You said the pain was intense?
Yeah, it was sharp on both sides.
And it didn't last long?
Just a few minutes.
And nothing in the 24 hours since then?
Mnh-mnh. My O.B. said it was probably round ligament pain.
Yeah, that's basically growing pains.
Your uterus is expanding. So do your ligaments.
Normal fetal heart rate and movement.
Your B.P. is perfect.
Everything seems normal.
Complications and miscarriage are also normal.
Lea's O.B. did not consider every possibility.
Which is why we're here.
Shaun made a list.
And I'm pretty sure he's not going to sleep
until every possibility is ruled out.
I categorized every medical complication
that could negatively impact Lea or the baby
and sorted by Case Fatality Risk.
I'll get started on the tests.
Shortness of breath, pulse ox and respiratory rate are dropping.
She needs oxygen.
Maxine Stanley, 87 years young.
She passed out on the dance floor
at a cocktail fundraiser for the Art Deco Society.
Art... Art Nouveau.
Oh!
She's in v-fib.
Getting the crash cart.
No, look at her bracelet.
The vintage Lalique? It's stunning.
Other wrist. Her medical bracelet.
She signed a DNR.
If we don't do anything, she's gonna go asystolic.
I know.
- But can't we just... - No.
Epinephrine?
Epinephrine doesn't qualify as extraordinary lifesaving measures.
She has a DNR for a reason.
Time of death,
two twe...
She still has no heartbeat, but her pressure is rising.
- Could the machines be screwing up? - All of them?
Her oxygen levels are climbing to over 90.
I'm hearing blood flow.
Oh.
I'm alive?
Which one of you bozos did this?
Synced & corrected by -robtor- www.addic7ed.com
Debbie asked me to bring this for the baby.
Stuffed toys aren't safe for infants under 12 months old.
They increase the risk of suffocation.
I'll tell her you said thank you.
You should be at work.
Yeah.
But you're not.
So you must be here for a reason.
Claire must have called you.
She's worried about Lea.
You got some of that right.
Except that Lea is fine.
You're not.
Shaun, you gotta relax.
N-No one expecting a baby should relax.
There are many things that could go wrong.
Okay, so after the baby's born, then you can relax?
N-No.
The baby will be helpless, need us for everything.
So, once the baby learns how to feed itself and dress itself,
- then you can relax? - No.
Is my point becoming at all obvious?
That I'm never going to relax ever again?
Kinda, yeah.
Shaun, this should be the most amazing moment of your life.
Every parent'll tell you the same thing.
If you blink, you're gonna miss it,
and you're blinking.
You're... You're... You're nervous and you're scared
when you s-should be excited.
No signs of preterm labor,
and tests on your liver ruled out obstetric cholestatis,
and it's not twin-twin transfusion,
because you're officially not having twins.
Turns out having a baby with a medical genius has a downside.
But if there is a problem,
I'd rather be here than anywhere else.
Gotta take care of this little girl.
Is the transducer secure?
I just checked it. Why?
Baby's heart rate is mildly bradycardic.
Um, heart rate fluctuates with activity,
and you've been off your feet for awhile.
But if Shaun were here,
he would check a transvaginal ultrasound.
Let's get it set up.
Good news.
The arrhythmia didn't do a lot of damage...
Three things I can't tolerate,
lactose, cargo pants,
and my wishes being ignored.
Mrs. Stanley, I can assure you, we did not disregard your DNR.
- Then who did? - It wasn't a "who."
You were treated for lung cancer recently?
Didn't work.
All chemo did was make me puke up any decent meal I ate.
You also had a lobectomy to remove the tumors.
They implanted a cardiac device.
A pacemaker.
So I wouldn't die on the table.
It's not a pacemaker.
It's basically a miniature pump inside your heart,
and if your heart stops, it takes over.
Can you turn it off?
Then take it out.
Mm, I love it.
It's too big for an infant to swallow,
which means it's only moderately hazardous.
Most good things in life are.
Someday we'll tell our daughter
how Dr. Ted and Dr. Dad both kept her safe.
We have found something.
You have Type 2 vasa previa.
It's when the fetal blood vessels run across the cervix,
making them extremely vulnerable.
Now, they could rupture at any time,
definitely when your water breaks,
but also under other added stress.
And if that were to happen, how bad would it be?
We...
Would lose the baby.
There's a small, secondary placental lobe
and multiple vessels at risk.
Gestational age?
22 weeks. Two weeks short of viability.
C-section is not an option.
I suggest fetoscopic laser ablation
to stabilize the vessels and avoid fetal exsanguination.
It's very risky, but has the highest potential
to avoid elective prematurity.
I wrote a preliminary surgical plan.
Should we review it?
- Well, I'm familiar with the procedure. - Good.
Since you're the head of surgery, you can take the lead.
I will assist.
And Claire showed excellent judgment
ordering the ultrasound, so I would like her to join us.
Also, Jordan has a calming bedside manner.
This is a good team.
I don't disagree.
Except you can't be on it.
Y-Yes, I can.
I reviewed the rules.
It is a conflict of interest
for doctors to operate on family members.
Lea and I are not married, so, mm... is no conflict.
Shaun, Lea is carrying your child.
We aren't operating on the child.
You're citing technicalities.
I am citing the rules.
And why are those rules in place?
So that people with emotional conflicts don't get...
Then the rule should have said that.
It doesn't. It just says...
Shaun.
I care about you and Lea too much
to put your baby's life at risk just to make you feel useful.
You are the president of the hospital.
You can overrule Dr. Lim.
I agree with Lim.
Everyone, including you, is always telling me
I'm not emotional enough,
and now you are saying that I am too emotional?
Are you not angry right now, Shaun?
Are you not scared?
You're as emotional as anyone.
Maybe you don't have access to it,
maybe you don't understand... Well, nobody understands it.
It's just that that's not the issue.
If I hadn't been scared, we wouldn't be here.
I wouldn't have ordered the tests,
and Lea would have lost the baby.
My emotion helped.
Dr. Lim made the right call.
Considering Maxine's age,
stopping her heart and placing her on bypass
is way too risky.
What about robotic-assisted surgery?
Adapt the approach used in cardiac tumors
to remove the device while her heart's still beating.
I'm sorry, but should we really
be operating on this woman at all?
A DNR is one thing, but now we're considering
an experimental elective surgery for the sole purpose
of facilitating the patient's death.
The patient agreed to the device to save her life,
not prolong her death.
Is that what we're doing when we treat terminally ill patients?
She's making a mistake.
She's making a choice.
Which is hers to make.
But it doesn't make sense.
She's more full of life
than any patient I've treated this month.
So talk to her.
Make her change her mind.
Or maybe she'll change yours.
I love you, too.
Pong.
I've been waiting for that Red Dragon.
You're ready for your close-up, Ms. Stanley.
A "Sunset Boulevard" reference.
And you were born, what, 10 years ago?
I've never seen it,
but my Bubbe... Uh, grandmother,
used to say it all the time.
She's the one who taught me Mah Jong.
Well, was she as naive as you think I am?
You have better things to do, young man.
And at this point in my life, I don't need any new friends.
Do you want to die?
Something only the young would ask.
Thinking there's actually an option.
Well, sometimes, if you're lucky,
there's a choice about when.
And sometimes, if you're really lucky,
there's a choice about how.
I want to die on the dance floor
with a song in my heart, drink in my hand.
You want me to die a few months later,
in pain, not knowing who I am or where I am.
Forgive me for not saying thanks for the opportunity.
Ah!
Mah jongg.
Feels weird, right?
Watching other people do your job
is like being the understudy in a Broadway show.
Or a couple college musicals.
Basically the same thing.
I should be part of the surgical team.
I have studied every aspect of this surgery extensively.
You know, I never expected to take you seriously as a surgeon.
I never saw you as competition
until that aortic dissection our second year.
There was surprise clotting in the false lumen.
Which you performed flawlessly.
That's when I realized I'd underestimated you.
Just like Dr. Lim is underestimating me now.
No, Shaun.
You didn't become a better doctor
because of that surgery with Melendez.
I became less of an idiot and finally realized
I wasn't the only person here capable of doing great work.
Lea's in good hands.
Even if they're not your hands.
The baby is fine.
Dr. Lim did an excellent job.
So did Claire and Dr. Allen.
The vessel is healing, but still vulnerable.
Also, the baby needs steroids to speed lung development.
We will recheck the ultrasound in 24 and 48 hours.
Until then, all we can do is watch and wait.
At least I know the password to the good Wi-Fi.
- You okay? - If you're researching
which steroid is most effective...
I'm not.
I'm trying to take my mind off of the baby
and what can go wrong
and all the other things I can do nothing about
and focus on something I can do well... my job.
Is that helping?
It could be.
Go do your job.
Robotic-assisted left anterior
thoracoscopic removal of a cardiac device.
Who wants to write the paper with me?
Assuming it works.
Shaun.
Wasn't aware you'd be joining us.
This surgery is interesting and very complicated,
and I don't care about the patient at all.
It seems like an excellent distraction.
Can always use another set of eyes.
I'm sorry about Lea. If there's anything I can do...
No, you can't.
As a first-year resident,
you're one of the least-qualified doctors here.
There's more scarring around the device
than the imaging showed.
We're gonna need to free it before we can remove it.
Clamp is loaded.
Let's begin with the outflow cannula.
We'll see if our patient can tolerate it.
Vitals are stable.
EKG is good.
EKG is good. This is excellent.
I am completely focused,
not thinking about Lea or how we could lose the baby.
Fetal heart rate is 125.
Mom's B.P. is 110 over 60. Vitals are normal.
There was some fluid leakage, so Dr. Allen checked for PROM.
Negative, and no contractions.
Let's confirm it's amniotic fluid,
then test for an L&S ratio
to see how the lungs are responding to the steroids.
How do you feel?
I don't speak "doctor," but if I were a car,
fluid leakage would be a problem.
Amniotic fluid can leak slightly after surgery.
It's just something for us to keep an eye on.
Right.
Wait and see.
Where is Dr. Ted? Who?
The toy Shaun brought for the baby. It was right here.
What kind of mother loses her baby's first teddy bear?
Lea, it's fine. One of the nurses probably...
- No, it's not. - It's fine,
it's just... He's right here.
Thank you.
Being in the hospital trying to protect your child
is a terrifying, awful, lonely feeling,
and there's nothing as a doctor I can say to make it better.
But as your friend,
I can let you know you're not alone.
Isabel and I have been trying to have a family.
I've almost lost track of how many IVF cycles.
People come over and ask how it's going.
We say, "Getting close," whatever that means.
Mostly, it's just an answer designed
to get people to stop asking questions.
I've been scared since I was a kid.
If I could just be better,
a better... Better daughter,
better student, a better doctor,
then I could stop bad things from happening.
But when Melendez died, I finally realized
that life is not something you're supposed to control.
It's something you're supposed to share.
Eight months pregnant,
Mia and I had everything planned.
Bags packed, alternate routes to the hospital.
Mia's water breaks at the mall.
Nothing went the way it was supposed to go.
And it was the best day of my life.
I thought I was ready, but when I lost Junior...
It took a long time for me to stop blaming myself.
A year later, I got a cat.
That helped.
You... You lost a child, and you got a cat?
Junior was my tortoise.
Oh.
First pet I ever owned.
That should've been at the beginning of the story,
Dr. Allen.
I wasn't the one who left the gate open.
Your tortoise ran away?
Your amniotic fluid levels are stable.
That is good.
We need a plan in case your water breaks at the mall.
I take it that's a specific concern you heard about from...?
Dr. Park says his wife...
Stop talking to people.
Okay.
There are three surgeries I'm thinking of using to distract me next.
One is a gallbladder removal...
...which sounds very boring, but it... Shaun.
Wha... What...?
Lower extremity swelling and shortness of breath
are symptoms of a pulmonary embolism.
Page Dr. Browne!
Congratulations, Mrs. Stanley.
The surgery was a success.
Success feels like I've been run over by a truck.
Surgery takes a toll.
You'll get a set of instructions for post-op care.
Healthy food choices, limiting activities...
And I can throw those instructions
in the trash for you, or you can do that yourself.
We'll give you something for the pain and some antibiotics
for a small infection around the surgical site.
Then you'll be back to the dance floor,
low blood pressure and erratic heart rhythm be damned.
Let me.
I-I don't turn over Rouge Dior to just anyone.
Thank you for the vote of confidence.
Mm.
Nice job.
Same bubbe.
So, Dr. Wolke,
what's on your agenda this time?
This time...
I just like you.
So, what are you gonna do?
You gonna keep going to Art Nouveau parties?
You say that like it's a bad thing.
It's not a bad thing.
It's just not a... meaningful thing.
My bubbe died when I was in med school.
I can't tell you what I'd give for a little more time with her.
May her memories be a blessing.
Family is important.
I have a favorite nephew.
It'll be nice to spend more time with him.
And a few others.
There.
The clot is in the lower right pulmonary artery.
It's small.
Could we use TPA to dissolve it?
Anticoagulants are too risky during pregnancy.
Maybe we just keep an eye on the clot
and hope it breaks up on its own.
Bed rest increases the likelihood of more clots.
I think we should insert an IVC filter.
That would trap future clots before they get to the lungs.
It's hard to know what the stress
of another procedure will do,
but I think we should risk it.
Shaun, what do you think?
I...
Trust your judgment.
Hey.
Have you seen Dr. Andrews?
I want to see if he'll talk to our oncology group
about enrolling Mrs. Stanley into a clinical trial.
What happened to dancing and drinking until she dies?
Well, I think I sold her on a little pain
for a little more life.
That's... great.
Which one of your patients rented the gourmet taco truck
that's blocking the clinic entrance?
If they're serving carnitas, I want in.
? I'm gonna live till I die ?
? I'm gonna laugh 'stead of cry ?
? I'm gonna take the town and turn it upside down ?
Doctors, welcome to my going-away soiree.
If you want some beads,
you're going to have to show a little...
Not happening, Maxine.
And as much as we understand your desire
to get back to partying, we have hospital rules about...
Oh, sue me.
Or, more accurately, sue my estate.
I am sorry about your grandmother, Asher,
but what you missed isn't more time.
It was a chance to say goodbye.
? I'll be a devil... ?
Thank you for giving me that chance.
I've decided to refuse the antibiotics.
? Gonna dance ?
Without antibiotics, you'll develop sepsis
and be in cardiogenic shock in as little as 24 hours.
I don't understand.
Why are you doing this?
Because it's my life.
All of it...
Including the ending.
Placing an IVC filter is a safe procedure
with a very low complication rate,
and Claire is an excellent doctor.
Shaun.
It's okay to be scared.
But it's not helpful.
I want to make things better.
I don't know how.
Look.
That's going to be us.
You don't need to fix things, Shaun.
Just believe with me that we're gonna get through this
and that the three of us are going home.
Somebody needs to check your oxygen, young lady,
because you're not making any sense.
I told you.
I am not delirious, Dr. Glassman.
I just happen to have my own opinion.
It's not a matter of opinion.
It's a matter of absolute fact.
Ted Williams was the greatest baseball player of all time.
End of discussion, full stop.
Ted Williams was good.
Not exactly a hot take,
but John Paciorek beat Ted Williams like a drum.
Only player to bat a thousand in Major League Baseball.
- Now you're gonna say... - I am.
..."But John Paciorek
- only played one game." - Played one game!
- That's right. - And I'm gonna say,
baseball wasn't fully integrated until 1959,
a year before Williams retired.
Numbers aren't everything, Dr. Glassman.
More does not mean better.
Not in life, not in baseball,
maybe in tacos.
Alright, why are we talking baseball and tacos?
Have you had one?
- I've had four, and they're wonderful. - Mm.
And you would make an excellent lawyer.
You know, I haven't had this much tongue in my mouth
since Woodstock.
Well, some of us think that you might be a little crazy.
A little.
Some people can't tell the difference
between crazy and happy.
Either way, you're perfectly capable
of making your own decision.
Now, I'm gonna leave this lovely party.
Excuse me.
Just do me one favor, will you?
Keep the volume down.
It was a pleasure to meet you.
Pleasure to meet you.
Are those Maxine's new ABG results?
No.
If you want to talk...
Why are you so upset about Mrs. Stanley refusing treatment?
She has terminal cancer. She is dying.
Doctors can't fix that.
I know my family loved me,
but they didn't... see me.
Except my grandmother.
She'd catch my eye at Shabbat dinner
and make some ridiculous face
so I'd laugh and get sent to my room,
and that's where I'd find it.
A book or music
or something verboten she thought I'd like.
She passed away a few years ago.
More time would've meant...
everything.
Time is hope.
ABG results for Mrs. Maxine Stanley.
Right before inserting the IVC filter,
I ordered a non-stress test
to make sure the baby could tolerate the procedure.
That's when I noticed the heart rate
had been getting progressively slower.
So, after we implanted the filter,
I ordered a Doppler ultrasound.
The tracing of the umbilical artery
was dampened with flow reversal.
There wasn't just one clot, Shaun, there were two.
One we couldn't see
because it was lodged in the umbilical artery.
Maybe I made a mistake or I missed something.
I-I really, really want to be wrong about this, Shaun.
You aren't wrong.
I saw the test results on the amniotic fluid.
The lungs aren't responding to the steroids.
The baby can't survive.
I'm sorry.
Did you talk to Lea?
No.
I couldn't protect Lea.
The only thing I can do for her now is give her more time...
To hope.
I don't think you're doing this for Lea.
I think you're protecting yourself
from the pain of watching her pain.
Would you like me to be there?
No. Thank you.
Crap.
There was nothing anyone could have done
that would have made any difference.
And nothing about this affects your chances
of having a healthy baby later.
What do we do now?
Medically, you have two choices.
You can be sedated and have a D&C.
Or some people decide to induce labor
so they can hold their child.
Uh, c-could you give us a minute?
Of course.
Do you want to discuss risks and benefits?
No.
I don't need any more information.
We've lost her.
We lost her,
and this isn't about medical questions anymore.
I can't go into labor and not leave here with our baby.
Remarkable.
Swelling's down, trends are improving.
Your infection appears to be clearing on its own.
Apparently, life isn't done with you yet.
Yesterday was one of the,
the best days I've had in a long time.
Not because of the party.
Because of the memories.
Midnight taco runs with my college roommates.
My sister messing up the words to my favorite song.
Arguing with my husband,
who served the best margaritas.
I... I've had a wonderful life
and with wonderful people.
Maxine, there's no reason you can't have more of that.
They're gone.
And now I, uh...
I have to go home alone.
Pretty incredible that a woman of her age,
ravaged by cancer,
could fight off an infection overnight.
If I were a religious man, I'd say,
"Wow, that's... That's a miracle."
So, either I should go join a church or a temple or a mosque,
or someone slipped antibiotics into Maxine Stanley's I.V.,
antibiotics which she specifically asked us not to give her.
Don't say anything. Not a word.
Say something stupid like a confession,
and I'm gonna have to fire you right on the spot.
Not to mention fending off a lawsuit,
which we would, and most certainly should, lose.
More importantly, none of this helps Maxine, does it?
So what happens now?
I don't know.
Let's just say for the sake of it that you know this doctor.
Would they feel at all guilty?
Yes.
Why?
Because she's a good woman, and...
It was her decision.
You knew it was her decision.
You were told it was her decision.
You didn't listen.
What makes you think next time will be any different?
Because I saw her this morning, and for the first time,
I saw... Her pain.
Okay.
You're gonna have to make this right.
Hey.
I'm sorry things didn't turn out like you wanted.
That's okay.
Lots of great books have final lousy chapters.
This is an aid-in-dying request.
There are procedures that allow you
to end things when you want to end things.
It can be complicated.
Quite a few regulatory hoops.
I'll get you through them.
Did I ever tell you about the day Kellan was...
You did.
But tell me again.
Hey, Deb...
No, I-I'm not gonna be late.
I just, um...
I just wanted to hear your voice.