Original subtitles

.

- He's putting me on a renal diet.

And if that doesn't turn things around, then...

- Dialysis?

I'm so sorry.

- I don't advertise my immigration status,

but I'm undocumented.

My future always feels precarious.

all: [chanting] More money in our checks!

We are essential!

- You're striking? - It's very important

that Liliana feels like I have her back.

- I'm going with my friends to celebrate.

Come! - Oh, no--

- You have to come. You're my boyfriend.

- Lil.

- Daniel.

Oh, the time.

I didn't realize.

I--I'm almost finished.

I'm usually done before you arrive.

I'm sorry. - Oh, no.

No, let me get that. Let me get that.

I'm the one who should be apologizing.

No. No, I had the interns in for pizza last night.

Then they dragged me out for a drink,

and--and we just left.

- It's OK. I've got it.

- I apologize for the mess. Really, I do.

- It's OK.

Compared to other offices, it's not that bad.

- Oh! - [laughs]

Daniel, have a good day.

- You too.

- [groans]

Ah.

- I think this belongs to you.

- Indeed, it does. Where did you find it?

- This time? Waiting room.

Top of the vending machine. - Mm.

You know, maybe I should just put it

in a little red-and-white striped shirt,

put a bobble hat on it, black glasses,

and call it my "Where's Waldo?" water bottle, huh?

You get it?

- I get it.

You have to stay hydrated.

- Thanks, Mom.

- Dr. Cuevas.

- Ms. Goodwin, good morning. - Good morning.

Do you have a moment to discuss your DACA renewal?

- Oh. Um, now?

- Well, the paperwork's not due for a few months,

but I want to make sure we get everything filed early,

just in case there's an unexpected policy change.

- Right, of course. I appreciate that.

I just was about to dig into these overnight charts.

- Understood.

How about we meet up at the end of the day?

- Yeah. Sure, that works.

[quickly] I will--I'll see you then.

- Dr. Asher. - Mm-hmm?

- Need you. - Oh, yeah.

Come this way.

Hi, I'm Dr. Asher.

- Leah, what's going on?

- Parents and their daughter.

Came in a few minutes ago. They're terrified.

Even scared me. - Going to two.

- I didn't get a history. Just came for you.

- Excuse me, Doctor. We need your help.

Our daughter. - All right.

Hi, I'm Dr. Halstead. What's your name?

- [stammering] - Maria.

Her name is Maria. Very sick!

- Listen. [speaking Spanish]

- I'm sorry. I don't speak Spanish.

Get Dr. Cuevas.

I'm just gonna feel your neck, OK?

- [inhales sharply]

- Does that hurt?

¿Malo?Bad?

[conversing in Spanish]

What are they saying?

- They're saying that she has the sickness,

and if we don't help her, she will die.

[tense music]

♪

.

[conversing in Spanish]

- Thank you.

- Hey. How's Maria doing?

- Still a bit groggy,

but responding to questions in English.

Whatever this is, it seems to be sporadic.

- Any guesses? - I don't know.

Maybe infectious encephalitis, but her vitals were normal.

I'm hoping labs shed some light.

What did Mom and Dad have to say?

- The sickness that they're referring to

has to do with her older brother, Hugo.

About a month ago, he came down with an illness,

was admitted to Oakview Community Hospital,

and then died a few days later. - Oh, man.

- Yeah, and even worse,

Oakview couldn't make a diagnosis.

- Well, explains why they're beating down our doors.

They're afraid whatever ravaged Hugo is now attacking Maria.

- But a death in the family, no answers,

plus the fear that she might have the same illness?

Since nothing's jumping out, I think it's possible

that her emotions could be manifesting physically.

I want to talk to her, see if there could be

a psych explanation. - OK.

Meantime, I'll reach out to Oakview,

get Hugo's records and autopsy results.

If Maria does have the same illness,

there could be a clue in there. - OK.

- OK, Layla, you're 7 centimeters dilated,

100% effaced.

How long ago did your water break?

- About an hour, hour and a--

[groans]

- 7:02 a.m., I think.

- This baby is coming out sideways.

- No, it just feels like that.

Your fetus is OP,

meaning it's facing up instead of down.

- Something's wrong? - No.

Baby's just moving around, letting us know

that it is time to come out.

- I'll have a nurse let L&D know.

- Oh, my God.

Quentin, our son is coming.

I'm gonna be a mom today.

- You know, I can't remember if I turned off the oven

before we left the house.

- Quentin, we haven't cooked in days.

The oven is off.

- I'm just gonna go home and check.

- Quentin, no!

- Mr. Bell, please don't go. - You know what?

Maybe you can have a neighbor check on it,

or maybe it's just nervous energy

that's making you think that you left it on.

- Yeah, I just don't feel like myself.

- I get it. It's a big day.

You know, a lot of new experiences

all happening at once.

But, Quentin, this is not new for me.

I have been here many, many times,

and I know exactly how to help you and Layla

get through this.

- Thank you.

- Sorry, Lay.

I just lost my mind for a minute.

- [chuckles]

- Nice save. - Mm-hmm.

- [chuckles]

- Hey, Sam. This is Dr. Tanaka-Reed.

He's gonna be scrubbing in with me today.

He's one of my surgical residents.

- Uh, technically I'm a resident

but definitely not a beginner.

- OK.

- Anyway, like we discussed,

it's a straight appendix removal.

You're gonna be a bit sore afterwards,

but in a week or two, you'll be back to full strength.

- Mm, perfect,

because I've been itching to get back in the gym.

Rugged Maniac is this summer.

- Rugged Maniac? The adventure race?

- You know it? - Yeah, sort of.

A couple of guys from the community

are putting a team together.

- Community? You mean other doctors?

- [laughs] No, CrossFit.

From my Kalsu group. Kalsu's a workout.

We do burpees and thrusters for time.

- Anyway, back to the task at hand.

If you're ready, we're ready.

- Let's do this. - Great.

Nurse Trisha will be in to get the prep started.

Anesthesia after that. - Sounds good, Doc.

- See you on the other side, all right?

- Appendix removal-- pretty basic.

- Well, sorry Sam's not sick enough for you.

- Oh, you know what I mean.

OR 2.0 is a Ferrari-- sexy surgery.

But a lap appy? That's a minivan.

- Well, not even in that today.

Sam had a sigmoid colon resection 18 months ago.

Likely adhesions in his pelvis,

so we're gonna do this appy open--

right lower quadrant incision.

OK? - Old school.

Gee, hope I'm up to the challenge.

- For a resident, guy sure is full of himself.

I'm not a fan.

- Hugo's gone.

I'm oldest now. I need to be strong.

For my other brothers and sisters.

For my parents.

They've been a wreck since Hugo died.

They can't sleep.

They can't eat.

Now I'm putting them through it again.

I have it too. - No.

Hey, we don't know that.

All of the labs Dr. Halstead ran came back normal.

- Then what's wrong with me?

- In some cases, it's possible

for grief and fear to lead to physical symptoms.

- No, I'm not imagining this.

- No, you're not.

Your symptoms are very real.

You suffered a devastating loss, a trauma.

- Hugo's tests were normal too.

And then he died.

- I don't think we're looking at a psych condition.

In conversion disorder, it's rare

that patients can express their emotions the way Maria is.

But her awareness of the situation,

her acknowledgment of the fear, it doesn't fit.

There's definitely something physical going on.

- I wish I knew what.

Medical examiner said Hugo died of brain swelling

but don't know what caused it.

And here's the kicker: it was only three days

from when Hugo was admitted to the time he died.

- OK, so whatever it is, it moved really fast.

- [groans] I think he's stuck.

- No, just a big head.

That's all. - [groaning]

- Oh, my God.

Is he gonna fit? - Yes, he will.

We just need to open up the birth canal a bit wider.

- McRoberts? - Yes.

Call the OB resident on call.

- Layla, we're gonna adjust you to a new position, OK?

It makes it easier for the baby to come out.

- OK.

- I'm right here. - All right, Quentin.

Why don't you let him take over for you, OK?

And I can use some pressure. - Yep.

- I'm right here.

- OK, now on your next contraction,

I want you to give me everything you've got.

Everything. - OK.

- OK. - I can do this.

- Yes, you can. - You got this.

You got this. You got this. - OK.

Oh.

[yelling]

- I've got the head.

Shoulder.

- [groans] [baby crying]

- I've got him.

I got him. He's here.

He's here.

He's here. - Oh, my God.

Oh, my God.

I'm a mom.

Our baby, he's beautiful.

He's perfect.

- Hey, Dad, do you want to cut the umbilical cord?

- [laughs nervously] Yeah.

- OK. Just right here in the middle, OK?

- I want to hold him.

- That's not my son.

- What?

- Layla, who's the father?

- You are, Quentin.

You are. That's our baby.

- No, you're lying! You're lying!

- Hey, Quentin, it's OK.

We'll figure this out, all right?

- That's not my son. - That's our baby.

Of course it is! - No, get back!

- Of course it is! Of course it is!

- I got to get out of here. - Hey, deep breaths, OK?

Quentin, breathe with me.

Breathe with me, Quentin. Deep breaths.

- I got to get out of here! - Stay! Baby, stay!

- Hey, call security. - Help!

Oh, my God. What's happening?

- Hey! Hey, stop!

Hey, guards! Quentin, stop!

[alarm blaring]

- Why are you chasing me? Just leave me--leave me alone!

- Hey, Quentin-- - Stay back! Stay back!

- It's OK. It's OK.

Deep breath. Please, just breathe.

- I just got to get out of here.

I just got to get out of here! - No, no, no, no, no!

All right, Quentin.

It's OK.

- [labored breathing]

- Oh, my God, the scissors, they're pulsating.

- They're penetrating the carotid artery.

- I'll get someone to turn off the machine.

- No, the magnet is holding everything in place,

including the scissors.

If gravity takes over, it'll shift everything,

and we'll have maybe 20 seconds before he bleeds out.

OK, we need help. Call Dr. Archer.

Dr. Charles too. - Yeah.

- Do not touch the scissors, OK?

We got you.

Everything's gonna be OK.

.

- Coming through. Excuse me.

- Thank you guys for coming.

- Absolutely.

- Hey, fellas. - Doctor.

- He's conscious and calm but out of it.

He's not being crushed. He's able to breathe.

He's got to be in pain, though. - OK.

So let's give him 50 mics of fentanyl IM.

Syringe is plastic and the needle nonferrous,

so it should be MRI safe.

- OK, I'll get it.

Dr. Asher went back to be with his wife, Layla.

She's still in L&D. - OK.

- It's a rescue situation.

I just don't really know where to start.

All of our tools have metal.

- So nothing is usable as long as the MRI machine is running.

All right, well, let's say we did turn the machine off.

- Everything falls to the floor.

Bed alone is a couple hundred pounds.

- I can put two of my guys in there to try and catch it,

then get it out of the way so you can get to Quentin.

- Scissors in his neck are magnetic too.

Cut the MRI's power, they're gonna move.

Quentin will bleed out fast.

- If you could go in there with clamps and stem the flow,

would that buy us some time? - Not enough.

Odds of survival are less than 1%.

I'm running outcome probabilities on our options,

and turning off the machine cold turkey is the worst.

- So what's the best?

- If CFD can secure Quentin

and ensure the bed won't displace him

and Dr. Archer can stabilize the neck wound

all before turning off the MRI machine,

then the odds of survival are roughly 61%.

- OK, we've got a plan. Can it be done?

- Well, safest way to secure the patient

would be to do a webbing harness.

We can throw the ropes over the MRI machine,

and then two of my guys can hold it on the other side.

- OK, the magnet's off, the bed falls.

How do we ensure that Quentin doesn't go with it?

- We can create a buffer zone between him and the bed

using wooden cribbing, wedges, and airbags.

- We can run some hoses and inflate them

from a tank here in the hallway.

- All right, we're halfway there.

Dr. Archer? - Yeah.

I just need to clamp the artery

in order to control the bleeding.

Then I could take the scissors out.

But the issue is the tools needed to do it.

- I can make them plastic. 3D printers.

There are four in the robotics lab.

- All right. Get on it.

And get a few of the 2.0 engineers to help.

- We'll get started too. - Good.

- OK, you're doing great.

Gonna give you a little injection.

Some pain meds, all right?

To just make you a little more comfortable, OK?

Little pinch.

OK.

- Daniel?

- I'm just gonna step away for a second,

have a little chat with my colleague.

I'm not going anywhere, OK?

- How's he doing?

- Well, you know, I mean, he's pinned to an MRI machine, so...

- Do you have any theories on what sparked the break?

- I've been really focusing on trying to keep him calm.

But how's the plan to get him off the thing going?

- Well, we've got one.

But it's a possibility that it won't work, Daniel,

so I've asked Dr. Asher to bring Quentin's wife down here

to see him 'cause it may be the last time.

- OK, thank you.

- OK, making the incision.

OK.

OK, nice and easy.

Lab cut.

Yep.

Definitely feeling some adhesions.

- Point taken.

Open surgery was the right call.

Go ahead, say it. "I told you so."

- Yeah, maybe later.

For now, why don't you get some practice old-school style?

Come around.

OK. You got it?

- Yeah. - All right.

- Babcock.

[stomach gurgles]

[grunts]

- You OK?

- Yeah, it's just a little heartburn.

I'm fine.

Oh, uh-- [farts]

Uh, God, excuse me. I'm sorry.

- [laughs] - Stop it.

Stop.

It's no big deal.

It happens, OK? Just focus on the field.

Stay focused.

[stomach gurgles]

- Uh-oh, here comes another one.

- [groans] - Kai?

- [groaning] - Kai, talk to me.

Hey, buddy! Hey!

Angel. Angel, check him.

- Got a pulse. - All right.

Give me the babcock, please.

- Maria! - Need some help in here!

- Maria!

- I was helping her to the bathroom,

and she started seizing.

- OK, 4 milligrams of Ativan.

- [speaking Spanish]

Please help her. Please.

- [speaking Spanish]

- Ativan's in.

- OK, she's gonna be postictal for a while.

Put her on a foley.

I don't want her getting out of the bed,

not even for the bathroom.

- A seizure expands our differential tenfold.

We got to widen our net-- CT panscan,

MRI brain, sed rate, autoimmune labs.

Let's rope in neurology. - Guys.

Ms. Goodwin just called.

She said stand down. No more treatment.

- What? What are you talking about?

- She's in the MRI suite.

Be here as soon as she can, OK?

- Hey, you OK? - This is overkill.

I probably just had some bad oatmeal.

- Well, bad oatmeal doesn't drop you

in the middle of surgery.

So how about you let me check you out?

- How's Sam? Appendectomy go OK?

- Yeah, all good. Dr. Graham is finishing up.

- At least it's just an appendectomy.

Not missing much.

[groaning]

[machinery beeping rapidly]

Oh, my chest. Pressure.

[farts]

Oh, God. I'm sorry.

- That was weird.

Your heart rate plummeted, but as soon as you passed gas,

it came back.

Will you sit up for me?

Take a deep breath.

- [breathes deeply]

- All right. Lean back for me.

Hey, Mike. Let's get an X-ray in here.

- What, did you hear a murmur?

- Honestly, I'm not sure what I heard.

- You're joking, right? Come on.

- Has heartburn been an issue before today?

- I mean, I get it.

Even when I was a kid, it would flare up here and there.

But it's never been an issue.

- X-ray up. Clear.

[machine whirring]

- What the hell? That's my colon.

It shouldn't be in my chest.

- No, it should not.

- Her brother. Hugo, was a patient treated at Oakview.

- So was Maria.

She was admitted yesterday via ambulance,

but this morning, her family just walked her out.

They just left--absconded.

- Well, her brother died at Oakview,

and they didn't get any answers.

You see how scared they are.

It's no wonder that they didn't want to stay.

- Look, I agree, but walking out

is the same as leaving against medical advice.

It's triggered an insurance nightmare

with the family's HMO.

They won't pay for any more treatment

until Maria is placed back

with their preferred network provider, Oakview.

- Are you kidding me? They're a community hospital.

They don't have the resources to run the tests she needs.

- Well, I've already reached out

to the director of patient services at Oakview,

and she assured me they'll do the best they can.

- The best they can?

- Ms. Goodwin, can't you reason with the insurance company?

Hector and Gloria aren't trying to take advantage of them.

They're trying to save their daughter's life.

- Look, I know, and I share

in your frustration, but they're--

- No. No, I don't care what the insurance company says.

I'm not sending Maria back to Oakview until I get a guarantee

she gets the treatment she needs in time.

- Dr. Halstead, the tests that you ordered

will cost tens of thousands of dollars,

and I know that's not coming out your pocket.

The family has to decide how to proceed.

.

- OK, Quentin, so listen,

we're gonna secure you to the machine

while it's still running with a harness.

So then, Dr. Archer, who is an excellent surgeon,

is gonna come in here and clamp your artery,

stabilize your neck wound,

and make it safer when they pull out the scissors.

All right? Then we turn off the machine.

The idea is, bed falls to the side,

you're held firmly in place by the harness, OK?

Still with me? - Mm-hmm.

- Great. Last thing.

Lower you onto a gurney, shoot you off the ER,

and finish fixing up your neck.

How's that sound? - Mm-hmm.

[grunts] Am I gonna die?

- Look, this is a complicated situation.

But some really skilled people have come up with this plan,

and it's the best option we got.

All you got to do: breathe in and out,

stay as still as you possibly can, OK?

All right.

Take all the time you need.

- Hey, hold the work. Everybody, out.

- You're my everything.

From our first date, I knew that I was in love.

And now we're parents.

Uh...

The nurse took a picture of him.

I named him Trevor, after your dad.

I think he'd like that.

- Tell Trevor I love him.

- You're gonna tell him yourself.

- You're gonna be a great mother.

- I love you, Quentin.

I will see you again, you hear me?

I will see you again.

[sobbing]

Sorry.

I didn't know what to say.

How do you put into words when--

- You can't.

But we could feel your love for each other.

- I just don't understand,

because Quentin is my rock,

and I don't even recognize the man that's in there.

He just snapped.

How does that happen all of a sudden?

- I mean, usually there are signs, you know?

Extreme expressions of emotional frustration,

anger, confusion, outbursts.

You noticed anything like that in Quentin recently?

- I don't think so. - How about physical changes?

I noticed he had some lumps on the back of his neck.

Have you-- do you know what those are?

- Lumps? I don't know.

I just wanted to get to today and to have the baby.

I've been so consumed by the pregnancy

that I haven't noticed anything else.

Oh, Quentin.

- Uh, give it to Spellman.

Thanks, Lori.

Mystery solved. Your chest CT.

- Hiatal hernia. - No, diaphragmatic.

Big enough that your colon migrated into your chest.

So the gas moving through it,

it puts pressure on the vagus nerve, drops your heartbeat.

- Breaking wind releases the pressure.

Heart returns to a normal rate. - Yeah.

You said you had heartburn since you were a kid.

Probably this: undiagnosed

asymptomatic congenital diaphragmatic hernia.

- I've never passed out before, though.

- Well, my guess is it's been slowly expanding over time.

But you do CrossFit now,

so the thrusters, burpees, other workouts--

safe bet that they've exacerbated the condition.

Led to today. - Yeah, well, I'll own that.

But I can't resist dropping in the OR again,

so let's fix this hernia. - OK.

Well, you've got a few surgical options.

Open. - No.

That's a huge incision. Lots of digging around.

I'll be laid up in the ICU for weeks.

- Laparoscopic, then.

Be more incisions for the scope and tools,

but less invasive-- - No old-school approaches.

Robotic assist in OR 2.0.

Shortest recovery time.

I just want this to be over with.

- OK, I'm gonna scrub in.

I'll see you after, OK?

- Holy cow. Look at this place.

It's like you guys are living in 2050 up here.

- So don't break anything.

- How's it going with the surgical tools?

- Almost there. Scalpel's printed.

Two of the three angled peripheral vascular clamps

are printed as well.

One Weitlaner retractor printed.

One to go. - Oh, it's like the real thing.

- It is the real thing, just plastic.

These tools, I think they can work.

- They'll have to.

They're all we got.

- [speaking Spanish]

- They never wanted to go to Oakview,

but the ambulance took them there anyway.

- Because Maria didn't require specialty care,

paramedics took her to the nearest hospital instead.

- [speaking Spanish]

- [speaking Spanish]

- I'm so sorry that you've been put in this situation.

We can continue to treat Maria,

but your insurance won't cover the costs.

- [speaking Spanish]

[both speaking Spanish]

- He said he'll sell the car. He can get a second job.

His oldest son can get a job as well.

- No. Papa, no.

No.

[speaking Spanish] I'll go back.

- No. [speaking Spanish]

- Maria-- - [speaking Spanish]

- Maria.

[speaking Spanish]

- [sighs]

[speaking Spanish]

You know, maybe Oakview will figure it out.

- All right.

Um, I'll set up the transfer.

- What was Maria saying?

- If she lets her parents bankrupt the family

paying for her medical care, then all of the opportunities

they've worked so hard to give their children will be lost.

- She is risking her life.

- No.

No, she's sacrificing it.

And it's awful,

but I get it.

.

Ready to inflate?

Up on blue.

[tank hissing]

Hold.

Up on red.

[tank hissing]

Hold.

- How's, uh-- how's Layla doing?

- She's in shock, full of grief,

and a first-time mom all at the same time.

It's a lot, but a psych resident is with her.

- Mm. And how about you?

How are you doing?

- Honestly, I didn't see this coming.

I just thought Quentin was a nervous first-time dad,

like the ones I see every single day.

Never suspected mental illness.

- You know, I'm not sure it is, per se.

You know those lumps on the back of his neck?

I have a very strong hunch that they're indicative

of a physical issue that could very well

be causing a sudden psychosis.

- It's physical, not psychological?

- Yeah, I'm leaning that way.

I mean, can't be sure until we run some tests.

- [labored breathing]

- Maria, this is a thumb drive

with all the work we did here, along with our notes.

You give this to the doctors as soon as you get there.

- Thank you.

- All right. Empty her foley.

- It's OK, Mama.

- [sniffs] Wait.

Will?

You smell that?

[speaking Spanish]

- We have to run one more test.

I'll pay for it myself, if I have to.

[both speaking Spanish]

- I'm scared.

- Well, you'll be less frightened if you can't see it,

so I'm gonna drape your face, OK?

[grunts] Yeah.

- All right.

- Here we go. Careful.

That's right. All right.

All right.

10cc's of lidocaine, please.

OK.

All right.

OK.

Scalpel.

All right. Grab hold of those scissors.

I don't want them flopping after I make the incisions.

Here we go.

[grunts]

OK.

All right.

Wheaties.

All right.

All right. Watch your fingers there.

That's it. That's it. Don't move it. Don't move it.

Clamp.

All right.

All right.

Carotid clamps in place. CFD, you're up.

- All right. Spread out around the bed.

When it falls down, we pull it away from the MRI machine.

- All right. And no slack at all, you understand?

If there's any movement, his clamps could pop off,

and then we'll have a problem we might not be able to fix.

All right.

On three, you're gonna cut the power to the MRI.

We ready? Everybody, ready?

- Ready.

- One, two, three.

[clattering]

All right. Clamps are holding.

I'm gonna remove the scissors now.

All right.

All right, we're clear. OK, bed.

Let's lower Quentin.

Lower him slowly. - One, two, three.

Slack!

- All right.

- OK, ropes are free.

- All right.

- Incredible, Doc. Freaking incredible.

- Thanks. Can someone get me a bottle of water, please?

- Dr. Archer, you did it.

- Dean, you all right? - Yeah.

I got to get to the OR, so...

- Whoa, whoa, whoa, whoa, whoa.

- Page Dr. Lanik to take over with Quentin.

- I'm just feeling a little dizzy.

That's all.

.

- Hernia fixed?

- I'd say you're as good as new.

- Yeah, not quite.

I'm the fart doctor now.

A punchline. - No.

What happened today was a result

of a medical ailment, OK?

- Like anyone's gonna care about that.

All they're gonna remember is the fart.

- Oh, come on. It'll blow over.

Sorry. Poor choice of words, but it will.

- [laughs] I doubt it.

- All right, look.

I'll check on you a little later, OK?

All right.

- So his neck is fixed, then? - Yeah.

The artery repair went very well.

- What about his mind? Because before--

- Well, I gave him a very small dose

of an antipsychotic called risperidone,

and he does seem to be thinking more clearly.

- And you think he'll stay that way?

- I don't think that what happened today

is the result of mental illness.

You know, tests are still pending,

but all indications are is that Quentin has

a genetic disease called neurofibromatosis type 2.

- Is it curable? - It's not.

But there are a lot of effective treatments out there.

And the good news is that with a little luck,

Quentin is gonna be the man you know again.

- Genetic means he's had it forever.

Why'd it suddenly go berserk today?

- NF is thought to be an inflammatory ailment, right?

So possibly triggered by changes in environment,

you know, lifestyle,

possibly diet, medication.

- Diet.

Oh, my God.

The minute I got pregnant, my hormones went crazy.

Smells were intense,

and Quentin's breath was the worst.

Everything he ate made me throw up.

So he gave up his entire diet.

No more fruits, vegetables, fish.

For the past nine months, he's been eating nothing

but bland, processed crap for me.

- Mrs. Bell, Quentin's asking to see you.

- [grunts]

Hi, honey.

- Layla...

I don't entirely understand

what happened or why,

but I know I put you in danger.

I'm sorry.

- No, Quentin.

I was so tied up in the pregnancy,

I was oblivious to what was going on with you.

I should've seen the signs. Forgive me.

- Oh, honey, there's nothing to forgive.

- I love you.

- I love you too.

- Someone's been missing you guys.

- Hi.

- Here you go.

- Hi, sweetheart. Look who's here.

- Hi.

I'm your dad.

I love you.

- Shh, sweetheart. - Hi.

- A metabolic condition? - Yeah.

It's called maple syrup urine disease,

and it's a rare condition that makes it difficult

for the body to break down certain amino acids.

- The trademark symptom is a distinct maple syrup smell

that shows up in urine.

- It usually presents in childhood,

and it's almost unheard of

to discover it in someone your age,

or Hugo's.

It's likely that he had it too.

- And I suspect this is why

Oakview couldn't diagnose him in time.

He didn't have a seizure or a foley catheter.

It made his doctors' jobs even harder.

- Wait, this disease killed Hugo.

Does that mean--

- No, you're gonna be OK.

You have an intermittent form of the disease,

which can be managed by closely monitoring protein levels.

- We've already reached out to nephrology

to discuss treatment options.

- Maria. [speaking Spanish]

- [speaking Spanish]

- [speaking Spanish]

- Gracias.

- Hello, Daniel. - Ooh!

Hey, you're, uh-- you're a little early.

- Oh, I couldn't wait to see you.

What's this? You cleaned your office?

- No, I didn't.

I'm tidying up a little bit.

- Why?

- I was very embarrassed by what happened this morning.

And um, you know, I just, uh--

I don't ever want you to feel that I--

I take for granted the job that you do, or--

or that I'm oblivious to how hard you work.

I really don't want that to happen.

- You're very sweet.

I care about you too, Daniel.

A lot.

- Yeah? - Mm-hmm.

- Huh.

- Hey. - Hey.

Ah!

Where'd you find it? - Nurses' station.

- Oh, makes sense.

That's where I was when the call about Quentin came in.

- Yeah, I totally get it.

I would have run off and left it behind too.

But my kidneys can handle some mild dehydration.

Yours can't. - Yeah, yeah.

- Yeah, pretty sure there will be another emergency tomorrow,

and the day after that,

so I'm gonna give you something.

It is a tracking device. - Ah.

- App connects it to your phone.

And I haven't lost my keys since I put it on, so...

- Well, keep it. I'm past water bottles.

Nephrologist just left.

Uh, my kidneys are getting worse.

- Dialysis?

- That was a big win today.

You saved that family.

- Yeah.

I suppose it's time to talk about my DACA renewal.

I know I've been dragging my feet.

- It's been a long day. We can speak in the morning.

- No. No, I'm ready.

- Yeah? All right.

- Truth is, I've been thinking about leaving Med.

- Really?

- I've always been in school or protected by my residency,

so my immigration status has always been stable.

But my parents, despite them always having jobs,

could never solidify theirs,

so they moved to Canada.

- Hmm.

- But they can't enter the country to come visit me.

And if I leave to go see them, I might be denied reentry.

So...

I haven't hugged my parents in a decade.

- Ugh.

That's--that's heartbreaking.

- But Maria today, her bravery,

what she was willing to sacrifice for her family,

reminded me that

"no one puts their child in a boat

unless the water is safer than the land."

- Warsan Shire.

Oh, that's a beautiful poem.

- So...

my parents' sacrifice to get me here

put me in this boat,

which is why I have to stay.

- And Dr. Cuevas,

I believe that you will find a way

to see your parents again.

But until that day,

know that you have family here in us at Med.

- Thank you.

.

[dramatic music]

♪

[wolf howls]