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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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00:09:01,132 --> 00:09:02,631
That question wasn't for me.
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00:09:02,656 --> 00:09:04,914
But you're right.
This is quite a safe process.
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00:09:04,933 --> 00:09:06,415
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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00:09:12,608 --> 00:09:15,016
Leela, I will walk you through
your first injection.
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Um, I was thinking...
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00:09:17,687 --> 00:09:19,762
maybe I can do it.
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You want to stick a needle in me?
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I just want to be part of this
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in every way that I can.
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00:09:24,694 --> 00:09:27,603
- You know.
- Of course.
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00:09:27,697 --> 00:09:30,206
I would like that, too.
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Does our patient have a visitor?
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00:09:36,690 --> 00:09:38,948
He does indeed.
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00:09:38,967 --> 00:09:41,209
- Gigi!
- Hi, Peter.
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00:09:41,361 --> 00:09:44,028
Ah, good friends are
good medicine.
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All right, you two, behave.
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00:09:46,337 --> 00:09:48,504
I'm gonna chat with your dad real quick.
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00:09:49,219 --> 00:09:51,886
Thought a fun distraction
for Peter could be good.
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00:09:51,980 --> 00:09:54,015
So his labs came back.
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00:09:54,040 --> 00:09:56,298
White blood cell count was
normal, no sign of infection.
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00:09:56,318 --> 00:09:59,152
Appendicitis, uh... seems unlikely.
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00:09:59,303 --> 00:10:01,470
Maybe it's psychological.
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00:10:01,564 --> 00:10:04,065
You know, he's been through a lot.
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00:10:04,217 --> 00:10:06,885
My gut's telling me
it's more than anxiety,
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00:10:06,978 --> 00:10:08,789
and I want to run a few more tests.
235
00:10:08,813 --> 00:10:09,813
What's up?
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00:10:09,890 --> 00:10:11,700
Did you fix his tummy, Daddy?
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00:10:11,725 --> 00:10:13,990
It's always his tummy.
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00:10:14,015 --> 00:10:15,910
What do you mean, "always," sweetheart?
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00:10:16,004 --> 00:10:17,170
It happened before?
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00:10:17,408 --> 00:10:19,983
How often does your tummy hurt, Pete?
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00:10:20,008 --> 00:10:22,935
A whole lot of times.
242
00:10:22,960 --> 00:10:25,037
Why didn't you tell me anything, Pete?
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00:10:25,062 --> 00:10:28,490
- I don't understand.
- I didn't want to stay at home.
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00:10:28,515 --> 00:10:31,834
I wanted to come here, with you.
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00:10:31,853 --> 00:10:34,837
I'll never leave you, okay?
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00:10:35,006 --> 00:10:37,232
I'll never leave you.
247
00:10:39,861 --> 00:10:41,027
Do you understand?
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00:10:41,254 --> 00:10:43,254
Daddy, there's something else.
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00:10:43,347 --> 00:10:45,924
It's weird, but maybe I should tell you.
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00:10:45,942 --> 00:10:47,845
This morning, Peter and I were playing
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00:10:47,869 --> 00:10:49,852
that we were on another planet.
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00:10:49,871 --> 00:10:52,096
He kept saying that I had two heads.
253
00:10:52,115 --> 00:10:54,115
Yeah, you told me that. Pretending.
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00:10:54,267 --> 00:10:55,875
No, he meant it.
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00:10:56,102 --> 00:11:00,088
He said I really was a space alien.
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00:11:02,366 --> 00:11:06,094
Peter, does anyone else have two heads?
257
00:11:07,334 --> 00:11:10,002
That nurse lady and you,
258
00:11:10,027 --> 00:11:11,860
kind of.
259
00:11:12,743 --> 00:11:15,647
Double vision. How many fingers
am I holding up?
260
00:11:17,290 --> 00:11:19,733
- What's going on?
- This could be neurological.
261
00:11:19,901 --> 00:11:22,444
We need to get him to CT.
262
00:11:24,314 --> 00:11:28,057
So this woman, who is 83, kept chickens.
263
00:11:28,134 --> 00:11:30,151
And she loved her chickens.
264
00:11:30,303 --> 00:11:31,970
She named each one of them.
265
00:11:31,988 --> 00:11:35,490
The-the first day I spent
with her, she gave me eggs.
266
00:11:35,584 --> 00:11:39,068
Anyway, she had a problem
with worsening anemia.
267
00:11:39,162 --> 00:11:42,404
Fatigue, muscle weakness,
intestinal problems.
268
00:11:42,499 --> 00:11:46,962
She started forgetting things
and... falling.
269
00:11:46,987 --> 00:11:49,912
Now, any ideas what was wrong with her?
270
00:11:50,006 --> 00:11:52,507
Likely more than one thing.
271
00:11:52,659 --> 00:11:55,994
Alzheimer's, and possibly cancer?
272
00:11:56,012 --> 00:11:57,586
Or a recent stroke.
273
00:11:57,680 --> 00:11:59,013
I'll give you a hint.
274
00:11:59,165 --> 00:12:01,257
The key was the chickens.
275
00:12:01,276 --> 00:12:04,018
People who name their chickens
don't eat them.
276
00:12:04,170 --> 00:12:06,504
Exactly. He's smart.
277
00:12:06,597 --> 00:12:08,075
You-you could be a gerontologist.
278
00:12:08,099 --> 00:12:09,449
I don't get it.
279
00:12:09,600 --> 00:12:13,279
Okay, it's a B12 deficiency,
common with age.
280
00:12:13,304 --> 00:12:15,104
Learned that from Dr. Kravitz's book.
281
00:12:15,123 --> 00:12:19,851
So I'm guessing that
the patient was a... vegan,
282
00:12:19,944 --> 00:12:22,444
because she gave away the eggs.
283
00:12:22,464 --> 00:12:24,872
Bingo.
284
00:12:25,025 --> 00:12:28,192
The woman's vegan diet was a good choice
285
00:12:28,211 --> 00:12:30,528
because it reduced her risk
of heart disease,
286
00:12:30,621 --> 00:12:32,116
Type 2 diabetes, certain cancers.
287
00:12:32,140 --> 00:12:35,185
But she forgot to supplement with B12,
288
00:12:35,210 --> 00:12:36,512
which was the source of
all of her symptoms.
289
00:12:36,536 --> 00:12:40,872
This is why gerontology is
a great profession.
290
00:12:40,965 --> 00:12:43,299
You spend time with patients.
291
00:12:43,318 --> 00:12:45,912
You talk with them, you get
to know the whole person,
292
00:12:45,937 --> 00:12:48,857
all the while keeping your eye
on the big picture.
293
00:12:48,882 --> 00:12:50,990
Which is the key to diagnosis.
294
00:12:51,142 --> 00:12:53,885
Oh! My lady awaits.
295
00:12:53,903 --> 00:12:58,072
And I see that they have put out
snacks, and I am peckish.
296
00:12:58,097 --> 00:13:00,217
- Excuse me.
- Thank you, Dr. Kravitz.
297
00:13:02,912 --> 00:13:05,063
Hi, sweetie.
298
00:13:05,081 --> 00:13:07,779
Hey, maybe gerontology is
an aphrodisiac.
299
00:13:07,804 --> 00:13:09,658
This old goat has
the prettiest lady in the place,
300
00:13:09,678 --> 00:13:11,856
and I have not had a
date since high school.
301
00:13:11,880 --> 00:13:12,951
Oh...
302
00:13:12,976 --> 00:13:14,681
No, no, I'm kidding.
303
00:13:14,832 --> 00:13:17,575
Gloria!
304
00:13:17,668 --> 00:13:18,759
Her pulse is thready.
305
00:13:18,854 --> 00:13:20,314
Call 911. Let's get her to Chastain.
306
00:13:20,338 --> 00:13:21,579
Somebody grab these pills.
To take with us.
307
00:13:21,598 --> 00:13:23,838
We're gonna need to know
what she's been taking.
308
00:13:29,161 --> 00:13:32,491
I don't understand.
Are you telling me I fainted?
309
00:13:32,516 --> 00:13:35,240
Yes. And they're
going to figure out why.
310
00:13:35,265 --> 00:13:37,019
I was probably just dehydrated.
311
00:13:37,038 --> 00:13:39,263
I didn't ruin your event, did I?
312
00:13:39,288 --> 00:13:40,781
No, we were winding down anyway.
313
00:13:40,934 --> 00:13:42,358
You added the drama.
314
00:13:42,452 --> 00:13:44,711
The good news is,
your wrist isn't broken.
315
00:13:44,862 --> 00:13:45,953
You just need a splint.
316
00:13:46,106 --> 00:13:47,841
And your EKG and your labs look normal.
317
00:13:47,865 --> 00:13:50,124
So how did you feel
right before you passed out?
318
00:13:50,276 --> 00:13:53,038
I got dizzy. A little lightheaded.
319
00:13:53,063 --> 00:13:55,857
A-A drop in blood pressure.
It's not uncommon
320
00:13:55,882 --> 00:13:57,592
among women on blood pressure meds.
321
00:13:57,617 --> 00:13:58,703
But she's-she's not on any.
322
00:13:58,727 --> 00:14:01,102
Oh, well, yes, I am, dear.
323
00:14:02,639 --> 00:14:04,805
- You are?
- Mm-hmm.
324
00:14:04,958 --> 00:14:06,548
Why didn't you tell me?
325
00:14:06,568 --> 00:14:08,809
I did.
326
00:14:08,904 --> 00:14:11,646
Let's start here.
327
00:14:11,798 --> 00:14:14,223
My thought exactly.
328
00:14:14,242 --> 00:14:16,817
Houston to Rocket Nine Niner,
329
00:14:16,970 --> 00:14:18,578
do you read me?
330
00:14:18,729 --> 00:14:21,322
Copy, Rocket Nine Niner.
331
00:14:21,474 --> 00:14:25,734
Please keep your hands
and arms inside the spacecraft.
332
00:14:25,812 --> 00:14:27,705
We are go for liftoff.
333
00:14:27,730 --> 00:14:30,590
Over and out.
334
00:14:32,001 --> 00:14:34,978
Was that for him or for you?
335
00:14:35,003 --> 00:14:37,132
A little bit of both.
336
00:14:37,157 --> 00:14:39,248
I'm worried about him.
337
00:14:40,268 --> 00:14:43,440
If Peter's abdominal issues
are caused by
338
00:14:43,465 --> 00:14:46,758
a neurological one, we could be
looking at a bleed.
339
00:14:52,005 --> 00:14:53,854
I don't see one.
340
00:14:53,931 --> 00:14:56,950
No evidence of a stroke, either.
341
00:14:57,101 --> 00:14:59,844
But his ventricles are
a little...
342
00:14:59,846 --> 00:15:02,497
Too little.
343
00:15:06,763 --> 00:15:08,353
His brain is swelling.
344
00:15:08,378 --> 00:15:10,533
Now, if we don't figure out why
and the swelling worsens,
345
00:15:10,558 --> 00:15:12,744
I'll have to perform a
craniectomy to relieve the pressure.
346
00:15:12,769 --> 00:15:14,760
Cutting a six-year-old's head
open on an "if."
347
00:15:14,785 --> 00:15:16,596
Of course not, but if things
move south quickly,
348
00:15:16,620 --> 00:15:18,080
we have to be ready to move to the OR.
349
00:15:18,104 --> 00:15:20,385
Fine, but let's keep in mind
the risks aren't just
350
00:15:20,516 --> 00:15:21,606
bleeding and infection.
351
00:15:21,625 --> 00:15:23,161
There could be permanent brain damage.
352
00:15:23,185 --> 00:15:26,353
We need to figure out how
to avoid surgery altogether.
353
00:15:26,371 --> 00:15:28,516
Let's start Peter on meds
to lower the pressure
354
00:15:28,540 --> 00:15:30,040
on his brain immediately,
355
00:15:30,192 --> 00:15:31,686
hope they work and move him to ICU.
356
00:15:31,710 --> 00:15:34,361
Yes, that sounds like a plan.
357
00:15:34,454 --> 00:15:38,215
Well, why didn't you tell me
you were taking all of these?
358
00:15:38,240 --> 00:15:39,601
Oh, I did, dear.
359
00:15:39,626 --> 00:15:41,546
Every time I added a medication.
360
00:15:41,628 --> 00:15:44,462
But you can't be expected
to remember all these.
361
00:15:44,556 --> 00:15:46,631
I-I forgot all of them.
362
00:15:46,650 --> 00:15:48,611
Multiple medications,
called polypharmacy,
363
00:15:48,635 --> 00:15:51,320
is associated with adverse outcomes,
364
00:15:51,489 --> 00:15:53,563
particularly as we age. They interact,
365
00:15:53,716 --> 00:15:55,732
causing falls, drug reactions,
366
00:15:55,884 --> 00:15:58,719
and can even lead
to increased mortality.
367
00:15:58,737 --> 00:16:00,554
It all started with the arthritis.
368
00:16:00,572 --> 00:16:02,572
The ibuprofen wasn't doing anything,
369
00:16:02,649 --> 00:16:05,408
so a doctor put me on prednisone.
370
00:16:05,503 --> 00:16:07,485
Well, that gave me heartburn,
371
00:16:07,505 --> 00:16:09,338
so he gave me omeprazole.
372
00:16:09,489 --> 00:16:10,892
But then that made me nauseous,
373
00:16:10,916 --> 00:16:13,992
so they added ondansetron
for my stomach.
374
00:16:14,086 --> 00:16:17,495
That made my heart flutter,
so they gave me metoprolol,
375
00:16:17,515 --> 00:16:18,997
and then my legs started to swell,
376
00:16:19,016 --> 00:16:20,660
so they gave me furosemide,
and that's when
377
00:16:20,684 --> 00:16:22,834
I stopped walking very much,
378
00:16:22,853 --> 00:16:25,762
and, uh, my blood pressure
shot up, so they...
379
00:16:26,116 --> 00:16:27,725
Should I keep going?
380
00:16:27,750 --> 00:16:29,394
...practitioner
to the ER, please.
381
00:16:29,418 --> 00:16:31,276
Nurse practitioner to the ER.
382
00:16:35,257 --> 00:16:36,590
Double shift?
383
00:16:36,683 --> 00:16:40,093
Actually, I'm just starting.
384
00:16:40,186 --> 00:16:41,998
Been having a hard time sleeping.
385
00:16:42,022 --> 00:16:44,765
- Oh, that sucks.
- Yeah, tell me about it.
386
00:16:44,783 --> 00:16:49,345
Oh, um, Leela told me about your mother.
387
00:16:50,030 --> 00:16:51,380
How is she?
388
00:16:51,531 --> 00:16:54,274
Sorry, it's... it's none of my business.
389
00:16:54,293 --> 00:16:56,443
No, it isn't.
390
00:16:56,445 --> 00:16:58,554
But it's nice of you to ask.
391
00:16:58,705 --> 00:17:00,592
She just moved in with me on Saturday.
392
00:17:00,616 --> 00:17:02,632
It's been good having her close.
393
00:17:02,785 --> 00:17:04,226
And how are you?
394
00:17:04,453 --> 00:17:06,895
Well, I'm trying to resist the urge
395
00:17:06,972 --> 00:17:09,289
to check my home security camera
every five minutes
396
00:17:09,382 --> 00:17:11,625
to see how she's doing.
397
00:17:11,718 --> 00:17:14,218
Okay, well, actually, I'm not resisting.
398
00:17:14,313 --> 00:17:18,073
Would you look at this woman?
She's out there gardening.
399
00:17:18,224 --> 00:17:19,466
Are those rhododendrons?
400
00:17:19,484 --> 00:17:23,970
A little pink for my taste,
but she loves them.
401
00:17:23,989 --> 00:17:27,249
I'm leading a meditation at 3:00.
402
00:17:27,476 --> 00:17:30,711
- Join us.
- Maybe I will.
403
00:17:32,331 --> 00:17:34,497
- So, how are you?
- Great.
404
00:17:34,650 --> 00:17:36,461
I just injected my sister with hormones
405
00:17:36,485 --> 00:17:37,645
so she can donate her eggs to me
406
00:17:37,669 --> 00:17:39,502
and I can be a mom. Hmm!
407
00:17:39,597 --> 00:17:42,848
Oh, wear something comfortable.
408
00:17:47,271 --> 00:17:51,607
So they put her
on hydrochlorothiazide...
409
00:17:51,758 --> 00:17:53,758
And that made Gloria feel fatigued.
410
00:17:53,852 --> 00:17:55,593
So they gave her methylphenidate.
411
00:17:55,613 --> 00:17:57,165
Which could have had
a negative interaction
412
00:17:57,189 --> 00:17:59,856
with the linezolid that she
was taking for that cellulitis.
413
00:18:00,008 --> 00:18:02,145
Or the zolpidem or quetiapine,
414
00:18:02,170 --> 00:18:04,521
which Gloria was also on.
415
00:18:06,849 --> 00:18:08,843
What are we even doing,
416
00:18:08,867 --> 00:18:10,016
Dr. Pravesh?
417
00:18:10,035 --> 00:18:13,203
We're looking into
all contraindications.
418
00:18:13,297 --> 00:18:16,431
But she is a sick older lady
who needs these drugs.
419
00:18:16,456 --> 00:18:18,628
Like, which do you even stop?
420
00:18:18,653 --> 00:18:20,337
We move carefully,
421
00:18:20,362 --> 00:18:23,889
removing one by one.
422
00:18:25,384 --> 00:18:26,867
No.
423
00:18:26,885 --> 00:18:30,387
This is over my head
and, honestly, kind of boring.
424
00:18:30,538 --> 00:18:32,705
I need to find a surgery to observe.
425
00:18:32,730 --> 00:18:36,306
I thought you were going into
primary care.
426
00:18:36,324 --> 00:18:37,721
No. I want to be a surgeon.
427
00:18:37,746 --> 00:18:39,073
It's exciting, and you fix problems
428
00:18:39,097 --> 00:18:42,352
that are actually fixable,
not buff up old people
429
00:18:42,377 --> 00:18:43,560
until they die.
430
00:18:43,585 --> 00:18:45,246
You don't think people die
on the OR table?
431
00:18:45,398 --> 00:18:46,730
They do all the time.
432
00:18:46,755 --> 00:18:48,443
Not everything is fixable with a knife.
433
00:18:48,468 --> 00:18:49,513
You get that, right?
434
00:18:49,533 --> 00:18:51,326
You can fix things with your brain.
435
00:18:51,350 --> 00:18:52,947
Excuse me, have you met me?
436
00:18:52,972 --> 00:18:54,329
I read that surgeons don't actually have
437
00:18:54,353 --> 00:18:58,217
the highest IQ, and I thought,
there, that's my specialty.
438
00:18:58,242 --> 00:18:59,242
Hmm.
439
00:18:59,267 --> 00:19:01,192
This woman needs us,
440
00:19:01,211 --> 00:19:04,120
and Dr. Kravitz needs her.
441
00:19:04,214 --> 00:19:07,913
So if you're not interested,
I say go hunt down Dr. Austin
442
00:19:07,938 --> 00:19:09,625
and see if he'll let you into his OR.
443
00:19:09,778 --> 00:19:11,680
But be aware that
he will not consider it
444
00:19:11,704 --> 00:19:13,780
for one nanosecond
445
00:19:13,873 --> 00:19:17,100
when I tell him
you deserted this patient.
446
00:19:22,566 --> 00:19:24,899
Okay, I will stay.
447
00:19:25,068 --> 00:19:29,112
But don't tell him about
that IQ thing, either.
448
00:19:33,977 --> 00:19:35,893
I want to go with him.
449
00:19:35,987 --> 00:19:37,949
You can't, honey. He needs special care
450
00:19:37,973 --> 00:19:39,563
in a special part of the hospital.
451
00:19:39,583 --> 00:19:41,899
You mean he's really sick?
452
00:19:41,918 --> 00:19:43,234
You fix people.
453
00:19:43,253 --> 00:19:47,255
- You'll fix him, can't you, Daddy?
- Spencer.
454
00:19:47,406 --> 00:19:49,674
I'll be right there.
455
00:19:51,486 --> 00:19:54,909
What's happening? His daddy is scared.
456
00:19:54,934 --> 00:19:57,142
You have to save Peter.
457
00:20:00,495 --> 00:20:02,495
I got him.
458
00:20:02,514 --> 00:20:05,188
I got him, I promise.
459
00:20:10,596 --> 00:20:11,923
He seems much worse.
460
00:20:11,948 --> 00:20:14,431
Please tell me you have some news.
461
00:20:14,526 --> 00:20:16,343
We gave him another round of meds
462
00:20:16,368 --> 00:20:18,077
to lower the intracranial pressure,
463
00:20:18,102 --> 00:20:21,289
but it'll take time... if it works.
464
00:20:23,943 --> 00:20:26,619
He was hurting, and I totally missed it.
465
00:20:27,872 --> 00:20:30,924
I get guilt, believe me,
but it is not earned here.
466
00:20:35,046 --> 00:20:37,454
Help him. Please.
467
00:20:37,479 --> 00:20:40,888
We're doing everything we can.
468
00:20:41,052 --> 00:20:42,644
Uh, just...
469
00:20:42,871 --> 00:20:45,629
I don't want anybody
cutting his head open.
470
00:20:45,649 --> 00:20:46,964
Not if we can avoid it.
471
00:20:46,983 --> 00:20:48,650
Understood.
472
00:20:54,215 --> 00:20:55,215
You all right?
473
00:20:56,901 --> 00:20:59,235
Now I feel guilty, about how lucky I am
474
00:20:59,387 --> 00:21:00,829
not to be in Spencer's shoes.
475
00:21:01,056 --> 00:21:02,550
Peter has to make it through this.
476
00:21:02,574 --> 00:21:04,557
- I know.
- And Gigi, she lost her mother.
477
00:21:04,576 --> 00:21:05,719
She can't lose her best friend.
478
00:21:05,743 --> 00:21:06,871
We have to make sure they both come
479
00:21:06,895 --> 00:21:08,022
out of this.
480
00:21:08,046 --> 00:21:10,046
Uh, Dr. Hawkins!
481
00:21:12,992 --> 00:21:16,845
Vomiting means his intracranial
pressure must be rising.
482
00:21:19,349 --> 00:21:20,515
I'm a little confused.
483
00:21:20,540 --> 00:21:22,068
- I'm sorry.
- So the metoprolol
484
00:21:22,093 --> 00:21:23,242
helped your heart,
485
00:21:23,261 --> 00:21:25,056
but it also lowered your blood pressure.
486
00:21:25,080 --> 00:21:26,579
And with all the
water pills you were on,
487
00:21:26,598 --> 00:21:28,343
plus the stimulants,
your heart rate sped
488
00:21:28,368 --> 00:21:31,187
and BP lowered, which caused you
to lose consciousness.
489
00:21:31,212 --> 00:21:32,487
Other doctors have been telling me
490
00:21:32,511 --> 00:21:35,386
that these meds are saving
my life, and you're telling me
491
00:21:35,411 --> 00:21:37,835
- the opposite?
- No, just listen to them, hon.
492
00:21:37,860 --> 00:21:40,776
They want to take you off
medications you may not need,
493
00:21:40,929 --> 00:21:42,682
and-and keep you on
ones that are working.
494
00:21:42,706 --> 00:21:43,930
But we'd like to keep you here
495
00:21:43,948 --> 00:21:45,748
to monitor you while we do it.
496
00:21:45,876 --> 00:21:49,093
But it's just for a day,
and then, um, you'll go home.
497
00:21:49,118 --> 00:21:52,105
- There's hope for him yet.
- Mm.
498
00:21:52,107 --> 00:21:53,697
Thank you both.
499
00:21:53,717 --> 00:21:56,292
We've given Peter the maximum doses,
500
00:21:56,444 --> 00:21:58,869
but he's... he's not improving.
501
00:21:58,963 --> 00:22:00,851
Well, time to book an OR.
502
00:22:00,876 --> 00:22:03,057
No, let's just...
503
00:22:03,702 --> 00:22:05,052
...start with a drain
504
00:22:05,077 --> 00:22:07,136
before you open his head.
505
00:22:10,216 --> 00:22:11,691
Okay, we can try it.
506
00:22:13,461 --> 00:22:15,737
I'll get an EVD monitor.
507
00:22:18,800 --> 00:22:21,634
- Talk to me.
- We're putting in a drain.
508
00:22:21,653 --> 00:22:24,245
It should help relieve
the pressure on his brain.
509
00:22:24,811 --> 00:22:26,286
It's a first step.
510
00:22:29,243 --> 00:22:32,619
I don't know how much longer
we can put off a craniectomy.
511
00:22:34,198 --> 00:22:36,007
It's my son.
512
00:22:39,821 --> 00:22:42,359
Let's take everything
one step at a time.
513
00:22:42,384 --> 00:22:45,635
Right now, we need to sedate
and intubate,
514
00:22:45,660 --> 00:22:48,161
and to protect his airway.
515
00:22:48,179 --> 00:22:51,681
I have to talk to him first,
before you, before you...
516
00:22:51,833 --> 00:22:54,859
Of course. Of course.
517
00:23:03,011 --> 00:23:05,436
Hey, bud.
518
00:23:06,623 --> 00:23:10,366
I just want you to know...
519
00:23:10,518 --> 00:23:14,611
I want you to know that
every second that you're asleep,
520
00:23:14,631 --> 00:23:17,448
I'm gonna be right here beside you.
521
00:23:17,467 --> 00:23:19,884
Deal?
522
00:23:24,975 --> 00:23:26,457
Okay.
523
00:23:44,310 --> 00:23:46,160
Hey, there she is.
524
00:23:46,312 --> 00:23:48,054
So, how'd it go this morning?
525
00:23:48,072 --> 00:23:52,816
The hormone shot was fine,
but this is not. Look.
526
00:23:52,910 --> 00:23:54,555
Padma picked a donor,
but I did a little bit
527
00:23:54,579 --> 00:23:55,964
of digging into this sperm bank.
528
00:23:55,988 --> 00:23:57,799
It's facing three lawsuits
from families who claim
529
00:23:57,823 --> 00:24:00,416
their donors misrepresented themselves.
530
00:24:00,510 --> 00:24:02,609
In one case, the family alleged
531
00:24:02,634 --> 00:24:05,343
that the donor had an undisclosed
history of schizophrenia.
532
00:24:05,368 --> 00:24:06,388
In another,
533
00:24:06,408 --> 00:24:08,299
a donor covered up a criminal record.
534
00:24:08,318 --> 00:24:11,135
Some claim college degrees
when they're really dropouts.
535
00:24:11,154 --> 00:24:12,561
These families were lied to.
536
00:24:12,581 --> 00:24:15,582
Yes. About the biggest decision
they'll ever make.
537
00:24:15,733 --> 00:24:18,031
The genes their kids
will share with its father.
538
00:24:18,056 --> 00:24:20,736
Yeah, but, I mean, this is just
539
00:24:20,814 --> 00:24:22,755
a few cases out of how many, right?
540
00:24:23,051 --> 00:24:24,292
I mean, I had a lot of friends
541
00:24:24,317 --> 00:24:25,574
in med school who donated.
They were good guys,
542
00:24:25,594 --> 00:24:27,220
they just needed cash;
they wanted to help.
543
00:24:27,313 --> 00:24:31,097
Is this your way of saying
there are little Devons out there?
544
00:24:31,248 --> 00:24:34,325
If it helps, every single one
of these donors
545
00:24:34,418 --> 00:24:35,993
had to undergo genetic testing.
546
00:24:36,087 --> 00:24:38,830
There is no test to show whether
you're a pathological liar,
547
00:24:38,848 --> 00:24:40,567
have a mental illness
or a criminal record.
548
00:24:40,591 --> 00:24:42,402
- And you're missing the point.
- No, I get it.
549
00:24:42,427 --> 00:24:43,906
Sperm banks are unregulated.
550
00:24:43,931 --> 00:24:46,023
The FDA requires that donors are tested
551
00:24:46,048 --> 00:24:48,764
for infectious diseases,
but beyond that, nothing.
552
00:24:48,783 --> 00:24:50,524
Their bios aren't even verified.
553
00:24:50,549 --> 00:24:51,806
That may work for some people.
554
00:24:51,831 --> 00:24:53,626
There are amazing kids out there
from anonymous donors,
555
00:24:53,651 --> 00:24:54,741
but that won't work for me.
556
00:24:54,766 --> 00:24:56,226
- This is my egg.
- Hey, babe...
557
00:24:56,440 --> 00:25:00,442
You have to accept
that this is Padma's choice.
558
00:25:01,521 --> 00:25:04,021
Well, I need to make sure
she knows what she's choosing.
559
00:25:08,136 --> 00:25:10,595
We'll talk later, okay?
560
00:25:15,810 --> 00:25:17,215
- Are you hot or cold?
- Both.
561
00:25:17,240 --> 00:25:18,293
Okay, don't worry, we're gonna help you.
562
00:25:18,313 --> 00:25:20,295
She's in A-fib and hypotensive.
563
00:25:20,373 --> 00:25:22,184
A-fib could be because we took
her off metoprolol.
564
00:25:22,208 --> 00:25:23,374
Let me check if her pressure dropped
565
00:25:23,393 --> 00:25:24,611
before she slipped into arrhythmia.
566
00:25:24,635 --> 00:25:26,355
I-I was here. Her BP started
to fall first,
567
00:25:26,379 --> 00:25:27,879
then her heart rate spiked.
568
00:25:27,897 --> 00:25:29,155
Peritonitis?
569
00:25:29,180 --> 00:25:31,807
Gloria, tell me where it hurts.
570
00:25:31,826 --> 00:25:33,915
- Rebound tenderness.
- This has nothing to do with the meds.
571
00:25:33,940 --> 00:25:35,622
She has an acute abdomen
and she may need surgery.
572
00:25:35,646 --> 00:25:39,000
Let's get her four of morphine.
Hang pressors and page Bell.
573
00:25:39,024 --> 00:25:41,650
Hey, hang in there, okay?
574
00:25:47,842 --> 00:25:49,158
Where to begin?
575
00:25:49,252 --> 00:25:51,678
Gloria has three lumbar
compression fractures
576
00:25:51,703 --> 00:25:52,719
from osteoporosis.
577
00:25:53,072 --> 00:25:55,232
And a hiatal hernia.
All incidental findings.
578
00:25:55,258 --> 00:25:56,643
Consequence of living for eight decades.
579
00:25:56,667 --> 00:26:00,169
So here's today's problem.
Colonic perforation.
580
00:26:00,188 --> 00:26:01,245
No wonder she was in so much pain.
581
00:26:01,264 --> 00:26:02,999
And no idea what caused this?
582
00:26:03,024 --> 00:26:04,432
It couldn't have been the fall.
583
00:26:04,584 --> 00:26:05,986
We thought she passed out
from too many meds,
584
00:26:06,010 --> 00:26:08,023
but something else was going on.
We just don't know what.
585
00:26:08,048 --> 00:26:10,735
Well, what we do know
is that without surgery,
586
00:26:10,760 --> 00:26:11,969
Gloria won't make it.
587
00:26:11,994 --> 00:26:14,512
You're talking about a surgery
that's dangerous at any age,
588
00:26:14,663 --> 00:26:16,238
and with Gloria nearly 80...
589
00:26:16,407 --> 00:26:18,741
Well, we'll be sure to be
very clear with her
590
00:26:18,759 --> 00:26:20,500
about what we're facing here.
591
00:26:20,520 --> 00:26:23,687
But I agree with you.
It's the only option.
592
00:26:23,880 --> 00:26:26,804
Okay. At least she's in the best hands.
593
00:26:26,829 --> 00:26:28,767
Well, I've had success
with patients older than her,
594
00:26:28,919 --> 00:26:30,085
much sicker.
595
00:26:30,104 --> 00:26:32,321
I really hope she's one of them.
596
00:26:35,602 --> 00:26:37,943
So you think "The Right Stuff"
is secretly
597
00:26:37,968 --> 00:26:39,756
- some sort of axe murderer?
- No.
598
00:26:39,780 --> 00:26:41,073
I'm just saying we can't
599
00:26:41,098 --> 00:26:43,076
- really be sure who he is.
- Okay, look,
600
00:26:43,100 --> 00:26:45,003
I really appreciate
you being protective of me,
601
00:26:45,027 --> 00:26:47,257
but there's no guarantees with kids.
602
00:26:47,282 --> 00:26:48,679
I mean, look at us.
603
00:26:48,704 --> 00:26:50,789
What, there's a one-in-a-million
chance of having twins?
604
00:26:50,941 --> 00:26:52,624
One in 250.
605
00:26:52,701 --> 00:26:55,869
And we are proof that
a random genetic accident
606
00:26:55,946 --> 00:26:58,218
can be the best gift ever.
607
00:26:58,243 --> 00:27:00,707
Look, I can't give up on being a mother
608
00:27:00,732 --> 00:27:01,777
just because there's risks.
609
00:27:01,802 --> 00:27:03,060
I don't want you to.
610
00:27:03,287 --> 00:27:05,545
I just want you to be aware
of what those risks are.
611
00:27:05,565 --> 00:27:10,309
Which is why I asked
Dr. Nolan to join us.
612
00:27:10,403 --> 00:27:11,551
What's up, ladies?
613
00:27:11,571 --> 00:27:13,295
Show her what you showed me.
614
00:27:13,314 --> 00:27:14,405
Oh.
615
00:27:17,151 --> 00:27:18,612
"Dream Doc"?
616
00:27:18,636 --> 00:27:20,652
I don't understand.
617
00:27:20,746 --> 00:27:22,426
- It's him.
- It's me.
618
00:27:23,899 --> 00:27:25,398
You're six-foot five?
619
00:27:25,418 --> 00:27:27,159
I do slouch some.
620
00:27:27,311 --> 00:27:28,586
And fluent in French?
621
00:27:28,737 --> 00:27:29,978
Yeah.
622
00:27:30,072 --> 00:27:32,072
Je suis Rosetta Stone.
623
00:27:33,259 --> 00:27:36,648
- Trombone prodigy?
- I got a standing ovation
624
00:27:36,673 --> 00:27:37,721
at my ninth grade recital.
625
00:27:39,748 --> 00:27:42,349
- Just think about it.
- Mm.
626
00:27:43,919 --> 00:27:45,844
Think about what?
627
00:27:45,996 --> 00:27:50,062
Surgery? Sounds... dangerous.
628
00:27:50,087 --> 00:27:52,092
Yeah, I'm not gonna lie to you. It is.
629
00:27:52,111 --> 00:27:55,762
But it is the only option.
630
00:27:55,856 --> 00:28:00,342
And without it, you may only have days.
631
00:28:00,361 --> 00:28:01,999
Maybe a week.
632
00:28:02,024 --> 00:28:04,012
I'm sorry.
633
00:28:04,031 --> 00:28:06,790
Y-You always say how
634
00:28:07,017 --> 00:28:10,127
e-easy choices are your favorite.
635
00:28:11,522 --> 00:28:15,132
I wish I could offer you more time
636
00:28:15,359 --> 00:28:16,950
to make this decision.
637
00:28:16,969 --> 00:28:18,861
But the sooner you operate,
638
00:28:18,879 --> 00:28:21,388
the better my chances are?
639
00:28:24,869 --> 00:28:26,960
Well, then, I'm ready.
640
00:28:26,979 --> 00:28:31,210
Arthur, I'm sure everybody
over at Brookhaven is worried.
641
00:28:31,235 --> 00:28:32,799
You think maybe you could go call them
642
00:28:32,893 --> 00:28:35,394
- and fill them in?
- Oh, of course.
643
00:28:35,419 --> 00:28:36,751
Any-Anything, darling.
644
00:28:37,047 --> 00:28:38,881
Yes, Brookhaven.
645
00:28:38,974 --> 00:28:40,899
Update, update Brookhaven.
646
00:28:41,051 --> 00:28:44,328
Update Brookhaven.
647
00:28:45,739 --> 00:28:47,624
I can't leave him.
648
00:28:47,649 --> 00:28:49,333
- He needs me.
- Oh, I...
649
00:28:49,484 --> 00:28:51,168
I get it.
650
00:28:51,319 --> 00:28:55,321
You have got to be better
than you have ever been.
651
00:28:56,083 --> 00:28:58,734
Neither one of us have children.
652
00:28:58,827 --> 00:29:01,476
Not even siblings.
653
00:29:01,501 --> 00:29:02,996
It's just the two of us.
654
00:29:03,015 --> 00:29:05,240
He has no one else.
655
00:29:05,259 --> 00:29:07,242
I have no one else.
656
00:29:09,363 --> 00:29:11,788
Do you know what it's like
to find the love of your life
657
00:29:11,813 --> 00:29:14,358
this late in the game?
658
00:29:14,435 --> 00:29:17,010
Actually, I do.
659
00:29:17,104 --> 00:29:19,588
And when the day comes,
660
00:29:19,681 --> 00:29:21,848
and he forgets my name,
661
00:29:21,942 --> 00:29:24,350
I won't even care.
662
00:29:24,519 --> 00:29:28,706
I'll fill in that blank,
'cause he'll still love me.
663
00:29:29,858 --> 00:29:31,357
And I'll love him.
664
00:29:31,377 --> 00:29:33,711
To the end.
665
00:29:33,862 --> 00:29:37,256
Just don't let it be today.
666
00:29:38,700 --> 00:29:40,384
Okay.
667
00:29:50,934 --> 00:29:53,601
His intracranial pressure
is still rising,
668
00:29:53,626 --> 00:29:55,546
and we're not sure of the cause.
669
00:29:55,686 --> 00:29:57,443
The MRI didn't show any tumors
670
00:29:57,463 --> 00:29:59,961
or blood clots in his brain.
671
00:29:59,986 --> 00:30:01,093
So what does this mean?
672
00:30:01,245 --> 00:30:02,911
That the drain wasn't enough.
673
00:30:03,005 --> 00:30:05,005
Mr. Shafer, we have no choice but to
674
00:30:05,158 --> 00:30:06,323
proceed with the craniectomy
675
00:30:06,342 --> 00:30:07,986
to relieve the pressure
in Peter's brain.
676
00:30:08,010 --> 00:30:09,644
My God.
677
00:30:12,014 --> 00:30:14,054
I can't believe this is happening.
678
00:30:14,079 --> 00:30:16,234
There must be something else you can do.
679
00:30:16,259 --> 00:30:19,610
If we wait any longer,
he's at risk of brain damage.
680
00:30:19,646 --> 00:30:21,646
Treat him like he's your child.
681
00:30:21,740 --> 00:30:26,551
Would you agree to this if it was Gigi?
682
00:30:30,507 --> 00:30:32,766
Spencer, give us a minute to review.
683
00:30:36,588 --> 00:30:39,664
- Tell me there's another option.
- There isn't.
684
00:30:39,683 --> 00:30:41,811
What he just said in there
won't help Peter.
685
00:30:41,835 --> 00:30:44,503
Keeping your objectivity will.
You have to.
686
00:30:44,521 --> 00:30:45,928
I'm sorry to interrupt,
687
00:30:45,948 --> 00:30:48,093
but the preschool's been trying
to get in touch.
688
00:30:48,117 --> 00:30:50,200
Gigi needs you.
689
00:30:52,696 --> 00:30:55,205
Do what you have to do
to reduce the swelling.
690
00:31:04,720 --> 00:31:06,691
Hey. She's been like this
691
00:31:06,785 --> 00:31:08,095
since Peter left this morning.
692
00:31:08,119 --> 00:31:10,887
She won't eat or talk.
693
00:31:11,548 --> 00:31:13,932
- Thank you.
- Yeah.
694
00:31:21,817 --> 00:31:22,983
What is that?
695
00:31:23,134 --> 00:31:25,560
A space helmet for Peter.
696
00:31:25,712 --> 00:31:29,489
If he goes into space, he can't die.
697
00:31:31,218 --> 00:31:34,494
Is he gonna die, like Mommy?
698
00:31:44,322 --> 00:31:47,399
I'm fighting for Peter.
699
00:31:47,417 --> 00:31:50,235
- I'm scared.
- I know. That's okay.
700
00:31:50,253 --> 00:31:51,678
I knew he was sick when
701
00:31:51,830 --> 00:31:53,996
he didn't want to eat my sandwich.
702
00:31:54,049 --> 00:31:57,742
We trade. He always eats my sandwich.
703
00:31:57,744 --> 00:32:00,336
When his mommy left, his daddy started
704
00:32:00,356 --> 00:32:03,840
making his lunch with roast beef.
705
00:32:03,859 --> 00:32:07,819
After he ate it all,
his tummy started hurting.
706
00:32:13,852 --> 00:32:15,892
Did he eat your sandwich this morning?
707
00:32:15,929 --> 00:32:17,704
No, Daddy.
708
00:32:25,288 --> 00:32:27,172
Craniotome to me.
709
00:32:30,886 --> 00:32:33,553
I've done this a hundred times,
but rarely on a child.
710
00:32:33,705 --> 00:32:37,599
You're more than qualified.
711
00:32:39,786 --> 00:32:42,287
Watch for bleeding, be gentle.
712
00:32:42,380 --> 00:32:44,648
When I pass through bone, I stop.
713
00:32:45,383 --> 00:32:48,793
Now, let's get started.
714
00:32:50,221 --> 00:32:51,312
Wait!
715
00:32:51,465 --> 00:32:52,942
I think Peter has urea cycle disorder.
716
00:32:52,966 --> 00:32:55,224
It's a genetic enzyme deficiency
that makes it hard
717
00:32:55,244 --> 00:32:56,888
for people to break down protein.
718
00:32:56,912 --> 00:32:59,562
Whenever Spencer packs his son
roast beef, he trades it away
719
00:32:59,731 --> 00:33:01,284
because it makes his stomach hurt.
720
00:33:01,308 --> 00:33:03,642
I think sharing his dad's
protein shake this morning
721
00:33:03,735 --> 00:33:05,196
gave him more protein
than he could process,
722
00:33:05,221 --> 00:33:07,156
and his body was already under
stress from his recent cold.
723
00:33:07,181 --> 00:33:09,423
Talk about a zebra.
Urea cycle is extremely rare.
724
00:33:09,591 --> 00:33:10,902
But it would explain all the symptoms.
725
00:33:10,926 --> 00:33:12,408
Let's get him back to the ICU,
726
00:33:12,428 --> 00:33:14,508
start him on dialysis,
clear the ammonia.
727
00:33:14,655 --> 00:33:16,327
Yeah, but do we have that kind of time?
728
00:33:16,352 --> 00:33:17,892
The odds you're right
are vanishingly small,
729
00:33:17,916 --> 00:33:19,302
and if you're wrong, this boy's brain
730
00:33:19,326 --> 00:33:20,416
continues to swell,
731
00:33:20,436 --> 00:33:22,476
which will cause him permanent damage.
732
00:33:23,657 --> 00:33:24,823
We need to operate now.
733
00:33:24,848 --> 00:33:26,659
A craniectomy is a gamble, too.
734
00:33:26,683 --> 00:33:28,235
At the rate the swelling is worsening,
735
00:33:28,259 --> 00:33:30,379
best-case scenario, what,
it buys Peter days?
736
00:33:30,504 --> 00:33:33,021
It doesn't fix the problem.
737
00:33:33,173 --> 00:33:34,614
That is true.
738
00:33:36,285 --> 00:33:38,860
So let's do both.
739
00:33:39,012 --> 00:33:41,771
Dialysis right here.
We can watch his ICP.
740
00:33:41,790 --> 00:33:44,032
If it doesn't drop, I'm ready to
741
00:33:44,184 --> 00:33:45,584
start a crani immediately.
742
00:33:56,621 --> 00:33:58,621
I'll be right here when you wake up.
743
00:33:58,682 --> 00:34:02,767
Okay, this is as far as you can go.
744
00:34:10,468 --> 00:34:12,894
I love you.
745
00:34:13,063 --> 00:34:16,156
I love you more.
746
00:34:21,312 --> 00:34:22,787
Okay.
747
00:34:39,089 --> 00:34:41,640
Wire, please.
748
00:34:47,764 --> 00:34:49,731
Dilator.
749
00:34:54,254 --> 00:34:56,863
All right, we're almost there.
750
00:34:57,774 --> 00:34:59,382
All right, catheter in.
751
00:34:59,407 --> 00:35:01,368
If you're right,
the pressure should trend down
752
00:35:01,519 --> 00:35:03,560
once the proteins are filtered out.
753
00:35:03,585 --> 00:35:05,785
Yeah, well, it's not gonna
happen immediately.
754
00:35:10,453 --> 00:35:12,653
If that number doesn't
come down soon, I start.
755
00:35:13,248 --> 00:35:15,549
Whether I want to or not.
756
00:35:18,461 --> 00:35:21,539
We're working through
some unexpected adhesions.
757
00:35:21,564 --> 00:35:23,990
Did Gloria mention anything
about prior surgeries?
758
00:35:24,142 --> 00:35:26,158
None. Any sign of the perforation?
759
00:35:26,235 --> 00:35:27,401
Running the bowel now.
760
00:35:27,420 --> 00:35:30,298
There's no sign of widespread ischemia.
761
00:35:30,323 --> 00:35:32,423
- Oh, there it is.
- Can you repair it?
762
00:35:32,575 --> 00:35:34,462
Well, the surrounding bowel is thickened
763
00:35:34,486 --> 00:35:37,487
with extensive lymphadenopathy.
764
00:35:37,580 --> 00:35:41,318
It sounds like whatever's going
on caused significant inflammation.
765
00:35:41,342 --> 00:35:43,342
I should be able to repair the perf,
766
00:35:43,495 --> 00:35:45,248
but, you know,
this didn't happen overnight.
767
00:35:45,272 --> 00:35:46,754
It's been going on for years.
768
00:35:46,831 --> 00:35:49,332
Bowel inflammation is extremely painful.
769
00:35:49,350 --> 00:35:52,193
Her daily steroids
must have been masking it.
770
00:35:53,626 --> 00:35:55,292
See the big picture.
771
00:35:55,765 --> 00:35:57,507
Dr. Kravitz told me in geriatrics
772
00:35:57,525 --> 00:36:00,118
you always gotta keep your eye
on the big picture.
773
00:36:00,345 --> 00:36:02,436
What if the arthritis
and the bowel inflammation
774
00:36:02,455 --> 00:36:04,158
are all part of the same
disease process?
775
00:36:04,182 --> 00:36:06,416
It's possible.
776
00:36:07,535 --> 00:36:09,438
If the side effects of her medications
777
00:36:09,462 --> 00:36:13,381
were actually symptoms of
the underlying issue.
778
00:36:14,467 --> 00:36:16,709
We've been looking at this all wrong.
779
00:36:16,861 --> 00:36:19,362
Let's get back to Gloria's prescriptions
780
00:36:19,455 --> 00:36:20,788
and see if we can't get her some answers
781
00:36:20,807 --> 00:36:22,598
when she wakes up.
782
00:36:25,537 --> 00:36:27,069
It just keeps rising.
783
00:36:27,071 --> 00:36:28,479
Can we dialyze faster?
784
00:36:28,556 --> 00:36:31,712
Any faster and his neurons could shear
from diffusion. Just give it a minute.
785
00:36:31,737 --> 00:36:33,509
Conrad, this is the brain.
A minute can be
786
00:36:33,534 --> 00:36:34,664
the difference between life and death.
787
00:36:34,689 --> 00:36:35,889
Just give me one more minute.
788
00:36:35,931 --> 00:36:37,317
We don't have good choices here.
789
00:36:37,341 --> 00:36:40,117
- Billie, we're on the same side.
- But this is my OR.
790
00:36:51,798 --> 00:36:53,881
- It dropped.
- Wait, Dr. Sutton.
791
00:36:55,026 --> 00:36:57,066
That number's still dangerously high.
792
00:37:11,542 --> 00:37:13,526
It worked.
793
00:37:17,639 --> 00:37:20,065
You ready to close?
794
00:37:20,218 --> 00:37:23,119
Sure am.
795
00:37:28,893 --> 00:37:31,577
Focus on that still space
796
00:37:31,729 --> 00:37:34,654
between our inhale
797
00:37:34,732 --> 00:37:37,174
and our exhale.
798
00:37:38,736 --> 00:37:40,489
Please remember to silence your devices
799
00:37:40,513 --> 00:37:42,162
before we begin the class.
800
00:37:48,142 --> 00:37:51,482
_
801
00:38:09,100 --> 00:38:11,024
- I seem to have gotten turned around.
- Okay.
802
00:38:11,044 --> 00:38:12,618
My wife is in surgery.
803
00:38:12,770 --> 00:38:14,598
Can you direct me to the waiting room?
804
00:38:14,622 --> 00:38:17,089
Uh, here, let me show you.
805
00:38:19,701 --> 00:38:21,384
The cavalry has arrived.
806
00:38:21,409 --> 00:38:22,778
77-year-old woman with a bowel perf.
807
00:38:22,797 --> 00:38:24,037
Pressure started tanking.
808
00:38:24,057 --> 00:38:25,517
At first I thought it was peritonitis,
809
00:38:25,541 --> 00:38:26,977
then I saw her neck.
810
00:38:27,002 --> 00:38:28,559
I need ultrasound now.
811
00:38:28,786 --> 00:38:30,539
Any idea why she might be in tamponade?
812
00:38:30,564 --> 00:38:32,213
No idea what the underlying issue is.
813
00:38:32,233 --> 00:38:34,458
Right now, we just need
to get her off the table.
814
00:38:34,551 --> 00:38:36,551
Start another epi and bolus a liter.
815
00:38:36,570 --> 00:38:38,979
There's fluid around her heart.
We need to prep her
816
00:38:39,073 --> 00:38:40,313
for pericardiocentesis.
817
00:38:40,408 --> 00:38:42,201
Okay, I'll finish up so I can assist.
818
00:38:42,225 --> 00:38:43,445
All right, but if
she doesn't stabilize, Bell,
819
00:38:43,469 --> 00:38:44,946
I'm gonna have to crack her chest open.
820
00:38:44,970 --> 00:38:47,371
Oh, God, let's hope not.
821
00:39:00,653 --> 00:39:02,986
Oh, man, I can't wait to tell 'em.
822
00:39:03,079 --> 00:39:04,430
Hey, we figured it out.
823
00:39:04,581 --> 00:39:06,517
Gloria's medications
didn't cause her problems,
824
00:39:06,541 --> 00:39:07,950
but they masked an underlying one:
825
00:39:07,952 --> 00:39:09,417
Whipple's disease.
826
00:39:09,437 --> 00:39:11,662
That's what caused her
arthritis, weight loss, fatigue.
827
00:39:11,680 --> 00:39:13,992
And steroids that her doctors
first thought was arthritis
828
00:39:14,016 --> 00:39:15,256
only made it worse.
829
00:39:15,350 --> 00:39:17,145
She told us that
they increased her dose,
830
00:39:17,169 --> 00:39:18,277
leading to the perf.
831
00:39:18,302 --> 00:39:19,613
Now all Gloria needs
is an antibiotic.
832
00:39:19,638 --> 00:39:20,821
We can take her off of
833
00:39:20,846 --> 00:39:22,755
- almost everything else.
- She didn't make it.
834
00:39:23,025 --> 00:39:25,951
- I'm sorry.
- What? She...
835
00:39:26,178 --> 00:39:29,103
She developed cardiac tamponade,
836
00:39:29,198 --> 00:39:31,515
which was probably
the final complication
837
00:39:31,684 --> 00:39:33,183
of her undiagnosed Whipple.
838
00:39:33,202 --> 00:39:35,702
And Austin was working to place
a pericardial drain
839
00:39:35,796 --> 00:39:37,629
when she coded.
840
00:39:37,654 --> 00:39:40,080
We did five rounds of CPR.
841
00:39:40,301 --> 00:39:42,859
More than I should have
on a woman her age.
842
00:39:42,861 --> 00:39:44,303
It was a tough one.
843
00:39:44,328 --> 00:39:45,954
Now, if she'd
been treated properly,
844
00:39:46,122 --> 00:39:47,960
or if she'd gotten to us sooner,
845
00:39:47,985 --> 00:39:49,866
maybe we could have done something
846
00:39:49,885 --> 00:39:50,976
to turn it around.
847
00:39:51,001 --> 00:39:54,236
But today... it was just far too late.
848
00:39:56,220 --> 00:39:58,400
Dr. Kravitz...
849
00:40:00,971 --> 00:40:02,729
Kit is his friend,
850
00:40:02,823 --> 00:40:05,657
so I will call her to tell him.
851
00:40:16,653 --> 00:40:18,837
Even if we had
diagnosed her sooner,
852
00:40:18,989 --> 00:40:21,081
Gloria's disease began years ago.
853
00:40:21,233 --> 00:40:22,490
There's nothing we could have done.
854
00:40:22,510 --> 00:40:26,011
Gloria wasn't just another
fragile old lady.
855
00:40:26,162 --> 00:40:29,072
She was strong, in love.
856
00:40:29,165 --> 00:40:31,683
She deserved more time.
857
00:40:31,835 --> 00:40:36,413
But every doctor looked at her
like just another lost cause.
858
00:40:36,506 --> 00:40:38,098
No one cared enough to see
859
00:40:38,192 --> 00:40:40,112
that by just treating her symptoms,
860
00:40:40,252 --> 00:40:42,528
they were actually making her worse.
861
00:40:47,368 --> 00:40:51,537
No one saw the bigger picture
until you did.
862
00:40:53,690 --> 00:40:56,933
Reconsider going into gerontology, Zach.
863
00:40:56,952 --> 00:40:59,086
You may have a gift.
864
00:41:21,068 --> 00:41:23,551
I am so sorry.
865
00:41:23,571 --> 00:41:25,796
I'm so sorry.
866
00:41:45,241 --> 00:41:47,484
Look what I made you.
867
00:41:47,577 --> 00:41:49,152
Wow!
868
00:41:49,245 --> 00:41:50,503
Hey.
869
00:41:50,823 --> 00:41:53,414
So we'll continue dialysis until
we lower his ammonia levels,
870
00:41:53,434 --> 00:41:56,493
but with some attention
and lifestyle modifications
871
00:41:56,586 --> 00:41:57,626
we can manage this.
872
00:41:57,771 --> 00:41:59,162
You will need to look out
for any signs that
873
00:41:59,181 --> 00:42:00,308
his ammonia levels are up.
874
00:42:00,332 --> 00:42:02,930
Sluggishness, nausea, vomiting.
875
00:42:02,955 --> 00:42:04,046
Avoid extreme temps.
876
00:42:04,071 --> 00:42:06,796
Keep him hydrated and
on a low-protein diet.
877
00:42:06,821 --> 00:42:08,930
No more roast beef sandwiches.
878
00:42:08,949 --> 00:42:11,432
He'll do great.
879
00:42:11,452 --> 00:42:13,601
I can't thank you enough.
880
00:42:13,770 --> 00:42:16,604
Well, we did have help.
881
00:42:16,624 --> 00:42:18,084
How would you two like a surprise?
882
00:42:18,108 --> 00:42:21,293
What is it, Daddy? What is it?
883
00:42:29,027 --> 00:42:31,637
Wow!
884
00:42:31,864 --> 00:42:35,223
It's beautiful.
885
00:42:48,155 --> 00:42:51,671
Nolan as a sperm donor?
Our Nolan?
886
00:42:51,696 --> 00:42:52,824
- Yep.
- Ooh.
887
00:42:52,901 --> 00:42:55,886
- That put the fear of God in me.
- Yeah, I bet.
888
00:42:55,904 --> 00:42:58,238
But the eggs are gonna be
retrieved in about two weeks,
889
00:42:58,407 --> 00:43:00,907
which means I need a volunteer, fast.
890
00:43:01,001 --> 00:43:03,818
Someone I trust, someone I care about.
891
00:43:03,837 --> 00:43:05,245
What are you gonna do?
892
00:43:05,397 --> 00:43:09,065
Actually, um, I had a crazy idea.
893
00:43:09,159 --> 00:43:10,509
You and I are good friends,
894
00:43:10,660 --> 00:43:13,828
now that we aren't lovers,
and I wouldn't mind
895
00:43:13,922 --> 00:43:15,739
a kid a lot like you.
896
00:43:15,832 --> 00:43:17,741
You could do worse.
897
00:43:17,834 --> 00:43:20,260
So what if I did...
898
00:43:20,336 --> 00:43:23,647
have a kid just like you?
899
00:43:26,342 --> 00:43:29,403
You want me to be your sperm donor?
900
00:43:34,257 --> 00:43:38,257
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