Good Sam (2022) s01e02 Episode Script
Natural Order
Previously on Good Sam
You're supervising these doctors.
You're above them in knowledge, rank and skill.
Act like it.
It's like undermining me as a sport for him.
I think I'm gonna take the Cleveland offer, Caleb.
You don't want to do that.
Are you saying I should stay? - It's not about me.
- Yeah.
Dad! My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
You've earned this.
And I say that as your chief medical officer, not your mother.
- I'm Sam, by the way.
- I'm Malcolm.
Kingsley.
I'm the new director of finance.
- Sam! - Mom? It's your father.
He's waking up.
You were shot six months ago.
How long till I can work again? You have to be proctored.
Oh, come on.
It's state law.
I'll do it.
I'll supervise him.
What, do you have company? I wanted to tell you.
A resident, Griff? Sam's best friend.
I've decided to continue proctoring you, if that's what you want.
I want to be very clear.
I am making this decision as a doctor.
As your daughter, I'm calling it.
Good morning, boss.
Getting to work bright and early.
Bright and early means arriving before the boss.
Who says I won't? After you.
Thank you.
The point of proctorship is to ensure a surgeon's skills have not diminished during a leave of absence.
The guidelines are rigorous.
But then again, so is heart surgery.
"A proctorship's successful conclusion is a win for the returning surgeon and the patients in his care.
" - It's all there.
- Well, I want to start out on the right foot, and I want to make sure that the terms are clear and easy to follow.
I just don't know that clarity is the issue, Sam.
I mean, we're talking about your father.
We're talking about my colleague.
I am in as a doctor.
Out as a daughter, remember? Good.
So you've drawn your boundaries with your colleague, but, um What about Lex? Hmm? Have you, uh, have you talked to her? Uh About work, yes.
About having an affair with my father, no, not so much.
But she's your best friend.
I appreciate your concern.
But right now, this department head needs her CMO more than your daughter needs her mother.
I'm gonna get these guidelines to Dr.
Griffith right away.
Thank you.
Hey, um, sorry to interrupt.
Uh, year-end projections just came in.
Thank you, Malcolm.
I'd like to review those before tomorrow.
Hi.
Hi.
I'll be, uh, in my office.
So, what's tomorrow? Board meeting.
Does that mean you're preparing for Mr.
Byron Kingsley's arrival? - He is the chairman of the board.
- So, tomorrow is Take Your Dad to Work day for both of us? Uh, yeah.
Yeah, always puts me a little on edge when he comes in.
Is there anything I can do to help? You could go to dinner with me tonight.
Well Dinner for me, uh, is usually takeout in the lab, awaiting test results.
And for me it's takeout on the couch, watching Cupcake Wars.
- You bake? - I watch other people bake.
We should go out to dinner.
Wow.
Nice haircut, Donna.
Thank you.
Morning, doctors.
What do you say, Donna? Is today the day we run away together? Try again next week when my wife's out of town.
No one else thinks this is weird? Griff was our boss, and now he's, what, - a resident like us? - He's being supervised.
It's how proctorship works.
Lex, you agree, it's weird, right? It's only weird if you make it weird.
How do I make it weird? You try too hard with him, Isan, and it always backfires.
You end up tripping over your shoelaces, dropping your instruments.
Cornering him in the men's room.
I don't corner him in the men's room, Joey.
No, you just told him a knock-knock joke at the urinal.
I was making small talk.
It's not my fault we're forced to pee next to each other.
Women get their own private stalls.
Oh, right.
This is all because the world is unfair to men.
- Morning, everyone.
- Morning.
Good morning.
Thank you.
Let's see.
Eval for a mitral valve replacement.
- Atrial fib.
- Morning.
Right on time.
Consider that an accomplishment, do you? Well, given how far away my new parking spot is, - and then I have to - What do we have? Patient with a lung mass needs VATS for biopsy.
And what else? Ten-month-old with a persistent cough and a new murmur.
Peds is asking for a consult.
Uh, since when do we take pediatric cases? Oh, since I instituted a cross-departmental policy to integrate care, which has significantly improved patient satisfaction.
What's next, a tonsillectomy? We are gonna start with the peds case.
And Dr.
Griffith will join us after he pages Dr.
Chen in radiology.
And why am I paging Dr.
Chen? Well, I have a feeling he's looking for his white coat.
Before you offer opinions on the cases I take, please make sure you've dressed yourself properly, Doctor.
First, they said it was a cold, and then they sent us here.
Nobody can tell us what's wrong.
And his cough keeps getting worse.
When did it start? Weeks ago.
What, two, three? Ellie, for the last time, put on your shoes.
How Bohemian.
Is there any family history of heart problems? Not that I know of.
Let's get a nebulizer with 2.
5 milligrams - Of albuterol.
- You got it.
His heart muscle does appear to be inflamed, so I'd like to put him on an anti-inflammatory and do a breathing treatment to calm the cough.
He's just been suffering so much.
Let's also run a 12-lead EKG and do a bacterial culture.
Well, it's most likely viral, so.
.
, Well, given the abnormality in the X-ray, I would like to be sure.
Let's give it back to Dr.
Hamamura in peds.
Those symptoms are basically - Oh! - Ellie.
Here you go.
Ready? There we go.
Sorry.
The findings are nonspecific.
Hence my desire for more diagnostic testing.
We should have some answers, for you all very soon.
How long are we gonna do this? You won't make eye contact with me, - you barely speak to me.
- What do you want me to say, Lex? Whatever you need to say for us to get through this.
We have always been straight with each other.
That was before you slept with my father.
I trusted you.
I confided in you about him.
- And this whole time, you - No, not this whole time.
I swear, it just started a few months before the shooting.
The fact that it started at all.
What is the drama with them? I don't know.
Ask Lex.
I did.
She told me to go back to my hobbit hole, which makes no sense.
What makes no sense? Well, hobbits are famously short, and they have hairy feet.
I possess neither of those traits.
You're more hobbit-y than I am.
Wow, thank you.
What's the holdup? - What are we talking about? - Oh.
Uh, just feet.
My feet, uh, which are not hairy.
Not that there's anything wr I mean, you could have hairy feet, and that's a beautiful thing.
Wow.
I can't do this right now.
Is that how it's gonna be from now on? This is how it's gonna be today.
I've reviewed your chart, Mr.
Morris.
- Ted's fine.
- Okay.
How long have you had the palpitations - and the dizziness? - Um A couple weeks, but it's-it's getting worse.
That is a rapid heart rate.
I'd like to revisit the dosages of your medications.
I don't take them.
I don't like pills.
Besides, I, uh, I pretty much felt fine up until now, so Says you almost passed out a couple times.
That doesn't sound fine.
Well, I'm just, I'm tired, you know.
I'm-I'm not the greatest sleeper.
Well, given your history of carotid artery disease, this could be a critical lesion that needs intervention.
Exactly.
I'd like to admit you.
And-and stay here? - Yes.
- Overnight? Yes.
No way.
Mr.
Morris, you may need to have surgery.
Yeah, you know what? I-It's fine.
I can always come back tomorrow.
I just, I just can't sleep here.
Can't sleep at home, though, either.
Can you? Given how many times you're woken up by your own snoring? How-how do you know I snore? Have you lost vision in an eye recently? Just for a minute or two? Yeah, yeah, but I thought it was a migraine.
Hmm, well, it wasn't a migraine.
It was a stroke.
Well, a ministroke.
Next time, it'll be a full cerebrovascular accident.
We're talking, well, paralysis, speech problems, - brain damage.
- Wait, I-I didn't I didn't tell anybody about my eye.
How do you How-how do you know this? I've been doing this job a long time, Ted.
Guys like you Young, don't smoke, no diabetes, no hypertension, none of the typical risk factors for carotid artery disease You all snore, and you're also stubborn, which means if you've experienced warning signs, you ignored them.
It's why guys like you, who shouldn't even have this disease, usually end up dying from it.
But, you know Hey, Hamamura.
We got a triple CABG later, you want it? Do I want your coronary artery bypass surgery? Yeah, you know, I thought since we were doing your job.
Keeping that baby alive is, in fact, all of our jobs.
And I'm happy to consult.
I'll be in touch.
Okay.
Your proctorship requires that you comply with my directives, not question them.
It's all in the guidelines I sent to you.
Mm, about those guidelines Surgeon's knots? Sim Lab? Isn't that a little remedial? They're standard benchmarks for evaluation.
And we can't skip the baby steps? No, you can't skip basic skill assessments.
I thought the goal was to get me back into surgery.
It is, once you've proven basic competency.
You're questioning my basic competency? I am saying that you have to follow the rules like everybody else.
Studies show that even two weeks away from surgery diminishes performance, and that's for surgeons who weren't in a coma for six months.
Accelerating your time line is just not in the patients' best interest.
Which one of us just prevented a patient from walking out? You can't skip ahead without putting in the time.
That's funny.
I know a department head that did exactly that.
Do you have an emergency contact, since you'll be staying here overnight? Yeah, my wife.
Well, my ex-wife.
Well, I only see an email address.
Um, yeah, that's I-I don't know her number.
She, uh, she changed it when she left.
Sounds like she'd maybe rather not be contacted.
She's just mad, you know.
It's just who she is.
How-how long's it been? How long were we married? No, how long since she left? Um About eight-eight years.
Give or take.
He doesn't take his meds for his heart condition.
Doesn't realize his wife's not coming back.
That's how denial works.
You see what you want to see.
You ignore what you don't.
Where is she going? Well, if I had to guess, I'd say she's going out.
With him.
What, like a date? No.
No way.
Hey, Caleb.
What's that you were saying about denial? I'm not saying that I wish my dad were still in a coma.
You're thinking you have had better conversations on a first date.
Actually, I am thinking about how beautiful you look right now.
Well I am, uh better at taking vitals than taking compliments.
Yeah.
Thank you.
You are welcome.
Right this way.
- Yeah.
Mm.
- Uh-huh.
Okay.
I needed this.
To get out of the hospital, mentally and physically.
And tonight, all I want to think about is My dad.
Sorry? My dad is here.
And he's having dinner with my dad.
The chairman of the board.
He's trying to go over my head.
Skip to the end of his proctorship.
Hey.
Hi.
Ugh.
I'm sorry again for bailing on you last night.
And I am sorry for accidentally taking you out on the worst double date in history.
It was a long night, but I am almost done here.
What is all of this? This is every study I could find on the value of empirical assessments for surgeons - after an extended leave.
- Hmm.
Before my dad convinces the board to fast-track him, I just think they should see all the data.
- This is a lot of data.
- Yeah.
Which I find to be very, um What? Preachy? Pedantic? Sexy.
Oh.
Data is my love language.
You and me both.
My mom is gonna slip these to the board before the meeting.
If they let my dad have his way and something goes wrong, they'll have blood on their hands.
Oh, my God.
Okay, you You didn't put that in there, did you? Not in so many words.
Good.
'Cause I'm guessing that blood on their hands is not their love language.
How are his vitals? Blood pressure 184/124.
Heart rate in the 120s.
Hmm.
Let's increase his nicardipine drip and order a beta-blocker.
Why haven't you done the surgery yet? You have to be medically optimized for surgery, and that can take some time, especially since you didn't take your prescribed anticoagulants.
Can't you just do it? - Well, I - Dr.
Griffith can't perform surgery right now.
- Why not? - He's undergoing proctorship.
I'll be hands-on.
I'll supervise the whole time.
In a completely hands-off kind of way.
Look, I just, I just want to get this over with.
I understand.
But there is a reason that we do things this way.
We want to reduce your risk and increase your chances of success.
And so, cutting corners or rushing the process would not be a good idea.
No matter what the board says.
There's the enlargement we saw on the X-ray.
The muscle tissue in the left ventricle is very thick.
The word is "hypertrophic.
" His heart muscle is enlarged, which can cause a fluid backup in his lungs.
It might explain the Page Respiratory for me now.
Why don't we step outside, please? - Why? What's going on? - Let's go down to the cafe.
What - Baby's in V-tach.
- What's wrong with him? - Crash cart! Cart! - What's wrong with him? Get me the pace pads, I need to shock him out of it.
We need you to step outside.
I'm not going.
Spontaneously converted.
Get him on an ACE inhibitor.
I want an MRI as soon as anesthesia can do it.
I don't understand.
- He had an arrhythmia.
- What caused that? That is what we're gonna find out.
- Hey.
- Hey.
- Thanks for coming.
- Well, you said that if I met you, you would stop texting me.
Uh-uh-uh.
Just so we are clear, whatever we used to do in here, we're not doing it now.
You have to stop this.
Don't you miss us? No.
I'm past this.
Okay? And you need to be, too.
I'm trying.
I need time.
It's It's been six months for you, not for me.
It's been six months for everyone, Griff.
You know, but you don't want to accept it because in your head, you're still there Before you were shot, before Sam took over, before we broke up.
It was good back then, though.
Wasn't it? We cannot go back to the way it was.
So No more texting.
No more calling.
And no more looking at me the way you do.
I like looking at you.
Well, you need to quit.
Look, it's in the past, and that's where it has to stay.
What are you doing? - Uh, nothing.
- Really? Because it looks like you were in the supply closet - racking up HR violations.
- Well, technically, it's not a violation because I'm no longer a supervisor.
Oh, my Where am I supposed to have a private conversation? My office is occupied.
It's not your office, and you are not in charge.
Hey, why were you having dinner with Byron Kingsley last night? Because I needed to talk to him, and, again, no office.
Do you know why Sam was given this job, Griff? Because I was in a coma? Because she was the best.
A lot of people went up for that position.
She was the best candidate.
I'm sure she was, compared to them, but not compared to me.
We both know I should be back in charge and back in surgery.
You want to get back in surgery? Then get out of the closet and focus on your proctorship.
Oh, I'm very focused.
I'm on it.
In fact, I got a meeting right now.
What meeting? Proctees don't have meetings.
Can't hear you.
I don't get it.
A ten-month-old with left ventricular hypertrophy, and his cough is getting worse despite the meds.
Maybe it's because of the meds? Side effect of the ACE inhibitor.
It's possible.
We can switch him - to irbesartan.
- Put him on irbesartan.
Yeah, that thing.
Sorry.
Go ahead.
And we'll put him on a diuretic to address the fluid built-up in him lungs.
Whose phone is that? It's unprofessional.
Oh.
Here, hold that.
It's me.
And I have to take it.
Excuse me.
You tell her I say hi.
Okay.
I got to go.
We have an infant undergoing diagnostic testing.
You cannot take a phone call.
- I understand.
- I don't think you do.
You are under my authority.
I dictate how this proctorship proceeds, no matter how many members of the board you take to dinner.
They concur.
- Who is they? - The board.
They just called.
They agree with you on the time line.
No fast-tracking.
This proctorship ends when you say it ends.
Oh.
Well, good.
They-they did also agree with me that when it ends, - I'll be reinstated as chief.
- What? I get my job back.
Things go back to how they were, and how they ought to be.
If I wasn't so angry, I'd be impressed.
How did he do this? How could the board have agreed to it? - What did he say to them? - Yeah, I-I don't know.
I wasn't there, but, uh The chief medical officer doesn't get invited to board meetings, but he gets a seat at the table.
He should never have been allowed in that room.
But he was.
What am I supposed to do now? You don't have to proctor him.
He'll just find someone else to do it.
Until you clear him, he answers to you.
And then what? He gets his job back? No, he can't just get it back.
They have to formally vote on it.
Without hearing my side? They can't do that.
I have to get in front of them.
Well, they've already adjourned, but Well, then I'll call an emergency meeting.
If he found a way to get into that room, so can I.
I am so much happier working for Sam.
Griff getting his job back is not good for me.
- You're right.
He never liked you.
- Have you seen Ted's labs? His blood sugar is through the roof.
He's afebrile.
Troponins are negative.
Could just be a stress response.
Or he's sneaking food in.
They all do it.
These delivery apps? Yesterday, I intercepted a Coney dog with fries.
We need the evidence, Donna.
I'm on it.
Would you relax? Sam is still the boss.
Just follow her lead.
I agree.
Because you're trying to get back together with her.
Oh, that ship has sailed.
Wrong, it hasn't sailed at all.
I know that ship well.
It's a very reliable vessel.
You do know Sam is not a boat, right? - The relationship's the boat.
- And it's still in the harbor.
It's halfway to Fiji.
Griff can't be our boss again.
I think I'm having a panic attack.
Lex, take my pulse.
You've lost your damn mind.
Look, we follow Sam.
All right? Don't get caught up in Griff's game.
Let's go.
Okay, back to our pediatric case.
MRI shows the muscle in the left ventricle is not only thick, it's filled with deep intertrabecular recesses.
The myocardium looks like a sponge.
It looks, I don't know, embryonic? Exactly, undeveloped cells that contribute nothing to the overall heart function.
Dr.
Shah, I'd like to follow up on this mitral valve replacement.
- Follow up with me? - Yeah.
I need you to get a PFT, please.
Dr.
Shah, stop right there.
No one should be ordering tests for or taking cases from Dr.
Griffith.
The board's decision is not immediately effective.
We are discussing this infant's treatment plan.
Put him on the transplant list, prepare for a Berlin Heart.
There, now can we talk about my thing? A transplant is not his only option.
- This is a genetic disorder.
- For which there is no cure.
A lot of major academic institutions are making huge achievements in gene editing therapy.
Which holds a lot of promise for the future, but not today.
Not for this patient.
Just because something is new and different does not automatically disqualify it - as a valid - Huntington's.
Sickle cell.
Hemophilia.
All caused by an alteration to a single nucleotide.
- Mm-hmm.
- How do we know which one? Dr.
Costa.
We mapped the genomes of patients with those diseases and found the common mutations.
Which requires what? Dr.
Shah? A big enough sample size of affected patients to draw comparisons.
There are over 50 genes affecting heart development.
Even if we mapped the baby's genome, even if we found the mutations, we would have no way of knowing which one caused the disease.
A sample size of one is simply too small.
What you got there, Ted? - Huh? Nothing.
- Really? Because Donna says she saw some candy wrappers in here earlier.
Gummy bears.
Under the pillow.
You can't eat before surgery, Ted, especially not candy.
Why not? Because high blood sugar causes something called oxidative stress, which will damage your blood vessels and increase your risk of stroke.
And risk of stroke is why you're here in the first place.
But we can't do your procedure until you're medically optimized.
What does that mean? That means you just delayed your surgery.
You mean I got to stay here longer? Yep.
Well, can I at least have a new nurse, then? No, Ted.
We will monitor his heart.
And there are medications that can help with his symptoms, but he will likely be on them, for the rest of his life.
What do you think? - Uh - There are potential treatment options that we would like to discuss.
We want what's best for our kids, don't we? Sometimes, that means making difficult decisions that they just don't understand.
- Thank you, Doctor.
- Wait.
Difficult decisions? What do you mean? Gene therapy is one of the options He's gonna need a Berlin Heart.
That looks like life support.
It is heart support, but he'll be breathing on his own.
It's just a stopgap measure while he awaits a heart transplant.
A heart transplant? That was out of line.
It's the next logical step.
I have barely finished walking those parents through the diagnosis, and you are talking about plugging their child into a machine.
It's a pediatric ventricular assist device, but yes.
It's designed for end-stage heart failure.
Now is not the time for that conversation.
Given his rate of decompensation, it is precisely the time.
In your opinion.
In my experience, which we both know - vastly outweighs yours.
- Yes, it does.
And in this case, your approach is outdated.
Look, space medicine is not gonna help that baby.
Gene therapy has helped a lot of people.
Look, Dad, I understand that you want to go back to a time where you were in charge and dinosaurs roamed the Earth.
- Ouch.
- But things change.
Meteorites hit, and a species that fails to evolve renders itself extinct.
Species evolve - by learning from experience.
- Okay.
I am not giving up on that baby.
Those parents would give anything to help their child, which I know you can't relate to as a father.
Wow.
I thought we were talking as doctors.
Are we getting personal now? Well, you make it hard not to.
So, what are we talking about? The job? Lex? Or We are talking about you and your ego making it impossible for me to do my job.
I'm trying to help.
I'm trying to help the patient.
Trying to help you.
- Trying to help the hospital.
- You want to help the patient? Don't undermine my treatment strategy.
And since you bought up Lex, the next time you want to help me, don't screw my best friend! Lex, I'm sorry.
I don't want your apology any more than you want mine.
It's not gonna change anything.
I didn't mean to out you like that.
I don't want to make this harder than it already is.
Too late.
I don't know what it's gonna take to make this better, but I know it's bigger than "sorry.
" Dr.
Tucker, I need you to prepare a surgical consent form for putting a patient on a Berlin Heart.
Here.
For the pediatric case? Is there another patient in imminent need of an assist device? Is Dr.
Griffith aware that we're moving forward - It's a timely request, Doctor.
- Right.
I'm on it.
What happened to "follow Sam's lead"? What was I supposed to do? Dr.
Tucker, we have a problem.
- No kidding.
- It's Ted.
Those were not ordinary gummy bears.
Somebody call 911! What is going on? - I'm-I'm having a heart attack.
- He was eating candy, again, when I checked on him this morning.
This time, when I confiscated it, I took a better look at the container.
Edible cannabis.
He's stoned? Ah, rapid heart rate, disorientation I'm dying, and-and - she's trying to kill me.
- And paranoia.
Yeah, very stoned.
How many of these did you eat? Dr.
Trulie, he ate them all.
Let's increase his maintenance fluids to help flush out his system.
It'll be a while before anesthesia touches him.
You just delayed your surgery again, Ted.
Uh I see that you got consent for the Berlin device.
It was the right call.
I just hope it doesn't come to that.
Griff had me do it.
Yeah, he can be very persuasive.
Just ask the board.
Have you tried talking to them - about his reinstatement? - Yeah.
I've tried, but only department heads can call a meeting with the board, and apparently, in light of yesterday's decision, I'm interim head.
- So - Like I said, he can be very persuasive.
Well, I-I, uh, did some research into pediatric gene therapy.
So, Boston Children's has multiple trials trying to tackle congenital cardiac disorders.
- I sent them an email.
- Really? And if there are other patients out there who have his disease, it could get you the sample size you need.
I really appreciate that.
Even if it's a long shot, it's Better than giving up.
- Thank you, Caleb.
- What can I say? I'm a sucker for the underdog.
The baby.
And Ted.
Oxygen sats are dropping.
Cardiac output is down.
- We need to get him to the OR now.
- What's happening? His heart is failing.
We need to place him on the Berlin device now.
What's going on with Ted? Started slurring his speech, said his face felt numb.
Ischemic stroke.
So much for medically optimizing him.
How long has it been? Couple minutes.
That's a lot of brain cells.
I'm accessing the internal carotid artery right now.
Shunt is in.
Come on, Ted.
Okay.
Thank God.
Let's clean this up.
Make sure they give him the unfractionated heparin - immediately.
- I know.
Deterioration of the filling behavior may indicate hypovolemia, obstruction of the inflow cannula.
- I know that, too.
- Well, atrial cannulation definitely can be a lot harder than you anticipate.
- Stop.
- You have to get up I cannot do this with you breathing down my neck.
This is as far as you go.
- Suction.
- Suction.
- Good, let's turn it.
- Mm-hmm.
15 blade.
- I should be in there.
- No, she can handle this.
And you would've kicked yourself out for far less.
Annular.
All right.
Dammit.
It's not threading.
I need to try again.
Push it.
- Decreasing cardiac output.
- Perfusion pressures are dropping.
I got to get this thing in before he codes.
Should we call Dr.
Griffith? Jodie, I am Dr.
Griffith.
15 blade.
Start bypass, Dr.
Costa.
Starting bypass.
Low flow.
Okay.
There you go.
You did it.
That'll be all, Jodie.
The procedure just started.
Mm-hmm.
Clamp.
There you go.
Clamp the aorta.
Start cardioplegia.
What's she waiting for? You can't keep doing this.
You are sinking your relationship with her.
I'm doing this for our relationship.
Things will get better when the natural order is restored.
Better for whom? For both of us.
She's not ready for all this.
She needs me more than she thinks.
Not right now, she doesn't.
And if you don't want to find yourself locked out of every surgery from now on, find a way to get on board with this proctorship.
- Hey.
- Hi.
- You ready? - Yeah.
How'd it go with the baby? He made it.
It was complicated, and we're still waiting for a transplant, but the procedure went well.
And I did it without my dad.
- Where was he? - I locked him out.
You locked your father out of surgery? Yeah.
He made me do it.
- Oh.
- He - Mm-mm.
We're doing it again.
- Yes.
- Yes, we are.
- Is there no way for you and I to go on a date without our dads ruining it? No, there-there is uh, if we start at the end.
You know, I once read that a ten-second kiss can result in the transfer of 80 million microbes.
Did you just tell me dirty data? It gets dirtier.
Come on.
Hi.
Were you guys here all night? Yeah, we didn't want to leave him alone his first night on the machine.
I'm about to take Ellie home to get some sleep.
Hey, can I help you with that? Come here.
Where is the one for this foot? I need to run some tests on her.
On Ellie? Peripheral edema.
Due to reduced systolic function.
Great minds.
I presume you ordered a diuretic.
And a vasodilator.
- But what we really need is - A DNA test.
- What is going on? - The baby's sister.
The reason she doesn't like to wear shoes.
It's a symptom.
Wait, of the same disease her brother has? Less severe, of course, but two siblings - with the same genetic disorder? - Yes.
That's a sample size we can work with.
We can map the genomes.
- Find the mutations.
- And fix it.
- Well - We need a DNA test right away.
This could change If we're everything for them.
Yeah.
I was wrong to dismiss gene therapy and to undermine you.
This is your department, and I am happy to respect that.
Thank you.
- For the next 87 days.
- 87 days? Which is when the board will vote to reinstate me.
Assuming I've proven my basic competency to your satisfaction.
Which reminds me, I got, um Surgeon's knots.
Mm Single knots.
Double knots, and I even threw in some granny knots.
So, I think that should check that off the list, - don't you? - Hmm.
Well, despite how dicey you made things for the anesthesiologist, the surgery went well.
I'm gonna be okay? Yeah.
Your arteries look good.
But, um before I discharge you, I want to talk to you about your other disease.
So, I took a closer look at your labs, and your liver enzymes are elevated.
So? Is there any chance that you don't take your medications because you can't drink alcohol on them? Okay.
What are you saying? That-that I'm an alcoholic? I'm saying someone who chooses alcohol over life-saving meds, or who ingests marijuana while they're being prepped for surgery, or who burned so many bridges with his ex-wife that she won't even give him her number, might have another disease.
But that's one that can be treated, too.
This is a good rehab, and they've got nightly meetings.
Yeah, I'm sure they're awesome.
They are, actually.
Take it from a fellow alcoholic.
Listen, I know how hard it is to admit that you got a problem.
And, uh, no one here even knows this, but I've been where you are.
And it cost me someone I care about, too.
But there's a solution.
He's gonna make it.
He has a long road ahead.
Yeah, well, at least there's a road.
Five years ago, his condition would've been a death sentence.
Hmm.
But he has a chance, because he has you for his doctor.
And he only had you as his doctor because we have you as a leader.
You think Hamamura would've brought that baby to Griff? I appreciate that, but I'm only an interim solution.
Oh, so, you're telling me that we can change that baby's genetic code, but you can't change the board's mind? I can't even talk to them.
- You have to be a department head.
- Hmm.
Right.
If only you knew one who owed you a favor.
You fought for that baby's future.
Now go fight for yours.
I know it's last-minute, but Dr.
Griffith was there when I needed help.
Calling this meeting was the least I could do to thank her.
I know that you don't think the I'm right person for the position of chief.
To be honest, neither did I.
I thought I was gonna finish my fellowship and move on.
I had an offer from the Cleveland Clinic.
And then I thought, "I am good at this.
" Patients are thriving, and doctors are, too.
They are happier than they were under my father, which means they are more effective.
They are more efficient.
They're more successful.
There's a baby alive today to prove it.
You all asked me to step in as chief.
And now my father is awake, and you are asking me to step aside, and I can't do that.
Which is why I'm not going anywhere.
We are a better department, and we are better doctors, because I am a better chief.
You know, the tyrannosaurus rex was a merciless predator, unrivaled by any creature of its age.
I take this as a compliment.
You should take it as a warning.
Oh? I spoke with the board.
They share my enthusiasm for this department's future, which means yours is not guaranteed.
They're not just gonna hand you the reins at the end of this.
They're gonna choose between us.
May the best Dr.
Griffith win? Is that what you want? You can be the T.
Rex, Dad.
I'm the meteorite.
And I'm coming for you.
You're above them in knowledge, rank and skill.
Act like it.
It's like undermining me as a sport for him.
I think I'm gonna take the Cleveland offer, Caleb.
You don't want to do that.
Are you saying I should stay? - It's not about me.
- Yeah.
Dad! My father can never be replaced, but I vow to carry on his legacy to the best of my ability.
You've earned this.
And I say that as your chief medical officer, not your mother.
- I'm Sam, by the way.
- I'm Malcolm.
Kingsley.
I'm the new director of finance.
- Sam! - Mom? It's your father.
He's waking up.
You were shot six months ago.
How long till I can work again? You have to be proctored.
Oh, come on.
It's state law.
I'll do it.
I'll supervise him.
What, do you have company? I wanted to tell you.
A resident, Griff? Sam's best friend.
I've decided to continue proctoring you, if that's what you want.
I want to be very clear.
I am making this decision as a doctor.
As your daughter, I'm calling it.
Good morning, boss.
Getting to work bright and early.
Bright and early means arriving before the boss.
Who says I won't? After you.
Thank you.
The point of proctorship is to ensure a surgeon's skills have not diminished during a leave of absence.
The guidelines are rigorous.
But then again, so is heart surgery.
"A proctorship's successful conclusion is a win for the returning surgeon and the patients in his care.
" - It's all there.
- Well, I want to start out on the right foot, and I want to make sure that the terms are clear and easy to follow.
I just don't know that clarity is the issue, Sam.
I mean, we're talking about your father.
We're talking about my colleague.
I am in as a doctor.
Out as a daughter, remember? Good.
So you've drawn your boundaries with your colleague, but, um What about Lex? Hmm? Have you, uh, have you talked to her? Uh About work, yes.
About having an affair with my father, no, not so much.
But she's your best friend.
I appreciate your concern.
But right now, this department head needs her CMO more than your daughter needs her mother.
I'm gonna get these guidelines to Dr.
Griffith right away.
Thank you.
Hey, um, sorry to interrupt.
Uh, year-end projections just came in.
Thank you, Malcolm.
I'd like to review those before tomorrow.
Hi.
Hi.
I'll be, uh, in my office.
So, what's tomorrow? Board meeting.
Does that mean you're preparing for Mr.
Byron Kingsley's arrival? - He is the chairman of the board.
- So, tomorrow is Take Your Dad to Work day for both of us? Uh, yeah.
Yeah, always puts me a little on edge when he comes in.
Is there anything I can do to help? You could go to dinner with me tonight.
Well Dinner for me, uh, is usually takeout in the lab, awaiting test results.
And for me it's takeout on the couch, watching Cupcake Wars.
- You bake? - I watch other people bake.
We should go out to dinner.
Wow.
Nice haircut, Donna.
Thank you.
Morning, doctors.
What do you say, Donna? Is today the day we run away together? Try again next week when my wife's out of town.
No one else thinks this is weird? Griff was our boss, and now he's, what, - a resident like us? - He's being supervised.
It's how proctorship works.
Lex, you agree, it's weird, right? It's only weird if you make it weird.
How do I make it weird? You try too hard with him, Isan, and it always backfires.
You end up tripping over your shoelaces, dropping your instruments.
Cornering him in the men's room.
I don't corner him in the men's room, Joey.
No, you just told him a knock-knock joke at the urinal.
I was making small talk.
It's not my fault we're forced to pee next to each other.
Women get their own private stalls.
Oh, right.
This is all because the world is unfair to men.
- Morning, everyone.
- Morning.
Good morning.
Thank you.
Let's see.
Eval for a mitral valve replacement.
- Atrial fib.
- Morning.
Right on time.
Consider that an accomplishment, do you? Well, given how far away my new parking spot is, - and then I have to - What do we have? Patient with a lung mass needs VATS for biopsy.
And what else? Ten-month-old with a persistent cough and a new murmur.
Peds is asking for a consult.
Uh, since when do we take pediatric cases? Oh, since I instituted a cross-departmental policy to integrate care, which has significantly improved patient satisfaction.
What's next, a tonsillectomy? We are gonna start with the peds case.
And Dr.
Griffith will join us after he pages Dr.
Chen in radiology.
And why am I paging Dr.
Chen? Well, I have a feeling he's looking for his white coat.
Before you offer opinions on the cases I take, please make sure you've dressed yourself properly, Doctor.
First, they said it was a cold, and then they sent us here.
Nobody can tell us what's wrong.
And his cough keeps getting worse.
When did it start? Weeks ago.
What, two, three? Ellie, for the last time, put on your shoes.
How Bohemian.
Is there any family history of heart problems? Not that I know of.
Let's get a nebulizer with 2.
5 milligrams - Of albuterol.
- You got it.
His heart muscle does appear to be inflamed, so I'd like to put him on an anti-inflammatory and do a breathing treatment to calm the cough.
He's just been suffering so much.
Let's also run a 12-lead EKG and do a bacterial culture.
Well, it's most likely viral, so.
.
, Well, given the abnormality in the X-ray, I would like to be sure.
Let's give it back to Dr.
Hamamura in peds.
Those symptoms are basically - Oh! - Ellie.
Here you go.
Ready? There we go.
Sorry.
The findings are nonspecific.
Hence my desire for more diagnostic testing.
We should have some answers, for you all very soon.
How long are we gonna do this? You won't make eye contact with me, - you barely speak to me.
- What do you want me to say, Lex? Whatever you need to say for us to get through this.
We have always been straight with each other.
That was before you slept with my father.
I trusted you.
I confided in you about him.
- And this whole time, you - No, not this whole time.
I swear, it just started a few months before the shooting.
The fact that it started at all.
What is the drama with them? I don't know.
Ask Lex.
I did.
She told me to go back to my hobbit hole, which makes no sense.
What makes no sense? Well, hobbits are famously short, and they have hairy feet.
I possess neither of those traits.
You're more hobbit-y than I am.
Wow, thank you.
What's the holdup? - What are we talking about? - Oh.
Uh, just feet.
My feet, uh, which are not hairy.
Not that there's anything wr I mean, you could have hairy feet, and that's a beautiful thing.
Wow.
I can't do this right now.
Is that how it's gonna be from now on? This is how it's gonna be today.
I've reviewed your chart, Mr.
Morris.
- Ted's fine.
- Okay.
How long have you had the palpitations - and the dizziness? - Um A couple weeks, but it's-it's getting worse.
That is a rapid heart rate.
I'd like to revisit the dosages of your medications.
I don't take them.
I don't like pills.
Besides, I, uh, I pretty much felt fine up until now, so Says you almost passed out a couple times.
That doesn't sound fine.
Well, I'm just, I'm tired, you know.
I'm-I'm not the greatest sleeper.
Well, given your history of carotid artery disease, this could be a critical lesion that needs intervention.
Exactly.
I'd like to admit you.
And-and stay here? - Yes.
- Overnight? Yes.
No way.
Mr.
Morris, you may need to have surgery.
Yeah, you know what? I-It's fine.
I can always come back tomorrow.
I just, I just can't sleep here.
Can't sleep at home, though, either.
Can you? Given how many times you're woken up by your own snoring? How-how do you know I snore? Have you lost vision in an eye recently? Just for a minute or two? Yeah, yeah, but I thought it was a migraine.
Hmm, well, it wasn't a migraine.
It was a stroke.
Well, a ministroke.
Next time, it'll be a full cerebrovascular accident.
We're talking, well, paralysis, speech problems, - brain damage.
- Wait, I-I didn't I didn't tell anybody about my eye.
How do you How-how do you know this? I've been doing this job a long time, Ted.
Guys like you Young, don't smoke, no diabetes, no hypertension, none of the typical risk factors for carotid artery disease You all snore, and you're also stubborn, which means if you've experienced warning signs, you ignored them.
It's why guys like you, who shouldn't even have this disease, usually end up dying from it.
But, you know Hey, Hamamura.
We got a triple CABG later, you want it? Do I want your coronary artery bypass surgery? Yeah, you know, I thought since we were doing your job.
Keeping that baby alive is, in fact, all of our jobs.
And I'm happy to consult.
I'll be in touch.
Okay.
Your proctorship requires that you comply with my directives, not question them.
It's all in the guidelines I sent to you.
Mm, about those guidelines Surgeon's knots? Sim Lab? Isn't that a little remedial? They're standard benchmarks for evaluation.
And we can't skip the baby steps? No, you can't skip basic skill assessments.
I thought the goal was to get me back into surgery.
It is, once you've proven basic competency.
You're questioning my basic competency? I am saying that you have to follow the rules like everybody else.
Studies show that even two weeks away from surgery diminishes performance, and that's for surgeons who weren't in a coma for six months.
Accelerating your time line is just not in the patients' best interest.
Which one of us just prevented a patient from walking out? You can't skip ahead without putting in the time.
That's funny.
I know a department head that did exactly that.
Do you have an emergency contact, since you'll be staying here overnight? Yeah, my wife.
Well, my ex-wife.
Well, I only see an email address.
Um, yeah, that's I-I don't know her number.
She, uh, she changed it when she left.
Sounds like she'd maybe rather not be contacted.
She's just mad, you know.
It's just who she is.
How-how long's it been? How long were we married? No, how long since she left? Um About eight-eight years.
Give or take.
He doesn't take his meds for his heart condition.
Doesn't realize his wife's not coming back.
That's how denial works.
You see what you want to see.
You ignore what you don't.
Where is she going? Well, if I had to guess, I'd say she's going out.
With him.
What, like a date? No.
No way.
Hey, Caleb.
What's that you were saying about denial? I'm not saying that I wish my dad were still in a coma.
You're thinking you have had better conversations on a first date.
Actually, I am thinking about how beautiful you look right now.
Well I am, uh better at taking vitals than taking compliments.
Yeah.
Thank you.
You are welcome.
Right this way.
- Yeah.
Mm.
- Uh-huh.
Okay.
I needed this.
To get out of the hospital, mentally and physically.
And tonight, all I want to think about is My dad.
Sorry? My dad is here.
And he's having dinner with my dad.
The chairman of the board.
He's trying to go over my head.
Skip to the end of his proctorship.
Hey.
Hi.
Ugh.
I'm sorry again for bailing on you last night.
And I am sorry for accidentally taking you out on the worst double date in history.
It was a long night, but I am almost done here.
What is all of this? This is every study I could find on the value of empirical assessments for surgeons - after an extended leave.
- Hmm.
Before my dad convinces the board to fast-track him, I just think they should see all the data.
- This is a lot of data.
- Yeah.
Which I find to be very, um What? Preachy? Pedantic? Sexy.
Oh.
Data is my love language.
You and me both.
My mom is gonna slip these to the board before the meeting.
If they let my dad have his way and something goes wrong, they'll have blood on their hands.
Oh, my God.
Okay, you You didn't put that in there, did you? Not in so many words.
Good.
'Cause I'm guessing that blood on their hands is not their love language.
How are his vitals? Blood pressure 184/124.
Heart rate in the 120s.
Hmm.
Let's increase his nicardipine drip and order a beta-blocker.
Why haven't you done the surgery yet? You have to be medically optimized for surgery, and that can take some time, especially since you didn't take your prescribed anticoagulants.
Can't you just do it? - Well, I - Dr.
Griffith can't perform surgery right now.
- Why not? - He's undergoing proctorship.
I'll be hands-on.
I'll supervise the whole time.
In a completely hands-off kind of way.
Look, I just, I just want to get this over with.
I understand.
But there is a reason that we do things this way.
We want to reduce your risk and increase your chances of success.
And so, cutting corners or rushing the process would not be a good idea.
No matter what the board says.
There's the enlargement we saw on the X-ray.
The muscle tissue in the left ventricle is very thick.
The word is "hypertrophic.
" His heart muscle is enlarged, which can cause a fluid backup in his lungs.
It might explain the Page Respiratory for me now.
Why don't we step outside, please? - Why? What's going on? - Let's go down to the cafe.
What - Baby's in V-tach.
- What's wrong with him? - Crash cart! Cart! - What's wrong with him? Get me the pace pads, I need to shock him out of it.
We need you to step outside.
I'm not going.
Spontaneously converted.
Get him on an ACE inhibitor.
I want an MRI as soon as anesthesia can do it.
I don't understand.
- He had an arrhythmia.
- What caused that? That is what we're gonna find out.
- Hey.
- Hey.
- Thanks for coming.
- Well, you said that if I met you, you would stop texting me.
Uh-uh-uh.
Just so we are clear, whatever we used to do in here, we're not doing it now.
You have to stop this.
Don't you miss us? No.
I'm past this.
Okay? And you need to be, too.
I'm trying.
I need time.
It's It's been six months for you, not for me.
It's been six months for everyone, Griff.
You know, but you don't want to accept it because in your head, you're still there Before you were shot, before Sam took over, before we broke up.
It was good back then, though.
Wasn't it? We cannot go back to the way it was.
So No more texting.
No more calling.
And no more looking at me the way you do.
I like looking at you.
Well, you need to quit.
Look, it's in the past, and that's where it has to stay.
What are you doing? - Uh, nothing.
- Really? Because it looks like you were in the supply closet - racking up HR violations.
- Well, technically, it's not a violation because I'm no longer a supervisor.
Oh, my Where am I supposed to have a private conversation? My office is occupied.
It's not your office, and you are not in charge.
Hey, why were you having dinner with Byron Kingsley last night? Because I needed to talk to him, and, again, no office.
Do you know why Sam was given this job, Griff? Because I was in a coma? Because she was the best.
A lot of people went up for that position.
She was the best candidate.
I'm sure she was, compared to them, but not compared to me.
We both know I should be back in charge and back in surgery.
You want to get back in surgery? Then get out of the closet and focus on your proctorship.
Oh, I'm very focused.
I'm on it.
In fact, I got a meeting right now.
What meeting? Proctees don't have meetings.
Can't hear you.
I don't get it.
A ten-month-old with left ventricular hypertrophy, and his cough is getting worse despite the meds.
Maybe it's because of the meds? Side effect of the ACE inhibitor.
It's possible.
We can switch him - to irbesartan.
- Put him on irbesartan.
Yeah, that thing.
Sorry.
Go ahead.
And we'll put him on a diuretic to address the fluid built-up in him lungs.
Whose phone is that? It's unprofessional.
Oh.
Here, hold that.
It's me.
And I have to take it.
Excuse me.
You tell her I say hi.
Okay.
I got to go.
We have an infant undergoing diagnostic testing.
You cannot take a phone call.
- I understand.
- I don't think you do.
You are under my authority.
I dictate how this proctorship proceeds, no matter how many members of the board you take to dinner.
They concur.
- Who is they? - The board.
They just called.
They agree with you on the time line.
No fast-tracking.
This proctorship ends when you say it ends.
Oh.
Well, good.
They-they did also agree with me that when it ends, - I'll be reinstated as chief.
- What? I get my job back.
Things go back to how they were, and how they ought to be.
If I wasn't so angry, I'd be impressed.
How did he do this? How could the board have agreed to it? - What did he say to them? - Yeah, I-I don't know.
I wasn't there, but, uh The chief medical officer doesn't get invited to board meetings, but he gets a seat at the table.
He should never have been allowed in that room.
But he was.
What am I supposed to do now? You don't have to proctor him.
He'll just find someone else to do it.
Until you clear him, he answers to you.
And then what? He gets his job back? No, he can't just get it back.
They have to formally vote on it.
Without hearing my side? They can't do that.
I have to get in front of them.
Well, they've already adjourned, but Well, then I'll call an emergency meeting.
If he found a way to get into that room, so can I.
I am so much happier working for Sam.
Griff getting his job back is not good for me.
- You're right.
He never liked you.
- Have you seen Ted's labs? His blood sugar is through the roof.
He's afebrile.
Troponins are negative.
Could just be a stress response.
Or he's sneaking food in.
They all do it.
These delivery apps? Yesterday, I intercepted a Coney dog with fries.
We need the evidence, Donna.
I'm on it.
Would you relax? Sam is still the boss.
Just follow her lead.
I agree.
Because you're trying to get back together with her.
Oh, that ship has sailed.
Wrong, it hasn't sailed at all.
I know that ship well.
It's a very reliable vessel.
You do know Sam is not a boat, right? - The relationship's the boat.
- And it's still in the harbor.
It's halfway to Fiji.
Griff can't be our boss again.
I think I'm having a panic attack.
Lex, take my pulse.
You've lost your damn mind.
Look, we follow Sam.
All right? Don't get caught up in Griff's game.
Let's go.
Okay, back to our pediatric case.
MRI shows the muscle in the left ventricle is not only thick, it's filled with deep intertrabecular recesses.
The myocardium looks like a sponge.
It looks, I don't know, embryonic? Exactly, undeveloped cells that contribute nothing to the overall heart function.
Dr.
Shah, I'd like to follow up on this mitral valve replacement.
- Follow up with me? - Yeah.
I need you to get a PFT, please.
Dr.
Shah, stop right there.
No one should be ordering tests for or taking cases from Dr.
Griffith.
The board's decision is not immediately effective.
We are discussing this infant's treatment plan.
Put him on the transplant list, prepare for a Berlin Heart.
There, now can we talk about my thing? A transplant is not his only option.
- This is a genetic disorder.
- For which there is no cure.
A lot of major academic institutions are making huge achievements in gene editing therapy.
Which holds a lot of promise for the future, but not today.
Not for this patient.
Just because something is new and different does not automatically disqualify it - as a valid - Huntington's.
Sickle cell.
Hemophilia.
All caused by an alteration to a single nucleotide.
- Mm-hmm.
- How do we know which one? Dr.
Costa.
We mapped the genomes of patients with those diseases and found the common mutations.
Which requires what? Dr.
Shah? A big enough sample size of affected patients to draw comparisons.
There are over 50 genes affecting heart development.
Even if we mapped the baby's genome, even if we found the mutations, we would have no way of knowing which one caused the disease.
A sample size of one is simply too small.
What you got there, Ted? - Huh? Nothing.
- Really? Because Donna says she saw some candy wrappers in here earlier.
Gummy bears.
Under the pillow.
You can't eat before surgery, Ted, especially not candy.
Why not? Because high blood sugar causes something called oxidative stress, which will damage your blood vessels and increase your risk of stroke.
And risk of stroke is why you're here in the first place.
But we can't do your procedure until you're medically optimized.
What does that mean? That means you just delayed your surgery.
You mean I got to stay here longer? Yep.
Well, can I at least have a new nurse, then? No, Ted.
We will monitor his heart.
And there are medications that can help with his symptoms, but he will likely be on them, for the rest of his life.
What do you think? - Uh - There are potential treatment options that we would like to discuss.
We want what's best for our kids, don't we? Sometimes, that means making difficult decisions that they just don't understand.
- Thank you, Doctor.
- Wait.
Difficult decisions? What do you mean? Gene therapy is one of the options He's gonna need a Berlin Heart.
That looks like life support.
It is heart support, but he'll be breathing on his own.
It's just a stopgap measure while he awaits a heart transplant.
A heart transplant? That was out of line.
It's the next logical step.
I have barely finished walking those parents through the diagnosis, and you are talking about plugging their child into a machine.
It's a pediatric ventricular assist device, but yes.
It's designed for end-stage heart failure.
Now is not the time for that conversation.
Given his rate of decompensation, it is precisely the time.
In your opinion.
In my experience, which we both know - vastly outweighs yours.
- Yes, it does.
And in this case, your approach is outdated.
Look, space medicine is not gonna help that baby.
Gene therapy has helped a lot of people.
Look, Dad, I understand that you want to go back to a time where you were in charge and dinosaurs roamed the Earth.
- Ouch.
- But things change.
Meteorites hit, and a species that fails to evolve renders itself extinct.
Species evolve - by learning from experience.
- Okay.
I am not giving up on that baby.
Those parents would give anything to help their child, which I know you can't relate to as a father.
Wow.
I thought we were talking as doctors.
Are we getting personal now? Well, you make it hard not to.
So, what are we talking about? The job? Lex? Or We are talking about you and your ego making it impossible for me to do my job.
I'm trying to help.
I'm trying to help the patient.
Trying to help you.
- Trying to help the hospital.
- You want to help the patient? Don't undermine my treatment strategy.
And since you bought up Lex, the next time you want to help me, don't screw my best friend! Lex, I'm sorry.
I don't want your apology any more than you want mine.
It's not gonna change anything.
I didn't mean to out you like that.
I don't want to make this harder than it already is.
Too late.
I don't know what it's gonna take to make this better, but I know it's bigger than "sorry.
" Dr.
Tucker, I need you to prepare a surgical consent form for putting a patient on a Berlin Heart.
Here.
For the pediatric case? Is there another patient in imminent need of an assist device? Is Dr.
Griffith aware that we're moving forward - It's a timely request, Doctor.
- Right.
I'm on it.
What happened to "follow Sam's lead"? What was I supposed to do? Dr.
Tucker, we have a problem.
- No kidding.
- It's Ted.
Those were not ordinary gummy bears.
Somebody call 911! What is going on? - I'm-I'm having a heart attack.
- He was eating candy, again, when I checked on him this morning.
This time, when I confiscated it, I took a better look at the container.
Edible cannabis.
He's stoned? Ah, rapid heart rate, disorientation I'm dying, and-and - she's trying to kill me.
- And paranoia.
Yeah, very stoned.
How many of these did you eat? Dr.
Trulie, he ate them all.
Let's increase his maintenance fluids to help flush out his system.
It'll be a while before anesthesia touches him.
You just delayed your surgery again, Ted.
Uh I see that you got consent for the Berlin device.
It was the right call.
I just hope it doesn't come to that.
Griff had me do it.
Yeah, he can be very persuasive.
Just ask the board.
Have you tried talking to them - about his reinstatement? - Yeah.
I've tried, but only department heads can call a meeting with the board, and apparently, in light of yesterday's decision, I'm interim head.
- So - Like I said, he can be very persuasive.
Well, I-I, uh, did some research into pediatric gene therapy.
So, Boston Children's has multiple trials trying to tackle congenital cardiac disorders.
- I sent them an email.
- Really? And if there are other patients out there who have his disease, it could get you the sample size you need.
I really appreciate that.
Even if it's a long shot, it's Better than giving up.
- Thank you, Caleb.
- What can I say? I'm a sucker for the underdog.
The baby.
And Ted.
Oxygen sats are dropping.
Cardiac output is down.
- We need to get him to the OR now.
- What's happening? His heart is failing.
We need to place him on the Berlin device now.
What's going on with Ted? Started slurring his speech, said his face felt numb.
Ischemic stroke.
So much for medically optimizing him.
How long has it been? Couple minutes.
That's a lot of brain cells.
I'm accessing the internal carotid artery right now.
Shunt is in.
Come on, Ted.
Okay.
Thank God.
Let's clean this up.
Make sure they give him the unfractionated heparin - immediately.
- I know.
Deterioration of the filling behavior may indicate hypovolemia, obstruction of the inflow cannula.
- I know that, too.
- Well, atrial cannulation definitely can be a lot harder than you anticipate.
- Stop.
- You have to get up I cannot do this with you breathing down my neck.
This is as far as you go.
- Suction.
- Suction.
- Good, let's turn it.
- Mm-hmm.
15 blade.
- I should be in there.
- No, she can handle this.
And you would've kicked yourself out for far less.
Annular.
All right.
Dammit.
It's not threading.
I need to try again.
Push it.
- Decreasing cardiac output.
- Perfusion pressures are dropping.
I got to get this thing in before he codes.
Should we call Dr.
Griffith? Jodie, I am Dr.
Griffith.
15 blade.
Start bypass, Dr.
Costa.
Starting bypass.
Low flow.
Okay.
There you go.
You did it.
That'll be all, Jodie.
The procedure just started.
Mm-hmm.
Clamp.
There you go.
Clamp the aorta.
Start cardioplegia.
What's she waiting for? You can't keep doing this.
You are sinking your relationship with her.
I'm doing this for our relationship.
Things will get better when the natural order is restored.
Better for whom? For both of us.
She's not ready for all this.
She needs me more than she thinks.
Not right now, she doesn't.
And if you don't want to find yourself locked out of every surgery from now on, find a way to get on board with this proctorship.
- Hey.
- Hi.
- You ready? - Yeah.
How'd it go with the baby? He made it.
It was complicated, and we're still waiting for a transplant, but the procedure went well.
And I did it without my dad.
- Where was he? - I locked him out.
You locked your father out of surgery? Yeah.
He made me do it.
- Oh.
- He - Mm-mm.
We're doing it again.
- Yes.
- Yes, we are.
- Is there no way for you and I to go on a date without our dads ruining it? No, there-there is uh, if we start at the end.
You know, I once read that a ten-second kiss can result in the transfer of 80 million microbes.
Did you just tell me dirty data? It gets dirtier.
Come on.
Hi.
Were you guys here all night? Yeah, we didn't want to leave him alone his first night on the machine.
I'm about to take Ellie home to get some sleep.
Hey, can I help you with that? Come here.
Where is the one for this foot? I need to run some tests on her.
On Ellie? Peripheral edema.
Due to reduced systolic function.
Great minds.
I presume you ordered a diuretic.
And a vasodilator.
- But what we really need is - A DNA test.
- What is going on? - The baby's sister.
The reason she doesn't like to wear shoes.
It's a symptom.
Wait, of the same disease her brother has? Less severe, of course, but two siblings - with the same genetic disorder? - Yes.
That's a sample size we can work with.
We can map the genomes.
- Find the mutations.
- And fix it.
- Well - We need a DNA test right away.
This could change If we're everything for them.
Yeah.
I was wrong to dismiss gene therapy and to undermine you.
This is your department, and I am happy to respect that.
Thank you.
- For the next 87 days.
- 87 days? Which is when the board will vote to reinstate me.
Assuming I've proven my basic competency to your satisfaction.
Which reminds me, I got, um Surgeon's knots.
Mm Single knots.
Double knots, and I even threw in some granny knots.
So, I think that should check that off the list, - don't you? - Hmm.
Well, despite how dicey you made things for the anesthesiologist, the surgery went well.
I'm gonna be okay? Yeah.
Your arteries look good.
But, um before I discharge you, I want to talk to you about your other disease.
So, I took a closer look at your labs, and your liver enzymes are elevated.
So? Is there any chance that you don't take your medications because you can't drink alcohol on them? Okay.
What are you saying? That-that I'm an alcoholic? I'm saying someone who chooses alcohol over life-saving meds, or who ingests marijuana while they're being prepped for surgery, or who burned so many bridges with his ex-wife that she won't even give him her number, might have another disease.
But that's one that can be treated, too.
This is a good rehab, and they've got nightly meetings.
Yeah, I'm sure they're awesome.
They are, actually.
Take it from a fellow alcoholic.
Listen, I know how hard it is to admit that you got a problem.
And, uh, no one here even knows this, but I've been where you are.
And it cost me someone I care about, too.
But there's a solution.
He's gonna make it.
He has a long road ahead.
Yeah, well, at least there's a road.
Five years ago, his condition would've been a death sentence.
Hmm.
But he has a chance, because he has you for his doctor.
And he only had you as his doctor because we have you as a leader.
You think Hamamura would've brought that baby to Griff? I appreciate that, but I'm only an interim solution.
Oh, so, you're telling me that we can change that baby's genetic code, but you can't change the board's mind? I can't even talk to them.
- You have to be a department head.
- Hmm.
Right.
If only you knew one who owed you a favor.
You fought for that baby's future.
Now go fight for yours.
I know it's last-minute, but Dr.
Griffith was there when I needed help.
Calling this meeting was the least I could do to thank her.
I know that you don't think the I'm right person for the position of chief.
To be honest, neither did I.
I thought I was gonna finish my fellowship and move on.
I had an offer from the Cleveland Clinic.
And then I thought, "I am good at this.
" Patients are thriving, and doctors are, too.
They are happier than they were under my father, which means they are more effective.
They are more efficient.
They're more successful.
There's a baby alive today to prove it.
You all asked me to step in as chief.
And now my father is awake, and you are asking me to step aside, and I can't do that.
Which is why I'm not going anywhere.
We are a better department, and we are better doctors, because I am a better chief.
You know, the tyrannosaurus rex was a merciless predator, unrivaled by any creature of its age.
I take this as a compliment.
You should take it as a warning.
Oh? I spoke with the board.
They share my enthusiasm for this department's future, which means yours is not guaranteed.
They're not just gonna hand you the reins at the end of this.
They're gonna choose between us.
May the best Dr.
Griffith win? Is that what you want? You can be the T.
Rex, Dad.
I'm the meteorite.
And I'm coming for you.