Transplant (2020) s02e13 Episode Script

Free for What

Ray's team have looked into your medical school transcripts.
They know that we don't have the originals.
What are they going to do with this information? Use it to convince a judge that neither of us are to be trusted.
When you told me you spoke to the Dean of my medical school.
Let me fix this.
You're telling me that Marcus had a step-daughter that I've never heard of? How is that possible? This is exactly what I'm talking about.
The narrative that you can only function if he's in the room.
Roche told me not to bother you about clipping the artery, that's why I trusted you, June.
It's okay that you wanted this life.
I know of an organisation that matches specialists with communities up North and flies them up there.
They're always looking for doctors.
I keep thinking that the problem is me, but the problem is you.
He's stuck in that cell that they put him in when they took him away from you! - Sir.
- Morning.
- Morning.
- Morning.
- Morning! - Morning.
- Hey.
- Hi! You're in early.
- What happened in there? - Motorcycle accident.
Patient came through.
And plans are underway to build a permanent Trauma OR.
Congratulations, Jed.
I'm very happy for you.
You fought for this and won.
I was actually just about to do a history in E.
Allow me? Thanks.
How can anyone stay so frozen? Go take a look.
Does your sister know what's going on? I haven't told anyone but you.
Your transcripts exist.
There must be a way to prove that and fix all this.
Not without doing something I can't live with.
The only solution is to resign.
- But - I'm telling Dr.
Bishop today.
How does that solve anything? If the truth is already out.
It's only out with the lawyers.
And mine agrees that if I quit and take all the blame in the lawsuit, this goes away and Bishop doesn't wear any of it.
Maybe this goes away, but so does everything you've worked for, brother.
If there's one thing I know, it's how to survive.
Have you seen Dr.
Bishop? - Not yet, why? - Ambo unloading! 33 year-old woman went down, unknown cause, then her grandmother had a heart attack, I think while trying to help.
Hamed, you take the unknown.
I can take the heart attack.
I've got the cardiology experience.
I'm not arguing Dr.
But I am joining you.
When we arrived Monika was bleeding and short of breath.
She'd collapsed and hit her head.
My grandmother, is she okay? We'll let you know as soon as we do.
Bleeding's slowed, Dr.
She put pressure on it and then she just collapsed too! Okay.
I need you to follow my finger with your eyes.
My kids, they're at school now We called your sister.
She's on it.
Which sister? She needs to be there right at 3:15.
Is your breathing getting worse? And my chest hurts.
The shortness of breath, was it before or after the fall? Before, definitely.
Everything started to swim and I passed out.
- O-two sat's 80 %.
- Okay, Arnold, fast.
- Was it always this low? - It was 95 when we got there.
Thanks, Joanie.
Large pericardial effusion.
I need a 60-cc syringe and a needle.
What does that mean? Why can't I breathe? There's fluid around your heart, putting pressure on the muscle.
My heart's not working? The fluid makes it harder for your heart to pump.
We're going to drain it and release the pressure.
- Jody Babish, 94 years old.
- What's the EKG say? Bradycardic.
Evidence of acute MI.
They defibrillated on site but her rhythm wouldn't stabilize.
- Down to 35.
- She needs emergent pacing.
Then you have a decision to make.
Externally pace and wait for the cath lab, - or go transvenous now.
- External's standard for emerg, but it'll only buy her time.
Internal's riskier, more invasive But could save her life.
If you're worried about it, I can do it.
I'm just worried about what's best for the patient.
Good breath sounds.
BP's holding.
Let's go transvenous, through the right internal jugular.
Set up a sterile field.
Lidocaine to freeze, Claire.
She needs a central line, a pacing catheter and make sure the pacer's ready to go.
What's happening? It's called pericardiocentesis.
We're just applying a local anesthetic so you don't feel the needle.
Just try to breathe normally.
I've got you, Dr.
Thoracic cavity, puncturing.
You're there.
Rates are improving.
Output's good.
I'll leave a drain in case it happens again, and we'll monitor with echocardiograms.
This could happen again? Depends on why it happened the first time, something that Dr.
Hamed will figure out for you.
The shortness of breath, have you felt that before today? It's maybe been a few weeks.
I've been tired but I thought it was stress.
I've been working a lot.
Baba, can you find out how she is? I'll get an update for you.
Thank you.
Should be near the right ventricle.
No PVC's on the monitor.
Steady, Leblanc.
I think I'm in.
- Claire? Is it pacing? - Hold on.
There it goes.
Check the settings.
Her heart rate's coming up.
Okay, she needs a chest X-ray and cath lab.
BP's still low.
Start a dopamine drip, so we don't get a repeat and keep me in the loop.
And good job? - Pacer's all she needs for now.
- You don't agree with him? Because he's wrong.
Hold on the drip until we know the whole story.
- You got it.
- Hey, guy passed out.
His buddies brought him in and split.
I'm having trouble getting an IV and I need a doctor to order labs, Mags.
I can do all that now.
He's all yours This way.
Poor guy.
You're telling me it has teeth? It's called a mature teratoma.
It's a rare type of benign tumour.
It normally develop in the reproductive organs, but in your case, it's in your intestine.
That would explain your digestive discomfort.
I figured you were going to tell me to eat more fibre! Please say you're removing it today? If it was causing an obstruction or internal bleeding, it'd be an emergency - so we would, but - Wait.
That means this revolting thing is now a part of me? Not permanently.
I'll get you in with a specialist.
But I would expect an eight to nine months wait for a slot.
What if it grows eyes or a brain by then? I will not sleep if I know it's alive in me! You can't leave me like this.
Let me see if I can get you a second opinion.
Bishop, we need to speak.
Differential on Ms Babich? Low heart rate is rare with pericardial effusion.
We should check her thyroid function.
Do that.
And a CT in case of cranial bleeding.
Agreed, but sir I wasn't talking about this patient.
- I know you weren't.
- Dr.
Bishop? - They're paging you to resus.
- I'll find you later.
Been thinking about your future, Dr.
Trauma OR.
It's going ahead.
I'd like you to play a bigger role.
I know you were a trauma surgeon back home.
What would you say to specializing in that here? I'd say I'm not sure that's even an option.
I know you're not a surgical resident, but with your prior experience, we could make a pitch, see what they say.
Think about it? Hey! Didn't we meet in this room? Yeah.
I had to kick a cop out first.
Then you kept asking me, "Who are you? Who are you?" As if you'd ever answer.
Hey, I just overheard what Novak said.
Are you gonna do it? Bash, why wouldn't you? It's an amazing offer.
Yeah, you're right.
It is.
And when did his symptoms start? Wyatt? Can you open your eyes for me? Yesterday he seemed fine! But just this morning I couldn't wake him up! Did you carry him up here yourself? My buddy helped.
We were careful.
Did the ATV hit something before your brother fell off? No, man, it just it tipped.
And Wyatt actually bounced right back up! And did he pass out? Any vomiting? No, no, he said he had a headache, but you know I figured that was normal from the fall.
Then he said he couldn't lift his arm, but I thought he was just, you know, milking it to get out of school.
- Your mom or dad around? - Dad's not around.
Mom comes and goes, but I haven't seen her in weeks.
So you look after Wyatt on your own.
What's wrong with my brother? I'm going to be direct now, Cory.
Okay, we can manage Wyatt's abdominal bleeding, but there's this bruising on his neck and with his trouble moving, it tells me something might be wrong with his spinal cord, and that's very serious.
Is he gonna die? Not if we find out what's causing the paralysis and fix it, okay? - Do you know what a medevac is? - No.
It means you and Wyatt are coming to my hospital in Toronto.
Hell of a teratoma, but elective.
That's what I told the patient.
Then why waste my time? He's a little obsessive.
About getting it out.
I think the whole thing really unsettles him.
You're a psychiatrist now? No, I just I said I'd ask.
And you have your answer.
Look, I'm sorry, alright.
I know I made a mistake when I clipped Mrs Sawatsky's artery and I definitely made it worse by not telling you, but she recovered.
She's okay.
This doesn't warrant emergency surgery.
Sir! Dr.
You want to talk about the lawsuit.
I've thought about it from every angle, and there's only one option.
I agree.
Which is why I resigned this morning.
No, I meant me! And now you don't have to.
Today is my last day.
- Sir! - Ray wants a sacrificial lamb.
I'm the best one he can get.
My leaving means he has no cause to go after you.
- No! Dr.
Bishop - It's done, Bashir.
His lawyers are drawing up the paperwork.
You have patients waiting.
Cory? We've gotta move, pal.
I've never flown before.
I've never even been out of this town before.
You know, I grew up not too far from here.
I know what it's like to leave for the first time.
You can do this.
I should've never let him on that ATV.
I shouldn't be in charge of anything! Cory trust me, blaming yourself isn't gonna help Wyatt, but getting on this chopper will.
And I've got your back, okay? - On my way to cardiology.
- Here you go.
And food poisoning is all yours.
The nurse says Monika's better? She was lucky you were there to help.
You live with your granddaughter? I refused a senior's home, so my family gets the joy of sharing me.
The ones with the space take turns.
So she's gonna be okay? I can see her? Yeah, they're still running tests, but she's stable.
But you're here to tell me I'm not.
Go ahead, I can take it.
Further testing shows that you're in congestive heart failure.
The pacemaker bought time but we're looking at a matter of days.
I'm so sorry, Mrs Babish.
My own grandmother would say, "If I had baitsim I'd be Zeyda.
If I had balls, I'd be your grandfather.
" You can't change what you can't change.
How old are you, honey? I'm 32.
I had three babies when I was 32.
I can't even imagine that.
Of course not.
You have options I didn't know existed.
It must be terrible.
You can do or be anything you want.
Career, family, both? I watch Monika struggle with this and sometimes I think I had it easy.
That is not at all what I was expecting you to say.
Benefit of getting to the end.
I can say whatever I want.
Is there anything I can do for you? Cellphone? You're not the only one in need of unsolicited wisdom.
And my address book.
It's in the bag.
The big pocket.
- You can still take it back.
- Absolutely not.
They were pushing me out anyway.
But if the Trauma OR is permanent, - that means they still need you! - Listen to me.
I've had my time.
You have your sister to worry about and you're building something here.
Bishop I know you're trying to protect me, but wallah, I can't let you take the blame for something I did! How many times do I have to say this? We did it together! This is my career, I think I've earned the right to decide how to end it.
I already registered for my courses.
Yeah, I know Marcus said he'd pay for all that, but believe me Shay, there's no money.
I just had to put his house up for sale so I can cover his debts.
Can't you take a student loan? Probably, I just his place is close to U of and he said I could live with him since my Mom's in Brampton and we don't talk.
I had roommates all through school.
And I'm still paying for my student loans so.
So that's it? Just go away, Shay? No, I'll let you know if there's any money after the house sells.
But what if this isn't only about money.
I just thought maybe you'd want to get to know me? Oh, I barely know my real family.
I guess Marcus was right about you.
- Excuse me? - He knew he made mistakes.
He said he begged you to forgive him and you just shut him out.
- It really hurt him.
- I'm not the bad guy here.
Have a nice life.
Hamed? Migraine's still waiting and stomach pain guy needs you.
I just saw him 10 minutes ago, his ultrasound was fine.
I know, but now he threw up.
Okay, get him start his own fluids and gravol, and let me know when his labs come in? - Yeah, got it.
- Thanks.
Hi, how are you feeling? - Tired.
- That's perfectly normal.
We'll keep the drain in case the fluid builds up again, but you CT is showing signs of a small subdural hematoma.
- That means bleeding? - Not a lot.
It should heal fine with some rest, we'll check again every few hours.
- Do you have a headache right now? - No.
Do you know why this happened? Your blood work is showing evidence of Myxedema.
It's advanced hypothyroidism, which explains the shortness of breath, your fatigue, and the fluid around your heart.
My thyroid caused all this? - Can you fix it? - We can manage it.
We'll start you on hormone replacement and keep you monitored, but it may take some time to build up.
And how's my grandmother? Her heart is failing.
I'm so sorry, Monika.
She's in our cardiac unit now, resting comfortably Wait, wait! You're saying she's dying? That to save me she sacrificed her own life? No, no.
Her heart was already weak.
Please, I have to see her.
I heard you did an emergent transvenous pacing? - Yeah.
- Impressive Oh, thanks.
Except she's still on death's door and all we can do is keep her comfortable in CCU.
If cardiology is what you want full time, I can talk to Fisher.
Where did that come from? I should've supported your interest earlier.
I'm correcting that.
Wow, well Thank you.
I'll think about it.
Well, don't think too long.
Did he say anything to you about that? I'm not really in the loop anymore.
I'm sorry.
Hey can I borrow your brain on something? Sure.
Ouch, he had a night.
He's gone through two bags of fluids, but his ketones are off, and his breath has that acetone smell, - I wish I didn't know.
- Good catch though.
No medical alert? Are you worried he's diabetic? I tried doing a history but Hart? Hey buddy, you're with us? Can we stop for some tacos, guys? Hart needs better friends.
Differential? Elevated glucose and ketoacidosis can both be alcohol-related, but his liver shows no signs of scarring.
If he is diabetic, he wasn't watching his sugars.
Maybe he doesn't know.
- What do you think we should do? - I was hoping you'd tell me.
Well, you ran the differential so I think I should start him on IV insulin, low and slow.
Check his sugars regularly and adjust.
That sounds like a plan.
You said bruising along C-five and C-six? Yeah, and left side weakness.
Unconscious and unresponsive to pain stimuli.
Well, it sounds like a vertebral bleed.
But then paralysis was latent so If a clot formed, it could be causing a spinal stroke.
Bishop is right.
A slow-forming clot could strangle circulation to that part of the cord, which gives us six hours? How long has it been? At least three.
Also potential organ rupture.
- June, it's - Yeah.
I know.
I'll have CT standing by.
Anything else he can do? He's still a praying man? Way ahead of you.
Book an OR, I'll call neurosurgery.
Hey teratoma guy, did you get him to go home? Yeah but not willingly.
He says it feels like it's gnawing at his insides.
How is that even Thank you for dealing with that.
No problem.
I thought I lost you.
You didn't, you saved me.
Do they know why you passed out? Your sister and I were just saying you haven't looked well for weeks.
I'm fine, Baba.
But you're this is all because of me.
Tell her that's not true, you with the beautiful eyelashes.
It's not.
And nobody's sorry here.
We're having a party, right? Everyone's coming.
Denise has the kids Mon, she's on her way.
With my kids? No! No, I don't want to scare them.
They're gonna know I've died.
I want to say goodbye.
And they're gonna know about you, too.
You can't hide from that forever.
I'm not hiding.
And Baba, I don't want you worrying about me.
We all see it, Mon.
But when we try to talk to you, you get upset.
- See what? - Yes, your divorce was hard.
But it's behind you.
You're not alone.
Let us help you.
What's wrong with her anyway? I'm sorry I can't discuss her health status.
Can you at least tell her there's more to life - than just surviving? - Why are you doing this to me now? I'm not the one who's dying! True, but if this is my last day on earth I'm going to speak my mind.
You suffer and you call it living.
I don't want that for you.
What's the matter? What's wrong? Give her some space, please.
Is it my heart again? Your brother has a grade 3 splenic rupture and a bleed from a vertebral artery.
But we got in here on time.
Um will Wyatt be able to walk again? We'll know more tomorrow, but there's reason to hope.
He's gonna need time to recover, and then physical therapy.
If you have to go back home, for work or school, our social worker here can make sure Wyatt's got somebody.
I got on the chopper.
I can stay and face this too.
There's Mari, our surgical assistant, and she'll show you where you can wait, okay? Thank you.
Heroic work, getting them here so fast, Dr.
Oh that kid is doing this alone, and not by choice.
But he's not running from it.
Hey, I heard that you had to pull Dr.
Guzman away from his cottage? Look at you, manning the trenches.
All in a day's work.
Is the chopper waiting to take you back? Yeah, two days left on this stint.
I know it may seem like I'm taking a lot on sir, but It's something you need to do.
Gideon, you're back, what happened? His BP tanked, and his pulse elevated.
Abdomen is rigid.
Does this hurt? You said if I was worse you'd operate.
Is it an emergency now? What did you do? Did you ingest something? Hydrogen peroxide.
I looked it up.
- Figured if I drank enough - It worked.
Looks like you have a perforated intestine.
Which means you need surgery now.
So you'll take the tumour out? First let's try and save your life.
- Dr.
- Hi.
Please have a seat.
What can I do for you? You can refuse Dr.
Bishop's resignation.
My medical school transcripts.
You know he vouched for me when I first started here.
What you may not know is that the people suing us, they plan to use that information to prove their case.
That's a good idea, I think he's ready.
Bash? What's going on? I can't prove that I graduated med school.
And this lawsuit is bringing that up again.
Why? To make a case that I can't be trusted.
And that Bishop knew, and covered for me.
Are you losing your job? What about Bishop? He resigned this morning.
What? I'll be back, okay? So is is Mags right? Are you leaving? Bishop quit to sweep this under the rug.
So I swept it back out.
I told the hospital what the lawyers had, and that I'm a liability.
Yes, you forced them to let you go, so Bishop doesn't have to step down.
It has to be me, Theo.
He said his throat felt thick.
And then he passed out and his SATS dropped.
Bagging wasn't enough, I tried tubing him, - I couldn't get access.
- Ah.
Yeah, he must have an insulin allergy.
Monika, can you hear me? She's unresponsive.
What's going on? I thought maybe more fluid, but there's no pericardial effusion.
When did she have her last head CT? Three hours ago.
We're doing it every six.
When I came in she said she couldn't feel her right arm.
Subdural bleed must've grown Dilated, non-responsive pupil.
Blood pressure's up, dropping heart rate, loss of consciousness, respiration decreasing.
Sir, if we don't relieve the pressure right now, she's going to die.
Arnold get a bottle cap, scalpel, retractors.
On it! So I made the wrong call.
No, you were working with the data you had.
It's all we can do.
Now we react to the outcome.
No, there's too much edema.
Uh We can't wait.
We're gonna have to cric him.
Okay I can get you some back up.
I've got back up.
Now I need 10 blade, bougie and an endotracheal.
We have a French six endotracheal.
Yeah, that's fine.
Behind you.
Two centimetres anterior, two centimetres posterior to the tragus on the ipsilateral side as the blown pupil.
Making incision.
I'm at the membrane.
Horizontal incision.
- How's his SAT? - Dropping.
He's getting air.
Bishop's quitting.
I'm not sure you knew.
Uh Takeover? Sure.
Ready, Dr.
Hamed? All set.
We're through.
Exposing the subdural.
We've got it.
Arnold, let neurosurgery know she's on her way.
Copy that.
You went behind me to the hospital.
Undid my work.
- Dr.
Bishop - I've been living on borrowed time since you saved me this way.
Why won't you let me save you? I can't believe you're leaving.
Trying to, anyway.
But you just got back.
You just You just got the trauma or going, I mean, how does this How does any of this function without you? That's the beauty of it, Mags.
If I've done my job properly, put the right people in place, it just will.
Meaning Novak? In some capacity, yes.
I know he's been tough on you Is that why you're pushing me in cardiology? Because I really want you to know that I can I can handle this, - and I can handle - I know.
I know.
But when you get to when you get to where I am, I want you to be able to look back and be happy at the path that you chose.
And I'm banking on the fact that if I need a job in five years, you'll maybe hire me into your department.
You'll have to interview, but, I mean.
Oh, of course, yeah, yeah.
They said you drilled into my skull.
I promise it will heal.
But it might take some time.
- My grandmother - Still here.
She's annoyingly right a lot.
I could do a better job of actually living my life.
Look I understand if that scares you, but you do have the chance to try now.
Maybe it's the hole in my head, but it kind of doesn't scare me.
Bash! I'm about to take off and you won't work here when I get back.
If you need help with anything, you know, making ends meet.
I'll be fine.
All right.
Hey, Theo.
Look, I know things have been hard with the divorce.
Are you sure jumping into this new work it's not just you Running? Looking for a healthier distraction? I don't know.
But I just need to find a way to stop punishing myself.
I think I was pretty clear that teratoma was elective.
If you're gonna outright ignore me when I tell you to do something He drank hydrogen peroxide.
Created enough oxygen to rupture his bowel.
We almost didn't get him in on time.
Then he crashed on the table and we had to defib.
Did he make it? Barely.
He's on his way to ICU.
I shouldn't let Roche get into my head.
It was a mistake.
Let me guess.
She told you I don't care about your future and that I'm just out for myself.
I'm sorry, Dr.
All right, you never gave me any reason to think that.
It's just, you know, I have problems trusting people.
June, I decided to transfer you to another attending.
What? Why? There's other surgeons you can learn from.
So I let you down once and you're just gonna cut me off? Professional relationships ebb and flow.
- Let's not make this personal.
- But it is personal! It is.
So either you can't handle that Or what, June? Or Roche was right.
- How's Hart doing? - Sober, finally.
Breathing, too.
He had no idea he was diabetic.
Which means even if he was awake, you wouldn't have been able to know about the allergy.
I was thinking we should try a different insulin preparation or get allergy involved and try to desensitize him.
Internal's on that.
They've admitted him.
- Did you do the surgical cric? - Mm-hmm.
Good technique.
Clean entry.
- Thanks.
- And just 'cause I know what's on your mind, I'm not gonna be the new chief.
- You're not? - No.
They let the division heads know that they're gonna go with an outside hire, so you can relax.
I feel like I should be happy about that but, I don't know I kinda don't care.
Hazard of reaching goal posts.
You look for the next ones.
They said I almost died.
Yeah, you gave us a scare.
We were able to repair most of the damage to your stomach, but we had to stop the surgery abruptly in order to resuscitate, so we weren't able to remove the teratoma.
That horrible thing is still inside me? You're on an elective list.
And I asked a psychiatrist to come and speak with you.
I'm sorry, Gideon.
Baba Jody seems to have it all figured out.
She told me that it must be terrifying to have options.
She also said it's okay to want more.
Thanks for coming back.
Why did I? - The kid's okay? - He is.
Thanks for running me back.
No problem.
My girls are gonna get a kick out of this.
Are we okay here? 1476 to control, mayday! Mayday! Mayday! Control, we have engine failure.
Attempting emergency landing.
Look, I know you're upset with me.
And I understand why.
But I don't want to leave on bad terms.
Because you don't have to leave.
The lawyers have accepted my offer.
- Dr.
Bishop - You went and faced this head on, and I respect that.
I should have expected it, knowing you.
It actually helped me leverage this.
It's a three-year contract.
If you sign it, they can't fire you over this technicality with your transcripts.
I used every ounce of power I had left to ensure they let me take the fall, and agree to not let this stand in your way.
Why? Because you deserve to be here.
You're free of this, Bashir.
We both are.
All you have to do is accept it.
The choice is yours.
Do I want to know what this is? I met this guy on my first day.
He's my oldest colleague and I am taking him home with me.
I was going to tell you.
It is amazing what you're doing for Bash.
I've been holding on too tightly for too long.
So what are your next plans? Other than some light vandalism? Well I've been offered several professorships in the past, so.
100 students hanging on your every word all at once.
When you put it like that, maybe I found my calling.
Your calling is to train great doctors, it's all you've ever done.
I could use a lookout man.
- Hey.
- Hey.
Did you hear about Bishop? - Yeah, what the hell.
- I know.
He just helped me pull off this complex surgery today and I had no idea.
Are you getting emotional about this? No.
Yeah, I mean, I did just uh told my dad's 17-year-old step-daughter that she could come live with me.
So Wow.
Are you sure that you can handle that? I mean have you ever Have someone depend on me? No.
I just I don't like this part of me that's scared of letting people in.
So that's ongoing.
Um I'm switching residencies.
- Really? - Yup.
Because Bishop's leaving.
Look, I know how much he means to you, but you're gonna be fine, Mags, seriously.
I know.
I know.
I know.
It's actually not about him.
It's about me.
Seven-foot tall basketball player who fainted because we had to freeze him to pull out his sliver.
Oh my gosh, remember the woman who convinced her husband he had a rare disease that only a vasectomy could cure? I remember Mags trying to prescribe a trial separation.
They were never gonna last! - What is this? - Most memorable patients.
Bash? All of them.
Aw, that's not an answer.
Come on! Back in the 90s a man told me that he was God, and that if any of the other sick people drank his blood, they'd be cured of all their diseases.
So naturally I took a few vials, kept them in a freezer at home.
It's what keeps me so spry, isn't it? We're gonna miss you, sir.
Yeah, all right, enough with the sentimentality.
Okay, we have an ambulance unloading.
MVC, four victims, two hemodynamically unstable.
All right I'll take one car in trauma two.
I've got trauma one.
I'll see you after.
45 years old, chest trauma, abdomen's distended! Pressure's low, I need a hand here! Start a central line, Arnold, activate MTP.
On it! Hi.

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