03x04 - Great Expectations

[bunniefuu]

Previously, on Doc.

Wasn't sure if you were

the same doctor you used to be.

Now you know
I'm as good as I was.

We had um, a dalliance.
Petered out. No hard feelings.

I want to have a child.

- We've wasted so much time.
- I know.

I'm sorry.
- Which cologne are you wearing?

What are you, pregnant?

- Ruth, crash cart!
- Coming!

That's the supply cart!

I don't feel like a doctor.

Where is the Chief,
Dr. Larsen?

She has early-onset Alzheimer's.

- Cece?
It was your heart all along.

You're going to get
your life back.

It was beyond frightening.

I actually thought I had
Alzheimer's for almost a year.

But then my amazing doctor
at Westside

figured out it was an issue
with my heart.

I wish you'd told me.

When you thought
you were so sick.

What was I going to say?

I'm losing my mind, come quick,

let me apologize
for all those things

I screwed up in our marriage?

Wouldn't have minded that.

Wouldn't mind it now either.
Since who knows how long I have.

Don't talk like that.

I have an inoperable tumor,
Cece,

what do you want me to say?
- That you're going to fight!

- I am. I have been.
- I know.

But now that my own
medical ordeal

has been resolved,
I wanna be there...

for whatever you need.

Oh! Dear!

Bonnie?

Bonnie!

Please talk to me!

I can't feel my arm.

I'm calling an ambulance.

Hey! Got your text.

What are we doing here?

I'm having kind of a crisis.

I got that from the way
you ran out last night.

I've been worried.

I know. I'm sorry
I didn't respond till now.

Okay, what's going on?

Yeah.

My OB couldn't get me in
till next week,

and I didn't want to
go downstairs,

so I need an ultrasound.

I-I know this is weird
and we're not friends, but...

I also know
that I can trust you.

Yes, you can.

Um...

There.

There it is.

CRL suggests seven weeks.

Oh.

So we can hear the heartbeat?

Are you sure?

Yeah, I've been up
all night and...

I'm sure there are
a million reasons why

I should just keep going
with my life as it is.

And-and thank God I have
the right to choose, but...

We see so much death here,
every day,

and this just feels like
I can do this.

And why not see this
as a blessing?

I-I mean, I can do this, right?

I have a great job,
and financial security,

and a community.

And TJ.

Yeah. Yes. Of course.

TJ.

You haven't told him yet?

We're having dinner tonight.

I just need the day, I think.

Then maybe wait
on the heartbeat.

So you can hear it together
when it's time.

Yeah.

Dr. Shaw's running behind,
we haven't even gone in yet.

Okay, well, just take it
one step at a time.

And give my love to Wendy.

I'm the one
who's gonna need the love

if this doesn't go how we hope.

Can you at least try
to let yourself be excited?

This is incredible.

There's a fine line between
excitement and anxiety.

I'll check in later.

Okay, bye.

So I'm sure Dr. Maitra
told you...

She thinks I have a problem
with compartmentalization.

Look, we all have our stuff.

We just have to be aware
of our blind spots and triggers

and try to stay ahead of them
so they don't affect our work.

Well, I just want you to know
that I've been working on it.

And I feel really confident
that I'll be able to deal

with whatever's thrown my way.

Ruth, I'm glad
that you're acknowledging this,

but I think you need
to slow down and hear me.

You are not going
to solve this in one day.

I know you have a relationship
with Dr. Larsen,

but there are other internists
I can bring in

if she's unavailable.
- Absolutely not.

She's the best and we will wait.

Hi.

I'm Dr. Larsen,
this is Dr. Chen, and we're...

Cece! Hi!
- Finally.

Dr. Grant here
was trying to pawn me off

on one of your underlings.

Dr. Larsen, meet Bonnie Carroll.

Tenured professor of archaeology
at the U of M.

She was also once married
to yours truly,

but that's the least
of her accomplishments.

Bonnie, this is Chief Larsen.

The brassy broad who saved
my life at least twice.

Chief Larsen?

I... it is so good to see
you, Cece...

but I have a confession to make,
I am no longer Chief.

- They demoted you?
- No, not exactly.

I had a car accident

and I was recovering
neurologically.

So the last time I saw you,

I was actually
working as an intern.

You told me you were Chief.

You were pretty unstable

and insistent that you saw
the doctor that you remembered.

Sounds like you, Cece.

So you lied?

I did. To help you.

I've been promoted
to Chief Resident.

But if you prefer,
we can ask the new

Chief of Medicine
to come and see you.

Will you enlighten her,
Dr. Grant?

Yes.

Ms. Carroll comes to us
from Eastside,

where she was being treated
for an unresectable

Pancoast tumor.
Biopsy confirmed

lung adenocarcinoma
in the right upper lobe.

She has weakness
in the right arm,

with near-complete paralysis
in grip for 24 hours.

So the tumor has infiltrated
the lower brachial plexus.

Those incipient doctors
were trying to shrink it

with chemo and radiation,

and now they're saying
that's failed.

They believe
the tumor's inoperable

given the invasion
of the subclavian artery.

They're recommending
palliative care.

And we refuse to accept it.

Present us with another option.

Dr. Chen,
get full admissions labs

and update the staging scans.

Mm-hmm.

If there is another way,
we will find it.

- Morning!
- Morning.

Heard you talking
to Dr. Douglas the other day,

saying you were
on a vanilla kick.

Ah, I am. Thank you.

You're on clinic duty today.

Clinic duty?

That a problem?

Not at all.

Paige,
Dr. Heller's yours today.

- Full house down there.
Get ready to move some meat.

Hey, listen, Doc, I am due
back at work in an hour,

so I would...
- Yeah.

Appreciate if kept this,
y'know, efficient.

Yes, sir,
I'm going to try my best,

but you got some
catching up to do.

It looks like you missed
all of your appointments

after your aortic valve
replacement last year?

Yeah, I am sorry about that.

Uh, recovery took a lot of
months, and...

I'm still paying that off,
so I can't really miss work.

Also, Dr. Swanson said that
the surgery went well, so...

Have you been feeling
sick lately? Fatigued?

I mean, yeah,

but I've been working
a ton of overtime on site.

Okay, well, I need to run
a few more tests,

but it's all routine.

I'll get the procedure set up
as soon as I can.

Are you serious?

I-I know you're in a rush,
but...

gotta get this done.

Okay? Just sit tight.

I'm sorry.

I didn't know what you were
stepping into earlier.

- I hope not.
'Cause I kind of caught you

enjoying it a bit too much.

I was just trying to figure out

how you pulled it off with Cece.
- What do you mean?

What people tell me is that

this version of you
is pretty different

than the one back then.

Dr. Coleman, just in time.

Whoa. That tumor's a beast.

Yeah. It's infiltrating
the subclavian artery,

vein, and brachial plexus,

it's even growing around
the vertebrae.

Yeah, I guess we know why
Eastside refused to cut into it.

Plus her uncontrolled
hypertension from the chemo

puts her in danger of having
a stroke mid-operation.

They were right.
You can't get it.

They can't get it. I can.

How's that?

Most surgeons
don't have the stomach

or the stamina to resect it.

Just have to go at it with three
different approaches at once.

Wa... we'll need to lower her
BP before even considering this.

Not at all. We can handle it
ourselves in the OR.

A lot better if I find
a medical solution first.

Now, we have been
down this road before.

That man had antlers
in his chest.

Plus, we don't have to scramble
with this patient.

It'll be risky no matter
when we attempt it.

You try to manage a risk away
and she'll die waiting.

Where are you going?

I'm taking my solution to them.

Now, if you have a better idea,
be my guest.

Pitch it.

- I need some time.
Don't let him start cutting.

- You sure you have to go?
- My panel starts in an hour.

And then it's straight
to the airport.

I'm just saying,
we have the room till 11,

and these panels,
they never start on time.

Ooh.

Or maybe we pick this up
in Austin next month.

Assuming you're going
to the AustinMed conference.

Round three.

Only thing is, um,

my divorce is getting
kind of nasty,

so if we could just keep this
on the down-low.

Yeah. How about
if we're in the same city,

if it makes sense.

There's no need to make it
into something it's not.

Yeah. And let's say
no texting.

To be safe. Just calls.

Yeah.

So you've done this before?

Well, not this approach exactly.

But I've dealt with a lot
of complex, invasive tumors,

and this will take more time.
But it's not impossible.

Still, you have not done this.

I'm not sure I love
the sound of that.

- What choice do we have?
Palliative care?

This is amazing news, Cece.

- Sorry I'm late.
I was doing my own assessment

of Bonnie's condition.

Good. Because he's selling us

on a surgery he's never
performed before.

The surgery's
a legitimate solution.

But Bonnie's blood pressure
needs to be stabilized first.

And I have found a way

to bring it under control
with fewer risks.

He said he could manage
the blood pressure.

And he's the Chief of Surgery.

Everyone told me
I had Alzheimer's.

And look at me now.

What's your plan, Dr. Larsen?

It's called carotid
baroreflex stimulation,

I've done it before...
- When exactly?

Three times, last year.

I see. Dr. Larsen...

A word.

I'll be right back.

When I said come up
with something,

I was hoping it'd be
a procedure you remember.

Not one you had to find
in your old notes.

My notes are thorough.

And at least
I've done the procedure.

And are you going to tell
Bonnie and Cece

that you never actually
recovered neurologically?

My memory loss
isn't an issue here.

Bonnie could die on the table
if we do it your way.

What I'm presenting
is lower risk,

and if you actually
read my notes,

you will see that
all three patients

were in much worse condition
than Bonnie.

- Right now, her BP's high.
But it's predictable.

If you destabilize it,
then surgery is off the table.

And we're out of options.

Thank you.
For taking time today

to come see
what I've been doing.

Did you think
I was a good doctor?

When you knew me before?

- You were brilliant.
- That hasn't changed.

So how about
you trust me this time?

Okay. I will.

Before I give you numbers,

I want you to remember
that you're an individual,

not a statistic.

We've done all the research,
and we know the odds.

We're here because
we know we need your help.

- Yeah.
- So you know that it could be

very difficult?
The important thing

is you came here today,
because at this point,

every day matters.

I've been taking
really good care of myself.

And we have faith.
- Mm-hmm.

Well, I was honestly assuming
we would test both of you.

Both of us?

Why not?

Um, I'm 48.

And I've had patients give birth

to beautiful healthy children
as old as 51.

You're here. Might as well
see what we're working with.

- More doctors?
- I know you're anxious

to get out of here,
but unfortunately,

your stress test results
indicate you might need

to be brought
into internal medicine.

Oh.

- Oh, my God, I'm so sorry.
It's my husband.

- Uh...
- Hello?

- What is this, a circus?
- I'm sure that was important.

He's 13 months post-surgical

aortic valve replacement
of a congenital bicuspid valve.

Heard a new murmur on exam,
and he reports worsening

fatigue upon exertion.

That's also 'cause
I'm on a construction site



What's going on?

I'm afraid you're in
heart failure again.

What?

Dr. Swanson said this would be
over after surgery.

Now I need another one?

I can't afford to miss
two more months of work.

Let's just take this
one step at a time.

Okay...

We need to figure out how long
his heart's been in failure.

- That's the problem.
He missed all of his follow-ups

with Swanson,
so there won't be any echoes.

Oh. So, what are you thinking?

We need valve gradients,
leaflet motion,

ventricular function,
so let's start with the TE,

then get CBCs...
- Yeah.

- CRP...
- Blood cultures

to rule out endocarditis.

Yep.

Be nice if your intern
was available to manage that.

- It's fine.
I'll order them myself.

The peak gradient's 80

and the leaflets
are barely moving.

Well, that valve's
critically obstructed.

No wonder he's back
in heart failure.

I'll call surgery.

Thanks, Mike,
we can take it from here.

Swanson didn't implant
the valve correctly.

Well, a post-op echo
would have showed that.

He should never
have been discharged.

- It's not here.
- He never ordered it?

I don't know, but it's not here

and I need to find out why.

So what we're doing here
is using electrical pulses

to trick your brain into
lowering your blood pressure.

How are her vitals?

Uh, BP is 195 over 100,
heart rate 85.

Hi, I'm Dr. Hamda,
Chief of Internal Medicine.

Cece suggested
I might pay a little visit.

She does love authority figures.

So. Carotid baroreflex
stimulation.

Did you want to supervise?

I'll observe
and assist if needed.

Great.

Are you ready?
- I trust Cece.

And she trusts you.

You tell us if it gets
too much for you, okay?

Increasing frequency
to 80 hertz.

Systolic's down to 150.
So far so good, Bonnie.

You doing okay?

- Feels weird, but I'm fine.
- Okay.



Uh, systolic's 190 and climbing?

It's all good.

Increasing stimulation settings
to compensate.

I'm feeling a bit...

Uh...

She's hypotensive,
with a weak pulse.

- She's losing consciousness.
- Crash cart! Now!

- Bonnie?! Bonnie!
Can you hear me? Bonnie!

I'm on my own

for my birthday this go around.

Actually, the first time
in three decades.

- Yeah?
How are you gonna celebrate?

With this mess of a year?

Drinking a whiskey
and watching the Knicks.

That sounds heavenly.

- Right?
- Ben!

Thought you were heading back
last night?

Hey! Um, well, Dr. Larsen
cornered me

after my VATs talk
and offered to lecture me

on post-op pleural
effusion management.

Over lukewarm omelettes.

An offer he couldn't refuse.

- Understandable.
Your reputation precedes you.

Elliot Norman. A pleasure.

Yeah, I feel like I know you
from all of your

acknowledgements in JAMA.
- Angling for another one

soon if Ben gets his way.

Eliot is the Chief
Research Officer

overseeing my bridge heart trial

at St. Mark's.
- Oh.

Love to get your read on it,

if you're gonna be
in New York any time soon.

I'm not a cardiologist.

No, but there are a dozen
medical co-morbid factors

that can complicate the trial.

Gotta make sure he's not getting
a home court advantage

from our internists.

Hey, it's more than fine by me.

I'm actually passing through
New York in a couple of weeks.

I'd love to stop by.

Splendid. Ben can give you
the details for my office.

I'll make sure your hotel
and flights are covered.

- Good to see ya.
- Thank you.

Couple of weeks?

Well, it seems like
he really wants me there.

So, she is in a medically
induced coma

for hypertensive crisis.

The increase
in stimulation was minimal.

There's no way it could've
bottomed out her BP like this.

What's the MRI show?

There's no anoxic brain damage.

I'm loading her on phenytoin.

And an EEG.

I don't need her seizing
on my table

if you ever manage
to get her there.

I'm sensing you had
a stark difference of opinion

about the correct course
of action.

- We did, yes.
- Well, that should've been

brought to me.
- I'm assuming if that

were the protocol,
Dr. Larsen would've done so.

We sorted it out ourselves,

and Dr. Grant agreed
that my idea was lower risk.

And obviously I was wrong.

I just got off the phone
with Eastside.

I want her transferred
there now.

That's not possible,
Ms. Reinhold.

She's in no condition
to be moved.

There is a variable
that we all missed.

But as soon as I find it,
we will address it

before there are any more
complications.

You need to trust me.

I already made that mistake.

Labs just came back.

BUN and creatinine are elevated,
but TSH is normal.

Okay, thank you, Ruth.

If Bonnie's going to stay here,

I want you,
the head of the department,

taking charge.
And maybe you can figure out

what Dr. Larsen
and this little intern did

that has backfired
so disastrously.

Now, outcomes
can't always be predicted.

And Bonnie was in terrible shape
when she walked in our door.

But we hear you.

And I'll be running point
on this from here on out.

If you'll excuse me,
I'll have to explain

to her family why they may never
get to say goodbye to her.

I'll be standing by

if you can ever find
your way back from this.

Dr. Chen.

Trend BUN, creatinine
and urine output,

and, uh, try to let that
slide off of you.

- Yeah, I appreciate that.
I'm fine.

I'm going to insert
a central line

so we can monitor her CVPs
and fluid status.

And get me your notes
on those old cases.

Michael.

I don't know yet
what went wrong,

but it was the right call.

So Dr. Swanson's not here?

He is, uh, tied up in another
surgery at the moment.

But listen, Dr. Humphrey
is excellent, okay?

We're lucky that he was on call.

He reviewed your TEE,

came up with an airtight
game plan, okay?

I don't understand
what went wrong

in the first place.

We're still trying to get
to the bottom of that.

Okay, but listen, right now,
the important thing

is that we solve this problem
once and for all, okay?

- Thanks, Doc.
I-I do appreciate it.

See you in post-op.

Hey, Roger, you got a sec?

I got 60.

Listen, I wanted
to give you a heads up

that one of your patients
was readmitted

with an improperly seeded
aortic valve.

- Oh. Who was it?
- Johnny Parsons.

Aortic valve stenosis, 33,

works construction,
needed a SAVR?

I can't say I remember him,

but, uh, I'm happy
to get back in there

and patch him up after this.

- Yeah, he's already in surgery.
Humphrey was on call.

And I'm just hearing
about it now?

I would have had
a duty to disclose

your potential negligence
before allowing you

to operate on him again.

So, this just felt
more expedient.

Negligence?

I'm not talking about the valve.

That could've happened
to anybody.

I'm referring
to the post-op echo

that I can't seem to find.

That would've shown a gradient.

You never would've
discharged him.

Oh, so, you're a detective now?

Or is it Internal Affairs?

Okay, well,
I'm headed to radiology.

Sure hoping they can find it.

Dr. Heller?

Proper protocol would have been

to go to the head
of the department.

Does Dr. Matos know you're
running around like this?

First-year fellow
on second week on the job?

You know, I was giving you
the benefit of the doubt.

Now I'm not so sure
it was earned.

- Dr. Swanson.
We're ready for you.

So, none of your other patients

had a BP spike like Bonnie's,

even though they were
in the same hypertensive range?

No. Which makes her reaction
all the more puzzling.

I'm not sure how you could've
ever liked her.

She uses anger
to cover her grief.

And I know a bit about that.

I'm sure you've heard.

Bonnie's EEG tracing continues
to be within normal limits,

but now her temperature's
all over the place, too.

She's been as high as 102.

Do the fluctuations track
with her blood pressure spikes?

Almost to the second.

We've been treating the tumor
like an adenocarcinoma,

but what if there's more
going on?

Divergent differentiation.

So the tumor consists
of two different cell types,

not just the one?
- Exactly.

So what kind of tumor cell

could explain
simultaneous spikes

in both blood pressure
and body temperature, Dr. Chen?

One secreting catecholamines.

- Yeah.
- Go get plasma metanephrines.

Yeah.

If you're right,

delaying surgery saved her life.

Pharmacadia's device
only lasts two years,

and a quarter of the patients
die waiting for transplants.

This is gonna
blow them out of the water.

In terms of long-term
durability?

No, not just durability,

this could be
a permanent solution.

Oh, you're getting
a little bit ahead of yourself.

Well, a man can dream.

So, uh, this is what
the book's gonna be about?

Wha... no, no, no,
I'm not publishing on this yet.

Uh, the book is about my father.

And grandfather. Both surgeons.

- That's quite the legacy.
- Both giants.

Dad still is.

Well, I'm sure this will
make him very proud.

Well, he's a tough one,
we'll see.

So what is it that Elliot
wants me to look at?

A catecholamine-secreting tumor.

And Eastside had no reason
to look for it

after the initial biopsy.

But clearly, the chemo

is not what was causing
her BP spikes.

And if I'd resected her tumor
the way I planned,

the hormone secretion
into her bloodstream

would've k*lled her.
- In all likelihood, yes.

In all certainty,
but I appreciate you

not rubbing it in my face.

Not really my style.

At least, not anymore.

I gave Cece the update

and told her we're deciding
best course of action.

Can you still operate?
- Well, I was hoping to do

a three-stage approach,
but now I can't.

I mean, I-I would need to remove

the hormone-secreting
tumor first,

which is a whole
different scale.

Didn't you do a paraganglioma
resection last year?

- You read that?
- 20 minutes ago.

I can do an en bloc removal
in my sleep,

but her tumor's
like an octopus now.

And it's in her lung,

not her bladder
like in that surgery.

Plus, the catecholamine release.

The second you touch it,
she could stroke out.

And we're talking six,
maybe eight hours

poking around in there.

Phentolamine
for any hypertensive surges,

metyrosine to suppress
the hormone production,

and titrate minute to minute.
It would be on me.

I'm game if you are.

It's up to him.

Once Johnny's out of surgery,

do a post-op exam
and present your findings to me.

Till then, it's admission H&Ps
in 617, 621...

Your husband?

- I am so, so sorry.
It's the sitter.

My husband's out of town

and our little guy
isn't feeling well.

Oh, um, it's okay. Take it.

Hey, how's he doing?

So radiology
doesn't have a post-op echo.

Swanson never ordered one.
- Unbelievable.

That patient of yours,
awhile back, um,

I think
he was a delivery driver,

what was his name, Abe?
- Yeah. What about him?

Didn't you tell me
that Joan had to step in

because Swanson closed up
mid-surgery or something

to go on vacation?
- Well, it wasn't quite

that simple, but yeah.

What, are you building a case?

Well, I checked into the timing

of Johnny's surgery last year.

It was Friday night at seven.

So, you and I both know
the echo team

would've been gone by then,
so Swanson would've had to call

someone in,
wait around for hours.

So you think he never ordered
an echo

because it was inconvenient?

I don't know. Could be.

But can you get me
the records on that case?

- I can.
- Okay.

But you should tread lightly.

You're already on probation
with Matos.

- Email it to me, okay?
- M-kay.

Sorry to keep you waiting.

The results are showing
a more complicated picture

than we had hoped.

But, ultimately,
there's a path forward here.

Okay.

So, Wendy, I know
this will be disappointing,

but your ovarian reserve
has become very low.

With Gina, however,
there's good news.

Your eggs appear
to still be viable.

- Really?
- Well, as I said,

you're an individual,
not a statistic.

And we can get started with
treatments as soon as tomorrow.

Which I would recommend.

You...

You made me wait.

Wendy.

You made me wait,

and now you get to have
everything that I wanted.

This is something
we're gonna do together.

Sorry, I just need a minute.

Check his electrolytes
every 12 hours,

and keep an eye on his sats.
- On it.

Hey, thanks for being
so understanding today,

Dr. Maitra.
I know I need to leave

my personal life at home.

- Well, you have a kid.
Some things can't wait.

Uh, no, I don't have a kid,
that was about my dog.

I mean, he's a puppy,
and we're training,

so it's a lot right now.
- Uh, excuse me?

He's my Wheaten terrier!

Oh God, a kid,

could you imagine?
- Uh, lots of doctors have kids.

- Well, I would never.
I mean, climate change alone.

Okay, that is the most
cynical thing I've ever heard.

You just wanna give up
on humanity?

It's just an opinion.

Kind of thought we were all
entitled to one.

- Just get back to work, Claire.
And no more calls.

Oh, um,

the nurses said you might have
a second to talk,

but it's a little delicate,
so I'll come back later.

No, no, no, you're looking at
the closest thing

I have to free time today.
So, sh**t.

We need to talk about Swanson.

- Tell me about your book.
- Mm.

Well...

My grandfather studied
at Howard.

Under the great
Daniel Hale Williams.

- No!
- Yeah, and by the time

my father came around,

living under the shadow of a man
who studied with the pioneer

of open-heart surgery,
it just...

He really had no choice
of what he was gonna do.

And then, the third
generation just, what, had

to follow in their footsteps?

Well, if they had been cobblers,

would I be mending soles?

Probably not.

No, what they did was inspiring.

I'm the first generation
in my family

to even go to college, so...

It's all upside for me.

Thank you for taking time today

to come see
what I've been doing.

Heart rate's spiking.

Pushing esmolol.

You see that translucent area
under my probe, Dr. Coleman?

Looks more like a cyst
than a tumor.

That's a bag of adrenaline.

If we squeeze it
or if we rupture it...

Things get very
interesting for me.

Her BP's stable.

I'd appreciate you
keeping it that way.

All right. Retract very gently
on your side.

Easy, easy.

It's matted
to the Pancoast tumor.

Can you give me more blood
pressure control, Dr. Larsen?

We'll be getting aggressive.
- Nicardipine.

Fine-tuned as we go.

- Smart.
- I try.

Okay, we need
to time this perfectly.

You retract very slowly
on your side,

and I'll release
the last adherent part.

Let's pull this monster out.

Okay. Here we go.

- Pressure crashing.
Pushing nor-epi.

Come on.

Stuck the landing.

Alright.
Let's put her back together.

So everything went great.

- I have heard that one before.
- Yeah, I know.

Julie, you mind
giving us the room?

Look, man, I know today's been
a terrible day,

and you have every right
to be upset,

but the good news is we know

you don't have something
that's gonna put you

back in the hospital
a year from now.

And how can you be sure of that?

Because the problem
was surgeon error.

The valve that Swanson put in
was placed incorrectly.

Now, they should've caught that
with the post-op study,

but he never ordered one.

That's why you went
into heart failure again.

What, was he, um...

supposed to order one?
I mean, normally,

the surgeon would do that?
- Yes. That is protocol.

So that's malpractice
I could sue, right?

- You can.
And between you and me,

I'd be rooting for you.

But do I have a case?

I-I don't know, Johnny,
I'm not a lawyer.

Then talk to me
like a human being.

All I can tell you is that
if I'm deposed,

I will tell the truth.

You're saying
he almost k*lled me.

So why isn't this a slam dunk?

The thing is, you did skip
your follow-up visits.

And that delayed the diagnosis.

So this is on me?

That's what the hospital's
going to argue, yeah.

So he's gonna
get away with this.

And be able to do it
to other people.

I've already talked
to the Chief of Surgery.

I'm hopeful that he can have
more eyes on him from now on.

And that's supposed
to be enough.

Tell me about Johnny Parsons.

Dr. Heller came to you.

Radiology says you never
ordered a post-op echo.

Is that true?

Look, I checked the date,

and, uh, my wife had an event
that night, so I had...

That's the wrong answer, Roger.

I get it.

I intended to do it
in the morning,

but I must've gotten slammed.

It won't happen again.

Are you sure about that?

Excuse me?

Two months ago,
a hotshot attorney

needs a heart procedure.

And you come in on a Saturday
and stay until midnight.

A real estate mogul
week before, well,

he gets a whole buffet of
post-op tests and VIP treatment.

But a delivery driver comes in
a couple months back,

and you left him to catch
a flight to the Bahamas.

There were complications
in that situation...

Which you were
uninterested in resolving

because of your vacation.

You're cherry-picking
a couple cases

out of a 23-year career.

In my experience,

where there's smoke,
there's fire.

And I don't like the way
this smells, Roger.

- Yeah, okay, so...
What is this?

Suspension? Because I'm not
taking a demotion.

- There's no need.
You're fired.

Four months' severance.
Leave your badge in your locker.

Ah, excuse me. Hey, there.

Good timing, I just confirmed
the hotel in Philly.

Ben, I'm reviewing
some of your data.

I don't love the trends
in some of these bicarbs.

And serum creatinine levels
are elevated.

I think you've got
a big problem here.

I get that, but they...

they'll self-resolve
in two weeks,

so... I'll send you the kidney
numbers on the Phase One trials

and you'll see.

You did the right thing,
bringing her here.

And trusting Dr. Grant.

And you.

I should've known you'd find
what was overlooked.

I lost Bonnie once,

and I was scared
of it happening again.

Well, I appreciate that.

But I get it.

- What happened to you?
In your accident...

the neurological issues.

I lost eight years of my memory.

When you came in here last year,
I didn't even know who you were.

So it's all been an act,
even today?

No, I'm all caught up
on the medicine.

The memory doesn't affect how
I do my job.

You sure about that?

Well, how did I do today?

And the last time you were here?

Brilliance is brilliance,
I suppose.

But you should've
told me before.

I like to think
it's my business.

If I told every patient
who came through that door

what I've been struggling with,

do you think
they'd let me treat them?

I'm not giving up this gift
I have.

What I can do with it
for others.

Well, I know what it's like
to be forsaken.

This will stay between us.

I hope Cece said thank you.

She did. And she apologized.

And I explained to her
why I ran that charade on her

a few months ago.

So you two are okay now?

We were okay then.

Conflict can be healthy.

Even sometimes
when it looks unhealthy.

So, what? Embrace the mess?

I think you're learning.

I'm sorry...

that I made us wait.

I'd accepted my life,
and you dropped a b*mb.

And I can only imagine
how much that must hurt.

But I asked Dr. Shaw.

You can carry the baby.

The child will be ours,

we will do it together,
and it will be incredible.

It's just not the vision
that I had this morning.

It's okay if you want to be
mad at me.

I can take it.

I don't want to be mad at you.

How you doing?

Long shift. How's Ruth doing?

Uh, learning by osmosis, I hope.

Claire told me
that you snapped at her.

Well,
there's a role reversal, huh?

Hmm.
- So, you're still freaking out.

I think so, yeah.

About which part?

Well, pretty soon,
I'm gonna be waddling around,

trying to train these people,
with all the street cred

of someone about
to go on maternity leave.

Oh. That can be handled,
Sonya. Come on.

I know, I...

It's TJ.

We've been together
for four months.

Do you think this is what
he signed up for?

He won't run
from his responsibilities.

No, of course not. He's TJ.

He'll say all the right things,

he'll do what needs to be done,
but...

From this point on,
I'll never know

if that's what he really wants.

Or if it's what I really want.

Do you love him?

I think we were on our way,

but now we'll never get
a clean shot to figure it out.

And I don't want him
to be with me out of obligation.

You know, look, you're right.

He will say and do
all the right things.

But if you obsess
about whether or not

you're both forcing it,
the relationship will be doomed.

I know that, trust me. I do.

Love is a risk. Always.

And you can't control what life
is gonna throw at you.

All you can do is lean in.

I hear you caused quite
the ruckus in surgery today.

And gave our general council
a liability scare.

I was just advocating
for my patient.

And why wasn't I looped in?

I wanted to come to you
with a solution

rather than a problem.
- You didn't come to me at all.

I had to hear about it
from Ben Grant.

I wanted to avoid putting you
into a difficult situation.

I know you and Swanson have
a long-standing relationship.

So now you're suggesting
that I wouldn't have

handled it objectively.
- No. No, that's not what...

Not for nothing,
but I thought that Swanson

was a tool 20 years ago.
I think he's a tool now.

But he is a reasonably
good doctor,

and what you did today
got him fired.

I think I can live with that.

I'm glad your conscience
feels clear.

Dr. Grant can make
whatever decision he wants

in his department.
But he should've made it

after talking to me, not to you.
That's the protocol.

- Understood.
Won't happen again.

I suppose you're learning
how things work

when you don't have
special privileges.

- Excuse me?
- Well, I get the sense

you had a very wide berth
with Dr. Larsen.

Because of your
romantic relationship.

So that's what this is about.

It's a question of character,
Dr. Heller.

Character informs judgment.

And from what I've seen,
yours is severely lacking.

Across the board.

There you are.

Hey, we really can't be late.

It took me forever to get us
reservations to this restaurant.

I'm pregnant.

About seven weeks.

Okay.

Wow.

Wow. That is...

I only found out yesterday.

- And you...
already did the ultrasound?

Yeah, this morning.

I'm keeping it, TJ.
- Right, right.

Right, for sure.
We can handle it.

You don't have to say that.

Whatever you're thinking,
if you're freaking out,

it's fine...
- I'm not. I'm-I'm not.

Okay?

This is beautiful.

I'm gonna take care of you.

No matter what.
You don't have to worry.

'Kay, I won't.

We can do this.

Hey.

Hey!

Bonnie's doing well.

I hope we got it all.

I'm sorry to start the day
going toe to toe like that,

and for not giving you
the benefit of the doubt

when things went wrong.

I think maybe we're both
used to being

the smartest person in the room.

Oh, for sure.

Anyway, you'll have a couple
days with me out of your hair.

I'm headed to New York tomorrow

to check in on
my clinical trial.

I heard it's being
transferred here.

Yeah. That's what
I'm organizing now.

Is that the trial
that I consulted on?

It is.

And happy to have you
wander down to us

whenever we get it
up and running.

I don't love the trends
in some of these bicarbs.

Look forward to it.

Good.