1 00:00:04,076 --> 00:00:06,744 I'm incising the uterine wall. 2 00:00:06,746 --> 00:00:09,580 You're doing great, really great. 3 00:00:09,582 --> 00:00:10,914 It's gonna be okay. 4 00:00:10,916 --> 00:00:13,049 You promise? 5 00:00:14,086 --> 00:00:17,662 - Baby's out. - Umbilical clip. Suction. 6 00:00:17,664 --> 00:00:18,920 Please... 7 00:00:18,922 --> 00:00:20,590 can I see my daughter? 8 00:00:20,592 --> 00:00:21,824 Yes. 9 00:00:21,826 --> 00:00:23,226 Of course. 10 00:00:26,215 --> 00:00:27,381 Sorry. 11 00:00:27,383 --> 00:00:29,049 We'll need to get her into surgery. 12 00:00:29,051 --> 00:00:30,818 We'll take good care of her. 13 00:00:43,833 --> 00:00:47,134 Your New Chief is fashionably late. 14 00:00:47,136 --> 00:00:48,601 Our Chief. 15 00:00:48,603 --> 00:00:51,405 Just because I endorsed Dr. Han to the Board 16 00:00:51,407 --> 00:00:52,772 doesn't mean I don't have any concerns. 17 00:00:52,774 --> 00:00:55,442 Connections like Dr. Han's come at a premium 18 00:00:55,444 --> 00:00:57,344 and, he assures me, will be well worth it 19 00:00:57,346 --> 00:00:59,246 given our current predicament with the Medical Board. 20 00:00:59,248 --> 00:01:01,949 I'm not just worried about the money. 21 00:01:01,951 --> 00:01:03,583 When you pay that much, 22 00:01:03,585 --> 00:01:05,632 they tend to think they're worth it. 23 00:01:06,341 --> 00:01:08,221 Makes a person think they don't have to show up 24 00:01:08,223 --> 00:01:10,131 for their own welcome brunch. 25 00:01:21,902 --> 00:01:23,269 The baby's bowel protrusion 26 00:01:23,271 --> 00:01:26,005 seemed less severe on the prenatal imaging. 27 00:01:26,007 --> 00:01:27,539 And it'll have to wait until 28 00:01:27,541 --> 00:01:29,241 we're done with her heart problem. 29 00:01:29,243 --> 00:01:33,079 Now that I'm in here, her septum looks more like Swiss cheese. 30 00:01:35,783 --> 00:01:38,684 Page the on-call neonatal cardiac surgeon. 31 00:01:38,686 --> 00:01:40,719 That won't be necessary. I'll scrub in. 32 00:01:40,721 --> 00:01:42,754 And who are you? 33 00:01:42,756 --> 00:01:44,357 I'm Jackson Han. 34 00:01:44,359 --> 00:01:46,092 Your new Chief of Surgery. 35 00:01:50,298 --> 00:01:58,308 Synced & corrected by -robtor- www.addic7ed.com 36 00:02:02,576 --> 00:02:04,610 Echo probe, please. 37 00:02:05,946 --> 00:02:07,779 And let's turn that music on. 38 00:02:12,452 --> 00:02:14,052 Advance the delivery sheath. 39 00:02:16,690 --> 00:02:18,356 It's in the patient's heart, Dr. Murphy. 40 00:02:18,358 --> 00:02:21,626 I think the music is a little distracting. 41 00:02:21,628 --> 00:02:23,961 I feel the same way about operating without music. 42 00:02:24,864 --> 00:02:26,664 I'll take a longer sheath, 43 00:02:26,666 --> 00:02:28,866 and Dr. Murphy will need some forceps. 44 00:02:34,206 --> 00:02:37,542 5-second rule. 45 00:02:40,513 --> 00:02:43,881 It was a joke. 46 00:02:44,918 --> 00:02:46,350 What about her bowels? 47 00:02:46,352 --> 00:02:49,286 Why isn't Dr. Lim inserting it into the abdomen right now? 48 00:02:49,288 --> 00:02:51,755 There is not enough room. 49 00:02:51,757 --> 00:02:54,258 There's... There's not enough room 50 00:02:54,260 --> 00:02:56,060 without increasing abdominal pressure, 51 00:02:56,062 --> 00:02:59,263 which would critically decrease blood flow to the bowel. 52 00:02:59,265 --> 00:03:01,798 According to what hemodynamic principle... 53 00:03:01,800 --> 00:03:03,140 Dr. Browne? 54 00:03:03,142 --> 00:03:05,169 Vascular impedance... blood flow is driven 55 00:03:05,171 --> 00:03:06,670 by the force induced by the pressure gradient. 56 00:03:06,672 --> 00:03:08,138 And how do you calculate it? 57 00:03:10,192 --> 00:03:12,008 Uh. Um... 58 00:03:12,010 --> 00:03:13,577 I-I'd have to look it up. 59 00:03:15,381 --> 00:03:18,248 8 times L.Nu. divided by Pi.R.4. 60 00:03:18,250 --> 00:03:20,650 Very good, Dr. Murphy. 61 00:03:20,652 --> 00:03:22,619 That's also why this occluder won't work. 62 00:03:22,621 --> 00:03:24,420 It won't hold up against the huge pressure gradient 63 00:03:24,422 --> 00:03:26,556 - in her heart. - Is there a fix? 64 00:03:26,558 --> 00:03:28,291 Long-term, I don't have one. 65 00:03:28,293 --> 00:03:31,094 Right now, I need umbilical tape and PE tubing. 66 00:03:38,451 --> 00:03:41,237 You're making a pulmonary artery band. 67 00:03:41,239 --> 00:03:42,739 That should buy us some time 68 00:03:42,741 --> 00:03:45,500 to come up with a plan before we lose this baby. 69 00:03:51,860 --> 00:03:53,682 Lab technician to O.R. 6. 70 00:03:53,684 --> 00:03:55,084 Lab technician to O.R. 6. 71 00:03:58,055 --> 00:04:00,422 You canceled my hernia repair? 72 00:04:00,424 --> 00:04:03,325 With no advance notice. Sorry about that. 73 00:04:03,327 --> 00:04:04,627 But so great to meet you. 74 00:04:04,629 --> 00:04:05,828 Jackson Han. 75 00:04:05,830 --> 00:04:07,395 - Neil Melendez. - Oh, I know. 76 00:04:07,397 --> 00:04:09,898 You did great work on that piggyback heart transplant. 77 00:04:09,900 --> 00:04:11,199 Huh. 78 00:04:11,201 --> 00:04:13,401 I need a consult on Minesh Goyal. 79 00:04:13,403 --> 00:04:14,837 He's the founding CEO of a company... 80 00:04:14,839 --> 00:04:17,172 - What's his diagnosis? - He doesn't have one. 81 00:04:17,174 --> 00:04:20,242 He's here for a full physical, complete diagnostic workup. 82 00:04:20,244 --> 00:04:22,978 I have a long-standing Executive Wellness... 83 00:04:22,980 --> 00:04:25,647 I'm a surgeon, not an internist. 84 00:04:25,649 --> 00:04:27,616 I don't do preventative medicine. 85 00:04:27,618 --> 00:04:30,170 No matter how rich the patient is. 86 00:04:30,654 --> 00:04:33,355 You know what's great about rich patients? 87 00:04:33,357 --> 00:04:35,759 They allow us to treat poor patients. 88 00:04:36,527 --> 00:04:38,260 Also, I promised Minesh the very best. 89 00:04:38,262 --> 00:04:40,447 So, really, who else am I gonna get? 90 00:04:42,132 --> 00:04:43,831 Dr. Johansen to pre-op. 91 00:04:43,833 --> 00:04:46,000 Dr. Johansen to pre-op. 92 00:04:47,371 --> 00:04:49,070 BP's 110 over 70. 93 00:04:50,106 --> 00:04:52,541 Uh, Jackson... Dr. Han... 94 00:04:52,543 --> 00:04:54,242 says great things about you. 95 00:04:55,745 --> 00:04:57,447 That's very kind. 96 00:04:58,482 --> 00:05:00,748 Normal EKG, optimal BMI, 97 00:05:00,750 --> 00:05:02,483 heart and lungs sound good. 98 00:05:02,485 --> 00:05:03,918 Any reason you're worried enough about your health 99 00:05:03,920 --> 00:05:06,087 to endure an entire day of tests? 100 00:05:06,089 --> 00:05:08,022 I'm not worried. 101 00:05:09,759 --> 00:05:11,592 Knowledge is power. 102 00:05:11,594 --> 00:05:13,494 Whenever I enter a new market, 103 00:05:13,496 --> 00:05:16,097 I learn everything I can about the landscape... 104 00:05:16,099 --> 00:05:18,966 consumer needs, target market, competitors. 105 00:05:18,968 --> 00:05:20,534 You're aware your body isn't a business. 106 00:05:22,238 --> 00:05:24,205 I know I sound like a rich lunatic 107 00:05:24,207 --> 00:05:27,519 with fantasies about controlling every aspect of my life. 108 00:05:28,664 --> 00:05:30,197 And I guess I kind of am. 109 00:05:33,583 --> 00:05:36,111 My dad was in good shape, too. 110 00:05:36,719 --> 00:05:39,322 Until he dropped dead on his daily jog. 111 00:05:50,399 --> 00:05:52,132 Hi. 112 00:05:52,134 --> 00:05:55,502 Dr. Markiel, please come to the mental health unit. 113 00:05:55,504 --> 00:05:59,540 Dr. Markiel, please come to the mental health unit. 114 00:06:10,132 --> 00:06:11,531 Hi. 115 00:06:12,587 --> 00:06:15,088 Hi. I'm Larry Childs. 116 00:06:15,090 --> 00:06:16,890 I'd shake your hand, but, you know, 117 00:06:16,892 --> 00:06:18,458 no functioning immune system. 118 00:06:19,628 --> 00:06:21,762 - Aaron. Hi. - Good to meet you. 119 00:06:21,764 --> 00:06:23,396 What flavor cancer do you have? 120 00:06:25,000 --> 00:06:26,900 - What flavor? - Yeah. 121 00:06:26,902 --> 00:06:28,368 Glioma. 122 00:06:28,370 --> 00:06:29,870 Shut the front door. 123 00:06:29,872 --> 00:06:31,666 Brain or spine? 124 00:06:32,007 --> 00:06:33,673 - Brain. - Dude... 125 00:06:33,675 --> 00:06:34,841 we're tumor twins. 126 00:06:34,843 --> 00:06:37,911 Wh-What do they have you on? 127 00:06:37,913 --> 00:06:39,246 Ooh. Vincristine. 128 00:06:39,248 --> 00:06:40,445 I hear that's intense. 129 00:06:40,447 --> 00:06:42,447 My doc thought it would wipe me out. 130 00:06:42,449 --> 00:06:44,817 You doing okay or longing for death? 131 00:06:44,819 --> 00:06:46,986 I am hanging in there. Thank you. 132 00:06:47,432 --> 00:06:49,955 I'm on my third round of temozolomide. 133 00:07:00,514 --> 00:07:02,381 I've seen you in here a few times. 134 00:07:04,638 --> 00:07:05,838 I've seen you in here a few times. 135 00:07:05,840 --> 00:07:07,953 You kind of keep to yourself, huh? 136 00:07:09,076 --> 00:07:10,409 Yeah. 137 00:07:10,411 --> 00:07:11,911 Well, I'm happy to introduce you around. 138 00:07:11,913 --> 00:07:13,245 It's a really friendly group. 139 00:07:13,247 --> 00:07:14,378 I'm okay. Thank you. 140 00:07:14,380 --> 00:07:16,014 You have a support group you go to? 141 00:07:17,050 --> 00:07:18,713 I do not. 142 00:07:19,352 --> 00:07:21,341 Everyone needs a cancer community. 143 00:07:54,554 --> 00:07:56,253 And try to hold still. 144 00:07:57,757 --> 00:07:59,045 Thank you. 145 00:07:59,525 --> 00:08:00,825 For bringing us in. 146 00:08:00,827 --> 00:08:03,193 This is the new Chief's patient. It's a great opportunity. 147 00:08:03,195 --> 00:08:05,663 Or it's a bunch of pointless tests. 148 00:08:07,933 --> 00:08:10,368 Uh, for which I thank you. 149 00:08:10,370 --> 00:08:12,035 Tell us about Dr. Han. 150 00:08:12,037 --> 00:08:14,705 He's direct, charming, 151 00:08:14,707 --> 00:08:15,939 very sure of himself. 152 00:08:15,941 --> 00:08:17,608 Big ego. 153 00:08:21,513 --> 00:08:24,848 There's nothing wrong with an ego if you can back it up. 154 00:08:24,850 --> 00:08:26,783 And Dr. Han's arterial switch technique 155 00:08:26,785 --> 00:08:28,818 is performed all over the world. 156 00:08:28,820 --> 00:08:30,820 The tests aren't all pointless. 157 00:08:30,822 --> 00:08:32,589 Way to stand firm, Park. 158 00:08:32,591 --> 00:08:34,090 No, look at the monitor. 159 00:08:34,092 --> 00:08:35,425 He has a tumor. 160 00:09:00,885 --> 00:09:02,618 Percy's stable? 161 00:09:02,620 --> 00:09:05,621 We're naming her Persephone. 162 00:09:05,623 --> 00:09:09,158 Yes. I put in a central line for nutrition. 163 00:09:09,160 --> 00:09:10,526 Percy is stable right now. 164 00:09:10,528 --> 00:09:13,662 We're looking for solutions to her problems. 165 00:09:13,664 --> 00:09:15,998 W-Wh-Why does... 166 00:09:16,000 --> 00:09:18,401 Why does she have all these birth defects? 167 00:09:18,403 --> 00:09:19,793 Diane. 168 00:09:20,271 --> 00:09:21,737 We spoke to our obstetrician. 169 00:09:21,739 --> 00:09:24,297 She said these defects can happen for no reason, right? 170 00:09:25,943 --> 00:09:27,142 That's true. 171 00:09:27,144 --> 00:09:29,978 Over 50% have no known cause. 172 00:09:32,182 --> 00:09:36,717 I was taking paroxetine for clinical depression. 173 00:09:36,719 --> 00:09:37,986 And you went off the meds 174 00:09:37,988 --> 00:09:39,554 as soon as you found out you were pregnant. 175 00:09:39,556 --> 00:09:42,190 She was five, six weeks at most. 176 00:09:42,192 --> 00:09:43,858 My OB told me studies show 177 00:09:43,860 --> 00:09:46,527 antidepressants are safe to take during pregnancy. 178 00:09:46,529 --> 00:09:47,829 But is that true, 179 00:09:47,831 --> 00:09:49,530 or is she protecting me? 180 00:09:51,801 --> 00:09:55,036 There was a study that associated paroxetine 181 00:09:55,038 --> 00:09:56,671 with these kinds of defects. 182 00:09:56,673 --> 00:09:59,040 It is a possibility. 183 00:10:10,467 --> 00:10:12,663 You can't tell whether it's cancerous or benign? 184 00:10:12,688 --> 00:10:13,953 Not until we do the biopsy, 185 00:10:13,955 --> 00:10:15,855 which I've scheduled for later. 186 00:10:15,857 --> 00:10:17,424 We'll know what's going on by the morning. 187 00:10:19,327 --> 00:10:20,593 Good. 188 00:10:20,595 --> 00:10:22,062 That's good. 189 00:10:24,833 --> 00:10:27,333 Maybe you'd like to call someone? 190 00:10:27,335 --> 00:10:29,502 A family member, a friend? 191 00:10:29,504 --> 00:10:31,504 I'll worry when I know it's cancer. 192 00:10:41,149 --> 00:10:43,850 We could use a transcatheter route 193 00:10:43,852 --> 00:10:46,504 and patch each hole individually. 194 00:10:47,055 --> 00:10:48,588 Her heart's the size of a walnut. 195 00:10:48,590 --> 00:10:51,224 It's too small to maneuver inside. 196 00:10:51,226 --> 00:10:53,525 A single large patch to close the holes 197 00:10:53,527 --> 00:10:54,793 would withstand the pressure. 198 00:10:54,795 --> 00:10:56,128 Yes. 199 00:10:58,099 --> 00:11:00,465 It would also block electrical conduction, 200 00:11:00,467 --> 00:11:02,735 causing deadly arrhythmias. 201 00:11:02,737 --> 00:11:04,522 Dr. Murphy... 202 00:11:05,405 --> 00:11:08,340 did you tell the mom that she caused her baby's birth defect? 203 00:11:08,342 --> 00:11:12,655 No. I said that her antidepressants could have. 204 00:11:13,547 --> 00:11:15,180 Why did you tell her that? 205 00:11:15,658 --> 00:11:17,616 It's the truth. 206 00:11:17,618 --> 00:11:20,497 And is that relevant to her current medical situation? 207 00:11:21,588 --> 00:11:22,821 No. 208 00:11:24,491 --> 00:11:27,559 And how did you think that answer would make her feel? 209 00:11:27,561 --> 00:11:29,466 What did you think would happen? 210 00:11:31,197 --> 00:11:33,364 The mother is devastated. 211 00:11:33,366 --> 00:11:34,966 The father is furious. 212 00:11:34,968 --> 00:11:36,300 I would be, too. 213 00:11:36,302 --> 00:11:38,102 Shaun is a resident. 214 00:11:38,104 --> 00:11:39,670 Residents make mistakes. 215 00:11:40,774 --> 00:11:42,807 Managing these parents' emotional concerns 216 00:11:42,809 --> 00:11:45,609 is as much a part of this job as operating on their daughter. 217 00:11:45,611 --> 00:11:48,012 Social cues are hard for Shaun, 218 00:11:48,014 --> 00:11:49,413 but we've been working with him... 219 00:11:49,415 --> 00:11:51,415 You should be focused on your own shortcomings, 220 00:11:51,417 --> 00:11:54,322 like retaining the formula for vascular impedance. 221 00:11:55,054 --> 00:11:56,420 Dr. Han. 222 00:11:59,159 --> 00:12:01,793 We could patch each individual hole in the heart 223 00:12:01,795 --> 00:12:03,661 if we cut open the ventricle... 224 00:12:03,663 --> 00:12:05,328 Don't change the subject, Dr. Murphy. 225 00:12:05,330 --> 00:12:06,830 I didn't, Dr. Han. 226 00:12:06,832 --> 00:12:09,232 We were talking about the baby. 227 00:12:09,234 --> 00:12:10,713 Really? 228 00:12:11,503 --> 00:12:13,770 You don't see a difference in the nature of your discussion 229 00:12:13,772 --> 00:12:15,705 before I arrived and after? 230 00:12:17,375 --> 00:12:21,111 We were talking about the baby. 231 00:12:26,618 --> 00:12:29,452 They tried the approach you suggested at L.A. Children's. 232 00:12:29,454 --> 00:12:31,288 The baby died a week later. 233 00:12:31,290 --> 00:12:34,691 The suture line didn't hold, and the cardiac wall ruptured. 234 00:12:34,693 --> 00:12:35,758 Keep looking. 235 00:12:35,760 --> 00:12:37,994 Dr. Murphy, 236 00:12:37,996 --> 00:12:40,743 do not talk with those parents again. 237 00:12:44,368 --> 00:12:45,767 I'll walk with you. 238 00:12:49,273 --> 00:12:51,106 You're pretty tough on my residents. 239 00:12:51,108 --> 00:12:52,441 Rebuking them in public, 240 00:12:52,443 --> 00:12:55,010 pimping them with questions during surgery. 241 00:12:55,012 --> 00:12:56,645 Shame-based learning isn't my style. 242 00:12:56,647 --> 00:12:58,714 I'll bear that in mind. 243 00:12:58,716 --> 00:13:00,716 But this isn't about my treatment of "the residents." 244 00:13:00,718 --> 00:13:02,384 You're concerned about Dr. Murphy. 245 00:13:02,386 --> 00:13:04,920 Well, a lot of doctors have less than ideal bedside manner. 246 00:13:04,922 --> 00:13:06,755 - He's young... - Would you ever have said 247 00:13:06,757 --> 00:13:08,824 something like that to a patient as a resident? 248 00:13:08,826 --> 00:13:10,459 As a med student? 249 00:13:10,461 --> 00:13:11,593 And Murphy doesn't even understand 250 00:13:11,595 --> 00:13:12,895 he did anything wrong. 251 00:13:12,897 --> 00:13:14,363 Shaun has hard-wired differences 252 00:13:14,365 --> 00:13:16,531 - in the way he perceives things. - Exactly. 253 00:13:16,533 --> 00:13:17,733 No matter how hard he works, 254 00:13:17,735 --> 00:13:20,502 no matter how hard you try and help him, 255 00:13:20,504 --> 00:13:23,104 his limitations are not going to change. 256 00:13:23,106 --> 00:13:26,441 He's going to continue to inflict them on our patients... 257 00:13:26,443 --> 00:13:29,143 all in the name of diversity and inclusion. 258 00:13:31,682 --> 00:13:33,415 Shaun deserves to be here. 259 00:13:34,551 --> 00:13:37,619 Once you see what he's capable of, you'll agree. 260 00:13:37,621 --> 00:13:39,386 I look forward to being proven wrong. 261 00:13:45,016 --> 00:13:46,795 Stay seated for 20 minutes. 262 00:13:46,797 --> 00:13:48,323 Don't want you passing out in the lobby. 263 00:13:48,325 --> 00:13:49,963 I know, I know. Thank you. 264 00:13:55,318 --> 00:13:57,070 This disease changed my relationships, 265 00:13:57,072 --> 00:13:59,874 changed my priorities, changed... 266 00:13:59,876 --> 00:14:01,241 who I am. 267 00:14:01,243 --> 00:14:02,574 Cancer is an identity. 268 00:14:02,576 --> 00:14:04,712 Cancer is cellular mutation. 269 00:14:04,714 --> 00:14:06,881 The people in this room are my people. 270 00:14:06,883 --> 00:14:09,983 What are you... 20 years old? I'm triple your age. 271 00:14:09,985 --> 00:14:11,285 I don't think you're my "people." 272 00:14:11,287 --> 00:14:13,533 The last time I hung out with my law-school friends... 273 00:14:13,535 --> 00:14:14,523 epic fail. 274 00:14:14,548 --> 00:14:16,413 The fact that you use the phrase "epic fail," 275 00:14:16,415 --> 00:14:17,558 kind of case in point. 276 00:14:17,560 --> 00:14:19,460 They're all focused on what firm they're gonna land at, 277 00:14:19,462 --> 00:14:21,562 and I'm all about whether... 278 00:14:21,564 --> 00:14:23,330 Candice's leukemia is responding 279 00:14:23,332 --> 00:14:25,032 to her new chemo regimen. 280 00:14:25,034 --> 00:14:26,599 By the way, she has this peppermint oil 281 00:14:26,601 --> 00:14:28,393 that is great for headaches. 282 00:14:32,741 --> 00:14:34,874 Ooh, I know that look. 283 00:14:34,876 --> 00:14:36,317 Here, here. 284 00:14:41,750 --> 00:14:43,583 Got you, brother... 285 00:14:43,585 --> 00:14:45,052 whether you like it or not. 286 00:14:49,458 --> 00:14:51,358 Show me where we are. 287 00:14:51,360 --> 00:14:54,127 That angle runs pretty close to the sacral nerve roots. 288 00:14:55,697 --> 00:14:57,063 How are we doing? 289 00:14:57,065 --> 00:14:58,497 Tumor's abutting the iliac artery. 290 00:14:58,499 --> 00:15:00,299 I'm trying not to disrupt the entire blood supply 291 00:15:00,301 --> 00:15:01,600 to his lower body. 292 00:15:01,602 --> 00:15:03,302 Dr. Han, I'm Morgan Reznick. 293 00:15:03,304 --> 00:15:05,604 I really enjoyed your article on Myotomy 294 00:15:05,606 --> 00:15:08,641 for infantile hypertrophic pyloric stenosis. 295 00:15:09,444 --> 00:15:12,578 I appreciate the thorough research behind your sucking up. 296 00:15:12,580 --> 00:15:14,380 And you are? 297 00:15:14,382 --> 00:15:15,848 Alex Park. 298 00:15:15,850 --> 00:15:18,317 Park... you were a cop. 299 00:15:18,319 --> 00:15:20,919 Medicine as a second career... good stuff. 300 00:15:20,921 --> 00:15:22,989 Tends to bring a fresh perspective. 301 00:15:25,593 --> 00:15:28,127 I hit an artery. Take the needle. 302 00:15:28,129 --> 00:15:29,294 Blood's pooling in the pelvis. 303 00:15:29,296 --> 00:15:30,958 - Should we open him up? - No. 304 00:15:30,960 --> 00:15:32,530 Prep the femoral artery. Get me an art cath set. 305 00:15:32,532 --> 00:15:34,550 - Pressure's dropping. - Platinum coil. 306 00:15:41,441 --> 00:15:43,718 Nice save. 307 00:15:44,344 --> 00:15:45,943 Next time, don't hit the vessel. 308 00:15:47,447 --> 00:15:49,614 There is no next time. 309 00:15:49,616 --> 00:15:51,449 The biopsy's too dangerous. 310 00:15:57,190 --> 00:16:00,558 It is likely that it's a benign notochord cell tumor. 311 00:16:00,560 --> 00:16:02,343 They look like chordomas, 312 00:16:02,345 --> 00:16:03,828 but they're harmless and way more common. 313 00:16:03,830 --> 00:16:05,162 But you don't know. 314 00:16:05,164 --> 00:16:07,231 Since we can't do the biopsy, no. 315 00:16:08,300 --> 00:16:10,286 This is the problem with broad testing. 316 00:16:11,103 --> 00:16:12,637 Everyone has abnormalities. 317 00:16:12,639 --> 00:16:14,171 Most of them are nothing. 318 00:16:14,173 --> 00:16:15,840 But when we do find them, 319 00:16:16,125 --> 00:16:17,942 we have to make some tough choices. 320 00:16:19,178 --> 00:16:22,212 So, what exactly is my tough choice? 321 00:16:23,841 --> 00:16:25,516 We could remove the tumor. 322 00:16:25,518 --> 00:16:27,151 This is a very risky surgery. 323 00:16:27,153 --> 00:16:29,353 There's a chance of paralysis or worse... 324 00:16:29,355 --> 00:16:31,140 you may not make it off the table. 325 00:16:31,724 --> 00:16:33,434 Or you do nothing. 326 00:16:33,760 --> 00:16:35,360 We'd continue to monitor it, 327 00:16:35,362 --> 00:16:36,726 do imaging every few weeks. 328 00:16:36,728 --> 00:16:38,828 But chordomas move very quickly. 329 00:16:38,830 --> 00:16:40,931 By the time any change showed up on imaging, 330 00:16:40,933 --> 00:16:43,433 it's most likely metastasized throughout your body. 331 00:16:45,537 --> 00:16:49,039 So it probably isn't cancer, 332 00:16:49,041 --> 00:16:52,576 but if it is and I wait, then I'll die. 333 00:16:52,578 --> 00:16:54,044 That's true. 334 00:16:54,046 --> 00:16:57,948 And if I don't wait and I get the surgery, 335 00:16:57,950 --> 00:16:59,849 then there's a good chance I'll die. 336 00:16:59,851 --> 00:17:00,951 Yes. 337 00:17:06,324 --> 00:17:08,491 I'm gonna need to think this over. 338 00:17:23,442 --> 00:17:27,577 This is the May Annals of Neonatal Surgery. 339 00:17:27,579 --> 00:17:30,779 I just finished March. I need to read April now. 340 00:17:30,781 --> 00:17:32,448 Oh, I have April, Shaun. 341 00:17:32,450 --> 00:17:34,016 No. 342 00:17:34,018 --> 00:17:36,210 No, you're supposed to be reading 343 00:17:36,212 --> 00:17:38,673 New Approaches in Neonatal Surgery. 344 00:17:38,675 --> 00:17:41,419 Claire has the British Journal of Neonatology... 345 00:17:49,500 --> 00:17:51,533 Shaun... 346 00:17:51,846 --> 00:17:54,802 I think maybe you should be quiet around Han 347 00:17:54,804 --> 00:17:57,018 for a little while. 348 00:17:57,641 --> 00:18:00,074 But then how will I answer his questions? 349 00:18:01,897 --> 00:18:04,646 Direct questions, absolutely answer. 350 00:18:04,648 --> 00:18:06,914 Otherwise, outside of the O.R., 351 00:18:06,916 --> 00:18:08,683 you should stay out of his way. 352 00:18:11,588 --> 00:18:14,189 If someone had convinced Shaun to do that with Dr. Melendez, 353 00:18:14,191 --> 00:18:16,558 he would still be on suction. 354 00:18:20,230 --> 00:18:22,464 Code blue... NICU, Bed 4. 355 00:18:22,466 --> 00:18:25,133 Code blue... NICU, Bed 4. 356 00:18:27,937 --> 00:18:30,604 O2 SATs dropped and central venous pressure shot up. 357 00:18:30,606 --> 00:18:32,239 The Pulmonary Artery Band is failing. 358 00:18:32,241 --> 00:18:34,275 - Eight of dopamine. - Let's get a mask on her. 359 00:18:34,277 --> 00:18:36,577 She won't last much longer. We need other options. 360 00:18:36,579 --> 00:18:38,345 I'll update the parents. 361 00:18:39,983 --> 00:18:41,961 Let's get her on full cardiac support. 362 00:18:57,028 --> 00:18:59,134 What have you got? Anything? 363 00:18:59,180 --> 00:19:01,079 This Cleveland group 364 00:19:01,081 --> 00:19:03,715 repaired a bowel protrusion using enterolysis. 365 00:19:03,717 --> 00:19:06,251 I could cut out this excess inflammatory tissue 366 00:19:06,253 --> 00:19:07,717 and segment of bowel atresia. 367 00:19:07,719 --> 00:19:09,829 Might make her intestines small enough to fit. 368 00:19:09,831 --> 00:19:11,089 Promising. 369 00:19:11,091 --> 00:19:12,691 Given the size of her abdomen, 370 00:19:12,693 --> 00:19:14,059 I need to remove a lot of bowel. 371 00:19:14,061 --> 00:19:16,562 There's a good chance she wouldn't be able to absorb food. 372 00:19:16,564 --> 00:19:18,319 We'll have to find the right balance. 373 00:19:18,320 --> 00:19:20,285 It's our only workable plan. 374 00:19:20,287 --> 00:19:22,253 Best bet on the heart is to cut through the ventricle, 375 00:19:22,255 --> 00:19:24,055 like Murphy suggested. 376 00:19:24,057 --> 00:19:26,891 Uh, you were concerned about the suture line holding. 377 00:19:26,893 --> 00:19:28,493 Well, I still am. 378 00:19:28,495 --> 00:19:30,761 Hopefully, horizontal mattress sutures will work. 379 00:19:30,763 --> 00:19:32,097 They should be able to withstand the tension 380 00:19:32,099 --> 00:19:33,598 at the suture line. 381 00:19:33,600 --> 00:19:35,900 There's still a risk of an aneurysm forming 382 00:19:35,902 --> 00:19:37,935 in the tissue underneath. 383 00:19:40,773 --> 00:19:42,456 Dr. Lim? 384 00:19:42,876 --> 00:19:45,210 I have an idea I'd like to share, 385 00:19:45,212 --> 00:19:47,879 even though Dr. Han didn't ask me a question. 386 00:19:52,085 --> 00:19:54,151 Yeah, go ahead, Shaun. 387 00:19:54,153 --> 00:19:56,020 If we go in through the atrium, 388 00:19:56,022 --> 00:19:57,854 we wouldn't have to worry about the suture line... 389 00:19:57,856 --> 00:19:59,689 It's the same issue we discussed. 390 00:19:59,691 --> 00:20:01,691 There's not enough room inside the baby's heart 391 00:20:01,693 --> 00:20:03,193 to stitch the patches in the place. 392 00:20:03,195 --> 00:20:05,695 Oh, we don't need to, Dr. Han. 393 00:20:05,697 --> 00:20:08,198 We can make a plug small enough for her heart... 394 00:20:08,200 --> 00:20:10,600 a PTFE disc with a stem like a mushroom. 395 00:20:10,602 --> 00:20:12,403 Then we can insert the stem through one of the holes 396 00:20:12,405 --> 00:20:14,104 until the disc presses against the wall, 397 00:20:14,106 --> 00:20:15,656 covering all the holes. 398 00:20:16,575 --> 00:20:20,444 L-Like a stopper in a bathtub. 399 00:20:20,446 --> 00:20:21,711 Yes. 400 00:20:21,713 --> 00:20:23,580 The higher pressure on the left side of her heart 401 00:20:23,582 --> 00:20:24,948 would keep it in place. 402 00:20:24,950 --> 00:20:26,883 We wouldn't even need to stitch. 403 00:20:28,421 --> 00:20:30,353 Great idea. 404 00:20:30,355 --> 00:20:32,088 We should take this to the parents. 405 00:20:32,090 --> 00:20:33,889 Great idea for the heart. 406 00:20:33,891 --> 00:20:36,459 But we need to tell them that our current plan 407 00:20:36,461 --> 00:20:37,493 for the abdominal repair 408 00:20:37,495 --> 00:20:39,929 is considerably more of a long shot. 409 00:20:39,931 --> 00:20:42,516 And that fixing the heart takes an option off the table. 410 00:20:43,368 --> 00:20:45,234 Withdrawing care. 411 00:20:54,645 --> 00:20:56,447 You can't move that card. 412 00:20:56,948 --> 00:20:58,414 Excuse me? 413 00:20:58,416 --> 00:20:59,615 Who cheats at solitaire? 414 00:20:59,617 --> 00:21:01,184 You're literally only cheating yourself. 415 00:21:01,186 --> 00:21:02,552 Again. 416 00:21:02,554 --> 00:21:03,919 Good morning, Larry. 417 00:21:03,921 --> 00:21:05,754 Is it a macho thing? 418 00:21:05,756 --> 00:21:07,522 Like a real man should be able to make it through 419 00:21:07,524 --> 00:21:10,025 without leaning on a label or the people who go with it? 420 00:21:12,129 --> 00:21:14,096 Embracing cancer as an identity 421 00:21:14,098 --> 00:21:16,364 is the last thing any one of us should be doing. 422 00:21:16,366 --> 00:21:19,534 It underscores everything horrible right now. 423 00:21:20,437 --> 00:21:22,370 We're in a daily battle for our lives. 424 00:21:22,372 --> 00:21:24,573 I see no value in dwelling on that. 425 00:21:28,946 --> 00:21:30,512 Candice is late. 426 00:21:31,816 --> 00:21:34,182 Which means either her niece forgot to pick her up. 427 00:21:34,184 --> 00:21:36,278 Again. 428 00:21:36,821 --> 00:21:38,697 Or she got some bad news. 429 00:21:39,590 --> 00:21:41,256 Or she's already dead. 430 00:21:43,494 --> 00:21:46,261 We are in a daily battle. 431 00:21:49,166 --> 00:21:51,454 I'd rather have some company. 432 00:22:07,217 --> 00:22:09,117 I spoke to my mother and brother, 433 00:22:09,119 --> 00:22:11,730 and they both think I shouldn't do the surgery. 434 00:22:12,389 --> 00:22:14,322 Apparently they're more scared of your surgical skills 435 00:22:14,324 --> 00:22:15,985 than they are of this tumor. 436 00:22:17,194 --> 00:22:19,093 And where do you stand? 437 00:22:19,095 --> 00:22:21,062 I need numbers. 438 00:22:21,064 --> 00:22:22,363 Please. 439 00:22:25,869 --> 00:22:28,872 The stats on something like this, it... 440 00:22:29,472 --> 00:22:30,738 there are a lot of variables. 441 00:22:30,740 --> 00:22:32,807 What are the odds I make it through the surgery 442 00:22:32,809 --> 00:22:35,129 without any complications? 443 00:22:35,745 --> 00:22:37,945 It's a challenging procedure. 444 00:22:37,947 --> 00:22:40,782 Zero complications, I'd say 80%. 445 00:22:42,351 --> 00:22:45,452 But it is very unlikely this tumor is malignant. 446 00:22:45,454 --> 00:22:47,182 Give me a number. 447 00:22:47,924 --> 00:22:50,558 About 5% chance it's a chordoma. 448 00:22:57,900 --> 00:23:00,067 The numbers agree with your family. 449 00:23:00,069 --> 00:23:01,569 So do I. 450 00:23:10,313 --> 00:23:11,878 I've always been more comfortable with action 451 00:23:11,880 --> 00:23:13,447 than inaction. 452 00:23:16,885 --> 00:23:19,286 I want you to do the surgery. 453 00:23:22,658 --> 00:23:24,786 Certainty comes at a price. 454 00:23:33,535 --> 00:23:36,369 She'll be able to get off the life support machines? 455 00:23:36,371 --> 00:23:38,238 If everything goes well, yes. 456 00:23:38,240 --> 00:23:39,972 She'll have a strong heart. 457 00:23:39,974 --> 00:23:41,807 How soon can you do it? 458 00:23:43,478 --> 00:23:45,144 You should know we feel less confident 459 00:23:45,146 --> 00:23:47,201 about our plan for her bowel. 460 00:23:47,582 --> 00:23:50,316 The chance of failure is quite high. 461 00:23:50,318 --> 00:23:51,784 How high? 462 00:23:51,786 --> 00:23:54,721 I put it at 90% that the repair won't work. 463 00:23:54,723 --> 00:23:57,823 Which would lead to irreversible malnutrition. 464 00:23:57,825 --> 00:24:01,340 Your daughter would slowly starve to death over months. 465 00:24:02,029 --> 00:24:04,130 Right now, her body is working very hard 466 00:24:04,132 --> 00:24:05,397 just to stay alive. 467 00:24:08,702 --> 00:24:11,003 If we were to turn off the machines... 468 00:24:11,005 --> 00:24:12,958 Turn off the machines? 469 00:24:15,743 --> 00:24:18,816 ...she would pass quickly. And peacefully. 470 00:24:19,346 --> 00:24:21,680 If the heart surgery is a success, 471 00:24:21,682 --> 00:24:23,783 that won't be an option. 472 00:24:23,785 --> 00:24:25,617 Oh. 473 00:24:25,619 --> 00:24:27,519 Why not try to fix the bowel first 474 00:24:27,521 --> 00:24:28,720 to see if it works? 475 00:24:28,722 --> 00:24:30,522 We won't know if the bowel is viable 476 00:24:30,524 --> 00:24:32,258 until after the heart is. 477 00:24:33,460 --> 00:24:35,874 We have to do the surgery. 478 00:24:36,229 --> 00:24:38,530 But if this doesn't work, she could starve to death. 479 00:24:38,532 --> 00:24:41,433 - It's worth the risk... - It's not our risk. It's hers. 480 00:24:41,435 --> 00:24:44,803 So, instead, you're ready to give up on our daughter? 481 00:24:44,805 --> 00:24:47,339 I mean, it's like we're right back at the ultrasound. 482 00:24:47,341 --> 00:24:49,941 We decided together to continue this pregnancy. 483 00:24:49,943 --> 00:24:51,910 So this is as much my fault as it is yours. 484 00:24:51,912 --> 00:24:53,312 My fault? 485 00:24:53,314 --> 00:24:55,280 Because of the medication? 486 00:24:56,917 --> 00:25:00,315 I cannot turn off that machine. 487 00:25:01,021 --> 00:25:03,855 Your guilt is stopping you from admitting what we need to do. 488 00:25:03,857 --> 00:25:06,490 My guilt has nothing to do with this. 489 00:25:06,492 --> 00:25:09,227 - I am fighting for my daughter. - So am I. 490 00:25:11,675 --> 00:25:13,676 Since the parents can't agree, the decision 491 00:25:13,678 --> 00:25:15,960 about the baby's care will be made by a judge 492 00:25:15,962 --> 00:25:17,814 who will rely on our recommendation. 493 00:25:18,399 --> 00:25:20,032 So we make the choice, 494 00:25:20,034 --> 00:25:21,600 but the parents live with it? 495 00:25:24,131 --> 00:25:25,804 Well, maybe that's a good thing. 496 00:25:27,474 --> 00:25:29,507 For parents to have to decide between 497 00:25:29,509 --> 00:25:31,243 letting their daughter die 498 00:25:31,245 --> 00:25:34,980 or fighting for her life, knowing she may suffer horribly, 499 00:25:34,982 --> 00:25:37,477 maybe it's better if we carry that burden. 500 00:25:40,221 --> 00:25:41,820 Dr. Lim? 501 00:25:41,822 --> 00:25:43,322 Your decision would be? 502 00:25:44,791 --> 00:25:46,491 Take her off life support. 503 00:25:46,493 --> 00:25:48,660 The odds are stacked against the bowel repair working. 504 00:25:48,662 --> 00:25:51,696 Those numbers reflect the general population of doctors. 505 00:25:51,698 --> 00:25:54,102 I think Dr. Lim and I are better than that. 506 00:25:54,703 --> 00:25:56,163 We can beat the odds. 507 00:26:03,921 --> 00:26:05,562 One of the things I'm not going to miss 508 00:26:05,564 --> 00:26:07,245 about being Chief of Surgery 509 00:26:07,247 --> 00:26:10,135 is being responsible for choices like this. 510 00:26:12,852 --> 00:26:15,219 Dr. Han, it's your department... 511 00:26:15,221 --> 00:26:16,888 it's your call. 512 00:26:24,430 --> 00:26:26,230 You've been here all night? 513 00:26:26,735 --> 00:26:28,165 I've been working on a case 514 00:26:28,167 --> 00:26:30,768 with the new Chief of Surgery, Dr. Han. 515 00:26:30,770 --> 00:26:33,388 - How's that going? - Not very well. 516 00:26:33,390 --> 00:26:35,405 He plays music in the operating room. 517 00:26:35,407 --> 00:26:36,889 Oh, geez. One of those. 518 00:26:36,891 --> 00:26:38,191 And he says I need to focus on 519 00:26:38,193 --> 00:26:40,290 our patients' emotional needs. 520 00:26:40,745 --> 00:26:42,845 Well, that's a tough assignment for you. 521 00:26:43,708 --> 00:26:45,175 Mm. 522 00:26:49,466 --> 00:26:53,167 You ever wish you had, you know, 523 00:26:53,169 --> 00:26:55,892 friends, co-workers on the spectrum? 524 00:26:56,264 --> 00:26:57,860 Not usually. 525 00:26:57,862 --> 00:27:00,773 But maybe Dr. Han wouldn't notice me as much 526 00:27:00,775 --> 00:27:03,105 if I weren't the only doctor with ASD. 527 00:27:06,204 --> 00:27:08,103 There's this kid in chemo, 528 00:27:08,105 --> 00:27:11,288 just obsessed with having cancer. 529 00:27:11,315 --> 00:27:12,615 It's all he talks about. 530 00:27:12,617 --> 00:27:14,254 He wants to be friends with everybody in the ward. 531 00:27:14,256 --> 00:27:15,926 That's very smart of him. 532 00:27:15,928 --> 00:27:19,121 Speigel et al. showed an increase in overall survival 533 00:27:19,123 --> 00:27:21,491 and quality of life measures in breast cancer patients 534 00:27:21,493 --> 00:27:24,527 who formed social bonds with others battling the disease. 535 00:27:25,430 --> 00:27:27,430 What should I do about Dr. Han? 536 00:27:29,901 --> 00:27:32,735 I don't know. Um... 537 00:27:32,737 --> 00:27:34,404 just do your work, 538 00:27:34,406 --> 00:27:36,706 be a good surgeon, be an excellent surgeon. 539 00:27:36,708 --> 00:27:38,941 Over time, he'll forget about the autism. 540 00:27:38,943 --> 00:27:40,342 Why would that happen? 541 00:27:40,344 --> 00:27:43,345 He'll see that you have the skill, you have dedication. 542 00:27:43,347 --> 00:27:45,680 I have autism. 543 00:27:45,682 --> 00:27:47,449 It's part of who I am. 544 00:27:58,129 --> 00:27:59,761 The judge...? 545 00:27:59,763 --> 00:28:01,463 Accepted our recommendation 546 00:28:01,465 --> 00:28:03,373 and ruled in favor of surgery. 547 00:28:04,001 --> 00:28:05,479 Thank you, Doctor. 548 00:28:11,042 --> 00:28:12,441 Okay, Percy. 549 00:28:14,278 --> 00:28:16,145 Momma loves you. 550 00:28:19,149 --> 00:28:20,458 I love you, Percy. 551 00:28:55,995 --> 00:28:57,661 Should we remove more bowel? 552 00:28:57,663 --> 00:28:58,863 That would take us to the ilium. 553 00:28:58,865 --> 00:29:01,032 She won't gain enough weight to thrive. 554 00:29:01,429 --> 00:29:03,128 Her abdominal muscles are tight 555 00:29:03,130 --> 00:29:05,393 from developing around an empty cavity. 556 00:29:07,968 --> 00:29:10,635 They're cinched around her tummy like a corset. 557 00:29:10,637 --> 00:29:12,037 What if we unbuttoned it? 558 00:29:12,039 --> 00:29:13,205 Released the muscle 559 00:29:13,207 --> 00:29:15,473 and increased the abdominal circumference. 560 00:29:15,475 --> 00:29:16,782 Those muscles are part of her abdominal wall. 561 00:29:16,807 --> 00:29:18,310 Not if we separate the layers... 562 00:29:18,312 --> 00:29:21,113 create a plane between the skin and the muscle. 563 00:29:22,950 --> 00:29:24,817 You good if Murphy and I start on the heart? 564 00:29:25,652 --> 00:29:28,220 Dr. Browne, you're with me on the abdomen. 565 00:29:29,623 --> 00:29:30,923 Clearing the field. 566 00:29:30,925 --> 00:29:32,925 Han is on the call schedule next weekend. 567 00:29:32,927 --> 00:29:35,160 Maybe Carmen will switch with me so I can cover with him? 568 00:29:35,162 --> 00:29:38,262 Or maybe you shouldn't try so hard. 569 00:29:38,264 --> 00:29:39,761 Retractor. 570 00:29:40,634 --> 00:29:42,567 Some of us don't have a cool former career... 571 00:29:42,569 --> 00:29:44,235 or an easy-going, mellow demeanor. 572 00:29:44,237 --> 00:29:45,603 People are never gonna crowd in my corner 573 00:29:45,605 --> 00:29:46,871 because I'm just so likable. 574 00:29:46,873 --> 00:29:48,906 Well, you could try being nice to them. 575 00:29:48,908 --> 00:29:50,642 - Well, this is easier. - There it is. 576 00:29:53,347 --> 00:29:55,046 Does it look like cancer? 577 00:29:55,048 --> 00:29:56,815 It's not labeled. 578 00:29:56,817 --> 00:29:59,155 We're all gonna have to wait for the pathologist's report. 579 00:30:01,020 --> 00:30:02,587 Probe. 580 00:30:07,594 --> 00:30:09,227 The artery is in the way. 581 00:30:09,229 --> 00:30:11,529 We can't get at the tumor without him bleeding out. 582 00:30:16,469 --> 00:30:17,969 We're gonna have to take it from the back. 583 00:30:17,971 --> 00:30:21,072 - But the S1 nerve root... - Is something he can live without. 584 00:30:21,074 --> 00:30:22,606 Dissecting scissors. 585 00:30:26,512 --> 00:30:27,912 Pledget anchor. 586 00:30:43,129 --> 00:30:44,262 The plug is in position. 587 00:30:44,264 --> 00:30:46,244 You ready to test the bowel repair? 588 00:30:48,000 --> 00:30:49,566 Let's take her off cardiac support. 589 00:30:49,568 --> 00:30:51,368 Dr. Murphy, it was your idea. 590 00:30:51,370 --> 00:30:52,969 You do the honors. 591 00:31:03,749 --> 00:31:06,683 Abdominal pressure is normal. 592 00:31:06,685 --> 00:31:09,052 The intestines are perfusing. 593 00:31:12,257 --> 00:31:14,324 Pulmonary pressure's spiking. 594 00:31:14,326 --> 00:31:15,526 Prostacyclin and nitric oxide... 595 00:31:15,528 --> 00:31:16,727 we need to get her lung pressure down. 596 00:31:16,729 --> 00:31:18,295 Oxygen SATs are dropping. 597 00:31:18,297 --> 00:31:20,563 No response to pulmonary vasodilators. 598 00:31:20,565 --> 00:31:23,299 Now the heart's too strong. It's overpowering her lungs. 599 00:31:23,301 --> 00:31:25,367 She needs to go back on cardiac support. 600 00:31:33,645 --> 00:31:37,045 Persephone won't starve to death... 601 00:31:37,615 --> 00:31:39,949 but she will drown in her own fluids. 602 00:31:54,665 --> 00:31:56,197 I'll talk to the parents. 603 00:31:56,199 --> 00:31:57,566 May I come? 604 00:32:09,112 --> 00:32:11,713 Now that Persephone's heart is pumping at full power, 605 00:32:11,715 --> 00:32:13,448 her lungs are overwhelmed. 606 00:32:15,185 --> 00:32:16,885 The humane thing to do 607 00:32:16,887 --> 00:32:19,554 is to turn off the machines and let her go. 608 00:32:20,724 --> 00:32:22,632 No, I-I can't... 609 00:32:22,960 --> 00:32:24,493 I can't give up on her. 610 00:32:27,564 --> 00:32:29,389 Because you fought for her 611 00:32:30,366 --> 00:32:32,633 every minute since she was born. 612 00:32:32,635 --> 00:32:34,935 Before that, when you were taking your medication 613 00:32:34,937 --> 00:32:36,069 for the depression, 614 00:32:36,071 --> 00:32:37,897 you were fighting to keep going 615 00:32:38,407 --> 00:32:40,140 so you could bring her into the world. 616 00:32:56,458 --> 00:32:59,527 But letting go of Percy is not giving up on her. 617 00:33:01,597 --> 00:33:04,397 It's listening to what her body is telling us. 618 00:33:09,203 --> 00:33:10,537 She's hit her limit. 619 00:33:27,789 --> 00:33:29,622 Okay. 620 00:34:03,875 --> 00:34:05,708 I want Persephone to look as good as possible 621 00:34:05,710 --> 00:34:07,243 for the parents. 622 00:34:12,216 --> 00:34:14,149 Let's turn off cardiac support. 623 00:34:19,256 --> 00:34:20,823 Ventilator. 624 00:34:22,225 --> 00:34:23,792 Let's take a minute. 625 00:35:07,104 --> 00:35:08,769 Check valve. 626 00:35:13,110 --> 00:35:15,543 Every time the heart contracted, 627 00:35:15,545 --> 00:35:17,778 blood went into the opposite side of the heart 628 00:35:17,780 --> 00:35:19,680 and raised lung pressure. 629 00:35:19,682 --> 00:35:22,416 The hole reduced the pressure when it got too high 630 00:35:22,418 --> 00:35:23,817 because it allowed backflow. 631 00:35:23,819 --> 00:35:27,254 But our repair of the defect blocked this backwards flow. 632 00:35:27,256 --> 00:35:29,656 What if we made it so she still had a heart defect, 633 00:35:29,658 --> 00:35:31,558 but only when she needed it? 634 00:35:31,560 --> 00:35:35,529 It'd be like an unlatched door in the wall of the heart. 635 00:35:35,531 --> 00:35:37,731 When the pressure gets too high on the right side, 636 00:35:37,733 --> 00:35:40,600 the door swings open, releasing the pressure on the lungs. 637 00:35:40,602 --> 00:35:42,503 The rest of the time, it stays shut. 638 00:35:42,505 --> 00:35:45,372 It should reduce lung pressure by a third. Is that enough? 639 00:35:45,374 --> 00:35:46,507 It depends on how high 640 00:35:46,509 --> 00:35:48,509 her pulmonary vascular resistance is. 641 00:35:48,511 --> 00:35:50,877 PVR is pulmonary artery pressure 642 00:35:50,879 --> 00:35:53,980 minus wedge pressure divided by cardiac output times 80. 643 00:36:04,846 --> 00:36:06,725 The last time I saw my doctor, 644 00:36:06,727 --> 00:36:09,628 he told me I had six months to live. 645 00:36:09,630 --> 00:36:11,431 He also told me I should marry an accountant 646 00:36:11,433 --> 00:36:12,765 and move to North Dakota. 647 00:36:12,767 --> 00:36:14,367 You don't say. 648 00:36:14,369 --> 00:36:16,869 When I asked if it would help my cancer, he said no, 649 00:36:16,871 --> 00:36:19,672 just make the six months seem much longer. 650 00:36:23,010 --> 00:36:26,679 What's the difference between a Neo-Nazi and cancer? 651 00:36:26,681 --> 00:36:28,274 Cancer doesn't discriminate. 652 00:36:31,519 --> 00:36:33,285 I knew a guy once... 653 00:36:33,287 --> 00:36:35,720 his Zodiac sign was Cancer. 654 00:36:35,722 --> 00:36:38,890 It was really ironic how he died. 655 00:36:40,260 --> 00:36:42,027 Uh, uh, how's that? 656 00:36:42,029 --> 00:36:43,962 He was eaten by a giant crab. 657 00:36:43,964 --> 00:36:47,832 Oh, geez. 658 00:36:49,269 --> 00:36:51,503 Aaron, glioma. 659 00:36:51,505 --> 00:36:54,038 Candice, leukemia. 660 00:36:54,040 --> 00:36:55,307 Gin rummy or blackjack? 661 00:36:55,309 --> 00:36:57,342 How fast do you want to take my money? 662 00:36:57,344 --> 00:36:58,843 Blackjack. 663 00:36:58,845 --> 00:37:00,326 Cut 'em. 664 00:37:12,243 --> 00:37:14,310 Did you get it all? 665 00:37:17,396 --> 00:37:18,829 Yes... 666 00:37:18,831 --> 00:37:20,764 totally clear margins. 667 00:37:20,766 --> 00:37:22,433 But the only way to achieve that 668 00:37:22,435 --> 00:37:24,935 involved removing the nerve that controls your left foot. 669 00:37:26,572 --> 00:37:29,873 Rehab and an advanced orthotic may help, 670 00:37:29,875 --> 00:37:32,676 but you will walk with a limp. 671 00:37:32,678 --> 00:37:34,978 Final pathology will let us know if it was worth it. 672 00:37:39,157 --> 00:37:40,984 I'll let you know when it comes in. 673 00:37:43,215 --> 00:37:45,481 It doesn't matter anymore. 674 00:37:48,412 --> 00:37:50,645 It's not like you can put the tumor back in. 675 00:38:05,777 --> 00:38:08,344 Is she... okay? 676 00:38:09,447 --> 00:38:13,683 She still has a surgery or two in her future, but, yes. 677 00:38:13,685 --> 00:38:15,276 She's gonna be great. 678 00:38:18,889 --> 00:38:20,422 Can I hold her? 679 00:38:20,424 --> 00:38:22,617 I think that would be very nice. 680 00:38:23,227 --> 00:38:25,093 For both of you. 681 00:38:40,010 --> 00:38:42,377 Hi, angel. 682 00:38:44,415 --> 00:38:47,249 Oh, my baby. 683 00:38:50,487 --> 00:38:52,019 Come hold her. 684 00:38:58,428 --> 00:39:00,928 You were fighting for her, too. 685 00:39:06,135 --> 00:39:08,569 She's beautiful. 686 00:39:15,712 --> 00:39:17,296 Nice work. 687 00:39:18,514 --> 00:39:20,132 Thank you. 688 00:39:21,050 --> 00:39:23,917 She's beautiful. 689 00:39:23,919 --> 00:39:25,486 Listen to her. Oh. 690 00:39:36,866 --> 00:39:38,398 Thank you. 691 00:39:43,538 --> 00:39:45,705 Minesh's biopsy results? 692 00:39:55,751 --> 00:39:57,050 You don't want to know if we wasted our time 693 00:39:57,052 --> 00:39:58,462 almost killing him? 694 00:39:59,621 --> 00:40:01,488 Can't put the tumor back. 695 00:40:17,506 --> 00:40:19,692 Hello, Dr. Han. 696 00:40:20,208 --> 00:40:22,442 You take the bus, too? 697 00:40:22,444 --> 00:40:23,843 No, Shaun. 698 00:40:23,845 --> 00:40:26,282 I just wanted to talk to you. 699 00:40:29,017 --> 00:40:33,218 You really do have remarkable diagnostic skills. 700 00:40:33,220 --> 00:40:36,188 I have to admit, you're an asset to this hospital. 701 00:40:36,626 --> 00:40:38,390 Yes, I am. 702 00:40:41,061 --> 00:40:44,383 I spoke to the Residency Director of Pathology. 703 00:40:45,032 --> 00:40:48,012 And we both agree you'll be a great fit there. 704 00:40:50,438 --> 00:40:53,706 I'm a surgical resident. 705 00:40:53,708 --> 00:40:55,808 As a pathology resident, 706 00:40:55,810 --> 00:40:58,677 you'll touch cases and lives 707 00:40:58,679 --> 00:41:02,247 across all the medical departments. 708 00:41:02,249 --> 00:41:04,483 It's an opportunity for you to help patients 709 00:41:04,485 --> 00:41:07,490 without having to deal with patients. 710 00:41:08,616 --> 00:41:12,457 Given your difficulties with communication and social cues, 711 00:41:12,459 --> 00:41:14,955 I think it will be a much better fit. 712 00:41:15,795 --> 00:41:17,458 No, thank you. 713 00:41:18,292 --> 00:41:21,198 I have been working very hard 714 00:41:21,200 --> 00:41:24,006 at my communication skills. 715 00:41:24,571 --> 00:41:26,759 Hard work isn't enough. 716 00:41:27,507 --> 00:41:29,273 You have to do the job. 717 00:41:31,811 --> 00:41:36,080 I am a surgical resident. 718 00:41:37,884 --> 00:41:39,522 You were. 719 00:41:40,787 --> 00:41:43,520 And you're gonna do great work in pathology.