1 00:00:00,980 --> 00:00:02,600 Previously on The Resident... 2 00:00:02,610 --> 00:00:04,820 Everything you thought you knew about medicine is wrong. 3 00:00:04,830 --> 00:00:06,870 All the rules you followed, we'll break. 4 00:00:06,880 --> 00:00:08,820 You don't have the right to play God, Conrad. 5 00:00:08,830 --> 00:00:11,640 I will do whatever it takes to get you back. 6 00:00:11,650 --> 00:00:13,070 Chief of surgery. 7 00:00:13,710 --> 00:00:15,710 Resident. Try to remember that. 8 00:00:18,610 --> 00:00:20,400 Dr. Okafor. 9 00:00:20,410 --> 00:00:22,400 Don't be nervous. I'll talk you through it. 10 00:00:22,610 --> 00:00:25,370 Acute leukemic, on chemo. 11 00:00:25,380 --> 00:00:26,910 Lily means a lot to all of us. 12 00:00:26,920 --> 00:00:29,380 She's been in and out of the ER so often we're all invested. 13 00:00:29,390 --> 00:00:31,330 - Where's Lily Kendall? - She went home. 14 00:00:31,340 --> 00:00:33,010 Her count improved substantially. 15 00:00:53,580 --> 00:00:55,640 - We're in third place. - Now or never. 16 00:00:55,650 --> 00:00:56,980 Sir, yes, sir. 17 00:00:59,890 --> 00:01:02,780 Second place. 18 00:01:02,790 --> 00:01:04,610 Oh, I know how you feel about losing. 19 00:01:19,350 --> 00:01:20,760 - We got this. - We do? 20 00:01:20,770 --> 00:01:22,230 I do. 21 00:01:50,100 --> 00:01:51,990 15th Marine Expeditionary. 22 00:01:52,000 --> 00:01:55,160 Valor, honor... Whoa... 23 00:01:55,170 --> 00:01:57,200 - Victory. - Yo! 24 00:01:57,210 --> 00:02:00,170 Dudes. Awesome race! 25 00:02:00,180 --> 00:02:02,600 Of course... random drunk guy. 26 00:02:02,610 --> 00:02:03,680 Cold ones on me. 27 00:02:07,020 --> 00:02:09,640 Aah... aah! 28 00:02:09,650 --> 00:02:12,650 My leg! I need a doct... 29 00:02:12,660 --> 00:02:14,320 It's broke. 30 00:02:14,330 --> 00:02:15,480 Doctor! 31 00:02:21,300 --> 00:02:23,120 Right fibula. Compound fracture. 32 00:02:23,130 --> 00:02:26,490 We need a splint. 33 00:02:26,500 --> 00:02:29,000 - Oh, it hurts. It hurts so bad. - Deep breaths, buddy, 34 00:02:29,010 --> 00:02:31,490 we don't want you going into shock. What's your name? 35 00:02:31,500 --> 00:02:33,000 - Ooh. Hank. - That's the best we got. 36 00:02:33,010 --> 00:02:35,980 - We'll just wrap him up. - Like old times... medic and surgeon? 37 00:02:35,990 --> 00:02:37,490 He's about to tell us how much he misses 38 00:02:37,500 --> 00:02:39,680 the good ol' days when we were in Afghanistan together. 39 00:02:39,690 --> 00:02:41,880 Give me some credit, hey. All right, listen, 40 00:02:41,890 --> 00:02:44,010 this is gonna sting. Might want to bite down on that. 41 00:02:44,020 --> 00:02:46,550 - But I do miss it sometimes. Don't you? - I don't miss 42 00:02:46,560 --> 00:02:48,220 being shot at. No sane person would. 43 00:02:48,230 --> 00:02:50,100 Not trying to take that personally. 44 00:02:51,160 --> 00:02:53,220 Setting the leg... 45 00:02:53,230 --> 00:02:55,060 now! 46 00:02:55,070 --> 00:02:57,230 There we go. All right. 47 00:02:57,240 --> 00:02:59,560 Doing great, buddy. 48 00:03:03,240 --> 00:03:05,610 Let's go! 49 00:03:17,740 --> 00:03:20,150 - Synced and corrected by Shazi89 - - www.addic7ed.com - 50 00:03:25,060 --> 00:03:27,050 Lily, hey. 51 00:03:27,060 --> 00:03:28,720 Oh, hey, Nic. 52 00:03:28,730 --> 00:03:31,230 You left Chastain so abruptly the other day. I was worried. 53 00:03:31,240 --> 00:03:32,930 Yeah, I'm fine. Thank you. 54 00:03:32,940 --> 00:03:35,030 Just grabbing a prescription. 55 00:03:35,410 --> 00:03:37,660 You feeling okay? 56 00:03:37,680 --> 00:03:40,070 You want to come upstairs? I can take your temperature, 57 00:03:40,080 --> 00:03:41,900 - make sure you don't have a fever. - No, no, I'm good. 58 00:03:41,910 --> 00:03:44,290 Yeah, I'll stop by Dr. Hunter's clinic if I need anything. 59 00:03:44,300 --> 00:03:45,410 - You sure? - Mm-hmm. 60 00:03:45,420 --> 00:03:47,720 - 'Kay. - Thanks. 61 00:03:54,830 --> 00:03:56,150 Come on, Mr. Rosenthal. 62 00:03:56,160 --> 00:03:58,590 I got to take you for some fresh air, and then to PT. 63 00:03:58,600 --> 00:03:59,920 No, thanks. 64 00:03:59,930 --> 00:04:02,420 What I need is a drink and smoke. 65 00:04:02,430 --> 00:04:05,160 Good morning, Mr. Rosenthal. 66 00:04:05,170 --> 00:04:08,430 Lucky you... a free ride with Louisa, our most popular transpo worker. 67 00:04:08,440 --> 00:04:10,100 Ah, just a quick spin. 68 00:04:10,110 --> 00:04:12,430 Don't want a spin around nothing. 69 00:04:12,440 --> 00:04:14,300 - You need sunshine. - Vitamin D, 70 00:04:14,310 --> 00:04:15,640 helps you absorb calcium. 71 00:04:15,650 --> 00:04:17,090 Which promotes bone density. 72 00:04:17,110 --> 00:04:19,130 You don't want to break your hip again, do you? 73 00:04:19,140 --> 00:04:21,180 You know, you should really listen to Louisa. You know why? 74 00:04:21,260 --> 00:04:23,940 - No, why? - She's studying to be a doctor. 75 00:04:23,950 --> 00:04:25,350 Med school, huh? 76 00:04:25,360 --> 00:04:26,830 You got a ways to go. 77 00:04:26,840 --> 00:04:28,130 How old are you, 12? 78 00:04:28,140 --> 00:04:29,800 Ah, close. 22. 79 00:04:29,810 --> 00:04:32,200 And she volunteered at Chastain all through high school. 80 00:04:32,210 --> 00:04:33,670 - Hmm. - Hi, Louisa. 81 00:04:33,680 --> 00:04:34,840 - Hey. - Nic, seriously, 82 00:04:34,850 --> 00:04:36,570 what is this mandatory meeting about? 83 00:04:36,580 --> 00:04:37,720 I have 30 patients to see. 84 00:04:37,820 --> 00:04:39,240 - Billing. - Billing? 85 00:04:39,250 --> 00:04:42,310 Whoa, sign me up. Love me some billing. 86 00:04:42,320 --> 00:04:43,610 Enough already. 87 00:04:43,620 --> 00:04:45,890 You okay? 88 00:04:45,910 --> 00:04:49,050 Yeah. Diagnosed myself with a muscle pull this morning. 89 00:04:49,770 --> 00:04:51,290 Some kind of softball injury. 90 00:04:51,300 --> 00:04:53,780 Might have to, uh, skip out early today. 91 00:04:53,790 --> 00:04:56,330 Plus, I have to cram. Midterms next week. 92 00:04:56,340 --> 00:04:57,350 Bio and calc. 93 00:04:57,360 --> 00:04:58,790 Well, if you need any help at all, 94 00:04:58,800 --> 00:05:00,910 I got a 132 on the bio section of my MCATs. 95 00:05:00,920 --> 00:05:02,730 Kid brags a lot, doesn't he? 96 00:05:02,740 --> 00:05:03,900 Thanks, Dr. Pravesh. 97 00:05:03,910 --> 00:05:06,010 I might take you up on that offer. 98 00:05:19,700 --> 00:05:22,120 Compound fracture of the right fibula. 99 00:05:22,130 --> 00:05:24,790 Now, we reset it in the field, but he might need surgery. 100 00:05:24,800 --> 00:05:26,190 All right. I'll be right there. 101 00:05:26,200 --> 00:05:28,120 - We'll see you inside. - Okay. 102 00:05:28,130 --> 00:05:30,090 - Thanks, Doc. - Let's go. 103 00:05:30,100 --> 00:05:32,290 You did great, Hank. 104 00:05:32,300 --> 00:05:33,800 Yeah, except for the crying. 105 00:05:33,810 --> 00:05:36,760 - And screaming for a doctor. - And breaking all those beer bottles. 106 00:05:37,900 --> 00:05:39,630 The truth? That was like old times. 107 00:05:39,640 --> 00:05:41,570 Well, you miss it so much, why don't you go back? 108 00:05:41,580 --> 00:05:43,040 Yeah, I've been meaning to tell you. 109 00:05:43,050 --> 00:05:44,810 Jude, I was joking. 110 00:05:46,130 --> 00:05:47,590 Thinking about re-enlisting. 111 00:05:47,600 --> 00:05:49,570 - Back into the Marines? - Yeah. 112 00:05:50,320 --> 00:05:52,060 - Do boys ever grow up? - Yes. 113 00:05:52,070 --> 00:05:53,650 - No. - Mandatory meeting, we're late. 114 00:05:53,660 --> 00:05:55,380 I thought you were gonna get us out of this? 115 00:05:55,390 --> 00:05:57,140 Yeah, well, I told her we had seven open cases... 116 00:05:57,220 --> 00:06:00,310 All residents, all nurses. Let's go. 117 00:06:01,980 --> 00:06:03,160 You smell like a barn. 118 00:06:03,170 --> 00:06:05,160 - I like barns. - Never been in one. 119 00:06:05,170 --> 00:06:06,730 What? I grew up in Queens. 120 00:06:06,740 --> 00:06:08,660 I've smelled worse, trust me. 121 00:06:08,670 --> 00:06:10,640 - Excuse me. - Morning, everyone. 122 00:06:10,650 --> 00:06:14,000 We're here today to talk about reimbursement. 123 00:06:14,010 --> 00:06:16,000 No one's favorite part of the day, right? 124 00:06:16,010 --> 00:06:17,280 Okay, put that away, sweetie. 125 00:06:17,290 --> 00:06:20,010 Now, to simplify, doctors and nurses at Chastain 126 00:06:20,020 --> 00:06:21,840 need to charge more per procedure. 127 00:06:21,850 --> 00:06:24,350 For example: ear infection. 128 00:06:24,360 --> 00:06:27,580 Typically billed to insurance as service code one 129 00:06:27,590 --> 00:06:29,730 at about... yeah? 130 00:06:31,430 --> 00:06:32,970 $200. 131 00:06:32,980 --> 00:06:35,860 But what if that ear infection took a trip to the brain? 132 00:06:35,870 --> 00:06:39,190 That's now a code four. Serious. 133 00:06:39,200 --> 00:06:40,400 Costly. 134 00:06:40,410 --> 00:06:42,360 We can bill in the thousands. 135 00:06:42,370 --> 00:06:45,980 Illness is unpredictable, so billing must be proactive. 136 00:06:46,000 --> 00:06:48,750 Right? It's called upcoding. 137 00:06:49,360 --> 00:06:51,990 Think... CUTE. 138 00:06:52,180 --> 00:06:55,610 Code. Up. To. Excellence. 139 00:06:55,620 --> 00:06:59,210 Enjoy. I'm out. 140 00:06:59,220 --> 00:07:00,920 Third year. First year. 141 00:07:00,930 --> 00:07:04,070 Welcome to American healthcare 101. 142 00:07:05,200 --> 00:07:08,300 Okay, what are we all concerned about? 143 00:07:10,300 --> 00:07:11,930 How much did you have to drink today? 144 00:07:11,940 --> 00:07:13,430 Not really sure. 145 00:07:13,440 --> 00:07:15,200 You were at the race all morning? 146 00:07:15,210 --> 00:07:17,870 Which Conrad and I won, by the way. 147 00:07:17,880 --> 00:07:19,930 I had a beer before the race. 148 00:07:19,940 --> 00:07:22,270 Jaundiced skin, scleral icterus. 149 00:07:22,280 --> 00:07:24,470 I'm sending him for a liver panel and an ultrasound. 150 00:07:24,480 --> 00:07:25,940 How's our number one fan? 151 00:07:25,950 --> 00:07:27,320 You see this? 152 00:07:27,340 --> 00:07:30,130 This is a stateside doctor, doing what he was born to do... 153 00:07:30,140 --> 00:07:33,950 running liver function tests in a cushy, big-city ER. 154 00:07:35,790 --> 00:07:38,190 ? I am the very model ? ? Of a modern major-general ? 155 00:07:38,200 --> 00:07:40,420 ? I've information vegetable, ? ? animal and mineral ? 156 00:07:40,430 --> 00:07:43,660 ? I know the kings of England and I quote the fights historical... ? 157 00:07:43,670 --> 00:07:45,240 I was also born to sing. 158 00:07:50,780 --> 00:07:52,270 You get out on the boat this weekend? 159 00:07:52,280 --> 00:07:54,300 Yeah, the fish weren't biting. You? 160 00:07:54,310 --> 00:07:56,120 Well, a little golf. 161 00:07:58,320 --> 00:08:00,280 You know, actually, I had a question for you. 162 00:08:00,290 --> 00:08:02,800 Old guy I was playing with has developed a bit of a tremor. 163 00:08:02,810 --> 00:08:05,290 And it's giving him the yips. And I prescribed the standard... 164 00:08:05,300 --> 00:08:07,750 beta blockers... but it hasn't helped. 165 00:08:07,760 --> 00:08:10,330 You know, I know there's surgery, but it seems a little drastic. 166 00:08:10,340 --> 00:08:12,970 Well, cracking open his head for a missed putt is a bit much, huh? 167 00:08:12,980 --> 00:08:14,350 Yeah, what about benzodiazepines? 168 00:08:14,360 --> 00:08:16,960 Last resort, he can try 'em. But the side effects are gonna be... 169 00:08:16,970 --> 00:08:19,330 - Aggression and cognitive impairment. - Yeah. 170 00:08:19,340 --> 00:08:21,800 I guess it just depends how desperate the guy is, though. 171 00:08:21,810 --> 00:08:23,600 - Cheers. - Cheers. 172 00:08:33,050 --> 00:08:36,280 Rosenthal in 5931... catheter out and discharge. 173 00:08:36,290 --> 00:08:37,980 Anderson 5942... 174 00:08:37,990 --> 00:08:40,880 Monitor her rhythm. Where were you and Dr. Silva deployed? 175 00:08:40,890 --> 00:08:42,650 Afghanistan. 176 00:08:42,660 --> 00:08:44,190 If she spikes a fever, you add... 177 00:08:44,200 --> 00:08:45,790 IV piperacillin. 178 00:08:45,800 --> 00:08:48,160 My brother was in the army, two tours in Iraq. 179 00:08:48,170 --> 00:08:50,290 He came back a very different guy. 180 00:08:50,300 --> 00:08:53,030 Did you see any action? 181 00:08:53,040 --> 00:08:55,530 I was a corpsman in the Marines. 182 00:08:55,540 --> 00:08:56,830 Jude was a base surgeon. 183 00:08:56,840 --> 00:08:58,570 We tried to save lives, not take them. 184 00:08:58,580 --> 00:09:00,500 But mostly, we had each other's back. 185 00:09:00,510 --> 00:09:03,870 Now let's move on to medicine. We have a busy day ahead of us. 186 00:09:03,880 --> 00:09:06,370 Let me know if there's anything in the marketing department... 187 00:09:06,380 --> 00:09:07,410 Look busy. 188 00:09:07,420 --> 00:09:10,070 - ... the upcoding system. - Don't forget testing. 189 00:09:10,090 --> 00:09:11,690 A well-insured patient should be tested 190 00:09:11,700 --> 00:09:13,830 for all possible outcomes, no matter how unlikely. 191 00:09:15,690 --> 00:09:19,020 Dr. Hawkins, have you met Barb Olsen? 192 00:09:19,030 --> 00:09:20,220 She's our billing consultant. 193 00:09:20,230 --> 00:09:22,520 Here for two weeks to help Chastain become more efficient. 194 00:09:22,530 --> 00:09:24,360 Of course. The bike shorts. 195 00:09:24,370 --> 00:09:27,230 Yeah, I already saw you at my presentation... well, briefly. 196 00:09:27,240 --> 00:09:28,360 I got paged. 197 00:09:28,370 --> 00:09:30,540 Didn't I get paged? 198 00:09:31,540 --> 00:09:32,910 I didn't hear anything. 199 00:09:34,950 --> 00:09:36,770 Well, nice meeting you. 200 00:09:36,780 --> 00:09:38,940 Barb, there's, um... 201 00:09:38,950 --> 00:09:42,240 Payback. For making me sit in that presentation. 202 00:09:42,250 --> 00:09:44,150 What's your problem? 203 00:09:44,160 --> 00:09:46,350 A strong kid like you... can't you go any faster? 204 00:09:46,360 --> 00:09:47,780 I got a life to lead. 205 00:09:47,790 --> 00:09:50,120 Hey, Louisa, how's my man Rosenthal treating you? 206 00:09:50,130 --> 00:09:51,790 Like the daughter he never had. 207 00:09:51,800 --> 00:09:52,860 A nightmare. 208 00:09:52,870 --> 00:09:55,790 The Chastain softball team crushed Emory yesterday. 209 00:09:55,800 --> 00:09:57,860 Yeah, we did. 210 00:09:57,870 --> 00:09:59,960 Is your back still bothering you? 211 00:09:59,970 --> 00:10:01,960 Uh, yeah, it's no big deal. 212 00:10:01,970 --> 00:10:04,800 Now I'm thinking it's a pinched nerve, lumbar spine. 213 00:10:04,810 --> 00:10:07,620 Pain that, uh, radiates along the affected nerve. 214 00:10:07,700 --> 00:10:10,140 That's impressive, but you're not quite a doctor yet. Let me have a look. 215 00:10:10,150 --> 00:10:11,170 Uh, maybe later. 216 00:10:11,180 --> 00:10:13,840 I told Joey in Ped Onc I'd take him to the play area. 217 00:10:13,850 --> 00:10:16,950 Man, that munchkin is cute. 218 00:10:19,320 --> 00:10:21,200 Check back in with her in an hour. 219 00:10:21,220 --> 00:10:22,720 I just want to examine her and make sure... 220 00:10:24,030 --> 00:10:26,130 Hey! We need some help in here! 221 00:10:29,470 --> 00:10:32,290 - Oh, my God, I'm sorry. - It's okay. 222 00:10:33,470 --> 00:10:34,500 It's okay, stay still. 223 00:10:34,510 --> 00:10:36,000 We got you. 224 00:10:36,980 --> 00:10:39,020 I'm too young for kidney stones. 225 00:10:39,080 --> 00:10:41,750 I'm thinking it's just a gas bubble. It's really no big deal. 226 00:10:41,760 --> 00:10:44,090 How long have you been short of breath? 227 00:10:44,100 --> 00:10:45,390 Just a few days. 228 00:10:45,400 --> 00:10:47,560 I was thinking it was from the pain. 229 00:10:47,570 --> 00:10:50,560 Your lungs sound congested. 230 00:10:50,570 --> 00:10:52,900 We need a full workup. 231 00:10:52,910 --> 00:10:54,100 This could be serious. 232 00:10:54,110 --> 00:10:56,070 No, I'm okay. I swear. 233 00:10:56,130 --> 00:10:58,200 I can't be sick, they'll send me back home. 234 00:10:58,210 --> 00:11:00,090 And I need every dime to make ends meet. 235 00:11:00,100 --> 00:11:01,640 And a CT scan as well. 236 00:11:01,650 --> 00:11:03,410 MRI's probably the better option. 237 00:11:03,430 --> 00:11:05,690 Actually, maybe we should check her insurance first. 238 00:11:05,700 --> 00:11:07,360 - Uh, can this wait? - No. 239 00:11:07,370 --> 00:11:09,030 Can I have moment with the patient, please? 240 00:11:09,040 --> 00:11:11,050 We're conducting an exam here. 241 00:11:11,060 --> 00:11:13,720 Dr. Hawkins, the administration has given me license 242 00:11:13,730 --> 00:11:16,140 to inspect all hospital finances. 243 00:11:16,850 --> 00:11:18,970 You're a subcontractor to the hospital, right? 244 00:11:18,980 --> 00:11:20,640 Yes. Is this really necessary? 245 00:11:20,650 --> 00:11:23,240 I'm feeling better. I just want to go home. 246 00:11:23,300 --> 00:11:23,980 Rest up. 247 00:11:23,990 --> 00:11:25,650 She wants to go home. Great. 248 00:11:25,660 --> 00:11:28,150 She can't. She needs an MRI. 249 00:11:28,160 --> 00:11:30,650 Do you know if your company will cover an MRI? 250 00:11:30,660 --> 00:11:33,020 Does anyone know that stuff? 251 00:11:33,030 --> 00:11:35,390 Then if it doesn't, an X-ray is more than sufficient. 252 00:11:35,400 --> 00:11:36,920 Actually, it isn't. 253 00:11:36,930 --> 00:11:38,560 Louisa is part of the Chastain family. 254 00:11:38,570 --> 00:11:40,960 - She deserves our best care. - Well, I can see 255 00:11:40,970 --> 00:11:42,460 that she's a wonderful young woman... 256 00:11:42,470 --> 00:11:43,730 I can't do this. 257 00:11:43,740 --> 00:11:45,680 I'm sorry, thank you, but I'll just leave. 258 00:11:47,680 --> 00:11:51,180 It would be wise for you to let her go. 259 00:11:57,020 --> 00:11:59,030 Wow. Really? 260 00:12:01,560 --> 00:12:02,920 Louisa... 261 00:12:06,590 --> 00:12:08,420 Easy. Easy. 262 00:12:08,430 --> 00:12:09,500 There you go. 263 00:12:11,150 --> 00:12:12,270 Pulse is weak. 264 00:12:12,280 --> 00:12:14,960 Distant heart sounds, distended jugular veins. 265 00:12:14,970 --> 00:12:16,100 Cardiac tamponade. 266 00:12:16,210 --> 00:12:17,570 Too unstable to move. 267 00:12:17,580 --> 00:12:20,960 I need 18-gauge spinal needle with a 20cc syringe. 268 00:12:20,980 --> 00:12:22,660 I'll prep the ultrasound in exam room four. 269 00:12:22,680 --> 00:12:23,680 Good. Go. 270 00:12:23,690 --> 00:12:25,210 Louisa, you have fluid around your heart. 271 00:12:25,220 --> 00:12:27,000 We're going to relieve the pressure. 272 00:12:27,010 --> 00:12:28,460 You cut, I draw. 273 00:12:41,470 --> 00:12:42,960 Quickly, we're losing her. 274 00:12:42,970 --> 00:12:44,100 Ready. 275 00:12:46,200 --> 00:12:49,240 Now, Louisa, you're gonna feel pressure and then stinging. 276 00:13:00,590 --> 00:13:02,320 You're okay, Louisa. 277 00:13:14,070 --> 00:13:16,090 Another loud noise 278 00:13:16,100 --> 00:13:17,830 and we're almost done. 279 00:13:17,840 --> 00:13:19,800 Don't worry, just a few more minutes. 280 00:13:22,980 --> 00:13:24,260 Get her out of that machine. 281 00:13:24,270 --> 00:13:26,050 - We're almost finished. - She's not insured. 282 00:13:26,060 --> 00:13:28,300 She can't pay for her treatment, that's why she ran away. 283 00:13:28,410 --> 00:13:30,050 Or maybe she didn't want to burden the hospital. 284 00:13:30,060 --> 00:13:32,480 Well, it's a little late for that, 'cause Chastain is gonna have 285 00:13:32,500 --> 00:13:34,400 to eat the cost of that MRI. That's $10,000. 286 00:13:34,410 --> 00:13:36,480 $10,000 is what they charge the insurance company. 287 00:13:36,490 --> 00:13:38,040 It doesn't cost the hospital anything like that. 288 00:13:38,060 --> 00:13:40,320 Are you offering to pay? 289 00:13:40,330 --> 00:13:42,650 Here, for your intake files. 290 00:13:42,660 --> 00:13:45,570 I will call her employer, see what I can negotiate. 291 00:13:49,270 --> 00:13:51,700 God, I hate that woman. 292 00:13:51,710 --> 00:13:54,330 You and I will run point on Louisa's care. 293 00:13:54,480 --> 00:13:56,400 We need to get as much done as we can 294 00:13:56,410 --> 00:13:58,050 before the administration pulls the plug. 295 00:13:58,060 --> 00:13:59,340 We can't let them kick her out. 296 00:13:59,350 --> 00:14:00,690 Well, don't panic yet. 297 00:14:00,700 --> 00:14:02,600 Worst case, we guide her to another hospital. 298 00:14:02,610 --> 00:14:05,930 Where she never even makes it past ER triage. 299 00:14:06,320 --> 00:14:07,440 Trust me. 300 00:14:12,360 --> 00:14:13,830 LFT panel. 301 00:14:15,900 --> 00:14:17,880 Hank, you have acute hepatitis. 302 00:14:18,930 --> 00:14:20,360 Is that bad? 303 00:14:20,370 --> 00:14:22,790 It means that you've consumed so much alcohol 304 00:14:22,800 --> 00:14:24,550 that your liver's temporarily paralyzed. 305 00:14:24,560 --> 00:14:27,500 - It's quite a feat, actually. - Exactly how many beers did you have? 306 00:14:27,510 --> 00:14:30,650 - Two... - Two beers? 307 00:14:33,050 --> 00:14:36,340 Two dozen. 308 00:14:36,350 --> 00:14:38,780 If you don't cut back, your liver's gonna stop functioning. 309 00:14:38,790 --> 00:14:41,810 Your stomach will swell, you're gonna become confused, then sleepy, 310 00:14:41,820 --> 00:14:43,950 you slip into a coma, then you die. 311 00:14:43,960 --> 00:14:46,190 I'm not trying to scare you, it's just the truth. 312 00:14:46,200 --> 00:14:48,440 You're drinking yourself to death. 313 00:14:52,390 --> 00:14:54,000 I know. 314 00:14:55,210 --> 00:14:56,250 Help me? 315 00:14:57,290 --> 00:14:59,080 I can get you into a rehab facility. 316 00:14:59,090 --> 00:15:00,560 I can't do rehab. 317 00:15:00,570 --> 00:15:02,150 I'd lose my job. 318 00:15:02,520 --> 00:15:04,530 But the rest of it, yeah. 319 00:15:04,820 --> 00:15:06,780 I'm ready to quit. 320 00:15:06,790 --> 00:15:09,050 I am. I've struggled with alcohol my whole life. 321 00:15:09,490 --> 00:15:11,180 Look, the moment I walk out of there, 322 00:15:11,200 --> 00:15:13,210 I swear, I will go straight to a meeting. 323 00:15:13,220 --> 00:15:16,750 I'll get a sponsor, I'll stay in AA the rest of my life. 324 00:15:16,760 --> 00:15:20,470 That's easy to say, pal. It's hard to do. 325 00:15:25,350 --> 00:15:28,940 Atwood, Henry, two of Lorazepam for withdrawal. 326 00:15:29,410 --> 00:15:30,690 Thank you, Doctor. 327 00:15:30,700 --> 00:15:32,930 You can do whatever you want, it's not gonna help. 328 00:15:32,940 --> 00:15:35,170 His problem is self-inflicted. 329 00:15:35,180 --> 00:15:37,260 Hell, 90% of the patients that come in here 330 00:15:37,270 --> 00:15:38,780 have done stupid stuff to themselves. 331 00:15:38,790 --> 00:15:40,400 Remind me how you got that scar on your thumb. 332 00:15:40,440 --> 00:15:43,180 - Wasn't it field-dressing a possum? - I was nine years old. 333 00:15:43,190 --> 00:15:44,930 And I treated the injury myself. 334 00:15:44,940 --> 00:15:45,990 Of course you did. 335 00:15:46,000 --> 00:15:47,800 It still doesn't explain why you eat possum. 336 00:15:48,160 --> 00:15:50,950 Yeah, we all didn't have moms who would shop and cook for us. 337 00:15:50,970 --> 00:15:53,380 Or dads who were sober enough to drive us to the ER. 338 00:15:53,390 --> 00:15:55,280 Exactly, and that's why I'm here... 339 00:15:55,490 --> 00:15:57,980 to help whoever walks in that door who can't help themselves. 340 00:15:57,990 --> 00:16:00,370 It doesn't matter whether they eat lobster or road kill. 341 00:16:00,380 --> 00:16:01,650 I take care of them. 342 00:16:02,640 --> 00:16:03,960 All right. 343 00:16:04,680 --> 00:16:05,840 Let me ask you this. 344 00:16:07,460 --> 00:16:10,470 What is the most fun you have had in the last week? 345 00:16:11,350 --> 00:16:12,840 My guess? 346 00:16:12,850 --> 00:16:16,640 You and me fixing up Hank in the back of that pickup truck. 347 00:16:16,650 --> 00:16:19,710 Seat-of-our-pants medicine. Nobody telling us what to do 348 00:16:19,720 --> 00:16:21,340 or making us fill out forms. 349 00:16:22,030 --> 00:16:23,810 Then what happens? 350 00:16:24,390 --> 00:16:26,180 We come back to work, 351 00:16:26,190 --> 00:16:29,760 and a patient is trying to run away because she doesn't have insurance. 352 00:16:30,090 --> 00:16:32,620 We can't even treat someone who's worked at Chastain 353 00:16:32,630 --> 00:16:34,170 for the past two years. 354 00:16:35,970 --> 00:16:39,410 How many wounded Marines did you ever ask for proof of insurance? 355 00:16:40,040 --> 00:16:41,670 Well... 356 00:16:41,680 --> 00:16:44,870 I guess I got my work cut out for me, then, don't I? 357 00:16:44,880 --> 00:16:46,580 You keep tilting at windmills, huh? 358 00:16:48,250 --> 00:16:51,240 - Currently on any medications? - No, but I'm... 359 00:16:51,250 --> 00:16:53,300 Have you eaten anything in the last eight hours? 360 00:16:53,310 --> 00:16:54,710 I'm not having surgery today. 361 00:16:56,490 --> 00:17:00,110 It says here, "Reynolds, hernia surgery, 2:15." 362 00:17:00,120 --> 00:17:02,730 - I'll be assisting. - I'm having some more tests. 363 00:17:02,740 --> 00:17:05,320 - Excuse me? - A very nice lady came in 364 00:17:05,330 --> 00:17:07,980 and talked my doctor into ordering some more blood work. 365 00:17:07,990 --> 00:17:10,300 Another CT scan and an MRI. 366 00:17:10,310 --> 00:17:12,770 You don't need an MRI, you need hernia surgery. 367 00:17:12,780 --> 00:17:15,070 She said I needed it to be on the safe side. 368 00:17:15,080 --> 00:17:16,910 She was very convincing. 369 00:17:18,440 --> 00:17:20,370 Why is my hernia patient having more tests? 370 00:17:20,390 --> 00:17:23,240 - He doesn't need more tests. - Another Barb victim. 371 00:17:23,250 --> 00:17:26,440 Profit before patients... the new healthcare mantra. 372 00:17:26,500 --> 00:17:28,990 Barb is like a migraine. You can feel it coming, 373 00:17:29,000 --> 00:17:30,100 but you can't stop it. 374 00:17:30,110 --> 00:17:32,150 Then it gets worse and worse, and you throw up. 375 00:17:32,160 --> 00:17:35,240 What do you guys think of the name "Say Ah" 376 00:17:35,250 --> 00:17:37,670 for a resident-nurse a cappella group? 377 00:17:38,250 --> 00:17:40,340 "Say Ah"? 378 00:17:40,350 --> 00:17:43,320 Yeah, you know, to serenade patients. 379 00:17:45,600 --> 00:17:47,560 No one wants you to sing them a song. 380 00:17:50,890 --> 00:17:53,560 The meaner she is to me, the more I'm in awe of her. 381 00:17:53,570 --> 00:17:55,640 Yeah, that's kind of how it works. 382 00:17:57,160 --> 00:17:58,620 Wow. 383 00:18:03,280 --> 00:18:05,640 You got Louisa's results? 384 00:18:07,930 --> 00:18:09,900 This is a T2 hyperintense, 385 00:18:09,910 --> 00:18:12,570 enhancing mass, encasing the spleen, kidney, 386 00:18:12,580 --> 00:18:14,200 and vertebral bodies. Most consistent with... 387 00:18:14,210 --> 00:18:15,840 A retroperitoneal sarcoma. 388 00:18:15,850 --> 00:18:17,870 Which would explain the fluid in her heart. 389 00:18:17,880 --> 00:18:20,410 She lied to us. And to her employer. 390 00:18:20,420 --> 00:18:22,650 She didn't run away because she doesn't have insurance, 391 00:18:22,660 --> 00:18:25,440 she ran away because she's an undocumented immigrant. 392 00:18:31,120 --> 00:18:33,220 She has a highly aggressive tumor. 393 00:18:33,480 --> 00:18:36,110 If she doesn't get surgery right away, she dies. 394 00:18:38,640 --> 00:18:40,310 No more tests, 395 00:18:40,320 --> 00:18:42,380 no more treatment on our dime. 396 00:18:42,600 --> 00:18:44,540 This hospital isn't a charity. 397 00:18:56,370 --> 00:18:59,020 I felt this was important enough to bring to the CEO's office 398 00:18:59,090 --> 00:19:00,990 right away. Ms. Rodriguez is an uninsured, 399 00:19:01,000 --> 00:19:02,790 undocumented immigrant. 400 00:19:02,800 --> 00:19:04,750 She has no family in this country. 401 00:19:04,760 --> 00:19:07,590 She was brought here from El Salvador as a child. 402 00:19:07,600 --> 00:19:10,090 No one can take her once she leaves the hospital. 403 00:19:10,100 --> 00:19:11,820 State rules are clear on this. 404 00:19:11,830 --> 00:19:15,830 Ms. Rodriguez cannot be released into her own care. 405 00:19:15,840 --> 00:19:18,730 That means Chastain would be stuck with her for a long time. 406 00:19:18,740 --> 00:19:22,670 She'd be living here at our expense. 407 00:19:22,680 --> 00:19:23,970 She would be a Perma Patient. 408 00:19:24,030 --> 00:19:25,660 Not every CEO knows that term. 409 00:19:25,670 --> 00:19:27,560 Claire is not your average CEO. 410 00:19:27,620 --> 00:19:29,610 Dr. Bell, what's her prognosis? 411 00:19:29,620 --> 00:19:31,710 Well, the five-to ten-year survival rate is excellent 412 00:19:31,720 --> 00:19:34,170 if we operate right away, but... 413 00:19:35,060 --> 00:19:36,950 the longer we wait, the worse her odds. 414 00:19:36,960 --> 00:19:39,390 And if her surgery is successful, what's the rehab? 415 00:19:39,400 --> 00:19:42,730 Six months to a year. 416 00:19:43,570 --> 00:19:46,240 Okay, best-case scenario, 417 00:19:46,250 --> 00:19:48,480 what is Louisa's care gonna cost us? 418 00:19:48,490 --> 00:19:51,320 Chastain does the surgery, it goes well, post-op, 419 00:19:51,330 --> 00:19:53,650 she can walk with a physical therapist down the hall... 420 00:19:53,660 --> 00:19:55,150 half a million dollars. 421 00:19:55,160 --> 00:19:57,490 And worst case? 422 00:19:57,500 --> 00:20:00,690 Post-op, Ms. Rodriguez can't even get out of the bed... 423 00:20:00,700 --> 00:20:02,270 two million dollars. 424 00:20:12,850 --> 00:20:15,830 Hang in there, your count is moving in the right direction. 425 00:20:16,450 --> 00:20:17,780 Lane. 426 00:20:17,790 --> 00:20:20,880 Hey, Conrad. How are you? 427 00:20:21,120 --> 00:20:23,510 I'd like to call you in for an oncology consult. 428 00:20:24,000 --> 00:20:25,750 Okay. Who's the patient? 429 00:20:25,760 --> 00:20:29,050 Louisa Rodriquez, transport worker here at Chastain. 430 00:20:29,060 --> 00:20:33,060 Good person. She's uninsured and an undocumented immigrant. 431 00:20:33,070 --> 00:20:35,860 Um, a full course of radiation and chemotherapy 432 00:20:35,870 --> 00:20:37,300 is, uh, very expensive. 433 00:20:37,310 --> 00:20:39,300 I understand, but don't you have a foundation 434 00:20:39,320 --> 00:20:41,390 - for cases like this? - Yes, I do, 435 00:20:41,410 --> 00:20:43,800 but it's not for the undocumented. 436 00:20:44,370 --> 00:20:47,150 Look, I'll make some inquiries, but I can't make any promises. 437 00:20:47,160 --> 00:20:49,310 - That'd be fantastic. - Conrad. 438 00:20:49,790 --> 00:20:51,690 Administration just put Louisa's surgery 439 00:20:51,700 --> 00:20:54,880 - on indefinite hold. - Lane... 440 00:20:55,290 --> 00:20:58,120 - Louisa's all alone. - I'll see what I can do. 441 00:21:01,130 --> 00:21:03,220 I forgot to tell you I saw Lily earlier. 442 00:21:03,230 --> 00:21:04,390 She didn't look good. 443 00:21:04,400 --> 00:21:05,970 Nic, she has cancer. 444 00:21:05,980 --> 00:21:07,160 I know we've been through this, 445 00:21:07,170 --> 00:21:09,960 and I'm sure Lane had every reason to discharge Lily, 446 00:21:09,980 --> 00:21:13,560 - but my instincts are... - Lane will take care of her. 447 00:21:13,570 --> 00:21:16,610 Lily's in good hands. 448 00:21:20,250 --> 00:21:21,940 Okay, well, I'll be going... Oh, excuse me. 449 00:21:21,950 --> 00:21:23,640 Oh, Nurse Nevin. 450 00:21:23,650 --> 00:21:24,980 If I could just have a moment? 451 00:21:24,990 --> 00:21:26,680 I'm actually really busy right now. 452 00:21:26,690 --> 00:21:29,240 Okay, but I don't think the nurses are getting the hang 453 00:21:29,250 --> 00:21:32,020 of the upcoding system and the multiple-test vectors. 454 00:21:32,030 --> 00:21:33,840 Our nurses are laser-focused on patient care. 455 00:21:33,850 --> 00:21:35,420 That is their primary responsibility. 456 00:21:35,430 --> 00:21:39,790 ? Too late to go back to sleep ? 457 00:21:39,800 --> 00:21:42,500 - ? It's time to trust my instincts ? - Excuse me. 458 00:21:42,520 --> 00:21:45,360 ? Close my eyes ? 459 00:21:45,370 --> 00:21:47,370 ? And leap ? 460 00:21:47,380 --> 00:21:49,870 ? It's time to try ? 461 00:21:49,880 --> 00:21:53,200 ? Defying gravity ? 462 00:21:53,210 --> 00:21:55,720 ? I think I'll try ? 463 00:21:55,730 --> 00:21:58,340 ? Defying gravity ? 464 00:21:58,350 --> 00:22:02,820 ? And you can't hold me down. ? 465 00:22:04,060 --> 00:22:05,480 A little flat. 466 00:22:05,490 --> 00:22:06,980 You're a little flat. 467 00:22:08,460 --> 00:22:09,700 Next! 468 00:22:10,150 --> 00:22:12,960 Claire, this is Jim Phillips, CEO of Atlanta General, 469 00:22:12,970 --> 00:22:14,950 and Stuart Green from our Lady of Mercy. 470 00:22:14,960 --> 00:22:16,690 The three of us go way back. 471 00:22:16,700 --> 00:22:18,820 Ms. Thorpe took over as CEO of Chastain, 472 00:22:18,840 --> 00:22:20,530 - what, six months ago? - Yes. 473 00:22:21,280 --> 00:22:22,830 They're all yours. 474 00:22:22,850 --> 00:22:24,720 Gentlemen, it's lovely to meet you both, 475 00:22:24,730 --> 00:22:26,680 and thank you for coming in on such short notice. 476 00:22:26,690 --> 00:22:28,150 I'll get right to the point. 477 00:22:28,170 --> 00:22:31,450 We have a patient, uninsured, undocumented, 478 00:22:31,460 --> 00:22:33,410 with a retroperitoneal sarcoma. 479 00:22:33,420 --> 00:22:35,800 Possible six months to a year rehab. 480 00:22:35,810 --> 00:22:37,650 Given our fixed costs per bed, 481 00:22:37,660 --> 00:22:40,550 this patient represents a considerable burden on Chastain. 482 00:22:40,560 --> 00:22:42,220 As they would for Atlanta General. 483 00:22:42,230 --> 00:22:44,760 Yes, but Atlanta General and Our Lady of Mercy's fixed costs 484 00:22:44,770 --> 00:22:46,520 are much lower than ours. 485 00:22:46,540 --> 00:22:49,190 What are you suggesting, Ms. Thorpe? 486 00:22:49,200 --> 00:22:51,960 If either one of you will take this patient off our hands, 487 00:22:51,970 --> 00:22:53,300 pre-surgery, 488 00:22:53,310 --> 00:22:57,080 we'll pay a fee, one-time, of $250,000. 489 00:22:59,050 --> 00:23:01,500 If you can funnel us five Medicare patients 490 00:23:01,510 --> 00:23:04,880 and up the fee to $300,000, we'll consider it. 491 00:23:04,890 --> 00:23:06,850 What if I offered you 492 00:23:06,860 --> 00:23:11,020 five Medicaid patients and $250,000? 493 00:23:11,030 --> 00:23:13,050 Medicaid reimbursements are junk. 494 00:23:14,050 --> 00:23:15,350 Ten Medicaid and 300 grand. 495 00:23:16,880 --> 00:23:19,940 I'm offering seven Medicaid and 275. 496 00:23:21,070 --> 00:23:23,190 Too low. We're out. 497 00:23:26,680 --> 00:23:29,630 Stuart, Our Lady of Mercy has a charity fund. 498 00:23:29,640 --> 00:23:31,760 What if we did the surgery and you did the rehab? 499 00:23:31,770 --> 00:23:35,440 We could give your fund $100,000 that you could use at your discretion. 500 00:23:35,450 --> 00:23:37,300 We just built a new cardiac wing. 501 00:23:37,310 --> 00:23:39,490 Which is a-a beautiful wing. 502 00:23:39,500 --> 00:23:41,020 Cost us $40 million. 503 00:23:41,030 --> 00:23:43,550 And I am sure that you will make that back in fees in no time. 504 00:23:44,440 --> 00:23:46,750 My board would kill me if we took another Perma Patient. 505 00:23:46,760 --> 00:23:49,050 I'm gonna to have to pass. 506 00:23:49,060 --> 00:23:50,600 I'm sorry. 507 00:23:58,470 --> 00:24:00,770 Who can we call, Louisa? 508 00:24:01,440 --> 00:24:03,380 You must have family here. 509 00:24:04,550 --> 00:24:07,130 My parents brought me here when I was three years old. 510 00:24:07,470 --> 00:24:09,770 My mom died two years ago, 511 00:24:09,790 --> 00:24:12,580 and my dad moved back to El Salvador. 512 00:24:12,590 --> 00:24:14,750 I'm alone. 513 00:24:16,970 --> 00:24:18,690 And you support yourself? 514 00:24:19,390 --> 00:24:20,950 Yeah. 515 00:24:22,980 --> 00:24:25,230 I guess I was crazy to think I'd make it to med school 516 00:24:25,240 --> 00:24:26,590 without being found out. 517 00:24:26,600 --> 00:24:28,610 If Immigration gets their hands on me, 518 00:24:28,620 --> 00:24:30,600 they'll send me back, no questions asked. 519 00:24:31,450 --> 00:24:34,170 But this is the only country I've ever known. 520 00:24:34,180 --> 00:24:36,280 And to be a doctor... 521 00:24:37,790 --> 00:24:39,700 that's my dream. 522 00:24:41,000 --> 00:24:44,090 I'm so sorry to cause all this trouble, Dr. Pravesh. 523 00:24:44,380 --> 00:24:47,180 Everyone at Chastain has been nothing but good to me. 524 00:24:47,630 --> 00:24:51,050 Louisa, we're going to help you, and you deserve better than this. 525 00:24:52,120 --> 00:24:54,150 I looked up the surgery on my phone. 526 00:24:55,460 --> 00:24:57,990 Cancer wrapped around a lot of organs. 527 00:24:59,370 --> 00:25:01,460 Pretty dangerous stuff, huh? 528 00:25:02,190 --> 00:25:03,230 Yes. 529 00:25:03,650 --> 00:25:04,700 It is. 530 00:25:04,710 --> 00:25:08,000 But we both know it is the only road to a cure. 531 00:25:08,860 --> 00:25:11,930 Do you know how some people say they're not afraid of dying? 532 00:25:12,150 --> 00:25:14,340 That's crazy, right? 533 00:25:14,350 --> 00:25:18,710 It scares the hell out of me. 534 00:25:18,720 --> 00:25:22,180 Louisa, you're going to be a doctor someday. 535 00:25:22,190 --> 00:25:24,720 Helping you get there... 536 00:25:24,730 --> 00:25:27,560 that's our dream. 537 00:25:37,400 --> 00:25:38,510 Hey. 538 00:25:39,500 --> 00:25:41,800 I, uh, checked with my foundation, 539 00:25:41,810 --> 00:25:43,730 and got a fast, hard no. 540 00:25:44,540 --> 00:25:48,340 Our donors expect their gifts to pay for the treatment of U.S. citizens. 541 00:25:48,350 --> 00:25:52,360 There are plenty of deserving Americans out there waiting for a chance. 542 00:25:54,330 --> 00:25:55,820 Ugh. 543 00:25:55,830 --> 00:25:58,920 I hate to disappoint you, Conrad, that's the hardest part. 544 00:25:58,930 --> 00:26:00,790 Thanks for trying. 545 00:26:03,280 --> 00:26:06,700 You know, we do the best we can, 546 00:26:06,710 --> 00:26:08,820 as often as we can. 547 00:26:10,890 --> 00:26:12,890 But we can't save everyone. 548 00:26:22,480 --> 00:26:24,990 You're all post-surgery, and you all want to go home. 549 00:26:25,000 --> 00:26:26,590 So today, we're going to have a race. 550 00:26:26,650 --> 00:26:29,520 Whoever gets to the end of the hallway first gets discharged. 551 00:26:29,580 --> 00:26:31,610 No more poking, needles, BP checks. 552 00:26:31,620 --> 00:26:34,770 You can cook your own meals, take a warm shower. Sound good? 553 00:26:34,780 --> 00:26:36,680 If you can't walk to the end of the hallway, 554 00:26:36,690 --> 00:26:37,950 you're here for another week. 555 00:26:37,960 --> 00:26:39,680 One, two, three. Go. 556 00:26:43,090 --> 00:26:44,690 Too slow, Mrs. Pill. You're done. 557 00:26:46,670 --> 00:26:48,670 Mr. Farragut, the same. 558 00:26:53,670 --> 00:26:55,200 No time to treat a heart attack, 559 00:26:55,210 --> 00:26:57,040 Mr. Smith, off you go. 560 00:26:59,480 --> 00:27:02,490 Discharge the winners. The losers can go back to their rooms. 561 00:27:02,500 --> 00:27:04,640 Take it easy, all right? You're gonna be fine. 562 00:27:04,700 --> 00:27:06,030 - Culling the herd? - Yep. 563 00:27:06,040 --> 00:27:07,320 Administration won't allow. 564 00:27:07,330 --> 00:27:08,930 - Louisa's surgery. - Unfortunate. 565 00:27:08,940 --> 00:27:10,330 But I heard she is undocumented. 566 00:27:10,340 --> 00:27:11,700 Rules are rules. 567 00:27:11,710 --> 00:27:13,970 Am I crazy, but aren't you and me supposed to be 568 00:27:13,980 --> 00:27:16,540 in the trenches together on situations like this? 569 00:27:16,550 --> 00:27:18,820 Please, tell me this is not actually how you feel. 570 00:27:18,830 --> 00:27:20,070 What I feel doesn't matter. 571 00:27:20,350 --> 00:27:21,440 What I feel doesn't help. 572 00:27:21,450 --> 00:27:23,010 I deal in facts. 573 00:27:23,070 --> 00:27:24,590 Okay. Fine. 574 00:27:24,600 --> 00:27:28,500 Because the hospital is trying to save money, Louisa might die. 575 00:27:28,690 --> 00:27:29,180 Fact. 576 00:27:29,190 --> 00:27:32,090 She might die from surgery, too. Fact. 577 00:27:32,100 --> 00:27:33,850 Love the optimism. 578 00:27:33,860 --> 00:27:35,520 How dangerous is it, Mina? 579 00:27:35,530 --> 00:27:38,160 Very intricate, very demanding. 580 00:27:38,170 --> 00:27:40,330 Seven, eight hours. 581 00:27:41,080 --> 00:27:42,630 But glorious. 582 00:27:42,640 --> 00:27:44,710 Sounds like it's right up your alley. 583 00:28:11,670 --> 00:28:14,870 Conrad, we all feel terrible for Louisa. 584 00:28:15,910 --> 00:28:17,900 She's an enormous liability. 585 00:28:17,910 --> 00:28:21,210 As much as two million dollars over the course of her treatment. 586 00:28:23,120 --> 00:28:26,250 Look, I get that it's a bottom-line world. 587 00:28:26,260 --> 00:28:27,340 You made that clear. 588 00:28:27,350 --> 00:28:29,210 But I want you to think back for a moment, 589 00:28:29,220 --> 00:28:31,010 to when you were in med school. 590 00:28:31,020 --> 00:28:34,380 It wasn't all about making money. 591 00:28:34,390 --> 00:28:36,380 That was a long time ago. 592 00:28:36,390 --> 00:28:38,020 Healthcare has changed since then. 593 00:28:38,030 --> 00:28:40,020 We need to deal with the new reality. 594 00:28:40,030 --> 00:28:42,790 I think we can both agree 595 00:28:42,800 --> 00:28:45,560 that every doctor has that singular moment 596 00:28:45,570 --> 00:28:47,370 when they decide they're going into medicine. 597 00:28:47,380 --> 00:28:49,530 For you, to be a surgeon. 598 00:28:49,540 --> 00:28:52,260 And even if it was decades ago, I'd bet everything I got 599 00:28:52,280 --> 00:28:53,960 you remember it like it was yesterday. 600 00:28:53,970 --> 00:28:56,030 And I don't buy for one second 601 00:28:56,040 --> 00:29:01,470 that it had anything to do with money. 602 00:29:01,480 --> 00:29:03,140 It didn't. 603 00:29:03,480 --> 00:29:05,240 I fell in love with cutting. 604 00:29:05,990 --> 00:29:08,810 I fell in love with the OR. 605 00:29:09,530 --> 00:29:10,710 I love it. 606 00:29:12,360 --> 00:29:13,510 Still. 607 00:29:14,100 --> 00:29:18,060 But the money has to come from somewhere. 608 00:29:18,070 --> 00:29:20,760 If we treat Louisa, our other patients will suffer. 609 00:29:20,770 --> 00:29:22,590 Services will be cut. 610 00:29:22,600 --> 00:29:24,600 Hours, staff. 611 00:29:24,610 --> 00:29:26,990 You know, I don't like the idea of putting a price tag 612 00:29:27,010 --> 00:29:28,470 on a life any more than you do. 613 00:29:28,480 --> 00:29:31,740 But the system doesn't run on air. 614 00:29:31,750 --> 00:29:34,240 No matter how much we love Louisa, 615 00:29:34,320 --> 00:29:35,610 her price tag 616 00:29:35,620 --> 00:29:39,090 is not two million dollars. 617 00:29:44,980 --> 00:29:46,300 Don't say anything. 618 00:29:46,310 --> 00:29:47,490 Nothing. 619 00:29:55,640 --> 00:29:56,730 Catch you at a bad time? 620 00:29:57,160 --> 00:29:58,720 I'd like to shove CUTE right up her... 621 00:29:58,730 --> 00:29:59,820 Throw it in the trash. 622 00:29:59,830 --> 00:30:01,000 You'll feel better. 623 00:30:04,500 --> 00:30:05,650 Look at that. 624 00:30:05,660 --> 00:30:07,320 Stress management. 625 00:30:08,250 --> 00:30:11,390 I'm guessing you didn't come up here to talk to me about upcoding. 626 00:30:11,400 --> 00:30:12,760 No. 627 00:30:12,770 --> 00:30:14,390 It's about your boy, Conrad. 628 00:30:14,400 --> 00:30:16,070 Look, he's taking things hard. 629 00:30:16,080 --> 00:30:18,650 If he doesn't start to choose his battles, he's gonna burn out. 630 00:30:21,230 --> 00:30:23,910 Yeah, well, I can't control Conrad. Never could. 631 00:30:23,920 --> 00:30:26,080 And he's not my boy. 632 00:30:26,090 --> 00:30:28,340 Not anymore. 633 00:30:29,020 --> 00:30:30,620 Sorry to hear that. 634 00:30:34,570 --> 00:30:37,490 Alabama Shakes is playing Terminal West next week. 635 00:30:37,500 --> 00:30:39,760 - Oh, yeah? - Mm-hmm. 636 00:30:39,770 --> 00:30:41,120 I got an extra ticket. 637 00:30:41,130 --> 00:30:42,960 I remember you saying you liked their music. 638 00:30:42,970 --> 00:30:44,510 I do. 639 00:30:46,860 --> 00:30:48,100 It's not a date. 640 00:30:48,110 --> 00:30:49,970 Just a concert. 641 00:30:49,980 --> 00:30:51,300 Have a little fun. 642 00:30:52,610 --> 00:30:56,010 Rapid response, 5922. Let's go. 643 00:30:56,020 --> 00:30:57,790 She's crashing. 644 00:30:57,800 --> 00:30:59,430 - Blood pressure? - 70/40. 645 00:30:59,440 --> 00:31:01,480 - Cycling right now. - Her IV blew in the MRI. 646 00:31:01,490 --> 00:31:03,340 We haven't been able to get another line since. 647 00:31:03,350 --> 00:31:05,630 - She's bleeding internally. - Now it's 60/30. 648 00:31:07,490 --> 00:31:09,220 She's a hard stick. 649 00:31:09,230 --> 00:31:12,120 Her vessels are clamped down, she's too volume-depleted. 650 00:31:12,970 --> 00:31:14,120 Emergency IO. 651 00:31:14,780 --> 00:31:16,890 - Yeah, I've never done that before. - Get the kit. 652 00:31:16,900 --> 00:31:18,070 You're doing it now. 653 00:31:23,840 --> 00:31:25,500 Push the needle in. 654 00:31:25,510 --> 00:31:27,800 Once you hit the bone, drill. 655 00:31:33,320 --> 00:31:35,320 Keep it steady. 656 00:31:44,060 --> 00:31:46,020 Drill. 657 00:31:46,030 --> 00:31:47,700 Okay, release. 658 00:31:52,440 --> 00:31:53,870 Flush. 659 00:32:03,380 --> 00:32:04,540 Running in fluids. 660 00:32:05,400 --> 00:32:06,620 We're in the clear. 661 00:32:06,630 --> 00:32:08,100 - For now. - She'll keep bleeding 662 00:32:08,110 --> 00:32:10,210 until we get her to surgery. 663 00:32:10,220 --> 00:32:12,590 There are four oncology surgeons on call. 664 00:32:12,600 --> 00:32:14,680 Why can't we ask one of them to do the operation? 665 00:32:14,690 --> 00:32:16,190 Good idea. Let's practice that. 666 00:32:16,200 --> 00:32:17,290 I'll be Dr. Hillis. 667 00:32:17,300 --> 00:32:18,620 Go ahead, pitch me the surgery. 668 00:32:18,630 --> 00:32:22,360 Hi, Dr. Hillis, I need a surgical oncologist 669 00:32:22,370 --> 00:32:24,090 to operate on a patient right away. 670 00:32:24,100 --> 00:32:26,400 - Okay, sure, who's the patient? - Louisa Rodriguez. 671 00:32:26,410 --> 00:32:28,130 Actually, I forgot. 672 00:32:28,140 --> 00:32:30,470 I'm booked solid today. 673 00:32:30,480 --> 00:32:31,800 Ask Dr. Miller. 674 00:32:31,810 --> 00:32:33,850 Dr. Miller, I need an oncology surgeon... 675 00:32:33,860 --> 00:32:36,870 Would love to, but I'm headed to Aruba today with my fiancée. 676 00:32:36,880 --> 00:32:39,830 Dr. Singh says the failure rate for this surgery is through the roof. 677 00:32:39,840 --> 00:32:42,020 Dr. Weiss heard the administration is dead set against it... 678 00:32:42,060 --> 00:32:44,210 - The administration is wrong. - Maybe they are, 679 00:32:44,220 --> 00:32:46,720 but Dr. Weiss makes 400K a year, really wants to keep his job. 680 00:32:46,730 --> 00:32:48,220 Okay. 681 00:32:49,560 --> 00:32:52,790 They're gonna wiggle their way out of it any way they can. 682 00:32:52,800 --> 00:32:55,500 But we know someone dying to do the operation. 683 00:32:58,520 --> 00:33:00,400 But it's not in your specialty. 684 00:33:00,410 --> 00:33:03,260 So? I'm arrogant enough to believe I can do it. 685 00:33:03,270 --> 00:33:04,630 And I'm your only option. 686 00:33:04,640 --> 00:33:06,110 Just get an attending to sign off. 687 00:33:07,960 --> 00:33:10,110 I need you to sign off on a surgery. 688 00:33:10,120 --> 00:33:12,440 It's not in your specialty. You'll just be supervising. 689 00:33:12,450 --> 00:33:13,980 Yeah, and what's the catch? 690 00:33:13,990 --> 00:33:15,610 No catch. 691 00:33:16,710 --> 00:33:18,330 Look, I know you, pal. 692 00:33:19,220 --> 00:33:20,920 What rules am I gonna break? 693 00:33:20,930 --> 00:33:22,990 Not breaking. Bending. 694 00:33:23,000 --> 00:33:24,420 Bending, okay. 695 00:33:24,430 --> 00:33:27,330 - Who's the patient? - Louisa Rodriguez. 696 00:33:30,910 --> 00:33:31,950 Oh, I'm in. 697 00:33:36,200 --> 00:33:38,490 Surgery's a go. Mina's on deck. 698 00:33:38,500 --> 00:33:40,980 Conrad, someone called Immigration. They're coming for Louisa. 699 00:33:53,410 --> 00:33:54,700 How can I help you, gentlemen? 700 00:33:54,720 --> 00:33:56,610 - Sir, you need to move aside. - I will, 701 00:33:56,620 --> 00:33:57,870 if you tell me what's going on. 702 00:33:57,880 --> 00:34:00,890 Hospitals are sensitive areas, along with schools and churches. 703 00:34:00,900 --> 00:34:03,940 And sensitive areas cannot be accessed by immigration officials 704 00:34:03,950 --> 00:34:06,350 without arrest warrants or under investigation 705 00:34:06,360 --> 00:34:08,220 of an imminent national security threat. 706 00:34:08,230 --> 00:34:11,850 ICE policy letter, October 24, 2011. 707 00:34:11,860 --> 00:34:14,620 You're interfering with the actions of authorized federal agents. 708 00:34:14,630 --> 00:34:16,380 - You're gonna regret this. - I doubt that. 709 00:34:16,390 --> 00:34:18,270 Well then, you better drag us both out of here. 710 00:34:18,280 --> 00:34:19,410 Conrad. 711 00:34:19,840 --> 00:34:20,900 Stop. 712 00:34:21,210 --> 00:34:23,840 Step aside or you will both be fired. 713 00:34:26,340 --> 00:34:28,050 It's okay. Let them pass. 714 00:34:51,180 --> 00:34:52,590 We need to hurry. 715 00:35:03,280 --> 00:35:06,410 Dr. Okafor, you may proceed. 716 00:35:11,420 --> 00:35:13,380 Surgery's underway. Sterile environment. 717 00:35:13,390 --> 00:35:16,130 You cannot enter under any circumstance. No one can. 718 00:35:35,150 --> 00:35:38,040 ... Pushing us to charge more, and order endless tests. 719 00:35:38,050 --> 00:35:40,580 Yeah, Dr. Pravesh wants the feeding tube out for 4710. 720 00:35:40,590 --> 00:35:42,410 Barb called Immigration. I'm sure of it. 721 00:35:42,420 --> 00:35:44,450 MRI order from Dr. Williams. 722 00:35:44,460 --> 00:35:45,720 Wait. Give that back to me. 723 00:35:47,420 --> 00:35:49,330 - Is this scheduled for right now? - Mm-hmm. 724 00:35:56,670 --> 00:35:58,420 - Pull him out. - What are you doing? 725 00:35:58,430 --> 00:36:00,180 Did you push his doctor to order this test? 726 00:36:00,190 --> 00:36:03,250 - I did. - Without checking the patient history? 727 00:36:05,100 --> 00:36:06,620 Open the microphone. 728 00:36:07,790 --> 00:36:10,110 Mr. Reynolds, do you know how an MRI works? 729 00:36:10,120 --> 00:36:12,510 It has incredibly powerful magnets. 730 00:36:12,520 --> 00:36:14,940 Magnets that will rip anything metal out of your body. 731 00:36:14,950 --> 00:36:16,550 Anything at all. 732 00:36:16,640 --> 00:36:20,110 Do you have anything metal in your body, Mr. Reynolds? 733 00:36:20,340 --> 00:36:22,320 Mr. Reynolds has a penile implant, 734 00:36:22,330 --> 00:36:25,320 a metal-based penile implant. 735 00:36:25,900 --> 00:36:27,990 How much is your penis worth to you, Mr. Reynolds? 736 00:36:28,000 --> 00:36:30,630 Say, in a lawsuit? A million dollars? Five million dollars? 737 00:36:30,650 --> 00:36:32,630 Stop the machine! 738 00:36:32,640 --> 00:36:35,030 You are not a doctor and you are not a nurse. 739 00:36:35,040 --> 00:36:37,970 Not every test is safe. Not every procedure should be billed 740 00:36:37,980 --> 00:36:39,380 for ten times what it's worth. 741 00:36:39,390 --> 00:36:40,800 You're gonna end up getting someone killed. 742 00:36:40,820 --> 00:36:43,120 - Now wait just a second... - I'll be filing an incident report 743 00:36:43,130 --> 00:36:44,870 with the Comptroller's office and the CEO. 744 00:36:44,880 --> 00:36:48,020 Good luck getting hired at Chastain again. 745 00:36:58,460 --> 00:36:59,790 Louisa. 746 00:36:59,800 --> 00:37:01,360 Do you have any nausea? 747 00:37:01,370 --> 00:37:02,620 No. 748 00:37:02,630 --> 00:37:04,960 I feel okay. 749 00:37:06,090 --> 00:37:08,460 You've been so kind to me, all of you. 750 00:37:08,470 --> 00:37:10,460 I'll never be able to repay you for this. 751 00:37:11,220 --> 00:37:14,170 But I'll still need some help on my bio midterm. 752 00:37:14,180 --> 00:37:15,250 Anytime. 753 00:37:16,370 --> 00:37:17,400 So... 754 00:37:17,580 --> 00:37:19,740 the operation came off without a hitch. 755 00:37:19,750 --> 00:37:22,150 You had a spectacular surgeon. 756 00:37:22,720 --> 00:37:23,810 Cake. 757 00:37:24,620 --> 00:37:26,250 What are her rehab markers? 758 00:37:26,710 --> 00:37:29,190 Well, if she can walk to the door, we're in the clear. 759 00:37:29,480 --> 00:37:30,620 If not... 760 00:37:33,000 --> 00:37:35,000 Hey. Well, you look good. 761 00:37:38,070 --> 00:37:40,030 You know, it's really important 762 00:37:40,040 --> 00:37:42,060 that we get you up on your feet right away. 763 00:37:42,170 --> 00:37:44,880 So... how about you get out of bed 764 00:37:44,900 --> 00:37:46,700 and show us how you can walk to the door? 765 00:37:47,880 --> 00:37:50,550 - Okay. - Let's really concentrate. 766 00:37:52,310 --> 00:37:53,590 Here we go. 767 00:38:11,620 --> 00:38:13,190 I'm so sorry. 768 00:38:17,040 --> 00:38:19,010 Two million. 769 00:38:22,140 --> 00:38:23,360 It's okay. 770 00:38:23,370 --> 00:38:25,240 You'll be fine. 771 00:38:39,060 --> 00:38:40,230 Louisa, 772 00:38:40,250 --> 00:38:42,870 rehab is gonna be a long, hard road, 773 00:38:43,330 --> 00:38:45,760 but we all know how tough you are. 774 00:38:45,770 --> 00:38:47,130 You'll get through this. 775 00:38:47,140 --> 00:38:48,460 With some time and care, 776 00:38:48,470 --> 00:38:50,600 you'll be right back where you were in a year or so. 777 00:38:50,610 --> 00:38:52,840 We've got your back the whole way. 778 00:39:08,850 --> 00:39:09,910 Hey, Art. 779 00:39:09,920 --> 00:39:11,000 Randolph. 780 00:39:17,110 --> 00:39:19,760 Hey, uh, how's your golfing buddy doing? 781 00:39:20,170 --> 00:39:22,670 The one with the tremor? He sink any more putts? 782 00:39:23,700 --> 00:39:25,510 Oh, uh... 783 00:39:26,480 --> 00:39:28,200 He just started taking the medication. 784 00:39:28,210 --> 00:39:30,430 - Probably too soon to tell. - Okay. 785 00:39:30,440 --> 00:39:31,970 Well, keep me updated. 786 00:39:31,980 --> 00:39:33,380 Yeah. Yeah. Will do. 787 00:40:06,410 --> 00:40:08,990 Jude and I are gonna go grab a beer. 788 00:40:09,000 --> 00:40:10,550 You want to join? 789 00:40:13,200 --> 00:40:15,910 She's a lot cuter than either of you guys. 790 00:40:16,220 --> 00:40:17,950 True enough. 791 00:40:22,660 --> 00:40:24,760 Enjoying your victory, Dr. Hawkins? 792 00:40:28,430 --> 00:40:29,600 Did you call Immigration? 793 00:40:32,540 --> 00:40:35,030 You had your billing consultant do it for you. 794 00:40:35,040 --> 00:40:37,770 Barb Olsen's contract with this hospital has been suspended. 795 00:40:37,780 --> 00:40:41,370 But I have to pull two million dollars out of thin air. 796 00:40:41,380 --> 00:40:42,610 - I understand... - No. 797 00:40:42,620 --> 00:40:45,340 You will understand full well when I take that money 798 00:40:45,350 --> 00:40:47,740 out of the Internal Medicine and ER budgets. 799 00:40:48,420 --> 00:40:52,130 Be prepared to be woefully understaffed for the next 12 months. 800 00:41:10,080 --> 00:41:13,940 By the way, thank you for today. 801 00:41:13,950 --> 00:41:15,300 Yeah. 802 00:41:15,310 --> 00:41:17,740 Thorpe could've had you canned on the spot. 803 00:41:17,750 --> 00:41:20,040 Well, I get fired, it makes the decision for me, right? 804 00:41:20,050 --> 00:41:23,210 I show up tomorrow at Fort Benning, 6:00 a.m. 805 00:41:23,220 --> 00:41:26,980 Hell, you could be there with me. 806 00:41:26,990 --> 00:41:28,620 Hmm? 807 00:41:28,920 --> 00:41:30,790 All right, so you're starting to come around. 808 00:41:30,800 --> 00:41:32,700 What are you so damn happy about? 809 00:41:32,710 --> 00:41:34,990 Because I know exactly where I'm supposed to be tomorrow, 810 00:41:35,000 --> 00:41:36,900 and it's at Chastain. 811 00:41:38,500 --> 00:41:39,970 Yeah. 812 00:41:42,580 --> 00:41:45,800 Valor, honor... 813 00:41:45,810 --> 00:41:47,780 Victory. 814 00:41:50,240 --> 00:41:51,340 Mm. 815 00:41:51,350 --> 00:41:54,420 I got these. 816 00:41:58,020 --> 00:42:00,750 So, you know, I've been meaning to ask, you and Nic... 817 00:42:00,760 --> 00:42:02,450 that still a thing? 818 00:42:02,460 --> 00:42:04,830 She doesn't think so, but... 819 00:42:06,420 --> 00:42:08,190 I think she's worth fighting for. Don't you? 820 00:42:08,200 --> 00:42:11,590 Oh, hell yeah. Game on. 821 00:42:54,510 --> 00:42:57,670 28-year-old female. Cancer patient. 822 00:42:57,680 --> 00:43:00,910 Short of breath and vomiting. BP's dropping. 823 00:43:00,920 --> 00:43:03,050 Volts and a liter of saline right now... 824 00:43:14,420 --> 00:43:16,880 - Synced and corrected by Shazi89 - - www.addic7ed.com -