Transplant (2020) s03e06 Episode Script
Audition
1
Amira wants to sing at my wedding.
And it's my school audition song.
Yeah, Amira thinks if
she keeps saying audition,
it will actually happen.
Okay when I was your age,
I really wanted to be a
professional soccer player but
I'm trying to tell you something
that will make me happy now.
- She knows, Bashir.
- That Mags and I are ?
Yeah.
His widow was hoping to meet you.
Maybe give her a call?
John's the pilot who died in the crash?
- You won't feel a thing.
- No, no, no, w-wait!
While we can't always control the wait,
we can improve how the
patient experiences it.
We were maxed out before
these policy changes.
This isn't working.
Hey! I need help in here!
She keeps jumping in and out of A-fib
which her pacemaker can't pick up.
She never said anything
about a heart history.
I never thought you'd be the one
with the bigger secret
out of the two of us.
I'm not denying that I would
need some kind of accommodations,
but I believe in what you're doing.
I've always hid this part of myself.
And now that this happened so publicly
I can't do that anymore.
Well there are worst things ♪
Staring at the water on a Sunday ♪
There are worse things
than staring at the water ♪
As you're posing for a picture ♪
After sleeping on the ferry
after getting up at seven ♪
To come over to an island
in the middle of a river ♪
Half an hour from
the city on a Sunday ♪
- In the park with ♪
- She is really belting.
Yeah, you must be doing something right
- to instill this kind of confidence.
- Look, I don't think
her copying my digital signature
for her school application
without telling me counts
as doing something right.
You went into her phone?
It was unlocked and I saw it there
Okay, she's pushing boundaries.
This is not pushing boundaries,
this is her directly
disobeying me and defying me.
Would you be okay with that?
Of course not, I'd be furious.
But, the benefit of being
me in this conversation is,
I don't have to be.
Okay, so, what do I do?
I used to avoid this street.
That's where I was when I
first decided to end things
after years in a very bad marriage.
Sorry, don't mean to be rude but
There's a point to this, I promise.
So, where are you now?
On my way to work.
Come on Bashir. Humor me.
If you let your mind wander
The past.
Specifically?
I don't know why this
is coming up but uh,
- the start of the Arab Spring.
- 2011.
Yeah. Me and my friends,
we went to a protest, uh,
the-the energy was incredible.
Um, what does that
have to do with Amira?
Was she there?
Uh no, she was too young.
Look. I know what you're doing.
You're trying to equate my experience
with her rebellious spirit.
Let That's not what this is.
I'm not doing anything.
But if that's the connection
that you're making,
then maybe you should
keep thinking about it.
What part of "It's not hot
enough" do you not understand?
I'm sorry but we already
tried a second pull
Look, I can tell you as a lab tech
that making an Americano a 195 degrees
- is not that complicated.
- Excuse me.
Is it really necessary to be so rude?
Why don't you stay out of this?!
You know what? Just
forget about it. Okay?
Whoa!
- Don't move please.
- W what are you doing? I need a doctor!
- It's okay, I am a doctor.
- No! Get off of me!
No, don't touch her!
Look, your hip is visibly
out of place, okay?
That means you're at risk
of avascular necrosis.
If you move wrong, you're
just gonna make it worse.
What do I do?
Just try not to push me again
while I figure out how to help you.
- Hello?
- Hey, Daniel.
- You look lost.
- Mags, do you know about this?
Colin Grant, fever, abdo pain, jaundice.
- No.
- The transfer from Ashmore?
They told me we have no capacity
and we're not supposed to
take any more transfers,
- I don't know who you spoke to but
- That was me.
Gallbladder rupture, Singh's
patient, straight to OR four.
Fielded a few calls to lighten the
nurses' load but got distracted, uh,
I guess there's a reason why they
don't let doctors answer the phones.
- I'll talk to Claire.
- First day back.
Am I throwing a wrench into an
already complicated situation?
Everyone knows your status
and that you won't be hiding
from what you're managing.
If it stays over a 110
for more than a minute,
it beeps and I have to take a break.
Use today to figure out what
you need to make this work.
Come back to me with a plan.
- Don't push yourself too hard, Mags.
- Yeah.
I've only done cholecystectomy open.
And it took Doctor
Curtis slicing her hand
to get you in on this one.
I'll drive, you navigate.
- ED looking for you?
- It can wait.
It's busy downstairs.
Lateral to manipulate the
neck of the gallbladder?
Medial subcostal. Have
you not been practicing?
Doctor Novak's been keeping
me busy in Trauma OR.
Then what use are you to me
if you don't know the steps?
You are aware that they may not
count all your Trauma OR time
towards your surgical hours, right?
Uh, Doctor Novak said
he thought they would.
The residency board
makes the final call,
eyes on the screen.
Um, it's distended.
Set up for needle aspiration.
Will I be able to convince the board
- to approve my Trauma OR hours?
- Hard to say.
Bureaucracy, etc.
And you'll need the support of
all your supervisors, not just Mark.
Ready to actually learn something?
Sounds like they need
you more than I do.
No, uh, it's not that serious, I just
probably shouldn't be making any
precision cuts for a little while.
Yep, I have a sub. Okay.
Is this gonna need a stitch?
Well if you'd keep still for a
second, I could get a better look.
Doctor Curtis, I just
heard you were injured.
It's nothing serious.
Thank you for coming in
on your off day, Claire.
Yeah, that's what happens
when two of my best nurses
call in sick and we
are strained for staff.
Let me know how I can support.
Doctor Curtis, you'll need to
fill out an incident report.
June! I'm gonna go do a Captain
Morgan on your assaultress.
You wanna be my first mate?
Get her hip back in order?
Maybe June should lay off
physical procedures for now?
Oh, yes, no, you're absolutely right.
How insensitive of me. June, why
don't you take the morning off and
Hmm, do admin?
I'm fine. I really just need a bandage.
Uh, Mark?
You and I are doing
that Trauma OR review
- this afternoon
- You got it, Neeta. Just tell me when.
I just did!
Excuse me?
Can you help me please? I told
the triage nurse I'm dizzy,
- and she said to sit and wait.
- Yeah, we're running at about
a two and a half hour wait
before being seen right now.
It's just I think I'm
having a diabetic crisis?
And just, I don't feel
- Are you okay? Oh my god!
- Whoa, whoa, whoa, whoa!
Okay, okay, okay.
- Mags, should you be doing this?
- Yeah, over my 10-pound limit but you know.
Well, when they fall, we catch them.
I'm so sorry
Is my son here? I'm such a space cadet
when it comes to tracking my sugars.
Well, we can definitely phone him.
And Doctor Hamed will find you
a bed and check your glucose.
- Thank you.
- Uh but you're sure you don't want to? You can.
I'm just trying to ease
myself back into it.
How was your talk with Karim?
Uh, it was more of a walk.
He has a very sneaky way
of getting me to spill.
Well, you can tell him that
if he needs some pointers,
um, I don't have any.
Um, hey, can I cook dinner
for you tonight at your place?
Since it's your first day back.
Yeah. How about at yours with Amira?
I asked her to come by
and face the consequences
for this school
audition thing in person.
- Can we see how that goes first?
- Yeah.
Okay.
- Did you test this morning?
- I think so.
- You think?
- Honey, come on.
You know how it is with me.
Yeah, you wait until I plan to go away
then down a macchiato so I
get a call from the hospital
and my friends go on
a road trip without me?
Excuse me, sir, diabetes
is not that predictable.
I'm Doctor Hamed. Hi, Elena.
Griff, and, I know that.
Mom? This is why we put all
those reminders in your phone.
- Yeah, they kept waking me up.
- So you turn them off?
Is she stable now?
Oh. Rehydration is helping
and we started a round
of infusion of insulin.
Okay, good. Then, you don't need me.
Then I'm gonna just
catch up with my friends.
- Wait, you're leaving?
- He just said you're fine!
It's still a very serious health event.
This is her fourth sugar
spike since I moved out.
You heard the doctor, my
disease is hard to manage.
That's my fault?
Look, Mom, this was
supposed to be my gap year
to travel and have fun.
She always promises
to get a handle on it
but somehow I get sucked back in.
Okay, is there someone else we can call?
No, that's my point!
No friends, no partner,
Mom, I can't be the
only thing in your life.
- It's it's just too much!
- Hey, hey.
Griff. I said I'm sorry.
Just call if there's
a real emergency, okay?
He used to be glued to my hip.
Say hi to a low dose
of ketamine, Leslie.
Hm, you're nice.
The nurse who did my
IV couldn't find a vein.
Oh!
Oh, this one's gonna
have to be uh, less alert.
- Just a little bit more.
- Okay.
Here we go.
Alright. Okey-dokey.
You know, I know what you're
thinking. I know. I know.
You want me to use my injury
to get some sympathy from Devi.
Uh, well, if you know that,
then why don't you do it?
Because it's gross?
And dumb.
This isn't working. Let's try the Allis.
Okay
So, what went down with
you and this lady anyway?
What, did you provoke her or something?
What? No! She's deeply
unpleasant all by herself.
Ah. Hm.
Well, if you don't wanna
leverage your own trauma,
then why don't you go to the
Trauma OR review in my place?
Devi doesn't want me there.
And you're using too much force.
And it's opportunistic,
it's not gross. Just
- It's gross.
- Go to the meeting,
you know, bond over
how distasteful I am.
And uh, figure out how
she's trying to screw me.
Trauma team to ICU.
- Trauma team to ICU.
- Hey, no, no, no, it's okay. I'll go.
You tend to that, uh, open wound.
I obviously thought
it was worth the risk.
Better to beg for forgiveness
than ask permission?
- You taught me that.
- Amira, you forged my signature,
you knew there'd be consequences.
And you broke into my phone!
And it's a good thing I did, okay?
Look, no screens, no
sleepovers, no dance!
No joy for anyone ever.
You know that affects you too.
No more staying over at your secret
girlfriend's house when I'm out.
And what do you mean, I taught you?
If I don't get in, none
of this will matter anyway.
Look, I'm withdrawing your application.
- Bashir no, you can't!
- No, I have to.
Okay, what you did was
What you did was fraud.
I passed my citizenship exam,
but I still have the
interview to go through.
None of this is official.
Okay, we're being scrutinized.
All of it could go away.
It scares me when you say that.
- I'm not trying to scare you.
- You don't want me to be happy!
You act like you're
doing a good job but
they were good parents.
You're not.
Hey it's Amira! This
voicemail could've been a text!
He's pinned and in shock.
He came out of nowhere!
Okay, don't move anything,
check on the driver.
Hey. Griff. Griff. Can you hear me?
We're going to get you help, alright?
Thanks for the help, Claire.
The abscess is on his lower back?
Yeah, he wanted me to drain it,
but by the time I got ready he conked,
and then I needed someone to
help me move him because uh
Because once Neil's out,
well there's no moving him.
- Uh. He's a regular?
- When the shelters are full.
- We'll rehydrate him if there's a bed.
- Hm. Okay.
Huh. He has cellulitis. If
it's also on his lower back
that's probably the
reason for the abscess.
- He needs antibiotics.
- Ceftriaxone infusion?
Yeah, two grams IV push.
Ah, it's so easy for guys like
him to fall through the cracks.
That is what I worry about
if nurses and management
- come to blows.
- Are things really that bad?
Now Devi is trying to de-escalate,
but small changes can have
really big consequences.
Yeah well she's gotta start somewhere.
Mags, I know she's gone
to bat for you, but
Okay. Neil?
Okay. Maybe if we roll him slightly,
we can try to prop a pillow under him.
Claire? The patient,
he keeps asking for you
- and someone's on the phone for the machine.
- Alright, thank you!
You know Devi's got a mandate
she's gotta live up to.
If she gives up on it now because
a few people are mad, I mean
Okay this isn't working,
we need a new plan.
Then it needs to be you
getting someone else to help you
because I actually have
six places I need to be.
- Claire
- And Mags?
It is more than a few people.
Make way! Wait, wait!
Nobody moving him, right?
Uh, not until we have more information.
Miraculously his pressure is
holding but I can't imagine for long.
- The driver of the SUV?
- Airbag broke his jaw. GCS 10.
Griff? I'm Mark. I'm a trauma
surgeon here at the hospital.
I want you to try and grip
my hands, okay? Please.
Good. Good.
That's a good sign that you're
alert and you can move your limbs.
Bashir, on him.
I kept hearing myself be such a jerk.
- I turned and I didn't see the SUV.
- Guys!
- Where do you need me?
- Crash injury protocol.
Can you help with the IV access?
Doctor Hunter is gonna set up an IV line
to get you some pain
management, okay, Griff?
Okay.
- Bring me up to speed, Mark?
- Uh we're getting a line in,
pressure's holding, but it's low.
Resp is elevated, he's tachy,
I'm sure there's internal
bleeding but without visibility
- we can't know for sure.
- I agree.
We need to start MTP
as soon as possible,
wanna keep him stable
until we can move the cars
and get him into Trauma OR.
IV's in, you need me to dose?
I could really use you
inside, Doctor Hunter.
I'll tag you out!
Doctor Hamed, I want you
keeping that kid informed.
Okay, absolutely. Good,
Rhoda, you're here.
- He's asking about his mother?
- Before you can answer,
you need to come and see
her with me, Doctor Hamed.
- I have to stay with him, okay?
- Go.
We can keep an eye on
him until you get back.
I can't wake her. And her
sugar's plummeted to 2,2.
She's hypoglycemic? That
doesn't make any sense.
Her sugars were elevated before.
Did you misprogram the pump?
I brought you in to
help me figure this out,
not to blame me. And I know
how to regulate insulin!
Okay well something
must have gone wrong.
Her son is fighting for his life,
now you want me to tell
him that his mother is too?
Let's get her sugars regulated.
Bash, go if you need to.
I got a co-sign as usual.
Maybe we missed something?
Where are the nurses?
Do you know how to turn this off?
Is this your hip dislocation patient?
Want me to take it?
Monitoring her
reduction's about my speed.
I don't need you to handle
my patients for me, Mags.
No, I know, I just, I heard
that she got kind of violent
- and I thought if you were upset
- I'm fine.
Fine.
We haven't really checked in
since I've been back and
So, now you want to dictate how
I manage my relationships. Cool.
Where the hell are the nurses?
You pressed the call button?
Yeah, I thought a nurse would come.
- They're busy.
- My other leg's hurting.
- It was before too, but now it's
- From one to 10?
I guess a four.
Um, it's just this throbbing
that was kind of freaking me out.
So the call button's for emergencies.
It's perfectly normal for you to
have soreness after a dislocation.
- Even in the wrong leg?
- You had a hard fall.
Doctor Curtis? Wait.
I've been lying here
replaying this morning and
I'm used to apologizing for my tone,
but the way I reacted to
you, that was so much worse.
Um, just knowing that
prejudice is inside of me,
I'm-I'm appalled.
So please accept my apology.
Massive internal
bleeding is the problem.
Priority is to get him to OR ASAP.
Let me make sure we're
all on the same page.
- I'll run point but I want you hands on.
- Okay.
My mom, this is what she does.
You're saying she did it to
herself? Why would she do that?
Because she knew I'd come back.
Okay! Let's do this!
Okay. Get ready Griff.
On my mark! Three, two, one, go.
Stop, stop, stop!
Feels like he's got a severed artery.
We need to replace the pressure!
If we don't get him inside and clamp,
our transfusions won't be able
to keep up with the blood loss.
The ambulance was tamponading.
Once it moved, it starts
exsanguinating into his belly!
Let's try this.
Good idea, Mark.
- How's that?
- Uh, he's stabilizing.
Okay. We gotta get him
inside on the table.
Hey, excuse me, um, I'm
bleeding on your sheets?
- What's your name?
- Pasha Lukin?
I know the nurse told me an
hour but it's been almost three.
- Am I in the wrong spot, or ?
- No, it is not you.
It is us.
Let's see. Ooh. Alright.
I'm gonna ask you to
just hang tight, Pasha.
And don't worry about the linens.
Yes, we are burning through O-neg units
and I am on the market for
any supplies that might help.
Uh, Theo, Mags wants some
help draining an abscess
and I need to tell Mr.
Baccus what's next for him?
Is that the guy with chest pain?
Yeah. Echo and monitoring?
And I might wanna do a CT.
- When might you know?
- I'll know when I know, Claire.
I get you have a lot on your plate,
but I don't wanna make
promises I can't keep.
Okay.
Uh, Doctor Hunter. Before you go
I'm still settling in, so if
you're looking for a rundown
- on my morning patients, it's
- Actually,
with added pressure
on doctors and nurses,
I'd like you to step back
into attending duties?
Sure. Hey, I mean, I
get we need more bodies.
You should also know that
the hospital has been talking
to Roberta Matheson and she
wants you to admit fault.
Uh, admit it how?
By apologizing. In person.
And she'll sign an NDA.
She's asking to hear the
truth validated by the abuser.
Her words. Not ours.
Think about it?
Thanks.
Mark. On my way.
So, when we pull the ambulance
back, he loses pressure.
Right.
I timed the run to Trauma
OR with no obstructions.
It's a 116 seconds.
Not fast enough to stop
him from bleeding out.
But we have to try. The
strain on his heart is immense.
We can't get to his abdomen to tamponade
- the source of the bleed.
- And we're fighting a losing battle
against blood and fluid loss.
Okay, so we reposition
and try again right away.
Or we come at that
problem from the outside.
Try to reduce how far the fluid
has to move within the body.
Oh. Theoretically, but practically?
In public health we had combat
action tourniquets on hand
for state police in case of terrorism,
they had a precision
dial and a quick release,
if we put one on every limb
Yeah, we don't tighten it
until we're ready to go.
Then when we're inside, quick release.
We'd lose our IV access,
he'd need a central line.
That will take some time.
Unless you went intraosseous.
Get blood in directly via the sternum.
Okay, we have the intraosseous
but what about the tourniquets?
I'll call Midcrest. If they
have them they can be here in 20.
20 minutes? Griff could go
into hemorrhagic shock by then.
Okay we're gambling on something
that might not even work!
All we have are imperfect
solutions, Doctor Hamed.
- I say it's worth it.
- I agree with Doctor Devi.
He's stable now, I say, get the gear.
Me too. I'm sorry Bashir.
Facts change. We pivot.
Griff trusts you.
Talk to him. Get him to fight!
Is that it then?
Absolutely not. We just need
a little bit more time. Okay?
My mother
I keep trying to tell her what I need.
And she just never hears me.
What if she's just isn't
capable of hearing it?
I'm scared, Doctor Hamed.
Once you've drained the abscess,
you redress with bactograph.
He comes back in a
week and then we assess.
We can't keep him here?
Claire says he's NF-something.
Uh, no fixed address.
Unfortunately no, we
just treat and discharge.
But isn't that just
a short-term solution?
- Ah! Ah! Where am I?! Where am I?
- Neil!
- Neil, Neil, Neil. Neil, you're in the hospital.
- Where am I?
We've cleaned your wound, we're
trying to keep you comfortable
but I need you to relax, okay?
- Okay.
- You're alright?
Yeah.
- We're gonna roll you over.
- Yeah.
- Okay.
- You already drained the abscess?
Can you prep the
medazelam, Nancy? I'll dose.
He's my patient, Theo.
All I needed help with
was positioning him.
And I came in and took over.
I-I should've paged you, Mags.
Except obviously, you
shouldn't have because
if I had been here when he was
thrashing, what would I have even done?
Well, that's why you called
for me. All part of your plan.
You know, I knew that in
order for me to make this work
I'd have to give less, but I didn't
realize that to accommodate that,
I'd be making other people do more.
Don't apologize for yourself, Mags.
That was more about me than you.
Roberta Matheson?
She wants me to admit
that I'm an abuser.
Well, that is a loaded
word, okay. But uh, you know,
you said it yourself, you
were messed up from the crash.
I was messed up long before the crash.
Okay I'm thinking more clearer, and
I tried apologizing,
she wouldn't accept it.
Abuser? I mean, like
I'm some kind of monster?
If that's how it felt to her, Theo,
maybe she just needs to
hear it to move on. You know?
I'm not gonna live a lie.
Not anymore.
So neither of us should
apologize to anyone?
Not unless they really owed it.
Okay Griff. Doing great.
We're going to get IV
access through your sternum.
Once we do that, we'll
get you on transfusions
before we move the ambulance back.
Ah, we lost peripheral access.
We need to get the IO in now.
No, wait, wait, wait!
He could have a sternal fracture.
Griff, does this hurt? Okay.
Uh, in that case, the IO won't work.
Fluid will take the path of
least resistance and leak out.
Then we go in through the humerus.
- I've never done that.
- I have. But it has to be now.
Doctor Novak? Doctor Singh?
Keeping his humerus vertical,
move his hand across his chest.
- You ready?
- Mm.
Blood product.
Hold on, Griff.
He's as ready as he's going to be.
Tighten the tourniquets,
I'll meet you inside and prep.
When we start this
time, we're not stopping.
- On your count.
- Okay.
One, two, three, go!
Okay. Hold on. Hold on.
And the sides
Applying pressure! Let's go!
Breathing's 130! Check that!
- 150!
- We're losing his pulse!
Okay, we're running out of time!
On my count.
One, two, three!
One, two, three.
Let's get those tourniquets
off. They've done their job.
- Activate MTP.
- Yeah. Okay.
- Getting a line in.
- Let me know when you're good.
Mm.
- And we're good.
- Pushing paralytic!
He's arresting!
Stay on compressions, Claire.
No time to wait!
Get the tube in.
- Tube is good.
- Incision!
Pushing epi! Pause compressions.
Still in V-fib!
Help her retract, Doctor Hamed.
- Do we defib or find the bleed?
- Both.
- Uh, agreed, Doctor Novak?
- Agreed.
Richardson!
Tell me what you see, Bashir.
Pause compressions!
200! Clear!
- How long has he been down?
- 20 seconds. No sinus rhythm.
Common iliac artery injury.
And the inferior
mesenteric, vascular clamp.
Uh, we still have a bleeder. Where?
We need to clamp the infrarenal
aorta. Doctor Singh, here!
- It's now or never!
- Hang on! He's almost got it.
Here.
- Charging to 360!
- Hold on!
- Bashir!
- Hold on! Got it!
Clear!
Still nothing. One more shot of epi.
Pause compressions.
Oh, my God.
Sinus rhythm.
- And pressure's up.
- Okay.
Those tourniquets really helped.
Every millimeter helped here today.
- Great job everyone.
- I'll uh, take in Doctor Hamed.
He needs a proper lap so we can
check for retroperitoneal injury
- and any more bleeders.
- I'll join you.
I -I'd like to assist, Doctor Singh.
Well, I did remind you to
start banking operative hours.
Gown up, Bashir, our work isn't done.
I forgot to ask how you took it,
so there's a bit of everything.
- Thanks for meeting me, Farrah.
- I was surprised you called.
I'd hope to meet you at the funeral.
Yeah, I sho I should've
reached out sooner.
A couple of John's pilot friends
had crashes they walked away from. I
I know it does a number on you.
I appreciate that. Farrah
One of the um,
hardest parts of this is
Has been knowing that
the crash was my fault.
I've spent the last four months
watching my dead husband's
employer bend over backwards
to deny mechanical error, and
you're just asking for blame?
I'm
I'm the reason we were up there.
It was late in the afternoon, I, eh
I insisted on us flying. If I
had just waited until the morning,
like I should have, then
John would still be alive
Stop. You don't need to do this.
Look, my husband put his
life on the line every day.
To help people.
Don't disrespect his
sacrifice by telling me
he made a mistake by doing his job.
I think I just wanted
you to know I wasn't
selling myself as some kind of hero.
I was a tourist and
John was a hero.
I'm sorry you lost him.
If you need to be angry, um
Angry at me,
at the world,
I can-I can handle that.
Hi, Miss Lukin, sorry you've been
waiting longer than we promised.
Um, you gashed your foot, is that right?
I did, but "Miss", not so
much. I go by they/them.
Great. Thank you for telling me.
That should've been on your chart.
Yeah, I've been trying
to change my health card
but the system's not
friends with nuance.
No, it is not. How did this happen?
I stepped on a broken beer
bottle in lake Ontario.
Yeah, you're gonna need some sutures
and a tetanus just to be safe.
- Okay.
- Maybe no lake swimming for a while.
Oh, I wasn't swimming. I was running.
Yeah I-I wade in chest deep
and run as fast as I can.
Hm. Less chance of beer
bottles at the community pool?
I like the way the current pushes back.
Except yesterday I
sucked up half the lake
trying to see what I stepped on.
I just Hm.
This should go lower.
Did you want to get someone to help?
No, no, no, no. We'll be fine.
Um, there is some high
chairs in the lounge,
so you just sit tight,
keep your foot elevated
and I'll be right back, okay?
She sounds great. So enthusiastic.
I need the stool. Please.
- Do I want to know why?
- Mm.
I heard about your race to the OR.
- Mm-hmm
- Oh I need the pillows too actually.
Don't worry, I'm too tired
to offer to help anyway.
Thank you.
Hey!
Get a loading dose,
100 milligrams of rtPA.
And get the cath lab on standby, please.
- Hey, what's going on?
- Uh
Let's go outside.
Our hip dislocation patient had
a blood clot in her uninjured leg.
It caused a pulmonary embolism.
Apparently she started coughing
and then struggling to breathe.
Why would she have a blood
clot in her other leg?
Could be May-Thurner syndrome,
a very rare form of DVT,
because her iliac arteries
cross in the pelvis.
She didn't press the call button?
She told me she was having pain.
It's just that she was
also trying to apologize
and I just I didn't interrogate.
It's my fault, June. I
shouldn't have made you
- No, I
- Take on this patient.
I'm gonna take it over, okay?
Hey Pasha, sorry about the wai Pasha?
Pasha?
Dammit.
I need some help in
here with a crash cart!
Secondary drowning.
I heard some crackling but no heartbeat.
I need you to compress.
- Your code, Doctor Leblanc.
- Hard and fast. Over 100.
I'm gonna give a shot of epi to
try and get the heart started.
We need help! Can you take over bagging?
Keep your pace steady Doctor
Devi, you're doing great.
Pushing epi.
Come on.
That's good.
Pasha, you with us?
You with us?
Okay we need Albuterol, furosemide,
and a non-rebreather.
Take them to imaging for an echo
and page whoever's covering for trauma.
Okay.
Just breathe.
You're okay.
They cut their foot running in the lake.
I would've caught it sooner
but I know that we're dealing
with a strain on resourcing so I
didn't wanna add to the problem.
Are you always this hard on yourself?
- Are you okay?
- So,
- what happened?
- You aspirated lake water into your lungs,
which caused them to create more fluid.
It's called secondary drowning.
- Eh?
- Just breathe. You're safe now.
So you're saying stick to the gym.
No, you can still run
against the current but,
now you know what to look out for. Okay?
We got you.
He's so pale.
It's uh, from the blood loss.
What are the chances
he comes back from this?
It's possible.
But unlikely.
Elena, what happened
earlier with the insulin,
Griff was concerned that you
might have taken some extra?
I'm not accusing you, I'm
just wondering how we can help.
He blames me, doesn't
he? For needing him.
No. In fact, the opposite.
He wants you to be happy.
He was only here because
I made him feel guilty.
This is my fault.
My mother used to say that not
even a hurricane could move me.
Griff wanted to be here.
Amira?
Mr. Varga.
Forklift accident.
Doctor Novak amputated his leg
20 minutes after presentation.
The consensus on
traumatic rhabdomyolysis
and early amputation is vague at best
But, I was there, and he
had multiple organ failure,
definitely the right call.
He's lucky to be alive.
And Miss Simcoe?
- Simcoe
- Simple appy,
could've been done in Trauma
OR but he sent her upstairs.
- Why?
- She, uh
- I will follow up with you.
- Mm.
Um, I believe I was off that day.
This is why I wanted
Mark at this meeting.
Uh, I know that Doctor Novak can be
really impossible to be around but uh,
Trauma OR doesn't really work without
someone like him at the helm.
Oh, did he tell you that himself
and then send you in here to defend him?
No.
Have you filled out
an incident report yet?
You need to since things got physical.
What if it was more than that?
What if that woman reacted to me?
In a discriminatory way?
Yeah, I mean she
apologized for being racist
and I'm pretty sure
she meant it, so yeah.
Look.
I gave her the benefit of the doubt
and I just kept trying to help her.
But hearing it
Put you in the position
of having to respond.
Uh, yeah, by missing a DVT symptom?
That Novak catches?
I'm so sorry this happened, June.
Well I appreciate having
someone who understands.
Yeah.
Um, resourcing.
Ah, should Trauma OR be
part of that conversation,
I would be happy to
shed some light on that.
Hey. You need me?
Uh, yes, but uh I realize I
don't have an appointment, uh,
I'm not sure what the protocol is.
You can trust me to tell
you when I'm unavailable.
- What's up?
- Um,
- you were right earlier.
- Okay.
- What did I say?
- That I was equating Amira with my own rebellion.
Actually, I think you said that
and then you said it wasn't true.
What changed your mind?
Um, like my mother, you know, she
She didn't want me to
become a rebel. Not overtly.
Even though we did end up treating him
eventually in the hospital.
But now that she's gone, uh
You're trying to fix things
with her through your sister?
You and every other parent.
You know we fight against our
modelling until we become it.
Yeah, she was afraid. My mother.
Do you regret it? Going against her?
I
No.
No, I-I believe in what I did.
But she was right that
it would affect my future.
- All of our futures.
- You and I,
we should talk about
generational trauma.
And how it passes
silently through families.
Should I talk to Amira
about this or not?
That is up to you.
But the reason that you're afraid to,
that's something we can explore.
I
- Go.
- Yeah.
- We'll talk later.
- Thank you.
It was too late for CPR.
She wasn't in her room and
By the time I found her,
she'd been down too long.
I think she had a stockpile
of insulin in her bag?
So nobody stayed with her?
- Bash!
- I had to check on another patient!
And there's just so much
for us to keep track of now.
She was so upset about Griff.
She blamed herself, I should've
I'll call Doctor Devi.
I'll stay with her.
Um
Griff is awake.
We are so sorry.
Griff.
Hey. Let me cover for you.
Go get some rest.
Can't keep going on like this, Claire.
We would like to do what we can
to help arrange a funeral home.
Um, thanks. Okay. Bye-bye.
- How's Rhoda?
- Blaming herself.
I told her to take
the rest of the night.
It's a terrible tragedy
but we could not have known
what Elena was going to do.
You're gonna hear this
formally but I believe
in being straight-up so I'm
gonna tell you right now.
ED nurses are moving to work-to-rule.
Claire are you sure we're there?
For us the writing has
been on the wall for days.
Our resourcing is depleted,
our hours are unsustainable
and patients are getting
caught in the crossfire.
Something has to change.
Hey.
Doctor Devi wants an action plan based
on how it went for me today.
I really wanna help her.
Why am I not surprised that
that woman's touchy feely
- idealism really works for you?
- Because my plan means needing
more support and I wouldn't
be a doctor now without her.
- Okay, I suck as a person.
- I didn't say that.
But it's true,
- a better friend would've checked in, Mags.
- Yeah.
I thought spending an hour
crying with a pilot's widow
was as intense as
things would get today.
You saw her? Are you okay?
- You both cried?
- We did.
It was exactly as hard as I expected.
But I am okay, yeah.
We should get drinks later.
Celebrate your triumphant return.
Or hash out whatever this is.
Actually, Mags and I have a date.
We do?
Do you want to have dinner
with me and Amira tonight?
Yeah.
Yeah, of course.
Amira wants to sing at my wedding.
And it's my school audition song.
Yeah, Amira thinks if
she keeps saying audition,
it will actually happen.
Okay when I was your age,
I really wanted to be a
professional soccer player but
I'm trying to tell you something
that will make me happy now.
- She knows, Bashir.
- That Mags and I are ?
Yeah.
His widow was hoping to meet you.
Maybe give her a call?
John's the pilot who died in the crash?
- You won't feel a thing.
- No, no, no, w-wait!
While we can't always control the wait,
we can improve how the
patient experiences it.
We were maxed out before
these policy changes.
This isn't working.
Hey! I need help in here!
She keeps jumping in and out of A-fib
which her pacemaker can't pick up.
She never said anything
about a heart history.
I never thought you'd be the one
with the bigger secret
out of the two of us.
I'm not denying that I would
need some kind of accommodations,
but I believe in what you're doing.
I've always hid this part of myself.
And now that this happened so publicly
I can't do that anymore.
Well there are worst things ♪
Staring at the water on a Sunday ♪
There are worse things
than staring at the water ♪
As you're posing for a picture ♪
After sleeping on the ferry
after getting up at seven ♪
To come over to an island
in the middle of a river ♪
Half an hour from
the city on a Sunday ♪
- In the park with ♪
- She is really belting.
Yeah, you must be doing something right
- to instill this kind of confidence.
- Look, I don't think
her copying my digital signature
for her school application
without telling me counts
as doing something right.
You went into her phone?
It was unlocked and I saw it there
Okay, she's pushing boundaries.
This is not pushing boundaries,
this is her directly
disobeying me and defying me.
Would you be okay with that?
Of course not, I'd be furious.
But, the benefit of being
me in this conversation is,
I don't have to be.
Okay, so, what do I do?
I used to avoid this street.
That's where I was when I
first decided to end things
after years in a very bad marriage.
Sorry, don't mean to be rude but
There's a point to this, I promise.
So, where are you now?
On my way to work.
Come on Bashir. Humor me.
If you let your mind wander
The past.
Specifically?
I don't know why this
is coming up but uh,
- the start of the Arab Spring.
- 2011.
Yeah. Me and my friends,
we went to a protest, uh,
the-the energy was incredible.
Um, what does that
have to do with Amira?
Was she there?
Uh no, she was too young.
Look. I know what you're doing.
You're trying to equate my experience
with her rebellious spirit.
Let That's not what this is.
I'm not doing anything.
But if that's the connection
that you're making,
then maybe you should
keep thinking about it.
What part of "It's not hot
enough" do you not understand?
I'm sorry but we already
tried a second pull
Look, I can tell you as a lab tech
that making an Americano a 195 degrees
- is not that complicated.
- Excuse me.
Is it really necessary to be so rude?
Why don't you stay out of this?!
You know what? Just
forget about it. Okay?
Whoa!
- Don't move please.
- W what are you doing? I need a doctor!
- It's okay, I am a doctor.
- No! Get off of me!
No, don't touch her!
Look, your hip is visibly
out of place, okay?
That means you're at risk
of avascular necrosis.
If you move wrong, you're
just gonna make it worse.
What do I do?
Just try not to push me again
while I figure out how to help you.
- Hello?
- Hey, Daniel.
- You look lost.
- Mags, do you know about this?
Colin Grant, fever, abdo pain, jaundice.
- No.
- The transfer from Ashmore?
They told me we have no capacity
and we're not supposed to
take any more transfers,
- I don't know who you spoke to but
- That was me.
Gallbladder rupture, Singh's
patient, straight to OR four.
Fielded a few calls to lighten the
nurses' load but got distracted, uh,
I guess there's a reason why they
don't let doctors answer the phones.
- I'll talk to Claire.
- First day back.
Am I throwing a wrench into an
already complicated situation?
Everyone knows your status
and that you won't be hiding
from what you're managing.
If it stays over a 110
for more than a minute,
it beeps and I have to take a break.
Use today to figure out what
you need to make this work.
Come back to me with a plan.
- Don't push yourself too hard, Mags.
- Yeah.
I've only done cholecystectomy open.
And it took Doctor
Curtis slicing her hand
to get you in on this one.
I'll drive, you navigate.
- ED looking for you?
- It can wait.
It's busy downstairs.
Lateral to manipulate the
neck of the gallbladder?
Medial subcostal. Have
you not been practicing?
Doctor Novak's been keeping
me busy in Trauma OR.
Then what use are you to me
if you don't know the steps?
You are aware that they may not
count all your Trauma OR time
towards your surgical hours, right?
Uh, Doctor Novak said
he thought they would.
The residency board
makes the final call,
eyes on the screen.
Um, it's distended.
Set up for needle aspiration.
Will I be able to convince the board
- to approve my Trauma OR hours?
- Hard to say.
Bureaucracy, etc.
And you'll need the support of
all your supervisors, not just Mark.
Ready to actually learn something?
Sounds like they need
you more than I do.
No, uh, it's not that serious, I just
probably shouldn't be making any
precision cuts for a little while.
Yep, I have a sub. Okay.
Is this gonna need a stitch?
Well if you'd keep still for a
second, I could get a better look.
Doctor Curtis, I just
heard you were injured.
It's nothing serious.
Thank you for coming in
on your off day, Claire.
Yeah, that's what happens
when two of my best nurses
call in sick and we
are strained for staff.
Let me know how I can support.
Doctor Curtis, you'll need to
fill out an incident report.
June! I'm gonna go do a Captain
Morgan on your assaultress.
You wanna be my first mate?
Get her hip back in order?
Maybe June should lay off
physical procedures for now?
Oh, yes, no, you're absolutely right.
How insensitive of me. June, why
don't you take the morning off and
Hmm, do admin?
I'm fine. I really just need a bandage.
Uh, Mark?
You and I are doing
that Trauma OR review
- this afternoon
- You got it, Neeta. Just tell me when.
I just did!
Excuse me?
Can you help me please? I told
the triage nurse I'm dizzy,
- and she said to sit and wait.
- Yeah, we're running at about
a two and a half hour wait
before being seen right now.
It's just I think I'm
having a diabetic crisis?
And just, I don't feel
- Are you okay? Oh my god!
- Whoa, whoa, whoa, whoa!
Okay, okay, okay.
- Mags, should you be doing this?
- Yeah, over my 10-pound limit but you know.
Well, when they fall, we catch them.
I'm so sorry
Is my son here? I'm such a space cadet
when it comes to tracking my sugars.
Well, we can definitely phone him.
And Doctor Hamed will find you
a bed and check your glucose.
- Thank you.
- Uh but you're sure you don't want to? You can.
I'm just trying to ease
myself back into it.
How was your talk with Karim?
Uh, it was more of a walk.
He has a very sneaky way
of getting me to spill.
Well, you can tell him that
if he needs some pointers,
um, I don't have any.
Um, hey, can I cook dinner
for you tonight at your place?
Since it's your first day back.
Yeah. How about at yours with Amira?
I asked her to come by
and face the consequences
for this school
audition thing in person.
- Can we see how that goes first?
- Yeah.
Okay.
- Did you test this morning?
- I think so.
- You think?
- Honey, come on.
You know how it is with me.
Yeah, you wait until I plan to go away
then down a macchiato so I
get a call from the hospital
and my friends go on
a road trip without me?
Excuse me, sir, diabetes
is not that predictable.
I'm Doctor Hamed. Hi, Elena.
Griff, and, I know that.
Mom? This is why we put all
those reminders in your phone.
- Yeah, they kept waking me up.
- So you turn them off?
Is she stable now?
Oh. Rehydration is helping
and we started a round
of infusion of insulin.
Okay, good. Then, you don't need me.
Then I'm gonna just
catch up with my friends.
- Wait, you're leaving?
- He just said you're fine!
It's still a very serious health event.
This is her fourth sugar
spike since I moved out.
You heard the doctor, my
disease is hard to manage.
That's my fault?
Look, Mom, this was
supposed to be my gap year
to travel and have fun.
She always promises
to get a handle on it
but somehow I get sucked back in.
Okay, is there someone else we can call?
No, that's my point!
No friends, no partner,
Mom, I can't be the
only thing in your life.
- It's it's just too much!
- Hey, hey.
Griff. I said I'm sorry.
Just call if there's
a real emergency, okay?
He used to be glued to my hip.
Say hi to a low dose
of ketamine, Leslie.
Hm, you're nice.
The nurse who did my
IV couldn't find a vein.
Oh!
Oh, this one's gonna
have to be uh, less alert.
- Just a little bit more.
- Okay.
Here we go.
Alright. Okey-dokey.
You know, I know what you're
thinking. I know. I know.
You want me to use my injury
to get some sympathy from Devi.
Uh, well, if you know that,
then why don't you do it?
Because it's gross?
And dumb.
This isn't working. Let's try the Allis.
Okay
So, what went down with
you and this lady anyway?
What, did you provoke her or something?
What? No! She's deeply
unpleasant all by herself.
Ah. Hm.
Well, if you don't wanna
leverage your own trauma,
then why don't you go to the
Trauma OR review in my place?
Devi doesn't want me there.
And you're using too much force.
And it's opportunistic,
it's not gross. Just
- It's gross.
- Go to the meeting,
you know, bond over
how distasteful I am.
And uh, figure out how
she's trying to screw me.
Trauma team to ICU.
- Trauma team to ICU.
- Hey, no, no, no, it's okay. I'll go.
You tend to that, uh, open wound.
I obviously thought
it was worth the risk.
Better to beg for forgiveness
than ask permission?
- You taught me that.
- Amira, you forged my signature,
you knew there'd be consequences.
And you broke into my phone!
And it's a good thing I did, okay?
Look, no screens, no
sleepovers, no dance!
No joy for anyone ever.
You know that affects you too.
No more staying over at your secret
girlfriend's house when I'm out.
And what do you mean, I taught you?
If I don't get in, none
of this will matter anyway.
Look, I'm withdrawing your application.
- Bashir no, you can't!
- No, I have to.
Okay, what you did was
What you did was fraud.
I passed my citizenship exam,
but I still have the
interview to go through.
None of this is official.
Okay, we're being scrutinized.
All of it could go away.
It scares me when you say that.
- I'm not trying to scare you.
- You don't want me to be happy!
You act like you're
doing a good job but
they were good parents.
You're not.
Hey it's Amira! This
voicemail could've been a text!
He's pinned and in shock.
He came out of nowhere!
Okay, don't move anything,
check on the driver.
Hey. Griff. Griff. Can you hear me?
We're going to get you help, alright?
Thanks for the help, Claire.
The abscess is on his lower back?
Yeah, he wanted me to drain it,
but by the time I got ready he conked,
and then I needed someone to
help me move him because uh
Because once Neil's out,
well there's no moving him.
- Uh. He's a regular?
- When the shelters are full.
- We'll rehydrate him if there's a bed.
- Hm. Okay.
Huh. He has cellulitis. If
it's also on his lower back
that's probably the
reason for the abscess.
- He needs antibiotics.
- Ceftriaxone infusion?
Yeah, two grams IV push.
Ah, it's so easy for guys like
him to fall through the cracks.
That is what I worry about
if nurses and management
- come to blows.
- Are things really that bad?
Now Devi is trying to de-escalate,
but small changes can have
really big consequences.
Yeah well she's gotta start somewhere.
Mags, I know she's gone
to bat for you, but
Okay. Neil?
Okay. Maybe if we roll him slightly,
we can try to prop a pillow under him.
Claire? The patient,
he keeps asking for you
- and someone's on the phone for the machine.
- Alright, thank you!
You know Devi's got a mandate
she's gotta live up to.
If she gives up on it now because
a few people are mad, I mean
Okay this isn't working,
we need a new plan.
Then it needs to be you
getting someone else to help you
because I actually have
six places I need to be.
- Claire
- And Mags?
It is more than a few people.
Make way! Wait, wait!
Nobody moving him, right?
Uh, not until we have more information.
Miraculously his pressure is
holding but I can't imagine for long.
- The driver of the SUV?
- Airbag broke his jaw. GCS 10.
Griff? I'm Mark. I'm a trauma
surgeon here at the hospital.
I want you to try and grip
my hands, okay? Please.
Good. Good.
That's a good sign that you're
alert and you can move your limbs.
Bashir, on him.
I kept hearing myself be such a jerk.
- I turned and I didn't see the SUV.
- Guys!
- Where do you need me?
- Crash injury protocol.
Can you help with the IV access?
Doctor Hunter is gonna set up an IV line
to get you some pain
management, okay, Griff?
Okay.
- Bring me up to speed, Mark?
- Uh we're getting a line in,
pressure's holding, but it's low.
Resp is elevated, he's tachy,
I'm sure there's internal
bleeding but without visibility
- we can't know for sure.
- I agree.
We need to start MTP
as soon as possible,
wanna keep him stable
until we can move the cars
and get him into Trauma OR.
IV's in, you need me to dose?
I could really use you
inside, Doctor Hunter.
I'll tag you out!
Doctor Hamed, I want you
keeping that kid informed.
Okay, absolutely. Good,
Rhoda, you're here.
- He's asking about his mother?
- Before you can answer,
you need to come and see
her with me, Doctor Hamed.
- I have to stay with him, okay?
- Go.
We can keep an eye on
him until you get back.
I can't wake her. And her
sugar's plummeted to 2,2.
She's hypoglycemic? That
doesn't make any sense.
Her sugars were elevated before.
Did you misprogram the pump?
I brought you in to
help me figure this out,
not to blame me. And I know
how to regulate insulin!
Okay well something
must have gone wrong.
Her son is fighting for his life,
now you want me to tell
him that his mother is too?
Let's get her sugars regulated.
Bash, go if you need to.
I got a co-sign as usual.
Maybe we missed something?
Where are the nurses?
Do you know how to turn this off?
Is this your hip dislocation patient?
Want me to take it?
Monitoring her
reduction's about my speed.
I don't need you to handle
my patients for me, Mags.
No, I know, I just, I heard
that she got kind of violent
- and I thought if you were upset
- I'm fine.
Fine.
We haven't really checked in
since I've been back and
So, now you want to dictate how
I manage my relationships. Cool.
Where the hell are the nurses?
You pressed the call button?
Yeah, I thought a nurse would come.
- They're busy.
- My other leg's hurting.
- It was before too, but now it's
- From one to 10?
I guess a four.
Um, it's just this throbbing
that was kind of freaking me out.
So the call button's for emergencies.
It's perfectly normal for you to
have soreness after a dislocation.
- Even in the wrong leg?
- You had a hard fall.
Doctor Curtis? Wait.
I've been lying here
replaying this morning and
I'm used to apologizing for my tone,
but the way I reacted to
you, that was so much worse.
Um, just knowing that
prejudice is inside of me,
I'm-I'm appalled.
So please accept my apology.
Massive internal
bleeding is the problem.
Priority is to get him to OR ASAP.
Let me make sure we're
all on the same page.
- I'll run point but I want you hands on.
- Okay.
My mom, this is what she does.
You're saying she did it to
herself? Why would she do that?
Because she knew I'd come back.
Okay! Let's do this!
Okay. Get ready Griff.
On my mark! Three, two, one, go.
Stop, stop, stop!
Feels like he's got a severed artery.
We need to replace the pressure!
If we don't get him inside and clamp,
our transfusions won't be able
to keep up with the blood loss.
The ambulance was tamponading.
Once it moved, it starts
exsanguinating into his belly!
Let's try this.
Good idea, Mark.
- How's that?
- Uh, he's stabilizing.
Okay. We gotta get him
inside on the table.
Hey, excuse me, um, I'm
bleeding on your sheets?
- What's your name?
- Pasha Lukin?
I know the nurse told me an
hour but it's been almost three.
- Am I in the wrong spot, or ?
- No, it is not you.
It is us.
Let's see. Ooh. Alright.
I'm gonna ask you to
just hang tight, Pasha.
And don't worry about the linens.
Yes, we are burning through O-neg units
and I am on the market for
any supplies that might help.
Uh, Theo, Mags wants some
help draining an abscess
and I need to tell Mr.
Baccus what's next for him?
Is that the guy with chest pain?
Yeah. Echo and monitoring?
And I might wanna do a CT.
- When might you know?
- I'll know when I know, Claire.
I get you have a lot on your plate,
but I don't wanna make
promises I can't keep.
Okay.
Uh, Doctor Hunter. Before you go
I'm still settling in, so if
you're looking for a rundown
- on my morning patients, it's
- Actually,
with added pressure
on doctors and nurses,
I'd like you to step back
into attending duties?
Sure. Hey, I mean, I
get we need more bodies.
You should also know that
the hospital has been talking
to Roberta Matheson and she
wants you to admit fault.
Uh, admit it how?
By apologizing. In person.
And she'll sign an NDA.
She's asking to hear the
truth validated by the abuser.
Her words. Not ours.
Think about it?
Thanks.
Mark. On my way.
So, when we pull the ambulance
back, he loses pressure.
Right.
I timed the run to Trauma
OR with no obstructions.
It's a 116 seconds.
Not fast enough to stop
him from bleeding out.
But we have to try. The
strain on his heart is immense.
We can't get to his abdomen to tamponade
- the source of the bleed.
- And we're fighting a losing battle
against blood and fluid loss.
Okay, so we reposition
and try again right away.
Or we come at that
problem from the outside.
Try to reduce how far the fluid
has to move within the body.
Oh. Theoretically, but practically?
In public health we had combat
action tourniquets on hand
for state police in case of terrorism,
they had a precision
dial and a quick release,
if we put one on every limb
Yeah, we don't tighten it
until we're ready to go.
Then when we're inside, quick release.
We'd lose our IV access,
he'd need a central line.
That will take some time.
Unless you went intraosseous.
Get blood in directly via the sternum.
Okay, we have the intraosseous
but what about the tourniquets?
I'll call Midcrest. If they
have them they can be here in 20.
20 minutes? Griff could go
into hemorrhagic shock by then.
Okay we're gambling on something
that might not even work!
All we have are imperfect
solutions, Doctor Hamed.
- I say it's worth it.
- I agree with Doctor Devi.
He's stable now, I say, get the gear.
Me too. I'm sorry Bashir.
Facts change. We pivot.
Griff trusts you.
Talk to him. Get him to fight!
Is that it then?
Absolutely not. We just need
a little bit more time. Okay?
My mother
I keep trying to tell her what I need.
And she just never hears me.
What if she's just isn't
capable of hearing it?
I'm scared, Doctor Hamed.
Once you've drained the abscess,
you redress with bactograph.
He comes back in a
week and then we assess.
We can't keep him here?
Claire says he's NF-something.
Uh, no fixed address.
Unfortunately no, we
just treat and discharge.
But isn't that just
a short-term solution?
- Ah! Ah! Where am I?! Where am I?
- Neil!
- Neil, Neil, Neil. Neil, you're in the hospital.
- Where am I?
We've cleaned your wound, we're
trying to keep you comfortable
but I need you to relax, okay?
- Okay.
- You're alright?
Yeah.
- We're gonna roll you over.
- Yeah.
- Okay.
- You already drained the abscess?
Can you prep the
medazelam, Nancy? I'll dose.
He's my patient, Theo.
All I needed help with
was positioning him.
And I came in and took over.
I-I should've paged you, Mags.
Except obviously, you
shouldn't have because
if I had been here when he was
thrashing, what would I have even done?
Well, that's why you called
for me. All part of your plan.
You know, I knew that in
order for me to make this work
I'd have to give less, but I didn't
realize that to accommodate that,
I'd be making other people do more.
Don't apologize for yourself, Mags.
That was more about me than you.
Roberta Matheson?
She wants me to admit
that I'm an abuser.
Well, that is a loaded
word, okay. But uh, you know,
you said it yourself, you
were messed up from the crash.
I was messed up long before the crash.
Okay I'm thinking more clearer, and
I tried apologizing,
she wouldn't accept it.
Abuser? I mean, like
I'm some kind of monster?
If that's how it felt to her, Theo,
maybe she just needs to
hear it to move on. You know?
I'm not gonna live a lie.
Not anymore.
So neither of us should
apologize to anyone?
Not unless they really owed it.
Okay Griff. Doing great.
We're going to get IV
access through your sternum.
Once we do that, we'll
get you on transfusions
before we move the ambulance back.
Ah, we lost peripheral access.
We need to get the IO in now.
No, wait, wait, wait!
He could have a sternal fracture.
Griff, does this hurt? Okay.
Uh, in that case, the IO won't work.
Fluid will take the path of
least resistance and leak out.
Then we go in through the humerus.
- I've never done that.
- I have. But it has to be now.
Doctor Novak? Doctor Singh?
Keeping his humerus vertical,
move his hand across his chest.
- You ready?
- Mm.
Blood product.
Hold on, Griff.
He's as ready as he's going to be.
Tighten the tourniquets,
I'll meet you inside and prep.
When we start this
time, we're not stopping.
- On your count.
- Okay.
One, two, three, go!
Okay. Hold on. Hold on.
And the sides
Applying pressure! Let's go!
Breathing's 130! Check that!
- 150!
- We're losing his pulse!
Okay, we're running out of time!
On my count.
One, two, three!
One, two, three.
Let's get those tourniquets
off. They've done their job.
- Activate MTP.
- Yeah. Okay.
- Getting a line in.
- Let me know when you're good.
Mm.
- And we're good.
- Pushing paralytic!
He's arresting!
Stay on compressions, Claire.
No time to wait!
Get the tube in.
- Tube is good.
- Incision!
Pushing epi! Pause compressions.
Still in V-fib!
Help her retract, Doctor Hamed.
- Do we defib or find the bleed?
- Both.
- Uh, agreed, Doctor Novak?
- Agreed.
Richardson!
Tell me what you see, Bashir.
Pause compressions!
200! Clear!
- How long has he been down?
- 20 seconds. No sinus rhythm.
Common iliac artery injury.
And the inferior
mesenteric, vascular clamp.
Uh, we still have a bleeder. Where?
We need to clamp the infrarenal
aorta. Doctor Singh, here!
- It's now or never!
- Hang on! He's almost got it.
Here.
- Charging to 360!
- Hold on!
- Bashir!
- Hold on! Got it!
Clear!
Still nothing. One more shot of epi.
Pause compressions.
Oh, my God.
Sinus rhythm.
- And pressure's up.
- Okay.
Those tourniquets really helped.
Every millimeter helped here today.
- Great job everyone.
- I'll uh, take in Doctor Hamed.
He needs a proper lap so we can
check for retroperitoneal injury
- and any more bleeders.
- I'll join you.
I -I'd like to assist, Doctor Singh.
Well, I did remind you to
start banking operative hours.
Gown up, Bashir, our work isn't done.
I forgot to ask how you took it,
so there's a bit of everything.
- Thanks for meeting me, Farrah.
- I was surprised you called.
I'd hope to meet you at the funeral.
Yeah, I sho I should've
reached out sooner.
A couple of John's pilot friends
had crashes they walked away from. I
I know it does a number on you.
I appreciate that. Farrah
One of the um,
hardest parts of this is
Has been knowing that
the crash was my fault.
I've spent the last four months
watching my dead husband's
employer bend over backwards
to deny mechanical error, and
you're just asking for blame?
I'm
I'm the reason we were up there.
It was late in the afternoon, I, eh
I insisted on us flying. If I
had just waited until the morning,
like I should have, then
John would still be alive
Stop. You don't need to do this.
Look, my husband put his
life on the line every day.
To help people.
Don't disrespect his
sacrifice by telling me
he made a mistake by doing his job.
I think I just wanted
you to know I wasn't
selling myself as some kind of hero.
I was a tourist and
John was a hero.
I'm sorry you lost him.
If you need to be angry, um
Angry at me,
at the world,
I can-I can handle that.
Hi, Miss Lukin, sorry you've been
waiting longer than we promised.
Um, you gashed your foot, is that right?
I did, but "Miss", not so
much. I go by they/them.
Great. Thank you for telling me.
That should've been on your chart.
Yeah, I've been trying
to change my health card
but the system's not
friends with nuance.
No, it is not. How did this happen?
I stepped on a broken beer
bottle in lake Ontario.
Yeah, you're gonna need some sutures
and a tetanus just to be safe.
- Okay.
- Maybe no lake swimming for a while.
Oh, I wasn't swimming. I was running.
Yeah I-I wade in chest deep
and run as fast as I can.
Hm. Less chance of beer
bottles at the community pool?
I like the way the current pushes back.
Except yesterday I
sucked up half the lake
trying to see what I stepped on.
I just Hm.
This should go lower.
Did you want to get someone to help?
No, no, no, no. We'll be fine.
Um, there is some high
chairs in the lounge,
so you just sit tight,
keep your foot elevated
and I'll be right back, okay?
She sounds great. So enthusiastic.
I need the stool. Please.
- Do I want to know why?
- Mm.
I heard about your race to the OR.
- Mm-hmm
- Oh I need the pillows too actually.
Don't worry, I'm too tired
to offer to help anyway.
Thank you.
Hey!
Get a loading dose,
100 milligrams of rtPA.
And get the cath lab on standby, please.
- Hey, what's going on?
- Uh
Let's go outside.
Our hip dislocation patient had
a blood clot in her uninjured leg.
It caused a pulmonary embolism.
Apparently she started coughing
and then struggling to breathe.
Why would she have a blood
clot in her other leg?
Could be May-Thurner syndrome,
a very rare form of DVT,
because her iliac arteries
cross in the pelvis.
She didn't press the call button?
She told me she was having pain.
It's just that she was
also trying to apologize
and I just I didn't interrogate.
It's my fault, June. I
shouldn't have made you
- No, I
- Take on this patient.
I'm gonna take it over, okay?
Hey Pasha, sorry about the wai Pasha?
Pasha?
Dammit.
I need some help in
here with a crash cart!
Secondary drowning.
I heard some crackling but no heartbeat.
I need you to compress.
- Your code, Doctor Leblanc.
- Hard and fast. Over 100.
I'm gonna give a shot of epi to
try and get the heart started.
We need help! Can you take over bagging?
Keep your pace steady Doctor
Devi, you're doing great.
Pushing epi.
Come on.
That's good.
Pasha, you with us?
You with us?
Okay we need Albuterol, furosemide,
and a non-rebreather.
Take them to imaging for an echo
and page whoever's covering for trauma.
Okay.
Just breathe.
You're okay.
They cut their foot running in the lake.
I would've caught it sooner
but I know that we're dealing
with a strain on resourcing so I
didn't wanna add to the problem.
Are you always this hard on yourself?
- Are you okay?
- So,
- what happened?
- You aspirated lake water into your lungs,
which caused them to create more fluid.
It's called secondary drowning.
- Eh?
- Just breathe. You're safe now.
So you're saying stick to the gym.
No, you can still run
against the current but,
now you know what to look out for. Okay?
We got you.
He's so pale.
It's uh, from the blood loss.
What are the chances
he comes back from this?
It's possible.
But unlikely.
Elena, what happened
earlier with the insulin,
Griff was concerned that you
might have taken some extra?
I'm not accusing you, I'm
just wondering how we can help.
He blames me, doesn't
he? For needing him.
No. In fact, the opposite.
He wants you to be happy.
He was only here because
I made him feel guilty.
This is my fault.
My mother used to say that not
even a hurricane could move me.
Griff wanted to be here.
Amira?
Mr. Varga.
Forklift accident.
Doctor Novak amputated his leg
20 minutes after presentation.
The consensus on
traumatic rhabdomyolysis
and early amputation is vague at best
But, I was there, and he
had multiple organ failure,
definitely the right call.
He's lucky to be alive.
And Miss Simcoe?
- Simcoe
- Simple appy,
could've been done in Trauma
OR but he sent her upstairs.
- Why?
- She, uh
- I will follow up with you.
- Mm.
Um, I believe I was off that day.
This is why I wanted
Mark at this meeting.
Uh, I know that Doctor Novak can be
really impossible to be around but uh,
Trauma OR doesn't really work without
someone like him at the helm.
Oh, did he tell you that himself
and then send you in here to defend him?
No.
Have you filled out
an incident report yet?
You need to since things got physical.
What if it was more than that?
What if that woman reacted to me?
In a discriminatory way?
Yeah, I mean she
apologized for being racist
and I'm pretty sure
she meant it, so yeah.
Look.
I gave her the benefit of the doubt
and I just kept trying to help her.
But hearing it
Put you in the position
of having to respond.
Uh, yeah, by missing a DVT symptom?
That Novak catches?
I'm so sorry this happened, June.
Well I appreciate having
someone who understands.
Yeah.
Um, resourcing.
Ah, should Trauma OR be
part of that conversation,
I would be happy to
shed some light on that.
Hey. You need me?
Uh, yes, but uh I realize I
don't have an appointment, uh,
I'm not sure what the protocol is.
You can trust me to tell
you when I'm unavailable.
- What's up?
- Um,
- you were right earlier.
- Okay.
- What did I say?
- That I was equating Amira with my own rebellion.
Actually, I think you said that
and then you said it wasn't true.
What changed your mind?
Um, like my mother, you know, she
She didn't want me to
become a rebel. Not overtly.
Even though we did end up treating him
eventually in the hospital.
But now that she's gone, uh
You're trying to fix things
with her through your sister?
You and every other parent.
You know we fight against our
modelling until we become it.
Yeah, she was afraid. My mother.
Do you regret it? Going against her?
I
No.
No, I-I believe in what I did.
But she was right that
it would affect my future.
- All of our futures.
- You and I,
we should talk about
generational trauma.
And how it passes
silently through families.
Should I talk to Amira
about this or not?
That is up to you.
But the reason that you're afraid to,
that's something we can explore.
I
- Go.
- Yeah.
- We'll talk later.
- Thank you.
It was too late for CPR.
She wasn't in her room and
By the time I found her,
she'd been down too long.
I think she had a stockpile
of insulin in her bag?
So nobody stayed with her?
- Bash!
- I had to check on another patient!
And there's just so much
for us to keep track of now.
She was so upset about Griff.
She blamed herself, I should've
I'll call Doctor Devi.
I'll stay with her.
Um
Griff is awake.
We are so sorry.
Griff.
Hey. Let me cover for you.
Go get some rest.
Can't keep going on like this, Claire.
We would like to do what we can
to help arrange a funeral home.
Um, thanks. Okay. Bye-bye.
- How's Rhoda?
- Blaming herself.
I told her to take
the rest of the night.
It's a terrible tragedy
but we could not have known
what Elena was going to do.
You're gonna hear this
formally but I believe
in being straight-up so I'm
gonna tell you right now.
ED nurses are moving to work-to-rule.
Claire are you sure we're there?
For us the writing has
been on the wall for days.
Our resourcing is depleted,
our hours are unsustainable
and patients are getting
caught in the crossfire.
Something has to change.
Hey.
Doctor Devi wants an action plan based
on how it went for me today.
I really wanna help her.
Why am I not surprised that
that woman's touchy feely
- idealism really works for you?
- Because my plan means needing
more support and I wouldn't
be a doctor now without her.
- Okay, I suck as a person.
- I didn't say that.
But it's true,
- a better friend would've checked in, Mags.
- Yeah.
I thought spending an hour
crying with a pilot's widow
was as intense as
things would get today.
You saw her? Are you okay?
- You both cried?
- We did.
It was exactly as hard as I expected.
But I am okay, yeah.
We should get drinks later.
Celebrate your triumphant return.
Or hash out whatever this is.
Actually, Mags and I have a date.
We do?
Do you want to have dinner
with me and Amira tonight?
Yeah.
Yeah, of course.