel.
398
00:13:21,198 --> 00:13:23,967
Hmm, can't say I'm any more enlightened.
399
00:13:24,001 --> 00:13:25,835
[heart monitor beeps rapidly]
400
00:13:25,869 --> 00:13:27,437
BP's falling. We're in to the 80s.
401
00:13:27,471 --> 00:13:28,738
Anterior lateral ST elevations.
402
00:13:28,772 --> 00:13:30,239
Damn it. Cardiac ischemia.
403
00:13:30,274 --> 00:13:32,141
One of your grafts must have went down.
404
00:13:32,176 --> 00:13:33,343
All right, get him back on the table.
405
00:13:33,377 --> 00:13:34,911
I'll go back in to fix the graft.
406
00:13:34,945 --> 00:13:35,945
No, we've already broken down the room.
407
00:13:35,980 --> 00:13:37,113
By the time we re-prep,
408
00:13:37,147 --> 00:13:38,114
we'll have lost too much time.
409
00:13:38,148 --> 00:13:39,482
IR's a better option.
410
00:13:39,516 --> 00:13:41,184
What about the hybrid room?
411
00:13:41,218 --> 00:13:42,919
I have it booked for
a stenotic dialysis arm graft.
412
00:13:42,953 --> 00:13:44,287
I'll bump it and cath Ray.
413
00:13:44,321 --> 00:13:45,955
If I can't fix the issue noninvasively,
414
00:13:45,990 --> 00:13:47,757
room's already prepped
for us to re-open him up.
415
00:13:47,791 --> 00:13:49,759
Dr. Rhodes?
416
00:13:49,793 --> 00:13:51,160
[dramatic music]
417
00:13:51,195 --> 00:13:52,295
It's a good idea.
418
00:13:52,329 --> 00:13:53,963
Okay, let's go.
419
00:13:53,998 --> 00:14:01,004
♪
420
00:14:03,407 --> 00:14:05,475
Myra's lumbar puncture was negative.
421
00:14:05,509 --> 00:14:06,776
There's no infection.
422
00:14:06,810 --> 00:14:10,113
However, her EEG was
positive for seizures.
423
00:14:10,147 --> 00:14:11,447
We've put her on Ativan,
424
00:14:11,482 --> 00:14:13,483
but unfortunately,
they haven't subsided.
425
00:14:13,517 --> 00:14:14,851
Myra's always been so healthy.
426
00:14:14,885 --> 00:14:16,285
I just don't understand.
427
00:14:16,320 --> 00:14:18,187
But the Ativan, it'll work, right?
428
00:14:18,222 --> 00:14:19,722
Well, we're gonna do an MRI
429
00:14:19,757 --> 00:14:21,324
to get a closer look at her brain,
430
00:14:21,358 --> 00:14:24,127
see if there's something
that the CT didn't pick up.
431
00:14:24,161 --> 00:14:25,294
- Oh, my God.
- What... what's happening?
432
00:14:25,329 --> 00:14:27,030
She's posturing again.
433
00:14:27,064 --> 00:14:29,632
I'm afraid whatever's going on
in her brain is getting worse.
434
00:14:29,667 --> 00:14:31,367
Her pupils are sluggish.
435
00:14:31,402 --> 00:14:32,702
Bolus another five milligrams
436
00:14:32,736 --> 00:14:33,970
of Ativan on top of the drip
437
00:14:34,004 --> 00:14:35,672
and get her up to MRI, quickly.
438
00:14:35,706 --> 00:14:36,906
Hey, can I... can I go with her?
439
00:14:36,940 --> 00:14:37,907
Sure.
440
00:14:37,941 --> 00:14:39,909
No, no.
441
00:14:39,943 --> 00:14:43,079
Eric, you stay with us.
442
00:14:43,113 --> 00:14:45,481
I'm gonna order an echo,
check for heart vegetations.
443
00:14:45,516 --> 00:14:47,016
You're thinking sepsis,
444
00:14:47,051 --> 00:14:49,318
but her white blood cell count
was totally normal.
445
00:14:49,353 --> 00:14:50,887
Everything was normal
the last time she was here,
446
00:14:50,921 --> 00:14:52,722
too, but she's back,
even worse than before.
447
00:14:52,756 --> 00:14:54,257
Ethan, these two ED visits
448
00:14:54,291 --> 00:14:55,825
could be totally unrelated.
449
00:14:55,859 --> 00:14:56,993
No, I think they missed
something last time.
450
00:14:57,027 --> 00:14:57,994
Missed what?
451
00:14:58,028 --> 00:14:59,162
I don't know.
452
00:14:59,196 --> 00:15:00,563
♪
453
00:15:00,597 --> 00:15:03,332
[sighs]
454
00:15:03,367 --> 00:15:04,600
Don't beat yourself up, Connor.
455
00:15:04,635 --> 00:15:06,235
Grafts fail,
456
00:15:06,270 --> 00:15:08,071
often in patients
with far less calcification
457
00:15:08,105 --> 00:15:09,105
than Ray.
458
00:15:09,139 --> 00:15:10,540
Doesn't make any sense.
459
00:15:10,574 --> 00:15:12,341
I checked every graft before I closed.
460
00:15:12,376 --> 00:15:13,342
They were solid.
461
00:15:13,377 --> 00:15:14,677
They still are.
462
00:15:14,712 --> 00:15:16,846
Good flow through all repaired vessels.
463
00:15:16,880 --> 00:15:18,347
One, two, three.
464
00:15:18,382 --> 00:15:19,949
The problem is here.
465
00:15:19,983 --> 00:15:22,185
Clot of the left anterior
descending artery.
466
00:15:22,219 --> 00:15:24,387
Likely a bad reaction to the protamine
467
00:15:24,421 --> 00:15:26,122
administered during anesthesia.
468
00:15:26,156 --> 00:15:27,623
Recommendations on how to proceed?
469
00:15:27,658 --> 00:15:29,792
Treat noninvasively with heparin.
470
00:15:29,827 --> 00:15:31,127
Thin the blood, let his heart
471
00:15:31,161 --> 00:15:32,695
clear the clot out on its own.
472
00:15:32,730 --> 00:15:34,030
Too conservative.
Clot's already stopped up
473
00:15:34,064 --> 00:15:35,765
the vessel. The LAD is the widow-maker.
474
00:15:35,799 --> 00:15:37,700
If it's down much longer,
Ray's not coming back.
475
00:15:37,735 --> 00:15:40,036
We've got to suck it out.
476
00:15:40,070 --> 00:15:41,738
I agree with Dr. Bekker.
477
00:15:41,772 --> 00:15:43,873
Thrombo-aspiration,
though the riskier procedure,
478
00:15:43,907 --> 00:15:46,476
ensures complete removal
of the blockage.
479
00:15:46,510 --> 00:15:47,777
Excuse me, Dr. Rhodes.
480
00:15:47,811 --> 00:15:53,382
♪
481
00:15:53,417 --> 00:15:56,486
Alex's tox screen's
negative for methamphetamine.
482
00:15:56,520 --> 00:15:58,154
Negative for all drugs,
in fact... he's clean.
483
00:15:58,188 --> 00:16:00,089
Yeah, I saw the report.
484
00:16:00,124 --> 00:16:02,091
So now can we start him
on a course of anti-psychotics?
485
00:16:02,126 --> 00:16:05,328
I'm just still not convinced
it's schizophrenia.
486
00:16:05,362 --> 00:16:06,996
How? He's presented with
487
00:16:07,030 --> 00:16:08,631
more than enough evidence
of a thought disorder
488
00:16:08,665 --> 00:16:09,999
to warrant the diagnosis.
489
00:16:10,033 --> 00:16:11,434
Yeah, but even so, before today,
490
00:16:11,468 --> 00:16:12,969
I mean, his medical record's clean.
491
00:16:13,003 --> 00:16:15,138
History doesn't track
with schizophrenia.
492
00:16:15,172 --> 00:16:16,739
Or meth addiction.
493
00:16:16,774 --> 00:16:17,840
He doesn't fit the profile
of a user, either.
494
00:16:17,875 --> 00:16:19,308
Just 'cause he's clean today,
495
00:16:19,343 --> 00:16:21,744
doesn't mean he's free of the drug.
496
00:16:21,779 --> 00:16:23,246
So that's what the fan is for?
497
00:16:23,280 --> 00:16:25,615
White noise, Dr. Charles? Really?
498
00:16:25,649 --> 00:16:26,682
Yes, really.
499
00:16:26,717 --> 00:16:28,417
White noise has been proven
500
00:16:28,452 --> 00:16:30,686
to trigger auditory hallucinations
501
00:16:30,721 --> 00:16:32,622
in meth users.
502
00:16:32,656 --> 00:16:33,756
How long have you been waiting
503
00:16:33,791 --> 00:16:34,824
for something to happen?
504
00:16:34,858 --> 00:16:36,192
[sighs]
505
00:16:36,226 --> 00:16:37,527
Hm, seven or eight minutes.
506
00:16:37,561 --> 00:16:39,929
How long does it usually take?
507
00:16:39,963 --> 00:16:42,832
Two or three.
508
00:16:42,866 --> 00:16:44,200
Probably not meth. Go ahead,
509
00:16:44,234 --> 00:16:46,903
start anti-psychotics.
510
00:16:49,807 --> 00:16:52,408
Two of Haldol...
511
00:16:54,211 --> 00:16:55,444
Dr. Charles...
512
00:16:55,479 --> 00:16:57,180
[dramatic music]
513
00:16:57,214 --> 00:16:58,614
Oh, my God.
514
00:16:58,649 --> 00:17:00,016
Alex... get his hand, get his hand!
515
00:17:00,050 --> 00:17:03,886
I needed it gone. Just see... wait!
516
00:17:03,921 --> 00:17:05,188
Help! We need some help in here!
517
00:17:05,222 --> 00:17:08,124
[breathing rapidly]
518
00:17:08,158 --> 00:17:09,559
What happened?
519
00:17:09,593 --> 00:17:11,027
He used a pen to pop the stitches
520
00:17:11,061 --> 00:17:12,061
and chisel through his abdominal wall.
521
00:17:12,095 --> 00:17:13,850
- Clearly.
- All right, no time to re-pack.
522
00:17:13,875 --> 00:17:15,298
Got to scoop and move. Saline.
523
00:17:15,332 --> 00:17:17,500
Okay, call OR. Tell them
we're coming immediately.
524
00:17:17,534 --> 00:17:18,701
Let's go!
525
00:17:18,735 --> 00:17:20,203
Okay, go, go, go!
526
00:17:20,237 --> 00:17:27,276
♪
527
00:17:31,964 --> 00:17:34,550
Hmm, sweet potato or quinoa?
528
00:17:36,147 --> 00:17:38,148
Noah's menu.
529
00:17:38,260 --> 00:17:39,593
Why don't you feed yourself
530
00:17:39,628 --> 00:17:41,295
before the next wave of orders
coming down?
531
00:17:41,329 --> 00:17:42,863
You've been ripping and running all day.
532
00:17:42,898 --> 00:17:45,900
Exactly why I need to get this done now.
533
00:17:48,136 --> 00:17:49,603
- Dr. Manning?
- Yes.
534
00:17:49,638 --> 00:17:51,144
We think we know
what might have caused this.
535
00:17:51,183 --> 00:17:52,206
Eric.
536
00:17:52,240 --> 00:17:53,574
Myra got sick
while he was staying with her.
537
00:17:53,608 --> 00:17:54,942
We never wanted him around our daughter.
538
00:17:54,967 --> 00:17:55,933
He's a bad influence.
539
00:17:55,958 --> 00:17:57,525
He never applied himself.
540
00:17:57,559 --> 00:17:59,026
He's the opposite of Myra.
541
00:17:59,061 --> 00:18:00,628
No job, hangs out with
a bunch of deadbeats.
542
00:18:00,662 --> 00:18:02,463
We kicked him out because
he was stealing from us.
543
00:18:02,498 --> 00:18:04,532
He takes drugs.
544
00:18:04,566 --> 00:18:06,801
I'm sorry. I'm... I'm not following.
545
00:18:06,835 --> 00:18:08,269
He probably slipped her something.
546
00:18:08,303 --> 00:18:09,804
A drug of some sort.
547
00:18:09,838 --> 00:18:11,172
There's no evidence of that.
548
00:18:11,206 --> 00:18:12,507
Well, are you sure? Because if you knew
549
00:18:12,541 --> 00:18:13,508
what it was...
550
00:18:13,542 --> 00:18:14,675
I understand that
551
00:18:14,710 --> 00:18:16,277
this is a very difficult time,
552
00:18:16,311 --> 00:18:17,979
but the best thing we can do right now
553
00:18:18,013 --> 00:18:19,614
is wait for the MRI to come back,
554
00:18:19,648 --> 00:18:22,116
and I promise,
as soon as we hear anything,
555
00:18:22,151 --> 00:18:24,152
you will be the first to know.
556
00:18:24,186 --> 00:18:25,520
Okay?
557
00:18:25,554 --> 00:18:27,188
- [scoffs]
- All right.
558
00:18:27,222 --> 00:18:29,056
[scoffs]
559
00:18:29,091 --> 00:18:30,825
They're blaming Eric for this?
560
00:18:30,859 --> 00:18:32,160
How is this his fault?
561
00:18:32,194 --> 00:18:33,361
They're desperate, looking for answers,
562
00:18:33,395 --> 00:18:34,629
and we don't know the whole story.
563
00:18:34,663 --> 00:18:36,364
Family dynamics can be complicated.
564
00:18:36,398 --> 00:18:37,999
Doesn't matter. It's family.
565
00:18:38,033 --> 00:18:39,801
It's blood. Time like this,
566
00:18:39,835 --> 00:18:41,235
they should be banding together,
567
00:18:41,270 --> 00:18:43,171
not ostracizing one of their own.
568
00:18:43,205 --> 00:18:46,474
I'd expect you to say that.
569
00:18:46,508 --> 00:18:48,142
This again? Really?
570
00:18:48,177 --> 00:18:49,410
[scoffs]
571
00:18:49,444 --> 00:18:51,078
Here we go.
572
00:18:51,113 --> 00:18:54,382
[somber music]
573
00:18:54,416 --> 00:18:56,217
You've got a soft spot for family,
574
00:18:56,251 --> 00:18:58,186
sometimes at your own expense.
575
00:18:58,220 --> 00:18:59,520
Planning meals for Noah
576
00:18:59,555 --> 00:19:01,088
when you're slammed at work,
for example.
577
00:19:01,123 --> 00:19:03,157
Helping my brother when he's exhausted.
578
00:19:03,192 --> 00:19:04,892
That's a bad thing in your eyes?
579
00:19:04,927 --> 00:19:06,494
♪
580
00:19:06,528 --> 00:19:09,330
The day I turned 18,
it was sink-or-swim.
581
00:19:09,364 --> 00:19:11,365
Noah's a grown man, April.
582
00:19:11,400 --> 00:19:12,834
You're not doing him any favors
583
00:19:12,868 --> 00:19:15,102
by constantly picking up his slack.
584
00:19:15,137 --> 00:19:16,404
Some point, we've all got to learn
585
00:19:16,438 --> 00:19:18,739
to go it alone.
586
00:19:18,774 --> 00:19:21,375
I'd expect you to say that.
587
00:19:21,410 --> 00:19:25,713
♪
588
00:19:25,747 --> 00:19:27,114
[sighs]
589
00:19:27,149 --> 00:19:33,020
♪
590
00:19:33,055 --> 00:19:34,555
All right, think we're there.
591
00:19:34,590 --> 00:19:37,225
♪
592
00:19:37,259 --> 00:19:39,927
Vacuuming.
593
00:19:39,962 --> 00:19:41,229
Got it.
594
00:19:41,263 --> 00:19:43,231
♪
595
00:19:43,265 --> 00:19:45,233
Ah, blood flow's good.
596
00:19:45,267 --> 00:19:46,567
BP's holding.
597
00:19:46,602 --> 00:19:48,870
Nice job.
598
00:19:48,904 --> 00:19:51,038
Thanks.
599
00:19:51,073 --> 00:19:53,307
Look, I know I have
a tendency to step on toes,
600
00:19:53,342 --> 00:19:54,775
Not personal. I just want to...
601
00:19:54,810 --> 00:19:56,277
Win?
602
00:19:56,311 --> 00:19:57,879
♪
603
00:19:57,913 --> 00:19:59,080
[heart monitor beeping rapidly]
604
00:19:59,114 --> 00:20:01,048
What happened?
605
00:20:01,083 --> 00:20:02,583
Artery ruptured.
606
00:20:02,618 --> 00:20:04,418
Blood is pouring into his chest.
607
00:20:04,453 --> 00:20:06,320
Blood flow was blocked,
and now it's out of control.
608
00:20:06,355 --> 00:20:07,822
All right, help me stent the leak
609
00:20:07,856 --> 00:20:09,156
- before he arrests.
- Where's the rupture?
610
00:20:09,191 --> 00:20:10,958
- Distal LAD.
- Are you kidding?
611
00:20:10,993 --> 00:20:12,393
That's not even where the clot was.
612
00:20:12,427 --> 00:20:13,895
It's an entirely different
section of vessel.
613
00:20:13,929 --> 00:20:15,229
[dramatic music]
614
00:20:15,264 --> 00:20:17,965
Murphy's Law.
615
00:20:27,175 --> 00:20:28,976
How's he doing?
616
00:20:29,011 --> 00:20:30,444
A few more feet to go,
617
00:20:30,479 --> 00:20:34,081
but no perforations to the bowel.
618
00:20:34,116 --> 00:20:36,117
I was just standing there.
619
00:20:36,151 --> 00:20:37,518
Meanwhile, he was ripping himself open
620
00:20:37,552 --> 00:20:39,153
with a pen? Wait.
621
00:20:39,187 --> 00:20:42,089
The extra Versed.
622
00:20:42,124 --> 00:20:43,958
It completely tranqed him out.
623
00:20:43,992 --> 00:20:47,461
But if I hadn't
given it to him, who knows?
624
00:20:47,496 --> 00:20:49,497
I mean, Alex was intent
on harming himself.
625
00:20:49,531 --> 00:20:51,132
He could have attacked one of us.
626
00:20:51,166 --> 00:20:53,334
♪
627
00:20:53,368 --> 00:20:55,369
What the hell?
628
00:20:55,404 --> 00:20:56,437
There's something embedded
629
00:20:56,471 --> 00:20:58,706
deep in his left gutter,
next to the colon.
630
00:20:58,740 --> 00:21:03,644
♪
631
00:21:03,679 --> 00:21:04,712
What is it?
632
00:21:04,746 --> 00:21:06,547
I have no idea.
633
00:21:06,581 --> 00:21:10,651
♪
634
00:21:10,686 --> 00:21:12,987
Did you see this? Myra's MRI.
635
00:21:13,021 --> 00:21:14,555
Global edema in the brain.
636
00:21:14,589 --> 00:21:16,457
Two hours ago,
there was no sign of swelling.
637
00:21:16,491 --> 00:21:18,626
Echo was clean, too. It's not sepsis.
638
00:21:18,660 --> 00:21:21,829
Or encephalitis, meningitis, HSV, CMV.
639
00:21:21,863 --> 00:21:24,031
We need to brainstorm zebras.
640
00:21:24,066 --> 00:21:26,467
Paraneoplastic syndrome?
Usually presents with a fever,
641
00:21:26,501 --> 00:21:28,469
but there could be cancer cells
in her spinal fluid.
642
00:21:28,503 --> 00:21:30,204
Or another autoimmune, lupus,
643
00:21:30,238 --> 00:21:32,139
sarcoid, some kind of tumor...
644
00:21:32,174 --> 00:21:33,975
What about FilmArray PCR tests?
645
00:21:34,009 --> 00:21:36,344
I'll draw paraneoplastic
and autoimmune panels.
646
00:21:36,378 --> 00:21:37,845
Have a lab put a rush on 'em.
647
00:21:37,879 --> 00:21:39,714
I'll talk to hem-onc,
get bone and PET scans.
648
00:21:39,748 --> 00:21:41,248
Okay.
649
00:21:41,283 --> 00:21:43,217
Myra's mom says
she's been busting her ass
650
00:21:43,251 --> 00:21:44,652
for this fellowship in New Zealand.
651
00:21:44,686 --> 00:21:47,054
She got it.
652
00:21:47,089 --> 00:21:49,090
She's just starting her life.
653
00:21:49,124 --> 00:21:51,993
We keep testing
till we find out what's wrong.
654
00:21:52,027 --> 00:21:53,527
Yeah.
655
00:21:57,265 --> 00:21:58,499
Dr. Halstead,
656
00:21:58,533 --> 00:21:59,767
I've been reviewing the write-up
657
00:21:59,801 --> 00:22:02,036
of our self-surgery patient, Alex.
658
00:22:02,070 --> 00:22:03,270
Not bad, but I think
659
00:22:03,305 --> 00:22:04,672
some small additions to the chart
660
00:22:04,706 --> 00:22:05,673
are in order.
661
00:22:05,707 --> 00:22:07,174
Additions?
662
00:22:07,209 --> 00:22:09,043
Perhaps "elaborations"
is the better word.
663
00:22:09,077 --> 00:22:11,345
Regarding the initial intake, you noted,
664
00:22:11,380 --> 00:22:13,547
"Wound lavaged and closed." I was there.
665
00:22:13,582 --> 00:22:16,417
It was a little more than that.
666
00:22:16,451 --> 00:22:18,452
I think we should say, "We lavaged
667
00:22:18,487 --> 00:22:20,454
"and irrigated with chlorhexidine
668
00:22:20,489 --> 00:22:23,924
and two liters of normal saline," okay?
669
00:22:23,959 --> 00:22:26,227
"Six-inch lacerations
repaired in two layers
670
00:22:26,261 --> 00:22:29,964
"with 60 interrupted 2-0 nylon sutures."
671
00:22:29,998 --> 00:22:31,799
You don't think that's
overdoing it a little bit?
672
00:22:31,833 --> 00:22:34,268
Absolutely not.
This is exactly what we did.
673
00:22:34,302 --> 00:22:35,636
So you'll adjust?
674
00:22:35,670 --> 00:22:37,538
- Yes?
- Yes.
675
00:22:37,572 --> 00:22:39,140
Residence charts, too.
676
00:22:39,174 --> 00:22:40,141
Yes.
677
00:22:40,175 --> 00:22:42,243
Good man.
678
00:22:45,781 --> 00:22:47,715
The art of charting.
679
00:22:47,749 --> 00:22:49,784
The one thing I didn't learn
in residency.
680
00:22:49,818 --> 00:22:52,086
I'll look them over.
681
00:22:52,120 --> 00:22:54,555
Thanks.
682
00:22:57,025 --> 00:22:58,759
I... don't understand.
683
00:22:58,794 --> 00:23:01,062
What are you... what are you saying?
684
00:23:01,096 --> 00:23:02,263
We did what's called
685
00:23:02,297 --> 00:23:03,898
a nuclear blood flow study
686
00:23:03,932 --> 00:23:06,167
and it showed no circulation
to her brain.
687
00:23:06,201 --> 00:23:08,135
Well, there must be
some other test you can run.
688
00:23:08,170 --> 00:23:11,072
They've all been negative.
689
00:23:11,106 --> 00:23:13,007
Something else you can do.
690
00:23:13,041 --> 00:23:14,141
I'm sorry.
691
00:23:14,176 --> 00:23:15,342
There isn't.
692
00:23:15,377 --> 00:23:18,145
[cries]
693
00:23:18,180 --> 00:23:20,448
We've done everything we can,
694
00:23:20,482 --> 00:23:23,150
but unfortunately,
your daughter is brain-dead.
695
00:23:23,185 --> 00:23:24,418
[pants]
696
00:23:24,453 --> 00:23:25,753
No...
697
00:23:25,787 --> 00:23:27,288
[sobbing] No...
698
00:23:27,322 --> 00:23:28,923
Okay.
699
00:23:28,957 --> 00:23:30,458
- Our little girl...
- I'm so sorry...
700
00:23:30,492 --> 00:23:31,959
No, no, no, no, no.
701
00:23:31,993 --> 00:23:33,094
She's gonna wake up.
She's gonna be fine.
702
00:23:33,128 --> 00:23:35,162
Myra? Myra...
703
00:23:35,197 --> 00:23:37,098
My baby.
704
00:23:37,132 --> 00:23:38,632
Myra.
705
00:23:38,667 --> 00:23:41,135
She's gone, sweetie.
706
00:23:41,169 --> 00:23:43,304
Your little girl's gone.
707
00:23:43,338 --> 00:23:46,140
[somber music]
708
00:23:46,174 --> 00:23:47,641
We'll give you some time with her.
709
00:23:47,676 --> 00:23:48,709
No...
710
00:23:48,743 --> 00:23:50,644
Our baby...
711
00:23:50,679 --> 00:23:52,513
[cries]
712
00:23:52,547 --> 00:23:55,216
Oh, baby...
713
00:23:55,383 --> 00:23:57,485
[cries]
714
00:23:57,519 --> 00:23:59,753
♪
715
00:24:07,780 --> 00:24:09,279
Excuse me.
716
00:24:09,313 --> 00:24:10,947
Mr. Adams.
717
00:24:10,981 --> 00:24:13,582
Our daughter was always
doing things for other people.
718
00:24:13,617 --> 00:24:15,651
She told us if anything
ever happened to her,
719
00:24:15,702 --> 00:24:17,453
she, uh...
720
00:24:17,487 --> 00:24:19,789
wanted to donate her organs.
721
00:24:19,823 --> 00:24:21,123
Of course.
722
00:24:21,158 --> 00:24:23,459
We'll get that started.
723
00:24:23,493 --> 00:24:25,995
We want her life
to have meant something.
724
00:24:26,029 --> 00:24:27,463
We understand.
725
00:24:27,497 --> 00:24:29,331
[breathes raggedly] Thank you.
726
00:24:29,366 --> 00:24:30,800
Of course.
727
00:24:30,834 --> 00:24:34,003
You're high. Look at you!
728
00:24:34,037 --> 00:24:35,337
You're high.
729
00:24:35,372 --> 00:24:38,367
Your sister's dead and you're high!
730
00:24:38,909 --> 00:24:42,258
Wait, Myra's, uh... de...?
731
00:24:42,303 --> 00:24:43,704
She's dead?
732
00:24:43,766 --> 00:24:44,933
Ah...
733
00:24:44,967 --> 00:24:47,035
This is your fault, isn't it?
734
00:24:47,069 --> 00:24:48,536
You did this.
735
00:24:48,571 --> 00:24:51,206
See? I told you he is no good.
736
00:24:51,240 --> 00:24:53,775
He is a drug addict.
737
00:24:53,809 --> 00:24:55,977
What did you give her?
738
00:24:56,012 --> 00:24:57,612
Nothing.
739
00:24:57,646 --> 00:25:00,448
We told you.
Myra's tox screen was negative.
740
00:25:00,483 --> 00:25:03,051
You worthless piece of....
741
00:25:03,085 --> 00:25:04,319
- Oh.
- Whoa.
742
00:25:04,353 --> 00:25:05,487
Get out.
743
00:25:05,521 --> 00:25:07,756
[dramatic music]
744
00:25:07,790 --> 00:25:09,124
Get out!
745
00:25:09,158 --> 00:25:16,197
♪
746
00:25:28,144 --> 00:25:29,944
He's moving in the wrong direction.
747
00:25:29,979 --> 00:25:31,446
He'll turn around.
748
00:25:31,480 --> 00:25:33,348
Your optimism is enchanting.
749
00:25:33,382 --> 00:25:34,582
Reality, though:
750
00:25:34,617 --> 00:25:35,950
between the clot, then the bleed,
751
00:25:35,985 --> 00:25:37,419
his heart is dying.
752
00:25:37,453 --> 00:25:39,788
We should push for a transplant.
753
00:25:39,822 --> 00:25:41,189
We're only a few hours post-op.
754
00:25:41,223 --> 00:25:43,091
We are miles away from that discussion.
755
00:25:43,125 --> 00:25:44,859
Normally, yes,
756
00:25:44,894 --> 00:25:47,629
but a hit-and-run just died in surgery.
757
00:25:47,663 --> 00:25:49,297
His heart is an HLA match.
758
00:25:49,331 --> 00:25:50,765
You already tested for compatibility?
759
00:25:50,800 --> 00:25:52,300
Ray's not even on the list.
760
00:25:52,334 --> 00:25:54,302
Anything that could go wrong
with Ray has.
761
00:25:54,336 --> 00:25:56,938
We fix one thing, something else breaks.
762
00:25:56,972 --> 00:25:58,640
A heart has fallen into our laps.
763
00:25:58,674 --> 00:26:00,442
Let's use it and steal a win.
764
00:26:00,476 --> 00:26:02,444
Is that our priority?
765
00:26:02,478 --> 00:26:04,145
You want his death on your record?
766
00:26:04,180 --> 00:26:06,214
Dr. Bekker, you may have
elbowed your way
767
00:26:06,248 --> 00:26:09,651
onto Ray's case,
but he's still my patient.
768
00:26:09,685 --> 00:26:11,886
Transplant's not an option.
769
00:26:11,921 --> 00:26:13,488
Then you're just wasting time,
770
00:26:13,522 --> 00:26:16,024
because the balloon pump
he's on won't hold.
771
00:26:16,058 --> 00:26:17,392
He'll max out on pressors
772
00:26:17,426 --> 00:26:19,360
but he'll still need to go on VA-ECMO.
773
00:26:19,395 --> 00:26:20,728
Then it gets invasive:
774
00:26:20,763 --> 00:26:22,163
a procedure for a temporary LVAD.
775
00:26:22,198 --> 00:26:23,631
When that's not enough,
776
00:26:23,666 --> 00:26:25,166
a bigger procedure for a permanent one.
777
00:26:25,201 --> 00:26:27,035
You're going to put Ray
through months of
778
00:26:27,069 --> 00:26:29,137
physical and emotional strain,
only to get back to
779
00:26:29,171 --> 00:26:31,039
exactly where we are right now.
780
00:26:31,073 --> 00:26:33,241
Ray's arteries were bad, not his heart.
781
00:26:33,275 --> 00:26:34,742
Now that the vessels are repaired,
782
00:26:34,777 --> 00:26:37,479
it will compensate
for the clot and the bleed.
783
00:26:37,513 --> 00:26:39,080
It'll heal.
784
00:26:39,115 --> 00:26:41,316
No, it won't.
785
00:26:41,350 --> 00:26:42,750
And when I'm right,
786
00:26:42,785 --> 00:26:45,753
I'll make sure the blame
is on you, not me.
787
00:26:45,788 --> 00:26:49,524
[tense music]
788
00:26:49,558 --> 00:26:52,393
Wow.
789
00:26:52,428 --> 00:26:54,529
I guess there was something
790
00:26:54,563 --> 00:26:57,699
living inside Alex.
791
00:26:57,733 --> 00:26:59,734
I'm still not exactly sure
what I'm looking at.
792
00:26:59,768 --> 00:27:01,536
Is it a tumor?
793
00:27:01,570 --> 00:27:02,904
Possibly.
794
00:27:02,938 --> 00:27:05,874
Or it could be a fetus in fetu:
795
00:27:05,908 --> 00:27:08,776
a twin that her absorbed in utero.
796
00:27:08,811 --> 00:27:10,378
Either way,
797
00:27:10,412 --> 00:27:13,948
it's not a result
of schizophrenia or meth.
798
00:27:13,983 --> 00:27:15,884
How about that?
799
00:27:15,918 --> 00:27:17,418
That's gotta be so rare.
800
00:27:17,453 --> 00:27:19,087
To say the least.
801
00:27:19,121 --> 00:27:21,723
It's very cool.
802
00:27:21,757 --> 00:27:24,459
Hm.
803
00:27:24,493 --> 00:27:26,394
But how did he...
804
00:27:26,428 --> 00:27:28,363
know, not only that there was
something inside him,
805
00:27:28,397 --> 00:27:29,464
but exactly where it was?
806
00:27:29,498 --> 00:27:30,765
Beats me.
807
00:27:30,799 --> 00:27:32,534
And after all the advances we've made,
808
00:27:32,568 --> 00:27:34,936
splicing the genome,
reprogramming viruses,
809
00:27:34,970 --> 00:27:36,538
mapping the brain...
810
00:27:36,572 --> 00:27:38,706
in this case, you know,
just completely trumped
811
00:27:38,741 --> 00:27:40,608
by human instinct.
812
00:27:40,643 --> 00:27:42,310
Everything I've learned
about human nature,
813
00:27:42,344 --> 00:27:45,880
I still can't see things coming.
814
00:27:45,915 --> 00:27:48,883
He scared you?
815
00:27:48,918 --> 00:27:50,485
There's risk in our work.
816
00:27:50,519 --> 00:27:52,287
I guess I realized a long time ago,
817
00:27:52,321 --> 00:27:55,890
you... you choose to see the threat
818
00:27:55,925 --> 00:27:57,892
or the opportunity.
819
00:27:57,927 --> 00:28:00,895
[solemn music]
820
00:28:00,930 --> 00:28:07,936
♪
821
00:28:11,373 --> 00:28:14,409
[distant siren wailing]
822
00:28:18,314 --> 00:28:20,348
Hey, Eric.
823
00:28:20,382 --> 00:28:22,083
Hey, uh, listen,
824
00:28:22,117 --> 00:28:23,651
the last thing that I need
right now is a lecture.
825
00:28:23,686 --> 00:28:26,721
Hey, I'm here for me
as much as I am for you.
826
00:28:29,391 --> 00:28:31,492
What happened back there...
827
00:28:31,527 --> 00:28:32,860
sometimes, when people are grieving,
828
00:28:32,895 --> 00:28:34,028
they lash out.
829
00:28:34,063 --> 00:28:35,196
Yeah, no, that's...
830
00:28:35,231 --> 00:28:37,498
that's how my folks always are.
831
00:28:37,533 --> 00:28:39,267
Man, they think I'm, uh...
832
00:28:39,301 --> 00:28:43,471
I'm worthless.
833
00:28:43,505 --> 00:28:46,107
I don't know. May... maybe I am,
834
00:28:46,141 --> 00:28:47,675
but they think I want to be like this,
835
00:28:47,710 --> 00:28:51,312
and... and I really don't.
836
00:28:51,347 --> 00:28:52,680
Uh, you know, My-Myra...
837
00:28:52,715 --> 00:28:54,382
she was the only one who ever, like...
838
00:28:54,416 --> 00:28:56,551
like, really, like... like, saw me.
839
00:28:56,585 --> 00:28:58,152
You know?
840
00:28:58,187 --> 00:29:00,188
Yeah.
841
00:29:02,391 --> 00:29:04,959
And now it's...
842
00:29:04,994 --> 00:29:07,428
[sighs]
843
00:29:09,732 --> 00:29:11,899
What do you want, Eric?
844
00:29:11,934 --> 00:29:15,003
I want to get clean.
845
00:29:15,037 --> 00:29:17,372
You know, I wanna, like, wake up
846
00:29:17,406 --> 00:29:18,906
and just feel clear.
847
00:29:18,941 --> 00:29:20,408
Okay.
848
00:29:20,442 --> 00:29:21,576
We'll set you up with a social worker,
849
00:29:21,610 --> 00:29:23,344
get you in a program.
850
00:29:23,379 --> 00:29:26,314
[laughs] Was... seriously?
851
00:29:26,348 --> 00:29:27,849
Yeah.
852
00:29:27,883 --> 00:29:29,217
You'll get the support you need,
853
00:29:29,251 --> 00:29:31,853
but it's up to you to come through.
854
00:29:31,887 --> 00:29:33,755
Why are you doing this for me?
855
00:29:33,789 --> 00:29:36,357
♪
856
00:29:36,392 --> 00:29:37,892
I guess I'm seeing that
there's a difference
857
00:29:37,926 --> 00:29:40,361
between a crutch and a helping hand.
858
00:29:40,396 --> 00:29:42,764
♪
859
00:29:42,798 --> 00:29:44,098
Thank you.
860
00:29:44,133 --> 00:29:45,867
Yeah.
861
00:29:45,901 --> 00:29:52,573
♪
862
00:29:52,608 --> 00:29:54,876
[laughs]
863
00:29:54,910 --> 00:29:56,344
Let's get you
something to eat first, huh?
864
00:29:56,378 --> 00:29:57,545
Help you come down.
865
00:29:57,579 --> 00:29:59,747
No, no, I had a burger earlier.
866
00:29:59,782 --> 00:30:02,717
Uh, it made me, like, feel really sick.
867
00:30:02,751 --> 00:30:04,886
It's why I... I had to get high.
868
00:30:04,920 --> 00:30:06,421
You know, not to... not to feel it.
869
00:30:06,455 --> 00:30:09,123
Maybe food poisoning?
870
00:30:09,158 --> 00:30:10,458
Uh, no, I just...
871
00:30:10,492 --> 00:30:12,860
I just felt crappy,
872
00:30:12,895 --> 00:30:14,295
like I always do.
873
00:30:14,330 --> 00:30:15,897
♪
874
00:30:15,931 --> 00:30:18,466
Always, or just after eating?
875
00:30:18,500 --> 00:30:24,339
♪
876
00:30:26,942 --> 00:30:28,476
Hey.
877
00:30:28,510 --> 00:30:30,211
Oh, you again.
878
00:30:30,245 --> 00:30:31,913
Yeah, last guy only had a hangnail.
879
00:30:31,947 --> 00:30:33,281
Brought him in anyway.
880
00:30:33,315 --> 00:30:34,749
Okay.
881
00:30:34,783 --> 00:30:36,451
Crew's meeting at Molly's tonight.
882
00:30:36,485 --> 00:30:39,821
Come and hang?
883
00:30:39,855 --> 00:30:41,723
This sudden flirting...
884
00:30:41,757 --> 00:30:42,824
what is it?
885
00:30:42,858 --> 00:30:46,060
Have you seen you?
886
00:30:46,095 --> 00:30:47,128
You're still a catch.
887
00:30:47,162 --> 00:30:49,564
I always have been.
888
00:30:49,598 --> 00:30:51,499
You should've thought about
that before you cheated.
889
00:30:51,533 --> 00:30:54,268
I'm not the same guy anymore.
890
00:30:54,303 --> 00:30:55,937
Hm.
891
00:31:00,542 --> 00:31:01,943
Barry up to something?
892
00:31:01,977 --> 00:31:03,444
I'm not sure.
893
00:31:03,479 --> 00:31:06,147
Yeah, right. This round two?
894
00:31:06,181 --> 00:31:07,482
Too much baggage.
895
00:31:07,516 --> 00:31:08,983
Mm-hmm. Make him work for it.
896
00:31:09,017 --> 00:31:09,984
Mm.
897
00:31:10,018 --> 00:31:11,786
[chuckles]
898
00:31:11,820 --> 00:31:13,187
Can I help you with something?
899
00:31:13,222 --> 00:31:14,589
No, I'm just giving today's charts
900
00:31:14,623 --> 00:31:15,957
a once-over.
901
00:31:15,991 --> 00:31:17,692
Ugh, well, you better settle in.
902
00:31:17,726 --> 00:31:19,627
Some of them are a few chapters long.
903
00:31:19,661 --> 00:31:21,763
Stohl's five-minute knee aspiration
904
00:31:21,797 --> 00:31:24,031
reads like "War and Peace."
905
00:31:24,066 --> 00:31:26,100
Hey, Nat, I was speaking with Eric
906
00:31:26,135 --> 00:31:27,535
The drugs... he's self-medicating.
907
00:31:27,569 --> 00:31:28,936
Since he was a kid,
908
00:31:28,971 --> 00:31:31,005
he's gotten sick after eating protein.
909
00:31:31,039 --> 00:31:32,540
Myra was a vegan... avoided protein.
910
00:31:32,574 --> 00:31:34,175
You're thinking that's
what made her sick, too?
911
00:31:34,209 --> 00:31:35,977
Last month, when Myra
was feeling confused,
912
00:31:36,011 --> 00:31:37,712
she was fasting while studying.
913
00:31:37,746 --> 00:31:39,647
Ketosis.
914
00:31:39,681 --> 00:31:41,149
Her body was starving,
915
00:31:41,183 --> 00:31:42,784
so it started digesting muscle as fuel,
916
00:31:42,818 --> 00:31:45,186
which released protein into her blood.
917
00:31:45,220 --> 00:31:47,121
Okay, well, that explains
what made her sick last month,
918
00:31:47,156 --> 00:31:48,122
but what about today?
919
00:31:48,157 --> 00:31:49,891
The fellowship.
920
00:31:49,925 --> 00:31:51,492
She probably wasn't eating again.
921
00:31:51,527 --> 00:31:53,294
I think this is OTC...
a metabolic disorder fits.
922
00:31:53,328 --> 00:31:54,996
You were right.
The visits were connected.
923
00:31:55,030 --> 00:31:56,564
- Yeah.
- Wait.
924
00:31:56,598 --> 00:31:58,800
Did they transplant the liver yet?
925
00:31:58,834 --> 00:32:00,568
It's still up in the OR.
They can't use it.
926
00:32:00,602 --> 00:32:02,503
[suspenseful music]
927
00:32:02,538 --> 00:32:03,871
If Myra had OTC,
928
00:32:03,906 --> 00:32:05,239
she couldn't break down nitrogen.
929
00:32:05,274 --> 00:32:06,507
So it built up in her body as ammonia
930
00:32:06,542 --> 00:32:07,909
and finally put her in a coma.
931
00:32:07,943 --> 00:32:09,343
And if the liver gets transplanted...
932
00:32:09,378 --> 00:32:11,412
Same thing will happen to the recipient.
933
00:32:11,447 --> 00:32:13,214
♪
934
00:32:13,248 --> 00:32:14,482
Is the transplant finished?
935
00:32:14,516 --> 00:32:16,484
No, the last surgery ran late.
936
00:32:16,518 --> 00:32:18,686
They moved the transplant to OR 3.
937
00:32:18,720 --> 00:32:20,588
Come on.
938
00:32:20,622 --> 00:32:25,593
♪
939
00:32:25,627 --> 00:32:27,361
Okay...
940
00:32:27,396 --> 00:32:29,063
- Stop!
- What the hell?
941
00:32:29,097 --> 00:32:30,164
Liver might not be good.
942
00:32:30,199 --> 00:32:31,199
The biopsy was clean.
943
00:32:31,233 --> 00:32:32,400
It's a genetic defect.
944
00:32:32,434 --> 00:32:33,835
It wouldn't show up on the biopsy.
945
00:32:33,869 --> 00:32:34,902
I got my patient wide open, Choi.
946
00:32:34,937 --> 00:32:36,070
You transplant that liver,
947
00:32:36,104 --> 00:32:37,538
he could be dead within hours.
948
00:32:37,573 --> 00:32:38,940
We need time to test the donor's blood,
949
00:32:38,974 --> 00:32:40,942
see if she had OTC.
950
00:32:40,976 --> 00:32:42,243
♪
951
00:32:42,277 --> 00:32:43,845
I'll pack and hold,
952
00:32:43,879 --> 00:32:45,379
but the donor's liver's
only got four hours
953
00:32:45,414 --> 00:32:46,848
till it's shot,
954
00:32:46,874 --> 00:32:48,618
so move it.
955
00:32:48,750 --> 00:32:49,750
♪
956
00:32:54,672 --> 00:32:56,171
A metabolic...
957
00:32:56,206 --> 00:32:58,140
disorder caused her death?
958
00:32:58,174 --> 00:32:59,541
The precise term is
959
00:32:59,576 --> 00:33:01,844
"ornithine transcarbamylase deficiency,"
960
00:33:01,878 --> 00:33:03,979
or OTC.
961
00:33:04,013 --> 00:33:06,982
You see, Myra's liver
was missing a vital enzyme
962
00:33:07,016 --> 00:33:09,485
that helps break down protein.
963
00:33:09,519 --> 00:33:11,487
Something as simple as eating a burger
964
00:33:11,521 --> 00:33:13,122
could cause toxic levels of ammonia
965
00:33:13,156 --> 00:33:15,691
to build up in her blood
and attack her nervous system.
966
00:33:15,716 --> 00:33:17,550
- But Myra was a vegan.
- Yeah.
967
00:33:17,594 --> 00:33:20,729
Which is how she was able to
avoid symptoms for so long,
968
00:33:20,771 --> 00:33:23,399
but when she pushed herself,
and didn't eat...
969
00:33:23,433 --> 00:33:25,134
finals, the fellowship...
970
00:33:25,168 --> 00:33:27,403
her body started breaking down muscle,
971
00:33:27,437 --> 00:33:30,706
which released protein into her blood.
972
00:33:30,740 --> 00:33:32,040
So, you mean,
973
00:33:32,075 --> 00:33:34,710
she'd be alive right now
if she'd just...
974
00:33:34,744 --> 00:33:37,413
eaten?
975
00:33:37,447 --> 00:33:40,149
[solemn music]
976
00:33:40,183 --> 00:33:43,318
If this disease is genetic,
977
00:33:43,353 --> 00:33:45,654
that means one of us gave it to her.
978
00:33:45,688 --> 00:33:48,991
Yes, um, it is passed
through the X chromosome,
979
00:33:49,025 --> 00:33:52,428
from mother to child, but...
980
00:33:52,462 --> 00:33:55,831
♪
981
00:33:55,904 --> 00:33:59,140
OTC sufferers exhibit
totally normal liver function.
982
00:33:59,191 --> 00:34:01,960
That's why all of Myra's tests
came back clean.
983
00:34:01,994 --> 00:34:04,662
We were only able to diagnose
her once Eric explained
984
00:34:04,697 --> 00:34:06,965
his lethargy and sickness after eating.
985
00:34:06,999 --> 00:34:09,167
We believe he has the defect as well,
986
00:34:09,201 --> 00:34:12,570
and he's been self-medicating
with drugs.
987
00:34:12,605 --> 00:34:13,905
Wha...?
988
00:34:13,939 --> 00:34:16,574
Oh...
989
00:34:16,609 --> 00:34:18,910
Eric...
990
00:34:18,944 --> 00:34:21,679
is this true?
991
00:34:21,714 --> 00:34:23,581
I'm so sorry.
992
00:34:23,616 --> 00:34:25,950
Oh, son...
993
00:34:25,985 --> 00:34:28,119
Forgive us?
994
00:34:28,153 --> 00:34:30,088
Will you forgive us?
995
00:34:30,122 --> 00:34:33,091
We're so sorry.
996
00:34:33,125 --> 00:34:35,093
Oh, Eric. [crying]
997
00:34:35,127 --> 00:34:42,133
♪
998
00:34:45,037 --> 00:34:46,371
So, how's our patient?
999
00:34:46,405 --> 00:34:47,972
Heading for ECMO?
1000
00:34:48,007 --> 00:34:49,274
Actually, no.
1001
00:34:49,308 --> 00:34:51,509
Uh, BP's risen and is holding,
1002
00:34:51,544 --> 00:34:52,710
vitals have stabilized as well,
1003
00:34:52,745 --> 00:34:55,980
so I'm going to remove the balloon pump
1004
00:34:56,015 --> 00:34:59,250
and give his heart back its full load.
1005
00:35:00,819 --> 00:35:03,288
What do you want, an "I was wrong"?
1006
00:35:03,322 --> 00:35:05,590
I'm not holding my breath.
1007
00:35:07,493 --> 00:35:09,127
Ah, I see our patient
1008
00:35:09,161 --> 00:35:10,328
is making a turn for the better.
1009
00:35:10,362 --> 00:35:11,796
For a moment, there was concern
1010
00:35:11,830 --> 00:35:13,364
the damage was irreparable.
1011
00:35:13,399 --> 00:35:14,832
A transplant option presented itself,
1012
00:35:14,867 --> 00:35:16,834
but upon discussing
the visual assessment
1013
00:35:16,869 --> 00:35:18,670
of the heart during surgery,
1014
00:35:18,704 --> 00:35:19,971
the decision was made
to give it more time
1015
00:35:20,005 --> 00:35:21,506
to come back on its own.
1016
00:35:21,540 --> 00:35:23,074
It was a risk,
1017
00:35:23,108 --> 00:35:26,911
but it appears we made the right choice.
1018
00:35:26,946 --> 00:35:28,546
Indeed.
1019
00:35:28,581 --> 00:35:30,548
Nice work, doctors.
1020
00:35:30,583 --> 00:35:32,150
Thank you.
1021
00:35:32,184 --> 00:35:35,353
♪
1022
00:35:35,387 --> 00:35:38,323
You and Dr. Bekker...
1023
00:35:38,357 --> 00:35:40,425
your successes suggest a good pairing,
1024
00:35:40,459 --> 00:35:42,427
but your...
1025
00:35:42,461 --> 00:35:45,563
exchanges often convey the opposite.
1026
00:35:45,598 --> 00:35:49,601
What's peculiar is Dr. Bekker
seems to enjoy this...
1027
00:35:49,635 --> 00:35:51,436
discordance.
1028
00:35:51,470 --> 00:35:53,671
Do you?
1029
00:35:53,706 --> 00:35:56,240
♪
1030
00:35:56,275 --> 00:35:58,910
Maybe I do.
1031
00:35:58,944 --> 00:36:05,817
♪
1032
00:36:11,557 --> 00:36:14,125
You okay?
1033
00:36:14,159 --> 00:36:16,961
We turned this hospital
upside-down chasing zebras,
1034
00:36:16,996 --> 00:36:18,563
but a simple ammonia test
1035
00:36:18,597 --> 00:36:19,964
would've given us
everything we needed to know.
1036
00:36:19,999 --> 00:36:22,300
There's no way you could've known.
1037
00:36:22,334 --> 00:36:24,102
Silver lining:
1038
00:36:24,136 --> 00:36:25,803
the liver transplant was stopped
1039
00:36:25,838 --> 00:36:28,573
before it was too late,
and thanks to you,
1040
00:36:28,607 --> 00:36:30,575
Eric's getting the help he needs.
1041
00:36:30,609 --> 00:36:32,443
♪
1042
00:36:32,478 --> 00:36:35,613
I may coddle my family,
1043
00:36:35,648 --> 00:36:39,150
but seems I'm not the only one
with a soft spot.
1044
00:36:39,184 --> 00:36:46,224
♪
1045
00:36:50,462 --> 00:36:52,163
Yes, yes, yes.
1046
00:36:52,197 --> 00:36:53,598
Wonderful, Dr. Halstead.
1047
00:36:53,632 --> 00:36:54,732
Above and beyond.
1048
00:36:54,767 --> 00:36:56,000
Excellent medicine,
1049
00:36:56,035 --> 00:36:57,602
and your writing for the ED.
1050
00:36:57,636 --> 00:36:59,737
It's been a good day.
1051
00:37:01,206 --> 00:37:04,509
We're gonna turn this place around.
1052
00:37:04,543 --> 00:37:08,746
He more happy
about the work, or the bill?
1053
00:37:08,781 --> 00:37:10,682
So I guess the rumors are true.
1054
00:37:10,716 --> 00:37:12,250
This morning's board meeting
1055
00:37:12,284 --> 00:37:13,451
was basically an edict
1056
00:37:13,485 --> 00:37:15,186
to shake the old money tree?
1057
00:37:15,220 --> 00:37:17,588
Ah, nothing that hasn't
come down the pipe before.
1058
00:37:17,623 --> 00:37:18,956
I'm handling it.
1059
00:37:18,991 --> 00:37:20,358
And these itemized charts
1060
00:37:20,392 --> 00:37:21,793
that Stohl's championing?
1061
00:37:21,827 --> 00:37:23,995
I mean, detail equals charges, right?
1062
00:37:24,029 --> 00:37:26,164
Basically a menu
1063
00:37:26,198 --> 00:37:28,766
for Billing to pad the invoices?
1064
00:37:28,801 --> 00:37:30,168
Well, I've looked at every chart
1065
00:37:30,202 --> 00:37:31,836
coming out of the ED today.
1066
00:37:31,870 --> 00:37:33,171
Each one has been accurate
1067
00:37:33,205 --> 00:37:34,839
to the services provided.
1068
00:37:34,873 --> 00:37:36,708
Well, I should hope
he's not committing fraud.
1069
00:37:36,742 --> 00:37:39,444
I mean, the fact that
you even had to check...
1070
00:37:39,478 --> 00:37:41,179
Look, Sharon.
1071
00:37:41,213 --> 00:37:42,714
You set the tone,
1072
00:37:42,748 --> 00:37:44,515
so if you're okay with it,
1073
00:37:44,550 --> 00:37:45,717
well, then, it must...
1074
00:37:45,751 --> 00:37:47,652
The numbers are clear.
1075
00:37:47,686 --> 00:37:49,020
If I don't improve the bottom line,
1076
00:37:49,054 --> 00:37:50,888
the board will start slashing.
1077
00:37:50,923 --> 00:37:53,725
Do you want to see the ED
closed, or contracted out?
1078
00:37:53,759 --> 00:37:55,026
Because that's what'll happen.
1079
00:37:55,060 --> 00:37:56,561
No, of course not,
1080
00:37:56,595 --> 00:37:57,628
but I also don't wanna see
the bottom line
1081
00:37:57,663 --> 00:37:59,530
dictating patient care.
1082
00:37:59,565 --> 00:38:01,833
Well, let me tell you something.
1083
00:38:01,867 --> 00:38:05,737
Psych is the biggest
money-loser in the ED.
1084
00:38:05,771 --> 00:38:07,205
You, Daniel,
1085
00:38:07,239 --> 00:38:09,207
are a major part of our problem,
1086
00:38:09,241 --> 00:38:12,276
so don't get on the soapbox with me.
1087
00:38:23,222 --> 00:38:24,355
You seen Natalie?
1088
00:38:24,389 --> 00:38:25,757
She's in the doctor's lounge.
1089
00:38:25,791 --> 00:38:27,191
Oh, she told me that you had
1090
00:38:27,226 --> 00:38:29,660
a hot date planned tonight.
1091
00:38:29,695 --> 00:38:31,229
Uh-huh,
1092
00:38:31,263 --> 00:38:32,430
and I'm even gonna shave.
1093
00:38:32,464 --> 00:38:33,598
No.
1094
00:38:33,632 --> 00:38:35,266
The things we do for love...
1095
00:38:35,300 --> 00:38:37,201
[chuckles]
1096
00:38:37,236 --> 00:38:38,936
[laughs softly]
1097
00:38:38,971 --> 00:38:41,939
[somber music]
1098
00:38:41,974 --> 00:38:49,013
♪
1099
00:38:56,421 --> 00:38:58,022
Hey.
1100
00:38:58,056 --> 00:39:01,025
Day like today... mm.
1101
00:39:01,059 --> 00:39:02,894
Tell me about it.
1102
00:39:02,928 --> 00:39:05,129
You make a really nice pillow.
1103
00:39:05,164 --> 00:39:11,202
♪
1104
00:39:15,741 --> 00:39:18,109
Your hot date?
1105
00:39:18,143 --> 00:39:20,444
♪
1106
00:39:20,479 --> 00:39:21,546
Nice.
1107
00:39:21,580 --> 00:39:28,586
♪
1108
00:39:45,637 --> 00:39:47,138
Hi.
1109
00:39:47,172 --> 00:39:49,607
Dirty Martini.
1110
00:39:49,641 --> 00:39:52,510
Extra olives.
1111
00:39:52,544 --> 00:39:54,445
You remember the important things.
1112
00:39:54,479 --> 00:39:57,515
Wasn't sure you'd show.
1113
00:39:57,549 --> 00:39:59,584
Well, don't get ahead of yourself.
1114
00:39:59,618 --> 00:40:01,986
You say that you've changed.
1115
00:40:02,020 --> 00:40:03,754
We'll see.
1116
00:40:03,789 --> 00:40:06,290
♪
1117
00:40:06,325 --> 00:40:07,792
Thank you.
1118
00:40:07,826 --> 00:40:14,832
♪
1119
00:40:29,248 --> 00:40:32,283
[phone buzzing]
1120
00:40:33,863 --> 00:40:37,534
April, I'll be there in ten minutes.
1121
00:40:38,152 --> 00:40:40,191
Okay.
1122
00:40:40,225 --> 00:40:47,265
♪
1123
00:40:47,289 --> 00:40:52,289
Synced & corrected by kinglouisxx
www.addic7ed.com
75084
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