Transplant (2020–…): Season 1, Episode 13 - The Only Way Out is Through - full transcript
Do you remember me, sir?
You have an epidural hematoma.
If I don't relieve the pressure
right now, you're going to die.
We're in this together now.
Sonia Jessup. She overdosed?
- Am I close?
- Keep going.
I think I nicked something.
Her spleen is ruptured.
The punctured spleen.
With a mistake like that,
what happens next?
There'll be an internal review.
I was the one who inserted the tube,
so if anyone deserves
the blame for it...
I was on imaging, guiding placement.
You know that.
Sir.
About what happened with the imaging...
Get back to me with a
differential on Sonja Jessup.
ASAP.
When I was putting in the chest tube,
what did you notice
when Dr. Bishop was guiding placement?
Same thing you did.
His first measurement was off.
He misread the imaging on the monitor...
Was it that he misread the monitor?
Or more like he couldn't see it?
It was like it wasn't even
in his field of vision.
I know you and Dr. Bishop are close.
This is in confidence?
Of course.
About a month ago, I noticed him
treating himself for
post-concussive nausea.
That's not abnormal
after his head injury,
- and the surgery he had.
- I know.
I'm not trying to avoid
responsibility for what happened.
I made the incision, and
I'll take the blame for it.
But...
But if his nausea's progressed
to vision problems,
what if he's getting worse?
Yesterday, a nurse came up with a chart.
He didn't see that either.
He brushed it off, I didn't
think anything about it.
The question is, is he intentionally
downplaying the symptoms?
What if they caught him by surprise?
I don't know, Claire.
What do we do?
- My favorite family.
- Hey-hey.
- Ah!
Look at you! Come here.
I know I'm not supposed to pet him,
but he's just got the
most beautiful coat.
Oh yeah... - It's cool.
Thor likes you, Theo...
I think it's because you're always
happier to see him than me.
He's pretty good at reading the room.
Well, you know the drill.
Sit on up for me.
What are you reading these days?
This play.
"Rosencrantz and Guildenstern Are Dead."
Finn's an existentialist now.
Well, you certainly
have come a long way
from "Treasure Island."
Tough couple of days?
Tough couple of weeks.
He was in for pulmonary
rehab two weeks ago.
Yeah. He's barely left
the house since then.
You know, we thought we were on
top of this infection, Theo.
It really took a turn.
We all know that cystic fibrosis
can be... unpredictable, right?
We'll check lung function,
and then start you on IV antibiotics.
What happens if they don't work?
Last time, they almost didn't.
Hey, don't think like that, Finn.
Okay? They're gonna work.
Let's start with airway clearance.
We'll loop your respirologist in.
Okay? Just, uh... Hang in there, Finn.
I always do. Then again, is
it really even up to me?
Yes, it is.
You can be an existentialist again
once we're through this rough patch.
Sure, Mom. No problem.
Well, I'll be back soon.
Thank you.
I have heard of situations
where the patient has a reflex reaction
just as you're placing the chest tube.
Or maybe it malforms...
Or maybe he just made a mistake.
Maybe...
Hey!
- You two good?
- I ended things.
- What?
- I ended things.
June, I'm... If you ever
want to talk about it, I...
When do I ever want to talk about it?
Oh, right, I know. I'm sorry.
- It's fine.
- Right, right, right.
- I'm fine.
- Yeah, yeah, yeah, okay.
I'll be right back.
Sir?
Sir?
Sir, can you hear me?
Sir, open your eyes if you can hear me.
Hey, do you know who this is?
No wristband.
He must not have signed in.
He's out cold.
One too many maybe?
I mean, it happens a
couple of times a week.
No, he's jaundiced. Feverish. I
think we have to get him a room.
- Yeah. Okay. I'm on it.
- Thanks.
Sir?
His name is Neil Evans.
He's got a ruptured, hemorrhaging
mass in his abdomen.
It could be threatening other organs.
Was he aware of it before now?
No way of knowing.
He's been unconscious
since we found him.
Any history in our system?
He had his health card.
I checked for a history
and nothing came up here.
We really need to stop the bleeding.
- No family we can call?
- Social worker's on it.
He came in alone with just
his wallet and his keys.
Then, we rely on our judgment
and sign a two physician consent.
Book the OR, category two.
And yes, before you
ask, you can scrub in.
Get him prepped.
Tell me what's on the list
and let them know we need to go ASAP.
Your team is working hard
to help that woman after
her spleen rupture.
My team works hard to
help every patient.
Jed.
I asked you if the nausea was normal
and nothing to be concerned about.
You said yes.
Then I asked you if the dizziness
was normal, and you said yes.
Now, if neither of those were true,
you have to tell me right now.
Because what happened last
night in the trauma bay,
Bash is now on the hook,
a patient's life is at risk
and if it's because you are not
taking care of yourself...
Alright, Claire! Alright!
I couldn't...
I couldn't see the damn monitor.
It went foggy.
Okay, how long has this been going on?
Have symptoms been getting worse
and you've just been lying about it?
No. I haven't in...
The nausea's normal.
The headaches too. But this...
These...
lapses in vision, I wasn't expecting.
I haven't been lying to you.
Maybe I've been lying to myself.
You need to call your neurosurgeon.
I will.
And you can't see patients.
I know it's terrifying.
I know your work is your life.
But you promised us a future.
Did you mean it when you did?
Because I believed you.
I meant it.
Call your doctor.
Seem him today.
We're still hopeful the
rupture will heal on its own
Other than what happened to her spleen,
have you figured out what's
causing her symptoms?
So far, the tests we've run
haven't given us any answers.
We need your help narrowing
down the possibilities.
Can you think of anything,
any symptoms or underlying
medical conditions
that she's been diagnosed with?
Or any injuries she's sustained
even going back years?
Sonja and I met when we were 18.
I knew everything there
was to know about her
for the longest time.
She was always basically healthy.
Until her back pain, her addiction.
I love her.
And I want my wife back.
Joel, why don't you take your sister
to the vending machines
to get something? Okay?
Okay. Thanks, Dad.
- One each, guys.
- Okay, Mom.
They're adorable.
Thank you.
How are you feeling since waking up?
Tired. My body hurts everywhere.
The doctors need to ask
you some questions.
Sonja, we need to figure out
whether you may have been
exposed to something.
You're thinking this
is something I caught?
There is an infection called
endocarditis which could explain
your symptoms.
If there's been any, um...
well, any intravenous drug
use, even months ago.
You think I was shooting up?
- No, we're...
- I would never do that.
I know I messed up yesterday,
but I was only taking pills.
How long have you had these?
- Spider veins on your leg?
- Years. Ten years, at least.
My GP said they're nothing
to worry about. You...
You believe me, right?
What is happening to her?!
Put your head back.
Put your head back. Just stay there.
Any closer to finding
anyone who knows this man?
Viv was able to reach his GP.
But no spouse and no kids.
Jesus.
Ah, this tumour has more
legs than a spider.
It's wrapped around his liver.
It's encroaching on his pancreas
and it's stuck to his bowel.
Have you ever seen
anything like this before?
Ah, it's in the lining of his abdomen,
could be colorectal cancer
- or malignant mesothelioma.
- So what do we do?
Unfortunately, there's not
much we can do, Dr. Curtis,
other than divert and refer oncology.
He's lucky if he has a week.
Let's close up.
Sonja's intubated.
Anything back from her CT?
Still waiting.
They met so young.
You could end up being married
to someone who isn't anything
like the person they started out as.
Or it just means that
you change together.
My parents met at 18
and they were more in love than
any couple I've ever seen.
Results are up.
Her spleen won't stop bleeding.
The blood's filling up her abdomen.
We've caused too much damage.
They're going to have to remove it.
I bet I'm the only kid you know
with a legitimate reason
to dress up like his dog?
The X-rays came back.
Unfortunately, the last few days
took their toll on Finn's lungs.
I know that's not something
you want to hear right now.
I'm not responding to the antibiotics?
Your infection's getting worse.
Pneumonia.
We're admitting you now.
Your CF team is on their way down.
But, um... we're not gonna
be able to stop it.
The vest didn't help?
What about PEP?
Or a bi-pap?
Those would buy time.
But it wouldn't stop the decompensation.
I'm... I'm so sorry.
Okay.
Okay. We're prepared for this. Right?
We've been on the
transplant list for months.
And this moves Finn
up to the top, right?
The list is based on need, yeah.
It doesn't matter because it's too late.
Finn! Don't say that!
Hey, that is not what's
happening here, okay.
There are more things that we can try.
I know you guys are trying
to protect me. I get that.
But I need to face what's
really going on here,
and I don't think you're hearing
what Theo's actually saying to us.
Even if lungs come,
your infection is too advanced.
He wouldn't be a candidate.
We, uh...
We're...
We're looking at end stage.
- I'm sorry, Mom.
- No.
Okay.
What happened?
They were prepping for her splenectomy
when she started to seize.
She seized? Why?
We don't know.
Well, we've stabilized her,
but, uh... they can't remove the organ
until we know what else
we're dealing with.
Yes, come in.
Is this about Sonja Jessup?
Every time we think
we're making progress,
she seems to be getting worse.
Take me through your thinking.
All of her symptoms. The
fluid around her heart.
The fluid on her lungs.
We can't see how they're connected.
She's negative for respiratory virus,
and her white blood cells are normal,
which means there's not
an infection either.
The fact is she's been here two days
and we still don't know
what's wrong with her.
Other than the ruptured
spleen, which we caused.
And before we could
repair that, the seizure.
Basically, all we know is
that she's extremely ill,
and her prognosis is worsening
because of what happened
in Trauma last night.
Which was my mistake.
And I'll tell that to the board.
Thank you.
Sir, I'm not going to let
you take responsibility...
It was my fault.
And I'm not having you come this far
for something like
this to hold you back.
Now, clear your mind, widen your views.
List everything that it can't be
until you see what it is.
There's poetry in the differential.
There's truth.
We get it wrong until...
we get it right.
And they get to start over.
Sir?
Dr. Bishop?
My numb is arm.
Sir?
Dr. Bishop?
Get a gurney! Call a code!
Sir! Dr. Bishop, can you hear me?
Oh my God! Jed?
Possible stroke! He collapsed,
and then lost his pulse.
Pause the compression.
V-tach on the monitor.
Defibing 200 joules.
- Pads are on.
- Charging!
What happened?
Everyone clear!
One amp epi! IV push!
Bash, you were with him? What happened?
He said his arm was numb
and he just collapsed.
- Ischemic stroke?
- Or hemorrhagic.
Could be a ruptured aneurysm.
A ruptured aneurysm
causing cardiac arrest?
How long has this thing been building?
We need Neurosurgery in here right away!
Let's do a pulse check.
He's still in V-tach.
Defib!
200! Charging!
Everyone clear!
Dr. Bishop? Sir!
Jed!
- GCS still three.
- He was down almost a minute.
We need to intubate him and
get him to CT right away.
Okay, he needs anti-convulsants,
we need manitol to
decrease cranial pressure.
Let's get him on three per cent saline.
And minimize damage as best as we can.
What happened?
Sudden loss of consciousness,
he went into V-tach
and we shocked him
back to normal rhythm.
Did he articulate any symptoms first?
Numbness.
And momentary vision loss,
he suffered last night.
He called my office.
We have a consultation
booked for tomorrow.
We'll get him upstairs.
Listen.
I know that wasn't easy.
But he's out of our hands now.
And we know exactly what
he'd tell us to do:
to get to work
and focus on the patients we can help.
Let's get to work.
Sonja needs us.
Get him prepped! He needs a
craniotomy to drain the blood.
Tell me how bad it is.
We won't know until after, but...
There's no guarantee he comes
back from this, Claire.
Okay, um... Well, let's
go back to the beginning.
So, Sonja was in a car accident.
But you wanted to rule
out a brain injury.
No visible head trauma.
Her resp rate was low
which I mistook for
symptoms of opioid use,
and then, heart and lung fluid
almost killed her later that day.
Her drug use raised the
possibility of endocarditis,
but she said she wasn't
using intravenously.
Which was confirmed
by bacterial culture.
Also, the CT scan of Sonja's
head came back clear,
so we know it's not a brain injury...
Which leads us back to
an underlying cause.
It needs to be something physiologic.
Sonja.
An abnormality we're not seeing...
Something... Something rare...
Something you wouldn't
normally think to look for.
There have been cases where
a penetrating head trauma
can cause an aneurysm months,
even years, down the road.
I could've caused this...
Dr. Bishop's...
With the drill, you mean?
You told me it was reckless
to drill without imaging.
Bash.
You saved his life because you did that.
And there could be so many
reasons this happened,
not the least of which is
Bishop going back to work
so soon after his accident...
And the aneurysm could've
sat there for months.
A ticking time bomb in his head.
Telangiectasia.
The... the spider veins on Sonja's leg?
Those almost always mean nothing.
What are you thinking?
You said something rare,
something that you wouldn't
normally think to look for
and you also said a ticking time bomb...
You know what's wrong with her?
I have a theory, but we're gonna need
more imaging to confirm.
Hey, Theo.
Hi, Finn.
I, uh...
I heard you're going home.
They're setting us up
with everything we need.
And Thor likes it better there.
So they're doing this for him, then?
I needed a say in how it happens.
I'm scared, Theo.
I know, Finn.
It's okay to be scared.
Thank you for everything, Theo.
He's, uh...
He's a brave kid.
An amazing kid.
I can't do this.
- I can't do this.
- It's okay.
"The pancreas is an ass."
- But also kind of important.
- Yeah. Who said that?
I remember someone saying that.
- I can't remember who it was.
- Dr. Waldon.
He did a three-hour
oncology lecture last year.
"The pancreas is an ass, which is why
it deserves more of our attention."
- Right. Yeah.
- Why?
Well, it's a highly
aggressive abdominal tumour.
It's compromising the other organs.
I was thinking an
intraperitoneal chemotherapy.
You're gonna surgically deliver chemo
right to his cancer cells?
Well, not me, but I was thinking
maybe someone like Doctor Waldon could.
He'd have to debulk most
of the cancer cells first.
Possibly resect part of the bowel,
and take the tail of the pancreas.
I don't know, but...
Singh asked you to organize that?
Well, he said to refer Oncology.
Pulling together an advanced
procedure like that
at the eleventh hour,
I don't think anyone here
is even trained for it.
Yeah.
The patient's completely alone.
Like he doesn't have anyone
to advocate for him.
I don't know what he did
to end up like this,
but anything we can do to help with...
Anything we can do to help.
You know who you could call...
Dr. Magnussen at Sunnybrook.
She just published on that
kind of thing last year.
Maybe she's looking for candidates.
Yeah. Yeah, thank you.
- You saw the radiologist?
- You were right.
- An "AVM?"
- "Arteriovenous malformation."
It's a rare, abnormal connection
between a person's arteries and veins.
Then this had nothing to
do with her drug use?
She was probably born with them.
AVMs disrupt circulation
and can cause a range of
life-threatening symptoms.
They can happen anywhere.
In Sonja's case, we identified one
in her lungs and one on her spine,
but it's the kind of thing you
don't even know to look for
until the other symptoms develop.
She's gonna need a surgical
procedure called an embolization.
But you said she's got one of
these things on her spine?
Could it have caused her back
pain in the first place?
It's possible. Even likely.
You couldn't have known.
Yeah, but I stopped believing in her.
I stopped trusting her.
Her condition is serious,
but it is treatable.
The surgery will last a few hours.
If you need some time to
take your children home,
we'll call you after.
We're not going anywhere.
Is that for her?
Wait here.
BP's tanking, she's tachycardic.
- Ultrasound. Mags?
- Yeah.
How many times can one woman crash?
Where are you on this patient?
She's got multiple AVMs.
We can embolize them, but
she's not stable enough.
She's got blood from her
spleen in her abdomen.
- Call OR.
- Yeah.
She's going into hemorrhagic shock.
She needs her spleen out stat.
We can't lose her now.
We finally know what's wrong with her.
And if she bleeds out because
we punctured her spleen,
- then Dr. Bishop...
- Is on the line.
- The OR says ten.
- She may not have ten.
Then we do it ourselves. In trauma.
You've removed a spleen before, right?
Mm-hmm.
Well, what are we waiting for?
She's bleeding out, Dr.
Hamed. Now or never.
I'm ready. We're starting.
Scalpel.
BP's dropping. Activate MTP.
Arnold, get the level one ready.
- Got it.
- Mags, help me open?
Hanging two packs of red cells
and two bags of plasma.
She's got a significant amount
of blood in her abdomen.
I'm gonna need packs, and a lot of them.
Richardson.
Metz.
I'll eviscerate the bowel
so we can start packing the abdomen.
Start packing and keep them coming.
- Pressures dropping!
- Clamp.
I've got you.
It's impressive you were able
to pull this together so quickly.
Magnussen's not making any promises,
but she thinks he's a viable candidate.
But you should know she brought
a full team here with her.
- So that means, you...
- Yeah. I know.
I'm not asking to scrub in.
I just wanted to give
the guy a chance. So...
Ah.
Sonja's stable.
We figured out what was wrong
with her just in time.
But not him.
I knew he still had symptoms.
Oh, Bash.
I could've said something earlier.
No, I could've stopped
this from happening.
Don't blame yourself. Don't do that.
Come here.
Baba.
Baba!
Baba!
I had to go.
I had to leave him.
If I'd stayed to treat him,
they would've found us.
If I tried to move him,
they would've heard us.
So I left him there to die.
It's my fault.
It's all my fault.
How's Dr. Bishop?
Conscious.
I mean, we can't really tell.
I know how much he means to all of you.
Yeah, thanks.
Well, I'll see you.
Hi. I heard you were awake.
Apparently, without a
spleen, thanks to you.
You can live without one.
You'll just be more prone to infections,
but you can take measures
to mitigate that.
You saved my life.
And you found the reason
for my back pain.
I know I'll always be an addict.
That doesn't mean you can't start over.
And that's all I want to do.
Beat this thing, for my family.
Is everything okay?
Your text said to come,
but you didn't say why.
Amira, what I said yesterday,
about only being in this
country because of you...
I'm sorry.
I didn't mean it like it sounded, but...
You deserve to know why I said it.
I don't bring you here enough.
Back home, do you remember
coming to the clinic after school?
Baba would always talk about
what he'd learned that day.
New medications and treatments.
No problem was ever too big and...
Mama always talked about her patients.
Learn how to treat the patients,
and not the symptoms.
Amira...
You know, when you were sent
to live with the cousins...
that was only because of how
much Mama and Baba loved you.
How much they wanted to
protect you from the war.
I know you miss them.
I miss them too.
And you were right when
you said yesterday
that I'm not honest with you.
But I want to be.
You've asked me why I
can't talk about them.
That day,
when the bombs came...
I wasn't there.
I was too late to save them.
And I feel guilty about that every day
because you lost them and you need them,
and we're alone because of me.
But the last thing our father told me
was to find you,
and build a future for both of us.
Because we weren't alone
if we had each other.
I know you need me to be better.
To do better.
And I'm learning as I go.
But, habibi, I promise,
I'm here for you.
Baba was right.
When you came to the camp,
when you found me,
I knew I was safe.
You saved me.
We're not alone because of you.
We're together because of you.
Theo?
What are you doing here? I thought
you were working all week?
I, uh...
I was just at the hospital an hour ago,
and I'll be catching a flight
first thing in the morning.
I just...
I had to see you.
And see the girls.
Life is...
It's impossible.
It's impossible and I know I screwed up.
Taking the job without telling you is...
I just, I wanted to take
control of my own life.
You know, not just have it happen to me.
I wanted...
I just, I went about it the wrong way.
And I'm sorry.
I hurt you, and I am so sorry.
Mel, I love you.
But if we want different
things, is that enough?
It has to be.
It has to be because I can't
imagine life without my family.
What are we gonna do?
I don't know.
They're closing up.
No guarantees, but...
that guy's got a shot because of you.
Yeah, this might be the first time
I actually wished my patient was awake.
Spoken like a true surgeon.
Walk with me.
You're almost in your fourth year, June.
You should consider applying for
the Chief Resident position.
Sir?
And don't get me wrong,
it's a thankless job.
Longer hours. Administrative crap.
Managing your peers
without any real power.
And you'll be up against a
bunch of egocentric bros
who think they've got it in the bag.
But it'll open doors.
Going above and beyond
for the sole purpose
of giving that patient a chance?
That's something you can't teach.
And it's what I've been
waiting to see from you.
Thanks.
I mean, I'll consider it.
You do that.
- You okay?
- Yeah, actually.
You?
Uh, I... I don't know.
You know, it was Bishop who told me
that if I wasn't careful,
this place would swallow me whole.
But if even he can't stop
that from happening...
Then what chance do any of us have?
Look.
You don't strike me as someone
who would back down from a challenge.
Just saying.
Hey. I'm glad you came.
I'm glad you called.
This way.
I'll be just outside if you need me.
Hi, Dad.
Has he said anything yet?
Not yet.
He's lucky to have you in his life.
You too.
I thought you were dead.
You have an epidural hematoma.
If I don't relieve the pressure
right now, you're going to die.
We're in this together now.
Sonia Jessup. She overdosed?
- Am I close?
- Keep going.
I think I nicked something.
Her spleen is ruptured.
The punctured spleen.
With a mistake like that,
what happens next?
There'll be an internal review.
I was the one who inserted the tube,
so if anyone deserves
the blame for it...
I was on imaging, guiding placement.
You know that.
Sir.
About what happened with the imaging...
Get back to me with a
differential on Sonja Jessup.
ASAP.
When I was putting in the chest tube,
what did you notice
when Dr. Bishop was guiding placement?
Same thing you did.
His first measurement was off.
He misread the imaging on the monitor...
Was it that he misread the monitor?
Or more like he couldn't see it?
It was like it wasn't even
in his field of vision.
I know you and Dr. Bishop are close.
This is in confidence?
Of course.
About a month ago, I noticed him
treating himself for
post-concussive nausea.
That's not abnormal
after his head injury,
- and the surgery he had.
- I know.
I'm not trying to avoid
responsibility for what happened.
I made the incision, and
I'll take the blame for it.
But...
But if his nausea's progressed
to vision problems,
what if he's getting worse?
Yesterday, a nurse came up with a chart.
He didn't see that either.
He brushed it off, I didn't
think anything about it.
The question is, is he intentionally
downplaying the symptoms?
What if they caught him by surprise?
I don't know, Claire.
What do we do?
- My favorite family.
- Hey-hey.
- Ah!
Look at you! Come here.
I know I'm not supposed to pet him,
but he's just got the
most beautiful coat.
Oh yeah... - It's cool.
Thor likes you, Theo...
I think it's because you're always
happier to see him than me.
He's pretty good at reading the room.
Well, you know the drill.
Sit on up for me.
What are you reading these days?
This play.
"Rosencrantz and Guildenstern Are Dead."
Finn's an existentialist now.
Well, you certainly
have come a long way
from "Treasure Island."
Tough couple of days?
Tough couple of weeks.
He was in for pulmonary
rehab two weeks ago.
Yeah. He's barely left
the house since then.
You know, we thought we were on
top of this infection, Theo.
It really took a turn.
We all know that cystic fibrosis
can be... unpredictable, right?
We'll check lung function,
and then start you on IV antibiotics.
What happens if they don't work?
Last time, they almost didn't.
Hey, don't think like that, Finn.
Okay? They're gonna work.
Let's start with airway clearance.
We'll loop your respirologist in.
Okay? Just, uh... Hang in there, Finn.
I always do. Then again, is
it really even up to me?
Yes, it is.
You can be an existentialist again
once we're through this rough patch.
Sure, Mom. No problem.
Well, I'll be back soon.
Thank you.
I have heard of situations
where the patient has a reflex reaction
just as you're placing the chest tube.
Or maybe it malforms...
Or maybe he just made a mistake.
Maybe...
Hey!
- You two good?
- I ended things.
- What?
- I ended things.
June, I'm... If you ever
want to talk about it, I...
When do I ever want to talk about it?
Oh, right, I know. I'm sorry.
- It's fine.
- Right, right, right.
- I'm fine.
- Yeah, yeah, yeah, okay.
I'll be right back.
Sir?
Sir?
Sir, can you hear me?
Sir, open your eyes if you can hear me.
Hey, do you know who this is?
No wristband.
He must not have signed in.
He's out cold.
One too many maybe?
I mean, it happens a
couple of times a week.
No, he's jaundiced. Feverish. I
think we have to get him a room.
- Yeah. Okay. I'm on it.
- Thanks.
Sir?
His name is Neil Evans.
He's got a ruptured, hemorrhaging
mass in his abdomen.
It could be threatening other organs.
Was he aware of it before now?
No way of knowing.
He's been unconscious
since we found him.
Any history in our system?
He had his health card.
I checked for a history
and nothing came up here.
We really need to stop the bleeding.
- No family we can call?
- Social worker's on it.
He came in alone with just
his wallet and his keys.
Then, we rely on our judgment
and sign a two physician consent.
Book the OR, category two.
And yes, before you
ask, you can scrub in.
Get him prepped.
Tell me what's on the list
and let them know we need to go ASAP.
Your team is working hard
to help that woman after
her spleen rupture.
My team works hard to
help every patient.
Jed.
I asked you if the nausea was normal
and nothing to be concerned about.
You said yes.
Then I asked you if the dizziness
was normal, and you said yes.
Now, if neither of those were true,
you have to tell me right now.
Because what happened last
night in the trauma bay,
Bash is now on the hook,
a patient's life is at risk
and if it's because you are not
taking care of yourself...
Alright, Claire! Alright!
I couldn't...
I couldn't see the damn monitor.
It went foggy.
Okay, how long has this been going on?
Have symptoms been getting worse
and you've just been lying about it?
No. I haven't in...
The nausea's normal.
The headaches too. But this...
These...
lapses in vision, I wasn't expecting.
I haven't been lying to you.
Maybe I've been lying to myself.
You need to call your neurosurgeon.
I will.
And you can't see patients.
I know it's terrifying.
I know your work is your life.
But you promised us a future.
Did you mean it when you did?
Because I believed you.
I meant it.
Call your doctor.
Seem him today.
We're still hopeful the
rupture will heal on its own
Other than what happened to her spleen,
have you figured out what's
causing her symptoms?
So far, the tests we've run
haven't given us any answers.
We need your help narrowing
down the possibilities.
Can you think of anything,
any symptoms or underlying
medical conditions
that she's been diagnosed with?
Or any injuries she's sustained
even going back years?
Sonja and I met when we were 18.
I knew everything there
was to know about her
for the longest time.
She was always basically healthy.
Until her back pain, her addiction.
I love her.
And I want my wife back.
Joel, why don't you take your sister
to the vending machines
to get something? Okay?
Okay. Thanks, Dad.
- One each, guys.
- Okay, Mom.
They're adorable.
Thank you.
How are you feeling since waking up?
Tired. My body hurts everywhere.
The doctors need to ask
you some questions.
Sonja, we need to figure out
whether you may have been
exposed to something.
You're thinking this
is something I caught?
There is an infection called
endocarditis which could explain
your symptoms.
If there's been any, um...
well, any intravenous drug
use, even months ago.
You think I was shooting up?
- No, we're...
- I would never do that.
I know I messed up yesterday,
but I was only taking pills.
How long have you had these?
- Spider veins on your leg?
- Years. Ten years, at least.
My GP said they're nothing
to worry about. You...
You believe me, right?
What is happening to her?!
Put your head back.
Put your head back. Just stay there.
Any closer to finding
anyone who knows this man?
Viv was able to reach his GP.
But no spouse and no kids.
Jesus.
Ah, this tumour has more
legs than a spider.
It's wrapped around his liver.
It's encroaching on his pancreas
and it's stuck to his bowel.
Have you ever seen
anything like this before?
Ah, it's in the lining of his abdomen,
could be colorectal cancer
- or malignant mesothelioma.
- So what do we do?
Unfortunately, there's not
much we can do, Dr. Curtis,
other than divert and refer oncology.
He's lucky if he has a week.
Let's close up.
Sonja's intubated.
Anything back from her CT?
Still waiting.
They met so young.
You could end up being married
to someone who isn't anything
like the person they started out as.
Or it just means that
you change together.
My parents met at 18
and they were more in love than
any couple I've ever seen.
Results are up.
Her spleen won't stop bleeding.
The blood's filling up her abdomen.
We've caused too much damage.
They're going to have to remove it.
I bet I'm the only kid you know
with a legitimate reason
to dress up like his dog?
The X-rays came back.
Unfortunately, the last few days
took their toll on Finn's lungs.
I know that's not something
you want to hear right now.
I'm not responding to the antibiotics?
Your infection's getting worse.
Pneumonia.
We're admitting you now.
Your CF team is on their way down.
But, um... we're not gonna
be able to stop it.
The vest didn't help?
What about PEP?
Or a bi-pap?
Those would buy time.
But it wouldn't stop the decompensation.
I'm... I'm so sorry.
Okay.
Okay. We're prepared for this. Right?
We've been on the
transplant list for months.
And this moves Finn
up to the top, right?
The list is based on need, yeah.
It doesn't matter because it's too late.
Finn! Don't say that!
Hey, that is not what's
happening here, okay.
There are more things that we can try.
I know you guys are trying
to protect me. I get that.
But I need to face what's
really going on here,
and I don't think you're hearing
what Theo's actually saying to us.
Even if lungs come,
your infection is too advanced.
He wouldn't be a candidate.
We, uh...
We're...
We're looking at end stage.
- I'm sorry, Mom.
- No.
Okay.
What happened?
They were prepping for her splenectomy
when she started to seize.
She seized? Why?
We don't know.
Well, we've stabilized her,
but, uh... they can't remove the organ
until we know what else
we're dealing with.
Yes, come in.
Is this about Sonja Jessup?
Every time we think
we're making progress,
she seems to be getting worse.
Take me through your thinking.
All of her symptoms. The
fluid around her heart.
The fluid on her lungs.
We can't see how they're connected.
She's negative for respiratory virus,
and her white blood cells are normal,
which means there's not
an infection either.
The fact is she's been here two days
and we still don't know
what's wrong with her.
Other than the ruptured
spleen, which we caused.
And before we could
repair that, the seizure.
Basically, all we know is
that she's extremely ill,
and her prognosis is worsening
because of what happened
in Trauma last night.
Which was my mistake.
And I'll tell that to the board.
Thank you.
Sir, I'm not going to let
you take responsibility...
It was my fault.
And I'm not having you come this far
for something like
this to hold you back.
Now, clear your mind, widen your views.
List everything that it can't be
until you see what it is.
There's poetry in the differential.
There's truth.
We get it wrong until...
we get it right.
And they get to start over.
Sir?
Dr. Bishop?
My numb is arm.
Sir?
Dr. Bishop?
Get a gurney! Call a code!
Sir! Dr. Bishop, can you hear me?
Oh my God! Jed?
Possible stroke! He collapsed,
and then lost his pulse.
Pause the compression.
V-tach on the monitor.
Defibing 200 joules.
- Pads are on.
- Charging!
What happened?
Everyone clear!
One amp epi! IV push!
Bash, you were with him? What happened?
He said his arm was numb
and he just collapsed.
- Ischemic stroke?
- Or hemorrhagic.
Could be a ruptured aneurysm.
A ruptured aneurysm
causing cardiac arrest?
How long has this thing been building?
We need Neurosurgery in here right away!
Let's do a pulse check.
He's still in V-tach.
Defib!
200! Charging!
Everyone clear!
Dr. Bishop? Sir!
Jed!
- GCS still three.
- He was down almost a minute.
We need to intubate him and
get him to CT right away.
Okay, he needs anti-convulsants,
we need manitol to
decrease cranial pressure.
Let's get him on three per cent saline.
And minimize damage as best as we can.
What happened?
Sudden loss of consciousness,
he went into V-tach
and we shocked him
back to normal rhythm.
Did he articulate any symptoms first?
Numbness.
And momentary vision loss,
he suffered last night.
He called my office.
We have a consultation
booked for tomorrow.
We'll get him upstairs.
Listen.
I know that wasn't easy.
But he's out of our hands now.
And we know exactly what
he'd tell us to do:
to get to work
and focus on the patients we can help.
Let's get to work.
Sonja needs us.
Get him prepped! He needs a
craniotomy to drain the blood.
Tell me how bad it is.
We won't know until after, but...
There's no guarantee he comes
back from this, Claire.
Okay, um... Well, let's
go back to the beginning.
So, Sonja was in a car accident.
But you wanted to rule
out a brain injury.
No visible head trauma.
Her resp rate was low
which I mistook for
symptoms of opioid use,
and then, heart and lung fluid
almost killed her later that day.
Her drug use raised the
possibility of endocarditis,
but she said she wasn't
using intravenously.
Which was confirmed
by bacterial culture.
Also, the CT scan of Sonja's
head came back clear,
so we know it's not a brain injury...
Which leads us back to
an underlying cause.
It needs to be something physiologic.
Sonja.
An abnormality we're not seeing...
Something... Something rare...
Something you wouldn't
normally think to look for.
There have been cases where
a penetrating head trauma
can cause an aneurysm months,
even years, down the road.
I could've caused this...
Dr. Bishop's...
With the drill, you mean?
You told me it was reckless
to drill without imaging.
Bash.
You saved his life because you did that.
And there could be so many
reasons this happened,
not the least of which is
Bishop going back to work
so soon after his accident...
And the aneurysm could've
sat there for months.
A ticking time bomb in his head.
Telangiectasia.
The... the spider veins on Sonja's leg?
Those almost always mean nothing.
What are you thinking?
You said something rare,
something that you wouldn't
normally think to look for
and you also said a ticking time bomb...
You know what's wrong with her?
I have a theory, but we're gonna need
more imaging to confirm.
Hey, Theo.
Hi, Finn.
I, uh...
I heard you're going home.
They're setting us up
with everything we need.
And Thor likes it better there.
So they're doing this for him, then?
I needed a say in how it happens.
I'm scared, Theo.
I know, Finn.
It's okay to be scared.
Thank you for everything, Theo.
He's, uh...
He's a brave kid.
An amazing kid.
I can't do this.
- I can't do this.
- It's okay.
"The pancreas is an ass."
- But also kind of important.
- Yeah. Who said that?
I remember someone saying that.
- I can't remember who it was.
- Dr. Waldon.
He did a three-hour
oncology lecture last year.
"The pancreas is an ass, which is why
it deserves more of our attention."
- Right. Yeah.
- Why?
Well, it's a highly
aggressive abdominal tumour.
It's compromising the other organs.
I was thinking an
intraperitoneal chemotherapy.
You're gonna surgically deliver chemo
right to his cancer cells?
Well, not me, but I was thinking
maybe someone like Doctor Waldon could.
He'd have to debulk most
of the cancer cells first.
Possibly resect part of the bowel,
and take the tail of the pancreas.
I don't know, but...
Singh asked you to organize that?
Well, he said to refer Oncology.
Pulling together an advanced
procedure like that
at the eleventh hour,
I don't think anyone here
is even trained for it.
Yeah.
The patient's completely alone.
Like he doesn't have anyone
to advocate for him.
I don't know what he did
to end up like this,
but anything we can do to help with...
Anything we can do to help.
You know who you could call...
Dr. Magnussen at Sunnybrook.
She just published on that
kind of thing last year.
Maybe she's looking for candidates.
Yeah. Yeah, thank you.
- You saw the radiologist?
- You were right.
- An "AVM?"
- "Arteriovenous malformation."
It's a rare, abnormal connection
between a person's arteries and veins.
Then this had nothing to
do with her drug use?
She was probably born with them.
AVMs disrupt circulation
and can cause a range of
life-threatening symptoms.
They can happen anywhere.
In Sonja's case, we identified one
in her lungs and one on her spine,
but it's the kind of thing you
don't even know to look for
until the other symptoms develop.
She's gonna need a surgical
procedure called an embolization.
But you said she's got one of
these things on her spine?
Could it have caused her back
pain in the first place?
It's possible. Even likely.
You couldn't have known.
Yeah, but I stopped believing in her.
I stopped trusting her.
Her condition is serious,
but it is treatable.
The surgery will last a few hours.
If you need some time to
take your children home,
we'll call you after.
We're not going anywhere.
Is that for her?
Wait here.
BP's tanking, she's tachycardic.
- Ultrasound. Mags?
- Yeah.
How many times can one woman crash?
Where are you on this patient?
She's got multiple AVMs.
We can embolize them, but
she's not stable enough.
She's got blood from her
spleen in her abdomen.
- Call OR.
- Yeah.
She's going into hemorrhagic shock.
She needs her spleen out stat.
We can't lose her now.
We finally know what's wrong with her.
And if she bleeds out because
we punctured her spleen,
- then Dr. Bishop...
- Is on the line.
- The OR says ten.
- She may not have ten.
Then we do it ourselves. In trauma.
You've removed a spleen before, right?
Mm-hmm.
Well, what are we waiting for?
She's bleeding out, Dr.
Hamed. Now or never.
I'm ready. We're starting.
Scalpel.
BP's dropping. Activate MTP.
Arnold, get the level one ready.
- Got it.
- Mags, help me open?
Hanging two packs of red cells
and two bags of plasma.
She's got a significant amount
of blood in her abdomen.
I'm gonna need packs, and a lot of them.
Richardson.
Metz.
I'll eviscerate the bowel
so we can start packing the abdomen.
Start packing and keep them coming.
- Pressures dropping!
- Clamp.
I've got you.
It's impressive you were able
to pull this together so quickly.
Magnussen's not making any promises,
but she thinks he's a viable candidate.
But you should know she brought
a full team here with her.
- So that means, you...
- Yeah. I know.
I'm not asking to scrub in.
I just wanted to give
the guy a chance. So...
Ah.
Sonja's stable.
We figured out what was wrong
with her just in time.
But not him.
I knew he still had symptoms.
Oh, Bash.
I could've said something earlier.
No, I could've stopped
this from happening.
Don't blame yourself. Don't do that.
Come here.
Baba.
Baba!
Baba!
I had to go.
I had to leave him.
If I'd stayed to treat him,
they would've found us.
If I tried to move him,
they would've heard us.
So I left him there to die.
It's my fault.
It's all my fault.
How's Dr. Bishop?
Conscious.
I mean, we can't really tell.
I know how much he means to all of you.
Yeah, thanks.
Well, I'll see you.
Hi. I heard you were awake.
Apparently, without a
spleen, thanks to you.
You can live without one.
You'll just be more prone to infections,
but you can take measures
to mitigate that.
You saved my life.
And you found the reason
for my back pain.
I know I'll always be an addict.
That doesn't mean you can't start over.
And that's all I want to do.
Beat this thing, for my family.
Is everything okay?
Your text said to come,
but you didn't say why.
Amira, what I said yesterday,
about only being in this
country because of you...
I'm sorry.
I didn't mean it like it sounded, but...
You deserve to know why I said it.
I don't bring you here enough.
Back home, do you remember
coming to the clinic after school?
Baba would always talk about
what he'd learned that day.
New medications and treatments.
No problem was ever too big and...
Mama always talked about her patients.
Learn how to treat the patients,
and not the symptoms.
Amira...
You know, when you were sent
to live with the cousins...
that was only because of how
much Mama and Baba loved you.
How much they wanted to
protect you from the war.
I know you miss them.
I miss them too.
And you were right when
you said yesterday
that I'm not honest with you.
But I want to be.
You've asked me why I
can't talk about them.
That day,
when the bombs came...
I wasn't there.
I was too late to save them.
And I feel guilty about that every day
because you lost them and you need them,
and we're alone because of me.
But the last thing our father told me
was to find you,
and build a future for both of us.
Because we weren't alone
if we had each other.
I know you need me to be better.
To do better.
And I'm learning as I go.
But, habibi, I promise,
I'm here for you.
Baba was right.
When you came to the camp,
when you found me,
I knew I was safe.
You saved me.
We're not alone because of you.
We're together because of you.
Theo?
What are you doing here? I thought
you were working all week?
I, uh...
I was just at the hospital an hour ago,
and I'll be catching a flight
first thing in the morning.
I just...
I had to see you.
And see the girls.
Life is...
It's impossible.
It's impossible and I know I screwed up.
Taking the job without telling you is...
I just, I wanted to take
control of my own life.
You know, not just have it happen to me.
I wanted...
I just, I went about it the wrong way.
And I'm sorry.
I hurt you, and I am so sorry.
Mel, I love you.
But if we want different
things, is that enough?
It has to be.
It has to be because I can't
imagine life without my family.
What are we gonna do?
I don't know.
They're closing up.
No guarantees, but...
that guy's got a shot because of you.
Yeah, this might be the first time
I actually wished my patient was awake.
Spoken like a true surgeon.
Walk with me.
You're almost in your fourth year, June.
You should consider applying for
the Chief Resident position.
Sir?
And don't get me wrong,
it's a thankless job.
Longer hours. Administrative crap.
Managing your peers
without any real power.
And you'll be up against a
bunch of egocentric bros
who think they've got it in the bag.
But it'll open doors.
Going above and beyond
for the sole purpose
of giving that patient a chance?
That's something you can't teach.
And it's what I've been
waiting to see from you.
Thanks.
I mean, I'll consider it.
You do that.
- You okay?
- Yeah, actually.
You?
Uh, I... I don't know.
You know, it was Bishop who told me
that if I wasn't careful,
this place would swallow me whole.
But if even he can't stop
that from happening...
Then what chance do any of us have?
Look.
You don't strike me as someone
who would back down from a challenge.
Just saying.
Hey. I'm glad you came.
I'm glad you called.
This way.
I'll be just outside if you need me.
Hi, Dad.
Has he said anything yet?
Not yet.
He's lucky to have you in his life.
You too.
I thought you were dead.