18x02 - Some Kind of Tomorrow
Posted: 10/08/21 07:23
Homeostasis is our body's way
of maintaining a consistent
and steady internal state.
Nick?
Hi.
Hi.
Yes, sorry.
This is a very old-fashioned way
to ask a girl on a date.
I know. I know. I'm sorry.
I-I forgot to ask for your phone number,
and then I-I didn't want to wake you.
So... note.
So, what do you think...
Should we get some dinner?
I know a place that's great.
It's, uh, right by the lake.
Yes.
Okay.
I'll pick you up at : .
Okay.
Okay.
Okay.
- I'll see you at : .
- Okay.
Multiple systems work in sync
to regulate factors like
temperature, blood pressure,
even sodium levels.
Okay. I'm not going to tell you
how to parent your son,
but this not going in Luna's bag.
These systems are designed
to resist and combat
anything that tries
to throw our bodies off.
It's a continual loop
with checks and balances.
So, what time did you tell them?
Ahh. Should be any minute now.
Feels like the old days.
Finally.
Until something manages
to break the cycle.
Hi-e-e-e!
How are you so awake?
Kombucha, girl.
Remind me why
we signed up to do this again?
To save lives.
Overrated.
Hey, Ortiz, where's your mom?
She transferred her residency
to take a job with Dr. Avery
and the foundation.
Good for her. Better for us.
More cases.
There's no statistical evidence
that proves residents learn
better at the crack of dawn.
I checked. I think we need
to stage a sleep-in.
Who's with me?
You finished?
Big day. And a long one.
Hope you ate breakfast.
We didn't.
Meet me in the skills lab, four minutes.
He said four minutes. It's
at least an eight-minute walk.
I'm with cardio today.
They requested me.
But have fun going back to day one.
Thanks for coming on such short notice.
Well, I went down two wrong hallways,
which feels like a metaphor for my life.
But when somebody offers
to pick you up in their private
jet, you get on that jet.
Meanwhile, Scout has decided
it is no longer cool
to sleep through the night,
so I looked like crap
when I dropped him off to Link,
who has mastered quiet disappointment.
But somehow looks so good doing it.
I think you look great.
Wait. Are you kidding?
They're giving you a lab?
Oh, you are definitely
not coming back to Seattle.
By the way, who actually
sent the private jet...
Amelia.
We're being offered millions
of dollars to cure Parkinson's.
Us?
Well, me. But I'm asking you,
so it's us.
Synced & corrected by -robtor-
www.addic ed.com
Leo says that Elsa needs a cape,
but he shoved it
in the dishwasher last night.
- Wasn't great.
- Well, even Snow Queens
need to learn that actions
- have consequences.
- Thanks.
So, is it, um, costume day or something?
No. Leo's world. We just live in it.
Oh.
Oh. Incoming trauma.
- Okay. I gotta go.
- Okay.
- Teddy.
- Yeah.
Allison, Elsa. I love you.
Bye. Bye. Bye.
Bye.
I'm sorry. Do you have a problem?
'Cause you're staring at my kid.
Oh, uh, I'm staring at his costume.
No, I-I know, and I would
really appreciate if...
Oh, my wife and I have been
looking for that same one
everywhere.
Oh. Oh, yeah.
- I-I'll... I'll ask my husband.
- Mm.
Oh, uh, here.
- Thanks.
- Yeah.
Hey. Hi.
We're gonna get you a new cape, okay?
Luna, it's important work, okay?
Just stop being so cute for seconds.
Stop. Stop.
I remember when Scout used to
cry when I dropped him off.
Now look at him.
Basically ready
for his first studio apartment.
Ow!
Okay. Um, I'm on scut all day,
so can you just, like, hop up here
and check on her every minutes?
Nope. Webber roped me
into a thing with the residents.
Luna's like a -second
elevator ride away,
if you need to see her.
Plus, they text you pictures.
Go.
- Go!
- Ugh.
Rashida Flowers, ,
chronic kidney disease
secondary to diabetes,
admitted for dialysis access insertion
after a thrombosed AV fistula.
After two failed grafts,
I'm back in the hospital, y'all.
Have to have another procedure.
But guess what?
My new doctor is a brother.
Mm! And he fly.
Say hi, Dr. Ndugu!
Hey. Do you mind not recording
so I can examine you?
Oh, right, of course.
Gotta go, y'all. Kisses.
Sorry. Gotta keep my followers happy.
I used to be a travel influencer,
ventured around the world,
but now I'm DiabeticBae,
which is way less exciting, so
I gotta get content where I can.
Well, today won't be
too exciting, I'm afraid.
I'll be inserting a catheter
into your chest
to help you start dialysis.
How long have you been diabetic?
Years now. But I was able to manage it
until I was visiting Thailand,
living my best life,
and I got real sick.
Hit my kidneys hard.
And every time my doctors tried
to get access for dialysis,
my body wouldn't cooperate
because... plot twist...
I have a clotting disorder.
But none of this was a shock.
Both my mother and brother
were diabetic,
and they both died from kidney failure.
Sorry to hear that.
Were they able
to get kidney transplants?
They weren't even able
to get on the list.
And neither am I.
You're not on the transplant list?
Nope.
Ortiz, set me up a consult
with Rashida's nephrologist, Dr. Krause.
Look, I know it's bad.
But it's okay.
That's really why I record everything.
I want the world to know who I am
before this disease... ends me.
Hey. Where's my resident?
I'm not their keeper.
- What do we got?
- Noah Young, ,
auto vs. Tree, restrained driver,
denies loss of consciousness,
O sats %,
- no visible chest trauma.
- Okay.
My son! I need to find my son!
Okay. We got Danny Young, , GCS ,
vital signs stable,
bleeding facial laceration.
- Daddy!
- There's my big guy!
I need to see my son, please!
Okay. Let's get you
both inside first, okay?
I'm fine! I just need to...
Trauma one, let's get a chest
X-ray and a full trauma panel.
Let's move! Somebody find me a resident!
Becoming a skilled surgeon
is like learning how to drive.
The more you do it,
the better you become.
And over the last year,
you have participated
in fewer surgeries than any
class of surgeon ever has.
Which means that you are not
where you're supposed to be, people.
We woke up early to be shamed.
Today, you will embark
on the toughest surgical workout
you have ever experienced.
Through a series of simulations
and skill assessments,
each of you will be evaluated
in four areas...
Laparoscopic,
suturing, vascular skills,
and endoscopic techniques.
You will be graded
on your proficiency and speed,
judged by your attendings.
Any questions?
It's like the surgical Olympics.
Or the Hunger Games.
I thought Dr. Grey was running
the residency program now.
Who do you think taught Dr. Grey?
Oh, and one more thing.
The resident with the highest score
flies solo in the OR this afternoon
with a surgery that's
appropriate to their level.
Laparoscopic skills start... now.
Ah!
- Relax your wrist for me.
- You know, back in my day,
every neurosurgeon I worked with
was an egotistical prick.
So you can imagine my delight right now.
You are brilliant
and charming, Dr. Shepherd.
Oh, except when I'm being
an egotistical prick.
Well,
as my friend Stephen Sondheim said,
"Nice is different than good."
You're friends with Stephen Sondheim?
Oh, I could be.
Okay. Follow my movements.
So, Dr. Shepherd, what's your
golden opinion? How do I look?
Well, you only have
a mild resting tremor
and slight bradykinesia, which is good,
but Parkinson's is unpredictable.
Your dopaminergic neurons
are degenerating gradually,
and it's only a matter of time.
Have you considered switching your meds
or deep-brain stimulation?
You know,
I'm not interested in a Band-Aid.
I need something
that'll make me whole again.
Dr. Hamilton,
Parkinson's is not a condition
that surgery can fix.
Yet. A condition
that surgery can't fix yet.
Enter brilliant, charming,
egotistical you.
As long as we can convince
your sister-in-law over here.
Chest pain, no.
Open fracture, too specialized.
Oh, right upper quadrant pain...
Now, that's promising.
Dr. Bailey.
Wong.
Uh, Richard's holding
the surgical Olympics.
It's a slow day, so I'm looking
for something good
to be the solo. You got anything?
Dr. Bailey, you've rescheduled
our meeting twice now.
- You're avoiding me.
- No...
I had surgeries. Uh, important ones.
He's also looking for judges,
so if you'd prefer
to help out that way...
No, I'm here to tender my resignation,
which I've been trying to do
- for days now.
- I know.
I just didn't want you to.
Chief, I'm retiring.
I already bought a condo,
picked out tile.
Okay, what could you possibly
want to do instead of surgery?
Mystery novels.
- I'm sorry?
- I have a series of books
where the main character is a PI
and a surgeon.
"Doc Undercover."
Uh, sounds... n-nice.
Wong, look, the hospital,
t-the country...
We're in dire need
of physicians with yo...
Miranda.
Truthfully? It's just not fun anymore.
I'll start your paperwork.
Perfect suturing ensures
proper wound closure,
less bleeding,
and a lower risk of infection.
Excellence matters.
This is an atraumatic tie.
You will have seconds
to tie three square knots.
Do not move the soda can.
Any movement counts against you.
And absolutely no air knots.
On your mark, set...
Go!
Kinda sloppy, Tseng.
- Huh.
- What's that supposed to mean?
It means, "Huh."
- Is that better?
- Nope.
I'd start over if I were you.
Opening with a compliment is customary.
Time's up!
Lincoln, do we have a winner?
- Schmitt takes the gold.
- Yes!
Is there a silver?
Name that tune.
I don't know.
Um, how long did you say
that you have been experiencing
abdominal pain for?
- Uh, a few days.
- Okay.
Whistling calms my nerves
when someone's, you know,
inspecting my hooha.
Ow.
Sorry, but I-I feel something.
It was "Twinkle, Twinkle, Little Star."
- What?
- The song I was whistling.
"Twinkle, Twinkle"?
- Oh.
- Technically, it's the same melody
as the ABCs.
And "Baa Baa Black Sheep."
Ah. Who knew.
Okay, I...
Yep, there's something in here...
I...
Robin, there was a strawberry
lodged in your...
Ohhhh.
Yep. That tracks.
So would that explain my abdominal pain?
Um, it shouldn't.
Why? Is there something...
strange in there, too?
Maybe?
Danny.
How you feeling?
Looks like you had quite the adventure.
Yeah.
Got to ride in an ambulance.
And now you have superhero marks.
Do they come with powers?
Maybe, if you eat enough
cherry Jell-O and Popsicles.
Owen's sister, right?
Oh, uh, yeah. You're peds?
- Cormac Hayes.
- Oh.
You coming to join our humble staff?
Bailey just asked me to help out,
cover some of Grey's cases.
Grey? Big shoes to fill.
Eh. So she performed
an abdominal-wall transplant.
Big whoop. It was actually my idea
to even need
an entirely new abdominal wall
so Grey could win the Fox award,
so, who's the genius now?
- So you were the patient?
- Yep.
Alright, Danny, I'll be back
to check on you, okay?
Where's my dad?
Can I please go sit with him?
He shouldn't be alone out there.
We have contacted your wife,
and she is on her way, okay?
It was supposed to be
a father-and-son weekend.
Fishing, camping out by Deception Bay.
I don't know what happened.
Maybe you passed out.
Your oxygen levels are very low.
How long have you had
shortness of breath?
It... It's nothing.
Okay, let's do an X-ray, please?
- No! No X-ray!
- Hey.
Look, I'm fine.
Relieved that me and Danny are alive.
Could you please let me out of here
so I can try to salvage this weeken...
I, uh... I saw your tattoo.
Bassett Infantry?
- rd generation, Bassett Infantry.
- Mm.
You?
Army trauma surgeon, two tours Iraq.
Two tours Afghanistan,
one Jordan, one Djibouti, two Iraq.
And I've never been to Vancouver.
Well, sounds like
you need a new travel agent.
Let's put him on high-flow O .
Let's push of fentanyl,
and somebody page Altman!
We're gonna get him up to CT!
Okay?
Okay.
Dr. Krause, hi.
Winston Ndugu, cardiothoracic surgery.
- Do you have a minute?
- Barely.
I've been drowning in cases.
My patients put off
seeing me for months,
and now I'm dealing with the backlog.
- What can I do for you?
- Yeah, I'm consulting
on your patient Rashida Flowers.
She mentioned that she's not
on the transplant list.
Yeah. Rashida, she's been through a lot.
Unfortunately, she doesn't fit
the transplant criteria.
But Rashida's renal function tests
seem to make her a prime candidate.
Well, you would think,
but Rashida's eGFR is high.
It's over , disqualifying her
from the list.
- Estimated.
- I'm sorry?
It's an estimated number of what
her kidney function should be,
- not what it really is.
- Dr. Ndugu,
the eGFR is the standard
clinical formula,
used in the field for the past years.
It's what we use to determine
care and qualification
of kidney transplant.
A transplant could save her
from having to need dialysis
in the first place, which we both know
has high mortality rates,
especially in the first three months.
I'm aware, but Rashida
just doesn't qualify.
And believe me, I hate that,
at least as much as you do.
So, what if we fail?
How do we know you'll even survive it?
I think we can both agree
that you learn more
in the attempt than the outcome.
And I am under no delusion
about how risky it is.
But what's life without risk?
Meredith?
Meredith.
Is this that robot arm
that does cell culture?
It is. And please don't touch it.
Dr. Grey, Dr. Shepherd,
please meet Dr. Kai Bartley,
a neuroscientist who accepted
an offer they couldn't refuse.
It's great to meet you.
I've been reading
your stem cell research.
Which is brilliant.
I've been following it for years.
Um, they were at Hopkins
a couple years behind me.
Um, o-okay. When you inject
the cells into the brain,
what about the risk of the cells
developing tumors?
That very question stalled
my research for two years.
But once I teamed up with David...
Once they took my funding.
I uncovered a Chinese herbal compound
that completely removes
the undifferentiated cells.
That's amazing. They're amazing.
Excuse me, I have a conference call.
But we'll talk more later?
- Great to meet you.
- Thank you, Dr. Bartley.
Thank you, David.
So?
What do you...
Yes. All the yeses.
An opportunity to impact
Parkinson's, change the world,
with this equipment and this team?
I am... I'm in.
Dr. Grey?
Just say yes.
Hey.
Should we shelve the Elsa costume?
- What?
- You know, put Leo in more...
T-shirts and jeans?
Just, is that the right parenting move?
Did something happen? No, I just...
You know, none
of the other kids at daycare
are wearing costumes, so I just...
What do we got?
MVC with no visible trauma.
A young vet
who did several tours in Iraq.
He has finger clubbing,
cyanosis, dyspnea.
He coughed up blood
when he was downstairs.
His chest X-ray does not look good.
And I'm thinking it's some kind
of respiratory illness.
Are you sure nothing happened?
Oh, my God. Owen...
His lungs look like a w*r zone.
Is Pierce taking a job in Boston?
Is that why you paged me?
Because if I lose one more surgeon...
No, her dad is having hip surgery.
Oh.
Well, now I feel badly.
Uh, Chief, I have a patient, ,
Black woman with chronic kidney
disease from diabetes.
She hasn't been able to get on dialysis
due to a clotting disorder.
A candidate for transplant?
Well, her eGFR is too high,
according to her nephrologist.
But look.
Here's another patient
on the transplant list.
Almost the same age, weight, and
health profile to my patient.
The only real differentiating
factor is that they're white.
So their eGFR measures lower,
making them
better transplant candidates.
When the estimated GFR was developed,
it was assumed that Black people
have higher muscle mass.
It added a multiplier
to account for that assumption,
which then increases
a Black patient's GFR
and registers them
as having less severe disease
than other people.
Making them ineligible for transplants.
How does this even happen?
Stems from a long line
of "assumptions" about Black people
that have snaked their way
into medicine...
You know, that we have
a higher tolerance for pain...
...different bone density,
lower lung capacity.
And yet these assumptions still
exist in clinical formulas.
I-I never even stopped to think
about the eGFR.
Is there any way around it, Chief?
Uh, can I write an appeal
to the transplant board?
That only works
if the patient qualifies
for medically urgent status.
Rashida might not have
that kind of time.
There's a lot of Rashidas, though.
Fight for them, too.
The IR suite is ready for us.
Sergeant Young,
this is Dr. Teddy Altman.
Major Teddy Altman.
- Where's Danny?
- He's with Dr. Hayes.
He's fine, but we need to do
a head CT just to be sure.
Your scans reveal severe
scarring in both your lungs.
We'd like to admit you and...
I have pulmonary fibrosis.
Mystery solved.
That's why I didn't want
any work-ups, no treatments.
I know what I have,
and I know there's no cure.
Just a crap-ton of different
ways to the poor house.
When were you diagnosed, Sergeant?
About a year ago.
I started coughing
after the second Iraq tour.
I couldn't shake it.
I started hearing from buddies
about the burn pits,
how they were linked
to all these cancers
and mystery illnesses.
The VA's gotta cover these conditions.
Barely.
They just started covering
stuff like asthma.
But I haven't heard of a single vet
who's been covered
for conditions like mine.
All kinds of ways to twist it
so you can't prove
it was service-related.
Cherry on top? I lost my job
at the seafood plant
'cause I was too weak
to finish my shift.
So I got no insurance, no job,
and a stack of medical bills.
- Sergeant, look...
- Please, just call me Noah.
Noah, would you sit down
with one of our pulmonologists?
We'll redo your workup, and we
will get you in for some tests
so that we can start some treatments...
Pass. No tests, no treatments.
Nothing against you guys,
but whatever time I have left,
I'd like to spend it with my son.
- Move. That's four.
- I know, I know, I know!
Pop these balloons, Tseng! Come on!
If you lose to a second-year,
you're cleaning the bathroom
for six months!
- Get away from me!
- Endoscopic proficiency
is just as important as speed.
One slip could mean
you've perforated a colon.
seconds!
- Yes, yes, yes!
- One more.
What category are they on?
- Endoscopy.
- Mm.
It's a trash fire.
- Mnh-mnh.
- You're a resident now.
Sleep when you can, eat when you can.
Nah, I'm on the scut diet.
Rectal exams?
Vaginas.
Right. Pink.
The scrubs!
I found a strawberry in my patient.
Back in med school,
I found a yam. bucks on Tseng.
- Okay, I'll take Helm.
- Come on, come on, come on!
- Go, go!
- Taryn, it's right there,
it's right there, it's right there!
Go, go, go! Come on, come on, come on!
Go, go.
- Done!
- Finished, finished. Me.
It's Tseng.
Today's winner of the competition...
Schmitt, you will be flying solo today.
I won. I won, I won!
I won! Oh!
Of course he won.
There was no actual blood.
Oh, come on! Wait, wait.
What's the... What's the...
What's the surgery?
- Find anything good?
- Wilson did.
Ex-lap on foreign-body extraction.
Yes! Oww!
Get it, get it!
Oww!
Yes!
I love you!
Hmm, let's think.
Deep pockets, unlimited time, space,
Kai Bartley's groundbreaking research,
and a chance at curing
a neurodegenerative disease.
You're forgetting about the part
where we have kids who need stability.
And I have a job that I love
that I just got back to.
I don't want to abandon them.
We're not abandoning anyone.
We're revolutionizing medicine,
and that's a great example
to set for our kids.
And Grey-Sloan, they're gonna be proud
to have us be part
of something so high-profile.
Exactly. If this surgery works,
it's huge.
If it doesn't, we've k*lled
an incredible surgeon
and set the research back years.
Give us more credit than that, Meredith.
You asked me here for my opinion.
I'm saying yes.
Because people with Parkinson's
need more than just hope.
Is this her last possible
access port for dialysis?
It is. We need to pull
back the catheter just a bit.
What about transhepatic
or translumbar access?
It'd be too dangerous,
given her clotting disorder.
Fluoro. This isn't
how medicine should work.
Anybody who needs life-saving
care should get it.
Heparinized saline.
What if this port clots off
and she loses it?
You tell me.
Waste will build up
in her blood, leading to uremia,
and her organs will start to
shut down, one after the other.
Secure the catheter with
stitches on the wings and shaft.
Get a chest X-ray.
Where are you going?
To get her a kidney.
You don't need to escort me
off the premises.
That's not what I'm doing.
Go home to your baby.
I just wanted to make sure that
I'm not being completely ridiculous
for even entertaining this.
No, you're being ridiculous
because you haven't
accepted the offer yet.
I mean, we're talking about
curing Parkinson's, Meredith.
Parkinson's. I mean,
what is the matter with you?
This... This famous surgeon is
basically throwing money at us
to play with the most innovative
equipment in the world.
And not only that, he wants
to give us his diseased brain
as a testing ground!
I mean, when you started your career,
you wanted to go into neuro.
This is your chance to get back to that.
I mean, maybe this is what
you're supposed to do.
What we're supposed to do.
And I-I... I cannot,
for the life of me, understand
why you would walk away
from something like this. I...
So don't.
I will see you at home.
I inserted Rashida's access point.
Great. Thanks.
Rashida needs to be
on the transplant list.
We found six cases of patients
with similar clinical profiles,
who are on the list.
The only major difference is
that these patients are white.
Are those cases patients of mine?
A few.
There's got to be more to it
than that. The patients' eGFR...
Yeah, their eGFR is lower,
which makes them eligible,
but that's only because
the formula unjustifiably
uses race as a factor.
Dr. Krause, we all know
race doesn't play a role
in kidney function.
- Dr. Ndugu...
- I know, you're busy,
but if you look at Rashida's eGFR
without accounting for her race,
she falls below the criterion of .
I don't understand. The eGFR
is the field's standard.
It's a tried and true formula.
Yes. And it's time we start
questioning our standards.
Look, I have clinic right now,
but I'll look into it.
Rashida doesn't have other
options for a dialysis port
- if this one fails.
- I hear you.
I'll look into it, Dr. Ndugu. Thank you.
Robin Jeter, , abdominal pain.
X-ray shows a lodged crystal
causing intestinal obstruction.
I think you mean to say
intestinal stone.
- No, I don't.
- No, she didn't.
It's a yoni egg.
- Amethyst, specifically.
- Uh...
It's... It's... It's a crystal egg
that is typically inserted
into the vagin...
- Got it.
- Huh?
Uh, I was doing a ritual
I saw on social media
that was supposed to bring love
and healing into your life.
But, um, I was doing it so fast,
I mixed it all up.
I was supposed to eat the strawberry
and insert the yoni egg.
What did you do with the strawberry?
Oh. Uh, I-I see. Um.
Oh! Right. I'm up.
Hello, Robin. I'm Dr. Schmitt.
I'll be doing your surgery
today, uh, to remove,
uh, the...
The... Yoni egg.
Mm-hmm.
How old is he?
Yeah, these symptoms sound familiar.
I have treated dozens of
soldiers exposed to burn pits.
What are burn pits?
Electronics, plastics,
soiled uniforms, human waste.
Douse it all with some jet fuel,
light it with a match,
then fwoosh... I mean,
what could possibly go wrong?
I mean, some of these men have illnesses
that we haven't even named yet.
Others are in pain / .
They get nowhere with the VA.
The guy did six tours of service.
To protect us.
Never questioning, never complaining.
He just answered the call,
and we need to do the same for him.
Tomorrow, I'm gonna go down to the VA.
I'm gonna demand answers.
Okay, so after you defeat
the US military,
maybe grab some lunch,
and then take on Putin?
- How's his kid?
- Danny's gonna be fine.
Head CT was clear. He can be
discharged later today.
Maybe Avery can help Noah
through the foundation.
He'll be dead before we even
line up the votes on the board.
We can't save Noah.
He just needs immediate medical
care just to be comfortable.
And we can give him that. We'll
figure out the details later.
Look at you two,
breaking rules and saving lives.
Aren't you glad
I got you to tie that knot?
- What happened?
- Her sats dropped,
and her face and neck keep
swelling more and more.
Superior vena cava syndrome.
The catheter must have blocked
her SVC entirely.
- I'm taking it out.
- Can we take her back to the IR suite
- and reposition it?
- No.
How else would she get dialysis?
- She wouldn't.
- Dr. Ndugu...
She's already clotted off
multiple access points.
Who's to say it wouldn't happen again?
Page Dr. Krause!
It's fine. Everyone's watching.
That's what happens.
People watch, you screw up,
and then you quit and
go find a rock to hide under.
You ready?
Scalpel.
- Nice extraction, Schmitt.
- Thank you.
- chromic, please.
Doppler.
Relax, Schmitt.
If you're calm, everyone else is calm.
Oh, this can't happen.
Come on, come on,
come on, come on. Think.
You can do this. Think.
I'm turning the speaker on.
Help him out, people.
Are you getting a good signal
from the adjacent segments?
Yes, both sides.
Resect that segment. Do a hand-sewn...
End to end anastomosis.
Uh, stapler.
To close, start bringing
the bowel together
with a vicryl suture,
coming around the corner
- with a Connell stitch and...
- And a millimeter gap
between every two sutures.
Got it.
Suction, Taryn...
Dr. Helm.
What happened?
There was a complication
from the catheter,
- so I had to remove it.
- So you'll reinsert it?
I won't. And because we couldn't
gain access for dialysis,
Rashida needs to be placed on
the transplant list immediately.
Rashida's been my patient for months.
These aren't your decisions to make.
Except that now she's also my patient.
And she has suffered from
multiple unnecessary procedures,
so I'm not putting her through
even more.
This is not protocol.
It's not. It's a life.
Rashida's.
Even if we list her,
we don't know
when a kidney will come through.
It'll come faster than if we didn't.
Oh, Hayes, uh, I'm looking
for Danny and Noah.
Uh, they left.
What do you mean they left?
I didn't discharge Noah.
No, but I discharged his son,
and he said he wanted
to go home with him.
So you just let him go?
Without asking me?
He said he declined all further testing,
and then he signed an AMA.
He has severe fibrosis in both lungs.
He needs supplementary oxygen,
a full pulmonary workup,
an evaluation by a specialist,
and we're gonna need to do
more studies, okay,
- if we're gonna...
- Hunt, he's terminal.
You know that, I know that,
Noah knows that, and he's accepted that.
Hayes, just...
Which is very difficult to do
when you've got a little one at home.
Believe me.
All those things you want to do
for him, they take time.
They take energy.
They're two things Noah wants
to give his son right now
while he still can.
Look, I'm sorry I didn't ask you,
but I'm not sorry I let him go.
You look amazing.
But, yeah, you may want to change.
Sorry.
It's okay.
Listen. You hear that?
- What?
- Exactly.
I mean, this right here, this is
why I pulled back on my hours.
I was... I was ignoring
everything around me.
You know?
The perfect silence,
the -mile hike through
the woods behind my house,
just sitting here, sitting,
staring up at the stars.
I don't stargaze much.
I'm sorry, since when?
Since ever.
Ooh, we're gonna have so much fun.
I've got so much to teach you.
Hey, tell me about
this, um, top-secret project.
Well, If I told you,
it wouldn't be top-secret.
Fine. Tell me one thing.
You really struggle
with the concept of secrets.
I guess I do.
I'm scared to say yes.
Hm.
And I am very rarely scared.
What are you scared of?
Failure.
This project will cost
millions of dollars,
will be very risky,
win or lose, will eventually
be written about.
And I'm just not sure
that I want the first thing
that I do after surviving COVID
to be a public failure.
And I know that's my ego.
I have a very comfortable
situation in Seattle.
I have safety. I have comfort.
And now you're gonna
trade all of that in.
You're gonna risk it all.
Listen, you're not
a safety person, Meredith.
You're not a comfort person.
- It's not your nature.
- How do you know?
Because it's not mine, either.
And it takes one to know one.
You're gonna risk it all,
and win or lose...
it's gonna be a hell of a ride.
I'm really sorry to say this, Rashida.
We couldn't gain access
for your dialysis.
But... you're on
the transplant list, Rashida.
Wait, what?
Are you serious?
Yeah.
Wow.
I honestly never thought
I would see this day.
You're not just saving my life.
You're changing it.
I can go back to who I was.
I don't know how to thank you.
I can't wait to tell everyone.
Oh, and, Dr. Ndugu,
when my followers find out
how you helped me...
Are you single?
I'm not.
I'm actually married to
another cardiothoracic surgeon
at this hospital... Dr. Pierce.
And she fly.
- What?
- Mm-hmm.
A cute doctor couple?
- Mm-hmm.
- Okay!
I gotta meet her ASAP.
Ooh, have you guys ever thought
about becoming influencers?
The brands would come flocking.
Influencers? For what? Health?
Yeah, I mean, there are
influencers for everything.
Okay, movies, restaurants, plants.
There are dog influencers, too.
Mm-hmm. Biggie the Pug
has million followers.
Ha! Come on. Okay. We gotta go live.
Hey!
- Hey.
- Ah!
I haven't seen them this happy
in months.
Helm's more thrilled than Schmitt.
He let her keep the crystal.
And you seem to be
the happiest of them all.
Feels good to be back, in front of them.
Well, Dr. Wong gave me
his retirement notice today.
Dr. Wong?
He used to be a student of mine.
Is something wrong?
Healthy as a horse.
And it's getting worse, Richard.
Every day, someone retires or
quits or moves to Minnesota...
We don't know if that's happening.
Whether it's burnout or exhaustion
or just needing a change,
these residents aren't the only
ones that need to reset.
This whole hospital needs
to remember why we're here.
COVID took that from us.
You know, remember when we
used to have, like, pizza night
and retreats, and... and
residents would prank each other
and... You hated that.
But there was joy
and the feeling that we were
all in this together,
for something bigger than ourselves.
I want to make room for that.
I want to make space for that again.
You want people to remember the why.
So do I.
I got some ideas, Bailey.
Big ones.
Okay, you need to stop
with the depressing lullabies.
Put him to sleep.
Link, I-I know that you are upset
and sad and grieving
the future you thought you had.
Obviously, I have been there.
And what did you do?
I looked for joy anywhere that I could.
Then along came OB...
and Luna.
I know that it sucks right now,
but you're gonna be okay.
Something did happen earlier with Leo.
I-I-I thought a parent was being
judgy about his Elsa costume,
so I-I confronted him. Who was it?
No, no one. He wasn't being judgy.
I'm just... Owen, I'm worried.
I...
I-I want Leo to be okay in the world,
and I'm... I'm...
I'm worried, what if we...
What if we let him be himself?
I'm worried that
the world won't be kind.
I'm worried that it will be hard.
I'm worried that people will be cruel.
And maybe they will be.
But we won't be.
Leo's happy. Let's...
Let's just let him be happy, okay?
Okay.
- Mommy!
- Oh, there he is.
- Hey!
- Hey!
Hey. How are you?
Look what I got.
- Whoa.
- A new cape for Elsa,
the Snow Queen.
You like it?
Yeah.
I love it.
Hi!
- You got her?
- Yeah.
I'll take him. Hi!
Hi!
- Let's go home.
- Okay.
- How was your day?
- Ah.
There is such a thing
as predictive homeostasis.
Late night.
You don't own me.
Mm, I know.
I need autonomy picking the team.
Absolutely.
I'd like any progress
that we make from this process
to be public and accessible
to everyone with Parkinson's.
Of course.
It's when our body anticipates
responses to future challenges.
I'd like to move
the whole project to Grey-Sloan.
Mnh. That I can't do.
It's... It's expensive.
Frankly, I don't have the time.
We have everything we need here.
I can't move to Minnesota.
I need you here as much as possible.
I could set up a satellite lab
in Seattle.
I could travel back and forth
once a week.
That's the best I can offer.
Done.
It understands
that change is inevitable...
Does this mean you're in?
It means I'm in.
...and doesn't have to be catastrophic.
of maintaining a consistent
and steady internal state.
Nick?
Hi.
Hi.
Yes, sorry.
This is a very old-fashioned way
to ask a girl on a date.
I know. I know. I'm sorry.
I-I forgot to ask for your phone number,
and then I-I didn't want to wake you.
So... note.
So, what do you think...
Should we get some dinner?
I know a place that's great.
It's, uh, right by the lake.
Yes.
Okay.
I'll pick you up at : .
Okay.
Okay.
Okay.
- I'll see you at : .
- Okay.
Multiple systems work in sync
to regulate factors like
temperature, blood pressure,
even sodium levels.
Okay. I'm not going to tell you
how to parent your son,
but this not going in Luna's bag.
These systems are designed
to resist and combat
anything that tries
to throw our bodies off.
It's a continual loop
with checks and balances.
So, what time did you tell them?
Ahh. Should be any minute now.
Feels like the old days.
Finally.
Until something manages
to break the cycle.
Hi-e-e-e!
How are you so awake?
Kombucha, girl.
Remind me why
we signed up to do this again?
To save lives.
Overrated.
Hey, Ortiz, where's your mom?
She transferred her residency
to take a job with Dr. Avery
and the foundation.
Good for her. Better for us.
More cases.
There's no statistical evidence
that proves residents learn
better at the crack of dawn.
I checked. I think we need
to stage a sleep-in.
Who's with me?
You finished?
Big day. And a long one.
Hope you ate breakfast.
We didn't.
Meet me in the skills lab, four minutes.
He said four minutes. It's
at least an eight-minute walk.
I'm with cardio today.
They requested me.
But have fun going back to day one.
Thanks for coming on such short notice.
Well, I went down two wrong hallways,
which feels like a metaphor for my life.
But when somebody offers
to pick you up in their private
jet, you get on that jet.
Meanwhile, Scout has decided
it is no longer cool
to sleep through the night,
so I looked like crap
when I dropped him off to Link,
who has mastered quiet disappointment.
But somehow looks so good doing it.
I think you look great.
Wait. Are you kidding?
They're giving you a lab?
Oh, you are definitely
not coming back to Seattle.
By the way, who actually
sent the private jet...
Amelia.
We're being offered millions
of dollars to cure Parkinson's.
Us?
Well, me. But I'm asking you,
so it's us.
Synced & corrected by -robtor-
www.addic ed.com
Leo says that Elsa needs a cape,
but he shoved it
in the dishwasher last night.
- Wasn't great.
- Well, even Snow Queens
need to learn that actions
- have consequences.
- Thanks.
So, is it, um, costume day or something?
No. Leo's world. We just live in it.
Oh.
Oh. Incoming trauma.
- Okay. I gotta go.
- Okay.
- Teddy.
- Yeah.
Allison, Elsa. I love you.
Bye. Bye. Bye.
Bye.
I'm sorry. Do you have a problem?
'Cause you're staring at my kid.
Oh, uh, I'm staring at his costume.
No, I-I know, and I would
really appreciate if...
Oh, my wife and I have been
looking for that same one
everywhere.
Oh. Oh, yeah.
- I-I'll... I'll ask my husband.
- Mm.
Oh, uh, here.
- Thanks.
- Yeah.
Hey. Hi.
We're gonna get you a new cape, okay?
Luna, it's important work, okay?
Just stop being so cute for seconds.
Stop. Stop.
I remember when Scout used to
cry when I dropped him off.
Now look at him.
Basically ready
for his first studio apartment.
Ow!
Okay. Um, I'm on scut all day,
so can you just, like, hop up here
and check on her every minutes?
Nope. Webber roped me
into a thing with the residents.
Luna's like a -second
elevator ride away,
if you need to see her.
Plus, they text you pictures.
Go.
- Go!
- Ugh.
Rashida Flowers, ,
chronic kidney disease
secondary to diabetes,
admitted for dialysis access insertion
after a thrombosed AV fistula.
After two failed grafts,
I'm back in the hospital, y'all.
Have to have another procedure.
But guess what?
My new doctor is a brother.
Mm! And he fly.
Say hi, Dr. Ndugu!
Hey. Do you mind not recording
so I can examine you?
Oh, right, of course.
Gotta go, y'all. Kisses.
Sorry. Gotta keep my followers happy.
I used to be a travel influencer,
ventured around the world,
but now I'm DiabeticBae,
which is way less exciting, so
I gotta get content where I can.
Well, today won't be
too exciting, I'm afraid.
I'll be inserting a catheter
into your chest
to help you start dialysis.
How long have you been diabetic?
Years now. But I was able to manage it
until I was visiting Thailand,
living my best life,
and I got real sick.
Hit my kidneys hard.
And every time my doctors tried
to get access for dialysis,
my body wouldn't cooperate
because... plot twist...
I have a clotting disorder.
But none of this was a shock.
Both my mother and brother
were diabetic,
and they both died from kidney failure.
Sorry to hear that.
Were they able
to get kidney transplants?
They weren't even able
to get on the list.
And neither am I.
You're not on the transplant list?
Nope.
Ortiz, set me up a consult
with Rashida's nephrologist, Dr. Krause.
Look, I know it's bad.
But it's okay.
That's really why I record everything.
I want the world to know who I am
before this disease... ends me.
Hey. Where's my resident?
I'm not their keeper.
- What do we got?
- Noah Young, ,
auto vs. Tree, restrained driver,
denies loss of consciousness,
O sats %,
- no visible chest trauma.
- Okay.
My son! I need to find my son!
Okay. We got Danny Young, , GCS ,
vital signs stable,
bleeding facial laceration.
- Daddy!
- There's my big guy!
I need to see my son, please!
Okay. Let's get you
both inside first, okay?
I'm fine! I just need to...
Trauma one, let's get a chest
X-ray and a full trauma panel.
Let's move! Somebody find me a resident!
Becoming a skilled surgeon
is like learning how to drive.
The more you do it,
the better you become.
And over the last year,
you have participated
in fewer surgeries than any
class of surgeon ever has.
Which means that you are not
where you're supposed to be, people.
We woke up early to be shamed.
Today, you will embark
on the toughest surgical workout
you have ever experienced.
Through a series of simulations
and skill assessments,
each of you will be evaluated
in four areas...
Laparoscopic,
suturing, vascular skills,
and endoscopic techniques.
You will be graded
on your proficiency and speed,
judged by your attendings.
Any questions?
It's like the surgical Olympics.
Or the Hunger Games.
I thought Dr. Grey was running
the residency program now.
Who do you think taught Dr. Grey?
Oh, and one more thing.
The resident with the highest score
flies solo in the OR this afternoon
with a surgery that's
appropriate to their level.
Laparoscopic skills start... now.
Ah!
- Relax your wrist for me.
- You know, back in my day,
every neurosurgeon I worked with
was an egotistical prick.
So you can imagine my delight right now.
You are brilliant
and charming, Dr. Shepherd.
Oh, except when I'm being
an egotistical prick.
Well,
as my friend Stephen Sondheim said,
"Nice is different than good."
You're friends with Stephen Sondheim?
Oh, I could be.
Okay. Follow my movements.
So, Dr. Shepherd, what's your
golden opinion? How do I look?
Well, you only have
a mild resting tremor
and slight bradykinesia, which is good,
but Parkinson's is unpredictable.
Your dopaminergic neurons
are degenerating gradually,
and it's only a matter of time.
Have you considered switching your meds
or deep-brain stimulation?
You know,
I'm not interested in a Band-Aid.
I need something
that'll make me whole again.
Dr. Hamilton,
Parkinson's is not a condition
that surgery can fix.
Yet. A condition
that surgery can't fix yet.
Enter brilliant, charming,
egotistical you.
As long as we can convince
your sister-in-law over here.
Chest pain, no.
Open fracture, too specialized.
Oh, right upper quadrant pain...
Now, that's promising.
Dr. Bailey.
Wong.
Uh, Richard's holding
the surgical Olympics.
It's a slow day, so I'm looking
for something good
to be the solo. You got anything?
Dr. Bailey, you've rescheduled
our meeting twice now.
- You're avoiding me.
- No...
I had surgeries. Uh, important ones.
He's also looking for judges,
so if you'd prefer
to help out that way...
No, I'm here to tender my resignation,
which I've been trying to do
- for days now.
- I know.
I just didn't want you to.
Chief, I'm retiring.
I already bought a condo,
picked out tile.
Okay, what could you possibly
want to do instead of surgery?
Mystery novels.
- I'm sorry?
- I have a series of books
where the main character is a PI
and a surgeon.
"Doc Undercover."
Uh, sounds... n-nice.
Wong, look, the hospital,
t-the country...
We're in dire need
of physicians with yo...
Miranda.
Truthfully? It's just not fun anymore.
I'll start your paperwork.
Perfect suturing ensures
proper wound closure,
less bleeding,
and a lower risk of infection.
Excellence matters.
This is an atraumatic tie.
You will have seconds
to tie three square knots.
Do not move the soda can.
Any movement counts against you.
And absolutely no air knots.
On your mark, set...
Go!
Kinda sloppy, Tseng.
- Huh.
- What's that supposed to mean?
It means, "Huh."
- Is that better?
- Nope.
I'd start over if I were you.
Opening with a compliment is customary.
Time's up!
Lincoln, do we have a winner?
- Schmitt takes the gold.
- Yes!
Is there a silver?
Name that tune.
I don't know.
Um, how long did you say
that you have been experiencing
abdominal pain for?
- Uh, a few days.
- Okay.
Whistling calms my nerves
when someone's, you know,
inspecting my hooha.
Ow.
Sorry, but I-I feel something.
It was "Twinkle, Twinkle, Little Star."
- What?
- The song I was whistling.
"Twinkle, Twinkle"?
- Oh.
- Technically, it's the same melody
as the ABCs.
And "Baa Baa Black Sheep."
Ah. Who knew.
Okay, I...
Yep, there's something in here...
I...
Robin, there was a strawberry
lodged in your...
Ohhhh.
Yep. That tracks.
So would that explain my abdominal pain?
Um, it shouldn't.
Why? Is there something...
strange in there, too?
Maybe?
Danny.
How you feeling?
Looks like you had quite the adventure.
Yeah.
Got to ride in an ambulance.
And now you have superhero marks.
Do they come with powers?
Maybe, if you eat enough
cherry Jell-O and Popsicles.
Owen's sister, right?
Oh, uh, yeah. You're peds?
- Cormac Hayes.
- Oh.
You coming to join our humble staff?
Bailey just asked me to help out,
cover some of Grey's cases.
Grey? Big shoes to fill.
Eh. So she performed
an abdominal-wall transplant.
Big whoop. It was actually my idea
to even need
an entirely new abdominal wall
so Grey could win the Fox award,
so, who's the genius now?
- So you were the patient?
- Yep.
Alright, Danny, I'll be back
to check on you, okay?
Where's my dad?
Can I please go sit with him?
He shouldn't be alone out there.
We have contacted your wife,
and she is on her way, okay?
It was supposed to be
a father-and-son weekend.
Fishing, camping out by Deception Bay.
I don't know what happened.
Maybe you passed out.
Your oxygen levels are very low.
How long have you had
shortness of breath?
It... It's nothing.
Okay, let's do an X-ray, please?
- No! No X-ray!
- Hey.
Look, I'm fine.
Relieved that me and Danny are alive.
Could you please let me out of here
so I can try to salvage this weeken...
I, uh... I saw your tattoo.
Bassett Infantry?
- rd generation, Bassett Infantry.
- Mm.
You?
Army trauma surgeon, two tours Iraq.
Two tours Afghanistan,
one Jordan, one Djibouti, two Iraq.
And I've never been to Vancouver.
Well, sounds like
you need a new travel agent.
Let's put him on high-flow O .
Let's push of fentanyl,
and somebody page Altman!
We're gonna get him up to CT!
Okay?
Okay.
Dr. Krause, hi.
Winston Ndugu, cardiothoracic surgery.
- Do you have a minute?
- Barely.
I've been drowning in cases.
My patients put off
seeing me for months,
and now I'm dealing with the backlog.
- What can I do for you?
- Yeah, I'm consulting
on your patient Rashida Flowers.
She mentioned that she's not
on the transplant list.
Yeah. Rashida, she's been through a lot.
Unfortunately, she doesn't fit
the transplant criteria.
But Rashida's renal function tests
seem to make her a prime candidate.
Well, you would think,
but Rashida's eGFR is high.
It's over , disqualifying her
from the list.
- Estimated.
- I'm sorry?
It's an estimated number of what
her kidney function should be,
- not what it really is.
- Dr. Ndugu,
the eGFR is the standard
clinical formula,
used in the field for the past years.
It's what we use to determine
care and qualification
of kidney transplant.
A transplant could save her
from having to need dialysis
in the first place, which we both know
has high mortality rates,
especially in the first three months.
I'm aware, but Rashida
just doesn't qualify.
And believe me, I hate that,
at least as much as you do.
So, what if we fail?
How do we know you'll even survive it?
I think we can both agree
that you learn more
in the attempt than the outcome.
And I am under no delusion
about how risky it is.
But what's life without risk?
Meredith?
Meredith.
Is this that robot arm
that does cell culture?
It is. And please don't touch it.
Dr. Grey, Dr. Shepherd,
please meet Dr. Kai Bartley,
a neuroscientist who accepted
an offer they couldn't refuse.
It's great to meet you.
I've been reading
your stem cell research.
Which is brilliant.
I've been following it for years.
Um, they were at Hopkins
a couple years behind me.
Um, o-okay. When you inject
the cells into the brain,
what about the risk of the cells
developing tumors?
That very question stalled
my research for two years.
But once I teamed up with David...
Once they took my funding.
I uncovered a Chinese herbal compound
that completely removes
the undifferentiated cells.
That's amazing. They're amazing.
Excuse me, I have a conference call.
But we'll talk more later?
- Great to meet you.
- Thank you, Dr. Bartley.
Thank you, David.
So?
What do you...
Yes. All the yeses.
An opportunity to impact
Parkinson's, change the world,
with this equipment and this team?
I am... I'm in.
Dr. Grey?
Just say yes.
Hey.
Should we shelve the Elsa costume?
- What?
- You know, put Leo in more...
T-shirts and jeans?
Just, is that the right parenting move?
Did something happen? No, I just...
You know, none
of the other kids at daycare
are wearing costumes, so I just...
What do we got?
MVC with no visible trauma.
A young vet
who did several tours in Iraq.
He has finger clubbing,
cyanosis, dyspnea.
He coughed up blood
when he was downstairs.
His chest X-ray does not look good.
And I'm thinking it's some kind
of respiratory illness.
Are you sure nothing happened?
Oh, my God. Owen...
His lungs look like a w*r zone.
Is Pierce taking a job in Boston?
Is that why you paged me?
Because if I lose one more surgeon...
No, her dad is having hip surgery.
Oh.
Well, now I feel badly.
Uh, Chief, I have a patient, ,
Black woman with chronic kidney
disease from diabetes.
She hasn't been able to get on dialysis
due to a clotting disorder.
A candidate for transplant?
Well, her eGFR is too high,
according to her nephrologist.
But look.
Here's another patient
on the transplant list.
Almost the same age, weight, and
health profile to my patient.
The only real differentiating
factor is that they're white.
So their eGFR measures lower,
making them
better transplant candidates.
When the estimated GFR was developed,
it was assumed that Black people
have higher muscle mass.
It added a multiplier
to account for that assumption,
which then increases
a Black patient's GFR
and registers them
as having less severe disease
than other people.
Making them ineligible for transplants.
How does this even happen?
Stems from a long line
of "assumptions" about Black people
that have snaked their way
into medicine...
You know, that we have
a higher tolerance for pain...
...different bone density,
lower lung capacity.
And yet these assumptions still
exist in clinical formulas.
I-I never even stopped to think
about the eGFR.
Is there any way around it, Chief?
Uh, can I write an appeal
to the transplant board?
That only works
if the patient qualifies
for medically urgent status.
Rashida might not have
that kind of time.
There's a lot of Rashidas, though.
Fight for them, too.
The IR suite is ready for us.
Sergeant Young,
this is Dr. Teddy Altman.
Major Teddy Altman.
- Where's Danny?
- He's with Dr. Hayes.
He's fine, but we need to do
a head CT just to be sure.
Your scans reveal severe
scarring in both your lungs.
We'd like to admit you and...
I have pulmonary fibrosis.
Mystery solved.
That's why I didn't want
any work-ups, no treatments.
I know what I have,
and I know there's no cure.
Just a crap-ton of different
ways to the poor house.
When were you diagnosed, Sergeant?
About a year ago.
I started coughing
after the second Iraq tour.
I couldn't shake it.
I started hearing from buddies
about the burn pits,
how they were linked
to all these cancers
and mystery illnesses.
The VA's gotta cover these conditions.
Barely.
They just started covering
stuff like asthma.
But I haven't heard of a single vet
who's been covered
for conditions like mine.
All kinds of ways to twist it
so you can't prove
it was service-related.
Cherry on top? I lost my job
at the seafood plant
'cause I was too weak
to finish my shift.
So I got no insurance, no job,
and a stack of medical bills.
- Sergeant, look...
- Please, just call me Noah.
Noah, would you sit down
with one of our pulmonologists?
We'll redo your workup, and we
will get you in for some tests
so that we can start some treatments...
Pass. No tests, no treatments.
Nothing against you guys,
but whatever time I have left,
I'd like to spend it with my son.
- Move. That's four.
- I know, I know, I know!
Pop these balloons, Tseng! Come on!
If you lose to a second-year,
you're cleaning the bathroom
for six months!
- Get away from me!
- Endoscopic proficiency
is just as important as speed.
One slip could mean
you've perforated a colon.
seconds!
- Yes, yes, yes!
- One more.
What category are they on?
- Endoscopy.
- Mm.
It's a trash fire.
- Mnh-mnh.
- You're a resident now.
Sleep when you can, eat when you can.
Nah, I'm on the scut diet.
Rectal exams?
Vaginas.
Right. Pink.
The scrubs!
I found a strawberry in my patient.
Back in med school,
I found a yam. bucks on Tseng.
- Okay, I'll take Helm.
- Come on, come on, come on!
- Go, go!
- Taryn, it's right there,
it's right there, it's right there!
Go, go, go! Come on, come on, come on!
Go, go.
- Done!
- Finished, finished. Me.
It's Tseng.
Today's winner of the competition...
Schmitt, you will be flying solo today.
I won. I won, I won!
I won! Oh!
Of course he won.
There was no actual blood.
Oh, come on! Wait, wait.
What's the... What's the...
What's the surgery?
- Find anything good?
- Wilson did.
Ex-lap on foreign-body extraction.
Yes! Oww!
Get it, get it!
Oww!
Yes!
I love you!
Hmm, let's think.
Deep pockets, unlimited time, space,
Kai Bartley's groundbreaking research,
and a chance at curing
a neurodegenerative disease.
You're forgetting about the part
where we have kids who need stability.
And I have a job that I love
that I just got back to.
I don't want to abandon them.
We're not abandoning anyone.
We're revolutionizing medicine,
and that's a great example
to set for our kids.
And Grey-Sloan, they're gonna be proud
to have us be part
of something so high-profile.
Exactly. If this surgery works,
it's huge.
If it doesn't, we've k*lled
an incredible surgeon
and set the research back years.
Give us more credit than that, Meredith.
You asked me here for my opinion.
I'm saying yes.
Because people with Parkinson's
need more than just hope.
Is this her last possible
access port for dialysis?
It is. We need to pull
back the catheter just a bit.
What about transhepatic
or translumbar access?
It'd be too dangerous,
given her clotting disorder.
Fluoro. This isn't
how medicine should work.
Anybody who needs life-saving
care should get it.
Heparinized saline.
What if this port clots off
and she loses it?
You tell me.
Waste will build up
in her blood, leading to uremia,
and her organs will start to
shut down, one after the other.
Secure the catheter with
stitches on the wings and shaft.
Get a chest X-ray.
Where are you going?
To get her a kidney.
You don't need to escort me
off the premises.
That's not what I'm doing.
Go home to your baby.
I just wanted to make sure that
I'm not being completely ridiculous
for even entertaining this.
No, you're being ridiculous
because you haven't
accepted the offer yet.
I mean, we're talking about
curing Parkinson's, Meredith.
Parkinson's. I mean,
what is the matter with you?
This... This famous surgeon is
basically throwing money at us
to play with the most innovative
equipment in the world.
And not only that, he wants
to give us his diseased brain
as a testing ground!
I mean, when you started your career,
you wanted to go into neuro.
This is your chance to get back to that.
I mean, maybe this is what
you're supposed to do.
What we're supposed to do.
And I-I... I cannot,
for the life of me, understand
why you would walk away
from something like this. I...
So don't.
I will see you at home.
I inserted Rashida's access point.
Great. Thanks.
Rashida needs to be
on the transplant list.
We found six cases of patients
with similar clinical profiles,
who are on the list.
The only major difference is
that these patients are white.
Are those cases patients of mine?
A few.
There's got to be more to it
than that. The patients' eGFR...
Yeah, their eGFR is lower,
which makes them eligible,
but that's only because
the formula unjustifiably
uses race as a factor.
Dr. Krause, we all know
race doesn't play a role
in kidney function.
- Dr. Ndugu...
- I know, you're busy,
but if you look at Rashida's eGFR
without accounting for her race,
she falls below the criterion of .
I don't understand. The eGFR
is the field's standard.
It's a tried and true formula.
Yes. And it's time we start
questioning our standards.
Look, I have clinic right now,
but I'll look into it.
Rashida doesn't have other
options for a dialysis port
- if this one fails.
- I hear you.
I'll look into it, Dr. Ndugu. Thank you.
Robin Jeter, , abdominal pain.
X-ray shows a lodged crystal
causing intestinal obstruction.
I think you mean to say
intestinal stone.
- No, I don't.
- No, she didn't.
It's a yoni egg.
- Amethyst, specifically.
- Uh...
It's... It's... It's a crystal egg
that is typically inserted
into the vagin...
- Got it.
- Huh?
Uh, I was doing a ritual
I saw on social media
that was supposed to bring love
and healing into your life.
But, um, I was doing it so fast,
I mixed it all up.
I was supposed to eat the strawberry
and insert the yoni egg.
What did you do with the strawberry?
Oh. Uh, I-I see. Um.
Oh! Right. I'm up.
Hello, Robin. I'm Dr. Schmitt.
I'll be doing your surgery
today, uh, to remove,
uh, the...
The... Yoni egg.
Mm-hmm.
How old is he?
Yeah, these symptoms sound familiar.
I have treated dozens of
soldiers exposed to burn pits.
What are burn pits?
Electronics, plastics,
soiled uniforms, human waste.
Douse it all with some jet fuel,
light it with a match,
then fwoosh... I mean,
what could possibly go wrong?
I mean, some of these men have illnesses
that we haven't even named yet.
Others are in pain / .
They get nowhere with the VA.
The guy did six tours of service.
To protect us.
Never questioning, never complaining.
He just answered the call,
and we need to do the same for him.
Tomorrow, I'm gonna go down to the VA.
I'm gonna demand answers.
Okay, so after you defeat
the US military,
maybe grab some lunch,
and then take on Putin?
- How's his kid?
- Danny's gonna be fine.
Head CT was clear. He can be
discharged later today.
Maybe Avery can help Noah
through the foundation.
He'll be dead before we even
line up the votes on the board.
We can't save Noah.
He just needs immediate medical
care just to be comfortable.
And we can give him that. We'll
figure out the details later.
Look at you two,
breaking rules and saving lives.
Aren't you glad
I got you to tie that knot?
- What happened?
- Her sats dropped,
and her face and neck keep
swelling more and more.
Superior vena cava syndrome.
The catheter must have blocked
her SVC entirely.
- I'm taking it out.
- Can we take her back to the IR suite
- and reposition it?
- No.
How else would she get dialysis?
- She wouldn't.
- Dr. Ndugu...
She's already clotted off
multiple access points.
Who's to say it wouldn't happen again?
Page Dr. Krause!
It's fine. Everyone's watching.
That's what happens.
People watch, you screw up,
and then you quit and
go find a rock to hide under.
You ready?
Scalpel.
- Nice extraction, Schmitt.
- Thank you.
- chromic, please.
Doppler.
Relax, Schmitt.
If you're calm, everyone else is calm.
Oh, this can't happen.
Come on, come on,
come on, come on. Think.
You can do this. Think.
I'm turning the speaker on.
Help him out, people.
Are you getting a good signal
from the adjacent segments?
Yes, both sides.
Resect that segment. Do a hand-sewn...
End to end anastomosis.
Uh, stapler.
To close, start bringing
the bowel together
with a vicryl suture,
coming around the corner
- with a Connell stitch and...
- And a millimeter gap
between every two sutures.
Got it.
Suction, Taryn...
Dr. Helm.
What happened?
There was a complication
from the catheter,
- so I had to remove it.
- So you'll reinsert it?
I won't. And because we couldn't
gain access for dialysis,
Rashida needs to be placed on
the transplant list immediately.
Rashida's been my patient for months.
These aren't your decisions to make.
Except that now she's also my patient.
And she has suffered from
multiple unnecessary procedures,
so I'm not putting her through
even more.
This is not protocol.
It's not. It's a life.
Rashida's.
Even if we list her,
we don't know
when a kidney will come through.
It'll come faster than if we didn't.
Oh, Hayes, uh, I'm looking
for Danny and Noah.
Uh, they left.
What do you mean they left?
I didn't discharge Noah.
No, but I discharged his son,
and he said he wanted
to go home with him.
So you just let him go?
Without asking me?
He said he declined all further testing,
and then he signed an AMA.
He has severe fibrosis in both lungs.
He needs supplementary oxygen,
a full pulmonary workup,
an evaluation by a specialist,
and we're gonna need to do
more studies, okay,
- if we're gonna...
- Hunt, he's terminal.
You know that, I know that,
Noah knows that, and he's accepted that.
Hayes, just...
Which is very difficult to do
when you've got a little one at home.
Believe me.
All those things you want to do
for him, they take time.
They take energy.
They're two things Noah wants
to give his son right now
while he still can.
Look, I'm sorry I didn't ask you,
but I'm not sorry I let him go.
You look amazing.
But, yeah, you may want to change.
Sorry.
It's okay.
Listen. You hear that?
- What?
- Exactly.
I mean, this right here, this is
why I pulled back on my hours.
I was... I was ignoring
everything around me.
You know?
The perfect silence,
the -mile hike through
the woods behind my house,
just sitting here, sitting,
staring up at the stars.
I don't stargaze much.
I'm sorry, since when?
Since ever.
Ooh, we're gonna have so much fun.
I've got so much to teach you.
Hey, tell me about
this, um, top-secret project.
Well, If I told you,
it wouldn't be top-secret.
Fine. Tell me one thing.
You really struggle
with the concept of secrets.
I guess I do.
I'm scared to say yes.
Hm.
And I am very rarely scared.
What are you scared of?
Failure.
This project will cost
millions of dollars,
will be very risky,
win or lose, will eventually
be written about.
And I'm just not sure
that I want the first thing
that I do after surviving COVID
to be a public failure.
And I know that's my ego.
I have a very comfortable
situation in Seattle.
I have safety. I have comfort.
And now you're gonna
trade all of that in.
You're gonna risk it all.
Listen, you're not
a safety person, Meredith.
You're not a comfort person.
- It's not your nature.
- How do you know?
Because it's not mine, either.
And it takes one to know one.
You're gonna risk it all,
and win or lose...
it's gonna be a hell of a ride.
I'm really sorry to say this, Rashida.
We couldn't gain access
for your dialysis.
But... you're on
the transplant list, Rashida.
Wait, what?
Are you serious?
Yeah.
Wow.
I honestly never thought
I would see this day.
You're not just saving my life.
You're changing it.
I can go back to who I was.
I don't know how to thank you.
I can't wait to tell everyone.
Oh, and, Dr. Ndugu,
when my followers find out
how you helped me...
Are you single?
I'm not.
I'm actually married to
another cardiothoracic surgeon
at this hospital... Dr. Pierce.
And she fly.
- What?
- Mm-hmm.
A cute doctor couple?
- Mm-hmm.
- Okay!
I gotta meet her ASAP.
Ooh, have you guys ever thought
about becoming influencers?
The brands would come flocking.
Influencers? For what? Health?
Yeah, I mean, there are
influencers for everything.
Okay, movies, restaurants, plants.
There are dog influencers, too.
Mm-hmm. Biggie the Pug
has million followers.
Ha! Come on. Okay. We gotta go live.
Hey!
- Hey.
- Ah!
I haven't seen them this happy
in months.
Helm's more thrilled than Schmitt.
He let her keep the crystal.
And you seem to be
the happiest of them all.
Feels good to be back, in front of them.
Well, Dr. Wong gave me
his retirement notice today.
Dr. Wong?
He used to be a student of mine.
Is something wrong?
Healthy as a horse.
And it's getting worse, Richard.
Every day, someone retires or
quits or moves to Minnesota...
We don't know if that's happening.
Whether it's burnout or exhaustion
or just needing a change,
these residents aren't the only
ones that need to reset.
This whole hospital needs
to remember why we're here.
COVID took that from us.
You know, remember when we
used to have, like, pizza night
and retreats, and... and
residents would prank each other
and... You hated that.
But there was joy
and the feeling that we were
all in this together,
for something bigger than ourselves.
I want to make room for that.
I want to make space for that again.
You want people to remember the why.
So do I.
I got some ideas, Bailey.
Big ones.
Okay, you need to stop
with the depressing lullabies.
Put him to sleep.
Link, I-I know that you are upset
and sad and grieving
the future you thought you had.
Obviously, I have been there.
And what did you do?
I looked for joy anywhere that I could.
Then along came OB...
and Luna.
I know that it sucks right now,
but you're gonna be okay.
Something did happen earlier with Leo.
I-I-I thought a parent was being
judgy about his Elsa costume,
so I-I confronted him. Who was it?
No, no one. He wasn't being judgy.
I'm just... Owen, I'm worried.
I...
I-I want Leo to be okay in the world,
and I'm... I'm...
I'm worried, what if we...
What if we let him be himself?
I'm worried that
the world won't be kind.
I'm worried that it will be hard.
I'm worried that people will be cruel.
And maybe they will be.
But we won't be.
Leo's happy. Let's...
Let's just let him be happy, okay?
Okay.
- Mommy!
- Oh, there he is.
- Hey!
- Hey!
Hey. How are you?
Look what I got.
- Whoa.
- A new cape for Elsa,
the Snow Queen.
You like it?
Yeah.
I love it.
Hi!
- You got her?
- Yeah.
I'll take him. Hi!
Hi!
- Let's go home.
- Okay.
- How was your day?
- Ah.
There is such a thing
as predictive homeostasis.
Late night.
You don't own me.
Mm, I know.
I need autonomy picking the team.
Absolutely.
I'd like any progress
that we make from this process
to be public and accessible
to everyone with Parkinson's.
Of course.
It's when our body anticipates
responses to future challenges.
I'd like to move
the whole project to Grey-Sloan.
Mnh. That I can't do.
It's... It's expensive.
Frankly, I don't have the time.
We have everything we need here.
I can't move to Minnesota.
I need you here as much as possible.
I could set up a satellite lab
in Seattle.
I could travel back and forth
once a week.
That's the best I can offer.
Done.
It understands
that change is inevitable...
Does this mean you're in?
It means I'm in.
...and doesn't have to be catastrophic.