- Previously on The Resident... - How are your surgical error
and complication rates? Transparency and accountability
force us to weed out the bad and grow the good.
- How you doing today, Lily? - Dr. Hunter caught my cancer
when other doctors missed it.
She's the only person that I trust.
As of this moment, you are no longer
going to be assigned to any of my patients.
Oh, don't worry about it. Don't worry...
Hey, move, move, move!
Oh, God...
Hang on, we're almost at Atlanta General.
No, not Atlanta General. Chastain Park.
Dr. Hawkins. I want Conrad Hawkins!
Breathe slow.
What's going on?
Lily's having a panic attack.
She's hyperventilating a little bit.
- She can't feel her fingers and toes. - Cup your hands.
Breathe into them slowly.
She just had an infusion at Lane's clinic.
Oh, God.
The chemo was so strong this time.
I think it's gonna kill me.
I mean, she almost gave me that bone marrow transplant.
I wouldn't have survived it, right?
Probably not, because your kidneys were impaired.
But she said it was the only way
to save my life, and-and now she's saying
that this last round of chemo could cure me,
but... both those things can't be true, can they?
Lily, remember when I suggested you get a second opinion?
You can still do it... a different oncologist
can examine your whole case and make sure the doses and drugs
you're getting are appropriate... Nic can give you a referral.
She worked for a great oncologist, Dr. Osder.
- - Yes, and I would trust her with my life.
She's careful, conservative, brilliant.
And I can call her right now if you want.
They need me in the ER.
I've got her.
35-year-old female with severe right-lower quadrant
abdominal pain and vomiting since this morning.
She's tachy and diaphoretic.
- Let's move her to Trauma Two. - Catherine?
Conrad?
- What do we got? - Could be an appy?
No, she had her appendix out in high school.
- Catherine? - Pulse is weak,
- but it's still there. - All right.
Probably vagalled from the pain.
Bolus her a liter and send a GI panel
with a stat hematocrit and EKG.
- Right away. - Conrad...
Conrad?
- Synced and corrected by Shazi89 - - www.addic7ed.com -
Thank you so much for picking these guys up from the shelter.
Oh, my gosh, they're adorable.
Look at these little faces... how can you resist?
I'm not a dog person.
Or a cat person.
Or a people person.
But the kids in pediatric are going to love them.
- Hey, you got that? - Yeah.
All right you guys.
- Oh! - Guys...
- Look, a dog! - A puppy!
I want a puppy.
Hey, guys,
I want you to be really,
really, really gentle with the puppies, okay?
This is mine.
Here's Donut.
- Doggy, doggy, doggy! - Be gentle.
- I have Jellybean. - And Jellybean, Brownie.
- Do you guys want Brownie? - I want to hold him.
You do? Okay, you can take it.
This is Cookie. Yeah, there you go.
That's Lifesaver.
Yeah, they're little.
Thank you.
- Jellybean! - Oh.
Oh, see hold his head down.
Jellybean!
- Oh. You got kissed. - Jellybean.
Oh, sweetie.
Oh, don't fall.
I'm getting hyperglycemic. Too much sugar.
Go, and thank you so much.
That's okay. They growl sometimes.
- Yeah? - Okay, remember to hold it...
There, you see. Lift him back over this way.
Oh, my goodness.
What are you doing here, you little darling?
Ah, ready to get some fresh air in the courtyard, Edna?
Oh, I'd rather just go to my room today, Harold.
Can't do. Doctor's orders.
Look at this face, though.
I want this one so much.
All five are available
- for adoption. - Five.
I only see four.
Lifesaver, Jellybean, Brownie, Donut.
Where's Cookie?
- Where's Cookie? - Aw!
- Ah. Wow. - Cookie!
I'm gonna check the hallway.
You're in charge, okay?
- Where is Cookie?! - We'll find her.
- We'll find her. We'll find her. - Cookie! Cookie!
She had rapid infusion, but I think we should up
- her meds. - Okay. Good.
Maybe up to 500 milligrams?
Yeah, that would work.
- What's concerning me is... - Oh.
Welcome back. You fainted from the pain.
We've given you some morphine. You should be feeling better.
Thank heavens you were here.
What has it been? Like, ten years?
Eleven.
Not that I'm counting.
I just moved back to Atlanta last month.
I heard that you were, um, working here.
When did the pain start?
It's been off and on for about a-a month.
I haven't been able to keep anything down, and then,
last night, it just became unbearable.
My husband's been away, so I was all alone.
It's lower.
I remember when you got that... in El Paso.
We stole my mom's car, and drove all night.
- Mm. -We were gonna hit Mexico and keep going.
I didn't even have my driver's license.
I don't know if I've ever done anything more romantic.
That joy ride got me a one-way ticket to military school,
but I liked it better than living with my dad.
Remember when he called me trailer trash?
He'd eat his words now. You look amazing.
- Hey. - Catherine,
this is Nurse Practitioner Nic Nevin.
Nic, Catherine Loy.
We're admitting her for acute abdominal pain.
Oh, I'm sorry to hear. Nice to meet you, Catherine.
We're old friends.
Oh, it's a bit more complicated than that.
Conrad was my fianc�.
I haven't seen Catherine in 11 years.
She's happily married.
- Can we talk about this? - You mean the fact that there's
this whole other part of your life that you never mentioned?
- Nope, not my business. - Nic.
Let's talk about Dr. Hunter.
Okay. What about her?
Lily's finally safe. Dr. Osder
will take care of her, but what about her other patients?
You're the only one who can keep an eye on them
since she doesn't trust Devon anymore.
Fine. Leave it to me. I'll do whatever I have to do
- to stay in her good graces. - Cool. Thanks.
- That's a great idea. - Terrific, yeah...
Lane? Lane?
Do you got a second?
Of course. What can I do for you?
I owe you an apology.
I undercut you with your patient.
I encouraged him to stop treatment
when you still had help to offer.
I was way out of line. It's been bothering me a lot.
I'm sorry.
I've been thinking a lot about that case, too.
I always say, never give up, but sometimes, I ought to.
I don't agree.
You've pulled off some miraculous cures.
I've also seen a lot of people that should have gone home
die alone in our ICU, getting chemo that wasn't working.
The tricky part is that you just never know
who can beat the odds.
Trying to make that call must be incredibly hard on you.
It is... actually.
No one thinks about the effect on doctors
when they have to watch their patients suffer.
That bone marrow transplant I almost gave to Lily...
I wake up in a cold sweat every night thinking about it.
- No one is perfect. - I have to be.
There's too much at stake.
I cannot make mistakes like that ever.
I'm sorry. I'm sorry for getting emotional.
Not at all.
You care.
That's why you're a great doctor.
Oh. Thank you.
Thank you, Conrad.
I'll see you later.
I lost two pounds.
That was the foot, Chad.
Comfort food.
You're diabetic.
This isn't on your approved diet.
You're my doctor, not my nanny.
I can't help you if you don't help yourself.
Look, I'm not married. I don't have a girlfriend.
I live with my mother.
There's only one thing that gets me out of bed in the morning...
a Belgian waffle with whipped cream on it.
Food can be an addiction.
It is my job to get you on a diet plan and a new exercise program.
Um...
maybe next time.
Where's my foot?
Come on, Edna, where's the puppy?
I don't know what you mean.
I saw you put Cookie under your lap blanket.
I found her in the hall.
But when Harold took me outside to the courtyard, she got away.
I couldn't catch her.
All right. I'll call security
and see if they can look for her outside.
This is just awful.
Precious. Mm.
Hey!
Yes. We love you.
Do you understand how serious this is?
I'm the healthiest fat guy you've ever seen.
You aren't healthy, Chad. You have diabetes
and worsening peripheral vascular disease.
- When am I cutting off your other foot? - Never.
We'll get it for sure if you don't shape up.
Might have to take the next one above the knee.
Start picking out a wheelchair.
She always like that?
Pretty much.
Check out these puppies.
You could take one home.
A dog is a great way to start a walking program.
He needs a forever home.
- You need an exercise buddy. - Oh.
Oh! Well, either he likes me or he tastes chocolate frosting.
His name is Donut.
Karma.
They'd've named him Quinoa, no deal.
How you feeling?
I'm flying high on some pretty fine drugs.
We'll have to adjust those, because I have some news.
You're pregnant.
Are you sure?
I'm positive.
Oh, my God, that's fantastic.
We've been trying for almost two years.
We even tried IVF, but nothing worked.
I cannot wait to... tell my husband.
Excellent.
The OB team is coming in to make sure all is well with the baby.
They'll do an ultrasound, see how far along you are.
Check the baby's heart.
I'm also ordering an X-ray to check your abdomen.
Is that... is that safe for the baby?
Absolutely.
Conrad...
you have no idea what this means to me.
I have a damn good idea.
We both came from broken families. You always wanted kids of your own.
I'm so happy for you.
Go on.
Ask me anything. I know you want to.
Why didn't you marry her?
She left me after I punched my father in the nose
- at the rehearsal dinner. - Wow.
He told Catherine I didn't really love her
and that the marriage was gonna be a disaster, so I decked him.
Right in front of the guests, including her family.
- No, you didn't. - I did.
And I had a fine time doing it, but...
Kate was afraid he was right.
And how do you feel about her now?
I did love her.
I don't love her anymore.
But I care about her very much, and I want to fix her.
Congratulations.
Your divorce is final.
Highway robbery.
Well, I hope you made a bundle on the house.
I barely paid off the mortgage. I bought it in 2008
at the height of the market, and now I'll be shelling out alimony
for the next ten years.
What's this?
My bill. It's three months past due.
I'm sorry, Randolph, but...
we're gonna have to start charging interest.
OB says she's six weeks and four days by ultrasound.
Normal intrauterine pregnancy. Good cardiac activity in the 150s.
What do you think I'm looking for?
All her symptoms say bowel obstruction.
Gold star, Harvard.
Now, tell me, what do you see?
Dilated bowel loops
and air fluid levels consistent with an SBO.
Surgery?
Standard of care is non-op management first.
And abdominal surgery on a pregnant woman? That's risky.
Priya's here.
I don't think you've formally met yet.
Priya, this is Dr. Conrad Hawkins and Nic Nevin.
- Thank you for helping us, Priya. - Of course.
Priya is a journalist, and she's
researching a cancer cluster for a story.
I asked her if she could find any information on Dr. Hunter's patients.
I used social media posts to find people Dr. Hunter treated,
and I ended up talking to about 15 people.
- What did you find? - All of them
had good things to say about Dr. Hunter.
Many repeated the same line. "She saved my life."
Did any of the patients have health problems
that were caused by the doses?
Two had heart damage.
One was infertile. Bone density decreased.
One man lost all his teeth.
None of that is unusual with chemo.
The most amazing thing I found
was four patients had a total remission
for cancers that are considered incurable.
I don't believe it.
Total remissions for cancers that are incurable?
I mean, it sounds incredible.
And it does show we have a steep hill to climb.
Miraculous cures can be used to justify her doses.
I get it. She's your mentor.
- But you got to trust me. - I talked to her,
and she seemed genuinely crushed by the error
she almost made with Lily. She cried, Nic.
- She cried? She is an excellent liar. - Yes.
And she will be just that good on the stand if we get that far.
We have to be careful. Lane is highly respected.
She makes millions of dollars for Chastain.
If we take her on and lose, our careers will be over.
I can't believe you're worried about your career right now.
All I'm saying is, if by some chance
that second opinion comes back in Lane's favor,
don't do anything until we get more information.
People could be dyind and you want me to wait for more information?
I thought you knew me better than that.
But then again, why should I be surprised? Since, apparently,
I never really knew you either.
It's too good to be true. Something's wrong here.
Then I'll dig deeper.
And I'll cheer you up at dinner.
Do you have anything special planned?
Today's the 28th, right?
30th.
Oh, Priya, you should've said something. I've been so busy at work
I completely lost track of time.
Happy birthday.
Whoa.
Mina,
where can I get an amazing present for Priya
that I can have delivered in two hours?
You're so asking the wrong person.
I could order flowers, but...
I don't know... it's not enough. It's her birthday.
I don't understand about birthdays.
What does it matter what day you were born?
It matters to every woman I've ever known.
Not this one.
Mina, have you ever been in love?
Don't do that. Don't ask stupid questions.
- Too personal? - No, no, not personal.
I said "stupid." You're a doctor. You should know
that romantic love is just a trick the brain plays on you
to get you to pump out babies.
Thank you for coming to meet with me, Randolph.
It's always a pleasure, Claire. What can I do for you?
Well, after our last board meeting, I did some digging
and found out we're doing a really poor job at monitoring our own errors.
Surgical errors can be easily covered up just by saying that
- they're complications. - Well...
I think you can trust the doctors at Chastain.
Apparently not. According to Medscape,
21% of physicians feel it's okay
to hide a mistake that harms a patient under certain circumstances.
- That is shocking. - Isn't it?
So I have decided
to shine a light on the physicians
that have the highest rate of complications
and get rid of them.
That's a radical move.
You know, to be brutally honest, we cannot handle one more lawsuit.
How can I help?
I have installed recording devices on every camera in every OR.
Starting today, there will be no hiding
from problematic performances or outcomes.
After you've rested a bit, Dr. Pravesh is gonna place a nasogastric tube
that will empty the contents of your stomach.
It should relieve the pain
and hopefully resolve the blockage.
It's not a pleasant procedure,
but there is a good chance that it'll make it possible
for you to avoid surgery.
Let's redraw another set of labs, and page me
as soon as we have the results.
Nic is gonna take great care of you.
- Thank you so much. - We'll catch up more later.
Okay.
Devon.
Conrad is so different.
He's nothing like the guy I almost married.
Oh, yeah? What was he like?
He was a wild man.
A real rebel.
Which was, um, part of the appeal.
But he was always emotionally distant.
He, um... wouldn't let me in.
Sounds like he hasn't changed at all.
No, he has.
He's so, um...
so grown-up
and, um, responsible and...
- gentle. - Well, that is because
you're his patient.
Okay, you're gonna feel...
a little prick here.
There we go.
How long have you been in love with him?
What makes you say that?
You're, um...
you're wearing the ring he gave you.
Belonged to his mother. Did you know that?
No.
He loved her very much.
You must mean a great deal to him
if he gave it to you.
Lane Hunter.
Dr. Hunter. This is Dr. Mary Osder.
I think we met once at a conference
on advances in breast cancer management.
Of course. You were the keynote. How can I help you, Mary?
I've just had a call from one of your patients
who's looking for a second opinion.
Okay. Happy to help. Who is it?
Uh, Lily Kendall.
Well, that's surprising.
I mean, Lily's had a rough road, but she's in the middle
of what we expect is her final round of chemo.
Rough road, indeed.
I'll do a full review of her case, so I'll need her records.
Of course.
I'll get you everything from her current treatment plan.
Well, you know as well as I do that won't be sufficient.
I'll need everything going back to her original diagnosis
and the doctor who first referred her.
Absolutely. Not a problem.
You know, Mary, I am so glad she came to you.
Um, who can I thank for this referral?
I believe she got my name from a terrific nurse
I've known for several years, Nic Nevin.
Are you ever in surgery?
You've been playing with that dog all day.
I am in love with Lifesaver, and I'm taking him home.
Puppies are way better than boyfriends.
I'll take that one.
Jellybean?
This will definitely work.
- What's going on? - Catherine's labs.
Not good. Her white count and lactate.
Her bowels are being strangulated.
- Whoa, whoa, whoa, whoa. - Help me.
- Right here. I'm right here. - Okay.
She's tachy at 137.
BP's dropping.
Diffuse guarding.
I think her intestines are getting ischemic.
She needs emergency exploratory surgery. Who's on call for gen surg?
- Dr. Bell. - Damn it.
And now they're calling me to the ER. Devon?
I got it. Nic.
- Okay. - Got it.
You're good. You're good. You're good.
It's Lily Kendall. They were called to her home.
She's hypotensive, vomiting. They're having a hard time
getting her blood pressure up with fluids.
She thinks it's a reaction
- to the chemo this morning. - Lily.
It's Dr. Pravesh. We're here for you, okay?
- What's her IV access? - She got a 22 in her hand.
It's going really slow. We couldn't get another line.
She feels cold. Place a large bore
antecubital line and bowl us two liters.
Send off a lactate and blood cultures.
- Grab cefepime to cover for sepsis. - I need a warming blanket over here.
- How is she? - She's in shock.
We're waiting on labs, but she's hypotensive and hypothermic.
We need to know exactly what drugs she got and the dosages.
Of course. She's on HiDAC chemo.
Cytarabine, 3,000 milligrams per meter squared.
Catherine's being prepped for surgery. What's going on?
It's Lily.
She had a severe reaction to her chemo this morning.
We're admitting her.
Oh, God.
- Dr. Bell. - I have to scrub in.
Who's the first woman you ever fell in love with?
You on drugs? What kind of question is that?
Your first great passion. The one who changed your life.
- My first great passion... - Mm-hmm.
was surgery. My father took me to see
an operation when I was ten years old.
It's the only love that's lasted.
My first great passion is the woman you're about to operate on tonight.
Who are you?
'Cause you're not Conrad Hawkins.
Must be one of your ham-fisted manipulations.
'Cause we don't talk like this, and we're not about to start now.
I understand why you can't walk away. I get it.
But this woman is deeply important to me,
and she's pregnant. Two lives are at stake.
Well, let me spell this out for you. It's emergency surgery.
I contacted Jude.
He's already here.
He'll take it.
I have 30 years of experience you can't match.
A lifetime of work to testify to my ability.
You're a rank amateur who deludes himself that he's learned
to play the game, but you just break things,
and that is gonna catch up with you in the end.
I've done probably...
a thousand similar procedures.
Do I need to do one tonight?
Not particularly.
You owe me.
It was too much.
I-I don't want any more chemo.
Hush, honey.
Every one of my patients has said that at some point.
We'll talk tomorrow, okay?
Devon, come with me.
I'm going to stay with her.
Dr. Pravesh,
please help me.
I'm scared.
It's okay. You're safe now.
Nurse Nevin. Can we talk for a moment?
- Sure. - I was wondering
if you would take over supervising Lily's care again.
Starting immediately.
I don't understand.
I-I know.
We started off on the wrong foot, and it was entirely my fault.
These last few weeks, I've come to realize
that you're one of the finest nurse practitioners we have at Chastain.
Lily needs you.
And she deserves to have you.
Well, I'd do anything for Lily.
Thank you.
Thanks for coming in
- on your day off. - Yeah, of course, man.
She's about six weeks pregnant, so you'll need
- to be extra careful around the uterus. - I know what I'm doing.
Nic told me all about her, okay? Don't stress.
I looked at the imaging.
I'll lyse the adhesions,
remove any of the unhealthy segments,
and she can be home in a couple days.
Wait.
About Nic...
Two women left me for the same reason.
You deserve Nic.
You can give her what I can't.
Thank you.
All right.
Incise the peritoneum.
I'll fix this sucker.
Opening now.
Her-her abdomen. It's filled with blood.
All right. Find where it's coming from.
I can't tell. I can't see a thing.
- Pressure's dropping. - All right, stay calm, everyone.
I need lap pads, and hook up more suction. Call the blood bank now.
Suction.
What's happening?
She's bleeding internally.
It's not the bowel.
No ischemia.
Packing to find the source.
BP's down to 65.
Hang two units wide open.
Come on, come on. Go, go.
Come on.
Come on. Come on, come on, come on.
We need more blood.
Call for the rapid infuser.
Activate the massive transfusion protocol.
Checked the liver. No, no bleeding.
No bleeding in the aorta
or IVC, either.
Come on.
Damn it.
Come on, we're losing her.
She has an ectopic. It must have ruptured.
You said it was an intrauterine pregnancy.
She has both. There's a second pregnancy in the right tube.
I just saw it on the ultrasound. OB missed it.
Check the pelvis.
He's right. I see bleeding at the right mesosalpinx.
Clamp.
Bleeding is controlled.
Pressure's back up to 95.
Make sure to continue the transfusion protocol.
I'll page GYN.
Thanks.
And we will continue to fix the obstruction.
That was a close one.
Yeah.
Hey.
I heard there was a complication. Is she okay?
We almost lost her.
What happened?
She presented with an ectopic ready to burst.
OB missed it, and it did.
In their defense, it was entwined with the bowel.
That's super rare. One in a 100,000?
Mina's gonna write it up as a case report.
- Lily? - She's doing better.
You here all night?
Yeah, I'll stay for them both.
Hey, Conrad?
Yeah.
When did your mom give you this ring?
When I left for Afghanistan.
Why didn't you tell me it belonged to her?
I wanted you to feel like it was yours alone.
She said, "Give it to the love of your life."
You want it back?
No.
You earned it.
Look at you sitting up.
And is that a smile?
Please, can I hold it?
Oh, my God, Cookie. I've been looking
for this little girl all day.
Hello. Come here, baby.
That's her name? Cookie?
Yeah.
Well, this goes against all rules, but I don't care.
Here you go. There you go.
Hi.
Can I keep her?
You can. She's all yours.
Hi.
Uh, Nic, I need you to give Lily
a liter with 40 milliequivalents of potassium.
You sure you want to give her that much?
Her renal function just started trending toward normal.
Thank you for being so vigilant,
but low potassium levels are not good for Lily's heart.
Just give it to her slowly over the entire shift so she can handle it.
Okay. Got it.
I'm on my way out for the night.
Are you gonna be around for a while?
Uh, I'm done in the next 15 minutes,
but I'll make sure I do this before I go.
Great. Thank you.
Mel, see you in about a half hour.
All right.
- Randolph? - Yeah.
I have a favor to ask you.
Okay.
Can I take you to dinner?
No. I'll take you.
Great.
Now?
Hello.
Hey.
Lily.
She's in V tach. Pulse is thready.
- We need a crash cart now. - Get her up.
Okay. Okay.
I'm dying. Please.
- Please help me. - Stay with me. Stay with me.
I'm right here. I'm right here.
Stay with me. Stay with me.
Stay with me.
Let's get the pads on her.
Possible chemo-induced cardiomyopathy.
Uh, go get her admission EKG.
Bolus 150 of amio and start a drip.
We lost her pulse.
Charge to 200.
- Ready. - Clear.
She's in V fib.
Continue CPR, push one of epi.
Her EKG was normal. This is...
Call for a stat echo. Hold CPR.
- No pulse. - Still V fib on the monitor.
Charge to 300.
- Ready. - Clear.
Charge to 360!
- Ready. - Clear.
That was our third round.
Push 100 of lidocaine and shock again at 360.
Shock again at 360!
Come on, come on, come on.
Come on with that lidocaine, come on.
Come on.
- Ready. - Clear.
Asystole.
I got it. I got it, I got it.
Dr. Hawkins?
Asystole for 20 minutes.
You got to call it.
You have to stop now.
Time of death...
21:58.
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