All language subtitles for the.resident.s05e11.Her Heart.eng

- Previously on The Resident...
- I hope it will be

a comfort that Nic

chose to be an organ donor.

"We, Jake and Gregg,
solemnly swear to treat

Sammie as our natural child".

Dr. Pravesh

is gonna be spending more time
doing clinical trials,

and we need somebody to fill his slot

- in the ER.
- Is that a job offer?

I need a photo

of my son.

Mom!

Perhaps when you feel up to it,

you'll tell me what's really going on.

This could be something
simple, treatable.

You know it's not.

And?

Would you like to talk in your office?

Let's just talk here.

It's multiple sclerosis.

Mixed white and gray matter

with black holes consistent
with worsening damage.

It's hard to know how long
it's been going on.

Months, at least. Years, maybe.

But the science is advancing
in this field,

and there are some amazing treatments.

There's no cure.

We will find ways to help
you get through this.

A specialist

- can tell you more.
- Okay. Thanks, Conrad.

Not now. Let's talk about it later.

Thanks.

Of course.

- Synced and corrected by Firefly -
- www.addic7ed.com -

♪ Feel like I gotta do it today ♪

♪ Crossing the street,
don't look no both ways ♪

♪ I'm duckin' 'em all
like a weekday... ♪

- What?
- Nothing.

You're staring.

No.

I'm just watching my boyfriend
get ready to change the world.

It's a tie.

On a doctor-turned-scientist

who's basically going to cure cancer

with his new clinical trial.

You are the one that is crushing
her neurosurgery rotation.

Billie's been telling everyone

what a star you are.

She's a great mentor.

And you're changing the subject.

Starting today, we get to finally enroll

our first patients.

This is the beginning of a new journey.

One which will end with you

receiving a Nobel Prize.

Let's not get ahead of ourselves.

But you did forget one of the best parts

of running a clinical trial.

- More than winning a Nobel?
- Oh, yeah.

Fewer hours at work

mean more time with you.

♪ So be cool ♪

I like the sound of that.

♪ Just be cool. ♪

I am so glad you could come.

Randolph has been so
looking forward to seeing you.

We both have.

- Will there be drums and firecrackers?
- So many.

And a lion dance from
local performers, darling.

But tonight is more than just a party.

Celebrating Lunar New Year
is just one of the ways

we hope to look out for the well-being

of our Asian American community.

Yeah, well, I'm all for that.

And I'm happy to help out
with the free hep B screenings.

- Thanks.
- Mm-hmm.

Look who's here!

- Hey!
- Grandpa!

Hi.

- Hey, Jake.
- Hey. Good to see you.

I'm so glad you guys could make it.

We love celebrating Lunar New Year

with Sammie,

and when she heard
about what you were doing,

she practically booked
the whole trip herself.

Where's Gregg?

He had to work last-minute,
but he sends his love.

Uh, the three of us need to talk.

Okay. What-What's this about?

Well, let's get Sammie settled first.

How would you like to help
the preschoolers

make some decorations, honey?

- How's that sound?
- Yes.

Yeah? Wonderful.
All right, come on. Let's do it.

Bay Two, drop an NG tube

for a gastric lavage
to identify if it's an upper

or lower GI bleed.

Bay Three, grab some sugar
packets from the breakroom.

Sprinkle them on the
prolapsed stoma, then reduce it.

- On it.
- Bay Four,

avoid sutures for that
poor girl's head lac.

Just use her hair and some Dermabond.

Dr. Sullivan, I see why Kit hired you.

- Bet you put the "go" in "go, team".
- If I'm not ordering

new sneakers every other month,

- I'm not doing my job.
- Me, too.

So, how's your first week been?

Fine.

A bunch of us are gonna hit
the Lunar New Year party

after work. You should join.

- Free food.
- Yeah, tonight's not gonna work.

Dr. Sullivan, I'm starting
to think you don't like us.

I don't know you well enough
to like you or not, Dr. Feldman.

Exactly. So maybe come hang
and, you know, find out.

Unfortunately, I have plans.

I don't think

she really has plans.

So, what do we say to everyone

who keeps asking us
who the new ER doctor is?

Tell them I believe in the soul.

The hanging curveball.
High fiber. Good Scotch.

That the novels of Susan Sontag
are self-indulgent crap.

I believe Lee Harvey Oswald acted alone.

And I believe there ought to be

a constitutional amendment
outlawing Astroturf

and the designated hitter.
I believe in opening

- your presents...
- ... in opening your presents Christmas morning

rather than Christmas Eve.

Crash Davis's speech from Bull Durham.

- Great movie.
- It's the best.

Evidence suggests you and I
could be friends, Feldman.

I'm impossible not to like, Sullivan.

So, you aren't on social media.

I tried to find you to make sure
you weren't a psychopath.

Well, I'm not an exhibitionist

- or a narcissist.
- Harsh.

- But a picture is emerging.
- Love to get back

- to my patients now. If you don't mind.
- Mm.

Do your thing.

I so agree with everything
you just said, by the way.

I, too, am tired of the humblebrags

and the... You're just
gonna keep wa... Okay.

Thanks, Dr. Sullivan.

Another successful interaction, Zach.

You paged?

29-year-old female.

Had a syncopal episode
during spinning class.

She had a heart transplant,

so figured you should take a look.

What do we have here? Initial EKG,

chest X-ray and head CT negative.

Vitals are stable.
She's awake and oriented.

Call Hawkins.

- For a consult?
- Just call him.

- What's up?
- Hey.

- Is it your mom?
- No. No, no,

this is about a young lady
here in the ER

with a syncopal episode
and a cardiac history.

They called me to do a consult

because she had a heart transplant.

- Okay. Let's have a look.
- It's...

a little more complicated than that.

The transplant was performed
by a former colleague of mine

at Redman Hospital three years ago.

Three years ago.

- In September.
- When in September?

September 17th.

Yeah, there's no doubt about it.

She has Nic's heart.

Gigi, this is Sammie,
and she'd like to help you

- with some decorations. Is that okay?
- Okay.

Hi, Sammie. I'm not
very good with scissors.

I can help. I'll show you how.

You're a great dad, Jake.

She's a sweetheart.

It's all Sammie. I think
she was born this way.

So, what's this all about?

Let's get a coffee,

- find a quiet place to talk.
- Okay.

Don't say anything to her.

There's no reason she has to know.

And I don't want to talk
about it. At least

- not until we know what's wrong and fix it.
- Understood.

Hannah.

Hey. I'm Dr. Austin,

- and this is my colleague Dr. Hawkins.
- Hello.

- Nice to meet you both.
- So, we heard you had a bad fall.

Yeah. I started taking a spin class.

Been getting in good shape,
and I love it.

So, you think maybe
you pushed yourself too hard?

That's what's weird.
I mean, I don't think so.

I forgot my spin shoes at home,
so I had to come back.

And I remember I'd just joined

the class when "Nonstop" came on.

Ah, I love that song.

Uh,

and all of a sudden,
I couldn't catch my breath

and just collapsed on the bike.

Paramedics had to unclip me,
and I came to in here.

Well, let's take a listen
to your heart, shall we?

Your turn.

Hmm?

Heart sounds normal.

All right, let's lie you
down for an echo.

Okay.

We saw that you had

a heart transplant a few years ago.

Yeah. I'm one of the lucky ones.

Well, aside from the shortness of breath

in class, you have any leg swelling?

Wake up with trouble breathing?

No, um,

not since my transplant.

It was like a miracle.

I was born with a bad heart.

I mean, I suffered

with every symptom of heart failure

for so long, it felt like
I was dying every day.

And then after I got my new heart,

I was alive again.

Any other symptoms? Anything at all?

I have headaches occasionally.

Well, the echo shows

that your heart's
ejection fraction is low.

Meaning it's-it's not pumping
as well as we'd like,

which is probably the cause
of your collapse.

Uh, Hannah,

I'm sorry to tell you this,

but you are in early heart failure.

No. No, no.

Um, I prayed that I'd never
hear those words again.

This heart can't fail.

It can't.

After my transplant, I did everything

the doctors told me to do.
I-I never missed an appointment.

I mean, I...

- How could this happen?
- Don't worry.

We're gonna run some labs,
and we're gonna figure this out.

Relax.

Take a deep breath.

- Okay?
- Okay.

There you go.

It's gonna be okay.

- What's the story there?
- Hmm?

Why do you ask?

Why the urgent page?

Now Hawkins seems concerned.

So, are we sharing personal tidbits now?

Okay. All right. I deserve that.

That young woman was
the recipient of a donor heart,

and it belonged to Conrad's wife,

who died in an auto accident
three years ago.

Damn.

She was a legendary nurse practitioner.

One of us.

And Nic and Conrad were a great couple.

A true love story.

That's tragic.

It's taken him years to recover.

He's finally starting to live again.

And...

if that woman has
something seriously wrong

and should happen to die...

- Who knows how he's gonna react.
- Yeah.

A few weeks ago,
I started feeling... off.

Numbness in my hands
and a loss of dexterity.

That's why I pulled myself
out of surgery.

I just wanted to make sure
I knew what it was first

before-before I worried you.

So I waited.

But I got the final results today.

And I...

I don't want to spoil this visit.

I've been so looking forward
to it. But you're here,

- so...
- What is it?

P-Please, just tell us.

I have multiple sclerosis.

Oh, darling, I'm so sorry.

- We're-we're here for you.
- And I...

I know. You know,
I just learned this morning,

so I'm...

still kind of processing.

A-And to be honest,

I'm just... I'm just reeling.

Of course.

But there's hope.

Whatever you've been experiencing

- can be treated with meds.
- Yeah.

W-We need to jump into this right away.

We need to find the best place for you

- to get treatment.
- I, you know, I have to round

on some patients that I've been
asked to consult on, so...

Of course. Go.
We'll get more information,

and come find us
in my office when you're done.

Yeah. Okay.

Now the decompression.

Placing the needle into
the subdural hematoma.

Nicely done.

I can see why AJ is courting you
for cardiothoracic.

Choosing a specialty
is gonna be so hard.

I wish I could do it all.

I think being a heart surgeon's great.

If you want to be a plumber.

Do not let Dr. Austin hear you say that.

No shade to Dr. Austin,
but the heart is just a pump.

The brain is more complex
than the universe

and the source of everything
that makes us human.

It's the source of my dyslexia
and the key to overcoming it.

See, it's personal to you.

That's how passion for a field is born.

You think I could do this?

We could always use more
women in neurosurgery.

We are overloaded with arrogant men.

But I would never try to recruit you.

Why?

Well, Devon would kill me,

- for one thing.
- Oh. He...

- He'll support whatever I choose to do.
- I know.

But as a neurosurgeon,
your life becomes the hospital.

To be truly excellent
requires total commitment,

and the pressure is intense.

If you ever want

- to have kids...
- That's far in the future.

If ever.

I really want to consider this.

All right.

Well, we can talk about it.

You have both the brains and the guts.

Okay, you ready to try it blind?

Oh, hell yeah.

Lunar New Year was your
father's favorite holiday.

And I also remember as a kid,

he would give me
those little red envelopes.

And I thought today,

perhaps you could use one.

Can always use a little luck.

Do you really think this drug trial

could beat my cancer?

Most success rates are low,
generally, in clinical trials,

but this one's different.

I mean, they're thinking this could be

the next big thing in lung cancer.

But one step at a time, Mom.

First, we have to get you
enrolled in the trial.

So, my mother's cancer is spreading.

Her lung masses are growing,

and there's a new met in her liver,

and if it continues to spread...

The next step will be hospice.

Yeah.

We're not there yet,

but I do want to give her
the best chance to live,

and-and right now, it's your trial.

But have you looked at the side effects

- of this trial?
- Yeah.

She can do this, Pravesh.

I'll need to assess that for myself

- very carefully.
- Yeah.

Yeah, please do.

But...

This is our last hope.

- Hey. I heard.
- How?

The gossip mill at Chastain

is alive and well.

We're all pulling for her.

- Do you know what's wrong?
- Heart failure.

We're seeing what we can do.

How are you holding up?

I'm keeping perspective.
The heart is a muscle.

Hey.

This is me, Conrad.

Inside this woman who walked into our ER

is a part of someone we both loved.

That means something.

After Nic died, I kept seeing things

that made me feel like she was near me.

A song we loved would
suddenly come on the radio.

A woman in the park with her laugh.

I'd find an old note
she left for me in the drawer.

That type of thing.

Then eventually, it faded.

But now a small part of her,

a real part of her, is here.

Alive.

Hannah, talk to me.

I can't... I can't breathe.

- I can't breathe.
- She's hypotensive,

tachycardic, and her sats are dropping.

This looks like cardiogenic shock.

- I need a norepinephrine drip.
- And page Austin.

Her ejection fraction is only 15%.

We need to get her to the cath lab now.

Inserting

the pump into the aorta.

That should help her heart
pump a little easier.

But it's only a stopgap.
Her heart failure

- is getting worse.
- She must be rejecting

the transplanted heart.

I wish there were
some other explanation.

Well, she stabilized enough to tolerate

the biopsy. That should tell us more.

Biopsy catheter to me.

So, AJ told me you've discussed how, um,

brutal and, uh, dangerous
this trial would be.

And you're sure you'd want to do it?

I'm sorry to ask you again,
but given the risks,

I need to hear it from you directly.

Yes.

And...

do you have any concerns that
you want to discuss with me?

I'm not just doing this for myself

but for others.

I mean,

it will help advance the science, right?

Yeah.

That's the point of the clinical trials.

They're experiments.

Okay. I'm in.

I admire that enormously.

But we still have to determine
if you meet the criteria,

which means one more test.

- Okay?
- Okay.

So,

I'm gonna put this over your nose.

Now I want you to put your mouth

around this mouthpiece
and breathe in normally.

All right, Carol. I want you

to pant. In and out.

Good.

Now take a deep breath in.

Now breathe all of the air out.

Keep going.

Come on.

And we're done.

Let me try that again.

Okay. One more time.

The rules of the trial are clear.

We need an FEV1 of 50% or more.

Hers were 45 both times.

I'm so sorry.

She didn't pass.

So, you're telling me that
she doesn't meet the criteria

based on what's essentially
a rounding error?

No, it's more than a rounding error.

There are other issues.

I reviewed Carol's chart.

Her echo and performance status
were borderline, AJ.

A-Are you cherry-picking

only healthy patients to protect

your numbers?

I'm not protecting my data.

I'm protecting Carol.

And given her condition,

I'm not sure how likely it is

this incredibly difficult regimen

would even help her.

"Not sure"

doesn't cut it when we're
talking about my mother's life.

I'm sorry,

but these criteria exist

for a reason.

Who are you?

No, really, is-is this who you are?

A numbers dude

who blocks a desperate
woman's last hope?

Wh-What happened?

Your heart failure is worsening.

We're waiting for tests to confirm,

but we're worried that...

your body is rejecting
your transplanted heart.

You have to fix it.

Please.

We're trying.

I'll let you know as soon as we
get the results of the biopsy.

Okay.

If you need anything

or you feel any discomfort,

I want you to push
this red button, okay?

I trust you.

I know you'll help me.

I will.

Hey.

I'm doing a split shift,

so I'll be taking care
of Hannah in the ICU.

- Want me to catch you up?
- No. Already did that myself.

I'll keep a close eye.

Page you if anything comes up.

Conrad?

Yeah?

I'm sorry about your wife.

Thanks, but this isn't about Nic.

It's about Hannah, okay?

Open. Ah. Open...

It's good. It's okay.

It's okay.

Oh!

Dr. Bell, are you okay?

Yeah, fine. Thanks.

We have great news.

Kit and I have been calling in

every favor. We're really excited

to tell you what we've come up with.

Sit down.

It's all right. I'm not
completely incapacitated yet.

Uh, n-no, I know. I just...

The landscape around MS
is always evolving.

New immunomodulator therapies
reduce relapses

and progression.

If you experience a relapse

after, uh, starting

one treatment,
many patients try another,

and-and they keep trying
until they're symptom-free.

Finding the right specialist
is paramount,

so Jake pulled some strings

and got you a neuro consult
at the Mayo Clinic on Tuesday.

The chair of the department's a friend.

I did his nephew's cleft palate
surgery a few years ago.

He's already been filled in.

Thank you. Both of you.

So you'll go?

Yeah, of course.

And I'm-I'm grateful.

I'm so encouraged.

- Jake, I need a couple minutes alone with Kit.
- Yeah.

I'll, uh, let Mayo know
you're confirmed.

Kit, I'm leaving Chastain.

A leave of absence.

- Of course. To heal...
- No. Permanently.

What?

I'll-I'll try the treatments,

and I'm grateful for the help,

but I'll never operate again,

- even if I get markedly better.
- Why not?

You at 95% is better than anyone at 100.

It's more complicated than that.

Then, please, explain it to me.

- Optic neuritis. You familiar?
- Of course.

Eye pain, vision loss.

Are you experiencing any?

I just had an episode. It cleared up.

But it's a sign the disease
is progressing rapidly.

I'll lose my strength,
then the ability to walk

and speak and eat.

And at some point,

- I'll end up paralyzed in a hospital bed...
- Okay, stop.

- ... unable to feed myself.
- Stop.

Stop.

See, you fell in love with
the man that I wanted to be.

And I became him because of you.

What are you saying?

I love you.

And I will not saddle you with this.

I have a welcome speech
to give, but don't leave.

- We have to talk about this.
- No, we don't.

I have an office to pack.

Kit!

Hey, Kit!

Kit!

What'd he say?

What happened?

Gigi, wait! Sammie, wait!

Sammie!

She's seizing. Two milligrams
of lorazepam now.

I'm gonna get her on her side
before she aspirates.

So, she came in with heart failure,

rapidly developed cardiogenic shock.

- And now seizures?
- Despite everything

we're throwing at her,
she continues trending

- in the wrong direction.
- She has a bleed.

Likely caused by the
blood thinners we put her on

for the balloon pump.

I mean, thankfully, it's small,
so we can just monitor.

But look at the meninges
lining her brain.

Usually they're smooth,
but here they're bumpy.

Something more serious
is happening here.

Infection.

An infection while we're
blasting her with meds

to suppress her immune
system would be deadly.

- Devi and I will do a spinal tap.
- I'll get her a full body scan.

I'll send off autoimmune labs
and talk to pathology,

see if the biopsy results are back.

- So what did I miss?
- Hannah's labs came back normal.

Spinal tap was negative.
No cancer on the full body scan.

Pathology told me her biopsy proves

she's rejecting her heart.

Tacro levels are in the basement.

So her heart's failing because
she's probably not taking

- her immunosuppressants.
- I don't think she would do that.

Not based on everything she told us.

Well, we don't really know her, do we?

You know, people can surprise you.

I got to check on a patient.

I'll be back in five.

You all right?

My mom's not getting into Devon's trial.

He said she missed the cut.

Why don't you talk to Hannah
about those meds?

I'll talk to Devon.

Carol was outside the FEV1
entry criteria by five percent?

Those are the rules. My hands are tied.

Protocol exists for a reason.

I taught you to break
the rules for the patients.

You taught me to also
follow the science.

And what you're saying
now is to ignore it.

Yeah, we both know her odds

are long and this is your first trial,

but to turn her down because
she'd skew your statistics?

Do you think it was easy for me

to tell AJ that she wasn't a candidate?

But I know it was the right thing to do.

The right thing to do for who?

The patient, the pharma
company or for you?

For everyone.

If your father were still alive,

and you had a chance
to save him with this trial,

but he didn't fit the criteria
by a small number,

would you make the same
call you did for Carol?

I have spent all day
trying to convince myself

it is okay to let her into this trial.

But I know that if I do,
she will likely end up

on dialysis when her kidneys fail.

Fluid in her lungs will make her
feel like she is drowning.

But what if she makes it through?

I don't see that happening.

Carol is brave.

She wants to help the science.

But if I bend the rules to let her in,

her sacrifice, it won't even do that.

I am not going to torture

an older immunocompromised woman.

She's already been through
enough. I won't do it.

- You talk to Devon?
- I did.

- And?
- I'll explain later.

But we will do what's right
for Carol, I promise.

We're out of time. She's getting worse.

What about the immunosuppressants?

She insists she's been taking
them. She has from the start.

She told us she had
headaches off and on.

She had seizures.

Maybe she thinks she's taking the meds.

She could be forgetting to take them,

because of an underlying
neurological problem.

How long has she been tapping like that?

For hours.

It's the same consistent tempo.

Her tapping matches the beat
of her heart on the monitor.

Maybe she's hearing
her heartbeat in her ears.

You're right. I can hear it.

Must be a dural arteriovenous fistula.

An abnormal connection

of blood vessels in the brain.

Explaining all her symptoms.

From the headaches to the seizures

to forgetting to take her meds,
resulting in the heart failure.

So, her heart problem
is really a brain problem.

And that can be fixed through surgery.

One second.

Unequal pupils.

Her brain bleed is getting worse.

I'll page Billie now.

Dr. Austin?

If you don't mind, I'd like to monitor

our patient's intraoperative
cardiac function.

Of course.

This one's for Nic.

- Sammie?
- Gigi?

- Sammie, Gigi!
- Gigi?

- Sammie!
- Gigi?

Sammie!

- Girls?
- Sammie!

Once there was a little bunny

who wanted to run away.

So he said to his mother,
"I'm running away".

"If you run away", said his mother,

"I'll run after you,
for you are my little bunny".

"If you run after me",
said the little bunny,

"I'll become a fish in a trout stream,

and I will swim away from you".

So the mommy keeps him safe?

Yes, you see? No matter
what the little bunny does,

he's always protected.

Like you protected me from the dragon?

That's right, Gigi.

Pickups and dural scissors to me.

Opening the dura now.

It was unavoidable.

Two large bore suctions.

Sutures. We have to repair the sinus.

Cardiac Doppler to me.

We got an air embolism.

If air in the blood hits the heart,

it could be fatal.

Chu, drop the head of the bed.

Devi, flood the field with irrigation.

I need a central line to
aspirate the embolism.

Heartrate's stable.

All good, man.

All right.

All right, let's keep it going.

You can run, but you can't hide.

I will find you.

Wherever you go, I will follow.

We will go to the Mayo Clinic together.

And wherever the road leads after that.

But it will lead back here, to Chastain.

Because you will get better.

You will operate again.

And you will save lives
as you have before.

Well, you don't know that.

I do know

that whatever complications
may be ahead,

we will face them together.

Because you are the
great love of my life,

and I'm pretty sure
I'm the great love of yours.

It's gonna be okay.

It's okay.

So?

Is my mother in your trial or what?

No. I'm sorry, AJ.

I agree with the decision.

What?

Wow.

Wow. I really expected more from you.

When Nic came into this hospital
gravely injured,

I would have died to save her,
but I couldn't.

No one could.

I know better than anyone
there is nothing harder

than not being able
to deliver a miracle.

This trial would not help your mom.

It would harm her.

But that doesn't mean
there's nothing we can do

for your mother.

I'm...

actually a little relieved.

If I'd qualified for the trial,

I'd have given it everything I've got.

But...

I'm tired.

Part of me was doing it for you.

Wow. Mom, I'm sorry.

I-I didn't mean to push this on you.

Hush. Hush, son.

You've been an angel.

Carol, I'm gonna call your oncologist

about starting you
on palliative care right away.

It's not hospice.

You don't need that yet.

No, no. Palliative care doctors
will treat your symptoms

and make sure you live
your best life without pain.

It's something we should've started

the day you were diagnosed.

Studies have shown that people
with metastatic lung cancer

can actually live longer...

- And better.
- ... than those who continue

aggressive and sometimes
harmful treatment.

And this will give us more time
to do the things that we love.

Together.

AJ, honey, I would love that.

That should heal in a few weeks.

And your neurologic symptoms
should start resolving soon.

The fistula in your brain

didn't just cause headaches.

It affected your memory.

That made you forget to take the meds,

which led to the rejection.

- And my heart?
- We've begun treatment,

and your heart is already
showing signs of recovery.

Dr. Hawkins made the diagnosis.

Dr. Hawkins.

How can I thank you?

All of you.

Get some rest.

I wasn't sure if I was
gonna tell you this, but...

My wife was an organ donor.

And she saved a lot of lives.

Including yours.

What?

I...

I have your wife's heart?

Can I see her picture?

I do have a favor to ask.

Yeah, anything.

Could I introduce you to my daughter?

Of course.

Gigi, I want you to meet
a very special person.

This is Hannah. Hannah, this is Gigi.

Hi, Gigi.

Hi.

Can we listen?

Yeah.

Hi, Mommy.

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