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- Previously on the Resident...
- Good morning. These are

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- the interns I told you about.
- I'm Zach,

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- Primary Care.
- Let's get started, shall we?

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Listen, I'm not a man
that you'll find in Child's Pose,

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so I'm just gonna be on my way to...

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AJ, I happen to know
from personal experience

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that you could really benefit
from a little extra flexibility.

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All right,

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come lie down and grab a mat.

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I don't know if I want kids.

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At least not right now.

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What Padma wants can help us both.

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I can give her the egg
she so desperately wants

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so she can have a baby,
and at the same time

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I can freeze some for us.

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- What about him?
- This guy?

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Yeah. He runs marathons,

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plays the cello and,

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Oh, Leela, look at that
chubby little face. Aww.

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Well, I wish we could meet
"Tall & Talented" in person.

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Or maybe see an adult photo,
not just a baby photo.

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Well, then these anonymous sperm donors

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wouldn't be very anonymous, would they?

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I just want the father of your child

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to be as amazing as you.

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My sister deserves Grade A sperm.

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Thank you for doing this for me.

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What, you think I'm doing this
for you? No.

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I'm only giving you my egg
so I can be an auntie.

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Well, you're gonna be the best one.

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- We should get to Chastain.
- Wait.

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What about him?

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- "The Right Stuff"?
- Yeah.

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He loves yoga, travel and Basquiat.

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No markers for genetic disease.

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And he's South Asian.

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I think it's a sign.

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Okay, well, why don't we
email the sperm bank

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- and try to get a voice sample?
- Leel, he is the one, I can feel it.

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No, no, you don't need
to decide right now.

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- Padma, are you sure?
- I am.

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"The Right Stuff" it is.

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Sorry, I know how busy you are.

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Not a problem. Happy to help.

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Usually I'm texting you to do
something a bit more fun, huh?

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Yeah.

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It's probably just a stomachache,

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- but Gigi insisted that you check.
- Oh, did she?

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I told Peter you fix hurt tummies.

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- Hey, Peter, remember me?
- Your Gigi's dad.

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I am. What's going on, buddy?

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We were playing super space, Daddy.

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Yeah, these two can go all day.

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He is the astronaut, she is the alien.

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Peter said he didn't want to play,

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but he always wants to play.

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I'm gonna place my hands on your stomach

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for a second, okay?

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All right.

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Peter's dad is on the way.

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Have him meet me in the ER.

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Do you like piggyback rides?

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Yeah, I thought so. Hop on.

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Can I go with you, Daddy?

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You wait here, my little alien.

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I'll come back soon and let you
know how Peter's doing.

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Kids, we're going on a field trip.

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A rite of passage.

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When I was a first year, like you,

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Dr. Hawkins took me,
and now it's your turn.

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Our turn for what?

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Since the start of your intern year,

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you've learned to become doctors
inside these walls,

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and today you are going outside Chastain

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to treat one of the most
challenging patient populations.

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A place you'll tackle
complex medical cases

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that make great doctors.

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Dr. Voss and Dr. Bell
will be joining us,

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so let's get moving.

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Where are we going?

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Dr. Pravesh didn't tell you?

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Let's not spoil the surprise.

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Okay.

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All right, here we are.

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Shall we?

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We got played.

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Oh, my God, old folks?

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- Synced and corrected by synk -
- www.addic7ed.com -

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All right, Mr. Astronaut,

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can you tell me when it started to hurt?

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Does the pain move around at all?

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I'm okay now.

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Is my dad coming?

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Yeah, he's coming.

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To take me home?
I don't want to go home.

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Oh, you're not going home, hon.

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You're gonna stay here with us
until we can

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figure out why you're not
feeling so great.

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- Hey, bud.
- Hey, Daddy.

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Are you okay? What's going on?

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Hey, Spencer. This is Nurse Hundley.

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Spencer works in our IT department.

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Nice to meet you.

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Peter has a stomachache.

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Normally, that's not
a reason to be worried.

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His temp's a little low.

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It could be a sign of infection.

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- Oh.
- He seemed fine this morning.

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Said that he and Gigi were
going to space.

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Has he been sick at all
in the past few weeks?

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Had a cold a few days ago,

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but nothing out of the ordinary.

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Any dietary changes this morning?

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I made him a smoothie, um, as a treat.

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Bananas, yogurt, protein powder, juice.

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I mean, we shared it. I feel all right.

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He won't tell us more about his pain.

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He keeps saying he's fine.

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Well, I think because
he doesn't want to go home.

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- Right?
- I'll go home

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if you stay with me, Daddy.

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I'll stay right here, no matter what.

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Okay, bud?

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No matter what.

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I'll get us ready to draw labs.

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I'm gonna step aside for a second, okay?

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- Can I talk to you?
- Yeah, sure.

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We're good here, right, hon?

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Uh...

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he's got separation anxiety.

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His mom left us both three months ago.

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She hasn't been back, or even called.

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New boyfriend, drug problem.

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It's a long story.

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I'm sorry to hear that.

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Now Peter's afraid
you might disappear, too?

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Yes.

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He feels safe at Chastain because

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he knows that I work in the building.

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Well, separation anxiety
may be behind this.

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It can cause stomach trouble.

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Do some blood work, run some tests,

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and then we'll go from there, all right?

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Dr. Milner to Emergency.

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Dr. Milner to Emergency.

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There he is.

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The Brookhaven resident
who happens to be

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- one of my health care heroes.
- Dr. Kravitz?

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Yes.

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Just be aware he has early mild
cognitive impairment.

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He remembers people and events
from the past perfectly,

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but his short-term memory's going.

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Okay, got it.

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- Dr. Kravitz.
- Kit. Lovely to see you.

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I did a gerontology rotation

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with Dr. Kravitz when I was a resident.

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He was one of my finest teachers.

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This is Dr. Randolph Bell.

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It's an honor.

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You're a legend in the field
of geriatrics.

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You know, your book,

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Compassionate Care of the Elderly,

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has been on my shelf for decades.

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I-I'm sorry, your name again?

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Randolph Bell.

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Randolph, Randolph, Randolph...

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So do all your friends here
wheedle you for free care?

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Oh, absolutely not. We won't allow it.

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Arthur here is fully retired.

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He's earned the right to have
others care for him.

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Gloria, darling, this is Kit,
and this-this is...

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Well, there's no introduction
necessary, sweetie.

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Everybody knows the famous
Dr. Randolph Bell.

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She not only has my heart,

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she is now my head.

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In every way, she takes care of me.

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Well, it's mutual.

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Well, it was nice of you to come today.

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You know, it can be kind of hard to get

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some of us old coots to get
our regular check-ups.

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Well, we have an ulterior motive

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for bringing some of
our interns here today.

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We're hoping to inspire them
to join your field.

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This country needs more gerontologists,

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and even some of the best doctors

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don't understand the particular
needs of senior citizens.

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Geriatricians have higher
career satisfaction

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than other medical specialties.

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But the pay...
not what you get in surgery.

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Would you consider talking
to some of our interns

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about your career?

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Let me at 'em.

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Do you think we'll still be that in love

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when we're their age?

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Why wouldn't we be?

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Padma, now that you picked
a sperm donor,

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we'll start Leela's daily
injections of hormones

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to encourage her body
to produce more eggs

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- than it does in a usual cycle.
- We're excited.

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Me, too. We'll be monitoring you
with blood tests

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and ultrasounds.

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I read about this thing called, uh,

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- ovarian hyper-something.
- Hyperstim.

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Yeah. Do we need to worry about that?

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No, not with regular monitoring
of my estradiol levels.

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If they get too high,
we back off, lower the dose.

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That question wasn't for me.

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But you're right.
This is quite a safe process.

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Okay, what can I do to help?

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For now, nothing. Not until we start you

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on meds in a few weeks to
prepare for the embryo transfer.

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- Okay.
- Okay?

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00:08:56,488 --> 00:08:58,896
Leela, I will walk you through
your first injection.

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Um, I was thinking...

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00:09:01,567 --> 00:09:03,642
maybe I can do it.

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00:09:03,736 --> 00:09:04,810
You want to stick a needle in me?

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00:09:04,829 --> 00:09:06,629
I just want to be part of this

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00:09:06,664 --> 00:09:08,556
in every way that I can.

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00:09:08,574 --> 00:09:11,483
- You know.
- Of course.

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I would like that, too.

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Does our patient have a visitor?

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He does indeed.

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- Gigi!
- Hi, Peter.

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Ah, good friends are good medicine.

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All right, you two, behave.

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00:09:30,217 --> 00:09:32,384
I'm gonna chat with your dad real quick.

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Thought a fun distraction
for Peter could be good.

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So his labs came back.

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White blood cell count was
normal, no sign of infection.

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Appendicitis, uh... seems unlikely.

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Maybe it's psychological.

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You know, he's been through a lot.

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My gut's telling me
it's more than anxiety,

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and I want to run a few more tests.

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What's up?

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Did you fix his tummy, Daddy?

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It's always his tummy.

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What do you mean, "always," sweetheart?

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It happened before?

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How often does your tummy hurt, Pete?

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A whole lot of times.

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Why didn't you tell me anything, Pete?

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- I don't understand.
- I didn't want to stay at home.

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I wanted to come here, with you.

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I'll never leave you, okay?

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I'll never leave you.

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Do you understand?

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Daddy, there's something else.

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It's weird, but maybe I should tell you.

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00:10:29,822 --> 00:10:31,725
This morning, Peter and I were playing

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00:10:31,749 --> 00:10:33,732
that we were on another planet.

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He kept saying that I had two heads.

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Yeah, you told me that. Pretending.

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No, he meant it.

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He said I really was a space alien.

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00:10:46,246 --> 00:10:49,974
Peter, does anyone else have two heads?

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That nurse lady and you,

258
00:10:53,907 --> 00:10:55,740
kind of.

259
00:10:56,623 --> 00:10:59,527
Double vision. How many fingers
am I holding up?

260
00:11:01,170 --> 00:11:03,613
- What's going on?
- This could be neurological.

261
00:11:03,781 --> 00:11:06,324
We need to get him to CT.

262
00:11:08,194 --> 00:11:11,937
So this woman, who is 83, kept chickens.

263
00:11:12,014 --> 00:11:14,031
And she loved her chickens.

264
00:11:14,183 --> 00:11:15,850
She named each one of them.

265
00:11:15,868 --> 00:11:19,370
The-the first day I spent
with her, she gave me eggs.

266
00:11:19,464 --> 00:11:22,948
Anyway, she had a problem
with worsening anemia.

267
00:11:23,042 --> 00:11:26,284
Fatigue, muscle weakness,
intestinal problems.

268
00:11:26,379 --> 00:11:30,842
She started forgetting things
and... falling.

269
00:11:30,867 --> 00:11:33,792
Now, any ideas what was wrong with her?

270
00:11:33,886 --> 00:11:36,387
Likely more than one thing.

271
00:11:36,539 --> 00:11:39,874
Alzheimer's, and possibly cancer?

272
00:11:39,892 --> 00:11:41,466
Or a recent stroke.

273
00:11:41,560 --> 00:11:42,893
I'll give you a hint.

274
00:11:43,045 --> 00:11:45,137
The key was the chickens.

275
00:11:45,156 --> 00:11:47,898
People who name their chickens
don't eat them.

276
00:11:48,050 --> 00:11:50,384
Exactly. He's smart.

277
00:11:50,477 --> 00:11:51,955
You-you could be a gerontologist.

278
00:11:51,979 --> 00:11:53,329
I don't get it.

279
00:11:53,480 --> 00:11:57,159
Okay, it's a B12 deficiency,
common with age.

280
00:11:57,184 --> 00:11:58,984
Learned that from Dr. Kravitz's book.

281
00:11:59,003 --> 00:12:03,731
So I'm guessing that
the patient was a... vegan,

282
00:12:03,824 --> 00:12:06,324
because she gave away the eggs.

283
00:12:06,344 --> 00:12:08,752
Bingo.

284
00:12:08,905 --> 00:12:12,072
The woman's vegan diet was a good choice

285
00:12:12,091 --> 00:12:14,408
because it reduced her risk
of heart disease,

286
00:12:14,501 --> 00:12:15,996
Type 2 diabetes, certain cancers.

287
00:12:16,020 --> 00:12:19,065
But she forgot to supplement with B12,

288
00:12:19,090 --> 00:12:20,392
which was the source of
all of her symptoms.

289
00:12:20,416 --> 00:12:24,752
This is why gerontology is
a great profession.

290
00:12:24,845 --> 00:12:27,179
You spend time with patients.

291
00:12:27,198 --> 00:12:29,792
You talk with them, you get
to know the whole person,

292
00:12:29,817 --> 00:12:32,737
all the while keeping your eye
on the big picture.

293
00:12:32,762 --> 00:12:34,870
Which is the key to diagnosis.

294
00:12:35,022 --> 00:12:37,765
Oh! My lady awaits.

295
00:12:37,783 --> 00:12:41,952
And I see that they have put out
snacks, and I am peckish.

296
00:12:41,977 --> 00:12:44,097
- Excuse me.
- Thank you, Dr. Kravitz.

297
00:12:46,792 --> 00:12:48,943
Hi, sweetie.

298
00:12:48,961 --> 00:12:51,659
Hey, maybe gerontology is
an aphrodisiac.

299
00:12:51,684 --> 00:12:53,538
This old goat has
the prettiest lady in the place,

300
00:12:53,558 --> 00:12:55,736
and I have not had a
date since high school.

301
00:12:55,760 --> 00:12:56,831
Oh...

302
00:12:56,856 --> 00:12:58,561
No, no, I'm kidding.

303
00:12:58,712 --> 00:13:01,455
Gloria!

304
00:13:01,548 --> 00:13:02,639
Her pulse is thready.

305
00:13:02,734 --> 00:13:04,194
Call 911. Let's get her to Chastain.

306
00:13:04,218 --> 00:13:05,459
Somebody grab these pills.
To take with us.

307
00:13:05,478 --> 00:13:07,718
We're gonna need to know
what she's been taking.

308
00:13:13,041 --> 00:13:16,371
I don't understand.
Are you telling me I fainted?

309
00:13:16,396 --> 00:13:19,120
Yes. And they're
going to figure out why.

310
00:13:19,145 --> 00:13:20,899
I was probably just dehydrated.

311
00:13:20,918 --> 00:13:23,143
I didn't ruin your event, did I?

312
00:13:23,168 --> 00:13:24,661
No, we were winding down anyway.

313
00:13:24,814 --> 00:13:26,238
You added the drama.

314
00:13:26,332 --> 00:13:28,591
The good news is,
your wrist isn't broken.

315
00:13:28,742 --> 00:13:29,833
You just need a splint.

316
00:13:29,986 --> 00:13:31,721
And your EKG and your labs look normal.

317
00:13:31,745 --> 00:13:34,004
So how did you feel
right before you passed out?

318
00:13:34,156 --> 00:13:36,918
I got dizzy. A little lightheaded.

319
00:13:36,943 --> 00:13:39,737
A-A drop in blood pressure.
It's not uncommon

320
00:13:39,762 --> 00:13:41,472
among women on blood pressure meds.

321
00:13:41,497 --> 00:13:42,583
But she's-she's not on any.

322
00:13:42,607 --> 00:13:44,982
Oh, well, yes, I am, dear.

323
00:13:46,519 --> 00:13:48,685
- You are?
- Mm-hmm.

324
00:13:48,838 --> 00:13:50,428
Why didn't you tell me?

325
00:13:50,448 --> 00:13:52,689
I did.

326
00:13:52,784 --> 00:13:55,526
Let's start here.

327
00:13:55,678 --> 00:13:58,103
My thought exactly.

328
00:13:58,122 --> 00:14:00,697
Houston to Rocket Nine Niner,

329
00:14:00,850 --> 00:14:02,458
do you read me?

330
00:14:02,609 --> 00:14:05,202
Copy, Rocket Nine Niner.

331
00:14:05,354 --> 00:14:09,614
Please keep your hands
and arms inside the spacecraft.

332
00:14:09,692 --> 00:14:11,585
We are go for liftoff.

333
00:14:11,610 --> 00:14:14,470
Over and out.

334
00:14:15,881 --> 00:14:18,858
Was that for him or for you?

335
00:14:18,883 --> 00:14:21,012
A little bit of both.

336
00:14:21,037 --> 00:14:23,128
I'm worried about him.

337
00:14:24,148 --> 00:14:27,320
If Peter's abdominal issues
are caused by

338
00:14:27,345 --> 00:14:30,638
a neurological one, we could be
looking at a bleed.

339
00:14:35,885 --> 00:14:37,734
I don't see one.

340
00:14:37,811 --> 00:14:40,830
No evidence of a stroke, either.

341
00:14:40,981 --> 00:14:43,724
But his ventricles are a little...

342
00:14:43,726 --> 00:14:46,377
Too little.

343
00:14:50,643 --> 00:14:52,233
His brain is swelling.

344
00:14:52,258 --> 00:14:54,413
Now, if we don't figure out why
and the swelling worsens,

345
00:14:54,438 --> 00:14:56,624
I'll have to perform a
craniectomy to relieve the pressure.

346
00:14:56,649 --> 00:14:58,640
Cutting a six-year-old's head
open on an "if."

347
00:14:58,665 --> 00:15:00,476
Of course not, but if things
move south quickly,

348
00:15:00,500 --> 00:15:01,960
we have to be ready to move to the OR.

349
00:15:01,984 --> 00:15:04,265
Fine, but let's keep in mind
the risks aren't just

350
00:15:04,396 --> 00:15:05,486
bleeding and infection.

351
00:15:05,505 --> 00:15:07,041
There could be permanent brain damage.

352
00:15:07,065 --> 00:15:10,233
We need to figure out how
to avoid surgery altogether.

353
00:15:10,251 --> 00:15:12,396
Let's start Peter on meds
to lower the pressure

354
00:15:12,420 --> 00:15:13,920
on his brain immediately,

355
00:15:14,072 --> 00:15:15,566
hope they work and move him to ICU.

356
00:15:15,590 --> 00:15:18,241
Yes, that sounds like a plan.

357
00:15:18,334 --> 00:15:22,095
Well, why didn't you tell me
you were taking all of these?

358
00:15:22,120 --> 00:15:23,481
Oh, I did, dear.

359
00:15:23,506 --> 00:15:25,426
Every time I added a medication.

360
00:15:25,508 --> 00:15:28,342
But you can't be expected
to remember all these.

361
00:15:28,436 --> 00:15:30,511
I-I forgot all of them.

362
00:15:30,530 --> 00:15:32,491
Multiple medications,
called polypharmacy,

363
00:15:32,515 --> 00:15:35,200
is associated with adverse outcomes,

364
00:15:35,369 --> 00:15:37,443
particularly as we age. They interact,

365
00:15:37,596 --> 00:15:39,612
causing falls, drug reactions,

366
00:15:39,764 --> 00:15:42,599
and can even lead
to increased mortality.

367
00:15:42,617 --> 00:15:44,434
It all started with the arthritis.

368
00:15:44,452 --> 00:15:46,452
The ibuprofen wasn't doing anything,

369
00:15:46,529 --> 00:15:49,288
so a doctor put me on prednisone.

370
00:15:49,383 --> 00:15:51,365
Well, that gave me heartburn,

371
00:15:51,385 --> 00:15:53,218
so he gave me omeprazole.

372
00:15:53,369 --> 00:15:54,772
But then that made me nauseous,

373
00:15:54,796 --> 00:15:57,872
so they added ondansetron
for my stomach.

374
00:15:57,966 --> 00:16:01,375
That made my heart flutter,
so they gave me metoprolol,

375
00:16:01,395 --> 00:16:02,877
and then my legs started to swell,

376
00:16:02,896 --> 00:16:04,540
so they gave me furosemide,
and that's when

377
00:16:04,564 --> 00:16:06,714
I stopped walking very much,

378
00:16:06,733 --> 00:16:09,642
and, uh, my blood pressure
shot up, so they...

379
00:16:09,996 --> 00:16:11,605
Should I keep going?

380
00:16:11,630 --> 00:16:13,274
...practitioner to the ER, please.

381
00:16:13,298 --> 00:16:15,156
Nurse practitioner to the ER.

382
00:16:19,137 --> 00:16:20,470
Double shift?

383
00:16:20,563 --> 00:16:23,973
Actually, I'm just starting.

384
00:16:24,066 --> 00:16:25,878
Been having a hard time sleeping.

385
00:16:25,902 --> 00:16:28,645
- Oh, that sucks.
- Yeah, tell me about it.

386
00:16:28,663 --> 00:16:33,225
Oh, um, Leela told me about your mother.

387
00:16:33,910 --> 00:16:35,260
How is she?

388
00:16:35,411 --> 00:16:38,154
Sorry, it's... it's none of my business.

389
00:16:38,173 --> 00:16:40,323
No, it isn't.

390
00:16:40,325 --> 00:16:42,434
But it's nice of you to ask.

391
00:16:42,585 --> 00:16:44,472
She just moved in with me on Saturday.

392
00:16:44,496 --> 00:16:46,512
It's been good having her close.

393
00:16:46,665 --> 00:16:48,106
And how are you?

394
00:16:48,333 --> 00:16:50,775
Well, I'm trying to resist the urge

395
00:16:50,852 --> 00:16:53,169
to check my home security camera
every five minutes

396
00:16:53,262 --> 00:16:55,505
to see how she's doing.

397
00:16:55,598 --> 00:16:58,098
Okay, well, actually, I'm not resisting.

398
00:16:58,193 --> 00:17:01,953
Would you look at this woman?
She's out there gardening.

399
00:17:02,104 --> 00:17:03,346
Are those rhododendrons?

400
00:17:03,364 --> 00:17:07,850
A little pink for my taste,
but she loves them.

401
00:17:07,869 --> 00:17:11,129
I'm leading a meditation at 3:00.

402
00:17:11,356 --> 00:17:14,591
- Join us.
- Maybe I will.

403
00:17:16,211 --> 00:17:18,377
- So, how are you?
- Great.

404
00:17:18,530 --> 00:17:20,341
I just injected my sister with hormones

405
00:17:20,365 --> 00:17:21,525
so she can donate her eggs to me

406
00:17:21,549 --> 00:17:23,382
and I can be a mom. Hmm!

407
00:17:23,477 --> 00:17:26,728
Oh, wear something comfortable.

408
00:17:31,151 --> 00:17:35,487
So they put her
on hydrochlorothiazide...

409
00:17:35,638 --> 00:17:37,638
And that made Gloria feel fatigued.

410
00:17:37,732 --> 00:17:39,473
So they gave her methylphenidate.

411
00:17:39,493 --> 00:17:41,045
Which could have had
a negative interaction

412
00:17:41,069 --> 00:17:43,736
with the linezolid that she
was taking for that cellulitis.

413
00:17:43,888 --> 00:17:46,025
Or the zolpidem or quetiapine,

414
00:17:46,050 --> 00:17:48,401
which Gloria was also on.

415
00:17:50,729 --> 00:17:52,723
What are we even doing,

416
00:17:52,747 --> 00:17:53,896
Dr. Pravesh?

417
00:17:53,915 --> 00:17:57,083
We're looking into
all contraindications.

418
00:17:57,177 --> 00:18:00,311
But she is a sick older lady
who needs these drugs.

419
00:18:00,336 --> 00:18:02,508
Like, which do you even stop?

420
00:18:02,533 --> 00:18:04,217
We move carefully,

421
00:18:04,242 --> 00:18:07,769
removing one by one.

422
00:18:09,264 --> 00:18:10,747
No.

423
00:18:10,765 --> 00:18:14,267
This is over my head
and, honestly, kind of boring.

424
00:18:14,418 --> 00:18:16,585
I need to find a surgery to observe.

425
00:18:16,610 --> 00:18:20,186
I thought you were going into
primary care.

426
00:18:20,204 --> 00:18:21,601
No. I want to be a surgeon.

427
00:18:21,626 --> 00:18:22,953
It's exciting, and you fix problems

428
00:18:22,977 --> 00:18:26,232
that are actually fixable,
not buff up old people

429
00:18:26,257 --> 00:18:27,440
until they die.

430
00:18:27,465 --> 00:18:29,126
You don't think people die
on the OR table?

431
00:18:29,278 --> 00:18:30,610
They do all the time.

432
00:18:30,635 --> 00:18:32,323
Not everything is fixable with a knife.

433
00:18:32,348 --> 00:18:33,393
You get that, right?

434
00:18:33,413 --> 00:18:35,206
You can fix things with your brain.

435
00:18:35,230 --> 00:18:36,827
Excuse me, have you met me?

436
00:18:36,852 --> 00:18:38,209
I read that surgeons don't actually have

437
00:18:38,233 --> 00:18:42,097
the highest IQ, and I thought,
there, that's my specialty.

438
00:18:42,122 --> 00:18:43,122
Hmm.

439
00:18:43,147 --> 00:18:45,072
This woman needs us,

440
00:18:45,091 --> 00:18:48,000
and Dr. Kravitz needs her.

441
00:18:48,094 --> 00:18:51,793
So if you're not interested,
I say go hunt down Dr. Austin

442
00:18:51,818 --> 00:18:53,505
and see if he'll let you into his OR.

443
00:18:53,658 --> 00:18:55,560
But be aware that
he will not consider it

444
00:18:55,584 --> 00:18:57,660
for one nanosecond

445
00:18:57,753 --> 00:19:00,980
when I tell him
you deserted this patient.

446
00:19:06,446 --> 00:19:08,779
Okay, I will stay.

447
00:19:08,948 --> 00:19:12,992
But don't tell him about
that IQ thing, either.

448
00:19:17,857 --> 00:19:19,773
I want to go with him.

449
00:19:19,867 --> 00:19:21,829
You can't, honey. He needs special care

450
00:19:21,853 --> 00:19:23,443
in a special part of the hospital.

451
00:19:23,463 --> 00:19:25,779
You mean he's really sick?

452
00:19:25,798 --> 00:19:27,114
You fix people.

453
00:19:27,133 --> 00:19:31,135
- You'll fix him, can't you, Daddy?
- Spencer.

454
00:19:31,286 --> 00:19:33,554
I'll be right there.

455
00:19:35,366 --> 00:19:38,789
What's happening? His daddy is scared.

456
00:19:38,814 --> 00:19:41,022
You have to save Peter.

457
00:19:44,375 --> 00:19:46,375
I got him.

458
00:19:46,394 --> 00:19:49,068
I got him, I promise.

459
00:19:54,476 --> 00:19:55,803
He seems much worse.

460
00:19:55,828 --> 00:19:58,311
Please tell me you have some news.

461
00:19:58,406 --> 00:20:00,223
We gave him another round of meds

462
00:20:00,248 --> 00:20:01,957
to lower the intracranial pressure,

463
00:20:01,982 --> 00:20:05,169
but it'll take time... if it works.

464
00:20:07,823 --> 00:20:10,499
He was hurting, and I totally missed it.

465
00:20:11,752 --> 00:20:14,804
I get guilt, believe me,
but it is not earned here.

466
00:20:18,926 --> 00:20:21,334
Help him. Please.

467
00:20:21,359 --> 00:20:24,768
We're doing everything we can.

468
00:20:24,932 --> 00:20:26,524
Uh, just...

469
00:20:26,751 --> 00:20:29,509
I don't want anybody
cutting his head open.

470
00:20:29,529 --> 00:20:30,844
Not if we can avoid it.

471
00:20:30,863 --> 00:20:32,530
Understood.

472
00:20:38,095 --> 00:20:39,095
You all right?

473
00:20:40,781 --> 00:20:43,115
Now I feel guilty, about how lucky I am

474
00:20:43,267 --> 00:20:44,709
not to be in Spencer's shoes.

475
00:20:44,936 --> 00:20:46,430
Peter has to make it through this.

476
00:20:46,454 --> 00:20:48,437
- I know.
- And Gigi, she lost her mother.

477
00:20:48,456 --> 00:20:49,599
She can't lose her best friend.

478
00:20:49,623 --> 00:20:50,751
We have to make sure they both come

479
00:20:50,775 --> 00:20:51,902
out of this.

480
00:20:51,926 --> 00:20:53,926
Uh, Dr. Hawkins!

481
00:20:56,872 --> 00:21:00,725
Vomiting means his intracranial
pressure must be rising.

482
00:21:03,229 --> 00:21:04,395
I'm a little confused.

483
00:21:04,420 --> 00:21:05,948
- I'm sorry.
- So the metoprolol

484
00:21:05,973 --> 00:21:07,122
helped your heart,

485
00:21:07,141 --> 00:21:08,936
but it also lowered your blood pressure.

486
00:21:08,960 --> 00:21:10,459
And with all the
water pills you were on,

487
00:21:10,478 --> 00:21:12,223
plus the stimulants,
your heart rate sped

488
00:21:12,248 --> 00:21:15,067
and BP lowered, which caused you
to lose consciousness.

489
00:21:15,092 --> 00:21:16,367
Other doctors have been telling me

490
00:21:16,391 --> 00:21:19,266
that these meds are saving
my life, and you're telling me

491
00:21:19,291 --> 00:21:21,715
- the opposite?
- No, just listen to them, hon.

492
00:21:21,740 --> 00:21:24,656
They want to take you off
medications you may not need,

493
00:21:24,809 --> 00:21:26,562
and-and keep you on
ones that are working.

494
00:21:26,586 --> 00:21:27,810
But we'd like to keep you here

495
00:21:27,828 --> 00:21:29,628
to monitor you while we do it.

496
00:21:29,756 --> 00:21:32,973
But it's just for a day,
and then, um, you'll go home.

497
00:21:32,998 --> 00:21:35,985
- There's hope for him yet.
- Mm.

498
00:21:35,987 --> 00:21:37,577
Thank you both.

499
00:21:37,597 --> 00:21:40,172
We've given Peter the maximum doses,

500
00:21:40,324 --> 00:21:42,749
but he's... he's not improving.

501
00:21:42,843 --> 00:21:44,731
Well, time to book an OR.

502
00:21:44,756 --> 00:21:46,937
No, let's just...

503
00:21:47,582 --> 00:21:48,932
...start with a drain

504
00:21:48,957 --> 00:21:51,016
before you open his head.

505
00:21:54,096 --> 00:21:55,571
Okay, we can try it.

506
00:21:57,341 --> 00:21:59,617
I'll get an EVD monitor.

507
00:22:02,680 --> 00:22:05,514
- Talk to me.
- We're putting in a drain.

508
00:22:05,533 --> 00:22:08,125
It should help relieve
the pressure on his brain.

509
00:22:08,691 --> 00:22:10,166
It's a first step.

510
00:22:13,123 --> 00:22:16,499
I don't know how much longer
we can put off a craniectomy.

511
00:22:18,078 --> 00:22:19,887
It's my son.

512
00:22:23,701 --> 00:22:26,239
Let's take everything
one step at a time.

513
00:22:26,264 --> 00:22:29,515
Right now, we need to sedate
and intubate,

514
00:22:29,540 --> 00:22:32,041
and to protect his airway.

515
00:22:32,059 --> 00:22:35,561
I have to talk to him first,
before you, before you...

516
00:22:35,713 --> 00:22:38,739
Of course. Of course.

517
00:22:46,891 --> 00:22:49,316
Hey, bud.

518
00:22:50,503 --> 00:22:54,246
I just want you to know...

519
00:22:54,398 --> 00:22:58,491
I want you to know that
every second that you're asleep,

520
00:22:58,511 --> 00:23:01,328
I'm gonna be right here beside you.

521
00:23:01,347 --> 00:23:03,764
Deal?

522
00:23:08,855 --> 00:23:10,337
Okay.

523
00:23:28,190 --> 00:23:30,040
Hey, there she is.

524
00:23:30,192 --> 00:23:31,934
So, how'd it go this morning?

525
00:23:31,952 --> 00:23:36,696
The hormone shot was fine,
but this is not. Look.

526
00:23:36,790 --> 00:23:38,435
Padma picked a donor,
but I did a little bit

527
00:23:38,459 --> 00:23:39,844
of digging into this sperm bank.

528
00:23:39,868 --> 00:23:41,679
It's facing three lawsuits
from families who claim

529
00:23:41,703 --> 00:23:44,296
their donors misrepresented themselves.

530
00:23:44,390 --> 00:23:46,489
In one case, the family alleged

531
00:23:46,514 --> 00:23:49,223
that the donor had an undisclosed
history of schizophrenia.

532
00:23:49,248 --> 00:23:50,268
In another,

533
00:23:50,288 --> 00:23:52,179
a donor covered up a criminal record.

534
00:23:52,198 --> 00:23:55,015
Some claim college degrees
when they're really dropouts.

535
00:23:55,034 --> 00:23:56,441
These families were lied to.

536
00:23:56,461 --> 00:23:59,462
Yes. About the biggest decision
they'll ever make.

537
00:23:59,613 --> 00:24:01,911
The genes their kids
will share with its father.

538
00:24:01,936 --> 00:24:04,616
Yeah, but, I mean, this is just

539
00:24:04,694 --> 00:24:06,635
a few cases out of how many, right?

540
00:24:06,931 --> 00:24:08,172
I mean, I had a lot of friends

541
00:24:08,197 --> 00:24:09,454
in med school who donated.
They were good guys,

542
00:24:09,474 --> 00:24:11,100
they just needed cash;
they wanted to help.

543
00:24:11,193 --> 00:24:14,977
Is this your way of saying
there are little Devons out there?

544
00:24:15,128 --> 00:24:18,205
If it helps, every single one
of these donors

545
00:24:18,298 --> 00:24:19,873
had to undergo genetic testing.

546
00:24:19,967 --> 00:24:22,710
There is no test to show whether
you're a pathological liar,

547
00:24:22,728 --> 00:24:24,447
have a mental illness
or a criminal record.

548
00:24:24,471 --> 00:24:26,282
- And you're missing the point.
- No, I get it.

549
00:24:26,307 --> 00:24:27,786
Sperm banks are unregulated.

550
00:24:27,811 --> 00:24:29,903
The FDA requires that donors are tested

551
00:24:29,928 --> 00:24:32,644
for infectious diseases,
but beyond that, nothing.

552
00:24:32,663 --> 00:24:34,404
Their bios aren't even verified.

553
00:24:34,429 --> 00:24:35,686
That may work for some people.

554
00:24:35,711 --> 00:24:37,506
There are amazing kids out there
from anonymous donors,

555
00:24:37,531 --> 00:24:38,621
but that won't work for me.

556
00:24:38,646 --> 00:24:40,106
- This is my egg.
- Hey, babe...

557
00:24:40,320 --> 00:24:44,322
You have to accept
that this is Padma's choice.

558
00:24:45,401 --> 00:24:47,901
Well, I need to make sure
she knows what she's choosing.

559
00:24:52,016 --> 00:24:54,475
We'll talk later, okay?

560
00:24:59,690 --> 00:25:01,095
- Are you hot or cold?
- Both.

561
00:25:01,120 --> 00:25:02,173
Okay, don't worry, we're gonna help you.

562
00:25:02,193 --> 00:25:04,175
She's in A-fib and hypotensive.

563
00:25:04,253 --> 00:25:06,064
A-fib could be because we took
her off metoprolol.

564
00:25:06,088 --> 00:25:07,254
Let me check if her pressure dropped

565
00:25:07,273 --> 00:25:08,491
before she slipped into arrhythmia.

566
00:25:08,515 --> 00:25:10,235
I-I was here. Her BP started
to fall first,

567
00:25:10,259 --> 00:25:11,759
then her heart rate spiked.

568
00:25:11,777 --> 00:25:13,035
Peritonitis?

569
00:25:13,060 --> 00:25:15,687
Gloria, tell me where it hurts.

570
00:25:15,706 --> 00:25:17,795
- Rebound tenderness.
- This has nothing to do with the meds.

571
00:25:17,820 --> 00:25:19,502
She has an acute abdomen
and she may need surgery.

572
00:25:19,526 --> 00:25:22,880
Let's get her four of morphine.
Hang pressors and page Bell.

573
00:25:22,904 --> 00:25:25,530
Hey, hang in there, okay?

574
00:25:31,722 --> 00:25:33,038
Where to begin?

575
00:25:33,132 --> 00:25:35,558
Gloria has three lumbar
compression fractures

576
00:25:35,583 --> 00:25:36,599
from osteoporosis.

577
00:25:36,952 --> 00:25:39,112
And a hiatal hernia.
All incidental findings.

578
00:25:39,138 --> 00:25:40,523
Consequence of living for eight decades.

579
00:25:40,547 --> 00:25:44,049
So here's today's problem.
Colonic perforation.

580
00:25:44,068 --> 00:25:45,125
No wonder she was in so much pain.

581
00:25:45,144 --> 00:25:46,879
And no idea what caused this?

582
00:25:46,904 --> 00:25:48,312
It couldn't have been the fall.

583
00:25:48,464 --> 00:25:49,866
We thought she passed out
from too many meds,

584
00:25:49,890 --> 00:25:51,903
but something else was going on.
We just don't know what.

585
00:25:51,928 --> 00:25:54,615
Well, what we do know
is that without surgery,

586
00:25:54,640 --> 00:25:55,849
Gloria won't make it.

587
00:25:55,874 --> 00:25:58,392
You're talking about a surgery
that's dangerous at any age,

588
00:25:58,543 --> 00:26:00,118
and with Gloria nearly 80...

589
00:26:00,287 --> 00:26:02,621
Well, we'll be sure to be
very clear with her

590
00:26:02,639 --> 00:26:04,380
about what we're facing here.

591
00:26:04,400 --> 00:26:07,567
But I agree with you.
It's the only option.

592
00:26:07,760 --> 00:26:10,684
Okay. At least she's in the best hands.

593
00:26:10,709 --> 00:26:12,647
Well, I've had success
with patients older than her,

594
00:26:12,799 --> 00:26:13,965
much sicker.

595
00:26:13,984 --> 00:26:16,201
I really hope she's one of them.

596
00:26:19,482 --> 00:26:21,823
So you think "The Right Stuff"
is secretly

597
00:26:21,848 --> 00:26:23,636
- some sort of axe murderer?
- No.

598
00:26:23,660 --> 00:26:24,953
I'm just saying we can't

599
00:26:24,978 --> 00:26:26,956
- really be sure who he is.
- Okay, look,

600
00:26:26,980 --> 00:26:28,883
I really appreciate
you being protective of me,

601
00:26:28,907 --> 00:26:31,137
but there's no guarantees with kids.

602
00:26:31,162 --> 00:26:32,559
I mean, look at us.

603
00:26:32,584 --> 00:26:34,669
What, there's a one-in-a-million
chance of having twins?

604
00:26:34,821 --> 00:26:36,504
One in 250.

605
00:26:36,581 --> 00:26:39,749
And we are proof that
a random genetic accident

606
00:26:39,826 --> 00:26:42,098
can be the best gift ever.

607
00:26:42,123 --> 00:26:44,587
Look, I can't give up on being a mother

608
00:26:44,612 --> 00:26:45,657
just because there's risks.

609
00:26:45,682 --> 00:26:46,940
I don't want you to.

610
00:26:47,167 --> 00:26:49,425
I just want you to be aware
of what those risks are.

611
00:26:49,445 --> 00:26:54,189
Which is why I asked
Dr. Nolan to join us.

612
00:26:54,283 --> 00:26:55,431
What's up, ladies?

613
00:26:55,451 --> 00:26:57,175
Show her what you showed me.

614
00:26:57,194 --> 00:26:58,285
Oh.

615
00:27:01,031 --> 00:27:02,492
"Dream Doc"?

616
00:27:02,516 --> 00:27:04,532
I don't understand.

617
00:27:04,626 --> 00:27:06,306
- It's him.
- It's me.

618
00:27:07,779 --> 00:27:09,278
You're six-foot five?

619
00:27:09,298 --> 00:27:11,039
I do slouch some.

620
00:27:11,191 --> 00:27:12,466
And fluent in French?

621
00:27:12,617 --> 00:27:13,858
Yeah.

622
00:27:13,952 --> 00:27:15,952
Je suis Rosetta Stone.

623
00:27:17,139 --> 00:27:20,528
- Trombone prodigy?
- I got a standing ovation

624
00:27:20,553 --> 00:27:21,601
at my ninth grade recital.

625
00:27:23,628 --> 00:27:26,229
- Just think about it.
- Mm.

626
00:27:27,799 --> 00:27:29,724
Think about what?

627
00:27:29,876 --> 00:27:33,942
Surgery? Sounds... dangerous.

628
00:27:33,967 --> 00:27:35,972
Yeah, I'm not gonna lie to you. It is.

629
00:27:35,991 --> 00:27:39,642
But it is the only option.

630
00:27:39,736 --> 00:27:44,222
And without it, you may only have days.

631
00:27:44,241 --> 00:27:45,879
Maybe a week.

632
00:27:45,904 --> 00:27:47,892
I'm sorry.

633
00:27:47,911 --> 00:27:50,670
Y-You always say how

634
00:27:50,897 --> 00:27:54,007
e-easy choices are your favorite.

635
00:27:55,402 --> 00:27:59,012
I wish I could offer you more time

636
00:27:59,239 --> 00:28:00,830
to make this decision.

637
00:28:00,849 --> 00:28:02,741
But the sooner you operate,

638
00:28:02,759 --> 00:28:05,268
the better my chances are?

639
00:28:08,749 --> 00:28:10,840
Well, then, I'm ready.

640
00:28:10,859 --> 00:28:15,090
Arthur, I'm sure everybody
over at Brookhaven is worried.

641
00:28:15,115 --> 00:28:16,679
You think maybe you could go call them

642
00:28:16,773 --> 00:28:19,274
- and fill them in?
- Oh, of course.

643
00:28:19,299 --> 00:28:20,631
Any-Anything, darling.

644
00:28:20,927 --> 00:28:22,761
Yes, Brookhaven.

645
00:28:22,854 --> 00:28:24,779
Update, update Brookhaven.

646
00:28:24,931 --> 00:28:28,208
Update Brookhaven.

647
00:28:29,619 --> 00:28:31,504
I can't leave him.

648
00:28:31,529 --> 00:28:33,213
- He needs me.
- Oh, I...

649
00:28:33,364 --> 00:28:35,048
I get it.

650
00:28:35,199 --> 00:28:39,201
You have got to be better
than you have ever been.

651
00:28:39,963 --> 00:28:42,614
Neither one of us have children.

652
00:28:42,707 --> 00:28:45,356
Not even siblings.

653
00:28:45,381 --> 00:28:46,876
It's just the two of us.

654
00:28:46,895 --> 00:28:49,120
He has no one else.

655
00:28:49,139 --> 00:28:51,122
I have no one else.

656
00:28:53,243 --> 00:28:55,668
Do you know what it's like
to find the love of your life

657
00:28:55,693 --> 00:28:58,238
this late in the game?

658
00:28:58,315 --> 00:29:00,890
Actually, I do.

659
00:29:00,984 --> 00:29:03,468
And when the day comes,

660
00:29:03,561 --> 00:29:05,728
and he forgets my name,

661
00:29:05,822 --> 00:29:08,230
I won't even care.

662
00:29:08,399 --> 00:29:12,586
I'll fill in that blank,
'cause he'll still love me.

663
00:29:13,738 --> 00:29:15,237
And I'll love him.

664
00:29:15,257 --> 00:29:17,591
To the end.

665
00:29:17,742 --> 00:29:21,136
Just don't let it be today.

666
00:29:22,580 --> 00:29:24,264
Okay.

667
00:29:34,814 --> 00:29:37,481
His intracranial pressure
is still rising,

668
00:29:37,506 --> 00:29:39,426
and we're not sure of the cause.

669
00:29:39,566 --> 00:29:41,323
The MRI didn't show any tumors

670
00:29:41,343 --> 00:29:43,841
or blood clots in his brain.

671
00:29:43,866 --> 00:29:44,973
So what does this mean?

672
00:29:45,125 --> 00:29:46,791
That the drain wasn't enough.

673
00:29:46,885 --> 00:29:48,885
Mr. Shafer, we have no choice but to

674
00:29:49,038 --> 00:29:50,203
proceed with the craniectomy

675
00:29:50,222 --> 00:29:51,866
to relieve the pressure
in Peter's brain.

676
00:29:51,890 --> 00:29:53,524
My God.

677
00:29:55,894 --> 00:29:57,934
I can't believe this is happening.

678
00:29:57,959 --> 00:30:00,114
There must be something else you can do.

679
00:30:00,139 --> 00:30:03,490
If we wait any longer,
he's at risk of brain damage.

680
00:30:03,526 --> 00:30:05,526
Treat him like he's your child.

681
00:30:05,620 --> 00:30:10,431
Would you agree to this if it was Gigi?

682
00:30:14,387 --> 00:30:16,646
Spencer, give us a minute to review.

683
00:30:20,468 --> 00:30:23,544
- Tell me there's another option.
- There isn't.

684
00:30:23,563 --> 00:30:25,691
What he just said in there
won't help Peter.

685
00:30:25,715 --> 00:30:28,383
Keeping your objectivity will.
You have to.

686
00:30:28,401 --> 00:30:29,808
I'm sorry to interrupt,

687
00:30:29,828 --> 00:30:31,973
but the preschool's been trying
to get in touch.

688
00:30:31,997 --> 00:30:34,080
Gigi needs you.

689
00:30:36,576 --> 00:30:39,085
Do what you have to do
to reduce the swelling.

690
00:30:48,600 --> 00:30:50,571
Hey. She's been like this

691
00:30:50,665 --> 00:30:51,975
since Peter left this morning.

692
00:30:51,999 --> 00:30:54,767
She won't eat or talk.

693
00:30:55,428 --> 00:30:57,812
- Thank you.
- Yeah.

694
00:31:05,697 --> 00:31:06,863
What is that?

695
00:31:07,014 --> 00:31:09,440
A space helmet for Peter.

696
00:31:09,592 --> 00:31:13,369
If he goes into space, he can't die.

697
00:31:15,098 --> 00:31:18,374
Is he gonna die, like Mommy?

698
00:31:28,202 --> 00:31:31,279
I'm fighting for Peter.

699
00:31:31,297 --> 00:31:34,115
- I'm scared.
- I know. That's okay.

700
00:31:34,133 --> 00:31:35,558
I knew he was sick when

701
00:31:35,710 --> 00:31:37,876
he didn't want to eat my sandwich.

702
00:31:37,929 --> 00:31:41,622
We trade. He always eats my sandwich.

703
00:31:41,624 --> 00:31:44,216
When his mommy left, his daddy started

704
00:31:44,236 --> 00:31:47,720
making his lunch with roast beef.

705
00:31:47,739 --> 00:31:51,699
After he ate it all,
his tummy started hurting.

706
00:31:57,732 --> 00:31:59,772
Did he eat your sandwich this morning?

707
00:31:59,809 --> 00:32:01,584
No, Daddy.

708
00:32:09,168 --> 00:32:11,052
Craniotome to me.

709
00:32:14,766 --> 00:32:17,433
I've done this a hundred times,
but rarely on a child.

710
00:32:17,585 --> 00:32:21,479
You're more than qualified.

711
00:32:23,666 --> 00:32:26,167
Watch for bleeding, be gentle.

712
00:32:26,260 --> 00:32:28,528
When I pass through bone, I stop.

713
00:32:29,263 --> 00:32:32,673
Now, let's get started.

714
00:32:34,101 --> 00:32:35,192
Wait!

715
00:32:35,345 --> 00:32:36,822
I think Peter has urea cycle disorder.

716
00:32:36,846 --> 00:32:39,104
It's a genetic enzyme deficiency
that makes it hard

717
00:32:39,124 --> 00:32:40,768
for people to break down protein.

718
00:32:40,792 --> 00:32:43,442
Whenever Spencer packs his son
roast beef, he trades it away

719
00:32:43,611 --> 00:32:45,164
because it makes his stomach hurt.

720
00:32:45,188 --> 00:32:47,522
I think sharing his dad's
protein shake this morning

721
00:32:47,615 --> 00:32:49,076
gave him more protein
than he could process,

722
00:32:49,101 --> 00:32:51,036
and his body was already under
stress from his recent cold.

723
00:32:51,061 --> 00:32:53,303
Talk about a zebra.
Urea cycle is extremely rare.

724
00:32:53,471 --> 00:32:54,782
But it would explain all the symptoms.

725
00:32:54,806 --> 00:32:56,288
Let's get him back to the ICU,

726
00:32:56,308 --> 00:32:58,388
start him on dialysis,
clear the ammonia.

727
00:32:58,535 --> 00:33:00,207
Yeah, but do we have that kind of time?

728
00:33:00,232 --> 00:33:01,772
The odds you're right
are vanishingly small,

729
00:33:01,796 --> 00:33:03,182
and if you're wrong, this boy's brain

730
00:33:03,206 --> 00:33:04,296
continues to swell,

731
00:33:04,316 --> 00:33:06,356
which will cause him permanent damage.

732
00:33:07,537 --> 00:33:08,703
We need to operate now.

733
00:33:08,728 --> 00:33:10,539
A craniectomy is a gamble, too.

734
00:33:10,563 --> 00:33:12,115
At the rate the swelling is worsening,

735
00:33:12,139 --> 00:33:14,259
best-case scenario, what,
it buys Peter days?

736
00:33:14,384 --> 00:33:16,901
It doesn't fix the problem.

737
00:33:17,053 --> 00:33:18,494
That is true.

738
00:33:20,165 --> 00:33:22,740
So let's do both.

739
00:33:22,892 --> 00:33:25,651
Dialysis right here.
We can watch his ICP.

740
00:33:25,670 --> 00:33:27,912
If it doesn't drop, I'm ready to

741
00:33:28,064 --> 00:33:29,464
start a crani immediately.

742
00:33:40,501 --> 00:33:42,501
I'll be right here when you wake up.

743
00:33:42,562 --> 00:33:46,647
Okay, this is as far as you can go.

744
00:33:54,348 --> 00:33:56,774
I love you.

745
00:33:56,943 --> 00:34:00,036
I love you more.

746
00:34:05,192 --> 00:34:06,667
Okay.

747
00:34:22,969 --> 00:34:25,520
Wire, please.

748
00:34:31,644 --> 00:34:33,611
Dilator.

749
00:34:38,134 --> 00:34:40,743
All right, we're almost there.

750
00:34:41,654 --> 00:34:43,262
All right, catheter in.

751
00:34:43,287 --> 00:34:45,248
If you're right,
the pressure should trend down

752
00:34:45,399 --> 00:34:47,440
once the proteins are filtered out.

753
00:34:47,465 --> 00:34:49,665
Yeah, well, it's not gonna
happen immediately.

754
00:34:54,333 --> 00:34:56,533
If that number doesn't
come down soon, I start.

755
00:34:57,128 --> 00:34:59,429
Whether I want to or not.

756
00:35:02,341 --> 00:35:05,419
We're working through
some unexpected adhesions.

757
00:35:05,444 --> 00:35:07,870
Did Gloria mention anything
about prior surgeries?

758
00:35:08,022 --> 00:35:10,038
None. Any sign of the perforation?

759
00:35:10,115 --> 00:35:11,281
Running the bowel now.

760
00:35:11,300 --> 00:35:14,178
There's no sign of widespread ischemia.

761
00:35:14,203 --> 00:35:16,303
- Oh, there it is.
- Can you repair it?

762
00:35:16,455 --> 00:35:18,342
Well, the surrounding bowel is thickened

763
00:35:18,366 --> 00:35:21,367
with extensive lymphadenopathy.

764
00:35:21,460 --> 00:35:25,198
It sounds like whatever's going
on caused significant inflammation.

765
00:35:25,222 --> 00:35:27,222
I should be able to repair the perf,

766
00:35:27,375 --> 00:35:29,128
but, you know,
this didn't happen overnight.

767
00:35:29,152 --> 00:35:30,634
It's been going on for years.

768
00:35:30,711 --> 00:35:33,212
Bowel inflammation is extremely painful.

769
00:35:33,230 --> 00:35:36,073
Her daily steroids
must have been masking it.

770
00:35:37,506 --> 00:35:39,172
See the big picture.

771
00:35:39,645 --> 00:35:41,387
Dr. Kravitz told me in geriatrics

772
00:35:41,405 --> 00:35:43,998
you always gotta keep your eye
on the big picture.

773
00:35:44,225 --> 00:35:46,316
What if the arthritis
and the bowel inflammation

774
00:35:46,335 --> 00:35:48,038
are all part of the same
disease process?

775
00:35:48,062 --> 00:35:50,296
It's possible.

776
00:35:51,415 --> 00:35:53,318
If the side effects of her medications

777
00:35:53,342 --> 00:35:57,261
were actually symptoms of
the underlying issue.

778
00:35:58,347 --> 00:36:00,589
We've been looking at this all wrong.

779
00:36:00,741 --> 00:36:03,242
Let's get back to Gloria's prescriptions

780
00:36:03,335 --> 00:36:04,668
and see if we can't get her some answers

781
00:36:04,687 --> 00:36:06,478
when she wakes up.

782
00:36:09,417 --> 00:36:10,949
It just keeps rising.

783
00:36:10,951 --> 00:36:12,359
Can we dialyze faster?

784
00:36:12,436 --> 00:36:15,592
Any faster and his neurons could shear
from diffusion. Just give it a minute.

785
00:36:15,617 --> 00:36:17,389
Conrad, this is the brain.
A minute can be

786
00:36:17,414 --> 00:36:18,544
the difference between life and death.

787
00:36:18,569 --> 00:36:19,769
Just give me one more minute.

788
00:36:19,811 --> 00:36:21,197
We don't have good choices here.

789
00:36:21,221 --> 00:36:23,997
- Billie, we're on the same side.
- But this is my OR.

790
00:36:35,678 --> 00:36:37,761
- It dropped.
- Wait, Dr. Sutton.

791
00:36:38,906 --> 00:36:40,946
That number's still dangerously high.

792
00:36:55,422 --> 00:36:57,406
It worked.

793
00:37:01,519 --> 00:37:03,945
You ready to close?

794
00:37:04,098 --> 00:37:06,999
Sure am.

795
00:37:12,773 --> 00:37:15,457
Focus on that still space

796
00:37:15,609 --> 00:37:18,534
between our inhale

797
00:37:18,612 --> 00:37:21,054
and our exhale.

798
00:37:22,616 --> 00:37:24,369
Please remember to silence your devices

799
00:37:24,393 --> 00:37:26,042
before we begin the class.

800
00:37:32,022 --> 00:37:35,362
_

801
00:37:52,980 --> 00:37:54,904
- I seem to have gotten turned around.
- Okay.

802
00:37:54,924 --> 00:37:56,498
My wife is in surgery.

803
00:37:56,650 --> 00:37:58,478
Can you direct me to the waiting room?

804
00:37:58,502 --> 00:38:00,969
Uh, here, let me show you.

805
00:38:03,581 --> 00:38:05,264
The cavalry has arrived.

806
00:38:05,289 --> 00:38:06,658
77-year-old woman with a bowel perf.

807
00:38:06,677 --> 00:38:07,917
Pressure started tanking.

808
00:38:07,937 --> 00:38:09,397
At first I thought it was peritonitis,

809
00:38:09,421 --> 00:38:10,857
then I saw her neck.

810
00:38:10,882 --> 00:38:12,439
I need ultrasound now.

811
00:38:12,666 --> 00:38:14,419
Any idea why she might be in tamponade?

812
00:38:14,444 --> 00:38:16,093
No idea what the underlying issue is.

813
00:38:16,113 --> 00:38:18,338
Right now, we just need
to get her off the table.

814
00:38:18,431 --> 00:38:20,431
Start another epi and bolus a liter.

815
00:38:20,450 --> 00:38:22,859
There's fluid around her heart.
We need to prep her

816
00:38:22,953 --> 00:38:24,193
for pericardiocentesis.

817
00:38:24,288 --> 00:38:26,081
Okay, I'll finish up so I can assist.

818
00:38:26,105 --> 00:38:27,325
All right, but if
she doesn't stabilize, Bell,

819
00:38:27,349 --> 00:38:28,826
I'm gonna have to crack her chest open.

820
00:38:28,850 --> 00:38:31,251
Oh, God, let's hope not.

821
00:38:44,533 --> 00:38:46,866
Oh, man, I can't wait to tell 'em.

822
00:38:46,959 --> 00:38:48,310
Hey, we figured it out.

823
00:38:48,461 --> 00:38:50,397
Gloria's medications
didn't cause her problems,

824
00:38:50,421 --> 00:38:51,830
but they masked an underlying one:

825
00:38:51,832 --> 00:38:53,297
Whipple's disease.

826
00:38:53,317 --> 00:38:55,542
That's what caused her
arthritis, weight loss, fatigue.

827
00:38:55,560 --> 00:38:57,872
And steroids that her doctors
first thought was arthritis

828
00:38:57,896 --> 00:38:59,136
only made it worse.

829
00:38:59,230 --> 00:39:01,025
She told us that
they increased her dose,

830
00:39:01,049 --> 00:39:02,157
leading to the perf.

831
00:39:02,182 --> 00:39:03,493
Now all Gloria needs is an antibiotic.

832
00:39:03,518 --> 00:39:04,701
We can take her off of

833
00:39:04,726 --> 00:39:06,635
- almost everything else.
- She didn't make it.

834
00:39:06,905 --> 00:39:09,831
- I'm sorry.
- What? She...

835
00:39:10,058 --> 00:39:12,983
She developed cardiac tamponade,

836
00:39:13,078 --> 00:39:15,395
which was probably
the final complication

837
00:39:15,564 --> 00:39:17,063
of her undiagnosed Whipple.

838
00:39:17,082 --> 00:39:19,582
And Austin was working to place
a pericardial drain

839
00:39:19,676 --> 00:39:21,509
when she coded.

840
00:39:21,534 --> 00:39:23,960
We did five rounds of CPR.

841
00:39:24,181 --> 00:39:26,739
More than I should have
on a woman her age.

842
00:39:26,741 --> 00:39:28,183
It was a tough one.

843
00:39:28,208 --> 00:39:29,834
Now, if she'd been treated properly,

844
00:39:30,002 --> 00:39:31,840
or if she'd gotten to us sooner,

845
00:39:31,865 --> 00:39:33,746
maybe we could have done something

846
00:39:33,765 --> 00:39:34,856
to turn it around.

847
00:39:34,881 --> 00:39:38,116
But today... it was just far too late.

848
00:39:40,100 --> 00:39:42,280
Dr. Kravitz...

849
00:39:44,851 --> 00:39:46,609
Kit is his friend,

850
00:39:46,703 --> 00:39:49,537
so I will call her to tell him.

851
00:40:00,533 --> 00:40:02,717
Even if we had diagnosed her sooner,

852
00:40:02,869 --> 00:40:04,961
Gloria's disease began years ago.

853
00:40:05,113 --> 00:40:06,370
There's nothing we could have done.

854
00:40:06,390 --> 00:40:09,891
Gloria wasn't just another
fragile old lady.

855
00:40:10,042 --> 00:40:12,952
She was strong, in love.

856
00:40:13,045 --> 00:40:15,563
She deserved more time.

857
00:40:15,715 --> 00:40:20,293
But every doctor looked at her
like just another lost cause.

858
00:40:20,386 --> 00:40:21,978
No one cared enough to see

859
00:40:22,072 --> 00:40:23,992
that by just treating her symptoms,

860
00:40:24,132 --> 00:40:26,408
they were actually making her worse.

861
00:40:31,248 --> 00:40:35,417
No one saw the bigger picture
until you did.

862
00:40:37,570 --> 00:40:40,813
Reconsider going into gerontology, Zach.

863
00:40:40,832 --> 00:40:42,966
You may have a gift.

864
00:41:04,948 --> 00:41:07,431
I am so sorry.

865
00:41:07,451 --> 00:41:09,676
I'm so sorry.

866
00:41:29,121 --> 00:41:31,364
Look what I made you.

867
00:41:31,457 --> 00:41:33,032
Wow!

868
00:41:33,125 --> 00:41:34,383
Hey.

869
00:41:34,703 --> 00:41:37,294
So we'll continue dialysis until
we lower his ammonia levels,

870
00:41:37,314 --> 00:41:40,373
but with some attention
and lifestyle modifications

871
00:41:40,466 --> 00:41:41,506
we can manage this.

872
00:41:41,651 --> 00:41:43,042
You will need to look out
for any signs that

873
00:41:43,061 --> 00:41:44,188
his ammonia levels are up.

874
00:41:44,212 --> 00:41:46,810
Sluggishness, nausea, vomiting.

875
00:41:46,835 --> 00:41:47,926
Avoid extreme temps.

876
00:41:47,951 --> 00:41:50,676
Keep him hydrated and
on a low-protein diet.

877
00:41:50,701 --> 00:41:52,810
No more roast beef sandwiches.

878
00:41:52,829 --> 00:41:55,312
He'll do great.

879
00:41:55,332 --> 00:41:57,481
I can't thank you enough.

880
00:41:57,650 --> 00:42:00,484
Well, we did have help.

881
00:42:00,504 --> 00:42:01,964
How would you two like a surprise?

882
00:42:01,988 --> 00:42:05,173
What is it, Daddy? What is it?

883
00:42:12,907 --> 00:42:15,517
Wow!

884
00:42:15,744 --> 00:42:19,103
It's beautiful.

885
00:42:32,035 --> 00:42:35,551
Nolan as a sperm donor? Our Nolan?

886
00:42:35,576 --> 00:42:36,704
- Yep.
- Ooh.

887
00:42:36,781 --> 00:42:39,766
- That put the fear of God in me.
- Yeah, I bet.

888
00:42:39,784 --> 00:42:42,118
But the eggs are gonna be
retrieved in about two weeks,

889
00:42:42,287 --> 00:42:44,787
which means I need a volunteer, fast.

890
00:42:44,881 --> 00:42:47,698
Someone I trust, someone I care about.

891
00:42:47,717 --> 00:42:49,125
What are you gonna do?

892
00:42:49,277 --> 00:42:52,945
Actually, um, I had a crazy idea.

893
00:42:53,039 --> 00:42:54,389
You and I are good friends,

894
00:42:54,540 --> 00:42:57,708
now that we aren't lovers,
and I wouldn't mind

895
00:42:57,802 --> 00:42:59,619
a kid a lot like you.

896
00:42:59,712 --> 00:43:01,621
You could do worse.

897
00:43:01,714 --> 00:43:04,140
So what if I did...

898
00:43:04,216 --> 00:43:07,527
have a kid just like you?

899
00:43:10,222 --> 00:43:13,283
You want me to be your sperm donor?

900
00:43:18,137 --> 00:43:22,137
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