Transplant (2020–…): Season 1, Episode 4 - Saleh - full transcript
When Bash's friend from Syria asks for his help starting patients, Bash works to balance his role at the hospital with his ties to home.
The state controls the universities.
And I am an enemy of the state.
There is no paper trail
because of who I am.
My place later?
You've got a second chance.
You should think about
how you're gonna use it.
_
_
_
You're in Idlib?
Kafr Halab. The building
collapsed this morning.
Bombs last night.
And we're looking for survivors.
How many of you on site, Saleh?
We're small team. Most
are trainees like me.
And what sort of equipment do you have?
The usual, basic first aid.
It's good you called.
You need to manage hemorrhagic
shock so he's safe to transport.
Can someone find a... a
sheet or towel to wrap him?
_
Place your hands on his
pelvis and compress inwards.
Feel around for movement.
_
They found a regime flag.
_
_
_
Planes?
Saleh, do you need to get out of there?
Just passing over, I hope.
How is... How is Zaynab?
We will be getting married.
Good for you. Poor her.
His radial is strong.
We need to keep looking.
More bodies might be trapped in rubble.
- Thank you, Bashir.
- Be safe, if you need...
- Oh. Is everything okay?
- Yes, thank you.
I'm gonna take it.
Wait, wait, wait.
I know what that means.
Dr. Singh says if you're not early...
you're late, so...
Well, your boss got no joy in his life.
He's a surgeon. We're not
exactly known for joy.
Dinner later?
Maybe. Don't forget to hold for five.
Everything alright?
A grade four student
in your household, Abigail
Hunter, was marked
absent at morning attendance.
I call the school, it goes
straight to voicemail.
Mel texted me after the drop off,
so I know Abby's there, or should be.
I called Mel, but she's not picking up.
She has meetings all day, so
she might have her phone off.
I'll cover your patients.
You do what you need to do.
Thank you.
Why would I get a message from
them saying you drop her off?
I don't know, the school didn't call me
so this is the first time
I'm hearing about this.
- Did you call back?
- It went to voicemail.
Look. When you dropped Abby
off, you saw her go in?
I left her in the yard with her
friends five minutes before the bell,
When she's been begging
ff, for this for months.
If we're making a decision like that,
shouldn't we have discussed it
Well you're not here. So you don't get
to tell me how to drop the kids off.
Look, I'm worried, okay?
Because if you didn't watch her go in,
doesn't that mean she
could actually be gone?
I'm worried too.
I'm already in the car.
I'll call you when I get there
Messy hair, flushed cheeks,
and almost smiling?
I wonder who the guy is.
Maybe she just overslept?
- No judgment.
- No.
Respect, actually.
It's basically impossible
to make a relationship work
- around this job.
- You don't date?
I've... I've had to accept
the fact that the hospital
is my current boyfriend.
You?
I sleep on a sofa so my
sister can have a bedroom.
MVC 3 minutes out. Code trauma. VSA.
Hit-and-run. Victim's not identified.
Driver of the vehicle,
head injury, GCS 6,
massive blood loss, ***, resus
on the field 8 minutes ago.
Passenger. Airbag
malfunctioned, didn't deploy.
Cyanosed, 02 sats at 80 percent.
Pulse 120, resp rate 35, BP 95 on 68
Bed one. Dr. Hamed.
Dr. Leblanc, bed two.
One, two, three.
It's all yours, doctors.
Arnold take compressions.
Activate MTP, and insert
two large boreVs.
ABCs, doctor.
Uh, I'll intubate and decompress
the chest bilaterally.
One, two, three.
We need two units O-neg.
Mags, an eFAST, and I need an art line.
EMS radioed from dispatch, we have IDs.
Marie Tabeh, 46, Ana Tabeh, 20.
This is a mother, daughter?
Pneumothorax. We need a chest tube!
Use a 28 French in case
there's a hemothorax.
Let's sedate with ketamine, she
needs 40mg, let's start her.
Still no pulse.
There's cardiac activity
on the ultrasound,
but her heart looks empty.
1mg epinephrine.
Epi won't help if there's no
blood for the heart to pump.
PEA, narrow complex. Not
a shockable rhythm.
Restart compressions. Let's focus on
resuscitation using blood product.
Preparing for chest
tube, making incision..
Test.
Get your finger in the pleural space.
- What are you feeling?
- Smooth pleural...
Lung. I think I'm good.
Chest tube.
Hemopneumo.
Left foot is cold.
No pulse.
Her knee looks pretty mangled.
This could be vascular injury.
Page vascular. She's gonna need the OR.
Still no pulse!
No cardiac or electrical activity.
Okay. I think that's it.
You think? Or you know.
I know.
So you're confident.
Yes.
Asystole, no cardiac
activity on ultrasound,
prolonged downtime.
We managed *** cause of
traumatic cardiac arrest.
3 units packed cells, bilaterally
chest decompression.
No pericardial effusion,
and a stable pelvis.
I'm confident that after the massive
head injuries suffered by this patient
she had no chance.
Then call it.
Time of Death, 10:14 AM.
Thank you, everyone.
Let's just take a moment to
acknowledge the end of a life
and the efforts of our team to save it.
Sir? About what just happened.
Being challenged? Consider
it the new normal.
Are you talking about
how I ran that trauma?
I'm talking about you telling legal
that you can't get us your transcripts.
Do you know what a lawyer hears
when you say enemy of the state?
They hear liability,
that puts the pressure on us to
make certain that you are not.
I need you to be above reproach.
Sharper than everyone else.
Hi, Jasmine Weber, peds two.
- Thanks.
- Where's Doctor Hunter?
I asked to take a couple extra patients.
Staying sharp.
Let's see.
Can you tell me what happened Mr.
Monroe?
Kinda stupid. My fault, really.
I've been trying to lose a few pounds
so I hid the cookies up in the cupboard.
I got a craving,
so I climbed up on a stool to get them,
and bam!
I didn't want to come
all the way down here
but the boss insisted when
she got back from work.
Are you a nurse?
Nurse's aide. At a retirement home.
I work the night shift.
You're not supposed to call it
the graveyard shift, there.
I get home and he's white as a sheet,
can barely stand from
the pain, but it's all,
"No, no, I'm fine."
She worries.
Only because she cares.
We should all be so lucky.
It's gonna be cold.
Okay, well, I'm seeing some fluid here,
so this could be an indication
of internal bleeding.
- You'll need a CT.
- If you say so, Doc.
We need to bring him to
the resus room, stat!
Then she lost control of her legs.
I needed the neighbour to
help me get her to the car.
Should I have called an ambulance?
No, the important thing
is that you're here now.
How old are you, Jasmine?
Thirteen.
And can you tell me when you
started feeling this way?
Earlier today.
It started with a little
slurring, and then it got worse.
Did you take any drugs or alcohol?
Any issues swallowing? Headaches?
Can you do this for me?
That's great.
Any indications leading to today?
Cognitive or behavioural?
Can I talk to you outside?
I'm her foster mother.
I've only had Jasmine a few weeks.
Do you have any family medical history?
Specifically, I'm looking for a history
of heart disease or strokes.
You think she's having a stroke?
With slurred speech and
loss of motor function,
that's the first thing to rule out.
Well, she's been in a series of
group homes for the past two yes.
She ran away from the last one.
That's all the information
the foster agency had.
I barely know her at all.
For labs, you want a
CBC and electrolytes?
Um... Also venous gas,
extended lytes, CK,
liver panel, hemoglobin A1C.
And get her to CT as soon as possible.
Got it.
So., uh, we'll do imaging
and send blood work to the lab
and see what's going on.
In the meantime, just stay with her
and keep her spirits up.
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Where's the rest of your team?
The building shifted again
and they got stuck on a higher floor.
We need your help.
Remember after your accident,
we talked about you
having a second chance?
I remember you talking about
how I was coming out
of a coma at the time,
so I wasn't saying much.
Running down Bash like that
in trauma for no reason?
If this is you trying
for a second chance,
you're failing.
I had a very good reason.
I could take you through it.
Over dinner.
My place.
Yeah, I thought we fished with
all that about five years ago.
Anyway, I don't recall
you ever actually making me dinner.
I wanted to.
I guess we both wanted things
that would not have worked.
What are you doing, Jed?
I mean, why now? After all this time.
You're the one who keeps
talking about second chances.
And you're the only one here who's
not afraid to tell me to piss off.
So...
Dinner?
What's your answer?
Piss off.
How is her airway? Blood pressure?
_
Before you move her, you
need to tourniquet her leg.
_
See? You know your stuff, Saleh.
I guess you don't have any blood.
Saline will have to do.
*** her to a clinic as soon as possible.
How much saline for a child like this?
_
_
Keep your phone on Bashir, please!
In a pediatric crush, uh,
normal saline is 20, 20 ml per kg?
We have a pediatric crush injury?
You should've paged me right away
No, no, it's just hypothetical.
- Something I came across in my reading.
- Uh, the saline dose is right.
Watch closely for hyperkalemia.
Thanks.
Uh, why did you order a
CT for Jasmine Weber?
The symptoms pointed to possible stroke
because of the dysarthria.
Did you call for a bedside glucose test?
- No.
- Claire?
I had blood sent to the lab.
Hemoglobin A1C.
- Isn't that protocol?
- DKA can mimic stroke symptoms.
Bedside glucose is the protocol
here for pediatric patients
She won't open her eyes!
Guys!
Jasmine? Jasmine? Come on, Jasmine.
Try and open your eyes for us.
Glucose is 25. She's in DKA.
- DKA? What is that?
- Diabetic ketoacidosis.
She's going to need insulin therapy.
I thought you said she
was having a stroke.
The symptoms can be very similar.
- She didn't tell me
- She probably didn't know.
Hello.
Um, the endoscopy showed
enlarged veins in the esophagus
which ruptured from your fall.
Subsequent tests, however, reveal...
cirrhosis and liver failure.
I'm sorry to tell you that
with this amount of damage,
the chances of the liver
recovering on its own are slim.
Is there anything we can do?
We're starting medication now,
but Walter will also need something
called a variceal ligation,
which means a surgeon
uses rubber bands to stop
the enlarged veins from bleeding.
Long term though, a liver
transplant is your only option.
That's what a lifetime
of drinking gets you.
It's probably what I deserve.
I'm sorry.
Excuse me, doctor?
- Yes?
- You mentioned a transplant.
Does it jeopardize that,
him having been a drinker?
Well, he would have to be sober
for a minimum of six months.
He's four years sober.
I'm six. We met in the program.
I'm sorry to bring you such bad news.
We've overcome a lot.
We'll get through this. too.
Let me guess. Jasmine Weber?
Any luck?
I called every contact
number that I could find,
pieced together that she
lived with a grandmother
until a few years ago when she passed.
Of what?
Heart attack. Apparently,
in front of Jasmine.
Not sure that's something you get over.
It isn't.
Then she was abandoned by an
uncle, who's now in jail.
Learned in the hard way
not to trust anyone.
Any type 1 diabetes in the family?
Medical records don't even start
until she was put in foster care.
But she's one of the lucky ones.
Most of the older kids don't find
someone conscientious like Liz
to look out for them.
Think we could speed walk a
variceal ligation into OR?
What's his coag look like?
Labs just came in. Mmm...
Blood alcohol level 0.09?
I couldn't smell it on him
Might've been vodka.
Is he cirrhotic?
Yeah. The seasoned ones
know how to hide it.
No, his fiancée says he's
been in recovery four years.
Guess he slipped. They always do.
I was so focused on the cirrhosis
I didn't question the X-ray.
Look. Do you see anything?
Fracture to the sternum,
none to the extremities.
Trauma to the abdomen.
- Was there any circular bruising?
- Yeah.
Does this look like a
fall off a stool to you?
That's a tough angle for a stool
Could it be steering wheel trauma?
My guess is that your drunk was driving.
And, by the looks of it,
may've been in a serious accident.
The timeline tracks for that
hit-and-run we got this morning.
The mother we lost. The
daughter, how's she doing?
She'll pull through. No
thanks to that asshole.
Well, even if he was in an accident,
doesn't make it a bad accident.
You sure about that?
Okay. Have a look.
Okay, her pupils are dilated.
She's losing consciousness?
Yes, she is.
Okay. So we manage pain
and get Fatima fluid resuscitation
or she risks kidney injury.
She needs a field hospital.
You can't wait, Saleh.
You need to get her out yourself.
- I can't do this alone, Bashir.
- Yes, you can.
Your adrenaline will give you strength.
Lou! Hey! Hi.
Uh, I saw you were talk to the cop
from the car accident before.
- Who, Desantos?
- Yeah.
Yeah. Our kids go to the same school.
Uh, quick question
_
I got her leg out, but it's a mess.
I need you to tell me how
to manage the bleeding.
Saleh. Saleh!
I'm sorry, okay?
I know, I know you have a
lot on your plate. I know.
Fine.
Hey.
Hey. I didn't mean to interrupt.
No, no. Mel called.
The school's automated
attendance software misfired.
Abby was there the whole time.
Good to know she's okay.
Mel had to cancel a meeting and
drive halfway across town,
but... Anyway, Abby is fine.
What's going on with you today?
That, uh...
That pediatric crush wound?
It was a child in Syria.
They found her pinned in
a bombed out building.
My friend Saleh he's a volunteer
medic, only a year of med school.
He calls sometimes with consults.
Is she okay?
We don't know yet.
You told me that was hypothetical.
- I didn't want to involve you.
- But you did!
When you asked my advice.
If I'd have known there
was a real child,
I would have asked more questions.
Made sure I had all the details!
What if something I said
cost that child's life?
I just needed guidance
on fluid resuscitation
Protocols change based on the scenarios.
You should know that.
Are you talking about the
testing I ordered for Jasmine?
I'm talking about you
being honest with me
instead of taking
everything on yourself.
We put in a chest tube
to drain the fluids,
and we performed a surgery to
repair a torn artery in your leg.
Both were successful.
We'll keep you for observation
but you should make a full recovery.
We've called your dad.
He's on a flight now.
So... - Can I see my mom?
I'm so sorry.
Lydia not here?
She's gone to get some air.
Walter, do you drive a blue sedan?
Why?
Because your labs came back
and there was alcohol
in your bloodstream.
And the bruising on your abdomen,
the placement of it, it suggests
you could've hit a steering wheel.
I... I started slipping.
Once or twice.
Then last night, with a buddy,
I...
I don't remember what happened.
I woke up a few blocks from the house
in a smashed car.
Lydia wasn't home from work
yet so I left it in the lot.
And just...
hoped that what I hit
was parked and empty.
A mother and daughter
came in this morning.
Hit by a blue sedan.
Oh... Oh...
Are they okay?
No, Walter.
They're not.
There were no complications and
you're responding to medication well.
Are you feeling better?
How long do I have to stay here?
A little while longer.
We want to make sure that your
blood sugar is under control.
And we have to show you
how to use a glucose
meter before you go.
It'll help you and Liz manage
things easier when you get home.
That's not my home.
I never wanted to go there.
I know it's hard,
adjusting to a new place.
Where I live isn't my home either.
Do you have to share it with
someone you barely know?
We'll try again later.
Do you have a minute?
I've got a hypothetical.
Sure.
If a patient
admits to a crime in confidence...
- Mm-hmm?
- Would you tell the authorities?
We can't. We're bound by
doctor-patient confidentiality.
I know, I know. Unless it's
to report a gunshot wound,
the safety of a child, or
intent to cause future harm.
I know. And it isn't.
Then you'd be breaking your oath.
Yeah, I know that too.
I just... I...
I can't help but think that you,
you know, the rule-breaker,
Doctor Instinct, would
understand that someone might
break the oath for a moral
obligation you felt
outweighed the needs of a patient.
There are consequences to
drawing lines like that.
Then you've done it?
During the war, I treated
regime soldiers.
Only when they forced me.
Often, at gunpoint.
It's fine.
The point is, I chose sides.
And now I can't go home.
His nausea's getting worse.
I always know something's
wrong when he gets quiet.
Liddy, could you go get me
a glass of water, please?
Sure.
No sign of new haemorrhaging.
We're just waiting to hear back from the
OR on a scheduled time for your ligation.
You haven't told her?
When are the cops coming for me?
I haven't told them either.
But I hurt those people.
I have to pay for what I've done.
I agree. But I have a duty to
protect your confidentiality.
So if you want to tell the police,
you'll have to them yourself.
What, what if, what if I...
If I can't bring myself to do it?
Then you'll have your
surgical procedure.
Lydia will take you home.
And I guess you try to live
with what you've done.
The Mannitol is helping.
Jasmine's going to be okay.
Thank God.
So, was this my fault? Is
it the food I'm making?
- Was I making the wrong...
- No, type 1 is genetic.
There was nothing you
could do to prevent this.
But you can help her control it.
I doubt she'll let me do that.
I thought I was doing a good
thing, becoming a foster mom.
- But this?
- I think you're very strong,
doing something like this.
I'm not questioning my decision.
I just...
I feel like I'm messing it up.
Like I'm messing her up, and she's
already been through so much already.
I'm sorry.
We all feel like that the
minute we become parents.
But the highs outweigh the lows.
And all we can do is...
get up every day, committed
to doing our very best.
Walter's ligation procedure.
When is that happening?
Well, procedures are triaged
according to urgency.
And because he stopped bleeding,
it may not be for a few more hours.
When... When he does get it,
how much time will it buy him?
Well, it only fixes the
bleeding, not his liver.
- Oh...
- And there are no guarantees, but...
Without the transplant...
maybe a year?
A year more than that young woman
will have with her mother.
I'm so sorry. Lydia
It won't be the life we planned,
- but...
- But...
He did a terrible thing,
but he's not a terrible person.
He'll never forgive himself for this.
What kind of a person would I be
if I left him alone with that?
You told the cops.
No, he did. And she's sticking by him.
And you wouldn't?
He killed somebody.
I would, yes, like to say that
if I was in love with somebody,
I would be able to get
past that, but I...
People stay with people who
hurt them all the time.
We're kind of stupid like that.
Well, if that cop arrests
Walter before his procedure,
there's no telling when he'll
be able to get another one.
Let me see what I can do.
Bashir? Hello?
Bashir?
Alhamdulellah.
I was on the road. The
cell towers are still...
Are you driving her yourself?
I had to. Nobody was coming for us.
She's feverish. She started
vomiting 15 minutes ago.
Can you...
Can you feel air under the flesh?
Press down on the tissue.
Yes, I feel air.
Crepitus. Saleh, you have
to amputate the leg.
On the side of the road? Now?
Alone? - If you don't, she'll die.
And you're not alone. I'm here.
So there's a patient waiting in
Emerg on a variceal ligation.
Let me guess, you want to scrub in?
Yes, always. But I was
actually just checking
to see if there was any wiggle room.
The patient needs the ligation
before he's arrested.
You mean arrested?
No. Like, hauled off to jail.
He's a drunk driver who
killed a woman this morning.
And you want to rush him into surgery
so he doesn't lose his chance to get it?
I didn't take you for someone
who'd be affected by that.
I'm not.
You know the girl with the arterial
injury we repaired earlier?
- Mm-hmm.
- Well, her mom died
because of him.
He should be healthy enough to serve
whatever sentence they throw at him.
Well...
The candor's refreshing.
Anyway, he's in luck.
An elective case dropped off the board
so I was about to move him
up to this evening anyway.
It's the ICU. It's the daughter.
Better go, then.
_
You paged me?
Patient is a nine-year-old girl.
Crushed lower right extremity.
Saleh called with a few questions.
We really need your help.
What do I need to know?
_
This is Saleh. We worked
together in Syria.
Hello, doctor.
Severe soft tissue injury
progressed by a gangrenous limb.
He's pulled over on the side of
the road and needs to perform
an above the knee amputation right now.
With what tools?
I have a scalpel, scissors,
hemo... The clips.
- Hemostatic clips.
- Yes, dressings.
- And a handsaw.
- Ketamine for sedation.
Uh, can you show me the girl again?
She weighs maybe 20 kilograms, Dr.
Hunter.
Try 20 megs, if you have that.
Uh, 20 milligrams.
Done.
Okay, Saleh.
If the tourniquet is tight,
make your incision.
Start by dividing the
skin circumferentially.
_
Good. Now cut through the
subcutaneous tissues
Okay.
You're doing great.
_
_
_
_
Code Blue. Room 305
- You've gotta go to that, Bash.
- I can't leave him.
Saleh?
You think we can do
this, just you and me?
Okay.
Who knows, something might
get lost in translation.
Bash.
We got this, okay? Go.
- Code blue, room 305.
- Thank you, Theo.
_
I finished the sewing.
There's blood everywhere.
Tighten the tourniquet,
then apply the hemostats to
the longitudinal structures
that are likely to be the
major blood vessels.
Hemostats to...
I'm sorry?
The structures that look like...
So...
The leg...
The blood vessels.
Okay? Yes? The structures,
the blood vessels.
- What happened?
- Acute respiratory failure,
we need a non-rebreather
at 15 litres per minute,
- and a stat portable chest.
- Chest tube's not working.
- O2 stats?
- Uh, 66.
Resp is 40, tachy's at 144, BP's 84 60.
Prep a new tube. If it's kinked,
we'll have to re-insert.
The chest tube's definitely not working.
Tension pneumothorax.
Your colleagues were
all here before you.
Sorry, I got held up.
If you can't get here on
time, we don't need you.
Insert a new tube, she'll settle.
You sure? Just try again.
Keep at it
Show me.
Here. Do you see it?
- Good.
- What do I do now?
Okay now, keep the tourniquet
- in the position, and...
- Okay.
Just examine for obvious blood vessels.
Then clamp with your hemostat
- Okay.
- That was fast.
She's okay.
Dr. Hunter, there's oozing.
That's normal, just keep an eye on it.
If it continues, you just need
more pressure on the dressing.
Thank you. Thank you both.
Well done, Saleh.
What the hell is going on in here?
Uh... nine-year-old, uh...
Syrian female, crushed lower extremities
after a building collapse.
Rapid onset of GFM
after tourniquet and rescue.
A volunteer medic just
successfully performed
a roadside amputation
with almost no equipment.
Prognosis?
Uh...
She's responsive and stable.
He, He saved her life.
Good.
Find me before you leave.
Who was that?
The big boss.
Call me when you get to
the hospital, Saleh.
You do that kind of thing a lot?
Not anymore.
Cops agreed to wait until he's out.
Thank you for pushing for the ligation.
Well, I didn't do it for him.
Dinner.
For one?
I have to get back.
My dad's a drinker,
and one time he almost
ran the car off the road
with me and my brother inside.
And the next day, he...
didn't even realize he'd done it.
We don't talk anymore.
Why are you telling me this?
Because...
I want you to know.
And...
if I'm closed off sometimes,
which I might be again,
it's not because I
don't want you around.
Well, you haven't driven
me away just yet.
Good news. You're almost
ready to be discharged.
Only one thing left.
You need to be able to test
your own blood sugar levels
in order to leave.
Liz knows how.
You know, I helped treat
a little girl today
who lost her leg in an accident.
Her life is going to be different,
and it will be hard at first.
It'll be hard forever.
I think that's up to her.
And I bet it won't be long before
she gets good on crutches.
Maybe even learns to
play soccer with them.
You said this isn't your home?
My home is Syria.
Do you wish you were still there?
Sometimes.
A lot of the time.
I wish my Grandma was still here.
What helps me is to focus on
the things I can control.
It makes everything I can't less scary.
What do you do?
I do this.
This child...
was on the other side of the world.
To be a part of saving her...
Puts things in perspective?
I'm sorry about earlier.
I just was... upset that I
couldn't do anything to help.
I know it's hard to be the one away.
I just...
I hate how much I'm missing.
You know, the good, the bad.
And I don't mean just with them.
With you, too.
In six months, you'll be back,
and everything will be so much better.
Hey, I have tomorrow off.
I can fly home.
Surprise the girls. Take
them out of school?
It's difficult when you
come home for such a short time.
When you go,
I'm picking up the pieces.
I know I didn't handle
things well today.
But if... If you're upset with me, or...
I'm not, I swear.
I'm just trying to be
honest about what I need.
Gotta go. I'll call you when I can.
Have a good night.
You too.
Hey, Mel?
And the timeline of this?
Okay, let's follow the progress for her.
Takes 24 hours, and then
get back to me, let me know,
how's the rest. Alright, thanks, Mark.
How's the Syrian girl?
They made it to the hospital.
Good. Take a seat.
Look, I understand what you did.
It's why I hired you.
But you can't ever do it again.
Not from work, not with
everything we're up against.
I need you to be better
than everyone else.
That means when you're paged, you
arrive first, and be present.
Yes, sir.
I spoke to the Dean's office
at your med school today.
I didn't get the transcripts.
But they did assure me they exist,
and confirmed your qualification
You... They did? How is that possible?
I told legal I would
swear whatever they need
so we can put this thing
to bed, once and for all.
Bashir, you need to learn
to take yes for an answer.
We're in this together now.
Don't let me down.
And I am an enemy of the state.
There is no paper trail
because of who I am.
My place later?
You've got a second chance.
You should think about
how you're gonna use it.
_
_
_
You're in Idlib?
Kafr Halab. The building
collapsed this morning.
Bombs last night.
And we're looking for survivors.
How many of you on site, Saleh?
We're small team. Most
are trainees like me.
And what sort of equipment do you have?
The usual, basic first aid.
It's good you called.
You need to manage hemorrhagic
shock so he's safe to transport.
Can someone find a... a
sheet or towel to wrap him?
_
Place your hands on his
pelvis and compress inwards.
Feel around for movement.
_
They found a regime flag.
_
_
_
Planes?
Saleh, do you need to get out of there?
Just passing over, I hope.
How is... How is Zaynab?
We will be getting married.
Good for you. Poor her.
His radial is strong.
We need to keep looking.
More bodies might be trapped in rubble.
- Thank you, Bashir.
- Be safe, if you need...
- Oh. Is everything okay?
- Yes, thank you.
I'm gonna take it.
Wait, wait, wait.
I know what that means.
Dr. Singh says if you're not early...
you're late, so...
Well, your boss got no joy in his life.
He's a surgeon. We're not
exactly known for joy.
Dinner later?
Maybe. Don't forget to hold for five.
Everything alright?
A grade four student
in your household, Abigail
Hunter, was marked
absent at morning attendance.
I call the school, it goes
straight to voicemail.
Mel texted me after the drop off,
so I know Abby's there, or should be.
I called Mel, but she's not picking up.
She has meetings all day, so
she might have her phone off.
I'll cover your patients.
You do what you need to do.
Thank you.
Why would I get a message from
them saying you drop her off?
I don't know, the school didn't call me
so this is the first time
I'm hearing about this.
- Did you call back?
- It went to voicemail.
Look. When you dropped Abby
off, you saw her go in?
I left her in the yard with her
friends five minutes before the bell,
When she's been begging
ff, for this for months.
If we're making a decision like that,
shouldn't we have discussed it
Well you're not here. So you don't get
to tell me how to drop the kids off.
Look, I'm worried, okay?
Because if you didn't watch her go in,
doesn't that mean she
could actually be gone?
I'm worried too.
I'm already in the car.
I'll call you when I get there
Messy hair, flushed cheeks,
and almost smiling?
I wonder who the guy is.
Maybe she just overslept?
- No judgment.
- No.
Respect, actually.
It's basically impossible
to make a relationship work
- around this job.
- You don't date?
I've... I've had to accept
the fact that the hospital
is my current boyfriend.
You?
I sleep on a sofa so my
sister can have a bedroom.
MVC 3 minutes out. Code trauma. VSA.
Hit-and-run. Victim's not identified.
Driver of the vehicle,
head injury, GCS 6,
massive blood loss, ***, resus
on the field 8 minutes ago.
Passenger. Airbag
malfunctioned, didn't deploy.
Cyanosed, 02 sats at 80 percent.
Pulse 120, resp rate 35, BP 95 on 68
Bed one. Dr. Hamed.
Dr. Leblanc, bed two.
One, two, three.
It's all yours, doctors.
Arnold take compressions.
Activate MTP, and insert
two large boreVs.
ABCs, doctor.
Uh, I'll intubate and decompress
the chest bilaterally.
One, two, three.
We need two units O-neg.
Mags, an eFAST, and I need an art line.
EMS radioed from dispatch, we have IDs.
Marie Tabeh, 46, Ana Tabeh, 20.
This is a mother, daughter?
Pneumothorax. We need a chest tube!
Use a 28 French in case
there's a hemothorax.
Let's sedate with ketamine, she
needs 40mg, let's start her.
Still no pulse.
There's cardiac activity
on the ultrasound,
but her heart looks empty.
1mg epinephrine.
Epi won't help if there's no
blood for the heart to pump.
PEA, narrow complex. Not
a shockable rhythm.
Restart compressions. Let's focus on
resuscitation using blood product.
Preparing for chest
tube, making incision..
Test.
Get your finger in the pleural space.
- What are you feeling?
- Smooth pleural...
Lung. I think I'm good.
Chest tube.
Hemopneumo.
Left foot is cold.
No pulse.
Her knee looks pretty mangled.
This could be vascular injury.
Page vascular. She's gonna need the OR.
Still no pulse!
No cardiac or electrical activity.
Okay. I think that's it.
You think? Or you know.
I know.
So you're confident.
Yes.
Asystole, no cardiac
activity on ultrasound,
prolonged downtime.
We managed *** cause of
traumatic cardiac arrest.
3 units packed cells, bilaterally
chest decompression.
No pericardial effusion,
and a stable pelvis.
I'm confident that after the massive
head injuries suffered by this patient
she had no chance.
Then call it.
Time of Death, 10:14 AM.
Thank you, everyone.
Let's just take a moment to
acknowledge the end of a life
and the efforts of our team to save it.
Sir? About what just happened.
Being challenged? Consider
it the new normal.
Are you talking about
how I ran that trauma?
I'm talking about you telling legal
that you can't get us your transcripts.
Do you know what a lawyer hears
when you say enemy of the state?
They hear liability,
that puts the pressure on us to
make certain that you are not.
I need you to be above reproach.
Sharper than everyone else.
Hi, Jasmine Weber, peds two.
- Thanks.
- Where's Doctor Hunter?
I asked to take a couple extra patients.
Staying sharp.
Let's see.
Can you tell me what happened Mr.
Monroe?
Kinda stupid. My fault, really.
I've been trying to lose a few pounds
so I hid the cookies up in the cupboard.
I got a craving,
so I climbed up on a stool to get them,
and bam!
I didn't want to come
all the way down here
but the boss insisted when
she got back from work.
Are you a nurse?
Nurse's aide. At a retirement home.
I work the night shift.
You're not supposed to call it
the graveyard shift, there.
I get home and he's white as a sheet,
can barely stand from
the pain, but it's all,
"No, no, I'm fine."
She worries.
Only because she cares.
We should all be so lucky.
It's gonna be cold.
Okay, well, I'm seeing some fluid here,
so this could be an indication
of internal bleeding.
- You'll need a CT.
- If you say so, Doc.
We need to bring him to
the resus room, stat!
Then she lost control of her legs.
I needed the neighbour to
help me get her to the car.
Should I have called an ambulance?
No, the important thing
is that you're here now.
How old are you, Jasmine?
Thirteen.
And can you tell me when you
started feeling this way?
Earlier today.
It started with a little
slurring, and then it got worse.
Did you take any drugs or alcohol?
Any issues swallowing? Headaches?
Can you do this for me?
That's great.
Any indications leading to today?
Cognitive or behavioural?
Can I talk to you outside?
I'm her foster mother.
I've only had Jasmine a few weeks.
Do you have any family medical history?
Specifically, I'm looking for a history
of heart disease or strokes.
You think she's having a stroke?
With slurred speech and
loss of motor function,
that's the first thing to rule out.
Well, she's been in a series of
group homes for the past two yes.
She ran away from the last one.
That's all the information
the foster agency had.
I barely know her at all.
For labs, you want a
CBC and electrolytes?
Um... Also venous gas,
extended lytes, CK,
liver panel, hemoglobin A1C.
And get her to CT as soon as possible.
Got it.
So., uh, we'll do imaging
and send blood work to the lab
and see what's going on.
In the meantime, just stay with her
and keep her spirits up.
_
_
_
Where's the rest of your team?
The building shifted again
and they got stuck on a higher floor.
We need your help.
Remember after your accident,
we talked about you
having a second chance?
I remember you talking about
how I was coming out
of a coma at the time,
so I wasn't saying much.
Running down Bash like that
in trauma for no reason?
If this is you trying
for a second chance,
you're failing.
I had a very good reason.
I could take you through it.
Over dinner.
My place.
Yeah, I thought we fished with
all that about five years ago.
Anyway, I don't recall
you ever actually making me dinner.
I wanted to.
I guess we both wanted things
that would not have worked.
What are you doing, Jed?
I mean, why now? After all this time.
You're the one who keeps
talking about second chances.
And you're the only one here who's
not afraid to tell me to piss off.
So...
Dinner?
What's your answer?
Piss off.
How is her airway? Blood pressure?
_
Before you move her, you
need to tourniquet her leg.
_
See? You know your stuff, Saleh.
I guess you don't have any blood.
Saline will have to do.
*** her to a clinic as soon as possible.
How much saline for a child like this?
_
_
Keep your phone on Bashir, please!
In a pediatric crush, uh,
normal saline is 20, 20 ml per kg?
We have a pediatric crush injury?
You should've paged me right away
No, no, it's just hypothetical.
- Something I came across in my reading.
- Uh, the saline dose is right.
Watch closely for hyperkalemia.
Thanks.
Uh, why did you order a
CT for Jasmine Weber?
The symptoms pointed to possible stroke
because of the dysarthria.
Did you call for a bedside glucose test?
- No.
- Claire?
I had blood sent to the lab.
Hemoglobin A1C.
- Isn't that protocol?
- DKA can mimic stroke symptoms.
Bedside glucose is the protocol
here for pediatric patients
She won't open her eyes!
Guys!
Jasmine? Jasmine? Come on, Jasmine.
Try and open your eyes for us.
Glucose is 25. She's in DKA.
- DKA? What is that?
- Diabetic ketoacidosis.
She's going to need insulin therapy.
I thought you said she
was having a stroke.
The symptoms can be very similar.
- She didn't tell me
- She probably didn't know.
Hello.
Um, the endoscopy showed
enlarged veins in the esophagus
which ruptured from your fall.
Subsequent tests, however, reveal...
cirrhosis and liver failure.
I'm sorry to tell you that
with this amount of damage,
the chances of the liver
recovering on its own are slim.
Is there anything we can do?
We're starting medication now,
but Walter will also need something
called a variceal ligation,
which means a surgeon
uses rubber bands to stop
the enlarged veins from bleeding.
Long term though, a liver
transplant is your only option.
That's what a lifetime
of drinking gets you.
It's probably what I deserve.
I'm sorry.
Excuse me, doctor?
- Yes?
- You mentioned a transplant.
Does it jeopardize that,
him having been a drinker?
Well, he would have to be sober
for a minimum of six months.
He's four years sober.
I'm six. We met in the program.
I'm sorry to bring you such bad news.
We've overcome a lot.
We'll get through this. too.
Let me guess. Jasmine Weber?
Any luck?
I called every contact
number that I could find,
pieced together that she
lived with a grandmother
until a few years ago when she passed.
Of what?
Heart attack. Apparently,
in front of Jasmine.
Not sure that's something you get over.
It isn't.
Then she was abandoned by an
uncle, who's now in jail.
Learned in the hard way
not to trust anyone.
Any type 1 diabetes in the family?
Medical records don't even start
until she was put in foster care.
But she's one of the lucky ones.
Most of the older kids don't find
someone conscientious like Liz
to look out for them.
Think we could speed walk a
variceal ligation into OR?
What's his coag look like?
Labs just came in. Mmm...
Blood alcohol level 0.09?
I couldn't smell it on him
Might've been vodka.
Is he cirrhotic?
Yeah. The seasoned ones
know how to hide it.
No, his fiancée says he's
been in recovery four years.
Guess he slipped. They always do.
I was so focused on the cirrhosis
I didn't question the X-ray.
Look. Do you see anything?
Fracture to the sternum,
none to the extremities.
Trauma to the abdomen.
- Was there any circular bruising?
- Yeah.
Does this look like a
fall off a stool to you?
That's a tough angle for a stool
Could it be steering wheel trauma?
My guess is that your drunk was driving.
And, by the looks of it,
may've been in a serious accident.
The timeline tracks for that
hit-and-run we got this morning.
The mother we lost. The
daughter, how's she doing?
She'll pull through. No
thanks to that asshole.
Well, even if he was in an accident,
doesn't make it a bad accident.
You sure about that?
Okay. Have a look.
Okay, her pupils are dilated.
She's losing consciousness?
Yes, she is.
Okay. So we manage pain
and get Fatima fluid resuscitation
or she risks kidney injury.
She needs a field hospital.
You can't wait, Saleh.
You need to get her out yourself.
- I can't do this alone, Bashir.
- Yes, you can.
Your adrenaline will give you strength.
Lou! Hey! Hi.
Uh, I saw you were talk to the cop
from the car accident before.
- Who, Desantos?
- Yeah.
Yeah. Our kids go to the same school.
Uh, quick question
_
I got her leg out, but it's a mess.
I need you to tell me how
to manage the bleeding.
Saleh. Saleh!
I'm sorry, okay?
I know, I know you have a
lot on your plate. I know.
Fine.
Hey.
Hey. I didn't mean to interrupt.
No, no. Mel called.
The school's automated
attendance software misfired.
Abby was there the whole time.
Good to know she's okay.
Mel had to cancel a meeting and
drive halfway across town,
but... Anyway, Abby is fine.
What's going on with you today?
That, uh...
That pediatric crush wound?
It was a child in Syria.
They found her pinned in
a bombed out building.
My friend Saleh he's a volunteer
medic, only a year of med school.
He calls sometimes with consults.
Is she okay?
We don't know yet.
You told me that was hypothetical.
- I didn't want to involve you.
- But you did!
When you asked my advice.
If I'd have known there
was a real child,
I would have asked more questions.
Made sure I had all the details!
What if something I said
cost that child's life?
I just needed guidance
on fluid resuscitation
Protocols change based on the scenarios.
You should know that.
Are you talking about the
testing I ordered for Jasmine?
I'm talking about you
being honest with me
instead of taking
everything on yourself.
We put in a chest tube
to drain the fluids,
and we performed a surgery to
repair a torn artery in your leg.
Both were successful.
We'll keep you for observation
but you should make a full recovery.
We've called your dad.
He's on a flight now.
So... - Can I see my mom?
I'm so sorry.
Lydia not here?
She's gone to get some air.
Walter, do you drive a blue sedan?
Why?
Because your labs came back
and there was alcohol
in your bloodstream.
And the bruising on your abdomen,
the placement of it, it suggests
you could've hit a steering wheel.
I... I started slipping.
Once or twice.
Then last night, with a buddy,
I...
I don't remember what happened.
I woke up a few blocks from the house
in a smashed car.
Lydia wasn't home from work
yet so I left it in the lot.
And just...
hoped that what I hit
was parked and empty.
A mother and daughter
came in this morning.
Hit by a blue sedan.
Oh... Oh...
Are they okay?
No, Walter.
They're not.
There were no complications and
you're responding to medication well.
Are you feeling better?
How long do I have to stay here?
A little while longer.
We want to make sure that your
blood sugar is under control.
And we have to show you
how to use a glucose
meter before you go.
It'll help you and Liz manage
things easier when you get home.
That's not my home.
I never wanted to go there.
I know it's hard,
adjusting to a new place.
Where I live isn't my home either.
Do you have to share it with
someone you barely know?
We'll try again later.
Do you have a minute?
I've got a hypothetical.
Sure.
If a patient
admits to a crime in confidence...
- Mm-hmm?
- Would you tell the authorities?
We can't. We're bound by
doctor-patient confidentiality.
I know, I know. Unless it's
to report a gunshot wound,
the safety of a child, or
intent to cause future harm.
I know. And it isn't.
Then you'd be breaking your oath.
Yeah, I know that too.
I just... I...
I can't help but think that you,
you know, the rule-breaker,
Doctor Instinct, would
understand that someone might
break the oath for a moral
obligation you felt
outweighed the needs of a patient.
There are consequences to
drawing lines like that.
Then you've done it?
During the war, I treated
regime soldiers.
Only when they forced me.
Often, at gunpoint.
It's fine.
The point is, I chose sides.
And now I can't go home.
His nausea's getting worse.
I always know something's
wrong when he gets quiet.
Liddy, could you go get me
a glass of water, please?
Sure.
No sign of new haemorrhaging.
We're just waiting to hear back from the
OR on a scheduled time for your ligation.
You haven't told her?
When are the cops coming for me?
I haven't told them either.
But I hurt those people.
I have to pay for what I've done.
I agree. But I have a duty to
protect your confidentiality.
So if you want to tell the police,
you'll have to them yourself.
What, what if, what if I...
If I can't bring myself to do it?
Then you'll have your
surgical procedure.
Lydia will take you home.
And I guess you try to live
with what you've done.
The Mannitol is helping.
Jasmine's going to be okay.
Thank God.
So, was this my fault? Is
it the food I'm making?
- Was I making the wrong...
- No, type 1 is genetic.
There was nothing you
could do to prevent this.
But you can help her control it.
I doubt she'll let me do that.
I thought I was doing a good
thing, becoming a foster mom.
- But this?
- I think you're very strong,
doing something like this.
I'm not questioning my decision.
I just...
I feel like I'm messing it up.
Like I'm messing her up, and she's
already been through so much already.
I'm sorry.
We all feel like that the
minute we become parents.
But the highs outweigh the lows.
And all we can do is...
get up every day, committed
to doing our very best.
Walter's ligation procedure.
When is that happening?
Well, procedures are triaged
according to urgency.
And because he stopped bleeding,
it may not be for a few more hours.
When... When he does get it,
how much time will it buy him?
Well, it only fixes the
bleeding, not his liver.
- Oh...
- And there are no guarantees, but...
Without the transplant...
maybe a year?
A year more than that young woman
will have with her mother.
I'm so sorry. Lydia
It won't be the life we planned,
- but...
- But...
He did a terrible thing,
but he's not a terrible person.
He'll never forgive himself for this.
What kind of a person would I be
if I left him alone with that?
You told the cops.
No, he did. And she's sticking by him.
And you wouldn't?
He killed somebody.
I would, yes, like to say that
if I was in love with somebody,
I would be able to get
past that, but I...
People stay with people who
hurt them all the time.
We're kind of stupid like that.
Well, if that cop arrests
Walter before his procedure,
there's no telling when he'll
be able to get another one.
Let me see what I can do.
Bashir? Hello?
Bashir?
Alhamdulellah.
I was on the road. The
cell towers are still...
Are you driving her yourself?
I had to. Nobody was coming for us.
She's feverish. She started
vomiting 15 minutes ago.
Can you...
Can you feel air under the flesh?
Press down on the tissue.
Yes, I feel air.
Crepitus. Saleh, you have
to amputate the leg.
On the side of the road? Now?
Alone? - If you don't, she'll die.
And you're not alone. I'm here.
So there's a patient waiting in
Emerg on a variceal ligation.
Let me guess, you want to scrub in?
Yes, always. But I was
actually just checking
to see if there was any wiggle room.
The patient needs the ligation
before he's arrested.
You mean arrested?
No. Like, hauled off to jail.
He's a drunk driver who
killed a woman this morning.
And you want to rush him into surgery
so he doesn't lose his chance to get it?
I didn't take you for someone
who'd be affected by that.
I'm not.
You know the girl with the arterial
injury we repaired earlier?
- Mm-hmm.
- Well, her mom died
because of him.
He should be healthy enough to serve
whatever sentence they throw at him.
Well...
The candor's refreshing.
Anyway, he's in luck.
An elective case dropped off the board
so I was about to move him
up to this evening anyway.
It's the ICU. It's the daughter.
Better go, then.
_
You paged me?
Patient is a nine-year-old girl.
Crushed lower right extremity.
Saleh called with a few questions.
We really need your help.
What do I need to know?
_
This is Saleh. We worked
together in Syria.
Hello, doctor.
Severe soft tissue injury
progressed by a gangrenous limb.
He's pulled over on the side of
the road and needs to perform
an above the knee amputation right now.
With what tools?
I have a scalpel, scissors,
hemo... The clips.
- Hemostatic clips.
- Yes, dressings.
- And a handsaw.
- Ketamine for sedation.
Uh, can you show me the girl again?
She weighs maybe 20 kilograms, Dr.
Hunter.
Try 20 megs, if you have that.
Uh, 20 milligrams.
Done.
Okay, Saleh.
If the tourniquet is tight,
make your incision.
Start by dividing the
skin circumferentially.
_
Good. Now cut through the
subcutaneous tissues
Okay.
You're doing great.
_
_
_
_
Code Blue. Room 305
- You've gotta go to that, Bash.
- I can't leave him.
Saleh?
You think we can do
this, just you and me?
Okay.
Who knows, something might
get lost in translation.
Bash.
We got this, okay? Go.
- Code blue, room 305.
- Thank you, Theo.
_
I finished the sewing.
There's blood everywhere.
Tighten the tourniquet,
then apply the hemostats to
the longitudinal structures
that are likely to be the
major blood vessels.
Hemostats to...
I'm sorry?
The structures that look like...
So...
The leg...
The blood vessels.
Okay? Yes? The structures,
the blood vessels.
- What happened?
- Acute respiratory failure,
we need a non-rebreather
at 15 litres per minute,
- and a stat portable chest.
- Chest tube's not working.
- O2 stats?
- Uh, 66.
Resp is 40, tachy's at 144, BP's 84 60.
Prep a new tube. If it's kinked,
we'll have to re-insert.
The chest tube's definitely not working.
Tension pneumothorax.
Your colleagues were
all here before you.
Sorry, I got held up.
If you can't get here on
time, we don't need you.
Insert a new tube, she'll settle.
You sure? Just try again.
Keep at it
Show me.
Here. Do you see it?
- Good.
- What do I do now?
Okay now, keep the tourniquet
- in the position, and...
- Okay.
Just examine for obvious blood vessels.
Then clamp with your hemostat
- Okay.
- That was fast.
She's okay.
Dr. Hunter, there's oozing.
That's normal, just keep an eye on it.
If it continues, you just need
more pressure on the dressing.
Thank you. Thank you both.
Well done, Saleh.
What the hell is going on in here?
Uh... nine-year-old, uh...
Syrian female, crushed lower extremities
after a building collapse.
Rapid onset of GFM
after tourniquet and rescue.
A volunteer medic just
successfully performed
a roadside amputation
with almost no equipment.
Prognosis?
Uh...
She's responsive and stable.
He, He saved her life.
Good.
Find me before you leave.
Who was that?
The big boss.
Call me when you get to
the hospital, Saleh.
You do that kind of thing a lot?
Not anymore.
Cops agreed to wait until he's out.
Thank you for pushing for the ligation.
Well, I didn't do it for him.
Dinner.
For one?
I have to get back.
My dad's a drinker,
and one time he almost
ran the car off the road
with me and my brother inside.
And the next day, he...
didn't even realize he'd done it.
We don't talk anymore.
Why are you telling me this?
Because...
I want you to know.
And...
if I'm closed off sometimes,
which I might be again,
it's not because I
don't want you around.
Well, you haven't driven
me away just yet.
Good news. You're almost
ready to be discharged.
Only one thing left.
You need to be able to test
your own blood sugar levels
in order to leave.
Liz knows how.
You know, I helped treat
a little girl today
who lost her leg in an accident.
Her life is going to be different,
and it will be hard at first.
It'll be hard forever.
I think that's up to her.
And I bet it won't be long before
she gets good on crutches.
Maybe even learns to
play soccer with them.
You said this isn't your home?
My home is Syria.
Do you wish you were still there?
Sometimes.
A lot of the time.
I wish my Grandma was still here.
What helps me is to focus on
the things I can control.
It makes everything I can't less scary.
What do you do?
I do this.
This child...
was on the other side of the world.
To be a part of saving her...
Puts things in perspective?
I'm sorry about earlier.
I just was... upset that I
couldn't do anything to help.
I know it's hard to be the one away.
I just...
I hate how much I'm missing.
You know, the good, the bad.
And I don't mean just with them.
With you, too.
In six months, you'll be back,
and everything will be so much better.
Hey, I have tomorrow off.
I can fly home.
Surprise the girls. Take
them out of school?
It's difficult when you
come home for such a short time.
When you go,
I'm picking up the pieces.
I know I didn't handle
things well today.
But if... If you're upset with me, or...
I'm not, I swear.
I'm just trying to be
honest about what I need.
Gotta go. I'll call you when I can.
Have a good night.
You too.
Hey, Mel?
And the timeline of this?
Okay, let's follow the progress for her.
Takes 24 hours, and then
get back to me, let me know,
how's the rest. Alright, thanks, Mark.
How's the Syrian girl?
They made it to the hospital.
Good. Take a seat.
Look, I understand what you did.
It's why I hired you.
But you can't ever do it again.
Not from work, not with
everything we're up against.
I need you to be better
than everyone else.
That means when you're paged, you
arrive first, and be present.
Yes, sir.
I spoke to the Dean's office
at your med school today.
I didn't get the transcripts.
But they did assure me they exist,
and confirmed your qualification
You... They did? How is that possible?
I told legal I would
swear whatever they need
so we can put this thing
to bed, once and for all.
Bashir, you need to learn
to take yes for an answer.
We're in this together now.
Don't let me down.