Good morning.
What time is it?
6:28.
You should be asleep, but I'm glad you're not.
Your post-op pathology and MRI results are finally in, and...
They're good.
Very good.
Was the pause for dramatic effect?
Yes.
The surgery was a success.
The only thing you need now is rest.
And chemo and radiation.
Have you been here all night?
I slept in a chair in the lab.
Well, you should go home and go to sleep.
I can't go home.
My next shift starts in 31 minutes.
The surgery was a success.
All Dr. Glassman needs now is rest.
That's great news.
And chemo and radiation.
How are you?
I don't need rest.
I fell asleep in a comfortable chair.
Good. Someone screwed up the on-call schedule
and left the ER short-staffed.
I need two volunteers to fill in.
Good news is you won't have me breathing down your neck.
Bad news is it's a 36-hour shift.
This new flex-time policy is ridiculous.
Aren't our salaries low enough already?
It's not about the money.
Andrews believes that surgeons need to be at their best
even when they're exhausted.
The only way for residents to learn it is to do it.
You got to practice like you play.
And you can't do either without sleep.
You're free to take it up with Andrews any time.
Pick a number between one and five.
2.5.
- One. - That's not between...
- Five. - Three.
Aw, damn it.
Good news.
Dr. Melendez won't be breathing down our necks.
You're second-year residents.
This is a great opportunity for you to prove
that you don't need a babysitter anymore.
And I have a ton of personal crap
I got to take care of today, so I'm on call,
but don't call me unless you absolutely need to,
but you better not need to.
You've got a M.I. in one and compound femur in two.
I'm gonna kill that bastard!
He's dead!
And a bleeding, angry drunk guy in five.
Get your hands off of me!
What the hell are you looking at?!
Synced & corrected by -robtor- www.addic7ed.com
Excising the endometrial lesions
should only take about an hour.
We'll be operating through a single incision in your belly button.
You won't even be able to see the scar.
How can you operate through such a small opening?
It's a new technique using a single port
divided into sections for the camera and our tools.
- New? - To them.
Don't worry. It isn't to me.
I'm confident that this will resolve your pain and infertility issues.
Thank you, all of you.
Being a mother is all I've ever wanted.
On our first date,
she told me the baby's name she'd picked out.
We were 17.
So let's hear 'em.
Jackson for a boy and Cameron for a girl.
Very nice. I like them.
So do I.
And you are going to be an amazing mother very soon.
Let's get her prepped.
I thought it was just because she was so pretty and, uh,
it had been a while,
but after she left, it stayed.
You think she roofied me with Viagra?
Sure. That could have happened.
Or maybe it was the alcohol, marijuana, and Molly you pre-gamed with.
A lot of different drugs can cause priapism.
Especially those cooked up in a garage.
Is it okay if I touch it?
Uh, okay.
Rigid corpora cavernosa and flaccid glands.
What's that mean? What's she getting?
It's been over four hours.
You don't want necrosis to set in.
N-Necrosis? Are you saying that my... My penis could die?
It could, but it won't because we're going to move fast.
What the hell are you going to do with that?
We need to remove the deoxygenated blood to restore circulation.
You're going to feel a small pinch and then some pressure.
Is she lying?
I'm not sure.
Holy mother of God, that hurts!
Wow!
I go out for a short walk so I can have one moment of peace,
and this is what I come home to.
What's the problem?
His mouth was obviously big enough to get it in.
He must have strained his masseter.
It's gone into spasm and caused lockjaw.
So give him a sedative and pry it open with a McIvor.
I tried. It won't budge.
And he said it hurt like a son of a...
Inez.
That's what he said.
I put in a bite block, but I don't know...
Call Lim.
We're supposed to be proving our independence.
I will try again with the McIvor.
You don't want to tear the masseter.
If the bite block slips and he gags,
he will have broken glass and vomit in his lungs.
I could put him under.
Then I can dislocate his jaw if I have to.
We definitely can't do that without calling Lim.
That's true.
I hope we don't interrupt anything important.
Don't worry. She's either sleeping or doing laundry.
There's nothing interesting going on in her life.
Not guilty.
Do you have something against traffic school, ma'am?
Your Honor, the defendant's not eligible for traffic school.
This is her third moving violation in the last year.
Alleged violation, thank you very much.
Traveling 100 miles per hour on a motorcycle? Do you have a death wish?
I wasn't going anywhere near 100.
So how fast were you going?
Excellent question.
And one I assure you the officer who issued my ticket
will not be able to answer.
California State Vehicle Code mandates
that all LIDAR speed-measurement devices be calibrated...
...at least once a...
Sorry, I need to get this.
No, you need to turn it off.
Your Honor, I'm a trauma surgeon at St. Bonaventure,
and I'm on call, so...
Five minutes.
The court is adjourned for a five-minute recess.
I thought I was clear.
I'm available to help with stuff you can't do on your own.
Uncle Fester Jr. does not qualify.
I think the situation warrants putting him under a general an...
And dislocating his jaw? He's not a damn snake.
So, what should we do?
Prove to me you're as capable as I think you are.
It doesn't make any sense.
We are the only hospital on the West Coast
that hasn't adopted the ACGME mandate
on a 24-hour max shift length.
And numerous studies have shown the negative effects
that sleep deprivation has on critical thinking,
which can cause residents to make mistakes
that not only harm patients, but that waste money.
You've done your homework.
Um, it's something I've been thinking about for a long time.
I actually did a paper on it at med school.
Well, Dr. Browne, I've also thought about it.
In fact, when the new ACGME guidelines were released,
I joined a nationwide study analyzing a flextime schedule.
It found that as long as a weekly max of 80 hours is adhered to,
patient outcomes and resident satisfaction scores are better
than at hospitals with a daily max.
So we're just going to have to agree to disagree
about whether my foolish new policies "make any sense."
No, I didn't say...
And I know I told you to be more assertive.
But you also need to make sure that you don't forsake
your normally excellent judgment in that effort.
- Whether... - Excuse me. Yeah, hi, I'm sorry.
- I'm back. - How wonderful.
Take a seat until your case is called.
Oh, my case was called.
You said I could have a five-minute break.
The court took a five-minute break.
Yours is going to be considerably longer.
Continue.
Make a stab incision with an 11 blade,
and I'll insert the Veress.
He'll get over it. Don't worry.
Andrews just likes to hammer a nail every now and then.
I didn't call him a fool. I just said his policy didn't make sense.
Insufflation's complete.
Ready for the multi-port.
You said it didn't make sense,
and he explained that in his opinion it did.
What's the problem?
The problem is men who tell women to be assertive,
then as soon as we are, they criticize us for it.
We're the bitch.
You didn't call him a fool. He didn't call you a bitch.
Not to her face.
He just suggested she choose her words more carefully.
So, women have to be assertive but careful?
When you're talking to your boss, yes. Everyone does.
If you're all done debating, this boss could use some help.
You see that?
There are lesions on her ovary.
That wasn't visible on the imaging.
It's small.
We can excise it without damaging the ovary, but...
There are others.
Her bowel, bladder, uterus.
No wonder she's been in so much pain.
We'll start with the Fallopian lesions
just go one by.
Browne, I need you to scrub out and brief the husband.
Explain the endometriosis is way more severe than we thought.
Why me? Why not Park?
Because I think you're better at talking to anxious relatives.
Is there a problem?
No.
Retract that tissue.
Why is she so on edge today?
No idea.
Just one of those days.
I didn't mean one of "those" days.
I just meant, people wake up
on the wrong side of the bed sometimes.
Dr. Browne explained exactly why she was "on edge."
Did you forget already,
or were you just not listening to begin with?
Excuse me?
We should cut back on the conversation and focus on the procedure.
I agree.
I want to see her.
I'm sorry. You can't go into the OR.
I'll just... I'll just look through the window, please.
Daniel, trust me.
Seeing your beautiful wife on the operating table
is not gonna make you less anxious.
Hey. Everything is under control.
The only thing that's changed
is how long the surgery's gonna take.
Look, I'm... I'm sorry.
I... I... I don't mean to be a pain.
You're not a pain. You're just scared.
I would be, too.
She's getting the best care possible,
and as soon as we're done, we'll bring you to her.
Thank you.
Okay.
Y-You're... You're good at this.
Dr. Monteo to pre-op.
Shouldn't you be in the ER?
Lea keeps calling me.
She wants to talk about why I told her to go back to Hershey.
You told Lea to go back to Hershey?
I thought it would solve the problem, but no.
No. It just made it worse.
Now she wants to talk about it more,
but there's no more to be said.
That's not the way it works, Shaun.
It can't just be one person who does the talking.
You have to listen, too.
I don't want to listen to her.
It's too... hard.
It's too hard.
Well, relationships aren't always easy.
They get complicated, messy.
Exactly.
That's why I don't want one.
Well, that's not true.
The reason that you left the ER to come talk to me
is because we have a relationship.
And we both benefit from it.
Lea's your friend.
You can't just wall yourself off from people
in the hope that you'll never get hurt.
We need to wall it off so he doesn't get hurt.
Stay calm, buddy.
Just relax your throat and breathe through your nose.
Clamp.
Got it. Cool!
Now bite down.
This is a surgical pouch.
It can't even be cut by a scalpel.
Come on, you can do it.
On the count of three.
One...
Two...
Three.
Inez! What? He was being a total wuss.
Callate la boca!
That was... amazing.
You want to create a plane between the outer serosa
and muscularis layer to avoid disrupting the lumen.
Everything go okay with the husband?
Yes. And, uh, I apologize.
I shouldn't have questioned your decision.
It's all good.
Two Fallopian lesions down, and one more to go.
You want to take the wheel on the next one?
Sure.
Figures.
Nurse Flores, do you have a problem
with Dr. Browne taking the lead?
No. I just find it interesting
that you only gave her the opportunity after she apologized.
You can scrub out.
No. I'll stay.
I'm not asking. I'm ordering. Scrub out.
No. I've done nothing wrong.
You're undermining my management of this procedure.
By answering a question you asked me?
By making snide comments questioning my judgment.
I'm not leaving my post,
so why don't we just get back to work?
You, me, and Andrews will be discussing this later.
I look forward to it.
Gonna need more saline now!
Hi, Daddy.
Have you eaten?
N-Not yet.
I'll get lunch after I finish this.
Lunch? It's almost 5:00.
Then dinner.
Look, I'll go now. I'm starving.
I'll be back in 30.
Hey, your erection's back.
She's not talking about me.
30-day suspended sentence and a $700 fine.
Take all these documents to Room 306.
Mr. Alex Leon.
No way, Your Honor. I've been waiting patiently.
We'll get to you.
When? At 4:59 so you can tell me you've run out of time
and make me come back to do this all over again?
Well, I guess we'll just have to see about that, won't we?
No, we won't. Take a seat, kid.
Your Honor, I am so sorry that my two-minute phone call
was such an incredible inconvenience,
but I went out of my way to be here today to have my case heard.
And that is exactly what I'm gonna do.
Now.
Can I have Dr. Lim's file, please?
Thank you.
And I promise this won't take long because,
as I started to explain...
Guilty.
$1,500 fine and license suspension for one year.
The bailiff will have some paperwork for you to sign on the way out.
You can't do that.
I have a thick book in my office that says I can.
No. This is America.
I pay taxes, which pay your salary, by the way.
- I wouldn't go there. - Oh, I am definitely going there.
I strongly advise you don't say another word.
You can appeal this verdict to a different judge.
I don't want a different judge.
I want this one to do her damn job!
We keep the TP up front.
Just give a yell if you need some.
Is it gonna die?
Just relax. Everything's under control.
That's not a "no."
We're gonna review your lab results and we'll be right back.
Excuse me.
We've already reviewed his labs.
There's no sign of a malignancy, sickle cell,
lymphoma, or leukemia.
I know. I just need a minute to think.
- I think we should... - No.
We're not calling Lim.
We got our asses chewed out last time,
and this is not life and death.
We can inject diluted phenylephrine
every five minutes for an hour.
That's a lot of injections in his penis.
I'll give him a lidocaine local.
Fine. A dorsal nerve block.
You guys are such wimps.
That much phenylephrine could also cause a hypertensive crisis.
Okay, Dr. No, what's your idea, then?
You already rejected it.
We are not calling Lim.
Are you awake?
Yes.
If a patient has reoccurring low-flow priapism
but there's no sign of sickle cell,
blood dyscrasia, or Hodgkins...
Why are you asking me? I'm a neurosurgeon.
My work is up here, not down there.
Because Morgan won't let me ask...
Dr. Glassman, why do you insist
on ignoring Dr. Ko's medical advice?
I'm not.
Really? She advised you to do consults from your ICU bed?
I didn't ask him to come in here.
Go to sleep.
What do you think I've been trying to do for the last 14 hours and...
What time is it?
8:17.
...47 minutes?
I would like some more morphine, please, and an Ambien.
You know you can't have either.
Well, then how the hell am I supposed to fall asleep?
Every time I turn, I strangle myself.
You nurses come in here every 30 minutes to steal my bodily fluids!
Have you tried easing yourself onto your side
and putting a pillow between your legs?
Of course, that's the problem.
I don't know how to use a pillow.
Try it.
And I will turn the light all the way off,
and Dr. Murphy will leave you alone.
Winter's procedure.
It's not the solution, but it'll buy you enough time to maybe find another one.
Thank you.
You're welcome.
Good night, Dr. Glassman.
Seems like for every lesion we excise, we find two more.
What time is it?
1:12 in the morning.
And my bladder is about to burst.
After I finish this one, I'm gonna take a break.
While I'm out, Park, you take over.
Start on the lesions I showed you on the bladder,
but be careful...
Her pressure's dropping.
She's bleeding out. I can't see anything. We're taking out the scope.
We're gonna have to open her up.
I've got two units on the rapid infuser.
MAP is still hovering at 60.
Moving as fast as I can.
Paint her with Chlorhexidine and don't make it a Picasso.
- It's a crash lap. - On it.
Knife.
Uh, the bleeding's under control.
What about her bladder?
There's infiltrating lesions all over it.
Even the walls are involved.
We're gonna have to remove it.
And give her a urostomy bag?
There has to be another option.
If I had another option, Nurse Flores, I would've suggested it.
What if we excise part of her bowel, reconstruct a bladder?
That's a lot more dangerous than...
Making a 28-year-old woman urinate through a hole
in her abdomen for the rest of her life?
I think the additional risk is worth it.
See if the husband agrees.
- Okay. I'll go. - No, Park will.
And while he does, I want everyone but J.L., Dr. Browne,
and Nurse Flores to clear the OR.
You, monitor the patient.
You two, we need to have a talk.
Do I have a choice?
Do you want to keep a fully functioning penis?
- Of course... - Then no.
That's even... Bigger than it was last time.
Winter's procedure requires an extra-large-gauge needle
to poke a hole big enough to restore blood flow.
We'll give you a lidocaine nerve block. You won't feel a thing.
W-Why wasn't I given that last time?
The risk wasn't worth it before.
Uh, trust me, it was worth it before, too.
Good choice. We'll be right back.
W... You said that we needed to do this right now!
We do. I just need to confer with my colleague for a moment.
You're talking to Lim behind my back?
No.
Don't lie. You're not good at it.
I saw you delete her text.
I knew Glassman didn't give you the Winter's idea.
The text wasn't from Dr. Lim. It was from Lea.
If it was from Lea, then why'd you delete it so fast?
Claire thinks I shouldn't push a good friend away,
but thinking about her...
I don't want to talk to her.
You shouldn't listen to them.
Either of them.
Lea and Claire are nice to you.
But... they're not your friends.
They want to take care of you, like a cute pet.
They take you seriously as a doctor but not as a man.
Lea kissed me.
After we sang karaoke.
Shaun, it was a pity kiss.
You've never even met Lea.
True.
But I know that she's not in middle school,
which means if she really thought of you as a man,
she wouldn't have settled for just one innocent peck.
I just...
What're you looking at?
Hey, Shaun.
What's going on? I thought I couldn't be released until I was arraigned.
The judge decided nine hours was enough punishment.
She's the one who should be punished. I should sue her.
What you should do is learn to keep your mouth shut.
You're lucky I'm hungry.
This stops now.
We need to work together.
We are.
That's how we came up with the idea to rebuild her bladder.
There's a way to offer your input without undermining my authority.
The only thing that undermines your authority
is your comments about Dr. Browne's supposed PMS.
- What? - I never said you had PMS.
I just asked Park if he knew
why you were more irritable than usual.
I'm not irritable, and I'm not a whiner!
I never said you were...
You told me to take it up with Andrews. This was your idea.
If anyone's a whiner, it's you.
That's enough.
You're 12 hours into an operation
you thought was gonna take one, so I think it's safe to say
you're all more irritable than usual.
But you need to get a grip.
Dr. Melendez, maybe it's time you took a little break.
Get an energy bar and some juice.
I don't need a...
Do it anyway.
And when he gets back, I expect everyone in this OR
to conduct themselves with the utmost professionalism.
Can I get two brisket tacos, please?
You know what? Actually, make it three.
Thank you.
You're out of order!
Hmm.
She's out of order!
This whole traffic court hearing is out of order!
Okay, very funny, smart-ass.
Actually, I gotta give you props.
You were right about the LIDAR calibration.
Hmm. If your phone hadn't rung, you might've gotten off.
Next time, I will turn my phone off.
Next time? You're done.
Case closed.
You're gonna start having to work on
upping your rideshare rating.
I'm obviously gonna appeal.
She was biased against me from the start.
I see it all the time... Women in power are worse than men.
No comment.
Order up. Brisket tacos.
Thanks.
Oh, thank you.
Want one?
I would love a beer. But I can't.
I'm on call for the next 17 hours.
You're still on call?
What would you have done if they needed you while you were locked up?
I would've had them phone my secondary coverage.
I didn't see the point in waking another doctor.
Or publicizing your predicament.
I'm competing for a promotion,
and I didn't feel the need to tell my boss I was locked up
unless I absolutely had to.
No harm, no foul.
Husband consented.
We're good to go whenever you are.
Scrub back in. I'll be right there.
Oh, I'm gonna kill them.
- Oh, God. - Oh.
- Sorry. - It's okay.
What?
We had a patient come in this morning with low-flow priapism.
We thought it was drug-induced,
but then I noticed a foot drop...
Cut to the chase.
We found an epidural abscess with pelvic extension and...
Get him prepped. I'll be there in 15.
What?
- I gotta go. - No.
Is someone dying?
Not if I can get there in time.
Oh, um, can you give me a ride?
Irrigate with diluted bacitracin.
Morgan, irrigation.
Sorry. It's been a long day.
And you only have another nine and a half hours to go.
Only 9 hours, 21 minutes.
Browne's right. This flextime schedule is absurd.
Yeah, it has its drawbacks.
But if this penis had been passed on to the next shift,
they would've assumed you missed something,
and they would've done a whole new work-up.
The delay could've paralyzed him.
Or maybe they wouldn't be so tired
and would've noticed the foot drop faster.
You guys are doing fine.
And you'll get used to the fatigue.
After a while, it won't even bother you.
That's easy for you to say.
You were on home-call chilling on your couch all day.
Good point.
Orthotopic neobladder is in place.
Let's make sure it drains properly before we move on.
Flow looks good.
Hold on, push it back again.
What's that? At the base of the uterus?
It looks dusky.
Can I get some more dye?
It's a polyploid mass.
It extends from the uterine to the ovarian artery.
All collateral blood supplies have been invaded.
We're gonna have to do a full hysterectomy.
What if we resect the mass
and graft a saphenous vein for bypass?
Risk of graft occlusion is too high. She'd go septic.
The last thing she told us was her lifelong dream was to be a mother.
It's an innovative idea. But...
It's not our decision.
I'll scrub out and talk to the husband.
No, I'll do it.
No, I... I... I can't make that decision for my wife.
Yes, you can.
You've already done it once.
This is different.
But this is what Gina wants.
I... I... It's why she made you her proxy.
No. I'm... I'm her proxy because she didn't think
she should ask her mother and sisters
to fly from Maine for a minor surgery.
Look, you have to call them.
No, Gina chose you.
You are the one who knows her, who truly understands her.
What would she want us to do?
I don't... I don't know.
I mean, how... How can any man...
Please, just tell me what to do.
I met her yesterday. I barely know her.
So you can be objective. You... You can make the right call.
No, Gina didn't choose someone to be objective.
- She chose you. - Please, just tell me what to do.
- I can't. - You have to! Because I won't.
I can't do that to her.
Please. Just... Just help me.
Whatever you say, that's... That's what I'll do.
Whatever you say.
Do you feel sorry for me?
Why would I?
Morgan says Lea is only nice to me
because she feels sorry for me.
Does Morgan have a theory for why Morgan is so nice to you?
I'm being honest, which is better than nice.
Cut this fibrinous tissue.
Bipolar.
Some women put a guy in the friend zone
and they end up treating him more like a pet than a person.
Morgan has a point. Some women do that.
But the only way to find out if Lea does that is to talk to her.
The wound is clean.
No more macroscopic signs of infection.
Any spinal nerve damage?
Won't be able to tell until he wakes up.
What'd he decide?
He didn't.
He refused to make a decision.
He, um, insisted that I do it for him.
She really wants to be a mom,
- so I think that we should try to... - No.
He chose me to make the decision.
Her life matters more than a dream.
Do a full hysterectomy.
You're right.
Let's go.
She's already been under for 22 hours
and we got a lot more work to do.
Metz and a forcep.
DR. MELENDEZ E uterosacral ligament.
Large pan.
Time?
4:10. She's been under 26 hours, 10 minutes.
All right, let's close her up so we can wake her up.
I'll go tell the husband.
No. I'll do it.
Dr. Browne, you take lead on the close.
Wiggle your toes.
All 10 are going to market.
You're gonna be fine.
And, uh, w-what about my...
He'll be fine, too.
Thank you.
Oh, don't thank me.
Those two are the ones who saved you.
All on their own...
Almost.
What happened?
The endometrial lesions were much more invasive
than we saw on the imaging.
In order to remove them all, we needed to reconstruct
a new bladder out of a section of your intestine.
And we had to remove your uterus.
Honey, I am so sorry.
It's gonna be okay.
I love you so much.
I love you, too.
Now that we've handled the surgical crisis,
it's time we deal with the unprofessional behavior.
The only question I have is, who exactly is to blame?
It was a 27-hour surgery.
There were some tense moments.
But I was very pleased with how everyone
ultimately worked together as a team.
I was especially impressed with how Dr. Browne
aggressively stood her ground and insisted
that I respect the husband's final decisions
regarding his wife's hysterectomy.
Is there anything the two of you would like to share?
No. I'm good.
Well, I'd like to say...
I was very impressed with Dr. Melendez's openness
to hearing input from all of the surgical team.
It's definitely something all of us
on the nursing staff appreciate.
Very good.
Go home, get some rest.
You're here.
Yeah, I am.
I shouldn't have told you to go away.
It wasn't very nice and you've always been nice to me.
You've been a good friend.
If you want to talk, I will listen.
You're right. I have been a good friend.
Actually, I've been an awesome friend,
but you have been a total jerk!
You are so worried about me hurting you?
What about how you hurt me?
What? You think you're the only one who has feelings?
You think you're the only one who needs someone
who doesn't judge them, doesn't make them feel totally alone,
like there's not one person in the world
who actually gives a damn about them?
Okay. I'm sorry.
No, you're not!
You're... You're just uncomfortable
and you're trying to get me to shut up.
Which, don't worry, I will.
Just as soon as I finish telling you
that friendship is a two-way street, Shaun!
A two-way street, you jackass!
Guess I was wrong.
She does think of you like a real man.
Are you awake?
Hi, Daddy.
Maddie?
How are you feeling?
It's so good to see you.
You're dead.
Don't you think I know that?
Am I dead?
No, dummy. You're just tired.
Synced & corrected by -robtor- www.addic7ed.com