Severe Winter Weather Advisories
have been issued from Kansas to western Minnesota.
Severe ice and snow reported.
Temperatures will likely reach below 20 degrees, and wind chill...
Shaun.
Mm. There is a severe weather warning in Minnesota.
You haven't been at work in three days.
I want to be left alone.
I'm sorry she hurt you.
But you are strong.
You're the most determined man I know.
You're gonna get through this.
I wish I was...
Normal.
Everyone wishes they were normal, Shaun.
You need to get up.
You need to do your exercise routine,
then shower, shave, and get to work.
And not because your patients need your help,
but because it'll make you feel better.
I'm not leaving without you.
Your sleep apnea is worse than we'd thought.
You have a condition related to your pseudoachondroplasia
that is narrowing the base of your skull
and compressing the part of your brain
that controls your breathing.
People always say I'm too full of myself.
Guess it's actually true.
Finn, this is serious.
Don't worry. I'm gonna be fine.
We can remove bone from the wall of your skull
and resect a small section of your cerebellum
to reduce brain-stem pressure.
You're... You're gonna cut out a piece of his brain?
It won't affect your intellect,
but it will cause a speech impediment
and some difficulty with balance.
I'd rather you knock a few points off my IQ.
Stop it.
I'm serious.
My "gift of gab" is what you love about me.
Uh, w-what's option two?
I'm sorry, there is no other option.
I'm a salesman. I don't hear the word "no."
Th-There's always another way.
You just got to think outside the box.
We've already done that,
which is how we came up with this surgery.
It's the only way to keep you alive,
so you have no choice but to accept it.
Dr. Murphy is being rude and insensitive,
but he's also right.
Finn, please, I love you.
And I will always be here for you
no matter how you talk or walk.
But you have to listen to your doctors.
I love you, too.
Do whatever you think's best.
Let me guess.
I'm gonna need another surgery.
What's that now, my tenth?
Eleventh.
And I still can't work the farm,
can't drive a tractor, pull a combine lever.
I can't even twist open a bottle of beer.
When we met, you were in an ambulance
and your arms were still in your harvester.
Today you have sensation and almost full mobility.
Now we just need to treat the neuropathy
and improve your strength.
So how do we do that?
I'm thinking a gracilis muscle transfer.
That should improve his grip and relieve some of the pain,
but there's only one way to eliminate all of it.
Tyson, have you given any more thought to amputation
and osseointegrated prosthetic arms?
They'd attach directly to the bones
and nerves in your forearm,
and you can control them just like your own hands.
Function would be reduced in some respects.
Less dexterity, no sensory feedback.
But others, like grip strength, would be better.
And more importantly, you'd be pain-free.
I want to be a farmer,
not a cyborg.
Okay.
The pain's getting worse.
Probably because I've been crazy busy in the O.R.
with Murphy out till today.
He's back?
Only because Browne went to his apartment
and dragged his ass in.
She shouldn't have done that.
He's trying to work this out on his own.
That's a good thing.
DMARDs aren't working.
I know.
Which is why I've been thinking about synovectomy surgery.
You're gonna remove the joint linings in your fingers?
That'll resolve the pain temporarily.
Then what?
It'll give me at least ten years.
And then you're gonna be bone on bone,
every joint in your hand will be mangled and deformed.
What's your plan then?
Who knows what treatments will be available in ten years?
Have you thought about oncology?
Surgeons do the real work.
They cut out the tumor, they cure the patient.
Oncologists just sweep up after.
You want to know an even better job?
Starting pitcher for the Oakland A's.
You want to know why I didn't get that job?
Because the scouts didn't like the way you wore your hat?
Yeah, that, and I was born with this arm.
You were born with those hands.
What are you gonna do,
practice surgery for a few more years
and then spend the rest of your life
not being able to pick up a pencil?
You can pursue another specialty.
You can practice for the rest of your life.
You get rear-ended on the way to work
or you just hate little people?
Neither. EKG is normal.
So you got dumped.
No, I didn't.
It's nothing to be ashamed of.
We were never even going out.
Finn?
I've been worried sick.
Ohh.
Take it easy.
I told you to stay home.
There's nothing to worry about.
Stop trying to act so tough.
You shouldn't have to go through this alone.
Sorry, baby, but you should wait outside.
Let the doctors finish up, and I'll be right out.
He's not going to the O.R. for a while,
so there will be plenty of time to visit when we're done.
Okay.
I'll be right outside.
Is there any way you could make sure
she and Nathalie stay in separate waiting rooms
and aren't allowed to visit at the same time?
No. We're not helping you cheat.
I'm not cheating.
I've always made it clear I'm not ready to settle down,
but sometimes women m-make assumptions.
Oh, and you don't feel the need to correct that?
I understand you don't approve,
but all I'm asking
is for you to help me get through brain surgery
without emotional turmoil
that I assume would be harmful to my recovery.
Okay.
Thank you.
Are you seeing the same thing I'm seeing?
The tendons are encased in scar tissue.
The gracilis muscle transfer isn't gonna work.
It still could. If we attach the muscle
further down the forearm and bypass the scar ball.
It wouldn't hold.
There'd be too much tension on the graft.
We can figure out a way to work around that.
Let's wake him up and put him back in his room
and pull every paper on free-muscle and nerve transfers.
His only option is double amputation
and the osseointegrated prosthetics.
We don't have a choice.
Yes, we do.
And as Chief of Surgery, I just made it.
He doesn't really look the part.
He's a handsome guy with a great sense of humor
and a high-paying job.
He means because women don't like
to be in relationships with men who are weird.
He's not weird. And neither are you.
And a week ago, you were juggling two women,
so stop feeling so sorry for yourself.
Have you ever dated anyone who wasn't tall,
handsome, and neurotypical?
It's not about me.
Talk to me. He stopped breathing,
and I haven't even administered the paralytics.
What just happened?
Pressure on the medulla must be getting worse.
He's lucky he didn't wait any longer to come in.
Let's tube him and get to work.
Wait. Flex his head into position again.
Extend his neck.
What's going on?
Flexing the neck offsets the posterior compression.
But that should take the pressure off, not make it worse.
Doesn't make any sense.
And we're not gonna do brain surgery on him until it does.
I don't see anything different in the flexed-neck views.
Should his C2 bone be curved inward like that?
It could exacerbate the narrowing on the front of his...
It's not significant.
Well, if his apnea's getting worse
because of pressure from the front as well as the back...
The treatment is the same.
Surgery to create more room in the skull base.
It's not the same, and stop interrupting me.
If we drill off the C2 in the front,
as well as open the back,
we might not have to resect the cerebellum.
He wouldn't have any speech impediment or balance issues.
We'd have to approach through his mouth,
a bacteria-rich environment,
which can't be fully sterilized.
There would be too high a risk of a post-op brain infection.
So we figure out another approach.
There's only one safe way to access the C2.
Okay, so come up with something outside the box.
No, that's a stupid expression. There is no box.
And you are wasting valuable time
just because you want to be nice to her.
Murphy...
We should do the cerebellar surgery before he has a fatal apnea...
Murphy.
I'm not being nice.
I'm using my experience and judgment to make the call.
That's my job.
You are being nice. And you're being a jerk.
You've got the night.
If you two can't come up with a solution by morning,
we'll proceed with the original plan.
Your patient's in desperate need
of an Oklahoma weather report?
I didn't even want to be here today.
You should try a martial arts class.
Focused distraction is key to dealing with stress
and heartbreaks.
That's just avoiding the problem.
Don't obsess over what you've lost,
focus on what you've gained from the relationship.
I hate to interrupt group therapy,
but what if we approached
through the side of the neck?
We could transpose the vertebral artery,
open up the spine laterally to drill off the C2.
It would leave his spine permanently unstable
and could cause a stroke.
There might be a way to mitigate stroke risk.
And he'd still have the instability and...
Come on, Shaun.
I need help, not criticism.
I have always supported you
when you were trying to come up with
an unconventional treatment option.
You supported me when you thought I was right.
What do you guys think?
We gotta go.
We do?
We remove the scar tissue and the nerves.
Then harvest nerves from his upper arm
to rewire his forearms.
It'll improve his grip,
and with the scar tissue removed,
the pain should decrease, too.
Does nothing to solve the blood-flow problem
that's causing the scarring.
I'm sure we can come up with a solve for that.
That's what you said last time.
And I was right. We're making progress.
Would you two give us a moment?
We'll meet you in the Residents' Lounge when we're done.
Are you so against the prosthetics
because you think it's in Tyson's best interest,
or because it's my idea?
You think I care whose idea anything is?
You're a competitive person
working with the guy who used to hold your job.
I'll admit my competitive drive may kick up a notch
when we work together.
I'll also admit that I admire the courage
of a guy who stumbled a half-mile back to his house
after his arms were ripped off by a combine.
He opened a door with his mouth
and dialed 911 with his nose,
and as long as he wants to keep fighting,
I'm gonna fight along with him.
Which has nothing to do with my ego.
Good.
That's all I wanted to confirm.
But I'm gonna start prepping for the amputation
because that's the only rational choice we have,
which I'm confident you'll realize soon enough.
Make any progress?
Yeah, I figured out a lateral approach,
but Shaun thinks it would leave his spine unstable
and increase his risk of stroke.
I agree. Yeah, me too.
There has to be a way to mitigate the...
Dr. Browne?
These just got delivered.
Enjoy. Thanks.
Dash is a romantic.
Thought you hated romantics.
Yeah, he's... He's teasing me.
I told him I thought guys who sent flowers were lame.
We haven't even kissed yet.
What are you waiting for?
I don't know.
Um...
I enjoy being with him.
Actually, I forgot how funny he is.
Just... hasn't seemed like the right time.
I'm more worried about the stroke risk
than spinal instability,
so focus on fixing that.
Okay.
And, Claire, if he's the right guy,
stop holding out for the right time.
Your vitals are stable.
The nurses will monitor you during the night.
Your problem's simple to solve.
You just need to ask someone else out.
Lea was special.
I'm sure she was.
But there are so many others, just as special.
You just have to get to know them.
No, I don't want to.
Yes, you do.
You think I don't know how you feel?
Afraid of being rejected because you're too...
Different.
Finally I decided, screw it.
I started talking to every woman I saw.
Street corners, elevators, grocery stores.
And I learned I'm pretty good at it.
That's my gift.
Everyone has one.
They just.
Have to figure out what it is...
Okay. Code Blue!
Code Blue!
Murphy and I just inserted a diaphragmatic pacemaker on Finn.
It'll only trigger shallow breaths,
so he's at high risk for pneumonia.
You got anything?
Yeah, I was thinking of using
a more inferior transatlas approach.
That would minimize stroke risk.
That won't work.
It would destabilize the C1-2 joint.
You did all you could.
Go home.
We'll do the original cerebellar surgery
first thing in the morning.
So I'll be able to work the farm.
We still need to find a way to increase blood flow.
You should regain most of your grip and forearm strength,
but you'd still be in some pain.
I-I can handle it.
Can you?
How can you know for sure?
As the years go by and the pain doesn't stop,
will you change your mind?
Because it'll be too late.
What's wrong? What are you... What are you feeling?
Like a horse just kicked in my chest.
I need an echo and pulmonary cath kit!
And page Lim, stat!
I think the last time that I was at an actual punk-rock show was, uh...
College.
Patti Smith.
Oh, my God!
I completely forgot about that.
You forgot getting your ass tossed offstage
by a 60-year-old woman?
Yeah.
Remember what you said when we picked you up?
Uh, oh, something about her being, uh, thin but strong?
"Thin but wiry."
Wiry. Wiry.
Okay, well, I, um...
I have an early surgery,
so I should probably get going.
Okay. Okay.
Have a good night.
Good night.
I got an idea.
Actually, you had it first.
It's the right approach, just the wrong route.
We go in from the back, posterior transdural,
gently move your spinal cord out of the way
so we can drill off the misshaped C2.
There is a risk of paralysis,
but we would be monitoring your spinal functions
to help avoid any nerve injuries.
Let's do it. Where do I have to sign?
You shouldn't sign anything.
Consenting to this surgery
would be incredibly shortsighted and reckless.
It is one thing to take your bad mood out on your colleagues,
but to try and undermine my surgical advice...
My opinion's valid.
Well, thankfully, he disagrees.
He's risking paralysis to be charming
because people expect everyone to be perfect.
Everyone's opinion is valid
all the way until we go into the patient room.
We are a team with one opinion.
I...
I don't feel better!
I feel worse!
And doing the wrong surgery
is not going to help anyone.
I don't want to do it, I'm going home.
You're not walking out on your patient.
Or your team.
I still have two sick days
and 76 hours of unused P.T.O.
You're not sick, and you're in the middle of a case.
I don't care about the case or the patient.
I don't care about anything.
I've had my heart broken twice
in the last few years.
You want to know what I did?
I came to work every day
and pretended everything was fine.
Until, eventually,
I wasn't pretending anymore.
That's not helpful at all.
How about this?
Go back in there
and help Claire prep Finn for surgery,
or you won't be my resident.
Or anyone else's at St. Bonaventure.
And I know you care about that.
We were able to clear the clot,
but due to the restricted arteries in your arms,
we're gonna need to keep you on blood thinners...
Indefinitely.
Okay.
The blood thinners
make the reconstructive surgery impossible.
We have no choice but to amputate.
I'm sorry.
No.
I'm not letting you cut off my arms.
I don't want false limbs.
I don't want to be that guy.
I want to be who I am.
You are the toughest,
most tenacious person I've ever met.
And that is not gonna change
because we replace your hands with titanium.
It's time to let go.
Okay.
Any way you could draw a skull
with a cobra coming out of its eyes while you're back there?
Would you settle for a lame smiley face?
Because that is the only thing I can draw.
There's my favorite nurse.
Did you check out that Ethiopian place
I told you about last night?
Actually, I did,
and the kik alicha was delish.
Now, if you want a truly life-changing meal,
you need to try Lennon's on Sixth.
Is it expensive? Outrageously.
But worth it.
Now, it's all white tablecloths and candles,
so you'll need a date.
How 'bout Dr. Murphy?
You told me yourself he's a gifted surgeon.
That's pretty high praise.
And he told me you're cute.
Good luck today.
Thanks.
I totally teed you up.
All you had to do was take a swing.
I'm not interested in her.
If she's not your type,
I'm sure there are plenty of other cool nurses
roaming around here
who could make you feel better about yourself.
He's miserable because he's had two relationships blow up.
I don't think jumping into another one is the answer.
No, no, no!
Finn, you can't exert yourself like this.
Just take it easy.
I ran into a woman in the cafeteria.
Real nice. But seemed stressed.
Turns out that her boyfriend
is having spinal surgery, too.
Big coincidence, huh?
But get this.
He also has pseudoachondroplasia.
I mean, what are the chances?
Nathalie, don't you dare.
Stop!
Just slow down.
You called me the love of your life!
I do love you!
Don't say that!
I don't want to hear any more of your garbage.
Please...
You have to... listen.
You need to get back to bed now, or you'll pass out.
What's up?
What are you doing in here?
Once you get a patient on the table,
there's too much going on
to appreciate what this place is.
Mm. It's nice.
It's perfect.
Time to scrub in.
This will be my last surgery.
Five months ago, I was diagnosed with rheumatoid arthritis.
I'm not responding to medication.
Why did you do that?
I felt like it.
It didn't change the fact that he cheated on you.
It won't make your life any better.
You can't control how you feel about someone.
But you can control what you do with those feelings.
I ended the relationship on my terms.
More importantly...
It made me feel better.
A Louisville Slugger to a Porsche?
It was insane.
I like her.
What is to like?
I don't know.
I just do.
A sudden complete loss of any SSEP and MEP signals.
B.P. and heart rate are tanking.
We've injured his cord.
Push high-dose steroids and pressors.
Remove the retractor to take the pressure off.
That's the last of the vessels and nerves ligated.
Mayos.
Specimen bag.
We have healthy bone-anchor sites.
Same here.
Time to give him functional arms.
Not me. Give it to her.
She's a third-year resident...
A talented one, but I wouldn't...
I'm sure she's read every article written on osseointegration,
spent countless hours in the Skills Lab,
and could probably do this with one of her own arms tied behind her back.
Blindfolded.
Get to work.
Push another milligram of atropine.
We may have just paralyzed him trying to avoid a stutter.
We won't know anything until we wake him up.
Where's the pressure still coming from?
Laterally now.
So if we remove the joints of the C1 and C2 bones,
that should make enough room
so we could drill off the odontoid.
We could replace them with screws and rods
to stabilize his spine. That's...
A good idea.
Yes, it is.
If he's not already paralyzed.
Colleen Brown.
Freshman year.
I took her to the roller-skating rink
'cause I thought that's what you're supposed to do,
take girls to the roller-skating rink.
I didn't know how to roller-skate,
she ended up leaving with Bobby K.'s little brother.
Broke me up.
Couldn't go to school for a week.
Convinced my mom that I was sick
for the first three days,
and the last two I spent in a double feature all day...
Where's Poppa? And Twelve Chairs.
To this day, I can quote both films verbatim.
So you think I should've stayed home for two more days?
No, I don't think it would've mattered.
It doesn't make a difference.
And then I made a list
of all the things that annoyed me about her.
The way she chewed her gum,
the way she used to sit in the front row of every class
so that the teacher would call on her
when she raised her hand,
the way she said, "Excuse me?"
instead of just "What?" or "Huh?"
None of it makes any difference.
Then why are you telling me?
Maybe it'll make you feel a little bit better to know that,
what you're going through,
every other young man in the history of the world has gone through.
You're trying to make it work with Lea and with Carly,
and you're getting a little beat up, and that's okay.
Join the club.
You're in the mix. That's a good thing.
I'm proud of you.
You ready?
It's gonna take some getting used to.
But they're the same nerves you used before.
All you have to do is think about using the arms
the way you normally would.
Whoa.
That's pretty cool.
It's not a beer,
but you got to start somewhere.
Now pinch your forefinger and thumb and twist off the cap.
I-I can't feel the thing.
You'll get used to it. You got this.
Nice.
You want me to say you were right?
About the patient, or you?
When you offered me a job,
you said it was to help me get back on the horse.
But what you really wanted was a mentor.
Which I'm fine with,
but I think maybe you feel threatened by that need.
Well, maybe that's true.
But maybe also you enjoy it a little too much.
Maybe because you're having a hard time giving up being Chief.
Maybe we're both right.
How did it go?
Can you lift your arms for me?
Okay.
I'm gonna push your arm, and I need you to resist.
Good. More.
Stronger.
That's great.
You should make a full recovery.
Thank you.
H-How's Nathalie's hand?
There was no nerve or tendon damage.
She'll be fine.
She's a good person.
A little spirited,
but that's what I loved about her.
Are you going to try to win her back?
I'm confident but not stupid.
You gotta know when to call it, Dr. Murphy.
I mean, there's a-a whole world
of amazing people out there.
Don't get bogged down with this notion of a soulmate.
Finn's exam was normal.
But I am not sure it was worth the risk.
We did a good thing today.
Mostly because of you.
That's kind of you to say but...
Your commitment to your patients
reminds me of why I got into medicine.
Being around you makes me a better surgeon.
A better person.
Well, good night.
Good night.
You did good work today.
And I understand you're leaving surgery.
And I know that's a... That's tough.
But it's the right call.
No, I don't think it is.
I love operating.
So I'm gonna keep doing it as long as I can.
I'm gonna have the synovectomy surgery.
That's really stupid.
That's incredibly stupid.
Not every dream comes true.
You have other opportunities.
You have another chance.
Not everybody does. Be grateful for that.
Pick another passion and pursue that.
I'm doing the surgery.
Enjoy.
Another, please.
Well, that's one way to start the night off right.
Hello, Nurse Fletch.
You can call me Julie.
Are you here alone, or are you meeting someone?
I'm alone.
Well, to us.
You have beautiful eyes.
Thank you.
Or did someone just tell you that
that's a good opening line?
It's right in our backyard,
and I've never even been there.
- Have you? - No.
It's, uh, time we unleash our inner tree-hugger.
You're off next weekend.
I think we should go to Yosemite.
What do you think?
Yeah, sounds fun.
I need to get me some hiking boots.
Mm. And, uh, like a fleece.
Mm-hmm. Beanie.
Mm. I'm rocking the full lumbersexual look.
'Cause I gotta blend in.
I hear a bear can spot a tourist a mile away.
Mm. Mm-hmm.
You okay?
Uh, you're, uh...
You're here, but, you know, not.
You're right. I'm sorry.
It's... It's just been a long week.
I'm a bit exhausted.
Yeah, I think I might call it an early night.
Oh, you sure?
I... You know, we don't have to go to the club.
We can chill here. We can watch a movie.
I'm sorry.
I just...
I just think I should go home.
Okay.
Shaun?
I want to smash your car up.
I think that's a bad idea.
I want to hurt you the way you hurt me.
I'm s-sorry.
You...
You're...
I can't.
You acted like you cared about me,
but you don't even respect me.
You're flaky.
And...
And you can't keep a boyfriend.
And you can't keep a job.
And no one likes you.
And... And you're going to end up alone,
and you deserve it!
Because you're a superficial,
selfish, and prejudiced person!
You ready to tell me what's on your mind?
Not really.
I...
I think I'm in love with my boss.