New Amsterdam Episode 5 – Cavitation
A Senseless Death
The department heads are mostly assembled in a room when Dr. Iggy Frome enters. The mood is heavy as each physician recounts reasons that their actions were a failure. It resembles a formal Mortality and Morbidity conference, but is too small for that. Max sporting a shiner, newspaper in hand, takes a seat on the desk at the front. He reads the first line of an article “Yesterday morning at 7:38 am, a bullet ripped through New Amsterdam”.
The ICU has the only decent coffee
Despite his impending deadline to begin treatment, aside from the day off, Max shows no signs of slowing down. We catch up to Dr. Goodwin taking a lap of his beloved hospital and as he passes through the ICU he overhears nurses complaining about survey responses. In a strangled voice, he tells them to rewrite the questions. Ask questions based on that which the patients should focus. He encounters Harold at the coffee station, far away from his station in the Morgue. Harold notes that the ICU has the only decent coffee. As always, Max hears and promises to investigate it. On his way out of the ICU he comments to Dr. Sharpe that he has solved the hospitals most vexing issue. Her response, “that the ICU has the only decent coffee?” Yes, Max, it is a thing. She quickly notices the strained voice and she and Max discuss scheduling a laryngoscopy to see if the “Nutella” has spread. Max, still unwilling to give voice to his cancer diagnosis, insists on calling it “Nutella”. If only coffee were his biggest concern.
On the Record
We meet Louis Navarro, a reporter who has been given full access to shadow Max for a day at the Dam. Navarro has a history of hard-hitting issue-based articles, though his work of late has been of a flashier nature. Lou wants to write a story about Max, but Max is clear. He is not the story; New Amsterdam is the story. It turns out that this is possibly the last day that the Dam needs a reporter in the building. A police-involved shooting, 2 victims, and the Chief of Police and Mayor vying for Max’s attention and policy position. Max, as always, is focused on the care of the patients and not a broader discussion on policy. In fact it is Navarro who catches Max off-guard when he reveals a discussion between Bloom and Richards over a breach of protocol.
A characteristic bulldog journalist, Lou is consistent in trying to “find the story”. Max is equally resolute in decreeing that the hospital is the story. It isn’t politics, optics for the Mayor’s office, the Police Department or public sentiment. The job of New Amsterdam is to heal people, no matter what situation brought them through the doors.
Throughout the episode, we aren’t sure what angle Navarro will take, but the headline “Senseless Death at New Amsterdam” and the first sentence read to us by Max suggest a less than flattering bent for the hospital. Instead, Navarro wrote the truth. The doctors at the Dam each did their jobs, but the bullet did its job better. Sometimes, the good guys don’t get the win.
Breaches of Protocol
The first GSW victim, Malik, needed an emergent procedure to relieve pressure from his heart. Dr. Richards was en route and his attendings were all scrubbed in for surgery. Faced with a 14-year-old dying on her table or trying to save him, Dr. Bloom breaks protocol and proceeds to relieve pressure from the heart. When the blood pours out, it is assumed that she botched the procedure. After a tense discussion with Richards during the handoff, Bloom is resistant to break protocol again.
As part of a complete care team following a trauma, Dr. Frome engages Malik’s aunt regarding his support system for recovery. A door shuts and she jumps, she is uninterested in answering Frome’s question, but wants to know why, with all the love and support Malik has had, did he still end up with a bullet in his chest? For the first time, we see the chinks in the eternal optimism armor that Iggy wears so well. Max catches up with him stress eating (a candy bar no less!) in the doctor’s lounge. Dr. Frome admits to stress eating and Max helps Iggy realize that Ruth is also his patient. With a clear course of intervention in mind, Dr. Frome continues.
In the way that only Iggy Frome can, he describes PTSD and how it can happen with any traumatic event. He disarmingly tells how his children (adopted from Bangladesh) were terrified of everything car horns, school bells and how they all slept in the same bed for months. He asks when she last slept well overnight? Never. He tells her he can help her and she can help Malik. A little hope in this crazy day.
In surgery, Dr. Richards is faced with a problem of his own. The bleeder that he can’t find seems to be in the abdomen, outside his scope of expertise. Rather than waiting for a general surgeon, he breaks protocol and begins expanding the surgical field for the abdomen. Dr. Bloom who has arrived for vindication with video evidence clearing her of any mistake, rushes to scrub in to assist. Dr. Richards, not one to second guess himself, assuredly continues to surgery and is able to stop the bleeding and repair the damage from the bullet. Malik’s aunt will get a chance to help him cope with this traumatic event.
When the stable patient dies
The second victim, Jalen, is stable but has a bullet lodged in his spinal cord, near T1. He needs an MRI, but Dr. Bloom won’t send him for one without parental consent. Max manages to get the young man to call his mother. Despite his agitation over personal issues, Dr. Kapoor checks in on Jalen. Dr. Kapoor is a puzzle master, he quickly assesses vertebral instability causing ascending paralysis. When he is challenged by the neurosurgeon, Dr. Hartman, he uncharacteristically raises his voice, stopping the whole area. We see the unflappable Dr. Vijay Kapoor clearly less together on this day. Dr. Hartman concedes and asks Kapoor if he will be joining them. While in the OR, Jalen has a clotting issue and Dr. Sharpe is called in. She offers some treatment measures to hold while she runs additional testing.
Just as Helen thinks she can get the scope to check the Nutella for Max, he responds to a skirmish in the ED between Jalen’s brother and security. The conflict escalates, and Max takes an elbow to the face. This allows Helen to perform the scope on Max’s throat, but also prompts her to realizes that Jalen’s clotting issues are related to anabolic steroid usage. Once the intervention is started, the surgery is a success and as they finish scrubbing out, Helen and Floyd share a poignant conversation about the realities of having brown skin in this country.
Rather than forcing disciplinary measures, Max takes Jalen’s brother up to see him but is alerted to the code blue before reaching Jalen’s room. Drs. Kapoor, Gomez and Goodwin all work with the nurses to save Jalen from the cardiac arrest. As usual, Max is unwilling to give up the fight. Continuing his unusual personality of the day, Kapoor yells at Max to stop and finally gets his attention. A defeated Max is forced to call the time of death as Jalen’s brother looks on. These days at the Dam take their toll on each of the doctors.
Nutella (or The Secrets we Keep)
Despite the various lies Max used to explain his voice throughout the day, it takes a punch in the face to slow him down enough for Helen to get the laryngoscope done. The Nutella has not spread. Max finally faces reality and knows it is time to call a spade a spade on his diagnosis: cancer. While delivering the news, Helen confides that she wants a baby. Her fertility will be a challenge, there are social constructs that make it more complicated, but in the end the only way to live is to choose life. Dr. Frome asks his husband to cancel their planned date night so he can spend time with him and the kids. On a day like this, Iggy Frome needs his support system too. Dr. Kapoor tries to mend his heart by looking in on his estranged son. We believe the relationship to be permanently severed, but this viewer hopes that not to be the case. Drs. Bloom and Richards are still navigating a post-personal relationship as colleagues while still challenging each other to be better and to recognize their own weaknesses. The Dam is lucky to have both of them.
As Max finishes reading the newspaper article, he acknowledges that each of these world-class physicians could work anywhere for better pay and easier hours. He is grateful they are at the Dam and bids them to move forward from the events of yesterday, today is a new day. Go.
My Thoughts
This episode had a little bit of everything in it. Hot button social issues, deep character development, and yes, medical drama. Every week this show gets better. As a viewer, I agree with Dr. Frome, this crew is starting to groove. The show doesn’t shy away from hard topics but genuinely treats them with respect and I, for one, truly appreciate it.
I think that despite the hard edges, the difficulties in their personal lives, these doctors truly embody what we all hope from the health care system. More importantly, they embody the best of what humanity has to offer without reaching perfection. These are, in my opinion, some of the most authentically written characters in a medical drama in quite some time. I look forward to my next appointment, but I have learned, bring tissues to the Dam.
You never know when you might need them.
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