01x12 - The Griffith Technique

[bunniefuu]

Previously on Good Sam...

Your proctorship is over.

I'm back in surgery.

I slept with someone else.

I feel really awful
about this whole Tim thing.

It was you.

You want my job? Come and get it.

I plan to.

I just wonder if any part of you

is hoping I'd keep a job search local.

Don't put this on me.

My mom found a field report

from the accident. It says
your dad was drunk that night.

I actually thought we were
starting to put this behind us.

My mom's not gonna let that happen.

Tina knows my secret, so now
you need to know the truth.

He's doing this for us.

Today you were the man I married,

not the man I divorced.

[SOFT SIGH]

Mmm. Hmm.

Oh, no.

Oh, no! No! Oh.

- Griff.
- [GROANS SOFTLY]

Wake up, Griff.

- Griff!
- No!

[SIGHS]

Oh, good morning to you.

I can't believe we slept here.

I think I lost my mind.

Oh. Think I lost my pants.

How could I let this happen?

What am I gonna tell Asher?

Tell him the truth.

You had a few drinks,
you slept at the office.

You don't have
to tell him the whole story.

No. He can never know
the whole story. No one can.

I can't have my whole life blowing up

over some mindless indiscretion
with my ex-husband.

Oh, you were always
so good at pillow talk.

Griff, listen to me.

This is serious.

I know. You know I do.

I have my own relationship
to think about.

I don't want anyone to get hurt.

Then we have to put this behind
us and forget it ever happened.

Here. Let me get that for you.

- Oh, thank you.
- [LAUGHS]

You are in a hurry.

Yeah, the board made a decision
about my dad's drunk driving thing.

I want to get in there

'cause we're expecting
a phone call any minute.

Uh, I guess
they're deciding his punishment

- before they get to my mom.
- What do you think they're gonna do?

Mm, I think they're gonna
take away her board seat.

They can do that?

They can if one
of their members is caught

taking kickbacks.

Look, the board has zero
tolerance for her misconduct.

Good. She would've sold this
place if we hadn't stopped her.

Ah, but we did stop her.

You and me.

Can you hurry up?

Yeah, it's one leg at a time, Vivian.

- That's how pants work.
- SAM: Mom?

[KNOCKING]

Okay.

- SAM: Hello?
- [GASPS]

- It's Sam. It's Sam. It's Sam.
- Uh...

Yup.

[GROANS SOFTLY]

Morning.

Sam! Hey, we were just, um...

I know what you were doing.

I've been doing the exact same thing.

Just going over it
and over it in my mind,

trying to think about
what the board is gonna say.

You know, no matter what it is,
Dad, I just want to say,

I'm proud of you.

Telling the truth was
the right thing to do.

- I second that.
- [PHONE BUZZES]

Oh.

- [SIGHS]
- This is it.

Yeah. Rob Griffith.

- Yes.
- [SIGHS]

I've been waiting for your call.

Okay. Yeah. No, I understand.

Oh, thank you, and, uh...

thank the board for me.

There's to be no
disciplinary action against me.

- What?!
- [CHUCKLES]

I was off the clock.

There's no arrest, police records,

no need for further action.

- What a relief!
- Oh.

That's great news, Dad.

- [PHONE RINGING]
- Oh. Now I'm ringing.

The board is taking
a hard line with Tina.

I thought they might
do the same with you.

Well, she's an active board member.

I guess they had
to make an example of her.

I just want to get back to work.

I think we all do.

- Yeah.
- I don't think we all can.

The board's been discussing
my role in the accident.

[STAMMERS]

You weren't on duty that night,
but I was, and

when I took the paramedic's report,

I violated my terms of employment.

They are required to take action.

What kind of action?

I've been relieved of my duties as CMO.

They cannot do this.
They-they can't suspend you

for a violation from years ago

without hearing your side.

Well, they'll hear my side
when they formally

- review the case in a few months.
- Ugh.

- A few months?
- Yeah.

- At the next staffing session.
- No.

We have to make it happen sooner.

I'm gonna keep calling Byron,

find out where he stands on this.

I will gather signatures,
and I will get letters

from every department head
in this hospital. We will keep

the pressure on
until they call a hearing.

Who's gonna run your department?

Dad. His proctorship is done.

It's about to be official,
the vote is next week,

and we all know he's ready.

A transition period
might be a good thing.

Yeah, it could be great for the team.

All right.

Thank you, both of you.

SAM: Morning, everyone.

Starting today, Dr. Griffith
is officially moving back

into his role as chief,
and I know... we will all

do our best to make it a smooth tran...

Where's the other one?

- Excuse me?
- There's usually one more.

Has anyone seen Isan?

He mentioned taking a personal day.

What is a personal day?

This is because I lied to him
about the hospital sale.

I'll keep calling and apologizing

until he calls me back.

CALEB: Welcome back, Dr. Griffith.

Dr. Tucker,
are you also taking a personal day?

- No.
- Then maybe you want

to prepare for rounds instead

of reclining like a renaissance nude.

[SIGHS]

SAM: Isan. Hey, it's me.

I just really want to talk. I...

Dr. Shah, if you don't want to be here,

there's a long line of people
waiting to take your place.

Suit up and show up,

or all your days will be personal days

- 'cause you will be out of a job.
- Hey...

- Okay.
- This is not a wellness retreat.

We're not here to talk
about your feelings.

Because you don't care
about people's feelings.

New chief is the same as the old chief.

He doesn't care
about anybody else but himself.

[DOOR OPENS]

Hey, hey, hey, what was that all about?

It's over, Griff.

Okay? We are done.

Hey, just-just talk to me.

Talk to you? Okay.

I saw you last night with Vivian.

Look, I...

I didn't know how to tell you...

Didn't know how to tell me?

There is nothing to tell.

I was there, and I saw you!

Lex?

Stay out of my way today!

[DOOR CLOSES]

SAM: What's wrong with Lex?

Why would you assume I know?

Are you saying you don't know?

I'm saying that's personal,
this is professional,

and I'd ask you to keep
the two things separate.

- Dad...
- Please, Sam.

Keep them separate.

First day back in charge.

I need to focus.

This is Tanya White.

She was referred to us
with shortness of breath.

And I get tired really easily.

I feel like I could pass out
from hardly doing anything.

- SAM: Hmm.
- She always had so much energy.

She's the reason we bought a vineyard.

- A vineyard?
- Mm.

Six acres in Italy.
It's our retirement plan.

- Oh.
- CURTIS: The idea was

we'd tend it together, but

lately, Tanya barely has enough energy

to go get the mail.

No family history
of heart disease, cholesterol

and blood pressure within normal range.

What could explain the fatigue
and lightheadedness? Dr. Tucker?

Cardiomegaly worsens with age,
and causes symptoms like these.

It's also more gradual than the onset

of these symptoms. Dr. Costa?

Symptoms of cardiomyopathy
can appear suddenly

even if it's been present for some time.

An echocardiogram
would be a good next step.

Mm-hmm.

We're gonna run some tests.

Okay.

Pretty color.

Oh, thank you.

Yeah, it's better
than what's going on underneath.

My nails look like I've been
working in the vineyard

and we haven't even gotten there yet.

Your nails look like they're
dirty even when they're clean?

Exactly.

Any cracked nails?

How'd you know that?

GRIFF: Okay.

Need a cardiac MRI, and
that polish needs to come off.

- Why?
- SAM: Uh,

what looks like dirt could be something

called "splinter hemorrhages."

Debris thrown from inside the heart

that collects in the extremities.

What causes that?

A mass, usually.

M-Mass?

L-Like a tumor? Are you saying

my wife has a tumor in her heart?

It's too soon to say without imaging.

We will get her in there
as fast as we can.

JOEY: How did we get in here so fast?

There was a long line when I
checked the radiology schedule.

I bumped her up.

- We can do that?
- Chief can.

Sam never did.

Sam never had one of these.

Oh... Gentlemen,

the atrial myxoma.

JOEY: I've never
seen anything like that.

And you never will again.

It's the Loch Ness monster of tumors.

Zoom in on that?

A tumor like this

is big news.

The network of blood vessels

feeding the mass is incredibly complex.

How do you remove it?

Most of the time, you don't.

Not successfully, anyway.

We need to strategize.

Dr. Tucker, find any case history

you can on tumors of this magnitude.

Dr. Costa, I need
a D model reconstruction

of this heart in the SIM lab right away.

All right, let's get
some measurements on this baby.

[SIREN WAILING]

Brian Jenkins, years old,
blunt chest trauma

- after a skateboarding accident.
- KACE: Do you know if Tim and Joey

worked things out? I wish
I'd known they were together.

I wish I didn't know
anything about this.

One, two.

- Three. Here we go.
- All right.

You said he's having problems breathing?

He fell, and when he got back
up, he wasn't breathing right.

Okay, I'm gonna listen
to your heart, kid, okay?

[LABORED BREATHING]

He's not moving much air.

All right, start him
on continuous nebs and give him

a dose of steroids.

Where's Mom?

She's on her way, Bri.

[BEEPING]

His heart rate sh*t up to .

SVT. I need six milligrams of adenosine.

You say that he fell off
of a skateboard?

N-No, he was running.
Climbing, actually. A fence.

Adenosine, six milligrams.

Does your brother have a
heart condition?

No. Why?

Because whatever this is, it did
not come from climbing a fence.

Oh, hey. I can't get
anywhere with the board.

- Another Griff mess.
- Well,

I think he was trying to do the
right thing. He couldn't know

- how the board was gonna react.
- That's not what I meant.

You know, the thing about boundaries is,

if you don't enforce 'em,
then they don't exist.

You can't cross a line
that's been erased.

What? Asher.

Where were you last night?

Well, like I... like I said,
I-I was working late, and...

I know what you told me,
and I didn't buy it then,

and I especially don't buy it now

that I see those two
empty glasses over there

and that guilty look on your face.

That's Griff's
favorite whiskey, isn't it?

Close the door.

[SIGHS]

[SCOFFS]

You okay, Donna?

- Why do you ask?
- I don't know.

- You seem a little...
- I don't like gossip.

See, that's where we differ.

But I also don't like the idea
of any of you being mistreated,

especially Dr. Trulie.

What'd you hear, Donna?

[ELEVATOR BELL DINGS]

- Hey.
- Hey.

Um, I heard what happened with your mom.

- Ah.
- Is she okay?

Yeah. She's gonna fight this.

I mean, that's actually
what I've been doing...

Gathering all of these
letters of support.

- Mm.
- What about your mom?

- Did the board revoke her seat?
- Ah, yes.

And they found her replacement.

Is it you?

- It's you!
- [LAUGHING]

I know this place... the
people and the finances.

I told them it should be me,
and they agreed.

Malcolm, you're on the board.

- [LAUGHING]
- How does it feel?

You know, I'm getting my head around it.

But maybe some good can come out
of what happened with my mom.

I think you're gonna do a lot
of good around here.

Well, yes. But first,
I need to get your mom back.

If I can finally
get this clinic approved,

I need her to see it through.

Well, I was just looking for someone

to give these letters to
on my mom's behalf.

And now that you're on the board,

maybe that someone is you?

I will see what I can do.

Okay. Thank you.

I'm all caught up on Tanya.
Sorry I missed the MRI.

Where's my dad?

CALEB: In the SIM lab

working on a plan to extract the tumor.

- He asked us to join him.
- But we didn't.

We don't think he should be chief.

Okay. Why not?

Lex is our friend, and we're not
following him after what he did.

What did he do?

- So it's true.
- Oh.

This thing with the two
of you... this happened?

It was a lapse of judgment,

but in the heat of the moment,
one thing led

- to another...
- Please stop.

This is a private and personal matter.

That everyone in this
hospital knows about.

My residents are upset
because you hurt their friend.

Nothing you have ever done

- has been personal or private.
- We have

an atrial myxoma of unprecedented size

and complexity to deal with.
We have no viable plan

to remove it. That's all anyone
should be thinking about.

They're people, Dad, not robots!
They have feelings,

and their feelings do matter.

- Not to that tumor.
- That tumor

didn't sleep with Mom last night!

- Uh...
- [EXHALES]

They don't want to follow you.

Then order them to.

- Excuse me?
- You're still the chief,

technically. Get them in line.

Everyone needs to put their personal

feelings aside and get to work,

including you.

- [SCOFFS]
- [DOOR CLOSES]

Sam...

Malcolm is working
on getting you a hearing.

You should prepare your argument.

You know what? This-this thing

- between me and your dad.
- No.

Don't, Mom.

I said that I would help you

fight this because you did not
deserve what happened to you.

But Lex did not deserve this, either.

So, my father hears
your concerns, and hopes

that we can put aside
our personal differences

and respect his authority
for the greater good.

Respect his authority
for the greater good?

Mm.

I think Mussolini said
something very similar.

SAM: Yeah. Joey, how
about you go down to the ER?

They're always short-staffed
and could use an extra hand.

And keep an eye out for Lex

in case she needs someone to talk to.

Happy to jump ship before it sinks.

Looks like it's just you and me.

And Griff.

He never deserved you, you're better off

without him, he's dead to me.

- Guess the word is out.
- If you need a good cry,

I'm here for you.
In fact, I will join you.

I don't. And I'm trying
to make a good impression

- down here, okay? Move.
- Mm-hmm.

My boss does not like drama.

Got it. So maybe we'll schedule
that cry for later tonight.

Deal. And while we're at it,

can you help me take these braids out?

Mmm, new 'do, new you. I'm in.

Whatever helps to move on.

Well, I can't move on until I find out

who Tim cheated with.

Whoa, whoa, whoa. Look, I know...

Hmm?...who Griff was with, and trust me,

- it doesn't help.
- It'll help me.

JOEY: He told me it actually
happened at a work party,

so I'm gonna go investigate,
round up a list of suspects.

Brian?

- Cameron? Uh...
- Mom.

You were supposed to watch out for him.

Hi, honey. Hi.

Hi, Ma...

Okay... What happened?

Uh, he had trouble breathing
and developed an arrhythmia.

Does Brian have any
allergies that you know of?

MONIQUE: No. No. Uh, Cameron does...

He carries an EpiPen... But n-not Brian.

He's healthy. So was Dad.

Their dad passed a couple of months ago.

They said his heart just stopped.

KACE: Sorry to hear that. Ma'am, did...

Did he happen to have a heart condition?

High cholesterol, blood pressure?

MONIQUE: No.

No, the doctor said something about

an abnormal EKG once,
but-but he was fine.

And then he was gone.

- Sudden cardiac death.
- Could be a lot of causes for that.

- Brugada syndrome...
- We need an EKG.

W-What's happening to me?

That's what we're gonna
find out. Okay, Brian?

We're gonna take good care of you.

Stay strong.

Hi.

[GRIFF MOANS]

Isn't it beautiful?

Sure. In a life-threatening,
nearly inoperable way.

SAM: The tumor is encroaching

in Koch's triangle.

If we take too much tissue,
we'll destroy the architecture

of the most critical region
of the heart and she'll die.

And if you're even slightly
off, you destroy the AV node

and doom her to abnormal
conduction issues.

[SIGHS] Still, a radical
resection is our best approach.

Well, that's the traditional approach.

Which is appropriate in this case.

You'll never get all the tumor.

Whatever you leave behind
will grow right back.

Well, what about
endovascular interventions?

- Not aggressive enough.
- CALEB: We could try

- to shrink it first and...
- There's not enough time.

The tumor's growth rate is too rapid.

What we need...
is the Griffith technique.

What is the Griffith technique?

It's not a technique, it's a theory.

It's a theory about
a technique. Cryoablation.

- He came up with it in med school.
- I came up with it in med school.

Liquid nitrogen.

Kills the tumor while avoiding the risk

of taking away too much tissue.

Has it ever been done?

Only in his mind.

You can't really run a trial.

True. But if we replicate the surgery

in a virtual environment,

you can have as many sh*ts as you want.

Exactly. Beam me up, Dr. Tucker.

SAM: Don't you think we should

also be strategizing

a conventional surgical approach?

If you can chart a course
through that AVM

without k*lling her, let me know.

I see nothing.

Haven't turned it on yet.

Ah.

Okay. You're good to go.

[LAUGHS]

SAM: Hmm.

Oh, uh, Doctor, one more thing.

Double ristretto. No sugar.

Ooh...

Oh.

I'll get him his coffee.

Oh, and apparently,
he also needs a snack.

" muffin."

[SIGHS]

Look, we can do this.
We've done it before.

Yeah, that's the thing.
We know where this road goes.

And we did it before
because we didn't know

there was a better way, but now we do.

You showed it to us, Sam.

Do you really want to go
back to the way it was?

I need to get my mom's job back.

- So I need him to take over...
- DONNA: Dr. Tucker,

a Dr. Quintero called,

says you were supposed
to meet with her an hour ago?

Yeah, I forgot,
I got wrapped up in the case.

Uh, is it okay if I...

Yeah, I'll go check on my mom.
I'll meet you in SIM lab?

- Okay.
- Okay.

How'd it go?

Uh, the board will hear your
mom's case on one condition.

What's the condition?

The interim CMO has
to sign off on her appeal.

What interim CMO?

[GASPS] Rhonda?

What can I do for you, Doctor?

Well, board didn't
waste any time, did they?

Ah, someone has to mind the shop

while your mother's case is pending.

Mm. About that...

I need your help.

The board's decision
to remove my mother was...

Was purely political.

Your father made the mess.

She was just the straw man.

So you agree, it's unfair.

Of course.

But fairness was never
a priority for your mother.

Rhonda, look,

I know you have personal
differences with my mom,

and frankly, right now, so do I.

But the board won't hear this appeal

without your support.

Vivian abused her power for too long.

Maybe it's not fair
that this is what unseats her,

but frankly, it could have been
a hundred things before this.

It's time for a change.

I'm not getting anywhere
with the tumor or my mom's case,

and I'm thinking that it
might be time for a plunge.

A plunge. Yeah.

- What, now?
- Yeah.

What do you say?

Okay, so you know that
doctor that was trying

to get in touch with me, Dr. Quintero?

Um, she works for Harbor Memorial.

They have an opening in
their residency program.

She's here to interview me.

Why would they interview
someone who didn't apply?

- I don't...
- Sam, I did apply.

Caleb... do you want to leave?

I don't know, Sam.

With your dad in charge again,

feels like we're going backwards.

Right.

Don't let me hold you up.

Sam...

No, have a great interview.

[SIGHS]

I've ruled out two paramedics
and an orderly.

But I think he's a prime
candidate. What do you think?

If you want to talk
about Tim's cheating,

talk about it with Tim.

Fine.

Somebody help!

- What's happening?
- He's in unstable V tach.

Get the pacer pads on him.
We got to shock him out of it.

[HIGH-PITCHED BEEPING]

[WHIRRING]

Charging. Clear.

Is this the Brugada syndrome?

No, it's not Brugada.

It didn't work. He's back in V tach.

Another of amio.

Increase to joules and shock again.

LEX: Clear.

[DEVICE DISCHARGES]

[BEEPING CONTINUES]

He's maxed out on antiarrhythmics.

I have an idea.

Double sequential
external cardioversion?

Took the words right out of my mouth.

- [HIGH-PITCHED WHIR]
- Ready?

Clear. Clear.

One, two, three.

[MONITOR BEEPING STEADILY]

He's back in sinus. It worked.

I mean, yeah,
but his pressure's still low.

Let's get him on an epi drip.

Somebody want to tell me
what I'm missing?

[MONITOR BEEPING RAPIDLY]

Acute heart failure.

Her tumor is obstructing the valve.

Get the intra-aortic balloon pump ready.

I know she's out, but sedate her anyway.

Should I page the rest
of the team again?

I think I'm it. Let's get this catheter

into her femoral artery.

Ready?

I'm into the aorta.

Ultrasound?

Confirming the balloon's position.

Good.

It's in place. Turn it on.

[BEEPS]

- CURTIS: What are you doing?
- SAM: The balloon should reduce

the workload of her heart and
allow it to pump more blood.

[EXHALES] Okay.

It's working.

- You got this?
- Yeah.

The device is working,

but it's gonna take hours
to reach maximum effect.

When are you going
to take the tumor out?

As soon as I know
that we can do it safely.

But it hasn't been done
successfully, though, has it?

That's what the reporter said.

What reporter?

[BEEPING]

[GRUNTS]

[SCOFFS] According to this

highly flawed video game,
I just k*lled the patient

times.

Did you call a medical
journal about our patient?

I called about the tumor.

I said nothing about the patient.

We do not alert the press to
patients currently in our care.

The tumor is a significant
medical finding.

What's the problem?

You are, Dad.

Do you really not see that?

Mom lost her job because of you.

- Well, I'll...
- Patient feels violated

because of you.

Caleb is interviewing for another job.

- Well, that...
- Joey is hiding in Trauma.

- And Isan will not call me back.
- [SIGHS]

The department is falling apart.

The department is fine.

No one thinks this is fine.

The chief does.
You stepped aside, remember?

Yes, because I didn't like
who I was becoming.

Because I'm a better chief.

I never said that.

No, I'm saying it.

And what I say goes.

Because I'm the chief.

- [CLEARS THROAT] Mm.
- [SIGHS]

Good luck not k*lling her a th time.

♪

What are you doing?

[CLEARS THROAT]

I'm jumping into a tub
of ice water to clear my head.

I have a better way to do that.

Can I wear my robe?

[CHUCKLES] If you want.

Uh, though, you will need
a pair of socks.

Has anyone ever told you
that bowling is deeply uncool?

That cool enough for you?

I stand corrected.

You're up.

[SCOFFS] Can't wait to follow that.

[LAUGHS]

[EXHALES]

Do you have any tips?

Uh, yeah, don't do that.

- Great. Thank you.
- [BOTH LAUGH]

Something is different about you.

You have a little spring in your step.

Must be the bowling shoes.

I don't think it's the shoes.

I think being on the board suits you.

You know what? It does.

Which is weird.

Why is that weird?

Well, I mean, nothing's
really changed since I got

the board seat, but
everything feels different.

Think about your day.

- Oh, no. I'd really rather not.
- [LAUGHS]

[SIGHS]

- Just a classic overcorrection.
- Yeah.

How many things in your day
are decided by somebody else?

Uh... Your dad calls a press conference,

you got to deal with it;

your mom's in trouble,

you got to deal with that; Rhonda

doesn't want to help you,
now you got to deal with that.

Now that I am on the board,

I realize that I don't want

to have to deal with
other people's decisions,

I want to make my own.

It's like I went from being the pins...

To being the ball.

Mm. And it feels good.

Okay, so...

is there another board seat
coming up for me, or...?

See, that's the thing.
You don't need a board seat.

You just need to decide
that you're not gonna let

anybody else run the game.

Stop being a pin.

"Stop being a pin."

Our relationship was a pin.

You know, we kept getting hit by things

that were out of our control.

It's like we never had a chance.

I see what you mean.

I think if things were
different around here,

they'd be different for us, too.

Your turn.

So, the epi drip
isn't helping Brian's heart.

Vega had to call a CT consult.

Who?

Me.

I just answered the page,
I'm not trying to...

Patient is years old, came
in with respiratory distress

and developed a persistent arrhythmia.

Yeah, also, his, uh, his name is Brian.

It was you.

- Whoa.
- I talked to Tim.

And I'm gonna take something
that belongs to you.

Guy, what are you doing?

Don't like how it feels?
Maybe you shouldn't have

slept with my fiancé.

- LEX: Stop.
- I'm gonna keep this.

No, you're not. Give me that.

And this is not the place, Joey.

Wait, you told him?

- You knew?
- Wait...

- You're just as evil as he is.
- Hey, watch how you talk to her.

Don't tell him how to talk to me.

I told you to stay out
of my way. I don't want

to see you, and I don't want to
hear anything out of your mouth.

- [VEGA CLEARS THROAT]
- What?

We done?

Out of my ER.

Griff?

Vega.

Patient's in .

Dr. Trulie, you know I don't like drama.

And since you got here,
I like it even less.

[MONITOR BEEPING RAPIDLY]

We've repleted his electrolytes
and put him on an epi drip.

Should we max it out?

Nope. He's decompensating too fast.

We need to get him on
an LV assist device now.

Ma'am, we're gonna
take him up to surgery.

I'll be back to talk to you soon.

Okay?

You, stay on the floor.

He's in good hands.

You know, of all the kids

who've come into this ER after a fall,

your brother's
the only one I've ever seen

without so much as a scraped knee.

What are you saying?

I don't think Brian fell.

I don't think he was
skateboarding or running

or climbing a fence.

I-I know you were trying
to look out for your brother,

and I bet that's hard,
especially with your dad gone.

But right now,

if you really want to look out
for him, you need to tell me

what actually happened.

Cameron. Honey.

What were you two doing?

Joey, is my dad with you?

He got called to the ER for a consult?

Yes, and he stirred up
a bunch of trouble down there,

for which I am being punished.

Is he with you or not?

Not. He's headed for surgery with Vega.

Okay, well, so are we.

The tumor in Amy's heart
is blocking her tricuspid valve.

Since when? It grew
since she's been here?

Yes, and it's gonna keep growing
unless we get it out of there.

Will you tell them
to prep an OR, please?

We need to move.

Stop the epi drip.

Go on.

The boys were vaping.

When Brian couldn't breathe,
his brother thought

he was having an allergic reaction.

We gave him the epi, but it didn't help.

'Cause it wasn't an allergy.

Catecholaminergic polymorphic
ventricular tachycardia.

- It's a genetic condition.
- Mm-hmm.

Vega's running tests to confirm.

I think it's what k*lled their father.

Right, I'll put him
on a temporary assist device

- till his heart recovers.
- Okay.

I'll let the mom know that we're
doing a different procedure.

Uh, Lex.

I blew it.

What we had was good, and I blew it.

You know what was good?

What Sam and I had.

That was good.

Lex, I...

I doubled down on us
and it cost me my best friend.

So, yeah.

I'm the one who blew it.

[WHIRRING, BEEPING]

SAM: Ten blade.

- [SAM GRUNTS]
- CALEB: Oh.

Let's get Tanya to her vineyard.

Ooh, okay. There's the AV node.

SAM: Mm-hmm.

We're almost there.

- [RAPID BEEPING]
- No, no, no, no.

No, no. Long scissors to me.
Come on, Tanya.

Stay with me.

Her cardiac output is falling.

SAM: Increase the pump
to six liters per minute.

We can do this.

NURSE: Hemoglobin dropping to . .

Infuse her with two more units of PRBCs.

I can't get the rest of the tumor.

Hey. It's not your fault.

There's nothing left to do.

Yes, there is.

What, your dad's technique?

He could never get it
to work in the SIM lab.

I did. Couple times.

You didn't tell me that.

Just needed a little modification.

Get me cc's of fibrin gel matrix.

For ortho reconstruction?

Exactly.

We'll freeze the remaining tumor,

and then reinforce
the healthy tissue around it.

I'll use the gel matrix

to create a connective tissue
scaffolding.

Oh. Well, that's a really good idea.

Well, here's hoping it works.

Have the cryoablation catheter ready.

More exposure, please.

- There it is.
- CALEB: Mm.

I hear we have an
atrial myxoma resection.

They're not resecting it.

What are they doing?

The Griffith technique.

[WATER RUNNING]

[SPRAY DISPENSING]

The remaining tumor is neutralized.

All the tissue is frozen.

The surrounding structure
appears intact.

Let's put it to the test.

CALEB: Taking her off pump.

[MACHINE CLICKS]

- [HEART b*ating]
- [MONITOR BEEPING]

[GASPS]

[EXHALES]: Oh...

[SAM LAUGHS]

CALEB: It worked.

SAM: Let's close her up.

Whew. That was incredible.

You were incredible.

- Fibrin gel reinforcement?
- Yeah.

- That's brilliant.
- [LAUGHS]

What made you think of that?

It was just an idea that I had.

And I was tired of waiting for my dad

to come up with something.

I was tired of being a pin.

[CHUCKLES] It's-it's this thing
that Malcolm said.

I need to change things instead
of waiting for them to change.

- Malcolm said that, huh?
- Yeah.

I also think that this might
help with my mom's case.

You know? Like...

good press would be a feather
in the cap of an interim CMO.

I wonder if Rhonda would support
her appeal in return.

Yeah, sounds like a good deal to me.

Yeah, I mean, you know, press is
normally more my dad's speed,

but, like, I could make
an exception for her.

- What's wrong?
- Nothing.

Um, but when you're done
with your press and the fanfare,

I just need a letter of recommendation,

for the Boston job.

Wow. Right.

So, you're going if you get the job.

If I get the job.

And even if you don't,

we're not...

I mean, "we're done"
is what you're saying.

I need to change things instead
of waiting for them to change.

Just like Malcolm said.

- Schedule's out.
- Hmm?

Hmm.

That was not my drama you saw today.

But since we're sharing,

my personal life did take a hit today.

A big one. But I kept it in check.

And if you had any idea
how hard that was,

you might appreciate
that I still gave it

everything I had today.

Now, that might not make you like me,

but at least you wouldn't
put me back on nights.

Whose drama was it?

I speak for myself.

Other peoples' personal lives
are their business.

- You prefer days.
- Yes.

- [KEYBOARD CLICKING]
- Weekdays?

Ideally.

Dr. Kace can have nights.

Okay.

Thank you.

Pyne.

- [EXHALES]
- Look,

I didn't mean to interfere
with your marriage.

Then you shouldn't have
slept with my wife.

See, I have spent

enough time with you lately
to know what's behind

your bloviating and bravado.

People look at you
and they see many things.

A renowned surgeon.

Pathological narcissist.

Womanizer.

But I know the truth.

I know that what you really are
is a petty, weak, insecure

little man clinging onto things
he has already lost.

And everyone knows it but him.

[DOOR OPENS]

[EXHALES]

- Hmm.
- Oh.

[CLEARS THROAT]

Successful cryoablation
on an atrial myxoma.

That's one for the books.

[LAUGHS SOFTLY]

One for the medical journals, anyway.

Rhonda wants me to do interviews,

so I am gonna talk about the procedure,

and she is gonna talk
to the board about Mom.

My procedure.

Your procedure repeatedly k*lled
a virtual patient.

Mine saved an actual life.

You're not really gonna turn
this into a turf w*r, are you?

You're not really gonna take credit

for my technique, are you?

I performed the surgery.

Which you could never have done
had I not first...

Excuse me, fibrin gel
reinforcement was my idea.

So you're going to steal my
technique like you stole my job.

It is never gonna change, is it?

[LAUGHS] We will just keep doing this,

and things are never going to
change unless I change them.

I'm taking the department back.

- It's all yours for the next week.
- No.

I am taking it back for good.

[ELEVATOR DOORS OPEN]

Hey, I heard you got Rhonda
to talk to the board.

I'm ready to be the ball.

Oh, really? What are you gonna do?

I'm gonna be the chief.

And you're gonna be on the board.

And things are gonna change around here.

I like the sound of that.

Then let's do it.

Let's do things differently.

I'm in.

- Sam.
- I can't stand the thought of you

going through a breakup alone.

[SIGHS]

How are we supposed to talk about it?

Uh... How do we talk about him?

I think we call him Barry.

- Barry.
- Yeah,

'cause we can talk about Barry.

I'm so sorry, Sam.

How could I let Barry
ruin our friendship?

He didn't ruin our friendship.

He helped it.

Lex, there were all sorts of things

we never would've talked
about if it wasn't for...

Barry.

Things that needed to be fixed.

So our friendship isn't ruined.

It's getting better.

Yeah. It is.

Barry is still a jackass, though.

Oh, yeah, he is the worst.

The worst.

Do you want to get those braids
out and talk about it?

- Can we sip on some wine first?
- [LAUGHS]: Yeah.

SAM: You always go in with a plan.

But then things change.

So then you have to change the plan.

Maybe you have to make a whole new one.

I still don't know what to do.

You said if I told you
that it would help.

[EXHALES] Lex was right.

Knowing who it is doesn't help.

I'm still so angry.

So then why are you down here?

♪

♪ You shut me down,
you like the control... ♪

SAM: It's complicated.
There's not always a clear right answer.

♪ Like I'm a child... ♪

Sometimes you just have
to make a decision

and hope it's the right one.

♪ Try to hold it down,
I know the answer ♪

♪ I can't shake it off ♪

♪ And you feel threatened by me... ♪

SAM [OVER DEVICE]: In this case, it was.

My method to neutralize
the tumor succeeded.

[LAUGHS] Damn.

What's Dr. Barry gonna think about that?

Oh, just wait.

I will continue to champion
this kind of innovation,

so that more doctors
can have more success stories

like this one, and more patients

can live longer, healthier lives.

And I will do that
as the permanent chief

of my department.

I don't think Barry's gonna like it.

Not even a little bit.

[LAUGHS]

SAM [ON RECORDING]:
This victory is all of ours.

But the technique is mine.

♪ I wanted you to know
that you don't belong here ♪

♪ You think you're so important
to me, don't you? ♪

- ♪ Don't k*ll my vibe... ♪
- [SHOUTS]