Previously on The Resident...
Dr. Voss, the CEO job is yours if you want it.
You're damn right I do.
No one has the skill set for a double hand replacement.
I might have someone.
Dr. Jake Wong,
my former stepson.
Chastain wants you here permanently.
What do you say?
I'll be looking forward
to working with you again, Dr. Voss.
My O-1 visa is expiring,
and so I applied way in advance.
Yesterday, I found out it was denied.
Cain may be down, but he's definitely not out.
Can't stay here. Where is he being taken?
There's only one option.
Hey, you're up.
Shh.
You hear that?
I don't hear anything.
Exactly.
Silence.
Once our baby comes, you can kiss that goodbye.
I think we can handle whatever she throws at us.
Yeah, sure. But you know...
feedings, crying, diapers...
- that's just the beginning. - I did two rotations in Peds.
Oh, did you have to deal with nightmares?
"Oh, Mom, Dad, can I come sleep in the bed with you?"
Then, suddenly, she's a teenager and she's out
with her friends till 1:00 in the morning
and you can't sleep because your heart's pounding so hard.
I didn't think about that.
All I'm saying is let's just
enjoy the peace while it lasts.
Technically, you are a recovering patient.
Maybe I should stay home with you today.
Mm...
Go.
Mwah.
- Hello? - Hawkins.
Man, I'm glad you picked up.
Hey, Captain, we still on for drinks on Friday?
Well, that depends.
You still work with Search and Rescue, right?
Yeah. What's wrong?
Decided to do some free-climbing.
Let's just say it didn't go my way.
Okay, what are we looking at in terms of injuries?
Remember the shrapnel injury that Rodriguez took
during the live...
live fire exercise?
- That bad? - It's worse.
I figured that you could, uh, get SAR moving
'cause you know 'em personally.
Well, I called Search and Rescue.
They're trying to track his cell signal before his battery dies.
Helped him stem the bleeding,
but it sounds like he's gonna need an OR.
- And who is this guy? - This is Captain Hill,
my commanding officer in Afghanistan.
Of all of the stories you've ever told me,
you never mentioned a Hill.
I know. I haven't spoken to him in years.
A few weeks ago, he calls me, says he wants to talk.
What aren't you telling me?
I promise I'll tell you more later.
Just trust me, please?
Okay.
I love you.
He's in respiratory distress!
All right, this may be uncomfortable.
Let me breathe!
He's-he's breathing.
- Synced and corrected by Firefly - - www.addic7ed.com -
Hill's cell signal puts him within 100 meters
from this point here.
It's hilly terrain, so we split up,
each cover a different sector.
Get Hill out before the storm hits.
Next few hours are critical.
Hey. Here you go.
Four shots, extra dry cap.
No sweetener.
Not the reaction I was expecting.
Because you're still thinking about your immigration status.
My lawyer hasn't called yet.
She will. All right? Just... just be patient.
Patience is for kindergarten teachers.
They already denied my visa renewal,
so this self-petition is my last shot.
You know, if only there were a...
a once-in-a-lifetime surgery happening today
to take your mind off things.
Maybe something like, I don't know...
a quadruple heart valve replacement?
- Mm. - One only done by 20 surgeons
in the entire world and now us.
I have been dreaming of those 40 sutures for weeks.
Oh, I know.
Last night you muttered the valves in your sleep:
aortic, pulmonary, tricuspid...
I did not.
- Did I? - Hmm.
Ms. Williams, I'm Dr. Pravesh.
I see that you're experiencing
- some hip pain from sickle cell. - Like I told your nurse,
I need Dilaudid. Two milligrams IV.
It's the only thing that helps.
I see that you've been to five different ERs
in the past few months.
IV opiates each time.
I'm not drug seeking.
Do you know what a sickle cell crisis is, Doctor?
Your red blood cells become misshapen,
like a sickle, not a sphere,
and it blocks blood flow to your organs and bones.
Yes, you know the science.
But do you know how it feels?
Sharp, stabbing pain in my back,
my shoulders, even my cheekbones.
And when they come on, they're more excruciating
than you can understand.
Ms. Williams, that is not why I'm not...
I don't want to be here.
And if you're not going to help me, then...
maybe I should leave. Ah...
Did that little movement hurt you?
Tell me more about your pain.
My hip feels like it's on fire,
even when I'm still.
It's not like my usual crisis pain.
And when I move...
it tears through me,
like shards of glass in my veins.
Here.
Stop. Stop, stop, stop.
Okay. Tell you what.
I will give you what you need...
if you let me take an X-ray of that hip.
And figure out what's going on.
Deal?
Captain Hill!
Found him.
We're a hundred meters northwest of Many Point Creek.
Roger that.
Hang in there, Captain.
Let's have a look, shall we?
Ah, deep gash through the abdomen.
Looks like it's gone through the peritoneum.
How far out are you?
Ten mikes.
That's not soon enough, is it?
You're bleeding internally,
into your abdomen and likely into your chest.
I'm gonna die out here.
Well, not on my watch, Cap.
We need to buy you some more time.
No idea what you're making there,
but am I correct in guessing
- that it's really gonna hurt? - Yeah, afraid so.
This is an old trick I learned back in training.
- You can handle it. - Yeah.
I'll make a slight incision.
All right. You ready?
Do your worst.
Here we go. One, two, three.
That's better.
Hey, everything all right?
Found him. We're going to airlift back to Chastain.
Okay, I'll meet you there.
Page Austin for me.
I want him to meet us in the ER.
Keep pushing. As hard as you can.
Well, Barrett,
you're doing quite well for someone
who just came off the vent this morning.
What about the damage in surgery?
The medial cord was completely severed.
Partial laceration of the lateral.
Both primarily repaired.
I'm sorry,
but the chances of you regaining full function of your hand
are 50% at best.
Will I ever operate again?
I expect your strength and mobility to return,
but it will take weeks, maybe months of PT
before you can even think about operating again.
It will be painful and strenuous.
I can deal with the pain.
More than pain tolerance,
what this process requires is patience.
We're done here.
I should get back to Chastain.
Tell the new CEO I want to talk to him.
You just did.
So, I overheard some nurses saying
you stole the show at Waylan's last night.
It was an ambush.
They didn't tell me it was karaoke night
and I ended up singing "I Want It That Way"
with half of Radiology.
Well, I'm glad to see you're making friends.
Thank you, but it's not like I'm 12 years old,
starting a new school.
Well... this seems like the perfect day
for a ten-hour valve replacement.
Ready for bypass.
So every time you have a crisis, the sickled blood cells
block blood flow to the hip bone right here.
Over time, that bone starts to die.
We call it avascular necrosis. It's why you're in so much pain.
Okay, so we treat the pain,
get me back on my feet, I go back to PT.
Well, I'm afraid pain management and PT aren't gonna cut it,
and that's why I brought in Dr. Voss to see you.
I'm sorry, Rose,
but you're gonna need a hip replacement.
Sorry, I have to get this.
Let me know what you decide.
I'm not doing the surgery. The risks are too high.
I know it's scary, but a hip replacement
- is your best option, Rose. - Doctors never get it.
You're the ones with the medical degrees,
but I have to school you on my disease.
It's exhausting.
I know from personal experience
that many patients of color aren't heard.
Chastain is different. I'm different.
Help me understand.
Surgery for sickle cell patients is even riskier.
You could fix my hip but leave me with other issues.
Tell me I won't have an anemia crisis
or a cardiac crisis or worse.
I can't imagine the pain you've endured,
and I understand why you are reluctant to think
more time in a hospital would help you. I get it.
It's more than just that.
It's about how I want to live my life.
I'm a dancer.
Was a dancer.
When the pain got to be so bad that I had to stop,
I put all of my savings into a studio.
Now I teach dance to high-risk kids.
Tonight they have a recital to showcase all their hard work.
Those girls, they're my life.
And I want to be there tonight.
I'd rather limp and be alive than die sooner
because of a surgery.
Your hip is about shot.
I want to do it today
because it's best that we take advantage
of this window while you're relatively well.
Because during a sickle cell crisis,
there would be such a high possibility
of a fatal blood vessel blockage
that a surgery would be even more dangerous.
So, Rose, let me help you.
We will do everything we can to keep you safe.
That's a promise.
All right, first suture's in place.
Threading through the suture ring.
Slight drop in pressure.
- Blood volume decreasing. - Keep transfusing.
Some blood loss is not atypical.
The call was for Dr. Austin.
Incoming abdominal trauma with hemothorax.
Dr. Hawkins is requesting you personally.
Conrad seldom does this.
Whoever the patient is must be special.
Which is why I have to go.
But we're fine here. I'll step out for a minute,
take care of this trauma and be back the moment I'm done.
Anything goes wrong, they'll blame the attending.
Mina, you got this.
38-year-old male with penetrating injuries
to the chest and abdomen.
Initially hypotensive.
O2 sat falling despite chest tube placed in the field.
It's been a long time since I felt pain like that.
You're talking, so airway's intact.
We need to get two units of O-neg running.
We need a portable chest X-ray ASAP!
On my count. One, two, three.
- Hemothorax? - Drained about 750cc's in the left chest.
It was likely a rupture to his diaphragm.
- Oh... - That's more blood than we'd like.
I need to get him to the OR.
His vitals are stable. Stop by CT first?
Yeah. We'll get X-ray then we'll pack him.
- I'll let OR know we're coming. - Thank you.
- Hey. You made it. - Hey.
What's going on?
Uh, he's stable at the moment.
I'm just waiting on the chest X-ray.
Okay.
I want to see the tube placement.
- This can't be right. - Apart from the chest tube
and a few broken ribs, looks clear to me.
Hey. Talk to me. What's wrong?
Nate's chest, it shouldn't be clear.
- Why? - There should be a bullet
next to his spine and...
there isn't.
Okay, so, the bullet that you're talking about,
you think it migrated to another place in his body?
Yeah, and I need to help them find it
'cause Nate got shot saving my life.
Nate and I were approaching a target
in the Sangin Valley.
We got ambushed.
Take cover!
They got us surrounded!
Nate ordered us to pull back.
Flank up!
But...
I thought one of our Marines who got shot up
on the road ahead was still alive, so...
Hawkins, stay put! That's an order!
Fall back! Fall back!
I made my way up the road,
I get there, and he's dead.
I start to head back, to regroup with my company.
But I get blindsided by an RPG.
I had a dislocated shoulder, broken knee,
shrapnel in my neck.
Figured this was it.
And then Nate showed up.
Saved my life.
That's when he, that's when he caught three in his chest.
But he kept going, made sure we both got to cover.
Doctors got two of the bullets out,
but the third was lodged near his spine
and it was too dangerous to remove.
It wasn't giving him any trouble, so they left it there.
And now it's gone.
I can't believe you kept this to yourself all these years.
It wasn't my proudest moment.
I disobeyed an order and it nearly cost my commander
and friend his life.
I was...
ashamed.
You were just doing your job,
and so was Nate when he came back for you.
When I was a kid,
my mom used to make me practice needlepoint.
And I would get so annoyed and I would tell her
that nobody uses that skill in the real world.
I'm gonna call her tonight
and I'm gonna beg for her forgiveness.
Well, this is needlepoint times a thousand.
If all 40 sutures aren't perfectly placed,
the valve won't fit
or the heart muscle will rip, and we start over.
Okay.
Ah. Perfect fit.
Now, by the time I'm ready to insert the next valve,
Austin should be here.
Actually, he won't.
That was Dr. Austin on the phone.
He took care of Dr. Hawkins' patient,
but an aortic rupture just came in.
He wants me to keep going.
- Alone. - He says to tell you
that you know this heart just as well,
if not better than him.
You got this.
Then we keep going.
Okay.
Suction.
- What's going on? - Get me a liter of normal saline.
Dr. Voss?
She's tachycardic, hypotensive and hypoxic.
Could she be bleeding?
She was earlier, but it was minimal
and I gave her a unit of blood.
Let's get her on 100% FIO2 and start norepinephrine.
Come on, Rose. Come on, come on, come on.
- Good, good. She's settling out. - Hopefully long enough
for me to finish and for you to figure out what's going on.
Hey.
Your former CO pulled through.
No complications.
And the bullet I told you about?
It wasn't in the surgical field.
- So, when is the head and neck CT? - To be determined.
There were no symptoms indicating that the bullet
- is migrating in Nate's body. - But there is one.
I specifically remember hearing the doctors say
there was a bullet they couldn't remove.
Well, did Nate tell you the bullet's still there?
No. I haven't spoken to him in, like, ten years.
I can't justify a CT on a postop patient
just to look for a bullet that might not be there.
Since when does my word not carry weight with you?
Your word always carries weight, Hawkins.
But the event in question was a decade ago
and the patient is personal.
My emotions are in check
- and my memory's just fine. - Hey.
- Austin's just doing his job. - No.
He's ignoring important information
that could save his patient's life.
Nate is unconscious, it's my call.
We will wait for the medical records
to confirm what you're saying.
If he codes while you're dotting your I's
and crossing your t's...
Look, Nate was badly injured saving Conrad.
- He's carrying a lot of guilt right now. - I get it.
He gets a pass.
Thanks.
I know what you're gonna say.
Really? Try me.
That guilt can play with our mind,
but that's not what's going on here.
Then why don't you tell me what is going on?
I was there when the doctors told Nate
they couldn't remove the last bullet.
I heard them tell a fifth-generation Marine
that his military career was over.
He had to retire because of me.
All right. I'll see you at home.
- Okay. Bye. - Okay?
Hi.
This, uh, this might... may seem a little strange. Um...
I'm Randolph Bell.
Yeah... I-I know who you are.
- Yeah. - You must be Jake's husband.
- Gregg, yes. - Yeah.
I just wanted to introduce myself, and, um,
you know, if you or Jake need anything, I'm-I'm here, so...
You want advice on how to open the door
so you can find a way back into Jake's life.
Yeah, I... You know, I certainly wouldn't turn it down.
But I have to stay out of it. This is between you and Jake.
Okay, yeah. No, I understand.
It was nice to meet you.
For what it's worth, I'm rooting for you.
How's my new hip?
Ceramic on polyethylene perfection.
I traded hip pain for something else, didn't I?
Your body had a dangerous reaction
to the blood that you received during surgery.
Because of all the transfusions I've had throughout my life?
You've developed antibodies that our labs can't easily test for.
When we gave you blood in the OR,
your body attacked it
and started to break down your own blood.
You're severely anemic.
We don't have compatible blood to give you.
We're working with the Red Cross.
We'll find blood your body will accept.
And until then?
Your heart is working very hard to keep up.
We're giving you supplemental oxygen.
And if the extra oxygen isn't enough,
my organs will fail and I'll die, right?
Please leave.
Glad you're feeling better,
but your career is still in jeopardy.
As your lawyer, I have to reiterate that
even if you manage to recover physically,
you falsified a patient's file.
That's a criminal offense.
You could lose everything.
Because someone at Chastain told Mullins I lied to him
to get him to the OR, putting him at risk for COVID.
Exactly. And now that whistleblower's gonna testify
against you at trial.
Find out who they are.
I want to know everything about them.
Hey. Just to be clear, blindsiding my husband?
Totally out of line.
Well, that... look, that was, that was never my intention.
- I just wanted him to feel welcome. - Oh, my God.
Do you remember when you said if I came to Chastain,
it'd be up to me if we had a relationship?
You told me you'd follow my lead.
- You said that. - Y-Yeah.
Of course. I ju... I'm...
Look, I'm here if you need me.
Oh, please. This isn't about me, it's about you.
It's always about you.
I guess I was hoping we could turn the page.
The last thing I want to do is drive you away.
But I... y-yeah.
I overstepped, and I'm sorry.
Okay, um...
I have a family.
And you are not in it.
Yeah, okay.
- That's your contract. - I know.
- It's unsigned. - I know that, too.
- Well, do you need a pen? - No, I need a do-over.
It was a mistake to take this job.
I can't work under the same roof as Bell.
Can I ask why?
He's trying to erase the past
and I won't let him, and now he's basically stalking me.
You may not know this,
but Randolph used to have my job.
How did he lose it?
Did his boss figure out what a colossal jerk he is?
Quite the opposite.
They asked him to turn on a fellow doctor.
He refused and resigned on his own.
Randolph stood up for a good man
because he is also a good man.
And now I'm standing up for him.
I don't know what happened between you
but I do know people can change.
Maybe you should give him a second chance.
Who knows, it could be the right thing for both of you.
At least share your reservations with him.
He might surprise you.
Great. Thank you.
The Red Cross has a blood match for Rose.
They're gonna put a rush on it.
You know that's good news, right?
It wouldn't be necessary
if I hadn't pushed her to do the surgery.
No. Hey, Pravesh, this isn't your fault.
She didn't want the surgery.
Okay? She knew there would be an unexpected complication
and now it's happening.
Dude, if she doesn't make it...
It's Rose. She's unstable.
I'll run the blood up when it arrives. Hey.
You listened to her and took her seriously.
Another doctor might not have.
Whatever happens, you did right by Rose.
Unstable tachycardia.
I need an amio 150 and a code cart.
- I don't feel right. - Your heart is working overtime
to bring blood to your body, and it's working too fast.
Hang on, Rose.
Your blood just got to Chastain. It's on the way up.
My chest. Help me.
Hold on, hold on.
I need to cardiovert.
120 joules.
Rose, this is gonna hurt.
Clear.
I'm so sorry, Rose.
Your heart rate's rising.
- I might need to shock again. - No. No, not again.
- Please. - There may not be enough time.
Here it is.
Lifesaver. I'll hang it.
It's the closest match they could find,
but, Devon, it isn't perfect.
- She could hemolyze this, too? - Mm-hmm.
I'll take the risk.
Hey.
Hey, Captain.
Surgery went well.
Though hold off on hiking for a while?
Yeah, I can do that.
I have to ask you, that bullet in your chest,
did they ever get it out?
No. They never did.
I'm gonna call Dr. Austin. I'll be right back.
Nic, can you fill him in?
We think the bullet may have migrated
to another part of your body.
- Well, that doesn't sound great. - Don't worry.
We're all over your case and we'll find it.
Look, I know what you did for Conrad.
It's a debt he'll never be able to repay,
but I know he's trying.
You know, I have some regrets...
... about the way I've treated Conrad.
He's reached out to me, uh, over the years, but, uh,
I've just been like a blockade, you know?
Feel... feel real bad about it.
But I think I'm...
I think I'm ready to clear the air now.
Sorry, could...
could you turn up the lights?
It's a little dark...
- Nate, are you feeling okay? - Uh...
- Little light-headed. - Hey, can you squeeze
- my hand? - My face...
I can't feel the side of my face.
I got to call you right back, okay?
He's showing signs of a stroke.
We need to get him to CT.
All right.
I don't see any foreign bodies in his neck or brain.
- Just dental cavities. - Yeah, but-but you see that?
The streak artifact from Nate's dental work
is distorting the images.
Look outside the distorted area.
You can barely see it.
There's a sharp outline of something.
It could be the bullet.
Could be.
It's at the carotid bifurcation; explains the mini-stroke.
If it shifts position even just a few millimeters,
it could travel up to his brain.
Blocking the blood supply, giving him a massive stroke.
Austin needs to get it out as soon as possible.
Ooh. Yes.
Blood volume in the circuit is dropping again fast.
There's no blood loss in the field.
And there's no blood on the floor.
He must be bleeding somewhere we can't see.
- Why is he waking up? - He's been dosed appropriately.
I don't know why he's not responding to the meds.
Blood volume approaching critical levels.
Brain perfusion is at risk.
And what are we looking for, Dr. Okafor?
- You fixed it. - We fixed it.
The blood must be emptying into the lung cavity.
Need to make an incision
into the left pleura.
The vena cava has been punctured by the central line.
Not only has he been bleeding out into the pleural cavity,
but all of the anesthesia medication
has been lost there, too.
Okay, on my mark, slowly
pull back your central line catheter.
I need a Prolene suture.
Pull back your central line now.
And stop.
Okay. Push meds now.
Volumes are stable.
How are you feeling?
Well, for a guy who just got a bullet taken out of his neck,
not half bad.
All right, I'll let you rest. Let's catch up tomorrow.
No.
You should sit.
I need this to sink in, okay?
I'm good.
I asked Dr. Austin to save it for me.
This thing has been my...
constant companion.
But I realized I wasn't the only one carrying it around
for all these years.
That's why I called you.
What happened...
the choice that I made...
... is what we do for each other.
You made the exact same choice.
So...
do me a favor.
Throw this away.
'Cause when you toss it,
I want you to toss away the guilt,
and the shame
and anything else that you've been holding onto.
Hey, you have got some friends in high places.
The CEO put in a good word for you.
Okay.
And you deserve an explanation.
The reason that I can't give you a second chance
is because my husband and I are...
adopting.
Wow. Well...
- that's, that's great. - Yeah.
I'm gonna be a parent, one that will never bail
- the way that you did. - Jake, I...
It...
It's fine.
I'm a grown man.
But the last thing I'm gonna let happen
is for you to become some beloved grandpa,
only to pull the same vanishing act on my kid.
Well, I get that.
I really do.
But I'm not going anywhere.
Thank you, Miguel. I'm so glad you came.
Let's talk again next week.
- What's this? - This is what happens
when you listen to the people.
They're ideas from our staff
on how to turn this place around.
For example, we'll be starting
an insulin-by-mail service
to decrease wait times at the pharmacy.
I'll be assembling a task force to address
post-surgical admission times,
which are far longer than average.
And most importantly, tri-tip sandwich day
will be more often than once a month.
Well, sounds like you had a great day.
And do I get the feeling I'm not the only one?
I-I scored a coffee date with my former stepson.
Here, tomorrow. And I...
I hear that you might've had something to do with it.
I may have.
Well... thank you.
You don't have to thank me,
but you do have to buy me a drink.
- Oh. - I'll make it a double.
Where did you get this blood from, the fountain of youth?
I haven't felt this good in a year.
Yeah, that's what I like to hear.
So... where are we going?
Well, Rose, like I told you,
it's a surprise.
Mm, I hate surprises.
Wasn't that in my patient file?
Well, I think you're gonna like this one, though.
'Cause I looked you up online,
- I made some phone calls. - Oh.
And...
bam.
No, you didn't.
You couldn't make the recital,
so we brought the recital to you.
You don't know how much this means to me.
Thank you.
Ah...
Basking in your own surgical glory.
A little bit.
I don't think you need to fear being deported
before becoming a world-class surgeon.
Because today you have proven that you already are one.
Not only does today mark
your accession to the upper echelon of surgeons,
but it also marks my last day as your mentor.
You really think so?
Yeah, you don't need a copilot.
You are more than capable of flying solo.
So...
tonight I am preparing
a very special dinner,
among other things.
Hmm.
Does this meal include...
- a chocolate soufflé? - Mmm.
How'd you guess?
Indeed it does.
Okay, okay, okay.
And the other things?
Ooh, well...
those you will just have to wait
and see.
Mm...
How was your talk with Nate?
It was good.
It was really good.
I'm glad I got to meet him.
Me, too.
You know, as parents,
we're gonna need to lean on each other
in all kinds of different ways.
I do.
I wish I would've told you
about what happened with Nate sooner. I just...
I couldn't and I'm sorry.
It's okay.
I get it.
- You coming up? - Yeah, I'll be right there.
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