- I'll be targeting your cancer directly
with stereotactic body radiotherapy...
With simultaneous intravenous Cis-Platinum.
Two-cycle regiment.
And I may throw in an EGFR inhibitor like cetuximab,
depending on how your tumor responds.
Works for me.
In English, please.
It sounds very important but, um,
all I care about is...
Could he...
What are his odds?
- Georgia. - No, Max.
I need an answer from your doctor.
Georgia, with cancer,
the odds are difficult to quantify.
But I believe that this is our very best option.
So why haven't we started already?
Yes, Max,
why haven't we started already?
B-Because there's a lot of pre-treatment procedures
I still need to get done.
Like, um, radiation tattoo,
- oral surgery... - Oral surgery?
Max's back molars will fall into the field of radiation
and they'll need to be extracted.
Um, so why haven't we done that yet?
Because I have been kicking this thing down the road,
a little bit.
To try to buy myself a little more time,
you know, as... as medical director.
Which, now that I say out loud,
in front of my wife, does not sound like the excuse
it sounded like in my head.
- Hmm, ya think? - Yep.
Could he have his molars out today?
That's up to him.
We have the big Domino Transplant today.
The run-through's in 30. I can't, uh... if I'm...
But I think I could because once they start,
they don't really... they don't really need me.
And I could probably be free as early as tomorrow.
Today...
Early afternoon.
- You're on board. - I'm on board.
- Just like that? - Just like that.
- Domino day. - Yeah.
- You excited? - Um, eh.
Transplant surgeons get to have all the fun.
I don't even get to sing back-up.
You know, I had a really good time last night.
And the night before.
I hope you did too.
Mm.
What?
I did.
I really like where this is going.
You know? You and me.
You sound so surprised.
No, no, I, um, I just didn't think
I don't know.
I don't know what I thought.
Well, when Lauren introduced us I had a feeling.
So, uh, what do you say?
We probably shouldn't walk in together, right?
Oh, yeah. It's way too soon.
I don't know about you, but on our side of the building
we're real gossipy.
I'll see you later.
Synced & corrected by -robtor- www.addic7ed.com
Haven't I told you about drinking those things?
You end up bouncing off the walls
and annoying the other nurses.
Yeah, that's part of my charm.
Besides, I need it.
Pull another double?
Bronx General.
"Knife and Gun Club?"
A guy's gotta eat.
Man, their ED never stops.
They need docs?
Since when are you hard up for cash?
I'm not. It sounds like fun.
Don't you just ever wanna go home and do nothing?
Now where's the fun in that?
Hi, I'm Dr. Bloom.
Diego. My daughter, Gianna.
Hi, Gianna.
So you're having some trouble breathing?
It's getting worse.
I waited too long.
- We can't... - Papa is...
Worried...
you can't help us.
You don't have insurance?
Undocumented.
Well, we treat everyone here.
You're safe from ICE.
If that's what you're worried about.
They won't even know you were here.
Come on. Pop, up Gianna. Let's have a listen.
"Sandstorm," huh?
You... know it?
Obsessed.
Been collecting single issues since the '90s.
Deep breath.
Again.
Good. Good.
You, uh, have you seen the platinum issue?
Gemini, she steals the Halter Cross
from the fourth dimension. It's wicked.
Gemini's... my favorite.
I'll be right back.
Casey, I need a chest x-ray,
and I need you to page Reynolds.
I need him now.
You got anything that will anchor the roll?
Ooh, science project?
Yeah, living that extra credit dream.
Yeah, I can see that.
Domino run-through.
- No time for chitchat. - Yes, I know.
Do you always have to be such a buzzkill?
How is she being a buzzkill?
Oh, um... well, do you remember how
I said I was gonna try to pull some strings for Blanca?
You couldn't do it. Figured.
Mmm, oh, you figured, did you?
Yeah, well, figure this,
my friend at Family Services got Blanca named
an Emergency Foster Provider.
Boom.
She had a site visit this morning.
Boom.
Guess what else.
Something that ends in "boom?"
Uh, yeah. She passed with flying colors.
You got a home.
Really?
Yes.
They can't take it back?
No, there are no backsies on this boom.
Okay, by this time tomorrow,
you're gonna be moving into your brand new digs.
Trust me, it's good. All right?
Yeah.
Okay, I better go before I have to relocate.
I'll see you later.
- Dr. Albert? - Here.
- Dr. Franz? - We're here.
We've got Pittsburgh and Newark.
Morning. Uh, Max Goodwin here.
I'm the new Medical Director at New Amsterdam,
and just to confirm, you are both in charge
of your respective harvest teams?
- Yes. - Correct.
Great. Dr. Sharpe here has been
working on this project for the last seven months,
so it is our job to not screw it up for her.
To that end, I would like to take everyone
through the Domino Transplant Chain one last time
set to the illustrious tunes of Mr. Van Morrison.
Max.
I'm just getting everyone pumped for the dry run.
Am I right, Newark?
Not a Van Morrison fan. What about Pittsburgh?
Yeah, all right, moving on.
We have six patients
receiving partial liver transplants today,
and, uh, six living donors from three states.
Our first donor surgery will be Tanya Mayer.
She just arrived at JFK.
Dr. Kapoor is running point on her.
Except Tanya isn't a match for her brother, Matthew.
So a lobe of her liver will be going to Aminah Ali.
My patient. Aminah is the anchor patient.
Her HLA factors were difficult to match.
That's why it took so long to find her a donor.
Each of our recipients couldn't find a donor match
within their own families, so their families agreed
to donate to someone else who would be a match for them.
Aminah's husband, Tariq, will donate to Francis Potter.
His mother, Lily Potter, will then donate
to Beck Newman.
Omar Kahn in Newark will donate to Lisa Verdad
here at New Amsterdam.
Mina Verdad will donate to Gil Hess.
And last but not least, to close the loop,
Peter Stern in Pittsburgh will donate
to our very own, Matthew Levy.
It's like Hands Across America but with livers.
Oh, yeah. I'll be here all week, Newark.
Thank you.
Wow.
Um, all these surgeries are time sensitive.
All right, let's, uh, give this our best shot.
And Dr. Sharpe... bravo.
Knock, knock.
How's the superstar doing today?
So happy the waiting's finally over.
Dr. Sharpe, back when Aminah was going through chemo,
I used to hate seeing you.
But now...
- Oh. - Tariq, she's a doctor.
Have some respect.
Sorry.
She's like family, umi.
Is the young lady who's donating here yet?
We would like to meet her.
Tanya should be arriving any moment.
Hey, T.
You're looking good.
How are the kids?
You know, they each have their own bedroom now.
So they kinda love that.
Until they told me you'd landed...
I wasn't sure you'd get on that plane.
Me either.
But I got over it.
It's for a good cause, right?
Family.
So this part of my liver,
why can't it go straight to Matty?
You're not a donor match for your brother.
The same is true for everyone in the chain.
Not a match for their own family
but a match for someone else's.
Sounds complicated.
It is.
But also very simple in the end.
Everyone lives.
Where's Reynolds this time?
We're not doing this again, are we?
He's busy.
He's been busy for the past three days,
whenever I need a consult.
Gianna, this is Dr. Flores.
She specializes in cheekiness and lungs.
Cool.
Do you know what's wrong with my daughter?
I do.
Scattered interstitial infiltrates
on the chest x-ray.
_
Dr. Bloom.
We miss you, Mommy.
Hope you have a good surgery.
Hello, Ms. Mayer. I'm Dr. Frome.
We spoke on the phone.
You have to do some kind of psych evaluation?
I do, yes.
Just to, you know, make sure
that you understand what you're getting into
before you give your liver away.
Part of my liver.
Right, yes.
One step ahead of me. Good.
Okay, just a few questions that aren't
on the forms you sent me.
First, I need to confirm that you are doing this
of your own free will.
Under no pressure from anyone else.
I'm doing this because my brother asked me to.
Siblings, am I right?
Do you have a brother, Dr. Frome?
I did, yes. He passed away.
Would you have given him
part of yourself to save him if you could've?
Yeah.
But you don't get do-overs, right?
Okay, why don't we talk about post-op care?
Tanya?
Are you all right?
What do you mean she's out?
I mean she's out, Max. I can't clear her for surgery.
I don't believe this.
This house of cards is built entirely on her consent.
Listen, Tanya Mayer is nowhere near emotionally
or psychologically capable of being a donor.
What... what exactly did she say?
Well, she's got two small kids.
She's worried she won't be able to take care of them
while she's in recovery.
What's the real reason?
On a deeper level,
on a more emotional, personal level...
She's not convinced that Matty
would make the same sacrifice for her.
She can't be serious.
They are deep wounds in this relationship,
- Kapoor, old ones. - They're family.
Can't you talk to her?
Anything I say to her at this point
could be construed as coercion.
No one is suggesting coercion.
Stop. Look at this board.
Look at these people.
How do we fix this chain?
Are you saying the chain's in jeopardy
and we might need to pull the plug on Omar Kahn's surgery?
Well, let's just call it a pause.
We can't hold the OR forever.
I know, just give us some time to regroup.
If we can put this thing back together,
then we are gonna need your donor.
Keep us in the loop.
Thanks. Any luck?
We have been on the phone
with the Organ Transplant Foundation
for the last couple hours.
No match for Aminah.
The same with the Living Donor Network.
Okay.
So what now?
We keep looking. The chain depends on it.
What if it didn't?
We might need a few more words
there from you, Boss.
We can still move forward with most
of the surgeries today.
Don't even say it.
Tanya is gone, all right?
Aminah doesn't have a donor,
but the rest of these recipients do.
Because of Aminah.
She's the anchor patient.
We started this chain to find her an organ.
Without her and Tariq, there would be no chain.
I know, and we will find Aminah a donor.
Just not today.
Will Tariq agree to donate without Aminah having a donor?
It's the right thing to do.
The right thing to do?
That he should give up a piece of himself
while we take away his wife's hope?
This is the best option we have.
I'm sorry to cause so much trouble.
It wasn't you. It was Tanya.
No, I-I knew it was risky.
We haven't been close in a long time.
She has her own family now...
She promised you, Matty.
She broke her promise.
And now because of her, a woman across the hall is...
Would you give me a second?
Hey. Hey.
What kind of a person makes a promise,
gets on to a plane and then throws
that promise in your face?
Um, a mother who's scared to die?
A sister who feels used?
Where I come from, that's not how we treat our family.
We don't turn our back on them.
Oh, okay, Vijay.
This is not about you and your son.
You can't make this about him turning his back on you.
Iggy, you are most welcome to play psychiatrist
with everyone else in this hospital, not me.
So no transplant today.
I am so sorry, Aminah.
Did the donor say why?
We can't ask those kinds of questions,
but we are searching for a new donor right now.
It took seven months to get here.
Aminah doesn't have another seven months.
Neither do the others in the chain.
What happens to them?
Many of the other recipients are very sick.
They're much sicker than you.
Allah yarhamahum.
That's why we...
That's why we need to proceed with the other surgeries today.
You're what?
We need to... I need to ask you...
You can't be serious.
You would be saving so many lives.
By sacrificing my wife's.
- Tariq. - No.
No, no, no. Hey, I love you.
I am not gonna let them do this to you.
The Qur'an teaches us that...
Not now, umi.
I know that it seems unfair...
I won't do it.
Not unless Aminah has a donor.
This should relieve the pressure
building up in Gianna's lungs.
I'm through the right atrium.
So is there a reason you keep sending me
to do ED consults when Dr. Bloom's on duty?
Do I need a reason?
I get the sense Dr. Bloom
thinks you're avoiding her.
That or she has no confidence in my abilities.
She thinks you're an excellent surgeon.
It's just that, uh,
she and I have a bit of a situation.
- Oh... - No, no, no.
Not like that.
Well, whatever it is,
may I suggest you start answering your own pages?
Right Ventricular pressure's 35.
Draining the fluid didn't work.
I got your page. What's up?
Jemma had an impulsive aggression episode.
How bad?
The other students said it came out of nowhere.
She was screaming, throwing things.
We put her in a quiet room to calm down, but...
It's not my fault!
Not so quiet.
Do you think we need to pump the brakes
on Jemma's home placement?
It's not my fault.
It's not my fault!
So your daughter has a condition called
idiopathic pulmonary fibrosis,
and we couldn't tell how advanced it was in the x-ray...
But she's going to need a new lung.
You can do that?
You can give her a new lung?
Normally, yes.
But because you're undocumented...
Dr. Bloom says you treat everyone here.
We do. We do.
But the Organ Transplant Foundation, they won't put
an undocumented person on their recipient list,
because post-operative care requires...
Well, stability.
And they don't think we have that.
No.
What about me?
Give her my lung.
Well, we can check to see if you're a match,
but they're won't be any guarantee.
Any chance is better than none.
Please.
That leaves only four recipients.
And we still have more donors to talk to.
Let's hope they stay in.
Why do you think any of them
will have a different reaction than Tariq?
They're good people, but they're not giving
out of the goodness of their hearts.
Quid pro quo.
How's the, uh, chain going?
Don't ask.
So, uh, I have a patient presenting with IPF.
She needs a lung, but she's undocumented.
No family matches?
She only has her father, but he's not a match.
I was hoping that maybe you could call the Mayor,
get her a visa, so we can get her on the OTF list.
Sharpe?
I don't see how this helps.
The HLA factors.
Uh, let's get the whole team in here.
We might have a way to save everyone.
The chain fell apart when we lost Tanya Mayer,
but it looks like we have a new match for Aminah.
And that is Diego Morales.
So the chain is complete?
It will be if Diego agrees
to donate part of his liver.
Wait, how does Diego donating his liver
help his daughter? She needs half a lung.
That's where the chain comes in.
We need the families of the donors
and the recipients to reach out to their people
to find anyone who might be willing to donate
their lung to Gianna.
Why would anyone do this
when they weren't willing to before?
Because they weren't getting anything in return before.
But now they would be saving the lives
of everyone in the chain, including their loved one.
It's a win-win. Win, win...
We don't have a lot of time.
Some of the recipients won't make it past tomorrow.
Then we better do it quickly.
You becoming part of this chain
is our best bet at saving Gianna.
We realize you may need some time.
I'll do it.
You understand what we're asking?
Give me the knife and I'll do it myself.
Well, let's hold off on that,
but we do appreciate the enthusiasm.
Um, now the hard part.
Are you seriously asking me to donate a lung, too?
No, you would just be the liver donor.
What I'm asking for is help finding someone
willing to donate a portion of their lung.
A second donor.
So we start this all over again.
This girl, she is just a child?
12 years old.
The only person she has is her father.
And he is not a match?
Gianna can only qualify for a "directed organ" transplant.
- Without it... - No.
We've done everything you've told us to do.
We've done enough.
Is there anyone else?
Another family member?
We need a lung donor to make this work.
My sister was all the family I had.
And you know how that ended.
Peter Stein is getting antsy about donating,
and frankly, so are we.
At some point we're gonna have to pull the plug.
Just not yet. Please.
I'll do what I can on my end,
but at this point, I can't promise anything.
Okay, thanks.
Dora, get me Iggy. Oh.
Hey.
- Hi. - Hey.
Guess what.
Helen pulled some strings, got us in with Dr. Britland.
Best dental surgeon in the city.
But something came up.
I'm not trying to get out of this, okay?
I am just trying to rebuild this transplant chain,
Uh, one piece at a time.
Until each piece falls into place,
but it just keeps falling apart.
You know I'm on Team Max, right?
Of course I do.
No, I mean, I have banners and hats and...
You have a hat?
But sometimes it feels like I'm the only one.
You're not. I promise.
Look, I want this cancer out of my body more than anything.
I just have to push this appointment a few hours.
Just until I can fix this chain.
Hey.
Team Max.
I'm here to make it 100% clear to you what happens
emotionally and physically after organ donation.
Dr. Frome, Gianna and I came here from Guatemala.
I was police there.
The gangs, they don't like it if they cannot corrupt you.
They threatened our lives.
That's why you left? You fled.
When Gianna could not walk and breathe at the same time,
I carried her.
And when we finally go to New York...
I made sure we were hidden, so they could not send us back.
And she got worse.
This is my fault.
And I'm going to fix it.
It doesn't matter what happens to me.
Okay.
That's all I needed to hear.
Hey, I was just about to head out.
I wanted to see if you needed anything.
Oh.
Are you okay?
I'm scared.
I don't like being... alone.
You wanna know a secret?
I don't like being alone either.
What do you say, you and I,
we keep each other company until your dad gets back?
- Yeah? - Yeah.
Okay. Come on, scoot over.
Okay.
Hey, you know, Gemini's boyfriend
was my very first crush.
But he's a one-eyed meteor beast.
Yeah.
Yeah, I was a weird kid.
We shared Gianna's case with all the families
in the Domino Transplant Chain.
And it was a tough ask of a perfect stranger
to donate a part of their lung.
I, uh, I understand.
The thing is, Diego, um,
we don't have a donor for Gianna.
We have 12.
Now with so many volunteers,
we are almost sure to find a match for Gianna today.
What is it?
- She just stopped breathing. - BP's dropping.
Got any room on her dopamine drip?
Maxed out. So is the dobutamine.
- Start levophed. - Start levophed.
- We've got this. - Heart rate's up to 120.
Are you sure her heart can tolerate the levo?
- No, but do it anyway. - Reynolds?
We've got this.
Come on, Gianna.
Come on.
Come on, come on.
Gianna's heart is failing, Diego.
Her lungs are so scarred
that her heart can't pump blood through them.
We have to take her to the OR
to put her on an aortic balloon pump.
That will stabilize her condition and hopefully
it will help her heart recover.
But until it does,
she's not strong enough to withstand transplant surgery.
I'm sorry.
Take care of my little girl.
We'll give you some time with her.
I really thought we were gonna make this chain work.
You're giving up?
There's nothing else to do today,
except hope everyone hangs on.
Is Gianna okay?
We're getting her to the OR now.
Uh, can we talk?
I don't know, can we?
It seems like you've been doing everything you can
not to talk to me.
I deserve that.
I got more, you wanna hear 'em?
Okay, look, uh, Evie and I
have been spending a lot of time together.
And our history makes that, you know, complicated.
And awkward.
Not for me.
Really?
I introduced the two of you.
I mean, shouldn't that prove that I'm fine with this?
Or do you think I just like torturing myself?
I mean...
Shut up. Come on, stop being weird.
We're friends and we're fine.
Now can you just please go and fix Gianna?
All right.
You can't lock me in here!
Okay, we can talk about that
but not while you're yelling.
It's not even my fault!
Janine was messing with my machine.
And I told her to stop it and she wouldn't!
Wow, you really cared about that project, huh?
- Yeah. - Okay.
So then, why did you break it?
All right, um...
Do me a favor and just close your eyes for a second.
Jemma, close them.
Close them, please. Thank you.
All right, now I want you to picture that machine.
I want you to see it broken in pieces all over the ground.
How does that make you feel?
- Sad, I guess. - Okay.
Why sad?
Because it's a waste.
All right, what else?
It's...
sad because...
It's useless now and nobody wants it.
Jemma.
I know what you're gonna say.
You do?
Okay, all right, smarty-pants. Then tell me.
What am I gonna say?
No one wants me.
Why would I say that?
- It's not true. - Yes, it is.
No, it's not. Blanca wants you.
Yeah, today she does.
Someday she won't.
Look, I'm gonna mess it up. I always do.
No, I don't believe that. Not for a second.
I know that trusting people is scary.
Th... that's the scariest thing.
But when it comes to family,
that's just the price of admission.
That's the way it goes.
And nobody deserves a family more than you do.
Nobody.
Trust me.
You don't have to go.
But...
If you do decide to take that leap of faith,
I'll be there with you.
I hate feeling like I'm giving up on these people.
Max, when have you ever given up on anyone?
Right now, if you don't take care of yourself,
how are you gonna take care of them?
- Max. - What's going on?
- Is everyone okay? - Everyone's fine.
Diego?
May I still give to the chain?
_
What did he say?
The Domino Chain's a go.
Okay.
I hereby bequeath unto you
the "Holy Sticky Notes."
Such an honor.
- We're gonna be late. - Text me, okay?
I wanna know everything that's going on,
every step of the way.
Absolutely. That sounds like a great use of my time.
I want a full play-by-play, right?
Leave no patient's condition un-texted.
Leave no surgeon's incision un-communicated.
Max, you're headed into quadruple molar extraction.
You'll be under anesthesia for hours.
I can multitask.
Just please say "okay", so I can push him into a passing cab.
Okay. I'll text so frequently, you'll need a new data plan.
That's what I'm talking about.
Good news?
Your organ just landed.
I'll be here with you every step of the way.
Go ahead.
Welcome home, kiddo.
Matty's in recovery.
Congratulations.
Your chain is complete.
Our chain.
Do you know, in Oncology,
you get so few wins.
It becomes harder and harder to believe
that things will ever work out.
Oh, I thought for sure this would not work out.
But it did.
Welcome back.
Gianna.
How is she?
Ask her yourself.
Como estas, Papi?
We were able to shore up her heart enough
to do her transplant.
She got her lung?
Your daughter is a fighter.
Just like Gemini.
She gets it from her mother.
I get it from you, Papi.
Thank you.
Thank you, doctor.
Oh.
I only saved one life today.
You saved six.
And that was awesome.
Yes, it was.
Hey, you wanna have lunch with me and Evie?
Her favorite spot's this place on 23rd that literally
puts everything on a donut.
As tempting as that sounds,
I think I'm just gonna head home and chill.
Chill?
Later.
Don't keep her waiting.
Hey, what are you doing here?
So the thing is...
I do wanna walk into work with you.
Haven't seen you in a while, Dr. Bloom.
Welcome home.
Bronx General Emergency Department.
It's Dr. Lauren Bloom.
Can I still pick up that shift tonight?
We could always use another set of hands.
I'll put you down.
Morning, sleepyhead.
Ready for breakfast?
Well, lunch.
Bone broth.
Yummy.
Oh, Helen texted you all right.
So many texts.
Lot of, uh, complicated doctor talk.
But there's only one thing you need to know right now.
"Our Domino Chain was a complete success.
Thank you for never letting us lose hope."
You can read the rest after you've had your bone broth.
_
We'll do it together.
One piece at a time.
Until each piece falls into place.
I got you.
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