Previously on The Resident...
You may not realize his yet, but we're a thing.
Where can I get an amazing present for Priya?
I'll take that one. This will definitely work.
You do whatever the hell I tell you,
no questions asked.
You came in here ready to save lives,
but today, you saved a brain stem
- 'cause you didn't listen to me. - You look well.
- Atlanta suits you. - Why are you here, Dad?
I'm looking for worthwhile investment opportunities.
Making you CEO was the smartest thing we ever did.
I want to introduce you to your new boss, Marshall Winthrop.
Thank you for busting me out of that hospital room.
This is what you need. Fresh air.
No, no, no, don't. I got it.
People will have to take care of you for a while, Micah.
Relax and get used to it.
Yeah, the invalid thing? Not my style.
You're ten days out of major surgery.
Yeah. I get that.
But you know.
What's wrong?
No one wants to talk about what's ahead for me.
Tell me the truth.
What's the average life expectancy of someone after a heart transplant?
You're not average.
You're young and you're strong.
Micah, we almost lost you.
Let's just enjoy this moment.
Right here, right now.
Isn't life beautiful?
You are what's beautiful.
Priya, we have to discipline this dog.
Bad doggy.
Bad, naughty little baby puppy-wuppy.
- That showed him. - Jellybean has got to be
at the wedding.
No, no, not the wedding.
We were having such a nice night.
Have you arranged for someone to teach you Bhangra?
A Bollywood dance would be so much fun.
You can do it for me, can't you?
All right.
You have to make sure the fish isn't overcooked.
Three minutes a side.
And then... taste this.
This new night nurse
keeps texting me about her COPD patient.
It's good, though, right?
I hope so.
Are we talking about the same thing?
- Chastain. - Veggie kabob.
Delicious.
Mullins is out of the ICU.
- Hey. - Hey.
- Give that back. - Hey, hey.
- Give me my phone. - Date night, date night.
We are off duty.
Oh, says the guy who's never off duty.
Who was she?
Love of my life.
Turned out to be a psychopathic doctor
who poisoned her own patients.
She's in jail for murder.
You have a nice night.
Uh, you look a lot like her.
- I can make you forget her. - Don't talk.
Your voice, it's not the same.
You're under arrest for solicitation.
- Synced and corrected by Shazi89 - - www.addic7ed.com -
Here you go. Should fit.
Thanks for arranging bail.
I just made CEO. Can we keep this quiet?
We need a not guilty verdict.
If you're convicted for solicitation,
the law says you have to report the arrest to the state medical board.
- Are you okay? - Yeah.
- Thank you. - You're welcome.
Look out!
Hey. You okay?
Help, I...
I-I can't breathe.
Someone call 911.
Teenage male, blunt abdominal trauma.
Pullman Yard, the meadow.
Roger that.
Medivac Midtown, we have a call.
Call received.
En route to Pullman Yard.
Medivac Midtown just got a call to Pullman Yard.
See if you can beat them to the scene.
Copy you. AirMed Atlanta
turning around and heading to Pullman Yard.
AirMed Atlanta just launched.
They're trying to poach a call, but we can get there first.
On my way.
You'll be fine.
Where the hell is the ambulance?
What the hell?
Look, there's two of them.
There's three of them.
You're okay. Just hold on.
AirMed Atlanta again?
What are you doing here? This is our call!
Pullman Yard is zone three.
- AirMed Atlanta has zone three. - You poached off the police scanner.
- That's the third time... - After you took one of ours last week.
Okay, we got you, buddy. You'll be in the ER in no time.
- What's your name? - Jack.
Jack? All right, where does it hurt? Right here?
Severe abdominal trauma.
Jack, I need you to keep still. We're gonna put a collar on you.
Two weeks ago, Piedmont Park.
- Tell me that wasn't you. - Okay, that was me,
but that was because that patient needed help.
Today I got here first!
- Southeast Air Ambulance One... - Hey, hey, hey. Wait, wait!
we have patient, inbound to Chastain Park.
All right, it's on, Mina.
Oh, no, no, no.
- Ok, that's the best you got? - You won.
- Serious question right now. - Laugh while you still can, my friend.
Very serious question: is that all you got?
Dr. Pravesh. Just the man we were looking for.
Time to grow up and be a role model.
First year med students.
Green as new mown grass.
They get to tour the hospital,
and guess who has the honor of showing them the ropes?
Oh, no. No, no, no, no, no.
Please, I have, I have patients to see.
Take them with.
Impart your wisdom.
- Be their Conrad. - Conrad 2.0.
Uh, no. No. No.
Hi. Aaron Holt.
Hey.
- Justin. - Okay, okay.
Hi. All right. Uh...
(CLICKS TONGUE) Yes, thank you.
You wanted to see me?
No.
He did.
In my opinion, it's wholly inappropriate
for a third year resident to attend a meeting between the CEO
and the chairman of the board.
We're discussing recent unfortunate events at Chastain.
Residents are on the frontline of patient care.
I want my son's input.
Conrad, if you had a magic wand,
what would you do first to improve the hospital?
Easy, weed out problematic staff.
Starting with a resident who breaks the rules
- whenever he damn well pleases? - Excellence comes from the top down.
What is your plan to balance the budget, Dr. Bell?
Increase volume. Screen patients, cut those at risk for nonpayment.
Every single one of those ideas threatens patient safety.
This is a business, it's not a charity.
No money, no mission.
Okay, you want to go there? Yeah, let's go there.
- How much does he make? - A million five.
A million five. Why does Dr. Bell make a million five
when the average hospital CEO salary is $600,000?
(SIGHS) I'm not average.
The CEO at Atlanta General makes $3 million. We both earn every penny.
You have no idea what this job entails.
All ten floors of this hospital rest on my back.
There are 30 departments, 45 surgeons, 200 internists,
ten CT scanners that do not
and will never pay for themselves.
And while you are feeling the pain and triumph
of helping a relative few,
I will be thinking of ways to raise or cut a dollar
so that I can keep you working, nurses attending, janitors cleaning,
those machines humming, so Chastain's patients keep breathing.
Exhibit A.
A medevac helicopter coming here,
and not Atlanta General.
Why? Because I pushed Chastain
to buy that air transport company so it brings patients
to our top-of-the-line, level one trauma center.
Perfect example of profits over patients.
Air ambulances used to be run by the county. Now they're for-profit.
You know how much we charge for that ten-minute flight? 40 grand.
You could fly around the world ten times...
Insurance pays. It's not our problem.
News flash. Millions of people are uninsured.
That flight could equal bankruptcy.
- Would they rather be dead? - Well, that's the option...
- your money or your life? - Gentlemen, enough.
I set up this meeting to find solutions.
Chastain needs revenue to make payroll.
It also needs to be a beacon of excellence.
You both have a point.
You're gonna have to learn to work together.
How long have you been diabetic?
Since I was ten. Three years.
Because you're a minor, we have to wait on your mom.
Okay.
Take a seat, and when she gets here, come back, okay?
14-year-old male,
skating accident, abdominal trauma, BP 80/40
- and dropping. Pulse is 126. - All right, Trauma Ten.
- What's his name? - Jack Alderwood.
- Jack, where's the pain? - Everywhere.
- Jack! That's our son! - All right, on a scale...
Sir, we're gonna take care of him, I promise you.
- We just need some space. - The doctors
are taking good care of your son.
On a scale of one to ten, ten being
- the most severe... - Ten. Can't breathe.
Okay, here's my credit card and insurance.
- Let's get you to registration, okay? - Right now. One, two, three.
We need another large-bore IV.
Hang one liter normal saline, get blood ready.
Trauma to the upper abdomen.
He's distended, diffuse pain.
Okay, hang in there, buddy. You're doing great.
His FAST is positive. Free fluid everywhere. He's bleeding out.
Hang two units O neg. Don't worry.
We're gonna take care of you.
He needs an OR. Where's Nolan?
Bowel surgery. Busy for another three hours.
- Who's available from trauma? - I am.
- You're cardiothoracic. - Well, actually,
I'm triple board certified... cardiothoracic,
general and trauma. I'm also IFR licensed on a twin engine plane,
and I can scuba dive up to 150 feet.
Kill me now.
All right, he's out.
Let's get him to OR One.
Let's look in on your very first patient.
Don't be nervous. There are no wrong answers.
Mr. Warden, these are medical students
rounding for the very first time.
I'd like them to listen to your heart.
Would that be all right with you?
- Sure. Have at it, Doc. - All right.
Heart sounds are notoriously tricky, but they are
a key diagnostic tool. So, what do you think...?
I can clearly hear a diastolic rumble with an opening snap,
which is indicative of mitral stenosis
secondary to rheumatic heart disease.
Actually, I hear a crescendo decrescendo systolic ejection
murmur radiating to the carotids,
with soft S2 and precordial thrill.
You know, I kind of just think it sounds like Ken-tucky.
And sometimes, it kind of sounds like Tennes-see, Tennes-see,
- Tennes-see. - What do you think?
Um... I didn't really hear anything abnormal.
I thought I was in for gallbladder surgery?
You are. You have a perfectly normal heart.
Are you sure? I distinctly heard a diastolic...
Thank you. Let's go.
It's, uh, pretty quiet up here. Couldn't we go to the ER, OR?
See some trauma, you know, blood and gore?
It's your first day. Just do what I tell you to do,
- no questions asked. - Heads up.
There's a device rep in the conference room,
luring in doctors to hear her sales pitch. Free Thai food.
Come on in, guys.
- Have some food. - Thank you.
- Mm-hmm. You're welcome. - Thank you.
Come on in, Doctor.
I'm Julian Booth, device rep for Quovadis.
Hi. Uh, Dr. Pravesh.
Um... Devon.
I have some cool gear to show you.
Let's see what you might need.
You're not a surgeon.
How do you know that?
It's my superpower.
I can guess a doctor's specialty at a glance,
even before they know it.
Take your medical students.
Born rad. Destined to spend his life
inside windowless rooms with imaging machines.
He does look like a submariner.
Okay, what about that one over there?
Peeds.
No way. My money's on derm.
No, I'm right.
That is impressive.
Good, right? And your shy one will probably cure cancer.
All right, the one on the end here.
Annoying gunner... neurosurgeon?
No. He'll get his MD,
skip residency and head straight to Silicon Valley.
That's what all the gunners do.
They invent devices like these.
Artificial sphincter.
You laugh,
but the urologist who came up with this
hauled down $40 million.
- You're kidding. - Medical devices
are even bigger than pharma.
Pacemakers, cardiac caths,
cochlear implants, artificial knees, skin, hips.
I was a dancer until one day I was hit by a car.
It shattered my pelvis.
A total hip replacement gave me my life back
and made me a true believer.
You're interested in ER, right?
Okay, now you're batting a thousand.
You won't be just a doctor, though.
You're too smart for that.
All the best ones do more than one thing.
Maybe you'll invent one of these.
No. I'm good.
- Thank you. - You never know.
$40 million.
Jack came through the splenectomy with flying colors.
- Thank God. - Oh.
I don't know what we would do if we lost him.
He's the center of our world. Jack is
the brightest, kindest...
This boy is the only thing that pulled us through when...
Amber, Jack's sister, passed two years ago from a brain tumor.
Am I okay?
- (GASPS) Yes, darling. - Hey, buddy.
You're gonna be fine. Isn't he, Dr. Hawkins?
Yeah. Jack, we had to do a procedure to remove your spleen.
Spleen filters blood, helps your body fight infections,
so you'll need a regular schedule of vaccines,
but other than that, you won't even know it's missing.
Hear that, Mom? It's okay.
She worries.
Why don't you two get some food while I do a post-op on Jack?
Okay, okay.
And thank you, Dr. Hawkins.
Looks like you have a touch of jaundice.
Is that serious?
Not necessarily.
Tell me about your weight. Any changes lately?
You're a thin guy.
I just dropped ten pounds.
I wasn't even trying, but I like it.
How were you feeling before the accident? Everything okay?
I have been having some back pain, but it's no big deal.
Probably pulled a muscle roller dancing.
Show me where it hurts.
I'm sorry to hear about your sister.
Any other history of cancer in the family?
My grandfather died young.
I never knew him.
Colon cancer, I think.
And Mom had breast cancer, but she's okay now.
Have to run a few more tests before I can let you go.
I'll go write up the orders.
Can I help you?
Hey, call security. We got a drug seeker.
Hey! Hey!
Okay, every doctor needs to know how to place an IV.
I want you to practice on each other.
Good work.
(SCOFFS) This is child's play.
Did all summer in my Dad's neurosurgery clinic.
Steady. Steady. Steady.
See, this is why you're going into radiology.
Steady. Just watch.
Feel it. Touch it. There you go, you feel that?
That's the vein. That's where you want to go.
- The pulsing thing. - Mm-hmm.
Lower your hand.
Can I get a new partner? He-he can't find the vein.
Maybe I can help.
Here.
Try this.
It uses infrared to find the vein.
- Here you go. - Oh.
- That's it right there. - See it?
That right there?
Yeah.
Got it.
(GASPS) I did it.
T-This device rocks.
- Whoa! - Oh!
You have to remove the tourniquet first
before you withdraw the needle.
Apply pressure to slow the bleed.
All right.
There you go.
Everything is gonna be perfectly fine now.
Whoa! Whoa, whoa, whoa. Whoa, whoa.
- You all right? Okay. - Mm-hmm.
Amazing catch, Conrad.
Don't tell me I guessed right.
You ordered a CT with a pancreas protocol on a 14-year-old.
How in the world did you know?
Uh, the family history was a red flag.
It was a long shot, but I had to check.
Jack has pancreatic cancer.
I know you may not feel lucky right now,
but you are.
The accident brought you into the hospital,
and Dr. Hawkins caught it early.
Am I gonna die?
There is every reason to believe that surgery will be
a total cure.
If we get him to Houston tonight,
will MD Anderson have a room for him?
Okay, please let me know as soon as possible.
- Thank you. - Mr. Alderwood.
Randolph Bell, Chief of Surgery, CEO here at Chastain.
I'm so sorry to hear about your son's diagnosis.
Now, you should know that Chastain's cancer wing is state of the art...
No, no. MD Anderson is a top five cancer center.
Only the best for Jack. We need to get him there as soon as possible.
I understand. You know, we do have a connection
to a helicopter company
that can handle the transfer to the airport.
They're not cheap. You might want to check
- with your insurance first. - No, money is no object.
Well, I'm glad we could help.
The next step is to stage the cancer,
check for metastasis, make sure Jack's lymph nodes are clear.
Okay?
Thank you.
(SIGHS) Baby...
You're gonna be okay, okay?
- What's up? - There's a young girl
running around the hospital. About 12 or 13.
I caught her stealing from the drug cart.
I think she's in withdrawal. She's blonde, pale.
- I'll check Five East. - Thanks.
Hey.
Check me out.
I got it, I got it.
No, Micah, don't!
No, I'm fine, I'm fine, I'm fine.
I just twisted it a little bit. That's all.
here's someone in here!
- Mina, hurry! - Go.
Go. I'm fine.
I see legs.
Okay. Careful, careful.
(GASPS) Oh, my gosh.
She's alive. Let's clear her from the door.
- Call a rapid response team. - Yeah.
Nic!
She's in here. She's diabetic.
Oh, my God.
She was looking for insulin.
- Is she in DKA? - Probably.
She tried injecting herself, but she was too late.
Let's get her out of here and find a vein.
If we don't get access, she's gonna code.
Hey. Just got the call. What do you need?
She's dry.
- Want me to do a central line? - Yes, but not here. Not sterile.
- Let's get her a room. - I discharged 5027
earlier this morning. Should be clean now.
Go to the crash cart at the end of the hall. Get me a central line kit.
And ask a nurse to help you. Go.
- Okay. One, two, three. - Three.
No, no, no. Here, here, here. Just take that.
Got it.
- But he said get a nurse. - I got it.
Pulse is tachy at 130.
Here.
This is a Foley catheter kit.
This is for urine. I told you to ask a nurse.
No kit, no choice. We have to do an EJ.
All right. I'm gonna crank the bed down so she's headfirst.
Prepping for an IO in case you can't get access.
Prepping for an EJ.
Swab, please.
We're in.
All right, let's hang fluids. Two liters to start.
- Wait. Let me get the blood first. - Okay.
Glucose, 583. Bicarb, undetectable.
PH, 6.8. She's DKA.
A little longer in a coma, she would have died.
Let's get her to the ICU. She still might.
You're Dr. AJ Austin. I'd recognize you anywhere.
I'm sure you have a job to do,
but salespeople should not be roaming the halls of Chastain.
The AJ Austin who did an ascending aortic reconstruction
with a coronary artery reimplantation
in two hours, skin to skin.
I might be that guy.
Okay, I am that guy, but I'm still not buying.
No agenda, I swear. I'm just a fangirl.
Dr. Benedict at Atlanta General told me all about you.
Said you were the best student he ever had.
You know Abe?
Quovadis has a fantastic, new left atrial appendage occlusion device.
Dr. Benedict has been putting it in for the past year.
I can show it to you if you're interested.
All right. You got about five minutes.
- Lead the way. - Great.
I have your lawyer, Mr. McCrary, line two.
All right. This is a private call. There's no need to take notes.
Yeah?
Turns out your hooker cop was wired.
We aren't gonna get a not guilty verdict.
The arraignment's first thing in the morning.
We'll try to plea bargain.
Look reasonable and contrite.
Judges want to see a defendant who knows he's made a mistake
and won't make another.
Micah?
Are you okay? I...
I'm sorry I had to leave you like that.
I'm fine.
I don't want to be a distraction.
You're a doctor. I understand you have important things to do.
You are important.
This isn't working.
I see what's going on.
So do you.
We may be a thing, but we're a brand-new thing.
And this is not what you signed up for.
I can't be a burden.
Dr. Okafor,
please report to OR One.
Dr. Okafor, please report to OR One.
I must go now.
But I am not agreeing with you.
No big decisions until we make one together.
Conrad. Jack's lymph nodes look clear.
The cancer is most likely localized to the pancreas.
- Okay, that's good news. - But the trauma.
The accident, it looks like it started a bleed
on the tumor itself. Right here.
It was too small to pick up before,
but there it is.
Stop!
He can't fly.
The helicopter's waiting.
His tumor is bleeding into his abdomen.
He needs to have the surgery now.
You put him on that helicopter, he dies before he gets to Houston.
Okay, patient's name is Jack Alderwood.
Confirmed.
Procedure is partial pancreatectomy. Surgeon is Dr. Albert Nolan.
- Consent form signed? - Signed and in the chart.
All right.
Partial pancreatectomy. Isn't that right up your alley?
I've done over 500 of these in my career.
More than anyone else in Atlanta. Maybe more than anyone in the country.
Yeah, well, CEO is an important job, too.
At least, I think it is.
It is.
I still miss the OR.
Just keep me updated on how this goes.
I'm here if they need me.
Yeah, you got it, boss.
Where are your med students?
I sent them home.
I'm done babysitting.
Thank you, Carol.
That's too bad, Conrad. Oops.
- I mean, Devon. - I'm not Conrad.
And they're sure not me.
That gunner nearly killed Abby.
Didn't your first patient end up brain-dead?
The kid who screwed up is still here.
He's in the ICU watching them work on Abby.
Thought you should know.
Hang in there, sweetie.
O2 sats dropping.
She's in respiratory failure.
Uh, we need to intubate.
Get the kit.
They're putting her on a vent. She may never recover.
We all make mistakes.
I've made plenty.
What matters is that you learn from them.
Poor thing. We got her name, Abby Arlen,
but we still can't find her parents.
- I'll go find them. - Good. Go.
Okay.
Pancreas is fully exposed.
Prepare a specimen cup
for tissue sample.
They're doing a resection of the pancreas,
which is a bitch.
The organ is like Jell-O.
Soft, warm Jell-O.
You cut it wrong, the whole thing falls apart.
You got to cut out that tumor, leave yourself margins,
keep the tumor cold when you walk it...
speed walk it, double-time... to pathology...
where the pathologist runs a stain,
puts the specimen under a microscope,
and looks for those nasty little cancerous mites.
But you got to do it fast; time is of the essence.
Our boy is still on the table.
Uh, margins not clear.
Pathologist says to keep going.
It means they didn't get all the cancer.
They have to take another slice of the pancreas,
and start the whole process all over again.
Margins still not clear.
What's going on?
There's hardly any pancreas left.
They'll have to remove the entire organ.
Worse still. They have to resect parts
of the gallbladder, the small intestine and the bile duct.
It's a Whipple procedure.
Even I've only done a handful of Whipples in my life.
Dr. Nolan cannot handle this.
You know who has to do this, right?
Oh, the prince walks into my office without even knocking.
Let's not make this harder than it needs to be.
I'll make it as hard as I want to every single time we meet.
I don't care who your father is.
We have an emergency in OR One. The Alderwood boy.
Pancreatic margins keep coming back cancerous.
He needs a Whipple procedure.
Back in the day,
you were the unsurpassed master of the Whipple, but we both know
an appendectomy patient died in your OR.
Your complication rates are through the roof.
Can you do this procedure safely?
I can do it flawlessly, and it's not your call.
Right angle, Cooley scissors to me.
Team HODAD.
The surgery was more radical than we'd hoped, but...
it went off beautifully.
Thank you, Dr. Bell. And thank you, too, Dr. Hawkins.
The most important thing is that Jack is likely cancer-free.
And I'll roller dance again, right?
Absolutely.
Jack, unfortunately, due to the nature of your surgery,
you will be a diabetic for the rest of your life, but...
Maybe not the rest of your life.
Scientists are working on growing organs in the lab.
Some day, we may get you a new pancreas.
Okay, and who are you?
Ms. Booth works for Quovadis Labs.
It's a cutting-edge medical device company.
I'd like to show you our new insulin pump.
The drug is delivered continuously over 24 hours,
and that keeps your blood glucose levels in range,
even overnight.
How much is it?
Around ten grand.
We'll take it.
Great.
Is that our new uninsured patient?
I hear she could end up costing Chastain a fortune.
That's one way to look at it.
Or you could see a 13-year-old girl,
who's fighting for her life.
Her name is Abby.
According to her mom,
she loves astronomy and Beyoncé.
She's a straight A student,
and got diabetes when she was ten.
Her mom works two jobs
but still can't afford the medicine.
It's over $2,000 a month.
So Abby didn't want her mom to know
that she needed more insulin.
Started rationing her doses and ended up here.
She gonna make it?
Maybe.
Is there any way this could have been prevented?
Technically, the hospital's a non-profit.
In order to keep our tax-exempt status,
we're supposed to have programs that benefit the community.
- What are we doing now? - Nothing.
Not true. We have health fairs and flu clinics.
- All kinds of... - Window dressing.
The price of insulin has gone
from $21 a vial to $275,
and the drug hasn't changed one bit.
That's a 1,200% increase,
and it's destroying people's lives.
Mina and I have an idea.
Let's hear it.
What about an outpatient clinic for the uninsured,
with community outreach.
I used to volunteer for one run by Partners in Health in Boston.
We'd love to start something like that here.
It could have helped Abby; we missed that chance.
We can't miss chances like that again.
With what funding?
How much would this cost,
and how much would it save?
I need to see data before making a commitment.
Is that a polite way of saying no?
I told you we need balance.
Patient safety and financial stability.
So get us numbers, we'll have a look at it,
maybe bring it up at the next board meeting.
Okay.
I can't say that was a win.
It wasn't a no, either. Your father left us an opening.
Yeah, I'll start putting together the numbers.
Okay. Hey.
Hey.
Maybe it's a good thing that he's here.
Maybe things will be different.
I'm still giving you an out.
And I'm not taking it.
You'll go to rehab, and you'll get better.
No big decision until then.
You sure you want to wait for me?
You told me the judge would show mercy for a first offense.
Luck of the draw.
We caught a hard-ass.
And this will be reported to the state medical board?
Not exactly.
By law, you now have to self-report
your conviction for solicitation.
Here are the forms.
You're the one who must report this to the state medical board.
You mean, if I don't file the forms,
they'll never know I was arrested?
The only way anyone would find out
is if they went to the police dtment
and requested a copy of your criminal record.
Who is ever gonna think of that?
I'm a doctor.
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