When I was 18, or night. I wanted a
tattoo of a panda right here, on my arm,
but, uh, my girlfriend at the time
talked me into a heart.
- Stop moving. - Yeah.
I don't know why I thought a panda would be so cool.
Well, this tattoo will guide
the external beam radiation
to within less than a millimeter of your tumor,
so, also cool.
Yeah, but three dots?
Three dots is so lame.
Why couldn't you give me, like, a badass teardrop
or a tiger?
I get that you're nervous.
Hmm.
When will you tell the staff?
I was kind of hoping they wouldn't notice.
Four days in you're gonna start vomiting constantly.
After two weeks, you'll be fed through a tube in your stomach.
You won't be able to swallow.
There'll be hair loss. Weight loss.
What I'm saying is, I think they're gonna notice.
They're gonna notice, yeah.
I'll tell them.
Somehow.
Okay.
Hold. Don't move.
Imagine it's a panda.
Synced & corrected by -robtor- www.addic7ed.com
So in the middle of stitching up her arm
she asks for a mai tai.
I was like, "Lady,
does this look like a tiki bar to you?"
Hey, thanks guys.
I would never have made it from the Bronx without you.
Next time, drinks are on me, okay?
Stealing snacks again?
No name, fair game.
Moonlighting before a double?
So? Like you don't.
Yeah, but I'm not the department chair.
Later.
All right.
Lauren?
Hey, do you know what kind of Scotch Floyd drinks?
What? You guys are buds.
Yeah, it's just weird hearing him called Floyd.
Oh, yeah, right.
It's way more normal to call somebody by their last name.
So Scotch?
Uh, if he's paying, whatever's in the well,
and if someone else is paying, then top shelf.
- Why? - Uh, it's his birthday.
Oh, man. Well, good luck.
Wait, why good luck?
Well, it just sucks to start dating a guy
and then have it be his birthday.
- Does it? - Yeah.
If he one of those guys who loves his birthday.
- I love my birthday. - Not like he does. It's impossible.
So you're thinking I should get something
- better than Scotch? - Yep.
Good luck.
Ah, thank you.
This is too much.
I don't even know how to...
Oh!
You got me a FloTech Cell Sorter for my birthday?
- No. - Man, you shouldn't have.
- I didn't. - And yet, here it is.
I guess HCC decided to upgrade our old cell sorter.
Which, no surprise, didn't need upgrading.
Whoa.
Maybe your girlfriend pulled some strings?
Oh, I don't know; this machine costs 100,000 bucks.
Which could have been better spent
almost anywhere else in the hospital.
- Yes. Bureaucracy. - Bureaucracy.
Here, help me get it to the OR before someone else nabs it.
You're keeping it?
Well, possession's 9/10 of the law.
It's not, actually.
Well, then I'm invoking the "finders, keepers" rule.
Just help me move it. Come on.
How do you, do you know how to...
Do you know how to do...
It's broken.
Yeah, well...
Bureaucracy.
Hup, keep walking.
Keep walking.
I am still very angry.
Down three with seven seconds left
and Hardaway's sitting on a bench?
And then they don't call a timeout.
He's our only three-point shooter.
Well, to love the Knicks is to suffer.
Would you like to watch the game tonight...
together?
I can't.
Okay.
I'm getting my one-year chip.
Chip?
For being clean.
I see.
It's at the downtown Y.
You could come if you'd like.
- That would be... - Strange to get a reward.
I mean, it's kind of a big deal.
I would think that
the real reward would be
not being an addict.
Okay.
- So I guess you're not coming. - I have a better idea.
Um...
Knicks game? Next week?
Yeah.
Patient.
So I'll... I'll see you next week?
Uh, Max.
Can I just get your thoughts on a patient?
- Yeah. - Um, locally advanced
pancreatic cancer.
Amenable to surgery?
Yes, he's prepped and ready to go.
- Great, then go for the cure. - There's a catch.
Cardiology work-up found a left-ventricular
ejection fraction of 35%.
That is a catch.
90% chance he'll die on the table.
But a 10% chance he won't.
Technically. But those are terrible odds.
That's for him to decide.
I can't suggest he go through with the surgery, can I?
Why not?
Because that's like me saying to you,
"Hey, let's scrap chemo and wing it
with precision-targeted therapy."
Well, some of those trials show a lot of promise.
Some show it makes the disease worse.
But we're not talking about you.
Right, but
we have to give your patient
both options, right?
"We"?
A man named Daniel
was captured by Roman soldiers.
The general told Daniel he could make...
Nurse, can you give us a minute?
Thank you, he's all yours.
The story was just getting good.
Rabbi Skillman, I'd like to introduce you
to our medical director, Max Goodwin.
Goodwin. Is that Jewish?
Uh, I believe my great-great-grandmother was,
but I was raised... nothing.
Then you're Jewish.
I'll take it.
So, Dr. Sharpe.
Do you have good news for me this morning?
Lot of whispering going on.
I wish I did.
Okay.
It's what you feared? His heart...
Work-up shows that it's not
pumping blood very well.
Mm.
The cherry on the cancer cake.
There's a 90% chance
of dying in surgery.
Or a 10% chance of a cure.
Not great odds.
The other option is no surgery.
You can go home.
Spend a year of good-quality life
with the people you love.
We'll make sure that you're comfortable.
Like any good conundrum,
I believe I'll need some time to think about this.
Yeah, of course.
And if you have any questions, I'm here.
Take all the time you need.
We just want to make sure
you really consider both options.
Okay.
Hmm.
Amy.
I see your...
migraines haven't improved.
And, uh...
your triptans did not help.
No.
We can run a second MRI,
but I'm afraid we've exhausted
all the traditional treatments.
Is there anything else...
Find a better treatment.
Yes, Mrs. Chiang.
I'm starting to think that stress
could be a factor.
And we might think about counseling
as an alternative treatment.
I speak many languages, Mrs. Chiang,
but Mandarin is not one of them.
Um, my mom is just saying...
My daughter is here for migraines.
I have a colleague, Dr. Iggy Frome,
and, uh... ah.
He's a wonderful psychiatrist.
Okay.
"Dr. Ignatius Frome.
Chair of behavioral health."
Mom. It's just to talk.
One appointment can't hurt.
Okay, but what if Dr. Frome could help?
We don't talk to strangers about our problems.
What do we got?
"Failure to fly." Bowery stop, attempted suicide.
Escort her out of here. Would you give me the rundown?
Amy Chiang. 21.
Got lucky, landed on the track bed
so the train went right over her.
Left her with lacerations, possible patellar fracture.
Amy, look at me.
Can you move your leg?
Got her chart.
Get ortho and prep for surgery. Now.
You're not gonna believe this,
but she was here this morning.
- Why? - Seeing Dr. Kapoor.
First generation Chinese-American.
First to go to college in her family.
Scholarship. Works full-time at the family restaurant.
Grades started to slip.
She came in complaining of migraines. Medication didn't work,
at which point Kapoor suggested stress
as a possible trigger, and then referred her to me.
- The next thing you know... - Only 21.
Possible undiagnosed severe depression.
We saw this at the Chinatown clinic.
Called it "the F train disease."
Never heard of it.
Well, the F train runs through Chinatown,
and a lot of women would use it as a last resort.
Uh, depression can be...
hard to accept in some Asian communities.
In many communities.
Yeah, well, stigma or no, if we don't help Amy,
she will probably try to kill herself again.
I've never seen anything so beautiful.
What does it even do?
Oh, nothing, you know,
just separates the white blood cells
from the red blood cells with the flick of a switch.
Best birthday present ever.
You really are a birthday dork.
My mom worked two jobs seven days a week,
but every year on my birthday she took the whole day off
and took me to the bookstore,
where she bought me as many books
as I could carry.
Correction. You are just a dork.
No way.
It's the wrong connector.
It's not compatible with any of the machines.
Call an electrician.
No, we'd have to upgrade the whole OR.
This is just $100,000 worth of useless junk.
Quality genes. I bet he's smart, too.
You don't get abs like that without crushing the SATs.
When I want input on my choice of sperm donor,
- I'll let you know. - Right.
Has the rabbi decided on the surgery yet?
I usually give my patients a little more time,
you know, when it comes to life-and-death decisions.
Well, you know, in poker they say,
"You think long, you think wrong."
Well, that's interesting,
because in oncology we say,
"Do the opposite of poker players."
Well, let's see what the patient has to say.
No. Max!
- Hmm? - I think you're getting
- too invested in this. - Really?
Isn't this the same amount of "too invested" I always get?
I take it, if you were the rabbi,
- you would take the year. - I have my reasons.
Well, I respect those reasons,
except they're ridiculous because a year is nothing.
A year is everything
if it's with someone that you love.
There's a year, and then there's a year with cancer.
Believe me, most people would take the surgery.
Max. Signatures.
Dora, my dear, how are you?
Ah, good, thanks.
- Actually you're not. - I'm not?
- You have terminal cancer. - What?
Ah, you're settling a debate between Sharpe and me.
Oh, do I have to?
Choice one: get a surgery that would cure you.
Right? Or choice two:
go home, do nothing, and die.
- Definitely the surgery. - No, hang on.
Max is trying to sway the jury.
Here's the real situation.
Option one: have a surgery so risky
you're more likely to survive a plane crash,
or go home and have a good year with your family
living in peace and comfort.
Definitely the year. Can I be done now?
- No. - Yes.
Thank you, Dora. See?
It's all in the presentation.
He's doing the surgery.
It's a no-brainer.
I'm not doing the surgery.
The risk is too great, I...
I was prepared, but now...
90% death rate?
I'm a Jets fan.
Historically, luck has not been in my favor.
Hey, hey, hey.
This is the path God chose for me.
We're gonna have a good year.
You could take more time...
to decide, if you want. You can...
go home and talk it over with the rest of your family,
your congregation...
I-I'm... I'm at peace with my decision.
I accept my circumstances for the way they are,
not the way I want them to be.
We both do.
I want the year.
And New Amsterdam will be here to support you
every step of the way.
Thank you, Dr. Sharpe.
Now let's talk about what comes next.
Mm.
We're going to connect you with staff members
who will discuss home care and medication.
Rebecca's going to be incredibly important.
And the focus of this year is you.
Your comfort.
- Mrs. Chiang. - How is she?
- Amy is stable. - When can I take her home?
Hi, um, I'm Dr. Frome.
Dr. Kapoor gave you my card earlier.
I just wanted to say I'm very, very sorry about what happened today.
When your daughter gets out of surgery, we would like to discuss
inpatient psychiatric care with you.
She's not crazy. She's a good girl.
No, no, we know that. We know she is.
She just needs help.
We're going to go now.
Okay. We want what's best for your daughter,
and I'm sure you do too.
But, uh, you're not the patient here.
Amy is.
Mrs. Chiang,
your daughter jumped in front of a subway train.
She didn't jump.
I beg your pardon?
She didn't jump. She slipped.
Come here, baby. Come here.
Studies found that docs working shifts
of 30 hours or more
end up making 36% more mistakes.
I'm fine. I'm a polyphasic sleeper.
That's not a real thing.
Me and Thomas Edison. We thrive off of short naps.
Define "thrive."
You gave the subway jumper 20 milligrams of morphine?
Is she dead?
No. Two. 2 milligrams.
It's a typo.
I didn't submit it.
I was gonna proof it.
- 36%. - Shut up.
Okay.
- Hey, Doc. - Hey.
Thought I was gonna miss you.
Everything all right?
Yeah, um...
Uh...
I... I need to ask you a question.
And, uh...
this isn't me, Dr. Goodwin, asking.
This is, uh...
This is me, Max.
What is it, Max?
That decision you made...
I don't think I could have made it.
And you seem so at peace, I mean...
real, in your bones, at peace.
You want to know how I can be at peace
when I know I'm going to die?
Yeah.
Do you know the story of Abraham and Isaac?
No.
Okay, so...
Abraham and Sarah have no children.
But when they're very old,
God gives them a son, Isaac.
And then God asks Abraham
to sacrifice Isaac. Kill him.
And he'll reward him with as many children
as there are stars in the sky and sand in the sea.
And Abraham, being a good and faithful man,
takes Isaac up the mountain to sacrifice him.
And God rewards him for it.
That's choice one.
But what if Abraham said no?
What if Abraham said,
"There's lots of stars in the sky,
"but only one Isaac,
"who I waited 100 years for,
"and I'd rather spend the time I have left on this Earth
with him and Sarah, reward be damned"?
That's choice two.
Two impossible choices.
So I took the one that makes me happier.
I have a confession.
Wrong religion, but I'm listening.
I have cancer.
I'm sorry.
Chemo stars tomorrow, and, uh...
what I'm learning is that I'm not a good patient.
'Cause I'm... scared.
And I'm frustrated.
And I'm angry, you know?
I don't... I don't know what to do.
Cancer changes everything and nothing at all.
Where is my sandwich?
I need a sandwich!
I need a sandwich.
Would you mind checking it out?
Yeah, no problem.
How are you feeling, Rodger?
His asthma seems better.
Do you know how much longer
we have to stay?
I'm sorry, what?
When can we go?
Yeah, uh, since your husband
uh, also has hypertension,
we're going to need to watch his pressure overnight.
I'm afraid the recital's gonna have to wait.
Is he gonna be okay?
Absolutely.
Okay, you were right.
Polyphasic sleepers are real.
Yeah, uh, you were right too.
Um, I'm gonna hit the on-call room
and just crash for five.
What the?
Can someone get whatever the hell this is
out of my ED?
You better be ready to party.
What?
Uh, I thought about what you said
and I decided to throw Floyd a surprise party
- right after work. - Right.
Great idea. He'll love it.
Just a few more quick questions.
Cake or pie?
Neither. Uh, cobbler. Peach.
Does he like karaoke?
Only if he can do power ballads.
Can't wait to see that.
You can't, really?
Are balloons too much?
Nothing is too much.
Thanks, you rock.
Dr. Bloom?
I could really use your opinion
on the patient in Bay 3.
Did you have a good nap?
Hi there, Amy.
I am, uh, I'm Dr. Frome,
I believe Dr. Kapoor spoke to you about me earlier?
Um...
Do you mind if I sit?
Thank you.
Okay, so.
I would like to talk to you about what happened today.
You are very lucky to be alive.
You know that, right?
Okay, tell me if any of these feel true for you.
Can't concentrate at school.
Chronic fatigue, but you can't sleep.
You feel like a failure
despite your many accomplishments.
Feel hopeless.
I thought it was stress.
That's depression.
And millions of people suffer from it.
I have a lot of good things in my life.
I shouldn't have depression.
Yeah.
Depression doesn't work that way.
But the good news
is it's highly treatable.
How?
Well, the first step is to ask for help.
I like to start with talk therapy.
What if my mom found out?
Or my dad?
They'd think I was acting weak.
I think it's a good thing
to talk to others about our problems.
I'm on my parents' insurance.
Okay.
They would know I was going to therapy.
They'd think I was talking about them
or telling family secrets.
They'd stop talking to me.
- Amy... - I can't.
I'm sorry.
Okay.
Amy shouldn't have to suffer
because her community is afraid of mental illness.
It is not about fear. It's about shame.
- No, it's about stigma. - You have to understand
that they are afraid of what others think.
Yeah, well, who cares what others think?
Look, we all want what's best for her, okay?
But we can't fight every cultural stigma in one day.
- Told you it was stigma. - It's shame.
We've got a patient that we want to help,
but we can't help her because of all these
stupid insurance forms.
- You're right. - See?
About what?
- Downcode it. - Are you serious?
I had to do it for girls whose parents
wouldn't allow them birth control.
Billed it as "round ligament pain."
Huh.
We would look incompetent.
But you'll help the patient.
You want us to defraud the hospital?
Exactly.
Okay...
Max.
What the hell did you tell the rabbi?
I have no idea what you're talking about.
After you talked to him, he changed his mind.
You have just talked him into a risky surgery
that will most likely lead to his death.
Sorry, Jane? Give us a second.
Please?
You're wondering why I changed my mind.
I am praying it is not because of me.
What can I say? You made a good case.
This is a high-risk surgery.
And for me to tip the scales in any way
with my own baggage
is the definition of unethical.
Tough luck.
You did.
- Max. - Rabbi.
Max, I make my own decisions.
Yeah, I could be home with family.
But I'd still be a patient.
That's not the life I want.
- But... - If I do this,
tomorrow I'll be better or I'll be dead,
but I won't be a patient.
Not sure that clears me of the malpractice suit, but...
Max, go. I absolve you.
Wrong religion.
Oh, now you're being picky.
Sorry. Rabbi?
Did Abraham actually sacrifice his own son?
No.
An angel came down and stopped him.
But he was going to.
And it was enough to pass God's test.
And God rewarded him with as many children
as there are stars in the sky and sands in the sea:
the Jewish people.
Some things are worth the risk.
Why is there a cell sorter in the hallway?
It won't connect to the other machines.
Bureaucracy.
Tell HCC
- to take it back. - They won't.
It's like we're working for the army.
Well, it can't live here.
I know. Can you take it?
And do what with it?
I don't know. But it's my birthday.
Dr. Goodwin, Sandra Fall from billing.
Yes. You left me a message?
Yeah, and you didn't call me back.
I knew there was something I forgot to do today.
Um, are you aware that two of your doctors are downcoding?
Downcoding?
Yeah, it's when doctors bill for something small
but provide more expensive care.
Why would they do that? Because if they were upcoding,
they could make money, but downcoding...
Yeah, exactly. So they told me
to put down CPT code 90868
for transcranial electrical stimulation
for patient Amy Chiang,
but that doesn't require three weekly sessions
in the psych ward, so I will also notify...
Okay, you got me. I told them to do it.
I just hoped they would do it a little better.
Uh, wait, you told your doctors
to extort money from the hospital?
Well, it sounds really bad when you say it like that,
but, uh,
we were just trying to help a patient.
Yeah, and it's my job to make sure the hospital has enough money
to help all our patients.
When is somebody
gonna get this thing out of here?
You bring up an excellent point.
So how do you intend to make up the lost revenue?
Would $100,000 cover it?
You can do that?
Call therapy something else?
We want to get you the help that you need
any way we can,
so we're gonna start therapy in here,
while you're in recovery, three times a week.
And, uh, and I will navigate your school schedule
and your work schedule.
Your mother will never find out.
But it's a lie.
On paper, yes.
And what will I tell my mother
when she asks about the brain stimulation?
Well, you can tell her it was very stimulating.
So then I will be lying to my mother.
- And to my father. - It's...
- it's for your mental health. - She'll know.
And even if she doesn't say anything...
she'll judge me.
I can teach you some coping mechanisms.
She won't... love me the same.
Is there a coping mechanism for that?
The downcoding will work.
But it's not gonna help, not in the long run.
The stress of having to lie to her family
is only going to exacerbate her depression...
her sense of isolation.
Our only option is to work around the mother.
I think that's the problem.
I don't think we should work around her.
I think we should bring her in.
- For therapy? - Yeah.
They need to do it together.
The whole reason we are here is because
the mother is against talking to anyone.
I know, but we have to get her on board,
or we're gonna lose Amy.
- Okay. - Okay.
Rodger Conway's gone into A-fib.
What?
Sorry, I can get someone else.
No, just, just give me a sec.
No, we can handle it.
I'm fine. I'm fine.
SVT. Ventricular rate of 160.
- Dr. Bloom? - Uh, how's the patient?
Any chest pain?
I would ask him, but he's unresponsive.
Okay. Uh, carotid massage.
He's a set-up for carotid stenosis.
He'll stroke out. We need a heavy hitter.
Okay. Okay.
What do you want us to do, Dr. Bloom?
Dr. Bloom, we need your instructions.
- Yes. - Yes?
BP's down to 95/50.
Dr. Bloom.
Okay. Okay.
Okay.
Atenolol, 5 milligram, IV.
You mean adenosine.
No, I said atenolol.
Atenolol.
- All right. - Got it. Here.
BP's down to 90/50.
Mr. Conway?
Are you with us?
Still unresponsive.
The medication will take a minute to work.
BP's down to 86.
He's about to convert to VTACH.
Blood pressure's still dropping.
We usually shock this rhythm.
Don't. No. This med will work.
We need to shock him now.
No, j... just wait.
Just stop!
He's back.
Normal sinus rhythm. The medication worked.
What just happened?
You're okay, Mr. Conway.
It's okay. You're okay.
Okay, one last quick question, and it's kind of funny.
How old is Floyd going to be?
I don't know. He's not my boyfriend.
We just slept together a couple of times.
There must be a part of you that knows...
that your daughter did not slip...
that she tried to end her life today.
I know it's hard to accept.
When a child needs help, one may think,
"I did a bad job as a parent."
One may wonder,
"Why I didn't see the signs sooner?"
Our children aren't perfect.
And why should they be?
We are not.
He's a good man.
Does that count for something?
In here, no. But...
everywhere else, yes.
He was always going to do the surgery, I think.
He just needed to explore the alternatives
to know it wasn't for him.
Do you...
resent him for it?
I love him for it.
Hi.
Just came by to check on you.
How you feeling?
Hmm, like I've been hit by an F train.
Whoa. Solid.
Solid jokes are a very good sign.
I'm sorry I can't go behind my mother's back.
You know...
You are obviously a very, very loyal,
very caring daughter.
I see that.
And you're part of a very tight-knit, close family,
and you care what they think.
I know it sounds...
silly...
but...
the hardest part of every day is...
just getting out of bed.
I lay there thinking about
all the things I have to get done.
I imagine it all in my mind.
And one by one,
I fail at everything.
I don't finish my schoolwork.
I'm late for work.
I say the wrong thing at home, and...
then I think maybe I shouldn't even try.
So I lay there for a while...
All the time, wishing
that I could just tell my mom...
How much pressure I feel
to make her proud.
Ma!
I told your mother how we will
bill your insurance.
She said it was quite clever.
I... yeah, I would like to... if it's okay with you...
see the two of you together.
I want you to get better.
I'm sorry.
I need help.
We all need help.
Surprise!
- Yeah, dawg! - Yeah!
Did you do all this?
It's no big deal.
Thank you.
Seriously.
How amazing are you?
Aww.
Paging Dr. Reynolds.
You are urgently needed
in the karaoke department!
How did you know?
Honestly, Bloom told me.
I believe I said "urgently needed"?
- Yeah. - Yeah, come on!
Whoo!
Rabbi Skillman's surgery is looking good.
Yeah, I got a text from Dr. Anders.
I'm so relieved.
Rolled the dice and came up huge.
Maybe you should do the same.
Choosing a donor.
I still miss him.
His name was Muhammad.
Internal medicine.
One of the good ones.
We were completely out of our minds for each other.
You know what that's like?
He asked me to marry him.
We were gonna have kids.
The whole thing.
You broke up?
Brain aneurysm.
All our plans, just...
And now here I am, freezing eggs
and asking strangers for help.
I feel like I'm b...
I feel like I'm betraying him,
and I... I don't know if it's worth it.
It's worth it.
Reynolds.
We should stop him before he moves onto prog rock.
Yeah, I didn't even know he could go that high.
I mean, that is...
And would you cancel my chemo tomorrow?
I wanna try precision-targeted therapy.
Clinical trials?
Mm.
Chemo's gonna take the life out of me, and I...
I wanna keep running this hospital.
I want to be there
for Georgia and the baby.
Max, we had a plan.
I know, but I don't want to be a patient.
I just want to be myself.
It's too big a risk.
It's a risk I have to take.