Transplant (2020) s01e13 Episode Script

The Only Way Out is Through

Do you remember me, sir? You have an epidural hematoma.
If I don't relieve the pressure right now, you're going to die.
We're in this together now.
Sonia Jessup.
She overdosed? - Am I close? - Keep going.
I think I nicked something.
Her spleen is ruptured.
The punctured spleen.
With a mistake like that, what happens next? There'll be an internal review.
I was the one who inserted the tube, so if anyone deserves the blame for it I was on imaging, guiding placement.
You know that.
About what happened with the imaging Get back to me with a differential on Sonja Jessup.
When I was putting in the chest tube, what did you notice when Dr.
Bishop was guiding placement? Same thing you did.
His first measurement was off.
He misread the imaging on the monitor Was it that he misread the monitor? Or more like he couldn't see it? It was like it wasn't even in his field of vision.
I know you and Dr.
Bishop are close.
This is in confidence? Of course.
About a month ago, I noticed him treating himself for post-concussive nausea.
That's not abnormal after his head injury, - and the surgery he had.
- I know.
I'm not trying to avoid responsibility for what happened.
I made the incision, and I'll take the blame for it.
But But if his nausea's progressed to vision problems, what if he's getting worse? Yesterday, a nurse came up with a chart.
He didn't see that either.
He brushed it off, I didn't think anything about it.
The question is, is he intentionally downplaying the symptoms? What if they caught him by surprise? I don't know, Claire.
What do we do? My favorite family.
- Hey-hey.
- Ah! Look at you! Come here.
I know I'm not supposed to pet him, but he's just got the most beautiful coat.
- Oh yeah - It's cool.
Thor likes you, Theo I think it's because you're always happier to see him than me.
He's pretty good at reading the room.
Well, you know the drill.
Sit on up for me.
What are you reading these days? This play.
"Rosencrantz and Guildenstern Are Dead.
" Finn's an existentialist now.
Well, you certainly have come a long way from "Treasure Island.
" Tough couple of days? Tough couple of weeks.
He was in for pulmonary rehab two weeks ago.
He's barely left the house since then.
You know, we thought we were on top of this infection, Theo.
It really took a turn.
We all know that cystic fibrosis can be unpredictable, right? We'll check lung function, and then start you on IV antibiotics.
What happens if they don't work? Last time, they almost didn't.
Hey, don't think like that, Finn.
Okay? They're gonna work.
Let's start with airway clearance.
We'll loop your respirologist in.
Okay? Just, uh Hang in there, Finn.
I always do.
Then again, is it really even up to me? Yes, it is.
You can be an existentialist again once we're through this rough patch.
Sure, Mom.
No problem.
Well, I'll be back soon.
Thank you.
I have heard of situations where the patient has a reflex reaction just as you're placing the chest tube.
Or maybe it malforms Or maybe he just made a mistake.
Maybe Hey! - You two good? - I ended things.
- What? - I ended things.
June, I'm If you ever want to talk about it, I When do I ever want to talk about it? Oh, right, I know.
I'm sorry.
- It's fine.
- Right, right, right.
- I'm fine.
- Yeah, yeah, yeah, okay.
I'll be right back.
Sir? Sir? Sir, can you hear me? Sir, open your eyes if you can hear me.
Hey, do you know who this is? No wristband.
He must not have signed in.
He's out cold.
One too many maybe? I mean, it happens a couple of times a week.
No, he's jaundiced.
I think we have to get him a room.
- Yeah.
I'm on it.
- Thanks.
Sir? His name is Neil Evans.
He's got a ruptured, hemorrhaging mass in his abdomen.
It could be threatening other organs.
Was he aware of it before now? No way of knowing.
He's been unconscious since we found him.
Any history in our system? He had his health card.
I checked for a history and nothing came up here.
We really need to stop the bleeding.
- No family we can call? - Social worker's on it.
He came in alone with just his wallet and his keys.
Then, we rely on our judgment and sign a two physician consent.
Book the OR, category two.
And yes, before you ask, you can scrub in.
Get him prepped.
Tell me what's on the list and let them know we need to go ASAP.
Your team is working hard to help that woman after her spleen rupture.
My team works hard to help every patient.
I asked you if the nausea was normal and nothing to be concerned about.
You said yes.
Then I asked you if the dizziness was normal, and you said yes.
Now, if neither of those were true, you have to tell me right now.
Because what happened last night in the trauma bay, Bash is now on the hook, a patient's life is at risk and if it's because you are not taking care of yourself Alright, Claire! Alright! I couldn't I couldn't see the damn monitor.
It went foggy.
Okay, how long has this been going on? Have symptoms been getting worse and you've just been lying about it? No.
I haven't in The nausea's normal.
The headaches too.
But this These lapses in vision, I wasn't expecting.
I haven't been lying to you.
Maybe I've been lying to myself.
You need to call your neurosurgeon.
I will.
And you can't see patients.
I know it's terrifying.
I know your work is your life.
But you promised us a future.
Did you mean it when you did? Because I believed you.
I meant it.
Call your doctor.
Seem him today.
We're still hopeful the rupture will heal on its own Other than what happened to her spleen, have you figured out what's causing her symptoms? So far, the tests we've run haven't given us any answers.
We need your help narrowing down the possibilities.
Can you think of anything, any symptoms or underlying medical conditions that she's been diagnosed with? Or any injuries she's sustained even going back years? Sonja and I met when we were 18.
I knew everything there was to know about her for the longest time.
She was always basically healthy.
Until her back pain, her addiction.
I love her.
And I want my wife back.
Joel, why don't you take your sister to the vending machines to get something? Okay? Okay.
Thanks, Dad.
- One each, guys.
- Okay, Mom.
They're adorable.
Thank you.
How are you feeling since waking up? Tired.
My body hurts everywhere.
The doctors need to ask you some questions.
Sonja, we need to figure out whether you may have been exposed to something.
You're thinking this is something I caught? There is an infection called endocarditis which could explain your symptoms.
If there's been any, um well, any intravenous drug use, even months ago.
You think I was shooting up? - No, we're - I would never do that.
I know I messed up yesterday, but I was only taking pills.
How long have you had these? - Spider veins on your leg? - Years.
Ten years, at least.
My GP said they're nothing to worry about.
You You believe me, right? What is happening to her?! Put your head back.
Put your head back.
Just stay there.
Any closer to finding anyone who knows this man? Viv was able to reach his GP.
But no spouse and no kids.
Ah, this tumour has more legs than a spider.
It's wrapped around his liver.
It's encroaching on his pancreas and it's stuck to his bowel.
Have you ever seen anything like this before? Ah, it's in the lining of his abdomen, could be colorectal cancer - or malignant mesothelioma.
- So what do we do? Unfortunately, there's not much we can do, Dr.
Curtis, other than divert and refer oncology.
He's lucky if he has a week.
Let's close up.
Sonja's intubated.
Anything back from her CT? Still waiting.
They met so young.
You could end up being married to someone who isn't anything like the person they started out as.
Or it just means that you change together.
My parents met at 18 and they were more in love than any couple I've ever seen.
Results are up.
Her spleen won't stop bleeding.
The blood's filling up her abdomen.
We've caused too much damage.
They're going to have to remove it.
I bet I'm the only kid you know with a legitimate reason to dress up like his dog? The X-rays came back.
Unfortunately, the last few days took their toll on Finn's lungs.
I know that's not something you want to hear right now.
I'm not responding to the antibiotics? Your infection's getting worse.
We're admitting you now.
Your CF team is on their way down.
But, um we're not gonna be able to stop it.
The vest didn't help? What about PEP? Or a bi-pap? Those would buy time.
But it wouldn't stop the decompensation.
I'm I'm so sorry.
We're prepared for this.
Right? We've been on the transplant list for months.
And this moves Finn up to the top, right? The list is based on need, yeah.
It doesn't matter because it's too late.
Finn! Don't say that! Hey, that is not what's happening here, okay.
There are more things that we can try.
I know you guys are trying to protect me.
I get that.
But I need to face what's really going on here, and I don't think you're hearing what Theo's actually saying to us.
Even if lungs come, your infection is too advanced.
He wouldn't be a candidate.
We, uh We're We're looking at end stage.
- I'm sorry, Mom.
- No.
What happened? They were prepping for her splenectomy when she started to seize.
She seized? Why? We don't know.
Well, we've stabilized her, but, uh they can't remove the organ until we know what else we're dealing with.
Yes, come in.
Is this about Sonja Jessup? Every time we think we're making progress, she seems to be getting worse.
Take me through your thinking.
All of her symptoms.
The fluid around her heart.
The fluid on her lungs.
We can't see how they're connected.
She's negative for respiratory virus, and her white blood cells are normal, which means there's not an infection either.
The fact is she's been here two days and we still don't know what's wrong with her.
Other than the ruptured spleen, which we caused.
And before we could repair that, the seizure.
Basically, all we know is that she's extremely ill, and her prognosis is worsening because of what happened in Trauma last night.
Which was my mistake.
And I'll tell that to the board.
Thank you.
Sir, I'm not going to let you take responsibility It was my fault.
And I'm not having you come this far for something like this to hold you back.
Now, clear your mind, widen your views.
List everything that it can't be until you see what it is.
There's poetry in the differential.
There's truth.
We get it wrong until we get it right.
And they get to start over.
Sir? Dr.
Bishop? My numb is arm.
Sir? Dr.
Bishop? Get a gurney! Call a code! Sir! Dr.
Bishop, can you hear me? Oh my God! Jed? Possible stroke! He collapsed, and then lost his pulse.
Pause the compression.
V-tach on the monitor.
Defibing 200 joules.
- Pads are on.
- Charging! What happened? Everyone clear! One amp epi! IV push! Bash, you were with him? What happened? He said his arm was numb and he just collapsed.
- Ischemic stroke? - Or hemorrhagic.
Could be a ruptured aneurysm.
A ruptured aneurysm causing cardiac arrest? How long has this thing been building? We need Neurosurgery in here right away! Let's do a pulse check.
He's still in V-tach.
Defib! 200! Charging! Everyone clear! Dr.
Bishop? Sir! Jed! - GCS still three.
- He was down almost a minute.
We need to intubate him and get him to CT right away.
Okay, he needs anti-convulsants, we need manitol to decrease cranial pressure.
Let's get him on three per cent saline.
And minimize damage as best as we can.
What happened? Sudden loss of consciousness, he went into V-tach and we shocked him back to normal rhythm.
Did he articulate any symptoms first? Numbness.
And momentary vision loss, he suffered last night.
He called my office.
We have a consultation booked for tomorrow.
We'll get him upstairs.
I know that wasn't easy.
But he's out of our hands now.
And we know exactly what he'd tell us to do: to get to work and focus on the patients we can help.
Let's get to work.
Sonja needs us.
Get him prepped! He needs a craniotomy to drain the blood.
Tell me how bad it is.
We won't know until after, but There's no guarantee he comes back from this, Claire.
Okay, um Well, let's go back to the beginning.
So, Sonja was in a car accident.
But you wanted to rule out a brain injury.
No visible head trauma.
Her resp rate was low which I mistook for symptoms of opioid use, and then, heart and lung fluid almost killed her later that day.
Her drug use raised the possibility of endocarditis, but she said she wasn't using intravenously.
Which was confirmed by bacterial culture.
Also, the CT scan of Sonja's head came back clear, so we know it's not a brain injury Which leads us back to an underlying cause.
It needs to be something physiologic.
An abnormality we're not seeing Something Something rare Something you wouldn't normally think to look for.
There have been cases where a penetrating head trauma can cause an aneurysm months, even years, down the road.
I could've caused this Dr.
Bishop's With the drill, you mean? You told me it was reckless to drill without imaging.
You saved his life because you did that.
And there could be so many reasons this happened, not the least of which is Bishop going back to work so soon after his accident And the aneurysm could've sat there for months.
A ticking time bomb in his head.
The the spider veins on Sonja's leg? Those almost always mean nothing.
What are you thinking? You said something rare, something that you wouldn't normally think to look for and you also said a ticking time bomb You know what's wrong with her? I have a theory, but we're gonna need more imaging to confirm.
Hey, Theo.
Hi, Finn.
I, uh I heard you're going home.
They're setting us up with everything we need.
And Thor likes it better there.
So they're doing this for him, then? I needed a say in how it happens.
I'm scared, Theo.
I know, Finn.
It's okay to be scared.
Thank you for everything, Theo.
He's, uh He's a brave kid.
An amazing kid.
I can't do this.
- I can't do this.
- It's okay.
"The pancreas is an ass.
" - But also kind of important.
- Yeah.
Who said that? I remember someone saying that.
- I can't remember who it was.
- Dr.
He did a three-hour oncology lecture last year.
"The pancreas is an ass, which is why it deserves more of our attention.
" - Right.
- Why? Well, it's a highly aggressive abdominal tumour.
It's compromising the other organs.
I was thinking an intraperitoneal chemotherapy.
You're gonna surgically deliver chemo right to his cancer cells? Well, not me, but I was thinking maybe someone like Doctor Waldon could.
He'd have to debulk most of the cancer cells first.
Possibly resect part of the bowel, and take the tail of the pancreas.
I don't know, but Singh asked you to organize that? Well, he said to refer Oncology.
Pulling together an advanced procedure like that at the eleventh hour, I don't think anyone here is even trained for it.
The patient's completely alone.
Like he doesn't have anyone to advocate for him.
I don't know what he did to end up like this, but anything we can do to help with Anything we can do to help.
You know who you could call Dr.
Magnussen at Sunnybrook.
She just published on that kind of thing last year.
Maybe she's looking for candidates.
Yeah, thank you.
- You saw the radiologist? - You were right.
- An "AVM?" - "Arteriovenous malformation.
" It's a rare, abnormal connection between a person's arteries and veins.
Then this had nothing to do with her drug use? She was probably born with them.
AVMs disrupt circulation and can cause a range of life-threatening symptoms.
They can happen anywhere.
In Sonja's case, we identified one in her lungs and one on her spine, but it's the kind of thing you don't even know to look for until the other symptoms develop.
She's gonna need a surgical procedure called an embolization.
But you said she's got one of these things on her spine? Could it have caused her back pain in the first place? It's possible.
Even likely.
You couldn't have known.
Yeah, but I stopped believing in her.
I stopped trusting her.
Her condition is serious, but it is treatable.
The surgery will last a few hours.
If you need some time to take your children home, we'll call you after.
We're not going anywhere.
Is that for her? Wait here.
BP's tanking, she's tachycardic.
- Ultrasound.
Mags? - Yeah.
How many times can one woman crash? Where are you on this patient? She's got multiple AVMs.
We can embolize them, but she's not stable enough.
She's got blood from her spleen in her abdomen.
- Call OR.
- Yeah.
She's going into hemorrhagic shock.
She needs her spleen out stat.
We can't lose her now.
We finally know what's wrong with her.
And if she bleeds out because we punctured her spleen, - then Dr.
Bishop - Is on the line.
- The OR says ten.
- She may not have ten.
Then we do it ourselves.
In trauma.
You've removed a spleen before, right? Mm-hmm.
Well, what are we waiting for? She's bleeding out, Dr.
Now or never.
I'm ready.
We're starting.
BP's dropping.
Activate MTP.
Arnold, get the level one ready.
- Got it.
- Mags, help me open? Hanging two packs of red cells and two bags of plasma.
She's got a significant amount of blood in her abdomen.
I'm gonna need packs, and a lot of them.
I'll eviscerate the bowel so we can start packing the abdomen.
Start packing and keep them coming.
- Pressure's dropping! - Clamp.
I've got you.
It's impressive you were able to pull this together so quickly.
Magnussen's not making any promises, but she thinks he's a viable candidate.
But you should know she brought a full team here with her.
- So that means, you - Yeah.
I know.
I'm not asking to scrub in.
I just wanted to give the guy a chance.
So Ah.
Sonja's stable.
We figured out what was wrong with her just in time.
But not him.
I knew he still had symptoms.
Oh, Bash.
I could've said something earlier.
No, I could've stopped this from happening.
Don't blame yourself.
Don't do that.
Come here.
Baba! Baba! I had to go.
I had to leave him.
If I'd stayed to treat him, they would've found us.
If I tried to move him, they would've heard us.
So I left him there to die.
It's my fault.
It's all my fault.
How's Dr.
Bishop? Conscious.
I mean, we can't really tell.
I know how much he means to all of you.
Yeah, thanks.
Well, I'll see you.
I heard you were awake.
Apparently, without a spleen, thanks to you.
You can live without one.
You'll just be more prone to infections, but you can take measures to mitigate that.
You saved my life.
And you found the reason for my back pain.
I know I'll always be an addict.
That doesn't mean you can't start over.
And that's all I want to do.
Beat this thing, for my family.
Is everything okay? Your text said to come, but you didn't say why.
Amira, what I said yesterday, about only being in this country because of you I'm sorry.
I didn't mean it like it sounded, but You deserve to know why I said it.
I don't bring you here enough.
Back home, do you remember coming to the clinic after school? Baba would always talk about what he'd learned that day.
New medications and treatments.
No problem was ever too big and Mama always talked about her patients.
Learn how to treat the patients, and not the symptoms.
Amira You know, when you were sent to live with the cousins that was only because of how much Mama and Baba loved you.
How much they wanted to protect you from the war.
I know you miss them.
I miss them too.
And you were right when you said yesterday that I'm not honest with you.
But I want to be.
You've asked me why I can't talk about them.
That day, when the bombs came I wasn't there.
I was too late to save them.
And I feel guilty about that every day because you lost them and you need them, and we're alone because of me.
But the last thing our father told me was to find you, and build a future for both of us.
Because we weren't alone if we had each other.
I know you need me to be better.
To do better.
And I'm learning as I go.
But, habibi, I promise, I'm here for you.
Baba was right.
When you came to the camp, when you found me, I knew I was safe.
You saved me.
We're not alone because of you.
We're together because of you.
Theo? What are you doing here? I thought you were working all week? I, uh I was just at the hospital an hour ago, and I'll be catching a flight first thing in the morning.
I just I had to see you.
And see the girls.
Life is It's impossible.
It's impossible and I know I screwed up.
Taking the job without telling you is I just, I wanted to take control of my own life.
You know, not just have it happen to me.
I wanted I just, I went about it the wrong way.
And I'm sorry.
I hurt you, and I am so sorry.
Mel, I love you.
But if we want different things, is that enough? It has to be.
It has to be because I can't imagine life without my family.
What are we gonna do? I don't know.
They're closing up.
No guarantees, but that guy's got a shot because of you.
Yeah, this might be the first time I actually wished my patient was awake.
Spoken like a true surgeon.
Walk with me.
You're almost in your fourth year, June.
You should consider applying for the Chief Resident position.
Sir? And don't get me wrong, it's a thankless job.
Longer hours.
Administrative crap.
Managing your peers without any real power.
And you'll be up against a bunch of egocentric bros who think they've got it in the bag.
But it'll open doors.
Going above and beyond for the sole purpose of giving that patient a chance? That's something you can't teach.
And it's what I've been waiting to see from you.
I mean, I'll consider it.
You do that.
- You okay? - Yeah, actually.
You? Uh, I I don't know.
You know, it was Bishop who told me that if I wasn't careful, this place would swallow me whole.
But if even he can't stop that from happening Then what chance do any of us have? Look.
You don't strike me as someone who would back down from a challenge.
Just saying.
I'm glad you came.
I'm glad you called.
This way.
I'll be just outside if you need me.
Hi, Dad.
Has he said anything yet? Not yet.
He's lucky to have you in his life.
You too.
I thought you were dead.

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