Transplant

Strategies for revealing your scars visible and invisible.

Sometimes.

I hurt myself, but we don't have to talk about it.

I'm on the transplant list.

The heart may come tomorrow or never.

You should both know you won't be in limbo for much longer, but fell shift spot.

I'm deciding by the end of the month.

Every time I think I've built something that feeling fades and I run.

Okay.

Oh my God.

Oh my God.

No.

No.

Did you see that?

Yep.

Bring.

Thank you.

You've got a phone? (?)

Morning, Darkland, I just...

Hi, hi.

I was just looking at the schedule.

Nights, weekends, all the least popular shifts. I know.

- You're feeling gaps for now. - No problem. Totally get it.

Dr. Debbie, I appreciate your faith in me and I plan to earn it.

Let Dr. Bergeron know if you have any questions about shifts or patient assignments.

Sure thing.

My only back because Dr. Wilson's strong after because in my parole meeting, that was the vibe.

I better...

Good luck with all that.

- June? - What's wrong?

Why does something have to be wrong?

We run a department together and merely want to discuss it.

Mm-hm.

Let me guess. It's about the rotating surgery residents that are cycling through.

Oh, by the way, this is Ryan. He's first year general surgery.

Hi, Ryan.

Why would I be concerned about Ryan that has inexperienced milk?

Getting in the way of us doing our jobs just so you can feed your benevolent leader.

We are a teaching hospital and you are CC'd on at least a

dozen emails about justifying the budget by training residents.

Nature of horrors of vacuum, Ryan.

Look, if you are not going to engage in the process, you don't get to be pissy about the results.

Oh, June's been practicing her mantras, Ryan.

Perhaps she'll teach them to you if you ask nicely

or you could do your actual job and help save our incoming patients flattened by a forklift, ETA 10.

You okay?

Yeah, why?

Let's go get set up.

All right.

Hi.

Hi.

Stupiud thing's supposed to be waterproof.

Did you want to talk about it? Because it's been a couple of days.

Well, Debbie said end of the month. That's technically today, right?

Debbie?

Yeah, about the fellowship. I thought you were talking about...

No, I was talking about, um, since... you and I uh...

How is your brain not fixated on the fellowship job?

I mean, it is, but did you want to talk about it?

About us?

Yeah.

Well...

Do you?

Unless you want to wait till today's over, if...

- No, that's not what I... - Mags, I've been texting you.

That's all.

- Oh, okay. Well, we need help in curtains. - Okay.

- Yeah, we'll just... - This is Dominic, he came in unconscious.

Central lives in, Ryan did the Foley cap, and now he's helping me to do Brad.

How long was he crushed for?

EMS says 2 hours. Apparently a forklift, knocked a pellet of bricks onto him, so it took a while to get him out.

He's an open femur fracture, BP still saw, heartrate's erratic.

- Ryan, right here. - Yeah.

And you checked to see that his urine isn't dark, Ryan?

He did, I already asked.

But he has the voice of his own, isn't he?

- Yeah, I checked. - Good.

And what's the mainstay of treatment for a crushed syndrome, Ryan?

Aggressive fluid resuscitation to reverse metabolic acidosis.

Track progress over the next few hours.

Treat, wrap the myelitisis and prevent renal failure.

Oh, he still has a pulse in his lower legs, so as long as ortho agrees, we will debride and clean for now.

Okay, sounds like I'm dismissed.

What do you think, Ryan?

- Um... - His BP's dropping.

Is urine output as dark, Ryan?

Did you check that or not?

After the Foley catheter, remember I told you to tell me his urine was discolored.

And then I asked you again, you said you checked it, and then it was fine.

It was.

I think that it was.

Was it or wasn't it?

He said renal failure was a risk, Ryan, but was that just knee-jerk

memorization because when proteins get released into the bloodstream,

after crush injury, they damage the kidney, which you have allowed to happen.

He's in V-TACH, set up the cardiovert.

Push 20 milligrams fentanyl, 2 of midazolam.

What can I do?

Out of the way, Ryan.

Charging.

- Clear. - Shock advised.

How long have you had the headache, Yuri?

A few weeks, and then I started getting pain here, and

these waves of tires where I can barely keep my eyes open.

- Any loss of appetite? - Yeah.

Has your son gotten sick? We're seeing a stomach bug going through the daycares.

Alexei is not in daycare.

I starting in my own contracting business.

Most of the time he comes along.

He loves it.

When the job is too messy, neighbor watches him.

It's just a the two of you?

His mother died when he was a baby.

I think there's something in the water in our building.

Lead, maybe.

I told the building manager that the pipes are corroding.

He even offered to fix them, but they'r. Too cheap to pay or even test,

Which is illegal. Not that that stops some.

I stopped giving Alexei tap water, but bottle is expensive, so I boil for me.

- But if it is lead... Hmm. - Well, then boiling won't help.

The city does have a program aimed at identifying and responding to environmental hazards in older buildings.

You mean lower-end ones.

- Well, you could qualify for extensive testing. - But healthcare is free here, No?

You can't just do the tests I need.

Yes, but this program allows us a wider scope.

It moves you to the front of the line. Not to mention, it outs the landlords that tend to cut corners.

But I would have to criticize the country that gave me asylum.

No, it's completely anonymous.

Look, all I want to do is help you and Alexei through this as fast as possible.

He's stable for now, but in trouble with kidney failure.

Amp of bicarb, give manitol, and get his potassium stat.

No, no, you have to think like a field surgeon, June.

The first priority is to flush.

Right, and then react with diuresis.

Okay, I'll, uh, I want to beat. (?)

Shit, should I do something?

You've done enough.

Look, Ryan, we'll debrief later, about what went wrong. Okay?

Why wait?

Started with the abysmal judgment of whoever matched Ryan to

this hospital bringing, to astounding incompetence today. (?)

But since we're debriefing, when your tiny brain can't remember

if you've done something or not, don't lie and say that you have.

Unless you want to kill someone.

Dr. Novak, I'm sorry, look, I just started...

Another mistake, because what you think means nothing in here.

And if you're going to insist on thinking, then why don't you think long and hard about

whether this is the right profession for you?

Dr. Novak, I think you made your point.

Look, you made a mistake in the heat of the moment these things happen, all right?

Uh, he's having a panic attack.

Can someone get him one of those kidney-based things...

No, no, no.

Did any get inside?

All right, I'm going to need to irrigate.

All right, just push as much prophylactic antibiotics as humanly possible.

Hey, hey, are you okay?

Look, but Novak said that was about him, all right?

Just don't make it about you.

Now let's keep irrigating, guys.

This is unacceptable.

I'm reporting both of you for creating an unsafe work environment.

Two months ago, after it happened, Claire said it was a sprain.

Hmm, and now you can't move it at all.

Yeah.

Are you on anything for the pain?

Well, that's the thing.

I'm on something for my blood pressure.

- This one? - Yep.

And, uh, water pills.

And you can't take those with aspirin, apparently.

Yeah, with NSAIDs, depending on what your pressure's at...

Oh, that, I think that's a restaurant receipt.

Oh.

And I'm also on this and also this, for high cholesterol,

but there was some other thing that interacts with those.

Okay, yeah, now you just, um... yeah, keep going.

You don't have a GP?

Oh, not for years.

Claire's been helping me manage.

I try not to overburden her, but I'm a bit of a handful.

150 over 92.

My wife used to keep track of things, but she... Anyway...

Donald, I'm really sorry.

No, no, she's not dead.

She just had enough of me, I guess.

Claire said I could text her if I needed to be looked at.

I... I tripped over an extension cord at work.

Claire said she'd book an X-ray for me, but when I didn't hear anything back,

I figured, "Well, if she's not worried, I shouldn't be."

Only it's gotten to the point where I can't work.

I do plaster, you know, so... I need my wrists.

To admissions committee, I've known Arnold for seven years, actually, at five years.

Wow, it feels so much longer than that.

Hey, can you please stop reading over my shoulder?

It's very annoying.

I can confidently say he possesses all the qualities that are essential for success in the medical field.

Oh, this is sweet.

Hey, I just caught one of Claire's frequent flyers.

Is she running late?