- Previously on The Resident... - I loved my sister very much.
One night, I decided to take a quick nap, and when I woke up,
the whole house was on fire.
- How's Jessie? - Her kidneys are failing.
I was a project for you, and now it's finished.
Tell me I'm wrong. Tell me I'm right. Either way, just open up
- like you asked me to do. - And I will.
When I'm ready, when I figure some things out.
I mean, my feelings aren't just gonna change.
Conrad and I have fought long and hard for our relationship.
We've been through it.
But I love him.
Come on!
It's freezing.
They're expecting six more inches.
Atlanta is essentially shut down.
So is the hospital.
Bell canceled elective procedures.
The med students need to go home.
They make good snowball targets, but otherwise,
they're useless. They need to go.
I don't know. A slow night
is a good time for them to practice their skills.
You keep these children, they're your responsibility.
Look at you.
The most popular girl on dialysis.
Yeah, apparently kidney failure
comes with more visitors than rehab.
- How are you holding up? - I don't feel great.
It's hard to keep my eyes open.
It's really taking a toll on her.
Dr. Shaw says that some people have to do this three days a week,
- four hours a session? - Now, there's no need
to get ahead of ourselves. We're doing a workup
to see if your kidney failure's reversible.
We'll have a better idea real soon.
I didn't know you added another doctor to your dance card.
Well, yeah, the clinic's closed because of the storm.
I came by to help out and figure I'd drop in and meet Nic's sister, too.
Can I steal you?
- Donna's asking for us. - Oh, this is important.
It's a patient we've had a long time.
- You'll be back soon? - Yes.
Okay.
Alec is into you.
- I noticed. - So I'm right.
He mentioned something, but I shut it down.
Must be complicated to have to work with him.
- I'm fine. - I'm sure you are.
Can I punch him?
Kidding.
This is the new Conrad, remember?
- Thanks. - Thank you.
Look, I'm handling it.
- Trust me. - Of course I trust you.
I don't have to be friends with the guy, though.
No, you don't.
Hey, Donna.
- How you feeling? - Not bad.
Ready to talk about how I'm gonna die?
There. You'll be fine.
You probably shouldn't try to get home until the snowplows come through.
Nurse Hundley will find you a cozy spot.
What's going on?
Hmm? Oh, Bell's making an announcement.
So, as you know, the blizzard is getting worse by the hour.
We're already working with a skeleton staff,
and because conditions are so hazardous,
we expect the next shift is gonna have trouble getting here,
so no matter what your specialty,
just help where you're needed.
I mean, so far we've been lucky, it's been quiet,
but we can expect storm-related...
complications all night.
- Where does it hurt? - Right here.
Are you guys okay?
Look, we're fine, but my dad, he needs help.
He's in the back. He's frozen. We dug him out of the snow.
- Synced and corrected by Shazi89 - - www.addic7ed.com -
We don't have a pulse. Let's get him to the trauma bay.
Wait, I have to stay with my dad.
No, we need to check you for injuries first.
- What's your name? - Eva Garcia, and that's Eli.
- Is my dad dead? - Nurse Hundley's gonna take care of you.
The doctors are working on him now, honey.
I'm leading this code. This man is in asystole.
Everyone get in line for compressions.
Bai, you're up next.
So much for a quiet night.
- We need access to the airway. - I'll intubate.
- I'll get access. - His body temperature is 72 degrees.
None of this matters if we can't get him warm.
We need heated blankets and warm saline.
I'm having trouble getting the tube in.
I can't get a view. Let's try succinylcholine.
Maybe that'll help me get the tube in.
Excuse me, but if possible,
could I maybe pronounce him dead when compressions stop?
See, Dr. Pravesh said it's good for us to practice our skills,
- and I've never had the opportunity... - Shut your mouth.
Listen, my dad is not dead. He's frozen.
Erik, out.
How's my dad?
Your father's heart has stopped.
- Because he's cold? - Yes.
His body temperature is dangerously low.
We're hoping, if we warm him up,
his heart will start again.
I know you'll save him.
Promise?
We'll do everything we can.
I expect updates.
Call Dr. Austin. We need him.
Hundley, I'm four miles away.
Whatever it is, get Dr. Kays.
Kays is on vacation in Florida.
Mina has a patient with severe hypothermia in cardiac arrest.
Just short of slamming my feet through the floor of this car
and Fred Flintstone-ing my ass there,
I'm not sure what I can do about it.
Dr. Okafor told me to tell you she needs you.
Then neither snow nor rain nor heat nor gloom of night
shall stay this doctor from the swift completion
of his appointed rounds.
Scale of one to ten, how's your pain?
It's a little worse.
But I don't want any more drugs yet,
because I have a visitor coming tomorrow
and I want to have a clear head.
Well, with all the years you spent working in hospice,
I'm sure you know exactly what you want.
25 years.
If there's one thing I understand, it's dying.
Uh, when the chemo stopped working,
I signed a "do not resuscitate" order,
so if my heart stops, no one will give me CPR.
Well, I know you were planning to get to hospice tonight,
but it looks like you're stuck with us.
What can we do to help? Your wish is our command.
Oh, just keep me comfortable.
No needle sticks.
Leave me be.
I really admire you.
- Oh... - I've seen too many people
over-treated and harmed in their last days.
Yeah, well, I'm hoping for a few more weeks.
Do you know, many people live longer in hospice.
I did know that.
Nic's got your back.
In hospice, it's going to be so much nicer.
Scented candles.
"Northern Fir" is my favorite.
I just love the smell of Christmas.
Me, too.
Friends surrounding me,
all of us drinking Tennessee whiskey
and listening to gospel hymns.
Okay, enough schmaltz.
I have a juicy audiobook that's going to put me to sleep.
Oh, and I'll be dreaming of that last item
that I'm gonna be checking off my bucket list.
What is that last item you're checking off your bucket list?
Bob.
Bob's the man, the visitor that I mentioned.
He was my chance at true love.
After Bob, there was no one.
But you're gonna see him?
Yes, I am.
I saw online that he's divorced,
and, um, I wrote him.
And wonder of all wonders, he's going to come see me.
He would have been here today, but he was delayed by the storm.
That is amazing, Donna.
Yeah, I haven't seen him for 30 years.
Oh, words that were never said will finally be spoken.
And I will die without regrets.
Look, I know I said
all hands on deck, but it's been a while since my pediatric rotation.
Did you get a hold of Dr. Jonas?
He's busy.
Feldman?
In with the injured paramedics.
So, you kids dug your dad out of the snow all by yourselves.
How'd you get him in the car, honey?
Well, we put him on the sled, and we pushed him.
It was dark, and everyone was gone, so we dragged him
into the car, and I drove straight here.
By yourself? Incredible.
She's very brave. Isn't she, Eli?
He doesn't talk much,
ever since my mom left.
Do you know how to get in touch with your mom?
Uh, the judge says we can't talk to her anymore.
Not for a while, at least.
So, just a few bumps and scrapes on Eli.
So, your turn.
How about I have a look at that wrist?
Okay...
He's not warming up fast enough from fluids.
The quickest way is to circulate warm blood.
- He needs to go on bypass. - Let's get him into the OR.
Hey, hey, hey, wait, wait, wait. Is my dad's heart beating now?
Uh, not yet. Uh, we're working on it.
I know you'll save his life.
You do realize I'm doing my damnedest to get there
even though I'm freezing to death.
I'm about to scrub in, and there's no attending here.
You have operated without an attending before.
I'm two miles out.
I am in the initial stages of frostbite.
I'd prefer not to lose my fingertips.
What's the procedure?
I'm setting up femoral cannulation for bypass to help him rewarm.
Are you serious right now?
You can put a patient on bypass in your sleep.
Start without me. Finish without me.
But what if there's complications?
Dissection. Pseudoaneurysm. Limb ischemia.
Mina,
are you afraid to fly solo?
I am not afraid.
Well, you should be.
Fear makes us careful.
It's a good thing.
But never let it paralyze you.
It's a dad.
He's frozen. He's in cardiac arrest.
He has two little kids.
The little girl is very brave.
She reminds me of my sisters.
All right.
As soon as my extremities warm up,
I will head back out.
But you got this, Okafor.
Hey.
What are you doing here?
Look, I-I know I messed up in the ER, and I'm so sorry.
But the kids aren't down here anymore,
and I'd still like to practice the death exam.
You realize we aren't talking about an item on a checklist.
It's a person.
- A father. A young man. - No, I-I understand that.
But I'm just a first-year med student.
I don't get that much time in a hospital.
And I haven't seen that many dead people;
only my cadaver in anatomy lab. Ernest.
I named him Ernest to remind me of his humanity
and also to say, "We were working in dead earnest."
Triage nurse to the ER.
- Triage nurse to the ER. - Come here.
Quit hanging around here like the angel of death, Erik.
I might have something you can help me with later tonight.
Careful.
That's got to hurt.
Yeah. I think it's broken.
I think you're right.
We're gonna take a picture. Don't move.
Okay.
See you've made a friend.
Yeah, it's not clear what he sees in me.
But they're great kids.
It's kind of hard to resist 'em. Not one word of complaint.
All they do is ask about their father.
You want to take 'em for a while?
I'd love to.
But as soon as I set Eva's wrist, I have to go to the ER.
Our paramedic has a dislocated hip.
It's all on you, Dr. Bell.
Okay, you ready?
So ready.
This guy is flying high.
You are gonna feel this nonetheless.
But I'm not gonna care.
Do it.
Okay. In three.
One... two...
I think we overshot on those meds.
Do we have any left?
You didn't say three!
All right.
I came in and found her like this.
She's delirious, maybe septic, and she's in pain.
Donna?
Could be a perforation.
What do you want to do? Up the morphine?
Let's give her two milligrams and get her up to CT.
She's DNR.
DNR doesn't mean "do not treat."
A scan could show if there's something we could do to buy her some time.
What happened?
Donna was in pain and altered.
She almost fell off the bed when I touched her belly.
Looks like a strangulated hernia.
Which we could fix in surgery.
Did Donna say she wanted surgery?
I mean, she's in and out of consciousness.
She can't make decisions for herself. But I do know...
she wants to stay alive for Bob.
Who's Bob?
Remember the visitor Donna was talking about?
Well, after you left,
she told me his name was Bob.
He was the love of her life.
She hasn't seen him in decades,
and he's finally on his way.
Okay, but we have her wishes in writing.
Her advanced directives says
she wants no major interventions.
And I get that, but you didn't hear what I heard.
And if she doesn't have this surgery,
she might not make it through the night.
Surgery could have complications.
She could end up stuck in the hospital tethered to machines.
Donna's health care proxy needs to be making these decisions.
- Have you reached her? - I've tried.
Several times. The phones must be down from the storm.
So, if there's no proxy, I have to decide.
She goes back to her room on pain meds.
And I think we should try to fix this,
so we disagree.
I'm her doctor. This is my decision.
You're pulling rank?
I'm saying the burden is on me.
And Donna explicitly decided to be DNR.
- I have to uphold that. - And I believe we should
uphold the wishes that she made clear to me.
I hear you.
And as painful as this is for both of us,
I believe that we have to uphold the written directive.
She's going back to her room.
Flawless procedure, Dr. O.
Well done.
Body temp is up to 80 degrees.
Still no heart rhythm.
How long do we wait?
I'll let you know... once I've figure that out.
I heard Eva's quite the little boss.
I really like that kid.
Wh... Seriously, Dr. Okafor?
I really like kids.
Especially that one.
His temperature is up to 83.
84...
We have a rhythm.
Eva was right.
Her father is not dead.
All right.
This is Atlanta.
It's not Chicago.
Let's go, baby.
Go!
Ah. I'm doing it!
Dad, Dad, I'm doing it!
You know,
he couldn't ride that bike until Dad put the cape on him.
Dad proved you're a superhero, didn't he?
I did it. Yeah!
Come on. Doctors...
they can be superheroes, too.
Doctor Strange, he's a neurosurgeon.
The Hulk... is a doctor.
Yeah, I like the Hulk.
I always did. I...
When I was your age...
I wanted to be the Hulk.
- Really? - Yeah.
- Yeah? - Dr. Bell, do you have a second?
Okay.
You have a fever.
You may have an infection.
- From what? - The dialysis line
can be an entry point for bacteria.
It's a common complication.
All right, let's have a look.
Yeah.
There is a little erythema there.
We'll get a set of blood cultures
before we start you on antibiotics.
I didn't ask Dr. Shaw to treat me.
He's a good doctor.
Maybe.
I prefer you.
So does Nic.
I know that.
So how are you doing? Really?
I'm just tired.
This is all like a bad dream.
It'll be over, and...
I'm gonna stay sober this time.
My dad's back.
My family's together again.
We can start over.
And my kidneys will get better... right?
Well...
there's no reason not to be optimistic.
Whatever's ahead...
we'll deal with it.
Okay.
Get some rest.
Nolan said that he can do it laproscopically,
but because Donna can't make decisions for herself,
we just need a second physician to sign off...
Surgery is not gonna cure her colon cancer.
She's got a DNR, and she's going to hospice.
And normally I would agree, 100%,
but, based off a conversation that I had with Donna,
I really believe she wants to make it through the night.
Why?
She's waiting on a very important visitor
who's just been held up by the storm.
Look, I have been with Donna through years of chemo.
I know her, and I really think
that she would want to go through
with this surgery if she could.
Is she insured?
Are you asking if the surgery's covered?
Yeah. Sorry, that's my job.
CEO, fiscal responsibility.
Medicare and supplementals, so yes, fully covered.
I'll sign off.
You know, better yet, this is gonna be simple.
It's gonna be in and out in under an hour.
I'll do the surgery myself.
Okay.
We're going somewhere.
What in the name of God is going on?
They're playing med student bowling, Dr. Bell.
You're not kindergarteners. How many children are there in this hospital?
Give them some scut to do.
Kit.
- Hi. - Just who I'm looking for.
I have a surgery. Are you free now
- to take care of these kids? - Sure.
- No. No. - I... you know, I'm...
I'm gonna tell you a secret.
Dr. Voss has superpowers
even stronger than mine.
I do.
I...
break bones and put them back together.
So, if you go with her
for a little while, she can show you.
Come on, kids, let's go.
Okay. Thank you.
Let's get something to eat, shall we?
You must be starving.
It's been a long day.
I'm just putting it back.
He looks like my dad.
You said you wanted to do this.
We have to confirm that he's dead.
Start the death exam, please.
He's warm. I thought he'd be cold.
He looks kind of alive. This is freaking me out.
What happened to this guy?
Cardiac amyloidosis.
Restrictive cardiomyopathy. Heart failure.
Impressive you know that.
I want to be a cardiologist.
My grandpa died young of a heart attack.
My dad had a heart attack last year, but...
he's okay now.
Whoa, whoa, whoa. You all right?
Okay. Sit.
Head between your knees.
Been an idiot.
Can't declare a guy dead.
Can you do it?
I can.
But you'll have to watch so you can learn, okay?
No heart sounds.
Pupils are fixed and dilated.
Go on.
Time of death:
2:41 a.m.
We're sending you a 42-year-old man,
presented in full arrest, now rewarmed
with normal sinus rhythm and stable blood pressure.
So we're done here?
Uh, since his temp is back to normal...
My feet are killing me.
And triceps are hurting from doing all those compressions.
Don't be a whiner.
Let's get him ready for transport.
His pressure's dropping.
- I'll do a quick exam. - I'm gonna give him
a liter wide open and start him on pressors.
His heart sounds muffled.
And distended neck veins.
Bai, pass me an echo probe.
Where's the Raptor?
Is he here yet?
- How's it going? - Not gonna be so simple.
There are a lot of adhesions from prior surgeries.
Gonna take a while to work through them.
Oh, wait. That's dead bowel.
I'm gonna have to do a bowel resection.
There's no way I can do this laparoscopically.
Look, if this could end with her unable to control
the end of her life, then you need to stop now.
You asked me to bring her here.
Now I'm gonna do everything I can
to make sure she gets off this table alive.
I'm not gonna have her die in my OR.
Convert to open. 10 blade.
Raptor isn't here.
I can't even get him on the phone.
Cell service is down.
So, what do we do?
I am making a pericardial window
to drain the blood from around the heart.
The sledding accident must have caused some traumatic injury.
Which started to bleed as we rewarmed him on bypass.
The pericardium is completely filled with blood.
15 blade.
Draining the pericardium.
He's bleeding too much. I need to open up his chest to control it.
Sternal saw.
What's going on?
Shouldn't we wait for Dr. Austin?
This man could die if we don't proceed.
Give me the saw!
Activate massive transfusion protocol.
Take it easy, man. Thank you.
No injuries to the atria or ventricles.
We're losing him.
I can't find the source of bleed.
Okay. Tear in the proximal P.A. Clamp.
Suture.
The Raptor has arrived! Where are we?
Bit late. We've already started closing.
He was in cardiac tamponade.
Mina had to perform a pericardial window.
Then she had to open him up
and repair a potentially fatal bleed.
It was awesome.
So...
you're telling me that you didn't need me?
Sorry.
I love that.
I... I love that.
See? I told you.
Yes.
Fist bump to Okafor.
You got Bell to take Donna to the OR?
I asked Nolan. Bell took over.
It was supposed to be a simple procedure
to help with her pain and get her back to hospice.
- She didn't even want a blood draw! - She was in pain, and it was fixable.
I made the call.
She's about to go into cardiac arrest.
- Are we coding her? - Yes, we are.
No. No, she's DNR. You got to let her go.
This isn't what she asked for.
- She's in cardiac arrest. - Damn it!
A death in his OR will go on Bell's stats.
He'll do anything to avoid that.
Get the defibrillator.
Dr. Bell, stop.
You have to stop.
Abductor pollicis,
flexor pollicis brevis...
Big exam?
Um, these hand muscles are impossible to remember.
"All for one and one for all."
It's a mnemonic.
It helps.
Are you all right?
I always thought of myself as a... a hero.
Saving lives.
I didn't even think about death.
Death is terrifying.
You're gonna see a lot of it.
Our job is to hold it off as long as possible
while never losing sight of the fact that it is a natural part of life.
His temperature's 105.
- He's tachycardic and hypertensive. - End tidal CO2 is high.
The urine in his Foley, it's the color of cola.
Hey, what's going on?
His fever shot up.
His heart rate is sky high.
His limbs are rigid.
Sounds like a drug reaction.
- What have we given him? - I'm checking right now.
Epinephrine, heparin, succinylcholine...
Stop. That's it. He was given succs in the ER.
His temp was so low it probably caused
- his metabolism to dramatically slow. - So, once he warmed up in the OR,
he started to metabolize the drug,
causing this rare reaction.
Malignant hyperthermia.
He's literally gone from dying by being too cold
- to dying by being too hot. - Well, let's treat him with dantrolene.
That helps, but the problem is, we need to get his temperature down quick.
More snow.
Looks like you did come to the rescue.
Got it?
His temperature is 105.
Hurry it up, people.
Pack the snow all around his body.
Hey, how can we help?
Hey, more troops.
We're building a snow angel. Why don't you pitch in.
Let's hope this works.
- You guys good? - Yeah.
Her blood cultures came back. Her catheter was infected.
Conrad was right.
I need a new one placed, but for now, I'll finish
the course of antibiotics you started.
That'll take care of it.
Well, thanks for checking in.
Okay, are you gonna say it,
- or are you gonna make me say it? - Say what?
Nic, the man with the hair and the eyes...
he wants you.
Maybe you should worry about your kidneys.
I am, but my kidneys are so boring compared to your love life.
Come on, tell me.
Spill. What's going on?
Look, I... I need Alec.
The clinic needs Alec. The patients need Alec.
You're using him.
I'm being pragmatic.
Totally. I'm impressed.
Hey, if you're into the hair and the eyes,
I can totally send him your direction.
Oh, yeah. Nothing turns a guy on
like getting to second base with a girl's catheter.
She's off the vent.
Off pressors. Breathing on her own.
Vitals are stable.
Donna.
Hey.
- I am so happy you're awake. - Ah.
Look who's doing great.
What happened?
You had a strangulated hernia, and surgery
was the only way to keep you from dying in the hospital.
We took a chance.
Been so worried we did the wrong thing.
Well, you kind of did.
It might have been easier if I just never woke up.
But I know you were only trying to do
what you thought was right for me.
I do respect that.
Besides, now I get to go to hospice,
see Bob again.
You just saying that to make me feel better?
Mm, maybe.
Well... maybe not.
Ah, sun's rising, the storm's over, so...
we can get you to hospice now.
Not yet.
Donna has a visitor.
How is he?
Still unconscious, but his vitals are stable.
If he wakes up, he could have brain damage.
Look, you guys did all you could.
But did we do too much?
We had to try... for him and his children.
Mr. Garcia?
I am Dr. Okafor. You're at Chastain Memorial Hospital.
You were in an accident, but you're all right.
Don't worry, we'll remove the breathing tube. Okay?
Eva and Eli are fine. They can't wait to see you.
Good morning.
Morning.
How's my dad?
How about we go see him?
Thank you.
All right, come on. Let's go.
Here we are.
Daddy!
It's okay now.
We're okay.
Thank you.
For taking good care of them.
You bet.
Daddy...
You never had kids, right?
No. Not to my knowledge.
I got to wash up. Why are kids always so sticky?
It's mostly snot, and a bit of saliva.
- Some sugar. - It-it was a rhetorical question.
Robert Tuttle?
Call me Bob.
And what's your name, pretty lady?
Uh, Nurse Practitioner Nevin.
Donna's very eager to see you.
Apparently, it's been a long time.
30 years.
I almost leaped out of my pants when she reached out.
Donna was my first real love.
She was...
- She was quite a beauty. - Mm.
I, uh... I guess we're both in for a bit of a shock.
But I'm prepared for anything.
- I'm a romantic at heart. - Mm.
I, uh, can't believe we have the chance
to say a decent good-bye.
Would you look at that.
She's playing our song.
? I took my love, took it down... ?
You look great, honey.
Oh, you're still a liar.
I look like death, which is appropriate.
Same old Donna.
Oh... when we first met, I was so happy.
Then you left me.
Destroyed me.
You broke my heart, and... you caused me so much pain.
For 30 years, I've needed to say something to you, Bob.
Something I should have said long before.
? Can I handle the seasons of my life? ?
Go to hell.
? Well, I've been afraid of changing 'cause I've... ?
That's what she wanted to say?
Yep.
Glad she got to say it.
Do you still think I was wrong?
Ah, seems to me we were both wrong.
Well, we got through it.
You're right.
I don't want us to regret the things we haven't said.
Me, either.
There's still a lot we need to talk about.
After a fight, it's easier to let it go.
- Yeah. - Not talk about it.
The same issues keep coming up over and over again.
It's been a long night.
Yes.
So, not now.
Tomorrow? My place?
I'll swing by before work.
Perfect.
I love you.
I love you, too.
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