Transplant (2020–…): Season 1, Episode 10 - Collapse - full transcript
Bishop offered to recommend me
for a full-time spot at the hospital.
You're pushing yourself too hard.
Unless you can strike a balance,
maybe the emergency
department is not for you.
And with post-traumatic stress injuries,
the only way out is through?
- Amira. Come on.
- Bye, Daneesha.
There's an apartment that sounds good
not far from here.
Should we go see it?
I know you don't want to move again,
but we have to find our own place.
Daneesha asked me to go to a movie.
- You can go right after.
- Please?
I really want to go.
Okay. I'll check it out
for the both of us.
Follow me.
Mr. Orr is 55 years old.
Presumed venous thromboembolism,
but the D-dimer was negative.
What's the next step?
Dr. Owens, go ahead.
You have the option of a
family practice back home.
What made you decide to apply
for this permanent position?
The resources available at Memorial,
and the range of what we're able
to do for our patients here.
Could you be more specific?
Why this job, Dr. Hunter?
What makes it worth
changing all your plans?
Next?
Free the neck of the gallbladder.
Mm-hmm.
Nice technique, Dr. Miller.
I'll go ahead and clip
the cystic artery.
Why did you jump in like that?
You hesitated.
I was waiting for the go-ahead.
Singh wants us showing confidence.
Hey! How's internal?
You hate it.
I love emergency medicine.
I always have, and I always will.
And that's exactly what I
should've said in my interview.
Was it really that bad?
At least now I won't
have to tell Melissa.
What was that?
Was that an explosion?
Auxiliary power... Does that
mean it was in the building?
No, we would have felt the shock wave.
Then where is it coming from?
Dispatch says a building up
the street just blew up.
Power's down on the whole block.
Bash!
We're still waiting for
an ETA from the scene.
- In the meantime...
- What's he doing?
Doctor Hamed!
Running into the fire, apparently.
I think it was a gas leak,
there are people trapped inside.
You got this?
Get as far away as you can.
Help.
Can anybody hear me? Please, help!
Are you hurt? I'm a doctor.
Not me.
Her.
We need all hands on deck.
We are implementing
mass trauma protocol.
That means wristbands for triage.
Red for critical,
yellow for intermediate
and green can wait.
Residents will help with assessment
and immediate action.
OR's are being cleared
of anything noncritical.
Page myself and Dr. Atwater
for anything above your pay grade.
Nursing staff are crucial and
will be the busiest today.
If you see a way to help them, do it.
Family members looking for patients,
Ms. Barnes and her staff are on that.
We're closest to the incident
and best equipped for trauma. But...
You to be prepared for any eventuality.
All right. Ready?
Let's go.
Dr. Leblanc, Internal's gonna
have to live without you today.
- We need all the help we can get.
- Yes, sir.
- No word from Bash?
- Nothing.
What's your name?
Julia.
Tell me how you're feeling, Julia.
Like a building fell on me?
We're going to get you out of here
as soon as help arrives.
Until then, we need to keep you hydrated
and combat any blood loss.
Maybe I can find something
to leverage this beam and dig her out.
Do you remember where you were
when the explosion happened?
Julia?
My wife...
Naomi.
Did you see her?
She has... brown hair, red sneakers.
Did you see her when you came in?
Tell me how you're feeling, Julia.
Fine. I'm just a little light-headed.
It's all a blur. We got blown back.
Tried to get out, then she got buried.
This thing's too heavy.
This place is unstable.
You need to leave.
No. Please, you gotta let me help.
She's lost a lot of blood
and I only have two bags of saline.
I'm going to stay with her.
There are rescue teams out there
and inside the building.
Go tell them where we are. Please!
Okay.
They're still trying to get
victims out the building.
Apparently, the whole place
could come down any minute,
and Bash is still in there.
Hey, guys, did you see
any doctors in there?
No, I'm sorry, I didn't.
- No pulse.
- She's in V-fib.
Charging to 100 joules.
Everyone clear?
Defib arrest.
We have a pulse.
How long was she down?
Paramedics found her alone
so there's no telling.
We need a cooling blanket, and
as many ice packs you can find.
You're starting targeted
temperature management?
I'm worried about
potential brain damage.
There's a chance you could
combat cellular decay
from lack of blood flow.
As long as she wasn't down
more than six minutes.
- Any word on mom or dad?
- Nothing yet.
Alright, there's a cooling unit in ICU.
Let's get it up there.
Come on, let's go!
You need blood.
So you're just gonna give me yours?
I'm a universal donor.
I've done this before.
At the hospital up the street?
In Syria, where I'm from.
During the war.
Lucky me.
I got the war vet.
I feel like I'm losing as
fast as you're putting it in.
Help is on the way.
My wife and I had an argument.
I was so angry at her.
It seems so stupid now.
I'm sure she thinks so too.
She was late getting out of the house.
She's always late.
What if the last thing I said to her
was over some dumb fight about
how disorganized she is?
Hey. Just hold on, Julia.
We're gonna get you out of here.
Julia? Julia!
Is there anybody here?
Over here!
This woman is in traumatic
rhabdomyolysis.
We need to fluid overload
before releasing pressure.
You should get out of here.
The building is unstable.
- I can't guarantee your safety.
- I'll risk it.
I'm not leaving her.
My wife... My...
Has anyone seen...
I've been waiting forever, okay?
I keep trying to ask
people where she is.
Her name is Julia Baranski.
Please tell me that you know.
We're moving as quickly as we can,
but right now, things
are still backing up.
So come with me please.
Okay.
- What's your name?
- Naomi.
But Julia, I need to find her.
I promise that we're
gonna look for Julia.
But right now, I need
to take care of you.
I tried to go back inside,
but I couldn't get in.
You did the right thing
not to go back in.
You have bruises and a number of wounds
that need to be treated.
Do you have any intense pain
anywhere in particular?
My stomach.
Okay. Lie down for me, please.
Okay.
I'm trying to find my boyfriend.
No one will tell me anything.
There's a list of people
from the explosion, at registration.
No, no. I asked them
already and they don't...
A number of people came in without ID's.
Look, I know it's hard,
but we've got a lot going on right now.
We just need you to stay
patient while we sort it out.
All right? Okay... Who is this?
I need you to sign off on the
on-calls I'm bringing in.
Our biggest problem is managing
just the minor injuries
and family coordination.
Triage nurses are doing great,
but we're barely keeping up.
I'll tell EMS to divert the
ambulances to St. Jacobs.
- I already did.
- Oh, good.
Anything else you need, as you need it.
Yeah. All right.
Excellent, thank you.
Claire.
Can anybody help me?
- Are you looking for someone?
- I'm looking for my daughter,
she's not answering her phone.
She goes by that building on
her way home from school.
- How old?
- Twelve.
Blonde hair, plaid private school skirt,
and a green sweater.
Her name is Gabriela.
She's in our intensive care unit.
Intensive care?
- Is she okay?
- Come with me.
Nurse.
Okay, Naomi, this is gonna be cold.
Let me know if I'm pressing too firmly.
Okay. I'm gonna have to...
scan to confirm, but you're
hemorrhaging inside,
which means our first priority right now
is to get you to surgery.
How Jules is gonna find me?
Look, if she's here, our support
staff are gonna find her
and they're gonna tell
her where you are,
I'll ask them to myself.
But for now, I really need you
to stay as still as possible. Okay?
Miss Petrakis.
Gabby.
What happened?
Gabby suffered a traumatic impact,
and she went into cardiac arrest.
Her heart stopped?
Yes. But we restarted it,
and we're hoping to rule out any
possible brain damage, but...
Brain damage?
Can you do anything to help her?
We're cooling down her system in order
to decrease her brain function,
so the lack of oxygen is less damaging.
After enough time, we
can warm her back up,
and her brain will reset
itself to normal functioning.
When will we know if she's okay?
Not until she wakes up.
But she will...
wake up?
Julia Burrenski, 33 years old,
open tip fib fractured, lost
a lot of blood on the scene,
possible smoke inhalation. GCS 15.
Okay. We've got this.
Welcome back, Dr. Hamed.
Bash?
Are you okay?
Yeah. What? Am I okay? Are you?
What were you thinking? You
could have been killed.
You can't just...
Show up and volunteer as a doctor?
- You gave blood?
- Yeah. At the scene.
Let me check you out.
No. This place is overflowing
and I see one of my
patients from the building.
I need to make sure he's okay.
You made it.
Because of you. You found help.
- Julia?
- She made it too.
Gav. Has anyone looked at you?
Just some bruised ribs.
Nothing I haven't done mountain biking.
Do buildings usually fall on you
when you are mountain biking.
Breathe for me, okay?
You said you were blown
back during the blast?
Yeah. I think maybe I
slammed into the wall.
Gavin, why didn't you tell anyone?
Julia needed you more.
Dr. Curtis?
No. Honestly, guys, you got
bigger problems than...
Gavin. You did your part
to help, let us do ours.
- What do we have?
- Impact trauma.
Tell me what you hear.
Bowel sounds...
Reduced air entry.
The porters are all backed up.
So I'm going to take you
up to surgery myself.
- Did you find Julia?
- Not yet.
It doesn't mean she's not here.
Won't be long.
Careful.
You think this is bad mountain biking?
Oh, not even close.
Let's have a look.
There it is. Free fluid.
Dr. Hamed?
Do you see the disruption
at the left diaphragm?
Is that the bowel?
Stomach, I think, I'm just...
We'll need a CT to confirm.
Anyone want to explain?
You may have torn your diaphragm
when you were blown backwards.
These type of tears can
cause your abdominal organs
to protrude into your chest cavity.
If so, you will need surgery,
but finding it early
means it's treatable.
Good catch, Dr. Hamed.
I'll get him to CT.
Um, Dr. Curtis will take
care of you from here.
Thank you for everything.
_
_
_
Dr. Hamed.
Dr. Hamed! Are you with us?
I heard you gave blood
at the scene today.
There were chemicals in that explosion.
We need to take care of those.
Anyone who was in there
could be exposed.
What was that?
Uh, it's... Power grid kicking in.
We've been on generator
since the explosion.
The elevator should start
up again in a second.
Why isn't it?
I don't know.
Naomi? Where does it hurt?
My neck.
Can you describe it for me?
It's tightening. Almost
like I'm being choked.
Okay.
We saw the hematoma earlier,
but I do see increased
swelling right now.
Likely residual effect
from impact trauma.
What do we do?
You're gonna be fine. Okay?
You're sure the burns are chemical?
It must have been something I
touched during the explosion,
maybe even one of the patients
had that substance on their skin.
And you didn't notice till now?
There are a number of corrosives
that don't take effect
until much after contact.
The timeline varies
depending on the chemical.
So there's no telling who
or what you touched.
You've seen this kind of burns before?
Regime chemical attacks were frequent.
Sometimes people would be exposed
and not know it at first.
You need to monitor every
patient from the explosion
to make sure they haven't been affected.
We will. But that includes you.
Sir, I'm fine.
My burns are minor. They
still need to be treated.
So do the people who
might have been exposed.
We're busy. They need my help.
And they will get it.
As soon as you finish
irrigating your burns
and do a pH assessment.
Understood? Good.
I'll send a nurse?
Is there anyone else presenting
with chemical burns?
We've been screening, so far nothing.
Triage knows to alert us
if they see any signs.
How's Bash?
His burns are minor and
we caught them in time.
You're worried about him?
He's seen chemicals like this before,
during the war.
Dr. Bishop.
We've got a problem with
one of the elevators.
Have you called Mechanical?
Yes, but I think you
need to come with me.
Hi. Can I help you?
I still can't find my boyfriend.
Did you check with triage?
They have the most updated
list from the explosion.
Yeah, I tried to tell the other nurse.
- He wasn't in the explosion.
- Okay.
- Tell me what happened.
- Uhm...
The paramedics brought
him here because he...
He OD'd. And I gave him naloxone,
but I think that maybe it was too late.
And no one is telling me anything so...
What's your boyfriend's name?
Chris Hewitt.
And yours?
Alexia.
Alexia. My name is Claire.
I'm going to figure out
what happened to him.
That's what the other guy
said and it's been forever.
It has been a bit of a
madhouse here today.
And it might take me a bit of time,
but I promise I'll find him, okay?
Just have a seat over here and wait.
Sure you will.
I was prepping him for surgery
when his burns started to develop.
Gavin, you said you
were in the bike shop
when the blast happened?
It felt like the explosion
was right under us.
What sort of chemicals do you use there?
Lots of stuff.
Degreaser, mineral
spirits, rust remover...
- Rust remover?
- Yeah. We use it all the time.
Hydrofluoric acid. It's used to
strip rust, among other things.
It can take some time to present.
It's easily neutralized with a
solution of calcium gluconate.
If it was localized to the shop
that will explain why we
haven’t see more burns.
I wasn't there alone, Dr. Hamed.
Excuse me.
This just came on now?
When I woke up.
You must have been in closer
proximity than Gavin.
It's in my lungs?
Aerosolized particles.
We can do a procedure
called a lung lavage.
It flushes out the
chemicals from your lungs.
Take slow breaths for me.
It's an internal hematoma which
is now swelling quickly.
A blast injury? Arterial?
A venous collection.
And it aggravated when
the elevator stopped.
Dr. Bishop, if it's
pressing on her airway...
How long until somebody can get us out?
When the power came back on,
the surge blew part of our grid.
We've got two elevators down,
but only yours was in use at the time.
Mechanical's working
with fire and rescue,
but you're between floors,
so it's delicate.
Sir, if the swelling continues
we lose our shot at intubating her.
You need to be prepared to
act before that happens.
You mean, open an
airway without imaging?
Sir, even if I could
approximate an incision point,
I don't have the proper tools.
Well, let's hope it
doesn't come to that.
How fast is the swelling accelerating?
It's doubled in the last nine minutes.
Well, if it keeps accelerating
at the same rate,
you won't have another nine minutes.
If I don't make it,
I need you to tell Jules...
If I knew this morning was
gonna be the last time...
Please, tell her that I love her.
- No.
- What?
I'm not gonna tell your
wife you love her.
Because you will.
You will.
Do we have an ETA on doctor Singh?
He's on OR4 with a thoracotomy.
He's going to be out for
at least ten more minutes.
Who else is on?
All the ORs are active right now.
We're it.
He's getting worse.
We're losing circulation
to the herniated bowel.
We're gonna have to go in.
Without Singh? Dr. Curtis...
If we lose blood flow, the
bowel will become ischemic.
It could cause severe damage.
I have to go in.
Scalpel.
Please.
May I?
So we're slowly bringing your
daughter's temperature back up.
I can't stand this.
Not knowing.
It shouldn't be too much longer now.
There must be something you can tell me.
Chances? Statistics?
I can't just sit here in the dark.
Gabby walks home from school on her own.
If I'd finished work early
and come to pick her up...
Elena...
This is not your fault.
I had the option to work
from home this year
and I didn't take it.
And if you did pick her up?
You could both be lying here.
I'm never letting her walk home again.
I bet you Gabby wouldn't be as
keen on that idea as you are.
She's always been so stubborn.
I'll come get you as soon
as there's news. Okay?
Thank you.
All I need to do is make
an incision distally.
I'll quickly insert a tube.
Dr. Leblanc.
Poor hemostatic technique
can increase the risk...
Mags.
To be careful to apply pressure...
- Mags!
- What?
Where do you spend every
waking moment of your day?
In this hospital?
Exactly. And when you're not
here, what are you doing?
Reading.
Reading what?
Medical textbooks.
I've read three studies
on this procedure
and I've watched every
video available online.
You're the one always telling me not
to overthink, but I'm ready for this
because... because of
all the work I've done.
I agree.
You do?
If I was stuck in an
elevator with a hematoma,
no imaging, and no tools,
I'd be lucky to have you
there to handle it.
I'm gonna do it now.
Slow and steady.
Come on. Come on.
It's working.
It's working. It's working!
Her O2 sats are rising.
Hey.
Alexia?
Did you find him?
Is Chris okay? Is he...
Do you mind coming with me?
No. If he's, uh...
If this is what I think,
please just tell me here.
I am so sorry to tell you,
but the doctors weren't
able to save Chris's life.
He died from the overdose.
I tried to help him. I did.
I spoke with the paramedics
and they said the exact same thing.
You did everything you could.
Is there anyone I can
call to be here with you?
No, there's, uh...
There's no one.
I know how hard this must be.
Do you? Really?
The only person who ever gave
a crap about me is dead.
You started without me?
The patient's stomach was
halfway into his chest cavity
and beginning to necrotize.
I had no choice.
Let me take a look at what you've done.
You were able to re-assemble
the edges without tension.
Yeah. I used running silk
and interrupted reinforcement
sutures along with some mesh.
You can close up.
Lung isolation established.
You fully evaluated potential
morbidity from the procedure?
No risk for complications.
We don't tape the joints.
They can leak.
We did a lot of these in
the field during the war.
Did you check for
effective lung isolation?
One lung needs to be ventilated
while the other is being flushed.
Clamp the drainage tube,
and introduce 1200 mL of lavage fluid.
Yes, sir.
Lavage fluid starting.
Clamping lavage tube.
Start percussion.
Starting percussion.
There's fluid leaking
into the ventilated lung.
We need to stop.
It's not draining.
All right, let's get her
to lie on the cubitous.
Lavage side down.
- Lift on three.
- One, two...
We need to aspirate.
Hyper-oxygenate the airway.
We need to move, Dr. Hamed.
Momma...
Momma...
Bashir!
Just do a scan, check for lung sliding.
I'll take over that.
I'll do it.
You got it? Okay.
No lung sliding.
Pneumothorax.
She's not getting enough oxygen.
Let's put a chest tube in.
Get me a scalpel and a 22 French?
Double time.
Bash. You're good?
Alright.
What if she doesn't wake?
Let's just give it a second.
Come on, Gabby.
Gabby?
Do you know where you are?
It's okay, baby.
You're in the hospital.
Everything's okay.
Hi, I'm Theo.
Gabby, I'm gonna ask
you something, okay?
Can you count backwards from ten for me?
Why... backwards?
That's a very good sign.
Your mother told me you
had a mind of your own.
It looks like she was right.
Welcome back, Gabby.
Oh, my baby.
Oh, you're okay.
She's okay.
She's okay.
Oh, baby.
That was just a split second.
It was long enough for me to
take over the aspiration.
You said you did those
procedures in the war.
It's understandable if
this one got to you,
given the events of the day.
It didn't. I hesitated. That's all.
I think we both know
it was more than that.
You pull something like that
again, you're off my team.
If I didn't intervene when I did,
the patient would be on a feeding
tube for the rest of his life.
I was minutes away. You
should have waited...
You would be saying the same
thing if I was Dr. Miller?
You think I'm giving you a hard time
because you're a woman?
When I started here 25 years ago,
I was the only brown
face in the department.
I guess you found a way to
pay that prejudice forward.
If that's what you want to believe Dr.
Curtis, fine.
But the truth is, you shouldn't
perform that procedure alone
for the same reason I didn't want Dr.
Miller
to go ahead and divide that
cystic artery this morning,
which I explained to him after you left.
Because you're not ready.
A patient's gonna live a normal life
because of what I did in there.
Your execution was sloppy.
You cut wider than necessary
and you used twice the
mesh that you needed.
He'll have a harder
recovery because of it.
This isn't about your gender,
or your sense of entitlement
or the massive chip on your shoulder.
It's about the patients.
Consider that next time before you cut.
Oh my God, that's her.
You sure she's okay?
Her lung lavage worked.
You'll both be home soon.
Thank you. For everything.
You ready?
Hi.
Took you long enough.
You know me. Always late.
I promise never to
complain about that again.
No, you don't.
I'm sorry.
Dr. Bishop?
Dr. Bishop, I just...
I want you to know that
you were wrong about me
when you suggested that
Internal would be a better fit
because Emergency is
where I belong and...
- I know.
- No, but what I'm saying is...
You showed me that today.
Welcome home, Dr. Leblanc.
_
Hi.
Uh... Sorry I missed your messages.
I'm coming home soon.
Uh, let's have dinner together tonight?
Yeah, it's been a crazy day.
Hey.
Can Amira and I stay with
you a little while longer?
Bash, I don't know how many
times I have to tell you,
but I love having you two around.
Stay as long as you need to.
How'd you do today?
I beat the odds.
That's what I should have
said in the interview.
We beat the odds here.
That was a tough day.
I know you're all exhausted.
We weren't perfect, but we came through.
What we do here is about
more than being perfect.
It's about showing up, no
matter how we're tested,
and leaving everything on the floor.
That's what we do every day.
And nothing makes me more
proud than knowing that.
Now get back to work.
Hey.
Hey.
There's a Gift card for the
grocery store down the street.
They have hot meals too.
There's also the name and
address of a woman's shelter.
Our social worker called ahead,
they have a bed waiting for you.
All you have to do is show up.
Why are you doing this?
I ran away when I was fifteen.
It's never too late to start again.
I'm here most days.
You need anything, you come back.
I bet you do something
like this every day
and no one ever notices.
Look at you, so sentimental today.
How are you feeling, Gavin?
I talked to the nurses.
Four people died in that explosion.
I was there. You did
everything you could.
Those people that didn't
make it, you have to...
You have to try and let that go.
Yeah.
for a full-time spot at the hospital.
You're pushing yourself too hard.
Unless you can strike a balance,
maybe the emergency
department is not for you.
And with post-traumatic stress injuries,
the only way out is through?
- Amira. Come on.
- Bye, Daneesha.
There's an apartment that sounds good
not far from here.
Should we go see it?
I know you don't want to move again,
but we have to find our own place.
Daneesha asked me to go to a movie.
- You can go right after.
- Please?
I really want to go.
Okay. I'll check it out
for the both of us.
Follow me.
Mr. Orr is 55 years old.
Presumed venous thromboembolism,
but the D-dimer was negative.
What's the next step?
Dr. Owens, go ahead.
You have the option of a
family practice back home.
What made you decide to apply
for this permanent position?
The resources available at Memorial,
and the range of what we're able
to do for our patients here.
Could you be more specific?
Why this job, Dr. Hunter?
What makes it worth
changing all your plans?
Next?
Free the neck of the gallbladder.
Mm-hmm.
Nice technique, Dr. Miller.
I'll go ahead and clip
the cystic artery.
Why did you jump in like that?
You hesitated.
I was waiting for the go-ahead.
Singh wants us showing confidence.
Hey! How's internal?
You hate it.
I love emergency medicine.
I always have, and I always will.
And that's exactly what I
should've said in my interview.
Was it really that bad?
At least now I won't
have to tell Melissa.
What was that?
Was that an explosion?
Auxiliary power... Does that
mean it was in the building?
No, we would have felt the shock wave.
Then where is it coming from?
Dispatch says a building up
the street just blew up.
Power's down on the whole block.
Bash!
We're still waiting for
an ETA from the scene.
- In the meantime...
- What's he doing?
Doctor Hamed!
Running into the fire, apparently.
I think it was a gas leak,
there are people trapped inside.
You got this?
Get as far away as you can.
Help.
Can anybody hear me? Please, help!
Are you hurt? I'm a doctor.
Not me.
Her.
We need all hands on deck.
We are implementing
mass trauma protocol.
That means wristbands for triage.
Red for critical,
yellow for intermediate
and green can wait.
Residents will help with assessment
and immediate action.
OR's are being cleared
of anything noncritical.
Page myself and Dr. Atwater
for anything above your pay grade.
Nursing staff are crucial and
will be the busiest today.
If you see a way to help them, do it.
Family members looking for patients,
Ms. Barnes and her staff are on that.
We're closest to the incident
and best equipped for trauma. But...
You to be prepared for any eventuality.
All right. Ready?
Let's go.
Dr. Leblanc, Internal's gonna
have to live without you today.
- We need all the help we can get.
- Yes, sir.
- No word from Bash?
- Nothing.
What's your name?
Julia.
Tell me how you're feeling, Julia.
Like a building fell on me?
We're going to get you out of here
as soon as help arrives.
Until then, we need to keep you hydrated
and combat any blood loss.
Maybe I can find something
to leverage this beam and dig her out.
Do you remember where you were
when the explosion happened?
Julia?
My wife...
Naomi.
Did you see her?
She has... brown hair, red sneakers.
Did you see her when you came in?
Tell me how you're feeling, Julia.
Fine. I'm just a little light-headed.
It's all a blur. We got blown back.
Tried to get out, then she got buried.
This thing's too heavy.
This place is unstable.
You need to leave.
No. Please, you gotta let me help.
She's lost a lot of blood
and I only have two bags of saline.
I'm going to stay with her.
There are rescue teams out there
and inside the building.
Go tell them where we are. Please!
Okay.
They're still trying to get
victims out the building.
Apparently, the whole place
could come down any minute,
and Bash is still in there.
Hey, guys, did you see
any doctors in there?
No, I'm sorry, I didn't.
- No pulse.
- She's in V-fib.
Charging to 100 joules.
Everyone clear?
Defib arrest.
We have a pulse.
How long was she down?
Paramedics found her alone
so there's no telling.
We need a cooling blanket, and
as many ice packs you can find.
You're starting targeted
temperature management?
I'm worried about
potential brain damage.
There's a chance you could
combat cellular decay
from lack of blood flow.
As long as she wasn't down
more than six minutes.
- Any word on mom or dad?
- Nothing yet.
Alright, there's a cooling unit in ICU.
Let's get it up there.
Come on, let's go!
You need blood.
So you're just gonna give me yours?
I'm a universal donor.
I've done this before.
At the hospital up the street?
In Syria, where I'm from.
During the war.
Lucky me.
I got the war vet.
I feel like I'm losing as
fast as you're putting it in.
Help is on the way.
My wife and I had an argument.
I was so angry at her.
It seems so stupid now.
I'm sure she thinks so too.
She was late getting out of the house.
She's always late.
What if the last thing I said to her
was over some dumb fight about
how disorganized she is?
Hey. Just hold on, Julia.
We're gonna get you out of here.
Julia? Julia!
Is there anybody here?
Over here!
This woman is in traumatic
rhabdomyolysis.
We need to fluid overload
before releasing pressure.
You should get out of here.
The building is unstable.
- I can't guarantee your safety.
- I'll risk it.
I'm not leaving her.
My wife... My...
Has anyone seen...
I've been waiting forever, okay?
I keep trying to ask
people where she is.
Her name is Julia Baranski.
Please tell me that you know.
We're moving as quickly as we can,
but right now, things
are still backing up.
So come with me please.
Okay.
- What's your name?
- Naomi.
But Julia, I need to find her.
I promise that we're
gonna look for Julia.
But right now, I need
to take care of you.
I tried to go back inside,
but I couldn't get in.
You did the right thing
not to go back in.
You have bruises and a number of wounds
that need to be treated.
Do you have any intense pain
anywhere in particular?
My stomach.
Okay. Lie down for me, please.
Okay.
I'm trying to find my boyfriend.
No one will tell me anything.
There's a list of people
from the explosion, at registration.
No, no. I asked them
already and they don't...
A number of people came in without ID's.
Look, I know it's hard,
but we've got a lot going on right now.
We just need you to stay
patient while we sort it out.
All right? Okay... Who is this?
I need you to sign off on the
on-calls I'm bringing in.
Our biggest problem is managing
just the minor injuries
and family coordination.
Triage nurses are doing great,
but we're barely keeping up.
I'll tell EMS to divert the
ambulances to St. Jacobs.
- I already did.
- Oh, good.
Anything else you need, as you need it.
Yeah. All right.
Excellent, thank you.
Claire.
Can anybody help me?
- Are you looking for someone?
- I'm looking for my daughter,
she's not answering her phone.
She goes by that building on
her way home from school.
- How old?
- Twelve.
Blonde hair, plaid private school skirt,
and a green sweater.
Her name is Gabriela.
She's in our intensive care unit.
Intensive care?
- Is she okay?
- Come with me.
Nurse.
Okay, Naomi, this is gonna be cold.
Let me know if I'm pressing too firmly.
Okay. I'm gonna have to...
scan to confirm, but you're
hemorrhaging inside,
which means our first priority right now
is to get you to surgery.
How Jules is gonna find me?
Look, if she's here, our support
staff are gonna find her
and they're gonna tell
her where you are,
I'll ask them to myself.
But for now, I really need you
to stay as still as possible. Okay?
Miss Petrakis.
Gabby.
What happened?
Gabby suffered a traumatic impact,
and she went into cardiac arrest.
Her heart stopped?
Yes. But we restarted it,
and we're hoping to rule out any
possible brain damage, but...
Brain damage?
Can you do anything to help her?
We're cooling down her system in order
to decrease her brain function,
so the lack of oxygen is less damaging.
After enough time, we
can warm her back up,
and her brain will reset
itself to normal functioning.
When will we know if she's okay?
Not until she wakes up.
But she will...
wake up?
Julia Burrenski, 33 years old,
open tip fib fractured, lost
a lot of blood on the scene,
possible smoke inhalation. GCS 15.
Okay. We've got this.
Welcome back, Dr. Hamed.
Bash?
Are you okay?
Yeah. What? Am I okay? Are you?
What were you thinking? You
could have been killed.
You can't just...
Show up and volunteer as a doctor?
- You gave blood?
- Yeah. At the scene.
Let me check you out.
No. This place is overflowing
and I see one of my
patients from the building.
I need to make sure he's okay.
You made it.
Because of you. You found help.
- Julia?
- She made it too.
Gav. Has anyone looked at you?
Just some bruised ribs.
Nothing I haven't done mountain biking.
Do buildings usually fall on you
when you are mountain biking.
Breathe for me, okay?
You said you were blown
back during the blast?
Yeah. I think maybe I
slammed into the wall.
Gavin, why didn't you tell anyone?
Julia needed you more.
Dr. Curtis?
No. Honestly, guys, you got
bigger problems than...
Gavin. You did your part
to help, let us do ours.
- What do we have?
- Impact trauma.
Tell me what you hear.
Bowel sounds...
Reduced air entry.
The porters are all backed up.
So I'm going to take you
up to surgery myself.
- Did you find Julia?
- Not yet.
It doesn't mean she's not here.
Won't be long.
Careful.
You think this is bad mountain biking?
Oh, not even close.
Let's have a look.
There it is. Free fluid.
Dr. Hamed?
Do you see the disruption
at the left diaphragm?
Is that the bowel?
Stomach, I think, I'm just...
We'll need a CT to confirm.
Anyone want to explain?
You may have torn your diaphragm
when you were blown backwards.
These type of tears can
cause your abdominal organs
to protrude into your chest cavity.
If so, you will need surgery,
but finding it early
means it's treatable.
Good catch, Dr. Hamed.
I'll get him to CT.
Um, Dr. Curtis will take
care of you from here.
Thank you for everything.
_
_
_
Dr. Hamed.
Dr. Hamed! Are you with us?
I heard you gave blood
at the scene today.
There were chemicals in that explosion.
We need to take care of those.
Anyone who was in there
could be exposed.
What was that?
Uh, it's... Power grid kicking in.
We've been on generator
since the explosion.
The elevator should start
up again in a second.
Why isn't it?
I don't know.
Naomi? Where does it hurt?
My neck.
Can you describe it for me?
It's tightening. Almost
like I'm being choked.
Okay.
We saw the hematoma earlier,
but I do see increased
swelling right now.
Likely residual effect
from impact trauma.
What do we do?
You're gonna be fine. Okay?
You're sure the burns are chemical?
It must have been something I
touched during the explosion,
maybe even one of the patients
had that substance on their skin.
And you didn't notice till now?
There are a number of corrosives
that don't take effect
until much after contact.
The timeline varies
depending on the chemical.
So there's no telling who
or what you touched.
You've seen this kind of burns before?
Regime chemical attacks were frequent.
Sometimes people would be exposed
and not know it at first.
You need to monitor every
patient from the explosion
to make sure they haven't been affected.
We will. But that includes you.
Sir, I'm fine.
My burns are minor. They
still need to be treated.
So do the people who
might have been exposed.
We're busy. They need my help.
And they will get it.
As soon as you finish
irrigating your burns
and do a pH assessment.
Understood? Good.
I'll send a nurse?
Is there anyone else presenting
with chemical burns?
We've been screening, so far nothing.
Triage knows to alert us
if they see any signs.
How's Bash?
His burns are minor and
we caught them in time.
You're worried about him?
He's seen chemicals like this before,
during the war.
Dr. Bishop.
We've got a problem with
one of the elevators.
Have you called Mechanical?
Yes, but I think you
need to come with me.
Hi. Can I help you?
I still can't find my boyfriend.
Did you check with triage?
They have the most updated
list from the explosion.
Yeah, I tried to tell the other nurse.
- He wasn't in the explosion.
- Okay.
- Tell me what happened.
- Uhm...
The paramedics brought
him here because he...
He OD'd. And I gave him naloxone,
but I think that maybe it was too late.
And no one is telling me anything so...
What's your boyfriend's name?
Chris Hewitt.
And yours?
Alexia.
Alexia. My name is Claire.
I'm going to figure out
what happened to him.
That's what the other guy
said and it's been forever.
It has been a bit of a
madhouse here today.
And it might take me a bit of time,
but I promise I'll find him, okay?
Just have a seat over here and wait.
Sure you will.
I was prepping him for surgery
when his burns started to develop.
Gavin, you said you
were in the bike shop
when the blast happened?
It felt like the explosion
was right under us.
What sort of chemicals do you use there?
Lots of stuff.
Degreaser, mineral
spirits, rust remover...
- Rust remover?
- Yeah. We use it all the time.
Hydrofluoric acid. It's used to
strip rust, among other things.
It can take some time to present.
It's easily neutralized with a
solution of calcium gluconate.
If it was localized to the shop
that will explain why we
haven’t see more burns.
I wasn't there alone, Dr. Hamed.
Excuse me.
This just came on now?
When I woke up.
You must have been in closer
proximity than Gavin.
It's in my lungs?
Aerosolized particles.
We can do a procedure
called a lung lavage.
It flushes out the
chemicals from your lungs.
Take slow breaths for me.
It's an internal hematoma which
is now swelling quickly.
A blast injury? Arterial?
A venous collection.
And it aggravated when
the elevator stopped.
Dr. Bishop, if it's
pressing on her airway...
How long until somebody can get us out?
When the power came back on,
the surge blew part of our grid.
We've got two elevators down,
but only yours was in use at the time.
Mechanical's working
with fire and rescue,
but you're between floors,
so it's delicate.
Sir, if the swelling continues
we lose our shot at intubating her.
You need to be prepared to
act before that happens.
You mean, open an
airway without imaging?
Sir, even if I could
approximate an incision point,
I don't have the proper tools.
Well, let's hope it
doesn't come to that.
How fast is the swelling accelerating?
It's doubled in the last nine minutes.
Well, if it keeps accelerating
at the same rate,
you won't have another nine minutes.
If I don't make it,
I need you to tell Jules...
If I knew this morning was
gonna be the last time...
Please, tell her that I love her.
- No.
- What?
I'm not gonna tell your
wife you love her.
Because you will.
You will.
Do we have an ETA on doctor Singh?
He's on OR4 with a thoracotomy.
He's going to be out for
at least ten more minutes.
Who else is on?
All the ORs are active right now.
We're it.
He's getting worse.
We're losing circulation
to the herniated bowel.
We're gonna have to go in.
Without Singh? Dr. Curtis...
If we lose blood flow, the
bowel will become ischemic.
It could cause severe damage.
I have to go in.
Scalpel.
Please.
May I?
So we're slowly bringing your
daughter's temperature back up.
I can't stand this.
Not knowing.
It shouldn't be too much longer now.
There must be something you can tell me.
Chances? Statistics?
I can't just sit here in the dark.
Gabby walks home from school on her own.
If I'd finished work early
and come to pick her up...
Elena...
This is not your fault.
I had the option to work
from home this year
and I didn't take it.
And if you did pick her up?
You could both be lying here.
I'm never letting her walk home again.
I bet you Gabby wouldn't be as
keen on that idea as you are.
She's always been so stubborn.
I'll come get you as soon
as there's news. Okay?
Thank you.
All I need to do is make
an incision distally.
I'll quickly insert a tube.
Dr. Leblanc.
Poor hemostatic technique
can increase the risk...
Mags.
To be careful to apply pressure...
- Mags!
- What?
Where do you spend every
waking moment of your day?
In this hospital?
Exactly. And when you're not
here, what are you doing?
Reading.
Reading what?
Medical textbooks.
I've read three studies
on this procedure
and I've watched every
video available online.
You're the one always telling me not
to overthink, but I'm ready for this
because... because of
all the work I've done.
I agree.
You do?
If I was stuck in an
elevator with a hematoma,
no imaging, and no tools,
I'd be lucky to have you
there to handle it.
I'm gonna do it now.
Slow and steady.
Come on. Come on.
It's working.
It's working. It's working!
Her O2 sats are rising.
Hey.
Alexia?
Did you find him?
Is Chris okay? Is he...
Do you mind coming with me?
No. If he's, uh...
If this is what I think,
please just tell me here.
I am so sorry to tell you,
but the doctors weren't
able to save Chris's life.
He died from the overdose.
I tried to help him. I did.
I spoke with the paramedics
and they said the exact same thing.
You did everything you could.
Is there anyone I can
call to be here with you?
No, there's, uh...
There's no one.
I know how hard this must be.
Do you? Really?
The only person who ever gave
a crap about me is dead.
You started without me?
The patient's stomach was
halfway into his chest cavity
and beginning to necrotize.
I had no choice.
Let me take a look at what you've done.
You were able to re-assemble
the edges without tension.
Yeah. I used running silk
and interrupted reinforcement
sutures along with some mesh.
You can close up.
Lung isolation established.
You fully evaluated potential
morbidity from the procedure?
No risk for complications.
We don't tape the joints.
They can leak.
We did a lot of these in
the field during the war.
Did you check for
effective lung isolation?
One lung needs to be ventilated
while the other is being flushed.
Clamp the drainage tube,
and introduce 1200 mL of lavage fluid.
Yes, sir.
Lavage fluid starting.
Clamping lavage tube.
Start percussion.
Starting percussion.
There's fluid leaking
into the ventilated lung.
We need to stop.
It's not draining.
All right, let's get her
to lie on the cubitous.
Lavage side down.
- Lift on three.
- One, two...
We need to aspirate.
Hyper-oxygenate the airway.
We need to move, Dr. Hamed.
Momma...
Momma...
Bashir!
Just do a scan, check for lung sliding.
I'll take over that.
I'll do it.
You got it? Okay.
No lung sliding.
Pneumothorax.
She's not getting enough oxygen.
Let's put a chest tube in.
Get me a scalpel and a 22 French?
Double time.
Bash. You're good?
Alright.
What if she doesn't wake?
Let's just give it a second.
Come on, Gabby.
Gabby?
Do you know where you are?
It's okay, baby.
You're in the hospital.
Everything's okay.
Hi, I'm Theo.
Gabby, I'm gonna ask
you something, okay?
Can you count backwards from ten for me?
Why... backwards?
That's a very good sign.
Your mother told me you
had a mind of your own.
It looks like she was right.
Welcome back, Gabby.
Oh, my baby.
Oh, you're okay.
She's okay.
She's okay.
Oh, baby.
That was just a split second.
It was long enough for me to
take over the aspiration.
You said you did those
procedures in the war.
It's understandable if
this one got to you,
given the events of the day.
It didn't. I hesitated. That's all.
I think we both know
it was more than that.
You pull something like that
again, you're off my team.
If I didn't intervene when I did,
the patient would be on a feeding
tube for the rest of his life.
I was minutes away. You
should have waited...
You would be saying the same
thing if I was Dr. Miller?
You think I'm giving you a hard time
because you're a woman?
When I started here 25 years ago,
I was the only brown
face in the department.
I guess you found a way to
pay that prejudice forward.
If that's what you want to believe Dr.
Curtis, fine.
But the truth is, you shouldn't
perform that procedure alone
for the same reason I didn't want Dr.
Miller
to go ahead and divide that
cystic artery this morning,
which I explained to him after you left.
Because you're not ready.
A patient's gonna live a normal life
because of what I did in there.
Your execution was sloppy.
You cut wider than necessary
and you used twice the
mesh that you needed.
He'll have a harder
recovery because of it.
This isn't about your gender,
or your sense of entitlement
or the massive chip on your shoulder.
It's about the patients.
Consider that next time before you cut.
Oh my God, that's her.
You sure she's okay?
Her lung lavage worked.
You'll both be home soon.
Thank you. For everything.
You ready?
Hi.
Took you long enough.
You know me. Always late.
I promise never to
complain about that again.
No, you don't.
I'm sorry.
Dr. Bishop?
Dr. Bishop, I just...
I want you to know that
you were wrong about me
when you suggested that
Internal would be a better fit
because Emergency is
where I belong and...
- I know.
- No, but what I'm saying is...
You showed me that today.
Welcome home, Dr. Leblanc.
_
Hi.
Uh... Sorry I missed your messages.
I'm coming home soon.
Uh, let's have dinner together tonight?
Yeah, it's been a crazy day.
Hey.
Can Amira and I stay with
you a little while longer?
Bash, I don't know how many
times I have to tell you,
but I love having you two around.
Stay as long as you need to.
How'd you do today?
I beat the odds.
That's what I should have
said in the interview.
We beat the odds here.
That was a tough day.
I know you're all exhausted.
We weren't perfect, but we came through.
What we do here is about
more than being perfect.
It's about showing up, no
matter how we're tested,
and leaving everything on the floor.
That's what we do every day.
And nothing makes me more
proud than knowing that.
Now get back to work.
Hey.
Hey.
There's a Gift card for the
grocery store down the street.
They have hot meals too.
There's also the name and
address of a woman's shelter.
Our social worker called ahead,
they have a bed waiting for you.
All you have to do is show up.
Why are you doing this?
I ran away when I was fifteen.
It's never too late to start again.
I'm here most days.
You need anything, you come back.
I bet you do something
like this every day
and no one ever notices.
Look at you, so sentimental today.
How are you feeling, Gavin?
I talked to the nurses.
Four people died in that explosion.
I was there. You did
everything you could.
Those people that didn't
make it, you have to...
You have to try and let that go.
Yeah.