Transplant (2020–…): Season 1, Episode 2 - Tell Me Who You Are - full transcript
You have an epidural hematoma.
Do you know whose head you drilled into?
I know who Doctor Bishop is.
We have met before, of course.
I interviewed you for a job,
but then didn't hire you.
I think we need to do it again.
Have you eaten anything?!
I can't find my math book.
It's over by the window.
What if everything is
different at the hospital?
Habibti, you're learning math
in a whole new language.
I'll be fine.
I was waiting until I
was a doctor again.
Sir, you need to get in line.
I'm not a patient, I'm...
We've got a trauma coming in!
Tim Stafford, 35 years old.
BP's 100 over 60. Pulse 150.
Page Atwater.
Construction site. Scaffolding collapse.
Fell 20 feet. Landed
on a piece of rebar.
We cut it off at the scene.
Did he get anything for pain?
You can't be here.
If the rebar punctured
his femoral artery,
- it could be potentially lethal.
- Yeah. I know that.
- You got the hand?
- Got it.
I got the leg. On three.
One, two, three.
I need an X-ray plate.
You can't just show up here
and volunteer as a doctor.
I'm not.
One, two, three.
One, two, three.
What the hell do you think you're doing?
His job. Did you page vascular?
They're on their way. OR needs five.
Sir, do you know where you are?
Please get that thing out of me!
Not here. First we
have to stabilize you,
then we'll get you down to the OR.
100 mics fentanyl. IV push.
The rebar may have hit
an important artery.
Believe me, you don't want
it bleeding inside you.
Dr. Leblanc is going
to tell us if it is.
- X-ray's up!
- Femoral's great. Good pulses.
It's your lucky day, sir.
Not yet. He has a ruptured spleen.
I'll do a scan.
- He's right.
- Good. And?
I'd do a splenectomy right now.
Maybe five years ago. Not now.
Dr. Curtis, tell him why.
Because it will be jump at the gun.
First we CT to find
out what grade it is.
Dr. Leblanc? I can see
you're dying to tell us
what happens pending that outcome?
ICU and monitor, after the rebar's out.
Get him to CT, stat!
There are thousands of pages
of co-curricular reading
and you'll need to catch up.
And next time you come to
work, get changed first
and find out where we
actually want you to be.
You may remember Dr.
Hamed from two weeks ago
when he drilled a hole in my head.
He's one of you now.
Welcome to the best
Emerge in the country.
Triage nurses assign patients to acute,
intermediate or ambulatory.
Ambulatory's the busiest.
Big waits, small problems, but for them,
it's the worst day of their lives.
They get a headache, go online,
convince themselves they've got a tumo
Acute's where the action is.
Traumas, Mis, GSWs,
stabbings, sepsis,
strokes, overdoses.
You were a trauma surgeon
already, but that was in Syria.
In this teaching hospital,
you'll start at the bottom.
Redo your residency,
learn our system from scratch.
- Questions so far?
- No, Sir.
I'm sure they'll have plenty for you.
Okay, see you soon.
Come on, then.
Did you know we are hiring him?
It's Dr. Bishop's prerogative.
But I want him shadowing you today.
And don't just do
everything yourself, Mags.
I need to know what we're
getting with this guy.
Dr. Wendy Atwater is your attending.
All the residents report
to her, she reports to me.
It's not every day a
patient from one week
becomes a doctor the next.
You'll get scrubs in the lounge,
an ID card's in your mailbox.
What happened in the trauma bay
is not how the rest of
your day is going to go.
You're gonna stick with Dr. Leblanc,
she's gonna teach you the rules.
Scripts, decisions, it
all goes through her.
- Understood?
- Mmm.
Maybe don't show him where
we keep the power tools.
- Hi.
- Who are you?
I mean, clearly you have experience
and you did save Bishop's life.
This is us moving on.
Uh. Dr. Bishop...
As Chief, does he always oversee
his patients like that?
Whenever he feels like it, yeah.
You're also an emergency resident?
Second year. The ruptured spleen.
How did you know without imaging?
From the way the patient was
clenching his shoulder.
Right. You trained in war
zones, I'm guessing.
Not a lot of equipment or resources.
Do you always just ask
whatever's on your mind?
When I'm being asked to trust
somebody with my patients? Yeah.
Practicing medicine in the dark,
you learn to sharpen other skills.
Yeah, well here we
always rely on imaging.
Oh. I'm sorry.
That one sticks.
Not everything we have
here is state of the art.
Thanks.
- Theo Hunter.
- Bashir Hamed.
Welcome aboard.
That looks like it has lived a life.
Was, uh...
Was that your family I saw you with?
Yeah. Saying goodbye for the week.
We live in Sudbury, I'm
here doing my fellowship.
- Pediatric EM.
- Uh. We have a patient waiting.
And those stitches should come out.
Mags here used to be a hall monitor.
And Theo here was almost a priest.
- Pastor!
- A Pastor.
It runs in the family.
I was on the bus.
They made me get off.
People don't like it when
you throw up on the bus.
Um, my purse and phone.
I had them when I talked to that nurse.
- Did she put them somewhere?
- We'll find them.
How long has this been going on?
Ms. Harper?
Irene?
The vomiting and the abdominal pain.
- When did it start?
- Few days, I think.
Maybe this morning?
I didn't wanna miss my shift today.
I just... thought it was the flu.
But it's worse, right?
Put your hands out for me, Ms. Harper?
Okay, thank you.
My kid.
I'm supposed to pick her
up from school later.
I need my phone so I can...
My husband doesn't know where I am.
It's okay, we'll take care of that.
Atwater wants me to let
you weigh in first, so...
She's confused and disoriented.
Hypotensive and tachycardic.
She's jaundiced.
I'd be concerned with liver injury.
Yeah, but those symptoms could
also describe biliary colic?
But not the trembling hands.
The asterixis can mean
acute liver failure.
We should do testing to confirm.
Given her level of consciousness,
I'd suggest an aggressive approach.
Intubation sooner rather than later.
She could go into
multiple organ failure.
But you want to do testing first.
We need blood. CVC, LFT, all of it.
Okay.
Bashir Hamed?
- Uh, I'll catch up.
- Okay.
Lavondra Kelly, HR. I have
been looking for you.
- Human Resources?
- Uh, yes.
Welcome to the team.
I'm still waiting for your transcripts.
Excuse me?
Your medical school transcripts from...
the University of Aleppo?
I... I sent the PDF.
I know. Didn't somebody
follow up with you on that?
Legal still needs certified original
copies of those transcripts
Without them we won't be able
to verify your credentials.
If I needed some time
to coordinate that?
Last year the infection deases ***
A doctor who pioneered a leading
approach to malaria in his country.
He couldn't get his
documents an order either,
and now he does data entry
at a university lab.
I see. So...
- The transcripts...
- The originals.
Are essential.
If you want to work as
a doctor, they are.
So, how long have you had this pain?
Two days. But it's getting
worse every hour.
Any other symptoms I should know about?
Fever, vomiting?
Does dry heaving count?
Have you ever experienced these
symptoms before, Ms. Bennet?
Cassie.
I have endometriosis.
But this is way worse than normal.
Have you spoken to your OBGYN
about these new symptoms?
Yes, I have,
and they can't see me until next week.
But last time I saw her, she
just told me to get pregnant.
At least then, I'd have
nine months of relief.
Right. Well, I heard that
*** a lot of side effects.
Look, the adhesions for endometriosis
can cause severe pain.
Unfortunately, it's a chronic issue
and there's really not too
much we can do for a flare-up
- here in the emergency department.
- I know, I know.
Look, and I know what
you're thinking, okay?
Woman with endo comes in
suffering from a flare-up,
is afraid it's something
worse, and it never is
and there's nothing you can do for her.
Look, I've been through this
more times than I can count.
Alright? I've been told to go home,
and take pain meds, and sleep it off,
and I have done all that.
And I...
Are you here by yourself?
My boyfriend's out of town.
Look, you're just gonna have
to trust me on this. Okay?
I know my body, and
this pain is different.
Irene Harper, INR's 2.1, Bili elevated
Her liver's failing. You
know the procedure?
Screen for hepatitis and acetaminophen.
- LOC?
- Signs of hepatic encephalopathy.
Her O2 sats are borderline.
If she's unconscious,
you need to intubate
She could go into
multiple organ failure.
We need to pre-oxygenate
then give her a hundred
ketamine and a hundred succs.
- She's apneic.
- Laryngoscope.
Endotracheal tube.
I can't visualize her cords.
- Airway edema?
- No. Cords are anterior.
Let's back off and bag her for a second.
I should call Respiratory Therapy.
Do you have light wands in here?
Um, bottom shelf I think, yeah, why?
With the lighted stylet, you'll be
able to guide it through the tube.
No, I don't have a view.
You will now.
When you said working in the
dark, you meant literally?
Occasionally. Do you need suction?
No.
Could you just...
Okay.
Did you ever think all
that would lead you here?
What led you here?
Everything okay?
Yeah. Tough airway. Just got it.
We don't intubate with
light wands anymore.
I proposed it.
Next time, call RT.
Now let's figure out what's
causing her liver to fail.
The bruising speaks to
rapid deterioration.
She wanted her family. Do you
know if they've been contacted?
No.
Update her chart, then see if
the social worker did that.
I'm gonna run down the rest of her labs.
55-year-old man with
adenocarcinoma of the pancreas.
He had radiation to
reduce the tumour load.
He wants a Whipple? We'll have to see.
What's your story, Dr. Curtis? Quickly.
Emergency walk-in.
I'd like to do a lab to isolate
the cause of her pain.
Endometriosis. We both know we don't do
*** procedures for chronic problems.
- Yes, but...
- She's likely having a flare-up.
I did a transvaginal ultrasound and...
Nothing's conclusive on it.
There have been cases
where imaging has missed
ovarian torsion, even a ruptured cyst.
Her abdomen's distended,
she's in extreme pain,
and I'm concerned it could be
more than endometriosis...
Are you?
Or are you fishing for OR time.
You know I want the operative time.
But that doesn't mean
my patient is wrong
about her pain being acute.
Dr. Curtis...
Endo's tricky.
Women can feel one thing one day,
and something completely
different the next.
The pathophysiology of uterine nerves...
They're complex.
And often don't correspond to
what's happening internally.
And every time we go in there,
we run the risk of doing
more harm than good.
Surgical intervention is not an option
in the absence of
extremely clear evidence,
which you simply do not have here.
She should follow up with her OBGYN.
Send them the ultrasound.
Otherwise, give her Toradol
and send her home to rest.
64-year-old female, arteriogram.
Aneurism at four centimeters.
Let's keep her under observation.
- It's okay, we're just gonna ask...
- You can't do this again!
Mr. Harper, calm down. Layla...
- Don't you touch her!
- Daddy
Layla, the nurse just wants
to ask you some questions.
I told you before to leave her alone!
- You have no right to do this!
- Actually, I do!
And for your daughter's sake,
why don't we calm down?
You tell me that my wife is sick,
and you take one look
at me and decide what?
- That I am a threat to my family?
- That's not what's happening, here!
You don't know me!
Is this Irene Harper's family?
I'm Dr. Hamed. She's my patient.
You're Irene's doctor?
Please tell me you can explain
what is wrong with her.
He will. But first, I need
to talk to your daughter
- and make sure that she's okay.
- Daddy, I wanna stay with you!
Baby, it's okay.
Is everything okay here, sir?
Yeah, we're okay, alright?
- We're okay.
- Lou, gimme a sec? Doctor.
Vivian Barnes, staff social worker.
Can you talk to me about
the bruising on Irene?
I need to know what we're
dealing with, here.
You wrote suspicious
bruising on her chart. Why?
You think that the bruising
was caused by her husband?
You don't?
Well, if she's suffering
from liver failure,
possible kidney failure,
either could cause bruising.
This family has a flag.
A history with Children's Aid Society.
There was an incident two years ago.
Layla fell down the stairs,
and CAS intervened for her protection.
I meant medically undetermined.
Not intentional...
You wrote suspicious, so
I have to investigate.
It's protocol.
And the father's behaviour
isn't helping the situation.
- People act out when they get scared.
- I know.
But Layla's safety is my priority.
I'll interview her, and
we'll go from there.
What will happen to her?
If we have reason to
believe that he's abusive,
- we can remove her.
- Wait, no, I can change the wording!
It's too late for that now.
Layla, it's time to go, okay?
It's okay, baby girl, I'll see you soon.
I promise.
Ms. Bennett.
You're sending me home.
Uh, well your imaging didn't, uh...
didn't warrant further action.
But we will forward it to
your OBGYN for a follow up.
In the meantime, I did...
I did give you some
anti-inflammatories for the pain.
- So, if it gets any worse...
- What, come back?
It's already worse.
Please, please don't be
like the rest of them.
Don't do this.
You can take your time getting dressed.
How's my wife? How's Irene?
Well, she doesn't have hepatitis,
which means the differential
is wider than we thought.
We're keeping her stable,
but we need to know if she's
been exposed to any toxins
- which could be affecting her liver.
- Does she drink?
- No more than anyone.
- Any drug use?
You think she's on drugs? No!
What about something she ate?
She ate what we always eat.
Chicken... Salad, I don't know. Okay?
Irene takes care of herself.
Of all of us.
Okay? No fast food, no junk.
What about her workplace.
Is she employed?
Yes, she's employed. Okay?
She cuts hair.
Hair dyes, chemicals?
- If we can narrow down the tox screen...
- Can you help her?
First we need to determine
why your wife is sick.
And I can't get my kid back until
I prove that I didn't hurt Irene.
Because I didn't, and I never would.
Or Layla.
That fall two years ago was an accident.
Sir, the social worker is
just following protocol here.
The last time this happened,
she thought she was going to lose us.
Then they kept coming back,
until they finally decide
to leave us alone.
But Layla wouldn't sleep
in her own bed for months.
And now it's happening again.
It wasn't my intention to suggest abuse.
I heard you.
Suspicious bruising,
that's what you said.
So I'm losing my family because you
don't know how to speak English?
Couldn't be worse than my last ones.
Saleh, Salaam alaikum.
W'alaikum Al-salaam, Bashir.
The many airstrikes targeted
homes hospitals and market
shattering the daily lives
of the local population.
Hundreds of thousands
of people fled north
to the overflowing Turkish border.
What started as a peaceful protest
against the Assad regime
in the spring of 2011
has turned into one of the bloodiest...
Bash.
- Have you eaten?
- No.
If there's any advice I can give you
about making it through your day here
is always remember to eat.
Come on!
Yeah, I gotta ask. That drill.
Was that standard operating
procedure for you?
You should see what I
can do with a hammer.
So were you already in medicine
- before the war broke out?
- I was doing my residency.
My first residency.
- Mmm. Come here with family?
- My sister. She's 12.
How's she handling everything?
She's adjusting.
You said your family lives
in a different city?
Sudbury. Much smaller town.
We didn't want to displace the girls.
My father-in-law has a family practice
waiting for me when I'm done. So...
You must miss them.
Terribly.
I try not to let myself
think that my absence
will be permanently scarring.
I, uh...
I have a patient who has a
child here today, and, uh...
- This social worker intervened...
- Layla Harper?
Yeah, Viv asked me to examine her.
No signs of physical abuse.
But her family's still
being separated? Why?
It's hard to overcome a
history like theirs.
Even if it's not true?
The father said he was
cleared of all wrong-doing.
Yeah. Doesn't seem fair, but...
he'll always be seen
with suspicion first.
Oh!
So much for my own advice! Gotta go!
My wife. Have you seen her?
I've been here six hours!
Unfortunately, your wife's
condition hasn't changed but...
What I said to you before.
I'm not racist.
That's not who I am. I'm just...
just scared.
I know.
Mr. Harper, are you feeling okay?
Do you need to sit down?
No, no, I'm fine, I'm fine. Listen.
When can I see my daughter?
Sir? Can you hear me?
Arnold!
What happened?
I got two blocks away and threw up.
You told me to come
back if it got worse.
They just...
They just gave me the bucket
and told me to wait here.
I was trying to make it to the
bathroom, but I-I couldn't
Come on.
I need someone to fight for me.
Just, uh...
Okay.
- You okay?
- Yeah.
Alright. Let's go.
Doctor Singh?
Doctor Singh.
The endometriosis patient
I brought you earlier...
I thought we sent her home.
We did, and she's back. In agony.
She's vomiting, she's hemorrhaging
which we both know are
signs of a ruptured cyst
and not just chronic endo pain.
She needs surgery now.
Book an OR. Stat.
And I wanna stay on and
see this patient through.
It's your call.
If it is ruptured, it's good
we caught it when we did.
He was starting to look jaundiced,
and losing consciousness, like his wife.
And his airway is compromised.
We should resuscitate and intubate.
- 100 ketamine, 100 succs.
- Heart rate's 110, BP's crashing.
I need two large bore IVs.
Let's get this patient ***
stats, CPC, chem, coags, LFTs,
and cross-match four units red cells.
IVC's flat. He's hypovolemic
but no signs of free fluid.
Hematemesis.
If he has genetic varices,
elevated INR will cause this
kind of sudden bleeding.
Which would mean his
liver's also failing?
And whatever caused Irene's
problem is affecting them both.
Get Dr. Hunter to check on the daughter.
- On it.
- Where is Atwater.
She's with a patient on six.
- I need a Blakemore kit.
- What?
This man will bleed to death if
we don't get a Blackmore now!
Okay. Got it.
We can't put in a Blakemore
without an attending.
- Atwater's on her way.
- His heart rate is through the roof!
Blakemores are incredibly risky,
we don't use them except...
As a last resort?
And if we don't do something
now this man is going to die.
- Have you ever seen one work?
- Yes.
And if this one's going to, we don't
have another second to waste.
Four units, O-negative!
No pulse. He's in cardiac arrest.
I need a board. On three.
One, two, three.
One, two, three.
1 amp epi, keep giving packed cells.
When I inflate it in his stomach,
it should stop the bleeding.
Okay, he's been down for 25 seconds!
What the hell's happening here?
Massive hematemesis and
hemorrhagic shock.
He just lost his pulse.
- You sanctioned this?
- He wasn't protecting his airway
- so I put in the Blakemore.
- Okay.
Packed cells through the Level one.
Pass me the OG tube, and
get out of the way.
He needs the proximal
balloon up as well.
Dr. Leblanc, you stay.
- One gram TXA.
- 50 mics of octreotide
Go!
Is Robbie alive?
He's hanging on by a thread in ICU.
Dr. Hunter checked the daughter,
took blood, her vitals look good.
I couldn't let her
lose both her parents.
Yeah. You didn't build *** you
just did whatever you wanted
and those decisions have consequences.
If I'd asked you permission,
you would have said
it's against the rules.
If you want me to trust you, I
need to know who you are first.
If you're here long enough
for that to happen.
Layla?
Where is Vivian?
You wanted to see your mom.
Is that hers?
- I can put it somewhere safe.
- I don't want it to get lost.
Good idea.
Do you want to put a bandage on me?
I know I could use one, too.
You should still be at home, resting.
Relax. I've been cleared for work.
Mm.
*** nausea,
Four milligrams will be plenty.
- I'm not a chemo patient, Claire.
- Mm.
Something tells me you haven't
even told your neurosurgeon
about your nausea.
Are you still getting those headaches?
Normal symptoms after my surgery.
Yeah?
What about questionable decision-making?
Come on, are you sure hiring this
guy was the right move, Jed?
Ugh.
Hey.
How's your son handling all this?
He's fine.
Have you even told him
about the accident?
Mm, well, managing your
concern is enough.
You're welcome.
We need to keep Layla
overnight and monitor.
Otherwise they'll send
her alone to strangers.
Well she can't go home
because there's obviously
some kind of exposure.
But she's not symptomatic, so it
can't be airborn or water, but...
Could it be food?
The father says they eat healthy.
Produce has pesticides?
Maybe. Although Layla is not sick.
What are you thinking?
She picked off all the
vegetables on her pizza.
So what did they eat that she didn't?
- Let's find out.
- No, no, no you can't.
After what you did, they
want you in the suture room
for the rest of your shift.
Dr. Leblanc.
Layla's all alone.
She's afraid of losing everything,
so if you push too
hard she'll shut down.
Everybody calls me Mags.
Hey, Layla.
I'm Dr. Leblanc.
Layla's feeling pretty quiet right now.
I need help narrowing down what
her parents might've eaten.
Layla?
Could you answer a few more questions
about your mom and dad for Dr. Leblanc?
Can I colour with you?
I'll go get her some water.
That's a nice tree.
This hospital's really
big and scary, huh?
Hm?
I want to go home.
I know.
When I was your age, I had to spend
the night in the hospital too.
Lots of times, actually.
But you know what?
I found out hospitals are full
of people that want to help.
So when I grew up, I...
I became one of the helpers.
And Layla there are maybe something
that your parents like to eat
that you don't, and that's
what's making them sick.
And if we can just find
that one little thing,
maybe I could help them feel better.
Do you think you can help me do that?
Layla picked out vegetables with
her father at a community garden.
Layla doesn't like mushrooms.
Her parents do.
It was a, uh...
It was a difficult surgery.
In addition to the extensive
scarring from endometriosis,
you also had a...
hemorrhaging, ruptured cyst.
And...
as a result of the damage,
we had to remove one of your ovaries.
I lost an ovary?
Well, the good news is we got in
in time to save the other one.
You...
You told us
that it was more serious all along,
and the system's just not good
at dealing with chronic pain,
- so...
- You don't know what it's like
to be dismissed and ignored.
Told what you feel isn't real.
Cassie, I just wanted you to hear
someone say that you were right.
I know I was.
Didn't your shift end 20 minutes ago?
Yes. But I, um...
I was just...
Waiting for Bishop to tell
you if you still work here?
He's gone.
Which means you get to spend
all night dreaming up plan B.
Hmm.
This is my plan B.
You should go home.
How is it feeling? The arm?
- Much better, thanks to you.
- Can you raise it?
Open.
Okay.
The sling can come off.
Favour your other side
if you need to work.
I wish I could.
Not the kind of place willing
to pay under the table.
Even for me, it's going to be difficult
getting them the papers they asked for.
- Which papers?
- My university transcripts.
I have copies, they need the originals.
I got your sister a phone.
Maybe I can get you these too.
Yeah, you mean forgeries, Khaled.
It would only prove who you already are.
No, there must be another way.
In case there isn't, I know
a man who makes documents.
You say the word, I will ask him.
Amira!
Are you here?
How was your first day?
It was fine.
Baba used to let me
listen to his heartbeat.
It always helped me fall asleep.
How was your first day, really?
I loved it.
Ah, you're supposed to find
Bishop before changing.
Don't apologize, he hates that.
You wanted to see me, sir?
The Blakemore.
It better not have been the first
time you pulled that move.
Dr. Leblanc thinks you
saved that man's life.
You could just as
easily have killed him.
Most emergent Blakemores
end in the morgue.
I did say to find your place, here.
Dr. Bishop?
I've been asked to provide
the original copies
of my medical school transcripts.
But I need you to know
my university might never release them.
But sir, I did earn my degree.
I am the doctor I told you I was.
Close the door on your way out.
We were able to confirm
that the toxin you and
your wife ingested
came from wild mushrooms.
I picked those mushrooms.
This was all my fault.
Well, you're both responding
to treatment well.
- It will take some time, but...
- Maybe...
they were right to judge me.
No they weren't.
People can think what
they want to think,
but you know who you are.
A man who loves his family.
Daddy!
Hey. There's my brave girl.
- Hey, baby.
- Hi.
We're okay, now.
I wasn't gonna be okay.
Can you believe it was the mushrooms?
You stayed with her all night?
Mushrooms, I know.
- I'm glad you're okay.
- Your stitches should come out.
I love you guys. I
love you guys so much.
Both my parents were doctors.
It was all I was ever going to be.
I lost them in the war.
And that's why I don't talk about it.
The scars will fade.
Dr. Hamed?
Detective Greggs.
I'm sorry to bother you at work.
- I know you have a lot on your plate.
- Mm-hmm.
You were involved in a major vehicle
incident a couple of weeks ago?
Mm-hmm.
I'd like to ask you a few
questions about that.
Uh, but I already spoke to the police.
Uh, I'm here about
your former colleague.
Khaled Abdullah.
Emergency personnel took his name,
but then lost track of him
when he fled the scene of the accident.
Do you know where he is?
Mr. Abdullah is wanted for
an immigration violation.
I need to locate him, so...
if you see him, call me.
Do you know whose head you drilled into?
I know who Doctor Bishop is.
We have met before, of course.
I interviewed you for a job,
but then didn't hire you.
I think we need to do it again.
Have you eaten anything?!
I can't find my math book.
It's over by the window.
What if everything is
different at the hospital?
Habibti, you're learning math
in a whole new language.
I'll be fine.
I was waiting until I
was a doctor again.
Sir, you need to get in line.
I'm not a patient, I'm...
We've got a trauma coming in!
Tim Stafford, 35 years old.
BP's 100 over 60. Pulse 150.
Page Atwater.
Construction site. Scaffolding collapse.
Fell 20 feet. Landed
on a piece of rebar.
We cut it off at the scene.
Did he get anything for pain?
You can't be here.
If the rebar punctured
his femoral artery,
- it could be potentially lethal.
- Yeah. I know that.
- You got the hand?
- Got it.
I got the leg. On three.
One, two, three.
I need an X-ray plate.
You can't just show up here
and volunteer as a doctor.
I'm not.
One, two, three.
One, two, three.
What the hell do you think you're doing?
His job. Did you page vascular?
They're on their way. OR needs five.
Sir, do you know where you are?
Please get that thing out of me!
Not here. First we
have to stabilize you,
then we'll get you down to the OR.
100 mics fentanyl. IV push.
The rebar may have hit
an important artery.
Believe me, you don't want
it bleeding inside you.
Dr. Leblanc is going
to tell us if it is.
- X-ray's up!
- Femoral's great. Good pulses.
It's your lucky day, sir.
Not yet. He has a ruptured spleen.
I'll do a scan.
- He's right.
- Good. And?
I'd do a splenectomy right now.
Maybe five years ago. Not now.
Dr. Curtis, tell him why.
Because it will be jump at the gun.
First we CT to find
out what grade it is.
Dr. Leblanc? I can see
you're dying to tell us
what happens pending that outcome?
ICU and monitor, after the rebar's out.
Get him to CT, stat!
There are thousands of pages
of co-curricular reading
and you'll need to catch up.
And next time you come to
work, get changed first
and find out where we
actually want you to be.
You may remember Dr.
Hamed from two weeks ago
when he drilled a hole in my head.
He's one of you now.
Welcome to the best
Emerge in the country.
Triage nurses assign patients to acute,
intermediate or ambulatory.
Ambulatory's the busiest.
Big waits, small problems, but for them,
it's the worst day of their lives.
They get a headache, go online,
convince themselves they've got a tumo
Acute's where the action is.
Traumas, Mis, GSWs,
stabbings, sepsis,
strokes, overdoses.
You were a trauma surgeon
already, but that was in Syria.
In this teaching hospital,
you'll start at the bottom.
Redo your residency,
learn our system from scratch.
- Questions so far?
- No, Sir.
I'm sure they'll have plenty for you.
Okay, see you soon.
Come on, then.
Did you know we are hiring him?
It's Dr. Bishop's prerogative.
But I want him shadowing you today.
And don't just do
everything yourself, Mags.
I need to know what we're
getting with this guy.
Dr. Wendy Atwater is your attending.
All the residents report
to her, she reports to me.
It's not every day a
patient from one week
becomes a doctor the next.
You'll get scrubs in the lounge,
an ID card's in your mailbox.
What happened in the trauma bay
is not how the rest of
your day is going to go.
You're gonna stick with Dr. Leblanc,
she's gonna teach you the rules.
Scripts, decisions, it
all goes through her.
- Understood?
- Mmm.
Maybe don't show him where
we keep the power tools.
- Hi.
- Who are you?
I mean, clearly you have experience
and you did save Bishop's life.
This is us moving on.
Uh. Dr. Bishop...
As Chief, does he always oversee
his patients like that?
Whenever he feels like it, yeah.
You're also an emergency resident?
Second year. The ruptured spleen.
How did you know without imaging?
From the way the patient was
clenching his shoulder.
Right. You trained in war
zones, I'm guessing.
Not a lot of equipment or resources.
Do you always just ask
whatever's on your mind?
When I'm being asked to trust
somebody with my patients? Yeah.
Practicing medicine in the dark,
you learn to sharpen other skills.
Yeah, well here we
always rely on imaging.
Oh. I'm sorry.
That one sticks.
Not everything we have
here is state of the art.
Thanks.
- Theo Hunter.
- Bashir Hamed.
Welcome aboard.
That looks like it has lived a life.
Was, uh...
Was that your family I saw you with?
Yeah. Saying goodbye for the week.
We live in Sudbury, I'm
here doing my fellowship.
- Pediatric EM.
- Uh. We have a patient waiting.
And those stitches should come out.
Mags here used to be a hall monitor.
And Theo here was almost a priest.
- Pastor!
- A Pastor.
It runs in the family.
I was on the bus.
They made me get off.
People don't like it when
you throw up on the bus.
Um, my purse and phone.
I had them when I talked to that nurse.
- Did she put them somewhere?
- We'll find them.
How long has this been going on?
Ms. Harper?
Irene?
The vomiting and the abdominal pain.
- When did it start?
- Few days, I think.
Maybe this morning?
I didn't wanna miss my shift today.
I just... thought it was the flu.
But it's worse, right?
Put your hands out for me, Ms. Harper?
Okay, thank you.
My kid.
I'm supposed to pick her
up from school later.
I need my phone so I can...
My husband doesn't know where I am.
It's okay, we'll take care of that.
Atwater wants me to let
you weigh in first, so...
She's confused and disoriented.
Hypotensive and tachycardic.
She's jaundiced.
I'd be concerned with liver injury.
Yeah, but those symptoms could
also describe biliary colic?
But not the trembling hands.
The asterixis can mean
acute liver failure.
We should do testing to confirm.
Given her level of consciousness,
I'd suggest an aggressive approach.
Intubation sooner rather than later.
She could go into
multiple organ failure.
But you want to do testing first.
We need blood. CVC, LFT, all of it.
Okay.
Bashir Hamed?
- Uh, I'll catch up.
- Okay.
Lavondra Kelly, HR. I have
been looking for you.
- Human Resources?
- Uh, yes.
Welcome to the team.
I'm still waiting for your transcripts.
Excuse me?
Your medical school transcripts from...
the University of Aleppo?
I... I sent the PDF.
I know. Didn't somebody
follow up with you on that?
Legal still needs certified original
copies of those transcripts
Without them we won't be able
to verify your credentials.
If I needed some time
to coordinate that?
Last year the infection deases ***
A doctor who pioneered a leading
approach to malaria in his country.
He couldn't get his
documents an order either,
and now he does data entry
at a university lab.
I see. So...
- The transcripts...
- The originals.
Are essential.
If you want to work as
a doctor, they are.
So, how long have you had this pain?
Two days. But it's getting
worse every hour.
Any other symptoms I should know about?
Fever, vomiting?
Does dry heaving count?
Have you ever experienced these
symptoms before, Ms. Bennet?
Cassie.
I have endometriosis.
But this is way worse than normal.
Have you spoken to your OBGYN
about these new symptoms?
Yes, I have,
and they can't see me until next week.
But last time I saw her, she
just told me to get pregnant.
At least then, I'd have
nine months of relief.
Right. Well, I heard that
*** a lot of side effects.
Look, the adhesions for endometriosis
can cause severe pain.
Unfortunately, it's a chronic issue
and there's really not too
much we can do for a flare-up
- here in the emergency department.
- I know, I know.
Look, and I know what
you're thinking, okay?
Woman with endo comes in
suffering from a flare-up,
is afraid it's something
worse, and it never is
and there's nothing you can do for her.
Look, I've been through this
more times than I can count.
Alright? I've been told to go home,
and take pain meds, and sleep it off,
and I have done all that.
And I...
Are you here by yourself?
My boyfriend's out of town.
Look, you're just gonna have
to trust me on this. Okay?
I know my body, and
this pain is different.
Irene Harper, INR's 2.1, Bili elevated
Her liver's failing. You
know the procedure?
Screen for hepatitis and acetaminophen.
- LOC?
- Signs of hepatic encephalopathy.
Her O2 sats are borderline.
If she's unconscious,
you need to intubate
She could go into
multiple organ failure.
We need to pre-oxygenate
then give her a hundred
ketamine and a hundred succs.
- She's apneic.
- Laryngoscope.
Endotracheal tube.
I can't visualize her cords.
- Airway edema?
- No. Cords are anterior.
Let's back off and bag her for a second.
I should call Respiratory Therapy.
Do you have light wands in here?
Um, bottom shelf I think, yeah, why?
With the lighted stylet, you'll be
able to guide it through the tube.
No, I don't have a view.
You will now.
When you said working in the
dark, you meant literally?
Occasionally. Do you need suction?
No.
Could you just...
Okay.
Did you ever think all
that would lead you here?
What led you here?
Everything okay?
Yeah. Tough airway. Just got it.
We don't intubate with
light wands anymore.
I proposed it.
Next time, call RT.
Now let's figure out what's
causing her liver to fail.
The bruising speaks to
rapid deterioration.
She wanted her family. Do you
know if they've been contacted?
No.
Update her chart, then see if
the social worker did that.
I'm gonna run down the rest of her labs.
55-year-old man with
adenocarcinoma of the pancreas.
He had radiation to
reduce the tumour load.
He wants a Whipple? We'll have to see.
What's your story, Dr. Curtis? Quickly.
Emergency walk-in.
I'd like to do a lab to isolate
the cause of her pain.
Endometriosis. We both know we don't do
*** procedures for chronic problems.
- Yes, but...
- She's likely having a flare-up.
I did a transvaginal ultrasound and...
Nothing's conclusive on it.
There have been cases
where imaging has missed
ovarian torsion, even a ruptured cyst.
Her abdomen's distended,
she's in extreme pain,
and I'm concerned it could be
more than endometriosis...
Are you?
Or are you fishing for OR time.
You know I want the operative time.
But that doesn't mean
my patient is wrong
about her pain being acute.
Dr. Curtis...
Endo's tricky.
Women can feel one thing one day,
and something completely
different the next.
The pathophysiology of uterine nerves...
They're complex.
And often don't correspond to
what's happening internally.
And every time we go in there,
we run the risk of doing
more harm than good.
Surgical intervention is not an option
in the absence of
extremely clear evidence,
which you simply do not have here.
She should follow up with her OBGYN.
Send them the ultrasound.
Otherwise, give her Toradol
and send her home to rest.
64-year-old female, arteriogram.
Aneurism at four centimeters.
Let's keep her under observation.
- It's okay, we're just gonna ask...
- You can't do this again!
Mr. Harper, calm down. Layla...
- Don't you touch her!
- Daddy
Layla, the nurse just wants
to ask you some questions.
I told you before to leave her alone!
- You have no right to do this!
- Actually, I do!
And for your daughter's sake,
why don't we calm down?
You tell me that my wife is sick,
and you take one look
at me and decide what?
- That I am a threat to my family?
- That's not what's happening, here!
You don't know me!
Is this Irene Harper's family?
I'm Dr. Hamed. She's my patient.
You're Irene's doctor?
Please tell me you can explain
what is wrong with her.
He will. But first, I need
to talk to your daughter
- and make sure that she's okay.
- Daddy, I wanna stay with you!
Baby, it's okay.
Is everything okay here, sir?
Yeah, we're okay, alright?
- We're okay.
- Lou, gimme a sec? Doctor.
Vivian Barnes, staff social worker.
Can you talk to me about
the bruising on Irene?
I need to know what we're
dealing with, here.
You wrote suspicious
bruising on her chart. Why?
You think that the bruising
was caused by her husband?
You don't?
Well, if she's suffering
from liver failure,
possible kidney failure,
either could cause bruising.
This family has a flag.
A history with Children's Aid Society.
There was an incident two years ago.
Layla fell down the stairs,
and CAS intervened for her protection.
I meant medically undetermined.
Not intentional...
You wrote suspicious, so
I have to investigate.
It's protocol.
And the father's behaviour
isn't helping the situation.
- People act out when they get scared.
- I know.
But Layla's safety is my priority.
I'll interview her, and
we'll go from there.
What will happen to her?
If we have reason to
believe that he's abusive,
- we can remove her.
- Wait, no, I can change the wording!
It's too late for that now.
Layla, it's time to go, okay?
It's okay, baby girl, I'll see you soon.
I promise.
Ms. Bennett.
You're sending me home.
Uh, well your imaging didn't, uh...
didn't warrant further action.
But we will forward it to
your OBGYN for a follow up.
In the meantime, I did...
I did give you some
anti-inflammatories for the pain.
- So, if it gets any worse...
- What, come back?
It's already worse.
Please, please don't be
like the rest of them.
Don't do this.
You can take your time getting dressed.
How's my wife? How's Irene?
Well, she doesn't have hepatitis,
which means the differential
is wider than we thought.
We're keeping her stable,
but we need to know if she's
been exposed to any toxins
- which could be affecting her liver.
- Does she drink?
- No more than anyone.
- Any drug use?
You think she's on drugs? No!
What about something she ate?
She ate what we always eat.
Chicken... Salad, I don't know. Okay?
Irene takes care of herself.
Of all of us.
Okay? No fast food, no junk.
What about her workplace.
Is she employed?
Yes, she's employed. Okay?
She cuts hair.
Hair dyes, chemicals?
- If we can narrow down the tox screen...
- Can you help her?
First we need to determine
why your wife is sick.
And I can't get my kid back until
I prove that I didn't hurt Irene.
Because I didn't, and I never would.
Or Layla.
That fall two years ago was an accident.
Sir, the social worker is
just following protocol here.
The last time this happened,
she thought she was going to lose us.
Then they kept coming back,
until they finally decide
to leave us alone.
But Layla wouldn't sleep
in her own bed for months.
And now it's happening again.
It wasn't my intention to suggest abuse.
I heard you.
Suspicious bruising,
that's what you said.
So I'm losing my family because you
don't know how to speak English?
Couldn't be worse than my last ones.
Saleh, Salaam alaikum.
W'alaikum Al-salaam, Bashir.
The many airstrikes targeted
homes hospitals and market
shattering the daily lives
of the local population.
Hundreds of thousands
of people fled north
to the overflowing Turkish border.
What started as a peaceful protest
against the Assad regime
in the spring of 2011
has turned into one of the bloodiest...
Bash.
- Have you eaten?
- No.
If there's any advice I can give you
about making it through your day here
is always remember to eat.
Come on!
Yeah, I gotta ask. That drill.
Was that standard operating
procedure for you?
You should see what I
can do with a hammer.
So were you already in medicine
- before the war broke out?
- I was doing my residency.
My first residency.
- Mmm. Come here with family?
- My sister. She's 12.
How's she handling everything?
She's adjusting.
You said your family lives
in a different city?
Sudbury. Much smaller town.
We didn't want to displace the girls.
My father-in-law has a family practice
waiting for me when I'm done. So...
You must miss them.
Terribly.
I try not to let myself
think that my absence
will be permanently scarring.
I, uh...
I have a patient who has a
child here today, and, uh...
- This social worker intervened...
- Layla Harper?
Yeah, Viv asked me to examine her.
No signs of physical abuse.
But her family's still
being separated? Why?
It's hard to overcome a
history like theirs.
Even if it's not true?
The father said he was
cleared of all wrong-doing.
Yeah. Doesn't seem fair, but...
he'll always be seen
with suspicion first.
Oh!
So much for my own advice! Gotta go!
My wife. Have you seen her?
I've been here six hours!
Unfortunately, your wife's
condition hasn't changed but...
What I said to you before.
I'm not racist.
That's not who I am. I'm just...
just scared.
I know.
Mr. Harper, are you feeling okay?
Do you need to sit down?
No, no, I'm fine, I'm fine. Listen.
When can I see my daughter?
Sir? Can you hear me?
Arnold!
What happened?
I got two blocks away and threw up.
You told me to come
back if it got worse.
They just...
They just gave me the bucket
and told me to wait here.
I was trying to make it to the
bathroom, but I-I couldn't
Come on.
I need someone to fight for me.
Just, uh...
Okay.
- You okay?
- Yeah.
Alright. Let's go.
Doctor Singh?
Doctor Singh.
The endometriosis patient
I brought you earlier...
I thought we sent her home.
We did, and she's back. In agony.
She's vomiting, she's hemorrhaging
which we both know are
signs of a ruptured cyst
and not just chronic endo pain.
She needs surgery now.
Book an OR. Stat.
And I wanna stay on and
see this patient through.
It's your call.
If it is ruptured, it's good
we caught it when we did.
He was starting to look jaundiced,
and losing consciousness, like his wife.
And his airway is compromised.
We should resuscitate and intubate.
- 100 ketamine, 100 succs.
- Heart rate's 110, BP's crashing.
I need two large bore IVs.
Let's get this patient ***
stats, CPC, chem, coags, LFTs,
and cross-match four units red cells.
IVC's flat. He's hypovolemic
but no signs of free fluid.
Hematemesis.
If he has genetic varices,
elevated INR will cause this
kind of sudden bleeding.
Which would mean his
liver's also failing?
And whatever caused Irene's
problem is affecting them both.
Get Dr. Hunter to check on the daughter.
- On it.
- Where is Atwater.
She's with a patient on six.
- I need a Blakemore kit.
- What?
This man will bleed to death if
we don't get a Blackmore now!
Okay. Got it.
We can't put in a Blakemore
without an attending.
- Atwater's on her way.
- His heart rate is through the roof!
Blakemores are incredibly risky,
we don't use them except...
As a last resort?
And if we don't do something
now this man is going to die.
- Have you ever seen one work?
- Yes.
And if this one's going to, we don't
have another second to waste.
Four units, O-negative!
No pulse. He's in cardiac arrest.
I need a board. On three.
One, two, three.
One, two, three.
1 amp epi, keep giving packed cells.
When I inflate it in his stomach,
it should stop the bleeding.
Okay, he's been down for 25 seconds!
What the hell's happening here?
Massive hematemesis and
hemorrhagic shock.
He just lost his pulse.
- You sanctioned this?
- He wasn't protecting his airway
- so I put in the Blakemore.
- Okay.
Packed cells through the Level one.
Pass me the OG tube, and
get out of the way.
He needs the proximal
balloon up as well.
Dr. Leblanc, you stay.
- One gram TXA.
- 50 mics of octreotide
Go!
Is Robbie alive?
He's hanging on by a thread in ICU.
Dr. Hunter checked the daughter,
took blood, her vitals look good.
I couldn't let her
lose both her parents.
Yeah. You didn't build *** you
just did whatever you wanted
and those decisions have consequences.
If I'd asked you permission,
you would have said
it's against the rules.
If you want me to trust you, I
need to know who you are first.
If you're here long enough
for that to happen.
Layla?
Where is Vivian?
You wanted to see your mom.
Is that hers?
- I can put it somewhere safe.
- I don't want it to get lost.
Good idea.
Do you want to put a bandage on me?
I know I could use one, too.
You should still be at home, resting.
Relax. I've been cleared for work.
Mm.
*** nausea,
Four milligrams will be plenty.
- I'm not a chemo patient, Claire.
- Mm.
Something tells me you haven't
even told your neurosurgeon
about your nausea.
Are you still getting those headaches?
Normal symptoms after my surgery.
Yeah?
What about questionable decision-making?
Come on, are you sure hiring this
guy was the right move, Jed?
Ugh.
Hey.
How's your son handling all this?
He's fine.
Have you even told him
about the accident?
Mm, well, managing your
concern is enough.
You're welcome.
We need to keep Layla
overnight and monitor.
Otherwise they'll send
her alone to strangers.
Well she can't go home
because there's obviously
some kind of exposure.
But she's not symptomatic, so it
can't be airborn or water, but...
Could it be food?
The father says they eat healthy.
Produce has pesticides?
Maybe. Although Layla is not sick.
What are you thinking?
She picked off all the
vegetables on her pizza.
So what did they eat that she didn't?
- Let's find out.
- No, no, no you can't.
After what you did, they
want you in the suture room
for the rest of your shift.
Dr. Leblanc.
Layla's all alone.
She's afraid of losing everything,
so if you push too
hard she'll shut down.
Everybody calls me Mags.
Hey, Layla.
I'm Dr. Leblanc.
Layla's feeling pretty quiet right now.
I need help narrowing down what
her parents might've eaten.
Layla?
Could you answer a few more questions
about your mom and dad for Dr. Leblanc?
Can I colour with you?
I'll go get her some water.
That's a nice tree.
This hospital's really
big and scary, huh?
Hm?
I want to go home.
I know.
When I was your age, I had to spend
the night in the hospital too.
Lots of times, actually.
But you know what?
I found out hospitals are full
of people that want to help.
So when I grew up, I...
I became one of the helpers.
And Layla there are maybe something
that your parents like to eat
that you don't, and that's
what's making them sick.
And if we can just find
that one little thing,
maybe I could help them feel better.
Do you think you can help me do that?
Layla picked out vegetables with
her father at a community garden.
Layla doesn't like mushrooms.
Her parents do.
It was a, uh...
It was a difficult surgery.
In addition to the extensive
scarring from endometriosis,
you also had a...
hemorrhaging, ruptured cyst.
And...
as a result of the damage,
we had to remove one of your ovaries.
I lost an ovary?
Well, the good news is we got in
in time to save the other one.
You...
You told us
that it was more serious all along,
and the system's just not good
at dealing with chronic pain,
- so...
- You don't know what it's like
to be dismissed and ignored.
Told what you feel isn't real.
Cassie, I just wanted you to hear
someone say that you were right.
I know I was.
Didn't your shift end 20 minutes ago?
Yes. But I, um...
I was just...
Waiting for Bishop to tell
you if you still work here?
He's gone.
Which means you get to spend
all night dreaming up plan B.
Hmm.
This is my plan B.
You should go home.
How is it feeling? The arm?
- Much better, thanks to you.
- Can you raise it?
Open.
Okay.
The sling can come off.
Favour your other side
if you need to work.
I wish I could.
Not the kind of place willing
to pay under the table.
Even for me, it's going to be difficult
getting them the papers they asked for.
- Which papers?
- My university transcripts.
I have copies, they need the originals.
I got your sister a phone.
Maybe I can get you these too.
Yeah, you mean forgeries, Khaled.
It would only prove who you already are.
No, there must be another way.
In case there isn't, I know
a man who makes documents.
You say the word, I will ask him.
Amira!
Are you here?
How was your first day?
It was fine.
Baba used to let me
listen to his heartbeat.
It always helped me fall asleep.
How was your first day, really?
I loved it.
Ah, you're supposed to find
Bishop before changing.
Don't apologize, he hates that.
You wanted to see me, sir?
The Blakemore.
It better not have been the first
time you pulled that move.
Dr. Leblanc thinks you
saved that man's life.
You could just as
easily have killed him.
Most emergent Blakemores
end in the morgue.
I did say to find your place, here.
Dr. Bishop?
I've been asked to provide
the original copies
of my medical school transcripts.
But I need you to know
my university might never release them.
But sir, I did earn my degree.
I am the doctor I told you I was.
Close the door on your way out.
We were able to confirm
that the toxin you and
your wife ingested
came from wild mushrooms.
I picked those mushrooms.
This was all my fault.
Well, you're both responding
to treatment well.
- It will take some time, but...
- Maybe...
they were right to judge me.
No they weren't.
People can think what
they want to think,
but you know who you are.
A man who loves his family.
Daddy!
Hey. There's my brave girl.
- Hey, baby.
- Hi.
We're okay, now.
I wasn't gonna be okay.
Can you believe it was the mushrooms?
You stayed with her all night?
Mushrooms, I know.
- I'm glad you're okay.
- Your stitches should come out.
I love you guys. I
love you guys so much.
Both my parents were doctors.
It was all I was ever going to be.
I lost them in the war.
And that's why I don't talk about it.
The scars will fade.
Dr. Hamed?
Detective Greggs.
I'm sorry to bother you at work.
- I know you have a lot on your plate.
- Mm-hmm.
You were involved in a major vehicle
incident a couple of weeks ago?
Mm-hmm.
I'd like to ask you a few
questions about that.
Uh, but I already spoke to the police.
Uh, I'm here about
your former colleague.
Khaled Abdullah.
Emergency personnel took his name,
but then lost track of him
when he fled the scene of the accident.
Do you know where he is?
Mr. Abdullah is wanted for
an immigration violation.
I need to locate him, so...
if you see him, call me.