1 00:00:00,934 --> 00:00:01,801 Previously on Doc... 2 00:00:02,001 --> 00:00:04,237 You having memory seizures? - Intense memories. 3 00:00:04,237 --> 00:00:05,805 Go ahead and start on these. 4 00:00:05,872 --> 00:00:07,374 What's the status of your transplant trial? 5 00:00:07,407 --> 00:00:09,342 I'll be bringing in some of my New York people, 6 00:00:09,442 --> 00:00:10,343 including Sasha. 7 00:00:10,443 --> 00:00:11,878 Didn't Dr. Larsen consult with you on this 8 00:00:11,945 --> 00:00:12,612 a few years ago? 9 00:00:12,645 --> 00:00:14,080 We've got a big problem here. 10 00:00:14,114 --> 00:00:16,015 She did, but she wouldn't remember that. 11 00:00:16,082 --> 00:00:17,117 One of my donors just dropped out. 12 00:00:17,150 --> 00:00:18,418 Anything I can do? 13 00:00:18,485 --> 00:00:20,487 You want me to put in a good word with my father? 14 00:00:20,520 --> 00:00:23,156 Nina's stepson is one of our most promising interns. 15 00:00:23,256 --> 00:00:24,924 Did you antagonize her? 16 00:00:24,958 --> 00:00:27,427 Just so you know, Dr. Larsen was down on the fourth floor. 17 00:00:27,527 --> 00:00:28,995 I get the feeling they didn't clue you in. 18 00:00:29,029 --> 00:00:30,597 What the hell is going on down here? 19 00:00:33,099 --> 00:00:35,168 You're here to finalize your wedding registry? 20 00:00:36,436 --> 00:00:38,271 Are these two not the cutest frickin' thing 21 00:00:38,304 --> 00:00:40,040 you've ever seen? 22 00:00:40,106 --> 00:00:41,107 So when's the big day? 23 00:00:41,174 --> 00:00:43,276 You know, I really think we need a minute here. 24 00:00:43,309 --> 00:00:46,379 Okay. Uh, but, you're running out of time. 25 00:00:47,547 --> 00:00:49,582 You're not like, worried for real? 26 00:00:49,683 --> 00:00:52,419 Well, he is windsurfing right now, and I'm here. 27 00:00:52,452 --> 00:00:54,754 Yeah, well, he's a dude. 28 00:00:54,788 --> 00:00:56,056 I gotta tell you, 29 00:00:56,156 --> 00:00:57,924 the way he stormed out this morning, 30 00:00:57,991 --> 00:00:59,893 I don't know if he's even coming back. 31 00:01:06,366 --> 00:01:08,468 Hello? Is this Kat Keating? 32 00:01:08,501 --> 00:01:09,703 Yes. 33 00:01:09,769 --> 00:01:12,272 This is Dr. Walker calling from Westside Hospital. 34 00:01:12,305 --> 00:01:14,641 You're the emergency contact for Rob Landis? 35 00:01:14,708 --> 00:01:16,176 Yes. Is something wrong? 36 00:01:16,276 --> 00:01:18,545 I'm sorry to tell you, but Rob was in an accident. 37 00:01:18,578 --> 00:01:20,580 He was found unconscious at White Bear Lake. 38 00:01:20,647 --> 00:01:24,451 Um... wait, um, what are you saying? 39 00:01:24,551 --> 00:01:27,120 Unfortunately he's in a coma. 40 00:01:27,153 --> 00:01:30,223 But he's gonna wake up, right? 41 00:01:30,990 --> 00:01:32,492 He'll wake up, right? 42 00:01:49,542 --> 00:01:50,477 A granuloma. 43 00:01:50,543 --> 00:01:52,045 Forming around the bone fragment 44 00:01:52,078 --> 00:01:53,580 and irritating the hippocampus. 45 00:01:53,613 --> 00:01:55,215 Which is causing the memory seizures. 46 00:01:55,281 --> 00:01:56,383 Most likely, yes. 47 00:01:56,449 --> 00:01:58,752 I haven't had any since I started taking the medication. 48 00:01:58,852 --> 00:02:01,287 Well, okay, but if the nodule keeps growing... 49 00:02:01,321 --> 00:02:03,356 It's likely the seizures will return, 50 00:02:03,423 --> 00:02:05,859 and they could become incapacitating. 51 00:02:05,892 --> 00:02:09,195 Well, I can't have you performing procedures 52 00:02:09,229 --> 00:02:10,729 until we understand what we're dealing with. 53 00:02:10,764 --> 00:02:12,932 And I'll have to read the board in on all of this, 54 00:02:12,966 --> 00:02:14,234 for everyone's protection. 55 00:02:14,334 --> 00:02:16,803 As long as I can keep seeing patients and diagnose. 56 00:02:16,836 --> 00:02:18,271 Absolutely. 57 00:02:19,706 --> 00:02:21,241 Well, I'm sorry, Amy. 58 00:02:21,307 --> 00:02:23,109 I know this isn't what you wanted to hear. 59 00:02:23,209 --> 00:02:24,477 It's fine. 60 00:02:24,511 --> 00:02:26,179 I'll get started on my rounds. 61 00:02:27,981 --> 00:02:29,582 So, no procedures? 62 00:02:29,616 --> 00:02:30,984 I can farm them out 63 00:02:31,084 --> 00:02:32,118 to specialists as they come up. 64 00:02:32,218 --> 00:02:33,253 Are you all right? 65 00:02:33,319 --> 00:02:34,287 Temporary speed bump. 66 00:02:34,354 --> 00:02:37,824 But now reason for the interns to know about it. 67 00:02:38,391 --> 00:02:39,793 Just keep an eye out for Graham. 68 00:02:39,893 --> 00:02:42,629 Still have no idea why he tried to turn us against each other. 69 00:02:42,662 --> 00:02:45,231 He's a spoiled brat who is used to 70 00:02:45,265 --> 00:02:47,133 pushing boundaries and getting his own way. 71 00:02:47,200 --> 00:02:49,936 Mm. I'm afraid it's more than that. 72 00:02:49,969 --> 00:02:51,204 I think he's a snake. 73 00:02:51,237 --> 00:02:53,873 Go do your rounds, I will deal with him. 74 00:03:01,981 --> 00:03:03,683 Trouble in paradise? 75 00:03:05,418 --> 00:03:06,986 Do you have your assignments, Claire? 76 00:03:07,020 --> 00:03:09,122 I do. Just waiting for Dr. Barrett. 77 00:03:09,155 --> 00:03:10,423 Go find her. 78 00:03:11,558 --> 00:03:12,692 'Kay. 79 00:03:14,127 --> 00:03:15,195 What's up? 80 00:03:15,261 --> 00:03:17,530 I think it's important you understand that Dr. Maitra 81 00:03:17,564 --> 00:03:21,034 and I are entirely in alignment. - Glad to hear. Of course. 82 00:03:22,135 --> 00:03:23,303 Good. 83 00:03:23,403 --> 00:03:25,772 Dr. Park needs you in 618. 84 00:03:25,839 --> 00:03:27,007 Great. 85 00:03:28,775 --> 00:03:30,377 - And Graham? - Yeah? 86 00:03:30,410 --> 00:03:33,380 I'd think twice before having your stepmother 87 00:03:33,413 --> 00:03:35,515 interfere with our work here. 88 00:03:42,856 --> 00:03:44,724 Hey, uh, Dr. Larsen said you needed me for something? 89 00:03:44,824 --> 00:03:46,559 Perfect timing, just about to start his enema. 90 00:03:46,593 --> 00:03:48,461 Enema? 91 00:03:48,561 --> 00:03:50,296 You'll probably need to flush it through 92 00:03:50,330 --> 00:03:51,831 several times. 93 00:03:51,865 --> 00:03:53,166 Report back when it's clear. - Mm-hmm. 94 00:03:57,570 --> 00:03:59,305 I hate to say it, 95 00:03:59,339 --> 00:04:00,206 but I agree with Michael. 96 00:04:00,273 --> 00:04:01,808 At least in the short term. 97 00:04:01,841 --> 00:04:04,944 - I get it. I'm not pushing back, Gina. 98 00:04:05,045 --> 00:04:06,212 Now, you asked for a consult? 99 00:04:06,312 --> 00:04:07,147 29-year-old male. 100 00:04:07,247 --> 00:04:09,749 He's had long-term life-supportive care. 101 00:04:09,816 --> 00:04:11,217 Windsurfing accident four years ago. 102 00:04:11,317 --> 00:04:13,720 Complete unresponsive state until last week. 103 00:04:13,753 --> 00:04:15,889 That's when I saw the first BP spike. 104 00:04:15,989 --> 00:04:19,192 BP spike doesn't indicate a change in cognitive status. 105 00:04:19,225 --> 00:04:20,627 Second one was 10 minutes ago. 106 00:04:20,694 --> 00:04:23,229 Both times they happened when I was reading to him. 107 00:04:23,263 --> 00:04:26,966 I assume you've done a coma recovery scale periodically. 108 00:04:27,033 --> 00:04:28,735 - Every three months. Nothing. 109 00:04:28,768 --> 00:04:33,106 But this week, there's this change. 110 00:04:33,173 --> 00:04:34,441 So, now you're thinking... 111 00:04:34,474 --> 00:04:35,442 Emerging consciousness. 112 00:04:35,475 --> 00:04:38,812 I want CMP, CBC, a full workup, 113 00:04:38,845 --> 00:04:40,246 and then an fMRI. 114 00:04:40,313 --> 00:04:42,649 It's a ten-point jump. 115 00:04:43,350 --> 00:04:44,951 Humor me. 116 00:04:51,791 --> 00:04:53,660 After six years of painstaking research, 117 00:04:53,727 --> 00:04:55,128 we've reached the human phase 118 00:04:55,195 --> 00:04:56,796 of our artificial heart trial. 119 00:04:56,896 --> 00:04:59,632 Which represents hope to thousands of people. 120 00:04:59,666 --> 00:05:00,867 When this proves successful, 121 00:05:00,900 --> 00:05:03,470 the people who receive our artificial heart 122 00:05:03,503 --> 00:05:06,272 will be tacking on years to their lives, yes, 123 00:05:06,339 --> 00:05:09,676 but the ultimate goal, our holy grail, 124 00:05:09,743 --> 00:05:12,645 will be for this to last long enough so that our patients 125 00:05:12,679 --> 00:05:16,683 can live full lives without ever relying on an organ donor. 126 00:05:16,783 --> 00:05:18,685 Our sentinel cohort of three patients 127 00:05:18,752 --> 00:05:20,253 will arrive on separate Medevacs 128 00:05:20,286 --> 00:05:21,955 taking off in the next hour or two. 129 00:05:22,022 --> 00:05:24,958 Each one has a different form of end-stage heart failure. 130 00:05:25,025 --> 00:05:27,027 Diverging symptoms, diverging risk profiles. 131 00:05:27,060 --> 00:05:30,163 Which is why they were chosen after exhaustive reviews 132 00:05:30,230 --> 00:05:31,831 by us and the IRB. 133 00:05:31,931 --> 00:05:35,201 Now, those flights will likely create further complications, 134 00:05:35,235 --> 00:05:38,571 so Dr. Douglas and Heller are on loan from Cardiology 135 00:05:38,672 --> 00:05:40,440 to assist with managing them 136 00:05:40,507 --> 00:05:41,574 and maintaining patient stability 137 00:05:41,641 --> 00:05:43,109 in preparation for their surgeries. 138 00:05:43,209 --> 00:05:48,148 The three-cohort mandate stipulates one surgery per week. 139 00:05:48,915 --> 00:05:49,949 If one of them crashes, 140 00:05:49,983 --> 00:05:53,153 the whole enterprise comes to a grinding halt. 141 00:05:53,186 --> 00:05:54,587 Make no mistake. 142 00:05:54,688 --> 00:05:57,557 This is gonna be a wild ride, so I need everybody here, 143 00:05:57,590 --> 00:06:01,127 everybody... firing on all cylinders. 144 00:06:08,335 --> 00:06:10,704 Such a fuss over a little wheezing. 145 00:06:10,737 --> 00:06:13,907 You know the asthma's related to your EGPA. 146 00:06:13,940 --> 00:06:15,442 So, like it or not, 147 00:06:15,475 --> 00:06:16,710 you're gonna get the full workup. 148 00:06:16,743 --> 00:06:19,779 I was supposed to see my grandbabies today. 149 00:06:22,749 --> 00:06:25,485 They're like actual little people now! 150 00:06:25,585 --> 00:06:27,887 They're beautiful. 151 00:06:27,954 --> 00:06:30,323 Uh, any other symptoms flaring up? 152 00:06:30,357 --> 00:06:32,325 Some numbness in my hands. 153 00:06:33,560 --> 00:06:36,062 - Pulmonary function test? - Please. 154 00:06:37,197 --> 00:06:38,365 Yeah. 155 00:06:38,431 --> 00:06:40,033 So, we haven't talked about you. 156 00:06:40,100 --> 00:06:43,336 I certainly hope you have a boyfriend by now. 157 00:06:43,370 --> 00:06:44,771 Matter of fact, I do. 158 00:06:44,838 --> 00:06:46,639 He's a doctor. - Don't tell me. 159 00:06:46,740 --> 00:06:50,710 Dr. Heller? - Uh, no. Dr. Coleman. 160 00:06:50,777 --> 00:06:52,112 TJ? 161 00:06:52,178 --> 00:06:53,980 You've met him. He works here. 162 00:06:54,080 --> 00:06:55,515 Show me a photo. 163 00:06:59,219 --> 00:07:01,454 Oh, I remember him. 164 00:07:01,488 --> 00:07:02,622 Yeah? 165 00:07:02,655 --> 00:07:05,658 - He's a good egg. - Yes, he is. For sure. 166 00:07:05,759 --> 00:07:09,262 What happened to the Wicked Witch of Westside? 167 00:07:09,362 --> 00:07:11,998 Uh, still haunting the halls? 168 00:07:13,099 --> 00:07:14,367 Hi, Rob. 169 00:07:14,401 --> 00:07:15,769 It's Dr. Walker, I'm sure you know 170 00:07:15,802 --> 00:07:17,370 my voice by now. I'm gonna ask you 171 00:07:17,404 --> 00:07:18,938 a few questions, okay? 172 00:07:19,005 --> 00:07:20,907 If your answer's yes, I want you 173 00:07:20,940 --> 00:07:23,143 to think of swinging a hammer. 174 00:07:23,209 --> 00:07:24,344 If your answer's no, 175 00:07:24,411 --> 00:07:26,946 I want you to think of what your apartment looked like. 176 00:07:30,383 --> 00:07:32,152 Do you live in California? 177 00:07:38,024 --> 00:07:40,827 - Hippocampal activation. That's a "no"! 178 00:07:40,927 --> 00:07:43,496 Reading you loud and clear, Rob. 179 00:07:43,530 --> 00:07:45,265 Do you live in Minnesota? 180 00:07:47,534 --> 00:07:49,836 - Motor area. Affirmative response. 181 00:07:49,903 --> 00:07:52,706 Okay, how about your fiancée, Kat? 182 00:07:52,772 --> 00:07:54,974 Motor, again, affirmative. 183 00:07:55,642 --> 00:07:57,944 Okay, that is great, Rob. 184 00:07:57,977 --> 00:08:00,647 Now, do you remember having an accident? 185 00:08:02,882 --> 00:08:03,917 Nothing. 186 00:08:04,684 --> 00:08:07,587 Do you remember having a windsurfing accident? 187 00:08:10,323 --> 00:08:11,891 That's a negative. 188 00:08:13,860 --> 00:08:15,428 But, even if he's conscious, 189 00:08:15,462 --> 00:08:16,863 that could be just a black-out area. 190 00:08:16,930 --> 00:08:20,433 These could be random bold fluctuations. 191 00:08:20,467 --> 00:08:22,302 We could be reading the tea leaves. 192 00:08:26,473 --> 00:08:28,575 Darrin, how long to switch to a vascular MRI? 193 00:08:28,608 --> 00:08:31,177 15 minutes for the IV contrast. 194 00:08:31,211 --> 00:08:32,178 Do it now. 195 00:08:32,212 --> 00:08:33,580 You see this distorted vessel? 196 00:08:33,613 --> 00:08:35,582 That's what's causing the BP spikes. 197 00:08:35,615 --> 00:08:37,317 He's having an aneurysm. 198 00:08:44,824 --> 00:08:46,760 So how are those study numbers looking? 199 00:08:47,193 --> 00:08:48,028 I was right, wasn't I? 200 00:08:48,395 --> 00:08:50,230 I thought they'd improve once the post-op inflammation... 201 00:08:50,296 --> 00:08:51,097 No you didn't. 202 00:08:51,164 --> 00:08:52,365 You're too smart for that. 203 00:08:52,432 --> 00:08:55,769 You knew the study was flawed long before I pointed it out. 204 00:08:55,835 --> 00:08:58,338 You're the only one that noticed. 205 00:08:58,371 --> 00:08:59,973 Elliot wants me to do a report 206 00:09:00,006 --> 00:09:02,642 for the Institutional Review Board. 207 00:09:02,742 --> 00:09:04,678 He wants a formal assessment. 208 00:09:05,245 --> 00:09:06,012 I didn't know that. 209 00:09:06,046 --> 00:09:07,347 Well, I guess you're gonna need 210 00:09:07,380 --> 00:09:08,715 my help fixing the problem, then. 211 00:09:10,784 --> 00:09:12,786 I feel like the bionic man... 212 00:09:12,852 --> 00:09:14,521 All these wires hanging off me. 213 00:09:15,989 --> 00:09:17,757 He has been making that joke all day. 214 00:09:17,791 --> 00:09:19,926 Wait 'till we get that titanium heart into him. 215 00:09:20,026 --> 00:09:21,227 Then he'll really be off to see the wizard. 216 00:09:21,261 --> 00:09:23,763 I think you might be mixing up your pop culture references 217 00:09:23,797 --> 00:09:24,864 there, Dr. Douglas, but yes, 218 00:09:24,931 --> 00:09:26,933 he's right, we're gonna take good care of you, okay? 219 00:09:27,033 --> 00:09:28,168 Are the other patients here? 220 00:09:28,201 --> 00:09:30,003 Not yet, but they're arriving today. 221 00:09:32,072 --> 00:09:32,772 What's wrong? 222 00:09:40,013 --> 00:09:42,282 So, he's got some fluid on his lungs, 223 00:09:42,382 --> 00:09:43,416 probably just from the flight over. 224 00:09:43,516 --> 00:09:45,418 Nothing to worry about yet. - Yet? 225 00:09:45,518 --> 00:09:46,686 Babe, babe, just relax, okay? 226 00:09:46,786 --> 00:09:49,289 They got a backup plan for the backup plan. 227 00:09:49,389 --> 00:09:50,557 Ain't that right, doc? 228 00:09:50,657 --> 00:09:52,258 - Of course. We're gonna get it figured out. 229 00:09:55,662 --> 00:09:57,230 So, he's fluid overloaded. 230 00:09:57,330 --> 00:09:59,432 Probably just from the low cabin oxygen pressure. 231 00:09:59,532 --> 00:10:01,301 I'll get a nurse to draw a BNP. 232 00:10:01,401 --> 00:10:02,836 Okay. 233 00:10:05,705 --> 00:10:07,841 So, it's a sentinel bleed. 234 00:10:07,941 --> 00:10:09,542 Needs to be treated in the next few hours, 235 00:10:09,576 --> 00:10:12,412 and I'm afraid a surgical approach will invite 236 00:10:12,445 --> 00:10:13,847 way too many complications. 237 00:10:13,913 --> 00:10:15,115 Well, it'll be tricky, 238 00:10:15,215 --> 00:10:18,551 but I think I can manage it intravascularly. 239 00:10:18,585 --> 00:10:20,453 I'm not sure we should do that. 240 00:10:20,520 --> 00:10:22,555 It's a heroic measure 241 00:10:22,589 --> 00:10:24,958 for someone with no quality of life. 242 00:10:24,991 --> 00:10:27,127 So you want to wait for it to rupture and let him die? 243 00:10:27,227 --> 00:10:28,428 He's trapped in there, and now he's presenting 244 00:10:28,461 --> 00:10:32,232 with a natural cause of death, we don't have to intervene. 245 00:10:32,265 --> 00:10:34,000 I've been reading to him every week for four years 246 00:10:34,100 --> 00:10:37,070 and this is the first time he's demonstrated consciousness 247 00:10:37,103 --> 00:10:40,273 which means he could be coming out of his unresponsive state. 248 00:10:40,373 --> 00:10:43,743 It's much more likely this activity is terminal lucidity. 249 00:10:43,843 --> 00:10:45,478 Well, "much more likely" isn't good enough for me. 250 00:10:45,545 --> 00:10:47,881 There's no advanced directive? 251 00:10:47,981 --> 00:10:50,216 - No living will. No proxy, no DNR. 252 00:10:50,283 --> 00:10:51,384 His parents died young. 253 00:10:51,451 --> 00:10:53,553 He has a fiancée, but we haven't heard from her in months. 254 00:10:53,586 --> 00:10:56,690 Darrin, reload the fMRI. 255 00:10:56,723 --> 00:10:58,024 What are you doing? 256 00:10:58,124 --> 00:11:00,560 Hi, Rob, this is Dr. Larsen. 257 00:11:00,593 --> 00:11:02,896 You've been in an unresponsive state 258 00:11:02,996 --> 00:11:06,099 for four years and now you have a brain aneurysm. 259 00:11:06,166 --> 00:11:07,267 If we do nothing, 260 00:11:07,300 --> 00:11:09,302 you will slip away peacefully and die. 261 00:11:09,402 --> 00:11:12,439 If we operate, it's likely that it won't help 262 00:11:12,539 --> 00:11:15,875 wake you up and you might live like this for years. 263 00:11:15,909 --> 00:11:18,378 We believe that the decision should be yours. 264 00:11:19,379 --> 00:11:22,615 So, if you want to live, 265 00:11:22,649 --> 00:11:24,150 think of swinging a hammer. 266 00:11:24,184 --> 00:11:26,386 And if you want us to let you pass away, 267 00:11:26,486 --> 00:11:28,088 think of your apartment. 268 00:11:33,860 --> 00:11:34,994 Hippocampus. 269 00:11:36,629 --> 00:11:38,064 If he can hear us, 270 00:11:38,164 --> 00:11:40,533 he is saying that he wants to die. 271 00:11:40,600 --> 00:11:43,403 Okay. Step aside, please. 272 00:11:46,873 --> 00:11:48,808 Hi, Rob, it's Dr. Walker. 273 00:11:48,908 --> 00:11:50,944 I want to ask you again. 274 00:11:53,413 --> 00:11:56,216 Never mind, Rob, we're gonna take care of you. 275 00:11:56,282 --> 00:11:59,085 There's no way we're letting him make this decision 276 00:11:59,185 --> 00:12:02,288 when we have no idea what his cognition level is. 277 00:12:02,355 --> 00:12:03,356 Do the procedure. 278 00:12:03,456 --> 00:12:05,358 We'll revisit the existential part of this later. 279 00:12:05,425 --> 00:12:07,427 So we restore his physical health, and then what? 280 00:12:07,460 --> 00:12:11,264 Debate euthanasia? You know we're not doing that. 281 00:12:12,532 --> 00:12:14,701 Get him to the procedure room. 282 00:12:14,801 --> 00:12:16,169 I'll start prepping. 283 00:12:20,640 --> 00:12:23,443 Transferring surgeon says Lewis Pinachek's tucked in 284 00:12:23,543 --> 00:12:25,545 and en route. - And Sam? 285 00:12:25,578 --> 00:12:26,780 Got here about 20 minutes ago. 286 00:12:26,846 --> 00:12:29,683 Dr. Heller's dealing with some fluid issues from the flight. 287 00:12:29,716 --> 00:12:32,152 And this is Nancy Breyer. Excuse me. 288 00:12:32,185 --> 00:12:33,253 Dr. Coleman. 289 00:12:33,353 --> 00:12:36,556 Ah, there she is! 290 00:12:36,589 --> 00:12:38,124 Welcome to Westside. 291 00:12:38,224 --> 00:12:41,127 I seriously cannot believe you traded New York for this. 292 00:12:41,194 --> 00:12:43,496 Can you manage to not be a snob for five minutes? 293 00:12:43,530 --> 00:12:45,865 It comes with the accent, but I'll try to hide it 294 00:12:45,932 --> 00:12:48,134 from your new gang from Fargo, doncha know? 295 00:12:48,234 --> 00:12:49,936 Oh, that's not bad for a Brit. 296 00:12:49,969 --> 00:12:52,205 We just lost Ward. 297 00:12:52,238 --> 00:12:54,240 - What are you talking about? I spoke to him last night. 298 00:12:54,274 --> 00:12:56,276 Some surgeon at Methodist sold him on a new med 299 00:12:56,343 --> 00:12:59,012 that he says will keep him alive until he gets a real heart. 300 00:12:59,079 --> 00:13:00,413 Did you explain that our protocol 301 00:13:00,447 --> 00:13:01,548 dictates a cohort of three, 302 00:13:01,648 --> 00:13:03,550 which means our other two patients can't move forward... 303 00:13:03,583 --> 00:13:05,185 Of course. 304 00:13:07,220 --> 00:13:08,021 All right. 305 00:13:08,121 --> 00:13:09,022 Get the files on all the alternates. 306 00:13:09,122 --> 00:13:10,757 Need a backup here in the next twelve hours. 307 00:13:10,824 --> 00:13:12,726 Eliminate anyone with overlapping symptoms 308 00:13:12,759 --> 00:13:14,594 or a clinical picture to Lewis and Sam. 309 00:13:14,627 --> 00:13:15,729 We need medical diversity. 310 00:13:15,762 --> 00:13:17,430 Got it. 311 00:13:19,366 --> 00:13:21,735 So, Vera's in an assisted-living facility? 312 00:13:21,768 --> 00:13:22,902 At her age? 313 00:13:23,003 --> 00:13:24,404 Since she was 51. 314 00:13:24,437 --> 00:13:27,607 It was a really difficult transition for her, obviously. 315 00:13:27,640 --> 00:13:29,209 You seem to know her really well. 316 00:13:30,310 --> 00:13:33,346 She was my first patient as an intern. 317 00:13:34,614 --> 00:13:35,782 I kept making mistakes, 318 00:13:35,849 --> 00:13:38,151 and even when some of the other doctors 319 00:13:38,184 --> 00:13:42,322 were hard on me she was very kind and supportive, 320 00:13:42,389 --> 00:13:45,058 which is not how it's supposed to be. 321 00:13:45,158 --> 00:13:46,893 I was supposed to be there for her. 322 00:13:48,595 --> 00:13:50,397 Results are in. 323 00:13:54,300 --> 00:13:57,270 - Call the 6th floor. Code team to Vera's room. 324 00:13:57,370 --> 00:13:58,204 What's wrong? 325 00:13:58,304 --> 00:14:00,073 She's about to go into cardiac arrest. 326 00:14:03,576 --> 00:14:06,146 I think you might've, uh, jumped the gun, Dr. Maitra. 327 00:14:06,179 --> 00:14:07,614 Just get that EKG hooked up. 328 00:14:07,681 --> 00:14:10,884 Vera, are you experiencing any pain or tightness in your chest? 329 00:14:10,917 --> 00:14:12,452 No, I just feel really nauseous. 330 00:14:12,485 --> 00:14:14,220 I think you may be having a heart attack. 331 00:14:14,320 --> 00:14:16,222 That machine's gonna tell us if I'm right. 332 00:14:18,224 --> 00:14:19,426 Tombstones on the inferior leads. 333 00:14:19,526 --> 00:14:20,093 You're right. 334 00:14:20,193 --> 00:14:21,361 Multivessel disease. 335 00:14:21,428 --> 00:14:23,830 Activate the cath lab and call the shock team. 336 00:14:31,905 --> 00:14:34,808 Oh, God, this is gross. 337 00:14:41,715 --> 00:14:43,350 Oh, hey Nina. Took you long enough. 338 00:14:43,383 --> 00:14:45,719 Sorry I don't jump at your every whim. 339 00:14:45,819 --> 00:14:46,853 Yeah, well, thanks to you, 340 00:14:46,953 --> 00:14:48,221 I got a problem with both Chiefs now. 341 00:14:48,254 --> 00:14:50,557 - Thanks to me? - Yeah. Clearly you made a call 342 00:14:50,590 --> 00:14:51,524 when I told you not to. 343 00:14:51,591 --> 00:14:53,593 And now Larsen just threw it back in my face. 344 00:14:53,693 --> 00:14:54,627 Oh, did she now? 345 00:14:54,661 --> 00:14:56,396 Yeah, so what are you gonna do to fix it? 346 00:14:56,496 --> 00:14:59,699 - Give me a beat. I'll get back to you. 347 00:15:00,333 --> 00:15:02,435 So you haven't found a replacement yet? 348 00:15:02,469 --> 00:15:03,603 It's a high-wire act, 349 00:15:03,636 --> 00:15:05,405 but we're closing in on several candidates. 350 00:15:05,505 --> 00:15:08,141 Well, the IRB does not like surprises. 351 00:15:08,241 --> 00:15:10,643 And putting a gun to their heads at the 11th hour 352 00:15:10,677 --> 00:15:13,079 after they've vetted your candidates for weeks 353 00:15:13,113 --> 00:15:14,581 is a recipe for disaster. 354 00:15:15,882 --> 00:15:17,484 Who's that with Dr. Grant? 355 00:15:18,118 --> 00:15:21,354 That is our hospital administrator. 356 00:15:21,454 --> 00:15:22,822 There a problem? 357 00:15:23,656 --> 00:15:26,593 Important day. Everyone wants to make sure it runs smoothly. 358 00:15:37,370 --> 00:15:40,273 - Got it. Thank you. - Okay, what do we got? 359 00:15:40,306 --> 00:15:42,909 - Richardson died last week. We are down to the final four. 360 00:15:42,976 --> 00:15:43,977 What about Frank Baldwin? 361 00:15:44,044 --> 00:15:45,011 I thought his acute hepatitis was under control. 362 00:15:45,078 --> 00:15:47,180 Liver enzymes have spiked to the thousands. 363 00:15:47,280 --> 00:15:48,214 He's not stable enough to travel. 364 00:15:48,248 --> 00:15:50,383 Dr. Heller just added a nitro drip on Sam, 365 00:15:50,417 --> 00:15:52,185 so we have to consider his fluid overload 366 00:15:52,252 --> 00:15:53,520 as an official complication now. 367 00:15:53,553 --> 00:15:54,788 Which knocks out Deborah Palmer. 368 00:15:54,888 --> 00:15:55,922 She's got the same profile. 369 00:15:55,989 --> 00:15:58,458 We really need that level of medical diversity? 370 00:15:58,558 --> 00:16:00,927 - That's the whole point. No overlapping diagnoses. 371 00:16:01,027 --> 00:16:03,163 I think Ivy Oringer's our best shot. 372 00:16:03,196 --> 00:16:06,166 Diabetic, cardiomyopathy from Milwaukee. 373 00:16:06,199 --> 00:16:07,200 That's the one. 374 00:16:07,300 --> 00:16:08,902 Her sugars are out of whack. 375 00:16:08,935 --> 00:16:10,337 I think we can manage it with continuous 376 00:16:10,403 --> 00:16:12,172 glucose monitoring and titrated insulin. 377 00:16:12,205 --> 00:16:13,807 I don't want to think, Sasha. 378 00:16:13,907 --> 00:16:15,075 We commit, she gets too unstable, 379 00:16:15,141 --> 00:16:16,943 they shut down the whole trial. Come on, now. 380 00:16:20,347 --> 00:16:22,182 We'll go in through the femoral artery, 381 00:16:22,215 --> 00:16:24,784 guide a micro catheter up into the aneurysm 382 00:16:24,818 --> 00:16:26,953 and then pack it with platinum coils. 383 00:16:38,031 --> 00:16:39,366 Am I interrupting? 384 00:16:39,432 --> 00:16:40,834 I was just checking in, anyway. 385 00:16:40,900 --> 00:16:42,335 What's up? - Uh, déja vu. 386 00:16:42,369 --> 00:16:43,937 I need to borrow that big brain of yours. 387 00:16:43,970 --> 00:16:45,338 An issue with your trial? 388 00:16:45,372 --> 00:16:46,740 Yeah. One of our patients dropped out. 389 00:16:46,773 --> 00:16:49,743 But I have an alternate I need moved from Milwaukee, 390 00:16:49,776 --> 00:16:52,712 Ivy Oringer, but her sugars are running in the high threes. 391 00:16:52,779 --> 00:16:54,114 She's 34? 392 00:16:54,180 --> 00:16:55,815 Yeah, and her mom's been fighting like hell 393 00:16:55,849 --> 00:16:56,916 to find a way to save her. 394 00:16:56,950 --> 00:16:58,418 I'm hopeful this is it. 395 00:16:59,619 --> 00:17:01,321 Yeah, her C peptides are a little high. 396 00:17:01,354 --> 00:17:03,189 Yeah, I wasn't sure what to make of that. 397 00:17:03,223 --> 00:17:05,258 It's an upstream marker of insulin resistance. 398 00:17:05,325 --> 00:17:09,362 Put her on metformin and ultra-rapid fiasp infusion. 399 00:17:09,396 --> 00:17:11,131 That should get her through the Medevac flight. 400 00:17:11,196 --> 00:17:13,566 But she'll have a much higher risk of hypoglycemia 401 00:17:13,599 --> 00:17:14,867 once she lands. 402 00:17:14,968 --> 00:17:16,403 How soon do you need her stabilized? 403 00:17:16,502 --> 00:17:17,936 First surgery's supposed to be tomorrow, 404 00:17:17,971 --> 00:17:19,271 but if I don't get the alternate in place, 405 00:17:19,339 --> 00:17:20,640 I can't move forward with the other two. 406 00:17:20,674 --> 00:17:23,376 Check her CGM the moment she lands, 407 00:17:23,410 --> 00:17:26,579 and give her a little dextrose IV. 408 00:17:27,614 --> 00:17:29,082 Thanks. 409 00:17:37,123 --> 00:17:38,692 So what exactly is she working on? 410 00:17:38,925 --> 00:17:41,394 She thinks the arteries aren't compensating properly. 411 00:17:41,661 --> 00:17:43,430 And I'm only hearing about this now? 412 00:17:43,496 --> 00:17:45,532 The point is, she thinks if we improve the flow 413 00:17:45,565 --> 00:17:47,600 and block the vasoconstrictive response, 414 00:17:47,634 --> 00:17:48,635 it'll solve the problem. 415 00:17:48,802 --> 00:17:50,904 No, Ben, the point is you didn't inform your partner 416 00:17:51,004 --> 00:17:52,672 of some pretty crucial information. 417 00:17:52,706 --> 00:17:54,641 'Cause I was trying to protect you. 418 00:17:54,708 --> 00:17:55,542 For our presentation. 419 00:17:55,575 --> 00:17:57,644 Well, now the cat's out of the bag. 420 00:17:57,677 --> 00:18:01,748 And I can't unknow what I know. - Sasha. She's gonna solve it. 421 00:18:02,649 --> 00:18:04,651 They're in the mid-hundreds? 422 00:18:04,718 --> 00:18:07,020 That's very encouraging. 423 00:18:07,053 --> 00:18:09,155 All right. Let's talk then. 424 00:18:09,189 --> 00:18:11,291 Lewis. - Hey. 425 00:18:11,324 --> 00:18:14,194 You have no idea how great it is to see you. 426 00:18:14,294 --> 00:18:15,895 Private plane. 427 00:18:15,929 --> 00:18:17,530 Felt like a rock star. 428 00:18:17,597 --> 00:18:18,465 And you are. 429 00:18:18,531 --> 00:18:20,400 Now, let's get you situated in our CCU, 430 00:18:20,433 --> 00:18:22,936 and then we should be ready to get things moving shortly. 431 00:18:23,036 --> 00:18:24,471 Thank you. 432 00:18:25,271 --> 00:18:28,308 So. Ivy Oringer's numbers are stabilizing. 433 00:18:28,341 --> 00:18:31,177 If they hold, she'll be flying out in 20 minutes. 434 00:18:31,211 --> 00:18:33,079 So someone came up with a new solution. 435 00:18:33,146 --> 00:18:35,548 And that's what internal medicine is for. 436 00:18:35,648 --> 00:18:36,950 You went to Amy. 437 00:18:37,017 --> 00:18:38,785 She's the best one here. 438 00:18:38,818 --> 00:18:40,820 Did you come here for her? 439 00:18:41,755 --> 00:18:43,923 I moved here because my sister is sick, 440 00:18:43,957 --> 00:18:45,558 and I had a chance to run surgery. 441 00:18:45,625 --> 00:18:47,193 Sure. 442 00:18:47,227 --> 00:18:49,329 Just remember you're rolling the dice 443 00:18:49,362 --> 00:18:50,830 with my career, too. 444 00:18:59,439 --> 00:19:03,543 - His numbers are fine. Blood pressure's stabilized. 445 00:19:03,576 --> 00:19:04,811 Completely. 446 00:19:04,844 --> 00:19:06,513 Even when I read to him. 447 00:19:07,614 --> 00:19:09,582 I love that you never give up on people. 448 00:19:09,616 --> 00:19:12,385 It's one of the best things about you. 449 00:19:14,254 --> 00:19:16,790 He was so vibrant. 450 00:19:16,823 --> 00:19:18,425 Before the accident. 451 00:19:19,359 --> 00:19:20,727 I mean, look at him. 452 00:19:21,394 --> 00:19:24,597 Rock climbing, sky-diving... he loved it all. 453 00:19:32,739 --> 00:19:33,606 Amy! 454 00:19:43,483 --> 00:19:45,485 He's tracking my movements. 455 00:19:47,020 --> 00:19:48,555 He's awake! 456 00:19:49,489 --> 00:19:51,391 Okay, Lewis, 457 00:19:51,424 --> 00:19:53,426 we're just gonna run baseline echo EKG labs. 458 00:19:53,526 --> 00:19:55,895 I'm sure you've been through this one too many times. 459 00:19:55,995 --> 00:19:57,530 Poke and prod all you want. 460 00:19:57,564 --> 00:19:59,766 I'm just grateful to have a chance here. 461 00:19:59,833 --> 00:20:00,700 Well, I gotta confess, 462 00:20:00,834 --> 00:20:02,268 I think we're all pretty pumped to be here. 463 00:20:02,302 --> 00:20:03,670 Hey, there was an EMT on the flight 464 00:20:03,703 --> 00:20:06,139 said somebody dropped out of the trial. 465 00:20:06,172 --> 00:20:08,174 Doesn't that affect us? 466 00:20:08,274 --> 00:20:10,443 Of course it does, you're a cohort. 467 00:20:10,510 --> 00:20:11,845 They can't operate on anybody 468 00:20:11,911 --> 00:20:14,147 unless all three of you are here and ready. 469 00:20:14,180 --> 00:20:15,582 That was the problem with that administrator. 470 00:20:15,682 --> 00:20:18,518 - All right, Sam. You already met Lewis? 471 00:20:18,585 --> 00:20:19,419 Yeah. 472 00:20:19,452 --> 00:20:22,622 - Is it true? Someone quit the trial? 473 00:20:25,291 --> 00:20:27,193 EMTs were talking on the Medevac. 474 00:20:27,694 --> 00:20:28,762 You know how many people wanted your spots? 475 00:20:28,795 --> 00:20:32,032 We've already identified an alternate who's en route. 476 00:20:33,867 --> 00:20:36,302 - So we are still on track? No delays? 477 00:20:36,336 --> 00:20:37,370 No delays. 478 00:20:37,404 --> 00:20:39,906 And it looks like Sam's fluids are under control. 479 00:20:39,939 --> 00:20:41,307 We got a litre off his lungs. 480 00:20:41,341 --> 00:20:42,942 See? Told you. 481 00:20:43,009 --> 00:20:44,344 That man's a miracle worker. 482 00:20:44,444 --> 00:20:46,179 It's the guys who invented the meds, but thank you, 483 00:20:46,212 --> 00:20:47,847 I do appreciate the shout out. 484 00:20:47,881 --> 00:20:49,916 Well, lungs are clear, you're good to go. 485 00:20:51,351 --> 00:20:53,453 Doc, I'm feeling dizzy. 486 00:20:53,486 --> 00:20:55,622 - Heart block. Low heart rate. One milligram Atropine. 487 00:20:55,689 --> 00:20:59,225 - Pushing O2 to 50 percent. - Still bradycardic. 488 00:20:59,325 --> 00:21:00,493 We gotta get a pacer in him. 489 00:21:00,593 --> 00:21:01,761 That doesn't sound great. 490 00:21:01,861 --> 00:21:03,229 Well, it's all under control, Lewis. 491 00:21:03,329 --> 00:21:04,631 We expected complications. 492 00:21:04,698 --> 00:21:05,632 What is happening with him? 493 00:21:05,699 --> 00:21:07,701 He's fine, Marie, we got this. 494 00:21:08,768 --> 00:21:10,036 I don't know. 495 00:21:10,737 --> 00:21:12,772 Yes, yes, Dr. Grant will be in touch with instructions 496 00:21:12,839 --> 00:21:15,075 on management during the transport. 497 00:21:15,108 --> 00:21:16,209 I appreciate it. 498 00:21:16,242 --> 00:21:17,243 You, too. 499 00:21:18,144 --> 00:21:22,215 Oh! We finally got a replacement for the dropout this morning. 500 00:21:22,248 --> 00:21:23,616 Oh, really? 501 00:21:23,650 --> 00:21:25,185 Yeah. She's got some sugar imbalances, 502 00:21:25,218 --> 00:21:26,353 and we have to make sure 503 00:21:26,386 --> 00:21:27,787 the flight doesn't destabilize... 504 00:21:27,887 --> 00:21:29,856 What if I had a patient who fit the bill? 505 00:21:29,956 --> 00:21:31,591 Is this Vera? 506 00:21:32,359 --> 00:21:33,460 It is. 507 00:21:33,526 --> 00:21:35,795 And you're sure you're not reaching because it's her? 508 00:21:35,862 --> 00:21:39,399 - Just get me in front of Ben. I won't embarrass you. 509 00:21:40,633 --> 00:21:42,502 It's good to have you back 510 00:21:42,535 --> 00:21:43,336 in the land of the living. 511 00:21:43,436 --> 00:21:46,873 Was I really like that for four years? 512 00:21:48,675 --> 00:21:50,410 So you could hear all of that? 513 00:21:50,477 --> 00:21:52,345 I was in and out, but... 514 00:21:53,146 --> 00:21:54,581 I heard enough. 515 00:21:56,016 --> 00:21:58,585 Thank you for taking care of me. 516 00:21:59,252 --> 00:22:00,453 Just doing my job. 517 00:22:01,654 --> 00:22:05,358 - Why did I suddenly wake up? - We're not sure exactly. 518 00:22:05,392 --> 00:22:08,862 We noticed an aneurysm developing on your brain... 519 00:22:08,895 --> 00:22:10,697 Right. I remember. 520 00:22:10,797 --> 00:22:14,034 You asked me if you should fix it. 521 00:22:14,134 --> 00:22:16,569 I'm glad that you didn't listen 522 00:22:16,670 --> 00:22:18,872 when I told you to let me die. 523 00:22:20,006 --> 00:22:21,441 Us too. 524 00:22:23,710 --> 00:22:25,578 I'm gonna look into this blood work, 525 00:22:25,645 --> 00:22:27,881 see if we can get to the bottom of this miracle. 526 00:22:30,650 --> 00:22:33,787 What about... my fiancée? 527 00:22:33,887 --> 00:22:34,888 What about Kat? 528 00:22:34,921 --> 00:22:35,989 Did you ever meet her? 529 00:22:36,089 --> 00:22:38,591 I was the one who called her the day of your accident. 530 00:22:38,658 --> 00:22:40,326 So, she was here? 531 00:22:40,393 --> 00:22:43,430 Every day for a long time. 532 00:22:43,463 --> 00:22:46,166 But then, she... she stopped? 533 00:22:46,733 --> 00:22:49,402 I haven't seen her for seven months. 534 00:22:51,071 --> 00:22:54,341 Did she tell you about the last time we saw each other? 535 00:22:54,407 --> 00:22:55,308 About the fight? 536 00:22:55,342 --> 00:22:56,609 She did. 537 00:22:56,710 --> 00:23:00,180 And she left you a note the last time she was here. 538 00:23:03,283 --> 00:23:04,784 I'll give you a minute. 539 00:23:07,187 --> 00:23:09,622 I, I, I can't. 540 00:23:09,689 --> 00:23:12,025 My vision... I can't read it. 541 00:23:12,092 --> 00:23:15,028 - Oh, that's to be expected. It'll get better soon. 542 00:23:15,495 --> 00:23:16,629 Can you? 543 00:23:17,931 --> 00:23:19,099 Please? 544 00:23:26,006 --> 00:23:30,043 "Dear Rob, I'm sitting here next to you writing this, 545 00:23:30,110 --> 00:23:33,480 "watching you like I have been every day. 546 00:23:33,513 --> 00:23:36,383 "I know that I loved you and I still do. 547 00:23:36,449 --> 00:23:38,051 "But I'm stuck. 548 00:23:38,118 --> 00:23:40,387 "Stuck in this room. Stuck watching over you. 549 00:23:40,487 --> 00:23:42,522 "Stuck with all this guilt and pain and grief 550 00:23:42,622 --> 00:23:44,991 "and I just don't think I can handle it anymore." 551 00:23:45,091 --> 00:23:46,993 Stop, stop. 552 00:23:47,060 --> 00:23:48,862 I get it. Please. 553 00:23:51,531 --> 00:23:53,733 Should I call her? 554 00:23:56,102 --> 00:23:57,971 I know she'd want to see you. 555 00:24:07,881 --> 00:24:09,416 It's over. 556 00:24:09,482 --> 00:24:10,550 It didn't work? 557 00:24:10,650 --> 00:24:12,719 Everything I did to get here. 558 00:24:15,155 --> 00:24:16,690 We could've saved so many lives. 559 00:24:16,756 --> 00:24:18,425 There has to be a way. 560 00:24:18,491 --> 00:24:20,360 We have a year or two before human trials... 561 00:24:21,261 --> 00:24:22,696 Human trials? 562 00:24:22,796 --> 00:24:24,931 We'll never make it to phase two with pigs. 563 00:24:24,964 --> 00:24:28,401 They'll pull the funding once they hear your assessment. 564 00:24:28,435 --> 00:24:30,570 Then it'll be seen as an abject failure 565 00:24:30,637 --> 00:24:33,039 and I'll never put the pieces back again. 566 00:24:37,577 --> 00:24:39,412 Is this gonna take me out of the trial? 567 00:24:40,080 --> 00:24:42,148 This is what's gonna keep you in it. 568 00:24:42,182 --> 00:24:43,249 Just try to relax. 569 00:24:43,350 --> 00:24:46,286 Sure. Maybe some mindfulness exercises, right Marie? 570 00:24:47,187 --> 00:24:49,723 No, we are praying for you, Lewis. 571 00:24:49,823 --> 00:24:51,558 Yeah. That's exactly what I want to hear. 572 00:24:51,591 --> 00:24:52,859 Hey, it's just a pace maker. 573 00:24:52,926 --> 00:24:54,594 This man does it in his sleep. 574 00:24:54,694 --> 00:24:56,196 You got that right, Sam. 575 00:24:56,296 --> 00:24:57,330 Set rate at 70 beats per minute. 576 00:24:57,430 --> 00:24:58,732 Copy. 577 00:24:58,832 --> 00:25:01,267 - What about you, Dr. Heller? You have any kids? 578 00:25:01,368 --> 00:25:04,304 - I do, in fact. One daughter. What about you two? 579 00:25:04,337 --> 00:25:06,840 19 and 22. 580 00:25:06,873 --> 00:25:10,610 Both girls in college. - Smart. Just like their momma. 581 00:25:10,677 --> 00:25:11,945 Nah... he's plenty smart. 582 00:25:11,978 --> 00:25:14,948 Just didn't get the same opportunities. 583 00:25:14,981 --> 00:25:16,683 They coming to watch their dad make history? 584 00:25:16,716 --> 00:25:19,586 Nah, I told them to, you know, focus on their studies. 585 00:25:19,619 --> 00:25:20,553 Come time for the surgery, 586 00:25:20,653 --> 00:25:22,889 they can hop on a flight, say their goodbyes. 587 00:25:22,989 --> 00:25:26,860 Hey. You do not get to joke around like that. 588 00:25:26,893 --> 00:25:28,028 Listen to your wife, Sam. 589 00:25:28,128 --> 00:25:30,797 - Oh, hey, I do. - Yeah, except when you don't. 590 00:25:32,198 --> 00:25:34,501 And we have capture. 591 00:25:34,601 --> 00:25:36,069 Increase output. 592 00:25:38,304 --> 00:25:41,508 You're gonna start feeling better almost immediately. 593 00:25:41,608 --> 00:25:43,610 The rate's coming up. 594 00:25:43,643 --> 00:25:45,178 Stabilizing. 595 00:25:46,946 --> 00:25:48,782 Amazing. 596 00:25:48,882 --> 00:25:50,316 - These things can be finicky. We'll probably need to 597 00:25:50,383 --> 00:25:54,020 adjust a bit later, but we're in good shape now. 598 00:25:54,054 --> 00:25:56,956 - His fluid status is neutral. He's stabilizing, too. 599 00:25:57,457 --> 00:25:58,625 All right, people. 600 00:25:58,658 --> 00:26:00,827 We are moving in the right direction! 601 00:26:01,628 --> 00:26:02,729 Check in soon. 602 00:26:06,599 --> 00:26:09,402 Ivy Oringer from Milwaukee. Dr. Ben Grant. 603 00:26:09,469 --> 00:26:10,904 Feels unreal to meet you. 604 00:26:10,937 --> 00:26:13,039 We've been following this trial since phase one. 605 00:26:13,073 --> 00:26:15,775 Eight years she's been on that transplant list. 606 00:26:15,809 --> 00:26:17,477 Could never get a real heart. 607 00:26:17,510 --> 00:26:18,912 Wow, you must be Mom. 608 00:26:18,945 --> 00:26:20,213 It's so great to have you both here. 609 00:26:20,313 --> 00:26:22,682 - Great for you? I feel like I won the Powerball. 610 00:26:22,749 --> 00:26:24,884 Well, you're very brave to volunteer for something 611 00:26:24,918 --> 00:26:26,086 no one's ever done before. 612 00:26:26,152 --> 00:26:28,088 But we still need to assess your viability, 613 00:26:28,188 --> 00:26:31,291 and then get you past these pesky folks at the IRB. 614 00:26:31,358 --> 00:26:32,659 Yeah, I understand. 615 00:26:32,692 --> 00:26:35,428 I'm still tripping out on the idea you're gonna be 616 00:26:35,528 --> 00:26:37,263 taking out half my heart, 617 00:26:37,297 --> 00:26:38,231 dumping it in the trash, 618 00:26:38,331 --> 00:26:40,533 and then what, inserting a shop-vac into me? 619 00:26:41,801 --> 00:26:43,069 You get used to her sense of humor. 620 00:26:43,103 --> 00:26:44,804 It's actually more like a sump pump. 621 00:26:44,838 --> 00:26:47,807 Don't tell anyone we're essentially plumbers. 622 00:26:47,841 --> 00:26:48,942 How's her sugar trending? 623 00:26:48,975 --> 00:26:50,410 - She's in the 130s. Holding steady. 624 00:26:50,443 --> 00:26:51,811 Excellent. 625 00:26:51,845 --> 00:26:54,581 No promises, Ivy, but you're looking good. 626 00:26:54,681 --> 00:26:56,416 Oh, Dr. Maitra's ready for you. 627 00:26:56,449 --> 00:26:58,318 All her ducks are in a row. 628 00:26:58,418 --> 00:26:59,753 Back soon. 629 00:27:02,055 --> 00:27:05,291 Hey, it's gonna be okay, Ma. 630 00:27:07,560 --> 00:27:11,164 It's gonna be okay if they accept you. 631 00:27:11,197 --> 00:27:12,766 Yeah. 632 00:27:13,733 --> 00:27:15,602 Your mom's heart's really weak, 633 00:27:15,702 --> 00:27:18,038 but we're not out of options yet. 634 00:27:18,438 --> 00:27:20,173 I'll call you back in a bit. 635 00:27:21,708 --> 00:27:24,444 - Okay, Dr. Maitra. I'm all ears. 636 00:27:36,489 --> 00:27:38,992 We have no definitive answer as to why he woke up? 637 00:27:39,025 --> 00:27:42,028 No, but vitals are holding, coils stable in the brain, 638 00:27:42,128 --> 00:27:45,632 perfusion is good, EEG readings in normal range... 639 00:27:45,699 --> 00:27:47,600 But I think without an explanation, 640 00:27:47,634 --> 00:27:48,635 we need to be careful. 641 00:27:48,702 --> 00:27:50,337 I think we should slow-roll this. 642 00:27:50,370 --> 00:27:51,871 Meaning sedate him? 643 00:27:51,905 --> 00:27:53,473 Prevent any blood pressure spikes, 644 00:27:53,506 --> 00:27:55,041 reduce any kind of stress, 645 00:27:55,108 --> 00:27:57,744 neuroprotective meds... That's my position. 646 00:27:57,777 --> 00:27:59,446 He's been immobilized for four years. 647 00:27:59,546 --> 00:28:02,882 He needs stimulation, socialization, neuro-rehab... 648 00:28:02,916 --> 00:28:04,951 Dr. Walker? 649 00:28:04,984 --> 00:28:07,387 Hi! 650 00:28:07,487 --> 00:28:09,489 I can't believe it, I just... 651 00:28:09,522 --> 00:28:11,124 I can't believe it. - I know. 652 00:28:11,491 --> 00:28:12,192 He's really awake? 653 00:28:12,325 --> 00:28:14,494 Yes. He's awake and he's verbal. 654 00:28:15,628 --> 00:28:16,763 Can I see him? 655 00:28:16,796 --> 00:28:17,764 Of course. 656 00:28:35,615 --> 00:28:36,850 Kat? 657 00:28:37,550 --> 00:28:39,252 - Hi. - Hi. 658 00:28:48,061 --> 00:28:50,964 She has massive infarct, bi-ventricular failure, 659 00:28:51,031 --> 00:28:52,899 nothing left to revascularize. 660 00:28:52,932 --> 00:28:55,902 Which means and LVAD only solves half her problem. 661 00:28:55,935 --> 00:28:57,237 And my heart solves all of it. 662 00:28:57,303 --> 00:28:58,905 But unlike your other two patients 663 00:28:58,938 --> 00:29:02,776 with low-output cardiac failure and end-organ damage. 664 00:29:04,544 --> 00:29:05,912 You understand how tenuous 665 00:29:05,945 --> 00:29:08,682 each patient's condition is, yeah? 666 00:29:08,782 --> 00:29:10,250 Of course. 667 00:29:10,316 --> 00:29:12,185 And we discussed at great length this morning 668 00:29:12,218 --> 00:29:15,288 that this trial demands medical diversity. 669 00:29:15,922 --> 00:29:17,824 - I understand that. And Vera's heart failure 670 00:29:17,924 --> 00:29:19,259 is autoimmune in origin, unlike... 671 00:29:19,325 --> 00:29:21,127 It is irrelevant where the heart failure comes from. 672 00:29:21,194 --> 00:29:23,663 What matters is what it is doing to her. 673 00:29:23,697 --> 00:29:25,331 I'm not sure I follow. 674 00:29:25,365 --> 00:29:28,134 Lewis has ascites and orthopnea, correct? 675 00:29:28,201 --> 00:29:29,803 Yes. Biventricular failure. 676 00:29:29,836 --> 00:29:31,438 And biventricular failure is virtually 677 00:29:31,471 --> 00:29:32,806 always a factor with patients 678 00:29:32,839 --> 00:29:34,207 with autoimmune myocardial infarction. 679 00:29:34,240 --> 00:29:38,078 Which will make Lewis and Vera's post-op risk profiles 680 00:29:38,144 --> 00:29:39,346 redundant. 681 00:29:40,013 --> 00:29:41,815 - I guess I didn't realize... - You didn't realize? 682 00:29:41,848 --> 00:29:43,216 Or you didn't do your research? 683 00:29:43,249 --> 00:29:45,585 Because your girlfriend gave you the idea. 684 00:29:47,287 --> 00:29:48,955 You gonna tell me that wasn't a factor? 685 00:29:48,988 --> 00:29:50,690 It won't happen again. 686 00:29:50,724 --> 00:29:52,525 And I will speak to her and tell her 687 00:29:52,625 --> 00:29:55,028 that we're going with Ivy. - No, I don't want you anywhere near this conversation. 688 00:29:55,095 --> 00:29:56,162 Not with her father's funding on the line. 689 00:29:56,196 --> 00:29:58,264 I mean, I told you it's not like that with them. 690 00:29:58,365 --> 00:30:00,767 Hey, I don't have the luxury of taking your word for it right now. 691 00:30:00,834 --> 00:30:02,569 And I will tell Dr. Maitra myself. 692 00:30:03,703 --> 00:30:06,306 It's the wrong day to waste my time. 693 00:30:10,977 --> 00:30:15,348 I'd ask if you're okay, but, how could you be? 694 00:30:15,849 --> 00:30:17,117 I told him I met someone. 695 00:30:18,451 --> 00:30:20,120 Okay. 696 00:30:20,153 --> 00:30:23,990 He seemed... relieved. 697 00:30:24,024 --> 00:30:26,026 He smiled that goofy smile 698 00:30:26,059 --> 00:30:28,628 and made a joke of it like he always did with everything. 699 00:30:30,630 --> 00:30:32,365 Guess we're both unstuck. 700 00:30:33,767 --> 00:30:35,402 Then we said goodbye. 701 00:30:36,036 --> 00:30:37,637 So what's keeping you here? 702 00:30:40,373 --> 00:30:42,075 She's a lawyer now. 703 00:30:42,876 --> 00:30:47,080 And she has a career and a life. 704 00:30:48,014 --> 00:30:49,883 And a new guy. 705 00:30:49,916 --> 00:30:51,885 I'm so sorry. 706 00:30:51,918 --> 00:30:55,088 She was always running circles around me. 707 00:30:56,189 --> 00:30:58,091 And it made me act like a jackass. 708 00:30:58,158 --> 00:31:00,694 - You were young. - I was an idiot. 709 00:31:00,760 --> 00:31:02,028 The day of the accident, 710 00:31:02,062 --> 00:31:03,430 she was trying to start our life together 711 00:31:03,463 --> 00:31:07,667 and I stormed out to go windsurfing. 712 00:31:09,502 --> 00:31:10,337 Who does that? 713 00:31:10,437 --> 00:31:13,139 So what did you say to her today? 714 00:31:14,441 --> 00:31:17,577 That even though we loved each other, 715 00:31:18,812 --> 00:31:20,814 we wanted different lives. 716 00:31:21,481 --> 00:31:25,585 The one thing I could do for her was to let her go. 717 00:31:26,586 --> 00:31:29,656 That doesn't sound like a jackass to me. 718 00:31:32,058 --> 00:31:34,194 What if he's just doing the noble thing? 719 00:31:34,227 --> 00:31:37,263 I don't know if I can believe anything he's saying to me. 720 00:31:37,330 --> 00:31:39,566 He didn't tell me one way or the other. 721 00:31:39,599 --> 00:31:41,935 But, let me ask you something. 722 00:31:41,968 --> 00:31:44,070 This new guy. 723 00:31:44,104 --> 00:31:45,672 Do you love him? 724 00:31:46,573 --> 00:31:48,475 I do. Yeah. 725 00:31:48,508 --> 00:31:50,710 But I can feel part of me's holding back. 726 00:31:53,079 --> 00:31:54,347 No matter how hard I try, 727 00:31:54,381 --> 00:31:56,616 there's a piece of me still in that room with Rob. 728 00:31:58,084 --> 00:32:01,221 So let's say he's setting you free. 729 00:32:01,254 --> 00:32:04,758 When someone gives you a gift, receive it. 730 00:32:04,824 --> 00:32:07,560 Go. Start your life. 731 00:32:07,594 --> 00:32:09,462 You've waited long enough. 732 00:32:11,698 --> 00:32:14,501 Thank you, Dr. Walker. 733 00:32:14,534 --> 00:32:16,836 For being here when I couldn't be anymore. 734 00:32:16,870 --> 00:32:19,172 And I'll be here for him now. 735 00:32:19,239 --> 00:32:21,341 You can count on that. 736 00:32:33,153 --> 00:32:35,055 Pressure's 88 over 52. 737 00:32:35,121 --> 00:32:36,656 And he's feeling dizzy and nauseous. 738 00:32:36,690 --> 00:32:38,591 - What happened? Can you rewind 5 minutes for me? 739 00:32:38,658 --> 00:32:40,927 Yeah, I just started to feel, you know, kinda sick. 740 00:32:40,960 --> 00:32:43,329 - And then he almost passed out. - I didn't pass out, Marie. 741 00:32:43,396 --> 00:32:45,198 I got a little light... lightheaded. 742 00:32:45,265 --> 00:32:47,033 Now, were you standing up or were you sitting down 743 00:32:47,067 --> 00:32:48,735 when you started to feel dizzy? - He was standing. 744 00:32:48,768 --> 00:32:50,136 I stood up for a second. 745 00:32:50,170 --> 00:32:51,738 You might just be dehydrated. 746 00:32:51,771 --> 00:32:53,073 Let me listen to your lungs. 747 00:32:53,139 --> 00:32:55,275 You having any chest pain? - No. No, not at all. 748 00:32:55,308 --> 00:32:57,477 BP 82 over 50. 749 00:32:57,544 --> 00:32:59,279 Okay, give me that I-stat, Julie. 750 00:32:59,312 --> 00:33:01,281 Just gonna check your electrolytes, okay. 751 00:33:04,284 --> 00:33:06,453 - Pacemaker malfunction. - Okay, give me the magnet. 752 00:33:06,553 --> 00:33:09,556 - Paging Dr. Douglas. - 250 saline bolus for Sam. 753 00:33:11,925 --> 00:33:14,427 Stat, Julie! - Going as fast as I can, Jake. 754 00:33:14,461 --> 00:33:17,464 - What's the status here? - Sam is dehydrated, 755 00:33:17,564 --> 00:33:18,365 we might've overshot the diuretics. 756 00:33:18,465 --> 00:33:20,533 Lewis is having a pacemaker malfunction. 757 00:33:21,434 --> 00:33:22,702 - It's not resetting. Give it to me. 758 00:33:22,736 --> 00:33:25,238 I'm right here, I got it. 759 00:33:28,942 --> 00:33:30,176 Dr. Heller. 760 00:33:35,115 --> 00:33:36,683 The hell just happened? 761 00:33:38,485 --> 00:33:40,387 Pressure's rising. 762 00:33:40,420 --> 00:33:42,422 110 over 70. 763 00:33:45,392 --> 00:33:47,560 Well, that was interesting. 764 00:33:47,594 --> 00:33:49,129 My God! 765 00:33:49,195 --> 00:33:51,798 I don't know if my heart can take any more of this. 766 00:34:01,675 --> 00:34:04,744 So? 767 00:34:04,811 --> 00:34:07,414 Am I getting that heart? 768 00:34:10,250 --> 00:34:11,951 I'm so sorry, Vera. 769 00:34:11,985 --> 00:34:13,719 I tried. 770 00:34:13,820 --> 00:34:16,156 I really tried. 771 00:34:16,222 --> 00:34:19,958 I know you did all you could. 772 00:34:23,228 --> 00:34:25,398 I'm sorry I pushed so hard this morning. 773 00:34:25,498 --> 00:34:27,300 It is a miracle that he's alive, 774 00:34:27,367 --> 00:34:29,735 and if it were up to me, he'd be gone. 775 00:34:30,170 --> 00:34:33,139 Like you said, it was a miracle. 776 00:34:34,974 --> 00:34:36,109 He's crashing! 777 00:34:56,463 --> 00:34:57,163 Nothing. 778 00:34:57,464 --> 00:34:59,699 He's braindead. 779 00:34:59,799 --> 00:35:02,535 We should've sedated him like you wanted. 780 00:35:02,569 --> 00:35:05,438 It was a catastrophic intracranial hemorrhage. 781 00:35:05,438 --> 00:35:07,474 It wouldn't have made any difference, Gina. 782 00:35:07,574 --> 00:35:09,909 This is collateral damage from his original injury. 783 00:35:12,212 --> 00:35:15,415 He signed an advance directive an hour ago. 784 00:35:16,649 --> 00:35:18,685 No heroic measures. 785 00:35:23,323 --> 00:35:25,291 Today wasn't for nothing. 786 00:35:25,325 --> 00:35:28,495 You gave him back his ability to make his own choices. 787 00:35:55,488 --> 00:35:57,691 Sounds like you had a day, Graham. 788 00:35:58,625 --> 00:36:00,827 Yeah, yeah, you could say that. 789 00:36:02,262 --> 00:36:03,863 Any thoughts? 790 00:36:03,897 --> 00:36:06,266 I will suffer the consequences of my choices 791 00:36:06,366 --> 00:36:09,336 and you will not be influenced by any hospital donors. 792 00:36:09,369 --> 00:36:11,738 So you did learn something, then. 793 00:36:16,242 --> 00:36:20,280 I, uh... was tracking your case with Rob. 794 00:36:21,981 --> 00:36:24,217 I'm sorry, must've been rough. 795 00:36:26,519 --> 00:36:29,622 You know that piece of bone lodged in my brain? 796 00:36:29,656 --> 00:36:32,826 An eight of an inch to the left, and I'd be like him. 797 00:36:32,926 --> 00:36:35,595 Guess we should be grateful for what we have, huh? 798 00:36:37,764 --> 00:36:42,736 Some people think I act like I always know better. 799 00:36:42,769 --> 00:36:43,770 But I don't. 800 00:36:43,803 --> 00:36:46,539 I just go confidently toward what I believe, 801 00:36:46,639 --> 00:36:48,274 let the chips fall where they may, 802 00:36:48,375 --> 00:36:51,144 and I admit when I'm wrong. 803 00:36:51,845 --> 00:36:55,315 - For sure. - I see some of that in you. 804 00:36:56,282 --> 00:36:58,518 The thinking you know better part. 805 00:36:59,419 --> 00:37:02,756 The thing is, I have earned that right. 806 00:37:02,756 --> 00:37:04,257 You haven't. 807 00:37:05,925 --> 00:37:07,660 Understood. 808 00:37:08,728 --> 00:37:12,999 So, how about you pretend that you don't know everything 809 00:37:13,033 --> 00:37:15,402 and follow my lead for a while. 810 00:37:15,435 --> 00:37:17,303 I'd welcome that. 811 00:37:17,337 --> 00:37:19,372 Tomorrow's another day, then. 812 00:37:29,783 --> 00:37:32,052 Dr. Heller. 813 00:37:32,052 --> 00:37:32,986 Great work today. 814 00:37:32,986 --> 00:37:36,322 Oh, thank you, but it was a team effort. 815 00:37:36,322 --> 00:37:38,591 Humility can be a virtue, but not when you're in 816 00:37:38,625 --> 00:37:41,461 a horse race for funding to keep your job. 817 00:37:41,494 --> 00:37:43,930 Trust me when I say I know what that's like. 818 00:37:44,564 --> 00:37:46,332 I'll put in a good word with Dr. Matos. 819 00:37:46,332 --> 00:37:48,535 I appreciate that. 820 00:38:01,648 --> 00:38:05,085 I heard Ivy cleared the IRB. 821 00:38:05,085 --> 00:38:06,486 Barely. 822 00:38:06,486 --> 00:38:08,521 And I'm sorry about Vera. Yeah. 823 00:38:08,621 --> 00:38:10,690 I know how much she means to you. 824 00:38:11,358 --> 00:38:13,093 Maybe you can put in a good word 825 00:38:13,093 --> 00:38:15,261 in case you need an alternate. 826 00:38:15,362 --> 00:38:16,796 I wouldn't make her any promises. 827 00:38:16,896 --> 00:38:20,633 I know, but, anything can happen, right? 828 00:38:20,633 --> 00:38:23,103 Any kind of complication can knock someone out... 829 00:38:23,136 --> 00:38:24,304 I can't do it, Sonya. 830 00:38:24,337 --> 00:38:26,139 I've already extended myself further than I should have. 831 00:38:26,239 --> 00:38:28,541 Oh, well... 832 00:38:28,641 --> 00:38:30,677 well, it seems like you have a late night. 833 00:38:30,777 --> 00:38:32,679 Why don't I just see you at mine? 834 00:38:32,712 --> 00:38:33,613 Sonya. 835 00:38:36,116 --> 00:38:38,018 I know you tried. 836 00:38:54,567 --> 00:38:56,369 I can figure this out. 837 00:38:56,403 --> 00:38:57,504 If we only had more time. 838 00:38:57,537 --> 00:38:59,139 Yeah, well, we don't have time, 839 00:38:59,139 --> 00:39:00,940 and now you're just torturing me. 840 00:39:00,940 --> 00:39:03,810 What if we only sent the August numbers to the IRB. 841 00:39:03,810 --> 00:39:05,879 They don't know that you did another round 842 00:39:05,912 --> 00:39:07,681 in November, do they? 843 00:39:07,781 --> 00:39:10,150 I could never ask you to lie for me. 844 00:39:10,183 --> 00:39:11,051 You didn't. 845 00:39:11,084 --> 00:39:12,852 Look, I know you've thought about it. 846 00:39:12,952 --> 00:39:14,688 That's why you were nervous about me 847 00:39:14,721 --> 00:39:16,790 even coming to the lab to begin with. 848 00:39:16,823 --> 00:39:18,291 Yeah, thinking about it and doing it 849 00:39:18,324 --> 00:39:19,959 are two very different things. 850 00:39:19,959 --> 00:39:23,296 In my wildest fantasy of breaking ethical boundaries 851 00:39:23,296 --> 00:39:25,432 we've all lived by since med school, 852 00:39:25,432 --> 00:39:27,667 it never involved anyone sitting next to me. 853 00:39:27,701 --> 00:39:29,469 There are ethical boundaries, 854 00:39:29,569 --> 00:39:31,705 and then there are bureaucratic burdens put on us 855 00:39:31,705 --> 00:39:34,941 by corporate pencil-pushers who don't understand what we do. 856 00:39:34,974 --> 00:39:36,943 And that's a rationalization you can live with? 857 00:39:36,976 --> 00:39:38,878 A lie of omission about the efficacy of a trial 858 00:39:38,978 --> 00:39:42,982 on pigs versus the potential to save thousands of lives 859 00:39:43,016 --> 00:39:46,119 and usher in a ground-breaking era of technology 860 00:39:46,219 --> 00:39:49,823 that can be extrapolated to every organ in the body? 861 00:39:49,856 --> 00:39:52,792 I'm not gonna lose sleep over that grand bargain. 862 00:39:53,193 --> 00:39:55,161 You'd be risking your career. 863 00:39:55,829 --> 00:39:59,065 You'd be risking your legacy. 864 00:39:59,165 --> 00:40:00,934 And I think it's worth it. 865 00:40:10,710 --> 00:40:13,747 Bypass machine, perfusionists on call, 866 00:40:13,780 --> 00:40:15,348 all blood typed and crossed? 867 00:40:15,382 --> 00:40:18,518 Of course. Done. Hours ago. 868 00:40:21,488 --> 00:40:23,089 It's game day tomorrow. 869 00:40:26,359 --> 00:40:27,694 Here we go. 870 00:41:12,005 --> 00:41:15,175 Hey. 871 00:41:15,208 --> 00:41:18,144 It's amazing how well you're keeping it together. 872 00:41:18,812 --> 00:41:22,515 - Well, I cried in the bathroom. - Oh. 873 00:41:23,283 --> 00:41:25,719 We can feel everything. 874 00:41:25,819 --> 00:41:30,957 But we just can't burden our patients with our feelings 875 00:41:30,957 --> 00:41:34,294 or let them see when we're afraid.