1. Your primary care doctor was right.
Copy !req
2. The mass is on the smaller side.
Copy !req
3. We'll confirm with the new images,
Copy !req
4. but it should be manageable
with medication.
Copy !req
5. No surgery needed.
Copy !req
6. Well, my fiancé will be so relieved.
Copy !req
7. He's been worried I'll look like
Frankenstein in all our photos.
Copy !req
8. Also that I might die.
Copy !req
9. When's the big day?
Copy !req
10. June.
Copy !req
11. You've been dealing
with wedding planning
Copy !req
12. on top of a pituitary tumor?
Copy !req
13. You deserve a medal.
Copy !req
14. Our medical record system,
on the other hand,
Copy !req
15. it has you listed as female.
Copy !req
16. Probably because of the Pap smears.
Copy !req
17. Software clearly needs
a trans update. Deep breath.
Copy !req
18. I'll fix it so everything is
correct going forward.
Copy !req
19. Please confirm your gender and pronouns.
Copy !req
20. Male, he/him/his. Thanks for asking.
Copy !req
21. We're the ones
with the messed-up software.
Copy !req
22. Your scans from this morning
were just uploaded.
Copy !req
23. In less than two weeks,
the tumor's doubled in size.
Copy !req
24. 34-year-old female, Zara Norton.
Tachycardic and delirious.
Copy !req
25. - Dr. Guerin, update vitals.
Copy !req
26. Dr. Wolke, draw blood
for CBC and electrolytes.
Copy !req
27. Pupils are dilated, but reactive.
Copy !req
28. Ms. Norton,
smells like you've had some marijuana?
Copy !req
29. Mm-mm. I just unloaded
a shipment at the dispensary.
Copy !req
30. Test for THC and a full tox screen.
Copy !req
31. I am a peddler.
Copy !req
32. Run it.
Copy !req
33. BP's elevated, 180 over 115.
Copy !req
34. That could explain the delirium.
Copy !req
35. Ooh, that sound high.
Better take my meds.
Copy !req
36. See, I never miss a… Oh, no.
Copy !req
37. Oh, no, that's not it.
Copy !req
38. BP's climbing, 210 over 120.
Copy !req
39. Enalaprilat, 1.25 milligrams, IV.
Copy !req
40. Ms. Norton, do you remember
the name of your medication?
Copy !req
41. You can call me Zara.
Copy !req
42. See? It say right here on the…
Copy !req
43. Forget the meds.
She is not taking any.
Copy !req
44. This is untreated chronic hypertension.
Copy !req
45. What if she's on a loop diuretic
for her pressure?
Copy !req
46. This could cause renal failure.
Copy !req
47. She's heading into hypertensive crisis.
Copy !req
48. What if we try
an angiotensin receptor blocker?
Copy !req
49. No drug interaction.
Copy !req
50. Angiotensin receptor blockers
work too slowly.
Copy !req
51. I'm giving her the ACE inhibitor.
Copy !req
52. - BP's going down.
Copy !req
53. Nice call.
Copy !req
54. Latest budget report.
Copy !req
55. Yeah, the PDF's sitting in my inbox.
Copy !req
56. I'm trying to ignore it.
Copy !req
57. And thus…
Copy !req
58. A sit-down visit?
Copy !req
59. - Just checking in, see how you're doing.
- Okay. You?
Copy !req
60. Me? I'm… recovering from the year,
Copy !req
61. like everybody else.
Copy !req
62. Pandemic, the surge.
Copy !req
63. You were here
for every minute of every day.
Copy !req
64. It must have taken a toll.
Copy !req
65. It… comes with the territory.
Copy !req
66. You're not, uh, stressed or distracted?
Copy !req
67. I'm… tired.
Copy !req
68. Okay. Well, maybe you should
take some time off.
Copy !req
69. No.
Copy !req
70. But thank you. I'm fine.
Copy !req
71. You don't seem fine.
Copy !req
72. Are there issues with my work performance?
Copy !req
73. No, you do great work.
Copy !req
74. Then why are we having this conversation.
Copy !req
75. Because I'm worried about you.
Copy !req
76. Because other people
are worried about you.
Copy !req
77. There's no shame
in struggling a little bit.
Copy !req
78. You know, what would be weird is
Copy !req
79. if you didn't struggle at all.
Copy !req
80. If you need to see someone,
the hospital will cover the cost.
Copy !req
81. Great. You'll pay my bills.
Copy !req
82. And the damage to my reputation,
who takes care of that?
Copy !req
83. I don't think that seeing a therapist
Copy !req
84. will affect your career.
Copy !req
85. Says the white guy.
Copy !req
86. Okay.
Copy !req
87. Privacy protections
are there for a reason.
Copy !req
88. No one needs to know.
Copy !req
89. Thank you for checking in.
Copy !req
90. - How you feeling?
- Good.
Copy !req
91. Be better when I understand
what landed me up in here.
Copy !req
92. You had an acute hypertensive crisis.
Copy !req
93. Oh, I know my blood pressure's high.
Copy !req
94. I'm already on medication for it.
You probably wanna know what it is.
Copy !req
95. There's no medication.
Copy !req
96. We need to do an echocardiogram
Copy !req
97. to make sure your heart
wasn't damaged in the crisis.
Copy !req
98. Fine by me.
Copy !req
99. Here's 10% discount
Copy !req
100. on any purchase
over $50 or more at Z & B Naturals.
Copy !req
101. I'm Z. B is my partner Bill.
Copy !req
102. You're surrounded by pot all day,
every day,
Copy !req
103. - but you never touch the stuff?
- How? Why?
Copy !req
104. It's just never been my thing.
Copy !req
105. Ah.
Copy !req
106. The name always trips me up.
Copy !req
107. Chlorthalidone.
Copy !req
108. That's for hypertension.
Copy !req
109. Yeah, bottle seems pretty full.
How long have you been on this?
Copy !req
110. About six months. Just refilled it.
Copy !req
111. Take it every day.
Copy !req
112. Smile.
Copy !req
113. Head tilt.
Copy !req
114. Now he smiles.
Copy !req
115. Burst of laughter.
Copy !req
116. Yeah.
Copy !req
117. Rio Gutierrez, 29,
Copy !req
118. pituitary mass
went from manageable with meds
Copy !req
119. to likely surgery.
Copy !req
120. So, talking to the new
radiology resident, huh?
Copy !req
121. I wanted Dr. D'Souza's opinion
on an intriguing set of scans.
Copy !req
122. She is very talented.
Copy !req
123. You're crushing on her.
Copy !req
124. N… No.
Copy !req
125. I am not. I love Lea.
Copy !req
126. Well, those two things
aren't mutually exclusive.
Copy !req
127. Mr. Gutierrez's blood
has high levels of prolactin.
Copy !req
128. Prolactin is produced
in the pituitary gland.
Copy !req
129. The tumor could be secreting it.
Copy !req
130. Or the tumor could be reacting
to the high levels of hormones
Copy !req
131. being produced elsewhere in the body.
Copy !req
132. The patient is a transgender man.
Copy !req
133. Do an ultrasound.
Copy !req
134. Advance the probe
until you see the cardiac chamber.
Copy !req
135. Maybe Zara has secondary hypertension
due to renal vascular disease.
Copy !req
136. She doesn't. Her creatinine is 1.2.
Copy !req
137. Her GFR is in normal range.
Copy !req
138. That would make it unlikely,
but not impossible.
Copy !req
139. It explains why her hypertension meds
weren't working
Copy !req
140. and why she got better
when you gave her that ACE inhibitor.
Copy !req
141. Simpler explanation,
she's not taking her meds.
Copy !req
142. Valve looks normal.
Copy !req
143. Should I move on to the two-chamber view?
Copy !req
144. Yeah.
Copy !req
145. We have no reason
to think that she's lying.
Copy !req
146. She seems to be telling the truth
about her pot usage.
Copy !req
147. No THC in her blood or urine.
Copy !req
148. She couldn't possibly be lying
about something else.
Copy !req
149. The left ventricle is thickened,
Copy !req
150. which is consistent
with untreated hypertension.
Copy !req
151. Heart rate's climbing.
Copy !req
152. Cardiac output is dropping.
Copy !req
153. Stroke volume as well.
Copy !req
154. She's in cardiogenic shock.
Copy !req
155. Would you mind
if I did an ultrasound on your abdomen?
Copy !req
156. For a brain tumor?
Copy !req
157. This is my fiancé, Eli Simpson.
Copy !req
158. When I heard about the new scans,
I kind of stormed the castle.
Copy !req
159. My hero.
Copy !req
160. Your prolactin levels are very high,
which might be caused by the tumor,
Copy !req
161. unless another condition
raised your prolactin,
Copy !req
162. encouraging more growth.
Copy !req
163. What condition boosts prolactin?
Copy !req
164. Do you think I'm pregnant?
Copy !req
165. He can't be. He's on testosterone.
Copy !req
166. Except for a few weeks last month.
Copy !req
167. I forgot to take my shot before our trip.
Copy !req
168. But there's no way that…
Copy !req
169. You're pregnant.
Copy !req
170. You went into cardiogenic shock
Copy !req
171. because your heart
wasn't pumping adequately.
Copy !req
172. We did a minor procedure
and installed an Impella pump,
Copy !req
173. but it's a short-term solution.
Copy !req
174. I do feel a little out of breath.
Copy !req
175. But that might be just 'cause of you,
Dr. Andrews.
Copy !req
176. Ms. Norton,
I'm a married man and your doctor.
Copy !req
177. You have a rare condition.
Copy !req
178. Certain parts of your heart muscle
Copy !req
179. have become abnormally thick.
Copy !req
180. So, this wall in between the chambers,
that's the septum.
Copy !req
181. That's a normal one.
Copy !req
182. This is what yours looks like.
Copy !req
183. Oh, wow.
Copy !req
184. It's gonna require surgery.
Copy !req
185. We're gonna run a few more tests
to determine the best approach.
Copy !req
186. Wait. You gonna be my surgeon,
Dr. Andrews?
Copy !req
187. I sure will.
Copy !req
188. And y'all two gonna be with him?
Copy !req
189. Yeah.
Copy !req
190. My lucky day.
Copy !req
191. Three doctors of color
taking care of me.
Copy !req
192. Doctors who won't talk down to me.
Copy !req
193. Not exactly what I'm used to.
Copy !req
194. You guys know what I mean.
Copy !req
195. My mother made me
wear a suit and tie
Copy !req
196. whenever we went
to the pediatrician.
Copy !req
197. Put on your Sunday best just to get
on the scale and touch your toes.
Copy !req
198. Yeah. Made me so mad,
I wound up becoming a doctor.
Copy !req
199. The testing confirmed
Copy !req
200. your tumor is
a hormone-producing prolactinoma.
Copy !req
201. And the pregnancy is
about six weeks along.
Copy !req
202. Do you consider yourself gay?
Copy !req
203. - I don't think that's…
- Yes.
Copy !req
204. Because I am gay.
Copy !req
205. But you have vaginal intercourse
with your fiancé.
Copy !req
206. - That is how he got pregnant…
- Dr. Murphy, that's enough.
Copy !req
207. - I… I just want…
- I think you should leave.
Copy !req
208. I'm sorry.
Copy !req
209. That was completely inappropriate.
Copy !req
210. Our treatment plan for your tumor
Copy !req
211. depends on your plan for your pregnancy.
Copy !req
212. So…
Copy !req
213. We've talked about kids,
Copy !req
214. but I always figured
that was way down the road.
Copy !req
215. And not this way.
Copy !req
216. I always assumed we'd adopt.
Copy !req
217. I'd have go off T, and stay off.
Copy !req
218. If Rio doesn't continue the pregnancy,
Copy !req
219. then what happens?
Copy !req
220. Your hormone levels
would drop quickly,
Copy !req
221. which would cause the tumor to shrink.
Copy !req
222. After that, we'd use medication,
possibly a minor surgery.
Copy !req
223. I'd like to terminate the pregnancy.
Copy !req
224. I looked over
all of Zara's labs.
Copy !req
225. All signs point to her taking
her hypertension medicine regularly.
Copy !req
226. Her MRIs show
significant ventricular septal thickness,
Copy !req
227. bad turbulence jet flow.
Copy !req
228. There's myocardial edema, too.
Copy !req
229. The ACE inhibitors were a bad call.
Copy !req
230. Which eventually sent our patient
into cardiogenic shock.
Copy !req
231. Why'd you ignore what she was telling us?
Copy !req
232. I made a medical diagnosis
Copy !req
233. based on pattern processing
that we're taught in med school,
Copy !req
234. which involves considering,
you know, race, education,
Copy !req
235. occupation, BMI.
Copy !req
236. Always sounded like profiling to me.
Copy !req
237. Yes, we have the rain,
Copy !req
238. but more impressively, the wind.
Copy !req
239. That rain's going to be
coming in sideways.
Copy !req
240. Just take a look at
how the wind increases
Copy !req
241. as we progress throughout the day.
Copy !req
242. So, this afternoon,
we're talking about
Copy !req
243. 50-mile-per-hour gusts possible.
Copy !req
244. Sorry for crashing.
Copy !req
245. Radiology doesn't have a TV.
Copy !req
246. You like The Weather Channel?
Copy !req
247. I find it soothing.
Copy !req
248. Would you like to join me?
Copy !req
249. And we have more intense
rainfall coming through,
Copy !req
250. and that's going to
also lead to some flood potential.
Copy !req
251. All of us are going
to get into the action.
Copy !req
252. You got the mountains.
Copy !req
253. Would you mind if I lowered the volume
by four output levels?
Copy !req
254. Oh.
Copy !req
255. That would be perfect.
Copy !req
256. All the areas around here
in Northern California,
Copy !req
257. Modesto, Stockton, Sacramento.
Copy !req
258. - The northern part of San Francisco…
Copy !req
259. I find the reflection
on the screen so distracting.
Copy !req
260. So do I.
Copy !req
261. Could I
Copy !req
262. do this?
Copy !req
263. Nurse paged me.
Copy !req
264. Is something wrong?
Copy !req
265. I've changed my mind.
Copy !req
266. I want to keep the baby.
Copy !req
267. Since you're continuing the pregnancy,
Copy !req
268. we'll need to surgically remove
the prolactinoma.
Copy !req
269. So, you'll cut into his brain?
Copy !req
270. Our safest option
is to go in through the nasal cavity
Copy !req
271. in what's known as
a transsphenoidal surgery, TSS for short.
Copy !req
272. It's less invasive than our other option.
Copy !req
273. That still sounds dangerous.
Copy !req
274. I've made up my mind.
Copy !req
275. Do I get any say in this?
Copy !req
276. I'm all for us having a family,
but I'm not ready to…
Copy !req
277. No one's ever ready for kids.
Copy !req
278. Yesterday, you said that
you never considered getting pregnant,
Copy !req
279. and now you're willing
to risk your life for it.
Copy !req
280. When I was about seven,
Copy !req
281. I had this one refuge.
Copy !req
282. I'd hang a quilt over a couple chairs
Copy !req
283. and hide out with my two buds,
Copy !req
284. Foxie the Fox and Fuzz the Lion,
Copy !req
285. and I'd imagine,
Copy !req
286. I was the dad.
Copy !req
287. And they were my twin little guys,
Copy !req
288. fraternal, obviously.
Copy !req
289. We were a family.
Copy !req
290. When I transitioned,
I put that dream aside.
Copy !req
291. At least, as far as
them coming from me.
Copy !req
292. But now…
Copy !req
293. Whether we planned it or not,
Copy !req
294. this is our baby.
Copy !req
295. How soon can you do the surgery?
Copy !req
296. I'll order an image-guidance MRI
to get things started.
Copy !req
297. Based on the cardiac MRI
and catheterization,
Copy !req
298. there are two treatment options.
Copy !req
299. Myectomy, basically open heart surgery,
Copy !req
300. and alcohol septal ablation,
Copy !req
301. where we use the alcohol to kill
targeted sections of the heart muscle.
Copy !req
302. Well, what would you recommend?
Copy !req
303. The surgery is more invasive,
tougher recovery,
Copy !req
304. but better efficacy long-term.
Copy !req
305. The ablation is less dangerous,
Copy !req
306. but you're more likely to need
further medical interventions.
Copy !req
307. Now, you call that a recommendation?
Copy !req
308. There are pros and cons to both.
Copy !req
309. Uh, you'll need to weigh them.
Copy !req
310. I'll give you some time.
Copy !req
311. You always want to take care of people,
Dr. Browne?
Copy !req
312. Pretty much.
Copy !req
313. Me, too.
Copy !req
314. Oh. Well, you run a marijuana dispensary.
Copy !req
315. It's not all about getting people high.
Copy !req
316. No, maybe not,
but I'm guessing most of your clientele…
Copy !req
317. My Great-Aunt Lucy
had pancreatic cancer.
Copy !req
318. A year, she hung on.
Copy !req
319. In agony.
Copy !req
320. Marijuana was the only thing
that helped her eat or sleep.
Copy !req
321. Doctors didn't give her anything
for the pain?
Copy !req
322. They suggested ibuprofen.
Copy !req
323. Now, you know doctors
are 22% less likely
Copy !req
324. to give pain meds to Black patients
Copy !req
325. than to white patients
with the same symptoms.
Copy !req
326. My point is, you and I, we're a lot alike.
Copy !req
327. We're both strong, Black women
finding our way in the world,
Copy !req
328. but one of us knows more
about medicine than the other.
Copy !req
329. So, I'd like to know,
what would you do in my situation?
Copy !req
330. The open myectomy is a bigger risk
Copy !req
331. but offers more long-term benefits.
Copy !req
332. I've made my decision.
Copy !req
333. I'm with you, Dr. Browne.
Copy !req
334. Book the myectomy.
Copy !req
335. Here's the Rio Gutierrez imaging
for your upcoming TSS.
Copy !req
336. Set that on the table, please.
Copy !req
337. I, um…
Copy !req
338. I noted the tumor's suprasellar expansion
Copy !req
339. and surrounding edema
and splaying of circle of Willis.
Copy !req
340. That is very helpful.
Copy !req
341. Bye, Dr. Murphy.
Copy !req
342. You're safe, Shaun. She's gone.
Copy !req
343. Not really.
Copy !req
344. Dr. D'Souza is still in my brain.
Copy !req
345. I don't like it.
Copy !req
346. We kissed.
Copy !req
347. - When?
- What?
Copy !req
348. I have so many thoughts about her,
Copy !req
349. and I have so many questions
I want to ask Rio.
Copy !req
350. Wouldn't he get
more pleasure for…
Copy !req
351. Questions you're not supposed to ask him.
The kiss. When did you kiss?
Copy !req
352. Last night. In my dream.
Copy !req
353. If I can't ask questions,
how do I understand?
Copy !req
354. My… My brain…
Copy !req
355. My… My brain isn't behaving
the way I want it to.
Copy !req
356. How do I make it stop?
Copy !req
357. You're attracted to Dr. D'Souza.
Copy !req
358. Why does that bother you?
Copy !req
359. When I was with Carly
and had feelings for Lea,
Copy !req
360. it meant I was supposed to be with Lea.
Copy !req
361. What if this means
I'm supposed to be with Dr. D'Souza?
Copy !req
362. No. You've loved Lea for years.
Copy !req
363. This is just… attraction.
Copy !req
364. But shouldn't loving Lea
make it go away?
Copy !req
365. Relationships would be
a lot easier if it worked that way.
Copy !req
366. You're feeling guilty.
Copy !req
367. I say take Lea out for a nice dinner,
something special.
Copy !req
368. And tell her about my crush.
Copy !req
369. I need to let Lea know.
Copy !req
370. - No, definitely not.
- No, you do not.
Copy !req
371. I want to get your thoughts
on the suprasellar extension of the tumor
Copy !req
372. - for this TSS.
- You remember Sarah Pepper?
Copy !req
373. Runs nephrology at S.F. Regional?
Copy !req
374. Always wears a shawl?
Copy !req
375. So, during the staff meeting last week,
she fell apart.
Copy !req
376. Screaming, crying in front
of the whole department. Totally nuts.
Copy !req
377. Rough day at the office.
Copy !req
378. Wonder how you'd approach
and resect without getting a CSF leak.
Copy !req
379. Yeah.
Copy !req
380. Place a lumbar drain, then infuse saline
and do Valsalva maneuver.
Copy !req
381. Okay.
Copy !req
382. Apparently, Pepper's meltdown
was so over the top,
Copy !req
383. the hospital forced her to take a leave.
Copy !req
384. - How long?
- Unspecified.
Copy !req
385. She's always been a little crazy.
Copy !req
386. Last I checked, eccentric and emotional
didn't qualify as crazy.
Copy !req
387. Thanks for taking a look.
Copy !req
388. I read that cisgender people
Copy !req
389. often reduce transgender people
to their genitalia,
Copy !req
390. and that that is offensive.
Copy !req
391. Did I do that to you and Rio?
Copy !req
392. Yes.
Copy !req
393. I'm sorry.
Copy !req
394. Rio will be going into surgery soon.
Copy !req
395. He's been asking for you.
Copy !req
396. You haven't been
answering your phone.
Copy !req
397. Thanks for letting me know.
Copy !req
398. He is very confusing to me, too.
Copy !req
399. Rio has worked so hard,
Copy !req
400. he had a bilateral
subcutaneous mastectomy
Copy !req
401. and takes hormone
replacement therapy,
Copy !req
402. but now he is choosing
the most female act.
Copy !req
403. It's not female if Rio's doing it.
Copy !req
404. Y… Yes.
Copy !req
405. And he must have
dealt with a lot of prejudice
Copy !req
406. during his transition.
Copy !req
407. I dealt with prejudice.
Copy !req
408. My brother helped me.
Does he have a brother?
Copy !req
409. His family doesn't talk to him.
Copy !req
410. And now Rio is having brain surgery.
Copy !req
411. He is very brave.
Copy !req
412. You can stay here.
Copy !req
413. I have a patient, Zara Norton.
Copy !req
414. We, uh… We diagnosed her with HOCM.
Copy !req
415. I saw the file.
Copy !req
416. Dr. Guerin expressed some concerns
Copy !req
417. about my initial handling
of the case in the ER.
Copy !req
418. He thinks I stereotyped her,
based on her race.
Copy !req
419. Do you think you did?
Copy !req
420. She was crashing.
Copy !req
421. I had to make a call.
I didn't have a lot to go on.
Copy !req
422. Glassman came to see me this morning.
Copy !req
423. Someone told him
I'm unstable and need help.
Copy !req
424. Any idea where he heard that?
Copy !req
425. I asked for help. You can, too.
Copy !req
426. You're a resident.
No one cares if you need help.
Copy !req
427. I got this job in part
Copy !req
428. because my main competition,
a man, backed me.
Copy !req
429. The second anyone thinks
I can't handle this…
Copy !req
430. No one is gonna think that…
Copy !req
431. They will if you keep
telling them I'm a mess.
Copy !req
432. You have PTSD.
Copy !req
433. You shouldn't be ashamed.
Copy !req
434. Says the women
who just profiled a Black female patient.
Copy !req
435. You judged her,
Copy !req
436. just like people will judge me
Copy !req
437. and whisper that I've always
been a little intense,
Copy !req
438. so no wonder I was asked to step down.
Copy !req
439. Nobody needs to know.
Copy !req
440. Exactly.
Copy !req
441. You tell me that it doesn't matter.
Copy !req
442. You tell me everyone will understand,
Copy !req
443. and then you tell me
to keep it to myself.
Copy !req
444. Should I be ashamed,
or shouldn't I be?
Copy !req
445. All right, Ms. Norton,
time to head to pre-op.
Copy !req
446. What's in the bag, handsome?
Copy !req
447. I like to know what goes into my body.
Copy !req
448. Uh, cefazolin. It's a prophylactic
antibiotic we give before surgeries.
Copy !req
449. Makes sense.
Copy !req
450. Hey, what was the med y'all gave me
when I first got here to the ER?
Copy !req
451. Enalaprilat. It's an ACE inhibitor.
Copy !req
452. Isn't that for hypertension?
Copy !req
453. Mm-hmm.
Copy !req
454. But I thought I already told y'all
I was on meds for my blood pressure.
Copy !req
455. You did.
Copy !req
456. So, you figured I needed more?
Copy !req
457. Or did you not believe me?
Copy !req
458. I'm sorry.
Copy !req
459. You must be scared.
Copy !req
460. You shouldn't have to be scared alone.
Copy !req
461. I love you.
Copy !req
462. I love you, too.
Copy !req
463. Eli.
Copy !req
464. I can't see you.
Copy !req
465. I'm right here, babe.
Copy !req
466. Can you follow this with your eyes?
Copy !req
467. It keeps disappearing.
Copy !req
468. You've lost peripheral vision.
Copy !req
469. The tumor is impinging
on the optic fibers.
Copy !req
470. We can't perform the TSS surgery.
Copy !req
471. With the tumor's
continued growth,
Copy !req
472. the best remaining option
is the open pterional craniotomy.
Copy !req
473. But it is higher risk
with a lengthier recovery.
Copy !req
474. All of which is on top of the potential
for gender dysphoria
Copy !req
475. during pregnancy.
Copy !req
476. Is that still a concern?
Copy !req
477. I think back to before I started taking T,
Copy !req
478. how terrible that felt.
Copy !req
479. The thought of feeling that
all over again…
Copy !req
480. We could go back to the original plan.
Copy !req
481. You mean terminate the pregnancy?
Copy !req
482. The tumor should shrink on its own.
Copy !req
483. After everything you've done
to get where you are in your life,
Copy !req
484. it's scary to think about doing something
that would put that at risk.
Copy !req
485. This is my next step.
Copy !req
486. I'm ready to take it, even if I'm scared.
Copy !req
487. You have to take risks sometimes, Dr. Lim.
Copy !req
488. Thank you.
Copy !req
489. Shouldn't you be prepping Zara
for surgery?
Copy !req
490. It's canceled.
Copy !req
491. She wants to be transferred
to a different hospital.
Copy !req
492. One where she won't be
"racially profiled into heart failure."
Copy !req
493. Shaun, you okay?
Copy !req
494. I am having thoughts
I don't want to have.
Copy !req
495. Both Park and Jordan
say I shouldn't tell you.
Copy !req
496. But you're going to, aren't you?
Copy !req
497. Yes, I am.
Copy !req
498. I have a work crush.
Copy !req
499. Also, my patient is a pregnant trans man…
Copy !req
500. Okay, one at a time, Shaun.
Copy !req
501. About this… crush?
Copy !req
502. Her name is Dr. Cintia D'Souza.
Copy !req
503. She is a second-year radiology resident.
Copy !req
504. Last night, I dreamed we were
in the Residents' Lounge,
Copy !req
505. watching The Weather Channel,
Copy !req
506. - and then we started kissing…
- Okay, I got it.
Copy !req
507. Are you mad?
Copy !req
508. Park and Jordan were right.
I shouldn't have told you.
Copy !req
509. No. I'm not mad.
Copy !req
510. A little surprised, but that's okay.
Copy !req
511. I'm still attracted
Copy !req
512. to other guys sometimes.
Copy !req
513. N… No.
Copy !req
514. No. What? Who?
Copy !req
515. - It doesn't matter.
- Who?
Copy !req
516. There… Okay, there is
this one physical therapist…
Copy !req
517. N… No.
Copy !req
518. No.
Copy !req
519. No.
Copy !req
520. What if we're attracted to other people
Copy !req
521. because there is something wrong
with our relationship?
Copy !req
522. You're not planning
on kissing Dr. D'Souza in real life?
Copy !req
523. No.
Copy !req
524. Or working late with her,
Copy !req
525. doing some X-rays alone,
Copy !req
526. where you might end up
leaning over the same light box.
Copy !req
527. We don't use light boxes anymore.
Copy !req
528. And I don't plan to work late with her.
Copy !req
529. Then I don't think either of us
has anything to be worried about.
Copy !req
530. I have to go prep
for a pterional craniotomy.
Copy !req
531. I'm Dr. Glassman,
president of the hospital.
Copy !req
532. Unless you're here
to drive me to S.F. Regional,
Copy !req
533. you can head right back on out.
Copy !req
534. I apologize for your experience
in the emergency room.
Copy !req
535. That's mighty white of you.
Copy !req
536. I don't recommend
that you transfer to S.F. Regional,
Copy !req
537. or any other hospital,
for that matter.
Copy !req
538. I'm sure they got
the same fancy equipment,
Copy !req
539. same shiny sets
of diplomas y'all got here,
Copy !req
540. and maybe a few less racist doctors.
Copy !req
541. Well, apparently,
that doesn't seem to be the case.
Copy !req
542. I pulled data on comparable hospitals
within 100 miles,
Copy !req
543. did numbers on surgical outcomes
Copy !req
544. and patient satisfaction,
aggregated by race.
Copy !req
545. Apparently, we're doing well,
comparatively.
Copy !req
546. Your argument is that
your hospital may be racially biased,
Copy !req
547. but it's less racially biased
than these other hospitals?
Copy !req
548. Yeah. Pretty much.
Copy !req
549. Stay at St. Bonaventure,
Copy !req
550. the president of the hospital will
monitor your care every step of the way.
Copy !req
551. For whatever it's worth,
Copy !req
552. I don't think you can do better than that.
Copy !req
553. She's gonna stay, on one condition.
Copy !req
554. That you're off the team.
Copy !req
555. Dr. Park,
please open Sylvian fissure.
Copy !req
556. Arachnoid knife
and Rhoton dissector.
Copy !req
557. Tumor is visible.
Copy !req
558. What makes someone a man?
Copy !req
559. I thought it was just the chromosomes,
Copy !req
560. but that must not be it,
Copy !req
561. which makes things
confusing and difficult,
Copy !req
562. and I know Rio
was uncomfortable when he…
Copy !req
563. Life is uncomfortable.
Copy !req
564. It hits you with tough situations
and you muscle through them.
Copy !req
565. I see a tiny bleed in the circular sinus.
Copy !req
566. Pack it with Floseal.
Copy !req
567. - Someone give me an update.
Copy !req
568. We got a drop
in end tidal CO2 and oxygen sat.
Copy !req
569. See any evidence
of exposed air cells?
Copy !req
570. No. But waxing
bone edges just to be safe.
Copy !req
571. But the tumor thinned
the sellar floor and sphenoid wall.
Copy !req
572. Making it permeable to oxygen.
Copy !req
573. It's an air embolism.
Copy !req
574. - BP's dropping.
Copy !req
575. Dr. Lim, what should we do?
Copy !req
576. Saline gauze,
Copy !req
577. tilt the table to eliminate
the negative air pressure gradient,
Copy !req
578. and place a central line.
Copy !req
579. This will stop the air leak
and allow us to access the air bubble.
Copy !req
580. Inserting Bunegin air-aspirating cath.
Copy !req
581. You are 2 centimeters
from the superior vena cava.
Copy !req
582. Aspirate the right atrium
until you don't see any more air bubbles.
Copy !req
583. Nice save, Dr. Lim.
Copy !req
584. Let's get this tumor out.
Copy !req
585. Make your transverse
aortotomy with Potts scissors, Dr. Wolke.
Copy !req
586. Extending the muscular incision
down to the mid-ventricle.
Copy !req
587. There's the myectomy site.
Copy !req
588. There's the aberrant muscle bundle.
Copy !req
589. Get her off bypass,
Copy !req
590. see how she does.
Copy !req
591. How's the cardiac output?
Copy !req
592. Reduced and insufficient.
Copy !req
593. Low output could mean
we need to further reduce the septum.
Copy !req
594. Unless it means that
we reduced it too much.
Copy !req
595. Damaged the cardiac
electrical conductors
Copy !req
596. - that control the heart rate.
Copy !req
597. She's having third-degree heart block.
Copy !req
598. Enrique's right.
Copy !req
599. We took too much muscle.
Copy !req
600. Put her back on bypass.
Copy !req
601. We could augment the wall
with a bovine patch.
Copy !req
602. Still wouldn't insulate
the electrical system.
Copy !req
603. She'd still be at risk of complete
heart block and cardiac arrest.
Copy !req
604. We could insert
a dual chamber pacer.
Copy !req
605. She won't need the conduction system
in the wall of her heart
Copy !req
606. to control her heart rate.
Copy !req
607. Let's go!
Copy !req
608. How was the craniotomy?
Copy !req
609. It went well.
Copy !req
610. The patient is in recovery.
Copy !req
611. Your text said you have good news.
Copy !req
612. And by good news, I mean
bad news for Dr. D'Souza.
Copy !req
613. Plenty of great stuff to crush a crush.
Copy !req
614. First observation,
Copy !req
615. she smells like cinnamon.
Copy !req
616. Mm.
Copy !req
617. Which is more puzzling than irritating.
Copy !req
618. Actually kind of nice.
Which is obviously not helpful.
Copy !req
619. Oh, okay. She does this
weird self-grooming gesture
Copy !req
620. where she tucks her hair behind her ear.
Copy !req
621. And then sorta massages her ear.
Copy !req
622. Also n… not helpful.
Copy !req
623. Okay. I'm sorry. I'm sorry.
Copy !req
624. Mm-hmm.
Copy !req
625. Okay. At the salad bar,
Copy !req
626. she used the cucumber tongs
to reach for the cucumbers,
Copy !req
627. and then the tomatoes.
Copy !req
628. And the olives.
Copy !req
629. And the pickles.
Copy !req
630. - Ugh.
- Mm.
Copy !req
631. Mm-hmm.
Copy !req
632. Hey.
Copy !req
633. Hey.
Copy !req
634. I can see all of you.
Copy !req
635. How'd… How'd we do?
Copy !req
636. Great. We got all of the mass,
vision is restored.
Copy !req
637. You have every reason
to expect a full recovery
Copy !req
638. and a healthy pregnancy.
Copy !req
639. We're gonna be dads.
Copy !req
640. Are you ready?
Copy !req
641. I've never been a pregnant man before.
Copy !req
642. You'll always be the best man
that I've ever known.
Copy !req
643. Came to see how you were doing.
Copy !req
644. Dr. Andrews told me you was the one
who figured out how to save me.
Copy !req
645. Still don't change
what went down earlier, though.
Copy !req
646. When I got to med school,
Copy !req
647. people took one look at me and they
thought they knew exactly who I was.
Copy !req
648. Black girl on financial aid.
Copy !req
649. She must not be that smart.
Copy !req
650. She must have gotten a lot of breaks.
Copy !req
651. She'll probably need a lot more.
Copy !req
652. And I worked…
Copy !req
653. I worked so hard
Copy !req
654. to prove them wrong,
Copy !req
655. that I wasn't who they thought I was,
Copy !req
656. that I deserved to be there, that I…
Copy !req
657. that I fit in.
Copy !req
658. When you came into the ER,
Copy !req
659. loud and messy,
Copy !req
660. I saw…
Copy !req
661. I saw everything
I have tried hard not to be.
Copy !req
662. And I think it made me angry.
Copy !req
663. And I'm ashamed of that.
Copy !req
664. And I'm really sorry.
Copy !req
665. I used to be that way.
Copy !req
666. But I got tired of working that hard
to make white people comfortable.
Copy !req
667. You two heading out for the night?
Copy !req
668. We sure are.
Copy !req
669. How did the craniotomy go, Shaun?
Copy !req
670. - Did you guys get all the prolactinoma?
Copy !req
671. Yes.
Copy !req
672. Is that cafeteria salad?
Copy !req
673. Are there pickles in there?
Copy !req
674. Did you want some?
Copy !req
675. You know, I'm good. Thank you.
Copy !req
676. Shaun, did you…
Copy !req
677. - No, thank you.
- Mm-hmm.
Copy !req
678. It does help to focus
on her irresponsible salad bar practices
Copy !req
679. and dietary preferences.
Copy !req
680. I've got a ton of strategies
to manage discomfort.
Copy !req
681. So do I.
Copy !req
682. - Hey.
- Hey.
Copy !req
683. To replenish your supply,
Copy !req
684. and a peace offering.
Copy !req
685. I wasn't aware we were at war.
Copy !req
686. Well, seemed like my gossip
about Pepper kind of landed wrong.
Copy !req
687. Bad day.
Copy !req
688. Sorry to crash the party.
Copy !req
689. Dr. Glassman wanted me
to show this to you two.
Copy !req
690. I asked Lea to run some numbers
on various metrics by race,
Copy !req
691. and the results are not great,
Copy !req
692. especially when it comes
to pain management.
Copy !req
693. We are under-treating
African-American and Latinx patients
Copy !req
694. by a considerable margin.
Copy !req
695. I think I need a little
of that peace offering.
Copy !req
696. Help yourself.
Copy !req
697. - Anyone else?
- No. Thank you.
Copy !req
698. Uh… me, neither.
Copy !req
699. I…
Copy !req
700. started taking sertraline.
Copy !req
701. For PTSD.
Copy !req
702. Sorry to hear that.
Copy !req
703. You doing okay?
Copy !req
704. Not really.
Copy !req
705. But I'm
Copy !req
706. working on it.
Copy !req
707. Okay.
Copy !req
708. Dr. Browne, good work.
Copy !req
709. Thank you.
Copy !req
710. I apologized to Zara.
Copy !req
711. She pointed out I spent med school
Copy !req
712. trying to make white people comfortable.
Copy !req
713. I mean, she's right.
Copy !req
714. It wasn't just med school.
Copy !req
715. Exhausting, isn't it?
Copy !req
716. But we had to do it, right?
Copy !req
717. To be here?
Copy !req