00:00:00,000 --> 00:00:04,162 WWW.MY-SUBS.COM 1 00:00:01,031 --> 00:00:03,383 Then why don't you check the drawer next to the pantry? 2 00:00:04,476 --> 00:00:06,671 I'm sorry, Robert, but I... I don't know where they are. 3 00:00:06,726 --> 00:00:09,334 I'll tell you what, I'll get another set made on my way home. 4 00:00:09,358 --> 00:00:10,990 [clears throat] 5 00:00:12,479 --> 00:00:15,381 [sighs] Look, babe, I really have to go. 6 00:00:15,415 --> 00:00:17,850 Yeah, sure, that's fine. 7 00:00:19,519 --> 00:00:20,920 Okay, I love you too. 8 00:00:21,020 --> 00:00:22,955 Bye-bye. 9 00:00:24,424 --> 00:00:25,725 My apologies. 10 00:00:25,759 --> 00:00:27,093 Everything okay? 11 00:00:27,127 --> 00:00:28,895 Yeah, Robin just couldn't find her keys. 12 00:00:28,929 --> 00:00:30,796 Rough morning? Perhaps I should take over the pre-op? 13 00:00:30,831 --> 00:00:33,399 That will not be necessary. 14 00:00:33,433 --> 00:00:34,734 Shall we? 15 00:00:34,768 --> 00:00:36,936 Please. 16 00:00:36,970 --> 00:00:38,638 Just a heads-up: 17 00:00:38,672 --> 00:00:40,640 the board is gonna push you for more growth. 18 00:00:40,674 --> 00:00:42,642 The bottom line has them concerned. 19 00:00:42,676 --> 00:00:44,143 When hasn't it? Can set my watch 20 00:00:44,177 --> 00:00:45,344 over their money worries. 21 00:00:45,379 --> 00:00:46,646 I'll be fine. 22 00:00:46,680 --> 00:00:47,980 It's different this time. 23 00:00:48,015 --> 00:00:51,517 C-Suite feels we can better recognize 24 00:00:51,551 --> 00:00:53,819 how medicine and business are one and the same. 25 00:00:53,854 --> 00:00:55,154 Ah, let me guess: 26 00:00:55,188 --> 00:00:56,956 scale back on outreach, 27 00:00:56,990 --> 00:00:59,592 combine responsibilities, outsource? 28 00:00:59,626 --> 00:01:02,261 So basically, sacrifice patient care? 29 00:01:02,296 --> 00:01:04,030 I won't do that, Peter. 30 00:01:04,064 --> 00:01:05,665 Well, Sharon, you have to do something, 31 00:01:05,699 --> 00:01:08,534 because the ED is hemorrhaging cash, 32 00:01:08,568 --> 00:01:09,936 and if the bleeding doesn't stop, 33 00:01:09,970 --> 00:01:11,637 it's not going to be good for anybody. 34 00:01:11,672 --> 00:01:13,539 - Mm. - Need I remind you 35 00:01:13,573 --> 00:01:17,109 Randall Memorial closed their ED? 36 00:01:19,313 --> 00:01:21,280 Dr. Halstead, Doris, you're with me. 37 00:01:21,315 --> 00:01:23,015 - Copy that. - Barry? 38 00:01:23,050 --> 00:01:24,684 - [heavy breathing] - Alex Mayer, 23. 39 00:01:24,718 --> 00:01:26,552 Slash and stab. Large diagonal lacerations 40 00:01:26,586 --> 00:01:27,720 of the abdomen. 41 00:01:27,754 --> 00:01:29,155 He's a little tachy. GCS 15. 42 00:01:29,189 --> 00:01:30,156 Get it out! 43 00:01:30,190 --> 00:01:31,190 You're going Baghdad. 44 00:01:31,224 --> 00:01:32,224 Get it out! 45 00:01:32,259 --> 00:01:33,659 The weapon still in? 46 00:01:33,694 --> 00:01:34,794 I don't know. Wasn't even a call. 47 00:01:34,828 --> 00:01:36,062 We were a few blocks away, 48 00:01:36,096 --> 00:01:37,463 I saw him on the street, bleeding, 49 00:01:37,497 --> 00:01:38,965 loaded him in the ambo and rolled. 50 00:01:38,999 --> 00:01:40,733 - I can feel it inside me! - Whoa, whoa! 51 00:01:40,767 --> 00:01:41,801 Alex, keep your hands down. 52 00:01:41,835 --> 00:01:43,336 I got you, Dr. Halstead. 53 00:01:43,370 --> 00:01:44,670 Let's transfer. 54 00:01:44,705 --> 00:01:47,139 On my count. One, two, three! 55 00:01:47,174 --> 00:01:48,140 [screams] 56 00:01:48,175 --> 00:01:49,475 [groans] 57 00:01:49,509 --> 00:01:50,977 Two of Versed to calm him down. 58 00:01:51,011 --> 00:01:52,712 Thank you, boys. 59 00:01:52,746 --> 00:01:55,548 [sobbing] 60 00:01:55,582 --> 00:01:57,817 - How's that Versed coming? - On it, Doctor. 61 00:01:57,851 --> 00:01:59,585 Gaping diagonal incision 62 00:01:59,619 --> 00:02:00,886 of the right upper quad. 63 00:02:00,921 --> 00:02:02,154 Evidence of evisceration? 64 00:02:02,189 --> 00:02:03,723 No, I can see the base. 65 00:02:03,757 --> 00:02:05,725 Abdomen's still intact. Just a flesh wound. 66 00:02:05,759 --> 00:02:07,059 It's really clean, though. 67 00:02:07,094 --> 00:02:08,361 Wash it out and stitch it up. 68 00:02:08,395 --> 00:02:09,362 Irrigation. 69 00:02:09,396 --> 00:02:10,930 Sir, you're a lucky man. 70 00:02:10,964 --> 00:02:13,065 Whoever knifed you didn't do any serious damage. 71 00:02:13,100 --> 00:02:15,735 [suspenseful music] 72 00:02:15,769 --> 00:02:17,169 Look at this. Betadine's smeared 73 00:02:17,204 --> 00:02:18,571 all over the abdomen. 74 00:02:18,605 --> 00:02:19,939 The skin was prepped before the cut. 75 00:02:19,973 --> 00:02:21,774 I'm telling you, that incision is precise. 76 00:02:21,808 --> 00:02:24,677 Back-alley surgery gone wrong? 77 00:02:24,711 --> 00:02:26,212 Alex, what happened? 78 00:02:26,246 --> 00:02:27,446 I was desperate. 79 00:02:27,481 --> 00:02:30,549 Dr. Halstead, his hand, under the blood. 80 00:02:30,584 --> 00:02:31,917 More Betadine. 81 00:02:31,952 --> 00:02:34,220 So he doused his own hands. 82 00:02:34,254 --> 00:02:35,855 Alex, did you cut into yourself? 83 00:02:35,889 --> 00:02:37,590 I had to! I had to get it out! 84 00:02:37,624 --> 00:02:38,858 Get what out? 85 00:02:38,892 --> 00:02:41,293 The person living inside me! 86 00:02:41,359 --> 00:02:46,290 87 00:02:46,892 --> 00:02:51,062 Synced & corrected by kinglouisxx www.MY-SUBS.com 88 00:02:53,840 --> 00:02:55,808 - [gasps] - Oh, I'm sorry. 89 00:02:55,842 --> 00:02:57,877 Are you all right? I was just trying to say "hi." 90 00:02:57,911 --> 00:03:00,046 Um, it's Edith Lake. 91 00:03:00,080 --> 00:03:01,647 Your insulin patient? 92 00:03:01,681 --> 00:03:03,949 The woman who slashed my tires? 93 00:03:03,984 --> 00:03:06,619 Oh, the woman you think slashed your tires. 94 00:03:06,653 --> 00:03:08,220 Who else? 95 00:03:08,255 --> 00:03:09,622 I saw her yesterday, 96 00:03:09,656 --> 00:03:11,257 across the street from my apartment. 97 00:03:11,291 --> 00:03:14,493 You really think it was her? 98 00:03:14,528 --> 00:03:16,562 Looked like her. 99 00:03:16,596 --> 00:03:18,464 Next. 100 00:03:22,803 --> 00:03:25,905 Dr. Latham, this is Ray Preston, 53. 101 00:03:25,939 --> 00:03:27,573 Fell short of breath while jogging. 102 00:03:27,607 --> 00:03:29,241 I was only two miles in. 103 00:03:29,276 --> 00:03:31,644 I'm always good for five before I start to get tired. 104 00:03:31,678 --> 00:03:33,179 Ray lives in Galena. 105 00:03:33,213 --> 00:03:35,314 It's about 3 1/2 hours west of Chicago. 106 00:03:35,348 --> 00:03:37,450 His cardiologist performed an EKG, 107 00:03:37,484 --> 00:03:39,418 stress test, and cardiac cath. 108 00:03:39,453 --> 00:03:40,853 Told me to skip the community hospital 109 00:03:40,887 --> 00:03:43,689 and come straight here. 110 00:03:43,723 --> 00:03:44,957 Dr. Rhodes, I know we're getting 111 00:03:44,991 --> 00:03:46,125 pretty close to show time here, 112 00:03:46,159 --> 00:03:47,126 but are you absolutely sure 113 00:03:47,160 --> 00:03:48,127 I need this surgery? 114 00:03:48,161 --> 00:03:49,929 I'm positive. 115 00:03:49,963 --> 00:03:51,297 But I'm not in any pain. 116 00:03:51,331 --> 00:03:53,332 I know, that's the danger. 117 00:03:53,366 --> 00:03:55,334 Severe three-vessel disease, complicated by... 118 00:03:55,368 --> 00:03:58,370 Heavy calcification and extremely poor targets. 119 00:03:58,405 --> 00:03:59,805 CABG is still doable, 120 00:03:59,840 --> 00:04:01,841 but it will be more challenging than normal. 121 00:04:01,875 --> 00:04:03,209 Indeed. 122 00:04:03,243 --> 00:04:04,610 You're a lucky man, Mr. Preston. 123 00:04:04,644 --> 00:04:06,145 Keeping fit bought you the time 124 00:04:06,179 --> 00:04:07,446 to notice something was wrong. 125 00:04:07,481 --> 00:04:09,548 Yeah. Well, Dr. Rhodes said 126 00:04:09,583 --> 00:04:11,183 people with arteries as damaged as mine 127 00:04:11,218 --> 00:04:12,485 usually just drop dead. 128 00:04:12,519 --> 00:04:15,788 He's absolutely right. 129 00:04:15,822 --> 00:04:18,457 Not to worry, Ray. We'll take great care of you. 130 00:04:19,493 --> 00:04:22,128 To streamline costs, Dr. Stohl and I 131 00:04:22,162 --> 00:04:24,663 are implementing a system to track supplies 132 00:04:24,698 --> 00:04:26,332 to know exactly what we've used. 133 00:04:26,366 --> 00:04:28,200 Everything will be barcoded 134 00:04:28,235 --> 00:04:29,969 and logged into Pyxis. 135 00:04:30,003 --> 00:04:31,637 It will operate by finger scan, 136 00:04:31,671 --> 00:04:33,172 like we do for medications. 137 00:04:33,206 --> 00:04:35,741 That's easy enough for minor treatments, 138 00:04:35,775 --> 00:04:37,309 but what about emergencies? 139 00:04:37,344 --> 00:04:40,237 Not a lot of time to stop down and scan your prints during a trauma. 140 00:04:40,308 --> 00:04:42,748 A tech will take note of what was used in the moment 141 00:04:42,782 --> 00:04:45,384 and then scan after the fact. 142 00:04:45,418 --> 00:04:47,019 "In the moment." They'll follow us 143 00:04:47,053 --> 00:04:48,921 into the trauma bay? 144 00:04:48,955 --> 00:04:51,357 Between nurses and equipment, we're already tight on space. 145 00:04:51,391 --> 00:04:52,358 Another body... 146 00:04:52,392 --> 00:04:53,392 We'll find the room 147 00:04:53,426 --> 00:04:55,694 because we have to. 148 00:04:55,729 --> 00:04:58,063 Not to worry, Miss Goodwin. 149 00:04:58,098 --> 00:05:00,266 All right, uh, let's get back to work. 150 00:05:00,300 --> 00:05:01,600 Thank you for your time. 151 00:05:01,635 --> 00:05:02,902 Doctors, one more thing before you go, 152 00:05:02,936 --> 00:05:05,704 while I have you here, charting. 153 00:05:05,739 --> 00:05:07,106 When I was in Attending, 154 00:05:07,140 --> 00:05:09,108 it was pen, paper, and long-form. 155 00:05:09,142 --> 00:05:11,911 Today, it's... it's tablets and shorthand. 156 00:05:11,945 --> 00:05:14,747 I get it... tech saves time... 157 00:05:14,781 --> 00:05:16,782 but details get lost in translation, 158 00:05:16,816 --> 00:05:20,586 so please be explicit in procedure notes. 159 00:05:20,620 --> 00:05:22,688 Okay? Document everything. 160 00:05:22,722 --> 00:05:25,224 If you do it, write it down. 161 00:05:25,258 --> 00:05:26,225 Okay? 162 00:05:26,259 --> 00:05:29,228 [dramatic music] 163 00:05:29,262 --> 00:05:33,132 164 00:05:33,166 --> 00:05:34,867 I clean up nice, don't I? 165 00:05:34,901 --> 00:05:36,035 I haven't noticed. 166 00:05:36,069 --> 00:05:40,072 I saw that. 167 00:05:40,106 --> 00:05:42,708 Why don't you believe me? 168 00:05:42,742 --> 00:05:44,243 I'm not crazy. 169 00:05:44,277 --> 00:05:46,712 Something lives inside of me, right here. 170 00:05:46,746 --> 00:05:47,913 I hear you. I understand. 171 00:05:47,948 --> 00:05:49,215 Then get it out! 172 00:05:49,249 --> 00:05:51,050 [sobs] I feel it all the time! 173 00:05:51,084 --> 00:05:55,955 Alex... we're gonna help you, I promise. 174 00:05:55,989 --> 00:05:58,090 Sedative? 175 00:05:58,124 --> 00:05:59,425 No, no, no. Wait, wait, wait. 176 00:05:59,459 --> 00:06:01,293 I'm sorry, I'm sorry. 177 00:06:01,328 --> 00:06:02,928 I'm telling you the truth. 178 00:06:02,963 --> 00:06:04,563 I can feel it inside of me. 179 00:06:04,598 --> 00:06:06,432 Please. [breathes fearfully] 180 00:06:06,466 --> 00:06:10,269 [breathing slows] 181 00:06:10,303 --> 00:06:12,438 Please... 182 00:06:12,472 --> 00:06:18,110 183 00:06:18,144 --> 00:06:19,411 What'd you give him? 184 00:06:19,446 --> 00:06:20,579 Five of Versed. 185 00:06:20,614 --> 00:06:21,914 Hm. 186 00:06:21,948 --> 00:06:24,316 Two probably would have sufficed. 187 00:06:24,351 --> 00:06:25,517 He put hands on you. 188 00:06:25,552 --> 00:06:28,020 I was being cautious. 189 00:06:28,054 --> 00:06:29,421 So what are you thinking? 190 00:06:29,456 --> 00:06:30,823 Schizophrenia. 191 00:06:30,857 --> 00:06:32,191 Yeah, that was my initial thought, 192 00:06:32,225 --> 00:06:33,425 but now I'm not so sure. 193 00:06:33,460 --> 00:06:35,928 Seriously? His, uh, paranoia 194 00:06:35,962 --> 00:06:37,463 that there's something living inside him, 195 00:06:37,497 --> 00:06:38,831 and his attempt to remove it 196 00:06:38,865 --> 00:06:40,132 is literally a textbook definition 197 00:06:40,166 --> 00:06:42,534 of a somatic delusional disorder. 198 00:06:42,569 --> 00:06:44,803 I'm stuck on the level of premeditation. 199 00:06:44,838 --> 00:06:46,772 You know, sterilization with Betadine, 200 00:06:46,806 --> 00:06:48,474 the clean incision, 201 00:06:48,508 --> 00:06:49,875 doing it near a hospital... 202 00:06:49,909 --> 00:06:51,610 All that kind of forethought... 203 00:06:51,645 --> 00:06:53,946 it's just not consistent with schizophrenic psychosis. 204 00:06:53,980 --> 00:06:56,048 So he's a germophobe with a steady hand. 205 00:06:56,082 --> 00:06:58,150 It doesn't mean he's not schizophrenic. 206 00:06:58,184 --> 00:07:00,119 Mm, could be true, too. 207 00:07:00,153 --> 00:07:03,222 So, um... start him on anti-psychotics 208 00:07:03,256 --> 00:07:04,690 and reassess when his mind's clear? 209 00:07:04,724 --> 00:07:06,392 I'm just not there yet. 210 00:07:06,426 --> 00:07:07,993 My gut tells me it's chemical. 211 00:07:08,028 --> 00:07:10,863 You know, like maybe a methamphetamine overdose. 212 00:07:10,897 --> 00:07:12,865 Before we go any further, let's run a tox screen, 213 00:07:12,899 --> 00:07:15,234 see if he's just... high. 214 00:07:15,268 --> 00:07:20,706 215 00:07:26,079 --> 00:07:28,847 What's with you? You look half-dead. 216 00:07:28,882 --> 00:07:31,483 Yeah, these 90-hour weeks are killing a brother. 217 00:07:31,518 --> 00:07:33,385 Law says you can't do more than 80. 218 00:07:33,420 --> 00:07:36,188 [laughs] When Dr. Stohl asks you to volunteer, 219 00:07:36,222 --> 00:07:37,890 you don't say "no." 220 00:07:37,924 --> 00:07:40,192 Game is rigged. 221 00:07:40,226 --> 00:07:42,861 All part of being a big-shot doc. 222 00:07:42,896 --> 00:07:44,730 Big shot, right. 223 00:07:44,764 --> 00:07:48,067 Big shot, living off of ramen and cheeseburgers. 224 00:07:48,101 --> 00:07:49,702 What? 225 00:07:49,736 --> 00:07:51,203 Yeah, that's all I got time for. 226 00:07:51,237 --> 00:07:53,339 You are getting a steady paycheck now. 227 00:07:53,373 --> 00:07:55,441 Sign up for one of those meal delivery services. 228 00:07:55,475 --> 00:07:57,343 You're gonna need the fuel. 229 00:07:57,377 --> 00:08:00,012 That's not a bad idea. 230 00:08:00,046 --> 00:08:02,414 Hey, um... 231 00:08:02,449 --> 00:08:05,117 do you mind setting it up for me? 232 00:08:05,151 --> 00:08:06,218 What? You... 233 00:08:06,252 --> 00:08:08,354 you always know what I like. 234 00:08:08,388 --> 00:08:09,388 Sure. 235 00:08:09,422 --> 00:08:10,456 Thank you. 236 00:08:10,490 --> 00:08:11,457 Thank you, thank you. 237 00:08:11,491 --> 00:08:13,058 I'ma try to get some Zs 238 00:08:13,093 --> 00:08:16,729 before the troll hawks me for more rounds. 239 00:08:20,300 --> 00:08:21,900 Don't give me that look. 240 00:08:25,438 --> 00:08:28,073 Mm-hmm. Okay. 241 00:08:28,108 --> 00:08:29,441 Thank you, Helen. 242 00:08:29,476 --> 00:08:30,776 Bye. 243 00:08:30,810 --> 00:08:31,944 Good news: 244 00:08:31,978 --> 00:08:34,446 Helen's gonna watch Owen tonight. 245 00:08:34,481 --> 00:08:35,614 Watch as in all night? 246 00:08:35,648 --> 00:08:36,815 - Mm-hmm. - Yes. 247 00:08:36,850 --> 00:08:38,751 [giggles] 248 00:08:38,785 --> 00:08:40,486 Just one thing I ask. 249 00:08:40,520 --> 00:08:41,487 Anything. 250 00:08:41,521 --> 00:08:44,757 That you shave. 251 00:08:44,791 --> 00:08:46,458 You don't like the sandpaper feel, huh? 252 00:08:46,493 --> 00:08:48,127 Uh-huh. 253 00:08:48,161 --> 00:08:49,294 You ask a lot... 254 00:08:49,329 --> 00:08:50,596 Mm. 255 00:08:50,630 --> 00:08:52,164 But okay. 256 00:08:52,198 --> 00:08:54,867 - Thank you. - Yeah. 257 00:08:57,303 --> 00:08:59,905 Proximal anastomosis is complete. 258 00:08:59,939 --> 00:09:00,939 That looks good. 259 00:09:00,974 --> 00:09:02,341 Let's move on to the base. 260 00:09:02,375 --> 00:09:03,942 Do you have a suitable landing spot? 261 00:09:03,977 --> 00:09:05,344 Yeah. 262 00:09:05,378 --> 00:09:07,146 Lighter calcification in this area. 263 00:09:07,180 --> 00:09:08,614 Potts, please. 264 00:09:08,648 --> 00:09:10,082 I'd go more distal. 265 00:09:10,116 --> 00:09:12,317 Vessel's bigger. You'll get a cleaner target. 266 00:09:12,352 --> 00:09:14,987 This area of vessel is perfect. 267 00:09:15,021 --> 00:09:17,923 If you say so. 268 00:09:17,957 --> 00:09:19,324 8-0 Prolene. 269 00:09:19,359 --> 00:09:20,993 The artery could probably handle the 7-0. 270 00:09:21,027 --> 00:09:22,594 I prefer the 8-0. 271 00:09:22,629 --> 00:09:23,862 Just thought the larger stitch 272 00:09:23,897 --> 00:09:25,197 might be easier for you to work with. 273 00:09:25,231 --> 00:09:26,598 I don't understand the debate. 274 00:09:26,633 --> 00:09:28,200 The difference between vessel location, 275 00:09:28,234 --> 00:09:29,935 and now suture choice, is negligible. 276 00:09:29,969 --> 00:09:31,270 Good point, Dr. Latham. 277 00:09:31,304 --> 00:09:32,538 Dr. Rhodes, you're lead surgeon. 278 00:09:32,572 --> 00:09:33,639 I'm only assisting. 279 00:09:33,673 --> 00:09:36,208 I defer to your preference. 280 00:09:36,242 --> 00:09:38,477 Thank you, Doctor. 281 00:09:38,511 --> 00:09:40,612 Now, how about from here on out, 282 00:09:40,647 --> 00:09:43,449 we keep the background noise to a minimum? 283 00:09:43,483 --> 00:09:45,951 [tense music] 284 00:09:45,985 --> 00:09:47,953 [alarm beeps] 285 00:09:47,987 --> 00:09:49,455 Myra Adams, 20. 286 00:09:49,489 --> 00:09:50,823 Passed out in her bathroom washing her face. 287 00:09:50,857 --> 00:09:52,191 Struck her head as she fell. 288 00:09:52,225 --> 00:09:53,292 Chamber two. 289 00:09:53,326 --> 00:09:56,495 GCS 6. BP 128 over 60, heart rate 102 290 00:09:56,529 --> 00:09:57,896 Her brother Eric's a step behind. 291 00:09:57,931 --> 00:09:59,498 - Total wreck. - Hey, uh, what's... 292 00:09:59,532 --> 00:10:01,033 what's wrong with her? 293 00:10:01,067 --> 00:10:02,334 She's tensing up. Decorticate posturing. 294 00:10:02,368 --> 00:10:04,069 - Can you hear me? - Excuse us. 295 00:10:04,103 --> 00:10:05,070 Can you tell me your name? 296 00:10:05,104 --> 00:10:06,672 Responds to pain. 297 00:10:06,706 --> 00:10:08,173 All right, we're gonna transfer on my count. 298 00:10:08,208 --> 00:10:09,508 One, two, three. 299 00:10:09,542 --> 00:10:11,143 Uh, she was complaining 300 00:10:11,177 --> 00:10:12,311 about her stomach last night. 301 00:10:12,345 --> 00:10:13,579 I-I told her it was, like, 302 00:10:13,613 --> 00:10:15,147 uh, something that she ate. 303 00:10:15,181 --> 00:10:16,415 It's okay. Please give the doctor 304 00:10:16,449 --> 00:10:17,583 some room to examine her. 305 00:10:17,617 --> 00:10:20,018 Okay. 306 00:10:20,053 --> 00:10:21,653 Clear breath sounds bilaterally. 307 00:10:21,688 --> 00:10:23,722 CBC, CMP, coags, and u-tox. 308 00:10:23,756 --> 00:10:25,157 Nat, belly's soft. 309 00:10:25,191 --> 00:10:26,725 All right, nasal airway and a head CT. 310 00:10:26,759 --> 00:10:28,227 And while we're there, let's scan 311 00:10:28,261 --> 00:10:29,394 her C spine and belly, okay? 312 00:10:29,429 --> 00:10:30,429 We're on it. 313 00:10:30,463 --> 00:10:33,398 314 00:10:33,433 --> 00:10:34,900 All right, let's move her. 315 00:10:34,934 --> 00:10:36,869 316 00:10:36,903 --> 00:10:40,038 Look, I-I should have brought her in last night. 317 00:10:40,073 --> 00:10:42,241 Uh, why... why is this happening to her? 318 00:10:42,275 --> 00:10:43,575 Look, we're gonna do everything we can 319 00:10:43,610 --> 00:10:45,010 to help your sister, okay? 320 00:10:45,044 --> 00:10:46,712 She's lucky you found her when you did. 321 00:10:46,746 --> 00:10:48,947 I-I gotta, uh, call my parents. 322 00:10:48,982 --> 00:10:50,282 Sure. 323 00:10:50,316 --> 00:10:53,285 324 00:10:53,319 --> 00:10:54,586 This level of posturing... 325 00:10:54,621 --> 00:10:55,954 Has to be some sort of brain injury. 326 00:10:55,989 --> 00:10:57,422 Yeah. 327 00:10:59,799 --> 00:11:01,899 Thank you. 328 00:11:01,934 --> 00:11:03,611 Uh, we're looking for our daughter, Myra Adams. 329 00:11:03,667 --> 00:11:05,268 Our son called. Is she all right? 330 00:11:05,302 --> 00:11:08,070 Come with me, please. Dr. Manning, Dr. Choi. 331 00:11:08,105 --> 00:11:09,439 These are Myra's parents. 332 00:11:09,473 --> 00:11:10,516 What happened? 333 00:11:10,570 --> 00:11:12,241 We talked to her two days ago. She was fine. 334 00:11:12,276 --> 00:11:13,242 Myra? 335 00:11:13,277 --> 00:11:14,321 Myra, honey! 336 00:11:14,346 --> 00:11:15,392 Oh, please, I'd like to see her. 337 00:11:15,417 --> 00:11:17,418 Yes, of course, please. 338 00:11:22,739 --> 00:11:24,544 - Honey. - What's going on? 339 00:11:25,433 --> 00:11:26,600 I don't know. 340 00:11:26,635 --> 00:11:28,669 You poor baby. 341 00:11:28,703 --> 00:11:30,337 Myra? 342 00:11:30,372 --> 00:11:31,605 Honey? 343 00:11:31,640 --> 00:11:32,606 We're here. 344 00:11:32,641 --> 00:11:33,641 What's wrong with her? 345 00:11:33,675 --> 00:11:35,342 We don't know yet. 346 00:11:35,377 --> 00:11:36,744 She collapsed in the bathroom 347 00:11:36,778 --> 00:11:38,279 and hasn't regained consciousness. 348 00:11:38,313 --> 00:11:39,580 We don't think it's a brain injury. 349 00:11:39,614 --> 00:11:41,749 Myra's CT scans were clear. 350 00:11:41,783 --> 00:11:44,351 Last month, her friends brought her in to the ED. 351 00:11:44,386 --> 00:11:46,253 Could that have something to do with this? 352 00:11:46,288 --> 00:11:48,455 Honey, that doctor said she was just dehydrated. 353 00:11:48,490 --> 00:11:51,659 She, uh, got an IV. She was, uh... 354 00:11:51,693 --> 00:11:53,494 she was fine. 355 00:11:53,528 --> 00:11:55,029 We checked her chart. 356 00:11:55,063 --> 00:11:56,630 Back then, Myra's tox screen and blood work 357 00:11:56,665 --> 00:11:58,966 was normal, except she was slightly anemic. 358 00:11:59,000 --> 00:12:00,834 Same as now. She vegetarian? 359 00:12:00,869 --> 00:12:01,869 Vegan. 360 00:12:01,903 --> 00:12:03,304 As long as I can remember. 361 00:12:03,338 --> 00:12:05,039 Never liked meat. [chuckles] 362 00:12:05,073 --> 00:12:06,635 Well, that would explain the anemia. 363 00:12:06,690 --> 00:12:08,424 Is there anything else you can tell us? 364 00:12:08,459 --> 00:12:11,027 Uh, she, um... 365 00:12:11,061 --> 00:12:13,229 What? 366 00:12:13,264 --> 00:12:15,565 No, it's just, uh, it was finals week, 367 00:12:15,599 --> 00:12:17,534 so she wasn't really, like, eating, 368 00:12:17,568 --> 00:12:19,035 or sleeping much at all. 369 00:12:19,069 --> 00:12:21,337 She always worked so hard. 370 00:12:21,372 --> 00:12:23,873 I tell her all the time, she needs to rest. 371 00:12:23,908 --> 00:12:27,210 How do you know all that? 372 00:12:27,244 --> 00:12:28,578 I've been staying with her. 373 00:12:28,612 --> 00:12:30,280 [scoffs] Since when? 374 00:12:30,314 --> 00:12:33,683 - [wheezing] - [machine beeping] 375 00:12:33,717 --> 00:12:35,084 Myra? 376 00:12:35,119 --> 00:12:36,419 She's tachycardic and tachypneic. 377 00:12:36,453 --> 00:12:37,720 That means her heart is racing 378 00:12:37,755 --> 00:12:38,721 and she's having trouble breathing. 379 00:12:38,756 --> 00:12:40,123 We need to intubate her. 380 00:12:40,157 --> 00:12:41,624 Please let the doctors help her, okay? 381 00:12:41,659 --> 00:12:43,860 - My baby, no, oh, God. - Please, okay? 382 00:12:43,894 --> 00:12:45,628 Let's get an EEG and LP, 383 00:12:45,663 --> 00:12:48,064 an antibiotics and antiviral, just in case. 384 00:12:48,098 --> 00:12:49,198 Gram of Ceftriaxone, 385 00:12:49,233 --> 00:12:50,967 500 milligrams Acyclovir. 386 00:12:51,001 --> 00:12:52,802 Why is it happening? Why? 387 00:12:52,836 --> 00:12:55,805 [dramatic music] 388 00:12:55,839 --> 00:12:57,874 389 00:12:57,908 --> 00:13:00,043 And lift. 390 00:13:00,077 --> 00:13:01,744 I still would've landed the grafts 391 00:13:01,779 --> 00:13:05,448 more distal, but your way worked, too. 392 00:13:05,482 --> 00:13:07,717 I'll take that as a "nice job." 393 00:13:07,751 --> 00:13:09,552 Didn't know my approval meant so much to you. 394 00:13:09,587 --> 00:13:13,790 Always on, aren't you? 395 00:13:13,824 --> 00:13:16,459 "Always on." What does that mean? 396 00:13:16,493 --> 00:13:19,329 Nothing. It's just, um... 397 00:13:19,363 --> 00:13:21,164 steel sharpening steel. 398 00:13:21,198 --> 00:13:23,967 Hmm, can't say I'm any more enlightened. 399 00:13:24,001 --> 00:13:25,835 [heart monitor beeps rapidly] 400 00:13:25,869 --> 00:13:27,437 BP's falling. We're in to the 80s. 401 00:13:27,471 --> 00:13:28,738 Anterior lateral ST elevations. 402 00:13:28,772 --> 00:13:30,239 Damn it. Cardiac ischemia. 403 00:13:30,274 --> 00:13:32,141 One of your grafts must have went down. 404 00:13:32,176 --> 00:13:33,343 All right, get him back on the table. 405 00:13:33,377 --> 00:13:34,911 I'll go back in to fix the graft. 406 00:13:34,945 --> 00:13:35,945 No, we've already broken down the room. 407 00:13:35,980 --> 00:13:37,113 By the time we re-prep, 408 00:13:37,147 --> 00:13:38,114 we'll have lost too much time. 409 00:13:38,148 --> 00:13:39,482 IR's a better option. 410 00:13:39,516 --> 00:13:41,184 What about the hybrid room? 411 00:13:41,218 --> 00:13:42,919 I have it booked for a stenotic dialysis arm graft. 412 00:13:42,953 --> 00:13:44,287 I'll bump it and cath Ray. 413 00:13:44,321 --> 00:13:45,955 If I can't fix the issue noninvasively, 414 00:13:45,990 --> 00:13:47,757 room's already prepped for us to re-open him up. 415 00:13:47,791 --> 00:13:49,759 Dr. Rhodes? 416 00:13:49,793 --> 00:13:51,160 [dramatic music] 417 00:13:51,195 --> 00:13:52,295 It's a good idea. 418 00:13:52,329 --> 00:13:53,963 Okay, let's go. 419 00:13:53,998 --> 00:14:01,004 420 00:14:03,407 --> 00:14:05,475 Myra's lumbar puncture was negative. 421 00:14:05,509 --> 00:14:06,776 There's no infection. 422 00:14:06,810 --> 00:14:10,113 However, her EEG was positive for seizures. 423 00:14:10,147 --> 00:14:11,447 We've put her on Ativan, 424 00:14:11,482 --> 00:14:13,483 but unfortunately, they haven't subsided. 425 00:14:13,517 --> 00:14:14,851 Myra's always been so healthy. 426 00:14:14,885 --> 00:14:16,285 I just don't understand. 427 00:14:16,320 --> 00:14:18,187 But the Ativan, it'll work, right? 428 00:14:18,222 --> 00:14:19,722 Well, we're gonna do an MRI 429 00:14:19,757 --> 00:14:21,324 to get a closer look at her brain, 430 00:14:21,358 --> 00:14:24,127 see if there's something that the CT didn't pick up. 431 00:14:24,161 --> 00:14:25,294 - Oh, my God. - What... what's happening? 432 00:14:25,329 --> 00:14:27,030 She's posturing again. 433 00:14:27,064 --> 00:14:29,632 I'm afraid whatever's going on in her brain is getting worse. 434 00:14:29,667 --> 00:14:31,367 Her pupils are sluggish. 435 00:14:31,402 --> 00:14:32,702 Bolus another five milligrams 436 00:14:32,736 --> 00:14:33,970 of Ativan on top of the drip 437 00:14:34,004 --> 00:14:35,672 and get her up to MRI, quickly. 438 00:14:35,706 --> 00:14:36,906 Hey, can I... can I go with her? 439 00:14:36,940 --> 00:14:37,907 Sure. 440 00:14:37,941 --> 00:14:39,909 No, no. 441 00:14:39,943 --> 00:14:43,079 Eric, you stay with us. 442 00:14:43,113 --> 00:14:45,481 I'm gonna order an echo, check for heart vegetations. 443 00:14:45,516 --> 00:14:47,016 You're thinking sepsis, 444 00:14:47,051 --> 00:14:49,318 but her white blood cell count was totally normal. 445 00:14:49,353 --> 00:14:50,887 Everything was normal the last time she was here, 446 00:14:50,921 --> 00:14:52,722 too, but she's back, even worse than before. 447 00:14:52,756 --> 00:14:54,257 Ethan, these two ED visits 448 00:14:54,291 --> 00:14:55,825 could be totally unrelated. 449 00:14:55,859 --> 00:14:56,993 No, I think they missed something last time. 450 00:14:57,027 --> 00:14:57,994 Missed what? 451 00:14:58,028 --> 00:14:59,162 I don't know. 452 00:14:59,196 --> 00:15:00,563 453 00:15:00,597 --> 00:15:03,332 [sighs] 454 00:15:03,367 --> 00:15:04,600 Don't beat yourself up, Connor. 455 00:15:04,635 --> 00:15:06,235 Grafts fail, 456 00:15:06,270 --> 00:15:08,071 often in patients with far less calcification 457 00:15:08,105 --> 00:15:09,105 than Ray. 458 00:15:09,139 --> 00:15:10,540 Doesn't make any sense. 459 00:15:10,574 --> 00:15:12,341 I checked every graft before I closed. 460 00:15:12,376 --> 00:15:13,342 They were solid. 461 00:15:13,377 --> 00:15:14,677 They still are. 462 00:15:14,712 --> 00:15:16,846 Good flow through all repaired vessels. 463 00:15:16,880 --> 00:15:18,347 One, two, three. 464 00:15:18,382 --> 00:15:19,949 The problem is here. 465 00:15:19,983 --> 00:15:22,185 Clot of the left anterior descending artery. 466 00:15:22,219 --> 00:15:24,387 Likely a bad reaction to the protamine 467 00:15:24,421 --> 00:15:26,122 administered during anesthesia. 468 00:15:26,156 --> 00:15:27,623 Recommendations on how to proceed? 469 00:15:27,658 --> 00:15:29,792 Treat noninvasively with heparin. 470 00:15:29,827 --> 00:15:31,127 Thin the blood, let his heart 471 00:15:31,161 --> 00:15:32,695 clear the clot out on its own. 472 00:15:32,730 --> 00:15:34,030 Too conservative. Clot's already stopped up 473 00:15:34,064 --> 00:15:35,765 the vessel. The LAD is the widow-maker. 474 00:15:35,799 --> 00:15:37,700 If it's down much longer, Ray's not coming back. 475 00:15:37,735 --> 00:15:40,036 We've got to suck it out. 476 00:15:40,070 --> 00:15:41,738 I agree with Dr. Bekker. 477 00:15:41,772 --> 00:15:43,873 Thrombo-aspiration, though the riskier procedure, 478 00:15:43,907 --> 00:15:46,476 ensures complete removal of the blockage. 479 00:15:46,510 --> 00:15:47,777 Excuse me, Dr. Rhodes. 480 00:15:47,811 --> 00:15:53,382 481 00:15:53,417 --> 00:15:56,486 Alex's tox screen's negative for methamphetamine. 482 00:15:56,520 --> 00:15:58,154 Negative for all drugs, in fact... he's clean. 483 00:15:58,188 --> 00:16:00,089 Yeah, I saw the report. 484 00:16:00,124 --> 00:16:02,091 So now can we start him on a course of anti-psychotics? 485 00:16:02,126 --> 00:16:05,328 I'm just still not convinced it's schizophrenia. 486 00:16:05,362 --> 00:16:06,996 How? He's presented with 487 00:16:07,030 --> 00:16:08,631 more than enough evidence of a thought disorder 488 00:16:08,665 --> 00:16:09,999 to warrant the diagnosis. 489 00:16:10,033 --> 00:16:11,434 Yeah, but even so, before today, 490 00:16:11,468 --> 00:16:12,969 I mean, his medical record's clean. 491 00:16:13,003 --> 00:16:15,138 History doesn't track with schizophrenia. 492 00:16:15,172 --> 00:16:16,739 Or meth addiction. 493 00:16:16,774 --> 00:16:17,840 He doesn't fit the profile of a user, either. 494 00:16:17,875 --> 00:16:19,308 Just 'cause he's clean today, 495 00:16:19,343 --> 00:16:21,744 doesn't mean he's free of the drug. 496 00:16:21,779 --> 00:16:23,246 So that's what the fan is for? 497 00:16:23,280 --> 00:16:25,615 White noise, Dr. Charles? Really? 498 00:16:25,649 --> 00:16:26,682 Yes, really. 499 00:16:26,717 --> 00:16:28,417 White noise has been proven 500 00:16:28,452 --> 00:16:30,686 to trigger auditory hallucinations 501 00:16:30,721 --> 00:16:32,622 in meth users. 502 00:16:32,656 --> 00:16:33,756 How long have you been waiting 503 00:16:33,791 --> 00:16:34,824 for something to happen? 504 00:16:34,858 --> 00:16:36,192 [sighs] 505 00:16:36,226 --> 00:16:37,527 Hm, seven or eight minutes. 506 00:16:37,561 --> 00:16:39,929 How long does it usually take? 507 00:16:39,963 --> 00:16:42,832 Two or three. 508 00:16:42,866 --> 00:16:44,200 Probably not meth. Go ahead, 509 00:16:44,234 --> 00:16:46,903 start anti-psychotics. 510 00:16:49,807 --> 00:16:52,408 Two of Haldol... 511 00:16:54,211 --> 00:16:55,444 Dr. Charles... 512 00:16:55,479 --> 00:16:57,180 [dramatic music] 513 00:16:57,214 --> 00:16:58,614 Oh, my God. 514 00:16:58,649 --> 00:17:00,016 Alex... get his hand, get his hand! 515 00:17:00,050 --> 00:17:03,886 I needed it gone. Just see... wait! 516 00:17:03,921 --> 00:17:05,188 Help! We need some help in here! 517 00:17:05,222 --> 00:17:08,124 [breathing rapidly] 518 00:17:08,158 --> 00:17:09,559 What happened? 519 00:17:09,593 --> 00:17:11,027 He used a pen to pop the stitches 520 00:17:11,061 --> 00:17:12,061 and chisel through his abdominal wall. 521 00:17:12,095 --> 00:17:13,850 - Clearly. - All right, no time to re-pack. 522 00:17:13,875 --> 00:17:15,298 Got to scoop and move. Saline. 523 00:17:15,332 --> 00:17:17,500 Okay, call OR. Tell them we're coming immediately. 524 00:17:17,534 --> 00:17:18,701 Let's go! 525 00:17:18,735 --> 00:17:20,203 Okay, go, go, go! 526 00:17:20,237 --> 00:17:27,276 527 00:17:31,964 --> 00:17:34,550 Hmm, sweet potato or quinoa? 528 00:17:36,147 --> 00:17:38,148 Noah's menu. 529 00:17:38,260 --> 00:17:39,593 Why don't you feed yourself 530 00:17:39,628 --> 00:17:41,295 before the next wave of orders coming down? 531 00:17:41,329 --> 00:17:42,863 You've been ripping and running all day. 532 00:17:42,898 --> 00:17:45,900 Exactly why I need to get this done now. 533 00:17:48,136 --> 00:17:49,603 - Dr. Manning? - Yes. 534 00:17:49,638 --> 00:17:51,144 We think we know what might have caused this. 535 00:17:51,183 --> 00:17:52,206 Eric. 536 00:17:52,240 --> 00:17:53,574 Myra got sick while he was staying with her. 537 00:17:53,608 --> 00:17:54,942 We never wanted him around our daughter. 538 00:17:54,967 --> 00:17:55,933 He's a bad influence. 539 00:17:55,958 --> 00:17:57,525 He never applied himself. 540 00:17:57,559 --> 00:17:59,026 He's the opposite of Myra. 541 00:17:59,061 --> 00:18:00,628 No job, hangs out with a bunch of deadbeats. 542 00:18:00,662 --> 00:18:02,463 We kicked him out because he was stealing from us. 543 00:18:02,498 --> 00:18:04,532 He takes drugs. 544 00:18:04,566 --> 00:18:06,801 I'm sorry. I'm... I'm not following. 545 00:18:06,835 --> 00:18:08,269 He probably slipped her something. 546 00:18:08,303 --> 00:18:09,804 A drug of some sort. 547 00:18:09,838 --> 00:18:11,172 There's no evidence of that. 548 00:18:11,206 --> 00:18:12,507 Well, are you sure? Because if you knew 549 00:18:12,541 --> 00:18:13,508 what it was... 550 00:18:13,542 --> 00:18:14,675 I understand that 551 00:18:14,710 --> 00:18:16,277 this is a very difficult time, 552 00:18:16,311 --> 00:18:17,979 but the best thing we can do right now 553 00:18:18,013 --> 00:18:19,614 is wait for the MRI to come back, 554 00:18:19,648 --> 00:18:22,116 and I promise, as soon as we hear anything, 555 00:18:22,151 --> 00:18:24,152 you will be the first to know. 556 00:18:24,186 --> 00:18:25,520 Okay? 557 00:18:25,554 --> 00:18:27,188 - [scoffs] - All right. 558 00:18:27,222 --> 00:18:29,056 [scoffs] 559 00:18:29,091 --> 00:18:30,825 They're blaming Eric for this? 560 00:18:30,859 --> 00:18:32,160 How is this his fault? 561 00:18:32,194 --> 00:18:33,361 They're desperate, looking for answers, 562 00:18:33,395 --> 00:18:34,629 and we don't know the whole story. 563 00:18:34,663 --> 00:18:36,364 Family dynamics can be complicated. 564 00:18:36,398 --> 00:18:37,999 Doesn't matter. It's family. 565 00:18:38,033 --> 00:18:39,801 It's blood. Time like this, 566 00:18:39,835 --> 00:18:41,235 they should be banding together, 567 00:18:41,270 --> 00:18:43,171 not ostracizing one of their own. 568 00:18:43,205 --> 00:18:46,474 I'd expect you to say that. 569 00:18:46,508 --> 00:18:48,142 This again? Really? 570 00:18:48,177 --> 00:18:49,410 [scoffs] 571 00:18:49,444 --> 00:18:51,078 Here we go. 572 00:18:51,113 --> 00:18:54,382 [somber music] 573 00:18:54,416 --> 00:18:56,217 You've got a soft spot for family, 574 00:18:56,251 --> 00:18:58,186 sometimes at your own expense. 575 00:18:58,220 --> 00:18:59,520 Planning meals for Noah 576 00:18:59,555 --> 00:19:01,088 when you're slammed at work, for example. 577 00:19:01,123 --> 00:19:03,157 Helping my brother when he's exhausted. 578 00:19:03,192 --> 00:19:04,892 That's a bad thing in your eyes? 579 00:19:04,927 --> 00:19:06,494 580 00:19:06,528 --> 00:19:09,330 The day I turned 18, it was sink-or-swim. 581 00:19:09,364 --> 00:19:11,365 Noah's a grown man, April. 582 00:19:11,400 --> 00:19:12,834 You're not doing him any favors 583 00:19:12,868 --> 00:19:15,102 by constantly picking up his slack. 584 00:19:15,137 --> 00:19:16,404 Some point, we've all got to learn 585 00:19:16,438 --> 00:19:18,739 to go it alone. 586 00:19:18,774 --> 00:19:21,375 I'd expect you to say that. 587 00:19:21,410 --> 00:19:25,713 588 00:19:25,747 --> 00:19:27,114 [sighs] 589 00:19:27,149 --> 00:19:33,020 590 00:19:33,055 --> 00:19:34,555 All right, think we're there. 591 00:19:34,590 --> 00:19:37,225 592 00:19:37,259 --> 00:19:39,927 Vacuuming. 593 00:19:39,962 --> 00:19:41,229 Got it. 594 00:19:41,263 --> 00:19:43,231 595 00:19:43,265 --> 00:19:45,233 Ah, blood flow's good. 596 00:19:45,267 --> 00:19:46,567 BP's holding. 597 00:19:46,602 --> 00:19:48,870 Nice job. 598 00:19:48,904 --> 00:19:51,038 Thanks. 599 00:19:51,073 --> 00:19:53,307 Look, I know I have a tendency to step on toes, 600 00:19:53,342 --> 00:19:54,775 Not personal. I just want to... 601 00:19:54,810 --> 00:19:56,277 Win? 602 00:19:56,311 --> 00:19:57,879 603 00:19:57,913 --> 00:19:59,080 [heart monitor beeping rapidly] 604 00:19:59,114 --> 00:20:01,048 What happened? 605 00:20:01,083 --> 00:20:02,583 Artery ruptured. 606 00:20:02,618 --> 00:20:04,418 Blood is pouring into his chest. 607 00:20:04,453 --> 00:20:06,320 Blood flow was blocked, and now it's out of control. 608 00:20:06,355 --> 00:20:07,822 All right, help me stent the leak 609 00:20:07,856 --> 00:20:09,156 - before he arrests. - Where's the rupture? 610 00:20:09,191 --> 00:20:10,958 - Distal LAD. - Are you kidding? 611 00:20:10,993 --> 00:20:12,393 That's not even where the clot was. 612 00:20:12,427 --> 00:20:13,895 It's an entirely different section of vessel. 613 00:20:13,929 --> 00:20:15,229 [dramatic music] 614 00:20:15,264 --> 00:20:17,965 Murphy's Law. 615 00:20:27,175 --> 00:20:28,976 How's he doing? 616 00:20:29,011 --> 00:20:30,444 A few more feet to go, 617 00:20:30,479 --> 00:20:34,081 but no perforations to the bowel. 618 00:20:34,116 --> 00:20:36,117 I was just standing there. 619 00:20:36,151 --> 00:20:37,518 Meanwhile, he was ripping himself open 620 00:20:37,552 --> 00:20:39,153 with a pen? Wait. 621 00:20:39,187 --> 00:20:42,089 The extra Versed. 622 00:20:42,124 --> 00:20:43,958 It completely tranqed him out. 623 00:20:43,992 --> 00:20:47,461 But if I hadn't given it to him, who knows? 624 00:20:47,496 --> 00:20:49,497 I mean, Alex was intent on harming himself. 625 00:20:49,531 --> 00:20:51,132 He could have attacked one of us. 626 00:20:51,166 --> 00:20:53,334 627 00:20:53,368 --> 00:20:55,369 What the hell? 628 00:20:55,404 --> 00:20:56,437 There's something embedded 629 00:20:56,471 --> 00:20:58,706 deep in his left gutter, next to the colon. 630 00:20:58,740 --> 00:21:03,644 631 00:21:03,679 --> 00:21:04,712 What is it? 632 00:21:04,746 --> 00:21:06,547 I have no idea. 633 00:21:06,581 --> 00:21:10,651 634 00:21:10,686 --> 00:21:12,987 Did you see this? Myra's MRI. 635 00:21:13,021 --> 00:21:14,555 Global edema in the brain. 636 00:21:14,589 --> 00:21:16,457 Two hours ago, there was no sign of swelling. 637 00:21:16,491 --> 00:21:18,626 Echo was clean, too. It's not sepsis. 638 00:21:18,660 --> 00:21:21,829 Or encephalitis, meningitis, HSV, CMV. 639 00:21:21,863 --> 00:21:24,031 We need to brainstorm zebras. 640 00:21:24,066 --> 00:21:26,467 Paraneoplastic syndrome? Usually presents with a fever, 641 00:21:26,501 --> 00:21:28,469 but there could be cancer cells in her spinal fluid. 642 00:21:28,503 --> 00:21:30,204 Or another autoimmune, lupus, 643 00:21:30,238 --> 00:21:32,139 sarcoid, some kind of tumor... 644 00:21:32,174 --> 00:21:33,975 What about FilmArray PCR tests? 645 00:21:34,009 --> 00:21:36,344 I'll draw paraneoplastic and autoimmune panels. 646 00:21:36,378 --> 00:21:37,845 Have a lab put a rush on 'em. 647 00:21:37,879 --> 00:21:39,714 I'll talk to hem-onc, get bone and PET scans. 648 00:21:39,748 --> 00:21:41,248 Okay. 649 00:21:41,283 --> 00:21:43,217 Myra's mom says she's been busting her ass 650 00:21:43,251 --> 00:21:44,652 for this fellowship in New Zealand. 651 00:21:44,686 --> 00:21:47,054 She got it. 652 00:21:47,089 --> 00:21:49,090 She's just starting her life. 653 00:21:49,124 --> 00:21:51,993 We keep testing till we find out what's wrong. 654 00:21:52,027 --> 00:21:53,527 Yeah. 655 00:21:57,265 --> 00:21:58,499 Dr. Halstead, 656 00:21:58,533 --> 00:21:59,767 I've been reviewing the write-up 657 00:21:59,801 --> 00:22:02,036 of our self-surgery patient, Alex. 658 00:22:02,070 --> 00:22:03,270 Not bad, but I think 659 00:22:03,305 --> 00:22:04,672 some small additions to the chart 660 00:22:04,706 --> 00:22:05,673 are in order. 661 00:22:05,707 --> 00:22:07,174 Additions? 662 00:22:07,209 --> 00:22:09,043 Perhaps "elaborations" is the better word. 663 00:22:09,077 --> 00:22:11,345 Regarding the initial intake, you noted, 664 00:22:11,380 --> 00:22:13,547 "Wound lavaged and closed." I was there. 665 00:22:13,582 --> 00:22:16,417 It was a little more than that. 666 00:22:16,451 --> 00:22:18,452 I think we should say, "We lavaged 667 00:22:18,487 --> 00:22:20,454 "and irrigated with chlorhexidine 668 00:22:20,489 --> 00:22:23,924 and two liters of normal saline," okay? 669 00:22:23,959 --> 00:22:26,227 "Six-inch lacerations repaired in two layers 670 00:22:26,261 --> 00:22:29,964 "with 60 interrupted 2-0 nylon sutures." 671 00:22:29,998 --> 00:22:31,799 You don't think that's overdoing it a little bit? 672 00:22:31,833 --> 00:22:34,268 Absolutely not. This is exactly what we did. 673 00:22:34,302 --> 00:22:35,636 So you'll adjust? 674 00:22:35,670 --> 00:22:37,538 - Yes? - Yes. 675 00:22:37,572 --> 00:22:39,140 Residence charts, too. 676 00:22:39,174 --> 00:22:40,141 Yes. 677 00:22:40,175 --> 00:22:42,243 Good man. 678 00:22:45,781 --> 00:22:47,715 The art of charting. 679 00:22:47,749 --> 00:22:49,784 The one thing I didn't learn in residency. 680 00:22:49,818 --> 00:22:52,086 I'll look them over. 681 00:22:52,120 --> 00:22:54,555 Thanks. 682 00:22:57,025 --> 00:22:58,759 I... don't understand. 683 00:22:58,794 --> 00:23:01,062 What are you... what are you saying? 684 00:23:01,096 --> 00:23:02,263 We did what's called 685 00:23:02,297 --> 00:23:03,898 a nuclear blood flow study 686 00:23:03,932 --> 00:23:06,167 and it showed no circulation to her brain. 687 00:23:06,201 --> 00:23:08,135 Well, there must be some other test you can run. 688 00:23:08,170 --> 00:23:11,072 They've all been negative. 689 00:23:11,106 --> 00:23:13,007 Something else you can do. 690 00:23:13,041 --> 00:23:14,141 I'm sorry. 691 00:23:14,176 --> 00:23:15,342 There isn't. 692 00:23:15,377 --> 00:23:18,145 [cries] 693 00:23:18,180 --> 00:23:20,448 We've done everything we can, 694 00:23:20,482 --> 00:23:23,150 but unfortunately, your daughter is brain-dead. 695 00:23:23,185 --> 00:23:24,418 [pants] 696 00:23:24,453 --> 00:23:25,753 No... 697 00:23:25,787 --> 00:23:27,288 [sobbing] No... 698 00:23:27,322 --> 00:23:28,923 Okay. 699 00:23:28,957 --> 00:23:30,458 - Our little girl... - I'm so sorry... 700 00:23:30,492 --> 00:23:31,959 No, no, no, no, no. 701 00:23:31,993 --> 00:23:33,094 She's gonna wake up. She's gonna be fine. 702 00:23:33,128 --> 00:23:35,162 Myra? Myra... 703 00:23:35,197 --> 00:23:37,098 My baby. 704 00:23:37,132 --> 00:23:38,632 Myra. 705 00:23:38,667 --> 00:23:41,135 She's gone, sweetie. 706 00:23:41,169 --> 00:23:43,304 Your little girl's gone. 707 00:23:43,338 --> 00:23:46,140 [somber music] 708 00:23:46,174 --> 00:23:47,641 We'll give you some time with her. 709 00:23:47,676 --> 00:23:48,709 No... 710 00:23:48,743 --> 00:23:50,644 Our baby... 711 00:23:50,679 --> 00:23:52,513 [cries] 712 00:23:52,547 --> 00:23:55,216 Oh, baby... 713 00:23:55,383 --> 00:23:57,485 [cries] 714 00:23:57,519 --> 00:23:59,753 715 00:24:07,780 --> 00:24:09,279 Excuse me. 716 00:24:09,313 --> 00:24:10,947 Mr. Adams. 717 00:24:10,981 --> 00:24:13,582 Our daughter was always doing things for other people. 718 00:24:13,617 --> 00:24:15,651 She told us if anything ever happened to her, 719 00:24:15,702 --> 00:24:17,453 she, uh... 720 00:24:17,487 --> 00:24:19,789 wanted to donate her organs. 721 00:24:19,823 --> 00:24:21,123 Of course. 722 00:24:21,158 --> 00:24:23,459 We'll get that started. 723 00:24:23,493 --> 00:24:25,995 We want her life to have meant something. 724 00:24:26,029 --> 00:24:27,463 We understand. 725 00:24:27,497 --> 00:24:29,331 [breathes raggedly] Thank you. 726 00:24:29,366 --> 00:24:30,800 Of course. 727 00:24:30,834 --> 00:24:34,003 You're high. Look at you! 728 00:24:34,037 --> 00:24:35,337 You're high. 729 00:24:35,372 --> 00:24:38,367 Your sister's dead and you're high! 730 00:24:38,909 --> 00:24:42,258 Wait, Myra's, uh... de...? 731 00:24:42,303 --> 00:24:43,704 She's dead? 732 00:24:43,766 --> 00:24:44,933 Ah... 733 00:24:44,967 --> 00:24:47,035 This is your fault, isn't it? 734 00:24:47,069 --> 00:24:48,536 You did this. 735 00:24:48,571 --> 00:24:51,206 See? I told you he is no good. 736 00:24:51,240 --> 00:24:53,775 He is a drug addict. 737 00:24:53,809 --> 00:24:55,977 What did you give her? 738 00:24:56,012 --> 00:24:57,612 Nothing. 739 00:24:57,646 --> 00:25:00,448 We told you. Myra's tox screen was negative. 740 00:25:00,483 --> 00:25:03,051 You worthless piece of.... 741 00:25:03,085 --> 00:25:04,319 - Oh. - Whoa. 742 00:25:04,353 --> 00:25:05,487 Get out. 743 00:25:05,521 --> 00:25:07,756 [dramatic music] 744 00:25:07,790 --> 00:25:09,124 Get out! 745 00:25:09,158 --> 00:25:16,197 746 00:25:28,144 --> 00:25:29,944 He's moving in the wrong direction. 747 00:25:29,979 --> 00:25:31,446 He'll turn around. 748 00:25:31,480 --> 00:25:33,348 Your optimism is enchanting. 749 00:25:33,382 --> 00:25:34,582 Reality, though: 750 00:25:34,617 --> 00:25:35,950 between the clot, then the bleed, 751 00:25:35,985 --> 00:25:37,419 his heart is dying. 752 00:25:37,453 --> 00:25:39,788 We should push for a transplant. 753 00:25:39,822 --> 00:25:41,189 We're only a few hours post-op. 754 00:25:41,223 --> 00:25:43,091 We are miles away from that discussion. 755 00:25:43,125 --> 00:25:44,859 Normally, yes, 756 00:25:44,894 --> 00:25:47,629 but a hit-and-run just died in surgery. 757 00:25:47,663 --> 00:25:49,297 His heart is an HLA match. 758 00:25:49,331 --> 00:25:50,765 You already tested for compatibility? 759 00:25:50,800 --> 00:25:52,300 Ray's not even on the list. 760 00:25:52,334 --> 00:25:54,302 Anything that could go wrong with Ray has. 761 00:25:54,336 --> 00:25:56,938 We fix one thing, something else breaks. 762 00:25:56,972 --> 00:25:58,640 A heart has fallen into our laps. 763 00:25:58,674 --> 00:26:00,442 Let's use it and steal a win. 764 00:26:00,476 --> 00:26:02,444 Is that our priority? 765 00:26:02,478 --> 00:26:04,145 You want his death on your record? 766 00:26:04,180 --> 00:26:06,214 Dr. Bekker, you may have elbowed your way 767 00:26:06,248 --> 00:26:09,651 onto Ray's case, but he's still my patient. 768 00:26:09,685 --> 00:26:11,886 Transplant's not an option. 769 00:26:11,921 --> 00:26:13,488 Then you're just wasting time, 770 00:26:13,522 --> 00:26:16,024 because the balloon pump he's on won't hold. 771 00:26:16,058 --> 00:26:17,392 He'll max out on pressors 772 00:26:17,426 --> 00:26:19,360 but he'll still need to go on VA-ECMO. 773 00:26:19,395 --> 00:26:20,728 Then it gets invasive: 774 00:26:20,763 --> 00:26:22,163 a procedure for a temporary LVAD. 775 00:26:22,198 --> 00:26:23,631 When that's not enough, 776 00:26:23,666 --> 00:26:25,166 a bigger procedure for a permanent one. 777 00:26:25,201 --> 00:26:27,035 You're going to put Ray through months of 778 00:26:27,069 --> 00:26:29,137 physical and emotional strain, only to get back to 779 00:26:29,171 --> 00:26:31,039 exactly where we are right now. 780 00:26:31,073 --> 00:26:33,241 Ray's arteries were bad, not his heart. 781 00:26:33,275 --> 00:26:34,742 Now that the vessels are repaired, 782 00:26:34,777 --> 00:26:37,479 it will compensate for the clot and the bleed. 783 00:26:37,513 --> 00:26:39,080 It'll heal. 784 00:26:39,115 --> 00:26:41,316 No, it won't. 785 00:26:41,350 --> 00:26:42,750 And when I'm right, 786 00:26:42,785 --> 00:26:45,753 I'll make sure the blame is on you, not me. 787 00:26:45,788 --> 00:26:49,524 [tense music] 788 00:26:49,558 --> 00:26:52,393 Wow. 789 00:26:52,428 --> 00:26:54,529 I guess there was something 790 00:26:54,563 --> 00:26:57,699 living inside Alex. 791 00:26:57,733 --> 00:26:59,734 I'm still not exactly sure what I'm looking at. 792 00:26:59,768 --> 00:27:01,536 Is it a tumor? 793 00:27:01,570 --> 00:27:02,904 Possibly. 794 00:27:02,938 --> 00:27:05,874 Or it could be a fetus in fetu: 795 00:27:05,908 --> 00:27:08,776 a twin that her absorbed in utero. 796 00:27:08,811 --> 00:27:10,378 Either way, 797 00:27:10,412 --> 00:27:13,948 it's not a result of schizophrenia or meth. 798 00:27:13,983 --> 00:27:15,884 How about that? 799 00:27:15,918 --> 00:27:17,418 That's gotta be so rare. 800 00:27:17,453 --> 00:27:19,087 To say the least. 801 00:27:19,121 --> 00:27:21,723 It's very cool. 802 00:27:21,757 --> 00:27:24,459 Hm. 803 00:27:24,493 --> 00:27:26,394 But how did he... 804 00:27:26,428 --> 00:27:28,363 know, not only that there was something inside him, 805 00:27:28,397 --> 00:27:29,464 but exactly where it was? 806 00:27:29,498 --> 00:27:30,765 Beats me. 807 00:27:30,799 --> 00:27:32,534 And after all the advances we've made, 808 00:27:32,568 --> 00:27:34,936 splicing the genome, reprogramming viruses, 809 00:27:34,970 --> 00:27:36,538 mapping the brain... 810 00:27:36,572 --> 00:27:38,706 in this case, you know, just completely trumped 811 00:27:38,741 --> 00:27:40,608 by human instinct. 812 00:27:40,643 --> 00:27:42,310 Everything I've learned about human nature, 813 00:27:42,344 --> 00:27:45,880 I still can't see things coming. 814 00:27:45,915 --> 00:27:48,883 He scared you? 815 00:27:48,918 --> 00:27:50,485 There's risk in our work. 816 00:27:50,519 --> 00:27:52,287 I guess I realized a long time ago, 817 00:27:52,321 --> 00:27:55,890 you... you choose to see the threat 818 00:27:55,925 --> 00:27:57,892 or the opportunity. 819 00:27:57,927 --> 00:28:00,895 [solemn music] 820 00:28:00,930 --> 00:28:07,936 821 00:28:11,373 --> 00:28:14,409 [distant siren wailing] 822 00:28:18,314 --> 00:28:20,348 Hey, Eric. 823 00:28:20,382 --> 00:28:22,083 Hey, uh, listen, 824 00:28:22,117 --> 00:28:23,651 the last thing that I need right now is a lecture. 825 00:28:23,686 --> 00:28:26,721 Hey, I'm here for me as much as I am for you. 826 00:28:29,391 --> 00:28:31,492 What happened back there... 827 00:28:31,527 --> 00:28:32,860 sometimes, when people are grieving, 828 00:28:32,895 --> 00:28:34,028 they lash out. 829 00:28:34,063 --> 00:28:35,196 Yeah, no, that's... 830 00:28:35,231 --> 00:28:37,498 that's how my folks always are. 831 00:28:37,533 --> 00:28:39,267 Man, they think I'm, uh... 832 00:28:39,301 --> 00:28:43,471 I'm worthless. 833 00:28:43,505 --> 00:28:46,107 I don't know. May... maybe I am, 834 00:28:46,141 --> 00:28:47,675 but they think I want to be like this, 835 00:28:47,710 --> 00:28:51,312 and... and I really don't. 836 00:28:51,347 --> 00:28:52,680 Uh, you know, My-Myra... 837 00:28:52,715 --> 00:28:54,382 she was the only one who ever, like... 838 00:28:54,416 --> 00:28:56,551 like, really, like... like, saw me. 839 00:28:56,585 --> 00:28:58,152 You know? 840 00:28:58,187 --> 00:29:00,188 Yeah. 841 00:29:02,391 --> 00:29:04,959 And now it's... 842 00:29:04,994 --> 00:29:07,428 [sighs] 843 00:29:09,732 --> 00:29:11,899 What do you want, Eric? 844 00:29:11,934 --> 00:29:15,003 I want to get clean. 845 00:29:15,037 --> 00:29:17,372 You know, I wanna, like, wake up 846 00:29:17,406 --> 00:29:18,906 and just feel clear. 847 00:29:18,941 --> 00:29:20,408 Okay. 848 00:29:20,442 --> 00:29:21,576 We'll set you up with a social worker, 849 00:29:21,610 --> 00:29:23,344 get you in a program. 850 00:29:23,379 --> 00:29:26,314 [laughs] Was... seriously? 851 00:29:26,348 --> 00:29:27,849 Yeah. 852 00:29:27,883 --> 00:29:29,217 You'll get the support you need, 853 00:29:29,251 --> 00:29:31,853 but it's up to you to come through. 854 00:29:31,887 --> 00:29:33,755 Why are you doing this for me? 855 00:29:33,789 --> 00:29:36,357 856 00:29:36,392 --> 00:29:37,892 I guess I'm seeing that there's a difference 857 00:29:37,926 --> 00:29:40,361 between a crutch and a helping hand. 858 00:29:40,396 --> 00:29:42,764 859 00:29:42,798 --> 00:29:44,098 Thank you. 860 00:29:44,133 --> 00:29:45,867 Yeah. 861 00:29:45,901 --> 00:29:52,573 862 00:29:52,608 --> 00:29:54,876 [laughs] 863 00:29:54,910 --> 00:29:56,344 Let's get you something to eat first, huh? 864 00:29:56,378 --> 00:29:57,545 Help you come down. 865 00:29:57,579 --> 00:29:59,747 No, no, I had a burger earlier. 866 00:29:59,782 --> 00:30:02,717 Uh, it made me, like, feel really sick. 867 00:30:02,751 --> 00:30:04,886 It's why I... I had to get high. 868 00:30:04,920 --> 00:30:06,421 You know, not to... not to feel it. 869 00:30:06,455 --> 00:30:09,123 Maybe food poisoning? 870 00:30:09,158 --> 00:30:10,458 Uh, no, I just... 871 00:30:10,492 --> 00:30:12,860 I just felt crappy, 872 00:30:12,895 --> 00:30:14,295 like I always do. 873 00:30:14,330 --> 00:30:15,897 874 00:30:15,931 --> 00:30:18,466 Always, or just after eating? 875 00:30:18,500 --> 00:30:24,339 876 00:30:26,942 --> 00:30:28,476 Hey. 877 00:30:28,510 --> 00:30:30,211 Oh, you again. 878 00:30:30,245 --> 00:30:31,913 Yeah, last guy only had a hangnail. 879 00:30:31,947 --> 00:30:33,281 Brought him in anyway. 880 00:30:33,315 --> 00:30:34,749 Okay. 881 00:30:34,783 --> 00:30:36,451 Crew's meeting at Molly's tonight. 882 00:30:36,485 --> 00:30:39,821 Come and hang? 883 00:30:39,855 --> 00:30:41,723 This sudden flirting... 884 00:30:41,757 --> 00:30:42,824 what is it? 885 00:30:42,858 --> 00:30:46,060 Have you seen you? 886 00:30:46,095 --> 00:30:47,128 You're still a catch. 887 00:30:47,162 --> 00:30:49,564 I always have been. 888 00:30:49,598 --> 00:30:51,499 You should've thought about that before you cheated. 889 00:30:51,533 --> 00:30:54,268 I'm not the same guy anymore. 890 00:30:54,303 --> 00:30:55,937 Hm. 891 00:31:00,542 --> 00:31:01,943 Barry up to something? 892 00:31:01,977 --> 00:31:03,444 I'm not sure. 893 00:31:03,479 --> 00:31:06,147 Yeah, right. This round two? 894 00:31:06,181 --> 00:31:07,482 Too much baggage. 895 00:31:07,516 --> 00:31:08,983 Mm-hmm. Make him work for it. 896 00:31:09,017 --> 00:31:09,984 Mm. 897 00:31:10,018 --> 00:31:11,786 [chuckles] 898 00:31:11,820 --> 00:31:13,187 Can I help you with something? 899 00:31:13,222 --> 00:31:14,589 No, I'm just giving today's charts 900 00:31:14,623 --> 00:31:15,957 a once-over. 901 00:31:15,991 --> 00:31:17,692 Ugh, well, you better settle in. 902 00:31:17,726 --> 00:31:19,627 Some of them are a few chapters long. 903 00:31:19,661 --> 00:31:21,763 Stohl's five-minute knee aspiration 904 00:31:21,797 --> 00:31:24,031 reads like "War and Peace." 905 00:31:24,066 --> 00:31:26,100 Hey, Nat, I was speaking with Eric 906 00:31:26,135 --> 00:31:27,535 The drugs... he's self-medicating. 907 00:31:27,569 --> 00:31:28,936 Since he was a kid, 908 00:31:28,971 --> 00:31:31,005 he's gotten sick after eating protein. 909 00:31:31,039 --> 00:31:32,540 Myra was a vegan... avoided protein. 910 00:31:32,574 --> 00:31:34,175 You're thinking that's what made her sick, too? 911 00:31:34,209 --> 00:31:35,977 Last month, when Myra was feeling confused, 912 00:31:36,011 --> 00:31:37,712 she was fasting while studying. 913 00:31:37,746 --> 00:31:39,647 Ketosis. 914 00:31:39,681 --> 00:31:41,149 Her body was starving, 915 00:31:41,183 --> 00:31:42,784 so it started digesting muscle as fuel, 916 00:31:42,818 --> 00:31:45,186 which released protein into her blood. 917 00:31:45,220 --> 00:31:47,121 Okay, well, that explains what made her sick last month, 918 00:31:47,156 --> 00:31:48,122 but what about today? 919 00:31:48,157 --> 00:31:49,891 The fellowship. 920 00:31:49,925 --> 00:31:51,492 She probably wasn't eating again. 921 00:31:51,527 --> 00:31:53,294 I think this is OTC... a metabolic disorder fits. 922 00:31:53,328 --> 00:31:54,996 You were right. The visits were connected. 923 00:31:55,030 --> 00:31:56,564 - Yeah. - Wait. 924 00:31:56,598 --> 00:31:58,800 Did they transplant the liver yet? 925 00:31:58,834 --> 00:32:00,568 It's still up in the OR. They can't use it. 926 00:32:00,602 --> 00:32:02,503 [suspenseful music] 927 00:32:02,538 --> 00:32:03,871 If Myra had OTC, 928 00:32:03,906 --> 00:32:05,239 she couldn't break down nitrogen. 929 00:32:05,274 --> 00:32:06,507 So it built up in her body as ammonia 930 00:32:06,542 --> 00:32:07,909 and finally put her in a coma. 931 00:32:07,943 --> 00:32:09,343 And if the liver gets transplanted... 932 00:32:09,378 --> 00:32:11,412 Same thing will happen to the recipient. 933 00:32:11,447 --> 00:32:13,214 934 00:32:13,248 --> 00:32:14,482 Is the transplant finished? 935 00:32:14,516 --> 00:32:16,484 No, the last surgery ran late. 936 00:32:16,518 --> 00:32:18,686 They moved the transplant to OR 3. 937 00:32:18,720 --> 00:32:20,588 Come on. 938 00:32:20,622 --> 00:32:25,593 939 00:32:25,627 --> 00:32:27,361 Okay... 940 00:32:27,396 --> 00:32:29,063 - Stop! - What the hell? 941 00:32:29,097 --> 00:32:30,164 Liver might not be good. 942 00:32:30,199 --> 00:32:31,199 The biopsy was clean. 943 00:32:31,233 --> 00:32:32,400 It's a genetic defect. 944 00:32:32,434 --> 00:32:33,835 It wouldn't show up on the biopsy. 945 00:32:33,869 --> 00:32:34,902 I got my patient wide open, Choi. 946 00:32:34,937 --> 00:32:36,070 You transplant that liver, 947 00:32:36,104 --> 00:32:37,538 he could be dead within hours. 948 00:32:37,573 --> 00:32:38,940 We need time to test the donor's blood, 949 00:32:38,974 --> 00:32:40,942 see if she had OTC. 950 00:32:40,976 --> 00:32:42,243 951 00:32:42,277 --> 00:32:43,845 I'll pack and hold, 952 00:32:43,879 --> 00:32:45,379 but the donor's liver's only got four hours 953 00:32:45,414 --> 00:32:46,848 till it's shot, 954 00:32:46,874 --> 00:32:48,618 so move it. 955 00:32:48,750 --> 00:32:49,750 956 00:32:54,672 --> 00:32:56,171 A metabolic... 957 00:32:56,206 --> 00:32:58,140 disorder caused her death? 958 00:32:58,174 --> 00:32:59,541 The precise term is 959 00:32:59,576 --> 00:33:01,844 "ornithine transcarbamylase deficiency," 960 00:33:01,878 --> 00:33:03,979 or OTC. 961 00:33:04,013 --> 00:33:06,982 You see, Myra's liver was missing a vital enzyme 962 00:33:07,016 --> 00:33:09,485 that helps break down protein. 963 00:33:09,519 --> 00:33:11,487 Something as simple as eating a burger 964 00:33:11,521 --> 00:33:13,122 could cause toxic levels of ammonia 965 00:33:13,156 --> 00:33:15,691 to build up in her blood and attack her nervous system. 966 00:33:15,716 --> 00:33:17,550 - But Myra was a vegan. - Yeah. 967 00:33:17,594 --> 00:33:20,729 Which is how she was able to avoid symptoms for so long, 968 00:33:20,771 --> 00:33:23,399 but when she pushed herself, and didn't eat... 969 00:33:23,433 --> 00:33:25,134 finals, the fellowship... 970 00:33:25,168 --> 00:33:27,403 her body started breaking down muscle, 971 00:33:27,437 --> 00:33:30,706 which released protein into her blood. 972 00:33:30,740 --> 00:33:32,040 So, you mean, 973 00:33:32,075 --> 00:33:34,710 she'd be alive right now if she'd just... 974 00:33:34,744 --> 00:33:37,413 eaten? 975 00:33:37,447 --> 00:33:40,149 [solemn music] 976 00:33:40,183 --> 00:33:43,318 If this disease is genetic, 977 00:33:43,353 --> 00:33:45,654 that means one of us gave it to her. 978 00:33:45,688 --> 00:33:48,991 Yes, um, it is passed through the X chromosome, 979 00:33:49,025 --> 00:33:52,428 from mother to child, but... 980 00:33:52,462 --> 00:33:55,831 981 00:33:55,904 --> 00:33:59,140 OTC sufferers exhibit totally normal liver function. 982 00:33:59,191 --> 00:34:01,960 That's why all of Myra's tests came back clean. 983 00:34:01,994 --> 00:34:04,662 We were only able to diagnose her once Eric explained 984 00:34:04,697 --> 00:34:06,965 his lethargy and sickness after eating. 985 00:34:06,999 --> 00:34:09,167 We believe he has the defect as well, 986 00:34:09,201 --> 00:34:12,570 and he's been self-medicating with drugs. 987 00:34:12,605 --> 00:34:13,905 Wha...? 988 00:34:13,939 --> 00:34:16,574 Oh... 989 00:34:16,609 --> 00:34:18,910 Eric... 990 00:34:18,944 --> 00:34:21,679 is this true? 991 00:34:21,714 --> 00:34:23,581 I'm so sorry. 992 00:34:23,616 --> 00:34:25,950 Oh, son... 993 00:34:25,985 --> 00:34:28,119 Forgive us? 994 00:34:28,153 --> 00:34:30,088 Will you forgive us? 995 00:34:30,122 --> 00:34:33,091 We're so sorry. 996 00:34:33,125 --> 00:34:35,093 Oh, Eric. [crying] 997 00:34:35,127 --> 00:34:42,133 998 00:34:45,037 --> 00:34:46,371 So, how's our patient? 999 00:34:46,405 --> 00:34:47,972 Heading for ECMO? 1000 00:34:48,007 --> 00:34:49,274 Actually, no. 1001 00:34:49,308 --> 00:34:51,509 Uh, BP's risen and is holding, 1002 00:34:51,544 --> 00:34:52,710 vitals have stabilized as well, 1003 00:34:52,745 --> 00:34:55,980 so I'm going to remove the balloon pump 1004 00:34:56,015 --> 00:34:59,250 and give his heart back its full load. 1005 00:35:00,819 --> 00:35:03,288 What do you want, an "I was wrong"? 1006 00:35:03,322 --> 00:35:05,590 I'm not holding my breath. 1007 00:35:07,493 --> 00:35:09,127 Ah, I see our patient 1008 00:35:09,161 --> 00:35:10,328 is making a turn for the better. 1009 00:35:10,362 --> 00:35:11,796 For a moment, there was concern 1010 00:35:11,830 --> 00:35:13,364 the damage was irreparable. 1011 00:35:13,399 --> 00:35:14,832 A transplant option presented itself, 1012 00:35:14,867 --> 00:35:16,834 but upon discussing the visual assessment 1013 00:35:16,869 --> 00:35:18,670 of the heart during surgery, 1014 00:35:18,704 --> 00:35:19,971 the decision was made to give it more time 1015 00:35:20,005 --> 00:35:21,506 to come back on its own. 1016 00:35:21,540 --> 00:35:23,074 It was a risk, 1017 00:35:23,108 --> 00:35:26,911 but it appears we made the right choice. 1018 00:35:26,946 --> 00:35:28,546 Indeed. 1019 00:35:28,581 --> 00:35:30,548 Nice work, doctors. 1020 00:35:30,583 --> 00:35:32,150 Thank you. 1021 00:35:32,184 --> 00:35:35,353 1022 00:35:35,387 --> 00:35:38,323 You and Dr. Bekker... 1023 00:35:38,357 --> 00:35:40,425 your successes suggest a good pairing, 1024 00:35:40,459 --> 00:35:42,427 but your... 1025 00:35:42,461 --> 00:35:45,563 exchanges often convey the opposite. 1026 00:35:45,598 --> 00:35:49,601 What's peculiar is Dr. Bekker seems to enjoy this... 1027 00:35:49,635 --> 00:35:51,436 discordance. 1028 00:35:51,470 --> 00:35:53,671 Do you? 1029 00:35:53,706 --> 00:35:56,240 1030 00:35:56,275 --> 00:35:58,910 Maybe I do. 1031 00:35:58,944 --> 00:36:05,817 1032 00:36:11,557 --> 00:36:14,125 You okay? 1033 00:36:14,159 --> 00:36:16,961 We turned this hospital upside-down chasing zebras, 1034 00:36:16,996 --> 00:36:18,563 but a simple ammonia test 1035 00:36:18,597 --> 00:36:19,964 would've given us everything we needed to know. 1036 00:36:19,999 --> 00:36:22,300 There's no way you could've known. 1037 00:36:22,334 --> 00:36:24,102 Silver lining: 1038 00:36:24,136 --> 00:36:25,803 the liver transplant was stopped 1039 00:36:25,838 --> 00:36:28,573 before it was too late, and thanks to you, 1040 00:36:28,607 --> 00:36:30,575 Eric's getting the help he needs. 1041 00:36:30,609 --> 00:36:32,443 1042 00:36:32,478 --> 00:36:35,613 I may coddle my family, 1043 00:36:35,648 --> 00:36:39,150 but seems I'm not the only one with a soft spot. 1044 00:36:39,184 --> 00:36:46,224 1045 00:36:50,462 --> 00:36:52,163 Yes, yes, yes. 1046 00:36:52,197 --> 00:36:53,598 Wonderful, Dr. Halstead. 1047 00:36:53,632 --> 00:36:54,732 Above and beyond. 1048 00:36:54,767 --> 00:36:56,000 Excellent medicine, 1049 00:36:56,035 --> 00:36:57,602 and your writing for the ED. 1050 00:36:57,636 --> 00:36:59,737 It's been a good day. 1051 00:37:01,206 --> 00:37:04,509 We're gonna turn this place around. 1052 00:37:04,543 --> 00:37:08,746 He more happy about the work, or the bill? 1053 00:37:08,781 --> 00:37:10,682 So I guess the rumors are true. 1054 00:37:10,716 --> 00:37:12,250 This morning's board meeting 1055 00:37:12,284 --> 00:37:13,451 was basically an edict 1056 00:37:13,485 --> 00:37:15,186 to shake the old money tree? 1057 00:37:15,220 --> 00:37:17,588 Ah, nothing that hasn't come down the pipe before. 1058 00:37:17,623 --> 00:37:18,956 I'm handling it. 1059 00:37:18,991 --> 00:37:20,358 And these itemized charts 1060 00:37:20,392 --> 00:37:21,793 that Stohl's championing? 1061 00:37:21,827 --> 00:37:23,995 I mean, detail equals charges, right? 1062 00:37:24,029 --> 00:37:26,164 Basically a menu 1063 00:37:26,198 --> 00:37:28,766 for Billing to pad the invoices? 1064 00:37:28,801 --> 00:37:30,168 Well, I've looked at every chart 1065 00:37:30,202 --> 00:37:31,836 coming out of the ED today. 1066 00:37:31,870 --> 00:37:33,171 Each one has been accurate 1067 00:37:33,205 --> 00:37:34,839 to the services provided. 1068 00:37:34,873 --> 00:37:36,708 Well, I should hope he's not committing fraud. 1069 00:37:36,742 --> 00:37:39,444 I mean, the fact that you even had to check... 1070 00:37:39,478 --> 00:37:41,179 Look, Sharon. 1071 00:37:41,213 --> 00:37:42,714 You set the tone, 1072 00:37:42,748 --> 00:37:44,515 so if you're okay with it, 1073 00:37:44,550 --> 00:37:45,717 well, then, it must... 1074 00:37:45,751 --> 00:37:47,652 The numbers are clear. 1075 00:37:47,686 --> 00:37:49,020 If I don't improve the bottom line, 1076 00:37:49,054 --> 00:37:50,888 the board will start slashing. 1077 00:37:50,923 --> 00:37:53,725 Do you want to see the ED closed, or contracted out? 1078 00:37:53,759 --> 00:37:55,026 Because that's what'll happen. 1079 00:37:55,060 --> 00:37:56,561 No, of course not, 1080 00:37:56,595 --> 00:37:57,628 but I also don't wanna see the bottom line 1081 00:37:57,663 --> 00:37:59,530 dictating patient care. 1082 00:37:59,565 --> 00:38:01,833 Well, let me tell you something. 1083 00:38:01,867 --> 00:38:05,737 Psych is the biggest money-loser in the ED. 1084 00:38:05,771 --> 00:38:07,205 You, Daniel, 1085 00:38:07,239 --> 00:38:09,207 are a major part of our problem, 1086 00:38:09,241 --> 00:38:12,276 so don't get on the soapbox with me. 1087 00:38:23,222 --> 00:38:24,355 You seen Natalie? 1088 00:38:24,389 --> 00:38:25,757 She's in the doctor's lounge. 1089 00:38:25,791 --> 00:38:27,191 Oh, she told me that you had 1090 00:38:27,226 --> 00:38:29,660 a hot date planned tonight. 1091 00:38:29,695 --> 00:38:31,229 Uh-huh, 1092 00:38:31,263 --> 00:38:32,430 and I'm even gonna shave. 1093 00:38:32,464 --> 00:38:33,598 No. 1094 00:38:33,632 --> 00:38:35,266 The things we do for love... 1095 00:38:35,300 --> 00:38:37,201 [chuckles] 1096 00:38:37,236 --> 00:38:38,936 [laughs softly] 1097 00:38:38,971 --> 00:38:41,939 [somber music] 1098 00:38:41,974 --> 00:38:49,013 1099 00:38:56,421 --> 00:38:58,022 Hey. 1100 00:38:58,056 --> 00:39:01,025 Day like today... mm. 1101 00:39:01,059 --> 00:39:02,894 Tell me about it. 1102 00:39:02,928 --> 00:39:05,129 You make a really nice pillow. 1103 00:39:05,164 --> 00:39:11,202 1104 00:39:15,741 --> 00:39:18,109 Your hot date? 1105 00:39:18,143 --> 00:39:20,444 1106 00:39:20,479 --> 00:39:21,546 Nice. 1107 00:39:21,580 --> 00:39:28,586 1108 00:39:45,637 --> 00:39:47,138 Hi. 1109 00:39:47,172 --> 00:39:49,607 Dirty Martini. 1110 00:39:49,641 --> 00:39:52,510 Extra olives. 1111 00:39:52,544 --> 00:39:54,445 You remember the important things. 1112 00:39:54,479 --> 00:39:57,515 Wasn't sure you'd show. 1113 00:39:57,549 --> 00:39:59,584 Well, don't get ahead of yourself. 1114 00:39:59,618 --> 00:40:01,986 You say that you've changed. 1115 00:40:02,020 --> 00:40:03,754 We'll see. 1116 00:40:03,789 --> 00:40:06,290 1117 00:40:06,325 --> 00:40:07,792 Thank you. 1118 00:40:07,826 --> 00:40:14,832 1119 00:40:29,248 --> 00:40:32,283 [phone buzzing] 1120 00:40:33,863 --> 00:40:37,534 April, I'll be there in ten minutes. 1121 00:40:38,152 --> 00:40:40,191 Okay. 1122 00:40:40,225 --> 00:40:47,265 1123 00:40:47,289 --> 00:40:52,289 Synced & corrected by kinglouisxx www.MY-SUBS.com