1 00:00:01,668 --> 00:00:02,668 Previously, on Doc. 2 00:00:02,669 --> 00:00:04,203 She's healing, and healing fast. 3 00:00:04,204 --> 00:00:05,537 That would explain the influx of new memories. 4 00:00:05,538 --> 00:00:07,306 Really hope you're not rushing this. 5 00:00:07,307 --> 00:00:09,341 I assure you, I can do this. 6 00:00:09,342 --> 00:00:10,943 Ruth Chen, this is Cal Ferguson. 7 00:00:10,944 --> 00:00:12,378 These are your co-chief residents. 8 00:00:12,379 --> 00:00:14,480 Ben! I heard you were coming. 9 00:00:14,481 --> 00:00:16,348 You want to replace Dr. Costa. 10 00:00:16,349 --> 00:00:19,284 If I'm coming to Westside, it'll only be to run surgery. 11 00:00:19,285 --> 00:00:22,054 So, now that you're not working with Dr. Larsen, 12 00:00:22,055 --> 00:00:23,856 you figured why not give cardiology a shot? 13 00:00:23,857 --> 00:00:26,458 - I'm happy to better myself. - I saw you, Jake. 14 00:00:26,459 --> 00:00:28,595 I saw how you looked at her through her window. 15 00:00:28,695 --> 00:00:30,430 You just pushed me away. 16 00:00:46,012 --> 00:00:47,413 Help! 17 00:00:47,414 --> 00:00:49,181 Help! 18 00:00:51,384 --> 00:00:54,253 Please, help! - What happened? Are you hurt? 19 00:00:54,254 --> 00:00:56,789 Not me. My family's in there, you've gotta help them. 20 00:01:25,385 --> 00:01:27,953 - Ibuprofen? - Mm-hmm. 21 00:01:27,954 --> 00:01:29,822 I didn't realize you were a nurse. 22 00:01:29,823 --> 00:01:31,624 Funny. 23 00:01:33,727 --> 00:01:35,094 And fun. 24 00:01:35,095 --> 00:01:38,464 That's a pretty sneaky martini you make, which is not fair. 25 00:01:38,465 --> 00:01:40,099 You want the recipe? 26 00:01:40,100 --> 00:01:42,968 Oh, God, no. 27 00:01:42,969 --> 00:01:45,838 How about my number? 28 00:01:48,108 --> 00:01:50,009 Oh, uh... 29 00:01:50,010 --> 00:01:51,643 You're not gonna call me, are you? 30 00:01:53,346 --> 00:01:56,181 I've got a lot on my plate right now. 31 00:01:56,182 --> 00:01:58,518 Can't blame a girl for trying. 32 00:02:05,592 --> 00:02:08,394 - It's your lucky day, pal. You're with me again. 33 00:02:08,395 --> 00:02:11,230 - Great. - Call came from on high. 34 00:02:11,231 --> 00:02:14,533 Clearly Dr. Matos sees some potential in you. 35 00:02:14,534 --> 00:02:17,403 Ooh. What you working on? 36 00:02:17,404 --> 00:02:19,905 Wait... 37 00:02:19,906 --> 00:02:21,640 Is that like, Rachel, Rachel? 38 00:02:21,641 --> 00:02:24,209 It's new, okay? So I just need you to keep it to yourself. 39 00:02:24,210 --> 00:02:27,212 All right? - Dude. Cardio code. Of course. 40 00:02:28,815 --> 00:02:30,683 Aw, you're nervous! 41 00:02:30,684 --> 00:02:32,818 No, that's... that's not what I said to her. 42 00:02:32,819 --> 00:02:36,755 - Right. Well, carpe diem. Let's go, grasshopper. 43 00:02:36,756 --> 00:02:38,824 Wait... 44 00:02:38,825 --> 00:02:41,226 Does this mean no more Amy? 45 00:02:43,797 --> 00:02:45,898 I had a few more memories last night, 46 00:02:45,899 --> 00:02:47,366 but nothing physical, 47 00:02:47,367 --> 00:02:48,667 so, don't go running to Michael. 48 00:02:48,668 --> 00:02:50,302 He is the head of your department, 49 00:02:50,303 --> 00:02:51,670 and I'm out over my skis for you, 50 00:02:51,671 --> 00:02:54,673 so I will report back to him as soon as I understand 51 00:02:54,674 --> 00:02:57,242 what this is. So how is this different? 52 00:02:57,243 --> 00:03:00,012 They're not painful or disorienting. 53 00:03:00,013 --> 00:03:04,183 Just constant and intrusive, and the last thing I need 54 00:03:04,184 --> 00:03:06,352 when I'm trying not to look back. 55 00:03:06,353 --> 00:03:09,788 All the more reason to look ahead. 56 00:03:09,789 --> 00:03:12,792 - Amy. - Hey, Ben. 57 00:03:14,494 --> 00:03:16,463 So I guess you work here now? - Looks that way. 58 00:03:16,563 --> 00:03:19,498 Double espresso, please. 59 00:03:19,499 --> 00:03:21,368 I think Joan would be glad 60 00:03:21,468 --> 00:03:22,901 that you're the one filling her position. 61 00:03:22,902 --> 00:03:25,471 Actually, I'm taking over the department. 62 00:03:25,472 --> 00:03:27,039 Does Dr. Costa know that? 63 00:03:27,040 --> 00:03:30,175 Yeah, he's pretty burnt out on the admin stuff, 64 00:03:30,176 --> 00:03:32,478 and he was happy to let that part go. 65 00:03:32,479 --> 00:03:33,979 Works out for everyone. 66 00:03:34,948 --> 00:03:36,215 You do background 67 00:03:36,216 --> 00:03:39,319 on everyone at the conference? Or just me? 68 00:03:40,653 --> 00:03:44,723 - Well, I'm glad you're here. I'm excited to work with you. 69 00:03:44,724 --> 00:03:45,792 Same. 70 00:03:48,328 --> 00:03:49,596 Department rolling out 71 00:03:49,696 --> 00:03:53,298 the red carpet for Ben on his first day? 72 00:03:53,299 --> 00:03:56,469 So, whose team are you on? 73 00:03:56,569 --> 00:03:59,138 - It's not dodgeball. - No. It's not. 74 00:03:59,139 --> 00:04:01,040 And I'm asking where you stand. 75 00:04:01,041 --> 00:04:02,941 This is ridiculous. 76 00:04:02,942 --> 00:04:05,244 'Cause I heard you and grant got pretty chummy 77 00:04:05,245 --> 00:04:06,679 during the contagion. 78 00:04:06,680 --> 00:04:08,981 Maybe you knew about the coup before it happened. 79 00:04:08,982 --> 00:04:10,216 - Oh, wow. - Come on. 80 00:04:10,316 --> 00:04:12,818 All I know is I've been a resident under Costa 81 00:04:12,819 --> 00:04:14,553 for four years, 82 00:04:14,554 --> 00:04:16,055 and he deserved better than this. 83 00:04:19,626 --> 00:04:21,961 Dr. Fox could use a Xanax. 84 00:04:22,062 --> 00:04:23,996 He may not be wrong. 85 00:04:23,997 --> 00:04:28,133 Ben is brilliant, but Costa's the one who hired me. 86 00:04:28,134 --> 00:04:30,803 Joan championed you. 87 00:04:30,804 --> 00:04:32,705 Costa went along. And that happened 88 00:04:32,706 --> 00:04:34,907 because you are really good. 89 00:04:34,908 --> 00:04:37,176 Yeah, I just don't like the way things went down. 90 00:04:37,177 --> 00:04:39,144 - I get that. But you said yourself, 91 00:04:39,145 --> 00:04:41,847 Costa can be conservative. 92 00:04:41,848 --> 00:04:44,616 I think Ben will be better for the department. 93 00:04:44,617 --> 00:04:47,152 I guess I'll find out for myself soon enough. 94 00:04:47,153 --> 00:04:48,621 Yeah. 95 00:04:51,624 --> 00:04:54,960 - Morning. - Dr. Grant. 96 00:04:54,961 --> 00:04:57,830 I figured you'd want to discuss what happened? 97 00:04:57,831 --> 00:05:01,300 As the guy who recommended you for an opening in surgery, 98 00:05:01,301 --> 00:05:03,569 I would've appreciated a heads up 99 00:05:03,570 --> 00:05:05,739 that you were planning to take it over. 100 00:05:05,839 --> 00:05:08,307 Sorry if that put you in an uncomfortable situation. 101 00:05:08,308 --> 00:05:10,642 - It did. And it does. - I saw the potential 102 00:05:10,643 --> 00:05:13,045 in the department, and this was the only move 103 00:05:13,046 --> 00:05:15,280 that made sense for me. And apparently the board 104 00:05:15,281 --> 00:05:17,216 saw an opportunity to upgrade. 105 00:05:17,217 --> 00:05:18,617 I don't disagree with their decision 106 00:05:18,618 --> 00:05:20,686 or the direction you want to take things. 107 00:05:20,687 --> 00:05:23,589 But surgery and medicine have to work together. 108 00:05:23,590 --> 00:05:27,593 And I'd be lying if I said you haven't lost some trust. 109 00:05:27,594 --> 00:05:31,697 Well, I hope you'll give me a chance to earn it back. 110 00:05:31,698 --> 00:05:33,632 Dr. Grant? 111 00:05:33,633 --> 00:05:34,867 You're needed in surgery. 112 00:05:34,868 --> 00:05:37,770 And they want you in the ICU. - Okay. 113 00:05:37,771 --> 00:05:40,472 - Teenage son was driving. ER checked him out. 114 00:05:40,473 --> 00:05:43,509 Scraps and a mild concussion. Mom's got rhabdo, 115 00:05:43,510 --> 00:05:46,211 causing renal failure and a subdural hematoma. 116 00:05:46,212 --> 00:05:48,714 12-year-old sister has a liver lac 117 00:05:48,715 --> 00:05:53,185 from the seatbelt, a pelvic ring fracture, and DIC. 118 00:05:53,186 --> 00:05:55,354 They're on their way up. 119 00:05:55,355 --> 00:05:58,791 Uh, we should assign the interns to floor work. 120 00:05:58,792 --> 00:05:59,925 They're just gonna get in the way today. 121 00:05:59,926 --> 00:06:02,628 Well, opportunities don't come when you're ready, 122 00:06:02,629 --> 00:06:04,464 they come when they come. 123 00:06:04,564 --> 00:06:07,132 I think it's a mistake but fine. 124 00:06:07,133 --> 00:06:08,734 You can have Kyle, I got Ruth. 125 00:06:08,735 --> 00:06:11,837 Try not to break her on day two. 126 00:06:13,273 --> 00:06:16,375 Anthony Evans, 48, MVA. 127 00:06:16,376 --> 00:06:18,977 Deer versus auto. Riding shotgun. 128 00:06:18,978 --> 00:06:21,814 FD came to extricate after he was found impaled 129 00:06:21,815 --> 00:06:25,250 on the scene. Wife and daughter are in the ER. 130 00:06:25,251 --> 00:06:26,985 All right, take him to OR 1. 131 00:06:26,986 --> 00:06:30,122 Dr. Coleman, call Radiology. I need a bedside chest film. 132 00:06:30,123 --> 00:06:31,390 You got it. 133 00:06:36,796 --> 00:06:38,531 Can you tell me what happened? 134 00:06:41,768 --> 00:06:46,038 Last night I, I was... I... 135 00:06:48,274 --> 00:06:49,675 Dr. Ferguson, can you get 136 00:06:49,676 --> 00:06:51,777 Mrs. Evans's latest files, please? 137 00:06:51,778 --> 00:06:53,178 Yeah. 138 00:06:53,179 --> 00:06:54,980 Uh, Dr. Larsen wants vitals. 139 00:06:54,981 --> 00:06:57,050 Hey, I know how hard this must be, 140 00:06:57,150 --> 00:06:58,717 but we are gonna do everything in our power 141 00:06:58,718 --> 00:07:00,786 to help your family. 142 00:07:00,787 --> 00:07:03,555 But in order to do that, I need you to tell me 143 00:07:03,556 --> 00:07:04,857 what happened. 144 00:07:04,858 --> 00:07:06,325 Um... 145 00:07:06,326 --> 00:07:08,093 We went to Mestiizos 146 00:07:08,094 --> 00:07:10,496 to celebrate Harper's middle school graduation. 147 00:07:10,497 --> 00:07:12,698 - Mm-hmm. - My sister can never decide 148 00:07:12,699 --> 00:07:14,066 between sushi and Mexican, 149 00:07:14,067 --> 00:07:18,003 so she was excited, 'cause you know, it-it's both. 150 00:07:19,506 --> 00:07:22,508 After dinner, we went back to our cabin. 151 00:07:22,509 --> 00:07:25,511 I-I begged my parents to let me drive. 152 00:07:25,512 --> 00:07:28,480 My, my mom, she said no way, 'cause I had just 153 00:07:28,481 --> 00:07:30,949 gotten my license. But my dad... 154 00:07:30,950 --> 00:07:34,019 He said I had to learn some time. 155 00:07:34,020 --> 00:07:35,521 I-I didn't see the deer. 156 00:07:35,522 --> 00:07:36,755 Before I knew what was happening, 157 00:07:36,756 --> 00:07:37,990 it crashed through the windshield. 158 00:07:37,991 --> 00:07:39,625 So your dad was in the passenger seat? 159 00:07:39,626 --> 00:07:41,560 Mom and Harper in the back. 160 00:07:41,561 --> 00:07:43,930 My airbag went off. We flipped into a ditch. 161 00:07:47,233 --> 00:07:49,001 The deer was kicking like crazy, 162 00:07:49,002 --> 00:07:51,470 it was freaking out, there was blood everywhere. 163 00:07:51,471 --> 00:07:53,005 BP 110 over 73. 164 00:07:53,006 --> 00:07:55,441 Heart rate's in the 90s and she's satting 97. 165 00:07:55,442 --> 00:07:56,875 Oh, great. 166 00:07:56,876 --> 00:07:59,611 Theo, your mom's vitals are all normal, okay? 167 00:07:59,612 --> 00:08:01,246 Yeah. Th-Thank you. 168 00:08:01,247 --> 00:08:03,182 During the accident, were you knocked out? 169 00:08:03,183 --> 00:08:05,784 Not for long. It was still dark when I came to, 170 00:08:05,785 --> 00:08:07,986 but there was no one else awake. 171 00:08:07,987 --> 00:08:11,690 I tried to get help, but there was no cell service. 172 00:08:11,691 --> 00:08:14,526 Seatbelt was jammed, the door was wedged shut. 173 00:08:14,527 --> 00:08:16,329 It took so long before I got out 174 00:08:16,429 --> 00:08:17,796 that when I finally got to the road, 175 00:08:17,797 --> 00:08:19,732 there was no one there for hours. 176 00:08:19,733 --> 00:08:22,201 After sunrise, a few people drove by, 177 00:08:22,202 --> 00:08:25,404 but the... I-I know they saw me, 178 00:08:25,405 --> 00:08:27,940 but they just kept going... - It's okay. 179 00:08:27,941 --> 00:08:30,509 You're all here now. - My dad's not here. 180 00:08:30,510 --> 00:08:32,244 I don't even know what's going on with him. 181 00:08:32,245 --> 00:08:35,147 He's gonna be in surgery for a while longer. 182 00:08:35,148 --> 00:08:36,548 We're waiting on his latest lab results. 183 00:08:36,549 --> 00:08:38,150 Can you check on them? 184 00:08:38,151 --> 00:08:40,652 Okay. 185 00:08:42,956 --> 00:08:45,891 - Are you in? If you didn't get a flash, 186 00:08:45,892 --> 00:08:47,493 then you're not in the vein. - Sorry. 187 00:08:47,494 --> 00:08:49,895 I've only done IVs on chicken thighs. 188 00:08:49,896 --> 00:08:53,465 Like, from the grocery store? 189 00:08:55,101 --> 00:08:57,370 - What's wrong with her? - Her heart rate's rising. 190 00:08:57,470 --> 00:09:00,906 It's okay, Theo. They'll take care of it. 191 00:09:00,907 --> 00:09:02,207 Liz. 192 00:09:02,208 --> 00:09:03,475 Okay. 193 00:09:03,476 --> 00:09:05,411 Harper has a grade 4 liver lac. 194 00:09:05,412 --> 00:09:07,546 Dr. Costa wanted to just monitor, 195 00:09:07,547 --> 00:09:08,915 but now BP's getting soft. 196 00:09:09,015 --> 00:09:10,783 She's hemodynamically unstable. 197 00:09:10,784 --> 00:09:12,685 She needs to go to the OR. 198 00:09:12,686 --> 00:09:14,520 Yeah. But DIC puts her at higher risk 199 00:09:14,521 --> 00:09:15,988 for bleeding out mid-surgery. 200 00:09:15,989 --> 00:09:17,956 Okay, so go with her and manage it 201 00:09:17,957 --> 00:09:20,626 while they operate on her liver. It has to happen now. 202 00:09:20,627 --> 00:09:22,961 Mm-hmm. Okay. All right. 203 00:09:22,962 --> 00:09:24,430 Okay. Okay, I got this. 204 00:09:28,335 --> 00:09:29,835 What's going on? 205 00:09:29,836 --> 00:09:31,370 We have to operate on your sister. 206 00:09:31,371 --> 00:09:33,138 What, her too? 207 00:09:33,139 --> 00:09:34,373 Will she be okay? 208 00:09:39,646 --> 00:09:41,013 - Did I miss something? Is it my fault. 209 00:09:41,014 --> 00:09:43,049 No, you did nothing wrong. 210 00:09:44,484 --> 00:09:46,585 This can't be happening! 211 00:09:46,586 --> 00:09:49,054 Can you start it? 212 00:09:49,055 --> 00:09:50,757 Hey, Theo. 213 00:09:52,392 --> 00:09:54,026 I know this is scary. 214 00:09:54,027 --> 00:09:57,864 - You have to save my family. Please. 215 00:10:02,068 --> 00:10:05,771 So early wound management and antibiotics are everything. 216 00:10:05,772 --> 00:10:10,275 Any wound that doesn't heal in a diabetic patient 217 00:10:10,276 --> 00:10:14,113 is osteomyelitis until proven otherwise. 218 00:10:14,114 --> 00:10:17,182 Try to remember, when we come across these patients, 219 00:10:17,183 --> 00:10:20,753 we're not just treating an infection, 220 00:10:20,754 --> 00:10:23,756 we're saving a limb. 221 00:10:23,757 --> 00:10:25,924 Thank you. 222 00:10:25,925 --> 00:10:30,964 Uh, I think it's time for Q and A. Any questions? 223 00:10:32,899 --> 00:10:34,366 Yes? 224 00:10:34,367 --> 00:10:37,102 Yeah, with all due respect, 225 00:10:37,103 --> 00:10:40,072 I'd argue surgical intervention is more effective 226 00:10:40,073 --> 00:10:42,941 than non-operative wound management of diabetic ulcers. 227 00:10:42,942 --> 00:10:46,111 The well-worn dichotomy, surgery versus medicine. 228 00:10:46,112 --> 00:10:48,147 It's not about cutting for the sake of cutting. 229 00:10:48,148 --> 00:10:49,815 - Never is. - Studies have shown 230 00:10:49,816 --> 00:10:52,284 that patients who undergo early surgical debridement 231 00:10:52,285 --> 00:10:55,487 have a much higher rate of remission, so... 232 00:10:55,488 --> 00:10:58,757 It was one study. I saw it. 233 00:10:58,758 --> 00:11:01,226 And the rate of remission by patient 234 00:11:01,227 --> 00:11:03,429 was anywhere from 28 to 81 percent, 235 00:11:03,430 --> 00:11:06,565 that's hardly consistent enough to call evidence. 236 00:11:06,566 --> 00:11:09,668 I guess Harvard didn't teach you to read the footnotes, 237 00:11:09,669 --> 00:11:12,038 Dr. Grant? 238 00:11:13,973 --> 00:11:15,474 I have never seen anything like this. 239 00:11:15,475 --> 00:11:19,078 Neither have I. And I've got over 25 years on you. 240 00:11:19,079 --> 00:11:21,080 And between the blood and the antlers, 241 00:11:21,081 --> 00:11:23,782 I could barely make out much of the hilum or lungs. 242 00:11:23,783 --> 00:11:25,684 - We'll have to go in blind. - It doesn't help 243 00:11:25,685 --> 00:11:27,653 that no one stopped for the kid. Cost us hours. 244 00:11:27,654 --> 00:11:28,888 No one stopped? 245 00:11:30,657 --> 00:11:32,958 Dr. Fox. Ready to assist? - Born ready. 246 00:11:32,959 --> 00:11:35,894 Good. We'll start by tying off any arterial injuries 247 00:11:35,895 --> 00:11:37,296 that could be the source of the bleeding. 248 00:11:37,297 --> 00:11:39,064 What about removing the antlers? 249 00:11:39,065 --> 00:11:40,065 That's where Dr. Coleman comes in. 250 00:11:40,066 --> 00:11:41,967 If I'm right, they're acting like a fish hook. 251 00:11:41,968 --> 00:11:43,836 Wrapping around the pulmonary artery, 252 00:11:43,837 --> 00:11:46,139 vein bronchi, which means... 253 00:11:46,239 --> 00:11:48,240 If we just pull them out, could rip out the entire 254 00:11:48,241 --> 00:11:51,276 vascular pedicle to his lung, make it impossible to repair. 255 00:11:51,277 --> 00:11:53,980 Exactly. So, no removal without more data. 256 00:11:54,080 --> 00:11:55,714 I need you to track down any case reports 257 00:11:55,715 --> 00:11:57,216 of similar penetrating injures. 258 00:11:57,217 --> 00:11:59,551 Every operative solution you can find. 259 00:11:59,552 --> 00:12:01,854 Go. Fast. 260 00:12:01,855 --> 00:12:03,823 Scrub in. - Yeah. 261 00:12:06,359 --> 00:12:08,560 He has severe acidosis. 262 00:12:08,561 --> 00:12:10,262 Well, given his massive pulmonary contusions, 263 00:12:10,263 --> 00:12:12,164 makes sense his blood gas is abnormal. 264 00:12:12,165 --> 00:12:14,466 - It's a mixed acidosis. The lung trauma alone 265 00:12:14,467 --> 00:12:15,568 wouldn't explain it. 266 00:12:15,669 --> 00:12:16,869 There's gotta be something else going on. 267 00:12:16,870 --> 00:12:18,871 Guess you gotta figure it out then. 268 00:12:18,872 --> 00:12:20,673 - Excuse me? - Medicine's your area. 269 00:12:20,674 --> 00:12:25,444 Mine is to operate like hell before he bleeds out. Excuse me. 270 00:12:26,980 --> 00:12:29,314 Who said I'm back out there? 271 00:12:31,217 --> 00:12:33,152 Serena, repeat the trauma panel 272 00:12:33,153 --> 00:12:35,554 and get a rhotem to the lab, stat. 273 00:12:35,555 --> 00:12:37,157 We need to look for everything. 274 00:12:39,325 --> 00:12:41,860 We're observing Mrs. Evans' hematoma for now. 275 00:12:41,861 --> 00:12:43,729 Kidneys are responding to IV hydration, 276 00:12:43,730 --> 00:12:47,032 but I think I saw PVCs on the monitor. 277 00:12:47,033 --> 00:12:49,501 So, I want a second opinion. 278 00:12:49,502 --> 00:12:53,472 Dr. Heller. What is a PVC? 279 00:12:53,473 --> 00:12:54,640 Are you kidding me? 280 00:12:54,641 --> 00:12:55,808 You're a beginner in cardiology, 281 00:12:55,809 --> 00:12:57,110 so we start at the beginning. 282 00:12:58,478 --> 00:13:02,147 It is a premature beat arising from the ventricle. 283 00:13:02,148 --> 00:13:04,283 And how frequently does this occur? 284 00:13:04,284 --> 00:13:07,086 Can we socratically skip to the solution, please? 285 00:13:07,087 --> 00:13:08,354 Mmm. 286 00:13:08,355 --> 00:13:10,789 We should check for any electrolyte abnormalities. 287 00:13:10,790 --> 00:13:12,658 Get a 12-lead EKG and an echo. 288 00:13:12,659 --> 00:13:15,194 - Correct, young Skywalker. - Okay, you don't cut that out, 289 00:13:15,195 --> 00:13:16,762 I'm gonna break out my lightsaber, 290 00:13:16,763 --> 00:13:18,197 send you on a visit to Obi-Wan. 291 00:13:18,198 --> 00:13:21,667 Okay, got it, yeah, sorry sir. 292 00:13:23,236 --> 00:13:26,305 - Jamie, sponge. There's a significant 293 00:13:26,306 --> 00:13:28,173 amount of bleeding from the liver. 294 00:13:28,174 --> 00:13:30,709 We're gonna need to administer cryo, fibrinogen, 295 00:13:30,710 --> 00:13:32,811 and TXA to get this under control. 296 00:13:32,812 --> 00:13:34,546 Then you operate on the fracture? 297 00:13:34,547 --> 00:13:36,950 No. She can't handle that. 298 00:13:38,118 --> 00:13:41,253 He didn't stabilize the pelvic fracture surgically? 299 00:13:41,254 --> 00:13:42,888 - Just put a binder on. Said she's too 300 00:13:42,889 --> 00:13:44,957 critically ill already. 301 00:13:44,958 --> 00:13:46,392 Too conservative, right? 302 00:13:46,393 --> 00:13:47,960 Even with borderline displacement, 303 00:13:47,961 --> 00:13:49,128 he should've operated. - Mmm. 304 00:13:49,129 --> 00:13:51,897 I'd keep an eye on her hematocrit. 305 00:13:51,898 --> 00:13:53,165 Any luck on your end? 306 00:13:53,166 --> 00:13:54,933 Turns out antlers through the chest 307 00:13:54,934 --> 00:13:57,002 is a one-in-a-million kind of situation 308 00:13:57,003 --> 00:13:58,704 and I am on the clock here. 309 00:13:58,705 --> 00:14:02,808 - What is it... improvise, adapt...? 310 00:14:02,809 --> 00:14:05,844 Overcome? That's the marines. 311 00:14:05,845 --> 00:14:07,713 Whatever, ranger. 312 00:14:07,714 --> 00:14:09,048 Think outside the box. 313 00:14:09,049 --> 00:14:12,418 Ben trusts you. Maybe trust yourself. 314 00:14:13,486 --> 00:14:15,287 I'm seeing some ventricular strain. 315 00:14:15,288 --> 00:14:19,792 We're in here now. No turning back. 316 00:14:19,793 --> 00:14:23,562 Keep scrolling, Carin. Show me the enzymes and lactate. 317 00:14:23,563 --> 00:14:27,866 - What are you looking for? - I'll know when I see it. 318 00:14:27,867 --> 00:14:31,503 Okay, this is unusual. 319 00:14:31,504 --> 00:14:32,938 Oh, God. 320 00:14:35,542 --> 00:14:37,910 Dr. Grant, Dr. Larsen's on the phone for you. 321 00:14:37,911 --> 00:14:39,978 - Now? - She says it's urgent. 322 00:14:39,979 --> 00:14:41,914 Put her on speaker. 323 00:14:41,915 --> 00:14:43,649 What is it? His results came back. 324 00:14:43,650 --> 00:14:46,218 Troponins BNP and lactate are off the charts. 325 00:14:46,219 --> 00:14:49,188 You need to stop the surgery. 326 00:14:49,189 --> 00:14:51,457 Wha... Where am I? 327 00:14:51,458 --> 00:14:53,258 It's okay. It's okay. 328 00:14:53,259 --> 00:14:57,629 You're at Westside Hospital in Minneapolis. 329 00:14:59,032 --> 00:15:02,167 - My head is killing me. What happened? 330 00:15:02,168 --> 00:15:05,972 - You were in an accident. Your car hit a deer. 331 00:15:07,273 --> 00:15:10,309 Careful. Careful. - Am I okay? 332 00:15:10,310 --> 00:15:11,977 This'll sound worse than it is, 333 00:15:11,978 --> 00:15:14,413 but you have a bleed around your brain. Now... 334 00:15:15,982 --> 00:15:18,150 Mom, you're okay! 335 00:15:18,151 --> 00:15:20,719 - Ah, I'm sorry. I don't know who you are. 336 00:15:22,455 --> 00:15:25,391 I'm your son. 337 00:15:25,392 --> 00:15:27,359 Theo. 338 00:15:27,360 --> 00:15:29,695 What is he talking about? 339 00:15:29,696 --> 00:15:31,231 I-I don't have a son. 340 00:15:36,736 --> 00:15:39,305 So, did I use up all my questions? 341 00:15:41,207 --> 00:15:43,677 Depends. Can you handle more of my answers? 342 00:15:43,777 --> 00:15:46,379 - Oh, I think so. - Okay, then. 343 00:15:46,479 --> 00:15:49,515 You do background on everyone at the conference? 344 00:15:49,516 --> 00:15:50,816 Or just me? 345 00:15:50,817 --> 00:15:55,120 Did you really come up here to ask me that or eat crow? 346 00:15:56,790 --> 00:16:00,125 Both. 347 00:16:00,126 --> 00:16:03,029 But I prefer to atone over a drink. 348 00:16:05,932 --> 00:16:07,933 What are you doing? 349 00:16:07,934 --> 00:16:09,935 I told you to stop. - I heard you. 350 00:16:09,936 --> 00:16:11,370 The transfusions we've given him 351 00:16:11,371 --> 00:16:13,772 have caused fluid overload. He's in heart failure. 352 00:16:13,773 --> 00:16:15,574 I've controlled all the bleeders I can visualize, 353 00:16:15,575 --> 00:16:17,676 but there could be more hiding behind the antlers. 354 00:16:17,677 --> 00:16:20,112 I'm pretty sure if I stop, he'll bleed out. 355 00:16:20,113 --> 00:16:22,147 If you don't stop, he's gonna die on your table. 356 00:16:22,148 --> 00:16:24,550 I have to fix the heart failure first. 357 00:16:24,551 --> 00:16:28,053 - And how you gonna do that? - Goal-directed diuresis. 358 00:16:28,054 --> 00:16:29,521 He can't handle single-lung ventilation. 359 00:16:29,522 --> 00:16:31,924 Had to put him on VV ECMO. - I'm aware. 360 00:16:31,925 --> 00:16:35,060 All right. I'll get him ready for you, but if he's not back 361 00:16:35,061 --> 00:16:36,528 in my OR in four hours, 362 00:16:36,529 --> 00:16:40,734 the circuit will clot, and he'll die in your ICU. 363 00:16:46,439 --> 00:16:48,774 - Can you do that? In four hours? 364 00:16:48,775 --> 00:16:50,377 We have no choice. 365 00:16:56,649 --> 00:16:58,217 ICU? 366 00:16:58,218 --> 00:16:59,818 Your sister should be waking up soon. 367 00:16:59,819 --> 00:17:03,589 Dr. Costa was able to get her bleeding under control. 368 00:17:03,590 --> 00:17:05,724 She looks so small. 369 00:17:05,725 --> 00:17:07,559 She's... She's strong. 370 00:17:07,560 --> 00:17:10,397 And stable for now. That's... That's good. 371 00:17:10,497 --> 00:17:12,698 Why doesn't my mom know me? 372 00:17:12,699 --> 00:17:14,199 It's not just you. 373 00:17:14,200 --> 00:17:16,603 She doesn't remember anyone right... 374 00:17:18,772 --> 00:17:20,472 Um... 375 00:17:20,473 --> 00:17:23,575 We're not sure yet. Not yet. 376 00:17:23,576 --> 00:17:25,711 She's getting... She's getting a repeat CT. 377 00:17:25,712 --> 00:17:29,748 It's a scan of her brain so they can figure it out. 378 00:17:29,749 --> 00:17:33,386 - What about my dad? Is he gonna be okay? 379 00:17:35,588 --> 00:17:37,356 Um... 380 00:17:37,357 --> 00:17:40,793 we... we're doing what... 381 00:17:40,794 --> 00:17:42,294 What... 382 00:17:42,295 --> 00:17:46,932 We're doing everything we can. For him. 383 00:17:46,933 --> 00:17:48,667 Okay? 384 00:17:54,841 --> 00:17:56,075 Sorry. 385 00:17:56,076 --> 00:17:58,877 Stay here and monitor Harper's serial crits 386 00:17:58,878 --> 00:18:02,582 and drain output. Any changes, let me know right away. 387 00:18:09,823 --> 00:18:12,825 Come on, Harp. Wake up. 388 00:18:12,826 --> 00:18:14,626 Can she hear me? - Probably. 389 00:18:14,627 --> 00:18:17,429 The anesthesia just takes some time to wear off. 390 00:18:17,430 --> 00:18:19,098 If you wake up now, I'll show you 391 00:18:19,099 --> 00:18:21,433 how to code in python. 392 00:18:21,434 --> 00:18:23,535 She's been bugging me to teach her. 393 00:18:26,840 --> 00:18:28,774 Theo, she needs to rest. 394 00:18:28,775 --> 00:18:31,043 I'm gonna take you to the waiting room, okay? 395 00:18:31,044 --> 00:18:32,344 Why? What-What's going on? 396 00:18:32,345 --> 00:18:34,079 I just, I need you to come with me. 397 00:18:34,080 --> 00:18:36,715 - I-Is this about my mom? - No. 398 00:18:36,716 --> 00:18:38,650 Well, they took her away and they won't tell me 399 00:18:38,651 --> 00:18:40,886 why she doesn't remember! - Remember what? 400 00:18:40,887 --> 00:18:43,423 Me! She doesn't know who I am. 401 00:18:44,657 --> 00:18:47,026 Um, I'm sorry, I've been treating your father. 402 00:18:47,027 --> 00:18:48,427 But I'll get you an update. 403 00:18:48,428 --> 00:18:50,729 I need you to go to the waiting room. Okay? 404 00:18:50,730 --> 00:18:52,798 Someone will be by soon. 405 00:18:52,799 --> 00:18:54,633 - Why did he have to go? Did something happen? 406 00:18:54,634 --> 00:18:56,602 We're bringing his father up here now. 407 00:18:58,738 --> 00:19:00,239 Oh. 408 00:19:00,240 --> 00:19:03,509 Oh, my God. The antler's still in him. 409 00:19:03,510 --> 00:19:05,944 We more access. Get a second line going. 410 00:19:05,945 --> 00:19:08,881 He needs Furosemide, Cefepime, and Vancomycin. 411 00:19:08,882 --> 00:19:12,084 - I can get it. - Julie's got it. Stay back. 412 00:19:12,085 --> 00:19:13,385 You paged Cardiology? 413 00:19:13,386 --> 00:19:14,753 Yeah, I need a transesophageal echo 414 00:19:14,754 --> 00:19:17,122 to monitor his cardiac function. - Yeah, no problem. 415 00:19:17,123 --> 00:19:18,891 I just need to get some more dressings. 416 00:19:18,892 --> 00:19:20,325 Yeah. 417 00:19:20,326 --> 00:19:23,162 Mrs. Evans doesn't remember what happened. 418 00:19:23,163 --> 00:19:26,131 Or recognize Theo or anyone in her family. 419 00:19:26,132 --> 00:19:27,666 Brain bleed must be getting worse. 420 00:19:27,667 --> 00:19:31,503 So we were wrong about it being stable enough to monitor? 421 00:19:31,504 --> 00:19:33,339 No, you weren't wrong. 422 00:19:33,340 --> 00:19:35,040 Her hematoma's getting smaller. 423 00:19:35,041 --> 00:19:37,309 Oh, so what's causing her symptoms? 424 00:19:39,179 --> 00:19:40,312 I'm sorry to interrupt. 425 00:19:40,313 --> 00:19:42,781 Dr. Hamda, can I have a word, please? 426 00:19:42,782 --> 00:19:44,483 EEG? MRI? 427 00:19:44,484 --> 00:19:46,118 Yeah, and I'll want to do 428 00:19:46,119 --> 00:19:47,954 some more advanced cognitive testing. 429 00:19:49,723 --> 00:19:52,057 - What can I do for you? - Yeah, I just want to make sure 430 00:19:52,058 --> 00:19:54,661 you've been apprised of the situation with my patient. 431 00:19:54,761 --> 00:19:56,161 Your patient? 432 00:19:56,162 --> 00:19:57,596 The guy with the antler in his chest. 433 00:19:57,597 --> 00:19:59,598 Anthony Evans. What about him? 434 00:19:59,599 --> 00:20:02,034 Dr. Larsen insisted that I stop mid-surgery 435 00:20:02,035 --> 00:20:05,471 so she can find a medical solution to his heart failure. 436 00:20:05,472 --> 00:20:07,339 - And? - And he was already at risk 437 00:20:07,340 --> 00:20:08,674 of dying from impalement. 438 00:20:08,675 --> 00:20:10,509 The longer we delay, she compounds that risk 439 00:20:10,510 --> 00:20:12,711 with the likelihood of ECMO failure and infection. 440 00:20:12,712 --> 00:20:14,713 Are you implying she's not up to the task? 441 00:20:14,714 --> 00:20:16,515 Listen, I just checked on the Evans's status, 442 00:20:16,516 --> 00:20:18,250 and they are no closer to an answer. 443 00:20:18,251 --> 00:20:20,687 So maybe you wanna give her a hand. 444 00:20:24,491 --> 00:20:25,457 How is he? 445 00:20:25,458 --> 00:20:27,226 Still alive for the moment. 446 00:20:27,227 --> 00:20:28,827 Julie, get me updated Is and Os, 447 00:20:28,828 --> 00:20:31,898 and his latest ABG and trops. - On it. 448 00:20:33,266 --> 00:20:36,201 I heard about Mrs. Evans. 449 00:20:36,202 --> 00:20:37,403 Poor Theo's a mess. 450 00:20:37,404 --> 00:20:38,537 He's actually handling it 451 00:20:38,538 --> 00:20:39,772 pretty well, considering. 452 00:20:39,773 --> 00:20:43,008 - Right. I guess you're an expert. 453 00:20:43,009 --> 00:20:46,512 When I woke up from my accident, I wasn't much fun either. 454 00:20:46,513 --> 00:20:48,747 Well, at least you remembered me. 455 00:20:48,748 --> 00:20:51,150 What's your plan here? - It's a tightrope. 456 00:20:51,151 --> 00:20:53,318 We gave him diuretics to get rid of the excess fluid 457 00:20:53,319 --> 00:20:55,421 and then the ECMO started chugging. 458 00:20:55,422 --> 00:20:57,423 Not enough blood flow to the pump. You drop the RPM? 459 00:20:57,424 --> 00:20:59,558 Yeah, I did, but if that doesn't work, 460 00:20:59,559 --> 00:21:01,193 we're gonna have to give him more fluids 461 00:21:01,194 --> 00:21:02,294 and then we're back at square one. 462 00:21:02,295 --> 00:21:04,196 And his clotting's gotten worse. 463 00:21:04,197 --> 00:21:06,198 Just as Dr. Grant predicted. 464 00:21:06,199 --> 00:21:08,133 - You talked to him? - I did. 465 00:21:08,134 --> 00:21:10,135 He's wary about what you're attempting. 466 00:21:10,136 --> 00:21:11,203 Well, that tracks. 467 00:21:11,204 --> 00:21:13,305 Is there something I should know about you two? 468 00:21:14,374 --> 00:21:16,643 What did you sign up for? 469 00:21:18,511 --> 00:21:20,346 Did you just have another memory? 470 00:21:20,347 --> 00:21:22,581 I'm managing. I'm fine. 471 00:21:22,582 --> 00:21:26,519 We need to regain control of his fluid status. 472 00:21:32,559 --> 00:21:35,794 Don't take it personally. 473 00:21:35,795 --> 00:21:37,096 Thought I was doing pretty well, 474 00:21:37,097 --> 00:21:38,797 but suddenly, she's acting like I'm in the way. 475 00:21:38,798 --> 00:21:41,633 Yeah, it gets hard to predict which version you're gonna get. 476 00:21:41,634 --> 00:21:43,435 And today especially. 477 00:21:43,436 --> 00:21:45,738 Not sure what you know about her, but... 478 00:21:45,739 --> 00:21:49,475 Oh, we all know. Everything. 479 00:21:49,476 --> 00:21:52,544 'Kay, well then, this should make sense. 480 00:21:52,545 --> 00:21:55,582 Car accident? Woman losing her memory? 481 00:21:55,682 --> 00:21:57,416 Family hanging in the balance? 482 00:21:57,417 --> 00:21:59,486 - Right. - But you can't control any 483 00:21:59,586 --> 00:22:01,854 of that. All you can do is just manage you. 484 00:22:01,855 --> 00:22:03,989 And try not to wake the beast. 485 00:22:03,990 --> 00:22:06,058 Thanks for the consult. 486 00:22:06,059 --> 00:22:07,292 Yeah. 487 00:22:07,293 --> 00:22:09,762 Jen Evans, coming in. 488 00:22:09,763 --> 00:22:13,098 - Her face is drooping. Speech is slurred. 489 00:22:13,099 --> 00:22:14,500 She's getting worse. 490 00:22:14,501 --> 00:22:16,835 No signs on the imaging, but it looks like a stroke. 491 00:22:16,836 --> 00:22:18,904 I started a low-dose heparin drip. 492 00:22:18,905 --> 00:22:21,640 Hopefully it reverses the effects and the memory loss. 493 00:22:21,641 --> 00:22:23,842 - Theo really wants an update. - Yeah. 494 00:22:23,843 --> 00:22:25,478 Okay. 495 00:22:27,180 --> 00:22:30,483 Just, um... text me the number. 496 00:22:31,851 --> 00:22:33,486 Thanks. 497 00:22:37,691 --> 00:22:40,659 That was Albert. My dad's friend. 498 00:22:40,660 --> 00:22:42,528 I'm glad you have someone to talk to. 499 00:22:42,529 --> 00:22:43,996 He's trying to find me a lawyer. 500 00:22:43,997 --> 00:22:45,964 - Why would you need a... - You think I don't know 501 00:22:45,965 --> 00:22:48,267 what's going on? The way you're all acting? 502 00:22:48,268 --> 00:22:50,636 My dad's not gonna make it. 503 00:22:50,637 --> 00:22:54,540 And my mom... she doesn't even know who we are. 504 00:22:54,541 --> 00:22:56,241 Look, we don't have anyone else. 505 00:22:56,242 --> 00:22:58,477 They'll put us in foster care. They'll separate us! 506 00:22:58,478 --> 00:23:00,279 Theo, you're getting ahead of yourself. 507 00:23:00,280 --> 00:23:01,480 Look, don't lie to me. 508 00:23:01,481 --> 00:23:03,115 You already sent your social worker 509 00:23:03,116 --> 00:23:04,717 to come talk to me. 510 00:23:04,718 --> 00:23:06,652 - I'm sorry. They shouldn't have done that. 511 00:23:06,653 --> 00:23:08,187 I don't get it! 512 00:23:08,188 --> 00:23:11,190 I'm old enough to drive. Old enough to kill my parents. 513 00:23:11,191 --> 00:23:14,427 But I'm not old enough to take care of my sister? 514 00:23:18,465 --> 00:23:19,832 I-I'm sorry, I just... 515 00:23:19,833 --> 00:23:22,602 Hey. It's okay. 516 00:23:24,170 --> 00:23:25,671 She didn't want me to drive, 517 00:23:25,672 --> 00:23:29,542 but I really thought I was ready. 518 00:23:31,277 --> 00:23:34,113 Uh, Dr. Maitra? 519 00:23:34,114 --> 00:23:35,080 What's going on? 520 00:23:35,081 --> 00:23:36,715 I know you said to watch her hematocrit, 521 00:23:36,716 --> 00:23:39,418 but Harper's getting tachypneic. 522 00:23:39,419 --> 00:23:40,886 I figured I should tell you. 523 00:23:47,360 --> 00:23:49,795 - You paged me? - Respiratory distress. 524 00:23:49,796 --> 00:23:51,730 I think it's a fat embolism from the pelvic fracture. 525 00:23:51,731 --> 00:23:54,867 Need an echo to confirm. - Okay, I got it. 526 00:23:54,868 --> 00:23:56,869 Decreasing RPM and giving volume isn't working. 527 00:23:56,870 --> 00:23:59,471 BP's still too low. - I know that, Michael. 528 00:23:59,472 --> 00:24:00,873 Well, d'you think there's bleeding? 529 00:24:00,874 --> 00:24:03,743 - Sorry, I know you're busy. - Not now, Kyle. 530 00:24:04,878 --> 00:24:06,745 Do you have any idea what you're doing? 531 00:24:06,746 --> 00:24:09,449 But we got the labs back. 532 00:24:09,549 --> 00:24:11,650 His hemoglobin's 19. That's high, right? 533 00:24:11,651 --> 00:24:13,485 - Very high. - So he's not bleeding. 534 00:24:13,486 --> 00:24:14,820 Doesn't make sense. 535 00:24:16,156 --> 00:24:19,158 Stay, Kyle. 536 00:24:19,159 --> 00:24:20,959 It's capillary leak syndrome. 537 00:24:20,960 --> 00:24:23,462 The hemoglobin's falsely elevated 538 00:24:23,463 --> 00:24:25,097 because his blood vessels are leaking fluid 539 00:24:25,098 --> 00:24:27,866 into his tissues. It can happen after a trauma. 540 00:24:27,867 --> 00:24:30,269 Explains the heart failure and why nothing we've been doing 541 00:24:30,270 --> 00:24:31,570 has worked to raise his BP. 542 00:24:31,571 --> 00:24:33,639 What about Hepastarch to pull the fluid back 543 00:24:33,640 --> 00:24:35,441 into his blood vessels? - His kidneys still won't 544 00:24:35,442 --> 00:24:37,343 get rid of the excess fluid in time. 545 00:24:37,344 --> 00:24:39,778 What if we dialyze him via his ECMO 546 00:24:39,779 --> 00:24:42,214 to fix the fluid overload in the OR? 547 00:24:42,215 --> 00:24:43,148 What does that mean? 548 00:24:43,149 --> 00:24:46,185 His ECMO is letting us bypass his lungs. 549 00:24:46,186 --> 00:24:48,253 If we hooked up a dialysis machine to it, 550 00:24:48,254 --> 00:24:49,489 we could bypass his kidneys, 551 00:24:49,589 --> 00:24:50,856 taking the fluid off faster, 552 00:24:50,857 --> 00:24:52,858 but still keeping it controlled. 553 00:24:52,859 --> 00:24:57,663 Which would allow Dr. Grant to proceed with the surgery. 554 00:24:57,664 --> 00:24:59,598 No journal articles, not one? 555 00:24:59,599 --> 00:25:00,933 All traditional lit was a bust. 556 00:25:00,934 --> 00:25:02,534 There's gotta be something out there. 557 00:25:02,535 --> 00:25:04,036 Good for you if you can find it. 558 00:25:04,037 --> 00:25:05,871 The fact that I couldn't, got me thinking. 559 00:25:05,872 --> 00:25:07,373 Docs who have dealt with this 560 00:25:07,374 --> 00:25:08,741 aren't the ones who write papers. 561 00:25:08,742 --> 00:25:11,510 They're the ones with real-life, hands-on experience. 562 00:25:11,511 --> 00:25:13,746 So, I called around to rural hospitals. 563 00:25:13,747 --> 00:25:15,748 Found a similar case in Grand Marais. 564 00:25:15,749 --> 00:25:17,049 Another one in Drummond. 565 00:25:17,050 --> 00:25:18,817 Based on what those surgeons said, 566 00:25:18,818 --> 00:25:20,552 I worked out a strategy for us. 567 00:25:20,553 --> 00:25:22,688 Keep talking. 568 00:25:22,689 --> 00:25:25,290 We need to treat it like a tumor, not a trauma. 569 00:25:25,291 --> 00:25:27,693 Instead of trying to save the damaged blood vessels 570 00:25:27,694 --> 00:25:30,295 by taking out the antler piece by piece, 571 00:25:30,296 --> 00:25:32,664 we should remove the whole section of the antler, 572 00:25:32,665 --> 00:25:34,900 and the penetrated vessels, and the airway. 573 00:25:34,901 --> 00:25:36,535 And then what? Watch him die? 574 00:25:36,536 --> 00:25:38,904 Then we take what's left over from the artery and bronchus, 575 00:25:38,905 --> 00:25:40,406 put those two ends back together. 576 00:25:40,407 --> 00:25:41,707 He'll bleed like a stuck pig. 577 00:25:41,708 --> 00:25:43,709 Means we gotta move fast. 578 00:25:43,710 --> 00:25:44,777 I like it. 579 00:25:44,778 --> 00:25:46,679 But it's all moot if Dr. Larsen can't stabilize 580 00:25:46,680 --> 00:25:49,715 the patient for surgery. She's got an hour. Tops. 581 00:25:49,716 --> 00:25:51,550 - I already checked in. Not ready yet. 582 00:25:51,551 --> 00:25:53,085 Argh. 583 00:25:53,086 --> 00:25:54,687 We've got Harper, pelvic binder wasn't enough. 584 00:25:54,688 --> 00:25:56,088 She needs ORIF. 585 00:25:56,089 --> 00:25:57,990 Echo confirmed the fracture's causing fat emboli. 586 00:25:57,991 --> 00:26:00,526 - Should I page Dr. Costa? - No, I got this. 587 00:26:00,527 --> 00:26:01,894 Let's go, Dr. Fox. 588 00:26:01,895 --> 00:26:04,096 Tell Dr. Larsen I'll be ready in 30, 589 00:26:04,097 --> 00:26:07,267 so she won't be waiting on me. Prep OR 2 right now. 590 00:26:12,539 --> 00:26:14,239 So, how long have you been separated? 591 00:26:14,240 --> 00:26:20,112 - Mm. Three months. We were together 26 years. 592 00:26:20,113 --> 00:26:22,681 Can't be easy getting back out there. 593 00:26:22,682 --> 00:26:24,850 Who said I'm back out there? 594 00:26:24,851 --> 00:26:26,852 Yeah, I'm sure it's going well for you. 595 00:26:26,853 --> 00:26:28,821 Ask me again in an hour. 596 00:26:30,323 --> 00:26:33,292 Really? Does that work on the other women? 597 00:26:33,293 --> 00:26:35,127 There are no other women. 598 00:26:35,128 --> 00:26:38,364 Um, as far as my ex knows, at least. 599 00:26:39,699 --> 00:26:42,401 No, yeah, our divorce isn't exactly amicable. 600 00:26:42,402 --> 00:26:43,969 So you did something wrong? 601 00:26:43,970 --> 00:26:45,637 I did lots of things wrong. 602 00:26:45,638 --> 00:26:49,641 But if you're asking was I unfaithful? 603 00:26:49,642 --> 00:26:52,111 No. We just disconnected. 604 00:26:52,112 --> 00:26:53,879 Kept it together for the kids, but once they were 605 00:26:53,880 --> 00:26:56,715 out of the house... you know. 606 00:26:56,716 --> 00:27:01,553 Well... okay. Your turn. 607 00:27:01,554 --> 00:27:03,356 No. 608 00:27:03,456 --> 00:27:06,625 No, I didn't sign up for that. 609 00:27:06,626 --> 00:27:09,396 What did you sign up for? 610 00:27:11,031 --> 00:27:12,498 Fluoro shows excellent 611 00:27:12,499 --> 00:27:14,633 alignment and stabilization of Harper's pelvic ring. 612 00:27:14,634 --> 00:27:17,336 - She gonna be okay? - She will now. 613 00:27:17,337 --> 00:27:20,205 So, you would've operated on the pelvis this morning. 614 00:27:20,206 --> 00:27:22,107 After the liver? Yeah. 615 00:27:22,108 --> 00:27:25,678 You were wrong. I am waiting for you. 616 00:27:25,679 --> 00:27:27,881 Mr. Evans is ready. 617 00:27:29,315 --> 00:27:30,649 Dr. Fox, close up. 618 00:27:30,650 --> 00:27:33,252 Dr. Coleman, suit up and scrub in. 619 00:27:33,253 --> 00:27:35,421 - Really? - It's your plan. Let's go. 620 00:27:35,422 --> 00:27:36,922 Pick-ups. 621 00:27:40,160 --> 00:27:41,427 Dr. Larsen, 622 00:27:41,428 --> 00:27:42,828 I'll need you to keep him stable 623 00:27:42,829 --> 00:27:44,596 so I can finish the surgery this time. 624 00:27:44,597 --> 00:27:45,764 Oh, I'll do my part. 625 00:27:45,765 --> 00:27:48,301 Curious how you plan to do yours. 626 00:27:48,401 --> 00:27:50,704 Ask Dr. Coleman. 627 00:27:51,971 --> 00:27:53,706 We'll follow sleeve resection guidelines 628 00:27:53,707 --> 00:27:56,342 for antler removal and anastomosis. 629 00:27:56,343 --> 00:27:58,644 Pull the whole thing out, then put the damaged vessels 630 00:27:58,645 --> 00:27:59,745 and the bronchi back together. 631 00:28:03,750 --> 00:28:05,250 What's happening? 632 00:28:05,251 --> 00:28:07,319 She's responding well to the heparin, 633 00:28:07,320 --> 00:28:09,955 but now she's got 102-degree fever. 634 00:28:09,956 --> 00:28:12,091 Well, maybe it wasn't the trauma. 635 00:28:12,092 --> 00:28:14,226 Could the stroke have been caused by an infection? 636 00:28:14,227 --> 00:28:16,462 I started her on broad-spectrum antibiotics 637 00:28:16,463 --> 00:28:18,597 just in case. 638 00:28:18,598 --> 00:28:19,965 Now she's tachycardic. 639 00:28:19,966 --> 00:28:21,266 She needs more fluids. 640 00:28:26,940 --> 00:28:28,107 Why is she getting worse? 641 00:28:28,108 --> 00:28:30,976 Theo, you can't be here right now. Liz! 642 00:28:30,977 --> 00:28:32,811 Please, help my mom. 643 00:28:32,812 --> 00:28:34,847 - Yes. Yes, they will. Theo, they will. Okay? 644 00:28:34,848 --> 00:28:36,715 But we gotta go now. 645 00:28:36,716 --> 00:28:39,385 C'mon. 646 00:28:39,386 --> 00:28:42,721 - Got a lot of bleeding here. What's the fluid status? 647 00:28:42,722 --> 00:28:44,790 Ultrafiltration is working. 648 00:28:44,791 --> 00:28:47,192 Dr. Coleman, I need you to ligate that bleeder 649 00:28:47,193 --> 00:28:49,194 with an O silk. 650 00:28:49,195 --> 00:28:49,996 I'm right here. 651 00:28:50,130 --> 00:28:51,831 And you gotta learn sometime. Let's go. 652 00:29:07,847 --> 00:29:09,516 You all right? 653 00:29:11,851 --> 00:29:13,285 When I finished med school, 654 00:29:13,286 --> 00:29:15,587 they gave me a piece of paper that said, you know, 655 00:29:15,588 --> 00:29:16,989 I'm a doctor. 656 00:29:16,990 --> 00:29:18,457 But I don't feel like a doctor. 657 00:29:18,458 --> 00:29:22,728 I feel the exact same way I did a month ago. 658 00:29:22,729 --> 00:29:24,029 You helped save his sister's life. 659 00:29:24,030 --> 00:29:25,297 Yeah, but what about his mom? 660 00:29:25,298 --> 00:29:27,199 His dad? What're we gonna tell that poor kid? 661 00:29:27,200 --> 00:29:29,201 - It's not easy. But you're gonna need 662 00:29:29,202 --> 00:29:31,437 to learn to compartmentalize. 663 00:29:31,438 --> 00:29:34,341 Otherwise you're just gonna keep freezing like you did earlier. 664 00:29:37,143 --> 00:29:41,980 - I'm gonna get better at this. I promise. 665 00:29:41,981 --> 00:29:43,282 CBC is normal. 666 00:29:43,283 --> 00:29:45,184 RVP and blood cultures all negative. 667 00:29:45,185 --> 00:29:48,320 - Still, the fever's going up. It's at 104 now. 668 00:29:48,321 --> 00:29:50,389 - This has to be an infection. - Yeah, but from what? 669 00:29:50,390 --> 00:29:53,326 The antibiotics would've treated all the usual suspects. 670 00:29:54,961 --> 00:29:56,495 The deer carcass. 671 00:29:56,496 --> 00:29:59,898 It was bleeding everywhere, she had open wounds. 672 00:29:59,899 --> 00:30:02,434 The fever, stroke, cognitive impairment. 673 00:30:02,435 --> 00:30:06,972 - It's Brucellosis. From the infected deer's blood. 674 00:30:06,973 --> 00:30:10,009 This is the point of no return. 675 00:30:10,010 --> 00:30:12,077 All right, I got a proximal and distal control 676 00:30:12,078 --> 00:30:14,113 with the clamps. As soon as this comes out, 677 00:30:14,114 --> 00:30:16,148 every millisecond counts. 678 00:30:16,149 --> 00:30:18,317 I'll reattach artery and bronchi as fast as I can. 679 00:30:18,318 --> 00:30:20,019 The rest of you, do whatever you need to do 680 00:30:20,020 --> 00:30:21,820 to control the blood and keep him stable. 681 00:30:21,821 --> 00:30:23,555 Understood? Everybody copy? - Got it. 682 00:30:23,556 --> 00:30:24,857 Yeah? 683 00:30:24,858 --> 00:30:27,427 All right. We got this. 684 00:30:29,629 --> 00:30:31,697 One... 685 00:30:31,698 --> 00:30:34,500 Two... 686 00:30:34,501 --> 00:30:35,734 Three. 687 00:30:35,735 --> 00:30:37,269 Ah! 688 00:30:40,573 --> 00:30:42,741 Serena, goggles. 689 00:30:42,742 --> 00:30:43,876 TJ, suction. 690 00:30:46,980 --> 00:30:50,115 Dr. Grant. Dr. Grant. 691 00:30:50,116 --> 00:30:54,053 Ben! There's air in the circuit. - Get it out. Now. 692 00:30:54,054 --> 00:30:57,056 Turn the ventilator to 100 percent FiO2. 693 00:30:57,057 --> 00:31:01,061 Dr. Ferguson, get me a 60cc syringe. 694 00:31:08,101 --> 00:31:10,536 - His oxygen is tanking! - 'Cause he's not getting any. 695 00:31:10,537 --> 00:31:12,771 I just need a few more minutes to finish reconstructing 696 00:31:12,772 --> 00:31:15,342 the pulmonary artery anastomosis. 697 00:31:17,644 --> 00:31:19,245 Can you get the air out? 698 00:31:22,615 --> 00:31:23,483 Amy? 699 00:31:25,852 --> 00:31:27,620 You got this? 700 00:31:31,791 --> 00:31:34,259 So... 701 00:31:34,260 --> 00:31:37,463 How do we rate? 702 00:31:37,464 --> 00:31:38,330 What do you mean? 703 00:31:38,331 --> 00:31:40,032 My hospital hosted the conference. 704 00:31:40,033 --> 00:31:42,435 Need to report back how we did. 705 00:31:43,903 --> 00:31:47,339 Ask me again in an hour. 706 00:32:18,438 --> 00:32:20,305 You still questioning my skills? 707 00:32:20,306 --> 00:32:22,641 Hey, my focus was on the patient. 708 00:32:22,642 --> 00:32:24,076 And you came through. 709 00:32:24,077 --> 00:32:25,444 In the end. 710 00:32:25,445 --> 00:32:27,946 That's not an apology. 711 00:32:27,947 --> 00:32:30,015 - Now, listen. What we did in there today 712 00:32:30,016 --> 00:32:32,284 was impossible on paper. 713 00:32:32,285 --> 00:32:34,420 I needed a rockstar to get it done, and I, 714 00:32:34,421 --> 00:32:38,123 I just wasn't sure you were the same doctor you used to be. 715 00:32:38,124 --> 00:32:41,127 - Well, now you know. Just as good as I ever was. 716 00:32:41,227 --> 00:32:42,995 With all due respect, you'd be chief of medicine 717 00:32:42,996 --> 00:32:44,229 if that were true. 718 00:32:44,230 --> 00:32:46,031 I gotta say, this is really starting 719 00:32:46,032 --> 00:32:47,666 to feel personal. 720 00:32:47,667 --> 00:32:49,735 How could it? 721 00:32:49,736 --> 00:32:52,504 We barely know each other. 722 00:32:52,505 --> 00:32:57,276 - I guess nobody told you. I get memories sometimes. 723 00:32:57,277 --> 00:33:02,014 Especially when I'm, uh, triggered emotionally. 724 00:33:03,917 --> 00:33:07,086 Um... 725 00:33:07,087 --> 00:33:09,655 I started to text you the other day, 726 00:33:09,656 --> 00:33:11,857 but I wasn't sure when was the right time to tell you 727 00:33:11,858 --> 00:33:13,992 or... or how. 728 00:33:13,993 --> 00:33:16,396 Tell me what, exactly? 729 00:33:19,165 --> 00:33:20,667 We had, um... 730 00:33:22,502 --> 00:33:23,803 a dalliance. 731 00:33:25,372 --> 00:33:27,406 - A dalliance? - After your divorce. 732 00:33:27,407 --> 00:33:30,275 It was about four years ago. On and off. 733 00:33:30,276 --> 00:33:35,814 Long distance. And mostly, we'd meet at conferences. 734 00:33:35,815 --> 00:33:39,518 Uh, so nothing serious? 735 00:33:39,519 --> 00:33:42,421 No. And you did a preliminary review 736 00:33:42,422 --> 00:33:46,425 of my clinical trials as a courtesy. 737 00:33:46,426 --> 00:33:49,862 I guess you didn't read anything about that in your emails. 738 00:33:49,863 --> 00:33:51,598 It doesn't ring a bell. 739 00:33:53,767 --> 00:33:56,168 How did it end? Us? 740 00:33:56,169 --> 00:33:59,538 Petered out with no hard feelings. 741 00:34:00,340 --> 00:34:01,507 I should've called 742 00:34:01,508 --> 00:34:03,510 after that last night in New York. 743 00:34:05,045 --> 00:34:07,746 So, uh, we're good. 744 00:34:07,747 --> 00:34:08,847 Absolutely. 745 00:34:08,848 --> 00:34:13,318 And Dr. Heller is a great guy. I'm happy for you. 746 00:34:13,319 --> 00:34:16,289 Yeah. Okay. 747 00:34:17,791 --> 00:34:19,758 You were outstanding today. 748 00:34:19,759 --> 00:34:22,795 Back at you. 749 00:34:34,941 --> 00:34:36,842 Theo? 750 00:34:36,843 --> 00:34:38,143 Harpo! 751 00:34:38,144 --> 00:34:39,945 That's not my name. 752 00:34:39,946 --> 00:34:44,450 It is if I say so. 753 00:34:44,451 --> 00:34:47,686 Don't make me laugh. It hurts. 754 00:34:47,687 --> 00:34:52,124 Mom, is she okay? 755 00:34:52,125 --> 00:34:53,992 Doctors say she will be. 756 00:34:53,993 --> 00:34:57,296 - What about Dad? - He's still in surgery. 757 00:34:57,297 --> 00:34:59,733 Actually, he's out. 758 00:34:59,833 --> 00:35:03,002 He's stable and resting in the recovery room. 759 00:35:04,337 --> 00:35:06,972 Now, I'm not really supposed to do this, but... 760 00:35:06,973 --> 00:35:08,874 you wanna go see him? 761 00:35:08,875 --> 00:35:10,377 Yeah! 762 00:35:12,746 --> 00:35:14,213 I just wanna warn you, 763 00:35:14,214 --> 00:35:17,216 surgery can cause swelling, discoloration. 764 00:35:17,217 --> 00:35:19,551 Your dad won't look like himself. 765 00:35:19,552 --> 00:35:20,820 I understand. 766 00:35:25,158 --> 00:35:27,326 Look what you did today. 767 00:35:27,327 --> 00:35:30,562 You fought with everything you had to get out of that car. 768 00:35:30,563 --> 00:35:32,531 To find help, to save your family. 769 00:35:32,532 --> 00:35:36,301 And you did it. You saved them. 770 00:35:36,302 --> 00:35:39,339 You said before you thought you were ready. 771 00:35:40,740 --> 00:35:44,476 Nobody's ever ready for anything until they do it. 772 00:35:44,477 --> 00:35:49,948 But after today, you can handle whatever's coming. 773 00:36:17,344 --> 00:36:19,379 Are you the one who operated? 774 00:36:23,049 --> 00:36:24,551 Thank you. 775 00:36:29,255 --> 00:36:32,424 You're welcome, my friend. 776 00:36:32,425 --> 00:36:34,259 - What am I thanking you for? - For accepting you 777 00:36:34,260 --> 00:36:37,096 into the secret society of saviors. 778 00:36:37,097 --> 00:36:38,831 Surgery loves to steal all the glory, 779 00:36:38,832 --> 00:36:41,233 but we Cardio Kings, we had a big part 780 00:36:41,234 --> 00:36:42,534 in saving that family today. 781 00:36:42,535 --> 00:36:44,903 Uh, to be fair, I think Dr. Grant gets the MVP, 782 00:36:44,904 --> 00:36:47,172 but, yeah, we can take some of the credit. 783 00:36:47,173 --> 00:36:48,741 Yeah, we can. 784 00:36:48,742 --> 00:36:50,976 People only notice us when things go wrong. 785 00:36:50,977 --> 00:36:53,712 We're basically the FBI. - You see right there. 786 00:36:53,713 --> 00:36:56,015 We almost had a moment, and you ruined it. 787 00:36:59,719 --> 00:37:02,821 Great work today. 788 00:37:02,822 --> 00:37:04,290 Yeah, you too. 789 00:37:07,794 --> 00:37:10,763 Go home to your soon-to-be-non-ex-wife and kid, 790 00:37:10,764 --> 00:37:11,964 my brave squire. 791 00:37:11,965 --> 00:37:15,735 And my pursuit of domestic bliss shall continue as ever. 792 00:37:24,678 --> 00:37:27,012 He wasn't supposed to know about that. 793 00:37:27,013 --> 00:37:28,547 Well, it won't come from me, 794 00:37:28,548 --> 00:37:32,451 but it's gonna get out eventually. 795 00:37:32,452 --> 00:37:35,854 And it's not fair for Amy to be blindsided. 796 00:37:35,855 --> 00:37:37,524 Yeah. 797 00:37:39,959 --> 00:37:42,795 Dr. Costa. 798 00:37:42,796 --> 00:37:44,497 Good work today. 799 00:37:51,404 --> 00:37:54,006 When a patient of mine is in trouble, 800 00:37:54,007 --> 00:37:55,374 I expect to be paged. 801 00:37:55,375 --> 00:37:57,377 Noted. 802 00:38:04,551 --> 00:38:06,151 You didn't mention the pelvic binder. 803 00:38:06,152 --> 00:38:08,420 He understands what happened. 804 00:38:08,421 --> 00:38:10,457 No reason to rub it in his face. 805 00:38:14,160 --> 00:38:16,095 Heard you killed it today. 806 00:38:16,096 --> 00:38:18,564 I don't know about that. 807 00:38:18,565 --> 00:38:20,632 You caught the first sign of emboli. 808 00:38:20,633 --> 00:38:22,334 Saved that little girl's life. 809 00:38:22,335 --> 00:38:25,404 And you survived Dr. Maitra. 810 00:38:25,405 --> 00:38:26,906 Barely. 811 00:38:29,609 --> 00:38:31,543 How was Ruth today? 812 00:38:31,544 --> 00:38:34,146 She's still intact and she learned some lessons. 813 00:38:34,147 --> 00:38:37,050 So maybe you were right. - Good. 814 00:38:49,429 --> 00:38:51,297 I know what my reputation is. 815 00:38:51,398 --> 00:38:52,831 From when I was Chief of Medicine. 816 00:38:52,832 --> 00:38:56,236 And I suspect some of my behavior today 817 00:38:56,336 --> 00:38:59,405 may have reinforced it. 818 00:38:59,406 --> 00:39:01,840 Yeah. I mean, you acted like I was in the way 819 00:39:01,841 --> 00:39:04,577 when I'm here to learn and contribute. 820 00:39:06,946 --> 00:39:08,347 Was that too honest? 821 00:39:08,348 --> 00:39:09,314 - Uh... - My folks say 822 00:39:09,315 --> 00:39:10,015 I can be that way. 823 00:39:10,016 --> 00:39:12,118 No, honesty can be underrated. 824 00:39:14,421 --> 00:39:17,423 Well, I saw a lot today, too. 825 00:39:17,424 --> 00:39:21,061 I learned a lot. So, you know, thanks for that. 826 00:39:24,431 --> 00:39:26,999 I'm sorry that I behaved badly. 827 00:39:27,000 --> 00:39:28,868 I just want to do well. 828 00:39:30,337 --> 00:39:32,172 Doesn't seem like it was really about me. 829 00:39:38,178 --> 00:39:40,612 Well, I'm hearing she hasn't changed very much. 830 00:39:40,613 --> 00:39:42,648 From who? 831 00:39:42,649 --> 00:39:45,384 I'm sure you know that these walls have ears. 832 00:39:45,385 --> 00:39:47,486 Apparently she went toe-to-toe 833 00:39:47,487 --> 00:39:49,922 with our new Chief of Surgery today? 834 00:39:49,923 --> 00:39:53,559 They managed to work it out and save the patient. 835 00:39:53,560 --> 00:39:56,962 But, she's not exactly treading lightly. 836 00:39:56,963 --> 00:39:59,164 Well, I don't think she ever will, Max. 837 00:39:59,165 --> 00:40:01,567 Which is why you put some serious guard rails on her. 838 00:40:01,568 --> 00:40:04,670 Around the management of her TVI, of course. 839 00:40:04,671 --> 00:40:06,939 And what's your prognosis regarding that? 840 00:40:06,940 --> 00:40:08,941 Her brain's a wild card. 841 00:40:08,942 --> 00:40:11,677 You know, has been ever since the accident. What is this? 842 00:40:11,678 --> 00:40:14,279 You asked to be Chief of Medicine knowing 843 00:40:14,280 --> 00:40:16,482 it meant overseeing her. 844 00:40:16,483 --> 00:40:18,417 - Yes. - And you understand 845 00:40:18,418 --> 00:40:21,720 that your success or failure in that job will depend greatly 846 00:40:21,721 --> 00:40:23,288 on how you navigate the situation. 847 00:40:23,289 --> 00:40:26,225 You know, we've had this conversation a dozen times. 848 00:40:26,226 --> 00:40:27,993 We've had this conversation when you were sitting 849 00:40:27,994 --> 00:40:31,497 on this floor. Now you're running Internal Medicine. 850 00:40:31,498 --> 00:40:32,999 And I know what it means to stake out 851 00:40:33,099 --> 00:40:34,867 a new path for yourself. 852 00:40:34,868 --> 00:40:37,671 So, if you're thinking of giving her the kind of leeway 853 00:40:37,771 --> 00:40:39,805 you have in the past, 854 00:40:39,806 --> 00:40:42,041 everyone knows the history there. 855 00:40:42,042 --> 00:40:45,477 You just said it yourself, Max. It's history. 856 00:40:45,478 --> 00:40:47,079 There's nothing between us anymore. 857 00:40:47,080 --> 00:40:48,447 And everyone also knows, 858 00:40:48,448 --> 00:40:50,616 my life would be easier if she wasn't here. 859 00:40:50,617 --> 00:40:53,420 Well, if you want her gone, just fire her. 860 00:40:53,520 --> 00:40:54,953 We'll back you. 861 00:40:54,954 --> 00:40:56,822 I won't do that without cause. 862 00:40:56,823 --> 00:40:59,024 But rest assured... 863 00:40:59,025 --> 00:41:00,893 she does anything to earn my distrust 864 00:41:00,894 --> 00:41:05,698 or to jeopardize this hospital's reputation, 865 00:41:05,699 --> 00:41:07,801 I'll be the first one showing her the door. 866 00:41:09,202 --> 00:41:12,204 Well, that's a helluva thing to say about the woman 867 00:41:12,205 --> 00:41:14,106 you once loved. 868 00:41:14,107 --> 00:41:16,208 If you mean it. 869 00:41:28,555 --> 00:41:30,356 - Go get him. - Daddy! 870 00:41:32,859 --> 00:41:34,693 Oh, what're you doing up this late? 871 00:41:34,694 --> 00:41:36,863 She wouldn't go to sleep until she saw you. 872 00:41:38,231 --> 00:41:40,300 Hi. - Hey. 873 00:41:43,103 --> 00:41:45,504 Come on. 874 00:41:45,505 --> 00:41:47,773 Let's go, Princess? 875 00:41:47,774 --> 00:41:50,777 - Yeah. - Okay, go find it.