Transplant (2020) s02e02 Episode Script
Jasmine
1
(WHEEZING)
- (BASHIR): I'm sorry but who are you?
- Rick Novak.
I'm the acting chief of this emergency department.
You've been on for two days straight.
How's the new guy already telling me I put too much on my plate? How long have you known we were here? Since you came.
(SIRENS WAILING IN THE DISTANCE) (BASHIR): I need a surgeon's eyes on something, June.
Car crash.
Impact wound, lower right quadrant.
How far are you from a hospital? Half an hour at least.
I tried to find a consult, but we're stretched thin.
- Inter-abdominal pressure? - Increasing.
And his pressure is rapidly decreasing.
One more dose of morphine, Saleh.
I see bowel protrusion.
Abdominal evisceration.
A tear in the peritoneum can release pressure.
It has nowhere to go, so it pushes the organs to the surface.
Yeah, don't push them back in.
Just douse a towel in saline, cover them, and handle them as little as possible.
There's an arterial bleed! (BASHIR): Find it, tie it off then seal it.
You need to keep the pressure up or he won't make it.
We're out of sealant.
Um - Do you have electrodes? - What's that? Yes, we have some.
Hold it.
(JUNE): Okay, take the adhesive, seal off the wound.
Yeah! (HEAVY BREATHING) Okay.
He did it.
Trick I learned on a ride along from hell.
(BRAKES SCREECHING) Thank you, Doctor? - Oh! June.
- I'm Saleh.
Where'd you learn to tie off an artery that fast? Ask the man beside you.
Thank you for this, June.
Oh, yeah.
Anytime.
So much has happened for the both of us.
(CHUCKLING) (GRUNTING) (DRY CHUCKLE) The last time I thrilled a woman by standing on my own, I was a child.
And my comparisons to your mother end there? Fiona was a handsome woman.
- (CHUCKLING) - That will do, pal.
You're fussing around me.
Don't you have an exam to study for? I'm ready for it.
Your rehab team wants to see you today at 4 PM.
They say I'm making fast progress.
Could be on my feet soon.
You just had a stroke, four days ago.
Okay? Now you gotta pace yourself.
And come up with a long-term strategy to build your strength.
I do happen to have a little expertise on this subject, both professionally and personally.
Hm, okay.
I will give you professionally.
But personally? Your previous strategy of racing back to work while I aided with your self-medication did not exactly help.
It helped get us back together.
Hm.
What are you worried about? This place is gonna fall apart without you? Or that maybe, it won't? (GROANING) - Ooh! - Wait, vulture! I made this for you! Hmm.
Ah, bravo, Amira.
Did you figure out the streetcar? I'm getting there.
I will show it to you.
Eat! What will you do today? How long can you stay at the hotel? They said until I find something.
- Hey, guys! - Oh, there he is.
Sorry to interrupt.
Don't get up.
- Theo, this is Rania.
- Hey.
Thank you for having me in your home.
I promise to leave.
Unlike those two.
He barely notices us anymore.
He's almost never around.
Theo was just made an attending.
Congratulations! I also hear you have two daughters? Yes! Who I'll only have time to put to bed if I can catch the 9 PM flight back to Sudbury.
That can't be easy, living apart from your family.
Champagne problems.
We're making it work.
I have to go! It was nice meeting you.
Bye! Oh, that reminds me, I'm on until 8 today, so straight home after school, okay? I have hip hop.
The after-school dance program.
I told you yesterday.
It goes to 7.
Amira, I don't want you taking the bus alone at night.
Maybe Rania could come? Let's not put her to work just yet.
Ask Sadie if Herman can drive you and let me know.
These remind me of that picnic in the park.
The pigeons wouldn't leave us alone, so Bashir threw olives at them.
Wallah, Amira, if you saw these pigeons! Was that the last time you two saw each other? No, um No.
But it was the last time I let a pigeon push me around.
Let's eat.
Mags? - Ephraim! - It's so good to see you.
Hey, Deena.
You're in another cycle of chemo? Three of seven.
I didn't wanna bug you this time, Mags.
But the pain was too much today.
And we couldn't get into the oncologist last minute.
Hm.
Are you taking something for the pain? Yeah, McKinney gave us a pharmacy of analgesics.
That I barely get to enjoy, since I spend all my time hugging the toilet.
- Any other side effects? - Huh, joint stiffness.
And I have been sending some strongly worded emails to the people in my life who have disappointed me, because at this point, I figured who gives a crap? Well, that one's widely reported in the literature.
Alright, well, let's get you to baseline and we'll take it from there.
I'll start fluids and something for the pain.
Yeah but they told us you're not our doctor.
I wanted to request you but But I told them you're busy saving people with an actual future.
I'm your doctor.
We never got the chance to thank you properly.
No, last time you stayed on after your shift to help us.
- Thank you! - No thanks necessary.
Meanwhile if you need anything? - Press the call button.
- Yeah.
No, no, you're not listening to me, okay? You tell your clients, if they didn't want this getting bloody they shouldn't have brought a knife to a gun fight, alright? See you in court! Everything okay? Aah! Corporate law, figure of speech.
You told our triage nurse that you could hear your heart? Does that mean beating fast in your chest? - Because it sounds normal.
- No, I can actually hear it.
Like a stethoscope in my ear.
- When did this start? - Today.
I know, I've got a lot on my plate, alright? But I don't get panic attacks.
Okay, well, I've seen the symptom you're describing accompany an inner ear infection or Alright, an infection.
It's minor then.
That's one possibility.
(SIGHING) Okay, I don't see any redness.
Have you experienced any dizziness at all? Yeah, actually.
So, what's that, just an antibiotic to clear it up? No! We need to rule out anything serious with a range of tests.
Fine.
How long is this gonna be? I need to get back to the office like an hour ago.
I'll be back as soon as I can.
The lady in five is on your list, but do you mind if I take her? I have a broken ankle if you wanted to swap? And good morning to you too, Mags.
It's not a buffet, Leblanc.
You have to get sign-off to trade patients.
But this is a woman I treat regularly for chemo side effects.
And do the two of you have some kind of exclusivity contract that I don't know about? What about you, Doctor Hamed, do you have any interesting patients this morning? I just saw a man in E who's presenting Yeah, I read the chart.
That usually describes tinnitus, the cause of which is, generally a fishing expedition, but I already called an EN and in the meanwhile, you can order an EKG and bloods just to be on the safe side, heart-wise.
Deena Kaplan has a terminal diagnosis of lymphoma.
She's in a fierce battle to extend her life but the pain and the nausea keep sending her here.
I have a short-hand with her and her husband.
- Are these people your friends? - Right.
Right.
You'd prefer I'd see my patients as needy bags of meat, - as you put it, right? - (LAUGHING) You don't have to sound so callous about it! Since I know their history, it'll be more efficient for me to help them.
This is about continuity of care.
Okay.
Okay that's it? Why not? I'm interested to see what you can offer that your other residents can't.
No, that's not what I Okay, that's not what I was saying at all.
Does your attending have you doing paperwork again? No, why would he need? Oh, nothing.
Just conversation.
Actually, I was taking it upon myself to propose some workflow efficiencies to Singh for the surgical calendar.
Oh! Good for you.
Never apologize for playing the game, Doctor Curtis.
Is that how Novak beat you to the Acting Chief position? Because you've been Bishop's second forever and I just thought it should be you.
Since you've been here for so long.
(SIGHING) Nice talk, June.
Nice Code blue in E! (SUSPENSEFUL MUSIC) - He's in V-fib! Mags! - Got it! Prep one amp of epi! Charge the defib two hundred J! - Is that the guy with tinnitus? - His EKG was normal.
We're waiting on bloods but he was stable.
Charged! - (MACHINE BEEPING) - Clear! Resume compressions.
EMS incoming! You need to take it, Arnold! (DRAMATIC MUSIC) Carly Miller, 16 years old.
BP is 105 over 80, rate's 140.
Severe blood loss, we've tried multiple lines but her veins are flat, so we've intubated to secure the airway.
Carly was home for lunch and then started coughing and then there was bleeding and it wouldn't stop! This is Hannah, her sister.
I'm Theo, Hannah.
Where are Mom and Dad? Huh.
They're on their way to Chile for work.
What's happening to her? Is she gonna be okay? We'll find out.
Epi in.
(MACHINE): Shock at five! Mags! She's lost a significant amount of blood and the clock is ticking.
I'm seeing fresh scabs where her tonsils used to be.
Recent tonsillectomy? Her sister didn't say but I've seen this before.
Post-op fibrin clot sloughs off the tonsillar pillar and ruptures.
We have to get her stable and put pressure on the bleeding.
Activating MTP.
Arnold, we need blood and lots of it.
Take over, I can't find the vein.
June, where are we on that line? It's a difficult stick.
It keeps collapsing.
She needs to have the blood.
Without blood she won't make it.
What's your plan, Doctor Curtis? - Bone gun? - Okay.
- What about it? - Doctor Curtis is proposing an interosseous transfusion.
Peripheral access isn't happening.
The humeral's IO it is.
Allow me.
- It's okay, I've got it.
- Good.
By all means.
(WHIRRING) Give me a line, Arnold.
Airway entry both sides? Placement.
Oxygen 98.
CO2 40.
Blood's coming in! Stabilizing but she'll need the OR.
- I'll call up.
- (BEEPING) I think you can take it from here, Wendy.
(BASHIR): Clear! Mags.
Go again, one more epi.
- How long's this guy been down? - 19 minutes.
- Who's running this code? - I am! Leblanc is slowing down.
Doctor Hamed, take over.
Epi in.
Hold compressions.
(PANTING) No, he's not responsive.
It's time to call it.
He's only 37 years old.
Came in with a minor hearing issue, otherwise he's healthy.
He's dead, Doctor Hamed.
Asystole, prolonged downtime.
No correctable causes.
No cardiac activity after eight rounds of CPR.
Did I miss anything? - No.
- In that case Time of death? 11:38 AM.
Let's take a moment to acknowledge the loss of a life, and the efforts of our team to save it.
(BEEPING) Rate's climbing.
Is that possible? That's something you don't see every day.
He's alive.
(GENTLE MUSIC) (STEADY BEEPING) Swift work with that bone gun.
Heard your bleeder needs an embolization? - Yeah.
- I called Doctor Yong in vascular.
We went to med school together.
I told him you should be the one assisting him today.
- So get ready.
- Uh Doctor Singh is my attending, he's in general surgery.
I know Aajay.
Is he still in love with the sound of his own voice? I just mean that I wouldn't normally be scrubbing in as part of the vascular team.
So Don't all surgical residents want a cross-section of experience? No one ever done you a favour before? Definitely not someone I barely know.
When a member of my team does good work like you did, in trauma, I like to see them get rewarded for it.
You're welcome.
(SCOFFS) (HANNAH): Why isn't Carly awake? Why does she still have the breathing tube? What's happening to her? A tiny blood clot ruptured and tore a hole in Carly's carotid artery.
Normally a surgeon would just make an incision and repair it, but the location of the tear puts your sister at a higher risk.
So we're looking at something called a transcatheter embolization, where instead of opening up her neck, we'll reach the wound by going through her leg.
- (STAMMERING) - I don't understand.
Are you saying that one of these options could kill her? I'm saying it won't heal on its own.
Carly's life is on the line either way.
We're recommending what we believe is the safer option but since your parents aren't here to weigh in You're asking me to decide? No.
No way.
You can't put this on me.
Hannah, I'm not putting anything on you.
We'll do this together, okay? But it's important that your sister has an advocate.
Okay? Someone who knows her, who can weigh in on the decision-making process.
For example, if we knew about her tonsillectomy, that would've helped us.
Oh, my God.
We I I told the paramedics about that, didn't I? Is that why this happened? I mean that surgery was like a month ago.
The doctors said that my mom and dad could go Hannah, Hannah, it's okay, we reached out to the surgeon No, no, no, it's not okay.
Look, you gotta understand.
Carly is everything to them.
I mean, to me! They would never want me involved and I know that's not true.
They left you in charge when I just got fired from my retail job.
Three engineers and one girl who can't fold a sweater.
That's our family.
Carly's younger than me but she's the responsible one.
I mean they were expecting her to take care of me.
Look, Carly's in the OR queue, so there's a little more time.
We'll keep trying to reach your parents for now, okay? (MACHINE BEEPING) You're saying I was dead.
Not unconscious.
Dead.
Auto-resuscitation is a rare phenomenon where the body responds to CPR after death.
For how long? You had a weak but shockable rhythm without pulse for 19 minutes, and then, nothing.
Isn't that extremely bad? It can be, but your vitals are normal again.
You're very lucky.
Okay.
I'm lucky.
What happens now? We need to do some more tests, to understand why this happened.
No kidding.
You said it was an ear infection, then a few minutes later, I die? Is there someone you want me to call, anybody you want to come down here to stay with you? What I want is for you to not make the same mistake you made before.
Just figure out what's going on and tell me what to do about it.
Navin, none of your tests presented any indication of cardiac abnormality.
We're widening our search but it will take some time to figure out exactly You're a resident, right? - Yes.
- Yeah.
Why don't you just admit you're in over your head and send me whoever you report to.
Maybe I won't have to die this time to get some help around here.
(BREATHING HEAVILY) (GENTLE MUSIC) Hey! Pain meds helping? The IV drip means at least I'm not throwing them up.
I think that nurse wants to strangle me.
Trust me, she's seen worse.
You're halfway through a chemo cycle.
Your nausea's normally progressive.
We knew it was an aggressive course.
They said if I make it through, it can buy six months.
So that's where we're at.
Speaking of that nurse who definitely does not want to strangle you, I asked her how often you've emptied your bladder - and she says not once? - I haven't needed to go.
Well, we've been loading you with fluids.
Can you sit up for me, please? And just raise your arms.
There's a few things I want to rule out.
Here we go.
Level with me, Mags.
What are we worried about? The usual.
Infection, kidney and liver function, things we've looked into before.
We'll run blood work, just to be safe.
You can lie back down.
Is Ephraim nearby to take you to the lab? I made him take a walk.
He won't like this.
I can explain it to him when he gets back - (CHUCKLING) - You can try! McKinney's been clear that my body can only take so much.
I hear that when she says it, but Eph thinks we're gonna make it to our 10th anniversary to New Zealand.
Why don't I take you to the lab.
Can I get a wheelchair in here? Don't you have a thousand more patients to see? Yes.
But it's on the way.
Liar.
But it saves that poor nurse from having to come back.
(CHUCKLING) Can you walk? (GENTLE MUSIC) Heard you were looking for me? Hum.
Navin Kutty.
We did two ECGs, both inconclusive.
His blood proteins look normal, echo looks normal, so I think we should give him a MRI just in case How does he feel about being alive? Sir? I'm curious.
How's the guy feel, coming back from the dead? He's more focused on the fact that we let him die than the mystery of being alive.
I wasn't wrong to terminate CPR when I did.
I didn't say you were.
And his being alive isn't a mystery.
It's lingering electrical current and luck.
I'd like to order an MRI in case of pulmonary AVM.
Circulatory problems can result a hearing issues Nah, I'd rather you get him to the cath lab for electrophysiology.
And do that soon, we need answers.
But sir, that's a very invasive test.
I'd also be interested to know where that patient is from.
Well, I would assume Canada.
- His lineage, Doctor Hamed.
- Why is that relevant? It's not, potentially, but then again maybe it is.
So find out, do the tests and let me know.
Well, he doesn't want to speak with me, Doctor Novak, - he'd rather speak with you.
- No.
I think you've got it handled.
It's interesting to see Doctor Bishop training his residents to push back.
It wasn't my experience with him.
Or maybe he doesn't and that's just you.
A good leader isn't afraid to be challenged.
And since we don't know how long he's gonna be out for, it's good we get along.
Carly Miller, 16 years old.
Arrived via ambulance with oral hemorrhage associated with a tonsillectomy clot rupture and secondary lacerated arterial wall.
I referred to vascular for embolization.
But kept a little piece for yourself.
We'll circle back post-op.
What's up next? We've got a discectomy in B.
(SCOFFS) You want me to send her to the corner for that? I earned a spot on vascular for this.
I'm not gonna feel bad because some resident thinks I skipped the line.
You're a fighter, June.
I get that.
And while you do need in on as many complex surgeries as possible, if you want to make Chief Resident What? I need to be liked? Respected.
There's a difference.
Does that not apply to Harris? Because she wants the job as much as I do.
Doctor Harris isn't the only Black surgical resident we've had here in three years.
So I both need the operative time but I shouldn't take it? What are you telling me to do here? I'm not.
I'm just pointing out the landmines.
(KNOCKING) I was just down the hall talking to a tech about electrophysiology.
Is this for your auto-resuscitation patient from this morning? The nurses have been talking about it.
Have you ever had one? Yeah once, when I was doing my residency.
We did CPR on a newborn.
Electrophysiology is not a test you order every day, - it's pretty invasive.
- It wasn't my call.
Doctor Novak.
He was one of your residents? He's a gifted doctor.
Did you know him long before he joined Doctors Without Borders? It's an interesting transition to the kind of structure you find here.
You'd know better than I would.
He's your Chief, Doctor Hamed.
Not me.
It's just, in his mind, sir He thinks this is a permanent position.
So he wants my job.
He'd be an idiot not to.
It's a great job.
The, uh newborn who came back to life.
We called her Baby Lazarus.
And would you explain that as lingering electrical current and luck? Yeah, I would.
Although the current was only lingering because we did more than 20 minutes of CPR.
But then, what some call luck, others call a miracle.
My patient's not exactly moved by his.
Maybe because they tend to scare you as much as save you.
It's easier to ignore that fear than face it.
But then, look at me.
(INDISTINCT CHATTER ON PA) Talk to me about shift change transition, Leblanc? Uh I'm still on another hour.
I cleared the food poisoning in six, broken ribs in three's being discharged, and my cancer patient in five still waiting on labs.
Which the next shift will handle.
Mm-hmm.
Do we not pay porters to take the patients up to the blood lab? Yes.
So your escorting Miss Kaplan up there earlier, that's the reason why you wanted to trade patients? I mean, can't a doctor go the extra mile? You know like I said earlier, I like to Yeah, you have a shorthand but, what I don't understand is why that makes you the only person capable of properly treating the patient.
You can't cure her cancer.
Unless you have some kind of superpower that you haven't told me about.
Of course not.
But if I can make it easier for her, I think I should do that, I think I should do that.
Feeling like the patients need you.
Like if you aren't the one taking care of them, then they won't be okay? That's ego, Leblanc.
Do you not trust your colleagues on the evening shift? Does nothing really get done around here without you doing it? - Of course, I trust them.
- Good.
Then let them do their jobs.
You go home, you preserve yourself for tomorrow's patients.
Mm-hmm.
Please if you could just explain to your supervisor this is a question of life and death.
Si muerte.
Vida y muerte.
Necesitamos hablar con el piloto? Gracias.
Okay, huh the parents have switched to a regional airline within Argentina, we're doing our best to find somebody who can radio the pilot directly, but this this could take ages.
Si.
No, el piloto.
I saw so many places, it's only ever people bidding up the rent.
You know it was the same for us.
We didn't find anything until after I started washing dishes and the owner knew someone with a vacancy.
Then I better hurry up and meet some people.
Knowing you, that won't be too hard.
(CHUCKLING) Bashir, I got this for you.
- (GENTLE MUSIC) - Hey Right before they took you.
Bashir? Where did you just go? I um (PAGER BEEPING) Um, I have to get back.
Uh, Bashir, I want you to know we don't have to jump into anything.
We can take our time.
Thank you for the plant.
Amira texted me about needing a chaperone home from dance.
I know it's not what you wanted this morning, but she was so excited.
- You said yes.
- Yeah.
(CHUCKLING) Doctor Atwater? Hi! So, huh it's none of my business why you did or didn't get the Acting Chief position.
And I shouldn't have asked.
But you still wanna know.
All they told me was that the role would be going to someone more suited to the leadership opportunity.
- So in other words, a man.
- (ATWATER SCOFFS) When I was where you are now, Doctor Curtis, that was my curse.
Now it's being too old.
But, uh there is a silver lining.
There is a freedom in not having to worry about playing the game anymore.
But if you have bigger goals for yourself, Doctor Curtis, don't make my mistakes.
I played by everyone else's rules and look where it got me.
(KNOCKING) Navin's MRI was negative for AVM, but the electrophysiology did detect a rare abnormal heart pattern so, my hunch was wrong, but yours was correct.
- Differential, Doctor Hamed? - Well, taking his rhythm within the context of his wider symptoms, arrhythmogenic cardiomyopathy is an option.
But then, wouldn't we have seen scarring on imaging of his myocardium? Most likely we're looking at a range of genetic disorders.
Not DND, Romano-Ward syndrome is possible but, uh something is For those kinds of inherited disorders, we'd need genetic testing.
Unless there was another marker to narrow it down.
- What about his lineage? - I did ask.
He's Canadian, but his parents are from Kerala, India.
Huh After my residency, I did a stint in northern Sri Lanka.
Based out of a refugee camp which was overflowing with displaced people.
Malnutrition, infection, dysentery.
But there were some doctors here that told me about this young man who presented with one, remarkably hyper-dramatic symptom.
Sudden cardiac death.
Brugada Syndrome, prevalent in South Asian men.
(CHUCKLING) Well done, Doctor.
Won't be as much fun telling the patient though.
No, but my mother and father are completely healthy.
You can live asymptomatic your whole life.
That's why it's so dangerous.
Okay.
The beating sounds I was hearing in my ears.
Might have been your body warning you.
Or could just as easily be unrelated and temporary, like tinnitus usually is.
(SIGHING) Genetic.
That means this heart defect can't be cured? Unfortunately, no.
But it can be managed.
And there is somebody from Cardiology coming later to talk to you about an implanted defibrillator device to avoid another episode.
Do you know what I did today, after coming back to life? I sat here, hooked up to these wires, and I sent work emails and I managed files.
After what you went through, it's normal to want a distraction.
What if my whole life was the distraction? There wasn't a single person that I could think of to ask down here.
Why would they come? I never made space for anyone.
- (THEO): Dammit.
- (MAGS): What? They cancelled the 9 PM.
And even if I could get out of here for the 7, which I can't, it's full.
You can't fly home tomorrow? I'm supposed to be back tomorrow.
Okay.
I'll just it's fine.
I'll drive.
Which means I need to finish my reports before I go.
You sure you can keep this pace up? I chose this, so it's, uh on me to make it work for my family.
Okay but this solution? You running yourself empty? Is that really what they need or is it just about you? If you're saying I should stop trying to see my kids I don't know what I'm saying.
I gotta go.
Deena, Deena! Hey.
I'm right here, come on.
Come back to me, Deena.
- Her labs? - Her breath is short.
- Like she's gasping for air.
- Deena, can you hear me? Nod if you can hear me.
She was confused and then I couldn't wake her.
I can hear arrhythmia, pulmonary edema.
Labs? Her creatinine levels spiked.
Potassium's at eight.
- What does that mean? - Acute kidney failure.
She needs them flushed.
Call dialysis.
We'll be there in 60 seconds! - I need help! - Deena, come on! Alright, we're ready! It's okay, I'm right here We've done everything we can to try to reach your folks.
It should be them here, not me.
It's not about that, okay? It's about what Carly needs.
I don't know what she needs! You're her doctor, you should know.
I can help treat her, Hannah, but Carly doesn't have a voice right now.
And she needs one and that voice is you.
So clear your head.
Let's talk this through.
And I'd do the same thing with your parents if they were here right now.
The trans-cath-thing Transcatheter embolization.
So that means that you get to the wound through her blood vessels.
Exactly, yeah.
You, uh the coils are threaded through her femoral Where you cauterize it, instead of opening and sewing because there could be too much blood.
Yeah, that's right.
You looked it up? Um And you think that that's the best option? I do.
The risks are primarily around bleeding in the brain and stroke, but Carly's young, she's strong.
We've heard from her pediatrician about her medical history, but you might know about other risk factors that run in the family.
High blood pressure? Heart disease? My grandpa had a stroke.
He used to get bad migraines.
Carly does too.
That's exactly the kind of thing we need to know.
Good! Does that mean she can't have the surgery? No, it just means that the surgeons now know to look out for that risk.
Okay.
Okay.
(SIRENS BLARING IN THE DISTANCE) (KNOCKING) Doctor Bishop? Claire said I should take you to rehab? (SIGHING) Your services will not be necessary.
- (CHUCKLING) - Claire also said you might say that and I should remind you that Never mind.
(EXHALING DEEPLY) (GENTLE MUSIC) (INDISTINCT CONVERSATIONS) (HUBBUB) (NOVAK LAUGHS) (PAGER BEEPING) (DRAMATIC MUSIC) What happened to Navin? His vitals tanked out of nowhere and he started crashing.
(MACHINE BEEPING) Clear! (PANTING) Resuming compressions.
I want to see you make it into the artery on your first stick, Doctor Harris, let's go.
Catheter.
That's the doctor from before, right? Why isn't she doing the operation? She's the one who helped when Carly came in.
Doctor Curtis isn't part of the vascular team.
She's there in case there's a complication.
When will we know? If it worked? Not until it's over.
Stopping compressions.
No, we're not giving up on this guy.
- Not yet.
- How long? 27 minutes.
Come on, Navin.
From like ninth grade, people are asking you to make these big decisions about your life.
Carly's lucky, she always knew exactly what she wanted.
What if I don't? There's nothing wrong with not having it all together.
In fact being able to admit that you don't? That's its own kind of skill.
Come on, Navin.
(PANTING) There's nothing more we could have done for him.
Fate was coming for this guy.
Time of death, 4:25 PM.
What's that? Your friend needs another consult? Uh, no, we lost a patient.
His phone has locked and I have no idea who to call.
Social worker.
Ask the social worker.
Thank you.
I heard your bleeder came through.
How was that, making the vascular save? It wasn't.
Doctor Curtis.
You can't turn down an opportunity to show the bosses what you're made of.
You keep waiting in the line and your chance is never gonna come.
- You gotta believe in yourself.
- Yeah, I know what I need.
You did me a huge favour and I really appreciate it.
It's just that other residents were promised OR time ahead of me and I need to respect that.
Carry on, then.
Surgeons needed to thread this tiny coil through Carly's artery so they could cauterize the bleeding.
But they said she came through like a star.
Oh, thank God.
I'm so relieved.
She's so brave, Mom, so strong.
So are you, honey.
(SIGHING) I was a pretty big mess actually.
But you did it.
Your sister is lucky you were there for her today.
I am so proud of you.
Uh, her doctor should explain the rest.
Hannah's got it covered, Miss Miller, she's almost ready to take over for me.
They never should have had to do this without us.
- (SIGHING) - But they got through it together.
You have two great kids here.
Carly.
Hi.
(GENTLE MUSIC) (PHONES RINGING) You responded quickly to the dialysis.
Which is good news.
The chemotherapy poisons your body, which is what it's supposed to do to fight the cancer, but sometimes the kidneys, they just can't keep up.
We knew it was a risk.
So we're keeping you overnight and I spoke with your oncologist and she says that Deena's treatment will have to be suspended.
McKinney's taking us off chemo? When can she go back on? That's something you'll need to discuss with her.
Are you saying there's a possibility she can't get back on? She's saying it's not her call.
I'm sorry, guys.
I'm gonna give you some time.
Mags? Mags.
Can you come back? We need you to talk us through this.
I know this is difficult, I'm sorry.
But Doctor McKinney will be here in the morning with next steps.
I'm worried that she's not gonna want to keep fighting through this.
I know you can make her see reason.
She doesn't need me, Ephraim.
She needs you.
Now the night shift has Deena's med plan and they know to call me if anything is unclear.
Go be with her.
Okay.
Okay.
It's gonna take me five hours of traffic.
Oh, hey.
Are you technically still here? Kid with the asthma attack just I can get a resident, it's totally okay.
I'm here.
- Hey.
- Everything okay? Oh, just Just preserving myself for tomorrow's patients.
Should I be nervous for them? I just left my bag in here, but I just Are you actually going home before the sun sets today? - (MAGS SIGHS) - Yep.
Even though all I'm gonna be doing there is think about what else I could be doing here.
- Long day? - Yeah.
Did you figure out why your auto-resus patient coded? Brugada Syndrome.
But uh, it it happened again.
He died? I'm so sorry, Bash.
You know he didn't even realize what his life was missing until today.
(SIGHING) - It's a nice plant.
- Yeah.
Jasmines.
They're loved in Syria.
A friend gave it to me.
Pretty.
She was my fiancée back home.
And she's here now.
Oh, wow.
That's incredible.
I, uh, I haven't really told anyone yet so No, I mean, yeah.
(CHUCKLING) Yeah, of course.
Well, congratulations.
I'm really happy for you.
I'm gonna go before I you know, talk myself into picking up another shift.
Mags.
Try to keep your mind off work tonight? Yeah.
(DOOR CLOSING) (HIGH-PITCHED SOUND) (FOREIGN LANGUAGE) Bashir Hamed.
(LOUD KNOCKING) (SHUDDERING) This is Next Level Chef
I'm the acting chief of this emergency department.
You've been on for two days straight.
How's the new guy already telling me I put too much on my plate? How long have you known we were here? Since you came.
(SIRENS WAILING IN THE DISTANCE) (BASHIR): I need a surgeon's eyes on something, June.
Car crash.
Impact wound, lower right quadrant.
How far are you from a hospital? Half an hour at least.
I tried to find a consult, but we're stretched thin.
- Inter-abdominal pressure? - Increasing.
And his pressure is rapidly decreasing.
One more dose of morphine, Saleh.
I see bowel protrusion.
Abdominal evisceration.
A tear in the peritoneum can release pressure.
It has nowhere to go, so it pushes the organs to the surface.
Yeah, don't push them back in.
Just douse a towel in saline, cover them, and handle them as little as possible.
There's an arterial bleed! (BASHIR): Find it, tie it off then seal it.
You need to keep the pressure up or he won't make it.
We're out of sealant.
Um - Do you have electrodes? - What's that? Yes, we have some.
Hold it.
(JUNE): Okay, take the adhesive, seal off the wound.
Yeah! (HEAVY BREATHING) Okay.
He did it.
Trick I learned on a ride along from hell.
(BRAKES SCREECHING) Thank you, Doctor? - Oh! June.
- I'm Saleh.
Where'd you learn to tie off an artery that fast? Ask the man beside you.
Thank you for this, June.
Oh, yeah.
Anytime.
So much has happened for the both of us.
(CHUCKLING) (GRUNTING) (DRY CHUCKLE) The last time I thrilled a woman by standing on my own, I was a child.
And my comparisons to your mother end there? Fiona was a handsome woman.
- (CHUCKLING) - That will do, pal.
You're fussing around me.
Don't you have an exam to study for? I'm ready for it.
Your rehab team wants to see you today at 4 PM.
They say I'm making fast progress.
Could be on my feet soon.
You just had a stroke, four days ago.
Okay? Now you gotta pace yourself.
And come up with a long-term strategy to build your strength.
I do happen to have a little expertise on this subject, both professionally and personally.
Hm, okay.
I will give you professionally.
But personally? Your previous strategy of racing back to work while I aided with your self-medication did not exactly help.
It helped get us back together.
Hm.
What are you worried about? This place is gonna fall apart without you? Or that maybe, it won't? (GROANING) - Ooh! - Wait, vulture! I made this for you! Hmm.
Ah, bravo, Amira.
Did you figure out the streetcar? I'm getting there.
I will show it to you.
Eat! What will you do today? How long can you stay at the hotel? They said until I find something.
- Hey, guys! - Oh, there he is.
Sorry to interrupt.
Don't get up.
- Theo, this is Rania.
- Hey.
Thank you for having me in your home.
I promise to leave.
Unlike those two.
He barely notices us anymore.
He's almost never around.
Theo was just made an attending.
Congratulations! I also hear you have two daughters? Yes! Who I'll only have time to put to bed if I can catch the 9 PM flight back to Sudbury.
That can't be easy, living apart from your family.
Champagne problems.
We're making it work.
I have to go! It was nice meeting you.
Bye! Oh, that reminds me, I'm on until 8 today, so straight home after school, okay? I have hip hop.
The after-school dance program.
I told you yesterday.
It goes to 7.
Amira, I don't want you taking the bus alone at night.
Maybe Rania could come? Let's not put her to work just yet.
Ask Sadie if Herman can drive you and let me know.
These remind me of that picnic in the park.
The pigeons wouldn't leave us alone, so Bashir threw olives at them.
Wallah, Amira, if you saw these pigeons! Was that the last time you two saw each other? No, um No.
But it was the last time I let a pigeon push me around.
Let's eat.
Mags? - Ephraim! - It's so good to see you.
Hey, Deena.
You're in another cycle of chemo? Three of seven.
I didn't wanna bug you this time, Mags.
But the pain was too much today.
And we couldn't get into the oncologist last minute.
Hm.
Are you taking something for the pain? Yeah, McKinney gave us a pharmacy of analgesics.
That I barely get to enjoy, since I spend all my time hugging the toilet.
- Any other side effects? - Huh, joint stiffness.
And I have been sending some strongly worded emails to the people in my life who have disappointed me, because at this point, I figured who gives a crap? Well, that one's widely reported in the literature.
Alright, well, let's get you to baseline and we'll take it from there.
I'll start fluids and something for the pain.
Yeah but they told us you're not our doctor.
I wanted to request you but But I told them you're busy saving people with an actual future.
I'm your doctor.
We never got the chance to thank you properly.
No, last time you stayed on after your shift to help us.
- Thank you! - No thanks necessary.
Meanwhile if you need anything? - Press the call button.
- Yeah.
No, no, you're not listening to me, okay? You tell your clients, if they didn't want this getting bloody they shouldn't have brought a knife to a gun fight, alright? See you in court! Everything okay? Aah! Corporate law, figure of speech.
You told our triage nurse that you could hear your heart? Does that mean beating fast in your chest? - Because it sounds normal.
- No, I can actually hear it.
Like a stethoscope in my ear.
- When did this start? - Today.
I know, I've got a lot on my plate, alright? But I don't get panic attacks.
Okay, well, I've seen the symptom you're describing accompany an inner ear infection or Alright, an infection.
It's minor then.
That's one possibility.
(SIGHING) Okay, I don't see any redness.
Have you experienced any dizziness at all? Yeah, actually.
So, what's that, just an antibiotic to clear it up? No! We need to rule out anything serious with a range of tests.
Fine.
How long is this gonna be? I need to get back to the office like an hour ago.
I'll be back as soon as I can.
The lady in five is on your list, but do you mind if I take her? I have a broken ankle if you wanted to swap? And good morning to you too, Mags.
It's not a buffet, Leblanc.
You have to get sign-off to trade patients.
But this is a woman I treat regularly for chemo side effects.
And do the two of you have some kind of exclusivity contract that I don't know about? What about you, Doctor Hamed, do you have any interesting patients this morning? I just saw a man in E who's presenting Yeah, I read the chart.
That usually describes tinnitus, the cause of which is, generally a fishing expedition, but I already called an EN and in the meanwhile, you can order an EKG and bloods just to be on the safe side, heart-wise.
Deena Kaplan has a terminal diagnosis of lymphoma.
She's in a fierce battle to extend her life but the pain and the nausea keep sending her here.
I have a short-hand with her and her husband.
- Are these people your friends? - Right.
Right.
You'd prefer I'd see my patients as needy bags of meat, - as you put it, right? - (LAUGHING) You don't have to sound so callous about it! Since I know their history, it'll be more efficient for me to help them.
This is about continuity of care.
Okay.
Okay that's it? Why not? I'm interested to see what you can offer that your other residents can't.
No, that's not what I Okay, that's not what I was saying at all.
Does your attending have you doing paperwork again? No, why would he need? Oh, nothing.
Just conversation.
Actually, I was taking it upon myself to propose some workflow efficiencies to Singh for the surgical calendar.
Oh! Good for you.
Never apologize for playing the game, Doctor Curtis.
Is that how Novak beat you to the Acting Chief position? Because you've been Bishop's second forever and I just thought it should be you.
Since you've been here for so long.
(SIGHING) Nice talk, June.
Nice Code blue in E! (SUSPENSEFUL MUSIC) - He's in V-fib! Mags! - Got it! Prep one amp of epi! Charge the defib two hundred J! - Is that the guy with tinnitus? - His EKG was normal.
We're waiting on bloods but he was stable.
Charged! - (MACHINE BEEPING) - Clear! Resume compressions.
EMS incoming! You need to take it, Arnold! (DRAMATIC MUSIC) Carly Miller, 16 years old.
BP is 105 over 80, rate's 140.
Severe blood loss, we've tried multiple lines but her veins are flat, so we've intubated to secure the airway.
Carly was home for lunch and then started coughing and then there was bleeding and it wouldn't stop! This is Hannah, her sister.
I'm Theo, Hannah.
Where are Mom and Dad? Huh.
They're on their way to Chile for work.
What's happening to her? Is she gonna be okay? We'll find out.
Epi in.
(MACHINE): Shock at five! Mags! She's lost a significant amount of blood and the clock is ticking.
I'm seeing fresh scabs where her tonsils used to be.
Recent tonsillectomy? Her sister didn't say but I've seen this before.
Post-op fibrin clot sloughs off the tonsillar pillar and ruptures.
We have to get her stable and put pressure on the bleeding.
Activating MTP.
Arnold, we need blood and lots of it.
Take over, I can't find the vein.
June, where are we on that line? It's a difficult stick.
It keeps collapsing.
She needs to have the blood.
Without blood she won't make it.
What's your plan, Doctor Curtis? - Bone gun? - Okay.
- What about it? - Doctor Curtis is proposing an interosseous transfusion.
Peripheral access isn't happening.
The humeral's IO it is.
Allow me.
- It's okay, I've got it.
- Good.
By all means.
(WHIRRING) Give me a line, Arnold.
Airway entry both sides? Placement.
Oxygen 98.
CO2 40.
Blood's coming in! Stabilizing but she'll need the OR.
- I'll call up.
- (BEEPING) I think you can take it from here, Wendy.
(BASHIR): Clear! Mags.
Go again, one more epi.
- How long's this guy been down? - 19 minutes.
- Who's running this code? - I am! Leblanc is slowing down.
Doctor Hamed, take over.
Epi in.
Hold compressions.
(PANTING) No, he's not responsive.
It's time to call it.
He's only 37 years old.
Came in with a minor hearing issue, otherwise he's healthy.
He's dead, Doctor Hamed.
Asystole, prolonged downtime.
No correctable causes.
No cardiac activity after eight rounds of CPR.
Did I miss anything? - No.
- In that case Time of death? 11:38 AM.
Let's take a moment to acknowledge the loss of a life, and the efforts of our team to save it.
(BEEPING) Rate's climbing.
Is that possible? That's something you don't see every day.
He's alive.
(GENTLE MUSIC) (STEADY BEEPING) Swift work with that bone gun.
Heard your bleeder needs an embolization? - Yeah.
- I called Doctor Yong in vascular.
We went to med school together.
I told him you should be the one assisting him today.
- So get ready.
- Uh Doctor Singh is my attending, he's in general surgery.
I know Aajay.
Is he still in love with the sound of his own voice? I just mean that I wouldn't normally be scrubbing in as part of the vascular team.
So Don't all surgical residents want a cross-section of experience? No one ever done you a favour before? Definitely not someone I barely know.
When a member of my team does good work like you did, in trauma, I like to see them get rewarded for it.
You're welcome.
(SCOFFS) (HANNAH): Why isn't Carly awake? Why does she still have the breathing tube? What's happening to her? A tiny blood clot ruptured and tore a hole in Carly's carotid artery.
Normally a surgeon would just make an incision and repair it, but the location of the tear puts your sister at a higher risk.
So we're looking at something called a transcatheter embolization, where instead of opening up her neck, we'll reach the wound by going through her leg.
- (STAMMERING) - I don't understand.
Are you saying that one of these options could kill her? I'm saying it won't heal on its own.
Carly's life is on the line either way.
We're recommending what we believe is the safer option but since your parents aren't here to weigh in You're asking me to decide? No.
No way.
You can't put this on me.
Hannah, I'm not putting anything on you.
We'll do this together, okay? But it's important that your sister has an advocate.
Okay? Someone who knows her, who can weigh in on the decision-making process.
For example, if we knew about her tonsillectomy, that would've helped us.
Oh, my God.
We I I told the paramedics about that, didn't I? Is that why this happened? I mean that surgery was like a month ago.
The doctors said that my mom and dad could go Hannah, Hannah, it's okay, we reached out to the surgeon No, no, no, it's not okay.
Look, you gotta understand.
Carly is everything to them.
I mean, to me! They would never want me involved and I know that's not true.
They left you in charge when I just got fired from my retail job.
Three engineers and one girl who can't fold a sweater.
That's our family.
Carly's younger than me but she's the responsible one.
I mean they were expecting her to take care of me.
Look, Carly's in the OR queue, so there's a little more time.
We'll keep trying to reach your parents for now, okay? (MACHINE BEEPING) You're saying I was dead.
Not unconscious.
Dead.
Auto-resuscitation is a rare phenomenon where the body responds to CPR after death.
For how long? You had a weak but shockable rhythm without pulse for 19 minutes, and then, nothing.
Isn't that extremely bad? It can be, but your vitals are normal again.
You're very lucky.
Okay.
I'm lucky.
What happens now? We need to do some more tests, to understand why this happened.
No kidding.
You said it was an ear infection, then a few minutes later, I die? Is there someone you want me to call, anybody you want to come down here to stay with you? What I want is for you to not make the same mistake you made before.
Just figure out what's going on and tell me what to do about it.
Navin, none of your tests presented any indication of cardiac abnormality.
We're widening our search but it will take some time to figure out exactly You're a resident, right? - Yes.
- Yeah.
Why don't you just admit you're in over your head and send me whoever you report to.
Maybe I won't have to die this time to get some help around here.
(BREATHING HEAVILY) (GENTLE MUSIC) Hey! Pain meds helping? The IV drip means at least I'm not throwing them up.
I think that nurse wants to strangle me.
Trust me, she's seen worse.
You're halfway through a chemo cycle.
Your nausea's normally progressive.
We knew it was an aggressive course.
They said if I make it through, it can buy six months.
So that's where we're at.
Speaking of that nurse who definitely does not want to strangle you, I asked her how often you've emptied your bladder - and she says not once? - I haven't needed to go.
Well, we've been loading you with fluids.
Can you sit up for me, please? And just raise your arms.
There's a few things I want to rule out.
Here we go.
Level with me, Mags.
What are we worried about? The usual.
Infection, kidney and liver function, things we've looked into before.
We'll run blood work, just to be safe.
You can lie back down.
Is Ephraim nearby to take you to the lab? I made him take a walk.
He won't like this.
I can explain it to him when he gets back - (CHUCKLING) - You can try! McKinney's been clear that my body can only take so much.
I hear that when she says it, but Eph thinks we're gonna make it to our 10th anniversary to New Zealand.
Why don't I take you to the lab.
Can I get a wheelchair in here? Don't you have a thousand more patients to see? Yes.
But it's on the way.
Liar.
But it saves that poor nurse from having to come back.
(CHUCKLING) Can you walk? (GENTLE MUSIC) Heard you were looking for me? Hum.
Navin Kutty.
We did two ECGs, both inconclusive.
His blood proteins look normal, echo looks normal, so I think we should give him a MRI just in case How does he feel about being alive? Sir? I'm curious.
How's the guy feel, coming back from the dead? He's more focused on the fact that we let him die than the mystery of being alive.
I wasn't wrong to terminate CPR when I did.
I didn't say you were.
And his being alive isn't a mystery.
It's lingering electrical current and luck.
I'd like to order an MRI in case of pulmonary AVM.
Circulatory problems can result a hearing issues Nah, I'd rather you get him to the cath lab for electrophysiology.
And do that soon, we need answers.
But sir, that's a very invasive test.
I'd also be interested to know where that patient is from.
Well, I would assume Canada.
- His lineage, Doctor Hamed.
- Why is that relevant? It's not, potentially, but then again maybe it is.
So find out, do the tests and let me know.
Well, he doesn't want to speak with me, Doctor Novak, - he'd rather speak with you.
- No.
I think you've got it handled.
It's interesting to see Doctor Bishop training his residents to push back.
It wasn't my experience with him.
Or maybe he doesn't and that's just you.
A good leader isn't afraid to be challenged.
And since we don't know how long he's gonna be out for, it's good we get along.
Carly Miller, 16 years old.
Arrived via ambulance with oral hemorrhage associated with a tonsillectomy clot rupture and secondary lacerated arterial wall.
I referred to vascular for embolization.
But kept a little piece for yourself.
We'll circle back post-op.
What's up next? We've got a discectomy in B.
(SCOFFS) You want me to send her to the corner for that? I earned a spot on vascular for this.
I'm not gonna feel bad because some resident thinks I skipped the line.
You're a fighter, June.
I get that.
And while you do need in on as many complex surgeries as possible, if you want to make Chief Resident What? I need to be liked? Respected.
There's a difference.
Does that not apply to Harris? Because she wants the job as much as I do.
Doctor Harris isn't the only Black surgical resident we've had here in three years.
So I both need the operative time but I shouldn't take it? What are you telling me to do here? I'm not.
I'm just pointing out the landmines.
(KNOCKING) I was just down the hall talking to a tech about electrophysiology.
Is this for your auto-resuscitation patient from this morning? The nurses have been talking about it.
Have you ever had one? Yeah once, when I was doing my residency.
We did CPR on a newborn.
Electrophysiology is not a test you order every day, - it's pretty invasive.
- It wasn't my call.
Doctor Novak.
He was one of your residents? He's a gifted doctor.
Did you know him long before he joined Doctors Without Borders? It's an interesting transition to the kind of structure you find here.
You'd know better than I would.
He's your Chief, Doctor Hamed.
Not me.
It's just, in his mind, sir He thinks this is a permanent position.
So he wants my job.
He'd be an idiot not to.
It's a great job.
The, uh newborn who came back to life.
We called her Baby Lazarus.
And would you explain that as lingering electrical current and luck? Yeah, I would.
Although the current was only lingering because we did more than 20 minutes of CPR.
But then, what some call luck, others call a miracle.
My patient's not exactly moved by his.
Maybe because they tend to scare you as much as save you.
It's easier to ignore that fear than face it.
But then, look at me.
(INDISTINCT CHATTER ON PA) Talk to me about shift change transition, Leblanc? Uh I'm still on another hour.
I cleared the food poisoning in six, broken ribs in three's being discharged, and my cancer patient in five still waiting on labs.
Which the next shift will handle.
Mm-hmm.
Do we not pay porters to take the patients up to the blood lab? Yes.
So your escorting Miss Kaplan up there earlier, that's the reason why you wanted to trade patients? I mean, can't a doctor go the extra mile? You know like I said earlier, I like to Yeah, you have a shorthand but, what I don't understand is why that makes you the only person capable of properly treating the patient.
You can't cure her cancer.
Unless you have some kind of superpower that you haven't told me about.
Of course not.
But if I can make it easier for her, I think I should do that, I think I should do that.
Feeling like the patients need you.
Like if you aren't the one taking care of them, then they won't be okay? That's ego, Leblanc.
Do you not trust your colleagues on the evening shift? Does nothing really get done around here without you doing it? - Of course, I trust them.
- Good.
Then let them do their jobs.
You go home, you preserve yourself for tomorrow's patients.
Mm-hmm.
Please if you could just explain to your supervisor this is a question of life and death.
Si muerte.
Vida y muerte.
Necesitamos hablar con el piloto? Gracias.
Okay, huh the parents have switched to a regional airline within Argentina, we're doing our best to find somebody who can radio the pilot directly, but this this could take ages.
Si.
No, el piloto.
I saw so many places, it's only ever people bidding up the rent.
You know it was the same for us.
We didn't find anything until after I started washing dishes and the owner knew someone with a vacancy.
Then I better hurry up and meet some people.
Knowing you, that won't be too hard.
(CHUCKLING) Bashir, I got this for you.
- (GENTLE MUSIC) - Hey Right before they took you.
Bashir? Where did you just go? I um (PAGER BEEPING) Um, I have to get back.
Uh, Bashir, I want you to know we don't have to jump into anything.
We can take our time.
Thank you for the plant.
Amira texted me about needing a chaperone home from dance.
I know it's not what you wanted this morning, but she was so excited.
- You said yes.
- Yeah.
(CHUCKLING) Doctor Atwater? Hi! So, huh it's none of my business why you did or didn't get the Acting Chief position.
And I shouldn't have asked.
But you still wanna know.
All they told me was that the role would be going to someone more suited to the leadership opportunity.
- So in other words, a man.
- (ATWATER SCOFFS) When I was where you are now, Doctor Curtis, that was my curse.
Now it's being too old.
But, uh there is a silver lining.
There is a freedom in not having to worry about playing the game anymore.
But if you have bigger goals for yourself, Doctor Curtis, don't make my mistakes.
I played by everyone else's rules and look where it got me.
(KNOCKING) Navin's MRI was negative for AVM, but the electrophysiology did detect a rare abnormal heart pattern so, my hunch was wrong, but yours was correct.
- Differential, Doctor Hamed? - Well, taking his rhythm within the context of his wider symptoms, arrhythmogenic cardiomyopathy is an option.
But then, wouldn't we have seen scarring on imaging of his myocardium? Most likely we're looking at a range of genetic disorders.
Not DND, Romano-Ward syndrome is possible but, uh something is For those kinds of inherited disorders, we'd need genetic testing.
Unless there was another marker to narrow it down.
- What about his lineage? - I did ask.
He's Canadian, but his parents are from Kerala, India.
Huh After my residency, I did a stint in northern Sri Lanka.
Based out of a refugee camp which was overflowing with displaced people.
Malnutrition, infection, dysentery.
But there were some doctors here that told me about this young man who presented with one, remarkably hyper-dramatic symptom.
Sudden cardiac death.
Brugada Syndrome, prevalent in South Asian men.
(CHUCKLING) Well done, Doctor.
Won't be as much fun telling the patient though.
No, but my mother and father are completely healthy.
You can live asymptomatic your whole life.
That's why it's so dangerous.
Okay.
The beating sounds I was hearing in my ears.
Might have been your body warning you.
Or could just as easily be unrelated and temporary, like tinnitus usually is.
(SIGHING) Genetic.
That means this heart defect can't be cured? Unfortunately, no.
But it can be managed.
And there is somebody from Cardiology coming later to talk to you about an implanted defibrillator device to avoid another episode.
Do you know what I did today, after coming back to life? I sat here, hooked up to these wires, and I sent work emails and I managed files.
After what you went through, it's normal to want a distraction.
What if my whole life was the distraction? There wasn't a single person that I could think of to ask down here.
Why would they come? I never made space for anyone.
- (THEO): Dammit.
- (MAGS): What? They cancelled the 9 PM.
And even if I could get out of here for the 7, which I can't, it's full.
You can't fly home tomorrow? I'm supposed to be back tomorrow.
Okay.
I'll just it's fine.
I'll drive.
Which means I need to finish my reports before I go.
You sure you can keep this pace up? I chose this, so it's, uh on me to make it work for my family.
Okay but this solution? You running yourself empty? Is that really what they need or is it just about you? If you're saying I should stop trying to see my kids I don't know what I'm saying.
I gotta go.
Deena, Deena! Hey.
I'm right here, come on.
Come back to me, Deena.
- Her labs? - Her breath is short.
- Like she's gasping for air.
- Deena, can you hear me? Nod if you can hear me.
She was confused and then I couldn't wake her.
I can hear arrhythmia, pulmonary edema.
Labs? Her creatinine levels spiked.
Potassium's at eight.
- What does that mean? - Acute kidney failure.
She needs them flushed.
Call dialysis.
We'll be there in 60 seconds! - I need help! - Deena, come on! Alright, we're ready! It's okay, I'm right here We've done everything we can to try to reach your folks.
It should be them here, not me.
It's not about that, okay? It's about what Carly needs.
I don't know what she needs! You're her doctor, you should know.
I can help treat her, Hannah, but Carly doesn't have a voice right now.
And she needs one and that voice is you.
So clear your head.
Let's talk this through.
And I'd do the same thing with your parents if they were here right now.
The trans-cath-thing Transcatheter embolization.
So that means that you get to the wound through her blood vessels.
Exactly, yeah.
You, uh the coils are threaded through her femoral Where you cauterize it, instead of opening and sewing because there could be too much blood.
Yeah, that's right.
You looked it up? Um And you think that that's the best option? I do.
The risks are primarily around bleeding in the brain and stroke, but Carly's young, she's strong.
We've heard from her pediatrician about her medical history, but you might know about other risk factors that run in the family.
High blood pressure? Heart disease? My grandpa had a stroke.
He used to get bad migraines.
Carly does too.
That's exactly the kind of thing we need to know.
Good! Does that mean she can't have the surgery? No, it just means that the surgeons now know to look out for that risk.
Okay.
Okay.
(SIRENS BLARING IN THE DISTANCE) (KNOCKING) Doctor Bishop? Claire said I should take you to rehab? (SIGHING) Your services will not be necessary.
- (CHUCKLING) - Claire also said you might say that and I should remind you that Never mind.
(EXHALING DEEPLY) (GENTLE MUSIC) (INDISTINCT CONVERSATIONS) (HUBBUB) (NOVAK LAUGHS) (PAGER BEEPING) (DRAMATIC MUSIC) What happened to Navin? His vitals tanked out of nowhere and he started crashing.
(MACHINE BEEPING) Clear! (PANTING) Resuming compressions.
I want to see you make it into the artery on your first stick, Doctor Harris, let's go.
Catheter.
That's the doctor from before, right? Why isn't she doing the operation? She's the one who helped when Carly came in.
Doctor Curtis isn't part of the vascular team.
She's there in case there's a complication.
When will we know? If it worked? Not until it's over.
Stopping compressions.
No, we're not giving up on this guy.
- Not yet.
- How long? 27 minutes.
Come on, Navin.
From like ninth grade, people are asking you to make these big decisions about your life.
Carly's lucky, she always knew exactly what she wanted.
What if I don't? There's nothing wrong with not having it all together.
In fact being able to admit that you don't? That's its own kind of skill.
Come on, Navin.
(PANTING) There's nothing more we could have done for him.
Fate was coming for this guy.
Time of death, 4:25 PM.
What's that? Your friend needs another consult? Uh, no, we lost a patient.
His phone has locked and I have no idea who to call.
Social worker.
Ask the social worker.
Thank you.
I heard your bleeder came through.
How was that, making the vascular save? It wasn't.
Doctor Curtis.
You can't turn down an opportunity to show the bosses what you're made of.
You keep waiting in the line and your chance is never gonna come.
- You gotta believe in yourself.
- Yeah, I know what I need.
You did me a huge favour and I really appreciate it.
It's just that other residents were promised OR time ahead of me and I need to respect that.
Carry on, then.
Surgeons needed to thread this tiny coil through Carly's artery so they could cauterize the bleeding.
But they said she came through like a star.
Oh, thank God.
I'm so relieved.
She's so brave, Mom, so strong.
So are you, honey.
(SIGHING) I was a pretty big mess actually.
But you did it.
Your sister is lucky you were there for her today.
I am so proud of you.
Uh, her doctor should explain the rest.
Hannah's got it covered, Miss Miller, she's almost ready to take over for me.
They never should have had to do this without us.
- (SIGHING) - But they got through it together.
You have two great kids here.
Carly.
Hi.
(GENTLE MUSIC) (PHONES RINGING) You responded quickly to the dialysis.
Which is good news.
The chemotherapy poisons your body, which is what it's supposed to do to fight the cancer, but sometimes the kidneys, they just can't keep up.
We knew it was a risk.
So we're keeping you overnight and I spoke with your oncologist and she says that Deena's treatment will have to be suspended.
McKinney's taking us off chemo? When can she go back on? That's something you'll need to discuss with her.
Are you saying there's a possibility she can't get back on? She's saying it's not her call.
I'm sorry, guys.
I'm gonna give you some time.
Mags? Mags.
Can you come back? We need you to talk us through this.
I know this is difficult, I'm sorry.
But Doctor McKinney will be here in the morning with next steps.
I'm worried that she's not gonna want to keep fighting through this.
I know you can make her see reason.
She doesn't need me, Ephraim.
She needs you.
Now the night shift has Deena's med plan and they know to call me if anything is unclear.
Go be with her.
Okay.
Okay.
It's gonna take me five hours of traffic.
Oh, hey.
Are you technically still here? Kid with the asthma attack just I can get a resident, it's totally okay.
I'm here.
- Hey.
- Everything okay? Oh, just Just preserving myself for tomorrow's patients.
Should I be nervous for them? I just left my bag in here, but I just Are you actually going home before the sun sets today? - (MAGS SIGHS) - Yep.
Even though all I'm gonna be doing there is think about what else I could be doing here.
- Long day? - Yeah.
Did you figure out why your auto-resus patient coded? Brugada Syndrome.
But uh, it it happened again.
He died? I'm so sorry, Bash.
You know he didn't even realize what his life was missing until today.
(SIGHING) - It's a nice plant.
- Yeah.
Jasmines.
They're loved in Syria.
A friend gave it to me.
Pretty.
She was my fiancée back home.
And she's here now.
Oh, wow.
That's incredible.
I, uh, I haven't really told anyone yet so No, I mean, yeah.
(CHUCKLING) Yeah, of course.
Well, congratulations.
I'm really happy for you.
I'm gonna go before I you know, talk myself into picking up another shift.
Mags.
Try to keep your mind off work tonight? Yeah.
(DOOR CLOSING) (HIGH-PITCHED SOUND) (FOREIGN LANGUAGE) Bashir Hamed.
(LOUD KNOCKING) (SHUDDERING) This is Next Level Chef