Good news. I have a VIP who needs
a multiple ligament reconstruction on his elbow,
and I've got room for a couple residents
- to assist me and Dr. Melendez. - Awesome.
I've never assisted on one of those before.
That's why Dr. Andrews is acting like it's Christmas morning.
I'm guessing you've never operated on a pro athlete, either.
Last time I checked,
a couple means two, and there's three of us.
More good news.
Whoever isn't with us will be assisting Dr. Coyle
on a double-leg fasciotomy.
Feeling lucky?
Murphy.
VIP elbow. Sweet.
Fasciotomy.
Whoo.
Bobby Ato? Don't think I've heard of him.
He's a pro athlete?
He's a pro. I don't know if I'd call him in athlete.
E-sports.
- Video games? - He's one of the best in the world.
Last year, he won enough prize money to buy his mom a beach house in Monterey.
Paid cash.
Is he considered a very important person
because he's an athlete or because he has a lot of money?
- Both. - Both.
I have to go.
Morning, Shaun.
This is Melissa Bourne,
the therapist that we talked about.
That you agreed to meet with, right, Shaun?
Hi, Shaun. It's nice to meet you.
Hi.
Dr. Glassman thought we should meet
before our first in-home session.
- Just to make sure you're comfortable. - I am not comfortable.
Shaun…
It's gonna be fine. You two are going to like each other.
Dr. Bourne has a PhD in cognitive psychology.
She can really help you, but you have to give her a chance.
Okay?
'Kay. Okay.
I'm proud of you, Shaun. I'm already proud of you.
Notice the separation at zero degrees.
It's indicative of complete tears of the LCL and the UCL.
A perfect candidate for surgery.
How's your mom? Still beating cancer?
Oh, she's good, bro.
She said she gets checked out at the beach all the time
ever since you did her breast reconstruction.
So, uh, thanks. I guess.
We're gonna take good care of you.
- See you in the O.R. - Thank you.
Which part of the UCL is the principal secondary restraint
to excessive valgus movement?
- Anterior. - Everything okay?
Yes, I'm fine.
I'm fine.
Squeeze my hands.
There is a paradoxical loss of grip strength on the left.
There are many possible explanations for that,
- one of which… - One of which is…
He has ligament tears in his left arm.
The anesthesiologist will be up in a few to get you ready for surgery.
Dope. Thank you.
Uh, Dr. Murphy.
- What's wrong with you? - Nothing.
I have a condition called…
You're autistic. Yeah, yeah, yeah. Mm, I get it.
But what is wrong with you, bro?
You gotta be legit smart to land a gig as a surgeon
and he just shut you down like a noob.
I'll bring the idea up again.
- I do that. - They don't respect you.
And they should listen to you the first time.
- I can't control what they do. - Of course you can.
That's what playing the game is all about. It's about controlling your opponent.
You gotta find the right strategy.
It is not a game.
Everything's a game, man. Everything's a game.
Just sometimes the stakes are higher, and this time it's my arm.
So, I'm guessing you drew the short straw.
- I beg your pardon? - Well, you're here,
and your co-residents are on the VIP case.
I'm awesome and I'd still rather be with Melendez and Andrews.
- No, it's fine… - Relax. It's cool.
Tell me about our patient.
Uh, 34-year-old female, software engineer
and entrepreneur presenting with Compartment Syndrome
caused by extreme overexertion at a spin class.
The condition has caused the muscles in her legs to…
- Okay. Great. - I wasn't finished.
Finished enough to show me you're smart and thorough.
- Treatment plan? - We need to make incisions on…
Good.
You take lead.
We need to make a number of long incisions
down both sides of each leg to relieve the tension
and return healthy circulation.
It's important we act quickly.
If we don't get the swelling under control,
the damage could be irreparable.
What does that mean? I could lose my legs?
From working out too hard in a spin class?
No, don't worry. Your sister's gonna be just fine.
Look, I'm very confident we caught this in time.
If you could lean forward?
I just need to check your kidneys haven't been affected.
Let me know if you have any tenderness.
Extracting the palmaris now.
Dr. Andrews, I read your op-ed in Gen Surge News.
Brilliant piece.
Never realized the lack of continuity of care was such a severe problem.
Dr. Melendez…
you have very beautiful hair.
- Thank you. - Given the patient's grip weakness,
we could do a nerve conduction test
to rule out any concurrent nerve damage.
No.
Okay, that looks like a good stopping point.
Dr. Kalu, step in.
- Something wrong? - No, it looks good.
I just want to give Dr. Kalu an opportunity to show us what he can do.
As long as that's okay with you.
Sure.
- Thank you, Dr. Andrews. - Mm-hmm.
All right, looking good.
Let's move to the lateral side.
So, what are we doing tonight, ladies?
How about we go to Viva's?
Sounds good.
Bovie.
You're awfully quiet over there, Dr. Browne.
I'm just focused.
I know you're used to operating with Melendez, but we have fun here.
I feel like when it's less tense, people make fewer mistakes.
Okay.
You wanna take the other leg?
- Really? - Yeah, best way to learn is by doing it.
Right?
- Definitely. - So go for it.
Well, it's another warm day
In the city of cold hearts
They all just play the part of who they are
And I'm here on my own
I'd rather be alone
Than try to be someone that I'm not
And you seem like someone who could appreciate the fact
That I'm no ordinary man
- Shaun, good morning. - Good morning, Dr. Glassman.
How'd it go with Melissa?
She was…
very helpful.
You're wearing the same clothes as yesterday, Shaun.
After you.
Apparently we are at an impasse.
I feel strongly that Melissa can be very helpful to you.
You feel so strongly that she can't that you're willing to sacrifice
a good night's sleep and hygiene.
Shaun, you smell.
I will shower in the doctor's lounge.
Well, great. That solves one problem.
You stayed here all night just to avoid a confrontation.
Just say no, Shaun.
- You know? Just say "no." - No!
- No. - Great. That's just great.
- I don't have to see Melissa? - No, you don't have to see Melissa.
You're a grown man. You can make your own decisions.
I just happen to feel that she could be of great help to you. That…
I'll tell you what.
You see Melissa three times
and I will buy you the surround-sound system
you want for your television.
Are you bribing me?
I suppose I am.
If you don't like her, she'll leave.
And I promise I will never say another word about it.
That's a pretty good deal.
- Okay. - Okay.
I will meet with her tonight.
That's good, Shaun.
Saline? I've never seen it done quite like that.
Yeah, I had a professor from Portugal.
Apparently it's how they do it over there.
It's supposed to lessen the pain.
Well, the good news is your tissue is nice and pink,
which means it's healthy.
Unfortunately, the swelling is not coming down like we'd hoped.
Does this mean you're going to have to amputate?
No, no. Sometimes it just takes time.
We'll take care of you.
Very nice work, Dr. Browne.
Hey.
Can you do me a solid and trade patients?
No, not a chance. Andrews let me take lead.
Coyle let me take lead, too.
So what is the problem?
He's a little too friendly.
He patted my back in a weird way. I don't know. It was… It was awkward.
I'm sure he's just trying to establish a rapport.
Maybe?
I don't…
Shaun? Switch?
No. I like Bobby.
He has very good advice.
So, who did what?
Well, I did, uh, most of the surgery along with Dr. Andrews
and Dr. Kalu aided in replacing one of your torn ligaments.
You should be back in competition shape in a few weeks' time.
Word. What about you? What'd you do?
I helped to clean the grafted tendons.
Ah. That's it.
- Yes. - Come on. You didn't get up in there?
You… Your muscle weakness
along with the high body temperature
could be an early indicator of multiple sclerosis.
We should order an MRI.
- We've talked about this countless times. - Yes.
We should order an MRI.
- We are not ordering an MRI. - You don't respect me.
Not right now, I don't.
Dr. Andrews, Dr. Melendez.
Given the fact he's a pro athlete,
even the slightest hiccup could be problematic.
I think Bobby would be impressed by our being extra attentive.
Kalu is right, he is a pro athlete in his prime earning years.
We should make sure we leave him 100 percent.
Do the MRI.
Nice score. You got 'em to listen.
Do the MRI.
No, Jared did.
How did he get there when you couldn't?
He asked nicely.
Okay, you asked nicely.
Yes. Yes, I did.
You gotta be fierce if you want the glory, bro.
Oh, no.
I do not want the glory, bro.
I just want to be a good surgeon.
Everyone wants glory.
It… It's how you get what you want. And everybody's got wants.
I want a surround-sound speaker system.
To get it, I have to see a therapist.
I don't want to have to see a therapist.
Okay, yeah, that's, that's how I got my first PS2.
Yeah, my parents bribed me to go to therapy after they split up.
What was therapy like?
Pretty basic, bro. She'd tell me what to do, how to deal with my parents.
Was it helpful?
I don't know.
I never did anything she told me to do.
Is that an option?
Doing whatever the hell you feel like doing is always an option.
Just a gentle reminder
dinner with my dad tonight at 8:00.
It is on my calendar.
So was the Gypsy Kings concert, and I, I seem to remember…
Fair enough.
How is the VIP case?
- Shaun seems off about something. - Did you talk to him?
Yes. Because talking to Shaun solves problems.
And Andrews is…
He's a pain in your ass.
No. He's actually too friendly.
Jared kisses his ass and suddenly he's cutting.
Well, ass kissing is a useful skill for a surgeon.
That's a very beautiful blouse. Do I still have to go to dinner?
Yes. It'll be nice.
You'll have some nice wine and my dad will pay.
- He'll push us to set a wedding date. - April 25th.
- Did you book something? - No.
But my dad doesn't need to know that.
What do you got?
Looks like the surgically repaired elbow is fine.
As I suspected.
But Murphy noticed something in the periphery,
a little higher up, just above the bicep.
It was my idea.
Yes, I just said that.
So, we took an image from higher up and noticed this.
It's encasing the entirety of his brachial plexus.
This thing is massive.
Biopsy indicated it's definitely a schwannoma.
And it's definitely malignant.
It's in a tricky spot, but you might be able to remove it.
Follow it up with a combo of radiotherapy and chemo to finish it off…
- What? What's the problem? - Robert Ato. Bobby Ato.
- Pro-gamer Bobby Ato? - You a fan?
I met him three years ago.
Oncology consult for SF Muni.
He had cancer three years ago?
Why the hell wouldn't you tell us that you had already had cancer?
It was in my lower leg three years ago.
How's that gonna change how you fix my elbow?
It would have an effect on how I viewed the symptoms that Dr. Murphy noticed.
You didn't listen to Dr. Murphy because you don't respect him.
- 'Cause Dr. Murphy is different. - I respect him.
He has good ideas, and he has bad ideas.
Turns out this was a good one. That you shot down.
Why did you hide the truth?
A previous cancer diagnosis isn't shameful.
After the first diagnosis,
all I was thinking was,
"Will it come back? How bad will it be?"
I was distracted, man. I couldn't focus, and I hit a slump…
You were worried that cancer was messing with your gaming?
Yeah, man!
It cost me a championship.
I decided to block it out along with all the thoughts of negativity
and physical weakness, and like that,
I became the best in the world.
We need to do a full-body scan
to make sure the cancer has not already metastasized.
What he said.
What I said.
This looks great.
The swelling is starting to reduce.
We can start tightening the sutures.
Finally some good news.
You look like you're doing better, too…
now your boss is gone.
Dr. Coyle? He's fine.
You don't have to toe the party line with me.
Trust me. I get it.
I almost rode myself to death in a spin class
because I overheard a couple of investors say that they
"liked the concept just fine,"
but that my cankles were "too distracting."
What? Your idea is brilliant.
And you're beautiful. Screw those jackasses.
Grace, you don't get it.
You got the face, perfect little hip-to-waist ratio,
and most VC firms are run by a bunch of bros,
so there is an inverse relationship between the size of my ass
and how much money I can raise.
Then you should do something else where you don't have to deal with bros.
Like what, become a nun?
- Sorry. - You agree with her?
She nearly worked herself to death trying to please some pigs with money?
- She shouldn't have to. - Great.
Let me know when you find utopia. But until then, I love what I do.
So I got to play the game 'cause if I call them out,
I just get labeled a bitch, or even worse.
Your heart rate's going up.
Hazel?
Hazel? She's barely moving any air.
Hazel, can you hear me?
Code blue! I need to intubate her.
Give me a laryngoscope and an ET tube.
Let's get her on 100 percent oxygen.
Code blue. 4 North, room 407.
- Talk to me. - Her lungs…
I think it's a reperfusion injury.
There's no room in here.
Mallampati 3, maybe 4. You should take over.
You're doing fine. Here, use the bougie.
- You feel the epiglottis? - I think so.
Okay, go a bit further, you should feel it stop.
If it keeps going, you're in the esophagus.
It stopped, got it. ET tube?
It's gonna be okay.
Strong work, Doctor.
Best in the world or not, this guy's insane.
Hiding from a diagnosis?
Doesn't work, it'll find you.
Bobby wanted to be the best.
He is the best.
I don't think so. I think he was just scared.
What's that? Next to the brain stem.
Oh, another schwannoma.
So much for the power of positive thinking.
He's a strange kid. He had cancer.
Stopped going to follow-ups because he started losing.
What's so strange? Sounds like a classic case of denial.
I was thinking we could try something new. Maybe gamma knife?
I don't think so. Wrong type of tumor for that.
What if I told you every few months that
you had a real possibility you were gonna die?
I'd be scared. And I'd listen.
Maybe you would, maybe you wouldn't.
Personally, I think he's right, shut down those voices of doom,
spend your days living instead of dying.
But he may also be crazy.
Short of making him a vegetable, there's nothing we can do.
Is… Is Shaun okay?
- Is his work okay? - Yeah.
- I just, um… - Then he's fine.
Damn.
Horse walks into a bar. Bartender says…
We found another mass.
That's not how it goes, but cool.
- Let's knock it out, too. - The mass is located on your brain stem.
Which controls your autonomic nervous system…
Your heart, respiration.
Its positioning makes it inoperable.
I had a good run.
Wish it was longer, but…
I'm gonna go out on top.
If you went out today,
could you say the same thing?
She's lucky you were there.
Me? You're the one who saved her.
With your help. A lot of it.
So, thank you.
Hey, look, you wanna, you wanna get a drink?
Maybe take the edge off?
No. But thank you, though.
Are you sure? I promise you'll have fun.
I give great massages.
And I'll make a killer omelet in the morning.
That's really inappropriate.
I said no.
I'm sorry. Where's this coming from?
You were… You were clearly giving me signals.
No, the only signal I gave you was that I wasn't interested in the slightest.
Okay, see, I just… I heard about you and Kalu
banging in the call room, so I figured…
This conversation is over. You're an ass.
I'm pretty easygoing,
but you're approaching insubordination.
You're gonna report me?
I'm not gonna report anybody.
But maybe next time, try not to have such a stick up your ass
about being asked out.
Oh, come on. I always thought Bunny was the cutest nickname.
Of course you did, but you could've stopped calling me that when I was 12
or, or 20.
Rough day?
Yeah. Yeah, it was something.
Well, this should make you a little happier.
I have decided to take care of your entire wedding.
We don't need it.
- You're welcome. - We're not 21.
We're more than capable of paying for our own wedding.
We make good money.
But you won't once you start having kids, Bunny.
What are you doing in here?
I'm hiding from my therapist.
I am not going to get a surround-sound speaker system.
But I am doing whatever the hell I feel like doing.
Mm-hmm.
Can you hand me that mop?
Hmm, okay.
Are you satisfied with what you've done with your life?
Would you be happy if you died tomorrow?
Uh, satisfied?
Happy?
I mean, I clean up a building, uh…
But I, I married the love of my life.
Uh, we raised three beautiful kids.
One of them had some troubles, but she's doing great now.
The other two are doing all right for themselves.
And I was good to people.
At least I think I was.
That's a very good answer.
I got pictures of the girls if you want see…
No.
So, why do I need to quit my job to have a family?
Agreed.
She can be a great lawyer and a great mom.
Yes, she can, but why?
Why waste your time working?
You should be enjoying life, like me.
There's plenty in the family trust.
Dad, my work is important. I'm helping people…
Bunny, you're pushing papers. How…
How is that really helping anyone?
And maybe I'm old-fashioned, but I don't get it.
I, I thought you were smarter than that.
You'd prefer her to be a lazy parasite living off a trust fund
as opposed to actually contributing to society?
Parasite?
My father made a lot of money.
I'm not going to apologize for that.
He made sure his children and his grandchildren could enjoy their lives.
I'm not hurting anyone. In fact,
I go out of my way to help people.
So I'm sorry if that doesn't qualify me
as a worthwhile person in your book.
I'll get the check on my way out.
Dad, you don't have to…
What am I doing wrong, Shaun?
I don't know.
I tried…
encouraging, I've tried being supportive, I've tried bribing you.
I don't need a therapist. No.
Look around you. You're sleeping… What is this, a broom closet?
Look at the sacrifices you're willing to make
just to avoid…
We're gonna pick this up later.
You have to file a complaint with HR.
I do that and I get labeled hostile and difficult,
neither of which work with my complexion or gender.
All the more reason to take a stand.
Claire, this situation is exactly what HR is for.
I didn't say it was easy.
- Yeah, you did. - Look, it's scary and it takes courage,
- but it's the right thing to do. - It's a pointless thing to do.
- They'll listen to you. - They will shift the blame onto me.
Like you did.
Whoa, what? How did I…
I came to you, you accused me of exaggerating to get back onto the case.
No, that's not what I meant.
I said he was too friendly.
You said "he was trying to establish a rapport."
I'm sleeping with you, Jared, and you thought I was overreacting.
How do you think three strangers will see things?
Claire, I'm sorry. I am so sorry.
Don't worry about it. It's just the way it is.
I've got a patient to round on.
Dr. Melendez and I had a talk
and we believe we can excise the tumor
if you're willing to make a sacrifice.
Sacrifice?
- That sounds better than death. - My thinking as well.
We believe we can remove the mass,
but we'll also have to take a piece out of your brain stem.
A chunk of the red nucleus,
which helps control the left side of your body.
You'll be paralyzed on that side.
It could also result in difficulty eating and swallowing.
Speech difficulties.
Let's do it.
Good for you.
Hold on. Hold on.
Bobby, this is very risky surgery.
You could die on the table, and even if all goes well,
you will be severely disabled.
Yeah, I, I was listening, and I'm in.
Guys, hey, I get it.
If I'm dead, I'm… I'm dead.
But if not, PT, relearning stuff, whatever.
It's not gonna stop me from competing.
Not ever.
Bobby, your career is over.
We need you to understand that.
Yeah?
Once a gamer, always a gamer, huh?
You got my respect.
What the hell is your problem? If you ever threaten Claire,
take a disrespectful tone, or so much as look at her cross-eyed again,
I'm gonna do a hell of a lot more than put you up against a wall.
We clear?
Your lungs are looking a lot better.
Overall, you're in pretty good shape.
Thank you.
You're welcome.
All part of the service.
And good for you.
I wasn't sleeping.
I heard the way you handled that other doctor.
You heard that? All of it?
I wish I had done that.
You were brave.
No, no.
If I was brave, I…
Rick Allen.
- Who? - One-armed drummer for Def Leppard.
Come on, man.
And there is the tumor capsule.
Richie Parker. Anyone?
Isn't he a NASCAR guy? An engineer, right? Born without arms?
And Nurse Ocampo gets the door prize.
And now we will take just a little piece of our friend here…
a nice sample to test.
- Thank you, Doctor. - And now the rest.
He may not be able to tie his own shoes,
but I wouldn't bet against him ever competing again.
Aut libertatem aut mortem mihi da.
Shaun, do you know that means?
No. It's not relevant to this surgery.
Oh, it's relevant. Look it up.
No, it's not.
Heart rate and ETCO2 are rising.
Slight change in body temperature.
His heart rate's 108.
Check tube placement and suction him.
If he takes a turn, we might have to abort.
I don't think so. I'm too far in.
- Keep him stable. - He's tachy. Heart rate's climbing.
115, 117, 120, and rising.
He is going into v-tach.
Robert Ato is dying.
I'm gonna pull out of the pons slowly.
You pull out now, you might damage the cerebellar peduncle.
If I don't get out now, I'll kill him if he starts seizing.
Something's not right. Tachycardia?
Bradycardia would make more sense.
- Ideas. - Anyone?
Tell me what you see.
Tachycardia, rising body temperature again,
muscle rigidity, CO2 is rising.
Muscle rigidity? Which side?
It's all over.
Then it's not the brain stem. We'd only have muscle rigidity on one side.
Think. Tachycardia, rising temp, CO2…
CO2… It's the anesthesia.
Malignant hyperthermia. Get the MH cart.
140 dantrolene, STAT.
Kalu, Murphy, get lots of cooling blankets.
- We need to get this temperature down. - Coming out.
- Now! - Hyperventilate at 100 percent O2,
10 liters per minute.
Flush out the old anesthetic, lower the ETCO2.
I want vecuronium on deck. We got to keep him under. Let's move!
And we're on.
- Uh, temp's not coming down. - Wait.
CO2 is coming down.
Heart rate is coming down, too.
Temperature is 101.
Okay. Nice work, everyone.
Thank you very much.
Terry Fox.
Or my personal favorite, Jim Abbott.
Come in.
Hi.
I need to talk to you about Dr. Coyle.
Dr. Browne.
I wanted to talk to you about the same thing.
Please.
The surgery was a success.
And the outcome might be better than expected.
There will still be significant neurological dysfunction
on your left side, but not as much as we'd anticipated.
Sick!
Thank you.
You did good, my friend.
You have to be patient.
Nah.
Is patience a bad thing?
Acceptance is a bad thing.
When I was a kid, I, I wasn't good at jack.
But I never quit.
I…
Found my thing.
Don't ever let anyone tell you
what you can and can't…
Do.
I'm sorry. For last night.
It was a rough day. I was tired.
Probably had a few too…
Your relationship with your father is your business…
Neil, you don't have to.
I'll call your dad, and…
I don't want to have kids.
Shaun, I'm gonna drive you home.
You're gonna see Melissa. If you don't like her, she'll leave.
But there's no more running away.
Why do you think I'm doing this?
Because you are stubborn.
Ok… Okay, yeah, okay, sure. I'm stubborn.
But I'm doing this for you, okay?
So that you can have a better life, so that you can have a happier life.
What if it doesn't make me happy?
What if it only makes you happy?
You think, you think I'm doing this to make me happy?
I'm not happy, Shaun.
I'm not close to being happy, and you know what? I am done explaining,
I am done bribing, and I am done talking.
- Now let's go. - No. No.
No.
No, I… I want to make my own decisions.
Shaun, can you keep your voice down, please? Please?
You cannot keep ordering me around, okay?
You're not my father!
I know that.
Shaun, I don't understand…
- why this is so upsetting. - You don't let anyone…
I don't get it.
- ever tell you what you can and can't do. - Shaun, let's just calm down now, please.
Don't let anyone ever tell you what you can and can't do!
- Hey, just calm… Shaun. - I want to make my own decisions.
- Okay… - I want to make my own decisions!
- I'm just trying to help. - I want make my own…
- Shaun! - I don't want help!
I…
What were you thinking?
I do not need you to fight my battles, and I certainly never asked you to.
And if you really respected me,
you would not treat me like some damsel who needed protection, okay?
You would treat me with the respect
that you would automatically give to a man.
You'd treat me like a person capable of handling her own life!
And maybe, maybe it's too much to ask of you.
Apparently Andrews agrees with you.
I've just been fired for physically assaulting an employee.
Shaun? Shaun!
Where would he go?
Is there a place he likes to hang out, a place where he feels comfortable?
No, I don't know.
I mean, he's not at the hospital.
And there used to be a picture here of Shaun…
And his brother, Steve.
What do you think that means?
It means he's not coming back.