Three Rivers (2009–2010): Season 1, Episode 10 - A Roll of the Dice - full transcript

Good morning, Mr. Becker.

Did you pass your drug test?

With flying colors,
nurse Acosta.

Scott Becker, 19.

First evidence
of toxic effect on his heart:

An MI at 17.

That's a heart attack at 17
from cocaine use.

This kid deserves
a second chance.

I am a serious screwup.

I can't take this heart.

It's just not right.



You know what, Scott?

Maybe the old you
doesn't deserve

this heart, but you do.

We're taking you
to the O.R. soon.

You nervous?
Kind of.

I can understand that--
your new life

starts today.

Right.

Well, that's exactly
what I told Cece.

I said you don't call
a parent meeting

unless all the committee chairs
are gonna be there.

Right.

Hey,

is it true that we
can't send juice boxes



with the kid's
snacks anymore?

Really?

Right.

So, anyway, how did Thanksgiving
go with Rick's parents?

Whoa!
Bill!

Easy, Hailey.
Oh, my goodness!

I gotcha.
I wasn't looking, and...

Hailey, honey.

If you want something,
use your words and tell mommy.

Oh, thank you, seriously.

I should have belted her in.
Here, uh,

this should keep her busy.

Nice moves, by the way.

Not bad for a 40-year-old.

Yeah, surprised myself.

I'm still stiff from running
the Philly Marathon last week.

Candace got tired of me
moaning on the couch,

so she sent me out
to try and be useful.

Well, you were
definitely that. Thank you.

Don't worry about it. Hey.

Take it easy, little daredevil.

Mm-hmm.
Bye-bye.

Aw...

Just a few more minutes,
Hales, okay?

Okay.

Oh, you're such a good girl.

You scared mommy.

Hey, Bill...

Bill! Oh, my God!

Bill! Somebody
call an ambulance!

Bill!

Morning.

Hi.

Doctor.

Hey, people.

How's it going?

Yo, Andy.

That's very funny.

Since you're taking over for Dr. Jordan

as Department Head
while she's at the conference,

we thought a gift was in order.

Yeah, we all...
All pitched in.

Try it on.

Aye, aye, Captain.

Nice. Whoo!

Oh, oh, oh,
I'm sorry, Andy,

I forgot to tell you,
um, Gilligan called.

That's-that's hilarious.

Seriously, there are, like,

three people waiting
to talk to Dr. Jordan,

and I transferred them
to your line.

Great.
And you have an HR meeting
in ten minutes.

Dr. Jordan told me that
you would cover for her.

I'm sure she did.

Dude... really?

Hey!

Scott!

Ah...

How long do I have to keep coming here
for these checkups?

How's "for life" sound?

Which I told you
before the transplant.

Tried to forget.
Mm-hmm.

So, how's it been

living back with your folks?

I know you guys weren't on
the best of terms for a while.

We're getting along.

And I got a job.

I'm working at a substance
abuse program for teens.

Check you out, giving back.

That's great, I like it.

It's a bummer about Brenda
moving to Oregon, huh?

She get her transplant,

and her dad landed a new job.

With her medical bills,
they need the dough.

We'll find a way to be together

if it's meant to be.

That's very Zen of you.

Zen with a huge-ass
text-messaging bill.

Okay.

How you been feeling?

Good.
Yeah? No aches, fever, coughs?

Negative. I'm-I'm a picture of health.
Okay.

Whoa.

Is that sore?

Not really. I-I fell
skateboarding last week.

Other leg's swollen, too.

I'll run some tests,

check it out.

Wait, isn't our president
trying to stop

unnecessary medical tests?

You had a heart transplant
six weeks ago.

Trust me, it's necessary.

I'll be back in a few minutes.

♫ Three Rivers 1x10 ♫
A Roll of the Dice
Original Air Date on June 12, 2010

What do you got?

23-year-old drowning Vic,

name's Penelope Kirkell.

Bystander CPR.

We found her bradycardic
and hypotensive.

Gave her atropine,
epi and intubated.

Any respiratory effort?
Not yet.

Bp 90 palp,

pulse 110,
pulse ox 90.

No breath sounds on right.

All right, we have
a possible hemothorax.

How did she get a hemothorax
from drowning?
No clue.

Let's get prepped for a chest
tube, and get Andy down here.

I don't like these breath sounds.

Pulse is dropping fast.

I'm sorry, I'm not quite sure
I understand how

a perfectly healthy man collapses

in a grocery store with kidney failure.

He ran a marathon last week.

Well, it seems that the running
has something to do with it.

Now, what kind of training
did you do?

Uh, around five miles a day.

I just figured I'd...

push it on race day,
see how far I could go.

I made it the whole 26.

Wow. Well,

it seems that the extra exertion

caused your muscles to break down,

and the by-products
flooded your kidneys.

It's called acute tubular necrosis.

From running?
Basically, yeah.

Your kidneys shut down,
and that's why

you collapsed.

Now, what do either of you know

about dialysis?

Oh, tell me

that's not where
we're headed here.

Candace's brother-in-law's
been on it for five years.

It's taken over his life.
Yeah, well,

transplant is also an option.

And we can get you
listed immediately,

but you both should know that,
because of your condition

and the fact that dialysis
is still an option,

you will be low
on the priority list.

Can I give him
one of my kidneys?

Yeah. We just have to make sure

the blood type and tissues match.

We can send a nurse in
to do samples,

if you're really interested.

Candace, I...
Stop it. Yes.

We're interested.

Okay.

Okay, doc, what do we got?

This kid, who we transplanted
a couple months back...

Yeah, Scott Becker.
Cardiac enzymes

are elevated.

Bnp and chest x Ray

confirm congestive heart failure.

Okay.

Gonna have to do
a myocardial biopsy,

and we'll go with pulse steroids,

see if we can reverse this.

Andy, Lisa needs you

in the E.R.
okay, thanks. Thanks, doc.

Please tell me that look on your face
isn't about Scott Becker.

His body's rejecting the heart.

Well, you were right--

she's definitely got
a bleeder in her chest.

Okay, let's advance the chest tube.

Hooking up to pleurovac.

Okay, people, she's got a massive

arterial hemorrhage--
we're not gonna be able

to stop the bleeding down here.

Let's get her up to the O.R.

Why is a drowning victim
bleeding like this?

If you figure it out,
please let me know.

Okay, come on, here we go.

Okay, talk to me, Dr. Lee.

Bleeding in the right chest
is continuous and diffuse,

with no specific site.

Pre-op labs?

PT and PTT are both normal.

Bleeding time's a bit elevated.

A little water here, please, Pam?
Mm-hmm.

So what's your call, doctor?

I think we load her up
with platelets and plasma.

So do I. Let's do it.

Do we know if she's
on any blood thinners?

Uh, University police

haven't given us
any information on her yet.

Do we know anything besides her name?

Anybody?

Pam, help a brother.

This bleeding's not stopping.

Andy needs...

A fresh joke.

Well, little buddy...

I have some news for you.

Call me "little buddy" again.

Li...

Sorry.

Candace Dula isn't a
tissue match for Bill.

So he can't have her kidney.

The Struckmeyers.

The Struckmeyers.
What?

The Struckmeyers.

Heather and Darren Struckmeyer.

She's on dialysis,
and he wanted to donate,

but he's not a match.

However, Candace Dula
has the same blood type

and HLA profile, which makes her
the ideal donor.

So... what are you proposing?

It... it's something
called a daisy chain.

If you were to donate
your kidney to Heather,

her husband would donate
his kidney to someone

who matches his criteria, and so on.
That's how you find

a kidney for me.
Exactly.

Now, you both should
know this hasn't

been approved
by the hospital just yet,

but I do plan on bringing it up

at the transplant committee meeting.

How many couples will this take?

If we're lucky, only one.

But... it most certainly
won't be that easy.

I'm in.

I'll do it.

But, honey, think about this.

You... you're gonna go through
surgery for a stranger.

If it means you're
gonna get a kidney, yes.

And I'm praying that somebody'll
do the same thing for you.

Okay.

We'll give it a shot.

I'll keep you posted. Great.

I can't believe this--
I showed up at work,

and the campus cops were there
asking questions about Penelope.

Where do you work?

At a medical research lab
on campus.

We're in the biochem Phd program.

Do you know of any medications
that Penelope was taking?

She has asthma.

She carries an inhaler.

Any recent injuries

that you know of?
No.

She works out all the time though.

She's been getting ready
for her wedding.

Oh, she's getting married?

Well, she was supposed to.

I'm not sure what's going on now.

She flew out to California
last week to visit her fiancé,

but they got into a big fight,

so she came back early.

Do you know how to get
in touch with her fiancé?

I'd like to ask him
a couple of questions.

Sure. His name's Jared.

He was in the undergrad
program with us.

Hey, Pam?

Do you have a second?

Excuse me.

Hey.

How's she doing?

Well, we did what we could,
but she lost a lot of blood.

So, whoever her people are,
get them down here asap.

Come on.
All this for a sprained ankle?

Your ankles aren't swollen
because of skateboarding.

Your heart is not pumping adequately,

so fluid is collecting at the low point.

It's a sign of congestive heart failure.

I've been feeling fine.

Yeah, but that could change overnight.

We're going to need
to take a biopsy of your heart,

then we're going to hit you
with a high dose of steroids.

We've stopped rejection
with them before.

Look, I swear,
I've been totally clean.

I mean, no smoking weed
or anything like that.

I know that, Scott.

But this is not about lifestyle.

Rejection can happen at any time.

But you're young, you're in good health,

so there's no reason why
we can't turn this around.

Here come my folks.

Take it easy with the
medical info, all right?

They get scared real easy.

All right.
Thanks.

Hey, mom. Dad.

Hi. Honey, are you okay?

Yeah. I'm fine.
This is Dr. Yablonski.

George Becker.

How do you do?
This is my wife, Ronda.

Pleasure.

Nice to meet you.

So, uh, we thought he was
just coming in for a checkup.

But, uh...

He called and said he needs
to stay for a couple of days.

Yeah. Don't worry.
We, um, we got it under control.

We have a plan now, don't we?

We do.

Uh, did you guys
bring the Backgammon?

Oh.
Yeah. Mom's got it in her bag.

If you hear screams from in here,

don't be alarmed.
It's just the sound of victory.

Okay.

It's very nice to meet you both.

Dr. Yablonski?

Yes?

I should have, um, called you

or sent a note or
something to thank you

for everything you've done
for Scott. I apologize.

There's no need.

I'm a huge fan of your son's.

We are, too.

But there were some years
there where we lost him.

And when you went in

and put the new heart
in him, it was like...

It's like you went inside
and flipped a switch

and you turned him back
into the Scott that we knew.

Well, I'm glad to hear that.

I'll check back soon,
see how he's doing.

Great. Thank you.

You're welcome.

Okay.

Hey, there, Penelope.

I'm Pam Acosta.

You're in Three Rivers Hospital.

Can you understand me?

You can just nod, okay?

You had an accident

yesterday morning,
when you were swimming.

You were bleeding internally
and needed surgery.

Do you know what could
have caused that?

I fell... on my bike.

I was riding to the pool.

I lost my balance.

Good. That could be what
caused your injury.

Can you tell me what medication
you've been taking?

Ambien, for sleeping.
Okay.

I have an inhaler for my asthma.

Um...

Aspirin. A lot lately, for headaches.

The aspirin could explain the bleeding.

Your doctors infused you with platelets.

That should help your body regain

its ability to clot.

The doctor's going
to come talk to you.

We're going to keep you here
for a few days.

I need to talk to Jared.

Is that your fiancé?

Your friend Jeni got a hold of him.

She said he was flying out today.

I can't believe he's going
to see me like this.

I'm sure he'll be happy
just to see you alive.

That's him.

Oh, thank you.

Dr. Lee?
Yes?

I'm Andrew Gold.

Penelope Kirkell works in my lab.

I was told you could
tell me how she's doing.

Um, well, she made a big
turnaround overnight.

All in all, she's doing a lot
better than I thought she'd be.

Did you determine why
she passed out in the pool?

I really can't discuss that.

Of course not.

I understand.

We're all just really worried
back at the lab.

Well, I can show you to her room,

if you'd like.

Um... no. That's okay.

She probably needs her rest.

I'll, uh...

No. I'll call back later.

Okay.

Thank you.

Food services, call 316.

Food services, call...

There you are.

Can't a man enjoy a meal alone?

You're in a hospital.

We make it our business
to invade your space.

Where are your parents?

Out on a walk.

Hey, so the, uh...

The results of your biopsy came back.

You're having what's called
an antibody-mediated rejection.

Well, that doesn't sound good.

It means you won't respond
to the steroid treatment.

We're going to put you
on a drug that's going

to help boost
the contraction of your heart.

And then we should start talking
about another transplant.

Scott, listen.
You really need

to let your parents know
what's going on here.

You know?

Yeah.

I wish I had better news, buddy.

Hey, I had
a freakin' heart transplant.

These things happen, right?

Yeah.

I'm late. I got to go.

Scott.
You okay?

I'm good. Go.
Leave me in peace.

Please.

Wow. You're early.

Yeah. Leading by example.

Jordan would be proud of you.

I'm proud just to know you.

You, too, Dr. Lee.
Let's get started.

First up, Scott Becker.

Received a heart transplant
six weeks ago.

Lab and echo suggest CHF.

Biopsy shows acute
antibody-mediated rejection,

so we added ATG.

I think we should relist him,

in case we can't stop this rejection.

Anybody object?

Good.

On to the next order of business.

Miranda?

Okay.

Patient's name is Bill Dula.

Age 43, current diagnosis is ATN

as a result of a marathon
he ran last week.

Another reason
not to move to Philly.

Bite your tongue.

His kidney function studies,

his bun and creatinine
are extremely elevated,

and he's not making any urine,

which means that he'll have

to go on long-term dialysis
if things don't improve.

But you want to list him anyway.

Yes, I do.

But he's a low priority,

which is why I am suggesting
an alternate approach.

Okay. His wife has offered
to donate her kidney,

but she is not a tissue match.

However, we have found
someone here who is,

so we've constructed
a partial Daisy chain.

With altruistic donors?

Yes.
The board vetoed daisy chains

because of the surgical risk
to altruistic donors.

Well, there's also a risk

of our patients dying,
waiting for a kidney.

Have you done psych evals
on all your donors?

This isn't 1972.

These are consenting adults
who'd like to help.

How do you know the family
members aren't being coerced?

Because when a family member
doesn't want to donate,

we tell the family
that they're not a match.

What about children?
Are any of your donors

under the age of consent?

Like I said,
we have eight consenting adults

who would like to save some lives.

And I don't think anybody here
should get in their way.

So, Dr. Acting Department Head,

how would you suggest we proceed?

Well, with Dr. Jordan absent,

I'm not sure this is the best time

to reverse our policies.

I can't believe I'm
hearing you say this,

considering you'd be making
the exact same argument

if you weren't
sitting in that chair.

All I'm saying is dialysis
is a safe option.

Temporarily.

Okay, so let's agree to disagree.

Let's agree to vote.

Okay.

All of those in favor

of enacting the daisy chain
procedure here, raise your hand.

Good news.

The committee approved
the daisy chain.

But I have to say,
finding a donor for you

was the hardest part.

Until we found...

DA, DA, DA, DA.

There he is.
Mr. Wilkinson.

See, Mr. Wilkinson wanted
to donate to his son Kevin,

but they weren't a match.

However, we did find someone
for Kevin through the chain,

and Mr. Wilkinson
agreed to donate to you.

What do you think, hon?

You know, my grandfather
was a labor leader.

A switchman on the railroad.

He was always talking to me
about the greater good,

and how one guy had to not
just think about himself,

but about the bigger picture,

and how we'd all be better
because of it.

I was such a knucklehead
back then.

Didn't think much
of what he was saying.

When do you want
to do the surgery?

You may be feeling better,

but you're not out of the woods yet.

Don't blame me.

She told me to bring her work.

And my favorite robe
and some of my things.

Most people use major surgery
as an excuse not to work.

Those people don't have
tenure track positions.

You know what they say,
"publish or perish."

You push it too far,

and the perish part
might actually happen.

Your boss came by.

Dr. Gold?
Mm-hmm.

He spoke to Dr. Lee.
Sounds like he had to run

before he could see you.

What's going on?

Dr. Gold had
this minor obsession with Pen.

His wife got wind of it,

and now he just skulks around,

barely talks to her.

It's... creepy and uncomfortable.

Well, for now, you can
hide out in here with us.

Ten more minutes,
then it's pencils down.

Chaplain to room 802.

Chaplain to room 802.

Dr. Foster said
there's some paperwork

to fill out about my surgery.

Candace Dula.

Mrs. Dula?

I'm Rick Wilkinson.

I'm going to be your husband's donor.

Oh, my God!

Thank you so much!

It's so nice to meet you.

You, too.

Can you believe this thing?

Bunch of people you don't know
giving kidneys to each other.

Well, kind of makes all the sense

in the world though, right?

I'd do anything to get
my boy back on track.

His kidneys started failing
when he was 13.

Affected his growth, his height.

I mean, he was a teenager

and his life just stopped
when he went on dialysis.

I wish I was the one
helping your son.

You are.

We all are.

Hey.

Did Penelope Kirkell mention
anything about taking digoxin?

No.

There was no reason to run the
screen when she was admitted,

but when I ordered the new
chem panels, it popped up.

Her levels are through the roof.

She doesn't have a heart condition,

so I don't know why
it would be in her system.

It's Penelope.
She's in fib.

All right, call a code!

Code Red.

Code Red ICU.

Amp of epi is in.

Okay. Everybody clear.

You got a rhythm.

Good carotid pulse.

Now let's make sure
she stays that way.

Hang an amiodarone drip. Repeat
blood count and chem panel.

What is going on with this girl?

That's a good question, Pam.

I mean, an internal bleed
wouldn't cause the v-fib, right?

The digoxin would.

And it would also
explain her bike fall.

She could've had an arrhythmia

from the high dig level
and blacked out.

But how's it getting
into her system?

I don't know.

Excuse me. Is that Penelope?
Sorry, sir.

W-who are you?

I'm Jared Douglas.
I'm her fiancé.

What's going on?

Dr. Yablonski?
Yeah.

I need you to sign off
on the organ donation

for Dr. Foster's kidney patient.

Uh, yeah.

Yeah.

Okay.

Where?

Uh, right there.

That's it.

That's great, thanks.
Okay.

This is Ryan Abbott.

Hey, Andy.
Yeah.

Let's clear the air
about this afternoon, please.

Yeah, if I sounded annoyed,
that's because I am.

That's fairly obvious.

It's not you.

I... I could never do Jordan's job.

I spend half my day
in stupid HR meetings

and signing forms and making calls.

I suck as an administrator.

It's a good thing you only

have to suck for a few more days.

Yeah.

Oh, God. If he's got

another form for me to sign,
I'll kill myself.

Just go, just go. What?

UNOS just called with an offer

for a kidney for Bill Dula.

It's in Carbondale.

We can send a team now.

What are we going to tell him?

We tell them a kidney
became available.

His wife won't need
surgery if he takes it.

That's right, she won't.

Then for sure he's gonna take it.

And that's gonna mess up
the whole daisy chain.

And what about all those
people we signed up?

They're not his problem, Ryan.

Oh, s-so th-that's it?

That's it.

This is crazy.

She doesn't have heart problems.

She's super-healthy.

We found a heart medicine in her system

called digoxin.

Did she ever mention taking it?

No.

But to be honest,
she hasn't been speaking to me.

She came out to visit.

We got into a stupid argument.

It started with the wedding invitations.

She wanted a card with glitter, I didn't.

I mean, literally, it was that stupid.

All the stress just came out.

Then she left.

That's the last time I talked to her.

Look, what if
I'm the reason why she's...

Don't...

Don't go there, Jared.

I'm not gonna lie to you,

she's definitely not out of the woods.

You need to stay positive.

I've been where you are,

sitting in a room like this,
waiting for news.

And what happened?

It just made me grateful

for every second
the two of us had together.

He told us about the heart rejecting.

And he said that

you feel positive about the options.

I do.

But I was coming to tell Scott

that I'm not liking
his blood pressure.

It's too low.

And it's probably an indication
that the inotropic agents

aren't working the way
I'd like them to.

Is there something else you can do?

Yes, there's a treatment where
we attack the white blood cells

in Scott's lymph nodes
by exposing him

to high doses of radiation.

It can help stop the rejection.

And if it doesn't?

Well, I think
the best hope for him then

is a new heart.

Will the... the people

who control the organs

hold it against him that
he's already had a transplant?

No, it's actually the opposite.

The chance of Scott
getting a new heart

is better now,
considering how sick he is.

We just got
our little boy back, doctor.

Please don't tell me

that we're gonna lose him again.

Hey, it's gonna be okay.

We can still turn this around.

Okay? I'm gonna do
everything in my power

to make that happen.

Thank you.
Thank you.

Hey, Pam.
Mm-hmm?

Want to get Penelope to Radiology,

get a CT of her pancreas.

How is her pancreas
causing a heart problem?

Oh, I just got her
blood work back.

She's got a blood sugar of 15.

It's probably what
caused her to crash.

Oh.

Why are her Insulin levels so high?

Could be a couple of reasons.

Maybe a pancreatic tumor

that's causing an increase
in Insulin production.

That's why I want to get the CT.

What's the other?

Look, we didn't give her digoxin, right?
No.

But the high levels
we found in her system

could have caused her
to pass out in that pool.

Now her Insulin is skyrocketing.

Which we also didn't give her.

But somebody did.

While she's been in this hospital.

Who would do that?

I don't know.

But if somebody's trying to kill her,

it'd be a good way to do it.

I'm a little surprised by this.

Well, yeah.

It usually takes a lot longer

to get a kidney from UNOS.

But you're a six-antigen match,

and perfect matches get first dibs.

The thing is, with the daisy chain,

we already have a kidney, don't we?

Absolutely. If you'd still
like to go that route.

Yeah, but if I take this kidney,

then you won't have to go
under the knife.

What'll happen to the chain if
we pull out all of a sudden?

We'll try to find a couple
to take your place.

I'm going to take the kidney
from the UNOS list.

I can't let Candace go through
major surgery if I can

get a kidney another way.

Well, I'm gonna let UNOS know,

and we're gonna get you

scheduled for surgery.

And then you can schedule me.

I'm sorry?

I'm going through with the donation.

Candace...

I can't let this fall apart.

It's not your responsibility.

Of course it is.

Those people are us, Bill.

We know the fear they're living with,

how it's crippling their lives.

I can help.

And I'm going to.

All right, listen.

There are no bad decisions here.

You can take the kidney
from UNOS, and if you

stayed on the chain,
four lives will be saved.

But if I stay in the chain
and UNOS offers the kidney

to the next person on the list...

Five lives will be saved.

Let's do it.

Let's stay with the Daisy chain.

Okay. Okay.

So no tumor.

Pancreas looks clean.

Did you go over her chart again?

She wasn't given any medication

that would account for her Insulin spike.

All right, so let's go back a few days.

Let's say somebody did slip her digoxin.

She gets dizzy, she
wipes out on her bike.

That causes a bleed, which later
on takes her down in the pool.

Then she comes to us
and we fix her up.

Then she crashes again because
of high Insulin levels.

So she recovers from the digoxin

and someone shows up here
and juices her with Insulin?

It's a pretty ballsy move, right?

All right, so who's been here?

Who's come to see her?

Hmm.

Her friend Jeni, the fiancé, the boss.

They all have biochem training.

And they all have the medical
knowledge to pull this off.

They could have given
her an injection,

they could've shot it
straight into her I.V.

Yeah, but Penelope was awake.

She would've noticed it.

There's inhalable Insulin now, right?

Yeah. Comes in little cartridges.

Why?

Because right after Penelope got here,

her friend Jeni brought her an inhaler.

Dr. Yablonski!

You're never gonna believe this.

Who's winning?

My mom.
The woman's a shark.

I mean, she seems
all sweet and everything,

but she's beating me like a drum.

Well, I got some good news.

You've been offered a heart.

Like, now?

Yeah, like, right now.

With your permission, I'm gonna send

a team to Scranton
to procure the heart.

They should be back in a few hours.

In the meantime, we'll get you
prepped for surgery.

When you wake up,
you'll have a new heart.

Seems like we've had
this conversation before.

Yeah, well, with any luck,
we won't have to have it again.

You think it's going
to work this time?

Dude, I thought it was going
to work the last time.

If it was just up to me,

I'd probably let nature run its course.

But then I think about my folks.

It's been a good year.

Let's go get a few more.

Hey.

All right?
Thank you.

I'll be back.

♪ Lay down my head
by the wayside ♪

♪ my worn out shoes ♪

♪ quite why she went
I can't decide ♪

♪ yeah, but I sure could use ♪

♪ one plate of food
steaming and hot ♪

♪ clean linen ironed ♪

♪ on a fresh made bed,
but I ain't got ♪

♪ one salty dime ♪

♪ one salty dime ♪

♪ just close your eyes,
it won't take long ♪

♪ it won't hurt a bit... ♪

I'm sure Mr. Dula would want
you to do the honors.

♪ Telling myself
I could be strong ♪

♪ or some such brave ... ♪

♪ trucks are roaring by,
I'm a red ghost ♪

♪ in their taillight gleam ♪

♪ I'm a tumbleweed,
I'm a spit roast ♪

♪ just turning in your flame ♪

♪ oh, my darling Kathleen. ♪

How we doing?

Can't stop staring at her.

I'm just so relieved she's okay.

Was it really Jeni who did this?

The police found digoxin
and vials of inhalable Insulin

in Jeni's apartment.

But why?

Penny, she was always
jealous of you.

She blamed you when she
got passed over for tenure.

She thought if you weren't
there, she'd get the job.

So she was poisoning me at work?

Putting digoxin in her coffee.

Once you were hospitalized
and being monitored,

she switched to a different poison

and hid it in your inhaler.

All of this over tenure?

Yeah.

You may want to rethink
your career in academia.

Go with something a little safer,

like lion taming.

How are my two favorite patients?

I kind of feel like
I got run over by a truck.

After it ran over me.

But I've never felt better.

Me, too.

We got a couple of days in bed,
we got a TV,

food coming to us three times a day.

Well, I have to say, what you did--

what you both did--
was just remarkable.

Thank you.

No, no.
Thank you.

For the opportunity.

It's probably the best thing
we'll ever do.

Well, listen. Do me a favor.

I want you to take it
easy with the running.

Oh, don't you worry.

From now on, he only runs
when something's chasing him.

I'll check in on you later.

♪ ♪

Okay, the new heart is in.

Suturing.

Cut here, please, nurse.

Excellent. Excellent. Looks great.

Okay, cross-clamp coming off.

Kind of weak beats.

Look, it's changing color.

It's hyperacute rejection syndrome.

He's in trouble!
V-fib!

Charge to 25.

Amp of epi.
Milrinone .5 Mikes per kilo.

Still in fib!

Recharge. Recharge.

Amiodarone 150 IV push.

This heart's not going to work.
Prime the heart/lung.

We're never going to get him
off bypass.

Hurry up and prime that machine!

We're going to have
to anticoagulate.

5000 units heparin.
Charge again! Charge again!

Thirty!

Prime that machine!

Damn it!
Charge to 40.

We're going to defibrillate again.

Here we go.

Oh, no.

Oh, no. No.

Oh, no!

It's times like these when you
wish hospitals served alcohol.

I have a department meeting
in three hours.

I've lost patients before.

You can't do this work
and not lose patients.

I mean, they're all
so close to death.

But Scott...

he was turning it all around.

He was turning it all around,
but he didn't get enough time.

It makes me want to walk away
and never do this work again.

You should get some rest
before your meeting.