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-[Leela] Previously on The Resident…
-Morning. These are

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

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

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Listen, I'm not a man

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that you'll find in Child's Pose,

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so I'm just gonna be on my way to…

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AJ, I happen to know
from personal experience

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you could really benefit
from a little extra flexibility.

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-[laughter]
-All right, come lie down and grab a mat.

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I don't know if I want kids.

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At least not right now.

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What Padma wants can help us both.

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I can give her the egg
she so desperately wants

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

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I can freeze some for us.

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-What about him?
-This guy?

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Yeah. He runs marathons,

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plays the cello and…

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

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

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

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Well, then these anonymous sperm donors

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wouldn't be very anonymous.

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I just want the father of your child
to be as amazing as you.

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My sister deserves Grade A sperm.

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Thank you for doing this for me.

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

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

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[laughs] Well, you're gonna be
the best one.

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-We should get to Chastain.
-Wait.

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What about him?

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-"The Right Stuff"?
-Yeah.

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He loves yoga, travel and Basquiat.

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No markers for genetic disease.

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And he's South Asian.

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I think it's a sign.

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

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

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

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-Padma, are you sure?
-I am.

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[both laugh]

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"The Right Stuff" it is.

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[children's song playing]

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Sorry, I know how busy you are.

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Not a problem. Happy to help.

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Usually I text you to do something fun.

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-Yeah.
-[laughs]

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It's probably just a stomachache,

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

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I told Peter you fix hurt tummies.

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Hey, Peter, remember me?

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You're Gigi's dad.

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I am. What's going on, buddy?

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We were playing super space, Daddy.

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Yeah, these two can go all day.

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He is the astronaut, she is the alien.

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Peter said he didn't want to play,

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but he always wants to play.

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I'm gonna place my hands on your stomach

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for a second, okay?

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All right.

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[groaning]

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[Marion] Peter's dad is on the way.

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Have him meet me in the ER.

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Do you like piggyback rides?

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Yeah, I thought so. Hop on.

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Can I go with you, Daddy?

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You wait here, my little alien.

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

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Kids, we're going on a field trip.

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A rite of passage.

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When I was a first year, like you,

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

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Our turn for what?

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Since the start of your intern year,

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you've learned to become doctors
inside these walls,

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and today you are going outside Chastain

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to treat one of the most
challenging patient populations.

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A place you'll tackle
complex medical cases

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that make great doctors.

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

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so let's get moving.

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Where are we going?

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Dr. Pravesh didn't tell you?

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Let's not spoil the surprise.

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Okay.

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All right, here we are.

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[Kit] Shall we?

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We got played.

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Oh my God, old folks?

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[opening theme music playing]

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All right, Mr. Astronaut,

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can you tell me when it started to hurt?

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Does the pain move around at all?

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I'm okay now.

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-Is my dad coming?
-Yeah, he's coming.

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

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Oh, you're not going home, hon.

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You're gonna stay here with us
until we can

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figure out why you're not
feeling so great.

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-Hey, bud.
-Hey, Daddy.

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Are you okay? What's going on?

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Hey, Spencer. This is Nurse Hundley.

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Spencer works in our IT department.

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Nice to meet you.

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Peter has a stomachache.

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

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His temp's a little low.

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It could be a sign of infection.

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-Oh.
-He seemed fine this morning.

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Said he and Gigi were going to space.

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

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Had a cold a few days ago,

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but nothing out of the ordinary.

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Any dietary changes this morning?

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

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Bananas, yogurt, protein powder, juice.

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

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He won't tell us more about his pain.

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He keeps saying he's fine.

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

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-Right?
-I'll go home

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if you stay with me, Daddy.

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I'll stay right here, no matter what.

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Okay, bud?

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-No matter what.
-[Hundley] I'll get us ready to draw labs.

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

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

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[Hundley] We're good here, right, hon?

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Uh…

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he's got separation anxiety.

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His mom left us both three months ago.

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She hasn't been back, or even called.

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[sighs] New boyfriend, drug problem.

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It's a long story.

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I'm sorry to hear that.

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Now Peter's afraid
you might disappear, too?

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Yes. He feels safe at Chastain because

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he knows that I work in the building.

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Well, separation anxiety
may be behind this.

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It can cause stomach trouble.

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Do some blood work, run some tests,

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and then we'll go from there.

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[woman over PA] Dr. Milner to Emergency.

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Dr. Milner to Emergency.

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There he is.
The Brookhaven resident who happens to be

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

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Yes.

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Just be aware he has early mild
cognitive impairment.

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He remembers people and events
from the past perfectly,

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but his short-term memory's going.

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Okay, got it.

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

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I did a gerontology rotation

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with Dr. Kravitz when I was a resident.

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He was one of my finest teachers.

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This is Dr. Randolph Bell.

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It's an honor. You're a legend
in the field of geriatrics.

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You know, your book,
Compassionate Care of the Elderly,

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has been on my shelf for decades.

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I-I'm sorry, your name again?

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Randolph Bell.

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Randolph, Randolph, Randolph…

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Do all your friends here
wheedle you for free care?

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

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Arthur here is fully retired.

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

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

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No introduction necessary, sweetie.

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Everybody knows the famous
Dr. Randolph Bell.

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[Kravitz] [chuckles]
She not only has my heart,

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she is now my head.

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In every way, she takes care of me.

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-Well, it's mutual.
-[chuckles]

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It was nice of you to come today.

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It can be kind of hard to get

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

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Well, we have an ulterior motive

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for bringing some of
our interns here today.

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

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This country needs more gerontologists,

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and even some of the best doctors

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don't understand the particular
needs of senior citizens.

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Geriatricians have higher
career satisfaction

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than other medical specialties.

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But the pay… not what you get in surgery.

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Would you consider talking
to some of our interns about your career?

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Let me at 'em.

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[sighs] Do you think
we'll still be that in love

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when we're their age?

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Why wouldn't we be?

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Padma, now that you picked a sperm donor,

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we'll start Leela's daily
injections of hormones

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to encourage her body to produce more eggs

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

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

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and ultrasounds.

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I read about this thing called, uh,

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-ovarian hyper-something.
-Hyperstim.

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Yeah. Do we need to worry about that?

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No, not with regular monitoring
of my estradiol levels.

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

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That question wasn't for me.

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

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Okay, what can I do to help?

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Nothing. Not until we start you

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

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-Okay.
-Okay?

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Leela, I will walk you through
your first injection.

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[Padma] Um, I was thinking…

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maybe I can do it.

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-You want to stick a needle in me?
-I just want to be part of this

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00:09:06,796 --> 00:09:08,589
in every way that I can.

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-You know.
-Of course.

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I would like that, too.

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Does our patient have a visitor?

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-He does indeed.
-[Hundley laughs]

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-Gigi!
-Hi, Peter.

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[grunts] Ah, good friends are
good medicine.

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All right, you two, behave.

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I'm gonna chat with your dad real quick.

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Thought a fun distraction
for Peter could be good.

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So his labs came back.

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

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Appendicitis, uh… seems unlikely.

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Maybe it's psychological.

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You know, he's been through a lot.

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

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and I want to run a few more tests.

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What's up?

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Did you fix his tummy, Daddy?

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It's always his tummy.

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What do you mean, "always," sweetheart?

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It happened before?

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How often does your tummy hurt, Pete?

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A whole lot of times.

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Why didn't you tell me anything, Pete?

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

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I wanted to come here, with you.

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I'll never leave you, okay?

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I'll never leave you.

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Do you understand?

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Daddy, there's something else.

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

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This morning, Peter and I were playing

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that we were on another planet.

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He kept saying that I had two heads.

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Yeah, you told me that. Pretending.

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No, he meant it.

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He said I really was a space alien.

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Peter, does anyone else have two heads?

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That nurse lady and you,

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kind of.

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Double vision. How many fingers
am I holding up?

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00:11:01,369 --> 00:11:03,996
-What's going on?
-This could be neurological.

256
00:11:04,080 --> 00:11:05,915
We need to get him to CT.

257
00:11:08,793 --> 00:11:12,296
So this woman, who is 83, kept chickens.

258
00:11:12,380 --> 00:11:14,548
And she loved her chickens.

259
00:11:14,632 --> 00:11:16,509
She named each one of them.

260
00:11:16,592 --> 00:11:20,096
The-the first day I spent
with her, she gave me eggs.

261
00:11:20,179 --> 00:11:23,432
Anyway, she had a problem
with worsening anemia.

262
00:11:23,516 --> 00:11:26,894
Fatigue, muscle weakness,
intestinal problems.

263
00:11:26,977 --> 00:11:31,107
She started forgetting things
and… falling.

264
00:11:31,190 --> 00:11:34,026
Now, any ideas what was wrong with her?

265
00:11:34,110 --> 00:11:36,904
Likely more than one thing.

266
00:11:36,987 --> 00:11:39,323
Alzheimer's, and possibly cancer?

267
00:11:40,199 --> 00:11:41,575
Or a recent stroke.

268
00:11:41,659 --> 00:11:43,285
I'll give you a hint.

269
00:11:43,411 --> 00:11:45,746
The key was the chickens.

270
00:11:45,830 --> 00:11:48,374
People who name their chickens
don't eat them.

271
00:11:48,457 --> 00:11:50,793
Exactly. He's smart.

272
00:11:50,876 --> 00:11:52,294
You-you could be a gerontologist.

273
00:11:52,378 --> 00:11:53,754
I don't get it.

274
00:11:53,879 --> 00:11:56,966
Okay, it's a B12 deficiency,
common with age.

275
00:11:57,049 --> 00:11:59,427
Learned that from Dr. Kravitz's book.

276
00:11:59,510 --> 00:12:02,221
So I'm guessing that the patient was a…

277
00:12:03,431 --> 00:12:06,392
vegan, because she gave away the eggs.

278
00:12:06,475 --> 00:12:07,810
Bingo.

279
00:12:09,270 --> 00:12:12,565
The woman's vegan diet was a good choice

280
00:12:12,648 --> 00:12:14,859
because it reduced her risk
of heart disease,

281
00:12:14,942 --> 00:12:16,485
Type 2 diabetes, certain cancers.

282
00:12:16,569 --> 00:12:18,988
But she forgot to supplement with B12,

283
00:12:19,071 --> 00:12:20,990
which was the source of
all of her symptoms.

284
00:12:21,073 --> 00:12:25,077
This is why gerontology is
a great profession.

285
00:12:25,161 --> 00:12:27,621
You spend time with patients.

286
00:12:27,705 --> 00:12:29,874
You talk with them, you get
to know the whole person,

287
00:12:29,957 --> 00:12:32,918
all the while keeping your eye
on the big picture.

288
00:12:33,002 --> 00:12:35,337
Which is the key to diagnosis.

289
00:12:35,421 --> 00:12:38,466
Oh! My lady awaits.

290
00:12:38,549 --> 00:12:41,927
And I see that they have put out
snacks, and I am peckish.

291
00:12:42,011 --> 00:12:44,138
-Excuse me.
-[Bell] Thank you, Dr. Kravitz.

292
00:12:47,683 --> 00:12:48,851
Hi, sweetie.

293
00:12:49,435 --> 00:12:51,729
Hey, maybe gerontology is an aphrodisiac.

294
00:12:51,812 --> 00:12:54,440
This old goat has
the prettiest lady in the place,

295
00:12:54,523 --> 00:12:56,400
and I have not had a date
since high school.

296
00:12:56,525 --> 00:12:59,028
-Oh.
-No, no, I'm kidding.

297
00:13:00,196 --> 00:13:01,697
[Kravitz] Gloria!

298
00:13:01,780 --> 00:13:04,200
-Her pulse is thready.
-Call 911. Let's get her to Chastain.

299
00:13:04,283 --> 00:13:05,993
Somebody grab these pills.
to take with us.

300
00:13:06,076 --> 00:13:08,245
we're gonna need to know
what she's been taking.

301
00:13:13,042 --> 00:13:16,170
I don't understand.
Are you telling me I fainted?

302
00:13:16,420 --> 00:13:17,713
Yes. And they're going to

303
00:13:17,796 --> 00:13:18,923
figure out why.

304
00:13:19,131 --> 00:13:21,133
I was probably just dehydrated.

305
00:13:21,342 --> 00:13:23,010
I didn't ruin your event, did I?

306
00:13:23,093 --> 00:13:24,970
No, we were winding down anyway.

307
00:13:25,054 --> 00:13:26,972
You added the drama.

308
00:13:27,056 --> 00:13:29,016
The good news is, your wrist isn't broken.

309
00:13:29,099 --> 00:13:30,142
You just need a splint.

310
00:13:30,226 --> 00:13:32,353
And your EKG and your labs look normal.

311
00:13:32,436 --> 00:13:34,647
So how did you feel
right before you passed out?

312
00:13:34,730 --> 00:13:37,233
I got dizzy. A little lightheaded.

313
00:13:37,358 --> 00:13:39,944
A-A drop in blood pressure.
It's not uncommon

314
00:13:40,027 --> 00:13:41,779
among women on blood pressure meds.

315
00:13:41,862 --> 00:13:42,947
But she's-she's not on any.

316
00:13:43,030 --> 00:13:45,032
Oh, well, yes, I am, dear.

317
00:13:46,909 --> 00:13:49,119
-You are?
-Mm-hmm.

318
00:13:49,203 --> 00:13:50,704
Why didn't you tell me?

319
00:13:50,788 --> 00:13:52,081
I did.

320
00:13:53,707 --> 00:13:55,125
Let's start here.

321
00:13:56,544 --> 00:13:57,711
My thought exactly.

322
00:13:58,629 --> 00:14:01,173
[Conrad] Houston to Rocket Nine Niner,

323
00:14:01,257 --> 00:14:02,841
do you read me?

324
00:14:02,925 --> 00:14:05,928
Copy, Rocket Nine Niner.

325
00:14:06,011 --> 00:14:07,888
Please keep your hands and arms

326
00:14:07,972 --> 00:14:09,890
inside the spacecraft.

327
00:14:09,974 --> 00:14:11,600
We are go for liftoff.

328
00:14:11,684 --> 00:14:14,937
Over and out. [imitating static, beeping]

329
00:14:15,020 --> 00:14:16,939
[Billie laughs]

330
00:14:17,022 --> 00:14:18,941
Was that for him or for you?

331
00:14:19,024 --> 00:14:20,317
A little bit of both.

332
00:14:21,902 --> 00:14:23,153
I'm worried about him.

333
00:14:24,947 --> 00:14:27,324
If Peter's abdominal issues are caused by

334
00:14:27,408 --> 00:14:29,994
a neurological one, we could be
looking at a bleed.

335
00:14:36,292 --> 00:14:37,751
I don't see one.

336
00:14:38,377 --> 00:14:40,546
No evidence of a stroke, either.

337
00:14:41,630 --> 00:14:44,133
[sighs] But his ventricles are a little…

338
00:14:44,216 --> 00:14:46,427
Too little.

339
00:14:50,639 --> 00:14:52,057
His brain is swelling.

340
00:14:52,182 --> 00:14:54,393
If we don't figure out why
and the swelling worsens,

341
00:14:54,476 --> 00:14:56,937
I'll have to perform a craniectomy
to relieve the pressure.

342
00:14:57,062 --> 00:14:58,606
Cutting a six-year-old's head on "if."

343
00:14:58,689 --> 00:15:00,649
Of course not, but if things
move south quickly,

344
00:15:00,733 --> 00:15:02,151
we have to be ready to move to OR.

345
00:15:02,234 --> 00:15:04,361
Fine, but let's keep in mind
the risks aren't just

346
00:15:04,445 --> 00:15:05,487
bleeding and infection.

347
00:15:05,571 --> 00:15:07,114
There could be permanent brain damage.

348
00:15:07,197 --> 00:15:10,534
We need to figure out how
to avoid surgery altogether.

349
00:15:10,618 --> 00:15:12,536
Let's start Peter on meds
to lower the pressure

350
00:15:12,620 --> 00:15:14,163
on his brain immediately,

351
00:15:14,246 --> 00:15:15,706
hope they work and move him to ICU.

352
00:15:15,789 --> 00:15:17,666
Yes, that sounds like a plan.

353
00:15:19,209 --> 00:15:22,129
Well, why didn't you tell me
you were taking all of these?

354
00:15:22,212 --> 00:15:23,631
Oh, I did, dear.

355
00:15:23,714 --> 00:15:25,633
Every time I added a medication.

356
00:15:25,716 --> 00:15:28,510
But you can't be expected
to remember all these.

357
00:15:28,594 --> 00:15:30,763
I-I forgot all of them.

358
00:15:30,846 --> 00:15:35,476
Multiple medications, called polypharmacy,
is associated with adverse outcomes,

359
00:15:35,559 --> 00:15:37,645
particularly as we age. They interact,

360
00:15:37,728 --> 00:15:39,939
causing falls, drug reactions,

361
00:15:40,022 --> 00:15:42,358
and can even lead to increased mortality.

362
00:15:42,483 --> 00:15:44,443
It all started with the arthritis.

363
00:15:44,526 --> 00:15:46,695
The ibuprofen wasn't doing anything,

364
00:15:46,779 --> 00:15:49,490
so a doctor put me on prednisone.

365
00:15:49,573 --> 00:15:51,533
Well, that gave me heartburn,

366
00:15:51,617 --> 00:15:53,410
so he gave me omeprazole.

367
00:15:53,494 --> 00:15:55,120
But then that made me nauseous,

368
00:15:55,204 --> 00:15:58,332
so they added ondansetron for my stomach.

369
00:15:58,415 --> 00:16:01,585
That made my heart flutter,
so they gave me metoprolol,

370
00:16:01,669 --> 00:16:03,128
and then my legs started to swell,

371
00:16:03,253 --> 00:16:05,047
so they gave me furosemide,
and that's when

372
00:16:05,130 --> 00:16:07,049
I stopped walking very much,

373
00:16:07,132 --> 00:16:09,760
and, uh, my blood pressure
shot up, so they--

374
00:16:09,843 --> 00:16:11,762
Should I keep going?

375
00:16:11,845 --> 00:16:15,015
[man over PA] Nurse practitioner
to the ER, please.

376
00:16:19,144 --> 00:16:20,729
Double shift?

377
00:16:20,813 --> 00:16:24,233
[chuckles] Actually, I'm just starting.

378
00:16:24,316 --> 00:16:25,985
Been having a hard time sleeping.

379
00:16:26,068 --> 00:16:29,029
-Oh, that sucks.
-Yeah, tell me about it.

380
00:16:29,113 --> 00:16:33,742
Oh, um, Leela told me about your mother.

381
00:16:33,826 --> 00:16:35,536
How is she?

382
00:16:35,619 --> 00:16:38,205
Sorry, it's… it's none of my business.

383
00:16:38,288 --> 00:16:40,416
No, it isn't.

384
00:16:40,499 --> 00:16:42,126
But it's nice of you to ask.

385
00:16:42,960 --> 00:16:44,670
She just moved in with me on Saturday.

386
00:16:44,753 --> 00:16:46,630
It's been good having her close.

387
00:16:46,714 --> 00:16:48,340
And how are you?

388
00:16:48,424 --> 00:16:51,301
Well, I'm trying to resist the urge

389
00:16:51,385 --> 00:16:53,512
to check my home security camera
every five minutes

390
00:16:53,595 --> 00:16:54,847
to see how she's doing.

391
00:16:55,848 --> 00:16:58,475
Okay, well, actually, I'm not resisting.

392
00:16:58,559 --> 00:17:01,437
Would you look at this woman?
She's out there gardening.

393
00:17:02,104 --> 00:17:03,439
Are those rhododendrons?

394
00:17:03,522 --> 00:17:06,942
A little pink for my taste,
but she loves them.

395
00:17:08,610 --> 00:17:11,363
I'm leading a meditation at 3:00.

396
00:17:11,447 --> 00:17:14,450
-Join us.
-Maybe I will.

397
00:17:16,368 --> 00:17:18,704
-So, how are you?
-Great.

398
00:17:18,787 --> 00:17:20,456
I just injected my sister with hormones

399
00:17:20,539 --> 00:17:21,832
so she can donate her eggs to me

400
00:17:21,915 --> 00:17:23,792
and I can be a mom. Hmm!

401
00:17:24,877 --> 00:17:26,628
Oh, wear something comfortable.

402
00:17:32,301 --> 00:17:35,679
[Devon] So they put her on
hydrochlorothiazide…

403
00:17:35,763 --> 00:17:38,057
And that made Gloria feel fatigued.

404
00:17:38,140 --> 00:17:39,475
So they gave her methylphenidate.

405
00:17:39,558 --> 00:17:41,602
Which could have had
a negative interaction

406
00:17:41,685 --> 00:17:44,063
with the linezolid that she
was taking for that cellulitis.

407
00:17:44,146 --> 00:17:45,689
Or the zolpidem or quetiapine,

408
00:17:45,773 --> 00:17:47,900
which Gloria was also on.

409
00:17:51,111 --> 00:17:54,406
-[sighs]
-What are we even doing, Dr. Pravesh?

410
00:17:54,490 --> 00:17:57,242
We're looking into all contraindications.

411
00:17:57,367 --> 00:17:59,995
But she is a sick older lady
who needs these drugs.

412
00:18:00,079 --> 00:18:02,539
Like, which do you even stop?

413
00:18:02,623 --> 00:18:04,249
We move carefully,

414
00:18:04,333 --> 00:18:07,753
removing one by one.

415
00:18:10,380 --> 00:18:11,840
No.

416
00:18:11,924 --> 00:18:14,593
This is over my head
and, honestly, kind of boring.

417
00:18:14,676 --> 00:18:16,261
I need to find a surgery to observe.

418
00:18:17,429 --> 00:18:20,015
I thought you were going into
primary care.

419
00:18:20,099 --> 00:18:21,809
No. I want to be a surgeon.

420
00:18:21,892 --> 00:18:23,519
It's exciting, and you fix problems

421
00:18:23,602 --> 00:18:26,146
that are actually fixable,
not buff up old people

422
00:18:26,230 --> 00:18:27,439
until they die.

423
00:18:27,523 --> 00:18:29,399
You don't think people die
on the OR table?

424
00:18:29,775 --> 00:18:30,859
They do all the time.

425
00:18:30,943 --> 00:18:33,570
Not everything is fixable with a knife.
You get that, right?

426
00:18:33,654 --> 00:18:35,239
You can fix things with your brain.

427
00:18:35,322 --> 00:18:36,907
Excuse me, have you met me?

428
00:18:36,990 --> 00:18:38,826
I read that surgeons don't actually have

429
00:18:38,909 --> 00:18:42,412
the highest IQ, and I thought,
there, that's my specialty.

430
00:18:42,496 --> 00:18:43,455
Hmm.

431
00:18:43,539 --> 00:18:45,541
This woman needs us,

432
00:18:45,624 --> 00:18:47,584
and Dr. Kravitz needs her.

433
00:18:48,836 --> 00:18:51,672
So if you're not interested,
I say go hunt down Dr. Austin

434
00:18:51,755 --> 00:18:53,841
and see if he'll let you into his OR.

435
00:18:53,924 --> 00:18:55,843
But be aware that he will not consider it

436
00:18:55,926 --> 00:18:57,553
for one nanosecond

437
00:18:58,470 --> 00:19:00,681
when I tell him you deserted this patient.

438
00:19:06,854 --> 00:19:09,106
Okay, I will stay.

439
00:19:10,399 --> 00:19:12,985
But don't tell him about
that IQ thing, either.

440
00:19:18,490 --> 00:19:19,950
I want to go with him.

441
00:19:20,033 --> 00:19:23,662
You can't, honey. He needs special care
in a special part of the hospital.

442
00:19:23,745 --> 00:19:25,914
You mean he's really sick?

443
00:19:25,998 --> 00:19:27,499
You fix people.

444
00:19:27,583 --> 00:19:30,460
-You'll fix him, can't you, Daddy?
-Spencer.

445
00:19:31,962 --> 00:19:33,463
I'll be right there.

446
00:19:36,091 --> 00:19:38,844
What's happening? His daddy is scared.

447
00:19:38,927 --> 00:19:40,637
You have to save Peter.

448
00:19:44,683 --> 00:19:45,976
I got him.

449
00:19:47,186 --> 00:19:48,770
I got him, I promise.

450
00:19:52,399 --> 00:19:53,442
[Spencer sighs]

451
00:19:54,735 --> 00:19:56,361
He seems much worse.

452
00:19:56,445 --> 00:19:58,739
Please tell me you have some news.

453
00:19:58,822 --> 00:20:00,240
We gave him another round of meds

454
00:20:00,324 --> 00:20:01,909
to lower the intracranial pressure,

455
00:20:01,992 --> 00:20:05,245
but it'll take time… if it works.

456
00:20:08,081 --> 00:20:10,584
He was hurting, and I totally missed it.

457
00:20:11,919 --> 00:20:14,880
I get guilt, believe me,
but it is not earned here.

458
00:20:19,092 --> 00:20:21,762
Help him. Please.

459
00:20:22,471 --> 00:20:24,389
We're doing everything we can.

460
00:20:25,641 --> 00:20:27,184
Uh, just…

461
00:20:27,267 --> 00:20:29,770
I don't want anybody
cutting his head open.

462
00:20:29,895 --> 00:20:31,021
Not if we can avoid it.

463
00:20:31,104 --> 00:20:32,064
Understood.

464
00:20:38,195 --> 00:20:39,196
You all right?

465
00:20:41,114 --> 00:20:43,450
Now I feel guilty, about how lucky I am

466
00:20:43,533 --> 00:20:44,993
not to be in Spencer's shoes.

467
00:20:45,118 --> 00:20:46,620
Peter has to make it through this.

468
00:20:46,703 --> 00:20:48,580
-I know.
-And Gigi, she lost her mother.

469
00:20:48,705 --> 00:20:49,957
She can't lose her best friend.

470
00:20:50,040 --> 00:20:52,000
We have to make sure
they both come out of this.

471
00:20:52,084 --> 00:20:53,543
Uh, Dr. Hawkins!

472
00:20:57,256 --> 00:21:00,175
Vomiting means his intracranial
pressure must be rising.

473
00:21:03,595 --> 00:21:04,888
I'm a little confused.

474
00:21:04,972 --> 00:21:06,223
-I'm sorry.
-So the metoprolol

475
00:21:06,306 --> 00:21:09,017
helped your heart,
but it also lowered your blood pressure.

476
00:21:09,101 --> 00:21:10,560
[Zach] With the water pills

477
00:21:10,644 --> 00:21:12,396
plus the stimulants, your heart rate sped

478
00:21:12,479 --> 00:21:15,023
and BP lowered, which caused you
to lose consciousness.

479
00:21:15,107 --> 00:21:17,025
Other doctors have been telling me

480
00:21:17,109 --> 00:21:19,569
that these meds are saving
my life, and you're telling me

481
00:21:19,653 --> 00:21:21,947
-the opposite?
-No, just listen to them, hon.

482
00:21:22,030 --> 00:21:24,783
They want to take you off
medications you may not need,

483
00:21:24,866 --> 00:21:26,868
and-and keep you on ones that are working.

484
00:21:26,952 --> 00:21:28,412
But we'd like to keep you here

485
00:21:28,495 --> 00:21:29,871
to monitor you while we do it.

486
00:21:29,955 --> 00:21:32,958
But it's just for a day,
and then, um, you'll go home.

487
00:21:33,458 --> 00:21:35,544
-There's hope for him yet.
-Mm.

488
00:21:36,253 --> 00:21:37,587
Thank you both.

489
00:21:38,046 --> 00:21:40,590
We've given Peter the maximum doses,

490
00:21:40,674 --> 00:21:43,260
but he's… he's not improving.

491
00:21:43,343 --> 00:21:44,928
Well, time to book an OR.

492
00:21:45,012 --> 00:21:47,306
No, let's just… [exhales]

493
00:21:47,973 --> 00:21:49,057
…start with a drain

494
00:21:49,141 --> 00:21:50,767
before you open his head.

495
00:21:54,396 --> 00:21:55,647
Okay, we can try it.

496
00:21:57,524 --> 00:21:59,318
I'll get an EVD monitor.

497
00:22:03,196 --> 00:22:06,033
-Talk to me.
-We're putting in a drain.

498
00:22:06,116 --> 00:22:08,618
It should help relieve
the pressure on his brain.

499
00:22:08,702 --> 00:22:09,870
It's a first step.

500
00:22:13,123 --> 00:22:16,126
I don't know how much longer
we can put off a craniectomy.

501
00:22:18,378 --> 00:22:19,463
It's my son.

502
00:22:24,217 --> 00:22:26,136
Let's take everything one step at a time.

503
00:22:26,219 --> 00:22:29,931
Right now, we need to sedate and intubate,

504
00:22:30,015 --> 00:22:31,600
and to protect his airway.

505
00:22:32,851 --> 00:22:36,188
I have to talk to him first,
before you, before you…

506
00:22:36,354 --> 00:22:38,190
Of course. Of course.

507
00:22:47,032 --> 00:22:48,492
Hey, bud.

508
00:22:49,951 --> 00:22:51,078
[sighs]

509
00:22:51,161 --> 00:22:53,288
I just want you to know…

510
00:22:55,123 --> 00:22:59,086
I want you to know that
every second that you're asleep,

511
00:22:59,169 --> 00:23:01,213
I'm gonna be right here beside you.

512
00:23:02,297 --> 00:23:03,423
Deal?

513
00:23:09,179 --> 00:23:10,430
Okay.

514
00:23:10,931 --> 00:23:12,099
[exhales sharply]

515
00:23:28,615 --> 00:23:30,534
Hey, there she is.

516
00:23:30,617 --> 00:23:32,744
So, how'd it go this morning?

517
00:23:32,828 --> 00:23:36,331
The hormone shot was fine,
but this is not. Look.

518
00:23:37,249 --> 00:23:39,000
Padma picked a donor,
but I did a little bit

519
00:23:39,084 --> 00:23:40,502
of digging into this sperm bank.

520
00:23:40,585 --> 00:23:42,671
It's facing three lawsuits
from families who claim

521
00:23:42,754 --> 00:23:44,798
their donors misrepresented themselves.

522
00:23:44,881 --> 00:23:46,550
In one case, the family alleged

523
00:23:46,633 --> 00:23:49,177
that the donor had an undisclosed history
of schizophrenia.

524
00:23:49,261 --> 00:23:51,930
In another,
a donor covered up a criminal record.

525
00:23:52,013 --> 00:23:55,100
Some claim college degrees
when they're really dropouts.

526
00:23:55,183 --> 00:23:56,977
These families were lied to.

527
00:23:57,060 --> 00:23:59,896
Yes. About the biggest decision
they'll ever make.

528
00:23:59,980 --> 00:24:02,190
The genes their kids
will share with its father.

529
00:24:02,274 --> 00:24:04,276
Yeah, but, I mean, this is just

530
00:24:04,401 --> 00:24:06,611
a few cases out of how many, right?

531
00:24:06,695 --> 00:24:09,197
I mean, I had a lot of friends
in med school who donated.

532
00:24:09,281 --> 00:24:11,158
Good guys. They needed cash,
wanted to help.

533
00:24:11,950 --> 00:24:14,578
Is this your way of saying
there are little Devons out there?

534
00:24:15,704 --> 00:24:18,415
If it helps, every single one
of these donors

535
00:24:18,498 --> 00:24:20,125
had to undergo genetic testing.

536
00:24:20,208 --> 00:24:22,919
There is no test to show whether
you're a pathological liar,

537
00:24:23,003 --> 00:24:24,754
have a mental illness
or a criminal record.

538
00:24:24,838 --> 00:24:26,298
-You're missing the point.
-No.

539
00:24:26,381 --> 00:24:27,716
Sperm banks are unregulated.

540
00:24:27,799 --> 00:24:29,593
The FDA requires that donors are tested

541
00:24:29,676 --> 00:24:32,554
for infectious diseases,
but beyond that, nothing.

542
00:24:32,637 --> 00:24:34,556
Their bios aren't even verified.

543
00:24:34,639 --> 00:24:35,932
That may work for some people.

544
00:24:36,016 --> 00:24:38,852
There are amazing kids from anonymous
donors, but that won't work.

545
00:24:38,935 --> 00:24:40,270
-This is my egg.
-Hey, babe…

546
00:24:40,604 --> 00:24:43,690
You have to accept
that this is Padma's choice.

547
00:24:45,650 --> 00:24:47,944
Well, I need to make sure
she knows what she's choosing.

548
00:24:48,028 --> 00:24:50,780
[pager vibrating, beeping]

549
00:24:50,864 --> 00:24:52,073
[scoffs]

550
00:24:52,157 --> 00:24:53,533
We'll talk later, okay?

551
00:24:59,497 --> 00:25:01,249
-Are you hot or cold?
-Both.

552
00:25:01,333 --> 00:25:02,792
Don't worry, we're gonna help you.

553
00:25:02,876 --> 00:25:04,252
She's in A-fib and hypotensive.

554
00:25:04,377 --> 00:25:06,046
Because we took her off metoprolol.

555
00:25:06,129 --> 00:25:08,590
Check if her pressure dropped
before arrhythmia.

556
00:25:08,673 --> 00:25:10,425
I-I was here. Her BP started
to fall first,

557
00:25:10,508 --> 00:25:11,718
then her heart rate spiked.

558
00:25:11,801 --> 00:25:13,136
Peritonitis?

559
00:25:13,261 --> 00:25:15,847
-Gloria, tell me where it hurts.
-[groans, cries out]

560
00:25:15,931 --> 00:25:18,058
-Rebound tenderness.
-Nothing to do with the meds.

561
00:25:18,183 --> 00:25:20,018
She has an acute abdomen
and may need surgery.

562
00:25:20,101 --> 00:25:22,854
Let's get her four of morphine.
Hang pressors and page Bell.

563
00:25:22,938 --> 00:25:25,482
Hey, hang in there, okay?

564
00:25:25,565 --> 00:25:26,691
[gasps]

565
00:25:31,780 --> 00:25:33,240
Where to begin?

566
00:25:33,323 --> 00:25:35,450
Gloria has three lumbar
compression fractures

567
00:25:35,533 --> 00:25:36,743
from osteoporosis.

568
00:25:36,826 --> 00:25:39,287
And a hiatal hernia.
All incidental findings.

569
00:25:39,371 --> 00:25:41,122
Consequence of living for eight decades.

570
00:25:41,206 --> 00:25:43,792
So here's today's problem.
Colonic perforation.

571
00:25:43,917 --> 00:25:45,335
No wonder she was in so much pain.

572
00:25:45,418 --> 00:25:46,628
And no idea what caused this?

573
00:25:46,711 --> 00:25:48,463
It couldn't have been the fall.

574
00:25:48,546 --> 00:25:50,131
Thought she passed out from meds,

575
00:25:50,215 --> 00:25:52,008
but something else's going on. But what?

576
00:25:52,092 --> 00:25:54,552
Well, what we do know
is that without surgery,

577
00:25:54,636 --> 00:25:56,137
Gloria won't make it.

578
00:25:56,221 --> 00:25:58,640
You're talking about a surgery
that's dangerous at any age,

579
00:25:58,723 --> 00:26:00,517
and with Gloria nearly 80…

580
00:26:00,600 --> 00:26:02,894
Well, we'll be sure to be
very clear with her

581
00:26:02,978 --> 00:26:04,854
about what we're facing here.

582
00:26:04,938 --> 00:26:07,399
But I agree with you.
It's the only option.

583
00:26:08,650 --> 00:26:10,819
Okay. At least she's in the best hands.

584
00:26:10,902 --> 00:26:13,029
Well, I've had success
with patients older than her,

585
00:26:13,113 --> 00:26:14,406
much sicker.

586
00:26:14,489 --> 00:26:16,283
I really hope she's one of them.

587
00:26:19,494 --> 00:26:21,621
So you think "The Right Stuff" is secretly

588
00:26:21,705 --> 00:26:23,415
-some sort of axe murderer?
-No.

589
00:26:23,748 --> 00:26:25,083
I'm just saying we can't

590
00:26:25,166 --> 00:26:27,002
-really be sure who he is.
-Okay, look,

591
00:26:27,127 --> 00:26:29,254
I really appreciate
you being protective of me,

592
00:26:29,337 --> 00:26:31,214
but there's no guarantees with kids.

593
00:26:31,298 --> 00:26:32,424
I mean, look at us.

594
00:26:32,507 --> 00:26:35,051
What, there's a one-in-a-million chance
of having twins?

595
00:26:35,468 --> 00:26:37,012
One in 250.

596
00:26:37,137 --> 00:26:40,015
And we are proof that
a random genetic accident

597
00:26:40,098 --> 00:26:42,058
can be the best gift ever.

598
00:26:42,142 --> 00:26:45,979
Look, I can't give up on being a mother
just because there's risks.

599
00:26:46,062 --> 00:26:47,397
I don't want you to.

600
00:26:47,480 --> 00:26:50,025
I just want you to be aware
of what those risks are.

601
00:26:50,734 --> 00:26:54,362
Which is why I asked Dr. Nolan to join us.

602
00:26:54,446 --> 00:26:55,697
What's up, ladies?

603
00:26:55,780 --> 00:26:57,198
Show her what you showed me.

604
00:26:57,282 --> 00:26:58,450
Oh.

605
00:27:01,369 --> 00:27:02,662
[Padma] "Dream Doc"?

606
00:27:02,746 --> 00:27:04,914
I don't understand.

607
00:27:04,998 --> 00:27:06,499
-It's him.
-It's me.

608
00:27:07,917 --> 00:27:09,461
You're six-foot five?

609
00:27:09,544 --> 00:27:11,046
I do slouch some.

610
00:27:11,171 --> 00:27:12,839
And fluent in French?

611
00:27:12,922 --> 00:27:14,132
Yeah.

612
00:27:14,215 --> 00:27:15,884
[bad accent] Je suis Rosetta Stone.

613
00:27:17,260 --> 00:27:20,347
-Trombone prodigy?
-I got a standing ovation

614
00:27:20,430 --> 00:27:21,848
at my ninth grade recital.

615
00:27:21,931 --> 00:27:23,892
[pager beeping]

616
00:27:23,975 --> 00:27:25,643
-Just think about it.
-Mm.

617
00:27:28,646 --> 00:27:30,273
Think about what?

618
00:27:30,357 --> 00:27:33,860
Surgery? Sounds… dangerous.

619
00:27:33,943 --> 00:27:35,779
Yeah, I'm not gonna lie to you. It is.

620
00:27:36,863 --> 00:27:40,075
But it is the only option.

621
00:27:40,658 --> 00:27:43,453
And without it, you may only have days.

622
00:27:44,829 --> 00:27:45,663
Maybe a week.

623
00:27:46,790 --> 00:27:47,624
I'm sorry.

624
00:27:49,459 --> 00:27:51,211
Y-You always say how

625
00:27:51,586 --> 00:27:54,130
e-easy choices are your favorite.

626
00:27:56,966 --> 00:27:59,511
I wish I could offer you more time

627
00:27:59,594 --> 00:28:01,137
to make this decision.

628
00:28:01,262 --> 00:28:03,181
But the sooner you operate,

629
00:28:03,264 --> 00:28:05,433
the better my chances are?

630
00:28:09,145 --> 00:28:10,271
Well, then, I'm ready.

631
00:28:11,606 --> 00:28:15,068
Arthur, I'm sure everybody
over at Brookhaven is worried.

632
00:28:15,151 --> 00:28:17,195
You think maybe you could go call them

633
00:28:17,278 --> 00:28:19,656
-and fill them in?
-Oh, of course.

634
00:28:19,739 --> 00:28:21,741
Any-Anything, darling.

635
00:28:21,825 --> 00:28:24,160
Yes, Brookhaven.

636
00:28:24,244 --> 00:28:25,870
Update, update Brookhaven.

637
00:28:25,954 --> 00:28:27,956
Update Brookhaven.

638
00:28:28,706 --> 00:28:29,958
[sighs]

639
00:28:30,041 --> 00:28:31,501
I can't leave him.

640
00:28:31,584 --> 00:28:33,545
-He needs me.
-Oh, I…

641
00:28:33,628 --> 00:28:35,088
I get it.

642
00:28:36,047 --> 00:28:39,551
You have got to be better
than you have ever been.

643
00:28:40,593 --> 00:28:42,887
Neither one of us have children.

644
00:28:42,971 --> 00:28:45,348
[sniffles] Not even siblings.

645
00:28:45,432 --> 00:28:47,350
It's just the two of us.

646
00:28:47,934 --> 00:28:49,519
He has no one else.

647
00:28:49,602 --> 00:28:51,563
I have no one else.

648
00:28:53,022 --> 00:28:55,316
Do you know what it's like
to find the love of your life

649
00:28:55,400 --> 00:28:57,819
this late in the game?

650
00:28:58,653 --> 00:28:59,946
Actually, I do.

651
00:29:01,573 --> 00:29:03,867
And when the day comes,

652
00:29:03,950 --> 00:29:06,286
and he forgets my name,

653
00:29:06,369 --> 00:29:08,288
I won't even care.

654
00:29:09,205 --> 00:29:12,709
I'll fill in that blank,
'cause he'll still love me.

655
00:29:13,960 --> 00:29:15,420
And I'll love him.

656
00:29:15,503 --> 00:29:16,838
To the end.

657
00:29:18,506 --> 00:29:20,633
Just don't let it be today.

658
00:29:22,969 --> 00:29:24,053
Okay.

659
00:29:27,348 --> 00:29:29,476
[monitor beeping]

660
00:29:34,481 --> 00:29:37,108
His intracranial pressure is still rising,

661
00:29:37,192 --> 00:29:39,068
and we're not sure of the cause.

662
00:29:39,152 --> 00:29:40,862
The MRI didn't show any tumors

663
00:29:40,945 --> 00:29:43,823
or blood clots in his brain.

664
00:29:43,948 --> 00:29:45,492
So what does this mean?

665
00:29:45,575 --> 00:29:47,118
That the drain wasn't enough.

666
00:29:47,202 --> 00:29:49,287
Mr. Shafer, we have no choice but to

667
00:29:49,370 --> 00:29:52,165
proceed with the craniectomy
to relieve the pressure in Peter's brain.

668
00:29:52,248 --> 00:29:53,333
My God.

669
00:29:56,252 --> 00:29:58,087
I can't believe this is happening.

670
00:29:58,171 --> 00:30:00,340
There must be something else you can do.

671
00:30:00,423 --> 00:30:02,926
If we wait any longer,
he's at risk of brain damage.

672
00:30:03,885 --> 00:30:05,553
Treat him like he's your child.

673
00:30:06,554 --> 00:30:09,808
Would you agree to this if it was Gigi?

674
00:30:14,479 --> 00:30:16,314
Spencer, give us a minute to review.

675
00:30:20,652 --> 00:30:23,780
-Tell me there's another option.
-There isn't.

676
00:30:23,863 --> 00:30:25,782
What he just said in there
won't help Peter.

677
00:30:25,865 --> 00:30:28,493
Keeping your objectivity will.
You have to.

678
00:30:28,576 --> 00:30:30,119
I'm sorry to interrupt,

679
00:30:30,203 --> 00:30:33,122
but the preschool's been trying
to get in touch. Gigi needs you.

680
00:30:36,876 --> 00:30:38,795
Do what you have to do
to reduce the swelling.

681
00:30:48,721 --> 00:30:52,225
Hey. She's been like this
since Peter left this morning.

682
00:30:52,308 --> 00:30:54,644
She won't eat or talk.

683
00:30:55,895 --> 00:30:57,355
-Thank you.
-Yeah.

684
00:31:05,655 --> 00:31:06,948
What is that?

685
00:31:07,031 --> 00:31:09,659
A space helmet for Peter.

686
00:31:09,784 --> 00:31:13,037
If he goes into space, he can't die.

687
00:31:14,914 --> 00:31:18,001
Is he gonna die, like Mommy?

688
00:31:23,381 --> 00:31:24,799
[sighs]

689
00:31:28,303 --> 00:31:30,096
I'm fighting for Peter.

690
00:31:30,972 --> 00:31:34,183
-I'm scared.
-I know. That's okay.

691
00:31:34,267 --> 00:31:35,727
I knew he was sick when

692
00:31:35,810 --> 00:31:38,229
he didn't want to eat my sandwich.

693
00:31:38,313 --> 00:31:41,733
We trade. He always eats my sandwich.

694
00:31:41,858 --> 00:31:44,402
When his mommy left, his daddy started

695
00:31:44,485 --> 00:31:47,906
making his lunch with roast beef.

696
00:31:47,989 --> 00:31:51,659
After he ate it all,
his tummy started hurting.

697
00:31:58,082 --> 00:31:59,626
Did he eat your sandwich this morning?

698
00:31:59,709 --> 00:32:01,252
No, Daddy.

699
00:32:09,302 --> 00:32:10,845
Craniotome to me.

700
00:32:15,183 --> 00:32:17,685
I've done this a hundred times,
but rarely on a child.

701
00:32:18,895 --> 00:32:20,730
You're more than qualified.

702
00:32:24,067 --> 00:32:26,319
Watch for bleeding, be gentle.

703
00:32:26,402 --> 00:32:28,363
When I pass through bone, I stop.

704
00:32:29,948 --> 00:32:31,908
Now, let's get started.

705
00:32:31,991 --> 00:32:33,368
[whirring]

706
00:32:34,202 --> 00:32:35,411
Wait!

707
00:32:35,495 --> 00:32:37,080
I think Peter has urea cycle disorder.

708
00:32:37,163 --> 00:32:39,248
It's a genetic enzyme deficiency
that makes it hard

709
00:32:39,332 --> 00:32:41,000
for people to break down protein.

710
00:32:41,084 --> 00:32:43,920
Whenever Spencer packs his son
roast beef, he trades it away

711
00:32:44,003 --> 00:32:46,381
because it makes his stomach hurt.
I think sharing his dad's

712
00:32:46,464 --> 00:32:47,674
protein shake this morning

713
00:32:47,757 --> 00:32:49,258
gave him more than he could process,

714
00:32:49,342 --> 00:32:51,177
and his body was under
stress from his cold.

715
00:32:51,260 --> 00:32:53,554
Talk about a zebra.
Urea cycle is extremely rare.

716
00:32:53,638 --> 00:32:55,139
It would explain all the symptoms.

717
00:32:55,223 --> 00:32:56,516
Let's get him back to the ICU,

718
00:32:56,599 --> 00:32:58,726
start him on dialysis, clear the ammonia.

719
00:32:58,810 --> 00:33:00,186
Do we have that kind of time?

720
00:33:00,269 --> 00:33:02,063
The odds you're right
are vanishingly small,

721
00:33:02,146 --> 00:33:04,565
and if you're wrong, this boy's brain
continues to swell,

722
00:33:04,649 --> 00:33:06,275
which will cause permanent damage.

723
00:33:07,819 --> 00:33:09,153
We need to operate now.

724
00:33:09,237 --> 00:33:10,947
[Conrad] A craniectomy is a gamble, too.

725
00:33:11,030 --> 00:33:12,615
At the rate the swelling is worsening,

726
00:33:12,699 --> 00:33:14,575
best-case scenario, what,
it buys Peter days?

727
00:33:15,118 --> 00:33:17,036
It doesn't fix the problem.

728
00:33:17,120 --> 00:33:18,413
That is true.

729
00:33:20,915 --> 00:33:22,291
So let's do both.

730
00:33:23,292 --> 00:33:25,962
Dialysis right here. We can watch his ICP.

731
00:33:26,879 --> 00:33:29,382
If it doesn't drop, I'm ready to
start a crani immediately.

732
00:33:40,476 --> 00:33:43,062
I'll be right here when you wake up.

733
00:33:43,146 --> 00:33:46,107
Okay, this is as far as you can go.

734
00:33:55,408 --> 00:33:56,659
I love you.

735
00:33:57,910 --> 00:33:59,454
I love you more.

736
00:34:00,455 --> 00:34:02,206
[chuckles]

737
00:34:05,460 --> 00:34:06,711
Okay.

738
00:34:23,770 --> 00:34:25,021
Wire, please.

739
00:34:31,778 --> 00:34:33,112
Dilator.

740
00:34:38,367 --> 00:34:40,870
All right, we're almost there.

741
00:34:41,537 --> 00:34:43,289
All right, catheter in.

742
00:34:43,372 --> 00:34:45,583
If you're right,
the pressure should trend down

743
00:34:45,708 --> 00:34:47,126
once the proteins are filtered out.

744
00:34:47,210 --> 00:34:49,337
Yeah, well, it's not gonna
happen immediately.

745
00:34:53,800 --> 00:34:55,927
If that number doesn't
come down soon, I start.

746
00:34:57,762 --> 00:34:59,347
Whether I want to or not.

747
00:35:02,767 --> 00:35:05,269
We're working through
some unexpected adhesions.

748
00:35:05,353 --> 00:35:07,605
Did Gloria mention anything
about prior surgeries?

749
00:35:07,688 --> 00:35:09,816
None. Any sign of the perforation?

750
00:35:09,899 --> 00:35:11,150
Running the bowel now.

751
00:35:11,234 --> 00:35:13,903
There's no sign of widespread ischemia.

752
00:35:13,986 --> 00:35:14,904
Oh, there it is.

753
00:35:14,987 --> 00:35:16,239
Can you repair it?

754
00:35:16,322 --> 00:35:18,074
Well, the surrounding bowel is thickened

755
00:35:18,157 --> 00:35:20,284
with extensive lymphadenopathy.

756
00:35:21,869 --> 00:35:24,997
It sounds like whatever's going on
caused significant inflammation.

757
00:35:25,081 --> 00:35:27,125
I should be able to repair the perf,

758
00:35:27,208 --> 00:35:28,960
but, you know,
this didn't happen overnight.

759
00:35:29,043 --> 00:35:30,461
It's been going on for years.

760
00:35:30,545 --> 00:35:33,047
Bowel inflammation is extremely painful.

761
00:35:33,131 --> 00:35:35,383
Her daily steroids
must have been masking it.

762
00:35:37,593 --> 00:35:39,428
See the big picture.

763
00:35:39,512 --> 00:35:41,389
Dr. Kravitz told me in geriatrics

764
00:35:41,472 --> 00:35:43,933
you always gotta keep your eye
on the big picture.

765
00:35:44,016 --> 00:35:46,269
What if the arthritis
and the bowel inflammation

766
00:35:46,352 --> 00:35:48,271
are all part of the same disease process?

767
00:35:48,354 --> 00:35:49,939
It's possible.

768
00:35:51,482 --> 00:35:53,317
If the side effects of her medications

769
00:35:53,401 --> 00:35:56,696
were actually symptoms of
the underlying issue.

770
00:35:58,364 --> 00:35:59,907
We've been looking at this all wrong.

771
00:36:01,200 --> 00:36:02,952
Let's get back to Gloria's prescriptions

772
00:36:03,035 --> 00:36:05,955
and see if we can't get her some answers
when she wakes up.

773
00:36:09,333 --> 00:36:10,626
[Billie] It just keeps rising.

774
00:36:10,710 --> 00:36:12,461
Can we dialyze faster?

775
00:36:12,545 --> 00:36:15,882
Any faster and his neurons could shear
from diffusion. Just give it a minute.

776
00:36:15,965 --> 00:36:18,342
A minute can be
the difference between life and death.

777
00:36:18,426 --> 00:36:21,470
-Just give me one more minute.
-We don't have good choices here.

778
00:36:21,554 --> 00:36:23,848
-Billie, we're on the same side.
-But this is my OR.

779
00:36:34,066 --> 00:36:35,610
[monitor beeps]

780
00:36:35,693 --> 00:36:37,570
-It dropped.
-Wait, Dr. Sutton.

781
00:36:39,030 --> 00:36:40,531
That number's still dangerously high.

782
00:36:49,123 --> 00:36:50,791
[monitor beeps]

783
00:36:50,875 --> 00:36:52,335
[laughs]

784
00:36:56,172 --> 00:36:57,298
It worked.

785
00:37:00,134 --> 00:37:01,552
[exhales sharply]

786
00:37:01,636 --> 00:37:03,054
[Jessica] You ready to close?

787
00:37:04,347 --> 00:37:05,514
Sure am.

788
00:37:13,022 --> 00:37:15,650
Focus on that still space

789
00:37:15,733 --> 00:37:17,276
between our inhale

790
00:37:18,778 --> 00:37:20,154
and our exhale.

791
00:37:21,155 --> 00:37:22,698
[phone chimes]

792
00:37:22,782 --> 00:37:24,367
Please remember to silence your devices

793
00:37:24,450 --> 00:37:25,993
before we begin the class.

794
00:37:26,077 --> 00:37:27,536
[phone chimes]

795
00:37:29,956 --> 00:37:31,666
[phone chimes]

796
00:37:35,544 --> 00:37:37,129
[pager beeps]

797
00:37:53,396 --> 00:37:55,147
-I seem to have gotten turned around.
-Okay.

798
00:37:55,231 --> 00:37:56,732
My wife is in surgery.

799
00:37:56,816 --> 00:37:58,609
Can you direct me to the waiting room?

800
00:37:58,693 --> 00:38:00,945
Uh, here, let me show you.

801
00:38:03,823 --> 00:38:05,408
The cavalry has arrived.

802
00:38:05,533 --> 00:38:08,077
77-year-old woman with a bowel perf.
Pressure started tanking.

803
00:38:08,160 --> 00:38:10,788
At first I thought it was peritonitis,
then I saw her neck.

804
00:38:10,913 --> 00:38:14,417
I need ultrasound now.
Any idea why she might be in tamponade?

805
00:38:14,500 --> 00:38:16,127
No idea what the underlying issue is.

806
00:38:16,210 --> 00:38:18,254
Right now, we just need
to get her off the table.

807
00:38:18,337 --> 00:38:20,756
Start another epi and bolus a liter.

808
00:38:20,840 --> 00:38:22,842
There's fluid around her heart.
We need to prep her

809
00:38:22,925 --> 00:38:24,468
for pericardiocentesis.

810
00:38:24,552 --> 00:38:25,761
I'll finish so I can assist.

811
00:38:25,845 --> 00:38:28,597
If she doesn't stabilize,
I'm gonna have to crack her chest open.

812
00:38:28,681 --> 00:38:30,933
Oh, God, let's hope not.

813
00:38:44,864 --> 00:38:46,866
Oh, man, I can't wait to tell 'em.

814
00:38:46,949 --> 00:38:48,617
Hey, we figured it out.

815
00:38:48,701 --> 00:38:50,494
Gloria's meds didn't cause her problems,

816
00:38:50,578 --> 00:38:51,787
but masked an underlying one,

817
00:38:51,871 --> 00:38:53,080
Whipple's disease.

818
00:38:53,205 --> 00:38:55,458
That's what caused her
arthritis, weight loss, fatigue.

819
00:38:55,541 --> 00:38:57,793
And steroids that her doctors
first thought was arthritis

820
00:38:57,877 --> 00:38:58,961
only made it worse.

821
00:38:59,045 --> 00:39:00,963
She told us that they increased her dose,

822
00:39:01,047 --> 00:39:02,089
leading to the perf.

823
00:39:02,214 --> 00:39:04,550
[Zach] Now all Gloria needs
is an antibiotic.

824
00:39:04,633 --> 00:39:07,303
-Take her off almost everything else.
-She didn't make it.

825
00:39:07,386 --> 00:39:09,930
-I'm sorry.
-What? She…

826
00:39:10,431 --> 00:39:12,975
[Bell] She developed cardiac tamponade,

827
00:39:13,184 --> 00:39:15,311
which was probably the final complication

828
00:39:15,394 --> 00:39:17,188
of her undiagnosed Whipple.

829
00:39:17,271 --> 00:39:19,482
And Austin was working to place
a pericardial drain

830
00:39:19,565 --> 00:39:20,983
when she coded.

831
00:39:21,484 --> 00:39:23,861
We did five rounds of CPR.

832
00:39:24,362 --> 00:39:26,572
More than I should have
on a woman her age.

833
00:39:26,655 --> 00:39:27,948
It was a tough one.

834
00:39:28,032 --> 00:39:29,992
[Bell] Now, if she'd been
treated properly,

835
00:39:30,076 --> 00:39:31,369
or if she'd gotten to us sooner,

836
00:39:31,452 --> 00:39:34,872
maybe we could have done something
to turn it around.

837
00:39:34,955 --> 00:39:37,500
But today… it was just far too late.

838
00:39:40,086 --> 00:39:41,337
Dr. Kravitz…

839
00:39:44,757 --> 00:39:46,592
Kit is his friend,

840
00:39:46,675 --> 00:39:49,011
so I will call her to tell him.

841
00:40:00,689 --> 00:40:02,817
[Devon] Even if we had
diagnosed her sooner,

842
00:40:02,900 --> 00:40:05,111
Gloria's disease began years ago.

843
00:40:05,194 --> 00:40:06,695
There's nothing we could have done.

844
00:40:07,321 --> 00:40:10,074
Gloria wasn't just another
fragile old lady.

845
00:40:10,157 --> 00:40:13,035
She was strong, in love.

846
00:40:13,119 --> 00:40:15,121
She deserved more time.

847
00:40:16,205 --> 00:40:19,625
But every doctor looked at her
like just another lost cause.

848
00:40:20,459 --> 00:40:22,169
No one cared enough to see

849
00:40:22,253 --> 00:40:24,130
that by just treating her symptoms,

850
00:40:24,213 --> 00:40:26,215
they were actually making her worse.

851
00:40:31,846 --> 00:40:34,849
No one saw the bigger picture
until you did.

852
00:40:37,726 --> 00:40:39,812
Reconsider going into gerontology, Zach.

853
00:40:40,938 --> 00:40:42,231
You may have a gift.

854
00:40:46,527 --> 00:40:47,903
[door opens]

855
00:40:50,239 --> 00:40:51,323
[door closes]

856
00:41:05,087 --> 00:41:07,339
-I am so sorry.
-[sobbing]

857
00:41:07,423 --> 00:41:09,133
I'm so sorry.

858
00:41:09,216 --> 00:41:11,719
[melancholy music playing]

859
00:41:29,320 --> 00:41:31,197
Look what I made you.

860
00:41:31,280 --> 00:41:32,615
Wow!

861
00:41:32,948 --> 00:41:34,366
Hey.

862
00:41:34,492 --> 00:41:37,661
So we'll continue dialysis until
we lower his ammonia levels,

863
00:41:37,745 --> 00:41:40,414
but with some attention
and lifestyle modifications

864
00:41:40,498 --> 00:41:41,665
we can manage this.

865
00:41:41,749 --> 00:41:44,251
You'll need to look for signs
his ammonia levels are up.

866
00:41:44,335 --> 00:41:46,337
Sluggishness, nausea, vomiting.

867
00:41:46,420 --> 00:41:47,671
Avoid extreme temps.

868
00:41:47,755 --> 00:41:50,674
Keep him hydrated and
on a low-protein diet.

869
00:41:50,758 --> 00:41:53,469
-No more roast beef sandwiches.
-[chuckles softly]

870
00:41:53,552 --> 00:41:54,762
He'll do great.

871
00:41:55,429 --> 00:41:57,473
I can't thank you enough.

872
00:41:57,556 --> 00:42:00,267
Well, we did have help.

873
00:42:00,392 --> 00:42:02,102
How would you two like a surprise?

874
00:42:02,186 --> 00:42:04,980
What is it, Daddy? What is it?

875
00:42:13,739 --> 00:42:15,658
[Gigi] Wow!

876
00:42:16,825 --> 00:42:18,869
It's beautiful.

877
00:42:32,424 --> 00:42:35,636
Nolan as a sperm donor?
[laughs] Our Nolan?

878
00:42:35,719 --> 00:42:37,054
-Yep.
-Ooh.

879
00:42:37,137 --> 00:42:40,224
-That put the fear of God in me.
-Yeah, I bet.

880
00:42:40,307 --> 00:42:42,560
But the eggs are gonna be
retrieved in about two weeks,

881
00:42:42,643 --> 00:42:45,104
which means I need a volunteer, fast.

882
00:42:45,187 --> 00:42:47,856
Someone I trust, someone I care about.

883
00:42:47,940 --> 00:42:49,483
What are you gonna do?

884
00:42:49,567 --> 00:42:52,319
Actually, um, I had a crazy idea.

885
00:42:53,279 --> 00:42:55,030
You and I are good friends,

886
00:42:55,114 --> 00:42:57,908
now that we aren't lovers,
and I wouldn't mind

887
00:42:57,992 --> 00:42:59,702
a kid a lot like you.

888
00:43:00,327 --> 00:43:01,704
You could do worse.

889
00:43:02,413 --> 00:43:03,581
So what if I did…

890
00:43:04,790 --> 00:43:07,376
have a kid just like you?

891
00:43:10,588 --> 00:43:13,215
You want me to be your sperm donor?

892
00:43:19,930 --> 00:43:22,850
[closing theme music playing]