New Amsterdam

I found a clinical trial.

Precision-targeted immunotherapy.

It's led by Dr. Panthaki at St. Simon's.

He's highly regarded.

And, unlike radiation and chemo,

it comes with no debilitating side effects.

That sounds perfect.

It's exactly what he wanted.

All right. Dr. Sharpe gets it done.

Which is the difference between me and this trial.

Because precision therapy might not work.

Your objection is noted. Again.

Yes, radiation chemotherapy is challenging,

- but it's... - It's brutal.

It's... It's hitting yourself with a brick over and over again

and hoping the cancer dies first.

That's the point.

The cancer dies.

Radiation and chemotherapy work.

Precision therapy is like gambling your life

on a lottery ticket.

People said the same thing about bone marrow transplants.

They also say it about lottery tickets.

Enough.

Is this what you really want?

She's right.

Chemo and radiation, they work.

They do the job.

But... they'll break me.

No matter how strong I am.

I'll lose my hearing.

My sight.

I'll lose my mind.

They don't always come back.

And I have so many things...

that I need to do.

So let's get in the trial.

So let's get in the trial.

Uh, so?

What? Oh, sorry, I didn't see you there.

You know what, an email would have covered it,

maybe even a text.

But now we're here in person

you should definitely be groveling.

Evie and I were up all night.

You stallion.

Fighting.

Look, I'm not trying to be a jerk here,

but telling Evie that we used to...

- I know. - It wasn't cool.

I said I know.

What you should be saying is, "I am sorry."

I am. I'm sorry.

You don't sound sorry.

Look, can we just not have this be a thing, okay?

You know what, you're the one who said

that we can be friends.

- This doesn't feel like friends. -

Early morning rush started early.

You got some nerve.

It's French vanilla.

Like hell it is.

Eh, maybe hazelnut?

You're mothering me or babying me.

Whichever one it is, stop it.

Are you okay?

You're doing it again.

What do we got?

This is LaDavius Powell.

45-year-old man with new onset

right-side abdominal pain.

No meds, no past medical history,

allergic to Cephilicam.

- Cephilicam? - Fancy penicillin.

- Bay 23, step lively. - Cephilicam.

Sarah Madsen.

36-year-old woman found down on the sidewalk.

Unresponsive, hypotensive.

BP 90 over palp, heart rate 120.

Said New Amsterdam was her hospital.

Okay, looks like previous heart surgery.

Find her medical records.

Drew this in the field.

Why is the blood so diluted?

No idea. No sign of bleeding.

The blood's gotta be going somewhere.

Page Dr. Sharpe.

We gotta get on this or she's not gonna make it.

Maximus, today is one of those days

that makes it all worth it, you know?

It's one of those days you jump out of bed excited

because you just know...

It's gonna be one of those days.

Yes! Yes, in a big, big way.

Are you feeling it too?

I am feeling it. I got a meeting with the nurses' union

about insurance and birth control.

Eh, so not so much.

Nah, it'll be good. What do you got?

Me, I have a transitioning teen

coming in with his parents.

And you know, society is not kind

to trans teens.

Bullying, cultural stigma, hate crimes,

which all leads to depression,

which way too often leads to suicide...

Sorry, this is your happy day?

No, no, my happy day is what happens

when these kids get to feel heard.

Today I get to help somebody find out who they are.

I get to help somebody find their voice.

- Happy day indeed. - Indeed.

Yeah, so I'm good with the whole voice thing,

like, got it, found it.

Fine with it. I've got...

other issues here.

Oh.

Okay.

Uh, what are they?

Exhibit those.

Parents.

All right.

Jillian, Grant?

Care to elaborate?

Well, Dr. Frome, Shay says he's ready

for top surgery.

- But we... - But they won't let me get it.

I mean, how's that for withholding?

- Shay, that's not fair. - We have concerns.

See, Doc?

Issues.

I mean...

help me out here.

We could do a sit-in. At shift change.

- Bigger. - Picket HCC's office.

Bigger.

You want to keep your birth control coverage?

Then kick 'em where it hurts.

Excuse me, Max,

- can I have a word please? - All right.

Keep thinking.

Kick some ass for the working class!

Did you hear from Dr. Panthaki?

No, this isn't about the trial.

Dr. Bloom asked me to consult on a hematology patient.

Turns out that she was a heart transplant recipient

here, 27 years ago.

And?

Her file says that she received her heart

from a "Luna Goodwin."

Your sister.

She's fading fast.

We've already infused two units of packed red cells

with a pressure bag but she's still net negative.

I would give her a plasma expander,

but her hematocrit's already in the toilet.

I mean, that's just gonna make it crash even more.

The usual production- destruction algorithm

doesn't seem to apply to her.

Let's order up two more units from the blood bank

and let's get a second large bore IV line.

Give me a little Trendelenburg.

How can I help?

That's where all the blood is going.

Sarah's right thigh.

Why is she bleeding in the first place?

There's no localized source.

No cuts, lacerations,

blown arterial aneurysm?

No, every organ just seems to be oozing blood.

Elevated PTT?

It's barely out of the normal range.

Yeah, but put that together with why she's bleeding so much.

Um, acquired hemophilia?

Her clotting factor eight isn't working.

That's why she's bleeding.

Rare, but it would explain it.

That's good.

I'm really thirsty.

Uh, uh, uh...

She's thirsty. Can we get her some water, nurse?

Uh, let's hold off on that.

Uh, Ms. Madsen, I...

I had a heart transplant.

At my last check-up my doctor said

that my cyclosporin levels were low

and I've been worried that my body's rejecting my heart.

Could that be causing this?

That wouldn't explain the bleeding.

But it might explain why the bleeding's

been making you so sick.

How sick am I?

I'm afraid acquired hemophilia is quite serious.

But we're gonna fix it, okay?

Uh, nurses are gonna take you up to ICU right now.

We're gonna start treatment and you're gonna do great.

Thank you.

Are you okay?

Uh, once the bleeding is stabilized

get me a transvenous heart biopsy.