A Gifted Man s01e03 Episode Script
In Case of Discomfort
This procedure's gonna be so cool.
Sure as hell isn't for the faint of heart.
So, first I'll perform a laminectomy to expose the spinal cord.
Then I'll excise the dura, peel it back, ever so delicately to get my fingers around the neoplasm If you're trying to get me in bed again it's not working.
Are you saying you don't find surgery as exciting as I do? Well, I do like the way your mouth moves when you describe it.
Really? Now, are we on or off the record? I take my recorder everywhere.
I don't remember it last night.
Maybe I dropped it.
Do you know what's at stake with this procedure? Tell me.
New York City marathon winner.
I succeed, he's winning races for the rest of his life.
The knife slips he's in a wheelchair forever.
I do trust those fingers of yours.
Mm, yeah, smart girl.
So that's my lead for my article: "There's nothing Michael Holt loves more than a challenge.
" It's what I live for.
I gotta go to work.
But I assume when that "Top Ten Surgeons List" comes out in your magazine You'll be right on top.
Whew! Nothing like a massive hemangioblastoma to kick off the day.
It was like that thing from Alien, all octopused around his spine.
Just had to show it who's boss.
You know I heard two surgeons turned this case down because it was such a cluster.
Really? Good morning, Michael.
Oh, you're looking happy.
You must have forgotten about the dinner tonight.
The paralysis research? Oh.
The Fallwyck Club at 8:00, business attire.
Pat Ross here? He's not on the schedule.
Old buddy of mine from med school.
I told him to stop by this morning.
You don't have time for reunions.
He's an ER doc.
The city shut down his hospital.
He's looking for a job.
I told him about Clinica Sanando, how Anna was running it when she died and, you know Michael, you already have an interview for your ex-wife's job.
I do? Mm-hmm.
Dr.
Sykora.
I don't know him.
He's a she.
Philip Romero called and asked if I could squeeze her in.
He said he used to be Anna's boyfriend when she died.
Yeah, and president of the Clinic Board.
I told him I'd find the new medical director.
Apparently, he wants to micromanage me.
Maybe he knows how busy you are.
Here at Holt Neuro.
Where you work.
Dr.
Sykora, sorry to keep you waiting.
I was in surgery.
Michael Holt.
Kate.
Hi.
Thanks for seeing me.
Yeah.
Sure.
My pleasure.
Have a seat.
Please, please, sit, sit.
Can I get you a cup of coffee or some water? Uh, no.
I'm good.
Thank you.
All right.
You're a friend of Philip's? Not really.
We met last year at a fund-raiser for the West Side Mission.
It's a homeless shelter up near Columbia.
Anyway, we got to talking, and I told Philip that I'm looking to get back in the trenches.
Well, Clinica Sanando is right at the bottom of one.
So let's see what we got here Wash U.
Med school, family medicine residency at UC San Diego, family practice for five years, VP, Community Affairs, Glentrix Health It's a nonprofit of some kind? New HMO.
I'm guessing you don't see very many HMO patients here.
None.
So what does a VP of Community Affairs actually do? Uh, well, I was hired to implement a wellness program for the uninsured.
It turned out to be a smoke screen.
The HMO just wanted the PR buzz, and I spent too much time in meetings and not treating patients.
Well, you'll get that in spades at the clinic.
Great.
I got to be brutally honest with you though, it's an uphill climb.
How steep? Almost vertical.
Too many patients, not enough staff, lousy equipment, no money to replace it.
I'm surprised somebody with your experience would want the job.
What? What's so funny? Well, that was the worst sales pitch I've ever heard.
It's not a sales pitch.
Obviously, you have someone else in mind for the job, and you're trying to scare me away.
Well, I didn't mean to Offend me? My time is as valuable as yours, Dr.
Holt.
And my feet hurt like hell in these heels.
So the next time you decide to waste someone's morning, why don't you do everyone a favor and just say no.
Now wait a minute.
Hope it works out with your new medical director.
We'll call you when Save it, sister.
Went well, didn't it? No good deed goes unpunished.
C-B! Ah.
Thanks for coming.
Pat Ross, this is Rita; she runs my life.
He can't possibly pay you enough.
Oh, I like you already.
What's the C-B stand for? Cadaver buddy.
Nobody could cut up a corpse like Michael here.
We were dissection partners in Anatomy.
He tutored me a bit.
I remember you were the only one who could ID the ligament of Treitz.
I'll let you two to reminisce.
Thanks, Rita.
Yeah.
So, this is it.
Looks like a fixer-upper.
Oh, Dr.
Mike! Glad you're here.
Only to give a tour.
This is Pat Ross; he's going to replace Dr.
Anna.
- Oh, today? Right on! - Yeah.
Right.
So we got a great staff, they got three exam rooms, you got a private office in the back - Uh, who's in charge of securing funding? - You.
Purchasing? Yeah, you.
Accounting? You, you, you.
All you.
You're in the driver's seat.
While I'm treating patients all day? Yeah, well, you know, I know it needs a lot of work, but you can make it your own.
Michael.
Thought I heard your voice.
Admit it, you can't get enough of us.
Yeah.
Zeke Barnes.
Pat Ross.
Zeke's a family doctor.
- I helped him out last week.
- You could do it again.
I got a compression fracture in Room Two with your name on it.
You look like a doc, too.
- I do? - Johns Hopkins tie tack gives it away.
Pat is going to be your new boss.
Oh, great.
Awesome.
Hey, you can take the lady in the waiting room with the mask on.
Rule out yellow fever.
You can use your new office.
Yellow fever? Oh, yeah.
Immigrants come in from all over.
You get to see everything here.
I've seen enough.
Come on, it's not that bad.
It's not that bad? It's a dump.
Look, Mike, Mike, I'm used to having everything I need.
What, you don't need a job? Not this one.
Thanks anyway.
If I change my mind, I'll call you.
You kidding me? I'm sorry, Mike.
Dr.
Mike, I need your help! Tavo, actually I'm just leaving.
Rafe, this is Dr.
Holt.
Oh.
What happened to you? - He shattered the backboard.
- I was showing off for the kids, trying to slam-dunk, and think I broke my arm.
Did you make the shot at least? Ah! Yeah, you dislocated your shoulder.
Come on, let Dr.
Holt take care of your dad.
- Tavo, honestly, I gotta - It's cool.
I got donuts for him.
I got these hiccups, too.
Oh, it's not uncommon after a shock to your system.
Now, what's going on here? Let's take a look.
Right here.
Hold still.
Kind of old to being doing slam dunks.
I run a youth league for troubled kids.
I'm the only dad most of them got.
Boys like that will eat you alive if you don't walk the walk, right? How are you doing over there? It's done.
Clean up those cuts.
- Sorry, I was lancing a mother of a boil.
- About time.
All right, finished.
You're in good hands with Dr.
Mike here.
He's a top-notch surgeon.
Sedate him with some midazolam.
We'll pop that shoulder back into place.
Uh, we don't keep midazolam here.
You're kidding.
No, we dispense benzos or narcotics, **** for a robbery.
So, good ol' fashioned lidocaine will have to do.
I gotta get to work.
How long is this gonna take? - What do you do? - I used to teach phys-ed in the Bronx, but I got laid off.
Now I'm flipping burgers to keep it together.
- This is gonna sting and burn a little.
- Okay.
All right, switch with me.
Sit up for a second.
Well, what's that for? Countertraction.
Tell me when you're ready.
Almost there.
Ow! There we go.
Ow.
Hold still.
Man, feels better already.
Hey, uh, what do I do about these hiccups? Try breathing into a paper bag.
Hey! Michael, hold up.
Professor Philip.
I just called your office.
Your assistant said you were here, giving our new clinic director a tour.
I'd like to meet him.
Well, unfortunately, - he didn't take it.
- Uh-huh.
Over money? It wasn't a good fit.
What about Kate Sykora? You met her, right? Yeah.
She wasn't really right for the job.
This place is a hard sell.
I know.
Anna was here 24/7.
Hard to date someone you barely get to see.
Don't worry.
I'll find someone to run it.
Dad! Somebody help! Please, help him! Everyone stay back.
Nathan, come with me.
He suddenly got dizzy and then collapsed.
He's not breathing.
We need a defibrillator! Hurry! What the hell happened? Syncopal episode.
His pulse is thready.
Where's the defibrillator? Right here.
I'll check his rhythm.
He's in V tach.
From a dislocated shoulder? Yeah.
We gotta zap him.
Everybody stand clear.
He's back in sinus rhythm.
He's breathing on his own.
His pulse is getting strong.
Wh-What happened? You passed out.
We had to shock your heart back into normal rhythm.
All right, Tavo, let's get him into a room.
- Yo, Philip, give me a hand.
- Gently, slowly.
Watch his shoulder.
Easy, easy, easy.
I don't get it.
A few lacerations shouldn't have sent him into V tach.
Yeah, neither should a shoulder reduction.
Lidocaine toxicity could have caused the arrhythmia.
No, I didn't hit a vein when I gave him the anesthetic.
Maybe it was cardio myopathy from a recent virus.
Yeah, or he's on something speed, energy drinks.
Well, whatever it is, I'd better keep him monitored.
Yeah.
I gotta go.
Thank you.
Nice work.
Not now.
Believe me, if I could, I would call your oh-so-adorable assistant and make an appointment, but I can't control when I appear.
Yeah, I can't stop and chat every time the ghost of my ex-wife shows up.
Were you talking to me? No, I was not I was just going in here.
Wow.
This is more of a mess than I remember.
Is that that's, that's what this is about, just, uh, cleaning up your, uh, your messes? Because I'm not gonna do that.
Why not? What?! Why can't you clean up my messes? What would be so wrong with that? I have a job.
Curing people with brain tumors, people with paralysis People with checkbooks.
Yeah, so? They get sick, too.
Can you just haunt somebody else for a while? Oh, believe me, there is nothing I would like more than to be resting in peace instead of fighting with you.
But something even bigger than you, Michael Holt, put me here, now, with you, and if you can't respect that and help to do the things that I can't do any longer, because I got hit by a damn car, then you might as well be dead, too.
Wait a minute I gotta go.
Hey, come on, man.
I don't have time! Dad, you're okay! Yeah, I'm all right.
Hey, Dr.
Mike, Rafe here is refusing to stay and be monitored.
Mr.
Douglas, listen to your doctor.
Let's roll.
Hey, dumb-ass! You could've died in there.
You need to be monitored and then go see a cardiologist.
Yeah? How much is that gonna cost? Echocardiogram, stress test, EBCT I don't know-- maybe three grand? Are you out of your mind? That's three months rent.
All right, come on, I can get you in to see a guy at County by the end of the week, for a couple hundred bucks.
What world are you living in, man? I make eight bucks an hour, and I don't have insurance.
I don't show up for work, I lose my job.
So what if you drop dead, face-first, into a deep-fat fryer? Look at you in your fancy suit with a smirk on your face, telling me what to do.
Tell your patient I'm sending him for a full workup.
Hey, I'm standing right here, and I'm telling you I can't afford any workup.
Tell him I'm referring him to Howard Eastman, best cardiologist in New York.
Arrogant son of a bitch.
Do what the doc says call the guy.
Yeah, all right.
I'll call him.
Wow, you really are good with people, aren't you? Got him to see a doctor, didn't I? Do me a favor you need any more help, don't call me.
First, it's hay fever, then it's a sinus infection.
Ed's sniffling and hacking all day long.
It scares the dogs.
Yeah, I bet.
Well, I wish I could help, but you need an allergist, and I'm a Neurosurgeon.
Excuse us.
Excuse me.
Michael Holt, right? Have we met? Not face-to-face, but I flew an emergency nerve donation from Seattle to LaGuardia last year.
Ambulance brought it to Holt Neuro.
I think the patient's name was Santiago.
Yeah left arm was mangled in a motorcycle accident.
Transplanted the radial nerve, got it working again.
You're the pilot who made that happen? Carol Gordon.
Nice to meet you.
Ow.
You okay? Please, I don't want to be one of those people at parties that pesters you with all of their little aches and pains.
Oh, no, you just rescued me from that.
May I? Any, uh swelling? Does it ever feel hot? Both.
Mm.
Couple of times.
You know, it could be carpal tunnel.
Guessing you do a lot of repetitive motions in the cockpit.
Uh, flicking switches, pressing buttons up and down panels.
It's a pretty simple procedure, actually, for the pain.
I'd be happy to do it.
Personally? Quick snip of the carpal ligament, you're good as new.
Send you home the same day.
Maybe after I'm healed, I'll fly you down to the Caribbean.
Personally? In my very own Challenger 604.
Wow! I'll drink to that.
Ooh! I'm so sorry.
Let me help you.
Got myself good, didn't I? Yeah, you could use a couple stitches.
Uh, let's get out of here.
Oh, you don't have to take me to the ER.
I'm not.
Come on.
Seems like overkill a neurosurgeon wasting time on a dumb cut.
I suture skin all the time.
Your place is impressive.
It's like a spa that happens to have an operating room.
We also have a top staff of neurologists, psychiatrists, sports medicine specialists, sauna and steam, So only the best for your patients.
I assume you do the same for your passengers.
All-leather seating, sleeping cabin, shower, a fully stocked galley, and all the latest state-of-the-art avionics.
We have a building-wide, positive-pressure HEPA filtration system.
Not a single post-op infection since we opened for business six years ago.
Are you trying to seduce me, Dr.
Holt? I'm trying to get you to let me run tests to confirm your carpal tunnel.
When I have time.
Carol, you let this go, your hand gets weaker, the pain and numbness gets worse.
You don't want to drop any more martinis.
I'm flying a charter to Bermuda late tomorrow afternoon.
Think you can test me first thing in the morning? Yes.
Come by.
I'll make sure you get in.
Thanks, Rich.
Morning, Rita.
Oh, I'm sure it is.
After the night you had in the OR with the young lady who was waiting here this morning.
Her name is Carol and I was suturing her hand.
Is that what the kids are calling it these days? She's here for a carpal tunnel test.
Just grab her a gown while I track down Bax.
Oh.
Okay.
You didn't prepare me for electroshock therapy.
Bax has to do the tests to indicate whether or not I need to operate.
So he's like your ground crew.
Yes, the navigator in the OR.
How we looking? Uh, latency and amplitude are normal.
It means your nerve functions are fine.
Then what's causing my pain? Could be tendonitis, arthritis I'll know more after I test your fast-twitch muscle functions.
That's going into me? Only into your abductor pollicis brevis muscle.
Your hand.
I'll be gentle, but it's gonna feel weird.
You ready? I guess.
All right.
So where exactly do you fly? Where do you want to go? I can get you to Europe and South America non-stop; Australia and Asia with one layover to refuel.
Very good.
Now, flex your thumb slowly, until I tell you to stop.
Your family must miss you, you being gone so much.
No family.
Just me and the big blue sky.
My father was a pilot.
I wanted to fly since the moment he let me take the yoke.
Okay, you can stop flexing your thumb.
EMG is normal, too.
So I don't have carpal tunnel.
Not necessarily.
Some people have it and their test results are still negative.
How much did you have to drink last night? Just the one Cosmo.
I was dying for another, but dropping that glass kind of nipped that in the bud.
Yeah.
Everything okay? Yeah, fine.
Bax and I need to discuss a few things.
Maria will take you in the exam room.
Hang tight.
We'll be right in.
I'll be waiting.
You saw the tremor, right? Yeah, yeah.
I got this new thing called "vision.
" She mention any other history of neuro symptoms, besides carpal tunnel? No.
No.
That's why I asked how many drinks she had at that benefit last night.
Could be alcohol related.
Pilot with a drinking problem that's, that's fantastic.
It's a high-stress job.
That could cause tremors; fatigue, too.
So could drug abuse, strokes and a brain tumor.
She needs an MRI.
MRI.
All right, Carol, let's get you to an MRI Colette, did you see Miss Gordon leave? Uh, yeah, couple minutes ago.
She said she was done and you told her to go home.
I've never seen a patient run out on you.
Yeah.
Second one in two days.
- Finished with your lady pilot yet? - No.
'Cause I've got all your other patients in a holding pattern.
Let me guess-- Zeke? It is indeed.
Hey, I never heard from Rafe Douglas, our dislocated shoulder from yesterday.
I got enough problems with my patients without having to deal with yours.
I just want you to ask your cardiologist pal if Rafe ever showed up there.
Do I have to hand-hold everybody? I gave you the number.
Call him yourself.
Don't call me.
I've had it with people who don't listen.
Are we leaving surgery to become a pathologist? Dead people never talk back.
That's what she thinks.
Uh Rita call the FAA.
Get me someone in Air Safety.
What on earth for? Just do it.
Never easy, is it? Thought you weren't speaking to me.
Eh, we could never stay mad with each other long, could we? Yeah? Try me.
So, besides me, what's bothering you? My patient, Carol Gordon, just walked out on me.
She's a pilot.
Her hand tremors.
Until I know what's causing it, she's got no business being in the cockpit of a plane.
Like the ice road trucker in Alaska.
With the crazy mustache.
Looked like he had a ferret on his lip.
His big ol' pupils.
Hands shaking.
You thought he had DTs from alcohol withdrawal.
You were about to call the cops.
Until you asked him how much coffee he drank.
"18 cups a day.
"18 cups a day.
Five sugars in each.
" Five sugars in each.
" That was different.
He was right there.
She ran away.
I let her fly, something bad happens, it's on me.
I got to call the FAA.
So you can fly off into the wild blue yonder? No, I am just doing my job, Anna.
Rita, you got them on the line yet? But what if you report her to the FAA and they yank her license? What if you find out it's just one too many cups of coffee? So she quits drinking caffeine no harm, no foul.
I'm not the bad guy here, Anna.
Yeah, that's not the same thing as being the good guy.
Do you think the FAA will ever let her fly again after you've turned her in? They'll wonder why she didn't go see a doctor and report herself.
FAA Safety Officer Collum on line two.
Michael.
I got it.
Michael.
You don't want me to let her fly.
I think you should find out the whole story.
some moderate to severe chop, which we do not want to have for this family.
So I think we'll climb to about Awfully far from those HEPA-filtered hallways of yours.
Well, my patients don't usually leave before I'm done.
I'm not your patient.
That's right, you're a pilot.
So let me guess, family vacation? You're in the way of my preflight.
Oh, by all means.
Plane looks great, it's the pilot who's not airworthy.
Screw you.
Me? Wow.
You stroke out at 30,000 feet, they're the ones who are screwed.
Nothing is going to happen.
You'd bet their lives on that? I have a copilot, and I'm fine.
Well, your left hand thinks differently.
Come with me right now to Holt Neuro, or I call the FAA.
You're not gonna do that.
Michael.
Two years ago, I flew my best friend Rachel and her family to Puerto Vallarta.
Surprise birthday present.
Hi.
Safety Officer Collum, please.
We were sitting on the beach, I noticed her foot twitching.
She said she would go to the doctor.
It was brain cancer.
Glioblastoma.
I'd never even heard of the word before.
The doctors kept trying to take it out, but it just kept coming back.
Until she died eight months later.
Her husband and two adorable little girls watched her slip away.
Carol, you don't know if you have cancer and neither do I.
Your tremor could be something or it could be nothing.
But we have to find out.
How long will this take? About 45 minutes.
Lie still and don't talk.
We don't want to do this twice.
I don't want to do it at all.
Just close your eyes and relax.
Imagine yourself at 35,000 feet, soaring through a cloudless sky.
Your MRI shows two lesions in your brain.
It's a glioblastoma, isn't it? Actually, that's the one thing that it isn't.
Multiple lesions usually mean that cancer has metastasized from somewhere else in your body.
But we scanned your entire body and didn't find anything.
Then what is it? I'm not exactly sure.
You're the best in the business, this place has every possible machine, every expert, you even bragged to me about it.
How could you not know? Well, because there are a number of conditions that can cause brain lesions.
Some of them are infectious.
Other than my hands, I feel fine.
Well, then you'll fly right through surgery.
You want to cut my head open? It's the only way to determine what those lesions are.
This one right here on your primary motor cortex is what's causing the tremor.
If I don't remove it, your arm could be permanently paralyzed.
I've had engines die during takeoff, I've landed in storms, I've even skidded off a runway in Beijing.
But you've never been as scared as you are right now.
'Cause you think you'll never fly again.
Carol, I'm gonna make sure that you do.
When do you want to operate? First thing tomorrow morning.
Hey, Rita, I'm going home.
So just forward me Carol Gordon's images and blood work so I can review them tonight, okay? Thanks.
Thanks, Rich.
Need to go right.
I need to go that way.
What's going on? You got to go straight.
UN General Assembly's in session.
Oh, man, I got to get to the bridge.
The bridge is all jammed up.
You're gonna have to go downtown.
Dr.
Holt.
Michael, Howard Eastman.
Howard, what's up? Haven't seen you at the club in a while.
Ah, I know.
Hope you're not trying to get me out there.
I don't have much time now for golf.
It's about that guy with the arrhythmia, Rafe Douglas.
Yeah.
He never called.
Ah, damn it.
You know Whoa.
Howard, I'll call you back.
Hey, buddy.
Hey.
Is this your ball? Nope.
No.
No.
No, no, no, no, no, Anna.
Rafe is not my patient, not my patient.
Tell you what.
I make this shot, I call.
I miss, I go home.
I'm never making this shot.
Tavo, Michael Holt.
Yeah, I just, I need a number of one of your patients.
Hello.
Ms.
Douglas, hi.
It's Dr.
Holt.
I treated your husband at Clinica Sanando.
It's that doctor.
No.
No.
I'm sorry, uh, Rafe's not home right now.
Well, has he had any chest pains, weakness, dizziness, passing out? No.
Rafe is feeling better.
He, uh, went to the store.
Okay.
Thank you very much.
Happy now, Anna? Carol, hi.
I'm Dr.
Lantz.
I'll be the anesthesiologist for your surgery.
Do me a favor, put me way, way under.
There is nothing to be nervous about.
Say that when they're operating on your brain.
So, ever have any problems during surgery with anesthesia? I have never had surgery before.
Any allergies? Only allergic to that Real Housewives show.
You're all set.
Give us a couple of minutes, we'll get started.
Dr.
Lantz.
Can I ask you a question? Fine, I'll give you my phone number.
It's about Michael.
Is he as good as he says he is? As everyone says he is? Honestly? No, he's not.
He's better.
Trust me, if you need your head cut open, you want to be in the hands of Michael Holt.
I'll excise the cyst on the primary motor cortex first.
That's a piece of cake.
Second one is no picnic though.
It's right next to Broca's.
On top of the frontal operculum.
Yeah.
Go even a millimeter too deep, she loses speech.
Only one way to make sure I don't.
Brain mapping.
She'll have to be awake.
Tell Lantz to wake her up.
Carol, I'm gonna show you some images.
I want you to identify them.
On top of cutting my head open, you're giving me a pop quiz? You'll do fine.
So, Michael, do I have a nice brain? Most beautiful I've ever seen.
I bet you say that to all the girls.
But I mean it with you.
No speech arrests, so let's start dissecting.
No speech what? The fact that you're speaking means I'm in a safe place.
That's a relief.
All right, Carol, tell me what you see.
A cat.
Good.
Okay, I'm down to the first mass.
Suction.
Carol, what do you see now? A helicopter.
Right again.
Michael, do I want to know what you found? Definitely.
Doesn't look like cancer.
Thank God.
Then what is it? Carol, focus on the pictures.
Now you sound like Bax.
What is it? It looks like neurocysticercosis.
What is that? A kind of larva.
What?! Relax.
They're not alive.
And besides, you'd rather have this than cancer.
Eat any bad pork lately? Pork? That's how our little worm friend got in.
Uh, back in January.
I had a layover in Ecuador.
Got really sick.
Now.
Hey, your hand stopped shaking.
Does that mean I can fly again? First things first Bax, I'm moving on to the other lesion.
All right.
Carol, take a look at the screen.
Tell me what you see.
The heels are my length, but I wouldn't be caught dead in those horr Michael, you hit her speech center.
I'm nowhere near Broca's.
Her speech should be intact.
Then what the hell's going on? She's lost consciousness.
Pulse is crashing.
BP's rising.
Cushing's reflex! The cyst ruptured spontaneously.
Fluid's leaking onto her brain; that's why she can't speak.
Pressure's 170! She's having an allergic reaction to the cyst fluid.
Her brain's herniating through the craniotomy.
We need to raise the head of the bed and hyperventilate.
Heart rate's still dropping.
Put her on a mannitol drip to lower the swelling, and nitroprusside to get her BP down.
Bax, bag her while I do it.
Come on, let's go! All right.
Done.
Irrigation and suction.
She's stabilizing.
BP's going down, heart rate's coming up.
Great work.
Swelling's going down.
Did you stop it in time? I hope so.
We'll know if she wakes up.
Her cyst didn't burst because of you.
You had no way of knowing it would.
I still should've removed that one first.
It could have sprung a leak when she was in the air.
You saved lives by getting her here.
Yeah, I hope hers is one of them.
Michael, I just got a call from Clinica Sanando.
Dr.
Zeke? Not now, Rita.
He said it was important about Rafe Douglas.
What about him? He's on his way to the clinic with neuro symptoms.
Severely disoriented.
That arrhythmia could have thrown a clot and caused a stroke.
I gotta run.
I'll have your car brought up.
There no time.
Just have someone drop it off at the clinic.
What's happening? He came in like this.
Lungs are clear, heartbeat's faint.
Give me your stethoscope.
Looks like his neck veins are dilated, too.
He didn't present with that when he came in the other day.
Pressure's dropping-- 80/40.
What the hell is going on? Distended neck veins, distant heartbeat, all the hiccupping He's got a sac full of blood around his heart, it stopped it from beating.
Cardiac tamponade.
Pressure's down to 60/30.
Call for an ambulance.
We gotta drain that blood.
Yeah.
I can't crack his chest here.
You're the surgeon.
Not a cardiac surgeon.
I'll do a pericardiocentesis.
Grab me a spinal needle.
Spinal needle.
He must have bruised his heart when he landed from that dunk.
Cardiologist would've seen it, if Rafe decided to show up.
- We don't have a spinal needle in here.
- Just get me any needle I can put through his sternum.
Pressure's down to 50.
Now get me an ultrasound so I can see where I gotta harpoon this guy.
- We don't have an ultrasound.
- Oh, come on.
I gotta go in blind? What kind of a place is this? The one that we got.
- Here you go.
- Fine, fine, fine.
I'll use landmarks.
Left clavicle sub-xiphoid go in at a 45 degree angle Get it right.
Don't want to drop a lung.
There we go.
Easy, easy.
Damn it, I'm not getting any blood.
Pressure's 40.
Yep.
There we go.
There it is.
Yep.
I got it.
There we go.
Pulse getting stronger.
Rhythm's regular, pressure's up to 80.
Dr.
Michael Holt, baby, in the house! Way to go! This isn't my house.
Is my dad okay? He will be if he gets to an OR.
Of course you're here.
No, Michael, wait.
I should've never let you drag me into this place.
I could never drag you anywhere.
What is this, Anna? What is what? You-you-you come back from the dead.
You get me all tangled up with these patients.
You make me go after Carol, now she's in a coma.
Well, would you rather have turned her in? I'd have rather gone straight home last night, but instead, you made me take a detour to Rafe's basketball court.
What was that? Then the ball just mysteriously comes out of nowhere, hits my windshield? And then all of a sudden, yeah, I gotta take a shot.
Just to call him! I didn't do any of that.
Well, none of that ever would have happened, until you died.
You're scared.
- I am pissed off.
- No.
You're scared.
You've built a beautiful wall around your life, and you filled it with people who are at your beck and call, with your hi-tech toys.
I didn't have what I needed in there.
Did you save him? You don't like being out of your comfort zone any more than I like being dead.
Or whatever you are.
Michael! Where do you want to send him? Manhattan Memorial.
Listen I'm going to send you to the best cardiac surgeon I know.
You need to go to surgery right now.
I can't afford it.
You can't afford not to.
For your wife and your son and all those kids who count on you.
All right? Even if it means you pay 20 bucks a week.
Rafe, we'll find a way.
Thanks for talking to me, man.
Michael! I've been trying to reach you.
About what? I talked to Kate Sykora she said you blew her off.
- Yeah, after you forced her on me.
- Forced her? I only want what's best for this place.
I thought you did, too.
Dr.
Holt.
Thank you.
Yeah, thank you.
You're welcome.
Ah what? What else? What did he say? Who, Rafe's son? He thanked me.
No, I mean Philip.
He asked if I found your replacement.
Why would he ask you that? Because I volunteered to do it.
Stupidly.
That's not stupid, that's sweet.
Maybe you liked Philip breathing down your neck, but I can live without it.
You're not angry about Philip, you're angry about being here.
When it comes to complex brain surgery, no one can touch you, but if a patient needs just a little bit more than medical care It's not my job.
I'm not like you, Anna.
I'm not the one to take care of your patients.
Did you find someone? No.
I offered it to someone, he turned it down.
Philip had somebody, but she was the wrong type.
Are you sure? So now you're gonna second-guess me? Philip may be a lot of things but he has good taste in women.
Dr.
Holt.
Dr.
Sykora.
I'm sorry to bother you at hom but, um you weren't returning my calls.
And I don't blame you.
What can I do for you? Accept my apology for acting like a jerk the other day.
And come and run your clinic because your first choice turned you down? Yeah.
So I'm offering you the job.
Okay.
Great.
No, I'll think about it.
Good night, Michael.
Rita? It's late.
What are you doing here? Since when do I have a life? Handball with Bax at 8:00 tomorrow morning.
A spina bifida repair at 10:30.
Then lunch with your investors.
Usual time and place? Yeah.
How's Carol? No change.
She's still unconscious.
Night, Michael.
Not yet.
Welcome back.
Sure as hell isn't for the faint of heart.
So, first I'll perform a laminectomy to expose the spinal cord.
Then I'll excise the dura, peel it back, ever so delicately to get my fingers around the neoplasm If you're trying to get me in bed again it's not working.
Are you saying you don't find surgery as exciting as I do? Well, I do like the way your mouth moves when you describe it.
Really? Now, are we on or off the record? I take my recorder everywhere.
I don't remember it last night.
Maybe I dropped it.
Do you know what's at stake with this procedure? Tell me.
New York City marathon winner.
I succeed, he's winning races for the rest of his life.
The knife slips he's in a wheelchair forever.
I do trust those fingers of yours.
Mm, yeah, smart girl.
So that's my lead for my article: "There's nothing Michael Holt loves more than a challenge.
" It's what I live for.
I gotta go to work.
But I assume when that "Top Ten Surgeons List" comes out in your magazine You'll be right on top.
Whew! Nothing like a massive hemangioblastoma to kick off the day.
It was like that thing from Alien, all octopused around his spine.
Just had to show it who's boss.
You know I heard two surgeons turned this case down because it was such a cluster.
Really? Good morning, Michael.
Oh, you're looking happy.
You must have forgotten about the dinner tonight.
The paralysis research? Oh.
The Fallwyck Club at 8:00, business attire.
Pat Ross here? He's not on the schedule.
Old buddy of mine from med school.
I told him to stop by this morning.
You don't have time for reunions.
He's an ER doc.
The city shut down his hospital.
He's looking for a job.
I told him about Clinica Sanando, how Anna was running it when she died and, you know Michael, you already have an interview for your ex-wife's job.
I do? Mm-hmm.
Dr.
Sykora.
I don't know him.
He's a she.
Philip Romero called and asked if I could squeeze her in.
He said he used to be Anna's boyfriend when she died.
Yeah, and president of the Clinic Board.
I told him I'd find the new medical director.
Apparently, he wants to micromanage me.
Maybe he knows how busy you are.
Here at Holt Neuro.
Where you work.
Dr.
Sykora, sorry to keep you waiting.
I was in surgery.
Michael Holt.
Kate.
Hi.
Thanks for seeing me.
Yeah.
Sure.
My pleasure.
Have a seat.
Please, please, sit, sit.
Can I get you a cup of coffee or some water? Uh, no.
I'm good.
Thank you.
All right.
You're a friend of Philip's? Not really.
We met last year at a fund-raiser for the West Side Mission.
It's a homeless shelter up near Columbia.
Anyway, we got to talking, and I told Philip that I'm looking to get back in the trenches.
Well, Clinica Sanando is right at the bottom of one.
So let's see what we got here Wash U.
Med school, family medicine residency at UC San Diego, family practice for five years, VP, Community Affairs, Glentrix Health It's a nonprofit of some kind? New HMO.
I'm guessing you don't see very many HMO patients here.
None.
So what does a VP of Community Affairs actually do? Uh, well, I was hired to implement a wellness program for the uninsured.
It turned out to be a smoke screen.
The HMO just wanted the PR buzz, and I spent too much time in meetings and not treating patients.
Well, you'll get that in spades at the clinic.
Great.
I got to be brutally honest with you though, it's an uphill climb.
How steep? Almost vertical.
Too many patients, not enough staff, lousy equipment, no money to replace it.
I'm surprised somebody with your experience would want the job.
What? What's so funny? Well, that was the worst sales pitch I've ever heard.
It's not a sales pitch.
Obviously, you have someone else in mind for the job, and you're trying to scare me away.
Well, I didn't mean to Offend me? My time is as valuable as yours, Dr.
Holt.
And my feet hurt like hell in these heels.
So the next time you decide to waste someone's morning, why don't you do everyone a favor and just say no.
Now wait a minute.
Hope it works out with your new medical director.
We'll call you when Save it, sister.
Went well, didn't it? No good deed goes unpunished.
C-B! Ah.
Thanks for coming.
Pat Ross, this is Rita; she runs my life.
He can't possibly pay you enough.
Oh, I like you already.
What's the C-B stand for? Cadaver buddy.
Nobody could cut up a corpse like Michael here.
We were dissection partners in Anatomy.
He tutored me a bit.
I remember you were the only one who could ID the ligament of Treitz.
I'll let you two to reminisce.
Thanks, Rita.
Yeah.
So, this is it.
Looks like a fixer-upper.
Oh, Dr.
Mike! Glad you're here.
Only to give a tour.
This is Pat Ross; he's going to replace Dr.
Anna.
- Oh, today? Right on! - Yeah.
Right.
So we got a great staff, they got three exam rooms, you got a private office in the back - Uh, who's in charge of securing funding? - You.
Purchasing? Yeah, you.
Accounting? You, you, you.
All you.
You're in the driver's seat.
While I'm treating patients all day? Yeah, well, you know, I know it needs a lot of work, but you can make it your own.
Michael.
Thought I heard your voice.
Admit it, you can't get enough of us.
Yeah.
Zeke Barnes.
Pat Ross.
Zeke's a family doctor.
- I helped him out last week.
- You could do it again.
I got a compression fracture in Room Two with your name on it.
You look like a doc, too.
- I do? - Johns Hopkins tie tack gives it away.
Pat is going to be your new boss.
Oh, great.
Awesome.
Hey, you can take the lady in the waiting room with the mask on.
Rule out yellow fever.
You can use your new office.
Yellow fever? Oh, yeah.
Immigrants come in from all over.
You get to see everything here.
I've seen enough.
Come on, it's not that bad.
It's not that bad? It's a dump.
Look, Mike, Mike, I'm used to having everything I need.
What, you don't need a job? Not this one.
Thanks anyway.
If I change my mind, I'll call you.
You kidding me? I'm sorry, Mike.
Dr.
Mike, I need your help! Tavo, actually I'm just leaving.
Rafe, this is Dr.
Holt.
Oh.
What happened to you? - He shattered the backboard.
- I was showing off for the kids, trying to slam-dunk, and think I broke my arm.
Did you make the shot at least? Ah! Yeah, you dislocated your shoulder.
Come on, let Dr.
Holt take care of your dad.
- Tavo, honestly, I gotta - It's cool.
I got donuts for him.
I got these hiccups, too.
Oh, it's not uncommon after a shock to your system.
Now, what's going on here? Let's take a look.
Right here.
Hold still.
Kind of old to being doing slam dunks.
I run a youth league for troubled kids.
I'm the only dad most of them got.
Boys like that will eat you alive if you don't walk the walk, right? How are you doing over there? It's done.
Clean up those cuts.
- Sorry, I was lancing a mother of a boil.
- About time.
All right, finished.
You're in good hands with Dr.
Mike here.
He's a top-notch surgeon.
Sedate him with some midazolam.
We'll pop that shoulder back into place.
Uh, we don't keep midazolam here.
You're kidding.
No, we dispense benzos or narcotics, **** for a robbery.
So, good ol' fashioned lidocaine will have to do.
I gotta get to work.
How long is this gonna take? - What do you do? - I used to teach phys-ed in the Bronx, but I got laid off.
Now I'm flipping burgers to keep it together.
- This is gonna sting and burn a little.
- Okay.
All right, switch with me.
Sit up for a second.
Well, what's that for? Countertraction.
Tell me when you're ready.
Almost there.
Ow! There we go.
Ow.
Hold still.
Man, feels better already.
Hey, uh, what do I do about these hiccups? Try breathing into a paper bag.
Hey! Michael, hold up.
Professor Philip.
I just called your office.
Your assistant said you were here, giving our new clinic director a tour.
I'd like to meet him.
Well, unfortunately, - he didn't take it.
- Uh-huh.
Over money? It wasn't a good fit.
What about Kate Sykora? You met her, right? Yeah.
She wasn't really right for the job.
This place is a hard sell.
I know.
Anna was here 24/7.
Hard to date someone you barely get to see.
Don't worry.
I'll find someone to run it.
Dad! Somebody help! Please, help him! Everyone stay back.
Nathan, come with me.
He suddenly got dizzy and then collapsed.
He's not breathing.
We need a defibrillator! Hurry! What the hell happened? Syncopal episode.
His pulse is thready.
Where's the defibrillator? Right here.
I'll check his rhythm.
He's in V tach.
From a dislocated shoulder? Yeah.
We gotta zap him.
Everybody stand clear.
He's back in sinus rhythm.
He's breathing on his own.
His pulse is getting strong.
Wh-What happened? You passed out.
We had to shock your heart back into normal rhythm.
All right, Tavo, let's get him into a room.
- Yo, Philip, give me a hand.
- Gently, slowly.
Watch his shoulder.
Easy, easy, easy.
I don't get it.
A few lacerations shouldn't have sent him into V tach.
Yeah, neither should a shoulder reduction.
Lidocaine toxicity could have caused the arrhythmia.
No, I didn't hit a vein when I gave him the anesthetic.
Maybe it was cardio myopathy from a recent virus.
Yeah, or he's on something speed, energy drinks.
Well, whatever it is, I'd better keep him monitored.
Yeah.
I gotta go.
Thank you.
Nice work.
Not now.
Believe me, if I could, I would call your oh-so-adorable assistant and make an appointment, but I can't control when I appear.
Yeah, I can't stop and chat every time the ghost of my ex-wife shows up.
Were you talking to me? No, I was not I was just going in here.
Wow.
This is more of a mess than I remember.
Is that that's, that's what this is about, just, uh, cleaning up your, uh, your messes? Because I'm not gonna do that.
Why not? What?! Why can't you clean up my messes? What would be so wrong with that? I have a job.
Curing people with brain tumors, people with paralysis People with checkbooks.
Yeah, so? They get sick, too.
Can you just haunt somebody else for a while? Oh, believe me, there is nothing I would like more than to be resting in peace instead of fighting with you.
But something even bigger than you, Michael Holt, put me here, now, with you, and if you can't respect that and help to do the things that I can't do any longer, because I got hit by a damn car, then you might as well be dead, too.
Wait a minute I gotta go.
Hey, come on, man.
I don't have time! Dad, you're okay! Yeah, I'm all right.
Hey, Dr.
Mike, Rafe here is refusing to stay and be monitored.
Mr.
Douglas, listen to your doctor.
Let's roll.
Hey, dumb-ass! You could've died in there.
You need to be monitored and then go see a cardiologist.
Yeah? How much is that gonna cost? Echocardiogram, stress test, EBCT I don't know-- maybe three grand? Are you out of your mind? That's three months rent.
All right, come on, I can get you in to see a guy at County by the end of the week, for a couple hundred bucks.
What world are you living in, man? I make eight bucks an hour, and I don't have insurance.
I don't show up for work, I lose my job.
So what if you drop dead, face-first, into a deep-fat fryer? Look at you in your fancy suit with a smirk on your face, telling me what to do.
Tell your patient I'm sending him for a full workup.
Hey, I'm standing right here, and I'm telling you I can't afford any workup.
Tell him I'm referring him to Howard Eastman, best cardiologist in New York.
Arrogant son of a bitch.
Do what the doc says call the guy.
Yeah, all right.
I'll call him.
Wow, you really are good with people, aren't you? Got him to see a doctor, didn't I? Do me a favor you need any more help, don't call me.
First, it's hay fever, then it's a sinus infection.
Ed's sniffling and hacking all day long.
It scares the dogs.
Yeah, I bet.
Well, I wish I could help, but you need an allergist, and I'm a Neurosurgeon.
Excuse us.
Excuse me.
Michael Holt, right? Have we met? Not face-to-face, but I flew an emergency nerve donation from Seattle to LaGuardia last year.
Ambulance brought it to Holt Neuro.
I think the patient's name was Santiago.
Yeah left arm was mangled in a motorcycle accident.
Transplanted the radial nerve, got it working again.
You're the pilot who made that happen? Carol Gordon.
Nice to meet you.
Ow.
You okay? Please, I don't want to be one of those people at parties that pesters you with all of their little aches and pains.
Oh, no, you just rescued me from that.
May I? Any, uh swelling? Does it ever feel hot? Both.
Mm.
Couple of times.
You know, it could be carpal tunnel.
Guessing you do a lot of repetitive motions in the cockpit.
Uh, flicking switches, pressing buttons up and down panels.
It's a pretty simple procedure, actually, for the pain.
I'd be happy to do it.
Personally? Quick snip of the carpal ligament, you're good as new.
Send you home the same day.
Maybe after I'm healed, I'll fly you down to the Caribbean.
Personally? In my very own Challenger 604.
Wow! I'll drink to that.
Ooh! I'm so sorry.
Let me help you.
Got myself good, didn't I? Yeah, you could use a couple stitches.
Uh, let's get out of here.
Oh, you don't have to take me to the ER.
I'm not.
Come on.
Seems like overkill a neurosurgeon wasting time on a dumb cut.
I suture skin all the time.
Your place is impressive.
It's like a spa that happens to have an operating room.
We also have a top staff of neurologists, psychiatrists, sports medicine specialists, sauna and steam, So only the best for your patients.
I assume you do the same for your passengers.
All-leather seating, sleeping cabin, shower, a fully stocked galley, and all the latest state-of-the-art avionics.
We have a building-wide, positive-pressure HEPA filtration system.
Not a single post-op infection since we opened for business six years ago.
Are you trying to seduce me, Dr.
Holt? I'm trying to get you to let me run tests to confirm your carpal tunnel.
When I have time.
Carol, you let this go, your hand gets weaker, the pain and numbness gets worse.
You don't want to drop any more martinis.
I'm flying a charter to Bermuda late tomorrow afternoon.
Think you can test me first thing in the morning? Yes.
Come by.
I'll make sure you get in.
Thanks, Rich.
Morning, Rita.
Oh, I'm sure it is.
After the night you had in the OR with the young lady who was waiting here this morning.
Her name is Carol and I was suturing her hand.
Is that what the kids are calling it these days? She's here for a carpal tunnel test.
Just grab her a gown while I track down Bax.
Oh.
Okay.
You didn't prepare me for electroshock therapy.
Bax has to do the tests to indicate whether or not I need to operate.
So he's like your ground crew.
Yes, the navigator in the OR.
How we looking? Uh, latency and amplitude are normal.
It means your nerve functions are fine.
Then what's causing my pain? Could be tendonitis, arthritis I'll know more after I test your fast-twitch muscle functions.
That's going into me? Only into your abductor pollicis brevis muscle.
Your hand.
I'll be gentle, but it's gonna feel weird.
You ready? I guess.
All right.
So where exactly do you fly? Where do you want to go? I can get you to Europe and South America non-stop; Australia and Asia with one layover to refuel.
Very good.
Now, flex your thumb slowly, until I tell you to stop.
Your family must miss you, you being gone so much.
No family.
Just me and the big blue sky.
My father was a pilot.
I wanted to fly since the moment he let me take the yoke.
Okay, you can stop flexing your thumb.
EMG is normal, too.
So I don't have carpal tunnel.
Not necessarily.
Some people have it and their test results are still negative.
How much did you have to drink last night? Just the one Cosmo.
I was dying for another, but dropping that glass kind of nipped that in the bud.
Yeah.
Everything okay? Yeah, fine.
Bax and I need to discuss a few things.
Maria will take you in the exam room.
Hang tight.
We'll be right in.
I'll be waiting.
You saw the tremor, right? Yeah, yeah.
I got this new thing called "vision.
" She mention any other history of neuro symptoms, besides carpal tunnel? No.
No.
That's why I asked how many drinks she had at that benefit last night.
Could be alcohol related.
Pilot with a drinking problem that's, that's fantastic.
It's a high-stress job.
That could cause tremors; fatigue, too.
So could drug abuse, strokes and a brain tumor.
She needs an MRI.
MRI.
All right, Carol, let's get you to an MRI Colette, did you see Miss Gordon leave? Uh, yeah, couple minutes ago.
She said she was done and you told her to go home.
I've never seen a patient run out on you.
Yeah.
Second one in two days.
- Finished with your lady pilot yet? - No.
'Cause I've got all your other patients in a holding pattern.
Let me guess-- Zeke? It is indeed.
Hey, I never heard from Rafe Douglas, our dislocated shoulder from yesterday.
I got enough problems with my patients without having to deal with yours.
I just want you to ask your cardiologist pal if Rafe ever showed up there.
Do I have to hand-hold everybody? I gave you the number.
Call him yourself.
Don't call me.
I've had it with people who don't listen.
Are we leaving surgery to become a pathologist? Dead people never talk back.
That's what she thinks.
Uh Rita call the FAA.
Get me someone in Air Safety.
What on earth for? Just do it.
Never easy, is it? Thought you weren't speaking to me.
Eh, we could never stay mad with each other long, could we? Yeah? Try me.
So, besides me, what's bothering you? My patient, Carol Gordon, just walked out on me.
She's a pilot.
Her hand tremors.
Until I know what's causing it, she's got no business being in the cockpit of a plane.
Like the ice road trucker in Alaska.
With the crazy mustache.
Looked like he had a ferret on his lip.
His big ol' pupils.
Hands shaking.
You thought he had DTs from alcohol withdrawal.
You were about to call the cops.
Until you asked him how much coffee he drank.
"18 cups a day.
"18 cups a day.
Five sugars in each.
" Five sugars in each.
" That was different.
He was right there.
She ran away.
I let her fly, something bad happens, it's on me.
I got to call the FAA.
So you can fly off into the wild blue yonder? No, I am just doing my job, Anna.
Rita, you got them on the line yet? But what if you report her to the FAA and they yank her license? What if you find out it's just one too many cups of coffee? So she quits drinking caffeine no harm, no foul.
I'm not the bad guy here, Anna.
Yeah, that's not the same thing as being the good guy.
Do you think the FAA will ever let her fly again after you've turned her in? They'll wonder why she didn't go see a doctor and report herself.
FAA Safety Officer Collum on line two.
Michael.
I got it.
Michael.
You don't want me to let her fly.
I think you should find out the whole story.
some moderate to severe chop, which we do not want to have for this family.
So I think we'll climb to about Awfully far from those HEPA-filtered hallways of yours.
Well, my patients don't usually leave before I'm done.
I'm not your patient.
That's right, you're a pilot.
So let me guess, family vacation? You're in the way of my preflight.
Oh, by all means.
Plane looks great, it's the pilot who's not airworthy.
Screw you.
Me? Wow.
You stroke out at 30,000 feet, they're the ones who are screwed.
Nothing is going to happen.
You'd bet their lives on that? I have a copilot, and I'm fine.
Well, your left hand thinks differently.
Come with me right now to Holt Neuro, or I call the FAA.
You're not gonna do that.
Michael.
Two years ago, I flew my best friend Rachel and her family to Puerto Vallarta.
Surprise birthday present.
Hi.
Safety Officer Collum, please.
We were sitting on the beach, I noticed her foot twitching.
She said she would go to the doctor.
It was brain cancer.
Glioblastoma.
I'd never even heard of the word before.
The doctors kept trying to take it out, but it just kept coming back.
Until she died eight months later.
Her husband and two adorable little girls watched her slip away.
Carol, you don't know if you have cancer and neither do I.
Your tremor could be something or it could be nothing.
But we have to find out.
How long will this take? About 45 minutes.
Lie still and don't talk.
We don't want to do this twice.
I don't want to do it at all.
Just close your eyes and relax.
Imagine yourself at 35,000 feet, soaring through a cloudless sky.
Your MRI shows two lesions in your brain.
It's a glioblastoma, isn't it? Actually, that's the one thing that it isn't.
Multiple lesions usually mean that cancer has metastasized from somewhere else in your body.
But we scanned your entire body and didn't find anything.
Then what is it? I'm not exactly sure.
You're the best in the business, this place has every possible machine, every expert, you even bragged to me about it.
How could you not know? Well, because there are a number of conditions that can cause brain lesions.
Some of them are infectious.
Other than my hands, I feel fine.
Well, then you'll fly right through surgery.
You want to cut my head open? It's the only way to determine what those lesions are.
This one right here on your primary motor cortex is what's causing the tremor.
If I don't remove it, your arm could be permanently paralyzed.
I've had engines die during takeoff, I've landed in storms, I've even skidded off a runway in Beijing.
But you've never been as scared as you are right now.
'Cause you think you'll never fly again.
Carol, I'm gonna make sure that you do.
When do you want to operate? First thing tomorrow morning.
Hey, Rita, I'm going home.
So just forward me Carol Gordon's images and blood work so I can review them tonight, okay? Thanks.
Thanks, Rich.
Need to go right.
I need to go that way.
What's going on? You got to go straight.
UN General Assembly's in session.
Oh, man, I got to get to the bridge.
The bridge is all jammed up.
You're gonna have to go downtown.
Dr.
Holt.
Michael, Howard Eastman.
Howard, what's up? Haven't seen you at the club in a while.
Ah, I know.
Hope you're not trying to get me out there.
I don't have much time now for golf.
It's about that guy with the arrhythmia, Rafe Douglas.
Yeah.
He never called.
Ah, damn it.
You know Whoa.
Howard, I'll call you back.
Hey, buddy.
Hey.
Is this your ball? Nope.
No.
No.
No, no, no, no, no, Anna.
Rafe is not my patient, not my patient.
Tell you what.
I make this shot, I call.
I miss, I go home.
I'm never making this shot.
Tavo, Michael Holt.
Yeah, I just, I need a number of one of your patients.
Hello.
Ms.
Douglas, hi.
It's Dr.
Holt.
I treated your husband at Clinica Sanando.
It's that doctor.
No.
No.
I'm sorry, uh, Rafe's not home right now.
Well, has he had any chest pains, weakness, dizziness, passing out? No.
Rafe is feeling better.
He, uh, went to the store.
Okay.
Thank you very much.
Happy now, Anna? Carol, hi.
I'm Dr.
Lantz.
I'll be the anesthesiologist for your surgery.
Do me a favor, put me way, way under.
There is nothing to be nervous about.
Say that when they're operating on your brain.
So, ever have any problems during surgery with anesthesia? I have never had surgery before.
Any allergies? Only allergic to that Real Housewives show.
You're all set.
Give us a couple of minutes, we'll get started.
Dr.
Lantz.
Can I ask you a question? Fine, I'll give you my phone number.
It's about Michael.
Is he as good as he says he is? As everyone says he is? Honestly? No, he's not.
He's better.
Trust me, if you need your head cut open, you want to be in the hands of Michael Holt.
I'll excise the cyst on the primary motor cortex first.
That's a piece of cake.
Second one is no picnic though.
It's right next to Broca's.
On top of the frontal operculum.
Yeah.
Go even a millimeter too deep, she loses speech.
Only one way to make sure I don't.
Brain mapping.
She'll have to be awake.
Tell Lantz to wake her up.
Carol, I'm gonna show you some images.
I want you to identify them.
On top of cutting my head open, you're giving me a pop quiz? You'll do fine.
So, Michael, do I have a nice brain? Most beautiful I've ever seen.
I bet you say that to all the girls.
But I mean it with you.
No speech arrests, so let's start dissecting.
No speech what? The fact that you're speaking means I'm in a safe place.
That's a relief.
All right, Carol, tell me what you see.
A cat.
Good.
Okay, I'm down to the first mass.
Suction.
Carol, what do you see now? A helicopter.
Right again.
Michael, do I want to know what you found? Definitely.
Doesn't look like cancer.
Thank God.
Then what is it? Carol, focus on the pictures.
Now you sound like Bax.
What is it? It looks like neurocysticercosis.
What is that? A kind of larva.
What?! Relax.
They're not alive.
And besides, you'd rather have this than cancer.
Eat any bad pork lately? Pork? That's how our little worm friend got in.
Uh, back in January.
I had a layover in Ecuador.
Got really sick.
Now.
Hey, your hand stopped shaking.
Does that mean I can fly again? First things first Bax, I'm moving on to the other lesion.
All right.
Carol, take a look at the screen.
Tell me what you see.
The heels are my length, but I wouldn't be caught dead in those horr Michael, you hit her speech center.
I'm nowhere near Broca's.
Her speech should be intact.
Then what the hell's going on? She's lost consciousness.
Pulse is crashing.
BP's rising.
Cushing's reflex! The cyst ruptured spontaneously.
Fluid's leaking onto her brain; that's why she can't speak.
Pressure's 170! She's having an allergic reaction to the cyst fluid.
Her brain's herniating through the craniotomy.
We need to raise the head of the bed and hyperventilate.
Heart rate's still dropping.
Put her on a mannitol drip to lower the swelling, and nitroprusside to get her BP down.
Bax, bag her while I do it.
Come on, let's go! All right.
Done.
Irrigation and suction.
She's stabilizing.
BP's going down, heart rate's coming up.
Great work.
Swelling's going down.
Did you stop it in time? I hope so.
We'll know if she wakes up.
Her cyst didn't burst because of you.
You had no way of knowing it would.
I still should've removed that one first.
It could have sprung a leak when she was in the air.
You saved lives by getting her here.
Yeah, I hope hers is one of them.
Michael, I just got a call from Clinica Sanando.
Dr.
Zeke? Not now, Rita.
He said it was important about Rafe Douglas.
What about him? He's on his way to the clinic with neuro symptoms.
Severely disoriented.
That arrhythmia could have thrown a clot and caused a stroke.
I gotta run.
I'll have your car brought up.
There no time.
Just have someone drop it off at the clinic.
What's happening? He came in like this.
Lungs are clear, heartbeat's faint.
Give me your stethoscope.
Looks like his neck veins are dilated, too.
He didn't present with that when he came in the other day.
Pressure's dropping-- 80/40.
What the hell is going on? Distended neck veins, distant heartbeat, all the hiccupping He's got a sac full of blood around his heart, it stopped it from beating.
Cardiac tamponade.
Pressure's down to 60/30.
Call for an ambulance.
We gotta drain that blood.
Yeah.
I can't crack his chest here.
You're the surgeon.
Not a cardiac surgeon.
I'll do a pericardiocentesis.
Grab me a spinal needle.
Spinal needle.
He must have bruised his heart when he landed from that dunk.
Cardiologist would've seen it, if Rafe decided to show up.
- We don't have a spinal needle in here.
- Just get me any needle I can put through his sternum.
Pressure's down to 50.
Now get me an ultrasound so I can see where I gotta harpoon this guy.
- We don't have an ultrasound.
- Oh, come on.
I gotta go in blind? What kind of a place is this? The one that we got.
- Here you go.
- Fine, fine, fine.
I'll use landmarks.
Left clavicle sub-xiphoid go in at a 45 degree angle Get it right.
Don't want to drop a lung.
There we go.
Easy, easy.
Damn it, I'm not getting any blood.
Pressure's 40.
Yep.
There we go.
There it is.
Yep.
I got it.
There we go.
Pulse getting stronger.
Rhythm's regular, pressure's up to 80.
Dr.
Michael Holt, baby, in the house! Way to go! This isn't my house.
Is my dad okay? He will be if he gets to an OR.
Of course you're here.
No, Michael, wait.
I should've never let you drag me into this place.
I could never drag you anywhere.
What is this, Anna? What is what? You-you-you come back from the dead.
You get me all tangled up with these patients.
You make me go after Carol, now she's in a coma.
Well, would you rather have turned her in? I'd have rather gone straight home last night, but instead, you made me take a detour to Rafe's basketball court.
What was that? Then the ball just mysteriously comes out of nowhere, hits my windshield? And then all of a sudden, yeah, I gotta take a shot.
Just to call him! I didn't do any of that.
Well, none of that ever would have happened, until you died.
You're scared.
- I am pissed off.
- No.
You're scared.
You've built a beautiful wall around your life, and you filled it with people who are at your beck and call, with your hi-tech toys.
I didn't have what I needed in there.
Did you save him? You don't like being out of your comfort zone any more than I like being dead.
Or whatever you are.
Michael! Where do you want to send him? Manhattan Memorial.
Listen I'm going to send you to the best cardiac surgeon I know.
You need to go to surgery right now.
I can't afford it.
You can't afford not to.
For your wife and your son and all those kids who count on you.
All right? Even if it means you pay 20 bucks a week.
Rafe, we'll find a way.
Thanks for talking to me, man.
Michael! I've been trying to reach you.
About what? I talked to Kate Sykora she said you blew her off.
- Yeah, after you forced her on me.
- Forced her? I only want what's best for this place.
I thought you did, too.
Dr.
Holt.
Thank you.
Yeah, thank you.
You're welcome.
Ah what? What else? What did he say? Who, Rafe's son? He thanked me.
No, I mean Philip.
He asked if I found your replacement.
Why would he ask you that? Because I volunteered to do it.
Stupidly.
That's not stupid, that's sweet.
Maybe you liked Philip breathing down your neck, but I can live without it.
You're not angry about Philip, you're angry about being here.
When it comes to complex brain surgery, no one can touch you, but if a patient needs just a little bit more than medical care It's not my job.
I'm not like you, Anna.
I'm not the one to take care of your patients.
Did you find someone? No.
I offered it to someone, he turned it down.
Philip had somebody, but she was the wrong type.
Are you sure? So now you're gonna second-guess me? Philip may be a lot of things but he has good taste in women.
Dr.
Holt.
Dr.
Sykora.
I'm sorry to bother you at hom but, um you weren't returning my calls.
And I don't blame you.
What can I do for you? Accept my apology for acting like a jerk the other day.
And come and run your clinic because your first choice turned you down? Yeah.
So I'm offering you the job.
Okay.
Great.
No, I'll think about it.
Good night, Michael.
Rita? It's late.
What are you doing here? Since when do I have a life? Handball with Bax at 8:00 tomorrow morning.
A spina bifida repair at 10:30.
Then lunch with your investors.
Usual time and place? Yeah.
How's Carol? No change.
She's still unconscious.
Night, Michael.
Not yet.
Welcome back.