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00:00Dr. Larson was in a car accident.
00:02She has no recollection of the last eight years.
00:05Previously on Doc.
00:06Let me run internal medicine.
00:08Back to your roots.
00:09When you need time to work out things with Michael, I accept it.
00:11But when the shoe's on the other foot...
00:12When the shoe's on the other foot, you have a hard time telling me the truth.
00:15Delayed decisions on his care have been hurting him a long time.
00:18You don't have to tell me the system's broken.
00:21How much prednisone does it take to get you through a shift?
00:23You will flame out in weeks.
00:25It's time for you to use your greatness to pull the greatness out of others.
00:28I'm going to miss you.
00:42Sorry.
00:43This guy loves his sleep.
00:45Oh, there he is.
00:47Hey, can I have a hug?
00:50Oh my goodness.
00:51This is yummy.
00:52Ethan was sorry to miss you.
00:54He had a really early meeting.
00:55Well, Robbie's the main event, right?
00:56What fabulous holiday have they canceled school for this time?
01:00It's Lunar New Year.
01:01Oh, well.
01:04Grandma's been all over the world.
01:06You know, she can probably teach you how to say hello in 50 different languages.
01:0967, but who's counting?
01:11I should be back around 6.
01:13Thanks so much for doing this.
01:14Are you kidding?
01:15The more time I get to spend with this little man, the better.
01:17Oh, I brought you donuts.
01:19Your dad said they're your favorite.
01:20Thanks, Grandma.
01:28Jonah, you okay?
01:30I'm fine.
01:35Robbie, why don't you go upstairs?
01:37Oh my God.
01:39Grandma!
01:40Jonah?
01:40Jonah?
02:07Good morning, everyone.
02:09Good morning.
02:10This is going to be an adjustment for all of us.
02:13Dr. Ridley certainly left some big shoes to fill.
02:15And I know all these leadership changes the past year have probably been unsteadying.
02:21There are a lot of reasons why I wanted to practice medicine again.
02:26But I want to be very clear about the reason I asked to sit in that chair.
02:31The past year, as your CMO, I have seen what every person standing in this room is capable of.
02:37Dr. Miller?
02:38Time and again, you have risen to the occasion.
02:41We have a 62-year-old female in respiratory failure, complications from chronic MDS.
02:46I'm on my way down.
02:47I'm not here just to lead you.
02:50I want to join you and help you do what you already do so well.
02:54An issue, a problem, a suggestion, my door will always be open.
03:00Before we go, some congratulations are in order.
03:03In two weeks, Dr. Matra and Dr. Larson will succeed Dr. Heller as chief resident.
03:09As we welcome our new class of interns.
03:16Now, if you both could hang back for a moment with Dr. Heller, the rest of you, do good work.
03:25I'd like our co-chiefs to shadow you before you start your pediatric fellowship.
03:30You can begin with Dr. Matra this morning and then alternate days.
03:33Yeah, sounds like a plan.
03:34Great.
03:39It's quite a move.
03:40Well, it was either this or a leather jacket and a motorcycle.
03:51Joan's in the ER.
03:53Paramedics said she was extremely short of breath, likely bilateral pleural effusions.
03:58So is she hypoxic?
04:00Oxygenation's improved on the mask, but she's hypotensive.
04:03Let's push norepimab goal above 65.
04:06No, Richard, that's not going to work.
04:07I'm sorry?
04:08She's on prednisone.
04:0930 milligrams and she's tapered off.
04:10I read her chart.
04:11No, her chart's wrong.
04:12She's on way more than that.
04:16I've been using it to get through a surgery.
04:20You knew about this.
04:23How much has she been taking?
04:26Double that.
04:31Turpol to get through the X.
04:32Vivo with Javi.
04:35My natural cortisone reduction's got me shot.
04:40Okay.
04:41Lucy, 100 milligram bolus of hydrocortisone before pressers and run a complete lab workup.
04:48We're all here, if you need anything, Joan.
04:54Should I call Ethan?
04:58He's on his way.
05:00Amy, I need you to remember where I am at the Anwar.
05:05Joan, no.
05:06We're nowhere near that.
05:19Good morning, Dr. Walker.
05:20Good morning to you, Walter.
05:22How's our rocket holding up?
05:24Can't wait to launch it.
05:25You think I can still leave today?
05:27Got to examine you first.
05:28Can't let you out of here until we're sure you're all better.
05:31I really want to show the rocket to the kids at the house.
05:34I bet.
05:35Looks like that thing might actually make it to space.
05:37Do you ever launch rockets with their kids?
05:39I don't have any.
05:41Really?
05:42I thought about it when I was younger, but decided to take a different path.
05:46What do you mean?
05:47Well, being a parent's a big commitment.
05:49But that's also true for being a friend, a sister, an aunt, especially a doctor.
05:55Eventually, I figured if I gave my best to all those other things, that'd be enough for me.
06:00You're a great doctor.
06:02That she is, buddy.
06:04Sorry I'm late.
06:05How's he doing?
06:06Well, breathing's much better.
06:07Let's look at those knees.
06:12Oh.
06:13How long has your leg been moving like that?
06:15It happens all the time with my RA.
06:16Shouldn't it be now with the medication you're on?
06:18Yeah, I'll order a CT.
06:20Well, that's bad.
06:20Just need to see what's going on.
06:22We'll get it sorted out, though.
06:24Time to find your social worker.
06:26Again?
06:29Atlanta actual instability this severe will progress fast.
06:32We have to operate now.
06:33We don't have to go ahead from his proxy.
06:34Well, his C1 and C2 are compressing his spinal cord.
06:37What's everybody waiting for?
06:38The social worker said he'd sign off on whatever we decide.
06:41But he doesn't want to get in the beads.
06:43Well, that makes things tricky, because we have two surgical routes.
06:46High risk, high reward.
06:48Open the neck, expose the vertebra, place the corrective hardware directly.
06:51But you're concerned about arterial or spinal cord trauma.
06:54Not to mention stroke, infection, ventral cord damage.
06:57Plus, he's still recovering from lung inflammation.
06:59Definitely a concern.
07:00And the second option is minimally invasive fusion.
07:02Far less trauma and easier recovery.
07:04But wouldn't we be relying on CT for navigation?
07:06Which means less precision with the hardware.
07:08Yeah, it may require going back in in six months or a year.
07:11And there's a higher chance for a screw misplacement.
07:13At the C1, C2 spinal cord, that could be severe.
07:16Both have risks.
07:19It's your call, Gina.
07:28Do the minimally invasive fusion.
07:30I'll go explain to Walter.
07:37So, I've got full-blown leukemia.
07:41Is he?
07:45My belief is that the steroids artificially raised your white blood cell count,
07:50hiding the degree of marrow infiltration.
07:53And I spoke to Dr. Rose, and he agrees.
07:56Now, if this goes unchecked, your decline will be rapid.
07:59So, we'd like to start induction chemotherapy,
08:01which could buy you a few extra months.
08:04This shows a pan-psychopenic picture without any sign of leukocytosis.
08:09Yes.
08:09As I just said, the steroids are complicating things.
08:12Her leukemia has an atypical presentation.
08:14But we need to act fast before it progresses.
08:17Or her presentation is atypical because it's not leukemia.
08:21Amy.
08:21Her counts are dropping across every line.
08:24That looks like marrow failure, not marrow takeover.
08:27You're reading too much into the blast count.
08:28No, I'm looking at the facts in front of us.
08:32She doesn't show cancer on the peripheral smear.
08:34If this is pan-psychopenia, we could give platelets and plasma to raise her levels.
08:38Blast proliferation and dysplasia are textbook signs of leukemia.
08:43And delaying treatment because of wishful thinking will cost you significant time.
08:48Or, if he's wrong, the chemo will damage all your organs.
08:52I believe this is Joan's decision.
08:59Start the chemo.
09:03I'll put the orders in.
09:10You're brilliant, Amy, and I know you don't want this to be true, but I can't.
09:17I can't lose any more time with my family.
09:23Yeah.
09:34Mom, any soreness in the incision?
09:36Oh, it was routine surgery.
09:37I'm fine.
09:39Where's John?
09:41He's here.
09:42Having a smoke.
09:43Surprised you didn't go with him.
09:45Believe me, if I thought I could get away with it.
09:48Not on my watch.
09:49Oh, I know.
09:50Dr. Larson.
09:52Not yet.
09:53Mom.
09:53Speaking of which, you should get back to Minneapolis.
09:56No, it's fine.
09:56But Dr. Ridley is away for a couple weeks, so I finally get a little bit of breathing room.
10:01Who's that?
10:01I've mentioned her, like, six times.
10:04Genius surgeon.
10:05Doctors without borders.
10:07Utterly terrifying.
10:08Oh, right.
10:09Her.
10:10Everyone wants her to be their mentor, but she travels around so much, I don't think she ever slows down
10:15enough to do that.
10:16What do you even need a mentor for?
10:17You want something, you get it.
10:19I've always been that way.
10:20Barely even needed to push you.
10:22Well, there were times I could have used some pushing.
10:28Amy.
10:29Hey.
10:30Hi.
10:31I got air spous as I could.
10:33She's stable now.
10:35Ooh.
10:36She's pretty drowsy from the chemo meds.
10:38Right.
10:40Okay.
10:43Amy.
10:45Joan's coag panels came back?
10:47Mm-hmm.
10:48She has DIC.
10:50If we had pushed platelets like you wanted, the runaway cloning could have caused a massive stroke.
10:56I know how hard this is for you, but you're going to have to let me do my job.
11:06Ethan.
11:07Dr. Miller.
11:08Hey.
11:09It's good to meet you.
11:10It's good.
11:10It's good.
11:11It's good.
11:11It's good.
11:15It's good.
11:15It's good.
11:16It's good.
11:16The phones are done.
11:17What's next?
11:18Well, your partner in crime is sitting vigil for a friend in the ICU.
11:21Have you checked in on her?
11:23I didn't want to invade her space.
11:25It's always better to extend yourself.
11:27Trust me.
11:27She's going to let you know if it's unwanted.
11:29I'm sure she will.
11:30So, as chief resident, you've got to be able to work with anyone.
11:33Is there anybody else?
11:35Anything you've got to get ahead of?
11:36I don't know if you ever noticed, but Liz kind of had a thing for TJ.
11:40Yeah.
11:41She wasn't exactly subtle about it.
11:42Why?
11:42What's the problem?
11:47So, you and TJ?
11:49Wow.
11:50Okay.
11:51Um, I guess I missed that.
11:52How long has that been going on?
11:53Not very, and you, of all people, don't get to judge.
11:56I'm just not sure how everyone else will react.
11:59Well, listen.
11:59I mean, you can't control how people feel about you.
12:02Okay?
12:02All you can do is show everyone that you're going to be there for them when things get tough.
12:08Uh, Dr. Hamda, do you have a minute?
12:10Of course.
12:11Yeah, come in.
12:11Have a seat.
12:15Um, I know I should have said something sooner.
12:19I think I was just too afraid that no one was going to take me seriously.
12:23It's okay, Liz.
12:25What is it?
12:28Dr. Miller.
12:30What he did to me.
12:31Everyone's just pretending like nothing happened, but it was an abuse of power.
12:38I appreciate your honesty.
12:40And I understand how you feel.
12:43Not how I feel.
12:44It's what happened.
12:48Nobody condones what Dr. Miller did.
12:51But an agreement was reached.
12:52What agreement?
12:54I'm afraid I can't discuss it.
12:55So you won't tell me what happened?
12:59It was a confidential settlement.
13:01I'm sorry, Liz.
13:05I guess this just proves why I never should have bothered coming forward in the first place.
13:17CT confirms location.
13:19We're clear of the vertebral artery.
13:21Advancing cannula into position.
13:28Hey, babe.
13:29Okay, so I nearly had to sell my body for it, but Spoon and Stable finally called me back.
13:36They had a cancellation?
13:37I told them it was our anniversary, and they said they could squeeze us in at six.
13:41Can you make that work?
13:43Oh, looks like I'm going to have to.
13:45No way we're missing out on those oysters.
13:47So, there's a chance I may need to swing back here.
13:50Oh, no.
13:51Is it that...
13:52Boy, you told me about it.
13:53Found a pretty serious issue with his spine.
13:55He's in surgery now.
13:56Oh, honey, that's terrible.
13:58Are the social workers being helpful?
14:00Not really.
14:01I had to make the decision myself about what surgery he should have.
14:05Okay, I know it's not my lane, and I love you for being a person who cares this much.
14:10But the last time you got this invested in a case...
14:13He has no one, Wendy.
14:15I have no choice.
14:19Well, she told me about the prednisone.
14:21I said I landed her here a lot sooner than she would have otherwise.
14:25Yeah.
14:26She is strong-willed.
14:29That's what we love about her.
14:31She probably felt like she had no choice.
14:34You know, I...
14:35After I told her I didn't want to see her,
14:37what else did she have besides work?
14:39And now Robbie may never even get to know her.
14:43She knew that making things right with you was on her.
14:46Not you.
14:49All you can do now is be there for each other.
15:16What did you do?
15:20She was fine.
15:21She was just fine an hour ago.
15:23What did you do?
15:24It's not their fault.
15:25She had a heart attack.
15:27Nobody could have seen this coming.
15:35Amy, how's Joan doing?
15:38Oh, she's so stable for now.
15:40On chemo.
15:43I'm sure this must be hard for you.
15:45If there's anything I can do...
15:46Something's escalating in there.
15:50Your temperature's dropping.
15:52Yeah, core temp can drop after starting chemotherapy.
15:55It's normal.
15:56But it can also be a sign of sepsis.
15:58No, all of her cultures were negative.
16:02Is that true?
16:03Yes, of course that's true.
16:05And you should know that Dr. Larson recommended a course of treatment earlier that could have been catastrophic for your
16:11mother.
16:11So, I don't think that it is a good idea for friends to treat each other.
16:20I admire your mom, but I can be objective.
16:23And that's what she needs.
16:27He's right.
16:29I'm sorry, then.
16:38Hey.
16:39Hey.
16:40Do you have any of Joan Ridley's blood leftover?
16:42Yeah, we should have some extra.
16:43Can you run a beta-D glue can?
16:45Or her cultures came back negative.
16:47What are you looking for?
16:48I want to rule out an invasive fungal infection.
16:51Something in the endothelial tissue.
16:53You got it.
16:54And when you're done, could you get me the results?
16:57Directly?
16:59Says Dr. Miller's a sign.
17:01He is.
17:03I need this, Karen.
17:05Please.
17:07Sure.
17:10Hey, how's it going?
17:11Hey, I'm at the school.
17:14Apparently, Nia got into a fight.
17:17Let me guess, with Logan?
17:18I haven't had a chance to talk to her about it, but figured we should do it together.
17:22Can I bring her by the hospital?
17:23Shouldn't take too long.
17:24Yeah, yeah, of course.
17:25Yeah, I'm here.
17:33She killed herself, Gina.
17:35All those times I begged her to quit smoking.
17:38Her blood pressure was through the roof.
17:41It was only a matter of time.
17:43You can't keep fixating on what could have gone differently, okay?
17:46All you can do now is start to process your pain.
17:48What makes you think I haven't?
17:50It's been a week and a half.
17:51I still haven't cried.
17:53Crying won't fix anything.
17:56I'm not saying force it, okay?
17:58But just let yourself feel.
18:00This is only going to get worse once you're an actual shrink, isn't it?
18:04That's neuropsychiatrist, thank you very much.
18:08I just need to focus on school.
18:10And maybe that hot bartender from Stanton...
18:14I'm serious, Amy.
18:16You're in grief.
18:17And you're mad at your mom.
18:18You can't just push all that away.
18:20Why not?
18:20Because when it comes to feelings, the piper has to get paid.
18:24One way or another.
18:35Hey.
18:35Just checking on you.
18:37Joan's BP and O2 sets are improving.
18:39Chemo must be having an effect.
18:41So I guess Richard was right about the leukemia.
18:44At least we have a diagnosis.
18:45Where are you?
18:47I'm in radiology with another patient.
18:49I'll be back soon.
18:51Okay.
18:54We won't be mad, honey.
18:56We just want you to tell us what happened.
18:59Look at those silly markers at me.
19:01I thought we said when he did stuff like that, you would tell the teacher.
19:04It did, but it didn't stop.
19:07So I took my chocolate pudding and I dumped it on his head.
19:14Um, so what happened?
19:17You told the teacher and they didn't do anything about it?
19:18They had him sit in the big chair.
19:20What's the big chair?
19:21It's a big comfy chair in the corner where you sit and think about what you did.
19:26So, like a time out.
19:28Okay, but, uh, last week when you won the spelling bee, you said you got to sit in a big
19:33comfy chair.
19:33Yeah, you sit in it if you do something good.
19:36But then, sometimes, you sit in it if you do something bad.
19:43I want her out of that school, Rach, okay?
19:46There's the public school.
19:47There's the Hebrew school we toured.
19:48I don't care which one.
19:49I just think that she needs to be somewhere with more boundaries and grit and fewer participation trophies and big
19:53chairs.
19:55Okay.
19:56Okay what?
19:57Okay, you're right.
19:59I'm wrong.
20:01Let's move her.
20:01But, hold on.
20:03Did you just tell me I was right about something?
20:06And if you play her cards right, it might even happen again.
20:12I'll take her home.
20:14Yeah, yeah.
20:24Are you all right?
20:30Yeah.
20:33I'm just realizing how little power I have here.
20:41What happened?
20:45There's nothing to be done about it, Sonia.
20:47No, no, no.
20:48I'm going to be chief resident, which means I can advocate.
21:01And this is unprofessional.
21:03You were never going to test for this, Richard, and it's positive.
21:06You were not going to listen to me.
21:08Well, that was my call to make you.
21:09You want to tell me what's going on here?
21:10She ran a test behind my back.
21:12That is hardly the headline here.
21:14Joan has a candida organ infection, which he wouldn't have caught.
21:17I'm assuming you're interested in treating this, even though I was the one who found it.
21:22All right, all right.
21:23That's enough.
21:23Clearly the chemo lowered her immune response.
21:26Decrease the dosage for now and treat the infection.
21:28But we are still on the right path here.
21:33You know, I might be more inclined to hear you if you weren't so concerned with putting me in my
21:39place.
21:42He was never going to order the panel, out of spite.
21:46If you needed backup.
21:48Which is it, Michael?
21:49I'm supposed to come to you because you want to help?
21:50Or I'm not supposed to come to you because I put you in a tough position?
21:54Because I've heard it both ways.
21:56I am chief now of your department.
21:58That's a lot different than running two floors up to talk to the CMO.
22:01And by the way, you lied.
22:03You told me you were in radiology on our first day working together.
22:10You're right.
22:11I'm sorry.
22:13I'm, I'm, uh...
22:16Every time I look at Joan in that bed, all I see is...
22:20Your mom.
22:26I wish you'd been there for that.
22:28I'm here now.
22:31I know.
22:32Try to hold on to that.
22:39I think he's waking up.
22:41Walter, can you hear me?
22:42It hurts.
22:43Please, it hurts.
22:44The blood pressure's spiking.
22:45Walter, try to breathe.
22:47My neck, it hurts so bad.
22:48Two milligrams IV morphine stats.
22:50Where in the neck?
22:50Why can't I move my hands?
22:52What's happening?
22:53It's okay, Walter.
22:53That can sometimes happen with swelling.
22:57He lost his Babinski.
23:00So, the spinal cord's not sending a signal.
23:02Kosta's running a CT to confirm, but it seems the cord swelling is causing compression.
23:06He's on morphine for the pain, but he's got serious neurological deficits.
23:10No movement below the neck.
23:11The sooner we can get back in and operate, the better.
23:13But his lungs are still inflamed from the RA.
23:15He may not be able to take another round of anesthesia.
23:18Dr. Kosta's booked an offer first thing in the morning.
23:20Anything longer than that, then he could have serious neurological issues permanently.
23:23We should have been more aggressive.
23:24We can't Monday morning quarterback.
23:26The surgeon gave you two choices.
23:28And I picked the safer one because I was worried Walter doesn't have the long-term support
23:31to go for what was really needed.
23:33It was a coin toss, Gina.
23:34No, it wasn't.
23:35You wanted to go for the other option.
23:36But Kosta waffled.
23:38It should not have been up to you.
23:39No, it shouldn't have been.
23:40So, let me take this off your plate now.
23:42Tell Kosta I want Walter in reverse Trendelenburg during the operation
23:46and to use lung protective ventilation with low tidal volume.
23:52He may never walk again, Michael.
23:59Induction chemo did a number on me.
24:02Well, you're almost through the first dose.
24:04We found an invasive fungal infection, presumptive candida.
24:07We're treating it with antifungals.
24:11Candida must have seeded in my liver.
24:14No, well, not the liver.
24:16It's likely diffused endothelial, given the high beta-D-glucan level.
24:20Did you finish your homework?
24:23Is your father home yet?
24:26Mom?
24:26Joan, look at me.
24:27Hey, what's wrong with her?
24:28Ethan, step back.
24:31What's happening?
24:32She sees it.
24:34Oxygen to 10 meters.
24:36Alternative mental status?
24:37It's got to be neurological.
24:38Increased ICP.
24:39Her brain is slow.
24:40If she had leukemia, this wouldn't be happening.
24:42Not this fast.
24:43You're right.
24:44We're missing something.
24:50Look, I know whatever decisions were made about bringing Dr. Miller back
24:54are way above my pay grade,
24:55but we can't just ask Liz to forget what happened
24:58because it'll make life easier for everyone else.
25:00I'm going to talk to Richard once Joan is stabilized.
25:03I'm sure he'll be willing to apologize to Liz.
25:06His apology is going to be hollow and meaningless.
25:10And you should know when Dr. Miller was chief,
25:12he tried to use me to find out mistakes Amy was making.
25:16Look, I'm sorry you ended up in the middle of that,
25:19but I know the board.
25:22They'd rather find a way to get rid of Liz
25:24than reopen this can of worms.
25:25Well, they can try,
25:26but if Liz starts talking,
25:28they're going to get blowback from the nurses
25:30and potentially the union.
25:31Is that a threat?
25:34It's a reality.
25:35I'm just trying to do the right thing for her
25:38and protect the department,
25:39which is part of my job now.
25:41She bears responsibility for her own decisions, Sonia.
25:44As you said, she has a very strong union
25:46she could have gone to when all this happened.
25:47I think maybe you're expecting too much
25:50or not understanding the dynamic
25:52between an older man with power
25:54and a young woman at the start of her career.
25:56It's blaming the victim
25:57and I don't think it'll be appreciated.
26:00I do hear you.
26:01Well, good.
26:04Because you started the day
26:05by saying your door was open,
26:06but now it seems like you're closing it on Liz.
26:15The MDS is late stage,
26:18but it's obscured by high steroid usage,
26:21pancytopenia, pleural effusions,
26:24DIC, elevated beta-diglucan,
26:26and now cerebral edema,
26:28and she's getting worse.
26:30Hey, just checked in on John.
26:32How are you holding up?
26:33I've been going toe-to-toe with Richard all day,
26:36and now we're running out of time.
26:37Who's this?
26:38Um, he's a doctor in Madrid
26:40who has a case study that might be relevant,
26:43and this translation app keeps glitching.
26:45Um, I mean, I minored in Spanish.
26:48We can see how rusty I am.
26:49Okay.
26:52Hola, doctor.
26:53Este, a ver si les puedo echar la mano y traducir.
26:56Ah, sí, gracias.
26:57Estaba tratando de entender a su colega.
27:00Su paciente padece leucemia?
27:04Eh, no, no, todavía no.
27:06Eso parecía,
27:07pero solo tenía una edema cerebral.
27:09Entonces, pues, hay algo que no nos cuadra.
27:11Ah, el caso que tratamos era un poco diferente
27:14de lo que ella explica.
27:16Pero la clave fue sarcoidosis latente.
27:18Todo lo demás eran pistas falsas.
27:20Entonces, no sabían qué buscar.
27:23Exacto.
27:24Ese factor lo cambió todo.
27:25Gracias.
27:26Um, so, what he's saying is that the symptoms were similar,
27:29but his patient had dormant sarcoidosis,
27:31so that was complicating the clinical picture,
27:33but once they found that,
27:34everything else just fell into place.
27:35So, a patient with MDS like Joe presented with these symptoms
27:39because of a different chronic issue?
27:42And it went undetected for years.
27:44Okay, okay.
27:45Thanks.
27:46Just remember,
27:47you got to find a way to work with Richard on this.
27:52Your spinal tap came back negative
27:53and a full neuropanel, too.
27:56Well, her procalcitonin is low,
27:58even though she just had an infection.
27:59I need total protein,
28:01C-reactive protein,
28:02and complement levels.
28:03How fast can you do that?
28:0520 minutes.
28:05And if the results could go to me,
28:07since I'm her doctor,
28:08that'd be appreciated.
28:12We've got a high complement protein level,
28:14and the prednisone must have dropped
28:16her immune surveillance,
28:17which means that we're looking for something
28:19that's been there,
28:20possibly for years, like you said,
28:22but that's been hiding in plain sight.
28:24When Joan woke up and I told her about the candidate,
28:27she asked if it's seated in her liver.
28:29Well, that wouldn't be uncommon,
28:30but the beta-D glucan is so high
28:32that the fungal load would be too large
28:34to be isolated to her liver.
28:35Okay, we've been assuming
28:36that the elevated liver enzymes
28:38are caused by the MDS and the prednisone,
28:41but look at her blood work going back to 2016.
28:46Higher range of normal.
28:47But low enough that nobody would flag it.
28:502016.
28:52That's a long time for her to be carrying something.
28:55Wait a minute.
28:56One of my last memories of her,
28:592016, she was in Ecuador,
29:00and she got sick,
29:02and I told her that she should come back.
29:04And she self-diagnosed.
29:08She thought it was dysentery.
29:09Which means that she was drinking unfiltered water.
29:11So, if it was a parasite,
29:13she could have been sick
29:15while she was digesting it,
29:17but by the time it migrated to her liver,
29:19she was fine.
29:19And she could have been fighting this quietly for years.
29:22And then the prednisone weakened her immune system
29:24and unleashed it on her.
29:28I think we have a path now.
29:34He's losing sympathetic tone.
29:36Surgery's set for 6 a.m.
29:37Can we up the steroids?
29:39I'm too worried about his blood pressure.
29:41I think we just have to stay the course
29:42and hope that he's strong enough to hold on.
29:46I appreciate what you said before.
29:48Trying to let me off the hook.
29:51You religious at all?
29:53From time to time.
29:55Depending on how I'm feeling about the world.
29:58I remember going to this sermon once.
30:00The minister was talking about how
30:02it can be a form of hubris
30:04to think that we can control things
30:06that are out of our control.
30:10Because that's somebody else's domain?
30:12Doesn't mean it's easy to accept it.
30:14But I think that's the idea.
30:15Yeah.
30:17I'll take that under advisement, Dr. Coleman.
30:20Good.
30:25Your wife's here.
30:30It's my anniversary and I forgot.
30:33You go.
30:33I am all over this.
30:34Hourly exams.
30:35I will not go home.
30:42I've been downstairs 15 minutes.
30:44Tried calling you.
30:45I'm sorry.
30:46There were problems with Walter's surgery.
30:48He needs another one tomorrow.
30:51Why don't we have dinner in your office tonight?
30:53And that way, if anything happens,
30:56you're close.
30:57What did I do to deserve you?
30:59I don't know.
31:01I'm sure you'll find a way to make it up to me.
31:05I'm thinking 400 milligrams of endazole.
31:08I'd go 300,
31:10giving the ALT, AST,
31:12and 20 of Ampho B to balance it out.
31:15And 100 milligrams of cimididine
31:17to cut the renal toxicity.
31:19It's a tightrope.
31:21Any idea where Liz is?
31:23Let's see.
31:24Code blue, ICU.
31:26Code blue, ICU.
31:28Joe's coding.
31:29Code blue, ICU.
31:31Code blue, ICU.
31:34No pulse.
31:36He's in V-fib.
31:37Push one milligram epi.
31:38Get the defibrillator.
31:38Code blue, ICU.
31:48Clear.
31:51Clear.
31:56Restarting compressions.
32:06Danny, Danny.
32:07Someone call 911.
32:11Charge to 50.
32:13Clear.
32:20Pushing another milligram of epi.
32:29Find V-fib.
32:30We're losing him.
32:31Going up to 100.
32:32Give me the paddles.
32:38Ready.
32:39Clear.
32:50Looks like sinus.
32:51We have a pulse.
32:53He's back.
32:54Paige, Dr. Costa,
32:55we can't wait on the surgery.
33:20Cores decompressed.
33:22Screws are seated.
33:23Let's secure the rods.
33:26Hey.
33:31That must have been really difficult for you.
33:34Yeah.
33:37And the hell of a first day for Michael.
33:40Oh, I hit pretty close to home.
33:44How's it going in there?
33:46Hardware's almost in place.
33:48But even if it works, no one's ever going to adopt him.
33:52Not when he needs this kind of support.
33:58You're not thinking of doing something drastic.
34:02Go be with Joan.
34:05Gina?
34:06Gina?
34:08I care about him.
34:10But I know what the boundaries are.
34:14Now go.
34:15Where you're needed.
34:30But you've got to quit smoking.
34:32You know that's never going to happen, honey.
34:38I don't know how much more we can pump into her before she starts shutting down.
34:43Her body's so fragile.
34:48Chemo didn't help with that.
34:51She was only on it for eight hours.
34:55The parasite is causing this, that, and the prednisone.
34:58It's not on you, Richard.
35:37Hey, it's okay, buddy.
35:51Can I see?
35:56Oh, she's going to love this.
36:01Is she going to wake up soon?
36:03I really hope so.
36:21Hello?
36:22Hi, Amy.
36:23It's Dr. Ridley.
36:25Oh.
36:27Hi.
36:27I hope it's not 2 a.m. there.
36:29I stopped tracking time zone differences ages ago.
36:32Now it's noon.
36:33Is there a problem?
36:35I spoke with Dr. Kelly this morning.
36:36He told me about your mother.
36:39I'm just so sorry, Amy.
36:42Thank you, Dr. Ridley.
36:45I respect your tenacity already being back in the hospital, but I just wanted to make sure that you're taking
36:49care of yourself.
36:50I think so.
36:56It's been hard, obviously.
37:00Your world shifted on its axis, but you will come out the other side.
37:04I just didn't even think you liked me.
37:10I just didn't even think you liked me.
37:22Well, that's by design, my dear.
37:24But the best way you can honor your mother is to live a life with purpose.
37:28You have greatness in you, Amy.
37:31And I'll be there to help you find it.
37:45Joan.
37:47Hey.
37:48Can you hear me?
37:50Can you get her son?
37:51He just went to get coffee.
37:54Hey.
37:55It's okay.
37:58Just go slow.
37:59Just breathe.
38:02What happened?
38:04You had cerebral edema.
38:07It's not leukemia.
38:10Not yet.
38:11You had a parasite in your liver.
38:14From Ecuador.
38:15Do you remember that?
38:17You thought it was dysentery?
38:19Oh, my God.
38:22Is that the one time in my life I misdiagnosed?
38:33You haven't looked after yourself for a long time.
38:38I know.
38:40Promise me that stops now.
38:43Mom.
38:48Thanks so much, Amy.
38:52I'll order CBC and liver function tests.
38:58The fact that she's conscious.
39:00Yeah, we got her some more time.
39:04I appreciate you finding a way to trust me today.
39:08Yeah, it worked out today.
39:11But I'm never going to trust you, Richard.
39:21Hey, Walter.
39:23Welcome back.
39:24Did you fix my spine?
39:26We'll need to run some tests over the next few days, but...
39:30Seems that way.
39:31And I'll be able to walk again?
39:32Well, it's going to be a long recovery.
39:34Lots of physical therapy as your body adjusts to the hardware in your spine.
39:38But, yes, you will.
39:44And I'll have to miss the next adoption fair.
39:48There'll be lots more.
39:50I promise.
39:51Thank you, Dr. Walker.
39:53Nobody ever killed the way you do.
39:59I am so sorry.
40:02It's okay.
40:03We'll do a rain check.
40:05Okay.
40:12Sometimes, I wonder how you manage to leave it all here when you come home.
40:18It can be really hard.
40:22Yeah.
40:33Let's go get a drink, huh?
40:35Yeah.
40:45Hey.
40:46So, I spoke to Liz.
40:48Told her if she wants to come forward to HR, we would both have her back.
40:54And I'm sorry if I was too...
40:56Sonia, speaking truth to power takes courage.
41:00I should be thanking you.
41:03Sorry, I didn't mean to interrupt.
41:05Oh, no.
41:05I was just leaving.
41:07Actually, I was hoping to speak to you.
41:12I just wanted to thank you for checking in earlier.
41:15Joan's improving.
41:16I heard.
41:17That's great news.
41:20So, are we going to do this thing together?
41:22Well, it's what she wants.
41:25She tends to get what she wants.
41:26Yeah.
41:28Yeah.
41:32I saw Joan.
41:34She's spunky as ever.
41:36Can't keep that lady down.
41:40Amen to that.
41:40Yeah.
41:42Good night, Jake.
41:43Hey, good night, man.
41:51Hey, did you know about her and Sonia?
41:53What about them?
41:56No.
41:57Yeah.
41:57No.
41:59I guess we set a good example.
42:07They heard your family was here today.
42:09Yeah.
42:11Mia, she got in trouble at school.
42:13It was, I don't know, it was ridiculous.
42:17Maybe you can tell me all about it on the way home.
42:22Yeah.
42:23What do you think, Chief?
42:23Chief, I can do that.
42:26It's co-chief.
42:27Co-chief.
42:28I'm sorry.
42:29That's just so awkward to say.
42:30No, you don't.
42:32Tell me about it.
42:33Co-chief.
42:35Let's go on a walk.
42:36How have you been?
42:39Did that fancy college art school let you in?
42:44Well, damn it, they'd be crazy
42:47If they never saw in you
42:49What I failed to see at 17
42:53I must have missed it too
42:55Oh, kiss me
42:57Kiss me slowly
43:00Like you did when we were young
43:05And hold me
43:08And hold me
43:09Like you know me
43:11Like the old days
43:14Take me home
43:17Take me home
43:19Like you
43:20Oh, kiss me
43:21Bye
43:21Oh, kiss meز
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