Getting On (2013–2015): Season 2, Episode 3 - Episode #2.3 - full transcript
Look what I got.
I bought a cello.
I know I really shouldn't be carrying
heavy things anymore, but...
I saw it in this beautiful
store that sold instruments.
Not a pawn shop.
And you know what? I'm gonna
play it for my baby in the womb.
That's nice.
All your stuff here
is taking up all the space.
Well, are you gonna
leave this here for six months?
No, just till Patsy sees it.
We're going in for my 12-week scan today.
Okay, well, now there's
no room for my feet.
Getting On - 02x03
Turnips...North Day...Yes, yes
Dr. James: Hello!
Good morning, Dr. James.
How was your three-day weekend?
It was so relaxing!
We took Renée to her fencing
tournament in San Diego,
and then I snuck off to the Del
for a two-hour Thai massage.
New lease on life.
Either of you, anything special? Weekends?
No?
Well...
Who's in comfort suite 109 now?
That is Hannah Doerr.
She's on respite care. She's deaf.
Oh, bless her heart.
Yeah, I ordered a video
remote interpretation unit
from patient services, so...
Mm-kay.
You, I could step in if you'd like,
and we could do her after the rounds?
It's just that I've admitted
a lot of deaf patients before,
and it can be kind of sensitive, Didi,
- and I've been trained.
- Okay.
I actually know a little sign language.
This is, um, "pain." Pain.
All right. Mm-hm.
Okay.
Mrs. Weller.
What's happening?
Why can't anyone tell me?
Well, unless things have
changed since last night,
you gonna be going
over to the hospital soon.
What's wrong with me now?
Well, it's your heart valve repair.
You remember, don't you?
I don't want it.
Calm down, it's all right.
No, it's not all right.
I don't want it.
- Okay, okay.
- I don't want it.
Then let's talk about it.
'Cause we don't force things on
people that they don't want.
That's not generally the way
we do things around here.
It isn't?
No, ma'am.
Okay, Mrs. Darlene Glennon.
She's here for a few days
to recover from an extensive
hiatal hernia repair.
Well, good morning,
Mrs. Glennon. What's cracking?
Oh, I can't get her bar code.
You had a hernia the
size of a large cantaloupe,
I believe, Mrs. Glennon.
Substantial intestinal adhesions.
Okay, she's scanned.
Hey, you're looking much better, today.
I am feeling better.
That's what I said. You do look better.
Okay, we have increasing
shortness of breath.
We have a persistent cough.
We have low blood oxygen
and a light fever and chills.
Respiratory distress. Could be?
Hospital-acquired pneumonia?
No, no, no, no, no. This is all wrong.
Resp rate, BP, and temp
all need to be on a whole separate page.
Could it be cardio myelitis?
Where's her medication file?
It's in the drop-down folder.
- What's that?
- That's a pop-up alert.
Well, get that... make that go away.
So, now, what's this whole field want?
Uh, the procedure code.
Oh, well, then you
put in the procedure code.
You go like this and cut and...
Shortness...
of...
breath...
Okay, it's not working, Dawn.
I don't really think
you know how to use this cart.
I took the training seminar, so yeah.
All right, bring it up.
Uh, different tab.
Enter, different tab.
[Repeating error alert]
Well, now it's frozen.
This is completely...
What was that you said again?
Let's get a sputum culture,
and why don't you check
your training seminar notes,
and maybe refresh yourself
on how this thing works.
Okay? Yeah? Good.
"It matters not how straight the gate,
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul."
I wish I felt this way.
Someday I want to feel this way.
You know what I mean, Mrs. Anthony?
"Out of the night that covers me..."
Patsy: Are you kidding me, right now?
Oh, well, I just don't...
Mm-hmm. All right.
Bye.
Well, our server crashed.
Or... the network connecting us
to our server crashed.
A virus began in S.W.A.D.D.L.E.
in pediatrics,
and worked its way through to our system.
Uh, okay.
Okay, so, the system is down, people.
Dawn: We've got cascading failures.
Um, charts, histories,
notes entry, all down.
So, we're going old-school.
Lab samples, you run them down.
Lab results, you run them up.
Pharmacy needs wet signatures.
That's signatures with a pen.
Now, Pyxis is on critical override.
If you don't know what that means,
you need to read the side of the machine.
Everything in longhand.
Spiral notebooks, people, spiral notebooks.
Pagers, beepers, old-school communication.
Communication is the key!
Everyone helps everyone.
We get each other's backs,
we get through this.
Okay? Great.
Things are escalating quickly.
That means everything,
everything, needs to be run through me.
Dawn.
Oh, good morning, Mrs. Willey-Weller. Hi.
What the H is going on?
Ellen is back there,
she is spitting kittens.
I... Yesterday, I'm told
heart surgery, okay.
And then today I get a call...
heart surgery's been canceled,
and now I'm told there's an oncologist
who wants to remove a lung instead.
Uh, Didi?
Yes, um...
I spoke with your
mother-in-law this morning.
We talked about the surgery,
and she changed her mind.
She changes her mind
all the time, she has dementia.
Dr. Stickley: Excuse me.
Pardon me.
Um, I just got a call
from my OR coordinator
that my valve repair,
that your mother's
heart surgery, is canceled.
And then I find a sticky on my door.
"Patient reevaluated surgery.
Please see me, Nurse Ortley."
Well, you gotta talk to her.
Uh, that would be me.
Yes, I tried to notate her chart,
but the computer was frozen.
So, I ran down and I left you a note.
You canceled a scheduled surgery?
I explained the surgery
to her and she got confused,
and then she said she didn't
want the surgery anymore.
She just wanted to be
with her family and her son.
Yeah, yeah, which is impossible.
Reminder, he's dead.
Okay, but with all due respect,
Mrs. Weller didn't
understand what was happening.
You are absolutely wrong.
I went over it very thoroughly with her.
I sat with her
and fully explained the risks
of the surgery to someone
showing signs of dementia.
She asked me for a social worker,
then she asked for a hospice case manager.
Hospice? Is that where we're at?
We've given up all hope?
Hey, I'm herto take Mrs. Elleller
down to the OA.
No, you're not.
Dr. James: Paul, are you
here for my meeting?
I'm here because this LPN decided
that she knew better
and talked my patient
into forgoing surgery.
Oh, Mrs. Willy-Wally?
Willey-Weller. Tell me, nurse,
what are your opinions on Iraq?
On cap and trade?
I mean there must be a plethora of things
you can opine on about which
you know absolutely nothing.
Ellen is agitated.
She won't talk to me,
she wants to talk to her son,
Phillip, my husband.
Reminder, he is dead.
Thank you, everybody, because
everything is completely unraveled.
You did see that the patient
has extensive lung tumors
which might preclude your surgery?
Of course I saw that.
Was I supposed to hear that?
I... I don't know where we're
at or what's going on.
I... I...
Clearly we need to schedule
a goals of care meeting.
We need to get everybody around the table.
Nurse, can you schedule
that for this afternoon?
- 'Cause that's what needs to happen.
- Thank you very much.
And that'll get everybody
right back on track.
All right, and Paul, I'll
see you in 30 minutes.
Wow...
What do you want, dear? What do you need?
Yeah, Mrs. Anthony just passed away
in room 107.
Thank you, all, for coming.
Extended care is raising new revenue
for the entire medical center
with our new aggressive focus on hospice.
And so, I just want to make
sure that as we move forward,
that those monies are duly credited
to those what brung 'em.
You're suggesting that that money does not
go into the general fund?
No, no, no, no.
Just merely that once it does,
a gentleman's agreement
that a small, fair amount
is returned from whence it came.
So, you're asking for a bounty?
It's an earmark, actually,
to support our operations
and, say, our research.
Well, uh, the committee will definitely
take everything under advisement.
All voices heard, that's the Lean way.
So, I heard that you have
moved into the old neonatal unit up on six?
Yes, like a hermit crab
into an empty shell.
Boston Deaconess...
Colombia Presbyterian...
And now Billy Barnes,
can all boast on-site mouse hospitals.
Phthalates in pregnant mouse urine
are linked to very specific genetic changes
in their male offspring.
So, what we're seeing now are
very female-like anogenital distances,
uh, incomplete descent
of testes, small penises.
So, now I'm collecting urine
from the women on the ward for comparison,
and what we're finding out is
these women are veritable receptacles
of fire retardant!
Aah! Oh, Paul!
Oh, god. I'm so sorry.
That's okay.
No, let me, please.
No, no, no. It... Jenna, don't worry. I'm...
I'm so sorry, I don't even know how...
These recycled napkins
are just not absorbent.
It's okay, Jenna.
I have a change in my... in my office.
I'm getting it. Now it's coming out.
I'm very determined.
I used to be a rock hound,
I always got my agates.
Jenna, that's okay.
Don't worry about it.
- No, it's fine. It's fine.
- Jenna, all right.
- It's coming. It's coming.
Jenna, that's enough.
So, I think we're done here.
- Yeah.
- Yeah.
Welcome to our brand new
comfort suite, Hannah Doerr.
Hannah is on home hospice,
but her husband is having
an emergency appendectomy
so there's no one at home
to take care of her right now.
I understand that you lip read, a little?
- A little.
- Okay.
Hannah has some anemia
after her last round of chemo,
and I think that the tumors
pressing on her spine
are causing her some
difficulty and some pain.
Hello! Hello?
Anybody there? Hello?
No, that's just us.
Well, I see that, Dawn.
I'm talking about in the screen or...
behind it, on the other side of...
Hello?
Or, is this gonna be another one of
those glitches like this morning?
No, and this morning wasn't me,
it was that the system is down.
But this works on wi-fi.
Are we really keeping score?
Okay, it's just that back here,
sometimes, it's kind of a dead zone.
So... Well, then what do you propose?
Maybe we should just
move her out into the ward?
Yes, let's try that.
Definitely try that. We're gonna go...
We're all gonna move out into the hallway.
It's all gonna be fine.
Grab a corner. Grab something.
Here, let me scooch over with you.
And, uh...
All right, watch the door.
Oh god, I don't know.
- It's big.
- Watch the sofa.
- You're getting on the sofa now.
- Oh, jeez.
All right, watch the door.
I don't know, I think it's...
Yeah, it's too big.
- Stop!
- It's the sofa.
Stop. I know, but look...
Look, there's privacy issues...
After all, we don't want
to do this whole thing
right out in the hallway, so...
Okay, well, I've got a connection.
Except now I'm getting
some kind of signal interference
from the other medical equipment.
Can you turn off all the EKG monitors?
We have a deaf patient.
Sorry. Thank you.
Welcome to BHB video relay information.
Please wait for the next
available interpreter.
I see you, can you see me?
Hello, yes, I'm Nurse Dawn Forchette.
I am pleased to be of service.
Ready when you are.
Okay, I want to start a transfusion
to address the anemia,
and then discuss a palliative
round of radiation
to shrink the tumors and ease the pain.
Yes, Doctor, please proceed. I
would like the opportunity.
I have been getting ducks in my ear.
North day. Yes, yes.
That's a little...
I don't know. That sounds kinda goofy.
Is the camera okay?
No, no, no. I'm not asking her,
I'm asking you.
I think it could be a little better.
Okay.
Can you tell her that I'm gonna
adjust the camera a little bit?
I think it's kind of obvious.
Thursday, not next.
Two turnips.
Train zoom.
Due day.
Have we used this agency before?
Because I think she's deaf too.
You know what, though?
Sign language is a little different.
Um, it's a conceptual language
made up of visual images.
Really? Thank you so much for that, Dawn.
Okay, I don't understand
what you are saying.
I'm trapped in a deaf sandwich here.
Did you say "turnips"?
No!
See, Dawn, can you put that down
and be present?
Well, I'm just trying to get it all.
All right, I think she's really angry,
now she's yelling.
Well, now she froze. Oh god.
Okay, guess what?
Dawn, cut it.
Everything back inside.
Come on, let's move.
I'm so sorry about this.
I can ask patient services
to go ahead and send over
our in-house signer.
I've got more pull over
there than Didi does,
so I think I can make it happen.
Okay, well, I think that
that should happen, Dawn,
because clearly, this
woman needs to get treated.
We have Americans with
Disabilities Act issues here.
'Cause the deaf can be really like...
Is she looking at me?
No, but she can see my face,
so I can't really say anything,
'cause she knows.
I think she knows, though,
that we're talking about her.
Once again, the whole thing has
just turned into a shambles.
Okay. Jesus, god.
[Hold music playing]
God, I've got toilets on the fritz.
I got labs backed up.
I don't know why this fucking ward
doesn't have a fucking pneumatic tube.
Oh, I have been on hold for six minutes
trying to get Antoine to come
pick up Mrs. Anthony's body.
Dawn!
The west-facing rooms are getting
really stuffy, and really hot.
Yeah, we know, we're on top of it.
No, there's like, nothing
coming out of the vents.
We know. We're on top of it.
[Phone rings]
Extended care, first floor.
Patsy: It's confirmed.
HVAC is on the blink.
The electronic controls are
tied into the information grid.
So, HVAC is down.
So, great, right?
HVAC is down.
No kidding.
Let me tell you something,
I sweat really, really bad, Dawn.
Okay.
This is no time to go
all princess on me, Denise.
Look, none of us like the heat.
Everyone perspires.
This is an emergency, all rise.
You know what, why don't
we go close the blinds.
Help me do that. That'll help, right?
That will help.
For what? Oh, the perspiration.
I got it off a patient last year.
It's kind of an old-timey thing.
Mm-mm.
You know, she also used
soap with bacon drippings.
It made her skin really soft.
What a disaster.
Sorry.
How you doing today, Miss Birdy?
Very good.
What's the temperature outside today?
Birdy, it's 100 degrees.
Oh.
I don't like waking up to 50
and having it be 100 in the afternoon.
Well, you and me, both.
Come on, it's time to do
your breathing treatment.
Miss Birdy.
It's just a spirometer.
It's too hot for this.
I got your iced macchiato,
and your single carrot cake.
Thank you, Colleen.
If you could just, um, put it...
Okay.
Dawn, she's dedicated hospice.
You can't just use her.
You know, I can talk
to them if I have to,
and she was going that
way anyway, Didi, okay?
I would advise you to get
in touch with Antoine
before Mrs. Anthony
overheats like a baked potato.
Why don't I do that.
Danae, is Darnell there?
Okay, I need you to get his keys,
and come down here,
bring me some fresh scrubs.
Uh-huh, two pair. Bring both.
You know how I get when I'm hot.
Girl, you can fry an egg on my head.
Huh?
No, I'm not gonna have a
conversation with you about shoes.
Excuse me, Dr. James?
Yes?
Um, do you have a moment?
Yeah.
I just... I lose myself up here, sometimes.
I'm just in my element.
You know, I think at heart
I'm a scientist trapped in a doctor's body.
You want to see how I hold my mice?
I grab 'em by the tail...
And I...
scruff him, and flip him,
and now he's all ready
for urine collection,
or injection, or vivisection.
Just kind of a rhythm thing.
Takes me back to freshman
biology like it was yesterday.
The years fly by, don't they?
Richard and Renée won't let
me have rodents in the house.
Well, I just have a minute,
but I wanted to let you know,
uh, that I'm pregnant.
I'm having a baby.
Pregnant? Oh, Dawn.
- 12 weeks.
- 12 weeks?
Uh-huh, good.
Uh, with...
Patsy De La Serda.
Nurse De La Serda, good.
Good deal.
Well, I just... I wanted you to know.
Yes.
Thank you for wanting me to know.
Okay!
Here you are, ladies.
Cool off.
Cool off.
Here you go. Refresh yourself.
Squeeze them from the bottom.
Here you are, Madam.
Now take the wrapper off.
Hey, sorry. Uh, do you have an IV pole?
Gon's sputum test just came
back positive for pneumonia.
So I got some penicillin,
and I'm gonna get her
started on it right away.
Well, okay, except,
in case you hadn't noticed,
our information ecosystem remains crippled.
So, we don't know her history,
we don't know whether there's
an allergic reaction...
Yeah, but except
Dr. James told me to do it.
So... Well,
actually, even if she did,
that's completely out of line,
because I haven't identified an allergy,
and you haven't either, so...
You know what? Well, I'll just
go ask Dr. James, then.
Um, you're not planning on
leaving an IV bag
of penicillin on my counter?
Could you just put it back in the
cabinet until the data comes back up?
Pyxis is down. My logs are closed.
I would suggest you
take that back down to Pharmacy
until you know what drugs she
is or is not allergic to.
Enjoy the ice cream social.
What's the matter?
I see "complaint"
written all over your face.
Dawn, the baking soda. What the hell?
My underarms are all stuck together,
my butt feels like it's got...
plaster of Paris up in it.
Maybe it wasn't baking soda.
Maybe it was corn starch.
I'm gonna be in the bathroom
trying to crack this off of me.
Sorry.
All right, ladies, cool off.
Don't eat the plastic.
What an exhilarating day.
Missteps,
miscommunications,
snafus.
Giving all the patients popsicles
was such a super idea.
Mm-hm.
I enjoy being selfless.
We're rising to the occasion.
You know we're both rescuers at heart.
You have a bruise?
Oh.
It's where you threw the vacuum
at me when I was watching golf.
I'm super sorry.
My emotions have been all over
the place with this baby.
I just go psycho.
And guess what?
Today's the day we're
gonna find out its sex.
Well, 90%.
I mean, the genitals may be
too swollen and undifferentiated
for 100%.
I mean, unless he's
really hung like his Daddy.
Now...
What's going on? I understand
you prevented my doctor
from administering medication?
Well, the thing is, you were
about to lose a patient.
Oh, right. Once again, Dawn,
I can't understand a word you are saying.
Well, your doctor was about
to administer an IV penicillin,
except, as you may know, the computer
systems are still completely down.
So I can't access patient histories,
so we don't know if she has allergies.
Well, of course she has no allergies.
Dr. Cesario would have
checked for allergies.
Andrew, you did a quick skin
test for allergies, correct?
No.
Um...
All right, well, we have two issues here.
Um, the first
is the manner in which
you dealt with this situation.
Well, I have just found that
sometimes doctors require a forceful manner
to get a point across.
Sometimes...
Andrew, could you please follow me.
Now I am taking some
me time for a few minutes.
I hope that is all right with everyone.
Dr. James: You could
have ruined your career!
You could have ruined my career!
Geriatrics is hanging on
by its fingernails.
We're about to become a food court!
Where's the deceased?
Over there.
Marguerite: Dawn?
Dawn!
Mrs. Heller needs a lunch,
but food services won't pick up,
and I can't order through "Let's Eat"
because the system's still down.
Plus, oh my god, there's,
like, this weird condensation
dripping from the vent in room 104.
I need some rags to collect it.
I am pregnant! Shut up!
Come on, you need some you time.
Dr. James: It's not just hives.
There could be anaphylactic
shock, loss of consciousness...
I know you don't like me.
When you yelled at me
when I bought you that new refrigerator,
it upset me so.
♪♪
with the nozzle still stuck in the car.
Well, that was stupid.
Are you in pain?
Can you feel the tumors?
What tumors?
Shit.
Welcome, everyone,
to our goals of care...
care meeting for the lovely
lady that is Mrs. Wally-Wally.
We have cardio, thoracic, neurology,
and our social worker, Mrs. Dodd.
Ultimately, it's
going to be up to the family
to decide what's to be done.
Okay, um, thanks, everyone.
I was a work-in psychotherapist
in New York before moving here.
So, uh, I don't need any hand-holding.
What I want to know
is how we get from here...
to a desirable there.
Okay, I think that we need to consider
what a "desirable there" is, exactly.
Actually, we should define here and there.
As to "here,"
your mother is very depressed.
- In-law.
- Yes,
and since we don't know
her non-depressed baseline,
it's hard to assess what "here" really is.
Fork in the road. Heart issues:
Road going down this way.
Lung and thoracic issues:
Road going down this way, so...
Paul, you want to
make your case for valve repair?
Okay, it's too late for a valve repair.
Um, what Ellen needs
is a valve replacement.
Preferably a biological prosthesis.
What are her odds of surviving that?
Well, most clinical trials
for cardiovascular therapies
exclude the elderly.
There's just not much evidence.
We just don't know.
Studies on valve repair on octogenarians
do show a short-term mortality rate of 20%.
However, how many die after 40 days?
50? We just don't know.
If we tackle her lung issues
first, what are the chances
the lobe removal being successful?
It... it's hard to say.
There's a heavy burden of comorbid diseases
uh, complicating outcomes.
We're not magicians.
So, what you're saying
is you really don't know?
No.
Ultimately, it's in the hands of our maker.
I mean, if you believe.
And, of course, if you don't, well...
You people are not empowering me.
I am not feeling empowered.
If she doesn't have either surgery,
can anyone tell me where this is headed?
Well, we can certainly all help you
look at that... those
there... there's there...
There is no baby.
Yes there is.
I'm pregnant.
Sort of.
What does "sort of" mean?
It means that everything, look here,
appears normal.
All of the pieces of life are there,
and yet...
there's no actual life there.
I don't understand.
You have a blighted ovum.
You had nausea, sore breasts,
conception occurred,
a fertilized egg was
implanted in your womb,
a placenta grew,
but a baby did not develop.
If your womb were a house,
it would be fully furnished.
There would be sofas, TVs, coffee tables,
everything you need for life.
Except, there is no life.
Only an empty gestational sac.
Can you check again, please?
I'll check again.
I am not taking the blame for this screw up
I'm not either.
How was I supposed to know?
Her bracelet wouldn't scan.
Ellen, there isn't
anything more for us here.
No more surgeries.
I'm taking you home.
And there's something I need to tell you...
about Phil.
And all those times I told him
not to solo sail to Cabo.
Oh.
Computers are up.
[Vents begin working]
[cello tuning]
[plays classical music]
♪ ♪
♪ ♪
I bought a cello.
I know I really shouldn't be carrying
heavy things anymore, but...
I saw it in this beautiful
store that sold instruments.
Not a pawn shop.
And you know what? I'm gonna
play it for my baby in the womb.
That's nice.
All your stuff here
is taking up all the space.
Well, are you gonna
leave this here for six months?
No, just till Patsy sees it.
We're going in for my 12-week scan today.
Okay, well, now there's
no room for my feet.
Getting On - 02x03
Turnips...North Day...Yes, yes
Dr. James: Hello!
Good morning, Dr. James.
How was your three-day weekend?
It was so relaxing!
We took Renée to her fencing
tournament in San Diego,
and then I snuck off to the Del
for a two-hour Thai massage.
New lease on life.
Either of you, anything special? Weekends?
No?
Well...
Who's in comfort suite 109 now?
That is Hannah Doerr.
She's on respite care. She's deaf.
Oh, bless her heart.
Yeah, I ordered a video
remote interpretation unit
from patient services, so...
Mm-kay.
You, I could step in if you'd like,
and we could do her after the rounds?
It's just that I've admitted
a lot of deaf patients before,
and it can be kind of sensitive, Didi,
- and I've been trained.
- Okay.
I actually know a little sign language.
This is, um, "pain." Pain.
All right. Mm-hm.
Okay.
Mrs. Weller.
What's happening?
Why can't anyone tell me?
Well, unless things have
changed since last night,
you gonna be going
over to the hospital soon.
What's wrong with me now?
Well, it's your heart valve repair.
You remember, don't you?
I don't want it.
Calm down, it's all right.
No, it's not all right.
I don't want it.
- Okay, okay.
- I don't want it.
Then let's talk about it.
'Cause we don't force things on
people that they don't want.
That's not generally the way
we do things around here.
It isn't?
No, ma'am.
Okay, Mrs. Darlene Glennon.
She's here for a few days
to recover from an extensive
hiatal hernia repair.
Well, good morning,
Mrs. Glennon. What's cracking?
Oh, I can't get her bar code.
You had a hernia the
size of a large cantaloupe,
I believe, Mrs. Glennon.
Substantial intestinal adhesions.
Okay, she's scanned.
Hey, you're looking much better, today.
I am feeling better.
That's what I said. You do look better.
Okay, we have increasing
shortness of breath.
We have a persistent cough.
We have low blood oxygen
and a light fever and chills.
Respiratory distress. Could be?
Hospital-acquired pneumonia?
No, no, no, no, no. This is all wrong.
Resp rate, BP, and temp
all need to be on a whole separate page.
Could it be cardio myelitis?
Where's her medication file?
It's in the drop-down folder.
- What's that?
- That's a pop-up alert.
Well, get that... make that go away.
So, now, what's this whole field want?
Uh, the procedure code.
Oh, well, then you
put in the procedure code.
You go like this and cut and...
Shortness...
of...
breath...
Okay, it's not working, Dawn.
I don't really think
you know how to use this cart.
I took the training seminar, so yeah.
All right, bring it up.
Uh, different tab.
Enter, different tab.
[Repeating error alert]
Well, now it's frozen.
This is completely...
What was that you said again?
Let's get a sputum culture,
and why don't you check
your training seminar notes,
and maybe refresh yourself
on how this thing works.
Okay? Yeah? Good.
"It matters not how straight the gate,
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul."
I wish I felt this way.
Someday I want to feel this way.
You know what I mean, Mrs. Anthony?
"Out of the night that covers me..."
Patsy: Are you kidding me, right now?
Oh, well, I just don't...
Mm-hmm. All right.
Bye.
Well, our server crashed.
Or... the network connecting us
to our server crashed.
A virus began in S.W.A.D.D.L.E.
in pediatrics,
and worked its way through to our system.
Uh, okay.
Okay, so, the system is down, people.
Dawn: We've got cascading failures.
Um, charts, histories,
notes entry, all down.
So, we're going old-school.
Lab samples, you run them down.
Lab results, you run them up.
Pharmacy needs wet signatures.
That's signatures with a pen.
Now, Pyxis is on critical override.
If you don't know what that means,
you need to read the side of the machine.
Everything in longhand.
Spiral notebooks, people, spiral notebooks.
Pagers, beepers, old-school communication.
Communication is the key!
Everyone helps everyone.
We get each other's backs,
we get through this.
Okay? Great.
Things are escalating quickly.
That means everything,
everything, needs to be run through me.
Dawn.
Oh, good morning, Mrs. Willey-Weller. Hi.
What the H is going on?
Ellen is back there,
she is spitting kittens.
I... Yesterday, I'm told
heart surgery, okay.
And then today I get a call...
heart surgery's been canceled,
and now I'm told there's an oncologist
who wants to remove a lung instead.
Uh, Didi?
Yes, um...
I spoke with your
mother-in-law this morning.
We talked about the surgery,
and she changed her mind.
She changes her mind
all the time, she has dementia.
Dr. Stickley: Excuse me.
Pardon me.
Um, I just got a call
from my OR coordinator
that my valve repair,
that your mother's
heart surgery, is canceled.
And then I find a sticky on my door.
"Patient reevaluated surgery.
Please see me, Nurse Ortley."
Well, you gotta talk to her.
Uh, that would be me.
Yes, I tried to notate her chart,
but the computer was frozen.
So, I ran down and I left you a note.
You canceled a scheduled surgery?
I explained the surgery
to her and she got confused,
and then she said she didn't
want the surgery anymore.
She just wanted to be
with her family and her son.
Yeah, yeah, which is impossible.
Reminder, he's dead.
Okay, but with all due respect,
Mrs. Weller didn't
understand what was happening.
You are absolutely wrong.
I went over it very thoroughly with her.
I sat with her
and fully explained the risks
of the surgery to someone
showing signs of dementia.
She asked me for a social worker,
then she asked for a hospice case manager.
Hospice? Is that where we're at?
We've given up all hope?
Hey, I'm herto take Mrs. Elleller
down to the OA.
No, you're not.
Dr. James: Paul, are you
here for my meeting?
I'm here because this LPN decided
that she knew better
and talked my patient
into forgoing surgery.
Oh, Mrs. Willy-Wally?
Willey-Weller. Tell me, nurse,
what are your opinions on Iraq?
On cap and trade?
I mean there must be a plethora of things
you can opine on about which
you know absolutely nothing.
Ellen is agitated.
She won't talk to me,
she wants to talk to her son,
Phillip, my husband.
Reminder, he is dead.
Thank you, everybody, because
everything is completely unraveled.
You did see that the patient
has extensive lung tumors
which might preclude your surgery?
Of course I saw that.
Was I supposed to hear that?
I... I don't know where we're
at or what's going on.
I... I...
Clearly we need to schedule
a goals of care meeting.
We need to get everybody around the table.
Nurse, can you schedule
that for this afternoon?
- 'Cause that's what needs to happen.
- Thank you very much.
And that'll get everybody
right back on track.
All right, and Paul, I'll
see you in 30 minutes.
Wow...
What do you want, dear? What do you need?
Yeah, Mrs. Anthony just passed away
in room 107.
Thank you, all, for coming.
Extended care is raising new revenue
for the entire medical center
with our new aggressive focus on hospice.
And so, I just want to make
sure that as we move forward,
that those monies are duly credited
to those what brung 'em.
You're suggesting that that money does not
go into the general fund?
No, no, no, no.
Just merely that once it does,
a gentleman's agreement
that a small, fair amount
is returned from whence it came.
So, you're asking for a bounty?
It's an earmark, actually,
to support our operations
and, say, our research.
Well, uh, the committee will definitely
take everything under advisement.
All voices heard, that's the Lean way.
So, I heard that you have
moved into the old neonatal unit up on six?
Yes, like a hermit crab
into an empty shell.
Boston Deaconess...
Colombia Presbyterian...
And now Billy Barnes,
can all boast on-site mouse hospitals.
Phthalates in pregnant mouse urine
are linked to very specific genetic changes
in their male offspring.
So, what we're seeing now are
very female-like anogenital distances,
uh, incomplete descent
of testes, small penises.
So, now I'm collecting urine
from the women on the ward for comparison,
and what we're finding out is
these women are veritable receptacles
of fire retardant!
Aah! Oh, Paul!
Oh, god. I'm so sorry.
That's okay.
No, let me, please.
No, no, no. It... Jenna, don't worry. I'm...
I'm so sorry, I don't even know how...
These recycled napkins
are just not absorbent.
It's okay, Jenna.
I have a change in my... in my office.
I'm getting it. Now it's coming out.
I'm very determined.
I used to be a rock hound,
I always got my agates.
Jenna, that's okay.
Don't worry about it.
- No, it's fine. It's fine.
- Jenna, all right.
- It's coming. It's coming.
Jenna, that's enough.
So, I think we're done here.
- Yeah.
- Yeah.
Welcome to our brand new
comfort suite, Hannah Doerr.
Hannah is on home hospice,
but her husband is having
an emergency appendectomy
so there's no one at home
to take care of her right now.
I understand that you lip read, a little?
- A little.
- Okay.
Hannah has some anemia
after her last round of chemo,
and I think that the tumors
pressing on her spine
are causing her some
difficulty and some pain.
Hello! Hello?
Anybody there? Hello?
No, that's just us.
Well, I see that, Dawn.
I'm talking about in the screen or...
behind it, on the other side of...
Hello?
Or, is this gonna be another one of
those glitches like this morning?
No, and this morning wasn't me,
it was that the system is down.
But this works on wi-fi.
Are we really keeping score?
Okay, it's just that back here,
sometimes, it's kind of a dead zone.
So... Well, then what do you propose?
Maybe we should just
move her out into the ward?
Yes, let's try that.
Definitely try that. We're gonna go...
We're all gonna move out into the hallway.
It's all gonna be fine.
Grab a corner. Grab something.
Here, let me scooch over with you.
And, uh...
All right, watch the door.
Oh god, I don't know.
- It's big.
- Watch the sofa.
- You're getting on the sofa now.
- Oh, jeez.
All right, watch the door.
I don't know, I think it's...
Yeah, it's too big.
- Stop!
- It's the sofa.
Stop. I know, but look...
Look, there's privacy issues...
After all, we don't want
to do this whole thing
right out in the hallway, so...
Okay, well, I've got a connection.
Except now I'm getting
some kind of signal interference
from the other medical equipment.
Can you turn off all the EKG monitors?
We have a deaf patient.
Sorry. Thank you.
Welcome to BHB video relay information.
Please wait for the next
available interpreter.
I see you, can you see me?
Hello, yes, I'm Nurse Dawn Forchette.
I am pleased to be of service.
Ready when you are.
Okay, I want to start a transfusion
to address the anemia,
and then discuss a palliative
round of radiation
to shrink the tumors and ease the pain.
Yes, Doctor, please proceed. I
would like the opportunity.
I have been getting ducks in my ear.
North day. Yes, yes.
That's a little...
I don't know. That sounds kinda goofy.
Is the camera okay?
No, no, no. I'm not asking her,
I'm asking you.
I think it could be a little better.
Okay.
Can you tell her that I'm gonna
adjust the camera a little bit?
I think it's kind of obvious.
Thursday, not next.
Two turnips.
Train zoom.
Due day.
Have we used this agency before?
Because I think she's deaf too.
You know what, though?
Sign language is a little different.
Um, it's a conceptual language
made up of visual images.
Really? Thank you so much for that, Dawn.
Okay, I don't understand
what you are saying.
I'm trapped in a deaf sandwich here.
Did you say "turnips"?
No!
See, Dawn, can you put that down
and be present?
Well, I'm just trying to get it all.
All right, I think she's really angry,
now she's yelling.
Well, now she froze. Oh god.
Okay, guess what?
Dawn, cut it.
Everything back inside.
Come on, let's move.
I'm so sorry about this.
I can ask patient services
to go ahead and send over
our in-house signer.
I've got more pull over
there than Didi does,
so I think I can make it happen.
Okay, well, I think that
that should happen, Dawn,
because clearly, this
woman needs to get treated.
We have Americans with
Disabilities Act issues here.
'Cause the deaf can be really like...
Is she looking at me?
No, but she can see my face,
so I can't really say anything,
'cause she knows.
I think she knows, though,
that we're talking about her.
Once again, the whole thing has
just turned into a shambles.
Okay. Jesus, god.
[Hold music playing]
God, I've got toilets on the fritz.
I got labs backed up.
I don't know why this fucking ward
doesn't have a fucking pneumatic tube.
Oh, I have been on hold for six minutes
trying to get Antoine to come
pick up Mrs. Anthony's body.
Dawn!
The west-facing rooms are getting
really stuffy, and really hot.
Yeah, we know, we're on top of it.
No, there's like, nothing
coming out of the vents.
We know. We're on top of it.
[Phone rings]
Extended care, first floor.
Patsy: It's confirmed.
HVAC is on the blink.
The electronic controls are
tied into the information grid.
So, HVAC is down.
So, great, right?
HVAC is down.
No kidding.
Let me tell you something,
I sweat really, really bad, Dawn.
Okay.
This is no time to go
all princess on me, Denise.
Look, none of us like the heat.
Everyone perspires.
This is an emergency, all rise.
You know what, why don't
we go close the blinds.
Help me do that. That'll help, right?
That will help.
For what? Oh, the perspiration.
I got it off a patient last year.
It's kind of an old-timey thing.
Mm-mm.
You know, she also used
soap with bacon drippings.
It made her skin really soft.
What a disaster.
Sorry.
How you doing today, Miss Birdy?
Very good.
What's the temperature outside today?
Birdy, it's 100 degrees.
Oh.
I don't like waking up to 50
and having it be 100 in the afternoon.
Well, you and me, both.
Come on, it's time to do
your breathing treatment.
Miss Birdy.
It's just a spirometer.
It's too hot for this.
I got your iced macchiato,
and your single carrot cake.
Thank you, Colleen.
If you could just, um, put it...
Okay.
Dawn, she's dedicated hospice.
You can't just use her.
You know, I can talk
to them if I have to,
and she was going that
way anyway, Didi, okay?
I would advise you to get
in touch with Antoine
before Mrs. Anthony
overheats like a baked potato.
Why don't I do that.
Danae, is Darnell there?
Okay, I need you to get his keys,
and come down here,
bring me some fresh scrubs.
Uh-huh, two pair. Bring both.
You know how I get when I'm hot.
Girl, you can fry an egg on my head.
Huh?
No, I'm not gonna have a
conversation with you about shoes.
Excuse me, Dr. James?
Yes?
Um, do you have a moment?
Yeah.
I just... I lose myself up here, sometimes.
I'm just in my element.
You know, I think at heart
I'm a scientist trapped in a doctor's body.
You want to see how I hold my mice?
I grab 'em by the tail...
And I...
scruff him, and flip him,
and now he's all ready
for urine collection,
or injection, or vivisection.
Just kind of a rhythm thing.
Takes me back to freshman
biology like it was yesterday.
The years fly by, don't they?
Richard and Renée won't let
me have rodents in the house.
Well, I just have a minute,
but I wanted to let you know,
uh, that I'm pregnant.
I'm having a baby.
Pregnant? Oh, Dawn.
- 12 weeks.
- 12 weeks?
Uh-huh, good.
Uh, with...
Patsy De La Serda.
Nurse De La Serda, good.
Good deal.
Well, I just... I wanted you to know.
Yes.
Thank you for wanting me to know.
Okay!
Here you are, ladies.
Cool off.
Cool off.
Here you go. Refresh yourself.
Squeeze them from the bottom.
Here you are, Madam.
Now take the wrapper off.
Hey, sorry. Uh, do you have an IV pole?
Gon's sputum test just came
back positive for pneumonia.
So I got some penicillin,
and I'm gonna get her
started on it right away.
Well, okay, except,
in case you hadn't noticed,
our information ecosystem remains crippled.
So, we don't know her history,
we don't know whether there's
an allergic reaction...
Yeah, but except
Dr. James told me to do it.
So... Well,
actually, even if she did,
that's completely out of line,
because I haven't identified an allergy,
and you haven't either, so...
You know what? Well, I'll just
go ask Dr. James, then.
Um, you're not planning on
leaving an IV bag
of penicillin on my counter?
Could you just put it back in the
cabinet until the data comes back up?
Pyxis is down. My logs are closed.
I would suggest you
take that back down to Pharmacy
until you know what drugs she
is or is not allergic to.
Enjoy the ice cream social.
What's the matter?
I see "complaint"
written all over your face.
Dawn, the baking soda. What the hell?
My underarms are all stuck together,
my butt feels like it's got...
plaster of Paris up in it.
Maybe it wasn't baking soda.
Maybe it was corn starch.
I'm gonna be in the bathroom
trying to crack this off of me.
Sorry.
All right, ladies, cool off.
Don't eat the plastic.
What an exhilarating day.
Missteps,
miscommunications,
snafus.
Giving all the patients popsicles
was such a super idea.
Mm-hm.
I enjoy being selfless.
We're rising to the occasion.
You know we're both rescuers at heart.
You have a bruise?
Oh.
It's where you threw the vacuum
at me when I was watching golf.
I'm super sorry.
My emotions have been all over
the place with this baby.
I just go psycho.
And guess what?
Today's the day we're
gonna find out its sex.
Well, 90%.
I mean, the genitals may be
too swollen and undifferentiated
for 100%.
I mean, unless he's
really hung like his Daddy.
Now...
What's going on? I understand
you prevented my doctor
from administering medication?
Well, the thing is, you were
about to lose a patient.
Oh, right. Once again, Dawn,
I can't understand a word you are saying.
Well, your doctor was about
to administer an IV penicillin,
except, as you may know, the computer
systems are still completely down.
So I can't access patient histories,
so we don't know if she has allergies.
Well, of course she has no allergies.
Dr. Cesario would have
checked for allergies.
Andrew, you did a quick skin
test for allergies, correct?
No.
Um...
All right, well, we have two issues here.
Um, the first
is the manner in which
you dealt with this situation.
Well, I have just found that
sometimes doctors require a forceful manner
to get a point across.
Sometimes...
Andrew, could you please follow me.
Now I am taking some
me time for a few minutes.
I hope that is all right with everyone.
Dr. James: You could
have ruined your career!
You could have ruined my career!
Geriatrics is hanging on
by its fingernails.
We're about to become a food court!
Where's the deceased?
Over there.
Marguerite: Dawn?
Dawn!
Mrs. Heller needs a lunch,
but food services won't pick up,
and I can't order through "Let's Eat"
because the system's still down.
Plus, oh my god, there's,
like, this weird condensation
dripping from the vent in room 104.
I need some rags to collect it.
I am pregnant! Shut up!
Come on, you need some you time.
Dr. James: It's not just hives.
There could be anaphylactic
shock, loss of consciousness...
I know you don't like me.
When you yelled at me
when I bought you that new refrigerator,
it upset me so.
♪♪
with the nozzle still stuck in the car.
Well, that was stupid.
Are you in pain?
Can you feel the tumors?
What tumors?
Shit.
Welcome, everyone,
to our goals of care...
care meeting for the lovely
lady that is Mrs. Wally-Wally.
We have cardio, thoracic, neurology,
and our social worker, Mrs. Dodd.
Ultimately, it's
going to be up to the family
to decide what's to be done.
Okay, um, thanks, everyone.
I was a work-in psychotherapist
in New York before moving here.
So, uh, I don't need any hand-holding.
What I want to know
is how we get from here...
to a desirable there.
Okay, I think that we need to consider
what a "desirable there" is, exactly.
Actually, we should define here and there.
As to "here,"
your mother is very depressed.
- In-law.
- Yes,
and since we don't know
her non-depressed baseline,
it's hard to assess what "here" really is.
Fork in the road. Heart issues:
Road going down this way.
Lung and thoracic issues:
Road going down this way, so...
Paul, you want to
make your case for valve repair?
Okay, it's too late for a valve repair.
Um, what Ellen needs
is a valve replacement.
Preferably a biological prosthesis.
What are her odds of surviving that?
Well, most clinical trials
for cardiovascular therapies
exclude the elderly.
There's just not much evidence.
We just don't know.
Studies on valve repair on octogenarians
do show a short-term mortality rate of 20%.
However, how many die after 40 days?
50? We just don't know.
If we tackle her lung issues
first, what are the chances
the lobe removal being successful?
It... it's hard to say.
There's a heavy burden of comorbid diseases
uh, complicating outcomes.
We're not magicians.
So, what you're saying
is you really don't know?
No.
Ultimately, it's in the hands of our maker.
I mean, if you believe.
And, of course, if you don't, well...
You people are not empowering me.
I am not feeling empowered.
If she doesn't have either surgery,
can anyone tell me where this is headed?
Well, we can certainly all help you
look at that... those
there... there's there...
There is no baby.
Yes there is.
I'm pregnant.
Sort of.
What does "sort of" mean?
It means that everything, look here,
appears normal.
All of the pieces of life are there,
and yet...
there's no actual life there.
I don't understand.
You have a blighted ovum.
You had nausea, sore breasts,
conception occurred,
a fertilized egg was
implanted in your womb,
a placenta grew,
but a baby did not develop.
If your womb were a house,
it would be fully furnished.
There would be sofas, TVs, coffee tables,
everything you need for life.
Except, there is no life.
Only an empty gestational sac.
Can you check again, please?
I'll check again.
I am not taking the blame for this screw up
I'm not either.
How was I supposed to know?
Her bracelet wouldn't scan.
Ellen, there isn't
anything more for us here.
No more surgeries.
I'm taking you home.
And there's something I need to tell you...
about Phil.
And all those times I told him
not to solo sail to Cabo.
Oh.
Computers are up.
[Vents begin working]
[cello tuning]
[plays classical music]
♪ ♪
♪ ♪