Look, I know we haven't talk in a while but...
I have to tell you this, and...
I don't know, you might not like it.
What do you get when you...
cross an elephant
with a rhino?
Elephino.
Yeah.
That's my first dad joke.
Did you just kick?
Hi, Luna.
You know...
three months from now,
we get to do this in person.
It's pretty cool.
Time for our song.
How can I help?
Uh, well, there's candy machines in the pediatric ward.
You know what's not good for kids before 9:00 a.m.?
Does it start with C and end with childhood obesity?
- Yes. - Consider them gone.
_
I'm hiring six new therapists
with training in CBT and DBT.
And I'm starting a patient advocacy division
because when I say things like CBT and DBT,
patients have no idea what I'm talking about.
Will this cost more money?
Yes, but...
who's with me?
Ooh, uh, we need to talk about my waiting room.
Thought we got rid of your waiting room.
Well, the plan was for nurses
to move patients straight to beds.
Okay, I'm not seeing a problem.
The plan requires nurses.
Got it.
More nurses.
_
Health care is the number one cause of bankruptcy in America.
Wow, you really know how to bring things down, don't you?
Patients should know that their...
hospital bills are negotiable.
We should revise our Patient Bill of Rights.
Love that idea. Way to bring things back up again.
Okay.
We need to provide better care
with fewer resources.
But I need your help.
I need your ideas.
Okay, I'm just gonna do this
until somebody speaks.
Is this jogging anybody's... Anyone?
I'm gonna go ahead, it's gonna become a robot now.
It's just gonna go downhill from here.
I'll just keep on doing this.
Does anybody have anything,
just one idea?
What about group appointments?
Thank God.
Yes. Please, share.
You give people with related issues
like diabetes or high blood pressure
- one shared appointment... - ? And I'm so glad
Time to go to work.
Synced & corrected by -robtor- www.addic7ed.com
32-year-old woman collapsed
with extreme shortness of breath and chest pain.
Heart rate 140, respirations 34,
BP 90 over 60.
Took 100% O2 to keep her sats over 90.
Where's Reynolds? Did anyone see what happened?
I'm her father. We were at a fund-raiser.
Jozette was accepting an award.
Then she just shook and fell.
We didn't know what to do.
What you got?
Holosystolic blowing murmur at the apex.
What took you so long?
Well, I'm the department chair now.
- I've got stuff to do. - Like what?
As soon as I figure that out, I'll let you know.
You're right. Acute mitral regurgitation.
- Trauma One. - Get a central line kit.
Lisa, prepare me a Levo drip.
Titrate to systolic at 90.
On the count of three.
One, two, three.
Watch out.
Yeah, oh, my gosh, my girls tested
for their orange belts last night in karate.
They're complete savages. I had no idea.
I looked at... I took a video of it.
Here. I'll show you.
Or wait, did I email it to myself already?
That's okay, I can imagine it.
Oh, okay. Well, remind me to show it to you later, because it is
intensely cute.
Gosh, I'm always talking about my kids. What about you?
- How come you never talk about yours? - I don't have any.
Oh, I'm sorry, I just assumed that you...
Life had other plans for me, and then it got too late.
Okay, well...
speaking of which, based on your extensive experience...
You mean to say "old."
Yes. Exactly.
How long do you think this Max guy
can shake things up before the dean steps in?
Not long. Dean of medicine does not like
things shaken up...
based on my extensive experience.
All right.
Leo. Hi.
How you doing? I'm Dr. Frome.
But, uh,
you can call me Iggy, all right?
No need to be so formal.
All right, so...
I had a chat with your mom,
and she told me that you're having a hard time
staying awake
and that, uh, you've been wetting the bed.
Is that right?
Okay.
No big deal, you know?
We can get to the bottom of this, easy-peasy.
Okay?
Let's see what we're looking at here.
All right, says here you've been on...
zotepine for the last few years?
Is that right?
Uh-huh.
Did, uh, something happen at school?
No? You sure about that?
'Cause zotepine, my friend, that is...
that's big-time.
That is no joke.
Nothing happened that you want to tell me about?
No.
Okay, cool. Fair enough.
All right. They've also got you on...
sertraline.
Huh.
Jeez.
And zolpidem.
Oh, my gosh, they have you on atomoxetine as well.
Okay. I mean, uh...
who needs breakfast, am I right?
Fistful of pills like that every morning?
Yeah. And I see that, um...
You also...
you lost your dad a few years back?
Yeah.
Yeah, that's really tough. I'm sorry.
You know what, Leo?
I want to try something different.
Instead of adding more medication
to your already impressive roster,
why don't we try this for a plan?
Let's take you off all of your medication.
I just want to know how much this is gonna cost me.
I'm sorry, but I can't tell you that.
So I can compare prices on my Subaru
and not on my wife's double bypass?
You know, it's funny, Congress actually
made it illegal for hospitals to disclose prices to you,
so it's the only industry in America
with a noncompete clause, but...
call your congressperson. Resist!
You're running late.
- For what? - For everything.
Dora, I'm educating patients.
You're inciting riots.
Dean of medicine called again.
Pass.
You can't keep ignoring him, Max.
When you fire half the staff,
disembowel an entire hospital,
you have to expect your boss is gonna be on you...
To what? Re-bowel it?
Sounds gross, doesn't it?
Max!
Dr. Sharpe, back in the trenches.
- How's reentry? - I wouldn't know.
You didn't show up to your appointment this morning.
Well, I had a department chair meeting.
Which you missed, I believe.
Because we had an appointment.
What... how... did I forget something?
No, no, just, uh,
Dr. Sharpe and I have a little thing.
Very, uh, informal.
It's not informal. It's quite serious.
- How serious? - Not very.
I'm taking care of it.
- Are you? - Mm-hmm.
Have you eaten today?
Does espresso count?
Dora, would you mind getting him an apple?
- An apple? - Mm.
He'll be in my office.
Uh, can't. I got a full schedule.
Your 2:00 p.m. just canceled.
Thank you, Dora.
Thought you were getting me an apple.
Max. You have can...
We have 1,500 patients.
I don't have time to be one of them.
You better find the time
before you run out of it.
One of the valves that controls the flow of blood
through Jozette's heart is broken,
and blood is backing up into her lungs,
which is why she can't breathe.
But how could this happen? Jozette is strong.
She's an aid worker for the people of Haiti.
I have to get to Jean-Rabel.
This week, a mudslide hit our village.
So many people have died.
That might explain what happened.
You thinking Takotsubo syndrome?
- Yeah. - Yeah.
That sounds bad.
Another name for it is, uh, broken heart syndrome.
The mudslide may have caused Jozette so much grief
that it actually made her heart beat so hard that
it tore the muscles that hold it together.
I hate to feel helpless.
I'm sorry.
Well, the good news is,
I can fix a broken heart.
Now, we're gonna get you prepped for surgery
and get you home as fast as we can.
First may we perform a Gad Ko?
- I'm sorry, a what? - It's a protection ritual.
We make a cut in the skin, rub in herbs.
Oh, no, that's out of the question.
Any cuts to the skin can introduce infection, so...
Gad Ko attaches Lwa to me.
Protects me from accidents.
Okay, look, Jozette,
there won't be any accidents, all right?
Now, if you'll excuse me,
I have to prep for surgery.
It's true.
He used to be energetic.
- Silly. - Yeah.
But you... you can't just
take him off of all of his medications.
Doesn't he need them? Honestly, I don't know.
I don't know what he needs. He's on so many
counterintuitive drugs, I can't see the real issue.
I want to try behavioral therapy.
Talk therapy.
He had, um...
outbursts at school... physical.
And when the school psychiatrist
started him on the zotepine, they completely stopped.
That drug may have succeeded in curbing your son's behavior,
but it did nothing to address the underlying issues.
Zotepine also causes lethargy, apathy.
So when he was prescribed a stimulant,
that led to his sleep issues.
And accelerated his weight gain,
which developed into Type 2 diabetes.
That's why he's wetting the bed. He has diabetes...
because of the drugs that he's on.
My God, I didn't... I didn't know.
I mean, they told me that he needed them.
I was just... I was trying to help him.
Of course you were. That's what we all would have done.
Yes, absolutely.
I'm sorry, I just...
Let me pull him off the meds.
You know, let me talk to him.
I really just want to talk to him.
When was the last time you saw your son smile?
Dora, are you stalking me?
It's definitely beginning to feel that way, isn't it?
Dr. Sharpe's office called.
I got pulled into OB.
Tell that to Dr. Sharpe. I got you an apple.
You know, I'm really more of a Golden Russet kind of guy.
Maybe keep that to yourself.
What do you have against Golden Russets?
Nothing, my issue is with people
who can identify Golden Russets.
- Dr. Reynolds. - What up?
- Now eat the apple. - Got you an apple.
Uh, also, I got a call from Jozette Pampil's family?
Apparently they're upset that you won't let them
perform some kind of protection ritual?
- That's correct. - Even though they believe
it's gonna help keep your patient safe from harm?
You fired the entire cardiac surgical department
because of the high infection rates,
and now you want me to let a family member
cut open my patient and put dirt in her wound?
Well, a superficial wound with a sterile blade
under your supervision.
Is this my call, or are you overstepping me?
- It's your call. - Good.
Then no one's cutting open my patient but me, okay?
- Hello. - She's ready to go.
All right. Wow.
Expeditions to the North Pole traveled lighter, huh?
Looks like V-fib.
- There's no pulse. - Defibrillator.
200 joules.
All clear.
Okay, got her back.
I'll back off the Levophed.
That should stabilize her.
- You're good? - Yeah.
Whew.
Back in V-fib!
- I don't have a pulse. - Let's go 300.
All clear.
Okay, I got her back.
What the hell?
She's too unstable for transport.
Maybe you should do the ritual.
Because Leo is on multiple medications,
we must devise a regimented detox program.
Mm-hmm.
The stimulant should leave his system overnight,
but the psychoactive medication
will require gradual tapering.
What, you don't agree?
No, no, I do. I do.
Just, um, for whatever it's worth,
I think you would have made a really good dad.
No, I wouldn't have.
Why do you say these crazy things?
- A word, you two? - Let me ask you something.
Don't you think Kapoor would have made, like, a totally rad dad?
- Uh, Dr. Villarreal, this is... - Look at this dad face.
This... hey! This is Dr. Kapoor,
head of our neurology department,
and this is Dr. Frome, head of our psych department.
Gentlemen, this is Dr. Villarreal.
She's the psychiatrist for all the public schools in Queens.
Including Leo Chen's.
His mother alerted me to the changes
you're making to his treatment.
Yes, we were just discussing his detox schedule.
Well, you should know that if Leo Chen
stops taking his medication,
he'll no longer be admitted back into his school
or, for that matter, any New York public school.
I'm sorry, how can you force a child to take medication?
Easy, it's the law.
Prohibition on Mandatory Medication Amendment.
It passed in 2004.
It is illegal for public schools
to force a student to take a controlled substance
to attend class.
Unless the mother signed
an Individualized Education Plan
agreeing to the medication.
- She did? - It's right there.
Not only are these medications
causing Leo physical harm, but nobody has studied
their long-term side effects, also.
Well, the school board doesn't seem to agree with you.
Max, I can get through to this kid, just not
- with all the drugs in the way. - Okay, okay.
You really feel that you can help this kid?
- I do. - And you think you can
- wean him off the drugs safely? - He does.
- What? You gotta talk faster. - I do.
Then present your evidence to a judge.
If you believe this is the best thing for your patient, prove it.
Take the New York public school system to court.
This pacing wire should get her stable
long enough to get her to the OR.
Or you could do the ritual.
If I believed in rituals, I would have become a shaman,
not a surgeon.
You're about to fix her heart valve.
If I were you, I'd take all the help I could get.
You know,
if a patient feels like
they've got to chant or knock on wood
or get their prayer warrior to lay hands on them
before I operate, then that means
they don't trust me, you know?
They don't have faith in my abilities.
Normal paced rhythm with capture.
See? Pacing wire is all the faith I need.
O2 sats are falling!
_
Jozette, I'm gonna sit you up so you can breathe.
I hear rales.
- Edema? - Backing up in her lungs
because of that valve.
- Here, toss me the furosemide. - I'm already on it.
You know, that's gonna take a while to dry out her lungs.
Well, I can't operate
until I get this under control.
So then maybe you do the ritual.
Don't.
Don't even say it.
Okay, look, uh,
the ritual isn't even about you
or what you believe or your abilities.
It's about her.
It's about what she believes, what she needs.
I mean...
why can't you just give her that?
So, Millie,
I've read your file.
Not so good, huh?
Well, your chemotherapy hasn't been as effective
as everyone hoped.
Starting tomorrow, I'd like to put you on a different regimen.
I wish I could offer better news.
No.
It's okay.
Well, at least I got to meet you.
Sorry?
I've seen you on TV.
Oh.
If I had known I was gonna meet the real Dr. Helen today,
I would have done my nails.
Your nails look fine, Millie.
No.
None of me looks fine.
I look like a cue ball.
Like a little, shrunken, nubby-nailed cue ball.
Hell, I tried to wear a wig.
It just kept falling off.
That was...
embarrassing.
Even my kids made fun of me... which I let them,
because it blows off steam, and...
I figured if...
they were laughing,
they wouldn't be thinking about me
keeling over dead.
I just wish
everything didn't make me nauseous.
Food makes me nauseous.
At first, I thought, "Well, I just won't eat anything,
so what could I throw up?"
- I was wrong. - I'm sorry.
Will you ex-excuse me? I need a moment.
You okay, Dr. Helen?
Yep, I just need, um...
I just need my diary.
Please tell me you're joking.
Green Jell-O?
Well, yeah, but... we make the food this bad on purpose
so that nobody wants to stay.
- Well, it's working. - Yeah.
Tell you what. I have an apple.
- What about you? - I'll be all right.
How are you?
Don't you have more important patients to see?
- Nope. - Max. Go.
Look, I just wanted to tell you that I'm not the same...
as that last job. I can be here...
for you, with you.
Max.
It's not just...
Look, even when you were there, you weren't.
I, um...
Sorry, I have to...
Go.
But when you come back,
let me in.
Promise.
Thank you for doing this.
I had no idea this was even possible.
Yeah, yeah. You know what?
New Amsterdam was actually the first hospital
to put a courtroom in the building
so we could, um, advocate for our patients in real time,
which is pretty neat.
Leo, come on through here.
You know, in the, uh, 1940s,
uh, New York was having a bit of a mental health moment,
if you will, and, um,
this psych department was completely overworked
and underfunded and...
uh, exactly like it is today,
come to think of it.
Dr Frome!
Oh, right, sorry.
Time to shut up now.
Mr. Bishop, as Dr. Frome already knows,
I like to keep my court informal,
so we're just going to jump in
unless you have any objections.
None, Your Honor.
Dr. Kapoor, we'll start with you.
I've read the file.
You have a course of treatment
you want me to rule on.
I get that. Tell me why all this is necessary.
Good morning, Your Honor.
Leo Chen is only ten years old,
and he's on four different medications,
many with very damaging side effects.
But none of the medications are actually
treating his root problem.
Which is what?
Uh, we don't know.
I mean...
we won't until Dr. Frome
can provide the therapy Leo needs.
And you don't think that's possible while he's medicated?
Overmedicated.
I don't envy Dr. Villarreal's position.
She's responsible for the mental health
of more than 3,000 students.
Prescribing medication is faster
than painstakingly evaluating
each individual student's needs.
- That's quite an indictment. - It's not meant to be.
It's simply the reality of the situation.
There are too many children in the public school system
in need of psychological help
and not enough mental health professionals to help them.
But you think you and Dr. Frome can.
Yes.
In a way that won't further endanger
Leo's physical health.
We shouldn't have to choose between
the physical and mental well-being of our children.
Thank you.
All right.
Let's get her to the OR.
Let's go slow.
The ritual worked.
Just don't tell Bloom.
Hey, how's it going?
Oh, my gosh, so good.
Kapoor nailed it, man.
He was like a slow, bald ninja out there.
Nice.
Ready, Your Honor.
Okay, let's start with...
the treatment plan
Dr. Kapoor lays out in Leo's file
seems very reasonable. What's wrong with it?
I'm sure it sounds reasonable, Your Honor, on paper.
But I'm sorry,
if Leo Chen is taken off his medications,
he poses a significant threat
to the rest of the student population.
That's an exaggeration.
If I may, Your Honor,
this is video footage of an incident
at school prior to Dr. Villarreal
prescribing the medications in question.
You're right about one thing, Dr. Kapoor.
I am responsible for over 3,000 children,
and I have to protect
the physical well-being of them all.
Hey.
They told me there was a fight.
But I have
never seen that video before,
and I just... I don't...
I know. It's okay.
I know this looks bad.
I'm not sure "bad" is the right word to describe it.
But what we saw on that tape
was rage.
Okay, and there's usually a reason for rage.
It's, uh... it's situational. It's not chemical.
How will you prove that?
Well...
just give me a second, okay?
I'll be right back.
So listen, Leo.
Do you think maybe you could tell the judge
what you felt that day?
You know what I mean? You can tell her why you did what you did...
in your own words.
Okay.
He can't.
Not on all these meds. There's no way.
There's just... there's no way.
There may be one.
"Thank whatever gods may be
"for my unconquerable soul.
"In the fell clutch of circumstance...
I have not winced, nor cried aloud."
I heard you did the ritual.
I'm glad it helped.
I'm pretty sure it was the Levophed,
the pacing wire, and the furosemide that helped.
How many times did you, uh, scrub each finger?
- What? - How many times?
- Ten. - Hmm.
Why not 9 or, uh, 11?
Superstition?
Routine.
What was that thing you were reciting earlier?
"Invictus."
Oh. Do you always recite "Invictus"
while scrubbing in?
I do.
Kinda like a prayer.
Mm. Habit.
Ritual.
Loosen up, Dr. Reynolds.
Not everything's gonna go according to your plan.
Or everyone.
Wanna tell me what's going on?
Rapid detox dialysis.
I heard that. I can see that.
And then I thought,
"Surely they can't be crazy enough
"to do something like that
in the middle of court proceedings."
It's the fastest way to get psychotropic drugs
out of Leo's system.
Right, but if we lose this case,
they are not gonna let Leo back into school.
You told us to put the patient first.
That's what we are doing. Off these medications,
Iggy will be able to work with him.
Yeah, if he can't, do you have any idea
the kind of liability you are opening this hospital up to?
Oh, I see.
What?
It's about now the new medical director
gets his first visit from the dean of medicine.
Or did the dean already come?
There you are. They need you in Hematology,
and you owe Dr. Sharpe a call.
So patient first or job first?
I think we broke him.
If you're looking for a hideout,
this one's taken.
Who are you running from?
Patients.
You?
Doctors.
One in particular.
I shouldn't be here.
Well, that makes two of us.
I really didn't expect to care
this much.
That's exactly why you should be here.
What about you?
I made a promise...
to my wife...
that I would slow down.
Before this, I ran a clinic in Chinatown,
and it almost broke us.
I mean, Georgia...
Georgia couldn't go through that again.
And I promised that...
she wouldn't have to.
I promised her that I would be there...
So we could start a family.
So I asked Georgia if she would slow down with me,
to stop dancing,
a career that she loved,
that she's really, really good at.
She did...
for me...
to be a mom, you know.
So we got pregnant, and then
I got the call
about New Amsterdam.
If Chinatown was K2, then New Amsterdam was...
Everest.
And who can resist climbing Everest?
Lots of people.
I wish I were one of them.
But I said yes...
without telling Georgia.
She didn't like that.
You betrayed her.
But that doesn't mean that you don't belong here.
I mean, the changes you've made are gonna help thousands of people.
What about the one I married?
Oh, Max.
You haven't told her that you have cancer, have you?
What are you waiting for?
To not have cancer?
You can't carry this load by yourself...
not as a medical director, not as a patient,
certainly not as a husband or father.
You've been telling everyone, "Put the patient first,"
so why don't you take your own advice?
Consider this your first appointment.
And your first order of business
is to tell your wife that you have cancer.
Hey, John, how am I doing on my suction?
?
- Good. - Okay.
Okay, can you give me a 2-0 polyester on a stick?
All right.
There we go.
Snip.
That should hold nicely.
That's the goal.
Okay, go ahead and restore blood flow
from the bypass machine through the heart.
Unclamping the aorta...
now.
Hmm.
Sutures holding.
Blood flow should...
stimulate the heart to start beating on its own.
I'm not seeing anything on monitors.
Okay, let's give it a little help.
Okay, here we go. Charge to 20.
Clear.
No visible beat.
Let's do it again.
Clear.
Still no heartbeat.
Gonna need something stronger.
Intracardiac high-dose EPI.
Give me 10 mls and a syringe.
- Dr. Reynolds. - I need it now, people.
Leo, can you tell Judge Hayashi what you told me?
It's okay.
She's a friend.
It was my fault.
What was your fault, Leo?
My dad died.
My fault.
Can you tell us the rest?
We were going to Sheep's Meadow...
in the park.
That's where we went to build LEGOs.
Then what happened?
Forgot them...
the LEGOs.
So my dad went back to get them.
And he didn't come back.
And you live on a fifth-floor walk-up, right?
Yeah, sometimes it was hard for his dad to walk all those stairs.
He had asthma and a...
heart condition.
And that day when he reached the top,
he had a heart attack.
And Leo found him.
And the video?
Can you tell me what happened?
Ryder...
he always said I should be dead
like my dad.
That day,
I finally...
I had to make it stop.
What are you proposing, Dr. Frome?
Well...
Leo needs to be able to process
all this displaced guilt.
And he can't do that when he's buried
in a drug-induced haze.
He needs to be able to feel.
He needs to be able to talk to somebody.
Let him talk to me.
Let me help him.
- Charged to 20. - Clear.
- All right, paddles in place. - How long do we keep this up?
Paddles in place! Nurse, loupes!
- Charged to 20. - Clear!
Still nothing.
Dr. Reynolds.
Do we call it?
What are you doing?
Trying cardiac massage.
That's not going to work.
All I need is one beat.
Just one.
Come on.
Dr. Reynolds.
Hold on, no.
I think I feel something.
I feel something.
Are you sure?
She's back.
You did it.
So...
The Gad Ko worked.
Please leave your message.
_
I know it's been a long time.
Too long.
Please call back.
I'm here.
_
- Max. - Hi.
How is she?
Better, but I'm still concerned.
She needs to be on bed rest until she stops spotting.
Okay.
She can't be put under any stress...
physical or emotional.
It could hurt her and the baby.
Understand?
Yeah.
Hey.
What's wrong?
I, um...
I...
Hey.
Remember?
You promised...
to let me in.
Just tell me one thing.
Just one true thing.
I love you.