This might be the first place we've visited that feels right.
That's good.
But, Shaun, we really need to
talk about something non-wedding related.
Oh, it's perfect.
Yes, and it is the only venue available on our date
that meets all our criteria.
I'll stand at the altar.
You walk down the aisle.
Okay.
The fireplace tile, is that original?
Uh, I have no idea.
Well, let's say it is.
If you want to up the curb appeal,
maybe a fresh coat of paint, some landscaping...
"As-is" is just fine.
How soon can we sell the place?
We'll get multiple bids on day one.
Oh, great.
Hi, Aaron.
Shelly Carroll, Ethan Ray Realty.
Ilana Reeves, ex-wife.
We should drop off this agreement
with our deposit check tomorrow.
Once I explain the issue to the pastor,
I'm sure he will replace the problematic floorboards.
Shaunie, there's something I really need to tell you.
S-Stop!
I'll call 911.
Hello, I'm Dr. Shaun Murphy.
Where are you hurt?
It's my hand.
Your fourth and fifth fingers are broken.
If you have no other injuries...
Shaun! Over here!
Hello, hi, I'm Dr. Shaun Murphy. Are you injured?
My leg's trapped.
My chest hurts when I breathe.
How far along is your pregnancy?
Twenty-six weeks.
Do you think my baby's okay?
I have no way of knowing...
...but you have tachycardia and your jugular is distended,
which are signs of a cardiac tamponade.
If I don't drain it, you'll die before the paramedics arrive.
Synced & corrected by -robtor- www.addic7ed.com
Sorry about the mess.
Uh, Debbie talk you into a fresh start?
No, no.
Um, we didn't exactly work out.
Oh, I'm sorry.
Yeah, me, too.
But I am moving to a small town in Montana,
which, hopefully, you know, will be good for me.
Aaron, I need your help.
It's my husband, Sunil.
He's dying.
What's your name?
Alma.
Alma. Hi, I'm Lea.
Is there anyone you need me to call?
Uh, um, no. My... My boyfriend's out of town.
What are you gonna do with that?
A subxiphoid pericardiocentesis.
An echo-guided one would be better,
but I don't have a J-tipped wire, or an echo machine.
Maybe we should wait for the paramedics.
Alma, you can trust him.
My... chest... is... exploding.
Okay, hold.
You are very lucky.
We usually don't drive to work this way.
His diagnosis is Lewy Body Dementia.
Oh.
How long has he had the symptoms?
It began two years ago.
Insomnia, muscle weakness, agitation.
Recently, he's started having bouts of confusion.
We found an experimental trial that uses deep brain stimulation
to slow cognitive deterioration.
Would you look at it, see if it's worth it?
There are so many more doctors
with more experience in this field than I have.
Aaron, I... I need somebody who's gonna give me the truth,
so we don't waste what time we have left.
How many clients have been referred
for elective procedures from the clinic?
Forty-three.
Those satisfied clients will lead to more.
And the automated intake screens have cut labor costs by 8%.
But the nurses don't like it. They think they're next.
Handle them right, they'll get over it.
If you have specific thoughts on that,
I'd love to hear them.
Maybe over lunch?
Morgan, you excel at striking the right balance
between enthusiasm and obsequiousness.
Thank you.
Instead of lunch,
how about you and Alex have dinner with Marcus and me?
Marcus...
Marcus Andrews?
It'll be a hoot.
Twenty-three-year-old pregnant female,
blunt chest trauma from a car accident.
I performed a subxiphoid pericardiocentesis
at the scene with a gas siphon.
Cool? Is the baby...
Fetal heart rate is normal, no signs of distress.
Mother became hemodynamically unstable en route.
She needs surgery for internal bleeding.
Okay, keep rolling. Keep rolling!
We're gonna do a couple of tests
to get a sense of your cognitive state,
and then we're gonna throw you in the MRI,
the big donut, very loud,
to see if you're right for the deep brain stimulation.
Any questions?
None.
What I know or don't know about the medicine
will not change the outcome.
A patient who doesn't think they know more than their doctors
is rare these days.
Implicit social contracts are my field of study.
They're the agreements we make daily,
often without even realizing.
But perhaps that's a conversation for another...
Who are you?
Why are we here?
Sunil? Sunil?
Uh...
You're right where you're supposed to be.
Take a deep breath.
Tell me their names.
Pavan.
Reema.
And little Raj.
Good.
Some spells pass a little more quickly than others.
I... I think I'm okay now.
Sunil.
Hmm?
Do you remember why you're here?
Because I'm dying.
Let's get started with those tests.
Sunil's MRI shows no contraindication
to deep brain stimulation.
Initial labs look good.
He's a great candidate.
Is the coat hanging in my closet your "good" blazer?
It's my only blazer, so, yes.
Get it dry-cleaned.
For our dinner with Andrews and Salen.
As intriguing as that pairing is,
dinner's a hard pass.
Not an option.
But compensation is fair.
We can finally binge The Wire.
Your first offer doesn't get you off the couch, and...
Wait, Andrews and Salen?
Game respects game.
And sometimes sleeps with it.
Tickets for you and Kellan to a UFC fight in Vegas.
Still no.
But save that thought for his birthday.
Salen and Andrews?
They may have one soul between them.
Any sign of motor weakness?
He's gonna have to tolerate the head frame.
Here's the cervical spine MRI.
We could replicate the DBS trial on site.
I'd be happy to coordinate.
Oh, that's very kind of you.
Are you sure you're gonna have time
while you overhaul my clinic into an Ethicure profit center?
Oh, and by the way, I'm gonna need my office back.
I hope you don't mind.
- Parathyroid looks off. - Hmm.
Is that an ectopic lesion?
He's had a history of renal stones.
I don't...
What were his calcium and PTH levels?
They were only mildly elevated.
Nothing that triggered for the workup.
What are you thinking?
I'm thinking this may not be Lewy Body Dementia.
Repairing the ventricular tear with Prolene sutures
No remaining arterial or major bleeds.
Good. I'd prefer not to have to open her belly.
I would like both of you to wear socks to my wedding.
No shoes. Just socks.
Lea and I found a nearly perfect church, but the floor squeaks.
Should make for some interesting pictures.
No.
No way you are robbing me
of a chance to show off my new Bruno Maglis.
Also, wet and stinky feet are not in Lea's dream wedding.
That's... probably true.
Last suture is in.
Dr. Allen, how's the baby?
Heart rate is stable.
Okay. Next step, get her down to imaging.
We need a surgical plan for these pelvic fractures
before they cause any more bleeding.
Aaron! Aaron!
I didn't expect a miracle, but thank you.
He's not out of the woods yet.
He still has a lesion.
Okay, hopefully benign, hopefully removable.
- I heard you. - Really?
Most people stop listening after they hear the very bad news,
or, in this case, the very good news.
Okay, the nuclear study this afternoon, I got it.
What happened with Debbie?
Why did my impulsive, whirlwind marriage
to a gun-toting barista not work out?
Hmm.
- You're hurt. - Do I look hurt?
I just saved a man.
I know how you hold onto things.
And I know how you try to fix things
and you try to fix everyone.
- I'm okay. - Talk to me.
'Cause I doubt very much you're talking to anybody else.
I was myself, and up close and personal,
Debbie didn't like what she saw.
She...
She said I was controlling and selfish.
Did you tell her she was right?
Well, yeah, 'cause she was.
It didn't help.
What's in Montana?
Pine trees and cowboy boots and
change for me.
In Montana, no one knows me,
and I have no history,
and no one has any expectations of me.
You've done this before. After Maddie.
That's not fair.
I know.
But my therapist would say you're
"pulling a geographic."
Has your therapist met me?
I have to go prepare for Sunil's procedure.
The safest path is external fixation.
We'd use a metal frame to stabilize the fractured bones
until your baby is ready to be delivered.
You'd need three weeks of bed rest,
and you'll likely develop debilitating arthritis.
There's a significant chance you will never
have full mobility ever again, bu...
I have grad school. A job. This baby.
- That can't be the only option. - No, it's not.
I was going to tell you, if we do a C-section now,
we could do an internal fixation,
which would greatly improve your chances
of walking without assistance.
Though it does increase the risk of complications
associated with premature birth.
So I either never walk right again,
or I jeopardize my baby's life?
Yes.
You have to decide.
My boyfriend,
at first, he didn't want to keep our girl.
But then he came around to it.
We said that we'd figure it outogether.
Then he signs up for this month-long research trip
off the Gulf of Alaska, and here I am.
I can't choose between myself or my baby.
No, you have to choose.
I can't.
Dr. Glassman, I'm glad you're back.
Lea and I have a problem.
I heard.
The floor squeaks.
At the church?
Is that it?
No. I also have a patient who won't decide on a surgical plan.
Have you talked to Lea?
She is no doctor.
No, I don't mean about the patient.
Shaun, I am not gonna be around.
I'm... I'm moving.
I'm selling my house, and I'm moving...
...to Montana.
Oh.
Will you still be my best man?
Yeah, of course.
Then you should give me your advice.
Shaun, you don't need my advice.
Sometimes I do.
You don't like to give it to me anymore.
Lea and you are partners now.
You can... You can talk to her,
and Lea has a whole lot of stuff she's gotta talk to you about.
And you'll work it out, without me.
Sharks tickets.
Doesn't being together mean that we have an unspoken agreement
that when I need a date, you're it?
No.
The lesion has an irregular shape,
and it's extending into the carotid sheath.
It's a malignant carcinoma, and it's invasive.
Hey, I thought you were working late.
I am going back, but first,
you and I need to make a decision about the church and the squeaky floor
and something else entirely.
Dr. Glassman said you have things you need to tell me.
Uh, I didn't go on a business trip a couple weeks ago.
I went to Montana to find Glassman
and convince him to come home.
Because I was really worried about you.
What were you worried about?
There have been so many changes at the hospital,
and I know that's been hard for...
- Not because of my... - I know.
Not because of your ASD, but because
change is hard.
And then your patient reviews,
and I knew you were struggling with them.
I was, but then I improved my interaction techniques,
and my scores went up.
That's not what happened, Shaun.
I omitted some of the patient reviews.
Just the ones where people said really mean stuff.
That's why your scores went up.
I told you I didn't want you to.
I know. I'm so sorry.
I just got so worried, and I wanted to protect you.
And I thought, if I could just help you, I...
What you did was very wrong.
I know.
I am truly so sorry.
No.
Your apology is not accepted.
The lesion in your neck is cancerous,
and it has grown very quickly.
I am suggesting a non-surgical approach,
one with targeted therapies and radiation.
It should give you a few more good years
before debilitating symptoms set in.
I'm very sorry.
There's no way of removing it?
It's attached to the carotid artery.
It's too dangerous.
Um...
Thank you, Aaron.
That's more than we hoped for when we came to you.
I was here all night with Dr. Allen.
We have not come up with a better surgical solution.
Your choices from yesterday remain the same.
How is she?
Normal fetal movement.
Heart rate is 140.
That's good.
Mm.
I talked to Matt.
He's making his way back, but it'll be a couple of days.
He says whatever I decide to do, he will support it.
Which isn't really helpful right now.
No, it's not.
You need to make a decision.
He shouldn't have gone, but we needed the money,
and it was a great opportunity.
But mostly, I feel like it was
a reason for him to be somewhere else.
He says one thing but does something different.
How do you know if he loves you?
He does.
But someone can love you and still let you down.
That doesn't seem right.
No.
No, it doesn't.
Knowing what to expect of others is difficult.
People can be very unreliable.
That's why I always wanted to be a doctor.
Science and biology and medicine are very reliable.
I like that.
She's relying on me.
I need to do what's best for my baby.
Go ahead with the external fixation.
How would you rate the new self-serve, self-pay system?
Four stars.
Not five?
I prefer to be stingy with my top rating.
Last night was a five.
So it was even better than
a convenient way to buy a smoothie?
Hey, what are you doing Thursday night?
I invited Morgan and Alex to have dinner with us.
A double date?
I didn't realize we were going public.
We're both consenting adults.
What's to hide?
As the boss, you are free to do what you like.
As a partner, that's not the way it works.
I'm sorry.
I should have asked you before I told anyone.
Marcus, you're smart and funny and almost too good-looking,
and your socks don't just match your sweaters,
they elevate your whole aesthetic.
And I told Morgan because I'm excited about you.
About us.
I'll make the reservation.
There's a surgical solution here, isn't there?
No, no, no. Not a safe one.
But you've built your career on doing surgeries
that most doctors think are too dangerous.
Yeah, because, to quote you, I am an insufferable egomaniac.
But that's who we came to see,
and now I'm getting some surgeon who's gonna run off to Montana
in the guise of becoming a decent human being?
Okay, uh, criticize me, yell at me if you like.
- I understand you're upset. - All those late nights
where you were tackling the most impossible cases,
exhausting every possible angle.
You come alive in surgery, more than you did in...
There are other surgeons. There are other hospitals.
I have done everything I know how to do to help you and Sunil.
I am sorry if that's not enough.
I think you're scared.
Of what?
Failing.
Of failing me again.
Yeah, I wish that were true.
It's Sunil.
I need to get out of here.
Don't you see what's happening?
Sunil, Sunil. Wait, wait, wait, wait. Sunil, Sunil.
Stand by with a sedative.
Ahead of you. Just trying to get close.
You're right where you're supposed to be, honey.
Take a deep breath.
All right, tell me... tell me their names.
Tell... Tell me their... Tell me the...
I don't know you!
Whoa, whoa, whoa, whoa, whoa, whoa!
- You got him? - I got him. I got him. I got him.
Oh...
I got him. I got him.
Are you hurt?
I'm okay.
My patient chose to prioritize her baby.
We did the external fixation.
She's resting comfortably, and you need to correct my scores.
I can't restore the data.
You are very smart.
You can figure out a way.
Shaun, I apologize,
but I... I can't undo what's been done.
Lea, the scores reflect my work and me.
No, it didn't.
The algorithm ignored what's best in you.
No, it should be the same for everyone.
The data has to be corrected.
I can't, Shaun. I'm sorry.
Then you need to tell Salen.
That's a terrible idea.
There is no other option.
Shaun, I could lose my job.
You broke the rules.
Maybe you should get fired.
I'm fine, really.
Humor me.
Pupil response is normal.
I'm sorry about before.
I was so frustrated.
I... I appreciate everything that you've done.
You owe us nothing,
and you've gone out of your way to help.
Here's some Naproxen.
It'll help with the pain and soreness.
I don't blame you anymore.
- For Maddie... - No, p...
No, don't. Please stop.
Don't do that. I need you to hear this.
For a long time, I did blame you.
I could barely look at a picture of Maddie
without being reminded about how angry I was,
and how angry I was at you trying to replace her with Shaun.
Shaun wasn't meant to replace Maddie.
My God.
Nobody can.
Becoming a part of Sunil's family has brought me peace.
They're my whole world.
And I'm so glad you found Shaun.
You're right, I am scared.
If I operate on Sunil and he died,
I'd be responsible for you losing someone you love.
Again.
I'll take another look at the imaging.
I can't promise anything.
Who knows, maybe this egomaniac can come up with something.
She's having severe abdominal pain.
BP's 73 over 49. She's hypotensive.
There's uterine bleeding from a placental abruption.
It's a delayed reaction to the crash.
Her choice was moot.
Okay, page Dr. Lim to the OR for an emergency C-section.
We're ready.
- I love you. - I love you, too.
Hey.
What are those for?
I know how mad you were
when these disappeared from the vending machine.
Salen's health-conscious revamp
was not a victimless crime.
I drove 20 minutes to a gas station to get those for you.
This is the bribe?
No, it's just chips.
And a declaration
that I will respect the boundaries you've set.
You don't have to do dinner.
I'll survive.
I assume Salen will be picking up the check?
I don't love your ambitious streak, but I do love you.
I'll be your arm candy for the night.
How long until we have access to start the C-section?
A few more seconds.
BP's 70 over 55. Heart rate 109.
Fetal tones?
Present, but we saw D-cells on the tracing. The baby is stressed.
Once the baby is out, we will immediately begin
an in-fix pedicle screw rod fixation.
She'll walk fine.
We'll need a two and a half millimeter drill bit
and titanium screws.
We're clear. ChloraPrep and scalpel.
BP and heart rate stable.
Carcinoma's in the cross hairs.
"Be quick, but don't hurry," as John Wooden used to say.
Starting resection.
Suction.
That's a lot of bleeding.
Yeah, well, we're poking around the carotid.
It's to be expected.
How's he doing?
BP's 64 over 42.
Do you see any vascular feeders you can clip?
No.
Tumor has completely invaded the artery.
We're gonna have to move fast.
Mother's BP is still dropping. 50 over 37.
Hang another two units. Extending uterine incision.
Okay, here she comes.
Dr. Murphy, Dr. Allen,
deliver the placenta.
Check for uterine bleeding before beginning internal fixation.
Dr. Lim, Apgar's three.
The baby's in distress.
She's not oxygenating. We need to intubate.
Dr. Murphy, with me.
Get a blood gas.
Bagging 100% oxygen.
Baby is acidotic with a pH of seven.
No improvement in vitals or oxygen sat.
Check the tube's positioning.
ET tube is in the correct position.
Equal breath sounds on both sides.
This doesn't make any sense.
The baby has a congenital heart defect.
The patent ductus arteriosus is closing. That is causing hypoxia.
We need to open the duct and oxygenate her blood.
Call the pharmacy for PGE, stat.
Start the PGE at 0.1.
BP's 61 over 42.
Tumor's hypervascular.
I can't see a damn thing. There's too much blood.
Should we stop the bleeding and abort the resection?
No.
Tubing... clear plastic surgical tubing.
Baby isn't pinking up.
PGE is in. IV looks good.
V-tach. Starting compressions.
What if it's not a heart defect?
We're gonna occlude the carotid,
blocking the blood until we can cut the damn thing out.
He'll stroke out.
That's what the plastic tube is for.
I'm gonna build a shunt bypass,
keep the blood flowing to the brain.
Suction.
Apply the clamp.
Dissecting scissors.
Ugly little thing.
Okay. Stand by with the patch.
Let's clean it up.
No obvious metabolic disorder.
No evidence of head trauma or pneumothorax.
No mucus plug in ET tube.
No transient tachypnea in the newborn.
The PGE is the right dosage...
What?
Oh.
Shaun, what?
It's expired.
Call the pharmacy.
We need more PGE, but from a different lot.
The PGE is expired. We need...
The pharmacy says we don't have another lot.
Our entire supply is expired.
Prep for catheterization.
We might be able to keep the PDA open with a stent.
Stop!
Alprostadil!
We need to run PGE at 0.1 micrograms.
Tell the pharmacist to mix 10 vials of 50 micrograms of Alprostadil
with 10 milliliters of saline solution.
Mix 10 vials of 50 micrograms of Alprostadil.
He says that's the wrong medication.
Where are you going?
It'll be faster if I do it myself.
Uh, you know this is for erectile dysfunction?
Yes.
Alprostadil is the same drug as PGE
but in a different concentration.
We need to run the IV at 0.056 milliliters per minute.
That will give the baby 0.1 micrograms per kilogram per minute.
Pushing 0.1.
Restarting compressions.
Mucous membrane's still blue.
Oxygen saturation's not registering.
We just need to give it more time.
Hold compressions.
Pulse not palpable.
No, push 0.2 of the solution.
Restarting compressions.
- Dr. Murphy. - No.
Push 0.2.
Dr. Murphy, the baby is flatlining.
- No. - There's nothing more we can do.
- No, I can save her! - Shaun.
Time of death, 18:23.
Sunil's recovering very nicely.
Just, no exercise or, you know,
strenuous activity for the next six weeks.
Thank you.
Don't go to Montana.
You still need Shaun.
He makes you better.
Hang up.
I need to call you back.
We just lost a baby, because this hospital wasn't prepared.
The medication we needed was expired.
All of it. No back-up batch.
Did the money you saved pay for your water wall?
In my 15 years here,
nothing like this has ever been allowed to happen.
This hospital's priorities... your priorities
are upside down, and today, that killed someone.
How's the mother?
Recovering.
She won't be conscious for a few hours.
I'll make sure and have a grief counselor standing by.
And call your lawyers, too.
When she finds out that her baby died
because of expired meds...
Dr. Lim, until we've done a thorough M&M
and identified what changes need to be made,
discretion is in everyone's best interest.
Are you suggesting we not tell her the truth?
I'm suggesting we all have exposure.
You, the residents.
Audrey,
this is a tragic day.
But we cannot allow a single event
to derail everything we do here.
Salen made cuts.
We're... We're behind on inventory.
It just...
It... it fell through the cracks.
Expired.
Expired!
They're all useless!
- Shaun. - No!
- Shaun, stop, stop, stop, stop! - They're all... No!
- It wasn't your... It wasn't your fault! - N-N... Please! Please! No!
- There's nothing you could have done! - No, you lied to me!
I can't trust you!
And I can't marry you.
Shaun. Shaun!
You're hyperventilating. Hey, hey, hey, hey.
Look at me. Look at me.
Look at me.
Take a deep breath now, okay?
Take a deep breath.
There you go.
You can talk to me.
Dr. Glassman,
you... you are a...
An awful best man
and a terrible mentor.
You said you would never abandon me, but that's a lie.
A lie.
That is a lie!
Why is everyone lying to me? Why?
You should have been running the hospital!
If you had, the baby would not have died!
Okay.
I'm here. I'm here.
Shaun.
I'm right here.
I'm right here. I got you.
I got you.
I got you. I got you.
I got you. I'm right here.