- A-chugga-chugga-chugga- chugga-chugga-chugga-
chugga-chugga-chugga-chugga.
Choo-choo!
Carrots are awesome. Daddy love carrots.
All right, forget carrots. Carrots are lame.
The pear patrol. ♪ Do, do, do, do, do
♪ Do, do, do
You don't like the pear patrol?
The banana boat, going for a ride across the waves,
coming in flying... it's yummy, it's yummy.
Please, please, please, eat the banana boat.
It's not happening. It's not happening.
We got the beets.
Yeah, we're gonna drop the beets.
We're gonna drop the beets right--
right in there. No?
Oh, oh, okay. You wanna take it?
Look at you. You gonna feed yourself?
Oh--
- Morning. - Morning.
So you know Evie's taken a job in San Francisco.
- I do. - Yeah, and, um,
seeing as we're, uh, gonna get married soon--
- Mm-hmm. You're leaving.
- Yeah. - Yeah.
Um, I really didn't have a choice here, Max.
I'll help you fill the position, of course.
You know, sort through resumes.
- Not necessary. Congrats.
- Tonight's the big night isn't it--dinner with mom?
- Oh, God, thank you for the reminder.
- You know why she reached out to you?
- Well, because she is sober this week
and wants to make amends for the thousandth time.
I'm only going because I like the restaurant.
Holland.
- I know, I know.
- I was really hoping
I wouldn't see you back here again.
- Yeah.
Now I have to send you home.
I just misjudged the dose. I'm not gonna OD again.
- Can someone help us? - On it.
- I'm already taking less than I was before,
and I have a whole new plan. - Okay, we talked about this.
Addiction is not something that you can tackle alone.
You need support.
Trust me.
I know the dance all too well.
Please.
- Lauren?
- Valentina? Do you have a minute to chat?
- Sure, I'm just late for a meeting.
- I saw Fatima Abassi yesterday.
Her eyes were glazed. She mumbling to herself.
I'm just curious if any other patients in your trial
had these symptoms. - What are you suggesting?
- Nothing. I'm just concerned.
When she was receiving traditional chemotherapy--
- She's no longer your patient.
- Understood. But I care about her--
- Under the guise of concern you're implying that
I'm withholding my drug's side effects to protect my trial.
Right?
Stay in your lane. I have a department to run.
- Altered mental state. Diaphoresis.
I must say your husband's symptoms
are rather confounding,
but they are not from stroke or dementia.
- Our tests have ruled out
liver failure, diabetes, and drug ingestion.
- He's never taken a drug in his life.
- What about alcohol? - Joe doesn't drink.
- Are you certain?
Sweating, delirium-- could be alcohol withdrawal.
- Yes. I'm certain.
I've lived with the man over 40 years.
- Okay, based on Joe's symptoms,
I'd like to start him on high-dose benzos.
And when he recovers, perhaps we will all know him better.
- A sip? - No thanks.
I just added something like that to my mulch pile.
- Okay, well, you have no idea what you're missing.
- That's supposed to cure your sugar cravings?
- Yup, no more junk food for me, Gladys.
My body deserves better. I deserve better.
- Dr. Frome. - Who's gonna tell that
to the pastry landfill in your desk?
- You know, I'm sending in a hazmat crew today
if you must know. - Mmm.
Well, the cleanup will have to wait.
There's a cute couple eager to see you.
Dr. Steiner's referral.
- Yes, the refreshing break that is couples counseling.
See?
Healthy choices are being rewarded Gladys.
Take heed.
Chris and Jenny, right?
- Uh, yeah.
Thanks for fitting us in.
Dr. Steiner told us you were one of his favorite students.
- One of?
Well, if that isn't a blow. Jeez.
And you two are both from Long Island, as well, right?
- Yeah, we both grew up there. - Okeydoke.
So what are we doing here today?
- Uh, Jenny and I have been together for nine years,
and we'd been planning on getting married
at the end of the month,
but we've been having some problems.
- It happens. - We're fighting, all the time.
We haven't had sex in over a month.
We're not even living together right now.
Jenny moved in with a friend. - I'm sorry--is this--
is this seriously what you're opening with?
- Well, Jenny,
what do you think he should be opening with?
- We, um, we got a--
an early wedding present from my uncle.
It was a--a DNA kit.
One of those things that tells you how French you are,
if you're related to George Washington--you know.
Um... - Did you guys send it in?
- We did.
- And?
- Well, we're not French.
- We're brother and sister.
- How can I help? - Are you aware that your ED
just discharged another patient who overdosed on opiates?
- No, but I'm not surprised.
We're up to about ten a day now.
- Do you know how much the opioid epidemic
cost this country last year? - $500 billion.
- 700 billion.
We've seen a massive increase in patient overdoses,
most of whom are simply treated and released,
only to return days later if they're lucky.
- And most of these folks are uninsured,
so we're operating at a loss. Is that your issue?
- It certainly is one of them.
- Well, Karen, I assure you that we spend a lot of time
talking to our patients about the dangers of opioids,
but when you have massive pharmaceutical companies
delivering a very different message--
- I know what they're delivering.
- Then what have I done wrong? - Nothing.
Which is precisely the problem.
- I thought you wanted me to do nothing.
- Not today.
Today I want you to turn this epidemic around.
All the crazy ideas,
all the impulsive, rash tantrums you want to throw--
throw them, break the law, I don't care.
You'll have my full, unwavering support.
- Is this, um-- Are there--are there cameras?
- Max.
I want to see how much damage you can do.
- Challenge accepted.
- This is one dose, one pill, of the opiate oxycodone.
The pharmacy asked me for a prescription,
and seeing as how I was only looking for a visual aid,
I didn't have one.
So I had to drag our chairwoman here to the dispensary
where we each had to sign wavers
affirming our educational intent.
But if I sold you this pill, or even just gave it to you,
it's a loss of medical license for me
and actual jail time for her.
1%.
That's how many doctors at New Amsterdam are in this room.
Yet, you prescribe 79% of the opioids here.
And given that we are hooking patients by the thousands
on drugs that are a molecule away from black tar heroin,
can anyone tell me why you all shouldn't be arrested?
- You know they have a legitimate use.
- Not at the levels you're prescribing them.
- None of us prescribe them lightly.
Standards of care suggest they're the best choice
for our patients. - Not true.
The SOC says they're the most efficient choice,
and if you're looking to drop a few pounds
amputation is pretty efficient too.
- Our patients want them, Max.
They ask for them by brand name.
- They also do that with cigarettes.
- And our funding is tied to patient satisfaction scores.
- Well, it's kind of hard to be satisfied if you're dead.
- Max. - Nope, this changes now.
All right? Since you all prescribe
79% of our opioids,
I'm giving you one year to prescribe 79% less,
and anyone who does not meet that mark will be fired.
Thank you for coming.
You may get some calls.
- This is war, Max.
And your solution is to berate our staff?
- Yeah--and threaten. - Hell, I could've done that.
I want a macro solution. I want the full Max.
But that down there-- very disappointing.
- What's wrong? - No pulse.
- V-fib. All clear.
- Still not there. - Going again.
All clear.
- He's back. - Thank God.
- Vijay. - ST segment elevations.
- Active ischemia. I'll page Reynolds.
- I'm afraid I owe you an apology.
Your husband is not going through alcohol withdrawal.
He had a heart attack. - Before he got here?
- No, just now.
Which speaks to an underlying condition.
- Meaning?
- We have a far greater problem.
- Approaching the right coronary artery.
You see that narrowing? - Proximal section?
- Yes, that blockage is causing his ischemia.
So I'm just gonna put a stent in there,
open up the artery, and he should be good to go.
- What's that?
In the left anterior. It also looks like a narrowing.
- That's weird. That wasn't there a second ago.
Okay, Lana, placing a second stent.
- Floyd, another area's constricting in the circumflex.
- The hell is going on?
Every time I open up an artery, another one closes.
- And if you stop?
- He'll die.
- So, you're situation, to put it mildly,
is a little more complicated than most.
You are half-siblings.
All right, what about, um,
let's start with a little context.
How did you two meet?
- It was the second day of freshmen year at NYU.
I was in a philosophy class.
Which I almost immediately realized
was the worst decision I'd ever made...
Until Jenny walked in.
She was 20 minutes late, and when the professor apologized
for having such an early class, she just said, "No problem."
Then she sat down next to me.
- How long before you two went out?
- We got coffee after class.
But immediately I knew we were meant to be together.
Even before we both learned we were from Port Jeff.
- Port Jefferson, that's a population of--
- 8,000. Pretty small.
- Especially if both your mothers
used anonymous sperm donors.
- Right.
Have you told your parents? - No.
No, we haven't told anyone. We're not going to tell anyone.
- Well, they are expecting us to get married in 16 days.
- Right.
Well, let me ask you this.
What are you both hoping to get out of this session?
- You know, processing this.
Finding our way back to each other.
- God, Chris, there's no finding our way back.
We are--we're related.
- Well, Chris, why do you think this can be fixed?
Because the day I met Jenny was the best day of my life...
And every day since has been better.
Look, I know that this is insane, okay?
Believe me.
And I can understand why you can't see a way through it,
but I can't imagine not going back to how we were.
Not coming home to you--
If you think it's impossible,
and you can look me in the eye and tell me right now
that you don't love me anymore,
then I will call off the wedding.
- You know I love you...
But love just isn't enough.
It isn't enough, is it?
- Hi, so, uh, I'm here to end the opioid epidemic.
- Okay.
- So half the ODs occur
within three months of a visit to the emergency room,
but if we prescribe suboxone--
- We could manage the symptoms of opioid withdrawal
without the risk of fatality. - Exactly.
- We'll need a Treatment Act Waiver by the DEA,
and even then, each licensed doctor's only allowed
to treat 30 patients at a time. - So who's all licensed?
- You're looking at her. - Really?
Well, that has to change. Today.
- To get everyone licensed,
they'll need to go on an all-day training course.
- Sure, okay, grab all the doctors, attendings,
and residents and have them take that test,
and nobody comes back until they pass.
- That would mean shutting down ED.
- Yeah, so shut it down.
- No, Max. - Yes.
- You want me to call the department of public health,
re-route all ambulances,
suspend our Level I Trauma status,
and potentially move a multitude of patients
who are already being treated?
- That's a great plan. - Max!
That's unheard of. It would make the news!
And Brantley-- - Will love it! Go!
- A secret rendezvous on the pier?
Are we catching up or practicing our spy craft?
- Audra.
I'm sorry for all the cloak and dagger,
but I have a dilemma, and I'm afraid it is a secret.
- What's up? - Um...
- It involves the NIH trial that Castro's running
out of New Amsterdam.
- What's your dilemma? - I'm not entirely sure.
Not yet.
- Are you concerned there's been a protocol deviation?
Because that could jeopardize
all NIH funding at your hospital.
We're talking hundreds of millions of dollars.
- Which is why I needed to speak with you off the record
without your NIH hat on.
I don't have a lot of details.
I'm simply trying to help one of my patients that's involved.
Have you heard of any significant side effects
from Castro's trial?
- She hasn't reported anything,
but she's supposed to document
any adverse reactions immediately.
Is your patient on the protocol or the placebo?
- I don't know. - Well, you have to find out.
It's the only way to verify.
- But that would mean violating the double-blind.
- You can Castro directly.
Yeah, that would be, um--awkward.
- Then go around her if you have to.
You need to know if the patient
is on the placebo or the drug.
And if it's the drug--
- We have a bigger conversation.
- Uh, not sure if you've heard,
but both NPR and New York One are buzzing about us.
- Because you shuttered the ED? - That's right.
Both lead stories, both focused on the opioid epidemic.
You know, we're gonna have more licensed suboxone doctors
in this hospital than any other hospital in the country.
- Wonderful. You want a cookie?
- What?
- I didn't ask you to raise awareness,
I asked you to solve the problem.
But instead you're handing out detox drugs
while millions of people
outside the hospital are suffering.
- I don't work outside the hospital.
- Yes, you do. When you want to.
Blood pressure testing in barber shops?
Chasing down insurance agents in their offices?
Come on, Max! It's me you're talking to.
People are dying.
Do better.
- Casey, Casey. Get him situated in Urology.
Don't let them pawn him off.
- Incoming!
- Carolyn Werner, 20, fell in Times Square.
Looks like a radial/ulna fracture.
BP 120 over-- - Okay, let me stop you
right there--she is stable with an isolated injury to the arm?
- Yeah. - Turn her around
and take her to Baptist. - Are you serious?
- Uh, we thought dispatch was mistaken.
- No. We are closed.
- What the hell am I supposed to do with all these?
I don't know, Dr. Skein.
They are patients admitted to your care, so...tend to them?
- 20 people?
You've clogged every bed in my department with this--this--
uh, whatever you're doing.
- We are trying to solve the opioid crisis.
A crisis you helped cause.
- I'm a dermatologist.
- I will admit that your situation is difficult.
Um, but is not my job to judge
whether your relationship is right or wrong.
What is very apparent to me
is the love between you two is very real.
And if you want, worth fighting for.
There is one inconvertible truth.
Biological children can never be an option.
- You think kids are what we're worried about?
I can't even look at him.
- Because this new information
has changed the way you see him?
Well, good news there.
Relationships can survive change.
In fact, almost all of them have to.
- This isn't like he's suddenly gained 20 pounds.
- No, um-- Look, I get it.
But life goes on, and you adjust.
Relationships adjust too, or they end.
If change is insurmountable in the heart, then that's it,
show's over.
But that is not the case with you two.
Is it?
So the real question becomes:
can we change what's in your heads?
- How?
- Jenny, will you sit on the couch with Chris?
- Good.
Jenny, will you take Chris's hand?
Jenny.
- I can't.
I can't. I can't.
I'm sorry.
- Floyd.
His test level shows
extremely high levels of creatinine kinase.
It's already damaged his kidneys.
- That means his muscles are breaking down.
- Vasospasm, delirium, muscle breakdown--
it all adds up to one thing: decompression sickness.
- The bends?
- Joe has never gone scuba diving in his life.
I tried to get him to go on our honeymoon,
but he's afraid of the water.
- That may be true, but I'm certain of this diagnosis.
- You were certain before, but you were wrong.
Joe doesn't drink, and he's not a water guy.
Even on vacation, he is a good, decent, no nonsense,
stay-in-the-room-and-watch-golf guy.
- But with the symptoms exhibiting,
if we do not put him in hyperbaric chamber right away,
I'm afraid he will be a dead guy.
- Who knows him better, Dr. Kapoor?
His wife of 40 years or you?
- Hi, I'm looking for Dr. Castro.
- She'll be back in about 15 minutes.
- Perfect.
- Satisfied?
I've tried to be the bigger person here.
- Valentina--
- If you focused a bit more on the patient
instead of trying to nail me to the wall,
you might have noticed that Fatima has aggressive arthritis
in her left wrist.
It was caused by an enterobacter infection
which then relisted as a thiamine deficiency.
That's what led to her delirium.
Not my drug.
You're welcome.
- Dr. Morris, I apologize that your hospital is overflowing,
but I will see you very soon, okay?
Uh, Max Goodwin.
Dr. Farnum, yes, I, um, did close the ED
and I look forward to explaining why shortly.
Max Goodwin. - Hi.
- Alice.
- I'm sorry to bother you at work.
Did you get my text?
- Yeah, no--I did, I've been, um--
- I know you're busy, but are you free tonight?
- Tonight?
Uh. Tonight, tonight?
- I got this gig, and I can't find a sitter.
I hate asking. I feel terrible.
- Oh, right. No, of course.
Yes, I can. Yes.
I thought--great. Yeah, Luna's gonna love that.
- Thank you so much. - Sure, sure.
Happy to help. - See you tonight.
Everybody told me that it would be impossible
to get the city's top medical directors
together in one room, but then I reminded them
how much medical directors enjoy a free lunch.
Yeah, so, um...
earlier today, I put New Amsterdam on diversion.
I know that closing our ED
caused problems for many of you.
To those of you who are still annoyed,
I just want to say it's about to get worse.
This is how much money New Amsterdam spends on opioids
every year, and every hospital network in the city
is spending the same. Just the 15 of us,
sitting here in this room
are spending $1 billion a year
on a product that we know is killing people.
We're hospitals. Killing people should be
pretty high on the list of things we try not to do.
- Opioids work incredibly well.
- That's right, Florence. They do work.
But they also worked in 1996, and back then they worked
without causing an international addiction crisis.
That was before the Nylers
started launching propaganda campaigns
and buying off hospitals-- - Including yours.
- That's right. Including mine.
Raise your hand if your hospital has a Nyler Wing.
I'm not saying that New Amsterdam
is better than anyone else.
I am saying it's time to return to ethical behavior.
So instead of giving the Nylers
another billion dollars this year,
I'd like to propose a new number.
I'm ready to cancel New Amsterdam's opioid contract
right now,
and I want you all to do the same.
We have to hit them hard, we have to hit them together,
and what we need is unity.
- Unity is an anti-trust violation.
- There is blood
on all of our hands.
I think it's time to wash it off.
So who's with me?
Florence? - Pass.
- We could change things. Dr. Farnum!
John.
- Yes, well, can you-- can you expedite it?
Yeah, I mean is there a fee that I can pay for a faster--
Mm-hmm.
Okay, well call me back.
Yep. Thank you.
Our pacemaker supplier can't make shipment.
No big deal, they're just people's hearts.
Stents are being held up too.
- Not to pile on, but several of my chemo drugs
won't be coming in tomorrow. Or ever.
- It's the Nylers. They're retaliating
because I ripped up their opioid contract.
- Their companies make more than just opioids, Max.
Most of my drugs are under their patent.
No one besides Nyler can make them.
Look, I love that we're finally taking a stand against them,
but this could jeopardize the lives of our patients.
- Can someone please tell me
why my supplier just killed my order for acne cream?
- His wife said he's afraid of the water.
- I know.
- What if he has an endocrine disorder or something?
I mean, isn't your whole thing about listening to the patient?
- I am listening.
To Joe.
Despite everything his wife believes,
his body's saying decompression sickness.
- You better hope you're right.
- Jenny, this is your DNA,
and Christopher, this is your DNA.
- They're the same. - Not quite.
There's a .1% variant between the two of you,
but yes, they are 98.5% identical.
- What more do we need?
- But this is my DNA.
Also 98.5% identical to both of yours.
Because that is the genetic similarity
between any two human beings.
Scientifically speaking, we are all very much the same.
- Jenny...
- What? I should carry a DNA chart
to the market to explain to everybody
why it's okay I'm married to my brother?
- Why do you feel the need to explain anything to anyone?
- Look, I'm sorry. I'm sorry, but there's just--
there's nothing that you're gonna say
that's gonna make me forget who Chris really is.
- Okay.
Okay, fair enough.
Is there anything that you could say?
You were planning on being married in 16 days.
You must've written your vows.
Okay. Good.
Chris.
"As I sit here in our half-painted living room
"that you promised to finish, listening to the, um,
"Spin Doctors Album that we bought for $1.00
"at a yard sale because the lady who sold it to us
had no idea who they were..."
"I can't believe how happy I am
or how lucky I am..."
"I never thought I would find somebody--
"Somebody who laughs at all my stupid duck jokes.
"Or likes my grandma's baked spaghetti.
Or picks up all of our bath towels all the time."
"So of course I said yes when you asked me to marry you.
"Nobody's ever loved me like you,
and I've never wanted to be with anybody..."
- Okay. Good.
Jenny.
Can you see that Chris?
- The Chris you wrote those vows for.
- That is the only Chris there is.
And if you ever forget that,
all you need to do is go back to those vows.
Just like every other couple.
- Feeling pretty whooped, huh?
- The Nylers took you good.
- That they did.
Do you have their new contract?
You know, I don't know what's worse.
People addicted to their drugs,
or the system addicted to their money.
- Celeste.
My little sister. - Hmm.
- She had this stupid surgery, gum grafts of all things,
but it hurt a lot, so they gave her Oxy.
She's gone now.
Two years.
- May I?
- Hey, we're closed.
- I know, just taking an OD down to the morgue.
- Oh, no.
- You knew her?
- It's a funny thing, you know,
when you don't know anything. I mean, I knew I was with you.
I just couldn't get the words out.
- It's okay, honey.
I'm just grateful that you're all right.
- Now, your wife said you'd never been scuba diving before,
but...
- Since our anniversary's coming up,
I wanted to surprise you by taking a few lessons.
You wanted to go on our honeymoon,
but I was too scared.
I wanted to show you I could do it.
- But you're not a water guy.
Which is why I knew it would be a surprise.
- I didn't think you could ever surprise me.
- But you did.
- So adorable. - Mmm.
Aren't they? - Mmm.
"Spiritualized"
You don't own me.
Mmm.
- Oh.
I wasn't sure if you were gonna come.
I mean, not that I blame you.
I'm sober now. - I don't wanna hear it, Mom.
You wanna know my earliest memory?
Was Dad's friend calling you an alcoholic.
But Dad said no you weren't. No, you were a drunk.
After that, I did everything I could to slow you down.
The first time I got wasted, I was seven.
- ♪ There's a lot of things that need to be done ♪
- I chugged half your martini
thinking the more I drank, the less you could.
You know what you did?
You licked the glass, and you made yourself another.
That night you shouted at me, not for being drunk--
for being sick on the rug.
- ♪ Lord, I have a broken dream ♪
- Lauren-- - No, I am not done, Mom.
I have spent years being angry at you.
Hating you.
Feeling sorry for you.
Then doing it all over again.
- ♪ There's a lot of things that I gotta do ♪
- And I don't know when it happened,
but I can't really feel anything for you anymore.
- ♪ Lord, I have a broken dream ♪
- I was a little kid.
- ♪ And I'm wasted all the time ♪
- I was a little kid
who was killing herself trying to get close you,
and you were an adult, and you did not even try.
So I am sad because I got cheated.
And it sucks.
It really sucks, because I didn't deserve it.
- ♪ I've been told that this will heal ♪
- Oh, do you know what?
Just tell me you're sorry so I can go.
- I wish I could.
I want to.
I am sorry.
That you feel so sad.
- ♪ I have to keep it covered up with a smile ♪
- But, sweetheart, I--I just don't--
I don't remember any of that happening.
- ♪ And I'll keep on moving on for a while ♪
♪ Lord, I have a broken heart ♪
- Max. Yo, you got a sec?
Look, I don't feel good about our conversation this morning.
- Okay. - No, it's not okay.
Look, I'm sorry I didn't tell you sooner,
but you're just gonna ice me now?
My fiancée moved to San Francisco.
It's either her or this hospital.
- Look, Floyd.
I just can't lose anyone else this year.
Dr. Brighton.
- Did you ask people to do this?
- No. - Mmm.
Everyone's talking about
how the Nylers retaliated against you
and against your hospital.
By shutting you out,
this company put patients' lives at risk,
and that's not business, it's a shakedown.
A shakedown that could happen to any of us.
- So what do you propose?
- Unity.
- This should counter the infection, Fatima.
Alleviate all your symptoms.
- Thank you for figuring out what was wrong.
- Mmm.
It wasn't me. Dr. Castro made the diagnosis.
You're very fortunate to be in her trial.
Hmm.
- Okay.
Lauren, call me as soon as you can.
I was wrong about the side effects
Castro's drug might be causing, but I was right about her.
She altered her patients' numbers before treatment
so their tumors would look worse
so her drug will appear to be performing better
than it actually is! Castro altered her trial.
- Hey. - Hi.
Wow, you look serious.
- Yikes.
That's not exactly what I was going for.
- No, no, I meant-- I just meant you look great.
Uh, come on in.
Hey, how'd it go?
- Really well, yeah. - Good.
- Thanks for asking. - Hey, yeah, sure.
- How're the babies? - They're exhausting.
Adorable. - Sleeping?
- Yes, sleeping. She, uh,
jammed on this bad boy quite a bit.
She loves this. - Yeah.
- You--you have a... - Oh.
- A sweet potato? - Oh.
I think yam actually.
- It's a good look for you.
- Yeah, it's kind of becoming my go to.
- There's more.
Here.
- Thanks.