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First, a confession: I watched this episode right after my own ED night shift. So I'm a little tired, a little strung out on caffeine. And I’m even less tolerant of histrionics, which is often this show’s calling card.

But I’ve got to say, this was Night Shift's best episode. It actually made me optimistic for the series, which just got renewed for a 14-episode block.

What worked? This was the first episode where it felt like the characters were driving the plot, instead of responding to extreme circumstances and wild coincidences. Pretty much everything that happened in this hour (aside from the extreme and coincidental bus accident at the beginning) was an outgrowth of choices the characters had made in the weeks before, or aspects of their personality we’ve come to know.

So, let’s get you up to speed on the major characters:

TC - an ED attending, with battlefield surgery experience from Afghanistan. Impulsive, with no respect for authority. Was fooling around with other ladies, but keeps pining for Jordan.

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Jordan - Chief of the Night Shift, TC’s ex, has finally moved on and is now with the new trauma surgeon, played by Scott Wolf from Party of Five.

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Drew - closeted EM resident, wants to be a Ranger. Hides his sexual orientation for fear it will hurt his Army ambitions. In love with Rick, who’s just returning from the front lines.

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The episode begins with Rick calling Drew from a bus full of returning vets. At the same time, TC shows up at Jordan’s house the day after their big, ill-advised kiss. TC says he can’t stop thinking about her. Jordan seems torn.

Then, improbably, Rick’s bus gets in a violent accident - and many of the survivors are taken to where Drew works. Jordan and TC race to the ED.

In the parking lot, Drew is looking for Rick, while other ED staff start a pericardiocentesis in the parking lot (seriously - they couldn’t wait another 15 seconds to wheel the patient into the ED, where all the equipment and monitors are? and the docs just happened to be carrying a spinal needle? The medical consultants for this show must be very frustrated, or very absent).

Scott Wolf from Party of Five identifies some soldiers in need of trauma surgery, including Rick, whose right leg will need amputation. He goes to set up the OR, while TC and Drew take Rick to the ED for stabilization.

In a side plot, the female intern fends off flirtations from a young private with a shoulder injury. When he starts bleeding spontaneously, he gets diagnosed with ITP (and when the docs discuss the differential, it comes as close as this show’s ever come to a real medical conversation). The private gets steroids, improves improbably fast, but then decompensates and dies when it turns out his low platelets and skin rash were due to Leishmaniasis. It’s concluded the guy was doomed before he ever left Afghanistan (though I bet those steroids didn’t help). The female intern grieves.

But the main crux of the episode was Rick’s increasingly obvious need for a BKA and how all the characters respond. Rick desperately tries to hold on to the life he has, and refuses amputation. Drew tries to offer support but also hides his relationship with Rick in front of nearly everyone else.

And TC, the brilliant renegade doc, naturally tries to re-perfuse the leg, with a popliteal bypass in the ED. When the trauma surgeon hears about this, he’s outraged he was kept waiting in the OR. TC asserts his approach is more patient-centered, but Scott Wolf from Party of Five is not having it, and they two start throwing punches.

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Jordan, the Chief of the Night Shift, is called in to mediate. For the first time in the whole series, the characters (especially TC) get a flicker of recognition about how childish they are. Someone says, “this wouldn’t be tolerated in any other emergency department in the country”and I cheered.

Ultimately Rick goes to the OR for amputation. Drew finally proclaims his love and commitment to Rick in front of the platoon, outing himself but saving his relationship. Everyone seems to be making decisions that demonstrate character growth, while remaining true to what’s come before.

Of course, there’s a Mariachi band in the waiting room, and they play taps for the Leishmaniasis patient as he’s wheeled to the morgue - because the show has to stay true to itself, too. But I’m choosing to look at this episode as progress.

Fast Track Items

There was some plotting unrelated to the amputation storyline that thankfully stayed in the background:

  • The overnight administrator, who had been my favorite character so far, remained mostly on the sidelines while he worked on his online dating profile.
  • The psychiatrist is forced to deal with a frequent flyer who seems to have pseudocyesis. It turns out it’s an ovarian tumor that also causes psychosis. Ridiculous (but not impossible - see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039209/ ). The subplot was redeemed by the recurring joke that Matt Damon was the father.
  • The male intern gets teased about how young he looks (the platoon calls him “Doogie”) but he eventually earns their respect by doing a lateral canthotomy in a hot tub. He had already earned my respect by picking up on Kussmaul breathing in a waiting room patient, and he actually lost points from me by doing the canthotomy without gloves. But he’s showing progress, too.
 

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