- Previously on The Resident... - My entire life, I've wanted
to be a surgeon, despite knowing
- I have one big obstacle to overcome. - You're dyslexic.
Tina's baby will go to a traditional family.
I'm so sorry.
I don't know what's going on with you,
but I'm gonna go to Waylon's.
Big world outside of the OR.
If you want to see it, that's where I'll be.
I'd like that.
Your mother has lung cancer.
You cannot come to Nigeria
with me.
- You are my sister. - And you are mine.
I wish things didn't have to be this way.
I wish I didn't have to leave Chastain.
The National Weather Service has issued a tornado watch
for Fulton County...
I think Fritz got a little wet,
but otherwise we are all okay.
Good. Here.
Thank you.
Hi, buddy.
- Hey, buddy. - Hey, little wet? That's okay.
Look at you getting all wet.
Hey... how about you don't go into work today?
Fritz needs you.
Well, the tornado's not supposed to touch down
anywhere near us.
Anyway, we're just as safe at Chastain as we are here.
Yeah, I was just thinking,
with all of your extra shifts, it's been a while since
I've seen you stand still.
Got to keep busy, otherwise all I think about
are all of the ways in which we could have kept Mina here.
We did everything we could.
Doesn't feel like it.
What's that?
It's from Mina.
She told me to give it to you if you started...
- Spinning out? - No. Yeah.
Very funny.
"Dear Nic...
"Please stop doing that thing you do when you feel guilty
"where you can't sit still.
Hmm.
"I know you need permission to let things go, so here,
"unclench your fist, let it go.
Last thing I want is to be an anchor around your neck. Mina."
She knows you almost as well as I do.
We better get going.
Bye, guys.
How's ur mom?
Okay. Waiting on a treatment plan.
Big tornado coming
Be careful .
The tornado has changed course
and is now just outside metro Atlanta.
We're expecting a mass increase of catastrophic injuries.
Pull out the disaster carts.
Prepare the portable monitors.
- Clear the hallways. - Let's move, people!
We have incoming.
Hey, Piper, Wes, let's take her to Bay Four.
Seven-year-old girl, severe abdominal pain,
nausea, vomiting.
Slightly hypertensive. 400cc's normal saline given en route.
We wouldn't have brought her in because of the tornado,
but she collapsed; We didn't know what to do.
Uh, Dr. Bell is our doctor.
- We left him a message. - I can let him know you're here.
- Thank you. - On my count.
One, two, three.
Hey, I'm Dr. Feldman.
I'm gonna listen to your heart and lungs, okay?
- Hi. - Hey.
What's going on, Sammie?
Ni hao, Dr. Bell.
It's her stomach pain. It's never been this bad.
And she's been having constant nosebleeds
these past few days.
Is it the tumors? Do you think they're getting worse?
Maybe, but we'll admit her
and look into why this is happening.
Sammie has a history of abdominal cancer.
The Ackermanns recently adopted her from China.
So let's finish the exam
and I'll get a hold of Dr. Wong for an urgent ENT consult.
Problems with parking?
So far so good.
Please have a seat, Dr. Cain.
Dr. Sutton is your new resident.
No, she isn't. I work alone.
It's my call. You've had residents before.
Yes, and they almost killed me on the table.
Now you want me to mentor someone
who's gunning for my job. No, thank you.
There's a lot I can learn from you.
I'm not looking to take your job.
Either you're lying or you lack ambition. Either way, pass.
I haven't had a good run with attendings either.
They seem hellbent on ending my career.
Is this you selling yourself?
This is me being truthful. It's how I roll.
Make it work. Both of you.
Oh, God.
It's a tornado.
It's coming right at us.
Code Yellow. Please seek immediate shelter.
Sir, we need to go.
What's going on?
Leela, we have to go. We're in the path of a tornado.
I know, I know.
I'm just trying to get him to come down.
Just gotta finish one thing.
Get down!
Everyone move quickly and safely, everyone take cover!
Come on, come on, hurry!
Everyone take cover, take cover!
- Safely and quickly, please. - Come on. Com e on.
- Let's go, let's go, let's go! - Are you sure everyone's okay?
- Here, take these. - Here.
- Here we go. - Take these.
- Get away from the glass. - Get away from the glass!
- Come on, hurry! - Check everyone's okay
- in that direction. Thank you. - Get in the corner.
This way. Go this way.
Thank you.
Get away from the glass!
Hey, hey, hey! Guys, hey!
- Got to get away from there. - Get away from the glass!
Get away from the glass!
sync and correction by solfieri www.addic7ed.com
- You all right? - Yeah.
- Yeah. You okay? - Yeah. Yeah, I'm good.
Hang on, hang on. Okay...
Okay, I'm gonna need you to stay really still, okay?
Cervical spine's exposed.
All right, I'm gonna switch you out.
You're gonna be fine.
All right, I'm gonna need you to stay really still, okay?
Mary Ann,
- can you give us a hand? - I'll take his feet.
Okay.
- Ready? - Yep.
All right.
We should take a look at those.
Later. It's not that bad.
Are you guys okay?
We have an open spinal injury over here.
Let's get this boy to the OR.
I'll call and let them know you're coming.
- Stay really still, okay? - Thank you.
- These guys are gonna take care of you. - Yeah.
- It's like a war zone down here. - Is everyone safe?
How's the rest of the hospital?
Still assessing, but it seems like most of the medicine
and surgery floors were left unharmed.
Let's triage the red critical patients to the PACU.
Yellows to the atrium, greens to the cafeteria.
We're gonna need more hands.
Hey. You okay?
I think so. Are you?
Yeah. We got lucky.
Where's the guy that was working on the lights?
He was right behind us.
- Wait. - Oh, my God.
- Headache... - Okay.
- Can you tell me your name? - Ted.
Okay, Ted, listen to me
and just take it easy, okay?
You have a metal rod lodged in your skull,
so I need to gently elevate your head.
We need to elevate his head.
Okay, right here. Here.
All right. Ready?
One, two...
- Okay. - There we go.
All right, Ted, look at me. Good, good, good.
Deep breath.
Damn. He needs surgery.
We need to get him out of here.
We're gonna get you out of here.
Damn it.
We're trapped.
No one even knows we're here.
Conrad, Nic.
The ambulance bay roof collapsed.
I was out for a beat, but Piper's hurt real bad.
Her leg is trapped under the wall; I couldn't free her.
- Piper, I got help. - This isn't good.
Hey, Wes, we need a tourniquet, an IV kit and some fluids.
All right?
Weak radial pulse.
- Anything else hurt? - Just my leg.
She's going into hemorrhagic shock.
She can't afford to lose any more blood.
- Tourniquet. - You are gonna be fine.
Worst-case scenario, you get some well-deserved time off with pay.
Wes can find the upside to anything.
It's nauseating.
I could use a little time away from you, Pollyanna.
I mean, you guys have been working together for about a decade now.
Tourniquet's on, but it's not stopping the bleed.
We've done everything we can out here. We need to get her inside.
Wes, give me a hand?
Help me get this thing off of her.
Damn it, the cell service is still down.
He's having a seizure.
We need Cain or he's gonna die.
Ugh...
Damn it.
We should reduce the fracture.
That might buy us some more time.
- Wes, you ready? - You are now officially
the most needy patient I've ever had.
Mm. Last thing I wanted to do is die needy.
Not gonna happen, Pipe.
All right, you ready?
Okay
One,
two...
It's better, but she's losing a lot of blood.
Guys, I-I don't feel so good.
We lost the pulse.
Grab the defibrillator.
Starting compressions.
We have to amputate her leg before she bleeds out.
Wes, have someone page Dr. Voss.
We need her now.
Damage could've been much worse.
Guess only one side of the hospital got hit.
Tell me about the patient.
I got a ridiculous consult about a woman with sickle cell
who's here for myeloablative chemo prior to gene therapy.
Rose Williams?
Yeah. How do you know her?
- What happened? - She fell and bonked her head.
I told them maybe don't call unless there's
an actual neurosurgical problem, but...
No. We'll see her.
Dr. Ward, please come to admitting
for a new patient assessment.
Rose.
This is Dr. Sutton, my resident.
Tell us what happened.
Oh, it's so stupid.
I fell in the bathroom and hit my head.
I'm sure I'm fine.
Okay, well, we'll just see.
Full power's back on.
I see you started chemo.
Yeah. They're blasting my marrow
and preparing me for gene therapy.
I knew it'd be tough, but...
... this is really doing a number on me.
Well, if anyone can handle it, it's you.
Pupils are equal, round and reactive.
Can you follow my finger?
I haven't seen you since Waylon's.
Yeah, I'm sorry, I've just been, been really busy.
Listen, given the effects that the chemo
is having on your bone marrow, I want to get you a head CT.
Dr. Sutton can finish the exam.
- Squeeze my fingers, please? - Uh...
So, Sammie's nose just started bleeding on its own?
Yeah, apparently, it's been happening
- like this a lot lately. - Okay, just...
All right, just let me know if this hurts, okay?
Oh, I'm sorry, she might not have understood you.
We've only had her six months, and, uh, she hasn't really
picked up English as quickly as we'd hoped.
It's a big adjustment.
Ni hao. I'm Dr. Wong. What's your name?
Li Xiao An
Where are you from?
Chengdu
Spicy hot pot capital of the world.
I've always wanted to visit.
Um, what happened to her biological parents?
Uh, we-we didn't ask.
Well, they didn't tell us. We...
We were just so thrilled there was a healthy little girl
waiting for us, and...
the first moment we met her,
- we fell in love with her. - She passed out
a couple of days after we got her home.
We took her to the ER and found out
she had tumors everywhere in her body.
They told us to take her home, make her comfortable
- for her last few months. - That's when we found Dr. Bell,
and he said he could treat her.
Well, I-I said
I might be able to perform a very risky surgery
that's only been done a few times before.
There's, uh, t-there's a lot we need to go over
- before we proceed. - Yeah, uh,
this is more than just an ordinary nosebleed.
Yeah, I thought so.
- Sammie? - Oh, my God.
- Sammie, baby, are you okay? - You okay?
It's a bit cramped.
I've amputated limbs
- under worse circumstances. - All right.
Please, save her.
We're gonna do everything we can.
Saline.
One, two, three. Let's go. Yep, yep.
Code Yellow. All visitors,
remain in the hospital.
Do not attempt to leave the hospital.
Dude, sorry about Mina.
Must be rough.
How you holding up?
On the bright side, maybe we can go get
that drink we were talking about getting, you know?
Do some sharing.
Go on about your business, Nolan.
Yep... That thing? Okay.
Yeah, I feel you, man. I have had it up to here
with the sad looks from people
about losing the baby we were gonna adopt.
I loathe pity.
- Yeah, me, too. - Look, I'm thinking
you can both use a distraction.
This is imaging of my seven-year-old patient Sammie.
Tumor in the pancreas wrapped around the stomach,
liver, spleen, large and small intestines.
This is inoperable.
It's an inflammatory myofibroblastic tumor. It's a death sentence.
Unless we can tag you in.
Are you talking auto-transplantation?
Pioneered by the legendary Dr. Kato
at Columbia Presbyterian.
You want to take out all of her abdominal organs,
extract the tumors and then put the organs back in her body?
Yeah, this is the highest-risk surgery
any of us will ever perform.
And I-I wanted to wait,
but the tumors have occluded
the spleno-mesenteric junction.
Her liver is failing, clotting factors are low
and she's bleeding uncontrollably.
That means she has to have the surgery today.
We're the only chance she's got.
Well, say no more. Let's go save a life.
She likes you.
She seems lovely.
You like her?
I'm only asking
because she couldn't take her eyes off you,
and you couldn't bolt out of there fast enough.
Geez. Patients fall for their doctors all the time,
and vice versa. What's the big deal?
First off, she's not actually my patient.
Second, mind your own business.
When you tell someone to mind their own business,
it just confirms what it is you don't want them to think.
How I feel about Rose, and how I choose
to interact with her is not something
I need to explain to a resident.
Mind your business.
I don't see anything. You?
No bleeds.
We'll need to monitor her.
Dr. Cain?
Thank God. I'm with Dr. Devi in the sim lab.
We're trapped with a patient who has a penetrating head trauma.
He's status post-grand mal seizure
and he's decompensating.
I just sent you a photo.
Okay, by the locations,
my money's on an epidural hematoma
with middle meningeal artery laceration.
You need to get him to an OR immediately.
There's significant debris from the tornado blocking the door.
We won't be able to get out.
From Kit. ER's overwhelmed. I-I got to get down there.
I'll have a crew send someone to free them, okay?
Dr. Devi, you are a surgical intern.
I need you to start cutting now.
- This can't wait. - Here in the sim lab?
Yes. Find any type of surgical equipment that you can use.
What's the status on the patient?
He's unresponsive to painful stimuli.
What else have you got, equipment-wise?
Sutures and gloves. Scalpels and surgical equipment
are in the cabinet but we can't get to it.
Okay, listen to me, you cannot do this without the right tools.
- We do have sheets and pillowcases - Okay, great
Great, great. Lay those around the patient.
How about sterilization?
Hand sanitizer.
Okay. So here's the deal. If you remove that rod,
he could die of exsanguination.
If you don't, he can die of herniation.
I want to do whatever gives him the best shot at survival.
Just tell us what to do, Dr. Cain.
And speak fast before we lose you.
Okay, remove that rod. But then you'll need to remove
a section of the skull around the impalement. Do you have
anything else in that room that you can use?
We have a toolbox.
Power drill.
Pliers.
X-Acto.
Okay, that's not ideal, but it's gonna have to work.
Once you take out that rod,
you have to stop the bleeding inside the cranial vault.
Fingers crossed that that artery's still intact.
Then you're gonna remove all of those bone fragments.
You have to be very...
Dr. Cain.
Damn it. We lost him.
We're on our own.
Hi. Hey, uh, why don't you go
- scrub and I'll catch up. - Okay.
Xiao An, what's wrong?
Don't go.
I'm not going anywhere.
I don't want to be alone.
My parents died of the virus.
I never got to say goodbye to them.
Don't cry, don't cry. Trust me, I won't leave you.
Okay.
It has to be you. I haven't been in surgery since med school.
Hey, can you hear me?
Whole wall's collapsed. At least an hour, maybe more.
Oh, God.
Listen, I know you're scared, but you have to do this now.
I'm not scared of anything.
But rushing me won't help.
Leela, what's happening? Tell me what to do, come on.
My brain needs more time to process one new thing
and this is... many.
Okay.
Visualize a quadrant around the rod.
Imagine drilling a hole in all four corners.
And then we cut open the bone.
We get underneath it.
And...
Extract the rod and stop the bleeding.
Right, Vascular clamping complete.
Yeah, let's remove the organs.
I know as a surgeon, we're supposed to play it cool. But this is insane.
Yeah, the clock is ticking. Let's resect
the tumors on the back table, then...
get the organs back inside her body.
I'll begin the portal vein reconstruction.
Dr. Austin, are you okay?
What about me suggests that I'm not okay, Jessica?
Am I not elbow deep in a child's abdominal cavity
doing the work of gods?
Am I sad? Yes.
Do I feel as empty as this poor child?
Yes.
Do I need people constantly reminding me
that I've been mortally wounded by the loss of love?
No!
Uh...
my bad, Jessica.
- Mm-hmm. - I'm fine.
Okay. Bovie?
- Thank you. - You're welcome.
Piper's blood pressure's failing.
- I think I see the source. - I'll keep transfusing,
but her body's starting to shut down.
She can't afford to lose any more blood.
There goes another one.
We didn't amputate Piper's leg just to let her die on the table.
She's going into V tach.
We need to speed this up.
Okay, let's get the bar out of his head.
Steady hands.
You move it even one millimeter in the wrong direction,
it could be catastrophic.
Look, you got this.
I'll hold his head.
No major bleeding.
Okay, now we have to remove
the remaining bone fragments.
The tumors are resected.
Yeah, we're running out of time.
She needs these organs re-implanted now.
The bad news is the tumors eviscerated
her pancreas, spleen and stomach.
The good news is we still have enough healthy liver and intestine.
-You ready for re-implantation? - No.
I just came across a smattering of
malignant growth in her abdominal wall.
They must've been undetected on imaging.
These are going to prevent us from closing.
Okay, we are gonna have to rebuild her quickly
from the inside out, starting with the GI
reconstruction, then the abdominal reconstruction.
It's a good thing we have a plastic surgeon in our midst.
Nice and slow.
Okay.
Let's do this.
All right, I think that's the last fragment. I don't see any more.
Oh, it's the artery... he's bleeding out. Apply pressure.
It's not working. We need something to seal it off.
All right, I'll look. Leela, keep applying pressure.
Okay.
The patient is becoming unstable.
The instability is related to a bleeding vessel.
We need to achieve homeostasis.
We don't have clips or wax.
What else?
We need to burn it.
We don't have electrocautery.
Does he have a soldering iron?
It might work. Give it a shot.
You did it.
Now let's hope they get us out in time.
Time of death 17:41.
Hey.
We tried everything.
Amputation was her only chance, but she lost too much blood.
She was one of us.
We'll tell Wes.
I know how close you and Piper were.
We're so sorry.
She saw the world as it is.
I saw...
like I wished it was.
We were two halves of a piece
that were better than either of us alone.
You'll always carry that part of her with you.
How am I gonna get back into the ambulance without her?
You will.
When you're ready, just one step at a time.
And she wouldn't want you to stop helping people.
And the last thing she would want is to be
an anchor around your neck.
Thank you for that.
Oh, man.
I have to pick up her dog.
I made her rescue him.
Dog's a total jerk.
And the only relationship that she had
besides me.
We'll see you soon, Wes.
Hardest part of our job.
Never gets easier.
No one does it better than you.
Get him to the OR.
Dr. Chan is waiting.
He had a bleed, and we almost lost him,
but Dr. Devi cauterized it with a soldering iron.
Well done.
I bet you didn't expect to perform brain surgery
with power tools when you woke up this morning.
Or any morning.
- Ever. - Well, now you know what it feels like
to exceed your own expectations.
I have always been confident in my abilities.
It's always been other people who have doubted me.
That being said, I'm happy Dr. Pravesh was with me today.
No, no. This is your moment.
Again, well done.
Let's go.
These are worse than you made them out to be.
Per usual.
Better me than you.
Look...
I know you want to work right up until you go to labor
and I will support whatever you decide.
But given everything that we have been through...
I'm ready.
Home sounds really good right about now.
For me and for her.
Mm.
You would have loved the autotransplant I just did.
Killed it. Natch.
It's not enough.
I miss you
Miss you too. OR911. Gotta go.
Look, we knew this was going to be hard,
but the recovery is going to be more challenging than we anticipated.
Yeah. Sammie will require ongoing care with constant follow-ups.
- For how long? - Years.
The truth is, Sammie's operations may not be over.
We will need to continually monitor her organs.
And at some point, more surgeries might be required.
Uh, w-we are so glad she has a chance.
But I-I don't know how we're gonna swing this.
Uh, the-the cost alone, uh...
What about her at-home care?
We will provide you with resources
to help with her dietary requirements
and her ongoing physical therapy.
And she may need to be home-schooled
- for the next 12 months. - I'll-I'll send up a social worker
that will speak to you about all of it.
No.
No, no social workers.
I'm really thankful for you all saving her life,
- it's just that the truth is that... - We have, uh,
two other kids at home.
We-we care about Sammie and we want her to be okay.
But this is so overwhelming.
Look, our family is falling apart.
I don't know if we're the best people for her.
I don't understand. She's your daughter.
There are options for situations like this.
We'll have to relinquish her.
Are you saying you're gonna give her back?
You're Sammie's parents.
She has no other home in this country.
She'll be better with a family who's equipped
to do this sort of thing. Sorry.
Uh, Doctors, why don't you get some air? I...
I can finish with the Ackermanns.
Want to go grab a drink?
Yeah. J... Uh, just give me a minute?
- Oh! - Did it work?
Okay, that's it. That's it.
Good shot. Okay.
Oh, yes, baby! Let's go.
- You were phenomenal today. - Thank you.
Did you tell your father what you did?
- Yep. - And was he appropriately impressed?
He was more excited by the fact that there was
a single male, Indian doctor trapped with me.
That must have been infuriating.
I'm used to being the imperfect child with the screwy brain.
He's convinced dyslexia will cause me to kill someone,
or lose my job, so a husband
is insurance against the inevitable collapse
of my medical career.
Well, you have the inalienable right to feel like a medical god tonight.
Don't let anyone take that away.
I won't.
- Cheers. - Cheers.
Next round's on me.
All right.
- Mm. - Hey.
Just so you know, this area has been officially designated
a pity-free zone.
- You got that right. - Noted. Again.
Well, Bell, I want to say thank you for
letting me be part of this auto-transplantation.
Brother, it's going on my highlight reel for the long haul.
I'll never forget it, either.
To Sammie.
? How can you be so mean? ?
To Sammie.
? My little Imogene ?
? How can you be so mean?
Another beer?
Thanks.
Well, this is a super sad tableau over here.
Point in fact, couldn't be happier.
Isn't there some small part of you that wants to blow off some steam?
You know, have a drink with your colleagues?
Eh, drunken small talk is not my jam. I'm good.
Look, the truth is, I do want your job.
Of course you do.
I wouldn't want a resident who didn't.
We're cut from the same cloth.
No hidden agendas.
- Can I ask you something personal? - No.
You want to know if there's something between Rose and me.
The answer's no.
Like you said, she's not your patient, she's Devon's.
Wouldn't be out of bounds.
She could die at any time.
She could. Anyone could.
You almost did.
About a year ago,
my college girlfriend shows up to Chastain.
It's been decades.
Lots of wheels start turning.
Thinking about what could have been.
What still could be.
Then she dies on my table.
Damn.
I'm so sorry.
No one really knew how it affected me, but...
... I just don't think I can go through that again.
Okay, I get that.
But it's a dangerous way to live, man.
Maybe you avoid heartbreak, but...
you end up where you are right now,
alone at the bar.
Just warming up. There it is, all right.
Just warming up.
- Oh. Yeah, uh... - Oh, yeah. That's what you get.
I'm-a say me,
- Jake and Leela. - Oh.
That's not gonna be fair.
All right, I get it.
The three of us are surgeons, we are
precise, competitive, finely-tuned,
highly-performing individuals
So I understand the intimidation factor.
You and Jake are so drunk you can't even see the board.
Well, it appears to me that Drs. Hawkins, Pravesh
and Sutton over there
may have a point.
However, I am too inebriated to control my ego,
- so what do you say? - I think we'll be fine.
Let's go.
Fine. Put your money where your mouth is.
Yes. There we go.
Now we're talking. Now we're talking.
I'm just curious.
Why do you think we'll be fine?
Trust me.
Dollar a point?
- We good with that? - Bring it.
- Yes, we're good with that. - Yeah?
Okay
Whoa.
- Awesome, man. - Yes.
Sneaky. This one's sneaky.
Good work.
- Put 'er there. - All right, all right, all right.
- Cheers. - Yes.
Well done, well done.
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