All language subtitles for Pure Genius s01e08 Kidneys.eng

Previously on Pure Genius...

When I opened Bunker Hill,

I made a promise that I would do
everything humanly possible

to save everyone
who came through these doors.

- I want to be part of this.
- So, how's the Malik sitch?

Zoe, I want to go out
with you to a concert.

- You know, like on a date.
- I'm really sorry, James, but I can't.

Right. Okay.

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Hey.

Malik. Hey.

How was your holiday?

Good. Yours?

Oh, it was...
great to be back home.

My niece is getting so big.

Anyway, I got to, uh,
go get some coffee,

because I am...
totally jetlagged, so...

Okay, so,

this isn't working for me.

Us not talking about anything.

I know you're not into
dating at work. Neither am I.

But I felt something
when we were together.

A connection.

I think you did, too.

I like you.

And I want to make a go of this.

Okay.

Okay you want to make a go of this
or okay you need coffee?

Um...

The first one.

Okay.

Uh... sorry.

We need to get to the Incubator.

Yeah, guys, I don't think
we should be watching this.

It's an invasion of privacy.

It is all over the Internet.

It has half a million views.

Hey, guys.

- James.
- Hey.

You're back.

How was your vacation?

Lovely.

Uh, nice.

Yours?

- Lovely.
- Yeah. Good.

- I had a good time.
- Yeah, good.

Everything looks good, Constance.

You adapted to the new
machine beautifully.

Another 24 hours of observation
and we can let you go home.

Any questions?

Uh, just the same one
I've been asking all week.

Do we really get to take
this machine

back with us to Baltimore?

That's the whole point of the trial;
You get the Rolls-Royce

of dialysis in the
privacy of your own home.

I-I can't believe we're gonna
get our freedom back.

Both of us.

Lauren, you have been my angel
for two years,

driving me to and from dialysis
three days a week.

She never complained.

It hasn't been that bad, mom.

We do what we got to do, right?

Dr. Wallace knows

Lauren has just had
her third callback

for the Paris Opera Ballet.

Isn't that one of the best
companies in the world?

The best.

- Wow.
- And that's why

this dialysis machine
is a godsend.

I mean, it's...

It's gonna give me
my independence back, and...

Lauren can move to Paris and...

Live her dream.

Whew.

Constance, are you...

Feeling lightheaded?
Any dizziness?

Yeah. Maybe. Just a little bit.

Blood pressure's fairly low.

I need to order an EKG
and echocardiogram.

There may be, um,

something wrong with your heart.

Listen up, everyone.

Constance Durand,
our kidney patient,

has worsening
congestive heart failure.

Heart failure? I thought
she just needed dialysis.

It's called
cardiorenal syndrome.

It's a known complication
in dialysis patients.

Acute kidney injury causes the
immune system to attack the heart.

The damage results in
impaired cardiac function.

And the onset, it can be sudden.

Based on her echo,

her left ventricular
ejection fraction is 18%.

Yeah, her heart's
barely pumping blood,

which means she can't tolerate
the lengthy dialysis.

Yeah, and her kidneys are shot.
Patients like this don't live

more than a few weeks
without a new kidney.

What about a kidney transplant?

Constance has a very
rare tissue type.

Her CPRA is 89,

which means she'll reject
most kidneys donated

through an organ network.

- What about her daughter?
- Not a match.

- What about a kidney paired donation?
- What's that?

It allows donors who are
incompatible with their loved ones

to switch their kidneys with
other donor/recipient pairs.

Yeah. Lauren would donate
her kidney to a stranger,

whose loved one would then donate
their kidney to another stranger...

The pattern would repeat itself

until the chain
circled back around

and Constance would get
a compatible kidney.

- Boom. Sounds great. Let's do that.
- Yeah, but it's not

gonna be easy building a chain
around a sensitized patient

- like Constance.
- She's right. These chains are built

using crude algorithms, designed
for single transplant networks.

Which is why we're
not gonna rely on

someone else's algorithm;
We're gonna build our own.

Of course we are.

So, what am I looking at?

Each node represents
a donor/recipient pair.

Constance and Lauren are
the one in the middle.

- Do those lines indicate matches?
- Mm-hmm. Yep.

So how long does it take
to build a chain?

I'm rendering the algorithm
on 4,000 cloud computers,

so what would take 36 hours
should prob... oh, it's done.

Damn it. No matches.

You know, Constance has
a very interesting ethnic background.

She's part French
and part Ashkenazi.

Tissue type is hereditary.

Patients of similar ethnicities
are more likely to be a match.

We could target people in
specific parts of the world...

You want me to expand
the algorithm internationally?

Can it be done?

Bonjour.
I'd like to request access

to your transplant database.

It's for
a kidney paired donation.

In the U.S.

Sure, I'll hold.

Hola. Informaci�n
del donantes de �rganos.

Bunker Hill y James Bell.
S�. Gracias.

I've already spoken
to the embassy.

Yes, I know international
organ donations are rare.

Guys, I think this is working.

We've got three pairs. Four.

Five. Six. Seven. Eight.

It's called
a kidney paired donation.

We used an algorithm to find

seven other donor/recipient
pairs from around the world.

We'd have 'em all fly here

and do the eight transplants
at one time.

And this is the only
way to save my mom?

This is the only option I see.

I'm sorry.
This is a lot.

I... first,
you tell me I'm dying,

and now you're telling me
that my daughter has

to donate her own kidney
to a stranger.

Yes.

But, in return,

a stranger donates a kidney
to you.

When would I be able
to dance again?

Your recovery would take...
six to eight weeks.

Well, then her answer's no.

- Mom...
- No.

The Paris Opera Ballet is like
winning the lottery for a dancer.

Lauren may not get
a chance ever again.

I'll do it.
I'll donate my kidney.

- Lauren...
- If it saves my mom,

I'll do it.

We have eight patients
in dire need of a kidney,

and we have eight donors
willing to donate.

But as we know, a kidney chain
is extremely delicate.

They are a giant house of cards.

So to avoid potential conflicts,
Dr. Wallace and I

have decided to keep all
donor/recipient pairs anonymous.

Patients won't know
who is donating to whom

until after the surgeries.

Why is pair number seven blank?

Pair number seven agreed to the
kidney chain on one condition:

Total anonymity from patients
and all Bunker Hill staff.

Get out.

All staff? How is
that even possible?

We shut down the east wing
on the fifth floor.

Only Dr. Wallace, myself and
a select team will have access to it.

Okay, Dr. Wallace,
hand out the assignments.

Listen carefully, everyone.

Dr. Channarayapatra,

you'll be in charge
of Luisah and Astrid Pierre.

Luisah,
born with only one kidney,

suffered a blunt force injury to it
during the 2010 earthquake in Haiti.

Her sister Astrid
will be donating on her behalf.

Dr. Brockett,
you'll be in charge

of Brandon and Lee Wen Hsu
of Hong Kong.

Brandon is ten and suffers
from minimal change disease.

His father, Lee Wen,
will be donating on his behalf.

Dr. Strauss, you'll have
Dean and Helen Trainer.

Dean has
polycystic kidney disease.

His wife will be donating
on his behalf.

Dr. Verlaine, you'll be
in charge of pair number seven,

our anonymous patients.

Welcome to Bunker Hill.

Good news, W.
All eight pairs have checked in.

This is happening.

It's like the United Nations out there.

We're making history.

Why aren't you excited?

I am, James.

But there are 16 links
in this chain.

If any one of them breaks,

the entire chain dies.

Lee Wen, your labs look good.

Unfortunately,
Brandon's serum albumin level

is 2.0 grams per liter.
That's very low.

It's been low. Our doctor almost
refused to let us get on the plane.

We can't thank you
enough for this.

My albumin
is why I'm so skinny, right?

Yes, that's right.

Your kidneys
lose albumin protein

and other nutrients
before your body can use them.

But after you get
your new kidney,

you should have
a big growth spurt.

I've seen it before.

I'll be like Niko the underdog,
who became Niko the warrior.

Japanese manga.
His latest obsession.

- Dr. Brockett, where's my donor from?
- We talked about this, Brandon.

She can't tell you anything
until the transplant is over.

But do they have
any special powers?

Can they fly?

He's convinced his
donor is a superhero.

'Cause they're giving me
their life force. Duh.

Actually, Brandon,
you're not entirely wrong.

When you were seven,
you got a few blood transfusions,

and those transfusions
made you special.

Sort of like...
how did Niko get his powers?

He got hit by comet dust.

Sort of like that.

Your blood changed,
and you became

a one-in-a-million match
for a transplant.

So your donor
kind of is a superhero,

because they're one in a million
just like you.

Hi. My name is Angie.

- I was sent up to deliver this.
- I'll take it.

Actually, uh,
they said I need to deliver it

to the patient in the east wing
in person.

No, they didn't.

What are you doing here, Angie?

Nothing. Uh...

Here's the thing...
I tried to access your patient files

on the Bunker Hill server,
but I got locked out.

What part of "totally anonymous"
don't you understand?

Thing is, since when do we keep
secrets here at Bunker Hill?

It flies in the face
of our open-source culture.

The patients requested it,
and we're respecting their wishes.

Before you go.

Is it a celebrity?

Just wink if I'm right;
Nod if I'm wrong.

Dean, what are you doing?

Thought I told you
not to eat before the surgery.

No, if I'm gonna get a new
kidney on James Bell's dime,

I'm gonna make the most of it.

Dr. Strauss,
I can see that

you and I have got
a lot in common.

I reckon we'd be
mates back home.

You're gonna have
my back today, right?

I-I don't know what you mean.

Look, listen.

I'm all for diversity.
I think it's great.

This whole international
thing you're doing here.

But...

I don't want a kidney
from just anyone.

You know what I mean?

No. I don't.

Hey.

Hey.

Uh, can I talk to you
for a second?

Brockett, we're about to start
a walk-through of patient labs.

Yeah, I know. I just...

I want to make sure...
we're okay.

Yes.

Absolutely.
Why would we not be okay?

No reason.

Excellent.

Hey. Did I miss anything?

Uh... no.

How are your patients?

Oh, you know.
Anonymous.

Mm.

Hey.

Oh. Wait. Okay.

- Yeah.
- What?

What did I do?

Nothing.
I just wasn't expecting...

You know what? Maybe we
shouldn't be physical at work.

Physical?

You had a hair in your eye.

Yeah. I just...

I'd rather push
my own hair back.

- Noted.
- Okay, guys,

we've got a problem.

- What is it, Doctor?
- My donor, donor eight, she's pregnant.

Astrid Pierre?

This jeopardizes
the entire chain.

Her doctor in Haiti
must have missed it

because she's only
four weeks along.

Pregnant?

I don't understand.

Why can't she donate
while pregnant?

In this case, your
donor's cardiovascular

and renal functions changed
as a result of the pregnancy.

Surgery would be too risky, uh,

for the mother and the fetus.

So we're back to square one.

I have less than a month
to live.

We're doing everything
in our power

to come up
with an alternative solution.

What's going to happen
to the kidney chain?

Well, Lauren, that's
the other reason I'm here.

A lot of that depends on you.

Why?

Well, I know this
is tough to hear,

but there are two options.

You can withdraw from the chain.

It's entirely your choice.

But that means
the chain falls apart.

So no one will get a kidney?

That's right.

Or?

Or you stay in the
chain and donate,

and become what we call
an altruistic donor.

Your participation

keeps the chain alive.

And my mom?

She wouldn't receive a kidney.

Has Lauren made a decision yet?

Not yet.

Okay, so...

Is she fully aware
what's at stake?

That there are seven other
families depending on her?

I told her the facts.
She's aware.

Yeah, it's just, she's
Brandon Hsu's donor.

She might be his only
chance of getting a kidney.

He's running out of time.

Is there anything
else we can do?

Dr. Brockett, you know
it's against the rules

to coerce a donor,
and highly unethical.

Yes, I know.

I know that, but this
is an extreme case.

Seven other people could die
if they don't get a kidney.

I realize that, Dr. Brockett.

I told her.

Now it's up to her to decide.

What are you making, Brandon?

Niko wears this mask
when he's fighting.

I'm making one
for me and my donor.

Dr. Brockett.

Can we have a word with you?

We heard there might be
a problem with the chain.

How bad is it?

Unfortunately,
a donor did fall out

due to an unexpected
medical complication.

But we are doing everything
we can to keep the chain alive.

Dr. Brockett, this is
our son's only hope.

He'll die if he
doesn't get a kidney.

What if I donated, too?
Would that help?

I'm afraid it's more
complicated than that.

What if we offered
the donor money?

We don't have much, but could
scrape together something.

Unfortunately, the process
doesn't work that way.

I'm so sorry.

Please... Dr. Brockett.

He's our only child.

Promise me that you'll do
everything you can to save him.

I promise.

- Where we at, Angie?
- I made two liters

of bioactive blood plasma,
like you asked.

It's the same formula we used to
test the new dialysis machine.

Perfect.

I have been making
some calls around town,

and according
to my sources, this...

Is the most promising
artificial kidney prototype

currently in development.

Wait, Hydrus Labs?

The owner of this company's
a moron.

Don't think I'm that bad.

- You... what?
- I just bought Hydrus.

But, James, I told you,
no prototypes are ready.

I mean, this one has
shoddy membranes.

How do you know?

Because it's my job to know.

I've been working on similar tech,
and the only reason

Hydrus Labs is ahead of me
is because they have

14 geeks in a lab working
on kidneys 24/7.

It's all they do.

Angie,
we're smarter than 14 geeks.

You and I can make this work.
Come on, let's test it out.

Come on.

Fine.

Okay, so, once
the bioactive blood

filters through the kidney...

...it should come out
in two streams.

Red for clean blood
and yellow for urine.

If they turn orange,
it's not working.

All right, go ahead.

See?

Told you it works.

See?

I told you.

Shoddy membranes.

- Hey.
- Hey.

You okay?

Just spoke to my patients.

They heard the chain
might be falling apart,

and they're getting desperate.

I asked Wallace to push
Lauren Durand to donate,

and he refused.

Said it would be unethical.

He's just following
transplant rules.

Yeah, but we're Bunker Hill...

since when do we ever
follow the rules?

He's our Chief of Staff.

He's just trying
to keep things on the rails.

So you agree with him?

You're not gonna like my answer.

Just be honest with me.

Forget about you and me,
and... just tell me...

as a doctor, what do you think?

I think the rules exist
for a reason.

I think Wallace is right.

I know you're invested
in your patient,

but it seems like you're getting
a little too emotional.

That's what I think.

As a doctor.

Best-case scenario:
The mechanical kidney

keeps your mom alive
for another year.

Hopefully, that will give us

enough time
to find another donor.

That's the best-case scenario.
What's the worst-case scenario?

Well, the mechanical kidney

is still experimental.

We're working around the
clock to finish it, but we...

May not have it ready in time.

So... if I donate,

I'll save the chain...

But I'll lose everything else?

I can't save my mom?

And I have to...

Turn down the offer?

Offer?

You got the job.

Why didn't you tell me?

Because I didn't...

I didn't want to upset you,

and I wanted to donate
so I could save you.

But everything is falling apart.

No. Lauren,
you need to go to Paris.

You need to take that job.

It isn't fair to make you
give up your dream

to save this chain.

This is not on you.

This isn't on you.

So the membranes are breaking

because the blood flow
entering the kidney

- is too strong.
- Yep.

Then why can't we just make
the membrane stronger?

'Cause they're made
of delicate silicon.

We're better off
reconfiguring the housing

to redistribute the force.

We're 3-D printing
a housing now.

Uh, guys,
the 3-D printer's done.

Let's test the kidney.

Go ahead.

Nice.

Damn it. Why isn't it working?

That doesn't sound good.

The membranes in the artificial
kidney are still breaking.

I wish I had better news.

Lauren's dropped out
of the chain.

Come on!

What did she say?

What did you say?
Did you even fight for it?

Doctor, these chains are fragile.

We all knew something like this
could happen at any time.

I know you're disappointed.
I am, too,

but we have to respect
Lauren's decision.

No, actually, we don't,
because...

End of discussion, Dr. Brockett.

Now I just need you
to do your job

and tell your patients,
unfortunately,

the chain has fallen apart.

Hi.

Lauren.
I'm Dr. Brockett.

I'm one of the doctors
from the kidney chain.

My patient, um, Brandon,

is the ten-year-old boy
who needs your kidney.

He's ten?

I didn't know.

I'm sorry. I know I'm
hurting a lot of people.

Lauren, I'm not judging you.
No one is.

I just want to give you
the chance to meet

a really amazing kid
before you go.

Could you excuse us
for a second?

Mm-hmm.

Hey, Brandon.

I want you to meet someone.

This is my friend Lauren.

- Hi.
- Hi.

Lauren's a ballet dancer.

Really?

Cool.

- Have you ever seen the ballet?
- Yeah.

My mom took me
to The Nutcracker once.

And I saw the one
with the swans.

Swan Lake.

What'd you think?

It was kind of boring,

but I liked the black swan.

She kicks butt.

Are you here
for the kidney chain?

Um...

Sort of.

Are you giving a kidney
or getting one?

'Cause I'm getting one.

I'm giving one.

She's incredible.

Do you know why
I called you here, Dr. Brockett?

I have an idea.

Lauren told me about
your meeting with Brandon.

Now that she's
decided to donate,

she'll be in recovery
for six weeks.

Her mother might not
live that long.

She wanted to see her daughter
dance one last time.

I didn't coerce Lauren.

No, you cornered her
with a dying ten-year-old boy.

You manipulated her.

I was trying to save my patient.

Believe me, I get doing everything
possible for your patient.

What you did in this case
was unethical.

I saved the chain.

I did what I had to do,
and I don't regret it.

I know James has
a management style.

"Best idea wins. No hierarchy."

But you are a doctor,
and I am your Chief of Staff.

Do not undermine me
like that ever again.

I'm taking you off
of Brandon's surgery tomorrow.

You won't be scrubbing in
as my assist.

But he's my patient.

I have to be in there with him.

You're losing a surgery,
Dr. Brockett.

Be grateful you're not
losing your job.

You want to check
his albumin level.

If he gets nervous in the O.R.,
just talk about Niko.

It's his favorite
manga character.

Okay.

Brandon will be in good hands.

I'm gonna go.

Zoe.

I'm exhausted.

I just got reamed by Wallace.

And I don't need to hear you say
"I told you so".

That's not what I was gonna say.

- Zoe...
- What?

For what it's worth,

I think what you did
today was amazing.

You don't have to say that.

I know you're on Wallace's side.

You made that very clear.

Professionally, yes.

I think he was right
and you were wrong,

but you did what you
believed was right.

You risked everything
for your patient.

That's the kind of
doctor I want to be.

Good morning, Dean.

You ready for your big day?

Depends.

Now's your chance
to tell me, Doc.

Straight up,
just between you and me.

Who's my donor?

- We're still on this?
- Yeah.

'Cause I've seen some pretty

suspicious-looking
people in the hallway.

You know what, Dean? Fine.

Your donor is Azeem Habib.

She's Egyptian,

and she's Muslim.

Then I'm out.

I'm not doing this.

I'm breaking the chain.

It's too late
to break the chain.

Your wife's already in surgery.

The only person
who wouldn't get a kidney is you.

You set me up, Doctor.

No. I didn't.

I simply protected the other
patients from your bigotry.

So it's up to you.

You can either take that hatred
that's inside of you

to your grave...

...or you can open up
your heart a little.

Hey. Rusty. Frank.

It's time to take
you guys to the O.R.

You ready?

Rusty.

You okay?

Rusty.

It's okay. Guys.

We're good, we're good.

Sorry, man.

My head was somewhere else.

I have to take you
to surgery now.

I arranged for
a private hallway,

so no one would see you.

I'm just here to get
my brother-in-law a kidney...

...not cause a scene.

I know.

Let's make that happen.

I've isolated the kidney.

And, uh, it is delivering it

through the Pfannenstiel incision.

There we are.

I've made a ten-centimeter incision
in the right lower quadrant.

- Very good work.
- You prep the kidney for implantation,

and I'll prep the iliac
vessels for anastomosis.

I should be in there.

I'll position
the donor kidney in the pelvis

inferior to the diseased kidney.

Well, that's weird.

Why is Wallace leaving
the bad kidney in?

Most people don't know this,
but you don't remove

the diseased kidney unless
it's causing a medical problem.

You just transplant
the new kidney right below it.

Oh, my God, Angie,
we have to go.

James.

Yeah?

I think I know how to
slow down the blood flow

going into the
artificial kidney.

I'm gonna show you.
Come on.

Say this is Constance's
diseased kidney.

What if we used
the diseased kidney,

which we left inside her body,
and used it

to slow down the blood going
into the artificial kidney.

Wait, you don't have to remove
the bad kidney?

- Yeah, apparently it's a thing.
- Listen, guys,

all organs, even unhealthy ones,
dampen blood pressure.

Blood flow in
is stronger than blood flow out.

So, if we forced Constance's blood
to go into the bad kidney first...

It'd depressurize the blood before
it enters the artificial kidney.

This is already being done
with some heart transplants.

It's called a heterotopic surgery
or a piggyback transplant.

But blood coming out of the bad
kidney would still be dirty.

It wouldn't matter, because it would enter
the artificial kidney with less force.

- The membranes wouldn't break.
- And the artificial kidney

could do its job,
clean the blood.

We'd have to reconfigure
some of the vessels

and build a connector
between the native kidney

and the artificial kidney,
but...

It's completely insane,
Brockett.

It's brilliant.

Thanks.

Brandon's surgery went great.

Wallace even let me anastomose
part of the ureter.

Which I should
probably keep to myself.

Dr. Brockett.

I'll check you later.
Dr. Wallace.

I-I owe you an apology,
Dr. Wallace.

I did what I thought was right.

Um, but I can see now

that I could have handled it
differently.

I was wrong
to undermine your authority,

and it won't happen again.

You solved
the artificial kidney problem.

A piggyback transplant
with a diseased kidney...

it's never been done before.

I'm implanting the artificial
kidney this afternoon.

I want you to scrub in,
Dr. Brockett.

Yes, sir.

- Hi, mom.
- Hi, honey.

Dr. Wallace said you did great.

She did.

In fact, all the surgeries
were successful.

Seven people now have a kidney

and will live long,
healthy lives thanks to you.

Seven people.

But not my mom.

Actually,
Dr. Wallace and his team

have figured out how to make
the mechanical kidney work.

They did?

Once we implant it,

it will keep your mother alive
for a year.

But there's one more thing.
Someone I want you to meet.

Constance, this is
Astrid Pierre,

your original donor.

Hello.

I'm so sorry
for the pain I caused.

I didn't know I was pregnant.

It's not your fault.

My husband and I have been
trying for six years.

We'd lost hope.

And, Lauren, I want
to thank you for donating,

for choosing
not to break the chain.

My sister is going to live
because of you.

This is for you.

What is it?

It's a contract.

I signed it today.

It's my promise that I will
donate my kidney to you

once my baby is born.

Thank you.

Thank you.

Listen...

The donors and recipients in
the chain are starting to meet.

I know you requested
to remain anonymous,

but the woman who received your
kidney would like to meet you.

I'm sure she doesn't
want to meet this.

What you did for her is bigger
than a pair of handcuffs

and a couple of guards.

You don't get it, do you?

I don't deserve her gratitude.

I'm no hero.

I've done bad things in my life.

I know one deed
doesn't make up for the bad.

But you did a really

good thing
for this woman today, Rusty.

Artificial kidney's prepped
and ready.

Need more medial retraction

on the artificial kidney
to expose the renal hilum.

Now you see the anterior
branch of the renal vein.

Clamp that.

Clamp, Doctor.

Do you need me to place
an anchoring suture?

No. Thank you, Doctor.

Clear the field.

I was hoping it was you.

- You were?
- Yeah.

You have a strong life force.

This is for you.

What's this for?

So you'll never forget
you're my superhero.

Brandon, I will...

Never forget.

Good work, Dr. Wallace.

- Good work, James.
- Mm.

I heard about your vacation.

Yachts.

You partied.

What brought all that on?

Just needed a break, I guess.

Been spending way too much
time lately worrying.

About my health, about people.

And for what?

It's pointless,
all that spinning.

People disappoint you.

People?

Or Zoe?

Is this because
you asked her out?

You mean did I charter a yacht
the size of a city block and booze my way

across Europe because
a girl I like said no to a date?

It's very possible.

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