- Previously on The Resident... - It's multiple sclerosis.
You will get better.
I actually want a child. Would you give me
one of your eggs?
You want me to be your sperm donor?
I don't like being alone.
I want to be a father.
Hi.
I'm here to save my daughter's life.
Who are you again?
You only get one father.
So, the two of you...
Oh, we're friends.
We're also friends.
So far.
Daddy! Daddy!
I'm coming, sweetheart.
Daddy.
It's okay. I'm here, honey.
What's going on?
There was a bad man. He scared me.
There's no one here but me. Look. Look.
See? See?
It was just a dream, bad dream.
He was going to hurt me.
I won't let anyone hurt you.
Can I sleep in your room tonight?
I'll stay right here until you go to sleep again.
Please?
Up you go.
? The way you move is gonna look like tax evasion ?
Look, we are all pretty blessed here tonight,
wouldn't we agree?
- Yes. - Yes.
- Cheers. - So, uh, which one of us
has the most to celebrate?
- Uh, me. - Me.
Because I'm having twins.
Perfect, healthy...
ooh... hiccupping at this very moment... baby boys.
Hear, hear.
- Identicals... - Identicals rule the world.
- Oh, yeah. - But in second place,
Devon's trial results just got published
- in the New England Journal of Oncology. - Ah.
- Hey. Respect, man. - Mm. - Aw, thank you.
Thank you. And not to brag,
but I have a great clinical trial about to come in, so...
- Yeah. All good. - Mm.
Well, I don't mind taking third place.
I just closed
on the perfect condo
for Padma and the babies.
And it's in a great school district, I might add.
- Nice. - AJ is controlling five years out.
- - Hear, hear. - And Conrad
finally has a new love at last.
That is a big deal.
And what about you?
Chastain's newest chief resident.
We all know what that means.
You are the most promising
young surgeon at Chastain.
The big news is I finally have my own office
with my own private shower.
Oh. Which actually means I have
the most to celebrate.- -
Oh. Okay.
Get a room.
You know, after four boring glasses of bubbly water, I think
I will make a bathroom run.
Oh, I'll come with.
Whew.
You okay?
Um... whew.
I'm not sure.
Woozy. I felt, uh...
a little faint.
Maybe I got up too fast.
You know, that's been happening.
Light-headed and...
Padma!
- Synced and corrected by Firefly - - www.addic7ed.com -
Devon, AJ,
don't you guys have work to do?
I feel seriously stressed
with everyone hovering over me.
Padma, you fainted. Scared all of us to death.
You should've let us take you to the ER last night.
I was dehydrated.
Okay? It's fine. I feel fine today.
- It was nothing. - You said you were
still feeling light-headed.
Go. You'll be late.
Devon is meeting Dr. Voss in his new lab.
I want to stay.
- Ugh. - Three doctors
in the room is plenty.
We've got this.
Okay.
- Update me, okay? - I will.
Ciara?
Oh, Dr. Hawkins. I'm so glad you're here.
- What have you done this time? - Me? Nothing.
I was viciously attacked.
- By a vat of barbecue sauce. - Let me see.
- Who knew being head chef would be so dangerous? - Yeah.
Oh.
That's a bad burn.
- How's the hand healing? - Finger's still sore.
Well, that's to be expected. You almost cut the damn thing off.
So much for my samurai knife skills, huh?
Can you clean and dress Ciara's burn?
Hmm? Oh, sure thing.
And, Hundley, give our cooking queen here
one gram of acetaminophen for the pain.
Uh, Bay Four.
- Give me a minute. - Yeah.
Right this way.
Hope you brought us some of those buttermilk biscuits.
With that fine honey butter.
I didn't, but you know I will.
As you know, Dr. Sullivan,
pancreatic cancer is usually fatal.
But your tumor was operable,
your nodes were clear
and there's no evidence of metastasis.
But there could still be
residual cancer cells that no test can see.
Yes, but you've had postsurgical chemo and radiation,
uh, you haven't developed diabetes,
your weight is good, so I think
that, for the foreseeable future,
you're all clear.
This couldn't be better news, Dad.
You missed the best reason I have for hope.
I have a great support system right here.
Well, there's nothing
I can prescribe that's better than that.
Thank you.
I love your barbecue ribs,
but they aren't worth this, Ciara.
Best barbecue in all of Alabama.
Atlanta. Unless you're opening up
a new branch.
Oh...
- Thank you. - There you go.
Oh, I got to go.
The lunch service won't wait for me.
Whoa. Dr. Feldman just got started.
That burn needs a lot more attention.
- Ataxic gait. - Slight confusion.
This is the second time we've treated her in a month.
It's time we talk about why she's so accident-prone.
Sorry, my friend,
but we have a few more things to check out.
What? Um...
Let's go.
We should get Billie on board for a neuro exam.
Mm, that won't be necessary.
Chefs have a high rate of addiction.
We should start with a tox screen.
Okay.
And this edema in your legs... is this recent?
No, but it has gotten worse,
and she's been complaining of headaches.
Maybe it's preeclampsia.
- What's that? - It's a, uh,
a condition during pregnancy that requires monitoring,
but it's manageable.
Thank you, Dr. Austin,
but I'm gonna dig a bit deeper before I make a diagnosis.
Ah. Sure.
Uh, I see you missed your last prenatal appointment.
You did what?
Padma.
I'm sorry, okay?
Oh, God, there's just so many appointments,
and I didn't want the ultrasound.
You know what, no one really knows what those electronic
vibrations or whatever do to tiny brains, so...
I'm going to be the bigger man right now
and pretend my head is not exploding.
Padma, you cannot
miss any medical tests or appointments.
Twin pregnancies often have complications.
It's dangerous for you and the babies.
Let's take a look.
I promise no brains will be harmed.
Okay.
Here's baby one.
Good size.
Look, he's waving at you.
And baby two
is...
... right here.
One is...
much bigger than the other.
I can see that.
What?
That... that can't be right.
It's fine. Deep breaths.
Their hearts don't sound the same.
They're... they're identical.
Their-their hearts should be identical.
What's going on?
I'm gonna go discuss this ultrasound with Dr. Sullivan.
- What? - I'll be right back.
Who's the president right now?
Um, I don't really follow politics, to tell you the truth.
I'm... I suffer from fragile sanity.
Eh, take a guess.
Uh, I know it's not Jimmy Carter.
Do I get a point for that?
No. No, I'm afraid not.
Oh, um, I forgot to tell you, um...
lately, I've had the memory of a goldfish
- with a drinking problem. - Squeeze my hands. Squeeze, squeeze, squeeze.
And I've been chalking it up to not getting any sleep.
- Do you have insomnia? - No.
I don't want to sleep because of the nightmares.
- What kind of nightmares? - Uh...
... usually I'm trapped
in this water,
no sound.
Why didn't you page me for a consult sooner?
We were waiting for the tox screen to come back.
Then Ciara decompensated rapidly.
It wasn't initially clear it was neurological.
Conrad thought it was.
It's my bad.
We've got this if you're needed in the ER.
- I hate to go. Keep me posted? - Yeah.
- How's Gigi? - The same.
She had another nightmare.
- Oh. I'm worried. - Me too.
I know when I was alone with her on Saturday,
she refused to nap.
I tried to get her to talk about the bad dreams
and what they're about, but she wouldn't say.
Do you think this could have anything to do
with Nic's death?
Yeah, maybe. It's possible.
But Gigi was a tiny baby when Nic died. I mean,
she thinks of Nic as her guardian angel
- looking out for her. - Yeah, but trauma
can take years to manifest.
I don't know any other reason why she'd be afraid.
Yeah, I mean, you control her screens and play dates.
Turn off the news.
I protect her with my life.
- Conrad. - This is brutal,
seeing her like this.
I can't stop it. Can't help.
Fixing things like this is supposed to be my job.
Hey, it's gonna be okay.
You're a great dad and a great diagnostician.
You'll get to the bottom of this.
Thank you.
I don't know what I'd do without your support.
Okay, well, there's our problem.
Our talented chef has a mass roughly the size of a marble
located between the temporal lobe and the cerebellum.
- Causing all her symptoms. - Yeah, we're gonna
have to operate to figure out what it is.
It's dangerously situated near the brain stem.
Let's get informed consent.
Yeah.
Thank you.
Wow. You've all done an incredible job
with the resources we have.
Everybody has been working around the clock
to meet our deadline for the diabetes trial.
Well, thank you.
As you know, clinical trials are crucial, not just
for our patients, but for the health of the hospital, too.
And there's an election coming up.
We may get a new governor who plans
to slash our budget $200 million.
Imagine voting for someone who attacks health care.
Yet he's polling to win.
Well, the steady stream of clinical trials...
it'll help keep us solvent.
I can't pretend I don't wish
we had the kind of facilities other labs offer.
Kit, I am confident in what we created here,
and I know that we're gonna get the job done.
It's Lewis Varner from Varner Scientific,
- sponsor of our trial. - Oh. Okay.
I'm so glad you called, Lewis. I have great news.
The lab is up and running, and we can't wait to start.
Uh, Lewis, this is a mistake.
Can we at least discuss it?
I see. Well, thank you
for letting me know in a timely fashion.
I-If anything changes,
if there's anything I can say or do, uh...
Yes. I hear you.
Well, good luck with everything.
What is it?
For this trial, they've decided to partner
with Baltimore Advanced Sciences
because of their superior facilities.
So they're cancelling our trial.
Yes. There will be other trials, I hope.
I-I'm sure.
We have to talk about this later.
I have to go. There's a
problem with Padma's pregnancy.
Oh, no. What is it?
I'm on my way to find out.
The ultrasound is diagnostic, there is no doubt,
but I can help.
Well, given how bad this is, I'm having trouble handling it.
And this is gonna be brutal for Padma.
She's quite fragile.
You have to be careful how you tell her.
Breaking the news is just the beginning.
I've done it many times. You can trust me to handle it.
- With your help. - Hey.
I came as fast as I could. What's happening?
Dr. Sullivan is getting ready to explain.
Hi, Padma. I'm Dr. Ian Sullivan,
a pediatric surgeon specializing in fetal medicine.
Oh, my God.
Please don't let there be anything wrong.
Dr. Sullivan is an expert in exactly what the twins need.
Tell me. What's happening?
Sometimes when babies are growing in the womb,
the process takes a wrong turn.
And in the past, when this happened,
we couldn't intervene to help the babies.
And, too often...
... they would die before they were born.
- No. No. - No, it's okay. Just let me finish.
That was the past.
Things are different now. Your twins have
something called twin-to-twin transfusion syndrome.
It only affects identical twins,
because they... they share the same placenta.
You see, what's happening
is there are abnormal connections
between the blood vessels
going from one twin to the other.
So, blood is not flowing evenly between them.
One twin... the larger one...
is getting too much blood, which will cause his heart to fail.
The heart of the other twin is not getting enough blood,
which is why he's so small.
We have to use lasers
to cut the blood vessels linking the babies.
Like this.
See? So they can each have their own blood supply.
And so the pregnancy can continue.
And if all goes well,
the babies will thrive to be healthy kids,
and then, ultimately, healthy adults.
You're making it sound simple,
- but I don't think it is. - You're right. I have to
tell you that no matter what we do,
the smaller baby is in grave danger and may not survive.
I shouldn't have missed my appointment. This is my fault.
There is no way that this is your fault.
Most likely, no one would have been able to see this earlier.
Just do whatever you have to do.
Please save my babies.
Odds.
There is an 80% chance that the smaller twin will die.
- And the larger baby? - Fifty-fifty.
If we don't do the procedure,
it's certain that both twins will die.
I didn't want to put too much on the mom so soon,
but you're doctors, you should know everything.
You've helped perfect this procedure, correct?
Yes, I have.
And I've performed it many times.
We're incredibly lucky to have you here at Chastain.
But the equipment I need to do it isn't here.
It requires very specialized tools.
The closest fetal surgery center
is in Orlando.
We need to transfer Padma as soon as possible,
and the surgery will have to be done by a doctor there.
But we want you to do the surgery.
Well, and I would love to.
I am incredibly frustrated that I can't, but...
public hospitals very rarely
have the capability to do fetal surgery.
Let's focus on what we have to do.
- How quickly must this happen? - As soon as possible.
The smaller baby could die within hours, and if that
happens, the other twin will die too.
Okay, doctors, well then, let's call Orlando right away.
I'll get Kit to order a helicopter.
A mass in my brain.
My aunt's husband, uh, died from glioblastoma.
It was... horrible.
We don't know this is cancer, much less a GBM.
What else could it be?
Dr. Sutton has to operate to find out.
The surgery is dangerous
with many possible complications.
- We need to go over them. - No, I...
I grew up homeless.
I never graduated high school.
I apprenticed in kitchens, and I learned my trade,
and I won a James Beard Award at 28.
I love my life,
and I will take any risk.
You're a badass.
- I've got to go. - Let's book an OR.
We'll be back.
Hey.
We can't stay long. I don't want to leave Padma alone.
She's not alone.
I just paged Conrad. He's gonna monitor her.
Are you okay?
My heart is breaking for her.
I know. Poor AJ.
So soon after he lost his mother.
This is how life is.
Everything's perfect,
and you think you have it figured out...
Just yesterday, we were all celebrating.
The problems never stop coming,
and we all have to live with that.
But things are different for us now.
We have each other.
Yeah.
And we always will.
What's the helicopter's ETA?
Okay, we'll have the patient waiting.
Half an hour. Orlando is prepared.
Get Padma ready for transport.
- I want to go with her. - Of course.
I-I'll get someone to cover your surgeries.
- You and Leela must both be there. - Thank you.
Hello, my dear.
So, I have some good news.
They're trying me on a new anti-CD20 antibody
that's been shown to reduce relapse rates,
and so far, I'm tolerating it really well.
Oh, that's wonderful news.
Bless your new doctors, Randolph,
because I needed some good news.
- What's wrong? - Everything.
Padma's twins have TTTS.
Oh, my God.
- So is Ian gonna operate? - He can't.
We have to send them out of state
because we don't have the right facilities here.
Well, Chastain needs more funding
- if it's gonna stay a first-class hospital. - Yeah.
And if this idiot becomes our new governor,
we'll have less than we ever had.
He's polling ahead.
It's just so hard being away from you.
I wish I was there to help.
No. You're exactly where you need to be.
You don't have to worry about me or Chastain.
Just concentrate on finishing the treatment.
It's just, a few more months just seems like forever.
Hmm. But it'll be worth it.
When you come back home you'll be healthy and strong
for our wedding.
I can't wait.
Love you.
I have to take a quick listen.
It's hard... to breathe.
Try to stay calm.
I'll give you some oxygen,
make you feel better, okay?
Here we go.
Better?
You have fluid building up in your lungs
and the rest of your body.
Sometimes with TTTS,
the mom starts mirroring the symptoms of her babies.
That's probably what caused you too faint in the bar.
Helicopter's here.
That's a good thing.
She's mirroring.
I'm sorry. They barely managed to land safely.
- Now they're grounded. They can't take off in this. - What?
It's okay. It's just a small delay.
All right, we have to take her back.
Padma can't afford to wait any longer.
She's showing signs of maternal mirror syndrome.
Mom's life is now at risk, too?
Surgery's the only way to save Padma and the babies.
We're out of time.
We have to find a way to do the surgery here.
- Devon. - Hey. We're headed into the ICU.
Okay, good. I'll page Cade.
Have her meet us there.
Kit. How can I help?
Is there any way to do the surgery
- with what we have at Chastain? - No.
But when I saw the weather coming in,
I-I made a few calls.
Lundsford College of Medicine is teaching surgical residents
how to operate on fetuses in their Sim lab.
They may have the equipment we need.
Bell's been teaching at Lundsford.
I'll get him involved immediately.
What's going on?
A lot. Can you get the Lundsford College of Medicine
to do us a favor?
Blood pressure's spiking.
- O2 sats are dropping. - I'm scared.
The alarms...
It's just telling us your oxygen levels are low.
Hey, let's give 'em some space to work.
We'll watch from outside.
If she needs you, you're right here.
- I'll be right outside, okay? - Okay.
The diuretic and blood pressure meds will keep you stable
until we do the procedure.
Are these medications safe for the baby?
Absolutely.
In fact, ten out of ten babies
prefer blood pressure to be lower than 140.
It makes for more excellent swimming conditions.
Hey.
Good news.
Bell pulled some strings at Lundstrom.
They're gonna send over the fetoscope
and some minimally invasive fetal surgery tools
via police escort.
So Ian will be able to do the surgery.
Okay, good. I'll go let the OR circulating nurse know,
make sure everyone's on deck and ready.
All right.
- Hey, how's it going in here? - Mm-hmm.
How's her pedal edema?
How much proteinuria is on her dip?
You're not the doctor or surgeon now, you're the father.
Here to support the mom.
Okay, well, in that capacity is my next question.
Should we wait for the weather to clear
instead of trying to jury-rig this thing?
- No. - There's no one else in this time zone
more qualified to make this call. Look.
He's done the science, had the outcomes.
You're in the best hands.
Thank you all for your high energy
in the middle of the night.
Well, we're honored to be a part of Chastain's
first fetal procedure.
The fetoscope has arrived.
Dr. Sullivan, are you confident
you can make the GI tower compatible with the fetoscope?
Doing surgery in small spaces
has made me a bit of an AV whiz.
The light post is smaller, but that just means
we'll white balance ahead of time.
And we'll-we'll pressure limit the suction port
to account for the smaller luminal diameter.
The cavalry has arrived,
though I can already sense there are way too many
advanced degrees in my OR.
And it looks like we have more company.
Dr. Voss said the surgical residents learning about
fetal surgery at Lundsford are going to watch
the famous Dr. Sullivan do his magic tricks.
Ian, have you met our night anesthesiologist?
- Dr. Lee. - Nice to meet you, Dr. Lee.
Three lives in our hands tonight. Pressure's on.
I'll go scrub in.
Hi, sweetheart.
Hey, they're ready for you in the OR.
Just getting my good glasses. You gonna watch?
- Oh, yes. - Great. After you.
Can you see the mass yet?
Almost there.
The tissue surrounding it appears enflamed.
Dissecting down carefully.
Does it seem like a malignancy?
Too soon to tell.
All right, hold on, I feel it.
That's odd, it's...
It's encapsulated.
So, no glioblastoma.
Could it be a teratoma?
No. I think...
... it's an egg.
That's not a tumor.
Nope.
A parasite.
Which means our patient is gonna be fine.
That is such great news.
I'm gonna go check on Padma.
Okay, I'll join you when I'm done here.
They haven't started yet. Ian just got here.
I heard he saved triplets once.
No one thought using a laser
inside the uterus would work.
He's a miracle worker. Touched by the hands of God.
All right, Padma.
Why don't you take your sister's hand.
And why don't you hold my arm with your other hand.
All right?
If at any point you feel any pain, you stop me. Okay?
Why don't we start with some Lidocaine.
Okay.
You're gonna feel some pressure now.
This is the tube through which
I will insert the fetoscope.
Problem. Mom's BP is spiking again.
I'm nearly maxed out on nicardipine.
What's happening?
Her mirror syndrome is getting worse.
Do we need to stop?
Yes. Take her back to the ICU.
Her heart could fail.
- We'll lose the twins. - No!
When the problem is the heart,
you page Dr. Austin.
Let's get IV furosemide hanging.
And I need an ultrasound wand.
AJ, please.
Don't want to die.
Don't want babies...
Padma, look at me.
No one is dying today, you hear me?
We're keeping all three of you alive.
He's just managing your pressures
so we can continue with the procedure, okay?
Right, and you should start to feel better in a moment.
No, no, it's not working. Her heart could still fail.
Another minute, Devi.
I will not risk Padma's life,
I promise you that.
We-we can't wait.
Blood pressure's coming back down to normal range.
Of course it is.
I can breathe.
Of course you can.
You watch that heart like a hawk.
I'm gonna keep her stable, you just do
what you need to do, all right?
You're doing great, Padma.
Now, we're going to insert
the fetoscope, okay?
This will give us the best look
we have of your babies.
Take a look at that monitor to your left.
140. Strong.
That's the larger twin.
You're losing him, Sullivan.
I'm now inserting the laser
to burn the connecting blood vessels.
The uterus is filling with blood.
Bleeding upon entry with the transplacental approach
can happen.
This is a known risk of the surgery.
All that blood will make it difficult to see.
She's bleeding out.
Heart rate's at 62. Can I have one liter
of Lactated Ringer's, please?
And infuse the uterus with fluid,
and clear the field.
This is awful.
Mother and twins are crashing.
Come on.
Come on, come on, come on, come on.
All clear.
Now ablating
the remaining blood vessels.
Incredible.
He barely blinked.
How did he do that?
I don't know.
And the smaller one's heart rate
is climbing to 103.
Ah...
Yes! Yes! Yes!
You did great.
- Ian. - Hey.
I want to thank you.
- You were masterful yesterday. - Oh...
Well, you have been every day since I've hired you.
You're too kind.
No, it's the truth.
You're a terrific addition to the hospital.
Well, Bell played a huge role, even in absentia.
Hard to believe in the middle of his treatment
in Minnesota, he was able to score that equipment
we needed from Lundsford.
Yeah, I wanted to discuss that with you.
It's killing me that we don't have what you need
here at Chastain.
Everything goes back to Lundsford today,
and we're right back where we started.
Well, maybe I could help raise some money
so we could build an intrauterine
surgical center of our own.
That would be amazing.
I have a pretty fair track record at raising funds.
- Grateful parents often become faithful donors. - Dr. Sullivan,
you're needed in OR Three.
- We'll talk later. - Appendectomy on a teenager.
There's no one else on call?
I just finished that four-hour biliary atresia.
I'm sorry, they tried, but it's an emergency.
- Be right there. - Thank you.
You see that?
Steady as a rock.
And Biden is president. And he won.
The best news is you don't have cancer.
- I had a cute little worm. - Which you got
from eating undercooked pork.
I can't believe I did that.
My kitchen test experiments with undercooked sausage
will not be repeated.
Well, at least now
you have an unusual pet.
I thought about naming him, but I think
I'm just gonna flush him down the toilet.
How's Gigi?
She had another nightmare last night.
I'm so sorry.
- Two nights in a row? - Yep.
I know a good child psychologist
if you want to talk to someone about how to handle this.
It may come to that, but I've been
doing some reading.
First, there are a few things I can try at home.
Hey, you.
Hey. Guess who got off early.
I convinced Irving to take my shift.
Do you want to get Gigi and go for some pizza?
- Oh, Billie, you should come with. - Yeah.
You're so kind, but, uh,
I have two more surgeries today.
Have fun.
All right. See you later.
I can't go either. I got to pick something up for Gigi
and work on this nightmare situation.
But I want to see you tonight.
She goes to bed at 8:30. Come by after?
- I'll bring the pizza. - Mmm.
Okay, so I don't get it.
Why didn't you tell him how you felt about him?
- Maybe I did. - No.
'Cause if you did, he would be with you right now.
I doubt that.
At Kit and Bell's engagement party,
I had my speech prepared.
Conrad left with Cade before I could get a word out.
Ah, that's painful. You missed the moment.
- But there's an upside. - Yeah?
Conrad and I are closer than we've ever been.
- Best friends. - Ouch.
My take.
Conrad chose Cade
thinking you weren't interested
because you were Nic's best friend.
He figured that was a line you wouldn't cross.
And you allowed him to think that
because you never crossed it.
- Now it's too late. - No.
It's never too late to win the love of your life back.
It's dark out here, Daddy.
Oh, I know.
I want you to see something beautiful
that you can only see in the dark.
What kind of moon is it?
- A crescent moon. - Mm-hmm.
It's beautiful, isn't it?
Yes, Daddy.
- You hear that owl? - Yeah.
Yeah, yeah. Owls love the dark.
That's when they come out.
Aren't owls beautiful?
I love owls.
Yeah, there are so many beautiful things in the dark.
- What else is there? - Stars?
Ah, stars.
Yeah, we love stars, right? What else?
Can we read The Runaway Bunny?
We can.
But I got you a new book.
This one is called...
... There's a Nightmare in My Closet.
No, Daddy, that sounds scary.
Well, it's not. It's about being brave at bedtime.
Turns out the nightmare isn't scary at all.
What do you say? You want to hear it?
- Okay. - Yeah, okay.
Get in tight. Snuggle up.
Okay, now I want you to go to sleep
and have good dreams.
I know you've had some bad ones,
but that's over now. You know you're safe.
There's nothing that can hurt you.
I'll go to sleep if you stay with me.
Okay, I will.
- Synced and corrected by Firefly - - www.addic7ed.com -