Air date: January 11, 2021
(SIREN WAILING IN DISTANCE)
[MisterWives – “Over the Rainbow” playing]
♫ I’m over the rainbow ♫
♫ No yellow brick road ♫
♫ Can’t seem to find home ♫
♫ Over the rainbow ♫
♫ Ah, ah, ah, ah, ah, ah, ah ♫
♫ Ah, ah, ah, ah, ah, ah, ah ♫
♫ Ah, ah, ah, ah, ah, ah, ah ♫
WOMAN: Oh, my God, what happened?
(SIREN WAILING IN DISTANCE) MAN: Is he okay?
I’m a doctor. What happened?
I don’t know. He was running. I honked. All of a sudden, he was in front of my car.
Pedestrian versus car, GCS five at scene. Rigid abdomen with active bleeding. Flail chest with pneumo. He needs an ex lap. Now.
We’ve got a massive hemoperitoneum. I need two large suctions and lap pads in all four quadrants. There’s a grade-three liver laceration in right lateral segments.
CLAIRE: Liver stitch, number 1 chromic on a blunt needle and a combat gauze. What were you doing on your bike at that hour?
Heading into work. Trying to prep for my budget meeting with Glassman. Mobilize the liver to check for any associated diaphragm injury.
It’s the other side of town.
I was taking the scenic route.
(ALARM BEEPING) ASHER: BP’s dropping. He’s got another bleed. Add more lap pads and run the bowel.
There’s a perforation near the terminal ileum.
Ah. Something tore through the intestinal wall.
ASHER: From the accident?
The coat’s eroded. It looks like it’s been in there a while. It must have gotten dislodged in the accident.
(THEME MUSIC PLAYING)
How does Asher seem to you?
He seems fine.
Too fine for someone who’s just lost their first patient.
I don’t have time to worry about people being too fine.
He’s faking it. Good.
The brain releases serotonin when you smile, even if you’re miserable. I feel better already.
Denial is not a proven strategy for psychological health.
Dwelling on things you can’t change doesn’t help either.
24-year-old woman came into the ER complaining of abdominal pain and headaches, and, surprise, she’s pregnant. Apparently not a happy surprise. She wants an abortion.
Well, what’s wrong with her? I assume you haven’t recently learned the value of sharing, which makes me think there’s another reason you’re unloading this onto the surgical department.
She has a congenital IgA deficiency and a history of severe infections. She’ll need IV antibiotics and close post-surgical observation. I figured one of your newbies may as well learn something.
TOY FROGS: (IN RASPY VOICE) ♫ …You’d say ♫
♫ What can make me feel this way ♫
♫ My girl ♫
♫ My girl, my girl ♫
Lea’s birthday is tomorrow. There are many cute frogs and many romantic songs. I can’t decide. It is my first gift as her boyfriend. It needs to be… awesome.
Well, then, maybe singing frogs, however cute, might be a mistake. Try something more personal or romantic. And find a resident who hasn’t done a suction D&C and teach them.
Oh. No, n… no. I’ll do it myself. I’m not going to teach anymore. I’m a good surgeon. I’ll do surgery.
Dr. Murphy, part of your job as a surgeon is to teach. You can’t opt out because it’s difficult.
I am opting out because I’m bad at it.
Well, you can’t opt out for any reason. But I may have given you too much responsibility too soon, so I will supervise your supervision until you get the hang of it. Pick someone.
Did you two lose something?
(SIGHS) Our patient. Rose Babcock. She’s post-op from repair of a distal radius fracture.
ENRIQUE: 60s. White hair. Looks at you like she’s staring into your soul.
Does she have a limp?
ENRIQUE AND OLIVIA: No.
Well, I think she does now.
Uh, Ms. Babcock, did you fall down again?
Oh, no, I’m fine. But… But there’s a poor man in room 318 who’s in a lot of pain.
DR. LIM: Let’s get you back in bed.
Apply a new Tegaderm, not antibiotic ointment.
They breathe. Don’t make us handcuff you to the bed, Rose. We charge extra for that.
Dry the skin more so it’ll stick.
You’re doing just fine, dear.
(MONITOR BEEPING RAPIDLY)
DR. PARK: Heart rate’s spiking in the 130s. BP 162 over 95.
Are you feeling any pressure in your chest?
No, it’s just anxiety. Not mine. It’s one of yours.
We’re gonna pretend, since it’s happening in your chest, that it’s yours. 20 milligrams IV labetalol.
I’m fine. I’m an empath. I can feel what other people are feeling, and one of you is very stressed out.
Olivia, stay where you are. And one milligram of Ativan.
RUNNER: Keep away from me! No! Step back!
DR. LIM: Sir, you were in an accident. We’re taking care of you.
Stop. Stop it! Now! Get away from me!
(WHISPERS) I need you to hold him down while I administer Haldol.
Sir, please just…
I’m warning you. This room is being cleared.
WOMAN: No one is gonna hurt you. Ben.
You’re having a flashback. You’re not in Afghanistan. You’re in the hospital. Look around. What do you see?
Yeah. Yeah, baby, it’s me.
Zoe, I… I couldn’t sleep. I… I went for a run, and I… I heard an explosion. (BREATH TREMBLING) (STUTTERS) And I don’t… I don’t know what happened after that.
You were hit by a car. We had to do surgery, but you’re gonna be okay.
(SIGHS) It’s okay.
Take him back to his room, make sure he didn’t open his wound.
Dr. Murphy? Rose is not your patient.
She was teaching me about her gift. She says the basis of empathy is curiosity, which I find curious because…
I’m curious about the job you’re supposed to be doing. Who are you leading through the D&C?
None of them. The only one who hasn’t done one does not want to, so I will.
Which resident? Wanting to is irrelevant. It’s their job.
Wanting to is irrelevant. It’s your job.
I’m a Christian. Performing an abortion goes against my beliefs.
You may encounter a situation one day where this procedure could save a woman’s life.
Then I hope someone else can…
And it’s my job to make sure you can perform all surgeries, including abortions. So where does that leave us?
I’ll do the surgery. I’ve only done one. I’m sure there’s a lot I still can learn.
Dr. Murphy, you have a new student. Get her started running pre-surgery assessments. Thank you, Olivia. That’s the kind of ambition I like to see.
He did three tours. He came home after he was injured in some kind of explosion. I don’t really know what happened. Some… He’s tried to tell me about it several times, but he just… He breaks down.
When was he diagnosed with PTSD?
Two years ago. But he hasn’t been the same since he got back. At first, he was moody, irritable. Little things would set him off. Then the insomnia started.
His mind is just… It’s never at rest. Nights are the worst, you know? He, um… He gets these terrible nightmares.
Flashbacks. Just… We can’t sleep in the same room anymore.
Make sure he stays off his feet.
Would you like us to arrange a psych consult?
ZOE: We’ve been down that road. Talk therapy, group therapy, exposure therapy… (VOICE BREAKING) endless medications.
Let us know if you change your mind.
(DISTORTED VOICES CONTINUE)
(FUTURE ROYALTY’S “KEEP DIGGIN’ UP DIRT” PLAYS ON HEADPHONES)
(MUSIC VOLUME INCREASES)
♫ Keep diggin’ up dirt ♫
♫ Keep diggin’ up dirt ♫
Jillian, I need those stats on elective surgeries for my budget meeting. And a coffee. (SIGHS) Jillian?
She’s not there. I need approval for this. And this. You said I couldn’t give her the frogs.
Oh, you can’t give her this either.
You don’t know what it is.
I know it would mean more if you had to leave the building to get it.
I would like to do the suction D&C surgery.
I assume your religious convictions haven’t changed in the last few hours.
No. But I believe I was put in this program for a reason. So, if you think it’s important for me to learn how to do an abortion, then I should learn.
Take Jordan to the skills lab. Run the surgery steps. You two will handle the D&C yourselves.
With you. How are you going to supervise my supervision if you’re not there?
I will help you prep and debrief afterwards. But this patient doesn’t need a gallery of strangers standing around, gawking at her most private experience.
Sorry to interrupt. Ben woke up complaining of pain.
Did you check the incision?
The pain is in his arm.
Now test external rotation of the shoulder.
We’re almost done. (EXHALES SHARPLY)
Can you describe the pain?
We’ll call it a 10.
It’s been hurting for years, but, aah, this is… This is something else.
How did you injure your shoulder before?
I was in a… (SIGHS) I was in a convoy in Kandahar, and there was a… (BREATH TREMBLING) (STAMMERS) I dislocated my… You don’t need to discuss it with us. What did you find?
Swelling, sensitivity to touch, discoloration. Could be CRPS.
What is that?
Well, it appears the car accident aggravated a prior injury. You’ve developed complex regional pain syndrome. We’ll start you on Gabapentin and Dilaudid.
Opioids make me a little insane.
We could do a stellate ganglion block. It’s an injection of anesthetic near the spine that blocks the pain signals, and could also help the PTSD.
I’ve been treated for PTSD for years. Why haven’t I heard about this?
It’s experimental, but promising.
The procedure comes with risks: vascular injury, infection, major hematoma.
Dr. Lim, I’ve been taking a risk every time I go to sleep. I want to do it.
Stellate block is an accepted procedure for treatment of pain.
Which you wouldn’t have suggested if the patient didn’t also have a mental health condition.
(BIRDS CHIRPING) I hear Jordan’s back on the D&C, in spite of her righteous indignation.
Is something chirping?
I think you’re being unfair.
Well, if anyone’s being unfair, it’s me. I told Jordan to do it. I told her. We make decisions that are hard to live with all the time. We make them anyway. And I told her pissing off the Chief was a very bad way to start your residency.
Glad to hear you’re still moonlighting as surgical department camp counselor, but I don’t mean you were being unfair to Jordan. You’re being unfair to the patient. She’s facing an emotionally fraught procedure. She needs the support of her doctors. And who she’s getting is a rookie who thinks she’s committing murder. And Shaun. I have a point.
I’ll lead Jordan through the D&C myself. You’re happy. Dr. Murphy will be happy. My cup runneth over. Now get whatever’s in that box out of my department.
Morning sickness. Nurse Ella’s. Rose claims she can feel her pregnancy. She was right about the guy in Room 318. He had a clot in his ankle.
I’m sure she picked up on some subtle clues, like the guy moaning and grasping his ankle. Get a CT to rule out abdominal injury from her fall.
DR. LIM: We’re going to insert a thin needle into your neck so we can inject the anesthetic. It may sting a bit. Use an in-plane approach to place the needle between the C6 tubercle and carotid artery.
CLAIRE: You might feel some discomfort.
(HIGH-PITCHED RINGING) (DISTORTED VOICES)
DR. LIM: What’s wrong?
Get some ice. Let me take a look. What happened?
I hit her.
ZOE: I was laying next to him. I know I shouldn’t, but the shot just made his pain feel so much better. I thought…
Zo. You didn’t do anything wrong. There was a noise in the hall. I lashed out. I know. I didn’t mean to. I’m sorry.
Nothing’s broken. I can get you something for the swelling.
No. I’m okay. I’m gonna go home, get cleaned up. I just need some time. I love you.
I think we can help Ben. There have been some promising results using Vagal Nerve Stimulation to treat PTSD.
DR. LIM: His scarring would make it impossible to expose and find the nerve without damaging it.
Those scars are the reason that we need to try. Imagine reliving your worst nightmare over and over again. (SCOFFS) Why doesn’t anyone around here want to do the job they were hired for?
What Ben needs is psychological help. I’ve ordered a consult. Leave it to the people who are trained to do it.
It sets a bad precedent to force a resident to do a procedure they’re not comfortable with.
Wow. Does anyone around here not have an opinion about who should do that damn abortion? Jordan had a choice, and in my opinion, she made the right one.
It’s not a true choice if you’re coerced by your boss.
I asked her to do her job.
You took an opportunity from a resident who wants to learn in favor of one who doesn’t.
Is this song and dance about Jordan doing the procedure or your niece not doing it?
Neither. There’s a misconception that Olivia came to St. Bonaventure because of me. She’s here because of your reputation. The great Dr. Lim, a master class in technique, professionalism, empathy. Lately, it doesn’t seem like that reputation holds up.
JORDAN: I’m giving you an antibiotic to prevent infection. The vacuum aspiration will take about 15 minutes, and you’ll be numbed with a local anesthetic. Conscious sedation is also an option, but you will need someone to drive you home afterwards. Do you have any questions for me?
(SIGHS SOFTLY) Are you certain you wanna go ahead with the abortion?
Then you don’t have to be scared. You’re the making the right decision for you.
Give her another 400 micrograms of misoprostol. I’ll be back for the procedure.
This doesn’t work. I need these numbers in spreadsheet format. Thank you.
DR. PARK: Oh, excuse me.
Rose’s CT was normal.
Get an upper GI barium study.
First quarter supply costs you requested. Also, one of your first-years seems upset. He’s been in the stairwell for a while.
DR. LIM: Everything okay in here?
I just needed some quiet.
Surgeons come into the stairwell for two reasons, fire drills or doctor trauma. You having a fire drill?
I just wish we had a more effective treatment for Ben. His head’s so messed up, and we can’t help him.
I don’t think this is about Ben.
Have you ever lost a patient you knew you could have saved?
When COVID was at its worst, we had to cancel all non-urgent procedures. A young mom with a heart condition was more urgent than I thought. And she died waiting for me to put her on the schedule.
How do you get past that?
You get past it because that’s the job. You will always remember it. And you will eventually stop reliving it.
How can you be so sure?
Because if you don’t, you can’t be a surgeon. And I’m pretty sure you’re a surgeon.
I should get back to work.
Insert the speculum. Now dilate the cervix. Begin suction. Begin gentle suction in the uterus.
Is anything wrong?
You’re okay. Dr. Allen, I can take it from here.
Don’t worry. We’re almost done. You’re gonna be just fine.
You have no idea what that woman was going through, and you made it worse for her.
I know. I didn’t…
You had an opportunity to opt out before you walked into that room, but you agreed to do the procedure, you took on an obligation to that patient, and you failed her. If you ever do anything like that again, I will have you removed from my program. Maybe you should be cleaning bedpans for a while. Hopefully there’s no moral objection to that.
Why are there adult toys on my desk?
I’ve heard good things about the Llama, but online reviews aren’t always accurate. Do you have a favorite?
They’re for Lea. Which one do you like the most, Claire?
Uh… Uh… Evidence suggests that trauma changes the way the brain works. An overactive amygdala can heighten someone’s response to emotional stimuli, including fear. I think we should consider amygdala ablation for Ben.
That’s crazy. And completely outside the scope of our care. We’re s… (ADULT TOY VIBRATING)
We’re surgeons. We fix physiological problems, not mental ones.
It is a physiological problem. His brain isn’t functioning properly. If it was a tumor that was causing these reactions, you wouldn’t hesitate to remove it.
But there is no tumor. You’re talking about inflicting damage on his brain. He could suffer a stroke or come out in a coma or not come out at all.
SHAUN: If you use a stereotactic laser approach rather than an open craniotomy, you would greatly reduce the risks.
This is not your case! You cannot jump into this one because you don’t want to do the one assigned to you, which is to teach, which you’ve made my problem just like you made Lea’s birthday gifts my problem. You need to grow up and accept some responsibility.
I was diagnosed with PTSD last year. I kept it mainly private. Melendez really helped me through it. It was nice to have a friend to lean on. So if you need one…
(INHALES DEEPLY) I feel off. Disconnected. Like I can’t catch my breath. But it comes with the job. I’ll get over it.
(CELLPHONES CHIME, VIBRATE)
Ben. No one is gonna hurt you. You’re having a flashback.
I know where I am. Every day since I came home, I’ve felt like there’s a monster chasing me. I try to outrun it but I end up hurting the one I love the most. I’m a threat to everyone around me.
No, Ben, you just need help.
Nothing helps. I can’t smile. I can’t laugh. I can’t feel anything but pain. I make everyone around me suffer.
Ben. There’s a surgery that may help.
I would like to scrub in on the amygdala ablation surgery. Rose said you’re feeling overwhelmed and need…
I don’t wanna hear any more things that woman has said. Your job is to supervise your residents. Why are you here instead of doing that?
You said you were going to supervise my supervision, but you didn’t. You took over my case. I don’t know what I was supposed to learn or how.
Dr. Murphy, walk Asher through the probe placement and trajectory to the amygdala. I will supervise your supervision.
Okay, insert the probe perpendicular to the cortical surface.
Stop! You’re off course. On the current trajectory, you will penetrate a branch of the choroidal artery and cause a hemorrhage. Step away from the probe.
Your job is to teach, not take over.
Adjust the probe one millimeter inferiorly. Avoid the temporal horn on your right.
I can’t see it on the image guidance.
Tell Asher what you see.
It should point toward your six o’clock on the Y axis. You have to feel it. The… The tissue plane along the parenchyma is smooth. It should feel like gliding. You’ve reached the amygdala.
CLAIRE: Ready to begin thermal laser ablation.
DR. PARK: (MUMBLING) Rose’s upper GI and labs were normal. Should we keep her another day to observe?
No. If she’s stable, let’s send her home. Okay, I’ll have Olivia…
Open your mouth.
Open your mouth.
I can, uh…
Shut your mouth.
DR. PARK: There’s this rat.
A mouse. A little dead mouse in the garage, and the big, strong man is afraid to get it out.
Not afraid, disgusted.
Neither of us wanna deal with it, so we are settling it in the only responsible way, a bet.
A dare. A series of dares, actually.
Whoever wusses out first has to…
Take those things out of your mouth. I will discharge Rose. You two, go home. We were just… Being idiots at work, while people are sick and dying. Go home.
All your tests are normal. We’re discharging you.
Right, because you’re psychic.
I’m an empath, not a psychic.
Whatever the case, I would suggest you take it easy. No drinking, no heavy lifting…
You have to let it out, dear. It was you. You made my heart rate spike. You’re about to implode.
There’s nothing wrong with you… or me.
(EKG FLATLINING) (ALARM BEEPING)
(KNOCK ON DOOR)
(DOOR OPENS, CLOSES)
Dr. Lim, my behavior yesterday was inexcusable and unprofessional. I let you down. I let the patient down. I am deeply sorry. And I promise it will not happen again.
You let your personal judgment get in the way of doing your job. You’re right. That is inexcusable.
(SIGHS) You said I had no idea what the patient was going through. The truth is I kinda do. Scared, alone, afraid of anyone finding out. I chose my career over motherhood, over my faith. But I don’t regret it. And I know God forgave me because I get to be here, living my dream of being a doctor. But I purposely try not to think about it.
You’re off scut duty.
That’s not why I…
(DOOR OPENS, CLOSES)
My name is Benjamin Alan Harris. I’m in St. Bonaventure Hospital in San Jose.
Language and memory appear to be intact, and your motor function is normal.
But that doesn’t mean it worked, does it?
No. We’ll have to do an fMRI to see how you respond to fear-inducing stimuli. But we’ll let you rest for now.
I’m not gonna rest until I know I’m better. I want you to know how I got these scars.
No. Not now. Just give yourself time.
I was in a convoy in Kandahar. I was in a Husky, the big vehicle at the front.
Ben, you don’t have to do this.
Ronnie was driving. He was telling me a story, something about a goat at the base, or maybe it was a chicken. I don’t know. But… We were laughing. Then the world was on fire. It’s the Husky’s job to spot IEDs. (VOICE BREAKING) And I missed one. I can’t see their faces. Just bodies everywhere. Dying alone, without their families. All I could do was hold their hand.
Are you okay, Ben?
(HIGH-PITCHED RINGING) (MUFFLED VOICES)
(VOICES AND RINGING CONTINUE)
STAFF: ♫ Happy birthday to you ♫
♫ Happy birthday to you ♫
♫ Happy birthday, dear Lea ♫
♫ Happy birthday to you ♫
OLIVIA: Fun day.
(PEOPLE LAUGHING, CHEERING)
What do you need?
We have a diagnosis.
ROSE: I thought I felt someone here. You’ve had a long day.
You have Prinzmetal’s Angina, Rose. A heart condition. But it’s very treatable. It explains all your symptoms, and it’s exacerbated by stress, which is likely what caused your heart attack. You need to stop seeking out other people’s pain. It’s literally killing you.
You’re the Chief of Surgery. You could have sent somebody else to tell me this.
Sure. But then I’d miss my chance to gloat.
You’re here because you’re hurting and you don’t know where else to go.
Go ahead. Use your magic. Tell me what’s wrong with me. How do I stop feeling like this?
It doesn’t work that way. I don’t have a magic wand. I can only hold up a mirror, make you slow down, look at the parts of yourself that you’ve been trying to ignore because you’re afraid if you look too closely, you’ll break. Maybe you will. I don’t know. Maybe breaking is the point. You can’t outrun your pain, Dr. Lim. If you keep trying, it’s gonna kill you.
♫ Oh, oh, oh-oh-oh, oh, oh-oh-oh ♫
♫ Oh, oh, oh-oh-oh, oh, oh-oh-oh ♫
♫ Where do my hands go? ♫
♫ Oh, oh, oh-oh-oh, oh, oh-oh-oh ♫
♫ Have time to play with my mind ♫
♫ Where does my tongue go? ♫
MAN 1: Time of death, 12:34.
WOMAN 1: Time of death, 7:13.
WOMAN 2: Time of death, 2:25.
WOMAN 3: Time of death, 2100 hours.
WOMAN 4: Time of death…
MAN 2: Time of death, 4:26.
WOMAN 5: Time of death…
WOMAN 6: Time of death, 7:13.
WOMAN 7: Time of death…
WOMAN 8: …4:26.
WOMAN 9: …8:55.
DR. LIM: Time of death…
(CLOSING THEME MUSIC PLAYING)