08x12 - We All Know What They Say About Assumptions

[bunniefuu]

OR . is the fruit
of years of development.

Dean won't be swayed
by Dayton's new shiny toys.

I don't know if we're
on a path to getting

back together or divorce.

I'm here if you ever need to talk.

I know.

Liliana? I've been out to her house
twice for dinner now.

Third one's on the books.

That's wonderful. I'm so happy for you.

In the OR, you were in pain.

I'm fine, Dr. Asher.

But you have to let
somebody check you out.

[DRAMATIC MUSIC]

Any nausea, vomiting?

Nope.

Trouble sleeping, headaches?

I mean, you've met my interns, right?

Come on, Mark.

I see the pulmonary edema in my X-ray.

What's going on?

BUN, creatin, potassium all elevated.

Heart rate and BP are up, too.

Fluid retention. Crap.

You been staying off the NSAIDs?

- Of course.
- Sticking to the renal diet?

Man, I think I've maxed out
on the amount of cabbage

I can eat in one day.

So what now?

Diuretics?

We'll start you on low-dose Lasix,
see if that reduces the swelling.

It's gonna be hard to run an ED

when I'm in the john every half hour.

You could always let
your kidneys fail and k*ll you

if your interns don't get you first.

Sweet release.

All right, Mark. Thanks.

Sure.

It's open mic night, so there'll be
more people there than before.

I'm gonna get there very early.

Gonna be seat
right down front right there.

You don't have to come
to every silly time I sing.

Of course I don't have to come.

I enjoy it. I enjoy watching you sing.

- Morning, Dan.
- Peter, how you doing?

Hey, Peter, have you...

Have you met my friend Liliana?

No, I mean, that is yes.

I seen you around.
Uh, housekeeping, right?

Yes.

We met actually at a... at a nightclub

where Liliana was performing.

She is a sensational opera singer.

I just sing for fun, for myself.

Well, it's very nice to meet you,

and thank you for
excellent work around here.

Mm-hmm.

Dave.

You know, I can't believe
this has never occurred to me

before, but...

But my... I have a really good
friend who was on the board

of the Lyric Opera.

Oh, no, no.

They're very nice, Daniel.

Oh, no, I was just thinking maybe

I could find out when the next
round of auditions are or something.

Oh, no, I don't think so, but thank you.

♪

I should get to work.

Okay.

Oh, I will...

I'll see you later.

[QUIET DRAMATIC MUSIC]

♪

Okay, thank you. Thank you.

- [CAR DOOR SLAMS]
- Maggie.

Sharon.

- You're a lifesaver.
- What happened?

Said it was the fan belt. I don't know.

Oh, man.

You know Ben normally
takes care of these things,

but, you know, I'm trying to
give him a little bit of space.

It's not easy, is it?

Yeah. Oh, thank you.

Thank you.

No.

Thank you.

No, I just... I don't know
how we come back from this

if we don't talk.

Well, you know time is a great healer.

I hope so.

Sorry I made you late for work.

Oh, please.

With Jack Dayton in charge,
no one's watching me clock in.

[ENGINE ROARING]

[TIRES SCREECH, OBJECT THUDS]

- Help!
- Did you hear that?

Yeah, over here.

Help! Help.

She's been hit. That car hit her!

We're nurses. Let us help you.

That maniac hit her straight on.

What is her name?

Rose Howard.

- Rose.
- Rose?

Are you okay?

I'm fine. I'm more worried about her.

- Please, please.
- Okay.

Rose, nod if you can hear me.

Let me call an ambo.

Please, you have to help her.

I'm gonna look into your eyes, Rose.

There you go.

There you go. Yes.

- Okay.
- Ambo's on its way.

Great.

- I'm right here.
- Gonna keep you warm, girl.

There you go.

[DRAMATIC MUSIC]

[SIREN BLARING]

Here's the ambo.

Eyes open. You're good. You're good.

Ms. Goodwin, Maggie, what do we got?

Peds versus auto.

No loss of consciousness,
but she's shocky.

Her name is Rose Howard.

All right, we gotta move her.

Okay. A little help.

On my count, one, two, three.

Rolling.

Okay, it's okay.

It's okay. There we go.

I'll switch places with you.

On my count, one, two, three.

All right. There we go.

♪

Yeah, we got an ambo coming in.
We're trailing.

I'm sorry. You can't ride along.

Rose is too unstable.

We'll send another ambo
to come check you out.

No, I'm fine. Go on.

Get her to the hospital please.

- She needs to be examined.
- Go.

We got her.

I have a first aid kit in my car.

Listen, listen, we work at the hospital

- where they're taking Rose.
- Okay.

Maybe you can ride with us
and so you can stay close,

and then we could get
you checked out, okay?

- Okay.
- It's all good, okay.

Okay.

Yeah, let's go.

Let's go.

All right, let's go.

Hey, Jack. Thank you.

You have a moment?

Yeah. For you, always.

Oh, actually, you two ought to meet.

Now this is Dr. Grace Song.

She's an incredible surgeon
in her own right,

and I managed to lure her
away to Dayton Corp.

Crockett Marcel.

Pleasure to meet you.

I heard you and .
are a match made in heaven.

Well, it's a remarkable advancement

and exactly what I'd like to talk about.

- Yeah.
- So I...

I'd like to train other surgeons on it.

Right now, it's just me,
but it would help

if more could familiarize
themselves with the suite.

Well, . was always intended to be

an adaptive platform, so more users,

more data, better outcome.

- Yeah, bring in who you want.
- Great.

I'll see you around.

- Mr. Dayton...
- Yeah.

Did you get a chance to read my email?

I saw it. I just haven't opened it yet.

Okay, I'd really like
to set up a time...

You know, just hold that thought.
This may address your concern.

Good morning, everyone.

Promise not to take up
too much of your time.

Now, it's become clear to me
over the past few weeks

that, well, I have a lot
to learn about medicine.

And when I don't know something,

I like to turn to the experts,
and that's you,

which is why I asked Dr. Grace Song here

to spend a little bit
more time in the ED.

Now she is one of my top minds,
and I've tasked her

with finding ways to make
your jobs easier, more efficient,

so that you can keep doing
your incredible work.

So please feel free to discuss
with her any areas

that you feel can be better optimized.

Thank you so much. I hope that helps.

Actually, no, that doesn't help.

So is that your plan,
replace us with robots?

Dr. Archer.

Yeah, you'd get more jokes in
if you were actually on time.

Or we can program
the robots to be funny.

No one likes change, and I tech
can feel overwhelming, but I...

I'm not some Luddite.

I... I just don't think we need
to invent high-tech solutions

for problems that don't exist.

Totally.

That's part
of what's exciting right now.

We're deciding how to use tech

so that it's empowering
without it making us

want to pull our hair out.

It works for us,
not the other way around.

Couldn't have said it better myself.
See you in a bit.

That's a fine sentiment, Dr. Song.

I'm curious to see
how you put it into action.

Okay, well,
take Ginger Spice over there.

You could be verbally charting directly

into our new EMR instead
of wasting time typing

or copy-and-pasting.

Typing after I see a patient
is how I've always done it.

You're creating more work for yourself.

You still have
to manually input your notes

and, in the interim, hope
that there's no gap

in communication with nursing.

Hasn't been a problem before.

Besides, it allows me to have time

to wrap my head around
patient history, lab results,

before handoff.

Or you could be spending that time
with more patients.

With my nose buried in a screen.

This little debate is stimulating,

but I'm sure you'll find
it's also very inefficient.

Case waiting for you in , Ginger Spice.

Thanks anyway for the suggestion.

Here to help.

Mr. and Mrs. Rouse.

- Please, Connie.
- David.

Our son Jason.

Hey, Jason.

Hey, heard you're not feeling well.

What?

Where am I?

We're at the hospital, honey.

I'm gonna listen
to your chest, all right?

Leave me alone.

Sorry, buddy. Almost done.

He's been irritable, confused.

We thought he was just tired.

He recently joined the soccer team.

He's crazy about it.
Wouldn't stop playing.

But then he stopped eating as much

and didn't have the energy to play.

Please, you gotta understand...

[SOFT MUSIC]

♪

years ago, we lost our son Axel
before his first birthday.

First, he wouldn't stop crying,
then he got weak,

and then finally seizures.

We had to watch our son disappear
right in front of our eyes.

The doctors poked and prodded
him with thousands of tests.

They even came up to our house
to check for lead and mold.

Yeah, all that and they
never figured out how to help.

I'm so sorry.

We've been vigilant,
probably paranoid, ever since.

Every sniffle, every scrape,
he goes to the doctor,

but now this.

Well, without a diagnosis,
I don't want to speculate

about a possible connection.

I think Jason is likely
dealing with an infection,

but I'll make sure
we're casting a wide net.

- Okay?
- Yes, please, anything.

Hang tight.

We'll figure this out.

Dr. Asher, incoming
postpartum and bleeding.

- Got it.
- Jackie, going to .

Laurel Wilson, years old,
G P postpartum day .

- Found unresponsive.
- There was so much blood.

GCS , BP initially over
palp with heart rate of .

Liter of saline improved her
to over , rate .

Okay, how much does she been bleeding?

I don't know. How... how could we?
That's the problem.

Okay, on my count.

Ready. One, two, three.

- Has she passed any clots?
- Yes.

What size? Golf ball, apple?

Golf ball, I think.

I... I told her to call ,

but she was passed out when I got home.

CBC type and cross-match, CMP coags,

and hang two units of O neg.

On it.

What's wrong with my wife?

I believe she has a piece
of retained placenta,

which is why she hasn't
been able to stop bleeding.

♪

Okay.

Yeah, there it is.

I can bring her through this, but I need

to perform a procedure
to remove the tissue, okay?

Yeah.

All right, open the hybrid OR
for an emergency D&C.

You got it.

♪

We're going to Baghdad. What do we got?

Rose Howard, -year-old female, MVC.

I gave her normal salines
on the ride,

but her BP's still hovering
at over .

Rate's s.

Okay, two units of whole blood please.

- Pelvic fracture?
- Yeah, Ms. Goodwin and Maggie

thought they felt instability,
so they wrapped in the field.

All right, we need X-ray in here.

All right, let's get her transferred.
Nice and easy on my count.

Here we go, one, two, three.

[MOANS SHARPLY]

All right, thanks, Caesar, Tanya.

All right, X-ray chest and pelvis,

and let's get her on the
rapid transfusion, please.

Hey, Rose. I'm Dr. Marcel.

We got you, okay?

It still hurts.

Okay, well, let's have a look.
Fast scan.

Yeah, good amount of fluid in her belly.

Yeah, she'll need a lap.

All right, let's see
what the X-ray shows.

Okay.

Thank you, Kaley.

X-ray up.

Comminuted pelvic fracture
to the iliac wing.

Mediastinum's high.

Right, we'll deal with those later.

The abdominal bleeding's our priority.

All right, Rose, we're gonna
take you up to surgery now.

Kizzy, yeah, call upstairs.
We need an OR.

. is open.

Better imaging's available,
and we still don't know

the full extent of her injuries.

And emergent trauma is not the time
to play with your fancy toy.

No, we're gonna treat
this abdominal case

like all the others, all right?
Let's go.

[UNEASY MUSIC]

♪

It's all my fault. We were arguing.

She started to walk away.

I ran after her and tried to grab her,

and that's when the car
came out of nowhere.

If I just let her go,
maybe she would have...

No, no.

It was the driver's fault.

Paola, you okay?

Talk to me.

I can't breathe.

I don't know...

Maggie, there's a stethoscope

in the first aid kit in the back.

Paola, listen to me.

Focus on your breathing.

Take long, slow breaths.

Okay?

[HYPERVENTILATING]

Diminished breath sounds on the left.

Distended neck veins.

Tension pneumothorax.

What's that mean?

Paola, did the car hit you, too?

Didn't think it was bad.

You probably have a broken rib
that's punctured your lung.

That's why you're having
problems breathing.

We can't wait.

We have to relieve
this pressure on her chest.

Okay.

There's an IV catheter
in the inner pocket.

Paola, we're gonna help you.

I'm gonna pull down your shirt,
and in count of three,

you're gonna feel a pinch.

Okay.

One, two, three.

Unfortunately, I can't offer
any solutions yet.

Jason has no signs
of electrolyte imbalance,

no markers for infection,
or any other abnormalities.

By the numbers, there's nothing
to explain his symptoms.

You're kidding me. Look at him.

I know this is frustrating,
which is why I'd like

to order a few more tests.

There's always more tests.

Can you at least tell us
what you're looking for?

Of course.

Jason symptoms still strike me
as an infection,

but it could be hiding,

okay, in his spinal cord or his brain,

which would explain
the lethargy, his confusion,

and the kind of infection that
wouldn't show up on standard tests.

So I'd like to do a CT of his head
and a lumbar puncture.

Basically, I'd insert a needle...

[ALARM BLARING]

He's seizing.

Jason!

Nancy, need a hand in here.

[DRAMATIC MUSIC]

. of Ativan.

♪

Okay, Ativan's in.

Hey, buddy.

Jason, can you hear me?

Okay, can you look at me?

Look at my finger.

That's good.

Good.

Mom, Dad?

It's happening again, isn't it?

It's just like Axel.

♪

Dr. Charles, can I get your help?

What's up?

Patient in treatment , Richard Wyatt.

Oh, the guy that's...

That's running for city council.

Yeah.

He was supposed to do
some interview this morning,

but his campaign manager
found him disoriented

and slurring his speech
with a small bruise

on his head.

Brought him in.

Anything interesting in his chart?

Yeah. Workup was negative. He's fine.

Except for the combo
of alcohol and benzos.

Don't know if it was
an accident or intentional.

Oh.

I will... I'll go chat with him.

Yeah. Thank you.

[KNOCK AT DOOR]

How you doing? I'm Dr. Charles.

I hope you come
bearing discharge papers.

Not sure that those are quite ready yet.

Any chance we could expedite them?

The sooner we leave,
the sooner I can reschedule

the interview with Mathews.

He doesn't know why
we're rescheduling, right?

You handled it?

Of course.

Do you mind if I just get
a quick moment with Mr. Wyatt?

Fine. Okay.

Be in the waiting room.

Thank you.

[LAUGHS] Feels like I'm
in the principal's office.

- Is something wrong?
- No.

Not at all.

I just wanted to have a quick chat.

You know, I really need
to get going, all right?

Lots to do.

Completely understand.

You did have a mixture
of alcohol and benzodiazepines

in your system, though.

I know what you're thinking
what this might look like,

but it was just a stupid accident.

Well, look, that's good to hear.

I just want to make sure
your prescribing doctor

did make it clear that it's

a potentially lethal combination.

I mean, I know you shouldn't
mix medication and alcohol,

but, you know, I defy anyone
to get through a fundraiser

without at least one scotch.

I mean, if I'd known
it was that dangerous...

Wow.

Your fundraisers sound
pretty stressful to me.

You think that might be
why you took the medication?

What? No.

No, look, I just needed to take
the edge off

for the Mathews interview, all right?
He's tough.

Do you just... Do you mind me asking

why you were prescribed
benzodiazepines in the first place?

Look, this was a one-off mistake,

and I'd appreciate it if you'd just
check on my discharge papers.

Got it.

I will get with Dr. Jacquerie and see
if we can move that along.

Nice to meet you.

So what's his deal?

I don't think
this has ever happened before,

but, you know, he's
definitely self-medicating.

Depression?

I think it's some kind
of anxiety disorder,

but anyway, he just wants
to get out of here.

I don't have a reason to keep him,

- but if he's got an issue...
- Not enough to hold him.

I'll just, you know, make sure
he has the proper referrals

before he leaves.

Yeah. This is why I like surgery.

Patients don't talk.

Hmm.

Saw you ordered DNA sequencing

on your patient Jason Rose.

You reading my charts?

It's a pretty unusual test
to order in the ED.

Caught my eye.

Apparently no one has anything
they wanna optimize

around here, so I'm
just twiddling my thumbs.

Jason's brother Axel d*ed years ago

from uncontrolled seizures,
no diagnosis.

And now that Jason's had a seizure...

You think they're connected,
so you ordered the sequence.

And these.

Epileptic encephalopathy.

I ruled out infection,
environmental factors,

and most autoimmune diseases.

Genetic mutation's

the only thing that makes sense.

Trouble is, epileptic encephalopathy

has link to hundreds
of different mutations.

More like , .

And every disease path has

a different course of treatment.

So it's gonna take forever to
narrow down this differential.

I think I might be able
to do that for you.

I could construct a neural network

using existing DNA databases.

Basically bundle them all
together and put Jason's DNA

and compare it against tens of thousands

of known mutations.

This neural network
would take a few hours to code,

but it could give you
a highly probable diagnosis.

Assuming the mutation's already

in one of these databases.

We work with what we have.

[SOFT MUSIC]

Uh, I appreciate the offer, Dr. Song,

but these parents are terrified and need

a human they can turn to.

So I have to figure this out
the best way I know how.

You know where to find me.

Yeah.

You know, my mom said
Nathan's looking all around.

- Sweet boy.
- [LAUGHS]

So, Laurel, the piece
of retained placenta

has been removed, which
should resolve the bleeding.

Thank God.

I'll still be able
to get pregnant, right?

A big family has always been the dream.

Infertility is
an extremely rare complication

from a D&C, so yes.

Then I can go home soon?

I'd like to continue
monitoring you for a while.

You did have heavy bleeding
for nine days.

You know, we called the doctor's office

to try to get checked out earlier,
and they said it was fine.

Yeah, I...

I felt like something was off,
had no appetite,

and the bleeding seemed heavy,

but I didn't know if heavy
to me was normal

to the doctors, you know.

Bleeding can be difficult
to gauge and is subjective.

And even harder
to evaluate over the phone.

Uh. Oh, uh...

Should I still be bleeding?

Doris, give her a gram of TXA,

. milligrams methergin,

and also need
, micrograms of Cytotec.

Yep.

Don't worry. We can handle this.

[DRAMATIC MUSIC]

It's okay.

So this is those referrals
that I was telling you about.

Top two guys on the list are excellent.

I know them personally...

Dr. Charles, you know, you've
been very thorough, but I'm all set.

Hey, just in case, you know.

And, look, good luck with the election.

We can't go out this way.

Mathews must have followed my car here.

[REPORTERS CLAMORING]

Oh God, this can't happen.

They can't see me.
I have to get out of here.

Is there another exit we could use?

You know, we might be able
to get you out

through the waiting room. Yeah.

No, there could be more press out there.

Damn it.

How could you let this happen, Carla?

- Hey.
- What am I supposed to do?

It's okay. It's okay.

This could ruin me.

Look, you'll be all right, all right.

- Keep...
- Oh, God,

- Okay, breathe in and out.
- The insinuation.

- In through the nose.
- The rumors.

Oh, God.

Richard, you're all right. Come here.

- Come sit over here.
- No, I can't!

No, no. Get over here.

Sit down. You need to sit down.

Okay, look at me. Look at me.

Look at me. Breathe in through the nose

and out through your mouth.

With me.

In through the nose.

There you go. There you go.

There you go. You're fine.

- Okay.
- Out through the mouth.

Zach, Paola Rivera,
the other half of the MVC,

delayed tension pneumothorax.

Needle decompressed her in the car.

Oh, geez. Got it. Going to .

Maggie, she's okay.

You need a breather.

Yeah.

Good job.

Thank you.

Spleen's out.

Rose's bleeding is under control.

I'll just close and move to the ICU.

You better chest X-ray.

Widened mediastinum
could mean an aortic injury.

Yeah.

Once she's warm, we'll get her
over to CT, clearer imaging.

In the meantime, we can control
her blood pressure

and heart rate.

But if we find anything,
we gotta move her again

- to IR in order to stent.
- Yep.

That's protocol. Come on, let's go.

Look, Dean, if it's
a contained pseudoaneurysm,

we're playing musical chairs
with a ticking time b*mb.

I really think
that we should take her . .

All right, listen,
she's still being resuscitated.

I mean, who knows if she'll
even be able to undergo

another procedure?

We have to warm her either way.

Might as well do so
where we can knock out

all our birds with one stone.

Listen, . has
advanced imaging sensors.

If the aortagram finds anything,
we can stent right there.

If Rose takes a turn,
we can easily convert to open.

No waiting, no scrambling.

Come on.

I mean, don't risk our patient
where there's another way.

All right, after we close,
we'll get her over to . ,

but it's still my case.

Yeah, of course.

[TENSE MUSIC]

♪

Hey, by any chance, did you
build that neural whatever?

Neural network? Yeah.

I fooled around with it. Why?

Jason had another seizure.

I got him out of it, but two
seizures this close together,

risk of anoxia is increasing.

I'm on the edge of intubating him.

I'm running out of ideas.

I thought it might be
Tay-Sachs or Batten disease

or Wernicke's,
but I'm basically guessing.

Can I send you Jason's DNA
to run through your system?

Absolutely.

I pulled from every
public genetic database,

but they're so new,
there isn't a ton of data.

I think I'll need to borrow
from a few private companies

to expand the pool.

Okay.

How long do you think it'll
take to get the diagnosis?

An hour, maybe a little longer.

I don't know if Jason has an hour.

Is there any way
you can buy me more time?

So you wanna put my son in a coma?

Temporarily, yes.

The barbiturates
would reduce the likelihood

of another seizure, and he would be

on a ventilator,
which would protect his airway.

So you can what,
Google search his diagnosis?

You can't be serious.

The neural network is scanning
nearly half a million patient profiles.

If Jason's genetic mutation
has been documented even once,

we'll find it.

And if it hasn't been documented?

Hey, I know we're asking a lot,

but this is Jason's best chance
for a swift diagnosis.

Okay.

Do what you have to to save him.

Thank you.

All right, I'll page anesthesia.

♪

Dr. Asher, we need you.

Shouldn't the dr*gs have stopped this?

Laurel, I'm afraid you have
what we call uterine atony.

What's that mean?

Your uterus can't contract
enough to compress

the blood vessels,

so you will keep bleeding.

Until what, I die?

Unless we act quickly.

Okay, what... what can we do?

Well, only have one option left:

a total hysterectomy.

No.

No, no, no, wait.

Wait, please.
There must be something else.

I'm so sorry, but there's not.

You are decompensating too quickly.

Come on. She's just .

We just... We just started our family.

I know, and I wish
that there was another way.

But in my opinion, a hysterectomy

is the only way I can guarantee

saving your life.

♪

Just... just do it.

Get me home to my baby.

I promise.

Archer.

Yeah.

I feel like I'm operating
at a freaking sports bar.

All right, let's get
the stent measurement.

. can calculate that for you.

Yeah? You think it can give me

the over-under on the Blackhawks?

All right, we've got
a -millimeter diameter.

Calculating.

Wait, wait, wait. Come on.

Just keep that up there, will you?

Recommend stent size,

millimeters with proximal neck

of millimeters.

Suggest placing millimeter distal

to the left subclavian artery.

Looks good to me.

Get the stent please.

Don't you be smirking under that mask.

Oh, I wouldn't dream of it.

Yeah.

Thank you. All right.

All right, nice and easy.

User's heart rate is elevated.

Fine motor coordination
may be compromised.

Risk assessment increased %.

That thing talking about me?

Yeah, it says your rate's up to .

You okay?

Steady as a rock.

User's heart rate is elevated.

Risk of surgical error increased by %.

Come on. Would you shut that thing up?

Listen, I could step in,
deploy the stent.

Dr. Marcel, do you think I'm incapable

- of completing this procedure?
- I didn't say that.

Okay, then stop trying to make
friends with a machine and assist me.

Heart rate is now .

Ahh, for Christ's sake, stop...

Stop it already. What the hell?

- Dean.
- Error.

- System malfunction.
- Relax.

We'll deal with that later.
We have a patient on the table.

That was unnecessary.

System malfunction.

Error. System malfunction.

It's over.

My campaign, everything
I've worked towards for years,

gone.

You know, I'm just
not so sure that that's

actually the case.

That kind of thinking, by the way,

we call it catastrophizing

'cause, you know, anxiety will do that.

- This is a catastrophe.
- Well...

Did you miss my meltdown out there?

You know, that wasn't my first.

They keep coming.

They keep getting worse.

What about if I have one in public?

You think the electorate
wants to see that

or hear how sometimes I get so panicked

that I can't think or function?

Half the time, I have no clue
why I'm even anxious.

Oh, yeah, you know,
that sounds like a real winner.

I don't think you realize
how many people

actually go through precisely
the experience you're describing.

You know, did you know that
fully % of American adults

struggle with anxiety disorders
of some kind?

You just confirmed it.

I'm crazy.

No one will elect me,
the mentally ill guy.

Would you?

Do you mind if I tell you something
personal about myself?

A long time ago, I was actually
diagnosed with depression,

and I vividly recall
what a blow that was,

how ashamed I felt,
like I was defective.

And then really smart person asked me

if I would feel embarrassed

if I'd been diagnosed with diabetes,

if I had a heart condition.

Of course not.

Really helped me reframe my diagnosis,

because that's what it was, Richard.

It was a diagnosis.

All of a sudden, I had a name
for how I felt.

Right? I had a path towards help.

You are not crazy, my friend.

I think you're making assumptions
about what other people think

and letting it influence your decisions.

- [HEART MONITOR BLARES]
- What is that?

- He's having a seizure.
- Another one.

Give him another . of Ativan.

You said the coma would stop them,
that this would help him.

This is much less traumatic
than if he were awake.

Baby, it's okay.

Stay with us. We love you.

Now we're just watching him die.
I'm not doing this again.

Do something more.

Autosomal recessive thiamine metabolism

dysfunction, syndrome .

What? What does that all mean?

It's what's wrong with Jason,
and it's treatable.

It's a really rare disorder
where Jason can't transmit thiamine

from his blood to his brain.

Yeah, thiamine helps the body
produce energy from food.

So we'll hit him with a heavy dose.

After that, over-the-counter supplements
should resolve the problem.

Jason's gonna be okay.

Are you sure this time?

Yes.

Absolutely.

[WARM MUSIC]

♪

So I'm very interested
to get your input on all this.

I can see you're busy,

so I'll just paraphrase my email.

Dr. Asher, you can't just
burst into our meeting.

The Department of Public
Health has a new program

partnering with hospitals
for in-home postpartum wellness

checks on mom and baby.

We need to join.

Yes, I'm familiar with it.

However, it requires too much in terms
of cost and resources.

It's pennies to you.

We can revisit it
once the initiative proves its worth.

Mr. Dayton, it has already
proven its worth.

I just did a full hysterectomy
on a year old.

For nine days,
she was bleeding so badly,

she almost d*ed, and no one
knew because no one saw her.

If my patient would have had
that program,

a nurse trained in postpartum care

could have seen that
that bleeding wasn't normal

and gotten her help
before she hemorrhaged.

Instead, she has given up
the chance at more children.

This never had to happen.

So put your money
to good use and sign us up.

[TENSE MUSIC]

Okay.

Get us enrolled.

Okay. [PHONE BUZZES]

♪

Would you excuse me, please?

Hey, hold on.

How's Rose?

Should be able to extubate her soon.

I'll connect with ortho,
schedule her pelvic fixation

for tomorrow.

We'll leave her wrapped up
in the meantime.

Paola's stable, and she's
really anxious about her.

She'll be able to visit
with Rose shortly.

Great. Thank you, doctors.

Yeah.

Hey, Dean, I know you didn't mean to...

- Here we go.
- No, listen.

. adds a lot of value to what we do.

It did in seconds what usually
takes us half an hour.

Yeah, it's a backseat driver, man.

It's a tool, just like any
other instrument in the ER.

Except I don't need a scalpel to tell me

my heart rate is up.

I know it's up,
and I make the adjustment.

. just takes some time to get used to.

Yeah, maybe that's the
difference between us

all right, 'cause I trust
my hands and my instincts,

and you've abdicated
your judgment to a machine.

Come on, Dean. I mean...

You broke it deliberately, didn't you?

Oh, whoa, hold on.

No, it was an accident.

You're fired, Dr. Archer.

- Oh, that's not necessary.
- I'm not talking to you.

I want you off campus in minutes.

[DRAMATIC MUSIC]

I'll get my things.

- I can come back.
- No.

No, no, I was actually...
I was looking for you.

I... want to talk to you
about... about this morning.

I just felt a little...

I don't know... Felt a little weird

- the way we... left it.
- Okay.

Yeah.

Yeah.

I couldn't help noticing
that people were...

I don't know...
Looking at us a little funny.

Yes, I saw it, too.

So I don't know.

I'm just... I'm sorry
if it made you uncomfortable.

I think you were, too.

Oh, sure.

Absolutely.

Is that's why you told
that man I was a singer?

I... I think I wanted him to know how...

How wonderful you are.

So he wouldn't just think
that I was a housekeeper?

What?

No. No.

Are you sure?

Ye... yeah, I think I'm sure.

I mean, I don't... I don't... I don't...

- I don't know.
- Daniel,

I will never be a true opera singer.

I know my voice, and I'm happy.

But I am wondering
if that can be enough for you.

♪

I suddenly hear
my old med school professor

reminding me adherence to orthodoxy

is the physician's curse.

I wonder if you might train me
on that new EMR program

you were talking about.

No, you're gonna have to wait.

I wanna modify the dictation microphone

so doctors don't have
their noses in iPads

when talking to patients.

Excellent idea.

We need to talk.

Look, I don't have time
to discuss my decision.

You fired the chief of my ED.

You need to make time.

Your ED?

Personnel decisions
fall under my authority.

Feel free to weigh in
on his replacement.

Dr. Archer is a vital part
of our hospital.

His knowledge, his experience,

his leadership...

Dr. Archer is a liability.

He destroyed expensive equipment.
He's antagonistic towards my staff

and a general pain in my ass.

Now, look, I'm happy to consult
with you over matters

concerning the operation
of this hospital,

but this decision is final.

If Dr. Archer goes, then I go.

Are you serious?

Over Dean Archer?

I am.

He steps out of line again, it's on you.

Hello.

Brought you a visitor.

Hey.

How are you feeling?

Like I got hit by a bus.

Or a souped-up sports car, I guess.

Sense of humor's intact.

That's a good sign.

Yeah.

Maybe we should let you get some rest.

No.

Stay.

Please stay.

I'm sorry.

[TENDER MUSIC]

♪

[KNOCK AT DOOR]

Come on in.

Hey.

You're working late.

Yeah.

Well...

Look, Ben,

the longer we don't talk,

it's like the bigger
the divide between us becomes,

and I can't stand it.

You can't?

Maggie, you lied to me.

I'm sorry.

And I know that I need
to earn back your trust,

but I can't let this stupid mistake ruin

the best thing
that's ever happened to me.

[DRAMATIC MUSIC]

I'm not gonna give up on us.

Our marriage, our...

Our love is stronger than this.

♪