All language subtitles for the.resident.s03e19.web.x264-xlf[eztv]

- Previously on The Resident...
- This is my son-in-law Derek.

He's been complaining
of shortness of breath.

- Mom.
- And my daughter Molly.

Derek has an aggressive B-cell lymphoma.

You have a 50% chance at being cured.

This is Dawn Long, the one from TV.

She's not getting better,
but Cain wants her treated

and sent back to the LTACH.

Your patient had Candida auris.

- The superbug?
- Once Candida auris

spreads throughout a building,
it's nearly impossible to eradicate.

Anyone know what this is about?

- Logan Kim is gonna give an announcement.
- These Red Rock speeches

are starting to drive
me up the wall, man.

Why can't we just go
back to paper memos?

Ah, okay.

As you know, ICU nurses

must chart patient data constantly.

This practice is inefficient, tedious

and expensive for the hospital.

Today is a new day.

As a trial run, these
rooms are being retrofitted

with state-of-the-art
automated patient monitoring.

The system is so sophisticated

that it could even tell
if doctors and nurses

don't wash their hands before
entering the patient room.

Chastain is taking its place

on the technological map in health care.

- Staff loves that guy.
- Just wish I could hug him.

Good times.

Through and through. Inside there,

and the ceiling all around. In there.

As far as anyone's concerned,

we're just installing A.I. technology.

No one knows we're also
eliminating a deadly fungus.

Candida auris is highly dangerous

in immune-compromised patients.

Half the people who get it die.

We're lucky it's not airborne

like the coronavirus.
The staff is not at risk,

but the patients could be.

The protocol here

is gonna be to notify the
state health authorities.

- We need to follow protocol.
- You didn't mind

bending protocol to keep
a vegetable on life support

just to protect your stats.

I kept Dawn Long alive for Red Rock.

It's because of me, you can
have the Mother of All Surgeries

- in the win column.
- No, you weren't helping Red Rock,

you were feeding your god complex.

As a result,

she brought a deadly
fungus into this hospital.

And there was no way for me to
know that she had the superbug.

It's common in nursing homes and LTACHs.

Even I know that. But you missed it.

You approved or demanded
every step I took in this.

According to you.

I've got your back,

as long as you've got mine,
and not a moment longer.

- Are you threatening me?
- Get on board

and help to fix this mess
or I'll tell the world

what happened when you were an intern.

- Synced and corrected by Firefly -
- www.addic7ed.com -

You need to be honest with me.

I haven't had any.

- I promise.
- Look,

we can only treat your
cardiovascular disease

without surgery if you quit smoking.

I haven't had a smoke
since you last saw me.

Oh, so what were the
cigarettes you had this morning?

Reformed addicts are the worst.

Yeah, I'm just looking out for you.

Look, there's a sign-up table over there

for a program that helps you quit.

Will you just walk over?

Maybe.

Uh, thanks for trying, Nic.

Are you feeling okay?

I'm good.

Well, let me just...

Your heart's racing, you're coughing.

Any muscle weakness, headaches?

Yes, to all of the above.
But before you say it...

I think we should get you to Chastain.

I'm not gonna go. You know
what my insurance deductible is.

Come on, people like me
only go to the hospital

- as a last resort.
- Right,

but I think this is
one of those moments.

Come on, let's get you to a doctor.

Look at the all the people
who need you to stay healthy.

Come on.

You rang?

We've got a case.

45-year-old female suffering from fever,

joint pain, chills and diarrhea.

Well, that's all painfully nonspecific.

She could have anything.

Yeah, which makes this
the perfect medical mystery

and teaching tool for you.

You mean it's full of grunt
work you don't want to do.

See? You're learning already.

Sophia, these are Drs.
Pravesh and Dreyfuss.

They're gonna help me
with your care today.

Great, 'cause I could use
all the help I can get.

Sophia, it's nice to meet
you. I've seen you around.

- You're an EMT, right?
- Guilty.

I had to take the day off,
though, 'cause I got this bug.

Good thing you did.

Your ketone and glucose
levels are sky-high.

You're in diabetic ketoacidosis.

How does an EMT not
understand how dangerous it is

to let her sugars get out of whack?

You'll have to forgive Dr. Dreyfuss.

He has an issue of his own.

His mouth moves before
his brain catches up.

It's all right.

I deserve the judgment.

I should be monitoring my
blood sugar more closely.

Uh, your diabetes diagnosis is recent.

Lifestyle adjustments, they take time.

See what he did there?

So, what's the plan?

An X-ray and empiric antibiotics.

I'll go check on your blood
and urine cultures, okay?

- Thanks, Dr. Hawkins.
- You got it.

Now, Dr. Dreyfuss, what do you recommend

for her diabetic ketoacidosis?

An insulin drip until
her anion gap closes.

Along with aggressive hydration
and dextrose to keep her glucose

from dropping too precipitously.

And the kid redeems himself.

I love unicorns.

Excuse me.

Has this vent been used
in the last 24 hours?

No, it's been down here for
the decontamination process.

Okay, good. Clean it now.

Like, right now.

- Okay.
- Hey.

I need to talk to you.

Lunch. Half hour.

What were you doing in there?

I'm making sure they
cleaned Dawn Long's vent.

Don't want one more person
getting the superbug.

It might be too late for that.

I had one of our I.T.
guys ping any patients

who might have had
contact with Dawn Long.

They got a hit with this
new admit Sophia Masters.

She's one of the EMTs
who brought Dawn here,

and she has fever,
joint pain and diarrhea.

That could mean a number of things.

Health care providers aren't at risk

unless they have a
compromised immune system.

According to her charts, she also has

poorly managed diabetes,
which would check that box.

Who's her doctor?

Conrad Hawkins.

The whistleblower you
let back into our house?

He finds out, he will
definitely trace it back to Dawn.

You have to handle this.

If it gets out now that we have
a deadly fungus at Chastain,

this hospital goes bankrupt.

Which is why I'll handle it.

- It's on me.
- Oh, wow.

Thanks, Dr. Cain, but
you don't have to do that.

Always here to help a
struggling young intern.

Well, um, thanks again.

You've done so much for me, and my mom.

Well, no more than she did for me.

Hey, you got a few? Let's walk.

You know, your mother is one of
the finest nurses I've ever met.

- How's she been?
- Oh. S-She... Well,

she's-she's, uh, she's much better

now that you've, uh,
recommended her for that new job.

Oh, good. Good. Do you know that

she helped me when I was an intern?

No, I didn't know that. How?

Well, nurses, they teach
interns more than anyone,

and she was so generous to me.

- Oh.
- She's why I wrote

the recommendation for you
to match here at Chastain.

Oh, well, uh, I-I wouldn't
be here without you.

Well, that's very true, very true.

Please, want to step in?

Mm.

I need a small favor.

Uh, sure. Uh, a-anything.

Now, I understand that you're
working with Dr. Hawkins

- on an EMT patient named Sophia.
- Mm-hmm.

I'm worried that she has Candida auris.

Candida auris?

That-that has a
mortality rate above 50%.

Yeah, well, it's-it's just a hunch.

Sophia transported my patient
Dawn Long here from LTACH.

What, did your patient have it?

I don't know for certain.

You know, but looking back,
uh, I believe that could be

the reason why Dawn's final illness

didn't respond to the antibiotics.

Well, we need to tell Dr. Hawkins.

Well, no, that can't happen.

Because if I'm right about this,
it all stems from my mistake.

I misdiagnosed a patient,

and let me tell you, I am
beating myself up about that.

So my-my hope is to fix it,

but quietly, by making sure
Sophia gets antifungals.

I just need to make sure

that you can treat Sophia
without Hawkins finding out.

What... Are... You're serious? I, um...

Dr. Cain, what you're asking...

Is a big, big favor. I know that.

But it repays a pretty big debt.

And I know that you'll help
me... because I helped you.

- Ezra.
- What are you doing?

Did something happen to Sophia?

Her MRSA and VRE screens were negative.

Well, given her symptoms,
I thought it could be

a-a C. diff infection.

- Why didn't you page us?
- I should have. I-I'm sorry.

I just, I guess I... my-my
OCD got the best of me.

I started thinking about the
germs and then... uh, you know,

I had no idea that, uh,
sending stool for C. diff

would trigger isolation protocols.

Look, interns overcall

C. diff all the time.

Since when are you the good cop?

When it's not my intern.

Because of what you did, Ezra,

Sophia will have to remain in isolation

until her stool sample
comes back negative.

Again, so sorry. I-I didn't realize.

Fine. OCD or not...

... you're going in there and
checking in on our patient.

Hi, Isaac.

This is Dr. Austin, our very
best cardiothoracic surgeon.

Oh, I need a surgeon now?

Woof. That can't be good.

- Or cheap.
- Wow, Nic was right about you.

- You are a charmer.
- Um, why are you here?

Well, you have some scarring
and other signs on your CT

that suggest you have a lung disease

called pulmonary fibrosis.

It's the reason you've been
having a hard time breathing.

I was homeless for a while
myself when I was a teenager.

Did I get this from
living on the streets?

No, not in this case.

In this case, it's more
likely it's genetic.

Premature gray hair

is a rare genetic
manifestation of the disease.

So... I got this from my family?

Wow, I've never seen a patient

so happy about inheriting a disease.

Probably because most of your patients

know where they came from.

My parents dropped me off at a
fire station after I was born.

I was raised in foster care.

And, uh, I've waited my whole life

to learn any scrap of
information about them.

So this is like Christmas for me.

Uh, tell me there's a cure

for pulmonary fibrosis
under the tree, too.

Uh, I'm sorry, Isaac.

I'm worried the damage to
your lungs cannot be repaired.

We're gonna try to ease your
symptoms with medication,

- but, um...
- But we need to take a biopsy

of your lungs to be certain.

What's wrong?

It's Derek.

I thought he was doing better.

He was.

But then one cough led to another,

and before we knew it,
shortness of breath.

I discussed it with Conrad,
and it's Derek's lungs.

He has diffuse bilateral crackles.

Pulmonary edema?

He thinks so.

Derek's gained five pounds
of fluid since chemo,

and his kidneys still
haven't bounced back.

Well, haven't they given him diuretics?

Yes, but that might not be enough.

And if that's the case...

They want to put you on
a ventilator to help you breathe,

and hopefully allow your lungs to heal.

A ventilator?

For how long?

There's no way of knowing.

Will I be awake, able to communicate?

No, we have to sedate you.

And there's a chance you could
develop other complications

that could prevent

the breathing tube from being removed.

So, when they p-put me under, there's...

... there's a chance
that I might not wake up,

that I might not see my family again.

- Is that what you're saying?
- Shh...

That's a worst-case scenario,

but it's the only way
you recover lung function.

Kit, there has to be another way.

- There has to be another way.
- No. Honey, honey.

I don't think there is.

If I do this,

I could die.

If you don't do this...
you definitely will.

How long can I delay being intubated?

The way things are going,

unless something changes,
it will need to happen soon.

Okay, well, I just, I have
to see Josie one more time.

- Yes.
- Okay, I know that we said

that she needed a day
a-away from all this but...

No, I'll-I'll let the babysitter
pick her up from school

and bring her here immediately.

This is a bag of antifungals.

- Yes, I'm aware.
- How did you get this?

You don't get to where I am
without making a few allies.

You know someone in pharmacy?

No, I have someone in pharmacy.

I have someone everywhere.

Is Sophia still being treated
with the insulin drip and D5?

- Yes.
- Here's a label for her fluids.

Put it on the antifungals and hang it.

Are you having doubts?

No, I want to help. I, uh...

Yes.

Chock-full of doubts.

I get it.

You know, when I was an intern,

I was faced with so many choices.

It was all confusing. I struggled, too.

But eventually, I learned to
just do what I was told to do

by the people who knew better.

And I got rewarded for that.

I didn't climb up the
ladder, I flew up it.

That could be you, Ezra.

Blood pressure 90/50,
tachycardic in the 130s.

My heart, it's pounding.

Ezra, check her lungs.

Uh-huh.

She's burning up. Temp is 101.5.

Breathing sounds are diminished.

She's septic.

Two liters of normal saline now.

Dizzy. Hot. Turn down heat.

Should we start her on pressors?

Let's see how she responds to volume.

I'm putting her in Trendelenburg.

Squeeze the bag.

Her BP is rising.

It's working.

Something is causing her to deteriorate.

Yeah, but there's nothing
in her labs that's suggesting

- what that could be.
- Well, something's changed.

We need a new set of labs.

And broaden her
antibiotics, just in case.

- I'll put in the orders.
- We'll have the nurse

come check on you, Sophia.

Hey. Ezra, what are you doing?

- Hey.
- When I said, "Put in the orders",

- I meant you would.
- Yeah, right. Coming.

We got the results
from your lung biopsy.

I'm so sorry, Isaac.

You need a transplant.

Well, what are my chances
of getting a new lung?

Well, you're a good candidate.

You're young, otherwise healthy.

But in order to be
eligible for a transplant,

all patients must have a support system.

Two people who can take care
of you after the surgery,

take you to appointments,
administer medication

for as long as necessary.

They'll have to commit to your recovery,

which can be a long process.

Yeah, I am the support
system for other people.

I don't have one of my own.

Well, surely there's someone
who can step up, right?

Old foster parents, friends?

It's my own fault.

Growing up, I had a
huge chip on my shoulder.

Anger cost me every
relationship in my life.

I found my companionship in drugs.

I lost my job and then my home.

I've lived my life alone.

Now it sounds like that's how I'll die.

Okay.

Why don't you give us some time,

see if there's something
that we can figure out, okay?

You know, I do have a contact

in the pulmonary fibrosis community.

Maybe they have some resources
that could help Isaac?

Never thought I'd say this,

but silence is not a good look on you.

What's up?

I was thinking about Isaac.

He was abandoned by his parents,

never had a real home or
people who cared about him.

And how he just ended
up living in the streets.

Do you think that could have
been you if you weren't adopted?

Look, I was dealt a
good hand. He was not.

He can't think of one
person that can help him?

I have worked with
Isaac for over a year.

He spends all of his time helping those

who aren't equipped to help themselves.

He really doesn't have anyone.

You know, he's not gonna
live long post transplant

without a lot of help.

But come on, who's got the
capacity and the willingness

to take responsibility of
a 20-something-year-old man?

Me.

I wanted to give them a moment
alone before Josie arrives.

Derek's parents are trying to get here,

but I'm not sure they'll make it.

And Molly's dad? Is he on the way?

Brett's in Denmark for work.

He's trying to get home,

but... we're not together
anymore, it's complicated.

I... That's none of my business.

And I... and I can... I know
I have no standing here.

But I... had to do something

for you and your family.

And this is just... the
best I could come up with.

What is it?

I approached our palliative
care people for advice,

and they suggested this.
It's a legacy book.

So, a guide that helps patients

facing a dangerous procedure
with an uncertain outcome.

It helps them organize
their memories and, um,

put their wishes in order.

Just in case the...

And if, and if this
is... if I'm intruding,

if this is the wrong thing,

- I'm...
- It's perfect.

Derek needs to feel
like he has some control.

Thank you.

Sorry. We got trapped in the ER.

How's Sophia?

She became more acidotic and hypoxic,

so I had to intubate her.

And she's still spiking a fever

despite being on new antibiotics.

Her latest set of labs
show an acute liver injury.

Right.

What if she doesn't have an infection?

You did a detailed patient history.

Tell us more about Sophia.

Well, her mom suffered from lupus

- and her dad had MS.
- Both are autoimmune disorders.

They could run in families.

Acute liver injury, joint pain,
and Sophia's other symptoms,

she may have adult-onset
Still's disease.

Ezra, what is the treatment
for adult-onset Still's?

Steroids. But we can't give her that.

That absolutely can't happen.

Why not?

Because... W-Well,
there's no test to confirm

adult-onset Still's, so we'd
be treating Sophia blind.

That's not ideal,

but if we do nothing,
Sophia could get worse.

I'm gonna check on Sophia.

And then I'll order the steroids.

Uh, uh, aren't-aren't there
risks in giving her steroids?

Yes. Why don't you
tell me what they are?

Death.

If you give high-dose
steroids to a patient

with Candida auris,

you'll exacerbate the fungal infection

- and kill her.
- Look, we can't let her die.

Her death won't make sense.

We could trigger an investigation.

We can't let Sophia die
because she's a human being

- and we could prevent it.
- Of course.

Of-of course, that's
the first priority here.

Let me think, we have to fix this.

We've gone too far already.

None of this would be happening
if not for the liver injury,

and that is a known side effect
of the antifungal I gave her.

Okay. I get it.

So what we have to do is
we have to stop Hawkins

- from treating with steroids.
- How do we do that?

I don't know!

- It's not just me?
- No, it's not just you.

Oh, that's nice. Although,
I'd like to be more of a...

Well, you two seem to be hitting it off.

Well, of course. I'm trying.

Or she's very easily
impressed. I'm not sure which.

People like you are why I run

a pulmonary fibrosis organization.

We are in contact with more
than two million people.

And I will absolutely put
you in touch with survivors

who can talk to you about what it's like

to live with the disease.

Just know that you're not alone.

I-I love the sound of that.

Well, hopefully you'll
like the sound of this, too.

Conrad and I have agreed
to be your support system.

Wait, you're serious?

And with that assurance,

we got you on the transplant list.

My entire life, I've never had anybody

really stand by me.

I don't even know how to thank you.

Wait, wait!

Are those steroids?

No, it's an antifungal.

Sophia has Candida auris.

Candida auris? H-How did
you go from diagnosing Sophia

with adult-onset Still's
to Candida auris?

There is no test to confirm
onset Still's disease...

- but you can rule it out.
- I'm sorry, I'm a...

intern, still learning here.

- Sophia had a fever. Right?
- Yeah.

The only telltale sign of Still's is...

a salmon-colored rash
when a fever spikes.

She didn't have one.

When that happens...

... you go back to the well.

And you dig deep.

Have a look.

Otitis externa. She
has an ear infection.

Which is how Candida
auris was discovered in 2009.

Hence the name...
auris is Latin for ear.

Seemed like a leap,
but I ran the cultures

and confirmed it.

Dr. Hawkins knows.

He figured out Sophia has Candida auris.

I heard.

He already notified
the health department.

It's over.

Get the bag of antifungals
that you hung and it will be.

It's the only thing
that connects us to this.

There's something I don't understand.

Why cover this up?

You're the most powerful doctor I know.

You could have survived this

if you'd just told the
truth from the beginning.

Why didn't you?

Because Logan Kim
would have destroyed me.

Over one mistake?

This isn't the first, Ezra.

When I was an intern, much like you...

something really bad happened.

We all make mistakes in the beginning.

Not like this one.

Laparoscopic instruments
got infected by bacteria.

Patients got sick just
from routine procedures.

Four of them ended up dead.

I suspected that the
instruments were contaminated,

but... I never said anything.

Why?

Fear.

Red Rock covered for me,
but that was all possible

because your mother took pity on me.

She helped them.

And I would not be here
right now without her.

My mom wouldn't have stuck
her neck out like that

if she didn't see something in you.

And with her sacrifice,
I've done a lot of good.

A lot. And I hope to do more.

But there's just one more loose end...

What else should we
put in our picture book?

My birthday party.

- Good idea.
- There you are at the steamboat restaurant

with your cake and ice cream. Hmm?

Mm.

So this one for sure
goes in the legacy book.

'Cause Josie and I,
we love our ice cream.

Yeah?

I'll get a print made.

Here.

Why does Daddy have to wear the mask?

It helps him breathe.

- He's still very sick?
- Yes.

But he's fighting to get better.

Honey? You and Mommy

are gonna be alone while
I'm in the hospital.

I know this is all confusing and scary.

But will you promise me

you'll take care of each other?

That's my girl.

Thought someone might
want a hot chocolate.

- What do we say?
- Thank you, Dr. Hawkins.

Oh, you're welcome.

What's that for?

Uh, the vent will help your dad breathe.

They're just setting it up for later.

Code Blue, Room 54-17.

- Code Blue, Room 54-17.
- I need a vent, now!

Go. I'll ask for another one.

Isaac. What's happening, man?

Sats in the 80s. BP's down to 70/50.

No, wait.

- If we wait, he'll code.
- Well, his neck veins,

they're distended up to his ears.

He's hyperresonant on the
left. There's air in there.

Chest tube is kinked.

What? You got to be kidding me.

That's what's causing the hemothorax.

Oh, yeah, there you go.
Hey, hey, hey, you all right?

- You're breathing now, right?
- Mm-hmm.

All right, all right, Isaac.

We got you.

Listen to me. Guys like Isaac,

if they go on the vent,
they never come off.

Vents fall into the "last
resort only" category.

- You got me?
- Got it.

All right, all right. We got you.

You need this?

No, it's okay. Put it over there.

Well, because your fibrosis is genetic,

I asked Cheryl if she knew
of anyone with premature

gray hair in their 20s.

Is she sure that this guy is my cousin,

not just some dude that recovered

from pulmonary fibrosis?

A DNA test will confirm,

but you cannot deny the resemblance.

Those are definitely my
eyes and my nose and my chin.

And everything.

His name is Gabriel, and
after hearing your story,

he thinks your mom is his aunt.

She got pregnant as a teen,
and ran away from home.

And they've been searching for
her and her child ever since.

Now, he's talked to
the rest of his family,

and they have agreed to
be your support system.

Even if you're not related.

I don't even know how to thank you.

You've been longing for
this your whole life.

And now it's here.

He's ready.

As ready as he'll ever be.

I helped him write a beautiful letter

for the legacy book that
Josie will have all her life.

Let's hope she never has to read it.

Yeah.

The legacy book was a great idea, Mom,

and made Derek feel
like... like no matter what,

he was still taking
care of me and Josie.

Oh, darling, it's okay.

Let it go.

Okay.

Remember this.

Derek can still make
it through, and no one

is giving up on him.

Come here.

- Thanks.
- Yeah.

It's gonna be okay.

Okay.

It's time for Dr. Bell to
take you to get some food.

I don't want to leave Daddy.

Daddy wants you to go with Dr. Bell.

He's very nice.

Sometimes even a little bit funny.

I love you.

I love you, too, Daddy.

We'll be here when you wake up.

They'll be fine.

I'll make sure of it.

I know.

I love you, too.

It's okay.

- You good?
- I'm good.

All right.

We're gonna give you a medication

that will put you to sleep.

All right, Kathleen.

There you go.

What happened to her?

Antifungals aren't working.

We've got her on four
liters of normal saline.

Her systolic is still in the 70s.

She's going into shock.
She needs pressors.

There's no access. Her
veins are collapsed.

Then let's get an IO.

Ezra, grab one out of the code cart.

Where's that drill going?

Directly into the bone marrow.

Now you have your central access.

Okay, starting her on norepi.

Turn it up to 50 mics per kilo.

Higher.

- She's maxed out.
- So what do we do?

Hit her with every
antifungal in our pharmacy.

And if none of them work?

Then she dies.

I mean, how did Sophia even
get Candida auris to begin with?

The health department will
have to find the source.

If we would have found it sooner,

maybe that would have
made the difference.

Hey, it's not your fault.

Candida auris is
notoriously difficult to diagnose.

She got antifungals from the start.

Long before you knew.

What are you talking about?

I gave them to her.

- What? Why would you do that?
- Dr. Cain told me to.

Why?

He knew she had Candida auris?

He suspected.

How?

It's been killing me
keeping Cain's secrets.

You better sit down and tell
us the whole story right now.

I assume you heard the EMT who
brought Dawn Long here is dead.

Sophia.

Say something.

What do you want me to say?

That you regret going to Logan

instead of the state health board.

That you wish you would have
come to me from the beginning,

'cause maybe we could've
done something to save her.

That you regret using a
scared, vulnerable kid,

saddling him with guilt

he'll carry with him
the rest of his life.

Spare me your self-righteous anger.

You're no angel.

You've caused harm.
You've made mistakes.

I don't willfully endanger my patients.

I told Kim and I warned him

to be straightforward
about Candida auris.

I told him about that.

- He threatened me.
- But you... you caved?

All that bluster, you
bow down to a suit?

Why do you come in here?

So you can feel like a king?

Convince yourself you're not a coward?

Get out.

How could someone so
brilliant and so gifted

throw it all away and sell
their soul to Red Rock?

Is it just the money? The power?

Your name on a building?

What does any of that
mean at the end of the day

if you can't look in the mirror?

Come on. It's okay.

Sleep tight, Daddy.

- Synced and corrected by Firefly -
- www.addic7ed.com -