Air date: January 25, 2021
Remember how I told you my parents drop in unannounced?
I just got a text. They are coming here tomorrow.
It’s not “okay,” Shaun, it’s an ambush. My parents don’t come to visit, they come to judge. They hate everyone I date, which means they’re gonna ask you a ton of awkward questions.
It’s going to be uncomfortable.
You hate surprises. Why aren’t you more thrown by this?
Because it’s not a surprise. They’re behaving exactly the way you said.
So a disaster is fine as long as it’s a predictable disaster?
A disaster implies consequences. We’re adults. Why would it matter what your parents think?
I don’t know, because they’re parents. Doesn’t it bother you that your grumpy second dad Glassman still doesn’t like me?
Dr. Glassman likes you.
No, he doesn’t.
(CELL PHONE CHIMES)
I have to go.
Fine. But I’m gonna text you some talking points. Mostly subjects to avoid. And it’s gonna be a very long list.
(CELL PHONE CHIMES)
How long has she had this wound?
Uh… She fell off the vault two months ago.
Oh. Slow healing and signs of oral bruising. Are you on a restricted diet?
Coach put me on a performance diet. High protein, high fiber.
I can show you her training log. It’s very standard stuff. (CHUCKLES) Although the noodles that she likes, they did a number on my stomach, too.
Konjac. Girls on the squad eat them all the time.
Konjac noodles were banned in Australia several years ago. They’re dangerous, basically indigestible. We will get another doctor to assess your symptoms and do a workup. But we need to get Darya to Imaging right away.
I review my schedule, starting with the last appointment and working backwards. It’s an effective technique. You might want to write this down.
Uncle Marcus, we had a deal. No special attention.
That deal’s off. Livvy, you’re struggling, and I can’t sit on the sidelines anymore.
But special treatment from my uncle, it’s only going to make things worse.
I owe it to you, and I owe it to this hospital. I know you have unique talent.
So you’ve noticed both that I’m screwing up and that I have unique talent?
I noticed the talent long before you started here. Aunt Tilly’s annual barbecue. You gave this to me when you were five years old. And that moment, I knew you were special.
Giant mass of fiber blocking entry to her intestines.
Her blood tests also show low calcium and other nutritional deficiencies. Can I see the 3D reconstructed images?
(MACHINE BEEPS) It’s unlikely to pass on its own. We’ll have to break it up and remove it endoscopically.
She also needs to quit gymnastics. She has severe osteoporosis with compression fractures in almost all of the thoracic vertebrae.
Interesting. She is a 14-year-old girl with the bone density of an 80-year-old woman.
SHAUN: You have kyphoscoliosis, caused by insufficient diet and overtraining. We need to surgically stabilize across the deformity to prevent the spine from failure and paralysis.
Spinal fusion… That means that she can’t compete, right?
And the Games, they’re less than a year away. Could we wait until after to have the surgery?
If left untreated, there’s a 20% chance of progression, which could lead to respiratory failure and death.
It’s your call.
I take risks every day. I’m not giving up my dream.
(SIGHS) You’re 14. It’s not your call.
Her mother passed away when she was a baby.
And my father just told you it’s my decision. Coach is my dad.
Do what you need to do to clear the blockage, but leave her spine alone.
CLAIRE: She wants to risk her life for a trophy, and her dad is okay with that. I mean, that has to be some form of abuse.
This hospital is not gonna win a lawsuit against a caring father who supports his daughter’s dreams. All you can do is pull him aside and try to convince him to be responsible.
(CHUCKLES) Yeah. Convincing people to be responsible has not been my strong suit lately.
We’re not still talking about Coach Dad, are we?
You’ve been avoiding me.
I’ve been busy.
Recovering from a motorcycle accident that you lied about?
There’s nothing to tell. I hit a patch of wet pavement.
Well, Audrey… (SIGHS) You have PTSD.
I’m dealing with it.
I don’t think you are.
Well, I also have a truckload of other things to deal with, including the annual surgical fundraiser Glassman just dumped in my lap.
Yeah, parties, they’re important.
I’m dealing with it.
How long have you had the severe heartburn?
Uh, six months, maybe a year.
BP is 142 over 90. That’s a little high.
Yeah, well, Darya and I travel a lot for competition. I don’t take care of myself.
Prioritizing your work over health is a bad idea. For you and your daughter.
Thank you. But may I kindly remind you, how long are the shifts that you doctors work? High stress, no sleep. When something is important, huh, you give it all you got.
True. But we’re adults. Darya’s not.
Yeah, but she’s very different from other girls her age. I mean, Darya, she works her butt off. She’s earned my r… Respect.
Oh, I’m feeling some kind of chest pain.
(MONITOR ALARM) His oxygen sat and pressure’s dropping.
Possible MI, lung problem, or aortic aneurysm. Secure his airway.
Poor perfusion. I think he’s septic.
And vitals aren’t improving. Might be a spontaneous pneumothorax and trapped air in his chest.
No, his chest would sound like a kettle drum. There’s fluid in there.
Give me a blade, curved clamp, and a chest tube.
Boerhaave syndrome is easily misdiagnosed. Nice catch with the percussion technique. You may have saved this man’s life.
Give me more retraction. These tissue planes are terrible.
We’re gonna have to debride the mediastinum.
There’s too much damage to repair the esophagus without risking a chronic fistula.
The ongoing leakage into his chest means it would just be a matter of time before he dies from an infection.
The safest approach would be to permanently divert the esophagus.
And he’d have to eat through a tube for the rest of his life.
But I don’t see a better option.
In 24 hours, with broad spectrum antibiotics and drains, the infection could clear and give us more options. Which buys everyone time to come up with another brilliant win.
ASHER: Does she really call her own father “Coach”?
He is her coach. What do you call your father?
That’s his name.
Do you respect any traditions?
Not random ones. Why should we create labels for things that already have names?
It’s not just what Darya calls her dad, it’s how they act with each other. They’re like coworkers.
That doesn’t sound bad. If I were meeting Lea’s co-workers tomorrow, she would be much less anxious.
Family is supposed to make you anxious. Introducing a new boyfriend to your parents, it’s a big deal. It’s a rite of passage.
Polymorphic ventricular arrhythmia.
Torsade de Pointes. We need magnesium sulfate two grams IV.
Heart rate’s 170. She’s not responding.
Move in the defibrillator.
Charged to 100 joules.
(ALARM STOPS, BEEPING RESUMES)
Did we do something wrong?
No. Which is puzzling. Mistakes by first-year residents are expected, but cardiac arrhythmia in a 14-year-old is definitely unexpected.
I was gonna ask if you wanted a ride, but if you’re working late…
Twenty hours to figure this out. You sure you want to waste one of them driving home and back?
I think while I drive.
Not as well. Not in the car. Not at home. Too comfortable, too many distractions. Better to buckle down here, where, as a bonus, your colleagues can see you.
I was under the impression that results are more important than how a doctor is perceived.
And Jordan is running rings around you there, too. Results don’t matter if you can’t make people listen.
Is that why you didn’t want to perform the esophageal diversion? You didn’t hear me?
I made a decision for the good of the patient. Now, it’s up to you to prove me right.
She has a prolonged QT interval and sporadic extra beats. Okay, I’m gonna get the newbies to recheck the renal panel and order endocrine and genetic studies.
I already did. Also a tox and drug screen.
Are you okay?
Mm. Then I should prepare myself. There is definitely something about me her parents won’t like.
No, Shaun. You are who you are. Who you are is great. You’ve been preparing for this your entire life.
When you do something important for the first time, like surgery, you practice. I should practice meeting her parents.
Mm, how? It’s not like there’s a simulator for learning how to navigate awkward social interactions.
There is. But I need pizza.
Shaun, I’d like you to meet my parents, Pam and Mike.
(SOFT JAZZ PLAYING)
Lea tells us you’re a doctor. What specialty?
I am a surgeon.
What a shame. I hear surgeons are arrogant and overrated.
DR. GLASSMAN: Okay. Morgan, I’m sorry, but can you just give it a rest for half a second?
I’m in character. Please address me as Pam.
I read recently that, while you’re sleeping, you accidentally eat eight spiders every year.
Yes. And I read that, sometimes, they lay eggs in your stomach, and then you can have thousands of spiders…
You said not to disagree with him when he says something wrong and pointless.
I didn’t tell you to agree with him, because that only gives him more wrong and pointless things.
Good. That’s helpful. Let’s continue.
Did you know that Arizona doesn’t have Daylight Savings Time?
Saving. It’s “saving,” not “savings.” That’s grammatic… Wh… How am I supposed to know what is pointless? Facts are facts.
Okay, okay, okay. This isn’t gonna work. We could spend the rest of the evening teaching Shaun the fine but trivial art of how to finesse trivia. But the real problem isn’t gonna be small talk and family bickering. The real problem is what happens when Lea’s parents express real concerns about their daughter?
Concerns any parent would have. You two barely know each other, you haven’t been dating very long, now you’re living together. This relationship is moving too fast.
I thought you said we shouldn’t argue with your dad.
That wasn’t my dad. That was 100% Glassy.
You can’t prepare for how these evenings can go wrong. Families are full of surprises.
Like how you don’t like Lea.
(CLEARS THROAT) I never actually said that.
Wow. A first-year all-nighter. Brings back memories. Not of myself, of course, but of the losers who thought staying up all night drooling on their laptops made them look like better doctors. So, cure cancer yet?
I’m trying to find a new way to repair a ruptured esophagus.
“Fundic reinforcement with intercostal muscle flap.” Pretty cutting-edge stuff. But why not go with diversion? It’s a lot safer.
Because “safe” is ordinary and boring. Like me. My uncle thinks I need a win. And the only way to do that is to be impressive, like Jordan.
That Dr. Allen is impressive? Yeah. And everybody knows that because Dr. Allen makes sure everybody knows that. She and your uncle are cut from the same fashionably high-end cloth.
So, I don’t just need to be a better doctor, I need to be a different person.
Wow. You might want to start by being a person who feels a little less sorry for themselves. Either you’re an awkward, inconsistent loner who’s irritatingly apologetic about your best qualities, or you’re a quietly brilliant surgeon whom others ignore at their own peril. If you’re the first one, quit now and stop wasting resources. But if you’re the second, be that. Maybe a little louder.
(INHALES AND EXHALES SHARPLY)
CLAIRE: Where should we start? Centerpieces, appetizers, color schemes?
Please tell me that you’re at a hotel in the middle of the day because you’re having an affair.
There were no surgeries scheduled, so I decided to volunteer to help.
Hmm. We can get the job done in half the time and still have time to talk. Or we can just talk.
I am not a 14-year-old girl whose next backflip could kill her, Claire. I don’t need saving.
What do you think about twinkle lights? Too prom?
ENRIQUE: Our tests show that your heart problems are being caused by excess estrogen levels.
ASHER: And we want to know how it got in your system.
Medication? A supplement?
Coach gave you my training logs. You know as much as I do.
We also know that you’re in a very competitive sport, so maybe there’s something you’re taking that’s not on the training log. If you are, we can’t divulge that to anyone.
You think I’m doping? No way.
If your coach is pressuring you…
He’s not. I’m sure it’s a one-time thing. Keep monitoring me. I’ll be fine.
Darya, you’ve made your dreams come true by being stubborn, being relentless, and just making things happen, but that’s not how your heart works. Or your spine.
She’s not being stubborn. It is going to go away, isn’t it? Because you are taking something. And now you’re going to stop. Which means that it wasn’t performance enhancing. What is it for?
You took drugs for boobs?
The girl on YouTube said it would make them bigger.
Phytoestrogens used in herbal remedies can cause swelling in breast tissue, but there are potentially dangerous side effects.
What the hell were you thinking?
I didn’t know it would make me sick. I got tired of hearing the boys on the men’s team talking about women with curves…
What if it showed up on a drug test? What if you got banned from the Olympics?
It’s natural. It doesn’t mess with performance. Other girls…
I don’t care about other girls, and I didn’t think that you cared about other girls. Are you… (SIGHS) I can’t believe that you’re willing to risk everything for something so childish.
It’s not childish. I give a lot to my sport. I just wanted something for me.
You’re not an adult. Mm. (EXHALES SHARPLY) Fix her heart and her spine.
(STAMMERS) What? You can’t do that. Are you punishing me?
I’m doing my job. I’m your father, and we’re a family, and it is my job to make good decisions when you won’t.
(VOICE BREAKING) Since when is being my father your job? We never do anything but talk about gymnastics, not even Mom. If you didn’t think I needed my father after she died, why start now?
I’m calling the team lawyer and filing for emancipation. You think I can’t make my own decisions? Try this one. You’re fired, Coach.
DR. PARK: We could try T-tubes. Using them results in the formation of a controlled fistula and route for drainage.
Interesting. But the patient would still have a long recovery and chance of reinfection. What else?
I found some very interesting research on endoscopic vacuum therapy. It’s under investigation for the management of esophageal leaks.
Definitely innovative, Dr. Allen, but a little too much so. This concept hasn’t even gone through clinical trials yet, and we need to perform surgery today. Dr. Jackson, you’ve been quiet.
I was thinking about fundic reinforcement. My idea is to use the patient’s own good tissue to reinforce the primary closure. In this case, using the stomach as the patch. Like the way we use a skin graft for third-degree burns.
Well, he’d be at risk of a diaphragmatic hernia.
Not if we cinch up the lower esophageal sphincter with a fundoplasty.
Shaun, Lea tells us you’re a doctor. What’s your specialty?
I am a surgeon. But we are not all arrogant. Though many of us are. I’m still not sure if that’s good or bad.
Is it hard? For you? I mean, it’s a difficult job.
Shaun is excellent at his job.
So, how do you feel about vaccines?
(SOFTLY) Oh, my God.
Because, uh, they worry me.
They don’t worry me.
Really? Because we’ve read a lot of stuff. Especially since Lea told us about you.
Vaccines don’t cause autism, Mom. Want to talk about religion now?
(SOFTLY) I think that that was on the list of things not to talk about.
Lea wrote you a list?
Honestly, Lea, if we’re so impossible to talk to, why even have us here?
Want more wine?
I removed a hemorrhoid from a patient with terminal cancer. He only had a few months to live, and nothing would change that, but the surgery did make him more comfortable. I suggest we treat this evening like hemorrhoid surgery.
Now, that’s… That’s a good point.
You don’t have to give him any more lists. Let him talk. I like this guy. (CHUCKLES)
To hemorrhoid surgery.
MIKE: (CHUCKLES) To hemorrhoid surgery.
♫ Everybody’s feeling warm and bright ♫
♫ It’s such a fine and natural sight ♫
(SIGHS) I went…
♫ Everybody’s dancing in the moonlight ♫
I went to see a psychiatrist.
I’m… I’m so relieved to hear that.
Well, once. The doctor said my symptoms warranted medication, so I haven’t been back since.
Why? If you need medication… Why did you keep your PTSD a secret? You chose to deal with your issues privately, on your own terms. Why am I not entitled to the same choice?
Doing something self-destructive is not a choice, it’s a mistake. Just like it was when I did it.
So, when I do something you agree with, it’s great. When I do something you disagree with, it’s because I’m sick.
You know, this is why I don’t want to talk to you, because it’s not a conversation, it’s a lecture.
( CELEBRATION PLAYING)
(SOUND RETURNS) Please, Claire, let me go.
I just want to go home. I’ll be fine.
Let me give you a ride. You can’t drive like this. Come on.
I said I’m fine!
No. You’re not!
♫ Celebrate good times Come on ♫
There! Now no one’s driving home. You happy?
♫ Celebrate good times… ♫
DR. ANDREWS: The two main challenges of Boerhaave syndrome are timely diagnosis followed by viability of repair, and with this innovative surgical approach, I think we might achieve both.
I need silk ties and LigaSure.
(DR. PARK SIGHS)
His chest infection leaked through the diaphragm into the intraperitoneal space.
There’s an abscess behind the stomach.
It’s making the entire posterior stomach friable.
What if we use an intercostal muscle flap to patch the esophagus instead?
If we do that, it raises the risk of sepsis.
The patient signed off on risk. We should at least try.
Not this level of risk. We need to do the diversion.
Uh… Your idea was good. Don’t give up on it so fast. Reverting to diversion doesn’t mean failure.
I searched “eating meat near me,” which was a mistake, but I did get a recommendation for a steak house your father might like.
You don’t have to be nice to my parents anymore, Shaun. We won’t be seeing them again.
“We need to talk about Shaun.”
Mm. They don’t think I’m mature enough to be in a challenging relationship. Leave it to my mom, she took us both out in one shot. You do get that this is insulting. To both of us. From the people who supposedly love me most in the world.
They don’t. Not the most. Not anymore. Lea… People who meet me are usually uncomfortable. And most of the time, that doesn’t go away.
How do you handle that?
I try to be patient. Sometimes it works.
Maybe you’re a more mature person than I am. But I’m not sure if that is gonna work for me.
Have you seen Dr. Lim this morning?
Uh, no. Why?
Darya’s lawyer called.
I need Dr. Lim.
Dr. Lim’s not here. I don’t know if she’ll be in today. If it’s an emergency, maybe Dr. Glassman…
Dr. Glassman’s in meetings this morning. Who needs me?
Darya’s lawyer is demanding that the hospital release her client.
Tell her lawyer we’re not releasing our patient until she’s healthy unless we receive a court order. What’s your problem?
Dr. Andrews encountered complications. He asked me to inform you that the surgical plan needs to change without the patient’s consent.
That’s Andrews’ call. I don’t need details, just coffee. I changed my mind. I need the details. Stay here.
Long, painful recovery with a feeding tube, or risk of death. As his next of kin, it’s your call.
I have to decide?
You made a life-or-death choice for yourself. In fact, you insisted on it.
Well, that’s different. The doctors were asking me to give up something I really wanted.
The only difference is, your father is laying on an operating table waiting for you to grow up.
If something bad happened, I’d be responsible.
That’s the definition of adulthood.
I don’t know what to do.
Of course you don’t. It’s an impossible choice. Terrible things happen either way. And, yeah, it’s on you.
(VOICE BREAKING) I can’t do it. I just can’t.
You’re not a grown-up, Darya. Luckily. So those of us who are will make the impossible decision for you. Dr. Andrews will do the diversion. Someone will bring you to see your father when he’s out of surgery.
What was that?
I saved that girl when you couldn’t.
Yesterday, you told me to respect her decision. Today, you tortured her into changing her mind.
Oh, did I make a little girl cry?
I can’t do this. I’m done trying to help you.
(CHUCKLES) Oh, please. You’re never really done.
You know who you were last night? My mom. Drunk, angry, refusing to lift a finger to help yourself, lying about it, and taking your pain out on me. It’s gonna keep happening until you get help. Take the medication, talk to someone, do something. Please.
I’m not your mother, Claire. I’m not your responsibility. I’m your boss. And I don’t owe you anything.
(ELEVATOR BELL DINGS)
Shaun? What are you doing here?
You’re wrong about me and Lea.
Oh. Well, no offense, Shaun, but this is between family.
Lea is my girlfriend, and the texts you sent were about us.
We’re sorry you saw those. Shaun, you’re a very nice young man, and we enjoyed meeting you. It’s just… (SCOFFS) We’ve known Lea a lot longer than you have.
Yeah, she’s, um… Well, I mean, she has a good heart, she just doesn’t think ahead. And she will do anything to get under our skin. You wouldn’t believe some of the people she’s dated.
I’m different than anyone she’s ever dated. How is that not a change?
That’s true, Shaun. I’m just not sure it’s a good thing.
You knew her then. You don’t know her now. All you know are her mistakes. And you don’t trust her because you aren’t sure you were good parents. You said our relationship has challenges. You’re right. Lea and I go through challenges together. It’s one of the things that makes us stronger. Lea challenges me to try things, even things I know I won’t like, because it is not always better to stop and think. And I make Lea patient, because I can be very frustrating. So can the two of you. Maybe this challenge will make your relationship stronger, too.
If you really think I should have the spinal surgery, I trust you.
I do. I’m sorry.
Ever since your mother died, I’ve been scared. What did I know about raising a little girl all by myself?
(CHUCKLES) And you… You were a handful. Bouncing off the walls, backflips off the furniture.
You couldn’t get me to the gym fast enough.
Because when you were on the beam, or flipping through the air, you’re not just a little girl. You are an amazing athlete. As your coach, you make me feel amazing, too. All this time, I thought I was giving you exactly what you needed. But I was wrong. What you needed was for me to be your dad. And what your dad would have told you, that no matter how you look, or what you achieve, you will always be a beautiful, strong superstar to me.
DR. GLASSMAN: Thank you.
I like you. Okay?
Stop. You’re gonna make me cry.
You’re a very cynical person, you know that?
Mm, actually, I’m not. But you’re a very grouchy person who cannot give a compliment.
You’re funny. You’re smart. And you make Shaun happy.
Which I guess is a good thing, but it also means you can make him very, very sad. And that worries me, frankly.
I am not planning on hurting Shaun.
It’s rarely intentional, you know?
My parents have an issue with Shaun. And I just don’t want Shaun’s parent to have a problem with us, too.
Too bad. Everything Shaun has gone through, all the rejection and the pain, the victories, they all belong to him. But I feel every single high and every single low. So, I’m sorry, I’m… I’m not going to stop worrying about him, even if he doesn’t need me to.
Well, if Shaun saw that stain on your tie, it would drive him crazy.
Hey, Liv. I’m sorry we didn’t get to perform your surgery, but I’m really proud of the way you stepped up.
That surgery wasn’t mine.
Of course it was, and it was brilliant…
And neither was the stone. That story you told me about how you spotted my talent? Um, I don’t remember any of it. I didn’t paint that rock, and if I handed it to you, it didn’t mean anything because I was five. You have been carrying around a memory for over 20 years that represents your dream, not mine.
Clearly, that’s not entirely true. You went to medical school.
Because I do want to be a great doctor. I wanted it so bad that I let you push me to think up some flashy surgery, even when my instincts already told me to do what I thought was the right thing, and was the right thing.
Livvy, I just want to help you be the best…
You want me to be Jordan. If you’re looking to mold someone in your image, she’s perfect. But, Uncle Marcus, I’ve got to be me. And you can’t help me do that.
Hey. I’m still gonna brag on you like a proud uncle. You know that, right?
(KNOCK ON DOOR)
It’s your parents.
Yep, Shaun. I saw.
They probably want something. We should prepare. Either they want to yell at us, in which case, we should not answer the door, or they could want to take us for dinner…
(CELL PHONE CHIMES) …but we are already halfway through…
They want to take us to dinner.
Should I open the door?
What do you think?
I think… they must have been good parents. We should have dinner with them. Do you want to text them back?
(CELL PHONE THUDS)
Last year, after my mom died, I was going through some problems emotionally. I was diagnosed with PTSD.
Melendez knew. Um… Morgan found out because she’s Morgan. But I didn’t tell anyone else. I… I didn’t want anyone to know.
Why are you telling me this now?
Because Lim is going through something like it, but maybe worse. She isn’t going to therapy. She has refused medication. She…
Okay. Um… (EXHALES SHARPLY) I don’t think you should be telling me this. Whatever Lim told you, she told you in confidence and as a friend.
Mm. But she’s not just a friend. She’s my boss. You’re her boss. So I’m telling you because I have no place else to turn. (EXHALES SHARPLY) She won’t let me help because she says it’s not my job. And she’s right. But it’s your job to protect the hospital. And her. So…
(THUNDER RUMBLES IN DISTANCE)