New Amsterdam (2018) s01e20 Episode Script


Next Tuesday's fine.
- Let's do that.
- Yeah.
Keep him on the leash, honey.
Thank you.
It's okay, honey.
It's okay.
How can I help? I can't find my mom.
- I don't know where she went.
- It's okay.
We'll find her.
What's your name? - Luna.
- Luna.
That's a pretty name.
What about your dad? Do you know where he is? I don't have a dad.
My dad died.
All right, I've got two infinity pools, I got a swim-up Jacuzzi, and this? This is where the Millennium Falcon lands.
- So - [LAUGHTER.]
What? No, Jeffery, it's, uh it's great.
It's just, it's safe to say you followed the letter of the exercise and perhaps not the spirit.
I mean, you said envision our futures, right? - Well, y'all, this is mine.
- Yes, Jeffery.
It's just, your future contains a few more two-piece bathing suits than I had anticipated.
- That's all.
Can can I go next, Dr.
Frome? Yes, Avi, please.
Talk us through your vision of your future.
Jeffery, it's fantastic.
Okay, so right here is Parthenon in Athens.
I'm gonna go after I learn some Greek, you know? So I can speak to the locals.
I hate that everybody just assume that everybody's just gonna speak English, you know? That's smart.
And this? This is Table Mountain in Cape Town.
One day I'm gonna hike it.
Right to the top.
What drew you to Cape Town? I guess I just, you know, want to see the world.
Go places I never been before.
I mean, come on.
Look at that view.
- That's spectacular.
- It's beautiful.
It is, Avi.
Fantastic, truly.
Now, guys, it is more than fine to look forward to material things - Yeah.
- Yes.
- But but sometimes goals are stronger when they affect who we are.
You know what I mean? - Iggy.
- Yes.
- You have a visitor.
- Ah.
It's my new Jet Ski.
Um, guys, keep filling out your vision boards.
I will be right back.
And Jeffrey, ease off the swimsuit models.
- Thank you.
Tiara Dobbs.
Avi Mantell's social worker.
It's good to finally meet you in person.
Yeah, likewise.
So, um, what brings you down to our neck of the woods today? Avi's mother's been offered a job in Missouri her hometown and she can't pass it up, so she's gonna be moving back there next week.
Oh, wow.
With Avi, obviously.
I reviewed Avi's case and it appears that he has made huge strides with you, so I can't think of any reason that he can't transfer from inpatient care to weekly visits with a local therapist.
I just need you to sign off so I can begin Avi's official discharge procedure.
Unless you don't agree.
I did I did have a pretty huge breakthrough with him recently.
Well, that's certainly good to hear.
I know, it is.
Yes, I think that Avi is ready for the next step.
- Wonderful.
- Okay.
I'll tell Avi to pack his things.
- What is so funny? I've just discovered that New Amsterdam has a listing on Yelp.
"Yelp"? Yeah, you know, where people post online reviews about places they love, things they hate, their experiences.
Oh, like Facebook but on the internet.
Yes, exactly.
Listen to this: it was posted two minutes ago by @NancyPants.
"The rooms at New Amsterdam are freezing, "the lights are horrifically bright, "and the only thing older than this mattress "is my bald doctor who can never seem "to find his glasses.
One star.
Let me see this.
I know this patient.
This is Nancy Nan.
She's doing a sleep study with me.
One star, Vijay.
- Ouch.
- One star? That's absurd.
All she has to do is to sleep.
I'm joking.
Don't worry about it.
40-plus years of practice and an expert in my field of study.
I should be able to do better than one star.
- We shall see about this.
- Uh, Vijay.
My phone and your glasses.
Nice cap, Williamsburg.
When does your artisan pickle shop open up? - Proud of that one? - Mm, I'm proud of all of them.
So, today's schedule isn't too terrible.
Fist up: Quarterly Allocation Review Committee.
- Pass.
- Uh, you can't really pass.
No? Watch me.
I'm skipping that redundant meeting.
- What's next? - [STAMMERS.]
Then there's a new pharma vendor show-and-tell.
- Pass.
- You okay.
Uh, the Board requested your presence at the Strategic Objective Luncheon in midtown.
- Pass.
Next? - Max Pass.
Next? Police commissioner called again.
I'm guessing it has to do with what happened to Officer McNeil.
Yeah, hard pass.
- Max.
- No.
There's not a single essential meeting on that entire list.
They're all just arbitrary, and I'm not wasting any more time on arbitrary.
Well, what well, now that you've cleared your entire schedule, what do you intend to do I don't know, something that matters.
You know, something worth my time.
Maybe something life and death.
What was that all about? He's in a mood.
It's okay, honey.
- Whoa, whoa! Whoa, whoa, whoa! What the hell happened in here? You might want to ask him.
Okay, I got this.
- It just came out of nowhere.
- It's okay.
All right, let's go.
That was your vision board, bud.
- What's going on? - I'm not going nowhere! Avi You're gonna do great today.
I've been to plenty of morbidity and mortality conferences.
Just never had to lead one.
Well, you're my, uh, chief resident now.
It comes with the job title.
Been going over your case and it sounded just awful.
Officer McNeil just bled out so fast.
I'm sorry, Dr.
So am I.
Look, I just want you to know I'm not gonna throw you under the bus or anything during this discussion.
No, no, no.
Look, M&Ms aren't about blame, all right? They're a teaching tool.
We come together to see if our actions contributed to the patient's death so we never repeat those mistakes.
But that's just the thing.
I've been preparing this for days.
I haven't found any mistakes.
Hey, that can happen too, all right? But we still study the case and we vow to do better the next time.
That's it.
Today's case is a white 40-year-old female trauma patient.
- She initially presented with - [DOOR OPENS.]
Go ahead.
The patient presented with a fractured femur, cervical and thoracic abrasions Was Officer McNeil on any medications? [PAPER RUSTLING.]
She was on low-dose birth control.
25 minutes post arrival Did Officer McNeil have a history of heart disease? Uh No, the patient did not.
We all know you're talking about Officer McNeil, Dr.
No need for anonymity.
Um 25 minutes post arrival, Officer McNeil developed a pneumomediastinum, necessitating Before the pneumomediastinum, were there any other signs in her vitals that could have predicted her eventual death? - Not that I'm aware of.
- Hmm.
What did Officer McNeil look like as she went into surgery? - I don't know.
- You don't know? I wasn't there.
You weren't there.
Well, if we have any hope of getting some real answers today then we need someone presenting this case who was actually there.
Reynolds? She was your patient, right? - Yes, she was.
- Hmm.
So you would have the most salient information on this case.
I think Nottingham is providing an accurate case review.
But, uh, to really get to the bottom of how she died, don't you think that you might be better qualified to lead this discussion? If it's not too much trouble.
- Next slide.
- Okay.
Let's go to the chest x-ray first.
- Okay, good.
- Next slide.
- Okay.
All right.
So here we have Marie McNeil's chest x-ray.
You will notice the mediastinum.
It measured just over 9 centimeters in length.
Now, Dr.
Nottingham, can you give us the criteria for pathological widening? 8 centimeters on a supine AP chest.
Very good.
We have met the criteria for pathological widening.
If we take a closer look right about here see that? Air bubbles.
That's the cause for the widened mediastinum.
Now, that's actually caused by tears in the esophagus called Boerhaave's syndrome, all right? And also of note: normal pulmonary parenchyma and normal cardiac silhouette.
Uh, wait, go back to the chest x-ray.
You said cardiac silhouette was normal? Yes.
But the chest x-ray is a rather blunt instrument for examining something as delicate as the human heart, wouldn't you say? So what other modalities did you use? An EKG and a transthoracic echocardiogram, both of which came back normal.
Can we see those? [TENSE MUSIC.]
Uh, Dr.
Nottingham didn't include them in today's presentation because they were normal.
Well, I can't tell if they were normal if I can't see them for myself.
Well, I don't have them here.
No? The entire purpose of an M&M is to analyze the data to ensure that if mistakes were made those mistakes will not be made again.
It is particularly difficult to analyze that data when that data isn't here.
So why don't we take a brief recess to allow Dr.
Reynolds to compile all the necessary cardiac data.
Uh, why are you moving me? I honestly have no idea.
To get better results on your sleep study we wish for you to, uh, have a warmer room with better lighting and much, much softer bed.
- Oh! - Uh, hello.
What's up with the lamp? Uh, we're moving this patient to a nicer room for some random reason.
- What? - No.
We have a reason.
The reason is because we are trying to provide Ms.
Nan with the most comfortable care here in the New Amsterdam because patient comes first.
Right? Yes.
Finally, someone who gets it.
Thank you.
- You are welcome.
- Yeah.
We gotta go the extra mile, you know? Our patients do come first.
I mean, this is what I've been saying.
You know, these people depend on us for care.
They put their very lives in our hands.
My boyfriend just hates my snoring.
You know, we can do better.
We can do better than just provide her - with comfortable care.
- We can? Yeah.
How would Ms.
Nan like a stay in our Presidential Suite? I imagine she would like that very much.
- Yes, thank you.
- Mm, good.
Come on, before he changes his mind.
Hurry up.
Why does she have to be here? Uh, Ms.
Dobbs and I are both your advocates, Avi.
- She's part of the team.
- I don't have a team.
You don't.
You have an entire network.
Me, Ms.
Dobbs, your mother.
The All Stars, man, you know? Everyone wants to see your transition to life outside of the hospital go smoothly.
Too big of a freak to be in the real world with normal people.
What is what are you doing? Time out, time out.
You know full well on this ward we don't use words like freak.
"Real world," "normal" whatever that is.
All right? Those are day-one ground rules, Avi.
Come on.
I think you're breaking the rules on purpose.
That's my theory.
I think you're scared of what's to come.
You're scared of these changes, so you think if you act out now you can get out in front of it and stop these changes from happening.
Talk to us.
When they kicked me out of school, I didn't care where they sent me.
I didn't care about anything.
It was like, whatever.
But then Things just got better here.
That's right.
Things were starting to make sense.
I felt like I belonged here.
But now that I'm starting to get the hang of it my mom is trying to ruin my life again.
No one no one is ruining your life, Avi.
I I don't even think anyone has that power.
All right? You put in the work.
You learned the tools.
You can cope anywhere.
Even Missouri.
How do you know? Just listen to me, okay? 'Cause I'm good at what I do.
I can promise you this: you are ready.
- He is not ready.
- What? Were we both in the same session? Avi accused his mother of ruining his life again.
And? Avi was admitted for a serious outburst at school.
Kids were teasing him over his learning disability, but it had nothing to do with his mother.
What are you saying? I'm saying whatever's going on with him was triggered only once he learned he was leaving.
Avi's mother can't just change her travel plans.
Her new job is expecting her there on Monday.
I need more time with him.
Frome, his discharge paperwork has been filed.
I know.
I know.
Just let me talk to him.
Let me see if I can get through to him.
That's it.
Thank you.
Oh, um, Dr.
Kao? How do you spell your last name? Uh, K-A-O? "Dr.
Agnes Kao" [SIGHS.]
Thomas Jefferson once stayed in our Presidential Suite.
- Is that right? - Mm.
This room has housed the architect of the Declaration of Independence.
And now @NancyPants from Yelp.
I know how this looks.
Yeah, I feel like if you did we wouldn't be having this conversation.
This was not my idea, I swear.
- It was Max's.
- Hold on.
The ludicrous coddling of Nancy Nan a woman who isn't even sick came from Max? Yes.
And if his error in judgment leads to an enhancement of my online status, well, this is just a happy coincidence.
Did Max seem like himself to you? He seemed erratic.
Annoyed, then excited, then distracted, all in quick succession.
And if it was anyone but Max, I would have got worried.
Should I be worried? Aww, she found the fizzy water.
Brought everything I could find.
Action logs, nursing notes, imaging studies.
Oh, and here are those, uh, ultrasounds.
Oh, good work.
I'm sorry about this, Dr.
I didn't really expect Dr.
Goodman would want to see every last scan.
It's not your fault.
This, uh, level of due diligence is extreme.
That's one way to put it.
But my work on Officer McNeil was solid, you know? Our job now is just to present the case clearly.
Hey, can we talk? I'll get these loaded onto the computer.
- I don't like this, Floyd.
- It's fine.
It doesn't feel fine.
Feels like you're putting yourself on the line.
Okay, these conferences are for internal use only.
They're protected.
But we both know that Max has been fielding calls on this one.
From the mayor, the police commissioner.
Board of Directors, malpractice department at HCC.
Evie There was a police officer that died on your table, under your knife.
You know that they're gonna be looking for someone to blame.
Hate to say it, but it sure feels like Max is trying to make sure that person is you.
Reynolds? Are you actually ready? [FOREBODING MUSIC.]
What we have here is the pre-op echocardiogram for Officer McNeil.
Now, let's focus on where the rupture occurred.
Here to here, all right? .
34 centimeters at the thinnest width of the right ventricular wall.
Also, normal valve function.
Normal papillary musculature.
And, as noted before, normal echo.
How about a second opinion? Dr.
Jessup? Yes, it appears normal.
How about you, Dr.
Flores? Don't you think the right ventricular wall looks a little thin? Uh, no.
It looks like a normal thickness to me.
Is there anyone here who disagrees? Dr.
Nottingham? I see what Dr.
Reynolds sees.
Normal ultrasound.
Well, an ultrasound is just an approximate image of the real heart.
But, fortunately for us, the real heart is still here down in pathology, so I think we should all take a trip down there and have a closer look for ourselves.
You can't be serious.
Oh, but I am serious.
Once we examine the real heart, then we'll know if these readings were in fact, as you say, normal.
Right now.
Here we go.
Everybody up.
You know you can talk to me, right? It's just me and you.
In here, just like before.
It'll never be like it was before.
Not where I'm going.
- Okay, let's talk about that.
- Let's not.
Avi, I believe there is something in your life that really upsets you.
Something you've worked very, very hard to lock away.
And now, for some reason, that thing has snuck back around to the front of your mind.
For some reason, that's all you can think about right now.
You know I can help you.
I can help you manage these emotions, but first you have to let me in.
I don't want to move back there.
- I hate it there.
- You hate it in Missouri? Why do I have to go with her? Why can't she just go back there and do her dumb job there and I could stay here, right? Don't make me go.
Does this have something to do with your mom? No! My mom doesn't know anything about it.
Doesn't know anything about what? No, no, no.
Avi, what doesn't she know about? You have to tell me.
You gotta let me in so we can face it together.
I don't want to face it! I want to stay here, but nobody cares about what I want! - That is not true.
- It is true! If you cared about me at all you'd be on my side right now.
You'd be on my side instead of working so hard to ship me off to Missouri! [OBJECTS CLATTERING.]
I can't go back.
- Have you got a minute? Well, despite this whimsical tableau I'm actually quite busy.
- Tough case? - Understatement.
But, you know, nothing fires up the brain like sugar and titanium dioxide.
Well, before you slip into insulin shock, I I want to get your professional opinion.
About? About Max.
You know, speculating on the boss's mental health is not my favorite thing.
Nor mine, but if the medical director of New Amsterdam's ability to make decisions is compromised, then I need to know about it.
Every cancer patient struggles, but in the past few days he has been exhibiting behavior that's erratic.
Unstable, even angry.
That's not Max.
Well, I do, um I have a theory but I don't think you're gonna like it.
Go on.
It's you.
Me? This all started once you passed him off to Dr.
Stauton like a hot potato.
That's irrelevant.
Our treatment plans are almost identical.
Yeah, but your relationships with Max are not, are they? Dr.
Stauton is an excellent doctor.
- Max knows that.
- Yeah, and he respects her.
But he believes in you.
I need your help right away.
- Hey.
- Not now.
This better be important.
I am at the end of my rope now.
I have a patient who, no matter the treatment, cannot be helped.
Is this about your spinocerebellar degeneration patient? No, he's fine.
It's about @NancyPants.
I brought this on myself, didn't I? Look at this.
"The 100-year-old doctor just tried to buy me off.
"Pro tip: want a better review? "Don't give me the scratchiest sheets on the planet.
One star.
" She is insufferable.
Isn't she in the Presidential Suite? Yes, and she's still displeased.
Wait, we use 600 thread-count Egyptian cotton in there.
Nothing will ever be good enough for this woman.
It's hard to believe she's a woman of fine taste given her screenname is @NancyPants.
I don't know what more to do.
Wait, what if she actually had incredibly sensitive skin? It has to be the most sensitive skin on this planet, or [FUNKY MUSIC.]
- Oh, dear.
- Exactly.
- Max, we should talk.
- Not really a good time.
What is this? A fool's errand.
If we look at the patient's heart, we see the chambers intact.
Normal in appearance.
But let's turn to the cardiac injury.
Even after this dramatic free wall rupture, the actual cardiac tissue itself is amazingly normal.
No thinning? - None.
- No? No, uh, infiltrative process like amyloid or fibrosis? No, no abnormalities whatsoever.
Reynolds, what about your, uh, mental state during the surgery? - Nothing of particular note.
- Really? Because I know for a fact on that day that you were, uh, distracted.
No, I was fine.
If you recall, you spent the entire morning going over your budgets.
It's unrelated and you know it.
Not if it compromised your concentration during the surgery.
You honestly believe I was still thinking about - your stupid budgets? - I don't know.
You tell me, Floyd.
- The woman died on your table.
- You know what? That's it.
This M&M is over.
Everyone back to work.
Now! Except for you.
We got business.
- You were way out of line.
- Not if I'm right.
Well, you're not right,f and that wasn't an M&M.
That was a public shaming.
I am only asking the tough questions.
No, you are undermining my credibility at this hospital.
In front of my staff.
In front of my colleagues.
Are you really making this patient's death about you? No, you made it about me when you brought up my mental state.
The whole point of this exercise was to determine, once and for all, if Officer Marie McNeil's death was preventable.
We have sifted through every notation, every scan, every piece of recorded imaging.
Hell, 50 people just watched you poke and prod at the poor woman's heart.
There's nothing else to investigate! - Then we start over! - Max.
You are unbelievable, you know that? Yeah, no, we start over.
We dig deeper.
We keep looking until we find No! What did you say? In what world do you think I'd stick around for more of this? I was so excited when you offered me chair.
To build a department that that we could both be proud of.
An environment based on mutual respect.
But in one afternoon you managed to tear it all down.
In one afternoon you showed how little you trust me, and you did it in front of everyone.
You can expect my resignation.
Do you want to tell me what this is really about? [SUSPENSEFUL MUSIC.]
You're not my doctor, remember? We must examine you right away.
- I'm trying to sleep, here.
- You're on your phone.
That's how I get to sleep.
Blue light disrupts the production of melatonin, but we'll talk about that later.
Uh, do you mind showing me your legs, please? Um Dr.
Kapoor believes your discomfort has nothing to do with the sheets.
O-okay, sure.
How long have you had this rash? I've never noticed it before.
Can I have that glass? The rash doesn't blanch under pressure.
We must get her to the procedure room now.
Wait, why? Ms.
Nan, it appears you have contracted meningococcal meningitis.
If we don't treat you now, you could die.
I need a procedure room, stat.
Something I can help you with? I need to talk to you about Max.
Somewhat irregular.
I know.
Come in.
Hey, Avi.
Yeah, come in.
Come in.
My mom's waiting.
I just wanted to, you know Say goodbye real quick.
You have my number, you know.
You can call me anytime.
Thank you for, you know trying to fix me.
I know I let you down.
- I'm really sorry for that, Doc.
- You never let me down.
But you couldn't fix me, so Hey, stop, stop.
Listen to me, listen to me.
"Fixed" that's not a thing.
It doesn't exist.
Nobody leaves this hospital fixed.
Do you understand? My job is to give you the tools to get through the day.
That's it.
I wish I could just stay here.
Hey, hey.
You're gonna make it to Missouri.
But that's just the beginning.
Don't forget about Table Mountain.
The Parthenon.
Right? Gonna hike all the way to the top.
Right to the top.
Use the tools.
- Use the tools.
- Every day.
Every day.
Come on.
You're gonna be great.
It's time to go.
All right.
Bye, Doc.
Bye, Avi.
Pulse ox 97, BP 100 over 60.
When you feel the pop [MONITOR BEEPING.]
You know you are in.
- There.
- HR normative range.
- Nancy? - Here you go.
You okay? Uh, I guess so.
We are collecting the fluid to identify which bacteria is making you so sick.
Additional LP tubes on the tray.
I just came in for a simple sleep study.
Nancy? - She's unresponsive.
- Heart rate is up to 124.
BP's down to 80 over 40.
She's going into septic shock.
Deliver to the lab.
Rapid response, procedure room number two.
What the hell was that? I did everything in my power to save this patient's life.
I did everything right, and now it's gonna bury my career? This doesn't need to land on you.
Max was I don't know what that was.
Out of control.
Babe, you have legal recourse here.
I have a friend at Adler & Morgan who would take on this case at the drop of a hat.
Yeah? Not the best time.
W-we should talk.
Text me later.
This better not be you defending him.
Not after what he did.
No, I I can't defend that.
- But, uh - But? But? Max's cancer.
It's not responding to chemo or radiation.
How bad? It's bad.
When did he find out? Stauton told him this morning.
Got enough light on the keyhole? Passing through the cerebral cortex.
The center of the infection is in the third ventricle.
I don't think you'll be able to hit it.
Keep looking at the CT.
Go ahead and remove [INDISTINCT.]
4 centimeters to the lateral ventricle.
You're too close.
I can make it.
If you clip that she'll never walk again.
Just imagine that review.
Advancing caudal to the corticospinal tract.
You're clear.
And I am into ventricle.
Injecting Cephillicam.
Heart rate and blood pressure are stable.
43 years ago, I made a decision to be a doctor.
Dedicate my life to the service of others.
It was never about reviews.
- I heard.
- Mm.
Yeah, well, what can you do? I get why you pushed hard.
I want answers too.
How do we just accept that her death or anyone's death, was random? Life, death.
It can't be arbitrary.
It's not.
I just thought maybe there was something That we missed.
You know, maybe there was something that we could have done differently.
Maybe maybe I could have done a lot of things differently.
Sometimes you do everything right.
You know? And get the same result.
As though you've done nothing.
I'm sorry, Floyd.
I don't know what else to say or how else to say it.
I just I don't know who that who that was today.
I mean, I look in the mirror and I I don't even recognize that person.
What's happening to you is not fair.
There's no reason behind it.
No answer that will make it better.
I know.
I just don't want my life or my death to be arbitrary.
Okay, well, the way I see it you got a choice.
You either let the randomness of this beat you down or you pick yourself up and you just keep fighting.
Endings be damned.
I know what you're gonna say.
I like your hat.
I have been sitting here all afternoon researching alternative options.
Have you heard of the Norton-Simon model? - No.
- It's called DDC.
- Dose-dense chemo.
- "Dose-dense"? Essentially, it's the same dose of cisplatin that you're on, but we would administer it twice as frequently.
By amping up the quantity and frequency of your treatment we could interrupt the rapid growth phase of your malignant tumor cells.
What's the catch? If you were experiencing side effects from your normal dose, DDC is the equivalent of napalming your internal organs.
Essentially, it's a human scorched-earth policy.
Take time to think it over.
It's a big decision.
So read that article, and then tomorrow Can we start tonight? [BITTERSWEET MUSIC.]
I wanna keep fighting.
Endings be damned.
Still here? I had a lot of paperwork to finish, given everything I saw today.
- Yeah, yeah.
Yeah, days like today, they, uh they hit hard, man.
Don't always get the time you need with a patient, so we do what we can and we find solace in knowing that our contribution helped, if even just a little bit.
Frome, I wasn't filling out paperwork - for Avi Mantell.
- No? I was opening a formal investigation on you.
I don't understand.
What I witnessed today was a therapist actively and knowingly forming non-therapeutic alliances with his patients.
No, that's not right.
The physical exchanges with Avi? The emotional boundaries? You overstepped with him.
It crossed a line, Dr.
This is my official report.
I wanted you to hear it from me.
I'm sorry but our patients must come first.