Original subtitles

Ohh.

Sorry.

Did I wake you?

Yes.

The baby's pressing on my bladder,

so I have to pee approximately 78 times every night.

We can talk about baby names since we are both awake.

I keep coming back to one name, Kelly.

It reminds me of a Kelly clamp,

and I will think about grasping onto tissue or vessels

every time I'm holding our son.

What about Addison?

Addison Murphy.

Addison is the name of a disease.

I'll worry our son is not producing enough cortisol

or aldosterone.

You can go back to sleep.

I have to go pee again anyway.

Morning!

Pancakes, anyone?

They are not just ordinary pancakes.

They are Dutch baby pancakes.

Also known as Bismarcks, Dutch puffs, and even Hootenannies.

- I looked it up. - That is correct.

They are baked in an oven, not fried.

I was up very early.

Oh, sorry if my frequent bathroom trips kept you up.

Oh, don't be silly. You're making a human.

Thank you.

So, Kelly and Addison are out.

I don't disagree.

How about Munchausen?

Shaun.

- Or Parkinson? - Oh. Ohh.

Our bedroom conversations are meant to be private.

All of them?

Well, it's not like you were talking about...

Never mind.

Let's eat.

A friend on the San Jose school board reached out.

They're looking for someone to give a series of online talks

to high schoolers about careers in medicine,

specifically to young women of color.

That's great.

I thought you'd be perfect.

Oh.

That wasn't the reaction I was expecting.

Maybe Dr. Tooks can do it.

Tooks is a mom.

These high school kids don't see themselves in her.

There's gotta be someone else.

There isn't, which is the whole point.

Only 2% of surgeons in the U.S. are Black.

Don't be afraid to step into the spotlight.

I'm not afraid. I'm just very busy.

Okay. It will only take a couple hours of your time.

"If you can see it, you can be it" is a real thing.

It is not my responsibility to be the one they see.

Okay.

Nathan hit his head on the trampoline frame

at his birthday party two days ago.

He got a bump, but he seemed fine.

Where's Daddy?

I told you. He's away for work helping people.

He'll be back in a few days, okay?

Is it possible to develop a concussion two days later?

Well, let's see if we can find out what's going on.

Nathan, what's your puppy's name?

Patches.

Can I look into Patches' eyes with this little light,

make sure he's okay?

Or you can do it?

Just look in here.

Can you pick this back up and give it to the doctor?

I can't. Where's Daddy?

Can you give me a high five, bud?

Good. Now high ten.

What's happening? Is... Is this a concussion?

It's not a concussion. Your son is having a stroke.

Synced & corrected by -robtor- www.addic7ed.com

You are late.

No, I'm not.

It's 8:01 a.m.

Oh, it... It is now,

but I'm pretty sure it was still 8:00

when I walked through the door.

Were you getting your hair cut?

No.

Are you using drugs again?

No.

You are on probation, and I am responsible for you.

Common signs of drug abuse

include ignoring responsibilities

and secretive behavior.

I promise you, I'm clean.

I'll pee in a cup if you want.

Okay.

I'm going to assist Dr. Park.

You can join the case if your sample comes back clean.

I wasn't even late.

Sorry, a chance to help young, diverse women

and kiss the hospital president's ass

at the same time?

There's only one answer to that.

It starts with a "Y," ends with a "Yes."

- That didn't work. - I know, I should've bailed.

But I stand by my point.

Aren't we busy enough?

And why do I have the burden of extra homework

just because I have more melanin than you?

_

And why is my Grandma E texting me right now?

You shouldn't think of it as homework,

and you definitely shouldn't think of it as a burden.

And you shouldn't think you know what it's like to be me.

Point taken.

Hm.

What the...?

Okay, can we just focus on our patients, please?

Thank you.

Quinque, there you are.

Grandma E, what are you doing here?

I was told they have doctors here.

I've got tightness in the chest,

shortness of breath, swollen ankles.

Why didn't you go see your doctors in Oakland?

Those idiots said that my ascites indicated

I had "cirrhosis of the liver" like I'm some kind of a drunk.

And I figured, with my family connections,

I could get some top-shelf care here.

I can't be involved in any of your...

But I can.

Delighted to meet you, Grandma E.

I'm Dr. Wolke.

Okay. Jordan, baby, you stay

and keep an eye on little mister here.

He might try to skate by on his good looks.

Ah.

Can you lean back for me?

Jordan, you never mentioned having a sister.

See? I like him.

Distended jugular veins with increased JVP.

Kussmaul's sign and pulsus paradoxus.

Maybe I don't like you so much now.

She does have a history of chest radiation.

Echo-brightness of the pericardium.

What does that mean?

The sac around your heart is inflamed.

There are calcium deposits.

Grandma?

All right, those are faint pulses.

Okay, if we don't do something, she's gonna arrest.

Set up an OR stat for a pericardiotomy.

No, Rick, stay.

I-I promise I've got this.

Sorry to interrupt. We're ready.

Can you please talk to my husband?

Of course.

This is Dr. Park.

How does a four-year-old end up with a stroke from bumping his head?

Head trauma's one of the main causes.

Well, I feel like I should get on a plane now,

but Linda's telling me to stay.

How far are you?

Alabama. We still have people missing

after the tornado ripped through.

I can't tell you how to prioritize,

but I can tell you I'm hoping to make your son better

well before you could get here.

Thank you.

We're okay.

You'll be back in a few days anyway,

so just stay and keep helping.

Okay.

Evacuating the hematoma.

I saw on the Weather Channel that the Alabama tornado

was the 15th to reach a 4 on the Enhanced Fujita Scale

in the last 3 years.

Together, they have caused 116 fatalities.

Luckily, we have people like his dad

who run towards a crisis.

But he also has a crisis right here with his son.

He didn't know that when he left.

I'm not seeing an active bleeder.

There is a hyper-vascularized brain parenchyma

in this resection cavity.

Oh, the major named vessels are all smaller than usual

and look scarred in.

The hemorrhage was not from hitting his head.

This boy and his brain are even sicker than we thought.

Widening the sternal retractor.

So, why does she call you Queen K?

It's Quinque.

Latin for five because I'm the fifth child of six.

So does she call your little brother "Sex"?

Please focus so you don't kill my grandmother.

Cauterizing the edges of the sternal periosteum.

She's so charming.

Why didn't you get any of those genes?

Charm is one of the many layers of a very complicated woman.

Grandma E drove me like a drill sergeant from the day I was born.

Ensure the pericardium is free from both the pleurae and the diaphragm.

15 blade.

Oh.

We need a new 15 blade.

What's happening?

I can't pierce it.

Never seen constrictive pericarditis this severe.

It's completely calcified.

Your grandma has what's known as a coconut heart.

Your son has a rare auto-immune disorder called primary CNS vasculitis.

It's causing inflammation of his blood vessels throughout his brain.

Okay, um...

Wh-What are the next steps?

Cyclophosphamide infusions.

That's chemo.

My mother had that when she had breast cancer.

And she... she lost her hair,

she threw up, she got sores all over her mouth.

Letting this go untreated is far worse...

Recurrent brain bleeds, possibly large territory strokes.

It could be fatal.

Nathan will be on some form of immunosuppression his whole life.

I'm sorry.

Thank you, Doctor.

How do you crack open a coconut

without puncturing what's underneath?

Constrictive pericarditis.

Please stop saying "coconut."

It's my grandmother and it's serious.

Not your case.

I'm just having a snack. And trying to help.

Mm-hmm.

We need ideas.

Left anterior thoracotomy

and partial excision of the pericardium.

Avoids sternal infection and seems likely the safest route.

It will require more surgeries.

Please go away.

What... What are you advocating for?

Complete removal.

Hear me out.

A median sternotomy gives us clear access to the diseased pericardium

from phrenic nerve to phrenic nerve.

That's way too risky.

Complete decortication fixes her heart... completely.

You are advocating for an extensive, high-risk surgery.

Meanwhile, a partial removal offers your 70-year-old grandmother

a shot at full health for what will likely amount

to the rest of her life.

Shouldn't you let the patient decide?

No.

I don't present something if it's not a viable option.

I think it is viable.

Her surgeon doesn't.

Jordan, go be a granddaughter.

If I hadn't become a surgeon, I think I would've been a writer.

I would've...

You never told me your grandmother worked at Marcus Books.

Was I supposed to?

I was just a lowly clerk.

It came up when I heard his name was Marcus.

There is nothing lowly about being at the center

of a cultural landmark.

My Auntie Winn used to take me to author readings

by Toni Morrison, Maya Angelou.

And you were there every day!

I probably served you some cookies.

You ever meet James Baldwin?

- I did. - What?

Okay.

She can probably use some rest.

Yes. Absolutely.

If you need anything at all, Miss Evelyn,

you know where to find me.

- Thank you, Marcus. - Yes, ma'am.

Marcus Books. Wow!

That was weird.

Not as weird as you refusing to do his mentorship program.

Let's talk about you...

and your heart.

Your pericardium has become hardened,

likely from your cancer treatments.

So what happens now?

Dr. Lim has decided on a partial removal.

And... And you think that's best?

Jordan Jacqueline Allen, you look at me and you tell me

if you think it's best.

Wow. It took you guys a while to get home, huh?

We went out to dinner because Lea thought that...

Why are you on the floor?

What's with the high chairs?

I stopped at Costco on the way home.

Surprisingly diverse selection of wines.

There's an open bottle if you... if you guys want,

although that might be empty.

Danger.

Oh, I remember wine.

Are you drunk?

No. Maybe a little.

I'm baby-proofing.

Danger.

Are you okay?

Oh, you guys gotta get down here and check this out.

From the baby's perspective,

this place is a frickin' death trap...

for Nicholas.

Placeholder name.

We can call him Nick or Nicky.

I like Nicky.

Okay, why did you buy three highchairs?

Well, one's a gift for you, and the other two I'll take back.

Danger.

That could be dangerous.

Y-You don't have to buy us anything.

I also got you a nanny cam.

It's a... it's... it's a teddy bear,

but you wouldn't believe it, there's a camera inside.

That is very practical. And cute.

Ugh, okay. We will not need a highchair or baby-proofing for a year.

And we will not name our son Nick, Nicholas, or Nicky,

or any variation thereof.

Okay.

Okay, well, that's fair enough.

But you... you're gonna want this.

It's a book by Dr. Spock on parenting.

Everyone read this book back in the day.

He was so popular, he ran for president.

Danger.

I'm going to bed.

Yeah, but you're gonna want to r-read this

before the baby comes and you get exhausted.

Already there.

Danger!

What were you thinking?

That my grandmother deserved the good muffin?

She told me she will only agree to complete decortication,

which she shouldn't even know about.

You do not present a patient with an option

that I have deemed unsafe and wouldn't even perform.

- It's unacceptable. - You're right.

I felt like your plan was a little conservative, but I...

You are a resident.

Your feelings about my decisions are not relevant.

I'll let her know I was wrong.

And convince her I'm right.

Or find her another hospital.

Yes, ma'am.

Um, your muffins are ready.

How's he handling the chemo?

You doing okay, bud?

Nathan, can you answer Dr. Park, please?

Is everything okay?

No.

You're right. It's not okay.

Okay, these aren't toys.

We okay, Mom?

He got dozens of new toys for his birthday.

He shouldn't have to be building castles with pill bottles.

I'm sorry.

Maybe you shouldn't be trying to do all of this alone.

My husband's saving lives. I can't pull him away from that.

I can.

Give me your phone.

Hi, Rick.

Dr. Park.

Mm.

You okay?

Yeah, I'm fine.

But you're not.

What happened?

I was wrong to question Dr. Lim's surgical advice.

She's the best.

I hope to be her someday.

And if she thinks the partial removal of the pericardium

is the best course of action, then I agree with her.

Okay.

Then that's what I'll do.

But why did you go against her advice in the first place?

I felt like I needed to do extra, to be a hero.

Why?

Since I was little, you told me I had to work twice as hard,

be twice as good as everybody else.

After all these years, I'm...

still striving to be good enough for you.

Yeah, see, that's a lot of pressure.

But it's what the world requires

from people that look like you and me.

When's my daddy coming?

Your daddy's getting on a plane. He's gonna be back soon.

But now, we have to see if the medicine's working, okay?

If it is, can I stop taking it?

I'm so sorry.

You still need it.

I hate it.

I know.

Let's play a game, like hide-and-seek, okay?

Okay, lie down.

You get to go in the tunnel.

And stay very still so nobody can find you.

I'll come back and get you when the coast is clear.

Sound good?

You are very good with him.

Starting the imaging.

Thanks.

Nathan, you're about to hear some banging.

It's just the machine.

But remember to stay really still, okay?

I am.

Try a little harder, okay, bud?

Ah, motion artifact.

We might have to sedate him.

Those are not artifacts.

He does not have CNS vasculitis.

He has moyamoya disease.

What the heck is that?

A narrow carotid artery is reducing blood flow to his brain.

This area here, looks like a puff of smoke?

That's what moyamoya means in Japanese.

A bunch of new, tiny vessels have developed

to circumvent the blockage.

But because the vessels are abnormal,

they're prone to bleeds.

We can fix the problem with a very interesting brain surgery.

Well, so... so now that you're done

poisoning our son with chemo that he didn't need,

we should trust you to crack open his skull?

We will use a small craniotomy to access...

I get why you're frustrated.

Moyamoya is rare and notoriously hard to diagnose.

Many kids get chemo they don't need for a lot longer.

We're hoping to do Nathan's first brain surgery tomorrow.

He needs more than one?

What's brain surgery?

Hey.

It's how we're gonna make you all better.

No more chemo?

No more chemo.

Are you gonna be here?

My plane got cancelled, buddy.

But, uh... but, look, I-I promise

I'm gonna be there as soon as I can, okay?

Can Patches get brain surgery, too?

N-No.

Patches is a stuffed animal.

It does not have a brain.

Oh.

Ohh!

Oh!

I just peed in our bathtub.

Glassman has to go.

Aah!

- Sorry! - Hey!

Sorry!

First years.

You are late again.

Come on. Like one minute.

And last time...

Your drug test from yesterday was negative.

You are not using.

So what is causing your tardiness?

Look, I'm sorry.

I've been doing really well.

And the reason I'm doing so well...

is my daily meeting.

Sets my mind right.

It's kinda far, and there's morning traffic.

Support is very important.

And so is punctuality.

I'm going to map a complex double-barrel vascular bypass.

Mnh! Dang it!

That's the sixth time you've killed my grandmother.

It wasn't working with the rongeur.

I'm trying to sell Lim on a little more power.

I just need to find the right torque.

That's reassuring.

Stop hovering. Go visit, visitor.

Convincing Evelyn Allen to do a surgery,

after convincing her not to, was a little bumpy.

Details, please.

I took the opportunity to explain how much pressure

she's put on me over the years,

and she took that opportunity

to make me feel inadequate once again.

I never thought of you as someone who lacks for confidence.

Fake it 'til you make it.

You're a resident in one of the top surgical programs.

You've already made it.

All I see is the ground I've still got to cover.

Mnh!

How's it going?

Not ready for prime time.

This STA anatomy is ideal as a donor vessel to bypass the blockage.

So, we'll reroute the scalp vessel into the brain here.

Gonna give you a little tip.

Next time a child asks if you could do surgery

on his stuffed animal so that he feels less scared?

Say yes.

I was only telling him the truth.

Oh.

This branch of the middle cerebral artery

looks like an ideal recipient.

You're about to be a father. Children are illogical.

And we can place temporary clips for vascular control,

and then anastomose the STA to the MCA using 10-0 Prolenes.

I was very logical as a child.

I did not like being talked to like I was dumb,

and I definitely did not like being lied to.

That child there felt that if his Dalmatian

went through this scary thing with him, he'd be less scared.

If can embrace another person's thought process,

it can strengthen the relationship.

Lea thinks she should not have to pee in the tub...

which I understand.

No kidnapping my grandmother.

I asked him to do a lap around the floor.

I needed a change of scenery.

Well, you've had your lap, now back to your cell.

Thanks for the tour, Speedy.

Speedy?

I'm guessing it's because I was sprinting through here this morning.

Yeah, I was late.

Second time this week.

Snooze buttons... the devil's plaything.

I was actually at a Narcotics Anonymous meeting this morning.

I go every day.

"Confess your sins to each other

and pray for each other so you may be healed."

James 5:16.

Amen to that.

Good for you, young man.

There's gotta be a closer meeting.

I've tried the closer one.

The hard-liners who run it think that

wearing a suit and tie is the key to staying sober.

Start your own meeting, here at the hospital.

Set your own tone.

And you're never late for work again.

I'm not...

I'm not qualified to be a leader.

No such thing.

Leaders lead.

Simple as that.

Hm.

You are annoying.

Well, nice to see you, too, Shaun.

Not to me, but to Lea.

And I want to keep our relationship strong.

She feels your presence has taken over our apartment,

and she wants her space back.

I overstepped with the baby-proofing?

And suggesting names.

And the Dr. Spock thing?

And there's more. The nanny cam...

Okay, okay, okay.

It was fun thinking about your baby

and the future, and...

Maybe it has been a nice distraction.

Yes, it was.

Which you've needed since your house burned down

and you lost all of your belongings

and you have no place to live.

Yes. Thank you, Shaun.

Dr. Glassman, you are not exactly my family.

I get it. I-I know, Shaun.

But I consider you to be the baby's grandfather.

Wow.

Thank you.

I never thought that would happen for me.

Thank you.

You can stay.

I will tell Lea, and she will change her mind.

No, no, no. I'm going to go.

Where?

I don't know.

Can I get you a magazine?

No, thank you.

Are your pillows positioned okay?

Okay, you're doing it again.

What?

That thing you've been doing since you were little

where you're just fussing over people,

when it's you that's in need.

Okay, come on.

Tell me.

You just met Dr. Perez,

and you were so nice and supportive.

Do you know how long I've waited for you to say,

"Good job" to me, or, "Wow, you're a doctor"?

Do you know who Rebecca Crumpler is?

No.

She was the first Black female doctor.

And when I read about her, I wanted to be just like her.

But, unfortunately, I didn't know who she was, either...

until you were in med school.

Quinque, I have been impressed by you

since you were in kindergarten.

Grandma?

Grandma?

What's going on?

She's having trouble breathing.

She's hypotensive.

Jugular vein distention has increased.

Her heart is failing.

Tell me you got through a practice run.

I was coming to say we were postponing the surgery

so we could practice more.

What are you hanging?

Uh, it's...

You can read, obviously.

Is this okay? I'm sorry.

I should've cleared it with you first.

Yes, you should have.

Because I would've told you to use the small conference room up on 6.

It's quieter up there, and the room has blinds...

to help with the "anonymous" part.

Thanks.

This is Park.

I had to fly to San Francisco. I'm just grabbing a cab now.

Can you... Can you hold the surgery until I get there?

We can't.

If he hemorrhages again...

Well, can... can... Can you put him on the phone?

He's already sedated.

But what if... what if this was my last chance

to talk to him?

I'll treat Nathan like my own son, I promise.

Thank you.

Try to puncture the pericardium

and grab an edge so we can start to peel the shell.

Mm!

Apply more pressure.

We might need to use another tool to pierce it.

Let's try the rongeur.

- Ah! - Perforation of the myocardium.

Manually tamponading the hole.

Pledgeted sutures.

The pericardium's just too calcified.

It's adherent to the myocardium.

So what do we do?

Repair the perforation. After that, I'm open to ideas.

We could put her on bypass.

Gently peel off the calcified pericardium bit by bit.

And then repair the damage as we go?

That's like poking holes in a bucket

and then hoping we can plug them before all the water leaks out.

I have an idea.

Go ahead.

It's called the waffle procedure.

I found a novel study that said dense calcified plaques

can be scored into multiple cross-hatched sections.

No removal at all?

Exactly. The shell stays in its place,

but the heart has room to expand and contract as it beats.

Mortality rate?

Under 8%.

Talk me through it.

Okay. Ultrasonic scalpel.

Start by incising the calcified pericardium.

ICG angio looks great.

Dr. Perez, you may do the dural closure, then replace the skull flap.

Before we close...

We're almost a full hour ahead of schedule.

Why not go ahead with the bypass in his other hemisphere?

Mm, that is not the plan.

Simultaneous bilateral surgery

risks altering brain flow too much.

It could cause another bleed.

But maybe there's a way to reduce that risk.

The wait for the follow-up surgery will be hell on the parents,

the whole time knowing their son's brain...

The parents' stress is not medically relevant.

I know, Shaun, but, please...

Can you think of any other way?

An encephaloduroarteriosynangiosis

of the left side would be relatively low risk.

We could safely do that now.

Thank you.

Rick, Linda.

The surgery went well.

There she is.

Right on schedule.

How do you feel?

Like I can breathe, for the first time in a long time.

Thank Dr. Lim for me.

I will.

Somebody's all puffed up.

Uh...

You did something.

The surgical team got a little stuck.

I just gave them a new idea.

Good job.

Wow! You're a doctor.

Wow. Okay.

You're just laying it on a little too thick now.

Looking good.

How are you feeling?

Okay.

Can you give me a high five?

High ten?

- Hey, good job! - Good job, buddy!

Good boy, buddy.

Where's Patches?

He is right here.

You did do the brain surgery on him.

No, I just put bandages on its head to make you feel better.

I do.

Uh, I'm sorry. There's a meeting.

I know. NA, right?

Uh, yeah.

It took me a few minutes to get the courage to come in.

It's just us. Sorry.

Where two or more are gathered...

Oh, um, have a seat, please.

Hm.

Um, hi.

I'm Danny. Um...

I am an addict.

Almost show time.

Don't say it like that. You're making me nervous.

Be yourself. That's more than enough.

Hi, everybody.

There's so many of you.

That's so good to see.

I'm Dr. Jordan Allen,

and I am a third-year surgical resident at St. Bonaventure Hospital.

Where's Glassy?

He will not be staying with us anymore.

He moved out?

Yes. We had a talk and decided it was best.

Did you tell him I was complaining about him?

Yes.

Oh, Shaun!

Now I feel horrible.

Oh. You don't need to.

He found a vacant apartment just down the hall.

In this building?

- Yes. - He's our next-door neighbor?

Our next-door neighbor's next-door neighbor.