New Amsterdam (2018) s04e10 Episode Script

Death Is the Rule. Life Is the Exception

1 Previously on "New Amsterdam.
" I see now why they created a fifth spot for you.
You know the last time that happened, Dr Nottingham's family had to donate a whole building to the hospital? And I'm sorry for caring so much about both of you.
I know how difficult it was for you to sign that budget.
These people are not your friends, Max.
They're your employees.
Believe it or not, you did what was best for this hospital.
Today I protected you, but I can't protect you tomorrow.
Don't most people start the day with good morning? Yeah, but today is no ordinary day, Sandra Fall.
Today is my last day.
Well, since this is our big, emotional farewell six feet.
- You can call me Sandra.
- Oh, wow.
That means a lot coming from you.
So listen, I wanted to thank you for all your hard work and your hot lists, and me running you all over this hospital to give me information you could've just as easily given me from your office.
- Okay.
- So excuse me, I'm just going to grab a quick something.
I got you this little gift, and by little Sweetpea What's all of this about Please don't tell me your cat died.
It's a first edition rare, first edition of "Gitanjali" by Rabindranath Tagore.
Remember Vijay used to have the book? He would read you poems from it, and sometimes you'd kind of get a little teared up.
Look at that.
Peter Lugar's steak dinner spectacular for two with all the fixings.
Yeah, I know it's one of your favorite restaurants, and I do have to say because I care about your health and the sustainability of the planet, not to mention the cruel treatment of animals I'm a vegetarian now.
Oh, great.
Oh, but then this is Very kind.
Very thoughtful.
Your heart was in the right place.
Now that stethoscope belonged to Vivien Thomas, one of your heroes, who used that stethoscope to help pioneer modern day heart surgery.
Appreciate it.
Appreciate it? What is with everybody today? Why is everybody so - Disappointed? - Yeah.
I'm just trying to do something nice for the people that I love the most in the place that I love the most one last time.
Max, look, I'm going to level with you.
The gift is beyond beautiful.
- So? - It's just that the only gift that anyone really wants is for you to stay.
Hi Trevor Vaughan? Reporting for duty, hopefully.
Right, right.
I am so sorry that I kept you waiting like this.
It's not my style, but my organization and my scheduling in general has gone off the rails since I lost my head nurse.
No problem at all.
I kept myself busy.
I hope you don't mind, I saw this on your desk.
The oh, yeah/ [LAUGHS.]
Yeah, the entire department's a little fanatical about the caption contest.
You got any brilliant ideas I can pass off as my own? Hope this isn't a deal breaker, but witty captions are outside of my skill set.
Drats, Trevor Vaughan.
Now if you want to talk keeping behavioral health wards from going off the rails, though, I'm your guy.
Okay, good, let's talk.
All right.
Trained at St.
Vincent's Hospital in Melbourne.
Rose up the ranks at Tufts.
Managed behavioral health at Baptist.
Trevor, this is really impressive.
- Thank you.
- Yeah, so I guess the biggest question I have right off the bat is you come from private institutions.
Do you foresee any problems working in a public hospital system like New Amsterdam? The only problem I see having is getting any work done while staring into those amazing blue eyes of yours.
Yeah Yeah, so He actually said that? Oh, he lobbed it at me like we were at a rave on Fire Island.
- Was he cute? - Was he cute? In a sent from Asgard kind of way.
Chiseled by the gods sort of way, you know? - And he totally knows it.
- Oh.
Deadly combo.
Yeah, well, it takes one to know one.
I think we can both agree that four kids has humbled me.
Perhaps a touch, my love.
But you know, you got to hand it to him, the kind of confidence it takes to go all kamikaze with the moves in a job interview? It's just completely unprofessional.
Oh, oh, yeah, completely.
Completely, no doubt.
Although he just so happens to be the best candidate I can afford under Veronica's new budget cuts I'm just saying.
Yeah, well, I'm sorry you have to keep looking, babe.
Yeah, I know.
Me too.
You know, I've got to say that the whole thing has left me feeling kind of charged, like the thrill of it left me feeling great, if not a touch guilty.
Iggy, don't feel guilty.
Your eyes are gorgeous.
Thank you, husband.
You'll find someone.
I know, I know.
Malvo, wait up.
Whew, man, you are a hard woman to catch-up to.
I did do the 400 in high school.
Yeah, I can see that, but can you just stop for one moment? That's generally not how one wins a race.
Look, I've been texting you and leaving you messages.
And can you just talk to me? I know you want to apologize and say you had nothing to do with Claude getting the axe.
I believe you, you're not vindictive.
That's not how you roll.
Okay, but look, what happened to Claude was messed up.
But, hey, we've been through too much to just end it.
But it's just it's, um It's too complicated now.
I'm sorry.
I know that we stopped eating meat and fish, but what do you say to 20 side orders of spinach? How much did you spend? Oh, that's the best part.
Zero dollars, a gift from Max.
How much did you spend to buy my residency? [SOFT TENSE MUSIC.]
Where did you hear that? Answer the question.
How big was your bribe? I didn't bribe.
I didn't bribe anyone.
I didn't, I All I did all I did was make a donation.
A donation that happened to get your girlfriend a non-existent residency at New Amsterdam? Come on, we both know it's a joke that you had to do your residency at all, but when the dean saw an application from a doctor who trained in Pakistan at a hospital he never heard of, he stopped reading.
I mean, you could have cured cancer and you wouldn't have gotten that spot.
All I did all I did was open up the dean's eyes to see that that you were the best candidate.
How much? $90,000.
Leyla, I did this for you.
For us.
Oh, hey, guys.
Hi, I'm glad I caught you.
Um, did you guys hear about the blue-eyed hottie that got hit on today in the psych ward? Did you? Did news reach the ED? It was me! Well, did they love your gifts? Oh, yeah, they They loved them.
If by love, you mean dispassionate indifference couched in a thinly veiled apathy, - with just a hint of anger.
Go easy on them.
It's hard to say goodbye.
You seem cool as a cucumber.
I am going to miss this place, you know I am, but we are getting ready for a brand new chapter of our lives together in London.
Tell me you're not excited about that? I'm excited, I am excited.
Okay, so Luna's all settled for a week in Connecticut - with Glenn and Calvin? - Check.
We have handed over the keys to the subletter? Check.
We've checked in for our flight? Check and check.
Well, then it's time to go.
It doesn't feel real, does it? Come on.
Sorry, uncheck.
Forgot to return it.
- Max.
- I'll be right back.
BP dropping, 60 over 20.
Septic shock, hypotension.
We're losing him here.
Patient came in for a routine cardiac stent.
What the hell happened? - [PAGER CONTINUES BEEPING.]
- Yeah, that makes sense.
That's why we try to reframe these feelings of anger, you know? New context Kaelen.
- Hey, what's the matter? - [GROANS.]
Kaelen? Kaelen, Kaelen Okay, you're okay.
You're okay, you're okay.
Ka help, help! I need some help.
No pulse.
No pulse, call a code team now.
- What is it? - Clear.
Still no pulse.
- Going again.
- Charging.
- Nothing.
- What the hell just happened? We just had nine code blues at the same time.
How is that possible? [MACHINES EMITTING FLAT TONE.]
We need to shut down the hospital.
Dead, in the hallway.
All right.
Everyone listen up.
I've alerted Veronica, but she's still in Chicago, so this is on us, and here are the facts.
Nine patients died this morning.
They were all colonized by a bacterium infection, Klebsiella Pneumoniae Carbapenemase.
I'm sorry, but what is that? A superbug that's resistant to most of our antibiotics.
- Ah.
- Now the good news is KPC isn't airborne like a virus or COVID.
It's spread by direct contact through an open wound or ingestion, but that's the only good news.
From there, the bacteria quickly spreads to the lungs, where our patient's died of either bacterial pneumonia or pulmonary embolism.
Where are they all getting it from? Well, all the infections came from different departments.
I mean, it could be anywhere in the hospital.
Ten more patients just tested positive.
So what do we do now? Well, we have to call the NIH.
I mean, this could be in other hospitals.
Hey! I'll call the top people at the CDC.
We'll get their infection control team here, we'll find a treatment for the infected, Dr.
Sharpe can conduct a hospital-wide search for the source.
Max, you've got a plane to catch.
I know, but there's no way I'm going to leave this hospital in crisis.
Absolutely, this is more important.
There's no easy way to say what I'm about to say.
Your son Was there another manic episode? - No, it's not that.
- Where's our son, Doctor? Your son contracted a bacterial infection here at the hospital, and [SOMBER MUSIC.]
He passed away.
I am so sorry.
Okay, are the cameras in here? Excuse me? I don't know how much you know about our son, Doctor.
Maybe you're part of this? He pranks us all the time for that TikTok thing.
He's obsessed.
He's 17.
He gets his friends to help.
- No, I-I assure you, I'm not - All right.
Maybe you're a part of this, maybe he's playing you.
I really don't care.
But I want to see him now.
and Mrs.
Mancini, I am very sorry, but your son is dead.
All right.
Enough fooling around.
I want to see Kaelen now.
Goodwin? Simon Holgate, from CDC.
Yeah, where is Julie Framm or Dr.
Wu? Sorry, we just had a major bacterial outbreak.
We've already lost patients and our ICU's completely overwhelmed.
We need the A team here, and you seem a little Gen Z-ish.
Goodwin, I started at the CDC straight out of Johns Hopkins.
I've resolved crises in Ghana, India, most recently at the NIH in Bethesda, where I identified the frame shift mutation in their KPC outbreak.
- Oh.
- I am the A team.
Everyone, listen up.
All non-trauma patients have been diverted, but we are still up and running.
Everything needs to be cleaned and disinfected.
If in doubt, toss it.
Years of medical school, but they can't make a decent pot of java to save their lives.
- What? - The coffee.
This stuff like's mud.
You got to ice it down to make it drinkable.
I'm actually a latte guy myself There is a superbug infection running rampant in the hospital, and you're talking about coffee.
Why do I even try? Addison Stadler, 24-year-old male.
Un-helmeted motorcycle accident, head trauma, unresponsive in the field.
Trauma one, Shinwari, you're with me.
Let's go.
Addison, can you hear me? Addison? [INDISTINCT CHATTER, MACHINERY BEEPING.]
Pupils are fixed and dilated.
GCS score of three.
He's becoming hyperthermic.
Complete brain stem dysfunction.
We've got to keep his temperature under control.
Wrap his body in ice and I'll grab a cooling blanket.
Check his license.
See if he's an organ donor.
He's not coming back from this.
- Lauren? - How's it going on your end? Any connection between the patients? None that I can find, but I need you to take over the KPC ward.
How bad? It's getting worse by the minute.
Okay, go.
I'll head up there now.
I heard your patient's lungs are stiff and difficult to ventilate.
Yes, and I paged for a general consult.
The chair of surgery doesn't need to swoop in.
If it's a possible KPC infection, - I need to know about it.
- Okay.
And, Lyn, you should know that I'm in for complicated.
And being with you has shown me that I might even like complicated.
Course rhonci throughout with diminished breath sounds.
Left lower lobe.
That's how my last patient with KPC started.
- X-ray tells the same story.
- All right.
Well, there's no treatment for this, but if we can remove the infected lobe before it spreads to the rest of the lungs, we might be able to stop the infection in its tracks.
- That's a long shot.
- It's all we got.
Simon, tell me you got good news.
I put the CDC's strongest antibiotics in each dish Cipro, Colistin, Vancomycin.
Bacteria should not be able to survive in this environment.
And? New Amsterdam's KPC strain not only survived, it flourished.
Nothing worked? This is what antibiotic resistance looks like.
New Amsterdam is the third hospital this year to get an infection like this.
And what happened to patients at the other hospitals? They died.
There must be a common link, but all the infected came from different floors.
They were admitted to different departments, and given various treatments.
From arrival to first symptoms, looks like roughly a 48-hour incubation period - for the bacteria.
- Okay.
So let's go back to hour one for every patient.
Where did they enter? All but three went in through the ED.
Okay, then what? Six went through radiology for imaging.
And five went to cardio.
Okay, then those are our common links.
We need to put the ED on full diversion and lockdown cardiology and radiology.
We have to test every square inch.
Don't we need the medical director to authorize that? Well, when she returns, you can tell her to give me a ring.
Okay, guys, let's go.
So you're telling me the strongest antibacterial the CDC has won't work? It doesn't even make a dent.
Well, then we need to think of something else, and fast.
Our supplies are pushed to the brink.
I mean, the ward you just put me in charge of is almost full.
Okay, what about something other than antibiotics, like phage therapy.
I've already tried it.
Nothing in the phage trials works on this train.
Immunotherapeutics, like pegfilgrastim? Or heavy doses of probiotics for microbiota modulation? They're good as preventative measures, but it's too late to help those already infected.
What about CRISPR? We could alter the Cas9 enzyme and turn the KPC gene function against itself.
It's experimental and time consuming, but it could work.
Let's do it.
Can you believe this, Thora? You believe what this kid puts us through? - Don't yell at him.
- I'm not going to yell at him.
- He's gonna know I'm over this.
- Okay, okay.
The denial of death, of our own mortality, of the mortality of the people we love, it is essential.
If we were constantly aware of our own fragility, of the emptiness that we are this close to all the time, we would be filled with terror.
Right now your brain is trying to protect you.
I am trying to protect you from that terror, but if I open that door and I show you your son Open the door, Doctor.
Oh, my God.
Kaelen? Kaelen? Kaelen? Kaelen? Kaelen? [CRYING.]
Mancini, I know the pain you must be in This ward is KPC patients only.
- That's why we're here.
- Walsh? Don't you dare be nice to me now.
Walsh hasn't been anywhere near radiology all week.
And we've cross-checked his whereabouts with all other departments.
Which leaves us with this.
Here's our epicenter.
Full resection of the left KPC-infected lobe complete.
I see pus on the right lung.
Oh, damn it.
That is KPC, all right.
We can probably resect the right lobe too.
Uh Won't matter.
It's spread.
It's everywhere.
So our only option will be a transplant? Yeah, I guess we can put her on ECMO.
That'll buy her 36 hours to find a donor.
And if we don't find one? [INTENSE MUSIC.]
Time of death, 2:14 p.
I've checked everyone's results on CRISPR.
It's not working.
We just lost another one.
It was immediately degraded in the body.
Okay, then we just have to think of something else.
Test every nook and cranny, trash can, table, chair, catheter bag, stethoscope, suture tray, and I hate Mondays mugs in this department.
Something is infecting people and we've got to find out what it is.
There's too many possibilities.
I hope you pushed your flight to next month.
Well, it'll take as long as it takes.
All right, let's try target signaling and regulation.
Unless you have a time machine, that's theoretical.
Okay, then we can change the patient's microbiome, and we can do a fecal transplant And risk more infection? Then how about you give me an idea instead of just shooting them down.
I have tested every drug, modeled every outcome, and all these roads lead to the same place.
I'm sorry, Max, but there's no antibiotics on the market that can fight this infection.
That could work.
Wait, what? You're saying test old antibiotics that aren't in the market.
Definitely not what I'm saying.
- It's brilliant.
- But it's not what I'm saying.
But it's genius.
Max, antibiotics get pulled from the market for specific reasons Namely for killing people.
And I've got over 14 patients upstairs with a superbug decimating their bodies, so I think we're in hail mary territory.
So please, can we start testing? Okay.
This isn't our fault.
No, I know.
No one is saying it is.
Yeah, but how could he be here one minute, and just The next minute, he's Our son is dead.
You know what, Dora, let's go.
We don't have to stay here.
Our baby is dead, Dominic.
I'm not going back into that house.
That emptiness.
We can find you somewhere quiet to grieve here.
What, in this hospital? This place that killed my boy? This isn't the hospital's fault, Dominic.
It's yours.
Kaelen was never good enough for him.
He never gave that boy an inch, so of course he acted out, and ended up in here.
Yeah, yeah, listen to this.
Perfect mama's boy, could never do anything wrong.
You know, I saw this coming for years, but she would never listen to me.
All she could do is protect him.
You screamed at him every day.
- I did not scream - No, stop! You can't You cannot blame each other.
All she ever did was blame me, always.
Oh, Kaelen.
God Kaelen.
Without our little boy, what do we have? [MACHINERY BEEPING.]
They're sick because of us.
This is a hospital.
Some people get better.
Some get worse.
Yeah, but ideally we're not the ones making it worse.
My sister died here.
From an infection just like this.
I remember you telling us that on your first day.
All the doctor said to me was, "I'm sorry, there's nothing we can do.
" I felt helpless.
How can I leave this hospital when it's happening all over again? Then don't.
Guys, I know you're all exhausted and frustrated, but people are Are counting on us.
Walsh is counting on us.
Okay, look, everybody, take a coffee break.
That might help give us a second wind.
The iceman cometh.
What does that mean? Oh, it's just an inside joke all the residents have with Walsh.
We nicknamed Walsh the iceman because he always complains that our coffee is too strong.
He always has to dump a ton of ice in his mug to water it down.
Drives him crazy.
How old is this ice machine? It's older than all of you.
Swab? Thank you.
We found our infection point.
Now what else was this machine used for? - I hate feeling lucky.
- Well, our patient is lucky that Mr.
Stadler was an organ donor.
You and I can feel grateful.
- Transplant team ready? - Yeah, they're coming in now.
They'll harvest both lungs to give Maru the best shot.
Stop! Is that Addison Stadler, motorcycle MDA? Yeah, are you assisting with the transplant? - You need to call it off.
- Why? That patient's lungs were exposed to the KPC bacteria.
- No.
- The ED wrapped him in ice to control his body temperature.
That ice harbors the bacteria.
My patient needs these lungs.
She only has hours left.
I understand that, but you can't use these.
They'll be a death sentence.
We've got something, an antibacterial solution that worked against the KPC.
See? What did I tell you? Hospital spent way too much money training you.
No way we're gonna let you die.
Your bedside manner is a thing to behold.
So what's the drug? - Tolomycin.
- From the 1950s? Wasn't that taken off the shelves because it decimated people's kidneys? Technically yes, but as we give people the drug, we'll simultaneously administer dialysis.
So we keep them alive but we risk destroying their renal systems? Is that really our best solution? At the moment, it's our only solution.
We're not quite ready to press go.
We haven't tried it on a patient yet.
I should hope not.
Try it on me.
He's gonna make it.
We've done all we can.
He has to make it.
I know.
Mark? Mark? Mark? [HOPEFUL MUSIC.]
Blood vessels are degrading.
How much longer do you give the patient? Fifteen minutes, tops.
Reynolds, you're a go on your lung transplant.
- New donor? - New antibiotic.
We can treat the infected lungs of the motorcyclist.
Now you can feel lucky.
All right, everyone, you heard Dr.
Let's get to work.
Dominic would you come over here and sit down with your wife? [SOMBER MUSIC.]
Thank you.
Can you two look at each other? Right now you're both in shock.
You are both in unimaginable pain.
You are angry.
You are lost.
But that doesn't mean that this is the end.
It doesn't have to mean that.
An event this traumatic can actually bring you closer together.
Because right now you are the only one who truly knows what the other one is experiencing.
You are the only one who knows what the other one is going through, and what comes next is going to be a challenge, absolutely.
Things are not going to go back to the way they were.
They will never be the same, but don't you dare turn on one another.
Instead, turn to each other.
Lean on each other.
You embrace your grief together.
And above all else, you talk.
You really talk to each other, because that is how you will survive this.
Lying on my back Dry your smoke-stung eyes So you can see the light Staring at the sky Thank you for sticking around.
Of course.
How are you gonna break it to Helen? What? That you're not going with her.
Watching stars If you leave When I go Follow me In the shallows If you leave Find me [LINE TRILLING.]
Hi, this is Trevor.
You know what to do.
Hi, Trevor, this is Dr.
Frome Iggy from New Amsterdam.
And listen, about the job, could you start on Monday? Okay, get back to me.
Thank you.
When the time comes On the last day I thought about what you said earlier.
And I'm glad that you're up for complicated because I'm pregnant.
Will you run away? Will you run away? And let it all rain down That was good work today, Dr.
Hey, stop.
You lied to me.
I asked you if this residency was on the level, and you said yes.
You said it was all me.
It was all you.
Okay, you earned it.
I just made sure that everyone knew it, and if I hadn't, I mean, you'd be half way across the country.
You'd be gone.
We'd be over.
If you leave Leyla, I would write a million dollar check to keep us together.
So you got a deal? That's not what I meant.
That's the only honest thing you've said.
What? You bought me clothes, food, and I went along with it, and that's on me.
But the one thing I thought I had earned was just paid for like everything else.
- Leyla.
- You didn't do this for us.
You did this for yourself.
Leyla, I love you.
No You tried to own me.
You bought me.
That's not love.
Lying on my back Lying on my back Lying on my back Watching stars collide Watching stars collide Watching stars collide Burden me.
Watching stars collide JFK, terminal four.

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