Three Rivers (2009–2010): Season 1, Episode 7 - The Luckiest Man - full transcript

The Luckiest Man

Roll call!

Dishes?

Check.

Beds?

Check.

Laundry?

Check.

Leaves raked into a pile?

Check.

Timber!



Michael, bury me.
Bury me.

It's my turn!

It's my turn!

Mikey?

Mike?

Michael!

Mike?
Mike?!

Mike!

Mike?
Mike!

Whoa, whoa! Slow down, Kuol.

That's a Ventricular Assist
Device, not a rocket pack.

So you say.

I have not felt my oats
in this way since I was a child

playing football
in the refugee camp.



Okay, well, just
dial it down a notch, okay?

The VAD helps, but your heart

and your immune system
are still weak.

Yes.

Good morning, ladies.

Okay, guys, a little

to the left.

Yeah, now to the left.

Yeah, a little higher on your end.

Perfect.

Hello, Ryan.

I'm Barbara Harris.

I was told that you
were Party Central.

Are you one of our recipients?

Dr. Wilson did my transplant
last October.

I just want everything
to be perfect

when I meet my donor's family.

Yeah.

I was supposed to be here
first thing, to set up,

but my flight was horribly delayed...

I think you'll be okay.

The donor-recipient party

is not until tomorrow, so...

I will go bug the caterers.

We know a thing or two
about barbecue in Dallas.

Hi, Cookie.

It's Daddy.

You were right, as usual.

I should have charged
my scooter battery.

I'm heading home with
my power cord between my legs.

Three Rivers 1x07
The Luckiest Man
Original Air Date on November 15, 2009

sync, corrections
elderman

Hey, who's the surgeon
on trauma call?

Uh, Dr. Jordan.
She's on her way.

We ready?

One, two, three.

Multi-trauma ALS patient.

He's hemodynamically unstable.

Multiple rib fractures
and a flail chest segment.

That's bad news with his ALS.

Put him on a vent.

He's going to need it.

You better have Andy come down
and have a look at him.

Before my heart transplant,
your father

personally came in to
wish me well, Dr. Foster.

Uh-huh.

It's good to see you

carrying on his welcoming spirit.

Oh, yeah.

What in the world is chipped ham?

It's a Pittsburgh delicacy.

The things you Yankees eat.

I see you got sucked into
the Welcome Wagon, too.

No. Are you kidding?

I just love a party.

Barbara? Barbara!

Barbara! Barbara!
Okay, okay, okay.

Call an ER right now!

Mr. Downing, I'm Dr. Lee,

one of the transplant
surgery residents.

The ER doc asked me to
look you over, okay?

Call-Call me Michael.

Okay, Michael.

The report?

Thank you.

Okay.

Let's up the O2,
give him 125 of Solu-Medrol,

repeat the nebulizer.

Thanks.

You had 50 to 60 ER visits over

- the past few years because of your lungs?
- Yeah.

Why haven't you followed up with any

of the doctors you were referred to?

I couldn't afford health insurance.

A year ago, his lungs got so bad,

he qualified for Medicare disability,

so he could finally see
a lung specialist.

But then, his lungs were trashed.

And that's when you finally found

underlying pulmonary hypertension?

- Yeah.
- Hmm.

Where are your parents?

Dead.

Michael takes care of us.

Okay. Is this why you signed out

against medical advice so many times?

I can't stay in the hospital.

One time, when he got admitted,

they put us all
in separate foster homes.

Let's get you turned around.

I need to repeat the pulmonary
function test, all right?

No admission.

We're gonna jump off that
bridge when we come to it, okay?

He's all right?

Yes, he's stable,
but we noticed he has ALS.

He may be in for
a really rough ride.

Oh, Daddy.

Are you okay?

It hurts.

Can you give him something?

We have. Mr. Stone?

Mmm? I don't want surgery.

No, no surgery, but we need
to do some CAT scans to look

to see if there's any more
major injuries.

ALS is winning, Cookie.

Don't say that.
Don't ever say that.

What's wrong with me?

I don't know yet.

Please tell me
I'm not rejecting this heart.

Hey, hey, hey, hey,
listen, calm down.

The echo's not showing
anything like that so far.

Thank God.

Then why did I pass out?

That's what we're
trying to figure out.

And so far, everything
looks normal, except

for your low white cell count.

You've got to get me
better by tomorrow.

I can't be sick
when I meet Rachel's family.

Listen, listen, listen to me.

I don't want you
to worry about this.

All right?
We're gonna sort it out.

Hello.

I'm Kuol.

Would you like something to read?

What happened to you?

I was in a car crash.

I have ALS.

It's a nerve disease
where you get weaker and weaker

till you croak.

Also called Lou Gehrig's Disease.

That I've heard of. Yes.

Lou Gehrig is perhaps
the greatest Yankee.

I'm a Pirates fan.

I hate the Yankees.

How can you hate the Yankees?

I love the Yankees.

They are like America itself...

mighty and proud.

Mazeroski's homer

to beat them in the '60 Series...

the high point in baseball history,

as far as I'm concerned.

Compared to Mr. Gehrig's
good-bye speech?

People say...

say, say...

I've had a bad break, break...

But today,
today, today...

I consider myself,
myself, myself...

the luckiest man,

man, man...

on the face of the earth,

earth, earth, earth.

Thank you.

That's the first laugh

I've had in ages.

What are you doing here?

Oh, I'm waiting for a heart
transplant from the great

Dr. Yablonski.

Oh.

That's sad.

You're such a young guy.

What's that?

My chest.

I will get help.
Nurse! Nurse!

Well, your wheezing's
getting better.

But you're still not moving much air.

Michael, the pulmonary

hypertension has
progressed to the point

where you need to be admitted
for a transplant assessment.

I told you, I can't
stay in the hospital.

Well, I can't get you
listed if you leave.

Can't someone

watch these kids?

There's no one but me.

You're too sick to go home.

Well, I'll tough it out.

You will be no good
to them if you die.

You need to be treated, Michael.

- This isn't jail.
- Chill, Michael.

I'll sign out

against medical advice,
so you're off the hook.

It is not about that.

Look at you.

Please, Doc...

my family needs me.

Write me some prescriptions
so I can go home.

If I get worse, I'll come back.

I promise.

All right.

All right.

First sign of trouble,
you get back in here.

That's my cell number.
If he gets worse,

I'll get an ambulance to bring
him back here to me, okay?

What's going on?

Hi, Laura.

This right here...

This a tear

in the pericardial sac
around your heart,

and the heart muscle

is wedged in that hole.

And I'm gonna have
to operate to repair it.

With his ALS,

will he survive that kind
of surgery?

Absolutely.

With time, I'll get you
back to the functional level

- you were at before the accident, okay?
- Oh.

I'm not sure I want to go
through major surgery.

Can it heal on its own?

I'm afraid not.

What if we let it be?

Victor...

this is going to affect
your heart's ability

to go on pumping.

And time is a factor here.

So...

...I have two choices:

...Fight this or die?

Yes, that's the bottom line.

Then do the surgery.

Okay.

Yeah.

Let's do it.

The doctor's coming.

We're here.

Hey, there.

How you feeling?

Like I was run over by a truck.

Yes, I can have that
effect on people.

Like I discussed
with Laura earlier,

we discovered a more
complicated injury

when we were in there.

Your heart is fine,

but not only is there a tear
in the sac around your heart,

there's also a tear
in the diaphragm.

The diaphragm injury is
a bad thing to have

on top of your ALS.

You're going to need to be on
a ventilator for life support.

If I wasn't breathing on a vent...?

You'd go into respiratory failure.

How long will I need it?

It's hard to say.

Permanently?

Maybe.

It's okay, Daddy.

I'll move back into my old room

and we can get the hospital

to help us set up
the living room for you.

I've got home health services
on standby right now.

Okay?

So...

I'm going to be stuck in bed?

We're going to work

on getting you into a chair,

so you can at least have
a degree of mobility.

Don't worry.

I'm going to take care
of everything.

Hey, Ryan.

The Krebs citric acid cycle
is blowing my mind.

Nice to know.

Look, I've got a sick patient

I need to get him on the lung
transplant list, okay?

Can you find out how many
patients we currently have waiting?

Break it down-- O negative
or B... uh, LAS above 50.

Hello, Dr. Lee.

Okay, okay, try to calm down.

What's your address?

I'll call the paramedics;
I'll meet you in the ER.

Male or female?

Male!

Michael? Michael?

It's Dr. Lee.
Can you hear me?

He's gone into respiratory failure.

I've got to RSI and intubate.

The pulse ox isn't reading.

He needs an airway.

You let this guy go home?

It was that or he was leaving AMA.

Start with the Versed.

Apply cricoid pressure.

Follow with the sux.

Sux in.

Okay, give me some suction.

Damn it.

Suction!

All right, push on his trachea.

Harder...

Okay, I'm in.

Inflate the balloon, check a CO2.

Come on, Michael.

Good bilateral breath sounds.

All right, chest for tube
placement, give me a blood gas.

Where are the kids?

What kids?

She's hypoxic, her pulse is up.

She's getting confused.

Hi, Barbara.

I'm Dr. Jordan.

I understand you're one of
our visiting dignitaries.

What are you thinking?

Well, she just flew in from Texas.

Let's try this.

One foot.

Yep.

Positive Homan's sign.

She could have a deep vein clot

that's showering pieces
to her lungs.

Pam, chest and urine?

Both normal.

Low white count's
the only thing out of whack.

You need to rule out
a pulmonary embolism.

What about infection?

WBC count's low, and she's afebrile.

You need to consider
meningitis, as well.

Meningitis?

Do the spinal tap.

Yes?

I came to check on
how you're doing.

I heard you had a big operation.

Fat lady's about to sing.

Which fat lady?

The one who sings...

when it's over.

It's not over.

We're alike, you and me.

We're both fighters...

tooth and nail.

Do you ever think...

about dying?

I once feared it.

Now, I feel if I were
to die tomorrow,

or if I were to get a new heart
and live for a hundred years,

I will have lived a beautiful life.

So, Michael,

your right heart
pressure's off the charts.

And your PPH is no longer responding
to medical treatment.

Yeah.

Here.

Now you need a lung transplant.

Do you know where
your brothers and sister are?

Because they're afraid
of being separated?

Ryan said you needed
to speak with a social worker?

I have a patient... Michael...

he's the legal guardian
of his three minor siblings.

He has end-stage lung disease,
so he can't go home.

The kids are hiding,
because they're scared

they're going to be put
into different foster homes.

Can you convince the kids
to come in?

Well, I think so.

If you can, I'll give you a voucher

for the MedStay for two weeks.

Fair enough.

Anything longer than two weeks,
we go to Child Services,

that's off the record or not.

Agreed. Thank you.

Well, the Doppler showed

a lower leg clot,
but the CT came back negative

for a lung embolism.

- A leg clot wouldn't make her sick like this.
- Mm-mmm.

And she was fine on the flight
from Dallas.

But she did say the flight was delayed.

And it could've been one of those

sitting on the runways,
toilet overflowing,

- AC off deals.
- Exactly.

And she could've picked up
an infection

- that's being masked by her
rejection meds, right?
- Yeah.

Hey, you.

I need you to track something
on Barbara Harris,

- in ICU 2.
- How's she doing?

She's not good... she flew in
from Dallas yesterday

on a delayed flight
that got in around noon.

I need you to see if there was
anybody else sick on that plane.

Hey.

Hi.

- Hi, there.
- Oh, okay.

I'm going to have a
little listen, okay?

That's just like her mother.

Doesn't the Great
Dr. Yablonski ever sleep?

You've obviously met Kuol.

- Yes, I have.
- Mm-hmm.

You believe in fate, Doc?

No. I don't.

Neither did I.

Maybe it's the cold breath
on my neck...

...but I feel a greater hand
moving things.

I don't know.

It-It all seems pretty random to me.

Fate kept me alive.

Brought me to a transplant hospital.

Introduced me to Kuol.

To what end?

I thought I had two options...

to fight or to die.

Now I see I have three.

I want to terminate life support.

I want to donate my heart to Kuol.

In order for me to get a new heart,

I knew a person had to die.

I never expected one
would choose to, on my behalf.

We're not even sure if a person
can do what Victor wants to do.

Not to mention the matching issues.

Because he's older than me
and has that disease?

No, not necessarily.

His heart is good.

I'm not even sure
whether to feel happy or sad.

I wouldn't lean too far either way

until Social Services, psych, UNOS

and the ethics committee
figure it out this morning.

How do you feel?

I want you to get a heart, Kuol.

More than you know.

I just don't know if this
is the best way to do it.

I am 100% opposed

to letting a man
commit suicide by doctor.

Victor has a right
to refuse medical care.

Not when doing so will kill him.

Whoa, whoa, wait-... before
we get too far into this,

- how is the match?
- No problem there.

Victor Stone is O-neg,
universal donor.

Okay, Dr. Margolis,
you did the psych eval.

The man has to be depressed.

He understands the decision.

As far as I'm concerned, he
is psychiatrically cleared

to make an informed choice.

He just fought

like hell through major surgery.

He's down right now.

With time to heal
and antidepressants,

we can get him back
to almost as good as he was.

But he was dying of ALS
even before the accident.

We need to revisit this decision
after he is stabilized.

That may not happen.

The trauma has left him
ventilator dependent

and hemodynamically unstable.

Melissa, you've been on
the phone with UNOS.

What did they decide?

UNOS says it's entirely our decision.

What about the list? I mean,

is this fair to the other

potential recipients
waiting out there?

They said, as long as all parties

were listed, we should treat it

like a direct donation
after cardiac death.

Kuol's not even listed.

We can list him provisionally.

We do not want to be known

as the place that did not transplant

a donated heart because
of a technicality.

Okay, what about
the ethics committee?

You guys can't possibly
support this.

There was quite a bit
of back and forth,

but the committee
voted to approve it.

Kuol is your patient, Andy.

He stands to gain from this most.

You don't think I know that?

I feel for Kuol...
I also feel for Victor...

but we're supposed to be
helping him fight death.

We're not supposed to be
helping him invite it in.

Okay, okay.

All right, all right, hang on.

Hang on, people. Listen, it is time

to settle this with a vote.

Wait. Sophia, we haven't
finished discussing this.

We can talk
till we're blue in the face.

It's time to settle it, Andy,

the way we always do when opinions

have been formed.

All in favor... aye.

Opposed?

Ayes have it.

Transplant approved.

- Next case.
- Are you kidding me?

- Ethics? Ethics?
-People.

It's time to move on.

Michael Downing.

Age 22.

End stage pulmonary disease.

Where's Laura?

I sent her home...

for a shower.

Since the ALS forced me to retire,

it's been rough on her.

What did you retire from?

Regional Sales Manager.

Redman Tools.

I traveled a lot when, uh...

I traveled a lot when she was a kid.

Wasn't a very good dad,

even when I was home.

Up on your side.

Well, she seems
to love you very much.

She's not going to like me deciding

to... you know...

pull the plug.

Can I help you?

I'm Jackie.

Uh, I'd like you to meet
my daughter Melissa.

Mom, everybody calls me Missy.

She needs a liver transplant.

I heard Mr. Stone is willing to, uh...

I'm going to have
to ask you to leave.

No.

It's all right.

Hi, Missy.

Hi.

I'm Victor.

Missy, can I speak
to your mom for a second?

- Okay.
- Thank you.

Uh, what were you doing in there?

That man has offered to donate
part of his liver to Missy.

Um, um, I'm sorry.

You asked him to donate his liver?

Yes.

I'd do anything
to save my daughter's life.

Hey.

How'd you get your patient
in to see Victor?

I didn't.

And I think it's atrocious.

I have a patient who's
in desperate need of lungs.

David, a potential
recipient's doctor does not go

trolling around for organs.

It violates every single
ethical principle in the book.

Miranda, this
is uncharted water, okay?

Who's to say who's right or wrong?

That's wrong.

My patient is 22, okay?

He's been at the back
of the line his whole life.

This is my chance
to help him catch a break.

It's still wrong.

You owe me a hat.

A what?

Like Sherlock Holmes wears.

I don't get it. Why?

Barbara Harris sat on the
runway for six hours.

Now, she was in seat 33A.

In 33B, was a Mr. Javier Colon.

Are you ready?

- I'm ready. What?
- I spoke to Mrs. Colon.

Mr. C., he couldn't come

to the phone because
he was recovering

from a night in the East
Stroudsberg ER, where he

was being treated for vomiting

- and diarrhea.
- Food poisoning.

Well, maybe the ER did cultures.

Look at you.

Listeriosis.

Um, Lisa, do me a favor.

I want you to stop Harris's
rejection meds, okay?

And I also want you to give her
three grams of amoxicillin Q4H

and 100 migs gentamicin TID.

First dose is stat.
Thank you.

Aren't those, like, elephant doses?

Yeah, but she needs it.

In an adult, Listeria infection
only causes stomach upset,

but in newborns
and transplant recipients,

it causes overwhelming sepsis.

Nice work, Sherlock.

And do not say,
"Elementary, my dear Watson."

I-I-I wasn't.

Yes, you were.

So, how was your day?

Your pulse ox should be higher
on the vent.

My condition's...

getting worse.

we need to talk.

Sure. What?

I'm going to donate my organs

to some people in need.

You're not going to die.

Actually, I am.

Because I'm taking myself...

off life support.

What are you talking about?

You have plenty...

Hear me out.

I'm taking back control...

while I still can.

Yes.

While something good
can come of it.

I'm donating my heart...

to a great young man.

Your heart is going nowhere.

Don't say that.

I am not going to let you
commit suicide.

There's a difference...

between committing suicide

and choosing to die...

...with whatever dignity...

I have left.

Cookie...

I'm ready.

Well...

I'm not.

I hear there was a line

of people outside Victor's room today.

He wanted me to find matches
for his other organs.

Now...

what is really behind your
objection to Victor's donation?

I told you... I'm against
donation after suicide.

You don't think patients

have a right
to refuse medical treatment?

Only after there's no hope
of a reasonable life.

As judged by whom?

You?

Are you playing God now?

Okay.

You know what?

All I know

is that I have opened up
a lot of chests,

and I've never seen God.

I've never seen a soul.

I've never seen an afterlife.

So, until you can show me

that what's on the other side
of that door

is better than what we have here,

then I'm not sending anyone
through it.

Are you doing Kuol's transplant?

No, I'm not.

If Victor's the donor, then no.

What Victor is doing
makes sense to Victor.

You need to talk to him...

...then decide.

A night's rest
sure does a girl good.

And some thermonuclear
antibiotics, yeah.

After a stop at the beauty parlor,

I'll be ready to go to the party
and meet my donor's family.

No, no, no, there are no parties
for you today.

You're on strict bed rest,

so you're not going anywhere.

Isn't there anything you can do?

Please?

Victor?

Huh?

Are you sure you're
ready to do this?

Clock's winding down.

It's okay.

Give them to me.

It's the first time I've had

an actual donor sign the
procurement authorization.

I just spoke with my lawyer.

And when my father signed his

living will,
three months ago, he gave me

irrevocable proxy healthcare

to make his end of life decisions.

I'm not going to let you do this, daddy.

I heard that Laura
stopped the donation.

So you can continue to flog me

till there's nothing left to flog.

I fought for your life.

And so did she.

And I cannot get behind you
throwing it away.

Death always wins.

Just a matter of when.

Or how.

I can't breathe on my own.

I can't drive.

I can't go for a walk.

Soon I... won't be
able to... swallow.

Or talk.

You... but you can feel.

You can think.

I feel angry...

that that's how I'm going to die.

And I think,

if I could've gone out on top

like I wanted,

that I could've beat that bastard...

ALS...

one last time.

And a bunch of people

would be better off.

Can't you see...

that's the best death...

I could have?

This is a reunion

for donor families and recipients.

Are you trying to make me feel bad?

Seven people could be
here with their families

next year, because of your father.

You know, I transplanted
some of these people.

They came to me,
begging to stay alive.

No one ever comes
to me asking to die.

But your father's at peace with it.

Then I realized I've been making it

more about me than him.

Is that what you think I'm doing?

My whole life...

I've longed...

craved...

to be close to my father.

Hugged, spun around...

I don't know, whatever dads do.

But he was always gone.

And even when he was home,

it just wasn't in him.

And then he got sick.

And I've been his nurse

and he's needed me...
more and more.

I finally have my father.

And I can't let him go.

I understand.

But that's not how he sees it.

This is what
he wants you to think of

when you think of him.

Well... I've got good news
this time.

We found some lungs for your brother.

A man named Victor is donating them.

Awesome!

Someone has to die, Will.

Oh. Yeah.

But it's okay.

He's, um...
he's ready.

My friend Victor

- truly is a saint.
- Uh-huh.

How do you like Dr. Williams?

Why do you ask?

Well, if you prefer
the Great Dr. Yablonski,

he's available.

Oh, yes.

You will do the surgery?

Yeah.

CellCept and Simulect
are on board, O Great One.

Thank you very much.

Andy.

What is it?

You have a fever.

Give me something
for it and let's go.

It doesn't work that way, Kuol.

We can't transplant a heart
into someone who has a fever.

Why not?

If you have an infection,

you'll reject the heart and die.

We have to do a sepsis workup and treat

the source of the infection.

Well, at least I'm now
on the waiting list.

It's not that simple, Kuol.

You were listed provisionally,
based on the fact that

it was a direct donation.

So I'm back to square one?

It's... It's more like square two.

My day will come.

What about Victor?

His condition is worsening.

His day is today.

What will happen...

to Kuol?

The VAD will keep him going.

And I'll keep working on
getting him a new heart.

What's gonna happen...

to mine?

Well, UNOS has a list of
people waiting for a heart.

Good idea.

List it with UNOS.

I can make that happen.

One more thing.

I'd be honored...

...if you'd do my surgery.

Absolutely.

Let's go.

Okay.

Thanks, Mr. Stone.

God bless you.

Thank you.

I love you, Daddy.

I love you, too, Cooks.

I love you.

I'll be okay.

Me too.

- Let me see you smile?
- Okay.

sync, corrections [HI]
elderman