‘New Amsterdam’ Recap: Season 4, Episode 18 “Ifs, Ands, or Buts”


Last week, we saw the aftermath of everyone’s fun night out which ended with Helen’s sudden inability to speak. This week’s episode picks up with how Helen is doing and other storylines like Iggy’s infidelity and Leila asking Lauren for financial help continue to develop.

Helen’s Recovery

The episode opens with Helen doing okay. She makes breakfast for herself and Max and physically is okay. She is still struggling to speak through. She can speak, but only in a word or two at a time, and saying them is a struggle.

She’s taking speech therapy at New Amsterdam. It’s revealed by her therapist that she had a stroke. At the end of her session, Helen wants to know if she’s doing better. The therapist avoids answering, but after Helen insists, she tells her that her scores are lower, which clearly upsets Helen.

As the episode progresses, Helen keeps working with her speech therapist and gets frustrated because she’s struggling to speak. The therapist tries to help her and tells her that her breaking through is coming, but they don’t know when and it’s going to take time and work to get there. She encourages Helen to bring Max as well because the support of a loved one has helped people in the past.

Helen visits Max in his makeshift office and he asks how therapy was. She struggles to express how she’s feeling and Max gives her words of encouragement that actually seem to stress her out more. She doesn’t end up asking him to go to her appointment.

Later, Max runs into Helen’s speech therapist, who mentions him going to the next session and he replies that Helen didn’t invite him. After that, Max shows up before her appointment and she questions why he’s there. He says he’s there for her appointment and she expresses that he’s too busy. He makes it clear that he wants to be with her and Helen tells him to go. She struggles to communicate what she’s feeling, especially when Max tries guessing what she’s saying or reacting before she gets the words out. Helen ends up breaking down and crying. She explains that she doesn’t see what he sees, because he keeps telling her how great she is and she feels like she’s failed and is broken. She asks if he’ll love her if she doesn’t get better, and he says he will, but he’s not giving up on her getting better. She still doesn’t let Max come with her to her appointment.

Helen comes home to Max and tells him that she should have let him come to her session but didn’t because she was scared, ashamed, and struggling. She does ask him to come with next time. Max gets her to work on saying the phrase she’s been working on all episode, “no ifs, ands, or buts,” with him. She says it with a bit of struggling at the end and then repeats it until she can say it clearly without struggling.

How To Deal With Pain

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To start to pay Lauren back for what she lent Leila, Leila gives her $1,000 in cash. The cash payment was at the recommendation of her lawyers to not leave a paper trail. Lauren responds distantly, which makes Leila anxious.

After that, Lauren tells Casey she needs a distraction from everything with Leila. This is hard for her, because her former distraction was taking medication in a manner that developed into substance abuse.

They start helping a patient who runs a local calzone shop. He did a trial for his MS at New Amsterdam with Mia and seems to be having reactions. Mia comes up to talk to Lauren about it. Lauren is short with her and lets her know that she’s now treating the patient “properly.”

Later, the patient Lauren has what looks to be an allergic reaction but she realizes it isn’t and believes he doesn’t have MS. While Lauren was working on a diagnosis, Mia took Lauren’s patient to try some of her methods. Lauren confronts her about taking her patient and Mia explains that the patient came to her and that her methods are helping. Lauren apologizes and explains to Mia that she’s struggling because she’s having a hard time, especially with fighting the want to fall back on drugs.

Mia explains that she needs to actually face her feelings and not find a way to avoid them. The conversation is cut short by the patient throwing up. Lauren figures out what’s wrong with him and tells him that he has celiac disease. Mia apologizes to him, because this means the calzones he loves so much are harming him. He decides to use this to boost his business though and start making gluten-free calzones.

When they leave the patient’s room, Lauren tells Mia that something she loves is hurting her and she doesn’t know how to let it out. Mia asks her how she can help. Later, we see Mia using some of her medical methods to help Lauren

The State of Iggy’s Marriage

In the aftermath of Martin learning about Iggy’s assistant, Iggy is sleeping on the couch and is trying to make things up to Martin. He tries to talk to Martin about what’s going on and he’s more interested in going out the door. Iggy tells him that he found a couple’s counselor 40 minutes away because they’re friends with all the ones in the area. Martin tells him to put it on his calendar while distractedly running out the door.

At the end of the episode, Iggy waits outside the therapist’s office alone and admits to the therapist that he told Martin not to come because he has work to do on himself first.

The Cost of Saving A Life

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After learning he’s going to be a father last week, Floyd starts thinking about his own dad. He goes to a garage and uncovers a nice red car. He looks nostalgically at a photo that was stored in it. While sitting there, he gets a call about surgery because his patient canceled.

When he calls the patient, he explains that he was billed for $28,000 after insurance for his last surgery because that’s what New Amsterdam charged for Floyd as a consulting surgeon. The patient goes on to say that he can’t afford to do another surgery. After the call, Floyd comes to Max about the bill his patient received hoping he could help. Max tells him that this could bring Veronica down and will happily help.

Floyd brings his dad’s car to the car wash that his patient runs. Floyd tells him that the surgery is on the house and if they charge him at all, then he can keep the car.

There’s a complication with the surgery after Floyd takes out what he needs to for the cancer and finds a different issue. He needs to call in a surgeon from New Amsterdam, which won’t be a cheap procedure because his insurance won’t cover another surgeon. When he calls, New Amsterdam doesn’t have anyone to spare. He has to search everywhere for a surgeon and he can’t find anyone. Eventually, he finds a surgeon to come in if he teaches her lecture for her.

Towards the end of the episode, Floyd drives his patient to the car wash and he tells Floyd that he wouldn’t have taken the car because it was his father’s. When he leaves, Floyd stares at the picture before calling someone. He says he’s trying to track down someone who used to work there.

First Love

A patient we’ve seen in the past returns. Juliet, who has issues with feelings and sees everything as a game, has her first relationship with another kid that’s inpatient. She’s very upset when he breaks up with her though.

She explains to Iggy that she wasted her first kiss on him and really liked him, but she wanted to test the feeling and kissed all the other boys on the inpatient floor. She learned that his kiss was indeed special, but when he learned about her kissing everyone, he broke up with her. Juliet wonders if you can get a person back after you really hurt them on accident, which hits close to home for Iggy.

Juliet apologizes to Issac and he doesn’t believe her because of her previous behaviors. She tells him that in all honesty, the kiss made her feel like she would throw up, but in a good way, and that she doesn’t want to lose that feeling. Issac tells her that he doesn’t want to lose her either and the pair make up.

Later, Issac is upset because Juliet dumped him. He talks about how she did this in a cruel manner and is confused because she was the one who wanted to get back together.

Iggy goes and talks to Juliet about how she reacted. He finds her crying and she admits that it’s not a manipulation tactic. She was happy when they got back together, but it was different this time. She knew he was going to break up with her again and she broke up with him first. This is all catching her off guard because, in her mind, she’s clinically supposed to be alone. Iggy points out that these are typical emotions that people feel during a break-up and because of this, he thinks he can help her feel the way she’s supposed to.

The Trojan Horse

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Veronica shows up again and learns that Max is working at New Amsterdam again and in a place where she doesn’t have control to fire him. After they talk, he talks to Karen about how a big malpractice suit happened in the past and he can use it, but she tells him that Veronica already told the board.

After talking to Floyd, Max tells Karen that Veronica is overcharging people for everything. Karen says the board just cares about money, so bringing this up won’t matter. Max says the world will care about it though. Karen explains that this will destroy New Amsterdam and Max believes that it’s needed to save it.

After this, Max hands out fliers about how New Amsterdam is scamming people. He tells people to come to the company he works for instead. Veronica comes out to talk to him about it. He tells her about all the patients they’ve taken from New Amsterdam.

In the board meeting, Max says he wants to dismiss Veronica as medical director. She replies she could just resign. She mentions that she could first buy out Urgent Medicine Inc. where Max works. There’s a buy-out option in the contract and this would be a $3,000,000 gain for New Amsterdam.

After the meeting, Max tells Karen that she just bought Urgent Medicine Inc. as they planned. Apparently, it’s a trojan horse that brings them back on the inside.

New Amsterdam will be back next week with two new episodes on back-to-back nights! You can catch episode 19 of season 4 on Monday night and episode 20 on Tuesday night both on NBC at 10 p.m. ET. Be on the lookout for more coverage of New Amsterdam in the future!

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