1 00:00:00,000 --> 00:00:03,880 Previously on Doc. I wasn't sure if you were the same doctor you used to be. Now 2 00:00:03,880 --> 00:00:05,080 you know I'm as good as I was. 3 00:00:05,520 --> 00:00:08,540 We had, um, dalliance. It petered out. No hard feelings. 4 00:00:08,840 --> 00:00:10,040 I want to have a child. 5 00:00:10,300 --> 00:00:12,480 We've wasted so much time. I know. 6 00:00:12,700 --> 00:00:13,700 I'm sorry. 7 00:00:13,720 --> 00:00:15,820 Which cologne are you wearing? What are you, pregnant? 8 00:00:17,180 --> 00:00:18,540 Ruth, cross-collar coming. 9 00:00:19,420 --> 00:00:20,720 That's the supply cart. 10 00:00:21,000 --> 00:00:25,340 I don't feel like a doctor. Where is the chief, Dr. Larson? She has early onset 11 00:00:25,340 --> 00:00:28,840 Alzheimer's. You see? It was your heart all along. You're going to get your life 12 00:00:28,840 --> 00:00:29,840 back. 13 00:00:30,030 --> 00:00:31,870 It was beyond frightening. 14 00:00:32,090 --> 00:00:34,970 I actually thought I had Alzheimer's for almost a year. 15 00:00:35,290 --> 00:00:38,950 But then my amazing doctor at Westside figured out it was an issue with my 16 00:00:38,950 --> 00:00:40,450 heart. I wish you'd told me. 17 00:00:40,890 --> 00:00:43,490 You thought you were so sick. What was I going to say? 18 00:00:43,750 --> 00:00:47,890 I'm losing my mind? Come quick, let me apologize for all those things I screwed 19 00:00:47,890 --> 00:00:48,890 up in our marriage? 20 00:00:49,250 --> 00:00:50,270 Wouldn't have minded that. 21 00:00:52,170 --> 00:00:53,390 Wouldn't mind it now either. 22 00:00:54,120 --> 00:00:55,420 Since who knows how long I have. 23 00:00:55,780 --> 00:00:57,100 Don't talk like that. 24 00:00:57,320 --> 00:01:00,860 I have an inoperable tumor, Cece. What do you want me to say? That you're going 25 00:01:00,860 --> 00:01:01,860 to fight. I am. 26 00:01:02,160 --> 00:01:06,340 I have been. I know. But now that my own medical ordeal has been resolved, I want 27 00:01:06,340 --> 00:01:08,220 to be there for whatever you need. 28 00:01:10,300 --> 00:01:11,560 Dear Bonnie. 29 00:01:14,140 --> 00:01:15,140 Bonnie. 30 00:01:18,720 --> 00:01:19,900 Please talk to me. 31 00:01:20,120 --> 00:01:21,380 I can't feel my arm. 32 00:01:21,680 --> 00:01:22,860 I'm calling an ambulance. 33 00:01:35,950 --> 00:01:37,410 Hey, got your text. 34 00:01:38,490 --> 00:01:39,690 What are you doing here? 35 00:01:40,050 --> 00:01:41,910 I'm having kind of a crisis. 36 00:01:42,590 --> 00:01:47,030 I got that from the way you ran out last night. I've been worried. 37 00:01:47,270 --> 00:01:49,970 I know. I'm sorry I didn't respond till now. 38 00:01:50,530 --> 00:01:51,910 Okay, what's going on? 39 00:01:54,570 --> 00:01:55,570 Nothing. 40 00:02:01,910 --> 00:02:04,890 My OB couldn't get me in till next week. 41 00:02:05,520 --> 00:02:09,300 And I didn't want to go downstairs, so I need an ultrasound. 42 00:02:10,220 --> 00:02:16,200 I know this is weird and we're not friends, but I also know that I can 43 00:02:16,200 --> 00:02:17,200 trust you. 44 00:02:17,640 --> 00:02:19,000 Yes, you can. 45 00:02:47,760 --> 00:02:48,760 There it is. 46 00:02:54,780 --> 00:02:56,600 CRL suggests seven weeks. 47 00:02:58,000 --> 00:02:59,000 Oh. 48 00:03:00,420 --> 00:03:01,800 So we can hear the heartbeat. 49 00:03:03,820 --> 00:03:05,000 Are you sure? 50 00:03:05,360 --> 00:03:11,560 Yeah. I've been up all night, and I'm sure there are a million reasons why I 51 00:03:11,560 --> 00:03:15,300 should just keep going with my life as it is. And thank God I have the right to 52 00:03:15,300 --> 00:03:16,300 choose, but... 53 00:03:16,460 --> 00:03:22,580 We see so much death here every day, and this just feels like I can do this. And 54 00:03:22,580 --> 00:03:25,660 why not see this as a blessing? 55 00:03:26,060 --> 00:03:31,620 I mean, I can do this, right? I have a great job and financial security and a 56 00:03:31,620 --> 00:03:32,920 community. And TJ? 57 00:03:34,120 --> 00:03:35,740 Yeah, yes, of course. 58 00:03:36,940 --> 00:03:37,940 TJ. 59 00:03:38,720 --> 00:03:40,040 You haven't told him yet. 60 00:03:40,580 --> 00:03:41,860 We're having dinner tonight. 61 00:03:42,880 --> 00:03:45,360 I just need the day, I think. 62 00:03:49,310 --> 00:03:50,610 Then maybe you wait on the heartbeat. 63 00:03:52,570 --> 00:03:56,130 So you can hear it together when it's time. 64 00:03:58,890 --> 00:03:59,890 Yeah. 65 00:04:04,410 --> 00:04:06,810 Dr. Shaw is running behind. We haven't even gone in yet. 66 00:04:07,050 --> 00:04:10,210 Okay, we'll just take it one step at a time. Give my love to Wendy. 67 00:04:10,630 --> 00:04:13,350 I'm the one who's going to need the love if this doesn't go how we hope. 68 00:04:13,550 --> 00:04:16,589 Can you at least try to let yourself be excited? 69 00:04:16,910 --> 00:04:17,910 This is incredible. 70 00:04:19,050 --> 00:04:21,190 Some fine line between excitement and anxiety. 71 00:04:22,250 --> 00:04:23,250 I'll check in later. 72 00:04:23,550 --> 00:04:24,550 Okay, bye. 73 00:04:30,710 --> 00:04:32,590 So I'm sure Dr. Major told you. 74 00:04:33,290 --> 00:04:35,390 She thinks I have a problem with compartmentalization. 75 00:04:35,810 --> 00:04:37,210 Look, we all have our stuff. 76 00:04:37,510 --> 00:04:43,230 We just have to be aware of our blind spots and triggers and try to stay ahead 77 00:04:43,230 --> 00:04:44,490 of them so they don't affect our work. 78 00:04:44,770 --> 00:04:47,810 Well, I just want you to know that I've... been working on it and i feel 79 00:04:47,810 --> 00:04:50,670 really confident that i'll be able to deal with whatever is thrown my way ruth 80 00:04:50,670 --> 00:04:54,910 i'm glad that you're acknowledging this but i think you need to slow down and 81 00:04:54,910 --> 00:05:01,470 hear me you are not going to solve this in one day i know you have a 82 00:05:01,470 --> 00:05:05,070 relationship with dr larson but there are other internists i can bring in if 83 00:05:05,070 --> 00:05:11,970 she's unavailable absolutely not she's the best and we will wait hi i'm 84 00:05:11,970 --> 00:05:16,970 dr larson this is dr chan and we're cc Hi, finally. 85 00:05:17,230 --> 00:05:20,510 Dr. Grant here was trying to pawn me off on one of your underlings. 86 00:05:20,730 --> 00:05:25,010 Dr. Larson, meet Bonnie Carroll, tenured professor of archaeology at the U of M. 87 00:05:25,090 --> 00:05:28,450 She was also once married to yours truly, but that's the least of her 88 00:05:28,450 --> 00:05:33,490 accomplishments. Bonnie, this is Chief Larson, the brassy broad who saved my 89 00:05:33,490 --> 00:05:34,490 life at least twice. 90 00:05:34,570 --> 00:05:35,890 Chief Larson? 91 00:05:36,650 --> 00:05:43,510 It is so good to see you, Cece, but I have a confession to make. I am 92 00:05:43,510 --> 00:05:44,510 no longer chief. 93 00:05:44,750 --> 00:05:50,090 They demoted you? No, not exactly. I had a car accident, and I was recovering 94 00:05:50,090 --> 00:05:54,370 neurologically. So the last time I saw you, I was actually working as an 95 00:05:54,370 --> 00:05:56,190 intern. You told me you were chief. 96 00:05:56,410 --> 00:06:01,250 You were pretty unstable and insistent that you saw the doctor that you 97 00:06:01,250 --> 00:06:03,310 remembered. Sounds like you, Cece. 98 00:06:03,670 --> 00:06:04,670 So you lied. 99 00:06:05,110 --> 00:06:06,029 I did. 100 00:06:06,030 --> 00:06:07,030 To help you. 101 00:06:07,530 --> 00:06:09,090 I've been promoted to chief resident. 102 00:06:09,510 --> 00:06:12,710 But if you prefer, we can ask the new chief of medicine to come and see you. 103 00:06:18,109 --> 00:06:19,670 Will you enlighten her, Dr. Grant? 104 00:06:22,330 --> 00:06:23,330 Yes. 105 00:06:23,770 --> 00:06:27,090 Miss Carol comes to us from Eastside, where she's being treated for an 106 00:06:27,090 --> 00:06:28,470 unresectable pancoast tumor. 107 00:06:28,750 --> 00:06:32,510 Biopsy confirmed, lung adenocarcinoma in the right upper lobe. She has weakness 108 00:06:32,510 --> 00:06:34,330 in the right arm with near-complete paralysis. 109 00:06:34,590 --> 00:06:36,190 In grip for 24 hours. 110 00:06:36,670 --> 00:06:40,870 So the tumor has infiltrated the lower brachial plexus. Those insipid doctors 111 00:06:40,870 --> 00:06:44,330 were trying to shrink it with chemo and radiation, and now they're saying that's 112 00:06:44,330 --> 00:06:47,030 failed. They believe the tumor is inoperable given the invasion of the 113 00:06:47,030 --> 00:06:48,029 subclavian artery. 114 00:06:48,030 --> 00:06:51,170 They're recommending palliative care. And we refuse to accept it. 115 00:06:51,510 --> 00:06:53,090 Present us with another option. 116 00:06:55,730 --> 00:06:59,030 Dr. Chen, get full admissions labs and update the staging scans. 117 00:06:59,930 --> 00:07:02,930 If there is another way, we will find it. 118 00:07:08,430 --> 00:07:11,530 Morning. Morning. Heard you talking to Dr. Douglas here today, saying you want 119 00:07:11,530 --> 00:07:12,289 a vanilla cake. 120 00:07:12,290 --> 00:07:13,290 Ah, I am. 121 00:07:13,470 --> 00:07:14,449 Thank you. 122 00:07:14,450 --> 00:07:15,850 You're on clinic duty today. 123 00:07:16,810 --> 00:07:17,810 Clinic duty. 124 00:07:18,630 --> 00:07:19,630 That a problem? 125 00:07:20,830 --> 00:07:21,830 Not at all. 126 00:07:22,630 --> 00:07:24,210 Paige, Dr. Heller's yours today. 127 00:07:24,510 --> 00:07:26,790 Full house down there. Get ready to move some meat. 128 00:07:30,010 --> 00:07:34,610 Hey, listen, Doc, I am due back at work in an hour, so I would appreciate if we 129 00:07:34,610 --> 00:07:35,610 kept this, you know, efficient. 130 00:07:35,830 --> 00:07:37,650 Yes, sir, I'm going to try my best, but... 131 00:07:38,080 --> 00:07:40,520 I guess I'm catching up to do. It looks like you missed all of your appointments 132 00:07:40,520 --> 00:07:43,440 after your aortic valve replacement last year. Yeah, I am sorry about that. 133 00:07:43,560 --> 00:07:49,440 Recovery took a lot of months, and I'm still paying that off, so I can't really 134 00:07:49,440 --> 00:07:50,440 miss work. 135 00:07:51,720 --> 00:07:56,520 Also, Dr. Swanson said that the surgery went well, so... 136 00:07:56,520 --> 00:08:00,160 Have you been feeling sick lately? 137 00:08:00,780 --> 00:08:06,300 Fatigued? I mean, yeah, but I've been working a ton of overtime at the site. 138 00:08:07,320 --> 00:08:10,660 Okay, well, I need to run a few more tests, but it's all routine. I'll get 139 00:08:10,660 --> 00:08:12,000 the procedure set up as soon as I can. 140 00:08:12,400 --> 00:08:16,260 Are you serious? I know you're in a rush, but I've got to get this done. 141 00:08:17,400 --> 00:08:19,220 Okay? Just sit tight. 142 00:08:23,080 --> 00:08:24,079 I'm sorry. 143 00:08:24,080 --> 00:08:25,980 I didn't know what you were stepping into earlier. 144 00:08:26,640 --> 00:08:27,640 I hope not. 145 00:08:27,800 --> 00:08:30,520 Because I kind of caught you enjoying it a bit too much. 146 00:08:31,420 --> 00:08:34,520 I was just trying to figure out how you pulled it off with Cece. What do you 147 00:08:34,520 --> 00:08:39,179 mean? What people tell me is that this version of you is pretty different than 148 00:08:39,179 --> 00:08:40,179 the one back then. 149 00:08:43,679 --> 00:08:45,060 Dr. Coleman, just in time. 150 00:08:46,640 --> 00:08:48,680 Whoa, that tumor's a beast. 151 00:08:48,980 --> 00:08:53,340 Yeah, it's infiltrating the subclavian artery, vein, and brachial plexus. It's 152 00:08:53,340 --> 00:08:56,380 even growing around the vertebrae. I guess we know why Issa refused to cut 153 00:08:56,380 --> 00:09:00,160 into it. Plus, her uncontrolled hypertension from the chemo puts her in 154 00:09:00,160 --> 00:09:01,640 danger of having a stroke mid-operation. 155 00:09:02,080 --> 00:09:03,080 They were right. 156 00:09:03,300 --> 00:09:04,340 You can't get it. 157 00:09:04,700 --> 00:09:05,900 They can't get it. I can. 158 00:09:06,600 --> 00:09:07,600 How's that? 159 00:09:07,720 --> 00:09:11,960 Most surgeons don't have the stomach or the stamina to resect it. You just have 160 00:09:11,960 --> 00:09:14,340 to go at it with three different approaches at once. 161 00:09:14,840 --> 00:09:18,700 We'll need to lower her BP before even considering this. Not at all. We can 162 00:09:18,700 --> 00:09:19,940 handle ourselves in the OR. 163 00:09:20,180 --> 00:09:23,980 A lot better if I find a medical solution first. 164 00:09:24,200 --> 00:09:25,760 Now, we have been down this road before. 165 00:09:26,080 --> 00:09:30,980 That man had antlers in his chest. Plus, we don't have to scramble with this 166 00:09:30,980 --> 00:09:34,400 patient. It'll be risky no matter when we attempt it. You try to manage her 167 00:09:34,400 --> 00:09:36,040 risk away and she'll die waiting. 168 00:09:37,020 --> 00:09:40,260 Where are you going? I'm taking my solution to them. Now, if you have a 169 00:09:40,260 --> 00:09:41,460 better idea, be my guest. 170 00:09:41,840 --> 00:09:42,840 Pitch it. 171 00:09:45,870 --> 00:09:46,870 I need some time. 172 00:09:47,050 --> 00:09:48,550 Don't let him start cutting. 173 00:09:54,470 --> 00:09:55,650 You sure you have to go? 174 00:09:56,050 --> 00:09:59,010 My panel starts in an hour, and then it's straight to the airport. 175 00:09:59,290 --> 00:10:01,990 I'm just saying we have the room till 11, and these panels, they never start 176 00:10:01,990 --> 00:10:02,990 on time. 177 00:10:06,070 --> 00:10:09,910 Or maybe we pick this up in Austin next month. 178 00:10:10,370 --> 00:10:12,070 Assuming you're going to the Austin Med Conference. 179 00:10:12,970 --> 00:10:13,970 Round three. 180 00:10:14,430 --> 00:10:18,730 Only thing is, my divorce is getting kind of nasty, so if we can just keep 181 00:10:18,730 --> 00:10:19,730 this on the down low. 182 00:10:20,090 --> 00:10:21,770 Yeah, how about if we're in the same city? 183 00:10:22,410 --> 00:10:23,410 If it makes sense. 184 00:10:23,870 --> 00:10:25,590 There's no need to make it into something it's not. 185 00:10:25,890 --> 00:10:27,950 Yeah, and let's say no texting. 186 00:10:28,310 --> 00:10:29,790 To be safe, just calls. 187 00:10:30,890 --> 00:10:31,890 Yeah. 188 00:10:33,800 --> 00:10:35,120 So you've done this before? 189 00:10:35,340 --> 00:10:38,920 Well, not this approach exactly, but I've dealt with a lot of complex 190 00:10:38,920 --> 00:10:42,240 invasive tumors, and this will take more time. It's not impossible. 191 00:10:42,460 --> 00:10:44,000 Still, you have not done this. 192 00:10:44,220 --> 00:10:46,860 I'm not sure I love the sound of that. What choice do we have? 193 00:10:47,280 --> 00:10:49,920 Palliative care? This is amazing news, Cece. 194 00:10:51,470 --> 00:10:55,230 Sorry I'm late. I was doing my own assessment of Bonnie's condition. 195 00:10:55,570 --> 00:10:58,910 Good, because he's selling us on a surgery he's never performed before. 196 00:10:59,190 --> 00:11:03,050 The surgery's a legitimate solution, but Bonnie's blood pressure needs to be 197 00:11:03,050 --> 00:11:07,650 stabilized first, and I have found a way to bring it under control with fewer 198 00:11:07,650 --> 00:11:11,110 risks. He said he could manage the blood pressure, and he's the chief of surgery. 199 00:11:11,330 --> 00:11:14,430 Everyone told me I had Alzheimer's, and look at me now. 200 00:11:15,070 --> 00:11:16,510 What's your plan, Dr. Larson? 201 00:11:16,730 --> 00:11:18,630 It's called carotid baroreflex stimulation. 202 00:11:18,850 --> 00:11:19,990 I've done it before. 203 00:11:20,330 --> 00:11:21,330 When? 204 00:11:21,490 --> 00:11:23,310 Exactly. Three times last year. 205 00:11:23,890 --> 00:11:25,130 I see, Dr. Larson. 206 00:11:27,790 --> 00:11:28,790 A word? 207 00:11:30,210 --> 00:11:31,210 I'll be right back. 208 00:11:35,350 --> 00:11:38,590 When I said come up with something, I was hoping it would be a procedure you 209 00:11:38,590 --> 00:11:41,310 remember, not one you had to find in your old notes. 210 00:11:41,570 --> 00:11:44,870 My notes are thorough, and at least I've done the procedure. 211 00:11:45,070 --> 00:11:47,630 Are you going to tell Bonnie and Cece that you never actually recovered 212 00:11:47,630 --> 00:11:50,170 neurologically? My memory loss isn't an issue here. 213 00:11:50,640 --> 00:11:55,140 Bonnie could die on the table if we do it your way. What I'm presenting is 214 00:11:55,140 --> 00:11:58,740 lower risk, and if you actually read my notes, you will see that all three 215 00:11:58,740 --> 00:12:02,780 patients were in much worse condition than Bonnie. Right now, her BP's high, 216 00:12:02,900 --> 00:12:06,980 but it's predictable. If you destabilize it, then surgery is off the table, and 217 00:12:06,980 --> 00:12:07,980 we're out of options. 218 00:12:10,500 --> 00:12:13,980 Thank you for taking time today to come see what I've been doing. 219 00:12:15,980 --> 00:12:19,600 Did you think I was a good doctor when you knew me before? 220 00:12:20,250 --> 00:12:21,250 You're brilliant. 221 00:12:21,370 --> 00:12:22,430 That hasn't changed. 222 00:12:22,930 --> 00:12:24,530 So how about you trust me this time? 223 00:12:27,810 --> 00:12:28,810 Okay. 224 00:12:29,150 --> 00:12:30,150 I will. 225 00:12:35,150 --> 00:12:39,250 Before I give you numbers, I want you to remember that you're an individual, not 226 00:12:39,250 --> 00:12:40,009 a statistic. 227 00:12:40,010 --> 00:12:43,310 We've done all the research and we know the odds. We're here because we know we 228 00:12:43,310 --> 00:12:46,910 need your help. So you know that it could be very difficult. The important 229 00:12:46,910 --> 00:12:49,990 thing is you came here today because at this point... Every day matters. 230 00:12:50,310 --> 00:12:52,370 I've been taking really good care of myself. 231 00:12:53,530 --> 00:12:55,030 And we have faith. 232 00:12:55,630 --> 00:12:58,650 Well, I was honestly assuming we would test both of you. 233 00:13:00,310 --> 00:13:01,690 Both of us? 234 00:13:02,130 --> 00:13:03,130 Why not? 235 00:13:04,170 --> 00:13:05,530 Um, I'm 48. 236 00:13:05,750 --> 00:13:08,990 And I've had patients give birth to beautiful, healthy children as old as 237 00:13:08,990 --> 00:13:10,770 51. You're here. 238 00:13:11,050 --> 00:13:13,070 Might as well see what we're working with. 239 00:13:16,110 --> 00:13:20,170 More doctors? I know you're anxious to get out of here, but unfortunately your 240 00:13:20,170 --> 00:13:22,530 stress test results indicate you might need to be admitted to internal 241 00:13:22,530 --> 00:13:27,990 medicine. Oh my God, I'm so sorry. It's my husband. 242 00:13:28,590 --> 00:13:29,590 Hello? 243 00:13:29,810 --> 00:13:31,270 What is this, a circus? 244 00:13:31,550 --> 00:13:32,890 I'm sure that was important. 245 00:13:33,770 --> 00:13:37,490 He's 13 months post-surgical aortic valve replacement of a congenital 246 00:13:37,490 --> 00:13:41,030 bicuspid valve. Heard a new murmur on exam and he reports worsening fatigue 247 00:13:41,030 --> 00:13:45,190 upon exertion. That's also because I'm on construction site 12 hours a day. 248 00:13:49,090 --> 00:13:50,090 What's going on? 249 00:13:51,210 --> 00:13:53,010 I'm afraid you're in heart failure again. 250 00:13:54,410 --> 00:14:00,910 What? Dr. Swanson said this would be over after surgery. Now I need another 251 00:14:00,910 --> 00:14:01,879 one? 252 00:14:01,880 --> 00:14:04,140 I can't afford to miss two more months of work. 253 00:14:05,220 --> 00:14:07,220 Let's just take this one step at a time. 254 00:14:09,360 --> 00:14:13,680 We need to figure out how long his heart's been in failure. 255 00:14:14,120 --> 00:14:15,079 That's the problem. 256 00:14:15,080 --> 00:14:17,900 He missed all his follow-ups with Swanson, so there won't be any echoes. 257 00:14:18,480 --> 00:14:19,720 So, what are you thinking? 258 00:14:20,060 --> 00:14:23,760 We need valve gradients, leaflet motion, ventricular function, so let's start 259 00:14:23,760 --> 00:14:29,020 with TE, then get CBC, CRP. Blood culture is to rule out endocarditis. 260 00:14:30,280 --> 00:14:32,460 Be nice if your intern was available to manage that. 261 00:14:36,200 --> 00:14:36,959 It's fine. 262 00:14:36,960 --> 00:14:38,260 I'll order them myself. 263 00:14:53,080 --> 00:14:55,480 Pete Grady and Sadie and the leaflets are barely moving. 264 00:14:56,020 --> 00:14:59,340 Well, that valve's critically obstructed. No wonder he's back in heart 265 00:14:59,340 --> 00:15:00,900 failure. I'll call surgery. 266 00:15:03,380 --> 00:15:04,620 Thanks, Mike. We can take it from here. 267 00:15:10,220 --> 00:15:11,720 Swanson didn't implant the valve correctly. 268 00:15:12,800 --> 00:15:16,300 Well, a post-op echo would have showed that. He should never have been 269 00:15:16,300 --> 00:15:17,860 discharged. It's not here. 270 00:15:18,260 --> 00:15:21,120 He never ordered it? I don't know, but it's not here, and I need to find out 271 00:15:21,120 --> 00:15:22,120 why. 272 00:15:22,520 --> 00:15:26,340 So what we're doing here is using electrical pulses to trick your brain 273 00:15:26,340 --> 00:15:28,660 into lowering your blood pressure. How are her vitals? 274 00:15:29,540 --> 00:15:32,300 BP is 195 over 100, heart rate 85. 275 00:15:32,820 --> 00:15:35,780 Hi, I'm Dr. Hamda, Chief of Internal Medicine. 276 00:15:36,140 --> 00:15:38,500 Cece suggested I might pay a little visit. 277 00:15:38,720 --> 00:15:40,440 She does love authority figures. 278 00:15:41,360 --> 00:15:44,260 So, carotid baroreflex stimulation. 279 00:15:44,980 --> 00:15:49,540 Did you want to supervise? I'll observe and assist if needed. 280 00:15:50,380 --> 00:15:51,380 Great. 281 00:15:52,040 --> 00:15:55,420 Are you ready? I trust Cece, and she trusts you. 282 00:15:56,580 --> 00:15:58,840 You tell us if it gets too much for you, okay? 283 00:16:06,600 --> 00:16:08,360 Increasing frequency to 80 hertz. 284 00:16:15,700 --> 00:16:16,700 Systolic's down to 150. 285 00:16:17,440 --> 00:16:18,540 So far, so good, Bonnie. 286 00:16:19,040 --> 00:16:20,040 You doing okay? 287 00:16:20,260 --> 00:16:21,760 Feels weird, but I'm fine. 288 00:16:24,840 --> 00:16:27,900 120 is now almost there 289 00:16:27,900 --> 00:16:34,720 systolic 190 290 00:16:34,720 --> 00:16:39,520 and climbing it's all good increasing stimulation settings to compensate 291 00:16:39,520 --> 00:16:48,700 I'm 292 00:16:48,700 --> 00:16:49,700 feeling a bit 293 00:16:54,730 --> 00:16:57,110 She's hypotensive with a weak post. She's losing consciousness. 294 00:16:57,450 --> 00:16:58,450 Crash cart, now! 295 00:16:58,990 --> 00:16:59,990 Bonnie? 296 00:17:00,490 --> 00:17:02,330 Bonnie, can you hear me? Bonnie? 297 00:17:04,589 --> 00:17:08,790 I'm on my own for my birthday this go-around. Actually, first time in three 298 00:17:08,790 --> 00:17:11,010 decades. Yeah? How are you going to celebrate? 299 00:17:11,310 --> 00:17:14,810 With this mess of a year, drinking whiskey and watching the Knicks. 300 00:17:15,770 --> 00:17:17,130 That sounds heavenly. 301 00:17:17,470 --> 00:17:18,470 Right? Ben! 302 00:17:18,849 --> 00:17:20,210 Thought you were heading back last night. 303 00:17:20,510 --> 00:17:23,450 Hey! Um, well, Dr. Larson... 304 00:17:23,819 --> 00:17:27,700 Cornered me after my VATS talk and offered to lecture me on post-op pleural 305 00:17:27,700 --> 00:17:30,720 effusion management over lukewarm omelets. 306 00:17:30,960 --> 00:17:32,400 An offer he couldn't refuse. 307 00:17:32,960 --> 00:17:35,880 Understandable. Your reputation precedes you. Elliot Norman. 308 00:17:36,350 --> 00:17:39,730 A pleasure. Yeah, I feel like I know you from all of your acknowledgements in 309 00:17:39,730 --> 00:17:43,050 JAMA. Angling for another one soon if Ben gets his way. Elliot is the chief 310 00:17:43,050 --> 00:17:46,710 research officer overseeing my bridge heart trial at St. Mark's. I'd love to 311 00:17:46,710 --> 00:17:49,010 get your read on it if you're going to be in New York anytime soon. 312 00:17:49,250 --> 00:17:50,470 I'm not a cardiologist. 313 00:17:50,850 --> 00:17:53,570 No, but there are a dozen medical comorbid factors that can complicate the 314 00:17:53,570 --> 00:17:56,590 trial. Got to make sure he's not getting a home court advantage from our 315 00:17:56,590 --> 00:17:58,630 internists. More than fine by me. 316 00:18:01,950 --> 00:18:04,410 I'm actually passing through New York in a couple weeks. 317 00:18:05,300 --> 00:18:06,360 I'd love to stop by. 318 00:18:06,700 --> 00:18:09,020 Splendid. Ben can give you the details from my office. 319 00:18:09,500 --> 00:18:11,180 I'll make sure your hotel and flights are covered. 320 00:18:11,560 --> 00:18:12,560 Good to see you. 321 00:18:16,120 --> 00:18:17,120 Couple of weeks? 322 00:18:17,700 --> 00:18:20,300 Well, it seems like he really wants me there. 323 00:18:24,270 --> 00:18:27,910 So, she is in a medically induced coma for hypertensive crisis. 324 00:18:28,210 --> 00:18:31,250 The increase in stimulation was minimal. There's no way I could have bottomed out 325 00:18:31,250 --> 00:18:33,050 her BP like this. What's the MRI show? 326 00:18:33,290 --> 00:18:34,470 There's no anoxic brain damage. 327 00:18:34,670 --> 00:18:37,070 I'm loading her on phenytoin. And an EEG. 328 00:18:37,450 --> 00:18:40,630 I don't need her seizing on my table if you ever manage to get her there. 329 00:18:41,110 --> 00:18:44,770 I'm sensing you had a stark difference of opinion about the correct course of 330 00:18:44,770 --> 00:18:45,770 action. We did, yes. 331 00:18:45,930 --> 00:18:48,050 Well, that should have been brought to me. I'm assuming if that were the 332 00:18:48,050 --> 00:18:51,690 protocol, Dr. Larson would have done so. We sorted it out ourselves, and Dr. 333 00:18:51,930 --> 00:18:54,250 Grant agreed that my idea was lower risk. 334 00:18:54,490 --> 00:18:55,490 Obviously, I was wrong. 335 00:18:55,750 --> 00:19:00,130 I just got off the phone with Eastside. I want her transferred there now. That's 336 00:19:00,130 --> 00:19:02,930 not possible, Ms. Reinhold. She's in no condition to be moved. 337 00:19:03,320 --> 00:19:06,660 There is a variable that we all missed, but as soon as I find it, we will 338 00:19:06,660 --> 00:19:10,300 address it before there are any more complications. You need to trust me. I 339 00:19:10,300 --> 00:19:11,300 already made that mistake. 340 00:19:12,440 --> 00:19:13,700 Labs just came back. 341 00:19:14,040 --> 00:19:17,960 BUN and creatinine are elevated, but TSH is normal. Okay, thank you, Ruth. 342 00:19:18,220 --> 00:19:21,780 If Bonnie's going to stay here, I want you, the head of the department, taking 343 00:19:21,780 --> 00:19:26,300 charge. And maybe you can figure out what Dr. Larson and this little intern 344 00:19:26,300 --> 00:19:28,640 did that has backfired so disastrously. 345 00:19:28,860 --> 00:19:32,820 Now, outcomes can't always be predicted, and Bonnie was in terrible shape when 346 00:19:32,820 --> 00:19:33,820 she walked in our door. 347 00:19:33,900 --> 00:19:37,620 But we hear you, and I'll be running point on this from here on out. 348 00:19:38,340 --> 00:19:41,920 If you'll excuse me, I'll have to explain to her family why they may never 349 00:19:41,920 --> 00:19:43,000 get to say goodbye to her. 350 00:19:46,360 --> 00:19:49,060 I'll be standing by if you can ever find your way back from this. 351 00:19:51,320 --> 00:19:52,320 Dr. Chen. 352 00:19:52,560 --> 00:19:54,800 Tren, B-U-N, creatinine, and urine output. 353 00:19:55,100 --> 00:19:57,620 And try to let that slide off of you. 354 00:19:58,200 --> 00:19:59,200 Yeah, appreciate that. 355 00:19:59,560 --> 00:20:03,200 I'm fine. I'm going to insert a central line so we can monitor her CVPs and 356 00:20:03,200 --> 00:20:04,119 fluid status. 357 00:20:04,120 --> 00:20:05,880 And get me your notes on those old cases. 358 00:20:06,160 --> 00:20:11,700 Michael, I don't know yet what went wrong, but it was the right call. 359 00:20:18,700 --> 00:20:19,579 So Dr. 360 00:20:19,580 --> 00:20:20,539 Swanson's not here? 361 00:20:20,540 --> 00:20:25,120 He is tied up in another surgery at the moment. But listen, Dr. Humphrey is 362 00:20:25,120 --> 00:20:27,020 excellent. Okay, we're lucky that he was on call. 363 00:20:27,300 --> 00:20:30,580 He reviewed your TEE, came up with an airtight game plan. I don't understand 364 00:20:30,580 --> 00:20:31,980 what went wrong in the first place. 365 00:20:32,720 --> 00:20:34,560 We're still trying to get to the bottom of that. 366 00:20:34,880 --> 00:20:37,920 Okay, but listen, right now the important thing is that we solve this 367 00:20:37,920 --> 00:20:38,920 problem once and for all, okay? 368 00:20:39,700 --> 00:20:40,700 Thanks, Doc. 369 00:20:40,820 --> 00:20:42,420 I do appreciate it. 370 00:20:42,900 --> 00:20:43,900 See you in post-op. 371 00:20:50,150 --> 00:20:51,190 Hey, Roger, you got a sec? 372 00:20:51,650 --> 00:20:53,050 I got 60. 373 00:20:53,810 --> 00:20:57,190 Listen, I wanted to give you a heads up that one of your patients was readmitted 374 00:20:57,190 --> 00:20:58,630 with an improperly seated aortic valve. 375 00:20:59,770 --> 00:21:00,770 Who was it? 376 00:21:00,950 --> 00:21:01,950 Johnny Parsons. 377 00:21:02,810 --> 00:21:06,090 Aortic valve stenosis, 33, worst obstruction, needed a SAVR. 378 00:21:06,630 --> 00:21:10,030 I can't say I remember him, but I'm happy to get back in there and patch him 379 00:21:10,030 --> 00:21:10,909 up after this. 380 00:21:10,910 --> 00:21:12,930 Yeah, he's already in surgery. Humphrey was on call. 381 00:21:13,450 --> 00:21:14,710 And I'm just hearing about it now? 382 00:21:15,860 --> 00:21:19,300 I would have had a duty to disclose your potential negligence before allowing you 383 00:21:19,300 --> 00:21:21,760 to operate on him again, so this just felt more expedient. 384 00:21:22,840 --> 00:21:25,300 Negligence? I'm not talking about the valve. That could have happened to 385 00:21:25,300 --> 00:21:27,740 anybody. I'm referring to the post-op echo that I can't seem to find. 386 00:21:27,940 --> 00:21:28,940 That would have shown a gradient. 387 00:21:29,140 --> 00:21:34,040 You never would have discharged him. Oh, so you're a detective now, or is it an 388 00:21:34,040 --> 00:21:35,040 internal affairs? 389 00:21:36,800 --> 00:21:39,220 Okay, well, I'm headed to radiologists. You're hoping they can find it. 390 00:21:40,700 --> 00:21:44,100 Dr. Heller, the proper protocol. 391 00:21:44,780 --> 00:21:46,320 Would have been to go to the head of the department. 392 00:21:46,900 --> 00:21:49,100 Does Dr. Matos know you're running around like this? 393 00:21:49,480 --> 00:21:51,960 First year fellow and a second week on the job. 394 00:21:52,280 --> 00:21:55,160 You know, I was giving you the benefit of the doubt. Now I'm not so sure it was 395 00:21:55,160 --> 00:21:56,019 her. 396 00:21:56,020 --> 00:21:58,300 Dr. Swanson, we're ready for you. 397 00:22:03,520 --> 00:22:07,540 So, none of your other patients had a BP spike like Bonnie's, even though they 398 00:22:07,540 --> 00:22:08,740 were in the same hypertensive range? 399 00:22:09,080 --> 00:22:10,080 No. 400 00:22:10,360 --> 00:22:12,760 Which makes her reaction all the more puzzling. 401 00:22:14,540 --> 00:22:16,440 I'm not sure how you could have ever liked her. 402 00:22:17,740 --> 00:22:22,260 She uses anger to cover her grief, and I know a bit about that. 403 00:22:23,060 --> 00:22:24,060 I'm sure you've heard. 404 00:22:25,220 --> 00:22:28,980 Bonnie's EEG tracing continues to be within normal limits, but now her 405 00:22:28,980 --> 00:22:31,760 temperature's all over the place, too. She's been as high as 102. 406 00:22:32,980 --> 00:22:35,900 Do the fluctuations track with her blood pressure spikes? 407 00:22:39,660 --> 00:22:40,700 Almost to the second. 408 00:22:42,000 --> 00:22:46,040 We've been treating the tumor like an adenocarcinoma, but what if there's more 409 00:22:46,040 --> 00:22:47,040 going on? 410 00:22:48,100 --> 00:22:49,100 Divergent differentiation. 411 00:22:49,200 --> 00:22:53,160 So the tumor consists of two different cell types, not just the one. Exactly. 412 00:22:53,160 --> 00:22:57,520 So what kind of tumor cell could explain simultaneous spikes in both blood 413 00:22:57,520 --> 00:22:59,280 pressure and body temperature, Dr. Chen? 414 00:22:59,980 --> 00:23:04,300 One's recruiting calicholamines. Yeah. Go get plasma metanephrines. Yeah. 415 00:23:05,040 --> 00:23:08,020 If you're right, delaying surgery saved her life. 416 00:23:13,220 --> 00:23:16,460 Pharmacadia's device only lasts two years and a quarter of the patients die 417 00:23:16,460 --> 00:23:20,260 waiting for transplants. This is going to blow them out of the water. 418 00:23:20,460 --> 00:23:22,780 In terms of long-term durability? 419 00:23:23,200 --> 00:23:26,020 Not just durability. This could be a permanent solution. 420 00:23:26,560 --> 00:23:28,340 Oh, you're getting a little bit ahead of yourself. 421 00:23:28,660 --> 00:23:29,660 Well, a man can dream. 422 00:23:31,940 --> 00:23:36,700 So this is what the book's going to be about? No, no, no. I'm not publishing on 423 00:23:36,700 --> 00:23:37,319 this yet. 424 00:23:37,320 --> 00:23:41,660 The book is about my father and grandfather, both surgeons. 425 00:23:43,120 --> 00:23:44,300 It's quite the legacy. 426 00:23:44,560 --> 00:23:45,600 Both giants. 427 00:23:46,000 --> 00:23:47,080 Dad still is. 428 00:23:48,440 --> 00:23:50,520 Well, I'm sure this will make him very proud. 429 00:23:50,900 --> 00:23:52,940 Well, he's a tough one. We'll see. 430 00:23:55,440 --> 00:23:58,160 So what is it that Elliot wants me to look at? 431 00:23:59,560 --> 00:24:01,760 A catecholamine-secreting tumor. 432 00:24:02,190 --> 00:24:05,770 And Eastside had no reason to look for it after the initial biopsy. But 433 00:24:05,770 --> 00:24:09,050 clearly, the chemo is not what was causing her BP spikes. 434 00:24:09,310 --> 00:24:13,590 And if I'd resected her tumor the way I planned, the hormone secretion into her 435 00:24:13,590 --> 00:24:16,290 bloodstream would have killed her. In all likelihood, yes. 436 00:24:16,710 --> 00:24:20,090 In all certainty, but I appreciate you not rubbing it in my face. 437 00:24:20,470 --> 00:24:21,470 Not really my style. 438 00:24:22,070 --> 00:24:23,650 At least, not anymore. 439 00:24:27,820 --> 00:24:31,900 I gave Cece the update and told her we're deciding best course of action. 440 00:24:32,260 --> 00:24:33,280 Can you still operate? 441 00:24:33,640 --> 00:24:37,020 Well, I was hoping to do a three-stage approach, but now I can't. I mean, I 442 00:24:37,020 --> 00:24:40,040 would need to remove the hormone-secreting tumor first, which is 443 00:24:40,040 --> 00:24:41,360 a whole different scale. 444 00:24:41,600 --> 00:24:43,960 Did you do a paraganglioma resection last year? 445 00:24:44,800 --> 00:24:45,800 You read that? 446 00:24:45,860 --> 00:24:46,860 20 minutes ago. 447 00:24:47,150 --> 00:24:50,170 I can do an in-block removal in my sleep, but her tumor's like an octopus 448 00:24:50,170 --> 00:24:53,450 now. And it's in her lung, not her bladder, like in that surgery. 449 00:24:53,670 --> 00:24:55,490 Plus the catecholamine release. 450 00:24:55,810 --> 00:24:59,030 The second you touch it, she could stroke out. And we're talking six, maybe 451 00:24:59,030 --> 00:25:00,750 eight hours poking around in there. 452 00:25:01,290 --> 00:25:05,510 Phentolamine for any hypertensive surges, metirozine to suppress the 453 00:25:05,510 --> 00:25:07,870 hormone production, and titrate minute to minute. 454 00:25:08,130 --> 00:25:09,170 It would be on me. 455 00:25:10,650 --> 00:25:11,790 I'm game if you are. 456 00:25:12,430 --> 00:25:13,430 It's up to him. 457 00:25:17,580 --> 00:25:21,140 Once Johnny's out of surgery, do a post-op exam and present your findings 458 00:25:21,140 --> 00:25:25,540 to me. Till then, it's admissions HandPs in 6-17, 6-21. 459 00:25:27,080 --> 00:25:30,340 Your husband? I am so, so sorry. It's a sitter. 460 00:25:30,780 --> 00:25:33,100 My husband's out of town and our little guy isn't feeling well. 461 00:25:33,740 --> 00:25:35,060 Oh, um, it's okay. 462 00:25:35,700 --> 00:25:36,700 Take it. 463 00:25:37,580 --> 00:25:38,780 Hey, how's he doing? 464 00:25:39,420 --> 00:25:41,580 So, radiology doesn't have the post-op echo. 465 00:25:41,940 --> 00:25:42,940 Swanson never ordered one. 466 00:25:43,400 --> 00:25:47,780 Unbelievable. That patient of yours a while back, I think he was a delivery 467 00:25:47,780 --> 00:25:49,980 driver, was his name Abe? Yeah, what about him? 468 00:25:50,800 --> 00:25:54,800 Didn't you tell me that Joan had to step in because Swanson closed up mid-surgery 469 00:25:54,800 --> 00:25:55,800 or something to go on vacation? 470 00:25:56,040 --> 00:25:58,220 Well, it wasn't quite that simple, but yeah. 471 00:25:58,780 --> 00:26:00,100 What are you, building a case? 472 00:26:00,400 --> 00:26:03,780 Well, I checked into the timing of Johnny's surgery last year. It was 473 00:26:03,780 --> 00:26:04,780 Friday night at 7. 474 00:26:04,980 --> 00:26:08,280 So you and I both know the Echo team would have been gone by then. So Swanson 475 00:26:08,280 --> 00:26:10,840 would have had to call someone in, wait around for hours. 476 00:26:11,100 --> 00:26:13,620 So you think he never ordered an Echo because it was inconvenient? 477 00:26:14,270 --> 00:26:15,270 I don't know. Could be. 478 00:26:15,530 --> 00:26:17,110 But can you give me the records on that case? 479 00:26:17,410 --> 00:26:18,089 I can. 480 00:26:18,090 --> 00:26:19,990 Okay. But you should tread lightly. 481 00:26:20,330 --> 00:26:22,270 You're already on probation with Matos. 482 00:26:22,830 --> 00:26:23,830 Email it to me, okay? 483 00:26:23,970 --> 00:26:24,970 Okay. 484 00:26:27,510 --> 00:26:28,610 Sorry to keep you waiting. 485 00:26:30,970 --> 00:26:35,150 The results are showing a more complicated picture than we had hoped, 486 00:26:35,270 --> 00:26:37,350 but ultimately there's a path forward here. 487 00:26:38,130 --> 00:26:39,130 Okay. 488 00:26:40,110 --> 00:26:43,810 So, Wendy, I know this will be disappointing, but your ovarian reserve 489 00:26:43,810 --> 00:26:44,810 has become very low. 490 00:26:46,450 --> 00:26:48,650 With Gina, however, there's good news. 491 00:26:49,870 --> 00:26:51,650 Your eggs appear to still be viable. 492 00:26:53,330 --> 00:26:56,730 Really? Well, as I said, you're an individual, not a statistic. 493 00:26:57,290 --> 00:27:01,150 And we can get started with treatments as soon as tomorrow, which I would 494 00:27:01,150 --> 00:27:02,150 recommend. 495 00:27:05,670 --> 00:27:06,850 You made me wait. 496 00:27:10,929 --> 00:27:14,530 Wendy. You made me wait and now you get to have everything that I wanted. 497 00:27:16,370 --> 00:27:18,230 This is something we're going to do together. 498 00:27:21,890 --> 00:27:23,450 Sorry, I just need a minute. 499 00:27:31,550 --> 00:27:35,150 Check his electrolytes every 12 hours and keep an eye on his stats. 500 00:27:35,430 --> 00:27:36,429 On it. 501 00:27:36,430 --> 00:27:39,740 Hey. Thanks for being so understanding today, Dr. Mitra. 502 00:27:40,000 --> 00:27:43,180 I know I need to leave my personal life at home. But you have a kid. 503 00:27:43,460 --> 00:27:44,580 Some things can't wait. 504 00:27:45,100 --> 00:27:47,460 No, I don't have a kid. That was about my dog. 505 00:27:47,820 --> 00:27:51,260 I mean, he's a puppy and we're training, so it's a lot right now. 506 00:27:51,760 --> 00:27:52,760 Excuse me? 507 00:27:53,060 --> 00:27:54,140 He's my Wheaton Terrier. 508 00:27:54,740 --> 00:27:56,800 Oh, God, a kid? Could you imagine? 509 00:27:57,460 --> 00:27:58,940 Lots of doctors have kids. 510 00:27:59,160 --> 00:27:59,979 Well, I would never. 511 00:27:59,980 --> 00:28:01,160 I mean, climate change alone. 512 00:28:01,400 --> 00:28:04,740 Okay, that is the most cynical thing I've ever heard. You just want to give 513 00:28:04,740 --> 00:28:05,740 up on humanity? 514 00:28:06,060 --> 00:28:07,080 It's just an opinion. 515 00:28:07,600 --> 00:28:11,000 Kind of thought we were all entitled to one. Just get back to work, Claire, and 516 00:28:11,000 --> 00:28:12,000 no more calls. 517 00:28:22,120 --> 00:28:26,440 Oh, um, the nurses said you might have a second to talk, but it's a little 518 00:28:26,440 --> 00:28:28,740 delicate, so I'll come back later. No, no, no. You're looking at the closest 519 00:28:28,740 --> 00:28:30,940 thing I have to free time today, so shoot. 520 00:28:32,580 --> 00:28:33,800 We need to talk about Swanson. 521 00:28:37,800 --> 00:28:38,800 Tell me about your book. 522 00:28:40,000 --> 00:28:41,000 Well, 523 00:28:41,240 --> 00:28:46,260 my grandfather studied at Howard under the great Daniel Hale Williams. 524 00:28:46,700 --> 00:28:51,520 No. Yeah, and by the time my father came around, living under the shadow of a man 525 00:28:51,520 --> 00:28:55,920 who studied with the pioneer of open-heart surgery, he really had no 526 00:28:55,920 --> 00:28:57,000 choice of what he was going to do. 527 00:28:57,280 --> 00:29:01,680 And then the third generation just had to follow in their footsteps. 528 00:29:01,880 --> 00:29:03,800 Well, if they had been cobblers, would I be mending souls? 529 00:29:04,520 --> 00:29:05,520 Probably not. 530 00:29:06,070 --> 00:29:07,530 No, what they did was inspiring. 531 00:29:08,270 --> 00:29:13,370 I'm the first generation in my family to even go to college, so it's all upside 532 00:29:13,370 --> 00:29:14,370 for me. 533 00:29:14,830 --> 00:29:18,610 Thank you for taking time today to come see what I've been doing. 534 00:29:21,850 --> 00:29:22,910 Heart rate's spiking. 535 00:29:24,090 --> 00:29:25,090 Pushing esmolol. 536 00:29:30,540 --> 00:29:33,160 You see that translucent area under my probe, Dr. Coleman? 537 00:29:33,460 --> 00:29:34,980 Looks more like a cyst than a tumor. 538 00:29:35,180 --> 00:29:36,180 That's a bag of adrenaline. 539 00:29:36,260 --> 00:29:39,720 If we squeeze it or if we rupture it... Makes it very interesting for me. 540 00:29:40,060 --> 00:29:41,060 Her BP's stable. 541 00:29:41,280 --> 00:29:42,600 I'd appreciate you keeping it that way. 542 00:29:42,880 --> 00:29:43,880 All right. 543 00:29:43,900 --> 00:29:46,240 Retract very gently on your side. 544 00:29:53,960 --> 00:29:54,980 Easy, easy. 545 00:30:03,630 --> 00:30:06,270 It's a matter to the Pankow's tumor. Can you give me more blood pressure control, 546 00:30:06,390 --> 00:30:07,630 Dr. Larson? I need to get aggressive. 547 00:30:08,270 --> 00:30:10,070 Nicotipine. Fine-tuned as we go. 548 00:30:11,590 --> 00:30:13,190 Smart. I try. 549 00:30:14,090 --> 00:30:16,150 Okay. You need to time this perfectly. 550 00:30:16,610 --> 00:30:20,430 You retract very slowly on your side, and I'll release the last editor in 551 00:30:20,430 --> 00:30:21,430 part. 552 00:30:22,370 --> 00:30:23,510 Let's pull this monster out. 553 00:30:38,160 --> 00:30:39,800 Okay. Here we go. 554 00:30:51,440 --> 00:30:52,620 Pressure crashing. 555 00:30:52,820 --> 00:30:53,820 Pushing norepi. 556 00:31:03,400 --> 00:31:04,400 Come on. 557 00:31:11,540 --> 00:31:12,540 Stuck the landing. 558 00:31:14,240 --> 00:31:16,120 All right, let's put it back together. 559 00:31:20,440 --> 00:31:24,160 So everything went great. I haven't heard that one before. Yeah, I know. 560 00:31:25,480 --> 00:31:26,720 Julie, you mind giving us a room? 561 00:31:32,800 --> 00:31:36,960 Look, man, I know today's been a terrible day and you have every right to 562 00:31:36,960 --> 00:31:40,410 be upset, but... The good news is we know you don't have something that's 563 00:31:40,410 --> 00:31:42,030 going to put you back in the hospital a year from now. 564 00:31:42,450 --> 00:31:43,870 How can you be sure of that? 565 00:31:45,110 --> 00:31:46,650 Because the problem was surgeon error. 566 00:31:49,210 --> 00:31:52,810 The valve that Swanson put in was placed incorrectly. 567 00:31:53,670 --> 00:31:56,930 Now, they should have caught that with a post-op study, but he never ordered one. 568 00:31:56,990 --> 00:31:58,450 That's why you went into heart failure again. 569 00:31:59,650 --> 00:32:04,570 Was he supposed to order one? I mean, normally the surgeon would do that? 570 00:32:04,810 --> 00:32:09,010 Yes. That is protocol. So that's about practice. I could sue, right? You can. 571 00:32:09,310 --> 00:32:11,510 And between you and me, I'd be rooting for you. 572 00:32:11,990 --> 00:32:14,950 But do I have a case? I don't know. Johnny, I'm not a lawyer. 573 00:32:15,310 --> 00:32:17,010 Then talk to me like a human being. 574 00:32:19,430 --> 00:32:22,510 All I can tell you is if I'm deposed, I will tell the truth. 575 00:32:23,070 --> 00:32:25,810 You're saying he almost killed me. 576 00:32:26,830 --> 00:32:28,670 So why isn't this a slam dunk? 577 00:32:28,950 --> 00:32:31,810 The thing is, you did skip your follow-up visits. 578 00:32:32,470 --> 00:32:34,450 And that delayed the diagnosis. 579 00:32:35,640 --> 00:32:36,680 So this is on me? 580 00:32:37,340 --> 00:32:38,720 That's what the hospital's going to argue. 581 00:32:38,940 --> 00:32:42,940 Yeah. So he's going to get away with this and be able to do it to other 582 00:32:42,940 --> 00:32:45,100 people. I've already talked to the chief of surgery. 583 00:32:45,540 --> 00:32:48,100 I'm hopeful that he can have more eyes on him from now on. 584 00:32:50,420 --> 00:32:51,440 That's supposed to be enough. 585 00:32:54,900 --> 00:32:56,660 Tell me about Johnny Parsons. 586 00:32:57,260 --> 00:32:58,300 Dr. Heller came to you. 587 00:32:58,580 --> 00:33:00,820 Radiology says you never ordered a post-op echo. 588 00:33:01,060 --> 00:33:02,060 Is that true? 589 00:33:03,040 --> 00:33:04,040 Look. 590 00:33:04,200 --> 00:33:08,580 I checked the date, and my wife had an event that night, so I... That's the 591 00:33:08,580 --> 00:33:09,720 wrong answer, Roger. 592 00:33:10,520 --> 00:33:11,540 I get it. 593 00:33:12,080 --> 00:33:15,440 I intended to do it in the morning, but I must have gotten slammed. 594 00:33:15,980 --> 00:33:17,020 It won't happen again. 595 00:33:17,600 --> 00:33:18,740 Are you sure about that? 596 00:33:19,600 --> 00:33:20,600 Excuse me? 597 00:33:21,040 --> 00:33:25,960 Two months ago, a hotshot attorney needs a heart procedure, and you come in on a 598 00:33:25,960 --> 00:33:27,660 Saturday and stay until midnight. 599 00:33:28,570 --> 00:33:32,670 A real estate mogul the week before, where he gets a whole buffet of post-op 600 00:33:32,670 --> 00:33:36,770 tests and the VIP treatment, but a delivery driver comes in a couple months 601 00:33:36,770 --> 00:33:40,950 back, and you left him to catch a flight to the Bahamas. There were complications 602 00:33:40,950 --> 00:33:43,930 in that situation. Which you are uninterested in resolving because of 603 00:33:43,930 --> 00:33:44,569 your vacation. 604 00:33:44,570 --> 00:33:47,890 You're cherry-picking a couple cases out of a 23-year career. 605 00:33:48,270 --> 00:33:50,550 In my experience, where there's smoke, there's fire. 606 00:33:51,270 --> 00:33:53,350 I don't like the way this smells, Roger. 607 00:33:54,370 --> 00:33:56,470 Yeah, okay, so what is this? 608 00:33:57,010 --> 00:34:00,950 Suspension? Because I'm not taking a demotion. No, there's no need. You're 609 00:34:00,950 --> 00:34:01,950 fired. 610 00:34:03,770 --> 00:34:06,090 Four months severance. Leave your badge in your locker. 611 00:34:17,590 --> 00:34:19,150 Ah, excuse me. 612 00:34:19,929 --> 00:34:20,888 Hey there. 613 00:34:20,889 --> 00:34:23,469 Good timing. I just confirmed the hotel in Philly. 614 00:34:23,929 --> 00:34:27,830 Ben, I'm reviewing some of your data. I don't love the trends in some of these 615 00:34:27,830 --> 00:34:30,870 bicarbs. And serum creatinine levels are elevated. 616 00:34:31,150 --> 00:34:33,389 I think you've got a big problem here. 617 00:34:33,909 --> 00:34:38,230 Yeah, I get that, but they'll self-resolve in two weeks. I'll send you 618 00:34:38,230 --> 00:34:41,290 the kidney numbers on the phase one trials, and you'll see. 619 00:34:44,550 --> 00:34:46,270 You did the right thing bringing her here. 620 00:34:46,989 --> 00:34:48,389 And trusting Dr. Grant. 621 00:34:49,030 --> 00:34:50,030 And you. 622 00:34:51,400 --> 00:34:54,080 I should have known you'd find what was overlooked. 623 00:34:55,460 --> 00:34:59,840 I lost Bonnie once, and I was scared of it happening again. 624 00:35:00,640 --> 00:35:04,180 Well, I appreciate that, but I get it. 625 00:35:05,320 --> 00:35:09,180 What happened to you in your accident, the neurological issues? 626 00:35:09,560 --> 00:35:11,300 I lost eight years of my memory. 627 00:35:11,900 --> 00:35:15,340 When you came in here last year, I didn't even know who you were. 628 00:35:15,720 --> 00:35:20,440 So it's all been an act even today? No, I'm all caught up on the medicine. 629 00:35:20,840 --> 00:35:24,100 The memory loss doesn't affect how I do my job. 630 00:35:24,440 --> 00:35:25,480 You sure about that? 631 00:35:26,060 --> 00:35:27,260 How did I do today? 632 00:35:28,500 --> 00:35:30,120 And the last time you were here? 633 00:35:31,500 --> 00:35:33,080 Brilliance is brilliance, I suppose. 634 00:35:34,380 --> 00:35:35,980 But you should have told me before. 635 00:35:37,060 --> 00:35:39,460 I like to think it's my business. 636 00:35:40,110 --> 00:35:43,510 If I told every patient who came through that door what I've been struggling 637 00:35:43,510 --> 00:35:45,310 with, do you think they'd let me treat them? 638 00:35:48,410 --> 00:35:53,410 I'm not giving up this gift I have, but I can do with it for others. 639 00:35:55,030 --> 00:35:57,350 Well, I know what it's like to be forsaken. 640 00:35:58,910 --> 00:36:00,410 This will stay between us. 641 00:36:11,630 --> 00:36:13,030 I hope Cece said thank you. 642 00:36:13,250 --> 00:36:14,250 She did. 643 00:36:14,490 --> 00:36:15,590 And she apologized. 644 00:36:16,090 --> 00:36:19,810 And I explained to her why I ran that charade on her a few months ago. 645 00:36:20,590 --> 00:36:21,810 So you two are okay now? 646 00:36:22,290 --> 00:36:23,370 We were okay then. 647 00:36:25,790 --> 00:36:26,930 Conflict can be healthy. 648 00:36:27,130 --> 00:36:29,150 Even sometimes when it looks unhealthy. 649 00:36:29,930 --> 00:36:30,930 So what? 650 00:36:31,890 --> 00:36:32,890 Embrace the mess? 651 00:36:34,670 --> 00:36:35,690 I think you're learning. 652 00:36:58,640 --> 00:37:01,940 I'm sorry that I made us wait. 653 00:37:03,680 --> 00:37:07,120 I had accepted my life, and you dropped a bomb. 654 00:37:07,580 --> 00:37:10,340 And I could only imagine how much that must hurt. 655 00:37:11,900 --> 00:37:16,540 But I asked Dr. Shaw, you can carry the baby. 656 00:37:19,100 --> 00:37:24,380 The child will be ours. We will do it together, and it will be incredible. 657 00:37:28,110 --> 00:37:32,150 It's just not the vision that I had this morning. 658 00:37:33,730 --> 00:37:35,690 It's okay if you want to be mad at me. 659 00:37:36,230 --> 00:37:37,270 I can take it. 660 00:37:40,290 --> 00:37:43,170 I don't want to be mad at you. 661 00:37:51,670 --> 00:37:57,310 How you doing? 662 00:37:58,480 --> 00:37:59,480 Long shift. 663 00:37:59,960 --> 00:38:00,980 How's Ruth doing? 664 00:38:01,300 --> 00:38:03,500 Learning by osmosis, I hope. 665 00:38:05,540 --> 00:38:07,820 Claire told me that you snapped at her. 666 00:38:08,060 --> 00:38:10,620 Well, there's a role reversal, huh? 667 00:38:12,620 --> 00:38:14,980 So, you're still freaking out? 668 00:38:15,560 --> 00:38:17,360 I think so, yeah. 669 00:38:18,220 --> 00:38:21,880 About which part? Well, pretty soon I'm going to be waddling around trying to 670 00:38:21,880 --> 00:38:25,400 train these people with all the street cred of someone about to go on maternity 671 00:38:25,400 --> 00:38:28,420 leave. Oh, that can be handled, Sonia. Come on. 672 00:38:30,380 --> 00:38:36,160 I know. I... It's TJ. 673 00:38:37,560 --> 00:38:39,440 We've been together for four months. 674 00:38:39,820 --> 00:38:41,880 Do you think this is what he signed up for? 675 00:38:42,320 --> 00:38:44,260 He won't run from his responsibilities. 676 00:38:44,820 --> 00:38:46,200 No, of course not. He's TJ. 677 00:38:47,299 --> 00:38:53,000 He'll say all the right things. He'll do what needs to be done. But from this 678 00:38:53,000 --> 00:38:55,600 point on, I'll never know if that's what he really wants. 679 00:38:56,320 --> 00:38:58,240 Or if it's what I really want. 680 00:39:00,180 --> 00:39:01,240 Do you love him? 681 00:39:03,780 --> 00:39:05,460 I think we were on our way. 682 00:39:06,780 --> 00:39:10,100 But now we'll never get a clean shot to figure it out. 683 00:39:10,960 --> 00:39:11,960 And... 684 00:39:12,520 --> 00:39:14,380 I don't want him to be with me out of obligation. 685 00:39:14,920 --> 00:39:18,300 You know, look, you're right. He will say and do all the right things. But if 686 00:39:18,300 --> 00:39:22,440 you obsess about whether or not you're both forcing it, the relationship will 687 00:39:22,440 --> 00:39:24,940 be doomed. I know that. Trust me, I do. 688 00:39:27,620 --> 00:39:29,440 Love is a risk. 689 00:39:30,540 --> 00:39:31,540 Always. 690 00:39:32,040 --> 00:39:37,680 You can't control what life is going to throw at you. All you can do is lean in. 691 00:39:43,020 --> 00:39:47,580 I hear you caused quite the ruckus in surgery today and gave our general 692 00:39:47,580 --> 00:39:49,420 counsel a liability scare. 693 00:39:49,700 --> 00:39:51,500 I was just advocating for my patient. 694 00:39:51,740 --> 00:39:54,940 And why wasn't I looped in? I wanted to come to you with a solution rather than 695 00:39:54,940 --> 00:39:56,460 a problem. You didn't come to me at all. 696 00:39:56,740 --> 00:39:58,720 I had to hear about it from Ben Grant. 697 00:39:59,240 --> 00:40:02,460 I wanted to avoid putting you into a difficult situation. I know you and 698 00:40:02,460 --> 00:40:03,880 Swanson have a long-standing relationship. 699 00:40:04,140 --> 00:40:08,000 So now you're suggesting that I wouldn't have handled it objectively. No, no. Not 700 00:40:08,000 --> 00:40:11,520 for nothing. But I thought that Swanson was a tool 20 years ago. 701 00:40:11,820 --> 00:40:12,920 I think he's a tool now. 702 00:40:13,300 --> 00:40:17,480 But he is a reasonably good doctor, and what you did today got him fired. 703 00:40:17,980 --> 00:40:19,180 I think I can live with that. 704 00:40:19,720 --> 00:40:21,620 I'm glad your conscience feels clear. 705 00:40:21,900 --> 00:40:26,160 Dr. Grant can make whatever decision he wants in his department, but he should 706 00:40:26,160 --> 00:40:28,260 have made it after talking to me, not to you. 707 00:40:28,800 --> 00:40:29,820 That's the protocol. 708 00:40:30,740 --> 00:40:32,560 Understood. Won't happen again. 709 00:40:33,960 --> 00:40:38,520 I suppose you're learning how things work when you don't have special 710 00:40:38,520 --> 00:40:39,520 privileges. 711 00:40:39,760 --> 00:40:43,380 Excuse me? Well, I get the sense you had a very wide berth with Dr. Larson 712 00:40:43,380 --> 00:40:45,620 because of your romantic relationship. 713 00:40:46,320 --> 00:40:47,680 So that's what this is about? 714 00:40:48,500 --> 00:40:51,840 It's a question of character, Dr. Heller. Character informs judgment. 715 00:40:52,360 --> 00:40:57,080 And from what I've seen, yours is severely lacking across the board. 716 00:41:05,280 --> 00:41:06,380 There you are. 717 00:41:07,050 --> 00:41:11,050 Hey, we really can't be late. It took me forever to get us reservations to this 718 00:41:11,050 --> 00:41:12,390 restaurant. I'm pregnant. 719 00:41:15,170 --> 00:41:16,450 About seven weeks. 720 00:41:18,650 --> 00:41:19,650 Okay. 721 00:41:21,990 --> 00:41:22,990 Wow. 722 00:41:23,870 --> 00:41:28,790 Wow. That is... I only found out yesterday. 723 00:41:30,790 --> 00:41:33,530 And you already did the ultrasound? 724 00:41:34,390 --> 00:41:35,430 This morning. 725 00:41:39,850 --> 00:41:41,410 I'm keeping it, TJ. 726 00:41:41,830 --> 00:41:43,250 Right, right, right, for sure. 727 00:41:44,110 --> 00:41:48,170 We can handle it. You don't have to say that. Whatever you're thinking, if 728 00:41:48,170 --> 00:41:50,390 you're freaking out, it's fine. I'm not, I'm not. 729 00:41:51,410 --> 00:41:52,410 Okay? 730 00:41:52,970 --> 00:41:53,970 This is beautiful. 731 00:41:55,990 --> 00:41:57,190 And I'm going to take care of you. 732 00:41:58,890 --> 00:42:00,770 No matter what, you don't have to worry. 733 00:42:05,750 --> 00:42:06,750 Okay, I won't. 734 00:42:13,840 --> 00:42:14,840 We can do this. 735 00:42:20,220 --> 00:42:21,220 Hey. 736 00:42:21,900 --> 00:42:22,900 Hey. 737 00:42:23,860 --> 00:42:24,860 Bunny's doing well. 738 00:42:25,200 --> 00:42:26,440 I hope we got it all. 739 00:42:27,140 --> 00:42:30,580 Sorry to start the day going toe-to-toe like that and for not giving you the 740 00:42:30,580 --> 00:42:32,180 benefit of the doubt when things went wrong. 741 00:42:33,580 --> 00:42:36,500 I think maybe we're both used to being the smartest person in the room. 742 00:42:36,860 --> 00:42:37,860 Oh, for sure. 743 00:42:39,340 --> 00:42:42,440 Anyway, you'll have a couple days with me out of your hair. I'm headed to New 744 00:42:42,440 --> 00:42:45,800 York tomorrow to... Checking on my clinical trial. I heard it's being 745 00:42:45,800 --> 00:42:46,738 transferred here. 746 00:42:46,740 --> 00:42:48,120 Yeah, that's what I'm organizing now. 747 00:42:48,880 --> 00:42:51,160 Is that the trial that I consulted on? 748 00:42:51,900 --> 00:42:52,900 It is. 749 00:42:53,180 --> 00:42:56,720 And I'm happy to have you wander down to us whenever we get it up and running. 750 00:42:57,820 --> 00:43:00,380 I don't love the trends in some of these bicarbs. 751 00:43:02,080 --> 00:43:03,080 Look forward to it. 752 00:43:04,820 --> 00:43:05,820 Good.