ER (1994–2009): Season 12, Episode 13 - Body & Soul - full transcript

MAN:
Sir?

MAN:
Sir

You... you can't
be out here.

Sir?

Sir?

It's not safe.

Sir?

Sir, you can't be here.

Sir?

They found some guy
wandering and disoriented.

Oh, just what we need--
another lost soul.



You can never have
enough of them.

Nate Lennox, 54.

Medic Alert bracelet
says he's ALS.

Paralyzed and
unresponsive.

He rolled out onto the ice
at Prospect Rink.

Somebody with him?

Uh, called the number
on the bracelet.

Left a message.

Mr. Lennox,
can you hear me?

How did he get
out of the house?

Good question.

Do you think
he was abandoned?

Somebody's taking
care of this guy.

He's got clean clothes



and it looks like
he had a shave this morning.

Pulse ox is only 89.

Let's get him
on five liters by mask. Okay.

Gonna need some
lifting help.

No, no, no, let's just leave him
in the chair for now.

If we lay him down,
it might compress his lungs.

It might make things worse.

Okay,
crackles bilaterally.

CBC, chem panel
and a portable chest.

Let's call for
his old medical records.

Whoa!

( grunting ):
Hey, hey.

What? Did you hit
the joystick?

No.

Okay. Sats are up to 92.

Have RT induce a sputum
for a gram stain

and culture.

Okay. Whoa! Hey.

Don't do that.

I didn't touch it.

Is there a short
or something?

I think the computer
has an eye sensor

that's controlling the chair.

I think he wants
to get out of here.

He's probably altered
from too low oxygen.

Yeah, well, I'm...

I'm gonna disconnect
the battery.

Need a hand?

ALS with pneumonia.

Could use a hep lock.

What's his name?

Nate Lennox.

I've seen him before,
a while back.

SYNTHESIZED VOICE:
No.

Help. Don't.

He did that with his eyes?

Well, looks like
a speech synthesizer program.

It's okay now, sir.

We're gonna take care of you.

Want out.
Please, let me out.

Please,

let me out.

Sats are
still borderline.

I'm not sure
how aggressive

we need to be
with this guy.

Is he a DNR?

If I were like that,
I sure as hell would be.

Mr. Lennox, your oxygen
levels are falling.

Do you understand?

We need to know your wishes
about resuscitation.

Okay.

Home...

Does that mean you don't
want heroic measures?

Home.

If you stop breathing,

do you want us to use
a machine,

a ventilator?

Hungry...

Food.

SAM:
Do you have
a living will?

An advanced
directive?

Drug store.
I don't think
we're getting through to him.

Do you know
where you are?

I have amyotrophic lateral
sclerosis,

also known
as Lou Gehrig's Disease.

It is a progressive degenerative
neurologic disorder

that has weakened my muscles.

All of my senses are intact.

My mind is clear.

Not today, it isn't.

Got his old records.

We need the name
of his neurologist.

Maybe he'll know
what to do with this one.

You want me
to up his oxygen?

I'm gonna say
let's go with BiPap.

It'll buy us time
without having to intubate.

I knew he
looked familiar.

What?
He should already be on BiPap.

Neela and I treated him
about a year ago.

He came in for
shortness of breath.

NATE:
Every time you have a thought,

every time you take a breath,

every time you move a muscle,

every time you take a crap...

( chuckling )

...you should thank your ATP...
AT... ATP.

Oxidative phosphorylation...

( inhaling )

gives...

gives us...

a whopping...

SAM:
The bedpan may distort
things a little.

Hoo, boy.

The kids at school are going
to make fun of me.

This too tight?
No, It's fine.

It's like
an oven in here.

I'm sorry, they're working
on the A/C.

So hot...

The BiPap increases
your tidal volume.

Your neurologist says it'll
give you more energy

and a longer survival.

That's great news.

Sam, labs were hemolyzed
on your heat stroke guy.

I'll be right back.
I'll wait here.

I should have another listen.

Where'd you go
to med school?

Um, right here.

I was a Biochemistry major
at Yale,

so I placed out of your class.

Yale...

I worked in Sandra Hamilton's
lab my senior year.

Yeah, I know.

We were in awe of your work
on anti-sense RNA.

I cited several
of your studies

in my paper
on gene inactivation

in Trypanosoma brucei.

You published
as an undergraduate?

Second author.

Impressive.

So what are you
doing here

in this,
uh, cesspool?

Are you just here
for the big bucks?

What is it
going to be?

Orthopedics?

Plastic surgery?

Neither.

I... can't stand
surgeons.

They're arrogant
workaholics

who can't relate to people
unless they're asleep.

WOMAN:
Sorry, Nate.

The car overheated
and I had to take the El.

What happened?

I'm fine.

He had some shortness
of breath.

I'm Dr. Rasgotra.

Uh, Fran Bevens...

Did you reach Dr. Ames?

He's already
been down.
Okay.

He's consulting
a speech pathologist.

Good.

Not good.

I don't need it.

It's getting hard for people

to understand
what you're saying, Nate.

Maybe they should start
listening better.

Hello, Fran.

Jared... it's good
to see you.

Ready to start?

I'm trying to contain
my enthusiasm.

How long are you guys
going to be?

Half an hour.
15 minutes.

We'll be back with your
aftercare instructions.

You...

think about

what you're doing.

You may realize

you don't... belong here.

Where does he think
you belong?

Probably back
at the Jumbo Mart.

I think he misses
my slushies.

Please be kind.

Hey, severe sunburn.

Dispo if the pain's down
with toradol and aloe.

Not too bad.

Soft rule out
going to tele...

Excellent.
And this guy's
with his PMD,

so there's nothing
for you to do.

Lennox?
Is that Nate Lennox?

Yeah, the biochemistry
professor.

Oh, wait,
I've got one more.

Yeah, I'll figure
it out.

Nate...

Do you like
my new look?

Well, not a lot of people
could pull that off.

Good to see you,
Abby.

Hi, Fran.
Whatcha doing?

Playing Medal of Honor.

I just killed
a convoy of Nazis.

AMES:
His facial muscles
are weakening,

he needs to practice
with assisted speech.

SYNTHESIZED VOICE:
Hey, I've got a great idea...

Oops.

AMES:
Well, we can wait
on speech therapy

for the time being, but I
got to tell you, Nate--

you're just putting off
the inevitable.

You need
to start wearing this.
Why?

Because it has your diagnosis
on it and your name

and your
phone number.

We're lucky you were
in class today.

Otherwise, who knows what might
have happened?

Huh?

Okay, okay.

How about this thing?

Do I have to wear it
all the time?

AMES:
Well, we'll start with
bedtime use.

You'll get the benefits
of eight hours a night

while you're asleep.

I keep waking up...

and something else is gone.

Thank God for the bracelet.

Is that comfortable?

Nate. Nate.

He was speaking with
the computer

when he first came in.

Can't get an IV in him.

He always needs
a central line.

He was at an ice rink?

Yeah. Any idea why?

It was like any other day.

I got up, I shaved him,
bathed him,

fed him breakfast
and then transferred
him to the chair.

He was watching television,
so I went to take a quick nap.

How did he
get outside?

He can open the front door
with his computer.

Ray, ready to present?

Yeah.
Dr. Kovac.

Fran Bevens.

Hello. Hello, sir.

FRAN:
You saw him
a few years ago.

Right middle and lower lobe
infiltrates.

He's altered, borderline
oxygenation, even with BiPap.

Can we have a word?

Yes, of course.

We, uh, may need
to make a decision

about intubating
and ventilation.

You think he can get over
the pneumonia?

BARNETT:
He could,

or he could be intubated
in the ICU,

going downhill
for four weeks.

TAGGART:
He hasn't got a lot
of reserve.

There's no guarantee
he'll get better.

This may be

the natural end point
of his disease.

So maybe it's time to focus
on keeping him comfortable.

Fran, I just heard
you were here.

Thank you for
coming by.

I've taken care
of him before.

He decided

to go out
by himself.

Why'd you do that, Nate?

COMPUTER:
In motion.

What's in motion?

Free.

LOCKHART:
His pulse ox is
down to 82.

What are you
doing?

Well, his lungs
are full of junk,

his sats are down,
he needs to be intubated.

Abby, we've been just discussing
about how best to proceed.

Well, helping him breathe

would be a good way to start,
don't you think?

I don't think that
he'd want that, Abby.

Abby...

Yankauer.

We haven't come
to a consensus.

I'm not comfortable
with this.

I'm not intubating.

( hissing and gurgling )

Large mucus plug
at the cords.

Okay, that should help.

Temporarily.

Sats are coming up.

Well, this will give us time
to treat him with

oxygen and antibiotics
until he's alert enough

to tell us what he wants.

Dr. Lennox.

Nate.

Nate, talk to us.

Around... and into
the subclavian.

Fluoro off.

Okay, that's as far
as we go.

Ceftriaxone's ready.

How'd he do?

Very well. We're starting
the IV antibiotics.

When did he
last eat?

I fed him this morning.

He could use
some calories.

How you doing?

You're in the
hospital, Nate.

LOCKHART:
Nate...

You remember when we talked
about putting in a trake

if you had
trouble breathing?

You said you wanted
to keep going

until they found
a stem cell cure.

BARNETT:
Why don't we just
let him rest?

Snowmobile versus tree.
Morris needs some help.

500 of Azithro
after the Rocephin.

Got it.

Okay, we all need
to agree on this.

You told me
you wanted a trake.

FRAN:
That was a long time
ago, Abby.

His biggest fear now is that
he'll end up on life support

aware of everything,
but with no way
to communicate.

He was communicating
a half hour ago, wasn't he?

BARNETT:
That could have been
random eye movements.

400 cc's of Jevity.

Yeah.

So if we do the trake...

LOCKHART:
He's out of here
in a day.

He can go home with
a portable ventilator.

You'd have to learn
how to suction

and troubleshoot
the vent.

But we can get you some help.

I know you're tired.

He's the one
who's tired.

Fran.

I'm with him
every day, Abby.

I know.

Looks like we've got
a clogged G-tube here.

Do you flush it
with water?

Yes, after every feeding.

He needs nutritional support
soon

to fight off the infection.

It won't go.
Do you know when
the tube was put in?

No. I...

G-tube placed
in May, 2002.

He came in after
a choking spell.

( applause )

You know, each May,
the graduating medical students

vote to present
a Teacher of the Year Award.

Now this year's award
is unique.
Fresh flowers.

in that the students
have chosen not a clinician,
They must think it will make up

but rather
a scientist,
for cutting back on my teaching.

whose dynamism
and passion for inquiry

made a strong impression
during their first year

and stayed with the students
throughout their training.

This year it gives
me great pleasure...
( choking )

to present the 2002 Teacher
of the Year Award
Nate, what is it? Nate? Nate?

to Dr. Nathan Lennox.
( gasps )

Well, your chest X-ray
is negative for aspiration.

You got lucky, Nate.

Yeah, I'm the luckiest man
on the face of the Earth.

It's time for
a feeding tube.

No, it's not.

Well, you know your chewing
and swallowing muscles

are getting pretty weak.

Well, then Fran will
have to cut my meat
smaller, won't she?

Takes him an hour
to eat a meal.

He's lost ten pounds.
More like five.

The rest
is water weight.

Weight loss accelerates
the progression of ALS.

The extra calories
from the tube feeding

will mean increased strength,
more energy

and longer survival.

I'll think about it.

Romano around?

He's stuck in the OR
with a pneumonectomy,

but I'll see about
getting you on the schedule.

I said I'll
think about it.

Well, we'll save
you a spot.

We can always cancel.

Good night.

I'll walk out
with you, Donald.

I'll be right back.
Night, guys.
It's been great.

Tell them to send
the trophy
to my mother.

Trophy?

I won the potato sack race
at the county retreat.

Abby Lockhart around?

No, not tonight.

It's pretty quiet
around here.

Sometimes it's slow.

It's not just that.

Are you cutting back
on staff or something?

One of our attendings died.

Mark Greene.

A lot of people took off
to go to his memorial.

Chen wants you in Exam Three
with the belly pain guy.

It's a slam-dunk
diverticulitis.

I called medicine--
all she has to do
is co-sign my chart.

I'll let you tell
her that yourself.

What year residency
you in?

First. I'm an intern.

Ooh, pretty cocky
for an intern,
aren't you, huh?

You're either real smart
or really insecure.

If I were you, I'd put
my money on the first one.

Of course, 'cause all
the great minds

want to work
in the County E.R.

Actually, this is
just temporary.

Planning on moving over
to Northwestern soon.

Congratulations.

Got in, huh?

Well, not yet, but believe me,
I will.

JARVIK:
Pre-op instructions
for the G-tube.

Okay, cool.
All right,
listen up.

This is going to show you
everything you need to know

about the procedure:
where to show up,

what to eat
the night before,
what to wear...

( sobs gently )

Uh... are you okay?

Look, I know it's hard.

This isn't me.

It's the disease.

Okay. The nerve deterioration
leads to pseudobulbar affect.

His emotions can be
very exaggerated.

Yeah, I see.

Okay, shh, shh.

It's called emotional
incontinence.

It sucks.

You get a little
upset about something,

and the next thing
you're crying like a baby.

Well, there has to be some sort
of medicine for that.

FRAN:
He won't take it.

NATE:
Side effects
are too much.

And it's the BDNF...

I've been injecting
Nerve Growth Factor

twice a day
for a year.

Stuff turns ALS mice

into Olympic athletes,

but the human trials--
worthless.

Results haven't
panned out in humans.

I'm sorry to hear that.

Now Fran has to pour...

Ensure in my stomach
tube all day long.

FRAN:
It's no big deal.
Shh. Come on.

Come on.
Calm down.
I just...

didn't want to be
a burden on anyone.
Shh. Come on.

( sobbing )
Come on.

FRAN:
Should this
be hurting him?

Maybe just
a little.

Okay, G-tube is in.

Balloon is up.
Check the flow.

I think he's
waking up a little bit.

Go ahead and set up
for PFT's.

The flow's looking good.

Thank you.

All right, we need
to test his lung function.

Nate, I'm going to put this
in your mouth

and Sam's going
to pinch your nose.

Here we go.

Easy. All right.

Easy.

Okay...

All right, deep breath in.

( wheezing breath )

And blow it out.

Blow it out,
blow it out.

Great.

Forced vital capacity
is 32% of normal.

That's the amount
of air that he can move...
I know what it means.

Okay.

Nate...

Nate.

Your lung capacity
has deteriorated.

The best way
to help your breathing

is for us to put in
a trake.

You're going to need
assisted ventilation.

Do you want us
to do it?

I'm not sure you'll
recover without it.

The trake is
the best chance you have

of clearing up
your pneumonia.

Nate...

Okay.

Okay.

Call Surgery.
He consented
to the procedure.

I'm okay.

Abby, I don't think that
that's what he meant.

What? He said, "okay."

He said "I'm okay,"
after that,

which could mean
leave him alone.

It's not exactly
informed consent.

Nate, you want
the trake, don't you?

I don't... you all heard
what he said.

At a vital capacity of 30%,
some ALS patients

enter into hospice care.

It means they have
six months to live.

His FVC is low, yes, but that's
because of the pneumonia.

We clear that up,
and his lung function

will bounce right back.
That's the best
case scenario.

He expressed his wishes
in advance.

Now he's too sick.
He can't give
reliable consent.

How's his PO2?
I want to do
a trake.

We have a consent
issue here.

I explained the procedure
to the patient.

I asked him if he wanted
us to do it.

he said, "okay,"
on his computer.

KOVAC:
He did?

He also said, "I'm okay,"
after that.

I don't think
that he understood.

LOCKHART:
He was alert

and looking at me
the entire time.
He understood.

I really don't think that this

is what
he wants.

Fran has
a durable power of attorney.

Thank you.
It's your call.

You know, with
all due respect,

I'm sorry, but...

Nate expressed

his wishes, and I think
we have to go with that.

Well, if there's a chance that
he asked for the procedure...

I'm not sure that he did.

I think we have to do it.

Dr. Kovac...

Ray, I need you next door
to help me with a central line.

Let's go.

I'd like to page
Dr. Ames.

I'll try to find him.

And call Dubenko to put
in the trash

and RT to set up a vent.

Between the first and second
tracheal rings.
Dr. Lennox,

close your eyes
if you're having any pain.

Doesn't look like
he's feeling anything.

Aspirate air,
confirm you're in.
Guidewire.

So you're in surgery
now, Neela?

I'm just doing an elective.

Well, things change, right?

Certainly do.

11 French dilator.

Balloon's good to go.

I hope he's okay
with this.

Mm.

Doesn't want to pass.

A little more muscle.

( soft gasps )

You doing all right, Nate?

DUBENKO:
Okay, remove the dilator.

Slide the trake
tube in.

Mm.

Bit of oozing here.

Direct pressure should
take care of that.

Little bit of bleeding
can be normal.

Tachy at 130.

I'll open up his fluids.

Is he okay?
Um, he could be sensitive
to the blood loss.

Let's take another look.

Oh, my God.
Pressure again.

Ten blade.
What are you doing?

Converting to an open procedure.
We need deep hemostasis.

Two units of packed cells.

A blood transfusion?
It's just a precaution.

Call for type specific.

And, Sam, can you see
if his antibody screen
is in the old chart?

Okay, Abby, grab a Yankauer.

What is happening?
It's just a minor complication.

It doesn't look minor.
ABBY:
Suction on high.

I never should've
let you do this.
Mosquito clamp.

Antibody screen's negative.

He looks like he's in pain--
you guys might

need to give
him some pain medication.

Four of morphine.

No. No morphine.

Yeah, don't give him morphine,
he had a bad reaction

in 2001 when he came in
with a broken wrist.

But the transgene
will be suppressed.

We'll use two
fluorescent reporters
with different spectra.

Why two?
One for transfected cells

and one for
translational fusion

with the target gene.

That's brilliant.
Well, it's simple.
I don't know if it's...

( groaning ):
Oh... ow!

Four morphine.

Get back to work
on the plasmid DNA vectors.
Right now?

I don't want Gregorio
beating us to the Nobel Prize.

KOVAC:
Right.

You know that
you're not supposed
to take the stairs.

They were servicing
one of the elevators.

So you wait
for the next one.
We were late, Fran.

All right. Listen, I...
I've canceled your
morning classes.

Don't be ridiculous.
Why would you do that?

I couldn't get ahold
of Baker, and he's
the only one...

Baker doesn't...
Uh, what did
he say?

Uh, he thinks it's time
to start using a wheelchair.

You've got to be kidding.

The weakness in your legs
is progressing to the point

that it's not safe.
Next time you could
break your hip.

They have power wheelchairs,

motorized scooters.

You-you'll still be
very independent.

Until my battery goes dead.

You won't be losing something,

you will be conserving energy
so you can do more things.

You're trying to turn me
into an invalid.

People with
degenerative diseases

do best when...
when they have...

What?

Hope?

Do you read the paper?

Bush just banned federal funding

for embryonic stem cell
research.

I am trying to hold on
to hope, Doctor...

but nobody's cooperating
these days.

Well, Dr. Ames
has some papers

on mobility assist
devices for...

I don't want 'em.

I'll-I'll go pick
them up. Thank you.
Not for me.

Not for me.

( sighs )

( groans ):
Ow!

So Fran drives you to
all your doctor visits.

Mostly she just
drives me crazy.

Ow, wow...

How long have
you been together?

We're not together.

She works for me.

Oh.
Yeah.

For some time now?

15 years.

She was right out of college.

I needed an assistant
who was on the ball.

She was ridiculously
overqualified.

Only thing that
really surprised me

is that she stayed
after that first year.

She could've gone
to law school,

to business school...

I have to say,
she stuck with me.

She knows you pretty well.

I think that's why
I assumed...

you guys were...
No, no. No, no, no.
( chuckles )

There was a point...

a million years ago...

when it almost happened.

But then I came to my senses.

You married?

Then you understand.

Who has time for family when
you're devoted to your work?

Well, some people try
for a balance.

Maybe if you're an E.R. doc.

But if you're trying

to push back
the frontiers of science,

it's 24/7.

Right.

It's not bad
to be married to your career.

My career is
a good companion.

Never nags me.

Whoa.

( gagging )
You okay?

( loud groan )

Side effect of
the morphine.

That's good to know.

This will make
you feel better.

Two of versed.

That should settle him down.
Sats are only 89.

Maybe we've done enough.
We need to find the
source of the bleeding.

And what if you can't?
We may have
to split open his chest,

but we'll find it.
Damn it!

It's a detour, Fran--
we can get back on track.

You don't know that.
If you'd like,

I can take you out
to the family room.

No!
Okay.

Stay there and hold his
hand and talk with him.

Vascular clamp
and pickups.
Frazier tip suction.

Nate, I am so sorry.
Careful, careful.

Whoa, whoa, whoa.
Right there.

( groans )

Deep to the
manubrium.

I think you've got it.

My, oh, my.
What?

We poked through the
left innominate vein.

I've never seen
anything like that.

RASGOTRA:
Very unusual anatomy.

Well, when they made Nate,
they broke the mold.

Sats are coming up,
B.P. 120/75.

Okay, we're out of the woods.
Good.

Trake's in, vent tubing.

Four-oh prolene.

You gave us
a little scare there.

Let me help you.
You're not gonna be
needing this anymore.

Nate.

RASGOTRA:
Dr. Lennox, open your eyes.

Could just be
because of the sedative.

Um, there might be some damage.

RASGOTRA:
The blood loss may have
deprived the brain

of oxygen.

Pass the tubing
all the way...

and cover the suction port
with your thumb.

( wheezing, coughing )
Then pull out slowly.

It's making him cough.

That's good-- it'll help
clear the secretions.

That's all there is to it.

How often?

Uh, maybe two,
three times a day.

More if he sounds junky.

We're gonna get you
some help at home.

I don't think so.
( chuckles )

You know how many caregivers
he's made me get rid of?

It's just easier
if I do it myself.

Sometimes
you need a break.
Well, I'm fine.

Uh, I've cut back
to 12 hours a day,

and we have
night aides now.

I mean, if there's
a problem, they still
come and wake me up.

It's hard for me to
see someone not giving
him the best care, so...

Nate.

Hey, Nate.

Okay, you let us know
when you're ready to talk.

Can I take him home?

In a couple of days.

How about tonight?

I think that after everything

he's been through,

we should probably
keep an eye on him.

I know, but I promised him

that I would keep
him at home.

It's what he wants.

Well, he'll do better
in the hospital.
Yeah.

But I promised him.

How long have you been with him?

Oh, 21 years.
( laughs )

It's hard for me to believe
sometimes.

It started out as just a job,
you know, but, um...

after a while...

There was this one time
I traveled with him to Boston.

It was, uh, September of '99.

It's beautiful there
in the fall.

He was giving a paper at a
molecular biology symposium.

I was still prepping
his slides and his handouts

five minutes
before the talk.

We worked so hard, he added
a couple of days to the trip.

We went up to Cape Cod.

The hotel was right
on the beach, and, uh...

( crying softly )

He took me sailing.

It was one of those times
in life where you think

everything is just
falling into place.

( sniffles )

Couple of weeks later
he got the diagnosis.

Oh, one more thing--
I saw the neurologist today.
Everything okay?

All the blood
tests are normal.
Oh, good.

No peri-ventricular lesions
on the MRI, so it's not MS.

Great!
Although I was kind
of hoping for MS.

What?
The EMG showed
denervation

of the muscles of
the right hand.

I have motor neuron
disease, Fran.

I have ALS.

Oh, my God.
The average
life expectancy

is four years, but five percent
of patients progress

and then plateau.

There's some guy in his 60s

who's still playing golf
40 years into the disease.

They're starting me
on a new drug called Riluzole.

It's very promising

at slowing the progression
of the degeneration.

There are going to
be some challenges.

But I'm very hopeful
about all the new research,

and they're setting me up

with a multi-disciplinary
support team,

physical and occupational
therapist, nutritionist,

speech pathologist,
respiratory therapists.

I could help, too.

Well, I'm still going to
need an assistant, Fran.

Obviously, of course.
Now more than ever.

That's not what I meant.

I have to put all my energy
into fighting this disease.

He didn't want
to start something

only to have it
taken away.

He was, um, he was afraid
it would be too painful.

For you or for him?

For both of us.

COMPUTER:
Hello.

Hey. Good to see
you're back.

My neck.

They did a trake.

LOCKHART:
To treat
your pneumonia.

Really?

Yes, your oxygen
levels are up,

your title volume's improved,
you're more alert.

I'll never wear
a turtleneck again.

You still want
an ICU bed?

Uh, no.

I'll get
a tele bed.
Thank you.

We're admitting you

for antibiotics and
respiratory therapy.

No trake.

I thought you
would've wanted this.

Appreciate it.

It saved your life, Nate.

I understand.

Um, you know, you can live
for a long time with this.

My facial muscles
are getting weaker.

Once I lose my eye movements,
I'll be locked in.

I'll be seeing, hearing,
and feeling my surroundings

but I'll be unable to
communicate my needs and wishes.

I don't want to get
to that point.

Well, this infection that you
have is a temporary setback.

Once you rid of that,

you're going to be right back
to where you were.

I'm going downhill.

Well, maybe more slowly

with good oxygenation
and ventilation.

Had enough.

No, you know what,
in a couple of days

you're going to have
a lot more energy...

He's made up his mind.

Take out trake.

I can't.

Fine.
Then home.

Poker.

He wants me to invite some of
his friends over for poker.

His friends can visit him
in the hospital.

Beer.

We've got beer.

Well, you're in no condition
to go home, Nate.

I'm not comfortable
with this.

I am.

Why don't we wait
in the lobby?

No. Outside.

I'm not sure that
the van is here yet.

Fresh air.

You know, it's
cold out there.

Oh, no.
I might catch pneumonia.

Well, I'm sending a respiratory
therapist home to assist you.

Don't bother.

You know, it's to help Fran.

Tonight, we turn off
the vent.

Go to sleep, won't wake up.

Fran...

I got those papers
for you to sign.

I'll be quick.

I know the way out.

Well, it's
hospital policy.

Somebody has to accompany
you to the van.

You forgot your coat.

You have a treatable
condition.

I'm just asking for two
days in the hospital.

Two days.

Can't.
Why not?

I don't want to be a soul
trapped in a corpse.

Well, you're
not there yet.

Close.

Wait. Just wait a minute.

Wait, wait.

What happened to
fighting this disease?

Too tired.

Well, once we treat
the pneumonia

you're going to feel better.

You can even plateau--
look at Stephen Hawking,

he's had this disease
for 40 years.

I'm not Stephen Hawking.

You're still advising
students, writing books.

You published the lead article
in Cel two months ago.

Just please wait. Wait.

If you recover from this,

you could hang on
until there's a cure.

If I don't recover?

Then I'll be there...

to make sure you're comfortable,

take you off the vent
and let you go.

I bet you ten bucks
you can get through this.

Ten bucks?

All you have to do is
go back into the hospital.

I'm impressed.

You've become
a pretty persuasive doctor.

I'm not so sure I'd be here
if it weren't for you.

NATE:
The air you breathe,

all the food you eat,

it all leads to the production
of one incredible molecule.

ATP-- adenosine triphosphatase--

the end result of oxidative
phosphorylation.

This is the force of life.

7,300 kilocalories per mole.

Pure unadulterated energy.

What are you doing right now?

You're taking notes,
uh, crossing your legs,

coughing, digesting your food,
listening to your voice mail

while the professor
is lecturing.

Every action of the human body,

every single thing it means
to be alive, is powered by ATP.

How much do you weigh?

155.
Stand up.

Stand up.

Every day, the human body
uses 180 pounds of ATP.

Yes, yes.
More than you weigh.

And yet... and yet, this body
only has half a pound of ATP.

What's going on?

You recycle it?

Yes. Yes, you do.

Thank you.

Bravo. Thank you.
A-plus.

You recycle it.

Otherwise, you would
burn off your ATP

in five minutes.

The human body recycles it
300 times a day.

If you were a car,

you would get 150,000 miles
to the tank.

Now, electron transport jams
protons

into the inter-membrane space
of the mitochondria.

ATP synthase is, in fact,
a rotary engine.

The flow of protons
spins the shaft.

That sucks in ADP
and blows out fresh ATP,

filled with the energy it takes
to fuel the human body,

the human mind and,
yes, yes, the human spirit.

Okay, we're done.
Thank you very much.

Tomorrow... thank you.
( applause )

Tomorrow, chapter 19, Lehninger.

Electron transport in detail.
Thank you.

Thank you.

Dr. Lennox...

Yeah.
Do you have
a minute?

And you are...?

Abby Lockhart.
I'm a first year.

Uh-huh.

Um, I need your signature
to drop this class.

You want to quit
Biochemistry?

Well, I failed the midterm,
and I'm not feeling

very optimistic about
the final, so...

It's a required course.

Well, maybe I'll
try again next year.

Tough to do, second year
curriculum is pretty busy.

I'm thinking about
maybe taking a year off

to just reconsider my options.

Wow, I'm surprised.

So, you don't want
to be a doctor?

I-I... I'm trying.

I just... it's a lot.

With biochemistry
and physiology,

and microbiology,
anatomy.

It's just a lot,
a lot to memorize.

Ah, there's your problem.

Rote memorization

is the path to failure.

Um...

You like sports?

Ice skate?
Not really, no.

You dance?
Everybody likes
to dance.

I took ballet when I was a kid,
yes.

Did you like it?

Yes.

I was the Sugarplum Fairy
in The Nutcracker,

third from the left.

Excellent.

Do you want to learn?

Stop memorizing and
think conceptually.

Biochemistry is
the dance of life.

Ballet is
its central dogma.

Adenine holds hands with
thymine, cytosine with guanine.

When they let go,

a line of gypsy dancers
breaks free

to look for new partners,

and messenger RNA
is created.

Ooh. Sorry.
Oh, sorry.

I'm not usually so clumsy.

See?

Um, yeah.
Can you sign my form?

My office hours begin
at 1:00 p.m. on Tuesdays.

Show up.

You're going to tutor me?

Think of it
as dance lessons.

After three weeks,
I guarantee

that you will pass
your makeup midterm
with flying colors.

In fact, I will
bet you ten bucks.

That's a very generous offer.
I just...

I-I just don't... I think...

I know that you
can do this.

I wish I had
your confidence.

You will. Don't give up.

If nothing else,
I will teach you how to fight.

See you Tuesday.

Thank you.