The Resident (2018–…): Season 5, Episode 17 - The Space Between - full transcript
Previously, on
"The Resident"...
Good morning. These are the interns
I told you about.
I'm Zach, Primary Care.
Let's get started,
shall we?
Listen, I'm not a man
that you'll find
in Child's Pose,
so I'm just gonna be
on my way to...
AJ, I happen to know
from personal experience
that you could really benefit
from a little extra flexibility.
All right, come lie down
and grab a mat.
I don't know if I want kids.
At least not right now.
What Padma wants
can help us both.
I can give her the egg
she so desperately wants
so she can have a baby,
and at the same time
I can freeze some for us.
- What about him?
- This guy?
Yeah. He runs marathons,
plays the cello and,
Oh, Leela, look at that
chubby little face. Aww.
Well, I wish we could meet
"Tall & Talented" in person.
Or maybe see an adult photo,
not just a baby photo.
Well, then these anonymous
sperm donors
wouldn't be very anonymous,
would they?
I just want the father
of your child
to be as amazing as you.
My sister deserves
Grade A sperm.
Thank you for
doing this for me.
- What, you think I'm doing this for you?
- No.
I'm only giving you my egg
so I can be an auntie.
Well, you're gonna be
the best one.
- We should get to Chastain.
- Wait.
What about him?
- "The Right Stuff"?
- Yeah.
He loves yoga, travel
and Basquiat.
No markers for genetic disease.
And he's South Asian.
I think it's a sign.
Okay, well, why don't we
email the sperm bank
- and try to get a voice sample?
- Leel, he is the one, I can feel it.
No, no, you don't need
to decide right now.
- Padma, are you sure?
- I am.
"The Right Stuff" it is.
Sorry, I know how busy
you are.
Not a problem.
Happy to help.
Usually I'm texting you to do
something a bit more fun, huh?
Yeah.
It's probably just
a stomachache,
- but Gigi insisted that you check.
- Oh, did she?
I told Peter you fix
hurt tummies.
Hey, Peter, remember me?
Your Gigi's dad.
I am.
What's going on, buddy?
We were playing
super space, Daddy.
Yeah, these two can go all day.
He is the astronaut,
she is the alien.
Peter said he didn't
want to play,
but he always wants to play.
I'm gonna place my hands
on your stomach
for a second, okay?
All right.
Peter's dad is on the way.
Have him meet me in the ER.
Do you like piggyback rides?
Yeah, I thought so.
Hop on.
Can I go with you, Daddy?
You wait here,
my little alien.
I'll come back soon and let you
know how Peter's doing.
Kids, we're going on
a field trip.
A rite of passage.
When I was a first year,
like you,
Dr. Hawkins took me,
and now it's your turn.
Our turn for what?
Since the start of your
intern year,
you've learned to become doctors
inside these walls,
and today you are going
outside Chastain
to treat one of the most
challenging patient populations.
A place you'll tackle
complex medical cases
that make great doctors.
Dr. Voss and Dr. Bell
will be joining us,
so let's get moving.
Where are we going?
Dr. Pravesh didn't tell you?
Let's not spoil the surprise.
Okay.
All right, here we are.
Shall we?
We got played.
Oh, my God, old folks?
*THE RESIDENT*
Season 05 Episode 17
Episode Title: "The Space Between"
Aired on: April 05, 2022.
All right, Mr. Astronaut,
can you tell me when
it started to hurt?
Does the pain move around
at all?
I'm okay now.
Is my dad coming?
Yeah, he's coming.
To take me home?
I don't want to go home.
Oh, you're not going home, hon.
You're gonna stay here with us
until we can
figure out why you're not
feeling so great.
- Hey, bud.
- Hey, Daddy.
Are you okay?
What's going on?
Hey, Spencer.
This is Nurse Hundley.
Spencer works in our IT
department.
Nice to meet you.
Peter has a stomachache.
Normally, that's not
a reason to be worried.
His temp's a little low.
It could be a sign of infection.
- Oh.
- He seemed fine this morning.
Said that he and Gigi were
going to space.
Has he been sick at all
in the past few weeks?
Had a cold a few days ago,
but nothing out of the ordinary.
Any dietary changes
this morning?
I made him a smoothie,
um, as a treat.
Bananas, yogurt,
protein powder, juice.
I mean, we shared it.
I feel all right.
He won't tell us more
about his pain.
He keeps saying he's fine.
Well, I think because
he doesn't want to go home.
- Right?
- I'll go home
if you stay with me, Daddy.
I'll stay right here,
no matter what.
Okay, bud?
No matter what.
I'll get us ready
to draw labs.
I'm gonna step aside
for a second, okay?
- Can I talk to you?
- Yeah, sure.
We're good here, right, hon?
Uh...
he's got separation anxiety.
His mom left us both
three months ago.
She hasn't been back,
or even called.
New boyfriend, drug problem.
It's a long story.
I'm sorry to hear that.
Now Peter's afraid
you might disappear, too?
Yes.
He feels safe at Chastain
because
he knows that I work
in the building.
Well, separation anxiety
may be behind this.
It can cause stomach trouble.
Do some blood work,
run some tests,
and then we'll go from there,
all right?
Dr. Milner to Emergency.
Dr. Milner to Emergency.
There he is.
The Brookhaven resident
who happens to be
- one of my health care heroes.
- Dr. Kravitz?
Yes.
Just be aware he has early mild
cognitive impairment.
He remembers people and events
from the past perfectly,
but his short-term memory's
going.
Okay, got it.
- Dr. Kravitz.
- Kit. Lovely to see you.
I did a gerontology rotation
with Dr. Kravitz
when I was a resident.
He was one of my finest
teachers.
This is Dr. Randolph Bell.
It's an honor.
You're a legend in the field
of geriatrics.
You know, your book,
Compassionate
Care of the Elderly,
has been on my shelf
for decades.
I-I'm sorry, your name again?
Randolph Bell.
Randolph, Randolph,
Randolph...
So do all your friends here
wheedle you for free care?
Oh, absolutely not.
We won't allow it.
Arthur here is fully retired.
He's earned the right to have
others care for him.
Gloria, darling, this is Kit,
and this-this is...
Well, there's no introduction
necessary, sweetie.
Everybody knows the famous
Dr. Randolph Bell.
She not only has my heart,
she is now my head.
In every way,
she takes care of me.
Well, it's mutual.
Well, it was nice of you
to come today.
You know, it can be
kind of hard to get
some of us old coots to get
our regular check-ups.
Well, we have an ulterior motive
for bringing some of
our interns here today.
We're hoping to inspire them
to join your field.
This country needs
more gerontologists,
and even some of
the best doctors
don't understand the particular
needs of senior citizens.
Geriatricians have higher
career satisfaction
than other medical specialties.
But the pay...
not what you get in surgery.
Would you consider talking
to some of our interns
about your career?
Let me at 'em.
Do you think
we'll still be that in love
when we're their age?
Why wouldn't we be?
Padma, now that you picked
a sperm donor,
we'll start Leela's daily
injections of hormones
to encourage her body
to produce more eggs
- than it does in a usual cycle.
- We're excited.
Me, too. We'll be monitoring you
with blood tests
and ultrasounds.
I read about this thing
called, uh,
- ovarian hyper-something.
- Hyperstim.
Yeah. Do we need
to worry about that?
No, not with regular monitoring
of my estradiol levels.
If they get too high,
we back off, lower the dose.
That question wasn't for me.
But you're right.
This is quite a safe process.
Okay, what can I do to help?
For now, nothing.
Not until we start you
on meds in a few weeks to
prepare for the embryo transfer.
- Okay.
- Okay?
Leela, I will walk you through
your first injection.
Um, I was thinking...
maybe I can do it.
You want to stick
a needle in me?
I just want to be
part of this
in every way that I can.
- You know.
- Of course.
I would like that, too.
Does our patient have
a visitor?
He does indeed.
- Gigi!
- Hi, Peter.
Ah, good friends are
good medicine.
All right, you two, behave.
I'm gonna chat with
your dad real quick.
Thought a fun distraction
for Peter could be good.
So his labs came back.
White blood cell count was
normal, no sign of infection.
Appendicitis, uh...
seems unlikely.
Maybe it's psychological.
You know,
he's been through a lot.
My gut's telling me
it's more than anxiety,
and I want to run
a few more tests.
What's up?
Did you fix his tummy, Daddy?
It's always his tummy.
What do you mean, "always,"
sweetheart?
It happened before?
How often does your
tummy hurt, Pete?
A whole lot of times.
Why didn't you tell me
anything, Pete?
- I don't understand.
- I didn't want to stay at home.
I wanted to come here,
with you.
I'll never leave you, okay?
I'll never leave you.
Do you understand?
Daddy, there's something else.
It's weird, but maybe
I should tell you.
This morning,
Peter and I were playing
that we were on another planet.
He kept saying that
I had two heads.
Yeah, you told me that.
Pretending.
No, he meant it.
He said I really was
a space alien.
Peter, does anyone else
have two heads?
That nurse lady and you,
kind of.
Double vision. How many fingers
am I holding up?
- What's going on?
- This could be neurological.
We need to get him to CT.
So this woman, who is 83,
kept chickens.
And she loved her chickens.
She named each one of them.
The-the first day I spent
with her, she gave me eggs.
Anyway, she had a problem
with worsening anemia.
Fatigue, muscle weakness,
intestinal problems.
She started forgetting things
and... falling.
Now, any ideas what was
wrong with her?
Likely more than one thing.
Alzheimer's,
and possibly cancer?
Or a recent stroke.
I'll give you a hint.
The key was the chickens.
People who name their chickens
don't eat them.
Exactly. He's smart.
You-you could be
a gerontologist.
I don't get it.
Okay, it's a B12 deficiency,
common with age.
Learned that from
Dr. Kravitz's book.
So I'm guessing that
the patient was a... vegan,
because she gave away the eggs.
Bingo.
The woman's vegan diet
was a good choice
because it reduced her risk
of heart disease,
Type 2 diabetes,
certain cancers.
But she forgot to supplement
with B12,
which was the source of
all of her symptoms.
This is why gerontology is
a great profession.
You spend time with patients.
You talk with them, you get
to know the whole person,
all the while keeping your eye
on the big picture.
Which is the key to diagnosis.
Oh! My lady awaits.
And I see that they have put out
snacks, and I am peckish.
- Excuse me.
- Thank you, Dr. Kravitz.
Hi, sweetie.
Hey, maybe gerontology is
an aphrodisiac.
This old goat has
the prettiest lady in the place,
and I have not had a date
ince high school.
- Oh...
- No, no, I'm kidding.
Gloria!
Her pulse is thready.
Call 911.
Let's get her to Chastain.
Somebody grab these pills.
To take with us.
We're gonna need to know
what she's been taking.
I don't understand.
Are you telling me I fainted?
Yes.
And they're going to
figure out why.
I was probably just
dehydrated.
I didn't ruin your event,
did I?
No, we were winding down
anyway.
You added the drama.
The good news is,
your wrist isn't broken.
You just need a splint.
And your EKG and your labs
look normal.
So how did you feel
right before you passed out?
I got dizzy.
A little lightheaded.
A-A drop in blood pressure.
It's not uncommon
among women on
blood pressure meds.
But she's-she's not on any.
Oh, well, yes, I am, dear.
- You are?
- Mm-hmm.
Why didn't you tell me?
I did.
Let's start here.
My thought exactly.
Houston to Rocket Nine Niner,
do you read me?
Copy, Rocket Nine Niner.
Please keep your hands
and arms
inside the spacecraft.
We are go for liftoff.
Over and out.
Was that for him
or for you?
A little bit of both.
I'm worried about him.
If Peter's abdominal issues
are caused by
a neurological one, we could be
looking at a bleed.
I don't see one.
No evidence of a stroke, either.
But his ventricles are
a little...
Too little.
His brain is swelling.
Now, if we don't figure out why
and the swelling worsens,
I'll have to perform
a craniectomy to relieve the pressure.
Cutting a six-year-old's head
open on an "if."
Of course not, but if things
move south quickly,
we have to be ready
to move to the OR.
Fine, but let's keep in mind
the risks aren't just
bleeding and infection.
There could be permanent
brain damage.
We need to figure out how
to avoid surgery altogether.
Let's start Peter on meds
to lower the pressure
on his brain immediately,
hope they work
and move him to ICU.
Yes, that sounds like a plan.
Well, why didn't you tell me
you were taking all of these?
Oh, I did, dear.
Every time I added
a medication.
But you can't be expected
to remember all these.
I-I forgot all of them.
Multiple medications,
called polypharmacy,
is associated with
adverse outcomes,
particularly as we age.
They interact,
causing falls, drug reactions,
and can even lead
to increased mortality.
It all started with
the arthritis.
The ibuprofen wasn't
doing anything,
so a doctor put me on
prednisone.
Well, that gave me heartburn,
so he gave me omeprazole.
But then that
made me nauseous,
so they added ondansetron
for my stomach.
That made my heart flutter,
so they gave me metoprolol,
and then my legs started
to swell,
so they gave me furosemide,
and that's when
I stopped walking very much,
and, uh, my blood pressure
shot up, so they...
Should I keep going?
...practitioner
to the ER, please.
Nurse practitioner to the ER.
Double shift?
Actually, I'm just starting.
Been having
a hard time sleeping.
- Oh, that sucks.
- Yeah, tell me about it.
Oh, um, Leela told me
about your mother.
How is she?
Sorry, it's...
it's none of my business.
No, it isn't.
But it's nice of you to ask.
She just moved in with me
on Saturday.
It's been good
having her close.
And how are you?
Well, I'm trying
to resist the urge
to check my home security camera
every five minutes
to see how she's doing.
Okay, well, actually,
I'm not resisting.
Would you look at this woman?
She's out there gardening.
Are those rhododendrons?
A little pink for my taste,
but she loves them.
I'm leading a meditation
at 3:00.
- Join us.
- Maybe I will.
- So, how are you?
- Great.
I just injected my sister
with hormones
so she can donate her eggs to me
and I can be a mom.
Hmm!
Oh, wear something comfortable.
So they put her on
hydrochlorothiazide...
And that made Gloria
feel fatigued.
So they gave her
methylphenidate.
Which could have had
a negative interaction
with the linezolid that she
was taking for that cellulitis.
Or the zolpidem or quetiapine,
which Gloria was also on.
What are we even doing,
Dr. Pravesh?
We're looking into
all contraindications.
But she is a sick older lady
who needs these drugs.
Like, which do you even stop?
We move carefully,
removing one by one.
No.
This is over my head
and, honestly, kind of boring.
I need to find a surgery
to observe.
I thought you were going into
primary care.
No. I want to be a surgeon.
It's exciting,
and you fix problems
that are actually fixable,
not buff up old people
until they die.
You don't think people die
on the OR table?
They do all the time.
Not everything is fixable
with a knife.
You get that, right?
You can fix things
with your brain.
Excuse me, have you met me?
I read that surgeons
don't actually have
the highest IQ, and I thought,
there, that's my specialty.
Hmm.
This woman needs us,
and Dr. Kravitz needs her.
So if you're not interested,
I say go hunt down Dr. Austin
and see if he'll let you
into his OR.
But be aware that
he will not consider it
for one nanosecond
when I tell him
you deserted this patient.
Okay, I will stay.
But don't tell him about
that IQ thing, either.
I want to go with him.
You can't, honey.
He needs special care
in a special part
of the hospital.
You mean he's really sick?
You fix people.
- You'll fix him, can't you, Daddy?
- Spencer.
I'll be right there.
What's happening?
His daddy is scared.
You have to save Peter.
I got him.
I got him, I promise.
He seems much worse.
Please tell me
you have some news.
We gave him another round
of meds
to lower
the intracranial pressure,
but it'll take time...
if it works.
He was hurting,
and I totally missed it.
I get guilt, believe me,
but it is not earned here.
Help him. Please.
We're doing everything we can.
Uh, just...
I don't want anybody
cutting his head open.
Not if we can avoid it.
Understood.
You all right?
Now I feel guilty,
about how lucky I am
not to be in Spencer's shoes.
Peter has to make it
through this.
- I know.
- And Gigi, she lost her mother.
She can't lose her best friend.
We have to make sure
they both come
out of this.
Uh, Dr. Hawkins!
Vomiting means his intracranial
pressure must be rising.
I'm a little confused.
- I'm sorry.
- So the metoprolol
helped your heart,
but it also lowered
your blood pressure.
And with all the water pills
you were on,
plus the stimulants,
your heart rate sped
and BP lowered, which caused you
to lose consciousness.
Other doctors have been
telling me
that these meds are saving
my life, and you're telling me
- the opposite?
- No, just listen to them, hon.
They want to take you off
medications you may not need,
and-and keep you on
ones that are working.
But we'd like to keep you here
to monitor you
while we do it.
But it's just for a day,
and then, um, you'll go home.
- There's hope for him yet.
- Mm.
Thank you both.
We've given Peter
the maximum doses,
but he's... he's not improving.
Well, time to book an OR.
No, let's just...
...start with a drain
before you open his head.
Okay, we can try it.
I'll get an EVD monitor.
- Talk to me.
- We're putting in a drain.
It should help relieve
the pressure on his brain.
It's a first step.
I don't know how much longer
we can put off a craniectomy.
It's my son.
Let's take everything
one step at a time.
Right now, we need to sedate
and intubate,
and to protect his airway.
I have to talk to him first,
before you, before you...
Of course.
Of course.
Hey, bud.
I just want you to know...
I want you to know that
every second that you're asleep,
I'm gonna be
right here beside you.
Deal?
Okay.
Hey, there she is.
So, how'd it go this morning?
The hormone shot was fine,
but this is not. Look.
Padma picked a donor,
but I did a little bit
of digging
into this sperm bank.
It's facing three lawsuits
from families who claim
their donors misrepresented
themselves.
In one case,
the family alleged
that the donor had
an undisclosed history
of schizophrenia.
In another,
a donor covered up
a criminal record.
Some claim college degrees
when they're really dropouts.
These families were lied to.
Yes. About the biggest decision
they'll ever make.
The genes their kids
will share with its father.
Yeah, but, I mean,
this is just
a few cases
out of how many, right?
I mean, I had a lot of friends
in med school who donated.
They were good guys,
they just needed cash;
They wanted to help.
Is this your way of saying
there are little Devons
out there?
If it helps, every single one
of these donors
had to undergo genetic testing.
There is no test to show whether
you're a pathological liar,
have a mental illness
or a criminal record.
- And you're missing the point.
- No, I get it.
Sperm banks are unregulated.
The FDA requires
that donors are tested
for infectious diseases,
but beyond that, nothing.
Their bios aren't even verified.
That may work for some people.
There are amazing kids out there
from anonymous donors,
but that won't work for me.
- This is my egg.
- Hey, babe...
You have to accept
that this is Padma's choice.
Well, I need to make sure
she knows what she's choosing.
We'll talk later, okay?
- Are you hot or cold?
- Both.
Okay, don't worry,
we're gonna help you.
She's in A-fib and hypotensive.
A-fib could be because we took
her off metoprolol.
Let me check
if her pressure dropped
before she slipped
into arrhythmia.
I-I was here. Her BP started
to fall first,
then her heart rate spiked.
Peritonitis?
Gloria, tell me where it hurts.
- Rebound tenderness.
- This has nothing to do with the meds.
She has an acute abdomen
and she may need surgery.
Let's get her
four of morphine.
Hang pressors and page Bell.
Hey, hang in there, okay?
Where to begin?
Gloria has three lumbar
compression fractures
from osteoporosis.
And a hiatal hernia.
All incidental findings.
Consequence of living
for eight decades.
So here's today's problem.
Colonic perforation.
No wonder she was
in so much pain.
And no idea what caused this?
It couldn't have been
the fall.
We thought she passed out
from too many meds,
but something else was going on.
We just don't know what.
Well, what we do know
is that without surgery,
Gloria won't make it.
You're talking about a surgery
that's dangerous at any age,
and with Gloria nearly 80...
Well, we'll be sure to be
very clear with her
about what we're facing here.
But I agree with you.
It's the only option.
Okay. At least
she's in the best hands.
Well, I've had success
with patients older than her,
much sicker.
I really hope she's one of them.
So you think "The Right Stuff"
is secretly
- some sort of axe murderer?
- No.
I'm just saying we can't
- really be sure who he is.
- Okay, look,
I really appreciate
you being protective of me,
but there's no guarantees
with kids.
I mean, look at us.
What, there's
a one-in-a-million chance
of having twins?
One in 250.
And we are proof that
a random genetic accident
can be the best gift ever.
Look, I can't give up
on being a mother
just because there's risks.
I don't want you to.
I just want you to be aware
of what those risks are.
Which is why I asked
Dr. Nolan to join us.
What's up, ladies?
Show her what you showed me.
Oh.
"Dream Doc"?
I don't understand.
- It's him.
- It's me.
You're six-foot five?
I do slouch some.
And fluent in French?
- Yeah.
- Je suis Rosetta Stone.
- Trombone prodigy?
- I got a standing ovation
at my ninth grade recital.
- Just think about it.
- Mm.
Think about what?
Surgery?
Sounds... dangerous.
Yeah, I'm not gonna lie to you.
It is.
But it is the only option.
And without it,
you may only have days.
Maybe a week.
I'm sorry.
Y-You always say how
e-easy choices are
your favorite.
I wish I could offer you
more time
to make this decision.
But the sooner you operate,
the better my chances are?
Well, then, I'm ready.
Arthur, I'm sure everybody
over at Brookhaven is worried.
You think maybe you could
go call them
- and fill them in?
- Oh, of course.
Any-Anything, darling.
Yes, Brookhaven.
Update, update Brookhaven.
Update Brookhaven.
I can't leave him.
- He needs me.
- Oh, I...
I get it.
You have got to be better
than you have ever been.
Neither one of us
have children.
Not even siblings.
It's just the two of us.
He has no one else.
I have no one else.
Do you know what it's like
to find the love of your life
this late in the game?
Actually, I do.
And when the day comes,
and he forgets my name,
I won't even care.
I'll fill in that blank,
'cause he'll still love me.
And I'll love him.
To the end.
Just don't let it be today.
Okay.
His intracranial pressure
is still rising,
and we're not sure
of the cause.
The MRI didn't show
any tumors
or blood clots in his brain.
So what does this mean?
That the drain wasn't enough.
Mr. Shafer,
we have no choice but to
proceed with the craniectomy
to relieve the pressure
in Peter's brain.
My God.
I can't believe
this is happening.
There must be something else
you can do.
If we wait any longer,
he's at risk of brain damage.
Treat him like he's your child.
Would you agree to this
if it was Gigi?
Spencer, give us a minute
to review.
- Tell me there's another option.
- There isn't.
What he just said in there
won't help Peter.
Keeping your objectivity will.
You have to.
I'm sorry to interrupt,
but the preschool's been trying
to get in touch.
Gigi needs you.
Do what you have to do
to reduce the swelling.
Hey. She's been like this
since Peter left
this morning.
She won't eat or talk.
- Thank you.
- Yeah.
What is that?
A space helmet for Peter.
If he goes into space,
he can't die.
Is he gonna die, like Mommy?
I'm fighting for Peter.
- I'm scared.
- I know. That's okay.
I knew he was sick when
he didn't want to eat
my sandwich.
We trade. He always
eats my sandwich.
When his mommy left,
his daddy started
making his lunch
with roast beef.
After he ate it all,
his tummy started hurting.
Did he eat your sandwich
this morning?
No, Daddy.
Craniotome to me.
I've done this a hundred times,
but rarely on a child.
You're more than qualified.
Watch for bleeding,
be gentle.
When I pass through bone,
I stop.
Now, let's get started.
Wait!
I think Peter has
urea cycle disorder.
It's a genetic enzyme deficiency
that makes it hard
for people to break down
protein.
Whenever Spencer packs his son
roast beef, he trades it away
because it makes
his stomach hurt.
I think sharing his dad's
protein shake this morning
gave him more protein
than he could process,
and his body was already under
stress from his recent cold.
Talk about a zebra.
Urea cycle is extremely rare.
But it would explain
all the symptoms.
Let's get him back
to the ICU,
start him on dialysis,
clear the ammonia.
Yeah, but do we have
that kind of time?
The odds you're right
are vanishingly small,
and if you're wrong,
this boy's brain
continues to swell,
which will cause him
permanent damage.
We need to operate now.
A craniectomy is a gamble, too.
At the rate the swelling
is worsening,
best-case scenario, what,
it buys Peter days?
It doesn't fix the problem.
That is true.
So let's do both.
Dialysis right here.
We can watch his ICP.
If it doesn't drop,
I'm ready to
start a crani immediately.
I'll be right here
when you wake up.
Okay, this is as far
as you can go.
I love you.
I love you more.
Okay.
Wire, please.
Dilator.
All right, we're almost there.
All right, catheter in.
If you're right,
the pressure should trend down
once the proteins are
filtered out.
Yeah, well, it's not gonna
happen immediately.
If that number doesn't
come down soon, I start.
Whether I want to or not.
We're working through
some unexpected adhesions.
Did Gloria mention anything
about prior surgeries?
None. Any sign
of the perforation?
Running the bowel now.
There's no sign of
widespread ischemia.
Oh, there it is.
Can you repair it?
Well, the surrounding bowel
is thickened
with extensive lymphadenopathy.
It sounds like
whatever's going on
caused significant inflammation.
I should be able
to repair the perf,
but, you know,
this didn't happen overnight.
It's been going on for years.
Bowel inflammation is
extremely painful.
Her daily steroids
must have been masking it.
See the big picture.
Dr. Kravitz told me
in geriatrics
you always gotta keep your eye
on the big picture.
What if the arthritis
and the bowel inflammation
are all part of the same
disease process?
It's possible.
If the side effects
of her medications
were actually symptoms of
the underlying issue.
We've been looking at this
all wrong.
Let's get back
to Gloria's prescriptions
and see if we can't
get her some answers
when she wakes up.
It just keeps rising.
Can we dialyze faster?
Any faster and his neurons
could shear from diffusion.
Just give it a minute.
Conrad, this is the brain.
A minute can be
the difference between
life and death.
Just give me one more minute.
We don't have
good choices here.
- Billie, we're on the same side.
- But this is my OR.
- It dropped.
- Wait, Dr. Sutton.
That number's still
dangerously high.
It worked.
You ready to close?
Sure am.
Focus on that still space
between our inhale
and our exhale.
Please remember
to silence your devices
before we begin the class.
- I seem to have gotten turned around.
- Okay.
My wife is in surgery.
Can you direct me
to the waiting room?
Uh, here, let me show you.
The cavalry has arrived.
77-year-old woman
with a bowel perf.
Pressure started tanking.
At first I thought
it was peritonitis,
then I saw her neck.
I need ultrasound now.
Any idea why
she might be in tamponade?
No idea what the underlying
issue is.
Right now, we just need
to get her off the table.
Start another epi
and bolus a liter.
There's fluid around her heart.
We need to prep her
for pericardiocentesis.
Okay, I'll finish up
so I can assist.
All right, but if
she doesn't stabilize, Bell,
I'm gonna have
to crack her chest open.
Oh, God, let's hope not.
Oh, man, I can't wait
to tell 'em.
Hey, we figured it out.
Gloria's medications
didn't cause her problems,
but they masked
an underlying one:
Whipple's disease.
That's what caused her
arthritis, weight loss, fatigue.
And steroids that her doctors
first thought was arthritis
only made it worse.
She told us that
they increased her dose,
leading to the perf.
Now all Gloria needs
is an antibiotic.
We can take her off of
- almost everything else.
- She didn't make it.
- I'm sorry.
- What? She...
She developed cardiac tamponade,
which was probably
the final complication
of her undiagnosed Whipple.
And Austin was working to place
a pericardial drain
when she coded.
We did five rounds of CPR.
More than I should have
on a woman her age.
It was a tough one.
Now, if she'd been
treated properly,
or if she'd gotten
to us sooner,
maybe we could have
done something
to turn it around.
But today...
it was just far too late.
Dr. Kravitz...
Kit is his friend,
so I will call her
to tell him.
Even if we had
diagnosed her sooner,
Gloria's disease began
years ago.
There's nothing
we could have done.
Gloria wasn't just another
fragile old lady.
She was strong, in love.
She deserved more time.
But every doctor looked at her
like just another lost cause.
No one cared enough to see
that by just treating
her symptoms,
they were actually
making her worse.
No one saw the bigger picture
until you did.
Reconsider going into
gerontology, Zach.
You may have a gift.
I am so sorry.
I'm so sorry.
Look what I made you.
Wow!
Hey.
So we'll continue dialysis until
we lower his ammonia levels,
but with some attention
and lifestyle modifications
we can manage this.
You will need to look out
for any signs that
his ammonia levels are up.
Sluggishness, nausea, vomiting.
Avoid extreme temps.
Keep him hydrated and
on a low-protein diet.
No more roast beef sandwiches.
He'll do great.
I can't thank you enough.
Well, we did have help.
How would you two
like a surprise?
What is it, Daddy?
What is it?
Wow!
It's beautiful.
Nolan as a sperm donor?
Our Nolan?
- Yep.
- Ooh.
- That put the fear of God in me.
- Yeah, I bet.
But the eggs are gonna be
retrieved in about two weeks,
which means I need a volunteer,
fast.
Someone I trust,
someone I care about.
What are you gonna do?
Actually, um,
I had a crazy idea.
You and I are good friends,
now that we aren't lovers,
and I wouldn't mind
a kid a lot like you.
You could do worse.
So what if I did...
have a kid
just like you?
You want me to be
your sperm donor?
Captioning sponsored by
20th CENTURY FOX TELEVISION
and TOYOTA.
"The Resident"...
Good morning. These are the interns
I told you about.
I'm Zach, Primary Care.
Let's get started,
shall we?
Listen, I'm not a man
that you'll find
in Child's Pose,
so I'm just gonna be
on my way to...
AJ, I happen to know
from personal experience
that you could really benefit
from a little extra flexibility.
All right, come lie down
and grab a mat.
I don't know if I want kids.
At least not right now.
What Padma wants
can help us both.
I can give her the egg
she so desperately wants
so she can have a baby,
and at the same time
I can freeze some for us.
- What about him?
- This guy?
Yeah. He runs marathons,
plays the cello and,
Oh, Leela, look at that
chubby little face. Aww.
Well, I wish we could meet
"Tall & Talented" in person.
Or maybe see an adult photo,
not just a baby photo.
Well, then these anonymous
sperm donors
wouldn't be very anonymous,
would they?
I just want the father
of your child
to be as amazing as you.
My sister deserves
Grade A sperm.
Thank you for
doing this for me.
- What, you think I'm doing this for you?
- No.
I'm only giving you my egg
so I can be an auntie.
Well, you're gonna be
the best one.
- We should get to Chastain.
- Wait.
What about him?
- "The Right Stuff"?
- Yeah.
He loves yoga, travel
and Basquiat.
No markers for genetic disease.
And he's South Asian.
I think it's a sign.
Okay, well, why don't we
email the sperm bank
- and try to get a voice sample?
- Leel, he is the one, I can feel it.
No, no, you don't need
to decide right now.
- Padma, are you sure?
- I am.
"The Right Stuff" it is.
Sorry, I know how busy
you are.
Not a problem.
Happy to help.
Usually I'm texting you to do
something a bit more fun, huh?
Yeah.
It's probably just
a stomachache,
- but Gigi insisted that you check.
- Oh, did she?
I told Peter you fix
hurt tummies.
Hey, Peter, remember me?
Your Gigi's dad.
I am.
What's going on, buddy?
We were playing
super space, Daddy.
Yeah, these two can go all day.
He is the astronaut,
she is the alien.
Peter said he didn't
want to play,
but he always wants to play.
I'm gonna place my hands
on your stomach
for a second, okay?
All right.
Peter's dad is on the way.
Have him meet me in the ER.
Do you like piggyback rides?
Yeah, I thought so.
Hop on.
Can I go with you, Daddy?
You wait here,
my little alien.
I'll come back soon and let you
know how Peter's doing.
Kids, we're going on
a field trip.
A rite of passage.
When I was a first year,
like you,
Dr. Hawkins took me,
and now it's your turn.
Our turn for what?
Since the start of your
intern year,
you've learned to become doctors
inside these walls,
and today you are going
outside Chastain
to treat one of the most
challenging patient populations.
A place you'll tackle
complex medical cases
that make great doctors.
Dr. Voss and Dr. Bell
will be joining us,
so let's get moving.
Where are we going?
Dr. Pravesh didn't tell you?
Let's not spoil the surprise.
Okay.
All right, here we are.
Shall we?
We got played.
Oh, my God, old folks?
*THE RESIDENT*
Season 05 Episode 17
Episode Title: "The Space Between"
Aired on: April 05, 2022.
All right, Mr. Astronaut,
can you tell me when
it started to hurt?
Does the pain move around
at all?
I'm okay now.
Is my dad coming?
Yeah, he's coming.
To take me home?
I don't want to go home.
Oh, you're not going home, hon.
You're gonna stay here with us
until we can
figure out why you're not
feeling so great.
- Hey, bud.
- Hey, Daddy.
Are you okay?
What's going on?
Hey, Spencer.
This is Nurse Hundley.
Spencer works in our IT
department.
Nice to meet you.
Peter has a stomachache.
Normally, that's not
a reason to be worried.
His temp's a little low.
It could be a sign of infection.
- Oh.
- He seemed fine this morning.
Said that he and Gigi were
going to space.
Has he been sick at all
in the past few weeks?
Had a cold a few days ago,
but nothing out of the ordinary.
Any dietary changes
this morning?
I made him a smoothie,
um, as a treat.
Bananas, yogurt,
protein powder, juice.
I mean, we shared it.
I feel all right.
He won't tell us more
about his pain.
He keeps saying he's fine.
Well, I think because
he doesn't want to go home.
- Right?
- I'll go home
if you stay with me, Daddy.
I'll stay right here,
no matter what.
Okay, bud?
No matter what.
I'll get us ready
to draw labs.
I'm gonna step aside
for a second, okay?
- Can I talk to you?
- Yeah, sure.
We're good here, right, hon?
Uh...
he's got separation anxiety.
His mom left us both
three months ago.
She hasn't been back,
or even called.
New boyfriend, drug problem.
It's a long story.
I'm sorry to hear that.
Now Peter's afraid
you might disappear, too?
Yes.
He feels safe at Chastain
because
he knows that I work
in the building.
Well, separation anxiety
may be behind this.
It can cause stomach trouble.
Do some blood work,
run some tests,
and then we'll go from there,
all right?
Dr. Milner to Emergency.
Dr. Milner to Emergency.
There he is.
The Brookhaven resident
who happens to be
- one of my health care heroes.
- Dr. Kravitz?
Yes.
Just be aware he has early mild
cognitive impairment.
He remembers people and events
from the past perfectly,
but his short-term memory's
going.
Okay, got it.
- Dr. Kravitz.
- Kit. Lovely to see you.
I did a gerontology rotation
with Dr. Kravitz
when I was a resident.
He was one of my finest
teachers.
This is Dr. Randolph Bell.
It's an honor.
You're a legend in the field
of geriatrics.
You know, your book,
Compassionate
Care of the Elderly,
has been on my shelf
for decades.
I-I'm sorry, your name again?
Randolph Bell.
Randolph, Randolph,
Randolph...
So do all your friends here
wheedle you for free care?
Oh, absolutely not.
We won't allow it.
Arthur here is fully retired.
He's earned the right to have
others care for him.
Gloria, darling, this is Kit,
and this-this is...
Well, there's no introduction
necessary, sweetie.
Everybody knows the famous
Dr. Randolph Bell.
She not only has my heart,
she is now my head.
In every way,
she takes care of me.
Well, it's mutual.
Well, it was nice of you
to come today.
You know, it can be
kind of hard to get
some of us old coots to get
our regular check-ups.
Well, we have an ulterior motive
for bringing some of
our interns here today.
We're hoping to inspire them
to join your field.
This country needs
more gerontologists,
and even some of
the best doctors
don't understand the particular
needs of senior citizens.
Geriatricians have higher
career satisfaction
than other medical specialties.
But the pay...
not what you get in surgery.
Would you consider talking
to some of our interns
about your career?
Let me at 'em.
Do you think
we'll still be that in love
when we're their age?
Why wouldn't we be?
Padma, now that you picked
a sperm donor,
we'll start Leela's daily
injections of hormones
to encourage her body
to produce more eggs
- than it does in a usual cycle.
- We're excited.
Me, too. We'll be monitoring you
with blood tests
and ultrasounds.
I read about this thing
called, uh,
- ovarian hyper-something.
- Hyperstim.
Yeah. Do we need
to worry about that?
No, not with regular monitoring
of my estradiol levels.
If they get too high,
we back off, lower the dose.
That question wasn't for me.
But you're right.
This is quite a safe process.
Okay, what can I do to help?
For now, nothing.
Not until we start you
on meds in a few weeks to
prepare for the embryo transfer.
- Okay.
- Okay?
Leela, I will walk you through
your first injection.
Um, I was thinking...
maybe I can do it.
You want to stick
a needle in me?
I just want to be
part of this
in every way that I can.
- You know.
- Of course.
I would like that, too.
Does our patient have
a visitor?
He does indeed.
- Gigi!
- Hi, Peter.
Ah, good friends are
good medicine.
All right, you two, behave.
I'm gonna chat with
your dad real quick.
Thought a fun distraction
for Peter could be good.
So his labs came back.
White blood cell count was
normal, no sign of infection.
Appendicitis, uh...
seems unlikely.
Maybe it's psychological.
You know,
he's been through a lot.
My gut's telling me
it's more than anxiety,
and I want to run
a few more tests.
What's up?
Did you fix his tummy, Daddy?
It's always his tummy.
What do you mean, "always,"
sweetheart?
It happened before?
How often does your
tummy hurt, Pete?
A whole lot of times.
Why didn't you tell me
anything, Pete?
- I don't understand.
- I didn't want to stay at home.
I wanted to come here,
with you.
I'll never leave you, okay?
I'll never leave you.
Do you understand?
Daddy, there's something else.
It's weird, but maybe
I should tell you.
This morning,
Peter and I were playing
that we were on another planet.
He kept saying that
I had two heads.
Yeah, you told me that.
Pretending.
No, he meant it.
He said I really was
a space alien.
Peter, does anyone else
have two heads?
That nurse lady and you,
kind of.
Double vision. How many fingers
am I holding up?
- What's going on?
- This could be neurological.
We need to get him to CT.
So this woman, who is 83,
kept chickens.
And she loved her chickens.
She named each one of them.
The-the first day I spent
with her, she gave me eggs.
Anyway, she had a problem
with worsening anemia.
Fatigue, muscle weakness,
intestinal problems.
She started forgetting things
and... falling.
Now, any ideas what was
wrong with her?
Likely more than one thing.
Alzheimer's,
and possibly cancer?
Or a recent stroke.
I'll give you a hint.
The key was the chickens.
People who name their chickens
don't eat them.
Exactly. He's smart.
You-you could be
a gerontologist.
I don't get it.
Okay, it's a B12 deficiency,
common with age.
Learned that from
Dr. Kravitz's book.
So I'm guessing that
the patient was a... vegan,
because she gave away the eggs.
Bingo.
The woman's vegan diet
was a good choice
because it reduced her risk
of heart disease,
Type 2 diabetes,
certain cancers.
But she forgot to supplement
with B12,
which was the source of
all of her symptoms.
This is why gerontology is
a great profession.
You spend time with patients.
You talk with them, you get
to know the whole person,
all the while keeping your eye
on the big picture.
Which is the key to diagnosis.
Oh! My lady awaits.
And I see that they have put out
snacks, and I am peckish.
- Excuse me.
- Thank you, Dr. Kravitz.
Hi, sweetie.
Hey, maybe gerontology is
an aphrodisiac.
This old goat has
the prettiest lady in the place,
and I have not had a date
ince high school.
- Oh...
- No, no, I'm kidding.
Gloria!
Her pulse is thready.
Call 911.
Let's get her to Chastain.
Somebody grab these pills.
To take with us.
We're gonna need to know
what she's been taking.
I don't understand.
Are you telling me I fainted?
Yes.
And they're going to
figure out why.
I was probably just
dehydrated.
I didn't ruin your event,
did I?
No, we were winding down
anyway.
You added the drama.
The good news is,
your wrist isn't broken.
You just need a splint.
And your EKG and your labs
look normal.
So how did you feel
right before you passed out?
I got dizzy.
A little lightheaded.
A-A drop in blood pressure.
It's not uncommon
among women on
blood pressure meds.
But she's-she's not on any.
Oh, well, yes, I am, dear.
- You are?
- Mm-hmm.
Why didn't you tell me?
I did.
Let's start here.
My thought exactly.
Houston to Rocket Nine Niner,
do you read me?
Copy, Rocket Nine Niner.
Please keep your hands
and arms
inside the spacecraft.
We are go for liftoff.
Over and out.
Was that for him
or for you?
A little bit of both.
I'm worried about him.
If Peter's abdominal issues
are caused by
a neurological one, we could be
looking at a bleed.
I don't see one.
No evidence of a stroke, either.
But his ventricles are
a little...
Too little.
His brain is swelling.
Now, if we don't figure out why
and the swelling worsens,
I'll have to perform
a craniectomy to relieve the pressure.
Cutting a six-year-old's head
open on an "if."
Of course not, but if things
move south quickly,
we have to be ready
to move to the OR.
Fine, but let's keep in mind
the risks aren't just
bleeding and infection.
There could be permanent
brain damage.
We need to figure out how
to avoid surgery altogether.
Let's start Peter on meds
to lower the pressure
on his brain immediately,
hope they work
and move him to ICU.
Yes, that sounds like a plan.
Well, why didn't you tell me
you were taking all of these?
Oh, I did, dear.
Every time I added
a medication.
But you can't be expected
to remember all these.
I-I forgot all of them.
Multiple medications,
called polypharmacy,
is associated with
adverse outcomes,
particularly as we age.
They interact,
causing falls, drug reactions,
and can even lead
to increased mortality.
It all started with
the arthritis.
The ibuprofen wasn't
doing anything,
so a doctor put me on
prednisone.
Well, that gave me heartburn,
so he gave me omeprazole.
But then that
made me nauseous,
so they added ondansetron
for my stomach.
That made my heart flutter,
so they gave me metoprolol,
and then my legs started
to swell,
so they gave me furosemide,
and that's when
I stopped walking very much,
and, uh, my blood pressure
shot up, so they...
Should I keep going?
...practitioner
to the ER, please.
Nurse practitioner to the ER.
Double shift?
Actually, I'm just starting.
Been having
a hard time sleeping.
- Oh, that sucks.
- Yeah, tell me about it.
Oh, um, Leela told me
about your mother.
How is she?
Sorry, it's...
it's none of my business.
No, it isn't.
But it's nice of you to ask.
She just moved in with me
on Saturday.
It's been good
having her close.
And how are you?
Well, I'm trying
to resist the urge
to check my home security camera
every five minutes
to see how she's doing.
Okay, well, actually,
I'm not resisting.
Would you look at this woman?
She's out there gardening.
Are those rhododendrons?
A little pink for my taste,
but she loves them.
I'm leading a meditation
at 3:00.
- Join us.
- Maybe I will.
- So, how are you?
- Great.
I just injected my sister
with hormones
so she can donate her eggs to me
and I can be a mom.
Hmm!
Oh, wear something comfortable.
So they put her on
hydrochlorothiazide...
And that made Gloria
feel fatigued.
So they gave her
methylphenidate.
Which could have had
a negative interaction
with the linezolid that she
was taking for that cellulitis.
Or the zolpidem or quetiapine,
which Gloria was also on.
What are we even doing,
Dr. Pravesh?
We're looking into
all contraindications.
But she is a sick older lady
who needs these drugs.
Like, which do you even stop?
We move carefully,
removing one by one.
No.
This is over my head
and, honestly, kind of boring.
I need to find a surgery
to observe.
I thought you were going into
primary care.
No. I want to be a surgeon.
It's exciting,
and you fix problems
that are actually fixable,
not buff up old people
until they die.
You don't think people die
on the OR table?
They do all the time.
Not everything is fixable
with a knife.
You get that, right?
You can fix things
with your brain.
Excuse me, have you met me?
I read that surgeons
don't actually have
the highest IQ, and I thought,
there, that's my specialty.
Hmm.
This woman needs us,
and Dr. Kravitz needs her.
So if you're not interested,
I say go hunt down Dr. Austin
and see if he'll let you
into his OR.
But be aware that
he will not consider it
for one nanosecond
when I tell him
you deserted this patient.
Okay, I will stay.
But don't tell him about
that IQ thing, either.
I want to go with him.
You can't, honey.
He needs special care
in a special part
of the hospital.
You mean he's really sick?
You fix people.
- You'll fix him, can't you, Daddy?
- Spencer.
I'll be right there.
What's happening?
His daddy is scared.
You have to save Peter.
I got him.
I got him, I promise.
He seems much worse.
Please tell me
you have some news.
We gave him another round
of meds
to lower
the intracranial pressure,
but it'll take time...
if it works.
He was hurting,
and I totally missed it.
I get guilt, believe me,
but it is not earned here.
Help him. Please.
We're doing everything we can.
Uh, just...
I don't want anybody
cutting his head open.
Not if we can avoid it.
Understood.
You all right?
Now I feel guilty,
about how lucky I am
not to be in Spencer's shoes.
Peter has to make it
through this.
- I know.
- And Gigi, she lost her mother.
She can't lose her best friend.
We have to make sure
they both come
out of this.
Uh, Dr. Hawkins!
Vomiting means his intracranial
pressure must be rising.
I'm a little confused.
- I'm sorry.
- So the metoprolol
helped your heart,
but it also lowered
your blood pressure.
And with all the water pills
you were on,
plus the stimulants,
your heart rate sped
and BP lowered, which caused you
to lose consciousness.
Other doctors have been
telling me
that these meds are saving
my life, and you're telling me
- the opposite?
- No, just listen to them, hon.
They want to take you off
medications you may not need,
and-and keep you on
ones that are working.
But we'd like to keep you here
to monitor you
while we do it.
But it's just for a day,
and then, um, you'll go home.
- There's hope for him yet.
- Mm.
Thank you both.
We've given Peter
the maximum doses,
but he's... he's not improving.
Well, time to book an OR.
No, let's just...
...start with a drain
before you open his head.
Okay, we can try it.
I'll get an EVD monitor.
- Talk to me.
- We're putting in a drain.
It should help relieve
the pressure on his brain.
It's a first step.
I don't know how much longer
we can put off a craniectomy.
It's my son.
Let's take everything
one step at a time.
Right now, we need to sedate
and intubate,
and to protect his airway.
I have to talk to him first,
before you, before you...
Of course.
Of course.
Hey, bud.
I just want you to know...
I want you to know that
every second that you're asleep,
I'm gonna be
right here beside you.
Deal?
Okay.
Hey, there she is.
So, how'd it go this morning?
The hormone shot was fine,
but this is not. Look.
Padma picked a donor,
but I did a little bit
of digging
into this sperm bank.
It's facing three lawsuits
from families who claim
their donors misrepresented
themselves.
In one case,
the family alleged
that the donor had
an undisclosed history
of schizophrenia.
In another,
a donor covered up
a criminal record.
Some claim college degrees
when they're really dropouts.
These families were lied to.
Yes. About the biggest decision
they'll ever make.
The genes their kids
will share with its father.
Yeah, but, I mean,
this is just
a few cases
out of how many, right?
I mean, I had a lot of friends
in med school who donated.
They were good guys,
they just needed cash;
They wanted to help.
Is this your way of saying
there are little Devons
out there?
If it helps, every single one
of these donors
had to undergo genetic testing.
There is no test to show whether
you're a pathological liar,
have a mental illness
or a criminal record.
- And you're missing the point.
- No, I get it.
Sperm banks are unregulated.
The FDA requires
that donors are tested
for infectious diseases,
but beyond that, nothing.
Their bios aren't even verified.
That may work for some people.
There are amazing kids out there
from anonymous donors,
but that won't work for me.
- This is my egg.
- Hey, babe...
You have to accept
that this is Padma's choice.
Well, I need to make sure
she knows what she's choosing.
We'll talk later, okay?
- Are you hot or cold?
- Both.
Okay, don't worry,
we're gonna help you.
She's in A-fib and hypotensive.
A-fib could be because we took
her off metoprolol.
Let me check
if her pressure dropped
before she slipped
into arrhythmia.
I-I was here. Her BP started
to fall first,
then her heart rate spiked.
Peritonitis?
Gloria, tell me where it hurts.
- Rebound tenderness.
- This has nothing to do with the meds.
She has an acute abdomen
and she may need surgery.
Let's get her
four of morphine.
Hang pressors and page Bell.
Hey, hang in there, okay?
Where to begin?
Gloria has three lumbar
compression fractures
from osteoporosis.
And a hiatal hernia.
All incidental findings.
Consequence of living
for eight decades.
So here's today's problem.
Colonic perforation.
No wonder she was
in so much pain.
And no idea what caused this?
It couldn't have been
the fall.
We thought she passed out
from too many meds,
but something else was going on.
We just don't know what.
Well, what we do know
is that without surgery,
Gloria won't make it.
You're talking about a surgery
that's dangerous at any age,
and with Gloria nearly 80...
Well, we'll be sure to be
very clear with her
about what we're facing here.
But I agree with you.
It's the only option.
Okay. At least
she's in the best hands.
Well, I've had success
with patients older than her,
much sicker.
I really hope she's one of them.
So you think "The Right Stuff"
is secretly
- some sort of axe murderer?
- No.
I'm just saying we can't
- really be sure who he is.
- Okay, look,
I really appreciate
you being protective of me,
but there's no guarantees
with kids.
I mean, look at us.
What, there's
a one-in-a-million chance
of having twins?
One in 250.
And we are proof that
a random genetic accident
can be the best gift ever.
Look, I can't give up
on being a mother
just because there's risks.
I don't want you to.
I just want you to be aware
of what those risks are.
Which is why I asked
Dr. Nolan to join us.
What's up, ladies?
Show her what you showed me.
Oh.
"Dream Doc"?
I don't understand.
- It's him.
- It's me.
You're six-foot five?
I do slouch some.
And fluent in French?
- Yeah.
- Je suis Rosetta Stone.
- Trombone prodigy?
- I got a standing ovation
at my ninth grade recital.
- Just think about it.
- Mm.
Think about what?
Surgery?
Sounds... dangerous.
Yeah, I'm not gonna lie to you.
It is.
But it is the only option.
And without it,
you may only have days.
Maybe a week.
I'm sorry.
Y-You always say how
e-easy choices are
your favorite.
I wish I could offer you
more time
to make this decision.
But the sooner you operate,
the better my chances are?
Well, then, I'm ready.
Arthur, I'm sure everybody
over at Brookhaven is worried.
You think maybe you could
go call them
- and fill them in?
- Oh, of course.
Any-Anything, darling.
Yes, Brookhaven.
Update, update Brookhaven.
Update Brookhaven.
I can't leave him.
- He needs me.
- Oh, I...
I get it.
You have got to be better
than you have ever been.
Neither one of us
have children.
Not even siblings.
It's just the two of us.
He has no one else.
I have no one else.
Do you know what it's like
to find the love of your life
this late in the game?
Actually, I do.
And when the day comes,
and he forgets my name,
I won't even care.
I'll fill in that blank,
'cause he'll still love me.
And I'll love him.
To the end.
Just don't let it be today.
Okay.
His intracranial pressure
is still rising,
and we're not sure
of the cause.
The MRI didn't show
any tumors
or blood clots in his brain.
So what does this mean?
That the drain wasn't enough.
Mr. Shafer,
we have no choice but to
proceed with the craniectomy
to relieve the pressure
in Peter's brain.
My God.
I can't believe
this is happening.
There must be something else
you can do.
If we wait any longer,
he's at risk of brain damage.
Treat him like he's your child.
Would you agree to this
if it was Gigi?
Spencer, give us a minute
to review.
- Tell me there's another option.
- There isn't.
What he just said in there
won't help Peter.
Keeping your objectivity will.
You have to.
I'm sorry to interrupt,
but the preschool's been trying
to get in touch.
Gigi needs you.
Do what you have to do
to reduce the swelling.
Hey. She's been like this
since Peter left
this morning.
She won't eat or talk.
- Thank you.
- Yeah.
What is that?
A space helmet for Peter.
If he goes into space,
he can't die.
Is he gonna die, like Mommy?
I'm fighting for Peter.
- I'm scared.
- I know. That's okay.
I knew he was sick when
he didn't want to eat
my sandwich.
We trade. He always
eats my sandwich.
When his mommy left,
his daddy started
making his lunch
with roast beef.
After he ate it all,
his tummy started hurting.
Did he eat your sandwich
this morning?
No, Daddy.
Craniotome to me.
I've done this a hundred times,
but rarely on a child.
You're more than qualified.
Watch for bleeding,
be gentle.
When I pass through bone,
I stop.
Now, let's get started.
Wait!
I think Peter has
urea cycle disorder.
It's a genetic enzyme deficiency
that makes it hard
for people to break down
protein.
Whenever Spencer packs his son
roast beef, he trades it away
because it makes
his stomach hurt.
I think sharing his dad's
protein shake this morning
gave him more protein
than he could process,
and his body was already under
stress from his recent cold.
Talk about a zebra.
Urea cycle is extremely rare.
But it would explain
all the symptoms.
Let's get him back
to the ICU,
start him on dialysis,
clear the ammonia.
Yeah, but do we have
that kind of time?
The odds you're right
are vanishingly small,
and if you're wrong,
this boy's brain
continues to swell,
which will cause him
permanent damage.
We need to operate now.
A craniectomy is a gamble, too.
At the rate the swelling
is worsening,
best-case scenario, what,
it buys Peter days?
It doesn't fix the problem.
That is true.
So let's do both.
Dialysis right here.
We can watch his ICP.
If it doesn't drop,
I'm ready to
start a crani immediately.
I'll be right here
when you wake up.
Okay, this is as far
as you can go.
I love you.
I love you more.
Okay.
Wire, please.
Dilator.
All right, we're almost there.
All right, catheter in.
If you're right,
the pressure should trend down
once the proteins are
filtered out.
Yeah, well, it's not gonna
happen immediately.
If that number doesn't
come down soon, I start.
Whether I want to or not.
We're working through
some unexpected adhesions.
Did Gloria mention anything
about prior surgeries?
None. Any sign
of the perforation?
Running the bowel now.
There's no sign of
widespread ischemia.
Oh, there it is.
Can you repair it?
Well, the surrounding bowel
is thickened
with extensive lymphadenopathy.
It sounds like
whatever's going on
caused significant inflammation.
I should be able
to repair the perf,
but, you know,
this didn't happen overnight.
It's been going on for years.
Bowel inflammation is
extremely painful.
Her daily steroids
must have been masking it.
See the big picture.
Dr. Kravitz told me
in geriatrics
you always gotta keep your eye
on the big picture.
What if the arthritis
and the bowel inflammation
are all part of the same
disease process?
It's possible.
If the side effects
of her medications
were actually symptoms of
the underlying issue.
We've been looking at this
all wrong.
Let's get back
to Gloria's prescriptions
and see if we can't
get her some answers
when she wakes up.
It just keeps rising.
Can we dialyze faster?
Any faster and his neurons
could shear from diffusion.
Just give it a minute.
Conrad, this is the brain.
A minute can be
the difference between
life and death.
Just give me one more minute.
We don't have
good choices here.
- Billie, we're on the same side.
- But this is my OR.
- It dropped.
- Wait, Dr. Sutton.
That number's still
dangerously high.
It worked.
You ready to close?
Sure am.
Focus on that still space
between our inhale
and our exhale.
Please remember
to silence your devices
before we begin the class.
- I seem to have gotten turned around.
- Okay.
My wife is in surgery.
Can you direct me
to the waiting room?
Uh, here, let me show you.
The cavalry has arrived.
77-year-old woman
with a bowel perf.
Pressure started tanking.
At first I thought
it was peritonitis,
then I saw her neck.
I need ultrasound now.
Any idea why
she might be in tamponade?
No idea what the underlying
issue is.
Right now, we just need
to get her off the table.
Start another epi
and bolus a liter.
There's fluid around her heart.
We need to prep her
for pericardiocentesis.
Okay, I'll finish up
so I can assist.
All right, but if
she doesn't stabilize, Bell,
I'm gonna have
to crack her chest open.
Oh, God, let's hope not.
Oh, man, I can't wait
to tell 'em.
Hey, we figured it out.
Gloria's medications
didn't cause her problems,
but they masked
an underlying one:
Whipple's disease.
That's what caused her
arthritis, weight loss, fatigue.
And steroids that her doctors
first thought was arthritis
only made it worse.
She told us that
they increased her dose,
leading to the perf.
Now all Gloria needs
is an antibiotic.
We can take her off of
- almost everything else.
- She didn't make it.
- I'm sorry.
- What? She...
She developed cardiac tamponade,
which was probably
the final complication
of her undiagnosed Whipple.
And Austin was working to place
a pericardial drain
when she coded.
We did five rounds of CPR.
More than I should have
on a woman her age.
It was a tough one.
Now, if she'd been
treated properly,
or if she'd gotten
to us sooner,
maybe we could have
done something
to turn it around.
But today...
it was just far too late.
Dr. Kravitz...
Kit is his friend,
so I will call her
to tell him.
Even if we had
diagnosed her sooner,
Gloria's disease began
years ago.
There's nothing
we could have done.
Gloria wasn't just another
fragile old lady.
She was strong, in love.
She deserved more time.
But every doctor looked at her
like just another lost cause.
No one cared enough to see
that by just treating
her symptoms,
they were actually
making her worse.
No one saw the bigger picture
until you did.
Reconsider going into
gerontology, Zach.
You may have a gift.
I am so sorry.
I'm so sorry.
Look what I made you.
Wow!
Hey.
So we'll continue dialysis until
we lower his ammonia levels,
but with some attention
and lifestyle modifications
we can manage this.
You will need to look out
for any signs that
his ammonia levels are up.
Sluggishness, nausea, vomiting.
Avoid extreme temps.
Keep him hydrated and
on a low-protein diet.
No more roast beef sandwiches.
He'll do great.
I can't thank you enough.
Well, we did have help.
How would you two
like a surprise?
What is it, Daddy?
What is it?
Wow!
It's beautiful.
Nolan as a sperm donor?
Our Nolan?
- Yep.
- Ooh.
- That put the fear of God in me.
- Yeah, I bet.
But the eggs are gonna be
retrieved in about two weeks,
which means I need a volunteer,
fast.
Someone I trust,
someone I care about.
What are you gonna do?
Actually, um,
I had a crazy idea.
You and I are good friends,
now that we aren't lovers,
and I wouldn't mind
a kid a lot like you.
You could do worse.
So what if I did...
have a kid
just like you?
You want me to be
your sperm donor?
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