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- Previously on the Resident...
- Good morning. These are
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- the interns I told you about.
- I'm Zach,
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- Primary Care.
- Let's get started, shall we?
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Listen, I'm not a man
that you'll find in Child's Pose,
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so I'm just gonna be on my way to...
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AJ, I happen to know
from personal experience
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that you could really benefit
from a little extra flexibility.
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All right,
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come lie down and grab a mat.
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I don't know if I want kids.
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At least not right now.
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What Padma wants can help us both.
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I can give her the egg
she so desperately wants
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so she can have a baby,
and at the same time
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I can freeze some for us.
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- What about him?
- This guy?
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Yeah. He runs marathons,
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plays the cello and,
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Oh, Leela, look at that
chubby little face. Aww.
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Well, I wish we could meet
"Tall & Talented" in person.
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Or maybe see an adult photo,
not just a baby photo.
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Well, then these anonymous sperm donors
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wouldn't be very anonymous, would they?
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I just want the father of your child
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to be as amazing as you.
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My sister deserves Grade A sperm.
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Thank you for doing this for me.
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What, you think I'm doing this
for you? No.
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I'm only giving you my egg
so I can be an auntie.
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Well, you're gonna be the best one.
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- We should get to Chastain.
- Wait.
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What about him?
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- "The Right Stuff"?
- Yeah.
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He loves yoga, travel and Basquiat.
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No markers for genetic disease.
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And he's South Asian.
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I think it's a sign.
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Okay, well, why don't we
email the sperm bank
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- and try to get a voice sample?
- Leel, he is the one, I can feel it.
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No, no, you don't need
to decide right now.
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- Padma, are you sure?
- I am.
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"The Right Stuff" it is.
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Sorry, I know how busy you are.
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Not a problem. Happy to help.
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Usually I'm texting you to do
something a bit more fun, huh?
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Yeah.
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It's probably just a stomachache,
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- but Gigi insisted that you check.
- Oh, did she?
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I told Peter you fix hurt tummies.
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- Hey, Peter, remember me?
- Your Gigi's dad.
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I am. What's going on, buddy?
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We were playing super space, Daddy.
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Yeah, these two can go all day.
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He is the astronaut, she is the alien.
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Peter said he didn't want to play,
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but he always wants to play.
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I'm gonna place my hands on your stomach
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for a second, okay?
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All right.
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Peter's dad is on the way.
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Have him meet me in the ER.
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Do you like piggyback rides?
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Yeah, I thought so. Hop on.
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Can I go with you, Daddy?
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You wait here, my little alien.
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I'll come back soon and let you
know how Peter's doing.
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Kids, we're going on a field trip.
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A rite of passage.
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When I was a first year, like you,
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Dr. Hawkins took me,
and now it's your turn.
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Our turn for what?
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Since the start of your intern year,
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you've learned to become doctors
inside these walls,
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and today you are going outside Chastain
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to treat one of the most
challenging patient populations.
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A place you'll tackle
complex medical cases
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that make great doctors.
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Dr. Voss and Dr. Bell
will be joining us,
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so let's get moving.
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Where are we going?
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Dr. Pravesh didn't tell you?
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Let's not spoil the surprise.
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Okay.
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All right, here we are.
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Shall we?
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We got played.
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Oh, my God, old folks?
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- Synced and corrected by synk -
- www.addic7ed.com -
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All right, Mr. Astronaut,
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can you tell me when it started to hurt?
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Does the pain move around at all?
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I'm okay now.
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Is my dad coming?
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Yeah, he's coming.
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To take me home?
I don't want to go home.
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Oh, you're not going home, hon.
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You're gonna stay here with us
until we can
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figure out why you're not
feeling so great.
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- Hey, bud.
- Hey, Daddy.
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Are you okay? What's going on?
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Hey, Spencer. This is Nurse Hundley.
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Spencer works in our IT department.
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Nice to meet you.
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Peter has a stomachache.
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Normally, that's not
a reason to be worried.
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His temp's a little low.
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It could be a sign of infection.
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- Oh.
- He seemed fine this morning.
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Said that he and Gigi were
going to space.
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Has he been sick at all
in the past few weeks?
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Had a cold a few days ago,
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but nothing out of the ordinary.
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Any dietary changes this morning?
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I made him a smoothie, um, as a treat.
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Bananas, yogurt, protein powder, juice.
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I mean, we shared it. I feel all right.
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He won't tell us more about his pain.
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He keeps saying he's fine.
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Well, I think because
he doesn't want to go home.
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- Right?
- I'll go home
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if you stay with me, Daddy.
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I'll stay right here, no matter what.
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Okay, bud?
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No matter what.
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I'll get us ready to draw labs.
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I'm gonna step aside for a second, okay?
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- Can I talk to you?
- Yeah, sure.
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We're good here, right, hon?
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Uh...
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he's got separation anxiety.
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His mom left us both three months ago.
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She hasn't been back, or even called.
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New boyfriend, drug problem.
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It's a long story.
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I'm sorry to hear that.
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Now Peter's afraid
you might disappear, too?
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Yes.
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He feels safe at Chastain because
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he knows that I work in the building.
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Well, separation anxiety
may be behind this.
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It can cause stomach trouble.
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Do some blood work, run some tests,
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and then we'll go from there, all right?
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Dr. Milner to Emergency.
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Dr. Milner to Emergency.
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There he is.
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The Brookhaven resident
who happens to be
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- one of my health care heroes.
- Dr. Kravitz?
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Yes.
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Just be aware he has early mild
cognitive impairment.
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He remembers people and events
from the past perfectly,
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but his short-term memory's going.
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Okay, got it.
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- Dr. Kravitz.
- Kit. Lovely to see you.
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I did a gerontology rotation
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with Dr. Kravitz when I was a resident.
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He was one of my finest teachers.
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This is Dr. Randolph Bell.
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It's an honor.
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You're a legend in the field
of geriatrics.
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You know, your book,
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Compassionate Care of the Elderly,
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has been on my shelf for decades.
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I-I'm sorry, your name again?
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Randolph Bell.
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Randolph, Randolph, Randolph...
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So do all your friends here
wheedle you for free care?
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Oh, absolutely not. We won't allow it.
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Arthur here is fully retired.
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He's earned the right to have
others care for him.
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Gloria, darling, this is Kit,
and this-this is...
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Well, there's no introduction
necessary, sweetie.
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Everybody knows the famous
Dr. Randolph Bell.
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She not only has my heart,
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she is now my head.
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In every way, she takes care of me.
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Well, it's mutual.
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Well, it was nice of you to come today.
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You know, it can be kind of hard to get
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some of us old coots to get
our regular check-ups.
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Well, we have an ulterior motive
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for bringing some of
our interns here today.
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We're hoping to inspire them
to join your field.
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This country needs more gerontologists,
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and even some of the best doctors
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don't understand the particular
needs of senior citizens.
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Geriatricians have higher
career satisfaction
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than other medical specialties.
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But the pay...
not what you get in surgery.
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Would you consider talking
to some of our interns
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about your career?
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Let me at 'em.
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Do you think we'll still be that in love
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when we're their age?
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Why wouldn't we be?
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Padma, now that you picked
a sperm donor,
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we'll start Leela's daily
injections of hormones
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to encourage her body
to produce more eggs
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- than it does in a usual cycle.
- We're excited.
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Me, too. We'll be monitoring you
with blood tests
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and ultrasounds.
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I read about this thing called, uh,
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- ovarian hyper-something.
- Hyperstim.
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Yeah. Do we need to worry about that?
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No, not with regular monitoring
of my estradiol levels.
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If they get too high,
we back off, lower the dose.
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That question wasn't for me.
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But you're right.
This is quite a safe process.
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Okay, what can I do to help?
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For now, nothing. Not until we start you
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on meds in a few weeks to
prepare for the embryo transfer.
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- Okay.
- Okay?
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Leela, I will walk you through
your first injection.
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Um, I was thinking...
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00:09:01,567 --> 00:09:03,642
maybe I can do it.
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You want to stick a needle in me?
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00:09:04,829 --> 00:09:06,629
I just want to be part of this
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in every way that I can.
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- You know.
- Of course.
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00:09:11,577 --> 00:09:14,086
I would like that, too.
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Does our patient have a visitor?
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He does indeed.
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- Gigi!
- Hi, Peter.
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00:09:25,241 --> 00:09:27,908
Ah, good friends are good medicine.
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All right, you two, behave.
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I'm gonna chat with your dad real quick.
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00:09:33,099 --> 00:09:35,766
Thought a fun distraction
for Peter could be good.
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00:09:35,860 --> 00:09:37,895
So his labs came back.
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White blood cell count was
normal, no sign of infection.
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Appendicitis, uh... seems unlikely.
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Maybe it's psychological.
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You know, he's been through a lot.
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My gut's telling me
it's more than anxiety,
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and I want to run a few more tests.
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What's up?
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Did you fix his tummy, Daddy?
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It's always his tummy.
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What do you mean, "always," sweetheart?
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It happened before?
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How often does your tummy hurt, Pete?
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A whole lot of times.
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00:10:06,840 --> 00:10:08,917
Why didn't you tell me anything, Pete?
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00:10:08,942 --> 00:10:12,370
- I don't understand.
- I didn't want to stay at home.
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I wanted to come here, with you.
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00:10:15,733 --> 00:10:18,717
I'll never leave you, okay?
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00:10:18,886 --> 00:10:21,112
I'll never leave you.
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00:10:23,741 --> 00:10:24,907
Do you understand?
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00:10:25,134 --> 00:10:27,134
Daddy, there's something else.
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00:10:27,227 --> 00:10:29,804
It's weird, but maybe I should tell you.
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00:10:29,822 --> 00:10:31,725
This morning, Peter and I were playing
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00:10:31,749 --> 00:10:33,732
that we were on another planet.
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He kept saying that I had two heads.
253
00:10:35,995 --> 00:10:37,995
Yeah, you told me that. Pretending.
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00:10:38,147 --> 00:10:39,755
No, he meant it.
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00:10:39,982 --> 00:10:43,968
He said I really was a space alien.
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00:10:46,246 --> 00:10:49,974
Peter, does anyone else have two heads?
257
00:10:51,214 --> 00:10:53,882
That nurse lady and you,
258
00:10:53,907 --> 00:10:55,740
kind of.
259
00:10:56,623 --> 00:10:59,527
Double vision. How many fingers
am I holding up?
260
00:11:01,170 --> 00:11:03,613
- What's going on?
- This could be neurological.
261
00:11:03,781 --> 00:11:06,324
We need to get him to CT.
262
00:11:08,194 --> 00:11:11,937
So this woman, who is 83, kept chickens.
263
00:11:12,014 --> 00:11:14,031
And she loved her chickens.
264
00:11:14,183 --> 00:11:15,850
She named each one of them.
265
00:11:15,868 --> 00:11:19,370
The-the first day I spent
with her, she gave me eggs.
266
00:11:19,464 --> 00:11:22,948
Anyway, she had a problem
with worsening anemia.
267
00:11:23,042 --> 00:11:26,284
Fatigue, muscle weakness,
intestinal problems.
268
00:11:26,379 --> 00:11:30,842
She started forgetting things
and... falling.
269
00:11:30,867 --> 00:11:33,792
Now, any ideas what was wrong with her?
270
00:11:33,886 --> 00:11:36,387
Likely more than one thing.
271
00:11:36,539 --> 00:11:39,874
Alzheimer's, and possibly cancer?
272
00:11:39,892 --> 00:11:41,466
Or a recent stroke.
273
00:11:41,560 --> 00:11:42,893
I'll give you a hint.
274
00:11:43,045 --> 00:11:45,137
The key was the chickens.
275
00:11:45,156 --> 00:11:47,898
People who name their chickens
don't eat them.
276
00:11:48,050 --> 00:11:50,384
Exactly. He's smart.
277
00:11:50,477 --> 00:11:51,955
You-you could be a gerontologist.
278
00:11:51,979 --> 00:11:53,329
I don't get it.
279
00:11:53,480 --> 00:11:57,159
Okay, it's a B12 deficiency,
common with age.
280
00:11:57,184 --> 00:11:58,984
Learned that from Dr. Kravitz's book.
281
00:11:59,003 --> 00:12:03,731
So I'm guessing that
the patient was a... vegan,
282
00:12:03,824 --> 00:12:06,324
because she gave away the eggs.
283
00:12:06,344 --> 00:12:08,752
Bingo.
284
00:12:08,905 --> 00:12:12,072
The woman's vegan diet was a good choice
285
00:12:12,091 --> 00:12:14,408
because it reduced her risk
of heart disease,
286
00:12:14,501 --> 00:12:15,996
Type 2 diabetes, certain cancers.
287
00:12:16,020 --> 00:12:19,065
But she forgot to supplement with B12,
288
00:12:19,090 --> 00:12:20,392
which was the source of
all of her symptoms.
289
00:12:20,416 --> 00:12:24,752
This is why gerontology is
a great profession.
290
00:12:24,845 --> 00:12:27,179
You spend time with patients.
291
00:12:27,198 --> 00:12:29,792
You talk with them, you get
to know the whole person,
292
00:12:29,817 --> 00:12:32,737
all the while keeping your eye
on the big picture.
293
00:12:32,762 --> 00:12:34,870
Which is the key to diagnosis.
294
00:12:35,022 --> 00:12:37,765
Oh! My lady awaits.
295
00:12:37,783 --> 00:12:41,952
And I see that they have put out
snacks, and I am peckish.
296
00:12:41,977 --> 00:12:44,097
- Excuse me.
- Thank you, Dr. Kravitz.
297
00:12:46,792 --> 00:12:48,943
Hi, sweetie.
298
00:12:48,961 --> 00:12:51,659
Hey, maybe gerontology is
an aphrodisiac.
299
00:12:51,684 --> 00:12:53,538
This old goat has
the prettiest lady in the place,
300
00:12:53,558 --> 00:12:55,736
and I have not had a
date since high school.
301
00:12:55,760 --> 00:12:56,831
Oh...
302
00:12:56,856 --> 00:12:58,561
No, no, I'm kidding.
303
00:12:58,712 --> 00:13:01,455
Gloria!
304
00:13:01,548 --> 00:13:02,639
Her pulse is thready.
305
00:13:02,734 --> 00:13:04,194
Call 911. Let's get her to Chastain.
306
00:13:04,218 --> 00:13:05,459
Somebody grab these pills.
To take with us.
307
00:13:05,478 --> 00:13:07,718
We're gonna need to know
what she's been taking.
308
00:13:13,041 --> 00:13:16,371
I don't understand.
Are you telling me I fainted?
309
00:13:16,396 --> 00:13:19,120
Yes. And they're
going to figure out why.
310
00:13:19,145 --> 00:13:20,899
I was probably just dehydrated.
311
00:13:20,918 --> 00:13:23,143
I didn't ruin your event, did I?
312
00:13:23,168 --> 00:13:24,661
No, we were winding down anyway.
313
00:13:24,814 --> 00:13:26,238
You added the drama.
314
00:13:26,332 --> 00:13:28,591
The good news is,
your wrist isn't broken.
315
00:13:28,742 --> 00:13:29,833
You just need a splint.
316
00:13:29,986 --> 00:13:31,721
And your EKG and your labs look normal.
317
00:13:31,745 --> 00:13:34,004
So how did you feel
right before you passed out?
318
00:13:34,156 --> 00:13:36,918
I got dizzy. A little lightheaded.
319
00:13:36,943 --> 00:13:39,737
A-A drop in blood pressure.
It's not uncommon
320
00:13:39,762 --> 00:13:41,472
among women on blood pressure meds.
321
00:13:41,497 --> 00:13:42,583
But she's-she's not on any.
322
00:13:42,607 --> 00:13:44,982
Oh, well, yes, I am, dear.
323
00:13:46,519 --> 00:13:48,685
- You are?
- Mm-hmm.
324
00:13:48,838 --> 00:13:50,428
Why didn't you tell me?
325
00:13:50,448 --> 00:13:52,689
I did.
326
00:13:52,784 --> 00:13:55,526
Let's start here.
327
00:13:55,678 --> 00:13:58,103
My thought exactly.
328
00:13:58,122 --> 00:14:00,697
Houston to Rocket Nine Niner,
329
00:14:00,850 --> 00:14:02,458
do you read me?
330
00:14:02,609 --> 00:14:05,202
Copy, Rocket Nine Niner.
331
00:14:05,354 --> 00:14:09,614
Please keep your hands
and arms inside the spacecraft.
332
00:14:09,692 --> 00:14:11,585
We are go for liftoff.
333
00:14:11,610 --> 00:14:14,470
Over and out.
334
00:14:15,881 --> 00:14:18,858
Was that for him or for you?
335
00:14:18,883 --> 00:14:21,012
A little bit of both.
336
00:14:21,037 --> 00:14:23,128
I'm worried about him.
337
00:14:24,148 --> 00:14:27,320
If Peter's abdominal issues
are caused by
338
00:14:27,345 --> 00:14:30,638
a neurological one, we could be
looking at a bleed.
339
00:14:35,885 --> 00:14:37,734
I don't see one.
340
00:14:37,811 --> 00:14:40,830
No evidence of a stroke, either.
341
00:14:40,981 --> 00:14:43,724
But his ventricles are a little...
342
00:14:43,726 --> 00:14:46,377
Too little.
343
00:14:50,643 --> 00:14:52,233
His brain is swelling.
344
00:14:52,258 --> 00:14:54,413
Now, if we don't figure out why
and the swelling worsens,
345
00:14:54,438 --> 00:14:56,624
I'll have to perform a
craniectomy to relieve the pressure.
346
00:14:56,649 --> 00:14:58,640
Cutting a six-year-old's head
open on an "if."
347
00:14:58,665 --> 00:15:00,476
Of course not, but if things
move south quickly,
348
00:15:00,500 --> 00:15:01,960
we have to be ready to move to the OR.
349
00:15:01,984 --> 00:15:04,265
Fine, but let's keep in mind
the risks aren't just
350
00:15:04,396 --> 00:15:05,486
bleeding and infection.
351
00:15:05,505 --> 00:15:07,041
There could be permanent brain damage.
352
00:15:07,065 --> 00:15:10,233
We need to figure out how
to avoid surgery altogether.
353
00:15:10,251 --> 00:15:12,396
Let's start Peter on meds
to lower the pressure
354
00:15:12,420 --> 00:15:13,920
on his brain immediately,
355
00:15:14,072 --> 00:15:15,566
hope they work and move him to ICU.
356
00:15:15,590 --> 00:15:18,241
Yes, that sounds like a plan.
357
00:15:18,334 --> 00:15:22,095
Well, why didn't you tell me
you were taking all of these?
358
00:15:22,120 --> 00:15:23,481
Oh, I did, dear.
359
00:15:23,506 --> 00:15:25,426
Every time I added a medication.
360
00:15:25,508 --> 00:15:28,342
But you can't be expected
to remember all these.
361
00:15:28,436 --> 00:15:30,511
I-I forgot all of them.
362
00:15:30,530 --> 00:15:32,491
Multiple medications,
called polypharmacy,
363
00:15:32,515 --> 00:15:35,200
is associated with adverse outcomes,
364
00:15:35,369 --> 00:15:37,443
particularly as we age. They interact,
365
00:15:37,596 --> 00:15:39,612
causing falls, drug reactions,
366
00:15:39,764 --> 00:15:42,599
and can even lead
to increased mortality.
367
00:15:42,617 --> 00:15:44,434
It all started with the arthritis.
368
00:15:44,452 --> 00:15:46,452
The ibuprofen wasn't doing anything,
369
00:15:46,529 --> 00:15:49,288
so a doctor put me on prednisone.
370
00:15:49,383 --> 00:15:51,365
Well, that gave me heartburn,
371
00:15:51,385 --> 00:15:53,218
so he gave me omeprazole.
372
00:15:53,369 --> 00:15:54,772
But then that made me nauseous,
373
00:15:54,796 --> 00:15:57,872
so they added ondansetron
for my stomach.
374
00:15:57,966 --> 00:16:01,375
That made my heart flutter,
so they gave me metoprolol,
375
00:16:01,395 --> 00:16:02,877
and then my legs started to swell,
376
00:16:02,896 --> 00:16:04,540
so they gave me furosemide,
and that's when
377
00:16:04,564 --> 00:16:06,714
I stopped walking very much,
378
00:16:06,733 --> 00:16:09,642
and, uh, my blood pressure
shot up, so they...
379
00:16:09,996 --> 00:16:11,605
Should I keep going?
380
00:16:11,630 --> 00:16:13,274
...practitioner to the ER, please.
381
00:16:13,298 --> 00:16:15,156
Nurse practitioner to the ER.
382
00:16:19,137 --> 00:16:20,470
Double shift?
383
00:16:20,563 --> 00:16:23,973
Actually, I'm just starting.
384
00:16:24,066 --> 00:16:25,878
Been having a hard time sleeping.
385
00:16:25,902 --> 00:16:28,645
- Oh, that sucks.
- Yeah, tell me about it.
386
00:16:28,663 --> 00:16:33,225
Oh, um, Leela told me about your mother.
387
00:16:33,910 --> 00:16:35,260
How is she?
388
00:16:35,411 --> 00:16:38,154
Sorry, it's... it's none of my business.
389
00:16:38,173 --> 00:16:40,323
No, it isn't.
390
00:16:40,325 --> 00:16:42,434
But it's nice of you to ask.
391
00:16:42,585 --> 00:16:44,472
She just moved in with me on Saturday.
392
00:16:44,496 --> 00:16:46,512
It's been good having her close.
393
00:16:46,665 --> 00:16:48,106
And how are you?
394
00:16:48,333 --> 00:16:50,775
Well, I'm trying to resist the urge
395
00:16:50,852 --> 00:16:53,169
to check my home security camera
every five minutes
396
00:16:53,262 --> 00:16:55,505
to see how she's doing.
397
00:16:55,598 --> 00:16:58,098
Okay, well, actually, I'm not resisting.
398
00:16:58,193 --> 00:17:01,953
Would you look at this woman?
She's out there gardening.
399
00:17:02,104 --> 00:17:03,346
Are those rhododendrons?
400
00:17:03,364 --> 00:17:07,850
A little pink for my taste,
but she loves them.
401
00:17:07,869 --> 00:17:11,129
I'm leading a meditation at 3:00.
402
00:17:11,356 --> 00:17:14,591
- Join us.
- Maybe I will.
403
00:17:16,211 --> 00:17:18,377
- So, how are you?
- Great.
404
00:17:18,530 --> 00:17:20,341
I just injected my sister with hormones
405
00:17:20,365 --> 00:17:21,525
so she can donate her eggs to me
406
00:17:21,549 --> 00:17:23,382
and I can be a mom. Hmm!
407
00:17:23,477 --> 00:17:26,728
Oh, wear something comfortable.
408
00:17:31,151 --> 00:17:35,487
So they put her
on hydrochlorothiazide...
409
00:17:35,638 --> 00:17:37,638
And that made Gloria feel fatigued.
410
00:17:37,732 --> 00:17:39,473
So they gave her methylphenidate.
411
00:17:39,493 --> 00:17:41,045
Which could have had
a negative interaction
412
00:17:41,069 --> 00:17:43,736
with the linezolid that she
was taking for that cellulitis.
413
00:17:43,888 --> 00:17:46,025
Or the zolpidem or quetiapine,
414
00:17:46,050 --> 00:17:48,401
which Gloria was also on.
415
00:17:50,729 --> 00:17:52,723
What are we even doing,
416
00:17:52,747 --> 00:17:53,896
Dr. Pravesh?
417
00:17:53,915 --> 00:17:57,083
We're looking into
all contraindications.
418
00:17:57,177 --> 00:18:00,311
But she is a sick older lady
who needs these drugs.
419
00:18:00,336 --> 00:18:02,508
Like, which do you even stop?
420
00:18:02,533 --> 00:18:04,217
We move carefully,
421
00:18:04,242 --> 00:18:07,769
removing one by one.
422
00:18:09,264 --> 00:18:10,747
No.
423
00:18:10,765 --> 00:18:14,267
This is over my head
and, honestly, kind of boring.
424
00:18:14,418 --> 00:18:16,585
I need to find a surgery to observe.
425
00:18:16,610 --> 00:18:20,186
I thought you were going into
primary care.
426
00:18:20,204 --> 00:18:21,601
No. I want to be a surgeon.
427
00:18:21,626 --> 00:18:22,953
It's exciting, and you fix problems
428
00:18:22,977 --> 00:18:26,232
that are actually fixable,
not buff up old people
429
00:18:26,257 --> 00:18:27,440
until they die.
430
00:18:27,465 --> 00:18:29,126
You don't think people die
on the OR table?
431
00:18:29,278 --> 00:18:30,610
They do all the time.
432
00:18:30,635 --> 00:18:32,323
Not everything is fixable with a knife.
433
00:18:32,348 --> 00:18:33,393
You get that, right?
434
00:18:33,413 --> 00:18:35,206
You can fix things with your brain.
435
00:18:35,230 --> 00:18:36,827
Excuse me, have you met me?
436
00:18:36,852 --> 00:18:38,209
I read that surgeons don't actually have
437
00:18:38,233 --> 00:18:42,097
the highest IQ, and I thought,
there, that's my specialty.
438
00:18:42,122 --> 00:18:43,122
Hmm.
439
00:18:43,147 --> 00:18:45,072
This woman needs us,
440
00:18:45,091 --> 00:18:48,000
and Dr. Kravitz needs her.
441
00:18:48,094 --> 00:18:51,793
So if you're not interested,
I say go hunt down Dr. Austin
442
00:18:51,818 --> 00:18:53,505
and see if he'll let you into his OR.
443
00:18:53,658 --> 00:18:55,560
But be aware that
he will not consider it
444
00:18:55,584 --> 00:18:57,660
for one nanosecond
445
00:18:57,753 --> 00:19:00,980
when I tell him
you deserted this patient.
446
00:19:06,446 --> 00:19:08,779
Okay, I will stay.
447
00:19:08,948 --> 00:19:12,992
But don't tell him about
that IQ thing, either.
448
00:19:17,857 --> 00:19:19,773
I want to go with him.
449
00:19:19,867 --> 00:19:21,829
You can't, honey. He needs special care
450
00:19:21,853 --> 00:19:23,443
in a special part of the hospital.
451
00:19:23,463 --> 00:19:25,779
You mean he's really sick?
452
00:19:25,798 --> 00:19:27,114
You fix people.
453
00:19:27,133 --> 00:19:31,135
- You'll fix him, can't you, Daddy?
- Spencer.
454
00:19:31,286 --> 00:19:33,554
I'll be right there.
455
00:19:35,366 --> 00:19:38,789
What's happening? His daddy is scared.
456
00:19:38,814 --> 00:19:41,022
You have to save Peter.
457
00:19:44,375 --> 00:19:46,375
I got him.
458
00:19:46,394 --> 00:19:49,068
I got him, I promise.
459
00:19:54,476 --> 00:19:55,803
He seems much worse.
460
00:19:55,828 --> 00:19:58,311
Please tell me you have some news.
461
00:19:58,406 --> 00:20:00,223
We gave him another round of meds
462
00:20:00,248 --> 00:20:01,957
to lower the intracranial pressure,
463
00:20:01,982 --> 00:20:05,169
but it'll take time... if it works.
464
00:20:07,823 --> 00:20:10,499
He was hurting, and I totally missed it.
465
00:20:11,752 --> 00:20:14,804
I get guilt, believe me,
but it is not earned here.
466
00:20:18,926 --> 00:20:21,334
Help him. Please.
467
00:20:21,359 --> 00:20:24,768
We're doing everything we can.
468
00:20:24,932 --> 00:20:26,524
Uh, just...
469
00:20:26,751 --> 00:20:29,509
I don't want anybody
cutting his head open.
470
00:20:29,529 --> 00:20:30,844
Not if we can avoid it.
471
00:20:30,863 --> 00:20:32,530
Understood.
472
00:20:38,095 --> 00:20:39,095
You all right?
473
00:20:40,781 --> 00:20:43,115
Now I feel guilty, about how lucky I am
474
00:20:43,267 --> 00:20:44,709
not to be in Spencer's shoes.
475
00:20:44,936 --> 00:20:46,430
Peter has to make it through this.
476
00:20:46,454 --> 00:20:48,437
- I know.
- And Gigi, she lost her mother.
477
00:20:48,456 --> 00:20:49,599
She can't lose her best friend.
478
00:20:49,623 --> 00:20:50,751
We have to make sure they both come
479
00:20:50,775 --> 00:20:51,902
out of this.
480
00:20:51,926 --> 00:20:53,926
Uh, Dr. Hawkins!
481
00:20:56,872 --> 00:21:00,725
Vomiting means his intracranial
pressure must be rising.
482
00:21:03,229 --> 00:21:04,395
I'm a little confused.
483
00:21:04,420 --> 00:21:05,948
- I'm sorry.
- So the metoprolol
484
00:21:05,973 --> 00:21:07,122
helped your heart,
485
00:21:07,141 --> 00:21:08,936
but it also lowered your blood pressure.
486
00:21:08,960 --> 00:21:10,459
And with all the
water pills you were on,
487
00:21:10,478 --> 00:21:12,223
plus the stimulants,
your heart rate sped
488
00:21:12,248 --> 00:21:15,067
and BP lowered, which caused you
to lose consciousness.
489
00:21:15,092 --> 00:21:16,367
Other doctors have been telling me
490
00:21:16,391 --> 00:21:19,266
that these meds are saving
my life, and you're telling me
491
00:21:19,291 --> 00:21:21,715
- the opposite?
- No, just listen to them, hon.
492
00:21:21,740 --> 00:21:24,656
They want to take you off
medications you may not need,
493
00:21:24,809 --> 00:21:26,562
and-and keep you on
ones that are working.
494
00:21:26,586 --> 00:21:27,810
But we'd like to keep you here
495
00:21:27,828 --> 00:21:29,628
to monitor you while we do it.
496
00:21:29,756 --> 00:21:32,973
But it's just for a day,
and then, um, you'll go home.
497
00:21:32,998 --> 00:21:35,985
- There's hope for him yet.
- Mm.
498
00:21:35,987 --> 00:21:37,577
Thank you both.
499
00:21:37,597 --> 00:21:40,172
We've given Peter the maximum doses,
500
00:21:40,324 --> 00:21:42,749
but he's... he's not improving.
501
00:21:42,843 --> 00:21:44,731
Well, time to book an OR.
502
00:21:44,756 --> 00:21:46,937
No, let's just...
503
00:21:47,582 --> 00:21:48,932
...start with a drain
504
00:21:48,957 --> 00:21:51,016
before you open his head.
505
00:21:54,096 --> 00:21:55,571
Okay, we can try it.
506
00:21:57,341 --> 00:21:59,617
I'll get an EVD monitor.
507
00:22:02,680 --> 00:22:05,514
- Talk to me.
- We're putting in a drain.
508
00:22:05,533 --> 00:22:08,125
It should help relieve
the pressure on his brain.
509
00:22:08,691 --> 00:22:10,166
It's a first step.
510
00:22:13,123 --> 00:22:16,499
I don't know how much longer
we can put off a craniectomy.
511
00:22:18,078 --> 00:22:19,887
It's my son.
512
00:22:23,701 --> 00:22:26,239
Let's take everything
one step at a time.
513
00:22:26,264 --> 00:22:29,515
Right now, we need to sedate
and intubate,
514
00:22:29,540 --> 00:22:32,041
and to protect his airway.
515
00:22:32,059 --> 00:22:35,561
I have to talk to him first,
before you, before you...
516
00:22:35,713 --> 00:22:38,739
Of course. Of course.
517
00:22:46,891 --> 00:22:49,316
Hey, bud.
518
00:22:50,503 --> 00:22:54,246
I just want you to know...
519
00:22:54,398 --> 00:22:58,491
I want you to know that
every second that you're asleep,
520
00:22:58,511 --> 00:23:01,328
I'm gonna be right here beside you.
521
00:23:01,347 --> 00:23:03,764
Deal?
522
00:23:08,855 --> 00:23:10,337
Okay.
523
00:23:28,190 --> 00:23:30,040
Hey, there she is.
524
00:23:30,192 --> 00:23:31,934
So, how'd it go this morning?
525
00:23:31,952 --> 00:23:36,696
The hormone shot was fine,
but this is not. Look.
526
00:23:36,790 --> 00:23:38,435
Padma picked a donor,
but I did a little bit
527
00:23:38,459 --> 00:23:39,844
of digging into this sperm bank.
528
00:23:39,868 --> 00:23:41,679
It's facing three lawsuits
from families who claim
529
00:23:41,703 --> 00:23:44,296
their donors misrepresented themselves.
530
00:23:44,390 --> 00:23:46,489
In one case, the family alleged
531
00:23:46,514 --> 00:23:49,223
that the donor had an undisclosed
history of schizophrenia.
532
00:23:49,248 --> 00:23:50,268
In another,
533
00:23:50,288 --> 00:23:52,179
a donor covered up a criminal record.
534
00:23:52,198 --> 00:23:55,015
Some claim college degrees
when they're really dropouts.
535
00:23:55,034 --> 00:23:56,441
These families were lied to.
536
00:23:56,461 --> 00:23:59,462
Yes. About the biggest decision
they'll ever make.
537
00:23:59,613 --> 00:24:01,911
The genes their kids
will share with its father.
538
00:24:01,936 --> 00:24:04,616
Yeah, but, I mean, this is just
539
00:24:04,694 --> 00:24:06,635
a few cases out of how many, right?
540
00:24:06,931 --> 00:24:08,172
I mean, I had a lot of friends
541
00:24:08,197 --> 00:24:09,454
in med school who donated.
They were good guys,
542
00:24:09,474 --> 00:24:11,100
they just needed cash;
they wanted to help.
543
00:24:11,193 --> 00:24:14,977
Is this your way of saying
there are little Devons out there?
544
00:24:15,128 --> 00:24:18,205
If it helps, every single one
of these donors
545
00:24:18,298 --> 00:24:19,873
had to undergo genetic testing.
546
00:24:19,967 --> 00:24:22,710
There is no test to show whether
you're a pathological liar,
547
00:24:22,728 --> 00:24:24,447
have a mental illness
or a criminal record.
548
00:24:24,471 --> 00:24:26,282
- And you're missing the point.
- No, I get it.
549
00:24:26,307 --> 00:24:27,786
Sperm banks are unregulated.
550
00:24:27,811 --> 00:24:29,903
The FDA requires that donors are tested
551
00:24:29,928 --> 00:24:32,644
for infectious diseases,
but beyond that, nothing.
552
00:24:32,663 --> 00:24:34,404
Their bios aren't even verified.
553
00:24:34,429 --> 00:24:35,686
That may work for some people.
554
00:24:35,711 --> 00:24:37,506
There are amazing kids out there
from anonymous donors,
555
00:24:37,531 --> 00:24:38,621
but that won't work for me.
556
00:24:38,646 --> 00:24:40,106
- This is my egg.
- Hey, babe...
557
00:24:40,320 --> 00:24:44,322
You have to accept
that this is Padma's choice.
558
00:24:45,401 --> 00:24:47,901
Well, I need to make sure
she knows what she's choosing.
559
00:24:52,016 --> 00:24:54,475
We'll talk later, okay?
560
00:24:59,690 --> 00:25:01,095
- Are you hot or cold?
- Both.
561
00:25:01,120 --> 00:25:02,173
Okay, don't worry, we're gonna help you.
562
00:25:02,193 --> 00:25:04,175
She's in A-fib and hypotensive.
563
00:25:04,253 --> 00:25:06,064
A-fib could be because we took
her off metoprolol.
564
00:25:06,088 --> 00:25:07,254
Let me check if her pressure dropped
565
00:25:07,273 --> 00:25:08,491
before she slipped into arrhythmia.
566
00:25:08,515 --> 00:25:10,235
I-I was here. Her BP started
to fall first,
567
00:25:10,259 --> 00:25:11,759
then her heart rate spiked.
568
00:25:11,777 --> 00:25:13,035
Peritonitis?
569
00:25:13,060 --> 00:25:15,687
Gloria, tell me where it hurts.
570
00:25:15,706 --> 00:25:17,795
- Rebound tenderness.
- This has nothing to do with the meds.
571
00:25:17,820 --> 00:25:19,502
She has an acute abdomen
and she may need surgery.
572
00:25:19,526 --> 00:25:22,880
Let's get her four of morphine.
Hang pressors and page Bell.
573
00:25:22,904 --> 00:25:25,530
Hey, hang in there, okay?
574
00:25:31,722 --> 00:25:33,038
Where to begin?
575
00:25:33,132 --> 00:25:35,558
Gloria has three lumbar
compression fractures
576
00:25:35,583 --> 00:25:36,599
from osteoporosis.
577
00:25:36,952 --> 00:25:39,112
And a hiatal hernia.
All incidental findings.
578
00:25:39,138 --> 00:25:40,523
Consequence of living for eight decades.
579
00:25:40,547 --> 00:25:44,049
So here's today's problem.
Colonic perforation.
580
00:25:44,068 --> 00:25:45,125
No wonder she was in so much pain.
581
00:25:45,144 --> 00:25:46,879
And no idea what caused this?
582
00:25:46,904 --> 00:25:48,312
It couldn't have been the fall.
583
00:25:48,464 --> 00:25:49,866
We thought she passed out
from too many meds,
584
00:25:49,890 --> 00:25:51,903
but something else was going on.
We just don't know what.
585
00:25:51,928 --> 00:25:54,615
Well, what we do know
is that without surgery,
586
00:25:54,640 --> 00:25:55,849
Gloria won't make it.
587
00:25:55,874 --> 00:25:58,392
You're talking about a surgery
that's dangerous at any age,
588
00:25:58,543 --> 00:26:00,118
and with Gloria nearly 80...
589
00:26:00,287 --> 00:26:02,621
Well, we'll be sure to be
very clear with her
590
00:26:02,639 --> 00:26:04,380
about what we're facing here.
591
00:26:04,400 --> 00:26:07,567
But I agree with you.
It's the only option.
592
00:26:07,760 --> 00:26:10,684
Okay. At least she's in the best hands.
593
00:26:10,709 --> 00:26:12,647
Well, I've had success
with patients older than her,
594
00:26:12,799 --> 00:26:13,965
much sicker.
595
00:26:13,984 --> 00:26:16,201
I really hope she's one of them.
596
00:26:19,482 --> 00:26:21,823
So you think "The Right Stuff"
is secretly
597
00:26:21,848 --> 00:26:23,636
- some sort of axe murderer?
- No.
598
00:26:23,660 --> 00:26:24,953
I'm just saying we can't
599
00:26:24,978 --> 00:26:26,956
- really be sure who he is.
- Okay, look,
600
00:26:26,980 --> 00:26:28,883
I really appreciate
you being protective of me,
601
00:26:28,907 --> 00:26:31,137
but there's no guarantees with kids.
602
00:26:31,162 --> 00:26:32,559
I mean, look at us.
603
00:26:32,584 --> 00:26:34,669
What, there's a one-in-a-million
chance of having twins?
604
00:26:34,821 --> 00:26:36,504
One in 250.
605
00:26:36,581 --> 00:26:39,749
And we are proof that
a random genetic accident
606
00:26:39,826 --> 00:26:42,098
can be the best gift ever.
607
00:26:42,123 --> 00:26:44,587
Look, I can't give up on being a mother
608
00:26:44,612 --> 00:26:45,657
just because there's risks.
609
00:26:45,682 --> 00:26:46,940
I don't want you to.
610
00:26:47,167 --> 00:26:49,425
I just want you to be aware
of what those risks are.
611
00:26:49,445 --> 00:26:54,189
Which is why I asked
Dr. Nolan to join us.
612
00:26:54,283 --> 00:26:55,431
What's up, ladies?
613
00:26:55,451 --> 00:26:57,175
Show her what you showed me.
614
00:26:57,194 --> 00:26:58,285
Oh.
615
00:27:01,031 --> 00:27:02,492
"Dream Doc"?
616
00:27:02,516 --> 00:27:04,532
I don't understand.
617
00:27:04,626 --> 00:27:06,306
- It's him.
- It's me.
618
00:27:07,779 --> 00:27:09,278
You're six-foot five?
619
00:27:09,298 --> 00:27:11,039
I do slouch some.
620
00:27:11,191 --> 00:27:12,466
And fluent in French?
621
00:27:12,617 --> 00:27:13,858
Yeah.
622
00:27:13,952 --> 00:27:15,952
Je suis Rosetta Stone.
623
00:27:17,139 --> 00:27:20,528
- Trombone prodigy?
- I got a standing ovation
624
00:27:20,553 --> 00:27:21,601
at my ninth grade recital.
625
00:27:23,628 --> 00:27:26,229
- Just think about it.
- Mm.
626
00:27:27,799 --> 00:27:29,724
Think about what?
627
00:27:29,876 --> 00:27:33,942
Surgery? Sounds... dangerous.
628
00:27:33,967 --> 00:27:35,972
Yeah, I'm not gonna lie to you. It is.
629
00:27:35,991 --> 00:27:39,642
But it is the only option.
630
00:27:39,736 --> 00:27:44,222
And without it, you may only have days.
631
00:27:44,241 --> 00:27:45,879
Maybe a week.
632
00:27:45,904 --> 00:27:47,892
I'm sorry.
633
00:27:47,911 --> 00:27:50,670
Y-You always say how
634
00:27:50,897 --> 00:27:54,007
e-easy choices are your favorite.
635
00:27:55,402 --> 00:27:59,012
I wish I could offer you more time
636
00:27:59,239 --> 00:28:00,830
to make this decision.
637
00:28:00,849 --> 00:28:02,741
But the sooner you operate,
638
00:28:02,759 --> 00:28:05,268
the better my chances are?
639
00:28:08,749 --> 00:28:10,840
Well, then, I'm ready.
640
00:28:10,859 --> 00:28:15,090
Arthur, I'm sure everybody
over at Brookhaven is worried.
641
00:28:15,115 --> 00:28:16,679
You think maybe you could go call them
642
00:28:16,773 --> 00:28:19,274
- and fill them in?
- Oh, of course.
643
00:28:19,299 --> 00:28:20,631
Any-Anything, darling.
644
00:28:20,927 --> 00:28:22,761
Yes, Brookhaven.
645
00:28:22,854 --> 00:28:24,779
Update, update Brookhaven.
646
00:28:24,931 --> 00:28:28,208
Update Brookhaven.
647
00:28:29,619 --> 00:28:31,504
I can't leave him.
648
00:28:31,529 --> 00:28:33,213
- He needs me.
- Oh, I...
649
00:28:33,364 --> 00:28:35,048
I get it.
650
00:28:35,199 --> 00:28:39,201
You have got to be better
than you have ever been.
651
00:28:39,963 --> 00:28:42,614
Neither one of us have children.
652
00:28:42,707 --> 00:28:45,356
Not even siblings.
653
00:28:45,381 --> 00:28:46,876
It's just the two of us.
654
00:28:46,895 --> 00:28:49,120
He has no one else.
655
00:28:49,139 --> 00:28:51,122
I have no one else.
656
00:28:53,243 --> 00:28:55,668
Do you know what it's like
to find the love of your life
657
00:28:55,693 --> 00:28:58,238
this late in the game?
658
00:28:58,315 --> 00:29:00,890
Actually, I do.
659
00:29:00,984 --> 00:29:03,468
And when the day comes,
660
00:29:03,561 --> 00:29:05,728
and he forgets my name,
661
00:29:05,822 --> 00:29:08,230
I won't even care.
662
00:29:08,399 --> 00:29:12,586
I'll fill in that blank,
'cause he'll still love me.
663
00:29:13,738 --> 00:29:15,237
And I'll love him.
664
00:29:15,257 --> 00:29:17,591
To the end.
665
00:29:17,742 --> 00:29:21,136
Just don't let it be today.
666
00:29:22,580 --> 00:29:24,264
Okay.
667
00:29:34,814 --> 00:29:37,481
His intracranial pressure
is still rising,
668
00:29:37,506 --> 00:29:39,426
and we're not sure of the cause.
669
00:29:39,566 --> 00:29:41,323
The MRI didn't show any tumors
670
00:29:41,343 --> 00:29:43,841
or blood clots in his brain.
671
00:29:43,866 --> 00:29:44,973
So what does this mean?
672
00:29:45,125 --> 00:29:46,791
That the drain wasn't enough.
673
00:29:46,885 --> 00:29:48,885
Mr. Shafer, we have no choice but to
674
00:29:49,038 --> 00:29:50,203
proceed with the craniectomy
675
00:29:50,222 --> 00:29:51,866
to relieve the pressure
in Peter's brain.
676
00:29:51,890 --> 00:29:53,524
My God.
677
00:29:55,894 --> 00:29:57,934
I can't believe this is happening.
678
00:29:57,959 --> 00:30:00,114
There must be something else you can do.
679
00:30:00,139 --> 00:30:03,490
If we wait any longer,
he's at risk of brain damage.
680
00:30:03,526 --> 00:30:05,526
Treat him like he's your child.
681
00:30:05,620 --> 00:30:10,431
Would you agree to this if it was Gigi?
682
00:30:14,387 --> 00:30:16,646
Spencer, give us a minute to review.
683
00:30:20,468 --> 00:30:23,544
- Tell me there's another option.
- There isn't.
684
00:30:23,563 --> 00:30:25,691
What he just said in there
won't help Peter.
685
00:30:25,715 --> 00:30:28,383
Keeping your objectivity will.
You have to.
686
00:30:28,401 --> 00:30:29,808
I'm sorry to interrupt,
687
00:30:29,828 --> 00:30:31,973
but the preschool's been trying
to get in touch.
688
00:30:31,997 --> 00:30:34,080
Gigi needs you.
689
00:30:36,576 --> 00:30:39,085
Do what you have to do
to reduce the swelling.
690
00:30:48,600 --> 00:30:50,571
Hey. She's been like this
691
00:30:50,665 --> 00:30:51,975
since Peter left this morning.
692
00:30:51,999 --> 00:30:54,767
She won't eat or talk.
693
00:30:55,428 --> 00:30:57,812
- Thank you.
- Yeah.
694
00:31:05,697 --> 00:31:06,863
What is that?
695
00:31:07,014 --> 00:31:09,440
A space helmet for Peter.
696
00:31:09,592 --> 00:31:13,369
If he goes into space, he can't die.
697
00:31:15,098 --> 00:31:18,374
Is he gonna die, like Mommy?
698
00:31:28,202 --> 00:31:31,279
I'm fighting for Peter.
699
00:31:31,297 --> 00:31:34,115
- I'm scared.
- I know. That's okay.
700
00:31:34,133 --> 00:31:35,558
I knew he was sick when
701
00:31:35,710 --> 00:31:37,876
he didn't want to eat my sandwich.
702
00:31:37,929 --> 00:31:41,622
We trade. He always eats my sandwich.
703
00:31:41,624 --> 00:31:44,216
When his mommy left, his daddy started
704
00:31:44,236 --> 00:31:47,720
making his lunch with roast beef.
705
00:31:47,739 --> 00:31:51,699
After he ate it all,
his tummy started hurting.
706
00:31:57,732 --> 00:31:59,772
Did he eat your sandwich this morning?
707
00:31:59,809 --> 00:32:01,584
No, Daddy.
708
00:32:09,168 --> 00:32:11,052
Craniotome to me.
709
00:32:14,766 --> 00:32:17,433
I've done this a hundred times,
but rarely on a child.
710
00:32:17,585 --> 00:32:21,479
You're more than qualified.
711
00:32:23,666 --> 00:32:26,167
Watch for bleeding, be gentle.
712
00:32:26,260 --> 00:32:28,528
When I pass through bone, I stop.
713
00:32:29,263 --> 00:32:32,673
Now, let's get started.
714
00:32:34,101 --> 00:32:35,192
Wait!
715
00:32:35,345 --> 00:32:36,822
I think Peter has urea cycle disorder.
716
00:32:36,846 --> 00:32:39,104
It's a genetic enzyme deficiency
that makes it hard
717
00:32:39,124 --> 00:32:40,768
for people to break down protein.
718
00:32:40,792 --> 00:32:43,442
Whenever Spencer packs his son
roast beef, he trades it away
719
00:32:43,611 --> 00:32:45,164
because it makes his stomach hurt.
720
00:32:45,188 --> 00:32:47,522
I think sharing his dad's
protein shake this morning
721
00:32:47,615 --> 00:32:49,076
gave him more protein
than he could process,
722
00:32:49,101 --> 00:32:51,036
and his body was already under
stress from his recent cold.
723
00:32:51,061 --> 00:32:53,303
Talk about a zebra.
Urea cycle is extremely rare.
724
00:32:53,471 --> 00:32:54,782
But it would explain all the symptoms.
725
00:32:54,806 --> 00:32:56,288
Let's get him back to the ICU,
726
00:32:56,308 --> 00:32:58,388
start him on dialysis,
clear the ammonia.
727
00:32:58,535 --> 00:33:00,207
Yeah, but do we have that kind of time?
728
00:33:00,232 --> 00:33:01,772
The odds you're right
are vanishingly small,
729
00:33:01,796 --> 00:33:03,182
and if you're wrong, this boy's brain
730
00:33:03,206 --> 00:33:04,296
continues to swell,
731
00:33:04,316 --> 00:33:06,356
which will cause him permanent damage.
732
00:33:07,537 --> 00:33:08,703
We need to operate now.
733
00:33:08,728 --> 00:33:10,539
A craniectomy is a gamble, too.
734
00:33:10,563 --> 00:33:12,115
At the rate the swelling is worsening,
735
00:33:12,139 --> 00:33:14,259
best-case scenario, what,
it buys Peter days?
736
00:33:14,384 --> 00:33:16,901
It doesn't fix the problem.
737
00:33:17,053 --> 00:33:18,494
That is true.
738
00:33:20,165 --> 00:33:22,740
So let's do both.
739
00:33:22,892 --> 00:33:25,651
Dialysis right here.
We can watch his ICP.
740
00:33:25,670 --> 00:33:27,912
If it doesn't drop, I'm ready to
741
00:33:28,064 --> 00:33:29,464
start a crani immediately.
742
00:33:40,501 --> 00:33:42,501
I'll be right here when you wake up.
743
00:33:42,562 --> 00:33:46,647
Okay, this is as far as you can go.
744
00:33:54,348 --> 00:33:56,774
I love you.
745
00:33:56,943 --> 00:34:00,036
I love you more.
746
00:34:05,192 --> 00:34:06,667
Okay.
747
00:34:22,969 --> 00:34:25,520
Wire, please.
748
00:34:31,644 --> 00:34:33,611
Dilator.
749
00:34:38,134 --> 00:34:40,743
All right, we're almost there.
750
00:34:41,654 --> 00:34:43,262
All right, catheter in.
751
00:34:43,287 --> 00:34:45,248
If you're right,
the pressure should trend down
752
00:34:45,399 --> 00:34:47,440
once the proteins are filtered out.
753
00:34:47,465 --> 00:34:49,665
Yeah, well, it's not gonna
happen immediately.
754
00:34:54,333 --> 00:34:56,533
If that number doesn't
come down soon, I start.
755
00:34:57,128 --> 00:34:59,429
Whether I want to or not.
756
00:35:02,341 --> 00:35:05,419
We're working through
some unexpected adhesions.
757
00:35:05,444 --> 00:35:07,870
Did Gloria mention anything
about prior surgeries?
758
00:35:08,022 --> 00:35:10,038
None. Any sign of the perforation?
759
00:35:10,115 --> 00:35:11,281
Running the bowel now.
760
00:35:11,300 --> 00:35:14,178
There's no sign of widespread ischemia.
761
00:35:14,203 --> 00:35:16,303
- Oh, there it is.
- Can you repair it?
762
00:35:16,455 --> 00:35:18,342
Well, the surrounding bowel is thickened
763
00:35:18,366 --> 00:35:21,367
with extensive lymphadenopathy.
764
00:35:21,460 --> 00:35:25,198
It sounds like whatever's going
on caused significant inflammation.
765
00:35:25,222 --> 00:35:27,222
I should be able to repair the perf,
766
00:35:27,375 --> 00:35:29,128
but, you know,
this didn't happen overnight.
767
00:35:29,152 --> 00:35:30,634
It's been going on for years.
768
00:35:30,711 --> 00:35:33,212
Bowel inflammation is extremely painful.
769
00:35:33,230 --> 00:35:36,073
Her daily steroids
must have been masking it.
770
00:35:37,506 --> 00:35:39,172
See the big picture.
771
00:35:39,645 --> 00:35:41,387
Dr. Kravitz told me in geriatrics
772
00:35:41,405 --> 00:35:43,998
you always gotta keep your eye
on the big picture.
773
00:35:44,225 --> 00:35:46,316
What if the arthritis
and the bowel inflammation
774
00:35:46,335 --> 00:35:48,038
are all part of the same
disease process?
775
00:35:48,062 --> 00:35:50,296
It's possible.
776
00:35:51,415 --> 00:35:53,318
If the side effects of her medications
777
00:35:53,342 --> 00:35:57,261
were actually symptoms of
the underlying issue.
778
00:35:58,347 --> 00:36:00,589
We've been looking at this all wrong.
779
00:36:00,741 --> 00:36:03,242
Let's get back to Gloria's prescriptions
780
00:36:03,335 --> 00:36:04,668
and see if we can't get her some answers
781
00:36:04,687 --> 00:36:06,478
when she wakes up.
782
00:36:09,417 --> 00:36:10,949
It just keeps rising.
783
00:36:10,951 --> 00:36:12,359
Can we dialyze faster?
784
00:36:12,436 --> 00:36:15,592
Any faster and his neurons could shear
from diffusion. Just give it a minute.
785
00:36:15,617 --> 00:36:17,389
Conrad, this is the brain.
A minute can be
786
00:36:17,414 --> 00:36:18,544
the difference between life and death.
787
00:36:18,569 --> 00:36:19,769
Just give me one more minute.
788
00:36:19,811 --> 00:36:21,197
We don't have good choices here.
789
00:36:21,221 --> 00:36:23,997
- Billie, we're on the same side.
- But this is my OR.
790
00:36:35,678 --> 00:36:37,761
- It dropped.
- Wait, Dr. Sutton.
791
00:36:38,906 --> 00:36:40,946
That number's still dangerously high.
792
00:36:55,422 --> 00:36:57,406
It worked.
793
00:37:01,519 --> 00:37:03,945
You ready to close?
794
00:37:04,098 --> 00:37:06,999
Sure am.
795
00:37:12,773 --> 00:37:15,457
Focus on that still space
796
00:37:15,609 --> 00:37:18,534
between our inhale
797
00:37:18,612 --> 00:37:21,054
and our exhale.
798
00:37:22,616 --> 00:37:24,369
Please remember to silence your devices
799
00:37:24,393 --> 00:37:26,042
before we begin the class.
800
00:37:32,022 --> 00:37:35,362
_
801
00:37:52,980 --> 00:37:54,904
- I seem to have gotten turned around.
- Okay.
802
00:37:54,924 --> 00:37:56,498
My wife is in surgery.
803
00:37:56,650 --> 00:37:58,478
Can you direct me to the waiting room?
804
00:37:58,502 --> 00:38:00,969
Uh, here, let me show you.
805
00:38:03,581 --> 00:38:05,264
The cavalry has arrived.
806
00:38:05,289 --> 00:38:06,658
77-year-old woman with a bowel perf.
807
00:38:06,677 --> 00:38:07,917
Pressure started tanking.
808
00:38:07,937 --> 00:38:09,397
At first I thought it was peritonitis,
809
00:38:09,421 --> 00:38:10,857
then I saw her neck.
810
00:38:10,882 --> 00:38:12,439
I need ultrasound now.
811
00:38:12,666 --> 00:38:14,419
Any idea why she might be in tamponade?
812
00:38:14,444 --> 00:38:16,093
No idea what the underlying issue is.
813
00:38:16,113 --> 00:38:18,338
Right now, we just need
to get her off the table.
814
00:38:18,431 --> 00:38:20,431
Start another epi and bolus a liter.
815
00:38:20,450 --> 00:38:22,859
There's fluid around her heart.
We need to prep her
816
00:38:22,953 --> 00:38:24,193
for pericardiocentesis.
817
00:38:24,288 --> 00:38:26,081
Okay, I'll finish up so I can assist.
818
00:38:26,105 --> 00:38:27,325
All right, but if
she doesn't stabilize, Bell,
819
00:38:27,349 --> 00:38:28,826
I'm gonna have to crack her chest open.
820
00:38:28,850 --> 00:38:31,251
Oh, God, let's hope not.
821
00:38:44,533 --> 00:38:46,866
Oh, man, I can't wait to tell 'em.
822
00:38:46,959 --> 00:38:48,310
Hey, we figured it out.
823
00:38:48,461 --> 00:38:50,397
Gloria's medications
didn't cause her problems,
824
00:38:50,421 --> 00:38:51,830
but they masked an underlying one:
825
00:38:51,832 --> 00:38:53,297
Whipple's disease.
826
00:38:53,317 --> 00:38:55,542
That's what caused her
arthritis, weight loss, fatigue.
827
00:38:55,560 --> 00:38:57,872
And steroids that her doctors
first thought was arthritis
828
00:38:57,896 --> 00:38:59,136
only made it worse.
829
00:38:59,230 --> 00:39:01,025
She told us that
they increased her dose,
830
00:39:01,049 --> 00:39:02,157
leading to the perf.
831
00:39:02,182 --> 00:39:03,493
Now all Gloria needs is an antibiotic.
832
00:39:03,518 --> 00:39:04,701
We can take her off of
833
00:39:04,726 --> 00:39:06,635
- almost everything else.
- She didn't make it.
834
00:39:06,905 --> 00:39:09,831
- I'm sorry.
- What? She...
835
00:39:10,058 --> 00:39:12,983
She developed cardiac tamponade,
836
00:39:13,078 --> 00:39:15,395
which was probably
the final complication
837
00:39:15,564 --> 00:39:17,063
of her undiagnosed Whipple.
838
00:39:17,082 --> 00:39:19,582
And Austin was working to place
a pericardial drain
839
00:39:19,676 --> 00:39:21,509
when she coded.
840
00:39:21,534 --> 00:39:23,960
We did five rounds of CPR.
841
00:39:24,181 --> 00:39:26,739
More than I should have
on a woman her age.
842
00:39:26,741 --> 00:39:28,183
It was a tough one.
843
00:39:28,208 --> 00:39:29,834
Now, if she'd been treated properly,
844
00:39:30,002 --> 00:39:31,840
or if she'd gotten to us sooner,
845
00:39:31,865 --> 00:39:33,746
maybe we could have done something
846
00:39:33,765 --> 00:39:34,856
to turn it around.
847
00:39:34,881 --> 00:39:38,116
But today... it was just far too late.
848
00:39:40,100 --> 00:39:42,280
Dr. Kravitz...
849
00:39:44,851 --> 00:39:46,609
Kit is his friend,
850
00:39:46,703 --> 00:39:49,537
so I will call her to tell him.
851
00:40:00,533 --> 00:40:02,717
Even if we had diagnosed her sooner,
852
00:40:02,869 --> 00:40:04,961
Gloria's disease began years ago.
853
00:40:05,113 --> 00:40:06,370
There's nothing we could have done.
854
00:40:06,390 --> 00:40:09,891
Gloria wasn't just another
fragile old lady.
855
00:40:10,042 --> 00:40:12,952
She was strong, in love.
856
00:40:13,045 --> 00:40:15,563
She deserved more time.
857
00:40:15,715 --> 00:40:20,293
But every doctor looked at her
like just another lost cause.
858
00:40:20,386 --> 00:40:21,978
No one cared enough to see
859
00:40:22,072 --> 00:40:23,992
that by just treating her symptoms,
860
00:40:24,132 --> 00:40:26,408
they were actually making her worse.
861
00:40:31,248 --> 00:40:35,417
No one saw the bigger picture
until you did.
862
00:40:37,570 --> 00:40:40,813
Reconsider going into gerontology, Zach.
863
00:40:40,832 --> 00:40:42,966
You may have a gift.
864
00:41:04,948 --> 00:41:07,431
I am so sorry.
865
00:41:07,451 --> 00:41:09,676
I'm so sorry.
866
00:41:29,121 --> 00:41:31,364
Look what I made you.
867
00:41:31,457 --> 00:41:33,032
Wow!
868
00:41:33,125 --> 00:41:34,383
Hey.
869
00:41:34,703 --> 00:41:37,294
So we'll continue dialysis until
we lower his ammonia levels,
870
00:41:37,314 --> 00:41:40,373
but with some attention
and lifestyle modifications
871
00:41:40,466 --> 00:41:41,506
we can manage this.
872
00:41:41,651 --> 00:41:43,042
You will need to look out
for any signs that
873
00:41:43,061 --> 00:41:44,188
his ammonia levels are up.
874
00:41:44,212 --> 00:41:46,810
Sluggishness, nausea, vomiting.
875
00:41:46,835 --> 00:41:47,926
Avoid extreme temps.
876
00:41:47,951 --> 00:41:50,676
Keep him hydrated and
on a low-protein diet.
877
00:41:50,701 --> 00:41:52,810
No more roast beef sandwiches.
878
00:41:52,829 --> 00:41:55,312
He'll do great.
879
00:41:55,332 --> 00:41:57,481
I can't thank you enough.
880
00:41:57,650 --> 00:42:00,484
Well, we did have help.
881
00:42:00,504 --> 00:42:01,964
How would you two like a surprise?
882
00:42:01,988 --> 00:42:05,173
What is it, Daddy? What is it?
883
00:42:12,907 --> 00:42:15,517
Wow!
884
00:42:15,744 --> 00:42:19,103
It's beautiful.
885
00:42:32,035 --> 00:42:35,551
Nolan as a sperm donor? Our Nolan?
886
00:42:35,576 --> 00:42:36,704
- Yep.
- Ooh.
887
00:42:36,781 --> 00:42:39,766
- That put the fear of God in me.
- Yeah, I bet.
888
00:42:39,784 --> 00:42:42,118
But the eggs are gonna be
retrieved in about two weeks,
889
00:42:42,287 --> 00:42:44,787
which means I need a volunteer, fast.
890
00:42:44,881 --> 00:42:47,698
Someone I trust, someone I care about.
891
00:42:47,717 --> 00:42:49,125
What are you gonna do?
892
00:42:49,277 --> 00:42:52,945
Actually, um, I had a crazy idea.
893
00:42:53,039 --> 00:42:54,389
You and I are good friends,
894
00:42:54,540 --> 00:42:57,708
now that we aren't lovers,
and I wouldn't mind
895
00:42:57,802 --> 00:42:59,619
a kid a lot like you.
896
00:42:59,712 --> 00:43:01,621
You could do worse.
897
00:43:01,714 --> 00:43:04,140
So what if I did...
898
00:43:04,216 --> 00:43:07,527
have a kid just like you?
899
00:43:10,222 --> 00:43:13,283
You want me to be your sperm donor?
900
00:43:18,137 --> 00:43:22,137
- Synced and corrected by synk -
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65717
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